Obs Gynae

Question 1

Definition of Primary amenorrhoea

Answer 1

No periods since birth

13yo > and no other secondary sex characteristics (eg pubes)

15yo > And other puberty characteristics (eg titties)

Question 2

Definitions:

1) Hypogonadotropic Hypogonadism
2) Hypergonadotropic Hypogonadism

Answer 2

1) Low LH and FSH. Problem with production

2) No responce to LH/FSH. Problem is in the ovaries

Question 3

LH/FSH deficiency causes

Answer 3

Hypothalamus damage (radiotherapy)
Chronic condition, anorexia, coeliac, IBD, CKD.
Increased exercise or dieting
Growth and endocrine disorders

Question 4

Hypergonadism

Answer 4

Turners syndrome xo

Damage to or lack of gonads

Question 5

15 yo girl presents to GP. She is above average heigh, has deep voice, some facial hirsutism. Primary amenorrhoea

1) Likely diagnosis
2) Serious neonatal presentation
3) Hormone imbalances that will be present
4) Enzyme involved
5) Pattern of inheritance

Answer 5

1) Congenital adrenal hyperplasia
2) Electrolyte imbalance, hypoglycaemia
3) Low cortisol and aldosterone, raised androgens
4) 21-Hydroxylase deficiency
5) Autosomal dominant

Question 6

Investigations for primary Amenorrhoea

1) Initial inx and why
2) Hormone inx and why
3) Imagining and why

Answer 6

1) FBC, ferritin (anaemia).
U/E for CKD.
Anti-ttg and anti-ema (coeliac)
2) TFTs (thyroid disease). FSH/LH (which hypogonadism). Prolatin (prolactinoma). Testosterone (PCOS)
3) wrist XR (bone age). MRI brain (pituitary). Pelvic USS (make sure all organs are there.

Question 7

Pathology of androgen insensitivity syndrome

Answer 7

Body unable to respond to androgens

Will have female phenotype externally. But not female organs internally.

Question 8

Definition of secondary amenorrhoea

Answer 8

No periods for 3 months following a regular cycle

Question 9

Two most common causes of secondary amenorrhoea

Answer 9

Pregnancy and early menopause.

Question 10

How can prolactin cause secondary amenorrhoea

Answer 10

Inhibits pituitary release of FHS and LH. Prolactinomas cause increased prolactin. Most common are pituitary adenomas - may be micro adenomas in which case would need repeat MRIs in order to identify development of tumour.

Question 11

Inx for secondary amenorrhoea

Answer 11

Prolactin
FSH and LH (raised LH alone can indicate PCOS)
MRI head.

Question 12

Management of amenorrhoea

Answer 12

Treat the cause
GnRH agonist can be used in hypodonotropic disease to promote fertility
If patient doesn’t want to be pregnant or it is an ovarian cause then COCP will provide hormone replacement therapy required.

Question 13

Pt presents with PV bleeding and abdominal pain. They are pregnant.

1) What initial 2 tests should be done
2) The cervix is closed and their is a fatal HB. The pt wishes to cont with the pregnancy, how should this be managed?

Answer 13

1) Serum B HCG

2) Allow patient to go home with info + safety netting. To return is symptoms don’t settle in 14 days.

Question 14

Pt presents with PV bleeding and abdominal pain. They are pregnant.
The TVUSS shows an open OS and retain products of conception.

1) How should this be initially managed.
2) How can this be medically managed
3) How can this be surgically managed
4) What must be done prior to surgery

Answer 14

Incomplete mistcarriage (can be managed the same as missed)

1) Expectant management - 7-14 days home, if symptoms don’t improve come back. Take pregnancy test at 3 weeks, should be negative.
2) Mistoprolol - prostogland - makes utters contract.
3) Manual vacuum aspiration
4) Anti-rhesus D immunoglobulin

Question 15

What determines early and later miscarriage?

Answer 15

<12 weeks

12-24 weeks

Question 16

common cause of miscarriage

Answer 16

genetic and chromosomal abnormalities

Question 17

Patient presents with their third miscarriage. They have a PMH of DVT.
What 3 antibodies should be tested for?

Answer 17

Anti-phospholipid syndrome

Lupus anticoagulant
Anti-cardiolipin
Anti-b2-glycoprotein

Question 18

Diseases that increase risk of miscarriage

Answer 18

Diabetes 
thyroid
Inflam pelvic disease
Thrombophilias 
cervical insufficiency

Question 19

Inx needed for recurrent miscarriages

Answer 19

Pelvic USS
Anti phospholipid abd 
Thrombophilia screen
karyotyping 
Foetal genetic analysis

Question 20

Patient presents with IF pain. They haven’t had a period in 9 weeks.

1) Likely diagnosis? Initial inx x 2
2) Criteria for expectant management?
3) Phamacological management and criteria
4) Pharmacological mx follow up
5) 2 x surgical procedures required
6) What should the pt receive prior to surgery

Answer 20

1) Ectopic preggers. TV USS + serum HCG
2) HCG < 1000, foetus < 35mm, no heart beat
3) HCG < 1500, no HB and <35mm. Single dose of methotrexate.
4) HCG at 4 and 7 days - should decline not plateau
5) Salpingectomy or salpingostomy
6) Anti-rhesus D immunoglobulin.

Question 21

Pt presents with cyclical pelvic pain. And haematuria.

1) Most likely diagnosis and other common symptoms.
2) Gold standard inx
3) Staging system
4) Medical management. Hormonal and non-hormonal
5) surgical mx

Answer 21

1) Endometriosis. Deep dyspareunia
2) Laparoscopic surgery
3) ASRM (1 - 4)
4) Mefanamic acid. NSAIDS. COCP, Mirena coil. POP.
5) Surgical ablation. Adhesionolysis

Question 22

Pregnant women (37yo) presents with painless vaginal bleeding at 32 weeks. She has not attended any of her antenatal scans. She smoked during the pregnancy.

1) Likely diagnosis
2) When is this normally diagnosed
3) Management (observations, drugs given, delivery)

Answer 22

1) Placenta previa
2) 20 week ananomaly scan
3) TV USS at 32 and 36 weeks. 34-35+6 weeks: give corticosteroids. Delivery at 36-37 weeks.

Question 23

1) What is vasa previa
2) What are the risks
3) when are steroids given
4) when does delivery take place

Answer 23

1) Vessels outside of the placenta and lie over the internal OS.
2) Fetal death
3) 32 weeks
4) 34-36 weeks

Question 24

34 week pregnant women presents with painful vaginal bleeding. She had known mildly raised BP throughout her pregnancy.

1) Diagnosis
2) Other signs and symptoms
3) Management (at least 7 things)

Answer 24

1) Placenta previa
2) WOODY ABDOMEN. Fetal distress. Hypotension + shock.
3) ….

Midwife, senior obstetrician, anaesthetist.
2 grey cannula
Bloods: usual + clotting + cm 4 units
Fluids + 0- + activate major haemorrhage pathway
steroids
rhesus prophylaxis (kleihauer test)
emergency c section

Question 25

Pregnant afro-caribean pregnant women presents to your antenatal clinic.

1) What antenatal problem are you concerned about and how might you screen for this
2) What are the positive results of this test
3) How is this condition managed (treatment lines 1-4)

Answer 25

1) Gestational diabetes. Screened with OGTT
2) Fasting > 5.6. After 2h >7.8
3)
Diet exercise.
Metformin
Insulin
Metformin + insulin

Question 26

Management of UTI in pregnancy

Answer 26

7 day Abx 
Nitro - avoid in 3rd trimester 
trimethoprim - avoid in 1st trimester 
Amoxicillin if sensitive known 
Cefalexin

Question 27

pregnant patient presents with malaise, ascites and anorexia.

1) What tests results might you expect
2) Most common cause and aetiology
3) Management

Answer 27

Acute fatty liver of pregnancy

1) Deranged LFTs - AST and ALT raised
2) LCHAD - autosomal recessive
3) Obstetric emergency - prompt delivery

Question 28

Name all risk factors for VTE in pregnancy

Answer 28

Smoking 
>Para 3 
>35yo
BMI > 30
Low mobility 
pre-eclampsia 
varicose veins 
FH 
IVF pregnancy 
thrombophilia

Question 29

Criteria for and management of VTE risk in pregnancy

When not to give treatment

Answer 29

28+ weeks + three RF

1st trimester + 4 RF

Mx with prophylactic dose LMWH
enoxaparin, deltaparin
Stop dose in labour, resume after unless spinal, epidural or haemorrhage

Question 30

pregnant patient presents with itching on their hands and soles of their feet.

1) Likely cause
2) Pathology
3) Management

Answer 30

1) Obstetric cholestasis
2) decreased outflow of bile ducts
3) Ursodeoxycholic acid + chlorphenamine

Question 31

22 week pregnant women presents with headaches, N+V, and upper abdominal/chest pain.

1) What is the likely cause
2) Diagnostic triad
3) Neurological symptom
4) Pathological cause
5) Management options (4)
6) Associated syndrome, and components

Answer 31

1) Pre-eclampsia
2) Oedema, Hypertension, Proteinura
3) Brisk reflexes
4) Vascular resistance of spiral arteries
5) Labetolol
Nifedipine
Methyldopa
Iv hydralazine if eclampsia/ITU
IV mg in labour (+24 hours after) to prevent seizures
6) HELLP syndrome
H aemolysis
E
Raised L iver enzymes
L ow platelets

Question 32

7 Drugs to be avoided in pregnancy

Answer 32

NSAIDS
warfarin 
b blockers
ACE-I
Warfarin 
Sodium valproate 
Lithium 
SSRIs

Question 33

What issues to these drugs cause in pregnancy 
NSAIDS
warfarin 
b blockers
ACE-I
Warfarin 
Sodium valproate 
Lithium 
SSRIs

Answer 33

NSAIDS - inhibit prostoglandins 
warfarin - teratogenic 
b blockers - reduced fetal growth, brady
ACE-I - oligohydraainoes 
Warfarin - teratogenic 
Sodium valproate - neural tube defects
Lithium - Epstein's anomaly 
SSRIs - congenital heart defects, persistent pulmonary hypertension