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Options for questions 1-2
A) Cerazette (desogestrel) progestogen-only pill
B) Noriday (norethisterone) progestogen-only pill
Norgeston (Levonorgestrel) Progestogen-only pill
C) Combined oral contraceptive pill
D) Depo-medroxyprogesterone acetate
E) Depo- Norethisterone oenanthate
F) Copper IUCD
G) Etonorgestrel implant
H) Levonorgestrel IUS
I) All options may be used
J) No option is suitable
For each scenario described below, choose the contraceptive option that may safely be used (UKMEC category 1 or 2) from the above list of options. Each option may be used once, more than once, or not at all.
1) A 33 year old woman has been referred for contraceptive advice. She has been diagnosed with SLE and has positive anti-phospholipid antibodies. Her BMI is 23 kg/m2 and she has never smoked. Her LMP was 1 week earlier with a regular 28 day cycle. FBC and renal function tests are normal.
2) A 28 year old woman has been referred for contraceptive advice. She has been diagnosed with SLE and has positive anti-phospholipid antibodies. Her BMI is 23 kg/m2 and she has never smoked. Her LMP was 1 week earlier with a regular 28 day cycle. She has severe thrombocytopaenia but renal function tests are normal.
Options for question 3-4
A) External beam radiotherapy
B) Chemotherapy
C) Combined chemo-radiotherapy
D) No additional treatment
E) Laparoscopic pelvic lymphadenectomy
F) Laparotomy + pelvic lymphadenectomy
G) Laparoscopy + bilateral salpingo-oophrectomy
H) Bilateral salpingo-oophrectomy + omentectomy
I) Intracavitary radiotherapy
J) Intracavitary + external beam radiotherapy
K) HPV vaccination
For each scenario described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.
3) A healthy 67 year old woman has a vaginal hysterectomy because of prolapse symptoms. Histological examination of the specimen identifies a 3 x 7mm area of squamous cell carcinoma in-situ.
4) A 38 year old woman with dysfunctional uterine bleeding has a laparoscopic total hysterectomy with conservation of the ovaries. Histological examination identifies a squamous cell carcinoma of the cervix measuring 2.5 x 4mm with a depth of invasion of 1.5mm.
Options for question 5
A) Inter-pregnancy interval of 5 years
B) BMI of 37 kg/m2
C) BMI of 45 kg/m2
D) 3 previous first trimester miscarriages
E) History of thyroid disease
F) Pre-eclampsia in her mother and sister
G) Di-chorionic di-amniotic twin pregnancy
H) Known carrier of Factor V Leiden mutation
I) History of recurrent miscarriage and carrier of Factor V Leiden mutation
J) Placental abruption in a previous pregnancy
K) Unexplained intra-uterine death in a previous pregnancy
L) Maternal age 29 years with chronic hypertension well controlled with beta-blockers
For each scenario described below, choose the single most appropriate option from the above list of options. Each option may be used once, more than once, or not at all.
5) A woman has been referred to the antenatal clinic at 10 weeks gestation. Low dose aspirin (75 mg once daily) should be recommended in the following circumstances
Options for question 6-7
A) Maintain BP below 140/90 mmHg
B) Maintain systolic BP below 160 mmHg
C) Maintain diastolic BP below 80 mmHg
D) BP less than 150/100 mmHg
E) BP less than 150/100 mmHg with diastolic BP not below 80 mmHg
F) Maintain mean arterial pressure below 125 mmHg
G) Maintain mean arterial pressure below 110 mmHg
H) Maintain BP below 120/80 mmHg
I) Maintain BP below 160/110 mmHg
J) Maintain diastolic BP between 80-90 mmHg
K) Maintain systolic BP between 140-160 mmHg
For each scenario described below, choose the single most appropriate target range for blood pressure control from the above list of options. Each option may be used once, more than once, or not at all.
6) A 40 year old woman attends the antenatal clinic at 20 weeks gestation. She has a history of chronic hypertension and ACE-inhibitors were changed to labetalol prior to pregnancy. Her renal function is normal and her BP is 162/102 mmHg with no proteinuria.
7) A 32 year old woman attends the antenatal clinic at 20 weeks gestation. She has a history of chronic hypertension secondary to reflux nephropathy and is known to have mild renal impairment. Her BP is 160/100 mmHg with no proteinuria.
Options for questions 8
A) The baby cannot be registered with indeterminate sex
B) The funeral may take place before registration of stillbirth
C) Registration of stillbirth is not necessary
D) The midwife should examine the baby and decide the sex
E) The obstetrician should examine the baby and decide the sex
F) The perinatal pathologist should examine the baby and decide the sex
G) The sex should be determined using QF-PCR
H) The sex should be determined using FISH
I) The sex can be registered as indeterminate and later changed
J) The sex of the baby is not required for registration
K) The sex should be determined at post-mortem
For each scenario described below, choose the single most appropriate option from the above list of options. Each option may be used once, more than once, or not at all.
8) A 36 year old woman presents with intra-uterine fetal death at 26 weeks gestation. Following induction of labour, she gives birth at 12:30 and the baby is severely macerated. For cultural reasons, the funeral has to take place by 18:00. The parents therefore wish to know the baby’s sex and have given consent for fetal karyotype but not for a post-mortem.
Options for question 9
A) FBC, renal function tests, group & save
B) FBC, renal function tests, liver function tests, coagulation screen
C) FBC, renal function tests, liver function tests, Kleihauer test
D) FBC, renal function tests, glucose tolerance test, Kleihauer test
E) FBC, renal function tests, CRP, Kleihauer test
F) FBC, renal function tests, coagulation screen, Kleihauer test
G) FBC, renal function tests, thrombophilia screen, glucose tolerance test, Kleihauer test
H) FBC, renal function tests, thrombophilia screen, glucose tolerance test
I) FBC, renal function tests, liver function tests, thrombophilia screen
J) FBC, renal function tests, thrombophilia screen, group & save
K) FBC, renal function tests, maternal and paternal karyotype
For each scenario described below, choose the single most appropriate group of investigations that should be performed prior to delivery from the above list of options. Each option may be used once, more than once, or not at all.
9) A healthy 23 year old woman presents at 35 weeks gestation with a history of reduced fetal movements for 24 hours. Intra-uterine fetal death is diagnosed on ultrasound scan. She is Rhesus negative. Her BP is 120/90 mmHg and there is no proteinuria.
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