Week 1

Question 1

Abortion is certified under a specific indication (5 clauses A-E), which clause are most abortions in the UK certified under?

Answer 1

Clause C

Question 2

Describe clause C

Answer 2

Clause C: continuing the pregnancy would involve risk of injury to the physical or mental health of the pregnant women, or her existing children/family.
Gestational limit of 24 weeks

Question 3

Describe clause E

Answer 3

There is a substantial risk that if the child were born it would suffer from physical or mental abnormalities aa to be seriously handicapped
There is no gestational limit

Question 4

Describe a medical abortion

Answer 4

Mifepristone then misoprostol. A second dose of misoprostol can be given 24-48hrs later if expulsion has not occurred

Question 5

What are the classifications of miscarriages?

Answer 5

Threatened miscarriage
Inevitable miscarriage
Incomplete miscarriage
Complete miscarriage
Missed miscarriage
Early fetal demise or NCP
Anembryonic pregnancy

Question 6

What is the latest a spontaneous loss of a pregnancy is classed an early pregnancy loss?

Answer 6

before 13 weeks

Question 7

In what classification of miscarriage is the os closed?

Answer 7

Threatened miscarriage

Question 8

What is seen on speculum examination of an inevitable miscarriage?

Answer 8

Products are sited at the open os

Question 9

What is seen on speculum examination of a complete miscarriage?

Answer 9

Products sited in the vagina and the os is closed

Question 10

A patient presents with heavy vaginal bleeding. The internal os is open, and a fetus is seen on ultrasound. What type of miscarriage is this?

Answer 10

Inevitable miscarriage

Question 11

What is the aetiology of a complete molar pregnancy?

Answer 11

In a complete molar pregnancy, a sperm fertilises an egg with no DNA

Question 12

What is the aetiology of an incomplete molar pregnancy?

Answer 12

In an incomplete molar pregnancy, two sperms fertilise an egg

Question 13

Define infertile

Answer 13

Inability to conceive after 12 months of regular intercourse without contraception

Question 14

How common is infertility?

Answer 14

Infertility affects 1 in 6 couples

Question 15

What is day 1 of the menstrual cycle?

Answer 15

The first day of bleeding

Question 16

Which phase of the menstrual cycle is always 14 days long?

Answer 16

Luteal phase

Question 17

When is the follicular phase?

Answer 17

From the first day of bleeding until she ovulates

Question 18

When is the luteal phase?

Answer 18

The 14 days after ovulation

Question 19

How does an ovulation prediction kit work?

Answer 19

It detects the LH surge

Question 20

Describe type 1 ovulatory disorders

Answer 20

Hypothalamic pituitary failure
- low levels of FSH and/or LH causing amenorrhoea
- can be caused by stress; excessive exercise; anorexia/low BMI; brain/pituitary trauma; head trauma; Kallman’s syndrome; drugs

Question 21

Describe type 2 ovulatory disorders

Question 22

Describe type 3 ovulatory disorders

Answer 22

Hyper-gonadotropic, hypoestrogenic anovulation
Caused by ovarian failure
Around 5% of women with ovulation disorders have a group III ovulation disorder

Question 23

What is the commonest reason for ovulatpry problems and what type of ovulatory disorder is it?

Answer 23

PCOS
type 2

Question 24

How do we induce ovulation?

Answer 24

1. Clomifene citrate
   alternatively Letrozole/Tamoxifen
2. Gonoadotrophin injections
3. Laparoscopic ovarian diathermy

Question 25

What is the revised Rotterdam diagnostic criteria?

Answer 25

Must have 2 of 3: 1. Oligo/amenorrhoea 2. Polycystic ovaries (on USS) 3. Clinical and/or biochemical signs of hyperandrogenism e.g. acne, hirsutism

Question 26

Why do cysts form on the ovaries in PCOS?

Answer 26

Underproduction of estrogen and overproduction of androgens by the ovaries can result in tiny cysts on the surface of the ovaries

Question 27

What produces gonadotrophins (LH and FSH)?

Answer 27

The anterior pituitary gland

Question 28

What part of the menstrual cycle has the main impact on cycle length?

Answer 28

Follicular phase

Question 29

When taking combined oral contraceptives to manage Pre-menstrual disorders, which form of progesterone should they include?

Answer 29

Drospirenone

Question 30

How do Pre-menstrual disorders differ from premenstrual symptoms?

Answer 30

Premenstrual disorders must impact daily living

Question 31

What is the pharmacoogical management of heavy menstrual bleeding?

Answer 31

1. IUS (mirena coil) 2. a. Tranexamic acid b. COC 3. a. Norethisterone b. DMPA (Depo injection)

Question 32

What is the management of pre-menstrual disorders?

Answer 32

ALL WORK BY OVULATION SUPPRESSION 1. Combined Oral Contraceptive (COCs) 2. GnRH agonists 3. Bilateral oophrectomy and hysterectomy with add back oestrogen only

Question 33

Define post-menopausal bleeding

Answer 33

Abnormal bleeding greater than 1 year after cessation of menstruation

Question 34

How is the definitive diagnosis of a miscarriage made?

Answer 34

Transvaginal USS

Question 35

In what types of miscarriage management is anti-D required?

Answer 35

any mother who is rhesus -ve and (beyond 12 weeks and/or having a surgical miscarriage)

Question 36

What are the 2 main risk factors for miscarriages

Answer 36

- previous miscarriages - increased maternal age

Question 37

How is a missed miscarriage usually diagnosed?

Answer 37

On TVUS: - crown rump length is >7mm and no fetal heart pulsation - mean gestation sac diameter is ≥25 mm with no obvious yolk sac

Question 38

What is the most common aetiology of miscarriages?

Answer 38

First trimester: Chromosomal abnormalities Second trimester: incompetent cervix

Question 39

When is an HSA1 form used? AND how many doctors have to sign it?

Answer 39

An HSA1 form is used for clause E for abortions 2 doctors have to sign it

Question 40

When is an HSA1 form used? AND how many doctors have to sign it?

Answer 40

An HSA1 form is used in an emergency abortion 1 doctor has to sign it

Question 41

Why does increasing maternal age increase the rates of miscarriage?

Answer 41

As you get older oocytes have more genetic abnormalities increase in poor-quality oocytes leads to chromo- somally abnormal conceptions.

Question 42

How is infertility initially investigated?

Answer 42

Progesterone is measured on day 21 of a woman's cycle