Climate MCQs 2020

Question 1

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

Answer 1

b. Hereditary spherocytosis

Question 2

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.

Answer 2

c. is associated with a raised ESR.

Question 3

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

Answer 3

a. Administration of Sotalol to the woman

Question 4

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

Answer 4

b. Tay-Sachs disease

Question 5

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

Answer 5

b. Acute fatty liver of pregnancy

Question 6

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

Answer 6

a. Avoid, transfer, then mitigate the risk

Question 7

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.

Answer 7

d. A “Low risk” NIPS result, has a negative predictive value of 99.99% for trisomy 21.

Question 8

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.

Answer 8

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.

Question 9

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

Answer 9

b. 26mm

Question 10

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

Answer 10

a. Low dose combined OCP

Question 11

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

Answer 11

b. Controlled ovarian hyperstimulation and intrauterine insemination

Question 12

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.

Answer 12

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.

Question 13

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%

Answer 13

a. The risk of needing to perform self catheterisation is ~1%

Question 14

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.

Answer 14

a. Serial antibody titres in the mother correlate well with fetal status.

Question 15

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

Answer 15

a. Transabdominal ultrasound reveals no gestational sac; ß-hCG 7,000 mIU/mL

Question 16

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.

Answer 16

c. repair after subsiding inflammation with multilayered closure without tension.

Question 17

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.

Answer 17

c. cervical cancer.

Question 18

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.

Answer 18

b. Sensitivity and specificity are properties of a test not affected by the prevalence of the disease in question.

Question 19

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

Answer 19

b. Right ovarian cystectomy

Question 20

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.

Answer 20

c. Breast development normally occurs due to peripheral conversion of testosterone to oestrogen.

Question 21

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.

Answer 21

c. Undertake appendicectomy.

Question 22

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.

Answer 22

c. has a reduced incidence of vaginal bleeding compared with combined MRT.

Question 23

The incidence of lymph node involvement in micro-invasive carcinoma of the cervix is:
Select one:
a. 5%.
b. 3%.
c. 10%.
d. 1%.

Answer 23

d. 1%.

Question 24

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%.

Answer 24

c. Reducing triplets to twins at 10-14 weeks gestation is not associated with a reduction in perinatal mortality.

Question 25

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

Answer 25

d. Intravenous oxytocin

Question 26

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

Answer 26

d. Autonomy

Question 27

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

Answer 27

c. Cardiomyopathy

Question 28

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.

Answer 28

b. Approximately 75% of children who develop cerebral palsy have normal Apgar scores.

Question 29

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.

Answer 29

a. Bone mass peaks in most women before 25 years of age.

Question 30

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

Answer 30

d. Gastroepiploic artery

Question 31

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.

Answer 31

a. The Canadian randomised trial (Hannah et al) showed that induction of labour increases the likelihood of caesarean section.

Question 32

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

Answer 32

c. 22 mmHg

Question 33

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

Answer 33

b. Glyceryl trinitrate (GTN)

Question 34

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.

Answer 34

d. low serum FSH concentration.

Question 35

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.

Answer 35

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%)

Question 36

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.

Answer 36

c. a complete feto-placental circulation is established by 5-6 weeks post-conception.

Question 37

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.

Answer 37

b. They are found, at post-mortem examination, in approximately 10% of women who have died of non-endocrine disease.

Question 38

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.

Answer 38

d. She has a 4% risk of any chromosomal abnormality detected at CVS at 11 weeks.

Question 39

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.

Answer 39

a. expiratory reserve volume.

Question 40

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.

Answer 40

c. CVS may indicate a cause for the growth restriction, not apparent with amniocentesis as placenta mosaicism is a potential cause.

Question 41

Which of the following is FALSE regarding human relaxin in pregnancy?

Select one:
a. The absence of circulating serum relaxin is not known to be associated with any significant clinical sequelae.
b. Recombinant human relaxin has not been shown to be an effective cervical ripening agent in randomised controlled trials.
c. Relaxin is structurally closely related to a growth hormone.
d. The corpus luteum of pregnancy is the most important source of circulating serum relaxin.

Answer 41

c. Relaxin is structurally closely related to a growth hormone.

Question 42

A woman G3P2 at 35 weeks gestation, has confirmed preterm pre-labour rupture of membranes. In the context of the PPROMT trial which of the following outcomes would be most likely if she was managed expectantly?

Select one:
a. Higher risk of antepartum haemorrhage
b. Higher risk of Caesarean section
c. Shorter hospital stay
d. Lower risk of intrapartum fever

Answer 42

a. Higher risk of antepartum haemorrhage

Question 43

Which of the following statements about ovarian thecomata is INCORRECT?
Ovarian thecomata:

Select one:
a. have a recognised association with endometrial hyperplasia.
b. are characteristically unilateral.
c. characteristically occur before puberty.
d. may present with virilising symptoms.

Answer 43

c. characteristically occur before puberty.

Question 44

A 21-year-old anxious and distressed nulliparous woman presents requesting a vaginal repair as her boyfriend commented that she had a lax vaginal wall and is putting pressure on her to have a reconstruction/repair. The gynaecological examination was normal.
What is the most appropriate initial option?

Select one:
a. Recommend pelvic floor physiotherapy
b. Perform the procedure after explaining risks and consequences
c. Provide psychosexual counselling to the couple
d. Explain to the woman that there is no medical indication for surgery

Answer 44

d. Explain to the woman that there is no medical indication for surgery

Question 45

Which of the following is LEAST true of vulval melanoma?

Select one:
a. Occur more frequently on the labia majora than labia minora.
b. Melanoma represents approximately 2% of all vulval malignancies.
c. 5-year survival with subcutaneous penetration is approximately 20%.
d. The majority of melanoma cases are postmenopausal.

Answer 45

a. Occur more frequently on the labia majora than labia minora.

Question 46

A meta-analysis of the early small randomised controlled trials of low dose aspirin in pregnancy showed a significant reduction in the frequency of proteinuric preeclampsia OR 0.4 (Confidence Interval 0.3 - 0.86).
Which of the following statements would be INCOMPATIBLE with this result?

Select one:
a. Low dose aspirin is effective in preventing proteinuric preeclampsia.
b. The result could have been due to chance.
c. Increasing the sample size would make the findings significant.
d. The result is consistent with an odds reduction of between 14% and 70%.

Answer 46

c. Increasing the sample size would make the findings significant.

Question 47

During an abdominal sacrocolpopexy procedure, on a woman with a large recurrent enterocoele and rectocoele, which of the following is the most appropriate?

Select one:
a. The procedure should generally be supported by Moscowitz operation.
b. The procedure should generally include a perineorrhaphy.
c. The use of a Type 3 (multifilament mesh, microporous) polyglactin mesh.
d. The upper end of the mesh should be attached between S1 and S3 at more than one point.

Answer 47

d. The upper end of the mesh should be attached between S1 and S3 at more than one point.

Question 48

A previously normotensive 42-year-old woman is on the combined oral contraceptive pill (COCP). She has a diastolic blood pressure reading of 95mmHg at review for a repeat script.
What would be her best initial management?

Select one:
a. Continue with COCP and recheck the blood pressure
b. Continue with COCP and perform renal function testing and review
c. Cease the COCP and review
d. Continue with COCP, begin anti-hypertensive treatment and review

Answer 48

a. Continue with COCP and recheck the blood pressure

Question 49

An 18-year-old patient with primary amenorrhoea has undeveloped breasts, scant pubic and axillary hair and a tall, eunuchoidal habitus. The vagina and external genitalia are normal. The uterus and cervix are hypoplastic and the adnexae are not palpable. Her karyotype is 46,XY.
What is the most likely diagnosis?

Select one:
a. True hermaphroditism
b. 21-hydroxylase deficiency
c. Androgen Insensitivity Syndrome
d. Pure gonadal dysgenesis

Answer 49

d. Pure gonadal dysgenesis

Question 50

Which of the following statements is FALSE?

Select one:
a. An increase in the “anion gap” (non-chloride, non-bicarbonate anions) is commonly seen in diabetic ketoacidosis.
b. In respiratory acidosis there is a low pH and a high PCO2.
c. The oxygen-haemoglobin dissociation curve in the fetus is shifted to the right when compared to the adult.
d. After bicarbonate, haemoglobin is the next most important acid-base buffer for the fetus.

Answer 50

c. The oxygen-haemoglobin dissociation curve in the fetus is shifted to the right when compared to the adult.

Question 51

The most frequent site of colonisation with Group B streptococci is:

Select one:
a. the lower vagina.
b. the cervix.
c. the lower intestinal tract.
d. the pharynx.

Answer 51

c. the lower intestinal tract.

Question 52

Which of the following is correct with regards to the internal iliac artery?

Select one:
a. The internal iliac artery supplies the buttocks.
b. The medial branch of the internal iliac artery supplies the pelvic viscera.
c. The internal iliac artery runs anterior to the ureters.
d. The internal iliac artery arises from the external iliac artery at the level of the sacroiliac joint.

Answer 52

a. The internal iliac artery supplies the buttocks.

Question 53

Which fetal diameter presents in an occipito-posterior presentation?

Select one:
a. Suboccipito-bregmatic
b. Occipito-frontal
c. Submento-bregmatic
d. Vertigo-mental

Answer 53

b. Occipito-frontal

Question 54

A 31-year-old HIV positive woman near term is on anti-retroviral therapy. Her viral load is undetectable and there is no fetal complication. She wants to have a vaginal birth rather than a caesarean section.
After explaining the risk, what is the next most appropriate step?

Select one:
a. Respect the patient’s decision as the risk of transmission is low.
b. Contact Psychiatry to evaluate the patient’s decision.
c. Contact the hospital lawyers for court orders for a caesarean section.
d. Perform the caesarean section at 38 weeks or if in labour.

Answer 54

a. Respect the patient’s decision as the risk of transmission is low.

Question 55

A 34-year-old woman G7P0M5T1 presents for her first antenatal visit at 10 weeks with a viable singleton pregnancy. All her miscarriages were in the first trimester. She has a normal uterine configuration and is thrombophilia screen negative.
What would be the most appropriate initial preventative management for her recurrent miscarriages?

Select one:
a. Cervical cerclage.
b. Low dose aspirin
c. Low molecular weight heparin
d. Maternal reassurance with intensive follow-up

Answer 55

d. Maternal reassurance with intensive follow-up

Question 56

A hepatitis B screening test is positive for antibody to core protein but negative for surface antigen and antibody.
This indicates that:

Select one:
a. the surface antibody will probably become positive soon.
b. the patient is a chronic carrier.
c. the patient has a high rate of infectivity.
d. the patient has probably never had hepatitis B.

Answer 56

a. the surface antibody will probably become positive soon.

Question 57

A 65-year-old woman has recovered from a Colles’ fracture. A recent bone scan reports decreased bone density. Her decreased bone mass is principally due to:

Select one:
a. decreased osteoblastic activity.
b. decreased intestinal calcium absorption.
c. decreased Vitamin D levels.
d. increased osteoclastic activity.

Answer 57

d. increased osteoclastic activity.

Question 58

A Chinese born woman is noted on her routine antenatal testing to have a haemoglobin concentration of 115g/L (Normal range: 110-150), MCV of 72fL (Normal range: 85-95). Her ferritin is 25mcg/L (Normal range: 20-100) and her haemoglobin electrophoresis is normal.Which test will help most to ascertain fetal risk?

Select one:
a. Test her partner’s haemoglobin electrophoresis
b. Test her haemoglobin DNA genotype
c. Test her partner’s full blood examination
d. Test for serum transferrin

Answer 58

c. Test her partner’s full blood examination

Question 59

Which one of the following is INCORRECT?

Select one:
a. Iron absorption in the non-pregnant adult is approximately 5% of daily intake.
b. Cord blood serum ferritin is greater than maternal serum ferritin.
c. Iron requirement in the menstruating, non-pregnant, female is approximately 2mg/day.
d. Iron requirement in the pregnant female is approximately 9mg/day.

Answer 59

d. Iron requirement in the pregnant female is approximately 9mg/day.

Question 60

Contraception in the peri-menopausal woman should be continued until:

Select one:
a. her cycle has begun to elongate.
b. she has had three anovulatory cycles in a row.
c. she has had one full year without periods and exogenous hormones.
d. she has had a blood test showing FSH:LH ratio has risen to two.

Answer 60

c. she has had one full year without periods and exogenous hormones.

Question 61

Which of the following statements is true regarding third trimester idiopathic oligohydramnios confirmed on ultrasound?

Select one:
a. Amnioinfusion should be performed regularly until term.
b. Isolated oligohydramnios is associated with worse perinatal outcomes.
c. The earlier the diagnosis in the 3rd trimester the worse the perinatal outcomes.
d. The use of amniotic fluid index (AFI) of less than 5cm rather than a single deepest pocket (SDP) of less than 2cm for diagnosis improves perinatal outcome.

Answer 61

c. The earlier the diagnosis in the 3rd trimester the worse the perinatal outcomes.

Question 62

The appropriate initial treatment of pulmonary thromboembolism is:

Select one:
a. low molecular weight heparin (LMWH) 1.5mg/kg BD subcutaneous injection.
b. unfractionated heparin 5000 units BD subcutaneous injection.
c. low molecular weight heparin (LMWH) 1mg/kg BD subcutaneous injection.
d. unfractionated heparin 10,000 units IV followed by IV infusion.

Answer 62

c. low molecular weight heparin (LMWH) 1mg/kg BD subcutaneous injection.

Question 63

The lifetime risk of having an operation for genital prolapse in Australia is approximately:

Select one:
a. 1 in 9.
b. 1 in 40.
c. 1 in 100.
d. 1 in 3.

Answer 63

a. 1 in 9.

Question 64

Which of the following statements about the recognised unwanted effects of drugs is correct?

Select one:
a. Hot flushes are associated with clomiphene citrate.
b. Hirsutism is associated with cyproterone acetate.
c. Hypertension is associated with bromocriptine.
d. Fetal virilisation is associated with medroxyprogesterone acetate.

Answer 64

a. Hot flushes are associated with clomiphene citrate.

Question 65

A woman G2P1 and her partner are referred to the antenatal clinic. She is at 14 weeks of gestation with positive anti-D antibodies during routine screening. Her qualitative titre is 1:16. She had an SVD two years ago. The baby had no issues. Her partner is heterozygous for D-antigen.
What is the most appropriate management plan?

Select one:
a. Cordocentesis
b. Check titres fortnightly in the mother
c. Amniocentesis
d. Weekly ultrasound of fetal MCA PSV (Middle cerebral artery peak systolic velocity) to detect fetal anaemia

Answer 65

b. Check titres fortnightly in the mother

Question 66

What is the primary mechanism of the low dose combined oral contraceptive pill in preventing pregnancy?

Select one:
a. Decidualization of the endometrium
b. Suppression of gonadotropin secretion
c. Alteration in fallopian tube motility
d. Alteration of cervical mucous thickness

Answer 66

b. Suppression of gonadotropin secretion

Question 67

A 62-year-old woman is reviewed in clinic for post-operative pain and the ultrasound reveals a vault haematoma. She has had a vaginal hysterectomy.
Which of the following statements is true?

Select one:
a. Most cases of post hysterectomy vault haematoma are symptomatic.
b. Vault haematomas require surgical drainage to ensure complete resolution.
c. Infected vault haematomas usually contaminate the peritoneal cavity.
d. Vault haematoma following hysterectomy occurs in approximately 20% patients.

Answer 67

d. Vault haematoma following hysterectomy occurs in approximately 20% patients.

Question 68

You deliver an Rh-positive infant of an Rh-negative patient at term. The blood bank reports that the Kleihauer-Betke test reveals a feto-maternal haemorrhage of 40mL of fetal red cells. The indirect Coombs’ test shows no anti-D antibodies.
Which of the following statements about this situation is correct?

Select one:
a. The usual dose of one vial (625 IU) of anti-D immunoglobulin should be protective against sensitisation.
b. Seven vials of anti-D immunoglobulin will be necessary to prevent sensitisation.
c. No anti-D immunoglobulin is indicated because the patient is already sensitised.
d. If anti-D immunoglobulin is given, the direct Coombs’ test on the mother should be repeated within 24 hours.

Answer 68

b. Seven vials of anti-D immunoglobulin will be necessary to prevent sensitisation.

Question 69

Complex atypical endometrial hyperplasia is most likely to be found in a woman:

Select one:
a. with adenomyosis.
b. with Type 2 diabetes mellitus.
c. on biphasic oral contraception.
d. on combined oestrogen-progestogen hormone replacement therapy.

Answer 69

b. with Type 2 diabetes mellitus.

Question 70

Which one of the following statements is true concerning toxoplasmosis infection in pregnancy?

Select one:
a. The risk of fetal infection after maternal seroconversion is higher in early pregnancy than in late pregnancy.
b. The predominant source of human infection is the domestic cat (Felis domestica).
c. Pyramethamine/Sulfadoxine is the most effective therapy but spiramycin is theoretically less embryotoxic.
d. Detection of IgM in fetal blood is the preferred method for diagnosis of intrauterine infection.

Answer 70

c. Pyramethamine/Sulfadoxine is the most effective therapy but spiramycin is theoretically less embryotoxic.

Question 71

Which statement is most correct with respect to malaria and pregnancy?

Select one:
a. Quinine can be used if necessary in the treatment of malaria in pregnancy.
b. Mefloquine cannot be used in women with G6PD deficiency.
c. Women in pregnancy and the puerperium are not at increased risk of contracting malaria.
d. Doxycycline is recommended chemoprophylaxis if travelling to chloroquine-resistant areas.

Answer 71

a. Quinine can be used if necessary in the treatment of malaria in pregnancy.

Question 72

The Guthrie test for phenylketonuria is:

Select one:
a. carrier testing.
b. diagnostic testing.
c. predictive testing.
d. exclusion testing.

Answer 72

b. diagnostic testing.

Question 73

With regard to perinatal mental health, which of the following statements is INCORRECT?

Select one:
a. Selective serotonin reuptake inhibitor (SSRI) treatment is unsafe antenatally but low risk during breastfeeding.
b. Approximately 10% of women will experience depression during pregnancy.
c. A woman with a Edinburgh Postnatal Depression Scale (EPDS) score of 13 or more should be further assessed promptly.
d. Up to 80% of women have “postnatal blues” at day four.

Answer 73

a. Selective serotonin reuptake inhibitor (SSRI) treatment is unsafe antenatally but low risk during breastfeeding.

Question 74

Which of the drugs below is most likely to be associated with oligohydramnios?

Select one:
a. Lithium
b. Prazosin
c. Verapamil
d. Captopril

Answer 74

d. Captopril

Question 75

Which of the following would be most likely to be found in a patient with Swyer syndrome (46,XY gonadal dysgenesis), who presents for evaluation of primary amenorrhoea at the age of 18 years?

Select one:
a. Uterus present, breasts developed
b. Uterus absent, breasts undeveloped
c. Uterus present, breasts undeveloped
d. Uterus absent, breasts developed

Answer 75

Uterus present, breasts undeveloped

Question 76

During surgery on an 11-year-old girl, a stage IA, grade 1, 10cm malignant (immature) teratoma is found in the left ovary.
Initial therapy should include:

Select one:
a. left salpingo-oophorectomy.
b. total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, postoperative chemotherapy.
c. total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, postoperative irradiation.
d. bilateral salpingo-oophorectomy.

Answer 76

a. left salpingo-oophorectomy.

Question 77

Which organism is responsible for Donovanosis?

Select one:
a. Gardnerella vaginalis
b. Haemophilus ducreyi
c. Klebsiella granulomatis
d. Corynebacterium donovaniae

Answer 77

c. Klebsiella granulomatis

Question 78

In the graafian follicle, the theca and granulosa cells cooperate to synthesize oestradiol (two-cell theory). The two-cell theory is plausible because:

Select one:
a. theca lutein cells express receptors for FSH.
b. granulosa cell has 17b hydroxylase.
c. androstenedione and testosterone are aromatised in theca cells to oestradiol.
d. granulosa cell has p450 aromatase.

Answer 78

d. granulosa cell has p450 aromatase.

Question 79

You are the on-call registrar for Obstetrics. A patient has delivered her 5th baby but has not delivered the placenta yet. You receive an urgent call to the delivery suite and on arrival you diagnose acute inversion of the uterus. The patient is in shock.
What is the most appropriate first management step?

Select one:
a. Give Terbutaline 0.25mg subcutaneous/intravenous
b. Take the patient immediately to theatre
c. Attempt to remove the placenta
d. Attempt to reposition the uterus

Answer 79

d. Attempt to reposition the uterus

Question 80

Which of the following statements about actinomycosis is FALSE?

Select one:
a. It can occur when an IUCD is in situ.
b. If antibiotics are required, high dose of penicillin or erythromycin are usual choices.
c. It is associated with Toxic Shock Syndrome.
d. It can be recognised by cervical cytology.

Answer 80

c. It is associated with Toxic Shock Syndrome.

Question 81

Which of the following statements regarding the mechanism of anti-androgen effects is LEAST correct?

Select one:
a. Finasteride inhibits 5-alpha-reductase.
b. Cyproterone Acetate inhibits 5-alpha-reductase.
c. Cimetidine weakly binds to the dihydrotestosterone receptor.
d. Spironolactone competitively inhibits binding to the dihydrotestosterone receptor and also inhibits 5-alpha-reductase.

Answer 81

b. Cyproterone Acetate inhibits 5-alpha-reductase.

Question 82

What effect does an electrosurgical waveform have if it is high-current, low voltage and elevates the tissue temperature rapidly (> 100˚ C) to produce vaporisation?

Select one:
a. Desiccation
b. Fulguration
c. Coagulation
d. Cutting

Answer 82

d. Cutting

Question 83

Which of the following causes of primary amenorrhoea are associated with spontaneous ovulation?

Select one:
a. Hypothalamic hypogonadism (Kallmann syndrome)
b. Turner syndrome (45X)
c. 5-alpha reductase deficiency
d. Müllerian agenesis

Answer 83

d. Müllerian agenesis

Question 84

A 32-year-old woman who has been infertile for four years has just completed the diagnostic phase of her infertility evaluation. Mid-luteal progesterone, semen analysis and hysterosalpingogram are all normal. A recent laparoscopy indicates moderate pelvic endometriosis without adhesions (stage III). Medical therapy for her endometriosis is recommended by another gynaecologist. The patient presents to the clinic with a list of questions concerning the proposed therapy. You advise her that:

Select one:
a. the availability of new medications has made medical therapy for endometriosis superior to operative therapy in terms of post-treatment pregnancy rates.
b. the degree of ovarian suppression (hypo-oestrogenism) achieved by treatment with gonadotrophin-releasing hormone (GnRH) agonists is greater than that achieved with danazol.
c. Danazol (Danocrine) is most effective when administered as a single daily dose.
d. medical therapy will defer pregnancy and is not recommended in the setting of infertility.

Answer 84

d. medical therapy will defer pregnancy and is not recommended in the setting of infertility.

Question 85

With respect to pregnancy in renal transplant patients:

Select one:
a. pregnancy is unlikely in the first 12 months after renal transplantation.
b. immunosuppressive agents should be decreased prior to pregnancy.
c. live birth rate approximates 75%.
d. pregnancy may increase graft rejection rates.

Answer 85

c. live birth rate approximates 75%.

Question 86

A 13-year-old patient has had very heavy menstrual bleeding for the past seven days. Menarche was at age 12 and this is the patient’s fourth menses. The last three menstrual cycles have varied between 31 days and 33 days, but each menses has become progressively heavier. The patient has a negative pregnancy test and is not taking any medication. Coagulation studies are normal. Ultrasound reveals a normal sized anteverted uterus. Her haematocrit is 25% and her haemoglobin is 85 g/L.
What is the most appropriate next step in management?

Select one:
a. Dilatation and curettage (D&C)
b. Cyclical progestogen therapy
c. Combined oral contraceptive therapy
d. Intravenous oestrogen therapy

Answer 86

c. Combined oral contraceptive therapy

Question 87

Which of these congenital malformations is most likely to be associated with maternal diabetes mellitus?

Select one:
a. Gastroschisis
b. Duodenal atresia
c. Posterior urethral valves
d. Isolated ventricular septal defect

Answer 87

d. Isolated ventricular septal defect

Question 88

Following the conclusion of the ORACLE trials, which of the following antibiotics, or combinations of antibiotics, would be indicated in women with threatened preterm labour (without premature rupture of the membranes) and no other clinical signs of infection?

Select one:
a. Amoxycillin and Metronidazole
b. Amoxycillin-clavulinic acid
c. None of these options are indicated
d. Erythromycin

Answer 88

c. None of these options are indicated

Question 89

A 45-year-old woman with known BRCA 1 had mastectomy and BSO for breast and ovarian cancers.
What are the most likely histology results?

Select one:
a. Breasts- oestrogen receptor positive; Ovaries – serous adenocarcinoma
b. Breasts- progesterone receptor positive; Ovaries – mucinous adenocarcinoma
c. Breasts- oestrogen receptor negative; Ovaries – mucinous adenocarcinoma
d. Breasts- progesterone receptor negative; Ovaries – serous adenocarcinoma

Answer 89

d. Breasts- progesterone receptor negative; Ovaries – serous adenocarcinoma

Question 90

Of the following antibodies, which is the predominant type produced by the fetus?

Select one:
a. IgA
b. IgE
c. IgG
d. IgM

Answer 90

d. IgM

Question 91

A 15-year-old patient requests evaluation of masculinisation and failure to begin menstruation. She was taller than her peers during childhood. Pubic hair growth began at about six years of age. Excessive facial hair growth began at eight years of age, and she now shaves her face three times a week. She is 160 cm tall, blood pressure is 120/80 mm Hg and she has prominent musculature. Her breasts are Tanner stage 2 and her clitoris is enlarged and there is moderate posterior labial fusion. No pelvic masses are noted on transabdominal USS and a uterus is present. This patient’s sex chromosomes are most likely:

Select one:
a. XYY.
b. XX.
c. XY.
d. XX/XY.

Answer 91

b. XX.

Question 92

Which of the following is the most appropriate treatment?

Select one:
a. Erythromycin for a 28-week pregnant patient with syphilis and a penicillin allergy
b. Ketoconazole for a 25-year-old patient with trichomonas
c. Ampicillin for a 15-year-old patient with pelvic inflammatory disease
d. Tetracycline for a recent immigrant with granuloma inguinale

Answer 92

d. Tetracycline for a recent immigrant with granuloma inguinale

Question 93

In patients who receive Clomiphene citrate (e.g. Clomid®) for induction of ovulation, the frequency of Ovarian Hyperstimulation Syndrome is:

Select one:
a. 5-10%.
b. 15-20%.
c. reduced with ultrasound follicle tracking.
d. less than 1%.

Answer 93

d. less than 1%.

Question 94

In developed countries fetal hypothyroidism is most likely to result when the mother has:

Select one:
a. iodine deficiency.
b. autoimmune thyroiditis.
c. Graves’ disease treated with thyroidectomy
d. carbamazepine overdose.

Answer 94

b. autoimmune thyroiditis.

Question 95

A 46-year-old woman presents with a feeling of a lesion inside her vagina. She is an asylum seeker and has a 10-12 year history of episodes of amenorrhoea and dysfunctional bleeding. She is concerned about going to a hospital and also the cost involved. Her GP has supplied a report of a pelvic ultrasound scan and it shows a moderate cystic change in the uterine cavity and endometrium thickness of 27mm. When you examine her you find a pedunculated cervical polyp which is not compromising her, but is bothering her.
What is the next step in the management of this patient?

Select one:
a. Explain your concern and long term risk of cancer and organise for hysteroscopy and curettage under GA after explaining the cost and procedure
b. Perform an outpatient pipelle aspiration and polypectomy in your room
c. Refer her to the public system and they will take care of her
d. Perform the polypectomy in your rooms

Answer 95

b. Perform an outpatient pipelle aspiration and polypectomy in your room

Question 96

The most frequent cause of dyspareunia is:

Select one:
a. pelvic inflammatory disease.
b. endometriosis.
c. inadequate vaginal lubrication.
d. vaginismus.

Answer 96

c. inadequate vaginal lubrication.

Question 97

A 22-year-old primigravid woman presents to your birthing suite. She has had limited antenatal care in Nigeria. She is at term and contracting 4:10. On vaginal examination she has grade 3 Female Genital Mutilation.

What is the most appropriate management?
Select one:
a. An anterior episiotomy and re-infibulate after delivery
b. A right mediolateral episiotomy
c. Immediate LSCS
d. An anterior episiotomy and control of bleeding only

Answer 97

d. An anterior episiotomy and control of bleeding only

Question 98

Which of the following statements concerning stillbirth is INCORRECT?

Select one:
a. The rate of stillbirth is increased with a true knot in the cord.
b. Approximately 1/500 women will have a stillbirth at or beyond 38 weeks gestation.
c. In each week of pregnancy between 26 weeks and 40 weeks, the rate of stillbirth is approximately 0.03%.
d. Between 41 weeks and 41 weeks and 6 days, the rate of stillbirth is approximately the same as between 38 weeks and 38 weeks and 6 days.

Answer 98

d. Between 41 weeks and 41 weeks and 6 days, the rate of stillbirth is approximately the same as between 38 weeks and 38 weeks and 6 days.

Question 99

A 30 year old woman has a severe exacerbation of her chronic asthma. She is 16 weeks gestation. She has been using inhaled salbutamol without relief.

The next most appropriate management is:
a. leukotriene modifiers
b. inhaled corticosteroids
c. increase the frequency of inhaled salbutamol
d. oral prednisolone

Answer 99

d. oral prednisolone

Question 100

A woman in mid-pregnancy develops intractable constipation which has not responded to fibre supplements.

The next appropriate therapy is:
a. Coloxyl (docusate)
b. Lactulose
c. Bisacodyl (Durolax)
d. Magnesium sulphate

Answer 100

b. Lactulose