Obstetrics & Gynaecology

Question 1

Anti-epileptic drugs and breastfeeding:

Answer 1

Acceptable

Question 2

Drugs contraindicated in breast feeding:

Answer 2

Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides, aspirin, methotrexate, amiodarone

Question 3

Risk factors for neural tube defects:

Answer 3

History of NTD
Obesity, diabetes, coeliac disease, thalassemia trait
Anti-epileptic drugs

Question 4

Indications for surgical management of ectopic pregnancy:

Answer 4

Visible heartbeat
Size >35 mm
Pain
hCG >5,000IU/L

Question 5

Rhesus negative woman, when to give vaccine:

Answer 5

Anti-D at 28 + 34 weeks

Question 6

Missed POP, what to do after 3 hours with traditional POPs and after 12 hours with desogestrel (cerazette):

Answer 6

Take missed pill ASAP, take next one at usual time. Condoms should be used until pill taking has been re-established for 48 hours

Question 7

Management of severe pre-menstrual syndrome:

Answer 7

SSRIs

Question 8

Unilateral dull ache intermittent or during intercourse, may cause abdominal swelling or pressure effects on the bladder:

Answer 8

Ovarian cyst

Question 9

Treatment for ated group B streptococcus (GBS) in pregnancy:

Answer 9

Intrapartum intravenous benzylpenicillin

Question 10

Treatment for menopausal symptoms in patient with Mirena

Answer 10

Estradiol, Mirena can provide the progesterone component of HRT for 4 years

Question 11

Treatment for pre-eclampsia in asthma:

Answer 11

Nifedipine, labetalol if not asthmatic

Question 12

Positive HPV smear, negative citology, negative smear at 12 months later:

Answer 12

Return to routine recall.
25-49 years, every 3 years. 50-65 years, every 5.

Question 13

Diagnostic thresholds for gestational diabetes:

Answer 13

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

Question 14

Capillary blood glucose targets in GDM:

Answer 14

Fasting: 5.3mmol/L
AND
1 hour postprandial: 7.8 mmol/L or
2 hours postprandial: 6.4 mmol/L

Question 15

Labour, Bishop <=6 after membrane sweep:

Answer 15

Vaginal prostaglandins or oral misoprostol

Question 16

Labour, Bishop >6

Answer 16

Amniotomy and oxytocin infusion

Question 17

Vaginal candidiasis treatment:

Answer 17

Oral fluconazole 150 mg as a single dose first-line, clotrimazole 500 mg intravaginal pessary if oral contraindicated

Question 18

Recurrent vaginal candidiasis, 4x or more per year, treatment:

Answer 18

Induction: oral fluconazole every 3 days for 3 doses
Maintenance: oral fluconazole weekly for 6 months

Question 19

2 or more COCP pills missed in weeks 1, 2, and 3:

Answer 19

abstain from sex until she has taken pills for 7 days in a row.
week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
- week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
- week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

Question 20

Contraceptives that may decrease bone mineral density

Answer 20

Depo provera

Question 21

Treatment for vaginal candidiasis in pregnancy:

Answer 21

Clotrimazole pessary, oral fluconazole contraindicated because of congenital abnormalities

Question 22

SSRIs of choice in breastfeeding women

Answer 22

Sertraline or paroxetine

Question 23

First-line contraception for women with idiopathic menorrhagia:

Answer 23

Levonorgestrel intrauterine system

Question 24

Need for contraception after the menopause:

Answer 24

• 12 months after the last period in women > 50 years
• 24 months after the last period in women < 50 years

Question 25

Test to confirm menopause (and premature ovarian failure):

Answer 25

FSH

Question 26

Exercise caution with what type of patients when prescribing ulipristal?

Answer 26

Severe asthma

Question 27

Treatment for stress incontinence who don’t respond to pelvic floor muscle exercises and decline surgical intervention

Answer 27

Duloxetine

Question 28

Intrauterine system (levonorgestrel) mode of action

Answer 28

Inhibits endometrial proliferation

Question 29

Progestogen-only pill (excluding desogestrel) mode of action

Answer 29

Thickens cervical mucus

Question 30

Treatment for secondary dysmenorrhea:

Answer 30

Refer to gynae

Question 31

Third-stage labour, loss of 700 mls, next step after IV crystalloids:

Answer 31

Compress uterus and catheterise

Question 32

Suspected PE in pregnant women with a confirmed DVT, treatment:

Answer 32

LMWH first then investigate to rule in/out

Question 33

Pregnant women ≥ 20 weeks, presents with chickenpox rash of less than 24 h, treatment:

Answer 33

Oral aciclovir

Question 34

Secondary menorrhagia, no symptoms of underlying pathology, requires contraception: first and second line:

Answer 34

IUS
COCP

Question 35

First line treatment for:
Urge incontinence
Stress incontinence

Answer 35

Urge: bladder retraining
Stress: pelvic floor muscle training

Question 36

Perineal muscle tear after delivery, degree and treatment

Answer 36

2nd degree, suture in ward

Question 37

Tear to perineum involving any anal sphincter after delivery, treatment and degree

Answer 37

3rd degree, suture in theatre

Question 38

First and second line treatment for pelvic inflammatory disease:

Answer 38

first-line: stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole
second-line: oral ofloxacin + oral metronidazole

Question 39

Pregnant, fasting glucose of 6.8 mmol/L, treatment:

Answer 39

Diet and exercise for 1-2 weeks. If targets not met, start metformin

Gestational diabetes: if the fasting plasma glucose is < 7 mmol/l a trial of diet and exercise should be offered for 1-2 weeks.
If >7, insulin.

Question 40

Combined oral contraceptive pill and risks of cancer:

Answer 40

Increased risk of breast and cervical cancer
Protective against ovarian and endometrial cancer

Question 41

22 weeks pregnant, exposure to chickenpox, unknown vaccination status:

Answer 41

Urgent blood test to check for varicella antibodies.

Antivirals or VZIG (if available) should be given at days 7-14 post-exposure, not immediately

If not immune, either varicella-zoster immunoglobulin (VZIG) or aciclovir can be given to a pregnant woman >20 weeks.

Less than 20 weeks pregnant and not immune, only VZIG would be offered.

Question 42

Alternative for oral metronidazole in bacterial vaginosis:

Answer 42

Topical metronidazole or clindamycin

Question 43

Drugs that can cause erythema nodosum

Answer 43

Penicillins, sulphonamides, COCPs

Question 44

26 weeks pregnant with heavy vaginal bleeding. Rhesus negative. Sensitisation management?

Answer 44

Anti-D followed by Kleihauer test. Kleihauer test for all sensitising events after 20 weeks.

Question 45

Most common cause of breast abscess in lactation:

Answer 45

Staph aureus

Question 46

Pharmacological measure for stress incontinence:

Answer 46

Duloxetine

Question 47

What is Meig’s syndrome:

Answer 47

Benign ovarian tumour (usually a fibroma) associated with ascites and pleural effusion

Question 48

Common adverse effect of Progestogen-only pill

Answer 48

Irregular bleeding