reproductive health

Question 1

when does fertility come back post childbirth?

Answer 1

21 days after giving birth

Question 2

is lactational amenorrhoea effective contraception?

Answer 2

yes, it is over 98% effective for up to 6 months after birth. for it to work women but be fully breastfeeding and amenorrhoeic.

Question 3

how do oestrogen and progesterone work as contraceptives?

Answer 3

have a negative feedback effect on the hypothalamus and anterior pituitary, suppressing the release of GnRH, LH and FSH. Without the effects of LH and FSH, ovulation does not occur

Question 4

when prescribing the COCP, which types are 1st line and why?

Answer 4

pill with either levonorgestrel or norethisterone
lower risk of VTE than the others

Question 5

which COCP is first line for PMS?

Answer 5

ones containing drospirenone

Question 6

which COCP is used for acne and hirsutism?

Answer 6

ones containing cyproterone (progestogen) -has anti-androgen effects

Question 7

according to NICE, if you’re on the COCP and have a major operation planned what should you do?

Answer 7

stop the COCP 4 weeks before a major operation to reduce risk of thrombosis.

Question 8

what is the one progesterone only pill that inhibits ovulation?

Answer 8

desogestrel

Question 9

how long is the mirena licensed to stay inside you?

Answer 9

5 years for contraception
4 years for HRT

Question 10

in a breastfed healthy term baby who was having minor growth faltering but all normal and no other red flags what would you do first?

Answer 10

take full breastfeeding history and encourage more frequent feeding.

Question 11

if a breastfeeding woman develops a hot red lump on her breast what is the most common organism that would be causing it?

Answer 11

staph aureus

Question 12

what is the only effective fertility treatment for large fibroids causing problems with fertility?

Answer 12

myomectomy

Question 13

what is parametritis?

Answer 13

inflammation of the parametrium -connective tissue around uterus.

Question 14

what is cervical motion tenderness?

Answer 14

severe pain on palpation of the cervix -may suggest pelvic inflammatory disease or ectopic pregnancy.

Question 15

what is the firstline test for endometrial cancer

Answer 15

transvaginal USS

Question 16

what happens if you use SSRIs in the third semester of pregnancy?

Answer 16

risk of persistent pulmonary hypertension of the newborn

Question 17

what are the top 3 causes of big antepartum haemorrhage?

Answer 17

placenta praevia
placental abruption
vasa praevia

Question 18

what is antepartum haemorrhage?

Answer 18

bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby.

Question 19

what are the features of congenital zika syndrome?

Answer 19

microcephaly
foetal growth restriction
other intracranial abnormalities eg ventriculomegaly and cerebellar atrophy

Question 20

what types of hormones does the patch have?

Answer 20

oestrogen and progesterone

Question 21

how often do you change the contraceptive patch?

Answer 21

weekly

Question 22

what forms does combined hormonal contraception come in?

Answer 22

COCP, transdermal patch, and vaginal rings

Question 23

how long does each vaginal contraceptive ring last for?

Answer 23

3 weeks

Question 24

when does full protection from female sterilisation kick in?

Answer 24

when next period starts after procedure

Question 25

how long does the copper coil stay in?

Answer 25

5-10 years

Question 26

what is the primary MOA of the copper coil?

Answer 26

decreases sperm motility and survival

Question 27

what is the effectiveness of the withdrawal method?

Answer 27

22/100 will get pregnant within a year.

Question 28

what is the effectiveness of condoms?

Answer 28

18% will get pregnant in a year with typical use 2% with perfect use

Question 29

how effective is female sterilisation?

Answer 29

0.5% chance in 1 year

Question 30

what is dilatation and curettage?

Answer 30

brief surgical procedure in which the cervix is dilated and a special instrument is used to scrape the uterine lining

Question 31

what is Fitz-Hugh-Curtis syndrome?

Answer 31

rare complication of pelvic inflammatory disease (PID) involving liver capsule inflammation leading to the creation of adhesions.

Question 32

what is a small risk of ondansetron if given for >5d in pregnancy?

Answer 32

cleft lip/palate

Question 33

what drug is firstline for magnesium sulfate induced resp depression?

Answer 33

calcium glucanate

Question 34

4 major direct obstetric killers of pregnant women?

Answer 34

haemorrhage pre-eclampsia sepsis thrombosis

Question 35

what position can help to put eclamptic women having seizures in?

Answer 35

left lateral position

Question 36

how common is vasa praevia and which situations is it usually associated with?

Answer 36

rare usually occurs with an ARM or in labour

Question 37

what level of hCG rise is expected in normal pregnancy?

Answer 37

65-70% in 48 hours

Question 38

what is a varicocoele?

Answer 38

varicose veins in scrotum

Question 39

when is anti-D needed in a miscarriage/ectopic situation?

Answer 39

needed for surgical management of an ectopic pregnancy/miscarriage not needed for spontaneous first trimester miscarriage or medical/expectant management of miscarriage/ectopic

Question 40

what do the different bishops scores mean?

Answer 40

8 or more -cervix is 'ripe', ready to dilate, and high chance of spontaneous labour. less than or equal to 6 -unfavourable/unripe for induction less than 5-labour unlikely to start on its own

Question 41

what is false labour?

Answer 41

occurs in last 4 weeks of pregnancy contractions felt in lower abdomen-irregular occur every 20 mins, no cervical changes

Question 42

how far into the pregnancy should the booking visit be?

Answer 42

ideally <10 weeks

Question 43

what do you do if someone has reduced foetal movements and no heartbeat is detected with handheld doppler after 28 weeks?

Answer 43

immediate USS

Question 44

what do you do if there is reduced foetal movements but doppler finds a foetal heartbeat?

Answer 44

cardiotocography for at least 20 minutes

Question 45

when do foetal movements start getting recognised and increase?

Answer 45

18-20 weeks -start getting recognised (multiparous -from 16) increase till 32w where they plateau off

Question 46

what is a worryingly low number of foetal movements to be getting (past 28 weeks)?

Answer 46

less than 10 in 2 hours

Question 47

how late in the pregnancy do they need referral because they haven't felt foetal movements yet?

Answer 47

24 weeks

Question 48

if a woman is in labour what HR readings would prompt a transfer to consultant led care?

Answer 48

pulse over 120bpm on 2 occasions 30mins apart

Question 49

where is the fundus throughout pregnancy?

Answer 49

12w -pubic symphysis 20w-umblicus 37w-full height

Question 50

if a woman is in labour what BP readings would prompt transfer to consultant led care?

Answer 50

160/90 or more (either reading) 2 readings of 140/90 or more taken 30 mins apart

Question 51

in labour what foetal HR readings would prompt referral to consultant led care?

Answer 51

foetal HR below 110 or above 160 deceleration heard

Question 52

what is actually the contents of the cervical smear tests?

Answer 52

all of them get tested for high risk hpv if positive get cytology (looking at cells under microscope), if negative do not.

Question 53

how do you manage a 1st episode of depression in a woman who is pregnant?

Answer 53

subtheshold/mild -referral for facilitated self help mild but history of severe depression -TCA, SSRI, or SNRI moderate to severe depression -1st line =CBT, 2nd line=TCA/SSRI/SNRI (1st line if she expresses preference). if not working can do combination.

Question 54

when should you be able to hear the foetal heart on doppler?

Answer 54

by 20 weeks shouldn't listen before 16 weeks-won't hear anything and will just stress out mum

Question 55

what are the risks of interpregnancy interval of less than 12 months?

Answer 55

increased risk of preterm birth, low birthweight, and SGA babies.

Question 56

what supplement do you need to take if you're breastfeeding?

Answer 56

vitamin d

Question 57

what do the different ACR levels mean?

Answer 57

3-30=microalbuminaemia 30+: proteinuria

Question 58

what is proteinuria on urine dip?

Answer 58

2+

Question 59

what are the rules for ACEis in pregnancy and why?

Answer 59

need to come off them straight away - especially in 2nd and 3rd trimesters causes kidney issues in baby, PDA, oligohydramnios

Question 60

what can happen if you use benzodiazepines in pregnancy to baby?

Answer 60

neonatal withdrawal if used regularly neonatal hypothermia

Question 61

What are the rules of NSAIDs in pregnancy and why?

Answer 61

don’t give at all - what they’re told in practise after 30 weeks - risks closing DA early

Question 62

What is the rules on warfarin in pregnancy and why?

Answer 62

Don’t use in gen- causes miscarriage, LD, bones, brain bleeds specialist led- can sometimes use with artificial heart valve

Question 63

What medication do you use for anti clotting in pregnancy?

Answer 63

LMWH- clexane (enoxaparin)

Question 64

what do you use for UTI in pregnancy?

Answer 64

nitrofurantoin at term- amoxicillin if you know culture, if not clarithromycin don’t use trimethoprim

Question 65

what is SGA and severe SGA?

Answer 65

foetus that measures below the 10th centile for gestational age sevre =below 3rd

Question 66

what is LBW?

Answer 66

below 2500g

Question 67

which hormone increases in menopause?

Answer 67

FSH

Question 68

what is the classic presentation of turner's?

Answer 68

short stature webbed neck, widely spaced nippled, shield chest primary amennorhoea biscuspid aortic valve (15%) -ESM

Question 69

what is the genetic code for turner's?

Answer 69

45, X0

Question 70

which combined HRTs are safe for VTE risk?

Answer 70

transdermal -no evidence of it increasing risk compared to general pop (oral does-they think maybe something to do with oral metabolism vs skin)

Question 71

what cancer is tamoxifen a risk factor for?

Answer 71

endometrial (oestrogen antagonist in breast but agonist in endometrium)

Question 72

patients who have had LLETZ for CIN need what follow up?

Answer 72

smear in 6 months after

Question 73

what is the classic triad of vasa praevia?

Answer 73

rupture of membranes followed by painless vaginal bleeding and foetal bradycardia

Question 74

what is the classic presentation of vesicovaginal fistula?

Answer 74

continuous dribbling incontinence after prolonged labour if they didn't get much antenatal care

Question 75

what imaging is best if they have bleeding in the first trimester?

Answer 75

transvaginal USS

Question 76

what do you do if they're exposed to chickenpoxin pregnancy?

Answer 76

check for abs. if not immune: VZIG: can give within 10 days of exposure PO acycylovir: can give within 24h of sx if >20w.

Question 77

what counts as precocious puberty?

Answer 77

<8 in F, <9 in M

Question 78

what are the contraindications to VBAC?

Answer 78

1) normal vaginal birth contraindications eg placenta praevia 2) vertical scar f`rom previous c section 3) previous uterine rupture

Question 79

what is the success rate of VBAC?

Answer 79

about 75%

Question 80

what are 3 drugs that can stimulate ovulation used in subfertility treatment?

Answer 80

clomifene letrozole gonadotrophins

Question 81

what are 3 drugs that can stimulate ovulation used in subfertility treatment?

Answer 81

clomifene letrozole gonadotrophins

Question 82

when doing hormone testing for subfertility when do you collect each female hormone

Answer 82

LH and FSH -day 2-5 of cycle progesterone -7 days before end of cycle eg day 21

Question 83

what sleeping position is associated with stillbirth?

Answer 83

sleeping on your back

Question 84

what can be used to suppress lactation after birth in a stillbirth?

Answer 84

dopamine agonists eg cabergoline

Question 85

what do you do with the COCP if they miss 2 pills in week 3 of the cycle?

Answer 85

finish pills in current pack and start new pack immediately, omitting pill free interval