Gynae

Question 1

What is needed following a medical termination of pregnancy?

Answer 1

Multiple level pregnancy test in 2 weeks

Question 2

Management of vaginal thrush?

Answer 2

Oral fluconazole

Question 3

Enlarged boggy uterus?

Answer 3

Adenomyosis

Question 4

What is a C/I to injectable progesterone contraceptives?

Answer 4

Current breast cancer

Question 5

Management of pregnant women who are<6 weeks gestation with painless bleeding?

Answer 5

Expectant management - repeat test in 7 days

Question 6

Imaging of choice for adenomyosis?

Answer 6

Transvaginal US

Question 7

How long should women wait before starting regular hormonal contraception after taking ulipristal?

Answer 7

5 days

Question 8

Management of 2 missed pills in week 3?

Answer 8

Take an active pill and omit the pill-free interval

Question 9

What is acceptable with nearly all anti epileptic drugs?

Answer 9

Breastfeeding

Question 10

Risks of HRT?

Answer 10

• Increased risk of breast cancer
• Increased risk of endometrial cancer(if no progresterone)
• Increased risk of VTE

Question 11

Unopposed oestrogen increases the risk of?

Answer 11

Endometrial cancer

Question 12

If one pill missed, what is the next steps?

Answer 12

Take the next pill ASAP then continue as normal

Question 13

If 2 pills are missed in week 2, what is the next steps?

Answer 13

No emergency contraception needed if previous 7 days have been taken correctly

Question 14

What is the drug of choice for reversing respiratory depression caused by mag sulphate?

Answer 14

Calcium Gluconate

Question 15

When should anti-D prophylaxis be given to women who are having an abortion?

Answer 15

If rhesus negative and after 10 weeks gestation

Question 16

Management of switching from IUD to COCP

Answer 16

No additional contraception needed if removed on day 1-5
If later, barrier contraception needed for 7 days

Question 17

When should oestrogen containing contraceptives be discontinued before surgery requiring immobilisation?

Answer 17

4 weeks before

Question 18

COCP protects against which cancers?

Answer 18

Ovarian and endometrial

Question 19

Presence of heartbeat on US of ectopic suggests what?

Answer 19

Surgical management needed

Question 20

When do women require contraception post partum?

Answer 20

After 21 days

Question 21

First line for menorrhagia?

Answer 21

Mirena IUS

Question 22

Risk factors for premature ovarian failure?

Answer 22

positive family history, exposure to chemotherapy/radiation and autoimmune disease.

Question 23

Which contraceptives are not affected by enzyme inducing drugs?

Answer 23

• Copper IUD
• Injection
• Mirena

Question 24

When is anti-D given?

Answer 24

28 and 34 weeks

Question 25

What are the normal blood test results for PCOS?

Answer 25

- Raised LH:FSH ratio - Normal/Raised testosterone - SHBG is normal/low

Question 26

Most common ovarian cancer type?

Answer 26

Epithelial cell tumour

Question 27

Most common type of fibroid?

Answer 27

Intramural fibroid

Question 28

Vulval itching with white atrophic patches of skin?

Answer 28

Lichen sclerosis

Question 29

What can be precipitated by antibiotic exposure?

Answer 29

Fungal infection

Question 30

Current breast cancer is a C/I to what?

Answer 30

All hormonal contraceptives

Question 31

Management of all postmenopausal women with atypical endometrial hyperplasia

Answer 31

Hysterectomy with bilateral salpingo-oophorectomy

Question 32

Itching and vaginal burning with latex condoms?

Answer 32

Irritant contact dermatitis

Question 33

blue and bulging membrane with a mass protruding from behind

Answer 33

Imperforate hymen

Question 34

Failure of the corpus luteum to regress can lead to what?

Answer 34

Corpus luteal cyst

Question 35

Why is a urine dip done when patients have hyperemesis gravidarum?

Answer 35

Assess for ketones as these would suggest ketosis/starvation

Question 36

What vitamin can be given to patients with hyperemesis?

Answer 36

Thiamine to prevent Wernickes

Question 37

What are causes of recurrent spontaneous miscarriages?

Answer 37

- Antiphospholipid - Infection - Uterine/Cervical abnormalities

Question 38

What is CIN and how do you differ between CIN1/2/3?

Answer 38

CIN - premalignant condition where abnormally diving cells have now invaded below the basement membrane 1 - 1/3 of epithelium 2 - 2/3 of epithelium, 3 - 3/3 of epithelium

Question 39

What are types of cervical cancer?

Answer 39

Squamous cell and adenocarcinoma

Question 40

What is the investigation of choice to look for local and distant spread of invasive cervical carcinoma?

Answer 40

CT

Question 41

What is an ectropion?

Answer 41

growth of endocervical columnar epithelium outside of the external os

Question 42

Side effects of GnRH agonists?

Answer 42

Menopausal symptoms Loss of bone mineral density

Question 43

What causes ovarian torsion?

Answer 43

Small cyst ruptures on a free pedicle, restricting its blood supply causing potential ovarian necrosis

Question 44

How do dermoid cysts arise?

Answer 44

Derived from primitive germ cells which can differentiate into any body tissue

Question 45

What are signs of endometriosis on examination?

Answer 45

- Fixed, retroverted uterus - Tender uterus - Enlarged ovaries - Uterosacral ligament nodules - Visible lesions

Question 46

Primary vs secondary infertility

Answer 46

Primary - couple have never been able to conceive Secondary - couple have achieved conception in the past

Question 47

Management of infertility in PCOS?

Answer 47

- Metformin - Clomiphene - Gonadotrophins

Question 48

What is the classic PCOS triad?

Answer 48

- Hyperandrogenism - Ovulatory dysfunction - Polycystic ovaries

Question 49

What bloods would you measure for ovulatory function?

Answer 49

- Day 21 progesterone - FSH/LH - Oestradiol

Question 50

What are C/I to IUD insertion?

Answer 50

- STI/PID - Ovarian/Endometrial/Cervical cancer

Question 51

Why can women sometimes feel faint and become bradycardic during IUD insertion?

Answer 51

Cervical shock leads to vasovagal which causes reflex bradycardia

Question 52

Where does endometrial cancer metastasize?

Answer 52

- Inguinal lymph nodes - Lung - Bone - Liver - Peritoneum

Question 53

What are non contraceptive ways to manage menorrhagia?

Answer 53

- Tranexamic acid - Aspirin - Indomethacin - Mefenamic acid

Question 54

What are common places for endometrial tissue to grow?

Answer 54

- Ovaries - Pouch of Douglas - Uterosacral ligaments

Question 55

What markers should be done in suspected ovarian cancer?

Answer 55

- CA125 - AFP - BHCG

Question 56

What are risk factors for uterovaginal prolapse?

Answer 56

- Multiparity - Raised intrabdominal pressure - Menopause - Hysterectomy

Question 57

What can be done to prevent prolapse?

Answer 57

- Pelvic floor excercises - Support the vaginal vault during hysterectomy

Question 58

What is management of prolapse?

Answer 58

- Pessaries - Physio - Surgical repair

Question 59

What can cause oligohydramnios?

Answer 59

- PROM, renal agenesis, foetal abnormalities, IUGR

Question 60

What complications can occur with oligohydramnios?

Answer 60

- Resp difficulties - Skull deformities - IUGR - Pulmonary hypoplasia - Cord compression - Shoulder dystocia - Foetal hypoxia

Question 61

What is the management of oligohydramnios?

Answer 61

- Encourage maternal hydration - Oligoinfusion

Question 62

When should serum progesterone levels be taken to check ovulation?

Answer 62

7 days before next expected period

Question 63

Missed pill rules

Answer 63

- If 1 missed (any time in cycle): take it and continue as normal - If 2 or more missed: take it and use condoms for 7 days - If 2 or more missed in week 1 and she has had sex this week or previous pill-free interval: + emergency contraception - If 2 or more missed in week 3: start next pack as soon as she finishes current pack

Question 64

Management of stage 1 cervical cancer to maintain fertility?

Answer 64

Cone biopsy

Question 65

Which should be measured when thinking about premature ovarian insufficiency?

Answer 65

FSH - will be raised

Question 66

What is the first line management for prolapse?

Answer 66

- If asymptomatic: nothing - Conservative: weight loss and pelvic floor excercises - Pessary - Surgery: colporrhaphy

Question 67

Which hormone surges just before ovulation?

Answer 67

LH

Question 68

What is a fibroid?

Answer 68

Benign smooth muscle tumour originating from the myometrium

Question 69

Most common tumour in young women?

Answer 69

Germ cell tumour

Question 70

Lichen sclerosus needs what to be treated?

Answer 70

Potent topical steroid

Question 71

Woman recently stopped breastfeeding with lump?

Answer 71

Galactocele

Question 72

PCOS increases the risk of what?

Answer 72

Endometrial and ovarian cancer

Question 73

What should be given to induce a withdrawal bleed when thinking about cancer in someone with PCOS?

Answer 73

Oral cyclical progestogen

Question 74

When should a follow up smear after LLETZ be done?

Answer 74

6 months

Question 75

Premenstrual syndrome management

Answer 75

COCP SSRI

Question 76

Before sterilisation, how long must women have been on effective contraception for?

Answer 76

1 month