O&G

Question 1

RFs for pre-eclampsia

Answer 1

• Aged 40 years or older
• Nulliparity
• Pregnancy interval of > 10 years
• Family history of pre-eclampsia
• Previous history of pre-eclampsia
• BMI of 30kg/m^2 or above
• Pre-existing vascular disease such as hypertension
• Pre-existing renal disease
• Multiple pregnancy

Question 2

which anti-emetic has slight increased risk of cleft palate if taking in 1st trimester

Answer 2

ondanestron

Question 3

The most common cause of ovarian enlargement in women of a reproductive age

Answer 3

follicular cyst

Question 4

Most common benign ovarian tumour in women under the age of 25 years

Answer 4

dermoid cyst (teratoma)

Question 5

diagnosis in a female with postmenopausal bleeding (PMB)

Answer 5

endometrial cancer until proven otherwise

Question 6

What is the most common cause of pruritus vulvae?

Answer 6

contact dermatitis

Question 7

The most common ovarian cancer

Answer 7

serous cystadenoma

Question 8

what is mefenamic acid used for

Answer 8

NSAID so primary dysmenorrhoea

Question 9

what is tranexamic acid used for

Answer 9

menorrhagia

Question 10

mx of missed miscarriage

Answer 10

mifepristone
misoprostol 48hrs later

Question 11

mix of incomplete miscarriage

Answer 11

misoprostol

Question 12

If ruptures may cause pseudomyxoma peritonei

Answer 12

Mucinous cystadenoma

Question 13

up to how many weeks can you terminate child with anencephaly

Answer 13

any time

Question 14

mx of prolapse

Answer 14

• first degree: pelvic floor exercises
• pessary ring
• urogynae referral for 3rd degree, failed PFEs, severe incontinence = surgery

Question 15

induction of labour

Answer 15

• Endovaginal prostaglandin gel is a method of cervical ripening prior to induction
• Membrane sweeps encourage normal labour but are not a recognised induction method on their own

Question 16

Mx of third stage of labour

Answer 16

• oxytocin

Question 17

cervical screening when pregnant

Answer 17

wait until 3 months PP

Question 18

pre-menstrual syndrome mx

Answer 18

• 1st: COCP
• 2nd: SSRI

Question 19

features of uterine fibroids

Answer 19

• menorrhagia
• bulk-related symptoms
  lower abdominal pain: cramping pains, often during menstruation
  bloating
• urinary symptoms, e.g. frequency, may occur with larger fibroids
• subfertility
• rare features: polycythaemia secondary to autonomous production of erythropoietin

Question 20

Mx of menorrhagia secondary to fibroids

Answer 20

• levonorgestrel IUS: cannot be used if there is distortion of the uterine cavity
• NSAIDs e.g. mefenamic acid
  tranexamic acid
• combined oral contraceptive pill
• oral progestogen
• injectable progestogen

Question 21

Treatment to shrink/remove fibroids

Answer 21

Medical
- GnRH agonists may reduce the size short-term treatment due to side-effects such as menopausal symptoms and loss of BMD (gosrelin)

Surgery
- myomectomy: preserve fertility
- hysteroscopic endometrial ablation
- hysterectomy
- uterine artery embolization

Question 22

Mx of PPRom

Answer 22

• erythromycin 10 days or until in established labour, whichever is sooner
• offer steroids (dex or betamethasone) if between 24 and 33+6 weeks 12mg 2 IM injection 12hrs apart for organ maturation
• can give tocolytics to ensure steroids are given

Question 23

examples of tocolytics

Answer 23

• atosiban
• nifedipine
• salbutamol and terbutiline
• indomethacin

Question 24

indications for cervical cerclage

Answer 24

• TVUS between 16+0 and 24+0 weeks show a cervical length of 25 mm or less, and who have had
  either:
• preterm prelabour rupture of membranes (P-PROM) in a previous
  pregnancy
• a history of cervical trauma.

Question 25

when to do cervical cerclage

Answer 25

- For prophylaxis, inserted between 12 and 14 weeks - “Rescue cerclage” until 23 weeks - Cerclage electively removed at 37 weeks

Question 26

which embryonic structure forms the vas deferns

Answer 26

Wolffian duct

Question 27

what is the risk of taking unopposed oestrogen in HRT

Answer 27

increased endometrial cancer

Question 28

increased cancer risk with progesterone HRT

Answer 28

breast cancer

Question 29

what is the aim of treating rhesus negative pt with anti D

Answer 29

prevent hydrops in future pregnancies

Question 30

which ART technique is not suitable for tubal subfertility

Answer 30

IUI

Question 31

complete molar pregnancy US sign

Answer 31

snowstorm appearance

Question 32

first line antibiotic in 1st/2nd trimester

Answer 32

nitrofurantoin

Question 33

where are bartholin's glands located on a clock face

Answer 33

4 and 8 o clock

Question 34

what can be done to prevent shoulder dystocia

Answer 34

McRoberts manoeuvre

Question 35

on what day in a 30 day cycle should mid luteal progesterone be measured

Answer 35

day 23 (7 days before end of cycle normal is day 21 of 28 cycle)

Question 36

system used to diagnose PCOS

Answer 36

Rotterdam criteria

Question 37

1st intervention to stop PPH

Answer 37

rub up uterine contraction

Question 38

Trichomonas vaginalis

Answer 38

- STI - protozoa parasite - yellow/green frothy discharge - strawberry cervix - Mx metronidazole

Question 39

what meds to give in PPH due to uterine atony

Answer 39

- oxytocinh IM - ergometrine - if unresponsive give carboprost

Question 40

how many phases in menstrual cycle

Answer 40

2 follicular (day 1-14 up until ovulation) luteal (day 15-28 ovulation to start of menstruation)

Question 41

what happens in follicular phase

Answer 41

- FSH stimulates further development of the secondary follicles. - increasing amounts of oestradiol (oestrogen) = negative feedback effect on the pituitary gland, reducing the LH and FSH - cervical mucus to become more permeable, allowing sperm to penetrate the cervix around the time of ovulation - LH spikes just before ovulation (egg released) can cause pain

Question 42

what happens in luteal phase

Answer 42

- after ovulation, the follicle that released the ovum collapses and becomes the corpus luteum. - corpus luteum secretes high levels of progesterone, which maintains the endometrial lining. - This progesterone causes the cervical mucus to become thick and no longer penetrable.

Question 43

UTI abx safe for breastfeeding

Answer 43

trimethoprim

Question 44

Ectopic pregnancy in which location is most associated with an increase risk of rupture?

Answer 44

isthmus

Question 45

mx of inevitable miscarriage

Answer 45

- expectant - medical (misoprostal or methotrexate) - dilatation and curettage if haemodynamically unstable

Question 46

Mx of mothers who have had a previous baby affected by early- or late-onset GBS

Answer 46

intrapartum benzylpenicillin (increased risk for other babies)

Question 47

haemoglobin cut-offs in normal, early/late pregnancy and post partum for iron supplementation

Answer 47

- 115 for non-pregnant women - 110 in early pregnancy (1st) - 105 in later pregnancy (2nd/3rd) - 100 after childbirth

Question 48

types of perineal tear

Answer 48

- 1st degree: Small tears affecting only the skin - 2nd degree: affecting the muscle of the perineum and the skin. These usually require stitches. - 3rd degree: injury to the perineum involving the anal sphincter complex but sparing the mucosa - 4th degree: injury to the perineum involving the anal sphincter complex and rectal mucosa

Question 49

when giving magnesium sulfate for eclampsia what do you need to monitor

Answer 49

- reflexes - Resp rate (to check for no no evidence of respiratory depression)

Question 50

contraindication to ulipristal acetate

Answer 50

asthma

Question 51

mx of hyperemesis gravidarum

Answer 51

IV normal saline with added potassium as hypokalaemia is common