chapter
PAPER FIVE
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Methotrexate in the treatment of ectopic pregnancy 19. Is contraindicated if a fetal heart beat is seen outside the uterine cavity 20. Is accompanied by an immediate fall in serum beta HCG levels 21. Is successful in > 90% of selected cases

Anaemia in pregnancy 22. Iron requirements are at their highest level in the late third trimester 23. Vitamin B12 deficiency is the commonest cause of megaloblastic anaemia 24. The overall incidence of megaloblastic anaemia in the UK is 5%

VIN 25. Presents with vulval itching 26. VIN associated cancers are commoner in young women 27. VIN has a malignant potential similar to CIN 28. The risk of progression of VIN to invasive cancer is greater in older

women TENS

29. Electrodes should be placed over the posterior rami of Tl0-Ll and S2-4 30. Works by stimulating large sensory fibres

Breech presentation 31. The incidence at 32 weeks gestation is 16% 32. The commonest type is the flexed breech 33. Is associated with handicap rates of 20% regardless of mode of delivery 34. Fetal weight estimation via ultrasound scan in late third trimester is more

useful than X-ray pelvimetry in deciding the mode of delivery

35. Undiagnosed breech is associated with increased perinatal mortality and morbidity

36. Up to a third of all breech presentations could first be diagnosed in labour Vulval cancer and pregnancy

37. Radical surgery for vulval cancer in pregnancy is contraindicated, especially because of the increased risk of abortion from the general anaesthetic

38. Vaginal delivery is contraindicated if vulval cancer is diagnosed in pregnancy Dyspareunia can be associated with

39. Hydrosalpinx 40. Bechet’s syndrome 41. Appendicitis

Delivery in women with cardiac disease 42. Elective forceps delivery is the preferred mode of delivery for woman with

cardiac disease 43. Ergometrine should not be used for the routine prophylaxis of post-partum

haemorrhage but can be used in the treatment of primary post-partum haemorrhage

44. Syntocinon is the drug of choice for the management of primary postpartum haemorrhage

45. 80 mg provide adequate prophylaxis against endocarditis in labour Risk factors for developing cervical cancer include

46. Smoking 47. Late menopause 48. Early age of first intercourse 49. Precocious puberty 50. Low social class

Cephalo-pelvic disproportion (CPD) 51. Is associated with a high head at 37 weeks of pregnancy 52. Prolonged latent phase of labour and significant caput are the signs 53. Mild degree of fetal head moulding in labour is a sign of CPD 54. The diagnosis should never be made without trial of labour

Warfarin 55. Is teratogenic when given at 10-12 weeks of pregnancy 56. If a pregnancy occurs whilst a woman is on warfarin termination is advised 57. Microcephaly and optic nerve atrophy are known associations 58. Breastfeeding is contraindicated 59. Based on the INR, therapeutic ranges should always be between 2 and 2.5 60. Warfarin should be converted to heparin therapy late in the third trimester

where possible 61. If a woman on warfarin starts to labour 10 mg of vitamin K IM will reverse

the hypocoagulation effectively 62. If a woman on warfarin starts to labour Caesarean section is the preferred

mode of delivery With regard to Paget’s disease of vulva

63. The incidence of underlying adenocarcinoma is 5% 64. Adenocarcinoma in association with Paget’s disease occurs only locally in

the lower genital tract 65. If Paget’s disease involves the perianal area the risk of rectal cancer is 10% 66. Paget’s disease is a squamous intraepithelial neoplasia

Neonatal risks in a diabetic pregnancy are 67. Hyperglycaemia 68. Anaemia 69. Hyperbillirubinaemia 70. Birth trauma 71. Hypermagnesaemia 72. Hypocalcaemia 73. Increased risk of developing diabetes in late life

74. Eight weeks after delivery about 40% of women still experience at least one health problem

75. The incidence of post-partum anaemia is 25-30% 76. Prophylactic antibiotics at Caesarean section reduce the risk of puerperal

febrile morbidity by a third and serious post-partum infection by 25% 77. Perineal pain persists for more than 2 months after delivery in 30% of

women 78. Megapulse and ultrasound post-partum significantly improve perineal pain 79. Mefenamic acid is more effective than paracetamol in relieving post-

partum perineal pain The incidence of vulvo-vaginal candidiasis is increased

80. In pregnancy 81. In HIV positive patients 82. In women with oestrogen implants 83. In renal transplant patients 84. By injection of depo-medroxyprogesterone acetate 85. By levonorgestrel implants 86. By use of the modern combined oral contraceptive pill 87. The incidence has increased over the last years

Amniocentesis 88. Prevents polyhydramnios 89. Down’s syndrome can be diagnosed by radioimmunoassay of amniotic

fluid 90. Positive Kleihauer test is a recognized complication

With regard to the management of recurrent miscarriage 91. Subcutaneous heparin with steroids should be used as a first line therapy

for the treatment of recurrent miscarriage associated with abnormal maternal blood clotting

92. GnRH analogues are highly effective in women with high basal LH level 93. HCG luteal phase support is an effective treatment in preventing

miscarriage Fetal hypoxia

94. When acute, leads to loss of fetal breathing movements, flexor tone and heart rate accelerations

95. When chronic manifests with oligohydramnios In the diagnosis of early pregnancy

96. Radio-immunoassays can detect beta HCG levels of 5 IU/1 97. Radio-immunoassays can detect beta HCG in serum 9 days after ovulation 98. Urinary beta HCG radio-immunoassays become positive before serum

ones

Problems in the puerperium

99. biochemical methods

100. Transvaginal scans allow for the earlier diagnosis of pregnancy than transabdominal scans

101. A beta HCG level of more than 5 IU/1 is diagnostic of pregnancy 102. Doubling serum beta HCG every 4 days is indicative of an intrauterine

pregnancy

Perioperative death 103. Is defined as a death under anaesthesia, during surgery and up to 42 days

after surgery Recognized indications for a GTT include

104. Single episode of glycosuria in early pregnancy 105. Family history of diabetes 106. Previous baby more than 4 kg 107. Polyhydramnios 108. Fetal macrosomia 109. When random blood glucose level exceeds 11 mmol/1

Regarding sterilization 110. The incidence of failure of female sterilization is 2-5/1000 111. 80-90% of failures of female sterilization are operator dependent 112. Male sterilization is a safer procedure than female sterilization 113. Laparoscopic sterilization has a higher success rate than sterilization at

Caesarean section 114. Quinacrine pellets have been used effectively

The following postoperative complications match 115. DVT Day 2-3 116. Paralytic ileus Day 7-10 117. Atelectasis Day 3-4 118. Wound dehiscence Day 3-4 119. Secondary haemorrhage Day 3-5

Haemoglobinopathies 120. Alpha-thalassaemia major deteriorates during pregnancy 121. HbH occurs when 2 alpha globin genes are absent, and is associated with

severe anaemia 122. Haemoglobin Barts occurs when 3 alpha chain genes are absent 123. Haemoglobin electrophoresis in a patient affected with beta-thalassaemia

major shows absence of haemoglobin A2 Mifepristone

124. Is a better tolerated and more effective post-coital contraceptive agent when compared to the Yuzpe regime

125. Can be used effectively in the conservative treatment of molar pregnancies

126. 127. Has a 3-5 times greater affinity for the progesterone receptor than

progesterone itself 128. Has anti-glucocorticoid effects

Match the contraceptives with the correct contraindications 129. OCP Dubin-Johnson syndrome 130. POP Recent trophoblastic disease 131. LNG-IUD Wilson’s disease 132. OCP Vincent’s angina

Polyhydramnios 133. Is diagnosed if the liquor volume at term is greater than 1000 ml 134. Is associated with an increased intrauterine pressure in over 60% of cases 135. Is associated with an increased incidence of leg oedema 136. Is associated with poorly controlled diabetes 137. Is found more often with dizygotic than monozygotic twins

Regarding cervical cytological screening 138. The Jordan spatula allows better sampling of the endocervical canal than

the Ayres spatula 139. After a cone biopsy a cytobrush is preferred to an Ayres spatula for

cytological follow up 140. If the squamo-columnar junction is invisible cytological screening loses its

value and should be abandoned 141. Residual VAIN on the vault after hysterectomy can be adequately

monitored with vault smears 142. In post-menopausal women an Ayres spatula is the best way to sample the

cervix

Drugs contraindicated whilst breastfeeding include 143. Rifampicin 144. Nalidixic acid 145. Fluoxetine 146. Senna

Leukoplakia 147. Is an irregular thickening and whitening of the vulval skin that is seen in

several pathological conditions The following maternal diseases can affect the neonate

148. Idiopathic thombocytopenic purpura 149. Chickenpox 150. Herpes simplex 151. Syphilis 152. Hyperthyroidism

153. Presence of cervical stromal invasion is stage IIb 154. Positive peritoneal cytology is characteristic for stage IIIa 155. A tumour invading bladder and bowel mucosa is stage IVa

The incidence of endometrial cancer 156. It is the third commonest cancer in women in the UK 157. Has been declining over the last decade 158. Is higher in the developing countries

Gonorrhoea 159. Gonococci are Gram-negative diplococci specifically affecting genital tract

epithelium 160. Transmission of the organism occurs more readily from women to men

than vice versa 161. The gonococcus is fastidious requiring carbon dioxide for its growth 162. Is adequately isolated with a high vaginal swab 163. Is associated with arthritis in 1% of cases 164. Late stage disease may present with collapse from a ruptured aortic

aneurysm Confidential Enquiry into Stillbirths and Deaths in Infancy

165. Sub-optimal care caused 78% of the intrapartum related deaths 166. Is an attempt to identify ways in which late fetal losses, stillbirths and

deaths in infancy might be prevented 167. The fourth biannual report was released in 1997 168. Intrapartum mortality rates have decreased steadily over the last years

In hepatitis B infection 169. HBe Ag is a marker of low infectivity 170. HBe Ab is a marker of low infectivity 171. HBc IgG is a medium term marker of previous exposure to HBV 172. HBc IgM is an indicator of acute infection

In the diagnosis of bacterial vaginosis 173. Clue cells are bacterial 174. Vaginal pH is >3.5 175. A positive amine test is demonstrated by the presence of a fishy smell

when adding 10% HCl to a slide containing the vaginal discharge With regard to urodynamics

176. The normal peak flow rate is at least 15 ml/s for a voided volume of at least 150 ml

177. Reduced maximum urine flow rate (< 15 ml/s) indicates outflow obstruction

178. A low compliant bladder is diagnosed by a detrusor pressure of at least 10 cm H2O for a filled volume of 500 ml

179. 2O Miscarriage and termination of pregnancy

180. WHO defines an abortion as the expulsion or extraction from its mother of a fetus or an embryo weighing 500 g or less

181. In UK law spontaneous abortion is defined as pregnancy loss before 24 weeks gestation

182. The upper limit for social termination of pregnancy is 24 weeks Misoprostol

183. Is prostaglandin E2 184. Is more expensive than gemeprost 185. Oral administration requires a much higher dose than vaginal

administration 186. 800 mg is the minimal effective dose for medical termination of pregnancy

Chorionic villus sampling (CVS) 187. Is safe before 8 weeks, with a fetal loss rate of 3-4% 188. Can be used to diagnose neural tube defects earlier than amniocentesis 189. If the procedure fails, later amniocentesis is contraindicated 190. Sampling is best achieved by taking 10-20 mg of villi from the chorion

laeve 191. Results are quicker than amniocentesis and as reliable

Regarding treatment of pruritus vulvae 192. Topical application of oestrogen cream is a universally effective treatment

method 193. Topical testosterone cream is an effective therapy 194. Betnovate is a more potent steroid than dermovate

Congenital dislocation of the hip (CDH) 195. Is more common in females than males 196. Is associated with breech presentation at term 197. Is bilateral in more than 50% of cases 198. Is associated with amniocentesis 199. Is associated with polyhydramnios 200. Its incidence is influenced by the method of breech delivery

Radiotherapy 201. lonizing radiation affects the genetic material of the cell 202. Cells with high mitotic rate are preferentially killed 203. Hypoxic cells have higher radiosensitivity 204. Is a treatment of choice for stage III vaginal cancer 205. Is a first line treatment for recurrent gynaecological cancer 206. Can be used to relieve lymphatic obstruction of the lower limb in advanced

gynaecological cancer

207. cervix

The following drugs administered during pregnancy are correctly paired

208. L-Thyroxine Neonatal thyrotoxicosis 209. α-Methyldopa Fetal tachycardia 210. Chlorothiazide Maternal pancreatitis 211. Glibenclamide Neonatal hyperglycaemia 212. Phenytoin sodium Maternal anaemia secondary to B12 deficiency

Clear cell adenocarcinoma of the vagina agina 213. Is a childhood tumour of infants who have been exposed to

diethylstilboestrol in utero 214. Chemotherapy is the treatment of choice

Ergometrine 215. Like oxytocin, causes contraction of the myoepithelial cells in the maternal

breasts 216. Its onset of action is 45 seconds after intravenous injection

Bartholin’s carcinomas 217. 25% of Bartholin’s carcinomas present as an abscess

Rubella is linked to 218. Neonatal anaemia 219. Spontaneous abortion 220. Neonatal purpura 221. Congenital deafness

Surgical management of urinary incontinence 222. Marshall-Marchetti-Kranz procedure is associated with periosteitis pubis

in 1 % 223. Porcine dermis could be used for Stamey procedure for GSI 224. The needle suspension of the bladder neck is associated with a 15%

incidence of voiding difficulties and de novo detrusor instability 225. If treatment of urinary incontinence with periurethral injections of collagen

fails other surgical procedures are necessary

Extremcly premature infants 226. Are at high risk for sudden infant death at home 227. Have a 10% risk of bilateral blindness 228. Have a 1% risk of severe sensorineural deafness 229. Have an almost 1% risk of major sensorineural impairment 230. Are at risk of later hospital admissions for medical and surgical indications

231. Is no longer required since the introduction of intracytoplasmic sperm injection (ICSI)

232. Decreased success rates occur with frozen as opposed to fresh samples 233. All donors are screened once for HIV 234. Is regulated by HFEA 235. Any donor is limited to the number of families they can create

Meconium aspiration 236. Is always associated with low Apgar score at 5 minutes 237. Is common in post-term pregnancies

Primary amenorrhoea is characteristically associated with 238. Down’s syndrome 239. Kallman’s syndrome 240. Turner’s syndrome 241. Testicular feminization syndrome 242. XXX karyotype 243. Edward’s syndrome

Post-coital bleeding can be caused by 244. CIN3 245. IUCD

Recognized complications of eclampsia include 246. Cerebral haemorrhage 247. Hypothermia 248. Renal cortical necrosis

The following are not associated with an increase in the risk of acquiring PID

249. Early commencement of sexual relations 250. Frequent intercourse 251. Pelvic surgery 252. Recurrent candidal infections 253. IUCD in a stable relationship

Face presentation 254. Incidence is 1 in 200 deliveries 255. First stage is prolonged 256. There is an increased chance of a cord prolapse 257. Presenting diameter is submento-vertical 258. At term mento-posterior position can safely be delivered vaginally 259. Vacuum extraction is safe when performed by a skilled person under

epidural analgesia After the menopause the following may occur

260. Reduction in vaginal acidity

Donor insemination

261. Loss of libido 262. Memory loss 263. Gonadotrophin secretion falls 264. Osteoblastic activity increases

The following mortalities match 265. Perinatal Stillbirths and live births up to 14 days per 1000 live births 266. Post-neonatal Deaths after 28 days of birth to 1 year 267. Neonatal Deaths within 7 days of birth

Treatment of the premenstrual syndrome 268. Patient response to placebo is around 90% 269. Pyridoxine and oil of evening primrose are highly effective in treatment of

mild cases 270. Levonorgestrel-loaded IUD can be successfully used in conjunction with

hormonal therapy in women refusing a hysterectomy 271. Combined surgical and hormonal therapy may be successful in

management of severe cases 272. Diuretics have been proven to be effective

Epilepsy in pregnancy 273. Multiple anticonvulsant therapy is preferred as it has a better prophylactic

effect in reducing the risk of convulsions 274. Anticonvulsants can be discontinued before pregnancy if a woman has

been symptom-free for 2 years 275. A woman on anticonvulsants planning a pregnancy should be started on

low dose folate 3 months before discontinuing contraception in order to reduce the risk of neural tube defects

276. Epileptic women in pregnancy should be treated with carbamazepine 277. Anticonvulsants in late pregnancy are known to be associated with Vitamin

K deficiency in the neonate 278. Anticonvulsant levels are better monitored in saliva 279. A woman requiring anticonvulsants in pregnancy can be reassured that the

fetal abnormalities liable to occur due to these medications can be diagnosed by ultrasound and the pregnancy terminated if necessary

280. Anticonvulsant therapy reduces the risk of intrauterine fetal death 281. The low dose combined oral contraceptive pill is the contraceptive of

choice for a woman on anticonvulsants Post-partum period and diabetes

282. A diabetic woman should be discouraged from breastfeeding 283. The contraceptive of choice is the combined oral contraceptive pill 284. IUCD should not be used

Bacteroides infection is associated with 285. Endotoxic shock

286. 287. Disseminated intravascular coagulation 288. Leucopenia 289. Renal tubular or cortical necrosis 290. Puerperal sepsis 291. B. fragilis colonization of the vagina

In pregnancy 292. To reduce the maternal mortality from road traffic accidents, three point

harness seat belts are recommended 293. Most drugs are safer for use in the second trimester of pregnancy than in

the first, because increasing placental maturation provides more effective protection for the fetus from the effects of therapeutic levels of the drugs

294. Visual display units are associated with increased risk of miscarriage 295. Vertical transmission of hepatitis C is less likely to occur than B, but it can

affect the fetus

Match 296. BRAC 1 1 Chromosome 17 297. Cystic hygroma Chromosome 21 298. Choroid plexus cysts Chromosome 18 299. Holoprosencephaly Chromosome 13

UTIs 300. E. coli is cultured in mid-stream urine specimens in 80% of women with

urinary tract infection