Reproductive

Question 1

What drugs are used to treat endometriosis?

Answer 1

GnRH agonist.

Question 2

What drugs are used to treat precocious puberty?

Answer 2

GnRH agonist.

Question 3

How would you manage a patient with a menstrual disorder?

Answer 3

Pharmacological - gonadotropin, progesterone, COCP/HRT.

Surgical depending on condition.

Question 4

How would you manage a patient with erectile dysfunction?

Answer 4

Viagra.
Therapy for psychological causes.
Surgery eg pump insertion.

Question 5

How would you manage a couple as a GP struggling to get pregnant?

Answer 5

Male - advise stop smoking, reduce alcohol intake, reduce stress levels, healthy diet.
Female - advise stop smoking, reduce alcohol intake, reduce stress levels, loose weight, regular sexual intercourse.
Refer to fertility clinic if not conceived after 1 year. Early referral for women >36years or know cause of infertility/family history.

Question 6

What fertility treatment can be recommended by a specialist clinic?

Answer 6

Medical - eg clomiphene, GnRH agonist/antagonist, and gonadotrophins.
Surgical - eg laparoscopy for ablation of endometriosis, and varicocele repair.
Assisted reproduction techniques - eg articulate insemination, and IVF.

Question 7

What drugs would you give to reduce the risk of respiratory distress syndrome if pre-term delivery is unavoidable?

Answer 7

Glucocorticoid treatment of the mother.

Question 8

How can labour be induced?

Answer 8

Membrane rupture (stimulated release of prostaglandins).
Artificial prostaglandins.
Synthetic oxytocin.
Anti-progesterone agents.

Question 9

What drugs are used to treat Chlamydia trachomatis and rectal chlamydia?

Answer 9

1st line - doxycycline or azithromycin.
2nd line - erythromycin or ofloxacin.
Rectal chlamydia - doxycycline.

Question 10

What drugs are used to treat Neisseria gonorrhoeae?

Answer 10

IM ceftriaxone plus oral azithromycin.

If allergic to penicillin give spectinomycin.

Question 11

What drugs are used to treat syphilis (early, late and neuro)?

Answer 11

Early syphilis - benzathine penicillin G single dose IM.
Late latent, CVS or gummatous - Ben Pen G 3 doses.
Neurosyphilis - IM procaine penicillin plus probenecid for 14 days.

Question 12

What drugs are used to treat herpes simplex viruses 1 and 2?

Answer 12

Aciclovir, valciclovir, or famciclovir.

Suppressive treatment for recurrent HSV.

Question 13

What drug is used to treat trichomonas vaginalis?

Answer 13

Metronidazole.

Question 14

What drug is used to treat scabies?

Answer 14

Permethrin.

Question 15

What drug is used to treat pubic lice?

Answer 15

Malathion.

Question 16

How would you manage a patient with anogenital warts?

Answer 16

No treatment as up to 70% spontaneously resolve within 1 year.
Topical application eg podophyllotoxin.
Physical ablation eg excision.

Question 17

What drug is used to treat bacterial vaginosis?

Answer 17

Metronidazole.

Question 18

What drugs are used to treat volvovaginal candidiasis?

Answer 18

Topical and oral azoles.

Question 19

How would you manage a patient with pelvic inflammatory disease?

Answer 19

Antibiotics for 14 days (beware sepsis) - outpatient IM ceftriaxone, PO doxycycline, PO metronidazole. Inpatient (severe disease) give same IV, then discharge with PO doxycycline and PO metronidazole.
Surgical management - laparoscopy/laparotomy if no response to therapy, clinically severe disease or presence of tube-ovarian abscess.
Symptom management - analgesia and rest.
Contact tracing.

Question 20

How would you manage a patient with pelvic organ prolapse?

Answer 20

Non-surgical - use of pessaries (ring, shelf and gelhorn).

Surgical - laparoscopic, vaginal or abdominal eg anterior repair, paravaginal repair etc.

Question 21

How would you manage a patient with urinary incontinence?

Answer 21

Pelvic floor exercises.
Surgery eg sling operations, and culposuspension.
Bulking agents.

Question 22

How would you manage a patient going through the menopause?

Answer 22

Non-hormonal treatments - dressing in light layers, avoid caffeine, alcohol, spicy foods, lifestyle changes eg increase exercise, reducing dietary fat intake. Antidepressants.
Hormonal - HRT in a pill , vaginally or transdermally.

Question 23

How would you manage a patient with CIN?

Answer 23

CIN I - follow-up or cryotherapy.

CIN II and III - superficial excision (cone, large loop excision of the transformation zone).

Question 24

How would you manage a patient with cervical carcinoma (invasive and microinvasive)?

Answer 24

Microinvasive - cervical cone excision.

Invasive - hysterectomy, lymph node dissection and if advanced chemotherapy and radiotherapy.

Question 25

What are the two types of oral contraceptive pill?

Answer 25

COCP - oestrogen and progestin.

POP - progestin only.

Question 26

What drug is used to induce ovulation?

Answer 26

Weak oestrogen which blocks receptors - clomiphene.

Question 27

What drug is used to reduce the risk of breast cancer?

Answer 27

Weak oestrogen that clocks receptors - tamoxifen.

Question 28

What drug is used for medical termination of pregnancy and induction of labour?

Answer 28

Anti-progestin - mifepristone.

Question 29

What drug can be used to treat advanced prostate cancer?

Answer 29

Anti-androgen progesterone derivative - cyproterone.

Question 30

What drug is used to reduce the risk of invasive breast cancer in post menopausal women with osteoporosis?

Answer 30

Selective oestrogen receptor modulators (SERMs) - raloxifene.

Question 31

What are the treatment options for a male patient needing testosterone replacement therapy?

Answer 31

Implants - testosterone.
IM - enenthate, proprionate.
Oral - undecanoate, mesterolone.

Question 32

What drug is used to prevent hair loss, male pattern baldness and benign prostatic hyperplasia in male patients?

Answer 32

Androgen replacement therapy - finasteride.