Reproduction medicine

Question 1

Rate of fetal anomalies is 2-5%

Answer 1

F (3-5%)

Question 2

1/5 to 1/4 of women have miscarriage

Answer 2

T

Question 3

1/10 of women develop pre-eclampsia

Answer 3

T

Question 4

Full term (40 weeks gestation) is not inclusive of the 2 weeks after LMP

Answer 4

F (40 weeks gestation = 2 week post LMP + 38 weeks)

Question 5

Very early preterm is 24-28 weeks & late preterm is 35-37 weeks

Answer 5

F (late preterm is 34-37 weeks)

Question 6

It is common to feel excitement, tiredness and nausea in the 1st trimester

Answer 6

T

Question 7

2nd trimester is from week 12-24

Answer 7

F (13-24)

Question 8

During pregnancy, patient will have increased uterine blood flow (50mls/min to 500mls/min), constipation and higher risk of clotting.

Answer 8

T

Question 9

In the 1st trimester, we need to do US scans ensure there is no physical deformity

Answer 9

F (anatomy scan is done in the 2nd trimester)

Question 10

During the 3rd trimester, it is compulsory to have US scan to observe the placenta growth and location.

Answer 10

F (it is not compulsory)

Question 11

Folic acid is best taken when the pregnancy test comes back positive.

Answer 11

F (neural tube is formed by 28 day, by then it may be too late.)

Question 12

It is normal to gain >10kg during pregnancy especially if your BMI prior was >30

Answer 12

F (>30 BMI usually gain only 5-9kg)

Question 13

For a smoker, switch to nicotine replacement therapy during pregnancy.

Answer 13

F (should quit, NRT is harmful)

Question 14

Second to the baby, most weight gain is contributed to increase stores of fat, protein and other nutrients.

Answer 14

T (baby ~3.4kg, stores ~3.2kg)

Question 15

The difference between DOMINO and ETH is the time difference required post delivery in hospital before heading home.

Answer 15

T (DOMINO - go home 6 hours postnatal while ETH - go home 1-2 days postnatal)

Question 16

A moderate contraction last 30-60seconds.

Answer 16

T

Question 17

The third stage of labour is the delivery of foetus only.

Answer 17

F (delivery of foetus to delivery of placenta)

Question 18

The first vaccine is at 6 weeks.

Answer 18

F (8 week)

Question 19

Puerperium is the period immediately after childbirth, when the womb is returning to its normal size, lasting approximately 8 weeks.

Answer 19

F (6 weeks)

Question 20

Kegel exercise is recommended for woman postnatally.

Answer 20

T

Question 21

After birth, the uterus shrinks from 1000g to a mere 350g by 6 weeks.

Answer 21

F (shrinks to 100-200g)

Question 22

Immediately after delivery, uterus shrinks to level of umbilicus, then midway between umbilicus and symphysis by week 2 and finally to pelvis by week 4.

Answer 22

T

Question 23

After birth, there will be constant volume of lochia up to 6 weeks.

Answer 23

F (lochia is reducing over 6 weeks)

Question 24

Breast feeding acts as a contraceptive.

Answer 24

F (can still get pregnant)

Question 25

Ovulation may return within 6-8 weeks in breastfeeding mothers.

Answer 25

F (in non-breastfeeding. breastfeeding preggos take longer time)

Question 26

Oestrogen promotes lactation.

Answer 26

F (prolactin)

Question 27

The AB in breast milk is only IgG

Answer 27

F (IgA and IgG)

Question 28

Mother will produce colostrum for 48-72 hours

Answer 28

T

Question 29

almost 50% of medicines taken during pregnancy is over the counter

Answer 29

T

Question 30

Vitamins are not considered medication.

Answer 30

F

Question 31

Thalidomide was marketed as an anti-emetic, anti-histamine and hypnotic. The critical period for exposure is 36-50 days menstrual age.

Answer 31

F (35-50)

Question 32

25% of exposed children are affected

Answer 32

F (20%)

Question 33

The mean age of diagnosis from DES syndrome is 18.9yo.

Answer 33

T

Question 34

In females with DES syndrome, they have adenocarcinoma of ovaries, and structural genital tract anomalies

Answer 34

F (cancer is cervix/vagina, not ovaries)

Question 35

Patients with hyperemesis gravidarum can be prescribe anti-psychotics.

Answer 35

T (anti-dopaminergic effect)

Question 36

Anti-emetics are first line in treating morning sickness.

Answer 36

F (Give cariban. Only give anti-emetics if cariban doesn't work)

Question 37

Cariban is comprised of pyridoxine and doxylamine.

Answer 37

T (pyridoxine = Vitamin B6) (Doxylamine = histamine)

Question 38

Conservative treatment of reflux includes drinking milk, gasvicon and ranitidine.

Answer 38

F (ranitidine H2 blocker and omeprazole PPI are medicinal approach)

Question 39

Constipation in pregnant women should be treated with a stimulant, followed by a bulking agent.

Answer 39

F (do not give Senna!)

Question 40

You can give Ca2+ and Fe2+ supplement to alleviate leg cramps.

Answer 40

T

Question 41

In anaemic patients, give vitamin D and Ca2+

Answer 41

F (vitamin C helps iron absorption) (Ca2+ prevents iron from being absorbed)

Question 42

Iron tablets work almost immediately to manage anaemia.

Answer 42

F (takes few weeks to work)

Question 43

Iron infusion is the first choice for anaemia.

Answer 43

F (reserved for those with low iron stores and unable to tolerate PO iron)

Question 44

Labetalol is safe for pregnant women.

Answer 44

T

Question 45

What are the medication for epilepsy in a pregnant women?

Answer 45

Lamotrigine, Levetiracetam

Question 46

What medication for epilepsy should be avoided?

Answer 46

Phenytoin, sodium valproate - causes foetal defect

Question 47

In the ovarian cycle, how many primary follicles develop and on which day will there be a dominant follicle?

Answer 47

15-20 | day 9

Question 48

FSH surge promotes ovulation

Answer 48

F (LH surge)

Question 49

What causes LH surge?

Answer 49

A rise in oestrogen in week prior to ovulation

Question 50

Basal body temperature falls during ovulation and rise during menstruation

Answer 50

F (opposite)

Question 51

What is the follicular and luteal phase?

Answer 51

Follicular phase = onset of menses till next LH surge Luteal phase = LH surge till onset of next menses

Question 52

Follicular phase is variable but luteal phase is constant (12-16 days)

Answer 52

T

Question 53

Before ovulation, granulosa cells produce androgens and theca cells converts these androgens to oestradiol.

Answer 53

F (theca produce androgen, granulosa converts)

Question 54

What happens when there is no implantation

Answer 54

Decrease in progesterone due to corpus luteum regression. Increase thromboxane and endothelin results in vasoconstriction. Decrease blood flow results in ischaemia/apoptosis of endothelium and sloughing and rupturing of spiral arteries (menstruation).

Question 55

Ovaries and testes are formed from primordial germ cells that migrated from the yolk sac to gonadal ridge

Answer 55

T

Question 56

Primordial follicle in a primary oocyte halted at prophase 2, surrounded by a single layer of flatted granulosa cell

Answer 56

F (prophase 1)

Question 57

How many days does it take for spermatogenesis

Answer 57

70-75 days

Question 58

how many days does it take to transport the sperm from epididymis to ejaculatory duct?

Answer 58

10-21 days

Question 59

What are the layers a sperm has to penetrate?

Answer 59

corona radiate zona pellucida perivitelline space vitelline membrane

Question 60

Most eggs are fertilized in the fallopian tube

Answer 60

T

Question 61

What are the 2 cell type of a fertilised eggs and what is their function

Answer 61

1. inner cell mass "embryonic disc" - endoderm, mesoderm, ectoderm which will go on to form the baby 2. Trophoblast - invades endometrium and form maternal venous sinuses to promote gas exchange, nutrient transfer, waste elimination also secretes hormones (HCG, oestrogen, progesterone)

Question 62

What are the 6 sites that an ectopic pregnancy can occur?

Answer 62

``` ovarian infundibular ampullar isthmic transmural cervical ```

Question 63

the umbilical cord contains 2 veins and 1 artery

Answer 63

F (1 vein and 2 arteries)

Question 64

The umbilical artery transport O2 and nutrients to the baby

Answer 64

F (transport CO2, waste etc, away from baby to placenta)

Question 65

what ages does girl and boys have puberty?

Answer 65

8-14 girls | 9-14 boys

Question 66

What is the timing of puberty dependent on?

Answer 66

1. genetics (50-80%) 2. environment E.g. nutritional status (starved = later age) 3. Leptin - regulates appetite and metabolism through hypothalamus

Question 67

What causes the formation of adrenarche?

Answer 67

rise in adrenal and androgens

Question 68

what are the stage in Marshal Tanner for both females and males?

Answer 68

too long.....

Question 69

After menarche, we only increase 6% of final height.

Answer 69

F (4%)

Question 70

Prepuberty, ovaries are what volume?

Answer 70

0.3-0.9cm3

Question 71

What volume of ovaries indicates puberty has begun?

Answer 71

> 1 cm3

Question 72

What volume are ovaries post-puberty?

Answer 72

4 cm3

Question 73

Delayed puberty can only be caused by hypogonadism.

Answer 73

F (hypergonadism can also cause delayed puberty)

Question 74

GH peaks at night.

Answer 74

T

Question 75

What effects does GH has on male sex organ?

Answer 75

delay of puberty diminished Leydig cell function Decrease response to gonadotrophins

Question 76

Precocious puberty is more common in males and usually benign.

Answer 76

F (less common, and mostly pathological)

Question 77

What does menarche, adrenarche, thelarche, pubarche mean?

Answer 77

menarche - first menses adrenarche - androgen dependent body change thelarche - reast development pubarche - first sign of pubic hair

Question 78

Most follicles due to ovulation

Answer 78

F (from atresia, which accelerates with age, esp after 37)

Question 79

High pearl index = more safe (less accidental pregnancy)

Answer 79

F (pearl index = number of unintended pregnancies per 100 women per year)

Question 80

how does the COCP works?

Answer 80

it blocks FSH surge early in the cycle, hence no follicles become mature. Progesterone also makes cervical mucus more viscous)

Question 81

What are CI of COCP?

Answer 81

``` Smoker (15 or more cigs/day for >35yrs) <6 weeks postpartum (if breastfeeding) >160/100bpm IHD Cirrhosis, liver failure Diabetes w complication Breast cancer ```

Question 82

Benefits of COCP?

Answer 82

reduce ovarian, endometrial and colonic cancer | reduce benign breast disease

Question 83

Chloasma will be reversed by stopping COCP

Answer 83

F (not always reversible)

Question 84

If I miss 2 pills in the 3rd week, what should I do?

Answer 84

do not have 7 day break, start new pack

Question 85

If I missed 3 pills, what should I do?

Answer 85

take emergency contraception

Question 86

What is the more common flora of genital tract

Answer 86

lactobacilli

Question 87

the normal vaginal pH is 3-5

Answer 87

F (3.5-4.6)

Question 88

How does lactobacilli protects female genitalia?

Answer 88

It metabolises glucose to lactic acid and create a vaginal pH of 3.5-4.6. It also produce hydrogen peroxide that is bactericidal.

Question 89

What are clue cells?

Answer 89

bacteria overwhelming vaginal epithelial cells till the point you cannot see the outline.

Question 90

What are features in trichomonas vaginalis?

Answer 90

tail behind the cell