clinical stuff

Question 1

compared with white babies (32 out of 10,000), the stillbirth rate for black babies is

Answer 1

more than twice as high in black babies (72 out of 10,000)

Question 2

compared with white babies (32 out of 10,000), the stillbirth rate for Asian babies is:

Answer 2

around 50% higher in Asian babies (51 out of 10,000)

Question 3

for intrapartum antibiotics (for PTL/GBS), you give benpen. What do you give if there is chorioamnionitis

Answer 3

benpen + gent + metronidazole

Question 4

for intrapartum antibiotics (for PTL/GBS) and non-severe penicillin allergy, what do you give?

Answer 4

cefotaxime (or some other ceph that works against GBS)

Question 5

for intrapartum antibiotics for chorioamnionitis AND non-severe penicillin allergy, what do you give?

Answer 5

cefotaxime + metronidazole
(you don’t also add gent like you do if you’re giving benpen)

Question 6

for intrapartum antibiotics (for PTL/GBS) and SEVERE penicillin allergy, what do you give?

Answer 6

Vancomycin

Question 7

for intrapartum antibiotics for CHORIOAMNIONITIS and SEVERE penicillin allergy what do you give?

Answer 7

Vancomycin + gent + metronidazole

Question 8

rate of recurrence of ectopic pregnancy

Answer 8

18% (?)

Question 9

rate of recurrence of pre-eclampsia

Answer 9

16% (?)

Question 10

dose of radiation to breast tissue during CTPA

Answer 10

a minimum radiation dose of 2.0 rad (20 mGy) to the breasts of an average-sized woman

Question 11

Recurrent implantation failure (RIF) is defined as…

Answer 11

a lack of implantation after the transfer of three or more good quality embryos (IVF)

Question 12

how does glucose get into the foetus?

Answer 12

the most crucial factor in determining the fetal glucose concentration is the FACILITATED DIFFUSION process at the basal membrane or, more specifically: the permeability of the basal membrane and the density of the transporter GLUT1 on its faces.

Question 13

failure rate of vascectomy

Answer 13

1/2000
The lifetime failure rate of vasectomy is approximately 1 in 2000 men (0.05%) following negative semen testing

Question 14

Failure rate of tubal ligation

Answer 14

1/200

Question 15

phases of the endometrium during menstrual cycle

Answer 15

menstrual, proliferative, secretory

Question 16

highest incidence of cervical cancer is in what age group?

Answer 16

60-64

Question 17

delayed onset of lactogenesis is defined as…

Answer 17

onset >72 hours after delivery and appears to occur more often with preterm delivery and maternal obesity, and may be predicted by markers of metabolic health

Question 18

the most abundant protein in human colostrum is…

Answer 18

casein, I think!! (according to the given answers)
the micellar casein : whey protein ratio is 40:60, but there are multiple types of whey protein (lactalbumin, lactoferrin, IgA, albumin) so perhaps casein overall is the more abundant single protein

Question 19

endometriosis-linked ovarian cancer

Answer 19

clear cell
endometroid

Question 20

percentage of Brenner tumours that are malignant

Answer 20

5%

Question 21

describe Brenner tumour

Answer 21

aka (ovarian) transitional cell tumour due to histological appearance
on surface of ovary
rare (3% of ovarian cancers)
usually small <2cm
usually not malignant (only 5% malignant)
age 40-70s most common
fibrous so hypointense (dark) on T2 MRI
calcifications in 85% on CT

Question 22

what is a Krukenberge tumour

Answer 22

signet ring subtupe of metastatic tumour to the ovary
usually from stomach cancer
but can also be from colon/breast/lung/contralateral ovary

Question 22

most common fallopian tube malignancy

Answer 22

serous

Question 23

define indirect maternal death

Answer 23

indirect maternal death results from the interaction of pregnancy with unrelated medical conditions which may predate conception or may first appear during pregnancy, labour or the puerperium

Question 24

define direct maternal death

Answer 24

direct maternal death results from the complications of pregnancy, labour or puerperium, or from intervention, omission of, or incorrect, treatment

Question 25

what is the biologically active form of vitamin D

Answer 25

1,25-dihydroxycholecalciferol AKA Calcitriol

Question 26

describe the vitamin D pathway, from cholesterol to cholecalciferol to calciDiol to calcTriol

Answer 26

In the presence of sunlight, cholecalciferol (vitamin D3) is synthesized from cholesterol in the skin. The liver converts cholecalciferol to calcidiol. Calcidiol is then converted to calcitriol (the active form of vitamin D) in the kidneys.

Question 27

category of forceps delivery between +2 and not quite at the pelvic floor?

Answer 27

low forceps

Question 28

where is the flexion point?

Answer 28

in the midline, 3cm anterior to the posterior fontanelle

Question 29

what type of forceps are used for rotational deliveries?

Answer 29

Kiellands (mnemonic - keels over?) deep transverse or occipuo posterior malpositions. By comparison to the non-rotational forceps, the Kielland’s forceps blades have fenestrated blades with a much-reduced pelvic curve (in order to allow for the safe rotation of the fetus), longer shanks (to enable rotation within the mid-cavity of the pelvis), and sliding lock to allow for correction of any degree of asynclitism of the fetal head.

Question 30

what type of forceps are used for OA deliveries?

Answer 30

Rhodes, Neville-Barnes or Simpsons

Question 31

What type of forceps are used at a Caesarean section

Answer 31

Wrigley's (mnemonic - a wriggly baby won't come down vaginally?)

Question 32

preterm gestation contra-indicating ventouse?

Answer 32

<34 weeks

Question 33

what is the highest reasonable position of the fetal head to use forceps?

Answer 33

spines and no more than 1/5 palpable per abdomen

Question 34

midcavity forceps classification?

Answer 34

spines to +2

Question 35

rate of OASIS in forceps vs ventouse vs NVD

Answer 35

1:10 vs 1:25 vs 1:100 10% vs 4% vs 1%

Question 36

how many pulls do you get as a maximum for operative vaginal birth?

Answer 36

3

Question 37

what comes between DHEA .. X ..testosterone

Answer 37

androstenedione

Question 38

do you need to treat vaginal GBS?

Answer 38

only once labour starts

Question 39

do you need to treat GBS bacteruria

Answer 39

yes, at the time, and again during labour at diagnosis, give a penicillin or erythromycin if allergic (?)

Question 40

what is Meig's syndrome

Answer 40

benign ovarian tumour, typically a FIBROMA + pleural effusion + ascites

Question 41

What is the most common congenital tumor in the fetus and neonate?

Answer 41

Sacrococcygeal teratoma The incidence is estimated at ~1:35,000-40,000. There is a recognized female predilection with a male-to-female ratio of 1:4.

Question 42

/A neoplasm of the female genital tract occurring in an 18-year-old girl whose mother was treated with diethylstilbestrol during the pregnancy is likely to be a...

Answer 42

Clear cell carcinoma of vagina (they also have double the risk of breast ca >40yoa, and double the risk of pancreatic cancer)

Question 43

According to the past paper answers given, how should you treat an MRSA (caesarean) wound infection?

Answer 43

clindamycin + vancomycin

Question 44

If continuous CTG monitoring has been started because of concerns arising from intermittent auscultation, after how long of a normal CTG trace can you switch back to intermittent auscultation?

Answer 44

20 mins of normal CTG

Question 45

If fetus <10th centile, do you offer intrapartum CTG?

Answer 45

only if there are also high-risk features e.g. abnormal doppler scan results, reduced liquor volume or reduced growth velocity

Question 46

what readings of maternal pyrexia hit criteria for CTG monitoring?

Answer 46

(a temperature of 38°C or above on a single reading or 37.5°C or above on 2 consecutive occasions 1 hour apart)

Question 47

what increase in baseline FHR is an amber warning on CTG?

Answer 47

20bpm increase from the start of labour/since the last review an hour ago

Question 48

reduced variability of <5bpm is an amber flag between what times, and a red flag after what time?

Answer 48

30-50 mins is amber (although if with other risk factors should consider expediting birth at >30 mins) >50 mins is red

Question 49

increased variability is how many bpm? for what time periods is it amber or red?

Answer 49

>25bpm <10 mins is amber >10 mins is red