Obstetrics + Gynaecology

Question 1

What is the standard testing regime for downs syndrome in pregnancy?

Answer 1

Combined test done between 11 - 13 + 6 weeks
Nuchal translucency, serum BHCG, PAPP A

Question 2

What result of the combined test suggests an increased risk of downs syndrome?

Answer 2

High HCG, Low PAPP A, Thickened nuchal translucency

Question 3

What screening test for down syndrome is offerred to women who book later in pregnancy?

Answer 3

Quadruple test
- AFP, Unconjugates oestriol, Human chorionic gonadotrophin and inhibin A

Question 4

In pre natal testing for downs syndrome what is classed as higher or lower chance?

Answer 4

Low chance - 1 in 150 or more
High chance 1 in 150 or less

Question 5

What test is offerred to women who have a higher chance of down syndrome on initial prenatal screening?

Answer 5

Non invasive prenatal screening (NIPT)

Question 6

What is the triad of symptoms in pre eclampsia?

Answer 6

New onset hypertension (over 140/90 after 20 weeks of pregnancy)
Proteinuria
Oedema

Question 7

What is the formal definition of pre eclampsia

Answer 7

New onset hypertension (over 140/90 after 20 weeks of pregnancy)
Proteinuria
Other organ involvement - renal, liverm neurological

Question 8

Risk factors for pre eclampsia

Answer 8

Hypertension in a previous pregnancy, CKD, Autoimmune disease, diabetes, Existing hypertension,

Also - age over 40, pregnancy interval of more than 10 years, high BMI, family history, multiple pregnancy

Question 9

What medication can be given to reduce the risk of pre eclampsia?

Answer 9

Aspirin 75mg OD

Question 10

When is aspirin advised during pregnancy to reduce risk of pre eclampsia

Answer 10

Women with more than 1 high risk factor or more than 2 moderate risk factors

Question 11

What level of proteinuria is considered significant in pregnancy?

Answer 11

over 30mg/mmol

Question 12

Over what blood pressure in late pregnancy is a women usually admitted for inpatient care (according to NICE guidelines)?

Answer 12

160/110

Question 13

What is the first line drug treatment for pre eclampsia?

Answer 13

Labetalol

Question 14

Management of obstetric cholestasis

Answer 14

Induction of labour at 37 - 38 weeks
Ursodeoxycholic acid
Vitamin K

Question 15

What causes obstetric cholestasis

Answer 15

Impaired flow of bile causing a build up of bile salts which are then depositied in the skin and placenta.

Question 16

Mathod of induction of labour if bishop score less than 6

Answer 16

Vaginal prostoglandins or oral misoprostol

Question 17

Induction of labour if bishop score over 6

Answer 17

Amniotomy and IV oxytocin

Question 18

When is external cephalic version performed

Answer 18

After 36 weeks

Question 19

Medication for stress incontinence

Answer 19

Duoloxetine

Question 20

Most common type of ovarian cyst

Answer 20

Follicular cyst

Question 21

How long is additional contraception needed after implant insertion

Answer 21

7 days if not inserted on day 1 of the menstrual cycle

Question 22

What are the criteria for expectant management for an ectoptic pregnancy

Answer 22

1) An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining

Question 23

Management of post partum haemmorhage

Answer 23

Mechanical - uterine palpation + catheterisation
IV oxytocin
Ergometrine
Carboprost IM
Misoprostol
Surgical managment

Question 24

Diagnosis of gestational diabetes

Answer 24

Fasting glucose over 5.6
2 hour glucose over 7.8

Question 25

Management of gestational diabetes

Answer 25

If fasting glucose less than 7 2 week trial of diet and excercise. If targets not met within 1 - 2 weeks of altering diet and excercise then metformin should be added
If not met - insulin (short acting)

If fasting glucose at the time of diagnosis is over 7 then insulin should be started

If fasting glucose less than 7 but there is evidence of complications then insulin should be started

Question 26

Definition of oligohydramnios

Answer 26

Less than 500ml amniotic fluid at 32 - 36 weeks and an AFI less than 5th percentile

Question 27

Most common type of overian cancer

Answer 27

Serous carcinoma

Question 28

What does the bishop score include

Answer 28

Cervical position
Cervical consistency
Cervical effacement
Cervical dilatation
Foetal station

A score of less than 5 indicated labour is unlikely to start without induction

Question 29

How long after UPSI can ella 1 be used

Answer 29

5 days (120 hours)

Question 30

How long after upsi can levonorgester be taken

Answer 30

72 hours

Question 31

Definition of premature ovarian failure

Answer 31

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