13/07

Question 1

What level does spinal cord become cauda equina?

Answer 1

L2

Question 2

What level is spinal/epidural anaesthetic injected?

Answer 2

L3-L4

Question 3

What level does sympathetic outflow exit spinal cord?

Answer 3

T1-L2

Question 4

Which nerve supplies somatic motor and sensory to the perinuem?

Answer 4

Pudendal nerve

Question 5

What are the nerve roots of pudendal nerve?

Answer 5

S2,3,4

Question 6

What arteries supply anterior abdo wall?

Answer 6

Superior epigastric (continuation of interal thoracic) 
Inferior epigastric (branch of ext iliac)

Question 7

What is relationship of ureter and uterine artery?

Answer 7

Ureter inferior to uterine artery = “water under the bridge”

Question 8

What structures are at risk of injury in sacrospinous fixation? Why?

Answer 8

Pudendal NVB
Sciatic nerve
(Runs around sacrospinous ligament)

Question 9

What does the placenta do if implantation occurs?

Answer 9

Secrete HCG - prevents deterioration of corpus luteum

Question 10

What is the most reliable test to assess ovulation?

Answer 10

Day 21 progesterone

Question 11

What hormone should be tested to confirm menopause?

Answer 11

FSH

Question 12

How does BP fluctuate in a normal pregnancy?

Answer 12

BP falls in 1st trimester (particularly diastolic) till 20-24 weeks - then gradually increases till term

Question 13

High risk groups for preclampsia

Answer 13

CKD
Previous HTN in pregnancy
Autoimmune disorders
Diabetes

Question 14

How long can pregnancy test remain positive after TOP?

Answer 14

4 weeks

Question 15

How is cryptorchidism treated if < 14 y/o?

Answer 15

Orchidoplexy (to minimise cancer risk)

Question 16

What does FSH act on in males?

Answer 16

Sertoli cells

Question 17

What does LH act on in males?

Answer 17

Leydig cells

Question 18

What do the seminal vesicle secrete?

Answer 18

Prostaglandins (stimulate motility)

Fibrinogen (clot precursor)

Question 19

In a normal menstrual cycle what inhibits FSH?

Answer 19

Inhibin

Question 20

What effect does oestrogen have on LH?

Answer 20

At low conc - inhibits LH

At high conc - stimulates LH

Question 21

What does the corpus luteum produce?

Answer 21

Oestrogen
Progesterone (Inhibits GNRH - stimulates endometrial growth)
Inhibin (inhibits FSH)

Question 22

Causes of cervical excitation

Answer 22

PID

Ecoptic pregnancy

Question 23

When is LH surge?

Answer 23

midpoint of cycle (24-48 hours before ovulation)

Question 24

When do entrometiral polyps commonly occcur?

Answer 24

Around and after menopause

Question 25

Most common organism that causes endometritis

Answer 25

Neisseria

Question 26

What is a molar pregnancy?

Answer 26

Non-viable fertilized egg that implants in uterus (or tube)

Question 27

Describe complete mole

Answer 27

1 or 2 sperm combine with egg without DNA | Complete 46 chromo set

Question 28

Describe partial mole

Answer 28

Egg is fertilized by 2 sperm or one sperm that replicates itself (69XXY)

Question 29

Drug to reverse respiratory depression caused by magnesium sulphate

Answer 29

Calcium gluconate

Question 30

Drug used in benzo overdose

Answer 30

Flumazenil

Question 31

ABC symptoms of IBS

Answer 31

Abdo pain Bloating Change in bowel habit

Question 32

What type of pain is caused by ovarian torsion?

Answer 32

Deep seated colicky pain

Question 33

4 T's of PPH

Answer 33

Tone Tissue Trauma Thrombin

Question 34

Causes of secondary PPH

Answer 34

Retained placenta | Endometritis

Question 35

What happens to Hb in normal pregnancy?

Answer 35

Decreases

Question 36

Effect of normal pregnancy on platelets, WCC and ESR?

Answer 36

Platelets decrease WCC increase ESR icrease

Question 37

Effect of pregnancy on GFR

Answer 37

Increases

Question 38

Effect of pregnancy on calcium

Answer 38

``` Demands increase (serum calcium and phosphate levels decrease) Gut absorption of calcium increases ```

Question 39

Effect of pregnancy on LFTs

Answer 39

ALP increases | Albumin decreases

Question 40

Why is folic acid given during pregnancy?

Answer 40

Reduce the risk of neural tube defects

Question 41

Causes of folic acid deficiency

Answer 41

Pregnancy Alcohol excess Methotrexate Phenytoin

Question 42

Folic acid regime for normal pregnancy

Answer 42

400mg up till 12 weeks

Question 43

Reasons for high folic acid dose

Answer 43

BMI >30 Partner or prev pregnancy with NTD Taking antieplileptics Has diabetes, coeliac or thalasseamia trait

Question 44

Most common type of ovarian cancer

Answer 44

Serous carcinoma

Question 45

First line in menorrhagia if not wanting to concieve

Answer 45

Mirena IUS

Question 46

Management of menorrhagia if not wanting contraception

Answer 46

Mefanamic acid (good for dysmenorrhoea) or tranxaemic acid

Question 47

Used to short term stop heavy bleeding

Answer 47

Northesterone 5mg tds

Question 48

What is used for a medical termination of pregnancy?

Answer 48

Mifepristone then prostagaldnins

Question 49

Mechanism of action of metformin increasing fertility in PCOS

Answer 49

Increases peripheral insulin sensitivity

Question 50

List of drugs contraindicated in breast feeding

Answer 50

``` Antibiotics Antipsychotics (lithium, benzos) Aspirin Methotrexate Suphonylureas Cytotoxic drugs Amiodarone ```

Question 51

Complications of PCOS

Answer 51

``` Endometrial ca Diabetes Stroke Obstructive sleep apnoea Coronary artery disease Subfertility ```