CPD questions for volume 20 number 4

DOI: 10.1111/tog.12528 The Obstetrician & Gynaecologist

2018;20:269?72

CPD questions for volume 20 number 4

CPD

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TOG Phenylketonuria in pregnancy

Regarding phenylketonuria (PKU),

1. it is a deficiency of the amino acid phenylalanine (Phe).

2. it is an X-linked recessive inherited metabolic disease.

3. it results in a deficiency in the amino acid tyrosine.

4. it is treated with a lowphenylalanine restricted diet.

5. the incidence is approximately 1:1000. 6. the Newborn Screening Programme has been a

great success in the diagnosis and management of children with PKU. 7. neonates with fetal alcohol syndrome and PKU are clinically difficult to distinguish at birth.

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8. in utero exposure to very high levels of phenylalanine results in reversible neurological damage to the fetus.

9. pregnancy outcome is improved substantially when treatment results in low maternal phenylalanine concentrations ideally before conception.

10. oral methods of contraception should be switched to barrier methods at least 12 months before conception.

11. the risk of congenital heart defects is estimated to be 7?10%.

12. it is an indication for early delivery by caesarean section.

13. neonates born to mothers with PKU should be offered screening for PKU as per the routine national screening programme.

14. breastfeeding is contraindicated in women with PKU.

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With regard to the biochemistry of PKU,

15. Phe is passively transported across the placenta.

16. fetal Phe levels are approximately 1.25?2.5 times greater than maternal levels.

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Children born to women with PKU,

17. tend to have blue eyes. 18. are fair skinned.

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With regard to the effect of high Phe levels on loss of IQ or behavioural changes,

19. these changes are reversible in utero. 20. they are reversible with resumption of diet

deficient of Phe.

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TOG Gynaecological disease in the developing world: a silent pandemic

With regard to women's health in low-resource countries (LRCs),

1. within the field of obstetrics and gynaecology, complications due to pregnancy and childbirth are the pre-eminent cause of death. T h F h

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2. reducing the burden of gynaecological disease is a specific target detailed in the Sustainable Development Goals.

3. high-quality epidemiological data which accurately detail the burden of disease due to gynaecological conditions are now available in most of these countries.

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With regard to gynaecological malignancies,

4. globally, around 500 000 women die annually from gynaecological cancers.

5. in sub-Saharan Africa, the number of deaths due to cervical cancer is reducing each year.

6. over a 10-year period, a comprehensive international vaccination programme with the bivalent human papillomavirus (HPV) vaccine could avert the deaths of up to 10 million women.

7. by 2014, worldwide, 50% of eligible women and girls from LRCs had received the bivalent HPV vaccine.

8. cytology-based screening is the most costeffective strategy for secondary prevention of cervical cancer in low-resource settings.

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Regarding abnormal uterine bleeding (AUB) in LRCs,

9. the most common presentation is heavy menstrual bleeding (HMB).

10. dysmenorrhoea accompanies HMB in up to 20% of women/girls.

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Regarding reproductive tract infection (RTI) and sexually transmitted infection (STI),

11. globally, 1 million new STIs are acquired each day.

12. infection with an STI doubles the risk of acquiring HIV.

13. post-abortion and puerperal infections are often caused by endogenous organisms.

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Regarding abortion worldwide,

14. over 8 million unsafe abortions are performed globally every year.

15. complications of abortion are one of the top five causes for maternal mortality.

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Regarding contraception in LRCs,

16. worldwide, over 220 million women have an unmet need for contraception.

17. in the face of competing demands for healthcare resources, family planning is often not a cost-effective investment.

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Regarding urogynaecological conditions in LRCs,

18. approximately 2 million women worldwide are living with obstetric fistula.

19. lifestyle differences mean that women are often at lower risk of urogynaecological conditions such as prolapse and urinary incontinence in later life.

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With regard to healthcare worker training in LRCs,

20. task shifting involves allocating complicated medical tasks to more highly qualified healthcare providers.

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TOG Metabolic syndrome in women with polycystic ovary syndrome

With regard to the pathogenesis of metabolic syndrome,

1. inertia to insulin has been attributed to a prebinding defect in the insulin signalling pathway.

2. free fatty acids induce hepatic synthesis of very low-density lipoprotein.

3. hyperandrogenaemia increases the predilection for central adiposity.

4. its prevalence in women with polycystic ovary syndrome (PCOS) is as high as 50%.

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With regard to the consequences of metabolic syndrome,

5. it confers a five-fold increase in the risk of type II diabetes mellitus.

6. endometrial cancer is five times more common in women with the syndrome.

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The diagnostic criteria for metabolic syndrome include,

7. a cut-off for waist circumference of 92 cm. 8. elevated triglyceride levels beyond 2 mmol/l. 9. a systolic blood pressure 140 mmHg. 10. a fasting glucose level 5.6 mmol/l.

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With regard to the management of women with metabolic syndrome,

11. those with a body mass index (BMI) 25 kg/m2 should have their blood pressure checked at every visit.

12. those with a normal lipid profile should be tested annually.

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Regarding the management of metabolic syndrome in women with PCOS,

13. lifestyle modification is the only recommended intervention.

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14. a minimum of a 15% loss in body weight is required for the beneficial metabolic effects.

15. high-intensity exercise for at least 150 minutes per week should be encouraged.

16. omega-3 fats improve insulin sensitivity. 17. metformin is recommended for the treatment

of insulin resistance in normoglycaemic women. 18. inositol supplements can be routinely used to

improve the metabolic profile. 19. orlistat reverses the syndrome in up to 40%

of obese women. 20. the routine use of statins for preventing the

development of atherogenic dyslipidaemia is recommended.

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TOG Haemoglobinopathy: considerations for reproductive health

Regarding haemoglobinopathies,

1. thalassaemia major is inherited in an autosomal dominant pattern.

2. sickle cell disease is more common in individuals of Mediterranean descent.

3. sickle cell disease is a result of an imbalance between alpha and beta globin chain production.

4. thalassaemia intermedia is transfusiondependent most of the time.

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With regard to iron overloading in haemoglobinopathies,

5. fetal growth restriction is a potential consequence.

6. serum ferritin is the gold standard for monitoring.

7. chelation therapy is effective. 8. in those with severe iron overload, tissue

cryopreservation may be an option.

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Tests used to measure ovarian reserve in women with a haemoglobinopathy include,

9. inhibin B. 10. follicle-stimulating hormone. 11. antral follicle count. 12. anti-mullerian hormone.

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Haemoglobinopathies with a potential adverse effect on reproductive outcomes include,

13. haemoglobin SC disease. 14. haemoglobin SS disease. 15. beta thalassaemia intermedia. 16. haemoglobin S beta thalassaemia.

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Potential adverse reproductive health effects secondary to iron overload include,

17. anovulation. 18. menorrhagia. 19. early puberty. 20. abnormal semen parameters.

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TOG Laparoscopic myomectomy: a review of alternatives, techniques and controversies

Uterine fibroids,

1. are the most common uterine tumours. 2. cause symptoms in approximately

25% of women. 3. are a recognised cause of venous thrombosis.

Laparoscopic myomectomy (LM),

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4. becomes more appropriate the closer a woman is to menopause.

5. is performed on approximately 300 women per year in the UK, compared to approximately 1300 women who undergo open myomectomy.

6. carries an approximate overall complication rate of 11%.

7. has an estimated risk of uterine dehiscence/ rupture in future pregnancies of approximately 0.5%.

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With regard to leiomyosarcoma,

8. pelvic irradiation is a risk factor. 9. it is estimated to occur in ................
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