O&G

Question 0

PCOS investigation results

Answer 0

Bloods: FSH (normal); prolactin; TSH etc, all to exclude other causes of secondary amenorrhea
USS: transvaginal. Cysts
Others: screen for diabetes and abnormal lipids.

Question 1

Treatment of cervical malignancies

Answer 1

Stage 1a: cone biopsy
Stage 1-2a: chemo and radiotherapy, or surgery.
Radical trachelectomy: fertility conserving - removes 80% of cervix and upper vagina. Cervical suture inserted afterwards

<stage2b: radiotherapy and chemotherapy.

Question 2

Complications of PCOS

Answer 2

50% develop T2DM
gestational diabetes
- risks can be reduced with weight reduction

NB. despite being amenorrheic, these patients are not at increased risk of osteoporosis as normal oestrogen levels.

Question 3

Endometriosis symptoms

Answer 3

Dysmenorrhoea (usually when get periods), menorrhagia sometimes.
Pain can be localised to where the lesion is, eg. Haematuria etc.

Always consider endometriosis as differential for IBS

Question 4

Management of ENDOMETRIOSIS

Answer 4

Conservative: enrol in support groups, chronic relapse-remit condition
Medical: COCP (suppress ovulation for 6-12months for lesions to regress); progestagens; IUD; danazol
Surgical: ablate. High relapse rate

Question 5

Menorrhagia symptoms

Answer 5

Girls: usually dysfunctional uterine bleed

Older ladies: fibroids, endometrial cancer, polyps etc

Question 6

Management of primary menorrhagia

Answer 6

1st line: IUD (if want such contraception)
2nd line: COCP, NSAID (especially NSAID if there is also dysmenorrhea), tranexamic acid (especially if pt does not want contraception)
3rd line: progestagens (eg. Norethisterone)
4th: GnRH analogues
Surgical: endometrial ablation etc.

Question 7

Management of DYSMENORRHOEA

Answer 7

1st line: mefenamic acid (NSAID inhibits PG-induced muscle contraction)
Paracetamol (works too)
Hyoscine

Treat any underlying causes (eg. Endometriosis, fibroids, chronic pelvic sepsis etc.)

Question 8

Combined screening test for DOWN’s SYNDROME

Answer 8

Maternal age (<35y/o)
Nuchal translucency
Beta-hCG
PPAP-A

Question 9

Triple test for DOWN’S SYNDROME

• when and why is it used?

Answer 9

“BAO”

Beta-hCG
AFP
Oestriol

• all performed at 16/40. Less sensitive than combined test, but cheaper.
• used for when nuchal translucency is unavailable, or when screening for the syndrome beyond 14wks.

Question 10

Conditions found with amniocentesis

Answer 10

Chromosomal abnormalities
Genetic conditions - autosomal recessive and dominant (eg. CF)
Sickle cell anaemia & thalassaemias
Infections: CMV, toxo, rubella

Question 11

Indications for admission in pregnant woman with proteinuria/pre-eclampsia

Answer 11

1. Symptomatic (ie. nausea &vomitting, headache etc)

2. BP>140/90mmHg, or increased by 30mmHg since last booking visit