OBG

Question 1

COCP risks and benefits:

Answer 1

protective: ovarian and endometrial cancer
risk: cervical and breast cancer, also increased risk of stroke

Question 2

Missed pill rule:

Answer 2

if forget to take the pill between day 8-14 and have taken it correctly 7 days before that= NO emergency contraception is required.

Question 3

Chickenpox in pregnancy:

Answer 3

Pregnant women ≥ 20 weeks who develop chickenpox are generally treated with oral Aciclovir if they present within 24 hours of the rash

Question 4

Pre-eclampsia Mx(to correct hypertension):

Answer 4

1st line: would be Labetalol (beta blocker) however this is contraindicated in asthmatics therefore 2nd line) Nifedipine (CCB)
- delivery of baby is most important and definitive step

Question 5

Pre-Eclampsia presentation (triad):

Answer 5

• new onset hypertension more than 140/90 after 20 weeks gestation
  -proteinuria
  -oedema

Question 6

MMR vaccination in preg:

Answer 6

Do not give at any stage of pregnancy

Question 7

Carboprost medication contraindication:

Answer 7

• Avoid in asthmatics= will cause exacerbate broncho constriction

Question 8

PPH(Post-partum Haemorrhage) causes (4):

Answer 8

-Tone (uterine atony)
-Trauma (eg. perineal tear
-Tissue (retained placenta)
-Thrombin (clotting/bleeding disorder)

Question 9

PPH 1st line surgical Mx:

Answer 9

Intrauterine balloon tamponade

Question 10

Order of PPH medical intervention drug:

Answer 10

if uterine atony:
1) IV oxytocin (to start uterine contractions), to stop contractions= give tocolytics
2) IM carboprost (but avoid in asthmatics)
3) IV/IM ergometrine: avoid if hypertension
4) Misoprostol (sublingual)

Question 11

Prescribing folic acid in preg:

Answer 11

Give 5mg daily(high dose not 400 micrograms) if obese(BMI more than 30 or is on anti-epileptics)

Question 12

Abdominal pain in pregnancy:

Question 13

Adenomyosis 1st line inv:

Answer 13

Transvaginal ultrasound

• presents with heavy, painful bleeding, enlarged boggy uterus

Mx: Definitive: Hysterectomy, tranexamic acid

Question 14

History: sharp abdominal pain, fever, no bleeding, vomiting, multiple large fibroids

Answer 14

Fibroid red generation

ddx: if ovarian torsion=would have risk factors such as ovarian cyst in history
Threatened miscarriage= would have vaginal bleeding

Question 15

HELLP Syndrome:

Answer 15

Haemolysis, Elevated liver enzymes, low platelets, serious manifestation of pre-eclampsia

Ddx: Obstetric cholestasis= intense pruritus, rise in serum bile acids

Question 16

Differences between Placenta accreta, increta and percreta:

Answer 16

Accreta: Attach to the myometrium, rather than being restricted within the decidua basalis
Increta: Invade into myometrium
Percreta: Invade through the perimetrium

Question 17

Asherman’s syndrome:

Answer 17

amenorrhoea due to intra-uterine adhesions= after trauma from miscarriage and childbirth

Question 18

Sheehan’s syndrome:

Answer 18

Pituitary and PPH cause

Question 19

Endometriosis gold standard Inv:

Answer 19

• Laparoscopy

Presents with: dysmenorrhea (cyclical) and dyspareunia

Mx: with NSAIDS/paracetamol or progestogen
Secondary: GnRh analogues

Question 20

Ectopic Pregnancy:

Answer 20

Px: Lower abdominal pain that is referred to shoulder, vaginal bleeding, lack of GI symptoms and positive pregnancy rest
- Risk factors: Endometriosis, progesterone only pill, damage to tubes(eg. by pelvic inflammatory disease)

Question 21

Urinary incontinence management:

Answer 21

• Urge incontinence: when coughing/sneezing= Bladder retraining, oxybutynin
• Stress incontinence: Pelvic floor exercises, duloxetine

Question 22

Expectant Mx. in an ectopic pregnancy (criterias)=

Answer 22

1) Unruptured embryo
2) less than 35mm in size
3) have no heartbeat
4) be Asymptomatic
5) have a bcg level of less than 1000 and declining

Question 23

Threatened miscarriage px:

Answer 23

painless vaginal bleeding, closed cervical os.

Question 24

Hyperemesis Gravidarum mx:

Answer 24

Mx: admit for IV saline+potassium replacement as patient could be in hypokalaemic from all the vomiting.

Question 25

Main complication of induction of labour:

Answer 25

• Hyperstimulation of the uterus

Question 26

Placenta praevia:

Answer 26

Painless bleeding more than 20 wks after gestation

Question 27

Medical management of ectopic pregnancy:

Answer 27

• Methotrexate

Inv. of choice: Transvaginal ultrasound

Question 28

Most accurate way to confirm ovulation:

Answer 28

• Day 21 Progesterone test; by checking progesterone levels.
• Progesterone level will peak 7 days after ovulation(more than 30=ovulation)

Question 29

Psych medication in breast feeding women for depression and anxiety:

Answer 29

• SSRIs eg. Sertraline/ Paroxetine is the choice of medication.

Question 30

Current breast cancer and prescribing contraception:

Answer 30

• Copper IUD as no hormonal involvement
• Progestogen only and all hormonal contraceptives is contraindicated in current breast cancer

Question 31

Starting contraceptives and when does effectiveness start:

Answer 31

• IUD= instant
• POP= 2 days
  -COC, injection, implant, IUS= 7 days

Question 32

Gestational Diabetes mx. at 28 weeks:

Answer 32

• If fasting glucose level is more tha 7mmol/L= Start insulin immediately
• Test of choice: Oral Glucose tolerance test

Question 33

Most common cause of PPH(postpartum haemorrhage):

Answer 33

• Uterine Atony

Other causes of PPH: (3 other causes)
- Tone (failure of adequate uterine contractions)
-Trauma (perineal tear)
-Tissue (retained placenta)
-Thrombin (coagulopathy)

PPH Management:
- Medical: IV Oxytocin, Ergometrine, Carboprost, Misoprostol
-Surgical: 1st line= Intrauterine balloon tamponade