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Flashcards in RANZCOG bank Deck (101)
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1

Which of the following is the most appropriate treatment?

a. Tetracycline for a recent immigrant with granuloma inguinale
b. Erythromycin for a 28-week pregnant patient with syphilis and a penicillin allergy
c. Ketoconazole for a 25-year-old patient with trichomonas
d. Ampicillin for a 15-year-old patient with pelvic inflammatory disease

a. Tetracycline for a recent immigrant with granuloma inguinale

Ketoconazole - topical treatment
Ampicillin - similar to amox, needed broader cover

Granuloma inguinale is a rare sexually transmitted disease caused by the bacteria Klebsiella granulomatis
- Azithromycin first line
- Other options cotrimoxazole, doxycycline, erythromycin

2

Which of the following causes of primary amenorrhoea are associated with spontaneous ovulation?

a. Hypothalamic hypogonadism (Kallmann syndrome)
b. Turner syndrome (45X)
c. 5-alpha reductase deficiency
d. Müllerian agenesis

d. Müllerian agenesis

3

Red degeneration of a uterine fibroid:

a. causes a leucopenia with a lymphocytosis.
b. is associated with a raised ESR.
c. is due to emboli occluding the major blood vessels supplying the myoma.
d. only occurs in pregnancy.

b. is associated with a raised ESR.

4

A previously normotensive 42-year-old woman is on the combined oral contraceptive pill (COCP). She has a diastolic blood pressure reading of 95mmHg at review for a repeat script.
What would be her best initial management?

a. Continue with COCP, begin anti-hypertensive treatment and review
b. Continue with COCP and perform renal function testing and review
c. Cease the COCP and review
d. Continue with COCP and recheck the blood pressure

d. Continue with COCP and recheck the blood pressure

Absolute contraindications:
- DBP >/=95mmHg

5

Which of the following is most typical of a fetal scalp pO2 measured in early labour?

a. 52 mmHg
b. 42 mmHg
c. 32 mmHg
d. 22 mmHg

d. 22 mmHg

Fetal scalp pO2 normal 20-30mmHg

Normal adult venous O2 approx 30-40mmHg
- 80-100mmHg for arterial

6

Of the following antibodies, which is the predominant type produced by the fetus?

a. IgA
b. IgM
c. IgE
d. IgG

b. IgM

Developed during fetal development from 20/40

7

With respect to pregnancy in renal transplant patients:

a. pregnancy is unlikely in the first 12 months after renal transplantation.
b. pregnancy may increase graft rejection rates.
c. immunosuppressive agents should be decreased prior to pregnancy.
d. live birth rate approximates 75%.

d. live birth rate approximates 75%.

8

A 34-year-old woman G7P0M5T1 presents for her first antenatal visit at 10 weeks with a viable singleton pregnancy. All her miscarriages were in the first trimester. She has a normal uterine configuration and is thrombophilia screen negative.
What would be the most appropriate initial preventative management for her recurrent miscarriages?

a. Cervical cerclage.
b. Maternal reassurance with intensive follow-up
c. Low dose aspirin
d. Low molecular weight heparin

b. Maternal reassurance with intensive follow-up

Wouldn't give LDA or heparin without thrombophilia diagnosis

Evidence that maternal reassurance with intensive f/u improves LBR

9

Which of the following statements regarding hyperandrogenic chronic anovulation and polycystic ovarian syndrome is most correct?

a. Approximately 5% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 90% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.
b. Approximately 5% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 75% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.
c. Approximately 30% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 90% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.
d. Approximately 30% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 75% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.

d. Approximately 30% of normal ovulatory women have an ultrasound appearance of polycystic ovaries and approximately 75% of women with hyperandrogenic chronic anovulation have an ultrasound appearance of polycystic ovaries.

10

Which congenital anaemia is inherited as autosomal dominant and found in people of European descent?

a. Pyruvate Kinase deficiency
b. Glucose 6 Phosphate dehydrogenose deficiency
c. Hereditary spherocytosis
d. Sickle Cell anaemia

c. Hereditary spherocytosis
- autosomal recessive or autosomal dominant
- most common in Northern European and Japanese families
- related to membrane proteins in red cells
- can cause haemolytic anaemia

Pyruvate Kinase deficiency
- autosomal recessive

Glucose 6 Phosphate dehydrogenose deficiency
- X-linked recessive disorder

Sickle Cell anaemia
- autosomal recessive

11

A 46-year-old woman presents with a feeling of a lesion inside her vagina. She is an asylum seeker and has a 10-12 year history of episodes of amenorrhoea and dysfunctional bleeding. She is concerned about going to a hospital and also the cost involved. Her GP has supplied a report of a pelvic ultrasound scan and it shows a moderate cystic change in the uterine cavity and endometrium thickness of 27mm. When you examine her you find a pedunculated cervical polyp which is not compromising her, but is bothering her.
What is the next step in the management of this patient?

a. Perform an outpatient pipelle aspiration and polypectomy in your room
b. Perform the polypectomy in your rooms
c. Explain your concern and long term risk of cancer and organise for hysteroscopy and curettage under GA after explaining the cost and procedure
d. Refer her to the public system and they will take care of her

a. Perform an outpatient pipelle aspiration and polypectomy in your room

12

A woman is 20 weeks pregnant in her second pregnancy. She terminated her first pregnancy at 14 weeks and had a haemorrhage requiring a three-unit blood transfusion. The pathologist phones you to say she has a 1:128 titre of anti-Kell present in her antibody screen.
All of the following are true EXCEPT:

a. Serial antibody titres in the mother correlate well with fetal status.
b. Peak systolic velocity in the MCA increases in the severely anaemic fetus and fetal blood sampling may be necessary.
c. If the father is Kell Ag positive, amniocentesis or fetal cordocentesis may be performed to assess fetal Kell Ag status.
d. Kell isoimmunisation is particularly severe as the antibodies affect both mature red cells and developing red cells in bone marrow.

a. Serial antibody titres in the mother correlate well with fetal status.

13

In advising a woman on whether she should continue her pregnancy to 42 weeks or be induced at 41 weeks, which of the following is FALSE?

a. An ultrasound will be indicated if she elects to wait.
b. The Canadian randomised trial (Hannah et al) showed that induction of labour increases the likelihood of caesarean section.
c. If the Bishop's cervical score is <5, intravaginal prostaglandins will be recommended.
d. Waiting is likely to be associated with a higher perinatal mortality

b. The Canadian randomised trial (Hannah et al) showed that induction of labour increases the likelihood of caesarean section.

1992
Induction of labour as compared with serial antenatal monitoring in post-term pregnancy. A randomised controlled trial. The Canadian Multicenter Post-term Pregnancy Trial Group.
- In post-term pregnancy, IOL results in a lower rate of C/S than serial antenatal monitoring
- Rates of perinatal mortality and neonatal morbidity are similar with the two approaches to management

14

Which of the following is LEAST true of HIV?

a. High viral load (>10,000 copies/mL, low CD4 count (<400 x 106) and more than 4 hours ruptured membranes all double the risk of mother-to-child transmission of HIV.
b. With all available initiatives, the incidence of mother-to-child transmission of HIV should be reduced to approximately 5%.
c. Antiviral chemotherapy lowers the risk of mother-to-child transmission of HIV to approximately one-third of the risk without chemotherapy.
d. Opportunistic infections commonly develop when the CD4 count falls below 200 x 106 per litre.

b. With all available initiatives, the incidence of mother-to-child transmission of HIV should be reduced to approximately 5%.

With ART, appropriate mode of delivery, formula feeding, baby receiving PEP, incidence of perinatal transmission <2%

Duration of ROM does matter

15

Oral contraceptives are associated with a decreased risk of each of the following EXCEPT:

a. ectopic pregnancy.
b. endometriosis.
c. pelvic inflammatory disease (PID).
d. cervical cancer.

d. cervical cancer.

16

Contraception in the peri-menopausal woman should be continued until:

a. she has had three anovulatory cycles in a row.
b. she has had one full year without periods and exogenous hormones.
c. she has had a blood test showing FSH:LH ratio has risen to two.
d. her cycle has begun to elongate.

b. she has had one full year without periods and exogenous hormones.

17

A woman in mid-pregnancy develops intractable constipation which has not responded to fibre supplements.
The next appropriate therapy is:

a. Magnesium sulphate.
b. Lactulose.
c. Coloxyl (Docusate).
d. Bisacodyl (Durolax).

b. Lactulose.

1st line - dietary fibre
2nd line - increase bulk
3rd line - osmotic - lactulose (MgSO4)
4th line - stimulant - bisadocyl, Docusate

Docusate - theoretically increase risk of PTB

18

The incidence of lymph node involvement in micro-invasive carcinoma of the cervix is:

a. 5%.
b. 1%.
c. 3%.
d. 10%.

b. 1%.

IA1 - (<3mm stromal invasion) incidence of positive LNs is <1%
IA2 - (3-5mm stromal invasion) - 7-8% LN involvement

19

A Chinese born woman is noted on her routine antenatal testing to have a haemoglobin concentration of 115g/L (Normal range: 110-150), MCV of 72fL (Normal range: 85-95). Her ferritin is 25mcg/L (Normal range: 20-100) and her haemoglobin electrophoresis is normal.
Which test will help most to ascertain fetal risk?

a. Test her partner's full blood examination
b. Test her partner's haemoglobin electrophoresis
c. Test her haemoglobin DNA genotype
d. Test for serum transferrin

a. Test her partner's full blood examination

Hemoglobin analysis and/or genetic testing is required to confirm the diagnosis of thalassemia

20

A 36-year-old, primigravid woman at 16 weeks of gestation, has received genetic counselling and has chosen to proceed with prenatal diagnosis as there has been unusually slow growth of the fetus since the 12 week scan.
Which of the following is most correct?

a. Amniocentesis is indicated because it is too late for chorionic villus sampling (CVS).
b. CVS may indicate a cause for the growth restriction, not apparent with amniocentesis as placenta mosaicism is a potential cause.
c. The risk of miscarriage associated with amniocentesis is 1:600 if performed by a maternal fetal medicine subspecialist.
d. CVS is unhelpful in this situation because of potential karyotypic disparity between fetus and trophoblast.

b. CVS may indicate a cause for the growth restriction, not apparent with amniocentesis as placenta mosaicism is a potential cause.

Confined placental mosaicism has been shown to be a clinically significant cause of FGR

Amnio - From 15/40
Optimal timing 15+0 to 17+6

CVS - From 11/40 (11 to 14 weeks)
Although CVS can be performed >14/40, amniocentesis is preferred from 15/40 as technically easier, more comfortable for patient and avoids placental mosaicism

21

Which of the following statements about pituitary prolactinomas is correct?

a. The effects of oestrogen deficiency are rarely an indication for treatment of young women with microprolactinomas and amenorrhoea.
b. Patients with microprolactinomas should be maintained on dopamine agonist therapy such as bromocriptine throughout pregnancy.
c. Patients with untreated microprolactinomas should be discouraged from breastfeeding.
d. They are found, at post-mortem examination, in approximately 10% of women who have died of non-endocrine disease.

d. They are found, at post-mortem examination, in approximately 10% of women who have died of non-endocrine disease.

22

A 26-year-old multigravid woman at 30 weeks gestation, comes to the labour suite at a Level II hospital with a frank breech presentation at +3 station. Delivery begins to occur spontaneously until expulsion of the fetal thorax, when the cervix is noted to be incompletely dilated and the fetal head entrapped.
Which of the following would be of most value in this clinical situation?

a. Glyceryl trinitrate (GTN)
b. Thiopentone
c. Magnesium sulphate
d. Fentanyl

a. Glyceryl trinitrate (GTN)

23

Which of the following is LEAST true of vulval melanoma?

a. Melanoma represents approximately 2% of all vulval malignancies.
b. Occur more frequently on the labia majora than labia minora.
c. 5-year survival with subcutaneous penetration is approximately 20%.
d. The majority of melanoma cases are postmenopausal.

b. Occur more frequently on the labia majora than labia minora.

Most common on the labia minora

Although vulvar melanomas account for less than 1 percent of all melanomas, they represent 10 percent of all malignant tumors involving the vulva

24

Select one:With regard to perinatal mental health, which of the following statements is INCORRECT?

a. A woman with a Edinburgh Postnatal Depression Scale (EPDS) score of 13 or more should be further assessed promptly.
b. Up to 80% of women have “postnatal blues” at day four.
c. Selective serotonin reuptake inhibitor (SSRI) treatment is unsafe antenatally but low risk during breastfeeding.
d. Approximately 10% of women will experience depression during pregnancy.

c. Selective serotonin reuptake inhibitor (SSRI) treatment is unsafe antenatally but low risk during breastfeeding.

25

A 31-year-old HIV positive woman near term is on anti-retroviral therapy. Her viral load is undetectable and there is no fetal complication. She wants to have a vaginal birth rather than a caesarean section.
After explaining the risk, what is the next most appropriate step?

a. Respect the patient’s decision as the risk of transmission is low.
b. Perform the caesarean section at 38 weeks or if in labour.
c. Contact Psychiatry to evaluate the patient’s decision.
d. Contact the hospital lawyers for court orders for a caesarean section.

a. Respect the patient’s decision as the risk of transmission is low.

26

Which of the following statements about the recognised unwanted effects of drugs is correct?

a. Hirsutism is associated with cyproterone acetate.
b. Hot flushes are associated with clomiphene citrate.
c. Hypertension is associated with bromocriptine.
d. Fetal virilisation is associated with medroxyprogesterone acetate.

b. Hot flushes are associated with clomiphene citrate.

Orthostatic hypotension = side effect of bromocriptine

27

A 53-year-old postmenopausal woman has been reading about Tibolone and would prefer to use it rather than oestrogen/progestogen therapy (Menopause Replacement Therapy-MRT).
You tell her that Tibolone:

a. is as effective as bioequivalent doses of combined MRT in reducing the frequency of vasomotor symptoms.
b. has a reduced incidence of vaginal bleeding compared with combined MRT.
c. decreases the risk for endometrial cancer compared with placebo.
d. has less risk for breast cancer recurrence than placebo.

b. has a reduced incidence of vaginal bleeding compared with combined MRT.

28

In the graafian follicle, the theca and granulosa cells cooperate to synthesize oestradiol (two-cell theory).
The two-cell theory is plausible because:

a. theca lutein cells express receptors for FSH.
b. androstenedione and testosterone are aromatised in theca cells to oestradiol.
c. granulosa cell has p450 aromatase.
d. granulosa cell has 17b hydroxylase.

c. granulosa cell has p450 aromatase.

Oestrogen production requires
- LH to stimulate ovarian theca cells to produce androgens from cholesterol (via desmolase)
- FSH stimulates ovarian granulosa cells to convert androgen into oestrogen (via aromatase)

29

Which one of the following is INCORRECT?

a. Iron requirement in the menstruating, non-pregnant, female is approximately 2mg/day.
b. Iron requirement in the pregnant female is approximately 9mg/day.
c. Iron absorption in the non-pregnant adult is approximately 5% of daily intake.
d. Cord blood serum ferritin is greater than maternal serum ferritin.

b. Iron requirement in the pregnant female is approximately 9mg/day.

Iron requirement (NZ MoH)
- breastfeeding 9mg/day
- pregnant women 27mg/day
- non-pregnant - 18mg/day

30

Which of the following statements is true regarding third trimester idiopathic oligohydramnios confirmed on ultrasound?

a. Amnioinfusion should be performed regularly until term.
b. Isolated oligohydramnios is associated with worse perinatal outcomes.
c. The use of amniotic fluid index (AFI) of less than 5cm rather than a single deepest pocket (SDP) of less than 2cm for diagnosis improves perinatal outcome.
d. The earlier the diagnosis in the 3rd trimester the worse the perinatal outcomes.

d. The earlier the diagnosis in the 3rd trimester the worse the perinatal outcomes.

Compared to SDVP of <2cm, an AFI <5cm is associated with increased:
- Diagnosis of oligohydramnios
- Induction of labour
- CS delivery for fetal distress

But with no difference in Apgar score, umbilical artery pH <7.1 or improvement in perinatal outcome
Therefore interpretation of amniotic fluid volume should be based on SDVP
- To reduce the diagnosis of oligohydramnios and need for obstetric intervention