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Tog 12685
Tog 12685
12685 2020;22:242–4
The Obstetrician & Gynaecologist
CPD
http://onlinetog.org
CPD credits can be claimed for the following questions 8. anosmia/hyposmia is a feature of
online via the TOG CPD submission system in the RCOG Kallmann syndrome. ThFh
CPD ePortfolio. You must be a registered CPD participant of 9. serum anti-m€ ullerian hormone level is a
the RCOG CPD programme (available in the UK and reliable predictor of ovarian reserve. ThFh
worldwide) in order to submit your answers. 10. the main drawback of gonadotrophin-
Participants can claim 2 credits per set of questions if at releasing hormone (GnRH) replacement
least 70% of questions have been answered correctly. CPD treatment by comparison with
participants are advised to consider whether the articles are gonadotrophins for ovulation induction is
still relevant for their CPD, in particular if there are more multiple pregnancies. ThFh
recent articles on the same topic available and if clinical
guidelines have been updated since publication. With regard to hypopituitarism,
Please direct all questions or problems to the CPD Office. 11. most cases are transient and self-limiting. ThFh
Tel: +44(0) 20 7772 6307 or email: [email protected]. 12. it is probably associated with increased risk of
The blue symbol denotes which source the questions refer early pregnancy loss following conception
to including the RCOG journals, TOG and BJOG, and RCOG with ovulation induction. ThFh
guidance, such as Green-top Guidelines (GTGs) and 13. pelvic ultrasound shows multicystic ovaries
Scientific Impact Papers (SIPs). All of the above sources are with a large number of antral follicles and
available to RCOG Members and Fellows via the RCOG minimal intervening stroma in most cases. ThFh
website. RCOG Members, Fellows and Associates have full 14. fertility treatment usually involves
access to TOG content via the TOG app (available for iOS administration of gonadotrophins for
and Android). ovulation induction. ThFh
TOG WHO type 1 anovulation: an update on In relation to the management of WHO type 1 anovulation,
diagnosis, management and implications 15. hormone replacement therapy is associated
for long-term health with maintenance of bone mineral density
levels in the spine in women with
With regard to the World Health Organization (WHO) prolonged amenorrhoea. ThFh
classification of ovulatory disorders, 16. multidisciplinary management involving
1. type 1 is characterised by hypogonadotrophic counselling/behavioural therapies should be
hypo-estrogenic states. ThFh considered in women with HA. ThFh
2. type 2 includes polycystic ovary syndrome and 17. gonadotrophin treatment is significantly
premature ovarian failure. ThFh more successful and has lower chances of
With regard to hypothalamic amenorrhoea (HA), multiple pregnancies by comparison with
3. it is reversible in many cases with lifestyle GnRH therapy. ThFh
modification alone. ThFh 18. cognitive behavioural therapy does not have
4. it is characterised by a high serum level any proven value in the management of
of leptin. ThFh women with HA presenting with subfertility. T h F h
5. clomiphene citrate has been shown to
With regard to the physiological role of the hypothalamo–
successfully induce ovulation in women with
pituitary–ovarian axis in female individuals,
normal gonadotrophins. ThFh
19. pulsatile secretion of GnRH from the
6. leptin therapy is not associated with any
hypothalamus varies in frequency throughout
significant adverse effects. ThFh
the menstrual cycle. ThFh
With regard to hypogonadotrophic hypogonadism, 20. theca cells of the ovary lack the aromatase
7. most cases of Kallmann syndrome are enzyme required to convert androgens
associated with midline craniofacial defects. ThFh to estrogens. ThFh
19. only 3–15% of mucosal melanomas carry a Features in ‘Hutchinson’s Triad’ include,
V600E mutation in the BRAF gene. ThFh 16. saber shins. ThFh
20. the toxicities associated with the BRAF 17. notched incisors. ThFh
inhibitor vemurafenib include 18. interstitial keratitis. ThFh
photosensitivity, nausea and diarrhoea. ThFh 19. eighth cranial nerve deafness. ThFh
20. saddle nose. ThFh
TOGSyphilis in pregnancy: identifying and
managing a historic problem on the rise TOG Ocular manifestations of pregnancy
and labour: from the innocuous to the
Syphilis is,
sight threatening
1. seen equally in male and female individuals. ThFh
2. the most common congenital Physiological changes in the eye in pregnancy include,
infection worldwide. ThFh 1. mild ptosis. ThFh
3. not part of the antenatal 2. increased intraocular pressure. ThFh
screening programme. ThFh 3. increased corneal thickness. ThFh
Risk factors for acquiring syphilis in pregnancy include, Referral to ophthalmology is indicated for,
4. three or more sexual partners in the last 4. subconjunctival haemorrhage. ThFh
12 months. ThFh 5. dry eyes. ThFh
5. a history of chlamydia. ThFh 6. central serous chorioretinopathy. ThFh
With regard to syphilis infection and pregnancy, 7. unilateral visual loss. ThFh
6. there is a 50% risk of transmission to the fetus 8. painful red eye with photophobia. ThFh
in primary disease. ThFh 9. bilateral blurred vision with headache. ThFh
7. transmission to the fetus is more likely if the
disease is in the latent stage. ThFh Pregnancy is a risk factor for,
8. 30–40% of infected fetuses will die in utero. ThFh 10. retinal detachment. ThFh
9. signs of congenital disease are seen at birth in 11. pituitary apoplexy. ThFh
approximately one-third of babies who
Eye drops deemed safe for dilatation of the pupils in
survive the pregnancy. ThFh
pregnancy include,
With regard to serological tests for syphilis, 12. tropicamide 1%. ThFh
10. the venereal disease research laboratory 13. phenylephrine 2.5%. ThFh
carbon antigen (VDRL) test does not illustrate 14. cyclopentolate 1%. ThFh
disease activity, only its presence. ThFh
11. inflammatory conditions such as systemic Regarding diabetic retinopathy in pregnancy,
lupus erythematosus are known to cause 15. if digital screening is normal after the first
false positives. ThFh antenatal appointment, repeat screening
12. when there are significant risk factors for the should be performed at 28 weeks. ThFh
infection, repeat tests should be sent at 6 and 16. if absent at the onset of pregnancy, the risk
12 weeks after the last sexual contact if the of severe retinopathy is high. ThFh
initial screening is negative. ThFh
Regarding central serous chorioretinopathy in pregnancy,
When using benzathine pencillin to treat syphilis in pregnancy, 17. binocular diplopia is a commonly
13. two doses are required to treat primary reported symptom. ThFh
disease after the first trimester. ThFh
14. the Jarisch–Herxheimer reaction is said to Causes of optic nerve head swelling in pregnancy include,
occur in up to 45% of cases. ThFh 18. idiopathic intracranial hypertension. ThFh
15. three doses are required when the patient has 19. migraine. ThFh
late-stage disease, regardless of trimester. ThFh 20. severe pre-eclampsia. ThFh