questions Flashcards
what are women offered as routine screening for Down’s syndrome
CUB - combined US/biochem screening
NOT amniocentesis as this is a diagnostic test, offered when risk of Down’s syndrome on screening is 1/25 or higher
40y/o, para 4, BMI 40
presents w/ leakage of urine on laughing and coughing
the following are appropriate management steps except:
- anticholinergic medication
- decrease caffeine intake
- physiotherapy
- transvaginal tape
- weight loss
anticholinergic medication - used for mixed urine incontinence and urgency, not stress urine incontinence
Which of the following is a CI to induction of labour:
- cephalic presentation
- obesity
- oblique lie
- previous C section
- rupture of membranes
oblique lie - unless baby is cephalic, labour won’t be induced; don’t want to risk cord prolapse
- cephalic presentation is a pre-requisite for induction
- prev CS is a relative CI
which of the following is CI in pregnancy:
ramipril
labetalol
methyldopa
magnesium sulphate
nifedipine
ramipril
ACEI are always CI in pregnancy
in order to prevent rhesus disease in the baby, which women are recommended to receive anti-D in their pregnancy
all rhesus -ve women - to prevent haemolytic disease of the newborn
routinely given in the 28th week
22y/o F w/ cyclical pain and dyspareunia
concerned re. endometriosis
what is the best investigation to confirm the diagnosis
diagnostic laparoscopy - endometriosis has to be physically seen to make a diagnosis
during the menstrual cycle the levels of hormones change. Which hormone has a sudden rise in level just before ovulation
LH - lutenising hormone
- progesterone is the predominant hormone following ovulation
- oestrogen is the predominant hormone in the 2wks prior to ovulation
31y/o F presents w/ severe R side upper abdo pain at 34wks gestation.
- She reported normal fetal movements up until now.
- She has no vaginal bleeding but the pain is getting worse
- Abdomen is tense and tender
- high BP recorded at midwife visit, urine dipstick is normal
what is the most likely diagnosis:
cholecystitis
placental abruption
pre-eclampsia
pre-term labour
urinary infection
placental abruption - upper abdo pain, abdomen is tense and tender
73y/o F presents w/ 3 episodes of unprovoked vaginal bleeding
- menopausal, obese, diabetic
- smears up to date until 60y/o
what is the most probable diagnosis :
cervical cancer
endometrial cancer
ovarian cancer
PID
rectal cancer
endometrial cancer (nulliparity is key risk factor as well as obesity and diabetes, PMB is key symptom)
- ovarian cancer less likely to cause post-menopausal bleeding
- PID unlikely w/ this hx, usually younger women
- rectal cancer would usually result in rectal bleeding
27y/o primagravid pt admitted at 37wks w/ 6hrs of contractions. 2 contractions in 10 mins, each lasting 50s.
No show and membranes are intact but she thinks she is in labour.
What is the best clinical sign to assess if she is in established labour
- abdo exam for descent of fetal head
- abdo exam for strength of contractions
- speculum exam for cervical dilatation
- vaginal exam for cervical dilatation
- vaginal exam to assess if membranes are intact
vaginal examination to assess cervical dilatation
whether membranes are intact or not isn’t a diagnostic feature of labour
cannot measure dilatation with speculum
contractions can be irritable uterus or braxton hicks
parous pt is in established labour and head is just visible at introitus
she has had no analgesia
she is pushing well but is screaming for pain relief, what method of pain relief is best:
epidural anaesthesia
entonox
morphine
spinal anaesthetic
supportive care
entonox
baby is almost out
- epidural - will take 20-40mins to put in
- morphine - try to avoid within 2hrs of birth to avoid effects on neonate
- spinal - not used during labour as it is shorter lasting, used for CS
- supportive care - not pain relief as such
26y/o, pregnant with her 1st baby, she has remained well during her pregnancy but her Hb has dropped from 13g/dl at 12wks to 11g/dl at 28wks
what is the most likely explanation:
concealed haemorrhage
iron deficiency anaemia
normal physiological change
pernicious anaemia
sickle cell
normal physiological change in pregnancy
considering 2y prevention of cervical cancer in UK, CIN is diagnosed by:
colposcopy
cytology
HPV testing
histology
MRI scan
histology
- colposcopy looks at surface of cervix, can’t give a diagnosis but can obtain tissue
- cytology looks at the cells themselves and often looks at fluid samples
- CIN is taken from tissue biopsy therefore histology
what is true about pregnant women who are diabetic:
- don’t suffer from a higher rate of stillbirth
- have babies who are at risk of neonatal hyperglycaemia
- need good diabetic control before conception to help prevent anomalies in the baby
- only suffer complications in the mother as glucose doesn’t cross the placenta and therefore doesn’t harm baby
- typically have smaller babies than non-diabetic mothers
need good diabetic control before conception to help prevent anomalies in the baby
- poor glycaemic control is associated w/ many complications in pregnancy
- are at higher risk of stillbirth w/ poor glycaemic control
- babies are at risk of neonatal hypoglycaemia
- complications can be seen in mother and baby w/ poor glycaemic control
- typically have larger babies
50y/o F has irregular periods and is suffering from mood swings and night sweats
she is perimenopausal and wishing to commence on HRT to help her symptoms
which hormone’s reducing level causes the menopausal symptoms
oestrogen
1y prevention of cervical cancer in the UK is performed by:
HPV 6 and 11 immunisation
high risk HPV testing
HPV 16 and 18 immunisation
HIV immunisation
cervical screening
HPV 16 and 18 immunisation
1y prevention is before exposure
6 and 11 HPV cause warts not cancer
in the UK national breast screening programme:
- screening target population are women ages 40-70y/o
- screening target population are offered 1y screening by clinical examination of the breasts
- screening target population are offered a mammogram every 5yrs
- screening target population are registered w/ a GP and aged 50-70y/o
- screening target population is anyone w/ FHx of a 1st degree relative w/ breast cancer
screening target population are registered w/ a GP and aged 50-70y/o
why should pregnancy women always be nursed in the left lateral position
in the supine position the pressure of the gravid uterus on the IVC causes a reduction in venous output to the heart w/ a possible 25% reduction in cardiac output
iron deficiency anaemia is by far the commonest cause of anaemia and is the most common haematological problem in pregnancy. In relation to this the following is true:
- pregnancy causes 10x increase in the requirement for iron not only for Hb synthesis but also for certain enzymes and the fetus
- because the expansion in plasma volume > increase in red cell mass there is a fall in Hb conc, haematocrit and RCC
- changes in the coagulation system during pregnancy produce a hypercoagulable state - clotting factors VIII, IX, X decrease and fibrinogen increases
- women will not be iron deficient if she has a normal Hb and MCV
- all women planning a pregnancy are advised to take 400mcg folate periconceptually and up till 12wks gestation to prevent megaloblastic anaemia
because the expansion in plasma volume > increase in red cell mass there is a fall in Hb conc, haematocrit and RCC
- folate is taken but is to prevent neural tube defects
33y/o para 1+2 presents at 9wks gestation
what can we tell from this about this woman’s obstetric hx
this is her 4th pregnancy and she has had 2 previous early pregnancy losses
1 pregnancy >24 wks, 2 pregnancies <24wks
- +2 can be any kind of pregnancy loss (not specific to miscarriage etc)
which of the following infections are women NOT routinely offered at booking:
hep B
HIV
sickle cell
thalassaemia
chicken pox (varicella)
chicken pox - they are asked about it in verbal hx but there is no serological testing
22y/o F presents to GP requesting emergency contraception
regular 28 day cycle and this is day 15
unprotected sex 78hrs ago
which is the most effective option for this woman:
emergency copper IUD
levonelle
mifepristone
mirena
illipristil acetate
emergency copper IUD - most effective
- mirena and mifepristone aren’t emergency contraceptive
- levonelle (72hrs) and illipristil (5days) are both hormonal and can only be used within certain timeframes
35y/o primigravid pt at 36wks gestation
BP 160/98 at routine antenatal check
which additional finding is diagnostic of pre-eclampsia
proteinuria
woman presents with vaginal bleeding and lower crampy abdo pain at 9wks gestation
speculum exam - blood and small clots coming through the open cervical os
which is the most likely diagnosis:
complete miscarriage
ectopic
inevitable miscarriage
pelvic infection
threatened miscarriage
inevitable miscarriage - open cervical os
- complete miscarriage needs scan to confirm
- open cervical os (uterine pregnancy rather than uterine)
- threatened miscarriage - bleeding but closed os
28y/o F has irregular periods and diagnosis of PCOS
partner’s semen analysis is normal
she is commenced on ovulation stimulation
which drug would be the best option:
clomiphene
danazol
decapeptyl SR
dianette
FSH
clomiphene - used for ovulation stimuation
some women w/ PCOS have oligomenorrhoea and don’t ovulate as well
- decapeptyl SR - used to switch off ovaries
- dianette - OCP
- FSH can be used but not usually for PCOS
