Feb 2010 MCQ Flashcards
The fertilised human ovum reaches the uterus approximately
A) 5 hours after ovulation
B) 36 hours after ovulation
C) 5 days after ovulation
D) 7 days after ovulation
E) 9 days after ovulation
C) 5 days after ovulation
Which of the following is LEAST correct regarding Tibolone?
A) it alleviates postmenopausal vasomotor symptoms
B) It does not stimulate the endometrium
C) It prevents osteoporosis
D) It inhibits proliferation of human breast cells
E) It improves the lipid profile with an increase in serum HDL cholesterol
F) It lowers sex hormone binding globulin increasing the bio-availability of endogenous testosterone
E) It improves the lipid profile with an increase in serum HDL cholesterol
A 26 y/o multigravida woman at 30/40 comes to the delivery suite of a level II hospital with a frank breech presentation at +3 station. Delivery begins to occur spontaneously until exclusion of the fetal thorax, when the cervix is noted to be incompletely dilated and the head entrapped. Which of the following would be of the MOST VALUE in this clinical situation?
A) nitrous oxide and oxygen
B) Thiopentone
C) Fentanyl
D) Glyceryl Trinitrate (GTN)
E) Salbutamol
D) GTN
Which of the following is MOST TYPICAL of cord blood gas measurements after normal labour and delivery at term?
A) arterial cord pH 7.27 and venous 7.34
B) arterial cord pH 7.34 and venous 7.26
C) arterial cord pH 7.30 and venous 7.37
D) arterial cord pH 7.37 and venous 7.30
E) arterial cord pH 7.37 and venous 7.34
A) arterial cord pH 7.27 and venous 7.34
Which of the following statements is LEAST CORRECT?
A) The perinatal mortality rate in Papua New Guinea is approximately 20/1000
B) The maternal mortality rate in Aus/NZ is approximately 1/10,000
C) The maternal mortality rate in Papua New Guinea is approximately 1/250
D) There are approximately 1500 maternal deaths worldwide each day
A) The perinatal mortality rate in PNG is approximately 20/1000
Which of the following is true concerning uterine fibroids?
Uterine fibroids:
A) undergo sarcomatous changes in 1% of cases
B) are associated with nulliparity
C) characteristically cause pain
D) Should be removed at Caesarean section if larger than 2cm
B) are associated with nulliparity
What effect does an electrosurgical waveform have if it is high current, low voltage and elevates the tissue temperature rapidly (>100deg) to produce vaporisation?
A) Cutting
B) Fulguration
C) Coagulation
D) Blend
E) Desiccation
A) Cutting
Each of the following is ovarian germ cell neoplasm EXCEPT:
A) Gynandroblastoma
B) Embryonal carcinoma
C) Gonadoblastoma
D) Polyembryoma
E) Endodermal sinus tumour
A) Gynandroblastoma (sex cord)
Which of the following would be the MOST APPROPRIATE next step in treating a woman with severe idiopathic cardiomyopathy who has just had a 1500ml PPH and is continuing to bleed? (syntocinon 5 units IV has been given for 3rd stage)
A) Ergometrine 0.25mg IV
B) Further 10 units oxytocinon IV
C) Prostaglandin F2 alpha 1.5mg intramyometrially
D) Oxytocinon 40 units in 1L Hartmanns over 4 hours
E) Misoprostol 200-400mcg orally
A) Ergometrine 0.25mg IV
Which one of the following is INCORRECT?
A) a fetus affected by Anti-bell antibodies and requiring intrauterine transfusion, can be given RBC from its mother
B) The amniotic fluid bilirubin is less reliable in detecting disease severity with Anti Kell antibodies compared to Anti- Duffy antibodies
C) A woman at 19/40 with AntiKell 1/2048 and a husband with a homozygous phenotype KK should have fetal blood sampling
D) Anti Kell antibodies both suppress erythropoiesis and cause haemolysis
E) The commonest Kell phenotype in the population is Kk
E) the commonest Kell phenotype in the population is Kk
a woman delivers a 3kg baby at term with ambiguous genitalia. The karyotype is 46XX and the 17-OH progesterone is 100 (normal is <20). The baby undergoes surgical correction of its genital anomalies successfully and is commenced on steroid replacement therapy. In her next pregnancy you would recommend?
A) commencement of dexamethasone at the diagnosis of pregnancy
B) commencement of prednisolone at the diagnosis of pregnancy
C) amniocentesis to diagnose fetal sex and commence dexamethasone if fetus is female
D) amniocentesis to diagnose fetal sex and commence prednisolone if fetus is female
A) commencement of dexamethasone at the diagnosis of pregnancy
The MOST COMMON chromosomal error observed in the abortuses from spontaneous abortion is?
A) autosomal trisomy
B) Triploidy
C) Sex chromosome abnormalities
D) Chromosomal translocation
A) autosomal trisomy
On withdrawing the main trocar inserted through the umbilicus during a diagnostic laparoscopy, and prior to inserting the viewing telescope, fecal matter is seen on the tip of the trocar. Should the surgeon?
A) remove the cannula, discontinue the operation, give antibiotics and wait and see?
B) remove the cannula and perform a laparotomy to find and repair the damaged bowel?
C) leave the cannula where it is and perform a laparotomy using a low transverse incision?
D) leave the cannula where it is and perform a laparotomy using a midline incision?
E) insert the telescope through a new puncture and attempt repair of the bowel using new laparoscopic techniques for suturing?
D) leave the cannula where it is and perform a laparotomy using a midline incision
In the HAIR-AN syndrome, the mechanism by which insulin resistance occurs is through?
A) abnormalities associated with the insulin receptor?
B) obesity related changes to ovarian function
C) alterations in ovarian steroidogenic enzymes
D) underlying diabetes mellitus
E) alterations in adrenal steroid synthesis pathways
A) abnormalities associated with the insulin receptor
Which of the features below would be MOST LIKELY to be found in a patient with Turners syndrome who presents for evaluation of primary amenorrhoea at the age of 18 years?
A) Uterus present, breasts undeveloped
B) Uterus present, breasts developed
C) Uterus absent, breasts undeveloped
D) uterus absent, breasts developed
E) Uterus present, clitoromegaly
A) Uterus present, breasts undeveloped
A 26 y/o multip who has T2DM had a spontaneous vaginal delivery 72 hours ago with a pudendal block anaesthesia and a midline episiotomy. A third degree laceration occurred at time of delivery. She now has a temp of 39.0C. her pulse is 120 bpm, RR of 32, and BP of 90/60. The uterus is 2cm below the umbilicus and is minimally tender to palpation. the lochia is equivalent to menstrual discharge but is malodorous. The perineum and lower vulva and vagina are oedematous but not tender to touch. The perineal skin and vagina are pale grey. Sensation to pinprick is markedly diminished in this area. Of the following the MOST LIKELY diagnosis is:
A) Perirectal abscess
B) Rectovaginal fistula
C) Endometritis
D) Necrotising fasciitis
D) necrotising fasciitis
( I think I would’ve put endometritis as MOST LIKELY??)
Which of the following is the KEY mode of current therapy for fetal alloimmune thrombocytopenia?
A) maternal immunoglobulin infusion
B) In-utero fetal platelet transfusion
C) Corticosteroid therapy with prednisolone
D) Plasmapheresis
A) maternal immunoglobulin infusion
A patient at 12/40 is found to have anti-Fya red cell antibodies on routine testing at a titre of 1:16. The MOST APPROPRIATE next step in management is to:
A) Quantify the antibody concentration using radioimmunoassay
B) Perform ultrasound at 18/40 to exclude any early hydrops fetalis
C) Ascertain the partner’s phenotype
D) Repeat the antibody test at 16/40
E) Reassure the patient that anti-Fya antibodies are non-haemolytic
C) ascertain the partners phenotype
A 27 year old patient with documented hypothalamic amenorrhoea who desires pregnancy asks you about induction of ovulation with gonadotrophin releasing hormone (GnRH). You tell her that the induction of ovulation with GnRH is effective:
A) If the drug is administered as a continuous subcutaneous infusion until follicular maturation occurs
B) Only if human chorionic gonadotrophin (hCG) is used to trigger ovulation
C) Only if human menopausal gonadotrophins (hMG) are administered simultaneously
D) If the hormone is administered in a pulsatile fashion
D. if the hormone is administered in a pulsatile fashion
A 40 year old woman from India presents for a routine pap smear. On examination, you notice a small group of vesicles on her right buttock. On questioning, she claims that this is a problem she has had intermittently for many years. The MOST LIKELY diagnosis is:
A) Lymphogranuloma venereum
B) Recurrent HSV 2
C) Dermatitis artifacta
D) Drug eruption
B. recurrent HSV2
A 27 year old woman presents with acute virilization and normal pelvic examination. The results of investigation are LH 2, FSH 3, 17OHP 2.9, Testosterone 8.9, DHEAS 5.3
(normal ranges for assays reported are, LH 4-25, FSH 3-25, 17OHP <5.5, Testosteone 0.5 – 2.5nmol/l, DHEAS 0.9-11.7)
Which ONE of the following is the MOST LIKELY diagnosis?
A) Sertoli-leydig cell tumour
B) Late onset congenital adrenal hyperplasia
C) Adrenal cortical adenoma
D) Polycystic ovarian syndrome with inuslin resistance
E) Cushing syndrome
A – Sertoli-leydig cell tumour
In the human fetus, behaviour state 2F is characterized by
A) Breathing and eye movements with frequent accelerations of the heart rate
B) Absent eye and breathing movements with minimal variability of the heart rate
C) Infrequent body movements but continual breathing and eye movements
D) Occurring most of the time by term gestation
E) High voltage, slow wave EEG patterns
A. Breathing and eye movements with frequent accelerations of the heart rate
Which organism is responsible for donovanosis?
A) Haemophilis ducreyi
B) Calymmatobacterium granulomatis
C) Gardnerella vaginalis
D) Corynebacterium donovaniae
B. Calymmatobacterium granulomatosis
A 32 year old primigravida had a midtrimester maternal serum screening test arranged by her family doctor. Her result indicates that the pregnancy is at an increased risk of Down syndrome. She has been sent to you for management. What would you do first?
A) Arrange a CVS to karyotype the fetus
B) Arrange an amniocentesis to karyotype the fetus
C) Arrange an USS to check the gestational age of the fetus
D) Arrange a termination of the pregnancy for Down syndrome
E) Arrange a contact with the down syndrome support grouyp in case she wishes to continue the pregnancy
C. Arrange an USS to check the gestation age of the fetus
All of the following are true about complications associated with clomiphene EXCEPT?
A) Ovarian enlargement has been reported in approx. 15% of women but true hyperstimulation occurs rarely.
B) Major malformation rates in clomiphene citrate related pregnancies are not distinguishable from rates in an age matched population
C) The chance of twins is approximately 20%
D) The pregnancy losses are similar to those of normal population
C) the chance of twins is approximately 20% (not true)
Which of the following statements regarding the androgen insensivitiy syndrome is correct?
A) The testosterone is below that of a normal male
B) The gonads should be removed as soon as the diagnosis is made
C) The risk of dysgerminoma or other gonadal neoplasm is high until 20 years of age
D) Pubescence is delayed because of the absence of endogenous hormone
E) The syndrome is a x linked recessive
E – the syndrome is x linked recessive