OpenLLM-France/wikimedia huggingface dataset:
# Obstetrics and Gynecology/Gestational Trophoblastic Disease

Gestational Trophoblastic Disease comprises a spectrum of tumors of the gestational trophoblast which range from completely benign to aggressively malignant.
There are four types of trophoblastic tumor
* Hydatidiform Mole
* Chorioadenoma Destruens (Invasive Mole)
* Choriocarcinoma
* Placental Site Trophoblastic Tumor
They all secrete the hormone human chorionic gonadotrophin (hCG).

## Hydatidiform Mole

Hydatidiform Mole is a benign tumor of the trophoblast caused by abnormal fertilization.

### Epidemiology

The incidence of hydatidiform mole differs depending on age, ethnic origin and classification of mole. The complete mole is most common in women under 20 and over 39, whilst the partial mole is more common in women between 20-30. The complete mole is most common among women from the Gulf region of the Middle East, while the partial mole is most common among South-East Asians. The incidence in the UK, Ireland and the USA is 1 in 2,000 pregnancies for the complete mole and 1 in 5,000 pregnancies for the partial mole.

### Etiology and Pathogenesis

In the case of the complete mole, the ovum has lost all maternal genetic material. This is subsequently fertilized by a single sperm which duplicates, or undergoes dispermic fertilization. In the case of the partial mole, a normal ovum undergoes dispermic fertilization resulting in a complicated triploid structure containing vesicular cysts and fetal and placental tissue. The complete mole has 46XX chromosomes and the partial mole has 69XXY chromosomes. Both are at low risk of development into malignant tumors of trophoblastic origin.

### Clinical Features

History
* Vaginal Bleeding
* Hyperemesis Gravidarum
Examination
* Soft uterus enlarged inconsistent with dates
* Pre-eclampsia
* Thyrotoxicosis
* Fetal heart sounds absent
* Ovarian enlargement
Investigations
* Raised hCG
* Snowstorm appearance on Ultrasound Scan

### Management

The treatment is surgical:
* Group and hold
* Evacutation suction
* IV syntocinon

## Chorioadenoma Destruens

Chorioadenoma Destruens is a malignant tumor of the trophoblast caused by abnormal fertilization. This results when a hydatidiform mole invades locally. 5-10% of all molar pregnancies are choriadenomas. A common complication is uterine rupture by the tumor itself, but metastasis is rare. Treatment is with chemotherapy and follow-up.

## Choriocarcinoma

Choriocarcinoma is the most malignant of the trophoblastic tumors. The incidence of choriocarcinoma has been estimated at between 1 in 30,000 pregnancies to 1 in 60,000 pregnancies. They are highly invasive and metastasise early to the lungs and brain, among other locations. Half result from hydatidiform moles but they can, occasionally, result from normal pregnancies. Treatment is by chemotherapy and follow-up.
# Obstetrics and Gynecology/Menorrhagia

Menorrhagia is defined by the Royal College of Obstetricians and Gynaecologists as "a history of heavy cyclical menstrual blood loss over several consecutive cycles without any intermenstrual or postcoital bleeding".

## Etiology

The etiology of menorrhagia can be divided into its gynecological and systemic causes:
Gynecological Causes:
* Polyps
* Fibroids
* Endometrial carcinoma
* Pelvic Inflammatory Disease
* Dysfunctional uterine bleeding
Systemic causes
* Coagulopathies
* Hypothyroidism

## Diagnosis

The diagnosis of menorrhagia is made using the following clinical skills:
* Gynecological History Taking
* Gynecological Examination
* Gynecological Investigations
# Obstetrics and Gynecology/Obstetric Examination

The Obstetric Examination involves the examination of the pregnant abdomen. This should always be performed after a thorough Obstetric History as this will guide the examination. The components of the examination are:
* General Approach
* Inspection
* Palpation
* Auscultation
* Conclusion of the Examination

## General Approach

The obstetric examination requires a thoughtful physician as many pregnant women are very aware of the risks to themselves and the fetus during pregnancy. A great deal of sensitivity is required upon discovery of any abnormal finding.

## Inspection

When inspecting the pregnant abdomen, adequate exposure is essential. The patient should be exposed from the xiphisternum to the top of the pubic hair line. The first item of note is the presence of a distended abdomen in keeping with pregnancy. The other findings on inspection include:
* Abdominal symmetry
* Movement with respiration
* Linea nigra
* Striae gravidarum (recent striae are purple; old striae are white)
* Surgical scars
* Fetal movements visible

## Palpation

Palpation of the pregnant abdomen involves:
* Measurement of uterine size from the uppermost point of the fundus to the pubic symphysis
   * Palpate the upper margin of the fundus using the ulnar aspect of the dominant hand
   * Palpate the symphysis pubis using the index and middle fingers of the non-dominant hand
   * Measure the distance with the inches side of the tape facing upward to avoid examiner bias
   * From 20-36 weeks the abdomen should be 2cm either side of the gestation date
   * From 36-40, this increases to 3 cm
   * Note if the size matches the dates
* Assessment of fetal position
   * Place both hands either side of the ubilicus
   * Press deep with one hand in a medially oblique angle of 45 degrees to the umbilicus and hold
   * Press deep with the other hand and remove slowly, then repeat above and below the initial non-dominant palpation
   * Repeat the last two steps but with switched hand roles
   * Palpate the lower border of the uterus and find the presenting part of the fetus
   * Note the position, presentation and lie of the fetus
   * Note if the head is engaged

## Auscultation

Auscultation of the fetal heart is done using a fetal stethoscope or a doppler. Auscultate for one minute and determine the fetal heart rate.The normal fetal heart rate usually varies between 120 and 160
# Obstetrics and Gynecology/Post-Menopausal Bleeding

Post-menopausal Bleeding is vaginal bleeding occurring after the menopause

## Differential Diagnosis

The differential diagnosis of post-menopausal bleeding is classified according the organ involved:
Uterine disorders:
* Endometrial carcinoma
* Endometrial Atrophy
Cervical disorders
* Cervical carcinoma
* Cervical polyp
Vaginal disorders
* Vaginal carcinoma
* Vaginal atrophy
Vulval disorders
* Vulval atrophy
* Vulval carcinoma
Other
* Hormone replacement therapy

## Diagnosis

The diagnosis of post-menopausal bleeding is made using the following clinical skills:
* Gynecological History Taking
* Gynecological Examination
* Gynecological Investigations
# Obstetrics and Gynecology/Obstetrical Hx (OSCE)

Obstetrical History - Pregnancy Checkup or Complication During Pregancny

## Intro

* introduce yourself

## ID

* check: name, age, occupation
* check: marital status

## CC

* use this to direct further questioning
* ask about: supportive partner, planned pregnancy, first pregnancy

## Hx
### HPI/Current Obstetric Hx
#### Menstrual Hx

* LMP; cycle length; (for EDC calculation)
* regularity = regular vs. irregular (metrorrhagia)
* flow: normal duration, quantity vs. prolonged,heavy (>7d,tamps/day; menorrhagia)
* color (dark red vs. bright (AUB))
* pain (? nonspecific?)
* PMS - headaches, anxiety, breast tenderness (? nonspecific?)
* Menarche, Menopause (? later is worse? nonspecific?)

#### PAPs Hx

* (last, frequency, abnormal)
* EDC Calculation (LMP + 7d -3mos + 1yr)

#### Contraceptive Hx

* Types, duration, date last use, compliance, future conception (may affect dates; progesterone/IUDS affect molar)

#### Current Pregnancy Hx

* Bleeding, discharge, vomiting, fever
* Contractions, fetal movements
* Smoking, drinking, drug use

##### Nutrition

* folate, vitamin D, caloric intake, iron, calcium

##### Ix

* Prenatal testing – MSS + NT U/S + fetal anatomy – defects?, dating?
* HIV
* others: thyroid, genetics, glucose tolerance test - outcome?

##### MAADS

* Meds, Allergies, Alcohol, Drugs, Smoking (esp during pregnancy)
* Immunizations (?unecessary?)

### Previous Pregnancy Hx

* GTPALM
*** pregnancies, term, premature (< 37 wks), abortions, live deliveries, multiples
* Year, sex, age children, birth weight
* Labour – type (vaginal or Cesarean), complications
* Postpartum complications (depression - "baby blues", feeding)

### PMHx + SxHx

Do you have any health problems (other than the bleeding or whatever)? Have you had any operations or illnesses? Many people have had psychological or emotional illnesses like depression. They may find it difficult to talk about. Have you had any illnesses of this kind?
* ToRCHHS – toxoplasmosis, rubella, CMV, HIV, HSV, syphilis
* Coagulopathy
* Other illnesses/surgery? - Diabetes, HTN, kidney/heart/thyroid disease

### FHx

Are there any illnesses that run in your family? Have any of the women in your family had problems with pregnancy? Have any babies been born with a problem or developed one later?
* Heart, diabetes, hypertension, seizures
* Genetic diseases (CF), congenital abnormalities (spina bifida, cleft lip)
* Multiple pregnancies (? nonspecific?)

### Social Hx

* Family support, adjustment, abuse

### FIFE + Discussion topics

* Feelings towards pregnancy, partner abuse?
* Ideas – what it’s going to be like, breastfeeding, prenatal classes
* Function – affect work? relationship w/ partner?
* Expectations – physician’s role, regular check-ups
# Obstetrics and Gynecology/Intermenstrual Bleeding

Intermenstrual Bleeding is abnormal bleeding between menstrual cycles.

## Differential Diagnosis

Endometrial disorders:
* Endometrial Carcinoma
* Endometrial Polyps
Cervical disorders:
* Cervical Carcinoma
* Cervical Polyps
* Cervical Ectropion
Other Causes:
* Contraception

## Diagnosis

The diagnosis of amenorrhoea is made using the following clinical skills:
* Gynecological History Taking
* Gynecological Examination
* Gynecological Investigations
# New Zealand Law/Criminal/Insanity
## Definition

Person labouring under:
    (a) natural imbecility or
    (b) disease of the mind
    such that the person is:
       (i) incapable of understanding the nature and quality of act; or
       (ii) incapable of knowing that act is morally wrong having regard to commonly accepted standards of right and wrong.
Crimes Act 1961-Sec 23

## R v Macmillan

* Facts
    Macmilian was charged with attempting to break out of Mt Eden prison. Evidence of schizophrenia.
* Held
* Even though M might have known that others thought his actions were morally wrong, he was still legally insane because he considered that those values didn’t apply to him.
* The tests of the accused’s knowledge of moral wrongfulness is subjective.
* If the accused could not, due to a disorder mind, rationally think of the reasons that make an act or omission wrong, he is entitled to an acquittal.

## Police v Bannin [1991] 2 NZLR 237

* Facts
* Schoolboy with Kleine-Levin syndrome.
* Expert said not automatism or disease of mind.
* Held
* Judge can receive expert evidence but must categorise himself.
* Automatism and Disease of the Mind are legal not medical terms.
* If the malfunction is internal and the risk of recurrence is high – the Court is entitled to order treatment.
* However, it is still necessary to prove that the defendant was not conscious. (There was evidence was that Bannin was aware of important facts and acted intentionally.)
* Nevertheless, prosecution had not proven that Bannin had an intention to commit a crime when he entered the house.

## R v Green

* Facts
* Green shot policeman, under the belief that the KGB were about to enter and kidnap him.
* At trial, the Crown raised all evidence of insanity.
* Held
* Unfair for Crown to adduce evidence of insanity
* New trial ordered.

## R v Hamblyn

* Facts
* Def convicted of theft.
* Evidence of multiple personalty disorder.
* Expert evidence disagreed as to whether at the relevant time, appellant was incapable of understanding nature and quality of act.
* Held
* Not possible to conclude on the balance of probabilities that appellant satisfied either limb.
* Defence claimed the defendant was unable to control alter egos. However, the judge's view was that the defendant's various personalities were not insane.

## Ericsson v Police

* Facts
    Evidence that 18 year old defendant had retarded personality and social skills.
* Held
* Insane automatism (applying Rabey v The Queen 1980 2 SCR 513, Supreme Court of Canada)
* The only identified precipitating event was argument with boyfriend.
# New Zealand Law/Criminal/Mens Rea
## Cases
### Kilbride v Lake

* Facts
    Defendant's car had no WOF sticker, although apparently it had passed its WOF and the sticker had been previously affixed.
* Held
    Where an offence requires no mental element, it is premature to discuss mens rea before actus reus.
    Defendant is not responsible for actus reus if he could not have acted in a different way, ie if failure was involuntary.

### Civil Aviation Dept v MacKenzie

* Facts
    Aeroplane's tailfin dragged on phone line.
* Held
    Due diligence defence available for public welfare regulatory offences.
    The onus is on the defendant on the balance of probabilities to prove due diligence, after prosecution proves actus reus.

### Millar v Ministry of Transport

* Facts
    Millar drove while disqualified - claimed he thought the period of disqualification was over.
* Held
    Belief has to be honest not reasonable.
    There are 3 types of offences:
       - those for which the prosecution must prove guilty mind
       - strict liability offences for which a due diligence defence is available on the balance of probabilities; and
       - absolute liability offences for which the prosecution need only prove the actus reus (and for which no defence is available).

### R v Howe

* Facts
    Rioters turned over police car.
* Held
    Prosecution has to prove mens rea for every part of the offence even though defendant unlikely to know vehicle was Crown vehicle.
    Honest and reasonable belief might provide a defence.

### R v Harney

* Facts
    Defendant stabbed victim who died, claimed he didn’t mean to injure victim seriously.
* Held
    Recklessness = foresight together with an intention to continue with a course of conduct regardless.
===Waaka v the police
* Facts
    Defendant is charged with assaulting a policeman in the execution of his duty.
* Held (CA)
    Accused must know that policeman is in the execution of his duty, although it is sufficient if he wilfully shut his eyes or was indifferent as to whether the policeman was in the execution of his duty.

### Police v Starkey

* Facts
    Published defamatory material about a candidate.
* Held
    The offence is a hybrid offence.
    The prosecution has to show:
       - defendant intended to publish the document
       - the document contained an untrue statement (strict liability)
       - the statement was defamatory (civil test); and
       - the statement was calculated (ie intended) to influence vote of any elector

### R v Nedrick

* Facts
    Defendant set fire to a house. A child inside the house died. The defendant was charged with murder.
* Held
    1. Usually a jury needs no explanation of intention.
    2. If jury does need an explanation, they should be told that a person can intend a result even if he or she doesn’t want it to occur.
    3. However, if the defendant doesn’t foresee, he cannot intend.
       If defendant foresaw but thought risk slight, might intend.
       If defendant did forsee and thought virtually certain, jury can easily infer intent.
# New Zealand Law/Criminal/Compulsion
## Definition

* Threats of immediate death or gbh by a person present when offence commit.
* Defendant must believe threats will be carried out.

### Exceptions

    Compulsion is not available for a number of offences, including murder, gbh, treason, kidnapping, robeery arson, piracy etc.

## R v Teichelman

* Facts
    T sold drugs to undercover drugs, said he supplied drugs in fear of O’Keefe. But O’Keefe was not present when T obtained drugs.
* Held CA
* The offence was to supply.
* The ingredients of the offence did not including obtaining.
* O’Keefe was present throughout entire supply.
* Compulsion requires continuing threat of death or gbh. Person must be both present and in a position to carry out threat. Believing one is is some danger is not the same as being in fear of instant death or gbh.

### R v Raroa

* Facts
* Raroa helped two men to dispose of bodies.
* The two men threatened anyone who narked on them.
* The two men did not specifically threaten Raroa.
* Held
* Raroa was no doubt very frightened but he was not under a threat of immediate death or gbh.
* Section 24 provides very narrow defence.

## R v Witika

* Facts
* Two year old died of abuse and neglect.
* Mother and partner charged w/ murder and in the alternative manslaughter.
* Crown didn’t try to identify principal and secondary, argued:
       - one must have been principal and the other the secondary;
       - both defendants had duty to intervene.
* Held
* Where there is a special relationship btwn the parties or btwn one of the parties and the victim, there is a duty to intervene.
* Failure to intervene, together with an intention to encourage/approve by non-intervention, amounts to abetting.

### R v Mauriere

* Facts
* Accused drove drunk because partner had hit and threatened her.
* History of domestic violence.
* Held
* Gbh = serious bodily harm = harm that will seriously interfere for a time with health and comfort.
* Seen against the background of the relationship, the threats of an assault/serious assault did not amt to threats of gbh.
* Defence could only succeed if accused had no realistic alternative but to offend – if actions were proportionate to the peril faced.
# New Zealand Law/Criminal/Conspiracy
## Commentary
### Definition

Conspiracy involves:
    (i) an intention to agree; and
    (ii) a common design to put the agreement into effect. (R v Gemmell)
There is no need to take any steps but there must be agreement that such steps will be taken.
Conspiracy is complete on the making of an agreement.

### Three types of conspiracy

There are 3 types of conspiracy:
    (a) simple;
    (b) circle or wheel; and
    (c) chain conspiracy.

### Impossibility

Impossibility is available as a 'defence' to conspiracy.

## Case Law
#### R v Gemmell

* Facts
    Gemmell and principal discussed a robbery.
    G refused to take part in an aggravated robbery.
    But on the day of robbery, G reluctantly agreed to drive principal and others to post office.
* Held
* There is difference in agreeing to commit one crime and aiding & abetting another.
* Aiding & abetting aggravated robbery cannot transform an agreement to commit (simple) robbery into agreement to commit aggravated robbery.
* Conspiracy requires:
       (a) intention common to the conspirators; and
       (b) a manifestation of that intention by mutual consultation or agreement

### R v Sanders

* An agreement made outside NZ to commit a crime in NZ is actionable in NZ if any act in furtherance of the conspiracy is performed in NZ.

### R v Richards

* Facts
    Thompson regularly bought heroin from Richards.
    Myers, Thompson's friend, asked Thompson to help him score some drugs.
    Thomspon got the drugs for Myers from Richards.
    Thompson was charged with conspiracy to supply and manufacture.
* Held
* A conspiracy is committed when the agreement is complete.
* The agreement must occur before the “object crime”. An agreement to supply and then later deliver, is sufficient.
* There must be a causal link btwn the agreement and crime taking place. If a party will have no influence over intended conduct (eg. acquiescence to a course of conduct) – there is no conspiracy.
* An exchange of promises is implied in some circumstances.
* The defendant encouraged supply, and knew that manufacture was necessary, therefore he agreed to it.
* There was no intention to actively assist in manufacture but support of whole operation means defendant is a conspirator to manufacture.
* A person who organises or encourages at the outset can be a conspirator if, at the time of the agreement, he expressly or impliedly commits to be a supporter in principle of the project, available to assist in ways that may not yet be specified.
* A drug user not only agrees that others should make and supply drugs but that he will continue to actively encourage and receive drugs.
* For the Crown to establish conspiracy, it must prove 4 things:
       (a) that the accused formed a common intention w/ at least one conspirator
       (b) that intention was expressed by agreement
       (c) the course of conduct, if carried out, would be a crime; and
       (d) that the agreement included intentional promise to actively assist AND made commission more likely (e.g influential, indicated commitment)
# New Zealand Law/Criminal/Evidence
## Evidence (Testimony)
### Veracity

General rule: no person may offer evidence about anyone's veracity unless it is substantially helpful.

### Propensity Evidence

Normal rule: A person may offer propensity evidence about any person except the defendant and a complainant in a sex case.

## Questioning of Witnesses
### Disallowing a question

A judge may disallow a question, or direct a witness not to answer, if the judge considers the question:
    (a) improper
    (b) unfair
    (c) misleading
    (d) needlessly repetitive; or
    (e) in language that is too complicated.

## Definitions
### Hearsay Statement

* A statement made by a person other than a witness offered in evidence to prove the truth of the statement. (Hearsay evidence is not normally admissible.)

### Opinion Statement

* A statement, offered in evidence, that tends to prove or disprove a fact. Opinion statements are not usually admissible.

### Associated defendant

* A person against whom proceedings instituted for:
    (a) an offence in relation to the same events; or
    (b) a connected offence.

### Veracity

The disposition to refrain from lying.

### Propensity Evidence

* Evidence that tends to show a person's tendency to act in a particular way or have a particular state of mind.

### Minister of Religion

A Minister of Religion is a person who has status in a church, or religious or spiritual community to:
    (a) receive confidential communications; and
    (b) respond with religious or spiritual advice, benefit or comfort.

### View

* Inspection of a place or thing outside the courtroom.
# New Zealand Law/Criminal/Demanding
## Definition

* By force or threat and without claim of right compelling any person to execute, make, accept, endorse, alter or destroy any document capable of conferring any pecuniary advantage with intent to obtain a benefit; OR
* With menace or by threat, demanding any property from any person with intent to steal it.
# New Zealand Law/Criminal/Burglary
## Burglary
### Definition

* Entering* any building or ship w/o authority and w/ intent to commit a crime; OR
* Having entered any building or ship remaining w/o authority and w/ intent to commit a crime.
(*Entering – as soon as any part of the body, or any instrument is within the building or ship.)

## Aggravated Burglary
### Definition

* Having a weapon or using anything as a weapon while committing burglary
* Having a weapon or using anything as a weapon in the building or ship after having commited burglary OR
* Being armed with a weapon with intent to burgle.

## Disguised or in Possession of Instrument of Burglary
### Definition

Without lawful excuse or authority:
    (a) having in possession any instrument capable of being used for burglary with intent to use it for that purpose; or
    (b) having one’s face covered or disguised with intent to commit a crime.