RANZCOG bank (2020) Flashcards by Edward P

Which of the following is the most appropriate treatment?

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

a. Tetracycline for a recent immigrant with granuloma inguinale

Ketoconazole - topical treatment
Ampicillin - similar to amox, needed broader cover

Granuloma inguinale is a rare sexually transmitted disease caused by the bacteria Klebsiella granulomatis

Azithromycin first line
Other options cotrimoxazole, doxycycline, erythromycin

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Which of the following causes of primary amenorrhoea are associated with spontaneous ovulation?

a. Hypothalamic hypogonadism (Kallmann syndrome)
b. Turner syndrome (45X)
c. 5-alpha reductase deficiency
d. Müllerian agenesis

d. Müllerian agenesis

MRKH - vaginal/uterine agenesis, ovaries are formed from a separate embryological pathway so will go through adrenarche and will ovulate

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Red degeneration of a uterine fibroid:

a. causes a leucopenia with a lymphocytosis.
b. is associated with a raised ESR.
c. is due to emboli occluding the major blood vessels supplying the myoma.
d. only occurs in pregnancy.

b. is associated with a raised ESR.

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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?

a. Continue with COCP, begin anti-hypertensive treatment and review
b. Continue with COCP and perform renal function testing and review
c. Cease the COCP and review
d. Continue with COCP and recheck the blood pressure

d. Continue with COCP and recheck the blood pressure

Absolute contraindications:
- DBP >/=95mmHg

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Which of the following is most typical of a fetal scalp pO2 measured in early labour?

a. 52 mmHg
b. 42 mmHg
c. 32 mmHg
d. 22 mmHg

d. 22 mmHg

Fetal scalp pO2 normal 20-30mmHg

Normal adult venous O2 approx 30-40mmHg
- 80-100mmHg for arterial

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Of the following antibodies, which is the predominant type produced by the fetus?

a. IgA
b. IgM
c. IgE
d. IgG

b. IgM

Developed during fetal development from 20/40

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With respect to pregnancy in renal transplant patients:

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

d. live birth rate approximates 75%.

?disagree
75% if Cr>125
>95% of Cr <125

Graft rejection is a risk especially if concieve <2years after transplant

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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?

a. Cervical cerclage.
b. Maternal reassurance with intensive follow-up
c. Low dose aspirin
d. Low molecular weight heparin

b. Maternal reassurance with intensive follow-up

Wouldn’t give LDA or heparin without thrombophilia diagnosis

Evidence that maternal reassurance with intensive f/u improves LBR

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Which of the following statements regarding hyperandrogenic chronic anovulation and polycystic ovarian syndrome is most correct?

a. 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.
b. 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.
c. 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.
d. 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.

d. 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.

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Which congenital anaemia is inherited as autosomal dominant and found in people of European descent?

a. Pyruvate Kinase deficiency
b. Glucose 6 Phosphate dehydrogenose deficiency
c. Hereditary spherocytosis
d. Sickle Cell anaemia

c. Hereditary spherocytosis
- autosomal recessive or autosomal dominant
- most common in Northern European and Japanese families
- related to membrane proteins in red cells
- can cause haemolytic anaemia

Pyruvate Kinase deficiency
- autosomal recessive

Glucose 6 Phosphate dehydrogenose deficiency
- X-linked recessive disorder

Sickle Cell anaemia
- autosomal recessive

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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?

a. Perform an outpatient pipelle aspiration and polypectomy in your room
b. Perform the polypectomy in your rooms
c. Explain your concern and long term risk of cancer and organise for hysteroscopy and curettage under GA after explaining the cost and procedure
d. Refer her to the public system and they will take care of her

a. Perform an outpatient pipelle aspiration and polypectomy in your room

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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:

a. Serial antibody titres in the mother correlate well with fetal status.
b. Peak systolic velocity in the MCA increases in the severely anaemic fetus and fetal blood sampling may be necessary.
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.

a. Serial antibody titres in the mother correlate well with fetal status.

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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?

a. An ultrasound will be indicated if she elects to wait.
b. The Canadian randomised trial (Hannah et al) showed that induction of labour increases the likelihood of caesarean section.
c. If the Bishop’s cervical score is <5, intravaginal prostaglandins will be recommended.
d. Waiting is likely to be associated with a higher perinatal mortality

b. The Canadian randomised trial (Hannah et al) showed that induction of labour increases the likelihood of caesarean section.

1992
Induction of labour as compared with serial antenatal monitoring in post-term pregnancy. A randomised controlled trial. The Canadian Multicenter Post-term Pregnancy Trial Group.
- In post-term pregnancy, IOL results in a lower rate of C/S than serial antenatal monitoring
- Rates of perinatal mortality and neonatal morbidity are similar with the two approaches to management

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Which of the following is LEAST true of HIV?

a. 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.
b. With all available initiatives, the incidence of mother-to-child transmission of HIV should be reduced to approximately 5%.
c. Antiviral chemotherapy lowers the risk of mother-to-child transmission of HIV to approximately one-third of the risk without chemotherapy.
d. Opportunistic infections commonly develop when the CD4 count falls below 200 x 106 per litre.

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

With ART, appropriate mode of delivery, formula feeding, baby receiving PEP, incidence of perinatal transmission <2%

Duration of ROM does matter

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Oral contraceptives are associated with a decreased risk of each of the following EXCEPT:

a. ectopic pregnancy.
b. endometriosis.
c. pelvic inflammatory disease (PID).
d. cervical cancer.

d. cervical cancer.

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Contraception in the peri-menopausal woman should be continued until:

a. she has had three anovulatory cycles in a row.
b. she has had one full year without periods and exogenous hormones.
c. she has had a blood test showing FSH:LH ratio has risen to two.
d. her cycle has begun to elongate.

b. she has had one full year without periods and exogenous hormones.

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A woman in mid-pregnancy develops intractable constipation which has not responded to fibre supplements.
The next appropriate therapy is:

a. Magnesium sulphate.
b. Lactulose.
c. Coloxyl (Docusate).
d. Bisacodyl (Durolax).

b. Lactulose.

1st line - dietary fibre
2nd line - increase bulk
3rd line - osmotic - lactulose (MgSO4)
4th line - stimulant - bisadocyl, Docusate

Docusate - theoretically increase risk of PTB

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The incidence of lymph node involvement in micro-invasive carcinoma of the cervix is:

a. 5%.
b. 1%.
c. 3%.
d. 10%.

b. 1%.

IA1 - (<3mm stromal invasion) incidence of positive LNs is <1%
IA2 - (3-5mm stromal invasion) - 7-8% LN involvement

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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?

a. Test her partner’s full blood examination
b. Test her partner’s haemoglobin electrophoresis
c. Test her haemoglobin DNA genotype
d. Test for serum transferrin

a. Test her partner’s full blood examination

Hemoglobin analysis and/or genetic testing is required to confirm the diagnosis of thalassemia

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A 36-year-old, primigravid woman at 16 weeks of 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?

a. Amniocentesis is indicated because it is too late for chorionic villus sampling (CVS).
b. CVS may indicate a cause for the growth restriction, not apparent with amniocentesis as placenta mosaicism is a potential cause.
c. The risk of miscarriage associated with amniocentesis is 1:600 if performed by a maternal fetal medicine subspecialist.
d. CVS is unhelpful in this situation because of potential karyotypic disparity between fetus and trophoblast.

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

Confined placental mosaicism has been shown to be a clinically significant cause of FGR

Amnio - From 15/40
Optimal timing 15+0 to 17+6

CVS - From 11/40 (11 to 14 weeks)
Although CVS can be performed >14/40, amniocentesis is preferred from 15/40 as technically easier, more comfortable for patient and avoids placental mosaicism

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Which of the following statements about pituitary prolactinomas is correct?

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

d. They are found, at post-mortem examination, in approximately 10% of women who have died of non-endocrine disease.

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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?

a. Glyceryl trinitrate (GTN)
b. Thiopentone
c. Magnesium sulphate
d. Fentanyl

a. Glyceryl trinitrate (GTN)

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Which of the following is LEAST true of vulval melanoma?

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

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

Most common on the labia minora

Although vulvar melanomas account for less than 1 percent of all melanomas, they represent 10 percent of all malignant tumors involving the vulva

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Select one:With regard to perinatal mental health, which of the following statements is INCORRECT?

a. A woman with a Edinburgh Postnatal Depression Scale (EPDS) score of 13 or more should be further assessed promptly.
b. Up to 80% of women have “postnatal blues” at day four.
c. Selective serotonin reuptake inhibitor (SSRI) treatment is unsafe antenatally but low risk during breastfeeding.
d. Approximately 10% of women will experience depression during pregnancy.

c. Selective serotonin reuptake inhibitor (SSRI) treatment is unsafe antenatally but low risk during breastfeeding.

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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? a. Respect the patient’s decision as the risk of transmission is low. b. Perform the caesarean section at 38 weeks or if in labour. c. Contact Psychiatry to evaluate the patient’s decision. d. Contact the hospital lawyers for court orders for a caesarean section.

a. Respect the patient’s decision as the risk of transmission is low.

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

b. Hot flushes are associated with clomiphene citrate. Orthostatic hypotension = side effect of bromocriptine

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

b. has a reduced incidence of vaginal bleeding compared with combined MRT.

In the graafian follicle, the theca and granulosa cells cooperate to synthesize oestradiol (two-cell theory). The two-cell theory is plausible because: a. theca lutein cells express receptors for FSH. b. androstenedione and testosterone are aromatised in theca cells to oestradiol. c. granulosa cell has p450 aromatase. d. granulosa cell has 17b hydroxylase.

c. granulosa cell has p450 aromatase. Oestrogen production requires - LH to stimulate ovarian theca cells to produce androgens from cholesterol (via desmolase) - FSH stimulates ovarian granulosa cells to convert androgen into oestrogen (via aromatase)

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

b. Iron requirement in the pregnant female is approximately 9mg/day. Iron requirement (NZ MoH) - breastfeeding 9mg/day - pregnant women 27mg/day - non-pregnant - 18mg/day

Which of the following statements is true regarding third trimester idiopathic oligohydramnios confirmed on ultrasound? a. Amnioinfusion should be performed regularly until term. b. Isolated oligohydramnios is associated with worse perinatal outcomes. c. 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. d. The earlier the diagnosis in the 3rd trimester the worse the perinatal outcomes.

d. The earlier the diagnosis in the 3rd trimester the worse the perinatal outcomes. Compared to SDVP of <2cm, an AFI <5cm is associated with increased: - Diagnosis of oligohydramnios - Induction of labour - CS delivery for fetal distress But with no difference in Apgar score, umbilical artery pH <7.1 or improvement in perinatal outcome Therefore interpretation of amniotic fluid volume should be based on SDVP - To reduce the diagnosis of oligohydramnios and need for obstetric intervention

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

a. with Type 2 diabetes mellitus.

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: a. leucotriene modifiers. b. oral prednisolone. c. increase the frequency of inhaled salbutamol. d. inhaled corticosteroids.

b. oral prednisolone. Normally use normal prednisone

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

b. 26mm

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? a. Hepatitis b. Cholecystitis c. Acute fatty liver of pregnancy d. Cholestasis of pregnancy

c. Acute fatty liver of pregnancy

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

d. Intravenous oxytocin

A 30-year-old patient G3P2 at 12 weeks gestation, asks you for information about aneuploidy screening. Which is the most appropriate response? a. NIPS is currently only validated for high risk pregnancies. b. Using a risk cut-off of 1:300, the combined first trimester screen will identify 90% of all fetuses with trisomy 21. c. A "High risk" NIPS (Non-Invasive Prenatal Screening) result, has a positive predictive value (PPV) of 99% for trisomy 21. d. A "Low risk" NIPS result, has a negative predictive value of 99.99% for trisomy 21.

a. NIPS is currently only validated for high risk pregnancies. MSS1 - Sensitivity 85% - Specificity 95% - Positive predictive value ~7-10%

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

a. low serum FSH concentration. RAISED FSH

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

d. diagnostic testing. ``` GUTHRIE CARD CONDITIONS Cystic fibrosis PKU Congenital hypothyroidism Congenital adrenal hyperplasia Maple syrup urine disease Fatty acid oxidation disorders (e.g. MCAD) Galactosaemia Severe combined immunodeficiency (SCID) Biotinidase deficiency ```

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? a. Immediate LSCS b. An anterior episiotomy and re-infibulate after delivery c. An anterior episiotomy and control of bleeding only d. A right mediolateral episiotomy

c. An anterior episiotomy and control of bleeding only Type 3 - Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora +/- excision of the clitoris

Which of the following statements concerning stillbirth is INCORRECT? a. In each week of pregnancy between 26 weeks and 40 weeks, the rate of stillbirth is approximately 0.03%. b. 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. 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.

b. 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. NZ neonatal death rate 2017 - 2.9/1000 live births NZ perinatal mortality rate 2017 - 9.2 Stillbirth rate - The number of stillbirths per 1000 livebirths and stillbirths (total births) - 4.8 /1000 live births

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

a. Relaxin is structurally closely related to a growth hormone. protein hormone insulin like peptide relaxes the ligaments in pelvis comes from the corpus luteum and placenta structurally related to a growth hormone

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: a. bilateral salpingo-oophorectomy. b. total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, postoperative irradiation. c. total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, postoperative chemotherapy. d. left salpingo-oophorectomy.

d. left salpingo-oophorectomy.

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

a. expiratory reserve volume. Expiratory reserve volume - Decreases Tidal volume - Increased

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? a. Perform ultrasound to exclude appendicitis. b. Perform MRI scan to exclude appendicitis. c. Undertake appendicectomy. d. Administer steroids for fetal lung maturation and observe.

c. Undertake appendicectomy. If there is a prolonged wait time for MRI evaluation, the risk of potential appendiceal rupture is balanced against the potential benefits of the study, such as identifying a different cause of pain or avoiding surgery. If MRI if not readily available, then CT scan can be performed if the diagnosis is unclear. If either imaging modality is not available quickly or if the patient declines CT because of the radiation exposure, surgery should not be delayed in pregnant women with findings suggestive of appendicitis despite inconclusive ultrasound results.

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? a. Higher risk of Caesarean section b. Shorter hospital stay c. Higher risk of antepartum haemorrhage d. Lower risk of intrapartum fever

c. Higher risk of antepartum haemorrhage The women assigned to expectant management group had higher risks of APH and use of postpartum antibiotics and a longer hospital stay - Lower risk of CS

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

c. Occipito-frontal Vertex - flexion of the fetal head - Suboccipitobregmatic = Below the occiput to the centre of the anterior fontanelle - 9.5cm Deflexed OP - Occipitofrontal =Occiput to the root of the nose - 11.5cm Brow - Mentovertical = Chin to the centre of the sagittal suture - 13-14cm Face - Submentobregmatic angle = Angle between the neck and chin and the centre of the anterior fontanelle - 9.5cm

In which of the following scenarios would you have legally fulfilled your duty of care as a medical practitioner? a. 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. b. 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. c. 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. d. 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

d. 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

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

c. 1 in 9. Lifetime risk of requiring an operation for prolapse or incontinence is 11-19% 7% for POP (RANZCOG)

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? a. Controlled ovarian hyperstimulation and intrauterine insemination b. Continue trying to conceive spontaneous pregnancy for a further 12 months c. She should consider an egg donor d. Ovulation induction with clomid

a. Controlled ovarian hyperstimulation and intrauterine insemination Sperm morphology - 4% normal forms (3.0-4.0) - Cindy 2018 said - Clomiphene or letrozole with IUI is superior to expectant management and natural cycle IUI for outcome of livebirth rate in couples with unexplained infertility

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? a. Right ovarian cystectomy b. Right salpingo-oophorectomy c. Cystectomy with wedge resection of the left ovary d. Aspirate the cyst only

a. Right ovarian cystectomy

Which one of the following statements is true concerning toxoplasmosis infection in pregnancy? 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).

b. Pyramethamine/Sulfadoxine is the most effective therapy but spiramycin is theoretically less embryotoxic. 1st trimester - fetal transmission 4-15% 2nd trimester - fetal transmission 25-44% 3rd trimester - fetal transmission 30-75%

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

b. autoimmune thyroiditis. in the developing world - it is iodine deficiency

Regarding benefits and risks of the tension free vaginal tape procedure, which of the following statements is correct? 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 risk of overactive bladder postoperatively is ~15% d. The vaginal erosion rate within 3 years is ~10%

b. The risk of needing to perform self catheterisation is ~1% No difference in de novo OAB - 10%

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

d. low molecular weight heparin (LMWH) 1mg/kg BD subcutaneous injection.

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? a. Uterus present, breasts undeveloped b. Uterus present, breasts developed c. Uterus absent, breasts undeveloped d. Uterus absent, breasts developed

a. Uterus present, breasts undeveloped

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? a. Desiccation b. Fulguration c. Cutting d. Coagulation

c. Cutting

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

d. repair after subsiding inflammation with multilayered closure without tension

60) . 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- progesterone receptor negative; Ovaries – serous adenocarcinoma b. Breasts- oestrogen receptor positive; Ovaries – serous adenocarcinoma c. Breasts- progesterone receptor positive; Ovaries – mucinous adenocarcinoma d. Breasts- oestrogen receptor negative; Ovaries – mucinous adenocarcinoma

a. Breasts- progesterone receptor negative; Ovaries – serous adenocarcinoma

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? a. She has a 1% risk of an infant with a neural tube defect. 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 4% risk of any chromosomal abnormality detected at CVS at 11 weeks.

d. She has a 4% risk of any chromosomal abnormality detected at CVS at 11 weeks.

Which of the following is most correct concerning bone mass? 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.

a. Bone mass peaks in most women before 25 years of age. Approximately 80% of the bone mass is in the cortical compartment. Bone mass peaks 20-30y The annual rate of postmenopausal bone loss has been calculated to be 1.3–1.5 percent at the lumbar spine and 1.4 percent at the femoral neck

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? a. Cordocentesis b. Amniocentesis c. Weekly ultrasound of fetal MCA PSV (Middle cerebral artery peak systolic velocity) to detect fetal anaemia d. Check titres fortnightly in the mother

d. Check titres fortnightly in the mother

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. Most cases of post hysterectomy vault haematoma are symptomatic. c. Vault haematomas require surgical drainage to ensure complete resolution. d. Infected vault haematomas usually contaminate the peritoneal cavity.

a. Vault haematoma following hysterectomy occurs in approximately 20% patients.

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

a. The upper end of the mesh should be attached between S1 and S3 at more than one point. type 1 mesh

Which of the following statements concerning multifetal reduction is FALSE? a. Reducing triplets to twins at 10-14 weeks gestation is associated with a subsequent rate of miscarriage of both twins of approximately 8%. b. Reducing triplets to twins at 10-14 weeks gestation is associated with an increase in mean gestation at delivery. 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

c. Reducing triplets to twins at 10-14 weeks gestation is not associated with a reduction in perinatal mortality. Procedure-related loss rates: - 4.5% for triplets - 8% for quadruplets USS guided injection of potassium chloride into the fetal thorax A pleural effusion and cardiac asystole should be seen

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

b. Increasing the sample size would make the findings significant.

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: a. the degree of ovarian suppression (hypo-oestrogenism) achieved by treatment with gonadotrophin-releasing hormone (GnRH) agonists is greater than that achieved with danazol. 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. Danazol (Danocrine) is most effective when administered as a single daily dose.

c. medical therapy will defer pregnancy and is not recommended in the setting of infertility. Danazol - don't use, high burden androgenic side effects (weight gain, acne, hirsutism) Androgen

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

a. The internal iliac artery supplies the buttocks. Superior and inferior gluteal arteries are terminal branches of the internal iliac - superior gluteal from posterior branch - inferior gluteal from anterior branch

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

a. Cyproterone Acetate inhibits 5-alpha-reductase. Cyproterone acetate blocks binding to dihydrotesterone to receptors 5-alpha-reductase - converts testosterone to dihydrotestosterone

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

b. Isolated ventricular septal defect Congenital heart defects 3-fold increased risk Most common, 35-40% of major anomalies in women with DM

74) 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: a. XY. b. XX. c. XYY. d. XX/XY.

b. XX. Non-classic CAH

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

b. Explain to the woman that there is no medical indication for surgery

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

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

Which of the following statements about ovarian thecomata is INCORRECT? Ovarian thecomata: a. have a recognised association with endometrial hyperplasia. b. are characteristically unilateral. c. characteristically occur before puberty. d. may present with virilising symptoms.

c. characteristically occur before puberty. 10% are androgenic

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? a. Transfer, avoid, then mitigate the risk b. Mitigate, transfer, then avoid the risk c. Avoid, mitigate, then transfer the risk d. Avoid, transfer, then mitigate the risk

d. Avoid, transfer, then mitigate the risk

Which statement is most correct with respect to malaria and pregnancy? a. Quinine can be used if necessary in the treatment of malaria in pregnancy. b. Doxycycline is recommended chemoprophylaxis if travelling to chloroquine-resistant areas. 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.

a. Quinine can be used if necessary in the treatment of malaria in pregnancy. In pregnancy, malaria parasites sequester in the placenta where infection is often extremely heavy

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

d. less than 1%.

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

d. Captopril Verapamil - CCB

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

b. Gastroepiploic artery Right and left gastroepiploic (a.k.a. gastromental arteries) Branches of coeliac trunk

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

d. a complete feto-placental circulation is established by 5-6 weeks post-conception. 600-700ml/min is placental blood flow = 80% of uterine perfusion at term fetal blood flows to the placenta at 500ml/min

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? a. Combined oral contraceptive therapy b. Intravenous oestrogen therapy c. Cyclical progestogen therapy d. Dilatation and curettage (D&C)

a. Combined oral contraceptive therapy

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

b. Transabdominal ultrasound reveals no gestational sac; ß-hCG >7,000 mIU/mL

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

d. Breast development normally occurs due to peripheral conversion of testosterone to oestrogen.

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

c. The oxygen-haemoglobin dissociation curve in the fetus is shifted to the right when compared to the adult. difference between positively and negatively charged anions in blood

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? a. Administration of Verapamil to the woman b. Administration of Sotalol to the woman c. Administration of Labetalol to the woman d. Administration of Amiodarone to the woman

b. Administration of Sotalol to the woman For fetal arrhythmias 1st line is flecanide 2nd line is sotalol 3rd digoxin 4th line is amiodarone

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

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

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

c. Klebsiella granulomatis

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? a. Erythromycin b. None of these options are indicated c. Amoxycillin and Metronidazole d. Amoxycillin-clavulinic acid

b. None of these options are indicated

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? a. Attempt to remove the placenta b. Attempt to reposition the uterus c. Take the patient immediately to theatre d. Give Terbutaline 0.25mg subcutaneous/intravenous

b. Attempt to reposition the uterus

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

a. It is associated with Toxic Shock Syndrome.

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? a. Autonomy b. Beneficence c. Justice d. Non-maleficence

a. Autonomy

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

a. Cardiomyopathy

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

d. Tay-Sachs disease - autosomal recessive

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? a. Pure gonadal dysgenesis b. True hermaphroditism c. 21-hydroxylase deficiency d. Androgen Insensitivity Syndrome

a. Pure gonadal dysgenesis

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

b. Suppression of gonadotropin secretion

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

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

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. increased osteoclastic activity. b. decreased intestinal calcium absorption. c. decreased osteoblastic activity. d. decreased Vitamin D levels

a. increased osteoclastic activity.

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? a. Tubal sterilisation b. Low dose combined OCP c. Progesterone only pill d. LNG-IUS

b. Low dose combined OCP