4th deck Flashcards
A 34 year old woman developed deep vein thrombosis at 25 weeks gestation. Initial blood tests are all normal the therapy with low molecular weight heparin is initiated. The platelet count should be checked after
7 days
The mean diameter of particles contained in surgical smoke
0.1 – 5.0 micrometres
The percentage of women in the general population who have anti-phospholipid antibodies
Anti-phospholipid antibodies are present in 15% of women with recurrent miscarriage (<2% general population) and are associated with adverse pregnancy outcome
A healthy 29 year old woman presents at 30 weeks of gestation with itching in her palms, feet and abdomen. Her skin appears normal and there are no other symptoms. BP = 123/62 mmHg and urine analysis is normal. FBC is normal. ALT = 72 IU, bile acids = 32 microM. One week later, ALT = 90 IU, Bile acids = 45 micromol/L. BP, urine analysis and all other blood tests are normal.
When to do next….
Bile acids 19–39 micromol/L: weekly testing as they approach 38 weeks’ gestation in order to inform timing of birth
Bile acid 40–99 micromol/L, especially approaching 35 weeks’ gestation: weekly testing should be considered, as timing of birth may be influenced if levels rise to 100 micromol/L or more
Bile acid 100 micromol/L or more: further routine testing of bile acids might not impact on decision making and therefore may not be routinely required
Background risk of stillbirth from 28 weeks = 0.29%
Mild ICP: peak bile acids 19–39 micromol/L and no other risk factors, risk of stillbirth is similar to the background risk. Consider options of planned birth by 40 weeks’ gestation or ongoing antenatal care according to national guidance.
Moderate ICP: peak bile acids 40–99 micromol/L and no other risk factors, the known risk of stillbirth is similar to the background risk until 38–39 weeks’ gestation. Consider planned birth at 38–39 weeks’ gestation.
Severe ICP: peak bile acids 100 micromol/L or more, risk of stillbirth is higher than the background risk (3.44% (2.05–5.37%)). Consider planned birth at 35–36 weeks’ gestation
A 32 year old woman develops primary cytomegalovirus infection in the third trimester. What is the risk of the fetus being infected?
40-70%
Risk of transmission for primary infection is 30 to 40% in the first and second trimesters, and 40 to 70% in the third trimester
The risk of transmission following non-primary infection is much lower (3%)
The risk of complications to the fetus is greatest if a primary infection occurs during the first trimeste
TSH receptor antibodies are typically found in patients with
Graves disease
When should the prophylactic dose of low molecular weight heparin (LMWH) be administered post caesarean section?
4 hours post spinal
22 year old woman presents at 20 weeks gestation with a history of fever and rigors. She returned from India 10 days ago. Investigations identify plasmodium falciparum malaria. Which one is the most appropriate treatment?
IV artesunate
Complicated P. falciparum malaria – iv artesunate. iv quinine is second line agent
Uncomplicated P. falciparum malaria - iv quinine and clindamycin
ovarian hyperstimulation syndrome (OHSS) presentation and electrolyte
OHSS is characterized by hypovolaemia and hypo-osmolality, hyponatraemia,
A 64-year-old woman undergoes a total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometrial carcinoma. This procedure will be placed in which of the following wound classifications?
Clean contaminated surgical wound
Clean wounds with a higher risk of infection such as those involving the gastrointestinal, respiratory or genitourinary tracts, as long as the surgery is uncomplicated
Which drug is a direct thrombin inhibitor?
Dabigatran
A 23 year old woman presents with symptoms suggestive of pulmonary embolism at 32 weeks gestation. Definitive diagnosis should be based on
Lung perfusion scan
A low-risk 23 year old woman presents in spontaneous labour at 39 weeks gestation. CTG is commenced because of epidural analgesia. At 8 cm dilatation, there is a deceleration (to 80 / min) which has lasted for 3 minutes. The preceding CTG was normal and there is good variability within the deceleration. What is the probability of the fetal heart rate recovering by 6 minutes?
90%
In the pelvic organ prolapse quantification (POPQ) system, if the woman has no prolapse, point Ba is located at
Point Ba.
A point that represents the most distal position of any part of the upper anterior vaginal wall from the vaginal cuff or anterior vaginal fornix to Point Aa.
By definition, Point Ba is at -8 cm in the absence of prolapse and would have a positive value equal to the position of the cuff in women with total post-hysterectomy vaginal eversion.
During the management of major post-partum haemorrhage, platelets should be transfused if the platelet count falls below
50 x 10g / L
In immunocompetent individuals, the infectious period of chickenpox is
24 hours before rash until 5 days after rash
In immunocompetent individuals, the infectious period should be taken as being from 24 hours prior to rash onset to 5 days after rash. For immunosuppressed individuals, the infectious period should be taken from 24 hours prior to rash onset until all lesions have crusted over.
Mechanism of action of Indomethacin
Cyclo-oxygenase inhibitor
Which one is not a recognized risk factor for OHSS?
Use of GnRH antagonists for controlled ovarian hyperstimulation
Which one of the following congenital infections is most characteristically associated with fetal hydrop
parvovirus b19
Ovarian reserve is a term that is used to determine the capacity of the ovary to provide egg cells that are capable of fertilization. Determination of ovarian reserve is important in the treatment of infertility. At what point in the menstrual cycle should serum FSH levels be measured
2-5
Donovan bodies are associated with
Granuloma inguinale
half life ergometrine
30-120mins
A 69 year old patient is seen in the gynaecology clinic. She has a 2.5 cm squamous cell carcinoma of the vulva with stream depth of 1.5mm confined to the perineum with no nodal involvement. What FIGO stage is this cancer
1B Lesions > 2 cm in size or with stromal invasion > 1 mm confined to the vulva or perineum
Which of the following hormones are required for alveolar morphogenesis during pregnancy
Progesterone, Prolactin and hPL.
With regard to the role of the placenta in preventing immune rejection. Which of the following HLA (Human Leukocyte Antigen) genes are not expressed by cells of the trophoblast?
Human trophoblast cells do not express the two main polymorphic classical class Ia antigens HLA-A and B
Tamoxifen is
Selective Estragen Receptor Modulator (SERM)
moa misoprostol
synthetic prostaglandin E1
what chemical is prostaglandin produced from
arachidonic acid
What pathway is prostaglandin production
COX
GnRH is released by which organ
Liver
Origin of the ligamentum falciparum
ventral mesentry
Ductus Arteriosus connects which structures
Pulmonary artery and aorta
MOA Clindamycin
inhibiting bacterial protein synthesis at the level of the 50S ribosome.
lincosamide
