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Deck 1 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

The median umbilical ligament is the embryological remnant of what fetal structure?

A

Urachus

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2
Q

The medial umbilical ligament is the embryological remnant of what fetal structure?

A

Fetal umbilical arteries

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3
Q

The superficial inguinal ring is strengthened posteriorly by which structure?

A

Conjoint tendon (Falx inguinalis)

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4
Q

In women, the inguinal canal transmits the round ligament to the labia majora. Which nerve also traverses the inguinal canal, exiting via the superficial inguinal ring?

A

Ilioinguinal nerve

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5
Q

Ilioinguinal nerve has motor supply to which muscles?

A

Internal oblique and transverses abdominus, so strengthens conjoint tendon

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6
Q

A urinary catheter is vigorously inflated in the urethra at the time of caesarean section. Urine leaks from the rupture into which anatomical space?

A

Anterior abdominal wall and mons pubis

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7
Q

The inferior hypogastric plexus is an important plexus supplying the hind gut. The sympathetic components are derived from the superior hypogastric plexus. What are the three nerve root origins of the parasympathetic components?

A

The parasympathetic components are carried by branches from S2, S3 and S4, which are the pelvic splanchnic nerves.

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8
Q

Which three muscles form the superficial group of muscles of the perineum?

A

Bulbospongiosus, superficial transverse perineal muscles and ischiocavernous

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9
Q

Sympathetic supply to the bladder is derived from which segments of the spinal cord?

A

L1/L2

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10
Q

The lower third of the vagina has lymphatic drainage to which lymphatic nodes?

A
  • Created via canalization of ectodermal thickening
  • Superficial inguinal nodes
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11
Q

Upper 2/3 vagina lymph drainage

A

External and internal iliac nodes
- Created from fusion of mesonephric ducts

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12
Q

A baby’s birth was complicated by shoulder dystocia and he was subsequently diagnosed with Erb’s palsy. Which component of the brachial plexus is most likely to be involved?

A

-C5/C6
- Pronation of forearm, internal rotation of shoulder, adduction of shoulder

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13
Q

A woman presents as an emergency with a painful lump in the vagina, and examination confirms that she has a Bartholin’s abscess. Which gland is involved?

A

Greater vestibular gland

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14
Q

If a woman sustains an ischaemic injury to the pelvic ureter, which artery supplying it has been occluded?

A

Superior or inferior vesicle

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15
Q

Abdominal ureter blood supply

A

Renal artery, ovarian artery and direct branches from aorta

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16
Q

What pelvic structure is lined by non-keratinised stratified squamous epithelium?

A

Vagina

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17
Q

Epithelium endocervix

A

Simple columnar (non-stratified)

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18
Q

Epithelium ectocervix

A

Stratified squamous, non-keratinized

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19
Q

Epithelium fallopian tubes

A

Simple columnar ciliated

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20
Q

Epithelium uterus

A

Simple columnar

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21
Q

Epithelium kidney

A

Simple cuboidal

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22
Q

Epithelium bladder/ureters

A

Transitional

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23
Q

Epithelium male urethra

A

Prostatic is transitional, membranous is stratified columnar, urethral opening is stratified squamous

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24
Q

A 28-year-old woman presents to the gynaecology clinic with a history of dysmenorrhoea, premenstrual pain and dyspareunia. Vaginal examination reveals a thickened nodule in the posterior fornix. Which anatomical structure is most likely to be affected?

A

Uterosacral ligament

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25
Q

A consultant anaesthetist is teaching a junior anaesthetist how to administer a spinal anaesthetic for a caesarean section. At what level in the spine does the spinal cord end and the cauda equina begin?

A

Spinal cord ends L1/L2, so performed at L3/L4 or L4/L5
Cauda equine exists in lumbar cistern, between arachnoid membrane and pia mater.

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26
Q

What is the lymphatic drainage of the ovaries?

A

Lateral aortic and pre/para aortic

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27
Q

Lymphatic drainage bladder

A

External (most), internal and common iliac

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28
Q

Lymphatic drainage ureters

A

Internal iliac nodes

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29
Q

Fallopian tubes + fundus of uterus lymphatic drainage

A

External and superficial iliac via round ligament or para-aortic (passMRCOG)

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30
Q

Cervix lymph drainage

A

External iliac (most), internal iliac, sacral, rectal and obturator

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31
Q

Uterus lymph drainage

A

Internal iliac nodes

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32
Q

An obstetric trainee is repairing a medio-lateral episiotomy following a ventouse delivery. Which nerve supplies the area of skin being sutured?

A

Pudendal nerve

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33
Q

What part of the spermatozoa has the highest concentration of mitochondria?

A

Middle piece

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34
Q

What type of cells are sertoli cells as defined by shape?

A

Tall columnar

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35
Q

What is the layer between the theca cells and the mural granulosa?

A

Basal lamina

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36
Q

With regard to ovulation, what is the fluid filled space in a follicle called?

A

Antrum

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37
Q

What size is a resting follicle?

A

0.02mm

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38
Q

What size is a follicle that is ready to ovulate?

A

20mm

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39
Q

What coats luminal surface of bladder?

A

A glycosaminoglycan layer coats the luminal surface of the bladder mucosa

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40
Q

The internal pudendal artery leaves the pelvis via what structure?

A

Greater sciatic foramen (branch of anterior internal iliac artery) and re-enters via lesser sciatic foramen

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41
Q

The most favourable pelvic shape of the bony pelvis for childbirth is the gynaecoid pelvis. Which is the largest diameter of the maternal pelvic inlet in this type of pelvis?

A

Between the farthest two points on the iliopectineal lines

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42
Q

Pelvic inlet boundaries

A
  • Sacral promontory
  • Alae of sacrum
  • Sacroiliac joints
  • Pubic tubercles
  • Pubic crests
  • Iliopectinal lines
  • Iliopectinal eminences
  • Upper border superior pubic rami
  • Upper border pubic symphysis
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43
Q

Through which foramen does the facial nerve exit the cranium?

A

Stylomastoid foramen

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44
Q

Mento-vertical presentation

A

14cm brow presentation

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45
Q

Occipito-frontal presentation

A

11.5cm deflexed vertex OP

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46
Q

Submento-bregmatic presentation

A

9.5cm Face presentation

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47
Q

Suboccipito-bregmatic presentation

A

9.5cm flexed vertex

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48
Q

Suboccipito-frontal 10.5cm

A

Partially deflexed vertex

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49
Q

Which ligament has been pierced by the epidural needle when ‘loss of resistance’ is experienced?

A

Ligamentum flavum
Skin, subcutaneous fat, supraspinous ligament, interspinous ligament ,ligaments flavum, epidural space –> dura mater

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50
Q

What is the narrowest part of the Fallopian tube?

A

Isthmus

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51
Q

There is a portal system which allows the hypothalamus to communicate with the anterior pituitary via the release of neurotransmitters into the bloodstream. Which artery directly supplies this portal system?

A

Superior hypophyseal artery (branch of internal carotid)

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52
Q

Which arteries directly contribute blood into the Circle of Willis?

A

Terminal branches of internal carotid and vertebral arteries.
- Anterior cerebral (internal carotid) , posterior cerebral (basilar artery) and internal carotid
- Anterior and posterior communicating provide connections.

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53
Q

Which nerve fibres lie in the ovarian fossa?

A

Obturator nerve

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54
Q

Which part of the adrenal gland exhibits the chromaffin reaction (catecholamine precursor molecules within the cytoplasm of the cells which are coloured brown by chromium salts)?

A

Adrenal medulla

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55
Q

Which pelvic muscle is the sacrospinous ligament part of?

A

Coccygeus

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56
Q

Which muscle does the deep part of the external anal sphincter blend with?

A

Puborectalis

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57
Q

Which of these ligaments are a supporting structure for the uterus?

A
  • Uterosacral, transverse cervical (cardinal) and pubocervical liagaments
    Infundibulopelvic ligament is ovarian suspensory ligament, in broad ligament and carries ovarian vessels
  • Round ligament: anterverts uterus but does not provide support.
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58
Q

As a result of electrophysiological studies, the motor supply to the levator ani group of muscles is now thought to enter the muscle from above via perineal branches of nerves.

Which nerve roots are the origin of these nerves?

A

S3/S4 (perineal branch pudendal nerve)

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59
Q

Pain from the uterus in labour is referred to the lumbo-sacral region, lower abdomen and loins. Which is the route that the afferent pain fibres take to the spinal cord?

A

Sympathetic fibers via inferior hypogastric plexus

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60
Q

The most common and favourable type of pelvis for vaginal birth is wide and open in shape, giving the baby plenty of room during delivery. Which type of female pelvis is this?

A

Gynecoid pelvis

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61
Q

What is Anthropoid pelvis?

A

long narrow oval shape pelvis, occurring in 25%.

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62
Q

What is Platypelloid pelvis?

A

wide pelvis flattened at the brim, present in 5% of women.

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63
Q

During this operation, ligation of which artery poses the greatest risk to the integrity of the ureter?

A

Uterine artery

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64
Q

Abdominal ureter blood supply

A

Renal artery, ovarian artery and direct from aorta

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65
Q

Pelvic ureter

A

superior/inferior vesicle artery

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66
Q

Ovaries epithelium

A

cuboidal

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67
Q

Separation of deep and superficial perineal pouches

A

Superior border deep = superior fascia of urogenital diaphragm
Inferior border = perineal membrane (inferior fascia of urogenital diaphragm)

Superior border superficial pouch = perineal membrane (inferior fascia of urogenital diaphragm)

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68
Q

In the process of fertilisation, what is the correct sequence for sperm penetration into the oocyte?

A

Corona radiata, zona pellucida, perivitelline space, plasma membrane

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69
Q

With regard to cardiovascular changes in pregnancy, what are the physiological changes by the third trimester?

A

The answer is 30% increase in blood volume, 45% increase in plasma volume and 20–30% increase in red blood cell volume. There is a relative increase in the plasma volume compared to red cell volume that causes dilutional anaemia.

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70
Q

What is the primary haemoglobin type in the baby at 32 weeks of gestation?

A

Hb F is produced from 6 weeks gestation and the levels remain high until the baby is a couple of months old.

Hb Gower-1 is a form of haemoglobin existing only during embryonic life and has two zeta chains and two epsilon chains.

Gower-2 exists at low levels during embryonic and fetal life and has two alpha chains and two epsilon chains. Portland-1 exists at low levels during embryonic and fetal life and has two zeta chains and two gamma chains. Portland-2 also exists at low levels and is composed of two zeta chains and two beta chains.

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71
Q

At what gestation does fetal urine become the major contributor to amniotic fluid volume?

A

18 weeks

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72
Q

Who should take 5mg folic acid?

A

As well as diabetics, women with spina bifida, a family history or previous affected pregnancy and women who are on epileptic or anti-retroviral medication are advised to take 5mg per day. The higher dose is also recommended for obese women (BMI >30), women with sickle cell anaemia, thalassaemia and coeliac disease.

Patients with coeliac disease or who eat a vegan diet may be short of iron and vitamin B12.

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73
Q

At what gestational age does the formation of the definitive alveoli take place?

A

The alveolar stage starts at 36 week and may take up to 2 years postnatal to complete.

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74
Q

Which test is used to diagnose haemolytic anaemia in a newborn?

A

Direct Coombs test

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75
Q

Signs of hypoglycaemia and hypocalcaemia are often similar. Which sign will help differentiate the two in a newborn?

A

Increased muscle tone

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76
Q

The physiological changes in pregnancy are associated with a change in serum concentration of various hormones. Which blood test is most appropriate in diagnosing thyroid dysfunction in pregnancy?

A

Free thyroxine (T4)

Total T4 and T3 levels are raised in pregnancy. hyroid-stimulating hormone levels fall in the first trimester as concentration of human chorionic gonadotropin rise, however they may occasionally rise. The levels of free T4 are altered less in pregnancy.

Pregnancy is associated with a relative iodine deficiency, which has two major causes. Maternal iodine requirement increases because of active transport to the fetoplacental unit. Also there is increased iodine excretion due to increased glomerular filtration and decreased renal tubular excretion.

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77
Q

A woman presents to the antenatal clinic at 30 weeks of gestation with vulval varicosities. What is the most likely cause?

A

Pressure effect of the gravid uterus on the inferior vena cava

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78
Q

What is the normal circulatory lifespan of a red blood cell?

A

The answer is 120 days. The process of erythropoiesis takes 7 days from a stem cell.

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79
Q

What is the average lifespan of platelets?

A

The answer is 5–10 days. Platelets are produced from megakaryocytes

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80
Q

What is the physiological function of bile salts?

A

Facilitate the absorption of fats

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81
Q

Which vitamin found in liver should be avoided in excess in pregnancy?

A

Vitamin A

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82
Q

During the postpartum period the uterine cavity develops new endometrial layers.

How long does it take the placental bed to acquire a new endometrial layer?

A

Within 1 week the uterine cavity has a new endometrial layer, with the exception of the placental bed which takes around 3 weeks.

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83
Q

At what gestation is physiological anaemia most pronounced?

A

32 weeks

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84
Q

By what percentage does oxygen consumption rise in pregnancy?

A

20%

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85
Q

Which subunits are found in fetal haemoglobin?

A

Fetal haemoglobin is composed of two alpha subunits and two gamma subunits. It has a greater affinity for oxygen than adult haemoglobin which is composed of two alpha and two beta subunits.

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86
Q

Which two hormones are required for maintenance of milk secretion?

A

Prolactin and Oxytocin

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87
Q

What biochemical disturbance most commonly associated with hyperemesis?

A

hypokalemia

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88
Q

What sort of junctions are found within uterine myometrical cells?

A

Gap junctions

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89
Q

Which hormone is responsible for relaxation of the blood vessels in pregnancy?

A

Progesterone

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90
Q

With regard to gestational diabetes, what is the likely change in plasma free fatty acids (FFA) and plasma ketone bodies?

A

Increased FFA and increased ketone bodies

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91
Q

What cells are transformed by spermeogenesis?

A

Spermatids

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92
Q

How many times the normal range is alkaline phosphatase increased in pregnancy?

A

3 x

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93
Q

What is the increase in oxygen consumption in pregnancy?

A

50 ml/min

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94
Q

What is the change in total lung capacity in pregnancy?

A

Decreased by 200 mls

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95
Q

What proportion of body calcium is stored in the skeletal system?

A

99%

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96
Q

What is the WHO definition of osteoporosis?

A

The correct answer is a T score < –2.5

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97
Q

What happens to gallbladder motility and bile composition in pregnancy?

A

Decreases gallbladder motility and increases the lithogenicity of bile

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98
Q

Regarding rheumatoid arthritis in pregnancy, which of the following is correct?

A

Exacerbation tends to occur in puerperium

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99
Q

A primiparous 18-year-old woman presents to the maternity assessment unit at 39 weeks of gestation. Urinalysis reveals a proteinuria value of 3+. The woman has a blood pressure of 170/110 mmHg and she is suffering from a headache. What underlying pathology would brisk reflexes indicate?

A

Cerebral irritation

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100
Q

A woman from South East Asia books for antenatal care at 12 weeks of gestation. Her BMI is calculated at 40, she has no comorbidities and is already taking folic acid.

What vitamin should be prescribed for this woman during pregnancy?

A

Vitamin D deficiency is especially an issue for obese women and causes rickets in children.

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101
Q

A primiparous woman with a BMI of 40 from South East Asia is seen by you in antenatal clinic. The woman is at 24 weeks of gestation and has a fundal height of 30 cm. What initial investigation do you organise?

A

Glucose tolerance test.

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102
Q

Which food substance is especially rich in vitamin D?

A

Oily fish

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103
Q

After 24 weeks’ gestation, type II pneumocytes begin to appear in the developing alveoli of the fetus.

What is the function of these type II alveolar cells?

A

Secrete surfactant

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104
Q

What is their function within the cell?

A

Breaking down bacteria and worn-out cell part

The Golgi apparatus forms lysosomes, secretory vesicles and other cytoplasmic components. At term the maternal cardiac output is increased by 1.5 L/minute.

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105
Q

At term the maternal cardiac output is increased by 1.5 L/minute.

What percentage of this increased blood flow is distributed to the uterus?

A

Increased blood flow to the uterus is 400 ml/minute at term - therefore roughly 30%.

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106
Q

Which steriod hormone is produced by the placenta?

A

PROGESTERONE ONLY STEROID HORMONE. others are protein (peptide) hormones.

The human placenta acts as both a transport organ and an endocrine organ, producing important hormones such as chorionic gonadotrophin, progesterone, estrogens (especially estriol) and human placental lactogen.

The placenta also produces relaxin, melatonin, serotonin, oxytocin and kisspeptin.

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107
Q

At what gestation are the primordial follicles maximum in number in a female fetus?

A

20 weeks

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108
Q

Which wave form occurs at the end of atrial systole?

A

X wave

X wave occurs at the end of atrial systole.

A wave = atrial systole

C wave = ventricular systole

V wave = atrial filling against closed tricuspid valve

Y descent occurs following tricuspid valve opening

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109
Q

By what percentage does total blood volume usually increase above pre-pregnancy levels at term?

A

40%

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110
Q

Patient has had multiple vaginal deliveries and now has incontinence - which muscle is weak?

A

Pubococcygeal (or other levator ani muscles)

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111
Q

Principle of the Haldane effect:

A

Affinity of deoxygenated blood is increased for CO2

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112
Q

Patient complaining of weakness + muscle spasms. Likely electrolyte disturbance:

A

Hypocalaemia

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113
Q

Patient had paralytic ileum - which electrolyte disturbance makes it worse?

A

Hypokalaemia

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114
Q

HPL maximum production at:

A

35 weeks

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115
Q

Cite of prolactin production without effect of dopamine:

A

Maternal decidua

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116
Q

Piezoelective crystals used in which mode of imaging?

A

USS

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117
Q

What is raised in Down’s syndrome in the quadruple test?

A

Increased inhibin + HCG

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118
Q

Female Kleinfelter patient will have:

A

Normal stature (or tall stature), small gonads + infertile

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119
Q

Commonest cancer during pregnancy + puerperium

A

Breast cancer

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120
Q

Vulval cancer with hard base:

A

Squamous cell cancer

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121
Q

Which cells are involved in innate + adaptive immunity?

A

Lymphocytes

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122
Q

Enzyme needed for catecholamine synthesis:

A

catecholamines dopamine, norepinephrine, and epinephrine are synthesized by Tyrosine hydroxylase .

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123
Q

In prostaglandin, OH is attached at which position?

A

15

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124
Q

Nerve injured during sacrospinous fixation surgeries:

A

pudendal nerve.

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125
Q

Warfarin teratogenicity occurs when?

A

6-12 weeks

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126
Q

Enzyme required for synthesis of ammonia?

A

Glutaminase

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127
Q

MOA of Dalteparin:

A

Inhibition of Xa

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128
Q

MOA of Raltegavir

A

Inhibit integrase

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129
Q

Nerve root value of obturator nerve:

A

L2 L3 L4

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130
Q

Patient with VIN, which HPV involved?

A

16

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131
Q

Transverse suprapubic incision during C/S is at which spinal level?

A

T12/L1 (L1 most likely)

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132
Q

Which one of the following structures is the origin of the labia minora?

A

Urethral folds

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133
Q

GFR is maximum at which gestation

A

16 weeks

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134
Q

Metabolism of isoniazid is by:

A

Acetylation

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135
Q

Appearance/hemolysis of strep on agar is by:

A

Beta hemolysis

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136
Q

Chief characteristic of fetal Hb:

A

Resists denaturation by acid

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137
Q

Properties of ultrasound waves:

A

Absorption, scattering & reflection

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138
Q

Bacterial load increases as which compliment decreases?

A

C5

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139
Q

What is the chief function of the glucose-6-phosphate dehydrogenase enzyme?

A

NADPH production in red blood cells

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140
Q

What is the function of the enzyme glucose 6 phosphatase in carbohydrate metabolism?

A

Converts glucose 6 phospahte to glucose

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141
Q

Remnant of upper mesonephric duct commonly seen on laparoscopy?

A

Garnet’s duct cyst

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142
Q

Antibodies of Grave’s disease:

A

Thyroid peroxidase antibodies (raised in Hashimoto’s + Graves)

Thyroid stimulating hormone receptor antibodies (Graves)

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143
Q

MOA of Clomefine Citrate

A

selective estrogen receptor modulator

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144
Q

Significant p-value =

A

0.05

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145
Q

Lowest level of dermatome to abolish pain of uterus/labour pain?

A

L1

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146
Q

Patient with fibroid on ulipristal acetate then requiring additional contraception - which one should be used?

A

Barrier contraception

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147
Q

CMV lab tests:

A

A positive test for CMV IgG indicates that a person was infected with CMV at some time during their life but does not indicate when a person was infected.

The presence of CMV IgM cannot be used by itself to diagnose primary CMV infection because IgM can also be present during secondary CMV infection. IgM positive results in combination with low IgG avidity results are considered reliable evidence for primary infection, with limitations of avidity testing described below.

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148
Q

Advantage of Co2 later for endometriosis/endometrium because?

A

Prevents lateral thermal spread/no lateral spread

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149
Q

Implant MOA:

A

Inhibits ovulation

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150
Q

Patient with lung cancer + abdominal pain + polyuria. Electrolyte abnormality?

A

Hypercalcaemia

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151
Q

CTG paper speed

A

1cm/minute

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152
Q

Endometrial hyperplasia without atypia - risk of cancer?

A

5%

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153
Q

PPH ongoing - at what point would a patient have a platelet transfusion?

A

10,000
10 x 10^9

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154
Q

Chlamydia treatment:

A

Azithromycin or Doxycycline

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155
Q

Which growth factor is in granular tissue in a wound?

A

vascular endothelial growth factor

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156
Q

Melanoma prognosis is assessed by?

A

Lesional thickness

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157
Q

Chief hormone in the acrosome reaction?

A

hyaluronidase

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158
Q

Which nerve passes below the inguinal ligament?

A

Lateral cutaneous nerve of thigh

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159
Q

Which nerve passes in front of the psoas muscle?

A

Genitofemoral nerve

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160
Q

Oocytes develop from which structure?

A

Yolk sac

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161
Q

Passage of free fatty acids is by:

A

Passive diffusion

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162
Q

What is the nerve supply to the cervix?

A

hypogastric and pelvic splanchnic nerves

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163
Q

Torturous glands in endometrium after ovulation:

A

Secretory

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164
Q

Sacroiliac joint type:

A

Synovial

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165
Q

Definition of massive blood loss:

A
  • Greater or equal to 150mls per min
  • OR 100% blood volume per 24 hours
  • 50% blood volume in 2 hours
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166
Q

How much FFP given in massive bleeding?

A

15 to 20 ml/kg or 3 to 6 units (given after 4 units of RBCs)

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167
Q

How much oxytocin is given during CS?

A

5IU

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168
Q

How long is uplistrail contraceptive effective?

A

120 hours

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169
Q

What criteria used to diagnose BV?

A

Hay/Ison Criteria
Grade 3 = BV

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170
Q

Suspected PPROM + no liquor on speculum examination. Next steps?

A

Swab to detect the presence of amniotic fluid in the vaginal canal. High concentrations of AFP and PP12

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171
Q

Largest/long diameter fetal presentation is:

A

Mento-vertical

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172
Q

Pregnant women with twins + sudden rupture of membranes - first action:

A

vaginal exam to check for cord prolapse.

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173
Q

What amount of the body’s iron in hemoglobin:

A

75%

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174
Q

COCP UKMEC 4 conditions (A condition which represents an unacceptable health risk if the method is used)

A

<6 weeks postpartum (breastfeeding)
<3 weeks postpartum (not breastfeeding) + other risk factor VTE
Age ≥ 35 and smoking ≥15 cigarettes/day
History VTE
Migraine with aura

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175
Q

7 Stages of labour:

A

engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.

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176
Q

Contraindications to instrumental delivery:

A
  • Unengaged fetal head
  • Incompletely dilated cervix
  • True cephalo-pelvic disproportion
  • Breech and face presentations, and most brow presentations.
  • Preterm gestation (<34 weeks) for ventouse.
  • High likelihood of any fetal coagulation disorder for ventouse.
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177
Q

Which antibody will associate in blood cell coagulation?

A

IgM

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178
Q

Ciprofloxacin acts by inhibiting:

A

DNA gyrase

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179
Q

Cancer from pelvic viscera can deposits cancerous cells in the
vertebrae this communication occur between the internal iliac veins
and the vertebral veins through the:

A

Prosatatic plexus

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180
Q

Lipoprotein lipase does what:

A

Hydrolyses TAG in chylomicrons and VLDL

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181
Q

Female known case of ovarian CA presented with
Medial thigh Parasethia the nerve involved by CA is

A

Obturator nerve

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182
Q

How do free radicals cause cell damage:

A

ROS-induced peroxidation of polyunsaturated fatty acids in the cell membrane bilayer

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183
Q

Comment about left ureter:

A

Has lumeneal construction when enters the pelvic brim

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184
Q

Inguinal lymph nodes means cancer from where?

A

Vulval and anal cancer

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185
Q

Internal iliac lymph nodes mean cancer from where?

A

Uterus

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186
Q

Breakdown of 1gm Haemoglobin produces:

A

35mg of bilirubin

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187
Q

The active transport system for hepatic uptake
of bilirubin is congenitally defective in:

A

Gilbert’s disease

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188
Q

Excretion of conjugation bilirubin from liver
cells into biliary canaliculi is defective in:

A

Rotor’s syndrome

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189
Q

Half life of oxytocin:

A

3-6 mins

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190
Q

Biological activity of ACTH is completely
lost on removal of :

A

24 C-terminal amino acids

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191
Q

Measles is characterized by:

A

Koplik’s spots

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192
Q

Assessment of fetal anemia :

A

Middle cerebral artery

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193
Q

Red infarction develop in:

A

Intestine

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194
Q

very efficient inhibitor of steroid
biosynthesis is:

A

Aminoglutethimide

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195
Q

In the synthesis of Angiotensin I, rennin acts
on Angiotensinogen and cleaves the:

A

Leucine - leucine at 10 and 11 position

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196
Q

normal range of ionized
calcium in plasma is:

A

4-5 mg/dl

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197
Q

Lymphogranuloma venerum (LGV) is
sexually transmitted disease is caused by:

A

Chlamydia trachomatis

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198
Q

Scrup typhus is caused by:

A

Orientia tsutsugamushi

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199
Q

grading of tumour is best described as:

A

degree of differentiation

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200
Q

pure hypertrophy is seen in:

A

muscle of athletes

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201
Q

Healing by first intention means:

A

the surface of wound is rapidly covered by
epithelium

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202
Q

Tetanus is caused by spread of:

A

exotoxin in sympathetic system

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203
Q

Phenotype is determined by:

A

sex chromosome (XX- XY) karyotyping

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204
Q

After treatment of myocardial infarction,
injury occurs because of:

A

free radical

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205
Q

mature placenta composed of:

A

maternal blood vessels, syncytiotrophoblast,
fetal blood vessels

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206
Q

Genital tubercle gives rise to the:

A

Clitoris

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207
Q

Poly-A tails are found in:

A

eukaryotic mRNA

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208
Q

MOA Tamoxifen

A

selectively binds to estrogen receptors, producing both estrogenic and anti-estrogen effects

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209
Q

Complement based agglutination reaction is
known as:

A

haemagglutination

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210
Q

The technique involved in comparing the
DNA component of two sample is known as:

A

DNA finger printing

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211
Q

furosemide MOA

A

inhibtion of Na k cl co-transporter

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212
Q

Amiloride potent diuretic action by:

A

reversibly blocking luminal epithelial sodium channels

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213
Q

Benzodiazepine MOA:

A

Enhanced Cl channels that act on GABA neurotransmitters

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214
Q

45 years old treated for ovarian cancer developed difficulty hearing the cause is:

A

Cisplatin

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215
Q

Coombs test is positive and associated with heamolytic anaemia in :

A

Methyldopa

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216
Q

female diagnosed with TB. before prescribing treatment you should be aware of that one antituberculus induce cytochrome P450 enzyme in the liver

A

rifampicin

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217
Q

A nucleophilic attack on deoxyribonucleic acid which cause disruption of base pairing occurs as a result

A

Cyclophosphamide

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218
Q

Cardiotoxicity limits the clinical usefulness of which antitumor antibiotics:

A

Doxorubicin

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219
Q

SPIROMETRY CHART PASSMRCOG

A

SPIROMETRY CHART - IDENTIFY ALL VALUES

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220
Q

Reversible inhibition of cycloxgenase in platelets is caused by which drug?

A

Ibuprofen

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221
Q

Malignant tumer in trigone of the bladder metastasize to the following lymph nodes

A

Internal + External iliac nodes

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222
Q

Femoral ring definition:

A

1.25 inch lateral and below the pupic tubercle

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223
Q

Ammonia is a good buffer in urine because

A

Kidneys produce large amounts of NH3 in chronic acidosis

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224
Q

Which substance increases renal blood flow/renal surface area?

A

Dopamine

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225
Q

ECG p wave =

A

Atrial depolarization

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226
Q

ECG QRS complex =

A

Ventricular depolarisation

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227
Q

T wave ECG =

A

Ventricular repolarisation

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228
Q

U wave ECG =

A

repolarisation of the interventricular septum

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229
Q

Hypokalaemia ECG =

A

Flat T waves
U waves

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230
Q

Hypercalcaemia ECG =

A

short QT

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231
Q

Hypocalcaemia ECG =

A

long QT

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232
Q

Glomerular filteration rate would be increased by:

A

increase in afferent arteriolar pressure

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233
Q

Patient with HBV +ve (hepatitis B) and has co-infection with hepatitis D. Which blood factor would prove whether there is co-infection?

A

HBc IgM (IgM anti-HBc )

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234
Q

newborn with periventricular calcification commonly associated with:

A

Cytomegalovirus

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235
Q

Pyruvate carboxylase MOA

A

Converts pyruvate to oxaloacetate

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236
Q

Krukenberg Tumor of the Ovary is an example of what kind of spread?

A

Transcolomic Spread

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237
Q

-The class of antibiotics known as the quinolones are bactericidal. MOA:

A

Inhibition of DNA gyrase

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238
Q

N. gonorrhoeae is a fastidious pathogen and found in sites often contaminated with normal flora. The best medium for isolation is

A

Thayer-Martin agar

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239
Q

The latest and most effective therapy for AIDS patients includes azidothymidine (AZT), dideoxyinosine (DDI), and saquinavir or similar agents. Use
of these three drugs would inhibit which of the following viral processes?

A

Reverse transcriptase, protease

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240
Q

Which of the following viruses causes an acute febrile rash and pro- duces
disease in immunocompetent children but has been associated with transient
aplastic crises in persons with sickle cell disease?

A

Parvovirus

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241
Q

leukocyte adhesion by which molecules?

A

selectin

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242
Q

Exudate is caused by:

A

Chronic inflammation

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243
Q

Cell of chronic inflammation are:

A

macrophages with giant cell

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244
Q

Central chemoreceptors are signaled by:

A

CO2

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245
Q

In what condition do babies have Snuffles, aka “syphilitic rhinitis”?

A

Congenital syphilis

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246
Q

Thyroperoxidase used H2O2 as oxidative
agent. Hydrogen peroxide MOA:

A

NADPH dependent enzyme

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247
Q

Thyroid hormones in pregnancy:

A

Total T3 and T4 increase in pregnancy
TSH levels are typically lower in pregnancy than non-pregnant state
Free T3 and T4 levels drop from 1st to 3rd trimester (free T4 affected less than T3 and can be normal)

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248
Q

Mother has flu-like symptoms + then baby has fetal bradycardia + hepatosplenmegaly. Cause?

A

Listeria = listeria causes flu-like syndrome as opposed to CMV

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249
Q

Old inferior MI on ECG:

A

2, 3 AVF - q waves

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250
Q

Which USS resolution is maximum at the focal point or interface?

A

Axial resolution

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251
Q

How does USS damage tissue?

A

Cavitation

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252
Q

Power of electro-cautery SI unit

A

Watt

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253
Q

Iodine transport in the thyroid by which ion?

A

Chloride

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254
Q

CTPA to breast - what is the dosage?

A

20 Gy

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255
Q

Pseudomonas on Mac Conkey colour:

A

Colorless or pale yellow

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256
Q

Patient had history of colon cancer + surgery was done - picture of ovary post-hysterectomy. Diagnosis?

A

Ovarian metastasis

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257
Q

Male ejaculation from:

A

seminle vesicle

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258
Q

Phagocytosis cells include:

A

Macrophages

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259
Q

In ongoing PPH, fibrinogen should be maintained above:

A

2-4 ul

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260
Q

When is gestational sac visible on USS?

A

4wks+3d
3mm when visible

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261
Q

When is Yolk sac visible on USS?

A

5 to 5+3wks
3mm when visible
Gestational sac 10mm when yolk sac visible

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262
Q

When is Embryonic pole visible on USS?

A

5wks+3d to 6 wks
3mm when visible
Gestational sac 16mm when embryonic pole visible

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263
Q

TVS mean sac 23mm with no fetal pole visualized. Outcome?

A

Unknown viability

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264
Q

Commonest uterine sarcoma?

A

Leiomyosarcoma

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265
Q

What is the percentage of lymphocytes?

A

20-40%

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266
Q

Hypotension from a spinal is caused by?

A

preganglionic autonomic blockade

267
Q

What is the main action of parathyroid hormone?

A

Decrease calcium excretion

268
Q

Which inflammatory marker is not affected by prostaglandins?

A

Cytokines

269
Q

What is the precursor for Warfarin?

A

Pro-thrombin

270
Q

Which immune cells clear viruses?

A

CD8 T cells

271
Q

Which factor enables Vitamin B12 to be absorbed?

A

Intrinsic factor

272
Q

What is the antidote for Methotrexate?

A

folinic acid.

273
Q

What is the MOA of Trimethoprim?

A

Antifolate inhibitor that inhibits bacterial dihydrofolate reductase
(anti-metabolite)

274
Q

In a patent with megaloblastic anaemia, which test should be performed?

A

Serum Vit B 12

275
Q

TAP block at suprapubic level passes through which structures?

A

Transversus abdominus muscle and internal oblique muscle

276
Q

What are the chances of brachial plexus injury during shoulder dystocia?

A

2.3 -16%

277
Q

Fatty acids cross placenta by?

A

Passive transport

278
Q

What group of patients would you give antibiotics to if they have a catheter?

A

Diabetic

279
Q

What is the commonest verres needle injury just below bifurcation of aorta?

A

Superior hypogastric plexus

280
Q

The sex determining gene is on which chromosome?

A

Short arm of chromosome Y

281
Q

The sigmoid colon anatomy includes:

A

Mesentery
Inferior mesentery artery
Pre-aortic + inferior mesenteric nodes

282
Q

An indirect inguinal hernia is divided by:

A

Inferior epigastric artery

283
Q

Chorioamnionitis transfer is by which sort of spread?

A

Hematological

284
Q

The paravesicle + infra rectal structures are divided by which artery?

A

Uterine artery

285
Q

How long does it take for resting ovarian follicles to reach maturity?

A

300 days

286
Q

Which enzyme is used in NAAT testing?

A

TAQ polymerase

287
Q

Ammonia production includes which enzyme?

A

Glutamase

288
Q

In clear cell ovarian cancer, which electrolyte rises?

A

Calcium

289
Q

Epiphyseal plates are closed at puberty by which hormone?

A

Estradiol

290
Q

Post-menopausal with dysfunctional uterine bleeding with granuloma cell tumour. Endometrial changes are:

A

proliferative

291
Q

Which bands are in DNA?

A

G bands

292
Q

In pre-eclampsia, what are the main physical symptoms?

A

Hyper-reflexia + clonus

293
Q

The sacro-iliac joint fixation is by which nerve value?

A

S2-S4 pudendal nerve

294
Q

Which hormone maintains the corpus luteum?

A

HCG

295
Q

What is the other name for omega 3?

A

α-Linolenic acid

296
Q

Chlamydia causes which congenital infection?

A

Ophathalmoa neonatorum

297
Q

GBS Rx if pancillin allergy

A

Erytheromycin

298
Q

pt pregnant developed goiter
Which nerve injured or compressed:

A

Recurrent laryngeal nerce

299
Q

pt has eclampsia cause intracranial hemorrhage to which artery?

A

Middle cerebral Artery

300
Q

2nd arch structures:

A

Facial nerve
facial expression muscles
stapedius
stapedial artery
platysma
stylohyoid
posterior belly digastric

301
Q

Which gynecological cancer has miss match mutation?

A

Ovarian cancer

302
Q

Origin of allantois

A

Endoderm

303
Q

Spindle shape cells formation
With pulmonary pneumonia With Meigs syndrome. What will the patient have?

A

Fibroma

Meigs syndrome is defined as the triad of benign ovarian tumor with ascites and pleural effusion that resolves after resection of the tumor. Ovarian fibromas constitute the majority of the benign tumors seen in Meigs syndrome.

304
Q

ureteric bud formed from

A

Mesonephric duct

305
Q

Bladder trigone forms from:

A

Mesonephric duct

306
Q

Arterial supply to the anterior abdominal wall:

A

Inferior epigastric artery

307
Q

Where does ovarian pain radiate to?

A

Umbillicus

308
Q

Iliacus muscle (picture) nerve supply?

A

Femoral nerve

309
Q

Primary hyperaldosteronism will cause which biochemical defects?

A

Hypertension
Hypernatremia
Hypokalemia
metabolic alkalosis

310
Q

Ductus venosus joins which two structures?

A

IVC + umbilical vein in RA

311
Q

CRISPR contains what?

A

DNA + enzyme

312
Q

Which structure is on the medial side of Ant iliac spine?

A

Lateral cutaneous nerve

313
Q

Finasteride MOA:

A

competitive inhibitor of 5 alpha-reductase
reduces dihydrotestosterone

314
Q

What is the most common cause of the female urethral caruncle?

A

Hypoestrogenism

315
Q

contraindication of the use of oxybutynin?

A

Myasthenia gravis
narrow angle Glaucoma

316
Q

Active form of Vit-D is produced in which organ?

A

Kidney

317
Q

A 60-year-old with erythematous erosive lichen planus on the vulva. What type of cancer is linked to lichen planus?

A

Squamous cell carcinoma

318
Q

Which class I major histocompatibility complex human leucocyte antigen (HLA) is
Not expressed in extravillous trophoblast?

A

HLA-A + HLA-B

319
Q

The most biologically active form of vitamin D is

A

1, 25-Dihydroxycholecalciferol (calcitrol

320
Q

Joint which resist horizontal rotation of the pelvis

A

Sacroiliac

321
Q

Most common dermatitis in pregnancy( not around the umbilicus)

A

Polymorphic (PUPP)
Pruritic urticarial papules and plaques of pregnancy - begins in striae around umbillicus

322
Q

Most common protozoan causes zoonotic infection(cerebral calcification, retinitis)

A

Toxoplasma

323
Q

Prophylaxis dose of Anti D in 2 doses are prescribed at which Gest age?

A

28 + 34 weeks

324
Q

Which immunoglobulin is secreted in mucosa?

A

IgA

325
Q

Primary amenorrhea with blind pouch vagina + absent uterus + inguinal hernias =

A

Congenital androgen insensitivity syndrome
46,XY karotype

326
Q

Macrophages develop from:

A

Monocytes

327
Q

Which structure differentiates superficial perineal pouch from deep pouch?

A

Perineal membrane

328
Q

Maximum radiation exposure seen in:

A

Hysterosalpingogram

329
Q

Blood test done on mother to check fetal DNA?

A

Prenatal cell-free DNA

330
Q

Layer of endometrium ablated for menorrhagia?

A

Basal layer (functional layer of endometrium)

331
Q

Which hormones affect post-natal lactation?

A

Prolactin
Oxytocin

332
Q

Gestational age is which type of data?

A

Interval

333
Q

The spiral arteries invade into?

A

Syncytiotrophoblast
Extravilous trophoblast
Endovascular trophoblast

334
Q

25-year-old woman patient presents with number of small genital blisters. A swab results reveals a diagnosis of genital herpes. Which of the following is the best drug to be used to treat this patient?

A

Topical acyclovir

335
Q

Aspirin MOA

A

irreversibly inhibits both COX-1 and COX-2 (but mostly COX-1)

336
Q

External pudendal artery is branch of

A

Femoral artery

337
Q

Patient having hepatic surgery +
Hepatic artery pressed because of bleeding +
Some maneuver applied - where is the artery compressed?

A

Hapatic porta

338
Q

Co-factor of DNA synthesis:

A

Folate/folic acid

339
Q

Which complements are part of the MAC?

A

C5-9 (C5b-9)

340
Q

Pulmonary capillary wedge pressure:

A

between 4 to 12 mmHg (unchanged in pregnancy)

341
Q

post op TAH after 26 hrs fever 38c , what is the reason?

A

Physiological cytokines release

342
Q

65 yrs old - what is the residual volume?

A

100 mls

343
Q

shelf life of whole blood

A

7 weeks

344
Q

In pph first surgical intervention

A

Ballon tamponade

345
Q

Sacrospinous fixation which artery injured ?

A

Pudendal art

346
Q

prolactine secret from lactotrophes
How many lactotrophes in ant pituitary

A

20%

347
Q

Bile acid level harm for baby during pregnancy needs to deliver the baby ?

A

40

348
Q

Abortion risk at 30-34 years old?

A

10-15%

349
Q

Dabigatran anticoagulation MOA:

A

Inhibits thrombin

350
Q

A 22-year-old primiparous woman books her pregnancy at 11 weeks’ gestation. Her booking blood tests reveal a haemoglobin level of 10.1 g/dL. Electrophoresis reveals haemoglobin karyotype HbAS. What is the diagnosis?

A

Sickle cell trait

351
Q

32-year old woman complains of amenorrhea since delivery of a baby 15 months ago. The delivery was complicated by excessive hemorrhage that required transfusion of 2.5 liters of blood. Few days later she complained of failure to produce any breast milk. The most likely cause for this is damage to which of the following endocrine glands?

A

Anterior pituitary

352
Q

How to calculate risk of type 2 error?

A

1 - power

353
Q

40-year-old woman who had a laparoscopic tubal ligation 6 hours previously complains of abdominal pain, not relieved with analgesics. On examination a tender cystic mass felt under umbilicus with oozing pus from one of the port sites.
What is the likely diagnosis?

A

Urinary retention

354
Q

fetus with abdominal anomaly
Liver and intestinal parts not covering with Amnion
Diagnosis?

A

gastroschisis

355
Q

major blood supply to transverse colon

A

SMA

356
Q

major nerve innervation to detrusor bladder

A

hypogastric

sympathetic via hypogastric N. T12-L2
parasympathetic via pelvic N. S2-S4
Somatic inervation via pudendal N. S2-S4

357
Q

diagram showing laparoscopy view of d pelvis. A vessel was pointed at stating dt one wouldn’t go beyond that during pelvic lymphadenectomy

A

umbilical artery (obliterated)

358
Q

Vitelline duct connects

A

Mid gut (small intestine) and yolk sac

359
Q

the developing liver and billiary duct arises from

A

Ventral mesentry

360
Q

choroid plexus develops from:

A

pia and ependyma

361
Q

During development of liver and biliary system , hepatic bud invaginate into which structure

A

Septum transversum

362
Q

Lowest part of vagina is derived from

A

Endoderm

363
Q

Paroxetine effects which system in the fetus?

A

CVS

364
Q

Allantois is derived from:

A

Endoderm

365
Q

Which condition is characterized by eosinophilia + hyponatremia?

A

Addison’s

366
Q

Test for Addison’s:

A

9am Cortisol & Synacthen test

Synacthen test < 100 = Admit
100-500 =refer endocrinology
>500 = normal

Hypotension, hyponatraemia & hyperkalaemia

367
Q

Test for cushing’s:

A

Dexamethasone suppression test or 24-hour urinary cortisol

368
Q

Test for Conn’s:

A

Renin/aldosterone ratio, saline (salt) suppression or fludrocortisone suppression test

369
Q

Organelle where lipids are synthesized

A

SER

370
Q

Organelle that contains the enzymes for glycolysis:

A

Cytoplasm

371
Q

What type of organism is Chlamydia?

A

Obligate intracellular

372
Q

Risk of gestational diabetes continuing as type-2 diabetes?

A

50%

373
Q

Anatomy of heart vessels from R - L

A

Svc , aorta, pulm A

374
Q

Which syndrome also results in premature menopause?

A

Turner’s syndrome
menopause precedes menarche as no ovarian function

375
Q

Which type of diathermy uses return pad technology/pad placed on body?

A

Monopolar

376
Q

Listeria treatment in pregnancy?

A

Ampicillin + Amoxicillin (both)

377
Q

Chromosomes involved in robertsonian translocation?

A

13 14 15 21 22 (13/14 most common)

378
Q

Female homologue of prostate?

A

skenes gland (paraurethral gland)

379
Q

Risk of transmission to baby in vaginal delivery in case of primary herpes infection?

A

40%
1% with recurrent attacks

380
Q

How many active TRH copies are produced from its precursor ??

A

6

381
Q

Bartholin gland Art supply??

A

External pudendal
Innervation from perineal nerve

382
Q

What is the upper limit of post void urine in a 65 yr old

A

100 mls

The postvoid residual volume less than 50 mL is considered normal,

383
Q

Nevirapine MOA

A

non-nucleoside reverse transcriptase inhibitor (NNRTI) of HIV-1.

384
Q

Somatotrophs are what percentage of anterior pituitary?

A

50%

385
Q

Which hormone is present in granulosa cells n not in theca cells?

A

Aromotase

386
Q

Scenario of numbness and parasthesia in pat with chrones dis and hex of gastric operation which vit deficiency

A

B12

387
Q

What is the origin of the hypothalamus?

A

Neural tube

388
Q

Which hormone produced by the fetus helps in increasing pulmonary surfactant?

A

Cortisol

389
Q

For detection of receptor of estrogen in endometrial sample use :

A

Western Blotting

390
Q

what physiological event happen during preg to make her able to breast feed

A

Ductal dilatation post natal
Stromal hyperplasia during pregnancy

391
Q

Carcinosarcoma histopathology description:

A

Epithelial and mesenchymal tissues

392
Q

Percentage of Brenner tumor of ovary are malignant

A

2-5%

393
Q

Diagram of rectus muscles below umbilicus asking for during suprapubic incision after cutting rectus sheath u will encounter

A

fascia transversalis

394
Q

Complication with retroverted uterus

A

Incarceration

395
Q

Woman with 28days menstrual cycle when to perform hysterosalpingography

A

6-12

396
Q

Decrease in amplitude of U\S due to absorption, scattering, reflection is called as

A

Attenuation

397
Q

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

A

Selective Beta-3 antagonist

398
Q

Antineoplastic drugs causing hemorrhagic cystitis?

A

Cyclophosphamide

399
Q

ligamentum arteriosus is completely obliterated after birth to form what adult structure?

A

truncus arteriosus

400
Q

The most common in Utero infection causing fetal anemia in the UK is

A

Parvovirus B19

401
Q

Location of Bartholin glands

A

superficial perineal pouch

402
Q

location of external anal sphincter

A

deep perineal pouch

403
Q

Mechanism of action of Apixaban

A

factor X inhibitor

404
Q

SI unit of radiation is

A

becquerel

405
Q

Botulinum toxin is now used to treat neurogenic bladder because of its ability to

A

Inhibit the release of acetylcholine

406
Q

Schiller Duval Bodies is found in

A

Endodermal Sinus Tumor

407
Q

bHCG tumor marker for

A

choriocarcinoma

408
Q

Mycoplasma genitalium shape

A

flask shaped and do not have a cell wall

409
Q

Group A streptococcus on Lancefield shows

A

B-hemolytic

410
Q

Most common cause of secondary hyperparathyroidism

A

chronic renal failure

411
Q

Innate and adaptive system are linked together via

A

Cytokines

412
Q

TRH structure:

A

tripeptide

413
Q

Carboprost MOA

A

Prostaglandin F2a

414
Q

Mitochondial DNA genes

A

37 genes

415
Q

Carbohydrate I breast milk

A

Lactose

416
Q

Dimer immunity + mucosal immunity antibody

A

IgA

417
Q

Internal anal sphincter

A

continuation of circular rectal muscles

418
Q

Nevirapine MOA

A

Non-competitively inhibit reverse transcriptase

419
Q

Only HRT breast cancer risk

A

low risk or no risk

420
Q

Female , early pregnancy , doesn’t know about her vaccination status for VZV , she may have immunity against it ?

A

60-80%

421
Q

vitamin d conversion in pregnancy is:

A

unchanged

422
Q

DmPA injection given

A

every 12 weeks

423
Q

Cardiac output increases in first stage of labor

A

50%

424
Q

Fetal cardiac output to fetal kidney

A

Less than 5%

425
Q

Remnant of patent umbilical artery

A

Superior vesical artery

426
Q

Type of necrosis in brain

A

Liquefactive

427
Q

HRT INCREASES WHAT?

A

increases thyroid binding globulin

428
Q

Which organism produce exotoxin that causes toxic shock syndrome

A

Staphylococcus aureus

429
Q

Fetal kidneys mature to form urine at

A

10 weeks

430
Q

Test done on pregnant patients; serum x is positive in a patient. How likely she may develop preeclampsia

A

80%

431
Q

Placenta previa early confirmed at what gestational age

A

32 weeks

432
Q

Monochorionic and diamniotic occurs at which stage

A

Morula

433
Q

ovaries contain enzyme for androgen production

A

3β-hydroxysteroid dehydrogenase

434
Q

In PKU there is deficiency of enzyme known as hydroxylase. This enzyme catalyze the reaction and converting phenylalanine to

A

Tyrosine

435
Q

one spontaneous mutation in human over years

A

One in 10 million years

436
Q

During the cell cycle second meiotic division occurs at which stage

A

Secondary oocyte

437
Q

Ebola virus is

A

Single standard RNA virus

438
Q

Herpes simplex virus 1

A

Double stranded DNA virus

439
Q

Pelvic diaphragm is formed by

A

Levator ani and coccygeus

440
Q

Increase in caloric requirements after first trimester

A

200 calories

441
Q

Cushing disease blood tests:

A

Increase ACTH, increase Cortisol, Increase GH

442
Q

Identify the muscle involved in episiotomy

A

bulbospongiosus

443
Q

Scenario of woman presented with amenorrhea, galactorrhea. Labs were advised which shows high TSH, high FSH, high prolactin

A

Hypothyroidism

444
Q

patient blood group O positive. Antibodies present would be

A

Anti A, Anti B

445
Q

Mechanism of action of POP implants

A

inhibition of ovulation

446
Q

Forest plot horizontal lines represent

A

95% CI

447
Q

Distal portion of Round ligament blood supply

A

inferior epigastric artery

448
Q

Free fatty acid are transported via

A

Albumin

449
Q

Patient on estrogen only HRT since 5years risk of breast cancer

A

Low risk or no risk

450
Q

Hepatocytic hematopoiesis commence at which week

A

6 weeks

451
Q

Man in infertility clinic for azoospermia with regular exercise

A

steroid overuse

452
Q

Menstrual cycle of 25days

A

ovulate at 11 days

453
Q

5 weeks Beta-hcg

A

4800

454
Q

Inhibin synthesis in which cells?

A

Granulosa cells

455
Q

Vitamin c promotes

A

hydroxylation in protein synthesis

456
Q

Which organelles do type II pneumocytes utilize for surfactant release?

A

Lamellar Bodies

457
Q

Dopamine agonist to suppress lactation

A

Quingolide

458
Q

Albumin synthesized in

A

HEPATOCYTES

459
Q

MCDA twins - split occurs at which stage?

A

Morula

460
Q

A woman have got stillbirth at 34 weeks,her thrombophilia screening shows: Hb:10.1 Platelates:135 Protein C:normal protein S :decreased
Anticardiolipin antibodies: -ve

Diagnosis?

A

Normal pregnancy changes

461
Q

Convex outline of uterus, lap and dye shows two uterine cavities

A

Septate uterus

462
Q

patient have normal menstrual cycles but now she have amenorrhea for 8 months,she is taking metoclopramide and valproate for epilepsy,she have no visual symptoms,no hirsutism,her serum prolactin is 1000,your further management?

A

stop metoclopramide and repeat test

463
Q

25 years old with chronic left lower abdominal pain for 3 months,she have previously received treatment for chlamydia,her ultrasound revealed a 4cm diffuse homogenous hypoechoic focal lesion with little fluid in pouch of douglas:

A

Endometrioma

464
Q

Patient having severe pre- eclampsia symptoms, BP 160/110,blurring of vision, severe headache, pulse 85,she is known case of asthma, drug you will give to decrease her BP:

A

I/v hydralazine

465
Q

Patient pregnant , PID due to gonorrhea, appropriate treatment:

A

Ceftriaxone + Azithromycin

466
Q

MRI picture of intramural fibroid

A

Look up intramural fibroid

467
Q

Combined oral contraception can be used in woman had GTD when:

A

After Bhcg titer return to normal, not rising at all.

468
Q

Which structure does not contain paracrine glands:

A

Mons pubis

469
Q

Difference between jejunum + ileum

A

Jejunum
Thick walled
Shorter
Longer arcades
Less arcades

Ileum
Thin walled
Longer
Shorter arcades
More arcades

470
Q

What line denotes junction between hindgut and lower anal canal?

A

dentate line

471
Q

sacral plexus situated behind which muscle :

A

Pyriformis

472
Q

During laparoscpy surgeons have limitization of lymphectomy on lateral abdominal wall due this structure:

A

Obliterated umblical artery

473
Q

What structure passes immediately anterior to SI joint?

A

Ureter

474
Q

Sacrotuberous and sacrospinous ligaments prevent from

A

Posterior rotation at horizontal line of sacrum

475
Q

hepatic artery is a branch of:

A

Coeliac trunk

476
Q

Difference between inguinal and femoral hernia:

A

Inguinal:
Superior and medial to pubic tubercle

Femoral:
inferior and lateral to pubic tubercle

477
Q

Rate limiting step in urea synthesis

A

N acetylglutamate dehydrogenase

478
Q

Left uterine vein drain into

A

Internal iliac vein

479
Q

Important function of glucagon

A

Gluconeogenesis
glycogenolysis

480
Q

Prostaglandins are synthesized from:

A

Unsaturated fatty acids

481
Q

Which organel can attach to tRNA and can synthesise protein

A

Ribosomes

482
Q

Bending used for Cytogenic analysis:

A

G banding

483
Q

Which metabolic processes produce the most energy needed for uterine contraction

A

Oxidative phosphorylation

484
Q

At 4 weeks primordial germ cells are within what structure:

A

Yolk sac

485
Q

Posterior fontanelle closes by

A

3 months

486
Q

when does the Odds ratio approximate risk ratio:

A

When the disease being studied is rare

487
Q

Histogram shows which variable:

A

Continuous variable

488
Q

Throid profile in pregnancy is checked by:

A

TSH
T4

489
Q

In girls puberty indicated by:

A

Growth spurt,Thelarchae,adrenarchae,menarchae

490
Q

Which hormone leads to nutrient transfer from mother to fetus:

A

HPL

491
Q

FNN act through :

A

Integrin

492
Q

Hormone raised in post menopausal woman :

A

FSH

493
Q

What is the component of placental barrier at term:

A

synchtrophoblast+endothelium

494
Q

Miscarriage occur due to withdraw of this hormone:

A

Progesterone

495
Q

POF may have karyotype or mutant gene:

A

46XX

496
Q

Oligohydroamnios,low set ears,limb hypoplasia,renal,agenesis;

A

Potter syndrome

497
Q

SS RNA viruses

A

Hepatitis ACDE
Rubella
HIV

498
Q

DS RNA virus

A

rotavirus

499
Q

SS DNA virus

A

Parvovirus B19

500
Q

DS DNA virus

A

Hep B
CMV
VZV
Herpes 1 & 2
Epstein Barr

501
Q

Patient have history of ca colon,ureter is fixed in colon,sigmoid audit is performed,shunts are left inside
gram negative bacilli in ureter:

A

psuedomonas aurginosa

502
Q

Red degeneration of fibroid occur due to:

A

Ischemia

503
Q

Postmenopausal women having typical complex hyperplasia progress to endometrial cancer:

A

<5%

504
Q

24 years old sexual contact with her new boyfriend,she is concerned about development of new lesions on vulva.On examination you note pearly white ,non tender,dome shaped ulcers:

A

Molloscum Contagiosum

505
Q

What percentage of lymphocytes is present in blood

A

20-40%

506
Q

Complemt system synthesized in:

A

Liver

507
Q

Radiation exposure with ventilation perfusion scan:

A

3 months

508
Q

ultrasound resolution maximum at:

A

Interface

509
Q

Type of TVS probe used in obese woman;

A

high frequency linear probe

510
Q

radiation dosing in:

A

Sievert

511
Q

Joint which resists horizontal rotation of pelvis

A

Ileolumbar

512
Q

Electrosurgery long loop is used for :

A

To complete circuit with high density current

513
Q

A small square of ECG represents:

A

0.04 sec

514
Q

Normal ECG changes in pregnancy

A

Q waves lead 3

515
Q

Earliest FH is detected on TV scan?

A

6 weeks

516
Q

In a study comparison of singleton and twin pregnancy is made:

A

If cervical length less than 20mm then double chances of preterm before 34 weeks in twins than singletons

517
Q

Normal level of fibrinogen in blood

A

1-2g

518
Q

Mechanism of action of neostigmine

A

Anti cholinesterase

519
Q

Mechanism of action of Indomethacin

A

cyclo oxygenase inhibitor

520
Q

Midazolam acts on which receptors?

A

GABA

521
Q

Depoprovera MOA

A

Inhibits ovualtion

522
Q

Nifedipine MOA

A

calcium channel blocker

523
Q

Non ergot dopamine agonist used after stillbirth

A

quinagolide

524
Q

Drug excretion decreases in pregnancy due to:

A

Dec albumin and binding proteins

525
Q

Indirect action of Warfarin on:

A

prothrombin II

526
Q

Hepatitis serology blood results:

A

HBsAg = Indicates current infection either acute or chronic

Anti HBs = Indicates immunity either due to infection or vaccination

Anti HBc = Indicates either current or past infection
Anti HBc persists for life after infection so is a marker of past infection.

IgM Anti HBc = Indicates recent infection

527
Q

Oligohydramnios

A

Oligohydramnios
AFI< 5cm or deepest amniotic fluid pocket < 2cm

528
Q

Polyhydramnios

A

AFI > 25cm or deepest amniotic fluid pocket > 8cm

529
Q

Endometrial measurements

A

Post menopausal <4mm

Reproductive years 5 to 14mm

530
Q

Anaemia definitions

A

1st trimester Hb < 110 g/l
2nd and 3rd trimester Hb < 105 g/l
Postpartum Hb less than 100 g/l

531
Q

What is responsible for Aquaporin-2 protein channel openings in the collecting duct?

A

ADH

532
Q

Biopsy is taken and reported as showing
epithelial nuclear atypia, loss of surface differentiation and increased mitosis. What is the diagnosis?

A

Vulval intraepithelial neoplasia (VIN)

533
Q

Fetal testing methods - when do we use amniocentesis/CVS:

A
  • Nuchal Thickness imaging is part of the combined
    The quadruple test is another screening test
  • RCOG guidelines advise amniocentesis should be performed after 15 weeks gestation.
  • CVS offers rapid results and is suitable for karyotyping/genotype analysis for chromosomal abnormalities such as Down’s
534
Q

Chromosomal abnormalities + biochemical markers

A

Down’s = trisomy 21
Basic Screening by Nuchal Thickness & PAPP-A and beta-hCG blood markers
- From 14 + 2 to 20 + 0 weeks gestation quadruple test can be used

PAPP A - reduced
AFP - reduced
Unconjugated estriol - reduced
Inhibit A - elevated
HCG - elevated

Edward’s = trisomy 18
90%+ detected on 18-20 week ultrasound fetal anomaly scan

PAPP A - reduced
AFP - reduced
Unconjugated estriol - reduced
Inhibit A - reduced
HCG - reduced

Patau’s = trisomy 13

AFP - raised in neural tube defects (like spina bifida) + multiple pregnancy

535
Q

What is the antibiotic prophylaxis for surgical abortions?

A

Doxycycline or metronidazole is advised as a single agent.

536
Q

Modification of Diet in Renal Disease Study GFR calculator uses:

A

creatinine
sex
age
ethnicity

537
Q

Ondansetron MOA

A

Serotonin 5-HT3 receptor antagonist

538
Q

Rotterdam Criteria For Diagnosis of PCOS

A

Two of the three following criteria are diagnostic of the condition:

Polycystic ovaries (either 12 or more peripheral follicles or increased ovarian volume (greater than 10 cm3)
Oligo-ovulation or anovulation
Clinical and/or biochemical signs of hyperandrogenism

Typical Biochemistry
Elevated LH
LH:FSH >2 (normal is 1:1 ratio)

539
Q

Which are the 2 major onco-proteins associated with high risk HPV?

A

E6 and E7

540
Q

Treatments for overactive bladder

A

1st line treatments:
1. Oxybutynin (immediate release)*
2. Tolterodine (immediate release)
3. Darifenacin (once daily preparation)

*Do not offer Oxybutynin to frail elderly patients

Adjuvant Treatments
Desmopressin can be considered for those with nocturia
Duloxetine may be considered for those who don’t want/unsiutable for surgical treatment

541
Q

According to RCOG guidance antenatal steroids should be offered to which group undergoing elective C-section?

A

C-section prior to 38+6 weeks gestation

542
Q

What is the incubation period for CMV?

A

3-12 weeks

543
Q

What proportion of pregnancies are affected by gestational diabetes?

A

2-5%

544
Q

A baby with shoulder dystocia suffers a brachial plexus injury. The mother asks you if this will be permanent. What percentage of babies will have permanent neurological dysfunction as a result of brachial plexus injury secondary to shoulder dystocia?

A

<10%

545
Q

Diffuse homogeneous low level echoes
Echoes sometimes described as ‘ground glass’ the result of haemorrhagic material

A

Endometrioma

546
Q

Advice for breastfeeding with HIV?

A

Mothers who are HIV positive regardless of viral load should be advised not to breastfeed. If they breastfeed against advice the infant should undergo additional testing on a monthly basis.

547
Q

What treatments for genital warts cannot be used in pregnancy?

A

Podophylline + 5-fluorouracil is considered potentially teratogenic and shouldn’t be used.

548
Q

From which germ layer does the myenteric plexus of the GI tract developed:

A

Neural crest of Ectoderm

549
Q

What is the relative risk of VTE in pregnancy?

A

Relative risk of VTE in pregnancy is increased 4 to 6 fold in pregnancy

550
Q

What is the typical daily dose (fraction) of radiotherapy for cancers?

A

1.8-2.0 Gy

551
Q

What is the mortality rate associated with disseminated neonatal herpes assuming appropriate antiviral treatment is given?

A

30%

552
Q

Management 3rd trimester Acquisition of Genital Herpes (from 28 weeks)

A

Initiate acicolvir 400 mg TDS and continue until delivery
C-section delivery is advised for these patients in whom this is a 1st episode of HSV

Following 1st or 2nd trimester acquisition, daily suppressive aciclovir 400 mg TDS from 36 weeks of gestation reduces HSV lesions at term and hence the need for delivery by caesarean section

553
Q

Management 1st or 2nd trimester Acquisition of Genital Herpes

A

Initial episode treated acicolvir 400 mg TDS for 5 days

554
Q

Risk factors/protective factors for fibroids:

A

Risk Factors
Black Ethnicity
Obesity
Early Puberty
Increasing age (from puberty until menopause)

Protective Factors
Pregnancy
Increasing number of pregnancies

555
Q

What is the half life of Ergometrine?

A

30-120 minutes

556
Q

Definition: frequency shift of reflected sound waves associated with movement of an object towards or away from their source (transducer)

A

Doppler effect

557
Q

Definition: change in wave direction as it passes from one medium to another

A

Refraction

558
Q

Definition: effect when sound waves are greater than the structure they come into contact with (e.g. red blood cells) causing uniform amplitude waves in all directions with little or no reflection returning to the transducer.

A

Scatter

559
Q

Definition: decreasing intensity of a sound wave as it passes through a medium

A

Attenuation

560
Q

Definition: bending of waves around small obstacles

A

Deffraction

561
Q

The COCP (Combined Oral Contraceptive Pill) causes all of the following biochemical reactions:

A

Suppress LH
Suppress FSH
Elevate SHBG
Reduce adrenal androgen secretion
Decrease ovarian androgen synthesis

562
Q

How long does uterine involution after delivery take?

A

4-6 weeks

563
Q

Which test is used to detect antibodies or complement bound to red blood cell antigens in vivo?

A

Direct coombs test

564
Q

When to restart Warfarin after delivery?

A

5-7 days (due to risk of PPH) + can breastfeed safely

565
Q

Definitions of placenta attachments:

A

Accreta = chorionic villi attached to myometrium rather than decidua basalis

Increta = chorionic villi invade into the myometrium.

Percreta = chorionic villi invade through the myometrium

566
Q

The juxtaglomerular apparatus (JGA) lies within which part of the kidney?

A

Renal cortex

567
Q

1st line anti-emetics in pregnancy:

A

Cyclizine and Promethazine are 1st line in pregnancy according to NICE.

Metoclopramide however is not licensed for people under 20 years old and is known to cause oculogyric crisis, especially in young adults.

568
Q

Hepatitis C is what kind of virus?

A

Flaviviridae

569
Q

What happens to blood volume during pregnancy?

A

During pregnancy blood volume increases slowly by 40-50%. The increase is thought to be due to increased Aldosterone. The rise in volume mostly occurs during the 1st trimester.

570
Q

What is the most common Type II congenital thrombophilia?

A

Factor V leiden is the most common congenital thrombophilia

Protein C and S deficiencies are type 1 (Not type 2) thrombophilias
Antiphospholipid syndrome is an acquired (NOT congenital) thrombophilia

571
Q

The following 4 hormones are structurally similar:

A

HCG
FSH
LH
TSH

572
Q

The following 3 hormones are structurally similar:

A

Prolactin
GH
HPL

573
Q

Drugs for uterine atony:

A

If uterine atony is perceived to be a cause of the PPH the following measures should be taken in turn
1. Syntocinon 5 units by slow intravenous injection (may have repeat dose)
2. Ergometrine 0.5 mg by slow intravenous or intramuscular injection (contraindicated in
women with hypertension)
3. Syntocinon infusion unless fluid restriction is necessary
4. Carboprost 0.25 mg by IM injection repeated at intervals of not less than 15
minutes to a maximum of 8 doses (contraindicated in women with asthma)
5. Direct intramyometrial injection of carboprost 0.5 mg
6. Misoprostol 1000 micrograms rectally

574
Q

Fentanyl MOA

A

Mu receptor agonist

575
Q

When assessing a women who has failed to conceive NICE advise 2 tests be performed in ALL women:

A
  1. Chlamydia screen
  2. Mid luteal phase Progesterone
576
Q

What is the role of DHEA produced by the fetal adrenal glands?

A

Stimulate placenta to form oestragen

577
Q

Dehydroepiandrosterone (DHEA) is a steroid hormone synthesised from

A

cholesterol (via Pregnenolone) by the adrenal glands.

578
Q

Treatment of chlamydia:

A

Doxycycline 100mg bd for 7 days OR
Azithromycin 1gm orally in a single dose

In pregnant patients:
Azithromycin OR Ezithromycin

579
Q

Common biochemical and haematological findings in patients who abuse alcohol:

A

Macrocytosis
Low Platelets
Can reduce WCC and RBC counts
Low serum urea
B12 deficiency
Raised GGT and deranged LFTs

580
Q

Myeloma biochemical markers:

A

ALP = normal
Calcium = high
PTH = normal/high
phosphate = normal/high

581
Q

Calcium Alkali Syndrome biochemical markers:

A

ALP = normal
calcium = high
PTH = low
phosphate = normal/high

582
Q

Regarding heart rate in pregnancy which of the following statements is true?

A

Heart rate increases by 15 beats per minute

583
Q

What is the composition of mature breast milk?

A

Fat 4%, Protein 1%, Sugar 7%

584
Q

From what gestation is CTG assessment of RFM advised?

A

28 weeks

585
Q

Significant proteinuria is considered when:

A

Urinary protein:creatinine ratio is >30 mg/mmol OR
24-hour urine collection >300 mg protein

586
Q

What frequency would typically be used for monopolar diathermy?

A

500KHZ

587
Q

Infertility investigations:

A

If there is likely tubal pathology (previous PID or pelvic surgery) then laparoscopy and dye testing is 1st line

Hysterosalpingography Typically performed using iodine based water soluble contrast

588
Q

Piezoelectric crystal resonance is used in what imaging modality?

A

USS

589
Q

Cardiac output is calculated by

A

stroke volume x heart rate

590
Q

Mifepristone (RU 486) when used to for management of abortion works via what mechanism?

A

Anti-progestogen

591
Q

You are asked to see a 42 year old women due to pelvic pain and PV discharge. She had IUCD fitted for emergency contraception 4 years ago. You send swabs. The microscopy reveals sulphur granules. What is the likely causative organism?

A

Actinomyces israelii

592
Q

Mullerian agenesis patients are karyotype

A

46XX

593
Q

CAIS patients are karyotype

A

46XY

594
Q

pheochromocytoma arises from which cells?

A

The main cell type of the adrenal medulla is the Chromaffin cell; neuroendocrine tumor of the medulla of the adrenal glands

595
Q

Forms of non-ionizing radiation:

A

MRI
USS
LASER

596
Q

Elevated JVP normal waveform

A

Right sided heart failure
Fluid Overload
Bradycardia

597
Q

Elevated JVP no pulsation

A

SVC obstruction

598
Q

Absent A-waves JVP

A

Atrial fibrillation

599
Q

Paradoxical JVP (Kussmauls)

A

Pericardial constriction

600
Q

Large V wave
Absent X wave JVP

A

Tricuspid Regurgitation

601
Q

Large A wave
Slow Y descent JVP

A

Tricuspid Stenosis

602
Q

What is the average lifespan of a basophil (white blood cell)?

A

3-4 days

603
Q

muscles assessed by urodynamic testing?

A

Detrusor and urethral sphincter muscles

604
Q

Primary Hyperparathyroidism biochemical markers

A

High PTH with hypercalcaemia is seen in Primary Hyperparathyroidism.
parathyroid adenoma accounts for 97% of cases of primary hyperparathyroidism.

High PTH with hypercalcaemia is also seen in tertiary hyperparathyroidism. Tertiary hyperparathyroidism usually follows a long period of secondary hyperparathyroidism (most commonly due to renal failure).

605
Q

What is the incubation period of Rubella (in days)?

A

14 (12-23)

606
Q

You diagnose cellulitis. What is the most common causative organism?

A

Streptococcus Pyogenes

607
Q

99% of body calcium is in what form?

A

Calcium Phosphate

608
Q

Menorrhagia management:

A

1st Line
Levonorgestrel-releasing intrauterine system (IUS eg Mirena)
2nd Line
Tranexamic Acid, NSAIDs (eg Mefenamic Acid), COCP
3rd Line
Norethisterone (15 mg) daily from days 5 to 26 of the menstrual cycle, or injected long-acting progestogens

609
Q

Tocolytic drug use may prolong pregnancy for

A

Up to 7 days

Choice of tocolytic (NICE)
1st line: Nifedipine
2nd line: Oxytocin receptor antagonists e.g. atosiban

610
Q

What is the average volume of blood loss during one menstrual cycle?

A

35-40 pls

611
Q

Which changes to biliary physiology occurs during pregnancy?

A

The lithogenic index increases in pregnancy hence the greater risk of gallstones.

612
Q

Warfarin targets:

A

2.0 - 3.0 Most common used for DVT,PE & tissue valve replacement treatment

2.5 - 3.5 Used in mechanical mitral valve replacement & some aortic mech.valve replacements

3.0 - 4.0 Used in mechanical valve replacement where PE has occurred despite anticoagulation at lower range

613
Q

A patient develops hypocalcaemia as a result of pancreatitis. What is the appropriate homeostatic response to hypocalcaemia?

A

Increased PTH, Increased 1,25 dihydroxycholecalciferol & Decreased phosphate

614
Q

The luteinizing hormone (LH) surge during ovulation causes:

A

Increases cAMP resulting in increased progesterone and PGF2 production

PGF2 causes contraction of theca externa smooth muscle cells resulting in rupture of the mature oocyte

615
Q

When do hormones peak during menstruation?

A

LH, FSH and Oestrogen have their peaks just before ovulation on day 14 whereas progesterone peaks around day 21.

616
Q

Cabergoline and Bromocriptine are agonists of which receptor?

A

D2 (Dopamine agonists )

617
Q

Laser ablation in TTTS - which laser?

A

Diode or ND:YAG

618
Q

Pre cancerous lower genital tract changes (CIN) and condylomata (primarily HPV) - which laser?

A

CO2 laser

619
Q

Factors shown to decrease risk of ovarian cancer are:

A

Oral contraceptive use
Higher Parity
Breast feeding
Hysterectomy
Tubal Ligation
Statins
SLE

620
Q

What is the average lifespan of a platelet?

A

5-9 days

621
Q

What is the normal rage for adjusted serum calcium?

A

2.2-2.6

622
Q

What percentage of patients with PROM will go into labour within 24 hrs?

A

60%

623
Q

In patients with endometriosis what is the infertility rate?

A

40%

624
Q

During the inflammatory phase of wound healing what is the predominant cell type found in the wound during days 3-4?

A

Macrophages

625
Q

What percentage of patients with cancer have hypercalcaemia?

A

Hypercalcaemia effects 10-30% of cancer patients. The main mechanism is through osteoclastic bone resorption which can occur with or without bony mets.

626
Q

A 29 year old women wants to speak to you regarding infections in pregnancy. Her two year old son has sensorineural deafness as a result of infection in her previous pregnancy. She tells you he was born with a ‘blueberry muffin’ rash. What was the most likely infection?

A

Rubella

627
Q

In type 2 necrotising fasciitis what is the most likely causative organism?

A

The most common single causative organism is Group A streptococcus (streptococcus pyogenes).

628
Q

Paraventricular nucleus of the hypothalamus releases which 5 hormones?

A

Thyrotropin-releasing hormone
Corticotropin-releasing hormone
Oxytocin
Vasopressin
Somatostatin

629
Q

What is the mode of action of Tranexamic acid?

A

Inhibits Plasminogen Activation

630
Q

Features of functional ovarian cysts on ultrasound are:

A

Thin walled and unilocular
Must be >3cm diameter (if <3cm described as follicle)
Anechoic (absence of internal echoes)
No colour flow
No solid components

631
Q

According to NICE guidelines what HBA1C level would prompt you to strongly advise this women NOT to get pregnant due to the signifiant risks it presents?

A

> 10.0% or 86mmol/mol

632
Q

At what stage of fetal development does fetal haemoglobin (HbF) replace embryonic haemoglobin (HbE) as the primary form of haemoglobin?

A

10-12 weeks

633
Q

Pelvic inlet diameters:

A

Anteroposterior Sacrum to Pubic Symphysis 11

Oblique SIJ - ileopectinal line 12

Transverse = Ileopectinal lines 13

634
Q

When do patients have gestational diabetes screening?

A

Screening for gestational diabetes should be offered and performed between 24-28 weeks.
Screening is via a 2-hour post 75 g oral glucose tolerance test.

635
Q

What is the mechanism of action of Cefalexin?

A

inhibit peptidoglycan cross-links in bacterial cell wall

636
Q

In the earliest phase of wound healing platelets are held together by what?

A

Fibrin

637
Q

metronidazole MOA

A

Inhibits nucleic acid synthesis via radical formation

638
Q

The UK National Screening Committee (UK NSC) currently recommends routine antenatal screening for the following 3 infectious diseases:

A

HIV
Hepatitis B
Syphilis

639
Q

A 38 year old women attends clinic follow up. You note pelvic ultrasound shows a 60mm simple cyst. What is the most appropriate course of action regarding this cyst according to the RCOG green top guidelines?

A

A 38 year old women attends clinic follow up. You note pelvic ultrasound shows a 60mm simple cyst. What is the most appropriate course of action regarding this cyst according to the RCOG green top guidelines?

640
Q

Which serum markers are measured when undertaking the combined test?

A

hCG and PAPP A

641
Q

Although hormone levels are not diagnostic of PCOS (and may be normal) the typical picture is:

A

Elevated LH
LH:FSH ratio increased (normally should be 1:1, in PCOS often 3:1)
FSH normal or low
Testosterone, Oestragen and Prolactin all typically normal or elevated
Sex Hormone Binding Globulin typically normal or reduced

642
Q

Which group of beta haemolytic streptococci is associated with chorioamnioitis?

A

Group B Streptococcus is associated with chorioamnioitis

643
Q

What family of virus does Rubella belong to?

A

Togaviruses

644
Q

correct gestational window for using the combined test for chromosomal screening?

A

11 weeks + 2 days and 14 weeks + 1 day gestation

645
Q

You are asked to review a patient. They have attended for a scan at 13 weeks following a positive pregnancy test. The patient has had 2 previous pregnancies for which she opted for termination on both occasions. The scan shows a large irregular haemorrhagic mass that appears to be invading into the myometrium. What is the likely diagnosis?

A

These are the typical features of choriocarcinoma. 20% occur after TOP.

646
Q

What is the maximum dose of lidocaine (without adrenaline)?

A

The maximum dose of lidocaine (without adrenaline) is 3mg/kg

647
Q

When is Varess needle entry inappropriate?

A

Morbid Obesity (BMI>40):
Hasson technique or entry at Palmers point
Reason: difficult penetration with Varess needle

Very Thin Patients:
Hasson technique or insertion at Palmers point
Reason: higher risk of vascular injury

648
Q

Blood supply to piriformis?

A

Superior and Inferior gluteal arteries and lateral sacral arteries

Nerve: L5-S2

649
Q

The HPV vaccine Gardasil® is what type of vaccine?

A

Recombinant vaccine of virus-like particles (VLPs)
HPV Types 6, 11, 16, and 18

650
Q

A 29 year old patient who is 8 weeks pregnant comes to see you. She currently has chickenpox. She is concerned her baby may get congenital fetal varicella syndrome (FVS). What would you advise her the risk of this is?

A

The risk of FVS to babies born to mothers who have chickenpox during the first 20 weeks gestation is 0.4% (1-12 weeks) - 2.0% (13-20 weeks).

FVS can cause the following abnormalities
Hypoplasia of one limb
Cicatricial lesions with a dermatomal distribution
CNS abnormalities
Eye abnormalities

651
Q

Delayed puberty in girls is defined as?

A

absence of breast development in girls beyond 13 years old

652
Q

The yolk sac reaches its maximum diameter at what week of gestation?

A

The yolk sac increases in size up until the 10th week reaching a maximum diameter of 6mm in normal pregnancy.

653
Q

Biopsy confirms VIN. What is the approximate risk of developing squamous cell carcinoma?

A

15%

654
Q

What type of virus is HIV?

A

HIV is a retrovirus/Its genus is lentivirus

655
Q

effects of the COCP on a patients hormone profile?

A

FSH decreased, LH decreased, E2 decreased

656
Q

anti-thyroid peroxidase (anti-TPO) and also anti-thyroglobulin (anti-Tg) antibodies seen in:

A

Hashimoto’s

657
Q

The World Health Organisation define the maternal mortality ratio as

A

Maternal deaths per 100,000 live births

658
Q

What is the typical oxygen consumption in a 75kg non-pregnant women?

A

The typical Oxygen Consumption (VO2) is 250ml/min.

In pregnancy this increases by around 20% to 300ml/min

659
Q

what is the most appropriate suture option for repairing the anal mucosa?

A

The RCOG suggests 3.0 polyglactin for repair of the AM (either interrupted or continuous)

660
Q

HPV genotypes 6 and 11 are associated with

A

Low grade squamous intraepithelial lesions of the cervix

661
Q

What is the maximum dose of lidocaine with adrenaline?

A

The maximum dose of lidocaine with adrenaline is 7mg/kg

662
Q

What is the causative organism of Scarlet Fever?

A

Streptococcus pyogenes

663
Q

What percentage of women with a diagnosis of Gonorrhoea will develop pelvic inflammatory disease?

A

15$

664
Q
A

Deck 1 (12 decks)

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