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.
What component for managing the delivery of the placenta at caesarean section has been shown to reduce the amount of blood loss?
Select one:
a. Immediate manual removal of the placenta
b. Secure the incisional angles whilst awaiting spontaneous separation
c. Controlled cord traction
d. Intravenous oxytocin
d. Intravenous oxytocin
A 31-year-old woman had a fetal anomaly ultrasound showing a VSD. An amniocentesis showed normal karyotype. A detailed discussion with the obstetrician and paediatric cardiologist suggests a good prognosis. However, the patient requests a termination of pregnancy.
What will be the most relevant guiding ethical principle to assist in this decision making? Select one: a. Non-maleficence b. Beneficence c. Justice d. Autonomy
d. Autonomy
Which of the following is NOT a recognised cause of pulmonary hypertension in pregnancy?
Select one:
a. Mitral stenosis
b. Left ventricular failure
c. Cardiomyopathy
d. Pulmonary embolism
c. Cardiomyopathy
Which of the following statements best describes the association of Apgar scores with infant neurological outcome?
Select one:
a. The 1-minute score correlates well with long-term neurological outcome.
b. Approximately 75% of children who develop cerebral palsy have normal Apgar scores.
c. One third of infants with a 5-minute score of 0-3 will have poor long-term neurological outcomes.
d. A 10-minute score of 0-3 accompanied by neonatal convulsions is not predictive of poor neurological outcome.
b. Approximately 75% of children who develop cerebral palsy have normal Apgar scores.
Which of the following is most correct concerning bone mass?
Select one:
a. Bone mass peaks in most women before 25 years of age.
b. A 70-year-old woman, not on hormone therapy, would lose approximately 2% of bone mass per year.
c. Bone mass is approximately 65% cortical and 35% trabecular bone.
d. The accelerated loss in bone mass begins after the age of 40 years.
a. Bone mass peaks in most women before 25 years of age.
Which artery should be ligated in order to remove the omentum?
Select one:
a. Left colic artery
b. Middle colic artery
c. Omental branch of the abdominal aortic artery
d. Gastroepiploic artery
d. Gastroepiploic artery
In advising a woman on whether she should continue her pregnancy to 42 weeks or be induced at 41 weeks, which of the following is FALSE?
Select one:
a. The Canadian randomised trial (Hannah et al) showed that induction of labour increases the likelihood of caesarean section.
b. If the Bishop’s cervical score is <5, intravaginal prostaglandins will be recommended.
c. An ultrasound will be indicated if she elects to wait.
d. Waiting is likely to be associated with a higher perinatal mortality.
a. The Canadian randomised trial (Hannah et al) showed that induction of labour increases the likelihood of caesarean section.
Which of the following is most typical of a fetal scalp pO2 measured in early labour?
Select one:
a. 42 mmHg
b. 32 mmHg
c. 22 mmHg
d. 52 mmHg
c. 22 mmHg
A 26-year-old multigravid woman at 30 weeks gestation, comes to the labour suite at a Level II hospital with a frank breech presentation at +3 station. Delivery begins to occur spontaneously until expulsion of the fetal thorax, when the cervix is noted to be incompletely dilated and the fetal head entrapped.
Which of the following would be of most value in this clinical situation? Select one: a. Fentanyl b. Glyceryl trinitrate (GTN) c. Thiopentone d. Magnesium sulphate
b. Glyceryl trinitrate (GTN)
Each of the following is more frequent in Klinefelter’s syndrome, compared to the normal male population, EXCEPT:
Select one:
a. tall stature.
b. persistence of prepubertal characteristics.
c. azoospermia.
d. low serum FSH concentration.
d. low serum FSH concentration.
Which of the following is LEAST true of HIV?
Select one:
a. Opportunistic infections commonly develop when the CD4 count falls below 200 x 106 per litre.
b. With all available initiatives, the incidence of mother-to-child transmission of HIV should be reduced to approximately 5%.
c. Antiviral chemotherapy lowers the risk of mother-to-child transmission of HIV to approximately one-third of the risk without chemotherapy.
d. High viral load (>10,000 copies/mL, low CD4 count (<400 x 106) and more than 4 hours ruptured membranes all double the risk of mother-to-child transmission of HIV.
b. With all available initiatives, the incidence of mother-to-child transmission of HIV should be reduced to approximately 5%.
(Suppression of the maternal viral load to undetectable levels (below 50 copies/mL) using highly active antiretroviral therapy (HAART) reduces transmission to 1-2%)
During placental development:
Select one:
a. endovascular migration by cytotrophoblasts proceeds in two episodes that are completed by 8-10 weeks gestation.
b. utero-placental blood flow increases to 200-250ml/min at term.
c. a complete feto-placental circulation is established by 5-6 weeks post-conception.
d. fetal blood flows to the placenta through paired umbilical arteries and a vein, and reaches an average flow rate of 350-400ml/min.
c. a complete feto-placental circulation is established by 5-6 weeks post-conception.
Which of the following statements about pituitary prolactinomas is correct?
Select one:
a. The effects of oestrogen deficiency are rarely an indication for treatment of young women with microprolactinomas and amenorrhoea.
b. They are found, at post-mortem examination, in approximately 10% of women who have died of non-endocrine disease.
c. Patients with microprolactinomas should be maintained on dopamine agonist therapy such as bromocriptine throughout pregnancy.
d. Patients with untreated microprolactinomas should be discouraged from breastfeeding.
b. They are found, at post-mortem examination, in approximately 10% of women who have died of non-endocrine disease.
A 40-year-old nulligravid woman has attended your clinic for booking at 10 weeks in her first pregnancy.
Which of the following statements concerning risks in this pregnancy is most correct?
Select one:
a. She has a 3% chance of an infant with Down Syndrome.
b. She has a 2% adjusted risk of miscarriage following amniocentesis at 15 weeks gestation.
c. She has a 1% risk of an infant with a neural tube defect.
d. She has a 4% risk of any chromosomal abnormality detected at CVS at 11 weeks.
d. She has a 4% risk of any chromosomal abnormality detected at CVS at 11 weeks.
All of the following increase in the pregnant woman over values in the non-pregnant woman EXCEPT:
Select one:
a. expiratory reserve volume.
b. tidal volume.
c. oxygen consumption.
d. respiratory rate.
a. expiratory reserve volume.
A 36-year-old, primigravid woman at 16 weeks of gestation, has received genetic counselling and has chosen to proceed with prenatal diagnosis as there has been unusually slow growth of the fetus since the 12 week scan.
Which of the following is most correct?
Select one:
a. CVS is unhelpful in this situation because of potential karyotypic disparity between fetus and trophoblast.
b. Amniocentesis is indicated because it is too late for chorionic villus sampling (CVS).
c. CVS may indicate a cause for the growth restriction, not apparent with amniocentesis as placenta mosaicism is a potential cause.
d. The risk of miscarriage associated with amniocentesis is 1:600 if performed by a maternal fetal medicine subspecialist.
c. CVS may indicate a cause for the growth restriction, not apparent with amniocentesis as placenta mosaicism is a potential cause.