questions

Question 1

what are women offered as routine screening for Down’s syndrome

Answer 1

CUB - combined US/biochem screening

NOT amniocentesis as this is a diagnostic test, offered when risk of Down’s syndrome on screening is 1/25 or higher

Question 2

40y/o, para 4, BMI 40
presents w/ leakage of urine on laughing and coughing
the following are appropriate management steps except:
- anticholinergic medication
- decrease caffeine intake
- physiotherapy
- transvaginal tape
- weight loss

Answer 2

anticholinergic medication - used for mixed urine incontinence and urgency, not stress urine incontinence

Question 3

Which of the following is a CI to induction of labour:

• cephalic presentation
• obesity
• oblique lie
• previous C section
• rupture of membranes

Answer 3

oblique lie - unless baby is cephalic, labour won’t be induced; don’t want to risk cord prolapse

• cephalic presentation is a pre-requisite for induction
• prev CS is a relative CI

Question 4

which of the following is CI in pregnancy:
ramipril
labetalol
methyldopa
magnesium sulphate
nifedipine

Answer 4

ramipril
ACEI are always CI in pregnancy

Question 5

in order to prevent rhesus disease in the baby, which women are recommended to receive anti-D in their pregnancy

Answer 5

all rhesus -ve women - to prevent haemolytic disease of the newborn

routinely given in the 28th week

Question 6

22y/o F w/ cyclical pain and dyspareunia

concerned re. endometriosis

what is the best investigation to confirm the diagnosis

Answer 6

diagnostic laparoscopy - endometriosis has to be physically seen to make a diagnosis

Question 7

during the menstrual cycle the levels of hormones change. Which hormone has a sudden rise in level just before ovulation

Answer 7

LH - lutenising hormone

• progesterone is the predominant hormone following ovulation
• oestrogen is the predominant hormone in the 2wks prior to ovulation

Question 8

31y/o F presents w/ severe R side upper abdo pain at 34wks gestation.

• She reported normal fetal movements up until now.
• She has no vaginal bleeding but the pain is getting worse
• Abdomen is tense and tender
• high BP recorded at midwife visit, urine dipstick is normal

what is the most likely diagnosis:

cholecystitis

placental abruption

pre-eclampsia

pre-term labour

urinary infection

Answer 8

placental abruption - upper abdo pain, abdomen is tense and tender

Question 9

73y/o F presents w/ 3 episodes of unprovoked vaginal bleeding

• menopausal, obese, diabetic
• smears up to date until 60y/o

what is the most probable diagnosis :

cervical cancer

endometrial cancer

ovarian cancer

PID

rectal cancer

Answer 9

endometrial cancer (nulliparity is key risk factor as well as obesity and diabetes, PMB is key symptom)

• ovarian cancer less likely to cause post-menopausal bleeding
• PID unlikely w/ this hx, usually younger women
• rectal cancer would usually result in rectal bleeding

Question 10

27y/o primagravid pt admitted at 37wks w/ 6hrs of contractions. 2 contractions in 10 mins, each lasting 50s.

No show and membranes are intact but she thinks she is in labour.

What is the best clinical sign to assess if she is in established labour

• abdo exam for descent of fetal head
• abdo exam for strength of contractions
• speculum exam for cervical dilatation
• vaginal exam for cervical dilatation
  
  • vaginal exam to assess if membranes are intact

Answer 10

vaginal examination to assess cervical dilatation

whether membranes are intact or not isn’t a diagnostic feature of labour

cannot measure dilatation with speculum

contractions can be irritable uterus or braxton hicks

Question 11

parous pt is in established labour and head is just visible at introitus

she has had no analgesia

she is pushing well but is screaming for pain relief, what method of pain relief is best:

epidural anaesthesia

entonox

morphine

spinal anaesthetic

supportive care

Answer 11

entonox

baby is almost out

• epidural - will take 20-40mins to put in
• morphine - try to avoid within 2hrs of birth to avoid effects on neonate
• spinal - not used during labour as it is shorter lasting, used for CS
• supportive care - not pain relief as such

Question 12

26y/o, pregnant with her 1st baby, she has remained well during her pregnancy but her Hb has dropped from 13g/dl at 12wks to 11g/dl at 28wks

what is the most likely explanation:

concealed haemorrhage

iron deficiency anaemia

normal physiological change

pernicious anaemia

sickle cell

Answer 12

normal physiological change in pregnancy

Question 13

considering 2y prevention of cervical cancer in UK, CIN is diagnosed by:

colposcopy

cytology

HPV testing

histology

MRI scan

Answer 13

histology

• colposcopy looks at surface of cervix, can’t give a diagnosis but can obtain tissue
• cytology looks at the cells themselves and often looks at fluid samples
• CIN is taken from tissue biopsy therefore histology

Question 14

what is true about pregnant women who are diabetic:

• don’t suffer from a higher rate of stillbirth
• have babies who are at risk of neonatal hyperglycaemia
• need good diabetic control before conception to help prevent anomalies in the baby
• only suffer complications in the mother as glucose doesn’t cross the placenta and therefore doesn’t harm baby
  
  • typically have smaller babies than non-diabetic mothers

Answer 14

need good diabetic control before conception to help prevent anomalies in the baby

• poor glycaemic control is associated w/ many complications in pregnancy
• are at higher risk of stillbirth w/ poor glycaemic control
• babies are at risk of neonatal hypoglycaemia
• complications can be seen in mother and baby w/ poor glycaemic control
• typically have larger babies

Question 15

50y/o F has irregular periods and is suffering from mood swings and night sweats

she is perimenopausal and wishing to commence on HRT to help her symptoms

which hormone’s reducing level causes the menopausal symptoms

Answer 15

oestrogen

Question 16

1y prevention of cervical cancer in the UK is performed by:

HPV 6 and 11 immunisation

high risk HPV testing

HPV 16 and 18 immunisation

HIV immunisation

cervical screening

Answer 16

HPV 16 and 18 immunisation

1y prevention is before exposure

6 and 11 HPV cause warts not cancer

Question 17

in the UK national breast screening programme:

• screening target population are women ages 40-70y/o
• screening target population are offered 1y screening by clinical examination of the breasts
• screening target population are offered a mammogram every 5yrs
• screening target population are registered w/ a GP and aged 50-70y/o
• screening target population is anyone w/ FHx of a 1st degree relative w/ breast cancer

Answer 17

screening target population are registered w/ a GP and aged 50-70y/o

Question 18

why should pregnancy women always be nursed in the left lateral position

Answer 18

in the supine position the pressure of the gravid uterus on the IVC causes a reduction in venous output to the heart w/ a possible 25% reduction in cardiac output

Question 19

iron deficiency anaemia is by far the commonest cause of anaemia and is the most common haematological problem in pregnancy. In relation to this the following is true:

• pregnancy causes 10x increase in the requirement for iron not only for Hb synthesis but also for certain enzymes and the fetus
• because the expansion in plasma volume > increase in red cell mass there is a fall in Hb conc, haematocrit and RCC
• changes in the coagulation system during pregnancy produce a hypercoagulable state - clotting factors VIII, IX, X decrease and fibrinogen increases
• women will not be iron deficient if she has a normal Hb and MCV
• all women planning a pregnancy are advised to take 400mcg folate periconceptually and up till 12wks gestation to prevent megaloblastic anaemia

Answer 19

because the expansion in plasma volume > increase in red cell mass there is a fall in Hb conc, haematocrit and RCC

• folate is taken but is to prevent neural tube defects

Question 20

33y/o para 1+2 presents at 9wks gestation

what can we tell from this about this woman’s obstetric hx

Answer 20

this is her 4th pregnancy and she has had 2 previous early pregnancy losses

1 pregnancy >24 wks, 2 pregnancies <24wks

• +2 can be any kind of pregnancy loss (not specific to miscarriage etc)

Question 21

which of the following infections are women NOT routinely offered at booking:

hep B

HIV

sickle cell

thalassaemia

chicken pox (varicella)

Answer 21

chicken pox - they are asked about it in verbal hx but there is no serological testing

Question 22

22y/o F presents to GP requesting emergency contraception

regular 28 day cycle and this is day 15

unprotected sex 78hrs ago

which is the most effective option for this woman:

emergency copper IUD

levonelle

mifepristone

mirena

illipristil acetate

Answer 22

emergency copper IUD - most effective

• mirena and mifepristone aren’t emergency contraceptive
• levonelle (72hrs) and illipristil (5days) are both hormonal and can only be used within certain timeframes

Question 23

35y/o primigravid pt at 36wks gestation

BP 160/98 at routine antenatal check

which additional finding is diagnostic of pre-eclampsia

Answer 23

proteinuria

Question 24

woman presents with vaginal bleeding and lower crampy abdo pain at 9wks gestation

speculum exam - blood and small clots coming through the open cervical os

which is the most likely diagnosis:

complete miscarriage

ectopic

inevitable miscarriage

pelvic infection

threatened miscarriage

Answer 24

inevitable miscarriage - open cervical os

• complete miscarriage needs scan to confirm
• open cervical os (uterine pregnancy rather than uterine)
• threatened miscarriage - bleeding but closed os

Question 25

28y/o F has irregular periods and diagnosis of PCOS partner's semen analysis is normal she is commenced on ovulation stimulation which drug would be the best option: clomiphene danazol decapeptyl SR dianette FSH

Answer 25

clomiphene - used for ovulation stimuation some women w/ PCOS have oligomenorrhoea and don't ovulate as well * decapeptyl SR - used to switch off ovaries * dianette - OCP * FSH can be used but not usually for PCOS