Obs & Gynae COPY

Question 1

Cervical cancer is associated with..

Answer 1

HPV 16 and 18

Question 2

Ix for cervical cancer

Answer 2

Urgent colposcopy
CT chest/abdomen/pelvis is used for staging

Question 3

Abdominal bloating, pelvic discomfort and loss of appetite. On examination, there is an abdominal mass and ascites. Transvaginal ultrasound shows a complex cystic mass with solid components. What is the most likely diagnosis?

Answer 3

Ovarian cancer

Question 4

Raised AFP, B-hCG and LDH point towards..

Answer 4

Germ-cell tumour - ovarian cancer

Question 5

Tx for CIN 1

Answer 5

Regresses spontaneously so conservative management with repeat cytology in 6 months

Question 6

Tx for CIN 2 - 3

Answer 6

LLETZ, cone biopsy or cryotherapy

Question 7

Bloating, frequency and urgency

Answer 7

Ovarian cancer

Question 8

Tx for PMS

Answer 8

Mild - regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates
Moderate - new-generation combined oral contraceptive pill (COCP) eg Yasmin
Severe - SSRI (may be taken continuously or just during the luteal phase)

Question 9

Lesion can consist of hair, skin, cartilage, teeth and thyroid tissue

Answer 9

Mature teratoma

Question 10

Lesion looks like a fried egg

Answer 10

Dysgerminoma

Question 11

Lesion has a complex papillary architecture, nuclear atypia and the presence of Psammoma bodies

Answer 11

Serous cystadenocarcinoma

Question 12

Post menopausal women presenting with abnormal bleeding need to be worked up for..

Answer 12

Endometrial and cervical cancer

Question 13

When a pregnancy is not seen on an early scan, a ______ should be performed

Answer 13

β-hCG

Question 14

If it is more than 1500 mIU/ml, the pregnancy should be treated as _________. If it is lower than this, the test will be repeated in 48 h and the two numbers compared. If the second reading is less than half of the first reading, it is most likely a _________. If the second reading is more than double the first reading, it is most likely a _________ pregnancy. If the second reading is between half and double the first reading, it should be treated as an _________ pregnancy

Answer 14

If it is more than 1500 mIU/ml, the pregnancy should be treated as ectopic. If it is lower than this, the test will be repeated in 48 h and the two numbers compared. If the second reading is less than half of the first reading, it is most likely a miscarriage. If the second reading is more than double the first reading, it is most likely a viable pregnancy. If the second reading is between half and double the first reading, it should be treated as an ectopic pregnancy

Question 15

Febrile and has signs of a recent sexually transmitted infection (new discharge and lower abdominal pain). Cervical motion tenderness

Answer 15

Pelvic inflammatory disease (PID)

Question 16

When is surgical management indicated in an ectopic pregnancy?

Answer 16

The patient is in a large amount of pain
The mass is greater than 35mm
Ultrasound identifies a fetal heartbeat
Serum beta-human chorionic gonadotropin (B-hCG) levels are over 5000 IU/L

Question 17

When are Mifepristone and Misoprostol used?

Answer 17

Mifepristone - termination of pregnancy to end the pregnancy
Misoprostol - expulsion of the products of conception.

Question 18

Painless, skin-coloured papules in his genital area

Answer 18

Warts - HPV

Question 19

Round, budding yeasts with pseudohyphae.

Answer 19

Candida albicans

Question 20

Small, pear-shaped parasites with a single nucleus and flagella

Answer 20

Trichomonas vaginalis

Question 21

Gram-negative intracellular diplococci

Answer 21

Neisseria gonorrhoea

Question 22

Small, round, elementary bodies within infected cells.

Answer 22

Chlamydia trachomatis

Question 23

Solitary, firm, non-tender ulcer that is usually located at the site of inoculation (genital, anal, or oral)

Answer 23

Syphilis - primary stage

Question 24

The POP is used by women who..

Answer 24

Cannot use oestrogen, such as women who smoke >15 cigarettes a day, whom are over 35 and who experience migraine with aura

Question 25

Which conditions test positive for CA-125?

Answer 25

Ovarian cancer
PID - bilateral abdominal pain and inter-menstrual bleeding + PMH of STIs

Question 26

Mucopurulent discharge, cervical tenderness and lower abdominal pain are typical of..

Answer 26

Pelvic inflammatory disease - Chlamydia trachomatis

Question 27

Vaginal discharge worse after bleeds, and an associated fishy odour

Answer 27

Bacterial Vaginosis

Question 28

Which form of contraceptives prevent ovulation?

Answer 28

Progestogen-only pill, the combined oral contraceptive pill and the progestogen implant prevent ovulation

Question 29

Maculopapular rash on the trunk, palms and soles, along with ulceration of the oral mucosa and a recent history of untreated chancre

Answer 29

Syphilis - secondary stage

Question 30

A solitary indurated painless ulcer or ‘chancre’ at the site of inoculation

Answer 30

Syphilis - primary stage

Question 31

Entropion and green discharge

Answer 31

Trachoma - Chlamydia trachomatis

Question 32

Tender inguinal lymphadenopathy and a green urethral discharge

Answer 32

Neisseria gonorrhoeae

Question 33

What is the window period fo 4th generation antigen and antibody test?

Answer 33

17.8 days (ranging from 13-26 days)

Question 34

What is viral PCR used for?

Answer 34

To look for vertical transmission of HIV, from mother to child

Question 35

Dendritic cell ulcer on fluorescein stain, which has a characteristic branched appearance

Answer 35

HSV keratitis - HIV

Question 36

Multiple small round pearly lesions with a central area of umbilication

Answer 36

Molluscum contagiosum

Question 37

What is a complication of bacterial vaginosis in pregnant women?

Answer 37

Increased risk of pre-term delivery

Question 38

What is a complication of chlamydia and gonorrhoea in pregnant women?

Answer 38

Neonatal conjunctivitis

Question 39

Guidelines if missed >2 COCP pills

Answer 39

If pills are missed in week 1: use emergency contraception if she had UPSI in pill free interval for 1 week

If pills are missed in week 2: no need for emergency contraception

If pills are missed in week 3: Take the last pill that was missed, finish the current pack and start the next pack immediately after.

Question 40

Oral hairy leukoplakia

Answer 40

HIV

Question 41

Gold standard investigation for confirming the diagnosis of PCP?

Answer 41

Bronchoalveolar lavage

Question 42

Every patient who presents for a booking appointment should be tested for..

Answer 42

HIV

Question 43

Smear displays 5 or more polymorphs per high power field, with no evidence of gram negative diplococci

Answer 43

Chlamydia

Question 44

Which form of HRT is given for woman is at risk of VTE?

Answer 44

Transdermal

Question 45

HRT decreases the risk of which two conditions?

Answer 45

Osteoporosis and colorectal cancer

Question 46

Which HRT regime is recommended for women with menopausal symptoms who continue to have regular periods?

Answer 46

Monthly, cyclical (sequential) HRT - taking oestrogen throughout the menstrual cycle, with progesterone taken only in the last 14 days

Question 47

Which HRT regime is recommended for women with menopausal symptoms who continue to have irregular periods?

Answer 47

3-monthly, cyclical (sequential) HRT - taking oestrogen throughout the 3 month period, with progesterone taken for approximately 14 days every 3 months

Question 48

Oestrogen only HRT increases the risk of __________ cancer

Answer 48

Endometrial

Question 49

What are the risks of oral HRT?

Answer 49

Breast cancer, endometrial cancer (if oestrogen given alone), and venous thromboembolism

Question 50

When is progestrogen used in addition to oestrogen-only HRT?

Answer 50

If the patient has a uterus to reduce the risk of endometrial hyperplasia and endometrial cancer

Question 51

Ix for menopause

Answer 51

> 45 - no Ix needed
<45 - two FSH bloods

Question 52

Criteria for suspected endometrial cancer?

Answer 52

Aged over 55 with postmenopausal bleeding

Question 53

Which method of delivery is offered for pregnant women with an undetectable viral load?

Answer 53

Vaginal delivery

Question 54

Which method of delivery is offered for pregnant women with detectable viral load?

Answer 54

Caesarean section

Question 55

Which dermatological condition is harmless in children, but could be an indication of HIV in adults?

Answer 55

Molluscum contagiosum

Question 56

Which test is used for PCP?

Answer 56

Silver stain

Question 57

Pregnant patient with light bleeding and no abdominal pain. Closed cervical os and ‘blighted’ ovum

Answer 57

Missed miscarriage

Question 58

Anything that slows the ovum’s passage through the fallopian tube to the uterus is a risk factor for developing an ectopic pregnancy. An example of this is..

Answer 58

Pelvic inflammatory disease

Question 59

Ix for endometriosis

Answer 59

Transvaginal US
Diagnostic laparoscopy

Question 60

Tx for PID

Answer 60

Ceftriaxone (given intramuscularly) + doxycycline + metronidazole
Ofloxacin + metronidazole

Question 61

Define gravidity

Answer 61

Number of times a woman has been pregnant, regardless of the outcome

Question 62

Define parity

Answer 62

Total number of pregnancies carried over the threshold of viability (typically 24 + 0 weeks)

E.g: P(no.of live births) + (no. of losses)

Question 63

When is serum progesterone levels used to check for ovulation?

Answer 63

7 days prior to the expected next period

Question 64

Course of action if patch change is delayed at the end of week 1 or week 2

Answer 64

If delay is less than 48 hours, it should be changed immediately and no further precautions are needed

If delay is greater than 48 hours, the patch should be changed immediately and a barrier method of contraception used for the next 7 days. If the woman has had sexual intercourse, then emergency contraception needs to be considered

Question 65

Course of action if patch change is delayed at the end of week 3

Answer 65

The patch should be removed as soon as possible and the new patch applied on the usual cycle start day for the next cycle, even if withdrawal bleeding is occurring. No additional contraception is needed

If patch application is delayed at the end of a patch-free week, additional barrier contraception should be used for 7 days following any delay at the start of a new patch cycle

Question 66

After giving birth, women require contraception after day..

Answer 66

21

Question 67

When is the POP started in postpartum women (breastfeeding and non-breastfeeding)?

Answer 67

Can start at any time postpartum

After day 21 additional contraception should be used for the first 2 days

Question 68

When is the COCP started in postpartum women (breastfeeding and non-breastfeeding)?

Answer 68

Contraindicated if breastfeeding < 6 weeks post-partum
If breastfeeding 6 weeks, then 6 months postpartum

Should not be used in the first 21 days due to the increased venous thromboembolism risk post-partum. After day 21 additional contraception should be used for the first 7 days

Question 69

The FIGO staging system is used to stage endometrial and ovarian cancers

Answer 69

Question 70

Pre menopausal women presenting with abnormal vaginal bleeding should have a ____________ test, post menopausal women presenting with abnormal bleeding need to be worked up for ____________ and ____________

Endometrial cancer work up includes a _____________ _____________ but for cervical cancer assessment _____________ is recommended.

Answer 70

Pre menopausal women presenting with abnormal vaginal bleeding should have a chlamydia test, post menopausal women presenting with abnormal bleeding need to be worked up for endometrial and cervical cancer

Endometrial cancer work up includes a transvaginal ultrasound but for cervical cancer assessment colposcopy is recommended

Question 71

Unopposed oestrogen increases the risk of ___________ cancer, so oestrogen-only HRT shouldn’t be given to people with a ___________. The addition of progesterone to the HRT (oestrogen + progesterone) prevents the increase in ___________ cancer, but progesterone exposure increases the risk of ___________ cancer. On balance, the risks are less to give combined HRT to post-menopausal people with ___________, and oestrogen-only HRT if they’ve had a ___________

Answer 71

Unopposed oestrogen increases the risk of endometrial cancer, so oestrogen-only HRT shouldn’t be given to people with a womb. The addition of progesterone to the HRT (oestrogen + progesterone) prevents the increase in endometrial cancer, but progesterone exposure increases the risk of breast cancer. On balance, the risks are less to give combined HRT to post-menopausal people with wombs, and oestrogen-only HRT if they’ve had a hysterectomy

Question 72

Stages of ovarian cancer

Answer 72

Stage 1 (1 word) = ovary
Stage 2 (2 words) = ovary + pelvis
Stage 3 (3 words) = ovary + pelvis + abdomen
Stage 4 = ovary + pelvis + abdomen + elsewhere

Question 73

For ovarian cancer, the most common site for lymphatic spread is the ___________ lymph nodes. The most common site for haematological spread is the ___________

Answer 73

For ovarian cancer, the most common site for lymphatic spread is the para-aortic lymph nodes. The most common site for haematological spread is the liver.

Question 74

Mx for simple endometrial hyperplasia without atypia

Answer 74

High dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be used

Question 75

Mx for simple endometrial hyperplasia with atypia

Answer 75

Hysterectomy with bilateral salpingo-oophorectomy

Question 76

Lactational amenorrhoea is a reliable method of contraception if the following criteria are fulfilled..

Answer 76

Baby under 6 months
Exclusively breastfeeding
Amenorrhoea
Gaps between feeds do not exceed 4 hours in the day or 6 hours at night

Question 77

Differentiate between open and closed cervical os in miscarriages

Answer 77

Open = incomplete or inevitable miscarriage
Closed = complete, missed, threatened miscarriage

“Open your I’s”

Question 78

Ix for reduced fetal movements if past 28 weeks gestation

Answer 78

1st: Doppler US, if no HB then immediate US
2nd: Doppler US, if HB present then CTG for 20 minutes

If concern persists then US within 24hrs, abdominal circumference or estimated fetal weight (to exclude SGA), and amniotic fluid volume measurement

Question 79

Ix for reduced fetal movements if between 24 and 28 weeks gestation

Answer 79

Handheld Doppler

Question 80

Ix for reduced fetal movements if below 24 weeks gestation

Answer 80

Handheld Doppler

Question 81

Ix if fetal movements have not yet been felt by 24 weeks

Answer 81

Onward referral should be made to a maternal fetal medicine unit

Question 82

The COCP causes an increased risk of which type of cancer?

Answer 82

Breast and cervical cancer

Question 83

When is a salpingectomy or salpingotomy used in the management of an ectopic pregnancy?

Answer 83

If the contralateral tube is healthy then salpingectomy may be the best option. However, if the contralateral tube is damaged, salpingotomy preserves the functional tube and helps minimise the risk of future infertility.

Question 84

Sudden increases in the size of mum’s abdomen and/or any breathlessness in a monochorionic multiple pregnancy

Answer 84

TTTS - result of polyhydramnios affecting the recipient twin

Question 85

Is the COCP C.I if breastfeeding?

Answer 85

Can do but follow up (UKMEC 2) - if breastfeeding 6 weeks - 6 months postpartum

Absolutely contraindicated (UKMEC 4) - if breastfeeding < 6 weeks post-partum

Question 86

When is the IUD/IUS used postpartum?

Answer 86

Within 48 hours of childbirth or after 4 weeks

Question 87

Menorrhagia, subfertility and an abdominal mass

Answer 87

Fibroids

Question 88

Ix for fibroids

Answer 88

TVUS

Question 89

Mx of menorrhagia secondary to fibroids

Answer 89

Levonorgestrel intrauterine system (LNG-IUS)
NSAIDs e.g. mefenamic acid
Tranexamic acid
COCP
Oral progestogen
Injectable progestogen

Question 90

Medical mx to shrink/remove fibroids

Answer 90

GnRH agonists

Question 91

Surgical mx to shrink/remove fibroids

Answer 91

Myomectomy
Hysteroscopic endometrial ablation
Hysterectomy
Uterine artery embolization

Question 92

Which contraception can be carried out immediately after TOP?

Answer 92

IUD

If heavy menstrual cycles then IUS

Question 93

What advice is given regarding air travel if > 37 week?

Answer 93

> 37 weeks with singleton pregnancy and no additional risk factors should avoid air travel women

Question 94

What advice is given regarding air travel if > 32 week?

Answer 94

Uncomplicated, multiple pregnancies should avoid travel by air once >32 weeks

Question 95

Expectant management for a miscarriage

Answer 95

Waiting for 7-14 days for the miscarriage to complete spontaneously

Question 96

In which situations are miscarriages better managed medically or surgically?

Answer 96

Increased risk of haemorrhage - late first trimester, coagulopathies or unable to have a blood transfusion
Previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage)
Evidence of infection

Question 97

Medical management for a miscarriage

Answer 97

Vaginal misoprostol with antiemetics and pain relief

Contact doctor if no bleeding in 24 hours

Question 98

Surgical management for a miscarriage

Answer 98

Vacuum aspiration (suction curettage)
Or surgical management in theatre

Question 99

Anemia cut off for first trimester?

Answer 99

< 110 g/L

Question 100

Anemia cut off for second/third trimester?

Answer 100

< 105 g/L

Question 101

Anemia cut off postpartum?

Answer 101

< 100 g/L

Question 102

Differentiate between turner and kallman’s regarding FSH & LH levels

Answer 102

KALLman = FALL (Low FSH & LH)
TURNer = TURNed up (High FSH & LH)

Question 103

↓ AFP
↓ oestriol
↑ hCG
↑ inhibin A

Answer 103

Down’s syndrome

Question 104

A combined/quadruple test is offered a from 14-20 weeks

Answer 104

Quadruple

Question 105

A combined/quadruple test is offered between 10-13+6 weeks

Answer 105

Combined

Question 106

M rules to classify cysts as malignant

Answer 106

Irregular, solid tumour
Ascites
At least 4 papillary structures
Irregular multilocular solid tumour with largest diameter ≥100 mm
Very strong blood flow

Question 107

Antenatal routine tests

Answer 107

4 3 2 1
4 blood (FBC, rhesus, blood group, alloantibodies)
3 virus (hepB, HIV, syphilis) rubella no more
2 UTI (dipstick, culture)
1 full physical examination (breast, BMI, BP)

Question 108

Induction oflabour

Answer 108

1) Membrane sweep - usually repeated if unsuccessful
2) Vaginal PGE2 - maximum of 2 doses, 6 hours apart. CTG is needed to monitor the fetus once contractions begin. Avoid this if uterine hyperstimulation (straight to
3) Amniotomy with syntocin

Question 109

Which medication suppresses breastfeeding?

Answer 109

Cabergoline

Question 110

Take MORE Folic acid (5mg) if…

Answer 110

M- Metabolic disease (diabetes or Coeliac)
O- Obesity
R- Relative or personal Hx of NTDs
E- Epilepsy (taking antiepileptic medications)

+ Sickle Cell and Thalassaemia

Question 111

Drugs to avoid in breastfeeding

Answer 111

LAMBAST + 4C’s:

L - Lithium
A - Aspirin
M - Methotrexate
B - Benzodiazepines
A - Amiodarone
S - Sulphonylureas/sulphonamides
T - Tetracycline

4’Cs - Carbimazole, Ciprofloxacin, Chloramphenicol, Cytotoxics

Question 112

Pruritus
Jaundice
Raised bilirubin

Answer 112

Obstetric cholestasis

Question 113

Mx for intrahepatic cholestasis of pregnancy/obstetric cholestasis

Answer 113

Induction of labour at 37-38 weeks
Ursodeoxycholic acid
vitamin K supplementation

Question 114

3 different types of placenta accreta

Answer 114

A - attach
I - invade
P - penetrate

accreta: chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis
increta: chorionic villi invade into the myometrium
percreta: chorionic villi invade through the perimetrium

Question 115

Mx for menorrhagia

Answer 115

Question 116

Which hormone can cause breast cancer in excess?

Answer 116

Progesterone (the p is like reverse b)

Question 117

Oestrogen, in excess, can cause which type of cancers?

Answer 117

Ovarian and Endomtrial: OEstrogen

Update: An increased risk of ovarian cancer has been suggested in some studies involving HRT use, but the overall evidence remains inconclusive

Question 118

Which situations would warrant continuous CTG monitoring?

Answer 118

Suspected chorioamnionitis, sepsis, or a temperature of 38°C or above
BP 160/110 mmHg or above
Oxytocin
Significant meconium
Vaginal bleeding develops in labour

Question 119

In a CTG, a HR of <100 is caused by..

Answer 119

Increased fetal vagal tone, maternal beta-blocker use

Question 120

In a CTG, a HR of >160 is caused by..

Answer 120

Maternal pyrexia, chorioamnionitis, hypoxia, prematurity

Question 121

In a CTG, a loss of baseline variability (<5) is caused by..

Answer 121

Prematurity, hypoxia

Question 122

In a CTG, early deceleration is caused by..

Answer 122

Innocuous feature - indicates head compression

Question 123

In a CTG, late deceleration is caused by..

Answer 123

Fetal distress e.g. asphyxia or placental insufficiency

Question 124

In a CTG, variable deceleration is caused by..

Answer 124

Cord compression

Question 125

Early onset GBS infection occurs within…

Answer 125

48h of birth

Question 126

Surgical mx of PPH in order

Answer 126

Intrauterine balloon tamponade
B-Lynch suture
Stepwise uterine devascularisation
Uterine artery embolisation
Hysterectomy

Question 127

During pregnancy, lithium is switched for..

Answer 127

An atypical antipsychotic

Question 128

Right upper quadrant pain, which can radiate up to the shoulder + vaginal discharge and fever.

Answer 128

Fitz–Hugh–Curtis syndrome

Question 129

For nulliparous and multiparous women, the recommended time for ECV is ____ and ____ weeks respectively

Answer 129

For nulliparous and multiparous women, the recommended time for ECV is 36 and 37 weeks respectively

Question 130

What is a complete mole?

Answer 130

Occurs when one or two sperm fertilise an egg that contains no chromosomal material. Therefore there is no maternal chromosomal material. A placenta is formed but there is no embryo

Question 131

What is a partial mole?

Answer 131

Occurs when two sperm fertilise a normal egg and instead of forming twins, there is an abnormal proliferation of tissue. There is embryonic tissue, but this is not a viable pregnancy.

Question 132

Patient began to bleed after delivery and the uterine fundus is no longer palpable in the abdomen

Answer 132

Inversion of the uterus

Question 133

Tx for inversion of the uterus

Answer 133

Johnson manoeuvre, hydrostatic methods, and laparotomy.

Question 134

Ix for inversion of uterus

Answer 134

Mostly clinical but ultrasound imaging can be used to confirm the diagnosis

Question 135

Occasional decelerations in the foetal heart rate with good recovery and no other signs of foetal distress

Answer 135

Normal labour variation

Question 136

Persistent decelerations in the foetal heart rate, poor variability, or late decelerations

Answer 136

Foetal distress

Question 137

Sudden prolonged decelerations in the foetal heart rate, often with a rapid recovery once the mother’s blood pressure is corrected

Answer 137

Maternal hypotension

Question 138

A variability of 3 bpm for 30 minutes most likely indicates..

Answer 138

Foetus is asleep

Question 139

A reduced variability of less than __bpm for over ___minutes is seen as worrying and if this continues for over ___minutes, it is considered abnormal

Answer 139

A reduced variability of less than 5 bpm for over 40 minutes is seen as worrying and if this continues for over 90 minutes, it is considered abnormal

Question 140

Borderline fetal pH

Answer 140

7.21 to 7.24

Question 141

Abnormal fetal pH

Answer 141

7.20 or below

Question 142

Borderline fetal lactate

Answer 142

4.2 to 4.8 mmol/l

Question 143

Abnormal fetal lactate

Answer 143

4.9 mmol/l or above

Question 144

If the foetal blood sample result is abnormal..

Answer 144

Inform a senior obstetrician and the neonatal team
Talk to the woman about what is happening and take her preferences into account
Expedite the birth

Question 145

If the foetal blood sample result is borderline and there are no accelerations in response to foetal scalp stimulation, consider..

Answer 145

Taking a second foetal blood sample no more than 30 minutes later

Question 146

If the foetal blood sample result is normal and there are no accelerations in response to foetal scalp stimulation, consider..

Answer 146

Taking a second foetal blood sample no more than 1 hour later

Question 147

Something coming forward

Answer 147

Rectocele

Question 148

Something coming downards

Answer 148

Uterine prolapse

Question 149

Effacement and dilatation up to 4cm

Answer 149

Latent first stage of labour

Question 150

Regular painful contractions and progressive cervical dilatation from 4cm

Answer 150

Established first stage of labour

Question 151

Full cervical dilatation, defined as 10cm, before or in the absence of involuntary expulsive contractions

Answer 151

Passive second stage of labour

Question 152

Full cervical dilatation, defined as 10cm, active maternal pushing, and the baby is visible

Answer 152

Active second stage of labour

Question 153

the period between the baby’s delivery and expulsion of the placenta and membranes

Answer 153

Third stage of labour

Question 154

Placenta accreta occurs due to a risk factor of..

Answer 154

Old Caesarean scar

Question 155

Which nerve injuries is most commonly seen as a complication to shoulder dystocia?

Answer 155

Erb’s palsy

Question 156

MOA of mifepristone

Answer 156

Synthetic steroid that acts as an antiprogestogen. Progesterone is essential for a pregnancy to develop and continue so it stops the development of the pregnancy

Question 157

MOA of misoprostol

Answer 157

Synthetic prostaglandin E1 analogue. It binds to smooth muscle cells within the myometrial layer of the uterus and increases the strength and frequency of contractions, it aids the expulsion of the pregnancy tissue.

Question 158

Which drug can be used to improve the success rate of external cephalic version?

Answer 158

Beta-2 receptor agonists such as terbutaline, ritodrine and salbutamol

Question 159

Which is a normal interpretation of a CTG in the first stage of labour?

Answer 159

Baseline rate: 125bpm
Variability: 15bpm
Accelerations: present
Decelerations: absent

Question 160

Abdominal pain, menorrhagia, boggy’ uterus with subendometrial linear striations

Answer 160

Adenomyosis

Question 161

Menorrhagia, anaemia, bulk-related symptoms e.g. bloating/urinary frequency

Answer 161

Uterine fibroids

Question 162

Define pre-existing hypertension

Answer 162

A history of hypertension before pregnancy or an elevated blood pressure > 140/90 mmHg before 20 weeks gestation

Question 163

Common long term complications of vaginal hysterectomy with antero-posterior repair include..

Answer 163

Enterocoele and vaginal vault prolapse

Question 164

_____________ may occur acutely following hysterectomy, but it is not usually a chronic complication

Answer 164

Urinary retention

Question 165

If a breastfed baby loses > 10% of birth weight in the first week of life then referral to a _____________ _____________ clinic may be appropriate

Answer 165

If a breastfed baby loses > 10% of birth weight in the first week of life then referral to a midwife-led breastfeeding clinic may be appropriate

Question 166

No method of contraception is contraindicated by age alone. All methods are UKMEC1 except for..

Answer 166

COCP (UKMEC2 for women >= 40 years)
Depo-Provera (UKMEC2 for women > 45 years)

Question 167

What are the three stages of postpartum thyroiditis?

Answer 167

1. Thyrotoxicosis
2. Hypothyroidism
3. Normal thyroid function (but high recurrence rate in future pregnancies)

Question 168

_____________ antibodies are found in 90% of patients with postpartum thyroiditis

Answer 168

Thyroid peroxidase

Question 169

Mx for postpartum thyroiditis

Answer 169

Thyrotoxic phase - propranolol
Hypothyroid phase - thyroxin

Question 170

Posterior vaginal fornix tenderness due to involvement of the uterosacral ligament + uterine motion tenderness

Answer 170

Endometriosis

Question 171

Cervical motion tenderness

Answer 171

PID

Question 172

Around 50% of cord prolapses occur at..

Answer 172

Artificial rupture of the membranes

Question 173

What causes primary dysmenorrhoea?

Answer 173

Endometrial prostaglandin production

Question 174

Tx for Primary dysmenorrhoea

Answer 174

NSAIDs such as mefenamic acid and ibuprofen
COCP

Question 175

What causes secondary dysmenorrhoea?

Answer 175

Endometriosis
Adenomyosis
Pelvic inflammatory disease
Copper coils
Fibroids

Question 176

Mx fo secondary dysmenorrhoea

Answer 176

Refer to gynae

Question 177

Maternal diabetes causes polyhydramnios/oligohydramnios

Answer 177

Polyhydramnios

Question 178

The COCP is protective against which cancer?

Answer 178

Ovarian and endometrial cancer

Question 179

What is the most important sign to elicit in pre-eclampsia?

Answer 179

Brisk tendon reflexes - increased ICP/oedema resultant from severe hypertension compresses descending UMN of the corticospinal tracts, inciting hyper-reflexia as an early clinical sign

Question 180

Which blood test is used to monitor treatment of DVT in pregnancy?

Answer 180

Anti-Xa but only if less than 50 kg and 90 kg or more or with other complicating factors (for example, with renal impairment or recurrent VTE)

Question 181

Which SSRIs can be used during breastfeeding?

Answer 181

Sertraline or paroxetine

Question 182

Screening for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome is offered between ___ and ___ weeks of pregnancy

Answer 182

Screening for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome is offered between 10 and 14 weeks of pregnancy

Question 183

The fetal anomaly scan, checking the physical development of the baby, is offered at ___ weeks

Answer 183

The fetal anomaly scan, checking the physical development of the baby, is offered at 20 weeks.

Question 184

Name the conditions for which screening should not be offered

Answer 184

Bacterial vaginosis
Chlamydia
Cytomegalovirus
Fragile X
Hepatitis C
Group B Streptococcus
Toxoplasmosis

Question 185

There can be positional changes in fetal movement awareness, generally being more prominent during ___________ and less when ________ and ________

Answer 185

There can be positional changes in fetal movement awareness, generally being more prominent during lying down and less when sitting and standing

Question 186

Patient with anterior/posterior placentas prior to 28 weeks gestation may have lesser awareness of fetal movements

Answer 186

Patient with anterior placentas prior to 28 weeks gestation may have lesser awareness of fetal movements

Question 187

Both alcohol and sedative medications like _______ or ______________ can temporarily cause reduced fetal movements

Answer 187

Both alcohol and sedative medications like opiates or benzodiazepines can temporarily cause reduced fetal movements

Question 188

Oligohydramnios/polyhydramnios can cause reduction in fetal movements

Answer 188

Both oligohydramnios and polyhydramnios can cause reduction in fetal movements

Question 189

Anterior/Posterior fetal position means movements are less noticeable

Answer 189

Anterior fetal position means movements are less noticeable

Question 190

Up to 29% of women presenting with RFM have a _____ fetus

Answer 190

SGA

Question 191

Examples of contraceptives that are unaffected by EIDs are…

Answer 191

Copper intrauterine device
Progesterone injection (Depo-provera)
Mirena intrauterine system

Question 192

Hyperemesis gravidarum triad

Answer 192

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

Question 193

The only form of contraception that is recommended by the as having no contraindication to a migraine with aura is..

Answer 193

Copper IUD

Question 194

Problems with IUD?

Answer 194

Make periods heavier, longer and more painful

Question 195

Problems with IUS?

Answer 195

Initial frequent uterine bleeding and spotting

Question 196

After giving birth, women require contraception after day..

Answer 196

21

Question 197

When is the POP pill started after birth?

Answer 197

Any time

Question 198

When is the COCP pill started after birth?

Answer 198

UKMEC 4 - if breastfeeding < 6 weeks post-partum
UKMEC 2 - if breastfeeding 6 weeks - 6 months postpartum

Should not be used in the first 21 days - after day 21 use it with additional contraception for the first 7 days

Question 199

When is the IUD/IUS started after birth?

Answer 199

48 hours of childbirth or after 4 weeks

Question 200

Test results for premature ovarian insufficiency

Answer 200

raised FSH, LH levels
e.g. FSH > 40 iu/l
elevated FSH levels should be demonstrated on 2 blood samples taken 4–6 weeks apart
low oestradiol
e.g. < 100 pmol/l

Question 201

Low levels of gonadotrophins indicate a ________ cause whereas raised levels suggest an __________ problem (e.g. Premature ovarian failure)

Answer 201

Hypothalamic
Ovarian

Question 202

Primary amenorrhoea causes

Answer 202

gonadal dysgenesis (e.g. Turner’s syndrome) - the most common causes
testicular feminisation
congenital malformations of the genital tract
functional hypothalamic amenorrhoea (e.g. secondary to anorexia)
congenital adrenal hyperplasia
imperforate hymen

Question 203

Secondary amenorrhoea causes

Answer 203

hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise)
polycystic ovarian syndrome (PCOS)
hyperprolactinaemia
premature ovarian failure
thyrotoxicosis*
Sheehan’s syndrome
Asherman’s syndrome (intrauterine adhesions)

Question 204

Hormonal contraception can be started _____________ after using levornogestrel (Levonelle) for emergency contraception

Answer 204

Immediately

Question 205

Contraception with the pill, patch or ring should be started _____________ after using ulipristal acetatefor emergency contraception

Answer 205

5 days

Question 206

Lower abdominal pain (usually unilateral) initially and vaginal bleeding later. Shoulder tip pain and cervical excitation may be present

Answer 206

Ectopic pregnancy

Question 207

Associated with exaggerated symptoms of pregnancy e.g. hyperemesis. The uterus may be large for dates and serum hCG is very high

Answer 207

Hydatidiform mole

Question 208

Human chorionic gonadotropin (hCG) is a hormone first produced by the ________ and later by the ________ ________

Answer 208

Human chorionic gonadotropin (hCG) is a hormone first produced by the embryo and later by the placental trophoblast

Question 209

Role of hCG

Answer 209

Prevent the disintegration of the corpus luteum

Question 210

hCG levels peak around…

Answer 210

8-10 weeks gestation

Question 211

Cyclical pelvic pain that is worse around periods. The pain starts 2 days before the period and lasts until several days after. Associated dyspareunia and has had some painful bowel movements

Answer 211

Endometriosis

Question 212

Mx for endometriosis

Answer 212

NSAIDS/paracetamol
COCP or progesterone e.g. medroxyprogesterone acetate if no interest in starting a family

If fertility is a priority, then GnRH analogues

Laparoscopic excision or ablation of endometriosis plus adhesiolysis or ovarian cystectomy

Question 213

Hypoechoic masses

Answer 213

Fibroids

Question 214

Tx for ovarian torsion

Answer 214

Laparoscopy

Question 215

Who gets intrapartum antibiotic prophylaxis?

Answer 215

Women who’ve had GBS detected in a previous pregnancy
Women with a previous baby with early- or late-onset GBS disease
Women in preterm labour regardless of their GBS status
Women with a pyrexia during labour (>38ºC)

Question 216

Around 50% of cord prolapses occur at…

Answer 216

Artificial rupture of the membranes

Question 217

Mx for cord prolapse

Answer 217

Patient is asked to go on ‘all fours’ - left lateral position is an alternative
Tocolytics to reduce uterine contractions
Retrofilling the bladder with 500-700ml of saline
Caesarian section is first-line method of delivery but an instrumental vaginal delivery is possible if the cervix is fully dilated and the head is low

Question 218

Women with preterm-PROM with a triad of maternal pyrexia, maternal tachycardia, and fetal tachycardia

Answer 218

Chorioamnionitis

Question 219

Tx for Chorioamnionitis

Answer 219

Prompt delivery of the foetus (cesarean section if necessary) and intravenous antibiotics

Question 220

Mx for Shoulder dystocia

Answer 220

HELPERR
H = call for Help immediately!
E = consider Episiotomy (continuous)
L = Legs! (McRobert’s)
P = Pressure! (suprapubic 30sec continuous then 30sec rocking)
E = ‘Enter’ manoeuvres
R = Remove posterior arm! (Pringles hand)
R = Rotate mum (on all four)

Question 221

Course of action if the patch change is delayed at the end of week 1 or week 2

Answer 221

If <48 hours then it should be changed immediately and no further precautions are needed

If >48 hours then it should be changed immediately and a barrier method of contraception used for the next 7 days. If there was UPSI in last 5 days or intercourse during this extended patch-free interval then emergency contraception needs to be considered

Question 222

Course of action if the patch change is delayed at the end of week 3

Answer 222

The patch should be removed as soon as possible and the new patch applied on the usual cycle start day for the next cycle, even if withdrawal bleeding is occurring. No additional contraception is needed.

If patch application is delayed at the end of a patch-free week, additional barrier contraception should be used for 7 days following any delay at the start of a new patch cycle

Question 223

Dilatation measurement of cervix during the first stage of labour

Answer 223

Latent phase = 0-3 cm dilation, normally takes 6 hours
Active phase = 3-10 cm dilation, normally 1cm/hr

Question 224

Head enters pelvis in ____________ position. The head normally delivers in an ____________ position

Answer 224

Head enters pelvis in occipito-lateral position. The head normally delivers in an occipito-anterior position

Question 225

_____________ is the most common cause of pelvic inflammatory disease

Answer 225

Chlamydia trachomatis

++ Neisseria gonorrhoeae
Mycoplasma genitalium
Mycoplasma hominis

Question 226

Mx for PID

Answer 226

Oral ofloxacin + oral metronidazole
Or
IM ceftriaxone + oral doxycycline + oral metronidazole

Question 227

Mx for primary dysmenorrhoea

Answer 227

NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women. They work by inhibiting prostaglandin production
combined oral contraceptive pills are used second line

Question 228

Mx for secondary dysmenorrhoea

Answer 228

Referring all patients with secondary dysmenorrhoea to gynaecology for investigation.

Question 229

Indications for a forceps delivery

Answer 229

Fetal/maternal distress in the second stage of labour
Failure to progress in the second stage of labour
Control of head in breech deliver

Question 230

Requirements for instrumental delivery

Answer 230

FORCEPS:

Fully dilated cervix the second stage of labour
OA position preferably. OP delivery is possible with Keillands forceps and ventouse
Ruptured Membranes
Cephalic presentation
Engaged presenting part i.e. head at or below ischial spines, the head must not be palpable abdominally
Pain relief
Sphincter (bladder) empty

Question 231

More than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
Family history of thromboembolic disease in first Degree relatives < 45 years
Controlled hypertension
Immobility e.g. wheel chair use
Carrier of known gene mutations associated with Breast cancer (e.g. BRCA1/BRCA2)
Current gallbladder disease

Which UKMEC is this?

Answer 231

UKMEC 3

Question 232

More than 35 years old and smoking more than 15 cigarettes/day
Migraine with aura
History of thromboembolic disease or Thrombogenic mutation
History of stroke or ischaemic heart disease
Breast feeding < 6 weeks post-partum
Uncontrolled hypertension
Current breast cancer
Major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

Which UKMEC is this?

Answer 232

UKMEC 4

Question 233

Diabetes mellitus diagnosed > 20 years ago is classified as UKMEC __ or __depending on severity

Answer 233

Diabetes mellitus diagnosed > 20 years ago is classified as UKMEC 3 or 4 depending on severity

Question 234

Contraceptives - time until effective (if not first day period):
instant: ?
2 days: ?
7 days: ?

Answer 234

instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

Question 235

Anticholinergics for urge incontinence are associated with confusion in elderly people - ______________ is a preferable alternative

Answer 235

Anticholinergics for urge incontinence are associated with confusion in elderly people - mirabegron is a preferable alternative

Question 236

Presence of slight proteinuria in isolation in pregnancy can be..

Answer 236

Physiological and does not mean pre-eclampsia is present

Question 237

Management of chickenpox exposure in pregnancy

Answer 237

<20 wk non-immune: VZIg within 10 days
>20 wk non-immune: VZIg / acyclovir after 7-14 days

Question 238

Management of chickenpox in pregnancy

Answer 238

< 20 wk - consider acyclovir with caution
>20 wk - acyclovir within 24hr of rash

Question 239

1st and 2nd most common cause of placental rupture

Answer 239

1st - placental rupture
2nd - placental praevia

Question 240

Fresh vaginal bleeds developing in labour could be a sign of…

Answer 240

Placental rupture or praevia

Question 241

Intermenstrual bleeding, post-menopausal bleeding, menorrhagia or irregular bleeding

Answer 241

Endometrial hyperplasia

Question 242

Risk factors for placental abruption

Answer 242

ABRUPTION:
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios;
T for Trauma + Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)

Question 243

Abdominal distension, abdominal pain, and bowel and bladder dysfunction symptoms

Answer 243

Ovarian cancer

Question 244

________ is a protective factor from Endometrial hyperplasia and HG

Answer 244

Smoking

Question 245

VEAL CHOP

Answer 245

Variable decelerations –> Cord compression
Early decelerations –> Head compression
Accelerations –> Okay!
Late decelerations –> Placental Insufficiency

Question 246

Asymmetrical uterus, abnormal myometrial echo texture and myometrial cysts

Answer 246

Adenomyosis

Question 247

Adenomyosis/Endometriosis is typically seen in multiparous women towards the end of their reproductive years

Answer 247

Adenomyosis

Question 248

Primary amenorrhoea, this is associated with the development of male secondary sexual characteristics in females (such as deep voice and hirsutism)

Answer 248

Congenital adrenal hyperplasia

Question 249

Primary amenorrhoea. Increased testosterone and examination shows little to no axillary or pubic hair and bilateral lower pelvic masses

Answer 249

Androgen insensitivity syndrome

Question 250

Secondary amenorrhoea. Anorexia or excessive exercise FSH and LH are decreased

Answer 250

Functional hypothalamic amenorrhoea

Question 251

Primary amenorrhoea. No evidence of starting puberty, including axillary and pubic hair. Hypogonadism. FSH and LH would be elevated

Answer 251

Turner’s syndrome

Question 252

Which incontinence is managed with pelvic retraining exercise?

Answer 252

streSSS incontinence = PelvisSSS i.e. pelvic retraining

Stress incontinence: caused by weak urethral sphincters which are controlled by pelvic floor muscles (which can be exercised)
Urge incontinence: caused by overactive detrusor muscle (which can be neurologically re-trained)

Question 253

Vulval carcinoma vs VIN

Answer 253

Vulval carcinoma: lump or ulcer on the labia majora
inguinal lymphadenopathy
may be associated with itching, irritation

VIN: itching, burning
raised, well defined skin lesions

Question 254

Only certain antibiotics that are ________________________ can decrease the effectiveness of hormonal contraceptives

Answer 254

Enzyme-inducing (such as rifampicin or rifabutin)

Question 255

When is OGTT done?

Answer 255

Immediately after booking (if previous pregnancy had gestational diabetes) and at 24-28 weeks

Question 256

COCP causes an increased risk of which cancer?

Answer 256

Breast and Cervical
COCP

Question 257

COCP is protective against which cancer?

Answer 257

Ovarian and Endometrial

Question 258

When in transverse lie, the foetus can be either _____________ (most common) where the foetus faces towards the mother’s back or _____________ where the foetus faces towards the mothers front

Answer 258

When in transverse lie, the foetus can be either ‘scapulo-anterior’ (most common) where the foetus faces towards the mother’s back or ‘scapulo-posterior’ where the foetus faces towards the mothers front

Question 259

Contra-indications for ECV?

Answer 259

Three Ms:

Maternal rupture in the last 7 days
Multiple pregnancy (except for the second twin)
Major uterine abnormality

Question 260

Heavy menstrual bleeding, discomfort during sexual intercourse (dyspareunia), and a feeling of abdominal bloating or fullness

Answer 260

Fibroids

Question 261

The serum βhCG is 453,000 mIU/ml indicates a a diagnosis of…

300,000 mIU/ml is approximately the upper limit of expected βhCG in an…

Answer 261

The serum βhCG is 453,000 mIU/ml indicates a a diagnosis of complete hydatidiform mole

300,000 mIU/ml is approximately the upper limit of expected βhCG in an intrauterine pregnancy during weeks 9-12

Question 262

When switching from an IUD to COCP no additional contraception is needed if removed day ____ of cycle

Answer 262

1-5 of cycle

Question 263

Examples indications for a category 1 caesarean section include..

Answer 263

Suspected uterine rupture
Major placental abruption
Cord prolapse
Fetal hypoxia or persistent fetal bradycardia

Question 264

The normal frequency of contractions is..

Answer 264

4 or less in the space of 10 minutes

Question 265

Which contraceptive is given in migraines with aura?

Answer 265

POP (doesn’t have oestrogen)

Question 266

The most common explanation for short episodes (< 40 minutes) of decreased variability on CTG is that the foetus is __________. However, if the decreased variability lasts for more than _____ minutes, we start to worry.

Answer 266

The most common explanation for short episodes (< 40 minutes) of decreased variability on CTG is that the foetus is asleep. However, if the decreased variability lasts for more than 40 minutes, we start to worry.

Question 267

Definitive treatment for placenta praevia

Answer 267

C-section

Question 268

Definitive treatment for placental abruption once the cardiotocograph has confirmed that there is no foetal distress

Answer 268

Vaginal delivery (so if not, then C-section)

Question 269

To investigate a pregnancy of unknown origin, a b-hCG is performed 48 hours apart. If the levels fall then it is suggested that..

Answer 269

The foetus will not develop or there has been a miscarriage

Question 270

To investigate a pregnancy of unknown origin, a b-hCG is performed 48 hours apart. If there is only a slight increase or a plateau then it suggests a..

Answer 270

Ectopic pregnancy

Question 271

To investigate a pregnancy of unknown origin, a b-hCG is performed 48 hours apart. If there is a normal increase then it suggests that..

Answer 271

The foetus is growing normally, but does not exclude an ectopic pregnancy

Question 272

How to investigate a pregnancy of unknown origin?

Answer 272

Perform serial serum B-hCGs 48 hours apart
Transvaginal ultrasound to potentially identify the location of the pregnancy

Question 273

Mx of a prolonged second stage

Answer 273

Instrumental delivery

Caesarean section if instrumental delivery is not possible or contraindicated. However, a caesarean section in the second stage is associated with increased maternal morbidity

Question 274

Give examples of pelvic organ prolapse in the anterior vaginal wall

Answer 274

Cystocele: bladder (may lead to stress incontinence)
Urethrocele: urethra
Cystourethrocele: both bladder and urethra

Question 275

Give examples of pelvic organ prolapse in the posterior vaginal wall

Answer 275

Enterocele: small intestine
Rectocele: rectum

Question 276

Give examples of pelvic organ prolapse in the apical vaginal wall

Answer 276

Uterine prolapse: uterus
Vaginal vault prolapse: roof of the vagina (common after hysterectomy)

Question 277

Ix for genital prolapse

Answer 277

Detailed pelvic examination
Ultrasound or MRI in complex cases or for surgical planning
Urodynamic studies if there are co-existing urinary symptoms

Question 278

Mx for pelvic prolapse

Answer 278

Lifestyle modification (weight loss, smoking cessation, avoiding heavy lifting) and pelvic floor exercises
Pessary use
Surgical repair - native tissue repairs or the use of mesh. Can be vaginal, abdominal, or laparoscopic/robotic

Question 279

FIGO staging for endometrial cancer

Answer 279

Stage 1: Confined to the uterus
Stage 2: Invades the cervix
Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes
Stage 4: Invades bladder, rectum or beyond the pelvis

Question 280

Amenorrhoea, abdominal and shoulder tip pain, abdominal distension and haemodynamic instability

Answer 280

Ruptured ectopic pregnancy

Question 281

This is the most common cause of secondary postpartum haemorrhage is..

Answer 281

Postpartum endometritis

Question 282

Broad-spectrum antibiotics and laxatives should be given post-operatively after surgical repair of a ______ degree tear

Answer 282

3rd/4th degree tear

Question 283

Tender, woody uterus with no PV bleeding

Answer 283

Placental abruption

Question 284

What is pre-term labour?

Answer 284

The onset of regular uterine contractions accompanied by cervical changes occurring before 37 weeks gestation

Question 285

What is pre-term birth?

Answer 285

The delivery of a baby after 20 weeks gestation but before 37 weeks gestation

Question 286

What is premature rupture of membranes?

Answer 286

The rupture of membranes at least one hour before the onset of contractions

Question 287

What is prolonged premature rupture of membranes?

Answer 287

The rupture of membranes more than 24 hours before the onset of labour

Question 288

What is preterm premature rupture of the membranes ?

Answer 288

Early rupture of the membranes before 37 weeks gestation

Question 289

Ix for preterm delivery

Answer 289

Foetal fibronectin test - negative indicates a low risk of delivery occurring within the next 7-14 days

Question 290

Mx for preterm labour

Answer 290

Corticosteroids
IV abx if GBS
Penicillin if no allergies
Tocolytic agent - Nifedipine

Question 291

How to differentiate between a uterine prolapse and -celes?

Answer 291

Cervix is normal in a uterine prolapse

Question 292

Often presents with sudden-onset abdominal pain, which typically starts during exercise (such as physical activity or sexual intercourse)

Answer 292

Ovarian cyst rupture

Question 293

Women over the age of 45 with irregular bleeding should be investigated with..

Answer 293

TVUS to rule out endometrial hyperplasia/cancer

Question 294

Causes of polyhydramnios

Answer 294

Maternal diabetes, foetal renal disorders or chromosomal disorders

Question 295

The sudden onset of abdominal pain and loss of contractions during labour, especially in the context of previous caesarean section, strongly suggests…

Answer 295

Uterine rupture

Question 296

Mx for lichen sclerosus

Answer 296

Topical corticosteroids to reduce inflammation and itching.
Avoidance of soaps in the affected areas to prevent further irritation.
Use of emollients to relieve dryness and soothe itching.

Question 297

____________ can cause aqueductal stenosis leading to congenital hydrocephalus

Answer 297

Rubella

Question 298

Raised testosterone and LH
Low sex hormone binding globulin (SHBG)
Normal FSH

Answer 298

PCOS

Question 299

Mx for TTTS

Answer 299

Laser transection of the problematic vessels in-utero

Question 300

In TTTS, both foetuses are at risk of developing…

Answer 300

Heart failure and hydrops

Question 301

In TTTS, the donor twin suffers from…

Answer 301

High output cardiac failure due to severe anaemia

Question 302

In TTTS, the recipient twin suffers from…

Answer 302

Fluid overload

Question 303

Factors leading to a larger _______ increase the risk of pre-eclampsia. This includes ____________, ____________ and ____________

Answer 303

Factors leading to a larger placenta increase the risk of pre-eclampsia. This includes twin or multiple pregnancies, fetal hydrops and molar pregnancy

Question 304

Clincal picture of unilateral pain and localised peritonism, combined with no evidence of ectopic pregnancy or acute inflammation

Answer 304

Ruptured ovarian cyst

Question 305

Ix for a ovarian cyst

Answer 305

A pregnancy test to exclude an ectopic pregnancy
Diagnostic laparoscopy, particularly in cases where the patient is unstable

Question 306

Mx for ovarian cyst

Answer 306

Conservative: monitoring and pain management

Laparoscopy or, in more severe cases, laparotomy

Question 307

Contraception is not required for the first ___ weeks after delivery

Answer 307

Contraception is not required for the first 3 weeks after delivery

Question 308

How to estimate due date?

Answer 308

First, determine the first day of your last menstrual period.
Next, count back 3 calendar months from that date.
Lastly, add 1 year and 7 days to that date.

Question 309

Mx of pain in obstetrics

Answer 309

Nitrous Oxide (Entonox or ““gas and air””)
Simple analgesia: E.g., Paracetamol.
Opiate analgesia: Including Oral Codeine Phosphate and IV/IM Diamorphine.
Epidural analgesia: A powerful form of pain relief used during labour.
Pudendal nerve block: A form of regional anesthesia

Question 310

Polyhydramnios/oligohydramnios increases the risk of a breech presentation

Answer 310

Polyhydramnios

Question 311

Chronic history of lower abdominal pain. The pain is rated as 4/10 in severity and described as a dull ache that occurs for about two days during the middle of each menstrual cycle. Site of the pain can vary between the right and left; however, it is predominately right-sided.

Answer 311

Mittelschmerz

Question 312

When attempting instrumental delivery, the procedure should be abandoned if there is no foetal descent following ___ pulls. A __________________ is the gold standard approach for surgical delivery following this

Answer 312

When attempting instrumental delivery, the procedure should be abandoned if there is no foetal descent following 3 pulls. A lower segment caesarean section is the gold standard approach for surgical delivery following this

Question 313

In nulliparous women, external cephalic version can be offered as early as..

Answer 313

36 weeks

Question 314

In multiparous women, external cephalic version shoud be offered at term, as early as..

Answer 314

37 weeks

Question 315

What is the most common type of uterine fibroid?

Answer 315

Intramural fibroids

Question 316

Foetal renal agenesis is a risk factor for..

Answer 316

Polyhydramnios

Question 317

Give examples of DOACs

Answer 317

Dabigatran
Rivaroxaban
Apixaban
Edoxaban

Anything ending with -ban

Question 318

Give examples of LMWHs

Answer 318

Bemiparin, Certoparin, Dalteparin, Enoxaparin, Nadroparin, Parnaparin, Reviparin, and Tinzaparin

Anything ending with -rin

Question 319

Mx for fibroadenoma <3cm

Answer 319

Watchful waiting without biopsy

Question 320

Mx for fibroadenoma >4cm

Answer 320

Core biopsy to exclude a phyllodes tumour

Question 321

Soft, fluctuant swellings. Halo sign

Answer 321

Breast cyst

Question 322

Mx for breast cyst

Answer 322

Aspirated and following aspiration the breast re-examined to ensure that the lump has gone.

Question 323

Postmenopausal women. Cheese like/thick and green in colour nipple discharge and slit like retraction of the nipple

Answer 323

Duct ectasia

Question 324

Tx for duct ectasia

Answer 324

No treatment - self limiting

Question 325

Blood stained nipple discharge +/- underlying mass or axillary lymphadenopathy

Answer 325

Carcinoma

Question 326

Young patient with blood stained discharge but no palpable lump

Answer 326

Intraductal papilloma

Question 327

Dysmenorrhoea
Menorrhagia
Enlarged, boggy uterus

Answer 327

Adenomyosis

Question 328

Adenomyosis is characterized by the presence of endometrial tissue within the..

Answer 328

Myometrium

Question 329

Ix for adenomyosis

Answer 329

TVUS
Alt. - MRI

Question 330

Tx for adenomyosis

Answer 330

Symptomatic treatment - tranexamic acid to manage menorrhagia
GnRH agonists
Uterine artery embolisation
Hysterectomy - definitive

Question 331

Fever or elevated WCC and CRP

Answer 331

Mastitis and cellulitis

Question 332

Involves the nipple from onset and spreads to the areola and breast. It presents with an eczema-like rash over the nipple with discharge and/or nipple inversion

Answer 332

Paget’s disease of the breast

Question 333

Progressive, erythema and oedema of the breast in the absence signs of infection such as fever, discharge or elevated WCC and CRP. Elevated CA 15-3

Answer 333

Inflammatory breast cancer

Question 334

What is the most common type of breast cancer

Answer 334

Invasive ductal carcinomas - some may arise as a result of ductal carcinoma in situ (DCIS)

Question 335

Surgical treatment for breast cancer in a patient with small breasts and a large tumour

Answer 335

Mastectomy +/- Reconstruction

Question 336

Surgical treatment for breast cancer in a patient with large breasts AND a large primary lesion

Answer 336

Breast conserving surgery even with a relatively large primary lesion (tumours >4cm is the recommendation for mastectomy)

+/- Reconstruction

Question 337

The main operations in common use of reconstruction

Answer 337

Latissimus dorsi myocutaneous flap and sub pectoral implants

Women wishing to avoid a prosthesis may be offered TRAM or DIEP flaps

Question 338

What is the criteria to warrant a mastectomy

Answer 338

Mastectomy:

Multifocal tumour
Central
Large lesion in small breast
DCIS >4CM

Question 339

What is the criteria to warrant a wide local excision

Answer 339

Solitary lesion
Peripheral tumour
Small lesion in large breast
DCIS <4cm

Question 340

Breast that tends to occur for a few days at a time each month in both breasts

Answer 340

Cyclical mastalgia

Question 341

Cyclical mastalgia + point tenderness of the chest wall

Answer 341

Tietze’s syndrome

Question 342

Tx for cyclical mastalgia

Answer 342

Supportive bra + standard oral and topical analgesia

If no response after 3months, affecting quality of life/sleep:
Referral. Consider hormonal agents such as bromocriptine and danazo

Question 343

REFER suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer if they are..

Answer 343

Aged 30 and over and have an unexplained breast lump with or without pain
OR
Aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern

Question 344

CONSIDER referral for suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer if they are..

Answer 344

Skin changes that suggest breast cancer or
Aged 30 and over with an unexplained lump in the axilla

Question 345

Consider non-urgent referral in people with suspected breast cancer if they are..

Answer 345

Aged under 30 with an unexplained breast lump with or without pain

Question 346

Risk factors for hyperemesis gravidarum

Answer 346

NOIF

Nulliparity
Obesity
Increased levels of beta-hCG (multiple pregnancies and trophoblastic disease)
Family or personal history of NVP

Question 347

What is the definitive indication for surgical management of an ectopic pregnancy?

Answer 347

> 35 mm in size or with a serum B-hCG >5,000IU/L

Question 348

Bulky uterus

Answer 348

Fibroids

Question 349

Give examples of liver enzyme inducing medications

Answer 349

RAPS

Rifampicin
Anticonvulsants: phenytoin, carbamazepine, phenobarbitone, and primidone
Spironolactone

Question 350

Sudden, strong need to urinate and often does not make it to the toilet in time

Answer 350

Overactive/urge incontinence

Question 351

Prior to surgery, women with no palpable axillary lymphadenopathy at presentation should have..

Answer 351

Pre-operative axillary ultrasound before their primary surgery

if negative then they should have a sentinel node biopsy to assess the nodal burden

Question 352

Prior to surgery, women with palpable axillary lymphadenopathy at presentation should have..

Answer 352

Axillary node clearance is indicated at primary surgery

Question 353

Axillary node clearance can cause…

Answer 353

Arm lymphedema and functional arm impairment

Question 354

When is radiotherapy indicated in breast cancer?

Answer 354

After a woman has had a wide-local excision

After a women has had a mastectomy for T3-T4 tumours and for those with four or more positive axillary nodes

Question 355

When is adjuvant hormonal therapy offered in breast cancer?

Answer 355

If tumours are positive for hormone receptors

Question 356

Which adjuvant hormonal therapy is offered in post-menopausal women?

Answer 356

Aromatase inhibitors such as anastrozole (for ER +ve)

Question 357

Which adjuvant hormonal therapy is offered in peri-menopausal women?

Answer 357

Tamoxifen

Question 358

Side effects of tamoxifen?

Answer 358

Endometrial cancer, venous thromboembolism and menopausal symptoms

Question 359

The most common type of biological therapy used for breast cancer is..

Answer 359

Trastuzumab (Herceptin)

Question 360

What is the downside of using biological therapy in breast cancer?

Answer 360

It is only useful in the 20-25% of tumours that are HER2 positive

Question 361

Trastuzumab cannot be used in patients with a history of..

Answer 361

Heart disorders

Question 362

When is cytotoxic therapy used in breast cancer?

Answer 362

Either prior to surgery (‘neoadjuvanant’ chemotherapy) to downstage a primary lesion
OR
After surgery depending on the stage of the tumour e.g. if there is axillary node disease - FEC-D is used in this situation

Question 363

Mx for hirsutism and acne in PCOS

Answer 363

COC
Eflornithine
Spironolactone, flutamide and finasteride may be used under specialist supervision

Question 364

Mx for infertility in PCOS

Answer 364

Clomifene (risk of multiple pregnancy) +/- metformin if obese
Gonadotrophins

Question 365

Is a pill free interval necessary when taking the COCP pill?

Answer 365

No - taking the COCP continuously, without a pill-free break

Question 366

Is a withdrawal bleed from contraception a real period?

Answer 366

No. It is an artificial bleed - the body’s response to the withdrawal of hormones

Question 367

In duct ectasia, patients with troublesome nipple discharge may be treated by..

Answer 367

Nicrodochectomy (if young) or total duct excision (if older)

Question 368

Mx if bishop score is <6

Answer 368

Vaginal prostaglandins or oral misoprostol
Balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean

Question 369

Mx if bishop score is >6

Answer 369

Amniotomy and an intravenous oxytocin infusion

Question 370

Bishop score

Answer 370

“Be Proactive, Let’s Induce Now, Baby’s Coming!”

Baby’s s
Pelvic dilation
Length of cervix
Is cervix soft?
Number (consistency) of cervix
Cervical station

Question 371

What is the main pathology that ultrasound monitoring performed between 16 and 24 weeks gestation aims to detect?

Answer 371

Twin-to-twin transfusion syndrome

Question 372

What is the main pathology that ultrasound monitoring performed between after 24 weeks gestation aims to detect?

Answer 372

Fetal growth restriction

Question 373

Reddening and thickening (may resemble eczematous changes) of the nipple/areola

Answer 373

Paget’s disease of the breast

Question 374

Obese women with large breasts. May follow trivial or unnoticed trauma. Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump

Answer 374

Fat necrosis

Question 375

What is Carboplatin used for?

Answer 375

Triple negative breast cancer.

Question 376

What is Docetaxel NOT used for?

Answer 376

Breast cancers that are sensitive to endocrine or HER2-targeted therapy

Question 377

_____________ can be used as a short-term option to rapidly stop heavy menstrual bleeding

Answer 377

Norethisterone

Question 378

What gets checked for in week 8 - 12?

Answer 378

Question 379

What gets checked for in week 10 - 13+6 weeks?

Answer 379

Early scan to confirm dates, exclude multiple pregnancy

Question 380

What gets checked for in week 11 - 13+6 weeks?

Answer 380

Down’s syndrome screening including nuchal scan

Question 381

What gets checked for in 16 weeks?

Answer 381

Information on the anomaly and the blood results. If Hb < 11 g/dl consider iron
Routine care: BP and urine dipstick

Question 382

What gets checked for in 18 - 20+6 weeks?

Answer 382

Anomaly scan

Question 383

What gets checked for in 28 weeks?

Answer 383

Routine care: BP, urine dipstick, SFH
Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron
First dose of anti-D prophylaxis to rhesus negative women

Question 384

What gets checked for in 34 weeks?

Answer 384

Routine care
Second dose of anti-D prophylaxis to rhesus negative women
Information on labour and birth plan

Question 385

Two risk factors for placenta accreta

Answer 385

Previous caesarean-section
Previous pelvic inflammatory disease

Question 386

____________ is the recommended treatment for delayed placental delivery in patients with placenta accreta

Answer 386

Hysterectomy

Question 387

Mx for stage 1 cervical cancer

Answer 387

Gold standard of treatment is hysterectomy +/- lymph node clearance
Nodal clearance or radical trachelectomy for A2 tumours

For patients wanting to maintain fertility: cone biopsy with negative margins

Question 388

The pain was initially periumbilical but is now worse in the lower abdomen

Answer 388

Appendicitis

Question 389

Intermittent pain in the left iliac fossa for the past 3 months. The pain is often worse during intercourse. She also reports urinary frequency and feeling bloated. There is no dysuria or change in her menstrual bleeding

Why is this an ovarian cyst and NOT fibroids?

Answer 389

Patient’s too young for fibroids
Localised to one side
No menorrhagia
No palpable pelvic mass

Question 390

Galactocele is due to occlusion of a _________ duct

Answer 390

Lactiferous

Question 391

A galactocele can be differentiated from an abscess by the fact that a galactocele is usually..

Answer 391

Painless with no local or systemic signs of infection

Question 392

Firm and non-tender, with no surrounding skin change. An ultrasound scan shows a well-circumscribed lesion and aspiration yields a white fluid

Answer 392

Galactocele

Question 393

How is symphysis-fundal height in cm calculated after 20 weeks?

Answer 393

Symphysis-fundal height in cm = gestation in weeks (+/- 2cm)

Question 394

The symphysis-fundal height (SFH) is measured from the top of the __________ to the top of the __________ in centimetres

Answer 394

The symphysis-fundal height (SFH) is measured from the top of the pubic bone to the top of the uterus in centimetres

Question 395

Why are mammograms not typically the first line of investigation in women below the age of 40?

Answer 395

Because the dense breast tissue can make the results harder to interpret

Question 396

First line of investigation in women below the age of 40 when suspecting a breast lump?

Answer 396

Ultrasound

Question 397

Which contraceptives increase the risk of ectopics?

Answer 397

IUD
POP

Question 398

Risk factors for ectopic pregnancy

Answer 398

E- endometreosis
C- Copper coil
T- Tube damage (PID, surgery)
O- Only progesterone pill
P- previous ectopic
IC- IVF

Question 399

Which renal condition can increase the risk of PROM?

Answer 399

Pyelonephritis

Question 400

T or F: An instrumental vaginal delivery is contra-indicated in cord prolapse

Answer 400

False - possible if the cervix is fully dilated and the head is low

Question 401

Which breast condition is common in smokers and may present with recurrent infections?

Answer 401

Periductal mastitis

Question 402

if it’s subareolar swelling, it’s a duct ectasia/periductal mastitis

Answer 402

Duct ectasia

Question 403

if it’s periareolar swelling, it’s a duct ectasia/periductal mastitis

Answer 403

Periductal mastitis

Question 404

Discharge in a multiparous postmenopausal woman. Nipple retraction but no bleeding

Answer 404

Duct ectasia

Question 405

Premenopausal smoker with signs of inflammation. Nipple retraction but no bleeding

Answer 405

Periductal mastitis

Question 406

Sudden breast pain then becomes painless and tends to be self-limiting. Presents as a red cord-like fibrous band

Answer 406

Mondor’s

Question 407

Tx for periductal mastitis

Answer 407

Co-amoxiclav

Question 408

____________ disease of the breast is a localised thrombophlebitis of a breast vein

Answer 408

Mondor’s

Question 409

Neither periductal/ductal mastitis cause bleeding. If it’s bleeding it’s either ________ (older woman) or ________ ________ (young woman)

Answer 409

Neither periductal/ductal mastitis cause bleeding. If it’s bleeding it’s either cancer (older woman) or intraductal papilloma (young woman)

Question 410

The first onset of fetal movements is known as quickening. This usually occurs between ______ weeks gestation, and increase until ___ weeks gestation at which point the frequency of movement tends to plateau

Answer 410

The first onset of fetal movements is known as quickening. This usually occurs between 18-20 weeks gestation, and increase until 32 weeks gestation at which point the frequency of movement tends to plateau

Question 411

Multiparous women will usually experience fetal movements from _______ weeks gestation. Towards the end of pregnancy, fetal movements should not reduce

Answer 411

Multiparous women will usually experience fetal movements from 16-18 weeks gestation. Towards the end of pregnancy, fetal movements should not reduce

Question 412

How often is depo provera given?

Answer 412

Every 12 weeks. It can however be given up to 14 weeks after the last dose without the need for extra precautions

Question 413

What is a disadvantage of depo provera?

Answer 413

Cannot be reversed once given. There is also a potential delayed return to fertility (maybe up to 12 months)

Question 414

Which contraceptive causes weight gain?

Answer 414

Depo provera

Question 415

Depo provera can increase the risk of which condition?

Answer 415

Osteoporosis

Question 416

Depo provera is contra-indicated in which type of cancer?

Answer 416

Breast cancer: current breast cancer is UKMEC 4, past breast cancer is UKMEC 3

Question 417

Outline the conditions for UKMEC 3

“Old Smokers Find Chairs Comfortable Inside Galleries”

Answer 417

O: >35 years old and BMI > 35 kg/m
S: <15 cigarettes/day
F: family history of thromboembolic disease in first-degree relatives <45 years
C: immobility (e.g., wheelchair use)
C: controlled hypertension
I: BRCA1/BRCA2
G: current gallbladder disease

Question 418

Outline the conditions for UKMEC 4
“SMASH BUBP”

Answer 418

S: >35 years old and smoking >15 cigarettes/day
M: migraine with aura
A: history of thromboembolic/arterial disease or thrombogenic mutation
S: history of **stroke or ischaemic heart disease
H: high uncontrolled BP
B: breastfeeding < 6 weeks post-partum
U: major su**rgery with prolonged immobilization
**B: **current breast cancer
P: positive antiphospholipid antibodies (e.g., in SLE)

Question 419

What are the side effects for GnRH agonists?

Answer 419

menopausal symptoms (hot flushes, vaginal dryness) and loss of bone mineral density

Question 420

Smoking is anti-oestrogenic and ___________ cancer is oestrogen-dependent

Answer 420

Endometrial

Question 421

Mx of endometrial cancer

Answer 421

Localised disease is treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy

Patients with high-risk disease may have postoperative radiotherapy

Question 422

Mx of endometrial cancer in frail elderly women not considered suitable for surgery

Answer 422

Progestogen therapy

Question 423

After managing an incomplete miscarriage, a pregnancy test should be performed at..

Answer 423

3 weeks

Question 424

What are surgical options for a miscarriage?

Answer 424

Vacuum aspiration (suction curettage) or surgical management in theatre

Question 425

Mx of septic miscarriage

Answer 425

Manual vacuum aspiration under local anaesthetic

Question 426

Differentiate between incomplete and complete mole

Answer 426

“Incomplete Mix - Two Dads, One Mama Fix.”

“Complete Clone - Father’s Genes All Alone.”

Question 427

What type of hydatidiform mole presents with snowstorm appearance?

Answer 427

Complete

Question 428

What type of hydatidiform mole presents with foetal parts?

Answer 428

Incomplete

Question 429

Uterus size greater than expected for gestational age

Answer 429

Complete hydatidiform mole

Question 430

Abnormally high serum hCG

Answer 430

Complete hydatidiform mole

Question 431

What does the following US show?

Answer 431

Complete hydatidiform mole - snowstorm appearance

Question 432

What does the following US show?

Answer 432

Ovarian torsion - whirlpool sign

Question 433

What are the three components of the RMI?

Answer 433

US findings, menopausal status and CA125 levels

Question 434

In patients with urinary incontinence, make sure to rule out a UTI and diabetes mellitus using..

Answer 434

Urinalysis

Question 435

Recurrent vaginal candidiasis is defined as ___ or more episodes per year

Answer 435

4 or more

Question 436

Ix for recurrent thrush

Answer 436

Compliance with previous treatment should be checked
Confirm the diagnosis of candidiasis
High vaginal swab for microscopy and culture
Blood glucose test to exclude diabetes

Question 437

Tx for recurrent thrush

Answer 437

Induction: oral fluconazole every 3 days for 3 doses
Maintenance: oral fluconazole weekly for 6 months

Question 438

When is a TVUS indicated in menorrhagia?

Answer 438

Intermenstrual or postcoital bleeding
Pelvic pain and/or pressure symptoms
Abnormal pelvic exam findings

Question 439

Next step if serum progestogen is <16

Answer 439

Repeat, if consistently low refer to specialist

Question 440

Next step if serum progestogen is 16 - 30

Answer 440

Repeat

Question 441

Next step if serum progestogen is >30

Answer 441

Indicates ovulation

Question 442

Is there any COCP - St Johns wort interaction?

Answer 442

Yes - use condoms

Question 443

Which contraceptives should be stopped at 50 years?

Answer 443

Depo-Provera
COCP

Question 444

Which contraceptives should be stopped after 2 years of amenorrhoea in <50?

Answer 444

Non-hormonal (e.g. IUD, condoms, natural family planning)

Question 445

Which contraceptives should be stopped after 1 year of amenorrhoea in >50?

Answer 445

Non-hormonal (e.g. IUD, condoms, natural family planning)

Question 446

Which contraceptives can be continued beyond 50 years?

Answer 446

Implant, POP, IUS

If amenorrhoeic check FSH and stop after 1 year if FSH >= 30u/l or stop at 55 years
If not amenorrhoeic consider investigating abnormal bleeding pattern

Question 447

MOA if on COCP/POP and >50 years old

Answer 447

COCP: switch to non-hormonal or progestogen-only method
Depo-Provera: switch to either a non-hormonal method and stop after 2 years of amenorrhoea
OR

Switch to a progestogen-only method. If amenorrhoeic check FSH and stop after 1 year if FSH >= 30u/l or stop at 55 years. If not amenorrhoeic consider investigating abnormal bleeding pattern

Question 448

What is the BP target when treating pre-eclampsia?

Answer 448

<135/85

Question 449

Contraception for transgender patients assigned female at birth and with a uterus

Answer 449

POP
IUS

Question 450

Contraception for transgender patients assigned male at birth

Answer 450

Condoms

Question 451

Course of action if missed a traditional POP (Micronor, Noriday, Nogeston, Femulen) <3 hours

Answer 451

No action required, continue as normal

Question 452

Course of action if missed a traditional POP (Micronor, Noriday, Nogeston, Femulen) >3 hours

Answer 452

Take the missed pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day
Continue with rest of pack
Extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours

Question 453

Course of action if missed a erazette (desogestrel) POP <12 hours

Answer 453

No action required, continue as normal

Question 454

Course of action if missed a erazette (desogestrel) POP >12 hours

Answer 454

Take the missed pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day
Continue with rest of pack
Extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours

Question 455

Ix for PPROM

Answer 455

Sterile speculum examination (to look for pooling of amniotic fluid in the posterior vaginal vault)

If pooling of fluid not observed then test the fluid for placental alpha microglobulin-1 protein (PAMG-1 e.g. AmniSure) or insulin-like growth factor binding protein‑1

US may be useful to show oligohydramnios

Question 456

_____________ should only be offered for women who cannot tolerate metformin or those who fail to meet the glucose targets with metformin but decline insulin treatment

Answer 456

Glibenclamide/Glipizide

Question 457

Targets for self monitoring of pregnant women (pre-existing and gestational diabetes)

Answer 457

Question 458

How often should a pregnant woman test blood glucose levels throughout her pregnancy?

Answer 458

Daily fasting, pre-meal and 1-hour post-meal bed time tests

Question 459

Which chronic condition increases the risk of miscarriage?

Answer 459

All of them eg diabetes

Question 460

Which uterine or cervical problems increases the risk of miscarriage?

Answer 460

Certain uterine abnormalities (Mullerian duct anomalies, large cervical cone biopsies)

Question 461

Normal laboratory findings in pregnancy

Answer 461

Reduced urea, reduced creatinine, increased urinary protein loss

Question 462

Fixed retroverted uterus

Answer 462

Endometriosis - the inflammation causes adhesions which results in the uterus being fixed and retroverted

Question 463

Mx for a potential ectopic pregnancy and is <6 weeks

Answer 463

If bleeding, but NO pain or risk factors for ectopic pregnancy:
Return if bleeding continues or pain develops
Repeat a urine pregnancy test after 7–10 days and to return if it is positive, a -ve test means that the pregnancy has miscarried

Question 464

What can cause cervical ectropion?

Answer 464

Elevated oestrogen levels (ovulatory phase, pregnancy, combined oral contraceptive pill use)

Question 465

Some women may wish to have their fibroadenomas excised, they can usually be shelled out through a __________ incision. Smaller lesions may be removed using a __________

Answer 465

Some women may wish to have their fibroadenomas excised, they can usually be shelled out through a circumareolar incision. Smaller lesions may be removed using a mammotome

Question 466

A fibroadenoma greater than 4cm attracts a recommendation for core biopsy to exclude a..

Answer 466

Phyllodes tumour

Question 467

Tx for Fat necrosis

Answer 467

Imaging and core biopsy

Question 468

Tx for duct papilloma

Answer 468

Microdochectomy

Question 469

Periductal mastitis is associated with..

Answer 469

Smoking

Question 470

Commonest cause may be response to emotional events, drugs such as histamine receptor antagonists are also implicated

Answer 470

Galactorrhoea

Question 471

Mx for non-malignant nipple discharge involves excluding…

Answer 471

endocrine disease

Question 472

Chronic breast or axillary sinus

Answer 472

Tuberculosis

Question 473

Paget’s disease differs from eczema of the nipple in that it involves…

Answer 473

The nipple primarily and only latterly spreads to the areolar (the opposite occurs in eczema)

Answer 474

1st: bimanual uterine compression if can’t rub up contraction
2nd: Oxytocin (Syntocin) THEN Ergometrine unless the patient has hypertension
3rd: IM Carboprost
4th: Intramyometrial Carboprost
5th: Rectal Misoprostol (Or sublingual)
6th: Balloon Tamponade
7th: B-Lynch suture, ligation of uterine/iliac arteries
8th: life-saving emergency hysterectomy

Question 475

Ectopic pregnancy is more dangerous if in..

Answer 475

Isthmus

Question 476

In an ectopic pregnancy, __________ invades the tubal wall, producing bleeding which may dislodge the embryo

Answer 476

In an ectopic pregnancy, trophoblast invades the tubal wall, producing bleeding which may dislodge the embryo

Question 477

Tumour composed of both stromal and epithelial fragments. The tumour cells are often described as growing in a ‘leaf like’ pattern

Answer 477

Phyllodes tumour

Question 478

Tumour shows irregularly distributed cells which form no obvious pattern, with atypically large nuclei. The basement membrane is not breached.

Answer 478

Ductal carcinoma in situ

Question 479

Tumour shows abnormal proliferation of lobular cells which are small and round and arranged in a uniform pattern. They would also infiltrate the basement membrane

Answer 479

Invasive lobular carcinoma

Question 480

Tumour shows an abnormal proliferation of small, round, lobular cells arranged in a uniform pattern. There would be no infiltration of the basement membrane

Answer 480

Lobular carcinoma in situ

Question 481

Tumour shows irregularly distributed cells which form no obvious pattern, with atypically large nuclei. The basement membrane is breached

Answer 481

Invasive ductal carcinoma

Question 482

What is the most common type of breast cancer?

Answer 482

Invasive ductal carcinoma

Question 483

There are specific conditions in a patient’s family history that may consider them at higher risk for breast cancer, which warrant referral from primary care. These include…

Answer 483

Breast cancer in a first-degree male relative of any age
Breast cancer in a first-degree relative under the age of 40
Bilateral breast cancer in a first-degree relative under the age of 50
Breast cancer in two first-degree relatives

Question 484

Smooth palpable lump that is growing in size

Answer 484

Malignant phyllodes tumour

Question 485

A __________________ is an accumulation of pus in the area of the breast and develops as a complication of infectious mastitis. It is more frequently seen in primiparous women

Answer 485

A lactational breast abscess is an accumulation of pus in the area of the breast and develops as a complication of infectious mastitis. It is more frequently seen in primiparous women

Question 486

TNM scoring system for breast cancer

Answer 486

N1: <4 lymph nodes
N2: 4-9 local lymph nodes (axillary or internal mammary)
N3: spread to supra- or infra-clavicular lymph nodes

Question 487

Visible and palpable cord-like structure in the axillary region, as well as a sensation of tightness and pulling in the chest area, restricted shoulder movement, and pain

Answer 487

Axillary web syndrome

Question 488

Swelling, discomfort, and a sensation of heaviness in the affected arm

Answer 488

Lymphoedema

Question 489

Irregular, hard 3cm shaped lump in the lower lateral right breast. On putting the patient’s hands on her hips the lump appears fixed to deep tissue

Answer 489

Invasive breast cancer (fixed to pectoralis major)

Question 490

Trauma to the breast tissue. Mammography shows an area of coarse, calcified tissue that may mimic the appearance of breast cancer

Answer 490

Fat necrosis of the breast

Question 491

Lymphoedema vs seroma

Answer 491

Lymphoedema: gradual (18–24 months post-surgery) and widespread

Seroma: rapid (7–10 days post-surgery) and localised

Question 492

Fluctuant tender lump with overlying erythema in a woman that recently gave birth

Answer 492

Breast abscess

Question 493

Wilson criteria for screening

Answer 493

• Should be an important health problem
• Natural history of the condition should be understood
• There should be a recognisable latent or early symptomatic stage
• There should be a test that is easy to perform and interpret, acceptable, accurate, reliable, sensitive and specific
• There should be an accepted treatment recognised for the disease
• Treatment should be more effective if started early
• There should be a policy on who should be treated diagnosis and treatment should be cost-effective
• Case-finding should be a continuous process

Question 494

Abx for group B strep

Answer 494

Benzylpenicillin

Question 495

Abx for PPROM

Answer 495

Erythromycin

Question 496

Abnormal cells will appear ________ when acetic acid is applied to the cervix

Answer 496

White

Question 497

Aqueous iodine (also known as Lugol’s iodine) is used during colposcopy as part of cervical cancer screening. It will stain normal cells _________, but it is not taken up by cancerous cells, which appear __________ under microscopy

Answer 497

Aqueous iodine (also known as Lugol’s iodine) is used during colposcopy as part of cervical cancer screening. It will stain normal cells black/brown, but it is not taken up by cancerous cells, which appear yellow under microscopy

Question 498

Which maternal drugs can cause oligohydramnios?

Answer 498

Prostaglandin inhibitors and ACE-inhibitors

Question 499

Which fetal urine abnormalities can cause oligohydramnios?

Answer 499

Renal agenesis
Polycystic kidneys or urethral obstruction)

Question 500

Which maternal conditions can cause oligohydramnios?

Answer 500

Hypertension, pre-eclampsia, maternal smoking and placental abruption

Question 501

Clubbed feet, facial deformity, congenital hip dysplasia

Answer 501

Fetal compression due to oligohydramnios

Question 502

Pulmonary hypoplasia in the fetus

Answer 502

Lack of amniotic fluid due to oligohydramnios

Question 503

Ix for oligohydramnios

Answer 503

Ultrasound, which shows a reduced amniotic fluid index (AFI) or single deepest pocket (SDP)

Question 504

Tx for oligohydramnios

Answer 504

Maternal rehydration
Amnioinfusion
Delivery

Question 505

Differentiate between primary and secondary dysmenorrhoea

Answer 505

Primary: pain occurs before the start of menstruation
Secondary: pain starts with the onset of menstruation

Question 506

Discharging sinus

Answer 506

Periductal mastitis

Question 507

Tx for Triple-negative breast cancer

Answer 507

Neoadjuvant chemotherapy followed by surgery and adjuvant therapy

Question 508

Raised FSH/LH
Reduced oestradiol level

Answer 508

Premature ovarian insufficiency

Question 509

____________ is a protective factor for breast cancer

Answer 509

Breast-feeding is a protective factor for breast cancer

Question 510

Ix for malignant phyllodes tumours

Answer 510

Mammography
Biopsy

Question 511

Mx for malignant phyllodes tumours

Answer 511

Small tumours (<2cm): wide local excision, ensuring clear margins

Larger tumours: mastectomy

Question 512

Thickened area of breast tissue alongside changes to the nipple or to the skin. It is difficult to detect using a mammogram and most women have a MRI scan of their breast to confirm/exclude the diagnosis.

Answer 512

Invasive lobular carcinoma

Question 513

________ of the nipple can occur after puerperal mastitis is treated with antibiotics

Answer 513

Candida

Question 514

Painful and itchy nipples, with flaky and cracked skin around the areola. Baby has white patches on his tongue

Answer 514

Candida of the nipple

Question 515

Mobile, cyst-like lesion which can be tender - recently ceased breastfeeding

Answer 515

Galactocele

Question 516

Patients with troublesome nipple discharge due to duct ectasia may be treated by ______________ (if young) or ______________ (if older)

Answer 516

Microdochectomy (if young)
Total duct excision (if older)
Reassurance if they’re not too fussed about it

Question 517

What would help a pregnant woman quit smoking?

Answer 517

NRT

Question 518

Hyperemesis gravidarum, diagnostic criteria triad

Answer 518

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

Question 519

Mode of delivery if viral load is less than 50 copies/ml at 36 weeks

Answer 519

Vaginal delivery

Question 520

Mode of delivery if viral load is more than 50 copies/ml at 36 weeks

Answer 520

C-section
Zidovudine infusion should be started four hours before

Question 521

Zidovudine is usually administered orally to the neonate if maternal viral load is _________ Otherwise __________ should be used. Therapy should be continued for 4-6 weeks

Answer 521

Zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml. Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks

Question 522

Conservative management for a prolapse

Answer 522

Weight loss, pelvic floor muscle exercises
Ring pessary
Surgery

Question 523

Surgical option for a cystocele/ cystourethrocele

Answer 523

Anterior colporrhaphy, colposuspension

Question 524

Surgical option for a uterine prolapse

Answer 524

Hysterectomy, sacrohysteropexy

Question 525

Surgical option for a rectocele

Answer 525

Posterior colporrhaphy

Question 526

Risk factor for placenta accreta

Answer 526

C section due to scarring and abnormal adherence of the placenta to the myometrium

Question 527

Individuals who have been treated for CIN1, CIN2, or CIN3 should be invited _________ after treatment for a test of cure repeat cervical sample in the community

Answer 527

6 months

Question 528

The latest gestational age where an abortion is legal from..

Answer 528

28 weeks to 24 weeks

Question 529

An abortion can be performed before 24 weeks if continuing the pregnancy involves greater risk to..

Answer 529

The physical or mental health of the mother or the existing children of the family

Question 530

What are the legal requirements for an abortion?

Answer 530

Two registered medical practitioners must sign to agree abortion is indicated
It must be carried out by a registered medical practitioner in an NHS hospital or approved premise

Question 531

Which medications are used in a medical abortion?

Answer 531

Mifepristone (anti-progestogen)
Misoprostol (prostaglandin analogue) 1 – 2 day later

Question 532

Rhesus negative women with a gestational age of ____ weeks or above having a medical TOP should have anti-D prophylaxis

Answer 532

10 weeks

Question 533

Prior to surgical abortion, medications are used for…

Answer 533

Cervical priming

Question 534

Option for surgical abortion up to 14 weeks

Answer 534

Vacuum aspiration (MVA) or electric vacuum aspiration (EVA)

Question 535

Option for surgical abortion 14-24 weeks

Answer 535

Cervical dilatation and evacuation using forceps

Question 536

When is a multi-level pregnancy test done after an abortion?

Answer 536

In 2 weeks

Question 537

Following a surgical abortion, which contraceptive can be inserted immediately after evacuation of the uterine cavity?

Answer 537

IUD/IUS

Question 538

Which type of bleeding is considered a red flag?

Answer 538

Intermenstrual
Postcoital bleeding

Question 539

Major causes of bleeding in the first trimester

Answer 539

Spontaneous abortion
Ectopic pregnancy
Hydatidiform mole

Question 540

Major causes of bleeding in the second trimester

Answer 540

Spontaneous abortion
Hydatidiform mole
Placental abruption

Question 541

Major causes of bleeding in the third trimester

Answer 541

Bloody show
Placental abruption
Placenta praevia
Vasa praevia

Question 542

Typically history of 6-8 weeks amenorrhoea with lower abdominal pain (usually unilateral) initially and vaginal bleeding later. Shoulder tip pain and cervical excitation may be present

Answer 542

Ectopic pregnancy

Question 543

Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis. The uterus may be large for dates and serum hCG is very high

Answer 543

Hydatidiform mole

Question 544

Constant lower abdominal pain and, woman may be more shocked than is expected by visible blood loss. Tender, tense uterus with normal lie and presentation. Fetal heart may be distressed

Answer 544

Placental abruption

Question 545

Vaginal bleeding, no pain. Non-tender uterus but lie and presentation may be abnormal

Answer 545

Placental praevia

Question 546

Rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia is classically seen

Answer 546

Vasa praevia

Question 547

Ix for androgen insensitivity syndrome

Answer 547

Buccal smear or chromosomal analysis to reveal 46XY genotype

After puberty, testosterone concentrations are high-normal

Question 548

Mx for androgen insensitivity syndrome

Answer 548

Counselling - raise the child as female
Bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
Oestrogen therapy

Question 549

Which procedures can cause Asherman’s syndrome

Answer 549

Pregnancy-related dilatation and curettage
Uterine surgery (e.g. myomectomy)
Several pelvic infection (e.g. endometritis)

Question 550

Ix for Asherman’s syndrome

Answer 550

Hysteroscopy
Hysterosalpingography
Sonohysterography
MRI scan

Question 551

Tx for Asherman’s syndrome

Answer 551

Dissecting the adhesions during hysteroscopy. Reoccurrence of the adhesions after treatment is common

Question 552

Which structure is affected in Sheehan’s syndrome?

Answer 552

Anterior pituitary gland - avascular necrosis

Question 553

Which hormones are affected by Sheehan’s syndrome?

Answer 553

Thyroid-stimulating hormone (TSH)
Adrenocorticotropic hormone (ACTH)
Follicle-stimulating hormone (FSH)
Luteinising hormone (LH)
Growth hormone (GH)
Prolactin

Released from anterior pituitary gland

Question 554

Which hormones are NOT affected by Sheehan’s syndrome?

Answer 554

Oxytocin
Antidiuretic hormone (ADH)

Released from posterior pituitary gland

Question 555

Mx of Sheehan’s syndrome

Answer 555

Oestrogen and progesterone (until menopause)
Hydrocortisone for adrenal insufficiency
Levothyroxine for hypothyroidism
Growth hormone

Question 556

If an imperforate hymen is not treated retrograde menstruation could occur leading to…

Answer 556

Endometriosis

Question 557

Girls will still menstruate, but can have difficulty with intercourse or tampon use

Answer 557

Perforate transverse vaginal septae

Question 558

Which condition would present similarly to imperforate hymen?

Answer 558

Imperforate transverse vaginal septae

Question 559

The upper vagina, cervix, uterus and fallopian tubes develop from the…

Answer 559

Paramesonephric ducts (Mullerian ducts)

Question 560

Bacterial vaginosis is a loss of which bacteria?

Answer 560

Lactobacilli - makes the environment more acidic (pH <4.5) so prevents other bacteria from growing there

Question 561

Fishy-smelling, watery grey or white vaginal discharge

Answer 561

Bacterial vaginosis

Question 562

Clue cells on microscopy mean..

Answer 562

Bacterial vaginosis

Question 563

Ix for bacterial vaginosis

Answer 563

Vaginal pH
Vaginal swab

Question 564

Amsel’s criteria for diagnosis of BV - 3 of the following 4 points should be present

Answer 564

Thin, white homogenous discharge
Clue cells on microscopy
Vaginal pH > 4.5
Positive whiff test (addition of potassium hydroxide results in fishy odour)

Question 565

Tx for bacterial vaginosis if asymptomatic

Answer 565

No treatment

Question 566

Tx for bacterial vaginosis if symptomatic

Answer 566

Oral metronidazole
Topical metronidazole or topical clindamycin as alternatives

Question 567

Painful ulcer and tender lymphadenopathy

Answer 567

Chancroid

Question 568

Painless ulcer and non-tender lymphadenopathy

Answer 568

Syphilis

Question 569

Painless ulcer and tender lymphadenopathy

Answer 569

Lymphogranuloma venereum

Question 570

Painful genital blisters or sores, fever, headache, muscle aches and swollen glands in the groin area

Answer 570

Genital herpes

Question 571

The ____________ is the contraceptive of choice amongst the epileptic population

Answer 571

Injection

Question 572

If a smear displays 5 or more polymorphs per high power field, with no evidence of gram negative diplococci, the current guidance is to treat for ____________ infection empirically with ____________

Answer 572

If a smear displays 5 or more polymorphs per high power field, with no evidence of gram negative diplococci, the current guidance is to treat for chlamydia infection empirically with Doxycycline

Question 573

Snowstorm appearance of axillary lymph nodes

Answer 573

Extracapsular breast implant rupture

Question 574

Pain during pregnancy + hard and tender uterus

Answer 574

Placental abruption

Question 575

Which form of contraceptive can be used in a PMH of PID?

Answer 575

Injectable/implantable contraceptive

Question 576

Which form of contraceptive can be used in a PMH of gastric sleeve/bypass/duodenal switch?

Answer 576

Nexplanon implantable contraceptive

Question 577

Braxton hicks occurs in the last ______ weeks of pregnancy

Answer 577

Four

Question 578

During labour, head enters pelvis in ____________ position. The head normally delivers in an ____________

Answer 578

During labour, head enters pelvis in occipito-lateral position. The head normally delivers in an occipito-anterior position

Question 579

Main ovarian cancer sx

Answer 579

BEAT

B- bloating
E- eating difficulty (getting full more quickly)
A- abdominal or pelvic pain/mass
T- toilet changes (change in bowel/urinary habits)

Question 580

Grey, gelatinous surface

Answer 580

Mucinous carcinoma

Question 581

Bilateral nipple discharge is unlikely to be associated with..

Answer 581

Breast cancer - most likely hormonal changes especially if they’re young (due to puberty)

Question 582

Which type of breast cancer presents with a discrete lump?

Answer 582

Invasive ductal carcinoma

Question 583

Which type of breast cancer presents with an area of thickened breast tissue?

Answer 583

Invasive lobular carcinoma

Question 584

There are two ways routine anti-D prophylaxis can be given: a one-dose injection between ____ and ____ weeks of pregnancy or two doses of injections at ____ weeks and ____ weeks of pregnancy

Answer 584

One-dose injection between 28 and 30 weeks of pregnancy

Two doses of injections at 28 weeks and 34 weeks of pregnancy

Question 585

Skin lesions in newborn + some degree of congenital deformity (for instance hypoplastic limbs, neurological impairment)

Answer 585

Varicella Zoster Virus

Question 586

Where are subserosal fibroids located?

Answer 586

Below the outer serosa of the uterus

Question 587

Where are pedunculated fibroids located?

Answer 587

On a ‘stalk’ and are protruding into the uterine cavity

Question 588

Where are submucosal fibroids located?

Answer 588

Below the endometrium

Question 589

Where are transmural fibroids located?

Answer 589

Within the wall of the myometrium of the uterus

Question 590

How does the cervical os look like in pregnancy compared to non-parous?

Answer 590

Parous: Slit-like
Non-parous: Pin-point

Question 591

SCJ distance is increased/decreased in pregnancy?

Answer 591

Increased

Question 592

Conditions for IOL

Answer 592

Prelabour rupture of membranes
Fetal growth restriction
Pre-eclampsia
Obstetric cholestasis
Existing diabetes
Intrauterine fetal death

Question 593

Components of a bishop score

Answer 593

Pregnancy Can Enlarge Dainty Stomachs! (Position, Consistency, Effacement, Dilation, Station)

Question 594

Options for IOL

Answer 594

Membrane sweep
Vaginal prostaglandin E2 (if doesn’t work then cervical ripening balloon, if can’t use E2 then artificial rupture of membranes with an oxytocin infusion)

Question 595

Two methods of monitoring IOL

Answer 595

Bishop score
CTG

Question 596

Main complication of IOL iwth vaginal prostaglandins

Answer 596

Uterine hyperstimulation

Question 597

Criteria for uterine hyperstimulation

Answer 597

Individual uterine contractions lasting more than 2 minutes in duration
More than five uterine contractions every 10 minutes

Question 598

Uterine hyperstimulation can lead to ____________

Answer 598

Uterine rupture

Question 599

Tx for uterine hyperstimulation

Answer 599

Removing the vaginal prostaglandins, or stopping the oxytocin infusion
Tocolysis with terbutaline

Question 600

Which parameters are checked every four hours during labour?

Answer 600

Maternal BP and temp
VE
Maternal urine for ketones and protein

Question 601

Which parameters are checked every 15 min during labour?

Answer 601

FHR

Question 602

Which parameters are checked every 30 min during labour?

Answer 602

Contractions

Question 603

Which parameters are checked every 60 min during labour?

Answer 603

Maternal pulse rate

Question 604

Which risk factors can cause uteroplacental insufficiency and therefore oligohydramnios?

Answer 604

Hypertension, pre-eclampsia, maternal smoking and placental abruption

Question 605

Which medications can cause oligohydramnios?

Answer 605

Prostaglandin inhibitors and ACE-inhibitors

Question 606

Complications of oligohydramnios due to fetal compression?

Answer 606

Clubbed feet, facial deformity, congenital hip dysplasia

Question 607

Complications of oligohydramnios due to lack of amniotic fluid?

Answer 607

Pulmonary hypoplasia in the fetus

Question 608

A combination of fetal compression and lack of amniotic fluid is called…

Answer 608

Potter syndrome

Question 609

Ix for oligohydramnios

Answer 609

US - amniotic fluid index (AFI) or single deepest pocket (SDP)

Question 610

Mx for oligohydramnios

Answer 610

Maternal rehydration
Amnioinfusion
Delivery: IOL or c-section

Question 611

Uterus which feels tense or large for dates and it may be difficult to feel the foetal parts on palpation of the abdomen

Answer 611

Polyhydramnios

Question 612

Two main causes of polyhydramnios

Answer 612

Increased foetal urination
Reduced foetal swallowing

Question 613

What causes increased foetal urination?

Answer 613

Maternal diabetes mellitus
Foetal renal disorders/anaemia
Twin-to-twin transfusion syndrome

Question 614

What causes reduced foetal swallowing?

Answer 614

Oesophageal or duodenal atresia
Diaphragmatic hernia
Anencephaly
Chromosomal disorders

Question 615

Tx for polyhydramnios

Answer 615

Management of any underlying causes (e.g. in maternal diabetes) and amnio-reduction in severe cases

Question 616

Which contraceptive method is avoided in breast cancer?

Answer 616

Any hormonal one

Opt for copper coil or barrier methods

Question 617

Which contraceptive method is avoided in cervical/endometrial cancer?

Answer 617

Intrauterine system (i.e. Mirena coil)

Question 618

Which contraceptive method is avoided in Wilson’s disease?

Answer 618

Copper coil

Question 619

The combined contraceptive pill can be used up to age ___ years, and can treat _____________ symptoms

Answer 619

The combined contraceptive pill can be used up to age 50 years, and can treat perimenopausal symptoms

Question 620

The progestogen injection (i.e. Depo-Provera) should be stopped before 50 years due to the risk of ____________

Answer 620

The progestogen injection (i.e. Depo-Provera) should be stopped before 50 years due to the risk of osteoporosis

Question 621

Women that are amenorrhoeic (no periods) when taking progestogen-only contraception should continue until either..

Answer 621

FSH blood test results are above 30 IU/L on two tests taken six weeks apart (continue contraception for 1 more year)
55 years of age

Question 622

Which contraceptive options are offered to women under 20?

Answer 622

Combined/POP
Progesterone implant - long acting reversible
Coils - risk of expulsion

Question 623

The _____________ and _______ are considered safe in breastfeeding and can be started at any time after birth

Answer 623

The progestogen-only pill and implant are considered safe in breastfeeding and can be started at any time after birth

Question 624

_____________ condoms can be used in latex allergy

Answer 624

Polyurethane condoms can be used in latex allergy

Question 625

Using ________________ can damage latex condoms and make it more likely they will tear

Answer 625

Oil-based lubricants

Question 626

Diaphragms and cervical caps are fitted before having sex, and are left in place for at least ___ hours after. They should be used with ____________ gel the further reduce the risk of pregnancy

Answer 626

Diaphragms and cervical caps are fitted before having sex, and are left in place for at least 6 hours after. They should be used with spermicide gel the further reduce the risk of pregnancy

Question 627

What are dental dams?

Answer 627

Used during oral sex to provide a barrier between the mouth and the vulva, vagina or anus to prevent infections

Question 628

Which COCP is used first line due to reduced risk of VTE?

Answer 628

Microgynon or loestrin

Question 629

Which COCP is used first line for premenstrual syndrome?

Answer 629

Yasmin

Question 630

Which COCP is used first line for acne and hirsutism?

Answer 630

Dianette (but higher risk of VTE so stop after 3 months)

Question 631

COCP carries a small increased risk of ___________ and ___________ cancer, returning to normal ten years after stopping

Answer 631

Breast and cervical cancer

Question 632

When using COCP, _______________ is common in the first three months and should then settle with time

Answer 632

Unscheduled bleeding

Question 633

The COCP reduces the risk of which conditions?

Answer 633

Endometrial, ovarian and colon cancer
Benign ovarian cysts

Question 634

Is additional contraception required when started the COCP?

Answer 634

No if started day 1-5 of menstrual cycle

If > day 5 then condoms for the first 7 days

Question 635

When switching between COCPs, finish one pack, then start the new pill pack..

Answer 635

Immediately without pill free interval

Question 636

When switching from a POP they can switch at any time but _________________ is required

Answer 636

7 days of extra contraception (i.e. condoms)

Question 637

When switching from desogestrel to COCP, they can switch…

Answer 637

Immediately, and no additional contraception is required

Question 638

Which conditions can reduce the effectiveness of COCP?

Answer 638

Vomiting, diarrhoea and medications (P450 inducers)

Smoking and Drinking in Barb’s and John’s Car Rifs her Phen

Question 639

The only UKMEC 4 criteria for the POP is..

Answer 639

Active breast cancer

Question 640

The traditional progestogen-only pill (Norgeston or Noriday) cannot be delayed by more than..

Answer 640

3 hours

Question 641

The desogestrel-only pill (Cerazette) cannot be delayed by more than..

Answer 641

12 hours

Question 642

Starting the POP on day 1 to 5 of the menstrual cycle means the woman is protected __________

Answer 642

Immediately

Question 643

If the POP is started > 5day then additional contraception is required for _________

Answer 643

48 hours

Question 644

POPs can be switched immediately without…

Answer 644

Extra contraception

Question 645

When switching from a COCP to a POP, they can start without additional contraception if..

Answer 645

Have taken the COCP consistently for more than 7 days (they are in week 2 or 3 of the pill pack)

Are on days 1-2 of the hormone-free period following a full pack of the COCP

Question 646

Common side effect of starting POP

Answer 646

Unscheduled bleeding in the first three months

Question 647

The POP has a small increased risk of..

Answer 647

Ovarian cysts
Ectopic pregnancy with traditional POPs
Breast cancer, returning to normal ten years after stopping

Question 648

Which method of contraception is unsuitable for those who wish to get pregnant in the near term?

Answer 648

Progestogen-only injection (Depo-Provera/Sayana-Press)

Question 649

The Progestogen-only injection is given at ________ intervals and contains _______________

Answer 649

12-13 week intervals
Medroxyprogesterone acetate (a type of progestin

Question 650

Noristerat is an alternative to the DMPA that contains _________ and works for ______ weeks. This is usually used as a ______ term interim contraception (e.g. after the partner has a ______)

Answer 650

Noristerat is an alternative to the DMPA that contains norethisterone and works for eight weeks. This is usually used as a short term interim contraception (e.g. after the partner has a vasectomy)

Question 651

UKMEC 4 for progesterone only injection

Answer 651

Active breast cancer

Question 652

UKMEC 3 for progesterone only injection

Answer 652

Ischaemic heart disease and stroke
Unexplained vaginal bleeding
Severe liver cirrhosis
Liver cancer

Question 653

The DMPA can cause ___________. This is something to consider in older women and patients on ___________ for asthma or inflammatory conditions

Answer 653

The DMPA can cause osteoporosis. This is something to consider in older women and patients on steroids for asthma or inflammatory conditions

Question 654

When is DMPA started?

Answer 654

1-5
if > day 5 then seven days of extra contraception

Question 655

Signs and symptoms for DMPA

Answer 655

Weight gain
Acne
Reduced libido
Mood changes
Headaches
Flushes
Hair loss (alopecia)
Skin reactions at injection sites

Question 656

The depot injection may be associated with a very small increased risk of ________ and ________ cancer

Answer 656

Breast and cervical cancer

Question 657

Irregular bleeding can occur in the first ____ months of taking DMPA. The _________ can be taken alongside this to help settle the bleeding

Answer 657

Irregular bleeding can occur in the first six months of taking DMPA. The COCP can be taken alongside this to help settle the bleeding

Question 658

Benefits for DMPA

Answer 658

Improves dysmenorrhoea and endometriosis symptoms
Reduces the risk of ovarian and endometrial cancer + severity of sickle cell crisis

Question 659

The progestogen only implant lasts for _________

Answer 659

3 years

Question 660

UKMEC 4 for progestogen only implant

Answer 660

Active breast cancer

Question 661

When is the progestogen only implant used?

Answer 661

Day 1-5

iF > 5 days then additional contraception for 7 days

Question 662

Benefits for progestogen only implant

Answer 662

It can improve dysmenorrhoea (painful menstruation)
It can make periods lighter or stop all together

Question 663

Drawbacks of It can improve dysmenorrhoea (painful menstruation)
It can make periods lighter or stop all together

Answer 663

Worsening of acne
Problematic bleeding (add COCP for three months)

Question 664

The implant can become impalpable or deeply implanted. Women are advised to ________________ occasionally, and if it becomes impalpable, ________________ is required until it is located

Answer 664

Rarely the implant can become impalpable or deeply implanted. Women are advised to palpate the implant occasionally, and if it becomes impalpable, extra contraception is required until it is located.

Question 665

The copper coil can lead to..

Answer 665

PID

Question 666

Levonorgestrel is not known to be harmful when breastfeeding, and breastfeeding can continue (unlikely __________)

Answer 666

Ulipristal

Question 667

The combined pill or progestogen-only pill can be started ___________ after taking levonorgestrel

Answer 667

Immediately

Question 668

The combined pill or progestogen-only pill can be started ________ after taking Ulipristal

Answer 668

5 days

Question 669

Ulipristal should be avoided in..

Answer 669

Severe asthma
Breastfeeding for 1 week

Question 670

Contraindications for coils

Answer 670

PID or infection
Immunosuppression
Pregnancy
Unexplained bleeding
Pelvic cancer
Uterine cavity distortion (e.g. by fibroids)

Question 671

There may be some temporary crampy period type pain after insertion of coils. _________ may be used to help

Answer 671

NSAIDs

Question 672

Women need to be seen 3 to 6 weeks after insertion of coils to check the _______. They should be taught to feel the _______ to ensure the coil remains in place

Answer 672

Women need to be seen 3 to 6 weeks after insertion of coils to check the threads. They should be taught to feel the strings to ensure the coil remains in place

Question 673

Before the coil is removed, women need to __________ or ___________, or there is a risk of pregnancy. The strings are located and slowly pulled to remove the device

Answer 673

Before the coil is removed, women need to abstain from sex or use condoms for 7 days, or there is a risk of pregnancy. The strings are located and slowly pulled to remove the device

Question 674

When the coil threads cannot be seen or palpated, three things need to be excluded…

Answer 674

Expulsion
Pregnancy
Uterine perforation

Question 675

Ix for non-visible threads

Answer 675

US

Abdominal and pelvic xray to look for a coil in the abdomen or peritoneal cavity after a uterine perforation

Hysteroscopy or laparoscopic surgery may be required

Question 676

Copper coil may reduce the risk of..

Answer 676

Endometrial and cervical cancer

Question 677

The _____ is commonly used for contraception, menorrhagia and endometrial protection for women on HRT

Answer 677

LNG-IUS

Question 678

The LNG-IUS can be inserted up to day __ of the menstrual cycle. If it is inserted after day __, __________ needs to be reasonably excluded, and __________ is required

Answer 678

The LNG-IUS can be inserted up to day 7 of the menstrual cycle. If it is inserted after day 7, pregnancy needs to be reasonably excluded, and extra protection (i.e. condoms) is required for 7 days

Question 679

Benefits for LNG-IUS

Answer 679

Make periods lighter or stop altogether

May improve dysmenorrhoea or pelvic pain related to endometriosis

Question 680

Problematic bleeding in LNG-IUS

Answer 680

First 6 months + can use COCP alongside this

Question 681

Actinomyces-like organisms are often discovered incidentally during smear tests in women with an..

Answer 681

Intrauterine device (coil)

Question 682

Tx for Actinomyces-like organisms

Answer 682

Removal of the intrauterine device

Question 683

MOA of COCP

Answer 683

Inhibits ovulation

Question 684

MOA of POP

Answer 684

Thickens cervical mucus

Question 685

MOA for POP - desogestrel

Answer 685

Primary: Inhibits ovulation
Also: thickens cervical mucus

Question 686

MOA for injectable contraceptives

Answer 686

Primary: Inhibits ovulation
Also: thickens cervical mucus

Question 687

MOA for implant

Answer 687

Primary: Inhibits ovulation
Also: thickens cervical mucus

Question 688

MOA for IUD

Answer 688

Decreases sperm motility and survival

Question 689

MOA for IUS

Answer 689

Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus

Question 690

MOA for Levonorgestrel

Answer 690

Inhibits ovulation

Question 691

MOA for ulipristal

Answer 691

Inhibits ovulation

Question 692

MOA for IUD

Answer 692

Primary: Toxic to sperm and ovum
Also: Inhibits implantation

Question 693

What would warrant continuous CTG monitoring during labour?

Answer 693

Suspected chorioamnionitis, or > 38°C
BP > 160/110 mmHg
Oxytocin use
Significant meconium
Fresh vaginal bleeding that develops in labour

Question 694

Multiparous woman towards end of reproductive years. US shows asymmetrical uterus, abnormal myometrial echo texture and myometrial cysts

Answer 694

Adenomyosis

Question 695

Which NSAID is not recommended in pregnancy?

Answer 695

Mefenamic acid

Question 696

Fixed, retroverted uterus

Answer 696

Endometriosis

Question 697

Incomplete emptying of urine

Answer 697

Overflow incontinence

Question 698

A high voiding detrusor pressure with a low peak flow rate is indicative of…

Answer 698

Bladder outlet obstruction (Overflow incontinence)

Question 699

High beta hCG
Low TSH
High thyroxine

Answer 699

Molar pregnancy

Question 700

A spot urine protein:creatinine ratio of __mg/mmol or more is used as the threshold for proteinuria in pregnancy

Answer 700

30mg/mmol or more

Question 701

__________ should be suspected in patients with continuous dribbling incontinence after prolonged labour and from a country with poor obstetric services

Answer 701

Vesicovaginal fistulae

Question 702

Candidial infection (‘thrush’) is often precipitated or exacerbated by…

Answer 702

Recent antibiotic exposure

Question 703

Menorrhagia, anaemia, bulk-related symptoms e.g. bloating/urinary frequency

Answer 703

Fibroids

Question 704

Risk factors for placental abruption

Answer 704

ABRUPTION

Abruption previously
Blood pressure (i.e. hypertension or pre-eclampsia)
Ruptured membranes, either premature or prolonged
Uterine injury (i.e. trauma to the abdomen- C-section)
Polyhydramnios
Twins or multiple gestation/multiparity
Infection - chorioamnionitis;
Older age (>35 years old)
Narcotic (i.e. cocaine, amphetamines, smoking)

Question 705

A cyst on US that has thin walls with no internal structures

Answer 705

Follicular cysts

Question 706

_____________cysts are often seen in early pregnancy

Answer 706

Corpus luteum cysts

Question 707

Give two types of sex-cord-stromals tumours seen in women

Answer 707

Sertoli–Leydig cell tumours and granulosa cell tumours

Question 708

Which cyst causes:

A deep voice
Enlarged clitoris
Facial hair
Loss in breast size
Stopping of menstrual periods

Answer 708

Sertoli–Leydig cell tumours

Question 709

Which cyst causes the following symptoms due to high oestrogen?

Abnormal uterine or postmenopausal bleeding
Increased abdomen size
Irregular menstrual cycles or absence of menses
Tender or sore breasts

Answer 709

Granulosa cell tumours

Question 710

Factors that will reduce the risk of ovarian cancer

Answer 710

Anything that decreases ovulations

Later onset of periods (menarche)
Early menopause
Any pregnancies
Use of the combined contraceptive pill

Question 711

Women under 40 years with a complex ovarian mass require tumour markers for a possible germ cell tumour. These are..

Answer 711

Lactate dehydrogenase (LDH)
Alpha-fetoprotein (α-FP)
Human chorionic gonadotropin (HCG)

Question 712

Mx for a simple ovarian cysts in premenopausal women that is <5cm

Answer 712

Always resolve within three cycles. They do not require a follow-up scan

Question 713

Mx for a simple ovarian cysts in premenopausal women that is 5cm-7cm

Answer 713

Routine referral to gynaecology and yearly ultrasound monitoring

Question 714

Mx for a simple ovarian cysts in premenopausal women that is >7cm

Answer 714

MRI scan or surgical evaluation as they can be difficult to characterise with ultrasound

Question 715

Ovarian fibroma (a type of benign ovarian tumour)
Pleural effusion
Ascites

Answer 715

Meig’s Syndrome

Question 716

A fibroid that is within the myometrium is called..

Answer 716

Intramural

Question 717

A fibroid that is below the outer layer of the uterus is called..

Answer 717

Subserosal

Question 718

A fibroid that is below the lining of the uterus is called..

Answer 718

Submucosal

Question 719

A fibroid that is on a stalk is called..

Answer 719

Pedunculated

Question 720

Ix for fibroids

Answer 720

Hysteroscopy if submucosal + heavy bleeding
Pelvic US if large
MRI scanning before surgery

Question 721

Surgical options for managing smaller fibroids with heavy menstrual bleeding are..

Answer 721

Endometrial ablation
Resection of submucosal fibroids during hysteroscopy
Hysterectomy

Question 722

Surgical options for larger fibroids are..

Answer 722

Uterine artery embolisation
Myomectomy
Hysterectomy

Question 723

Pregnant woman with a history of fibroids presenting with severe abdominal pain and a low-grade fever

Answer 723

Red Degeneration of Fibroids

Question 724

Risk factors of cervical cancer

Answer 724

Non-engagement with cervical screening

Early sexual activity
Increased number of sexual partners
Sexual partners who have had more partners
Not using condoms

Question 725

Which contraceptive can increase the risk of cervical cancer?

Answer 725

COCP (if more than five years)

Question 726

Outline the CIN grading system

Answer 726

CIN I: mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment

CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated

CIN III: severe dysplasia, very likely to progress to cancer if untreated

Question 727

FIGO staging for cervical cancer

Answer 727

Stage 1: Confined to the cervix
Stage 2: Invades the uterus or upper 2/3 of the vagina
Stage 3: Invades the pelvic wall or lower 1/3 of the vagina
Stage 4: Invades the bladder, rectum or beyond the pelvis

Question 728

Mx for cervical intraepithelial neoplasia and early-stage 1A

Answer 728

LLETZ or cone biopsy

Question 729

Mx for 1B - 2A cervical cancer

Answer 729

Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy

Question 730

Mx for 2B - 4A cervical cancer

Answer 730

Chemotherapy and radiotherapy

Question 731

Mx for 4B cervical cancer

Answer 731

Management may involve a combination of surgery, radiotherapy, chemotherapy and palliative care

Question 732

Risk factors for endometrial cancer

Answer 732

Unopposed oestrogen

Increased age
Earlier onset of menstruation
Late menopause
Oestrogen only hormone replacement therapy
No or fewer pregnancies
Obesity
Polycystic ovarian syndrome
Tamoxifen

Question 733

Protective factors against endometrial cancer

Answer 733

Combined contraceptive pill
Mirena coil
Increased pregnancies
Cigarette smoking

Question 734

FIGO staging for endometrial cancer

Answer 734

Stage 1: Confined to the uterus
Stage 2: Invades the cervix
Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes
Stage 4: Invades bladder, rectum or beyond the pelvis

Question 735

A Krukenberg tumour refers to a metastasis in the ovary, usually from a…

Answer 735

Gastrointestinal tract cancer (particularly the stomach)

Question 736

“Signet-ring” cells on histology

Answer 736

Krukenberg tumours

Question 737

Risk factors for ovarian cancer

Answer 737

Early-onset of periods
Late menopause
No pregnancies

Question 738

Protective factors for ovarian cancer

Answer 738

Combined contraceptive pill
Breastfeeding
Pregnancy

Question 739

Around 90% of vulval cancers are __________ carcinomas. Less commonly, they can be malignant __________

Answer 739

Around 90% of vulval cancers are squamous cell carcinomas. Less commonly, they can be malignant melanomas

Question 740

Uterosacral nodularity and tenderness

Answer 740

Endometriosis

Question 741

Three types of breech

Answer 741

Frank: longitudinal lie, hips flexed and knees extended
Complete: longitudinal lie, hips and knees flexed
Footling: foot or 2 feet first

Question 742

Mx for missed miscarriage

Answer 742

Mifepristone
Misoprostol 48 hours later

Question 743

Mx for incomplete miscarriage

Answer 743

Single dose of misoprostol

Question 744

47XXY

Answer 744

Klinefelter syndrome

Question 745

46XY

Answer 745

Androgen insensitivity syndrome

Question 746

45XO

Answer 746

Turner syndrome

Question 747

Rupture of membranes followed by painless vaginal bleeding and fetal bradycardia

Answer 747

Vasa praevia

Vasa Praevia -blood comes from foetus. Foetus is stressed with bradycardia, late decelerations etc
Placenta Praevia - blood mostly comes from mother. Foetus isn’t stressed

Question 748

Vulval carcinomas vs Vulval intraepithelial neoplasia

Answer 748

Vulval carcinoma: commonly ulcerated and can present on the labium majora

VIN: white or plaque like and don’t tend to ulcerate

Question 749

Ultrasound revealed a solid collection of echoes with numerous small anechoic spaces

Answer 749

Hydatidiform mole

Question 750

Which contraceptive has a reduced effectiveness if interacted with rifampicin-like abx/st johns worts?

Answer 750

COCP

Question 751

Which conditions cause a increase in AFP?

Answer 751

Neural tube defects (meningocele, myelomeningocele and anencephaly)
Abdominal wall defects (omphalocele and gastroschisis)
Multiple pregnancy

Question 752

Which conditions cause a decrease in AFP?

Answer 752

Down’s syndrome
Trisomy 18
Maternal diabetes mellitus

Question 753

Calculate weight loss percentage in someone that went from 75 to 68 kgs

Answer 753

75 - 68
7/75 x 100
9.3% weight loss

Question 754

Endometriosis vs adenomyosis regarding fertility and imaging findings

Answer 754

E: subfertility. either nothing or clumps of tissue on TVUS

A: had children before. Boggy uterus on TVUS

Question 755

Placental praevia vs vasa praevia

Answer 755

PP: Painless vaginal bleeding with a history of c-section. No foetal distress

VP: Bradycardia, rupture of membranes, painless vaginal bleeding triad. Foetal distress

Question 756

Rokitansky’s protuberance

Answer 756

Teratomas (dermoid cysts)

Question 757

When is axillary node clearance indicated?

Answer 757

If more than three lymph nodes affected

If less than 3 then no action

Question 758

Post-coital bleeding in premenopausal women + COCP

Answer 758

Cervical ectropion

Question 759

Post-coital bleeding, vaginal dryness or painful intercourse

Answer 759

Endometrial cancer

Question 760

Narrowing of the introitus
Diminished labial subcutaneous fat
Desiccated vaginal mucosa
Reduced tone of vaginal musculature

Answer 760

Atrophic vaginitis

Question 761

ALT/AST greater than that of ALP
Raised white cell count and potential clotting abnormalities

Answer 761

Acute fatty liver of pregnancy

Question 762

High ALP and GGT, with a lesser rise in ALT

Answer 762

Intrahepatic cholestasis of pregnancy

Question 763

The only time hormonal contraception can be used after ulipristal immediately instead of 5 days is..

Answer 763

After they meet ALL conditions:

A patient must already be established on the COCP
COCP must be restarted after a pill-free interval
Pills must be missed later than the first week of pill takin

Question 764

Enzyme inducing CYP450 drugs

Answer 764

CRAP GPs

Carbemazepines
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas

Question 765

CYP450 inhibitors

Answer 765

SICKFACES.COM

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol & Grapefruit juice
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole

Question 766

Contraceptives that are unaffected by EIDs

Answer 766

Copper intrauterine device
Progesterone injection (Depo-provera)
Mirena intrauterine system

Question 767

Who gets Fibroadenosis

Answer 767

Tends to present in older women described as painful and lumpy, often worse around menstruation

Question 768

Contraception for patients assigned female at birth and with a uterus

Answer 768

Progesterone only contraceptives
IUS/injections can suspend menstruation
Can use IUD but that exacerbated menstrual bleeding

Question 769

Contraception for patients assigned male at birth

Answer 769

Condoms

Can use oestradiol, GnRH, finasteride or cyproterone acetate as it may lower sperm count but unreliable

Question 770

Tx for endometritis

Answer 770

Refer to hospital for intravenous antibiotics (clindamycin and gentamicin until afebrile for greater than 24 hours)

Question 771

Cervical smears should be delayed until ____ months after birth, miscarriages and terminations

Answer 771

3 months

Question 772

Drugs avoided in pregnancy

Answer 772

LAMBAST+ 4C’s

Lithium
Aspirin
Methotrexate
Amiodarone
Sulphonylureas/sulphonamides
Tetracyclines

Chloramphenicol, cytotoxics, ciprofloxacine, carbimazole

Question 773

The main risks associated with lithium use during pregnancy include..

Answer 773

High likelihood of congenital abnormalities - Ebstein’s anomaly

Increased risk of miscarriage

Question 774

Lithium side effects

Answer 774

LITHIuM:

Leucocytosis
Insipidus
Tremor (fine)
Hypothyroid
Increased weight
Metallic taste

Question 775

Women of child bearing age should take __________ if commenced on lithium, which is generally avoided in pregnancy due to the high risk of development of __________ __________ in the first trimester

Answer 775

Women of child bearing age should take contraception if commenced on lithium, which is generally avoided in pregnancy due to the high risk of development of cardiac malformations in the first trimester

Question 776

Risk factors for ectopic

Answer 776

E- Endometreosis
C- Copper coil
T- Tube damage (PID, surgery)
O- Only progesterone pill
P- Previous ectopic
I- IVF
C- Chlamydia

Question 777

Which RA drugs can be used during pregnancy?

Answer 777

Sulfasalazine
Hydroxychloroquine
Low-dose corticosteroids
NSAIDs may be used until 32 weeks due to the risk of early close of the ductus arteriosus

Question 778

Sex cord stromal tumours (Thecomas, Fibromas, Sertoli cell and granulosa cell tumours) are associated with __________________

Sub-type Granulosa cell tumours are associated with the development of __________________

Answer 778

Sex cord stromal tumours (Thecomas, Fibromas, Sertoli cell and granulosa cell tumours) are associated with an increased production of hormones

Sub-type Granulosa cell tumours are associated with the development of endometrial hyperplasia

Question 779

Women with preterm-PROM with a triad of maternal pyrexia, maternal tachycardia, and fetal tachycardia

Answer 779

Chorioamnionitis

Question 780

Comedo necrosis

Answer 780

Ducal carcinoma in situ

Question 781

Calcification is seen in ductal/ lobular

Answer 781

Ductal carcinoma in situ

Question 782

Grey, gelatinous surface

Answer 782

Mucinous carcinomas

Question 783

Need for contraception after the menopause

Answer 783

12 months after the last period in women > 50 years
24 months after the last period in women < 50 years

Question 784

Normally, fundal height growth is ___ per week. After 24 weeks you would only expect the fundal height to increase by ___ a week

Answer 784

Normally, fundal height growth is 2cm per week. After 24 weeks you would only expect the fundal height to increase by 1cm a week

Question 785

Down’s syndrome: quadruple test result

Answer 785

“Hi is High up”
↓ AFP
↓ oestriol
↑ hCG
↑ inhibin A

Question 786

In patients with urinary incontinence, make sure to rule out a..

Answer 786

UTI and diabetes mellitus using urinalysis

Question 787

At which week does the uterus extend up to the umbilicus?

Answer 787

20 weeks gestation

Question 788

After what period of time would continued lochia warrant further investigation with ultrasound?

Answer 788

6 weeks

Question 789

______________ should be suspected in patients with continuous dribbling incontinence after prolonged labour and from an area with limited obstetric services

Answer 789

Vesicovaginal fistulae

Question 790

‘Beads-on-a-string’

Answer 790

Chronic salpingitis

Question 791

Hypoechoic masses

Answer 791

Fibroids

Question 792

Placenta accreta describes the attachment of the placenta to the myometrium, due to a defective..

Answer 792

Decidua basalis

Question 793

Cyst lined by ciliated cells (similar to Fallopian tube)

Answer 793

Serous cystadenoma

Question 794

Psammoma bodies seen (collection of calcium)

Answer 794

Serous cystadenocarcinoma

Question 795

Cyst lined by mucous-secreting epithelium (similar to endocervix)

Answer 795

Mucinous cystadenoma

Question 796

May be associated with pseudomyxoma peritonei (although mucinous tumour of appendix is the more common cause)

Answer 796

Mucinous cystadenocarcinoma

Question 797

Contain Walthard cell rests (benign cluster of epithelial cells), similar to transitional cell epithelium. Typically have ‘coffee bean’ nuclei

Answer 797

Brenner tumour

Question 798

Account for 90% of germ cell tumours. Contain a combination of ectodermal (e.g. hair), mesodermal (e.g. bone) and endodermal tissue

Answer 798

Teratoma

Question 799

Most common malignant germ cell tumour
Histological appearance similar to that of testicular seminoma
Associated with Turner’s syndrome
Typically secrete hCG and LDH

Answer 799

Dysgerminoma

Question 800

Typically secrete AFP
Schiller-Duval bodies on histology are pathognomonic

Answer 800

Yolk sac tumour

Question 801

Rare tumour that is part of the spectrum gestational trophoblastic disease
Typically have increased hCG levels
Often characterised by early haematogenous spread to the lungs

Answer 801

Choriocarcinoma

Question 802

Produces oestrogen leading to precocious puberty if in children or endometrial hyperplasia in adults
Contains Call-Exner bodies (small eosinophilic fluid-filled spaces between granulosa cells)

Answer 802

Granulosa cell tumour

Question 803

Produces androgens → masculinizing effects
Associated with Peutz-Jegher syndrome

Answer 803

Sertoli-Leydig cell tumour

Question 804

Associated with Meigs’ syndrome (ascites, pleural effusion)
Solid tumour consisting of bundles of spindle-shaped fibroblasts
Typically occur around the menopause, classically causing a pulling sensation in the pelvis

Answer 804

Fibroma

Question 805

Metastases from a gastrointestinal tumour resulting in a mucin-secreting signet-ring cell adenocarcinoma

Answer 805

Krukenberg tumour

Question 806

Causes of an increased nuchal translucency include

Answer 806

Down’s syndrome
Congenital heart defects
Abdominal wall defects

Question 807

Causes of hyperechogenic bowel

Answer 807

Cystic fibrosis
Down’s syndrome
Cytomegalovirus infection

Question 808

Smoking + mammary duct fistula+ discharging sinus

Answer 808

Periductal mastitis

Question 809

What is the most likely cause of delayed menarche in a girl that has developed secondary sexual characteristics?

Answer 809

Constitutional delay

Question 810

Cervical screening in pregnancy is usually delayed until ___ months post-partum unless missed screening or previous abnormal smears

Answer 810

3

Question 811

Cervical screening in HIV patients

Answer 811

Annual cervical cytology

Question 812

It is said that the best time to take a cervical smear is around..

Answer 812

Mid-cycle

Question 813

________ is co-infected with gonorrhoea

Answer 813

Chlamydia trachomatis

Question 814

Diffuse abdominal pain that later localises to the right iliac fossa

Pain reproduced in the right iliac fossa by palpation of the left iliac fossa (Rovsings sign)

Answer 814

Appendicitis

Question 815

Right iliac fossa pain but this would be mild, and not associated with nausea and vomiting.

Answer 815

Mittelschmerz

“Ovulation pain”

Question 816

Tx of nipple candidiasis whilst breastfeeding should involve __________ for the mother and __________ for the baby

Answer 816

Miconazole cream for the mother and nystatin suspension for the baby

Question 817

Breast pain/discomfort worse just before a feed. Infant may find it difficult to attach and suckle

Fever may be present but settles within 24 hours

Answer 817

Engorgement

Question 818

Nipple pain often intermittent and present during and immediately after feeding. Blanching of the nipple may be followed by cyanosis and/or erythema

Nipple pain resolves when nipples return to normal colour

Answer 818

Raynaud’s disease of the nipple

Question 819

Tx of Raynaud’s disease of the nipple

Answer 819

Minimise exposure to cold, use of heat packs following a breastfeed, avoiding caffeine and stopping smoking

If symptoms persist consider specialist referral for a trial of oral nifedipine (off-license)

Question 820

Often asymptomatic in women. If symptomatic, the patient may experience dyspareunia or dysuria. It may lead to pelvic inflammatory disorder and infertility.

Answer 820

Chlamydia trachomatis

Question 821

Which contraceptives are UKMEC2 for migraines with aura?

Answer 821

IUS
Progesterone only methods

Question 822

Which contraceptives are UKMEC1 for migraines with aura?

Answer 822

IUD

Question 823

Women who are between 16-32 weeks pregnant are offered which vaccines?

Answer 823

Pertussis and influenza

Question 824

Tx for primary attack of herpes occurs during pregnancy at greater than 28 weeks gestation

Answer 824

Elective C-section
PO aciclovir three times daily until delivery

Question 825

Women with recurrent herpes who are pregnant should be treated with…

Answer 825

Suppressive therapy and be advised that the risk of transmission to their baby is low

Question 826

HIV seroconversion occurs from..

Answer 826

3-12 weeks

Question 827

Blood should be tested for parvovirus B19 specific IgM and IgG

IgG positive & IgM negative - ?

IgG negative & IgM positive - ?

IgG negative & IgM negative - ?

Answer 827

IgG positive & IgM negative - shows immunity to parvovirus. Reassure, no further action

IgG negative & IgM positive - non-immune. Recent parvovirus infection in last 4 weeks. Refer immediately for further tests/fetal medicine

IgG negative & IgM negative - repeat test in 4 weeks. If both tests still negative, this confirms susceptibility, but no recent infection. Reassure, further action required only if subsequent exposure occurs

Question 828

Continuous CTG monitoring if any of the following are present or arise during labour..

Answer 828

Suspected chorioamnionitis or sepsis, or >38°C
>160/110 mmHg
Oxytocin
Significant meconium
Fresh vaginal bleeding that develops in labour

Question 829

If there is evidence of infection and haemodynamic instability in the context of a miscarriage, _________ would be an appropriate management. The patient’s infection should also be treated appropriately with IV antibiotics and fluids as needed

Answer 829

Surgical intervention with vacuum aspiration

Question 830

Amniocentesis: ______ weeks
CVS: ______ weeks

Answer 830

Amniocentesis: 16-20 weeks
CVS: 11-14 weeks

Question 831

Secondary PPH occurs between 24 hours - ___ weeks. It is typically due to _________ or _________

Answer 831

Secondary PPH occurs between 24 hours - 6 weeks. It is typically due to retained placental tissue or endometritis

Question 832

Hypo vs hyperthyroidism

Answer 832

Question 833

Which contraceptive to give if seeking control over menstrual bleeding schedules?

Answer 833

Combined oral contraceptive pill with a 7-day pill-free interval between every 3 packs

Question 834

Mx of placental abruption if <36 with fetal distress

Answer 834

Immediate caesarean

Question 835

Mx of placental abruption if <36 with no fetal distress

Answer 835

Observe closely, steroids, no tocolysis, threshold to deliver depends on gestation

Question 836

Mx of placental abruption if >36 with fetal distress

Answer 836

Immediate caesarean

Question 837

Mx of placental abruption if >36 with no fetal distress

Answer 837

Deliver vaginally

Question 838

Mx of placental abruption + fetus is dead (rip)

Answer 838

Induce vaginal delivery

Question 839

Factors that are associated with an increased risk of miscarriage

Answer 839

Increased maternal age
Smoking, drinking, drugs, caffeine
Obesity
Infections and food poisoning
Health conditions, e.g. thyroid problems, severe hypertension, uncontrolled diabetes
Ibuprofen, methotrexate and retinoids
Unusual shape or structure of womb
Cervical incompetence

Question 840

Women with asymptomatic bacterial vaginosis do not usually require treatment unless they are..

Answer 840

Undergoing termination of pregnancy

Question 841

Ix for galactocele

Answer 841

No imaging needed

Question 842

T or F: Gillick competence is used in medical law to decide whether a child is able to CONSENT to their own medical treatment, but a minor cannot REFUSE treatment that is deemed in their best interest

Answer 842

True

Question 843

High LH
Low testosterone

Answer 843

Primary hypogonadism (Klinefelter’s syndrome)

Question 844

Low LH
Low testosterone

Answer 844

Hypogonadotrophic hypogonadism (Kallman’s syndrome)

Question 845

High LH
Normal/high testosterone

Answer 845

Androgen insensitivity syndrome

Question 846

Low LH
High testosterone

Answer 846

Testosterone-secreting tumour

Question 847

Often taller than average
Lack of secondary sexual characteristics
Small, firm testes
Infertile
Gynaecomastia - increased incidence of breast cancer
elevated gonadotrophin levels

Answer 847

Klinefelter’s syndrome - 47 XXY

Question 848

Klinefelter’s diagnosis is by..

Answer 848

Chromosomal analysis

Question 849

Delayed puberty
Hypogonadism, cryptorchidism
Anosmia
Sex hormone levels are low
LH, FSH levels are inappropriately low/normal
Patients are typically of normal or above average height

Answer 849

Kallman’s syndrome

Question 850

Mode of inheritance in Kallman’s syndrome

Answer 850

X-linked recessive trait

Question 851

Mode of inheritance in Androgen insensitivity syndrome

Answer 851

X-linked recessive

Question 852

Androgen insensitivity syndrome is diagnosed by..

Answer 852

Buccal smear or chromosomal analysis to reveal 46XY genotype

Question 853

Worrying symptoms suggestive of an ectopic

Answer 853

If a woman has a positive pregnancy test and any of the following she should be referred immediately to an early pregnancy assessment service:

• pain and abdominal tenderness
• pelvic tenderness
• cervical motion tenderness

Question 854

Breast feeding is generally considered safe for mothers taking antiepilepticswith the possible exception of the..

Answer 854

Barbiturates

Question 855

It is advised that pregnant women taking phenytoin are given __________ in the last month of pregnancy to prevent clotting disorders in the newborn

Answer 855

Vitamin K

Question 856

Common long term complications of vaginal hysterectomy with antero-posterior repair include…

Answer 856

Enterocoele and vaginal vault prolapse

Urinary retention may occur acutely following hysterectomy

Question 857

T or F: NO radiotherapy for mastectomies!! Only WLE

Answer 857

True

Question 858

Classical grading of placenta praevia

Answer 858

I - placenta reaches lower segment but not the internal os
II - placenta reaches internal os but doesn’t cover it
III - placenta covers the internal os before dilation but not when dilated
IV (‘major’) - placenta completely covers the internal os

Question 859

Surgical management of ectopic pregnancy:

________ if haemodynamically unstable
________ if haemodynamically stable

Answer 859

Open if haemodynamically unstable
Laparoscopic if haemodynamically stable

Question 860

Do a ___________ in incontinence if unsure what’s wrong (bladder diary inconclusive)

Answer 860

Urodynamic study

Question 861

Risk of venous thromboembolism in HRT is increased by the addition of a..

Answer 861

Progestogen

Question 862

___________ HRT does not appear to increase the risk of VTE

Answer 862

Transdermal

Question 863

Women requesting HRT who are at high risk for VTE should be referred to ___________ before starting any treatment (even transdermal)

Answer 863

Haematology

Question 864

Levonorgestrel efficacy is greatest when taken within ___ hours, and no later than ___ hours, post-intercourse

Answer 864

Levonorgestrel efficacy is greatest when taken within 12 hours, and no later than 72 hours, post-intercourse

Question 865

__________ is an appropriate method of delivery for pregnant women at >= 37 weeks gestation with a single previous Caesarean delivery

Answer 865

Planned VBAC

Question 866

C.I for planned VBAC

Answer 866

Previous uterine rupture or classical caesarean scar

Question 867

Indications for c-section

Answer 867

Absolute cephalopelvic disproportion
Placenta praevia grades 3/4
Pre-eclampsia
Post-maturity
IUGR
Fetal distress in labour/prolapsed cord
Failure of labour to progress
Malpresentations: brow
Placental abruption: only if fetal distress; if dead deliver vaginally
Vaginal infection e.g. active herpes
Cervical cancer (disseminates cancer cells)

Question 868

C- section grades

Answer 868

1 - Immediate threat to the life of the mother or baby: suspected uterine rupture, major placental abruption, cord prolapse, fetal hypoxia or persistent fetal bradycardia. Delivery should occur within 30 minutes of making the decision

2 - Maternal or fetal compromise which is not immediately life-threatening, delivery of the baby should occur within 75 minutes of making the decision

3 - Delivery is required, but mother and baby are stable

4 - Elective caesarean

Question 869

Women _____ weeks with singleton pregnancy and no additional risk factors should avoid air travel

Answer 869

> 37

Question 870

Women with uncomplicated, multiple pregnancies should avoid travel by air once ____ weeks

Answer 870

> 32

Question 871

Risk of prematurity

Answer 871

Increased mortality depends on the gestation
Respiratory distress syndrome
Intraventricular haemorrhage
Necrotizing enterocolitis
Retinopathy of prematurity
Hearing problems
Chronic lung disease, hypothermia, feeding problems, infection, jaundice

Question 872

One of the contributing factors of visual impairment in babies born before 32 weeks gestation is thought to be…

Answer 872

Over oxygenation (e.g. during ventilation) resulting in a proliferation of retinal blood vessels (neovascularization)

Question 873

For babies who are born to mothers who are hepatitis B surface antigen positive, or are known to be high risk of hepatitis B, should receive the…

Answer 873

First dose of hepatitis B vaccine soon after birth

Question 874

Those born to mother’s who are surface antigen positive should also receive ________________ within 12 hours of birth. The baby should then further receive a second dose of hepatitis B vaccine at 1-2 months and at 6 months

Answer 874

0.5 millilitres of hepatitis B immunoglobulin

Question 875

___________ typically cause an irregularly shaped enlarged uterus because they form discrete masses

Answer 875

Uterine fibroids

Question 876

___________ leads to a more symmetrical enlargement of the uterus as there is diffuse thickening of the uterine wall

Answer 876

Adenomyosis

Question 877

Types of uterus:

Placental abruption
Adenomyosis
Fibroids

Answer 877

Placental abruption - woody (plank)
Adenomyosis (>30) - boggy (bAggy)
Fibroids - bulky (bulky fitness)

Question 878

Starting POP if switching from a combined oral contraceptive (COC) gives immediate protection if continued directly from the..

Answer 878

End of a pill packet (i.e. Day 21)

Question 879

_______________ methods of contraception are safe to use as contraception alongside sequential HRT (not the injection due to risk of osteoporosis)

Answer 879

Pill or implant progestogen-only

Question 880

__________ is the first-line treatment for overweight or obese women with polycystic ovarian syndrome (PCOS) who are struggling to conceive. If this fails - either because the woman is unable to lose weight or because she cannot conceive in spite of losing weight - then ___________ can be added as an adjunct

Answer 880

Weight loss
Metformin

Question 881

When to do pregnancy tests in miscarriage/TOP?

Answer 881

Miscarriage - multi-pregnancy test 3 weeks

TOP - multi-pregnancy test 2 weeks, Urinary pregnancy tests can be positive up to 4 weeks post-termination

Question 882

If sperm conc 10-15 million - recheck in ________
If sperm conc <5 million - recheck ________

Answer 882

If sperm conc 10-15 million - recheck in 3 months
If sperm conc <5 million - recheck immediately

Question 883

__________ insulin is not preferred in pregnancy as it may be associated with adverse birth outcomes. Equally, it may lead to maternal hypoglycaemia

Answer 883

Long-acting

Question 884

Anti-D prophylaxis should be given to women who are rhesus D negative and are having an abortion after____ weeks’ gestation

Answer 884

10+0

Question 885

The combination of a persistent lump spanning at least one menstrual cycle and the irregularity point to a diagnosis of….

Answer 885

Cancer

Question 886

Non-surgical management for fibroids causing abnormal bleeding and under 3cm in size with no uterine distortion.

Answer 886

NSAIDs, anti-fibrinolytics, combined hormonal contraception, and Levonorgestrel-releasing intrauterine system (Mirena)

Question 887

Surgical management for fibroids causing symptoms due to their mass effect

Answer 887

Myomectomy, ablation, uterine artery embolisation, and hysterectomy

Question 888

During a lower segment Caesarian section, the following lies in between the skin and the fetus:

Answer 888

Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus

Question 889

________ cancer increased risk with all HRT

Answer 889

Ovarian

Question 890

_____ slightly increased risk with oral oestrogen HRT

Answer 890

Stroke

Question 891

___________ combined HRT may be associated with a slight increase in risk

Answer 891

Coronary heart disease

Question 892

Examples of GnRH agonists are…

Answer 892

Goserelin and leuprorel

Question 893

Examples of GnRH antagonists are….

Answer 893

Cetrorelix, degarelix, and ganirelix

Question 894

Drug given if hypertensive + proteinuria during labour

Answer 894

Labetalol (<135/85)

Question 895

Tx for cystocele/cystourethrocele

Answer 895

Anterior colporrhaphy, colposuspension

Question 896

Tx for uterine prolapse

Answer 896

Hysterectomy

Question 897

Tx for rectocele

Answer 897

Posterior colporrhaphy

Question 898

The ____________ is the LARC of choice is young people

Answer 898

Progesterone-only implant (Nexplanon)

Question 899

___________ is often the site of origin of many ‘ovarian’ cancers

Answer 899

Distal end of the fallopian tube

Question 900

Stereotypical PCOS results

Answer 900

Raised LH:FSH ratio
Testosterone may be normal or mildly elevated
SHBG is normal to low

Question 901

Antibiotics which are cautioned or contra-indicated in breastfeeding

Answer 901

Ciprofloxacin (potential joint problems)
Nitrofurantoin (G6PD deficiency)
Teicoplanin
Clindamycin (antibiotic-associated colitis)
Co-trimoxazole

Question 902

The ectocervix is lined with _____________, correlating clinically with ~80% of cervical cancers

Answer 902

Stratified squamous non-keratinized epithelium

80% cervical cancers are stratified squamous non-keratinized epithelium

Question 903

Simple columnar epithelium may be found within the…

Answer 903

Cervical os

Question 904

Adenocarcinomas are derived from _________ epithelium

Answer 904

Columnar

Question 905

Histopathology of malignancy

Answer 905

Abnormal tissue architecture
Coarse chromatin
Invasion of basement membrane
Abnormal mitoses
Angiogenesis
De-differentiation
Areas of necrosis
Nuclear pleomorphism

Distinguish invasive malignancy from in situ disease

Question 906

__________ has teratogenic properties and may cause hand, nose, and eye defects and growth retardation

Answer 906

Warfarin

Question 907

_________ get deposited in the teeth and bones and therefore may cause discolouration of the teeth and bone defects

Answer 907

Tetracyclines

Question 908

The ______________ is located in the paramedian area of the midbrain and pons

Answer 908

Medial longitudinal fasciculus

Question 909

_________ infections are a cause of neonatal cataracts

Answer 909

TORCH

Toxoplasmosis, others (syphilis, hepatitis B), rubella, cytomegalovirus, herpes simplex

Question 910

Hypergonadotropic hypogonadism

Answer 910

Turner’s syndrome

Question 911

C section wound infection

Answer 911

Tenderness upon palpation of the affected area

Question 912

MOA of Raloxifene

Answer 912

Complete antagonism of the oestrogen receptor

Question 913

MOA of Tamoxifen

Answer 913

Partial antagonism of the oestrogen receptor

Question 914

MOA of Anastrazole

Answer 914

Reducing peripheral synthesis of oestrogen

Question 915

When are antibiotics indicated in mastitis?

Answer 915

Systemically unwell
Nipple fissure present
Symptoms do not improve after 12-24 hours of effective milk removal
Culture indicates infection

Question 916

What is the least common type of prolapse?

Answer 916

Urethrocele/Enterocele - herniation of the pouch of Douglas, including small intestine, into the vagina

Question 917

Risk factors for Urogenital prolapse

Answer 917

Increasing age
Multiparity, vaginal deliveries
Obesity
Spina bifida

Question 918

sensation of pressure, heaviness, ‘bearing-down’
urinary symptoms: incontinence, frequency, urgency

Answer 918

Urogenital prolapse

Question 919

Glisson’s Capsule

Answer 919

Fitz-Hugh-Curtis syndrome - Hepatic adhesions

Question 920

What is type 1 FGM?

Answer 920

Partial or total removal of the clitoris and/or the prepuce (clitoridectomy)

Question 921

What is type 2 FGM?

Answer 921

Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision)

Question 922

What is type 3 FGM?

Answer 922

Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation)

Question 923

What is type 4 FGM?

Answer 923

All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterisation

Question 924

Types of tocolytics

Answer 924

Betamimetics (such as terbutaline)
Magnesium sulfate
Prostaglandin inhibitors (like indomethacin, ketorolac)
Calcium channel blockers (such as nifedipine)
Nitrates (like nitroglycerine)
Oxytocin receptor blockers (such as atosiban)

Question 925

High pressure exerted by a vacuum during a ventouse delivery can cause bleeding in the neonate

_____________ or more severely, __________ haemorrhage, can be exacerbated in the context of neonatal thrombocytopenia

Answer 925

Cephalohaematoma
Subgaleal haemorrhage

Question 926

Gestational thrombocytopenia may be considered more likely if the platelet count continues to fall as pregnancy progresses, but this is not a reliable sign

If the patient becomes dangerously thrombocytopenic, she will usually be treated with __________ and a diagnosis of ____ assumed. Pregnant women found to have low platelets during a booking visit or those with a previous diagnosis of ITP may need to be tested for ______________ for confirmation

Answer 926

Steroids
ITP
Serum antiplatelet antibodies

Question 927

Tx for cervical cancer if confined to uterus <3mm deep

Answer 927

1A1:
Not aiming fertility/gold standard: hysterectomy +/- lymph node clearance
Aiming fertility: Cone biopsy

Question 928

Tx for cervical cancer if confined to uterus 3-5 mm deep

Answer 928

1A2:
Nodal clearance +/- Radical trachelectomy

Question 929

Tx for cervical cancer if confined to uterus larger than 7 mm wide and <4cm diameter

Answer 929

1B1:
Radiotherapy + chemotherapy (Cisplatin)

Question 930

Tx for cervical cancer if confined to uterus larger than 7 mm wide and >4cm diameter

Answer 930

1B2:
Radical hysterectomy with pelvic lymph node dissection

Question 931

Tx for cervical cancer if extension of tumour beyond cervix but not to the pelvic wall

Answer 931

II
Radiotherapy + chemotherapy (Cisplatin)
If hydronephrosis - nephrostomy

Question 932

Tx for cervical cancer if extension of tumourbeyond the cervix and to the pelvic wall

Answer 932

III
Radiotherapy + chemotherapy (Cisplatin)
If hydronephrosis - nephrostomy

Question 933

Tx for cervical cancer if extension of tumour beyond the pelvis with involvement of bladder or rectum

Answer 933

IVA
Radiotherapy + chemotherapy (Cisplatin)

Question 934

Tx for cervical cancer if extension of tumour beyond the pelvis with involvement of distant sites outside the pelvis

Answer 934

IVB
Palliative chemotherapy

Question 935

Mx of recurrent cervical cancer

Answer 935

Primary surgical treatment: offer chemoradiation or radiotherapy
Primary radiation treatment: offer surgical therapy

Question 936

Complications of cone biopsies and radical trachelectomy

Answer 936

Preterm birth in future pregnancies

Question 937

Complications of radical hysterectomy

Answer 937

Ureteral fistula

Question 938

Short term complications of radiotherapy

Answer 938

Diarrhoea, vaginal bleeding, radiation burns, pain on micturition, tiredness/weakness

Question 939

Long term complications of radiotherapy

Answer 939

Ovarian failure, fibrosis of bowel/skin/bladder/vagina, lymphoedema

Question 940

Breast lump imaging in <35 years old

Answer 940

US

Question 941

Breast lump imaging in >35 years old

Answer 941

Mammogram

Question 942

High/moderate risk factors for pre-eclampsia

Answer 942

Question 943

CTG findings

Answer 943

Question 944

Contractions felt in the lower abdomen. The contractions are irregular and occur every 20 minutes. Progressive cervical changes are absent

Answer 944

False Labor

Question 945

Stages of labour

Answer 945

Stage 1: from the onset of true labour to when the cervix is fully dilated
latent phase = 0-3 cm dilation, normally takes 6 hours
active phase = 3-10 cm dilation, normally 1cm/hr

Stage 2: from full dilation to delivery of the fetus
Stage 3: from delivery of fetus to when the placenta and membranes have been completely delivered

Question 946

What type of HRT is used if menstruated less than a year ago?

Answer 946

Cyclical combined HRT

Question 947

What type of HRT is used if menstruated more than a year ago?

Answer 947

Continuous combined HRT

Question 948

Early referral for infertility should be considered when..

Answer 948

Question 949

Women with breast cancer and no palpable axillary lymphadenopathy at presentation should have..

Answer 949

Pre-operative axillary ultrasound before their primary surgery

If a pre-operative axillary ultrasound is negative then they should have a sentinel node biopsy to assess the nodal burden

Question 950

__________ is a risk factor for the development of mastitis

Answer 950

Smoking

Question 951

Mx for a potential ectopic pregnancy and is >6 weeks

Answer 951

TVUS

Question 952

Fundal height growth of 2cm per week. After _______weeks you would only expect the fundal height to increase by 1cm a week.

Answer 952

24

Question 953

IUD insertion is contraindicated in active _________________ and active _________________

Answer 953

IUD insertion is contraindicated in active pelvic inflammatory disease and active sexually transmitted infections

Question 954

Shoulder dystocia secondary to a macrosomic child = _________’s palsy

Answer 954

Erb’s palsy

Shoulder dystocia - posterior dislocation so internally rotated and addu