Obs/Gynae Passmed Test Questions |
100% Correct Answers | Verified | Latest
2024 Version
A 38-year-old woman with a 4.5cm fibroid has been listed for a myomectomy following a 5 month
history of heavy menstrual bleeding, What drug should be prescribed to be taken whilst awaiting
surgery? - ✔✔GnRH anaologue to reduce the size of fibroids
In who are fibroids more common? - ✔✔more common in Afro-Caribbean women
rare before puberty, develop in response to oestrogen, don't tend to progress following menopause
How do fibroids present? - ✔✔Most are ASx
Sx:
- bleeding: longer, heavier periods; anemia
- pressure: pelvic pressure and bloating; constipation and rectal pressure; urinary frequency or retention
- pain: secondary dysmenorrhea, dyspareunia
- pelvic sx: firm, nontender, irregular enlarged ("lumpy-bumpy") or cobblestone uterus may be seen
How do we diagnose fibroids? - ✔✔Transvaginal USS
How do we manage fibroids? - ✔✔-symptomatic management with a levonorgestrel-releasing
intrauterine system is recommended by CKS first-line
-other options include tranexamic acid, combined oral contraceptive pill etc
-GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment
-surgery is sometimes needed: myomectomy, hysterscopic endometrial ablation, hysterectomy
,uterine artery embolization
What is a Cx of fibroids? - ✔✔red degeneration - haemorrhage into tumour - commonly occurs during
pregnancy
A 24-year-old woman presents to her GP 8 days after giving birth. She complains of a persistent pink
vaginal discharge which is 'smelly'. On examination her pulse is 90 / min, temperature 38.2ºC and she
has diffuse suprapubic tenderness. On vaginal examination the uterus feels generally tender.
Examination of her breasts is unremarkable. Urine dipstick shows blood ++. What is the most
appropriate management? - ✔✔Admit to hospital (puerperal pyrexia)
What is the definition of puerperal pyrexia? - ✔✔Temp >38C, within 14 days of delivery
What are the causes of puerperal pyrexia? - ✔✔endometritis: most common cause
urinary tract infection
wound infections (perineal tears + caesarean section)
mastitis
venous thromboembolism
How do we manage endometritis/puerperal pyrexia? - ✔✔1. Admit
2. IV Abs (clindamycin and gentamicin until afebrile for over 24 hours)
A 36-year-old nulliparous woman is admitted in labour at 37 weeks gestation. On examination, the cervix
is 7 cm dilated, the head is direct Occipito-Anterior, the foetal station is at -1 and the head is 2/5 ths
palpable per abdomen. The cardiotocogram shows late decelerations and a foetal heart rate of 100
beats/min which continue for 15 minutes. How should this situation be managed? - ✔✔C-section
(late decelerations in context of bradycardia is worrying)
, - can't do inhstrumental delivery because the cervix isnt fully dilated and baby's head is high
-oxytocin and PG are contraindicated due to foetal distress
What is the normal variation of foetal HR? - ✔✔100-160
Causes of baseline bradycardia - ✔✔Increased faetal vagal tone
Maternal BB use
Causes of baseline tachycardia - ✔✔maternal pyrexia
Chorioamnionitis
Hypoxia
Prematurity
Causes of a loss of baseline variability - ✔✔Prematurity/hypoxia (<5BPM)
What is the cause of an early deceleration and what does it mean? - ✔✔Deceleration of the heart rate
which commences with the onset of a contraction and returns to normal on completion of the
contraction
Usually inocuous- indicates head compression
What is the cause of a late deceleration and what does it mean? - ✔✔Deceleration of the heart rate
which lags the onset of a contraction and does not returns to normal until after 30 seconds following the
end of the contraction
Indicates fetal distress e.g. asphyxia or placental insufficiency
100% Correct Answers | Verified | Latest
2024 Version
A 38-year-old woman with a 4.5cm fibroid has been listed for a myomectomy following a 5 month
history of heavy menstrual bleeding, What drug should be prescribed to be taken whilst awaiting
surgery? - ✔✔GnRH anaologue to reduce the size of fibroids
In who are fibroids more common? - ✔✔more common in Afro-Caribbean women
rare before puberty, develop in response to oestrogen, don't tend to progress following menopause
How do fibroids present? - ✔✔Most are ASx
Sx:
- bleeding: longer, heavier periods; anemia
- pressure: pelvic pressure and bloating; constipation and rectal pressure; urinary frequency or retention
- pain: secondary dysmenorrhea, dyspareunia
- pelvic sx: firm, nontender, irregular enlarged ("lumpy-bumpy") or cobblestone uterus may be seen
How do we diagnose fibroids? - ✔✔Transvaginal USS
How do we manage fibroids? - ✔✔-symptomatic management with a levonorgestrel-releasing
intrauterine system is recommended by CKS first-line
-other options include tranexamic acid, combined oral contraceptive pill etc
-GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment
-surgery is sometimes needed: myomectomy, hysterscopic endometrial ablation, hysterectomy
,uterine artery embolization
What is a Cx of fibroids? - ✔✔red degeneration - haemorrhage into tumour - commonly occurs during
pregnancy
A 24-year-old woman presents to her GP 8 days after giving birth. She complains of a persistent pink
vaginal discharge which is 'smelly'. On examination her pulse is 90 / min, temperature 38.2ºC and she
has diffuse suprapubic tenderness. On vaginal examination the uterus feels generally tender.
Examination of her breasts is unremarkable. Urine dipstick shows blood ++. What is the most
appropriate management? - ✔✔Admit to hospital (puerperal pyrexia)
What is the definition of puerperal pyrexia? - ✔✔Temp >38C, within 14 days of delivery
What are the causes of puerperal pyrexia? - ✔✔endometritis: most common cause
urinary tract infection
wound infections (perineal tears + caesarean section)
mastitis
venous thromboembolism
How do we manage endometritis/puerperal pyrexia? - ✔✔1. Admit
2. IV Abs (clindamycin and gentamicin until afebrile for over 24 hours)
A 36-year-old nulliparous woman is admitted in labour at 37 weeks gestation. On examination, the cervix
is 7 cm dilated, the head is direct Occipito-Anterior, the foetal station is at -1 and the head is 2/5 ths
palpable per abdomen. The cardiotocogram shows late decelerations and a foetal heart rate of 100
beats/min which continue for 15 minutes. How should this situation be managed? - ✔✔C-section
(late decelerations in context of bradycardia is worrying)
, - can't do inhstrumental delivery because the cervix isnt fully dilated and baby's head is high
-oxytocin and PG are contraindicated due to foetal distress
What is the normal variation of foetal HR? - ✔✔100-160
Causes of baseline bradycardia - ✔✔Increased faetal vagal tone
Maternal BB use
Causes of baseline tachycardia - ✔✔maternal pyrexia
Chorioamnionitis
Hypoxia
Prematurity
Causes of a loss of baseline variability - ✔✔Prematurity/hypoxia (<5BPM)
What is the cause of an early deceleration and what does it mean? - ✔✔Deceleration of the heart rate
which commences with the onset of a contraction and returns to normal on completion of the
contraction
Usually inocuous- indicates head compression
What is the cause of a late deceleration and what does it mean? - ✔✔Deceleration of the heart rate
which lags the onset of a contraction and does not returns to normal until after 30 seconds following the
end of the contraction
Indicates fetal distress e.g. asphyxia or placental insufficiency
