Obstetrics and gynaecology Flashcards

Question 1

Q

Fibroadenoma

Answer

A

Highly mobile, encapsulated breast masses.

Question 2

Q

Breast cysts

Answer

A

Presence of breast lumps, potentially with distension.

Question 3

Q

Mastitis

Answer

A

reast redness, mastalgia, malaise, and fever.

Question 4

Q

Intraductal Papilloma

Answer

A

Bloody discharge from the nipple
+/-mass.
Breast tenderness may also be present.

Question 5

Q

Radial scar

Answer

A

Presents on mammogram as a stellate pattern of central scarring surrounded by proliferating glandular tissue.

Question 6

Q

Fat necrosis

Answer

A

Painless breast mass, skin thickening, or radiographic changes on mammography.

Question 7

Q

Fibrocytic breast disease presentation

Answer

A

Breast lump
pain
tender

Question 8

Q

Mammary duct ectasia

Answer

A

Palpable peri-areolar breast mass,
thick nipple discharge,
mammographic similarities to cancer.

Question 9

Q

Risk of breast cancer (8)

Answer

A

Advancing age
Caucasian ethnicity
Obesity and lack of physical activity
Alcohol and tobacco use
History of breast cancer
Previous radiotherapy treatment
BRACA1/2
Increase hormone exposure

Question 10

Q

Common symptoms for breast cancer (4)

Answer

A

Unexplained breast mass in patients aged 30 and above, with or without pain
50 and older, nipple discharge, retraction or other concerning symptoms
Skin changes suggestive of breast cancer (peu’d orange)
Unexplained axillary mass in those aged 30 and above

Question 11

Q

Lymphoedema

Answer

A

common after breast surgery- axillary clearance

Question 12

Q

Cyclical mastalgia

Answer

A

Breast tenderness that fluctuates around monthly menstrual cycle

Question 13

Q

Epidemiology of cyclical mastalgia

Answer

A

experienced by peri- and premenopausal women

Question 14

Q

Signs and symptoms of breast mastalgia

Answer

A

Breast tenderness
Pain usually beginning a few days before the onset of menstruation and subsiding by the end of the period
Possible breast “lumpiness” associated with fibrocystic changes
Potential presentation of duct ectasia

Question 15

Q

cyclical mastalgia investigations

Answer

A

Mammography or ultrasound: especially for women over 40
hormone panel

Question 16

Q

Managment of cyclical mastalgia

Answer

A

NSAIDs
Severe cases: oral contraceptives or danazol

Question 17

Q

Fat necrosis of the breast

Answer

A

non-malignant condition in which there is death of adipose tissue (fat cells) within the breast
comon in obese patients
associated with trauma

Question 18

Q

Signs and symptoms of fat necrosis

Answer

A

Firm/hard, irregular lump in the breast
skin inflammation, warmth, or bruising

Question 19

Q

Investigations of fat necrosis

Answer

A

Clinical examination
Imaging: Mammography and/or ultrasound
Tissue sampling: Fine needle aspiration cytology (FNAC) or core biopsy

Question 20

Q

Fat necrosis managment

Answer

A

conservative

Question 21

Q

Signs and symptoms of mastitis

Answer

A

Localised symptoms: Painful, tender, red, and hot breast.
Systemic symptoms: Fever, rigors, myalgia, fatigue, nausea, and headache.
usually the first week postpartum.

Question 22

Q

Mastitis investigation

Answer

A

Ultrasound: Utilised to identify a potential abscess, appearing as a collection of pus.
Additional information: Early referral to secondary care is vital if an abscess is suspected.

Question 23

Q

Mastitis management

Answer

A

continue breast feeding
manual expression
analgesia
cephalexin
consider intravenous antibiotics or surgical intervention, especially if a breast abscess develops.

Question 24

Q

Managment of puperal mastitis (5)

Answer

A

continue expression
analgesia
antibiotics
surgical drainage
miconazole (if candidiasis seen)

Question 25

Q

Complications of puperal mastitis

Answer

A

candidiasis of the nipple can occur

Question 26

Q

Fibroadenoma

Answer

A

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

Question 27

Q

epidemiology of fibroadenoma

Answer

A

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

Question 28

Q

Signs and symptoms of fibroadenoma

Answer

A

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

Question 29

Q

Investigations of fibroadenoma

Answer

A

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

Question 30

Q

Managment of fibroadenoma

Answer

A

reassurance
surgical excision

Question 31

Q

Managment of fibrocytic disease

Answer

A

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.

Question 32

Q

Question 33

Q

What has been the significant change in cervical cancer screening in recent years?

Answer

A

The introduction of HPV testing and the move to an HPV first system

The HPV first system tests for high-risk strains of human papillomavirus (hrHPV) before cytological examination.

Question 34

Q

What does hrHPV testing allow for in patients with mild dyskagasis?

Answer

A

Further risk stratification

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

Question 35

Q

What is the management protocol for a negative hrHPV test?

Answer

A

Return to normal recall, unless in the test of cure (TOC) pathway

Individuals treated for CIN1, CIN2, or CIN3 should be invited for a TOC at 6 months.

Question 36

Q

What is the follow-up for untreated CIN1?

Answer

A

Follow-up for incompletely excised CGIN/SMILE or cervical cancer

This includes monitoring for borderline changes in endocerical cells.

Question 37

Q

What happens if hrHPV is positive?

Answer

A

Samples are examined cytologically

If cytology is abnormal, a colposcopy is performed.

Question 38

Q

What cytological results warrant a colposcopy after a positive hrHPV test?

Answer

A

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

Question 39

Q

What should be done if cytology is normal but hrHPV is positive?

Answer

A

Repeat the test at 12 months

If the repeat test is hrHPV negative, return to normal recall.

Question 40

Q

What is the follow-up if hrHPV remains positive after 24 months?

Answer

A

Colposcopy

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

Question 41

Q

What is the protocol for an inadequate sample?

Answer

A

Repeat the sample in 3 months

If two consecutive samples are inadequate, then a colposcopy is performed.

Question 42

Q

What is the most common treatment for cervical intraepithelial neoplasia?

Answer

A

Large loop excision of transformation zone (LLETZ)

LLETZ may be performed during the initial colposcopy visit or at a later date.

Question 43

Q

What is an alternative technique to LLETZ for treating CIN?

Answer

A

Cryotherapy

Cryotherapy is less common compared to LLETZ.

Question 44

Q

What is the definition of amniotic fluid embolism?

Answer

A

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

Question 45

Q

What is the incidence of amniotic fluid embolism in the U.K.?

Answer

A

2/100,000

Question 46

Q

What is the epidemiology of amniotic fluid embolism?

Answer

A

Rare complication of pregnancy associated with a high mortality rate.

Question 47

Q

What risk factors are associated with amniotic fluid embolism?

Answer

A

Maternal age and induction of labour.

Question 48

Q

What must happen for an amniotic fluid embolism to occur?

Answer

A

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

Question 49

Q

When do the majority of cases of amniotic fluid embolism occur?

Answer

A

During labour, caesarean section, or immediate postpartum.

Question 50

Q

List some symptoms of amniotic fluid embolism.

Answer

A

Chills
Shivering
Sweating
Anxiety
Coughing

Question 51

Q

List some signs of amniotic fluid embolism (6)

Answer

A

Cyanosis
Hypotension
Bronchospasms
Tachycardia
Arrhythmia
Myocardial infarction

Question 52

Q

How is amniotic fluid embolism diagnosed?

Answer

A

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

Question 53

Q

What is the management approach for amniotic fluid embolism?

Answer

A

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

Question 54

Q

What is threatened miscarriage?

Answer

A

Painless vaginal bleeding occurring before 24 weeks, typically at 6-9 weeks, often less than menstruation, with a closed cervical os

Complicates up to 25% of all pregnancies.

Question 55

Q

What symptoms are associated with a missed (delayed) miscarriage?

Answer

A

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

When the gestational sac is > 25 mm and no embryonic/fetal part can be seen, it’s termed a ‘blighted ovum’ or ‘anembryonic pregnancy’.

Question 56

Q

What characterizes an inevitable miscarriage?

Answer

A

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

Question 57

Q

What defines an incomplete miscarriage?

Answer

A

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

Question 58

Q

Fill in the blank: Threatened miscarriage typically occurs at _______ weeks.

Question 59

Q

True or False: In a missed miscarriage, the mother usually experiences significant pain.

Question 60

Q

What is the definition of miscarriage?

Answer

A

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

Question 61

Q

What percentage of confirmed pregnancies in the UK are affected by miscarriage?

Answer

A

Approximately 10-20%.

Question 62

Q

When does the highest incidence of miscarriage occur?

Answer

A

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

Question 63

Q

What accounts for about 50% of early miscarriages?

Answer

A

Chromosomal abnormalities.

Question 64

Q

List three risk factors for miscarriage.

Answer

A

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

Answer 62

A

Women over 35 have a significantly higher risk.

Answer 63

A

Smoking
Alcohol consumption
Obesity

Answer 64

A

Uncontrolled diabetes
Thyroid disorders

Answer 65

A

Three or more consecutive losses.

Answer 66

A

Expectant management, medical management, surgical management

These management types are recommended based on individual circumstances and medical history.

Answer 67

A

Waiting for a spontaneous miscarriage

It involves waiting for 7-14 days for the miscarriage to complete spontaneously.

Answer 68

A

Medical or surgical management may be offered

This is contingent on the circumstances of the miscarriage.

Answer 69

A

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

These factors increase the risk and necessitate alternative management approaches.

Answer 70

A

Weakening of attachment to the endometrial wall, cervical softening and dilation, induction of uterine contractions

Mifepristone is a progesterone receptor antagonist used in the management of missed miscarriage.

Answer 71

A

Induces strong myometrial contractions leading to expulsion of products of conception

It is administered 48 hours after mifepristone unless the gestational sac has already been passed.

Answer 72

A

Contact their healthcare professional

Monitoring is crucial to ensure the effectiveness of the treatment.

Answer 73

A

A single dose of misoprostol (vaginal, oral or sublingual)

Women should also be offered antiemetics and pain relief.

Answer 74

A

To confirm the completion of the miscarriage

This is an important follow-up step in the management process.

Answer 75

A

Vacuum aspiration (suction curettage)
Surgical management in theatre

These procedures can be performed under local or general anaesthetic.

Answer 76

A

Under local anaesthetic as an outpatient

This allows for less invasive management compared to surgical procedures requiring general anaesthesia.

Answer 77

A

Evacuation of retained products of conception

This terminology reflects the procedure’s purpose in managing miscarriage.

Answer 78

A

Recurrent miscarriage is defined as 3 or more consecutive spontaneous abortions.

It occurs in around 1% of women.

Answer 79

A

Antiphospholipid syndrome
Endocrine disorders
Uterine abnormality
Parental chromosomal abnormalities
Smoking

Endocrine disorders may include poorly controlled diabetes mellitus and thyroid disorders, as well as polycystic ovarian syndrome.

Answer 80

A

False

It occurs in around 1% of women.

Answer 81

A

Poorly controlled diabetes mellitus
Thyroid disorders
Polycystic ovarian syndrome

These disorders can impact hormonal balance and overall reproductive health.

Answer 82

A

Uterine septum

A uterine septum can interfere with implantation and pregnancy maintenance.

Answer 83

A

[chromosomal]

Answer 84

A

Smoking

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

Answer 85

A

The caudal end of the fetus occupies the lower segment.

Answer 86

A

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

Answer 87

A

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

Answer 88

A

No evidence suggests it does.

Answer 89

A

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

Answer 90

A

The caudal end of the fetus occupies the lower segment.

Answer 91

A

Around 25%.

Answer 92

A

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

Answer 93

A

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

Answer 94

A

Higher perinatal morbidity.

Answer 95

A

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

Answer 96

A

Cord prolapse.

Answer 97

A

Many fetuses will turn spontaneously.

Answer 98

A

From 37 weeks.

Answer 99

A

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

Answer 100

A

No evidence suggests it does.

Answer 101

A

Increased fear of litigation

This reflects a broader trend in medical practice where legal concerns influence clinical decisions.

Answer 102

A

Lower segment caesarean section
Classic caesarean section

Answer 103

A

Longitudinal incision in the upper segment of the uterus

Answer 104

A

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

Answer 105

A

Category 1

Answer 106

A

Within 30 minutes

Answer 107

A

Maternal or fetal compromise which is not immediately life-threatening

Answer 108

A

Within 75 minutes

Answer 109

A

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

Answer 110

A

Lacerations (1-2 babies in every 100)

Answer 111

A

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

Answer 112

A

Previous uterine rupture
Classical caesarean scar

Answer 113

A

[Subfertility due to postoperative adhesions]

Answer 114

A

Haemorrhage
Infection (wound, endometritis, UTI)

Answer 115

A

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)

These complications highlight the risks associated with hysterectomy procedures.

Answer 116

A

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

These risks are significant considerations for women who have had a hysterectomy and plan to conceive again.

Answer 117

A

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)

These complications can affect recovery and future delivery options.

Answer 118

A

Lacerations, one to two babies in every 100

These fetal risks underscore the importance of careful surgical management during pregnancy.

Answer 119

A

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

Answer 120

A

Cesarean section if necessary

Answer 121

A

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

Answer 122

A

Preterm premature rupture of membranes

Answer 123

A

Prompt delivery of the fetus and administration of intravenous antibiotics

Answer 124

A

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 125

A

Second stage of labour.

Answer 126

A

Posterior wall of the vagina and perineum.

Answer 127

A

Fetal distress in the second stage of labour

Fetal distress refers to abnormal fetal heart rate patterns that may indicate a compromised fetus.

Answer 128

A

Maternal distress in the second stage of labour

Maternal distress may involve significant pain or fatigue affecting the mother’s ability to continue labor.

Answer 129

A

Failure to progress in the second stage of labour

This situation occurs when the labor does not advance as expected, potentially risking the health of both mother and baby.

Answer 130

A

Superficial damage with no muscle involvement.

First degree tears do not require any repair.

Answer 131

A

Injury to the perineal muscle, but not involving the anal sphincter. Requires suturing on the ward by a suitably experienced midwife or clinician.

Second degree tears are more significant than first degree but less severe than third degree.

Answer 132

A

3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn

Third degree tears require repair in theatre by a suitably trained clinician.

Answer 133

A

Injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa. Requires repair in theatre by a suitably trained clinician.

Fourth degree tears are the most severe type of perineal tear.

Answer 134

A

Primigravida

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

Answer 135

A

False

First degree tears do not require any repair.

Answer 136

A

Large babies
Precipitant labour
Shoulder dystocia

Forceps delivery is also a risk factor.

Answer 137

A

A temperature of > 38ºC in the first 14 days following delivery

Puerperal pyrexia is a clinical sign often used to identify potential infections post-delivery.

Answer 138

A

Endometritis

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

Answer 139

A

Urinary tract infection
Wound infections (perineal tears + caesarean section)
Mastitis

These conditions can lead to fever in the postpartum period and should be considered in differential diagnosis.

Answer 140

A

Venous thromboembolism

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

Answer 141

A

Refer the patient to hospital for intravenous antibiotics

The recommended antibiotics include clindamycin and gentamicin until the patient is afebrile for greater than 24 hours.

Answer 142

A

[intravenous antibiotics]

Intravenous antibiotics are crucial for managing suspected endometritis effectively.

Answer 143

A

Clindamycin
Gentamicin

These antibiotics are typically administered until the patient has been afebrile for over 24 hours.

Answer 144

A

A complication of vaginal cephalic delivery characterized by the inability to deliver the body of the fetus after the head has been delivered

Shoulder dystocia occurs due to the impaction of the anterior fetal shoulder on the maternal pubic symphysis.

Answer 145

A

Fetal macrosomia
High maternal body mass index
Diabetes mellitus
Prolonged labour

Fetal macrosomia is often associated with maternal diabetes mellitus.

Answer 146

A

Senior help should be called

It is crucial to have experienced personnel involved in the management of shoulder dystocia.

Answer 147

A

Flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen

This manoeuvre increases the relative anterior-posterior angle of the pelvis and often facilitates a successful delivery.

Answer 148

A

False

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

Answer 149

A

McRoberts’ manoeuvre

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

Answer 150

A

No

Oxytocin administration is not indicated in shoulder dystocia.

Answer 151

A

Postpartum haemorrhage
Perineal tears

These complications can arise during or after the delivery process.

Answer 152

A

Brachial plexus injury
Neonatal death

These complications can have serious long-term effects on the neonate.

Answer 153

A

A complication of vaginal cephalic delivery characterized by the inability to deliver the body of the fetus after the head has been delivered

Shoulder dystocia occurs due to the impaction of the anterior fetal shoulder on the maternal pubic symphysis.

Answer 154

A

Fetal macrosomia
High maternal body mass index
Diabetes mellitus
Prolonged labour

Fetal macrosomia is often associated with maternal diabetes mellitus.

Answer 155

A

Senior help should be called

It is crucial to have experienced personnel involved in the management of shoulder dystocia.

Answer 156

A

Flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen

This manoeuvre increases the relative anterior-posterior angle of the pelvis and often facilitates a successful delivery.

Answer 157

A

False

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

Answer 158

A

McRoberts’ manoeuvre

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

Answer 159

A

No

Oxytocin administration is not indicated in shoulder dystocia.

Answer 160

A

Postpartum haemorrhage
Perineal tears

These complications can arise during or after the delivery process.

Answer 161

A

Brachial plexus injury
Neonatal death

These complications can have serious long-term effects on the neonate.

Answer 162

A

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

Answer 163

A

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

Answer 164

A

Longitudinal lie

Answer 165

A

One in 300 foetuses

Answer 166

A

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

Answer 167

A

On the lateral side of the pelvis

Answer 168

A

Scapulo-anterior (most common)
Scapulo-posterior

Answer 169

A

Previous pregnancies

Answer 170

A

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

Answer 171

A

Routine antenatal appointments
Abdominal examination
Ultrasound scan

Answer 172

A

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

Answer 173

A

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

Answer 174

A

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

Answer 175

A

Appointment with the obstetric medical antenatal team to discuss management options

Answer 176

A

External cephalic version

Answer 177

A

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

Answer 178

A

Around 50%

Answer 179

A

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

Answer 180

A

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 181

A

Using a small cup connected to a suction device attached to the baby’s head to help pull the baby out

Ventouse delivery involves applying careful traction to assist in the delivery process.

Answer 182

A

One-fifth or less

This indicates that the fetal head is not overly engaged in the pelvis.

Answer 183

A

The cervix must be fully dilated

Full dilation is necessary to ensure safe delivery.

Answer 184

A

< 34 weeks gestation
Cephalopelvic disproportion
Breech, face or brow presentation

These factors can complicate the delivery process and pose risks to the baby or mother.

Answer 185

A

Cephalhaematoma
Retinal haemorrhages

These complications can arise from the suction and traction applied during the procedure.

Answer 186

A

A single dose of IV co-amoxiclav

This antibiotic helps reduce the risk of infection after the procedure.

Answer 187

A

False

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

Answer 188

A

A condition characterized by an imbalance of bacteria in the vagina

Commonly associated with thin, white discharge and a vaginal pH greater than 4.5.

Answer 189

A

A sexually transmitted infection caused by the protozoan parasite Trichomonas vaginalis

Symptoms include frothy, yellow-green discharge and a ‘strawberry cervix’.

Answer 190

A

Thin, white discharge

Often has a fishy odor, especially after intercourse.

Answer 191

A

Clue cells

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

Answer 192

A

Greater than 4.5

Normal vaginal pH is typically between 3.8 and 4.5.

Answer 193

A

Metronidazole

This antibiotic is effective in restoring the normal vaginal flora.

Answer 194

A

Frothy, yellow-green discharge

This discharge may also have a foul odor.

Answer 195

A

Strawberry cervix

This refers to the appearance of the cervix due to inflammation.

Answer 196

A

Motile trophozoites

These are the active form of the parasite that can be seen under a microscope.

Answer 197

A

Inflammation of the vulva and vagina

It can have various causes including infections, irritants, and allergies.

Answer 198

A

A highly motile, flagellated protozoan parasite

It is the causative agent of trichomoniasis, a sexually transmitted infection.

Answer 199

A

A sexually transmitted infection (STI) caused by Trichomonas vaginalis

It primarily affects the urogenital tract.

Answer 200

A

Offensive, yellow/green, frothy

This type of discharge is a common symptom of the infection.

Answer 201

A

Strawberry cervix

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

Answer 202

A

pH > 4.5

This indicates an alkaline environment, which is associated with the infection.

Answer 203

A

Usually asymptomatic but may cause urethritis

Many men do not show symptoms, making it harder to diagnose.

Answer 204

A

Microscopy of a wet mount shows motile trophozoites

This is a key diagnostic feature observed under the microscope.

Answer 205

A

Oral metronidazole for 5-7 days

A single dose of 2g metronidazole is also supported by the BNF.

Answer 206

A

Atrophic vaginitis

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

Answer 207

A

Vaginal dryness, dyspareunia, occasional spotting

Dyspareunia refers to painful intercourse.

Answer 208

A

Pale and dry

These changes are due to the thinning of the vaginal lining.

Answer 209

A

Vaginal lubricants and moisturisers

These products help alleviate symptoms by adding moisture to the vaginal area.

Answer 210

A

Topical oestrogen cream

This treatment helps to restore vaginal tissue health by increasing estrogen levels locally.

Answer 211

A

Atrophic vaginitis

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

Answer 212

A

Vaginal dryness, dyspareunia, occasional spotting

Dyspareunia refers to painful intercourse.

Answer 213

A

Pale and dry

These changes are due to the thinning of the vaginal lining.

Answer 214

A

Vaginal lubricants and moisturisers

These products help alleviate symptoms by adding moisture to the vaginal area.

Answer 215

A

Topical oestrogen cream

This treatment helps to restore vaginal tissue health by increasing estrogen levels locally.

Answer 216

A

1 in 10 women will seek help at some point

Answer 217

A

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

Answer 218

A

Atopic dermatitis
Seborrhoeic dermatitis
Lichen planus
Lichen sclerosus
Psoriasis

Answer 219

A

Around a third of patients with psoriasis

Answer 220

A

Take showers rather than taking baths

Answer 221

A

An emollient such as Epaderm or Diprobase

Answer 222

A

Clean only once a day

Answer 223

A

Topical steroids

Answer 224

A

Combined steroid-antifungal

Answer 225

A

An autoimmune disorder affecting the gastric mucosa that results in vitamin B12 deficiency

‘Pernicious’ means causing harm, especially in a gradual or subtle way.

Answer 226

A

Pernicious anaemia, atrophic gastritis, gastrectomy, malnutrition

Malnutrition can include conditions such as alcoholism.

Answer 227

A

Antibodies to intrinsic factor and gastric parietal cells

Intrinsic factor antibodies block the vitamin B12 binding site.

Answer 228

A

Reduced vitamin B12 absorption

This occurs due to the presence of gastric parietal cell antibodies leading to atrophic gastritis.

Answer 229

A

Megaloblastic anaemia and neuropathy

Vitamin B12 is crucial for blood cell production and myelination of nerves.

Answer 230

A

1.6:1 (female to male)

More common in females, typically develops in middle to old age.

Answer 231

A

Thyroid disease, type 1 diabetes mellitus, Addison’s disease, rheumatoid arthritis, vitiligo

These associations highlight the autoimmune nature of pernicious anaemia.

Answer 232

A

Blood group A

This suggests a potential genetic predisposition.

Answer 233

A

Lethargy, pallor, dyspnoea

These are common symptoms of anaemia.

Answer 234

A

Peripheral neuropathy

Typically symmetrical and affects the legs more than the arms.

Answer 235

A

Progressive weakness, ataxia, paresthesias, which may progress to spasticity and paraplegia

This condition is linked to vitamin B12 deficiency.

Answer 236

A

Memory loss, poor concentration, confusion, depression, irritability

These symptoms can significantly affect quality of life.

Answer 237

A

A sore tongue

This can be a symptom of pernicious anaemia.

Answer 238

A

‘Lemon tinge’

This describes a specific coloration seen in some patients.

Answer 239

A

An autoimmune disorder affecting the gastric mucosa that results in vitamin B12 deficiency

‘Pernicious’ means causing harm, especially in a gradual or subtle way.

Answer 240

A

Pernicious anaemia, atrophic gastritis, gastrectomy, malnutrition

Malnutrition can include conditions such as alcoholism.

Answer 241

A

Antibodies to intrinsic factor and gastric parietal cells

Intrinsic factor antibodies block the vitamin B12 binding site.

Answer 242

A

Reduced vitamin B12 absorption

This occurs due to the presence of gastric parietal cell antibodies leading to atrophic gastritis.

Answer 243

A

Megaloblastic anaemia and neuropathy

Vitamin B12 is crucial for blood cell production and myelination of nerves.

Answer 244

A

1.6:1 (female to male)

More common in females, typically develops in middle to old age.

Answer 245

A

Thyroid disease, type 1 diabetes mellitus, Addison’s disease, rheumatoid arthritis, vitiligo

These associations highlight the autoimmune nature of pernicious anaemia.

Answer 246

A

Blood group A

This suggests a potential genetic predisposition.

Answer 247

A

Lethargy, pallor, dyspnoea

These are common symptoms of anaemia.

Answer 248

A

Peripheral neuropathy

Typically symmetrical and affects the legs more than the arms.

Answer 249

A

Progressive weakness, ataxia, paresthesias, which may progress to spasticity and paraplegia

This condition is linked to vitamin B12 deficiency.

Answer 250

A

Memory loss, poor concentration, confusion, depression, irritability

These symptoms can significantly affect quality of life.

Answer 251

A

A sore tongue

This can be a symptom of pernicious anaemia.

Answer 252

A

‘Lemon tinge’

This describes a specific coloration seen in some patients.

Answer 253

A

Macrocytic anaemia

Answer 254

A

Polymorphs

Answer 255

A

Low WCC and platelets

Answer 256

A

> = 200 nh/L

Answer 257

A

Sensitivity 50%, specificity 95-100%

Answer 258

A

Radiolabelled B12 given on two occasions, urine B12 levels measured

Answer 259

A

Intramuscularly

Answer 260

A

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

Answer 261

A

More frequent doses of vitamin B12

Answer 262

A

Oral vitamin B12

Answer 263

A

Folic acid

Answer 264

A

Increased risk of gastric cancer

Answer 265

A

Macrocytic anaemia

Answer 266

A

Polymorphs

Answer 267

A

Low WCC and platelets

Answer 268

A

> = 200 nh/L

Answer 269

A

Sensitivity 50%, specificity 95-100%

Answer 270

A

Radiolabelled B12 given on two occasions, urine B12 levels measured

Answer 271

A

Intramuscularly

Answer 272

A

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

Answer 273

A

More frequent doses of vitamin B12

Answer 274

A

Oral vitamin B12

Answer 275

A

Folic acid

Answer 276

A

Increased risk of gastric cancer

Answer 277

A

Red blood cell development and maintenance of the nervous system

Answer 278

A

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

Answer 279

A

Pernicious anaemia

Answer 280

A

passively

Answer 281

A

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

Answer 282

A

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

Answer 283

A

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

Answer 284

A

To avoid precipitating subacute combined degeneration of the cord

Answer 285

A

The dorsal column (joint position, vibration)

Answer 286

A

Macrocytic anaemia

Answer 287

A

Joint position sense loss
Vibration sense loss
Distal paraesthesia
Mood disturbances

Answer 288

A

Pregnancy

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

Answer 289

A

At booking and on any subsequent hospital admission

This ensures continuous monitoring of the woman’s risk status.

Answer 290

A

Considered high risk; requires low molecular weight heparin throughout the antenatal period

Expert input is also recommended for high-risk cases.

Answer 291

A

Hospitalisation, surgery, co-morbidities, or thrombophilia

These factors necessitate consideration for antenatal prophylactic low molecular weight heparin.

Answer 292

A

Age > 35
Body mass index > 30
Parity > 3

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 293

A

Immediate treatment with low molecular weight heparin continued until six weeks postnatal

This is crucial for high-risk patients to prevent VTE.

Answer 294

A

From 28 weeks and continued until six weeks postnatal

This timing helps mitigate the risk of VTE during the later stages of pregnancy.

Answer 295

A

Continue anticoagulation treatment for at least 3 months

This is consistent with the management of other patients with provoked DVTs.

Answer 296

A

Low molecular weight heparin

It is preferred over Direct Oral Anticoagulants (DOACs) and warfarin, which should be avoided during pregnancy.

Answer 297

A

False

DOACs should be avoided in pregnancy due to safety concerns.

Answer 298

A

Benign smooth muscle tumours of the uterus

Answer 299

A

Around 20%

Answer 300

A

Around 50%

Answer 301

A

Afro-Caribbean women

Answer 302

A

Before puberty

Answer 303

A

Oestrogen

Answer 304

A

Asymptomatic
Menorrhagia
Lower abdominal pain
Bloating
Urinary symptoms
Subfertility

Answer 305

A

Iron-deficiency anaemia

Answer 306

A

Polycythaemia secondary to autonomous production of erythropoietin

Answer 307

A

Transvaginal ultrasound

Answer 308

A

No treatment is needed other than periodic review

Answer 309

A

Levonorgestrel intrauterine system (LNG-IUS)

Answer 310

A

Mefenamic acid
Tranexamic acid

Answer 311

A

Combined oral contraceptive pill
Oral progestogen

Answer 312

A

Injectable progestogen

Answer 313

A

To reduce the size of the fibroid

Answer 314

A

Hot flushes
Vaginal dryness
Loss of bone mineral density

Answer 315

A

Ulipristal acetate

Answer 316

A

Myomectomy
Hysteroscopic endometrial ablation
Hysterectomy
Uterine artery embolization

Answer 317

A

They generally regress

Answer 318

A

Red degeneration

Answer 319

A

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

Answer 320

A

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

Answer 321

A

Oral glucose tolerance test (OGTT)

Answer 322

A

24-28 weeks

Answer 323

A

> = 5.6 mmol/L

Answer 324

A

> = 7.8 mmol/L

Answer 325

A

Within a week

Answer 326

A

Eating foods with a low glycaemic index

Answer 327

A

A trial of diet and exercise

Answer 328

A

Metformin

Answer 329

A

Short-acting insulin

Answer 330

A

Start insulin

Answer 331

A

5.3 mmol/L

Answer 332

A

7.8 mmol/L

Answer 333

A

6.4 mmol/L

Answer 334

A

Glibenclamide should be offered

Answer 335

A

Retinopathy

Answer 336

A

Weight loss

Answer 337

A

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

Answer 338

A

Occurs in 1/500 deliveries.

Answer 339

A

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

Answer 340

A

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

Answer 341

A

At artificial rupture of the membranes.

Answer 342

A

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 343

A

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

Answer 344

A

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

Answer 345

A

All fours.

Answer 346

A

Left lateral position.

Answer 347

A

Tocolytics.

Answer 348

A

It gently elevates the presenting part.

Answer 349

A

Caesarian section.

Answer 350

A

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

Answer 351

A

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

Answer 352

A

Classically seen in post-menopausal women

Around 25% of cases occur before menopause.

Answer 353

A

Usually carries a good prognosis due to early detection

Early detection is key to better outcomes.

Answer 354

A

Excess oestrogen
Nulliparity
Early menarche
Late menopause
Unopposed oestrogen
Metabolic syndrome
Obesity
Diabetes mellitus
Polycystic ovarian syndrome
Tamoxifen
Hereditary non-polyposis colorectal carcinoma

The addition of a progestogen to oestrogen reduces the risk.

Answer 355

A

Multiparity
Combined oral contraceptive pill
Smoking

The reasons for smoking being protective are unclear.

Answer 356

A

Postmenopausal bleeding

Typically, it is slight and intermittent initially before becoming heavier.

Answer 357

A

Menorrhagia
Intermenstrual bleeding

Pain is not common and typically signifies extensive disease.

Answer 358

A

Refer using the suspected cancer pathway

This is crucial for timely diagnosis.

Answer 359

A

Trans-vaginal ultrasound

A normal endometrial thickness (< 4 mm) has a high negative predictive value.

Answer 360

A

Surgery

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

Answer 361

A

Postoperative radiotherapy

This is to reduce the risk of recurrence.

Answer 362

A

Progestogen therapy

This is a less invasive treatment option.

Answer 363

A

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

Answer 364

A

Around 10%.

Answer 365

A

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 366

A

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

Answer 367

A

Laparoscopy.

Answer 368

A

The patient should be referred for a definitive diagnosis.

Answer 369

A

NSAIDs
Paracetamol

Answer 370

A

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

Answer 371

A

Referral to secondary care.

Answer 372

A

GnRH analogues
Surgery

Answer 373

A

They induce a ‘pseudomenopause’ due to low oestrogen levels.

Answer 374

A

It does not seem to have a significant impact.

Answer 375

A

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

Answer 376

A

[trying to conceive]

Answer 377

A

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

Answer 378

A

Miscarriage
Gestational diabetes
Pre-eclampsia

Answer 379

A

Higher caesarean section rate.

Answer 380

A

Congenital anomaly
Prematurity

Answer 381

A

Increased risk of developing obesity
Metabolic disorders in childhood

Answer 382

A

5mg, rather than 400mcg.

Answer 383

A

24-28 weeks.

Answer 384

A

In a consultant-led obstetric unit.

Answer 385

A

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

Answer 386

A

Venous thromboembolism
Dysfunctional labour
Postpartum haemorrhage

Answer 387

A

Increased risk of neonatal death.

Answer 388

A

Postpartum haemorrhage (PPH)

PPH may be primary or secondary.

Answer 389

A

Within 24 hours

It affects around 5-7% of deliveries.

Answer 390

A

Tone (uterine atony)
Trauma (e.g. perineal tear)
Tissue (retained placenta)
Thrombin (e.g. clotting/bleeding disorder)

The vast majority of cases are due to uterine atony.

Answer 391

A

Previous PPH
Prolonged labour
Pre-eclampsia
Increased maternal age
Polyhydramnios
Emergency Caesarean section
Placenta praevia, placenta accreta
Macrosomia

The effect of parity on the risk of PPH is complicated; modern studies suggest nulliparity is a risk factor.

Answer 392

A

ABC approach

Involvement of senior staff is essential.

Answer 393

A

Lie her flat

This is part of the immediate response to PPH.

Answer 394

A

Two peripheral cannulae, 14 gauge

This is important for fluid resuscitation.

Answer 395

A

Group and save

Blood tests are crucial for transfusion planning.

Answer 396

A

Palpate the uterine fundus and rub it to stimulate contractions

This technique is known as ‘rubbing up the fundus’.

Answer 397

A

IV oxytocin: slow IV injection followed by an IV infusion

Oxytocin is a key medication used to manage uterine atony.

Answer 398

A

Ergometrine

It is administered slow IV or IM.

Answer 399

A

Interest in its role may be significant

It is being researched for its effectiveness in PPH.

Answer 400

A

Intrauterine balloon tamponade

This is recommended by the RCOG.

Answer 401

A

B-Lynch suture
Ligation of the uterine arteries
Ligation of internal iliac arteries
Hysterectomy (if severe)

Hysterectomy is a life-saving procedure in cases of uncontrolled hemorrhage.

Answer 402

A

Between 24 hours - 12 weeks

It is typically due to retained placental tissue or endometritis.

Answer 403

A

Postpartum haemorrhage (PPH)

PPH may be primary or secondary.

Answer 404

A

Within 24 hours

It affects around 5-7% of deliveries.

Answer 405

A

Tone (uterine atony)
Trauma (e.g. perineal tear)
Tissue (retained placenta)
Thrombin (e.g. clotting/bleeding disorder)

The vast majority of cases are due to uterine atony.

Answer 406

A

Previous PPH
Prolonged labour
Pre-eclampsia
Increased maternal age
Polyhydramnios
Emergency Caesarean section
Placenta praevia, placenta accreta
Macrosomia

The effect of parity on the risk of PPH is complicated; modern studies suggest nulliparity is a risk factor.

Answer 407

A

ABC approach

Involvement of senior staff is essential.

Answer 408

A

Lie her flat

This is part of the immediate response to PPH.

Answer 409

A

Two peripheral cannulae, 14 gauge

This is important for fluid resuscitation.

Answer 410

A

Group and save

Blood tests are crucial for transfusion planning.

Answer 411

A

Palpate the uterine fundus and rub it to stimulate contractions

This technique is known as ‘rubbing up the fundus’.

Answer 412

A

IV oxytocin: slow IV injection followed by an IV infusion

Oxytocin is a key medication used to manage uterine atony.

Answer 413

A

Ergometrine

It is administered slow IV or IM.

Answer 414

A

Interest in its role may be significant

It is being researched for its effectiveness in PPH.

Answer 415

A

Intrauterine balloon tamponade

This is recommended by the RCOG.

Answer 416

A

B-Lynch suture
Ligation of the uterine arteries
Ligation of internal iliac arteries
Hysterectomy (if severe)

Hysterectomy is a life-saving procedure in cases of uncontrolled hemorrhage.

Answer 417

A

Between 24 hours - 12 weeks

It is typically due to retained placental tissue or endometritis.

Answer 418

A

The 1967 Abortion Act

The law was amended in 1990, reducing the upper limit from 28 weeks to 24 weeks gestation.

Answer 419

A

Two registered medical practitioners (only one in an emergency)

This is a legal requirement under the 1967 Abortion Act.

Answer 420

A

Only a registered medical practitioner

The procedure must take place in an NHS hospital or licensed premise.

Answer 421

A

Anti-D prophylaxis

This is to prevent Rh incompatibility.

Answer 422

A

RU486

It is an anti-progestogen used in medical abortions.

Answer 423

A

Prostaglandins (e.g., misoprostol)

This is administered 48 hours later to stimulate uterine contractions.

Answer 424

A

A multi-level pregnancy test

This test detects the level of hCG.

Answer 425

A

Manual vacuum aspiration (MVA)
Electric vacuum aspiration (EVA)
Dilatation and evacuation (D&E)

These are surgical options for abortion.

Answer 426

A

Cervical priming with misoprostol +/- mifepristone

It is used before surgical procedures.

Answer 427

A

Local anaesthesia alone
Conscious sedation with local anaesthesia
Deep sedation
General anaesthesia

Choice depends on the woman’s preference and the procedure.

Answer 428

A

Women should be offered a choice between medical or surgical abortion

Patient decision aids are usually provided.

Answer 429

A

False

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

Answer 430

A

They are usually done at home

This is often due to the lower risk of complications.

Answer 431

A

To save the life of the woman
Evidence of extreme fetal abnormality
Risk of serious physical or mental injury to the woman

These exceptions are outlined in the 1967 Abortion Act.

Answer 432

A

That the pregnancy has not exceeded its 24th week and involves risks to the woman’s health or life

This is based on the provisions of the 1967 Abortion Act.

Answer 433

A

Descent of one of the pelvic organs resulting in protrusion on the vaginal walls

It probably affects around 40% of postmenopausal women

Answer 434

A

Cystocele, cystourethrocele
Rectocele
Uterine prolapse
Urethrocele (less common)
Enterocele (less common)

Enterocele involves herniation of the pouch of Douglas, including small intestine, into the vagina

Answer 435

A

Increasing age
Multiparity, vaginal deliveries
Obesity
Spina bifida

Answer 436

A

Sensation of pressure, heaviness, ‘bearing-down’
Urinary symptoms: incontinence, frequency, urgency

Answer 437

A

No treatment needed

Answer 438

A

Weight loss
Pelvic floor muscle exercises
Ring pessary

Answer 439

A

Anterior colporrhaphy
Colposuspension

Answer 440

A

Hysterectomy
Sacrohysteropexy

Answer 441

A

Posterior colporrhaphy

Answer 442

A

A statistical definition with no universally agreed percentile, often using the 10th percentile

10% of normal babies will be below the tenth percentile; applicable antenatally or postnatally.

Answer 443

A

A clinical diagnosis indicating a fetus is not achieving its growth potential due to pathological reasons.

IUGR is a subset of SGA.

Answer 444

A

No, not all SGA babies have IUGR.

All IUGR babies are considered SGA.

Answer 445

A

Incorrect dating, constitutionally small (normal), or an abnormal fetus

Can be symmetrical or asymmetrical.

Answer 446

A

Symmetrical: fetal head circumference & abdominal circumference are equally small; Asymmetrical: abdominal circumference slows relative to head circumference increase

Symmetrical accounts for 60% of cases, asymmetrical for 40%.

Answer 447

A

Idiopathic
Race (white > black > Asian)
Sex (boy > girl)
Placental insufficiency
Pre-eclampsia
Chromosomal and congenital abnormalities
Infection (CMV, parvovirus, rubella, syphilis, toxoplasmosis)
Malnutrition

Symmetrical SGA causes are primarily idiopathic.

Answer 448

A

Toxins: smoking, heroin
Toxins: alcohol (FAS), cigarettes, heroin
Chromosomal and congenital abnormalities

Asymmetrical SGA is influenced by external factors.

Answer 449

A

Fortnightly ultrasound growth assessment to demonstrate normal growth rate and check for pathological causes

Includes checking maternal blood for infections and searching the fetus for chromosomal abnormality markers.

Answer 450

A

Fortnightly ultrasound growth assessment, biophysical profile, Doppler waveforms from umbilical circulation, and consider daily CTGs

If sub-optimal results, consider delivery.

Answer 451

A

False

Some causes are related to fetal factors or external toxins.

Answer 452

A

[clinical]

Answer 453

A

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

Answer 454

A

1,000-4,000 deaths.

Answer 455

A

Around 15%.

Answer 456

A

Management was based solely on the degree of dyskaryosis.

Answer 457

A

Further risk-stratification of patients with mild dyskaryosis.

Answer 458

A

An HPV first system.

Answer 459

A

Between the ages of 25-64 years.

Answer 460

A

Every 3 years.

Answer 461

A

Every 5 years.

Answer 462

A

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

Answer 463

A

From ages 25-64 every 5 years.

Answer 464

A

3 months post-partum.

Answer 465

A

They have a very low risk of developing cervical cancer.

Answer 466

A

Around mid-cycle.

Answer 467

A

No, there is limited evidence.

Answer 468

A

Infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries, and surrounding peritoneum.

Usually results from ascending infection from the endocervix.

Answer 469

A

Chlamydia trachomatis

Other causative organisms include Neisseria gonorrhoeae, Mycoplasma genitalium, and Mycoplasma hominis.

Answer 470

A

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

Answer 471

A

A pregnancy test

Other investigations include a high vaginal swab, which is often negative, and screening for Chlamydia and Gonorrhoea.

Answer 472

A

Stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole

This regimen is preferred to avoid systemic fluoroquinolones where possible.

Answer 473

A

Oral ofloxacin + oral metronidazole

Answer 474

A

Intrauterine contraceptive devices (IUDs)

BASHH guidelines suggest that evidence is limited, but removal of the IUD should be considered for better short-term clinical outcomes.

Answer 475

A

A complication of PID characterized by right upper quadrant pain, which may be confused with cholecystitis.

Occurs in around 10% of cases.

Answer 476

A

10-20%

Infertility is one of the serious complications of PID.

Answer 477

A

Infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries, and surrounding peritoneum.

Usually results from ascending infection from the endocervix.

Answer 478

A

Chlamydia trachomatis

Other causative organisms include Neisseria gonorrhoeae, Mycoplasma genitalium, and Mycoplasma hominis.

Answer 479

A

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

Answer 480

A

A pregnancy test

Other investigations include a high vaginal swab, which is often negative, and screening for Chlamydia and Gonorrhoea.

Answer 481

A

Stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole

This regimen is preferred to avoid systemic fluoroquinolones where possible.

Answer 482

A

Oral ofloxacin + oral metronidazole

Answer 483

A

Intrauterine contraceptive devices (IUDs)

BASHH guidelines suggest that evidence is limited, but removal of the IUD should be considered for better short-term clinical outcomes.

Answer 484

A

A complication of PID characterized by right upper quadrant pain, which may be confused with cholecystitis.

Occurs in around 10% of cases.

Answer 485

A

10-20%

Infertility is one of the serious complications of PID.

Answer 486

A

Nausea and vomiting of pregnancy (NVP)

This term replaces the previously used term ‘morning sickness’.

Answer 487

A

The extreme form of nausea and vomiting of pregnancy (NVP)

It occurs in around 1% of pregnancies.

Answer 488

A

Between 8 and 12 weeks

It may persist up to 20 weeks.

Answer 489

A

Raised beta hCG levels

Beta hCG is a hormone produced during pregnancy.

Answer 490

A

Increased levels of beta-hCG
Multiple pregnancies
Trophoblastic disease
Nulliparity
Obesity
Family or personal history of NVP

Nulliparity refers to a woman who has never given birth.

Answer 491

A

False

Smoking is associated with a decreased incidence of hyperemesis.

Answer 492

A

Ovarian cancer

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

Answer 493

A

Around 90%

70-80% of these cases are due to serous carcinomas.

Answer 494

A

Distal end of the fallopian tube

This recognition has increased in recent studies.

Answer 495

A

BRCA1 or BRCA2

Family history of these mutations significantly raises risk.

Answer 496

A

Early menarche, late menopause, nulliparity

These factors contribute to increased ovulation cycles.

Answer 497

A

Abdominal distension and bloating, abdominal and pelvic pain, urinary symptoms, early satiety, diarrhea

These symptoms are often vague and nonspecific.

Answer 498

A

CA125

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

Answer 499

A

35 IU/mL or greater

A raised CA125 level prompts further imaging studies.

Answer 500

A

No

CA125 should not be used for screening in asymptomatic women.

Answer 501

A

Combination of surgery and platinum-based chemotherapy

This approach is standard for treating ovarian cancer.

Answer 502

A

80%

Late-stage presentation is common, impacting prognosis.

Answer 503

A

46%

This statistic highlights the poor prognosis associated with the disease.

Answer 504

A

False

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

Answer 505

A

Reduces the risk

Fewer ovulations lead to a decreased risk of ovarian cancer.

Answer 506

A

diagnostic laparotomy

This procedure is typically necessary due to the difficulty of diagnosis.

Answer 507

A

not alone a sign of low milk supply

Answer 508

A

a poor latch

Answer 509

A

blocked duct (‘milk bleb’)

Answer 510

A

miconazole cream; nystatin suspension

Answer 511

A

flucloxacillin

Answer 512

A

a breast abscess

Answer 513

A

first few

Answer 514

A

blocked milk ducts
mastitis
difficulties with breastfeeding
difficulties with milk supply

Answer 515

A

hand expression of milk

Answer 516

A

intermittent

Answer 517

A

exposure to cold

Answer 518

A

10% cut-off

Answer 519

A

midwife-led breastfeeding clinics

Answer 520

A

not alone a sign of low milk supply

Answer 521

A

a poor latch

Answer 522

A

blocked duct (‘milk bleb’)

Answer 523

A

miconazole cream; nystatin suspension

Answer 524

A

flucloxacillin

Answer 525

A

a breast abscess

Answer 526

A

first few

Answer 527

A

blocked milk ducts
mastitis
difficulties with breastfeeding
difficulties with milk supply

Answer 528

A

hand expression of milk

Answer 529

A

intermittent

Answer 530

A

exposure to cold

Answer 531

A

10% cut-off

Answer 532

A

Galactosaemia, viral infections (controversial with HIV)

The controversy around HIV relates to the higher infant mortality and morbidity associated with bottle feeding.

Answer 533

A

Penicillins, cephalosporins, trimethoprim

These antibiotics have been deemed safe for breastfeeding mothers.

Answer 534

A

Glucocorticoids (avoid high doses), levothyroxine

Levothyroxine is considered safe in small amounts.

Answer 535

A

Sodium valproate, carbamazepine

Answer 536

A

Salbutamol, theophyllines

Answer 537

A

Tricyclic antidepressants, antipsychotics

Clozapine should be avoided.

Answer 538

A

Beta-blockers, hydralazine

Answer 539

A

Warfarin, heparin

Answer 540

A

Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

Answer 541

A

Lithium, benzodiazepines

Answer 542

A

Carbimazole

Answer 543

A

Methotrexate

Answer 544

A

Cytotoxic drugs

Answer 545

A

Amiodarone

Answer 546

A

Galactosaemia, viral infections (controversial with HIV)

The controversy around HIV relates to the higher infant mortality and morbidity associated with bottle feeding.

Answer 547

A

Penicillins, cephalosporins, trimethoprim

These antibiotics have been deemed safe for breastfeeding mothers.

Answer 548

A

Glucocorticoids (avoid high doses), levothyroxine

Levothyroxine is considered safe in small amounts.

Answer 549

A

Sodium valproate, carbamazepine

Answer 550

A

Salbutamol, theophyllines

Answer 551

A

Tricyclic antidepressants, antipsychotics

Clozapine should be avoided.

Answer 552

A

Beta-blockers, hydralazine

Answer 553

A

Warfarin, heparin

Answer 554

A

Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

Answer 555

A

Lithium, benzodiazepines

Answer 556

A

Carbimazole

Answer 557

A

Methotrexate

Answer 558

A

Cytotoxic drugs

Answer 559

A

Amiodarone

Answer 560

A

Stop suckling/expressing

This technique involves preventing stimulation of the breast, which triggers milk production.

Answer 561

A

Well-supported bra and analgesia

These measures help to alleviate discomfort associated with the cessation of lactation.

Answer 562

A

Cabergoline

Cabergoline is a dopamine agonist that can help suppress lactation.

Answer 563

A

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 564

A

No, BV is not a sexually transmitted infection.

Answer 565

A

Sexually active women.

Answer 566

A

‘Fishy’, offensive discharge.

Answer 567

A

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 568

A

They are stippled vaginal epithelial cells observed on microscopy.

Answer 569

A

The addition of potassium hydroxide results in a fishy odour.

Answer 570

A

Treatment is not usually required.

Answer 571

A

Oral metronidazole for 5-7 days.

Answer 572

A

A single oral dose of metronidazole 2g.

Answer 573

A

Topical metronidazole or topical clindamycin.

Answer 574

A

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

Answer 575

A

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

Answer 576

A

Oral metronidazole is recommended throughout pregnancy.

Answer 577

A

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

Answer 578

A

The higher, stat dose of metronidazole.

Answer 579

A

Condoms and diaphragms/cervical caps

Barrier methods are widely used for contraception.

Answer 580

A

98%

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

Answer 581

A

80%

Efficacy rates can vary between perfect use and typical use.

Answer 582

A

92-96%

This efficacy is contingent upon the use of spermicide.

Answer 583

A

False

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

Answer 584

A

Polyurethane condoms

These condoms provide an alternative for those with latex allergies.

Answer 585

A

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 586

A

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 587

A

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 588

A

Recurrence occurs in 45-90% of subsequent pregnancies.

Answer 589

A

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 590

A

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

Answer 591

A

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

Answer 592

A

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

Answer 593

A

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

Answer 594

A

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

Answer 595

A

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

Answer 596

A

Gilbert’s syndrome and Dubin-Johnson syndrome

Answer 597

A

Haemolysis
Elevated Liver enzymes
Low Platelets

Answer 598

A

‘Baby-blues’ to puerperal psychosis

Answer 599

A

10-item questionnaire, maximum score of 30

Answer 600

A

‘Depressive illness of varying severity’

Answer 601

A

Self-harm

Answer 602

A

Anxious, tearful, and irritable

Answer 603

A

Around 10%

Answer 604

A

Within a month

Answer 605

A

Approximately 0.2%

Answer 606

A

Within the first 2-3 weeks

Answer 607

A

Severe swings in mood and disordered perception

Answer 608

A

Reassurance and support

Answer 609

A

Cognitive behavioural therapy

Answer 610

A

*Sertraline
*Paroxetine

Answer 611

A

Admission to hospital, ideally in a Mother & Baby Unit

Answer 612

A

Paroxetine

Answer 613

A

Fluoxetine

Answer 614

A

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

After 20-24 weeks, blood pressure typically increases to pre-pregnancy levels by term.

Answer 615

A

Guidance on management and recommendations on reducing the risk of hypertensive disorders

Specifically, women at high risk of pre-eclampsia should take aspirin 75mg od from 12 weeks until birth.

Answer 616

A

Systolic > 140 mmHg or diastolic > 90 mmHg or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic

This definition helps categorize the patient’s condition.

Answer 617

A

Pre-existing hypertension
Pregnancy-induced hypertension (PIH)
Pre-eclampsia

Each category has specific criteria and implications for management.

Answer 618

A

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

No proteinuria or oedema is present.

Answer 619

A

Occurs in 3-5% of pregnancies

More common in older women.

Answer 620

A

These should be stopped immediately and alternative antihypertensives started

Labetalol is a recommended alternative while awaiting specialist review.

Answer 621

A

Hypertension occurring in the second half of pregnancy (after 20 weeks) with no proteinuria or oedema

Occurs in around 5-7% of pregnancies.

Answer 622

A

Increased risk of future pre-eclampsia or hypertension later in life

PIH typically resolves following birth, usually after one month.

Answer 623

A

Oral labetalol

Alternatives include oral nifedipine and hydralazine.

Answer 624

A

Pregnancy-induced hypertension with proteinuria (> 0.3g / 24 hours)

Oedema may occur but is now less commonly used as a criterion.

Answer 625

A

False

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

Answer 626

A

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

Answer 627

A

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

Answer 628

A

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 629

A

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 630

A

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 631

A

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 632

A

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 633

A

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

Answer 634

A

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

Answer 635

A

Blood pressure ≥ 160/110 mmHg

Answer 636

A

Oral labetalol

Answer 637

A

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

Answer 638

A

Delivery of the baby

Answer 639

A

≥ 140/90 mmHg

Answer 640

A

Ectopic pregnancy

This condition can be life-threatening if not diagnosed and treated promptly.

Answer 641

A

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

The history helps in identifying the condition early.

Answer 642

A

Lower abdominal pain

Pain is typically constant and may be unilateral.

Answer 643

A

Usually less than a normal period, may be dark brown in color

This bleeding differs from typical menstrual bleeding.

Answer 644

A

6-8 weeks from the start of the last period

If longer, it may suggest other causes such as inevitable abortion.

Answer 645

A

Dizziness, fainting or syncope, breast tenderness

These symptoms may indicate complications or associated conditions.

Answer 646

A

Abdominal tenderness, cervical excitation, adnexal mass

Cervical motion tenderness is an important finding.

Answer 647

A

NOT to examine for an adnexal mass due to increased risk of rupturing the pregnancy

A pelvic examination for cervical excitation is still recommended.

Answer 648

A

Serum bHCG levels >1,500

This level is significant in differentiating ectopic pregnancy from other conditions.

Answer 649

A

Implantation of a fertilized ovum outside the uterus

Ectopic pregnancies are often life-threatening conditions that require prompt medical attention.

Answer 650

A

c. 0.5% of all pregnancies

This statistic indicates that ectopic pregnancies are relatively rare but can have serious implications.

Answer 651

A

Damage to tubes (pelvic inflammatory disease, surgery)
Previous ectopic pregnancy
Endometriosis
IUCD
Progesterone only pill
IVF (3% of pregnancies are ectopic)

Understanding these risk factors can help in identifying women who may be at higher risk for ectopic pregnancies.

Answer 652

A

[outside the uterus]

Answer 653

A

True

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

Answer 654

A

3%

This highlights the increased risk of ectopic pregnancy associated with assisted reproductive technologies.

Answer 655

A

In an early pregnancy assessment unit

Answer 656

A

She should be referred to the emergency department

Answer 657

A

Transvaginal ultrasound

Answer 658

A

Expectant management
Medical management
Surgical management

Answer 659

A

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

Answer 660

A

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

Answer 661

A

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

Answer 662

A

Closely monitoring the patient over 48 hours

Answer 663

A

Giving the patient methotrexate

Answer 664

A

Can involve salpingectomy or salpingotomy

Answer 665

A

Salpingectomy

Answer 666

A

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

Answer 667

A

Around 1 in 5 women

Answer 668

A

intrauterine pregnancy

Answer 669

A

97%

Most of these occur in the ampulla segment of the tube.

Answer 670

A

Isthmus

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

Answer 671

A

3%

These locations include the ovary, cervix, or peritoneum.

Answer 672

A

Invades the tubal wall, producing bleeding

This invasion may dislodge the embryo.

Answer 673

A

Absorption and tubal abortion

These outcomes refer to the body’s response to the ectopic tissue.

Answer 674

A

A process where the ectopic pregnancy is expelled from the tube

This can happen if the embryo is shed or absorbed.

Answer 675

A

If the tube does not rupture, blood and embryo may be shed or converted into a tubal mole and absorbed

This is a non-destructive outcome of an ectopic pregnancy.

Answer 676

A

A significant complication of ectopic pregnancy

This can lead to severe internal bleeding and requires immediate medical attention.

Answer 677

A

A placenta lying wholly or partly in the lower uterine segment

It can lead to complications during pregnancy and delivery.

Answer 678

A

5%

Most of these placentas rise away from the cervix by delivery.

Answer 679

A

0.5%

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

Answer 680

A

Multiparity
Multiple pregnancy
Lower segment scar from previous caesarean section

These factors increase the likelihood of implantation in the lower uterine segment.

Answer 681

A

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

These features help differentiate it from other obstetric emergencies.

Answer 682

A

Digital vaginal examination

It may provoke a severe haemorrhage.

Answer 683

A

During the routine 20 week abdominal ultrasound

This is a standard practice in prenatal care.

Answer 684

A

Use of transvaginal ultrasound

It improves accuracy and is considered safe.

Answer 685

A

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

This grading system helps in assessing the severity of the condition.

Answer 686

A

A placenta lying wholly or partly in the lower uterine segment

Answer 687

A

Rescan at 32 weeks

Answer 688

A

No, unless they bleed

Answer 689

A

Scan every 2 weeks

Answer 690

A

At 36-37 weeks

Answer 691

A

Elective caesarean section

Answer 692

A

A trial of vaginal delivery

Answer 693

A

Perform an emergency caesarean section

Answer 694

A

Post-partum haemorrhage

Answer 695

A

Admit the woman

Answer 696

A

ABC approach

Answer 697

A

Emergency caesarean section

Answer 698

A

Emergency caesarean section

Answer 699

A

Death is now extremely rare

Answer 700

A

Post-partum haemorrhage

Answer 701

A

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

This condition can lead to serious complications for both the mother and the fetus.

Answer 702

A

Approximately 1 in 200 pregnancies

This indicates that placental abruption is relatively uncommon.

Answer 703

A

Proteinuric hypertension
Cocaine use
Multiparity
Maternal trauma
Increasing maternal age

These factors may increase the risk of experiencing placental abruption.

Answer 704

A

Shock out of keeping with visible loss

This means that the severity of the shock may not correlate with the amount of blood loss observed.

Answer 705

A

Pain is constant

This constant pain can be a significant indicator of placental abruption.

Answer 706

A

Tender, tense uterus

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

Answer 707

A

Absent or distressed fetal heart

This can indicate fetal distress or compromise due to the abruption.

Answer 708

A

Beware pre-eclampsia, DIC, anuria

Coagulation problems can complicate the clinical picture and require careful management.

Answer 709

A

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

Answer 710

A

Immediate caesarean

Answer 711

A

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

Answer 712

A

Immediate caesarean

Answer 713

A

Deliver vaginally

Answer 714

A

Induce vaginal delivery

Answer 715

A

Shock
DIC
Renal failure
PPH

Answer 716

A

IUGR
Hypoxia
Death

Answer 717

A

High perinatal mortality rate

Answer 718

A

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

Answer 719

A

Nausea
Breast tenderness
Fluid retention and weight gain

Answer 720

A

Increased risk of breast cancer.

Answer 721

A

The risk increases with the duration of use.

Answer 722

A

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

Answer 723

A

Increased risk of endometrial cancer.

Answer 724

A

By the addition of a progestogen.

Answer 725

A

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

Answer 726

A

Increased risk of venous thromboembolism.

Answer 727

A

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

Answer 728

A

They should be referred to haematology before starting any treatment.

Answer 729

A

Increased risk of stroke.

Answer 730

A

Increased risk of ischaemic heart disease.

Answer 731

A

The permanent cessation of menstruation due to the loss of follicular activity

Menopause is a clinical diagnosis made when a woman has not had a period for 12 months.

Answer 732

A

Roughly 75%

Symptoms typically last for 7 years but may vary in duration and severity.

Answer 733

A

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

Answer 734

A

Regular exercise
Weight loss
Reduce stress

Answer 735

A

Late evening exercise

Maintaining good sleep hygiene is also important.

Answer 736

A

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

Answer 737

A

Approximately 10%

There is a drive by NICE to increase this number.

Answer 738

A

Oral or transdermal combined HRT

Unopposed oestrogens increase the risk of endometrial cancer.

Answer 739

A

Venous thromboembolism
Stroke
Coronary heart disease
Breast cancer
Ovarian cancer

Answer 740

A

Fluoxetine, citalopram or venlafaxine

Answer 741

A

vaginal lubricant or moisturiser

Answer 742

A

Gradually reducing HRT is effective at limiting recurrence only in the short term

In the long term, there is no difference in symptom control.

Answer 743

A

Treatment has been ineffective
Ongoing side effects
Unexplained bleeding

Answer 744

A

False

The risk of dying from breast cancer is not raised.

Answer 745

A

2-5 years

Answer 746

A

Symptoms typically last for 2-5 years

Treatment with HRT brings certain risks.

Answer 747

A

Self-help groups
Cognitive behaviour therapy
Antidepressants

Answer 748

A

Herbal medicine from a North American plant Actaea racemosa

Black Cohosh is often used for the relief of menopausal symptoms.

Answer 749

A

Traditional Herbal Registration by MHRA for the relief of menopausal symptoms

Menoherb is a preparation of Black Cohosh.

Answer 750

A

Risk of liver toxicity

Women should be informed about this risk when considering Black Cohosh.

Answer 751

A

Mixed results

This indicates variability in effectiveness and safety.

Answer 752

A

May potentiate seizures

This is particularly relevant for individuals with seizure disorders.

Answer 753

A

Sleep problems and nausea

These effects may affect the quality of life for users.

Answer 754

A

Phytoestrogens

These compounds can mimic estrogen in the body.

Answer 755

A

Endometrial hyperplasia and stimulating hormone-sensitive cancers

Caution is advised when using Red Clover, especially in women with a history of these conditions.

Answer 756

A

Type of Chinese medicine

It is often used in traditional practices for various health issues.

Answer 757

A

Photosensitivity and interference with warfarin metabolism

This can lead to increased bleeding risks.

Answer 758

A

51 years old

This is the typical age range for menopause onset.

Answer 759

A

The period prior to menopause when women may experience symptoms

This is a transitional phase as ovarian function declines.

Answer 760

A

12 months

This is to prevent unintended pregnancies during the transition.

Answer 761

A

24 months

This reflects the increased variability in menstrual cycle patterns.

Answer 762

A

Up to 50%

This highlights the importance of understanding potential adverse effects.

Answer 763

A

Reduced levels of female hormones, principally oestrogen

Oestrogen is key in regulating various bodily functions in women.

Answer 764

A

Change in length of menstrual cycles and dysfunctional uterine bleeding may occur

These changes can vary significantly from woman to woman.

Answer 765

A

Hot flushes and night sweats; affects around 80% of women

These symptoms usually occur daily and may continue for up to 5 years.

Answer 766

A

Vaginal dryness and atrophy, urinary frequency; affects around 35% of women

These changes can lead to discomfort and other complications.

Answer 767

A

Anxiety and depression; around 10% of women

Short-term memory impairment may also occur.

Answer 768

A

Osteoporosis and increased risk of ischaemic heart disease

These complications can significantly impact women’s health later in life.

Answer 769

A

84%

This statistic highlights the natural conception rates in couples without infertility issues.

Answer 770

A

1 in 7 couples

This indicates a significant number of couples facing infertility challenges.

Answer 771

A

Male factor: 30%
Unexplained: 20%
Ovulation failure: 20%
Tubal damage: 15%
Other causes: 15%

Understanding these causes is crucial for diagnosis and treatment.

Answer 772

A

To assess ovulation

Serum progesterone levels are measured 7 days prior to the expected period.

Answer 773

A

Day 21

This timing is standard for evaluating ovulation in a regular cycle.

Answer 774

A

Indicates ovulation

This level suggests that ovulation has occurred.

Answer 775

A

Refer to specialist

Consistently low levels may indicate underlying issues that require expert evaluation.

Answer 776

A

20-25

Maintaining a healthy BMI can positively influence fertility.

Answer 777

A

Regular sexual intercourse every 2 to 3 days

This frequency helps maximize the chances of conception.

Answer 778

A

Smoking and drinking

These factors can negatively impact fertility and overall health.

Answer 779

A

Within 1 hour

Answer 780

A

> 15 million / ml

Answer 781

A

NICE 2013 values

Answer 782

A

Benign smooth muscle tumours of the uterus

Answer 783

A

Around 20%

Answer 784

A

Around 50%

Answer 785

A

Afro-Caribbean women

Answer 786

A

Before puberty

Answer 787

A

Oestrogen

Answer 788

A

Asymptomatic
Menorrhagia
Lower abdominal pain
Bloating
Urinary symptoms
Subfertility

Answer 789

A

Iron-deficiency anaemia

Answer 790

A

Polycythaemia secondary to autonomous production of erythropoietin

Answer 791

A

Transvaginal ultrasound

Answer 792

A

No treatment is needed other than periodic review

Answer 793

A

Levonorgestrel intrauterine system (LNG-IUS)

Answer 794

A

Mefenamic acid
Tranexamic acid

Answer 795

A

Combined oral contraceptive pill
Oral progestogen

Answer 796

A

Injectable progestogen

Answer 797

A

To reduce the size of the fibroid

Answer 798

A

Hot flushes
Vaginal dryness
Loss of bone mineral density

Answer 799

A

Ulipristal acetate

Answer 800

A

Myomectomy
Hysteroscopic endometrial ablation
Hysterectomy
Uterine artery embolization

Answer 801

A

They generally regress

Answer 802

A

Red degeneration

Answer 803

A

The presence of excessive amniotic fluid

It may be detected when a uterus is large for dates or it is difficult to feel the fetal parts on palpation.

Answer 804

A

Multiple pregnancy
Poorly controlled maternal diabetes mellitus
Tracheo-oesophageal fistula

Answer 805

A

Impaired swallowing reflex

This can lead to an accumulation of amniotic fluid.

Answer 806

A

Umbilical cord prolapse

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

Answer 807

A

Increased risk of urinary tract infections

Answer 808

A

Duodenal atresia
Oesophageal atresia

Answer 809

A

Polyhydramnios is associated with an increased risk of prematurity.

Answer 810

A

Fetal distress as a response to chronic hypoxia in utero

This is concerning as it reflects risk of stillbirth and fetal growth restriction.

Answer 811

A

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

Answer 812

A

32 weeks gestation

Answer 813

A

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

Answer 814

A

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

Answer 815

A

Up to 15% of pregnancies

Answer 816

A

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

Answer 817

A

Using handheld Doppler or ultrasonography

Answer 818

A

Immediate ultrasound should be offered

Answer 819

A

To monitor fetal heart rate and assist in excluding fetal compromise

Answer 820

A

Onward referral should be made to a maternal fetal medicine unit

Answer 821

A

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

Answer 822

A

Between 40-55%

Answer 823

A

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

Answer 824

A

Around 50%

This statistic highlights the importance of early detection and screening in younger women.

Answer 825

A

Aged 25-29 years

This indicates a critical age for cervical cancer screening efforts.

Answer 826

A

Squamous cell cancer (80%)
Adenocarcinoma (20%)

These types represent the majority of cervical cancer cases.

Answer 827

A

Abnormal vaginal bleeding
Vaginal discharge

Abnormal bleeding can occur postcoital, intermenstrual, or postmenopausal.

Answer 828

A

Human papillomavirus (HPV)

Particularly serotypes 16, 18, and 33 are critical in this process.

Answer 829

A

Smoking
Human immunodeficiency virus (HIV)
Early first intercourse
Many sexual partners
High parity
Lower socioeconomic status
Combined oral contraceptive pill

The association with the combined oral contraceptive pill is debated but supported by studies.

Answer 830

A

E6 (HPV 16)
E7 (HPV 18)

These oncogenes play a crucial role in the development of cervical cancer.

Answer 831

A

Inhibits the p53 tumour suppressor gene

The p53 gene is essential for regulating the cell cycle and preventing tumor growth.

Answer 832

A

Inhibits the RB suppressor gene

The RB gene is crucial for controlling cell division and preventing excessive cell growth.

Answer 833

A

True

High parity refers to having had many pregnancies.

Answer 834

A

debated

A large study published in the Lancet in 2007 confirmed the link.

Answer 835

A

Human papilloma virus (HPV) infection

HPV is a significant concern in public health due to its association with various cancers.

Answer 836

A

Subtypes 16, 18 & 33

These subtypes are known for their strong association with cervical cancer.

Answer 837

A

Subtypes 6 & 11

These subtypes do not lead to cancer but can cause warts.

Answer 838

A

Development of koilocytes

Koilocytes are a marker of HPV infection.

Answer 839

A

They have the following characteristics:
* Enlarged nucleus
* Irregular nuclear membrane contour
* Hyperchromatic nucleus
* Perinuclear halo may be seen

These features help in identifying HPV-infected cells.

Answer 840

A

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

Answer 841

A

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

Answer 842

A

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

Answer 843

A

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

Answer 844

A

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

Answer 845

A

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

Answer 846

A

A = upper two thirds of vagina
B = parametrial involvement

Answer 847

A

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

Answer 848

A

A = lower third of vagina
B = pelvic side wall

Answer 849

A

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

Answer 850

A

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

Answer 851

A

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

Answer 852

A

Hysterectomy +/- lymph node clearance.

Answer 853

A

Nodal clearance for A2 tumours.

Answer 854

A

Cone biopsy with negative margins.

Answer 855

A

Close follow-up and node evaluation must be performed.

Answer 856

A

Radiotherapy with concurrent chemotherapy.

Answer 857

A

Brachytherapy
External beam radiotherapy

Answer 858

A

Cisplatin.

Answer 859

A

Radical hysterectomy with pelvic lymph node dissection.

Answer 860

A

Radiation with concurrent chemotherapy.

Answer 861

A

Nephrostomy should be considered.

Answer 862

A

Radiation and/or chemotherapy.

Answer 863

A

Palliative chemotherapy.

Answer 864

A

Offer chemoradiation or radiotherapy.

Answer 865

A

The FIGO staging.

Answer 866

A

Bleeding
Damage to local structures
Infection
Anaesthetic risk

Answer 867

A

Cone biopsies and radical trachelectomy.

Answer 868

A

Ureteral fistula.

Answer 869

A

Diarrhoea
Vaginal bleeding
Radiation burns
Pain on micturition
Tiredness/weakness

Answer 870

A

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

Answer 871

A

Varicella zoster virus

Chickenpox is caused by primary infection with this virus.

Answer 872

A

Reactivation of dormant varicella zoster virus

Shingles occurs when the virus reactivates in the dorsal root ganglion.

Answer 873

A

Via the respiratory route

It can also be caught from someone with shingles.

Answer 874

A

4 days before rash, until 5 days after rash appears

This period includes the time before and after the rash.

Answer 875

A

10-21 days

Answer 876

A

Fever and itchy rash

The rash starts on the head/trunk before spreading.

Answer 877

A

Macular, papular, vesicular

The rash progresses through these stages.

Answer 878

A

Supportive care

This includes keeping cool and trimming nails.

Answer 879

A

To relieve itching

Answer 880

A

Most infectious 1-2 days before rash appears

Infectivity continues until all lesions are dry and crusted over.

Answer 881

A

Immunocompromised patients and newborns with peripartum exposure

Answer 882

A

IV aciclovir

Answer 883

A

Secondary bacterial infection of the lesions

Answer 884

A

Invasive group A streptococcal soft tissue infections

This can result in necrotizing fasciitis.

Answer 885

A

Pneumonia
Encephalitis
Disseminated haemorrhagic chickenpox
Arthritis
Nephritis
Pancreatitis

Answer 886

A

A mild condition

Answer 887

A

At-risk groups

Answer 888

A

To pregnant women and the developing fetus

Answer 889

A

How to manage it

Answer 890

A

Significant exposure to chickenpox or herpes zoster

Answer 891

A

Exposure to limited, covered-up shingles

Answer 892

A

A clinical condition that increases the risk of severe varicella

Answer 893

A

Immunosuppressed patients
Neonates
Pregnant women

Answer 894

A

No antibodies to the varicella virus

Answer 895

A

A blood test for varicella antibodies

Answer 896

A

Within 7 days

Answer 897

A

Varicella-zoster immunoglobulin (VZIG)

Answer 898

A

Management of chickenpox exposure in pregnancy

Answer 899

A

Varicella-zoster virus

Answer 900

A

Reactivation of dormant varicella-zoster virus in dorsal root ganglion

Answer 901

A

5 times greater risk of pneumonitis

Answer 902

A

A syndrome resulting from maternal varicella exposure

Answer 903

A

Around 1%

Answer 904

A

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

Answer 905

A

1-2% risk

Answer 906

A

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

Answer 907

A

Maternal blood should be urgently checked for varicella antibodies

Answer 908

A

Varicella zoster immunoglobulin (VZIG)

Answer 909

A

Oral aciclovir (or valaciclovir)

Answer 910

A

Between day 7 to day 14 after exposure

Answer 911

A

Higher incidence and severity of varicella infection if given immediately

Answer 912

A

Seek specialist advice

Answer 913

A

Increased maternal risk of serious infection
Fetal varicella risk

Answer 914

A

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

Answer 915

A

Considered with caution

Answer 916

A

An acute, unilateral, painful blistering rash caused by reactivation of the varicella-zoster virus (VZV)

Shingles is also known as herpes zoster infection.

Answer 917

A

In the dorsal root or cranial nerve ganglia.

Answer 918

A

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

Answer 919

A

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 920

A

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

Answer 921

A

Usually clinical.

Answer 922

A

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 923

A

Paracetamol
NSAIDs

Answer 924

A

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

Answer 925

A

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

Answer 926

A

Within 72 hours for most patients.

Answer 927

A

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

Answer 928

A

Aciclovir
Famciclovir
Valaciclovir

Answer 929

A

Post-herpetic neuralgia.

Answer 930

A

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

Answer 931

A

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

Answer 932

A

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

Answer 933

A

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

Answer 934

A

A live attenuated vaccine, examples include Varilrix and Varivax.

Answer 935

A

Healthcare workers not already immune to VZV
Contacts of immunocompromised patients

Answer 936

A

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

Answer 937

A

All patients aged 70-79 years.

Answer 938

A

Immunosuppression.

Answer 939

A

Injection site reactions.

Answer 940

A

80 and over.

Answer 941

A

‘Less severe’ and ‘more severe’ depression

Answer 942

A

A score of < 16

Answer 943

A

A score of ≥ 16

Answer 944

A

Guided self-help

Answer 945

A

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

Answer 946

A

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

Answer 947

A

‘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 948

A

A need for a more in-depth assessment

Answer 949

A

Anxiety and depression

Answer 950

A

14 questions

Answer 951

A

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

Answer 952

A

Selective serotonin reuptake inhibitors (SSRIs)

Answer 953

A

Citalopram
Fluoxetine

Answer 954

A

Gastrointestinal symptoms

Answer 955

A

A proton pump inhibitor

Answer 956

A

Direct switch is possible for some SSRIs

Answer 957

A

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

Answer 958

A

Increased mood change
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
Gastrointestinal symptoms
Paraesthesia

Answer 959

A

Increased risk of congenital heart defects

Answer 960

A

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

Answer 961

A

Warm and cold AIHA

Answer 962

A

Warm AIHA

Answer 963

A

Body temperature

Answer 964

A

Extravascular sites, e.g., spleen

Answer 965

A

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

Answer 966

A

Steroids (+/- rituximab)

Answer 967

A

4 degrees C

Answer 968

A

Raynaud’s and acrocynosis

Answer 969

A

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

Answer 970

A

Membrane defects
Metabolism defects
Haemoglobin defects

Answer 971

A

Hereditary spherocytosis/elliptocytosis
G6PD deficiency
Sickle cell
Thalassaemia

Answer 972

A

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

Answer 973

A

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

Answer 974

A

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 975

A

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

Answer 976

A

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

Answer 977

A

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

Answer 978

A

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

Answer 979

A

Iron deficiency anaemia

Answer 980

A

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

Answer 981

A

Preschool-age children

Answer 982

A

Menorrhagia

Answer 983

A

Koilonychia (spoon-shaped nails)

Answer 984

A

Hypochromic microcytic anaemia

Answer 985

A

Dark-green leafy vegetables
Meat
Iron-fortified bread

Answer 986

A

Vitamin B12 deficiency
Folate deficiency

Answer 987

A

Alcohol
Liver disease
Hypothyroidism
Pregnancy
Reticulocytosis
Myelodysplasia
Drugs (cytotoxics)

Answer 988

A

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

Answer 989

A

Underlying malignancy

Answer 990

A

Disproportionate to the anaemia

Answer 991

A

anaemia of chronic disease
chronic kidney disease
aplastic anaemia
haemolytic anaemia
acute blood loss

Normocytic anaemia is characterized by red blood cells that are of normal size but reduced in number.

Answer 992

A

Giant cell arteritis (GCA)

Temporal arteritis is a type of vasculitis that affects medium and large-sized arteries.

Answer 993

A

Patients over 50 years old, with a peak incidence in those in their 70s

Early recognition and treatment are crucial to avoid complications.

Answer 994

A

High-dose prednisolone

Treatment must be started promptly upon suspicion of temporal arteritis.

Answer 995

A

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

Complications may include temporary or permanent visual loss.

Answer 996

A

It can reveal skip lesions

Skip lesions are areas of inflammation that may not be continuous.

Answer 997

A

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)

Each type has distinct characteristics and treatments.

Answer 998

A

The development of seizures in association with pre-eclampsia

Pre-eclampsia is characterized by pregnancy-induced hypertension and proteinuria.

Answer 999

A

Magnesium sulphate

It is used to prevent and treat seizures.

Answer 1000

A

A single seizure lasting >5 minutes or >= 2 seizures within a 5-minute period without return to normal

It is a medical emergency requiring immediate intervention.

Answer 1001

A

Benzodiazepines

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

Answer 1002

A

Monitor urine output, reflexes, respiratory rate, and oxygen saturations

Respiratory depression can occur as a side effect.

Answer 1003

A

A dramatic response

If there is no response, the diagnosis should be reconsidered.

Answer 1004

A

Intense pain around one eye
Restlessness during an attack
Accompanied by redness, lacrimation, lid swelling

Attacks typically occur once or twice a day.

Answer 1005

A

20

It involves pregnancy-induced hypertension and proteinuria.

Answer 1006

A

True

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

Answer 1007

A

Pressure changes in the uterus using internal or external pressure transducers

Answer 1008

A

100-160 /min

Answer 1009

A

Heart rate < 100 /min

Answer 1010

A

Increased fetal vagal tone
Maternal beta-blocker use

Answer 1011

A

Heart rate > 160 /min

Answer 1012

A

Maternal pyrexia
Chorioamnionitis
Hypoxia
Prematurity

Answer 1013

A

< 5 beats /min

Answer 1014

A

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

Answer 1015

A

Fetal distress e.g. asphyxia or placental insufficiency

Answer 1016

A

Contractions

Answer 1017

A

Group B Streptococcus (GBS)

Answer 1018

A

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

Answer 1019

A

Universal screening for GBS should not be offered to all women

Answer 1020

A

Benzylpenicillin

Answer 1021

A

A process where labour is started artificially

Answer 1022

A

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

Answer 1023

A

To assess whether induction of labour will be required

Answer 1024

A

Labour is unlikely to start without induction

Answer 1025

A

The cervix is ripe, or ‘favourable’

Answer 1026

A

To separate the chorionic membrane from the decidua

Answer 1027

A

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

Answer 1028

A

Uterine hyperstimulation

Answer 1029

A

Prolonged and frequent uterine contractions (tachysystole)

Answer 1030

A

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 1031

A

Normally takes 6 hours

Answer 1032

A

The active process of maternal pushing

Answer 1033

A

Lasts around 5-15 minutes

Answer 1034

A

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

Answer 1035

A

1 cm per 2 hours

Answer 1036

A

1 cm per hour

Answer 1037

A

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

Answer 1038

A

A pregnancy that has extended to or beyond 42 weeks

Answer 1039

A

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

Answer 1040

A

Implantation of a fertilized ovum outside the uterus

Commonly occurs in the fallopian tubes.

Answer 1041

A

History of 6-8 weeks amenorrhoea, lower abdominal pain, and later develops vaginal bleeding

Pain is usually constant and may be unilateral.

Answer 1042

A

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)

Shoulder tip pain can also occur due to peritoneal bleeding.

Answer 1043

A

Abdominal tenderness
Cervical excitation
Adnexal mass (examination not recommended due to risk of rupture)

Cervical motion tenderness is recommended to check.

Answer 1044

A

Serum bHCG levels >1,500

This points toward a diagnosis of an ectopic pregnancy.

Answer 1045

A

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

Around 10% of women of reproductive age have a degree of endometriosis.

Answer 1046

A

Chronic pelvic pain
Secondary dysmenorrhoea
Deep dyspareunia
Subfertility
Urinary symptoms (e.g., dysuria)
Dyschezia

Pain often starts days before bleeding.

Answer 1047

A

Laparoscopy

There is little role for investigation in primary care.

Answer 1048

A

NSAIDs
Paracetamol

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

Answer 1049

A

Referral to secondary care for treatments like GnRH analogues, surgery, or laparoscopic excision

Laparoscopic surgery is shown to improve chances of conception.

Answer 1050

A

60 years

It generally carries a poor prognosis due to late diagnosis.

Answer 1051

A

Family history (BRCA1 or BRCA2 mutations)
Early menarche
Late menopause
Nulliparity

Many ovulations are also a risk factor.

Answer 1052

A

Abdominal distension and bloating
Abdominal and pelvic pain
Urinary symptoms (e.g., urgency)
Early satiety
Diarrhoea

Symptoms are often vague.

Answer 1053

A

CA125 test

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

Answer 1054

A

Combination of surgery and platinum-based chemotherapy

Diagnosis often requires diagnostic laparotomy.

Answer 1055

A

Infection and inflammation of the female pelvic organs, including the uterus, fallopian tubes, and ovaries

Usually results from ascending infection from the endocervix.

Answer 1056

A

Chlamydia trachomatis
Neisseria gonorrhoeae
Mycoplasma genitalium
Mycoplasma hominis

Chlamydia is the most common cause.

Answer 1057

A

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

Menstrual irregularities may also occur.

Answer 1058

A

Stat IM ceftriaxone followed by 14 days of oral doxycycline and oral metronidazole

This regimen avoids systemic fluoroquinolones where possible.

Answer 1059

A

Perihepatitis (Fitz-Hugh Curtis Syndrome)
Infertility
Chronic pelvic pain
Ectopic pregnancy

Infertility risk may be as high as 10-20% after a single episode.

Answer 1060

A

The most common cause of pelvic pain in women

Some women experience transient pain due to ovulation (mittelschmerz).

Answer 1061

A

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

Occurs in approximately 1/200 pregnancies.

Answer 1062

A

Shock out of keeping with visible loss
Constant pain
Tender, tense uterus
Absent or distressed fetal heart

Coagulation problems may also occur.

Answer 1063

A

Benign smooth muscle tumors of the uterus

Occur in around 20% of white women and 50% of black women in later reproductive years.

Answer 1064

A

Asymptomatic
Menorrhagia
Lower abdominal pain
Urinary symptoms (e.g., frequency)
Subfertility

May also cause iron-deficiency anaemia.

Answer 1065

A

No treatment needed other than periodic review

Monitoring for size and growth is important.

Answer 1066

A

Levonorgestrel intrauterine system (LNG-IUS)
NSAIDs (e.g., mefenamic acid)
Tranexamic acid
Combined oral contraceptive pill
Oral progestogen
Injectable progestogen

LNG-IUS cannot be used if there is distortion of the uterine cavity.

Answer 1067

A

Fibroids generally regress after menopause

Some complications may still persist.

Answer 1068

A

A protein produced by the developing fetus

Answer 1069

A

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

Answer 1070

A

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

Answer 1071

A

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

Answer 1072

A

Neural tube defects
Chromosomal disorders
Inborn errors of metabolism

Answer 1073

A

400 mcg from before conception until 12 weeks

Answer 1074

A

Women who take antiepileptics

Answer 1075

A

Intake above 700 micrograms might be teratogenic

Answer 1076

A

Pregnant women should not drink alcohol at all

Answer 1077

A

Low birthweight
Preterm birth

Answer 1078

A

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

Answer 1079

A

They should be informed of their maternity rights and benefits

Answer 1080

A

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

Answer 1081

A

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

Answer 1082

A

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

Answer 1083

A

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

Answer 1084

A

< 110 g/L

Answer 1085

A

Macrocytic, megaloblastic anaemia
Neural tube defects

Answer 1086

A

10 micrograms of vitamin D per day

Answer 1087

A

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

Answer 1088

A

‘Lower chance’ or ‘higher chance’ results

Answer 1089

A

Non-invasive prenatal screening test

Answer 1090

A

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

Answer 1091

A

Transfer of 1-carbon units for DNA & RNA synthesis

Answer 1092

A

< 110 g/L

Answer 1093

A

< 105 g/L

Answer 1094

A

< 100 g/L

Answer 1095

A

oral ferrous sulfate or ferrous fumarate

Answer 1096

A

8-10 weeks and at 28 weeks

Answer 1097

A

Progesterone

Answer 1098

A

Amenorrhoea
Nausea
Vomiting
Breast enlargement and tenderness
Fatigue
Increased skin pigmentation

Answer 1099

A

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

Answer 1100

A

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

Answer 1101

A

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

Answer 1102

A

BMI >= 30 kg/m²

Answer 1103

A

Miscarriage
Venous thromboembolism
Gestational diabetes
Pre-eclampsia
Postpartum haemorrhage

Answer 1104

A

Higher caesarean section rate
Complications during labour

Answer 1105

A

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

Answer 1106

A

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

Answer 1107

A

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

Answer 1108

A

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

Answer 1109

A

Oedema
Jaundice
Anaemia
Heart failure

Answer 1110

A

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

Answer 1111

A

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

Answer 1112

A

Dizygotic (non-identical)
Monozygotic (identical)

Answer 1113

A

Polyhydramnios
Pregnancy induced hypertension
Anaemia

Answer 1114

A

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

Answer 1115

A

Down’s syndrome
Congenital heart defects
Abdominal wall defects

Answer 1116

A

Cystic fibrosis
Down’s syndrome
Cytomegalovirus infection

Answer 1117

A

A protein produced by the developing fetus

AFP levels can indicate certain fetal conditions in prenatal testing.

Answer 1118

A

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

Answer 1119

A

A procedure used in prenatal diagnosis where fluid is removed from the amniotic sac to study fetal cells

It is typically performed between 15-20 weeks of pregnancy.

Answer 1120

A

Neural tube defects
Chromosomal disorders
Inborn errors of metabolism

Answer 1121

A

Folic acid 400mcg

Answer 1122

A

It might be teratogenic

Answer 1123

A

10 micrograms of vitamin D per day

Answer 1124

A

Low birthweight and preterm birth

Answer 1125

A

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

Answer 1126

A

They should avoid air travel

Answer 1127

A

Avoid unless the benefits outweigh the risks

Answer 1128

A

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

Answer 1129

A

10 visits

Answer 1130

A

The number of times a woman has been pregnant

Answer 1131

A

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

Answer 1132

A

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

Answer 1133

A

Alpha-fetoprotein
Unconjugated oestriol
Human chorionic gonadotrophin
Inhibin A

Answer 1134

A

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

Answer 1135

A

A test that analyzes small DNA fragments in the blood of a pregnant woman for chromosomal abnormalities

It has high sensitivity and specificity for trisomy 21.

Answer 1136

A

Macrocytic, megaloblastic anaemia
Neural tube defects

Answer 1137

A

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

Answer 1138

A

HSV-1
HSV-2

Answer 1139

A

Nucleic acid amplification tests (NAAT)

Answer 1140

A

Elective caesarean section at term

Answer 1141

A

Human papillomavirus (HPV), especially types 6 & 11

Answer 1142

A

Topical podophyllum or cryotherapy

Answer 1143

A

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

Answer 1144

A

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

Answer 1145

A

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

Answer 1146

A

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

Answer 1147

A

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

Answer 1148

A

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

Answer 1149

A

< 110 g/L

Answer 1150

A

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

Answer 1151

A

Progesterone

Answer 1152

A

Amenorrhoea
Nausea
Vomiting

Answer 1153

A

Palpitations and syncope
Increased sweating
Urinary frequency
Back pain
Breathlessness

Answer 1154

A

The size of a small pear.

Answer 1155

A

After the 12th week.

Answer 1156

A

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

Answer 1157

A

BMI >= 30 kg/m²

Answer 1158

A

Miscarriage
Gestational diabetes

Answer 1159

A

Congenital anomaly
Prematurity

Answer 1160

A

5mg of folic acid

Answer 1161

A

24-28 weeks

Answer 1162

A

D antigen

Answer 1163

A

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

Answer 1164

A

At 28 and 34 weeks

Answer 1165

A

It is irreversible

Answer 1166

A

Kleihauer test

Answer 1167

A

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 1168

A

Oedematous (hydrops fetalis)
Jaundice
Anaemia
Hepatosplenomegaly
Heart failure
Kernicterus

Answer 1169

A

Herpes simplex virus (HSV) type 2

Answer 1170

A

Painless ulcer (chancre)
Local non-tender lymphadenopathy

Answer 1171

A

9-90 days

Answer 1172

A

Haemophilus ducreyi

Answer 1173

A

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

Answer 1174

A

Doxycycline

Answer 1175

A

Gestational age in weeks ± 2 cm

Answer 1176

A

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

Answer 1177

A

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

Answer 1178

A

Polyhydramnios
Pregnancy induced hypertension
Anaemia
Antepartum haemorrhage

Answer 1179

A

Twins: 37 weeks
Triplets: 33 weeks

Answer 1180

A

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

Answer 1181

A

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

Answer 1182

A

Down’s syndrome
Congenital heart defects
Abdominal wall defects

Answer 1183

A

Cystic fibrosis
Down’s syndrome
Cytomegalovirus infection

Answer 1184

A

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

Answer 1185

A

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

Answer 1186

A

No intercourse since the start of the last menstrual period.

Answer 1187

A

Correct and reliable contraception use.

Answer 1188

A

Within 5 days of the onset.

Answer 1189

A

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

Answer 1190

A

Inhibits ovulation.

Answer 1191

A

Thickens cervical mucus.

Answer 1192

A

endometrial.

Answer 1193

A

Irregular bleeding.

Answer 1194

A

Stop contraception after 1 year of amenorrhea.

Answer 1195

A

Increased risk of blood clots.

Answer 1196

A

Risks of adverse pregnancy outcomes.

Answer 1197

A

Inhibits ovulation.

Answer 1198

A

Extra precautions are advised for enzyme-inducing antibiotics.

Answer 1199

A

Depo-Provera.

Answer 1200

A

Decreases sperm motility and survival.

Answer 1201

A

Potential harms and benefits.

Answer 1202

A

Use alternative contraception for the first 7 days.

Answer 1203

A

Should be taken at the same time every day.

Answer 1204

A

Reduced risk of colorectal cancer

Other benefits may include protection against pelvic inflammatory disease, reduced ovarian cysts, benign breast disease, and acne vulgaris.

Answer 1205

A

Offers no protection against sexually transmitted infections

Other disadvantages include the risk of venous thromboembolic disease, breast and cervical cancer, stroke, and temporary side effects.

Answer 1206

A

No causal relationship supported

Some users report weight gain, but the evidence does not support this as a direct effect of the COCP.

Answer 1207

A

30 mcg ethinyloestradiol with levonorgestrel/norethisterone

An example is Microgynon 30.

Answer 1208

A

Combination of estradiol valerate and dienogest with a quadraphasic dosage regimen

This regimen is designed for optimal cycle control.

Answer 1209

A

0.4 failures per 100 women-years

This indicates its efficacy is similar to other COCPs.

Answer 1210

A

Currently £8.39 per month

Standard COCPs can cost less than 70p per month.

Answer 1211

A

It is classified as ‘missed’

This is different from the 24-hour rule for standard COCPs.

Answer 1212

A

24/4 pill regimen instead of 21/7

This shorter pill-free interval is aimed at reducing premenstrual symptoms.

Answer 1213

A

UKMEC 2

This applies to certain health conditions and contraceptive choices.

Answer 1214

A

UKMEC 4

This indicates an unacceptable health risk.

Answer 1215

A

UKMEC 1

This classification applies regardless of age or smoking status.

Answer 1216

A

COCP is contraindicated (UKMEC 4)

Women with migraines without aura have different UKMEC classifications.

Answer 1217

A

Consistent use of condoms in addition to other contraceptives

This is to address interactions between contraceptives and anti-epileptic medications.

Answer 1218

A

UKMEC 3

This indicates that there are concerns about their use.

Answer 1219

A

UKMEC 1

This indicates it is a safer choice.

Answer 1220

A

Someone whose gender identity is not congruent with the sex they were assigned at birth

This includes transgender men and women, as well as nonbinary individuals.

Answer 1221

A

Cervical screening

This is a preventive measure against cervical cancer.

Answer 1222

A

Risk of hepatitis A & B and offered vaccinations

This is important for sexual health.

Answer 1223

A

18%

The failure rate with perfect use is 2%.

Answer 1224

A

Does not provide protection against pregnancy

If a patient becomes pregnant while on testosterone therapy, it is contraindicated.

Answer 1225

A

Condoms

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

Answer 1226

A

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

Answer 1227

A

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 1228

A

2 and 12 weeks

Answer 1229

A

Progesterone-only implant (Nexplanon)

Answer 1230

A

Levonorgestrel and Ulipristal

Answer 1231

A

The dose should be repeated

Answer 1232

A

Inhibition of ovulation

Answer 1233

A

No later than 120 hours

Answer 1234

A

Copper IUD

Answer 1235

A

Nexplanon has a redesigned applicator and is radiopaque

Answer 1236

A

0.07/100 women-years

Answer 1237

A

Irregular/heavy bleeding, headache, nausea, breast pain

Answer 1238

A

Depo Provera

Answer 1239

A

Medroxyprogesterone acetate

Answer 1240

A

Not quickly reversible, potential delayed return to fertility

Answer 1241

A

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

Answer 1242

A

More than 99%

Answer 1243

A

Prevention of fertilisation by decreasing sperm motility

Answer 1244

A

Heavier periods, uterine perforation, infection, expulsion

Answer 1245

A

98% effective

Answer 1246

A

More than 12 months

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