PAPER TWO

A 24-year-old primigravida at 37 weeks gestation has had a blood pressure of 150/100 mm Hg and 4 g of proteinuria for the preceding day. The following findings would be expected

10. A raised plasma urate level 11. Loss of diurnal variation in blood pressure 12. A creatinine clearance of 120-150 ml per minute 13. Hyperreflexia 14. A low level of FDP 15. Hypernatraemia

The following are more common after an abdominal (rather than vaginal) hysterectomy

16. Lung atelectasis 17. Febrile morbidity 18. Pulmonary embolism

Monozygotic multiple pregnancy 19. Is monoamniotic in 25% of cases 20. Incidences are more common in Japan than in North America 21. Incidences are more common in pregnancies conceived on clomiphene

22. 23. Such pregnancies are familial 24. Is the usual mechanism of conception in triplet pregnancies 25. Is associated with higher incidence of fetal abnormalities than polyzygotic

pregnancies 26. Communicating vessels in the placenta are usually demonstrated

Depo medroxyprogesterone acetate 27. Is the only available licensed depot contraceptive preparation 28. Is associated with significant loss of bone mineral density in long-term

users 29. The duration of its contraceptive efficacy is dose related 30. Induces amenorrhoea in 45% in the first year of use 31. Has androgenic side effects 32. Is contraindicated in women who have previously had an ectopic

pregnancy 33. Is associated with reduced incidence of PID 34. Is contraindicated in sickle cell disease 35. Is discontinued by a third of users because of menstrual irregularities

Regarding miscarriage, which of the following statements are true? 36. One in four women will have at least one miscarriage 37. One in five first trimester miscarriages are associated with chromosomal

anomalies 38. One in 100 women experience recurrent miscarriage 39. One in five women experience vaginal bleeding in early pregnancy 40. One in three spontaneous miscarriages will resolve spontaneously

In pregnancy 41. The incidence of appendicitis is 1 in 2500 42. Pancreatitis is associated with 50% mortality 43. Asymptomatic bacteriuria may presents with suprapubic pain 44. Nephrolithiasis occurs in 1 in 5000-10 000 cases 45. Sickle cell disease may present with sharp abdominal pain

In labour 46. Uterine hypertonia is the commonest type of abnormal uterine activity 47. Uterine hypotonia is commoner in parous than in primigravidae 48. Supine position is associated with uterine hypotonia 49. Adequate pain relief may correct uterine hypertonia 50. Uterine hypotonia is associated with fetal hypoxia

The following indicate abnormal sperm function 51. Volume <2 ml 52. Density of 10 million/ml 53. 70% abnormal forms

54. Motility 40% Short stature is associated with

55. Androgen insensitivity 56. Klippel-Feil syndrome 57. Turner’s syndrome 58. XXX genotype

There is a recognized association between Down’s syndrome and 59. Congenital deafness 60. Patent ductus arteriosus 61. 21 triploidy 62. Hypotonia 63. 13/21 translocation defect

The following side effects match 64. Digoxin Agranulocytosis 65. Methyldopa Depression 66. Warfarin Osteoporosis 67. Clomiphene Alopecia 68. Cimetidine Mastalgia 69. Norethisterone Neonatal virilism 70. Danazol Acne 71. Bromocriptine Hypertension

Regarding contraception in late reproductive life 72. At 50 years of age the pregnancy rate in women not using any

contraception is 10-20 per 100 women years 73. Contraception should be discontinued with the last menstrual period if this

has occurred after the age of 50 74. Contraception should be discontinued 1 year after the last menstrual period

if this has occurred before the age of 50 75. Methods of contraception with a high failure rate in young women are

more reliable in the peri-menopausal period 76. The indications and contraindications for post-coital contraception are

exactly the same in peri-menopausal women as for younger age groups 77. Modern low dose combined oral contraceptive pills can be taken in healthy

nonsmoking women in the peri-menopausal age range 78. Modern cyclical and continuous combined hormone replacement therapy

provides reliable contraception 79. Older women have the highest incidence of therapeutic abortion of any age

group New genetics

80. The majority of mutations causing genetic diseases are single base substitutions

81. 82. Restriction endonucleases always cut DNA strands at the same point 83. Restriction enzymes are useful in diagnosing sickle cell disease 84. Introns are important in coding for genetic products 85. All patients with alpha-1-

antitrypsin deficiency have the same underlying base substitution ARDS

86. Is rarely associated with sepsis 87. Is commonly associated with aspiration of gastric contents 88. Is associated with multiple blood transfusions in only 25% of cases 89. Develops within 24 hours in 80% of patients 90. Mortality rates vary according to the underlying cause

Presumptive evidence of ovulation is indicated by 91. A biphasic temperature chart during a menstrual cycle 92. The development of subnuclear vacuolation in the endometrial glands 93. A rise in urinary LH 94. A fall in urinary pregnanediol excretion during the third week 95. The development of supranuclear vacuolation in the endometrial glands

Listeria monocytogenes in pregnancy 96. Is destroyed by cooking 97. Causes a glandular fever-like illness 98. Severe diarrhoea is characteristic 99. Is best treated with chloramphenicol

100. Is a cause of recurrent miscarriage 101. May result in neonatal hydrocephalus 102. Causes meconium ileus

Pelvic abscess is a recognized complication of 103. Diverticulitis coli 104. Crohn’s disease 105. Ulcerative colitis 106. Appendicitis 107. Schistosoma hematobium infestation 108. Pyometra

The following are associated with an increased risk of fetal malformations

109. Diagnostic amniocentesis 110. Poliomyelitis vaccine administered in early pregnancy

Characteristic features of primary spasmodic dysmenorrhoea include 111. Relief of pain by mefenamic acid 112. Endometrium in the secretory phase 113. Mildly elevated serum prolactin levels

114. Ovulation 115. Excess production of PGF2α by the endometrium 116. Increased production of parathormone

Genetic counselling includes 117. An attempt to eliminate hereditary disease 118. Always offering chorionic villus sampling (CVS)

Which of the following associations are correct 119. 46 XXX Superfemale 120. 47 XXY Testicular feminization syndrome 121. 46 XX True hermaphroditism 122. 46 XY/47 XXY Klinefelter’s syndrome 123. 47 XXX Tall stature 124. 46 XO Turner’s syndrome 125. 46 XX Female adrenogenital syndrome

Ectopic pregnancy 126. The incidence has been declining in the UK over the last few years 127. In the UK the incidence is 1/500 births 128. Following one ectopic pregnancy the risk of a further ectopic pregnancy is

40-50% 129. The incidence of maternal deaths due to ectopic pregnancy in the UK in

1991-93 was 0.3/1000 Regarding drugs in the neonate, the following match

130. Phenytoin Jaundice 131. Rifampicin Hypoprothrombinaemia 132. Tetracycline Discolouration, dysplasia of teeth and bones 133. Lithium Retention of urine 134. Maloprim Steven Johnson syndrome 135. Streptomycin Deafness due to VIIth nerve damage 136. Tetracycline Cataract

Peripartum cardiomyopathy 137. Persisting cardiomegaly at 1 year is associated with mortality of over 80% 138. Most commonly occurs post-partum 139. Is more common with multiple pregnancies, eclampsia and nulliparity 140. Normally presents with signs of right sided heart failure 141. May necessitate heart transplantation 142. Heparin is advised to reduce emboli

Causes of raised HCG include 143. Carcinoma of the colon 144. All forms of trophoblastic disease 145. Carcinoma of the bronchus 146. Carcinoma of the bladder

147. Carcinoma of the stomach

CIN 3 is characterized by 148. Visible lesions at colposcopy 149. Histological changes beneath the basement membrane 150. Full thickness loss of stratification throughout the epithelium 151. Full thickness loss of polarity throughout the epithelium 152. Lymph node deposits

Oligohydramnios is characteristically associated with 153. Post-maturity 154. Amniotic bands 155. Fetal polycystic kidneys 156. Rhesus alloimmunization 157. Haemangioma of the placenta 158. Diabetes mellitus 159. Increased levels of amniotic prolactin 160. A reduced efficiency of labour 161. All cases of renal agenesis of the fetus

The levonorgestrel loaded IUCD 162. Effectively improves dysmenorrhoea 163. Does not alter the serum lipid profile 164. May reduce the size of fibroids 165. Retains contraceptive efficacy for up to 3 years 166. Is associated with significant weight gain 167. Reduces menstrual blood loss by up to 95% after 1 year of use

In amniotic fluid 168. Presence of phosphatidyl inositol indicates fetal lung maturity 169. A lecithin-sphingomyelin ratio of 2:1 indicates fetal lung maturity in

maternal diabetes 170. Absence of phosphatidyl glycerol indicates that the fetal lung is immature 171. Phospholipids make up more than 80% of surfactant 172. Lecithin contributes about 80% of surfactant after 37 weeks gestation

The following fall after the menopause 173. Serum testosterone levels 174. Plasma calcium concentration 175. Karyopyknotic index in the vagina 176. HDL and coronary heart disease 177. Plasma oestradiol concentrations 178. Urinary calcium/creatinine ratio 179. Interest in sexual intercourse

180. Post-maturity 181. Anencephaly 182. Breech presentation 183. Perinatal death 184. Closed spina biflda 185. Monozygotic twins 186. IUGR 187. Prolonged labour

Toxoplasmosis infection in pregnancy 188. Occurs from improperly washed raw vegetables 189. Can be effectively treated in pregnancy 190. The fetus is affected in less than 5% cases 191. Less than 20% of fetuses are affected if the mother was affected in

previous pregnancies 192. 80% of fetuses are affected if infection occurs in the first or second

trimester 193. Causes abortion in 20-30% of cases 194. Causes jaundice on the first day of life

The following statements relate to pelvic inflammatory disease (PID) 195. 8% of women suffer with tubal factor infertility after one episode 196. 40% of women suffer with tubal factor infertility after three or more

episodes 197. 1% of women are infertile after one episode of mild disease 198. 20% are infertile after the first episode of severe disease 199. 1% with laparoscopically proven PID have Fitz-Hugh-Curtis syndrome 200. 3% will have another episode within a year 201. 80% of partners of women with PID will have urethritis

Folic acid deficiency in pregnancy 202. Is more likely to occur in women of low social class 203. Is associated with Hirshsprung’s disease 204. Has no known association with Crohn’s disease 205. Causes fetal neural tube defects

With regard to ovarian carcinoma the following screening methods are beneficial

206. Ultrasound using colour flow doppler 207. CA 125 208. Genetics

Pethidine 209. The maximum dose is 400 mg in 24 hours, and it should be entirely

avoided in pre-eclampsia

In pregnancy above 35 years old the incidence of the following are increased

210. Delayed gastric emptying, and maternal respiratory depression are known side effects

211. If given in labour, prophylactic ranitidine should be administered concurrently The following drugs are associated with hirsutism

212. Phenytoin 213. Diazoxide 214. Salicylate 215. Digoxin 216. Cimetidine

Placenta praevia 217. Occurs in 2-4% of pregnancies 218. Occurs with higher incidence in women who have previously had a D&C 219. Is associated with an increased incidence of neonatal respiratory distress

syndrome 220. Classically presents with painless antepartum haemorrhage late in the

second trimester 221. One in three women with placenta praevia have no history of antepartum

haemorrhage 222. Always necessitates Caesarean delivery 223. Is associated with maternal mortality of 0.1% 224. Is associated with placenta acreta in 15%

Atelectasis 225. Is a rare postoperative complication after general anaesthesia 226. Has a more aggressive course in non-smokers than smokers 227. May present with pyrexia 228. The risk increases with increased duration of anaesthesia

Breech delivery 229. Footling breech presentation is an indication for Caesarean section 230. Vaginal delivery is impossible if the maternal sacrum is flat 231. Ideally the membranes should be kept intact during labour for as long as

possible 232. In primigravida a trial of labour is contraindicated 233. The risk of cord prolapse in labour is highest in flexed breech 234. Breech extraction in singleton pregnancy is contraindicated 235. The after-coming head entrapped with an incompletely dilated cervix could

be released with incisions at 6 and 12 o’clock 236. In the early 1990s Caesarean sections for breeches in England accounted

for 30% of all Caesarean sections 237. Pushing should commence as soon as full dilatation is achieved

rather overweight and is found to have second degree uterine prolapse. Routine cervical cytology has shown severe dyskaryosis, confirmed as CIN 3 by colposcopic biopsy. Acceptable management for this woman could be

238. Sterilization and treatment of the cervix 239. Abdominal hysterectomy 240. Manchester repair with sterilization 241. Schauta’s operation 242. Cone biopsy

Transverse lie in late pregnancy is associated with 243. Renal agenesis 244. IUGR 245. Microcephaly 246. Placenta circumvallata 247. Haemangioma of the placenta 248. Arcuate uterus 249. Multiple pregnancy 250. Placenta praevia

Precocious puberty 251. Can be treated with cyproterone acetate 252. Is rarely of the familial constitutional type 253. Is associated with Albright’s syndrome 254. Is associated with juvenile hypothyroidism 255. Is associated with granulosa cell tumours 256. Is associated with sarcoma botryoides 257. Is associated with Waterhouse-Friedrichsen’s syndrome

Recognized causes of post-partum shock without excessive visible blood loss include

258. Inversion of the uterus 259. Intravenous administration of ergometrine 260. Rupture of the uterus 261. Vaginal haematoma 262. An eclamptic fit

Partial moles 263. Incidence in the UK is 1 in 600 deliveries 264. 5% of patients will need treatment for persistent trophoblastic disease 265. Do not need follow up with serial HCG 266. May be associated with fetal erythrocytes 267. Are triploid (one paternal, two maternal)

268. Clomiphene tartrate 269. Human menopausal gonadotrophins 270. FSH 271. Tamoxifen 272. HCG

Right iliac fossa (RIF) pain occurring at 32 weeks of pregnancy could be due to

273. Constipation 274. Chronic salpingitis 275. A strangulated femoral hernia

Heparin 276. When used in prophylactic doses does not require monitoring of clotting 277. For therapeutic use, its anticoagulant effect is monitored by measuring PT 278. The target level of PT for a woman on a therapeutic dose of heparin is 1.5-

2 times normal 279. Osteopenia due to prolonged heparin therapy is reversible after

discontinuation of the treatment 280. The disadvantage of the low molecular weight heparin is a higher

incidence of allergic reactions when compared with unfractionated heparin 281. The APTT should be measured 12 hours after starting intravenous heparin

therapy 282. Heparin associated thrombocytopenia could be life threatening 283. Epidural anaesthesia is safe in women on prophylactic dose of

unfractionated heparin The transformation zone of the cervix

284. Is entirely visible when colposcopy is regarded adequate 285. Is the usual site for the development of CIN 286. Has the squamo-columnar junction at its ectocervical limit 287. May extend to include the vagina in 5% of patients 288. Only contains columnar cells 289. May contain dysplastic cells

Breast cancer in pregnancy 290. Is characterized by a worse prognosis if it occurs during or shortly after

pregnancy 291. Could be treated with radiotherapy 292. In pregnancy there is a preponderance of unfavourable types of breast

cancer 293. Pregnancy after breast cancer should be delayed for 2 years because of the

poor prognosis 294. Breast feeding is not advisable

Ovarian hyperstimulation syndrome may be associated with

295. Is a common gynaecological problem 296. Is a side effect of cholinergic drugs 297. Is a common complication of early pregnancy 298. Could be caused by primary syphilis 299. Could be caused by genital herpes 300. Could be caused by regional anaesthesia

Urinary retention