29/3

Question 1

Hyperthryoidism in pregnancy

Answer 1

Carbimazole and PTU – compete with tyrosyl residues of thyroglobulin for iodine -> inhibit TPO
PTU preferred in pregnancy – lower placental transfer and excretion in breast milk
Radio-iodine contraindicated
Aim for TFTs upper 1/3 normal

Question 2

Carbimazole

Answer 2

aplasia cutis, choanal atresia, gastrointestinal anomalies, and abdominal wall defects.

Question 3

Iron homeostasis in pregnancy

Answer 3

Increase in hCG which stimulates the thyroid gland

Increase in urinary iodide excretion, leading to decrease in plasma iodine

Increase in T4-binding globulin (TBG) during 1st trimester, leading to increase binding of T4

= increased demand for LT4 treatment during pregnancy

Question 4

Dx of diabetes

Answer 4

PRE-DIABETES 6-8-42
HbA1c
42-47 mmol/mol
OGTT
7.8-11.0 mmol/L
Fasting plasma glucose
6.1 – 6.9 mmol/L

DIABETES 7-11-48
HbA1c
≥48 mmol/mol
OGTT
≥11.0 mmol/L
Fasting plasma glucose
≥7.0 mmol/L

Symptomatic → 1x HbA1c or fasting plasma glucose can be used
Asymptomatic → repeat test (ideally same test)

Question 5

HbA1c that you would not advise conception at

Answer 5

86 mmol/mol

Question 6

Plasma glucose levels to aim for in preg

Answer 6

Aim for fasting plasma glucose level of:
5–7 mmol/L on waking
4–7 mmol/L before meals at other times of the day

Monitor HbA1c monthly
Aim <48mmol/mol

Question 7

Sodium valproate tetatogenicity

Answer 7

Cardiac anomalies, spina bifida, developmental delay, hypospadias

Men: Do not donate sperm during valproate Tx and for 3/12 after stopping

Question 8

AED that effect neurodevelopment

Answer 8

Phenobarbital; phenytoin

Question 9

Topiramate teratogenicity

Answer 9

Hypospadias, oral clefts

Question 10

How long after MMR vaccine to avoid pregnancy for ?

Answer 10

4 weeks

Question 11

Hep B transmission rate

Answer 11

1st trimester = 10%
3rd trimester = 90%

Question 12

LH pulses in menstrual cycle

Answer 12

Beginning follicular phase = 1-2 hours
Mid cycle surge (surge mode)
4 hours luteal phase

Question 13

LH pulses reduced in what condition

Answer 13

Prolacinaemia

Question 14

LH pulses increased in what condition

Answer 14

PCOS

Question 15

Chromosome deletions

Answer 15

Digeorge - 22
Criduchat - 5

Question 16

Where in ant pit is hypothalamus

Answer 16

infundib/ arcuate nucleus

Question 17

When to give acic in vzv

Answer 17

> 20 /40
rash within 24 hours

Question 18

Toxplasmosis rx

Answer 18

Spiramycin
If risk of baby having then –> sulfadiazine / pyridine

Question 19

Which congenital infective thing causes jaundice

Answer 19

CMV

Question 20

Interstitial keratitis

Answer 20

scarring of cornea
late syphilis

Question 21

Group B Streptococcus

Answer 21

S. agalactiae
High morbidity – blindness, mental retardation

Prophylactic Abx (IV benzylpenicillin) peri-partum if:
GBS in previous pregnancy
GBS found incidentally in urine/vagina
PROM at term
Preterm ROM (<37/40) w/ known GBS
Intrapartum fever

Question 22

Drugs that dont cross the placenta

Answer 22

Heparin
Tubocurarine
Insulin

Question 23

Abx to avoid in preg

Answer 23

Tetracyclines (e.g. Doxycycline)
→ permanent discoloration of teeth
→ impaired bone growth (chelate Ca2+)

Sulphonamides (e.g. Septrin)
Inhibit folate metabolism
Benzoic acid → folate (sulphonamides)
Folate → tetrahydrofolate by dihydrofolate reductase (trimethoprim; methotrexate)
Kernicterus (displace bilirubin from protein)

Question 24

Abx caution in preg

Answer 24

Aminoglycosides (e.g. streptomycin, gentamicin)
→ nephrotoxic (tubular destruction)
→ ototoxic (8th CN nerve damage)

Quinolones
Permanent arthropathy

Nitrofurantoin
Neonatal haemolysis

Chloramphenicol
Grey baby syndrome (cardiovascular collapse) if given close to term

Question 25

Isotretinoin embryopathy

Answer 25

CNS: microcephaly, hydrocephaly, Dandy Walker-malformation Craniofacial: abnormalities/absent external ear, microphthalmia Cardiac: Aortic arch defect Thymic aplasia

Question 26

Lithium teratogenicity

Answer 26

Ebstein's anomaly (right ventricular outflow tract obstruction)

Question 27

Complete molar on uss

Answer 27

5-7 weeks: polypoid mass >8 weeks: cystic appearances of villous tissue, no gestation sac/fetus >13 weeks: ‘bunch of grapes’ appearance

Question 28

Oestrogen synthesis in pregnancy

Answer 28

The primary oestrogen in pregnancy is oestriol, the precursors of which are synthesised by the fetal adrenal cortex and liver (DHEA and 16-hydroxy DHEA respectively). Trophoblast cells aromatise 16-hydroxy DHEA to produce Oestriol.

Answer 29

Cell shrinkage Cell cytoplasm condenses and organelles tightly packed Pyknosis Chromatin condensation Blebbing Small blebs in the plasma membrane form Budding Formation of apoptotic bodies: portions of cytoplasm and intact organelles with or without DNA Budding prevents release of cellular contents into the surrounding interstitium Plasma membrane remains intact Phagocytosis Macrophages quickly engulf apoptotic bodies They do not release cytokines so there is no inflammatory response

Question 30

Emergency abortion which HSA cert and order etc

Answer 30

HSA2 (Certificate B) Order 2

Question 31

Which cells produce AMH

Answer 31

Sertoli cells

Question 32

Germ layer origins of the reproductive system:

Answer 32

Ectoderm: Epithelia of the distal urethra, penis and vulva Intermediate mesoderm: Urogenital system (excluding epithelium) Pronephros Paramesonephric duct Mesonephric duct Endoderm: Epithelia of the urogenital system

Question 33

Barr body

Answer 33

Klinefelter syndrome (XXY) where there is an additional X chromosome - not usually in XY None in Turners XO when usually in XX

Question 34

Meta-analysis

Answer 34

a technique in which results from a number of studies that are similar in nature are gathered to give one overall estimate of the effect. The formal steps include (1) decide on effect of interest, (2) check for statistical homogeneity, (3) estimate the average effect of interest with CIs, (4) interpret the results and present the findings (forest plot). The advantages include refinement and reduction, efficiency, generalizability and consistency, reliability, power and precision. The disadvantage include publication bias, clinical heterogeneity, quality differences, lack of independence of study subjects.

Question 35

systemic review vs meta-analysis

Answer 35

A systematic review synthesizes evidence on a specific topic using a rigorous, transparent methodology, ---> A qualitative or quantitative summary of the findings, often including a narrative synthesis of the evidence while a meta-analysis is a statistical technique used within a systematic review to combine data from multiple studies to obtain a more precise estimate of an effect

Question 36

Refinements of simple randomization

Answer 36

stratified randomization (controls for effects of factors), blocked randomization (assures treatment groups to be equal-sized), cluster randomization (allocates groups of patients) response-adaptive randomization (also termed outcome-adaptive randomization) in which the probability of being assigned to a group increases if the responses of the prior patients is deemed favorable. Allocation bias and confounding are avoided as much as possible to maximize efficiency of the study.