PASSMED

Question 1

MOA of HRT

Answer 1

has oestrogen combined with a progestrogen in women with uterus

Question 2

SEs fo HRT

Answer 2

nausea
breast tenderness
fluid retention

Question 3

potential complications of HRT

Answer 3

1) increased risk of breast cancer
- increased by the addition of a progestogen

2) increased risk of endometrial cancer
- oestrogen by itself should not be given as HRT to women with a womb

3) increased risk of VTE
- increased by the addition of a progestogen
- transdermal HRT does not appear to increase the risk of VTE

4) increased risk of stroke
5) increased risk of IHD if taken more than 10 years after menopause

Question 4

when to suspect rubella

Answer 4

• ‘pink or light red’ rash, small, red papules on her son’s soft palate
• resolution of the rash after around 3 days then a diagnosis of rubella may be suspected - especially if the child has not had the MMR (measles, mumps and rubella) vaccination.

Question 5

what is vasa praevia

Answer 5

complication in which fetal blood vessels cross or run near the internal orifice of the uterus. The vessels can be easily compromised when supporting membranes rupture, leading to frank bleeding.

Question 6

what is the classic triad of vasa praevia

Answer 6

1) rupture of membranes
2) painless vaginal bleeding
3) fetal bradycardia

Question 7

classification of FGM

Answer 7

Type 1 - Partial or total removal of the clitoris and/or the prepuce (clitoridectomy).

Type 2 - Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).

Type 3 - Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation).

Type 4 - All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization.

Question 8

Mx for large fibroids

Answer 8

myomectomy

Question 9

features of uterine fibroids

Answer 9

• may be asymptomatic
• menorrhagia
• • -> may result in iron-deficiency anaemia
• lower abdominal pain: cramping pains, often during menstruation
  bloating
  urinary symptoms, e.g. frequency, may occur with larger fibroids
  subfertility
  rare features:
  polycythaemia secondary to autonomous production of erythropoietin

Question 10

Diagnosis of fibroids

Answer 10

transvaginal US

Question 11

bleeding in 1st trimester

Answer 11

spontaneous abortion
ectopic pregnancy
hydatidiform mole

Question 12

bleeding in 2nd trimester

Answer 12

Spontaneous abortion
Hydatidiform mole
Placental abruption

Question 13

bleeding in 2rd trimester

Answer 13

• Bloody show
• Placental abruption
• Placenta praevia
• Vasa praevia

Question 14

what is hydatidiform mole

Answer 14

Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis. The uterus may be large for dates and serum hCG is very high

Question 15

what is normal dose of folic acid

Answer 15

400mvg until the 12th week of pregnancy

Question 16

what is high dose of folic acid and when will you give it

Answer 16

5mg before conception until the 12 th week

• partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD
• the woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
• the woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).

Question 17

bleeding and <6 weeks gestation Mx

Answer 17

• to return if bleeding continues or pain develops
• to repeat a urine pregnancy test after 7–10 days and to return if it is positive
• a negative pregnancy test means that the pregnancy has miscarried

Question 18

bleeding and >6 weeks gestation

Answer 18

EPAU

Question 19

RFs for cord prolapse

Answer 19

prematurity
multiparity
polyhydramnios
twin pregnancy
cephalopelvic disproportion
abnormal presentations e.g. Breech, transverse lie
placenta praevia
long umbilical cord
high fetal station

Question 20

major cause for cord prolapse and diagnosis

Answer 20

ARM

fetal HR abormal
cord is palpable vaginally
cord is visible beyond the level of the introitus.

Question 21

Mx for cord prolapse

Answer 21

presenting part of the fetus may be pushed back into the uterus to avoid compression

tocolytics

Question 22

clinical findings of chorioamnioitis

Answer 22

foul smelling discharge

uterine tenderness

fever
tachycardia
neutrophilia

Question 23

drugs that should be avoided when breastfeeding

Answer 23

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

Question 24

What are women with PCOS at particular risk of when undergoing IVF?

Answer 24

ovarian hyperstimulation syndrome

Question 25

if woman has intrahepatic cholestasis when can IOL take place

Answer 25

37-38 weeks gestation

Question 26

causes if an increased nuchal translucency

Answer 26

Down's syndrome congenital heart defects abdominal wall defects

Question 27

causes of hyperechogenic bowel

Answer 27

cystic fibrosis Down's syndrome cytomegalovirus infection

Question 28

presentation of fibroid degeneration

Answer 28

low-grade fever pain vomiting.

Question 29

what are false labour features

Answer 29

contractions felt in the lower abdomen. The contractions are irregular and occur every 20 minutes. Progressive cervical changes are absent. occurs in the last 4 weeks of pregnancy

Question 30

what manouevre do you do for shoulder dystocia

Answer 30

McRobert's entails flexion and abduction of the maternal hips, bringing the mother's thighs towards her abdomen. This rotation increases the relative anterior-posterior angle of the pelvis and often facilitates a successful delivery.

Question 31

define sensitisation

Answer 31

fetal red blood cells (RhD-positive) enter the maternal circulation, where the mother is RhD-negative. The fetomaternal haemorrhage (FMH) can cause antibodies to form in the maternal circulation that can haemolyse fetal red blood cells.

Question 32

potentially sensitising events in pregnancy

Answer 32

- Ectopic pregnancy - Evacuation of retained products of conception and molar pregnancy - Vaginal bleeding < 12 weeks, only if painful, heavy or persistent - Vaginal bleeding > 12 weeks - Chorionic villus sampling and amniocentesis - Antepartum haemorrhage - Abdominal trauma - External cephalic version - Intra-uterine death - Post-delivery (if baby is RhD-positive)

Question 33

RFs for vaginal candidiasis

Answer 33

diabetes mellitus drugs: antibiotics, steroids pregnancy immunosuppression: HIV

Question 34

features and Ix for vaginal candidiasis

Answer 34

'cottage cheese', non-offensive discharge vulvitis: superficial dyspareunia, dysuria itch vulval erythema, fissuring, satellite lesions may be seen

Question 35

Mx for vaginal candidiasis

Answer 35

local treatments include clotrimazole pessary (e.g. clotrimazole 500mg PV stat) oral treatments include itraconazole 200mg PO bd for 1 day or fluconazole 150mg PO stat if pregnant then only local treatments (e.g. cream or pessaries) may be used - oral treatments are contraindicated

Question 36

recurrent vaginal candidiasis

Answer 36

BASHH define recurrent vaginal candidiasis as 4 or more episodes per year compliance with previous treatment should be checked confirm the diagnosis of candidiasis high vaginal swab for microscopy and culture consider a blood glucose test to exclude diabetes exclude differential diagnoses such as lichen sclerosus consider the use of an induction-maintenance regime induction: oral fluconazole every 3 days for 3 doses maintenance: oral fluconazole weekly for 6 months

Question 37

chocolate cysts

Answer 37

endometrial cyst

Question 38

what is HCG and its main role

Answer 38

hormone first produced by the embryo and later by the placental trophoblast. main role is to prevent the disintegration of the corpus luteum

Question 39

Rokitansky protuberance means

Answer 39

dermoid cyst

Question 40

what is fibronectin

Answer 40

is produced by the gestational sac and its sort of indicates premature labour

Question 41

features of primary dysmennorhoea

Answer 41

- pain typically starts just before or within a few hours of the period starting - suprapubic cramping pains which may radiate to the back or down the thigh

Question 42

Mx of primary dysmennorhoea

Answer 42

NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women. They work by inhibiting prostaglandin production combined oral contraceptive pills are used second line

Question 43

features of secondary dysmennorhoea

Answer 43

In contrast to primary dysmenorrhoea the pain usually starts 3-4 days before the onset of the period. Causes include: - endometriosis - adenomyosis - pelvic inflammatory disease - intrauterine devices* - fibroids

Question 44

what is immune thrombocyopenia

Answer 44

autoimmune condition can pass to the child

Question 45

complications of twin pregnancy

Answer 45

preterm labour and birth - c section placental problems - slows fetal growth esp late 3rd trimester twin-twin trasfusion - one gets more blood than the other preeclampsia diabetes risk of cerebral palsy 4x

Question 46

what is conscientious objection in health care

Answer 46

A person is engaging in conscientious objection when they 1. refuses to provide legal and professionally accepted goods or services that fall within the scope of their professional competence, and 2. justifies their refusal by claiming that it is an act of conscience or is conscience-based

Question 47

when can a professional object and what are the legislations

Answer 47

The only two areas where the right to conscientious objection of health care professionals are: ``` Termination of pregnancy (Abortion Act 1967) Fertility treatment (Human Fertilisation and Embryology Act 1990 ``` Conscientious objection (Medical Activities) Bill 2017 (currently HoL)- relates to end of life care