passmed 01/06

Question 1

subfertility and PCOS management?

Answer 1

Clomifene

Question 2

in preterm prelabour rupture of membranes, how is antenatl steroid given?

Answer 2

IM dexamethasone

Question 3

endometrial cancer risk factors?

Answer 3

EXCESS OESTROGEN:
nulliparity
early menarche
late menopause
unopposed oestrogen

Metabolic syndrome:
> obesity
>DM
> PCOS

tamoxifen
HNPCC

Question 4

how is endometrial cancer investigated?

Answer 4

> 55 present with bleed
tVUSS >4 bad sign
hysteroscopy w endometrial biopsy

Question 5

most common cause of puritus vulvae?

Answer 5

contact dermatitis

Question 6

stress incontinence is managed with?

why?

Answer 6

SNRI -
sphincter tone is increased during filling phase of urinary bladder dysfunction

Question 7

how can an overactive bladder / urge incontinence be managed?

Answer 7

1) bladder diary 3 days minimum
2) vaginal exam : prolapse
3) urine dipstick
4) urodynamic studies

1) bladder retraining: 6 weeks
2) bladder stabilising drugs oxybutynin - anticholinergic (but not in frail old women)
tolterodine
darifenac
mirabegron- beta 3 agonist - old frail
3) Surgery: Botox, percutaneous tibial nerve stimulation

Question 8

ulipristal acetate 30mg

Answer 8

ellaOne - 120 hours

progesterone receptor modulator
delays ovulation and thickens endometrial lining

Question 9

levonorgestrol -

Answer 9

72 hours
progesterone derivative

Question 10

when should 3mg levonorgestrel be given?

Answer 10

this is the double dose
BMI >26.5
>70kg

Question 11

asthmatic women 4 days post UPSI

can she be given ellaOne?

Answer 11

no as ulipristal is contraindicated in asthma

can give copper coil

Question 12

Injectable contraceptive

Answer 12

medroxyprogesterone acetate
150mg
IM every 12 weeks

inhibits ovulation

UKMEC - breast cancer

Question 13

what does colposcopy do - HPV + and low level dyskaryosis on cytology?

Answer 13

allows closer examinarion of cervix and identification of disease

Question 14

what does abnormal cytology mean?

Answer 14

borderline changes in squamous or endocervical cells.
low-grade dyskaryosis.
high-grade dyskaryosis (moderate).
high-grade dyskaryosis (severe).
invasive squamous cell carcinoma.
glandular neoplasia

Question 15

Cervical interaepithelial neoplasia how to treat it?

Answer 15

large loop excision of transformation zone

/ cryotherapy

after LLETZ invited at 6 months for test of cure repeat

Question 16

ovarian cancer -

Answer 16

serous carcinoma’s
epithelial in origin
BRCA1
BRCA2

raised ca 125 35IU/mL

Question 17

first trimester diff?

Answer 17

Miscarriage
Ectopic
implantation
cervical ectropion
vaginitis
trauma
polyps

Question 18

when would you arrange immediate EPU assessment in first trimester bleed?
<10 weeks pregnant?

Answer 18

if worried about ectopic
abdominal, cervical,pelvic motion tenderness

so if pain
or on examination
pain
or obs suggest ruptured ectopic

or shoulder tip pain

Question 19

stress incontinence medical management?

Answer 19

duloxetine

Question 20

palpable bladder after urinating? in urinary incontinence?

Answer 20

think overflow due to urinary retention

Question 21

when is cyclical vs continuous used in menopausal HRT?

Answer 21

cyclical for peri menopause
> don’t want to overload with oestrogen
continuous is for post menopause

Question 22

in trasngender male pt - (assigned female at birth) is contraception needed?

Answer 22

yes - use copper coil, oestrogen is contraindiacyed
can use POP
IUS
Depo-provera

Question 23

if ruptures can cause pseudomyxoma peritonei

Answer 23

mucinous cystadenoma

Question 24

Older woman with labial lump and inguinal lymphadenopathy

Answer 24

→ ?vulval carcinoma

Question 25

62-year-old woman presents
‘leaks’ small amounts of urine’
increased urinary frequency

she has slight suprapubic tenderness

initial best investigation?

Answer 25

urinalysis

Question 26

with COCP if 2 pills missed in 1st week?

Answer 26

UPSI - use EC

if sex in pill free week or week 1

Question 27

COCP 2 or more pills missed in week 2?

Answer 27

if taken 7 days in a row protected
but if not taken 7 days in a row use condom or abstain from sex

Question 28

why do GNRH agonist treat in shrinking fibroids prior to surgery?

Answer 28

act to overstimulate GNRH in opposition to of GnRH axis which reduces oestrogen and progesterone concentration

because oestrogen is decreased increassed risk o bone mineral density loss and hot flush, vaginal dryness

Question 29

UKMEC 4 conditions for OCP

Answer 29

positive antiphospholipid antibodies (SLE)

Anticardiolipin antibody IgG and IgM titres
Anti-beta2-glycoprotein I antibody IgG and IgM titres
Lupus anticoagulant

Question 30

what is a vaginal vault prolapse?

Answer 30

This is a long-term complication of vaginal hysterectomy with anteroposterior repair

vagina loses its normal shape and sags