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12 Flashcards

1
Q

A 52 year old woman presents with irregular vaginal bleeding. Endometrial biopsy shows endometrial hyperplasia without atypia. Trans-vaginal scan identifies a 7 cm solid tumour in the right ovary. What is the most likely diagnosis?

A

Granulosa cell tumour

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2
Q

management genital warts

A

Genital warts - Podophyllin, 5-fluorouracil and interferon. Cryotherapy, Electro-cautery & Laser treatment are alternatives

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3
Q

management gonorrhea

A

Gonorrhoea – cefixime

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4
Q

when do most VTE events occur

A

antenatally

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5
Q

risk of needing a blood transfusion following physiological management of 3rd stage

A

40/1000

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6
Q

22-year-old woman 7 weeks pregnant. Her Chlamydia test is positive. Which is the single most appropriate treatment?

A

Azithromycin

CANNOT GIVE DOXY TO PREGNANT PEOPLE

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7
Q

What is the estimated gestational age at crown-rump length of 10 mm?

A

7 weeks

Gestation by CRL is calculated:
Weeks = 5.2876 + (0.1584 * Crown_Rump_Length) - (0.0007 * Crown_Rump_Length2). This will be gestation at time of ultrasound.

5.3 + (0.16 x10) - (0.0007 x 10 squared) =

5.3 + 1.6 - 0.07 =

7 weeks

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8
Q

Which one is typical of haemolytic anaemia?

A

Schistocytes on blood film

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9
Q

Which one is an ultrasound scan sign indicating a tubal ectopic pregnancy?

A

adenexal mass seperate to ovary

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10
Q

he cause of hyperprolactinaemia in women with polycystic ovary syndrome

A

oestrogen stimulation

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11
Q

4 The risk of having a baby with a congenital anomaly in a woman with epilepsy treated with low dose carbamazepine monotherapy

A

2-4%

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12
Q

Which type of ovarian cancer occurs which BRCA 1 mutation?

A

papillary serous cystadenocarcinoma

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13
Q

For overactive bladder a drug called Mirabegron is used. Which is the single mechanism of action for this drug?

A

Selective Beta 3 AGONST (go go)

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14
Q

A woman has been diagnosed with carrying the BRCA1 gene. What is her life time risk of breast cancer and ovarian cancer?

A

Ovarian cancer = 65%, breast cancer = 85%

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15
Q

A 34-year-old woman attends antenatal clinic for a routine ultrasound scan. Abnormalities of placentation are detected and an MRI scan is organized by the fetal medicine consultant. The MRI report shows: The placenta is located in the lower anterior aspect of the uterus and invades through the myometrium up to the uterine serosa. What is the most likely diagnosis?

A

PERCRETA

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16
Q

The proportion of first trimester miscarriages that have evidence of chromosomal rearrangements

A

5%

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17
Q

A 24 year old woman attends the antenatal clinic at 20 weeks. She has one previous lower segment caesarean section for breech presentation and is considering planned vaginal birth. What is the risk of uterine rupture?

A

1/200 - 1/250

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18
Q

Fetal to maternal concentrations of phenylalanine are typically

A

2:1

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19
Q

women using PATCH standard combined hormonal contraceptives, the hormone-free period begins

A

when patch is removed

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20
Q

Following intramuscular injection of ergometrine, uterine contractions persist for

A

3 hours

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21
Q

The life-time risk of breast cancer in men in the UK

A

0.1%

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22
Q

A 24 year old woman is using epidural for analgesia in the first stage of labour. What is the lowest level of the block required for effective analgesia?

A

T10

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23
Q

The incidence of early-onset group B streptococcus disease in the UK in the absence of routine screening

A

0.1-1.0 per 1000 births

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24
Q

A 23 year old woman contacts the maternity assessment unit at 11 weeks of gestation because her 5 year old son has just developed chickenpox. The woman does not recall a personal history of chickenpox.

A

blood for varicella zoster IgG and IgM + Oral acyclovir in 7 days if susceptible

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25
Q

The most common side-effect in women using remifentanil for labour analgesia

A

dizzy

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26
Q

The incidence of monozygotic twins is what world wide

A

consistent

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27
Q

A general practitioner telephones about a 44 year old woman who is taking the progestogen-only pill. She has not had any periods for 9 months and wishes to stop contraception. FSH = 20 IU

A

cont for 2 years post LMP

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28
Q

The cut-off for cervical length indicating a positive result in a woman presenting with symptoms of pre-term labour at 32 weeks of gestation

A

less 15mm

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29
Q

The Rotterdam criteria for diagnosing PCOS include biochemical evidence of

A

hyper ANDROGENAEMIA

PCOS is a diagnosis of exclusion and other conditions must be excluded. The recommended baseline screening tests are TFT, serum prolactin and a free androgen index (total testosterone divided by SHBG x 100)

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30
Q

The proportion of women who need chemotherapy after a partial molar pregnancy

A

0.5-1%

after a COMPLETE molar 13-16%

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31
Q

A 23 year old woman contacts the maternity assessment unit at 11 weeks of gestation because her 5 year old son has just developed chickenpox. The woman does not recall a personal history of chickenpox.

A

C Blood for varicella zoster IgG and IgM + Oral acyclovir in 7 days if susceptible

acyclovir 7-14 days post exposure

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32
Q

A 23 year old woman presents in spontaneous labour at 38 weeks gestation. She is found to be 5 cm dilated with intact membranes on vaginal examination. Following the examination, the fetal heart rate is 60-70 bpm and CTG is started. You are called urgently because the fetal heart rate has been 60-70 bpm for 4 minutes despite changes in maternal position. All maternal observations are normal and the uterus is relaxed between contractions (3-4 every 10 minutes).

A

LSCS

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33
Q

If fertilization is day 0, implantation is complete

A

day 12

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34
Q

The epithelium of the fallopian tube

A

cilliated columnar epitherlieum

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35
Q

The antero-posterior diameter of pelvic inlet in the female

A

12

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36
Q

The abdominal wall defect in gastroschisis is typically located

A

to the right of the umbilicus

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37
Q

Which bacteria typically cause toxic shock syndrome?

A

Coagulase positive staphylococci
staph aureus

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38
Q

Beta lactam antibiotics are effective against what

A

Effective against all gram positive bacteria and gram negative cocci

excreted renally

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39
Q

Tetracycline antibiotics are effective against which

A

Are effective against mycoplasma

Penetrate tissues well and are active against intracellular bacteria

  • Effective against chlamydial, mycoplasma and rickettsiae infections

Inhibit bacterial protein synthesis by preventing aminoacyl tRNA from entering the acceptor site on ribosomes

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40
Q

Trimethoprim is effective against what

A

Effective against gram negative bacilli EXCEPT pseudomonas

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41
Q

A 23 year old woman complains of vaginal discharge. On examination, there is a scanty white vaginal discharge with an erythematous cervix. Microscopy of an ectocervical swab shows cells with a peri-nuclear halo. What is the most likely causative organism?

A

HPV

perinuclear halo = hpv

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42
Q

Organism that causes hospital-acquired infections

A

Pseudomonas, aerobic Gram –ve
Staphylococcus, aerobic, Gram +ve

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43
Q

What is the mechanism of action of zidovudine?

A

Nucleoside / nucleotide reverse transcriptase inhibitor

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44
Q

What is the mechanism of action of lamivudine?

A

Nucleoside / nucleotide reverse transcriptase inhibitor

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45
Q

What is the mechanism of action of nevirapine?

A

Non-nucleoside reverse transcriptase inhibitor

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46
Q

What is the mechanism of action of Efavirenz?

A

Non-nucleoside reverse transcriptase inhibitor

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47
Q

What is the mechanism of action of lopinavir?

A

Protease inhibitor

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48
Q

endotoxins

A

Are lipopolysaccharide molecules
Relatively heat stable
Detectable by the Limulus test
Do not stimulate production of natural anti-toxins
Produced by E. coli, N. meningitides, S. typhi, P. aeruginosa

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49
Q

the structure on the HIV virus that allows it to enter the host cell is a

A

glycoprotein

50
Q

Isoniazide is predominantly metabolised by

A

Acetylation

51
Q

Pyridoxine is typically used to reduce the risk of side-effects associated with which drug?

A

Isoniazide

52
Q

The internal anal sphincter is composed of

A

Circular layer of smooth muscle

53
Q

The structure arrested in prophase 1 during oogenesis

A

primary oocyte

54
Q

The antero-posterior diameter of pelvic inlet in the female

A

12

55
Q

Which structure / organ does not develop from neural crest cells?

A

Cysterna chyli

56
Q

Glucocorticoids are secreted from which region of the adrenal gland?

A

Zona fasciculata

57
Q

Pituitary cells producing prolactin

A

Lactotroph, acidophil

58
Q

This hormone acts by stimulating insulin-like growth factor release by the live

A

grwoth hormone

59
Q

Anti-Mullerian hormone is secreted by

A

Granulosa cells

60
Q

Stimulates deposition of cartilage at the ends of bones

A

growth hormone

61
Q

Oxytocin is typically associated with

A

inc peristalsis

62
Q

Order the androgens from most potent to least potent

A

Androstendione, Testosterone, Dihydrotestosterone, DHEA-sulfate

63
Q

Which of the following eicosanoids are mainly increased in the endometrium before menstruation?

A

C Proataglandin F2 alpha

64
Q

4 From what parent compound are most eicosanoids derived?

A

Arachidonic acid

65
Q

Physiological variation of the menstrual cycle between 21-35 days due to

A

variation in the length of the follicular phase

66
Q

Recognised haematological changes in pregnancy include

A

Mean cell volume is increased
Plasma and urinary erythropoietin concentrations are increased
Platelet count falls at term while the leucocyte count is increased slightly
Iron demand is increased with increased absorption from the gut.
Total serum iron binding capacity is increased with decreased serum iron and serum ferritin. Transferrin concentration increased
Erythrocyte free protoporphyrin is increased
Reticulocyte count may increase in pregnancy

67
Q

The change in total red cell mass by the end of the first trimester in normal pregnancy

A

25-30%

68
Q

The change in serum albumin concentration by 24 weeks gestation

A

-20%

69
Q

A 23 year old woman has haemoglobin electrophoresis because of her ethnic origin. Levels of HbA2 are raised and HbA and HbS are present. What is the diagnosis?

A

sickle cell trait

70
Q

Main site of phosphate excretion

A

kidneys

71
Q

The structure of renin

A

PROTEIN

72
Q

The transport of amino acids across the placenta

A

secondary active transport

73
Q

Bile acids include

A

Cholic acid and Chenodeoxycholic acid

74
Q

Normal cardiac end diastolic volume

A

about 125mL

75
Q

What type of compound is Histones?

A

positivitvely charged proteins

76
Q

Which one of the following stages of the cell cycle is preceded by mitosis?

A

G1

77
Q

What is the function of DNA polymerase?

A

dna synthesis

78
Q

what is not a typical feature of osteogenesis imperfect type I?

A Blue sclera
B Recurrent fractures
C Normal life span
D Nerve conduction deafness
E Bone tumours

A

bone tumors

79
Q

Which one is not a typical feature of congenital adrenal hyperplasia?
A Primary amenorrhoea
B Premature ovarian failure
C Secondary amenorrhoea
D Elevated plasma ACTH
E Elevated plasma 17-hydroxyprogesterone

A

B premature ovarian failure

80
Q

Women with phenylketonuria need what dietary changes during pregnancy

A

Need a low phenylalanine diet during pregnancy

81
Q

A 23 year old woman attends the antenatal clinic at 10 weeks gestation. Her father has haemophilia A

A

There is a 25% chance that the woman’s child would be a carrier

82
Q

A 23 year old woman suffers a stillbirth at 26 weeks gestation and the baby is found to have Downs syndrome. The woman has a normal karyotype but her husband is found to have a 14q21q balanced translocation. What are the chances of the couple having another baby with trisomy 21?

A

2% when MALES carry the translocation

10% when FEMALES carry the translocation

83
Q

What percentage of Down occur due to Robertsonian Translocation?

A

3%

84
Q

The standard for conventional cytogenetic analysis of human chromosomes is

A

Metaphase spread (karyotype)

85
Q

During which one of the following stages of the cell cycle does mitosis proceeds?

A

G2

86
Q

Which one is involved in the acute inflammatory response?
A von Willebrand factor
B Nitric oxide
C Bradykinin
D Prostacyclin
E All of the above

A

All ove the above

87
Q

The most common benign epithelial ovarian tumour

A

Serous cystadenoma

88
Q

Which one is not a characteristic feature of the maintenance phase of acute tubular necrosis?
A Hypokalaemia
B Oliguria
C Raised serum creatinine
D Salt retention
E Water retention

A

A Hypokalaemia

89
Q

what type of condition is lichen sclerosis

A

auto immune

90
Q

Which one is not a recognized feature of vulval lichen sclerosus?
A Involvement of the peri-anal skin
B Involvement of the vaginal mucosa
C Narrowing of the introitus
D Fissuring
E Hyperkeratosis

A

B Involvement of the vaginal mucosa

91
Q

Clear cell carcinoma of the vagina is what type of cancer

A

adenocarcinoma

92
Q

During acute inflammatory response

A

White blood cells emigrate through the vascular basement membrane into the extra-vascular space

93
Q

Which one is not associated with metaplasia

A Squamous cell carcinoma of the bronchus B Barrett’s oesophagus
C Endometroid adenocarcinoma of the ovary D Mucinous adenocarcinoma of the ovary
E Cervical cancer

A

E Cervical cancer

94
Q

Endometrial cancer spreads where

A

internal iliac and paraaortic

95
Q

A histological diagnosis of endometriosis is made by the identification of

A

Haemosiderin-laden macrophages

96
Q

Ovarian granulosa cell tumours can present with what

A

PMB

97
Q

Ovarian Leydig cell tumours may present with what

A

ammenorrhoea and virilisation

98
Q

Ability to identify a true positive

A Power
B Error
C Sensitivity
D Bias
E Specificity

A

Specificity

99
Q

A random source of inaccuracy

A

error

100
Q

The z value for the 99% confidence interval is

A

2.58

Important component of confidence intervals
Measures the number of standard errors to be added and subtracted in order to achieve your desired confidence level

80% z = 1.28

85% z = 1.44

90% z = 1.64

95% z = 1.96

98% z = 2.33

99% z = 2.58

101
Q

A research scientist undertakes a study in a primary school. The students answer questions as TRUE or FALSE. The data are

A Ordinal B Nominal
C Ratio D Interval
E Paired

A

B NORMINAL

Nominal / categorical - names or categories that do not use / require an order - eye colour, sex, ethnic group. The values of the scale have no ‘numeric’ meaning

102
Q

Ten students sat an exam with the following scores: 10, 11, 11, 12, 14, 18, 20, 22, 25, 27. Calculate the interquartile range.

A

11

Approach to calculating IQR is below

The interquartile range is a measure of where the “middle fifty” is in a data set; a measure of where the bulk of the values lie. It is preferred over many other measures of spread
The range is a measure of where the beginning and end are in a set
The interquartile range formula is the first quartile subtracted from the third quartile:
IQR = Q3 – Q1

Count all numbers out around middle, then half again and take middle number of group 1-3

103
Q

Granulated white blood cells with phagocytic activity

A

Neutrophils

104
Q

Sample size 30, variance 25 and standard error of mean 3. What is the standard deviation?

A

5

square root of variance

105
Q

Diagnostic studies frequently use a receiver operating characteristic curve. If the area under the curve is 0.99

A The test has a sensitivity of 99% B The test has a specificity of 99%
C The test is an almost perfect diagnostic test D The test has a negative likelihood ratio of 0.99
E The test has a positive likelihood ratio of 0.01

A

C The test is an almost perfect diagnostic test

106
Q

You wish to investigate the time it takes to perform a caesarean section on women with and without pre-eclampsia. At the end of the study you have two groups of women with the duration of caesarean sections recorded for each. It cannot be assumed that these are normally distributed. Which test would you use?

A Paired t-test B Chi-squared test
C ANOVA test D Mann-Whitney U test
E Unpaired t-test

A

Mann-Whitney U test

one of the most powerful non-parametric tests for comparing two populations. It is used to test the null hypothesis that two populations have identical distribution functions against the alternative hypothesis that the two distribution functions differ only with respect to location (median), if at all

107
Q

30 year old woman has a radiological test during pregnancy. She is informed that her baby will need monitoring of thyroid function tests after birth. Which test did the woman have?

A

CTPA

108
Q

A clinical research fellow is examining the relationship between myocardial infarction in women aged 50-60 years and an obstetric history of pre-eclampsia, correcting for other variables including smoking, diabetes mellitus and BMI. Which one is the most appropriate analysis?

A Pearson correlation coefficient
B Multiple regression analysis
C Multiple logistic regression analysis
D Simple logistic regression analysis
E Spearman correlation coefficient

A

Multiple logistic regression analysis

109
Q

Which bacteria typically cause toxic shock syndrome?

A

Coagulase positive staphylococci

110
Q

Tetracycline antibiotics …

A Inhibit bacterial cell wall synthesis
B Are ineffective against intra-cellular organisms
C Do not cross the placenta
D Are effective against mycoplasma
E Are poorly absorbed from the GI tract

A

D Are effective against mycoplasma

111
Q

Iodophores (7.5 – 10%) used for surgical disinfection

A Have no activity against Mycobacterium tuberculosis
B Are effective in destroying viruses and fungi
C Are effective in destroying endospores
D Should not be used as surgical scrub
E Should not be used to disinfect the vagina

A

Useful as surgical scrub and skin prep
Can be used on mucous membranes

are effective against viruses and fungi

112
Q

Varicella zoster infection is contagious

A

48 h before rash

113
Q

An obligate intracellular gram negative bacterium

A

neisseriea gonorrhea

114
Q

Exotoxins are

A

Highly toxic polypeptides produced by living bacteria *
Act at specific target sites *
Are highly antigenic (except Cl. Tetani toxin)
Are converted into antigenic non-toxic toxoids by formalin *
Are often destroyed by heat
Are neutralised by anti-toxins *
Typically produced by gram positive bacteria *

115
Q

Endotoxins are

A

Are lipopolysaccharide molecules
Present in the outer layer of the cell wall of gram negative bacteria, released on disintergration
Relatively heat stable
Not converted into toxoid by formalin
Act non-specifically on the reticulo-endothelial system causing increased vascular permeability and prostaglandin release
May cause DIC and cardiovascular collapse
Detectable by the Limulus test
Do not stimulate production of natural anti-toxins
Produced by E. coli, N. meningitides, S. typhi, P. aeruginosa

116
Q

Screening test for iron deficiency anaemia

A

mean cell volume

117
Q

The Pfannestiel incision is situated where

A

2-3cm above pubic symphysis

118
Q

Down’s syndrome is associated with

A

Lower maternal serum pregnancy associated plasma protein A in the first trimester

119
Q

In the pelvic organ prolapse quantification (POPQ) system, the most distal (dependent) edge of the cervix is point

A

c

120
Q

The proportion of women who need chemotherapy after a partial molar pregnancy

A

0.5-1%

121
Q

A 49-year-old female asks about the benefits and risks of hormone replacement therapy (HRT) to control the effects of menopause. The use of hormone replacement therapy (HRT) will decreases the risk of which cancer?

A Ovarian cancer B Breast cancer
C Cervical cancer D Melanoma
E Colorectal cancer

A

Colorectal cancer

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