December Flashcards
1
Q
What is the first line treatment for hyperthyroidism in pregnancy?
A
Propylthiouracil as it crosses the placenta less readily than carbimazole
2
Q
What is the risk of PPH in deliveries complicated by shoulder dystocia?
A
10%
3
Q
How should low mood be treated in patients taking Tamoxifen?
A
CBT
avoid SSRIs, St John’s Wort & soy isofavones
4
Q
Compression of which nerve commonly results in foot drop?
A
Common peroneal nerve
Often from lithotomy position
5
Q
What is the impact on VTE risk of taking COCPs containing levonorgestrel?
A
3 times
2:10,000 to 5-7:10,000
6
Q
What is the suture absorption time of monocryl?
A
90-120 days
7
Q
Which anti-epileptic drug has levels lowered by estrogen- containing contraception?
A
Lamotrigine
8
Q
Spinal cord lesions at which level are associated with autonomic dysreflexia?
A
T6
9
Q
What are the absolute contraindications to ECV?
A
Multiple pregnancy
Abnormal CTG
Ruptured membranes
CS needed for other reasons
Hemorrhage in last 7 days
Uterine anomaly
10
Q
What are the reintervention rates for uterine artery embolisation?
A
1:3 within 5 years
11
Q
How are patients with thalassaemia managed for VTE risk in pregnancy?
A
Splenectpmy OR platelets >600: aspirin
“. AND. “. : aspirin + LMWH
12
Q
What is the incidence of IBS in women in the UK?
A
10-15%
13
Q
COCP containing which progestogens have the lowest VTE risk?
A
1st & 2nd generation eg norethisterone, levonorgestrel
14
Q
What is the risk of needing a CS hysterectomy for placenta praevia?
A
11%
15
Q
In suspected PE, how do CXR findings impact on imaging modality?
A
Normal CXR: V/Q
Abnormal CXR: CTPA
16
Q
What percentage of UK obstetric admissions are complicated by AKI?
A
1.5%
17
Q
What natural menopause remedy is banned in the UK due to causing liver damage?
A
Kava kava
18
Q
Women with which conditions should be referred to haematologists for antenatal VTE decisions?
A
Asymptomatic antithrombin, protein C or protein S deficiency
More than 1 thrombophilic defect out of: homozygous factor V Leiden, homozygous prothrombin gene mutation, compound heterozygotes
19
Q
What is the student’s t-test used for?
A
Comparing 2 sample means,
Assuming normal distribution
20
Q
What is the chi squared test used for?
A
Nonparametric test
Comparing numerical or categorical data sets
21
Q
What is the ANOVA test used for?
A
Comparing multiple population means
22
Q
With tubal ectopics, what is the MSD cut-off for expectant management?
A
30mm
23
Q
What is the management for ultrasound finding of cervical length <25mm without hx of PTB or mid-trimester loss?
A
Prophylactic vaginal progesterone
24
Q
What is the risk of placenta praevia after 1 previous?
A
23:1000
25
How does 1 shoulder dystocia affect the rate of future shoulder dystocia?
10 x general population
26
What is the risk of requiring further treatment after a salpingotomy?
1:5
27
What are the risk factors for endometrial polyps?
Increasing age
HRT
Tamoxifen
28
What is the management for stage 1a vaginal cancer?
Wide local excision only
29
What is the incidence of 3rd & 4th degree tears in instrumental births?
Forceps no epis: 22.7%
Forceps with epis: 6%
Ventouse no epis: 6%
Ventouse with epis: 2%
30
What is the risk of serious haemorrhage with abdominal hysterectomy?
23:1000
31
What are the RCOG risk categories?
1:1 - 1:10 Very common
1:10 - 1:100 Common
1:100 - 1:1000 Uncommon
1:1000 - 1:10,000 Rare
< 1:10,000 Very rare
32
What are the risks with CF in pregnancy?
1. Prematurity rate 25%
2. Spontaneous preterm labour
3. Diabetes
4. Stillbirth (live birth rates 70-90%)
33
Define relative risk!
Rate of disease in exposed group divided by rate of disease in unexposed group, aka risk ratio
34
Define odds ratio!
Relative measure of effect, comparing exposed group to control group
Odds in exposed group divided by odds in control group
35
What is the management of asymptomatic placenta praevia confirmed at 32/40?
Course of corticosteroids 34/40-35+6
36
What is the 1st line Mx of PMS?
1. Exercise
2. CBT
3. Vitamin B6
4. COCP new generation
5. Low dose SSRI, continuous or luteal phase
37
What is the rate of bowel obstruction following radiotherapy for cervical cancer?
10-15%
38
What is the NNT for elective Caesareans & faecal incontinence?
90-170
39
What is the NNT for breech ElCS for any adverse outcome vs vaginal breech?
16-35
40
What is the NNT for ElCS vs vaginal breach for perinatal death?
170-440
41
What is the rate of conversion to open procedure for transabdominal cerclage?
10%
42
What is the order of ligament division in vaginal hysterectomy?
1. Uterosacrals
2. Cardinals
3. Broads
4. Rounds
43
Tumour markers!!!
Make mnemonics
44
What is a common nerve injury in traumatic births, leading to sensory loss anterior thigh & knee, quadriceps weakness & loss of knee jerk?
Femoral nerve
45
What is the risk of ureteric injury in laparoscopic resection of severe endometriosis with hydronephrosis?
20%
46
Following intrauterine death of 1 morochorionic twin, what is the risk of a) death & b) neurological abnormality in the 2nd twin?
a) 15%
b) 25%
47
What is the mortality rate associated with necrotising fasciitis?
20-40%
48
What is the treatment for uncomplicated malaria in pregnancy for plasmodium vivax, ovale & malariae?
1. Admit
2. PO chloroquine
3. 600mg loading dose then 300mg 6-8 hours later, daily for 3 days then weekly
49
What is the treatment for uncomplicated malaria in pregnancy with plasmodium falciparum?
1. Admit
2. Oral quinine 600mg 8-hourly
3. Oral clindamycin 450mg 8-hourly
4. For 7 days
50
What is the 1st line treatment for chicken pox exposure in pregnancy?
Oral Aciclovir
7-14 days post-exposure
51
What is the cause of MRKH syndrome?
Müllerian agenesis
52
Which complications of CS for placenta praevia are classed as “very common”?
Emergency hysterectomy
Massive obstetric haemorrhage
53
What is the lifetime risk of ovarian cancer in the general population?
1.4%
54
Which conditions result in hypogonadotrophic hypogonadism?
1. Kallman syndrome
2. Prader-Willi syndrome
3. CHARGE
4. Pituitary tumours
5. Brain injury
55
What are the proportions of patients with different impacts of pregnancy on MG?
30% remission
30% no change
40% worsen
56
What proportion of CIN2 lesions regress spontaneously within 2 years?
50%
57
What is the absolute risk of VTE in pregnancy & the puerperium?
1-2:1000
58
What is the 1st line varicella post-exposure prophylaxis?
Oral Aciclovir or valaciclovir
7-14 days after exposure
59
What is the incidence of ectopic pregnancy in the UK?
11 in 1000
60
Following radical hysterectomy for cervical cancer, what proportion of patients need to ISC for long-term voiding difficulties?
2-3%
61
What proportion of ectopic pregnancies are interstitial?
1-6%
62
What is the presenting diameter of a brow presentation?
Mento-vertical
63
What is the leading cause of direct maternal deaths in the UK?
Thrombosis & thromboembolism
64
What are the contraindications to flying in pregnancy?
1. Severe anaemia <75
2. Recent haemorrhage
3. Otitis media & sinusitis
4. Serious cardiac or respiratory disease
5. Recent sickling crisis
6. Recent GI surgery
7. Bone fracture, if may cause leg swelling
65
What are the general points for flying in pregnancy?
1. Singletons don’t fly >37/40
2. Twins don’t fly >32/40
3. Flights >4 hours special measures
4. LMWH for high-risk patients
66
What proportion of CIN1 & 2 lesions regress spontaneously within 2 years?
50%
67
What are the high-risk factors for pre-eclampsia?
1. Hypertensive disease in previous pregnancy
2. CKD
3. Autoimmune disease eg SLE or Antiphospholipid syndrome
4. T1 or T2 DM
5. Chronic hypertension
68
What are the moderate risk factors for pre-eclampsia?
1. 1st pregnancy
2. Age ≥ 40
3. Pregnancy interval > 10 years
4. BMI ≥ 35
5. Family hx PET
6. Multi-fetal pregnancy
69
Which women should be started on aspirin?
1. 1+ high risk factors
2. 2+ moderate risk factors
70
What uterotonic should be given for 3rd stage at vaginal birth?
10 units oxytocin IM
71
In what situations is antenatal VTE prophylaxis given & for how long?
1. 4+ risk factors or previous unprovoked VTE: throughout pregnancy to 6/52 PN
2. 3+ risk factors: 28/40 to 6/52 PN
3. Short-term: hospital admission, surgical procedure, OHSS
4. Consider for medical comorbidities, high-risk thrombophilia, previous VTE following major surgery
72
What is the incidence of umbilical cord prolapse in breech presentation?
1%
73
What is the absolute risk of VTE in pregnancy & the puerperium?
1-2:1000
74
What is the risk of placenta praevia with 4 previous Caesareans?
10%
75
What is the risk of a baby developing fetal varicella syndrome if the mother develops chicken pox in the first 20/40 & doesn’t receive VZIg?
2.8%
76
What level of testosterone points towards serious ovarian or adrenal pathology?
> 5 nmol/L
> 1.5 ng/L
77
When should pregnant patients with HIV not on ART be started?
13/40
78
What is the average cycle fecundity in unexplained subfertility?
1.3-4.1%
79
What is the chance of conceiving within 12 months in unexplained subfertility?
74%
80
By how much is the rate of intraoperative trauma increased in CS at full dilation vs 1st stage?
More than double
81
What is the management of single 2nd trimester miscarriage?
1. Screen for inherited thrombophilias: factor V Leiden, prothrombin gene mutation, protein S deficiency
2. Antiphospholipid antibodies
3. Pelvic ultrasound
82
What % of infants with neonatal herpes have disseminated &/or CNS infection?
70%
83
What is the incidence of 3rd & 4th degree tears in multiparous women?
1.7%
84
What is the incubation period of rubella?
12-23 days
Average 14 days
85
What is the mechanism of gestational diabetes insipidus?
ADH deficiency secondary to increased vasopressinase activity
86
What is the risk of congenital CMV infection if primary infection occurs during pregnancy?
30-40%
87
If a patient is taking lithium for bipolar disorder, what should she do in pregnancy?
Stop over 4 weeks
If at high risk of relapse, switch to antipsychotic
88
What is the incidence of cerebral palsy at different gestations?
22-27/40: 14.6%
28-31/40: 6.2%
32-36/40: 0.7%
Term: 0.1%
89
What is the association between endometriosis & cancer?
Increased ovarian & non-Hodgkins lymphoma
Decreased cervical
No change in endometrial
90
With diaphragm use, when should spermicide be reapplied?
When in place for >3 hours & sex planned
91
Following uterine artery embolisation, which obstetric complications are there higher rates of?
1. Caesarean section
2. PPH
92
What is the incidence of PE in the UK in pregnancy & the puerperium?
1.3 per 10,000
93
In which patients is additional cervical screening recommended?
1. HIV: annually
2. End-stage renal disease: at diagnosis
3. Renal transplant: within 1 year
4. Cytotoxic rheumatology drugs: at start of Tx
94
What is the most common presenting feature of endometrial polyps in premenopausal women?
Menorrhagia
95
What are the risks of vertical transmission of parvovirus?
<15/40: 15%
15-20/40: 25%
Term: 70%
96
What are paravaginal haematomas bounded by?
Superiorly by cardinal ligament
Inferiorly by pelvic diaphragm
97
How should menopause be investigated in patients over 50 on combined contraception?
1. Stop for 2 weeks
2. Check FSH
3. If > 30, recheck in 4-6 weeks
4. If still raised, stop contraception in 1 year
98
What proportion of patients would labour spontaneously within 3 weeks of IUFD?
>85%
99
What is the incidence of focal nodular hyperplasia?
3%
100
What are the risk factors for OHSS?
1. Past history OHSS
2. PCOS
3. Increased antral follicle count
4. High levels of AMH
101
In what proportion of pregnancies are red cell autoantibodies detected?
1.2%
102
What proportion of neonates with congenital CMV appear asymptomatic at birth but later develop hearing loss?
15%
103
How does a transverse vaginal septum impact on fertility rates?
Lower 1/3: normal
Middle 1/3: 40%
Upper 1/3: 20%
104
With expectant management of IUFD, what is the risk of DIC occurring within 4 weeks?
10%
105
What is the incidence of 3rd & 4th degree tears in shoulder dystocia?
3.8%
106
How many women become pregnant within the first year of using a copper coil?
8 in 1000
107
What is the risk of death from a diagnostic laparoscopy?
3-8 in 100,000
108
When should birth be planned for monochorionic twins?
36-37/40
109
What % of patients with acute fatty liver of pregnancy develop renal impairment?
14%
110
Which conditions result in hypergonadotrophic hypogonadism?
1. Kleinfelter‘s
2. Noonan‘s
3. Cryptorchidism
4. Injury
5. Varicocoele
6. Tumours
7. Chemo/radiotherapy
8. Idiopathic
111
Which conditions result in normogonadotrophic hypogonadism?
1. Congenital absence of vas deferens
2. Cystic fibrosis
3. Young‘s
4. Infection
5. Vasectomy
6. Immotile cilia syndrome
7. Sperm maturation defects
8. Immunological infertility
9. Globozoospermia
112
What is the global incidence of conjoined twins?
1:100,000
113
What features define complicated malaria?
1. >2% parasitised RBCs
2. Respiratory distress
3. Pulmonary oedema
4. Hypoglycaemia
5. Secondary sepsis
114
What is the risk of lichen sclerosus progressing to invasive disease?
4%
115
What 6 points are measured wrt hymen for POP-Q?
Aa: midline anterior wall 3cm proximal
Ap: midline posterior wall 3cm proximal
Ba: most distal position of upper anterior wall
Bp: most distal position of upper posterior wall
C: cervix
D: posterior fornix
116
What % of patients with stage 1 ovarian cancer have an elevated Ca-125?
55%
117
What are the 1st line treatments for overactive bladder?
1. Oxybutynin (unless frail elderly)
2. Tolterodine
3. Darifenacin
118
What are the rates of congenital rubella syndrome at different gestations?
a) < 11/40: 90%
b) 11-16/40: 20%
c) > 20/40: no reported cases
119
What is the incidence of puerperal psychosis?
1:1000
120
What are the risks of preterm birth for cervical length a) < 25mm, b) < 20mm
< 25mm: 25% before 28/40
< 20mm: 42% before 32/40
62% before 34/40
121
What are the cut-offs for medical management of ectopic pregnancies?
35mm
hCG 5000
122
What is the incidence of chronic pain following different numbers of TOAs?
1: 12%
2: 30%
3: 67%
123
What is the incubation period for Zika virus?
3-12 days
124
What 3 methods are effective in preventing PHVP?
1. McCall culdoplasty
2. Sacrospinous fixation
3. Suturing the cardinal & uterosacral ligaments to the vaginal cuff
125
What are the mechanisms of action of drugs used for hirsutism?
1. Cyproterone: anti-androgen & progestogen
2. Goserelin: GnRH analogue
3. Finasteride: 5 α reductase inhibitor
4. Metformin: insulin sensitiser
5. Eflornithine: antiprotozoal
126
By what proportion does blood volume increase in pregnancy?
40-50%
127
What is the 5-year survival for vulval cancer a) with no lymph node involvement, b) with inguinal lymph nodes, c) with iliac & other pelvic nodes?
a) 80%
b) <50%
c) 10-15%
128
When should hCG repeated following evacuation of molar pregnancy?
1. Until normalised
2. If normalised within 56 days, 6 months from evacuation
3. If normalised > 56 days, 6 months from normalisation
129
What is the risk of progression to cancer of endometrial hyperplasia a) without atypia, b) with atypia?
a) < 5%
b) 25-30%
130
What is the rate of miscarriage in women infected with Rubella in the 1st trimester?
20%
131
What are the cut-off points for a) oligospermia, b) severe oligospermia?
a) < 15 million/ml
b) < 5 million/ml
132
What % of patients with acute fatty liver of pregnancy need renal replacement?
3.5%
133
What are the predictors of successful medical Mx of ectopic pregnancy?
1. Low initial hCG
2. Smaller increases in pre-Tx hCG
3. Decrease in hCG from d1-4 of Tx
4. Absence of yolk sac, fetal pole or cardiac activity
134
What is the NNT for elective IOL at 40/40 to prevent 1 perinatal death?
1040
135
What is the NNT for IAP in intrapartum fever to prevent 1 GBS infection?
208
136
What % of laparoscopic a) bladder & b) ureteric injury are diagnosed postoperatively?
a) 50%
b) 70%
137
For US-identified cervix <25mm, in which circumstances is prophylactic cerclage offered?
1. Previous spontaneous PTB or midtrimester loss
2. Previous PPROM
3. Hx of cervical trauma
138
Within what time frame is a prolonged 3rd stage diagnosed?
a) active: 30 mins
b) physiological: 60 mins
139
In what proportion of women receiving radiotherapy for cervical cancer does bowel fistula occur?
8%
140
What is the failure rate of POP with perfect use?
3:1000 per year
141
Which progestogens have the highest VTE risk?
1. 4th generation
2. Dienogest
3. Drospirenone
4. Nestorone
5. Nomegestrol
6. Trimegestone
142
When should breastfeeding ideally commence?
Within 1 hour of birth
143
What is the recurrence rate of placental abruption after a) 1 & b) 2 previous?
a) 4%
b) 20%
144
What is the risk of SCBU admission, for a) CS at full dilatation, b) OVB
a) 11%
b) 6%
145
In granulosa cell tumour of the ovary, what is the rate of a) EH, b) endometrial cancer?
a) 1:3
b) 10-15%
146
Which maternal biomarker is associated with placental abruption?
Raised AFP
147
In GTD, in which circumstances should prenatal invasive testing be carried out?
1. Unclear if coexisting twin
2. Abnormal placenta, eg mesenchymal hyperplasia
148
What is the infectivity period of parvovirus B-19?
7-10 days before rash onset
To 1 day after rash develops
149
What is the incidence of breast cancer during pregnancy?
1:3000
150
In what proportion of women with untreated APS does gestational hypertension or PET occur?
30-50%
151
What is the risk of fetal malformations with anti-TNF drugs?
Similar to general population
152
How do you calculate odds ratio?
(Exposed with x unexposed without) /
(Exposed without x unexposed with)
153
How do you calculate relative risk?
(Exposed with / total exposed) /
(Unexposed with / total unexposed)
154
What is the experimental event rate?
Exposed with / total exposed
155
What is the incidence of diabetes insipidus in pregnancy?
2-4 per 100,000
156
How do primary vs metastatic ovarian mucinous adenocarcinomas present?
Primary: large unilateral ovarian mass with smooth surface
Metastatic: bilateral, multinodular ovarian surfaces, compressible & fluid-filled, may have local vascular invasion
157
What is the incidence of hirsutism in the general UK population?
10%
158
What % of healthy individuals have Antiphospholipid antibodies?
2-3%
159
Which points in POP-Q are defined & which are variable?
Defined: Aa, Ap
Variable: Ba, Bp
160
How do obesity & diabetes impact on risk of cancer in PMB?
General: 10%
Obesity: 18%
Diabetes: 21%
Both: 29%
161
What are the risks of preterm delivery by different gestations for different cervical lengths?
1. < 25mm: 25% before 28/40
2. < 20mm: 42% before 32/40
62% before 34/40
162
What is the risk of malignant transformation of hepatic adenomas?
5%
163
Injury of which vessels causes a) vulval & vulvovaginal haematoma, b) paravaginal & supralevator haematoma?
a) internal pudendal
b) uterine
164
What action should be taken if a Rh -ve patient is transfused +ve red blood cells?
> 15ml: 1500 or 2500 units anti-D
> 1 unit: exchange transfusion
165
How many units of +ve platelets can be covered with 250 units anti-D?
5
166
What % of women who develop varicella infection in pregnancy develop pneumonia?
5%
167
What is the risk of neonatal varicella infection if mother develops chicken pox within 4 weeks of delivery?
50%
