Volume 20 issue 1 Flashcards
A 30-year-old with a twin pregnancy has a cervical length measurement of 22mm at 20 weeks of gestation. Approximately what proportion of women like her will deliver before 28 weeks of gestation?
A- 20% B - 25% C -30% D - 35% E -40%
25%
asymptomatic women with twins, a cervical length of <25mm: 25% risk of delivery before 28 wks
<20mm: 20-24 wks:
- 42.4% risk of preterm birth < 32 wks and a
- 62% risk of birth < 34 wks
A 29-year-old primigravida with twin pregnancies presents at 22 weeks of gestation for routine antenatal assessment. A cervical length measurement is performed and this is reported as 22mm. What intervention has been shown to have the best benefit with respect to reducing the risk of preterm birth in this woman?
A - Cervical cerclage B - Intramuscular progesterone C - None D -The Arabin pessary E - Vaginal progesterone
None
There appears to be no benefit of cervical cerclage in reducing the risk of PTB in multiple compared to singleton pregnancies. This is also the case with vaginal progesterone. The evidence for the Arabin pessary is poor and conflicting.
A 20-year-old primigravida has been diagnosed with diabetes insipidus at 20 weeks of gestation. What is the most likely biochemical abnormality associated with this condition?
A - Hypernatraemia B - Hypocalcaemia C - Hypokalaemia D - Hypomagnesaemia E - Metabolic acidosis
Hypernatraemia
Diabetes insipidus is the failure of the renal tubules to conserve water. If not corrected this can lead to symptoms of polydipsia and dilute polyuria and can result in hypernatraemic dehydration with neurological sequelae such as weakness, confusion and seizures.
A 30-year-old has been diagnosed with diabetes insipidus (DI). What would help differentiate between the different types of diabetes insipidus that this patient may have?
A - Failure to respond to treatment with vasopressin
B - Improvement, in response to treatment with
vasopressin
C - The time of diagnosis – with GDI being diagnosed
mainly after the first trimester
D - The urine:plasma osmolality ratio is >2 in gestational
DI (GDI) compared to neurogenic and nephrogenic DI
E - Urine specific gravity of <1.005 in non-gestational DI
compared to neurogenic and nephrogenic DI
Improvement, in response to treatment with vasopressin
Vasopressin treatment differentiates between the different types of DI. As central and gestational DI result from a lack of circulating ADH (caused by inadequate production and metabolic degradation respectively), vasopressin therapy can lead to improved biochemical and physiological parameters. However, it will have no effect in nephrogenic DI because ADH production and circulation is already adequate; the receptor is unresponsive to the hormone.
In which group of women with a heart disease undergoing an IUD insertion does the FSRH recommend the administration of prophylactic antibiotics?
A - Those with a history of rheumatic fever
B - Those with a prosthetic valve
C - Those with congenital heart disease
D - Those with hypertrophic cardiomyopathy
E - Those with septal defects
Those with a prosthetic valve
There is a theoretical risk of infective endocarditis, which is of particular concern in women with mechanical valve replacements, valvular heart disease, structural congenital heart disease, hypertrophic cardiomyopathy or a history of infective endocarditis. Current FSRH guidelines do not advocate the use of routine prophylactic antibiotics for protection against infective endocarditis because of lack of evidence supporting reduced infection rate. However, the FSRH recommends that all women with previous endocarditis or with prosthetic hear vales require intravenous antibiotic prophylaxis to protect against bacterial endocarditis during insertion of IUD.
A 30-year-old attends for contraceptive advice. She suffers from pulmonary hypertension and does not wants to get pregnant. What WHOMEC (UKMEC) category will you place this patient in with respect to offering her contraception?
A - UNMEC category I B - UKMEC category II C - UKMEC category III D - UKMEC category IV E - UNMEC category V
UKMEC category IV
The WHOMEC and UKMEC categories for the administration of contraception are: 1 – condition with no restriction for use of the contraceptive method – always useable; (2) condition where the advantages of the method generally outweigh the risks – mostly useable; (3) condition where the risks of the method usually outweigh the advantages, alternatives are usually preferable. Exceptions apply if the woman accepts the risk and rejects alternatives or where the risk of the pregnancy is very high and the only acceptable alternative methods are less effective and (4) conditions where the method represents an unacceptable health risk. Examples of category 4 conditions include pulmonary hypertension of any cause, severe heart failure and severe left heart obstruction.
A 30-year-old with learning disability is seen in the gynaecology clinic with significant menstrual disturbances. What will be useful in determining mental capacity in this woman?
A - The ability of the assessor (clinician) to determine if there is any disturbance in the functioning of her mind
B - The ability of the assessor (clinician) to determine if there is any impairment in the functioning of her mind
C - The ability of the assessor (clinician) to determine whether the patient is able to comprehend
D - The principle of the two-stage test of capacity (diagnostic and functional component)
E - The rationality of the patient to make a decision considered logical by the clinician (assessors)
The principle of the two-stage test of capacity (diagnostic and functional component)
Mental capacity can be determined subjectively through the two-stage test of capacity or objectively by validated tests. The two-stage test has a diagnostic and a functional component. The diagnostic component relies on the ability of the assessor to determine whether there is a disturbance or impairment in the functioning of the mind or brain of the individual and then proceed to clarify if the impairment is sufficient enough to prevent the individual from making the decision in question. The second stage of the test which is its functional component dictates that the individual will be unable to perform one of four tasks: understand, retain and evaluate information provided to reach a decision and to communicate any decision made.
When is “substituted judgement” considered as a guide to decision-making for individuals who lack mental capacity?
A - The best interest judgement is ambiguous
B - The individual does not have any advanced directive in place for a particular decision
C - The individual does not have a next of kin to make decisions
D - The individual has wishfully delegated the decision to another person
E - The individual judgement is such that an LPA is not appropriate
The individual does not have any advanced directive in place for a particular decision
Substituted judgement is considered as a guide to decision making when an individual who lacks mental capacity to make a particular decision has no advanced directive in place. The decision made using this framework is based on the assumption that the decision made by the third party will be comparable to what the individual would have made if competence were not in question.
You have requested for screening for Chlamydia trachomatis and Neisseria gonorrhoea on a 23-year-old admitted with a diagnosis of a right tubo-ovarian abscess confirmed on ultrasound scan. In approximately what proportion of such women will these organisms be isolated?
A - 0% (1:10) B - 15% (1:6) C - 20% (1:5) D - 25% (1:4) E - 33% (1:3)
25% (1:4)
Screening for sexually transmitted infections such as Chlamydia trachomatis and Neisseria gonorrhoea is important although in the UK it may only be positive in one-quarter of cases.
A 19-year-old student is unwell and presents with a temperature of 38.5oC, pulse of 135 bpm, lower abdominal pains, a vaginal discharge and an adnexal mass on bimanual examination. What will be your management of this patient?
A -Blood cultures, IV antibiotics and fluids and monitor urine output
B -Blood cultures, IV antibiotics and monitor urine output and oral fluid intake
C - Blood cultures, IV antibiotics and urine output, serum lactate and monitor oral fluid intake
D - Commence on IV antibiotics, IV fluids, blood cultures and measure urine output
E - Initiate the six-sepsis protocol (iv fluids and antibiotics, take blood for cultures and lactate, measure urine output and administer oxygen)
Initiate the six-sepsis protocol (iv fluids and antibiotics, take blood for cultures and lactate, measure urine output and administer oxygen)
The initial management of a woman with suspected TOA is dictated by clinical findings and ultrasound. In the presence of systemic sepsis (as in this patient), appropriate resuscitation and prompt surgery with concurrent commencement of broad-spectrum intravenous antibiotics may be considered. The sepsis six protocol should be followed: administration of oxygen, take blood for cultures, prior to commencing intravenous broad spectrum antibiotics, measure serum lactate, commence intravenous fluids and accurately measure urine output.
