Miscellaneous

Question 1

What is hCG secreted by, and how early can it be detected?

Answer 1

In blood = 8 days after conception Secreted by syncytiotrophoblast Maintains production of progesterone by corpus luteum

Question 2

What is Meigs syndrome?

Answer 2

Benign ovarian tumour (usually fibroma) associated with ascites + pleural effusion

Question 3

When does lochia persisting become abnormal?

Answer 3

6 weeks postpartum

Question 4

Vasa previa presentation

Answer 4

Rupture of membranes then painless bleeding, bradycardia + late decels on CTG

Question 5

When is transdermal HRT useful?

Answer 5

Bypasses hepatic system so less chance of clotting

Question 6

What is the aim of antiretroviral treatment for HIV?

Answer 6

Keep CD4 >350 Keep viral load <50

Question 7

Pt with high risk for gestational diabetes - what + when to investigate?

Answer 7

BM or OGTT as soon after booking visit as poss If normal, repeat at 24 - 28 weeks

Question 8

Investigations for DIC

Answer 8

Elevated PT + APTT Low platelets

Question 9

High risk factors for pre-eclampsia

Answer 9

Personal hx Diabetes HTN CKD Autoimmune eg SLE, antiphospholipid syndrome

Question 10

Moderate risk factors for pre-eclampsia

Answer 10

BMI >35 Fam hx pre-e Age >40 First pregnancy Multiple pregnancy Pregnancy interval >10 years

Question 11

Protective + risk factors for fibroids

Answer 11

Exercise, smoking + multiparity = protective

Fam hx, obesity, African, early menarche = risk factors

Question 12

What is vulvodynia?

Answer 12

Sharp burning pain in vagina with no cause

Provoked by tampons + sex

Question 13

When does uterus reach umbilicus during pregnancy?

Answer 13

20 weeks

Question 14

What swabs can you do for PPROM?

Answer 14

If not sure about PPROM - swab vaginal fluid for insulin like growth factor binding protein 1 or placental alpha microglobulin 1

Question 15

Management of PPROM under 34 + over 37 weeks

Answer 15

Under 34 weeks: delay delivery unless infection

Over 37 weeks: induce

Question 16

What is anovulatory dysfunctional uterine bleeding?

Answer 16

Irregular + unpredictable uterine bleeding in first 2 years of menses

Due to inadequate gonadotrophin release + LH surge, leading to anovulation

Question 17

What is the histology of the epithelium in the vagina, fallopian tubes, cervix, endometrium + ovary?

Answer 17

Cervix = stratified squamous

Ovary = cuboidal cells

Endometrium = pseudostratified columnar with tubular glands

Vagina = glycogen containing stratified squamous

Fallopian tubes = columnar ciliated

Question 18

What is a luteoma of pregnancy?

Answer 18

Benign solid ovarian tumour that develops during pregnancy

Question 19

What are the signs + investigation results of congenital adrenal hyperplasia in late onset women?

Answer 19

Hirsutism, multiple ovarian cysts

Due to 21-hydroxylase deficiency

Causes menstrual irregularity

Raised serum-17-hydroxyprogesterone

Question 20

How to make the diagnosis of uterine hyperstimulation syndrome?

Answer 20

One of the following:

>6 contractions in 10 mins

<60s between contractions

Question 21

Best anticonvulsant in pregnancy

Answer 21

Lamotrigine

Question 22

What is ovarian stromal hyperthecosis?

Answer 22

Hyperplasia of ovarian stroma + clusters of luteinising cells.

Increased androstenodione + testosterone = hirsutism + virilisation

Conversion of androstenodione to oestrogen = hyperoestrogenic state causing endometrial hyperplasia

Question 23

S+S of adrenal tumour

Answer 23

Symptoms of virilisation, HTN, hypokalaemia + easy bruising

Question 24

What are the investigation results for DIC?

Answer 24

Thrombocytopenia

Increased PT + APPT

Elevated D dimer

Schistocytes on blood smear

Question 25

What follow up care is given to babies born from HIV+ mums?

Answer 25

Antiretrovirals 4hrs after delivery + continuing for 4-6 weeks Blood test within first 2 days, discharge, 6 weeks, 12 weeks + 18 months

Question 26

What is the classical sign of Jiroveci pneumonia?

Answer 26

Desaturations with exercise

Question 27

When are FBCs done during pregnancy?

Answer 27

At booking + at 28 weeks

Question 28

What is a chancroid?

Answer 28

Tropical STD - forming painful ulcers + lymphadenopathy

Question 29

What does Trichomonas look like?

Answer 29

Motile, flagellated protozoon

Question 30

Which cells produce testosterone + Anti-Mullarian hormone?

Answer 30

Testosterone = Leydig cells Anti-mullerian = Sertoli cells

Question 31

What hormones are increased in pregnancy?

Answer 31

Oestriol

Question 32

Behcets disease - S+S + management

Answer 32

S+S: Inflammation of blood vessels, genital + mouth ulcers, red painful eyes, headaches, painful joints Treat with steroids + immunosuppressants

Question 33

Prolactinoma, S+S + management

Answer 33

Prolactin producing tumour of pituitary gland Galactorrhoea, amenorrhoea, low libido Dopamine agonists eg Cabergoline

Question 34

VBAC chance of success + risk of rupture

Answer 34

Risk of rupture 0.5% Chance of success = 75%

Question 35

Vasa praevia - when does the bleeding occur?

Answer 35

Usually after a SROM

Question 36

What is the management of placenta praevia a) presenting in shock or \>37 weeks b) presenting \<37 weeks with intermittent bleeding

Answer 36

A) LSCS + Xmatch for 4-6 units B) Steroids + anti D, elective LSCS at 39 weeks

Question 37

What is the management of placental abruption if a) CTG normal + \>37 weeks b) CTG normal + \<37 weeks

Answer 37

a) amniotomy induction b) conservative, discharge as high risk

Question 38

When to give VTE prophylaxis (how many points for what type)?

Answer 38

4 points: LMWH from 1^st trimester until 6w PP 3 points: LMWH from 28w until 6w PP 2 during pregnancy: mobilise + hydrate 2 points PP: 10 days LMWH

Question 39

Syphilis treatment

Answer 39

Penicillin G

Question 40

When do you do test of cure for gonorrhoea?

Answer 40

NAAT after 2 weeks Blood cultures after 72 hrs

Question 41

What scores 4 points on VTE prophylaxis?

Answer 41

Previous unprovoked VTE OHSS

Question 42

What scores 3 points on VTE prophylaxis?

Answer 42

Previous provoked VTE Known high risk thrombophilia Medical co-morbidities: cancer, HF, SLE etc Hyperemesis Surgery in pregnancy