PAPER ONE

In a paper describing the use of a new drug for the treatment of hypertension in pregnancy you read: The mean fall in diastolic blood pressure in the treated group (n=30) was 10 mmHg+/-3 (SD) and in the control group (n=29) given placebo the mean fall was 4 mmHg +/–2.6 (SD). Using the t-test, p> 0.001.' The following statements are correct:

20. Assuming a normal distribution, approximately 68% of the treated group would have shown a fall in the diastolic pressure of between 7 and 13 mmHg

21. The difference observed in the fall of blood pressure between the two groups did not reach a level of statistical significance

22. If the trial was properly conducted, the doctors involved should have known which patients were receiving the active drug and which the placebo

23. The most appropriate way to allocate patients to the drug and to the placebo group would have been to give the drug or placebo to alternate patients

24. It would be possible to calculate the value of χ (Chi-squared) on the data given With regard to hysterectomy

25. One in ten women in the UK will have a hysterectomy before becoming menopausal

26. Vaginal hysterectomy is performed four times more rarely than abdominal 27. Overall mortality is 4.1-14.6/10 000 hysterectomies 28. Overall morbidity is 500-1000/10 000 hysterectomies 29. Vault prolapse is a common complication of vaginal hysterectomy and can

be prevented by suturing the utero-sacral ligaments together 30. 30-40% of ovaries can be removed vaginally if desired 31. Vaginal hysterectomy is associated with an overall complication rate 40-

50% less than for abdominal hysterectomy The following drugs administered in pregnancy may have adverse effects on the newborn

32. Betablockers 33. Barbiturates 34. Magnesium sulphate 35. Naloxone hydrochloride

In the UK the following incidences are correct 36. Toxoplasmosis 2/1000 37. Down’s syndrome 1.3/1000

38. The following are not advantages of magnetic resonance imaging (MRI) in investigating cervical tumours

39. It is safe 40. It can be used in pregnancy 41. MRI demonstrates depth of stromal invasion (in up to 90% of cases) 42. It may show total tumour volume 43. MRI is superior to clinical staging and CT images

Ovarian cysts are relative contraindications to the use of 44. The combined pill 45. Depo-provera 46. Norplant

Prostaglandins 47. Are polypeptides 48. Hypertonus cannot be reversed by beta-mimetics 49. PGF2α is 20 times more potent than PGE2 in causing uterine contractions 50. PGE2 is five times more potent than PGF2α in ripening the cervix 51. PGF2α is commonly used in induction of labour 52. PGE2 is the drug of choice in refractory post-partum haemorrhage at

Caesarean section 53. Are diuretics

Regarding the progesterone only pill (POP) 54. 60% of women using it will ovulate 55. Ideally it should be taken just before bedtime 56. The Pearl Index is higher in the older reproductive age group 57. It is associated with a higher risk of an ectopic pregnancy than for a non-

user 58. It is at least as effective as the combined contraceptive pill 59. Amenorrhoea/oligomenorrhoea occurs in 10-20% 60. It is contraindicated in lactating mothers with benign breast disease 61. It is not contraindicated in latent diabetes mellitus 62. It contains norethisterone and is taken from day 5 of the menstrual cycle for

21 days followed by a 7-day break 63. It should always be taken within+/ — 3 hours of the usual taking time to

achieve reliable contraceptive efficacy 64. Liver enzyme inducers reduce its efficacy

The following conditions may deteriorate during pregnancy 65. Sarcoidosis 66. Systemic lupus erythematosus (SLE) 67. Coeliac disease 68. von Willebrand’s disease

69. Crohn’s disease Psychiatric disorders of childbirth

70. Postnatal mental disorder is less likely to be a serious illness than one not associated with childbirth

71. Being single, ambivalent about the pregnancy and undergoing antenatal hospital admissions are all risk factors for postnatal depression

72. For a well woman with a family history of a serious affective disorder, the risk of postnatal depression is higher than that for a woman with a history of postnatal depression

73. Among women with puerperal affective disorder, two-thirds have the manic form

74. Treatment with steroids is highly effective 75. Maternity blues affect up to 30% of all newly confined women

In a 26-year-old woman the serum follicle-stimulating hormone (FSH) concentration may be raised in association with

76. Acromegaly 77. Polycystic ovarian disease 78. Hydatidiform mole 79. Ovarian agenesis 80. Sheehan’s syndrome 81. GnRH administration

The following diseases are inherited as autosomal recessive traits 82. Congenital spherocytosis 83. Myotonic dystrophy 84. Nephrogenic diabetes insipidus 85. Congenital heart disease 86. Alkaptonuria

Following a hip fracture, bone densitometry in a 60-year-old woman who is 10 years post menopausal reveals osteoporosis of the spine and both hips

87. Her bone density will not be improved by prescribing her oestrogen containing HRT

88. If given oestrogens, these will act uniformly at both sites to improve her osteoporosis

89. Sodium etidronate will reduce the risk of further fractures Management of abnormal smears

90. A third of woman with a single smear showing mild dyskaryosis have CIN 3

91. The risk of invasive malignancy remains equal to that of normal population in women who have undergone excisional treatment for CIN 3

92. Following a hysterectomy treatment of CIN 3 annual smears are required for the next 5 years if the CIN was completely removed Lichen sclerosus

93. Manifests itself with pruritus 94. Histological features include atrophic thinning of the epidermis and loss of

rete ridges 95. Is a premalignant condition characterized by cellular atypia 96. Is a condition specific to vulval skin 97. Surgery is the main treatment modality in modern management 98. Progression to invasive carcinoma of the vulva is more likely to occur if

lichen sclerosus is associated with squamous cell hyperplasia Endometrial cancer

99. Constitutes 25-30% of all gynaecological malignancies 100. The commonest type is adenosqamous 101. Pelvic nodes are involved in 5% of poorly differentiated cases 102. Adenosquamous carcinoma has a better prognosis than adenocarcinoma 103. Has a greater tendency to metastasize if it involves the lower uterus rather

than the fundus Regarding syphilis

104. This is the commonest cause of painless genital ulcers 105. Syphilis can be transferred to the fetus transplacentally in early pregnancy 106. VDRL detects antibodies to treponemal cardiolipin antigen 107. VDRL is a highly specific test for the diagnosis of syphilis 108. A positive VDRL could be a manifestation of SLE 109. Fluorescent treponemal antibody (FTA) test has specificity similar to VDRL 110. Dark ground microscopy for the diagnosis of syphilis has been abandoned 111. Neonatal syphilis syndrome occurs due to transmission of the infection to

the fetus after 5 months’ gestation 112. The patient should be regarded as being infectious for up to 2 years 113. Primary syphilis is associated with a generalized rash 114. Syphilis may cause Horner’s syndrome

Trigger events that could initiate a risk management protocol include 115. Birth of a baby with a structural abnormality 116. Admission to SCBU 117. Failed trial of instrumental delivery 118. Failed termination of pregnancy 119. Peritonitis after laparoscopy 120. Failed instrumental delivery

Termination of pregnancy 121. Is associated with an increased risk of recurrent miscarriage

122. Sarcoma botryoides

123. Is a tumour of teenage years 124. Occurs in association with in utero exposure to synthetic oestrogens 125. The treatment of choice is combination chemotherapy

Premenstrual syndrome 126. Is a rare condition 127. Is diagnosed by retrospective symptom charts 128. Hormonal imbalance is a proven underlying cause

Syntocinon augmentation of labour 129. May cause or aggravate neonatal jaundice 130. Is more often required in multiparous women 131. May have to be reduced as labour progresses

Factors predisposing to genuine stress incontinence (GSI) include 132. Multiple Caesarean deliveries 133. Chronic constipation 134. Chronic bronchitis 135. Oestrogen deficiency 136. Gross obesity

In treating preterm labour with ritodrine, certain caution should be taken with

137. Adrenergic stimulants 138. Tricyclic antidepressants 139. Thiazide diuretics 140. Twins 141. Aortic stenosis 142. Transverse lie

Endometrial cystic glandular hyperplasia 143. Occurs with ovulatory failure 144. May predispose to endometrial carcinoma 145. Is associated with low oestrogen levels 146. Is transmitted by a virus in cheese 147. Generally occurs post-menopausally

Thyrotoxicosis in pregnancy 148. Subtotal thyroidectomy is ‘safe’ during the first trimester 149. Propyl-thiouracil should be stopped 6 weeks prior to delivery 150. Over-treatment with carbimazole may cause fetal goitre 151. Measurement of T4 is helpful in monitoring the disease process 152. The disease deteriorates in pregnancy

153. Mild disease may not be from normal changes of pregnancy in mid-trimester

154. An anti-thyroid drug and thyroxine is the optimum treatment 155. Propranolol should be added from 36 weeks onwards

Group B streptococcal infections 156. Is the commonest cause of non-iatrogenic bacterial sepsis 157. 20-25% of women are carriers 158. Mortality rates are 20% in affected neonates 159. Infections can be eliminated by screening all women at 28 weeks 160. Risk factors include preterm labour, ruptured membranes of greater than 18

hours and intra-partum fever. There is a recognized association between gynaecomastia and

161. Carcinoma of the stomach 162. Normal puberty 163. Hyperprolactinaemia 164. Carcinoid tumour 165. Cirrhosis of the liver 166. Klinefelter’s syndrome 167. 5-alpha reductase deficiency 168. Spironolactone 169. Phaeochromocytoma

Asymptomatic bacteriuria 170. Is found in 2% of pregnant women 171. Is associated with an increase in perinatal mortality 172. Predisposes to acute pyelonephritis 173. Is defined as a bacterial count of greater than 10000 organisms/ml 174. Should be checked for at each antenatal visit 175. Predisposes to glomerulonephritis 176. Predisposes to hypertension 177. Requires an IVP after pregnancy 178. Causes anaemia 179. Causes neonatal death 180. Causes preterm labour

Eclampsia 181. Less than 10% of cases occur during the post-partum period 182. Has a poorer prognosis if it occurs ante-partum than during the intra-

partum period 183. Hydralazine treatment is contraindicated with chlormethiazole 184. Cerebral haemorrhage is the commonest cause of death 185. Diuresis is a prodromal symptom prior to a fit 186. Peripheral oedema is common 187. The circulating blood volume is increased

188. 189. Oxprenolol 160 mg per day would be the best antihypertensive therapy 190. Delivery is contraindicated before 28 weeks gestation 191. Renal failure is the commonest cause of death

GnRH agonists are used effectively in the treatment of 192. Leiomyosarcomas 193. Premenstrual tension 194. Adenomyosis 195. Menstrual migraines 196. Hidradenitis suppurativa 197. Precocious puberty

Maternal cardiovascular system (CVS) in pregnancy 198. The majority of heart murmurs detected for the first time during pregnancy

are due to functional mitral regurgitation 199. Anticoagulants administered to patients with heart valve prostheses should

be withdrawn at 36 weeks gestation 200. In patients with uncorrected chronic rheumatic valvular heart disease,

crystalline penicillin alone provides adequate prophylaxis at the time of delivery

201. Supraventricular arrhythmias occur with greater frequency than in a nonpregnant woman

202. Frusemide is contraindicated for the treatment of heart failure The following are true when comparing modern obstetric practices regarding instrumental deliveries

203. Forceps can be used if the cervix is not fully dilated, a ventouse cannot 204. Forceps are associated with a twofold increase in trauma to the birth canal,

but a twofold decrease in cephalohaematomas when compared to a ventouse

205. Forceps double the risk of anal sphincter damage and bowel symptoms compared to ventouse Vaginal pH

206. During reproductive life it is lowest during menstruation 207. Rises post-menopausally 208. Declines from birth through the first years of life 209. Low vaginal pH is caused by cervical secretions 210. High pH predisposes to vaginal infections 211. Atrophic vaginitis is associated with a high pH 212. Oestrogen replacement therapy increases vaginal pH

Predisposing factors to face presentation include 213. Iniencephaly 214. Multiple pregnancy

215. Placenta praevia 216. Increasing maternal age 217. Multiparity 218. Prematurity 219. Polyhydramnios 220. Bicornuate uterus

The following are not associated with hirsutism 221. Anorexia nervosa 222. Hyperthecosis of the ovary 223. Testicular feminization 224. Acromegaly 225. Juvenile hypothyroidism 226. Hilar cell tumour

Ovarian tumours may be associated with 227. Peutz-Jegher syndrome 228. Gorlin’s syndrome 229. Gonadal dysgenesis 230. Kallman’s syndrome

In massive obstetric haemorrhage 231. Platelets should be given early 232. Fresh frozen plasma should be given early 233. Colloids are preferable to crystalloids 234. 10% calcium chloride should be given routinely

Progestogens, when given with oestrogens to post-menopausal women 235. Decrease LDL cholesterol 236. Cause endometrial hyperplasia 237. Protect the patient from developing breast cancer 238. May cause depression 239. Act as insulin antagonists 240. Protect against bone loss

Deep venous thrombosis (DVT) and pregnancy 241. 80% of DVTs occur in the right leg 242. Clinical examination misses 50% 243. Treatment should be commenced on clinical grounds if the confirmatory

tests are not immediately available 244. The risk of pulmonary embolism in patients with DVT is 2-5% 245. Occurs primary to pulmonary embolism

Recognized features of Turner’s syndrome include 246. Recurrent miscarriage 247. Elevated serum gonadotrophin levels 248. Renal abnormalities

249. Coarctation of the aorta 250. Red-green colour blindness 251. Chromatin positive buccal cells 252. Anosmia 253. Bone age appropriate for age

The menstrual cycle 254. New endometrial growth begins during menstruation 255. In irregular cycles the luteal phase is always constant (14 days) whereas

the follicular phase alters 256. Ovulation coincides with the LH peak 257. A normal day 21 progesterone is a direct indicator of ovulation 258. Menstruation occurs following oestrogen withdrawal 259. The average size of a follicle at the time of ovulation is 23 mm 260. GnRH pulses increase in frequency and amplitude throughout the follicular

phase 261. Thecal cells of the ovarian stroma exclusively secrete androstenedione

Intrauterine contraceptive devices (IUCD) 262. All types are contraindications to MRI scan 263. Increase the risk of preterm delivery 264. Induces a foreign body reaction in the endometrium which interferes with

blastocyst implantation 265. If inserted into the uterus after the age of 40 can be left in situ indefinitely 266. Are recommended for renal transplant receipients 267. The risk of ascending infection into the uterine cavity is the highest during

the first 2-3 weeks after insertion 268. Contraceptive efficacy of copper devices is proportional to the weight of

the copper loaded on the device 269. Protects from ectopic pregnancies as effectively as from intrauterine

pregnancies 270. Most modern IUCDS are effective for 5 years after insertion 271. The commonest reasons for removal are bleeding and pain

In rupture of the uterus, the following may occur 272. Hypotension 273. Increased uterine contractions 274. Haematuria 275. Vaginal bleeding 276. Fetal distress

Causes of pruritus ani include 277. Anal fissure 278. Diverticulitis coli 279. Rectal prolapse 280. Ascaris lumbricoides infestation

281. Perianal condylomata SLE in pregnancy

282. There is a high risk of puerperal exacerbation 283. Increases the risk of spontaneous miscarriage 284. Is associated with symptoms similar to pre-eclampsia 285. Should never be treated with azathioprine 286. The presence of lupus anticoagulant decreases the risk of thrombosis

The following conditions can be detected by ultrasound scanning of the fetus

287. Duodenal atresia 288. Syndactyly 289. Hydrops fetalis 290. Fetal polycystic kidneys 291. Congenital heart block

Regarding puberty 292. Puberty is associated with nocturnal pulses of LH occurring during REM

sleep 293. Peak height velocity appears after menarche 294. Puberty occurs at the average age of 11 in the UK

Regarding dural tap 295. The incidence is 1-2% 296. The incidence is operator-dependant 297. It has neurological implications 298. Post-dural puncture headaches commonly occur immediately with the

puncture 299. It may be followed by headache in 70% of cases 300. A blood patch takes effect within 2-3 days