Climate MCQs 2020 Flashcards
Which congenital anaemia is inherited as autosomal dominant and found in people of European descent?
Select one:
a. Pyruvate Kinase deficiency
b. Hereditary spherocytosis
c. Glucose 6 Phosphate dehydrogenose deficiency
d. Sickle Cell anaemia
b. Hereditary spherocytosis
Red degeneration of a uterine fibroid:
Select one:
a. only occurs in pregnancy.
b. is due to emboli occluding the major blood vessels supplying the myoma.
c. is associated with a raised ESR.
d. causes a leucopenia with a lymphocytosis.
c. is associated with a raised ESR.
At the time of a routine antenatal examination at 28 weeks gestation, the fetus of a 23-year-old woman G1P0 has a fetal heart rate of 240 bpm. Echocardiography confirms a supraventricular tachyarrhythmia. The fetus has a small pericardial effusion and a moderate amount of ascites.
Which of the following would be most appropriate?
Select one:
a. Administration of Sotalol to the woman
b. Administration of Amiodarone to the woman
c. Administration of Labetalol to the woman
d. Administration of Verapamil to the woman
a. Administration of Sotalol to the woman
Which of the following disorders does NOT have autosomal dominant inheritance?
Select one:
a. Von Recklinghausen’s disease (neurofibromatosis)
b. Tay-Sachs disease
c. Huntington’s chorea
d. Achondroplasia
b. Tay-Sachs disease
A woman G1P0 presents at 34 weeks gestation with a 2-day history of vomiting, including coffee-ground-like material, and upper abdominal pain. Urine contains a trace of protein. Investigations include:
· haemoglobin 106g/L
· white cell count 30x109/L
· platelets 155x109/L
· uric acid 4f50µmol/L (normal 135-395µmol/L)
· total bilirubin 25µmol/L (normal 1-20µmol/L)
· alkaline phosphatase 180U/L (normal 125 - 250U/L)
· aspartate transaminase 800U/L (normal 0-45U/L)
· creatinine 100µmol/L (normal 40-80µmol/L)
· blood glucose 1.8mmol/L
What is the most likely diagnosis?
Select one:
a. Hepatitis
b. Acute fatty liver of pregnancy
c. Cholecystitis
d. Cholestasis of pregnancy
b. Acute fatty liver of pregnancy
Effective risk management is paramount in the day-to-day life of any medical practitioner. Typically, there are three strategies practitioners utilise to manage risk: transfer, mitigate or avoid the risk. When managing risk, in which order would you implement the aforementioned strategies?
Select one:
a. Avoid, transfer, then mitigate the risk
b. Avoid, mitigate, then transfer the risk
c. Transfer, avoid, then mitigate the risk
d. Mitigate, transfer, then avoid the risk
a. Avoid, transfer, then mitigate the risk
A 30-year-old patient G3P2 at 12 weeks gestation, asks you for information about aneuploidy screening.
Which is the most appropriate response?
Select one:
a. Using a risk cut-off of 1:300, the combined first trimester screen will identify 90% of all fetuses with trisomy 21.
b. NIPS is currently only validated for high risk pregnancies.
c. A “High risk” NIPS (Non-Invasive Prenatal Screening) result, has a positive predictive value (PPV) of 99% for trisomy 21.
d. A “Low risk” NIPS result, has a negative predictive value of 99.99% for trisomy 21.
d. A “Low risk” NIPS result, has a negative predictive value of 99.99% for trisomy 21.
In which of the following scenarios would you have legally fulfilled your duty of care as a medical practitioner?
Select one:
a. You perform an emergency caesarean section on one of your private patients due to fetal distress in labour. Her next pregnancy is complicated by a caesarean scar pregnancy and uterine rupture. You had discussed possible complications with her prior to her initial surgery but had not mentioned this rare but serious complication
b. You are on a flight travelling between Brisbane and Auckland. A passenger in first class has collapsed and a call has been made for assistance from any doctors on board. You do not respond.
c. One of your regular patients has high grade abnormalities detected on her routine cervical screening. You arrange a referral for colposcopy but you receive a note from the hospital that your patient did not attend. You try to contact her by telephone but her number has been disconnected. You take no further action.
d. A woman arrives at your practice before the clinic opens carrying a sick infant. She is not one of your patients. She asks you if you are a doctor and you reply that you are not.
a. You perform an emergency caesarean section on one of your private patients due to fetal distress in labour. Her next pregnancy is complicated by a caesarean scar pregnancy and uterine rupture. You had discussed possible complications with her prior to her initial surgery but had not mentioned this rare but serious complication.
What is the minimum mean sac diameter for the diagnosis of a blighted ovum (anembryonic pregnancy)? Select one: a. 21mm b. 26mm c. 16mm d. 31mm
b. 26mm
A 44-year-old Para 2 woman sees you to discuss options of contraception. She has regular menstrual periods. She has BMI of 26 and is a non-smoker. She has a known subseptate uterus, osteoporosis and has had multiple operations for diverticular disease. She also had an unplanned pregnancy while using barrier contraception and her husband is not keen to have a vasectomy.
What is the most appropriate contraception for her?
Select one:
a. Low dose combined OCP
b. Progesterone only pill
c. LNG-IUS
d. Tubal sterilisation
a. Low dose combined OCP
A 36-year-old female with a male partner presents with primary infertility for one year. Her periods are regular and she is ovulating based on a mid-luteal progesterone concentration. Her BMI is 25. They have no sexual difficulties. She has had a normal pelvic ultrasound and has patent tubes. The partner’s SA is 100 million/ml, motility 50%, abnormal forms 80%.
What is the best option to achieve pregnancy in the next 12 months?
Select one:
a. Continue trying to conceive spontaneous pregnancy for a further 12 months
b. Controlled ovarian hyperstimulation and intrauterine insemination
c. She should consider an egg donor
d. Ovulation induction with clomid
b. Controlled ovarian hyperstimulation and intrauterine insemination
Which of the following statements regarding hyperandrogenic chronic anovulation and polycystic ovarian syndrome is most correct?
Select one:
a. Approximately 30% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 75% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.
b. Approximately 30% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 90% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.
c. Approximately 5% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 75% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.
d. Approximately 5% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 90% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.
a. Approximately 30% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 75% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.
Regarding benefits and risks of the tension free vaginal tape procedure, which of the following statements is correct?
Select one:
a. The risk of needing to perform self catheterisation is ~1%
b. The vaginal erosion rate within 3 years is ~10%
c. The risk of overactive bladder postoperatively is ~15%
d. The cure rate on 24 hours pad test at 3 years is ~95%
a. The risk of needing to perform self catheterisation is ~1%
A woman is 20 weeks pregnant in her second pregnancy. She terminated her first pregnancy at 14 weeks and had a haemorrhage requiring a three-unit blood transfusion. The pathologist phones you to say she has a 1:128 titre of anti-Kell present in her antibody screen.
All of the following are true EXCEPT:
Select one:
a. Serial antibody titres in the mother correlate well with fetal status.
b. If the father is Kell Ag positive, amniocentesis or fetal cordocentesis may be performed to assess fetal Kell Ag status.
c. Peak systolic velocity in the MCA increases in the severely anaemic fetus and fetal blood sampling may be necessary.
d. Kell isoimmunisation is particularly severe as the antibodies affect both mature red cells and developing red cells in bone marrow.
a. Serial antibody titres in the mother correlate well with fetal status.
Which of the following is most suggestive of an ectopic pregnancy?
Select one:
a. Transabdominal ultrasound reveals no gestational sac; ß-hCG 7,000 mIU/mL
b. Transabdominal ultrasound reveals no gestational sac; ß-hCG 4,000 mIU/mL
c. Transvaginal ultrasound reveals no gestational sac; ß-hCG 600 mIU/mL
d. ß-hCG 7,000 mIU/mL, serum progesterone 40 mg/mL
a. Transabdominal ultrasound reveals no gestational sac; ß-hCG 7,000 mIU/mL
Principles of management of a recto-vaginal fistula complicated by fever following obstetric trauma include:
Select one:
a. immediate repair with partial excision of fistula tract.
b. immediate repair with minimal mobilisation of adjacent tissue planes.
c. repair after subsiding inflammation with multilayered closure without tension.
d. repair after subsiding inflammation with single layer closure without tension.
c. repair after subsiding inflammation with multilayered closure without tension.
Oral contraceptives are associated with a decreased risk of each of the following EXCEPT:
Select one:
a. ectopic pregnancy.
b. pelvic inflammatory disease (PID).
c. cervical cancer.
d. endometriosis.
c. cervical cancer.
Which of the following statements is correct?
Select one:
a. Specificity is the reciprocal of the negative predictive value.
b. Sensitivity and specificity are properties of a test not affected by the prevalence of the disease in question.
c. When testing for a rare disease, a test with a high sensitivity and specificity will also have a high predictive value.
d. The sensitivity of a test is proportional to the specificity.
b. Sensitivity and specificity are properties of a test not affected by the prevalence of the disease in question.
A 17-year-old patient having a laparotomy for a ruptured right ectopic pregnancy has a 10cm cyst of the right ovary and a normal appearing left ovary. Regarding the right ovarian cyst, what is the most appropriate surgical procedure?
Select one:
a. Right salpingo-oophorectomy
b. Right ovarian cystectomy
c. Cystectomy with wedge resection of the left ovary
d. Aspirate the cyst only
b. Right ovarian cystectomy
A tall 16-year-old athletic girl presents with primary amenorrhoea. She has been diagnosed with androgen insensitivity syndrome and asks for further explanation. Which of the following statements is correct?
Select one:
a. Menstruation is irregular, occurring only 1-2 times per year.
b. Axillary and pubic hair normally develops due to peripheral conversion of testosterone to oestrogen.
c. Breast development normally occurs due to peripheral conversion of testosterone to oestrogen.
d. Normal vulva, vagina and ovaries are present.
c. Breast development normally occurs due to peripheral conversion of testosterone to oestrogen.
A primigravid woman is seen at 30 weeks gestation with right sided abdominal pain and vomiting. Appendicitis is suspected.
What is the correct management of this instance?
Select one:
a. Administer steroids for fetal lung maturation and observe.
b. Perform ultrasound to exclude appendicitis.
c. Undertake appendicectomy.
d. Perform MRI scan to exclude appendicitis.
c. Undertake appendicectomy.
A 53-year-old postmenopausal woman has been reading about Tibolone and would prefer to use it rather than oestrogen/progestogen therapy (Menopause Replacement Therapy-MRT).
You tell her that Tibolone:
Select one:
a. has less risk for breast cancer recurrence than placebo.
b. decreases the risk for endometrial cancer compared with placebo.
c. has a reduced incidence of vaginal bleeding compared with combined MRT.
d. is as effective as bioequivalent doses of combined MRT in reducing the frequency of vasomotor symptoms.
c. has a reduced incidence of vaginal bleeding compared with combined MRT.
The incidence of lymph node involvement in micro-invasive carcinoma of the cervix is: Select one: a. 5%. b. 3%. c. 10%. d. 1%.
d. 1%.
Which of the following statements concerning multifetal reduction is FALSE?
Select one:
a. KCl and xylocaine are alternative agents to use for Selective Feticide.
b. Reducing triplets to twins at 10-14 weeks gestation is associated with an increase in mean gestation at delivery.
c. Reducing triplets to twins at 10-14 weeks gestation is not associated with a reduction in perinatal mortality.
d. Reducing triplets to twins at 10-14 weeks gestation is associated with a subsequent rate of miscarriage of both twins of approximately 8%.
c. Reducing triplets to twins at 10-14 weeks gestation is not associated with a reduction in perinatal mortality.