Repro

Question 1

What is meant by gravidity?

Answer 1

The number of times a woman has been pregnant, regardless of the outcome

Question 2

What is meant by parity?

Answer 2

The total number of pregnancies carried over the threshold of viability (24 weeks)

Question 3

How are multiple pregnancies counted in terms of parity?

Answer 3

They are counted as one pregnancy

Question 4

What specific symptoms should you ask about in a gynae history?

Answer 4

Abdominal/pelvic pain or swellling, vaginal discharge, abnormal vaginal bleeding, pain during sex, itching/skin changes

Question 5

What extra things should be asked about in a gynae history?

Answer 5

Menstrual history, contraception/HRT use, smears, previous gynae/obstetric history

Question 6

When taking an obstetric history, what points should you clarify in the first instance?

Answer 6

Gestation, single or multiple pregnancy, first pregnancy or not

Question 7

What specific symptoms should you ask about in an obstetric history?

Answer 7

Abdominal/pelvic pain, vaginal discharge, vaginal bleeding, nausea/vomiting, headaches/visual changes, swelling

Question 8

What are the two most important things to ask about in an obstetric history?

Answer 8

Foetal movements and mental health

Question 9

What extra things should be asked about in an obstetric history?

Answer 9

Current pregnancy (is antenatal care up to date, have they had any problems) and previous pregnancies (any complications, type of delivery etc)

Question 10

What specific symptoms should you ask about in a male sexual history?

Answer 10

Abdominal/pelvic pain, testicular pain/swelling, urethral discharge or bleeding, skin changes, dysuria

Question 11

What extra things must you remember to ask females in a sexual history?

Answer 11

Is there any chance they could be pregnant? When was their last period? Have they ever been pregnant before? Are they on any contraception? Are they up to date on their smears?

Question 12

What questions must you ask about each sexual encounter in a sexual history?

Answer 12

Was it a male or female partner? Was it a regular partner? Was the sex consensual? What type of sex was it? Did they use a condom?

Question 13

What questions should you ask in a sexual history to establish an individual’s risk of BBVs?

Answer 13

Have they ever had sex with someone from overseas? Have they ever had sex with someone who they knew had HIV/hepatitis? Have they ever injected drugs or had sex with someone who did? Have they had any non-professional tattoos or piercings? Have they ever paid for sex or been paid for sex?

Question 14

What should you always warn patients at the end of a sexual history if they are undergoing STI testing?

Answer 14

To abstain from sex until the results come back or make sure they use a condom

Question 15

What conditions should you always ask about a personal/family history of when discussing contraceptive options?

Answer 15

Migraines with aura, VTE, breast/cervical cancer

Question 16

What should you always warn patients about at the end of a contraceptive history?

Answer 16

To continue using condoms in order to prevent STIs

Question 17

It is important to warn patients that they might experience what symptom after a speculum examination?

Answer 17

Light spotting

Question 18

How many times should you rotate the brush in a smear? How many times should you dunk it against the base of the pot?

Answer 18

5 / 10

Question 19

At what age would women receive a smear every 3 years?

Answer 19

25 - 49

Question 20

At what age would women receive a smear every 5 years?

Answer 20

50 - 64

Question 21

Results of a smear test will usually be in the post in what timeframe? Patients should contact their GP if they haven’t received them by when?

Answer 21

2 weeks / 4 weeks

Question 22

What is the action of a smear result saying ‘we found no HPV’?

Answer 22

Return for routine smear in 3/5 years

Question 23

What is the action of a smear result saying ‘we found HPV but no cell changes’?

Answer 23

Return for a smear in 1 year

Question 24

What is the action of a smear result saying ‘we found HPV with cell changes’?

Answer 24

Refer for colposcopy

Question 25

What is the action of a smear result saying 'unclear result'?

Answer 25

Return for another smear

Question 26

After you have placed a urine sample on a pregnancy test, how long should you wait before reading the results?

Answer 26

3 minutes

Question 27

On a urinary pregnancy test, what do each of the following results imply: 1) 2 lines? 2) 1 line on 'C'? 3) 1 line on 'T'?

Answer 27

1) Positive 2) Negative 3) Invalid

Question 28

Testing for each of the following sexually transmitted infections should take place how long after potential exposure: 1) Chlamydia/Gonorrhoea? 2) HIV? 3) Syphilis/Hepatitis?

Answer 28

1) 2 weeks 2) 4 weeks 3) 3 months

Question 29

Sexual health serology (HIV, hepatitis, syphilis) is taken as a single blood test in what vacutainer?

Answer 29

Gold

Question 30

What colour of swab is used to take a chlamydia/gonorrhoea NAAT from the vulvo-vagina, pharynx or rectum?

Answer 30

Orange

Question 31

What colour of tube is used to take a chlamydia/gonorrhoea NAAT from a first pass urine sample?

Answer 31

Yellow

Question 32

How should chlamydia/gonorrhoea NAAT testing take place in women?

Answer 32

Vulvo-vaginal swabs

Question 33

How should chlamydia/gonorrhoea NAAT testing take place in men?

Answer 33

First pass urine sample

Question 34

What colour of swab is used to take a sample for HSV or syphilis serology?

Answer 34

Red

Question 35

What colour of swab is used to take a high vaginal sample for microscopy and gram stain to detect candida, group b strep, trichomonas or BV?

Answer 35

Blue

Question 36

What colour of swab is used to take urethral chlamydia/gonorrhoea gram stain, microscopy and culture in symptomatic males?

Answer 36

Blue

Question 37

How is vaginal candidiasis treated?

Answer 37

Fluconazole 150mg one-off dose + Clotrimazole 1% cream 2-3 times daily

Question 38

How are bacterial vaginosis and trichomonas vaginalis treated?

Answer 38

Metronidazole 400mg BD for 7 days

Question 39

How is chlamydia treated?

Answer 39

Doxycycline 100mg BD for 7 days

Question 40

How is gonorrhoea treated?

Answer 40

IM ceftriaxone 1g one-off dose

Question 41

A test of cure for gonorrhoea is required after how long?

Answer 41

2 weeks

Question 42

How is syphilis treated?

Answer 42

IM benzylpenicillin 2.4 million units one-off dose

Question 43

What blood tests are taken for syphilis serology?

Answer 43

Syphilis IgG and IgM plus EIA

Question 44

How are genital herpes treated?

Answer 44

Aciclovir 400mg TDS for 5 days

Question 45

What investigations should you consider at the end of a sexual history?

Answer 45

Any required swabs, bloods for sexual health serology, CRP and FBC, urinary pregnancy test, urinalysis, MSSU for culture and sensitivity

Question 46

What is the standard outpatient treatment for PID?

Answer 46

Ofloxacin and metronidazole 400mg BD for 14 days

Question 47

What is the outpatient treatment for PID in those aged < 18 or at high risk of gonorrhoea?

Answer 47

1g IM ceftriaxone one-off dose and doxycycline 100mg and metronidazole 400mg BD for 14 days

Question 48

What are the absolute contraindications to using combined hormonal contraceptives?

Answer 48

Smoker aged > 35 years, < 6 weeks post-partum or breastfeeding, migraine with aura, breast/cervical cancer, VTE, hypertension/CVD

Question 49

How do combined hormonal contraceptives, the implant, injection and IUS work?

Answer 49

Inhibition of ovulation, thickening of cervical mucus, thinning of the endometrium

Question 50

What are the main hormonal effects that may be experienced with combined or progesterone only methods of contraception (apart from IUS)?

Answer 50

Weight gain, acne, mood change, headache

Question 51

What are the two main risks of combined hormonal contraceptives?

Answer 51

VTE and increased risk of breast and cervical cancer

Question 52

Contraception should ideally be started within the first 5 days of regular menstruation. If this does not occur, which contraceptives require 7 days of condom use?

Answer 52

Combined methods, implant, injections and IUS

Question 53

What is the advice if one COCP is missed?

Answer 53

Take it ASAP, even if it is with the next pill

Question 54

What is the advice if two COCPs are missed in the first week?

Answer 54

Take one pill ASAP, use condoms for the next 7 days, consider emergency contraception if had sex that week

Question 55

What is the advice if two COCPs are missed in the second week?

Answer 55

Take one pill ASAP, use condoms for the next 7 days

Question 56

What is the advice if two COCPs are missed in the third week?

Answer 56

Take one pill ASAP, use condoms for the next 7 days, omit the pill-free interval

Question 57

What advice should be given to someone on the COCP with diarrhoea and/or vomiting?

Answer 57

Use condoms for 7 days

Question 58

What are the absolute contraindications to the use of the progesterone only pill?

Answer 58

Breast cancer and liver cirrhosis

Question 59

How does the progesterone only pill work?

Answer 59

Increasing cervical mucus and thinning the endometrium

Question 60

How should the progesterone only pill be taken?

Answer 60

At the same time every day with no pill-free interval

Question 61

Contraception should ideally be started within the first 5 days of regular menstruation. If this does not occur, which contraceptives require 2 days of condom use?

Answer 61

Progesterone only pill

Question 62

What is the advice if one POP is missed (< 3 hours)?

Answer 62

Take it ASAP

Question 63

What is the advice if two POPs are missed? (> 3 hours or > 12 hours for Cerazette)

Answer 63

Use condoms for 2 days and consider emergency contraception if had sex 2-3 days before or during the break

Question 64

What are some side effects specific to the contraceptive injection?

Answer 64

Weight gain, osteoporosis, delay in return of fertility

Question 65

What is the main contraindication to the use of intra-uterine contraceptive devices?

Answer 65

Any pelvic infection within the last 3 months or any gynae malignancy

Question 66

What should you do before inserting an intra-uterine contraceptive?

Answer 66

STI test

Question 67

How does the copper-IUD work?

Answer 67

Copper acts as a spermicide and causes intra-uterine inflammation

Question 68

Which is the only contraceptive that is likely to make periods heavier?

Answer 68

Copper-IUD

Question 69

When can the copper-IUD be used for emergency contraception?

Answer 69

Up to 120 hours after unprotected sex or up to 5 days after expected ovulation

Question 70

Those who use the copper-IUD for emergency contraception require what follow-up?

Answer 70

Pregnancy test 3-6 weeks later

Question 71

When can ulipristal acetate be used for emergency contraception?

Answer 71

Within 120 hours of unprotected sex

Question 72

A second dose of emergency contraception is required if vomiting occurs within what timeframe?

Answer 72

3 hours

Question 73

When can levonorgestrel be used for emergency contraception?

Answer 73

Within 72 hours of unprotected sex

Question 74

When should the dose of levonorgestrel for emergency contraception be doubled?

Answer 74

BMI > 26 or weight > 70kg

Question 75

Which causes of a testicular swelling will be continuous with the testis?

Answer 75

Tumour and hydrocele

Question 76

Which causes of a testicular swelling will be separate from the testis?

Answer 76

Epididymal cyst and varicocele

Question 77

Which testicular swellings will transilluminate?

Answer 77

Hydroceles and epididymal cysts

Question 78

What are some investigations you might consider in someone with a testicular swelling?

Answer 78

Ultrasound, fluid aspirate, bloods for HCG and AFP

Question 79

A varicocele is more common on which side? Why is it important to be aware of these?

Answer 79

Left side - can be a sign of renal cancer

Question 80

When performing inspection as part of a breast exam, you should ask the woman to sit in what three different positions?

Answer 80

Hands on thighs, hands on hips, hands behind head

Question 81

How should you position patients when palpating during a breast exam?

Answer 81

At 45 degrees on the bed with their arm behind their head

Question 82

Which lymph nodes should you palpate during a breast exam?

Answer 82

Axillary, supraclavicular and all head/neck nodes

Question 83

What is the further management after history and examination of a woman with a breast lump?

Answer 83

Referral to breast clinical for imaging (US/mammography) and biopsy

Question 84

What is a good system to use for explaining your findings of a breast lump?

Answer 84

Size, site, shape/consistency, mobility, skin changes

Question 85

When taking a history of a breast lump, you should always ask if there is any relationship with what?

Answer 85

The menstrual cycle

Question 86

What are some important questions to ask about the characteristics of a breast lump in a history?

Answer 86

Is it hard or soft? Is it smooth or irregular? Is it mobile? Is it painful?

Question 87

What are some specific symptoms related to breast pathology you should ask about when taking a history of a breast lump?

Answer 87

Any nipple discharge or bleeding? Any changes in the skin of the breast or nipple?

Question 88

In a history of a breast lump, you should take a focused O+G history. What sort of things should you include?

Answer 88

Menstrual history, use of contraceptives/HRT, pregnancies/breastfeeding

Question 89

What procedure is a risk factor for the development of breast cancer and may be a useful thing to ask about during past medical history?

Answer 89

Radiation to the chest

Question 90

When is it normal to feel foetal movements by?

Answer 90

20 weeks - however, they may be noticed earlier in multiparous women

Question 91

If a woman reports any change in foetal movements, what investigations should be done?

Answer 91

CTG and ultrasound

Question 92

What are some important points to discuss before beginning a pregnant abdomen exam?

Answer 92

Single/multiple pregnancy? First pregnancy? Gestation? How have things been going so far? Foetal movements? Maternal mental health?

Question 93

What are some questions you should ask women before beginning a pregnant abdomen exam to ensure their comfort?

Answer 93

Do they need to go to the toilet? Are they currently in any pain? Get them to tell you if they feel breathless at any point.

Question 94

What are you looking for on inspection of a pregnant abdomen?

Answer 94

Skin changes, size of bump, symphyseal-fundal height

Question 95

Symphyseal-fundal height should be measured at all antenatal appointments from what point in pregnancy?

Answer 95

24 weeks

Question 96

The symphyseal-fundal height in cm should correlate roughly with what?

Answer 96

The gestation in weeks (+/- 2)

Question 97

When should the fundus be roughly at the height of the umbilicus? What should the fundus be roughly at the height of the xiphisternum?

Answer 97

20 weeks, 36 weeks

Question 98

What should you palpate during a pregnant abdomen exam and what are you trying to find out?

Answer 98

Palpate the top of the bump (fundus) for height, the sides of the bump for lie and the bottom of the bump for presentation and engagement

Question 99

The lie and presentation of a baby is only relevant after what gestation?

Answer 99

36 weeks

Question 100

Where should you try to auscultate for a foetal pulse? What should you do at the same time?

Answer 100

Roughly at the anterior shoulder, you should feel the maternal pulse at the same time

Question 101

If the presenting part feels hard and round, what is the most likely presentation?

Answer 101

Cephalic

Question 102

If the presenting part is broad, soft and poorly defined, what is the most likely presentation?

Answer 102

Breech

Question 103

When may you not be able to feel the presenting part of a foetus?

Answer 103

If they are in a transverse lie

Question 104

What are the three potential ways a foetus can lie in the abdomen?

Answer 104

Longitudinal, oblique or transverse

Question 105

What further assessment is always required after a pregnant abdomen examination?

Answer 105

BP and urinalysis

Question 106

For a singleton pregnancy, when is the fundus usually palpable?

Answer 106

12 weeks

Question 107

When are the two different types of Down's syndrome screening in pregnancy used?

Answer 107

Combined test (bloods + US) is used from 11-13+6 weeks; 2nd trimester screening (bloods only) is used from 15-20 weeks

Question 108

What bloods are tested for in combined Down's syndrome screening and what do they show if positive for the condition?

Answer 108

Beta HCG (high) and PAPP-A (low)

Question 109

What US measurement is used for combined Down's syndrome screening? What happens to this measurement if positive for the condition?

Answer 109

Nuchal translucency - will be increased in Down's

Question 110

What four bloods are tested for in second trimester Down's syndrome screening and what do they show if positive for the condition?

Answer 110

Beta HCG and inhibin-A are high; AFP and unconjugated oestriol are low

Question 111

The results of Down's syndrome screening are combined with what factors to produce a personalised risk?

Answer 111

Gestational age and maternal age

Question 112

If the results of Down's syndrome screening come back as > 1/150, what further tests are offered?

Answer 112

CVS (11-14 weeks) or amniocentesis (> 15 weeks)

Question 113

Women who are at high risk of developing pre-eclampsia should be taking what medication and when?

Answer 113

75mg aspirin OD from 12 weeks

Question 114

What supplements should all women take in pregnancy?

Answer 114

Folic acid 400mcg until 12 weeks, vitamin D 10mcg throughout pregnancy and breastfeeding

Question 115

Pre-eclampsia can only be diagnosed when hypertension and proteinuria are present at what gestation?

Answer 115

> 20 weeks

Question 116

If a woman has suspected pre-eclampsia, what further investigations should be done?

Answer 116

Spot urine PCR, bloods (particularly FBC and LFTs for HELLP syndrome)

Question 117

What is the first-line antihypertensive to use in pregnancy?

Answer 117

Oral labetalol

Question 118

Women with pre-eclampsia need to be admitted- what for?

Answer 118

Regular blood pressure measurements and blood tests, also US scans

Question 119

Delivery is suggested for women with pre-eclampsia beyond what gestation? This can be delayed by 24-48 hours to allow what to be done?

Answer 119

34 weeks - to allow maternal corticosteroids to be given to mature the foetal lungs