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Obs And Gyne > Y 5 > Flashcards

Y 5 Flashcards

1
Q

Which of the following is NOT a cause of fetal tachycardia? Select one:
a. Beta blockers
b. Salbutamol
c. Maternal hyperthyroidism
d. Anaemia from fetal bleeding
e. Chorioamnionitis

A

Beta blockers

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2
Q

Choose the option that is the GREATEST contraindication to epidural anaesthesia.
a. Previous treatment with anticoagulants
b. Hypertension in pregnancy
c. Multiple pregnancy
d. Hypovolaemia
e. Patients receiving narcotics

A

Hypovolaemia

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3
Q

A 29-year-old presents with a painless vaginal bleed at 30 weeks gestation. She is a gravida 3 para 2, both by spontaneous vertex delivery. Her blood group is O Rhesus negative. Ultrasound scan shows the baby to be breech with normal biometry. The placenta is anterior, covering the cervical os but not centrally placed. What is the main risk to the fetus with this diagnosis?
a. Caesarean section I
b. Haemorrhage
c. Rhesus isoimmunization
d. Malpresentation
e. Prematurity

A

(e) prematurity if bleeding necessitates early delivery.

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4
Q

A 68-year old presents with recurrent episodes of heavy bleeding. She went through menopause at age 46 and was started on estrogen only HRT which she was taking up to the point of presentation. Endometrial aspirate is performed, and the histology returns as endometrial hyperplasia with atypia. What would you advise for this patient?
a. Oral progestogens and repeat the aspirate in 6 months I
b. Mirena and repeat the aspirate in 6 months
c. Endometrial resection
d. Discontinue the estrogen and repeat the aspirate in 6 months
e. Total abdominal hysterectomy and bilateral salpingo-oophorectomy

A

(e) “Total abdominal hysterectomy and bilateral salpingo-oophorectomy”.

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5
Q

All of the following are recognised causes of hydrops fetalis EXCEPT:
Select one:
a. Gaucher’s disease
b. Turner’s syndrome
c. Supraventricular tachycardia
d. Beta thalassemia
e. Congenital cystic adenomatoid malformation of the lung

A

Beta thalassemia

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6
Q

Endometriosis: Select one:
a. Is a uni-factorial genetic disorder
b. Is associated with later age of menarche
c. Has a lower association with first degree relatives
d. Involves cytochrome p450 genes
e. Involves cytochrome q genes

A

d. Involves cytochrome p450 genes

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7
Q

A patient is currently 10 weeks pregnant, has three children (two of them being identical twins delivered via Caesarean section and the other being a successful VBAC). She also had a previous ectopic pregnancy. What would be her gravidity and parity?
Select one:
a. G4, P2+1
b. G5, P3+1
c. G4, P3+ 1
d. G3, P3+1
e. G3, P2+1

A

c. G4, P3+ 1

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8
Q

A 28-year old attends for a routine Pap smear. The result returns as high-grade squamous intraepithelial lesion, HSIL. What is the next course of action for this patient?
a. Cryotherapy
b. HPV-DNA testing
lc. Repeat Pap smear in 3-6 months
d. Co-testing in 3-6 months
e. Colposcopy

A

e. Colposcopy

Next step after a Pap smear returns high-grade squamous intraepithelial lesion (HSIL) in women of all ages is to perform a colposcopy (registered in the American College of Obstetricians and Gynecologists’ guidelines). Colposcopy is a diagnostic procedure used to enable the examining physician to take a closer and illuminated look at the cervix, vulva, and vagina using a device named colposcope. During this procedure, biopsies can be taken if there’s suspicion of neoplasia.

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9
Q

During what procedure is this instrument MOST likely to be used?
Image result for auvard speculum

A

Vaginal hysterectomy

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10
Q

A 35-year-old is admitted to Couva Hospital at 30 weeks of gestation. She has been receiving treatment for gestational diabetes from her
specialist. Which investigation would we perform to assess the level of glycaemic control for the previous two-three months?

A

Glycosylated haemoglobin

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11
Q

A 38-year-old attends clinic with a history of subfertility, menorrhagia and intermenstrual bleeding. Saline infusion sonography demonstrates
a lesion on the posterior endometrium suggestive of a 2cm Type 1 submucosal fibroid. Which of the following would be the most appropriate
definitive management option?

A

Trans-cervical fibroid resection

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12
Q

Which of the following is NOT a recognised indication for use of MgSO4?

A

Prevention of RDS in the neonate in preterm labour

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13
Q

A 26-yr-old nulliparous women presented to the gynaecology clinic with abnormal uterine bleeding (AUB). She gives a history of irregular,
infrequent periods, dysmenorrhea and superficial dyspareunia. She has recurrent visits to the dermatologist for acne. An ultrasound done
showed three 2cm subserosal fibroids and an endometrial thickness of 8mm. Which of the following is the MOST LIKELY cause of her
bleeding?

A

Polycystic ovary syndrome

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14
Q

A 38-year old presents with dysmenorrhea and heavy menstrual bleeding. On pelvic examination the uterus is found to be globular, soft and
enlarged to 12-weeks size. The doctor thinks adenomyosis is the most likely diagnosis. Which imaging modality would be best to support
this diagnosis?

A

Transvaginal ultrasound

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15
Q

All of the following drugs are used in the management of hypertension in pregnancy except:

A

Enalapril

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16
Q

Hormone Replacement Therapy (HRT), please select the statement that is best suited to HRT.

A

d. Is contraindicated in patients with a past history of deep vein thrombosis.

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17
Q

A 38-year-old with a parity of 2+0 presents to the labour ward at 35 weeks gestational age complaining of constant abdominal pain. She is
having PV bleeding and her BP is 200/120 mmHg. A fetal heart rate could not be found on ultrasound. You perform a digital examination and
she is found to be 3 cm dilated. A CBC done showed a haemoglobin of 9.1 g/dl and a platelet count of 287 x 109/l. Which of the following is
LEAST likely to be part of the management?

A

c. Augment labour with a Syntocinon infusion

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18
Q

An 18-year-old is having intractable nausea and vomiting at 7 weeks gestation in her first pregnancy. What parameter in her urinalysis can be
used to assess severity and the need for intravenous fluid intervention?

A

Ketones

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19
Q

Which of the following ultrasound findings suggests a missed miscarriage?

A

c. A gestational sac diameter of 26mm with no fetal pole

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20
Q
A
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21
Q

The registrar on call is about to perform a forceps delivery. He is trying to determine the position of the fetal head. Which of the following is NOT considered a malposition?
Select one:
a. Ocipito-anterior
b. Occipito-transverse
c. Rtoccipito-anterior
d. Occipito-posterior
e. Occipito-obliqie

A

a. Ocipito-anterior

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22
Q

Which of the following is not a cause of hypergonadotrophic hypogonadism? Select one:
a. Turners syndrome I
b. Kallman’s syndrome
c. Irradiation to ovary
d. Premature ovarian insufficiency
e. Fragile X syndrome

A

Kallman’s syndrome

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23
Q

In an HIV positive woman on HAART, at what viral load level can a vaginal delivery be attempted?
Select one:
a. Less than 250 copies/ml
Ib. Less than 25 copies/ml
c. Less than 200 copies/ml
d. Less than 100 copies/ml
e. Less than 50 copies/ml

A

Less than 50 copies/ml

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24
Q

Which of the following is NOT TRUE regarding Clomiphene citrate?
Select one:
a. It is given on days 2-6 of the menstrual cycle
Ib. It can cause ovarian hyperstimulation syndrome
c. It is an anti-oestrogen
d. It increases the chance of having a multiple pregnancy

A

It is an anti-oestrogen

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25
Q

A 35-year-old woman with a parity of 2+2 had an OGTT done at 28 weeks. The values were as follows: Fasting - 90mg/dl, 1hr - 160 mg/dl, 2hr - 135 mg/dl. What would be the next step in management?
a. Advise on BSP with a 1600 – 1800 calorie diet
b. Reassure and repeat OGTT in 2-4 weeks Ic. Advise on BSP with normal diet
d. Advise on BSP and start Metformin
e. Reassure and continue routine antenatal care

A

Reassure and continue routine antenatal care

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26
Q

You are assisting at an abdominal myomectomy being done through a Pfannenstiel incision. At what point in the surgery would the consultant point out the arcuate line?
a. While dividing the abdominal peritoneum
b. After mobilizing the uterus from the Pouch of Douglas
c. After dividing the anterior rectus sheath but before separating the rectus abdominus muscles
d. While dividing the anterior rectus sheath
e. After the skin incision in the subcutaneous layer

A

After dividing the anterior rectus sheath but before separating the rectus abdominus muscles

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27
Q

During which phase of the menstrual cycle are progesterone levels highest?
Select one:
a. Ovulation
b. Follicular phase
c. Luteal phase
d. Proliferative phase
e. Menstruation

A

Luteal phase

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28
Q

The relationship between a chosen portion of the fetal presenting part to the maternal pelvis is known as: Select one:
a. Lie
b. Presentation
c. Attitude
d. Position
e. Engagement

A

Position

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29
Q

Tranexamic acid:
Select one:
a. Is contraindicated in women with a history of peptic ulcers
b. Is contraindicated in women with a previous thromboembolism
c. Is an anti-prostaglandin
d. Prevents the conversion of plasmin to plasminogen e. Is a fibrinolytic agent

A

b. Is contraindicated in women with a previous thromboembolism

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30
Q

When performing a routine uncomplicated Caesarean section, which of the following is NOT usually done?
a. A Joel-Cohen’s incision is made
b. The uterovesical fold is deflected
c. The uterus is closed in 2 layers
d. A lower transverse uterine incision is made

A

b. The uterovesical fold is deflected

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31
Q

A 23-year-old G1 Para 0 at week 38 is being managed with magnesium sulphate while she undergoes induction of labour for severe pre- eclampsia. She received a 4 g bolus followed by a continuous infusion of 1.0 g/hr. The nurse found the patient to have absent patellar reflexes and a respiratory rate of 6 breaths per minute. The patient was arousable but very drowsy. In addition to discontinuing the drug, what should be your next step in the management?
Select one:
a. Administer calcium gluconate
b. Intubate immediately
c. Administer Terbutaline
d. Give betamethasone
e. Do nothing further

A

Administer calcium gluconate

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32
Q

The most common presentation for vulvar intra-epithelial neoplasia (VIN) is:
Select one:
a. Pruritis
b. Ulcerative lesion
c. Vaginal bleeding
d. Papular lesion
e. Vaginal discharge

A

Pruritis

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33
Q

A 27-year-old primigravida goes into labour at term. On admission she is 3 cm dilated. The resident gets permission from the consultant to do a Caesarean section 12 hours after admission for failure to progress in labour. The cardiotocograph has been normal. What category of Caesarean section would this be?
a. 4
lb. 0
c. 2
d. 3
e. 1

A

3

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34
Q

Which of the following is LEAST LIKELY to be recommended for contraception in a woman with Sickle cell disease? Select one:
a. The low- dose oral contraceptive pill I
b. Sterilization
c. Barrier contraception
d. The progesterone only pill (mini-pill)
e. The levonogestrel containing IUCD

A

Sterilization

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35
Q

A 16-year-old attends the gynaecolgy clinic with her mother complaining of painful menstruation. She has been using mefenamic acid regularly with no relief in symptoms. Which of the following would be the most appropriate next step in management?
Select one:
a. Danazol
Ib. Tramadol
c. Norethisterone enanthate
d. COCP
e. GnRH analogues

A

COCP

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36
Q

Which of the following complaints is least likely in a woman with pre-menstrual syndrome PMS

A

Weight loss 

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37
Q

Is 16 year old premiere Vida is admitted to Port-of-Spain hospital with intermittent abdominal pain after 32 weeks of gestation. She comments that the pain is becoming more severe. On examination, the cervix is 3 cm dilated and 60 to 70% effacement. Membranes are intact. No breeding is noted for venom. What is the most likely diagnosis? 

A

Preterm labor 

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38
Q

It’s 35 year old primigravida was diagnosed with gestational diabetes at 26 weeks gestational age. she was placed on a 1600 to 1800 cal diet and advised to record a blood sugar profile. She returns at 27 weeks and the results of her blood sugar profile over the last week as shown below. What would be your next step in management?

A

Start metformin 500 mg PO bd

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39
Q

23 year old primigravida presented to her general practitioner at 20 weeks, gestation with fever, headaches and swollen, cervical lymph nodes. At 28 weeks ultrasound scan was done which showed hydrocephalus with intracranial calcification. Which of the following is the most likely caused?

A

Toxoplasmosis 

40
Q

36 year old presents with a Maria for seven months. She is not on any hormonal contraception. Her BMI and examination and normal. FSH and LHR, markedly elevated, prolactin, and androgen levels are normal. She does not bleed after progesterone challenge, but bleeds after combined estrogen, progesterone administration. What is the diagnosis?

A

Premature ovarian failure 

41
Q

The greater vestibular glands

A

Are also known as a bartholin glands

42
Q

Complications of hyperemesis gravidarum include the following, except.

A

Central pontine myelinosis

43
Q

A5 three year old presents with abnormal vaginal bleeding. She is unsure whether she has gone through menopause as she has had extended periods of amenorrhea for all her reproductive life and was told she had PCOS. Despite that she has had two children, breast-fed both, and use the combined, oral, contraceptive pill, intermittently. When not on the pill, she used condoms as contraception. She recalls having only two Pap smears the last 10 years. What factor in history would increase her risk of endometrial carcinoma

A

Periods of amenorrhea

44
Q

Regarding decelerations on a CTG, which of the following is false 

A

Variable decelerations occurred due to fetal hypoxia 

45
Q

Which of the following is usually used to compare uterine vessels when performing an uncomplicated hysterectomy

A

HEANEY forceps 

46
Q

The burn Marshall technique

A

Causes hyper extension of the fetal neck 

47
Q

Your mother books are 20 weeks gestation. In her history, she has been on warfarin for a pulmonary embolism six months ago. What congenital malformation would the fetus be at risk of having

A

Chondrodysplasia punctata

48
Q

Regarding the fetal circulation, which one of the following does not occur within minutes of birth

A

Ductus arteriosus 

49
Q

The luteal phase of the ovarian cycle

A

Commences about 14 days prior to menstruation

50
Q

Is 66 year old woman with a BMI of 36 presents with a three day history of moderate vaginal bleeding. On examination, there were no cervical or vaginal lesions. What is the most appropriate management?

A

Hysteroscopy and directed biopsy 

51
Q

Which of the following is least directed to be associated with advanced maternal age

A

Anemia

52
Q

Which of the following should be avoided when managing, cardiac patient in labor

A

Intramuscular syntrometrine

53
Q

Which of the following cardiac defect is most common with congenital rubella syndrome?

A

PDA

54
Q

Using the RCG classification of urgency, criteria, which of the following is inappropriately matched

A

Category two cesarean section - a patient with a complete placenta previous schedule for cesarean section 38 weeks

55
Q

Which of the following cardiovascular changes is not as associated with pregnancy

A

Pulmonary hypertension

56
Q

Regarding the differences between the male and female pelvis, which of the following is false

A

The male pelvis is wider than a female pelvis 

57
Q

A 32 year old complains of Vulval itching, burning on urination, and a foul smelling discharge. On speculum examination, there were multiple small, red circular lesion, stippled throughout, the cervix. Which of the following is most applicable?

A

The most likely cause organism is a protozoan

58
Q

820 year-old sexually active woman presents with a vaginal discharge. On passing the speculum, the consultant says this is a classic strawberry cervix. What would the best treatment for this infection be?

A

Metronidazole

59
Q

When performing routine uncomplicated cesarean section, which of the following is not usually done

A

The uterovesical fold is deflected

60
Q

847 year old presents with postcoital, bleeding and in male order as discharge. Speculum examination reveal a fable, fungi and cervix filled with tumor and over 4 cm in diameter. The tumor extends to the parametrium, but doesn’t reach the sidewall. The vagina is involved down to the lower third. From the information given what states can be

A

3A

61
Q

Is 17 year old developed painful blisters on her labia seven days after sex with her new partner. She has a company and fever, muscle pains and pain on urination. On examination, she has extensive Volvo vehicles and ulceration and enlarged lymph nodes. What is the most likely diagnosis?

A

Herpes simplex, primary infections

62
Q

It’s 32 years old primigravida, racist, Dee mother presents to the admission room at 24 weeks gestational age with vaginal bleeding. Which of the following is most accurate regarding management in this case

A

RHOGAM 500 units should be administered

63
Q

836 year old with a parity of 3+3 presented to the A&E department with a referral from the radiology department for an ultrasound showing a live cordial ectopic pregnancy. She is asymptomatic and her hemoglobin is 10.1. What is the most appropriate management?

A

Wedge resection

64
Q

It has a spontaneous vaginal delivery at term. The midwife place is the baby on her mothers abdomen and delays clamping the umbilical cord for one minute. Which of the following is associated with this action

A

Increase hemoglobin levels at birth 

65
Q

825 year old with a parity of OnePlus zero present to the hospital, complaining of vaginal bleeding at 32 weeks gestational age. And trying to arrive at a diagnosis which of the following is least relevant when taking a focus history.

A

When was her last baby delivered? 

66
Q

826 year old primigravida is found to have a sysop fundal height of 28 cm at 32 weeks gestation. She is sent for an ultrasound on his phone to have a fetus with normal biometry, normal umbilical artery, Doppler and an amniotic fluid index of 3.0. What fetal condition would be associated with these findings

A

Renal aGenesis 

67
Q

With respect to screening for down syndrome, the combine test involves performing nuclear translucency at 11 to 13+6 weeks and which of the following

A

BACG and PAPPA

68
Q

24 year old has seen with her partner in the gynecology outpatient clinic with a history of five first trimester miscarriages and a left femoral DVT. Her partner is 30 years old and has two children within a different partner. Which of the following investigations would be most helpful in reaching a diagnosis.

A

Lupus, anticoagulant, antibodies

69
Q

827 year old primigravida goes into labor at home. On admission she is 3 cm dilated. The resident gets permission from the consultant to do a Siri and section 12 hours after admission for failure to progress in labor. The cardio graph has been normal. What category of Cesarean and section would this be?

A

3

70
Q

24 year old, attends your clinic, thinking she may have endometriosis. What triad of symptoms is most typically associated with this diagnosis

A

Dysmenorrhea, dysperunia, infertility 

71
Q

828 year old attends for a routine Pap smear. The result returns as high-grade squamous intravital lesion. HSIL. What is the next course of action for this patient

A

COLPOSCOPY

72
Q

With regards to mirena, which of the following statements is incorrect

A

Releases both progesterone and estrogen 

73
Q

A 33 year old gravies 2 para 1 attends for an antenatal visit at 41 weeks and four days gestation. She had an uneventful delivery of a 3900 g baby boy at 39 weeks in her last pregnancy. Labor induction is recommended. In counseling her regarding the risks of going post term what would be the most important risk you would like to avoid

A

Still birth

74
Q

Which of the following is not usually associated with shoulder dystocia

A

If fetal fractures occur, usually occurs with the anterior arm 

75
Q

845 year old, attends complaining of severe menopausal symptoms affecting her quality of life. She had a hysterectomy for uterine fibroids at age 40. Both her ovaries were conserved. What would you offer her for relief

A

Estrogen, only HRT

76
Q

Is 37 year old para three woman had a difficult force delivery for fetal distress. The baby was 4.2 kg and the delivery was complicated by a shoulder Gia. She had active management of the third stage of labor. She developed a primary postpartum hemorrhage. The uterus was found to be well contracted. She had no previous surgeries. Which of the following is the most likely cause of her PPH.

A

Vaginal laceration

77
Q

A 38 year old presents with this Maria and heavy menstrual bleeding. On pelvic examination, the uterus is found to be globular, soft and enlarged at 12 weeks size. The doctor thinks adenomyosis is the most likely diagnosis. Which imaging modality would be best to support this diagnosis

A

Trans. Vaginal ultrasound.

78
Q

If 33 year old para two presents with heavy menstrual breathing. She is sexually active and does not want any more children. Clinically she is taught to have 12 weeks size uterine fibroids, and these are confirmed by transvaginal ultrasound. Which of the following options of medical management would also shrink her fibroids.

A

Ulipristal acetate

79
Q

Regarding cervical cancer, which of the following is false

A

The treatment for stage, three diseases radical hysterectomy

80
Q

Which of the following is true?

A

Spasmodic dysmenorrhea is attributed to painful contractions

81
Q

Recognize treatment options for osteoporosis include the following, except

A

Tamoxifen

82
Q

826 year old primigravida is found to be Rh D negative at booking. Her IDCT is negative at booking, and again at 28 weeks. You are seeing her at 30 weeks gestation. What would be your recommendation for this visit

A

Anti-Natal prophylaxis with anti D ig at this visit 

83
Q

Regarding the fetal circulation, which of the following does not occur within minutes of birth

A

Ductus arteriosus

84
Q

A 23 year old Gravida 2 para 1 at 16 weeks gestation complains of Fishy smelling vaginal discharge at her routine Anil visit. On examination, grey, homogenous, discharges seen. How would you manage this?

A

Oral metronidazole, 500 mg twice daily for seven days 

85
Q

A 32 year old presents to the Anil clinic after missing her period her UPT is positive. Her LNMP was 18th, May 2020. She has a regular 24 day menstrual cycle was not on any contraception and conception was spontaneous. What is her estimated date of delivery?

A

Neageles rule cannot apply

86
Q

Which of the following is not a cause of hypergonadotrophic hypogonadism

A

Kallmans syndrome

87
Q

823 year old presents with vaginal bleeding and abdominal pain. Her last menstrual period was six weeks ago, and her pregnancy test is positive. Transvaginal ultrasound reveals an empty uterus and normal ovaries. And annex cell mass is not seen. Is serum beta hcg returns at 1800 IU/L. What is the most likely diagnosis

A

Ectopic pregnancy 

88
Q

823 is having heavy, bleeding at cesarean section being performed for failure to progress in labor. The baby has been delivered, as well as the placenta and membranes. The anesthesiologist has given intravenous, oxytocin, and Urin, but the uterus remains at tonic. What would be the next best step for the resident attic

A

B lynch compression suture

89
Q

29 year old presents with painless, vaginal bleed at 30 weeks gestation. She is G3 P2 both by spontaneous Vortexx Delivery. Her blood group is O rhesus negative. Ultrasound scan shows the baby to be breached with normal biometry. The placenta is anterior, covering the cervical us OS but not centrally replaced. What is the main risk to the fetus with the diagnosis?

A

Prematurity

90
Q

Mother books at 20 weeks gestation. In her history, she has been on warfarin for a pulmonary embolism six months ago. What congenital malformation would the fetus be at risk of having

A

Chondrodysplasia punctata

91
Q

Which of the following is least likely to be associated with oligohydraminos

A

Trachea, esophageal fistula

92
Q

Is 16 year old at Tanza gynecology clinic with her mother, complaining of painful menstruation. She has been using mefanamic acid regularly with no relief and symptoms. Which of the following would be the most appropriate next step in management

A

COCP

93
Q

If 30 year old lady attends for routine Pap smear. At that visit she indicates that she is desires of pregnancy in the near future and Plants to discontinue her oral contraceptive pill. Her BMI is 36. What would be the most appropriate advice at the stage

A

 she should try to optimize her weight through diet and exercise before conception

94
Q

When proceed with an operative vaginal delivery in the labor award, which of the following is not usually done

A

Obtain written consent

95
Q

Which of the following instruments is least likely to be used when performing an uncomplicated cesarean section

A

Deavers retractor 

Obs And Gyne (2 decks)

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