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WRITTEN EXAM 2023 > May 2011 MCQs > Flashcards

May 2011 MCQs Flashcards

1
Q

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.

A

d. repeat antibody titre in 2 weeks.

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2
Q

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

A

c. maternal plasmapheresis is indicated for severe cases

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3
Q

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

A

d. If the mother is HPA-1a negative and the and the father is HPA-1a positive

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4
Q

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

A

d. Posterior urethral valves

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5
Q

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

A

d. Antepartum steroids given to the mother before the premature delivery of an infant

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6
Q

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

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)

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7
Q

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

A

b. lower risk of delivery within 48 hours

Beta sympathomimetic examples: Terbutaline, salbutamol

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8
Q

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

A

d. after a course of GnRH analogue therapy, fecundity is transiently improved in comparison to expectant managemen

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9
Q

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

A

c. progression to choriocarcinoma does not occur although there may be persistent trophoblastic disease after evacuation

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10
Q

The percentage of invasive cervical carcinomas missed on colposcopic examination without biopsy is best estimated at:

a. 9%
b. 14%
c. 27%
d. 55%

A

c. 27%

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11
Q

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

c. contraindicates exogenous estrogen

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12
Q

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

A

c. with Type 2 diabetes mellitus

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13
Q

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%

A

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

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14
Q

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

A

d. It forms white lesions on mucosal surfaces and causes an erosive vaginitis

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15
Q

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

a. smoking

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16
Q

Lichen sclerosus of the vulva is MOST EFFECTIVELY treated with:

a. estrogen
b. testosterone
c. corticosteroids
d. excisional surgery

A

c. corticosteroids

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17
Q

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

A

c. laparoscopy bilateral salpingo-oophorectomy is the usual procedure of choice if surgical treatment is undertaken

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18
Q

The MOST COMMON benign ovarian tumour found in postmenopausal women is

a. cystic teratoma
b. serous cystadenoma
c. mucinous tumour
d. endometrioid tumour

A

b. serous cystadenoma

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19
Q

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

A

c. HPV serotypes 31, 33, 35, 51 & 52 are the serotypes most commonly seen with genital warts

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20
Q

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.

A

d. Prophylactic oophorectomy is NOT appropriate in the presence of BRCA1 or 2 as primary peritoneal carcinomas may still occur.

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21
Q

The principal secretory product of polycystic ovaries is:

a. androstenedione
b. testosterone
c. dehydroepiandrosterone sulphate (DHEAS)
d. oestone
e. oestradiol

A

a. androstenedione

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22
Q

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

A

d. increased levels of SHBG

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23
Q

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

A

d. Metformin increases circulating androgen levels by reducing serum insulin

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24
Q

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

A

b. continuous catheter drainage

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25
Q

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

A

d. Uterovaginal agenesis

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26
Q

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.

A

c. bromocriptine, 1.25mg at night in bed, increasing over 2 weeks to 2.5mg twice daily with food

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27
Q

Amenorrhoea and galactorrhoea is LEAST likely to be cause by:

a. pituitary tumour
b. use of chlorpromazine
c. use of metoclopramide
d. thyrotoxicosis

A

d. thyrotoxicosis

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28
Q

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

A

b. 1 in 9

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29
Q

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

A

b. order measurement of 17-OH progesterone

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30
Q

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

A

b. approximately 25% of babies with grade III hypoxic-ischaemic encephalopathy will develop cerebral palsy

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31
Q

Which of the following is the MOST COMMON cause of female disorders of sex development?

a. Virilising ovarian tumour
b. Exogenous androgen
c. Chromosomal abnormality
d. Congenital adrenal hyperplasia

A

d. Congenital adrenal hyperplasia

32
Q

A 34 year old woman in her first pregnancy has had an unsuccessful ECV at 36 weeks gestation for a breech with extended legs. She 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 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

b. 9%

33
Q

A female neonate aged 4 days suddenly becomes acutely ill, dehydrated and hypotensive. The genitalia shows clitoromegaly (1 cm) with marked rugosity of the labia. Investigations show plasma sodium 126nmol/L, plasma postassium 5.9 mmol/L, blood urea 8.0 mmol/L. Following resuscitation, which of the following is the MOST LIKELY additional laboratory finding?

a. Lymphocyte karyotype 46XY
b. Serum testosterone 2 nmol/L (normal <0.5)
c. Serum 17-hydroxyprogesterone 200 nmol/L (normal <4 nmol/L)
d. Blood glucose 20 nmol/L

A

c. Serum 17-hydroxyprogesterone 200 nmol/L (normal <4 nmol/L)

34
Q

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

a. size of the defect
b. presence of other anomalies
c. method of delivery
d. method of surgical repair

A

b. presence of other anomalies

35
Q

Which one of the following statements BEST describes the association of Apgar scores with infant neurological outcome?

a. The 1 minute score correlates well with long-term neurological outcome.
b. One third of infants with a 5 minute score of 0-3 will have poor long term neurological outcomes.
c. Approximately 75% of children who develop cerebral palsy have normal Apgar scores.
d. A 10-minute score of 0-3 accompanied by neonatal convulsions is not predictive of poor neurological outcome.

A

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

36
Q

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

a. The infant needs immediate transfer to special care nursery.
b. The infant needs resuscitation.
c. The infant will develop seizures.
d. The infant has significant hypoxia.

A

b. The infant needs resuscitation.

37
Q

Which of the following is FALSE?

a. The risk of thromboembolism in a healthy young women is approximately 1 per 10,000 women years.
b. Progestagen-only contraception increases the risk of thromboembolism by 50%.
c. Obesity (BMI >30) approximately doubles the risk of thromboembolism.
d. Smoking increased the risk by 50% of thromboembolism.

A

b. Progestagen-only contraception increases the risk of thromboembolism by 50%.

38
Q

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

a. Prothrombin 20210A gene mutation
b. Lupus anticoagulant
c. Thrombim gene mutation
d. Factor V Leyden mutation

A

c. Thrombim gene mutation

39
Q

Which of the following is NOT correct?

a. Risk of thromboembolism with pregnancy is approximately 60/100,000 women years.
b. Risk of thromboembolism with the combined oral contraceptive pill is approximately 15/100,000 women years.
c. Risk of thromboembolism with the combined contraceptive pill is greater in a pill with 50 microgram than 30 microgram of ethinlyoestradiol.
d. Risk of thromboembolism with the combined contraceptive pill is less with the pills containing gestodene or desogestrel.

A

d. Risk of thromboembolism with the combined contraceptive pill is less with the pills containing gestodene or desogestrel.

40
Q

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

a. asthma
b. pulmonary tuberculosis
c. Graves’ disease
d. antiphospholipid syndrome

A

d. antiphospholipid syndrome

41
Q

Which of the following is NOT a recognised feature of massive pulmonary embolism?

a. pulmonary vascular congestion in the chest x-ray
b. right ventricular strain in the electorcardiogram
c. sinus tachycardia
d. tachypnoea

A

a. pulmonary vascular congestion in the chest x-ray

42
Q

In recommending influenza vaccination to your patients, each of the following would be correct statements EXCEPT:

a. 90% of deaths due to influenza are of individuals over the age of 60.
b. the incidence of clinical and serological influenza is reduced by half by immunisation.
c. advanced cardiac or pulmonary disease is a contraindication to vaccination.
d. the pulmonary complications of influenza are reduced by 70% in immunised populations.

A

c. advanced cardiac or pulmonary disease is a contraindication to vaccination.

43
Q

All of the following statements concerning Treponema pallidum infection are correct EXCEPT:

a. syphilis can be transmitted from the skin lesions of secondary syphilis.
b. lesions of tertiary syphilis largely result from an immune response to Treponema pallidum and its products.
c. the VDRL (Venereal Disease Research Laboratory) test is specific for Treponema pallidum infection
d. secondary syphilis may cause loss of scalp hair and eyebrows.

A

c. the VDRL (Venereal Disease Research Laboratory) test is specific for Treponema pallidum infection

44
Q

Which of the following is the most appropriate treatment?

a. Erythromycin for a 28 week pregnant patient with syphilis.
b. Ampicillin for a 15 year old patient with pelvic inflammatory disease.
c. Ketoconazole for a 25 year old patient with Trichomonas
d. Tetracycline for a recent immigrant with granuloma inguinale.

A

d. Tetracycline for a recent immigrant with granuloma inguinale.

45
Q

A 47 year old woman, gravid 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:

a. fetal platelet count (by scalp sample)
b. notification of blood bank to have platelet packs available for maternal transfusion
c. normal labour management and neonatal platelet count.
d. caesarean section rather than midforceps to minimise fetal trauma

A

c. normal labour management and neonatal platelet count.

46
Q

Which of the following statements about rubella and pregnancy is CORRECT?

a. Maternal infection occurring in the second trimester is followed by the neonatal rubella syndrome in less than 1% of cases.
b. The rubella haemagglutination inhibition test becomes positive within four days of the infection.
c. Viraemia precedes the rash.
d. Treatment with immunoglobulin reduces the risk of congenital abnormality.

A

c. Viraemia precedes the rash.

47
Q

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

a. Contact with domestic cats.
b. Ingestion of kangaroo meat.
c. Ingestion of sheep meat from the Western District of Victoria.
d. Ingestion of undercooked meat.

A

d. Ingestion of undercooked meat.

48
Q

Which of the following is true of genital HSV (herpes simplex infection)?

a. Prior infection with HSV-1 significantly reduces the risk of acquiring HSV-2 infection in pregnancy.
b. Approximately 10% of those with recurrent attacks have asymptomatic secretion at the time of delivery.
c. Approximately 10% of those with a clinical recurrence at the time of delivery will have an infection neonate.
d. Most babies who develop neonatal herpes simplex infection are born to women with a history of recurrent genital herpes.

A

a. Prior infection with HSV-1 significantly reduces the risk of acquiring HSV-2 infection in pregnancy.

49
Q

Which of the following is LEAST true of HIV?

a. Opportunistic infections commonly develop when the CD4 count falls below 200 x10^6 per Litre.
b. Antiviral chemotherapy lowers the risk of mother-to-child transmission of HIV to approximately one-third of the risk without chemotherapy.
c. High viral load (>10,000 copies/mL), low CD4 count (<400 x 10^6) and more than 4 hours ruptured membranes all double the risk of mother-to-child transmission of HIV.
d. With all available initiatives, the incidence of mother-to-child transmission of HIV should be reduced to approximately 5%.

A

d. With all available initiatives, the incidence of mother-to-child transmission of HIV should be reduced to approximately 5%.

<1% if on treatment

50
Q

Which statement is MOST CORRECT with respect to Malaria and Pregnancy?

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

A

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

51
Q

Which of the following is CORRECT of Varicella-zoster?

a. The case mortality of varicella infection in adults is no different than in childhood varicella.
b. The overall incidence of Congenital Varicella Syndrome is approximately 2% if the mother contracts chicken pox during pregnancy.
c. Typical features of congenital varicella syndrome include limb hypoplasia and dermatome scarring, but ocular and CNS effects are rare.
d. Seronegative pregnant women having a close recent exposure within 96 hours should receive passive varicella zoster immunoglobulin because this will reduce the risk of fetal varicella sydrome.

A

b. The overall incidence of Congenital Varicella Syndrome is approximately 2% if the mother contracts chicken pox during pregnancy.

52
Q

An 18 year old primigravid woman is at 26 weeks gestation. Culture of a mucopurulent endocervical discharge is positive for chlamydia trachomatis. Which of the following antibiotics would be MOST appropriate for treatment of this infection?

a. Doxycycline
b. Ceftriaxone
c. Erythromycin
d. Azithromycin

A

d. Azithromycin

53
Q

Which of the following statements is TRUE concerning cytomegalovirus infection in pregnancy?

a. It is the commonest known virus transmitted transplacentally
b. It is usually symptomatic at birth
c. The usual source of infection is undercooked meat
d. It may cause an elevation of IgG in cord blood

A

a. It is the commonest known virus transmitted transplacentally

54
Q

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

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

A

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

55
Q

Which of the following statements about infection with Group B haemolytic streptococci is NOT true?

a. the major reservoir of the organism is the gastro-intestinal tract
b. it cause 5-10% of maternal asymptomatic bacteruria
c. 5-10% of women who are negative at 28 weeks will be positive at term
d. a serious neonatal infection will occur in 5 % of carriers

A

d. a serious neonatal infection will occur in 5 % of carriers

56
Q

The MOST FREQUENT site of colonisation with Group B streptococci is:

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

A

d. the lower intestinal tract

57
Q

A women presents at 10 weeks gestation Her 2 year old child has just developed chicken pox. The woman has no history of chicken pox, and testing shows her to have no detectable IgG or IgM. You advise her that:

a. as the risk of fetal varicella syndrome is low, no further action is warranted.
b. she should have an intramuscular injection of zoster immune globulin to decrease the risk of the fetal varicella syndrome.
c. she should have an intramuscular injection of zoster immune globulin to decrease the risk of contracting chicken pox.
d. she should start taking oral famciclovir to decrease the risk of developing chicken pox.

A

c. she should have an intramuscular injection of zoster immune globulin to decrease the risk of contracting chicken pox.

58
Q

Of the following conditions, which is MOST likely to have an adverse affect on normal pregnancy outcomes?

a. Blood pressure of 140/90 in the first trimester
b. Weight gain of only 2kg throughout pregnancy
c. Severe lower limb oedema
d. Blood urea of 12 mmol/L at booking

A

d. Blood urea of 12 mmol/L at booking

59
Q

A pregnant woman who is a heroin addict is evaluated initially at 28 weeks gestation and started on methadone substitution therapy, requiring 40mg per day to avoid symptoms of withdrawal. She is now 31 weeks gestation. At this time the preferred management is to:

a. decrease methadone maintenance by 5mg per week and use promethazine (eg. Phenergan) to control symptoms.
b. continue methadone maintenance to the time of delivery.
c. continue methadone maintenance to the time of delivery and add naloxone (eg. Narcan) in incremental doses from 37 weeks gestation.
d. continue methadone maintenance to the onset of labour and substitute promethazine at that time.

A

b. continue methadone maintenance to the time of delivery.

60
Q

Which of the following conditions below is NOT a recognised cause of pulmonary hypertension in pregnancy?

a. Pulmonary Embolism
b. Left Ventricular failure
c. Mitral Stenosis
d. None of the above

A

d. None of the above

61
Q

The incidence of fetal infection after maternal seroconversion of Cytomegalovirus infection in pregnancy is APPROXIMATELY

a. 95%
b. 80%
c. 50%
d. 20%

A

c. 50%

62
Q

Which of the following is a COMMON withdrawal symptom experiences by smokers attempting to quit?

a. Memory loss
b. Indigestion
c. Increase in cough
d. Skin sores

A

c. Increase in cough

63
Q

A 28 year old, gravida 3, para 2, woman presents at 16 weeks’ gestation with a threatened miscarriage. On speculum examination an obvious carcinoma of the cervix is apparent, 3cm in diameter. A biopsy shows poorly differentiated adenocarcinoma. The MOST APPROPRIATE next step is:

a. MRI
b. treatment with radiation therapy
c. termination of pregnancy and then reassessment
d. conservative management until fetal viability.

A

a. MRI

64
Q

Which of these conditions is MOST LIKELY to cause galactorrhoea?

a. Adrenal androgen excess
b. Sertoli-Leydig cell tumour
c. Cushing syndrome
d. Hypothyroidism

A

d. Hypothyroidism

65
Q

Loss of collagen and osteoporosis may be associated with all of the following EXCEPT?

a. anorexia nervosa
b. ovarian dysgenesis
c. late onset adrenal hyperplasia
d. competitive rowing

A

c. late onset adrenal hyperplasia

66
Q

Which of the following is NOT a risk factor for osteoporosis?

a. Caucasian race
b. Immobility
c. Chronic alcoholism
d. Obesity

A

d. Obesity

67
Q

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

a. Phenytoin
b. Amitryptiline
c. Captopril
d. Warfarin

A

a. Phenytoin

68
Q

Which one of the following is LEAST TRUE of osteoporosis?

a. Biphosphonates have comparable efficacy to oestrogen in both the prevention and treatment of osteoporosis.
b. Hepatic impairment limits the use of biphosphonates but they are well-tolerted orally.
c. Calcitonin is effective therapy for osteoporosis but must be given nasally or subcutaneously as it is not effective orally.
d. Tamoxifen increases bone mineral density when compared to placebo in postmenopausal wome.

A

b. Hepatic impairment limits the use of biphosphonates but they are well-tolerted orally.

69
Q

A chinese born woman is noted on her routine antenatal testing to have a haemoglobin concentration of 115g/L. MCV 72. Her ferritin is 25mcg/L and her haemoglobin electrophoresis is normal.
The MOST APPROPRIATE next investigation is:

A. to test her partner’s full blood examination
B. to test her partner’s haemoglobin electrophoresis
C. to test her haemoglobin DNA genotype
D. no further investigations are necessary

A

A. to test her partner’s full blood examination

70
Q

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

A. Anti-thrombin III deficiency
B. Factor V Leiden homozygosity
C. Protein S deficiency
D. Hyperhomocysteinaemia

A

A. Anti-thrombin III deficiency

71
Q

Which of the following would be LEAST desirable in a pregnancy woman with a severe non-hypertrophic cardiomyopathy?

A. digoxin
B. frusemide
C. labetalol
D. prazosin

A

C. labetalol

72
Q

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

A. Drug eruption
B. Polymorphic Eruption of Pregnancy (PEP)
C. Bullous Pemphigoid
D. Pemphigoid Gestationis

A

D. Pemphigoid Gestationis

73
Q

Advantages of depot medroxyprogesterone (Depo-provera) include all of the following EXCEPT:

A. no significant effect on coagulation system
B. no significant effect on blood pressure
C. no reported deaths directly attributable to the drug
D. low incidence of menstrual disturbance

A

D. low incidence of menstrual disturbance

74
Q

All of the following statements about bilateral oophorectomy in a 45 year old woman are correct EXCEPT:

Bilateral oophorectomy in a 45 year old woman:
A. should be followed by hormone replacement therapy even in the presence of essential hypertension.
B. is not indicated at the time of surgery for endometriosis involving the bowel.
C. increases the risk of developing ischaemic heart disease.
D. increases the risk of developing osteoporosis.

A

B. is not indicated at the time of surgery for endometriosis involving the bowel.

75
Q

A pregnant woman who is a heroin addict is evaluated initially at 28 weeks gestation and started on methadone substitution therapy, requiring 40mg per day to avoid symptoms of withdrawal. She is now 31 weeks gestation. At this time the preferred management is to:

a. decrease methadone maintenance by 5mg per week and use promethazine (eg. Phenergan) to control symptoms.
b. continue methadone maintenance to the time of delivery.
c. continue methadone maintenance to the time of delivery and add naloxone (eg. Narcan) in incremental doses from 37 weeks gestation.
d. continue methadone maintenance to the onset of labour and substitute promethazine at that time.

A

b. continue methadone maintenance to the time of delivery.

WRITTEN EXAM 2023 (23 decks)

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