Obs and Gynae

Question 1

Pregnant woman with UTI management

Answer 1

7 day course
Nitro unless close to term (then risk of neonatal haemolysis)

Question 2

Risk factors for endometrial cancer

Answer 2

Excess oestrogen
- Nulliparity
- Early menarche
- Late menopause
- Unopposed oestrogen i.e. if wrong HRT given
Metabolic syndrome
Tamoxifen
Hereditary non-polyposis colorectal carcinoma

Question 3

Endometrial Ca investigations

Answer 3

TV USS - normal endometrial thickness <4mm
Hysteroscopy with biopsy

Question 4

Endometrial Ca management

Answer 4

Total abdominal hysterectomy with bilateral salpingo-oophorectomy is first line for stage I and II
Provera is a hormonal treatment
Wertheim’s radical hysterectomy includes removing lymph nodes - for stage IIB

Question 5

Causes of secondary dysmenorrhoea

Answer 5

Develops many years after menarche

-Endometriosis
-Adenomyosis
-Pelvic inflammatory disease
-Intrauterine devices
-Fibroids

Question 6

Primary dysmenorrhoea

Answer 6

No underlying pelvic pathology
Appears within 1-2 years of menarche
Thought to be due to excessive endometrial prostaglandin production

Question 7

Primary dysmenorrhoea management

Answer 7

NSAIDs e.g. mefenamic acid
COCP second line