O&G

Question 1

Hirsitiusm, oligo/amenorrheoa, raised androgens - what would be DDx?

Answer 1

PCOS** (Rotterdam criteria)
Late onset congenital adrenal hyperplasia (lack of cotisol and aldosterone but lots of androgens giving PCOS like symptoms due to lack of 21–hydroxylase deficiency - check serum 17-hydroxyprogesterone levels to see if raised)

Question 2

What is an absolute contraindication of COCP and what does it increase the risk of?

Name six other absolute contraindications

Answer 2

Migraine with aura - increases risk of haemorragic stroke

Previous DVTs
Previous Breast Cancer (current or within 5 years)
Ischaemic heart disease
Uncontrolled HTN (>160 systolic, >110 diastolic)
Major surgery with prolonged immobilisation (especially ortho/genera - COCP should be stopped 4-6 weeks before surgery)

Question 3

Levonorgestrel Intrauterine System - how does it work, how long for?

Answer 3

Thins endometrial lining - ovum unable to implant
Thickens cervical mucus - sperm unable to enter

3-5 years for

Question 4

Risks of IUS and its insertion

Answer 4

Small risk of uterine rupture
increased risk of ectopic pregnancy
increased risk of pelvic inflammatory disease
icreased risk of infection with Actinomyces organisms

Question 5

Benefits of IUS

Answer 5

Lighter bleeding (may take up to 6 months for this to settle) - good for patients with menorragia 
Long term contraception (3-5 years) with immediate reversal of its effects

Question 6

What is inhibin and where is it secretes

Answer 6

Hormone produced by Sertoli cells in men and Granulosa cells in women that blocks the seretion of FSH

Question 7

Mastitis treatment recommendation

Answer 7

Analgesia, continue to breast feed, if there is infection/fissure in nipple treat with fluclox

Question 8

Gestational trophoblastic disease is likely to metastatise/have complications where?

Answer 8

Metastatise to lung and cause thryoid dysfunction

Question 9

What dose gestational trophoblastic disease look like on US?

Answer 9

Snow-storm appearance (no feotal forms can be identified)

Question 10

Miscarriage definition WHO and UK

Answer 10

WHO - before 20 weeks

UK - before 24 weeks

Question 11

When is GDM likely to manifest? Why are pregnant women more vulnerable to DM in pregnancy?

Answer 11

After 20 weeks

hPL produced from the placenta opposes maternal insulin action to allow more glucose in the blood to be available for the feotus. Also increased levels of cortisol and growth hormone in pregnancy - which have anti-insulin effects

Question 12

What are the fasting glucose and OGTT levels needed to diagnosis GDM

Answer 12

Fasting >5.6
OGTT >7.8

(note if fasting >7.0 then start the mum on insulin straight away)

Question 13

Treatment of GDM for mother with fasting glucose <6.2

Answer 13

Fasting glucose <6.2 so lifestyle advice with two weeks to implement changes, if control still poor, add metformin, follow up in two weeks, if still poor, combined therapy with metformin and insulin. Follow up in joint diabetes clinic every two weeks throughout pregnancy.

> 7.0 fasting - straight on the insulin
BMI encouraged to get below 27

Question 14

Three signs of hyperandrogenism

Answer 14

Acne
Hirstitism
Acanthosis nigricas (thickened, hyperpigmented areas in axillae/intertrogial regions)

Question 15

ACEi in pregnancy associated with what

Answer 15

Oligohydroamnios

Question 16

Recommended HbA1C in pregnancy

Answer 16

<48mmol/mol

Question 17

What gestation should women with GDM/DM be advised to induce labour by and what are the risks if not?

Answer 17

37 - 38+6 weeks

Stillbirth,

Question 18

BASHH guidelines for treatment of PID in a patient with temperature <38

Answer 18

Outpatient treatment with IM ceftriaxone and 14 day course of doxycycline and metronidazole

Question 19

Phenytoin teratogenic effects

Answer 19

Fetal hydrantoin syndrome

• hypolastic fingernails
• IUGR
• Microcephaly
• CLEFT LIP/PALATE
• distal limb deformities
• mental retardation

Question 20

Meningiomyloceole - what is it and what’s it associated with?

Answer 20

Type of spina bifida/neural tube defect that has neural tissue as well as meninges in the outpouchhing (as opposed to spina bifida occulta and meningioceole)

Associated with anti-folate medications e.g. methotrexate and sodium valproate
Also folate deficient pregnancies - alcohol/poor diet/ceoliac/DM?obesity

Question 21

Contra indications to LMWH

Answer 21

Active bleeding, peptic ulcer, allergy, recent cerebral heamorrage

If pregnant women CI to LMWH and needs VTE treatment or prophylaxis warafarin treatment can be considered after consulting about the individual case with haematology

Question 22

Pregnant woman with suspected PE - what test would you do?

Answer 22

VQ scan as opposed to CTPA to minimise radiation to the feotus

Question 23

Pelvic organ prolapse quantification grading for uterine prolapse grading

Answer 23

first degree - descent but above level of introitus
second - at level of introitus
third - below introitus i.e. outside
fourth - outside plus ulceration