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Question 1
Explanation
Repeat treatment
If botulinum toxin A treatment is effective, offer follow-up at 6 months or sooner if symptoms return for
repeat treatment without an MDT referral
Tell women how to self-refer for prompt specialist review if symptoms return.
Botulinum toxin B is not recommended for the treatment of women with idiopathic OAB
Question 2
A 67 year old woman is being treated with mirabegron for urinary incontinence. She has a history
of cardiac disease treated with digoxin.
Explanation
Mirabegron - Drug interactions
Clarithromycin
Avoid or reduce dose of mirabegron in hepatic or renal impairment when given with clarithromycin
Digoxin
Mirabegron increases plasma concentration of digoxin reduce initial dose of digoxin
Itraconazole
Avoid or reduce dose of mirabegron in hepatic or renal impairment when given with itraconazole
Metoprolol
Mirabegron increases plasma concentration of metoprolol
Ritonavir
Avoid or reduce dose of mirabegron in hepatic or renal impairment when given with ritonavir
Question 3
Explanation
HYPEREMESIS GRAVIDARUM
Vomiting severe enough to require hospital admission - associated with dehydration + weight loss of at least 3kg.
Affects 3-10 women /1000 pregnancies
Presents in first trimester and is unusual after 16 weeks gestation.
Peak incidence 8-12 weeks
Aetiology not fully understood but related to HCG and TSH levels +/- psychological factors. There is, however, no
direct relationship between the severity of the disorder and HCG or TSH levels
An association exists with hyperthyroidism, pyridoxine deficiency, and psychological factors
50% recurrence rate
Diagnosis of exclusion - UTI / Gastroenteritis / pancreatitis / peptic ulceration, hepatitis, diabetic ketoacidosis, acute
appendicitis should be considered
Associated with metabolic alkalosis - hypochloraemic alkalosis with hypokalaemia and potassium loss in urine
Urine is acidic despite systemic alkalosis - when alkalosis is associated with volume depletion, bicarbonate is not
excreted
Excretion of bicarbonate only occurs with restoration of extracellular fluid volume
Question 4
Explanation
HYPEREMESIS GRAVIDARUM
Vomiting severe enough to require hospital admission - associated with dehydration + weight loss of at least 3kg.
Affects 3-10 women /1000 pregnancies
Presents in first trimester and is unusual after 16 weeks gestation.
Peak incidence 8-12 weeks
Aetiology not fully understood but related to HCG and TSH levels +/- psychological factors. There is, however, no
direct relationship between the severity of the disorder and HCG or TSH levels
An association exists with hyperthyroidism, pyridoxine deficiency, and psychological factors
50% recurrence rate
Diagnosis of exclusion - UTI / Gastroenteritis / pancreatitis / peptic ulceration, hepatitis, diabetic ketoacidosis, acute
appendicitis should be considered
Associated with metabolic alkalosis - hypochloraemic alkalosis with hypokalaemia and potassium loss in urine
Urine is acidic despite systemic alkalosis - when alkalosis is associated with volume depletion, bicarbonate is not
excreted
Excretion of bicarbonate only occurs with restoration of extracellular fluid volume
Question 5
A 17 year old woman has surgical evacuation of a molar pregnancy at 8 weeks gestation.
Karyotype is reported as 46XX. The risk of her needing chemotherapy is
5-7%
C 15-18%
25-30%
E 40-50%
Explanation
Question 6
Pre-eclampsia
C Placental abruption
E Post-partum haemorrhage
A(Correct answ er: A)
Explanation
Inherited thrombophilias
Include protein C / S and antithrombin III deficiency, activated protein C resistance (most commonly Factor V Leiden
mutation), hyperhomocystinaemia, prothrombin gene and Methylenetetrahydrofolate mutation.
Factor V Leiden mutation is associated with recurrent first-trimester miscarriage, recurrent fetal loss after 22 weeks
and non-recurrent fetal loss after 19 weeks
Activated protein C resistance is associated with recurrent first-trimester miscarriage.
Prothrombin gene mutation is associated with recurrent first-trimester miscarriage, recurrent fetal loss before 25
weeks and late non-recurrent fetal loss.
Protein S deficiency is associated with recurrent fetal loss and non-recurrent fetal loss after 22 weeks.
Methylenetetrahydrofolate mutation and protein C and antithrombin deficiencies are not associated with fetal loss.
Protein C and antithrombin III deficiencies are rare.
Question 7
A 31 year old woman with an ectopic pregnancy has been treated with single dose
methotrexate. The dose of methotrexate should be calculated based on
Explanation
Among women trying to become pregnant, intra-uterine pregnancy rate = 54% and recurrent ectopic rates = 8-10% comparable to those following laparoscopic salpingostomy??
Intra-muscular methotrexate - dose calculated pre m2 body surface area (50mg/square m)??
Question 8
A 23 year old woman with epilepsy has been referred for antenatal care. She enquires about
vitamin K supplementation. She needs vitamin K
Explanation
Maternal vitamin K supplementation from 34-36 weeks in women taking enzyme-inducing AEDs to reduce the risk of
maternal and neonatal bleeding. May be oral or im
Question 9
Explanation
VON WILLEBRAND'S DISEASE ???
Type 1 - quantitative deficiency - autosomal dominant, mild bleeding disorder - improves during pregnancy??
Type 2 - qualitative deficiency - autosomal dominant, mild bleeding disorder - usually improves during
pregnancy??
Type 3 - very low / absent vWF and low VIII - autosomal recessive, severe bleeding disorder - no improvement
during pregnancy??
Pregnancy, exercise, stress, inflammation and recent surgery increase VIII and vWF levels
Question 10
A 33 year old woman has been referred for colposcopy because of high grade dyskaryosis
(moderate).