Questions

Question 1

where is CIN most likely to arise

Answer 1

the transformation zone at the squamo-columnar junction

Question 2

how long is the female urethra

Answer 2

4cm

Question 3

at what stage of pregnancy does the uterus rise out of the pelvis

Answer 3

12 weeks

Question 4

describe some of the physiological changes that occur during pregnancy

Answer 4

an increase in plasma volume by 50% resulting a physiological anaemia.
Blood pressure decreases from second trimester due to vasodilatation.
Glomerular filtration increases to cope with the additional load of the fetus, resulting in a decrease in creatinine and urea levels.
Due to increase 30-45% increase in cardiac output, systolic ejection murmurs are common.
Thromboembolism increase in pregnancy due to the thrombophilic state resulting from haemostatic and fibrinolytic changes

Question 5

how long does the vagina measure

Answer 5

8cm

Question 6

where does the pudendal nerve pass in relation to the ischail spine

Answer 6

The pudendal nerve passes behind and below the ischial spine

Question 7

where does the ovarian artery arise

Answer 7

the aorta

Question 8

in preeclampsia what is defined as significant proteinuria

Answer 8

more than 300mg/L

Question 9

a small for gestational age baby is one which has an abdominal cicumferance below which centile

Answer 9

10th

Question 10

what factors increase the risk of endometrial cancer

Answer 10

PCOS
diabetes
obesity

Question 11

what weight is defines as macrosomia

Answer 11

birthweight more than 4 kg regardless of gestational age

Question 12

what incontinence medication should not be used in frail elderly people

Answer 12

oxybutinin

use tolteridine instead

Question 13

what is adenomyosis

Answer 13

endometrial tissue within the myometrium

Question 14

how is adenomysosis diagnosed

Answer 14

MRI pelvis

Question 15

what is the combined test for down’s syndrome and when in pregnancy is it done

Answer 15

nuchal translucecny on ultrasound scan + bHCG and PAPP-A

recommended at 10-14 weeks
in down’s syndrome PAPP-A is low and bHCG is high

Question 16

what is the quadruple test for down;s syndrome and when is it done in pregnancy

Answer 16

Alfa-fetoprotein (AFP), unconjugated oestriol, beta-hCG and inhibin A.

In pregnancies with Down Syndrome, AFP and unconjugated oestriol are low and beta-hCG and inhibin A are raised.

done if combined test window missed - weeks 14-20

Question 17

what changes on a CTG would be termed pre terminal and thus require emergency caesarian

Answer 17

terminal bradycardia - HR below 100 for more than 10 minutes

terminal decelerations - HR drops and does not recover within 3 minutes

Question 18

who gets anti D give prophylactially in pregnancy at at what gestations

Answer 18

given to Rh neg mothers what have not been senstitised ad 28-34 weeks

Question 19

how should you managed a pregnant woman who comes into contact with chicken pox and is unsure if they have had it before

Answer 19

check varicella IgM and IgG if IgG neg it suggests never having had it

give varicella immunoglobulin if there is doubt about immunity

do not give vaccine as it is live attenuated and there is a small risk of causing chicken pox

Question 20

how do you manage a women who has a high vaginal swab postivie for GBS during pregnancy

Answer 20

do not need to treat immediately

give IV benzylpenicillin during delivery “intrapartum”

Question 21

how long should magnesium sulphate be continue in pre eclampsia

Answer 21

either 24 hours after delivery or 24 hours after last seizure

Question 22

what drugs are safe in breastfeeding

Answer 22

antibiotics: penicillins, cephalosporins, trimethoprim
endocrine: glucocorticoids (avoid high doses), levothyroxine*
epilepsy: sodium valproate, carbamazepine
asthma: salbutamol, theophyllines
psychiatric drugs: tricyclic antidepressants, antipsychotics**
hypertension: beta-blockers, hydralazine
anticoagulants: warfarin, heparin
digoxin

Question 23

what drugs are contraindicated in breastfeeding

Answer 23

Lithium
Aspirin
Methotrexate
Benzos
Amioderone
Sulphonylureas
Tetracyclines
4Cs- Carbimazole, Ciprofloxacin, Chloramphenicol, Cytotoxics

Question 24

Rokitansky’s protuberance.

Answer 24

Dermoid cyst/teratoma

Question 25

what does a positive fetal fibronectin (fFN) test indicated

Answer 25

that preterm labour is likely (not definite)

Question 26

what makes up the risk malignancy index in ovarian cancer

Answer 26

USS, Ca125 and menopausal status

Question 27

what should babies born to mothers acutely or chronically infected with hep B during pregnancy

Answer 27

hep B vaccine at birth , one month and 6 months

if mother is antigen positive then also hep b immuniglobulin at birth

Question 28

woman who does not want to take HRT - what can you give her for the vasomotor symptoms of menopause

Answer 28

SSRI

Question 29

give causes of polyhydramnios

Answer 29

multiples
fetal anomolies
diabetes
hydrops fetalis 
idiopathic

Question 30

give causes of oligohydramnios

Answer 30

premature rupture of membranes
fetal renal problems e.g. renal agenesis
intrauterine growth restriction
post-term gestation
pre-eclampsia

Question 31

at what cut off should a woman recieve oral iron therapy in pregnancy

Answer 31

HB less than 11 at booking or 10.5 at 28 weeks

Question 32

contraindications to breastfeeding

Answer 32

HIV

galactosaemia

Question 33

what medications are avoided in breast feeding

Answer 33

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines, cloazapine
aspirin
carbimazole
methotrexate
sulphonylureas
cytotoxic drugs
amiodarone

Question 34

what medications are okay in breastfeeding

Answer 34

antibiotics: penicillins, cephalosporins, trimethoprim
endocrine: glucocorticoids (avoid high doses), levothyroxine*
epilepsy: sodium valproate, carbamazepine
asthma: salbutamol, theophyllines
psychiatric drugs: tricyclic antidepressants, antipsychotics**
hypertension: beta-blockers, hydralazine
anticoagulants: warfarin, heparin
digoxin

Question 35

first line treatment of post natal depression in a woman with no previous history of depression

Answer 35

psychological intervention (CBT)

SSRI or TCA if not improving with CBT or if CBT refused

Question 36

chlamydia +perihepatic adhesions

Answer 36

fitz hugh curtis

Question 37

scissoring of legs

Answer 37

cerebral palsy

Question 38

A 6-year-old girl presents with a one week history of febrile illness with sore throat and headache. One day prior to hospital admission, the patient awoke with pain and swelling in the right ankle. On examination, she has a warm swollen right ankle and a systolic heart murmur, consistent with mitral regurgitation.

Answer 38

rheumatic fever - group A step ie step pyoogenes