O&G Flashcards by Maria Constantinescu

Gardasil. What does it protect against?

HPV types 6, 11, 16, 18

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UTI in 1st trimester of pregnancy. What would be safest and most effective treament?

1st line
Nitrofurantoin (avoid at term) 100mg modified-release twice a day for 7 days if eGFR ≥45ml/minute.

As second-choice (no improvement in lower UTI symptoms on first-choice taken for at least 48 hours or when first-choice not suitable) consider prescribing:

Amoxicillin (only if culture results available and susceptible) 500mg three times a day for 7 days.
Cefalexin 500mg twice a day for 7 days.
For alternative second-choices discuss with local microbiologist.

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Amenorrhea for 4 months. What test do you do?

BHCG

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19 year old, abdo swelling, weight gain, irregular periods usually, can’t remember last period, denies being sexually active. What test do you do 1st?

Pregnancy test

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Girl with cycstic ovaries on USS. What other symptom would be best indicator for her having PCOS?

Dysmenorrhea
Hirsutism
Obesity
Acne

Hirsutism

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Woman with PCOS. Best medication to increase fertility

Clomiphene

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Woman with signs of premature ovarian failure. What test would be best to confirm this diagnosis?

FSH

FSH >20 IU/L suggests POV

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Man with azoospermia. Whats the most likely cause

Mumps hx
Hx of testicular torsion
Varicocele

Varicocele apparently

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Post menopausal woman with PV bleed. What ix do you do?
Laparotomy and hysteroscopy
Outpatient USS with endometrial biopsy
CT
MRI

Outpatient USS with endometrial biopsy

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Asymptomatic woman, nulliparous, found to have 5.4 cm unilocular ovarian cyst on USS. no FHx. Management/IX?

USS guided cyst taspiration
Laparoscopic removal of cyst
Discharge and safety net
Rearrange USS in 3 mo and CA125 follow up

Apparently its rearrange USS in 3 mo and CA125 follow up

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Lady with cyclic pain 1 week before periods start. Trying for a baby for 1 year. Whats the diagnosis?

Endometriosis

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Woman 8 weeks after normal vaginal delivery and 2nd degree tear. still bleeding and mild lower pelvic pain. Diagnosis?
Normal menstruation
PID
endometritis
Lochia

Endometritis

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What is a 23 week USS useful for?

Nuchal thickness
Congenital heart disease identification
Predicting placenta position at term

Congenital heart disease identification

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What causes increased urinary volume and frequency in first trimester?

Increased GFR
Pressure of uterus on bladder
glycosuria

Increased GFR

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Effect of taking fluoxetine during pregnancy on baby?

Persistent pulmonary hypertension of the newborn

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Woman with Nexplanon. Most likely reason for wanting to change contraceptive? 
Weight gain
Acne
Mood swings
Irregular bleed

Irregular bleed

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14 yo wants TOP, can’t/will not inform parents. What do you do?

Assess gillick/fraser competency and decide

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Pregnant lady being domestically abused by husband and scared to go home. What do you do in GP?

Send her home and ask her to come back with husband
Give a leaflet about domestic abuse
Call and arrange emergency accomodation

Lol - give her a leaflet to show to her husband
no jokes
call and arrange emergency contraception

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Woman with slow growing painless lesion on labia

?genital wart or bartolin cyst

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Woman with tender lump inside vagina

?Vaginal cancer

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Young woman, pain during sex, strawberry cervix on examination

Trichomonas vaginalis

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Old woman complaining of superficial dyspaneuria

Atrophic vagina

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Woman with cheesy white discharge

Candidiasis

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Woman who has gone through menopause. Had hysterectomy. Wants HRT mainly to prevent osteoporosis and treat hot flushes. Doesn’t want tablets

Transdermal oestrogen (NICE guidelines no uterus give only oestrogen)

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HRT: Swimmer wants to treat hot flushes, doesn't want patch.

combined HRT (oestrogen + progesterone)

HRT: Woman with premature ovarian failure wants to have periods.

offer sex steroid replacement with a choice of HRT or a combined oral contraceptive (why does she want periods is she crazy?)

HRT: Woman who just wants to treat osteoporosis?

Bisphosphonates

Breast: lady with high WBC count, fever ,lump in breast

Abscess

Breast: General breast tenderness, left sided, breastfeeding

Mastitis

Breast: Small slow growing lesion on labia, pregnant lady

Genital wart (why was this in breast weird)

Breast: Small painful lump inside vagina of sexually active woman

?malignancy

40 year old premature ovarian failure and wanted medication to deal with symptoms of menopause. What would you prescribe her? Combined HRT or COCP?

COCP or HRT bad question cuz NICE says either

Woman is pregnant and HIV negative at booking but partner is HIV positive. What do you do? Start her on antiretrovirals Retest her in 2 weeks Nothing

Apparently nothing

``` What signifies onset of active labour? ROM Os is 4 cm Woman can feel contractions Regular contractions ```

Os is 4 cm

Woman has cervical cancer, is a smoker, hasnt had a smear for 8 years. What is the most likely contributing factor? HPV smoking Family history

HPV

37 yo wants COCP. Which of the following is an absolute contraindication to the GP? Smokes 20 cigs a day Recent abnormal smear in last 6 months breakthrough vaginal bleeding Recent history of PID

Smoking < 6 wks postpartum smoker over the age of 35 (>15 cigarettes per day) hypertension (systolic > 160mmHg or diastolic > 100mmHg) current of past histroy of venous thromboembolism (VTE) ischemic heart disease history of cerebrovascular accident complicated valvular heart disease (pulmonary hypertension, atrial fibrillation, histroy of subacute bacterial endocarditis) migraine headache with focal neurological symptoms breast cancer (current) diabetes with retinopathy/nephropathy/neuropathy severe cirrhosis liver tumour (adenoma or hepatoma)

Woman with white discharge and itch. What is the treatment? Fluconazole Azithromycin

Oral antifungal (oral fluconazole) + intravaginal or pessary antifungal (topical clotrimazole)

Woman with itchy feet .What investigation? Transaminases Urine bilirubin Serum bile acids

Serum bile acids

``` Couple seen in subfertility clinic and male and female investigations are given. Results show azoospermia. How should they be managed IVF Egg donation Intrauterine insemination Intracytoplasmic sperm injection ```

Intracytoplasmic sperm injection

Ovarian cysts: Cyst contains hair and teeth

Teratoma

Ovarian cysts: Ground glass appearance

Endometrioma

Gyne cancer: post menopausal bleed

endometrial cancer

Gyne cancer: 70 yo lady has spotting and says she uses some steroid cream for a rash down there

endometrial cancer until proven otherwise otherwise maybe vulval cancer?

Gyne cancer: woman had some bleeding and curettage of endometrium had carcinomatous change ?

Endometrial cancer again?

Gyne cancer: Lady is on tamoxifen. Which cancer does this increase the risk of

Endometrial cancer

STI: green discharge

Trichomonas vaginalis

STI: White discharge

Candidiasis

``` HIV with undetectable viral load. What is contraindicated in labour? Forceps Ventouse foetal blood sampling C section ```

foetal blood sampling

``` Chicken pox in pregnancy what do you do? Check igG antb Check igM antb Give varicella Ig Give acyclovir ```

Check IgG antb

Woman with BMI 40, abdo distension, urinary symptoms, bowel symptoms, weight loss. What could it be? Ovarian cancer Colorectal cancer Endometrial cancer

Ovarian cancer

72 yo with post menopausal bleed and endomethrial thickness >4mm on USS.

Endometrial cancer

60 yo with post menopausal bleed and superficial dyspaneuria. Whats the most likely diagnosis

Atrophic vagitnitis MOST LIKELY lool

``` 47 yo with 2 cm simple ovarian cyst on USS and 12 mm endometrium. What do next? Repeat USS Ca 125 Hysteroscopy Pipelle biopsy Reassure and discharge ```

Pipelle biopsy apparently >10 mm in premenopausal >4 mm in postmenopausal

Woman with ROM, painless bleed. Whats the likely diagnosis?

Placenta previa

Woman had implant inserted but shes getting it remvoed. Whats the most likely reason why Weight gain irregular bleed hirsutism

Irregular bleed

What cancer are you at increased risk of with HRT? ``` Ovarian endometrial cervical bowel breast ```

Breast

cervical os opened in young woman early pregnancy. What is it? Inevitable misscarrige Threatened

Inevitable if bleeding

Woman with pre eclampsia what is 1st line drug?

Labetalol

Mother had ROM at 32 weeks. What do you give her?

IM dexamethasone

Intermittent pain in a young woman not pregnant? Ovarian torsion primary dysmenorrhea Endometriosis

Endometriosis

17 yo wants Emergency contraception more than 5 days after sex?

Copper IUD

Woman wsants contraception 6 hours after giving birth. what is good? (not giving any wasnt an option)

Progesterone pill

post partum contraception in breastfeeding lady

None needed

Babies head comes out and then goes back in. Whats the cause

Shoulder dystocia in turtle neck

Woman had intrauterine growth and endometrial thickness

Fibroids

``` Pregnant woman with gram -ve bacilli in urine microscop. What do? Watch and wait give amoxicillin urgent referal some scans ```

I mean you give nitrofuratonin but not an option maybe they forgot

Some girl with painful periods in first 2 days of period ever since menarche. she is heavy bleeder.

Primary dysmenorrhea

BP 120/80, smokes 5/d, wants contraception | can you give cocp?

COCP (doesnt meet absolute contraindications)

Abscess 2ry to mastitis how do you treat Surgical excitison aspirate and culture ciprofloxacin

Ciprofloxacin

``` Pregnant lady in early pregnancy on sertraline for depression and anxiety what do? stop sertraline carry on prescribe high dose folic acid reduce sertraline dose amitryptalline ```

Carry on sertraline

``` What do in woman in labour after 4 hrs of check and shes still 4 cm Prostaglandins cervical sweek oxytocin ergometrin ARM ```

Cervical sweep

Foreign woman has come in pregnant. What vaccine shall she be offereD? Hep A hep B Whooping cough

Hep b or whooping cough dumb question

Woman with really heavy periods. Whats 1st line mx. Doesnt want to get pregnant.

IUS

fOETUS WITH TRANSVERSE LIE, RECENT srom, ctg SHOWS FETAL DISTRESS

Cord prolapse

HRT for menopasual woman with flushes. LMP 10months. What give?

Cyclical combined HRT

Whats the MX for DVR risk iin prenant woman.

LMWH and Ted stockings