Example MCQs Flashcards
At the time of a routine prenatal examination at 26 weeks’ gestation, a 23 year old primigravid woman has a fetal heart rate of 220 bpm. Echocardiography confirms a supraventricular tachyarrhythmia. The fetus has a small pericardial effusion and a moderate amount of ascites. The next step in management should be:
A. continued observation.
B. fetal paracentisis.
C. administration of betamethasone to the woman.
D. administration of digoxin to the woman.
E. delivery
D - administration of digoxin to the woman
A 26 year old, G4P2, woman at 33 weeks is admitted in early labour and draining copious amounts of greenish-brown liquor. Her cervix is 2-3 cm dilated but not effaced. Urgent management should include:
A. examination of the liquor for gram positive rods suggestive of Listeria.
B. examination of the liquor for lamellar bodies.
C. an attempt to measure the fetal scalp pH.
D. an ultrasound examination of the fetus to exclude oesophageal atresia.
E. the administation of glucocorticoids to accelerate fetal lung maturation.
A - examination of the liquor for gram positive rods suggestive of listeria
An elective caesarean section is being performed at 37 weeks of gestation because of a grade III anterior placenta praevia. The presentation of the baby is cephalic with the head high and mobile. The most appropriate way of effecting delivery is by:
A. classical caesarean section.
B. lower uterine segment caesarean section, incising the placenta and using obstetric forceps.
C. lower uterine segment caesarean section, incising the placenta and guiding the fetal head out manually.
D. lower uterine segment caesarean section, entering the amniotic cavity below the placenta and using obstetric forceps.
E. lower uterine segment caesarean section, entering the amniotic cavity above the placenta and performing internal version and breech extraction.
E - lower uterine segment caesarean section, entering the amniotic cavity above the placenta and performing internal version and breech extraction.
A multigravid patient is known to have a grossly hydrocephalic baby. She has been in spontaneous labour at 38 weeks for six hours, the cervix is 3 cm dilated and there has been no progress during the last three hours. The appropriate management is:
A. Syntocinon infusion with a view to performing ventriculocentesis when the cervix is at or near full dilatation.
B. transabdominal ventriculocentesis.
C. transvaginal ventriculocentesis.
D. lower uterine segment caesarean section.
E. classical caesarean section.
C - transvaginal ventricuocentesis
A 32 year old woman with a history of two previous normal deliveries is in spontaneous labour at term gestation. The cervix is 5 cm dilated. Intermittent auscultation of the fetal heart rate has suggested decelerations during contractions. Electronic fetal heart rate monitoring has been commenced which reveals variable decelerations down to 80 beats per minutes, lasting 20 seconds, and associated with good baseline variability. The most appropriate action is:
A. perform a scalp pH measurement.
B. administer 500 ml saline intravenously.
C. perform a caesarean section.
D. perform Doppler studies of the umbilical circulation.
E. reposition the patient and continue observation
E - reposition the patient and continue observation
You are about to perform a non-elective caesarean section for failure to progress in a healthy 19 year old primigravida at term. There is no fetal distress. Your anaesthetist is unable to intubate the patient. The best course of action is to:
A. continue as normal using a mask anaesthetic.
B. continue using a mask anaesthetic, with the patient on her side and head down.
C. perform a tracheostomy.
D. stop and wait for a regional anaesthetic
E. stop and transfer the patient to a major centre.
?D - stop and wait for a regional anaesthetic
A 24 year old Australian woman, gravida 2, para 1, previously delivered an anencephalic infant. She now is at 8 weeks’ gestation and seeks your advice concerning the possibility of having a second affected infant. You should inform her that the risk of a neural tube defect in the next pregnancy is:
A. less than 0.5%.
B. 1 to 2%.
C. 4 to 5%.
D. 8 to 9%.
E. 12 to 13%.
C - 4-5%
A 19-year-old nulliparous patient with last menstrual period 6 weeks ago presents to the emergency department with sudden onset of pelvic pain and genital spotting. Pelvic examination reveals bilateral adnexal tenderness. Pelvic ultrasound reveals no gestational sac in the uterus. The quantitative serum hCG is 6000 IU. The next appropriate step is:
A. laparotomy.
B. laparoscopy.
C. repeat ultrasound in one week.
D. serial hCG determinations.
E. endocervical culture for Chlamydia.
B - laparoscopy
If the parents of a stillborn fetus with major malformations view the fetus after delivery, the likely outcome is:
A. facilitation of the grieving process.
B. an out-pouring of anger.
C. delay and difficulty with grieving.
D. a high probability they will not try for another child.
E. development of difficulties in their relationship with their existing children.
A - facilitation of the grieving process
The optimum treatment for early stage, but symptomatic, endometriosis in a young married woman aged 25 is:
A. encourage pregnancy as soon as possible, but otherwise offer no treatment.
B. ablate the endometriosis visible by laser laparoscopy.
C. treat with Danazol 200 mg daily for 12 months.
D. perform exploratory laparotomy and resect endometriotic deposits.
E. give GnRH agonist therapy for three months and then encourage pregnancy
B - laparoscopy
A 35 year old woman complains of a white malododourous vaginal discharge especially evident postcoitally. The most likely cause is:
A. Chlamydia trachomatis infection.
B. Gardnerella vaginalis infection.
C. Neisseria gonorrhoea infection.
D. florid cervical erosion.
E. Candida albicans infection.
B - Gardneralla vaginalis infection
A 30 year old patient undergoes a simple abdominal hysterectomy for intraepithelial carcinoma of the cervix. Twelve hours postoperatively you are notified that her temperature is 39.4oC. She appears flushed and acutely ill. Her pulse is 140 per minute and weak, and the respirations are 24 per minute. Her chest is clear to ausculation. Which of the following is the most likely diagnosis?
A. Pulmonary embolus.
B. Pelvic cellulitis secondary to Bacteroides fragilis.
C. b-haemolytic streptococcal septicaemia.
D. Pelvic vein thrombosis.
E. Reaction to blood transfused during surgery.
C - septicaemia
A significant reduction in neonatal and infant mortality in developing countries can be achieved by all the following EXCEPT:
A. Breastfeeding of the infant.
B. Tetanus toxoid immunisation of the mother antenatally.
C. Improving maternal nutrition during pregnancy.
D. Anti-malarial prophylaxis during the antenatal period.
E. Provision of neonatal intensive care facilities in the capital cities
E - provision of NICU facilities in capital cities
All of the following are proven to be established benefits of the oestrogen/progestogen oral contraceptive pill EXCEPT:
A. Reduction in incidence of cervical carcinoma.
B. Reduction in incidence of menorrhagia.
C. Reduction in incidence of benign breast disease.
D. Reduction in incidence of pelvic inflammatory disease.
E. Reduction in incidence of ovarian carcinoma.
A - cervical carcinoma
Recognised causes of erectile impotence in the male include all of the following EXCEPT:
A. spinal cord lesions.
B. administration of methyldopa.
C. chronic renal failure.
D. sulphasalazine therapy.
E. hyperprolactinaemia.
D - sulpasalazine therapy
