OBGY

Question 1

CIx to POP (progesterone only pills)

what are the side effects?

Answer 1

Absolute CIx : 
 suspected pregnancy
 breast cancer
undiagnosed vaginal bleeding.
taking enzyme inducing drugs (anti-epileptics, rifampicin etcs) 

Relative CIx :
active viral hepatitis, severe chronic liver disease

side effects : 
 breakthrough bleeding 
 HA
 Nausea 
 mood change/weight change 
rare : cholesterol increase, ectopic preg, ovarian cyst

Question 2

combined hormone replacement therapy (estrogen + progesterone) for menopausal symptoms
Impact on?

endometrial cancer risk
breast cancer risk

Answer 2

endometrial cancer risk : decrease 
breast cancer risk : no change 
colorectal cancer : decrease
ovarian cancer : decrease 
cervical cancer : increase

Question 3

GDM Dx?

Answer 3

75g glucose OGTT

fasting blood glucose > 5.5 mmol/L
2hr blood glucose > 8 mmol/L

Question 4

pregnant, exposed to shingles
no Hx of chicken pox
management?

Answer 4

check for Varicellar Zoster IgG Antibody.

present, no further management.

absent, Varicellar Zoster immunoglobulin within 10 days since the exposure to shingles.

Question 5

a women with regular periods.

which test to see predict ovulation?

Answer 5

serum progesterone .

a level greater 20nmol/L indicates ovulation took place.

Question 6

folic acid supplement dose for normal pregnancy.

dose for patients with high risks

Answer 6

folic acid 0.5 mg for normal

up to 5 mg for high risk patients

Question 7

best time to insert IUD?

Answer 7

During the first 7 days of menstrual cycle, which starts with the first day of bleeding

Question 8

asymptomatic ovarian cysts management?

Answer 8

0-3cm : no follow up
3-5cm : repeat ultrasound in 3 months
5-7cm : repeat ultrasound in 3 months and yearly follow-up
>7cm : MRI or surgical evaluation

Question 9

preg, bipolar, on lithium.

Management during pregnancy?

Answer 9

Monitor renal, thyroid, parathyroid funtions, lithium level.
high resolution sono at 16-20 weeks
dose reduction by 25% in the third trimester to prevent possible neonatal toxicity.

Question 10

warfarin during pregnancy

what complications in 1st and 2nd trimester?

Answer 10

1st trimester : fetal warfarin syndrome (nasal hypoplasia, short fingers, chondrodysplasia punctuta)

2nd trimester : CNS anomalies (microcephaly, hydrocephalus, etc) and eye anomalies (optic atrophy, microphtalmia, etc)

Question 11

combined oral contraceptives.
increase risk of which cancer?
decrease risk of which cancer?

Answer 11

increased risk : cervical cancer after 5 yrs
decreased risk : endometrial, ovarian, colorectal cancers
neutral : breast cancer

Question 12

PCOS

which hormonal change is highly suggestive of PCOS?

Answer 12

testosterone increase

Question 13

primary genital herpes after 30 weeks gestation.

Management?

Answer 13

prophylactic antiviral to mom

c.sec

Question 14

post-coitus contraception
Postinor-2 (2 tablets of levonorgestrel 750mcg)
when to take?

Answer 14

first tablet within 72 hrs of unprotected sex
2nd tablet after 12 hours

or

take two at the same time : lower risk of failure and less adverse effects

Question 15

menopausal symptoms with Hx of DVT 18 months ago. Hysterectomy state.
How to administer HRT?

Answer 15

estrogen transdermal patch

transdermal patch is not associated with increase risk of venous thromboembolism

Question 16

a valvular heart disease that can lead to the most significant complications during pregnancy?

Answer 16

Mitral valve stenosis

Question 17

folic acid supplementation in pregnancy. the right dose?

Answer 17

0.5 mg

take 10 times the minimal dose = (4-5mg) if

Family Hx of neural tube defects
a previous pregnancy with NTD 
on antiepileptics 
DM
BMI >35

Question 18

the best test to predict ovulation?

Answer 18

serum progesterone

> 20nmol/L indicates that ovulation took place

Question 19

gray vaginal discharge? Dx?

Answer 19

bacterial vaginosis
(Gardnerella vaginalis )

Tx Metronidazole

Question 20

green vaginal discharge? Dx?

Answer 20

STI. (chlamydia, trichomonas)

Question 21

what to give to pregnant patients with major risk factors for pre-eclampsia?

Answer 21

Low dose aspirin : 100mg, 12 weeks - 36 weeks.

Calcium supplement

Question 22

PCOS (acne, weight gain, irregular menses, hirsutism)

treatment ?

Answer 22

Pharmacological therapy
at least 6 months before making changes in dose or medication
Primary therapy is the COCP (monitor glucose tolerance in those at risk of diabetes)

Anti-androgen monotherapy (eg. aldactone or cyproterone acetate) should not be used without adequate contraception

Combination therapy – if 36 months of COCP is ineffective, add anti-androgen to COCP (daily spironolactone >50 mg twice daily or cyproterone acetate 25 mg/day, days 1–10 of COCP)