Professional Documents
Culture Documents
E.60%
E.80%
In case of term it reduce 4_6% in 38 wk 1-1.7% in 39 and 11%
4 - Patient forelective CS at 38wks need to know how much in 37 wk
steroid will reduce respiratory
A.3%
Prev. one abruption 4.4% (10-folds)recurrence. Prev. 2 abruption
B.4-6% 20-25% recurrence
ANSWER : B
C.10%
D.19%
E.25%
6 - Previous shoulder dystocia want to know recurrence
:compared to general population
A. 2fold
B.3fold
C.4fold GTG: Incidence of SD 0.58-0.7%, Recurrence 1-25%, Conventional
RFs predict 16% of SD
D.5fold Infants of diabetic mothers have 2-4 fold ↑ for SD
Midcavitary forceps = 10 fold SVD, Elective CS in > EFW 4.5kg of
E.10fold diabetic mothers
:baby
if (f ) is carrier 25% affected / 25% carrier 50% SEX – LINKED RECESSIVE
A.zero unaffected child
Male to male never 1 – DUCHENE MUSCULLAR
B.1in2 risk of doughter carrier 1 : 2 occurs ATROPHY
A.7yrs develop 2ry sexual ch.ch. before 8 yrs old in girls, 9 yrs in boys
B.8yrs
C.9yrs
D.10yrs
E.12yrs
A.10%
.30%
B.1in10
C.1in 20
D.1in 25
TIME TARGET
A. 60 - 65 SPO2
1 MIN 60 – 65 %
B. 65- 70
2MIN 65 – 70 %
C. 70 - 90
3 MIN 70 – 75 %
D.80 - 95 4 MIN 75 – 80 %
E. 90- 95 5 MIN 80 – 85 %
10 MIN 85 – 95 %
B.1in 1500
C.1in10000-1/100000
D.<1/100000 E.1in 30
16 -40 years lady first trimester pregnancy ask about her risk to
: have miscarriage
Answer : E
A. 12%
B.20%
C.30%
D.40%
E.50%
17 - Patient need to have forceps delivery in
ANSWER : B
C.15%
D.20%
E.25%
D.CEFM
19 - Patient delivered baby at the acid base PH7.1 HCO -11 at zero
APGAR 3 then 5 and 9 he and his mother did fine for how long do you
keep the ctg paper ANSWER : E
A.5yrs
C.failure to monitor
D.failure to refer
B.oxytocin
C.ARM
D.CEFM
E.exam in 2hrs
F.forceps D
A. cephalohaematoma
B.subglialial H
C.capaut
D.ICH
E.chingon
E.ECV
F.ARM
G.instrumental delivery
H.exam in 2hr
I.exam in4hrs
exam
26 - A 30 year old nullipara presented to labour ward , she is low risk and
39 wks GA ; on examination the cervix is 6 cm dilatation , intact
membrane with the presenting part on Rt. Occipito posterior position
. and fully effaced cervix with the head at the level of the ischial spine
E.ARM
A. 1mg/kg
B.2mg/kg
C.3mg/kg .
D.5mg/kg
Total ml acc. to dose & solution conc. 1or 2% = [)3or7( ‚ 10] x
E.7mg/kg [wt. ‚ conc
:28 - SLE lady pregnant worried about fetal risk what test should be done
SLE
B.lupus anticoagulant More than 90% of mothers of affected offspring have anti-Ro antibodies,
and 50%–70% have anti-La antibodies
C. Anti Ro &La antibodies The prevalence of anti-Ro in the general popu- lation is <1%, although
anti-Ro/La are present in about 30% of patients with SLE, commonly
D.dstranded DNA associated with photosensitivity, Sjögren’s syndrome, subacute lupus
erythematosus and ANA-negative SLE
E.antinuclear abs In babies of Ro/La-positive mothers, the risk of transient cutaneous lupus
is about 5% and the risk of CHB about 2%
The risk of neonatal lupus is increased if a previous child has been
affected, rising to 16%–18% with one affected child and 50% if two
children are affected; subse- quent infants tend to be affected in the same
.way as their siblings
29 - 38 wks patient with primery herps plus HIV what measures you do to
prevent vertical transmission
A. IOL
CS for all ( nice : may permit vd ) 1st episode genital herpes in
B. acyclovir T3, particularly within 6 weeks of EDD, as the risk of neonatal
transmission of HSV is very high at 41% and in recurrence 0 – 3
C. ELCS at 39wks .%
D.vaginal delivery
Causative agent
E.varicella virus
F.others 2
** A red-pink rash
Picture of the rubella rash
The rubella rash is typically a red-pink colour. It consists of a number of small spots, which may
.be slightly itchy
The rash usually starts behind the ears before spreading around the head and neck. It may then
spread to the chest and tummy (the trunk), and legs and arms. In most cases the rash disappears
by itself within three to five days
** The measles rash appears around 2 to 4 days after the initial symptoms and normally fades
.after about a week
.You'll usually feel most ill on the first or second day after the rash develops
:The rash
is made up of small red-brown, flat or slightly raised spots that may join together into larger
blotchy patches
usually first appears on the head or neck, before spreading outwards to the rest of the body
is slightly itchy for some people
can look similar to other childhood conditions, such as slapped cheek syndrome, roseola or
rubella
is unlikely to be caused by measles if the person has been fully vaccinated (had 2 doses of the
.MMR vaccine) or had measles
A.aneinatal LMWH and 6wks post natal BMI above 30 and antepartum 1
score
B. highdose antenatal LMWH and 6wks postnatal BMI 30 or above and p.partum 1
score
C.theraputic LMWH and 6wks postnatal
If in question only mentioned
D.antenatal antiembolism stoking and postnatal and didn't give any
comments about antenatal so if
10 days postnatalLMWH
2 or 3 or 4 or more risk give 10
E.LMWH 10days post natal d
He did not
say
39 - 31yrs lady undergone CS BMI 30 blood loss 1100 ml ANSWER : E
A.mamogram
B.US
C.CT
D. MRI
E.CXR
ANSWER : B
43 - Patient pregnant with breast cancer need chemotherapy needed
A.oxytocin
B.Bakri balloon
C. 3doses of carbpoprost
G.hystrectomy
F.interventional radiology
.B.lynch
ANSWER : E
44 - patient with previous scar in her 2 nd
C. At 24-28wks D. At 28wks
E. At 16 -24wks Answer : a
50 - Postpartum patient with preeclampsia devolped dyspnia
,tachycardia,basal crepitation and O2 saturation 91 and low urine out put
diagnosis Answer : b
A. Pul embolism B. Pul.oedema C. Pneumonia D. MI E.
Ischemic heart disease
51 - pregnant lady with high BP C/O of headache for many days present
collapse GCS3 BP 200/120 your diagnosis
D.Pull method
E.??64
[.try to test ptn. > HIV-ve ..> D]
55 - * What action you do Ptn. is +ve >check the doctor + take prophylaxis
either in occupational health (morning working
A. Deliver by CS hours) or in accident&emergency department
(evening hours)
B. IOL C. Report to occupational health tomorrow /
E. Start cART
EMQ
A. CVS
B. Amniocentesis
NICE CG 62 0f ANC:
Screening for sickle cell diseases and thalassaemias should be offered to all women ASAP
in pregnancy (ideally by 10 weeks).
Where prevalence of sickle cell disease is high (fetal prevalence > 1.5 cases per 10,000
pregnancies), laboratory screening to all pregnant women to identify carriers of sickle cell
disease and/or thalassaemia.
Where prevalence of sickle cell disease is low (fetal prevalence < 1.5 cases per 10,000
pregnancies), all pregnant women should be offered screening for haemoglobinopathies
using the Family Origin Questionnaire.
If the Family Origin Questionnaire indicates a high risk of sickle cell disorders,
laboratory screening should be offered.
Mean corpuscular haemoglobin is < 27 picograms laboratory screening.
If the woman is identified as a carrier , the father of the baby should be offered counselling
and appropriate screening without delay.
A. cyclizine im iv oral
B.meteclopromide
C.ondansteron
Answer : a
D.corticosteroid
C. plasmaphresis
D. no need for antiD
Pregnant lady known haemophillia her baby status not known. .
plan of delivery will be and
B. induction of labour
C.allow VD and avoid FBS
C.platelet
D. desmopressin
E.cryopreciptate
* Desmopressin (DDAVP)
Aspirin and NSAIDs should not be given to women with vWD
factor VIII levels may be indicated, e.g., prior to procedures, delivery, epidural
or C.S
If not respond to DDAVP, FFP or plasma-derived factor concentrates
containing vWF and factor VIII may be used to control or prevent severe
bleeding
*( DDAVP ) Fluid intake should be restricted to 1 litre for 24 hours following
DDAVP administration to prevent maternal hyponatraemia. If additional fluid is
required, electrolytes should be monitored .
71 - Asthmatic pregnant lady received short acting beta blocker .
and 800 steroid but her asthma not controlled next step
A. steroid
B. LABA
C.theophillin
D.leukotriene
72 - Pregnant lady with renal transplant stable came for .
prepregnancy counseling which drug to stop
ANSWER : D
A.ciclosporin
B.predinsolone
C.calcium
D. Ramipril
A.hypothyoidism Answer : B
B.migraine TOG 2014: Migraine have a > 2-fold ↑ risk
of pre-eclampsia, a 17-fold ↑ risk of stroke
C.celiac disease and a 4-fold ↑ risk of acute myocardial
infarction
D.marfan
74 - which condition without other risk factor let you consider
thromboprophylaxis during pregnancy ANSWER: B
A.diabeties
B.sickle cell anaemia
C. IUGR
??.D
all of them take score 3
* All medical comorbidities: cancer, heart failure ,active SLE inflammatory
polyarthropathy ,ibd .ns , type 1 dm with nephropathy , scd .ivud
* hyperemesis in the 1st trimester
* any vte provoked by surgery
* any hight risk thrombophelia
* any surgery in perperium el surgery
all of them take score 4
AntiD* * previous vte not provoked by surgery
* ohss in yhe 1st trimester
A.offer antiD 250 B.anti D 500 C. no anti D needed D. paternal
genotype E.CFFDNA F.measure maternal antibodies G.CVS
C.coincidental
D.accidental
E.late
ANSWER : A
F.not maternal death
81 - lady with pre eclampsia developed ICH take 5wks in ICU .
and died
82 - Lady is collapsed 48 hrs post delivery postmortem was
Esimenger synd ANSWER B
A. scan in 7 to 10 days
B.HCG in 48 hrs
C.surgical mx
D.expectant mx
ANSWER
E. evacuation RPOC :A
A. ectopic
B.appendicitis
C. OHSS
D.hetertopic
E. tortion
F.miscarriage
87 - Surrogate for her sister retained 2 babies at 6wks
confirmed single IUP present with sudden onset of lower abd
pain and tenderness Answer : D
A.O negative
A. morphine ANSWER : B
A.BPD
B.AC
C.CRL
D.HC
E.FL
B. surgical evacuation
C. US
E. others
94. early pregnancy loss follow medical TOP call gyn C/O of cramps and
some bleeding otherwise ok ANSWER : A
95 - 14 days post medical TOP call the midwife that her PT is positive
ANSWER D
97 - Pregnant lady with rash involve the abd striae what is good
prognostic finding for baby ANSWER : B
TOG 2013
A. involve face
Polymorphic eruption of preg. Have
B. periumlical spare C.presence of C3 no impact on maternal / fetal
outcome
98 - Cystic fibrosis both parent carrier under gone IVF 12 embryo how
many will be affected
Answer : b 3
A. 2
B.3
C.4
Commonest leathal g condition in
D.6 coucasian affecting 1 / 2000 and carrier
risk is 1/25 in uk
Aurosomal recessive disease
99 - Evidence based step to avoid perineal trauma during vaginal
delivery
answer : C
A. perineal massage
B. hand on technique
C.warm compresses
A. eclampsia
B.ICH
C.P.edema
Answer : c
B.male problem
C.tubal factor
D.uterine factor
E.ovulotory
Un explained can be good choice if it wasnot for word ( obese ) other option
are cause of 1ry infertility
INFERTILITY
106 - infertile couple man ok woman PCO with anovulation induced with
clomid 50mg estrogen level was high follicle 20mm but progestron on
day 23 of 26 cycle showed un ovulation 3 ithink Aswer : c
107 - infertility 2yrs all investigations normal except woman PCO with
anovulation evident by progestron
Red level
clomid for 6 m lap drilling add
Answer : a metformin or gonadotophin ( FSH & LH ) IVF
108 - nfertility 3 yrs all normal woman PCO received 6 cycle of clomifen
citrate day 23 out of 26 cycle progestron range between 32 to 67
Answer : h IVF
infertility *
C.cyclical progesterone
D.merina
E.induction of ovulation
F.CC
112 - Young concerned about her period .irregular last was 9month
ago.BP 150/104 not in sexual relation ship ( pco >>>>>ht) Answer : c
113 - same scenario with high BP and adult polycystic kidney PCO and
not in sexaual relation Answer : d
As kidney disease ass with endometrial hyperplasia and HMB so Mirena
Ethics
A. non malficience عدم االيذاء
B.beneficience االعانه
D.paternalism االبوة
الحكم الذاتى
E. autonomy
Answer : E some down sy. Have level of IQ and they are not complete
دMR SO THE doctor discuss the patient and the examinar put this word
اخمد البيهوتي
116 -Patient with IUGR Ithink abnormal CTG need CS patient refused
and said she rely on nature and every thing will be ok Answer : e
*autonomy[1] is the capacity to make an informed, un-coerced decision
*Paternalis is the opposite
117 - Pregnant at 36wks ask for induction because her hasband will
travel somewhere you refuse to offer her induction
Cohort Study (Prospective Observational
Anawer : A Answer :a
Study)
A clinical research study in which people who
STUDY as Q99 M 2016
presently have a certain condition or receive a
particular treatment are followed over time and
A.cohort
compared with another group of people who are
B.case control not affected by the condition. Example:
Smokeless tobacco cessation in South Asian
C.retrospective observational study communities: a multi-centre prospective cohort
study. Croucher R, et al. Addiction. 2012
D.systematic review Some time cohort my be retrospective
E. metaanalysis Case-control Study
Case-control studies begin with the outcomes and
F.RCT do not follow people over time. Researchers
choose people with a particular result (the cases)
G.other option and interview the groups or check their records to
Answer :a ascertain what different experiences they had.
They compare the odds of having an experience
118 - . DR conducted study over 15 yrs with the outcome to the odds of having an
experience without the outcome. Example: Non-
to see effect of carbiplatin on 5yrs use of bicycle helmets and risk of fatal head
Cohort start with exposure risk factor Some time cohort my be retrospective
COHART STUDY
More specific in data collection ,may use studies collected in systemic review
and filter them according to exclusionand inclusion criteria high level
of evidence
LEARNING
A.brainstorming
B.ischema activation
C.ischema refinement
D.1step perception
E.snowballing
F.goldfishbowel
Answer : B
G.icebreaking
A Brainstorming
B Delphi technique
C Doughnut rounds
D Goldfish bowl
E Lecture
G Schema activation
H Schema refinement
J Snowballing
For each of the teaching scenarios described in the items below select the single most
correct term from the list of options. Each option may be used once, more than once or not
.at all
Q 1 You are asked to initiate ideas for research among a group of junior trainees .
You get the trainees together and everyone contributes ideas, experiences and
.different perspectives. These are recorded onto a flip chart
ANSWER A Brainstorming
Q 2 You are asked to teach a group of 3 trainees on the structure of the cell
membrane and membrane receptors. Each of the trainees is given a chapter to read
on the relevant subjects. You also require each trainee to develop 10 questions on
the subject material. A week later they cover the facts by sitting together and testing
.each other by using their questions
Q 3 You are paired with a Consultant and are required to demonstrate good practice
in “Breaking Bad News” to a group of 14 trainees. Both of you facilitate learning by a
role play in front of the whole group to demonstrate behaviour you want the
.members of the group to assimilate
Q4 The lecturer gave the student a tutorial on the anatomy, physiology and
endocrinology appropriate to amenorrhoea followed by a series of clinical cases
which including post-chemotherapy amenorrhoea, Turner syndrome,
hyperprolactinaemia and complete androgen insensitivity syndrome. The learners
recall what they have experienced in the tutorial and attempt to solve clinical
.problems
Q6 You are required to lead a group of senior trainees on concepts in the clinical
management of hirsutism. You begin by activating their recall of the relevant
physiology and biochemistry and give them tutorial to clarify their understanding of
the basic concepts. Then, you give the group a series of clinical problems in which
hirsutism was the presenting complaint. The trainees recall what have experienced in
.the tutorial and solve clinical problems
Answer J Snowballing
Q8 You are required to teach a group of junior trainees on the subject of changes in
the postmenopausal women. In the first instance, you ask the trainees to recall their
knowledge of basic endocrinology concerning the hypothalamic -pituitary ovarian
.axis
Mustafa
D.stop training
A. increase thromboxane
A.testesterone
B. DHEA ANSWER :
D
C.DHEAS
B.carbamazepine
C.lamotrigne
129 - 50yrs present with simple ovarian cyst 4x4x4.5 and in her note
there cyst 1 yr ago not followed 4x4x4.5 and CA125 is 25 (repeated
question in all recalls) Answer : A
130 - 40 yrs lady present with multilocular or solid component( not sure )
not simple cyst CA125 30
Answer : B
131 - 9years girl came with her parent to the ER with sudden onset of Lt
iliac fossa pain with nausea and vomiting ithink high TWBC
Answer : E
A. analgesia and observation
Q12
8
Q 129
132 - Patient with history of subfertility and PID present with Rt iliac
fossa pain nausea and vomiting …TWBCS 19.000 CRP 20 US non
compressible mass 5cm diameter 10mm what is the diagnosis
ANSWER : A
A. acute appendicitis * Ct for app. In preg. Potentially carcinogenic and is it useful
after u/s
B. fallopian tube infection * MRI is the alternative immging
* THE ACOG dicatates mri if us not incluosive
C.pelvic abscess
5 - yrs survival
A. 40 -50
B.60-70
C.70-80
D.80-90
136 80 yrs lady present with 1cm vulval mass near the clitoreal hood
next step ANSWER : B
A. excisional biopsy
137 - Young lady in sexually active present with pain less fleshy lesion at
vulva diagnosis
A.hpv
C. no intervention now SEND IUD FOR CULTURE AND GIVE AB . GIVE ALTERNATIVE CC &
GYNE REFERAL TO CHECK RESOLUTION OF SYMPTOMS +
NHSCSP:
RESULT
2016
B.RR in 3yrs
C.RR 5yrs
D. hystrctomy
140 - 50 yrs Cx screening high grade colposcopy unsatisfactory next
:step( CONE / LLITZ)
A.hysterectomy
Colposcopic examination
A. Superior gluteal
B. inferior gluteal
The Inferior rectal nerves (inferior anal nerves, inferior
C. ovarian hemorrhoidal nerve) usually branch from the pudendal nerve
but occasionally arises directly from the sacral plexus; they
D. uterine cross the ischiorectal fossa along with the inferior
hemorrhoidal[disambiguation needed] vessels, toward the
E.internal pudendal
anal canal and the lower end of the rectum, and is distributed
F. internal iliac to the Sphincter ani externus (external anal sphincter, EAS)
.and to the integument (skin) around the anus
G.others
143 - Patient durig VD had 4th degree tear and massive bleeding
ANSWER : B The inferior rectal artery arises from the internal pudendal artery
D. remove x from y
E.remove x &y
G. go as planned
Beneficience,For the best interest of the pt, GANGEROUS tube or overy With
clear diagnosis, we do exesion but otherwise we do re-tortion
C. UTI
F. bowel injury
h.active bleeding
147 - Patient smocker present 48 hrs post hysterectomy with fever temp
39 ,tachycardia and tachypnea ANSWER :B
148 - 3days post op not recoverd well ask for analgesia with abd and
back pain not febrile mild tachycardia poor urine out put ANSWER :G
V. Heamtoma taking more than 24 hrs and fever shd be sign ,no symptoms is infection
and discharge rigid tender abdomin means internal HE , common symptoms for VH is
vaginal discharge
A.anterior wall
B.posterior
C. cervical
D.fundus
ANSWER :A
151 -What you do to reduce risk of uterine perforation during evacuation
==================================
reduces the risk of perforation Reports have also suggested that the use of a tapered
.
Hawkins-Ambler dilator requires less force to achieve cervical dilatation than the
parallel-sided Hegar dilators that are used in many NHS units in the UK.21
Additionally, ultrasound guidance in experienced hands can reduce the risk of
perforation, as can laparoscopic guidance if an abdominal procedure is being carried
out on the patient at the same time
A. SSRI Answer : d
c. 1
A .2
E.3
H.4
E.5
A.summative summative
B.formmative formative
C. sum +form
D.form + sum
154 - Multiple sclerosis patient with history of difficulty emptying bladder
with high residual volume
ANSWER: B
A. indwelling catheter
B. CISC
C.urodynamic
B.SUI
C. constipation
D.voiding dysfunction
A. mirabegron
B.trospium
C. deluxtine
A. oxybutanin
B. merabegron
C.trospium
D.deluxtine ANSWER : D
Duloxetine
B. refer to GUM
C.admit
159 - EMQ patient C/O watery blood stained vaginal discharge and
colicky pelvic pain wt finding A. polyp protruding through Cx
A. PMFT
C.ASC
D. SSF
E. pessay
160 - 80yrs with vault prolapse and sopting normal vaginal exam patient
had comorbidities
ANSWER : E ……HE SAID NORMAL
161 - PHVP with short vagina VAGINA
162 - Patient with anterior vaginal wall prolapsed and uterine prolapse
ask for definitive ttt
ANSWER : H VH
163 - Patient athlet devolped SUI post VD O/E anterior prolapse grade 2
patient start PFMT not improved next step ANSWER : B
A. colposuspension Before operation
B. urodynamic
Colposuspension
Do not offer laparoscopic colposuspension as a routine procedure for the
treatment of stress UI in women. Only an experienced laparoscopic surgeon
working in an MDT with expertise in the assessment and treatment of UI should
perform the procedure. [2006]
Considerations following unsuccessful invasive SUI procedures or recurrence of
symptoms Women whose primary surgical procedure for SUI has failed (including women whose
symptoms have returned) should be
referred to tertiary care for assessment (such as repeat urodynamic testing including additional
tests such as imaging and urethral function studies) and discussion of treatment options by the
MDT, or
offered advice as described in recommendation 1.6.9 if the woman does not want continued
invasive SUI procedures. [new 2013]
Answer : c
164 - Confirmation of post hystroscopic sterlisation
A.it work immidiatly
A.10%
Answer : d
B.20%
Transenersr 23 %
C.40%
0.5 % without sur.
D.50%
A. PE
C.blood transfusion
D.bowel injury
E.ovarian failure ?
Answer : c bl transfusion
A.6month
B.12month
C.18 month
D.24month
E.30month
C.bowel preparation
Pelvic pain
A.uretheral prolapsed
B.abnormal Cx
C.fistula
D.vaginal septum
Answer a
170 - 17yrs with history of dysuria recurrent UTI and dyspareunia
A. microarray CGH
32
B. PCR
C.FISH
174 - 56yrs old thin vulval skin fused labia taken fluconazole orally and
topically no relieve best Answer : b
:option
A. biopsy
C. emollient
evidence suggests that bowel injury is not reduced, but is more readily
identified
Serotonin Norepinephrine Reuptake Inhibitor ( SSNRI) will be treatment of choice as
SSRIs paroxetine and fluoxetine should not be offered to women with breast cancer
who Is on tamoxifen
The selective serotonin re-uptake inhibitor (SSRI) antidepressants paroxetine [14]
and fluoxetine [14] may be offered to women with breast cancer for relieving
menopausal symptoms, particularly hot flushes, but not to those taking tamoxifen. In
ER negative
Women with vaginal dryness can use moisturisers and lubricants such as Replens
. in ER positive on tamoxifen
significant amount of evidence exists for the efficacy of selective serotonin reuptake
inhibitors (SSRIs)
and selective noradrenaline reuptake inhibitors ( SNRIs) in the treatment of
.vasomotor symptoms
Although there are some data for SSRIs such as fluoxetine12 and paroxetine,13 the
most convincing data
.are for the SNRI venlafaxine at a dosage of 37.5 mg twice daily
The main drawback with these preparations (especially the SNRIs) is the high
incidence of nausea
In women with estrogen/progesterone-dependent tumours, such as breast cancer,
general clinicians
should probably avoid using phytoestrogens and progestogens/progesterone as
first-line therapy, as these
preparations may have an effect on breast tissue (an SNRI may be the best choice
here). If possible, the
hormone receptor expression of the tumour should be taken into account. The main
drawback of SNRIs
can be reduced by uptitrating the dosage. Also, there are concerns that paroxetine
reduces tamoxifen’s
effectiveness by inhibiting its bioactivation by cytochrome P450 2D6 (CYP2D6),
resulting in an
.increased risk of death from breast cancer
Dr / hamada said aboroumh