Past paper questions

Question 1

How much Levonorgestrel is contained in a mirena coil?

Answer 1

52mg

Question 2

How long after a trachelectomy can a patient start trying to conceive?

Answer 2

6 months
Vaginal progesterone pessaries from 12 weeks - 36 weeks

Question 3

What percentage of epileptic women have intrapartum seizures?

Answer 3

3.5%

Question 4

According to Department of Health data, how many episodes of domestic violence do women experience before they report it?

Answer 4

35

Question 5

What is iron’s role in electron transfer?

Answer 5

Iron acts as an electron donor when it is in the ferrous state and an acceptor in the ferric state.

Question 6

Where in the body is iron found?

Answer 6

About two-thirds of the body’s iron is found in haemoglobin, with the remainder stored as ferritin and haemosiderin in the liver and reticuloendothelial system

Question 7

What is Hepcidin and what does it do?

Answer 7

During normal physiological functioning, iron levels are regulated by a homeostatic system which is controlled by hepcidin, a peptide hormone mainly synthesised in the liver.

Hepcidin expression increases in response to high circulating and tissue levels of iron.

Conversely, hepcidin levels decrease in tissue hypoxia, blood loss (then increased importation of iron by ferroportin) iron deficiency and increased erythropoietic activity as a result of inhibited transcription.

Question 8

What is the recommended daily intake of iron for women of reproductive age

Answer 8

12mg/day

Question 9

What percentage of girls undergoing cranial irradiation for childhood cancer present with hypogonadotrophic hypogonadism?

Answer 9

11%

Question 10

When do the majority of ACS in pregnancy occur?

Answer 10

Peripartum - about 50%

Question 11

What percentage of prolactin is in monomeric form?

Answer 11

Approximately 80–90% of prolactin is monomeric (23 kDa), and this is its most potent biological form; 8– 20% is dimeric (45–50 kDa); and 1–5% is polymeric (150 kDa). The latter fraction is called macroprolactin (or ‘big-big prolactin’).

Question 12

What percentage of hyperprolactinaemia is due to macroprolactin?

Answer 12

10%

Macroprolactin is composed of an antigen–antibody complex of monomeric prolactin and immunoglobulin G. It is immunoreactive but biologically inactive. Macro-prolactinaemia is generally associated with normal gonadotrophin activity and gonadal function. It has been estimated that approximately 10% of cases of hyperprolactinaemia are attributed directly to macroprolactinaemia, which is generally asymptomatic and not usually associated with pituitary pathology.

Question 13

What is the percentage risk of macroprolactinoma enlarging in pregnancy?

Answer 13

30%

Question 14

What ultrasound feature is diagnostic of TOA?

Answer 14

Cogwheel sign

Question 15

What is Bosentan and what considerations should be taken when prescribing contraception to patients taking it?

Answer 15

Bosentan - used to treat pulmonary hypertension
Dual Endothelin receptor antagonist

Enzyme Inducer
Avoid: COCP, POP, implant
Can have: Depot or coil, double COCP dose

Also - theoretically teratogenic, to avoid pregnancy whilst taking

Question 16

Endometrial ablation techniques aim to permanently destroy the functionally active endometrial glands, which are located in the endomyometrial junction. Up to what thickness of myometrium is ablated?

Answer 16

Upto 5mm

Question 17

What is normal cervical length at 18 weeks?

Answer 17

In normal pregnancy the cervix is more than 40 mm long at 18 weeks of gestation.
This is manifested by approximately 2 cm of vaginal cervix and 2 cm of supravaginal cervix.

Question 18

The only skin condition which carries an increased risk of pregnancy loss?

Answer 18

Pustular psoriasis of pregnancy

Question 19

Which skin condition in pregnancy has an increased risk of fetal prematurity and SGA?

Answer 19

Pemphigoid gestationis

Also has neonatal cutaneous manifestations.

Question 20

What are the physiological changes of the cardiac system in pregnancy?

Answer 20

Increased preload (increased circulating volume)
Decreased afterload (reduced BP/peripheral vascular resistance)
Increased cardiac output by 20% by 8 weeks of gestation (upto 40% later in pregnancy)
Decreased serum colloid osmoid pressure by 10-15%

Question 21

What proportion of pre-eclampsia can be predicted by maternal history alone in first trimester of pregnancy?

Answer 21

40-50%

Question 22

What amount of vitamin A is safe in pregnancy?

Answer 22

Pregnant women should be informed that vitamin A supplementation intake above 700 micrograms may be teratogenic and should be avoided.

Question 23

At what point in pregnancy should women be offered the whooping cough vaccine?

Answer 23

Pregnant women should be offered a single dose between 16-32 weeks to maximize likelihood that baby will be protected from birth.

Question 24

How long should women wait after receiving the MMR vaccine before getting pregnant?

Answer 24

28 days

Question 25

Active management of labour is associated with nausea and vomi􏰀ng in what percentage of women? (old stats)

Answer 25

10%

Question 26

What is the benefits of active management of 3rd stage?

Answer 26

ACTIVE Nausea and vomiting, headache, hypertension 186/1000 Haemorrhage >500ml 68/1000 Haemmorhage >1000ml 13/1000 Blood transfusion 13/1000 Post-partum anaemia 30/1000 Need for further uterotonic 47/1000 PHYSIOLOGICAL N&V, headache, hypertension 90/1000 Haemmorhage >500ml 188/1000 Haemmorhage >100ml 29/1000 Blood transfusion 35/1000 Post-partum anaemia 60/1000 Need for further uterotonic 247/1000

Question 27

What are risk factors for recurrent OASIS injury?

Answer 27

Risk factors for sustaining recurrent OASIS in the subsequent pregnancy include: Asian ethnicity (OR 1.59, 95% CI 1.48–1.71) Forceps delivery (OR 4.02, 95% CI 3.51–4.60) Birthweight more than 4 kg (OR 2.29, 95% CI 2.16–2.43).

Question 28

What percentage of women are found to sustain “occult “anal sphincter injury following vaginal delivery?

Answer 28

33%

Question 29

What is the incidence of suture migration after repair of OASIS?

Answer 29

7% The risk of sustaining a further third- or fourth-degree tear after a subsequent delivery is 5–7% The risks of a subsequent vaginal delivery after a third- degree tear have been assessed, with 17% of women developing worsening faecal symptoms after a second vaginal delivery

Question 30

What is the incidence of 3rd or 4th degree perineal tear following vaginal deliveries complicated with shoulder dystocia?

Answer 30

3.8%

Question 31

Most babies who sustain brachial plexus injury (BPI) do not have any residual neurologic dysfunc􏰀on, but what percentage of babies who have sustained BPI have permanent neurological dysfunction?

Answer 31

10%

Question 32

What percentage of twin pregnancies in the UK are monochorionic?

Answer 32

30%

Question 33

How is twin to twin transfusion graded? what are the stages?

Answer 33

QUINTERO SYSTEM (5 STAGES) 1. Significant discordance in amniotic fluid - Oligo (<2cm) and Poly (>8cm before 20/40 and >10 after 20/40) Normal copper and bladder seen 2. Bladder of donor twin not seen. Dopplers not critically abnormal. 3. Critically abnormal doppler - reversed flow during atrial contraction within the ductus and or pulsatile umbilical vein velocities 4. Ascites, pericardial or pleural effusion, scalp oedema, hydrops 5. Demise of one or both babies

Question 34

What percentage of MCDA pregnancies are affected by TAPS?

Answer 34

2% uncomplicated 13% post laser ablation Characterised by signs of fetal anaemia and polycythemia without significant change in FI. Associated increased MCA peak velocity or decreased MCA velocity.

Question 35

How do you categorise selective growth restriction in twin pregnancies?

Answer 35

Growth discordance of >20% Affects 10-15% of MCDA twins 1. Growth discordance but normal dopplers 2. Absent or reversed end diastolic flow velocities 3. Growth discordance with cyclical artery diastolic waveforms (positive then absent then reversed in a cyclical pattern over several minutes)

Question 36

Regarding infertility in women of childbearing age: Absolute uterine factor infertility (AUFI) is considered to affect how many women?

Answer 36

1/500

Question 37

Which side effects are associated with monopoly and which with bipolar?

Answer 37

Monopolar Capacitive coupling Direct coupling Bipolar Mushroom effect Electrical bypass effect (from over compression of tissues) Both Lateral thermal spread Insulation failure Current leakage through cord Inadvertent activation

Question 38

What is the rate of inconclusive results from V/Q or CTPA scans when assessing for PE?

Answer 38

The median frequency of inconclusive results was 5.9% for CTPA and 4.0% for V/Q scanning.

Question 39

What is Type 1 and Type 2 error?

Answer 39

Type 1 Error - risk of false positive Normally set with p value of <0.05, therefore 5% Also known as 'alpha' Type 2 Error - risk of false negative Also known as 'beta'

Question 40

How do you calculate power for a study?

Answer 40

1 - beta Typically set at 80%

Question 41

How do you calculate positive and negative likelihood ratio?

Answer 41

POSITIVE Sens/ 1-Spec NEGATIVE 1-Sens/Spec