Volume 19 issue 4 Flashcards
Which progestogen in combined hormonal contraception is associated with the highest risk of venous thromboembolism?
A - Gestodene B - Levonorgestrel C - Medroxyprogesterone D - Norethisterone E - Norgestimate
Gestodene
In non-hormonal contraception users, the risk of venous thromboembolism (VTE) is 2 per 10 000 women per year. Use of combined hormonal contraception (CHC) increases that risk up to six-fold, depending on the progestogen chosen, with pills containing levonorgestrel, norethisterone and norgestimate having the lowest risk. The risk is highest with third-generation progestogen (e.g., gestodene)-containing CHCs.
A 45-year old is on the progestogen-only pill containing desogestrel. What would be considered a missed pill in this woman?
A - Delay in taking the pill by more than 3 hours
B - Delay in taking the pill by more than 6 hours
C - Delay in taking the pill by more than 12 hours
D - Delay in taking the pill by more than 8 hours
E - Delay in taking the pill by more than 24 hours
Delay in taking the pill by more than 12 hours
A missed progestogen-only pill is one that is taken more than 3 hours late, or with desogestrel pills more than 12 hours late.
During a routine booking antenatal clinic, which group of women should be asked about a history of female genital mutilation (FMG)?
A - All women from Africa and Asia
B - All women from all high-risk areas
C - All women form high-risk areas born outside of UK
D - All women irrespective of their country of origin
E - Women from the Horn of Africa, such as Sudan, Somalia and Djibouti
All women irrespective of their country of origin
Clinicians should be aware of the communities that practise FGM and ask all high-risk patients whether they have undergone the procedure. Every woman irrespective of the country of origin should be asked about a history of FGM at their booking visit.
A 26-year-old woman books for antenatal care at 8 weeks of gestation and on examination is found to have type 3 female genital mutilation (FMG). You have documented this in her notes, provided appropriate counselling and fulfilled the legal requirements. What would be the best approach to managing this patient’s FGM to reduce its consequences on the pregnancy and labour?
A - Recommended deinfibulation at 10–16 weeks of gestation
B - Recommend deinfibulation at 13–20 weeks
C - Recommend deinfibulation after the second trimester
D - Recommend deinfibulation intrapartum
E - Recommend deinfibulation in the third trimester
Recommend deinfibulation at 13–20 weeks
If type 3 FGM is identified antenatally at booking, deinfibulation (division of the labial scar tissue in the midline upwards the point of the urethral meatus) should be offered between 13 and 20 weeks of gestation to allow for the labia to heal before delivery.
A 33-year-old woman has been diagnosed with stage IA2 carcinoma of the cervix. She has been offered fertility-sparing surgery in the form of trachelectomy. What does this procedure entail?
A - Removal of the cervix
B - Removal of the cervix and parametrial tissue
C - Removal of cervix, parametrium & parametrial nodes
D - Removal of cervix upper vagina and parametrium
E - Removal of the cervix, upper vagina, parametrium and lymph nodes
Removal of the cervix upper vagina and parametrium
The basic concept of trachelectomy is to remove the cervix with surrounding tissue (parametrium and upper vagina) in order to achieve oncological clearance of the central tumour, while retaining the uterus.
What is the treatment of choice in a 32-year-old single woman with stage IA1 cervical cancer and who has never been pregnant?
A - Knife cone biopsy B - Radical trachelectomy C - Total abdominal hysterectomy and bilateral salpingoophorectomy D - Trachelectomy E - Wertheim’s hysterectomy
Knife cone biopsy
In this woman, who is single and with no previous pregnancies, fertility-sparing treatment in the form of knife conisation with or without laparoscopic lymphadenectomy will be the preferred treatment for stage IA1 disease. For stage IA2 to IB1, the treatment is trachelectomy if fertility is to be preserved.
How does the estimated risk of major congenital malformations in babies born to women with epilepsy but are not on any medication compare to that in the non-affected pregnant aged-matched population?
A - Double B - Five times higher C - Four times higher D - Similar E - Three times higher
Similar
Most anti-epileptic drugs (AEDS) cross the placenta and are potentially teratogenic. The incidence of major malformations in the fetuses of women with epilepsy who are not exposed to AEDs is similar to that in the general population (1–3%).
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When during pregnancy does exposure to anti-epileptic drugs (AEDs) run the risk of causing harm to the fetus?
A - First and second trimester B - First trimester C - Second trimester D - Third trimester E - Throughout pregnancy
Throughout pregnancy
The potential toxicity associated with AEDs use can occur in any trimester (i.e. throughout pregnancy).
What is the commonest cause of vulval itching in children?
A - Atopic vulvitis B - Contact dermatitis C - Lichen sclerosus D - Vulval seborrhoeic eczema E - Vulvovaginal candidiasis
Atopic vulvitis
Atopic eczema can affect the vulva in conjunction with typical eczema elsewhere on the body. Features typical of eczema include poorly defined symmetrical scaly erythematous areas on the skin creases (typically the antecubital fossae and behind the knees). Atopic vulvitis is the commonest cause of vulval itch in children.
A 30-year-old woman has been diagnosed with recurrent vulvovaginal candidiasis. What treatment will you recommend for this patient?
A - Fluconazole 100 mg daily for 3 months
B - Initial treatment with fluconazole 100mg, followed by 3 months of maintenance treatment with fluconazole 100 mg daily
C - Initial treatment with fluconazole 100mg, followed by a 6-month maintenance regimen of 100 mg weekly
D - Oral fluconazole 100 mg daily for 6 months
E - Topical steroid followed by fluconazole 100 mg daily for 3 months
Initial treatment with fluconazole 100mg, followed by a 6-month maintenance regimen of 100 mg weekly
A suggested treatment regimen for recurrent candidiasis includes initial treatment followed by a maintenance regimen for 6 months (fluconazole 100 mg weekly for 6 months).
The corpus luteum produces progesterone to support early pregnancy. By when is a corpus luteum cyst expected to regress in pregnancy?
A - Week 6 B - Week 8 C - Week 10 D - Week 12 E - Week 16
Week 8
Corpus luteum cysts produce progesterone and support pregnancy in the early first trimester. Usually they spontaneously regress by the 8th week of pregnancy when the placenta take over progesterone production.
What is the most common adnexal cystic lesion diagnosed after 16 weeks of gestation?
A - Corpus luteum cyst B - Follicular cyst C - Haemorrhagic cysts D - Luteoma of pregnancy E - Matured cystic teratoma
Matured cystic teratoma
Dermoid (matured teratomas) are the most common adnexal cystic lesions diagnosed after 16 weeks of gestation. Dermoid cysts less than 6 cm in diameter are generally asymptomatic in pregnancy. Cysts between 6 and 8 cm in diameter are particularly prone to torsion.
