opic

Question 1

after 36 weeks is it likely a transverse lie baby will move

Answer 1

no

Question 2

You can attempt external cephalic version for a transverse lie if the

Answer 2

amniotic sac has not ruptured

Question 3

If a pregnant woman is not immune to rubella, she should be

Answer 3

offered the MMR vaccination in the post-natal period

Question 4

abortion meds

Answer 4

Oral mifepristone and vaginal misoprostol

Question 5

A 64-year-old woman presents with a 1 month history of post-menopausal bleeding. Her only medication is aspirin 75 mg once daily. An ultrasound scan of the uterus shows an endometrial lining thickness of 4.1 mm. An endometrial pipelle biopsy is taken but is inconclusive. What is the next step?

Answer 5

hysteroscopy with biopsy

Question 6

perineal tears classification and RF

Answer 6

Question 7

A 22-year-old woman presents to the early-pregnancy unit with painless vaginal bleeding. She had a positive urine pregnancy test 6 weeks ago. An ultrasound shows an unruptured left tubal pregnancy that is 36mm in size. There is a detectable foetal heartbeat. Her serum beta-hCG level is 6,150 IU/L.
mx

Answer 7

Laparoscopic salpingectomy would be the most appropriate surgical management as the patient has no history of contralateral fallopian tube damage. The removal of the affected fallopian tube would be the most effective way to prevent the progression of the intratubal pregnancy while maintaining fertility.

Laparoscopic salpingotomy would not be indicated here. This is a surgical procedure that is reserved for women with risk factors for infertility. It involves an incision made into the fallopian tube, through which the ectopic pregnancy is removed. Its goal is to terminate the intratubal pregnancy whilst preserving the fallopian tube. There is no evidence of contralateral tube damage in this case, and as this procedure is less effective than salpingectomy, it would not be appropriate here.

Question 8

do you use hba1c in GDM

Answer 8

no HbA1c of 6.5% may suggest diabetes in a non-pregnant individual, but it is not used to diagnose gestational diabetes due to physiological changes during pregnancy that can affect HbA1c levels.

Question 9

baby losing weight after birth mx

Answer 9

If a breastfed baby loses > 10% of birth weight in the first week of life then referral to a midwife-led breastfeeding clinic may be appropriate

Question 10

when emergency contraception with missed COCP

Answer 10

could be considered if she had missed two or more pills in the first week of starting the COCP or after a pill-free week and presented within 72 hours of unprotected sexual intercourse (levornogestrel) or 120hrs (ulipristal acetate)

Question 11

metformin when breastfeeding?

Answer 11

yes

Question 12

If a semen sample is abnormal, a repeat test should be arranged

Answer 12

3 months after

Question 13

what type of USS to confirm placenta praevia

Answer 13

transvaginal

Question 14

HRT: adding a progestogen increases the risk of

Answer 14

breast cancer

Question 15

N and V, 5% weight loss, cyclizine didnt help, Mx

Answer 15

Arrange hospital admission is correct. This patient has had nausea and vomiting in pregnancy and has already trialled oral cyclizine without success. Despite using oral antiemetics, she has had more than 5% weight loss compared to her pre-pregnancy weight. Despite having no ketonuria NICE and the Royal College of Obstetricians recommend arranging hospital admission for any pregnant patient with nausea and vomiting with >5% weight loss compared to pre-pregnancy and/or ketonuria despite oral antiemetics. This is due to the risk of complications emerging such as complications to the mother (e.g. malnutrition, Mallory-Weiss tears, oesophageal ruptures etc.) and to the foetus (e.g. growth restriction).

Question 16

does COCP or parity influence cervical cancer

Answer 16

no

Question 17

smoking and cervical cancer

Answer 17

2x risk

Question 18

what before LLETZ

Answer 18

colposcopy

Question 19

In gestational diabetes, if blood glucose targets are not met with diet/metformin then

Answer 19

insulin should be added

Question 20

in induced labour in pre eclampsia, what should help reduce bp

Answer 20

epidural anaesthesia

Question 21

same day delivery in pre eclampsia an option after

Answer 21

34 weeks

Question 22

nifedipine safe in breastfeeding?

Answer 22

yes

Question 23

folic acid in overweight women

Answer 23

Pregnant women with a BMI >= 30 kg/m² should receive 5 mg folic acid daily until the 13th week of pregnancy

Question 24

do you use VZIG in pregnant lady with chickenpox

Answer 24

no - just oral acyclovir, IV if severe

once chickenpox symptoms have manifested, VZIG plays no role in management.

Question 25

Mx in pregnant lady with T1DM additional medication

Answer 25

The correct answer is commence daily aspirin, because this woman has risk factors for pre-eclampsia, and aspirin is used as a preventative measure in these cases. e.g. T1DM, 40 years and nulliparity

Question 26

EPDS of 11 on day 5

Answer 26

An Edinburgh postnatal depression scale (EPDS) score of more than 13 suggests a 'depressive illness of varying severity'

Question 27

hep B mum, Mx of baby

Answer 27

For babies who are born to mothers who are hepatitis B surface antigen positive, or are known to be high risk of hepatitis B, should receive the first dose of hepatitis B vaccine soon after birth and those born to mother's who are surface antigen positive should also receive 0.5 millilitres of hepatitis B immunoglobulin within 12 hours of birth. The baby should then further receive a second dose of hepatitis B vaccine at 1-2 months and at 6 months.

Question 28

downs results

Answer 28

The following results would be expected in a trisomy 21 (Down's syndrome) pregnancy: Low alpha fetoprotein (AFP) Low oestriol High human chorionic gonadotrophin beta-subunit (-HCG) Low pregnancy-associated plasma protein A (PAPP-A) Thickened nuchal translucency

Question 29

ovarian cancer mets

Answer 29

local invasion to para aortic lymph nodes

Question 30

COCP protective against

Answer 30

protective against ovarian and endometrial cancer