Obstetrics and gynaecology Flashcards

Question

Complications of puperal mastitis

Answer 1

candidiasis of the nipple can occur

Answer 2

* benign tumours that consist of a mixture of fibrous and epithelial tissue. * They originate from the lobules, the milk-producing glands in the breast.

Answer 3

* highest incidence occurring in the early 20s * seen in puberty, pregnancy, and perimenopause.

Answer 4

* A firm, non-tender breast mass * smooth edges * highly mobile upon palpation, often referred to as having a "rubbery" consistency * The mass typically does not grow beyond 3cm in diameter

Answer 5

* reassure * Clinical examination * ultrasound and/or mammogram * Needle biopsy (fine needle aspiration or core biopsy)

Answer 6

* reassurance * surgical excision

Answer 7

* Encouraging the use of a soft but well-fitting bra for comfort. * Providing appropriate analgesia for pain relief. * Most cases resolve after menopause, and reassurance can be provided about this natural course.

Answer 8

The introduction of HPV testing and the move to an HPV first system ## Footnote The HPV first system tests for high-risk strains of human papillomavirus (hrHPV) before cytological examination.

Answer 9

Further risk stratification ## Footnote HPV is a strong risk factor, allowing HPV-negative patients to be treated as having normal results.

Answer 10

Return to normal recall, unless in the test of cure (TOC) pathway ## Footnote Individuals treated for CIN1, CIN2, or CIN3 should be invited for a TOC at 6 months.

Answer 11

Follow-up for incompletely excised CGIN/SMILE or cervical cancer ## Footnote This includes monitoring for borderline changes in endocerical cells.

Answer 12

Samples are examined cytologically ## Footnote If cytology is abnormal, a colposcopy is performed.

Answer 13

Abnormal cytology results such as: * Borderline changes in squamous or endocerical cells * Low-grade dyskaryosis * High-grade dyskaryosis (moderate) * High-grade dyskaryosis (severe) * Invasive squamous cell carcinoma * Glandular neoplasia

Answer 14

Repeat the test at 12 months ## Footnote If the repeat test is hrHPV negative, return to normal recall.

Answer 15

Colposcopy ## Footnote If hrHPV is negative at 24 months, return to normal recall.

Answer 16

Repeat the sample in 3 months ## Footnote If two consecutive samples are inadequate, then a colposcopy is performed.

Answer 17

Large loop excision of transformation zone (LLETZ) ## Footnote LLETZ may be performed during the initial colposcopy visit or at a later date.

Answer 18

Cryotherapy ## Footnote Cryotherapy is less common compared to LLETZ.

Answer 19

This is when fetal cells/amniotic fluid enters the mother's bloodstream and stimulates a reaction which results in symptoms.

Answer 20

Rare complication of pregnancy associated with a high mortality rate.

Answer 21

Maternal age and induction of labour.

Answer 22

Maternal circulation must be exposed to fetal cells/amniotic fluid.

Answer 23

During labour, caesarean section, or immediate postpartum.

Answer 24

* Chills * Shivering * Sweating * Anxiety * Coughing

Answer 25

* Cyanosis * Hypotension * Bronchospasms * Tachycardia * Arrhythmia * Myocardial infarction

Answer 26

Clinical diagnosis of exclusion, as there are no definitive diagnostic tests.

Answer 27

Critical care unit by a multidisciplinary team; management is predominantly supportive.

Answer 28

Painless vaginal bleeding occurring before 24 weeks, typically at 6-9 weeks, often less than menstruation, with a closed cervical os ## Footnote Complicates up to 25% of all pregnancies.

Answer 29

A gestational sac containing a dead fetus before 20 weeks without expulsion symptoms; may have light vaginal bleeding/discharge and disappearing pregnancy symptoms, with a closed cervical os ## Footnote When the gestational sac is > 25 mm and no embryonic/fetal part can be seen, it's termed a 'blighted ovum' or 'anembryonic pregnancy'.

Answer 30

Heavy bleeding with clots and pain, with an open cervical os

Answer 31

Not all products of conception have been expelled, accompanied by pain and vaginal bleeding, with an open cervical os

Answer 32

Miscarriage, or spontaneous abortion, is a prevalent outcome of pregnancy.

Answer 33

Approximately 10-20%.

Answer 34

In the first trimester, with around 80% occurring before 12 weeks gestation.

Answer 35

Chromosomal abnormalities.

Answer 36

* Advanced maternal age * A history of previous miscarriages * Previous large cervical cone biopsy

Answer 37

Women over 35 have a significantly higher risk.

Answer 38

* Smoking * Alcohol consumption * Obesity

Answer 39

* Uncontrolled diabetes * Thyroid disorders

Answer 40

Three or more consecutive losses.

Answer 41

Expectant management, medical management, surgical management ## Footnote These management types are recommended based on individual circumstances and medical history.

Answer 42

Waiting for a spontaneous miscarriage ## Footnote It involves waiting for 7-14 days for the miscarriage to complete spontaneously.

Answer 43

Medical or surgical management may be offered ## Footnote This is contingent on the circumstances of the miscarriage.

Answer 44

* Increased risk of haemorrhage * Late first trimester * Coagulopathies or unable to have a blood transfusion * Previous adverse and/or traumatic experience associated with pregnancy * Evidence of infection ## Footnote These factors increase the risk and necessitate alternative management approaches.

Answer 45

Weakening of attachment to the endometrial wall, cervical softening and dilation, induction of uterine contractions ## Footnote Mifepristone is a progesterone receptor antagonist used in the management of missed miscarriage.

Answer 46

Induces strong myometrial contractions leading to expulsion of products of conception ## Footnote It is administered 48 hours after mifepristone unless the gestational sac has already been passed.

Answer 47

Contact their healthcare professional ## Footnote Monitoring is crucial to ensure the effectiveness of the treatment.

Answer 48

A single dose of misoprostol (vaginal, oral or sublingual) ## Footnote Women should also be offered antiemetics and pain relief.

Answer 49

To confirm the completion of the miscarriage ## Footnote This is an important follow-up step in the management process.

Answer 50

* Vacuum aspiration (suction curettage) * Surgical management in theatre ## Footnote These procedures can be performed under local or general anaesthetic.

Answer 51

Under local anaesthetic as an outpatient ## Footnote This allows for less invasive management compared to surgical procedures requiring general anaesthesia.

Answer 52

Evacuation of retained products of conception ## Footnote This terminology reflects the procedure's purpose in managing miscarriage.

Answer 53

Recurrent miscarriage is defined as 3 or more consecutive spontaneous abortions. ## Footnote It occurs in around 1% of women.

Answer 54

* Antiphospholipid syndrome * Endocrine disorders * Uterine abnormality * Parental chromosomal abnormalities * Smoking ## Footnote Endocrine disorders may include poorly controlled diabetes mellitus and thyroid disorders, as well as polycystic ovarian syndrome.

Answer 55

False ## Footnote It occurs in around 1% of women.

Answer 56

* Poorly controlled diabetes mellitus * Thyroid disorders * Polycystic ovarian syndrome ## Footnote These disorders can impact hormonal balance and overall reproductive health.

Answer 57

Uterine septum ## Footnote A uterine septum can interfere with implantation and pregnancy maintenance.

Answer 58

[chromosomal]

Answer 59

Smoking ## Footnote Smoking is known to negatively affect reproductive health and can increase miscarriage risk.

Answer 60

The caudal end of the fetus occupies the lower segment.

Answer 61

External cephalic version (ECV), which has a success rate of around 60%.

Answer 62

It carries a reduced perinatal mortality and early neonatal morbidity for babies with a breech presentation at term compared with planned vaginal birth.

Answer 63

No evidence suggests it does.

Answer 64

* Where caesarean delivery is required * Antepartum haemorrhage within the last 7 days * Abnormal cardiotocography * Major uterine anomaly * Ruptured membranes * Multiple pregnancy

Answer 65

The caudal end of the fetus occupies the lower segment.

Answer 66

Around 25%.

Answer 67

The most common presentation with the hips flexed and knees fully extended.

Answer 68

A presentation where one or both feet come first with the bottom at a higher position.

Answer 69

Higher perinatal morbidity.

Answer 70

* Uterine malformations * Fibroids * Placenta praevia * Polyhydramnios or oligohydramnios * Fetal abnormality (e.g. CNS malformation, chromosomal disorders) * Prematurity

Answer 71

Cord prolapse.

Answer 72

Many fetuses will turn spontaneously.

Answer 73

From 37 weeks.

Answer 74

It carries a reduced perinatal mortality and early neonatal morbidity for babies with a breech presentation at term compared with planned vaginal birth.

Answer 75

No evidence suggests it does.

Answer 76

Increased fear of litigation ## Footnote This reflects a broader trend in medical practice where legal concerns influence clinical decisions.

Answer 77

* Lower segment caesarean section * Classic caesarean section

Answer 78

Longitudinal incision in the upper segment of the uterus

Answer 79

* Absolute cephalopelvic disproportion * Placenta praevia grades 3/4 * Pre-eclampsia

Answer 80

Category 1

Answer 81

Within 30 minutes

Answer 82

Maternal or fetal compromise which is not immediately life-threatening

Answer 83

Within 75 minutes

Answer 84

* Emergency hysterectomy * Need for further surgery * Admission to intensive care unit * Thromboembolic disease * Bladder injury * Ureteric injury * Death (1 in 12,000)

Answer 85

* Lacerations (1-2 babies in every 100)

Answer 86

* Increased risk of uterine rupture during subsequent pregnancies/deliveries * Increased risk of antepartum stillbirth * Increased risk of placenta praevia and placenta accreta

Answer 87

* Previous uterine rupture * Classical caesarean scar

Answer 88

[Subfertility due to postoperative adhesions]

Answer 89

* Haemorrhage * Infection (wound, endometritis, UTI)

Answer 90

* Emergency hysterectomy * Need for further surgery at a later date, including curettage (retained placental tissue) * Admission to intensive care unit * Thromboembolic disease * Bladder injury * Ureteric injury * Death (1 in 12,000) ## Footnote These complications highlight the risks associated with hysterectomy procedures.

Answer 91

* Increased risk of uterine rupture during subsequent pregnancies/deliveries * Increased risk of antepartum stillbirth * Increased risk in subsequent pregnancies of placenta praevia and placenta accreta ## Footnote These risks are significant considerations for women who have had a hysterectomy and plan to conceive again.

Answer 92

* Persistent wound and abdominal discomfort in the first few months after surgery * Increased risk of repeat caesarean section when vaginal delivery attempted in subsequent pregnancies * Readmission to hospital * Haemorrhage * Infection (wound, endometritis, UTI) ## Footnote These complications can affect recovery and future delivery options.

Answer 93

* Lacerations, one to two babies in every 100 ## Footnote These fetal risks underscore the importance of careful surgical management during pregnancy.

Answer 94

A potentially life-threatening condition affecting both mother and fetus, considered a medical emergency

Answer 95

Cesarean section if necessary

Answer 96

An ascending bacterial infection of the amniotic fluid, membranes, or placenta

Answer 97

Preterm premature rupture of membranes

Answer 98

Prompt delivery of the fetus and administration of intravenous antibiotics

Answer 99

An incision in the posterior wall of the vagina and perineum performed in the second stage of labour to facilitate the passage of the fetus.

Answer 100

Second stage of labour.

Answer 101

Posterior wall of the vagina and perineum.

Answer 102

Fetal distress in the second stage of labour ## Footnote Fetal distress refers to abnormal fetal heart rate patterns that may indicate a compromised fetus.

Answer 103

Maternal distress in the second stage of labour ## Footnote Maternal distress may involve significant pain or fatigue affecting the mother's ability to continue labor.

Answer 104

Failure to progress in the second stage of labour ## Footnote This situation occurs when the labor does not advance as expected, potentially risking the health of both mother and baby.

Answer 105

Superficial damage with no muscle involvement. ## Footnote First degree tears do not require any repair.

Answer 106

Injury to the perineal muscle, but not involving the anal sphincter. Requires suturing on the ward by a suitably experienced midwife or clinician. ## Footnote Second degree tears are more significant than first degree but less severe than third degree.

Answer 107

* 3a: less than 50% of EAS thickness torn * 3b: more than 50% of EAS thickness torn * 3c: IAS torn ## Footnote Third degree tears require repair in theatre by a suitably trained clinician.

Answer 108

Injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa. Requires repair in theatre by a suitably trained clinician. ## Footnote Fourth degree tears are the most severe type of perineal tear.

Answer 109

Primigravida ## Footnote Other risk factors include large babies, precipitant labour, shoulder dystocia, and forceps delivery.

Answer 110

False ## Footnote First degree tears do not require any repair.

Answer 111

* Large babies * Precipitant labour * Shoulder dystocia ## Footnote Forceps delivery is also a risk factor.

Answer 112

A temperature of > 38ºC in the first 14 days following delivery ## Footnote Puerperal pyrexia is a clinical sign often used to identify potential infections post-delivery.

Answer 113

Endometritis ## Footnote Endometritis is an infection of the endometrium and is frequently encountered in postpartum patients.

Answer 114

* Urinary tract infection * Wound infections (perineal tears + caesarean section) * Mastitis ## Footnote These conditions can lead to fever in the postpartum period and should be considered in differential diagnosis.

Answer 115

Venous thromboembolism ## Footnote Venous thromboembolism can occur in the postpartum period and may present with fever.

Answer 116

Refer the patient to hospital for intravenous antibiotics ## Footnote The recommended antibiotics include clindamycin and gentamicin until the patient is afebrile for greater than 24 hours.

Answer 117

[intravenous antibiotics] ## Footnote Intravenous antibiotics are crucial for managing suspected endometritis effectively.

Answer 118

* Clindamycin * Gentamicin ## Footnote These antibiotics are typically administered until the patient has been afebrile for over 24 hours.

Answer 119

A complication of vaginal cephalic delivery characterized by the inability to deliver the body of the fetus after the head has been delivered ## Footnote Shoulder dystocia occurs due to the impaction of the anterior fetal shoulder on the maternal pubic symphysis.

Answer 120

* Fetal macrosomia * High maternal body mass index * Diabetes mellitus * Prolonged labour ## Footnote Fetal macrosomia is often associated with maternal diabetes mellitus.

Answer 121

Senior help should be called ## Footnote It is crucial to have experienced personnel involved in the management of shoulder dystocia.

Answer 122

Flexion and abduction of the maternal hips, bringing the mother's thighs towards her abdomen ## Footnote This manoeuvre increases the relative anterior-posterior angle of the pelvis and often facilitates a successful delivery.

Answer 123

False ## Footnote An episiotomy does not relieve the bony obstruction but may be used to allow better access for internal manoeuvres.

Answer 124

McRoberts' manoeuvre ## Footnote Symphysiotomy and the Zavanelli manoeuvre can cause significant maternal morbidity and are not first-line options.

Answer 125

No ## Footnote Oxytocin administration is not indicated in shoulder dystocia.

Answer 126

* Postpartum haemorrhage * Perineal tears ## Footnote These complications can arise during or after the delivery process.

Answer 127

* Brachial plexus injury * Neonatal death ## Footnote These complications can have serious long-term effects on the neonate.

Answer 128

A complication of vaginal cephalic delivery characterized by the inability to deliver the body of the fetus after the head has been delivered ## Footnote Shoulder dystocia occurs due to the impaction of the anterior fetal shoulder on the maternal pubic symphysis.

Answer 129

* Fetal macrosomia * High maternal body mass index * Diabetes mellitus * Prolonged labour ## Footnote Fetal macrosomia is often associated with maternal diabetes mellitus.

Answer 130

Senior help should be called ## Footnote It is crucial to have experienced personnel involved in the management of shoulder dystocia.

Answer 131

Flexion and abduction of the maternal hips, bringing the mother's thighs towards her abdomen ## Footnote This manoeuvre increases the relative anterior-posterior angle of the pelvis and often facilitates a successful delivery.

Answer 132

The long axis of the foetus relative to the longitudinal axis of the uterus

Answer 133

* Longitudinal lie (99.7% of foetuses at term) * Transverse lie (<0.3% of foetuses at term) * Oblique (<0.1% of foetuses at term)

Answer 134

Longitudinal lie

Answer 135

One in 300 foetuses

Answer 136

The foetal longitudinal axis lies perpendicular to the long axis of the uterus

Answer 137

On the lateral side of the pelvis

Answer 138

* Scapulo-anterior (most common) * Scapulo-posterior

Answer 139

Previous pregnancies

Answer 140

* Fibroids and other pelvic tumours * Pregnant with twins or triplets * Prematurity * Polyhydramnios * Foetal abnormalities

Answer 141

* Routine antenatal appointments * Abdominal examination * Ultrasound scan

Answer 142

The head and buttocks are not palpable at each end of the uterus

Answer 143

* Pre-term rupture membranes (PROM) * Cord-prolapse (20%) * Compound presentation during vaginal delivery (extremely rare)

Answer 144

No management required; most foetuses will spontaneously move to longitudinal lie

Answer 145

Appointment with the obstetric medical antenatal team to discuss management options

Answer 146

External cephalic version

Answer 147

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

Answer 148

Around 50%

Answer 149

* Patient opts for caesarian section * ECV has been unsuccessful or is contraindicated

Answer 150

* Perceived risks to the mother and foetus * Preference of the patient * Patient's previous pregnancies and co-morbidities * Patient's ability to access obstetric care rapidly

Answer 151

Using a small cup connected to a suction device attached to the baby's head to help pull the baby out ## Footnote Ventouse delivery involves applying careful traction to assist in the delivery process.

Answer 152

One-fifth or less ## Footnote This indicates that the fetal head is not overly engaged in the pelvis.

Answer 153

The cervix must be fully dilated ## Footnote Full dilation is necessary to ensure safe delivery.

Answer 154

* < 34 weeks gestation * Cephalopelvic disproportion * Breech, face or brow presentation ## Footnote These factors can complicate the delivery process and pose risks to the baby or mother.

Answer 155

* Cephalhaematoma * Retinal haemorrhages ## Footnote These complications can arise from the suction and traction applied during the procedure.

Answer 156

A single dose of IV co-amoxiclav ## Footnote This antibiotic helps reduce the risk of infection after the procedure.

Answer 157

False ## Footnote An episiotomy is not always necessary and depends on the specific circumstances of the delivery.

Answer 158

A condition characterized by an imbalance of bacteria in the vagina ## Footnote Commonly associated with thin, white discharge and a vaginal pH greater than 4.5.

Answer 159

A sexually transmitted infection caused by the protozoan parasite Trichomonas vaginalis ## Footnote Symptoms include frothy, yellow-green discharge and a 'strawberry cervix'.

Answer 160

Thin, white discharge ## Footnote Often has a fishy odor, especially after intercourse.

Answer 161

Clue cells ## Footnote These are vaginal epithelial cells that appear stippled due to the presence of bacteria.

Answer 162

Greater than 4.5 ## Footnote Normal vaginal pH is typically between 3.8 and 4.5.

Answer 163

Metronidazole ## Footnote This antibiotic is effective in restoring the normal vaginal flora.

Answer 164

Frothy, yellow-green discharge ## Footnote This discharge may also have a foul odor.

Answer 165

Strawberry cervix ## Footnote This refers to the appearance of the cervix due to inflammation.

Answer 166

Motile trophozoites ## Footnote These are the active form of the parasite that can be seen under a microscope.

Answer 167

Inflammation of the vulva and vagina ## Footnote It can have various causes including infections, irritants, and allergies.

Answer 168

A highly motile, flagellated protozoan parasite ## Footnote It is the causative agent of trichomoniasis, a sexually transmitted infection.

Answer 169

Offensive, yellow/green, frothy ## Footnote This type of discharge is a common symptom of the infection.

Answer 170

Strawberry cervix ## Footnote This refers to the appearance of the cervix, which may be red and inflamed.

Answer 171

pH > 4.5 ## Footnote This indicates an alkaline environment, which is associated with the infection.

Answer 172

Usually asymptomatic but may cause urethritis ## Footnote Many men do not show symptoms, making it harder to diagnose.

Answer 173

Microscopy of a wet mount shows motile trophozoites ## Footnote This is a key diagnostic feature observed under the microscope.

Answer 174

Oral metronidazole for 5-7 days ## Footnote A single dose of 2g metronidazole is also supported by the BNF.

Answer 175

Atrophic vaginitis ## Footnote Atrophic vaginitis is characterized by changes in the vaginal tissue due to decreased estrogen levels.

Answer 176

Vaginal dryness, dyspareunia, occasional spotting ## Footnote Dyspareunia refers to painful intercourse.

Answer 177

Pale and dry ## Footnote These changes are due to the thinning of the vaginal lining.

Answer 178

Vaginal lubricants and moisturisers ## Footnote These products help alleviate symptoms by adding moisture to the vaginal area.

Answer 179

Topical oestrogen cream ## Footnote This treatment helps to restore vaginal tissue health by increasing estrogen levels locally.

Answer 180

Atrophic vaginitis ## Footnote Atrophic vaginitis is characterized by changes in the vaginal tissue due to decreased estrogen levels.

Answer 181

Vaginal dryness, dyspareunia, occasional spotting ## Footnote Dyspareunia refers to painful intercourse.

Answer 182

Pale and dry ## Footnote These changes are due to the thinning of the vaginal lining.

Answer 183

Vaginal lubricants and moisturisers ## Footnote These products help alleviate symptoms by adding moisture to the vaginal area.

Answer 184

Topical oestrogen cream ## Footnote This treatment helps to restore vaginal tissue health by increasing estrogen levels locally.

Answer 185

1 in 10 women will seek help at some point

Answer 186

Irritant contact dermatitis (e.g. latex condoms, lubricants)

Answer 187

* Atopic dermatitis * Seborrhoeic dermatitis * Lichen planus * Lichen sclerosus * Psoriasis

Answer 188

Around a third of patients with psoriasis

Answer 189

Take showers rather than taking baths

Answer 190

An emollient such as Epaderm or Diprobase

Answer 191

Clean only once a day

Answer 192

Topical steroids

Answer 193

Combined steroid-antifungal

Answer 194

An autoimmune disorder affecting the gastric mucosa that results in vitamin B12 deficiency ## Footnote 'Pernicious' means causing harm, especially in a gradual or subtle way.

Answer 195

Pernicious anaemia, atrophic gastritis, gastrectomy, malnutrition ## Footnote Malnutrition can include conditions such as alcoholism.

Answer 196

Antibodies to intrinsic factor and gastric parietal cells ## Footnote Intrinsic factor antibodies block the vitamin B12 binding site.

Answer 197

Reduced vitamin B12 absorption ## Footnote This occurs due to the presence of gastric parietal cell antibodies leading to atrophic gastritis.

Answer 198

Megaloblastic anaemia and neuropathy ## Footnote Vitamin B12 is crucial for blood cell production and myelination of nerves.

Answer 199

1.6:1 (female to male) ## Footnote More common in females, typically develops in middle to old age.

Answer 200

Thyroid disease, type 1 diabetes mellitus, Addison's disease, rheumatoid arthritis, vitiligo ## Footnote These associations highlight the autoimmune nature of pernicious anaemia.

Answer 201

Blood group A ## Footnote This suggests a potential genetic predisposition.

Answer 202

Lethargy, pallor, dyspnoea ## Footnote These are common symptoms of anaemia.

Answer 203

Peripheral neuropathy ## Footnote Typically symmetrical and affects the legs more than the arms.

Answer 204

Progressive weakness, ataxia, paresthesias, which may progress to spasticity and paraplegia ## Footnote This condition is linked to vitamin B12 deficiency.

Answer 205

Memory loss, poor concentration, confusion, depression, irritability ## Footnote These symptoms can significantly affect quality of life.

Answer 206

A sore tongue ## Footnote This can be a symptom of pernicious anaemia.

Answer 207

'Lemon tinge' ## Footnote This describes a specific coloration seen in some patients.

Answer 208

An autoimmune disorder affecting the gastric mucosa that results in vitamin B12 deficiency ## Footnote 'Pernicious' means causing harm, especially in a gradual or subtle way.

Answer 209

Pernicious anaemia, atrophic gastritis, gastrectomy, malnutrition ## Footnote Malnutrition can include conditions such as alcoholism.

Answer 210

Antibodies to intrinsic factor and gastric parietal cells ## Footnote Intrinsic factor antibodies block the vitamin B12 binding site.

Answer 211

Reduced vitamin B12 absorption ## Footnote This occurs due to the presence of gastric parietal cell antibodies leading to atrophic gastritis.

Answer 212

Megaloblastic anaemia and neuropathy ## Footnote Vitamin B12 is crucial for blood cell production and myelination of nerves.

Answer 213

1.6:1 (female to male) ## Footnote More common in females, typically develops in middle to old age.

Answer 214

Thyroid disease, type 1 diabetes mellitus, Addison's disease, rheumatoid arthritis, vitiligo ## Footnote These associations highlight the autoimmune nature of pernicious anaemia.

Answer 215

Blood group A ## Footnote This suggests a potential genetic predisposition.

Answer 216

Lethargy, pallor, dyspnoea ## Footnote These are common symptoms of anaemia.

Answer 217

Peripheral neuropathy ## Footnote Typically symmetrical and affects the legs more than the arms.

Answer 218

Progressive weakness, ataxia, paresthesias, which may progress to spasticity and paraplegia ## Footnote This condition is linked to vitamin B12 deficiency.

Answer 219

Memory loss, poor concentration, confusion, depression, irritability ## Footnote These symptoms can significantly affect quality of life.

Answer 220

A sore tongue ## Footnote This can be a symptom of pernicious anaemia.

Answer 221

'Lemon tinge' ## Footnote This describes a specific coloration seen in some patients.

Answer 222

Macrocytic anaemia

Answer 223

Polymorphs

Answer 224

Low WCC and platelets

Answer 225

>= 200 nh/L

Answer 226

Sensitivity 50%, specificity 95-100%

Answer 227

Radiolabelled B12 given on two occasions, urine B12 levels measured

Answer 228

Intramuscularly

Answer 229

3 injections per week for 2 weeks followed by 3 monthly injections

Answer 230

More frequent doses of vitamin B12

Answer 231

Oral vitamin B12

Answer 232

Folic acid

Answer 233

Increased risk of gastric cancer

Answer 234

Macrocytic anaemia

Answer 235

Polymorphs

Answer 236

Low WCC and platelets

Answer 237

>= 200 nh/L

Answer 238

Sensitivity 50%, specificity 95-100%

Answer 239

Radiolabelled B12 given on two occasions, urine B12 levels measured

Answer 240

Intramuscularly

Answer 241

3 injections per week for 2 weeks followed by 3 monthly injections

Answer 242

More frequent doses of vitamin B12

Answer 243

Oral vitamin B12

Answer 244

Folic acid

Answer 245

Increased risk of gastric cancer

Answer 246

Red blood cell development and maintenance of the nervous system

Answer 247

After binding to intrinsic factor and actively absorbed in the terminal ileum

Answer 248

Pernicious anaemia

Answer 249

* Pernicious anaemia * Post gastrectomy * Vegan diet or a poor diet * Disorders/surgery of terminal ileum * Crohn's disease * Metformin (rare)

Answer 250

* Macrocytic anaemia * Sore tongue and mouth * Neurological symptoms * Dorsal column affected first * Neuropsychiatric symptoms

Answer 251

1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months

Answer 252

To avoid precipitating subacute combined degeneration of the cord

Answer 253

The dorsal column (joint position, vibration)

Answer 254

Macrocytic anaemia

Answer 255

* Joint position sense loss * Vibration sense loss * Distal paraesthesia * Mood disturbances

Answer 256

Pregnancy ## Footnote Pregnancy increases the risk of VTE due to physiological changes in the body.

Answer 257

At booking and on any subsequent hospital admission ## Footnote This ensures continuous monitoring of the woman's risk status.

Answer 258

Considered high risk; requires low molecular weight heparin throughout the antenatal period ## Footnote Expert input is also recommended for high-risk cases.

Answer 259

Hospitalisation, surgery, co-morbidities, or thrombophilia ## Footnote These factors necessitate consideration for antenatal prophylactic low molecular weight heparin.

Answer 260

* Age > 35 * Body mass index > 30 * Parity > 3 ## Footnote Other factors include smoking, gross varicose veins, current pre-eclampsia, immobility, family history of unprovoked VTE, low risk thrombophilia, multiple pregnancy, and IVF pregnancy.

Answer 261

Immediate treatment with low molecular weight heparin continued until six weeks postnatal ## Footnote This is crucial for high-risk patients to prevent VTE.

Answer 262

From 28 weeks and continued until six weeks postnatal ## Footnote This timing helps mitigate the risk of VTE during the later stages of pregnancy.

Answer 263

Continue anticoagulation treatment for at least 3 months ## Footnote This is consistent with the management of other patients with provoked DVTs.

Answer 264

Low molecular weight heparin ## Footnote It is preferred over Direct Oral Anticoagulants (DOACs) and warfarin, which should be avoided during pregnancy.

Answer 265

False ## Footnote DOACs should be avoided in pregnancy due to safety concerns.

Answer 266

Benign smooth muscle tumours of the uterus

Answer 267

Around 20%

Answer 268

Around 50%

Answer 269

Afro-Caribbean women

Answer 270

Before puberty

Answer 271

* Asymptomatic * Menorrhagia * Lower abdominal pain * Bloating * Urinary symptoms * Subfertility

Answer 272

Iron-deficiency anaemia

Answer 273

Polycythaemia secondary to autonomous production of erythropoietin

Answer 274

Transvaginal ultrasound

Answer 275

No treatment is needed other than periodic review

Answer 276

Levonorgestrel intrauterine system (LNG-IUS)

Answer 277

* Mefenamic acid * Tranexamic acid

Answer 278

* Combined oral contraceptive pill * Oral progestogen

Answer 279

Injectable progestogen

Answer 280

To reduce the size of the fibroid

Answer 281

* Hot flushes * Vaginal dryness * Loss of bone mineral density

Answer 282

Ulipristal acetate

Answer 283

* Myomectomy * Hysteroscopic endometrial ablation * Hysterectomy * Uterine artery embolization

Answer 284

They generally regress

Answer 285

Red degeneration

Answer 286

A condition that may develop during pregnancy, complicating around 4% of pregnancies.

Answer 287

* BMI of > 30 kg/m² * Previous macrosomic baby weighing 4.5 kg or above * Previous gestational diabetes

Answer 288

Oral glucose tolerance test (OGTT)

Answer 289

24-28 weeks

Answer 290

>= 5.6 mmol/L

Answer 291

>= 7.8 mmol/L

Answer 292

Within a week

Answer 293

Eating foods with a low glycaemic index

Answer 294

A trial of diet and exercise

Answer 295

Short-acting insulin

Answer 296

Start insulin

Answer 297

5.3 mmol/L

Answer 298

7.8 mmol/L

Answer 299

6.4 mmol/L

Answer 300

Glibenclamide should be offered

Answer 301

Retinopathy

Answer 302

Weight loss

Answer 303

Involves the umbilical cord descending ahead of the presenting part of the fetus.

Answer 304

Occurs in 1/500 deliveries.

Answer 305

Can lead to compression of the cord or cord spasm, causing fetal hypoxia and irreversible damage or death.

Answer 306

* Prematurity * Multiparity * Polyhydramnios * Twin pregnancy * Cephalopelvic disproportion * Abnormal presentations (e.g., breech, transverse lie)

Answer 307

At artificial rupture of the membranes.

Answer 308

When the fetal heart rate becomes abnormal and the cord is palpable vaginally, or if the cord is visible beyond the level of the introitus.

Answer 309

The presenting part of the fetus may be pushed back into the uterus to avoid compression.

Answer 310

There should be minimal handling and it should be kept warm and moist to avoid vasospasm.

Answer 311

All fours.

Answer 312

Left lateral position.

Answer 313

Tocolytics.

Answer 314

It gently elevates the presenting part.

Answer 315

Caesarian section.

Answer 316

If the cervix is fully dilated and the head is low.

Answer 317

Reduced by the increase in caesarian sections being used in breech presentations.

Answer 318

Classically seen in post-menopausal women ## Footnote Around 25% of cases occur before menopause.

Answer 319

Usually carries a good prognosis due to early detection ## Footnote Early detection is key to better outcomes.

Answer 320

* Excess oestrogen * Nulliparity * Early menarche * Late menopause * Unopposed oestrogen * Metabolic syndrome * Obesity * Diabetes mellitus * Polycystic ovarian syndrome * Tamoxifen * Hereditary non-polyposis colorectal carcinoma ## Footnote The addition of a progestogen to oestrogen reduces the risk.

Answer 321

* Multiparity * Combined oral contraceptive pill * Smoking ## Footnote The reasons for smoking being protective are unclear.

Answer 322

Postmenopausal bleeding ## Footnote Typically, it is slight and intermittent initially before becoming heavier.

Answer 323

* Menorrhagia * Intermenstrual bleeding ## Footnote Pain is not common and typically signifies extensive disease.

Answer 324

Refer using the suspected cancer pathway ## Footnote This is crucial for timely diagnosis.

Answer 325

Trans-vaginal ultrasound ## Footnote A normal endometrial thickness (< 4 mm) has a high negative predictive value.

Answer 326

Surgery ## Footnote Localised disease is treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy.

Answer 327

Postoperative radiotherapy ## Footnote This is to reduce the risk of recurrence.

Answer 328

Progestogen therapy ## Footnote This is a less invasive treatment option.

Answer 329

A common condition characterised by the growth of ectopic endometrial tissue outside of the uterine cavity.

Answer 330

Around 10%.

Answer 331

* Chronic pelvic pain * Secondary dysmenorrhoea * Pain often starts days before bleeding * Deep dyspareunia * Subfertility * Urinary symptoms (e.g., dysuria, urgency, haematuria) * Dyschezia (painful bowel movements)

Answer 332

* Reduced organ mobility * Tender nodularity in the posterior vaginal fornix * Visible vaginal endometriotic lesions

Answer 333

Laparoscopy.

Answer 334

The patient should be referred for a definitive diagnosis.

Answer 335

* NSAIDs * Paracetamol

Answer 336

Hormonal treatments such as the combined oral contraceptive pill or progestogens (e.g., medroxyprogesterone acetate).

Answer 337

Referral to secondary care.

Answer 338

* GnRH analogues * Surgery

Answer 339

They induce a 'pseudomenopause' due to low oestrogen levels.

Answer 340

It does not seem to have a significant impact.

Answer 341

* Laparoscopic excision or ablation of endometriosis plus adhesiolysis * Ovarian cystectomy (for endometriomas)

Answer 342

[trying to conceive]

Answer 343

A body mass index (BMI) >= 30 kg/m² at the first antenatal visit.

Answer 344

* Miscarriage * Gestational diabetes * Pre-eclampsia

Answer 345

Higher caesarean section rate.

Answer 346

* Congenital anomaly * Prematurity

Answer 347

* Increased risk of developing obesity * Metabolic disorders in childhood

Answer 348

5mg, rather than 400mcg.

Answer 349

24-28 weeks.

Answer 350

In a consultant-led obstetric unit.

Answer 351

An antenatal consultation with an obstetric anaesthetist and a plan made.

Answer 352

* Venous thromboembolism * Dysfunctional labour * Postpartum haemorrhage

Answer 353

Increased risk of neonatal death.

Answer 354

Postpartum haemorrhage (PPH) ## Footnote PPH may be primary or secondary.

Answer 355

Within 24 hours ## Footnote It affects around 5-7% of deliveries.

Answer 356

* Tone (uterine atony) * Trauma (e.g. perineal tear) * Tissue (retained placenta) * Thrombin (e.g. clotting/bleeding disorder) ## Footnote The vast majority of cases are due to uterine atony.

Answer 357

* Previous PPH * Prolonged labour * Pre-eclampsia * Increased maternal age * Polyhydramnios * Emergency Caesarean section * Placenta praevia, placenta accreta * Macrosomia ## Footnote The effect of parity on the risk of PPH is complicated; modern studies suggest nulliparity is a risk factor.

Answer 358

ABC approach ## Footnote Involvement of senior staff is essential.

Answer 359

Lie her flat ## Footnote This is part of the immediate response to PPH.

Answer 360

Two peripheral cannulae, 14 gauge ## Footnote This is important for fluid resuscitation.

Answer 361

Group and save ## Footnote Blood tests are crucial for transfusion planning.

Answer 362

Palpate the uterine fundus and rub it to stimulate contractions ## Footnote This technique is known as 'rubbing up the fundus'.

Answer 363

IV oxytocin: slow IV injection followed by an IV infusion ## Footnote Oxytocin is a key medication used to manage uterine atony.

Answer 364

Ergometrine ## Footnote It is administered slow IV or IM.

Answer 365

Interest in its role may be significant ## Footnote It is being researched for its effectiveness in PPH.

Answer 366

Intrauterine balloon tamponade ## Footnote This is recommended by the RCOG.

Answer 367

* B-Lynch suture * Ligation of the uterine arteries * Ligation of internal iliac arteries * Hysterectomy (if severe) ## Footnote Hysterectomy is a life-saving procedure in cases of uncontrolled hemorrhage.

Answer 368

Between 24 hours - 12 weeks ## Footnote It is typically due to retained placental tissue or endometritis.

Answer 369

Postpartum haemorrhage (PPH) ## Footnote PPH may be primary or secondary.

Answer 370

Within 24 hours ## Footnote It affects around 5-7% of deliveries.

Answer 371

* Tone (uterine atony) * Trauma (e.g. perineal tear) * Tissue (retained placenta) * Thrombin (e.g. clotting/bleeding disorder) ## Footnote The vast majority of cases are due to uterine atony.

Answer 372

* Previous PPH * Prolonged labour * Pre-eclampsia * Increased maternal age * Polyhydramnios * Emergency Caesarean section * Placenta praevia, placenta accreta * Macrosomia ## Footnote The effect of parity on the risk of PPH is complicated; modern studies suggest nulliparity is a risk factor.

Answer 373

ABC approach ## Footnote Involvement of senior staff is essential.

Answer 374

Lie her flat ## Footnote This is part of the immediate response to PPH.

Answer 375

Two peripheral cannulae, 14 gauge ## Footnote This is important for fluid resuscitation.

Answer 376

Group and save ## Footnote Blood tests are crucial for transfusion planning.

Answer 377

Palpate the uterine fundus and rub it to stimulate contractions ## Footnote This technique is known as 'rubbing up the fundus'.

Answer 378

IV oxytocin: slow IV injection followed by an IV infusion ## Footnote Oxytocin is a key medication used to manage uterine atony.

Answer 379

Ergometrine ## Footnote It is administered slow IV or IM.

Answer 380

Interest in its role may be significant ## Footnote It is being researched for its effectiveness in PPH.

Answer 381

Intrauterine balloon tamponade ## Footnote This is recommended by the RCOG.

Answer 382

* B-Lynch suture * Ligation of the uterine arteries * Ligation of internal iliac arteries * Hysterectomy (if severe) ## Footnote Hysterectomy is a life-saving procedure in cases of uncontrolled hemorrhage.

Answer 383

Between 24 hours - 12 weeks ## Footnote It is typically due to retained placental tissue or endometritis.

Answer 384

The 1967 Abortion Act ## Footnote The law was amended in 1990, reducing the upper limit from 28 weeks to 24 weeks gestation.

Answer 385

Two registered medical practitioners (only one in an emergency) ## Footnote This is a legal requirement under the 1967 Abortion Act.

Answer 386

Only a registered medical practitioner ## Footnote The procedure must take place in an NHS hospital or licensed premise.

Answer 387

Anti-D prophylaxis ## Footnote This is to prevent Rh incompatibility.

Answer 388

RU486 ## Footnote It is an anti-progestogen used in medical abortions.

Answer 389

Prostaglandins (e.g., misoprostol) ## Footnote This is administered 48 hours later to stimulate uterine contractions.

Answer 390

A multi-level pregnancy test ## Footnote This test detects the level of hCG.

Answer 391

* Manual vacuum aspiration (MVA) * Electric vacuum aspiration (EVA) * Dilatation and evacuation (D&E) ## Footnote These are surgical options for abortion.

Answer 392

Cervical priming with misoprostol +/- mifepristone ## Footnote It is used before surgical procedures.

Answer 393

* Local anaesthesia alone * Conscious sedation with local anaesthesia * Deep sedation * General anaesthesia ## Footnote Choice depends on the woman's preference and the procedure.

Answer 394

Women should be offered a choice between medical or surgical abortion ## Footnote Patient decision aids are usually provided.

Answer 395

False ## Footnote After 9 weeks, medical abortions become less common due to various factors.

Answer 396

They are usually done at home ## Footnote This is often due to the lower risk of complications.

Answer 397

* To save the life of the woman * Evidence of extreme fetal abnormality * Risk of serious physical or mental injury to the woman ## Footnote These exceptions are outlined in the 1967 Abortion Act.

Answer 398

That the pregnancy has not exceeded its 24th week and involves risks to the woman's health or life ## Footnote This is based on the provisions of the 1967 Abortion Act.

Answer 399

Descent of one of the pelvic organs resulting in protrusion on the vaginal walls ## Footnote It probably affects around 40% of postmenopausal women

Answer 400

* Cystocele, cystourethrocele * Rectocele * Uterine prolapse * Urethrocele (less common) * Enterocele (less common) ## Footnote Enterocele involves herniation of the pouch of Douglas, including small intestine, into the vagina

Answer 401

* Increasing age * Multiparity, vaginal deliveries * Obesity * Spina bifida

Answer 402

* Sensation of pressure, heaviness, 'bearing-down' * Urinary symptoms: incontinence, frequency, urgency

Answer 403

No treatment needed

Answer 404

* Weight loss * Pelvic floor muscle exercises * Ring pessary

Answer 405

* Anterior colporrhaphy * Colposuspension

Answer 406

* Hysterectomy * Sacrohysteropexy

Answer 407

Posterior colporrhaphy

Answer 408

A statistical definition with no universally agreed percentile, often using the 10th percentile ## Footnote 10% of normal babies will be below the tenth percentile; applicable antenatally or postnatally.

Answer 409

A clinical diagnosis indicating a fetus is not achieving its growth potential due to pathological reasons. ## Footnote IUGR is a subset of SGA.

Answer 410

No, not all SGA babies have IUGR. ## Footnote All IUGR babies are considered SGA.

Answer 411

Incorrect dating, constitutionally small (normal), or an abnormal fetus ## Footnote Can be symmetrical or asymmetrical.

Answer 412

Symmetrical: fetal head circumference & abdominal circumference are equally small; Asymmetrical: abdominal circumference slows relative to head circumference increase ## Footnote Symmetrical accounts for 60% of cases, asymmetrical for 40%.

Answer 413

* Idiopathic * Race (white > black > Asian) * Sex (boy > girl) * Placental insufficiency * Pre-eclampsia * Chromosomal and congenital abnormalities * Infection (CMV, parvovirus, rubella, syphilis, toxoplasmosis) * Malnutrition ## Footnote Symmetrical SGA causes are primarily idiopathic.

Answer 414

* Toxins: smoking, heroin * Toxins: alcohol (FAS), cigarettes, heroin * Chromosomal and congenital abnormalities ## Footnote Asymmetrical SGA is influenced by external factors.

Answer 415

Fortnightly ultrasound growth assessment to demonstrate normal growth rate and check for pathological causes ## Footnote Includes checking maternal blood for infections and searching the fetus for chromosomal abnormality markers.

Answer 416

Fortnightly ultrasound growth assessment, biophysical profile, Doppler waveforms from umbilical circulation, and consider daily CTGs ## Footnote If sub-optimal results, consider delivery.

Answer 417

False ## Footnote Some causes are related to fetal factors or external toxins.

Answer 418

[clinical]

Answer 419

To detect pre-malignant changes rather than to detect cancer.

Answer 420

1,000-4,000 deaths.

Answer 421

Around 15%.

Answer 422

Management was based solely on the degree of dyskaryosis.

Answer 423

Further risk-stratification of patients with mild dyskaryosis.

Answer 424

An HPV first system.

Answer 425

Between the ages of 25-64 years.

Answer 426

Every 3 years.

Answer 427

Every 5 years.

Answer 428

No, cervical screening cannot be offered to women over 64.

Answer 429

From ages 25-64 every 5 years.

Answer 430

3 months post-partum.

Answer 431

They have a very low risk of developing cervical cancer.

Answer 432

Around mid-cycle.

Answer 433

No, there is limited evidence.

Answer 434

Infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries, and surrounding peritoneum. ## Footnote Usually results from ascending infection from the endocervix.

Answer 435

Chlamydia trachomatis ## Footnote Other causative organisms include Neisseria gonorrhoeae, Mycoplasma genitalium, and Mycoplasma hominis.

Answer 436

* Lower abdominal pain * Fever * Deep dyspareunia * Dysuria * Menstrual irregularities * Vaginal or cervical discharge * Cervical excitation

Answer 437

A pregnancy test ## Footnote Other investigations include a high vaginal swab, which is often negative, and screening for Chlamydia and Gonorrhoea.

Answer 438

Stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole ## Footnote This regimen is preferred to avoid systemic fluoroquinolones where possible.

Answer 439

Oral ofloxacin + oral metronidazole

Answer 440

Intrauterine contraceptive devices (IUDs) ## Footnote BASHH guidelines suggest that evidence is limited, but removal of the IUD should be considered for better short-term clinical outcomes.

Answer 441

A complication of PID characterized by right upper quadrant pain, which may be confused with cholecystitis. ## Footnote Occurs in around 10% of cases.

Answer 442

10-20% ## Footnote Infertility is one of the serious complications of PID.

Answer 443

Infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries, and surrounding peritoneum. ## Footnote Usually results from ascending infection from the endocervix.

Answer 444

Chlamydia trachomatis ## Footnote Other causative organisms include Neisseria gonorrhoeae, Mycoplasma genitalium, and Mycoplasma hominis.

Answer 445

* Lower abdominal pain * Fever * Deep dyspareunia * Dysuria * Menstrual irregularities * Vaginal or cervical discharge * Cervical excitation

Answer 446

A pregnancy test ## Footnote Other investigations include a high vaginal swab, which is often negative, and screening for Chlamydia and Gonorrhoea.

Answer 447

Stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole ## Footnote This regimen is preferred to avoid systemic fluoroquinolones where possible.

Answer 448

Oral ofloxacin + oral metronidazole

Answer 449

Intrauterine contraceptive devices (IUDs) ## Footnote BASHH guidelines suggest that evidence is limited, but removal of the IUD should be considered for better short-term clinical outcomes.

Answer 450

A complication of PID characterized by right upper quadrant pain, which may be confused with cholecystitis. ## Footnote Occurs in around 10% of cases.

Answer 451

10-20% ## Footnote Infertility is one of the serious complications of PID.

Answer 452

Nausea and vomiting of pregnancy (NVP) ## Footnote This term replaces the previously used term 'morning sickness'.

Answer 453

The extreme form of nausea and vomiting of pregnancy (NVP) ## Footnote It occurs in around 1% of pregnancies.

Answer 454

Between 8 and 12 weeks ## Footnote It may persist up to 20 weeks.

Answer 455

Raised beta hCG levels ## Footnote Beta hCG is a hormone produced during pregnancy.

Answer 456

* Increased levels of beta-hCG * Multiple pregnancies * Trophoblastic disease * Nulliparity * Obesity * Family or personal history of NVP ## Footnote Nulliparity refers to a woman who has never given birth.

Answer 457

False ## Footnote Smoking is associated with a decreased incidence of hyperemesis.

Answer 458

Ovarian cancer ## Footnote Ovarian cancer has a peak age of incidence at 60 years and generally carries a poor prognosis due to late diagnosis.

Answer 459

Around 90% ## Footnote 70-80% of these cases are due to serous carcinomas.

Answer 460

Distal end of the fallopian tube ## Footnote This recognition has increased in recent studies.

Answer 461

BRCA1 or BRCA2 ## Footnote Family history of these mutations significantly raises risk.

Answer 462

Early menarche, late menopause, nulliparity ## Footnote These factors contribute to increased ovulation cycles.

Answer 463

Abdominal distension and bloating, abdominal and pelvic pain, urinary symptoms, early satiety, diarrhea ## Footnote These symptoms are often vague and nonspecific.

Answer 464

CA125 ## Footnote Elevated CA125 levels can indicate various conditions, not just ovarian cancer.

Answer 465

35 IU/mL or greater ## Footnote A raised CA125 level prompts further imaging studies.

Answer 466

No ## Footnote CA125 should not be used for screening in asymptomatic women.

Answer 467

Combination of surgery and platinum-based chemotherapy ## Footnote This approach is standard for treating ovarian cancer.

Answer 468

80% ## Footnote Late-stage presentation is common, impacting prognosis.

Answer 469

46% ## Footnote This statistic highlights the poor prognosis associated with the disease.

Answer 470

False ## Footnote Recent evidence suggests no significant link between infertility treatment and ovarian cancer risk.

Answer 471

Reduces the risk ## Footnote Fewer ovulations lead to a decreased risk of ovarian cancer.

Answer 472

diagnostic laparotomy ## Footnote This procedure is typically necessary due to the difficulty of diagnosis.

Answer 473

not alone a sign of low milk supply

Answer 474

a poor latch

Answer 475

blocked duct ('milk bleb')

Answer 476

miconazole cream; nystatin suspension

Answer 477

flucloxacillin

Answer 478

a breast abscess

Answer 479

* blocked milk ducts * mastitis * difficulties with breastfeeding * difficulties with milk supply

Answer 480

hand expression of milk

Answer 481

intermittent

Answer 482

exposure to cold

Answer 483

10% cut-off

Answer 484

midwife-led breastfeeding clinics

Answer 485

not alone a sign of low milk supply

Answer 486

a poor latch

Answer 487

blocked duct ('milk bleb')

Answer 488

miconazole cream; nystatin suspension

Answer 489

flucloxacillin

Answer 490

a breast abscess

Answer 491

* blocked milk ducts * mastitis * difficulties with breastfeeding * difficulties with milk supply

Answer 492

hand expression of milk

Answer 493

intermittent

Answer 494

exposure to cold

Answer 495

10% cut-off

Answer 496

Galactosaemia, viral infections (controversial with HIV) ## Footnote The controversy around HIV relates to the higher infant mortality and morbidity associated with bottle feeding.

Answer 497

Penicillins, cephalosporins, trimethoprim ## Footnote These antibiotics have been deemed safe for breastfeeding mothers.

Answer 498

Glucocorticoids (avoid high doses), levothyroxine ## Footnote Levothyroxine is considered safe in small amounts.

Answer 499

Sodium valproate, carbamazepine

Answer 500

Salbutamol, theophyllines

Answer 501

Tricyclic antidepressants, antipsychotics ## Footnote Clozapine should be avoided.

Answer 502

Beta-blockers, hydralazine

Answer 503

Warfarin, heparin

Answer 504

Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

Answer 505

Lithium, benzodiazepines

Answer 506

Carbimazole

Answer 507

Methotrexate

Answer 508

Cytotoxic drugs

Answer 509

Amiodarone

Answer 510

Galactosaemia, viral infections (controversial with HIV) ## Footnote The controversy around HIV relates to the higher infant mortality and morbidity associated with bottle feeding.

Answer 511

Penicillins, cephalosporins, trimethoprim ## Footnote These antibiotics have been deemed safe for breastfeeding mothers.

Answer 512

Glucocorticoids (avoid high doses), levothyroxine ## Footnote Levothyroxine is considered safe in small amounts.

Answer 513

Sodium valproate, carbamazepine

Answer 514

Salbutamol, theophyllines

Answer 515

Tricyclic antidepressants, antipsychotics ## Footnote Clozapine should be avoided.

Answer 516

Beta-blockers, hydralazine

Answer 517

Warfarin, heparin

Answer 518

Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

Answer 519

Lithium, benzodiazepines

Answer 520

Carbimazole

Answer 521

Methotrexate

Answer 522

Cytotoxic drugs

Answer 523

Amiodarone

Answer 524

Stop suckling/expressing ## Footnote This technique involves preventing stimulation of the breast, which triggers milk production.

Answer 525

Well-supported bra and analgesia ## Footnote These measures help to alleviate discomfort associated with the cessation of lactation.

Answer 526

Cabergoline ## Footnote Cabergoline is a dopamine agonist that can help suppress lactation.

Answer 527

An overgrowth of predominately anaerobic organisms such as Gardnerella vaginalis leading to a fall in lactic acid producing aerobic lactobacilli and a raised vaginal pH.

Answer 528

No, BV is not a sexually transmitted infection.

Answer 529

Sexually active women.

Answer 530

'Fishy', offensive discharge.

Answer 531

3 of the following 4 points should be present: * Thin, white homogenous discharge * Clue cells on microscopy * Vaginal pH > 4.5 * Positive whiff test.

Answer 532

They are stippled vaginal epithelial cells observed on microscopy.

Answer 533

The addition of potassium hydroxide results in a fishy odour.

Answer 534

Treatment is not usually required.

Answer 535

Oral metronidazole for 5-7 days.

Answer 536

A single oral dose of metronidazole 2g.

Answer 537

Topical metronidazole or topical clindamycin.

Answer 538

Increased risk of preterm labour, low birth weight, chorioamnionitis, and late miscarriage.

Answer 539

Oral metronidazole should be avoided and topical clindamycin should be used instead.

Answer 540

Oral metronidazole is recommended throughout pregnancy.

Answer 541

Discuss with the woman's obstetrician if treatment is indicated.

Answer 542

The higher, stat dose of metronidazole.

Answer 543

Condoms and diaphragms/cervical caps ## Footnote Barrier methods are widely used for contraception.

Answer 544

98% ## Footnote Efficacy is defined as the percentage of women experiencing an unintended pregnancy within the first year of use.

Answer 545

80% ## Footnote Efficacy rates can vary between perfect use and typical use.

Answer 546

92-96% ## Footnote This efficacy is contingent upon the use of spermicide.

Answer 547

False ## Footnote Oil-based lubricants should not be used with latex condoms.

Answer 548

Polyurethane condoms ## Footnote These condoms provide an alternative for those with latex allergies.

Answer 549

ICP, also known as obstetric cholestasis, affects around 1% of pregnancies in the UK and is associated with an increased risk of premature birth.

Answer 550

Pruritus: Often intense, typically worse on palms, soles, and abdomen. Jaundice: Clinically detectable in ~20% of patients. Raised bilirubin: Present in >90% of cases.

Answer 551

Induction of labour: Common at 37-38 weeks, though evidence is unclear. Ursodeoxycholic acid: Widely used, but evidence base is uncertain. Vitamin K supplementation.

Answer 552

Recurrence occurs in 45-90% of subsequent pregnancies.

Answer 553

ICP, also known as obstetric cholestasis, occurs in around 1% of pregnancies, typically in the third trimester. It is the most common liver disease in pregnancy.

Answer 554

Pruritus: Often affects the palms and soles. No rash: Skin changes may occur due to scratching. Raised bilirubin.

Answer 555

Increased rate of stillbirth. Not generally associated with increased maternal morbidity.

Answer 556

AFLP is a rare complication that occurs in the third trimester or the immediate postpartum period.

Answer 557

Abdominal pain. Nausea & vomiting. Headache. Jaundice. Hypoglycaemia. Severe cases may lead to pre-eclampsia.

Answer 558

ALT is typically elevated (e.g., 500 U/L).

Answer 559

Supportive care. Delivery: Definitive management once the patient is stabilised.

Answer 560

Gilbert's syndrome and Dubin-Johnson syndrome

Answer 561

Haemolysis Elevated Liver enzymes Low Platelets

Answer 562

'Baby-blues' to puerperal psychosis

Answer 563

10-item questionnaire, maximum score of 30

Answer 564

'Depressive illness of varying severity'

Answer 565

Anxious, tearful, and irritable

Answer 566

Around 10%

Answer 567

Within a month

Answer 568

Approximately 0.2%

Answer 569

Within the first 2-3 weeks

Answer 570

Severe swings in mood and disordered perception

Answer 571

Reassurance and support

Answer 572

Cognitive behavioural therapy

Answer 573

*Sertraline *Paroxetine

Answer 574

Admission to hospital, ideally in a Mother & Baby Unit

Answer 575

Paroxetine

Answer 576

Fluoxetine

Answer 577

Blood pressure usually falls, particularly the diastolic, and continues to fall until 20-24 weeks ## Footnote After 20-24 weeks, blood pressure typically increases to pre-pregnancy levels by term.

Answer 578

Guidance on management and recommendations on reducing the risk of hypertensive disorders ## Footnote Specifically, women at high risk of pre-eclampsia should take aspirin 75mg od from 12 weeks until birth.

Answer 579

Systolic > 140 mmHg or diastolic > 90 mmHg or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic ## Footnote This definition helps categorize the patient's condition.

Answer 580

* Pre-existing hypertension * Pregnancy-induced hypertension (PIH) * Pre-eclampsia ## Footnote Each category has specific criteria and implications for management.

Answer 581

A history of hypertension before pregnancy or elevated blood pressure > 140/90 mmHg before 20 weeks gestation ## Footnote No proteinuria or oedema is present.

Answer 582

Occurs in 3-5% of pregnancies ## Footnote More common in older women.

Answer 583

These should be stopped immediately and alternative antihypertensives started ## Footnote Labetalol is a recommended alternative while awaiting specialist review.

Answer 584

Hypertension occurring in the second half of pregnancy (after 20 weeks) with no proteinuria or oedema ## Footnote Occurs in around 5-7% of pregnancies.

Answer 585

Increased risk of future pre-eclampsia or hypertension later in life ## Footnote PIH typically resolves following birth, usually after one month.

Answer 586

Oral labetalol ## Footnote Alternatives include oral nifedipine and hydralazine.

Answer 587

Pregnancy-induced hypertension with proteinuria (> 0.3g / 24 hours) ## Footnote Oedema may occur but is now less commonly used as a criterion.

Answer 588

False ## Footnote It is classified as pregnancy-induced hypertension (PIH).

Answer 589

The emergence of high blood pressure during pregnancy that may lead to eclampsia and other complications.

Answer 590

A triad of: * new-onset hypertension * proteinuria * oedema

Answer 591

New-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following: * proteinuria * other organ involvement (e.g. renal insufficiency, liver, neurological, haematological, uteroplacental dysfunction)

Answer 592

Consequences include: * eclampsia * neurological complications (altered mental status, blindness, stroke, clonus, severe headaches, persistent visual scotomata) * fetal complications (intrauterine growth retardation, prematurity) * liver involvement (elevated transaminases) * haemorrhage (placental abruption, intra-abdominal, intra-cerebral) * cardiac failure

Answer 593

Features include: * hypertension typically > 160/110 mmHg * proteinuria (dipstick ++/+++) * headache * visual disturbance * papilloedema * RUQ/epigastric pain * hyperreflexia * platelet count < 100 * 10^6/l * abnormal liver enzymes or HELLP syndrome

Answer 594

High risk factors include: * hypertensive disease in a previous pregnancy * chronic kidney disease * autoimmune disease (e.g. systemic lupus erythematosus, antiphospholipid syndrome) * type 1 or type 2 diabetes * chronic hypertension

Answer 595

Moderate risk factors include: * first pregnancy * age 40 years or older * pregnancy interval of more than 10 years * body mass index (BMI) of 35 kg/m² or more at first visit * family history of pre-eclampsia * multiple pregnancy

Answer 596

Aspirin 75-150mg daily from 12 weeks gestation until the birth for women with: * ≥ 1 high risk factors * ≥ 2 moderate factors

Answer 597

Arrange emergency secondary care assessment for any woman in whom pre-eclampsia is suspected.

Answer 598

Blood pressure ≥ 160/110 mmHg

Answer 599

Oral labetalol

Answer 600

Other medications include: * Nifedipine (e.g. if asthmatic) * Hydralazine

Answer 601

Delivery of the baby

Answer 602

≥ 140/90 mmHg

Answer 603

Ectopic pregnancy ## Footnote This condition can be life-threatening if not diagnosed and treated promptly.

Answer 604

6-8 weeks amenorrhoea, lower abdominal pain, and later vaginal bleeding ## Footnote The history helps in identifying the condition early.

Answer 605

Lower abdominal pain ## Footnote Pain is typically constant and may be unilateral.

Answer 606

Usually less than a normal period, may be dark brown in color ## Footnote This bleeding differs from typical menstrual bleeding.

Answer 607

6-8 weeks from the start of the last period ## Footnote If longer, it may suggest other causes such as inevitable abortion.

Answer 608

Dizziness, fainting or syncope, breast tenderness ## Footnote These symptoms may indicate complications or associated conditions.

Answer 609

Abdominal tenderness, cervical excitation, adnexal mass ## Footnote Cervical motion tenderness is an important finding.

Answer 610

NOT to examine for an adnexal mass due to increased risk of rupturing the pregnancy ## Footnote A pelvic examination for cervical excitation is still recommended.

Answer 611

Serum bHCG levels >1,500 ## Footnote This level is significant in differentiating ectopic pregnancy from other conditions.

Answer 612

Implantation of a fertilized ovum outside the uterus ## Footnote Ectopic pregnancies are often life-threatening conditions that require prompt medical attention.

Answer 613

c. 0.5% of all pregnancies ## Footnote This statistic indicates that ectopic pregnancies are relatively rare but can have serious implications.

Answer 614

* Damage to tubes (pelvic inflammatory disease, surgery) * Previous ectopic pregnancy * Endometriosis * IUCD * Progesterone only pill * IVF (3% of pregnancies are ectopic) ## Footnote Understanding these risk factors can help in identifying women who may be at higher risk for ectopic pregnancies.

Answer 615

[outside the uterus]

Answer 616

True ## Footnote While IUCDs are effective for contraception, they can increase the risk of ectopic pregnancies.

Answer 617

3% ## Footnote This highlights the increased risk of ectopic pregnancy associated with assisted reproductive technologies.

Answer 618

In an early pregnancy assessment unit

Answer 619

She should be referred to the emergency department

Answer 620

Transvaginal ultrasound

Answer 621

* Expectant management * Medical management * Surgical management

Answer 622

* Size <35mm * Unruptured * Asymptomatic * No fetal heartbeat * hCG <1,000IU/L * Compatible if another intrauterine pregnancy

Answer 623

* Size <35mm * Unruptured * No significant pain * No fetal heartbeat * hCG <1,500IU/L * Not suitable if intrauterine pregnancy

Answer 624

* Size >35mm * Can be ruptured * Pain * Visible fetal heartbeat * hCG >5,000IU/L * Compatible with another intrauterine pregnancy

Answer 625

Closely monitoring the patient over 48 hours

Answer 626

Giving the patient methotrexate

Answer 627

Can involve salpingectomy or salpingotomy

Answer 628

Salpingectomy

Answer 629

For women with risk factors for infertility such as contralateral tube damage

Answer 630

Around 1 in 5 women

Answer 631

intrauterine pregnancy

Answer 632

97% ## Footnote Most of these occur in the ampulla segment of the tube.

Answer 633

Isthmus ## Footnote Ectopic pregnancies in the isthmus can lead to more severe complications.

Answer 634

3% ## Footnote These locations include the ovary, cervix, or peritoneum.

Answer 635

Invades the tubal wall, producing bleeding ## Footnote This invasion may dislodge the embryo.

Answer 636

Absorption and tubal abortion ## Footnote These outcomes refer to the body's response to the ectopic tissue.

Answer 637

A process where the ectopic pregnancy is expelled from the tube ## Footnote This can happen if the embryo is shed or absorbed.

Answer 638

If the tube does not rupture, blood and embryo may be shed or converted into a tubal mole and absorbed ## Footnote This is a non-destructive outcome of an ectopic pregnancy.

Answer 639

A significant complication of ectopic pregnancy ## Footnote This can lead to severe internal bleeding and requires immediate medical attention.

Answer 640

A placenta lying wholly or partly in the lower uterine segment ## Footnote It can lead to complications during pregnancy and delivery.

Answer 641

5% ## Footnote Most of these placentas rise away from the cervix by delivery.

Answer 642

0.5% ## Footnote This indicates that most placentas do not remain low-lying by the time of delivery.

Answer 643

* Multiparity * Multiple pregnancy * Lower segment scar from previous caesarean section ## Footnote These factors increase the likelihood of implantation in the lower uterine segment.

Answer 644

* Shock in proportion to visible loss * No pain * Uterus not tender * Lie and presentation may be abnormal * Fetal heart usually normal * Coagulation problems rare * Small bleeds before large ## Footnote These features help differentiate it from other obstetric emergencies.

Answer 645

Digital vaginal examination ## Footnote It may provoke a severe haemorrhage.

Answer 646

During the routine 20 week abdominal ultrasound ## Footnote This is a standard practice in prenatal care.

Answer 647

Use of transvaginal ultrasound ## Footnote It improves accuracy and is considered safe.

Answer 648

* 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 - placenta completely covers the internal os ## Footnote This grading system helps in assessing the severity of the condition.

Answer 649

A placenta lying wholly or partly in the lower uterine segment

Answer 650

Rescan at 32 weeks

Answer 651

No, unless they bleed

Answer 652

Scan every 2 weeks

Answer 653

At 36-37 weeks

Answer 654

Elective caesarean section

Answer 655

A trial of vaginal delivery

Answer 656

Perform an emergency caesarean section

Answer 657

Post-partum haemorrhage

Answer 658

Admit the woman

Answer 659

ABC approach

Answer 660

Emergency caesarean section

Answer 661

Emergency caesarean section

Answer 662

Death is now extremely rare

Answer 663

Post-partum haemorrhage

Answer 664

Separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space ## Footnote This condition can lead to serious complications for both the mother and the fetus.

Answer 665

Approximately 1 in 200 pregnancies ## Footnote This indicates that placental abruption is relatively uncommon.

Answer 666

* Proteinuric hypertension * Cocaine use * Multiparity * Maternal trauma * Increasing maternal age ## Footnote These factors may increase the risk of experiencing placental abruption.

Answer 667

Shock out of keeping with visible loss ## Footnote This means that the severity of the shock may not correlate with the amount of blood loss observed.

Answer 668

Pain is constant ## Footnote This constant pain can be a significant indicator of placental abruption.

Answer 669

Tender, tense uterus ## Footnote A tense uterus can indicate underlying complications, such as bleeding.

Answer 670

Absent or distressed fetal heart ## Footnote This can indicate fetal distress or compromise due to the abruption.

Answer 671

Beware pre-eclampsia, DIC, anuria ## Footnote Coagulation problems can complicate the clinical picture and require careful management.

Answer 672

Separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space

Answer 673

Immediate caesarean

Answer 674

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

Answer 675

Immediate caesarean

Answer 676

Deliver vaginally

Answer 677

Induce vaginal delivery

Answer 678

* Shock * DIC * Renal failure * PPH

Answer 679

* IUGR * Hypoxia * Death

Answer 680

High perinatal mortality rate

Answer 681

The use of a small dose of oestrogen, combined with a progestogen in women with a uterus, to alleviate menopausal symptoms.

Answer 682

* Nausea * Breast tenderness * Fluid retention and weight gain

Answer 683

Increased risk of breast cancer.

Answer 684

The risk increases with the duration of use.

Answer 685

The risk begins to decline and by 5 years reaches the same level as in women who have never taken HRT.

Answer 686

Increased risk of endometrial cancer.

Answer 687

By the addition of a progestogen.

Answer 688

The additional risk is eliminated if a progestogen is given continuously.

Answer 689

Increased risk of venous thromboembolism.

Answer 690

No, it does not appear to increase the risk of VTE.

Answer 691

They should be referred to haematology before starting any treatment.

Answer 692

Increased risk of stroke.

Answer 693

Increased risk of ischaemic heart disease.

Answer 694

The permanent cessation of menstruation due to the loss of follicular activity ## Footnote Menopause is a clinical diagnosis made when a woman has not had a period for 12 months.

Answer 695

Roughly 75% ## Footnote Symptoms typically last for 7 years but may vary in duration and severity.

Answer 696

* Lifestyle modifications * Hormone replacement therapy (HRT) * Non-hormone replacement therapy

Answer 697

* Regular exercise * Weight loss * Reduce stress

Answer 698

Late evening exercise ## Footnote Maintaining good sleep hygiene is also important.

Answer 699

* Current or past breast cancer * Any oestrogen-sensitive cancer * Undiagnosed vaginal bleeding * Untreated endometrial hyperplasia

Answer 700

Approximately 10% ## Footnote There is a drive by NICE to increase this number.

Answer 701

Oral or transdermal combined HRT ## Footnote Unopposed oestrogens increase the risk of endometrial cancer.

Answer 702

* Venous thromboembolism * Stroke * Coronary heart disease * Breast cancer * Ovarian cancer

Answer 703

Fluoxetine, citalopram or venlafaxine

Answer 704

vaginal lubricant or moisturiser

Answer 705

Gradually reducing HRT is effective at limiting recurrence only in the short term ## Footnote In the long term, there is no difference in symptom control.

Answer 706

* Treatment has been ineffective * Ongoing side effects * Unexplained bleeding

Answer 707

False ## Footnote The risk of dying from breast cancer is not raised.

Answer 708

Symptoms typically last for 2-5 years ## Footnote Treatment with HRT brings certain risks.

Answer 709

* Self-help groups * Cognitive behaviour therapy * Antidepressants

Answer 710

Herbal medicine from a North American plant Actaea racemosa ## Footnote Black Cohosh is often used for the relief of menopausal symptoms.

Answer 711

Traditional Herbal Registration by MHRA for the relief of menopausal symptoms ## Footnote Menoherb is a preparation of Black Cohosh.

Answer 712

Risk of liver toxicity ## Footnote Women should be informed about this risk when considering Black Cohosh.

Answer 713

Mixed results ## Footnote This indicates variability in effectiveness and safety.

Answer 714

May potentiate seizures ## Footnote This is particularly relevant for individuals with seizure disorders.

Answer 715

Sleep problems and nausea ## Footnote These effects may affect the quality of life for users.

Answer 716

Phytoestrogens ## Footnote These compounds can mimic estrogen in the body.

Answer 717

Endometrial hyperplasia and stimulating hormone-sensitive cancers ## Footnote Caution is advised when using Red Clover, especially in women with a history of these conditions.

Answer 718

Type of Chinese medicine ## Footnote It is often used in traditional practices for various health issues.

Answer 719

Photosensitivity and interference with warfarin metabolism ## Footnote This can lead to increased bleeding risks.

Answer 720

51 years old ## Footnote This is the typical age range for menopause onset.

Answer 721

The period prior to menopause when women may experience symptoms ## Footnote This is a transitional phase as ovarian function declines.

Answer 722

12 months ## Footnote This is to prevent unintended pregnancies during the transition.

Answer 723

24 months ## Footnote This reflects the increased variability in menstrual cycle patterns.

Answer 724

Up to 50% ## Footnote This highlights the importance of understanding potential adverse effects.

Answer 725

Reduced levels of female hormones, principally oestrogen ## Footnote Oestrogen is key in regulating various bodily functions in women.

Answer 726

Change in length of menstrual cycles and dysfunctional uterine bleeding may occur ## Footnote These changes can vary significantly from woman to woman.

Answer 727

Hot flushes and night sweats; affects around 80% of women ## Footnote These symptoms usually occur daily and may continue for up to 5 years.

Answer 728

Vaginal dryness and atrophy, urinary frequency; affects around 35% of women ## Footnote These changes can lead to discomfort and other complications.

Answer 729

Anxiety and depression; around 10% of women ## Footnote Short-term memory impairment may also occur.

Answer 730

Osteoporosis and increased risk of ischaemic heart disease ## Footnote These complications can significantly impact women's health later in life.

Answer 731

84% ## Footnote This statistic highlights the natural conception rates in couples without infertility issues.

Answer 732

1 in 7 couples ## Footnote This indicates a significant number of couples facing infertility challenges.

Answer 733

* Male factor: 30% * Unexplained: 20% * Ovulation failure: 20% * Tubal damage: 15% * Other causes: 15% ## Footnote Understanding these causes is crucial for diagnosis and treatment.

Answer 734

To assess ovulation ## Footnote Serum progesterone levels are measured 7 days prior to the expected period.

Answer 735

Day 21 ## Footnote This timing is standard for evaluating ovulation in a regular cycle.

Answer 736

Indicates ovulation ## Footnote This level suggests that ovulation has occurred.

Answer 737

Refer to specialist ## Footnote Consistently low levels may indicate underlying issues that require expert evaluation.

Answer 738

20-25 ## Footnote Maintaining a healthy BMI can positively influence fertility.

Answer 739

Regular sexual intercourse every 2 to 3 days ## Footnote This frequency helps maximize the chances of conception.

Answer 740

Smoking and drinking ## Footnote These factors can negatively impact fertility and overall health.

Answer 741

Within 1 hour

Answer 742

> 15 million / ml

Answer 743

NICE 2013 values

Answer 744

Benign smooth muscle tumours of the uterus

Answer 745

Around 20%

Answer 746

Around 50%

Answer 747

Afro-Caribbean women

Answer 748

Before puberty

Answer 749

* Asymptomatic * Menorrhagia * Lower abdominal pain * Bloating * Urinary symptoms * Subfertility

Answer 750

Iron-deficiency anaemia

Answer 751

Polycythaemia secondary to autonomous production of erythropoietin

Answer 752

Transvaginal ultrasound

Answer 753

No treatment is needed other than periodic review

Answer 754

Levonorgestrel intrauterine system (LNG-IUS)

Answer 755

* Mefenamic acid * Tranexamic acid

Answer 756

* Combined oral contraceptive pill * Oral progestogen

Answer 757

Injectable progestogen

Answer 758

To reduce the size of the fibroid

Answer 759

* Hot flushes * Vaginal dryness * Loss of bone mineral density

Answer 760

Ulipristal acetate

Answer 761

* Myomectomy * Hysteroscopic endometrial ablation * Hysterectomy * Uterine artery embolization

Answer 762

They generally regress

Answer 763

Red degeneration

Answer 764

The presence of excessive amniotic fluid ## Footnote It may be detected when a uterus is large for dates or it is difficult to feel the fetal parts on palpation.

Answer 765

* Multiple pregnancy * Poorly controlled maternal diabetes mellitus * Tracheo-oesophageal fistula

Answer 766

Impaired swallowing reflex ## Footnote This can lead to an accumulation of amniotic fluid.

Answer 767

Umbilical cord prolapse ## Footnote Polyhydramnios may stop the fetus from engaging with the pelvis, leaving room for the umbilical cord to prolapse.

Answer 768

Increased risk of urinary tract infections

Answer 769

* Duodenal atresia * Oesophageal atresia

Answer 770

Polyhydramnios is associated with an increased risk of prematurity.

Answer 771

Fetal distress as a response to chronic hypoxia in utero ## Footnote This is concerning as it reflects risk of stillbirth and fetal growth restriction.

Answer 772

The first onset of recognised fetal movements, usually occurring between 18-20 weeks gestation

Answer 773

32 weeks gestation

Answer 774

Multiparous women usually experience fetal movements sooner, from 16-18 weeks gestation

Answer 775

Less than 10 movements within 2 hours in pregnancies past 28 weeks gestation

Answer 776

Up to 15% of pregnancies

Answer 777

* Posture * Distraction * Placental position * Medication * Fetal position * Body habitus * Amniotic fluid volume * Fetal size

Answer 778

Using handheld Doppler or ultrasonography

Answer 779

Immediate ultrasound should be offered

Answer 780

To monitor fetal heart rate and assist in excluding fetal compromise

Answer 781

Onward referral should be made to a maternal fetal medicine unit

Answer 782

In 70% of these pregnancies, there is no onward complication

Answer 783

Between 40-55%

Answer 784

[various factors including posture, distraction, placental position, medication, fetal position, body habitus, amniotic fluid volume, and fetal size]

Answer 785

Around 50% ## Footnote This statistic highlights the importance of early detection and screening in younger women.

Answer 786

Aged 25-29 years ## Footnote This indicates a critical age for cervical cancer screening efforts.

Answer 787

* Squamous cell cancer (80%) * Adenocarcinoma (20%) ## Footnote These types represent the majority of cervical cancer cases.

Answer 788

* Abnormal vaginal bleeding * Vaginal discharge ## Footnote Abnormal bleeding can occur postcoital, intermenstrual, or postmenopausal.

Answer 789

Human papillomavirus (HPV) ## Footnote Particularly serotypes 16, 18, and 33 are critical in this process.

Answer 790

* Smoking * Human immunodeficiency virus (HIV) * Early first intercourse * Many sexual partners * High parity * Lower socioeconomic status * Combined oral contraceptive pill ## Footnote The association with the combined oral contraceptive pill is debated but supported by studies.

Answer 791

* E6 (HPV 16) * E7 (HPV 18) ## Footnote These oncogenes play a crucial role in the development of cervical cancer.

Answer 792

Inhibits the p53 tumour suppressor gene ## Footnote The p53 gene is essential for regulating the cell cycle and preventing tumor growth.

Answer 793

Inhibits the RB suppressor gene ## Footnote The RB gene is crucial for controlling cell division and preventing excessive cell growth.

Answer 794

True ## Footnote High parity refers to having had many pregnancies.

Answer 795

debated ## Footnote A large study published in the Lancet in 2007 confirmed the link.

Answer 796

Human papilloma virus (HPV) infection ## Footnote HPV is a significant concern in public health due to its association with various cancers.

Answer 797

Subtypes 16, 18 & 33 ## Footnote These subtypes are known for their strong association with cervical cancer.

Answer 798

Subtypes 6 & 11 ## Footnote These subtypes do not lead to cancer but can cause warts.

Answer 799

Development of koilocytes ## Footnote Koilocytes are a marker of HPV infection.

Answer 800

They have the following characteristics: * Enlarged nucleus * Irregular nuclear membrane contour * Hyperchromatic nucleus * Perinuclear halo may be seen ## Footnote These features help in identifying HPV-infected cells.

Answer 801

The FIGO staging and the wishes of the patient to maintain fertility.

Answer 802

Confined to cervix, only visible by microscopy and less than 7 mm wide.

Answer 803

* A1 = < 3 mm deep * A2 = 3-5 mm deep

Answer 804

Confined to cervix, clinically visible or larger than 7 mm wide.

Answer 805

* B1 = < 4 cm diameter * B2 = > 4 cm diameter

Answer 806

Extension of tumour beyond cervix but not to the pelvic wall.

Answer 807

* A = upper two thirds of vagina * B = parametrial involvement

Answer 808

Extension of tumour beyond the cervix and to the pelvic wall.

Answer 809

* A = lower third of vagina * B = pelvic side wall

Answer 810

Any tumour causing hydronephrosis or a non-functioning kidney is considered stage III.

Answer 811

Extension of tumour beyond the pelvis or involvement of bladder or rectum.

Answer 812

* A = involvement of bladder or rectum * B = involvement of distant sites outside the pelvis

Answer 813

Hysterectomy +/- lymph node clearance.

Answer 814

Nodal clearance for A2 tumours.

Answer 815

Cone biopsy with negative margins.

Answer 816

Close follow-up and node evaluation must be performed.

Answer 817

Radiotherapy with concurrent chemotherapy.

Answer 818

* Brachytherapy * External beam radiotherapy

Answer 819

Cisplatin.

Answer 820

Radical hysterectomy with pelvic lymph node dissection.

Answer 821

Radiation with concurrent chemotherapy.

Answer 822

Nephrostomy should be considered.

Answer 823

Radiation and/or chemotherapy.

Answer 824

Palliative chemotherapy.

Answer 825

Offer chemoradiation or radiotherapy.

Answer 826

The FIGO staging.

Answer 827

* Bleeding * Damage to local structures * Infection * Anaesthetic risk

Answer 828

Cone biopsies and radical trachelectomy.

Answer 829

Ureteral fistula.

Answer 830

* Diarrhoea * Vaginal bleeding * Radiation burns * Pain on micturition * Tiredness/weakness

Answer 831

* Ovarian failure * Fibrosis of bowel/skin/bladder/vagina * Lymphoedema

Answer 832

Varicella zoster virus ## Footnote Chickenpox is caused by primary infection with this virus.

Answer 833

Reactivation of dormant varicella zoster virus ## Footnote Shingles occurs when the virus reactivates in the dorsal root ganglion.

Answer 834

Via the respiratory route ## Footnote It can also be caught from someone with shingles.

Answer 835

4 days before rash, until 5 days after rash appears ## Footnote This period includes the time before and after the rash.

Answer 836

10-21 days

Answer 837

Fever and itchy rash ## Footnote The rash starts on the head/trunk before spreading.

Answer 838

Macular, papular, vesicular ## Footnote The rash progresses through these stages.

Answer 839

Supportive care ## Footnote This includes keeping cool and trimming nails.

Answer 840

To relieve itching

Answer 841

Most infectious 1-2 days before rash appears ## Footnote Infectivity continues until all lesions are dry and crusted over.

Answer 842

Immunocompromised patients and newborns with peripartum exposure

Answer 843

IV aciclovir

Answer 844

Secondary bacterial infection of the lesions

Answer 845

Invasive group A streptococcal soft tissue infections ## Footnote This can result in necrotizing fasciitis.

Answer 846

* Pneumonia * Encephalitis * Disseminated haemorrhagic chickenpox * Arthritis * Nephritis * Pancreatitis

Answer 847

A mild condition

Answer 848

At-risk groups

Answer 849

To pregnant women and the developing fetus

Answer 850

How to manage it

Answer 851

Significant exposure to chickenpox or herpes zoster

Answer 852

Exposure to limited, covered-up shingles

Answer 853

A clinical condition that increases the risk of severe varicella

Answer 854

* Immunosuppressed patients * Neonates * Pregnant women

Answer 855

No antibodies to the varicella virus

Answer 856

A blood test for varicella antibodies

Answer 857

Within 7 days

Answer 858

Varicella-zoster immunoglobulin (VZIG)

Answer 859

Management of chickenpox exposure in pregnancy

Answer 860

Varicella-zoster virus

Answer 861

Reactivation of dormant varicella-zoster virus in dorsal root ganglion

Answer 862

5 times greater risk of pneumonitis

Answer 863

A syndrome resulting from maternal varicella exposure

Answer 864

* Skin scarring * Eye defects (microphthalmia) * Limb hypoplasia * Microcephaly * Learning disabilities

Answer 865

Risk of neonatal varicella, which may be fatal in around 20% of cases

Answer 866

Maternal blood should be urgently checked for varicella antibodies

Answer 867

Varicella zoster immunoglobulin (VZIG)

Answer 868

Oral aciclovir (or valaciclovir)

Answer 869

Between day 7 to day 14 after exposure

Answer 870

Higher incidence and severity of varicella infection if given immediately

Answer 871

Seek specialist advice

Answer 872

* Increased maternal risk of serious infection * Fetal varicella risk

Answer 873

Should be given if ≥ 20 weeks and within 24 hours of rash onset

Answer 874

Considered with caution

Answer 875

An acute, unilateral, painful blistering rash caused by reactivation of the varicella-zoster virus (VZV) ## Footnote Shingles is also known as herpes zoster infection.

Answer 876

In the dorsal root or cranial nerve ganglia.

Answer 877

* Increasing age * HIV * Other immunosuppressive conditions (e.g. steroids, chemotherapy)

Answer 878

* Burning pain over the affected dermatome for 2-3 days * Pain may be severe and interfere with sleep * 20% of patients may experience fever, headache, lethargy

Answer 879

* Initially erythematous, macular rash * Quickly becomes vesicular * Well demarcated by the dermatome and does not cross the midline

Answer 880

Usually clinical.

Answer 881

* Remind patients they are potentially infectious * Advise avoiding pregnant women and the immunosuppressed * Advise that they are infectious until vesicles have crusted over * Covering lesions reduces the risk

Answer 882

* Paracetamol * NSAIDs

Answer 883

Use of neuropathic agents (e.g. amitriptyline).

Answer 884

In the first 2 weeks in immunocompetent adults with localized shingles if the pain is severe.

Answer 885

Within 72 hours for most patients.

Answer 886

Reduced incidence of post-herpetic neuralgia, particularly in older people.

Answer 887

* Aciclovir * Famciclovir * Valaciclovir

Answer 888

Post-herpetic neuralgia.

Answer 889

Affects between 5%-30% of patients depending on age.

Answer 890

Shingles affecting the ocular division of the trigeminal nerve, associated with ocular complications.

Answer 891

Herpes zoster oticus that may result in ear lesions and facial paralysis.

Answer 892

* Vaccine that prevents primary varicella infection (chickenpox) * Vaccine that reduces incidence of herpes zoster (shingles)

Answer 893

A live attenuated vaccine, examples include Varilrix and Varivax.

Answer 894

* Healthcare workers not already immune to VZV * Contacts of immunocompromised patients

Answer 895

A vaccine to boost immunity against herpes zoster for elderly people.

Answer 896

All patients aged 70-79 years.

Answer 897

Immunosuppression.

Answer 898

Injection site reactions.

Answer 899

80 and over.

Answer 900

'Less severe' and 'more severe' depression

Answer 901

A score of < 16

Answer 902

A score of ≥ 16

Answer 903

Guided self-help

Answer 904

* Guided self-help * Group cognitive behavioural therapy (CBT) * Group behavioural activation (BA)

Answer 905

A combination of individual cognitive behavioural therapy (CBT) and an antidepressant

Answer 906

* 'During the last month, have you often been bothered by feeling down, depressed or hopeless?' * 'During the last month, have you often been bothered by having little interest or pleasure in doing things?'

Answer 907

A need for a more in-depth assessment

Answer 908

Anxiety and depression

Answer 909

14 questions

Answer 910

Five (or more) symptoms present during the same 2-week period

Answer 911

Selective serotonin reuptake inhibitors (SSRIs)

Answer 912

* Citalopram * Fluoxetine

Answer 913

Gastrointestinal symptoms

Answer 914

A proton pump inhibitor

Answer 915

Direct switch is possible for some SSRIs

Answer 916

Withdraw, then leave a gap of 4-7 days before starting a low dose of the alternative SSRI

Answer 917

* Increased mood change * Restlessness * Difficulty sleeping * Unsteadiness * Sweating * Gastrointestinal symptoms * Paraesthesia

Answer 918

Increased risk of congenital heart defects

Answer 919

Gradually reduce the dose over a 4 week period (not necessary with fluoxetine)

Answer 920

Warm and cold AIHA

Answer 921

Body temperature

Answer 922

Extravascular sites, e.g., spleen

Answer 923

* Idiopathic * Autoimmune disease (e.g., systemic lupus erythematosus) * Neoplasia * Lymphoma * Chronic lymphocytic leukaemia * Drugs (e.g., methyldopa)

Answer 924

Steroids (+/- rituximab)

Answer 925

4 degrees C

Answer 926

Raynaud's and acrocynosis

Answer 927

* Neoplasia (e.g., lymphoma) * Infections (e.g., mycoplasma, EBV)

Answer 928

* Membrane defects * Metabolism defects * Haemoglobin defects

Answer 929

* Hereditary spherocytosis/elliptocytosis * G6PD deficiency * Sickle cell * Thalassaemia

Answer 930

* Immune causes (Coombs-positive) * Non-immune causes (Coombs-negative)

Answer 931

* Autoimmune (warm/cold antibody type) * Alloimmune (transfusion reaction, haemolytic disease of newborn) * Drug (e.g., methyldopa, penicillin)

Answer 932

* Microangiopathic haemolytic anaemia (MAHA): TTP/HUS, DIC, malignancy, pre-eclampsia * Prosthetic heart valves * Paroxysmal nocturnal haemoglobinuria * Infections (e.g., malaria) * Drug (e.g., dapsone) * Zieve syndrome

Answer 933

A rare clinical syndrome of Coombs-negative haemolysis, cholestatic jaundice, and transient hyperlipidaemia associated with heavy alcohol use

Answer 934

Free haemoglobin is released and binds to haptoglobin, forming methaemalbumin.

Answer 935

* Mismatched blood transfusion * G6PD deficiency * Red cell fragmentation (heart valves, TTP, DIC, HUS) * Paroxysmal nocturnal haemoglobinuria * Cold autoimmune haemolytic anaemia

Answer 936

* Haemoglobinopathies (sickle cell, thalassaemia) * Hereditary spherocytosis * Haemolytic disease of newborn * Warm autoimmune haemolytic anaemia

Answer 937

Iron deficiency anaemia

Answer 938

* Excessive blood loss * Inadequate dietary intake * Poor intestinal absorption * Increased iron requirements

Answer 939

Preschool-age children

Answer 940

Menorrhagia

Answer 941

Koilonychia (spoon-shaped nails)

Answer 942

Hypochromic microcytic anaemia

Answer 943

* Dark-green leafy vegetables * Meat * Iron-fortified bread

Answer 944

* Vitamin B12 deficiency * Folate deficiency

Answer 945

* Alcohol * Liver disease * Hypothyroidism * Pregnancy * Reticulocytosis * Myelodysplasia * Drugs (cytotoxics)

Answer 946

It may suggest polycythaemia rubra vera causing iron deficiency secondary to bleeding.

Answer 947

Underlying malignancy

Answer 948

Disproportionate to the anaemia

Answer 949

* anaemia of chronic disease * chronic kidney disease * aplastic anaemia * haemolytic anaemia * acute blood loss ## Footnote Normocytic anaemia is characterized by red blood cells that are of normal size but reduced in number.

Answer 950

Giant cell arteritis (GCA) ## Footnote Temporal arteritis is a type of vasculitis that affects medium and large-sized arteries.

Answer 951

Patients over 50 years old, with a peak incidence in those in their 70s ## Footnote Early recognition and treatment are crucial to avoid complications.

Answer 952

High-dose prednisolone ## Footnote Treatment must be started promptly upon suspicion of temporal arteritis.

Answer 953

* Typically patient > 60 years old * Rapid onset (e.g. < 1 month) * Headache (found in 85%) * Jaw claudication (65%) * Tender, palpable temporal artery * Anterior ischemic optic neuropathy ## Footnote Complications may include temporary or permanent visual loss.

Answer 954

It can reveal skip lesions ## Footnote Skip lesions are areas of inflammation that may not be continuous.

Answer 955

* Migraine * Tension headache * Cluster headache * Temporal arteritis * Medication overuse headache * Other acute causes (e.g., meningitis, subarachnoid haemorrhage) * Chronic causes (e.g., Paget's disease) ## Footnote Each type has distinct characteristics and treatments.

Answer 956

The development of seizures in association with pre-eclampsia ## Footnote Pre-eclampsia is characterized by pregnancy-induced hypertension and proteinuria.

Answer 957

Magnesium sulphate ## Footnote It is used to prevent and treat seizures.

Answer 958

A single seizure lasting >5 minutes or >= 2 seizures within a 5-minute period without return to normal ## Footnote It is a medical emergency requiring immediate intervention.

Answer 959

Benzodiazepines ## Footnote In a prehospital setting, PR diazepam or buccal midazolam may be used.

Answer 960

Monitor urine output, reflexes, respiratory rate, and oxygen saturations ## Footnote Respiratory depression can occur as a side effect.

Answer 961

A dramatic response ## Footnote If there is no response, the diagnosis should be reconsidered.

Answer 962

* Intense pain around one eye * Restlessness during an attack * Accompanied by redness, lacrimation, lid swelling ## Footnote Attacks typically occur once or twice a day.

Answer 963

20 ## Footnote It involves pregnancy-induced hypertension and proteinuria.

Answer 964

True ## Footnote Around 50% of patients with temporal arteritis have features of PMR.

Answer 965

Pressure changes in the uterus using internal or external pressure transducers

Answer 966

100-160 /min

Answer 967

Heart rate < 100 /min

Answer 968

* Increased fetal vagal tone * Maternal beta-blocker use

Answer 969

Heart rate > 160 /min

Answer 970

* Maternal pyrexia * Chorioamnionitis * Hypoxia * Prematurity

Answer 971

< 5 beats /min

Answer 972

Deceleration of the heart rate which commences with the onset of a contraction and returns to normal on completion of the contraction

Answer 973

Fetal distress e.g. asphyxia or placental insufficiency

Answer 974

Contractions

Answer 975

Group B Streptococcus (GBS)

Answer 976

* Prematurity * Prolonged rupture of membranes * Previous sibling GBS infection * Maternal pyrexia e.g. secondary to chorioamnionitis

Answer 977

Universal screening for GBS should not be offered to all women

Answer 978

Benzylpenicillin

Answer 979

A process where labour is started artificially

Answer 980

* Prolonged pregnancy * Prelabour premature rupture of membranes * Maternal medical problems * Diabetic mother > 38 weeks * Pre-eclampsia * Obstetric cholestasis * Intrauterine fetal death

Answer 981

To assess whether induction of labour will be required

Answer 982

Labour is unlikely to start without induction

Answer 983

The cervix is ripe, or 'favourable'

Answer 984

To separate the chorionic membrane from the decidua

Answer 985

* Membrane sweep * Vaginal prostaglandin E2 (dinoprostone) * Oral prostaglandin E1 (misoprostol) * Maternal oxytocin infusion * Amniotomy * Cervical ripening balloon

Answer 986

Uterine hyperstimulation

Answer 987

Prolonged and frequent uterine contractions (tachysystole)

Answer 988

* Stage 1: Onset of true labour to full dilation * Stage 2: Full dilation to delivery of the fetus * Stage 3: Delivery of fetus to delivery of placenta and membranes

Answer 989

Normally takes 6 hours

Answer 990

The active process of maternal pushing

Answer 991

Lasts around 5-15 minutes

Answer 992

* Use of uterotonics * Clamping and cutting of the cord * Controlled cord traction

Answer 993

1 cm per 2 hours

Answer 994

1 cm per hour

Answer 995

Usually an amniotomy is performed with a repeat examination in 2 hours

Answer 996

A pregnancy that has extended to or beyond 42 weeks

Answer 997

* Reduced placental perfusion * Oligohydramnios * Increased rates of intervention including forceps and caesarean section * Increased rates of labour induction

Answer 998

Implantation of a fertilized ovum outside the uterus ## Footnote Commonly occurs in the fallopian tubes.

Answer 999

History of 6-8 weeks amenorrhoea, lower abdominal pain, and later develops vaginal bleeding ## Footnote Pain is usually constant and may be unilateral.

Answer 1000

* Lower abdominal pain * Vaginal bleeding (usually less than a normal period) * History of recent amenorrhoea * Dizziness, fainting or syncope * Symptoms of pregnancy (e.g., breast tenderness) ## Footnote Shoulder tip pain can also occur due to peritoneal bleeding.

Answer 1001

* Abdominal tenderness * Cervical excitation * Adnexal mass (examination not recommended due to risk of rupture) ## Footnote Cervical motion tenderness is recommended to check.

Answer 1002

Serum bHCG levels >1,500 ## Footnote This points toward a diagnosis of an ectopic pregnancy.

Answer 1003

A common condition characterised by the growth of ectopic endometrial tissue outside of the uterine cavity ## Footnote Around 10% of women of reproductive age have a degree of endometriosis.

Answer 1004

* Chronic pelvic pain * Secondary dysmenorrhoea * Deep dyspareunia * Subfertility * Urinary symptoms (e.g., dysuria) * Dyschezia ## Footnote Pain often starts days before bleeding.

Answer 1005

Laparoscopy ## Footnote There is little role for investigation in primary care.

Answer 1006

* NSAIDs * Paracetamol ## Footnote If these do not help, hormonal treatments like the combined oral contraceptive pill or progestogens should be tried.

Answer 1007

Referral to secondary care for treatments like GnRH analogues, surgery, or laparoscopic excision ## Footnote Laparoscopic surgery is shown to improve chances of conception.

Answer 1008

60 years ## Footnote It generally carries a poor prognosis due to late diagnosis.

Answer 1009

* Family history (BRCA1 or BRCA2 mutations) * Early menarche * Late menopause * Nulliparity ## Footnote Many ovulations are also a risk factor.

Answer 1010

* Abdominal distension and bloating * Abdominal and pelvic pain * Urinary symptoms (e.g., urgency) * Early satiety * Diarrhoea ## Footnote Symptoms are often vague.

Answer 1011

CA125 test ## Footnote A raised CA125 (>35 IU/mL) warrants an urgent ultrasound scan.

Answer 1012

Combination of surgery and platinum-based chemotherapy ## Footnote Diagnosis often requires diagnostic laparotomy.

Answer 1013

Infection and inflammation of the female pelvic organs, including the uterus, fallopian tubes, and ovaries ## Footnote Usually results from ascending infection from the endocervix.

Answer 1014

* Chlamydia trachomatis * Neisseria gonorrhoeae * Mycoplasma genitalium * Mycoplasma hominis ## Footnote Chlamydia is the most common cause.

Answer 1015

* Lower abdominal pain * Fever * Deep dyspareunia * Dysuria * Vaginal or cervical discharge * Cervical excitation ## Footnote Menstrual irregularities may also occur.

Answer 1016

Stat IM ceftriaxone followed by 14 days of oral doxycycline and oral metronidazole ## Footnote This regimen avoids systemic fluoroquinolones where possible.

Answer 1017

* Perihepatitis (Fitz-Hugh Curtis Syndrome) * Infertility * Chronic pelvic pain * Ectopic pregnancy ## Footnote Infertility risk may be as high as 10-20% after a single episode.

Answer 1018

The most common cause of pelvic pain in women ## Footnote Some women experience transient pain due to ovulation (mittelschmerz).

Answer 1019

Separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage ## Footnote Occurs in approximately 1/200 pregnancies.

Answer 1020

* Shock out of keeping with visible loss * Constant pain * Tender, tense uterus * Absent or distressed fetal heart ## Footnote Coagulation problems may also occur.

Answer 1021

Benign smooth muscle tumors of the uterus ## Footnote Occur in around 20% of white women and 50% of black women in later reproductive years.

Answer 1022

* Asymptomatic * Menorrhagia * Lower abdominal pain * Urinary symptoms (e.g., frequency) * Subfertility ## Footnote May also cause iron-deficiency anaemia.

Answer 1023

No treatment needed other than periodic review ## Footnote Monitoring for size and growth is important.

Answer 1024

* Levonorgestrel intrauterine system (LNG-IUS) * NSAIDs (e.g., mefenamic acid) * Tranexamic acid * Combined oral contraceptive pill * Oral progestogen * Injectable progestogen ## Footnote LNG-IUS cannot be used if there is distortion of the uterine cavity.

Answer 1025

Fibroids generally regress after menopause ## Footnote Some complications may still persist.

Answer 1026

A protein produced by the developing fetus

Answer 1027

* Neural tube defects (meningocele, myelomeningocele, anencephaly) * Abdominal wall defects (omphalocele, gastroschisis) * Multiple pregnancy * Down's syndrome * Trisomy 18 * Maternal diabetes mellitus

Answer 1028

A procedure used in prenatal diagnosis to study fetal cells in amniotic fluid

Answer 1029

Between 15-20 weeks of gestation, usually at 16 weeks

Answer 1030

* Neural tube defects * Chromosomal disorders * Inborn errors of metabolism

Answer 1031

400 mcg from before conception until 12 weeks

Answer 1032

Women who take antiepileptics

Answer 1033

Intake above 700 micrograms might be teratogenic

Answer 1034

Pregnant women should not drink alcohol at all

Answer 1035

* Low birthweight * Preterm birth

Answer 1036

* Listeriosis: unpasteurized milk, soft cheeses, pate, undercooked meat * Salmonella: raw or partially cooked eggs and meat

Answer 1037

They should be informed of their maternity rights and benefits

Answer 1038

Women > 37 weeks with singleton pregnancy and women with uncomplicated, multiple pregnancies after >32 weeks

Answer 1039

An antenatal ultrasound test assessing amniotic fluid volume, fetal tone, activity, breathing movements, and heart reactivity

Answer 1040

To screen for Down's syndrome and other conditions between 15-20 weeks of gestation

Answer 1041

A woman has been pregnant three times, and two of these pregnancies resulted in viable offspring

Answer 1042

* Macrocytic, megaloblastic anaemia * Neural tube defects

Answer 1043

10 micrograms of vitamin D per day

Answer 1044

It includes nuchal translucency measurement, serum B-HCG, and PAPP-A, done between 11-13+6 weeks

Answer 1045

'Lower chance' or 'higher chance' results

Answer 1046

Non-invasive prenatal screening test

Answer 1047

Small DNA fragments (cell free fetal DNA, cffDNA) that circulate in the blood of a pregnant woman

Answer 1048

Transfer of 1-carbon units for DNA & RNA synthesis

Answer 1049

oral ferrous sulfate or ferrous fumarate

Answer 1050

8-10 weeks and at 28 weeks

Answer 1051

Progesterone

Answer 1052

* Amenorrhoea * Nausea * Vomiting * Breast enlargement and tenderness * Fatigue * Increased skin pigmentation

Answer 1053

* Palpitations * Increased sweating * Urinary frequency * Back pain * Breathlessness * Constipation * Varicose veins * Spider angiomas * Ankle oedema

Answer 1054

* 6-8 weeks: size of a small pear * 8-10 weeks: size of an orange * 10-12 weeks: size of a grapefruit

Answer 1055

* Urine hCG * Serum hCG * Ultrasound of the fetus * Identification of fetal heart rate

Answer 1056

BMI >= 30 kg/m²

Answer 1057

* Miscarriage * Venous thromboembolism * Gestational diabetes * Pre-eclampsia * Postpartum haemorrhage

Answer 1058

* Higher caesarean section rate * Complications during labour

Answer 1059

They should not try to reduce this risk by dieting while pregnant.

Answer 1060

It is the most important antigen found on red blood cells, with the D antigen being the most significant.

Answer 1061

Test for D antibodies at booking and give anti-D at 28 and 34 weeks.

Answer 1062

* Delivery of a Rh +ve infant * Termination of pregnancy * Miscarriage after 12 weeks

Answer 1063

* Oedema * Jaundice * Anaemia * Heart failure

Answer 1064

To match the gestational age in weeks to within 2 cm after 20 weeks.

Answer 1065

* Twins: 1/105 * Triplets: 1/10,000

Answer 1066

* Dizygotic (non-identical) * Monozygotic (identical)

Answer 1067

* Polyhydramnios * Pregnancy induced hypertension * Anaemia

Answer 1068

A nuchal scan is performed at 11-13 weeks to assess nuchal translucency.

Answer 1069

* Down's syndrome * Congenital heart defects * Abdominal wall defects

Answer 1070

* Cystic fibrosis * Down's syndrome * Cytomegalovirus infection

Answer 1071

A protein produced by the developing fetus ## Footnote AFP levels can indicate certain fetal conditions in prenatal testing.

Answer 1072

* Neural tube defects (meningocele, myelomeningocele, anencephaly) * Abdominal wall defects (omphalocele, gastroschisis) * Multiple pregnancy * Down's syndrome * Trisomy 18 * Maternal diabetes mellitus

Answer 1073

A procedure used in prenatal diagnosis where fluid is removed from the amniotic sac to study fetal cells ## Footnote It is typically performed between 15-20 weeks of pregnancy.

Answer 1074

* Neural tube defects * Chromosomal disorders * Inborn errors of metabolism

Answer 1075

Folic acid 400mcg

Answer 1076

It might be teratogenic

Answer 1077

10 micrograms of vitamin D per day

Answer 1078

Low birthweight and preterm birth

Answer 1079

* Unpasteurized milk * Ripened soft cheeses * Pate * Undercooked meat * Raw or partially cooked eggs and meat

Answer 1080

They should avoid air travel

Answer 1081

Avoid unless the benefits outweigh the risks

Answer 1082

An antenatal ultrasound test assessing amniotic fluid volume, fetal tone, activity, breathing movements, and heart reactivity

Answer 1083

The number of times a woman has been pregnant

Answer 1084

The number of pregnancies that have resulted in the birth of potentially viable offspring

Answer 1085

To screen for Down's syndrome, Edward's syndrome, neural tube defects, among others

Answer 1086

* Alpha-fetoprotein * Unconjugated oestriol * Human chorionic gonadotrophin * Inhibin A

Answer 1087

Indicates a 1 in 150 chance or less for conditions like Down's syndrome

Answer 1088

A test that analyzes small DNA fragments in the blood of a pregnant woman for chromosomal abnormalities ## Footnote It has high sensitivity and specificity for trisomy 21.

Answer 1089

* Macrocytic, megaloblastic anaemia * Neural tube defects

Answer 1090

5mg of folic acid from before conception until the 12th week of pregnancy

Answer 1091

* HSV-1 * HSV-2

Answer 1092

Nucleic acid amplification tests (NAAT)

Answer 1093

Elective caesarean section at term

Answer 1094

Human papillomavirus (HPV), especially types 6 & 11

Answer 1095

Topical podophyllum or cryotherapy

Answer 1096

It indicates a higher chance of fetal anomalies, prompting further testing

Answer 1097

The number of times a woman has been pregnant, regardless of the outcome.

Answer 1098

The number of pregnancies that have resulted in the birth of potentially viable offspring.

Answer 1099

As one gestational event, with the Para count incremented by one for each pregnancy that results in a birth.

Answer 1100

A woman has been pregnant twice, with one pregnancy resulting in one or more viable offspring.

Answer 1101

At the booking visit (8-10 weeks) and at 28 weeks.

Answer 1102

Oral ferrous sulfate or ferrous fumarate, continued for 3 months after correction.

Answer 1103

Progesterone

Answer 1104

* Amenorrhoea * Nausea * Vomiting

Answer 1105

* Palpitations and syncope * Increased sweating * Urinary frequency * Back pain * Breathlessness

Answer 1106

The size of a small pear.

Answer 1107

After the 12th week.

Answer 1108

* Urine hCG * Serum hCG * Ultrasound of the foetus * Identification of foetal heart rate

Answer 1109

BMI >= 30 kg/m²

Answer 1110

* Miscarriage * Gestational diabetes

Answer 1111

* Congenital anomaly * Prematurity

Answer 1112

5mg of folic acid

Answer 1113

24-28 weeks

Answer 1114

A leak of fetal red blood cells may occur, causing anti-D IgG antibodies to form in the mother.

Answer 1115

At 28 and 34 weeks

Answer 1116

It is irreversible

Answer 1117

Kleihauer test

Answer 1118

* Delivery of a Rh +ve infant * Any termination of pregnancy * Miscarriage if gestation is > 12 weeks * Ectopic pregnancy (if managed surgically) * External cephalic version * Antepartum haemorrhage * Amniocentesis, chorionic villus sampling, fetal blood sampling * Abdominal trauma

Answer 1119

* Oedematous (hydrops fetalis) * Jaundice * Anaemia * Hepatosplenomegaly * Heart failure * Kernicterus

Answer 1120

Herpes simplex virus (HSV) type 2

Answer 1121

* Painless ulcer (chancre) * Local non-tender lymphadenopathy

Answer 1122

Haemophilus ducreyi

Answer 1123

* Stage 1: Small painless pustule that forms an ulcer * Stage 2: Painful inguinal lymphadenopathy * Stage 3: Proctocolitis

Answer 1124

Doxycycline

Answer 1125

Gestational age in weeks ± 2 cm

Answer 1126

* Dizygotic: Non-identical, from two separate ova * Monozygotic: Identical, from a single ovum

Answer 1127

* Previous twins * Family history * Increasing maternal age * Multigravida * Induced ovulation and in-vitro fertilisation * Race (e.g., Afro-Caribbean)

Answer 1128

* Polyhydramnios * Pregnancy induced hypertension * Anaemia * Antepartum haemorrhage

Answer 1129

* Twins: 37 weeks * Triplets: 33 weeks

Answer 1130

* Gummas * Ascending aortic aneurysms * General paralysis of the insane * Tabes dorsalis * Argyll-Robertson pupil

Answer 1131

* Hutchinson's teeth * Mulberry molars * Rhagades * Keratitis * Saber shins * Saddle nose * Deafness

Answer 1132

* Down's syndrome * Congenital heart defects * Abdominal wall defects

Answer 1133

* Cystic fibrosis * Down's syndrome * Cytomegalovirus infection

Answer 1134

Starting contraception at any time other than the start of the menstrual cycle.

Answer 1135

At any time in the menstrual cycle if it is reasonably certain that there is no risk of pregnancy.

Answer 1136

No intercourse since the start of the last menstrual period.

Answer 1137

Correct and reliable contraception use.

Answer 1138

Within 5 days of the onset.

Answer 1139

Combined oral contraceptive, progestogen-only pill, or progestogen-only implant.

Answer 1140

Inhibits ovulation.

Answer 1141

Thickens cervical mucus.

Answer 1142

endometrial.

Answer 1143

Irregular bleeding.

Answer 1144

Stop contraception after 1 year of amenorrhea.

Answer 1145

Increased risk of blood clots.

Answer 1146

Risks of adverse pregnancy outcomes.

Answer 1147

Inhibits ovulation.

Answer 1148

Extra precautions are advised for enzyme-inducing antibiotics.

Answer 1149

Depo-Provera.

Answer 1150

Decreases sperm motility and survival.

Answer 1151

Potential harms and benefits.

Answer 1152

Use alternative contraception for the first 7 days.

Answer 1153

Should be taken at the same time every day.

Answer 1154

Reduced risk of colorectal cancer ## Footnote Other benefits may include protection against pelvic inflammatory disease, reduced ovarian cysts, benign breast disease, and acne vulgaris.

Answer 1155

Offers no protection against sexually transmitted infections ## Footnote Other disadvantages include the risk of venous thromboembolic disease, breast and cervical cancer, stroke, and temporary side effects.

Answer 1156

No causal relationship supported ## Footnote Some users report weight gain, but the evidence does not support this as a direct effect of the COCP.

Answer 1157

30 mcg ethinyloestradiol with levonorgestrel/norethisterone ## Footnote An example is Microgynon 30.

Answer 1158

Combination of estradiol valerate and dienogest with a quadraphasic dosage regimen ## Footnote This regimen is designed for optimal cycle control.

Answer 1159

0.4 failures per 100 women-years ## Footnote This indicates its efficacy is similar to other COCPs.

Answer 1160

Currently £8.39 per month ## Footnote Standard COCPs can cost less than 70p per month.

Answer 1161

It is classified as 'missed' ## Footnote This is different from the 24-hour rule for standard COCPs.

Answer 1162

24/4 pill regimen instead of 21/7 ## Footnote This shorter pill-free interval is aimed at reducing premenstrual symptoms.

Answer 1163

UKMEC 2 ## Footnote This applies to certain health conditions and contraceptive choices.

Answer 1164

UKMEC 4 ## Footnote This indicates an unacceptable health risk.

Answer 1165

UKMEC 1 ## Footnote This classification applies regardless of age or smoking status.

Answer 1166

COCP is contraindicated (UKMEC 4) ## Footnote Women with migraines without aura have different UKMEC classifications.

Answer 1167

Consistent use of condoms in addition to other contraceptives ## Footnote This is to address interactions between contraceptives and anti-epileptic medications.

Answer 1168

UKMEC 3 ## Footnote This indicates that there are concerns about their use.

Answer 1169

UKMEC 1 ## Footnote This indicates it is a safer choice.

Answer 1170

Someone whose gender identity is not congruent with the sex they were assigned at birth ## Footnote This includes transgender men and women, as well as nonbinary individuals.

Answer 1171

Cervical screening ## Footnote This is a preventive measure against cervical cancer.

Answer 1172

Risk of hepatitis A & B and offered vaccinations ## Footnote This is important for sexual health.

Answer 1173

18% ## Footnote The failure rate with perfect use is 2%.

Answer 1174

Does not provide protection against pregnancy ## Footnote If a patient becomes pregnant while on testosterone therapy, it is contraindicated.

Answer 1175

Condoms ## Footnote This is the recommended method for those engaging in vaginal sex.

Answer 1176

If they feel the young person is 'competent' based on the Fraser guidelines

Answer 1177

Requirements for providing contraceptive advice to young people, including: * Understanding professional advice * Cannot be persuaded to inform parents * Likely to have sexual intercourse * Likely to suffer without contraceptive treatment * Best interests require contraceptive advice or treatment

Answer 1178

2 and 12 weeks

Answer 1179

Progesterone-only implant (Nexplanon)

Answer 1180

Levonorgestrel and Ulipristal

Answer 1181

The dose should be repeated

Answer 1182

Inhibition of ovulation

Answer 1183

No later than 120 hours

Answer 1184

Copper IUD

Answer 1185

Nexplanon has a redesigned applicator and is radiopaque

Answer 1186

0.07/100 women-years

Answer 1187

Irregular/heavy bleeding, headache, nausea, breast pain

Answer 1188

Depo Provera

Answer 1189

Medroxyprogesterone acetate

Answer 1190

Not quickly reversible, potential delayed return to fertility

Answer 1191

UKMEC 3: Risks outweigh benefits, UKMEC 4: Unacceptable risk

Answer 1192

More than 99%

Answer 1193

Prevention of fertilisation by decreasing sperm motility

Answer 1194

Heavier periods, uterine perforation, infection, expulsion

Answer 1195

98% effective

Answer 1196

More than 12 months

Answer 1197

Bleeding after 24 weeks of pregnancy

Answer 1198

* Spontaneous abortion * Ectopic pregnancy * Hydatidiform mole

Answer 1199

Painless vaginal bleeding typically around 6-9 weeks

Answer 1200

Light vaginal bleeding with disappearance of symptoms of pregnancy

Answer 1201

* Complete miscarriage: little bleeding * Incomplete miscarriage: heavy bleeding and crampy lower abdominal pain

Answer 1202

6-8 weeks amenorrhoea with unilateral lower abdominal pain and later vaginal bleeding

Answer 1203

* Bleeding in first or early second trimester * Exaggerated symptoms of pregnancy * High serum hCG

Answer 1204

* Constant lower abdominal pain * Tender, tense uterus * Possible fetal heart distress

Answer 1205

Vaginal bleeding with a non-tender uterus

Answer 1206

Rupture of membranes followed immediately by vaginal bleeding and fetal bradycardia

Answer 1207

Invasive ductal carcinoma

Answer 1208

* Mastectomy * Wide local excision

Answer 1209

* Tumour size * Lesion location * Patient choice

Answer 1210

To give an indication of survival in breast cancer

Answer 1211

Tumour Size x 0.2 + Lymph node score + Grade score

Answer 1212

* 2.0 to 2.4: 93% * 2.5 to 3.4: 85% * 3.5 to 5.4: 70% * >5.4: 50%

Answer 1213

* Galactosaemia * Viral infections (e.g. HIV)

Answer 1214

* Antibiotics: penicillins, cephalosporins, trimethoprim * Endocrine: glucocorticoids, levothyroxine * Epilepsy: sodium valproate, carbamazepine * Asthma: salbutamol, theophyllines * Psychiatric: tricyclic antidepressants, antipsychotics * Hypertension: beta-blockers, hydralazine * Anticoagulants: warfarin, heparin * Digoxin

Answer 1215

* Antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides * Psychiatric: lithium, benzodiazepines * Aspirin * Carbimazole * Methotrexate * Sulfonylureas * Cytotoxic drugs * Amiodarone

Answer 1216

* Bonding * Involution of uterus * Protection against breast and ovarian cancer * Cost-effective * Contraceptive effect (unreliable)

Answer 1217

* Transmission of drugs * Transmission of infection (e.g. HIV) * Nutrient inadequacies * Vitamin K deficiency * Breast milk jaundice

Answer 1218

The most common cause of early-onset severe infection in the neonatal period

Answer 1219

* Prematurity * Prolonged rupture of membranes * Previous sibling GBS infection * Maternal pyrexia

Answer 1220

* Universal screening should not be offered * Maternal request is not an indication for screening * Women with previous GBS should be informed of a 50% risk in the current pregnancy

Answer 1221

A viral infection caused by the togavirus, known as German measles

Answer 1222

As high as 90%

Answer 1223

* Sensorineural deafness * Congenital cataracts * Congenital heart disease * Growth retardation * Hepatosplenomegaly * Purpuric skin lesions * 'Salt and pepper' chorioretinitis * Microphthalmia * Cerebral palsy

Answer 1224

Discuss with the local Health Protection Unit for appropriate investigations

Answer 1225

Pregnancy-associated pain, instability, and dysfunction of the symphysis pubis joint

Answer 1226

Around 20%

Answer 1227

* Discomfort in suprapubic or low back area * Pain radiating to upper thighs and perineum * Pain on weight-bearing activities

Answer 1228

* Tenderness of the symphysis pubis * Pain on hip abduction * Waddling gait

Answer 1229

Blood pressure usually falls, particularly the diastolic. ## Footnote Blood pressure continues to fall until 20-24 weeks.

Answer 1230

Blood pressure usually increases to pre-pregnancy levels by term. ## Footnote This trend is part of normal physiological changes during pregnancy.

Answer 1231

Guidance on the management of hypertension and recommendations to reduce the risk of hypertensive disorders. ## Footnote This includes advice for women at high risk of pre-eclampsia to take aspirin.

Answer 1232

75 mg od from 12 weeks until the birth of the baby. ## Footnote 'od' stands for 'once daily'.

Answer 1233

Systolic > 140 mmHg or diastolic > 90 mmHg or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic. ## Footnote These thresholds are used to diagnose hypertension in pregnant women.

Answer 1234

Pre-existing hypertension, Pregnancy-induced hypertension (PIH or gestational hypertension), Pre-eclampsia. ## Footnote Each category has distinct characteristics and management strategies.

Answer 1235

A history of hypertension before pregnancy or an elevated blood pressure > 140/90 mmHg before 20 weeks gestation. ## Footnote Pre-existing hypertension can complicate pregnancy if not managed properly.

Answer 1236

Occurs in the second half of pregnancy (after 20 weeks), no proteinuria, no oedema. ## Footnote PIH occurs in around 5-7% of pregnancies and resolves after birth.

Answer 1237

These should be stopped immediately and alternative antihypertensives started (e.g. labetalol). ## Footnote This is crucial to avoid potential harm to the fetus.

Answer 1238

Pregnancy-induced hypertension in association with proteinuria (> 0.3g / 24 hours). ## Footnote Oedema may occur but is less commonly used as a criterion.

Answer 1239

Oral labetalol. ## Footnote Other options include oral nifedipine and hydralazine.

Answer 1240

False. ## Footnote Pre-existing hypertension occurs in this percentage; PIH occurs in around 5-7%.

Answer 1241

Increased risk of future pre-eclampsia or hypertension. ## Footnote Understanding these risks is important for long-term health management.

Obstetrics and gynaecology Flashcards

Conditions and Presentations