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OSCE > Repro > Flashcards

Repro Flashcards

1
Q

What is meant by gravidity?

A

The number of times a woman has been pregnant, regardless of the outcome

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2
Q

What is meant by parity?

A

The total number of pregnancies carried over the threshold of viability (24 weeks)

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3
Q

How are multiple pregnancies counted in terms of parity?

A

They are counted as one pregnancy

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4
Q

What specific symptoms should you ask about in a gynae history?

A

Abdominal/pelvic pain or swellling, vaginal discharge, abnormal vaginal bleeding, pain during sex, itching/skin changes

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5
Q

What extra things should be asked about in a gynae history?

A

Menstrual history, contraception/HRT use, smears, previous gynae/obstetric history

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6
Q

When taking an obstetric history, what points should you clarify in the first instance?

A

Gestation, single or multiple pregnancy, first pregnancy or not

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7
Q

What specific symptoms should you ask about in an obstetric history?

A

Abdominal/pelvic pain, vaginal discharge, vaginal bleeding, nausea/vomiting, headaches/visual changes, swelling

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8
Q

What are the two most important things to ask about in an obstetric history?

A

Foetal movements and mental health

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9
Q

What extra things should be asked about in an obstetric history?

A

Current pregnancy (is antenatal care up to date, have they had any problems) and previous pregnancies (any complications, type of delivery etc)

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10
Q

What specific symptoms should you ask about in a male sexual history?

A

Abdominal/pelvic pain, testicular pain/swelling, urethral discharge or bleeding, skin changes, dysuria

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11
Q

What extra things must you remember to ask females in a sexual history?

A

Is there any chance they could be pregnant? When was their last period? Have they ever been pregnant before? Are they on any contraception? Are they up to date on their smears?

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12
Q

What questions must you ask about each sexual encounter in a sexual history?

A

Was it a male or female partner? Was it a regular partner? Was the sex consensual? What type of sex was it? Did they use a condom?

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13
Q

What questions should you ask in a sexual history to establish an individual’s risk of BBVs?

A

Have they ever had sex with someone from overseas? Have they ever had sex with someone who they knew had HIV/hepatitis? Have they ever injected drugs or had sex with someone who did? Have they had any non-professional tattoos or piercings? Have they ever paid for sex or been paid for sex?

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14
Q

What should you always warn patients at the end of a sexual history if they are undergoing STI testing?

A

To abstain from sex until the results come back or make sure they use a condom

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15
Q

What conditions should you always ask about a personal/family history of when discussing contraceptive options?

A

Migraines with aura, VTE, breast/cervical cancer

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16
Q

What should you always warn patients about at the end of a contraceptive history?

A

To continue using condoms in order to prevent STIs

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17
Q

It is important to warn patients that they might experience what symptom after a speculum examination?

A

Light spotting

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18
Q

How many times should you rotate the brush in a smear? How many times should you dunk it against the base of the pot?

A

5 / 10

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19
Q

At what age would women receive a smear every 3 years?

A

25 - 49

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20
Q

At what age would women receive a smear every 5 years?

A

50 - 64

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21
Q

Results of a smear test will usually be in the post in what timeframe? Patients should contact their GP if they haven’t received them by when?

A

2 weeks / 4 weeks

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22
Q

What is the action of a smear result saying ‘we found no HPV’?

A

Return for routine smear in 3/5 years

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23
Q

What is the action of a smear result saying ‘we found HPV but no cell changes’?

A

Return for a smear in 1 year

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24
Q

What is the action of a smear result saying ‘we found HPV with cell changes’?

A

Refer for colposcopy

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25
Q

What is the action of a smear result saying ‘unclear result’?

A

Return for another smear

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26
Q

After you have placed a urine sample on a pregnancy test, how long should you wait before reading the results?

A

3 minutes

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27
Q

On a urinary pregnancy test, what do each of the following results imply: 1) 2 lines? 2) 1 line on ‘C’? 3) 1 line on ‘T’?

A

1) Positive 2) Negative 3) Invalid

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28
Q

Testing for each of the following sexually transmitted infections should take place how long after potential exposure: 1) Chlamydia/Gonorrhoea? 2) HIV? 3) Syphilis/Hepatitis?

A

1) 2 weeks 2) 4 weeks 3) 3 months

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29
Q

Sexual health serology (HIV, hepatitis, syphilis) is taken as a single blood test in what vacutainer?

A

Gold

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30
Q

What colour of swab is used to take a chlamydia/gonorrhoea NAAT from the vulvo-vagina, pharynx or rectum?

A

Orange

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31
Q

What colour of tube is used to take a chlamydia/gonorrhoea NAAT from a first pass urine sample?

A

Yellow

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32
Q

How should chlamydia/gonorrhoea NAAT testing take place in women?

A

Vulvo-vaginal swabs

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33
Q

How should chlamydia/gonorrhoea NAAT testing take place in men?

A

First pass urine sample

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34
Q

What colour of swab is used to take a sample for HSV or syphilis serology?

A

Red

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35
Q

What colour of swab is used to take a high vaginal sample for microscopy and gram stain to detect candida, group b strep, trichomonas or BV?

A

Blue

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36
Q

What colour of swab is used to take urethral chlamydia/gonorrhoea gram stain, microscopy and culture in symptomatic males?

A

Blue

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37
Q

How is vaginal candidiasis treated?

A

Fluconazole 150mg one-off dose + Clotrimazole 1% cream 2-3 times daily

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38
Q

How are bacterial vaginosis and trichomonas vaginalis treated?

A

Metronidazole 400mg BD for 7 days

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39
Q

How is chlamydia treated?

A

Doxycycline 100mg BD for 7 days

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40
Q

How is gonorrhoea treated?

A

IM ceftriaxone 1g one-off dose

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41
Q

A test of cure for gonorrhoea is required after how long?

A

2 weeks

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42
Q

How is syphilis treated?

A

IM benzylpenicillin 2.4 million units one-off dose

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43
Q

What blood tests are taken for syphilis serology?

A

Syphilis IgG and IgM plus EIA

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44
Q

How are genital herpes treated?

A

Aciclovir 400mg TDS for 5 days

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45
Q

What investigations should you consider at the end of a sexual history?

A

Any required swabs, bloods for sexual health serology, CRP and FBC, urinary pregnancy test, urinalysis, MSSU for culture and sensitivity

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46
Q

What is the standard outpatient treatment for PID?

A

Ofloxacin and metronidazole 400mg BD for 14 days

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47
Q

What is the outpatient treatment for PID in those aged < 18 or at high risk of gonorrhoea?

A

1g IM ceftriaxone one-off dose and doxycycline 100mg and metronidazole 400mg BD for 14 days

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48
Q

What are the absolute contraindications to using combined hormonal contraceptives?

A

Smoker aged > 35 years, < 6 weeks post-partum or breastfeeding, migraine with aura, breast/cervical cancer, VTE, hypertension/CVD

49
Q

How do combined hormonal contraceptives, the implant, injection and IUS work?

A

Inhibition of ovulation, thickening of cervical mucus, thinning of the endometrium

50
Q

What are the main hormonal effects that may be experienced with combined or progesterone only methods of contraception (apart from IUS)?

A

Weight gain, acne, mood change, headache

51
Q

What are the two main risks of combined hormonal contraceptives?

A

VTE and increased risk of breast and cervical cancer

52
Q

Contraception should ideally be started within the first 5 days of regular menstruation. If this does not occur, which contraceptives require 7 days of condom use?

A

Combined methods, implant, injections and IUS

53
Q

What is the advice if one COCP is missed?

A

Take it ASAP, even if it is with the next pill

54
Q

What is the advice if two COCPs are missed in the first week?

A

Take one pill ASAP, use condoms for the next 7 days, consider emergency contraception if had sex that week

55
Q

What is the advice if two COCPs are missed in the second week?

A

Take one pill ASAP, use condoms for the next 7 days

56
Q

What is the advice if two COCPs are missed in the third week?

A

Take one pill ASAP, use condoms for the next 7 days, omit the pill-free interval

57
Q

What advice should be given to someone on the COCP with diarrhoea and/or vomiting?

A

Use condoms for 7 days

58
Q

What are the absolute contraindications to the use of the progesterone only pill?

A

Breast cancer and liver cirrhosis

59
Q

How does the progesterone only pill work?

A

Increasing cervical mucus and thinning the endometrium

60
Q

How should the progesterone only pill be taken?

A

At the same time every day with no pill-free interval

61
Q

Contraception should ideally be started within the first 5 days of regular menstruation. If this does not occur, which contraceptives require 2 days of condom use?

A

Progesterone only pill

62
Q

What is the advice if one POP is missed (< 3 hours)?

A

Take it ASAP

63
Q

What is the advice if two POPs are missed? (> 3 hours or > 12 hours for Cerazette)

A

Use condoms for 2 days and consider emergency contraception if had sex 2-3 days before or during the break

64
Q

What are some side effects specific to the contraceptive injection?

A

Weight gain, osteoporosis, delay in return of fertility

65
Q

What is the main contraindication to the use of intra-uterine contraceptive devices?

A

Any pelvic infection within the last 3 months or any gynae malignancy

66
Q

What should you do before inserting an intra-uterine contraceptive?

A

STI test

67
Q

How does the copper-IUD work?

A

Copper acts as a spermicide and causes intra-uterine inflammation

68
Q

Which is the only contraceptive that is likely to make periods heavier?

A

Copper-IUD

69
Q

When can the copper-IUD be used for emergency contraception?

A

Up to 120 hours after unprotected sex or up to 5 days after expected ovulation

70
Q

Those who use the copper-IUD for emergency contraception require what follow-up?

A

Pregnancy test 3-6 weeks later

71
Q

When can ulipristal acetate be used for emergency contraception?

A

Within 120 hours of unprotected sex

72
Q

A second dose of emergency contraception is required if vomiting occurs within what timeframe?

A

3 hours

73
Q

When can levonorgestrel be used for emergency contraception?

A

Within 72 hours of unprotected sex

74
Q

When should the dose of levonorgestrel for emergency contraception be doubled?

A

BMI > 26 or weight > 70kg

75
Q

Which causes of a testicular swelling will be continuous with the testis?

A

Tumour and hydrocele

76
Q

Which causes of a testicular swelling will be separate from the testis?

A

Epididymal cyst and varicocele

77
Q

Which testicular swellings will transilluminate?

A

Hydroceles and epididymal cysts

78
Q

What are some investigations you might consider in someone with a testicular swelling?

A

Ultrasound, fluid aspirate, bloods for HCG and AFP

79
Q

A varicocele is more common on which side? Why is it important to be aware of these?

A

Left side - can be a sign of renal cancer

80
Q

When performing inspection as part of a breast exam, you should ask the woman to sit in what three different positions?

A

Hands on thighs, hands on hips, hands behind head

81
Q

How should you position patients when palpating during a breast exam?

A

At 45 degrees on the bed with their arm behind their head

82
Q

Which lymph nodes should you palpate during a breast exam?

A

Axillary, supraclavicular and all head/neck nodes

83
Q

What is the further management after history and examination of a woman with a breast lump?

A

Referral to breast clinical for imaging (US/mammography) and biopsy

84
Q

What is a good system to use for explaining your findings of a breast lump?

A

Size, site, shape/consistency, mobility, skin changes

85
Q

When taking a history of a breast lump, you should always ask if there is any relationship with what?

A

The menstrual cycle

86
Q

What are some important questions to ask about the characteristics of a breast lump in a history?

A

Is it hard or soft? Is it smooth or irregular? Is it mobile? Is it painful?

87
Q

What are some specific symptoms related to breast pathology you should ask about when taking a history of a breast lump?

A

Any nipple discharge or bleeding? Any changes in the skin of the breast or nipple?

88
Q

In a history of a breast lump, you should take a focused O+G history. What sort of things should you include?

A

Menstrual history, use of contraceptives/HRT, pregnancies/breastfeeding

89
Q

What procedure is a risk factor for the development of breast cancer and may be a useful thing to ask about during past medical history?

A

Radiation to the chest

90
Q

When is it normal to feel foetal movements by?

A

20 weeks - however, they may be noticed earlier in multiparous women

91
Q

If a woman reports any change in foetal movements, what investigations should be done?

A

CTG and ultrasound

92
Q

What are some important points to discuss before beginning a pregnant abdomen exam?

A

Single/multiple pregnancy? First pregnancy? Gestation? How have things been going so far? Foetal movements? Maternal mental health?

93
Q

What are some questions you should ask women before beginning a pregnant abdomen exam to ensure their comfort?

A

Do they need to go to the toilet? Are they currently in any pain? Get them to tell you if they feel breathless at any point.

94
Q

What are you looking for on inspection of a pregnant abdomen?

A

Skin changes, size of bump, symphyseal-fundal height

95
Q

Symphyseal-fundal height should be measured at all antenatal appointments from what point in pregnancy?

A

24 weeks

96
Q

The symphyseal-fundal height in cm should correlate roughly with what?

A

The gestation in weeks (+/- 2)

97
Q

When should the fundus be roughly at the height of the umbilicus? What should the fundus be roughly at the height of the xiphisternum?

A

20 weeks, 36 weeks

98
Q

What should you palpate during a pregnant abdomen exam and what are you trying to find out?

A

Palpate the top of the bump (fundus) for height, the sides of the bump for lie and the bottom of the bump for presentation and engagement

99
Q

The lie and presentation of a baby is only relevant after what gestation?

A

36 weeks

100
Q

Where should you try to auscultate for a foetal pulse? What should you do at the same time?

A

Roughly at the anterior shoulder, you should feel the maternal pulse at the same time

101
Q

If the presenting part feels hard and round, what is the most likely presentation?

A

Cephalic

102
Q

If the presenting part is broad, soft and poorly defined, what is the most likely presentation?

A

Breech

103
Q

When may you not be able to feel the presenting part of a foetus?

A

If they are in a transverse lie

104
Q

What are the three potential ways a foetus can lie in the abdomen?

A

Longitudinal, oblique or transverse

105
Q

What further assessment is always required after a pregnant abdomen examination?

A

BP and urinalysis

106
Q

For a singleton pregnancy, when is the fundus usually palpable?

A

12 weeks

107
Q

When are the two different types of Down’s syndrome screening in pregnancy used?

A

Combined test (bloods + US) is used from 11-13+6 weeks; 2nd trimester screening (bloods only) is used from 15-20 weeks

108
Q

What bloods are tested for in combined Down’s syndrome screening and what do they show if positive for the condition?

A

Beta HCG (high) and PAPP-A (low)

109
Q

What US measurement is used for combined Down’s syndrome screening? What happens to this measurement if positive for the condition?

A

Nuchal translucency - will be increased in Down’s

110
Q

What four bloods are tested for in second trimester Down’s syndrome screening and what do they show if positive for the condition?

A

Beta HCG and inhibin-A are high; AFP and unconjugated oestriol are low

111
Q

The results of Down’s syndrome screening are combined with what factors to produce a personalised risk?

A

Gestational age and maternal age

112
Q

If the results of Down’s syndrome screening come back as > 1/150, what further tests are offered?

A

CVS (11-14 weeks) or amniocentesis (> 15 weeks)

113
Q

Women who are at high risk of developing pre-eclampsia should be taking what medication and when?

A

75mg aspirin OD from 12 weeks

114
Q

What supplements should all women take in pregnancy?

A

Folic acid 400mcg until 12 weeks, vitamin D 10mcg throughout pregnancy and breastfeeding

115
Q

Pre-eclampsia can only be diagnosed when hypertension and proteinuria are present at what gestation?

A

> 20 weeks

116
Q

If a woman has suspected pre-eclampsia, what further investigations should be done?

A

Spot urine PCR, bloods (particularly FBC and LFTs for HELLP syndrome)

117
Q

What is the first-line antihypertensive to use in pregnancy?

A

Oral labetalol

118
Q

Women with pre-eclampsia need to be admitted- what for?

A

Regular blood pressure measurements and blood tests, also US scans

119
Q

Delivery is suggested for women with pre-eclampsia beyond what gestation? This can be delayed by 24-48 hours to allow what to be done?

A

34 weeks - to allow maternal corticosteroids to be given to mature the foetal lungs

OSCE (14 decks)

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