Women's Health

Question 1

What is Meig’s syndrome triad?

Answer 1

Benign ovarian tumour
Ascites
Pleural effusion

Question 2

Which drugs should be avoided in breastfeeding?

Answer 2

The following drugs should be avoided:
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

Question 3

Criteria for hyperemesis gravidarum

Answer 3

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

Question 4

Management of hyperemesis gravidarum

Answer 4

(1st line) Antihistamines - promethazine

(2nd line) Ondansetron and metoclopramide

Question 5

How would vasa praevia present?

Answer 5

painless vaginal bleeding + include fetal bradycardia and membrane rupture

Question 6

Symptoms of vaginal candidiasis & treatment

Answer 6

‘Cottage cheese’, non-offensive discharge
itch, dyspareunia, dysuria

Tx:

• Local: clotrimazole pessary
• Oral: itraconazole

Question 7

What is endometrial hyperplasia associated with? (e.g. what increases its risk factors)

Answer 7

Endometrial hyperplasia is associated with;

Taking oestrogen unopposed by progesterone
Obesity
Late menopause
Early menarche
Aged over 35-years-old
Being a current smoker
Nulliparity
Tamoxifen

Question 8

what do you give a pregnant woman with high blood pressure + PMH of asthma?

Answer 8

Nifedipine

Question 9

HRT: unopposed oestrogen increases risk of…

Answer 9

endometrial cancer

Question 10

If a patient is at moderate risk of pre-eclampsia - from when does she need to commence what medication

Answer 10

Asprin 75mg OD from 12 weeks gestation until birth

Question 11

What anti-epileptic have the smaller effects on the developing fetus?

Answer 11

Lamotrigine, carbamazepine and levetiracetam

Question 12

Causes of an increased nuchal translucency include:

Answer 12

Down’s syndrome
congenital heart defects
abdominal wall defects

Question 13

Patients with continuous dribbling incontinence after prolonged labour should be suspected for having…

Answer 13

vesicovaginal fistula

Do urinary dye study to ix this

Question 14

First dose of anti-D prophylaxis to rhesus neg women is given at week…

Answer 14

28

Question 15

Target blood pressure in woman with pre-eclamspia is

Answer 15

NICE recommends that blood pressure is targeted at systolic < 150 mmHg and diastolic 80-100 mmHg.

Question 16

What type of ovarian tumour is associated with Meig’s syndrome?

Answer 16

Fibroma

Question 17

In preterm prelabour rupture of membranes, antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome - which steroid should be given?

Answer 17

Dexamethasone

Question 18

pregnant women with pre-existing diabetes can be treated with

Answer 18

metformin, either alone or in combination with insulin

Question 19

Women between the ages of 50-64 years have smears every…

Answer 19

5 years

Question 20

What is the classic uterus positioning in endometrosis

Answer 20

Fixed, retroverted uterus

Question 21

How do you define PPH?

Answer 21

Postpartum haemorrhage is defined as blood loss of 500 ml or more within 24 hours of the birth of a baby

Question 22

Risk factors for cervical cancer

Answer 22

smoking
human immunodeficiency virus
early first intercourse, many sexual partners
high parity
lower socioeconomic status
combined oral contraceptive pill*

Question 23

Babies born to hep B serology positive woman should be given…

Answer 23

Hep B vaccine & 0.5ml of HBIG within 12 hours of birth with a further hep vaccine at 1-2 months and a further vaccine at 6 months

Question 24

Risk factor for endometrial cancer

Answer 24

obesity
nulliparity
early menarche
late menopause
unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously
diabetes mellitus
tamoxifen
polycystic ovarian syndrome
hereditary non-polyposis colorectal carcinoma

More oestrogen -> more endometrial lining and more cancerous
Therefore early and late menopause means more oestrogen
Nulliparity means more oestrogen (PREGNANCY REDUCES OESTROGEN)
(COCP & smoking is protective)

Question 25

When do you measure ____ in pregnant pts for treatment of VTE and what do you measure?

Answer 25

‘Routine measurement of peak anti-Xa activity for patients on LMWH for treatment of acute VTE in pregnancy or postpartum is not recommended except in women at extremes of body weight (less than 50 kg and 90 kg or more) or with other complicating factors (for example, with renal impairment or recurrent VTE).’

A woman with a previous VTE history is automatically considered high risk and requires low molecular weight heparin throughout the antenatal period

Question 26

Risk factors for ovarian cancer

Answer 26

Risk factors
family history: mutations of the BRCA1 or the BRCA2 gene
many ovulations*: early menarche, late menopause, nulliparity

Question 27

HIV and pregnancy management plan

Answer 27

Maternal antiretroviral therapy
C-section mode of delivery
Neonatal antiretroviral therapy
Infant feeding (bottle feeding)

Question 28

What would you expect in a trisomy 21 pregnancy?

Answer 28

Low alpha fetoprotein (AFP)
Low oestriol
High human chorionic gonadotrophin beta-subunit (-HCG)
Low pregnancy-associated plasma protein A (PAPP-A)
Thickened nuchal translucency

Question 29

When is the combined test done and when?

Answer 29

At 11-13+6 weeks to screen for autosomal trisomies. This involves PAPP-A and -HCG blood tests along with nuchal translucency measurement by ultrasound

Question 30

When is the triple test done and when?

Answer 30

16 weeks but is less accurate than the ‘combined test’ and so should only be used when trisomy screening is performed after 14 weeks. It consists of AFP, -HCG and oestriol blood tests.

Question 31

Endometriosis management

Answer 31

Management depends on clinical features - there is poor correlation between laparoscopic findings and severity of symptoms. NICE published guidelines in 2017:
NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief
if analgesia does help then hormonal treatments such as the combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate should be tried

If analgesia/hormonal treatment does not improve symptoms or if fertility is a priority the patient should be referred to secondary care. Secondary treatments include:
GnRH analogues - said to induce a ‘pseudomenopause’ due to the low oestrogen levels
drug therapy unfortunately does not seem to have a significant impact on fertility rates
surgery: some treatments such as laparoscopic excision and laser treatment of endometriotic ovarian cysts may improve fertility

Question 32

Difference between endometrosis vs PID

Answer 32

The key signs and symptoms of endometriosis are cyclical abdominal pain and deep dyspareunia. It can be associated with fertility problems.

Pelvic inflammatory disease can also cause sub-fertility, dyspareunia and pelvic pain, but this pain is not typically associated with menstruation (oligomenorrhoea)

Question 33

Antimuscarinics examples for bladder incontinence

Answer 33

oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation)

Question 34

First line ix of pregnant woman with painless bleeding

Answer 34

Transvaginal ultrasound

Question 35

Increased AFP

Answer 35

Neural tube defects (meningocele, myelomeningocele and anencephaly)
Abdominal wall defects (omphalocele and gastroschisis)
Multiple pregnancy