Sharma's SBAs modified Flashcards
1
Q
What is the most likely time frame in an average 28-day cycle when women are most likely to conceive?
A
Day 8-14 (around 6 days prior to ovulation)
2
Q
Which vitamin in liver is most commonly associated with congenital abnormalities?
A
Vitamin A
3
Q
What is the most commonly recommended dose of folic acid to take during pregnancy and when should it be commenced and stopped?
A
400 micrograms, 12 weeks before getting pregnant up until the 12th week of pregnancy.
4
Q
A pregnant woman who takes diclofenac is at increased risk of what?
A
First trimester miscarriage
5
Q
Beta-blocker use in pregnancy is associated with what?
A
Growth restriction
6
Q
What are the most common serum markers that comprise the triple test?
A
Beta hCG
estriol
alpha-fetoprotein
7
Q
What is the most appropriate time frame for performing an USS screening for Down’s?
A
11-14 weeks
8
Q
What is the most appropriate time frame for performing an amniocentesis to screen for Down’s?
A
15 weeks
9
Q
What is the risk of miscarriage from an amniocentesis?
A
1% - minimal
10
Q
What is the most appropriate time frame for chorionic villous sampling in screening for Down’s?
A
11-14 weeks
11
Q
What time frame is oligohydramnios usually detected?
A
18-24 weeks
12
Q
Which hormone is responsible for nausea and vomiting during pregnancy?
A
beta HCG
13
Q
What happens to serum protein levels in pregnancy and why?
A
They fall due to a drop in serum albumin concentrations
14
Q
Which anti-hypertensive would you instigate first in managing hypertension in a pre-eclampsia patient?
A
Methyldopa
15
Q
38 week pregnancy. Pre-eclampsia. Feautres HELLP syndrome. What is the most appropriate step in management?
A
Immediate delivery. This is only true cure for pre-eclampsia.
16
Q
Pregnant lady
A
Placenta Praevia. (blood and painless)
17
Q
Pregnant lady
A
Placental abruption. (Woody uterus because of spontaneous uterine contractions)
18
Q
Pregnant lady
A
Placenta praevia. (No abdo pain and high fetal head.
19
Q
Pregnant lady
A
USS.
20
Q
Pregnant lady
A
IV access and urgent fluid resuscitation. (most likely an APH requiring aggressive fluid resus).
21
Q
Pregnant lady 37/40. Fresh red vaginal bleeding. Denies abdominal pain/discomfort. BP=125/80mmHg. HR=85bpm. What has she got and what is the management plan?
A
Placenta praevia. Delivery by caesarean section.
22
Q
36/40. O/E: palpate head in fundus of uterus and in the midline. What is the most likely diagnosis?
A
Extended breech (aka Frank Breech) usually the head is in the midline.
23
Q
36/40. O/E: palpate head in fundus of uterus. What is the next most appropriate step in management?
A
External cephalic version.
24
Q
What happens in the first stage of labour?
A
Cervical dilatation
25
What happens in the second stage of labour?
Delivery of the fetus
26
What happens in the third stage of labour?
Delivery of placenta
27
What does internal rotation involve?
Rotation from a lower occipital transverse position to an occipito anterior position.
28
How often should FHR monitoring be performed during labour?
every 15 minutes, duration of 1 minute.
29
What FHR is classified as fetal bradycardia?
30
Syntometrine is contraindicated in who?
Pregnant women with hypertension, asthma, active cardiac disease
31
The bishop's score is made up of what components, what is each component scored out of?
```
Position - 2
Consistency - 2
Effacement - 3
Dilation - 3
Fetal station - 3
```
32
What organisms can be responsible for mastitis?
Staphylococcus Aureus - most common
Staphylococcus epidermis
Streptococci
33
Episode of vaginal bleeding. Two weeks post-delivery. BP=90/50mmHg. HR=140bpm. Speculum= open cervical os. Bimanual= soft bulky uterus. Most likely diagnosis? What investigation would you perform to confirm?
Retained products of conception.
| TVUSS
34
What are the five criteria of the Apgar score? What would a completely healthy baby score?
```
Appearance
Pulse
Grimace
Activity
Respiration
```
Healthy baby score=10.
35
Middle-aged woman in active labour. Head has been delivered slowly but the neck does not appear with the chin retracting against the perineum. What is the most likely diagnosis?
shoulder dystocia
36
PPH is associated with oligohydramnios or polyhydramnios?
Polyhydramnios
37
Contraindications for the use of the COCP?
```
Migraine
Stroke
Hypertension
Ischaemic Heart Disease
Thrombosis
Smokers over the age of 35
Liver disease
Pregnancy
```
38
A 35 year old woman. Sexually active seeking contraception. Life-long smoker, history of hypertension. PID in the past. FHx of endometrial cancer. Which form of contraception is specifically contraindicated and why? Considering her history, what form of contraception would you recommend and why?
COCP is contraindicated because she is a smoker and a history of hypertension.
The implant device has been shown to reduce the risk of PID and endometrial cancer.
39
30 year old woman. New onset headache and weight gain. Blood pressure of 160/40 mmHg. She has recently been started on a contraceptive device. Given her history which contraceptive is she most likely on?
COCP - it is associated with migraine, thrombosis and hypertension.
40
Middle aged woman seeking contraception. History of hypertension, on ramipril. Treated for PID in the past. She is getting forgetful and has difficulty in taking her tablets. What form of contraception are you thinking of prescribing?
The implant device - due to her history of hypertension (which contraindicates COCP use), increasing forgetfulness and history of PID.
41
Long term use of Medroxyprogesterone IM has been linked to what condition?
Osteoporosis
42
30 year old woman seeking contraception. Previous ectopic pregnancy. Light smoker. Occasional drinker. What form of contraception are you going to prescribe her?
Mirena coil is associated with a reduced risk of ectopic pregnancy.
43
25 year old woman seeking contraception. History of menorrhagia and PID. What form of contraception would you not want to give to her?
Copper coil - it has been linked to menorrhagia and increased risk of PID.
44
What is the recommended dose of levonorgestrel?
1.5mg
45
What is the gold standard test for Neisseria gonorrhoeae?
Endocervical swab.
46
23 year old woman. Complaining of lower abdominal pain, irrgeular vaginal bleeding. Admits recent episode of unprotected intercourse. Endocervical swab confirms chlamydia. What three treatment options are there?
Azithromycin
Doxycycline
Erythromycin
47
25 year old woman presents following episode of unprotected intercourse. Complains of foul smelling yellow vaginal discharge and dysuria. On examination there is a strawberry-red cervix. What is the most likely diagnosis and what investigation would you perform?
Trichomonas infection.
High vaginal swab.
48
What is the recommended treatment in trichomonas infection? dose and route
Metronidazole, 2g, oral
49
Middle-aged woman presents following an episode of unprotected intercourse. Presence of several small labial blisters and feeling generally unwell. Which investigation is most likely to lead to a diagnosis? What treatment would you like to use?
Lesions swab
| Aciclovir
50
35 year old woman. Recent episode of unprotected intercourse. On examination presence of several pedunculated lesions on her vagina approximately 5mm in size. What has she got and What are the treatment options?
Genital warts
Podophyllin
Cryotherapy
Excision
Laser therapy
51
23 year old escort presents with single ulcer on her genitalia. Denies any pain or discomfort. Most likely diagnosis? What is the most likely causative factor for this condition?
Primary syphilis - single painless ulcer, commonly referred to as a chancre.
Treponema pallidum - a spirochaete with an incubation period of up to 90 days.
52
35 year old married woman. Complains of feeling unwell with non-specific joint pains and perianal discomfort. On examination you note evidence of wart like lesions on her perineum. She admits to being unfaithful to her husband for several years. What is the most likely diagnosis? What are these warts sometimes known as?
Secondary syphilis.
Condylomata lata.
53
Middle-aged woman presents to her GP following episode of unprotected intercourse. Complains of single painless ulcer within her vagina. What is the next most appropriate step in management?
She's got syphilis.
Procaine penicillin IM
or doxycycline if penicillin allergic.
54
25 year old woman. Unprotected intercourse. Complains of generalised abdominal pain and irregular bleeding. Speculum examination reveals evidence of a discharge. Bimanual examination demonstrates cervical excitation. What is the most likely aetiological cause for such symptoms? The complications of this cause?
Chlamydia trachomatis.
PID, infertility, ectopic pregnancy.
55
What agent would you use to treat vaginal yeast infection?
Clotrimazole or miconazole
56
Middle aged woman complaining of a cream-coloured dischage. Unprotected intercourse recently. Microscopy shows clue cells. Most likely diagnosis?
Bacterial vaginosis (clue cells are diagnostic)
57
What are the most likely causative organisms in bacterial vaginosis?
Gardnerella vaginalis
Mycoplasma hominis
Mobilincus species
58
What are some complications of chalmydia infection in pregnancy?
```
PID
Ectopic pregnancy
Infertility
Pre-term delivery
Fetal growth restriction
Low birth weight
```
59
On gram staining, what type of bacteria is Neisseria gonorrhoea (including its shape)
Gram negative diplococcus
60
24 year old woman complaining of a grey curd like vaginal discharge. What investigation would you like to perform to aid diagnosis?
High vaginal swab because she has a candida infection.
61
26 year old woman presents following an episode of unprotected intercourse. She is concerned with the development of new lesions vaginally. On examination you note the presence of several pearl-white lesions approximately 5mm in diameter. What is the most likely diagnosis?
Molluscum contagiosum - 'pearl-white lesions' are diagnostic.
62
28 year old woman complaining of new onset vaginal ithcing. She has noted brown specks in her underwear. She admits to having episodes of unprotected intercourse. What is the most likely diagnosis?
Crabs - the brown specks are most likely louse droppings.
63
What is the Pearl Index?
The number of women who will become pregnant if 100 women use that form of contraception for one year.
64
The progesterone-only pill is associated with weight gain or weight loss?
Gain
65
How would you define an inevitable miscarriage?
Open cervical os, heavy bleeding, products of conception not passed.
66
What is mifepristone and when can it be used?
It is an antiprogesterone.
It is used for termination of pregnancies up to 9 weeks gestation.
67
lower abdominal pain. irregular bleeding. serum bHCG greater than 1500 IU. What have they got?
ectopic pregnancy
68
You suspect a patient has an ectopic pregancy. What investigations are most likely to lead to a diagnosis?
serum bHCG
| TVUSS
69
Where is GnRH released from and what does it do?
Released from the hypothalamus
| Stimulates FSH and LH release
70
Which hormone is mainly responsible for the ovulatory phase of the menstrual cycle and what does it lead to the formation of?
LH
| leads to the corpus luteum
71
What hormone(s) does the corpus luteum produce?
oestrogen and progesterone
72
Which hormone is responsible for the growth and thickening of the endometrium?
oestrogen
73
Which hormone(s) is/are responsible for the vascularisation of the endometrium?
oestrogen and progesterone
74
A reduction in which hormone is a trigger to the start of menstruation?
Progesterone
75
25 year old woman presents with menorrhagia. She has a Hb of 8.2g/dL. You request a set of haematinics and a blood film. What type of anaemia has she most likely got and what on the blood film is associated with that type?
Iron deficiency anaemia. Pencil cells.
76
middle aged woman presents with unusually heavy periods. Noticed clots of blood being passed. Heavy smoker with a history of hypertension. What medical treatment is contraindicated in her management and what would you like to try next.
COCP is contraindicated because of smoking and hypertension.
Give mefenamic acid.
77
What type of drug has been shown to be effective in treating the symptoms of pre-menstrual syndrome?
Selective serotonin reuptake inhibitors.
78
What type of drug is Mefenamic acid and what is it prescribed for?
Anti-inflammatory
| Dysmenorrhoea
79
What serum measurement do you usually look for in PCOS? What level should it be at?
LH:FSH ratio
| around 2:1 or 3:1
80
In PCOS, serum FSH is usually ... raised, normal or low?
normal
81
In PCOS, serum LH is usually ... raised, normal or low?
raised
82
What malignancy is associated with PCOS?
Endometrial cancer
83
What is a normal sperm count (units)
Great than 20 million per mL
84
HRT tends to lead to ... weight gain or weight loss?
weight gain
85
Name some contraindications to hormone replacement therapy use?
```
Breast cancer
Ovarian cancer
Endometrial cancer
DVTs
PEs
Uncontrolled hypertension
Pregnancy
```
86
26 year old woman complains of painful intercourse and painful periods. Speculum examination reveals the presence of blue nodules. What is the most likely diagnosis?
Vaginal endometriosis
87
What is the gold standard for endometriosis diagnosis?
Laparoscopy
88
What is often first-line treatment in endometriosis?
COCP
89
A middle aged woman complaining of new onset vaginal discharge. Speculum examination reveals the presence of an erythematous raw-looking cervix. Current medication includes the OCP. What is the most likely diagnosis?
Cervical ectropion - commonly seen during puberty or pregnancy, alongside use of the oral contraceptive pill.
90
When is a smear test best performed with regards to the cycle?
mid-cycle
91
A cervical smear report: differentiation in the upper third of the epithelium with mitotic figures in the basal two thirds. What intervention would you like to do?
Excision!
92
63 year old woman. Sudden onset vaginal bleeding and a purulent discharge. Post-menopausal. Speculum shows ulcerated cervix. Most likely diagnosis?
Cervical Cancer
93
30 year old Afro-Carribbean woman presents to her GP. C/O increasingly heavy periods and abdominal discomfort. What is the likely diagnosis? What medication would you like to try?
Fibroids
| GnRH analogues or progesterone tablets
94
What tumour accounts for over 50% of all ovarian malignancies?
Serous Cystadenoma
95
Serous cystadenomas account for what % of all ovarian malignancies.
50%
96
What type of ovarian tumour can contain tissue from germ cells of the ovary, hair and teeth?
Teratoma.
97
What is Meig's syndrome?
A triad of ascites, pleural effusion and ovarian tumour (fibroma, Brenner tumour or granulose cell tumour)
