Practice MCQs (Acquire)

Question 1

Which of the following is most correct concerning bone mass?
Select one:
a.
Bone mass peaks in most women before 25 years of age.
b.
The accelerated loss in bone mass begins after the age of 40 years.
c.
Bone mass is approximately 65% cortical and 35% trabecular bone.
d.
A 70-year-old woman, not on hormone therapy, would lose approximately 2% of bone mass per year.

Answer 1

A - Bone mass peaks in most women before 25 years of age.

Question 2

A 13-year-old patient has had very heavy menstrual bleeding for the past seven days. Menarche was at age 12 and this is the patient’s fourth menses. The last three menstrual cycles have varied between 31 days and 33 days, but each menses has become progressively heavier. The patient has a negative pregnancy test and is not taking any medication. Coagulation studies are normal. Ultrasound reveals a normal sized anteverted uterus. Her haematocrit is 25% and her haemoglobin is 85 g/L.

What is the most appropriate next step in management?
Select one:
a.
Intravenous oestrogen therapy
b.
Combined oral contraceptive therapy
c.
Cyclical progestogen therapy
d.
Dilatation and curettage (D&C)

Answer 2

B - combined oral contraceptive
- can use POP if contraindications

Question 3

A woman G1P0 presents at 34 weeks gestation with a 2-day history of vomiting, including coffee-ground-like material, and upper abdominal pain. Urine contains a trace of protein. Investigations include:

· haemoglobin 106g/L
· white cell count 30x109/L
· platelets 155x109/L
· uric acid 450µmol/L (normal 135-395µmol/L)
· total bilirubin 25µmol/L (normal 1-20µmol/L)
· alkaline phosphatase 180U/L (normal 125 - 250U/L)
· aspartate transaminase 800U/L (normal 0-45U/L)
· creatinine 100µmol/L (normal 40-80µmol/L)
· blood glucose 1.8mmol/L

What is the most likely diagnosis?
Select one:
a.
Cholestasis of pregnancy
b.
Acute fatty liver of pregnancy
c.
Hepatitis
d.
Cholecystitis

Answer 3

B - Acute fatty liver

Question 4

Which organism is responsible for Donovanosis?
Select one:
a.
Gardnerella vaginalis
b.
Corynebacterium donovaniae
c.
Klebsiella granulomatis
d.
Haemophilus ducreyi

Answer 4

C - Klebsiella granulomatis

Question 5

Which of the following is LEAST true of HIV?
Select one:
a.
With all available initiatives, the incidence of mother-to-child transmission of HIV should be reduced to approximately 5%.
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 106) and more than 4 hours ruptured membranes all double the risk of mother-to-child transmission of HIV.
d.
Opportunistic infections commonly develop when the CD4 count falls below 200 x 106 per litre.

Answer 5

Answer is A
A - Suppression of the maternal viral load to undetectable levels (<50) using HAART reduces transmission to 1-2%
B - unknown, but transmission more related to viral load than therapy
C - could be true, >4hrs of PROM does double risk of transmission. Other factors increase transmission but not necessarily x2
D - CD4 <200 is defined as AIDS and is associated with opportunistic infections

Question 6

Which of the following is NOT a recognised cause of pulmonary hypertension in pregnancy?
Select one:
a.
Cardiomyopathy
b.
Pulmonary embolism
c.
Left ventricular failure
d.
Mitral stenosis

Answer 6

A - cardiomyopathy
B - definite cause, C- definite cause, D - very likely cause

Question 7

During surgery on an 11-year-old girl, a stage IA, grade 1, 10cm malignant (immature) teratoma is found in the left ovary.

Initial therapy should include:
Select one:
a.
total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, postoperative irradiation.
b.
bilateral salpingo-oophorectomy.
c.
left salpingo-oophorectomy.
d.
total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, postoperative chemotherapy.

Answer 7

C - but should also include washings

Question 8

A Chinese born woman is noted on her routine antenatal testing to have a haemoglobin concentration of 115g/L (Normal range: 110-150), MCV of 72fL (Normal range: 85-95). Her ferritin is 25mcg/L (Normal range: 20-100) and her haemoglobin electrophoresis is normal.

Which test will help most to ascertain fetal risk?
Select one:
a.
Test her partner’s haemoglobin electrophoresis
b.
Test for serum transferrin
c.
Test her haemoglobin DNA genotype
d.
Test her partner’s full blood examination

Answer 8

D - Test her partners full blood examination

Question 9

Which of the following statements is correct?
Select one:
a.
Sensitivity and specificity are properties of a test not affected by the prevalence of the disease in question.
b.
The sensitivity of a test is proportional to the specificity.
c.
Specificity is the reciprocal of the negative predictive value.
d.
When testing for a rare disease, a test with a high sensitivity and specificity will also have a high predictive value.

Answer 9

A - Sensitivity and specificity are properties of a test not affected by the prevalence of the disease in question

Question 10

What effect does an electrosurgical waveform have if it is high-current, low voltage and elevates the tissue temperature rapidly (> 100˚ C) to produce vaporisation?
Select one:
a.
Desiccation
b.
Cutting
c.
Coagulation
d.
Fulguration

Answer 10

B - cutting

Question 11

Which of the following is most typical of a fetal scalp pO2 measured in early labour?
Select one:
a.
32 mmHg
b.
42 mmHg
c.
52 mmHg
d.
22 mmHg

Answer 11

D - 22mmHg
Oxygen sats in term fetus 67-75% with a pO2 of 20-24mmHg and a pH of 7.38-7.41

Question 12

Which of these congenital malformations is most likely to be associated with maternal diabetes mellitus?
Select one:
a.
Isolated ventricular septal defect
b.
Duodenal atresia
c.
Gastroschisis
d.
Posterior urethral valves

Answer 12

A - VSD

Question 13

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?
Select one:
a.
Fentanyl
b.
Magnesium sulphate
c.
Thiopentone
d.
Glyceryl trinitrate (GTN)

Answer 13

D - GTN

Question 14

The Guthrie test for phenylketonuria is:
Select one:
a.
predictive testing.
b.
carrier testing.
c.
exclusion testing.
d.
diagnostic testing.

Answer 14

D - Diagnostic testing

Question 15

A 31-year-old woman had a fetal anomaly ultrasound showing a VSD. An amniocentesis showed normal karyotype. A detailed discussion with the obstetrician and paediatric cardiologist suggests a good prognosis. However, the patient requests a termination of pregnancy.

What will be the most relevant guiding ethical principle to assist in this decision making?
Select one:
a.
Justice
b.
Autonomy
c.
Beneficence
d.
Non-maleficence

Answer 15

B - Autonomy

Question 16

A 36-year-old female with a male partner presents with primary infertility for one year. Her periods are regular and she is ovulating based on a mid-luteal progesterone concentration. Her BMI is 25. They have no sexual difficulties. She has had a normal pelvic ultrasound and has patent tubes. The partner’s SA is 100 million/ml, motility 50%, abnormal forms 80%.

What is the best option to achieve pregnancy in the next 12 months?
Select one:
a.
Controlled ovarian hyperstimulation and intrauterine insemination
b.
Continue trying to conceive spontaneous pregnancy for a further 12 months
c.
Ovulation induction with clomid
d.
She should consider an egg donor

Answer 16

A - Controlled ovarian hyperstimulation and intrauterine insemination

Question 17

Which of the following statements regarding hyperandrogenic chronic anovulation and polycystic ovarian syndrome is most correct?
Select one:
a.
Approximately 30% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 75% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.
b.
Approximately 30% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 90% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.
c.
Approximately 5% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 75% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.
d.
Approximately 5% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 90% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.

Answer 17

A - 30% USS appearances of PCOS, 75% chronic anovulation have PCOS on USS

Question 18

Regarding benefits and risks of the tension free vaginal tape procedure, which of the following statements is correct?
Select one:
a.
The cure rate on 24 hours pad test at 3 years is ~95%
b.
The risk of needing to perform self catheterisation is ~1%
c.
The vaginal erosion rate within 3 years is ~10%
d.
The risk of overactive bladder postoperatively is ~15%

Answer 18

B - risk of ISC is approx. 1%
Not A - cure rate at 1 year 92% and 3 years 79% on 2019 review
Not C - erosion in 2-8% of patients

Question 19

Which of the following statements about pituitary prolactinomas is correct?
Select one:
a.
Patients with microprolactinomas should be maintained on dopamine agonist therapy such as bromocriptine throughout pregnancy.
b.
The effects of oestrogen deficiency are rarely an indication for treatment of young women with microprolactinomas and amenorrhoea.
c.
They are found, at post-mortem examination, in approximately 10% of women who have died of non-endocrine disease.
d.
Patients with untreated microprolactinomas should be discouraged from breastfeeding.

Answer 19

C - incidentally noted at post mortem study from 2023 said 14%
Not A or D
Not B - hyperprolactinaemia can cause oestrogen deficiency and potentially amenorrhea and infertility so should be an indication for treatment in women wishing to conceive

Question 20

A 45-year-old woman with known BRCA 1 had mastectomy and BSO for breast and ovarian cancers.

What are the most likely histology results?
Select one:
a.
Breasts- oestrogen receptor positive
Ovaries – serous adenocarcinoma
b.
Breasts- progesterone receptor positive. Ovaries – mucinous adenocarcinoma
c.
Breasts- oestrogen receptor negative. Ovaries – mucinous adenocarcinoma
D.
Breasts - progesterone receptor negative. Ovaries - serous adenocarcinoma

Answer 20

D
Breasts- progesterone receptor negative; Ovaries – serous adenocarcinoma

Question 21

A primigravid woman is seen at 30 weeks gestation with right sided abdominal pain and vomiting. Appendicitis is suspected.

What is the correct management of this instance?
Select one:
a.
Administer steroids for fetal lung maturation and observe.
b.
Undertake appendicectomy.
c.
Perform ultrasound to exclude appendicitis.
d.
Perform MRI scan to exclude appendicitis.

Answer 21

B - undertake appendicectomy.
Ultrasound sensitivity 70-100%, Specificity 85-96% and readily available. MRI highest sensitivity but less available

Question 22

A 22-year-old primigravid woman presents to your birthing suite. She has had limited antenatal care in Nigeria. She is at term and contracting 4:10. On vaginal examination she has grade 3 Female Genital Mutilation.

What is the most appropriate management?
Select one:
a.
A right mediolateral episiotomy
b.
An anterior episiotomy and control of bleeding only
c.
An anterior episiotomy and re-infibulate after delivery
d.
Immediate LSCS

Answer 22

B - ant epis and control bleeding.
FGM type 3 is infibulation where whole vulva has been covered except for small opening. RCOG guideline states deinfibulation/anterior episiotomy can be done in labour under local anaesthetic. If not possible then C/S indicated

Question 23

The lifetime risk of having an operation for genital prolapse in Australia is approximately:
Select one:
a.
1 in 100.
b.
1 in 40.
c.
1 in 3.
d.
1 in 9.

Answer 23

D - 1 in 9

Question 24

Which of the following statements is true regarding third trimester idiopathic oligohydramnios confirmed on ultrasound?
Select one:
a.
The earlier the diagnosis in the 3rd trimester the worse the perinatal outcomes.
b.
Isolated oligohydramnios is associated with worse perinatal outcomes.
c.
Amnioinfusion should be performed regularly until term.
d.
The use of amniotic fluid index (AFI) of less than 5cm rather than a single deepest pocket (SDP) of less than 2cm for diagnosis improves perinatal outcome.

Answer 24

A

Question 25

Which one of the following is INCORRECT?
Select one:
a.
Iron requirement in the menstruating, non-pregnant, female is approximately 2mg/day.
b.
Iron absorption in the non-pregnant adult is approximately 5% of daily intake.
c.
Iron requirement in the pregnant female is approximately 9mg/day.
d.
Cord blood serum ferritin is greater than maternal serum ferritin.

Answer 25

C - Iron requirement in the pregnant female is approximately 9mg/day.
Should be 27mg/day

Question 26

In advising a woman on whether she should continue her pregnancy to 42 weeks or be induced at 41 weeks, which of the following is FALSE?
Select one:
a.
An ultrasound will be indicated if she elects to wait.
b.
If the Bishop’s cervical score is <5, intravaginal prostaglandins will be recommended.
c.
Waiting is likely to be associated with a higher perinatal mortality.
d.
The Canadian randomised trial (Hannah et al) showed that induction of labour increases the likelihood of caesarean section.

Answer 26

D - Hannah at al study from 1992, showed reduced rates of C/S, similar perinatal mortality and neonatal morbidity

Question 27

Which one of the following statements is true concerning toxoplasmosis infection in pregnancy?
Select one:
a.
Detection of IgM in fetal blood is the preferred method for diagnosis of intrauterine infection.
b.
Pyramethamine/Sulfadoxine is the most effective therapy but spiramycin is theoretically less embryotoxic.
c.
The risk of fetal infection after maternal seroconversion is higher in early pregnancy than in late pregnancy.
d.
The predominant source of human infection is the domestic cat (Felis domestica).

Answer 27

B - Pyramethamine/Sulfadoxine is the most effective therapy but spiramycin is theoretically less embryotoxic.

Question 28

You deliver an Rh-positive infant of an Rh-negative patient at term. The blood bank reports that the Kleihauer-Betke test reveals a feto-maternal haemorrhage of 40mL of fetal red cells. The indirect Coombs’ test shows no anti-D antibodies.

Which of the following statements about this situation is correct?
Select one:
a.
If anti-D immunoglobulin is given, the direct Coombs’ test on the mother should be repeated within 24 hours.
b.
The usual dose of one vial (625 IU) of anti-D immunoglobulin should be protective against sensitisation.
c.
Seven vials of anti-D immunoglobulin will be necessary to prevent sensitisation.
d.
No anti-D immunoglobulin is indicated because the patient is already sensitised.

Answer 28

C - Seven vials of anti-D immunoglobulin will be necessary to prevent sensitisation

Question 29

The most frequent cause of dyspareunia is:
Select one:
a.
pelvic inflammatory disease.
b.
endometriosis.
c.
inadequate vaginal lubrication.
d.
vaginismus.

Answer 29

C - inadequate vaginal lubrication

Question 30

What is the primary mechanism of the low dose combined oral contraceptive pill in preventing pregnancy?
Select one:
a.
Alteration in fallopian tube motility
b.
Suppression of gonadotropin secretion
c.
Decidualization of the endometrium
d.
Alteration of cervical mucous thickness

Answer 30

B - Suppression of gonadotropin secretion

Question 31

The appropriate initial treatment of pulmonary thromboembolism is:
Select one:
a.
low molecular weight heparin (LMWH) 1mg/kg BD subcutaneous injection.
b.
low molecular weight heparin (LMWH) 1.5mg/kg BD subcutaneous injection.
c.
unfractionated heparin 10,000 units IV followed by IV infusion.
d.
unfractionated heparin 5000 units BD subcutaneous injection.

Answer 31

A - LMWH 1mg/kg BD

Question 32

During an abdominal sacrocolpopexy procedure, on a woman with a large recurrent enterocoele and rectocoele, which of the following is the most appropriate?
Select one:
a.
The use of a Type 3 (multifilament mesh, microporous) polyglactin mesh.
b.
The procedure should generally include a perineorrhaphy.
c.
The procedure should generally be supported by Moscowitz operation.
d.
The upper end of the mesh should be attached between S1 and S3 at more than one point.

Answer 32

D - The upper end of the mesh should be attached between S1 and S3 at more than one point.

Question 33

The incidence of lymph node involvement in micro-invasive carcinoma of the cervix is:
Select one:
a.
5%.
b.
3%.
c.
10%.
d.
1%.

Answer 33

D - 1%

Question 34

Which of the following statements concerning multifetal reduction is FALSE?
Select one:
a.
Reducing triplets to twins at 10-14 weeks gestation is associated with an increase in mean gestation at delivery.
b.
Reducing triplets to twins at 10-14 weeks gestation is associated with a subsequent rate of miscarriage of both twins of approximately 8%.
c.
Reducing triplets to twins at 10-14 weeks gestation is not associated with a reduction in perinatal mortality.
d.
KCl and xylocaine are alternative agents to use for Selective Feticide.

Answer 34

C - Reducing triplets to twins at 10-14 weeks gestation is not associated with a reduction in perinatal mortality

Question 35

Following the conclusion of the ORACLE trials, which of the following antibiotics, or combinations of antibiotics, would be indicated in women with threatened preterm labour (without premature rupture of the membranes) and no other clinical signs of infection?
Select one:
a.
Amoxycillin and Metronidazole
b.
None of these options are indicated
c.
Amoxycillin-clavulinic acid
d.
Erythromycin

Answer 35

B - None of these options are indicated

Question 36

A woman G2P1 and her partner are referred to the antenatal clinic. She is at 14 weeks of gestation with positive anti-D antibodies during routine screening. Her qualitative titre is 1:16. She had an SVD two years ago. The baby had no issues. Her partner is heterozygous for D-antigen.

What is the most appropriate management plan?
Select one:
a.
Cordocentesis
b.
Check titres fortnightly in the mother
c.
Weekly ultrasound of fetal MCA PSV (Middle cerebral artery peak systolic velocity) to detect fetal anaemia
d.
Amniocentesis

Answer 36

B - Check titres fortnightly in the mother

Question 37

In patients who receive Clomiphene citrate (e.g. Clomid®) for induction of ovulation, the frequency of Ovarian Hyperstimulation Syndrome is:
Select one:
a.
reduced with ultrasound follicle tracking.
b.
less than 1%.
c.
5-10%.
d.
15-20%.

Answer 37

B - less than 1%

Question 38

Which statement is most correct with respect to malaria and pregnancy?
Select one:
a.
Doxycycline is recommended chemoprophylaxis if travelling to chloroquine-resistant areas.
b.
Quinine can be used if necessary in the treatment of malaria in pregnancy.
c.
Mefloquine cannot be used in women with G6PD deficiency.
d.
Women in pregnancy and the puerperium are not at increased risk of contracting malaria.

Answer 38

B - Quinine can be used if necessary in the treatment of malaria in pregnancy

Question 39

In which of the following scenarios would you have legally fulfilled your duty of care as a medical practitioner?
Select one:
a.
A woman arrives at your practice before the clinic opens carrying a sick infant. She is not one of your patients. She asks you if you are a doctor and you reply that you are not.
b.
You perform an emergency caesarean section on one of your private patients due to fetal distress in labour. Her next pregnancy is complicated by a caesarean scar pregnancy and uterine rupture. You had discussed possible complications with her prior to her initial surgery but had not mentioned this rare but serious complication
c.
One of your regular patients has high grade abnormalities detected on her routine cervical screening. You arrange a referral for colposcopy but you receive a note from the hospital that your patient did not attend. You try to contact her by telephone but her number has been disconnected. You take no further action.
d.
You are on a flight travelling between Brisbane and Auckland. A passenger in first class has collapsed and a call has been made for assistance from any doctors on board. You do not respond.

Answer 39

B

Question 40

Contraception in the peri-menopausal woman should be continued until:
Select one:
a.
she has had three anovulatory cycles in a row.
b.
she has had one full year without periods and exogenous hormones.
c.
her cycle has begun to elongate.
d.
she has had a blood test showing FSH:LH ratio has risen to two.

Answer 40

B - she has had one full year without periods and exogenous hormones

Question 41

What component for managing the delivery of the placenta at caesarean section has been shown to reduce the amount of blood loss?
Select one:
a.
Secure the incisional angles whilst awaiting spontaneous separation
b.
Controlled cord traction
c.
Immediate manual removal of the placenta
d.
Intravenous oxytocin

Answer 41

D - IV Oxytocin

Question 42

A previously normotensive 42-year-old woman is on the combined oral contraceptive pill (COCP). She has a diastolic blood pressure reading of 95mmHg at review for a repeat script.

What would be her best initial management?
Select one:
a.
Continue with COCP and perform renal function testing and review
b.
Continue with COCP and recheck the blood pressure
c.
Continue with COCP, begin anti-hypertensive treatment and review
d.
Cease the COCP and review

Answer 42

B - Continue COCP and recheck BP

Question 43

Of the following antibodies, which is the predominant type produced by the fetus?
Select one:
a.
IgG
b.
IgM
c.
IgA
d.
IgE

Answer 43

B - IgM

Question 44

At the time of a routine antenatal examination at 28 weeks gestation, the fetus of a 23-year-old woman G1P0 has a fetal heart rate of 240 bpm. Echocardiography confirms a supraventricular tachyarrhythmia. The fetus has a small pericardial effusion and a moderate amount of ascites.

Which of the following would be most appropriate?
Select one:
a.
Administration of Sotalol to the woman
b.
Administration of Amiodarone to the woman
c.
Administration of Labetalol to the woman
d.
Administration of Verapamil to the woman

Answer 44

A - Sotalol

Question 45

A 31-year-old HIV positive woman near term is on anti-retroviral therapy. Her viral load is undetectable and there is no fetal complication. She wants to have a vaginal birth rather than a caesarean section.

After explaining the risk, what is the next most appropriate step?
Select one:
a.
Contact Psychiatry to evaluate the patient’s decision.
b.
Contact the hospital lawyers for court orders for a caesarean section.
c.
Perform the caesarean section at 38 weeks or if in labour.
d.
Respect the patient’s decision as the risk of transmission is low.

Answer 45

D

Question 46

Which of the following statements about ovarian thecomata is INCORRECT?

Ovarian thecomata:
Select one:
a.
are characteristically unilateral.
b.
may present with virilising symptoms.
c.
characteristically occur before puberty.
d.
have a recognised association with endometrial hyperplasia.

Answer 46

C - characteristically occur before puberty

Question 47

Which of the following is the most appropriate treatment?
Select one:
a.
Tetracycline for a recent immigrant with granuloma inguinale
b.
Ketoconazole for a 25-year-old patient with trichomonas
c.
Ampicillin for a 15-year-old patient with pelvic inflammatory disease
d.
Erythromycin for a 28-week pregnant patient with syphilis and a penicillin allergy

Answer 47

A - Tetracycline for granuloma inguinale

Question 48

Which congenital anaemia is inherited as autosomal dominant and found in people of European descent?
Select one:
a.
Sickle Cell anaemia
b.
Glucose 6 Phosphate dehydrogenose deficiency
c.
Pyruvate Kinase deficiency
d.
Hereditary spherocytosis

Answer 48

D - Hereditary spherocytosis

Question 49

Oral contraceptives are associated with a decreased risk of each of the following EXCEPT:
Select one:
a.
ectopic pregnancy.
b.
endometriosis.
c.
cervical cancer.
d.
pelvic inflammatory disease (PID).

Answer 49

C - Cervical cancer

Question 50

A 32-year-old woman who has been infertile for four years has just completed the diagnostic phase of her infertility evaluation. Mid-luteal progesterone, semen analysis and hysterosalpingogram are all normal. A recent laparoscopy indicates moderate pelvic endometriosis without adhesions (stage III). Medical therapy for her endometriosis is recommended by another gynaecologist. The patient presents to the clinic with a list of questions concerning the proposed therapy.

You advise her that:
Select one:
a.
Danazol (Danocrine) is most effective when administered as a single daily dose.
b.
the availability of new medications has made medical therapy for endometriosis superior to operative therapy in terms of post-treatment pregnancy rates.
c.
medical therapy will defer pregnancy and is not recommended in the setting of infertility.
d.
the degree of ovarian suppression (hypo-oestrogenism) achieved by treatment with gonadotrophin-releasing hormone (GnRH) agonists is greater than that achieved with danazol.

Answer 50

C - Medical therapy will defer pregnancy and is not recommended in the setting of infertility

Question 51

Principles of management of a recto-vaginal fistula complicated by fever following obstetric trauma include:
Select one:
a.
immediate repair with minimal mobilisation of adjacent tissue planes.
b.
repair after subsiding inflammation with single layer closure without tension.
c.
immediate repair with partial excision of fistula tract.
d.
repair after subsiding inflammation with multilayered closure without tension.

Answer 51

D

Question 52

A 65-year-old woman has recovered from a Colles’ fracture. A recent bone scan reports decreased bone density. Her decreased bone mass is principally due to:
Select one:
a.
decreased intestinal calcium absorption.
b.
increased osteoclastic activity.
c.
decreased Vitamin D levels.
d.
decreased osteoblastic activity.

Answer 52

B - increased osteoclastic activity

Question 53

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

Answer 53

C - Approx 75% of children with CP have normal Apgars

Question 54

The most frequent site of colonisation with Group B streptococci is:
Select one:
a.
the pharynx.
b.
the cervix.
c.
the lower intestinal tract.
d.
the lower vagina.

Answer 54

C

Question 55

Which of the following would be most likely to be found in a patient with Swyer syndrome (46,XY gonadal dysgenesis), who presents for evaluation of primary amenorrhoea at the age of 18 years?
Select one:
a.
Uterus present, breasts undeveloped
b.
Uterus present, breasts developed
c.
Uterus absent, breasts undeveloped
d.
Uterus absent, breasts developed

Answer 55

A - uterus present, breasts undeveloped

Question 56

Which of the following is FALSE regarding human relaxin in pregnancy?
Select one:
a.
The absence of circulating serum relaxin is not known to be associated with any significant clinical sequelae.
b.
The corpus luteum of pregnancy is the most important source of circulating serum relaxin.
c.
Recombinant human relaxin has not been shown to be an effective cervical ripening agent in randomised controlled trials.
d.
Relaxin is structurally closely related to a growth hormone.

Answer 56

D

Question 57

Red degeneration of a uterine fibroid:
Select one:
a.
is due to emboli occluding the major blood vessels supplying the myoma.
b.
only occurs in pregnancy.
c.
is associated with a raised ESR.
d.
causes a leucopenia with a lymphocytosis.

Answer 57

C - raised ESR

Question 58

Which of the drugs below is most likely to be associated with oligohydramnios?
Select one:
a.
Verapamil
b.
Lithium
c.
Captopril
d.
Prazosin

Answer 58

C - Captopril

Question 59

During placental development:
Select one:
a.
a complete feto-placental circulation is established by 5-6 weeks post-conception.
b.
fetal blood flows to the placenta through paired umbilical arteries and a vein, and reaches an average flow rate of 350-400ml/min.
c.
utero-placental blood flow increases to 200-250ml/min at term.
d.
endovascular migration by cytotrophoblasts proceeds in two episodes that are completed by 8-10 weeks gestation.

Answer 59

A

Question 60

Which of the following is LEAST true of vulval melanoma?
Select one:
a.
The majority of melanoma cases are postmenopausal.
b.
5-year survival with subcutaneous penetration is approximately 20%.
c.
Occur more frequently on the labia majora than labia minora.
d.
Melanoma represents approximately 2% of all vulval malignancies.

Answer 60

C

Question 61

Which of the following disorders does NOT have autosomal dominant inheritance?
Select one:
a.
Von Recklinghausen’s disease (neurofibromatosis)
b.
Huntington’s chorea
c.
Achondroplasia
d.
Tay-Sachs disease

Answer 61

D - Tay Sachs disease

Question 62

A 53-year-old postmenopausal woman has been reading about Tibolone and would prefer to use it rather than oestrogen/progestogen therapy (Menopause Replacement Therapy-MRT).

You tell her that Tibolone:
Select one:
a.
is as effective as bioequivalent doses of combined MRT in reducing the frequency of vasomotor symptoms.
b.
has less risk for breast cancer recurrence than placebo.
c.
decreases the risk for endometrial cancer compared with placebo.
d.
has a reduced incidence of vaginal bleeding compared with combined MRT.

Answer 62

D

Question 63

Which fetal diameter presents in an occipito-posterior presentation?
Select one:
a.
Occipito-frontal
b.
Vertigo-mental
c.
Suboccipito-bregmatic
d.
Submento-bregmatic

Answer 63

A - occipito frontal

Question 64

A hepatitis B screening test is positive for antibody to core protein but negative for surface antigen and antibody.

This indicates that:
Select one:
a.
the patient has a high rate of infectivity.
b.
the surface antibody will probably become positive soon.
c.
the patient is a chronic carrier.
d.
the patient has probably never had hepatitis B.

Answer 64

B

Question 65

Which of the following statements about actinomycosis is FALSE?
Select one:
a.
It can occur when an IUCD is in situ.
b.
If antibiotics are required, high dose of penicillin or erythromycin are usual choices.
c.
It can be recognised by cervical cytology.
d.
It is associated with Toxic Shock Syndrome.

Answer 65

D

Question 66

Which of the following is correct with regards to the internal iliac artery?
Select one:
a.
The internal iliac artery supplies the buttocks.
b.
The medial branch of the internal iliac artery supplies the pelvic viscera.
c.
The internal iliac artery runs anterior to the ureters.
d.
The internal iliac artery arises from the external iliac artery at the level of the sacroiliac joint.

Answer 66

A - supplies the buttocks

Question 67

Complex atypical endometrial hyperplasia is most likely to be found in a woman:
Select one:
a.
on combined oestrogen-progestogen hormone replacement therapy.
b.
on biphasic oral contraception.
c.
with adenomyosis.
d.
with Type 2 diabetes mellitus.

Answer 67

D - T2DM

Question 68

A 62-year-old woman is reviewed in clinic for post-operative pain and the ultrasound reveals a vault haematoma. She has had a vaginal hysterectomy.

Which of the following statements is true?
Select one:
a.
Vault haematoma following hysterectomy occurs in approximately 20% patients.
b.
Infected vault haematomas usually contaminate the peritoneal cavity.
c.
Vault haematomas require surgical drainage to ensure complete resolution.
d.
Most cases of post hysterectomy vault haematoma are symptomatic.

Answer 68

A

Question 69

What is the minimum mean sac diameter for the diagnosis of a blighted ovum (anembryonic pregnancy)?
Select one:
a.
31mm
b.
16mm
c.
26mm
d.
21mm

Answer 69

C- 26mm

Question 70

Which of the following statements is FALSE?
Select one:
a.
The oxygen-haemoglobin dissociation curve in the fetus is shifted to the right when compared to the adult.
b.
In respiratory acidosis there is a low pH and a high PCO2.
c.
After bicarbonate, haemoglobin is the next most important acid-base buffer for the fetus.
d.
An increase in the “anion gap” (non-chloride, non-bicarbonate anions) is commonly seen in diabetic ketoacidosis.

Answer 70

A

Question 71

In the graafian follicle, the theca and granulosa cells cooperate to synthesize oestradiol (two-cell theory).

The two-cell theory is plausible because:
Select one:
a.
granulosa cell has p450 aromatase.
b.
granulosa cell has 17b hydroxylase.
c.
theca lutein cells express receptors for FSH.
d.
androstenedione and testosterone are aromatised in theca cells to oestradiol

Answer 71

A - granulosa call has p450 aromatase

Question 72

A 34-year-old woman G7P0M5T1 presents for her first antenatal visit at 10 weeks with a viable singleton pregnancy. All her miscarriages were in the first trimester. She has a normal uterine configuration and is thrombophilia screen negative.

What would be the most appropriate initial preventative management for her recurrent miscarriages?
Select one:
a.
Cervical cerclage.
b.
Low molecular weight heparin
c.
Maternal reassurance with intensive follow-up
d.
Low dose aspirin

Answer 72

C - maternal reassurance with intensive follow up

Question 73

In developed countries fetal hypothyroidism is most likely to result when the mother has:
Select one:
a.
carbamazepine overdose.
b.
Graves’ disease treated with thyroidectomy
c.
iodine deficiency.
d.
autoimmune thyroiditis.

Answer 73

D - autoimmune thyroiditis

Question 74

A woman is 20 weeks pregnant in her second pregnancy. She terminated her first pregnancy at 14 weeks and had a haemorrhage requiring a three-unit blood transfusion. The pathologist phones you to say she has a 1:128 titre of anti-Kell present in her antibody screen.

All of the following are true EXCEPT:
Select one:
a.
Peak systolic velocity in the MCA increases in the severely anaemic fetus and fetal blood sampling may be necessary.
b.
Serial antibody titres in the mother correlate well with fetal status.
c.
If the father is Kell Ag positive, amniocentesis or fetal cordocentesis may be performed to assess fetal Kell Ag status.
d.
Kell isoimmunisation is particularly severe as the antibodies affect both mature red cells and developing red cells in bone marrow.

Answer 74

B - serial antibody titres in the mother correlate well with fetal status

Question 75

A 15-year-old patient requests evaluation of masculinisation and failure to begin menstruation. She was taller than her peers during childhood. Pubic hair growth began at about six years of age. Excessive facial hair growth began at eight years of age, and she now shaves her face three times a week. She is 160 cm tall, blood pressure is 120/80 mm Hg and she has prominent musculature. Her breasts are Tanner stage 2 and her clitoris is enlarged and there is moderate posterior labial fusion. No pelvic masses are noted on transabdominal USS and a uterus is present. This patient’s sex chromosomes are most likely:
Select one:
a.
XX.
b.
XY.
c.
XYY.
d.
XX/XY.

Answer 75

A - XX

Question 76

Which artery should be ligated in order to remove the omentum?
Select one:
a.
Omental branch of the abdominal aortic artery
b.
Middle colic artery
c.
Gastroepiploic artery
d.
Left colic artery

Answer 76

C - gastroepiploic

Question 77

A meta-analysis of the early small randomised controlled trials of low dose aspirin in pregnancy showed a significant reduction in the frequency of proteinuric preeclampsia OR 0.4 (Confidence Interval 0.3 - 0.86).

Which of the following statements would be INCOMPATIBLE with this result?
Select one:
a.
The result is consistent with an odds reduction of between 14% and 70%.
b.
Low dose aspirin is effective in preventing proteinuric preeclampsia.
c.
Increasing the sample size would make the findings significant.
d.
The result could have been due to chance.

Answer 77

C - increasing the sample size would make the finding significant

Question 78

All of the following increase in the pregnant woman over values in the non-pregnant woman EXCEPT:
Select one:
a.
oxygen consumption.
b.
expiratory reserve volume.
c.
respiratory rate.
d.
tidal volume.

Answer 78

B - expiratory reserve volume

Question 79

A 30-year-old woman has a severe exacerbation of her chronic asthma. She is 16 weeks gestation. She has been using inhaled salbutamol without relief.

The next most appropriate management step is:
Select one:
a.
oral prednisolone.
b.
leucotriene modifiers.
c.
inhaled corticosteroids.
d.
increase the frequency of inhaled salbutamol.

Answer 79

A - oral prednisone

Question 80

An 18-year-old patient with primary amenorrhoea has undeveloped breasts, scant pubic and axillary hair and a tall, eunuchoidal habitus. The vagina and external genitalia are normal. The uterus and cervix are hypoplastic and the adnexae are not palpable. Her karyotype is 46,XY.

What is the most likely diagnosis?
Select one:
a.
True hermaphroditism
b.
21-hydroxylase deficiency
c.
Pure gonadal dysgenesis
d.
Androgen Insensitivity Syndrome

Answer 80

C - pure gonadal dysgenesis

Question 81

Which of the following statements concerning stillbirth is INCORRECT?
Select one:
a.
Between 41 weeks and 41 weeks and 6 days, the rate of stillbirth is approximately the same as between 38 weeks and 38 weeks and 6 days.
b.
In each week of pregnancy between 26 weeks and 40 weeks, the rate of stillbirth is approximately 0.03%.
c.
Approximately 1/500 women will have a stillbirth at or beyond 38 weeks gestation.
d.
The rate of stillbirth is increased with a true knot in the cord.

Answer 81

A

Question 82

A tall 16-year-old athletic girl presents with primary amenorrhoea. She has been diagnosed with androgen insensitivity syndrome and asks for further explanation.

Which of the following statements is correct?
Select one:
a.
Normal vulva, vagina and ovaries are present.
b.
Breast development normally occurs due to peripheral conversion of testosterone to oestrogen.
c.
Menstruation is irregular, occurring only 1-2 times per year.
d.
Axillary and pubic hair normally develops due to peripheral conversion of testosterone to oestrogen.

Answer 82

B - breast development normally occurs due to peripheral conversion

Question 83

A 40-year-old nulligravid woman has attended your clinic for booking at 10 weeks in her first pregnancy.

Which of the following statements concerning risks in this pregnancy is most correct?
Select one:
a.
She has a 4% risk of any chromosomal abnormality detected at CVS at 11 weeks.
b.
She has a 2% adjusted risk of miscarriage following amniocentesis at 15 weeks gestation.
c.
She has a 3% chance of an infant with Down Syndrome.
d.
She has a 1% risk of an infant with a neural tube defect.

Answer 83

A - she has a 4% risk of any chromosomal abnormality detected at cvs at 11 weeks

Question 84

Effective risk management is paramount in the day-to-day life of any medical practitioner. Typically, there are three strategies practitioners utilise to manage risk: transfer, mitigate or avoid the risk. When managing risk, in which order would you implement the aforementioned strategies?
Select one:
a.
Transfer, avoid, then mitigate the risk
b.
Mitigate, transfer, then avoid the risk
c.
Avoid, transfer, then mitigate the risk
d.
Avoid, mitigate, then transfer the risk

Answer 84

C - avoid, transfer and mitigate risk

Question 85

With respect to pregnancy in renal transplant patients:
Select one:
a.
immunosuppressive agents should be decreased prior to pregnancy.
b.
pregnancy is unlikely in the first 12 months after renal transplantation.
c.
pregnancy may increase graft rejection rates.
d.
live birth rate approximates 75%.

Answer 85

D - live birth rate approx 75%
(Although CNP states 95% if no hypertension or proteinuria)

Question 86

A 46-year-old woman presents with a feeling of a lesion inside her vagina. She is an asylum seeker and has a 10-12 year history of episodes of amenorrhoea and dysfunctional bleeding. She is concerned about going to a hospital and also the cost involved. Her GP has supplied a report of a pelvic ultrasound scan and it shows a moderate cystic change in the uterine cavity and endometrium thickness of 27mm. When you examine her you find a pedunculated cervical polyp which is not compromising her, but is bothering her.

What is the next step in the management of this patient?
Select one:
a.
Perform the polypectomy in your rooms
b.
Explain your concern and long term risk of cancer and organise for hysteroscopy and curettage under GA after explaining the cost and procedure
c.
Perform an outpatient pipelle aspiration and polypectomy in your room
d.
Refer her to the public system and they will take care of her

Answer 86

C

Question 87

Each of the following is more frequent in Klinefelter’s syndrome, compared to the normal male population, EXCEPT:
Select one:
a.
tall stature.
b.
azoospermia.
c.
persistence of prepubertal characteristics.
d.
low serum FSH concentration.

Answer 87

D - low serum FSH

Question 88

A 44-year-old Para 2 woman sees you to discuss options of contraception. She has regular menstrual periods. She has BMI of 26 and is a non-smoker. She has a known subseptate uterus, osteoporosis and has had multiple operations for diverticular disease. She also had an unplanned pregnancy while using barrier contraception and her husband is not keen to have a vasectomy.

What is the most appropriate contraception for her?
Select one:
a.
Tubal sterilisation
b.
Low dose combined OCP
c.
Progesterone only pill
d.
LNG-IUS

Answer 88

B

Question 89

A woman G3P2 at 35 weeks gestation, has confirmed preterm pre-labour rupture of membranes. In the context of the PPROMT trial which of the following outcomes would be most likely if she was managed expectantly?
Select one:
a.
Higher risk of Caesarean section
b.
Lower risk of intrapartum fever
c.
Higher risk of antepartum haemorrhage
d.
Shorter hospital stay

Answer 89

C - higher risk of APH

Question 90

Which of the following is most suggestive of an ectopic pregnancy?
Select one:
a.
Transabdominal ultrasound reveals no gestational sac; ß-hCG <4,000 mIU/mL
b.
Transabdominal ultrasound reveals no gestational sac; ß-hCG >7,000 mIU/mL
c.
ß-hCG >7,000 mIU/mL, serum progesterone <40 mg/mL
d.
Transvaginal ultrasound reveals no gestational sac; ß-hCG <600 mIU/mL

Answer 90

B

Question 91

A 30-year-old patient G3P2 at 12 weeks gestation, asks you for information about aneuploidy screening.

Which is the most appropriate response?
Select one:
a.
A “High risk” NIPS (Non-Invasive Prenatal Screening) result, has a positive predictive value (PPV) of 99% for trisomy 21.
b.
A “Low risk” NIPS result, has a negative predictive value of 99.99% for trisomy 21.
c.
NIPS is currently only validated for high risk pregnancies.
d.
Using a risk cut-off of 1:300, the combined first trimester screen will identify 90% of all fetuses with trisomy 21.

Answer 91

B

Question 92

A 21-year-old anxious and distressed nulliparous woman presents requesting a vaginal repair as her boyfriend commented that she had a lax vaginal wall and is putting pressure on her to have a reconstruction/repair. The gynaecological examination was normal.

What is the most appropriate initial option?
Select one:
a.
Recommend pelvic floor physiotherapy
b.
Perform the procedure after explaining risks and consequences
c.
Explain to the woman that there is no medical indication for surgery
d.
Provide psychosexual counselling to the couple

Answer 92

C

Question 93

You are the on-call registrar for Obstetrics. A patient has delivered her 5th baby but has not delivered the placenta yet. You receive an urgent call to the delivery suite and on arrival you diagnose acute inversion of the uterus. The patient is in shock.

What is the most appropriate first management step?
Select one:
a.
Take the patient immediately to theatre
b.
Give Terbutaline 0.25mg subcutaneous/intravenous
c.
Attempt to reposition the uterus
d.
Attempt to remove the placenta

Answer 93

C - attempt to reposition the uterus

Question 94

Which of the following statements about the recognised unwanted effects of drugs is correct?
Select one:
a.
Hot flushes are associated with clomiphene citrate.
b.
Hirsutism is associated with cyproterone acetate.
c.
Fetal virilisation is associated with medroxyprogesterone acetate.
d.
Hypertension is associated with bromocriptine.

Answer 94

A

Question 95

Which of the following causes of primary amenorrhoea are associated with spontaneous ovulation?
Select one:
a.
5-alpha reductase deficiency
b.
Turner syndrome (45X)
c.
Hypothalamic hypogonadism (Kallmann syndrome)
d.
Müllerian agenesis

Answer 95

D - mullerian agenesis

Question 96

A woman in mid-pregnancy develops intractable constipation which has not responded to fibre supplements.

The next appropriate therapy is:
Select one:
a.
Magnesium sulphate.
b.
Coloxyl (Docusate).
c.
Bisacodyl (Durolax).
d.
Lactulose.

Answer 96

D - lactulose

Question 97

A 17-year-old patient having a laparotomy for a ruptured right ectopic pregnancy has a 10cm cyst of the right ovary and a normal appearing left ovary. Regarding the right ovarian cyst, what is the most appropriate surgical procedure?
Select one:
a.
Right ovarian cystectomy
b.
Right salpingo-oophorectomy
c.
Aspirate the cyst only
d.
Cystectomy with wedge resection of the left ovary

Answer 97

A - right ovarian cystectomy

Question 98

With regard to perinatal mental health, which of the following statements is INCORRECT?
Select one:
a.
Selective serotonin reuptake inhibitor (SSRI) treatment is unsafe antenatally but low risk during breastfeeding.
b.
A woman with a Edinburgh Postnatal Depression Scale (EPDS) score of 13 or more should be further assessed promptly.
c.
Approximately 10% of women will experience depression during pregnancy.
d.
Up to 80% of women have “postnatal blues” at day four.

Answer 98

A

Question 99

Which of the following statements regarding the mechanism of anti-androgen effects is LEAST correct?
Select one:
a.
Finasteride inhibits 5-alpha-reductase.
b.
Cyproterone Acetate inhibits 5-alpha-reductase.
c.
Cimetidine weakly binds to the dihydrotestosterone receptor.
d.
Spironolactone competitively inhibits binding to the dihydrotestosterone receptor and also inhibits 5-alpha-reductase.

Answer 99

B - cyproterone acetate inhibits 5-alpha reductase

Question 100

A 36-year-old, primigravid woman at 16 weeks gestation, has received genetic counselling and has chosen to proceed with prenatal diagnosis as there has been unusually slow growth of the fetus since the 12 week scan.
Which of the following is most correct?

Select one:

A. CVS is unhelpful in this situation because of potential karyotyoic disparity between fetus and trophoblast
B. Amniocentesis is indicated because it is too late for CVS
C. CVS may indicate a cause for the growth restriction, not apparent with amniocentesis as placenta mosaicism is a potential cause
D. The risk of miscarriage associated with amniocentesis is 1:600 if performed by a maternal fetal medicine sub specialist

Answer 100

C. CVS may indicate a cause for the growth restriction, not apparent with amniocentesis as placenta mosaicism is a potential cause