OG

Question 1

Benefits of HRT?

Answer 1

Improves:

• vasomotor symptoms
• sleep, muscle aches, QoL
• mood
• sexual function

Reduces:

• Urogenital atrophy
• Vaginal dryness
• Osteoporosis risk
• Cardiovascular risk
• Colon cancer risk

Question 2

Risks of HRT?

Answer 2

• VTE risk
• endometrial/ovarian cancer risk in those with a uterus if oestrogen-only therapy
• breast cancer risk
• stroke risk

Question 3

How can premature ovarian insufficiency be diagnosed?

Answer 3

Women aged under 40 years, based on:

• menopausal symptoms, including no or infrequent periods (taking into account presence of uterus!) AND
• elevated FSH on 2 blood samples taken 4-6weeks apart.

Question 4

What symptoms might you get with urethral prolapse?

Answer 4

Asymptomatic or dysuria

Question 5

How might you manage urethral prolapse?

Answer 5

Topical estrogen cream
Sitz bath
Antibiotics

Question 6

How might a urethral diverticulum present?

Answer 6

Dysuria
Dribbling incontinence
urgency
haematuria

Question 7

How might you treat a urethral diverticulum?

Answer 7

Excision and marsupilization

Question 8

How might you manage a Bartholin cyst?

Answer 8

Usually leave it
Can insert a Word catheter to drain it
Marsupilization

Question 9

What might you prescribe for somebody with candida vulvitis?

Answer 9

Topical imidazole

oral fluconazole

Question 10

What signs/symptoms are there of lichen sclerosus?

Answer 10

External genitalia losing shape/definition
Epithelial thinning
Dry, shiny fragile parchment-like genitalia

Question 11

How can you treat lichen sclerosus?

Answer 11

Topical steroid cream

Question 12

How might you manage vestibulodynia?

Answer 12

pelvic floor exercises
CBT
TCAs

Question 13

What is Mullerian agenesis?

Answer 13

Congenital absence of the uterus and upper portions of the vagina

Question 14

What are typical symptoms associated with imperforate hymen?

Answer 14

Cyclical pelvic pain with amenorrhoea

Question 15

How might you manage an imperforate hymen?

Answer 15

COCP
NSAIDs
Hymenotomy

Question 16

Where can Gartner’s duct cysts be found?

Answer 16

Along the lateral walls of the vagina

Question 17

How can Gartner’s duct cysts be managed?

Answer 17

expectantly

surgical excision if painful

Question 18

What are Nabothian cysts?

Answer 18

Normal mucinous filled cysts found on cervical surface.

Question 19

What are some contraindications to VBAC?

Answer 19

Previous uterine rupture
‘Classical’ cesarean scar (high vertical)
Major placenta praevia

Question 20

Signs of uterine rupture?

Answer 20

Maternal shock (hypotension, fainting, tachycardia)
Persistent severe abdominal/scar pain
Abnormal PV bleeding
Haematuria
Cessation of previously normal uterine activity

Abnormal CTG
Loss of station of presenting part

Question 21

What is the percentage risk of uterine rupture in VBAC?

Answer 21

less than 1%

Question 22

What is the percentage success rate of VBAC?

Answer 22

70 - 90%

Question 23

By how many weeks gestation should a planned VBAC or elective cesarean section take place?

Answer 23

ideally after 39 weeks, before 41 weeks

Question 24

If a patient is post-dates, 41+ weeks, what should happen regarding her VBAC?

Answer 24

Review by a senior obstetrician for induction of labour versus cesarean. Induction and augmentation increases the risk of uterine rupture.

Question 25

What effect does preterm labour have on VBAC success rate and complication rate versus term labour?

Answer 25

Preterm VBACs have similar success rates to term VBACs | Reduced risk of rupture in preterm

Question 26

If a patient has a twin pregnancy what should happen regarding her VBAC?

Answer 26

Review by senior obstetrician | Some studies show similar success rates compared to singleton VBACs

Question 27

Name the top 5 causes of direct maternal mortality in the UK.

Answer 27

``` Thrombosis/VTE APH/PPH Amniotic fluid embolism Genital tract sepsis Early/ectopic pregnancy ```

Question 28

What are the top 5 causes of maternal mortality according to the WHO?

Answer 28

1. PPH 2. post-partum infection 3. Pre-eclampsia/eclampsia 4. Complications during delivery 5. Unsafe abortions

Question 29

Criteria for diagnosing menopause

Answer 29

- Women over the age of 45 - Menopausal symptoms (vasomotor, musc, mood, urogenital, sex) - No period for 1 year - Not on any hormonal contraception

Question 30

Criteria for diagnosing perimenopause

Answer 30

- Women over the age of 45 - Vasomotor symptoms - Irregular periods

Question 31

When should you use an FSH test to diagnose menopause?

Answer 31

- women aged 40-45 with menopausal symptoms and change in menstrual cycle - women aged under 40 in ?menopause

Question 32

If a fetus dies under 24 weeks what is it known as?

Answer 32

miscarriage or late fetal loss

Question 33

If a fetus dies over 24 weeks what is it known as?

Answer 33

If delivered - 'Still birth' | If in utero - Intrauterine fetal death

Question 34

According to NICE guidelines when should you clinically assess/investigate a woman with her partner regarding infertility?

Answer 34

- she is of reproductive age - trying for 1 year unprotected vaginal sex - in absence of known cause of infertility

Question 35

What is the name of the system used to assess pubertal development?

Answer 35

Tanner Scale

Question 36

How is delayed puberty in girls defined?

Answer 36

No breast development by 13 years or no menarche by 3 years after breast development (or by 16)

Question 37

What factors improve/reduce chance of IVF success?

Answer 37

Things that improve chances: - Being younger - BMI 19-30 - Previous pregnancy/live birth Things which reduce chances: - Previous unsuccessful IVF - Smoking - Alcohol greater than 1unit/day - Caffeine consumption

Question 38

6 steps for IVF in women

Answer 38

1. Suppress cycle - injection/spray OD - two weeks 2. Boost egg supply - FSH injection OD - 10-12 days 3. Monitor progress - USS/bloods 4. Collect eggs - 34 hours before have final hormone injection - USS and per vaginal extraction - 20 minutes, cramps or bleed afterwards normal 5. Fertilise eggs - partner/donor sperm mixed in lab - 2-6days - pessary to prep uterus lining 6. Transfer embryo

Question 39

Based on age, how many embryo transfers should a woman have in the first, second and third IVF cycles?

Answer 39

Under 37: - first IVF cycle = single embryo transfer - second = single (consider double if no top-quality) - third = no more than two 37-39: - first = single (consider double if no top-quality) - second = single (consider double if no top-quality) - third = no more than two 40-42: - double

Question 40

Hypothalamic causes of pathological amenorrhoea?

Answer 40

Functional: stress; exercise | Non-functional: SOL; surgery

Question 41

Anterior pituitary causes of pathological amernorrhoea?

Answer 41

Micro/macroadenoma Surgery Sheehan's

Question 42

Ovarian causes of pathological amenorrhoea?

Answer 42

PCOS POF Ovarian dysgenesis due to Turner's

Question 43

Genital tract outflow obstruction causes of pathological amenorrhoea?

Answer 43

Transverse vaginal septum Imperforate hymen Cervical stenosis Asherman's syndrome

Question 44

Endocrinopathies causing pathological amenorrhoea?

Answer 44

Hyperprolactinaemia Severe hypo/hyperthyroidism CAH Cushing's syndrome

Question 45

Common physiological causes of amenorrhoea?

Answer 45

Pregnancy Lactation Menopause

Question 46

Common iatrogenic causes of amenorrhoea?

Answer 46

Progestagenic stuff: depot/miraena/POP | Continuous COCP