Women's health

Question 1

Name 8 contraindications for COCP use:

Answer 1

1. more than 35 years old and smoking >15 / day
2. migraine with aura
3. history of thromboembolic disease
4. history of stroke / ischaemic heart disease
5. breast feeding <6 weeks post-partum
6. uncontrolled hypertension
7. current breast cancer
8. major surgery with prolonged immobilisation

Question 2

ame 8 contraindications for COCP use:

Answer 2

1. more than 35 years old and smoking >15 / day
2. migraine with aura
3. history of thromboembolic disease
4. history of stroke / ischaemic heart disease
5. breast feeding <6 weeks post-partum
6. uncontrolled hypertension
7. current breast cancer
8. major surgery with prolonged immobilisation

Question 3

Management of urge incontinence:

Answer 3

bladder retraining - minimum 6 months
bladder stabilising drugs e.g. antimuscarinics e.g. oxybutynin, tolterodine, darifenacin
mirabegron - in frail elderly patients

Question 4

Management of stress incontinence?

Answer 4

pelvic floor muscle training - 3 months
surgical procedures
duloxetine

Question 5

How does incomplete miscarriage present?

Answer 5

pain and vaginal bleeding
cervical os OPEN
not all products of conception have been expelled

Question 6

How does inevitable miscarriage present?

Answer 6

heavy bleeding with clots and pain

cervical os OPEN

Question 7

How does missed (delayed) miscarriage present?

Answer 7

gestational sac which contains a dead fetus <20 weeks
may have light vaginal bleeding / discharge, usually painless
cervical os CLOSED

Question 8

How does a threatened miscarriage present?

Answer 8

Painless vaginal bleeding <24 weeks

cervical os CLOSED

Question 9

How does the lactational amenorrhoea method work?

Answer 9

Woman has to be fully breast-feeding, amenorrhoeic and <6 months post partum

Question 10

When can you start contraception after prengnacy?

1. progesterone only pill
2. COCP
3. IUD / IUS

Answer 10

1. can be started immediately
2. if breastfeeding, contraindicated <6 weeks. Should not be used within first 21 days due to thromboembolism risk.
3. within 48 hours or after 4 weeks

Question 11

Management of uterine hyperstimulation:

Answer 11

removal of vaginal prostaglandin / stop oxytocin infusion

TOCOLYSIS with TERBUTALINE

Question 12

Complication of induction of labout?

Answer 12

uterine hyperstimulation = prolonged and frequent uterine contractions

Question 13

Options for induction of labour:

Answer 13

Membrane sweep  - at 40-41 weeks 
Vaginal prostaglandin E2 (PGE2) = preferred method
maternal oxytocin infusion
amniotomy
cervical ripening balloon

Question 14

Interpretation of bishop’s score:

Answer 14

<5 = labour unlikely to start without induction
>/= 8 = high chance of spontaneous labour

Question 15

5 indications for induction of labour:

Answer 15

1-2 weeks overdue
diabetic mother >38 weeks
premature rupture of membranes when labour doesn't start
pre-eclampsia
rhesus incompatibility

Question 16

Management of obstetric cholestasis:

Answer 16

induction of labour at 37-38 weeks
URSODEOXYCHOLIC acid
vitamin K supplementation

Question 17

Who can access the cervical screening programme and how regularly is it?

Answer 17

25-49: every 3 years

50-64: every 5 years

Question 18

What medication is used to suppress lactation?

Answer 18

cabergoline

Question 19

Management of premature prelabour rupture of membranes (PPROM)?

Answer 19

admission
regular observations 
oral erythromycin for 10 days
antenatal corticosteroids 
delivery considered at 34 weeks gestation

Question 20

Management of hyperemesis gravidarum:

Answer 20

antihistamines - promethazine
ondansetron / metoclopramide second line
admission for IV hydration

Question 21

Features of trichomonas vaginalis:

Answer 21

offensive green / yellow frothy discharge
vulvovaginitis
strawberry cervix
pH <4.5

Question 22

Management of trichomonas vaginalis:

Answer 22

oral metronidazole for 5 days

Question 23

Features of BV:

Answer 23

vaginal discharge - ‘fishy’

thin white discharge
clue cells on microscopy
positive whiff test

Question 24

Management of BV:

Answer 24

oral metronidazole for 5-7 days