chapter
PAPER THREE
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Match the following pills with their correct constituents

21. Marvelon 30 (µg ethinyloestradiol 150 μg desogestrel 22. Microgynon 30 μg ethinyloestradiol 150 μg levonorgestrel 23. Neogest 30 [μg ethinyloestradiol 250 μg levonorgestrel 24. Femodene 30 μg ethinyloestradiol 150 μg gestodene

Primary pruritus vulvae 25. Is commonly associated with perineal and anal itch 26. Is commonly caused by vaginal discharge 27. Improves at night 28. Vulval skin biopsy is mandatory for diagnosis 29. Psychological sequel are possible 30. Is commoner in young women

The Confidential Enquiries into Maternal Deaths in the United Kingdom (1991-93) reported that

31. The mortality rate following Caesarean section was 1/1000 operations 32. Avoidable factors were present in over 75% of anaesthetic deaths 33. The use of antacids regularly during labour protects against Mendelson’s

syndrome 34. More women died from post-partum haemorrhage than antepartum

haemorrhage 35. 50% of deaths from amniotic fluid embolism occurred before the onset of

labour The risk of an endometrial cancer

36. In nulliparous women is twice that of a women with one child 37. Is raised in women on tamoxifen 38. Is increased in women with an early menarche 39. Is increased in women with a late menopause 40. Is decreased in women with diabetes mellitus 41. Is reduced by cigarette smoking 42. Is reduced by repeat prolonged lactation 43. Is increased in users of continuous combined HRT

HIV infection 44. In the UK 200 babies are born each year to women infected with HIV 45. About 20% of babies born to women infected with HIV are themselves

infected 46. Over half of HIV infected women in London are known to their

obstetricians at the time of delivery 47. Breastfeeding doubles the risk of HIV transmission in HIV infected

women 48. There is evidence that Caesarean delivery reduces the risk of the vertical

transmission of HIV

49. 50. Over 70% of HIV positive adults are thought to be women

Colposuspension 51. Burch colposuspension for GSI has success rates up to 90% in the short-

term 52. Is a first line management for a woman with predominantly stress

symptoms 53. Has lower complication rates than vaginal operations 54. Can lead to detrusor instability 55. Can lead to worsening detrusor instability 56. Is associated with a 20% incidence of urinary retention postoperatively 57. Should be performed using a supra pubic catheter in order to keep the

bladder empty during the operation 58. Is associated with increased risk of rectocoele postoperatively 59. May cause the occurrence of a cystocoele

Chorioamnionitis 60. Anaerobic infection is characteristic 61. Cannot occur in the presence of intact membranes 62. Should be immediately delivered by Caesarean section

Thyrotoxicosis in pregnancy and the neonate 63. Propyl-thiouracil is safe during breast feeding 64. Neonatal thyrotoxicosis does not occur if the mother is euthyroid 65. Neonatal thyrotoxicosis is normally apparent within 24 hours of birth 66. Neonatal thyrotoxicosis is reversible

Vaginal carcinomas 67. Are most commonly secondary tumours 68. Constitute less than 0.1% of genital tract malignancies 69. The peak incidence is in the fourth and fifth decades 70. The minority are squamous

In normal spontaneous labour 71. Artificial rupture of membranes shortens the length of first stage 72. 50% of women will rupture membranes spontaneously by 4 cm dilatation 73. Moulding of the fetal head implies cephalopelvic disproportion 74. Contraction strength is stronger in multiparous women 75. Cardiotocography has reduced intrapartum fetal loss 76. Endogenous oxytocin plays an early role

Painful bleeding from the anus is a recognized feature of 77. Prolapsed rectum 78. Anal fissure 79. Endometriosis coli 80. Perianal haematoma

81. Recto-vaginal fistula Regarding barrier methods of contraception

82. They reduce the risk of transmission of herpes simplex infection 83. Use of the diaphragm is associated with an increased risk of male urinary

tract infections 84. They reduce the risk of cross infection from the bacteria chlamydia 85. The advantages of latex barrier contraceptives over the polyurethane ones

is that the second is easily destroyed by oil-based lubricants 86. They reduce the risk of transmission of hepatitis A, B, HIV and Neisseria

infections during vaginal intercourse Jaundice appearing on the third day and still present at 2 weeks of age may be due to

87. Haemolytic disease of the newborn due to Rhesus incompatibility 88. Galactosaemia 89. Atresia of the bile duct 90. Phenylketonuria 91. Neonatal hyperthyroidism 92. Neonatal hypothyroidism 93. TORCH infection

Phaeochromocytoma in pregnancy 94. Characteristically presents under 20 years of age 95. May produce paroxysms of hypertension 96. May secrete dopamine 97. Causes a high output of 5-hydroxyindoleacetic acid in the urine 98. Is a recognized cause of impaired glucose tolerance

Regarding sexual function 99. Intact cognitive process is important for normal sexual function

100. Orgasm in the female partner is not necessary for fertilization to occur 101. 30% of women in their thirties are anorgasmic 102. Orgasmic dysfunction means sexual dysfunction 103. Intensive sexual counselling can improve sexual function in 90% of

women 104. The commonest type of female sexual dysfunction is vaginismus 105. Dyspareunia can lead to sexual dysfunction 106. Sexual function can be improved by using vaginal lubricating creams

Acute inversion of the uterus 107. Is associated with preterm delivery 108. Is a recognized consequence of genital prolapse 109. Is more common in twin than singleton pregnancies 110. Is a recognized complication of ergometrine administration

111. Occurs more commonly is sited in the fundus of the uterus

112. Is common after prolonged labour 113. Is treated by the hydrostatic method of O’Sullivan

Common causes of vaginal discharge in a prepubertal girl include 114. Ectopic ureter 115. Neisseria gonorrhoae 116. Enterobius vermicularis 117. Foreign body 118. Ovarian dysgerminoma 119. Candidiasis

Following PID there is an increased risk of 120. Hysterectomy 121. Ectopic pregnancy

Gestational trophoblastic tumours 122. Can occur following a normal delivery 123. Are always choriocarcinoma after a full-term pregnancy 124. May occur after an ectopic pregnancy 125. May also secrete oestrogens and progesterones 126. Secrete multiple forms of hCG 127. May present with persistent post-partum haemorrhage

Placental abruption 128. Is associated with a perinatal mortality rate of 9/1000 births 129. Has a recurrence rate of 16% 130. Is associated with cocaine use 131. When associated with premature labour should be treated with tocolytics 132. Can reliably be excluded by an ultrasound scan 133. If confirmed, expectant management is contraindicated 134. If large, is an indication for Caesarean section 135. Could lead to an increased level of D-dimers in blood 136. The amount of vaginal blood loss should be used as a guide for the

estimation of the degree of abruption The following are elevated in women with polycystic ovarian disease

137. Serum FSH 138. Serum TRH 139. Serum 17-hydroxyprogesterone 140. Serum oestradiol 141. Serum androstendione

Perinatal death 142. Congenital abnormalities account for 20% of all causes 143. Unexplained deaths in neonates over 2500 g account for 40% of cases

144. Hypovolaemic shock may be the first manifestation of concealed post-

operative bleeding 145. Postoperative internal bleeding may manifest with progressive anaemia 146. Pyrexia in the postoperative period may be a sign of an ileus 147. Pyrexia in the postoperative period may be a sign of haematoma 148. Pyrexia in the postoperative period may be associated with venous

thrombosis 149. Once a vaginal vault haematoma has occurred it should be drained

surgically The biophysical profile

150. The disadvantage of this test is that it only measures indices of chronic fetal hypoxia

151. The use of this test can reduce perinatal mortality by over 10 times in high risk pregnancies

152. Correlates closely with fetal umbilical cord blood pH 153. An amniotic fluid pocket depth of less than 8 cm late in the third trimester

indicates chronic fetal hypoxia 154. Perinatal mortality exceeds 80/1000 when BPP is less than four 155. Biophysical profile has a higher specificity than the non-stress test

Late complications of radiotherapy include 156. Leukopenia 157. Erythema 158. Bladder fibrosis 159. Vaginal stenosis

Radiological tests in pregnancy 160. Fetal weight estimations via ultrasound are more accurate when the fetal

weight is around 3500-4500 g 161. The radiation dose of CT pelvimetry is higher than with X-ray pelvimetry 162. The dose of radiation to which the women is exposed during a venogram is

higher than the dose of radiation at pelvimetry 163. Ventilation/perfusion scan exposes the patient to a higher dose of radiation

than X-ray pelvimetry Cervical cancer and pregnancy

164. Treatment should not be deferred as this worsens the prognosis 165. In early pregnancy cervical cancer is better treated by termination of

pregnancy and radical surgery or radiotherapy 166. Vaginal delivery promotes direct spread 167. If diagnosed in late pregnancy a Caesarean Wertheim’s hysterectomy

should be performed or Caesarean section should be followed by radiotherapy after achieving fetal maturity at 36 weeks

168. The commonest are papillary adenosarcomas 169. May be suggested clinically by a watery vaginal discharge 170. May be suggested hystologically on a cervical smear 171. Surgery is the optimum treatment 172. Adjuvant chemotherapy may have a role

Cardiac disease and maternal mortality 173. The mortality from myocardial infarction is higher in the puerperium

compared with early pregnancy 174. In the early 1990s substandard care was documented in the majority of

cases of death associated with cardiac disease 175. Mortality in women with Eisenmenger’s syndrome approximates 100%

when pregnancy is continued to term 176. In women with Eisenmenger’s syndrome termination of pregnancy does

not offer significant improvement in survival rates over continuation of pregnancy

177. Fallot’s tetralogy is associated with mortality rates of over 40%

The following associations are correct 178. Marcain Fetal distress 179. Heparin Two different types of thrombocytopenia 180. Syntocinon Hypertensive crisis 181. Syntometrine Cardiac arrest 182. Warfarin 5% risk of fetal chondrodysplasia 183. Chloramphenicol Neonatal haemolysis 184. Sulphonamides ‘Grey baby’ syndrome 185. Anticonvulsants Fetal neural tube defects 186. Nitrous oxide Megaloblastic anaemia 187. Metronidazole Oculogyric crisis

Minimal access surgery 188. Is a cost effective alternative to laparotomy 189. Requires less postoperative analgesia than vaginal surgery 190. If visceral damage occurs during laparoscopic surgery, laparotomy is

indicated 191. Laparoscopically assisted vaginal hysterectomy is associated with lower

intraoperative blood loss than open abdominal surgery Urge incontinence

192. This is an involuntary loss of urine preceded by a sudden strong desire to void

193. Symptoms of stress, urge, urgency and frequency are highly specific for urge incontinence

194. Pelvic floor exercises are an effective form of treatment

195. Detrusor instability can if cystometry shows an intravesical pressure rise > 15 cm H2O at filling or on provocation

196. Increased trabeculation of the bladder on cystoscopy could be a sign of detrusor instability Epidural analgesia

197. Is associated with long-term backache 198. Is relatively contraindicated within 12 hours of administration of low

molecular weight heparin 199. Previous Caesarean delivery is a contraindication 200. Cardiorespiratory collapse is a known complication 201. Mendelson’s syndrome is a known complication 202. Reduces pelvic floor muscle tone 203. Solely should be used for the treatment of hypertension in labour

Regarding complications of IUCDs 204. Absent threads suggest expulsion or perforation 205. Absent threads are an indication for hysteroscopy 206. The commonest reason for an intrauterine pregnancy is partial expulsion of

the coil 207. The incidence of expulsion is 1/1000 insertions 208. The incidence of PID in IUCD users after 20 days of insertion equals the

background incidence for the population Amniocentesis assists in the diagnosis of

209. Tay-Sach’s disease 210. Cystic fibrosis 211. Rhesus allo-immunization

Conditions associated with ulcerative vulval lesions include 212. Behcet’s syndrome 213. Ulcerative colitis 214. Herpes simplex 215. Chancroid

Forty patients participated in a randomized controlled trial of complete bed rest versus ambulation in the management of proteinuric hypertension in pregnancy. The measurement of urinary oestriol (mmol/l) in the two groups was as follows

Rested group Ambulatory group (n= 20) (n =20)

Mean 52.1 365.6 SD 270.3 197.1 Range 180-1200 115-860 t=2.08 Difference between means=155.7 p=0.022

Rested group Ambulatory groupThe following statements are true

216. The standard error of the mean for the ‘rested’ group was 270.3 217. Patients were allocated alternately to ‘ambulant’ and ‘rested’ groups 218. The observed differences did not occur by chance 219. The value ‘t’ refers to a test for the difference between the means 220. In the ambulant group 95% of the oestriol values were between 365.6 +/–

197.1

HRT is always contraindicated with 221. Recent history of breast cancer 222. Previous endometrial cancer 223. Previous DVT 224. Surgery 225. Diabetes mellitus

A single Barr body is found in association with 226. Klinefelter’s syndrome 227. Down’s syndrome male 228. Turner’s syndrome 229. Pituitary hypoplasia 230. Adrenogenital syndrome 231. Testicular feminization syndrome 232. Male with 21-hydroxylase deficiency 233. Superfemale

Which of the following gastrointestinal associations are true? 234. Diverticulitis Intestinal fistula 235. Ulcerative colitis Radiologically detected ‘skip lesions’ 236. Crohn’s disease Right sided hydronephrosis 237. Paralytic ileus Hypokalaemia 238. Prevention of colonic carcinoma HRT

Achondroplasia 239. Can be excluded by a normal femur length at 18 weeks scan 240. Is the most common lethal anomaly 241. Survivors are usually infertile 242. Inheritance is autosomal recessive 243. Causes mental retardation 244. Can be diagnosed by amniocentesis

The following are true associations 245. Abnormally high FSH level in the follicular phase of the menstrual cycle is

associated with an increased risk of spontaneous miscarriage

246. rent miscarriage

247. Women on immunosuppressive therapy have an increased incidence of spontaneous miscarriage

The following placentally transmitted infections that harm the fetus may be linked

248. Cheddar cheese Listeria monocytogenes 249. Sheep faeces Toxoplasma gondii 250. Oysters Hepatitis A 251. Milking cows Chlamydia psittaci

Magnesium sulphate 252. Causes respiratory depression before loss of deep tendon reflexes 253. Is proven to prevent eclamptic fits in pre-eclamptic women 254. Is excreted by the kidney, so doses must be reduced in women with

protinuric hypertension 255. May cause diplopia, slurred speech and feelings of warmth 256. Overdose is treated with calcium carbonate

The following features are found in idiopathic hirsutism 257. Increased FSH secretion 258. Decreased SHBG 259. Dexamethasone suppresses renal function 260. Idiopathic hirsutism may be treated successfully by the oral contraceptive

pill 261. Idiopathic hirsutism may be treated with the loop diuretic spironolactone 262. Plasma testosterone > 4 µmol /1

Rubella 263. Infection occurring early in the second trimester has a less than 1% risk of

neonatal rubella syndrome 264. Once diagnosed immediate treatment with immunoglobulin reduces the

risk of congenital malformation 265. The rubella haemagglutination inhibition test becomes positive within 4

days of the infection 266. Viraemia precedes the rash 267. Conjunctivitis is a characteristic feature

Hyperprolactinaemia 268. Carbergoline has fewer side effects than bromocriptine 269. Bromocriptine may cause renal failure 270. Surgery is advocated for pituitary tumours with frontal lobe extension

Regarding ovarian cysts 271. A 4 cm endometrioma can be successfully treated with GnRH analogues 272. They are present in 6% of asymptomatic women

273. 274. The risk of ovarian cysts being malignant in premenopausal women is

about 2% 275. Ovarian cysts can be confirmed to be benign if CA 125 levels are normal 276. Ovarian cysts often develop as luteinized unruptured follicles which occur

in about 10% of cycles in infertile couples Diagnostic amniocentesis at 16 weeks gestation is associated with an increased incidence of

277. Preterm labour 278. Talipes equinovarous

The umbilical cord 279. Contains nerves 280. Contains lymphatics 281. Vellamentous insertion is associated with congenital abnormality of the

fetus 282. Fetal abnormalities are found in 40% cases of single umbilical artery 283. Umbilical artery blood flow is a reliable predictor of fetal distress 284. During cordocentesis, the transplacental approach is usually preferred with

an anterior placenta 285. Chances of cord prolapse increase greatly if the length is more than 35 cm

A 25-year-old smoker at 32 weeks is found to have a growth-retarded baby on one scan. Which of the following may be associated with these findings?