GENITOURINARY



GENITOURINARY SUSAN TUCKER

1.Which is the most likely organism to cause a UTI?

a) staph saprophyticus

b) e coli

c) pseudomonas

d) klebsiella

e) strep faecalis

2.Which is not a recommended regimen for treatment of UTI in the non pregnant woman?

a) trimethoprim 300 mg orally daily for 5 days

b) augmentin duo orally b.d for 5 days

c) cephalexin 500 mg orally b.d for 5 days

d) nitrofurantoin 50 mg qid for 5 days

e) all of the above are correct

3.For what length of time should a man with a UTI be treated for?

a) 3 days

b) 5 days

c) 7days

d) 10-14 days

e) 20 days

4.Which statement is incorrect regarding the treatment of UTI in pregnant women?

a) regardless of the antibiotic chosen, the duration of treatment should be 10-14 days

b) augmentin duo b.d

c) nitrofurantoin 50mg qid

d) cephalexin 250mg qid

e) trimethoprin 300mg daily

5.What is usually considered the number of white cells necessary on microscopy to make the diagnosis of a definite UT1?

a) 1000 per mm3

b) 10000

c) 50000

d) 100000

e) 500000

6.Regarding urinalysis which is incorrect?

a) the haematuria square will also be positive for myoglobinuria and haemoglobinuria

b) pyuria has is nearly always present in a UTI

c) nitrates are not present in all UTIs, only those caused by coagulase splitting bacteria

d) nitrates are not seen if the UTI is caused by gm+ve or pseudomonas

e) Vitamin C gives many false positives – nitrites,bilirubin,ketonuria

7.If a patient presents with dysuria and only 100-1000 WBC should they receive antibiotic treatment?

a) yes

b) no

c) no, but repeat culture in 2 weeks

d) only if two such results in two specimens two days apart

e) just ural sachets

8.What is the most common age group for testicular torsion?

a) 60 years

9.Which is not a cause of epididimoorchitis?

a) amioderone

b) mumps

c) pseudamonas

d) cryptococcus

e) eruthromycin

10.Which group of people are unlikely to need treatment for their asymptomatic bacteruria- assuming their renal tracts are normal?

a) pregnant women

b) young children

c) non pregnant women

d) men under 60 years of age

e) noenates

11.Which is an correct statement regarding treatment of a torted appendix testis?

a) analgesia alone is all that is required

b) analgesia plus antibiotics for 10 days

c) surgical resection is mandatory

d) local anaesthetic infiltration into the appendix is often used

e) methotrexate has been shown to be beneficial

12.Which size renal stones have a 90% chance of passing?

a) 40 years

c) Multiple gestation

d) Diabetes mellitus

e) Multiparity

11. 25 year old female 9 weeks pregnant. PV bleed cervical os is open. This is a

A. threatened miscarriage

B. inevitable miscarriage

C. complete miscarriage

D. missed abortion

E. incomplete miscarriage

11 B

14. Regarding ectopic pregnancy:

a) 15% of all pregnancies are ectopic

b) Up to 50% of pregnancies following tubal sterilisation are ectopic

c) A 19 yo girl with abdominal pain who denies she’s pregnant does NOT need a pregnancy test

d) Rhesus negative women with ectopic pregnancies do not need anti D immune globulin

e) Most patients with ectopic pregnancy present to ED with haemodynmamic instability

53. Regarding blunt abdominal trauma in the 3rd trimester of pregnancy, which of the following is FALSE:

a) Post mortem caesarean section is only indicated if foetal heart sounds are present

b) If the patient is hypotensive, a pillow should be placed under the left hip

c) Coagulation abnormalities suggest placental injury

d) CTG is indicated even in relatively minor trauma

e) Anti-D should be administered routinely

54. With regards to drug administration in pregnancy, which of the following is TRUE:

a) Warfarin can cause abnormal foetal syndromes

b) Maintaining therapeutic maternal gentamicin levels minimizes foetal toxicity

c) Pregnancy following failure of “the morning after pill” is associated with increased incidence of foetal urogenital abnormalities

d) Quinolones are the lowest risk category for foetal toxicity

e) Sulphonamides are safe in the third trimester

Warfarin is class D in pregnancy

• In first trimester (weeks 6-9) can cause specific embryopathy syndrome

• In last few weeks can cause perinatal and intracerebral CNS bleeding and should be avoided in later pregnancy

Gentamicin is completely contraindicated in pregnancy (class D) and cause ototoxic and nephrotoxicity, monitoring levels will not help

Pregnancy after MAP is unaffected

Quinolones are category B3

Sulphonamides are class C drugs and can cause jaundice and haemolytic anaemia in the newborn and should be avoided in third trimester

14. B 53. B 54. A

1. A woman who is 6 weeks pregnant by dates presents with lower abdominal pain and PV bleeding. She has not had an ultrasound for this pregnancy. The βHCG level is 998 mIU/ml.

a) A transabdominal ultrasound is likely to demonstrate an intrauterine pregnancy, if present.

b) The βHCG level is concordant with dates.

c) If there is no intrauterine pregancy on transvaginal ultrasound, she is likely to have an ectopic pregnancy.

d) There is a significant risk of a hydatidiform mole.

e) An ultrasound is unlikely to provide a definitive diagnosis currently.

Tint 689-690

36. The following antibiotics are considered relatively safe in pregnancy except:

a) penicillin

b) trimethoprim

c) erythromycin

d) cephalothin

e) ceftriaxone

Tint 1028

1) Normal Pregnancy

a. Red cell size increase at the same rate as blood volume

b. Blood volume increases by 40% by 28 weeks

c. HR increases significantly

14. Which ONE of the following is TRUE, regarding ectopic pregnancy:

a) 15% of all pregnancies are ectopic

b) Up to 50% of pregnancies following tubal sterilisation are ectopic

c) A 19 yo girl with abdominal pain who denies she’s pregnant does NOT need a pregnancy test

d) Rhesus negative women with ectopic pregnancies do not need anti D immune globulin

e) Most patients with ectopic pregnancy present to ED with haemodynmamic instability

53. Regarding blunt abdominal trauma in the 3rd trimester of pregnancy, which ONE of the following is FALSE:

a) Post mortem caesarean section is only indicated if foetal heart sounds are present

b) If the patient is hypotensive, a pillow should be placed under the left hip

c) Coagulation abnormalities suggest placental injury

d) CTG is indicated even in relatively minor trauma

e) Anti-D should be administered routinely

54. Regarding drug administration in pregnancy, which ONE of the following is TRUE:

a) Warfarin can cause abnormal foetal syndromes

b) Maintaining therapeutic maternal gentamicin levels minimizes foetal toxicity

c) Pregnancy following failure of “the morning after pill” is associated with increased incidence of foetal urogenital abnormalities

d) Quinolones are the lowest risk category for foetal toxicity

e) Sulphonamides are safe in the third trimester

33A woman in the third trimester of pregnancy presents to the ED complaining of abdominal pain without vaginal bleeding. Vital signs are remarkable for a systolic blood pressure of 160, heart rate of 105, and a respiratory rate of 18. Which one of the following statements is TRUE concerning this patient?

A. A normal ultrasound excludes the diagnosis of placental abruption.

B. Lack of vaginal bleeding excludes the diagnosis of placental abruption.

C. A pelvic examination should be avoided.

D. A CBC, electrolytes, and renal and liver function tests should be obtained.

E. Immediate delivery is indicated.

35When a gravid female presents in cardiac arrest, all of the following statements are TRUE, EXCEPT

F. the “human wedge” is useful in bystander CPR.

G. ideally, a Cardiff wedge should be placed under the patient’s left hip and flank.

H. manual displacement of the uterus off the inferior vena cava helps increase venous return.

I. pregnant women are in an edematous state that can make intubation difficult.

J. the use of a femoral line to deliver medications should be discouraged.

2. 24year female with syncope and abdo pain

Which exludes ectopic

a) Negative betaHCG

b) USS with intrauterine sac

c) Absence of shoulder tip pain

d) ?

e) None of the above

9. 34/40 with abdo pain, PV bleeding, BP 90/-

Which is wrong?

a) Praevia unlikely

b) PV should be done

c) Blood loss 90% effective

b. LSCS must be urgently booked in all cases

c. Phenytoin is ineffective

d.

e.

20) In the treatment of eclampsia which is true

a. *Magnesium is >90% effective – sounds about right

b. LUSCS must be urgently booked in all cases. Bosh – never all

c. Phenytoin is ineffective. Bosh- it is effective but considered second line

7) In a female patient at 10 weeks gestation presenting with PV bleeding and an open cervical os which of the following best describes the situation

a. Threatened miscarriage

b. Complete miscarriage

c. Missed miscarriage

d. Incomplete miscarriage

e.

7) In a female patient at 10 weeks gestation with PV bleeding and an open cervix which of the following best describes the situation?

a. Threatened abort. Flase – os closed

b. Complete abort. False – os closed

c. Missed abort. False os closed with dead fetus inside

d. *Incomplete abort. True os can remain open

Open os is typical of an inevitable abortion.

5. Use of tocolytics in pregnancy is indicated in which of the following

Distressed fetus

22/40

34/40 For preterm labour between 24 weeks and 36 weeks TRUE

chorioamnionitis

pain from protracted contraction

19. A young female presents after a syncopal episode and is still pre-syncopal on sitting up. The following exclude ectopic pregnancy:

Tubal ligation

Past history of PID

USS demonstrating intrauterine sac

Urine HCG < 25

None of the above

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