O&G

Question 1

What are the three main emergency contraceptions?

Answer 1

Levonorgestrel (within 72 hours of UPSI)
Ulipristal (within 120 hours of UPSI)
IUD (ideally within 120 hours of UPSI)

Question 2

What is the pill regimen in week 3 of the pill cycle if 2 pills are missed?

Answer 2

The woman should resume her active pills and omit her pill free interval as she has reduced contraceptive protection

Question 3

If 2 pills are missed- what should the woman be advised depending on the week of her pill cycle?

Answer 3

General advice- abstain from sex or use condoms for seven days if missed a pill.
Take last missed pill and active pill on one day and continue to take pill daily therafter.
Week 1- emergency contraception considered if UPSI during pill free break or week 1.
Week 2- no need for emergency contraception following 7 days of COCP cover.
Week 3- finish current pack and omit pill free break.

Question 4

Which contraceptive choice is usually associated with delayed return of fertility?

Answer 4

Depo-provera (injectable contraceptive)

Question 5

Which choice of contraception is most appropriate for diagnosed breast cancer patients?

Answer 5

Copper IUD. All hormonal forms are contraindicated (UKMEC4)

Question 6

Which pill is contraindicated post-partum upto 6 months?

Answer 6

COCP- reduces breast milk production.
POP can be started immediately, if started after day 21 requires 2 days additional protection

Question 7

What is the MOA of POP?

Answer 7

Thickens cervical mucus

Question 8

What is the MOA of injectable contraceptives?

Answer 8

Inhibits ovulation

Question 9

What is the MOA of IUS?

Answer 9

Prevents endometrial proliferation

Question 10

Contraceptive of choice in young people?

Answer 10

Nexplanon- implantable progestogen

Question 11

How long before the COCP is considered effective when starting?

Answer 11

7 days

Question 12

How long before the POP is considered effective when starting?

Answer 12

2 days

Question 13

How long before the implant is considered effective when starting?

Answer 13

7 days, but if started within days 1-5 of menstrual cycle- then immediately

Question 14

When can nexplanon be implanted following termination of pregnancy?

Answer 14

Immediately

Question 15

In antenatal care- at what weeks is Down Syndrome screened?

Answer 15

11-13+6 weeks plus the nuchal scan

Question 16

What folic acid doses should be given to women trying to conceive and when and why?

Answer 16

400mcg from pre conception to 12th week of pregnancy
5mg from pre conception to 12th week of pregnancy if obese, history of NTD, diabetes, antiepileptic drugs or coeliac disease

Question 17

When should MMR be given to non immune pregnant ladies?

Answer 17

Post natally

Question 18

What should you do in a pregnant woman unsure of chickenpox vaccine status who has had contact with an infected person?

Answer 18

If <20 weeks- tests for antibodies and VZIG within 10 days
If >20 weeks- tests for antibodies and VZIG/aciclovir 7-14 days post exposure.

Question 19

What are the classifications of perineal tears post delivery?

Answer 19

First degree- superficial damage with no muscle involvement- no repair.
Second degree- damage to perineal muscles but not anal sphincter complex damage- repaired on ward.
Third degree- damage to perineal muscles and anal sphincter complex but not rectal mucosa- repaired in theatre.
Fourth degree- damage to perineal muscles, ASC and mucosa- repaired in theatre.

Question 20

What is the main feature of intrahepatic cholestasis of pregnancy?

Answer 20

Pruritis- usually on hands and soles. No rash.

Question 21

Main investigation for obstetric cholestasis and first line treatment?

Answer 21

Weekly LFTs and ursodeoxycolic acid

Question 22

What are the features of fetal varicella syndrome?

Answer 22

skin scarring, eye defects, limb hypoplasia and microcephaly

Question 23

What are the features of placenta praevia?

Answer 23

Painless vaginal bleeding, abnormal lie, non tender abdomen/uterus,

Question 24

What are the 4 T’s of PPH?

Answer 24

Tone- uterine atony
Thrombin- clots
Tissue- retained products
Trauma- perineal tear

Question 25

Management of PPH?

Answer 25

1st line- palpate uterine fundus and catheterise
1st line medical- IV oxytocin
2nd line medical- IV ergometrine
3rd line medical- IM carboprost
4th line medical- sublingual misoprostol
Surgical- intrauterine balloon tamponade, ligation of arteries, hysterectomy

Question 26

How should you manage a pregnant lady infected/previously infected with GBS?

Answer 26

Intrapartum IV antibiotics- usually IV Benpen. Abx should only be given to the child if they present with symptoms of neonatal sepsis.

Question 27

When should the patient be admitted with pre-eclampsia?

Answer 27

If BP is >160/100 with proteinuria

Question 28

When should anti-D be given to rhesus negative ladies?

Answer 28

28 and 34 weeks during pregnancy

Question 29

What is the SFH post 20 weeks?

Answer 29

SFH=gestation in weeks

Question 30

What is chorioamnionitis and how do you treat it?

Answer 30

Ascending bacterial infection from the vagina and cervix of the amniotic fluid and fetal sac- it is a medical emergency.
Usually presents in PPROM.
Prompt C section and IV abx.

Question 31

What is a breech presentation?

Answer 31

When the caudal end is close to the internal os.
Pre 36 weeks advise that the baby will become cephalic
At 36 weeks- external cephalic version
If ECV fails- planned vaginal or C section

Question 32

What is eclampsia?

Answer 32

Eclampsia is the development of seizures in association with pre-eclampsia (HTN, proteinuria and oedema).
Treated with IV magnesium

Question 33

What is the Bishop score?

Answer 33

The score is completed prior to induction of labour. Score of <5 means spontaneous labour unlikely, >8 spontaneous labour is likely or induction methods will work. It includes
Cervical consistency
Cervical dilation
Cervical effacement
Cervical position
Foetal station

Question 34

What are the different types of incontinence?

Answer 34

Stress incontinence- ass. with coughing and sneezing- treated with pelvic floor exercises and then duloxetine
Urgency incontinence- urgency, frequency & nocturia- botox type A, percutaneous sacral nerve stimulation, augmentation cystoplasty and urinary diversion
Mixed urinary incontinence- both