9th Flashcards
management
1
Q
During pudendal block, the end of the needle guard should be placed
A
1 cm anterior + medial to ischial spine
2
Q
The success rate of a pudendal block is about
A
50%
3
Q
A 23 year old woman has induction of labour at 41 weeks gestation. She progresses to 8 cm dilatation. Which feature would be considered abnormal on the CTG?
A
Variable decelerations with no concerning characteristics for 115 minutes
4
Q
A 23 year old primigravida presents in spontaneous labour at 38 weeks of gestation. The cervix is 5 cm dilated. Four hours later, the cervix is 9 cm dilated with intact membranes. There are 4 contractions every 10 minutes.
A
reassess in 2 hours
5
Q
A healthy 29 year old woman with one previous lower segment caesarean section presents in spontaneous labour at 39 weeks of gestation. Uterine rupture most commonly occurs
A
4-5cm
6
Q
Minor post-partum haemorrhage refers to blood loss
A
Of 500 to 1000 ml without clinical shock
7
Q
During the transversus abdominis plane (TAP) block, the needle goes through
A
Skin, sub-cutaneous tissue, external oblique and internal oblique muscles
8
Q
Which one is a recognised complication of the transversus abdominis plane (TAP) block?
A
bowel injury
9
Q
You are performing a vaginal operative delivery and the leading point of the fetal skull is 1 cm below the ischial spines. The fetal head is not palpable per abdomen. This is classified as
A
mid-cavity
0-1cm below spines
(low = -2cm)
10
Q
When testing for anaesthesia prior to caesarean section, what is the lowest level of the block needed to ensure the woman is pain free?
A
T5
11
Q
Mechanism of action of Indomethacin
A
COX inhibitor
12
Q
Following a water birth, a woman elects not to have oxytocics for the management of the third stage of labour. Thirty minutes later, she is brought to the consultant unit with a postpartum haemorrhage owing to an atonic uterus. If she had received standard oxytocic management for the third stage of labour, by what amount would she have reduced her risk of a postpartum haemorrhage?
A
47%
13
Q
A 30 year old primigravida presents in spontaneous labour at 38 weeks of gestation. The cervix is 5cm dilated with intact membranes. CTG is commenced because of epidural analgesia. All maternal observations are normal with 3-4 contractions every 10 minutes. You are asked to review the CTG because the baseline variability has been less than 5 bpm for 30 minutes with a baseline FHR of 140 bpm. There are no decelerations and no accelerations. Maternal position has been changed on three occasions.
A
r/v 20 mins
14
Q
A healthy 52 year old woman has urodynamic stress incontinence which has not improved with physiotherapy. She is awaiting surgical treatment and would like medical treatment to reduce the embarrassment of incontinence
A
Duloxetine
15
Q
he mechanism of action of aspirin differs from that of ibuprofen in that
A
Aspirin causes irreversible COX inhibition and ibuprofen causes reversible COX inhibition
16
Q
The plasma half life of oxytocin following intra-muscular injection
A
1-6mins
17
Q
11 Which drug is associated with constriction of the ductus arteriosus?
A
INDOMETHACIN
18
Q
Professional antigen-presenting cells
A
Dendritic cells
19
Q
Which cells secrete histamine and serotonin
A
Basophils
20
Q
Which cell type secretes heparin and histamine?
A
Mast Cells
21
Q
Which of the following cell types lyses cells that have been infected with virus?
A
cytotoxic T cells
22
Q
Histamine is released by
A
Mast cells and Basophils
23
Q
Hep B vaccine is a
A
sub unit virus vaccine
24
Q
Which class of immunoglobulin is predominantly involved inactivating the classical complement pathway?
A
IgM
25
Extra-genital lichen sclerosus looks like what
Is usually described as having a cigarette-paper-like appearance
26
Autoimmune is not a recognised sub-group of which condition
lichen simplex
27
vulval lichen simplex presents with
thickened scaly skin, excoriations, loss of pubic hair and erosions
28
Vaginal adenosis is associated with what
in-utero exposure to diethysitlbestrol
29
In CIN II, dysplastic cells are confined to
lower 2/3rd epithelium
30
Carcinoma of the cervix usually arised where
squamo-columnar junctitno
31
A 23 year old woman has undergone chorionic villus sampling at 13 weeks gestation following a ‘high risk’ result from the combined test. She should be informed that the results will be available
48-72 hours
32
The proportion of human pre-implantation embryos that show mosaicism is
50%
33
The standard for conventional cytogenetic analysis of human chromosomes is
comparative genomic hybridisation
34
In which one of the following stages of the cell cycle does the cell become quiescent?
G0
quiescent - stat of inactivity
35
Co-factor in the synthesis of clotting factors
vit K
36
The Cori cycle typically occurs when
During strenuous exercise
37
Glucose-6-phosphatase plays an important role in
Gluconeogenesis
38
The main enzymes of the citric acid (Krebs) cycle are located in the
mitochondria
39
Where does fatty acid synthesis occur within the cell?
The cytosol
40
The change in maternal cardiac out-put by 12 weeks gestation
40%
41
Change in renal plasma flow at 24 weeks gestation compared to pre-pregnancy
75% inc
42
During labour maternal oxygen consumption increased by
60%
43
The change in glomerular filtration rate by 24 weeks in a normal pregnancy
50%
44
Normal pregnancy is associated with what change in aldosterone sectretion
increased
45
Which organ removes old red blood cells from the circulation?
spleen
46
Pre-pubertal girls have
low progesterone levels, oestrogen, LH and FSH levels
47
what effect does progesterone have on uterine contractions
inhibits contractions
thickens cervical mucus,
48
Maternal serum HCG concentration peaks at
10 weeks
peaks at 100,000 international unites
reducesto 10,000-20,000 untis at 18-20 weeks and remains here until term.
49
42 year old woman has an endometrial biopsy because of heavy menstrual bleeding. Histology shows tortuous endometrial glands with glycogen and lipid vacoules. In which phase of the menstrual cycle was the sample taken?
secretory phase
50
Gestational diabetes insipidus occurs as a result of
Placental production of vasopressinase
51
Gestational diabetes insipidus typically presents in
3rd trimester
52
During pregnancy, the concentration of 17 alpha hydroxyprogesterone is lowest when
at 10 weeks
53
Compared to levels in non-pregnant women, serum prolactin levels in pregnancy are increased
x20
54
Mechanism by which the effects of prostaglandins are mediated
paracrine
55
Site where prolactin secretion is not affected by dopamine
UTERINE DECIDUA
56
Completion of first meiosis division during oogenesis
PUBERTY
57
The appendix testis is derived from
MULLERIAN DUCT
58
THE OVARY FORMS FROM
The gonadal ridge develops medial to the mesonephros by proliferation of the coelomic epithelium and condensation of the underlying mesenchyme, forming the primitive sex cords
59
fetal urine productions begins
week 12
The mesonephros is functional between the 6th - 10th week, producing urine.
Metanephros - permanent kidney (MRCOG 1)
Develops in the 5th-15th week from the metanephric mesoderm in the sacral region
Ureters - develop from the ureteric bud, an outgrowth of the mesonephric duct close to its opening into the cloaca (MRCOG 1). Grows into the metanephric mesoderm, successive divisions forming the renal pelvis, major and minor calyces and collecting tubules
The metanephric mesoderm develops into the excretory units under inductive influence of the ureteric bud, forming the Bowman’s capsule and excretory tubules. If the ureteric bud is missing, the kidney does not develop
The metanephros is functional from the 10th week
60
Glucose uptake by the placentA
FASCILIATED DIFFUSION
61
With respect to the transfer of amino acids from the maternal to fetal circulation
NA+ DEPENDANT TRANSPORTERS
62
According to the Green-top guidelines CVS should NOT be performed before what gestational age
10
63
What is the approximate risk of uterine perforation in diagnostic hysteroscopy?
0.1%
64
The femoral triangle contains
Femoral nerve and terminal branches.
Femoral sheath.
Femoral artery and branches.
Femoral vein and its proximal tributaries inc SFJ
Deep inguinal lymph nodes & lymphatic vessels.
65
The primary stimulus for ADH (anti-diuretic hormone AKA Vasopressin) release is
high serum osmolality
66
The pudendal nerve exits the pelvis via
greater sciatic foreman
67
WHO defines the perinatal mortality rate as
: The number of stillbirths and deaths in the first week of life per 1000 births
68
At what stage of fetal development does fetal haemoglobin (HbF) replace embryonic haemoglobin (HbE) as the primary form of haemoglobin?
10-12 weeks
69
With regard to primary vaginal cancer what is the most likely type?
squamous cell carcinoma
70
pubic symphysis, what type of joint is it
secondary cartilaginous join
71
The histology shows Psammoma bodies. What type of tumour would this be consistent with?
serous
72
What vein does the IMV drain into?
the splenic vein
73
Which of the following Oestragens (Estrogens) becomes the predominant circulating oestrogen during pregnancy?
Estriol (E3).
74
the predominant oestrogen during female reproductive years
Estradiol (E2)
75
Obesity causes what in SHBG.
drop
less shbg = more testosterone = hirtuisum
76
Blood supply to the lateral aspects of the cerebral hemispheres
middle cerebral
77
Blood supply to the superior-medial aspects of the parietal lobes of the brain
anterior cerebral
78
normal PR interval
0.12-0.20 seconds
79
normal qrs interval
0.06 - 0.10
80
normal QT interval
0.3 - 0.43 (0.45 women)
81
A 36 year old woman is known to have essential hypertension treated with ramipril. She attends for pre-conception advice as she is planning a pregnancy. Her BP is 125/75 mmHg. Which one of the above options is correct?
ramipril should be changed
82
risk factors for pre-eclampsia
HTN, renal disease, diabetes, thrombophilia, FH
83
What is an indication for the use of graduated elastic compression stockings during pregnancy?
During the antenatal period in all women with a previous thromboembolic event
84
A 34 year old woman has been admitted because of pulmonary embolism and is treated with low molecular weight heparin. Test to monitor anticoagulant effect should be done
3 hours
85
screening test for haemolytic anaemia
haptoglobin
Protein that binds free Hb released from erythrocytes with high affinity
The haptoglobin-hemoglobin complex will then be removed by the reticuloendothelial system (mostly the spleen)
Haptoglobin assay is used to screen for and monitor intravascular hemolytic anemia
86
Phenylketonuria is caused by a deficiency of
Phyenlalanine Hydroxylase
87
A healthy 23 year old woman had high blood pressure in her first pregnancy but further details are unavailable. She attends the antenatal clinic at 10 weeks of gestation. What is her risk of developing pre-eclampsia in this pregnancy?
1/5
88
A healthy 23 year old woman developed pre-eclampsia in her first pregnancy. She attends the antenatal clinic at 10 weeks of gestation. What is her risk of developing hypertensive disease in this pregnancy?
1/7
89
A healthy 25 year old woman developed pre-eclampsia in her first pregnancy. Delivery was required at 32 weeks of gestation. She attends the antenatal clinic at 10 weeks of gestation. What is the risk of her developing pre-eclampsia?
1/3
90
Maternal breast exposure to radiation during CT pulmonary angiography (CTPA)
10 mGy
91
Graves disease is caused by
Thyroid stimulating immunoglobulin
92
TSH receptor antibodies are typically found in patients with
Graves disease
93
Isoniazid is metabolised by
Hepatic N acyetyl transferase
94
antedote DABIGATRAN
idarucizumab
95
The most common feature of warfarin embryopathy is
nasal hypoplasia
96
accurately describes the mode of action of letrozole?
NON STEROID REVERSIBLE AROMATASE INHIBITOR
97
The recommended first-line treatment for clostridium difficile infection
oral Vanc
98
MacConkey agar is used to
Identify gram negative bacteria using lactose fermentation
99
Receptor binds to ligand in the cytosol resulting in dimerization and translocation to the nucleus
oestrogen
100
Receptor binding results in conversion of Phosphatidylinositol 4,5-bisphosphate into Phosphatidylinositol 3,4,5-trisphosphate
insulin receptor - tyrosine kinase
Binding of ligand triggers autophosphorylation of the tyrosine residues, with each subunit phosphorylating its partner. This then catalyses the conversion of Phosphatidylinositol 4,5-bisphosphate into Phosphatidylinositol 3,4,5-trisphosphate (PIP3).
PIP3 acts as a second messenger and induces the activation of phosphatidylinositol dependant protein kinase, which then activates several other kinases – most notably protein kinase B. PKB triggers the translocation of glucose transporter (GLUT4) containing vesicles to the cell membrane
101
The main metabolic action of glucagon
stimulate hepatic glycogenolysis (break down of glycogen)
102
The adrenal medulla produces catecholamines of which %
85% adrenaline, 15% noradrenaline
chromaffin cells from neural crest
103
Which amino acids characteristically potentiate glucose-stimulated insulin secretion?
arginine and lysine
104
insulin stimulations what from hepatic glucose
Stimulates fatty acid production from hepatic glucose
105
what will stimulate both glucagon and insulin secretion
alanine and arginine
106
Glucagon secretion is stimulated by
amino acides, hypoglcaemia and exercise
107
symptoms of phaechromocytoma
headache, tachy, hyperhidrosis
108
UNCONJUGATED BILIRUBIN x blood brain barrier
= kernicturis
109
The breakdown of this protein makes the largest contribution to total bilirubin concentration
haemoglobin
110
Phagocytic cells are present in the fetus during the
1st trimester
111
A premature infant develops progressive difficulty breathing over the first few days of life. Deficient surfactant synthesis by which of the following cell types may have contributed to the respiratory problems?
type 2 pneumocyte
112
how many codons are there
64
113
when is the cell tetraploid
G2
114
A 32 year old woman attends the antenatal clinic at 10 weeks gestation. Her 5 year old son has just been diagnosed with neuromuscular disorder. She has been told that he will be wheel-chair bound by the age of 12 years.
X linked recessive
(duchenne - onset by 5, wheelchair by 12)
115
A five year old boy has been diagnosed with Duchenne muscular dystrophy. There is no family history of the disease. what will his muscle biopsy show
His muscle biopsy will show an absence of dystrophin on immunohistochemistry
116
Which has a better prognosis Becker or Duchenne
Becker
117
Androgen insensitivity syndrome is cuased by
a mutation in the gene fro androgen receptors
X linked Recessive - female pheotype, increased risk of gonadoblastoma, infertility, 46XY karyotype, NO UTERUS
118
In pre-menopausal women, endometrial tuberculosis is associated with
histological evidence of chronic endometritis
119
Endometrial sarcomas are homologous if they contrain
endometrial stromal and / or glandular tissue only
120
The most common site of endometriosis is
ovary
121
Red degenerations is caused by
fibroid outgrowing blood supply
122
In a region with 250,000 live births, there are 75 maternal deaths related to pregnancy and 250 stillbirths. What is the Maternal mortality ratio?
Number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes)
250,000 live births and 75 maternal deaths
100,000 live births (divide by 2.5) = 75 /2.5 maternal deaths = 30
123
Ability to identify a true negative
sensitivity
124
A study is undertaken on high risk HPV vaccination in a particular district. Ten thousand children are included in the study with a mean age of 15 years and the variance is 9. What is the standard error?
Standard deviation = square root of 9 = 3
Sample size n = 10,000
Square root of n = 100
Standard error = 3 / 100 = 0.03
Standard Deviation - square root of the variance. It is the most commonly used measure of spread (MRCOG) *
125
trial has been conducted to investigate the effect of tranexamic acid on blood loss following vaginal delivery. 1921 women were randomised to tranexamic acid and 1918 to placebo. Postpartum haemorrhage (PPH, blood loss of at least 500 ml), occurred in 156 women (8.1%) in the tranexamic acid group and in 188 (9.8%) in the placebo group. Which one is the most appropriate statistical test to analyse these data?
chi squared
PPH = categorical variable. 2 x 2 contingency table and number in each cell greater than 5
2 groups – Tranexamic acid / Placebo = categorical variables
Blood loss = continuous variable and large sample size means normal distribution can be assumed
Arterial embolism or surgery for PPH = categorical variable. 2 x 2 contingency table with small numbers (3 and 5) means Fisher’s exact test should be used.
126
A trainee is undertaking a PhD project looking at the expression of myosin light-chain phosphatase in the non-pregnant and pregnant myometrium. Myometrial samples are collected from non-pregnant (n = 12), term pregnant not in labour (n = 15) and term pregnant in labour (n = 20) women and the expression of myosin light-chain phosphatase determined by quantitative PCR. Which one is the most appropriate statistical test?
Quantitative PCR would determine mRNA concentration and generate continuous data
Sample size is small (12 – 20) therefore data will not be normally distributed
3 independent groups (non-pregnant, pregnant not in labour and pregnant in labour)
Kruskal-Wallis test therefore appropriate
127
With respect to the utility of clinical tests, a highly specific test is useful in
ruling in
128
A researcher wishes to assess the postoperative recover for a group of postmenopausal women who had hysterectomy. He classified the patients as felt worse, same, improve. Which type of measurement is this classification?
ordinal
Ordinal - numbers, names or categories. Data are ordered - for instance, pain scores of 1-10
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
129
Lancefield grouping of streptococci is based on
carbohydrate composition of cell wall antigens
130
Infection with listeria monocytogenes in pregnancy should be treated with
AMPICILLIN
131
Exposure to warfarin in-utero is associated with
DIAPHRAGMATIC HERNIA
132
Drug transport across cell membranes is due to
non-ionisation
133
A 34 year old woman with bi-polar disorder attends the antenatal clinic at 10 weeks gestation. This is an unplanned pregnancy and the woman has been taking lithium carbonate
risk cardiac abnormalities 60/1000
134
The risk of neonatal herpes following vaginal birth to a woman with recurrent genital herpes around the time of delivery
1%
135
A healthy 29 year old woman develops chickenpox 10 days before her planned caesarean section. What is the risk of the new born baby developing chickenpox if no intervention is offered?
23%
136
A 32 year old woman develops primary cytomegalovirus infection in the third trimester. What is the risk of the fetus being infected?
40-70%
137
22 year old woman develops chicken pox at 20 weeks of gestation. What is her risk of developing pneumonitis?
10%
138
A 29 year old woman has contacted the maternity assessment unit at 14 weeks of gestation because her 5 year old son has just been diagnosed with chickenpox. The woman has no history of chickenpox. Her booking bloods were tested and the woman is varicella zoster IgG and IgM negative. If no treatment is offered, what is her risk of developing chickenpox?
70-80%
139
The incubation period of measles
10-14 days
140
A 27 year old teacher telephones the maternity assessment unit at 15 weeks of gestation. There has been an outbreak of measles in her school and she has been in contact with some of the infected children. She does not know if she has been vaccinated against measles.
screen booking bloods
141
Varicella zoster infection is associated with a risk of congenital anomalies if infection occurs before
28w
