May 2011 MCQs Flashcards
A 32 year old Rhesus negative woman with a history of a single previous pregnancy which was uncomplicated is referred at 32 weeks gestation with an anti D antibody titre of 1:4. Ultrasound examination reveals a single live fetus and an anterior placenta. There are no signs of hydrops. The MOST appropriate next course of action with respect to her immunisation is:
a. elective delivery at 35-36 weeks gestation
b. amniocentesis
c. fetal monitoring
d. repeat antibody titre in 2 weeks.
d. repeat antibody titre in 2 weeks.
Which of the following statements regarding the management of iso-immunised pregnancies is NOT true?
a. middle cerebral artery Doppler peak flow is a sensitive predictor of fetal anaemia.
b. cordocentesis may be useful in the second trimester
c. maternal plasmapheresis is indicated for severe cases
d. the mortality from exchange transfusion is less than that from intrauterine transfusion
c. maternal plasmapheresis is indicated for severe cases
In which of the following circumstances is it POSSIBLE for the fetus to have alloimmune thrombocytopenia?
a. If the mother is HPA-1a positive and the and the father is HPA-1a negative
b. If the mother is HPA-1a positive and the and the father is HPA-1a positive
c. If the mother is HPA-1a negative and the and the father is HPA-1a negative
d. If the mother is HPA-1a negative and the and the father is HPA-1a positive
d. If the mother is HPA-1a negative and the and the father is HPA-1a positive
Which of the cogenital malformations below is MOST LIKELY to be associated with oligohydramnios?
a. Duodenal atresia
b. Unilateral uteropelvic junction (UPJ) obstruction
c. Gastroschisis
d. Posterior urethral valves
d. Posterior urethral valves
Which of the following programs LOWERS total medical costs?
a. Maternal serum alpha-fetoprotein screening in pregnanct women
b. Complete blood counts as part of annual examinations
c. Screening mammograms for women aged 40-50
d. Antepartum steroids given to the mother before the premature delivery of an infant
d. Antepartum steroids given to the mother before the premature delivery of an infant
Which of the following is the LEAST CORRECT with respect to meconium in the amniontic fluid at term?
a. Meconium is found in the amniotic fluid of approximately 5% of women in labour at 38 weeks or beyond
b. The finding of meconium in the amnitoic fluid at term, increases the subsequent perinatal mortality from approximately 0.3 per 1000 five-fold to approximately 1.5 per 1000
c. Meconium-stained liquor is an indication for continuous electronic fetal monitoring in labour
d. The incidence of meconium aspiration syndrome in the presence of meconium-stained liquor at term is approximately 1%
a. Meconium is found in the amniotic fluid of approximately 5% of women in labour at 38 weeks or beyond
(7 to 22% evidence varies)
Beta sympathomimetics, in randomised, placebo controlled trials, have been demonstrated most convincingly to
a. lower risk of preterm delivery
b. lower risk of delivery within 48 hours
c. cause higher birthweight
d. lower perinatal mortality
b. lower risk of delivery within 48 hours
Beta sympathomimetic examples: Terbutaline, salbutamol
Regarding the current status of therapy for mild to moderate endometriosis, which of the following statements is LEAST correct?
a. monthly fecundity over the first 36 weeks is significantly increased after laparoscopic treatment of mild or moderate endometriosis
b. there is a tendency for fertility to plateau at the same level with either surgical therapy or expectant management of mild or moderate endometriosis
c. danazol reduces both pain and disease progression with endometriosis
d. after a course of GnRH analogue therapy, fecundity is transiently improved in comparison to expectant management
d. after a course of GnRH analogue therapy, fecundity is transiently improved in comparison to expectant managemen
All of the following statements about partial molar pregnancy are true EXCEPT:
a. the karyotype is usually triploid
b. beta-hCG follow-up is indicated after molar evacuation
c. progression to choriocarcinoma does not occur although there may be persistent trophoblastic disease after evacuation
d. early pre-eclampsia is more common in patients with a partial mole, than a normal pregnancy
c. progression to choriocarcinoma does not occur although there may be persistent trophoblastic disease after evacuation
The percentage of invasive cervical carcinomas missed on colposcopic examination without biopsy is best estimated at:
a. 9%
b. 14%
c. 27%
d. 55%
c. 27%
Adenocarcinoma of the cervix:
a. is equally as radiosensitive as squamous cell carcinoma
b. contraindicates ovarian conservation
c. contraindicates exogenous estrogen
d. all of the above
a. is equally as radiosensitive as squamous cell carcinoma
Endometrial cystic glandular hyperplasia is most likely to be found in a woman:
a. on biphasic oral contraception
b. with adenomyosis
c. with Type 2 diabetes mellitus
d. on combined estrogen-progestogen hormone replacement therapy
c. with Type 2 diabetes mellitus
Which of the following is LEAST true of vulval melanoma?
a. Melanoma represents approximately 2% of all vulval malignancies
b. A majority of melanoma cases are postmenopausal
c. Occur more frequently on the labia majora than labia minora
d. 5-year survival with subcutaneous penetration is approximately 20%
c. Occur more frequently on the labia majora than labia minora
Which of the following is TRUE of lichen planus?
a. Topical corticosteroids are ineffective
b. There are multiple purple scaly papules present
c. It favours extensor surfaces
d. It forms white lesions on mucosal surfaces and causes an erosive vaginitis
d. It forms white lesions on mucosal surfaces and causes an erosive vaginitis
Which of the following is NOT a risk factor for endometrial cancer?
a. smoking
b. high animal fat diet
c. early menarche
d. late menopause
a. smoking
Lichen sclerosus of the vulva is MOST EFFECTIVELY treated with:
a. estrogen
b. testosterone
c. corticosteroids
d. excisional surgery
c. corticosteroids
Which of the following is LEAST true of simple cysts in postmenopausal women?
a. approximately 20% of such cysts will resolve in the next 2-3 months
b. less than 1% of such cysts are malignant
c. laparoscopy bilateral salpingo-oophorectomy is the usual procedure of choice if surgical treatment is undertaken
d. aspiration is associated with a reccurence rate of approximately 25% at 3 months
c. laparoscopy bilateral salpingo-oophorectomy is the usual procedure of choice if surgical treatment is undertaken
The MOST COMMON benign ovarian tumour found in postmenopausal women is
a. cystic teratoma
b. serous cystadenoma
c. mucinous tumour
d. endometrioid tumour
b. serous cystadenoma
Which of the following statements regarding cervical dysplasia is LEAST correct?
a. HPV serotypes 16, 18, 45 & 46 are high risk serotypes for progression to invasive cancer
b. HPV serotypes 6, 11, 42, 43 & 44 are low risk serotypes for progression to invasive cancer
c. HPV serotypes 31, 33, 35, 51 & 52 are the serotypes most commonly seen with genital warts
d. First intercourse at a young age, smoking and multiple sexual partners are independent risk factors for progression of dysplasia to invasive cancer
c. HPV serotypes 31, 33, 35, 51 & 52 are the serotypes most commonly seen with genital warts
Which of the following statements is LEAST CORRECT?
a. The lifetime risk of ovarian cancer is approximately 1%
b. The lifetime risk of ovarian cancer is approximately 50% in BRCA1 gene carriers
c. The lifetime risk of ovarian cancer is approximately 20% in BRCA2 gene carriers
d. Prophylactic oophorectomy is NOT appropriate in the presence of BRCA1 or 2 as primary peritoneal carcinomas may still occur.
d. Prophylactic oophorectomy is NOT appropriate in the presence of BRCA1 or 2 as primary peritoneal carcinomas may still occur.
The principal secretory product of polycystic ovaries is:
a. androstenedione
b. testosterone
c. dehydroepiandrosterone sulphate (DHEAS)
d. oestone
e. oestradiol
a. androstenedione
The following have all been described in patients with hyperandrogenic chronic anovulation EXCEPT:
a. elevated LH:FSH ratio in serum
b. hyperoestrogenism
c. serum triglycerides increased, HDL cholesterol decreased
d. increased levels of SHBG
d. increased levels of SHBG
Which of the following statements regarding hyperadrogenic chronic anovulation is LEAST correct?
a. Insulin inhibits granulosa cell production of IGF-1 binding protein
b. Insulin inhibits hepatic production of sex hormone binding globulin
c. Insulin, through homology with IGF-1, binds to the IGF-1 receptor.
d. Metformin increases circulating androgen levels by reducing serum insulin
d. Metformin increases circulating androgen levels by reducing serum insulin
A 45 year old woman underwent a total abdominal hysterectomy 3 weeks ago and now complains of a constant watery vaginal discharge. Appropriate evaulation documents a 3mm vesicovaginal fistula above the trigone and opening into the vagina approximately 1.5cm below the apex of the vaginal vault. The most appropriate initial therapy for this patient is:
a. vaginal repair with a gracilis flap
b. continuous catheter drainage
c. vaginal excision of the fistula
d. oestrogen administration prior to operative therapy
b. continuous catheter drainage
Individuals with which of the following causes of primary amenorrhoea ovulate spontaneously?
a. Turner syndrome (45X)
b. Hypothalamic hypogonadism (Kallman syndrome)
c. Androgen insensitivity syndrome
d. Uterovaginal agenesis
d. Uterovaginal agenesis
In a 30 year old woman with a five year history of secondary amenorrhoea, galactorrhoea and infertility, the serum prolactin concentration is 1120mU/L (normal range is 150-400 mU/L). You recommend bromocriptine therapy. The most appropriate advice is:
a. bromocriptine, 2,5mg daily with food
b. bromocriptine, 5mg at night with food
c. bromocriptine, 1.25mg at night in bed, increasing over 2 weeks to 2.5mg twice daily with food
d. bromocriptine, 1.25mg three time daily with food, increasing over two weeks to 2.5mg two or three times daily with food.
c. bromocriptine, 1.25mg at night in bed, increasing over 2 weeks to 2.5mg twice daily with food
Amenorrhoea and galactorrhoea is LEAST likely to be cause by:
a. pituitary tumour
b. use of chlorpromazine
c. use of metoclopramide
d. thyrotoxicosis
d. thyrotoxicosis
The lifetime risk of having an operation for genital prolapse is:
a. 1 in 5
b. 1 in 9
c. 1 in 20
d. 1 in 35
b. 1 in 9
You are called to the delivery suite one night to a recently delivered baby with ambiguous genitalia. You are not able to assign a sex to the baby. After 24 hours, your next step should be to:
a. order serum electrolytes estimations immediately
b. order measurement of 17-OH progesterone
c. arrange for serum testosterone and 17-oxosteroids for the next day
d. order an ultrasound examination seeking the presence or absence of a uterus or testicles
b. order measurement of 17-OH progesterone
Which of the following is LEAST correct regarding Cerebral palsy?
a. approximately 5% of those babies with an Apgar score of less than 4 at 10 minutes will develop cerebral palsy.
b. approximately 25% of babies with grade III hypoxic-ischaemic encephalopathy will develop cerebral palsy
c. approimately 50 per thousand of surviving triplets will develop cerebral palsy
d. approximately 10 per thousand of surviving twins will develop cerebral palsy
b. approximately 25% of babies with grade III hypoxic-ischaemic encephalopathy will develop cerebral palsy