B Flashcards by Philippa S

Which one of the above is not a contraindication to the use of mifepristone?

sickle cell

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One hundred women are taking the levonorgestrel-only contraceptive pill. How many unwanted pregnancies will occur over 1 year?

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The proportion of first trimester miscarriages that have evidence of chromosomal rearrangements

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A 23 year old woman attends the early pregnancy assessment unit with 7 weeks amenorrhoea, a positive pregnancy test and a 24 hour history of vaginal spotting. Clinical examination is unremarkable. Ultrasound shows irregular sac, with yolk sac and no fetal pole and no fetal heart action noted. The ovaries and adnexa appear normal. What is the most likely diagnosis?

missed misscarraige

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A 23 year old woman attends the fertility clinic with her 24 year old husband because of primary infertility. Clinical assessment and investigation of the female are normal. Semen analysis shows azoospermia. The clinical features in the male are shown in the attached diagram (click icon to view). The most likely endocrine profile in the man is

low Test, raised FSH, raised LH, raised SHBG

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Erbs palsy

C5/6

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The negative likelihood ratio that is considered by convention to indicate a very useful clinical test

less than 0.1

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During major postpartum haemorrhage, the PT ratio should be maintained

below 1.5

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A 32 year old woman develops primary cytomegalovirus infection in the second trimester. What is the risk of the fetus being infected?

30-40% second trimester

increased in 3rd trimester to 30-40%

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A positive indirect Coombs tests confirms the presence of

circulating red cell autoantibodies

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Perineal infiltration is usually undertaken when a pudendal block is performed for vaginal operative delivery because

pudendal block might be ineffective

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risk of ectopic in UK

1/100

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The sensitivity of microscopy in diagnosing endocervical infection with Neisseria gonorrhoea when compared with culture

30-50%

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fetal absorbed dose

0.17mgy 1st trimester
0.09 mgy 2nd trimester
0.12 mgy 3rd trimester

VQ scan has slightly lower dose of radiation for baby than CTPA

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The attached image shows a trans-vaginal scan in a 37 year old woman presenting with a 3 day history of offensive vaginal discharge.What is the most appropriate management?

keep coil in
swabs and abx

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The proportion of women who need chemotherapy following a complete molar pregnancy

13-16%

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Which biochemical abnormality is typically associated with hyperemesis gravidarum?

Hypochloraemic alkalosis

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A patient presents with condyloma lata. At what stage of syphilis does this feature occur?

2ndary syphylis

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Bone mineral density loss at the spine after 12 months of depo-medroxyprogesterone acetate use

0.5-3%

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In a 25 year old woman who is planning a pregnancy, which one of the above drugs should be discontinued and replaced by safer alternatives?

paroxetine

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A 23 year old woman presents with nausea and vomiting at 7 weeks gestation. Severity is assessed using the Pregnancy Unique Quantification of Emesis (PUQE) score. She has severe nausea and vomiting if her score is

severe 13-15
mod 7-12
mild <6

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A 23 year old woman with a history of Graves disease presents at 8 weeks gestation with severe nausea and vomiting. Graves disease is treated with carbimazole. Ultrasound scan identifies a twin pregnancy and biochemical investigations show TSH = 0.1 mu/L and free T4 = 35 pmol/L. What is the most appropriate management?

treat N+V and repeat TFT in 2 weeks

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The risk of expulsion of the levonorgestrel IUS

1/20

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The contraceptive method with the lowest failure rate

progesterone implant

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During resuscitation of a term neonate, the lungs should be aerated with

air

A 25 year old woman is found to have a 10cm complex ovarian cyst. Which tumour markers should be measured?

ca125 afp hcg ldh

A 33-year-old woman presents to her GP with a 2-month history of galactorrhoea. She is otherwise healthy and is not taking any medications. Nothing abnormal is found in the examination. Her hormonal profile shows: FSH 8.7 iU/L; LH 4.5 iU/L; Oestradiol 100 pmol/L; Prolactin 700 mU/L; TSH 15 mU/L; Free T4 9 pmol/L. What is the most likely cause?

hypothyroidism 3-5% of women with hyperprolacinaemia have hypothyroidism Increased TRH stimulates prolactin release

A 22 year old woman presents with abdominal pain and fresh vaginal bleeding at 38 weeks gestation. Pulse = 102 / min, BP = 110/68 mmHg. The cervix is 5cm dilated with intact membranes and there is moderate vaginal bleeding. You have been asked to review the patient at 09:30 (click icon to view CTG).

vaginal exam in 4 hours presentation consistent with placental abruption however established labour, CTG normal with no evidence of Maternal/fetal compromise

A 30 year old woman presents in spontaneous labour at 38 weeks gestation following spontaneous rupture of the membranes. She makes excellent progress to 6 cm dilatation and CTG is commenced following maternal request for epidural analgesia. All maternal observations are normal and there is clear liquor draining. The CTG shown (click icon to view) was normal until 04:31. You are asked to review the trace at 05:01. The CTG should be classified as

pathological repetitive decelerations

Drug transport across cell membranes is due to

Non-ionisation

Renal excretion of methotrexate is reduced by

aspirin

Which of the following drugs is associated with hemorrhagic cystitis?

cyclophosphamide

Test results in a pregnant woman with tertiary syphilis

VLDR neg fluorescent treponemal antibody tests positive

What percent of untreated individuals move on to the tertiary stage of syphilis?

33%

Antibody-producing cells

plasma cells

The human papilloma virus (HPV) vaccine is a

Virus-like particle vaccine

Antigen-presenting cells in the cervix

langerhans cells

What is the most common solid benign tumour of ovary?

fibroma

Ovarian dysgerminomas

are radiosenstive

Ovarian tumour associated with Meig’s syndrome

fibroma, thecoma

What is the most likely histological subtype of ovarian cancer associated with endometriosis?

clear cell adenocarcinoma

Psammoma bodies are typically found in

serous cystadenocarcinomas

DUCHENNE

x linked recessive

Rett syndrome is associated with learning difficulties. The mode of inheritance is

new sporadic mutations

Androgen insensitivity syndrome

Is caused by a mutation in the gene for the androgen receptor

Which one is not a typical feature of glucose-6-phosphate dehydrogenase deficiency?

Mutation in the gene for spectrin

Recognised haematological changes in normal pregnancy include

increased iron binding capacity

The change in total red cell mass by the end of the first trimester in normal pregnancy

25-30%

Change in GFR at 24 weeks gestation compared to pre-pregnancy

50%

Change in renal plasma flow at 24 weeks gestation compared to pre-pregnancy

75%

The insertion of the psoas major muscle

lesser trochanter

Menstrual blood does not usually clot because

It contains fibrinolysin

During pregnancy, the concentration of 17 alpha hydroxyprogesterone is

lowest 10 weeks

Human chorionic gonardotrophin

produced by8 cell embryo

Corticotrophin-releasing hormone (CRH) is produced where

hypothalamus

Inhibitors of TSH

thyroxine, growth hormone, cortisol, dopamine

TSH has what subunits

alpha and beta

During the late third trimester of pregnancy, the apex beat of the heart is located in which left inter-costal space?

4th intercostal space

what happens to peak expiratory flow in pregancy

no change

The change in colloid oncotic pressure by 24 weeks in a normal pregnancy

-10%

A 35 year old woman attends the antenatal clinic at 15 weeks gestation in her third pregnancy. Her blood group is O Rh negative and she is known to have anti-D antibodies. The blood group of her husband is A Rh positive with Rh genotype cDE / CDE. What is the blood group of the fetus?

A Rh positive or O Rh positive

RCOG guidelines make a recommendation based on evidence from a high-quality meta-analysis which is directly applicable to the target population. This recommendation should be categorised as

Grade A

RCOG guidelines make a recommendation based on evidence from a high-quality case-control study which is directly applicable to the target population. This recommendation should be categorised as

Grade B

A woman books in for her third pregnancy at 12 weeks of gestation. Routine hepatitis B virus (HBV) screening shows: HBsAg = POSITIVE; Anti-HBc IgG = POSITIVE; Anti-HBc IgM = NEGATIVE; HBeAg = NEGATIVE; Anti-HBe IgG = POSITIVE; HBV DNA = 2000 iu/ml. All other routine screening tests are normal. Which additional investigation is required?

LFT

A 65 year old woman is due to be admitted for vaginal hysterectomy because of prolapse symptoms. She has a history of anti-phospholipid antibody syndrome and is on long-term warfarin therapy. To enable surgery to proceed, how many days before surgery should warfarin therapy be discontinued?

5 days

Low transverse abdominal incisions have a higher risk of what than midline incision

nerve injury

Which one of the above vessels is likely to be injured when making a McBurney’s incision?

deep circumflex artery

The shelf life of stored platelets is approximately

5 days

The risk of needing a blood transfusion following active management of the third stage of labour

14/1000

A 32 year old woman has a spontaneous vaginal birth at 39 weeks gestation. The baby is delivered in excellent condition and there is physiological management of the third stage of labour. The neonatal blood volume is

125ml/kg

A 32 year old woman has a spontaneous vaginal birth at 39 weeks gestation. The baby is delivered in excellent condition and weighs 3500 g. The volume of additional blood transferred to the neonate as a result of delayed cord clamping is

160mL

A 29 year old primigravida with a history ankylosing spondylitis presents at 14 weeks of gestation with severe neck and upper back pain not relieved by hot packs. Which one is the most suitable analgesic?

oral ibuprofen

A 23 year old woman with a history of migraine presents with severe headache typical of migraine at 9 weeks of gestation. She discontinued her treatments for migraine once she had a positive pregnancy test. Neurological examination is normal. Which one is the most suitable analgesic?

oral ibuprophen

Which test is useful in predicting pre-term birth in women with intact membranes?

cervical length measurement

A 32 year old woman presents at 32 weeks gestation with a history of ruptured membranes but no contractions. Which of the following procedures should be avoided in this patient?

digital examination

Following parturition how long does involution of the uterus take?

4-6 weeks

Pregnant patients are at higher risk of thromboembolism due to a hypercoaguable state. Which of the following clotting factors reduces during pregnancy?

factor 11 and 13

A small study shows the lifetime incidence of breast cancer in smokers to be 20 in 100. In non smokers the incidence is 10 in 100. Which of the following represents the absolute risk of breast cancer in smokers?

20%

Which major hormone of pregnancy is produced by the placenta from 16-hydroxydehydroepiandrosterone sulfate (16-OH DHEAS)?

The placenta produces Estriol from 16-OH DHEAS. Estriol is the major oestrogen (estrogen) of pregnancy and the placenta is the primary site of production.

What is the typical volume increase from a non-pregnant to term uterus?

100ml to 5000ml

You are asked to review a 65 year old ladies legs pre-operatively. You diagnose cellulitis. What is the most common causative organism?

Group A streptococcus AKA Streptococcus Pyogenes

Which group of beta haemolytic streptococci is associated with chorioamnioitis?

GBS

Approximately how many oocytes are present in the ovaries at birth?

1 mill

What is the incubation period of Rubella (in days)?

incubation period of around 14 days. Rage 12-23 days

Regarding lymph drainage of the lower vagina where does the majority of lymph drain to?

inguinal

What is the approximate lifetime risk of endometrial cancer in patients with HNPCC (Lynch syndrome)?

40%

A 55 year old presents to clinic due to vulval itch and discolouration. examination reveals pale white discoloured areas to the vulva. A biopsy shows epidermal atrophy with sub-epidermal hyalinization and deeper inflammatory infiltrate. What is this characteristic of?

lichen sclerosis

B Flashcards

(88 cards)