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1
Q

Desiring contraception and skin prone to outbreaks

Best option?

A

COCP: can treat acne too

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2
Q

2 HIV +ve people in sexual relationship. Contraception?

A

Still recommend condoms due to risk of transmission of variants of virus

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3
Q

Inevitable vs incomplete miscarriage

A

Cervix open in incomplete and can be open in inevitable, BUT in incomplete passage of POC has started

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4
Q

Pubic symphisis Rx

A 
Explain and reassure
Normally not helped by analgesics (even paracetamol)
But can offer co-codamol
In severe cases can consider:
Obstetric physio
TENS machine
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5
Q

Maternal anaemia is more common in multiple pregnancy. When to recheck FBC?

A

20-24/40

Recheck again at 28/40 as normal

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6
Q

Indications for aspirin in multiple pregnancy

A

Age >40
First pregnancy in >10 years
BMI >35
FHx pre-eclampsia

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7
Q

When to offer elective birth in multiple pregnancy?

A

Dichorionic: 37/40
Monochorionic: 36/40
Triplets: 35/40

Give steroids in build up to each

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8
Q

Monitoring in monochorionic twins

A

Fortnightly USS to assess twin-twin transfusion

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9
Q

Contraindications to POP

A

Active liver disease

Breast ca

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10
Q

Congenital rubella syndrome features:

A

CCC-SMITH

Cardiac anomaly
Cataracts
Cerebral calcification
Splenomegaly
Microcephaly
Icterus
Thrombocytopenia
Hepatomegaly
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11
Q

Criterion for referral for pre-eclampsia

A

Greater than 30/20 increase from Booking
BP >160/100
BP 140/90 + Sx/proteinuria
Features of IUGR

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12
Q

What is septic pelvic thrombophlebitis?

Px, Ix, Rx

A

Rare post-partum condition

Px: abdo pain and fever during postpartum
Continue to spike despite ABx

Ix: CT/MRI

Rx: IV Heparin - quickly resolves
(long term anticoagulation seldom needed)

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13
Q

What is the National Screening Programme for Downs Syndrome?

A

Nuchal translucency scan at 11-13/40

If risk >1/150, offer amniocentesis or chorionic villus sampling
counsel for risk of miscarriage

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14
Q

Rapidly enlarging central pelvic mass
+/- vag bleeding
+/- mass effect symptoms

A

Uterine leiomyosarcoma

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15
Q

Rx for breech baby

A

External cephalic version

if fail, elective C-section

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16
Q

Most common indication for induction

A

“post dates”

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17
Q

Modes of induction

A
  1. Membrane sweep

2. vaginal prostaglandins in pessary form (commonest medical IOL)

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18
Q

UK Perinatal Mortality Rate

A

Number of neonatal deaths from 24/40 to 7 days old + stillbirths, per 1000

(WHO includes late miscarriage from 22-24/40 but UK does not)

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19
Q

LH:FSH ratio in PCOS

A

2:1-3:1

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20
Q

RFs for uterine rupture

A

High parity
Macrosomia
Previous c-section
Birth within 18months of c-section (Scar still healing)

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21
Q

Commonest cause of maternal death in pregnancy in UK

A

PE/VTE

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22
Q

Amniotic fluid embolism Px + RFs

A

Px: similar to PE

RFs:
trauma
ruptured membranes
traumatic delivery
instrumental delivery
amniocentesis
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23
Q

Which HRT regimen produces withdrawal bleed?
Which HRT regimen is indicated in post-menopausal women as it stops menses?
Which HRT recommended in hysterectomy?

A
  1. Continuous Oes + cyclical Prog
  2. Continuous Oes + Prog
  3. Continuous Oes
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24
Q

Up to what gestation is medical abortion appropriate? What is the therapy?

A

9/40
Mifepristone followed by prostaglandin 48h later

NB. Can also be used 9-20/40 “late medical abortion”

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25
Q

Post partum endometritis
Px
RFs
Rx

A

2-10days post partum: fever, tachycardia, abdo pain

RFs:
HIV
PROM
Retained POC
Obesity
DM
Extremes of productive age
Manual removal of placenta

Rx: IV ABx +/- septic 6

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26
Q

When can secondary PPH happen

A

24h to 12/52 postpartum

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27
Q

Ogilvie syndrome?

A

pseudoobstruction post surgery/acute medical illness eg. delivery

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28
Q

Ovarian cyst classification

A

o Physiological
 Follicular cyst = most common cyst
 Corpus luteum cyst
o Benign germ cell tumours
 Dermoid cyst/teratoma = most common benign ovarian tumour
o Benign epithelial cell tumours
 Serous cystadenoma = most common benign epithelial tumour
 Mucinous cystadenoma ~pseudomyxoma peritonei if ruptures
o (NB. Fibroma ~Meig’s syndrome)

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29
Q

Most common benign ovarian tumour

A

Dermoid cyst/teratoma

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30
Q

Most common benign epithelial tumour

A

Serous cystadenoma

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31
Q

Meig’s syndrome associated with which ovarian cyst

A

Fibroma

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32
Q

Most common ovarian cyst

A

follicular

33
Q

Cyst associated with pseudomyxoma peritonei

A

Mucinous cystadenoma (if ruptures)

34
Q

Transient idopathic osteoporosis Px

A

Hip/Groin pain, unable to weight bear, raised ESR

in THIRD trimester

35
Q 
Endometrial cancer
Px
RFs
Prognosis
Rx
A

Px: postmenopausal bleeding in >55yo
REFER TWR + TVUS

RFs:
oes exposure
(COCP and smoking are protective)

Prognosis: good

Rx: TAHBSO +/- radiotherapy
If frail: progestogen therapy

36
Q

Postmenopausal woman with ovarian cyst.

Key Rx?

A

Urgent referral to gynaecologist for ALL

37
Q

When is booking visit?

38
Q

When is the downs/nuchal scan

A

11-13+6/40

39
Q

When is the anomaly scan

A

18-20+6/40

40
Q

In obstetrics, who gets vitamin D replacement?

A

ALL pregnant AND breastfeeding women

41
Q

Malignant associations of COCP

A

Increased incidence of BREAST and CERVICAL

Reduced incidence of ovarian and endometrial cancer

42
Q

MoA of contraception

A

All inhibit ovulation EXCEPT:
o POP (EXCEPT desogestrel): thickens cervical mucus
o IUD toxic to sperm
o IUS prevents endometrial proliferation

43
Q

Cervical screening frequency and ages

A

25-49yo: every 3 years

50-64yo: every 5 years

44
Q

When to investigate for infertility

A

After 12 mo of regular intercourse
OR
After 6mo if >35yo female

45
Q

Diagnostic features of hyperemesis gravidarum

A

Electrolyte imbalance
Dehydration
5% w/l from pre-pregnancy weight

46
Q

Scale for assessment of Postnatal depression

A

Edinburgh scale

47
Q

Px of vulval cancer

A

elderly female with itchy, sore, ulcerated lesion on labia majora

48
Q

Molar pregnancy:

Complete mole genetics

A

o 2 sperm fertilise empty ovum = 46chr all paternal
o 2-3% of choriocarcinoma
o May see hyperthyroidism

49
Q

Molar pregnancy:

Partial mole genetics

A

Haploid egg fertilised by 2 sperm or 1 that duplicates = 69 XXX or 69 XXY

50
Q

Hirsutism Ax

A 
o	PCOS – most common
o	Cushings
o	CAH
o	Primary adrenal tumour
o	Androgen-secreting ovarian tumour
o	Androgen therapy
o	Obesity
o	Drugs: phenytoin, steroids
51
Q

Bacteria involved in BV

A

anaerobes that replace lactobacilli ie. isolate gram positives and gram negatives

52
Q

Features of congenital VZV

A 
MERLS:
Microcephaly
Eye defects
Rudimentary digits
Limb hypoplasia
Skin scarring
53
Q

Management of prem labour (early stages)

A

Tocolytics + steroids

  • tocolytics may stop labour
  • steroids in case of delivery to reduce risk of RDS
54
Q

Vasomotor premenopausal Sx
Hx of VTE

?option for Rx

55
Q

COCP and surgery

A

Stop 4/52 prior

can switch to POP

56
Q

Asymptomatic bacteriuria at booking for pregnancy, treat or not?

57
Q

Contraceptive patch directions and missed changes

A

o Change patch every week for 3 weeks, then remove for a week for withdrawal bleed
o If patch removal delayed by <48h, immediately change patch + no further precautions
o If patch removal delayed be >48h, immediately change + 7/7 condoms + ?emergency contraception
o If patch removal delayed at end of 3 weeks: remove and change on upcoming day as normal
o If patch application delayed at end of 4 weeks, apply patch + use condoms 7/7

58
Q

Puerperal pyrexia Ddx

A

Likely endometritis (needs IV ABX eg. Clinda)

Other causes:
UTI, wound infection, mastitis, VTE

59
Q

Premature babies and vaccinations

A

Get them as normal, according to chronological age

If <28/40 born, should receive them in hospital

60
Q

SDLD RFs:

SDLD prophylaxis?

A

o DM mother
o Male
o C-section
o 2nd born of prem twins

prophylaxis: maternal steroids

61
Q

Gestational DM Dx and Rx

A

Dx:
Screen with OGTT @ booking + 24-28/40
 FG >5.6; 2h G>7.8

Rx:
FG <7: lifestyle -> add metformin if targets not met within 2 weeks
• Add insulin if still not met
FG>7: start insulin
FG 6-6.9 + evidence of complications: start insulin
If cannot tolerate metformin or decline insulin: glibenclamide

62
Q

Post partum emergency contraception

A

o EC not required prior to 21/7
o After 21/7: Progesterone only EC (Levonelle, EllaOne) can be used
o Do not insert Cu IUD prior to 28/7
o B-F 98% effective if fully BF, amenorrheic and <6mo

63
Q

Contraception time until effective

A

o Instant = IUD
o 2 days = POP
o 7 days = all else

64
Q

Contraceptive of choice in younger people

A

Nexplanon/Prog implant:

  • easier compliance
  • lasts 3 years!
65
Q

Contraceptives unaffected by enzyme induction

A

IUD
IUS
Depoprovera

66
Q

COCP if breastfeeding?

A

Breastfeeding <6/52 postpartum = UKMEC 4

67
Q

Pharm emergency contraceptives, within what time frame can they be used?

A
  • Levonelle ~72h
  • EllaOne ~120h, avoid in sev. Asthma

Both can be used >1x/cycle

68
Q

Nitrofurantoin + pregnancy

A

Can be used in early preg but avoid near term due to neonatal haemolysis risk

Cefalexin or amox instead

69
Q

C/Is to foetal blood sampling

A

Maternal HIV/Hep
Foetal haemophilia
Delivery <34/40

70
Q

Medical abortion Rx

A

Mifepristone -> Misoprostol

NB. Mifepristone sensitises myometrium to prostaglandin-induced contractions

71
Q

Incomplete abortion Rx

A

Misoprostol

72
Q

Precocious puberty definition

A

Puberty <8 in females; <9 in males

73
Q

Mcune-Albright Syndrome Px

A

unilateral cafe au lait spots
precocious puberty
polyostotic fibrous dysplasia ~fractures

74
Q

POF definition and RFs

A

= onset of premenopausal Sx + elevated FSH/LH at <40yo

RFs:
	Chemo
	Radio
	AI
	Idiopathic
75
Q

RFs for hyperemesis gravidarum

A
  • Hx eating disorder
  • molar pregnancy
  • multiple pregnancy
  • primp

NB. Smoking not a RF (actually more common in non-smokers)

76
Q

When should child with mother who has HIV be tested for ANTIBODY

77
Q

Antihypetensives in pregnancy

A

Labetalol
Methyldopa
Hydralazine
Nifedipine

78
Q

RFs for retained placenta

A 
Age >35
>5 births
Prematurity
Hx PPH
INDUCED labour

MSRA (18 decks)

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