O+G

Question 1

Initial investigations in urinary incontinence?

Answer 1

• bladder diaries min 3 days
• vaginal exam to exclude pelvic organ prolapse
• urine dip + MSU
• urodynamic studies

Question 2

Mx of stress incontinence?

Answer 2

• pelvic floor muscle training

- 2nd line: surgical procedures

Question 3

Mx of urge incontinence?

Answer 3

• bladder retraining for min 6 wks
• anti-muscarinics: oxybutynin (immediate release), tolterodine (IR) or darifenacin (OD)

*Avoid oxybutynin IR in frail older women

Question 4

Mx of urge incontinence if there are concerns about anticholinergic side effects in frail elderly patients?

Answer 4

mirabegron (beta-3 agonist)

Question 5

Which varieties of HPV are assoc with genital warts?

Answer 5

HPV Types 6 & 11

Question 6

Which varieties of HPV are associated with cervical cancer?

Answer 6

HPV Types 16, 18 and 33

Question 7

Mx of genital warts

Answer 7

1st line: topical podophyllum (if multiple, non-keratinised warts) or cryotherapy (if single, keratinised wart)

2nd line: imiquimod cream

Question 8

Risks of COCP?

Answer 8

clots, MI/ stroke, Br and cervical cancer

Question 9

Risks of smoking in pregnancy?

• includes cannabis

Answer 9

increased risk of miscarriage, preterm labour, stillbirth, IUGR, sudden unexpected death in infancy

Question 10

Risks of Alcohol in pregnancy?

Answer 10

Fetal alcohol syndrome: learning difficulties, characteristic facies (smooth philtrum, thin vermilion, small palpebral fissures, epicanthic folds, microcephaly), IUGR & postnatal restricted growth.

*binge drinking is major risk factor

Question 11

Risks of heroin in pregnancy?

Answer 11

risk of neonatal abstinence syndrome

Question 12

Risks of cocaine in pregnancy?

Answer 12

Maternal risks: HTN, pre-eclampsia

Fetal risks: prematurity, neonatal abstinence syndrome

Question 13

Management of breech presentation at 36 weeks?

Answer 13

Recommend External cephalic version.

If multiparous -> offer ECV from 37 wks

Question 14

Absolute contraindications to external cephalic version?

Answer 14

• where caesarean delivery is required
• antepartum haemorrhage within last 7 days
• abnormal cardiotocography
• major uterine anomly
• ruptured membranes
• multiple pregnancy

Question 15

failure rate of sterilisation in females?

Answer 15

1 in 200

Question 16

Mx of labial adhesions?

Answer 16

Conservative mx in the majority. If recurrent UTIs, oestrogen cream. If this fails, may warrant surgical intervention

Question 17

Treatment for nipple candidiasis in breast feeding mother?

Answer 17

treat mother and child: miconazole cream applied to the nipple post feed and the oral mucosa of the infant + nystatin suspension for baby. continue breastfeeding during tx.

Question 18

Mx of acute mastitis during breastfeeding?

Answer 18

Flucloxacillin for 10-14 days. treat ‘if systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal of if culture indicates infection’. continue breastfeeding

Question 19

management of exposure to chickenpox in non immune lady <20 wks gestation?

Answer 19

VZIG Asap (effective up to 10 days post exposure)

Question 20

management of exposure to chickenpox in non immune lady >20 wks gestation?

Answer 20

either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

Question 21

mx of chickenpox in pregnancy?

Answer 21

oral aciclovir if the pregnant women is ≥ 20 weeks and she presents within 24 hours of onset of the rash.

if <20 wks, consider oral acyclovir with caution

Question 22

Features of L3 nerve root compression?

Answer 22

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

Question 23

Features of L4 nerve root compression?

Answer 23

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

Question 24

Features of L5 nerve root compression?

Answer 24

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

Question 25

Features of S1 nerve root compression?

Answer 25

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

Question 26

Pathophysiology of diphtheria?

Answer 26

Diphtheria toxin commonly causes a ‘diphtheric membrane’ on tonsils caused by necrotic mucosal cells. Systemic distribution may produce necrosis of myocardial, neural and renal tissue -> can cause heart block, cranial nerve neuritis

Question 27

Mx of diphtheria?

Answer 27

IM penicillin, diphtheria antitoxin

Question 28

primary vs secondary dysmenorrhoea?

Answer 28

In primary dysmenorrhoea there is no underlying pelvic pathology. It affects up to 50% of menstruating women and usually appears within 1-2 years of the menarche. Excessive endometrial prostaglandin production is thought to be partially responsible.

Secondary dysmenorrhoea typically develops many years after the menarche and is the result of an underlying pathology. In contrast to primary dysmenorrhoea the pain usually starts 3-4 days before the onset of the period.

Question 29

causes of secondary dysmenorrhoea?

Answer 29

endometriosis
adenomyosis
pelvic inflammatory disease
intrauterine devices*
fibroids

Clinical Knowledge Summaries recommend referring all patients with secondary dysmenorrhoea to gynaecology for investigation.