Crash course 3 Flashcards
A multiparous 55-year-old woman presents with a 6-month history of stress incontinence on coughing and sneezing:
A. She therefore has ‘genuine stress incontinence’
B. An obstetric history is unhelpful in making the diagnosis
C. A bimanual pelvic examination is always
diagnostic
D. A midstream sample of urine may help in
making the diagnosis
E. Urodynamic studies are unnecessary
D. A midstream urine sample will exclude a urinary tract infection as the cause of the urinary symptoms. The diagnosis of genuine stress incontinence can be made only in the absence of detrusor overactivity on urodynamic investigation. An obstetric history indicating traumatic deliveries of large infants would support a diagnosis of genuine stress incontinence. Occasionally, stress incontinence can be due to pressure from a large pelvic tumour, e.g. fibroid, ovarian cyst, but this may not always be the case. Urodynamic studies are essential to exclude detrusor overactivity as a cause for the symptoms.
A 26-year-old woman complains of recurrent episodes of frequency, urgency and nocturia:
A. A neurological history is important
B. The likely cause is detrusor overactivity
C. A pelvic examination will usually show an abnormality
D. A high vaginal swab is mandatory to exclude infection
E. Prolapse is usually found on examination
A. A neurological examination is important to exclude causes such as multiple sclerosis. In this age group the likely diagnosis is sensory urgency where DO is absent. It is unlikely that a pelvic abnormality will be found. A midstream urine will exclude a urinary tract infection as the cause of the symptoms. Genital prolapse is unlikely to be found in this scenario.
Effective treatments for genuine stress incontinence in women wanting more children include: A. Pelvic floor exercises B. Anticholinergics C. Behaviour therapy D. Tension free vaginal tape E. Antibiotics
A. Pelvic floor exercises improve the tone of pelvic floor muscles to prevent loss of urine. Anticholinergics are indicated for detrusor instability to prevent involuntary muscle contraction. Bladder drills are used to treat detrusor instability. Tension free vaginal tape may be used in women who have completed their families. Antibiotics are only helpful for detrusor instability caused by a urinary tract infection.
Effective treatments for detrusor instability include: A. Pelvic floor exercises B. Antimuscarinics C. Colposuspension D. Treating chlamydia E. Myomectomy
B. Antimuscarinics to relax the detrusor muscle. Pelvic floor exercises are used to treat GSI. Colposuspension is indicated for GSI. Treating urine tract infections may improve detrusor instability, but pelvic infections do not affect detrusor instability. A myomectomy is performed to remove fibroids. This may help relieve stress incontinence.
The following are possible causes of precocious puberty: A. Congenital adrenal hyperplasia B. Hyperprolactinaemia C. Hypothyroidism D. Turner’s syndrome E. Cystic fibrosis
A. Congenital adrenal hyperplasia due to adrenal hyperandrogenism. Hyperprolactinaemia causes amenorrhoea. Hypothyroidism, Turner’s syndrome and cystic fibrosis cause delayed puberty.
Which of these drugs can cause hirsutism: A. H2 antagonists, e.g. cimetidine B. Prednisolone C. Combined oral contraceptive pill D. P e n ic illin E. Progestogens
E. Most synthetic progestogens can have androgenic side effects due to stimulation of androgen receptors. H2 antagonists can cause gynaecomastia in men. Prednisolone, although a steroid, is not associated with hirsutism. The combination of oestrogen and progesterone in the combined oral contraceptive pill counteract the androgenic side effects of progesterone alone. There is no link at all with progestogens!
An 18-year-old girl presents with a history of primary amenorrhoea. The following conditions usually present in this way: A. Fib r o id s B. Testicular feminization C. Premature ovarian failure D. Polycystic ovarian syndrome (PCOS) E. Lichen sclerosis
B. The genotype for testicular feminization is XY, therefore, by definition there is primary amenorrhoea. Fibroids cause menorrhagia. Premature ovarian failure can occur at this age, but it usually presents as secondary amenorrhoea. Polycystic ovary syndrome usually presents as secondary amenorrhoea. Lichen sclerosis is a vulval skin condition, which does not cause primary amenorrhoea.
A 40 year old primiparous woman attends antenatal clinic at 12 weeks gestation. She has a history of essential hypertension, with a family history of multiple pregnancy. She is allergic to penicillin. Which factor in her history is the most important in the antenatal risk assessment? A. Maternal age 40 B. Primiparity C. Essential hypertension D. Family history of multiple pregnancy E. Allergy to penicillin
C. A history of essential hypertension is the most important factor since this, in conjunction with a and b, increases the risk of developing pre-eclampsia.
Which of the following is not a routine booking investigation?
A. FullBloodCount
B. Blood Group
C. Hepatitis B status
D. High Vaginal Swab
E. Urine Microscopy, Culture and Sensitivity
D. There is currently no recommendation by the National Screening Committee to perform a high vaginal swab at booking. However, it is currently being considered, in order to diagnose Group B Streptococcus infection.
Which of the following is NOT a risk factor for gestational diabetes?
A. BodyMassIndex>30kg/m2
B. South Asian origin
C. Family history of Type 2 diabetes in a first degree relative
D. Previous gestational diabetes E. Husband with Type 2 diabetes
E. The husband’s medical history is not relevant to his partner’s risk of gestational diabetes.
When should an amniocentesis be performed? A. Before 12 weeks
B. After 15 weeks but before 19 weeks
C. After 20 weeks
D. After 12 weeks but before 13 weeks E. After 15 weeks
E. Amniocentesis can be performed from 15 to approx 22 weeks, or possibly later in the pregnancy after 32 weeks. There is a 1% risk of miscarriage associated with the procedure.
A 22 year old woman with a history of drug misuse presents to the Labour Ward at 26 weeks gestation with a 6 hour history of constant abdominal pain and some vaginal bleeding. What is the most likely diagnosis is? A. Symphysis pubis dysfunction B. Preterm labour C. Uterine fibroid degeneration D. Placental abruption E. Acute fatty liver of pregnancy
D. A placental abruption classically presents with vaginal bleeding associated with abdominal pain. It can occur at any stage in pregnancy. It is associated with cigarette smoking and cocaine use.
A 34 year old woman is seen in antenatal clinic complaining of 2 weeks of lower abdominal discomfort. On further questioning, she has no urinary symptoms or vaginal discharge but is passing hard stools. What is the most likely diagnosis? A. Peptic ulcer disease B. Ligament pain C. Constipation D. Ovarian cyst rupture E. C y s t it is
C. The effect of increasing serum progesterone in pregnancy causes a slowing of gastrointestinal motility, commonly resulting in symptoms such as heartburn and constipation.
A 26 year old woman with no medical or gynaecological history of note presents with a history of fresh vaginal bleeding within the last 12 hours. On further questioning, the bleeding started after sexual intercourse. What is the most likely diagnosis? A. Cervical polyp B. Vulval varicosities C. Cervical ectropion D. Cervical carcinoma E. Vaginitis
C. During pregnancy, the normal tube-like shape of the cervix everts to expose the columnar epithelium within the cervical canal. This type of epithelium is prone to bleeding from pressure during intercourse.
Ultrasound scan is useful in the diagnosis of which of the following causes of antepartum haemorrhage? A. Cervical polyp B. Vasa praevia C. Circumvallate placenta D. Placental abruption E. Placenta praevia
E. Placental abruption and vasa praevia are more commonly clinical diagnoses which necessitate urgent delivery rather than awaiting scans . A scan for placental location will diagnose placenta praevia and determine the grading, either major or minor.
