Women's key facts

Question 1

What is the difference between stress and urge incontinence?

Answer 1

Stress - leakage occurs when coughing or laughing.
Urge - Frequency with sudden rushes to the toilet.

Question 2

What is the first line treatment for stress and urge incontinence?

Answer 2

Stress - Pelvic floor exercises for at least 3 months
Urge - Bladder retraining.

Question 3

What is the second line (medical) management for stress and urge incontinence?

Answer 3

Stress - Duloxetine (SNRI)
Urge - Oxybutynin (anticholinergic)

Question 4

What are the initial investigations for incontinence?

Answer 4

Bladder diary
Urine dipstick (UTI?)
Urodynamics (if no response to treatment)

Question 5

What is a:
Uterine prolapse
Vault prolapse
Cystocele
Rectocele

Answer 5

Uterine prolapse - Uterus descends into the vagina
Vault prolapse - after a hysterectomy, the top of the vagina descends into the vagina
Cystocele - the bladder prolapses backwards into the vagina through the anterior vaginal wall
Rectocele - the rectum prolapses forwards into the vagina through the posterior vaginal wall.

Question 6

What are the key risk factors for vaginal prolapse?

Answer 6

• Multiparity
• Obesity
• Traumatic delivery
• Menopause
• Advanced age
• Chronic coughing or constipation

Question 7

What is the key initial investigation for prolapse?

Answer 7

Speculum examination

Question 8

How is prolapse graded?

Answer 8

Grade 1 - the uterus is more than 1cm away from the opening of the vagina.
Grade 2 - the uterus is within 1cm of the introitus (above or below)
Grade 3 - the uterus is more than 1cm from the introitus, but not fully descended
Grade 4 - the uterus is fully everted and descended

Question 9

What is the conservative management for a uterine prolapse?

Answer 9

Pelvic floor exercises
Incontinence pads
Weight loss
Reduce caffeine
Oestrogen cream

Question 10

What can be inserted to help manage prolapse?

Answer 10

A vaginal pessary - adds support to the pelvic organs to help with prolapse

Question 11

What is the definitive management for pelvic organ prolapse?

Answer 11

Surgery

Question 12

What are the key risk factors for perianal tear?

Answer 12

First pregnancy
Macrosomia
Shoulder dystocia
Instrumental delivery

Question 13

How is a perianal tear graded?

Answer 13

Grade 1 - just involves the vagina
Grade 2 - involves the vagina and the perianal muscles
Grade 3 - involves the anal sphincter:
- 3a - involves less than 50% of the external sphincter
- 3b - involves more than 50% of the external anal sphincter
- 3c - involves the internal anal sphincter.
Grade 4 - involves the rectal mucosa.

Question 14

What is the management for a perianal tear (grade dependant)?

Answer 14

Grade 1 - repairs on own.
Grade 2 - repair with sutures on the ward.
Grade 3 or 4 - requires suturing in theatre.

Question 15

What timeframe is the copper coil suitable for emergency contraception?

Answer 15

• 5 days after unprotected sexual intercourse
  OR
• Up to 5 days after the likely ovulation date (calculated as menstrual cycle length minus 14 days)

Question 16

What timeframe is levonorgestrel suitable for?

Answer 16

Must be taken within 72 hours of unprotected sexual intercourse.

Question 17

What timeframe is ulipristal acetate (EllaOne) suitable for?

Answer 17

Must be taken within 5 days of unprotected sexual intercourse.

Question 18

What are the categories of C-section and what are the timeframes for each?

Answer 18

Cat 1 - within 30 mins
Cat 2 - within 75 mins
Cat 3 - Delivery is required but mother and baby are stable.
Cat 4 - elective C-section

Question 19

What medication is given to treat HER2 positive breast cancer?

Answer 19

Trastuzumab

Question 20

How is estimated day of delivery calculated?

Answer 20

Add one year and seven days to the first day of the last menstrual period, and then subtract three months.

Question 21

What are some common risk factors that indicate thromboprophylaxis after giving birth?

What drug is given?

Answer 21

Give LMWH
- Previous VTE
- Age over 35
- BMI over 30
- Smoking
- Multiple pregnancy
- Pre-eclampsia
- C-section
- Prolonged labour
- Preterm birth
- Stillbirth
- Postpartum haemorrhage.

Question 22

What hormone should be checked to check for ovulation and when?

Answer 22

Check progesterone 7 days before the end of the cycle

e.g. 28 day cycle check at 21 days.

Question 23

What is the likely history for fat necrosis of the breast?

Answer 23

Breast trauma followed by a firm/hard irregular lump in the breast.

Question 24

What are the three components of triple assessment of any breast lump?

Answer 24

• Clinical examination
• Imaging (mammography and/or USS)
• Tissue sampling/biopsy.

Question 25

What drugs are given in intrahepatic cholestasis of pregnancy?

Answer 25

Chlorphenamine and aqueous cream.

Question 26

What is the management for a UTI during pregnancy?

Answer 26

Trimethoprim - avoid alltogether
Nitrofurantoin - avoid in the third trimester of pregnancy

Amoxicillin - the next best option when trimethoprim and nitrofurantoin are not suitable.

Question 27

What is HELLP syndrome?

Answer 27

H - Haemolysis
EL - Elevated Liver enzymes
LP - Low Platelets

Question 28

What is the management for HELLP syndrome?

Answer 28

Delivery of the baby.
Steroids to develop baby’s lungs
Blood transfusion if very anaemic/thrombocytopenic.