FRANZCOG Written MCQ flashcards

31 cards. Read the term and the definition here. The deck at the top of this page is optional.

Pre-eclampsia definition

New hypertension after 20 weeks plus proteinuria or maternal organ dysfunction. Severe features include very high blood pressure, low platelets, renal impairment, liver involvement, pulmonary oedema, or neurological symptoms.

Placenta praevia presentation

Painless bright vaginal bleeding in later pregnancy with a soft, non-tender uterus. The placenta lies over or near the cervical os. Digital vaginal examination is avoided until ultrasound excludes it.

Placental abruption features

Painful vaginal bleeding with a tense, tender uterus, often with fetal compromise or distress. Bleeding may be concealed. Risk factors include hypertension, trauma, and previous abruption.

Shoulder dystocia manoeuvres

Sequence: call for help, McRoberts manoeuvre with suprapubic pressure, then internal rotational manoeuvres, then posterior arm delivery. Document the head-to-body interval and any fetal injury.

Antenatal corticosteroids

Betamethasone given before 34 weeks reduces neonatal respiratory distress, intraventricular haemorrhage, and death. Consider use at 34-36 weeks when preterm delivery is imminent and steroids are not already given.

Magnesium sulphate neuroprotection

Given before preterm birth under 30 weeks, magnesium sulphate reduces the risk of cerebral palsy. It is also used for seizure prophylaxis in pre-eclampsia and eclampsia.

Group B streptococcus prophylaxis

Intrapartum penicillin is indicated for prior infant with invasive GBS disease, GBS bacteriuria this pregnancy, or positive swab. Also for unknown status with preterm labour, prolonged rupture, or intrapartum fever.

Primary postpartum haemorrhage

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, and thrombin.

Tranexamic acid in PPH

Give 1 g intravenously within 3 hours of birth in postpartum haemorrhage. It reduces death from bleeding and is given alongside uterotonics, resuscitation, and treatment of the underlying cause.

Cardiotocography normal baseline

Baseline rate 110-160 bpm with variability 5-25 bpm, accelerations present, and no decelerations. This is a normal category and requires no intervention beyond routine observation.

Late decelerations

Decelerations beginning after the contraction peak, suggesting uteroplacental insufficiency and fetal hypoxia. Management includes maternal repositioning, fluid bolus, stopping oxytocin, and escalation if persistent.

Variable decelerations

Abrupt decelerations of variable shape and timing, typically caused by umbilical cord compression. Repositioning the mother and considering amnioinfusion or expedited delivery are management options.

Gestational diabetes diagnosis

A 75 g oral glucose tolerance test at 24-28 weeks is diagnostic if fasting is at least 5.1 mmol/L, one-hour at least 10.0 mmol/L, or two-hour at least 8.5 mmol/L.

Rhesus prophylaxis schedule

Anti-D immunoglobulin for Rh-negative unsensitised women at 28 and 34 weeks, within 72 hours of an Rh-positive delivery, and after sensitising events such as miscarriage, ectopic pregnancy, or amniocentesis.

Pregnancy hypertension thresholds

Hypertension in pregnancy is a systolic of 140 mmHg or more or diastolic of 90 mmHg or more. Severe hypertension is 160/110 or higher and requires urgent treatment.

PALM-COEIN classification

Classification of abnormal uterine bleeding. PALM covers structural causes: polyp, adenomyosis, leiomyoma, malignancy and hyperplasia. COEIN covers non-structural causes: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not otherwise classified.

Cervical screening and HPV

Liquid-based cytology combined with HPV testing. Persistent oncogenic HPV, especially types 16 and 18, prompts colposcopy. HPV-negative women with normal cytology have low risk and longer screening intervals.

Ectopic pregnancy discriminatory zone

A serum human chorionic gonadotropin of about 1500-3500 IU/L at which a normal intrauterine sac should be visible on transvaginal ultrasound. An abnormal rise over 48 hours suggests ectopic or failing pregnancy.

Methotrexate for ectopic

A medical option for a stable, unruptured ectopic pregnancy with low human chorionic gonadotropin and no fetal cardiac activity. It is contraindicated with significant pain, haemodynamic instability, or large mass.

Ovarian torsion management

Sudden severe unilateral pelvic pain with nausea and a tender adnexal mass suggests torsion. Urgent laparoscopy is required. Detorsion with ovarian preservation is preferred over oophorectomy, even if the ovary looks dusky.

Endometriosis first-line therapy

Combined hormonal contraception or progestogens are first-line medical treatment. Laparoscopy with histology provides definitive diagnosis. GnRH agonists cause hypo-oestrogenism and need add-back therapy for bone protection.

Menopause diagnosis

Clinical diagnosis after 12 months of amenorrhoea in a woman over 45 with no other cause. Follicle-stimulating hormone testing is not required. Hormone therapy is the most effective treatment for vasomotor symptoms.

Combined pill contraindications

Avoid the combined oral contraceptive with migraine with aura, prior venous thromboembolism, uncontrolled hypertension, smoking over age 35, and thrombophilia. Progestogen-only methods are alternatives.

Levonorgestrel intrauterine system

An intrauterine device releasing levonorgestrel, effective for heavy menstrual bleeding, dysmenorrhoea, and endometrial protection. It also provides long-acting contraception and reduces menstrual loss over months.

Ovarian cancer presentation

Most cases present at an advanced stage with vague abdominal bloating and pain. CA125 supports investigation but is not a screening test. Risk-reducing bilateral salpingo-oophorectomy is offered to BRCA carriers.

Polycystic ovary syndrome criteria

Rotterdam criteria require two of three features: oligo-ovulation or anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound. Other causes must be excluded first.

Abnormal uterine bleeding workup

Initial evaluation includes pregnancy test, full blood count, thyroid function, and pelvic ultrasound. Endometrial biopsy is indicated for postmenopausal bleeding or in women over 45 with abnormal bleeding.

Postmenopausal bleeding

Any vaginal bleeding after 12 months of amenorrhoea requires investigation. Transvaginal ultrasound and endometrial biopsy are performed, as a proportion of cases represent endometrial carcinoma.

Molar pregnancy features

Vesicular mole presents with bleeding, a large uterus for dates, and very high human chorionic gonadotropin. Ultrasound shows a snowstorm appearance. Management is suction curettage with follow-up of gonadotropin levels.

Emergency contraception options

Levonorgestrel or ulipristal acetate oral tablets are used, or a copper intrauterine device. The copper device is the most effective and can be inserted up to five days after unprotected intercourse.

Uterine fibroids and fertility

Submucosal fibroids distort the uterine cavity and are linked to reduced fertility and miscarriage. Hysteroscopic myomectomy is considered when cavity distortion is present; intramural and subserosal fibroids are less clearly implicated.