SEARCH

SEARCH BY CITATION

CPD credits can be claimed for the following questions online via the TOG CPD submission system. You must be a registered CPD participant of the RCOG CPD programme (available in the UK and worldwide) in order to submit your answers. Participants will need to log in to the RCOG website (www.rcog.org.uk) and go to the ‘Our Profession’ tab.

Participants can claim 2 credits per set of questions if at least 70% of questions have been answered correctly. At least 50 credits must be obtained in this way over the 5-year cycle.

Please direct all questions or problems to the CPD Office. Tel: +44(0) 20 7772 6307 or email: cpd@rcog.org.uk

The blue symbol denotes which source the questions refer to including the RCOG journals, TOG and BJOG, and RCOG guidance, such as Green-top Guidelines (GTG) and Scientific Impact Papers (SIPs). All of the above sources are available to RCOG members and fellows via the RCOG website.

image Postpartum psychosis

  1. Top of page
  2. image Postpartum psychosis
  3. image Pelvic congestion syndrome
  4. image Ambulatory hysteroscopy
  5. image Management of vault prolapse
  6. image Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism
  7. image The relationship between infertility treatment and cancer including gynaecological cancers
  8. image Delivery outcomes for nulliparous women at the extremes of maternal age – a cohort study
  9. Supporting Information

Postpartum psychosis complicating childbirth occurs in approximately,

  • 1.
    1–2 in 1000 women in the general population. T □ F □
  • 2.
    1 in 4 women with bipolar disorder. T □ F □

The definition of postpartum psychosis includes,

  • 3.
    the continuation of a chronic schizophrenic illness into the postpartum period. T □ F □
  • 4.
    the onset of a severe obsessive–compulsive illness in the first 2 weeks following delivery. T □ F □
  • 5.
    an episode of major depression with onset in the first postpartum month. T □ F □
  • 6.
    acute onset in the first postpartum week of an episode with marked manic and psychotic features. T □ F □
  • 7.
    acute onset 2 years postpartum of an episode with manic and psychotic features, including delusional thoughts of harming the baby. T □ F □

The postpartum onset specifier in Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) identifies postpartum episodes as those with an onset following delivery within:

  • 8.
    1 month. T □ F □
  • 9.
    6 months. T □ F □
  • 10.
    3 months. T □ F □

In the treatment of postpartum psychosis,

  • 11.
    the woman should not breastfeed. T □ F □
  • 12.
    lithium is the gold standard. T □ F □
  • 13.
    referral to safeguarding teams should be routine. T □ F □
  • 14.
    the whole range of psychotropic medication may need to be employed. T □ F □

In the prevention of puerperal psychosis,

  • 15.
    a woman who has experienced an episode should be advised about both the risk of postpartum and non-postpartum recurrence. T □ F □
  • 16.
    only women with psychiatric symptoms at their antenatal booking visit should be screened for risk factors. T □ F □
  • 17.
    women at high risk, even if they are well, should be referred in pregnancy for psychiatric assessment and management. T □ F □

With regard to postpartum mood disorders in the UK,

  • 18.
    suicide is a leading cause of maternal mortality. T □ F □
  • 19.
    a survival analysis comparing women with bipolar disorders who stopped taking lithium because of pregnancy compared with age-matched non-pregnant control, has shown similar recurrence rates during the first 40 weeks after lithium discontinuation. T □ F □
  • 20.
    women with schizophrenia have a similar risk of admission for this disorder in the postpartum period compared to those with bipolar disorders. T □ F □

image Pelvic congestion syndrome

  1. Top of page
  2. image Postpartum psychosis
  3. image Pelvic congestion syndrome
  4. image Ambulatory hysteroscopy
  5. image Management of vault prolapse
  6. image Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism
  7. image The relationship between infertility treatment and cancer including gynaecological cancers
  8. image Delivery outcomes for nulliparous women at the extremes of maternal age – a cohort study
  9. Supporting Information

The following aetiological factors have been associated with pelvic congestion syndrome:

  • 1.
    ovarian varicoceles. T □ F □
  • 2.
    pregnancy. T □ F □
  • 3.
    estrogen and progesterone. T □ F □
  • 4.
    nutcracker syndrome. T □ F □

Regarding pelvic congestion syndrome (PCS),

  • 5.
    it is a widely accepted clinical condition. T □ F □
  • 6.
    more than 75% of affected individuals are symptomatic. T □ F □

Regarding the clinical presentation of PCS,

  • 7.
    pain is the most common feature. T □ F □
  • 8.
    psychological symptoms such as anxiety and depression are common. T □ F □

Regarding investigations for PCS,

  • 9.
    selective venography is recommended first line. T □ F □
  • 10.
    tortuous pelvic veins greater than 4 mm in diameter are diagnostic of PCS on ultrasound. T □ F □

Regarding the medical management of PCS,

  • 11.
    ovarian suppression can cause venous vasoconstriction. T □ F □
  • 12.
    medroxyprogesterone acetate (MPA) has only been shown to subjectively reduce pelvic pain. T □ F □
  • 13.
    gonadotropin-releasing hormone (GnRH) agonists shave been shown to subjectively and objectively improve pelvic pain. T □ F □
  • 14.
    MPA has been proven to be more effective treatment than GnRH agonist at 12 months. T □ F □
  • 15.
    psychotherapy has been shown to have an additive benefit to the treatment of pelvic pain compared with MPA alone. T □ F □

Regarding the surgical management of PCS,

  • 16.
    there is good evidence to suggest the application of laparoscopic bilateral transperitoneal ligation of ovarian veins. T □ F □
  • 17.
    hysterectomy and bilateral oophorectomy has not been shown to achieve a statistically significant reduction in pelvic pain in women with PCS. T □ F □

Regarding the role of endovascular treatment in PCS,

  • 18.
    transcatheter embolotherapy has been shown to improve overall pain perception by more than 60%. T □ F □
  • 19.
    only the refluxing ovarian vein should be embolised. T □ F □
  • 20.
    there has been no significant hormonal disturbance after embolotherapy. T □ F □

image Ambulatory hysteroscopy

  1. Top of page
  2. image Postpartum psychosis
  3. image Pelvic congestion syndrome
  4. image Ambulatory hysteroscopy
  5. image Management of vault prolapse
  6. image Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism
  7. image The relationship between infertility treatment and cancer including gynaecological cancers
  8. image Delivery outcomes for nulliparous women at the extremes of maternal age – a cohort study
  9. Supporting Information

Pain can be minimised during diagnostic outpatient hysteroscopy by the routine use of,

  • 1.
    a vaginal speculum. T □ F □
  • 2.
    conscious sedation. T □ F □
  • 3.
    non-steroidal anti-inflammatory agents 1-hour pre-procedure. T □ F □

Vaginoscopy,

  • 4.
    refers to a ‘no touch’ technique for hysteroscopy that bypasses the routine requirement for a vaginal speculum or instrumentation of the cervix. T □ F □
  • 5.
    requires a hysteroscope with a 30° offset distal lens. T □ F □
  • 6.
    is useful in women with atrophic lower genital tracts or restricted vaginal access. T □ F □

Outpatient hysteroscopic removal of endometrial polyps,

  • 7.
    requires infiltration into or around the cervix with a local anaesthetic. T □ F □
  • 8.
    has evidence to support feasibility, but not effectiveness. T □ F □
  • 9.
    is limited to some degree by the size, location and number of lesions. T □ F □
  • 10.
    with Versapoint® bipolar diathermy requires continuous flow hysteroscopes >5 mm in outer diameter. T □ F □
  • 11.
    using bipolar electrosurgery needs a non-conducting distension media. T □ F □
  • 12.
    using the new morcellator systems is compatible with standard hysteroscopes. T □ F □

Regarding submucous fibroids,

  • 13.
    most can be removed in an outpatient setting. T □ F □
  • 14.
    formal resection of fibroids usually requires general anaesthesia. T □ F □
  • 15.
    the likelihood of complete excision of a grade 1 submucous fibroid (>50% visible within the uterine cavity) is increased with preliminary capsular incision in the outpatient setting following diagnosis. T □ F □

Hysteroscopic sterilisation with the Essure® system:

  • 16.
    is not feasible in approximately 20% of women. T □ F □
  • 17.
    is completed in less than 15 minutes. T □ F □
  • 18.
    requires routine dilatation of the cervix. T □ F □
  • 19.
    has a higher cumulative pregnancy rate compared with laparoscopic sterilisation. T □ F □
  • 20.
    needs a routine hysterosalpingogram to confirm tubal occlusion. T □ F □

image Management of vault prolapse

  1. Top of page
  2. image Postpartum psychosis
  3. image Pelvic congestion syndrome
  4. image Ambulatory hysteroscopy
  5. image Management of vault prolapse
  6. image Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism
  7. image The relationship between infertility treatment and cancer including gynaecological cancers
  8. image Delivery outcomes for nulliparous women at the extremes of maternal age – a cohort study
  9. Supporting Information

Regarding the role of conservative treatment in vaginal vault prolapse,

  • 1.
    physiotherapy has been shown in trials to be beneficial. T □ F □
  • 2.
    pessary use has a high patient satisfaction rate. T □ F □

Regarding the vaginal route for the surgical treatment of vaginal vault prolapse,

  • 3.
    objective outcomes for sacrospinous fixation are poor. T □ F □
  • 4.
    complications of sacrospinous fixation are comparable to those of sacrocolpopexy. T □ F □
  • 5.
    NICE recommends the use of routine iliococcygeal fixation. T □ F □
  • 6.
    colpocleisis is the procedure of choice in the frail and elderly. T □ F □
  • 7.
    erosion is a recognised complication in cases treated with a mesh. T □ F □

Regarding sacrocolpopexy,

  • 8.
    open abdominal sacrocolpopexy has a lower incidence of recurrent prolapse compared to vaginal sacrospinous fixation. T □ F □
  • 9.
    laparoscopic sacrocolpopexy has a shorter stay and quicker recovery in comparison to the open procedure. T □ F □
  • 10.
    robotic laparoscopic sacrocolpopexy involves more ports. T □ F □
  • 11.
    robotic procedures have poorer visualisation of the surgical field. T □ F □
  • 12.
    capital cost is high for laparoscopic sacrocolpopexy in comparison to the robotic surgery. T □ F □

Risk factors for vault prolapse include:

  • 13.
    body mass index. T □ F □

With regard to the use of pessaries in the treatment of vault prolapse,

  • 14.
    the outcome (in terms of success) is similar to that of surgery at 1 year. T □ F □
  • 15.
    difficulties in fitting them are encountered in less than 10% of patients at presentation. T □ F □
  • 16.
    spontaneous expulsion is one of the commonly reported side effects. T □ F □

With regard to colpocleisis,

  • 17.
    when undertaken, the reported success rate is approximately 75%. T □ F □

Regarding the vaginal routine for the surgical treatment of vaginal vault prolapse,

  • 18.
    when mesh is used, its contraction is not a recognised complication. T □ F □

With regard to the abdominal approach to surgery for vaginal vault prolapse,

  • 19.
    sacrocolpopexy has a lower recurrent prolapse rate compared to sacrospinous fixation. T □ F □
  • 20.
    laparoscopic sacrocolpopexy has been shown to have similar reoperation rates as those after treatment with a vaginal mesh. T □ F □

image Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism

  1. Top of page
  2. image Postpartum psychosis
  3. image Pelvic congestion syndrome
  4. image Ambulatory hysteroscopy
  5. image Management of vault prolapse
  6. image Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism
  7. image The relationship between infertility treatment and cancer including gynaecological cancers
  8. image Delivery outcomes for nulliparous women at the extremes of maternal age – a cohort study
  9. Supporting Information

Androgen excess in women is associated with,

  • 1.
    menstrual irregularity. T □ F □

With regard to normal androgen physiology in women,

  • 2.
    the adrenal medulla makes dehydroepiandrosterone sulfate. T □ F □
  • 3.
    less than 10% of testosterone is bound to sex hormone binding globulin. T □ F □

With regard to androgen action and metabolism,

  • 4.
    androgens are excreted unchanged in the urine. T □ F □
  • 5.
    testosterone binds to a nuclear receptor. T □ F □

With regard to the clinical presentation of hyperandrogenism,

  • 6.
    the Ferriman-Gallwey score is useful in objectively assessing the severity of hirsutism. T □ F □
  • 7.
    deepening voice and breast atrophy are features suggestive of an adrenal tumour. T □ F □

Regarding the biochemical assessment of hyperandrogenic patients,

  • 8.
    serum testosterone >5 nmol/l should prompt further investigation. T □ F □

Regarding the pathophysiology of polycystic ovary syndrome,

  • 9.
    a combination of genetic and lifestyle factors are likely to be causative. T □ F □
  • 10.
    arrest of follicular development is characteristic. T □ F □

Regarding the differential diagnoses of hyperandrogenism,

  • 11.
    ovarian hyperthecosis is a disease of childhood. T □ F □
  • 12.
    congenital adrenal hyperplasia is often diagnosed in infancy. T □ F □
  • 13.
    the most common virilising adrenal tumours are the Sertoli-Leydig cell type. T □ F □

With regard to the pathophysiology of hyperandrogenism,

  • 14.
    approximately 50% of circulating androgens are conjugated with either glucuronic or sulfuric acid. T □ F □

In hyperandrogenaemic women with PCOS,

  • 15.
    it has been shown that there is an increased risk of breast cancer. T □ F □

With regard to the quantification of androgens in secondary care institutions in the UK,

  • 16.
    automated immunoassays on whole serum are known to consistently overestimate serum testosterone concentrations. T □ F □

In case of hyperandrogenism,

  • 17.
    ovarian hyperthecosis accounts for less than 50% of cases in postmenopausal women. T □ F □
  • 18.
    the non-classic 21-hydroxylase deficiency tends to typically present in childhood. T □ F □
  • 19.
    luteomas of the ovary are one of the most common causes of gestational hyperandrogenism. T □ F □
  • 20.
    unilateral solid ovarian lesions as a cause have an increased risk of malignancy when presenting in pregnancy. T □ F □

image The relationship between infertility treatment and cancer including gynaecological cancers

  1. Top of page
  2. image Postpartum psychosis
  3. image Pelvic congestion syndrome
  4. image Ambulatory hysteroscopy
  5. image Management of vault prolapse
  6. image Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism
  7. image The relationship between infertility treatment and cancer including gynaecological cancers
  8. image Delivery outcomes for nulliparous women at the extremes of maternal age – a cohort study
  9. Supporting Information

Infertile patients,

  • 1.
    are at increased risk of developing ovarian cancers. T □ F □

Nulliparity,

  • 2.
    is associated with a ten-fold increase in the risk of developing ovarian cancer. T □ F □

Regarding infertility treatment and ovarian cancer,

  • 3.
    when clomiphene citrate is given for more than 12 cycles, it is associated with an increased risk of borderline and invasive cancer. T □ F □
  • 4.
    nulligravidae who received fertility treatment have been shown to be at an increased risk of ovarian cancer regardless of whether they conceived or not. T □ F □
  • 5.
    there is strong evidence linking multiple in vitro fertilisation (IVF) cycles and an increased risk of developing the cancer. T □ F □
  • 6.
    treatment with fertility drugs does not increase risk compared with non treated infertile women. T □ F □
  • 7.
    compared with the general population, those who have IVF treatment are at an increased risk of ovarian cancer. T □ F □

Regarding infertility treatment and uterine cancer,

  • 8.
    there is a persistent trend linking usage of clomiphene citrate and increased risk. T □ F □
  • 9.
    there is some evidence pointing to a transient increase in risk in the first year following infertility treatment. T □ F □
  • 10.
    there is evidence showing that ever use of gonadotropins is associated with increased risk. T □ F □
  • 11.
    IVF, particularly after multiple IVF cycles, increases risk. T □ F □

Regarding infertility treatment and breast cancer,

  • 12.
    most studies observed an increased risk following the use of fertility drugs. T □ F □
  • 13.
    there is strong evidence showing an increased risk following fertility treatment in women with family history of the disease. T □ F □
  • 14.
    there is strong evidence linking the development of the cancer with increased maternal age at first IVF cycle. T □ F □
  • 15.
    there is robust evidence linking the development of the cancer with multiple IVF cycles. T □ F □
  • 16.
    there is good evidence that women exposed to fertility drugs have a transient increase in the risk of the cancer diagnosed in the first year after treatment. T □ F □

Regarding infertility treatment and non gynaecological cancers,

  • 17.
    there is evidence linking fertility treatment with increased risk of melanoma. T □ F □
  • 18.
    the evidence linking thyroid cancer with clomiphene citrate is weak. T □ F □

Regarding fertility treatment and childhood cancer,

  • 19.
    there is a consistently increased risk of retinoblastoma. T □ F □
  • 20.
    children born following IVF are at a significantly increased risk of developing cancer compared with the general population. T □ F □

image Delivery outcomes for nulliparous women at the extremes of maternal age – a cohort study

  1. Top of page
  2. image Postpartum psychosis
  3. image Pelvic congestion syndrome
  4. image Ambulatory hysteroscopy
  5. image Management of vault prolapse
  6. image Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism
  7. image The relationship between infertility treatment and cancer including gynaecological cancers
  8. image Delivery outcomes for nulliparous women at the extremes of maternal age – a cohort study
  9. Supporting Information

Vaughan DA, Cleary BJ, Murphy DJ. Delivery outcomes for nulliparous women at the extremes of maternal age – a cohort study. BJOG 2013; DOI: 10.1111/1471-0528.12311

With regard to the epidemiology of maternal age in pregnancy,

  • 1.
    the live birth rate in young women aged 20 years and under has halved in the UK between 1997 and 2007. T □ F □
  • 2.
    the number of live births in women aged between 40 and 44 years has almost doubled in the UK between 1997 and 2007. T □ F □

With regard to maternal risk factors, compared to women aged 20 to 34 years,

  • 3.
    young teenagers (under 18 years) are more likely to be underweight (BMI <18.5 kg/m2) when assessed at the first antenatal visit. T □ F □
  • 4.
    young teenagers are more likely to report smoking cigarettes when questioned at the first antenatal visit. T □ F □
  • 5.
    women aged 40 years and over are more likely to abstain from alcohol in pregnancy. T □ F □
  • 6.
    women aged 40 years and over are more likely to have hypertension in pregnancy. T □ F □
  • 7.
    women aged 40 years and over are more likely to be of higher socioeconomic status. T □ F □

When compared to women aged 20 to 34 years,

  • 8.
    young teenagers are more likely to deliver preterm (<37 weeks of gestation). T □ F □
  • 9.
    young teenagers are no more likely to have small for gestational age babies (<10th percentile) when potential confounding factors are taken into account. T □ F □
  • 10.
    young teenagers are more likely to have an instrumental delivery by vacuum or forceps. T □ F □

Supporting Information

  1. Top of page
  2. image Postpartum psychosis
  3. image Pelvic congestion syndrome
  4. image Ambulatory hysteroscopy
  5. image Management of vault prolapse
  6. image Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism
  7. image The relationship between infertility treatment and cancer including gynaecological cancers
  8. image Delivery outcomes for nulliparous women at the extremes of maternal age – a cohort study
  9. Supporting Information
FilenameFormatSizeDescription
tog12038-sup-0001-Supporting-information.pdfapplication/PDF151K

CPD questions for the BJOG article ‘Timing of prophylactic antibiotics for caesarean section: a systematic review and meta-analysis' were published in TOG Vol 15 No 2.

Additional supporting information regarding the CPD questions may be found in the online version of this article. Please read the supporting information before attempting the questions.

Please access TOG online here: http://onlinetog.org. RCOG fellows and members can access TOG via the RCOG website.

Please note: Wiley Blackwell is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.