Past Paper topics

Question 1

What are the different UKMEC levels?

Answer 1

Question 2

What are the UKMEC levels for a 35 yo woman who smokes?

Answer 2

If <35 and
* smoking <15/ day: 3
* Smoking >15/ day: 4

Question 3

How does Obesity change UKMEC for the COCP

Answer 3

If BMI 30-34: 2
IF >35: 3

Question 4

What is the UKMEC criteria for COCP with current or personal history of VTE?

Answer 4

4

Question 5

What contraception can be used in breastfeeding women 0-6 weeks postpartum?

Answer 5

IUS + IUD (if inserted <48h OR >4 Weeks)

Progresterone only implant
Progesterone only Pill
+ Depot progesterone (UKMEC 2)

Question 6

What contraception can be used in breastfeeding women >6 Weeks?

Answer 6

Essentiall all but

• COCP UKMEC 2 if 6 weeks-6 months

Question 7

What is the recomendation for administration of anti-D <12 weeks?

Answer 7

anti-D Ig prophylaxis is only indicated following

• ectopic pregnancy
• molar pregnancy
• therapeutic termination of pregnancy
• in cases of uterine bleeding where this is repeated, heavy or associated with abdominal pain

The minimum dose should be 250 IU. A test for fetomaternal haemorrhage (FMH) is not required (Grade 2C).

Question 8

What is the recommendation on the administration of Anti-D 12-20 Weeks gestation?

Answer 8

For potentially sensitising events between 12 and 20 weeks gestation, a minimum dose of 250 IU should be administered within 72 h of the event. A test for FMH is not required (Grade 2C)

Question 9

What is the recommendation of Anti-D administration after 20 weeks gestation?

Answer 9

For potentially sensitising events after 20 weeks gestation, a minimum anti-D Ig dose of 500 IU should be administered within 72 h of the event. A test for FMH is required (Grade 2C).

Question 10

When is routine anti-D prophylaxis administered?

Answer 10

28 + 34 weeks

(+ after delivery if then baby is tested and confirmed Rhesus D+ve)

Question 11

What additional investigations should be done at booking if a woman discloses previous (but no current) IV drug use?

Answer 11

Hepatitis C bloods

Question 12

What should be done if a woman discloses current drug use during pregnancy (pre-booking)

Answer 12

Midwive should gain consent for
* urine toxicology screen

+ consider referral to safeguarding team and drugs and alcohol services

Question 13

When are periods expected to come back with

• bottle feeding
• mixed feeding
• exclusive breast feeding

Answer 13

1. Bottle feeding: 5-6 weeks
2. Mixed feeding: same
3. exclusively breastfeed: potentially until no more night time feeds or weaning+ milk substitution begins

Question 14

When can a woman who got methotrexate for ectopic pregnancy try to get pregnant again?

Answer 14

12 Weeks

Question 15

What are some reasons for an echogenic bowel at 20 Week scan?

Answer 15

1. Small bleed + swallowing of blood (benign)
2. Cystic fibrosis (3% have CF if echogenic bowel seen)
   3.CMV infection

Question 16

What is the pharmacological management of nausea in Hyperemesis Gravidarum?

Answer 16

1st line:
i. H1 receptor antagonist (Cyclizine, meclozine, diphenhydramine (safe in pregnancy)

2nd line
i. Combination can be used if not responding to a single anti-emetic

3nd line:
i. Metaclopromide for 5 days, phenothiazines Increased risk of extrapyramidal side effect
ii. Ondansetron (slight increase of cleft palate, not very strong data)

If resistant: corticosteroids (but used as reserve)

Question 17

What is the rehydration regime in hyperemesis gravidarum?

Answer 17

a. 1 bag pabrinex
b. 2 bags of saline with some potassium chloride (1L over 2h, 2nd Litre in next 2-4h)

+ LMWH as long as IV fluids needed

Question 18

A 1 day old infant presenting with a rash - what is the most likely diagnosis?

Answer 18

Eythema toxicum

Common rash presentign in full-term newborns (within first week of life)

Usually small red macules and papules (can progress to pustules)

Self-limiting with 7-14 days

Question 19

A woman presents with Reduced Fetal movements - what should be done?

Answer 19

All if pregnancy >28 weeks:

1. Fetal Heart rate auscultation w hendheld doppler
2. Asessment for FGR/ SGA (can be USS, can also be SFH)
3. CTG
4. If all normal but recurrent RFM: USS growth scan
   5.

Question 20

What should be the management of periorbital cellulatis in children?

Answer 20

Periorbital cellulitis should be treated promptly with IV antibiotics (e.g. high-dose ceftriaxone)
* MRSA will require vancomycin
* May give empirical antifungal therapy

• This is to prevent posterior spread of the infection which could cause orbital cellulitis
• Incision, drainage and culture of peri-ocular abscess may be required
• Consider ophthalmologist advice

Question 21

What is the recommendation for mediation switching from fluoxetine to other antidepressants, including
* SSRI
* TCA
* SNRI

Answer 21

Generlly: Stop fluoxetine, start SSRI at a low dose 4–7 days later

Question 22

What are the recommendations of mediaction switching of citalopram, escitalopram, sertraline, or paroxetine to a different antidepressant medication?

Answer 22

Question 23

What are the most common electrolyte abnormalities in anorexia?

Answer 23

1. Hypokalaemia
2. Hyperlipidaemia (high triglycerides)

Question 24

What is the management of 1+ asymptomatic proteinura during pregnancy?

Answer 24

Follow up in 1 week and repeat BP + urine dip

If still proteinuria: albumin: creatinine ratio

Question 25

What is the management of new 2+ proteinuria but normotensive during pregnacy?

Answer 25

Same day obs asessment, regardless of associated symptoms of UTI presen t

Question 26

What is the scoring system used in croup?`

Answer 26

Westley croup score

Question 27

How long should people stay in hospital after a 1. vaginal hyterectomy? 2. abdominal hysterectomy?

Answer 27

1. Vaginal: 1-4 days 2. Abdominal: up to 5 days

Question 28

When should someone after a histerectomy return to work?

Answer 28

f your job does not involve manual work or heavy lifting, it may be possible to return after 6 to 8 weeks. Your doctor will advise you when you can return to work.

Question 29

Girl with dyskaryosis has colposcopy and biopsy showing CIN1. When should next colposcopy be?

Answer 29

1 year

Question 30

How do you calculate EDD based on LMP?

Answer 30

LMP - 3 months, + 7 days (+1 year) (+ days that the regular cycle was over 28 days)

Question 31

What is the management for PID?

Answer 31

1. Empirical abx (Ceftriaxone 1 g as a single intramuscular (IM) dose, followed by oral doxycycline 100 mg twice daily plus oral metronidazole 400 mg twice daily for 14 days) 2. Analgesia 3. STI screen (ideally before commencement of abx but should not delay abx) 4. consider removal of IUS/IUD) | *

Question 32

What are the age definitions for 1. POI? 2. early menopause 3. menopause

Answer 32

1. POI <40 2. early menopause 40-45 3. menopause from 45 (average 51)

Question 33

When should you do a Kleinhauer test?

Answer 33

For sensitising events >20 weeks +

Question 34

What is the management of vaginal candidiasis 1. without pregnancy 2. in pregnancy

Answer 34

1. without pregnancy:Advise fluconazole 150 mg oral capsule as a single dose first-line. 2.Pregnancy: Prescribe clotrimazole pessary 500 mg intravaginally at night for up to 7 consecutive nights first-line (if aged 16 years and older).

Question 35

what is the medical management for OCD?

Answer 35

SSRI first line 2nd line: clomipramine (always with CBT and exposure CBT)