Obstetrics

Question 1

What is involved in first trimester Down’s Syndrome screening?

Answer 1

Nuchal translucency + B-HCG + pregnancy associated plasma protein A

Question 2

What is involved in second trimester Down’s syndrome screening?

Answer 2

α-fetoprotein, unconjugated oestriol, β-hCG and inhibin-A

Question 3

When in pregnancy should Folic Acid be taken?

Answer 3

From 12 weeks before conception to 12 weeks after ideally

Question 4

What are the first-line anti-hypertensives in pregnancy?

Answer 4

1. Labetalol
2. Nifedipine
3. Methyldopa

Question 5

Fever, uterine tenderness and foul-smelling discharge in pregnancy suggests…

Answer 5

Chorioamnionitis

Question 6

What is Chorioamnionitis?

Answer 6

Ascending infection of the amniotic sac - potentially life-threatening

Question 7

Which emergency contraception can be given during breast feeding?

Answer 7

Copper IUD or Levonestrogel

Question 8

When is the first dose of Anti-D given to rhesus negative women in pregnancy?

Answer 8

24 weeks

Question 9

What is the preferred method for induction of labour?

Answer 9

Vaginal Prostaglandin E2

Question 10

What are the first-line anti-emetics in pregnancy?

Answer 10

anti-histamines that also have anti-emetic effects such as cyclizine, prochlorperazine or promethazine

Question 11

How are 1st degree perineal tears usually managed?

Answer 11

Usually no suturing required

Question 12

How are 2nd degree perineal tears managed?

Answer 12

Sutured on the ward by a trained doctor/midwife

Question 13

How are 3rd and 4th degree perineal tears managed?

Answer 13

Sutured in theatre by a trained clinician

Question 14

What are the SSRIs of choice in breastfeeding women?

Answer 14

Sertraline or Paroxetine

Question 15

When should the first USS scan be done in pregnancy?

Answer 15

10 - 13 + 6 weeks

Question 16

How long after declaring a Cat 1 C-section should it be performed?

Answer 16

Within 30 minutes

Question 17

What is the anti-depressant of choice in breast-feeding women?

Answer 17

Sertraline

Question 18

Which antibiotic should be used for UTI if breastfeeding?

Answer 18

Trimethoprim

Question 19

Which diabetic medications are safe in pregnancy?

Answer 19

Metformin & Insulin

Question 20

What are the main risk factors for gestational diabetes?

Answer 20

Previous GDM
First-degree relative with diabetes
BMI > 30
Age > 35

Question 21

What is the screening test for gestational diabetes?

Answer 21

OGTT at 24-28 weeks

Question 22

Which glucose values are diagnostic of GDM?

Answer 22

Fasting glucose > 5.6

OGTT > 7.8

Question 23

What follow-up should women with gestational diabetes receive?

Answer 23

Fasting glucose 6-13 weeks after birth

HbA1C every year

Question 24

Which women should be started on LDA?

Answer 24

One of Hypertension, CKD, Autoimmune disease, T1/2DM, Hypertension OR
Two of prim, age > 40, BMI > 35, FH of PET, multi-foetal pregnancy or pregnancy interval > 10 years

Question 25

What are the diagnostic criteria for pre-eclampsia?

Answer 25

``` New HTN and one of: Proteinuria Renal failure Liver involvement Haematological Placental dysfunction ```

Question 26

How should eclamptic seizures be managed?

Answer 26

Mag sulphate

Question 27

Which AEDs are most safe in pregnancy?

Answer 27

Carbamazepine, Lamotrigine, Levetiracetam

Question 28

What must you remember before examining a woman with APH?

Answer 28

Need to exclude placenta praevia with TV USS before DVE

Question 29

Give risk factors for placental abruption.

Answer 29

previous PA, trauma, PET, smoking & drug use

Question 30

What is vasa praevia?

Answer 30

Umbillical cord/vessels pass near to the cervix

Question 31

What is the biggest risk factor for vasa praevia?

Answer 31

Artifical rupture of membranes

Question 32

Which maneovres may be used in vasa praevia?

Answer 32

Can support the presenting part or get Mum on all fours

Question 33

What is the investigation for suspected placenta praevia?

Answer 33

TV USS

Question 34

How long after a Cat 2 C-section is declared should it be performed?

Answer 34

Within 75 mins

Question 35

What should you look for on examination in suspected pre-labour ROM?

Answer 35

Speculum examination - pooling of amniotic fluid in posterior fornix

Question 36

By what week of pregnancy should foetal movements be felt?

Answer 36

24 weeks

Question 37

Under what circumstances can lactational amenorrhoea be used as a contraceptive method?

Answer 37

amenorrhoeic, baby <6 months, and breastfeeding exclusively

Question 38

Which vaccines are offered in pregnancy?

Answer 38

Influenza and pertussis

Question 39

What is the normal baseline CTG rate?

Answer 39

110-160

Question 40

What is the normal variability on a CTG?

Answer 40

5 - 25

Question 41

Which type of decelerations are abnormal?

Answer 41

Late or prolonged (> 3 mins)

Question 42

When is the 'combined test' offered?

Answer 42

~12 weeks

Question 43

When is the 'quadruple test' offered?

Answer 43

15 - 20 weeks

Question 44

If a higher risk of aneuploidy is identified in combined or quadruple screening, which test(s) should be offered?

Answer 44

NIPT first then diagnostic testing (CVS or amniocentesis) if high/Mum wants definitive testing

Question 45

What is the miscarriage rate in CVS/amniocentesis?

Answer 45

around 1%

Question 46

When is CVS usually performed?

Answer 46

Between 11 and 13+6 weeks

Question 47

When is amniocentesis usually performed?

Answer 47

From 15 weeks

Question 48

Which women with gestational diabetes should be commenced on insulin at the time of diagnosis?

Answer 48

Those with glucose > 7

Question 49

How long after birth can women start the COCP?

Answer 49

3 weeks if not breastfeeding, 6 weeks if breastfeeding

Question 50

Which type of insulin is used in pregnancy?

Answer 50

Short-acting only

Question 51

What is the cut-off for iron supplementation in the first trimester?

Answer 51

< 110 Hb

Question 52

What is the cut-off for iron supplementation in the second and third trimester?

Answer 52

< 105 Hb