Obs & Gynae 2

Question 1

Name 5 complications of PCOS?

Answer 1

Infertility
Diabetes
Stroke + TIA
CAD + MI
Endometrial cancer

Question 2

When counselling for HRT how should it be done?

Answer 2

Quick history around symptoms (any breast Ca or clots?)
- ICE
Explain lifestyle (exercise, diet etc can improve)
Ask them what they want to know
- Benefits
- Risks
- How it’s given?

Question 3

Benefits of HRT?

Answer 3

Reduced risk CRC

Reduced risk osteoporosis

Question 4

Risks of HRT?

Answer 4

Increased risk breast and endometrial cancer

Increased risk clots (VTE and stroke)

Question 5

Name 5 presenting features of PID?

Answer 5

• Bilateral lower abdominal pain (which is also tender)
• Deep dyspareunia
• Abdominal vaginal bleeding (postcoital, intermenstrual)
• Vaginal or cervical discharge that is purulent (pus)
• Fever (>38)
Speculum examination: Cervical discharge and cervicitis / cervical excitation

Question 6

How should PID be managed?

Answer 6

Mild disease: Ceftriaxone IM plus doxy and metronidazole for 14 days
Mod/ Severe: Admit

Question 7

How is endometriosis managed?

Answer 7

1st: NSAIDS or Paracetamol
2nd: COCP or Mirena coil or depo (IM medroxyprogesterone every 3 months)
(In secondary care)
3rd: Surgical management
Diagnostic laparoscopy +/- biopsy often has seen and treat approach
4th: GnRH agon`ist (leuprorelin)

Question 8

How does endometriosis most commonly present?

Answer 8

• Dysmenorrhoea
• Dyspareunia
• Cyclical or chronic pelvic pain
• Subfertility
• May also feel pelvic mass or a fixed, retroverted uterus (shows pelvic adhesions)

(Key is worsening of symptoms before or during menstruation)

Question 9

How do you treat chlamydia?

Answer 9

Azithromycin (stat)
or
Doxycycline (7 days)

Question 10

How do you treat gonorrhoea?

Answer 10

Ceftriaxone 500 mg IM stat plus azithromycin 1 g orally stat

Question 11

Key pregnancy dates for booking and scans?

Answer 11

Booking = 8-12wks
First scan = 11-13+6
Second (anomly scan) = 18-20+6wks

Question 12

How long do the common contraceptives take to work if not starting at beginning of cycle?

Answer 12

Contraceptives - time until effective (if not first day period):
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

Question 13

What features make up HELPP syndrome? How is it managed?

Answer 13

Haemolysis
ELevated liver enzymes
LP low platelet counts

Manage is delivery (After 34 weeks hopefully, can short delay of 1-2 days without increased risk)

Question 14

Name 4 blood tests you would do for secondary ammenorrhoea and why you would do each one?

Answer 14

hCG > exclude pregnancy
Gonadotrophins (FSH/LH) > raised if premature ovarian failure, low if hypothalamic problem
Prolactin > hyperprolactinaemia is a common cause of ammenorrhoea (pregnancy/ lacation/ tumours)
TFT’s - Hypothyroid can cause ammenorrhoea

Question 15

What is the classic triad of vasa praevia?

Answer 15

The classic triad of vasa praevia is rupture of membranes followed by painless vaginal bleeding and fetal bradycardia.

Question 16

What is the definition of Puerperal pyrexia and name 3 causes?

Answer 16

Puerperal pyrexia is a temperature of > 38ºC in the first 14 days following delivery.

• Endometritis (most
  common) - admit for IV antibiotics
• Urinary tract infection
• Wound infections (perineal tears + caesarean section)
• Mastitis
• VTE

Question 17

What is the most common ovarian cancer?

Answer 17

90% are epithelial

- Most common subtype within this is serous

Question 18

If breastfeeding, what contraception can you have post-partum?

Answer 18

No COCP when breastfeeding

• Otherwise can get pregnant anytime from week 3, don’t insert coils until wk 4 and all progrestone contraceptions are fine when breastfeeding