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Question 1

What is the initial step in prem rupture of membranes (PPROM)

Answer 1

Sterile speculum exam
- check for pool of liquor
- vaginal swabbing
- ?cord prolapse

Question 2

How often should HbA1c be monitored?

How often should all other diabetic complications be monitored?

Answer 2

HbA1c = 6 months

Rest = annual - diabetic annual review

Question 3

1st line management of PPH

Answer 3

1. Oxytocin - stimulates uterine contractions + reduces bleeding
2. TXA/misoprostol

Question 4

How do you remember the types of abnormal placental villous adherence?

Answer 4

Accreta = Attaches myometrium
Increta = Infiltrates myometrium
Percreta = Penetrates past myometrium

Increasing level of severity

Question 5

How do you assess constipation?

Answer 5

• Frequency and what’s normal for them
• Consistency (use BSS - should be 3/4)
• Incontience/straining

Question 6

After how long of regular sex without contracpetion are further invx needed?

What is the first line of invx

Answer 6

1 yr

Mid-luteal-phase progesterone and semen analysis

Question 7

What are the Pharma and non-pharma ways to manage constipation?

Answer 7

Non-pharma
= adjust seat position - raise feet on stool

Pharma
- Bowel softener
- Laxido or lactulose (one used for risk of hepatic encephalopathy) must be mixed with water

Stimulant (better for opioids)
Senna 15mg taken at night

If PR rocks/fully unable to pass
1. Glycaine suppositories
2. Enemas

Question 8

What are the side effects of anti-cholingeric medications

Give examples

Answer 8

Dry mouth
Constipation
Urinary retention
Bowel obstruction
Increased HR
Decreased sweating

oxybutynin
amitriptyline

Question 9

What electrolyte can cause constipation?

Answer 9

Hypercalcemia

Question 10

What should be commented on when reporting a PR

Answer 10

• Hard Stool or empty passage
• Tone/sensation (ask to squeeze and if they can feel finger)
• Pathology (prostate size, fissure/roids, bleeding, discharge, overflow)

Question 11

DKA vs HHS

Presentation, findings and management

Answer 11

DKA
- hyperglycaemia >11
- KETONES present

HHS
- hyperglycaemia >30
- NO KETONES

Both present
- vomiting
- thirst and polyuria

DKA - acute onset
HHS - insidious onset

Manage
BOTH 1. Fluids
2. All need LMWH

DKA
- IV fixed rate insulin (monitor K+) - important to start fluids first

Question 12

Go to notes and complete breast lump flowchart

Who is referred on a 2 wk wait for breast lump

Answer 12

Look at notes for answers

unexplained breast lump >30
unexplained axiallary lump >30
unilateral nipple changes >50
skin changes suggestive of breast ca

Question 13

Who gets mammogram screening and how often?

Answer 13

Every 3 years for 50-70 yo

Question 14

Where does breast cancer spread

Answer 14

Bone
Brain

Lung
Liver

Lauren and Brooklyn massive boobs - 2 of them