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College MCQ Flashcards

1
Q

A 22-year-old woman is seen at 10 weeks gestation in her second pregnancy, her first child being born with a closed spina bifida.

Which of the following statements is TRUE?

  1. The risk of a neural tube defect in this pregnancy is 10%
  2. Amniocentesis is indicated at 15-16 weeks
  3. She should start on a folate supplement now
  4. An ultrasound examination is indicated at 11-12 weeks
A
  1. An ultrasound examination is indicated at 11-12 weeks
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2
Q

The primary group of lymph nodes that drain the vulva is the

  1. deep inguinal.
  2. deep femoral.
  3. obturator.
  4. superficial inguinal.
A
  1. superficial inguinal.
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3
Q

One hundred high-risk patients undergo a fetal biophysical profile (FBPP). Ten patients have a positive test. Two stillbirths result, both of which are from among the patients with a positive FBPP. The sensitivity of the FBPP in this population is

  1. 0%.
  2. 20%.
  3. 80%.
  4. 100%.
A
  1. 100%.
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4
Q

Intraoperative findings that are indications for abandoning radical hysterectomy for cervical cancer include all of the following EXCEPT

  1. Stage IIA disease with a unilateral 30 mm diameter ovarian cyst.
  2. intraperitoneal metastasis.
  3. extra-nodal parametrial/pelvic sidewall disease.
  4. extensive, unresectable pelvic lymph node disease.
A
  1. Stage IIA disease with a unilateral 30 mm diameter ovarian cyst.
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5
Q

Of the following, what is the SMALLEST fetal pole size in which a competent ultrasonologist would be confident diagnosing a missed abortion on transvaginal ultrasound because of the absence of fetal heart activity?

  1. 7 mm
  2. 9 mm
  3. 11 mm
  4. 13 mm
A
  1. 7 mm
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6
Q

Which of the following genetic conditions is NOT associated with a particular ethnic group or groups?

  1. Tay-Sachs disease
  2. von Willebrand disease
  3. Sickle cell disease
  4. alpha thalassaemia
A
  1. von Willebrand disease

A- more common Ashkenazi jews
B: occurs 1% of population, regardless of ethnicity.
C; more common subsaharan africa (also indian, arabs)
D: Common in south east Asia, also middle East, subsaharan Africa.

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7
Q

An epileptic patient on phenytoin (Dilantin) requests contraception. You recommend the

  1. combination pill with 35 μg of ethinyloestradiol.
  2. combination pill with 30 μg of ethinyloestradiol.
  3. Mirena IUD.
  4. progestagen only pill with 35 μg of levo-norgestrel.
A
  1. Mirena IUD.
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8
Q

Which one of the following statements concerning twin-twin transfusion syndrome (TTS) is LEAST CORRECT?

  1. In stage I TTS there is polyhydramnios, stage II empty bladder of the donor twin, stage III absent or reversed umbilical arterial doppler waveform, stage IV fetal hydrops, stage V fetal death of one or both twins
  2. The presence of increased arterial-arterial anastamoses on the surface of the placenta is associated with an increased risk of TTS
  3. Survival in twin-twin transfusion syndrome is approximately 30% untreated, 50% if treatment is available
  4. Serious disability still occurs in approximately 10% of TTS survivors treated with laser coagulation (where both twins are survivors)
A
  1. The presence of increased arterial-arterial anastamoses on the surface of the placenta is associated with an increased risk of TTS
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9
Q

Thyroid hormone

  1. must be present for the fetus to grow normally.
  2. is active in the fetus in the form of reverse T3.
  3. is necessary for shivering, but not non-shivering thermogenesis in the fetus.
  4. has increased concentrations in the fetus after birth because of a surge in TSH concentrations.
A
  1. has increased concentrations in the fetus after birth because of a surge in TSH concentrations.
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10
Q

The failure rate among typical users of which of the following methods of contraception is LESS THAN 1%?

  1. Combined oral contraceptives
  2. Depot medroxyprogesterone acetate
  3. Progestogen only contraceptive pills
  4. Condoms
A
  1. Depot medroxyprogesterone acetate
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11
Q

Regarding the current status of therapy for mild or moderate endometriosis, which of the following statements is LEAST correct?

  1. monthly fecundity over the first 36 weeks is significantly increased after laparoscopic treatment of mild or moderate endometriosis
  2. there is a tendency for fertility to plateau at the same level with either surgical therapy or expectant management of mild or moderate endometriosis
  3. danazol reduces both pain and disease progression with endometriosis
  4. after a course of GnRH analogue therapy, fecundity is transiently improved in comparison to expectant management
A
  1. after a course of GnRH analogue therapy, fecundity is transiently improved in comparison to expectant management
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12
Q

An 18 year old, 63 kg nullipara, with a history of two terminations of pregnancy, presents at 21 weeks’ gestation with pain and bleeding. Limbs are palpable through an 8 cm dilated cervix. Ultrasound reveals the fetus in a transverse lie with its back uppermost and the arms and legs occupying the lower uterine segment. Which of the following is the MOST APPROPRIATE form of management?

  1. internal podalic version and breech extraction
  2. external cephalic version under a beta-mimetic infusion
  3. take no specific action
  4. destructive procedure (embryotomy)
A
  1. take no specific action
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13
Q

a 25 yr old has developed hirsutism, weight gain and deepening of the voice over the last year. Her menstrual cycles are irregular and infrequent. Examination reveals severe facial hair growth and clitoromegaly. The uterus is slightly enlarged. The patient is obese and the ovaries are very difficult to palpate. Investigation shows a testosterone concentration of 17.3 nmol/L (normal range 0.5 - 2.8) and a DHEAS concentration of 9.8 umol/L (normal range 0.9 - 11.7). The MOST APPROPRIATE next step in this patient’s evaluation is

  1. measurement of serum androstenedione.
  2. measurement of serum 17-hydroxyprogesterone.
  3. CT scan of the adrenals.
  4. vaginal ultrasound of the ovaries.
A
  1. vaginal ultrasound of the ovaries.
  • Late onset CAH presents at puberty with virulisation.Elevated DHEAS. dx by serum 17 OHP
  • this is rapid onset ? pelvic mass, and high testorterone- could be a virilising tumor. ( levels > 6.94nmol/Lor DHEAS > 24nmol/L indicate virilising tumour (eg sex chord tumour: sertoli or legdig cells). Elevated DHEAS would suggest adrenal source of the androgen secreting tumour)
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14
Q

A major histologic ovarian structural change associated with menopause is proliferation of

  1. theca interna cells.
  2. granulosa cells.
  3. epithelial surface cells.
  4. stromal cells.
A
  1. stromal cells.
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15
Q

In an adolescent, which of the following is a manifestation of a defect in the migration of primordial germ cells?

  1. Precocious puberty
  2. Pubertal failure
  3. Pubertal delay
  4. Congenital absence of the vagina
A
  1. Pubertal failure
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16
Q

What is the prevalence of PLA-1 (HPA-1a) negative women in the population?

  1. 0.02%
  2. 0.1%
  3. 0.5%
  4. 2%
A
  1. 2%

Neonatal alloimmune thrombocytopenia ( NAIT) - fetus thrombocytopenia because the mother’s immune system attacks her fetus’ or newborn’s platelets. (Like rhesus disease but for platelets). Prevalence of HPA-1a neg women =2%. NAIT prevalence 1:600- 1:5000.

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17
Q

Which of the following conditions is associated with the highest risk of thromboembolism in the puerperium?

  1. Anti-thrombin III deficiency
  2. Factor V Leiden homozygosity
  3. Protein S deficiency
  4. Hyperhomocysteinaemia
A
  1. Anti-thrombin III deficiency

Highest risk: antithrombin 3 deficiency 11-28% risk postpartum VTE,
Protein C or S deficiency 3% risk postpartum
Factor V Leiden homozygos risk 1-10%

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18
Q
  1. Obstetric cholestasis is associated with
  2. right upper quadrant tenderness.
  3. preeclampsia.
  4. pruritus without rash.
  5. Gilbert’s syndrome.
A
  1. pruritus without rash.
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19
Q

Your patient is a 17 year old with short stature and severe oligomenorrhoea. LH 8, FSH 9, 17OHP 11.5, Testosterone 2.9, DHEAS 13.8.

(Normal ranges for assays reported are, LH 4-25, FSH 3-25, 17- hydroxyprogesterone (17OHP) <5.5nmol/L, Testosterone 0.5-2.5nmol/l, dehydroepiandrosterone (DHEAS) umol/L 0.9-11.7)

This patient is MOST LIKELY to have the diagnosis of

  1. Sertoli-Leydig cell tumour.
  2. late onset congenital adrenal hyperplasia.
  3. Adrenal Cortical adenoma.
  4. Cushing syndrome.
A
  1. late onset congenital adrenal hyperplasia.
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20
Q

Which of the following conditions is related to a preventable increased risk of preterm delivery?

  1. Periodontal disease
  2. Dental caries
  3. Endodontal disease
  4. Impacted wisdom teeth
A
  1. Periodontal disease
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21
Q

What is the MOST COMMON mode of transmission of Toxoplasma Gondii to women in Australia?

  1. Contact with domestic cats
  2. Ingestion of kangaroo meat.
  3. Ingestion of sheep meat from the Western District of Victoria.
  4. Ingestion of undercooked meat.
A
  1. Ingestion of undercooked meat.
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22
Q

Which of the following is the KEY mode of current therapy for fetal alloimmune thrombocytopenia?

  1. Maternal immunoglobulin infusion
  2. In-utero fetal platelet transfusion
  3. Corticosteroid therapy with prednisolone
  4. Plasmapheresis
A
  1. Maternal immunoglobulin infusion

NAIT treatment:
IVIG- mainstay
Steroids
Fetal blood sampling
Fetal platelet transfusion
Mode of delivery

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23
Q

In the newborn infant, normal circulatory changes associated with neonatal life include an increase in all of the following EXCEPT

  1. the flow in the pulmonary veins.
  2. the left atrial pressure.
  3. pulmonary vascular resistance.
  4. renal blood flow.
A
  1. pulmonary vascular resistance.
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24
Q

A 30 year old woman, gravida 4, para 3, presents with spontaneous rupture of membranes and irregular contractions at 40 weeks gestation. Her current and prior pregnancies were uncomplicated. Full blood count at the time of admission reveals a platelet count of 85x109/L per mm, but is otherwise normal. She is asymptomatic. The management of her labour should include

  1. fetal platelet count (by scalp sample).
  2. notification of blood bank to have platelet packs available for maternal transfusion.
  3. normal labour management and neonatal platelet count.
  4. caesarean section rather than midforceps to minimise fetal trauma
A
  1. normal labour management and neonatal platelet count.
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25
Q

Which of the following is FALSE?

  1. The risk of thromboembolism in a healthy young women is approximately 1 per 10,000 women years.
  2. The risk of thromboembolism with Progestagen-only contraception is 10 per 10,000 women years.
  3. The risk of thromboembolism on the combined oral contraceptive pill is 4 per 10,000 women years.
  4. The risk of thromboembolism in pregnancy is 30 per 10,000 women years.
A
  1. The risk of thromboembolism with Progestagen-only contraception is 10 per 10,000 women years.
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26
Q

Which one of the following is LEAST CORRECT?

  1. A finding of no difference between the two arms of a Randomised Controlled Trial may reflect the fact that the study did not have a sufficient sample size to detect a clinically important difference
  2. Where a Randomised Controlled Trial that addresses a clinical problem has been performed, this will outweigh all other evidence
  3. The incorporation of multiple trial centres facilitates the achievement of a large sample size often required for a Randomised Controlled Trial, but may necessitate flexible trial protocols to accommodate a broad spectrum of clinical opinion
  4. Flexible entry criteria facilitate the achievement of a large sample size often required for a Randomised Controlled Trial, but at the cost of a conclusion drawn from a heterogeneous population that may not apply to subgroups within the population
A
  1. Where a Randomised Controlled Trial that addresses a clinical problem has been performed, this will outweigh all other evidence
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27
Q

A rapid diagnostic test for Chlamydia trachomatis has a sensitivity of 95% and a specificity of 95%. In a sexually transmitted diseases clinic with a prevalence of chlamydial infection of 30%, the predictive value of a positive test is approximately 90%. In a private practice with chlamydia prevalence of 5%, the predictive value of a positive test would be about

  1. 5%.
  2. 30%.
  3. 50%.
  4. 90%.
A
  1. 50%.
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28
Q

Which of the following statements concerning monozygotic twins is NOT TRUE?

  1. Approximately 30% of monozygotic twins are diamniotic dichorionic
  2. Approximately 25% of twins are monozygotic
  3. Placental vascular anastamoses are present in approximately 95% of monochorionic twins
  4. Splitting of the embryo before day 8 post-conception will result in dichorionic twins, splitting after day 8 results in monochorionic twins
A
  1. Splitting of the embryo before day 8 post-conception will result in dichorionic twins, splitting after day 8 results in monochorionic twins

(day 4)

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29
Q

Which of the following is MOST TYPICAL of cord blood gas measurements after normal labour and vaginal delivery at term?

  1. Arterial cord pH 7.27 and venous 7.34
  2. Arterial cord pH 7.30 and venous 7.37
  3. Arterial cord pH 7.37 and venous 7.30
  4. Arterial cord pH 7.37 and venous 7.34
A
  1. Arterial cord pH 7.27 and venous 7.34
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30
Q

A 22 yr old has infrequent and heavy periods that last 10-12 days and increased facial hair growth. She is normotensive and moderately obese. Her last menstrual period started 25 days ago and ended 12 days later. A biopsy specimen from the endometrium would MOST LIKELY show

  1. supranuclear vacuoles.
  2. stromal oedema with perivascular decidualisation.
  3. haemorrhagic stroma and collapsed endometrial glands.
  4. crowding of straight tubular glands.
A
  1. crowding of straight tubular glands.
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31
Q

Which one of the following statements concerning pseudo myxoma peritonei is CORRECT? Pseudo myxoma peritonei:

  1. requires leakage from a parent cyst for the development of the condition.
  2. responds to treatment with alkylating agents.
  3. is characteristically associated with intestinal obstruction.
  4. responds to treatment with total abdominal irradiation.
A
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32
Q

A 35 yr old primigravid is referred from GP at 30 weeks gestation. Ultrasound examination is performed to check fetal growth. This shows that the largest pocket of amniotic fluid measures 15 cm and the amniotic fluid index is 35. Which of the following congenital anomalies is LEAST LIKELY to be associated with this finding?

  1. Duchenne muscular dystrophy
  2. Myotonic dystrophy
  3. Congenital Diaphragmatic hernia
  4. Hydrocephaly
A
  1. Duchenne muscular dystrophy
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33
Q

Ovulation CANNOT be induced with FSH in individuals with which of the following causes of amenorrhoea?

  1. Galactosaemia
  2. Polycystic ovary syndrome
  3. Hypothalamic hypogonadism (Kallmann’s syndrome)
  4. Hyperprolactinaemia
A
  1. Galactosaemia
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34
Q

All of the following statements concerning Treponema pallidum are correct except:

  1. syphilis can be transmitted from the skin lesions of secondary syphilis.
  2. lesions of tertiary syphilis largely result from an immune response to Treponema pallidum and its products.
  3. the VDRL (Venereal Disease Research Laboratory) test is specific for Treponema pallidum infection.
  4. secondary syphilis may cause loss of scalp hair and eyebrows
A
  1. the VDRL (Venereal Disease Research Laboratory) test is specific for Treponema pallidum infection.
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35
Q

Which of the diagnoses below is MOST LIKELY to be associated with pruritus and bullae in pregnancy?

  1. Drug Eruption
  2. Pruritic Urticarial Papules of Pregnancy (PUPP)
  3. Bullous Pemphigoid
  4. Herpes Gestationis
A
  1. Herpes Gestationis

herpes gestationis = pemphigoid gestationis

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36
Q

Randomised controlled trials have shown that maternal indomethacin therapy is significantly associated in the fetus with

  1. renal insufficiency.
  2. constriction of the ductus arteriosus.
  3. necrotising enterocolitis.
  4. deafness.
A
  1. constriction of the ductus arteriosus.
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37
Q

Signet ring cells are characteristic findings in which of the following tumours of the ovary?

  1. Brenner tumour
  2. Krukenberg tumour
  3. Dermoid cyst
  4. Dysgerminoma
A
  1. Krukenberg tumour
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38
Q

In Syndrome X, the mechanism by which insulin resistance occurs is through

  1. abnormalities associated with the insulin receptor.
  2. obesity-related changes in ovarian function.
  3. alterations in ovarian steroidogenic enzymes.
  4. underlying diabetes mellitus.
A
  1. abnormalities associated with the insulin receptor.
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39
Q

Chromosome mosaicism is detected at CVS performed for advanced maternal age. As a NEXT STEP you would recommend

  1. a repeat of the CVS.
  2. an amniocentesis.
  3. consideration of termination of pregnancy.
  4. no further action.
A
  1. an amniocentesis.
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40
Q

Which of the conditions below, if treated during pregnancy, may have thrombocytopenia and/or osteoporosis induced by the treatment?

  1. asthma
  2. pulmonary tuberculosis
  3. Graves’ disease
  4. antiphospholipid syndrome
A
  1. antiphospholipid syndrome
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41
Q

A cystic structure is found at the fourchette in the midline. Which one of the following is the MOST LIKELY diagnosis?

  1. Epidermoid cyst
  2. Skene’s gland cyst
  3. Gartner’s duct cyst
  4. Sebaceous cyst
A
  1. Epidermoid cyst
42
Q

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?

  1. Thiopentone
  2. Fentanyl
  3. Glyceryl trinitrate (GTN)
  4. Salbutamol
A
  1. Glyceryl trinitrate (GTN)
43
Q

The LEAST COMMON symptom associated with the premenstrual syndrome (PMS) is

  1. bloating.
  2. breast tenderness.
  3. increased appetite.
  4. urinary frequency.
A
  1. urinary frequency.
44
Q

A 26 year old multiparous woman who has Type 2 diabetes had a spontaneous vaginal delivery 72 hours ago with pudendal block anaesthesia and a midline episiotomy. A third degree laceration occurred at the time of delivery. She now has a temperature of 38.90C. Her pulse is 120/min, respiration is 32/min and blood pressure is 90/60 mm Hg. The uterus is 2 cm below the umbilicus and is minimally tender to manipulation. The lochia is equivalent to a menstrual discharge and is malodorous. The perineum and lower vulva and vagina are oedematous but not tender to touch. The perineal skin and vaginal mucosa are pale grey. Sensation to pinprick is markedly diminished in this area. Of the following, the MOST LIKELY diagnosis is

  1. perirectal abscess.
  2. rectovaginal fistula.
  3. endometritis.
  4. necrotising fasciitis.
A
  1. necrotising fasciitis.
45
Q

A multigravida presents at 38 weeks gestation with spontaneous rupture of membranes for 20 hours and early labour. She has not had any antenatal care. She is not febrile. CTG is normal.

The MOST APPROPRIATE Group B Streptaccus (GBS) prophylaxis is

  1. 1G Ampicillin IMI stat
  2. 500mg Erythromycin orally 6 hourly
  3. 1.2G Benzyl Penicillin IV stat
  4. GBS prophylaxis is not required
A
  1. 1.2G Benzyl Penicillin IV stat
46
Q

Which of the following is the MOST COMMON cause of female pseudohermaphroditism?

  1. Virilising ovarian tumour.
  2. Exogenous androgen.
  3. Chromosomal abnormality.
  4. Congenital adrenal hyperplasia.
A
  1. Congenital adrenal hyperplasia.
47
Q

A 30 year old patient, gravida 3, para 2, at 14 weeks gestation asks you for information about second trimester maternal serum screening. Select the MOST APPROPRIATE response.

  1. Using a risk cut-off of 1 in 250, the triple test will identify 90% of all fetuses with trisomy 21
  2. 1 in 100 women will have a “positive test” (risk greater than 1in 250)
  3. The test performs best in patients with a high risk of trisomy 21
  4. The test should not be offered to women with a high (>1/250) age-related risk of trisomy 21
A
  1. The test performs best in patients with a high risk of trisomy 21
48
Q

All of the following statements regarding genital herpes are correct EXCEPT

  1. the acquisition of herpes simplex virus (HSV) type I offers some protection against HSV type II infection.
  2. HSV type II is more commonly associated with genital herpes than is HSV type I.
  3. Acyclovir treatment of the acute disease significantly reduces the recrudescence rate.
  4. women with cervical carcinoma have a higher prevalence of HSV antibodies.
A
  1. Acyclovir treatment of the acute disease significantly reduces the recrudescence rate.
49
Q

Which of the following is NOT a recognised cause of thrombophilia?

  1. Prothrombin 20210A gene mutation
  2. Lupus anticoagulant
  3. Thrombin gene mutation
  4. Factor V Leiden mutation
A
  1. Thrombin gene mutation
50
Q

Which ONE of the following is the optimal therapy for persistent nonmetastatic trophoblastic neoplasia in a 26 year old nulliparous woman?

  1. Multiagent chemotherapy
  2. Single agent chemotherapy
  3. Pelvic irradiation
  4. Total abdominal hysterectomy
A
  1. Single agent chemotherapy
51
Q

Klinefelter’s Syndrome is characteristically associated with each of the following EXCEPT

  1. Testicular hypoplasia.
  2. Raised serum FSH concentration.
  3. Azoospermia.
  4. Impotence.
A
  1. Impotence.
52
Q

At the routine antenatal screening tests, a 20-year-old woman from Nauru has negative RPR (Rapid Plasma Reagin) and positive TPHA (Treponema pallidum haemagglutination).

The MOST LIKELY explanation is that

  1. the patient probably has early syphilis.
  2. the patient probably has late latent syphilis.
  3. the result is probably a biological false positive.
  4. the patient has probably been treated for syphilis in the past.
A
  1. the patient has probably been treated for syphilis in the past.
53
Q

Which of the following carries the HIGHEST relative risk of ectopic pregnancy if the woman accidentally becomes pregnant?

  1. condoms
  2. diaphragm
  3. combination oral contraceptive pills
  4. Progestagen-only pills
A
  1. Progestagen-only pills
54
Q

Which of the following would NOT be an accurate description of 47XXY in an adult?

  1. serious intellectual disability
  2. tall stature
  3. elevated Serum FSH
  4. female fat distribution
A
  1. serious intellectual disability
55
Q

A woman has an RPR/VDRL titre of 1:8 in early pregnancy and a history of documented successful treatment of syphilis. What is your NEXT course of action?

  1. Perform TPHA and FTA tests
  2. Check post treatment RPR/VDRL titres
  3. Administer 1.8g IMI Bicillin
  4. Undertake contact tracing
A
  1. Check post treatment RPR/VDRL titres
56
Q

Which one of the following would be MOST likely to contribute to osteoporosis?

  1. Phenytoin
  2. Amitryptiline
  3. Captopril
  4. Warfarin
A
  1. Phenytoin
57
Q

The Pearl index (formula) is expressed in the

  1. percentage of women who become pregnant using a particular contraceptive.
  2. percentage of women who do not become pregnant using a particular contraceptive.
  3. number of pregnancies per 100 woman-years’ use of a particular contraceptive.
  4. number of pregnancies per 1000 woman-years’ use of a particular contraceptive.
A
  1. number of pregnancies per 100 woman-years’ use of a particular contraceptive.
58
Q

A 34 year old woman in her first pregnancy requests an elective caesarean section at 37 weeks gestation because her husband is in the armed forces and is being posted overseas soon. You advise her that the RISK of neonatal admission to a special care baby unit following an elective caesarean section at this gestation is

A. 12%.

B. 9%.

C. 6%.

D. 3%.

A

A. 12%.

59
Q
  1. An 18 year old woman presents never having had a spontaneous period. She has had vaginal bleeding following administration of the oral contraceptive pill. She has little breast development. Which one of the following would be the LEAST useful in determining cause?
  2. Chromosomal analysis
  3. Oestrogen assay
  4. Prolactin assay
  5. FSH and LH assay
A
  1. Oestrogen assay
60
Q
  1. What is the MOST COMMON cause of introital dyspareunia?
  2. Monilial vulvo-vaginitis
  3. Herpes genitalis
  4. Inadequate arousal
  5. Vaginismus
A
  1. Inadequate arousal
61
Q
  1. Which organism is responsible for chancroid?
  2. Haemophilus ducreyi
  3. Chlamydia trachomatis
  4. Treponemum pallidum
  5. Mycoplasma hominis
A
  1. Haemophilus ducreyi
62
Q

In a first trimester (12 weeks gestation) twin pregnancy, where there is discordancy of the nuchal translucency measurements, the next most important information needed is

  1. the chorionicity of the twins.
  2. the zygosity of the twins.
  3. the karyotypes of the twins.
  4. the amniotic indices for the twins.
A
  1. the chorionicity of the twins.
63
Q
  1. A woman is referred to you in mid-pregnancy for review. She has quiescent rheumatoid arthritis. She is ribosmal antibody negative, lupus anticoagulant negative and anticardiolipin negative. You counsel her that
  2. her fetus is at severe risk of placental insufficiency.
  3. she has a risk of postpartum exacerbation.
  4. her fetus is at risk of complete heart block.
  5. she should expect no problems with this pregnancy.
A
  1. she has a risk of postpartum exacerbation.
64
Q

Which of the following disorders is associated with the highest maternal mortality?

  1. Hypothyroidism
  2. Systemic lupus erythematosus
  3. Ventricular septal defect
  4. Primary pulmonary hypertension
A
  1. Primary pulmonary hypertension
65
Q

All of the following statements about partial molar pregnancy are true EXCEPT

  1. the karyotype is usually triploid.
  2. Beta-hCG follow-up is indicated after molar evacuation.
  3. progression to choriocarcinoma does not occur although there may be persistent trophoblastic disease after evacuation.
  4. early pre-eclampsia is more common in patients with a partial mole, than a normal pregnancy.
A
  1. progression to choriocarcinoma does not occur although there may be persistent trophoblastic disease after evacuation.
66
Q

You administer prophylactic anti-D gamma globulin to a Rhesus negative woman at 28 weeks gestation. Immediately afterwards your midwifery colleague informs you that the woman’s medical record states that she is a Jehovah’s Witness. The MOST APPROPRIATE response is to

  1. remove the drug chart from the medical record and destroy it.
  2. inform your medical defence organisation of the incident.
  3. immediately inform the patient of the error and apologise.
  4. report the midwife’s failure to alert you in advance.
A
  1. immediately inform the patient of the error and apologise
67
Q

Which of the following IS FALSE regarding the use of Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) in pregnancy?

  1. Oligohydramnios is a side effect of selective COX-2 antagonists
  2. Premature closure of the ductus arteriosus is less likely at an advanced gestational age than extremely premature gestations
  3. NSAIDs are safe to use in the presence of maternal hepatic dysfunction
  4. Sulindac has reduced concentration of the active metabolite in the fetal circulation but has been associated with premature closure of the ductus arteriosus and oligohydramnios
A
  1. Premature closure of the ductus arteriosus is less likely at an advanced gestational age than extremely premature gestations
68
Q
  1. Which of the following is NOT a risk factor for endometrial cancer?
  2. smoking
  3. high animal fat diet
  4. early menarche
  5. late menopause
A

1.

  1. smoking
69
Q

Which of the following statements about the composition of breastmilk is FALSE?

  1. Human Breast Milk has approximately one-quarter the amount of protein in comparison with Cow’s Milk
  2. Human Breast Milk has approximately one-third the amount of NaCl in comparison with Cow’s Milk
  3. Human Breast Milk has approximately one-quarter the amount of calcium in comparison with Cow’s Milk
  4. Human Breast Milk has approximately double the Vitamin D content in comparison with Cow’s Milk
A
  1. Human Breast Milk has approximately double the Vitamin D content in comparison with Cow’s Milk
70
Q

A patient at 12 weeks gestation is found to have anti-Fya red antibodies on routine testing at a titre of 1 in 16. The MOST APPROPRIATE next step in management is to

  1. perform ultrasound at 18 weeks to exclude early hydrops fetalis.
  2. ascertain the partner’s phenotype.
  3. repeat the antibody test at 16 weeks.
  4. reassure the patient that anti-Fya antibodies are non-haemolytic.
A
  1. ascertain the partner’s phenotype.
71
Q

Which of the following statements concerning anticoagulation with warfarin sodium is CORRECT?

A. The effects of the drug are reversed most rapidly by the administration of fresh frozen plasma
B. Paracetamol administration in normal therapeutic dosage may cause a drug interaction

C. Treatment should be monitored by measuring the partial thromboplastin time

D. Breast feeding is contraindicated

A

A. The effects of the drug are reversed most rapidly by the administration of fresh frozen plasma

72
Q
  1. The blood volume of a normal 3500gm newborn at term is APPROXIMATELY
  2. 200 ml.
  3. 250 ml.
  4. 300 ml.
  5. 350 ml.
A
  1. 300 ml.
73
Q

A blood assay of which of the following steroids is the MOST DIRECT measure of adrenal androgen activity?

  1. Androstenedione
  2. Cortisol
  3. Dehydroepiandrosterone sulphate (DHEAS)
  4. Testosterone
A
  1. Dehydroepiandrosterone sulphate (DHEAS)
74
Q

Approximately what percentage of patients with vulvar intraepithelial neoplasia (VIN) are 40 years of age or younger?

  1. None
  2. 10%
  3. 20%
  4. 50%
  5. 90%
A
  1. 50%
75
Q

Which of the following is a risk factor for the development of uterine sarcoma?

  1. Use of exogenous oestrogens
  2. Multiparity
  3. Family history
  4. Prior pelvic irradiation
A
  1. Prior pelvic irradiation
76
Q

a 15 yr old girl presents to ED with severe low abdominal pain. The pain is intermittent and commenced 12 months ago. Her periods have not started yet but she has normal secondary sex characteristics and a normal BMI. Her twin sister has regular periods. What is the MOST LIKELY diagnosis?

A. Hyperthyroidism
B. Androgen insensitivity

C. Polycystic ovary syndrome

D. Imperforate hymen

A

D. Imperforate hymen

77
Q

The lifetime risk for ovarian cancer in a woman with one first degree relative with ovarian cancer is about

  1. 0.1%.
  2. 1%.
  3. 5%.
  4. 15%.
A
  1. 5%.
78
Q

Which of the following statements regarding the androgen insensitivity syndrome is CORRECT?

  1. The testosterone is below that of a normal male.
  2. The risk of dysgerminoma or other gonadal neoplasm is high until 20 years of age.
  3. Pubescence is delayed because of the absence of endogenous hormones.
  4. The syndrome is an X-linked recessive.
A
  1. The syndrome is an X-linked recessive.
79
Q

Which of the following conditions is NOT increased by the use of salbutamol?

  1. hypoglycaemia
  2. ventricular tachycardia
  3. pulmonary oedema
  4. hypokalaemia
A
  1. hypoglycaemia
80
Q
  1. Which of the following would be the MOST APPROPRIATE next step in treating a woman with a severe idiopathic cardiomyopathy who has just had a 1500ml postpartum haemorrhage and is continuing to bleed? (Syntocinon 5 units intravenously has been given for 3rd stage.)
  2. Ergometrine 0.25 mg intravenously
  3. Prostaglandin F2-alpha 1-5 mg intramyometrially
  4. Oxytocin 40 units in 1L Hartman’s over 4 hours
  5. Misoprostol 200-400 microgram orally
A
  1. Oxytocin 40 units in 1L Hartman’s over 4 hours
81
Q

Which of one of the following is FALSE concerning uterine fibroids?

  1. Major chromosomal abnormalities are identified in more than 20% of fibroids.
  2. Medroxy progesterone acetate most commonly inhibits fibroid mitotic activity.
  3. Fibroids develop in approximately 50% of women.
  4. Genetic studies indicate all cells in a fibroid arise from a single cell.
A
  1. Medroxy progesterone acetate most commonly inhibits fibroid mitotic activity
82
Q

Which of the following is FALSE regarding Oxytocin in pregnancy and parturition?

  1. Oxytocin is a nonapeptide
  2. Oxytocin initiates G-protein dependent activation of Phospholipase C
  3. Oxytocin receptors in the Decidua lead to PGF2-alpha production
  4. Oxytocin receptor concentrations markedly increase with advancing gestation
A
  1. Oxytocin receptors in the Decidua lead to PGF2-alpha production
83
Q

The husband of a woman who is 10 weeks pregnant is diagnosed with acute hepatitis B. The woman is tested for hepatitis B serology and is negative for hepatitis B surface antigen, hepatitis B core IgM antibody, hepatitis B core antibody and hepatitis B surface antibody.

The MOST APPROPRIATE management of the patient is

  1. repeat blood tests for hepatitis B in 2 weeks.
  2. hepatitis B immune globulin.
  3. commence hepatitis B vaccine.
  4. hepatitis B immune globulin and commence hepatitis B vaccine.
A
  1. hepatitis B immune globulin and commence hepatitis B vaccine.
84
Q

Which one of the following statements about spontaneous miscarriage is CORRECT?

  1. Bacterial vaginosis is associated with an increased risk of first trimester miscarriage
  2. Among chromosomally abnormal spontaneous abortuses, the most common chromosomal abnormality is triploidy
  3. In utero exposure to diethylstilboestrol (DES) increases a woman’s risk of spontaneous miscarriage
  4. The karyotypic abnormalities in spontaneous abortuses are similar to those in liveborn neonates
A
  1. In utero exposure to diethylstilboestrol (DES) increases a woman’s risk of spontaneous miscarriage
85
Q

The significance of an ultrasound finding of polycystic ovaries in the prepubertal sister of a woman with PCOS is that

  1. it means that she will develop PCOS.
  2. it is a marker for insulin resistance.
  3. it suggests that there is partial 21 hydroxylase deficiency in the family.
  4. it indicates that she is using oocytes at an increased rate and will have an earlier menopause.
A
  1. it is a marker for insulin resistance.
86
Q

In a neonate born with an omphalocoele at 38 weeks’ gestation, the MOST important factor determining prognosis is

  1. size of the defect.
  2. presence of other anomalies.
  3. method of delivery.
  4. method of surgical repair.
A
  1. presence of other anomalies.
87
Q

All of the following factors are associated with an increased risk for pre-term delivery EXCEPT

  1. hyperemesis gravidarum.
  2. bleeding in the first trimester.
  3. oligohydramnios.
  4. placenta praevia.
A
  1. hyperemesis gravidarum.
88
Q

Following ovulation, the survival of the unfertilised human ovum is APPROXIMATELY

  1. 12-24 hours.
  2. 24-48 hours.
  3. 2-3 days.
  4. 4-5 days.
A
  1. 12-24 hours.
89
Q

Which one of the following is FALSE regarding depot medroxyprogesterone acetate?

  1. Amenorrhoea is expected in approximately 50% at 12 months
  2. Amenorrhoea is expected in approximately 25% at 24 months
  3. There maybe a modest reduction in bone mineral density compared to controls
  4. Depot medroxyprogesterone acetate is good contraception for women with epilepsy
A
  1. Amenorrhoea is expected in approximately 25% at 24 months
90
Q

Which one of the following is INCORRECT?

  1. A fetus affected by antiKell antibodies and requiring intrauterine transfusion, can be given red cells from its mother
  2. The amniotic fluid bilirubin is less reliable in predicting disease severity with antiKell antibodies compared to antiDuffy antibodies
  3. A woman at 19 weeks with antiKell 1/2048 and a husband with a homozygous phenotype (KK) should have a fetal blood sampling
  4. The commonest Kell phenotype in the population is Kk
A
  1. A fetus affected by antiKell antibodies and requiring intrauterine transfusion, can be given red cells from its mother
91
Q

A 6 year old girl is brought to you by her mother who has noticed that the child has persistent blood-stained vaginal discharge. The MOST APPROPRIATE management is

  1. inspect the vulva and perform a rectal examination to exclude a foreign body.
  2. take a bacteriological swab from the discharge and treat accordingly.
  3. counsel the mother and arrange an examination under anaesthesia.
  4. perform a pelvic ultrasound to exclude foreign body and malignant disease.
A
  1. counsel the mother and arrange an examination under anaesthesia.
92
Q

A 36 year old woman is referred to you because of a 6 month history of postcoital and intermenstrual bleeding. A Pap smear done by her general practitioner was reported as Low grade squamous interaepithelial lesion with numerous inflammatory cells present. Speculum examination shows a friable fungating lesion 2 cm in diameter on the posterior lip of the cervix. There is no evidence of extension of the lesion into the parametrium or uterosacral ligaments and the uterus is of normal size and mobile. The MOST APPROPRIATE next step is

  1. examination under anaesthesia.
  2. colposcopy with punch biopsy.
  3. cone biopsy.
  4. intravenous pyelogram.
A
  1. colposcopy with punch biopsy.
93
Q

Delayed Puberty (no secondary sex characteristics by 13 or no menses by 15 years of age), would be expected to occur in APPROXIMATELY what percent of the female population?

  1. 0.25%
  2. 1.0%
  3. 2.5%
  4. 5.0%
A
  1. 2.5%
94
Q

A 25yr old lactating women has vulvovaginal irritation and burning sensation with intercourse four weeks postpartum. Examination shows a well healed episiotomy, no discharge and an erythematous, thin vaginal mucosa. Findings on bimanual examination are normal. Potassium hydroxide and saline preparation of vaginal secretions are negative.

The MOST LIKELY diagnosis is

  1. Mycoplasma hominis vaginitis.
  2. Candida vulvovaginitis.
  3. Bacterial vaginosis.
  4. Atrophic vaginitis.
A
  1. Atrophic vaginitis.
95
Q

A 50 year old patient has received conflicting advice concerning hormone therapy (HT). Which of the following would be CORRECT information to relate to this patient?

  1. Bone loss is most rapid in the first 3 years after the onset of menopause
  2. Ingestion of 1,500 mg of elemental calcium per day will lead to an increased incidence of kidney stones
  3. HT is not indicated after the age of 60
  4. HT increases the risk of colorectal cancer
A
  1. Bone loss is most rapid in the first 3 years after the onset of menopause
96
Q

A term infant has an Apgar score of 2 at one minute. Select the MOST APPROPRIATE statement.

  1. The infant needs immediate transfer to special care nursery.
  2. The infant needs resuscitation.
  3. The infant will develop seizures.
  4. The infant has significant hypoxia.
A
  1. The infant needs resuscitation
97
Q

The MOST COMMON cause of vaginal discharge in a seven year old girl is

  1. vaginal injury.
  2. candidiasis.
  3. atrophic vulvovaginitis.
  4. a foreign body.
A
  1. atrophic vulvovaginitis.
98
Q

Which of the following is LEAST correct regarding Cerebral Palsy?

  1. Approximately 5% of those babies with an Apgar score of less than 4 at 10 minutes will develop cerebral palsy.
  2. Approximately 25% of babies with grade III hypoxic-ischaemic encephalopathy will develop cerebral palsy.
  3. Approximately 5 % of surviving triplets will develop cerebral palsy.
  4. Approximately 1% of surviving twins will develop cerebral palsy.
A
  1. Approximately 25% of babies with grade III hypoxic-ischaemic encephalopathy will develop cerebral palsy.
99
Q

Crossing over of chromosomes occurs during

  1. metaphase I.
  2. mitotic prophase.
  3. meiotic prophase I.
  4. meiotic prophase II.
A
  1. meiotic prophase I.
100
Q

A 55-year-old woman has been treated for stage III ovarian carcinoma by hysterectomy, bilateral salpingo-oophorectomy, and 80% reduction of the tumour mass, followed by multiple-agent chemotherapy. She now has large intra-abdominal masses. Further therapy is not possible. Her terminal state is most likely to be associated with

  1. intestinal obstruction.
  2. ureteral obstruction.
  3. urinary retention.
  4. brain metastases.
A
  1. intestinal obstruction.
101
Q

Of the fetal cardiac output,

  1. 50% of the outflow of the right ventricle traverses the pulmonary arteries.
  2. approximately 40% is directed to the placenta.
  3. approximately 33% perfuses the brain via the carotid arteries.
  4. 50% of the outflow of the right ventricle traverses the ductus arteriosus.
A
  1. approximately 40% is directed to the placenta.
102
Q

A 33-year-old woman, G3P2 who has had two previous LUSCS is diagnosed on a 20 week US with a low lying anterior placenta that is invading the myometrium. There has been no bleeding and the fetus is morphologically normal. You recommend that

  1. the pregnancy should be terminated immediately and a hysterectomy should be arranged.
  2. she should be admitted to hospital for close observation until delivery at 34 weeks.
  3. she should be transferred to a tertiary hospital for further management and level III US.
  4. an elective USCS at 37 weeks should be arranged followed by a hysterectomy.
A
  1. she should be transferred to a tertiary hospital for further management and level III US.

MCQ (10 decks)

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