Reproductive medicine

Question 1

50-year-old on cyclical HRT complaining of irregular vag bleeding 1st line Ix?

Answer 1

Trans vaginal US

Question 2

When endometrial biopsy if post-menopausal bleeding

Answer 2

> 5mm thick on US

Question 3

palpable abdo mass in 55-year-old 1st line Ix?

Answer 3

trans abdo US

Question 4

55 on warfarin with irregular vaginal bleeding 1st line Ix?

Answer 4

Trans vag US
- need to assess endometrial thickness

Question 5

When secondary care if unable to conceive

Answer 5

after 12 months

Question 6

1 off Bleeding in 3rd trimester with suspected placenta previa management and Ix? Which IX never? When would you give betamethasone

Answer 6

Admit to hospital for elective CS
Can do speculum exam - NEVER digital as risk of catastrophic haemorrhage
Betamethasone if <34weeks

Question 7

Diabetic mums what happens to babies other than macrosomia

Answer 7

Sacral agenesis
[Cardiac defects and cleft palate]

Question 8

Maternal valproate ->

Answer 8

Cleft palate
Learning impairment
Spinal abnomralities

Question 9

Edwards syndrome mneumonic

Answer 9

EDWARDS
Eighteen - trisomy 18
Digital overlapping [when fist closed]
Wide head, Webbing of toes
Absent intellect - learning difficulties
Rocker bottom feet
Diseased heart
Small jaw

Question 10

Pelvic radiation complication

Answer 10

Cancer, obstruction, fractures

Question 11

Lifetime risk of breast Ca in women

Answer 11

1 in 8

Question 12

Young with a non-tender mobile smooth breast lump has

Answer 12

Fibroadenoma

Question 13

When can breast lumps get a routine referral

Answer 13

<30 with no suspicious features

Question 14

Which cheeses do you need to avoid when preg

Answer 14

Soft ones - risk of listeria

Question 15

How much caffine safe in preg

Answer 15

200mg / day - about 2 cups

Question 16

Which fish have too much mercury for preg people

Answer 16

Swordfish and shark

Question 17

Vitamin supplement a no no for preg

Answer 17

Vit A

Question 18

BV rx

Answer 18

Metronidazole

Question 19

Cerical dyskaryosis on smear referral speeds

Answer 19

Low grade - 6 weeks
High grade - 2 weeks
[for colposcopy]

Question 20

Post TAH with severe dyspareunia and perimenopausal syndrome Rx

Answer 20

Bilat oophorectomy

Question 21

Bilat ovarian endometrialomas rx

Answer 21

GnRH analogue and surgery

Question 22

Mild Sx of endometriosis in young person Rx

Answer 22

COCP

Question 23

Severe endometrosis in old gubbed person Rx

Answer 23

Danazol or GnRH analouge

Question 24

Hx suggestive of PID Ix

Answer 24

Swabs including chlamydia PCR [not just culture]

Question 25

Hx suggestive of vag-urethra fistula Ix

Answer 25

Dye injected into bladder + swabs in vag

Question 26

child with sore vagina and discharge Ix

Answer 26

Vaginoscopy -Need to exclude foreign body, sexual abuse or infection

Question 27

Downs screening in preg which are screening/diagnositic when are they done?

Answer 27

First trimester10-14 Chorionic venous sampling - Diagnostic Nuchal translucency scan - Screening Combined test - NT scan, PAPP-A, HCG - screening Second 14-20weeks Aminocenteiss - diagnosistic Tripple / quad test

Question 28

Key infection to screen in a well couple struggling to conceive

Answer 28

Chlamydia

Question 29

Which Ca risk a tiny bit higher with COCP

Answer 29

Breast

Question 30

Epilepsy which contraceptive pill

Answer 30

POP Oestrogen reduces seiure threshold

Question 31

How does Paget's disease of breast present ? Ix?

Answer 31

Chronic eczema rash by nipple Biopsy

Question 32

Which Ca if nulliparous and early menarche?

Answer 32

Ovarian Breast endometrial

Question 33

Which Ca linked to long-term oral contraceptive use and is squamous?

Answer 33

Cervical

Question 34

When can you use oestrogen-only HRT

Answer 34

TAH - as risk of endometrial Ca Or if on a progesterone contraceptive eg implant / mirena

Question 35

Which infection causes gross fetal hydrops at 26weeks with anaemia

Answer 35

parvovirus b19

Question 36

Which infection causes interuterine death in 3rd trimester with green coloured amniotic fluid

Answer 36

listeria

Question 37

Which infection causes intracerebral calcification and ventriculomegaly

Answer 37

CMV

Question 38

Most common cause of overwhelming meningitis and neonatal death

Answer 38

Group B strep

Question 39

fibroid red degeneration in preg rx

Answer 39

Conservative [Analgesia, rehydration and supportive measures]

Question 40

when post partum most common for VTE

Answer 40

5-10 days [up to 6 weeks]

Question 41

Lumpy breasts especially around periods

Answer 41

Diffuse cystic mastopathy

Question 42

Key Ix for fetal CMV

Answer 42

Aminocentesis

Question 43

Ix if fetal hydrops in preg

Answer 43

[US then confirmed with] cordocentesis

Question 44

Ix for fetal sickle cell

Answer 44

chorion villus sampling

Question 45

Post preg and restarted pill. Now non-offensive discharge and occasional spotting =

Answer 45

cervical ectropion

Question 46

What is climateric

Answer 46

Basically vasomotor and mood sx of menopause

Question 47

What is morning after pill

Answer 47

Levonogestrel

Question 48

pregnant woman in contact with chicken pox now has vesicular rash rx?

Answer 48

acyclovir Has sx so too late to check antibody status / Ig

Question 49

Emergency contraception - when can pill be used up to ? what if after that?

Answer 49

72hrs copper coil - up to 5 days after unprotected sex

Question 50

Pregnancy booking US shoes Gestational sack >25mm with no fetal pole =?

Answer 50

Missed misscarriage Complete misscariage has no fetal products

Question 51

1st line rx symphysis pubis dysfunction in 3rd trimester ? 2nd?

Answer 51

Advice and reassurance Can use paracetamol Obstetric physiotherapist or TENS machine

Question 52

Extra Ix for women with twin pregnancy

Answer 52

FBC at 20-24 weeks

Question 53

When do you use fornightly US scans in preg

Answer 53

Monochorionic twins

Question 54

Painless ulcer which resolved and now painful pelvic lymphadenopathy

Answer 54

lymphogranuloma venereum [chlamydia]

Question 55

2 contra indications for progesterone only pill

Answer 55

Acute porphyria Breast Ca

Question 56

PE in pregnancy with HD instability

Answer 56

unfractionated heparin

Question 57

Preg with BP 140/90 one off everything else fine plan?

Answer 57

Repeat next day

Question 58

Painless bleed after 28 weeks most likely

Answer 58

Previa

Question 59

US of preg -> snowstorm =? Usual presentation? Plan? Risk developing?

Answer 59

Hydatiform mole Usually hyperemesis / large for dates Uterine evacuation ->monitor hCG and if persistnetly raised then may be Choriocarcinoma (gestational trophoblastic disease)

Question 60

10 days post delivery has abdo pain and fever. Abx -> no improvement. What is it? Rx?

Answer 60

Septic pelvic thrombophebitis IV heparin

Question 61

Screen for downs? Dx?

Answer 61

Nuchal translucency 11-13 weeks Amniocentesis / chorionic vilus sampling

Question 62

When is fetal anomaly scan done

Answer 62

20 weeks

Question 63

Maternal HIV reduce risk of transmission

Answer 63

Treat HIV C section

Question 64

post menopausal vaginal bleeding and weight loss

Answer 64

Endometrial ca

Question 65

Post menopausal on tamoxifen with weight loss and PV bleeding. Large central pelvic mass with hard node in inguinal region

Answer 65

Uterine leiomyosarcoma [Large mass key]

Question 66

3d old baby has bilat conjunctivitis ?

Answer 66

Gonorrhoea / chlamydia

Question 67

meconium stained liquor with premature rupture of membranes but normal CTG?

Answer 67

Induce labour continuous monitoring

Question 68

No signs of labour at 40 + 2 plan?

Answer 68

Membrane sweep + book induction at 41-42 weeks

Question 69

Define Perinatal mortality rate? Neonatal mortality rate?

Answer 69

Peri - Still births + neonatal (<7days) / 1000 live + still birth Neo - neonatal deaths / 100 live births

Question 70

Conns rx

Answer 70

Aldosterone agonists eg spironolactone Surgery

Question 71

Which hormon raised in PCOS

Answer 71

Testosterone LH:FSH ratio raised

Question 72

painful vaginal bleeding and fetal distress at 39 weeks

Answer 72

Abruption

Question 73

Which contraception is contraindicated in women breastfeeding at <6weeks post partum

Answer 73

COCP

Question 74

Contraceptive contraindicated in symptomatic chlamydia

Answer 74

Intrauterine coil

Question 75

Hepatocellular carcinoma - which contraception contraindicated

Answer 75

COCP

Question 76

HRT if still have monthly bleeds? If post-menopausal? Which if hysterectomy / have mirena?

Answer 76

Monthly bleed - Continuous oestrogen and cyclical progesterone Post menopause - Continuous combined Hysterectomy - oestrogen only [risk of endometrial cancer if still have uterus]

Question 77

UTI in preg

Answer 77

cefalexin

Question 78

When can you get a medical abortion? What is it?

Answer 78

up to 9 weeks usually, can go up to 20 weeks mifepristone followed by prostaglandin

Question 79

1st line emergency contraception

Answer 79

copper coil

Question 80

What is ogilive syndrome

Answer 80

Large bowel pseudoobstruction following surgery of acute medical illness

Question 81

Depression + IBS / Chronic pain? + recent MI? + Bipolar on lithium?

Answer 81

+ IBS / Chronic pain - tricyclics eg amitriptyline + recent MI - Sertraline + Bipolar on lithium - citalopram

Question 82

Tamoxifen - which antidepressant contraindicated

Answer 82

Fluoxetine TamoxiFen

Question 83

antiemetic in preg -> baby with structural heart defect and cleft palate

Answer 83

ondansetron [low risk and used as second-line antiemetic for hyperemesis]

Question 84

hyperemesis antiemetic?

Answer 84

antihistamines phenothiazines - eg levomepromazine