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9th Flashcards

management

1
Q

During pudendal block, the end of the needle guard should be placed

A

1 cm anterior + medial to ischial spine

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2
Q

The success rate of a pudendal block is about

A

50%

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3
Q

A 23 year old woman has induction of labour at 41 weeks gestation. She progresses to 8 cm dilatation. Which feature would be considered abnormal on the CTG?

A

Variable decelerations with no concerning characteristics for 115 minutes

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4
Q

A 23 year old primigravida presents in spontaneous labour at 38 weeks of gestation. The cervix is 5 cm dilated. Four hours later, the cervix is 9 cm dilated with intact membranes. There are 4 contractions every 10 minutes.

A

reassess in 2 hours

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5
Q

A healthy 29 year old woman with one previous lower segment caesarean section presents in spontaneous labour at 39 weeks of gestation. Uterine rupture most commonly occurs

A

4-5cm

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6
Q

Minor post-partum haemorrhage refers to blood loss

A

Of 500 to 1000 ml without clinical shock

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7
Q

During the transversus abdominis plane (TAP) block, the needle goes through

A

Skin, sub-cutaneous tissue, external oblique and internal oblique muscles

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8
Q

Which one is a recognised complication of the transversus abdominis plane (TAP) block?

A

bowel injury

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9
Q

You are performing a vaginal operative delivery and the leading point of the fetal skull is 1 cm below the ischial spines. The fetal head is not palpable per abdomen. This is classified as

A

mid-cavity

0-1cm below spines

(low = -2cm)

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10
Q

When testing for anaesthesia prior to caesarean section, what is the lowest level of the block needed to ensure the woman is pain free?

A

T5

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11
Q

Mechanism of action of Indomethacin

A

COX inhibitor

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12
Q

Following a water birth, a woman elects not to have oxytocics for the management of the third stage of labour. Thirty minutes later, she is brought to the consultant unit with a postpartum haemorrhage owing to an atonic uterus. If she had received standard oxytocic management for the third stage of labour, by what amount would she have reduced her risk of a postpartum haemorrhage?

A

47%

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13
Q

A 30 year old primigravida presents in spontaneous labour at 38 weeks of gestation. The cervix is 5cm dilated with intact membranes. CTG is commenced because of epidural analgesia. All maternal observations are normal with 3-4 contractions every 10 minutes. You are asked to review the CTG because the baseline variability has been less than 5 bpm for 30 minutes with a baseline FHR of 140 bpm. There are no decelerations and no accelerations. Maternal position has been changed on three occasions.

A

r/v 20 mins

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14
Q

A healthy 52 year old woman has urodynamic stress incontinence which has not improved with physiotherapy. She is awaiting surgical treatment and would like medical treatment to reduce the embarrassment of incontinence

A

Duloxetine

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15
Q

he mechanism of action of aspirin differs from that of ibuprofen in that

A

Aspirin causes irreversible COX inhibition and ibuprofen causes reversible COX inhibition

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16
Q

The plasma half life of oxytocin following intra-muscular injection

A

1-6mins

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17
Q

11 Which drug is associated with constriction of the ductus arteriosus?

A

INDOMETHACIN

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18
Q

Professional antigen-presenting cells

A

Dendritic cells

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19
Q

Which cells secrete histamine and serotonin

A

Basophils

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20
Q

Which cell type secretes heparin and histamine?

A

Mast Cells

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21
Q

Which of the following cell types lyses cells that have been infected with virus?

A

cytotoxic T cells

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22
Q

Histamine is released by

A

Mast cells and Basophils

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23
Q

Hep B vaccine is a

A

sub unit virus vaccine

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24
Q

Which class of immunoglobulin is predominantly involved inactivating the classical complement pathway?

A

IgM

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25
Q

Extra-genital lichen sclerosus looks like what

A

Is usually described as having a cigarette-paper-like appearance

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26
Q

Autoimmune is not a recognised sub-group of which condition

A

lichen simplex

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27
Q

vulval lichen simplex presents with

A

thickened scaly skin, excoriations, loss of pubic hair and erosions

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28
Q

Vaginal adenosis is associated with what

A

in-utero exposure to diethysitlbestrol

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29
Q

In CIN II, dysplastic cells are confined to

A

lower 2/3rd epithelium

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30
Q

Carcinoma of the cervix usually arised where

A

squamo-columnar junctitno

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31
Q

A 23 year old woman has undergone chorionic villus sampling at 13 weeks gestation following a ‘high risk’ result from the combined test. She should be informed that the results will be available

A

48-72 hours

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32
Q

The proportion of human pre-implantation embryos that show mosaicism is

A

50%

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33
Q

The standard for conventional cytogenetic analysis of human chromosomes is

A

comparative genomic hybridisation

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34
Q

In which one of the following stages of the cell cycle does the cell become quiescent?

A

G0

quiescent - stat of inactivity

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35
Q

Co-factor in the synthesis of clotting factors

A

vit K

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36
Q

The Cori cycle typically occurs when

A

During strenuous exercise

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37
Q

Glucose-6-phosphatase plays an important role in

A

Gluconeogenesis

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38
Q

The main enzymes of the citric acid (Krebs) cycle are located in the

A

mitochondria

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39
Q

Where does fatty acid synthesis occur within the cell?

A

The cytosol

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40
Q

The change in maternal cardiac out-put by 12 weeks gestation

A

40%

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41
Q

Change in renal plasma flow at 24 weeks gestation compared to pre-pregnancy

A

75% inc

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42
Q

During labour maternal oxygen consumption increased by

A

60%

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43
Q

The change in glomerular filtration rate by 24 weeks in a normal pregnancy

A

50%

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44
Q

Normal pregnancy is associated with what change in aldosterone sectretion

A

increased

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45
Q

Which organ removes old red blood cells from the circulation?

A

spleen

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46
Q

Pre-pubertal girls have

A

low progesterone levels, oestrogen, LH and FSH levels

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47
Q

what effect does progesterone have on uterine contractions

A

inhibits contractions
thickens cervical mucus,

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48
Q

Maternal serum HCG concentration peaks at

A

10 weeks

peaks at 100,000 international unites
reducesto 10,000-20,000 untis at 18-20 weeks and remains here until term.

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49
Q

42 year old woman has an endometrial biopsy because of heavy menstrual bleeding. Histology shows tortuous endometrial glands with glycogen and lipid vacoules. In which phase of the menstrual cycle was the sample taken?

A

secretory phase

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50
Q

Gestational diabetes insipidus occurs as a result of

A

Placental production of vasopressinase

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51
Q

Gestational diabetes insipidus typically presents in

A

3rd trimester

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52
Q

During pregnancy, the concentration of 17 alpha hydroxyprogesterone is lowest when

A

at 10 weeks

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53
Q

Compared to levels in non-pregnant women, serum prolactin levels in pregnancy are increased

A

x20

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54
Q

Mechanism by which the effects of prostaglandins are mediated

A

paracrine

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55
Q

Site where prolactin secretion is not affected by dopamine

A

UTERINE DECIDUA

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56
Q

Completion of first meiosis division during oogenesis

A

PUBERTY

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57
Q

The appendix testis is derived from

A

MULLERIAN DUCT

58
Q

THE OVARY FORMS FROM

A

The gonadal ridge develops medial to the mesonephros by proliferation of the coelomic epithelium and condensation of the underlying mesenchyme, forming the primitive sex cords

59
Q

fetal urine productions begins

A

week 12

The mesonephros is functional between the 6th - 10th week, producing urine.

Metanephros - permanent kidney (MRCOG 1)

Develops in the 5th-15th week from the metanephric mesoderm in the sacral region
Ureters - develop from the ureteric bud, an outgrowth of the mesonephric duct close to its opening into the cloaca (MRCOG 1). Grows into the metanephric mesoderm, successive divisions forming the renal pelvis, major and minor calyces and collecting tubules
The metanephric mesoderm develops into the excretory units under inductive influence of the ureteric bud, forming the Bowman’s capsule and excretory tubules. If the ureteric bud is missing, the kidney does not develop
The metanephros is functional from the 10th week

60
Q

Glucose uptake by the placentA

A

FASCILIATED DIFFUSION

61
Q

With respect to the transfer of amino acids from the maternal to fetal circulation

A

NA+ DEPENDANT TRANSPORTERS

62
Q

According to the Green-top guidelines CVS should NOT be performed before what gestational age

A

10

63
Q

What is the approximate risk of uterine perforation in diagnostic hysteroscopy?

A

0.1%

64
Q

The femoral triangle contains

A

Femoral nerve and terminal branches.
Femoral sheath.
Femoral artery and branches.
Femoral vein and its proximal tributaries inc SFJ
Deep inguinal lymph nodes & lymphatic vessels.

65
Q

The primary stimulus for ADH (anti-diuretic hormone AKA Vasopressin) release is

A

high serum osmolality

66
Q

The pudendal nerve exits the pelvis via

A

greater sciatic foreman

67
Q

WHO defines the perinatal mortality rate as

A

: The number of stillbirths and deaths in the first week of life per 1000 births

68
Q

At what stage of fetal development does fetal haemoglobin (HbF) replace embryonic haemoglobin (HbE) as the primary form of haemoglobin?

A

10-12 weeks

69
Q

With regard to primary vaginal cancer what is the most likely type?

A

squamous cell carcinoma

70
Q

pubic symphysis, what type of joint is it

A

secondary cartilaginous join

71
Q

The histology shows Psammoma bodies. What type of tumour would this be consistent with?

A

serous

72
Q

What vein does the IMV drain into?

A

the splenic vein

73
Q

Which of the following Oestragens (Estrogens) becomes the predominant circulating oestrogen during pregnancy?

A

Estriol (E3).

74
Q

the predominant oestrogen during female reproductive years

A

Estradiol (E2)

75
Q

Obesity causes what in SHBG.

A

drop

less shbg = more testosterone = hirtuisum

76
Q

Blood supply to the lateral aspects of the cerebral hemispheres

A

middle cerebral

77
Q

Blood supply to the superior-medial aspects of the parietal lobes of the brain

A

anterior cerebral

78
Q

normal PR interval

A

0.12-0.20 seconds

79
Q

normal qrs interval

A

0.06 - 0.10

80
Q

normal QT interval

A

0.3 - 0.43 (0.45 women)

81
Q

A 36 year old woman is known to have essential hypertension treated with ramipril. She attends for pre-conception advice as she is planning a pregnancy. Her BP is 125/75 mmHg. Which one of the above options is correct?

A

ramipril should be changed

82
Q

risk factors for pre-eclampsia

A

HTN, renal disease, diabetes, thrombophilia, FH

83
Q

What is an indication for the use of graduated elastic compression stockings during pregnancy?

A

During the antenatal period in all women with a previous thromboembolic event

84
Q

A 34 year old woman has been admitted because of pulmonary embolism and is treated with low molecular weight heparin. Test to monitor anticoagulant effect should be done

A

3 hours

85
Q

screening test for haemolytic anaemia

A

haptoglobin

Protein that binds free Hb released from erythrocytes with high affinity
The haptoglobin-hemoglobin complex will then be removed by the reticuloendothelial system (mostly the spleen)
Haptoglobin assay is used to screen for and monitor intravascular hemolytic anemia

86
Q

Phenylketonuria is caused by a deficiency of

A

Phyenlalanine Hydroxylase

87
Q

A healthy 23 year old woman had high blood pressure in her first pregnancy but further details are unavailable. She attends the antenatal clinic at 10 weeks of gestation. What is her risk of developing pre-eclampsia in this pregnancy?

A

1/5

88
Q

A healthy 23 year old woman developed pre-eclampsia in her first pregnancy. She attends the antenatal clinic at 10 weeks of gestation. What is her risk of developing hypertensive disease in this pregnancy?

A

1/7

89
Q

A healthy 25 year old woman developed pre-eclampsia in her first pregnancy. Delivery was required at 32 weeks of gestation. She attends the antenatal clinic at 10 weeks of gestation. What is the risk of her developing pre-eclampsia?

A

1/3

90
Q

Maternal breast exposure to radiation during CT pulmonary angiography (CTPA)

A

10 mGy

91
Q

Graves disease is caused by

A

Thyroid stimulating immunoglobulin

92
Q

TSH receptor antibodies are typically found in patients with

A

Graves disease

93
Q

Isoniazid is metabolised by

A

Hepatic N acyetyl transferase

94
Q

antedote DABIGATRAN

A

idarucizumab

95
Q

The most common feature of warfarin embryopathy is

A

nasal hypoplasia

96
Q

accurately describes the mode of action of letrozole?

A

NON STEROID REVERSIBLE AROMATASE INHIBITOR

97
Q

The recommended first-line treatment for clostridium difficile infection

A

oral Vanc

98
Q

MacConkey agar is used to

A

Identify gram negative bacteria using lactose fermentation

99
Q

Receptor binds to ligand in the cytosol resulting in dimerization and translocation to the nucleus

A

oestrogen

100
Q

Receptor binding results in conversion of Phosphatidylinositol 4,5-bisphosphate into Phosphatidylinositol 3,4,5-trisphosphate

A

insulin receptor - tyrosine kinase

Binding of ligand triggers autophosphorylation of the tyrosine residues, with each subunit phosphorylating its partner. This then catalyses the conversion of Phosphatidylinositol 4,5-bisphosphate into Phosphatidylinositol 3,4,5-trisphosphate (PIP3).
PIP3 acts as a second messenger and induces the activation of phosphatidylinositol dependant protein kinase, which then activates several other kinases – most notably protein kinase B. PKB triggers the translocation of glucose transporter (GLUT4) containing vesicles to the cell membrane

101
Q

The main metabolic action of glucagon

A

stimulate hepatic glycogenolysis (break down of glycogen)

102
Q

The adrenal medulla produces catecholamines of which %

A

85% adrenaline, 15% noradrenaline

chromaffin cells from neural crest

103
Q

Which amino acids characteristically potentiate glucose-stimulated insulin secretion?

A

arginine and lysine

104
Q

insulin stimulations what from hepatic glucose

A

Stimulates fatty acid production from hepatic glucose

105
Q

what will stimulate both glucagon and insulin secretion

A

alanine and arginine

106
Q

Glucagon secretion is stimulated by

A

amino acides, hypoglcaemia and exercise

107
Q

symptoms of phaechromocytoma

A

headache, tachy, hyperhidrosis

108
Q

UNCONJUGATED BILIRUBIN x blood brain barrier

A

= kernicturis

109
Q

The breakdown of this protein makes the largest contribution to total bilirubin concentration

A

haemoglobin

110
Q

Phagocytic cells are present in the fetus during the

A

1st trimester

111
Q

A premature infant develops progressive difficulty breathing over the first few days of life. Deficient surfactant synthesis by which of the following cell types may have contributed to the respiratory problems?

A

type 2 pneumocyte

112
Q

how many codons are there

A

64

113
Q

when is the cell tetraploid

A

G2

114
Q

A 32 year old woman attends the antenatal clinic at 10 weeks gestation. Her 5 year old son has just been diagnosed with neuromuscular disorder. She has been told that he will be wheel-chair bound by the age of 12 years.

A

X linked recessive
(duchenne - onset by 5, wheelchair by 12)

115
Q

A five year old boy has been diagnosed with Duchenne muscular dystrophy. There is no family history of the disease. what will his muscle biopsy show

A

His muscle biopsy will show an absence of dystrophin on immunohistochemistry

116
Q

Which has a better prognosis Becker or Duchenne

A

Becker

117
Q

Androgen insensitivity syndrome is cuased by

A

a mutation in the gene fro androgen receptors

X linked Recessive - female pheotype, increased risk of gonadoblastoma, infertility, 46XY karyotype, NO UTERUS

118
Q

In pre-menopausal women, endometrial tuberculosis is associated with

A

histological evidence of chronic endometritis

119
Q

Endometrial sarcomas are homologous if they contrain

A

endometrial stromal and / or glandular tissue only

120
Q

The most common site of endometriosis is

A

ovary

121
Q

Red degenerations is caused by

A

fibroid outgrowing blood supply

122
Q

In a region with 250,000 live births, there are 75 maternal deaths related to pregnancy and 250 stillbirths. What is the Maternal mortality ratio?

A

Number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes)
250,000 live births and 75 maternal deaths

100,000 live births (divide by 2.5) = 75 /2.5 maternal deaths = 30

123
Q

Ability to identify a true negative

A

sensitivity

124
Q

A study is undertaken on high risk HPV vaccination in a particular district. Ten thousand children are included in the study with a mean age of 15 years and the variance is 9. What is the standard error?

A

Standard deviation = square root of 9 = 3

Sample size n = 10,000

Square root of n = 100

Standard error = 3 / 100 = 0.03

Standard Deviation - square root of the variance. It is the most commonly used measure of spread (MRCOG) *

125
Q

trial has been conducted to investigate the effect of tranexamic acid on blood loss following vaginal delivery. 1921 women were randomised to tranexamic acid and 1918 to placebo. Postpartum haemorrhage (PPH, blood loss of at least 500 ml), occurred in 156 women (8.1%) in the tranexamic acid group and in 188 (9.8%) in the placebo group. Which one is the most appropriate statistical test to analyse these data?

A

chi squared

PPH = categorical variable. 2 x 2 contingency table and number in each cell greater than 5

2 groups – Tranexamic acid / Placebo = categorical variables

Blood loss = continuous variable and large sample size means normal distribution can be assumed

Arterial embolism or surgery for PPH = categorical variable. 2 x 2 contingency table with small numbers (3 and 5) means Fisher’s exact test should be used.

126
Q

A trainee is undertaking a PhD project looking at the expression of myosin light-chain phosphatase in the non-pregnant and pregnant myometrium. Myometrial samples are collected from non-pregnant (n = 12), term pregnant not in labour (n = 15) and term pregnant in labour (n = 20) women and the expression of myosin light-chain phosphatase determined by quantitative PCR. Which one is the most appropriate statistical test?

A

Quantitative PCR would determine mRNA concentration and generate continuous data

Sample size is small (12 – 20) therefore data will not be normally distributed

3 independent groups (non-pregnant, pregnant not in labour and pregnant in labour)

Kruskal-Wallis test therefore appropriate

127
Q

With respect to the utility of clinical tests, a highly specific test is useful in

A

ruling in

128
Q

A researcher wishes to assess the postoperative recover for a group of postmenopausal women who had hysterectomy. He classified the patients as felt worse, same, improve. Which type of measurement is this classification?

A

ordinal
Ordinal - numbers, names or categories. Data are ordered - for instance, pain scores of 1-10

Nominal / categorical - names or categories that do not use / require an order - eye colour, sex, ethnic group. The values of the scale have no ‘numeric’ meaning

129
Q

Lancefield grouping of streptococci is based on

A

carbohydrate composition of cell wall antigens

130
Q

Infection with listeria monocytogenes in pregnancy should be treated with

A

AMPICILLIN

131
Q

Exposure to warfarin in-utero is associated with

A

DIAPHRAGMATIC HERNIA

132
Q

Drug transport across cell membranes is due to

A

non-ionisation

133
Q

A 34 year old woman with bi-polar disorder attends the antenatal clinic at 10 weeks gestation. This is an unplanned pregnancy and the woman has been taking lithium carbonate

A

risk cardiac abnormalities 60/1000

134
Q

The risk of neonatal herpes following vaginal birth to a woman with recurrent genital herpes around the time of delivery

A

1%

135
Q

A healthy 29 year old woman develops chickenpox 10 days before her planned caesarean section. What is the risk of the new born baby developing chickenpox if no intervention is offered?

A

23%

136
Q

A 32 year old woman develops primary cytomegalovirus infection in the third trimester. What is the risk of the fetus being infected?

A

40-70%

137
Q

22 year old woman develops chicken pox at 20 weeks of gestation. What is her risk of developing pneumonitis?

A

10%

138
Q

A 29 year old woman has contacted the maternity assessment unit at 14 weeks of gestation because her 5 year old son has just been diagnosed with chickenpox. The woman has no history of chickenpox. Her booking bloods were tested and the woman is varicella zoster IgG and IgM negative. If no treatment is offered, what is her risk of developing chickenpox?

A

70-80%

139
Q

The incubation period of measles

A

10-14 days

140
Q

A 27 year old teacher telephones the maternity assessment unit at 15 weeks of gestation. There has been an outbreak of measles in her school and she has been in contact with some of the infected children. She does not know if she has been vaccinated against measles.

A

screen booking bloods

141
Q

Varicella zoster infection is associated with a risk of congenital anomalies if infection occurs before

A

28w

revision (14 decks)

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