FRANZCOG Written MCQ cheat sheet

Hypertensive disorders: pre-eclampsia is new hypertension after 20 weeks plus proteinuria or maternal organ dysfunction; severe features include BP at least 160/110, platelets under 100, creatinine over 110 micromol/L, transaminases over twice normal, pulmonary oedema, or visual/cerebral symptoms.

Antepartum haemorrhage: placenta praevia causes painless bright bleeding with a soft uterus; abruption causes painful bleeding with a tense uterus and fetal compromise. Never perform a digital vaginal examination until praevia is excluded by ultrasound.

Shoulder dystocia sequence: call for help, McRoberts manoeuvre plus suprapubic pressure, then internal rotational manoeuvres, then posterior arm delivery; the HELPERR mnemonic organises this. Document the head-to-body interval.

Preterm labour: antenatal corticosteroids (betamethasone) reduce respiratory distress, intraventricular haemorrhage, and neonatal death; give before 34 weeks, and consider 34-36 weeks when delivery is imminent without steroids. Magnesium sulphate before 30 weeks reduces cerebral palsy.

Group B streptococcus: intrapartum penicillin prophylaxis is indicated for previous infant with invasive GBS disease, GBS bacteriuria in this pregnancy, or a positive rectovaginal swab; also for unknown status with risk factors such as labour before 37 weeks, rupture over 18 hours, or intrapartum fever.

Postpartum haemorrhage: primary PPH is blood loss of 500 mL or more after vaginal birth or 1000 mL or more after caesarean, or any loss causing haemodynamic compromise. Causes are tone, trauma, tissue, thrombin. Give tranexamic acid 1 g within 3 hours.

Fetal surveillance: cardiotocography categories - baseline 110-160 bpm, variability 5-25 bpm, accelerations, no decelerations is normal. Late decelerations suggest uteroplacental insufficiency; variable decelerations suggest cord compression; prolonged deceleration over 3 minutes requires escalation.

Gestational diabetes: screen at 24-28 weeks with 75 g oral glucose tolerance test; diagnose if fasting at least 5.1 mmol/L, 1-hour at least 10.0 mmol/L, or 2-hour at least 8.5 mmol/L. Target fasting under 5.0 mmol/L.

Rhesus prophylaxis: give anti-D immunoglobulin to Rh-negative unsensitised women at 28 and 34 weeks, and within 72 hours of delivery of an Rh-positive infant, plus after sensitising events such as miscarriage, ectopic pregnancy, or amniocentesis.

Abnormal uterine bleeding is classified by PALM-COEIN: structural causes are polyp, adenomyosis, leiomyoma, malignancy/hyperplasia; non-structural are coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified.

Cervical screening: liquid-based cytology with HPV testing; HPV-negative women with normal cytology have low risk and extended screening intervals. Persistent oncogenic HPV (especially types 16 and 18) drives referral to colposcopy.

Ectopic pregnancy: discriminatory human chorionic gonadotropin zone is about 1500-3500 IU/L for transvaginal ultrasound to visualise an intrauterine sac. A rise of less than 50% over 48 hours suggests an abnormal pregnancy; methotrexate is an option when stable and unruptured.

Ovarian torsion presents with sudden severe unilateral pain, nausea, and a tender adnexal mass; do not delay surgery for imaging that may show a normal ovary. Detorsion with ovarian preservation is preferred over oophorectomy.

Endometriosis: definitive diagnosis is laparoscopic visualisation with histology; first-line medical therapy is combined hormonal contraception or progestogens; GnRH agonists cause hypo-oestrogenism and require add-back therapy for bone protection.

Menopause: diagnosed clinically after 12 months of amenorrhoea in a woman over 45 with no other cause; FSH is not required. Hormone therapy is the most effective treatment for vasomotor symptoms and should be individualised.

Contraception: the combined oral contraceptive is contraindicated with migraine with aura, prior venous thromboembolism, and uncontrolled hypertension. The levonorgestrel intrauterine system is effective for heavy menstrual bleeding and endometrial protection.

Ovarian cancer: most present at advanced stage with vague symptoms; CA125 is a marker, not a screening test. Risk-reducing bilateral salpingo-oophorectomy is offered to BRCA1/BRCA2 carriers after childbearing is complete.

Polycystic ovary syndrome uses Rotterdam criteria: two of three of oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound, after excluding other causes.