Women's Health

Question 1

What are the risks of oral combined HRT?

Answer 1

VTE

Question 2

What are the risks of oral AND dermal combined HRT?

Answer 2

Breast cancer

Question 3

What are the risks of oestrogen only HRT?

Answer 3

Endometrial cancer

Question 4

What are the risks of HRT regardless of combined or oestrogen only?

Answer 4

IHD if used >10 years post-menopause, and CVE.

Question 5

What are the risk factors for gestational diabetes?

Answer 5

BMI over 30, previous macrosomic baby and a 1st degree relative with any type of diabetes

Question 6

How is gestation diabetes screened? Who should be screened and when?

Answer 6

Using OGTT. If previous gestational diabetes, screen ASAP after booking and at 24-28 weeks if 1st negative. If any risk factors present, screen at 24-28 weeks.

Question 7

What are the diagnostic values for gestation diabetes?

Answer 7

Fasting glucose >=5.6
2 hour tolerance >= 7.8

Question 8

How is gestational diabetes managed?

Answer 8

If fasting glucose is <7, allow 2 weeks of lifestyle modification and then metformin, then insulin
If fasting glucose is >=7, go straight to insulin

Question 9

When is COCP safe to use post-partum and why?

Answer 9

After 6 weeks - due to VTE risk and lactational suppression

Question 10

When is postpartum contraception needed?

Answer 10

After 21 days

Question 11

How effective is lactational ammenorrhoea and for how long?

Answer 11

98% effective for 6 month if fully breastfeeding

Question 12

Which contraceptive is safe to use at any time postpartum?

Answer 12

POP

Question 13

Which emergency contraceptive is safe to use up to 72 hours post UPSI?

Answer 13

Levonogestrel

Question 14

When do you increase dose of levonogestrel?

Answer 14

Weight over 70kg or BMI over 26

Question 15

Which emergency contraceptive is used up to 120 hours post UPSI?

Answer 15

Ulipristal

Question 16

What is a major contraindication for ulipristal?

Answer 16

Severe asthma

Question 17

What time frames can IUD (copper coil) be used as emergency contraceptive?

Answer 17

Within 5 days of UPSI or within 5 days of estimated ovulation

Question 18

How should a <35mm unruptured, asymptomatic ectopic pregnancy, with no foetal heartbeat and HCG <1000 be managed?

Answer 18

Expectant - 48 hours of monitoring and serial HCGs.

Question 19

How should an ectopic pregnancy over 35mm be managed?

Answer 19

Surgically - either with salpigectomy or salpingotomy

Question 20

How should an ectopic pregnancy with visible foetal heart beat on US be managed?

Answer 20

Surgically

Question 21

What are the HCG cut offs for medical and surgical management in ectopic pregnancy?

Answer 21

Medical <1500
Surgical > 5000

Question 22

Which strains of HPV cause cervical cancer and which cause genital warts?

Answer 22

Cancer - 16 + 18
Warts - 6 + 11

Question 23

How to manage a pregnant person who has chicken pox?

Answer 23

Aciclovir

Question 24

How to manage a pregnant person who has been exposed chicken pox, is unsure regarding immunity and is asymptomatic?

Answer 24

Check varicella IgG and consider treatment with IVIg later (up to day 10)

Question 25

How to manage a pregnant patient who has been exposed to varicella, is certain they have no immunity and is asymptomatic?

Answer 25

Give IVIg and check varicella IgG

Question 26

What would an US showing an emplty gestational sac over 25mm and no foetal pole mean?

Answer 26

Missed miscarriage

Question 27

What would an open cervical os and PV bleeding mean?

Answer 27

Inevitable miscarriage

Question 28

What would painful bleeding, a dilated cervix and products in utero mean?

Answer 28

Incomplete miscarriage

Question 29

How to treat atrophic vagnitis?

Answer 29

2 weeks of oestradiol cream

Question 30

What is the diagnostic level for serum bile acid in intrahepatic cholestasis of pregnancy?

Answer 30

Greater than 19mcmol/L

Question 31

What are the possible complications of severe (bile acid >100mcmol/L) intrahepatic cholestasis of pregnancy?

Answer 31

Preterm labour, still birth and foetal distress. Consider planned labour at 38 weeks.

Question 32

What are the risk factors for preeclampsia?

Answer 32

Age over 40 OR >10 years since last pregnancy BMI over 35 Family history of preeclampsia Commence baby aspirin if any RF present

Question 33

What blood pressure readings should prompt referral during pregnancy?

Answer 33

Rise of >30/20 from booking BP BP >160/100 at any time BP >=140/90 with proteinuria or symptomatic with IUGR

Question 34

At how many weeks gestation whould dichorionic twins be delivered?

Answer 34

37 weeks

Question 35

At how many weeks gestation whould monochorionic twins be delivered?

Answer 35

36 weeks

Question 36

At how many weeks gestation whould triplets be delivered?

Answer 36

35 weeks

Question 37

What are the risk factors for placenta praevia?

Answer 37

Previous caesarian section, IVF, smoking, multiparity or multiple pregnancy

Question 38

What should you consider in any female presenting with new bloating and early satiety over 50?

Answer 38

Investigating for ovarian cancer with CA125 +/- US

Question 39

What are risk factors for endometrial cancer?

Answer 39

Unopposed oestrogen, nulliparity, obestiy and infertility

Question 40

What is a leiomyosarcoma and how might it present?

Answer 40

Malignant growth in smooth muscle of uterus. Generally a rapidly growing pelvic mass, PV bleeding +- discharge

Question 41

What antiepileptics are first line in pregnancy?

Answer 41

Keppra or lamotrigine

Question 42

What should you co-prescribe for any pregnant person taking an antiepileptic?

Answer 42

High dose folate