Staph aureus is the most common causative organism of skin and soft tissue infections.

If a mother has been abusing drugs during antenatal period, there are some contraindications to discharge her baby home. These conditions includes:
– excessive weight loss, which is greater than ten percent of birth weigh
– suspected baby neglect or abuse
– suspected domestic violence
– a court order preventing baby from being discharged home or if there is requirement for further assessment of withdrawal symptoms.

A 2-3 percentages weight loss during the early neonatal period is considered to be a normal finding and is therefore not considered as a contraindication to discharge the baby home.

A cervical screening test was performed on this patient, and the result revealed the presence of the Human Papilloma Virus Type non-16/18. Reflex liquid base cytology was conducted, but no further abnormalities were seen. In this case, the patient should be offered a 12-month repeat cervical screening cytology. If the patient’s repeated cervical screening cytology after 12 months revealed LSIL, she should be referred for a colposcopy.
If HPV is discovered at 12 months, regardless of the LBC result, some women may be at higher risk of having high-grade abnormalities and should be referred to colposcopy. These include:
– women 2 or more years overdue for screening at the time of the initial screen
– women who identify as being of Aboriginal or Torres Strait Islander
– women aged 50 years or older.

Summary of recommended actions based on the level of risk
Intermediate danger:
– HPV non-16/18 positive, intermediate risk (with negative or low-grade cytology)
If feasible, repeat the HPV test after 12 months.
A three-to-six-month delay would be acceptable. Delays of longer than six months are discouraged.
Follow up HPV test – HPV non 16/18 (possible high grade cytology or high-grade squamous lesion (HSIL) – Treated as Higher risk.

High-risk:
HPV non-16/18 positive on follow-up HPV test (with negative or low-grade cytology)
Refer to an expert right away for further investigation.

If your patient is: 2 years or more past due for screening at the time of the initial screening, and identifies as Aboriginal or Torres Strait Islander aged 50 or older, they may be at higher risk and should be referred to a professional at once for additional evaluation.

HPV 16/18 positive with any of the following non–16/18 positive: a glandular anomaly in high-grade cytology high-grade squamous lesion (HSIL) cancer. Refer to an expert right away for further investigation.

Currently, several colposcopy facilities are experiencing strong demand and extended wait times. If you are concerned that your patient will be delayed, you should call the specialist or clinic to which your patient has been referred.
On the Cure Test Pathway, wherever possible, continue testing as planned. A woman who has been treated for HSIL (CIN2/3) should have a 12-month follow-up co-test and annual tests after that. She can resume standard 5-yearly screening after receiving two consecutive negative co-tests.

Congenital Herpes Simplex Virus infection may cause high levels of morbidity and mortality in neonates. Risk of infection with HSV 1 and 2 is highest within 6 weeks of delivery and is transferred to the neonate via maternal secretions at birth. Affected babies can present as skin manifestations, CNS infection, or disseminated infection, which carries an 85% risk of mortality if left untreated. Treatment with high dose antivirals such as acyclovir can help decrease the case mortality rate to 30% in cases of disseminated infection.

The ischial spines and palpable through the vagina and are used as landmarks to assess the decent of the fetal head from the cervix. It also serves as a landmark for giving the pudendal block.

The posterior scrotal artery is a terminal branch of the perineal artery which is a branch of the internal pudendal artery.

Normal menstrual blood loss is about 40-45 ml. More than 80 ml per period is defined as heavy menstrual bleeding.

Klinefelter syndrome is associated with testicular atrophy, eunuchoid body shape, tall, long extremities, female hair distribution and gynaecomastia. It is a common cause of hypogonadism seen during fertility workup.

If the patient has a negative Chlamydia screen then a stat dose of metronidazole monotherapy is appropriate. You do not know this patients Chlamydia status and therefore dual therapy with metronidazole + doxycycline or azithromycin is appropriate.

The principal screening test for detecting maternal HBV infection is the serologic identification of HBsAg. Screening should be performed in each pregnancy, regardless of previous HBV vaccination or previous negative HBsAg test results.

A test for HBsAg should be ordered at the first prenatal visit. Women with unknown HBsAg status or with new or continuing risk factors for HBV infection (e.g., injection drug use or a sexually transmitted infection) should be screened at the time of admission to a hospital or other delivery setting.

Interventions to prevent perinatal transmission of HBV infection include screening all pregnant women for HBV, vaccinating infants born to HBV-negative mothers within 24 hours of birth, and completing the HBV vaccination series in infants by age 18 months.

The clinical diagnosis of polycystic ovaries (PCO) is confirmed by the ultrasound. Therefore, the best next step to treat this woman’s infertility is to start treatment with metformin (correct answer). Patients with polycystic ovaries, frequently develop insulin resistance and metformin has been shown to be beneficial in this situation. Metformin treatment corrects any metabolic abnormalities and decreases insulin resistance resulting in a return of normal ovulatory menstrual cycles and a rapid improvement in fertility.

Additional treatment with clomiphene citrate may be required in some patients but gonadotrophin therapy is no longer commonly used.

Clomiphene citrate could also have been recommended as a possible next treatment option since the available data indicate that both clomiphene and metformin are equally effective.

Laparoscopic ovarian drilling has been used previously to treat polycystic ovaries; however, it is only used nowadays when all other treatment methods have been ineffective.

Similarly, gonadotrophin therapy or in vitro fertilisation would not be the best next step to treat the infertility and they are used when other treatment options have not provided the required results.

Even though changes in the semen analysis have been noted since the first pregnancy was achieved, these are not likely to be the cause of the secondary infertility, particularly because the current semen analysis is not significantly abnormal. Therefore, it is unlikely that donor insemination would be needed.

Pregnant women with high-grade squamous intraepithelial lesions (HSIL) on cervical cytology should be evaluated with colposcopy. Principles of management of pregnant women include the following:
– An immediate diagnostic excisional procedure should NOT be performed.
– When colposcopy is performed during pregnancy:
– Endocervical sampling with a curette and endometrial sampling should NOT be performed, as there is a risk of disturbing the pregnancy; however, the endocervical canal may be sampled gently with a cytobrush.
– Cervical biopsy should be performed only if a lesion is present that appears to be high grade or suspicious for cancer.
– If the examination is unsatisfactory, repeating the colposcopy after 6 to 12 weeks should allow visualization of the entire squamocolumnar junction.

There is no indication for inducing abortion or performing a hysterectomy.

The Rotterdam criteria for the diagnosis of PCOS is based on a score of two out of the three criteria:
1) Oligo or anovulation
2) Hyperandrogenism – clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone)
3) on ultrasound – contain 12 or more follicles measuring 2 to 9 mm in diameter and/or have an increased volume of 10 cm3 or greater.

Women with a bicornuate uterus are at increased risk of recurrent abortions, premature birth, fetal malpositioning, placenta previa and retained products of placenta leading to post partum haemorrhage.

Urodynamics is a broad term that comprises cytometry, urethral pressure measurement, leak point pressure, pressure flow studies, EMG and videourodynamics. They assess the function of the bladder and urethra as a functional unit. This may provide information such as the site of bladder outlet obstruction, overactivity of the detrusor and sphincter weakness. In muscular terms the detrusor and sphincter muscles are being assessed.

Mifepristone is a prostaglandin antagonist. It acts as a competitive inhibitor of the receptor.

Shoulder dystocia occurs when the bisacromial diameter, which is the breadth of the shoulders, exceed the diameter of pelvic inlet. This typically results in a bony impaction of the anterior shoulder against the maternal symphysis pubis, instead of an arrest at the pelvic inlet. Brachial plexus palsies including Erb’s palsy is the most common foetal injury associated with shoulder dystocia.

It is not hyper-extension but the hyper-flexion of maternal legs tightly on her abdomen, called as McRoberts manoeuvre, which facilitates delivery during shoulder dystocia. This technique is effective as it increases the mobility of sacroiliac joint during pregnancy, which allows the rotation of pelvis and thereby facilitating the release of fetal shoulder.
If this manoeuvre does not succeed, another technique called suprapubic pressure is done where an assistant applies pressure on the lower abdomen and gently pulls the delivered head. This technique is useful in about 42% of cases with shoulder dystocia.

Maternal diabetes mellitus and foetal macrosomia both are a risk factor for shoulder dystocia.

Administration of epidural anaesthesia during labour increases the possibility of shoulder dystocia.

Risk of shoulder dystocia may increase with Oxytocin augmentation also.

Turner syndrome patients present with primary amenorrhea. These ladies have non functional or streak ovaries and they cant conceive. Their genetic traits is 45X. They have a shielded chest, webbed neck and low height. These patients suffer from primary amenorrhea.

Vaginal atrophy (thinning of vaginal tissue): Oestrogen helps to keep this tissue healthy. After menopause, low oestrogen levels can cause your vaginal walls to become thin, dry, and inflamed. That often leads to bleeding after sex.

Vaginal atrophy is the most common cause of post menopausal vaginal bleeding.

With a normal pap smear a year ago, this patient is unlikely to develop cervical cancer.

Cervical ectropions are not common in post-menopausal women.

Endometrial cancer and cervical polyps are possible causes of postcoital bleeding, however, they are not as common as vaginal atrophy.

The blastocyst hatchs from the Zona Pellucida

Pelvic Outlet Boundaries Anteriorly: Pubic arch Laterally: Ischial tuberosities Posterolaterally: Inferior margin of the sacrotuberous ligament Posteriorly: Tip of the coccyx Note: The pelvis outlet is also called the inferior aperture. The pelvic brim is the superior aperture

Oxytocin binds to the G protein coupled receptors that triggers the IP3 mechanism leading to an elevated intracellular calcium ion.

Mammary duct ectasia occurs when the lactiferous duct becomes blocked or clogged. This is the most common cause of greenish discharge. Mammary duct ectasia can mimic breast cancer. It is a disorder of peri- or post-menopausal age.

Between 18-20 weeks of gestation is the best time to perform an ultrasound for the identification of any physical or anatomical abnormalities including neural tube defects.

Maternal serum screening for Down syndrome is best performed between 15-17 weeks of pregnancy and this screening includes analysis of alpha fetoprotein, estriol, and beta-HCG in maternal blood. Conducting tests on accurate dates is necessary to obtain reliable results.

Amniocentesis which is very accurate for the diagnosis of chromosomal anomalies including Down syndrome, is best performed between 16-18 weeks of gestation and it carries a risk of 1 in 200 for miscarriage. Rh negative women will need Rh D immunoglobulin (anti-D).

Chorionic villus sampling is best performed between 10-12 weeks of gestation and carries a 1 in 100 risk of miscarriage, this test is also very much accurate for diagnosis of chromosomal anomalies. Rh negative women need Rh D immunoglobulin (anti-D).

It is best to perform rubella screen before conception than during pregnancy, this is because rubella vaccine is not recommended to be given to a pregnant mother as its a live vaccine.

Bicornuate uterus is associated with an increased chance of urinary tract anomalies. Urinary tract anomalies were present in about 23.6% of cases of bicornuate uterus patients.

DNA replication occurs during S phase but that isn’t one of the options. Remember Interphase comprises G1,S and G2 phases!

The tests listed can all be performed during the work-up of a woman with secondary amenorrhoea. They are useful in that they cam diagnosis the most likely cause for the amenorrhoea as well as guide the treatment required if the patient wanted to become pregnant. Of these, the hormone test best able to predict a poor response to ovulation-induction therapy is the follicle-stimulating hormone (FSH) assay. If there are high levels of FSH, most of the ovulation-induction therapies are ineffective, although the rare spontaneous pregnancy can occur.

To maximise the chance of pregnancy in patients with elevated FSH levels, the most effective technique is an ovum donation from a young woman. The ovum would be fertilised in the laboratory and transferred to the uterus of the woman with the high FSH level after administering hormonal preparation of her uterus.

If the FSH level is normal, ovulation-induction therapy is usually effective. For these patients, correction of thyroid function will be necessary if the thyroid function is not normal. Dopamine agonist therapy is indicated if the prolactin level is elevated. Clomiphene or gonadotrophin therapy can be used where the luteinising and oestradiol levels are low, normal, or minimally elevated.

There is marked elevation of FSH and LH in ovarian dysgenesis, produced by the pituitary.

Fetal production of immunoglobulin begins early on, at about 10 weeks gestation with the production of IgM antibodies. Maternal IgG, which is a key component of fetal immunity, is passed on to the foetus through the placenta from 12 weeks of gestation. Secretory IgA is not produced until after birth.

Routine ultrasonography at around 18-22 weeks gestation has become the standard of care in many communities. Acceptance is based on many factors, including patient preference, medical-legal pressure, and the perceived benefit by physicians. However, rigorous testing has found little scientific benefit for, or harm from, routine screening ultrasonography.