OBGYN

Question 1

Causes of PPH?

Answer 1

TONE: Reduced uterine tone (70%)
TRAUMA: laceration, rupture of uterus (20%)
TISSUE: Retained placenta or blood clots (10%)
THROMBIN: Coagulopathy (1%)

Question 2

PPH Management?

Answer 2

1. IV access
2. Blood transfusion sample
3. Oxytocin 10units IM
   1g TXA acid
4. Oxytocin infusion 40units over 4hrs
5. Look for trauma or tissue
6. Bimanual compression
7. Catheter
8. Prepare for emergency hysterectomy if needed
9. Pad checks

Question 3

PV bleeding - PALM COEIN

Answer 3

P- Polyps 30s
A - Adenomyosis
L- Leiomyomas
M- Malignancy and hyperplasia40s

C- Coagulopathy *12-18 bleeding disorders eg VWBD
O- Ovulatory *12-18 anovulatory
E- Endometrial
I- Iatrogenic
N- Not otherwise classified

Question 4

PV bleeding (not pregnant) Mx

Answer 4

Unstable

Resus- ABC

1. Conjugated oestrogen (IV Premarin 25mg 4hrly 24hrs)

In SA
1. Progestin norethisterone 5mg 4hrly for 48hrs
Or
2. TXA

Tamponade

COC

Question 5

Normal stages of labour

Answer 5

Stage 1
Stage 2
Stage 3
Stage 4

Question 6

Partogram

Question 7

CTGs

Question 8

Syphilis
Stages

Answer 8

Primary: painless chancre

Secondary:
maculopapular rash - papulosqamous
Palms and soles
Condulomata lata
Constitutional Sx

Tertiary:
Gumma
Neurosyphilis
Cardiovascular- thoracic aorta aneurysm (vaso vasorum)
Tabes dorsalis
Argyll-Robertson pupil - no reaction to light but reacts with accommodation

Question 9

Rx Syphilis ?

Answer 9

Primary secondary or early latent:
Pen G 2.4mil units stat

Tertiary
Same as above but weekly for 3 wks

Neuro syphilis
Different

Question 10

HSV

Answer 10

Type 1 oral
Type 2 genital

Painful ulcers
Recurrent

Rx: acyclovir

Question 11

Chancroid

Answer 11

Cause: haemophilis ducreyi

Ulcers painful demarcated purulent base. Painful inguinal LAD - Bubos fluctuations that can burst

Rx: azithromycin and ceftriaxone

Question 12

LGV
Chlamydia trachomatis

Answer 12

Painless ulcers
LAD with bubos
Groove sign

Mx: doxycycline

Question 13

Granuloma inguinale

Answer 13

Painless ulcers
Beefy red

Mx: Azithromycin

Question 14

Condylomata acuminatum

Answer 14

HPV 6,11
Warts
NB rule out Cancer

DDX: syphilis condyloma lata

Question 15

Chlamydia

Answer 15

PID
Mucopurulent cervicitis
Epididymitis
Neonatal conjunctivitis
Reiter syndrome (reactive arthritis)

Question 16

Gonorrhea

Answer 16

VDS
PID
MUS
Epididymitis
Conjunctivitis
Disseminated - septic arthritis or migratory polyarthritis
Rash - haemorrhagic painful pustules on erythematous base

Chlamydia co infection