pass med questions obgyn

Question 1

If a woman has an inadequate smear test result in what timeframe should they have a repeat smear?

Answer 1

repeat the test in 3 months
- inadequate means that the cells weren’t able to be visualised properly, no evidence that the transformation zone was properly sampled

Question 2

what is a smear test detecting

Answer 2

smear tests are done on a HPV first system.
If there is evidenced of HPV, then only after is a cytological exam performed

Question 3

if there are two consecutive inadequate smear samples then what is the next step?

Answer 3

carry out a colposcopy

Question 4

what are two common causes for hyperemesis gravidarium

Answer 4

this is usually due to high levels of BhcG, the body isn’t used to this hormone.
If it is a twin pregnancy or a molar pregnancy.

Question 5

which medication is often used to treat hyperemesis gravidarium

Answer 5

cyclizine

Question 6

why would you avoid using metoclopramide in HG

Answer 6

avoid using it for more than 5 days as it can cause acute dystonia
a movement disorder that involves involuntary muscle contractions. torticollis

Question 7

what is the treatment for thrush in non-pregnant women

Answer 7

single dose of oral - fluconazole

Question 8

which part of the fallopian tube is an ectopic pregnancy more likely to rupture

Answer 8

isthmus as it is the most narrow part of the fallopian tube

Question 9

how would you manage a pregnant woman who is <6 weeks pregnant and presents with vaginal bleeding but no pain

Answer 9

• monitor expectantly and repeat pregnancy test in 7 days
  *if negative then this confirms a miscarriage
• if the test is positive or the symptoms continue to worsen then this is a urgent referral to EPAU

Question 10

if someone presents with premature ovarian insufficiency and they present with a raised FSH then what’s the next step

Answer 10

repeat a FSH test in 4-6 weeks and it should remain raised

Question 11

what is cervical excitation and when is it seen

Answer 11

• cervical excitation is also known as cervical motion tenderness, this when there is pain in the cervix when it is being moved in a pelvic exam
• it is often seen in PID and ectopic pregnancy

Question 12

what is the timeframe of a threatened miscarriage?

Answer 12

painless vaginal bleeding before 24 weeks
cervical os is closed

Question 13

When do you need to take a progesterone test

Answer 13

7 days before the next expected period

Question 14

progesterone in HRT increases the risk of what?

Answer 14

breast tenderness, headaches, and mood swings. There’s also a small increased risk of stroke and ovarian cancer.

Question 15

how long should someone wait post partum for a smear test

Answer 15

12 weeks
3 months

Question 16

when would you prefer to do a laparoscopic salpingotomy vs salpingectomy

Answer 16

when there is a high risk of infertility in the woman, for example if they have PID, multiple adhesions

Question 17

what are some indications to immediately refer to EPAU

Answer 17

woman with a positive pregnancy test with:
- positive pregnancy test
- abdominal pain
- cervical motion tenderness - ain experienced when a healthcare provider gently moves the cervix during a pelvic exam, often indicating an inflammatory process in the pelvic region, most commonly associated with pelvic inflammatory disease (PID) or ectopic pregnancy; i

Question 18

when would surgical options in a miscarriage be necessary

Answer 18

• if there is evidence of haemorrhage or infection

Question 19

what is the treatment for PID

Answer 19

stat IM Ceftriaxone (gonorrhoea)
14 days oral doxy (chlamydia)
and metro (trichomonias)

Question 20

what is endometriosis a big risk factor for

Answer 20

ectopic pregnancy, the blastocyst has been implanted in other endometrial tissue

Question 21

which ovarian tumour is associated with endometrial hyperplasia

Answer 21

granulose cell tumours

Question 22

widely spaced nipples and primary amenorrhoea which are characteristics seen in

Answer 22

Turners syndrome Turner’s syndrome is caused by the presence of only one sex chromosome (X) or a deletion of the short arm of one of the X

Question 23

what is a diagnostic test for turners syndrome

Answer 23

increased FSH / LH levels

Question 24

High-risk human papillomavirus (hrHPV): POSITIVE.
Cytology: NEGATIVE.
what’s the next step

Answer 24

just continue with regular smear testing, only need to do colposcopy if the cytology comes back as abnormal

Question 25

at what age is premature menopause

Answer 25

40

Question 26

after 36 weeks of pregnancy a woman gets chicken pox what is the effect on the baby

Answer 26

This is the time when your baby is at greatest risk of getting chickenpox. If your baby is born within 7 days of your chickenpox rash appearing or you get chickenpox within the first week after birth, your baby may get severe chickenpox. He or she will be given VZIG and treated with an antiviral drug called aciclovir and monitored closely after birth. This causes a risk of neonatal sepsis / disseminated infection after 36 weeks baby is at a high chance of getting neonatal chickenpox

Question 27

infection of chicken pox between 28 and 36 weeks in the mum can cause what affect in the baby

Answer 27

it can cause the baby to be exposed to the virus, it will stay dormant in the body and reappear as shingles

Question 28

at first pregnancy will you likely feel baby move closer to 16 weeks or 20 weeks

Answer 28

closer to 20 weeks if no movement by 24 weeks then this is bad

Question 29

menopause can cause which type of incontinence

Answer 29

stress muscles are weakened

Question 30

69 year old woman has dramatic increase in urinary frequency, she has urgency, dysuria, and constantly wears a pad, she has been post menopausal for 20 years. She is not on HRT and urinalysis reveals blood and protein. Pelvic examination reveals there is a tender mass palpable anterior to the vagina what do you think this is and how would you manage it??

Answer 30

??

Question 31

18 year old who started periods art 12 has heavy menstrual bleeding for 7-8 days which are not painful since then. What do you think its could be and what would your investigation be. her Hb is low and platelets would be low

Answer 31

clotting as her platelets are low and her periods have always been heavy and non painful. its not always first line ti do thyroid tests unless they have signs of thyroid dysfunction usually hypothyroidism its not first line to do ferritin either

Question 32

In pregnant woman if they have a UTI, what would your investigation be

Answer 32

MSU and urine dip, urine dip will show there is an infection and the MSU will show the culture and the antibiotics

Question 33

what UTI meds do you give to pregnant woman and when

Answer 33

nitrofurantoin during the first and second trimester as in the last it can cause heamolysis trimethoprim can cause low folate in the first trimester so it is not safe to give.

Question 34

what is the most common cause for small for gestational age fetus

Answer 34

placental insufficiency

Question 35

when do you do fetal blood sampling

Answer 35

Diagnose blood disorders, like fetal anemia Diagnose fetal infections, such as toxoplasmosis Diagnose genetic or chromosome abnormalities Check oxygen levels in the baby Give certain medicines to the baby

Question 36

sagittal sinus thrombosis

Question 37

someone with hyperemesis gravidarium should be given what treatments

Answer 37

- anti sickness - cyclizine - iv fluids - thiamine as they are at a risk if deficiency

Question 38

what are the rhesus status of the mother and baby that causes issues

Answer 38

mum is rhesus negative baby rhesus positive if new baby is rhesus positive then mothers IGG will attack baby

Question 39

when is the earliest external cephalic conversion can be offered

Answer 39

in nulliparous women 36 weeks is the earliest 37 for multiparous

Question 40

what are some indications for an elective c section

Answer 40

Indications for elective caesarean section include: Abnormal presentation e.g. breech or transverse. Twin pregnancy if first twin is not cephalic. Maternal HIV. Primary genital herpes in third trimester. Placenta praevia. Anatomical reasons

Question 41

if a mother is found to be GBS positive during pregnancy what is the management

Answer 41

She should be given antibiotics intravenously during labour and delivery to prevent newborn GBS infection peniclllin

Question 42

what week of pregnancy is anti d given

Answer 42

Rhesus negative mothers are also routinely given Anti-D at 28 weeks of pregnancy.

Question 43

what are some rhesus sensitisation events

Answer 43

Sensitisation events are those which carry a risk of foetal blood crossing the placenta into the material circulation and triggering formation of these antibodies. Sensitisation events include: Antepartum haemorrhage Significant abdominal trauma Ectopic pregnancy Miscarriage Termination Intrauterine death External cephalic version Invasive uterine procedures e.g. chorionic villus sampling or amniocentesis Delivery of foetus (vaginal or by caesarean section)

Question 44

acronym for PPH

Answer 44

Tone - uterine atony is the most common for primary Trauma Thrombus Tissue retained

Question 45

difference between primary and secondary PPH

Answer 45

Primary postpartum hemorrhage (PPH) is heavy bleeding within the first 24 hours after giving birth, while secondary PPH is heavy bleeding after 24 hours and up to 12 weeks after birth.

Question 46

most common cause for secondary PPH

Answer 46

postpartum endometriosis

Question 47

which test is specific for downs vs test for downs, Edwards and patau

Answer 47

downs specific is quadruple for all three - combined test (10-14) weeks

Question 48

first line management for PPH

Answer 48

oxytocin

Question 49

at what stage of pregnancy is it serious if a non immune woman to varicella zoster is infected

Answer 49

usually bad in the first trimester

Question 50

what is the treatment for a pregnant woman who is not immune to varicella zoster

Answer 50

give treatment immediately oral aciclovir should be given as a preventive measure 7-14 days post-exposure. Post delivery, the neonate should be monitored and given IV aciclovir.

Question 51

what is the treatment for asymptomatic bacteriuria in pregnancy

Answer 51

Oral antibiotics are recommended in cases of asymptomatic bacteriuria to prevent progression to pyelonephritis and increased risk of preterm labour. Women should have a routine urinalysis at booking to screen for asymptomatic bacteriuria. If this is positive for nitrites or leukocytes, it should be sent for culture

Question 52

what is the main cause for polyhydramnios

Answer 52

oesophageal atresia - foetus cant swallow amniotic fluid and maintain normal levels

Question 53

following rupture of membranes when should induction of Labour be commenced

Answer 53

within 24 hours

Question 54

what is the immediate management when the mother presents with an amniotic fluid embolism

Answer 54

offer 15l oxygen non re breathe mask before emergency c section as there is a high risk of maternal hypoxia

Question 55

what pain relief is used in Labour for mild pain

Answer 55

Entonox Entonox is a patented mixture of inhaled nitrous oxide and oxygen (1:1). It is the most popular form of analgesia for mild labour pain

Question 56

treatment for candida

Answer 56

Oral fluconazole 150mg as a single dose is the standard treatment for uncomplicated cases of this fungal infection.

Question 57

what complication can polyhydramnios have in pregnancy

Answer 57

umbilical cord prolapse excess amniotic fluid can prevent engagement of the head and leave room for the cord to extend past the presenting part

Question 58

test to determine pre rupture of membranes

Answer 58

An Actim-PROM vaginal swab detects insulin-like growth factor binding protein-1 (IGFBP-1) in vaginal fluid. The concentration of IGFBP-1 is much higher in the amniotic fluid than in the maternal blood. Therefore, a positive Actim-PROM suggests pre-labour rupture of membranes.

Question 59

maternal eclampsia treatment

Answer 59

IV magnesium sulfate

Question 60

regular blood tests needed in pre eclampsia

Answer 60

THREE TIMES A WEEK U&E, FBC, transaminases and bilirubin bilirubin -= Low levels of bilirubin were associated with poor maternal and infant outcomes in women diagnosed with pre-eclampsia.

Question 61

what is the diagnostic testing for ovarian tortion

Answer 61

laparoscopy

Question 62

what increase in bHCG over 48 hours suggests a viable pregnancy

Answer 62

more than double

Question 63

what is a big no no for vaginal delivery once had a c section

Answer 63

classic c section scar - vertical - uterine abruption

Question 64

what is a common rule for unexplained problematic bleeding after starting a form of contraception

Answer 64

1. screen for pregnancy 2. screen for STI 3. screen cervix start cocp for 3 months

Question 65

what medication can be prescribed in advanced PMS

Answer 65

fluoxetine

Question 66

triad of pre eclampsia

Answer 66

high blood pressure over 140/90 protein in urine PCR > 30 ACR > 8 odema - end organ failure - appears more than 20 weeks, do to vasospasm and vasoconstriction of the spiral arteries causing high vascular resistance, and poor perfusion of the placenta, leading to oxidative stress of placenta

Question 67

if you see a woman who is at risk of developing pre eclampsia what prophylaxis can you offer before 20 weeks

Answer 67

from 12 weeks gestation offer them aspirin till birth

Question 68

In Gestational Diabetes what is the treatment management depending on the fasting glucose level

Answer 68

< 7 mmol/L then lifestyle and consider metformin if after two weeks its not improving >7 Insulin and can consider metformin consider more regular US reason for high glucose is because the body resists the insulin to allow more glucose for the baby to grown gestational diabetes is only diagnosed when the mother has not had any history of diabetes in the past, if she did this would not be classesd as gestational diabetes (20 weeks) can present with high uric acid if kidneys are damaged

Question 69

HELLP syndome summary

Answer 69

It is part of the hypertensive issues in pregnancy, associated with pre eclampsia Occurs post 20 weeks gestation and is very serious, leading to end organ failure, rupture of placenta and IUGR

Question 70

what are some key complications to baby when the mother has an issue with her blood pressure

Answer 70

- too high can cause IUGR - Placental abruption

Question 71

key difference between pre eclampsia and eclampsia

Answer 71

eclampsia is a condition with generalised tonic clonic siezures, have headache, Vision changes, abdominal pain, vomiting Mg sulphate first line one as a bolus then infusion, second line is lorazepam Cure is delivery of the placenta

Question 72

when screening for HPV in cervical cancer which strands are we looking for

Answer 72

16 18

Question 73

in eclampsia what do you need to look out for when giving magnesium sulphate

Answer 73

it can cause a drop in their RR can give IV labetalol or hydralazine

Question 74

if a woman has a pre rupture of membrane what could be two potential causes of maternal SEPSIS and what are the names of the bacteria

Answer 74

GBS - chorioamnionitis Escherichia coli - UTI

Question 75

preterm prlabour prolonged rupture of membranes

Answer 75

Preterm <37 weeks Prolonged > membranes ruptured for more than 24 hours prelabour - there are no uterine contractions -> give erythromycin 10 days, try to delay pregnancy - corticosteriods and magnesium sulfate f

Question 76

PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth) BUNDLE

Answer 76

if mother is going to give birth to a preterm baby this is what should be given to her: Antenatal steroids Antenatal Magnesium sulfate BABY BORN: Delayed cord clamping maternal breast milk (colostrum) probiotics caffeine citrate THEN: - thermoregulation -volume targeted ventilation

Question 77

main method to induce labour when term

Answer 77

1. prostaglandin pessary to RIPEN cervix 2. then oxytocin infusion to start labor 3. Can do a membrane sweep if post term,

Question 78

how long should a couple try having regular intercourse for before they start IVF

Answer 78

2 years

Question 79

how does a rectocele present

Answer 79

rectum prolapsing forwards into the vagina due to a defect in the posterior vaginal wall. It classically presents as a lump or feeling of a lump coming forwards, which may need to be pushed back again to allow passage of stool. The main risk factor here is straining, usually due to constipation. While constipation is not directly mentioned here, opiates often cause constipation and should be co-prescribed with a laxative, which this woman is not taking.

Question 80

treatment for pre rupture of membranes

Answer 80

Oral erythromycin for 10 days , antenatal corticosteroids, and intravenous magnesium sulphate

Question 81

what is another name for oxytocin

Answer 81

syntocinon

Question 82

features of placental abruption

Answer 82

Presents with sudden abdominal pain in the third trimester. On examination the mother can be seen to be in extreme pain and cold to touch. Bleeding is present in 80% of cases. Absence of visible bleeding does not rule out this diagnosis. Risk factors include: maternal hypertension (common), cocaine, trauma, uterine overdistension, tobacco and previous placental abruption.

Question 83

what blood pressure is a red flag in obstetrics and means the woman needs to be admitted

Answer 83

BP >160/110

Question 84

In molar pregnancies what is one weird side effect and what is the blood result of It

Answer 84

hyperthyroidism low TSH and high thyroxine biochemical structure of beta hCG is very similar thyroid-stimulating hormone (TSH). That being said, high levels of beta hCG can stimulate the thyroid gland to produce thyroxine (T4), and then triiodothyronine (T3). This can result in signs and symptoms of thyrotoxicosis.