ABSTRACT
A. vaginal candidiasis predisposes to oral infections of the neonate B. Gardnerella vaginalis is encouraged by an increase in the number
of doderleins bacilli in the vagina C. vaginal discharge due to Candida albicans is effectively treated by
metronidazole D. metronidazole is contraindicated in late pregnancy E. gonorrhoea causes bartholinitis
A. cause spontaneous abortion B. are a cause of antepartum haemorrhage C. cause watery vaginal discharge D. are covered by sqaumous epithelium E. cause intermenstrual bleeding
A. retention of urine may be due to an enterocoele B. urge incontinence associated with detrusor instability is improved
by pelvic floor exercises C. detrusor instability is associated with upper motor neurone
lesions D. if a woman presents with mainly stress incontinence,
urodynamics are not needed E. acute retention may be due to haematocolpos
A. may prevent complete emptying of the bladder B. is more common in women of African origin C. if second degree may be treated by a Hodge pessary D. is associated with a large uterus E. occurs only after the menopause
A. is associated with a double uterus B. is associated with multiple pregnancy C. is the commonest lie of the second twin D. can be found with an antepartum haemorrhage E. should be delivered by classical Caesarean section
A. substandard care was implicated in nearly 25% of deaths B. the main causes of direct maternal deaths were cerebral
hypertensive disorders and haemorrhage C. the number of maternal deaths due to haemorrhage had doubled
since the previous triennium D. deaths due to anaesthesia had decreased E. the direct obstetric mortality rate was higher in England than in
Northern Ireland
A. risk factors include opposed HRT B. it can be diagnosed by an endometrial biopsy C. common UK treatment is a radical hysterectomy followed by
external beam radiotherapy D. the incidence is lower in thin women as they have more
conversion of androgen precursors to oestrone E. can be preceded by cystic or adenomatous hyperplasia
A. it should not occur if the third stage of labour is managed appropriately
B. it should prompt suspicion of morbid adherence of the placenta C. if the placenta is attached it should be removed immediately D. it can be replaced by the hydrostatic method E. the uterus should not be replaced before anaesthesia (GA,
epidural or spinal) is administered
A. unilateral enlargement can be due to a hydrocoele of the canal of Gordon
B. pruritus vulvae can be caused by pox virus C. with atrophic dystrophies testosterone cream may be useful D. vulval carcinoma forms about 10% of all female genital tract
cancers E. vulval carcinoma may present with the symptoms of intractable
pruritus
A. she may have a tubal pregnancy B. if the urinary pregnancy test is negative an ectopic is excluded C. she may be miscarrying D. she may have inadequate luteal phase E. if she has dysfunctional uterine bleeding high-dose progestagens
should stop the bleeding
A. all normal term babies lose weight after delivery but regain their birthweight by 5 days
B. neonates with phenylketonuria should not be breastfed C. erythema toxicum has a high mortality D. jaundice occurring in the first 24 hours is most likely to be
physiological and is due to increased unconjugated bilirubin levels
E. excessive oxygen administration in the preterm infant can cause retinopathy
A. azoospermia may respond to steroid treatment B. in a semen sample 5 white blood cells (WBCs) per high-power
field is normal C. in a semen sample 40% of abnormal forms is acceptable D. low FSH and LH suggest testicular failure E. micromanipulation of the zona pellucida increases fertility rates
A. have a mortality rate of approximately 1 in 30,000 B. may be complicated by an H20 embolus C. commonly produce shoulder-tip pain postoperatively D. should always be preceded by emptying of the bladder E. can cause peritonitis
A. the incidence is higher in Indonesia than Australia B. the uterus may be smaller than the dates signify C. it may present with symptoms and signs of pre-eclampsia D. it must be followed up by the local hospital E. a subsequent pregnancy can stimulate a recurrence
A. the first priorities are to insert an IV line, then establish an airway, then ventilate
B. if she has had an amniotic fluid embolism she may develop disseminated intravascular coagulopathy (DIC)
C. she is having a massive postpartum haemorrhage so the most likely cause is a tear of the cervical artery
D. she has had a previous Caesarean section, but as she has just had a normal delivery, uterine rupture could not be a cause
E. a pulmonary embolus is unlikely as she has had a normal delivery
A. Turner’s syndrome B. testicular feminization (androgen insensitivity) C. cryptorchidism D. adrenogenital syndrome E. Klinefelter’s syndrome
A. the blood urea level falls to 3.0 mmol/L or less B. there is a decrease in mucoid discharge from the cervix C. respiratory tidal volume falls D. there is an increase in cardiac output by 8 weeks gestation E. fasting blood glucose levels in the first trimester are greater than
in the non-pregnant state
A. the creatinine clearance rate is higher than in normal pregnancy B. there are defects of the development of the placental bed in the
second trimester C. there is an increased incidence of placental abruption D. the intravascular compartment is increased E. plasma urea levels are raised
A. anti-D should be given if antibodies are detected in early pregnancy
B. it may be caused by genetic amniocentesis C. rhesus disease is routinely prevented by giving anti-D
gammaglobulin in the first trimester of pregnancy D. is not present if the Kleihauer test is negative E. is more likely to occur in a rhesus-negative mother with an
ABO-incompatible fetus
A. it becomes fixed in the pelvic brim B. the leading part is 1 cm above the ischial spines C. the biparietal diameter has passed through the pelvic brim D. one fifth of the fetal head is palpable abdominally E. the caput succedaneum reaches the level of the ischial spines
A. accompanied by a surge of follicle-stimulating hormone B. characteristically followed by the development of secretory
endometrium C. followed by increased ferning of the cervical mucus D. associated with a sustained rise in basal body temperature E. occurs 14 days before the next menstrual period
A. with a history of thromboembolic disease oral therapy is preferable to transdermal
B. premarin 0.625 mg is adequate for prevention of bone loss C. cystic hyperplasia must be treated by Wertheims hysterectomy D. an endometrial thickness of 3 mm suggests hyperplasia E. oestrogen replacement therapy will decrease HDL levels
A. delay in the second stage is usually treated by oxytocin B. it is best managed by extraction soon after full cervical dilatation C. when the legs are extended the presenting diameter is the
ditrochanteric D. the commonest cause of perinatal death is prematurity E. the fetal back (sacrum) should be kept posterior
A. the maternal mortality rate 1988-1990 was 10 per 10,000 births B. deaths related to hypertension are most commonly caused by
cardiac failure C. emergency general anaesthesia contributes to death from
Mendelssohn's syndrome D. the number of deaths from pulmonary embolism after Caesarean
section has not fallen during the past 20 years E. in modern obstetrics amniotic fluid embolism should be
preventable
A. is a cause of infertility in women B. may be treated with dopamine antagonist drugs C. may be difficult to diagnose with certainty D. can by physiological E. is caused by an adenoma of the posterior pituitary gland
A. has a low placebo response rate B. may respond to dietary manipulation C. diagnosis must be supported by written or visual evidence D. can be treated by ovulation suppression E. does not respond to mefenamic acid
A. palmar rash is a sign of secondary syphilis B. the primary chancre heals spontaneously after 5-8 days C. presenting signs are often condylomata acuminata D. the regional lymph nodes become enlarged, soft and very tender
in primary disease E. secondary syphilis has a low infectivity
A. classically presents with postmenopausal bleeding B. if stage lb it can be treated with a Wertheim’s hysterectomy and
conservation of the ovaries C. if treated surgically is usually followed with chemotherapy D. has had a decreased incidence since introduction of the cervical
screening programme in the UK E. can present with true incontinence
A. is also known as Stein-Curtis syndrome B. may be treated with clomiphene C. may present with alopecia D. is associated with raised LH and FSH levels E. commonly presents with menorrhagia
A. the slowest acceptable rate of progress in a multiparous woman is 1 cm every 2 hours
B. if delay occurs in the second stage in a primigrávida, oxytocin must not be used
C. if delay occurs at 7 cm in a multiparous woman inefficient uterine action is the commonest cause
D. they are graphic descriptions of labour E. they are only useful if vaginal examinations are documented
every 2 hours
1. A - T
B - F
C - F
D - F
E - T
Vaginal candidiasis can be transmitted to the fetus at the time of vaginal delivery Gardnerella vaginalis is discouraged by an increase in the number of doderleins bacilli in the vagina, as the latter act to lower the pH of the vagina vaginal candidiasis is treated by local therapy, e.g. clotrimazole pessaries or oral therapy, e.g. fluconazole metronidazole can be given throughout pregnancy but as with all drugs is best avoided in the first trimester gonorrhoea can cause bartholinitis, cervicitis, urethritis, pelvic and inflammatory disease
2 . A - F B - T
C - F
D - F E - T
cervical polyps do not cause miscarriage cervical polyps can cause bleeding at any time either in the nonpregnant or pregnant state. The majority, however, are asymptomatic water discharge is usually due to infection or very rarely tubal carcinoma; it would be a most unusual presentation for a cervical polyp cervical polyps are covered by columnar epithelium cervical polyps can cause both intermenstrual and postcoital bleeding
3 . A - F
B - F
C - T
D - F
E - T
an enterocoele is a prolapse of the pouch of Douglas which may contain bowel or omentum and does not affect bladder function pelvic floor exercises may improve stress incontinence. Bladder drill is more useful in the patient with detrusor instability upper motor neurone lesions are associated with a hyper-reflexic or so called ‘neuropathic' bladder urodynamics should be performed in all women with incontinence. Symptoms of stress incontinence may be caused by detrusor contractions any mass in the pelvis can cause acute urinary retention, including retained blood in the vagina secondary to an imperforate hymen
prolapse there may be persistent residual urine in the bladder following voiding
B - F African women rarely suffer uterovaginal prolapse, the reason for this remaining uncertain
C - F a Hodge pessary is used for anteversion of a retroverted uterus. A ring or shelf pessary may be used for uterine prolapse
D - F an enlarged uterus is not a predisposing factor E - F the factor contributing most to utero-vaginal prolapse
is childbirth, so premenopausal women can have this problem, although the condition may deteriorate when the tissues become oestrogen deficient with ovarian failure
5 . A - F a ‘double’ (didelphic) uterus acts as a single uterus. It is the more subtle Mullerian duct abnormalities (e.g. arcuate uterus) that result in abnormal presentations
B - T multiple pregnancies have a higher incidence of transverse lie and all other malpresentations
C - F the commonest presentation of a second twin is cephalic, followed by a breech
D - T if the placenta is in the lower segment or overlying the cervix, i.e. placenta praevia, there will be an increased chance of a transverse he
E - F in the presence of ruptured membranes and a preterm fetus a classical Caesarean section may be necessary but each case must be considered individually. At term the transverse fetus is usually delivered at Caesarean section by bringing the legs down and out of the wound first
6 . A - F substandard care was evident in nearly 50% of the reported cases of direct and indirect deaths
B - F the main causes of direct maternal deaths were thrombosis and thromboembolism, hypertensive disorders and haemorrhage
C - T guidelines have been issued with regard to the management of major obstetric haemorrhage. These include prompt and adequate fluid replacement and
senior assistance D - T deaths due to anaesthesia had decreased, in part
related to the use of epidurals and spinals as opposed to general anaesthesia
E - T figures reported in this trienium were for the United Kingdom as a whole but comment was made regarding the lower rate in Ireland
7 . A - F
B - T
C - F
D - F
E - T
if estrogen replacement therapy is given in conjunction with 12 days of progestagen therapy, the incidence of carcinoma of the endometrium is decreased an endometrial biopsy will provide an histological diagnosis treatment is usually a total abdominal hysterectomy with bilateral salpingo-oophorectomy and may be followed by radiotherapy depending on the depth of endometrial involvement obese women have more conversion of androgen precursors to oestrone and so have a higher incidence endometrial hyperplasia without atypia carries a small risk (around 2%) of developing malignancy, but the presence of atypical cells increases the risk
8. A - T correct management of the third stage involves placing a hand suprapubically to prevent inversion of the uterus when the placenta is delivered. However, the aetiology in some women remains uncertain
B - T placenta accreta or percreta must be considered in the presence of uterine inversion
C - F removal of an attached placenta in this situation may cause uncontrollable bleeding
D - T if initial manual attempts at replacing the uterus have failed, then the hydrostatic method is used
E - F replacement should be attempted as soon as uterine inversion occurs by placing a fist beneath the inverted fundus and pushing cephalad. If this procedure is delayed then oedema of the tissues occurs making replacement even more difficult
B -
C -
D -
E -
10. AB -
C -
D -
E -
B -
C -
D -
the canal of Nuck
T pox virus (Molluscum contagiosum), as with other viral infections (herpes, warts), can cause itchy vulva
T testosterone cream (2%) may be of value in atrophic vulval lesions. Commonly aqueous cream or hydrocortisone ointments are tried initially
F vulval carcinoma forms about 5% of all genital tract cancers
T because of this rather embarrassing complaint, presentation is often delayed. Physicians should also not hesitate to inspect the vulva, prior to prescribing topical therapy
T chronic ectopic pregnancies can present in this way F urinary pregnancy tests may be negative in ectopic
pregnancy, therefore serum /ff-HCG should be measured. Where this service is not available, the case should be managed on clinical grounds
T an incomplete miscarriage may present with a history of this nature. The diagnosis is often made by ultrasound; if the clinical findings are not conclusive
F this phrase is only infrequently used now. It was thought to apply to a shortened luteal phase (less than 10 days) and low peak serum progesterone secondary to inadequate follicular development. Proof of its existence, however, is almost impossible
T prolonged bleeding due to hormonal causes will usually respond to high-dose progestagens. Alternatively oestrogens can be tried
F all normal term babies will lose up to 10% of their birthweight in the first few days of life; however, birthweight should be regained by 7-10 days
T babies with inborn errors of metabolism should not be breastfed as they require specifically artificially manipulated feeds
F erythema toxicum (urticaria neonatorum) occurs in the first week of life and is of uncertain cause but harmless
F physiological jaundice commences on days 2-4 of life
and is due to increased unconjugated bilirubin levels. Onset of jaundice in the first 24 hours of life is abnormal and requires investigation
E - T oxygen administration in preterm infants can cause retrolental fibroplasia and in severe cases can lead to blindness
1 2 . A - F
B - F C - T
D - F E - T
there is no treatment for azoospermia unless it is due to a vasectomy, in which case re-anastomosis of the vas deferens may be successful no WBCs are normally seen in a semen sample a maximum of up to 50% of abnormal forms are acceptable in a semen sample testicular failure produces high FSH and LH levels micromanipulation allows easier entry of the spermatozoon into the zygote. Its usefulness has been proven in cases of poorly motile sperm
1 3 . A - F
B - F
C - T
D - T
E - T
laparoscopies have a mortality of approximately 1 in 15,000, although this may vary with the increasing use of laparoscopic surgery C 0 2 embolus is a complication which can occur in laparoscopy. This gas is used to insufflate the abdomen through a verres needle C 0 2 left in the abdominal cavity can irritate the diaphragm postoperatively and cause shoulder-tip pain via the phrenic nerve the bladder must be empty before insertion of the verres needle peritoneal infection can result from laparoscopies by direct introduction of bacteria, by damaging internal organs or by injecting dye through the cervix into the upper genital tract
1 4 . A - T the large differences in various populations may have been exaggerated by selection bias. In the USA and England rates of incidence between 0.5-2 per 1000 pregnancies have been reported
B - T the uterus may be larger, equivalent or smaller than
expected for the expected gestation C - T vaginal bleeding is the most common presenting
symptom. Theca lutein ovarian cysts are not infrequent and associated with hyperemesis and pre-eclampsia
D - F regional centres (Charing Cross Hospital in London) operate a computerized follow-up system. Patients are contacted direct and urine or serum samples for /ff-HCG sent through the post
E - T following any subsequent pregnancy HCG levels should be estimated to ensure that they have fallen to insignificant levels
1 5 . A - F
B - T
C - F
D - F
E - T
as with all cases of collapse the priorities are Airway, Breathing and Circulation as thromboplastin is released into the circulation, DIC rapidly develops and may be impossible to correct the most likely cause is an atonic uterus; a cervical tear is rare. A systematic approach to the patient ensures that all possibilities are investigated a uterine dehiscence should always be thought of in a woman with a previous Caesarean section pregnant women have an increased incidence of thromboembolism regardless of the mode of delivery
1 6 . A - F
B - F
C - F
D - T
E - F
women with Turner's syndrome have normal external female genitalia in testicular feminization the phenotype is female but the gentotype contains a Y chromosome and testes are present in cryptorchidism the testes have failed to descend and may be in the inguinal canal, but the external genitalia are male the adrenogenital syndrome is the commonest cause of intersex and is caused by a female fetus being exposed to an excess of adrenal androgens Kleinfelter’s syndrome is a chromosomal disorder with 47XXY composition. The genitalia are male
B - F
C - F
D - T
E - F
because of the increase in plasma volume (approximately 50% in primiparas and 60% in multigravidae) the actual values of electrolytes decrease the mucoid discharge from the cervix increases in pregnancy the respiratory tidal volume increases, as does the pulmonary blood flow cardiac output rises in the first trimester and continues to rise until it plateaus at around 34 weeks gestation in pregnancy a fasting blood glucose less than 5.8 mmol/L is normal and unchanged from the pre-pregnant state
1 8 . A - F
B - T
C - T
D - F E - T
in severe pre-eclampsia the creatinine clearance rate is reduced the second wave of trophoblastic invasion to form the placental microcirculation is thought to be defective in women with severe PET there is an increased incidence of placental abruption, the placenta itself having reduced perfusion secondary to vasoconstriction the intravascular compartment is decreased all levels of electrolytes are increased because the fluid volume in the intravascular compartment is decreased. Rising serum urate levels are used to monitor the disease process
1 9 . A - F
B - T
C - F
D - F
once significant antibodies are present there is no point in giving anti-D amniocentesis can cause rhesus sensitization and therefore 250 IU of anti-D are given intramuscularly to rhesus-negative women (at 20 weeks or less of gestation) anti-D is not given routinely in early pregnancy to rhesus-negative women although it should always be given after a miscarriage or ectopic pregnancy the Kleihauer test may not be sensitive enough to pick up a very small transfer of fetal cells into the maternal circulation
E - F the ABO incompatibility does not influence initiation of rhesus disease
B - F
C - T
D - T
E - F
engagement is defined as when the maximum diameter of the head (the biparietal diameter) has passed through the pelvic brim engagement is determined by the abdominal findings as the vaginal level of the presenting part is altered by moulding and therefore is an unreliable finding engagement is defined as when the maximum diameter of the head (the biparietal diameter) has passed through the pelvic brim in abdominal palpation, engagement is defined as 0/5, 1/5 or 2/5 of the head palpable above the pelvic brim it is the bony parts of the fetal head that are of importance, not the oedema and swelling of the soft tissues of the scalp (caput succedaneum)
2 1 . A - T
B - T
C - F
D - T
E - T
in addition to the surge of follicle stimulating hormone there is a surge in luteinizing hormone, the detection of which is used in commercial urine ovulation detector kits as a result of ovulation, the endometrium changes from proliferative to secretory following ovulation the cervical mucus becomes less fluid and more viscous. It helps prevent the ascent of organisms and sperm to the upper genital tract the basal body temperature rises by approximately 0.3°C following ovulation and remains high throughout the secretory phase the second half of the menstrual cycle is usually constant and is 14 days from ovulation to menstruation. The proliferative phase of the endometrium cycle can vary
2 2 . A - F as oestrogen is metabolized through the liver oral therapy will cause a decrease in antithrombin III. Therefore a woman with past history of thromboembolic disease should be given parenteral
therapy, e.g. transdermal or implants B - T premarin 0.625 mg has been shown to be bone sparing C - F cystic hyperplasia can be treated medically by giving 12
days of progestagens each month. Repeated endometrial biopsy is warranted
D - F an endometrial thickness greater than 5 mm on ultrasound examination is significant
E - F oestrogen replacement therapy will increase HDL levels
2 3 . A - F if a breech is to be delivered vaginally then oxytocin should not be used
B - F extraction should never normally be employed. The accoucheur merely guides the delivery of the fetus which is occuring by uterine contractions and maternal effort
C - T this is the widest dimension of the presenting part in a ‘frank’ or extended breech. It accounts for approximately two-thirds of vaginal breech deliveries
D - T in addition to the risks of prematurity, the fetus presenting by the breech has a higher rate of congenital abnormality and antepartum stillbirth than those with vertex presentation
E - F it is important to keep the fetal back anteriorly otherwise the chin may become caught on the symphysis pubis causing extension of the head and obstruct delivery
2 4 . A - F the latest triennial report (1988-1990) and the maternal mortality rate for the past two reports has been 10 per 100 000 total births
B - F deaths related to hypertension are most commonly caused by intracerebral haemorrhage
C - T Mendelssohn’s syndrome is aspiration of gastric contents and this most commonly occurs after emergency general anaesthesia rather than an elective general or epidural anaesthetic
D - T the incidence of death from pulmonary embolism (PE) after Caesarean section has fallen during the last twenty years but not the actual number of deaths. The
reason for this is that the incidence of PE’s themselves has decreased, but there are more Caesarean sections performed
E - F it is very difficult to prevent amniotic fluid embolism
B - F
C - T
D - T
E - F
hyperprolactinaemia can cause infertility and amenorrhoea. A serum prolactin estimation is an important baseline investigation, even in the woman without galactorrhoea hyperprolactinaemia is treated with dopamine agonist drugs, most commonly bromocriptine laboratory limits vary and some set the upper limit of normal unrealistically low. The level also increases with stress, eating, nipple stimulation, during sleep, intercourse and anaesthesia hyperprolactinaemia can be physiological during pregnancy and breast feeding a microadenoma or adenoma of the anterior pituitary gland is often found
B - T
C - T
D - T
E - F
placebo response rates are in the region of 90%, hence the utmost importance of placebo control in any therapeutic trial success has been reported by eating frequent meals, reducing sugar and salt intake and cutting out caffeine sources a symptom diary together with menstrual dates over the course of 2-3 months is important to exclude a symptom pattern not in agreement with PMS the combined oral contraceptive and luteinizing hormone releasing hormone (LHRH) agonists have been successfully used in this role controlled trials have shown this drug to be successful in improving the symptoms of fatigue, depression, headache, tension and irritability
2 7 . A - T palmar rash is a sign of secondary syphilis, together with the symptoms of fever, headache, bone and joint pains
C - F condylomata acuminata are warts caused by human
papilloma virus, condylomata lata are the classical lesion of secondary syphilis
D - F it is with secondary disease that the regional lymph nodes become active
E - F secondary syphilis is highly infective
B - T
C - F
D - F
E - T
carcinoma of the cervix can be asymptomatic, or be associated with intermenstrual, postcoital or postmenopausal bleeding stage lb can be treated with Wertheim’s hysterectomy with removal or conservation of the ovaries, depending on the clinical setting and the age of the patient adjuvant therapy in carcinoma of the cervix is radiotherapy the introduction of the cervical screening programme in the UK unfortunately has not decreased the incidence of cervical carcinoma. The rate in younger women (less than 40) is increasing if a fistula develops following local infiltration then true urinary incontinence can occur
2 9 . A - F
B - T
C - F
D - F
E - F
polycystic ovarian syndrome is also known as Stein-Leventhal syndrome; the clinical symptoms are hirsutism, menstrual problems and obesity if the patient wants to conceive she may respond to oral clomiphene citrate therapy if the patient's serum testosterone is raised hirsutism may be the presenting complaint although the plasma LH level is usually increased the FSH level is low or normal. A follicular phase LH to FSH ratio should be 3 to 1 or more women with polycystic ovarian syndrome present with oligoamenorrhoea rather than menorrhagia
3 0 . A - F the slowest acceptable rate of progress in a primigrávida woman is 1 cm every hour and in a multiparous woman 2 cm every hour
primigrávida woman is inefficient uterine action and oxytocin can be safely used, even in the second stage, once the patient has been assessed
C - F in a multiparous woman delay at 7 cm often implies obstructed labour
D - T a partogram is a graphic description of labour. Its visual nature conveys much information at a glance
E - F vaginal examinations are normally performed hourly to four hourly depending on the unit’s policy. It is important that each is documented accurately, together with descent of the head, as palpated per abdomen
