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MRCOG part 2 > Passmrcog > Flashcards

Passmrcog Flashcards

1
Q

Pcos - what level of testosterone would lead you to look for other causes?

A

> 5nmol

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2
Q

Treatment of overactive bladder in frail elderly

A

Tolterodine (immediate release)
Or Darifenacin (once daily preparation)

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3
Q

Chlamydia in pregnancy treatment

A

Amoxicillin TDS 7/7
Erythromycin
Azithromycin 1g stat (if can’t give others)

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4
Q

Risk of hysterectomy in placenta praevia

A

11%

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5
Q

Pathognomic USS sign of TOA

A

Cogwheel sign

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6
Q

TB treatment in pregnancy - what supplement should you give?

A

Pyridoxine 10mg OD

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7
Q

Risks of early onset neonatal GBS

A

Overall incidence 0.57/1000 births in UK
Incidence in term infants without risk factors is 0.2/1000 births
Risk of EOGBS if GBS in previous pregnancy 0.9/1000 births
Risk of EOGBS if GBS in current pregnancy 2.3/1000 births
Risk of EOGBS if intrapartum pyrexia (>38oC) is 5.3/1000 births

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8
Q

Normal amniotic fluid production in singleton pregnancy

A

increases progressively until 33 weeks of gestation, with a plateau between 33 and 38 weeks before declining

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9
Q

Transient Neonatal Myasthenia Gravis

A

20% infants of mothers with MG
Symptoms within 12 hours - 4 days
Usually resolves spontaneously within 3-4 weeks
Due to maternal abs crossing placenta

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10
Q

Percentage of stillbirths no cause found

A

50%

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11
Q

Background risk of VTE in non-contraceptive users who are not pregnant

A

2 per 10,000 women per year

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12
Q

Risk of future ectopic having had one ectopic

A

18.5%

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13
Q

Risk of future ectopic following treatment for ectopic

A

18.5%

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14
Q

Rate of shoulder dystocia following previous shoulder dystocia

A

10 fold higher

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15
Q

Molar pregnancy hcg follow up

A

If hcg normal within 56 days of pregnancy - follow up = 6 months post uterine evacuations
If not, follow up = 6 months from normalisation of hcg

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16
Q

Incidence of hirsuitism in UK

A

10%

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17
Q

Presenting diameters

A

Vertex - 9.5cm - suboccipitobregmatic
Deflected OP - 11.5 - occipitofrontal
Brow - 13.5 - mentovertical
Face - 9.5cm - submentobregmatic

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18
Q

recommended baseline biochemical test for hyperandrogenism in PCOS

A

Free androgen index = total testosterone / SHBG x 100

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19
Q

Features of miscarriage on TVUS

A

CRL>7 and no FH
MSD>25mm and no fetal pole

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20
Q

Pre-testicular male infertility features and causes

A

Hypogonadotrophic Hypogonadism
FSH low

Hypothalamic disease
Kallmans
Prader-Willi
CHARGE

Pituitary pathology
Tumours - pituitary
Brain injury inc iatragenic

Acquired
Steroid abuse
Raised prolactin

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21
Q

testicular male infertility features and causes

A

Hypergonadotrophic Hypogonadism
FSH raised

Genetic
Kleinfelters
Noonan’s

Cryptorchidism

Acquired
injury
varicocele
tumours
chemo/xrt
idiopathic

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22
Q

Post-testicular male infertility features and causes

A

FSH Normal

Congenital
Congenital absence of the vas deferens
CF
Youngs

Acquired
Infection
Vasectomy
Sperm dysmotility
Immotile cilia syndrome
Maturation defects
Immunological infertility
Globozoospermia
Sexual dysfunction

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23
Q

Risk of bowel injury in laparoscopy

A

0.4 per 1000

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24
Q

Cyst follow up

A

<50mm no follow up required
50-70mm yearly ultrasound
>70mm consider further imaging or surgical intervention

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25
Q

Management of GTD

A

Complete mole = 46XX
Mx = smm

Partial mole = 69XXY
Mx = smm unless over 15/40 then mmm

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26
Q

Uterine perforation rates at ERPC/hysteroscopy

A

ERPC for PPH 5.1 to 5.7%
Curretage intrauterine adhesions 0.07 - 1.8%
TOP 0.4 - 0.6%
Hysteroscopy for PMB 0.2% - 2%

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27
Q

Rubella
Incubation period
Miscarriage rate
Rate of congenital rubella

A

Incubation 12-24 days, 14 days average
20% miscarriage rate
90% rate of congenital rubella if <11/40
20% if 11-16/40
0% if >20/40

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28
Q

1st line treatment for myasthenia graves in pregnancy

A

Pyridostigmine = ACh esterase inhibitor

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29
Q

Risk if vertical transmission of parvovirus

A

<15 weeks gestation - 15%
15 - 20 weeks - 25%
Term - 70%

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30
Q

Risk of 3/4th degree tears with forceps

A

Without epis= 22.7%
With epis = 6%

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31
Q

What gestation is fetus at greatest risk of ionising radiation?

A

10-17 weeks

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32
Q

Changes in blood composition during pregnancy
- platelets
- coag factors
- fibrinogen
- ESR

A

Decreased platelets
Increased coag factors
Increased fibrinogen
Increased ESR

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33
Q

Hepatic adenoma risk

A

Increased risk with COCP use
Highest risk of haemorrhage/rupture in third trimester
- lifetime risk bleed 27%
- lifetime risk rupture 17%
Risk malignant transformation 5%

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34
Q

Chemo for GTD

A

Women with FIGO scores less than or equal to 6 treated with single-agent intramuscular methotrexate alternating daily with folinic acid for 1 week followed by 6 rest days

Women with FIGO scores greater than or equal to 7 are treated with intravenous multi-agent chemotherapy.

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35
Q

Treatment for hyperthyroid in pregnancy

A

PTU

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36
Q

Timings of GBS testing

A

35-37 weeks
3-5 weeks prior to expected delivery

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37
Q

Risk of male sterilisation failure

A

1 in 2000

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38
Q

Prevent of stillbirth with chromosomal abnormality

A

6%

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39
Q

Most common complication of acute fatty liver

A

Renal impairment

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40
Q

Percentage of babies needing nicu after fully CS
Percentage needing nicu after AVB

A

11%
6%

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41
Q

Incidence of breast cancer in pregnancy

A

1 in 3000

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42
Q

Autonomic dysreflexia

A

Assoc with spinal cord injury above T6
Presents with hypertension and Brady

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43
Q

Risks following death of one monochorionic twin

A

Death 15%
Neuro abnormality 25%

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44
Q

Treatment for toxoplasmosis

A

Spiramycin if suspected

pyrimethamine/sulfadiazine if confirmed on amnio

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45
Q

Number to treat calculation
- CS to prevent Fecal incontinece
- Cs for breech to prevent adverse outcome
- cs for breech to prevent neonatal death
- IOL to prevent stillbirth

A

1/(experiemental event rate-control event rate)
- 167
- 30
- 175-400
- 1040

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46
Q

Zika incubation period

A

7-18 days

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47
Q

Monitor of diabetes in beta thalassemia

A

Serum fructosamine

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48
Q

Fetal loss with appendicitis

A

Simple: 1.6%
Peritonitis: 6%
Perforation: 36%

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49
Q

% of woman with radiation cystitis following pelvic radiotherapy

Symptoms?

A

26% women surviving beyond 5 years

Urgency, dysuira, haematuria

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50
Q

Incidence of erbs palsy in shoulder dystocia

A

2-16% case
<10% permenant

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51
Q

Indications for cervical cerclage

A

CL<25mm plus
1. Hx spont PTL or midtrimester loss
2. PPROM in prev pregnancy
3. Hx of cervical trauma

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52
Q

% Risk post CS:
Infection
Bleeding
Hosp admissions
Pain

A

Infection 6%
Bleeding 5 in 1000
Hosp admissions 5%
Pain 9%

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53
Q

Max dose of lidocaine 1%
Half life?

A

3ml/kg
2 hours

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54
Q

Perinatal mortality rates with:
SVB breech
SVB cephalic
ELCS

A

2.0/1000 with planned vaginal breech birth
1.0/1000 with planned vaginal cephalic birth
0.5/1000 with caesarean section after 39+º weeks

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55
Q

Onset of postpartum psychosis

A

50% symptom onset day 1-3
Majority within 2 weeks

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56
Q

POP failure rate with perfect use

A

3 in 1000

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57
Q

POP method of action

A

Thickening cervical mucus
Desogestrel = inhibits ovulation

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58
Q

What percentage of CIN 1 and 2 lesions will regress spontaneously

A

> 50% within 2 years

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59
Q

What layers does CIN2 effect

A

Basal 2/3 of cervix

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60
Q

How many years for CIN 2/3 to progress to cancer ?
What percentage will progress to cancer within 10 years if left untreated

A

15-25years
<2.5%

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61
Q

Feature needed for expectant management of ectopic

A

<30mm on scan with no heartbeat
Hcg <1500

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62
Q

At what gestational age do placental changes prevent significant passage of maternal thyroxine across the placenta?

A

12 weeks

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63
Q

Which serum marker if abnormal is assoc with oligohydramnios

A

Low unconjugated estrogen

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64
Q

Risk of emergency CS following ecv

A

1 in 200

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65
Q

For women who had gestational hypertension in a previous pregnancy whats the risk of hypertensive disorders in future pregnancies:
PIH
PET
Any HTN

A

Gestational hypertension 11-15%
Pre-eclampsia 7%
Any hypertensive disease 22%

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66
Q

Steps for management of PPH due to atony

A
  1. Palpate and rub uterine fundus to stimulate contractions (rubbing up the fundus)
  2. Ensure bladder is empty (leave Foley catheter in situ)
  3. Oxytocin 5 iu by slow IV injection* (may have repeat dose)
  4. Ergometrine 0.5 mg by slow IV or IM injection (contraindicated in women with hypertension)
  5. Oxytocin infusion (40 iu in 500 ml isotonic crystalloids at 125 ml/hour)
  6. Carboprost 0.25 mg by IM injection repeated at intervals of not less than 15 minutest (maximum 8 doses - caution in asthmatics)
  7. Misoprostol 800 micrograms sublingual.
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67
Q

What % patients undergoing CS for placenta praevia will require further laparotomy

A

7.5%

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68
Q

What is the most common cause of spontaneous miscarriage and implantation failure in those undergoing IVF

A

Aneuploidies

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69
Q

success rate of VBAC in patients with previous CS for labour dystocia

A

64%

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70
Q

Injury to branches of which of the following vessels is responsible for a supralevator haematoma

A

Uterine artery branches in broad ligament

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71
Q

Semen analysis
Volume
pH
Sperm conc
Total number
Total motility
Vitality
Normal morphology

A

Semen analysis
Volume 1.5ml
pH >7.2
Sperm conc 15mill
Total number 39mill
Total motility 40% mobile, 32% progressive motility
Vitality 58%
Normal morphology 4%

39 million sperm meet to concentrate on 15 dances, 40 got moves, 32 try, 58 come alive but only 4 look normal

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72
Q

Chance of conceiving spontaneously with expectant management within 12 months in unexplained subfertility

A

74%

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73
Q

Average cycle fecundity without treatment in women with unexplained subfertility %

A

1.3-4.1%

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74
Q

Male infertility in CF
Cause?
What percent affected?

A

Congenital absence of vas deferens
98%

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75
Q

What percentage of subfertile couples will have unexplained infertility

A

30-40%

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76
Q

What is the surface cell protein composition of uterine natural killer cells?

A

CD56bright/CD16-

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77
Q

What is the surface cell protein composition of peripheral natural killer cells?

A

CD56 dim/CD16+

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78
Q

Nexplanon
Failure rate
% discontinuing due to side effects of…
% amenorrhoea

A

0.05% failure rate
20% discontinue due to heavy/irregular bleeding
20% amennorhoea

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79
Q

VTE risk with contraception per 10,000

Non-contraceptive users, not pregnant
CHC
Pregnancy

A

Non contraceptive users and not pregnant=2 per 10,000
CHC containing ethinylestradiol plus levonorgestrel, norgestimate or norethisterone=5-7 per 10,000
CHC containing etonogestrel (ring) or norelgestromin (patch)=6-12 per 10,000
CHC containing ethinylestradiol plus gestodene, desogestrel or drospirenone=9-12 per 10,000
Pregnancy=10 per 10,000

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80
Q

Cyclical HRT inhibits ovulation in what percentage of patients?

A

40%

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81
Q

LNG-IUD
Failure rate
Perforation rate
Expulsion rate
Infection risk
Risk of ectopic if ectopic occurs

A

Failure rate <1%
Perforation rate 1-2:1000
Expulsion rate 1:20
Infection risk 1:100 for 3/52 after insertion
Risk of ectopic if pregnancy occurs 1:20

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82
Q

Women over 40, % of unplanned pregnancies

A

20%

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83
Q

Women over 40, % of pregnancies ending in TOP

A

28%

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84
Q

Incidence of mitochondrial disorders

A

1 in 6500

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85
Q

Incidence of premature ovarian failure in <40yo

A

1%

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86
Q

Cu-IUD
Pregnancy rate
- within 1st year
- over 5 years
Perforation rate
Expulsion rate
Infection risk
Risk of ectopic if ectopic occurs

A

Pregnancy rate
- within 1st year 0.6-0.8%
- over 5 years 1-2%
Perforation rate 1-2:1000
Expulsion rate 1:20
Infection risk 1:100 for 3/52 after insertion
Risk of ectopic if pregnancy occurs 1:20

87
Q

Stopping contraception around menopause

Age can stop
non-hormonal methods
POP
CHC
depot

A

Age >55 can stop

If non-hormonal methods
>50: stop 1 year after amennorhoea
<50: stop 2 years after amennorhoea

If POP:
Stop 1 year after 2xFSH>30 taken 6/52 apart
Do not use FSH in <50 to stop contraception

If CHC: stop 2/52 before checking FSH
If depot: stop 1yr before checking FSH

88
Q

Condom effectiveness rate
Male and female typical and perfect use

A

Male typical use: 83%
Female typical use: 79%
Male condom perfect use: 98%
Female condom perfect use: 95%

89
Q

Diaphragm
Effectiveness rate - typical and perfect
Timing of removal post sex
Timing of application of spermicide
HIV risk

A

Typical use: 88%
Perfect use: 94%
Remove >6hrs post sex
Apply more spermicide if >3hrs inserted
Noxyl-9 spermicide increase HIV transmission

90
Q

Scoring system for hirsuitism

A

Ferriman and Gellwey

91
Q

Complications following cervical ca radiotx

A

Bowel obstruction 14.5%
Fistula 8%
Dyspaerunia 55%

92
Q

Zika primary vector

A

Aedes mosquito

93
Q

Reduction in fibroid size with GnRH analgoues

A

36% reduction in fibroid size after 12 weeks

94
Q

VBAC success rates

A

Planned overall 72-75%
Previous SVB 85-90%
Prev CS for malpresentation 84%
Prev CS for fetal distress 73%
Prev CS for labour dystocia 64%

95
Q

Cu-IUD method of action

A
  1. Prevents fertilisation - toxic effect of Cu on egg and sperm
  2. Alters cervical mucus
  3. Inflammatory reaction in endometrium
96
Q

CHC method of action

A

prevents ovulation

97
Q

Depot injection method of action

A

Prevents ovulation

98
Q

Implant method of action

A

Prevent ovulation

99
Q

POP

A

thickens cervical mucus

100
Q

LNG-IUD

A
  1. Prevents implantation by suppressing endometrium and increased endometrial phagocytic cells
  2. Thickens cervical mucus
101
Q

Gonnorhoea treatment

A

1g ceftriaxone IM stat

102
Q

Chlamydia treatment

A

Doxy 100mg BD for 7/7

103
Q

M. genitalis treatment

A

Doxy 100mg BD 7/7 then azithro 1g stat + 500mg OD for 2/7

If resistant or complicated: moxifloxacin 400mg OD for 7 or 14 days

104
Q

Trichomonas treatment

A

metro 400mg bd for 7/7

105
Q

Amsels criteria for BV

A

3 of 4 of:
1. thin white discharge
2. clue cells on microscopy
3. ph>4.5
4. Fishy small on adding alkali 10% KOH

106
Q

BV
2 eponymous criteria’s
Treatment

A
  1. Amsels
  2. Hay/Ison = lactobacilli vs gardnerella/mobilluncus dominance
    Tx = metro
107
Q

Neonatal herpes - % skin vs disseminated
Mortality and neuro morbidity with local skin, local CNS disease and disseminated disease

A

30% skin, 70% local CNS/disseminated
Skin best prognosis, neurological/ocular morbidity <2%
Local CNS disease - mortality ~6%, neurological morbidity 70%
Disseminated disease - mortality ~30%, neurological morbidity 17%

108
Q

What is the acceptable level of plasma factor VIII and factor IX levels in severe haemophilia pre procedure

A

0.5iu/ml

109
Q

How often should you cross match blood in placenta praevia and red cell antibodies

A

Weekly

110
Q

What is the tool for diagnosing IBS

A

Rome III criteria

111
Q

Parvovirus antibody results
IgG/IgM

A

IgG +ve / IgM -ve Immune
IgG -ve / IgM -ve Susceptible to infection
Positive for IgM (irrespective of the IgG result) Suggests recent infection

112
Q

Investigations following T2 miscarraige

A
  • screen for inherited thrombophilias
  • APS screen
  • pelvic USS
113
Q

Treatment for mastitis if penicillin allergic

A

clarithro/erythro for 10-14 days

114
Q

Inheritance of Rokitansky-Küster-Hauser syndrome

A

autosomal dominant inheritance with incomplete penetrance

115
Q

Prognostic indicators in vulval SCC

A

nodal status
primary lesion diameter

116
Q

Management of fibroids - reintevention rates of uAE vs surgery

A

32% vs 4%

117
Q

who is highest risk of complete molar pregnancy

A

women >45

118
Q

Egg/sperm description of partial molar pregnancy

A

normal egg is fertilised by two or more sperm

119
Q

Amniocentesis sensitivity for CMV diagnosis

A

70-80%

120
Q

Associations in pregnancy with raised afp

A

fetal growth restriction
placental abruption
fetal demise after 24 weeks
preterm delivery
spontaneous miscarriage

121
Q

Associations in pregnancy with raised inhibit A

A

preterm delivery
gestational hypertension
pre-eclampsia
fetal demise after 24 weeks
fetal growth restriction

122
Q

Associations in pregnancy with low unconjugated oestrogen

A

Oligohydramnios
Fetal demise after 24 weeks
low birth weight
spontaneous miscarriage

123
Q

Associations in pregnancy with raised b-hcg

A

preterm delivery
gestational hypertension
pre-eclampsia
fetal demise after 24 weeks
fetal growth restriction

124
Q

Boundaries of paravaginal haematomas

A

Inferior - pelvic diaphragm
Superior - cardinal ligament

125
Q

Percentage of general population with benign liver lesions

A

20%

126
Q

Risks at section for placenta praevia
Hysterectomy:
VTE:
Bladder/ureteric injury:
MOH:
Further laparotomy:

A

Hysterectomy: 11% (27% if previous CS)
VTE: 3%
Bladder/ureteric injury: 6%
MOH: 21%
Further laparotomy: 7.5%

127
Q

Contraindications to cabergoline

A

PET
Cardiac valvulopathy
Hx if pericardial fibrosis
Hx of puerperal psychosis
Hx pulmonary fibrosis
Hx of retroperitoneal fibrosis
Hypersensitivity to ergot alkaloids

128
Q

Vulval cancer 5 year survival

A

No LN involvement >80%
Inguinal LN involvement <50%
Iliac and other Pelvic LNs 10-15%

129
Q

Vulval cancer 5 year survival

A

No LN involvement >80%
Inguinal LN involvement <50%
Iliac and other Pelvic LNs 10-15%

130
Q

Figo vulval cancer stages

A

1: confined to vulva
1A: <2cm, <1mm deep
1B: >2cm, >1mm deep
2: extends to lower third urethra/vagina/anus with no nodes
3: extends beyond with nodes
3A: upper third urethra/vagina/anus/mucosa or regional LN<5mm
3B: regional LN >5mm
3C: regional LN with extracapsular spread
4A: bones mets, ulcerated LN
4B: distant mets

131
Q

FIGO Stage 1 cervical cancer divisions

A

1A: invasive carcinoma dx by microscopy, max depth <5mm
1A1: stomal invasion <3mm depth
1A2: stromal invasic >=3 and <5mm depth

1B: invasive carcinoma >=5mm deep, limited to cervix
1B1: >/= 5 mm stromal depth, <2 cm dimension
1B2: >/= 2 cm and < 4cm dimension
1B3: >=4cm dimension

132
Q

Cervical cancer FIGO stages 2-4

A

2: beyond uterus, but not to pelvic side wall or lower 1/3 vagina
2A: upper 2/3 vagina but not parametrium (A1<4cm, A2>=4cm)
2B: parametrium

3A: lower 1/3 vagina
3B: pelvic side wall +/- hydronephrosis/renal failure
3C1: pelvic LNs
3C2: paraaortic LNs

4A: pelvic organs
4B: distant mets

133
Q

Rates of urinary incontinence postpartum

A

17-32%

134
Q

Time taken for fibroids to return to pre-treatment size after stopping GnRH analogues

A

4-6 months

135
Q

Risk of vault prolapse following hysterectomy

A

Hysterectomy for prolapse: 11.6%
Hysterectomy for other benign disease: 1.8%

136
Q

Risk of co-existing endmetrial cancer with hyperplasia with atypia

A

up to 59%

137
Q

hcg testing post salpingotomy

A

7 days postop
then weekly until negative result obtained

138
Q

Risk of preterm birth by cervical length

A

<25mm - 25% risk of delivery before 28 weeks
<20mm:
42.4% before 32 weeks
62% before 34 weeks

139
Q

Lifetime risk of ovarian cancer

A

1.4%

140
Q

Low long should ureteric stents remain in following ureteric injury

A

6 weeks

141
Q

Percentage of babies thy are breech at:
28 weeks
Term

A

28 weeks - 20%
Term - 3-4%

142
Q

Enzyme inducing AEDs

A

Phenobarbital
Phenytoin
Carbamazepine (Tegretol®)
Topiramate
Oxcarbazepine

Philip found carbohydrates too overly inducing

143
Q

What percentage of EH without atypia regress back to normal endometrium

A

75%-80%

144
Q

Chance of a successful pregnancy outcome with open transabdominal cervical cerclage

A

85%

145
Q

Aspirin moderate risk factors

A

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

146
Q

What proportion of ectopics are interstitial

A

2-5%

147
Q

Indication for desmopressin in incontinence
Contraindications

A

Nocturia
>65, hypertension

148
Q

Chance of GBS colonisation if GBS in a previous pregnancy

A

50%

149
Q

Percentage of women who are GBS carriers

A

20-40%

150
Q

Which AED does COCP lower levels of resulting in increased seizure prequency

A

Lamotrigine

151
Q

Lifetime risks of endometrial cancer
-Normal weight
-Obese

A

3%
10%

152
Q

What gestation should you stop these biologics and are they safe for BF:

  • etanercept:
  • infliximab
  • Adalimumab
  • certolizumab
A
  • etanercept: stop prior to T3
  • infliximab: stop prior to 16/40
  • Adalimumab: stop prior to T3
  • certolizumab: safe all trimesters
    All safe for BF
153
Q

Incidence of 3/4th degree tears:

  • overall
  • primip
  • multip
  • multip with previous 3/4th test:
A
  • overall 2.9%
  • primip 6%
  • multip 1.7%
  • multip with previous 3/4th tear 7.2%
154
Q

% of patients with spinal cord injury who have worsening spacicity

A

12%

155
Q

Histological findings in lichen sclerosis

A

Epidermal atrophy
sub-epidermal hyalinization
deeper inflammatory infiltrate

156
Q

Positive kleihauer, doses of anti-D dependent on volume

A

Fetal leak up to 4ml = 500IU anti-D
Then 125IU/ml fetal red cells

157
Q

CS and placenta praevia risk

A

No previous CS: 1 in 400, 0.25%
1 previous: 1 in 160, 0.6%
2 previous: 1 in 60, 1.6%
3 previous: 1 in 30, 3.3%
4 previous: 1 in 10

158
Q

Benefits of rescue cerclage

A

Delay birth by 5 weeks
2-fold reduction in chance of birth <34/40

159
Q

Most common liver lesion in pregnancy
USS features
Incidence in healthy individuals

A

Hepatic haemangioma

well circumscribed and hyperechoic

10%

160
Q

incidence of endometrial cancer amongst patients diagnosed with granulosa cell tumour of the ovary

A

10%

161
Q

Antibody levels at which to refer to FMU
- anti-D
- anti-C
- anti-K
- anti-E
Frequency of monitoring
What do FMU do

A
  • anti-D >4
  • anti-C > 7.5
  • anti-K - if detected
  • anti-E - if anti-c present
    Every 4 weeks to 28 weeks then every 2 weeks
    Weekly MCA - if > 1.5 multiples of median then consider invasive tx
162
Q

What should you check in vulval detmatitis?
What % of patients with vulval dermatitis have a deficiency in this?

A

Ferritin
20%

163
Q

How many days background radiation is one cxr equivalent to

A

10

164
Q

Ovarian cancer risk with HRT

A

Increased by 1 per every 1000 women taking HRT

165
Q

Risk of VTE with HRT

A

Risk of VTE increased 2-3 fold with PO HRT

166
Q

Proportion of live births amongst women with CF
Prematurity rate

A

80%
25%

167
Q

Flying in pregnancy
1. When not to fly beyond
2. Time when need special measures
3. Special measures

A
  1. Single>37/40, twins>32/40
  2. <4hrs= no special measures, >4hrs=special measures
  3. TEDS, hydrate, in seat exercise every 30 mins, regular walks
168
Q

Contraindications to flying in pregnancy

A

Severe anaemia (hb <7.5 g/dl)
Recent haemorrhage
Otitis media and sinusitis
Serious cardiac or respiratory disease
Recent sickling crisis
Recent gastrointestinal surgery
Bone fracture, where significant leg swelling may occur in flight

169
Q

What BMI is a risk factor for abruption

A

Low BMI

170
Q

Timing of 1st smear after CIN treatment

A

6 months
If negative —> 3yearly
If positive —> colp

171
Q

Risk of molar pregnancy if one previous molar

A

1 in 80

172
Q

What is the risk of a baby developing fetal varicella syndrome (FVS) if the mother develops chickenpox during the first 20 weeks of pregnancy and does not receive VZIG?

A

2.8%
If receives it then is nearly 0%

173
Q

Anaphylaxis risk with VZIG

A

<0.1%

174
Q

What percentage of twin pregnancies deliver before 37 weeks

A

50%

175
Q

incidence of umbilical cord prolapse:
- overall
- in breech presentation

A

0.1-0.6%
1%

176
Q

Incidence of ectopic pregnancy in the UK

A

1.1% or 11 in 1000

177
Q

Associations with cord prolapse

A

Multiparity
Low birthweight (< 2.5 kg)
Preterm labour (< 37+0 weeks)
Fetal congenital anomalies
Breech presentation
Transverse, oblique and unstable lie
Second twin
Polyhydramnios
Unengaged presenting part
Low-lying placenta

178
Q

Therapeutic targets for massive blood loss

A

Hb greater than 80 g/l
Platelet count greater than 50
PT and APTT <1.5x normal
Fibrinogen greater than 2 g/l

179
Q

What percentage of patients with stage 1 ovarian cancers have an elevated CA125?

A

55%

180
Q

accepted background cumulative dose of ionising radiation during pregnancy?

A

50mGy or 5rad

181
Q

When should you perform amniocentesis for CMV diagnosis

A

At least 6 weeks after maternal infection
After 21 weeks gestation

182
Q

Risks of developing cancer in complex endometrial hyperplasia
4 yrs
9 yrs
19 yrs

A

In 4 years: 8%
In 9 years: 12.4%
In 19 years: 27.5%

183
Q

Rate of concomitant carcinoma in complex endometrial hyperplasia

A

Up to 43%

184
Q

Minor risk factors for SGA
How many mean more scans
Scan timings

A

Age >35
IVF pregnancy
BMI <20
BMI 25-35
Smoker 1-10 cigs
Previous PET
Pregnancy interval <6/12 or >60/12

3 or more –> uterine artery doppler
If normal –> scan at 36/40
If abnormal –> serial growth scans

185
Q

Major risk factors for SGA
How many mean more scans
Scan timings

A

Age >40
Maternal/paternal SGA
Cocaine
Overexercise
Previous SGA baby
Smoker >10/day
Chronic HTN
Diabetic vascular disease
Renal impairment
APS
Heavy PVB
Low Papp-a (<0.4)

186
Q

What do you give if fibrinogen <2

A

2 pools cryoprecipitate

187
Q

Trigger level for giving platelets in haemorrhage
How many pools

A

<75
1 pool

188
Q

MOH and FFP
1. After how many units RBC should you give FFP and how much?
2. If prolonged APTT/PT, how much FFP do you give?

A
  1. After 4 units blood transfused –> give 4 pools FFP
  2. 12-15ml/kg
189
Q

When is the anomaly scan

A

18+0 to 20+6

190
Q

When is combined screening

A

10+0 to 14+1 weeks

191
Q

Contraindications to EllaOne

A

uncontrolled asthma
severe hepatic impairment

192
Q

Risk of future placenta praevia if placenta praevia

A

23 in 1000
or 2.3%

193
Q

Associations with VIN
- undifferentiated
- differentiated

A

undifferentiated = high risk HPV
differentiated = lichen sclerosis

194
Q

most common reasons for converting from laparoscopic to open transabdominal cerclage

A

Bleeding from uterine vessels
Poor views due to morbid obesity

195
Q

Incidence of endometriosis

A

10-15% (same as endometriosis)

196
Q

Miso regimes for IUD by dates

A

<26+6 weeks 100µg 6 hourly
≥27+weeks 25-50µg 4 hourly

197
Q

Risk of haemorrhage requiring transfusion in hysterectomy for benign conditions

A

2.3%

198
Q

Components of FIGO scoring for GTN

A

Age
Antecedent pregnancy (Mole, abortion, Term)
Interval months from end of index pregnancy to treatment
Pre-treatment serum hCG (iu/l)
Largest tumour size, including uterus (cm)
Site and number of metastasis
Previous failed chemo

199
Q

Risk of progression to cancer with EH over 20 years

A

Without atypia: <5% over 20 years.
With atypia: 25-30%

200
Q

Risk of GBS colonisation

A

50% if had previously
20-40% women carriers

201
Q

Risk of vascular injury at laparoscopy

A

0.1-0.2 per 1000

202
Q
A
203
Q

NNT for IAP for preventing GBS in
- PROM
- intra partum fever

A
  • 595
  • 208
204
Q

Tool for investigating patient safety incident

A

London protocol

205
Q

When should you perform deinfibulation of FGM

A

13-20 weeks

206
Q

NNT IAP to prevent GBS

A

595

207
Q

NNT IAP to prevent GBS if maternal temp >38

A

208

208
Q

Autopsy alone provides classification of death in what percentage of stillbirths

A

46%

209
Q

Drugs to start if stop lithium

A

Antipsychotic eg. quetiapine

210
Q

Mortality rates in sepsis

A

Severe sepsis with acute organ dysfunction = 20-40%
Septic shock = 60%

211
Q

Approximately what percentage of women will have vaginal discharge within 12 months of UAE

A

16%

212
Q

Incidence of pelvic pain following TOA

A

12% after one episode
30% after two episodes
67% after three or more episodes

213
Q
A

MRCOG part 2 (9 decks)

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