womens health

Question 1

what cancer is nulliparity a risk factor for?

Answer 1

endometrial

Question 2

what is primary amenorrhoea?

Answer 2

menstruation has never begun

By 13 years when there is no other evidence of pubertal development
By 15 years of age where there are other signs of puberty, such as breast bud development

Question 3

causes of primary amenorrhoea

Answer 3

hypogonadotrophic hypogonadism
hypergonadotrophic hypogonadism
kallmann’s
Turner’s
congenital adrenal hyperplasia
androgen insensitivity syndrome
structural problems- imperforate hymen, vaginal agenesis, FGM

Question 4

what is hypogonadotrophic hypogonadism?

Answer 4

Hypogonadotropic hypogonadism involves deficiency of LH and FSH, leading to deficiency of the sex hormones (oestrogen)

Question 5

causes of hypogonadotrophic hypogonadism

Answer 5

Hypopituitarism
Damage to the hypothalamus or pituitary
cystic fibrosis or inflammatory bowel disease
Excessive exercise or dieting
Constitutional delay in development
growth hormone deficiency, hypothyroidism, Cushing’s or hyperprolactinaemia
Kallman syndrome

Question 6

what is hypergonadotrophic hypogonadism?

Answer 6

Hypergonadotropic hypogonadism is where the gonads fail to respond to stimulation from the gonadotrophins (LH and FSH). Without negative feedback from the sex hormones (oestrogen), the anterior pituitary produces increasing amounts of LH and FSH. Consequently, you get high gonadotrophins (“hypergonadotropic”) and low sex hormones (“hypogonadism”)

Question 7

causes of hypergonadotrophic hypogonadism

Answer 7

damage to the gonads- ovarian torsion, cancer, mumps

congenital absence of ovaries

Turners syndrome

Question 8

mechanism of action of oxybutynin

Answer 8

anti-muscarinic

Question 9

features of Sheehans syndrome

Answer 9

amenorrhoea
reduced lactation
adrenal insufficiency/ addisons crisis
hypothyroidism

Question 10

investigations done in suspected infertility (female)

Answer 10

measure serum progesterone on day 21/ 7 days from next expected period

Question 11

3 key features in meigs syndrome

Answer 11

a benign ovarian tumour
ascites
pleural effusion

Question 12

drugs to avoid when breastfeeding

Answer 12

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

Question 13

presentation of Intrahepatic cholestasis of pregnancy (also known as obstetric cholestasis)

Answer 13

pruritus - may be intense - typical worse palms, soles and abdomen
clinically detectable jaundice occurs in around 20% of patients
raised bilirubin is seen in > 90% of cases

Question 14

management of intrahepatic cholestasis of pregnancy

Answer 14

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

Question 15

if risk factors for pre eclampsia present what should we offered and till when?

Answer 15

aspirin 75-150mg daily from 12 weeks gestation until the birth

Question 16

risk factors of a breech presentation

Answer 16

uterine malformations, fibroids
placenta praevia
polyhydramnios or oligohydramnios
fetal abnormality (e.g. CNS malformation, chromosomal disorders)
prematurity (due to increased incidence earlier in gestation)

Question 17

risk factors for shoulder dystocia

Answer 17

fetal macrosomia (hence association with maternal diabetes mellitus)
high maternal body mass index
diabetes mellitus
prolonged labour

Question 18

what is included in the bishop score?

Answer 18

Cervical position
Cervical consistency
Cervical effacement
Cervical dilation
Fetal station

Question 19

bishop score interpretation

Answer 19

a score of < 5 indicates that labour is unlikely to start without induction

a score of ≥ 8 indicates that the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour

Question 20

induction of labour- stages

Answer 20

membrane sweep
prostaglandin E2 infusion
oxytocin infusion
amniotomy
cervical ripening balloon

Question 21

complication of induction of labour

Answer 21

uterine hyperstimulation- the main complication of induction of labour
refers to prolonged and frequent uterine contractions - sometimes called tachysystole
potential consequences
intermittent interruption of blood flow to the intervillous space over time may result in fetal hypoxemia and acidemia
uterine rupture (rare)

Question 22

pregnancy- obesity- what 2 things are different during the pregnancy (monitoring and medication)?

Answer 22

obese women should take 5mg of folic acid, rather than 400mg for the 1st trimester

all obese women should be screened for gestational diabetes with an oral glucose tolerance test (OGTT) at 24-28 weeks

Question 23

downs syndrome screening- combined test results and when is this done

Answer 23

these tests should be done between 11 - 13+6 weeks

Down’s syndrome is suggested by ↑ HCG, ↓ PAPP-A, thickened nuchal translucency

Question 24

downs syndrome screening- triple and quadruple tests- when is this done and what is included?

Answer 24

triple test: alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin

quadruple test: alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin-A

Question 25

causes of oligohydramnios

Answer 25

premature rupture of membranes
fetal renal problems e.g. renal agenesis
intrauterine growth restriction
post-term gestation
pre-eclampsia

Question 26

GBS prophylaxis- what antibiotic is used?

Answer 26

benzylpenicillin

Question 27

which SSRI’s are safe during pregnancy?

Answer 27

sertralline and paroxetine

Question 28

contraceptives- time until effective

Answer 28

Contraceptives - time until effective (if not first day period):
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

Question 29

Trichomonas treatment

Answer 29

oral metronidazole

Question 30

Gestational diabetes- management if fasting glucose >7

Answer 30

insulin +/- metformin

Question 31

how long does a mirena coil last

Answer 31

5 years

Question 32

breast cancer screening

Answer 32

mammorgram every 3 years 50-70

Question 33

medical management of termination of pregnancy

Answer 33

mifepristone and prostaglandins

Question 34

oestrogren receptor +ve breast cancer- pre and post- menopausal management

Answer 34

pre= tamoxifen

post= aromatase inhibitors (anastrazole)

Question 35

medical management of a missed miscarriage

Answer 35

vaginal misoprostol

Question 36

how long is lactational amenorrhoea a viable contraceptive for?

Answer 36

6 months- providing they are amenorhhoeic + breastfeeding exclusively

Question 37

side effect of POP

Answer 37

irregular bleeding