Obstetrics and gynaecology

Question 1

What are the features of trichomonas vaginalis?

Answer 1

Offensive yellow/green frothy discharge
Strawberry cervix
Give metronidazole

Question 2

What are the features of gonorrhoea?

Answer 2

White purulent sputum
Dysuria and frequency 2-5 days post infection
Give Ciprofloxacin

Question 3

What are the stages of syphilis?

Answer 3

1. Painless solitary ulcer, chancre
2. Rash of face, trunk, palms and soles
3. Gummas - non-cancerous granulomas, Argyll Robertson pupils, psychosis

Question 4

What are the features of Argyll Robertson pupils?

Answer 4

Small irregular pupils
Absent light reflex
Prompt accommodation reflex

Question 5

What tests should be done for infertility in a female with regular cycles?

Answer 5

FSH, LH, oestradiol on day 1-5 
Progesterone 7 days prior to menses 
Rubella serology 
AMH 
Cervical smear
Transvaginal USS

Question 6

What are the symptoms of endometriosis?

Answer 6

Cyclical pelvic pain
Dysmenorrhoea
Deep dyspareunia
Menstrual disturbance

Question 7

What are some causes of anovulation?

Answer 7

Premature ovarian failure
Turner's
Surgery/chemotherapy 
PCOS
Low weight/excessive exercise 
Hyperprolactinaemia

Question 8

What are the benefits and risk of HRT?

Answer 8

Benefits - lower risk colorectal cancer, osteoporosis and symptoms
Risk - higher risk breast and endometrial cancer, blood clots

Question 9

What are some causes of recurrent miscarriage?

Answer 9

Bacterial vaginosis
Parental chromosomal abnormality
Antiphospholipid syndrome
Thrombophilia

Question 10

How much show b-hCG rise by in a normal pregnancy?

Answer 10

66% every 48 hours

Question 11

What criteria must be met for conservative management of ectopic?

Answer 11

Few symptoms
Stable patient
Low/falling hCG
US mass <4cm

Question 12

What criteria must be met for medical management of ectopic?

Answer 12

hCG <3000iu
US mass <3.5cm
Contraception for 3 months

Question 13

What criteria must be met for surgical management of ectopic?

Answer 13

Internal bleeding 
Unstable patient 
hCG >5000iu 
Mass >3.5cm 
Failed medical management

Question 14

What are the cardinal movements of labour?

Answer 14

1. Engagement
2. Descent
3. Flexion
4. Internal rotation
5. Extension
6. Restitution

Question 15

What are some causes of bleeding in early pregnancy?

Answer 15

Miscarriage

Implantation bleed

Question 16

What are some causes of bleeding in late pregnancy?

Answer 16

Placenta previa

Placental abruption

Question 17

What bloods should be done at a pregnancy booking appointment?

Answer 17

Group, rhesus status
FBC
Hep B, HIV, rubella, syphilis

Question 18

What are the tests for Down’s?

Answer 18

Combined test at 11-14 weeks - nuchal translucency, bHCG, PAPP-A
Quad test at 15-20 weeks - bHCG, estradiol, AFP, inhibin A

Question 19

When should OGTT be done?

Answer 19

24-28 weeks for increased risk - BMI 30, previous macrosomia, 1st degree relative with DM, black/asian
16-18 weeks for previous GDM

Question 20

What are some high risk criteria for pre-eclampsia?

Answer 20

CKD
SLE/APS
DM
Give 75mg aspirin

Question 21

What are some moderate risk criteria for pre-eclampsia?

Answer 21

2 of:
1st pregnancy 
Over 40 
BMI >35 
FH
Multiple pregnancy 
Give 75mg aspirin

Question 22

What are some causes of PPH?

Answer 22

Uterine atony, trauma, teamed tissue, thrombin

Question 23

What are some differentials for menorrhagia?

Answer 23

Malignancy, fibroids, von Willenbrand’s, STI

Question 24

What makes up the first stage of labour?

Answer 24

Latent phase - 8-12 hours, 3cm dilation
Active phase - regular contractions 3-7cm dilation
Transition phase - intense contractions