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Gaby’s PassMRCOG repeats > December > Flashcards

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

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2
Q

What is the risk of PPH in deliveries complicated by shoulder dystocia?

A

10%

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3
Q

How should low mood be treated in patients taking Tamoxifen?

A

CBT
avoid SSRIs, St John’s Wort & soy isofavones

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4
Q

Compression of which nerve commonly results in foot drop?

A

Common peroneal nerve
Often from lithotomy position

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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

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6
Q

What is the suture absorption time of monocryl?

A

90-120 days

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7
Q

Which anti-epileptic drug has levels lowered by estrogen- containing contraception?

A

Lamotrigine

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8
Q

Spinal cord lesions at which level are associated with autonomic dysreflexia?

A

T6

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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

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10
Q

What are the reintervention rates for uterine artery embolisation?

A

1:3 within 5 years

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11
Q

How are patients with thalassaemia managed for VTE risk in pregnancy?

A

Splenectpmy OR platelets >600: aspirin
“. AND. “. : aspirin + LMWH

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12
Q

What is the incidence of IBS in women in the UK?

A

10-15%

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13
Q

COCP containing which progestogens have the lowest VTE risk?

A

1st & 2nd generation eg norethisterone, levonorgestrel

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14
Q

What is the risk of needing a CS hysterectomy for placenta praevia?

A

11%

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15
Q

In suspected PE, how do CXR findings impact on imaging modality?

A

Normal CXR: V/Q
Abnormal CXR: CTPA

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16
Q

What percentage of UK obstetric admissions are complicated by AKI?

A

1.5%

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17
Q

What natural menopause remedy is banned in the UK due to causing liver damage?

A

Kava kava

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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

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19
Q

What is the student’s t-test used for?

A

Comparing 2 sample means,
Assuming normal distribution

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20
Q

What is the chi squared test used for?

A

Nonparametric test
Comparing numerical or categorical data sets

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21
Q

What is the ANOVA test used for?

A

Comparing multiple population means

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22
Q

With tubal ectopics, what is the MSD cut-off for expectant management?

A

30mm

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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

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24
Q

What is the risk of placenta praevia after 1 previous?

A

23:1000

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25
Q

How does 1 shoulder dystocia affect the rate of future shoulder dystocia?

A

10 x general population

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26
Q

What is the risk of requiring further treatment after a salpingotomy?

A

1:5

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27
Q

What are the risk factors for endometrial polyps?

A

Increasing age
HRT
Tamoxifen

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28
Q

What is the management for stage 1a vaginal cancer?

A

Wide local excision only

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29
Q

What is the incidence of 3rd & 4th degree tears in instrumental births?

A

Forceps no epis: 22.7%
Forceps with epis: 6%
Ventouse no epis: 6%
Ventouse with epis: 2%

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30
Q

What is the risk of serious haemorrhage with abdominal hysterectomy?

A

23:1000

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31
Q

What are the RCOG risk categories?

A

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

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32
Q

What are the risks with CF in pregnancy?

A
  1. Prematurity rate 25%
  2. Spontaneous preterm labour
  3. Diabetes
  4. Stillbirth (live birth rates 70-90%)
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33
Q

Define relative risk!

A

Rate of disease in exposed group divided by rate of disease in unexposed group, aka risk ratio

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34
Q

Define odds ratio!

A

Relative measure of effect, comparing exposed group to control group
Odds in exposed group divided by odds in control group

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35
Q

What is the management of asymptomatic placenta praevia confirmed at 32/40?

A

Course of corticosteroids 34/40-35+6

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36
Q

What is the 1st line Mx of PMS?

A
  1. Exercise
  2. CBT
  3. Vitamin B6
  4. COCP new generation
  5. Low dose SSRI, continuous or luteal phase
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37
Q

What is the rate of bowel obstruction following radiotherapy for cervical cancer?

A

10-15%

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38
Q

What is the NNT for elective Caesareans & faecal incontinence?

A

90-170

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39
Q

What is the NNT for breech ElCS for any adverse outcome vs vaginal breech?

A

16-35

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40
Q

What is the NNT for ElCS vs vaginal breach for perinatal death?

A

170-440

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41
Q

What is the rate of conversion to open procedure for transabdominal cerclage?

A

10%

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42
Q

What is the order of ligament division in vaginal hysterectomy?

A
  1. Uterosacrals
  2. Cardinals
  3. Broads
  4. Rounds
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43
Q

Tumour markers!!!

A

Make mnemonics

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44
Q

What is a common nerve injury in traumatic births, leading to sensory loss anterior thigh & knee, quadriceps weakness & loss of knee jerk?

A

Femoral nerve

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45
Q

What is the risk of ureteric injury in laparoscopic resection of severe endometriosis with hydronephrosis?

A

20%

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46
Q

Following intrauterine death of 1 morochorionic twin, what is the risk of a) death & b) neurological abnormality in the 2nd twin?

A

a) 15%
b) 25%

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47
Q

What is the mortality rate associated with necrotising fasciitis?

A

20-40%

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48
Q

What is the treatment for uncomplicated malaria in pregnancy for plasmodium vivax, ovale & malariae?

A
  1. Admit
  2. PO chloroquine
  3. 600mg loading dose then 300mg 6-8 hours later, daily for 3 days then weekly
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49
Q

What is the treatment for uncomplicated malaria in pregnancy with plasmodium falciparum?

A
  1. Admit
  2. Oral quinine 600mg 8-hourly
  3. Oral clindamycin 450mg 8-hourly
  4. For 7 days
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50
Q

What is the 1st line treatment for chicken pox exposure in pregnancy?

A

Oral Aciclovir
7-14 days post-exposure

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51
Q

What is the cause of MRKH syndrome?

A

Müllerian agenesis

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52
Q

Which complications of CS for placenta praevia are classed as “very common”?

A

Emergency hysterectomy
Massive obstetric haemorrhage

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53
Q

What is the lifetime risk of ovarian cancer in the general population?

A

1.4%

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54
Q

Which conditions result in hypogonadotrophic hypogonadism?

A
  1. Kallman syndrome
  2. Prader-Willi syndrome
  3. CHARGE
  4. Pituitary tumours
  5. Brain injury
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55
Q

What are the proportions of patients with different impacts of pregnancy on MG?

A

30% remission
30% no change
40% worsen

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56
Q

What proportion of CIN2 lesions regress spontaneously within 2 years?

A

50%

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57
Q

What is the absolute risk of VTE in pregnancy & the puerperium?

A

1-2:1000

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58
Q

What is the 1st line varicella post-exposure prophylaxis?

A

Oral Aciclovir or valaciclovir
7-14 days after exposure

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59
Q

What is the incidence of ectopic pregnancy in the UK?

A

11 in 1000

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60
Q

Following radical hysterectomy for cervical cancer, what proportion of patients need to ISC for long-term voiding difficulties?

A

2-3%

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61
Q

What proportion of ectopic pregnancies are interstitial?

A

1-6%

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62
Q

What is the presenting diameter of a brow presentation?

A

Mento-vertical

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63
Q

What is the leading cause of direct maternal deaths in the UK?

A

Thrombosis & thromboembolism

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64
Q

What are the contraindications to flying in pregnancy?

A
  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
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65
Q

What are the general points for flying in pregnancy?

A
  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
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66
Q

What proportion of CIN1 & 2 lesions regress spontaneously within 2 years?

A

50%

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67
Q

What are the high-risk factors for pre-eclampsia?

A
  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
Q

What are the moderate risk factors for pre-eclampsia?

A
  1. 1st pregnancy
  2. Age ≥ 40
  3. Pregnancy interval > 10 years
  4. BMI ≥ 35
  5. Family hx PET
  6. Multi-fetal pregnancy
69
Q

Which women should be started on aspirin?

A
  1. 1+ high risk factors
  2. 2+ moderate risk factors
70
Q

What uterotonic should be given for 3rd stage at vaginal birth?

A

10 units oxytocin IM

71
Q

In what situations is antenatal VTE prophylaxis given & for how long?

A
  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
Q

What is the incidence of umbilical cord prolapse in breech presentation?

A

1%

73
Q

What is the absolute risk of VTE in pregnancy & the puerperium?

A

1-2:1000

74
Q

What is the risk of placenta praevia with 4 previous Caesareans?

A

10%

75
Q

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?

A

2.8%

76
Q

What level of testosterone points towards serious ovarian or adrenal pathology?

A

> 5 nmol/L
1.5 ng/L

77
Q

When should pregnant patients with HIV not on ART be started?

A

13/40

78
Q

What is the average cycle fecundity in unexplained subfertility?

A

1.3-4.1%

79
Q

What is the chance of conceiving within 12 months in unexplained subfertility?

A

74%

80
Q

By how much is the rate of intraoperative trauma increased in CS at full dilation vs 1st stage?

A

More than double

81
Q

What is the management of single 2nd trimester miscarriage?

A
  1. Screen for inherited thrombophilias: factor V Leiden, prothrombin gene mutation, protein S deficiency
  2. Antiphospholipid antibodies
  3. Pelvic ultrasound
82
Q

What % of infants with neonatal herpes have disseminated &/or CNS infection?

A

70%

83
Q

What is the incidence of 3rd & 4th degree tears in multiparous women?

A

1.7%

84
Q

What is the incubation period of rubella?

A

12-23 days
Average 14 days

85
Q

What is the mechanism of gestational diabetes insipidus?

A

ADH deficiency secondary to increased vasopressinase activity

86
Q

What is the risk of congenital CMV infection if primary infection occurs during pregnancy?

A

30-40%

87
Q

If a patient is taking lithium for bipolar disorder, what should she do in pregnancy?

A

Stop over 4 weeks
If at high risk of relapse, switch to antipsychotic

88
Q

What is the incidence of cerebral palsy at different gestations?

A

22-27/40: 14.6%
28-31/40: 6.2%
32-36/40: 0.7%
Term: 0.1%

89
Q

What is the association between endometriosis & cancer?

A

Increased ovarian & non-Hodgkins lymphoma
Decreased cervical
No change in endometrial

90
Q

With diaphragm use, when should spermicide be reapplied?

A

When in place for >3 hours & sex planned

91
Q

Following uterine artery embolisation, which obstetric complications are there higher rates of?

A
  1. Caesarean section
  2. PPH
92
Q

What is the incidence of PE in the UK in pregnancy & the puerperium?

A

1.3 per 10,000

93
Q

In which patients is additional cervical screening recommended?

A
  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
Q

What is the most common presenting feature of endometrial polyps in premenopausal women?

A

Menorrhagia

95
Q

What are the risks of vertical transmission of parvovirus?

A

<15/40: 15%
15-20/40: 25%
Term: 70%

96
Q

What are paravaginal haematomas bounded by?

A

Superiorly by cardinal ligament
Inferiorly by pelvic diaphragm

97
Q

How should menopause be investigated in patients over 50 on combined contraception?

A
  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
Q

What proportion of patients would labour spontaneously within 3 weeks of IUFD?

A

> 85%

99
Q

What is the incidence of focal nodular hyperplasia?

A

3%

100
Q

What are the risk factors for OHSS?

A
  1. Past history OHSS
  2. PCOS
  3. Increased antral follicle count
  4. High levels of AMH
101
Q

In what proportion of pregnancies are red cell autoantibodies detected?

A

1.2%

102
Q

What proportion of neonates with congenital CMV appear asymptomatic at birth but later develop hearing loss?

A

15%

103
Q

How does a transverse vaginal septum impact on fertility rates?

A

Lower 1/3: normal
Middle 1/3: 40%
Upper 1/3: 20%

104
Q

With expectant management of IUFD, what is the risk of DIC occurring within 4 weeks?

A

10%

105
Q

What is the incidence of 3rd & 4th degree tears in shoulder dystocia?

A

3.8%

106
Q

How many women become pregnant within the first year of using a copper coil?

A

8 in 1000

107
Q

What is the risk of death from a diagnostic laparoscopy?

A

3-8 in 100,000

108
Q

When should birth be planned for monochorionic twins?

A

36-37/40

109
Q

What % of patients with acute fatty liver of pregnancy develop renal impairment?

A

14%

110
Q

Which conditions result in hypergonadotrophic hypogonadism?

A
  1. Kleinfelter‘s
  2. Noonan‘s
  3. Cryptorchidism
  4. Injury
  5. Varicocoele
  6. Tumours
  7. Chemo/radiotherapy
  8. Idiopathic
111
Q

Which conditions result in normogonadotrophic hypogonadism?

A
  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
Q

What is the global incidence of conjoined twins?

A

1:100,000

113
Q

What features define complicated malaria?

A
  1. > 2% parasitised RBCs
  2. Respiratory distress
  3. Pulmonary oedema
  4. Hypoglycaemia
  5. Secondary sepsis
114
Q

What is the risk of lichen sclerosus progressing to invasive disease?

A

4%

115
Q

What 6 points are measured wrt hymen for POP-Q?

A

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
Q

What % of patients with stage 1 ovarian cancer have an elevated Ca-125?

A

55%

117
Q

What are the 1st line treatments for overactive bladder?

A
  1. Oxybutynin (unless frail elderly)
  2. Tolterodine
  3. Darifenacin
118
Q

What are the rates of congenital rubella syndrome at different gestations?

A

a) < 11/40: 90%
b) 11-16/40: 20%
c) > 20/40: no reported cases

119
Q

What is the incidence of puerperal psychosis?

A

1:1000

120
Q

What are the risks of preterm birth for cervical length a) < 25mm, b) < 20mm

A

< 25mm: 25% before 28/40
< 20mm: 42% before 32/40
62% before 34/40

121
Q

What are the cut-offs for medical management of ectopic pregnancies?

A

35mm
hCG 5000

122
Q

What is the incidence of chronic pain following different numbers of TOAs?

A

1: 12%
2: 30%
3: 67%

123
Q

What is the incubation period for Zika virus?

A

3-12 days

124
Q

What 3 methods are effective in preventing PHVP?

A
  1. McCall culdoplasty
  2. Sacrospinous fixation
  3. Suturing the cardinal & uterosacral ligaments to the vaginal cuff
125
Q

What are the mechanisms of action of drugs used for hirsutism?

A
  1. Cyproterone: anti-androgen & progestogen
  2. Goserelin: GnRH analogue
  3. Finasteride: 5 α reductase inhibitor
  4. Metformin: insulin sensitiser
  5. Eflornithine: antiprotozoal
126
Q

By what proportion does blood volume increase in pregnancy?

A

40-50%

127
Q

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

a) 80%
b) <50%
c) 10-15%

128
Q

When should hCG repeated following evacuation of molar pregnancy?

A
  1. Until normalised
  2. If normalised within 56 days, 6 months from evacuation
  3. If normalised > 56 days, 6 months from normalisation
129
Q

What is the risk of progression to cancer of endometrial hyperplasia a) without atypia, b) with atypia?

A

a) < 5%
b) 25-30%

130
Q

What is the rate of miscarriage in women infected with Rubella in the 1st trimester?

A

20%

131
Q

What are the cut-off points for a) oligospermia, b) severe oligospermia?

A

a) < 15 million/ml
b) < 5 million/ml

132
Q

What % of patients with acute fatty liver of pregnancy need renal replacement?

A

3.5%

133
Q

What are the predictors of successful medical Mx of ectopic pregnancy?

A
  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
Q

What is the NNT for elective IOL at 40/40 to prevent 1 perinatal death?

A

1040

135
Q

What is the NNT for IAP in intrapartum fever to prevent 1 GBS infection?

A

208

136
Q

What % of laparoscopic a) bladder & b) ureteric injury are diagnosed postoperatively?

A

a) 50%
b) 70%

137
Q

For US-identified cervix <25mm, in which circumstances is prophylactic cerclage offered?

A
  1. Previous spontaneous PTB or midtrimester loss
  2. Previous PPROM
  3. Hx of cervical trauma
138
Q

Within what time frame is a prolonged 3rd stage diagnosed?

A

a) active: 30 mins
b) physiological: 60 mins

139
Q

In what proportion of women receiving radiotherapy for cervical cancer does bowel fistula occur?

A

8%

140
Q

What is the failure rate of POP with perfect use?

A

3:1000 per year

141
Q

Which progestogens have the highest VTE risk?

A
  1. 4th generation
  2. Dienogest
  3. Drospirenone
  4. Nestorone
  5. Nomegestrol
  6. Trimegestone
142
Q

When should breastfeeding ideally commence?

A

Within 1 hour of birth

143
Q

What is the recurrence rate of placental abruption after a) 1 & b) 2 previous?

A

a) 4%
b) 20%

144
Q

What is the risk of SCBU admission, for a) CS at full dilatation, b) OVB

A

a) 11%
b) 6%

145
Q

In granulosa cell tumour of the ovary, what is the rate of a) EH, b) endometrial cancer?

A

a) 1:3
b) 10-15%

146
Q

Which maternal biomarker is associated with placental abruption?

A

Raised AFP

147
Q

In GTD, in which circumstances should prenatal invasive testing be carried out?

A
  1. Unclear if coexisting twin
  2. Abnormal placenta, eg mesenchymal hyperplasia
148
Q

What is the infectivity period of parvovirus B-19?

A

7-10 days before rash onset
To 1 day after rash develops

149
Q

What is the incidence of breast cancer during pregnancy?

A

1:3000

150
Q

In what proportion of women with untreated APS does gestational hypertension or PET occur?

A

30-50%

151
Q

What is the risk of fetal malformations with anti-TNF drugs?

A

Similar to general population

152
Q

How do you calculate odds ratio?

A

(Exposed with x unexposed without) /
(Exposed without x unexposed with)

153
Q

How do you calculate relative risk?

A

(Exposed with / total exposed) /
(Unexposed with / total unexposed)

154
Q

What is the experimental event rate?

A

Exposed with / total exposed

155
Q

What is the incidence of diabetes insipidus in pregnancy?

A

2-4 per 100,000

156
Q

How do primary vs metastatic ovarian mucinous adenocarcinomas present?

A

Primary: large unilateral ovarian mass with smooth surface
Metastatic: bilateral, multinodular ovarian surfaces, compressible & fluid-filled, may have local vascular invasion

157
Q

What is the incidence of hirsutism in the general UK population?

A

10%

158
Q

What % of healthy individuals have Antiphospholipid antibodies?

A

2-3%

159
Q

Which points in POP-Q are defined & which are variable?

A

Defined: Aa, Ap
Variable: Ba, Bp

160
Q

How do obesity & diabetes impact on risk of cancer in PMB?

A

General: 10%
Obesity: 18%
Diabetes: 21%
Both: 29%

161
Q

What are the risks of preterm delivery by different gestations for different cervical lengths?

A
  1. < 25mm: 25% before 28/40
  2. < 20mm: 42% before 32/40
    62% before 34/40
162
Q

What is the risk of malignant transformation of hepatic adenomas?

A

5%

163
Q

Injury of which vessels causes a) vulval & vulvovaginal haematoma, b) paravaginal & supralevator haematoma?

A

a) internal pudendal
b) uterine

164
Q

What action should be taken if a Rh -ve patient is transfused +ve red blood cells?

A

> 15ml: 1500 or 2500 units anti-D
1 unit: exchange transfusion

165
Q

How many units of +ve platelets can be covered with 250 units anti-D?

A

5

166
Q

What % of women who develop varicella infection in pregnancy develop pneumonia?

A

5%

167
Q

What is the risk of neonatal varicella infection if mother develops chicken pox within 4 weeks of delivery?

A

50%

Gaby’s PassMRCOG repeats (18 decks)

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