obs + gynae

Question 1

twin
triples
when to offer elective birth

Answer 1

37 dichorionic
36 monochorionic
35 triplets

Question 2

referral for pre-eclampsia

Answer 2

• BP >160/100
• rise in >30/20 over booking BP
• or >140/90 BP + proteinuira and or symptomatic I intrauterina growth restriction

Question 3

placental previa
when present weeks?

Answer 3

• low lying placenta
• 28 weeks + painless bleeding

Question 4

placental abruption

Answer 4

painful vaginal bleeding + shock

Question 5

PH in foetus to cause immediate C section?

Answer 5

7.19 and below –> C section
as fetal distress

Question 6

meconium passed in utero?

Answer 6

sign of fetal distress
induce and continuous monitoring
risk of fetal meconium aspiration syndrome so deliver in neonatal unit

Question 7

Infertility in PCOS

Answer 7

1st line clomifene
2nd line metformin

Question 8

GONORRHEA
bacteria

SYPHILLIS

CHLAYMIDIA

Answer 8

CEFTRIAXONE IM
gram-negative diplococcus (dripollococus)
more syx - often green/yellow discharge

BEN PEN

DOXYCYCLINE
unless pregnancy as CI so -Azithromycin, erythromycin or amoxicillin
gram-negative bacteria
more asymptomatic

Question 9

cause ovulation?

Answer 9

LH surge causes ovulation

Question 10

secondary dysmenorrhea

causes

Answer 10

• develops many years after the menarche
• pain usually starts 3-4 days before the onset of the period.
• referring all patients with secondary dysmenorrhoea to gynaecology for investigation

Causes include:
endometriosis
adenomyosis
pelvic inflammatory disease
intrauterine devices*
fibroids

Question 11

Emergency contraception
Levonorgestrel

Ulipristal (ellaone)

copper IUD

Answer 11

L- 72 hr UPSI, double over 70kg, can start OCP after. inhibit ovulation and implant

U- 120hrs UPSI - barrier 5d after, inhibit ovulation, caution severe asthma

C- most effective, should be offered to all women, 5 day UPSI or 5 days after likely ovulation - inhibit fertilisation or implantation

Question 12

turners aka gonadal dysgenesis

Answer 12

Raised FSH/LH in primary amenorrhoea
underdevelopment of secondary sexual characteristics

Question 13

mrnopause hormones

Answer 13

LH and FSH high
progesterone and oestradiol low

Question 14

antiemetic in pregnancy 1st line

Answer 14

cyclizine

Question 15

all breastfeeding women should take

Answer 15

vitamin D tablets

Question 16

Diagnostic thresholds for gestational diabetes

if not managed with metformin?

Answer 16

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

add insulin - short acting

Question 17

fibroid management

size dependent?

if surgery what to give before?

Answer 17

For fibroids less than 3 cm, the medical management is the same as with heavy menstrual bleeding:

Mirena coil (1st line) – fibroids must be less than 3cm with no distortion of the uterus or COCP / NSAIDs

For fibroids more than 3 cm, women need referral to gynaecology for medical vs surgical tx
GnRH agonists reduce the size of the uterus prior to surgery

Question 18

methotrexate and contraception

Answer 18

Methotrexate: must be stopped at least 6 months before conception in both men and women

Question 19

downs syndrome prenatal test results

Answer 19

nuchal translucency thickened
B-HCG is raised
PAPP-A is low.

Question 20

when do women need contraception post partum?

Answer 20

Women do not require contraception until day 21 post partum
after this POP advised

Question 21

spot urine protein:creatinine ratio considered high?

Answer 21

of 30mg/mmol or more is used as the threshold for significant proteinuria in pregnancy.

Question 22

PPH defnition
management PPH?

Answer 22

blood loss of > 500 ml after a vaginal delivery
step 1 A-E and Iv crystalloid
step 2 mechanical = catheter and palpate on uterus
step 3 medical IV oxytocin or ergometrine
step 4 surgical intrauterine balloon tamponade

Question 23

Contraceptives - time until effective (if not first day period):

Answer 23

instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

Question 24

Antenatal care: anomaly scan

Answer 24

done at 18-20 + 6 weeks

Question 25

down’s syndrome screening including the nuchal scan is done at

Answer 25

11-13+6 weeks

Question 26

surgical management ectopic
what size?

Answer 26

> 35mm, fetal heartbeat
if no fertility risk, salpingectomy preferred (remove whole thing)

Question 27

More than 35 years old and smoking more than 15 cigarettes/day ?cocp

Answer 27

absolute contraindication to the COCP

Question 28

placental abruption

Answer 28

uterus may be in spasm and feel firm or ‘woody’
continuous abdominal pain
shock disproportionate to the amount of blood loss

Question 29

induction of labour related to bishop score

Answer 29

if the Bishop score is ≤ 6
vaginal prostaglandins or oral misoprostol
if the Bishop score is > 6
amniotomy and an intravenous oxytocin infusion

Question 30

clonidine

tibolone

Answer 30

menopausal hot flushes or sweats
non hormonal

combined H

Question 31

The most common ovarian cancer

Answer 31

Serous carcinoma

Question 32

Placenta praevia

Answer 32

placenta lying wholly or partly in the lower uterine segment
HIGH presenting part

Question 33

medical management for termination

Answer 33

mifepristone = anti progesterone - stops pregnancy

misoprostol = misoPUSH out

Question 34

BV

Answer 34

Gardnerella vaginalis
clue cells !!!
tx metronidazole

Question 35

Rhesus negative woman -

Answer 35

anti-D at 28 + 34 weeks

Question 36

diabetics in pregnancy supplements?

Answer 36

• vitamin D 10mcg
• aspirin 75mg 12 weeks
• 5mg folic (400mcg)

Question 37

thrush in pregnancy

Answer 37

pessary only no oral fluconazole as CI in pregnancy

Question 38

premature ovarian failure defined?

Answer 38

The onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years

Question 39

pre-eclampsia prophylaxis if had prior

Answer 39

aspirin 75mg od from 12 weeks until the birth of the baby.