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
2
Q
management genital warts
A
Genital warts - Podophyllin, 5-fluorouracil and interferon. Cryotherapy, Electro-cautery & Laser treatment are alternatives
3
Q
management gonorrhea
A
Gonorrhoea – cefixime
4
Q
when do most VTE events occur
A
antenatally
5
Q
risk of needing a blood transfusion following physiological management of 3rd stage
A
40/1000
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
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
8
Q
Which one is typical of haemolytic anaemia?
A
Schistocytes on blood film
9
Q
Which one is an ultrasound scan sign indicating a tubal ectopic pregnancy?
A
adenexal mass seperate to ovary
10
Q
he cause of hyperprolactinaemia in women with polycystic ovary syndrome
A
oestrogen stimulation
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%
12
Q
Which type of ovarian cancer occurs which BRCA 1 mutation?
A
papillary serous cystadenocarcinoma
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)
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%
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
16
Q
The proportion of first trimester miscarriages that have evidence of chromosomal rearrangements
A
5%
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
18
Q
Fetal to maternal concentrations of phenylalanine are typically
A
2:1
19
Q
women using PATCH standard combined hormonal contraceptives, the hormone-free period begins
A
when patch is removed
20
Q
Following intramuscular injection of ergometrine, uterine contractions persist for
A
3 hours
21
Q
The life-time risk of breast cancer in men in the UK
A
0.1%
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
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
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
25
The most common side-effect in women using remifentanil for labour analgesia
dizzy
26
The incidence of monozygotic twins is what world wide
consistent
27
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
cont for 2 years post LMP
28
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
less 15mm
29
The Rotterdam criteria for diagnosing PCOS include biochemical evidence of
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)
30
The proportion of women who need chemotherapy after a partial molar pregnancy
0.5-1%
after a COMPLETE molar 13-16%
31
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.
C Blood for varicella zoster IgG and IgM + Oral acyclovir in 7 days if susceptible
acyclovir 7-14 days post exposure
32
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).
LSCS
33
If fertilization is day 0, implantation is complete
day 12
34
The epithelium of the fallopian tube
cilliated columnar epitherlieum
35
The antero-posterior diameter of pelvic inlet in the female
12
36
The abdominal wall defect in gastroschisis is typically located
to the right of the umbilicus
37
Which bacteria typically cause toxic shock syndrome?
Coagulase positive staphylococci
staph aureus
38
Beta lactam antibiotics are effective against what
Effective against all gram positive bacteria and gram negative cocci
excreted renally
39
Tetracycline antibiotics are effective against which
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
40
Trimethoprim is effective against what
Effective against gram negative bacilli EXCEPT pseudomonas
41
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?
HPV
perinuclear halo = hpv
42
Organism that causes hospital-acquired infections
Pseudomonas, aerobic Gram –ve
Staphylococcus, aerobic, Gram +ve
43
What is the mechanism of action of zidovudine?
Nucleoside / nucleotide reverse transcriptase inhibitor
44
What is the mechanism of action of lamivudine?
Nucleoside / nucleotide reverse transcriptase inhibitor
45
What is the mechanism of action of nevirapine?
Non-nucleoside reverse transcriptase inhibitor
46
What is the mechanism of action of Efavirenz?
Non-nucleoside reverse transcriptase inhibitor
47
What is the mechanism of action of lopinavir?
Protease inhibitor
48
endotoxins
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
49
the structure on the HIV virus that allows it to enter the host cell is a
glycoprotein
50
Isoniazide is predominantly metabolised by
Acetylation
51
Pyridoxine is typically used to reduce the risk of side-effects associated with which drug?
Isoniazide
52
The internal anal sphincter is composed of
Circular layer of smooth muscle
53
The structure arrested in prophase 1 during oogenesis
primary oocyte
54
The antero-posterior diameter of pelvic inlet in the female
12
55
Which structure / organ does not develop from neural crest cells?
Cysterna chyli
56
Glucocorticoids are secreted from which region of the adrenal gland?
Zona fasciculata
57
Pituitary cells producing prolactin
Lactotroph, acidophil
58
This hormone acts by stimulating insulin-like growth factor release by the live
grwoth hormone
59
Anti-Mullerian hormone is secreted by
Granulosa cells
60
Stimulates deposition of cartilage at the ends of bones
growth hormone
61
Oxytocin is typically associated with
inc peristalsis
62
Order the androgens from most potent to least potent
Androstendione, Testosterone, Dihydrotestosterone, DHEA-sulfate
63
Which of the following eicosanoids are mainly increased in the endometrium before menstruation?
C Proataglandin F2 alpha
64
4 From what parent compound are most eicosanoids derived?
Arachidonic acid
65
Physiological variation of the menstrual cycle between 21-35 days due to
variation in the length of the follicular phase
66
Recognised haematological changes in pregnancy include
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
The change in total red cell mass by the end of the first trimester in normal pregnancy
25-30%
68
The change in serum albumin concentration by 24 weeks gestation
-20%
69
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?
sickle cell trait
70
Main site of phosphate excretion
kidneys
71
The structure of renin
PROTEIN
72
The transport of amino acids across the placenta
secondary active transport
73
Bile acids include
Cholic acid and Chenodeoxycholic acid
74
Normal cardiac end diastolic volume
about 125mL
75
What type of compound is Histones?
positivitvely charged proteins
76
Which one of the following stages of the cell cycle is preceded by mitosis?
G1
77
What is the function of DNA polymerase?
dna synthesis
78
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
bone tumors
79
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
B premature ovarian failure
80
Women with phenylketonuria need what dietary changes during pregnancy
Need a low phenylalanine diet during pregnancy
81
A 23 year old woman attends the antenatal clinic at 10 weeks gestation. Her father has haemophilia A
There is a 25% chance that the woman’s child would be a carrier
82
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?
2% when MALES carry the translocation
10% when FEMALES carry the translocation
83
What percentage of Down occur due to Robertsonian Translocation?
3%
84
The standard for conventional cytogenetic analysis of human chromosomes is
Metaphase spread (karyotype)
85
During which one of the following stages of the cell cycle does mitosis proceeds?
G2
86
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
All ove the above
87
The most common benign epithelial ovarian tumour
Serous cystadenoma
88
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 Hypokalaemia
89
what type of condition is lichen sclerosis
auto immune
90
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
B Involvement of the vaginal mucosa
91
Clear cell carcinoma of the vagina is what type of cancer
adenocarcinoma
92
During acute inflammatory response
White blood cells emigrate through the vascular basement membrane into the extra-vascular space
93
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
E Cervical cancer
94
Endometrial cancer spreads where
internal iliac and paraaortic
95
A histological diagnosis of endometriosis is made by the identification of
Haemosiderin-laden macrophages
96
Ovarian granulosa cell tumours can present with what
PMB
97
Ovarian Leydig cell tumours may present with what
ammenorrhoea and virilisation
98
Ability to identify a true positive
A Power
B Error
C Sensitivity
D Bias
E Specificity
Specificity
99
A random source of inaccuracy
error
100
The z value for the 99% confidence interval is
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
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
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
Ten students sat an exam with the following scores: 10, 11, 11, 12, 14, 18, 20, 22, 25, 27. Calculate the interquartile range.
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
Granulated white blood cells with phagocytic activity
Neutrophils
104
Sample size 30, variance 25 and standard error of mean 3. What is the standard deviation?
5
square root of variance
105
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
C The test is an almost perfect diagnostic test
106
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
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
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?
CTPA
108
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
Multiple logistic regression analysis
109
Which bacteria typically cause toxic shock syndrome?
Coagulase positive staphylococci
110
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
D Are effective against mycoplasma
111
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
Useful as surgical scrub and skin prep
Can be used on mucous membranes
are effective against viruses and fungi
112
Varicella zoster infection is contagious
48 h before rash
113
An obligate intracellular gram negative bacterium
neisseriea gonorrhea
114
Exotoxins are
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
Endotoxins are
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
Screening test for iron deficiency anaemia
mean cell volume
117
The Pfannestiel incision is situated where
2-3cm above pubic symphysis
118
Down’s syndrome is associated with
Lower maternal serum pregnancy associated plasma protein A in the first trimester
119
In the pelvic organ prolapse quantification (POPQ) system, the most distal (dependent) edge of the cervix is point
c
120
The proportion of women who need chemotherapy after a partial molar pregnancy
0.5-1%
121
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
Colorectal cancer
