Repro

Question 1

A 25-year-old woman at 25 weeks gestation presents with constant lower abdominal pain and a small amount of vaginal bleeding. On examination blood pressure is 90 / 60 mmHg. Most likely diagnosis

Answer 1

Placental abruption

Question 2

A 31-year-old woman presents with painless vaginal bleeding at 15 weeks gestation. She has not yet had any antenatal care despite suffering from severe vomiting. On examination the uterus is large for dates - what is it

Answer 2

Hydatidiform mole

Question 3

A 19-year-old woman presents with a two day history of central lower abdominal pain and one day history of vaginal bleeding. Her last period was 8 weeks ago. On examination her cervix is tender to touch - what is it

Answer 3

Ectopic pregnancy

Question 4

What can bleeding in the 1st trimester suggest

Answer 4

Spontaneous abortion
Ectopic pregnancy
Hydatidiform mole

Question 5

What can bleeding in 2nd trimester be caused by

Answer 5

Spontaneous abortion
Hydatidiform mole
Placental abruption

Question 6

What can be bleeding in 3rd trimester be caused by

Answer 6

Bloody show
Placental abruption
Placenta praevia
Vasa praevia

Question 7

what is vasa previa

Answer 7

Rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia is classically seen

Question 8

What is placenta previa

Answer 8

Vaginal bleeding, no pain. Non-tender uterus* but lie and presentation may be abnormal

Question 9

What is placental abruption presentation

Answer 9

Constant lower abdominal pain and, woman may be more shocked than is expected by visible blood loss. Tender, tense uterus* with normal lie and presentation. Fetal heart may be distressed

Question 10

What is a hydatidiform mole presentation

Answer 10

Constant lower abdominal pain and, woman may be more shocked than is expected by visible blood loss. Tender, tense uterus* with normal lie and presentation. Fetal heart may be distressed

Question 11

What is an ecptopic pregnancy and presentation

Answer 11

Typically history of 6-8 weeks amenorrhoea with lower abdominal pain (usually unilateral) initially and vaginal bleeding later. Shoulder tip pain and cervical excitation may be present

Question 12

Why is vaginal examination not performed in primary care for sus antepartum haemorrhage

Answer 12

Women with pllacenta previa may haemorrhage

Question 13

What should add in gestational diabetes if not controlled with metformin

Answer 13

Insulin

Question 14

What are rocker-bottom feet a feature of

Answer 14

Edwards syndrome, trisomy 18

Question 15

Clinical features of Downs

Answer 15

face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face
flat occiput
single palmar crease, pronounced ‘sandal gap’ between big and first toe
hypotonia
congenital heart defects (40-50%, see below)
duodenal atresia
Hirschsprung’s disease

Question 16

Cardiac complications of downs

Answer 16

multiple cardiac problems may be present
endocardial cushion defect (most common, 40%, also known as atrioventricular septal canal defects)
ventricular septal defect (c. 30%)
secundum atrial septal defect (c. 10%)
tetralogy of Fallot (c. 5%)
isolated patent ductus arteriosus (c. 5%)

Question 17

Later complications of downs

Answer 17

subfertility: males almost always infertile due to impaired spermatogenesis. Females are usually subfertile, increased incidence of problems with pregnancy and labour
learning difficulties
short stature
repeated respiratory infections (+hearing impairment from glue ear)
acute lymphoblastic leukaemia
hypothyroidism
Alzheimer’s disease
atlantoaxial instability