O&G Passmed 2

Question 1

Latest date to insert emergency IUD

Answer 1

5 days after likely OVULATION date

Question 2

What is the mechanism of action of metformin in PCOS?

Answer 2

Increases peripheral insulin sensitivity which leads to complex changes in the HPG axis

Question 3

Rx for menopause apart from HRT

Answer 3

SSRIs

Question 4

Examples of muscarinic agonists

Answer 4

Tolterodine, Oxybutynin and solifenacin

Question 5

Most common type of ovarian pathology associated with Meigs’ syndrome

Answer 5

Fibroma

Question 6

Most common benign ovarian tumour in women under the age of 25 years

Answer 6

Teratroma

Question 7

Most suitable contraception for 48YO, perimenopausal

Answer 7

IUS

Question 8

most common side effect of progesterone only pill

Answer 8

Irregular bleeding

Question 9

Sometimes referred to as chocolate cysts due to the external appearance

Answer 9

Endometriotic cyst

Question 10

Most common ovarian cancer

Answer 10

Serous carcinoma

Question 11

3cm simlpe cyst, asymptomatic young woman

Answer 11

Follicular cyst

Question 12

Which oral antihyperglycaemic is safe when breastfeeding

Answer 12

Metformin

Question 13

Which blood test is monitored in >90kg or <50g women on VTE treatment

Answer 13

Anti-Xa activity

Question 14

What to do for women on COCP prior to surgery

Answer 14

Switch to progestogen only pill 4 weeks before operation

Question 15

Medical management of miscarriage

Answer 15

Vaginal misoprostol (a prostaglandin) alone is the usual treatment for missed or incomplete miscarriage, however, oral misoprostol can alternatively be given if preferred by the patient

Question 16

Commonest epithelial cell tumour

Answer 16

Serous cystadenoma

Question 17

Features of vulval carcinoma

Answer 17

lump or ulcer on the labia majora

may be associated with itching, irritation

Question 18

Management of puerperal pyrexia

Answer 18

Likely caused by endometritis

Rx: Admit to hospital for IV antibiotics (gentamycin and clindamycin until afebril for >24hrs)

Question 19

Woman wants reinfibulation for previous FGM after vaginal delivery

Answer 19

Advise that reinfibulation is illegal and cannot be done under any circumstances

Question 20

Commonly heard murmurs in pregnancy

Answer 20

Ejection systolic is heard in 96%
3rd heart sound is heard in 84%
Forceful apex beat also often heart
All of these are not concerning

Question 21

Bleeding 1 week post partum, no other symptoms

Answer 21

Reassure, advise and discharge, this is notmal bleeding in first 2 weeks post partum (Lochia)

Question 22

Management of ovarian cancer

Answer 22

Stages 2-4 are treated mainly bu surgery, many have chemotherapy too
stage 1 is too I guess?

Question 23

False labour

Answer 23

Occurs in last 4 weeks of pregnancy
Contractions in lower abdomen, irregulart and occur every 20 mins.
Progressive cervical changes are absent
Rx: Reassure and discharge

Question 24

Which agent is most likely to be used after the birth to facilitate delivery of the placenta and to prevent postpartum haemorrhage?

Answer 24

Oxytocin or ergometrine

Question 25

most common complication following a TOP

Answer 25

infection

Question 26

medication associated with development of endometrial hyperplasia

Answer 26

Tamoxifen

Question 27

Umbilical cord is palpable vaginally able the level of the introitus. ammbranes have ruptured

Answer 27

This is cord prolapse | Rx: Presenting part may be pushed back into uterus and then C-section (pt on all 4s)

Question 28

Degrees of tearing of vaginal tear

Answer 28

- 1st degree = tear within vaginal mucosa only - 2nd degree = tear into subcutaneous tissue - 3rd degree = laceration extends into external anal sphincter - 4th degree = laceration extends through external anal sphincter into rectal mucosa

Question 29

a contraindication for using epidural anaesthesia during labour?

Answer 29

coagulopathy

Question 30

abdo pain, menorrhagia, non-tender abdomen and uterus feels bulky

Answer 30

fibroids

Question 31

PPH 4 hrs afterbirth. Pharmacological management hasn't succeeded. First surgical management

Answer 31

Intrauterine balloon tamponade

Question 32

How long after giving birth does she not require any contraception?

Answer 32

21 days

Question 33

Suspected endometrial cancer, biopsy is inconclusive, next step?

Answer 33

Hysteroscopy with biopsy

Question 34

Which cancer is most at risk by giving oestrogen only HRT rather than combined

Answer 34

Endometrial cancer

Question 35

Time of first scan to confirm dates

Answer 35

10-13+6 weeks

Question 36

Time for first screen of anaemia and atypical red cell alloantibodies

Answer 36

8-12 weeks

Question 37

Management of lactation mastitis

Answer 37

Non infective: nothing, continue breastfeeding Infective (infected nipple fissure, symptoms worsen after 12-24hrs despite milk removal, bacterial culture positive) - Flucloxacillin and continue to breastfeed

Question 38

Pelvic pain 2 weeks after period

Answer 38

Mittelschmerz, common, usually subsides over next 1-2 days

Question 39

PCOS diagnostic crietria

Answer 39

Need 2/3 of: Infrequent or no ovulation (thus oligomenorrhoea is the correct answer in this scenario) Clinical or biochemical signs of hyperandrogenism or elevated levels of total or free testosterone (no mention of 'low levels of oestrogen') Polycystic ovaries on ultrasonography or increased ovarian volume

Question 40

A 22-year-old female has a Nexplanon inserted. For how long will this provide effective contraception?

Answer 40

3 years

Question 41

Risk factors for hyperemesis gravidarium

Answer 41

``` multiple pregnancies trophoblastic disease hyperthyroidism nulliparity obesity ``` (Smoking DECREASES risk)

Question 42

cyclical pelvic pain associated with dysmenorrhoea and dyspareunia.

Answer 42

endometriosis | Laparoscopy is gold standard investigation

Question 43

best short term (few months) contraception after birth

Answer 43

Progesterone only pill