OBs, Gynae, Breast, GUM

Question 1

What should be monitored while taking Trastuzumab?

Answer 1

Cardiac function
Trastuzumab can cause cardiotoxicicty

Question 2

What age is the cut off for urgent referral to breast clinic for a women with a new breast lump?

Answer 2

<30 is non urgent referral
=> 30 is urgent referral

Question 3

Clinical features of congenital rubella syndrome

Answer 3

Newborns with CRS commonly present with sensorineural deafness, cataracts or retinopathy and congenital heart disease.

Other features include:

Organ dysfunction
Microcephaly
Micrognathia
Haematological abnormalities
Low birth weight
Later children may have developmental delay and learning disability
Neonates also may develop a characteristic petechial rash described as a “blueberry muffin” rash.

Question 4

What is the gold standard fir diagnosis of HIV?

Answer 4

serum HIV enzyme-linked immunosorbent assay (ELISA) which tests for both HIV-1 and HIV-2 antibodies and HIV-1 p24 antigen. p24 antigen is usually detectable earlier than HIV antibody, and can be detectable as early as 14 days after exposure.

Question 5

What does the risk of malignancy index for ovarian cancer consider?

Answer 5

Menopausal status
USS findings (ie ascites, solid areas, cysts)
CA125 levels

Question 6

How often should women with PCOS induce a withdrawal bleed while on the pill

Answer 6

Every 3 months

Question 7

How do you interpret syphilis serology?

Answer 7

Syphilis serology aids diagnosis and treatment.

Serology can be divided into treponemal and non-treponemal.

Non treponemal tests include the venereal disease research laboratory (VDRL) and rapid plasma reagin (RPR), and detect biomarkers released after infection. False positives can occur due to spirochaetes such yaws and pinta, pregnancy, and autoimmune disorders.
If the RPR is positive and the titre is greater than 1:8,and there is no history of treatment, a diagnosis of syphilis is made and the patient should begin treatment.
If the RPR decreases fourfold (i.e. from 1:32 to 1:8), or decreases below 1:8, this is considered adequately treated

Treponemal tests include T pallidum particle agglutination assay (TPPA) and Treponemal enzyme immunoassay (EIA). These work by detecting antibodies to the Treponema pallidum and therefore remain active for life, even in adequately treated patients.

Question 8

What don you give for recurrent thrush?

Answer 8

3 doses of fluconazole 150mg

Question 9

What type of ovarian cancer do younger women get?

Answer 9

Germ cell tumour

Question 10

What chemicals does a germ cell tumour secrete?

Answer 10

Alpha fetoprotein and beta - HCG

Question 11

What may be raised in neuropletc malignant syndrome?

Answer 11

Creatine kinase may be raised if there is muscle rigidity.

Question 12

How long can you return to work after open hysterectomy if heavy lifting needed?

Answer 12

6-8 weeks

Question 13

Which drugs target HER2 receptors?

Answer 13

Trastuzumab (brand name: Herceptin)
Pertuzumab
Neratinib

Question 14

What cancer does BRCA2 gene increase risk of men, apart from breast cancer?

Answer 14

Prostate, pancreatic and gastric

Question 15

What is PICA?

Answer 15

‘eating non-food items or food items in obscene quantities’?

Question 16

What is pounding?

Answer 16

Fascination with repetitive, mechanical tasks like assembling and dismantling.
Associated with Parkinson’s and methamphetamine.

Question 17

What is mitmachen?

Answer 17

Motor symptom of schiz where limbs can be moved without any resistance but return to original position after

Question 18

What Is logoclonia?

Answer 18

patient may get stuck on a word in a sentence and repeat it over again

Question 19

Which immunoglobulin attacks a rhesus positive fetus?

Answer 19

IgG

The first baby will sensitive the mother. The mother will oprioduce IgM which will attack fetal blood cells in the mothers bloodstream. However, IgM cannot cross the placenta so first baby is fine.

Over time, IgM will convert it to IgG. IgG can cross the placenta which is why subsequent babies will be affected.

Question 20

Is Amiodarone CI in breastfeeding?

Answer 20

Yes

Question 21

What is the most common type of ovarian cancer? What is the most common subtype of this? What is seen on histology in this subtype?

Answer 21

Epithelial ovarian cancer = most common subtype of ovarian cancer. (90%)

Serous cystenocarcinoma = most common subtype of epithelial ovarian cancer. Characterised by presence of psamoma bodies.

Question 22

How do you calculate an expected date of delivery?

Answer 22

Naegele’s rule
Add 9 months to LMP plus 7 days

Question 23

1st line med for pre-eclampsia

Answer 23

Lebetalol

Question 24

What is fetal pulmonary hypoplasia a complication of?

Answer 24

Oligohydramnios.
Amniotic fluid is needed for maturation of fetal lungs

Question 25

Is Turner’s syndrome hyogonadotropic hypogonadism or hypergonadotropic hypogonadism?

Answer 25

Hypergonadotropic hypogonadism

Question 26

What kind of pain does mittelschmerz cause? Why?

Answer 26

Mid cycle ovulatory pain and is common. Pain is due to rupture of the grafian (dominant) follicle each month which results in the release of the ovum into the fallopian tube.

Question 27

Which part of the vagina is most commonly affected in vaginal cancer?

Answer 27

Labia majora

Question 28

What med can you give a women with premenstrual syndrome if they decline the COCP?

Answer 28

SSRI

Question 29

What kind of conditions is premature ovarian failure associated with?

Answer 29

Autoimmune conditions

Question 30

What might be a pathological cause of a women not restarting periods again after an obstetric heamorrhage?

Answer 30

Sheehans syndrome - pituitary gland infarction following a major obstetric haemorrhage. - caused by hypotension associated with major haemorrhage causing pituitary necrosis

Question 31

Which type pf HSV affects the mouth?

Answer 31

HSV1

Question 32

Who is more likely to get lymphogranuloma venerum?

Answer 32

MSM

Question 33

How does lymphogranuloma venerum (LGV) present?

Answer 33

Begins with painless ulcers which progresses to form painful inguinal buboes, causing characteristic groove sign

Question 34

What pathogen causes molluscum contagiosum? How does molluscum contagiosum present?

Answer 34

viral skin infection caused by the molluscum contagiosum virus (MCV presents as small, pearly papules with central umbilication, often occurring on the genitals

Question 35

What is Kaposi’s sarcoma caused by?

Answer 35

Human herpes virus 8

Question 36

What antigen is expressed by Kaposi’s sarcoma-associated herpesvirus (KSHV)?

Answer 36

LANA1

Question 37

Which STD presents with painful genital ulcers and tender inguinal lymph nodes?

Answer 37

Chancroid

Question 38

What trimesters can you use trimethoprim and Nitrofurantoin in pregnancy?

Answer 38

Trimethoprim is safe to use in the 3rd trimester Nitrofurantoin is avoided in the 3rd trimester due to risk of neonatal haemolysis

Question 39

How does periductal mastitis present?

Answer 39

Smoking history Mammary duct fistula - sinus discharging pus

Question 40

What is a Jarisch-Herxheimer reaction?

Answer 40

transient immunological response that may occur in the early phase of antibiotic treatment of infections such as syphilis. This phenomenon is characterized by fever, rash, rigors, and tachycardia, which are thought to be triggered by bacterial endotoxins released upon lysis of the bacteria. Management mainly involves observation, hydration, and symptomatic treatment.

Question 41

Mechanism of action of doxycycline

Answer 41

Protein synthesis inhibition by blocking the 30S ribosomal subunit

Question 42

What pathogen causes frothy smelly discharge?

Answer 42

Trichomonas

Question 43

What do you see on a slide of thrush?

Answer 43

Spores and hyphae

Question 44

What does salt and pepper mean on a slide?

Answer 44

Bacterial vaginosis

Question 45

What does molluscum contagiousum look like?

Answer 45

Vesicles with central umbilicus. It’s a virus

Question 46

Where can the syphilis rash be?

Answer 46

Anywhere but especially look for rash on palms and soles

Question 47

What birth defects does methotrexate cause if being used in pregnancy?

Answer 47

Anencephaly, hydrocephalus, cleft lip/palate, skull defects

Question 48

What is the first line treatment for mastitis in a woman breastfeeding? When would you give abx?

Answer 48

1st line = continue breastfeeding Give abx (flucloxacillin) if patient is systemically unwell, a positive culture is seen, a nipple fissure is present or if symptoms do not improve after a day of milk expression

Question 49

What is the treatment for chancorid?

Answer 49

Ciprofloxacin and Ceftriaxone

Question 50

A woman has thrush while pregnant? Do you give oral or vaginal antifungals?

Answer 50

Vaginal. NICE recommend against the use of oral antifungals in pregnancy