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  • Question 1 - A 30 year old women who is 24 weeks pregnant attends EPU due...

    Correct

    • A 30 year old women who is 24 weeks pregnant attends EPU due to suprapubic pain. Ultrasound shows a viable foetus and also a fibroid with a cystic fluid filled centre. What is the likely diagnosis?

      Your Answer: Red degeneration of fibroid

      Explanation:

      Red degeneration of fibroids is one of 4 methods of fibroid degeneration. Although uncommon outside pregnancy it is thought to be the most common form of fibroid degeneration during pregnancy and typically occurs in the 2nd trimester. It is thought to arise from the fibroid outgrowing its blood supply and haemorrhagic infarction occurs. Ultrasound will typically show a localised fluid collection (blood) within the fibroid.

    • This question is part of the following fields:

      • Clinical Management
      53.4
      Seconds
  • Question 2 - Stages of labour ...

    Correct

    • Stages of labour

      Your Answer: The third stage ends with the delivery of the placenta and membranes

      Explanation:

      First stage: The latent phase is generally defined as beginning at the point at which the woman perceives regular uterine contractions. A definition of active labour in a British journal was having contractions more frequent than every 5 minutes, in addition to either a cervical dilation of 3 cm or more or a cervical effacement of 80% or more.

      Second stage: fetal expulsion begins when the cervix is fully dilated, and ends when the baby is born.

      Third stage: placenta delivery – The period from just after the foetus is expelled until just after the placenta is expelled is called the third stage of labour or the involution stage.

    • This question is part of the following fields:

      • Clinical Management
      4.8
      Seconds
  • Question 3 - At what gestational age does the luteo-placental shift occur? ...

    Incorrect

    • At what gestational age does the luteo-placental shift occur?

      Your Answer: 18-20 weeks

      Correct Answer: 6-8 weeks

      Explanation:

      Luteo-placental shifts occurs around 6-8 week when the placenta takes over from the corpus luteum as the main producer of oestrogen and progesterone.

    • This question is part of the following fields:

      • Clinical Management
      3.4
      Seconds
  • Question 4 - Which of the following tests for the detection of chlamydia is considered the...

    Correct

    • Which of the following tests for the detection of chlamydia is considered the gold standard?

      Your Answer: Nucleic Acid Amplification Test

      Explanation:

      Chlamydia is one of the most prevalent STIs in the UK. Many infected individuals can be asymptomatic making it difficult to detect. The gold standard in the diagnosis of Chlamydia is the nucleic acid amplification test (NAAT). A sample is taken from a vulvovaginal self swab, or a cervical swab on speculum examination in women.

    • This question is part of the following fields:

      • Clinical Management
      5
      Seconds
  • Question 5 - Which of the following hormones inhibits lactogenesis during pregnancy? ...

    Correct

    • Which of the following hormones inhibits lactogenesis during pregnancy?

      Your Answer: Oestrogen and Progesterone

      Explanation:

      Under the influence of prolactin, oestrogen and progesterone and human placental lactogen (hPL), the mammary epithelium proliferates but remains presecretory during mammogenesis. Lactogenesis is inhibited by high circulating levels of progesterone and oestrogen which block cortisol binding sites. Cortisol would have otherwise have worked synergistically with prolactin in milk production. A sharp decrease in progesterone levels after delivery allows prolactin and oxytocin to stimulate milk production and the milk ejection reflex in response to suckling. Prolactin continues to maintain milk production in galactopoiesis.

    • This question is part of the following fields:

      • Clinical Management
      39.1
      Seconds
  • Question 6 - You see a diabetic women in preconception clinic. Which of the following is...

    Correct

    • You see a diabetic women in preconception clinic. Which of the following is appropriate advice regarding folic acid supplementation?

      Your Answer: 5 mg daily until week 12

      Explanation:

      The aim of pre-pregnancy counselling is to achieve the best possible glycaemic control before pregnancy and to educate diabetic women about the implications of pregnancy. Patient information leaflets about pregnancy should make clear the risks of pregnancy in diabetes, and include advice to take high dose (5 mg) folic acid pre-conception and for the first 12 weeks.

    • This question is part of the following fields:

      • Clinical Management
      8.6
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  • Question 7 - A 28 year old patient presents to clinic with a maculopapular rash to...

    Correct

    • A 28 year old patient presents to clinic with a maculopapular rash to the hands and soles of the feet. Examination reveals wart like lesions on the vagina and a diagnosis of condyloma latum is made. What stage of syphilis infection is this?

      Your Answer: Secondary

      Explanation:

      Condylomas are warty neoplasms of the vulvar area. The most common type are condyloma acuminatum which occur due to HPV 6 or 11. Condyloma latum are also known as secondary syphilis are less common. Both of these are sexually transmitted.

      Stages of Syphilis:
      – Primary 3-90 days
      Chancre and lymphadenopathy
      – Secondary 4-10 weeks
      Widespread rash typically affecting hands and soles of feet.
      Wart lesions (condyloma latum) of mucus membranes
      – Latent Early <1 yr. after secondary stage
      – Late >2 yr. after secondary stage
      Asymptomatic
      – Tertiary 3+ years after primary infection
      Gummas or
      Neurosyphilis or
      Cardiovascular syphilis

    • This question is part of the following fields:

      • Clinical Management
      27.3
      Seconds
  • Question 8 - Which of the following hormones inhibits Galactopoiesis and Lactogenesis postpartum? ...

    Correct

    • Which of the following hormones inhibits Galactopoiesis and Lactogenesis postpartum?

      Your Answer: Dopamine

      Explanation:

      Galactopoiesis and Lactogenesis are stimulated by Prolactin. Dopamine released under hypothalamic control inhibits Prolactin production. Note oestrogen and progesterone inhibit lactogenesis up until term.

    • This question is part of the following fields:

      • Clinical Management
      5.4
      Seconds
  • Question 9 - During pregnancy which hormone(s) inhibit lactogenesis? ...

    Correct

    • During pregnancy which hormone(s) inhibit lactogenesis?

      Your Answer: Oestrogen and Progesterone

      Explanation:

      Prolactin levels rise steadily during pregnancy during which time it promotes mammary growth (along with the other hormones mentioned below). Oestrogen and progesterone inhibit lactogenesis and it is only with the loss of these placental steroid hormones at term that Prolactin exhibits its lactogenic effect.

    • This question is part of the following fields:

      • Clinical Management
      4.2
      Seconds
  • Question 10 - A 24 year old, 16 week pregnant patient presents with vaginal discharge. There...

    Incorrect

    • A 24 year old, 16 week pregnant patient presents with vaginal discharge. There is heavy growth of N. gonorrhoea as shown on swabs taken. Which treatment course is most advisable?

      Your Answer: Ceftriaxone 1g intramuscularly as a single dose with azithromycin 2 g oral as a single dose

      Correct Answer: Ceftriaxone 1 mg intramuscularly as a single dose with azithromycin 2g oral as a single dose

      Explanation:

      Gonorrhoea is a diplococcus bacteria known to infect the female genital tract. The bacteria is sexually transmitted and can cause an ascending infection in the uterus and fallopian tubes. According to the BASHH guidelines (British Association for Sexual Health and HIV), indication for therapy include confirmation of intracellular diplococci on microscopy or a confirmed positive NAAT. Treatment of gonorrhoea in pregnancy is as follows: Ceftriaxone 1g intramuscularly as a single dose with azithromycin 2g oral as a single dose. Pregnant individuals are not to be treated with quinolones or tetracyclines.

    • This question is part of the following fields:

      • Clinical Management
      33.8
      Seconds
  • Question 11 - Which vitamin deficiency leads to Wernicke's encephalopathy? ...

    Correct

    • Which vitamin deficiency leads to Wernicke's encephalopathy?

      Your Answer: B1

      Explanation:

      Vitamin B1 deficiency can lead to Wernicke’s encephalopathy. Alcoholics are at particular risk. In obstetrics all women with hyperemesis gravidarum should receive thiamine supplementation to prevent Wernicke’s.

    • This question is part of the following fields:

      • Clinical Management
      2.9
      Seconds
  • Question 12 - A 32 year old women who is 25 weeks pregnant presents with vaginal...

    Correct

    • A 32 year old women who is 25 weeks pregnant presents with vaginal bleeding and cramping lower abdominal pain. On examination the cervix is closed. Fetal cardiac activity is noted on ultrasound. What is the likely diagnosis?

      Your Answer: Antepartum Haemorrhage

      Explanation:

      Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby.

    • This question is part of the following fields:

      • Clinical Management
      9.4
      Seconds
  • Question 13 - A 24 year old who is 32 weeks pregnant presents with a rash...

    Correct

    • A 24 year old who is 32 weeks pregnant presents with a rash to the abdomen. Looking at the picture below what is the diagnosis?

      Your Answer: Polymorphic Eruption of Pregnancy

      Explanation:

      This is Polymorphic Eruption of Pregnancy (PEP) also known as Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP). Papules and plaques form on the abdomen (commonly within striae). It is most common in women during their first pregnancy and typically occurs in the 3rd trimester.

    • This question is part of the following fields:

      • Clinical Management
      18.1
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  • Question 14 - Endometrial tissue found within the myometrium is classed as ...

    Correct

    • Endometrial tissue found within the myometrium is classed as

      Your Answer: Adenomyosis

      Explanation:

      Endometrial tissue found within the myometrium is Adenomyosis. If endometrial tissue is found at a distant site to the uterus it is termed endometriosis. Fibroids are smooth muscle tumours (Leiomyoma’s) sometimes called myoma’s.

    • This question is part of the following fields:

      • Clinical Management
      7.7
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  • Question 15 - Amongst women with a diagnosis of Gonorrhoea, what percentage will develop pelvic inflammatory...

    Incorrect

    • Amongst women with a diagnosis of Gonorrhoea, what percentage will develop pelvic inflammatory disease?

      Your Answer: 50%

      Correct Answer: 15%

      Explanation:

      Gonorrhoea is a sexually transmitted diplococcus bacteria known to infect the female genital tract, which can cause an ascending infection in the uterus and fallopian tubes. About 15 percent of women with this infection may develop pelvic inflammatory disease (PID), which poses risks of long term consequences: ectopic pregnancy, infertility and chronic pelvic pain.

    • This question is part of the following fields:

      • Clinical Management
      55.5
      Seconds
  • Question 16 - The midwife asks for your advice about a 33 year old woman who...

    Correct

    • The midwife asks for your advice about a 33 year old woman who she has just seen at her booking appointment. The patient had an uncomplicated pregnancy 10 years ago. This is her second pregnancy. There is no significant personal or family history. On examination the patients blood pressure is 120/75, BMI 32.5kg/m2. The midwife asks your advice on testing for gestational diabetes. What would you advise?

      Your Answer: OGTT at 24-28 weeks

      Explanation:

      Gestational diabetes (GDM) occurs in 2–9 per cent of all pregnancies. Screening for diabetes in pregnancy can be justify ed to diagnose previously unrecognized cases of pre-existing diabetes and to identify a group of women who are at risk of developing NIDDM later in life. No single screening test has been shown to be perfect in terms of high sensitivity and specific city for gestational diabetes. Urinary glucose is unreliable, and most screening tests now rely on blood glucose estimation, with an oral glucose tolerance test commonly used. The aim of glucose control is to keep fasting levels between 3.5 and 5.5 mmol/L and postprandial levels 7.1 mmol/L, with insulin treatment usually indicated outside these ranges.

    • This question is part of the following fields:

      • Clinical Management
      20.3
      Seconds
  • Question 17 - What is the average volume of blood loss during the menstrual cycle ...

    Correct

    • What is the average volume of blood loss during the menstrual cycle

      Your Answer: 35-40ml

      Explanation:

      The average menstrual blood loss is 35-40ml The maximum normal blood loss is 80ml

    • This question is part of the following fields:

      • Clinical Management
      4
      Seconds
  • Question 18 - A patient attends the maternity unit as her waters have broken but she...

    Correct

    • A patient attends the maternity unit as her waters have broken but she hasn't had contractions. She is 39+6 weeks gestation. Speculum examination confirms prelabour rupture of membranes. What is the likelihood of spontaneous labour starting within 24 hours?

      Your Answer: 60%

      Explanation:

      In pregnancy, term refers to the gestational period from 37 0 to 41 6 weeks. Preterm births occur between 24 0 and 36 6 weeks. 60% of the women will go into labour with in 24 hours in PPROM. After 24 hours have past without any contraction and the gestation age is more than 34 week than prostaglandins can be used to augment labour.

    • This question is part of the following fields:

      • Clinical Management
      6
      Seconds
  • Question 19 - A 30 year old women who is 24 weeks pregnant attends clinic due...

    Incorrect

    • A 30 year old women who is 24 weeks pregnant attends clinic due to suprapubic pain. Ultrasound shows a viable foetus and also a fibroid with a cystic fluid filled centre. What is the likely diagnosis?

      Your Answer: Red degeneration of fibroid

      Correct Answer: Cystic degeneration of fibroid

      Explanation:

      A fibroid is a benign tumour of the smooth muscles of the uterus also known as a leiomyoma. It has a typical whorled appearance and this may be altered following degeneration which occurs in four main types:
      1. Red degeneration, also known as carneous degeneration, of degeneration that can involve a uterine leiomyoma. While it is an uncommon type of degeneration, it is thought to be the most common form of degeneration of a leiomyoma during pregnancy. Red degeneration follows an acute disruption of the blood supply to the fibroid during growth typically in a mid-second trimester presenting as sudden onset of pain with tenderness localizing to the area of the uterus along with pyrexia and leucocytosis. On ultrasound it can have peripheral (rim).

      2. Hyaline degeneration is the most common form of degeneration that can occur in a uterine leiomyoma. It is thought to occur in up to 60% of uterine leiomyomasoccurs when the fibroid outgrows its blood supply. this may progresses to central necrosis leaving a cystic space in the centre knowns as cystic degeneration.

      3. Cystic degeneration is an uncommon type of degeneration that a uterine leiomyoma (fibroid) can undergo. This type of degeneration is thought to represent ,4% of all types of uterine leiomyoma degeneration. When the leiomyoma increases in size, the vascular supply to it becomes inadequate and leads to different types of degeneration: hyaline, cystic, myxoid, or red degeneration. Dystrophic calcification may also occur. Hyalinization is the commonest type of degeneration. Cystic degeneration is an extreme sequel of edema. Ultrasound may show a hypoechoic or heterogeneous uterine mass with cystic areas.

      4. Myxoid degeneration of leiomyoma is one of the rarer types of degeneration that can occur in a uterine leiomyoma. While this type of degeneration is generally considered rare, the highest prevalence for this type of degeneration has been reported as up to 50% of all degenerations of leiomyomas. Fibroids (i.e. uterine leiomyomas) that have undergone myxoid degeneration are filled with a gelatinous material and can be difficult to differentiate from cystic degeneration; however, they typically appear as more complex cystic masses. They appear hypocellular with a myxoid matrix.

    • This question is part of the following fields:

      • Clinical Management
      6.2
      Seconds
  • Question 20 - Which of the following dugs is a strong inducer of cytochrome P450? ...

    Correct

    • Which of the following dugs is a strong inducer of cytochrome P450?

      Your Answer: Phenytoin

      Explanation:

      It is important to be aware of which ant-epileptics induce cytochrome P450. Of the above Topiramate and Phenytoin are moderate and strong inducers respectively.

    • This question is part of the following fields:

      • Clinical Management
      5.7
      Seconds
  • Question 21 - What is the most common Type II congenital thrombophilia? ...

    Correct

    • What is the most common Type II congenital thrombophilia?

      Your Answer: Factor V Leiden mutation

      Explanation:

      The most common congenital thrombophilia is Factor V Leiden mutation. Other congenital causes are JAK-2 mutations and the Prothrombin G20210A mutation. Protein C and S deficiencies are type 1 and antiphospholipid syndrome is not congenital it is an acquired thrombophilia.

    • This question is part of the following fields:

      • Clinical Management
      3.1
      Seconds
  • Question 22 - Regarding anti-epileptic use in the 1st trimester of pregnancy, which of the following...

    Correct

    • Regarding anti-epileptic use in the 1st trimester of pregnancy, which of the following is closely associated with the development of congenital malformations?

      Your Answer: Sodium valproate

      Explanation:

      Sodium Valproate is known to be the most teratogenic when used in the first trimester of pregnancy. This antiepileptic increases the risk of congenital malformations including a 10-20 fold risk of neurodevelopmental defects. Though the use of antiepileptics should generally be avoided during pregnancy, carbamazepine, or newer drugs such as Lamotrigine are thought to carry less of a risk of teratogenicity.

    • This question is part of the following fields:

      • Clinical Management
      6.4
      Seconds
  • Question 23 - Regarding pelvic Gonorrhoea infection in women. What percentage of cases are asymptomatic? ...

    Correct

    • Regarding pelvic Gonorrhoea infection in women. What percentage of cases are asymptomatic?

      Your Answer: 50%

      Explanation:

      Gonorrhoea is a sexually transmitted disease that is caused by Neisseria gonorrhoea. It infects the mucous membrane of the genital tract epithelium in the endocervical and the urethral mucosa. Around 50% of the women are asymptomatic. However it presents as increase vaginal discharge, dysuria, proctitis and pelvic tenderness.

    • This question is part of the following fields:

      • Clinical Management
      3.8
      Seconds
  • Question 24 - Regarding gestational diabetes which of the following is NOT a recognised risk factor...

    Incorrect

    • Regarding gestational diabetes which of the following is NOT a recognised risk factor

      Your Answer: Smoking

      Correct Answer: High polyunsaturated fat intake

      Explanation:

      Gestational diabetes (GDM) occurs in 2–9 per cent of all pregnancies. Screening for diabetes in pregnancy can be justify ed to diagnose previously unrecognized cases of pre-existing diabetes and to identify a group of women who are at risk of developing NIDDM later in life. No single screening test has been shown to be perfect in terms of high sensitivity and specific city for gestational diabetes. Urinary glucose is unreliable, and most screening tests now rely on blood glucose estimation, with an oral glucose tolerance test commonly used. The aim of glucose control is to keep fasting levels between 3.5 and 5.5 mmol/L and postprandial levels 7.1 mmol/L, with insulin treatment usually indicated outside these ranges. There are various risk factors for gestational diabetes including increasing age, ethnicity, previous still births etc.

    • This question is part of the following fields:

      • Clinical Management
      11
      Seconds
  • Question 25 - Regarding urinary tract infection (UTI) in pregnancy. What is the most common causative...

    Correct

    • Regarding urinary tract infection (UTI) in pregnancy. What is the most common causative organism of urinary tract infection?

      Your Answer: Escherichia coli

      Explanation:

      E.coli is the most common cause of UTI. Other organisms include pseudomonas, proteus and klebsiella.

      NICE guidelines: UTI in pregnancy (updated in July 2015)

      Send urine for culture and sensitivity from all women in whom UTI is suspected before starting empirical antibiotics and 7 days after antibiotic treatment is completed.
      Prescribe an antibiotic to all women with suspected UTI (awaiting culture result is not advised)
      Although local antibiotic resistance needs to be taken into account the following is advised in terms of antibiotic selection:
      1. Nitrofurantoin 50 mg QDS (or 100 mg MR BD) for 7 days.
      2. Trimethoprim 200 mg twice daily, for 7 days
      Give folic acid 5 mg OD if it is the 1st trimester
      Do not give trimethoprim if the woman is folate deficient, taking a folate antagonist, or has been treated with trimethoprim in the past year.
      3. Cefalexin 500 mg BD (or 250 mg 6qds) for 7 days

    • This question is part of the following fields:

      • Clinical Management
      2.6
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  • Question 26 - When deciding on entry method for laparoscopy a patients build is important. Which...

    Incorrect

    • When deciding on entry method for laparoscopy a patients build is important. Which of the following entry methods is inappropriately matched to the patient?

      Your Answer: Palmers point entry in a very thin patient (BMI 17.5)

      Correct Answer: Varess needle entry in a very thin patient (BMI 16)

      Explanation:

      In patients with normal BMI there is no preferential entry method. The Varess technique is not appropriate for morbidly obese or very thin patients for the reasons set out below: Morbid Obesity (BMI>40): Hasson technique or entry at Palmers point Reason: difficult penetration with Varess needle Very Thin Patients: Hasson technique or insertion at Palmers point Reason: higher risk of vascular injury

    • This question is part of the following fields:

      • Clinical Management
      5.6
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  • Question 27 - What is the mode of action of Tranexamic acid? ...

    Correct

    • What is the mode of action of Tranexamic acid?

      Your Answer: Inhibits Plasminogen Activation

      Explanation:

      Tranexamic acid is an antifibrinolytic drug which is one of the treatment options in menorrhagia i.e. heavy menstrual bleeding. It acts by binding to the receptor sites on plasminogen thus preventing plasmin from attaching to those receptors thus inhibiting plasminogen activation.

      If pharmaceutical treatment is appropriate NICE advise treatments should be considered in the following order:

      1. levonorgestrel-releasing intrauterine system (LNG-IUS) provided at least 12 months use is anticipated
      2. tranexamic acid or NSAIDs* or combined oral contraceptives (COCs) or cyclical oral progestogens
      3. Consider progesterone only contraception e.g. injected long-acting progestogens

      *When heavy menstrual bleeding (HMB) coexists with dysmenorrhoea NSAIDs should be preferred to tranexamic acid. Also note NSAIDs and tranexamic are appropriate to use if treatment needed pending investigations.

    • This question is part of the following fields:

      • Clinical Management
      3.3
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  • Question 28 - Mifepristone when used for management of abortion works via what mechanism? ...

    Correct

    • Mifepristone when used for management of abortion works via what mechanism?

      Your Answer: Anti-progestogen

      Explanation:

      Mifepristone is a prostaglandin antagonist. It acts as a competitive inhibitor of the receptor.

    • This question is part of the following fields:

      • Clinical Management
      3
      Seconds
  • Question 29 - A patient attends the maternity unit as her waters have broken but she...

    Correct

    • A patient attends the maternity unit as her waters have broken but she hasn't had contractions. She is 39+6 weeks gestation. Speculum examination confirms prelabour rupture of membranes (PROM). According to NICE guidelines after what time period should induction be offered?

      Your Answer: 24 hours

      Explanation:

      Induction of labour is appropriate approximately 24 hours after rupture of the membranes.

    • This question is part of the following fields:

      • Clinical Management
      4.2
      Seconds
  • Question 30 - An HIV positive woman who is 18 weeks pregnant complains of frothy yellow...

    Incorrect

    • An HIV positive woman who is 18 weeks pregnant complains of frothy yellow vaginal discharge and vaginal soreness. A wet mount and microscopy confirms a Trichomonas vaginalis infection. Which of the following is the most appropriate treatment regime?

      Your Answer: Metronidazole 2g orally single dose

      Correct Answer: Metronidazole 500mg BD 7 days

      Explanation:

      Trichomoniasis is considered a sexually transmitted infection found both in men and women caused by the flagellate protozoan Trichomonas vaginalis. The organism is mainly found in the vagina and the urethra. Though many infected women can be asymptomatic, they can also present with yellow frothy vaginal discharge, itching and vaginitis, dysuria or an offensive odour. For the diagnosis of t. vaginalis in women, a swab is taken from the posterior fornix during speculum examination and the flagellates are detected under light-field microscopy. The recommended treatment for t. vaginalis for a HIV positive woman who is pregnant is 500mg of metronidazole twice daily for 7 days. High dose metronidazole as a 2g single dose tablet is not advised during pregnancy. All sexual partners should also be treated, and screening for other STIs should be carried out.

    • This question is part of the following fields:

      • Clinical Management
      9.3
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  • Question 31 - What is the prevalence of antiphospholipid syndrome in patients with recurrent miscarriage? ...

    Correct

    • What is the prevalence of antiphospholipid syndrome in patients with recurrent miscarriage?

      Your Answer: 15%

      Explanation:

      Anti phospholipid syndrome is an autoimmune disorder in which abnormal antibodies are formed which increases the risk of blood clots to develop in vessels and leads to recurrent miscarriages to occurs. The changes of recurrent miscarriage in a previously known case of APL is 15%.

    • This question is part of the following fields:

      • Clinical Management
      5.3
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  • Question 32 - Regarding gestational diabetes which of the following is NOT a recognised risk factor...

    Correct

    • Regarding gestational diabetes which of the following is NOT a recognised risk factor

      Your Answer: High polyunsaturated fat intake

      Explanation:

      There are several risk factors for gestational diabetes:
      Increasing age
      – Certain ethnic groups (Asian, African Americans, Hispanic/Latino Americans and Pima Indians)
      – High BMI before pregnancy (three-fold risk for obese women compared to non-obese women)
      – Smoking doubles the risk of GDM
      – Change in weight between pregnancies – an inter-pregnancy gain of more than three units (of BMI) doubles the risk of GDM
      – Short interval between pregnancies
      – Previous unexplained stillbirth
      – Previous macrosomia
      – Family history of type 2 diabetes or GDM – more relevant in nulliparous than parous women

      High polyunsaturated fat intake has been shown in some studies to be protective against gestational diabetes. Physical activity is also thought to be effective.

    • This question is part of the following fields:

      • Clinical Management
      3.8
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  • Question 33 - A 42 year old smoker attends clinic due to vulval soreness and shows...

    Correct

    • A 42 year old smoker attends clinic due to vulval soreness and shows you a number of vulval lumps. Biopsy is taken and reported as showing

      Your Answer: Vulval intraepithelial neoplasia (VIN)

      Explanation:

      This is VIN. Smoking is a risk factor. It is also more common in immunocompromised patients.

    • This question is part of the following fields:

      • Clinical Management
      10.3
      Seconds
  • Question 34 - Which of the following contraceptives primary mode of action is inhibition of ovulation?...

    Incorrect

    • Which of the following contraceptives primary mode of action is inhibition of ovulation?

      Your Answer: Micronor®

      Correct Answer: Cerazette®

      Explanation:

      Desogestrel only POPs work mainly by inhibiting ovulation. Cerazette Is the only brand in this list which belongs to this group.

      Types of Progesterone Only Pills

      1. Traditional (e.g. Femulen®, Micronor®, Norgeston®)

      Main mode of action: thickening cervical mucus preventing sperm entry at neck of womb and may also cause anovulation but this effect variable and unreliable

      2. Desogestrel (e.g. Cerazette®)

      Main mode of action: inhibition of ovulation and also cause thickening of cervical mucus

    • This question is part of the following fields:

      • Clinical Management
      6.7
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  • Question 35 - Regarding gestational diabetes which of the following statements is TRUE? ...

    Incorrect

    • Regarding gestational diabetes which of the following statements is TRUE?

      Your Answer: it occurs in 15-25% of pregnancies

      Correct Answer: it occurs in 2-5% of pregnancies

      Explanation:

      Gestational Diabetes occurs in 2-9% of all the pregnancies.

    • This question is part of the following fields:

      • Clinical Management
      6.2
      Seconds
  • Question 36 - Which of the following is associated with use of a tocolytic drug? ...

    Correct

    • Which of the following is associated with use of a tocolytic drug?

      Your Answer: Prolongation of pregnancy for up to 7 days

      Explanation:

      The WHO recommends that tocolytics can safely be used to prolong pregnancy for up to seven days. The tocolytic drugs are used to suppress contractions to allow for more favourable conditions in the case of preterm labour, such as transfer to a better-equipped health care facility with a neonatal intensive care unit, or for those who have not yet completed a full dose of corticosteroids. It is not however associated with better neonatal outcomes in the imminent delivery of preterms. Examples of tocolytics include calcium channel blockers, magnesium sulphate, and oxytocin antagonists.

    • This question is part of the following fields:

      • Clinical Management
      2.3
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  • Question 37 - A 45 year old women is seen in clinic following hysteroscopy and biopsy...

    Correct

    • A 45 year old women is seen in clinic following hysteroscopy and biopsy due to irregular menstrual bleeding. Her BMI is 34 kg/m2. This shows atypical hyperplasia. Which of the following is the most appropriate 1st line management?

      Your Answer: Laparoscopic hysterectomy

      Explanation:

      Endometrial hyperplasia with atypia is at high risk of progression to cancer and hysterectomy is indicated There is high risk of progression to cancer with endometrial hyperplasia with atypia and hysterectomy is indicated. Although weight loss would be beneficial this shouldn’t delay surgical management.

    • This question is part of the following fields:

      • Clinical Management
      17.1
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  • Question 38 - At what gestation does the foetus typically start swallowing? ...

    Correct

    • At what gestation does the foetus typically start swallowing?

      Your Answer: 12 weeks

      Explanation:

      From the 12th week of gestation the foetus starts yawning, sucking and swallowing.

    • This question is part of the following fields:

      • Clinical Management
      3.8
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  • Question 39 - Ovarian cancer is associated with which type of metastasis? ...

    Correct

    • Ovarian cancer is associated with which type of metastasis?

      Your Answer: Transcoelomic

      Explanation:

      The common route of metastases of the ovarian cancer is transcoelomic route.

    • This question is part of the following fields:

      • Clinical Management
      4.4
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  • Question 40 - A 67 year old patient with endometrial carcinoma is to undergo staging investigations....

    Incorrect

    • A 67 year old patient with endometrial carcinoma is to undergo staging investigations. There is evidence of invasion into the vaginal wall, but the lymph nodes are spared, and there is no distant metastasis. According to FIGO, what stage is this?

      Your Answer: 2

      Correct Answer: 3B

      Explanation:

      Endometrial cancer is one of the most common gynaecological malignancies present in postmenopausal women, with a peak incidence between the ages of 60-89. Factors associated with endometrial cancer include obesity, hypertension and diabetes. Full staging for endometrial cancer is surgical, including several other radiologic investigations. According to FIGO staging classifications:
      Stage 1 indicates a tumour confined to the uterine body
      Stage 2 indicates the invasion of the cervical stroma
      Stage 3 indicates local and regional spread, where the tumour invades the serosa in stage 3A, spreads to the vagina and parametrium in stage 3B, and metastasizes to the pelvic or para-aortic lymph nodes in stage 3C.
      Stage 4 indicates tumour invasion on the bladder or bowel mucosa, or distant metastasis.

    • This question is part of the following fields:

      • Clinical Management
      4.8
      Seconds
  • Question 41 - In a patient who undergoes a medical abortion at 10 weeks gestation, what...

    Correct

    • In a patient who undergoes a medical abortion at 10 weeks gestation, what advice would you give regarding Rhesus Anti-D Immunoglobulin?

      Your Answer: All RhD-negative women who are not alloimmunized should receive Anti-D IgG

      Explanation:

      The Rhesus status of a mother is important in pregnancy and abortion. The exposure of an Rh-negative mother to Rh antigens from a positive foetus, will influence the development of anti-Rh antibodies. This may cause problems in subsequent pregnancies leading to haemolysis in the newborn. Rh Anti RhD- globulin is therefore given to non-sensitised Rh-negative mothers to prevent the formation of anti-Rh antibodies within 72 hours following abortion. Anti RhD globulin is not useful for already sensitized, or RhD positive mothers.

    • This question is part of the following fields:

      • Clinical Management
      15.3
      Seconds
  • Question 42 - Which of the following statements is true regarding management of caesarean section? ...

    Incorrect

    • Which of the following statements is true regarding management of caesarean section?

      Your Answer: Co-amoxiclav 1.2g IV should be given prior to skin incision

      Correct Answer: Uterine closure can be in 1 or 2 layers

      Explanation:

      Closure of the uterus should be performed in either single or double layers with continuous or interrupted sutures. The initial suture should be placed just lateral to the incision angle, and the closure continued to a point just lateral to the angle on the opposite side. A running stitch is often employed and this may be locked to improve haemostasis. If a second layer is used, an inverting suture or horizontal suture should overlap the myometrium. Once repaired, the incision is assessed for haemostasis and ‘figure-of-eight’
      sutures can be employed to control bleeding. Peritoneal closure is unnecessary. Abdominal closure is performed in the anatomical planes with high strength, low reactivity materials, such as polyglycolic acid or polyglactin. Diamorphine is advised for intra and post op analgesia and oxytocin is advised to reduce blood loss.

    • This question is part of the following fields:

      • Clinical Management
      9.7
      Seconds
  • Question 43 - A patients MSU comes back showing heavy growth of E.coli that is resistant...

    Correct

    • A patients MSU comes back showing heavy growth of E.coli that is resistant to trimethoprim, amoxicillin and nitrofurantoin. You decide to prescribe a course of Cephalexin. What is the mechanism of action of Cephalexin?

      Your Answer: inhibit peptidoglycan cross-links in bacterial cell wall

      Explanation:

      Cephalosporins are beta lactum drugs, like penicillin. They act by inhibiting the cross linkage of the peptidoglycan wall in bacteria.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 44 - A 26 year old primigravida woman attends A&E due to worsening vomiting. She...

    Correct

    • A 26 year old primigravida woman attends A&E due to worsening vomiting. She is currently 10 weeks pregnant. For the past 4 weeks she has had morning sickness but for the last 4 days she has been unable to tolerate any oral fluids without vomiting and thinks she has lost weight. On questioning she has no significant past medical history prior to this pregnancy. She is currently taking the following medication:

      Your Answer: Hyperemesis gravidarum

      Explanation:

      This patient has severe nausea and vomiting with ketosis and evidence of dehydration (low BP and tachycardia) in the early part of pregnancy. There is no history of diabetes and the blood glucose doesn’t indicate hyperglycaemia. This is consistent with hyperemesis gravidarum (HG)

    • This question is part of the following fields:

      • Clinical Management
      9
      Seconds
  • Question 45 - Which of the following statements regarding management of obstetric anal sphincter injuries (OASIS)...

    Correct

    • Which of the following statements regarding management of obstetric anal sphincter injuries (OASIS) is true?

      Your Answer: Broad-spectrum antibiotics should be given routinely following OASIS

      Explanation:

      After perineal repair, lactulose and a bulking agent should ideally be given for 5-10 days as well as broad spectrum antibiotics should be given that will cover all possible anaerobic bacteria. At 6-12 months a full evaluation should be done regarding the progress of healing. 60 to 80% of women are asymptomatic 12 months post delivery and external anal sphincter repair.

    • This question is part of the following fields:

      • Clinical Management
      7.4
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  • Question 46 - Fetal urine production starts at what gestation? ...

    Correct

    • Fetal urine production starts at what gestation?

      Your Answer: 8-11 weeks

      Explanation:

      Fetal urine contributes significantly to amniotic fluid production in the second trimester of pregnancy. As early as 8-11 weeks, urine production begins and can be observed in the fetal bladder on ultrasound scans. The urine creates a hypotonic fluid which contains increasing concentrations of urea and creatinine. By term, a foetus produces about 800 ml of urine a day, of which 250ml is eliminated through fetal swallowing.

    • This question is part of the following fields:

      • Clinical Management
      4.5
      Seconds
  • Question 47 - In reducing the risk of blood transfusion in pregnancy and labour which of...

    Correct

    • In reducing the risk of blood transfusion in pregnancy and labour which of the following strategies is recommended?

      Your Answer: A Hb of less than 10.5g/l should prompt haematinics and exclusion of haemoglobinopathies

      Explanation:

      Anaemia in pregnancy is most frequently caused by iron or folate deficiency, however, a wide variety of other causes may be considered, especially if the haemoglobin value is below 9.0 g/dL. A haemoglobin level of 11 g/dL or more is considered normal early in pregnancy, with the upper limit of the ‘normal range’ dropping to 10.5 g/dL by 28 weeks gestation. Haemoglobin < 10.5 g/dl in the antenatal period, one should exclude haemoglobinopathies and consider haematinic deficiency. Oral iron is 1st line treatment for iron deficiency. Anaemia not due to haematinic deficiency will not respond to any form of iron. This should be managed with transfusion

    • This question is part of the following fields:

      • Clinical Management
      12
      Seconds
  • Question 48 - What type of drug is clavulanic acid? ...

    Correct

    • What type of drug is clavulanic acid?

      Your Answer: Beta-lactamase inhibitor

      Explanation:

      Clavulanic acid is a beta-lactamase inhibitor that is most often combined with a penicillin to form Augmentin or Co-amoxiclav for greater antibiotic efficacy. The drug works by irreversibly binding to enzymes present in bacteria which posses the Beta-lactamase enzyme. This enzyme is responsible for inactivating Beta-Lactam antibiotics such as penicillin.

    • This question is part of the following fields:

      • Clinical Management
      5.8
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  • Question 49 - A 28 year old patient is treated for hydatidiform mole with methotrexate. What...

    Correct

    • A 28 year old patient is treated for hydatidiform mole with methotrexate. What is the mechanism of action of methotrexate?

      Your Answer: Inhibits dihydrofolate reductase

      Explanation:

      Methotrexate is a folic acid antagonist. It inhibits dihydrofolate reductase (DHFR). DHFR catalyses the conversion of dihydrofolate to the active tetrahydrofolate which is required for DNA synthesis. It is either administered as a single intramuscular injection or multiple fixed doses.

    • This question is part of the following fields:

      • Clinical Management
      5.4
      Seconds
  • Question 50 - According to the RCOG Green-top guideline published in 2013 at what stage of...

    Correct

    • According to the RCOG Green-top guideline published in 2013 at what stage of gestation should pregnant patients with PCOS be offered screening for gestational diabetes

      Your Answer: 24-28 weeks gestation

      Explanation:

      Screening for gestational diabetes should be offered and performed between 24-28 weeks. It should be noted PCOS alone does not make screening essential. It is advised for PCOS patients who are overweight or if not overweight but has other risk factors (age >40, personal history of gestational diabetes or family history of type II diabetes). Screening is via a 2-hour post 75 g oral glucose tolerance test.

    • This question is part of the following fields:

      • Clinical Management
      6.6
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  • Question 51 - You are called to see a patient in A&E who attended due to...

    Correct

    • You are called to see a patient in A&E who attended due to finger splinter that has been removed. The HCA took some routine obs that show her blood pressure to be 162/110. She is 32 weeks pregnant. According to the NICE guidelines which of the following is appropriate?

      Your Answer: Admit and start oral labetalol

      Explanation:

      BP over 159/109 is classed as Severe. NICE guidance advises admission and treatment with oral Labetalol as 1st Line. Patient should have BP checked QDS and shouldn’t be discharged until BP is below 159/109

    • This question is part of the following fields:

      • Clinical Management
      3.7
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  • Question 52 - At what gestation does a mother typically first become aware of fetal movements?...

    Correct

    • At what gestation does a mother typically first become aware of fetal movements?

      Your Answer: 18-20 weeks

      Explanation:

      Typically fetal movements become apparent by 18-20 weeks

    • This question is part of the following fields:

      • Clinical Management
      3
      Seconds
  • Question 53 - Which of the following increases the risk of endometrial hyperplasia? ...

    Correct

    • Which of the following increases the risk of endometrial hyperplasia?

      Your Answer: Tamoxifen

      Explanation:

      Tamoxifen increases risk of endometrial hyperplasia Aromatase inhibitors such as Letrozole and Anastrozole are not associated and have not been shown to increase the risk of endometrial pathology Whereas unopposed oestrogens increase endometrial cancer risk combined oral contraceptive decrease risk

    • This question is part of the following fields:

      • Clinical Management
      263
      Seconds
  • Question 54 - A 31 year old patient undergoes an elective c-section delivery. You estimate blood...

    Incorrect

    • A 31 year old patient undergoes an elective c-section delivery. You estimate blood loss has reached 1000ml and you suspect uterine atony is the likely cause. Following bimanual uterine compression what pharmacological intervention is advised?

      Your Answer: Direct intramyometrial injection of carboprost 0.5 mg

      Correct Answer: Syntocin 5u by slow intravenous injection

      Explanation:

      Syntocin 5u by slow intravenous injection is the first line pharmacological measurement in this scenario

    • This question is part of the following fields:

      • Clinical Management
      13.9
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  • Question 55 - A 24 year old patient presents as 24 weeks pregnant with vaginal discharge....

    Correct

    • A 24 year old patient presents as 24 weeks pregnant with vaginal discharge. Swabs show Chlamydia Trachomatis detected. Which of the following is the most appropriate treatment regime?

      Your Answer: Erythromycin 500 mg twice a day for 14 days

      Explanation:

      The treatment of Chlamydia includes avoidance of intercourse, use of condoms and antibiotic treatment. Erythromycin 500mg orally QID for 7 days or Amoxicillin 500mg TDS for 7 days or Ofloxacin 200mg orally BD for 7 days.

    • This question is part of the following fields:

      • Clinical Management
      5.4
      Seconds
  • Question 56 - A 32 year old lady with known stage III cervical cancer presents to...

    Incorrect

    • A 32 year old lady with known stage III cervical cancer presents to A&E with lower abdominal and unilateral flank pain. From the following list what is the likely diagnosis?

      Your Answer: Ischaemia secondary to Uterine artery obstruction

      Correct Answer: Ureteric Obstruction

      Explanation:

      In stage III cervical cancer there is involvement of the pelvic wall and ureter which may result in abdominal pain and hydronephrosis.

      2010 FIGO classification of cervical carcinoma

      Stage
      0 – Carcinoma in situ
      1 – Confined to the cervix (diagnosed microscopy)
      1A1 – Less than 3mm depth & 7mm lateral spread
      1A2 – 3mm to 5mm depth & less than 7mm lateral spread
      1B1 – Clinically visible lesion or greater than A2 & less than 4 cm in greatest dimension
      1B2 – Clinically visible lesion, Greater than 4 cm in greatest dimension
      2 – Invades beyond uterus but not to pelvic wall or lower 1/3 vagina
      2A1 – Involvement of the upper two-thirds of the vagina, without parametrical invasion & Less than 4cm
      2A2 – Greater than 4 cm in greatest dimension
      2B – Parametrial involvement
      3 – Extends to Pelvic side wall or lower 1/3 vagina or hydronephrosis
      3A – No pelvic side wall involvement
      3B – Pelvic side wall involved or hydronephrosis
      4 – Extends beyond true pelvis
      4A – Invades mucosa bladder and rectum
      4B – Distant Metastasis

    • This question is part of the following fields:

      • Clinical Management
      6.3
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  • Question 57 - A 26 year old women presents for her 12 week scan. She has...

    Correct

    • A 26 year old women presents for her 12 week scan. She has been pregnant once before but had a 1st trimester miscarriage. She reports no problems with this pregnancy and has had no vaginal bleeding or spotting. The scan shows no fetal cardiac activity and a small gestational sac. What is the likely diagnosis?

      Your Answer: Missed Miscarriage

      Explanation:

      As there has been no bleeding or expulsion of the products of conception this is a missed miscarriage

    • This question is part of the following fields:

      • Clinical Management
      5.5
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  • Question 58 - A 46 year old lady presents to the gynaecology clinic with a one...

    Correct

    • A 46 year old lady presents to the gynaecology clinic with a one month history of vulval soreness and lumps. She smokes several packs of tobacco cigarettes a day. A biopsy confirms vulvar intraepithelial neoplasia. What is her risk of developing squamous cell carcinoma?

      Your Answer: 15%

      Explanation:

      Vulvar Intraepithelial Neoplasia (VIN) is a non-invasive squamous type lesion that carries a 15% chance of developing into squamous cell carcinoma of the vulva. Human Papillomavirus (HPV) infection, or chronic inflammatory conditions such as lichen sclerosis and lichen planus, can cause changes in the basal cells of the vulvar epithelium. Other risk factors of VIN include multiple sexual partners, cigarette smoking, and immunocompromised states. Diagnosis is by clinical examination and a biopsy confirms neoplasia.

    • This question is part of the following fields:

      • Clinical Management
      20.9
      Seconds
  • Question 59 - When consenting a patient for abdominal hysterectomy what would you advise regarding the...

    Incorrect

    • When consenting a patient for abdominal hysterectomy what would you advise regarding the risk?

      Your Answer:

      Correct Answer: Injury to ureter or bladder is approximately 1%

      Explanation:

      Abdominal hysterectomy is performed through a Pfannenstiel incision. There are certain complications associated with hysterectomy including haemorrhage, injury to the ureter(1%) and less commonly bladder and bowel (0.04%).

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 60 - A 75 year old woman has a lesion biopsied from the cervix that...

    Incorrect

    • A 75 year old woman has a lesion biopsied from the cervix that is histologically confirmed as endometrial carcinoma. Further staging investigations shows no spread to the serosa or adnexa, no spread to the para-aortic, pelvic or inguinal lymph nodes and no evidence of distant metastasis. What FIGO stage is this?

      Your Answer:

      Correct Answer: 2

      Explanation:

      It is stage 2 of the disease.

      Staging:
      1 Confined to uterus
      1A < 50% myometrial invasion
      1B > 50% myometrial invasion
      2 Cervical stromal invasion but not beyond uterus
      3 Extension beyond the uterus
      3A Tumour invades the serosa or adnexa
      3B Vaginal and/or parametrial invasion
      3C1 Pelvic nodal involvement
      3C2 Para aortic nodal involvement
      4 Distant Metastasis
      4A Tumour invasion of the bladder and/or bowel mucosa
      4B Distant metastases including abdominal metastases and/or inguinal lymph nodes

    • This question is part of the following fields:

      • Clinical Management
      0
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  • Question 61 - A 24 year old lady is 9 weeks pregnant with her first child....

    Incorrect

    • A 24 year old lady is 9 weeks pregnant with her first child. She attends clinic complaining of severe vomiting and is unable to keep fluids down. The most likely diagnosis is hyperemesis gravidarum. Which of the following is the underlying cause?

      Your Answer:

      Correct Answer: Increased circulating HCG

      Explanation:

      Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy, associated with weight loss of more than 5% of pre-pregnancy weight, dehydration and electrolyte imbalance. HG is usually most severe during the first 12 weeks of pregnancy and is thought to be caused by high circulating levels of HCG.

      There is not yet any evidence that pregnancy itself increases the sensitivity of the area postrema, or that the hormones, oestradiol, or progesterone increase vomiting. Generally, higher concentrations of dopamine stimulates receptors in the chemoreceptor trigger zone leading to nausea and vomiting. Although this has not been demonstrated as the cause of hyperemesis gravidarum.

    • This question is part of the following fields:

      • Clinical Management
      0
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  • Question 62 - What is the main reason for the active management of the third stage...

    Incorrect

    • What is the main reason for the active management of the third stage of labour?

      Your Answer:

      Correct Answer: Prevent postpartum haemorrhage

      Explanation:

      According to the WHO, active management of the third stage of labour has been shown to decrease the risk of postpartum haemorrhage in vaginal births worldwide. Per the guidelines from the International Federation of Gynaecologists and Obstetricians (FIGO), the active management of the third stage is summarised as follows:
      1. The administration of a uterotonic (oxytocin, ergometrine or misoprostol), within one minute of fetal delivery,
      2.Controlled cord traction with manual support to the uterus until placental delivery
      3. Fundal massage immediately after placental delivery.

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 63 - Following parturition how long does involution of the uterus take? ...

    Incorrect

    • Following parturition how long does involution of the uterus take?

      Your Answer:

      Correct Answer: 4-6 weeks

      Explanation:

      Involution of the uterus takes 4-6 weeks

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 64 - Hypemesis gravidarum occurs in what percentage of pregnancies? ...

    Incorrect

    • Hypemesis gravidarum occurs in what percentage of pregnancies?

      Your Answer:

      Correct Answer: 1.50%

      Explanation:

      Nausea and vomiting experienced in 80% of pregnancies Hyperemesis gravidarum (HG) is an extreme form of nausea and vomiting which affects around 1.5% of women. Caused by high levels HCG. Definitions vary but most consider it to be defined by severe nausea and vomiting associated with weight loss greater than 5% of pre-pregnancy weight with metabolic disturbance (typically dehydration and/or ketosis).

    • This question is part of the following fields:

      • Clinical Management
      0
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  • Question 65 - At what week in pregnancy is testing for gestational diabetes (GD) advised ...

    Incorrect

    • At what week in pregnancy is testing for gestational diabetes (GD) advised

      Your Answer:

      Correct Answer: As soon as possible after booking if past history of GD

      Explanation:

      Testing for GD should use the 2 hour 75g oral glucose tolerance test (OGTT) to test for GD in women. Testing women who have had GD in a previous pregnancy: early self monitoring of blood glucose OR a 75 g 2 hour OGTT as soon as possible after booking (whether in the first or second trimester) and a further 75 g 2hour OGTT at 24-28 weeks if the results of the first OGTT are normal. Testing women with risk factors for GD: 75g 2 hour OGTT at 24-28 weeks

    • This question is part of the following fields:

      • Clinical Management
      0
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  • Question 66 - According to the NICE guidelines on intrapartum care a multiparous women with intact...

    Incorrect

    • According to the NICE guidelines on intrapartum care a multiparous women with intact membranes should be offered amniotomy if there is inadequate progress of the active second stage of labour (in terms of rotation and/or descent of the presenting part) after how long?

      Your Answer:

      Correct Answer: 30 minutes

      Explanation:

      Multiparous women active 2nd stage labour: Suspect delay if progress inadequate after 30 minutes Diagnose delay if progress inadequate after 1 hour If delay is suspected amniotomy should be offered if membranes are intact If delay diagnosed then preparations should be made for C-section Nulliparous women active 2nd stage labour: Suspect delay if progress inadequate after 1 hour Diagnose delay if progress inadequate after 2 hours If delay is suspected amniotomy should be offered if membranes are intact If delay diagnosed then preparations should be made for C-section

    • This question is part of the following fields:

      • Clinical Management
      0
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  • Question 67 - What is the incidence of hyperthyroidism in complete molar pregnancy? ...

    Incorrect

    • What is the incidence of hyperthyroidism in complete molar pregnancy?

      Your Answer:

      Correct Answer: 3%

      Explanation:

      As B-HCG and TSH have similar structures, increased B-HCG can lead to hyperthyroidism, however there is only a 3% chance of this happening.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 68 - A patient is being discharged following a termination of pregnancy at 14 weeks....

    Incorrect

    • A patient is being discharged following a termination of pregnancy at 14 weeks. She had been taking Microgynon in the past but stopped taking this 6 months prior to falling pregnant as she wasn't in a serious relationship.

      Your Answer:

      Correct Answer: Start immediately

      Explanation:

      Combined oral contraceptive pills (COCPs) can be started immediately following abortion or miscarriage. Note following childbirth COCPs should not be restarted for 3 weeks (assuming the patient is not breastfeeding).

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 69 - Which of the following contraceptives primary mode of action is inhibition of ovulation?...

    Incorrect

    • Which of the following contraceptives primary mode of action is inhibition of ovulation?

      Your Answer:

      Correct Answer: Cerazette®

      Explanation:

      Traditional POP main mode of contraceptive action: thickening of cervical mucus Desogestrel-only POP main mode of contraceptive action is inhibition of ovulation Cerazette® is the only Desogestrel-only POP in the options above. Other desogestrel brands include: Aizea® Cerelle® Nacrez® The other POPs listed are considered traditional POPs and have the following compositions: Norgeston® – Levonorgestrel 30 mcg Micronor® & Noriday® – Norethisterone 350 mcg Femulen® – Ethynediol diacetate 500 mcg

    • This question is part of the following fields:

      • Clinical Management
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  • Question 70 - A 19 year old patient on Lamotrigine 125 mg twice a day for...

    Incorrect

    • A 19 year old patient on Lamotrigine 125 mg twice a day for the past two years has recently been prescribed Microgynon 30 as a contraceptive before she leaves for Uni. What could the main concern be?

      Your Answer:

      Correct Answer: Combined contraceptive may reduce Lamotrigine levels and increase seizure risk

      Explanation:

      Lamotrigine, a drug used to treat epilepsy, is less effective when taken with combined oral contraceptives. The oestrogen component of the pill decreases the circulating levels of Lamotrigine, increasing the risk of seizures. The combination is therefore classified as a UKMEC 3, as the risk of the drug combination may outweigh the benefit. As an alternative, the progesterone-only pill, depo progesterone, Mirena or the copper IUD may be considered as there is no restriction on concomitant use. Lamotrigine is not metabolised through cytochrome P450 like other antiepileptic drugs such as carbamazepine and phenytoin, neither is it an enzyme inhibitor.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 71 - A 23 year old patient presents to the emergency department with sudden onset...

    Incorrect

    • A 23 year old patient presents to the emergency department with sudden onset of severe lower abdominal and pelvic pain. History reveals she normally has regular 28 day cycles but she missed her last period. Past medical history reveals 2 termination of pregnancy procedures in the past 3 years. The most recent one 6 months ago. She smokes 5 cigarettes per day.

      Your Answer:

      Correct Answer: Ectopic pregnancy

      Explanation:

      This patient is most likely to have a ruptured ectopic pregnancy. The history of multiple TOPs suggests her contraceptive methods are not reliable and her missed period is suggestive she may currently be pregnant. There is no temperature or vaginal discharge to suggest PID though this is of course possible as is appendicitis. The last termination was 6 months ago so endometritis is unlikely.

    • This question is part of the following fields:

      • Clinical Management
      0
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  • Question 72 - Breast feeding stimulates the hypothalamus to produce which of the following hormones? ...

    Incorrect

    • Breast feeding stimulates the hypothalamus to produce which of the following hormones?

      Your Answer:

      Correct Answer: Oxytocin

      Explanation:

      Breast feeding facilitates the production of Oxytocin by the hypothalamus which is stored and secreted by the posterior pituitary.
      Ergometrine is an ergoline derivative that can be used to increase uterine tone.
      Atosiban is an antagonist of Oxytocin receptors
      ADH is another posterior pituitary hormone.
      Prostaglandin E2 plays an important role in cervical ripening.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 73 - A 26 year old patient with a past medical history of 2 terminations...

    Incorrect

    • A 26 year old patient with a past medical history of 2 terminations of pregnancies over the past 2 years, presents to the emergency centre complaining of severe abdominal pain and some vaginal bleeding. She has a regular 28 day cycle, and is on an oral contraceptive pill, but missed last month's period. Her last termination was over 6 months ago. She smokes almost a pack of cigarettes a day. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Ectopic pregnancy

      Explanation:

      The clinical picture demonstrated is most likely that of a ruptured ectopic pregnancy. The period of amenorrhea may point to pregnancy, while the past medical history of 2 recent terminations of pregnancy may indicate a failure of her current contraceptive method. Smoking cigarettes have been shown to not only decrease the efficacy of OCPs, but also serve as a known risk factor for ectopic pregnancy. The lady is unlikely to have endometritis as her last termination was over 6 months ago. The lack of fever helps to make appendicitis, PID and pyelonephritis less likely, though they are still possible.

    • This question is part of the following fields:

      • Clinical Management
      0
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  • Question 74 - Which of the following conditions is associated with blunt trauma in a pregnant...

    Incorrect

    • Which of the following conditions is associated with blunt trauma in a pregnant woman?

      Your Answer:

      Correct Answer: Abruptio placentae

      Explanation:

      Abruptio placentae, defined as a premature separation of the placenta from the uterine wall, is commonly seen with blunt abdominal trauma and can cause fetal distress. It occurs in 1% to 3% of pregnant women with minor trauma and in 40% to 50% with major life-threatening trauma.8,9 Abruption may present with vaginal bleeding, abdominal pain and tenderness, uterine contractions, or fetal distress; however, it may be occult with no vaginal bleeding in up to 20% of cases.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 75 - What percentage of cervical cancers are HPV related? ...

    Incorrect

    • What percentage of cervical cancers are HPV related?

      Your Answer:

      Correct Answer: 99.70%

      Explanation:

      99.7% of cervical cancers among women are related to Human Papilloma virus infection (HPV).

    • This question is part of the following fields:

      • Clinical Management
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  • Question 76 - Which of the following ultrasound findings form part of the Rotterdam criteria for...

    Incorrect

    • Which of the following ultrasound findings form part of the Rotterdam criteria for diagnosis of PCOS (Polycystic Ovary Syndrome) ?

      Your Answer:

      Correct Answer: Increased ovarian volume >10cm3

      Explanation:

      The Rotterdam criteria for the diagnosis of PCOS is based on a score of two out of the three criteria:
      1) Oligo or anovulation
      2) Hyperandrogenism – clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone)
      3) on ultrasound – contain 12 or more follicles measuring 2 to 9 mm in diameter and/or have an increased volume of 10 cm3 or greater.

    • This question is part of the following fields:

      • Clinical Management
      0
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  • Question 77 - Oxytocin binds to what receptor type? ...

    Incorrect

    • Oxytocin binds to what receptor type?

      Your Answer:

      Correct Answer: G-protein-coupled receptors

      Explanation:

      Oxytocin binds to the G protein coupled receptors that triggers the IP3 mechanism leading to an elevated intracellular calcium ion.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 78 - A 70 year old patient is being reviewed in clinic for post menopausal...

    Incorrect

    • A 70 year old patient is being reviewed in clinic for post menopausal bleeding. Examination reveals a lesion of the vaginal wall. Which is the most common type of primary vaginal cancer?

      Your Answer:

      Correct Answer: Squamous cell carcinoma

      Explanation:

      The vaginal epithelium is made of squamous cells. Hence the most common carcinoma that occurs in the Vagina is squamous cell carcinoma. Diagnosis is made with vaginal biopsy. Usually the pain only presents if the disease extends beyond the vagina involving the perineal nerves.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 79 - What is the average volume of blood loss during the menstrual cycle? ...

    Incorrect

    • What is the average volume of blood loss during the menstrual cycle?

      Your Answer:

      Correct Answer: 35-40ml

      Explanation:

      Normal menstrual blood loss is about 40-45 ml. More than 80 ml per period is defined as heavy menstrual bleeding.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 80 - Which of the following is the most accurate estimate of mature breast milk...

    Incorrect

    • Which of the following is the most accurate estimate of mature breast milk composition?

      Your Answer:

      Correct Answer: Fat 4%, Protein 1%, Sugar 7%

      Explanation:

      Breast milk contains around 4% fat, 7% sugar and 1% proteins. The rest is water and minerals.

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  • Question 81 - A 24 year old lady is rushed to the emergency department complaining of...

    Incorrect

    • A 24 year old lady is rushed to the emergency department complaining of vaginal spotting and abdominal cramping. Her 6 week pregnancy was confirmed by ultrasound scan last week. On speculum examination, the cervical os is open with blood noted around it. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Inevitable Miscarriage

      Explanation:

      A miscarriage is defined as the spontaneous loss of a pregnancy before the age of viability at 24 weeks in the UK. An inevitable miscarriage occurs with the usual symptoms of a miscarriage such as menstrual-like cramping, vaginal bleeding and a dilated cervix. The gestational sac has ruptured but products of conception have not been passed. The products of conception will eventually pass.

      A missed miscarriage is described as a loss of pregnancy without vaginal bleeding, loss of tissue, cervical changes or abdominal pain. During a scan, a fetal heartbeat is not observed, and the gestational sac may be small.

      A threatened miscarriage is when the cervix dilates and uterine bleeding is seen; the pregnancy could still be viable.

      A complete miscarriage occurs when all the products of conception are expelled from the uterus, bleeding has stopped, and the cervix has closed up after dilation. Recurrent miscarriages are described as spontaneous pregnancy loss of more than 2 to 3 consecutive times.

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  • Question 82 - You are asked to review a patient. They have attended for a scan...

    Incorrect

    • You are asked to review a patient. They have attended for a scan at 13 weeks following a positive pregnancy test. The patient has had 2 previous pregnancies for which she opted for termination on both occasions. The scan shows no identifiable fetal tissue or gestational sac and you note the radiologist has reported a 'bunch of grapes sign'. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Complete molar pregnancy

      Explanation:

      Gestational trophoblastic disorder is abnormal conception that is characterised by swollen and oedematous villi with proliferation of the trophoblasts. In a complete mole there is absence of fetal tissue, there is diffuse proliferation of trophoblastic tissue around hydropic villi and on USG it appears as a bunch of grapes or snow storm appearance.

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  • Question 83 - A 36 year old patient is diagnosed with cervical cancer and staging investigations...

    Incorrect

    • A 36 year old patient is diagnosed with cervical cancer and staging investigations show there is parametrial involvement but it is confined within the pelvic wall and does not involve the lower 1/3 vagina. There is no evidence of hydronephrosis. What FIGO stage is this?

      Your Answer:

      Correct Answer: 2B

      Explanation:

      It is stage 2B. Stage I: is strictly confined to the cervix; extension to the uterine corpus should be disregarded. The diagnosis of both Stages IA1 and IA2 should be based on microscopic examination of removed tissue, preferably a cone, which must include the entire lesion.
      2010 FIGO classification of cervical carcinoma:
      Stage IA: Invasive cancer identified only microscopically. Invasion is limited to measured stromal invasion with a maximum depth of 5 mm and no wider than 7 mm.
      Stage IA1: Measured invasion of the stroma no greater than 3 mm in depth and no wider than 7 mm diameter.
      Stage IA2: Measured invasion of stroma greater than 3 mm but no greater than 5 mm in depth and no wider than 7 mm in diameter.

      Stage IB: Clinical lesions confined to the cervix or preclinical lesions greater than Stage IA. All gross lesions even with superficial invasion are Stage IB cancers.
      Stage IB1: Clinical lesions no greater than 4 cm in size.
      Stage IB2: Clinical lesions greater than 4 cm in size.

      Stage II: carcinoma that extends beyond the cervix, but does not extend into the pelvic wall. The carcinoma involves the vagina, but not as far as the lower third.
      Stage IIA: No obvious parametrial involvement. Involvement of up to the upper two-thirds of the vagina.
      Stage IIB: Obvious parametrial involvement, but not into the pelvic sidewall.

      Stage III: carcinoma that has extended into the pelvic sidewall. On rectal examination, there is no cancer-free space between the tumour and the pelvic sidewall. The tumour involves the lower third of the vagina. All cases with hydronephrosis or a non-functioning kidney are Stage III cancers.
      Stage IIIA: No extension into the pelvic sidewall but involvement of the lower third of the vagina.
      Stage IIIB: Extension into the pelvic sidewall or hydronephrosis or non-functioning kidney.

      Stage IV: carcinoma that has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum.
      Stage IVA: Spread of the tumour into adjacent pelvic organs.
      Stage IVB: Spread to distant organs.

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  • Question 84 - A 34 weeks pregnant patient has a blood pressure of 149/98. Urine dipstick...

    Incorrect

    • A 34 weeks pregnant patient has a blood pressure of 149/98. Urine dipstick shows protein 3+. You send a for a protein:creatinine ratio. What level would be diagnostic of significant proteinuria?

      Your Answer:

      Correct Answer: >30 mg/mmol

      Explanation:

      Pre-eclampsia is defined as hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hour collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the sixth postpartum week. Significant proteinuria = urinary protein: creatinine ratio >30 mg/mmol or 24-hour urine collection result shows greater than 300 mg protein.

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  • Question 85 - The COCP (Combined Oral Contraceptive Pill) causes all of the following biochemical effects...

    Incorrect

    • The COCP (Combined Oral Contraceptive Pill) causes all of the following biochemical effects EXCEPT which one?

      Your Answer:

      Correct Answer: Elevate FSH

      Explanation:

      Remember patients with PCOS have elevated LH. COCPs suppress synthesis and secretion of FSH and the mid-cycle surge of LH, thus inhibiting the development of ovarian follicles and ovulation COCPs reduce hyperandrogenism as reduced LH secretion results in decreased ovarian synthesis of androgens. Furthermore they stimulate the liver to produce Sex Hormone Binding Globulin which leads to decreased circulating free androgens. Other mechanisms include reduction in adrenal androgen secretion and inhibition of peripheral conversion of testosterone to dihydrotestosterone and binding of dihydrotestosterone to androgen receptors

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  • Question 86 - Regarding uterine fibroids, which of the following statements is false? ...

    Incorrect

    • Regarding uterine fibroids, which of the following statements is false?

      Your Answer:

      Correct Answer: The risk of fibroids is increased by pregnancy

      Explanation:

      Fibroids are a common gynaecological condition found in many women above the age of 35. They are however uncommon before puberty. They are most common in black women vs white women, and its prevalence increases from puberty to menopause. Risk factors for fibroids include increasing age, obesity and infertility. Protective factors, on the other hand, include pregnancy, as the risk of fibroids decreases with increasing numbers of pregnancies.

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  • Question 87 - Which of the following uterotonic drugs is most strongly associated with a transient...

    Incorrect

    • Which of the following uterotonic drugs is most strongly associated with a transient pyrexia occurring within 45 minutes of administration?

      Your Answer:

      Correct Answer: Dinoprostone

      Explanation:

      Induction of Labour is produced by the infusion of PGF-2 alpha or PGE2. Dinoprostone is a PGE2 and is associated with transient pyrexia that resolved within 4-5 hours of stopping the use of the drug.

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  • Question 88 - You review a patient in the fertility clinic. The ultrasound and biochemical profile...

    Incorrect

    • You review a patient in the fertility clinic. The ultrasound and biochemical profile are consistent with PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2. She is a non-smoker. You plan to initiate Clomiphene. According to NICE guidance how long should treatment continue for (assuming patient remains non-pregnant)?

      Your Answer:

      Correct Answer: 6 months

      Explanation:

      Treatment with Clomiphene should not exceed 6 months.

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  • Question 89 - A baby with shoulder dystocia suffers a brachial plexus injury. The mother asks...

    Incorrect

    • A baby with shoulder dystocia suffers a brachial plexus injury. The mother asks you if this will be permanent. What percentage of babies will have permanent neurological dysfunction as a result of brachial plexus injury secondary to shoulder dystocia?

      Your Answer:

      Correct Answer:

      Explanation:

      of cases there is no permanent neurological disability. Shoulder dystocia is the most common cause of Erb’s palsy (Erb-Duchenne palsy) where there is injury to C5 and C6 of the brachial plexus (C5 to T1)

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      • Clinical Management
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  • Question 90 - What is the most common Type II congenital thrombophilia? ...

    Incorrect

    • What is the most common Type II congenital thrombophilia?

      Your Answer:

      Correct Answer: Factor V Leiden mutation

      Explanation:

      Factor V Leiden is the most common congenital thrombophilia. Named after the Dutch city Leiden where it was first discovered. Protein C and S deficiencies are type 1 (Not type 2) thrombophilias Antiphospholipid syndrome is an acquired (NOT congenital) thrombophilia

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  • Question 91 - Endometriosis is an example of which of the following? ...

    Incorrect

    • Endometriosis is an example of which of the following?

      Your Answer:

      Correct Answer: Pathological hyperplasia

      Explanation:

      Endometriosis is a condition in which the endometrial tissue lies outside the endometrial cavity. There are 4 theories which explain this. First is pathological hyperplasia resulting in menstrual regurgitation and implantation, second is the coelomic epithelium transformation, third is immunogical factors and the fourth is via the lymphatic or vascular spread.

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      • Clinical Management
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  • Question 92 - A patient has returned to your clinic. She presented with painful periods 18...

    Incorrect

    • A patient has returned to your clinic. She presented with painful periods 18 months earlier and laparoscopy confirmed endometriosis. She now gets pain on opening her bowels as well as low back pain. What structure is likely to be involved?

      Your Answer:

      Correct Answer: Uterosacral ligament

      Explanation:

      Lower abdominal pain during menstrual periods and lower back or leg pain are associated with endometriosis in the uterosacral ligaments. Endometriosis can cause diarrhoea and IBS type symptoms. Note Endometriosis on the uterosacral ligament can cause tender nodules to form. These can be palpated during pelvic exam. Tender nodules are specific to endometriosis of the uterosacral ligament so if the question mentions feeling a tender nodule during PV exam think endometriosis of the Uterosacral ligaments!

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      • Clinical Management
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  • Question 93 - A fibroid is a type of ...

    Incorrect

    • A fibroid is a type of

      Your Answer:

      Correct Answer: Leiomyoma

      Explanation:

      A fibroid is a benign smooth muscle tumour or Leiomyoma. As such it is something of a misnomer. Leiomyosarcoma and Angioleiomyoma are malignant tumours of smooth muscle under the WHO sort tissue tumour classification Rhabdomyoma is a skeletal muscle tumour Myofibroma is seen in fibromatosis

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  • Question 94 - According to the RCOG Green-top guidelines on prevention and management of post-partum haemorrhage...

    Incorrect

    • According to the RCOG Green-top guidelines on prevention and management of post-partum haemorrhage (PPH) which of the following statements is true?

      Your Answer:

      Correct Answer: For women delivering by caesarean section, Oxytocin 5 iu by slow IV injection should be used

      Explanation:

      Misoprostol is not as effective as oxytocin but may be used if Oxytocin is not available e.g. home birth Recommended doses of Oxytocin For vaginal deliveries: 5 iu or 10 iu by intramuscular injection. For C-section: 5 iu by IV injection

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  • Question 95 - Syphilis is caused by which one of the following organisms? ...

    Incorrect

    • Syphilis is caused by which one of the following organisms?

      Your Answer:

      Correct Answer: Treponema Pallidum

      Explanation:

      Syphilis is a sexually transmitted disease which is caused by spirochete called treponema pallidum. It can be divided into three stages. i.e. primary, secondary and tertiary syphilis.
      – Primary syphilis is characterized by chancre formation at the site of sexual contact.
      – Secondary syphilis ranges from maculopapular lesions to scaly lesions, inguinal lymphadenopathy, condylomata lata and split papules at the corner of mouth.
      – Tertiary syphilis is the late stage of syphilis which is characterized by gummas formation and general paresis along with signs and symptoms of visceral involvement.

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  • Question 96 - A 56 year old lady presents with a vulval itch and discolouration. A...

    Incorrect

    • A 56 year old lady presents with a vulval itch and discolouration. A biopsy conforms Lichen Sclerosis (LS). What is the risk of developing squamous cell carcinoma compared to patients with a normal vulval biopsy?

      Your Answer:

      Correct Answer:

      Explanation:

      Lichen Sclerosis is a destructive inflammatory condition that effects the anogenital region of women. It effects around 1 in 300 women. It destroys the subdermal layers of the skin resulting in hyalinization of the skin leading to parchment paper appearance of the skin. It is associated with vulval cancer and it is estimated that the risk of developing vulval cancer after lichen sclerosis is around 3-5%.

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  • Question 97 - Galactopoiesis is maintained by which hormone? ...

    Incorrect

    • Galactopoiesis is maintained by which hormone?

      Your Answer:

      Correct Answer: Prolactin

      Explanation:

      The production of milk is regulated by the hormone Prolactin. Oxytocin on the other hand is responsible for the let down reflex that occurs during breast feeding.

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  • Question 98 - What percentage of pregnancies will be uncomplicated following a single episode of reduced...

    Incorrect

    • What percentage of pregnancies will be uncomplicated following a single episode of reduced fetal movements?

      Your Answer:

      Correct Answer: 70%

      Explanation:

      Reduced fetal movements can be the first indication of possible fetal abnormalities. Movements are first perceived by the mother from about 18-20 weeks gestation, increase in size and frequency until 32 weeks gestation when they plateau at about 31 movements per hour. Investigations for reduced fetal heart rate include auscultation of the fetal heart rate using a handheld doppler device, and a cardiotocograph or ultrasound if the foetus is above 28 weeks gestation. About 70% of women who experience one episode of reduced fetal movement have uncomplicated pregnancies. They are advised to report to a maternal unit if another episode occurs.

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  • Question 99 - You receive a swab result from a patient who had complained of odorous...

    Incorrect

    • You receive a swab result from a patient who had complained of odorous vaginal discharge. It confirms bacterial vaginosis (BV). Which pathogen is most commonly associated with BV?

      Your Answer:

      Correct Answer: Gardnerella vaginalis

      Explanation:

      Bacterial vaginosis is characterised by a foul smelling vaginal discharge without inflammation. The most common spp to cause this is gardnerella vaginalis. Other spp include mycoplasma hominis and bacteroides. It occurs due to growth and increase in anaerobic spp with simultaneous reduction in lactobacilli in vaginal flora causing an increase in vaginal pH. It is the most common cause of abnormal vaginal discharge in women of childbearing age.

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  • Question 100 - Which of the following is a pro-thrombotic agent? ...

    Incorrect

    • Which of the following is a pro-thrombotic agent?

      Your Answer:

      Correct Answer: Thromboplastin

      Explanation:

      Protein C, protein S, plasminogen and anti thrombin III are all anti thrombotic agents. Thromboplastin is a pro-thrombotic.

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  • Question 101 - You are asked to review a patient. They have attended for a scan...

    Incorrect

    • You are asked to review a patient. They have attended for a scan at 13 weeks following a positive pregnancy test. The patient has had 2 previous pregnancies for which she opted for termination on both occasions. The scan shows a large irregular haemorrhagic mass that appears to be invading into the myometrium. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Choriocarcinoma

      Explanation:

      Choriocarcinoma may arise as a complication of gestation or as spontaneous germ cell tumours. As this scenario depicts that the women has previous abortion points to the fact that these may have been molar pregnancies. As choriocarcinoma can arise from a molar pregnancy it can be differentiated from it by the presence of invasion into the uterus and metastasis to the lungs primarily.

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  • Question 102 - Which of the following regarding the use of tocolytics is true? ...

    Incorrect

    • Which of the following regarding the use of tocolytics is true?

      Your Answer:

      Correct Answer: Use of a tocolytic drug is not associated with a clear reduction in perinatal or neonatal mortality, or neonatal morbidity

      Explanation:

      Tocolytics are used to suppress contractions. The Canadian preterm labour trial which remains a very influential tocolytic trial to date concluded that tocolytics such as a beta agonist have no significant benefit on perinatal mortality or morbidity or prolong pregnancy to term however it did reduce the number of women delivering within 2 days by 40%. This 48 hour window is the only reason for the use of tocolytics.
      Choice of tocolytic (NICE)
      1st line: Nifedipine
      2nd line: Oxytocin receptor antagonists e.g. atosiban

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  • Question 103 - Which one of the following has the most significant effect on slowing drug...

    Incorrect

    • Which one of the following has the most significant effect on slowing drug metabolism in pregnancy?

      Your Answer:

      Correct Answer: Progesterone effect on gastric motility

      Explanation:

      Progesterone down regulates gastric motility meaning drugs are absorbed and metabolised more slowly, thus drugs are absorbed, metabolised and cleared more slowly. Most of the drugs are transported after binding to the albumin.
      Lower albumin levels mean a greater unbound drug fraction but as this may be thought to increase drug concentrations it actually leaves more available for hepatic clearance or renal excretion so overall drug concentrations are unchanged and metabolism increased.
      Increase in hepatic flow will increase the metabolism of the drug as the drug will be transported faster.
      Increased renal blood flow will result in the faster clearance of the drug from the body.

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  • Question 104 - A patient admitted to the medical ward complains of a mild fever and...

    Incorrect

    • A patient admitted to the medical ward complains of a mild fever and vaginal discharge. Clue cells are seen on microscopy from a vaginal swab. Which of the following infections feature clue cells?

      Your Answer:

      Correct Answer: Bacterial Vaginosis

      Explanation:

      Bacterial vaginosis (BV) is a common infection of the vagina caused by the overgrowth of atypical bacteria, most commonly Gardnerella vaginalis, a gram-negative rod. In diagnosing BV, a swab is taken for microscopy, often revealing clue cells. Clue cells are cells of the vaginal epithelium which are covered by adherent Gardnerella, giving them a distinctive look under the microscope. Though many are asymptomatic, some infected women complain of a greyish, foul-smelling vaginal discharge. Their vaginal fluid pH may also become more alkaline. BV does not however present with pyrexia, so the lady’s fever could be attributed to another cause as she is still a patient on the medical ward.

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  • Question 105 - Which of the following uterotonic drugs is most strongly associated with a transient...

    Incorrect

    • Which of the following uterotonic drugs is most strongly associated with a transient pyrexia occurring within 45 minutes of administration?

      Your Answer:

      Correct Answer: Dinoprostone

      Explanation:

      Dinoprostone is associated with a transient pyrexia. This typically normalises within 4 hours of stopping treatment

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  • Question 106 - The amniotic fluid volume progressively increases during pregnancy. At which of the following...

    Incorrect

    • The amniotic fluid volume progressively increases during pregnancy. At which of the following gestational ages will amniotic fluid volume reach a maximum?

      Your Answer:

      Correct Answer: 35 weeks

      Explanation:

      Amniotic fluid volume begins to increase rapidly in the second and third trimester as the fetal kidneys continue to develop. By 35 weeks gestation the amniotic fluid volume reaches a maximum average of about 800 ml after which it decreases slightly to term.

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  • Question 107 - A 25 year old prim gravida carrying a twin male pregnancy presents at...

    Incorrect

    • A 25 year old prim gravida carrying a twin male pregnancy presents at 31 weeks gestation. She is lethargic, clinically jaundiced and complains of abdominal pain with frequent vomiting. You suspect acute fatty liver of pregnancy (AFLP). What is the maternal mortality rate with AFLP?

      Your Answer:

      Correct Answer: 20%

      Explanation:

      Acute fatty liver of pregnancy occurs in 1-10000 pregnancies and presents as jaundice with abdominal pain. The maternal mortality is around 20%

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  • Question 108 - A patient is attending for medical abortion. She is 15 weeks gestation. She...

    Incorrect

    • A patient is attending for medical abortion. She is 15 weeks gestation. She has no known drug allergies. Which of the following is the most appropriate regarding antibiotic prophylaxis?

      Your Answer:

      Correct Answer: Stat Azithromycin 1g and metronidazole 800 mg orally at time of abortion

      Explanation:

      If the patient has a negative Chlamydia screen then a stat dose of metronidazole monotherapy is appropriate. You do not know this patients Chlamydia status and therefore dual therapy with metronidazole + doxycycline or azithromycin is appropriate.

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  • Question 109 - A 20 year old patient attends clinic for a medical abortion at 12...

    Incorrect

    • A 20 year old patient attends clinic for a medical abortion at 12 weeks gestation. She has no known drug allergies and her STI screen was negative. What drug should she be prescribed as antibiotic prophylaxis?

      Your Answer:

      Correct Answer: Metronidazole 1g PR stat dose

      Explanation:

      According to the Royal College of Obstetrics and Gynaecology guidelines for abortion care it advises dual antibiotic regimes for antibiotic prophylaxis.
      Metronidazole 1g per rectum or 800 mg orally can be given before or at the time of the abortion in women who have tested negative for Chlamydia trachomatis infection.

      Alternatively, Doxycycline (100mg oral, twice daily for 7 days) or Azithromycin 1g stat doses should be given in addition to metronidazole to be effective against Chlamydia trachomatis anaerobes.

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  • Question 110 - A 29 year old patient presents due to the sensation of reduced fetal...

    Incorrect

    • A 29 year old patient presents due to the sensation of reduced fetal movements (RFM). From what gestation is CTG assessment of RFM advised?

      Your Answer:

      Correct Answer: 28+0 weeks

      Explanation:

      The cardiotocograph (CTG) is a continuous tracing of the fetal heart rate used to assess fetal wellbeing. The Doppler effect detects fetal heart motion and allows the interval between successive beats to be measured, thereby allowing a continuous assessment of fetal heart rate. The mother perceives the fetal movement by the 18-20 week of gestation and these increase until the 32 week. A mother should under go CTG if the fetal movements are reduced by the 28 week of gestation.

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  • Question 111 - What is the mode of action of Mefenamic acid? ...

    Incorrect

    • What is the mode of action of Mefenamic acid?

      Your Answer:

      Correct Answer: Inhibits Prostaglandin Synthesis

      Explanation:

      Mefenamic acids is a NSAID. It works by inhibiting prostaglandin synthesis – It inhibits COX-1 and COX-2 hence reducing the process of inflammation. Activation of antithrombin III and inactivation of factor Xa is the primary mechanism of action of Heparin.

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  • Question 112 - You are consenting a patient for a diagnostic hysteroscopy. What is the approximate...

    Incorrect

    • You are consenting a patient for a diagnostic hysteroscopy. What is the approximate risk of uterine perforation in diagnostic hysteroscopy?

      Your Answer:

      Correct Answer: 0.10%

      Explanation:

      The risk of uterine perforation is 0.1% during therapeutic hysteroscopy.

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      • Clinical Management
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  • Question 113 - What is the RCOG advice regarding timing of Rhesus Anti-D Immunoglobulin following abortion?...

    Incorrect

    • What is the RCOG advice regarding timing of Rhesus Anti-D Immunoglobulin following abortion?

      Your Answer:

      Correct Answer: Anti-D IgG within 72 hours following abortion

      Explanation:

      All non-sensitised RhD negative women should receive Anti-D IgG within 72 hours following abortion

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      • Clinical Management
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  • Question 114 - A mother typically becomes aware of fetal movements at what gestation? ...

    Incorrect

    • A mother typically becomes aware of fetal movements at what gestation?

      Your Answer:

      Correct Answer: 18-20 weeks

      Explanation:

      Foetal movements often become apparent at about 18-20 weeks gestation. This phenomenon is also called quickening. The Foetal movements continue to increase in frequency and force until 32 weeks where they plateau. Foetal movements can be used to monitor the wellbeing of the foetus, alerting the mother and healthcare providers to a problem.

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  • Question 115 - A patient is diagnosed with cervical cancer and staging investigations show there is...

    Incorrect

    • A patient is diagnosed with cervical cancer and staging investigations show there is parametrial involvement but it is confined within the pelvic wall and does not involve the lower 1/3 vagina. There is no evidence of hydronephrosis. What FIGO stage is this?

      Your Answer:

      Correct Answer: 2B

      Explanation:

      This is stage 2B.

      2010 FIGO classification of cervical carcinoma
      0 – Carcinoma in situ
      1 – Confined to the cervix (diagnosed microscopy)
      1A1 – Less than 3mm depth & 7mm lateral spread
      1A2 – 3mm to 5mm depth & less than 7mm lateral spread
      1B1 – Clinically visible lesion or greater than A2 & less than 4 cm in greatest dimension
      1B2 – Clinically visible lesion, Greater than 4 cm in greatest dimension 2 Invades beyond uterus but not to pelvic wall or lower 1/3 vagina
      2A1 – Involvement of the upper two-thirds of the vagina, without parametrical invasion & Less than 4cm
      2A2 – Greater than 4 cm in greatest dimension
      2B – Parametrial involvement
      3 – Extends to Pelvic side wall or lower 1/3 vagina or hydronephrosis
      3A – No pelvic side wall involvement
      3B – Pelvic side wall involved or hydronephrosis
      4 – Extends beyond true pelvis
      4A – Invades mucosa bladder and rectum
      4B – Distant Metastasis

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  • Question 116 - Your consultant agrees to supervise you performing a Caesarean Section (CS). When making...

    Incorrect

    • Your consultant agrees to supervise you performing a Caesarean Section (CS). When making a Joel Cohen incision where should this be placed?

      Your Answer:

      Correct Answer: 3 cm above the symphysis pubis

      Explanation:

      The Joel Cohen incision is superior to the Pffannenstiel incision. It is a straight incision that is 3 cm below the line joining the anterior iliac spines.

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  • Question 117 - Which of the following fasting plasma glucose (FPG) values for OGTT (Oral glucose...

    Incorrect

    • Which of the following fasting plasma glucose (FPG) values for OGTT (Oral glucose tolerance test) is diagnostic of gestational diabetes according to the WHO criteria?

      Your Answer:

      Correct Answer: FPG 6.1mmol/L; 2 hour 7.8mmol/L

      Explanation:

      There are several criteria that aid in the diagnosis of gestational diabetes in pregnancy including NICE, WHO and modified WHO:
      GDM Diagnostic Criteria:
      NICE: Immediate FBG >5.6, 2 hour glucose >7.8
      WHO: Immediate FBG >6.1, 2 hour glucose >7.8
      Modified WHO: Immediate FBG >7.1, 2 hour glucose >7.8

      Random glucose and OGTT 2 hour readings of >11.1 are diagnostic of diabetes in non-pregnant states but are not part of the gestational diabetes criteria.

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  • Question 118 - A 30 year old woman with a history of two previous C section...

    Incorrect

    • A 30 year old woman with a history of two previous C section deliveries, is rushed to the hospital for an emergency c-section at 36 weeks gestation due to antenatal haemorrhage. Upon examination of the uterus, the placenta has invaded the myometrium but the serosa is spared. Which of the following identifies this condition?

      Your Answer:

      Correct Answer: Placenta Increta

      Explanation:

      Abnormal placental adherence to the uterus, generally termed Placenta Accreta, is divided into 3 conditions.
      – Placenta accreta: refers to the invasion of the chorionic villi beyond the decidual surface of the myometrium.
      – Placenta increta: the villi invade deep into the myometrium but spare the serosa;
      – Placenta percreta: the chorionic villi invade through the myometrium, penetrate the uterine serosa, and may invade surrounding pelvic structures.

      These conditions can predispose patients to obstetric bleeding in the third trimester, often requiring emergency intervention.

      Risk factors in the development of an abnormal placental adherence include previous c-sections. Placenta Previa, is also a cause of antepartum haemorrhage and serves as a risk factor in the development of abnormal placental adherence.

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  • Question 119 - A 30 year old patient attends for non-invasive pre-natal screening for Down's syndrome....

    Incorrect

    • A 30 year old patient attends for non-invasive pre-natal screening for Down's syndrome. You advise her that the result will take the form of a risk score and higher risk results will be offered CVS or amniocentesis. What is the cut-off figure between low and high risk?

      Your Answer:

      Correct Answer: 1 in 150

      Explanation:

      1 in 150 is the cut off. Where pre-natal screening shows a risk of 1 in 150 or greater invasive testing is typically offered.

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  • Question 120 - What is the most common cause of sepsis in the puerperium? ...

    Incorrect

    • What is the most common cause of sepsis in the puerperium?

      Your Answer:

      Correct Answer: Endometritis

      Explanation:

      Significant puerperal pyrexia is defined as a temperature of 38ºC or higher on any two of the first 10 days postpartum, exclusive of the first 24 hours. A mixed flora normally colonizes the vagina with low virulence. Puerperal infection is usually polymicrobial and involves contaminants from the bowel that colonize the perineum and lower genital tract. Following delivery, natural barriers to infection are temporarily removed and therefore organisms with a pathogenic potential can ascend from the lower genital tract into the uterine cavity. Placental separation exposes a large raw area equivalent to an open wound, and retained products of conception and blood clots within the uterus can provide an excellent culture medium for infection.

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  • Question 121 - Which of the following is the most common cause of abnormal vaginal discharge...

    Incorrect

    • Which of the following is the most common cause of abnormal vaginal discharge in patients of childbearing age?

      Your Answer:

      Correct Answer: Bacterial vaginosis

      Explanation:

      Bacterial Vaginosis is a common condition which results in a foul smelling discharge from the vagina without any inflammation. It is the most common cause of abnormal PV discharge. Most of the women are asymptomatic carriers.

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  • Question 122 - Which of the following describes Neisseria Gonorrhoea? ...

    Incorrect

    • Which of the following describes Neisseria Gonorrhoea?

      Your Answer:

      Correct Answer: Gram Negative Cocci

      Explanation:

      Neisseria Gonorrhoeae is a Gram negative diplococci.

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      • Clinical Management
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  • Question 123 - What percentage of pregnant women have asymptomatic vaginal colonisation with candida? ...

    Incorrect

    • What percentage of pregnant women have asymptomatic vaginal colonisation with candida?

      Your Answer:

      Correct Answer: 40%

      Explanation:

      90% of genital candida infections are the result of Candida albicans. 20% of women of childbearing age are asymptotic colonisers of Candida species as part of their normal vaginal flora. This increases to 40% in pregnancy

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  • Question 124 - A 16 year old girl has been referred as she has amenorrhoea. She...

    Incorrect

    • A 16 year old girl has been referred as she has amenorrhoea. She reports never having periods. Her mother and 2 sisters menarche was at age 12. On examination you note the patient is 152cm tall and BMI 29.0 and secondary sexual characteristics are not developed. Her FSH is elevated. Prolactin is normal. What is the suspected diagnosis?

      Your Answer:

      Correct Answer: Turner Syndrome

      Explanation:

      Turner syndrome is the most common chromosomal abnormality in females occurring in 1 in 2500 live births. It is characterised by short stature, webbed neck and wide carrying angle. It is also associated with renal, endocrine and CVS abnormalities. In this condition the ovaries do not completely develop and do not produce oestrogen or oocytes, thus no secondary sexual characteristic develop and neither does the girl starts menstruating.

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  • Question 125 - A 24 week pregnant patient complains of itching over the past 6 weeks...

    Incorrect

    • A 24 week pregnant patient complains of itching over the past 6 weeks particularly to the hands and feet which is worse at night. She has taken cetirizine but this hasn't settled her symptoms. Examination is unremarkable with no rash. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Intrahepatic Cholestasis of Pregnancy

      Explanation:

      The history is typical of Intrahepatic Cholestasis of Pregnancy, also known as obstetric cholestasis and prurigo gravidarum. It is characterised by itching without rash and abnormal LFTs beyond normal pregnancy ranges. Itching affects around 23% of pregnancies and can occur before biochemical changes.

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  • Question 126 - Following parturition uterine contractions called Afterpains may typically continue for how long? ...

    Incorrect

    • Following parturition uterine contractions called Afterpains may typically continue for how long?

      Your Answer:

      Correct Answer: None of the above

      Explanation:

      Afterpains may continue for 2-3 days (so none of the above). Breastfeeding may intensify pain due to stimulation of Oxytocin which causes uterine contractions

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  • Question 127 - What is the half life of Oxytocin? ...

    Incorrect

    • What is the half life of Oxytocin?

      Your Answer:

      Correct Answer: 5 minutes

      Explanation:

      The half-life of Oxytocin is approximately 5 minutes
      The half-life of Misoprostol is approximately 20-40 minutes
      The half-life of Ergometrine is approximately 30-120 minutes

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  • Question 128 - In the 3rd trimester anaemia is defined by? ...

    Incorrect

    • In the 3rd trimester anaemia is defined by?

      Your Answer:

      Correct Answer:

      Explanation:

      Anaemia in pregnancy is defined by the British Committee for Standards in Haematology (BCSH) guidance: 1st trimester Hb < 110 g/l 2nd and 3rd trimester Hb < 105 g/l Postpartum Hb less than 100 g/l

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      • Clinical Management
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