O&G

Question 1

Drugs CI in breastfeeding

Answer 1

abx: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines sodium valporte and carbezapine are SAFE)
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
( warfarin and heparin are SAFE)

Question 2

Cancer risk and HRT

Answer 2

breast ( due to progesterone exposure) worse with combines regimine, reduced risk when stop HRT, reduce risk of use for <5 years

endometrial ( due to unopposed oestrogen), worse with sequential regimines, only if uses for >10 years

Question 3

magnesium sulphate use in eclampsia

Answer 3

neuroprotection/seizure management
–> need to also control BP

IV bolus of 4g over 5-10 minutes should be given followed by an infusion of 1g / hour

urine output ( can become easily overloaded), reflexes, respiratory rate and oxygen saturations, K level should be monitored during treatment

respiratory depression can occur: calcium gluconate is the first-line treatment for magnesium sulphate induced respiratory depression

treatment should continue for 24 hours after last seizure or delivery (around 40% of seizures occur post-partum)

Question 4

Causes of oligohydramnios

Answer 4

Reduction if amnniotic fluids ( AFI <5%)
premature rupture of membranes
Potter sequence: bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post-term gestation
pre-eclampsia

Question 5

Dysmennorhea mangemenet

Answer 5

Primary vs secondary:

Primary - early onset after menarche, usually due to ecxcess prostaglandins

NSAIDS - reduces prostoglandin productoin
- menenfemic acid

COCP can be very effective for managing dysmenorrhoea by suppressing ovulation and reducing prostaglandin production

Secondary - a few years later, may have underlying pathology needing investigations
-> eg adenomysiosis, endometriosis, PID, fibroids

Question 6

Antenatal downs screening

Answer 6

Done between 11-13+6

Nucal transluence test (USS)

NIPT ( blood test) primarily screens for Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), Patau syndrome (trisomy 13)

Question 7

Menorrhagia management

Answer 7

Investigations
- FBC, ?Pelvic USS (for example, intermenstrual or postcoital bleeding, pelvic pain and/or pressure symptoms) suggest a structural or histological abnormality

• If pt does not require contraception
• mefenamic acid 500 mg tds (particularly if there is dysmenorrhoea as well)
• or tranexamic acid 1 g tds.
  –> both are started on the first day of the period

Requires contraception
-> IUD (Mirena) should be considered first-line
-> combined oral contraceptive pill
-> long-acting progestogens

Short term to STOP bleeding
Norethisterone 5 mg tds can be used as a short-term option to rapidly stop heavy menstrual bleeding

Question 8

COCP and cancer risks/protection

Answer 8

Risks: breast and cervical

Benefits: endometrial and ovarian

Question 9

OHSS signs and symptoms

Answer 9

increased oestrogens and progesterone AND vascular endothelial growth factor (VEGF). This results in increased membrane permeability and loss of fluid from the intravascular compartmen = fluid ++

vomiting, abdo pain, oligouria, fluid overload, ascities, VTE risk

rarely seen with clomifene therapy is more likely to be seen following gonadotropin or hCG treatment

Question 10

Vulval carcinoma vs vulval intraepithilial neoplasm

Answer 10

• skin lesiosn which havent respondes to initial mx ( eg striods –> red flag )
  Carcinoma - ulcerate, pigmeted

Vulval intraepithelial neoplasia tend to be white or plaque like and don’t tend to ulcerate

Question 11

when are contraceptions start working if not started on first day of cycle

Answer 11

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

Question 12

side effects of Depo contraceptive

Answer 12

only one to reduce bone mineral density

irregular bleeding
weight gain

Question 13

emergency contracetives: when to use

Answer 13

LNG = within 72 hours
-single dose of levonorgestrel 1.5mg (a progesterone)
the dose should be doubled for those with a BMI >26 or weight over 70kg
dose should also be doubled if taking enzyme-inducing drugs
-hormonal contraception can be started immediately after using levornogestrel (Levonelle) for emergency contraception

UPA= within 120
-Ulipristal may reduce the effectiveness of hormonal contraception.
- can be used more than once in same cycle

IUD ( copper) = within 120

Question 14

post menopasal contraception ?

Answer 14

women using non-hormonal methods of contraception can be advised to stop contraception after 1 year of amenorrhoea if aged over 50 years, 2 years if the woman is aged under 50 years