O&G/ Sexual Health

Question 1

What are the risk factors that require higher doses of Folic Acid in pregnancy?

Answer 1

BMI >30, Sickle cell, thallesemia, coeliac, hx of neural tube defect/ anti epileptic meds

Question 2

Management of chickenpox (varicella) exposure in less than 20 weeks

Answer 2

Check immunoglobulins and if non immune start on IV varicella zoster immunoglobulin

Question 3

Mangement of chickenpox (varicella) EXPOSURE if over 20 weeks

Answer 3

Check immunoglobulins and if non immune start on IV varicella zoster immunoglobulin OR acyclovir 7 to 14 days post exposure

Question 4

What phase of the mensutrual cycle is Progesterone highest?

Answer 4

Luteal phase- secreted from corpus luteum

Question 5

What drug is first line for infertility in PCOS?

Answer 5

Clomifene (Metformin used in combination if increased BMI)

Question 6

What is the first line tx for Gonorrhoea?

Answer 6

IM Ceftriaxone

Question 7

What type of bacteria is a Gonorrhoea (eg what would be seen in microscopy??)

Answer 7

Gram neg diplocci

Question 8

First line treatment of chalymdia? (Uncomplicated)

Answer 8

Doxycycline 7 day course.

Question 9

When should test of cure be performed for Chylamidia infections?

Answer 9

After 5 weeks in pregnant woman. TOC is not routinely in men or non pregnant females

Question 10

Whooping cough (Pertussis) vaccine- when is it given during pregnancy?

Answer 10

between 16-32 weeks

Question 11

TOPs can be carried out until what gestation in the UK Abortion Act?

Answer 11

23+6

Question 12

When would you refer to colposcopy in a patient with HPV pos cervical smear but normal cytology?

Answer 12

at 24 months. eg if initial smear was HPV pos, then 12 month FU was still HPV pos and then 3rd smear at 24 months also pos.

Question 13

What is the emergency contraception up to 5 days?

Answer 13

Ella one- Uliprisate up to 120 hours

Question 14

What is the emergency contraception up to 3 days?

Answer 14

Levongesterol (1.5mg) progesterone

Question 15

Treatment of premature ovarian failure

Answer 15

Combined HRT until aged 51

Question 16

How long does the COCP need to be stopped prior to surgery?

Answer 16

4 weeks!

Question 17

Chancres are due to which organism?

Answer 17

Haemophilus ducreyi.

Question 18

Screening for downs syndrome- what is offered?

Answer 18

Combined test (nuchal and bloods) between 11- 13+6

Triple or quadruple screening 15-20

Question 19

What fetal abnormalities would be seen in Varicella (chickenpox) infection intrapartum?

Answer 19

Scarring of the skin, limb hypoplasia, microcephaly and eye defects

Question 20

What drugs are inducers of the PY450 system? and why is this relevant?

Answer 20

Carbamazapine, Phenytoin, Rifamicin, St Johns work and therefore they will reduce the efficacy of the COCP.

SICKFACES

St John’s Wort
isonidiazid
carbamazepine
Ketconazole
Fluconazole
Alchohol
Chloramphenicol
Erythromycin
Smoking

Question 21

What age and regime is used for cervical ca screening in UK?

Answer 21

Aged 25-64.
25-50 every 3 years
50-65 every 5 years

Question 22

When to start infertility testing? How many months of trying to concieve

Answer 22

12 months if under 35
6 months if over 35

Question 23

Management of fibroadenoma?

Answer 23

Depends on size! 3cm or above= surgery
under 3cm= reassurance and monitoring

Question 24

Management of GDM

Answer 24

If fasting BM >7 = Insulin
If fasting BM under 7= trial of diet+lifestyle.

Question 25

Trichomonas is treated with?

Answer 25

Oral metronidazole

Question 26

What are the risk factors for breast cancer?

Answer 26

HRT, early menarche, late menopause and COCP

Question 27

Is Aspirin allowed in breastfeeding?

Answer 27

NO!

Question 28

What are the rules around COCP and breastfeeding

Answer 28

UKMEC 2 between 6 weeks and 6 months

Question 29

GDM. What fasting glucose on the OGTT should insulin be started?

Answer 29

If fasting glucose is over 7 = start Insulin Or if fasting 6-6.9 but with complications such as macrosomia = consider Insulin

Question 30

Secondary dysmenorrhagia management in GP

Answer 30

Refer to Gynae

Question 31

How many days from starting the POP is it effective?

Answer 31

2 days

Question 32

What age does cervical screening go to 5 yearly?

Answer 32

50-65 years old - 5 yearly screening

Question 33

What is the treatment if a pregnant woman HAS chickenpox eg presents with the rash?

Answer 33

Aciclovir if over 20 weeks and Aciclovir can be considered if less than 20 weeks

Question 34

Presentation of Lymphogranuloma venereum

Answer 34

Stage 1: painless genital ulcer Stage 2: Painful lymphadenopathy

Question 35

What are some contraindications to POP?

Answer 35

Acute porphyria/ current breast ca.

Question 36

What are the features of congenital rubella syndrome?

Answer 36

Cataracts, cardiac lesions, splenomegaly, cerebral palsy

Question 37

How do you define Perinatal Mortality Rate?

Answer 37

Number of stillbirths and early neonatal deaths (7 days) by number of livebirths and stillbirths PER 1000

Question 38

What is HELLP syndrome?

Answer 38

Haemolysis Elevated liver enzymes Low platelets Diagnostic criteria need raised LFTs (twice upper limit of normal) and low platelets

Question 39

What are the risk factors for endometrial ca.

Answer 39

Nulliparious High BMI Unopposed oestrogen PCOS HRT Tamoxifen

Question 40

What are the neonatal effects of maternal toxoplasmosis infection?

Answer 40

CNS and eyes! Neonatal seizures, hydrocephalus, chorioretinitis, cerebral calcification, cataracts

Question 41

When can the copper IUD be fitted as emergency contraception?

Answer 41

5 days or 120 hours of USPI OR within 5 days of the earliest estimated date of ovulation. Copper IUD should be offered to everyone first line!

Question 42

When can Ullipristate vs Levongestrol be used for emergency contraception?

Answer 42

Levongestrol - 72 hours Ullipristate- 5 days/ 120 hours (shouldn't be used in severe Asthma)

Question 43

Risk factors for HE?

Answer 43

Non smokers, twin pregnancies, molar pregnancies, eating disorders, N+v outside of pregnancy.

Question 44

PID Antibiotics?

Answer 44

Ceftriaxone 1 g as a single intramuscular (IM) dose, doxycycline 100 mg twice daily metronidazole 400 mg twice daily for 14 days.

Question 45

Gonorrhoea in a man- presentation and Abx?

Answer 45

Discharge and dysuria Mx: IM Cef + Azithromycin

Question 46

Chlamydia in a man- presentation and Abx?

Answer 46

Itchiness and urethritis but no discharge Mx: Azithromycin

Question 47

Management of Pre menstrual tension

Answer 47

1. Lifestyle 2. COCP 3. SSRI if severe and can be discontinued when pregnant

Question 48

When can a copper IUD be fitted?

Answer 48

Within 5 days after the first UPSI in a cycle OR within 5 days of the earliest estimated date of ovulation.

Question 49

What are some of the contraindications to copper IUD?

Answer 49

Unexplained bleeding Current chlaymida/ gonorrhoea Post TOP/ Post postpartum sepsis Cervical CA Molar pregnancies PID

Question 50

Treatment of Gonorrhoea? and how would it be prescribed under the microscope?

Answer 50

IM CEF!!! Gram neg diplococci

Question 51

What do these terms mean? Azoospermia Oligospermia Hypospermia Tetartospermia Asthenzoospermia

Answer 51

Azoospermia- no sperm Oligospermia- reduced sperm Hypospermia- reduced semen volume Tetartospermia- poor sperm morphology Asthenzoospermia - reduced sperm motility

Question 52

Treatment of epidiymo-orchitis?

Answer 52

IM Cef (STAT) + Doxy for 10-14 days

Question 53

What would a high FSH indicate in the investigations of secondary amenorrhoea?

Answer 53

Primary Ovarian Failure

Question 54

Placental abruption presents with which examination finding?

Answer 54

Tender woody uterus Pain PV bleeding

Question 55

Which rash spares the umbilicus in pregnancy?

Answer 55

Polymorphic eruption of pregnancy

Question 56

What are the missed pill rules for POP?

Answer 56

Missed pill occurs if >3 hours late. If this happens- take next pill and extra precautions for 48 HOURS! EC only required if UPSI occurred between missed pill and 48 hour window

Question 57

What are the TORCH infections?

Answer 57

Toxoplasmosis Other (syphillis) Rubella Cytomegalovirsus H erpes simplex

Question 58

What gestation does ECV take place?

Answer 58

Nulliparous 36/40 Multiparous 37/40

Question 59

What gestation is routine anti D given?

Answer 59

28 weeks and 34 weeks

Question 60

What gestation is presentation palpated for

Answer 60

36 weeks

Question 61

Indications for high dose folic acid (5)

Answer 61

Sickle cell/ Thalassemia Diabetes Epileptic medication BMI >30 Fhx of neural tube defects

Question 62

What drugs for medical TOP?

Answer 62

Mifepristone Followed by Misoprostol 48 hours later

Question 63

Missed pill rules COCP

Answer 63

1 pill- fine - take next one and carry on 2 pills- 7 days extra precautions. If at beginning of pack will need EC

Question 64

How to start COCP

Answer 64

If between D1-D5 quick start and no additional contraception required If after D5 of period need 7 additional condom days!

Question 65

Lipid modification drugs in pregnancy?

Answer 65

All lipid modification drugs are contraindicated in pregnancy. And should stop 3 months prior to pregnancy

Question 66

Risk factors for endometrial ca

Answer 66

Obesity Nulliparity Late menopause Tamoxifen

Question 67

Treatment of listeria infection in pregnancy

Answer 67

Amoxicillin

Question 68

Treatment of Toxoplasmosis in pregnancy

Answer 68

Spiramycin

Question 69

What is a UK MEC 4 (unacceptable risk) for progesterone implant and injectables?

Answer 69

Current breast ca (within 5 years)

Question 70

What are the causes of painless genital ulcer (3)

Answer 70

1. Syphillis 2. Chancroid (haemophyllis ducreyi) 3. Lymphogranuloma venereum (chlaymidia trichomatosis)