MRCOG

Question Answer
What is the % change of plasma volume during pregnancy, and when does it reach maximum? 50%, Max at 32 weeks
Total blood volume increase during pregnancy (%) 40%
Red blood cell volume increase during pregnancy (% and figures in ml) 30% Red cell mass increases from 1400ml to 1700-800ml
Cardiac output increase in pregnancy (% and L/min) and when does it plateau? 40% from 4.5L/min to around 6L/min, plateau at 24-30 weeks
Stroke volume increase at term (%) 30%
Heart rate increase at term (% + bpm) 25%, 15bpm
Oxygen consumption increase in pregnancy in ml/min +30-50mL/min
Which increase is greater in pregnancy, ventilation or oxygen consumption? What is significance? Increase in ventilation is greater therefore the arterio-venous gradient is reduced
ECG changes in pregnancy (5) 1. HR increased 2. Left axis deviation by 15degrees, 3. Inverted T wave in lead III 4. Q wave in lead III and AVF, 5. non-specific ST changes
ECG changes in pregnancy are secondary to… (4) 1. Left ventricular hypertrophy and dilatation 2. No change in contractility 3. Upward displacement of the diaphragm 4. apex is shifted anterior and left
What happens to ventilation in pregnancy? (%) Increases by 40%
Is progesterone a bronchodilator or bronchoconstrictor? Bronchodilator
Does airway resistance increase or decrease in pregnancy? Decrease
Does respiratory rate change during pregnancy? No
Is there any change in vital capacity during pregnancy? No
Is there any change to residual volume during pregnancy? Yes, decrease by 200ml
What happens to expiratory reserve volume during pregnancy? Decreases
Is there ay change to FEV1 or peak flow during pregnancy? No
What happens to tidal volume in pregnancy? Increases
How much iron do pregnant women need? And how much extra is it? 6.6mg/day at term (this is 700-1400mg total extra)
Which coagulation factors DON'T rise in pregnancy? XI, XIII
Most significant prolactin inhibitory factor? Dopamine
What keeps the ductus arteriosus patent during pregnancy? PEG2
How does USS work? Is it ionising? Non ionising, apply charges across piezoelective crystals
5 facts about rubella 1. Togavirus, 2. Single stranded RNA 3. Incubation 12-23 days 4. Vaccination is live attenuation 5. Congenital rubella poor prognosis
Which area of hypothalamus produces TRH SRH and oxytocin Paraventricular nucleus
3 facts about leydig cells 1. produces testosterone 2. testicular cells 3. Have LH receptors
Formula for positive likelyhood ratio sensitivity/(1-specificity)
Formula for sensitivity TP/(TP+FN)
Formula for specificity TN/(TN+FP)
Which hormones are required for alveolar morphogenesis? Progesterone, prolactin and hPL
Which strains of HPV are covered by gardasil? 6, 11, 16, 18
What is the prevalence of HIV in the UK obstetric population? 2/1000 live births
Abdominal CT radiation dose is equivalent to… 400 x-rays or 2.7 years background radiation
What initiates the extrinsic pathway? Tissue damage/tissue factor
What are spearman and pearson and how are they different? correlation coefficients, pearson is parametric and spearman is non-parametric
Incidence of placenta accreta all inclusive 1.7/10000
Typical oxygen consumption in non pregnant 75kg woman 250ml/min
Group 1 ovulation disorders Hypothalamic failure ie stress, underweight etc
Incidence of molar pregnancy in UK 1 in 1000
Vasopressin is also known as? and is released from? Anti-diuretic hormone, posterior pituitary
4 phases of wound healing 1. haemostasis 2. inflammatory 3. proliferation 4. remodelling
Lifespan of RBCs 120 days
Main site of reabsorption of all ions? Proximal collecting tubule
Lifespan of platelets? 5-9 days
What is a type 1 error? Incorrectly rejecting the null hypothesis, aka false positive
Hindgut is innervated by? (nerve roots) T12/L1
Prolactin is similar to… hPL + GH
Type 2 error Incorrectly accepting null hypothesis
Addisons – what is it and how do you test for it? Chronic Primary adrenal insufficiency. Test: 9am cortisol and synacthen test
3 points on Sertoli cells 1. FSH receptors, 2. secrete inhibin, 3. Forms blood-testis barrier.
Average lifespan of a basophil? 3-4 days
4 Facts about THeca cells 1. ovarian cells, 2. Produce androgens 3. produce progesterone 4. LH receptors
4. facts about granulosa cells 1. ovarian cells, 2. FSH receptors 3. Convert androgens to aromatase (then into estradiol) 4. Produce progesterone
Plasma accounts for what % of body weight? 4%
Diagnose gestational diabetes if a woman has either… Fasting blood sugar >5.6 or 2 hour glucose >7.
Oxytocin 1. initiates letdown of milk 2. induces contraction of uterine muscle via activation of phospholipase c 3. can stimulate uterine prostaglandin synthesis
Embryonic haemoglobin 1. primary form of haemoglobin until 10-12 weeks 2. produced from the yolk sac 3. tetramer 4. primary form is Gower 1
How much radiation is a chest x-ray equivalent to? 2.5 days background radiation
Edwards syndrome 1. Trisomy 18, 2. 1 in 5000, 3. all serum markers are reduced 4. 90% detected on anomaly scan 5. lifespan 5-15 days
Endometrial carninoma, FIGO stage 1 def + 5yr survival Confined to uterus, 1a <1/2 myometrial invasion, 1b >1/2 myometrial invasion. 85-90% 5yr survival
Endometrial cancer FIGO stage 2 def + 5yr survival Cervical stromal invasion but not beyond uterus, 65% 5yr survival
Endometrial cancer FIGO stage 3, def + 5yr survival Beyond uterus: 3a serosa or adnexa, 3b vaginal and/or parametrial, 3c1 pelvic nodal involvement, 3c2 para-aortic nodal involvement. 5yr survival 45-60%
Endometrial carcinoma FIGO stage 4, def + 5yr survival Distant metastasis: 4a tumour invasion bladder/bowel mucosa 4b distant mets inc abdominal mets/inguinal lymph nodes. 5yr survival 15%
lifetime risk of breast cancer in general population 12%
4 facts on internal anal sphincter 1. involuntary 2. sympathetic contraction 3. parasympathetic relaxation 4. pelvic splanchnic nerve (S4)
Contents of superficial perineal pouch (6) 1. bulbospongiosus muscle 2. ischiocavernosus muscle 3. superficial transverse perineal muscle 4. crura of clitoris 5. vestibular bulbs 6. greater vestibular glands
Contents of deep perineal pouch (5) 1. Deep transverse perineal muscle 2.external sphinchter muscle of urethra 3. compressor urethrae muscle 4. urethrae vaginal sphincter 5. proximal portion of urethra
Calcitonin 1. released by parafollicular cells in response to hypercalceamia, 2. reduced osteoclast activity 3.increased osteoblast activity 4. inhibits calcium absorption in intestines 5. inhibits renal tubule reabsorption of calcium
max dose of lidocaine 3mg/kg
define oligohydramnios AFI <5cm or deepest pool <2cm
define polyhydramnios AFI >25cm, deepest pool >8cm
Tranexamic acid plasminogen-activator inhibitor. It inhibits the dissolution of thrombosis (and fibrin) that leads to menstrual flow. It can reduce flow by up to 50%
3 facts on VTE in pregnancy 1) 10-20% of VTEs are PE's. The majority are DVT2) Inherited Thrombophilia is present in approximately 40% of women with pregnancy associated VTE3) Obesity (BMI >30) increases DVT risk by 4 to 5 times
WHO classification of bone denisties Normal: T-score greater than or equal to -1Osteopenia: T-score less than -1 but greater than -2.5Osteoporosis: T-score less than or equal to -2.5Severe osteoporosis: T-score less than or equal to -2.5 + fragility fracture
Components, arterial supply and innervation of Levator Ani Innervation: Pudendal, Perineal and Inferior Rectal nerves S3 and S4 spinal nervesArterial Supply: Inferior gluteal artery3 Muscle Componenets: puborectalis, pubococcygeus muscle (puborectalis is part of) and iliococcygeal muscle.
Cytomegalovirus 5 points 1. >50% women sero +ve 2. Vertical transmission approx 40% 3.10% of infected infants will be symptomatic 4.Transmission also via breastmilk 5. Incubation period 3-12 weeks
4 increased risks associated with VBAC 1. 2-3/10,000 additional risk of birth-related perinatal death 2. 8/10,000 infant hypoxic ischaemic encephalopathy 3.22-74/10,000 Risk of uterine rupture (previous lower segment c-section) 4. 1% additional risk of either blood transfusion or endometritis
UK incidence of OASIS Primiparous 6.1%Multiparous 1.7%Overall 2.9%

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