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GROUP 1Q 1. A 22-year-old primiparous woman books her pregnancy at 11 weeks’ gestation. Her booking blood tests reveal a haemoglobin level of 10.1 g/dL. Electrophoresis reveals haemoglobin karyotype HbAS.What is the diagnosis?A Beta-thalassaemia majorB Beta-thalassaemia traitC Hereditary spherocytosisD Sickle cell anaemiaE Sickle cell trait?Q2. A 32-year-old woman is being continuously monitored during labour using a cardiotocograph (CTG). She has had one previous caesarean section for breech presentation at term. She is currently 40 weeks’ gestation and in spontaneous labour. e baseline of the CTG is 115 beats per minute.Regarding CTG analysis, what is the accepted range for the baseline rate?A 80–100 beats per minuteB 90–120 beats per minuteC 100–150 beats per minuteD 110–160 beats per minuteE 120–180 beats per minuteQ3?Recognized feature of Sheehan syndrome :A. Menorrhagia B. Galactorrhea C. Insulin resistanceD. ??Hypothyroidism E. DwarfismQ4 .Is not a uterine cause of amenorrhea ??A.mullerian agensis B.asherman syndrome C.cervical stenosis D.??Sheehan syndrome E.rokitansy syndromeQ5 . In Sheehan syndrome, changes that take place include the following EXCEPT :A. Complete lactation failureB. Feeling of lethargyC. Genital atrophyD. AmenorrheaE.?? Increased Basal Metabolic Rate (B.M.R) Q6 Patients with the following condition present with primary amenorrhea:A. Bicornuate uterusB. Polycystic ovary syndromeC. ??Imperforate hymenD. Sheehan’sSyndromeE. Anorexia nervosaQ7 .A syndrome of amnenorrhea-glactorrhea developing postpartum is :A. Ahumada del CastilloB. ??Ciari-formmelC. Budd-chiariD. Sheehan's E. SimmondQ8 .Which of the following is recognized cause of hirsutism? A anorexia nervosa B.??Cushing syndromeC.haemochromatosisD.hypothyroidismE.sheehan syndrome. Q9 .Which one is not a recognized effect of oestrogen? A Stimulates proliferation of endometrial glands B Increased ciliary activity in the epithelium of the fallopian tube C ??Decreases sensitivity of the myometrium to oxytocin D Increased uterine blood flow E Induces ferning of cervical mucusQ10 .Secondary amenorrhoea is most commonly associated with:A)sheehan's syndrome B)premature ovarian failure C)??polycystic ovarian diseasesD)HyperprolactinaemiaQ11 .Which one is a recognized physiological effect of oestrogen? A Decreased concentration of sex hormone binding globulin B Decreased concentration of thyroxine binding globulin C Decreased concentration of cortisol binding globulin D ??Increased insulin resistanceE Increased concentration of free cortisolQ12 .Which one is not a recognized effect of oestrogen? A Stimulates fat deposition in the breasts B ??Stimulates development of the alveoli of the breasts C Increases blood supply to the skin D Increases deposition of sub-cutaneous fat E Stimulates sodium and water retention by the kidneysQ13 .What is the first stage of development in tanner staging? Development of breastGrowth spurtQ14 . MRSA respond to all except A. CephalosporinsB. RifampicinC. Tetracycline D. VancomycinQ15 -Which of the following clinical features are not suggestive of PID?A. Lower abdominal pain which is typically bilateral.B. Deep dyspareunia.C. Abnormal vaginal bleeding, including post coital, intermenstrualand menorrhagia.D. Abnormal vaginal or cervical discharge which is o en purulent.E. Lower abdominal pain which is typically unilateral.Q16 .To perform an elective lower segment caesarean section, the obstetrician makes a transverse suprapubic incision. Which of the following abdominal wall layers will not be encountered transected during this incision? A. Anterior rectus sheathB. Posterior rectus sheathC. Rectus abdominis muscle D. Skin and subcutaneous tissue E. Transversalis fascia and parietal peritoneumQ17 . Which of the following is a branch of the posterior division of the internal iliac artery?A Inferior gluteal arteryB Internal pudendal arteryC Obturator arteryD Superior gluteal arteryE Uterine arteryQ18 _Which of the following hormones are stimulated by somatostatin?A) Growth Hormone (GH)B) Thyroid‐stimulating hormone (TSH) C) ProlactinD) GlucagonE) None of the aboveQ19_ What percentage of testosterone is unbound (free) in men?A) 25‐30% B) 15‐20% C) 5‐10% D) 1‐3% E) 0.1%Q20_ Prolactin is structurally similar to which of the following hormones?A) OestradiolB) Follicle Stimulating Hormone (FSH)C) Human Chorionic Gonadotrophin (HCG) D) Growth Hormone (GH)E) Anti‐diuretic Hormone (ADH)Q21_Human Chorionic Gonadotrophin (HCG) is structurally similar to which of the following hormones?A) Thyroid Stimulating Hormone (TSH) B) Growth Hormone (GH)C) ProlactinD) OxytocinE) OestradiolQ22_ Which hormone is responsible for contraction of myoepithelial cells in lactation?ALuteinizing hormoneBHuman placental lactogenCFollicle stimulating hormoneDThyrotropin-releasing hormoneEOxytocinQ23 .Lady in labour 5cm dilated vertex on 0 station cervix fully effaced. After time labour progress with 4-5 uterine contraction/ 10 min without fetal head descent..A. Forcep deliveryB. C. Section?C. Oxytocin infusionQ24 . A 30-year-old woman presents to the antenatal clinic with a history of cytomegalovirus(CMV) infection. Which test would be the most sensitive for diagnosis of congenitalinfection in pregnancy?Amniotic fluid PCRAntenatal serologyCMV-specific IgGCMV-specific IgMUltrasound scan of the fetusQ25 . Oestrogens are excreted by A Metabolism by plasma aromatases B Conjugation in the liver and excretion in urineC Conjugation in the liver and excretion in bile D Conjugation in the liver E Direct excretion in urineQ26 . what percentage of pregnancies are affected by hypothyroidism( including subclininocal hypothyroidism)??A) <0.5 %B)1%C)2.5 % ?D)5%E)10%Q27_you see a 42 year old woman in clinic who mentions she has been sweating and has frequent headaches. In examination you note her blood pressure is 195/105 and pulse rate is 110 . You suspect pheochromocytoma . Which of the following condition is not associated with higher risk of pheochromocytoma??A) multiple endocrine neoplasia type 1 ??B) multiple endocrine neoplasia type 2 C) paraganglioma syndromes type 3 D) von hippel -Lindau disease E) neurofibromatosis type 1 Q28_you are asked to review a pt with known adrenal insufficiency. Which of the following causes of adrenal insuffieciency would you not expect hyperpigmentation to be a clinical feature of ??A) water house friderichsen syndrome B) adrenal dysgenesisC) auto immune adrenalitisD) primary adrenal insufficiencyE) secondary adrenal insufficiency ??Q29_which of the following is true of nephrogenic diabetes incipidius ??A) there is deficiency of arginine vasopressin B) there is deficiency of anti diuretic harmone (ADH)C) There is insensitivity to vasopressin??D) there is deficiency of insulin E) there is insensitivity to insulin Q30_A pt with amenorrhea is seen in clinic .history and examination reveal the pt runs 10-20 miles every day and her BMI is 17.8 . Which of the following is likely to explain her symptoms ??A) polycystic ovarian syndrome B) who type 1 ovulation disorders??C) who type 2 ovulation disorder D) who type 3 ovulation disorder E) who type 4 ovulation disordersQ31_which of the following statements regarding progesterone production in the ovary is true ??A) synthesized from androgen by granulosa cells B) synthesized from androgen by granulosa cells C) synthesized from cholesterol by luteal cells??D) synthesized from cholesterol by sertoli cellsE) synthesized from aromatase by theca cells Q32_A pt is attending pre-ok clinic prior to elective excission of a bartholin 's cyst . The pt is well in them selves apart from feeling a bit tired . The nurse asks you to review them as the pt blood pressure is 88/ 58 and the bloods are as follows .Na 133mmol/lK 5.4 mmol/l Urea 8.5 mmol/l Creatinine 80 umol/lU suspect adrenal insuffieciency . What would the most appropriate next test be ??A) synachten testB) 9am cortisol ??C) 24 hour urinary cortisol D) dexamethasone suppression test E) MRI adrenal glands Q33_you review a pt notes to see they are consistently hypertensive with average BP of 160/105 . The Uand Es are also abnormal with a border line low potassium of 3.2 mmol/ l . You suspect Conns syndrome . Which of the following would be the most appropriate next test ??A)9am cortisolB) synathen test C) aldosterone -to Reno ratio ??D) dexa methasone suppression test E) 24 hour urinary catecholamines Q34_what is the appropriate response to Inc calcitonin production ??A) Inc osteoblast activity and Inc phosphate B) Inc osteoblast activity and Inc phosphate C) Inc osteoclast activity and Dec phosphate D) decreased osteoblast activity and increased phosphate E) increased osteoblast activity and Dec phosphate Q35_ which of the following inhibit glucagon??A)Ureamia??B) cholecystokinin C) arginine D) epinephrineE) acetylcholineQ . 36. A 35-year-old diabetic woman underwent vaginal surgery. Postoperatively, she has Loss of cutanous sensation over the anterior and lateral surface of the thigh. The compression of which nerve is likely to be responsible?A. Superior gluteal nerveB. Lateral cutanous nerveC. Sciatic nerveD. Femoral nerveE. Obturator nerveQ 37_What is the leading cause of primary aldosteronism ??A)Familial hyperaldosteronismB) bilateral idiopathic adrenal hyperplasia??C) Renal artery stenosis D) Renin producing tumor of juxtaglomerular appartus E) polycystic kidney Q238_ proganathism and macroglossia are fratures of which of the following ??A)acromegaly??B) sheehans syndrome C) downs syndrome D) cridu chat syndrome E) cushings syndrome Q239_what is the most common cause of hypothyroidism world wide ??A) iatrogenic B) hashimotos thyroiditis C) Reidels thyroiditis D) Iodine deficiency ??E) Ords thyroiditis Q40_what is the most common cause of premature menppuse in the UK ??A) autoimmuneB)idiopathic??C) Turners syndrome D) Fragile XE) chemotherapy Q41_ A 15 year old girl is being investigated for primary amenorrhea . She has normal secondary sexual characteristics . An ultrasound shows no uterus .what is the likely diagnosis ??A) complete androgen insensitivity syndrome ( CAIS ) B) Testicular feminaization syndrome C) Rokitansky - muster - Hauser syndrome ??D) Turned syndrome E) Swer syndrome Q42_At ovulation the surge in LG causes rupture of the mature oocyte via action on what ??A) Theca internaB) Theca extrrna??C) Granulosa internaD) Granulosa extrnaE) Large luteal cells Q43_which of the following is not a recognised cause of Hyperprolactinaemia??A) H2 antagonist B) Hyerthyroisism??C) chest wall injury D) pcos E) pregnancy Q44_ Glucagon is stimulated by which of the following ??A) Inc keto acidsB) cholecystokinin??C) somato statins D) Raised ureaE) Increased free fatty acids Q45_which of the following harmones are stimulated by somato statin ??A ) growth harmone B) thyroid stimulating harmone C) Prolactin D) Glucagon E) none of the above ??Q46_you review a 3o year old woman in clinic who's thyroid function test have demonstrated hypothyrodism. On taking a detailed history she reports having felt tired for around 6 months and noticed some wt gain but there are no other symptoms and no recent illness .Examination reveal a non tender hard goitre . Further bloods show anti thyroid peroxidase ( anti -Tpo ) and also anti thyroglobylin ( anti- Tg ) antibodies are present . What is the likely diagnosis ??A) Dequairvains disease B) Graves disease C) Toxic diffuse goitre D) Hashimotos ??E) Endemic goitresQ 47. Is not a uterine cause of amenorrhea ??A.mullerian agensis B.asherman syndrome C.cervical stenosis D.Sheehan syndrome E.rokitansy syndromeQ 48. A pregnant woman is diagnosed with toxoplasmosis. What is the drug of choice forreducing the risk of fetal infection?AciclovirIntrauterine blood transfusionMetronidazolePenicillinSpiramycin Q49 . .ALL of following features of prolectinoma in 30 yrs old lady Except?A . amenorrhoea B.bitemporal hemianopiaC.hirsutism?D.Reduced bone mineral density (BMd)E.TSH deficiency Q50 .During the menstrual cycle which of following is true of Ovulation?A.follows a midcycle Fsh surgeB.occurs 2 days after peak of LHC.?Occurs 14 days before onset of menstrual flow.D.occurs after follicles have ripened in ovary.E.occurs immediately before Lh surge.Q 51.Is the following True in testicular feminisation syndrome? A.has high testosterone levelsB.have Xy sex chromosomes?C.patient are Chromatin positive.D.Patients are Xy mosaic.E.karyotype is 47 xxyQ52 . Is following True regarding normal human seminal fluid?A.coagulates in vitroB.contains SucroseC.has Ph of 5D.is produced predominantly with in testes.E.?may contains 15% of morphologically abnormal spermatozoa.Q 53.Is the Source of oestrogen in a post menopausal woman believed to be attribute to following :A.adrenal originB.face cream with hormone contentC.hepatic originD.ovarian stromal origin?E.small amount for bone marrow.Q54. Which of the following true regarding insulin?A.interact with nuclear membrane.B.cause an increased glucose protein transport on endoplasmic reticulum. C.acts via similar mechanism as steroids.D.can b detected in lymph.??E.synthesized in alpha cells of islets of Langerhans.Q55 .In pregnancy which of following preferentially used by Mother for fetus?A . amino acid B.fatty acid?C.glucoseD.glycogenE.proteinQ56 .Which of following is true Characteristic finding in anoraxia nervosa?A . decrease in cortisol levelB.increase in LH levelC.impaired glucose tolerence.?D.raised androgen level.E.hyperkalaemiaQ 57.how many days after Conception is earliest time at which Hcg can detected in blood?A.Day 1B.Day 8?C.Day 14D.Day 20E.Day 28Q58 .which of following is true in treatment of cushing syndrome?A.After bilateral adrenalectomy nelson syndrome is prevented by adequate glucocorticoid replacement. B.Cabergoline used in petients unfit for surgery.C.?long term metyapone may b used.D.recurrece of Cushing Disease after transphenoidal surgery is virtually zero.E.Ytrium implantation is indicated in treatment of piuatory tumours compressing optic Chiasma.Q59. ALL of following features of prolectinoma in 30 yrs old lady Except?A . amenorrhoea B.bitemporal hemianopiaC.hirsutismD.Reduced bone mineral density (BMd)E.TSH deficiency Q60 .During the menstrual cycle which of following is true of Ovulation?A.follows a midcycle Fsh surgeB.occurs 2 days after peak of LHC.Occurs 14 days before onset of menstrual flow.D.occurs after follicles have ripened in ovary.E.occurs immediately before Lh surge.Q61 .Is the following True in testicular feminisation syndrome? A.has high testosterone levelsB.have Xy sex chromosomesC.patient are Chromatin positive.D.Patients are Xy mosaic.E.karyotype is 47 xxyQ62 .Is following True regarding normal human seminal fluid?A.coagulates in vitroB.contains SucroseC.has Ph of 5D.is produced predominantly with in testes.E.may contains 15% of morphologically abnormal spermatozoa.Q63 .Is the Source of oestrogen in a post menopausal woman believed to be attribute to following :A.adrenal originB.face cream with hormone contentC.hepatic originD.ovarian stromal originE.small amount for bone marrow.Q64 .Which of the following true regarding insulin?A.interact with nuclear membrane.B.cause an increased glucose protein transport on endoplasmic reticulum. C.acts via similar mechanism as steroids.D.can b detected in lymph.E.synthesized in alpha cells of islets of Langerhans.Q65 .In pregnancy which of following preferentially used by Mother for fetus?A . amino acid B.fatty acidC.glucoseD.glycogenE.proteinQ66 .Which of following is true Characteristic finding in anoraxia nervosa?A . decrease in cortisol levelB.increase in LH levelC.impaired glucose tolerence.D.raised androgen level.E.hyperkalaemiaQ67 .how many days after Conception is earliest time at which Hcg can detected in blood?A.Day 1B.Day 8C.Day 14D.Day 20E.Day 28Q 68.which of following is true in treatment of cushing syndrome?A.After bilateral adrenalectomy nelson syndrome is prevented by adequate glucocorticoid replacement. B.Cabergoline used in petients unfit for surgery.C.long term metyapone may b used.D.recurrece of Cushing Disease after transphenoidal surgery is virtually zero.E.Ytrium implantation is indicated in treatment of piuatory tumours compressing optic Chiasma.Q69_which of tbe following statement best describes menarche?a.is followed by growth spurtb.??preceded by onset of breast devlpmentc.occurss earlier in girls blw normal weightd.usually follows an ovulatory cycleQ70_A 32-year-old Asian woman is diagnosed at 28 weeks’ gestation with gestational diabetes. Treatment with metformin is commenced.Which of the following is an insulin antagonist?A CortisolB Free fatty acidsC Growth hormone D ProlactinE ??SomatostatinQ71_A 52-year-old woman with Cushing’s syndrome is referred to the preassessment clinic prior to a vaginal hysterectomyWhich of the following is a feature of Cushing’s syndrome?A Decreased plasma lactate dehydrogenaseB HypoglycaemiaC ??HypokalaemiaD HyponatraemiaE Metabolic alkalosisQ72_After ingestion of protein rich mealA Decrease insulin B ??increase insulinC decrease glucagon D decrease insulin & glucagon E increase insulin & glucagonQ73_Postoperative patient with history of DM and Asthma develop felling unwellness... Na 112 mEq/L and othe parameters normal... Diagnosis A?? AddisonB cushing $ C Conns $ D SIADHE dehydrationQ 74_Hormone secreted by placenta and fetal adrenal gland and promote maturation of fetal lung, liver, thyroid, git? A androstenodione B Dehydroepiandrosterone C corticosteroneD?? cortisolE cortisoneQ75_ An 18 year old patient comes to see you following her recent diagnosis of Polycystic Ovarian syndrome. Her BMI is 25.0 and her BP is 122/80. She is a non‐smoker and there is no personal or family history of VTE or migraine. She would like to start the pill for her facial hair. What is the most appropriate option? A) Advise her PCOS is a relative contraindication to starting the COCP. Suggest she try waxing instead B) Offer topical eflornithine as this is 1st line treatment C) ??Start co‐cyprindiol D) Start Yasmin E) Start MicrogynonQ76_Which of the following causes a decrease in SHBG? A) Combined oral contraceptive pill B) Hyperthyroidism C) Anorexia D) PregnancyE) ??ObesityQ77_ You take some pre‐op bloods on a patient with Addison's. Which of the following abnormalities is mediated primarily by glucocorticoid deficiency? A)?? Hypogylcaemia B) Hyponatraemia C) Hyperkalaemia D) Hypercalcaemia E) Metabolic acidosisQ78_ All related with primary amenorrhoea except ?A.Rokitansy syndrome B.??Sheehan syndrome C.thyroid disease D.micro adenoma ( craniapharyngiomas) E.Cushing syndrome.Q79_ Which of the following is recognized cause of hirsutism? A anorexia nervosa B.Cushing syndromeC.haemochromatosisD.hypothyroidismE.sheehan syndromeQ80_ A 48 yx old woman is found to have persistent hypertension during a work up for gynaecology operation. Further investigation reveals pheochromocytomaWhich of the following biochemical changes is associated with pheochromocytoma.A. BasophiliaB. HyperglycaemiaC. HyperkalemiaD. HypocalcemiaE. Reduced urinary catecholaminesQ 81_ Which stimulates glucagon release?Increased free fatty acids Increased amino acidsHypoglycaemia Exercise AdrenalineQ 82_ Regarding the pathophysiology of hot flushes during menopause, where is the site of initiation of the thermoregulatory dysfunction?AHypothalamusBOvaryCPineal glandDPituitary glandEThyroid gland.Q83_ What hormone is responsible for the initiation and progression of puberty?A.Gonadotropin‐releasing hormoneB.LeptinC.OestrogenD.ProgesteroneE.TestosteroneQ84_ In males, which of the following hormones facilitates the generation spermatozoa?A.DopamineB.Follicle‐stimulating hormone (FSH) C.Growth hormoneD.SomatostatinE.Thyroid stimulating hormone (TSH)Q85_PG at 14 weaks of gestation have hypertension she is most likely have risk of ?abruptionpre eclampsia.Q 86_Which one of represent as good indicator of degree of estrogenisation of female, (respond to steroid) ?A. Endometrial thickness 12mm in secretory phaseB. Endometrial thickness 10mm in secretory phaseC. Endometrial thickness 06mm in secretory phaseD. Endometrial thickness 4 mm in follicular phaseE Endometrial thickness 14mm in secretory phaseQ87_The yolk sac reaches its maximum diameter at what week of gestation?A) 6 weeks B) 10 weeks C) 16 weeks D) 24 weeks E) 38 weeksExplanation: The yolk sac increases in size up until the 10th week reaching a maximum diameter of 6mm in normal pregnancy. After the 10th week the yolk sac will gradually disappear. It is usually sonographically undetectable by 20 weeks.A yolk sac greater than 6mm diameter is suspicious of failed pregQ88_A what gestation does the fetal heart first become detectable on ultrasound?A) 4 weeks B) 6 weeks C) 7 weeks D) 8 weeks E) 9 weeksExplanation: Sources can vary on this. Some texts state the earliest time being 5+1 or 5+2 weeks. Most radiological resources quote 5+6 or 6 weeks even with high quality TVS.Q89_ A 28 year old women presents for an early scan at the EPU. On TVS what size is the gestational sac when the embryonic pole should become visible?A) 3mm B) 6mm C) 9mm D) 12mm E) 16mmExplanation: The yolk sac and embryonic pole are typically visible on TVS when they reach 3mm in size.Once the gestational sac diameter is greater than or equal to 16mm the embryonic pole should become visible.Pregnancy failure is not diagnosed until a fetal pole is not seen when mean sac diameter reaches 25 mm on TVS (and this should be confirmed by a second scan according to NICE guidance)Q90_ A 28 year old women undergoes transvaginal ultrasound scan (TVS) at the EPU. What size is the gestational sac typically when the yolk sac becomes visible on TVS?A) 3mm B) 5mm C) 10mm D) 16mm E) 20mmExplanation: The yolk sac is usually seen on TVS when gestational sac diameter reaches 8‐10mm (approx 5.5 wks) and should be visible in all pregnancies when gestational sac measures over 12mm.The yolk sac is seen on transabdominal ultrasound when the gestational sac diameter reaches 20 mm (approx 7 wks)Q91_ In early pregnancy at what gestation does the Gestational sac become visible on transvaginal ultrasound?A) 4 weeksB) 4 weeks + 3 daysC) 5 weeksD) 5 weeks + 3 days. E) 6 weeksQ92_ Regarding Ultrasound which one falseA) cavitation.B ) HeatingC) Micro streaming D) decreased velocity of blood flowQ93_ Soft markers for chromosomal abnormalities seen on an ultrasound scan not include :A) choroid plexus cyst B) echogenic bowel C)Mild renal pelvic dilatation D) fetal hydrops ??Q94_ Concerning electro surgery which one is true A) Bipolar diathermy can be used to cut tissueB) Diathermy uses low frequency electrical currentsC) Desication of tissue can be achieved using mono and bipolar diathermy???D) Direct coupling is achieved by adhering to strict safety principalQ95_A 53-year-old woman presents with chronic renal failure and a potassium concentration of 5.8 mmol/l. An electrocardiography (ECG) has been requested. What ECG feature can occur with this potassium concentration?Tall U waves, ST depressionTall T waves, wide QRS complex?Tall T waves, ST depressionFlattened T waves, ST elevationFlattened T Waves, ST depressionQ96_ With regard to the jugular venous pressure (JVP) waveform, what can cause an elevated JVP reading with a normal waveform?Tricuspid stenosisTricuspid regurgitationRight-sided heart failure?Left-sided heart failureAtrial fibrillationQ 97_ In the case of hypocalcaemia, what electrocardiography (ECG) changes typically occur?The presence of Q wavesST elevationST depressionShort QT intervalLong QT interval??Q98_You have been asked to review an early pregnancy ultrasound scan that shows a mean gestational sac of less than 25 mm and a crown rump length less than 6 mm with no visible fetal heart. What is the likely diagnosis?Threatened miscarriagePregnancy of unknown locationPregnancy of uncertain viability?Missed miscarriageInevitable miscarriageQ99_ A 16-year-old primiparous woman presents to the Early Pregnancy Unit with a two-day history of PV bleeding. She is approximately 7 weeks in to a spontaneous unplanned pregnancy. She is otherwise fit and well. Her serum HCG is 94 000 iu/l. An ultrasound scan is performed on this patient which shows no evidence of a fetal pole, but does show a placental mass in the uterus, containing multiple echoes with a 'bunch of grapes' appearance. These ultrasound findings are characteristic of which condition?Complete hydatidiform mole?Endometrioma?Live intrauterine pregnancy?Missed miscarriagePartial hydatidiform moleQ100. In Syphilis.following feature present A. Syphilitic chancre is painful.B. Chancre usually appears on the genital region 2–4 weeks after infection.C. The Wasserman reaction (WR) is a non specific test.D. Aortitis is a feature of tertiary syphilis.GROUP 2Q 1- ?After birth the proximal portion of umbilical arteries will become?A. Urachus B.medial umblical ligament C. Common iliac artery D.Internal iliac artery E.ligamentum venosum ?Only the proximal part of the umbilical arteries stays open as the intermal iliac &vwsicular arteries . The distal part forms the medial umbilical ligament on both sides in the anterior abdominal wall. The umbilical vein transforms itself into the ligamentum teres hepatis.Q 2- #microbiology #pharmacology #recalls2017 A 33-year-old woman is admitted with surgical wound infection after emergency caesarean section for suspected fetal compromise. Culture of the wound demonstrates methicillin-resistant Staphylococcus aureus (MRSA). She has no known allergies. Which is the most appropriate treatment? A. Cephalosporins B. Clindamycin C. Vancomycin D. Clindamycin and vancomycin E. Piperacillin/tazobactamQ 3- which of following organism colonize copper IUd?A.lactobacillus B.actinomycetes species C.mobilincus D.ureaplasma E.straphylococcus aureusQ 4- bacterial vaginosis is diagnosed with depletion in number of which organism?A.lactobacillus B.mobiluncus?C.gardenella vaginallisD.Trichomonas vaginalisE.Trepenoma pallidumQ 5-Which hormone has a primary site of action on granulosa cells?A . Gonadotropin releasing hormone (GnRH)B. Follicle stimulating hormone (FSH)??C. InhibinD .Luteinising hormone (LH)E. RelaxinQ 6- Which hormone stimulates androgen production by action upon theca interna cells?A)Follicle stimulating hormone (FSH)B)Gonadotropin releasing hormone (GnRH)C)InhibinD)Luteinising hormone (LH)?E)RelaxinQ 7- Which of following hormone secreted from posterior pituitary:a) A .CTH b) TSH c) Oxytocin? d) LH e) FSHQ 8. Which of the following hormone secreted from acidophilic cells of pituitary gland:a) FSH b) LH c) TSH d) GH? e) ACTHQ 9. Which of following is wrong statement abut hormones:a) Protein hormones present in bound form in circulation?b) Protein hormones half life is in minutec) Steroid hormone present in boud form in circulationd) Steroid hormone receptors are intracellulare) Protein hormone receptors are present on outer surface of cell membrane. q 10.which clinical syptoms is not characteristic of mild thyrotoxics.A.thyromegaly B.tachycardia C.cold intolerance? D.poor maternal weightQ 11.women with thyroid peroxidase antibodies was an associated increased risk of which of the following?A.placenta previa B.preterm delivery?C.placental abruption? D.PROM25.maternal source accounts for what percentage of fetal thyroxine at term?A.10% B.30%?C.50% D.70%Q 12.Which of the following is true of thyroid stimulating hormone during pregancy?A.decrease levels are found in early pregancy?B.TSH cross the placenta and stimulates fetal throxine production.C.TSH levels are increased in early pregnancy because of the effects of HCG.D.none of the above Q 13.Which of the following increases sex hormone binding globulin?A Growth hormone B Hepatic cirrhosis C Hyperprolactinaemia.?D Hypogonadism ? E. HypothyroidismQ 14.A 23-year-old woman is seen in the gynaecology clinic after an ultrasound scan?reveals multiple cysts on both ovaries. She also complains of irregular menstrual cycles and has been trying to conceive for over 1 year .Which of the following lead to clinical manifestations of polycystic ovarian syndrome?A Decrease in oestradiol levels ?B. Decrease in prolactin C. Decrease in testosterone and androstenedione D. Increase in fasting insulin ?E. Increase in sex hormone binding globulinQ 15. A 34-year-old woman undergoes regular ultrasound scans for follicle tracking having been started on clomiphene treatment. Which of the following statements most appropriately describes the mature?ovarian follicle?A. Its development is primarily controlled by luteinising hormone.B. It is surrounded by theca cells.C. It is usually the only primary follicle to develop during each cycle.D. It produces progesterone.?E. It reaches a diameter of 20–30mm prior to ruptureQ 16 .A 32-year-old woman is referred to the gynaecology clinic with secondary amenorrhoea. Day 21 progesterone levels indicate that she is not ovulating.Which of the following statements best describes the events occurring at the midluteal phase of the menstrual cycle?A An increase in progesterone and selective rise in follicle-stimulating?hormone (FSH)B High progesterone leads to low FSH and luteinising hormone (LH)C Oestradiol decreases and FSH increasesD Oestradiol feedback becomes negative leading to LH surge?E Peak of LH surgeQ 17 .A 21-year-old woman is started on the mini pill. She asks you about the possible?side effects of progesterone.Which of the following is a property of progesterone?A Increases contractility of uterine smooth muscleB Increases respiratory driveC Inhibits lobular alveolar development of mammary glandsD Promotes lactation during pregnancyE Reduces bone densityQ 18 .A 51-year-old woman is started on hormonal replacement therapy (HRT). You consider the properties of oestrogen when discussing the contraindications to HRT treatment.Which of the following is a property of oestrogen?A Decreases bone formation. ?B Decreases circulating coagulation factors. C Increases bowel motility.D Reduce triglycerides in blood. E Stimulates growth of endometrium Q 19 .Which immunoglobulin class has a "pentameric" structure and is unable to cross the placenta?A. IgA B. IgG C. IgM D. IgD E. IgEQ 20.The following promote wound healing except A. Ascorbic acid B. Cortisol C. ProteinD. ZincE. InsulinQ 21.Of the following which one cannot be diagnosed prenatally by ultrasound?A)renal agenesisB)down syndromeC)neural tube defectsD)club footE)omphaloceleQ 22.rubella infection is diagnosed in a female your advise would be?A. termination of pregnancy B.vaccination in pregnancy C. continue the pregnancy D. screening of Ab Igm in meternal bloodQ 23.?Which of the following is the most common cause of hyperthyroidism and is typically characterised by a small to moderate diffuse firm goitre?A) Toxic adenomaB) Ovarian TeratomaC) De Quervain's thyroiditisD) Graves DiseaseE) Follicular Thyroid Carcinoma Q 24. A 29-year-old woman who is 39 weeks pregnant presents to the delivery suite in labour. Her previous child was affected by group B streptococcus (GBS) infection. She is allergic to penicillin. Which antibiotic should be prescribed for her as a prophylaxis for GBS?A.AmpicillinB.CephalosporinsC.ClindamycinD.GentamycinE.MetronidazoleQ 25. The following serum markers increase during pregnancy EXCEPT:a T3. b Protein c Alkaline phosphatase. d T4? e Thyroxine-binding globulin (TBG)Q 26.Which of the following best describes the histolgical type of endometrium soon after ovulation??A decidual react. ?B atrophic endometrium. ?C proliferative. D secret ?E arias stella phenomenonQ 27.How many days it take from the resting follicle state to ovulate? Explain pleaseA- 14 day. B_ 28 d C_ 85 d D_ 120 d E_ 375 dQ 28 You suspect adrenal insufficiency. What would the most appropriate next test be?ASynacthen test. B.24 hour urinary cortisol. C.Dexamethasone suppression test. D.MRI Adrenal glands E.?9am Cortisol.Q 29 Chromaffin cells produce which of the following hormones?ADopamine. BCorticotropin-releasing hormone C.Somatostatin D.Prolactin E.Vasopressin Q 30 A patient with amenorrhoea is seen in clinic. History and examination reveal the patient runs 10-20 miles every day and her BMI is 17.8. Which of the following is likely to explain her symptoms?A.Polycystic Ovarian Syndrome B WHO type I Ovulation Disorder. C WHO type II Ovulation Disorders. D. WHO type III Ovulation Disorders. E.WHO type IV Ovulation Disorders.Q 31?Which hormone is responsible for contraction of myoepithelial cells in lactation?ALuteinizing hormone. BHuman placental lactogen. C.Follicle stimulating hormone. D.Thyrotropin-releasing hormone E.OxytocinQ32 .Aromatase is key to Estradiol production in the ovaries. Which of the following statements is true?A. FSH induces the theca cells to make aromatase. B.Progesterone induces the granulosa cells to make aromatase. C. FSH induces the granulosa cells to make aromatase. D.LH induces the granulosa cells to make aromataseQ33 . Which of the following hormones stimulate ductal morphogenesis ?A.Progesterone, Prolactin and Hpl. B.Progesterone and hPL. C.Progesterone and?GH? D Estrogen and GH E.Oxytocin and hPLQ34 .Which of the following statements is correct with regard to oxytocin?A.Causes relaxation of myoepithelial cells in mammary glands. B.Has 10% of the antidiuretic activity of antidiuretic hormone C.Is synthesised in the posterior pituitary gland. D.Lowers the threshold for depolarisation of the uterine smooth muscle. E.The sensitivity of the uterus to oxytocin decreases as pregnancy progresses.Q35 .Which of the following is true with regard to the treatment of Cushing's disease?A:After bilateral adrenalectomy, Nelson's syndrome is prevented by adequate glucocorticoid replacementB:Cabergoline is used in patients unfit for surgeryC:Long term metyrapone may be used. D:Recurrence of CD after transphenoidal surgery is virtually zeroE yttrium implantation is indicated in the treatment of pituitary tumours compressing the optic chiasmaQ36.Which of the following drugs in pharmacological doses has been shown to cause a rise in blood glucose??AAspirinBAtenololCEthanolDGliclazideEThiazide diuretics.Q37.Which of the following is correct regarding sex hormone binding globulin (SHBG)?A.It is depressed by increasing plasma oestrogensB.It is depressed in hyperthyroidismCIt is increased by increasing levels of plasma androgensD.It is increased in pregnancy? Q38. Drugs readily cross the placenta because of which qualityA. High lipid solubilityB. High protein bindingD. ionization of molecules.Q39.Indications for emergency caesarean section following external cephalic version includeA. Vaginal bleedingB. Unexplained abdominal painC. Persistent abnormal CTGD. Fetal bradycardiaE. All of the aboveQ 40. In Chronic inflammation all occurs except A. Is associated with increased levels of IgG in the blood.B. In chronic pyelonephritis there are multiple small abscesses in the renal cortex.C. In chronic inflammation the inflammatory and healing processes proceed side by side.D. Pyaemia is an essential feature of abscess formation.E. Endoarteritis obliterans is the condition in which there are occlusions of small sized arteries by intimal proliferationQ 41 All features are of Acute inflammation exceptA. Fibrin forms a union between severed tissues.B. Kinins are polypeptides which cause relaxation of smooth muscle.C. Eosinophilia is characteristic of asthma and diphtheria.D. Prostacyclin is responsible for increased capillary permeability.E. The neutrophils cells are the first cells to emigrate through the endothelial gaps.Q42. Which of the following best describes the mechanism of action of radiotherapy?A) DNA damage via free radical generationB) Ionisation leading to cellular burstC) Cell death via oxidative phosphorylationD) Cell death via convergent thermoradiation heating effect E) Proton reductionQ43. A 57-year-old woman has finished primary treatment with chemo-radiotherapy for stage IIIa cervical cancer 3 years ago. She now presents with lower abdominal pain and loss of appetite.Which imaging modality is most suitable to investigate a potential recurrence? 1- CT 2- MRI?. 3- PET Ct. 4- TAS. 5- TVSQ44. The QRS complex in a normal ECG Represents:A.Atrial depolarization and contraction.B.electrical activity of sinoatrial node.C.final stage of ventricular repolarization.D.ventricular depolarization and contraction.E.ventricular repolarization. Q45. The lateral resolution of an ultrasound image/system depends on:A.Acoustic power B.frequency. C.position of focusd.slice thickness E.type of transducer used._______________________________________________ Q46. at what serum level bhcg should an experienced sonographer using transvaginal ultrasonography expect to detect an intrauterine sac in a normally developing pregnancy? A.10. B.50 C.100. D.500. E.1000_______________________________________________________________Q47. Magnetic resonance imaging uses following physical principles to form an image?A.alteration of electronB.conversion of low frequency current to high frequency current.C.stimulated emission of radiation.D.alignment of protons in water.E.vibration of pizoelectric crystal. Q48 .Whats main muscle being evaluated during urodynamic testing?A.detrusor B.levator ani. C.pyramidalisD.pyriformis. E.rectus abdominisQ49. Which?of?the following?might?you?expect?to?see?on?the?ECG?of?a? patient?with?hypocalcaemia???A)?Peaked?T?waves????????B)?Delta?Wave????????C)?Prolonged?PR????????D)?ST?elevation???????? E)?Long?QTExplanation:? ECG Features of Hypocalcaemia:?? Narrow QRS complex ? Reduced PR interval ? T wave flattening and inversion Prolongation of the QT-interval ? Prominent U-wave ? Prolonged ST and ST-depressionQ50. Regarding?the?ECG,?what?does?the?T?wave?represent?????????A)?Atrial?depolarisation????????B)?Atrial?repolarisation????????C)?Ventricular?depolarisation???D)Ventricular?repolarisatio??E)?Repolarisation?of?the? interventricular?septum_____________________________________________________________Q51 B) Better penetrationC) Higher sensitivity to detect flow D) Provides information on flow velocity. E) Higher sensitivity to detect small vesselsQ53. A patient is to undergo radiotherapy for locally advanced cervical carcinoma. What is the typical daily dose (fraction) of radiotherapy?A) 0.1Gy B) 0.5Gy C) 1.0Gy D) 2.0Gy E) 5.0Gy Q-54. A 34 year old patient is being investigated in the infertility clinic and is offered Hysterosalpingography (HSG). She has 28 day cycles. Which of the following statements regarding HSG is correct?A) Typically performed using iodine based water soluble contrastB) Safe to use in acute pelvic infectionC) Safe to use in pregnancyD) Utilises non‐ionizing radiationE) Appropriate 1st line test of tubal potency in patients with past history of pelvic inflammatory diseaseExplanation: HSG is contraindicated in acute pelvic infection and pregnancyIf there is likely tubal pathology (previous PID or pelvic surgery) then laparoscopy and dye testing is 1st lineQ55. Which of the following is likely to reduce the effectiveness of local radiotherapy?A) Metronidazole treatment B) Hypoxic environmentC) Polycythaemia. D) Cisplatin chemotherapyE) Cetumixab therapyQ56.You?perform?bloods?on?a?patient?with?a?history?of?anorexia.?Biochemistry? phone?with?her?U&E?results:Sodium?135?mmol/l?. Potassium?2.6?mmol/l?Urea?5.0?mmol/l?. Creatinine?35?umol/l??Which?of?the ?following?would?you?expect?to?see?on?a?patient?ECG?? A)?Peaked?T?waves???????B)?U?waves????????C)?Epsilon?waves????????D)?Flat?P?waves??. E)?Tall?Tented?T?waves?Q57. Question 8 Which?of?the ?following?is?a?form?of?non‐ionising? radiation?????????A)?X‐RAY????????B)?DEXA????????C)?Iodine ?131???????D)?CT????????E)?LASER??Q58. HYSTEROSALPINGIOGRAPGYA.ultrasound is used.B.performed during menstruak phase of cycle.C.used to investigate infertility.D.no need to do pregnancy test before hysterosalpingography.E.it is contraindicated in patients with history of chlymidia and took treatment for same. Q59.At what crown-rump length would u first expect to see a fetal heart beat using transvaginal ultrasonography ??A) 2mm?. B) > 3mm C)> 4mm D) > 5mm. E) > 6 mmQ60. Fluid filled space in follicle called :A. Lacuna B.Blastocyst. C. Antrum. Q61. Regarding Ultrasound which one false: A) cavitation. B ) HeatingC) Micro streaming D) decreased velocity of blood flow Q62. Which laser can be used in gynaecological surgery, is invisible without an aim beam andcannot be transmitted down a fibre optic cable?A. Potassium titanyl phosphate. B. Neodymium:YAGC .Helium–neon. D .Carbon dioxide. E. ArgonQ63. Gold standard for diagnosis of ectopic pregnancy isA) mri B) laparoscopy. C) usN.B:us is for diagnosis of ectopic pregnancy and laparoscopy for it's tttQ64. which of the following best describes acoustic impedance ??A) it is estimate of mean velocity of flow within a vesselB) it id the apparent bending of wavesC) it is the opposition to the passage of sound waves and is a function of density and elasticity ??D) it is when reflected waves from a moving interface undergo a frequency shift E ) it is the angle at which the wave is incident on the surface equals the angle of reflectionExplanation: acoustic impedance is a term used in description of ultrasound behaviour within a tissue . It represent the apparition to the passage of sound waves and function of density and elasticity . Q65. Which one of the following is not associated with a significant risk of pulmonary embolism?A.Femoral fracture. B.Obesity (BMI >40) C.Pelvic surgeryD.Malignant disease E. Surgical termination of early pregnancy?Q66.Regarding?PCOS?(PolyCystic?Ovary?Syndrome)?which?of?the?following?ultrasound?findings?form?part?of?the?Rotterdam?criteria?for?diagnosis?of?PCOS????????A)?Increased?ovarian?volume?>?5?cm3????????B)?Increased?ovarian?volume?>10cm3????????C)?5?or?more?peripheral?ovarian? follicles????????D)?10?or?more?peripheral?ovarian? follicles????????E)?None?of?the?above?Q67.A?34?year?old?patient?is?being?investigated?in?the?infertility? clinic?and?is?offered?Hysterosalpingography?(HSG).?She?has?28?day?cycles.?When?should?the?HSG?test?be?performed?A)?Anytime?during?cycle????????B)?Days?1‐5????????C)?Days?6‐12????????D)?Days?13‐18???????? E)?After?day?18?Q68. Which organism contains ribosomes,don not have rigid cell wall but can not be grown on inanimate culture?A.Bacteria B.CHLAMYDIA C.MYCOPLASMAD.VIRUSES. E.RICKETTSIAEQ 69. Does G6pd defiency lead to agenesis of uterus in females?Noooooo___________________________________________________Q70. Woman multipara with history of asthma,mitral stenosis in prolonged Labour since 12hours what condition is more concernA.prolonged Labour B.asthma C.mitral stenosis D.congestive heart failure. E.supraventricular trachycardia___________________________________________________Q71. A?34?year?old?patient?is?being?investigated?in?the?infertility? clinic?and?is?offered?Hysterosalpingography?(HSG).?She?has?28?day?cycles.?Which?of?the?following?statements?regardingHSG?is?correct?????????A)?Typically?performed?using ?iodine?based?water?soluble? contrast??????B)?Safe?to?use?in?acute?pelvic?infection????????C)?Safe?to?use?in?pregnancy????????D)?Utilises?non‐ionizing?radiation????????E)?Appropriate?1st?line?test?of?tubal?potency?in?patients?with?past?history?of?pelvic??inflammatory diseases___________________________________________________Q 72. 6.Regarding?the?ECG,?what?does?the?P?wave?represent??A)?Atrial?depolarisation?????. B)?Atrial?repolarisation????????C)?Ventricular?depolarisation?. ?. D)?Ventricular?repolarisation?. E)?Repolarisation?of?inter?ventricular?septum?___________________________________________________Q73. A 25 year old woman presents in emergency 12 hrs after DNC with severe abdominal pain ,dizziness and vomiting.What should be the next step in management?A)repeat DnC. B)medical management. C)laparotomyD)laparoscopy. E)myomectomy___________________________________________________Q74.Which one of the following is an example of lasers commonly used in surgery?A.Carbon monoxide B.Helium. C.MagnesiumD.NdYAG??. E.Silicon___________________________________________________Q75 :Which of the following are true of laser?A.Is an acronym for Light Amplification of Stimulated Ejection of Radiation.B.Lasing medium must be liquid. C.Produces multichromatic light.D.Requires a pair of mirrors at opposite ends of an optical cavity containing the lasing medium?E.Wavelength is determined by the stimulating current.___________________________________________________Q76 :Which of the following is true of the physics of ultrasound?A.Acoustic enhancement occurs with solid structures.B.The size of a pulse generated in an A-scan is a measure of the intensity of the reflected ultrasonic echo?C.The sound travels well through air.D.The velocity is independent on the temperature of the material through which it travels.E.Ultrasound waves pass more slowly through denser materials.___________________________________________________Q77 .Regarding external beam radiation, whicht simulation enhancer is used?A. brachytheraoy. B. 3D CRT ?. C. nd:YAG.D. CO2. E. Diode.___________________________________________________Q78. .pregnant woman with suspected PE, which test is preferable?A.CT Pulmonary Angiography(CTPA)?.B. Ventilation perfusion scan.C.duplex ultrasound. D.chest x ray.___________________________________________________Q 79. Vesicovaginal fistula due to persistent infection is diagnosed by??A. Cystourethroscopy. B. Probe test?. C. IVP.D. MRI. E. CT scan.___________________________________________________Q80. Piezoelectric crystal resonance is used in what imaging modality?A.PETB.CAT scanC.MRID.X-ray E.Ultrasound?___________________________________________________Q81:You are performing a diagnostic laparoscopy on a patient. What is the appropriate pressure for gas insufflation prior to inserting the primary trocar?A.2-5 mmHg.B.12-15 mmHg.C.20-25 mmHg??D.35-50 mmHg.E.50-55 mmHg.___________________________________________________Q82. with advance in field of radiotherapy, Refractory non hodgkin lymphoma can be treated withA. 3D CRTB. External beam radiationC. IMRTD. Radioimmunotherapy?Q83:Developments in field of radiotherpay, introduction of monoclonal antibody against CD20 conjugated to a radioisotope molecule for the treatment of refractive disease called??A. RadiosupertherapyB. Radioimmunotherapy?C.IMRTD 3D CRTE. radionon immunotherapy___________________________________________________Q84: Which type of advanced laser produce painless precise radiation?A. IMRT?B. 3D CRTC. BrachytherapyD. CO2 + ARgonE. semiconductor laser___________________________________________________Q85. Areas appear dark on USG?A.hyperechoicB.anechoicC.isoechoicD.hypoechoic ?___________________________________________________Q86 :Sonographically, fluid appear?A. Echogenic.B. Hypoechoic.C. Anechoic?D. Isoechoic.E. Hyperechoic.___________________________________________________Q87:What is the best way to achieve a cutting and simultaneous coagulation effect from the diathermy machine ?A. Use bipolar diathermy with blended waveform.B. Use bipolar diathermy with yellow (cutting pedal).C. Use monopolar diathermy with blended waveform?D. Use monopolar diathermy with yellow(cutting) and blue(coagulation) pedal simultaneously.E. Use fulguration.___________________________________________________Q88. What is the frquency of a transvaginal ultrasound scan?32 MIxB.23MHz.C.18MHz.D.6MHz?E.2MHz.___________________________________________________Q89. The difference between the peak and the baseline of ultrasound wave is called?A. Amplitude?B. Acoustic impedenceC. FrequencyD. ResolutionE. Wave length___________________________________________________Q90. Which one of the following imaging techniques gives maximum radiation exposure to the pat ient during checking tubal patency?A. Robin tube cannulationB. Hysterosalpingography?C.hystero contrast salpingography D.Hysteroscopic tube visualization E. Laparoscopy and dye intubation.___________________________________________________Q91. With regard to ultrasound with colour Doppler, how can the blue coloured flow pattern be described?A.Deoxygenated blood flow.B.Flow away from the colour box?C.Flow towards the colour box.D.Low volume of flow per unit area.E.Venous flow pattern.___________________________________________________Q92. What is the SI Unit of magnetic field? A.TeslaB.Weber.C.Gray.___________________________________________________Q93. The lateral resolution of an ultrasound image/system depends on??A.Acoustic power.B.Frequency.C.Position of focus?d.Slice thickness.E.Type of transducer.Q94. Electric conduction in biolgical tissue is due to A. ECFB. ICFC. RBCD. Interstitial fluidE. Plasma___________________________________________________Q94. Sensitivity of neural & muscle cell to electric current is A. directly propotional to frequencyB. inversely propotional to wavelengthC. directly propotional to wavelengthD. inversely propotional to frequency___________________________________________________Q95. Soft markers of chromosomal abnormalities on ultrasound includeA echogenic bowelB mid renal pelvis dilationC choroid plexus cyst D. A,B nd C E. only A nd C___________________________________________________Q96.Gold standard test to evaluate tubal patency is:A . Hysero- contrast- sonography B. ultrasoundC. HysterosalpingogramD. laparoscopy and chromotubation___________________________________________________Q97. Which modality you will use to check growing thyroid nodule in pregnancy A.Technetium scanB.Radio isotopeC. UltrasoundD.CT E. MRI___________________________________________________Q98. what is the range of wave frquencies used in ultrasonography ??A) 0.5-1MhzB)1- 20 KHzc) 30-50 MhzD) 50-100 MhzE)100 Mhz___________________________________________________Q99. Dual energy x-Ray absorptiometry which one is true A) is not used to estimate bone density B ) uses ultrasoundC) osteoporosis is diagnosed with a z score of less than -2.5 D) can be used to detect malignancyE) can ne used in children ___________________________________________________Q100. Regarding laparoscopic injuries all are true except A) serious complication occur 1in 1000B) usually occur before visualization of the peritoneal cavity C) it is easier to diagnose bowel injury than bladder injury D) intraabdominal pressures of 20-25 mmhg should be used for gas insufflation for insertion of the primary trochar E) Direct trochar insertion is an acceptable technique___________________________________________________GRoup 3Q1. parameters of fetal biophysical profile areA) non stress test B) fetal breathing C) fetal movmentD) amniotic fluid index and fetal toneE) all of above ___________________________________________________Q2. defination of pregnancy failure is A) gestational sac > 25 mm with no visible fetusB) CRL > 7 mm with no cardiac activity C ) fetal heart should be observed for 30 seconds D) all of above E) none of above ___________________________________________________Q3. Nuchel translucency is abnormal when more than A) 1mm B) 2mmC) 3mmD) 5mmE) 10 mm___________________________________________________Q4. you are discussing radiation doses for an abdominal CT .the radiation dose of an abdominal CT is equivalent to which of the following ??A) 40 chest x-RayB) 1 year natural background radiationC) 400 chest x-Ray D) 10 year natural back ground radiation E) 40 days natural background radiation __________________________________________________Q5. you asscess a 68 year old lady who has been admitted with heavy p/c bleeding . She has known heart failure . In A& E she had 1 litre of I/v saline 0.9% over 1 hour and her second litre bag of I/v saline is almost empty.you ascess her jvp. Which of the following would you expect to see in some one with heart failure and fluid over load ??A) Elevated JVP normal wave formB) kussmaul signC) Cannon A waves D) paradoxical JvpE) absent A waves ___________________________________________________Q6. you are assessing a pt pre-op who is due to undergo endometrial ablation . You notice a short PR interval and delta waves og her ECG. What is likely cause ??A) HyperkalemiaB) arrythmyogenic right ventricular dysplasiaC) Hypocalcemia D) wolf Parkinson white syndromeE) Myocardial infarction___________________________________________________Q7. Most comon mechanism of action of radiotherapy?A. direct DNA damageB. Water ionization to produe hydroxyl & hydrogen ion ??C. Photoablative effectD. Pellets insertion___________________________________________________Q8. MRI provides high contrast between differentA. BonesB. Soft tissue??C. EpiphysisD. DiaphysiscE. joints___________________________________________________Q9. in ultrasound tissue experienceA. Primary heatingB. secondary heating??C. tertiary heatingD. dual heating___________________________________________________Q10. Colonic diverticulosis is best diagnosed byA. Colonoscopy B. Nuclear scanC. Barium enema??D. CT scanE.MRI___________________________________________________Q11. Regarding X-ray which is incorrectA. are a form of electromagnetic radiationB.are longer than gamma raysC.are measured in candela??D.are very energy inefficient to produceE.are formed by acceleration of electrons___________________________________________________Q12. The typical effective dose for abdominal CT scan is..A. 0.1-0.5 mSvB. 1-2 mSvC. 3-5 mSvD. 10-15 mSv?E. 20-25 mSv___________________________________________________Q13. Which one will improve accuracy of suspected posterior placenta prévia ?A .CT scan B. sterile PV C. pelvic x Ray D. TVS ?E .MRI___________________________________________________ Q14 . Which modality you will use to check growing thyroid nodule in pregnancy A.Technetium scanB.Radio isotopeC.Ultrasound?D. CT E. MRI___________________________________________________Q15. what is the range of wave frquencies used in ultrasonography ??A) 0.5-1Mhz B)1- 20 KHz? c) 30-50 MhzD) 50-100 Mhz E)100 Mhz___________________________________________________Q16. Dual energy x-Ray absorptiometry which one is true A) is not used to estimate bone density B ) uses ultrasoundC) osteoporosis is diagnosed with a z score of less than -2.5 D) can be used to detect malignancyE) can ne used in children ?___________________________________________________Q17. Regarding laparoscopic injuries all are true except A) serious complication occur 1in 1000B) usually occur before visualization of the peritoneal cavity C) it is easier to diagnose bowel injury than bladder injury ?D) intraabdominal pressures of 20-25 mmhg should be used for gas insufflation for insertion of the primary trochar E) Direct trochar insertion is an acceptable technique___________________________________________________Q18. defination of pregnancy failure is A) gestational sac > 25 mm with no visible fetusB) CRL > 7 mm with no cardiac activity C ) fetal heart should be observed for 30 seconds D) all of above ?E) none of above Q19. Nuchel translucency is abnormal when more than A) 1mm B) 2mm C) 3mm? D) 5mm E) 10 mmQ20. you are discussing radiation doses for an abdominal CT .the radiation dose of an abdominal CT is equivalent to which of the following ??A) 40 chest x-RayB) 1 year natural background radiationC) 400 chest x-Ray ?D) 10 year natural back ground radiation E) 40 days natural background radiationQ21. you asscess a 68 year old lady who has been admitted with heavy p/c bleeding . She has known heart failure . In A& E she had 1 litre of I/v saline 0.9% over 1 hour and her second litre bag of I/v saline is almost empty.you ascess her jvp. Which of the following would you expect to see in some one with heart failure and fluid over load ??A) Elevated JVP normal wave form?B) kussmaul signC) Cannon A waves D) paradoxical JvpE) absent A waves Q22. you are assessing a pt pre-ok who is due to undergo endometrial ablation . You notice a short PR interval and delta waves og her ECG. What is likely cause ??A) HyperkalemiaB) arrythmyogenic right ventricular dysplasiaC) Hypocalcemia D) wolf Parkinson white syndrome?E) Myocardial infarction Q23. At what gestational age fetal spine can be identified? A.6 wk B. 8wk C.9wk D. 11wk E. 13wkQ24. A 40-year-old woman is noted to have an elevation of alphafetoprotein. Which is the most likely pathology diagnosed by ultrasound scan? A.Cleft lipB.Congenital diaphragmatic herniaC.MicrocephalyD.Spina bifidaE.Umbilical herniaQ25. You have taken a history from a patient with symptoms of urinary incontinence. There is no history of cancer, no suggestion of neurological disease and no pelvic masses. According to NICE guidelines which of the tests below is indicated in the initial assessment of patients with urinary incontinence?A.Post void residual volume by bladder scanB.Multi-channel cystometryC.Ambulatory urodynamicsD. VideourodynamicsE. CystoscopyQ26. DEXA scans measure bone density byA.Measuring absorption from a standardised XRAY beam energy (approx 30 KeV) aimed at 2 or more sites?A.Measuring absorption from two different XRAY beams with different energy peaks at the same siteB. Uses a computer to analyse absorption from multiple XRAYs aimed at bone from different anglesC. Uses geographical digital processing to anaylse XRAY beams in a single axis of rotationD.Measuring absorption from a standardised XRAY beam energy (approx 30 KeV) aimed at a single site from 2 or more anglesQ27. ?Regarding PCOS (PolyCystic Ovary Syndrome) which of the following ultrasound findings form part of the Rotterdam criteria for diagnosis of PCOSA. Increased ovarian volume > 5 cm3?B.Increased ovarian volume >10cm3C. 5 or more peripheral ovarian folliclesD.10 or more peripheral ovarian folliclesE. None of the aboveQ28.?Which of the following statements, if any, regarding diathermy (electrosurgery) is true?A. Frequencies above 200 KHz should not be used due to risk of electrocutionB. Plates must be properly adhered or inadequate current will be generated and will impede cuttingC. Diathermy utilises frequencies of 50-100 KHz?D. Plates must be properly adhered to prevent local burnsNone of the aboveQ29. A 28 year old women undergoes transvaginal ultrasound scan (TVS) at the EPU. What size is the of gestational sac typically when the yolk sac becomes visible on TVS?A. 3mm. B. 5mm C.?10mm D.16mm. E. 20mmQ30. ?What frequency would typically be used for monopoly diathermy?A.5 Hz B.50 KHzC.100 KHz D.?500 KHzE.10,000 KHzQ31. ?What frequency is used for trans-abdominal ultrasound?A.1.5 MHz B.?3.0 MHz. C.4.5 MHz D.6.0 MHz. E.7.5 MHz?Q.32. In early pregnancy at what gestation does the Gestational sac become visible on transvaginal ultrasound?A.4weeks B.?4 weeks + 3 days. C.5 weeksD.5 weeks + 3 days E.6 weeksQ33. ?A 28 year old women presents for an early scan at the EPU. What size is the gestational sac when the embryonic pole should become visible?A.3mm. B.6mm C.9mm. D. 12mm E.?16mmQ.34.?The doppler effect refers to which of the following The change in wave direction as it passes from one medium to another.A.?The frequency shift of reflected sound waves associated with movement of an object in respect to the transducerB.The effect when sound waves are greater than the structure they come into contact with causing uniform amplitude waves in all directions with little or C.no reflection returning to the transducer.D.Apparent bending of waves around small obstaclesE.The decreasing intensity of a sound wave as it passes through a mediumQ35. Regarding The timing of prophylactic antibiotics for Caesarean section:A- It should be given prior to skin incision .?B- It should be given at the time of the umbilical cord clamping.C- It should be given immediately after recovery of anesthesiaQ36. Comparing letrozole with clomifene citrate in patients withpolycystic ovarian syndrome, clomifene citrate is associated with:A. Lower live birth rate.?B. Lower rate of multiple pregnancy.C. Lower incidence of ovarian hyperstimulation. D. Better side e ects pro le.E. Higher implantation rate. Q37. The patient requests that you do not talk at all to husband about her medical care ... This request falls under the ethical concept of :-A). Informed consent .B). Confidentiality .?C). Personal requestQ38. A 43-year old woman attends the antenatal clinic at 16 weeksinto her first on-going pregnancy. She has undergone several rounds of IVF .Which one of the following is not an important point to discuss with her as part of your antenatal clinic counselling?a) An increased risk of gestational diabetesb) An increased risk of fetal growth restrictionc) An increased risk of pre-eclampsiad) An increased risk of Caesarean sectione) An increased risk of pre-labour rupture of the membranes?Q39. Volatage is product ofA. Electric current & wavelengthB. Electric current & velocityC. Electric current & resitance?D. Electric current & frequencyQ40. Which of the following utilises ionising radiation?A. PET? B.MRIC. LaserD. Duplex scanningE. Doppler E. Is caused by a trapanoma paQ42. Implantation of the embryo occurs at which stage?A. Blastocyst. B. Morula C. Pronuclear phaseD. Trophoblast E. ZygoteQ43. Gubernaculum ovarii is ?A. Scrotal ligament B. Ovarian ligament C. Round ligamentQ44. How many days after fertilisation does the morula form?A. 1B. 2 C.4??D. 6E. 9Q45. From which of the following structures in the fetal circulation do the umbilical arteries arise?A. Common iliac artery. B.Direct from the abdominal aortaC.Ductus arteriosusD.Ductus venosusE.Internal iliac arteries Q46. How many weeks after conception does the fetal heart and its conduction system develop?A.One to three weeks B.Three to six weeks ??C.Six to nine weeksD.Nine to twelve weeksE.Twelve to sixteen weeksQ47. From which embryological structure is the round ligament of the uterus derived?A.CloacaB.Gubernaculum ??C.Mullerian ductD.UrachusE.Wolffian ductQ48. From which of the following structures is the malleus derived?A. Mesoderm of first pharyngeal archB.Mesoderm of second pharyngeal archC.Pouch of first pharyngeal?? archD.Pouch of second pharyngeal archQ49. In pregnancy which hormone mediates involution of the uterus?A. Oestrogen. B.OxytocinC.ProgesteroneD.ProstacyclinE.RelaxinQ50. Which ONE of the following should be considered as first line treatment for hirsutism?a) Hormonal contraceptivesb) Insulin sensitizers c) 5a-reductase agonists d) GlucocorticoidsQ51.From which of the following structures is the stapes derivedMesoderm of first pharyngeal archMesoderm of second pharyngeal archPouch of first pharyngeal archPouch of second pharyngeal arch??Pouch of third pharyngeal archQ5. From which of the following structures are the stylopharyngeus muscle derived?Cleft of first pharyngeal archMesoderm of second pharyngeal archMesoderm of third pharyngeal arch ??Pouch of fourth pharyngeal archPouch of second pharyngeal archQ53. From which of the following structures are the inferior parathyroid glands derived?Mesoderm of first pharyngeal archMesoderm of second pharyngeal archPouch of first pharyngeal archPouch of second pharyngeal archPouch of third pharyngeal arch??Q54. what is the long term effect of PID?A)subfertility. B)ectopic pregnancy. C)asherman's syndromeQ55. postmenopausal woman complaining of vaginal irritation dryness etc.Ultrasound shows atrophic endometrium . What will you advise her?A) HRT. B)estrogen only pills C)topical estrogen creamsQ56 .what is risk of uterine perforation at hysteroscopy?A.0.01% B.0.1% C.1% D.10% E.15%Q57. woman 11 wks pregnant reffeted to gynae ward with 2 wks history of vormiting.she prescribed interavenous rehydration and antiemetic She shud also b prescribed which vit to reduce chance of wericke's Encephalopathy?A.vit A. B.vit B1. C.vit B6. D.vit B12. E.vit CExplanation: Wernicke's encephalopathy (or Wernicke's disease) is the presence of neurological symptoms caused by biochemical lesions of the central nervous system after exhaustion of B-vitamin reserves, in particular thiamine (vitamin B1). The condition is part of a larger group of diseases related to thiamine insufficiency, including beriberi in all its forms, and Korsakoff syndrome. When Wernicke's encephalopathy occurs simultaneously with Korsakoff syndrome it is known as Wernicke–Korsakoff syndrome.Treatment: In patients suspected of WE, thiamine treatment should be started immediately.Blood should be immediately taken to test for thiamine, other vitamins and minerals levels. Following this an immediate intravenous or intramuscular dose of thiamine should be administered two or three times daily. Thiamine administration is usually continued until clinical improvement ceases.Q58. 25 yrs old Primigravida presents at 34 wks of pregnancy with intense itching which is worse on palms of her hands and solez of her feet.A set of LFTS requested resulted;Albumin....29g/lSerum alk phos.....279u/lAlanine transaminase..80u/lGamma Gt....50u/lBiluribin.......19 u mol/lit.What other test would u request?A.bile acidsB.calcium and phosphate levelsC.full blood countD.urea electrolyteE.viral hepatitis screenQ59. midwife calls obstetric registar to review a labouring womanpartogram shows no progress of cervical dilatation for past four hrs cervix is 7 cm dilated and membranes intact.midwife concerned regarding Ctg is suspecious.whats next course of Action?A.advice woman to mobilise and review again in 2 hrs.B.arrange Caesearean sectionC . commence an oxytocin infusionD.perform artificial rupture of membranesE.perform fetal blood sampling.Q60 .following forceps delivery woman found to have extensive vaginal and perineal tears.when examined in theatre she noted 40% of external anal sphincter torn .although internal anal sphincter is intact.what degree of tear is this?A.2B .3a C.3b D.3cE.4Q61. following water bath woman elects not to have oxytocin for management of third stage of labour.thirty minutes later she is brought to consultant unit with a post partum haemorrhage owiing to an atonic uterus .if she had recieved standard oxytocin management for 3rd stage of labour by what amount would she reduced her risk of postpartum haemorrhage? A.10%B.20%C.30%D.60%E.90%Q62. An overweight 80yrs old woman with type 2 Diabetes mallitus and atrial fibrillation reffered to gynae clinic with lumpdown below.examined by registar who finds moderate size cystocle but no rectocele.what would most appropriate first time management ?A.insertion of ring pessary. B. Physiotherapy C.insertion of shelf pessary.D.treatment with hormone replacement therapy.E.vaginal hysterectomy and pelvic floor repair.Q63. 45 yrs old woman is fit and well is reffered to fertility clinic as shr would like to become pregnant.She has marked oligomenorrhoea.basic tests are organised for woman and her husband with following results:FSH..22.3 I.U//LProgesterone(mid leuteal) less than 2 nmolUltrasound. ..normal uterus .Ovaries not clearly seen.HSG:normal uterine cavity .both tubes patent.Semen analysis×2:Normal.What treatment give them greatest chance of acheiving a pregnancy?A.clomifene CitrateB.intra uterine inseminationC.IVFD.IVF with donar eggsE.IVF with donar spermQ64.21 yrs old lady with new sexual partner attends A &e department with fever,lower abdominal pain and vaginal discharge .She is otherwise well.she examined and appropriate swabs taken.a pregnancy test is negative and ultrasound scan is organised which is unremarkable. Whats appropriate course of action?A.Admit to hospital for intravenous antibiotics.B.arrange for laproscopy.C.arrange for mence treatment with antibiotics and manage as an outpatient.E.Discharge home and wait for results of swabs.Q65. following early pregnancy loss,woman can b offered treatment medical or surgical management. What percentage of women express a strong preference for surgical Evacuation for Uterus?A.12%B.19%C.34%D.64%E.82%Q66. Most sensitive body system thru out entire Pregnancy A.Cvs s C.Resp D.GitQ67. Most affected system by congenital anomalyA.Cvs. sC.GIT D.RESPQ68. which of the following best describes the process of compation ??A) It leads to the formation of trophoblast B ) IT leads to the formation of cytotrophoblast C) it is a reaction of chromosomes during meiosis D) it leads to the formation of the morula after the 16 call stageE) it refers to reaction of the sperm head on penetration of ovumQ69. True or False?Higher prevalence of the polycystic ovarian "morphology" has been reported in East Asian PCOS populations compared to Caucasian PCOS subjects. Q70. contrast dye used in MRI scans a.iodine. b.barium. c.thalium. d.gadolinium. e.tecnisiaQ71. Regarding Breech presentation, What is the Bi-trochanteric diameter?A)9 cm B)10 cm C)11 cm D)8 cm E)13 cmQ72. Regarding aneuploidies:A Trisomy 16 is the most common trisomy in miscarried fetusesB Monosomy X is incompatible with lifeC Individuals with triple X have multiorgan abnormalitiesD Noonan’s syndrome is caused by trisomy of chromosome 12E The majority of trisomies follow a non-disjunction event at mitosisQ 73. A 48 yx old woman is found to have persistent hypertension during a work up for gynaecology operation. Further investigation reveals pheochromocytomaWhich of the following biochemical changes is associated with pheochromocytoma.A. BasophiliaB. Hyperglycaemia C. HyperkalemiaD. Hypocalcemia. E. Reduced urinary catecholaminesQ 74. Following fertilization ovum completed:A.first meiotic divisionB.second meiotic divisionC.second polar bodyD.only A is correct.E.both a and c correct.Q75. First mitotic division of zygote acheived atA.20 hrsB.30hrsC.40 hrsD.50 hrsE.60 hrsQ76. Gastrulation occurs in A.1wkB.3 wksC.4 wksD.5 wksE.6 wks77. Cranial neuropore closes byA.day 16B.day18C.day 20D.day 22E.day 24Q78. Caudal neuropore closes byA.day 26B.day 16C.day 20D.day 22.E.day 24Q79. Urogenital system doesnot formA.bladderB.prostateC.bartholin glandD.collecting duct E.skene's glandQ80 . The cells of which strucutre form the chorionic villi ? A.neural crest B.endoderm C.hypoblast D.extra embryonic mesodermQ81. The first week of human development is characterized by formation of the:A. inner cell massB. hypoblastC. trophoblastD. blastocystE. all of the aboveQ82 . The early stages of cleavage are characterized by:A. formation of a hollow ball of cellsB. formation of the zona pellucidaC. increase in the size of the cells in the zygoteD. increase in the number of cells in the zygoteE. none of the aboveQ 83. With the light microscope, the zona pellucida appears as a translucent membrane surrounding the:A. primary oocyteB. zygoteC. morulaD. very early blastocystE. all of the above are correctQ84. The amniotic cavity develops:A. on the tenth dayB. within the outer cell massC. within the inner cell mass near the cytotrophoblastD. in extraembryonic mesodermE. none of the aboveQ85. During the second week of development, the trophoblast differentiates into:A. syncytiotrophoblastB. ectodermC. intraembryonic mesodermD. yolk sac (secondary)Q86. The first two intraembryonic germ layers to differentiate are the:A. ectoderm and hypoblastB. epiblast and hypoblastC. ectoderm and endodermD. ectoderm and mesodermQ87. The blastocoele becomes the:A. amniotic cavityB. extraembryonic coelomC. primary yolk sacD. chorionic cavityE. secondary cavityQ88. The bilaminar germ disc:A. consists of epiblast and mesoblastB. is derived from the outer cells of the morulaC. forms the embryo properD. synthesizes human chorionic gonadotropin, HCGQ89. The primitive streak first appears at the beginning of the _____ week.A. firstB. secondC. thirdD. fourthE. fifthQ 90. Primitive heart tube is formed at day : A.20 B.23C.19D.18 Q91. The part of the sperm containing proteolytic enzymes to digest the zona pellucida is the:A. capacitorB. headC. coronaD. acrosomeE. cumulusQ92. During the 3rd week of embryonic development, splanchnic mesoderm differentiates into blood islands with angioblasts. In what developing tissue site does this process occur?A Heart B LiverC SpleenQ93. An ovum is fertilized. After 3 weeks a blastocyst implanted on the endometrium has an inner embryoblast and an outer trophoblast. Which of the following is the next step in forming a 3-layered embryonic disk?A DecidualizationB GastrulationQ94. 80 yrs old lady with heavy post menopausal bleeding .a hysteroscopy and endometrial biopsy performed and history result confirms endometrial Ca.whats most appropriate next step?A.arrange abdominal hystrectomyB.arrange vaginal hystrectomyC.refer to radiotherapyD.refer case to multidisciplinary team meeting for management planE.refer to palliative care.Q95. 60 yrs old lady referred to gynae clinic with symptoms of urinary urgency and frequency, nocturia and urge incontinence. She also leaks urine when coughing and sneezing.physical exam unremarkable. Whats most appropriate course of action?A.arrange laproscopic colposuspensionB.arrange anterior repairC.arrange inserton of TvtD.arrange urodynamic mence treatment with oxybutyninQ96. which immunoglobulin class has a pentameric structure and is unable to cross placenta?A.IgA B.IgD C.IgED.IgG E.IgMQ97. what is immunological basis of haemolytic disease of new born (rhesus disease)and correct associated therapy.A.Rh d negative mother carries Rh d negative fetus .....administer D serumB.Rhd negative mother carries Rh d positive fetus ....administer anti d serumC.Rh positive mother carries Rh negative fetus... administer D serumD.Rh positive mother carries Rh positive fetus .. . Administer anti D serumE.Rh pisitive mother Rh positive father administer anti D serumQ98. pregnant uterus is viewed as immunopriviliged .whats cellular basis for phenomenon? A.extravillous trophoblast donot express higher levels of Mhc 1 antigen HLA-A HLA-B but do express HLA E AND GB.extravillous trophoblast express higher level of highly polymorphic Mhc 1 antigen HLA GC.extravillous trophoblast express higher levels of MHC 1 antigen HLA A B C AND GD.syncytiotrophoblast do not express higher level of MHC 1 antigen HLA A And B but do express Hla c and G.E.Syncytiotrophoblast express higher level of Mhc1 antigen HLA A;B;E and G.Q99.what type of immune hypersensitivity reaction best describe haemolytic disease of newborn (rhesus disease)?A.type 1B.type 2C.type 3D.type 4E.type 5Q100. The second wave of trophoblastic invasion occurs at which age of gastation A)4-6 weeks B) 8-12 weeksC) 12-16 weeksD)16-18 weeksE) 22-24 weeksGROUP 4Q1. Amniotic fluid A) Has a PH lower than that of fetal blood B) has higher concentration of glucose than maternal bloodC) Does not contain albuminD) Does not co rain globulin E) Has higher Fibronogen concentrationQ2. Which of the following is not radily transfered across placenta?A) Amino acidB) GlucoseC) Thyroxine D) IgGE) CaQ3. Concentration of this hormone peak in first trimester and rise again at term ?A) inhibin B) ActivinC) HcgD) Human placental lactogen E) ProgesteroneQ4. Which of the above is readily transfered across the placenta ?A) Testosterone B) parathyroid hormone C) vit DD) IgME) CalcitoninQ5. Regarding cardiac partitioning A) The atria separate from ventricle firstB) The septum primum separates the atria into 3 C) The foramen primum remains patent D) The foramen ovale forms in septum primum E) The foramen secondum forms around the foramen ovaleQ6. Regarding development of fetal heart ?which event does not occur ?A)The primordial heart and vascular system appears in the middle of week 3B)The cardiac jelly separates the my oblasts from endothelial tube C) The endocardium is formed by endothelial lining in the cardiac loop D) The pericardium is formed from the outer most my oblast E) The coronary arteries are formed from the meso thelial cell myocardium. Q7. Expansion of lungs in newborn due to A closure of ductus venosus B decreased pulmonary vascular resistance C closure of ductus arteriosus D increased pulmonary vascular resistanceQ8.the thyroid cartilage and cricothyroid muscle develop from which pharyngeal arch? A ) 1 st B) 2nd C) 3rd D ) 4 thE)6thQ9.The external carotid artery develops from which pharyngeal arch? A) ?1 st B) 2nd C) 3rd D ) 4 th E ) 6Q10.Which of the following is a feature of intestinal malrotation? A) ?Ladd's bands B) Meckel's diverticulum C) Angelman syndromeD) Cecal Diverticul E) Fibrous band of Champenois Q11.Which of the following structures develop from the mesodermal somites? A) Epidermis B) Neural Crest C) Liver D) Pancreas E) ?Ribs Q12.From which germ layer does the kidney develop? A) Endoderm B) paraxial mesoderm C)? Intermediate mesoderm D) EctodermE) lateral plate mesodermQ13.Somites are derived from which germ layer? A) Endoderm B) Ectoderm C) Intermediate Mesoderm D)? Paraaxial Mesoderm E) Lateral Plate MesoderQ14. A Bicornuate uterus is due to which of the following? A) Crossed fused ectopia B) ?Abnormal fusion and reabsorption of the paramesonephric ducts C) PKD-1 gene mutations D) Mullerian agenesis E) None of the above Q15.At what gestation does physiological gut herniation occur? A) 1 week B) 3 weeks C) 5 weeks D)? 8 weeksE) 12 weeksQ16.During formation of the mid, fore and hind guts the initial guttube undegoes rotation. Which of the following is correct regarding rotation of the midgut during this process? A) rotates 90 degrees clockwise B) rotates 130 degrees anticlockwise C) rotates 180 degrees clockwise D)? rotates 270 degrees anticlockwise E) rotates 270 degrees clockwise Q17. which of the following statements best describes the development of the urogenital system ??A) sex cords are developed from coelomic epithelium ??B) sex differentiation is present 35 days after fertilization C) Myometrial walls are present in the fetal uterus by the 5th month D) Reproductive organs are developed from paraxial mesoderm E) in female sex organ development , upper part of gubernaculum becomes the round ligamentQ18. with regard to amniotic fluid which one is false ??A) prior to keratinization, it is formed from fluid passing across fetal skin B) consist mainly of water during the first trimester C) Fetal renal function does not begin during the 6th wk D) compared with blood , amniotic fluid is slightly alkalotic ?E)albumin is the main proteinQ19. Which of the following statements best describes the development of the cardiac system ?A) fetal circulation includes two umblical veinsB) The ligamentum venosum is a remanant of umblical vein C) The heart is developed from endodermal cells D) ??The cardinal vein runs into the sinus venosus E ) Cardiac pulsations are visible 34th day after conceptionQ20. which of the following is not a derivative of the vitelline vein ??A) lower inf vena cavaB) inferior mesentric from??c) superior mesentric veinD) portal veinE) Hepatic veinQ21. with regard to development of ailementary system which one is true ??A) embryonic forgut is supplied by the coeliac artery B) MID gut includes the second part of the duodenumC) Hint gut incorporates the appendix D) Mickels diverticulum is a remanant of the vitelline duct??E) Gut is derived from ectodermQ22'. Functions of the metanephros include :A) electrolyte balance of the fetus B) production of amniotic fluid ?C) begin functioning during the 8th week D) production of fetal haemoglobinQ23. with regard to phyrangeal arches which one is false A) 1st arch : eustachian tube and middle earB) 2nd arch : muscles of facial expression , served by the 7th cranial nerveC) 3rd arch : common carotid artery D) 4th arch : glossophyrangeal nerve ?E) 6th arch : laryngeal cartilagesQ24. with regard to early embryonic development Which one is true ??A) The trilaminar forms during the second wk of development B) The notocord forms around 18 day ??C) The primitive streak is formed by day 12D) anterior neuropore closes by day 22E) upper limb buds appear around day 32Q25. Which of the following describes the mode used in creating standard grey scale ultrasound images?A A-modeB B-modeC M-mode. D Doppler modeE None of aboveQ26. standard chest X-ray is equivalent to what duration of natural background radiation:A 2–3 daysB 10 daysC 2 monthsD 18 monthsE 5 yearsQ27.biochemical markers can b used to indicate presence of a tumour.which serum marker is used to screen for trophoblastic tumour?A.activin-aB.alpha -FpC.BRCA 1D.CA125E.HCGQ28 .It is estimated that surgical site infections account for 9% of All hospital acquired infections.which of becteria are most commonly associated with such infection?A.candida albicansB.cryptococcus neoformansC.plasmodium falciparumD.staphylococcus aureusE.trichomonas vaginalisQ29 .Roughly 60% of babies born to mothers who carry gp b streptococcus will also become colonized as they pass through vagina at birth. Which strain of streptococcus is responsible for Majority of GBS infection?A.steptococcus agalactiaeB.streptococcus angiosusC.streptococcus bovisD.Streptococcus pnemoniaeE.streptococcus pyogenesQ30 .Ascending infection of vagina van induce premature labour.which pathogen is most commonly associated with bacterial vaginosis?A.Candida albicansB.chaymidia trachomatisC.gardnerella vaginalisD.listeria monocytogenesE.Neisseria meningitis31 .In Uk obstetric population risk based approach is employed to determine which women will benefit from prophylactic antibiotic treatment for GP b streptococcus infection.Assuming woman does not have an allergy to penicillin based antibiotics, which antibiotics is used for prophylaxis during labour?A.AmpicillinB.benzylpenicillinC.cefalexinD.climdamycinE.flucloxacillinQ32 .woman who had prolonged rupture of membranes presents to hospital three days after a spontaneous vaginal delivery with abdominal pain;fever and vaginal bleeding.on exam uterus tender.cervix is closed but bleeding is noted with offensive odour . what is most likely diagnosis?A . endometriosis B.endometritisC.PIDD.RPOCE.urinary tract infection Q33 .woman presents to A&E department with a painful swelling on left side of vaginal introitus.she was recently treated for PID.which gland is most likely to infected ?A.Bartholin glandB.nabothian gland.C.Sebaceous glandD.skene s glandE.sweat glandQ34. Which organism causes tubal infection that that is responsible for majority of cases of secondry infertility?A.Chlamydia trachomatisB.mycobacterium tuberculosisC.Neisseria gonorrhoeaeD.treponema Pallidum pallidumE.treponema pallidum pertenue.Q35 .Which pathogen underlines late congenital infection during childhood and presents with Eight nerve deafness;interstitial keratitis and abnormal teeth?A.Chlamydia trachomatisB.mycobacterium tuberculosisC.neisseria gonorrhoeae D.Treponema pallidum pallidumE.Treponema pallium pertenueQ36 .Chorioamnionitis infection increase risk of preterm birth by two to three fold.What Is Azithromycin sensitive pathogen which can Cause Chorioamnionitis?A.Chlamydia trachomatisB.clostridium botulinumC.listeria monocytogenes D.Streptococcus mutansE.vibrio choleraeQ37 .HPV 16 and HPV 18 are most common high risk type of infection leading to cervical cancer.what are key cellular proteins targeted by HPV E6 and E7 Protein?A.A20 And IkBAlphaB..p53 and pRbC.helicase and telomeraseD.NF -kB And p300E. cyclin E And cyclin dependant kinase 438 .Which organism is implicated in majority of urinary tract infections in pregnancy?A.E coliB.pseudomonas aeruginosaC.GbsD.staphylococcus aureusE.Trichomonas vaginalisQ39 .From which germ cell layer does the GIT tract initially develop A)?Endoderm?B)?Ectoderm?C)?Lateal?Plate?Mesoderm?D)?Paraxial? Mesoderm?E)?IntermediateQ40. What is the normal axis of the heart?A Zero to plus 90 degrees B Minus 90 to plus 180 degrees C Minus 30 to plus 90 degrees D Minus 20 to plus 70 degreesEMinus 10 to plus 90 degreesQ41. Primary alveoli develop in A glandularB canalicular C saccular D alveolar E after birthQ42. Radiologically detectable tumour is A 5mmB 10mm?C 15mmD 20 mmQ43. What process would you expect a secondary spermatocyte to undergo during spermatogenesis? A) 1st Meiotc Division B) 2nd Meiotc Division C) 1st Mitotic Division D) 2nd Mitotic DivisionE) Differentiation explanation: Secondary spermatocytes undergo the 2nd meiotic division ? Primary spermatocytes undergo the 1st (or primary) meiotic division Q44. Q12. Radiologically detectable tumour is A 5mmB 10mmC 15mmD 20 mmQ45. A 24 years old lady was diagnosed of having a twin pregnancy. She was then arranged for a scan to identify the chorionicity of her fetus. Below was the finding at the site of placenta. Based on you embryology understanding, when did the zygote divided?a. spliting of morula (day 3)?b. spliting of inner cell mass within a single blastocyst (day 4-8)c. spliting after the formation of bilaminar disc (day 9-12)d. splitting after day 12e. none of the aboveQ46. from which of following structures umblical arteries arise??A) internal iliacB) common iliacC) abdominal aortaD)ductus arteriosusE) ductus venosusQ47. how many weks after conception does fetal heart n its conduction developA. 1-3 wksB. 3-6 wksC. 6-9 wksD. 9-12 wksE. 12-16 wksQ48. How many oocytes are available at the time of puberty?125 000. 250 000500 0001 million2 millionThe answer is 250 000. There are 1-2 million primordial follicles present at birth but through the atretic process only 250 000 oocytes are available at puberty. Q49. A cystic structure is noted lateral to the vagina. This is believed to be a Gartners duct. What is the embryological origin of this structure?CloacaGenital tubercleMesonephric ductParamesonephic ductUrogenital septumThe answer is Mesonephric duct. The mesonephric duct forms the ureter and collecting system and in the female can form theepoophoron, appendix vesiculosa and Gartner's duct.Q50. Which sperm cell type undergoes the second meiotic division?Primary spermatocytesSpermatidsSecondary spermatocytes SpermSpermatogoniumThe answer is Secondary spermatocytes. Spermatogoniun are diploid and divide by mitosis to produce diploid primary spermatocytes. These divide by the first stage of meiosis to create haploid secondary spermatocytes. Secondary spermatocytes complete the second stage of meiosis to become spermatids. The conversion from spermatids to sperm is known as spermiogenesis.Q51. The intraembryonic coelom forms within which structure?EndodermIntermediate mesodermSomitesLateral plate mesodermNeural tubeThe answer is Lateral plate mesoderm. In the second week of development the lateral plate mesoderm splits to create this cavity. Itwill form the space for the thoracic and abdominal cavity.Q52. What is the best indicator of gestational age on a dating scan in the first trimester?Biparietal diameterCrown rump lengthFemur lengthGestational sac diameterHead circumference.The answer is Crown rump length. Biparietal diameter is appropriate after 14 weeks. Gestational sac measurements help in early pregnancy diagnosis.Q53. The canal of Nuck is associated with what?Broad ligamentInguinal ligamentIschiorectal fossaRound ligamentUrogenital diaphragmThe answer is Round ligament. The round ligament arises from the body of the uterus antero inferior to the cornue. It passes through the layers of broad ligaments across the psoas and external iliac vessels. It then passes through the deep inguinal ring and the inguinal canal to the labium majus. In the fetus, the round ligament is surrounded by a peritoneum, processus vaginalis, which is obliterated at birth but may remain patent as the canal of Nuck.Q54. The yolk sac rapidly degenerates before birth. In rare occasions it may persist to develop into which condition?GastrochiasisMeckel’s diverticulumUmbilical herniaVermiform appendixVolvulusThe answer is Meckel’s diverticulum. A part of the viteline duct within an abdominal wall persists, forming an omphalomesenteric fistula, omphalomesenteric cyst or a ligament. This was first described by J.F. Meckel in early 19th century. Volvulus is caused by abnormal rotation or fixation of the mid gut.Q55. The inferior one-third of the anal canal originates from which structure?Cloacal membraneEctoderm of the proctodeumEndoderm of the hind gutUrorectal septumEndoderm of the mid gutThe answer is Ectoderm of the proctodeum. The junction between the superior and inferior part is delineated by a pectinate line, justbelow the anal columns. The endoderm of the hind gut develops into the superior part of the anal canal.Q56. At what gestational age do fetal breathing movements commence?12 weeks20 weeks30 weeks36 weeks40 weeksThe answer is 12 weeks. The movements increase in frequency and strength further on in the gestational period. The movements also increase after maternal meals, acidosis and are reduced by hypoxia, maternal alcohol consumption and sedative drugs.Q57-Implantation of the embryo occurs at which stage?Blastocyst Morula Pronucleur phaseTriphoblastZygotThe answer is Blastocyst. Within 24 hours of fertilisation, the zygote undergoes cleavage. It then further subdivides into blastomeres. By the third day, the embryo contains 12 cells. By the fourth day, it is comprised of 16-32 cells and is called a morula. On day 5, the blastocyst hatches from the zona pellucida and implants into the endometrium. For in vitro fertilisation, transfer of the embryo with blastocyst has been shown to be more effective and is recommended with a single embryo transfer.Q58. Which one of the following is not associated with a significant risk of pulmonary embolism? (Please select 1 option)A. Femoral fracture B. Obesity (BMI >40)C. Pelvic surgeryD. Malignant disease E. Surgical termination of early pregnancyQ59. Which one of the following is an example of lasers commonly used in surgery?A. Carbon monoxideB. HeliumC. Magnesium D. NdYAG E. SiliconQ60. From what does the blastocyst hatch? A) Corona radiata B) Cumulus oophorus C) Perivitelline space D) Trophectoderm E) Zona PellucidaQ61. The subclavian artery develops from which pharyngeal arch? A) 1st B) 2nd C) 3rd D) 4th E) 5thQ62. From which germ layer does the kidney develop? A) Endoderm B) Ectoderm C)Intermediate mesoderm D) paraxial mesoderm E) lateral plate mesodermQ62.Which of the following structures develop from the mesodermal somites? A) Epidermis B) Neural Crest C) Liver D) Pancreas E)RibsQ63. The 7th cranial nerve develops from which pharyngeal arch? A) 1st B)2nd C) 3rd D) 4th E) 5thQ64. How many days after fertilisation does the morula form? A) 1 B) 2 C)4 D) 6 E) 9Q65. Which of the following is a feature of intestinal malrotation A)Ladd's bands B) Meckel's diverticulum C) Angelman syndrome D) Cecal Diverticula E) Fibrous band of ChampenoisQ66. The internal carotid artery develops from which pharyngeal arch? A) 1st B) 2nd C) 3rd D) 4th E) 6thQ67.The thyroid cartilage and cricothyroid muscle develop from which pharyngeal arch? A) 1st B) 2nd C) 3rd D) 4th E) 6thQ68. At what age does meconium first appear in the fetal terminal ilium? A) 2‐4 weeks gestation B) 10‐16 weeks gestation C) 18‐26 weeks gestation D) 24‐30 weeks gestation E) 34‐38 weeks gestationQ69. A 40 year old women who is 13 weeks pregnant is found to have be high risk for Downs following the combined screening test. What is the most appropriate further test to see if the foetus is affected? A) Qaudruple test. B) Early amniocentesis C) Amniocentesis D) Chorionic Villous Sampling E) Nuchal thickness imagingQ70. A women has undergone genetic testing due to her family history and has the BRCA 1 gene. What would you advise her lifetime risk of breast cancer is? A) 15 B) 30% C) 40% D) 70% E) 95%Q71. All of the following are autosomal dominant EXCEPT which one? A) RetnoblastomaB) Huntingtons C) Polycystic Kidneys D) Rett Syndrome E) Noonans SyndromeQ72. 84. A woman is 8 weeks pregnant attends for genetic counseling as she worried about CF, her sister has a child with cystic fibrosis. She is a carrier and her partner is Caucasian with a rate of 1/25 What is the risk of the child having cystic fibrosis? A. 1% B. 12.5% C. 25% D. 75% E. 100%Q73. A 2-week-old neonate is admitted to hospital with failure to thrive, tachypnoea and difficulty feeding. He is thought to have a circulatory defect. Administration of prostaglandin antagonists soon after birth can be used to therapeutically close which patent structure of fetal origin?A ?Ductus arteriosusB Ductus venosusC Foramen ovaleD Fossa ovalisE Ligamentum venosumQ74. In fetal circulation which structure caryy oxygenated blood from right atrium to left atrium? A.Ductus venosus B.?foramen ovale C.ductus arteriosus D.descending aortaQ75. In fetal circulation:A. Oxygenated blood goes along the umbilical arteriesB. The fetal lung is bypassed by means of ductus venosusC. The foramen ovale connects the two ventriclesD. ?Most of the blood entering the right atrium flows into the left atrium E. The blood in the umbilical arteries is more oxygenated that blood inumbilical VeinQ76. The following are true regarding fetal circulation except:A-?the blood in the umblical vein and ducts venosus is 100% saturated with oxygen.B-right-left shunt through the foramen ovale is maintained by high venoud return from placenta.C-right-left shunt through ductus arteriosus is mantained by high pulmonary vascular resistance.D-at birth,the ductus aretiosus closes due ti direct effect of increasing pc2.Q77. In the fetal circulation, which structure bypasses the liver, carrying oxygenatedblood directly into the inferior vena cava?A.? Ductus venosusB. Ductus arteriosusC. Foramen ovaleD. Right hepatic veinE. Portal veinQ78. how to calculate cardiac output of fetal heart????A.foramen ovale + left ventricle B. Lt ventricle alone C. ?Ductus arteriosus + aortaD.ductus venosus+aortaQ79. All are true about fetal circulation EXCEPT:A. the foramen ovale permits blood to pass from the right to the left atriumB. the ductus arteriosus carries blood from the pulmonary artery to the aortaC. ?the ductus venosus carries blood to the inferior vena cava from the umbilical arteryD. the ductus arteriosus is contractileE. the umbilical vein becomes the ligamentum teres of the adultQ80. fetal blood is returned to the umbilical arteries and the lacenta through the :A. ?hypogastric arteriesB. ductus venosusC. portal veinD. inferior vena cava E. foramen ovaleQ81. At birth, which of the following circulatory changes occurs?A.A 20-fold increase in lung blood flowB.A rise in right atrial pressureC.Anatomical closure of the ductus arteriosusD.Anatomical closure of the ductus venosusE.?Flap closure of the foramen ovaleQ82. Which of the following pair is true?a. ?umbilical vein : round ligament of liverb. umbilical artery : median umbilical ligamentc. ductus venosus : ligamentum arteriosumd. ductus arteriosus : ligamentum venosume. septum secundum : patent ductus arteriosusQ83. Which of the following statement regarding fetal circulation is correct.? A.the ductus arteriosus carries blood to the pulmonary arteries B.?the ductus venosus empties into the IVCC.foreman ovale connects the right & left ventricle D.the portal vein contains oxygenated blood E.there are 2 umbilical veins.Q84. Ductus venosus closes after birth by??A.?3 hours B.4 hours C.12 hours D.24 hoursQ85. A 15 year old girl is being investigated for primary amenorrhoea. ultrasound shows no uterus Mullerian agenesis is suspected. What is the Karyotype in Mullerian agenesis?A) 45 X B) 47 XXYC) 47 XXXD) 46 XYE) 46 XXQ87.A 45 year old woman attends the fertility clinic for the results of her recent blood tests: Test Result Follicle stimulating hormone 54.0 IU/l Leutinizing hormone 30 IU/l Progesterone 0.2 nmol/lProlactin 20 ng/ml TSH 2.5 mIU/mlWhat is the most likely cause of her subfertility?A) Hypothyroidism B) Hyperthyroidism C) Male factor infertilityD) Menopause E) Pituitary dysfunctionQ88.Regarding accelerations on the CTG which of the following statements is true regarding the RCOG interpretation of FHR (fetal heart rate):A) Their presence is abnormal B) Their presence is reassuring C) Their presence is not‐reassuring D) Their absence is not‐reassuring E) Their absence is abnormalQ89.A 32 year old has a transvaginal ultrasound that shows a left ovarian mass. The ultrasound report describes a unilocular cyst with acoustic enhancement and diffuse homogeneous ground‐glass echoes as a result of the haemorrhagic debris. What is the likely diagnosis? A) Functional cyst B) Physiological cyst C) Endometrioma D) Teratoma E) Germ cell tumourQ90. Evidence from meta‐analysis of RCTs is what level of evidence? A) Ia B) Ib C) IIa D) III E) IVQ91.A 35 year old women has been admitted to the ward. One of the nurses asks to you to review her as she appears to be sweaty and a little agitated. You review her bloods which are as follows: Hb 10.2 g/l reference range 11.5 to 16.5 Platelets 120 * 109/l reference range 150 to 400WBC 3.5 * 109/l reference range 4.0 to 11.0 MCV 102 fl reference range 80 to 97 Sodium 135 mmol/l reference range 135 to 145Potassium 3.8 mmol/l reference range 3.5 to 5.5 Urea 1.9 mmol/l reference range 2.8 to 7.8Creatinine 54 umol/l reference range 45 to 90 What is the likely causeA) Gastrointestinal bleed B) Iron deficiency C) Alcohol abuse D) Thyrotoxicosis E) LeukaemiaQ92. What is the incidence of molar pregnancy in the UK?A) 1 per 100 pregnanciesB) 5 per 100 preganciesC) 1 per 1000 pregnanciesD) 5 per 1000 pregnanciesE) 5 per 10,000 pregnanciesQ93. A 40-year-old woman presents at 14 weeks of gestation. She opts to have antenatal screening. Her blood tests show an increase in β-hCG and low PAPP-A. At her dating scan there is a raised nuchal translucency noted. What is the most likely explanation for these results?Down syndromeEdward’s syndromeNormal pregnancyPatau's syndromeTwin pregnancyPappalysin-1, also known as pregnancy-associated plasma protein A, is a protein encoded by the PAPPA gene in humans. PAPPA is a secreted protease whose main substrate is insulin-like growth factor binding proteins. Pappalysin-1 is also used in screening tests for Down syndrome.low PAPPA may be commonly seen in prenatal screening for Down syndrome.Q94. Which chromosomal abnormality has a known association with severely impaired semen quality?Formation of isochromosomes of the X chromosomeFormation of ring chromosomesMicrodeletions of the X chromosomeMicrodeletions of the Y chromosomeParacentric inversion of the Y chromosomeThe answer is microdeltions of the Y chromosomes. There is a known association of microdeletions and men with impaired semen quality undergoing intracytoplasmic sperm injection.It is suggested that these lesions may result in oligospermia or azoospermia. This is confirmed on testicular biopdy. These can be transferred to the male offsprings. Y microdeletion screening may be beneficial not only to define the aetiology of spermatogenic failure, but also because it may provide information that can lead to a more appropriate clinical plan for both the infertile male and his future male child.However, it is not commonly screened for in the UK due to a lack of substantial evidence. Currently screening for Y deletions is neither available nor recommended in the UK.Q95. A couple have presented to a clinic with suspected infertility. Diagnostic tests reveal that the man has azoospermia, testicular atrophy and gynaecomastia. Which karyotype result would be most likely in this case?46 XX46 XY47 XXY47 XY+2147 XYYThe answer is 47 XXY. This is a likely description of Klinefelter's syndrome. The karyotype in this case is normally 47 XXY. The other variants that present are XXYY or XXXY. The affected individual is generally tall and has feminine fat distribution. Other features include small testes, external genitalia and low gonadotrophin levels.Q96. A teenager presents to a gynaecology clinic with primary amenorrhoea and delayed puberty. Further investigations reveal a karyotype as 45 XO. What condition is the teenager likely to have?Congenital adrenal hyperplasiaDown syndrome Kallmann syndromeTurner syndrome Mayer-Rockitansky-Kuster-Hauser syndromeThe answer is Turner Syndrome.Turner syndrome is the most common cause of gonadal dysgenesis. In the most severe form it is associated with the following features: short stature, webbing of the neck, cubitus valgus, widely spaced nipples and cardiac and renal abnormalities. Spontaneous menstruation may occur due to mosaicism, but premature ovarian failure is more common. Low-dose estrogen therapy is beneficial to promote puberty changes. Long-term hormone replacement is essential to prevent osteoporosis.Congenital adrenal hyperplasia has a normal female karyotype and the aetiology is due to an enzyme deficiency. Down syndrome is associated with trisomy 21.Androgen insensitivity syndrome p a normal male karyotype. The aetiology is due to the influence of anti- müllerian hormone, preventing the development of internal müllerian structures and failure of wolffian structures due to insensitivity to testosterone.Mayer - Rokitansky - Küster -Hauser syndrome has 46 XX karyotype. There is a developmental defect due to lack of fusion of the müllerianducts. The patient will have a uterine remnant and a blind vagina.Q97. If both parents carry the trait for beta thalassaemia, what is the chance of a female baby having beta thalassaemia?10%15%25%50%75%25 will be affected 50 carrier 25 normal Beta thalassaemia is autosomal recessiveThe chance of inheriting both mutated genes is 25% There is a 50% chance of inheriting one mutated gene and becoming a carrierQ98. The following clinical features are compatible with what genetic syndrome: renal abnormalities, omphalocele, holoprosencephaly and polydactyly?Down syndromeEdwards syndromeFetal alcohol syndromeGardner syndromePatau syndromeThe answer is Patau syndrome. This is a classical presentation of trisomy 13 . Establish whether the presentations are mid-line structures because Patau syndrome often presents in this way (especially in examination settings). Edwards syndrome (trisomy 18) often presents with a ventricular septal defect, facial clefts, clenched hands and rocker-bottom feet.Q99. Chorionic villus sampling (CVS) is associated with fetal limb reduction if performed too early in gestation. What is the earliest appropriate gestational age to perform CVS?8 weeks9 weeks10 weeks11 weeks12 weeksGROUP 5Q1. Which error in meiosis is the most common cause of Down syndrome?AneuploidyInversionsMosaicismNondysjunctionTranslocationQ2. What effect does Down syndrome have on the quadruple test?a/ Decreased alphafetoprotein, decreased human chorionic gonadotrophin, decreased unconjugated estradiol and increased inhibinb/ Decreased alphafetoprotein, increased human chorionic gonadotrophin, decreased unconjugated estriol and decreased inhibinc/ Decreased alphafetoprotein, increased human chorionic gonadotrophin, decreased unconjugated estriol and increased inhibind/ Decreased alphafetoprotein, increased human chorionic gonadotrophin, increased unconjugated estriol and increased inhibine/ Increased alphafetoprotein, decreased human chorionic gonadotrophin, decreased unconjugated estradiol and increased inhibinQ3. Male infertility in a patient with cystic fibrosis is likely to be due to which condition?Congenital absence of testes. Hypothalamic failureOligospermiaTesticular failureCongenital absence of vas deferensThe answer is congenital absence of vas deferens. Male infertility in patients with cystic fibrosis is due to obstructive azoospermia. Other causes of azoospermia are idiopathic epididymal obstruction, infections, vasectomy, or other iatrogenic injuries to the male reproductive tract. In these cases, couples should undergo karyotyping of the woman to determine if she is a carrier of the gene. Patients have the option of assisted reproduction treatment, retrieving the sperm from the epidydimis or testes, followed by intracytoplasmic sperm injection.Q4. Rawia:What type of inheritance pattern does Red Green Colour blindness followMitochondrialAutosomal dominantAutosomal RecessiveX-Linked DominantX-Linked RecessiveA summary of genetic conditions and their inheritance patterns:Autosomal Dominant Conditions? Achondroplasia ? Adult PKD? Ehlers Danlos? Familial Hypercholesterolaemia ? FAP ? HHT? Huntingtons ? Marfans ? MEN? Myotonic Dystrophy ? Neurofibromatosis. ? Noonans? Osteogenesis Imperfecta. ? Retinoblastoma. ? Spherocytosis? Tuberous Sclerosis ? Von Willebrand. ? Von Hippel LendeauAutosomal Recessive Conditions? Albinism? Congenital Adrenal Hyperplasia? Cystic Fibrosis? Fredrichs Ataxia? Glycogen Storage Disease? Haemochromatosis? Homocystenuria? Infantile PKD? Kartagner's Syndrome? PKU? Sickle Cell? Tay Sachs? Thalassemia? Usher Syndrome? Wilsons Disease? Wolfram's SyndromeQ5. The following cells are connected to each other via gap junctions:A.Granulosa cells and oocyteB.Granulosa cells and theca cells C.Small intestine cellsD.Sertoli and Leydig cellsE.Oocyte and polar bodyQ6. Which of the following conditions is caused by a chromosome micro deletion?Edwards' Syndrome Noonan SyndromeDown's Syndrome Cri-du-Chat Patau's SyndromeQ7. What is the inheritance of sickle cell disease(SCD)?single gene autosomal dominant. B. polygenic autosomal dominantsingle gene autosomal recessive polygenic autosomal recessive X-linked dominantQ8. Which of the following conditions follows an autosomal recessive inheritance patternAdult Polycystic Kidney DiseaseInfantile Polycystic Kidney DiseaseMENRett SyndromeVitamin D resistant RicketssQ9. A women with a strong family history of breast cancer has genetic testing as she is worried she may have the mutated BRCA gene. Fortunately tests for this are negative but the patient wants to know if she is at risk of breast cancer. What would you advise her lifetime risk of breast cancer is?8%12%18%25%30%In the general population 12% of women will develop breast cancer during their lifetime. The lifetime risk of developing breast cancer with BRCA 1 is 55-65% and BRCA 2 is 45%In the general population 1.3% of women will develop ovarian cancer during their lifetime. The lifetime risk of developing ovarian cancer with BRCA 1 is 40% and BRCA 2 is 15%BRCA BRCA 1Lifetime Breast Cancer Risk 60%Lifetime Ovarian Cancer Risk 40%BRCA 2Lifetime Breast Cancer Risk 45%Lifetime Ovarian Cancer Risk 15%NOTE Lifetime risk means the chance of developing cancer by the age 70 and the above figures are applied to femalesQ10. All of the following are autosomal recessive conditions EXCEPT which one?Cystic FibrosisSickle CellOsteogenesis Imperfecta Wilsons diseasePKUQ11. A 40 year old women who is 13 weeks pregnant is found to have be high risk for Downs following the combined screening test. What is the most appropriate further test to see if the foetus is affected?Qaudruple testEarly amniocentesisAmniocentesisChorionic Villous SamplingNuchal thickness imagingNuchal Thickness imaging is part of the combined test and has been done already. The quadruple test is another screening test and isn't appropriate here. Early amniocentesis (before 14 weeks of gestation) has a higher fetal loss rate and increased incidence of fetal talipes and respiratory morbidity compared with other procedures. RCOG guidelines advise amniocentesis should be performed after 15 weeks gestation.CVS offers rapid results and is suitable for karyotyping/genotype analysis for chromosomal abnormalities such as Down's and this is the most suitable option here. Waiting a few weeks and performing amniocentesis is a legitimate option but would delay diagnosis and ability to make decision on TOP. Amniocentesis would be the preferred method from 15 weeks onwardsQ12. Regarding Turner syndrome which of the following statements is true?Complete monosomy is rare accounting for <10% of cases of TurnersTurner syndrome occurs in approximately 1 in every 20,000 live female birthsOnly 1% of affected fetuses will survive to termTurners is thought to affect 0.1% of all conceptusesLong fingers are a recognised clinical featureQ13. A 34 year old women is admitted to the labour ward via A&E. She has not had any contact with the health services during her antenatal period. Emergency C-section is performed due to signs of fetal distress. A small female is born and is noted to have cleft lip and palate, prominent occiput, low set ears, omphalocele and clenched hands with over-riding fingers. The baby is transferred to SCBU due to apnoeic episodes. What is the most likely diagnosis?Trisomy 13Trisomy 18Trisomy 21Turners SyndromeCri-du-chatThe features described above are both seen in Trisomy 13 (Patau's) and Trisomy 18 (Edwards'). Many of the features are also seen in Cri-du-chat. The key here as to which is the most likely is in the incidence rates:? Edwards' Syndrome 1 in 5000 live births? Patau's Syndrome 1 in approx 15000 live births? Cri-du-chat 1 in 50,000 live birthsQ14. A 31 year old women has bloods taken at 12 weeks gestation which show: Elevated AFP (alpha fetoprotein) and normal pregnany-associated plasma protein A (PAPP A) and unconjugated estriol(uE3) What are the results suggestive of?Down's SyndromeEdward's SyndromeSpina Bifida Trisomy 18Normal PregnancyQ15. This granulated white blood cell has phagocytic action but constitute only 2-3% of total WBC count:a. Macrophageb. Lymphocytec. Neutrophilsd. Eosinophilse. AcidophilsQ.16. Immunologic factor involved in the pathophysiology of polycystic ovarian syndrome:a. Complementb. IL 8c. VEGFd. IL2e. TNQ17. The diamond shape Forest graph, lateral angles represents:a. Probabilityb. Coefficient of variationc. Standard deviationd. The meanf. 95% CIQ18. What is the estimated successful pregnancy rate following transabdominal cerclage performed by laparotomy at approximately 11 weeks of gestation?40–50% 50–60%60–70% 70–80%>80%The successful pregnancy rate for transabdominal cerclage varies depending on the experience of the surgeon and the timing of the procedure (whether it is an interval procedure or it is performed during pregnancy). In the reported series performed during pregnancy, the success rates have been at least 80%; some series report rates as high as 97.6%. The success rates from the laparoscopic approach have varied from 71.4% to 83.3%.Q19. A woman who had treatment for ovarian cancer a few years ago presents with symptoms of bowel obstruction. Which symptom will make you suspect that the obstruction is in the proximal intestines? Absolute constipationNausea and vomiting Intermittent diarrhoea alternating with constipationSpasmodic pain and vomitingSpurious diarrhoea and then obstructionNausea and vomiting as the dominant symptoms may indicate proximal intestinal obstruction and may not be associated with marked abdominal distension; abdominal pain (often spasmodic) and distension are suggestive of distal obstruction. Absolute constipation is a classic feature of total obstruction, whereas watery/loose stools are often typical of partial or intermittent obstruction. Spurious diarrhoea can lead to a delayed diagnosis, as bowel evacuation is not initially considered consistent with an obstruction.Q20. A woman who has had treatment for a gynaecological cancer is admitted with bowel obstruction. What type of gynaecological cancer is most associated with bowel obstruction?Cervical cancer post radiotherapyEndometrial cancer post radiotherapyEpithelial ovarian cancer Germ cell ovarian cancerStroma ovarian canceQ21. .:A 50-year-old woman who had surgical treatment for cervical cancer three years ago now presents with clinical features of relapsed disease. This has been confirmed. What investigation will help determine whether she will have a chance of local control and cure from chemoradiation?Computed tomography scan Examination under anaesthesiaMagnetic resonance imagingPositron emission tomography Ultrasound of the pelvis and abdomenWhen patients relapse after primary surgical management, chemoradiation offers a chance for local control and cure if there is no evidence of distant metastatic disease. Positron emission tomography (PET)/computed tomography (CT) scanning will help identify patients with metastatic disease who are not suitable for radical treatments, but salvage levels may be quite high in carefully selected patients. Magnetic resonance imaging is best for pre-surgery imaging while PET scans are better for recurrence.Q22. A 58 year old woman has been diagnosed with endometrial cancer following investigations that included histology on an endometrial biopsy. She had surgery and has come back for review two weeks after the surgery. What will be the most important factor in providing a guide to prognosis?Depth of myometrial invasionHistological type of the malignancyStage of the diseaseLymphovascular space invasionVolume of the tumourSurgical staging for endometrial cancer allows histological grading of the tumour as well; as assessment of the depth of myometrial invasion, and perhaps most importantly in the last decade we have recognised that lymphovascular space invasion is arguably the most important prognostic factor. Q23. How long after correction of diabetic ketoacidosis would the fetal heart rate be expected to have been normalised? As soon as the DKA has been corrected30–60 minutes1?2 hours2?4 hours4?8 hoursFetal heart rate may demonstrate acidosis which is often corrected by rehydration of the mother and correction of metabolic acidosis. Normalisation of the fetal heart rate after the correction of DKA may require 4-8 hours. Fetal biophysical profile and Doppler studies may also reflect fetal acidotic status.Q24. A 36-year-old woman with type 1 diabetes on insulin is seen as an emergency at 34 weeks of gestation with severe vomiting, polyuria and blurred vision. She is examined and found to be drowsy, hyperventilating, tachypnoeic and hypotensive. You suspect that she has diabetic ketoacidosis. What test value will help you confirm the diagnosis?Bicarbonate level of less than 10 mmol/lBlood glucose of more than 11mmol/lBlood ketone of more than 2.0 mmol/lBlood pH of less than 7.4Urinalysis that shows ketonuriaWhen a pregnant diabetic presents with features highly suggestive of diabetic ketoacidosis (DKA) a series of investigations have to be performed to confirm the diagnosis. These include a blood glucose level of more than 11 mmol/l, a blood ketonuria of at least 3.0 mmol/l or urinary ketonuria of more than 2+ and a bicarbonate of less than 15 mmol/l or a pH of less than 7.3.Q25. A 25-year-old woman who had Hodgkin’s lymphoma as a child treated with chemotherapy only. With respect to her cancer treatment she is at a slightly increased risk of which pregnancy complication?Congenital malformationsMiscarriagePreterm delivery Small-for-gestational-age fetus StillbirthWomen who are survivors of childhood cancer and are embarking on pregnancy should be advised about the slightly increased risk of preterm birth. They can be reassured that the risk of congenital malformations is not greater than in the general population. However, for those women with a history of abdomino-pelvic radiation, or who have developed secondary medical conditions, there may be an increased risk of miscarriage, stillbirths and small for gestational age. For these women, growth scans may be appropriate.Q26 A 30-year-old had a routine recall cervical smear, which was reported as high-grade dyskaryosis. She attends for a colposcopy and a large loop excision of the transformation zone is performed. What follow-up should be arranged for her?Cervical cytology alone at 6 monthsCervical cytology and colposcopy at 6 monthsCervical cytology and if negative, HPV test at 6 monthsCervical cytology at 6 and 12 months and then yearly for 9 yearsCervical cytology, colposcopy and, if negative, HPV test at 6 monthsFollowing treatment for abnormal cervical cytology that was reported as high-grade moderate-to-severe dyskaryosis, a follow-up visit should be arranged at 6 months. At this visit, a repeat cytology and HPV testing should be done. Further management will depend on the cytology and the HPV test result. If the cytology is negative or borderline/low-grade and the HPV test is negative, she should be referred for routine 3-yearly recall cytology. If the HPV is positive, or high-grade moderate/severe dyskaryosis, referral to colposcopy should be arranged. Where the HPV test in inadequate and the cytology is low grade, refer to colposcopy but if it is borderline, repeat at 3 months.Q27. 25 pregnant w omen w ere sampled during the antenatal period, looking at the number of episodes of urinary incontinence. Thissample w as f rom a population of 3500. The number of episodes of incontinence per patient w as 30, w ith a standard deviation of 10.What is the standard error of the mean?108642The answer is 2. Standard error of the mean (SEM) = standard deviation divided by the square root of n.SEM = 10 √ 25SEM = 10/5SEM = 2Although the question attempts to trick you by providing several numbers in the question, these are not needed. If you know the definition of the standard error of the mean, then you are able to find the answer. Since this is not a mathematics examination, there would not be difficult mathematics in the solution.Q28. Heparin induced thrombocytopenia due to antibody against heparin occur in A.1 dayB.2 daysC.5 daysD.2 hourE.4 wksQ29. Patient in labour with occipito posterior what is the presenting dimeter?? a. Suboccipitofrontal b. Suboccipitobregmatic c. Occipitofrontal d. MentofrontalQ30. .A middle-aged woman presents to her GP. She has been trying to get pregnant, but despite regular intercourse with her partner has been unable to do so. She enquires about when in her menstrual cycle she is likely to conceive. What is the most likely time frame in an average 28-day cycle when women are most likely to conceive?a Day 2-4 b Day -1-6c Day 8-10d Day 8-14e Dav 16-20Q31.Which anti‐epileptic is associated with the highest risk of congenital malformations if taken in the 1st trimester? A) Topiramate B) LamotrigineC) Carbamazepine D) Phenytoin E) Sodium valporateQ32.Following caesarian section you close the skin with Polyglecaprone (monocryl). What is the absorption time of this suture in days? A) 7‐14 B) 21‐28 C) 40‐60 D) 90‐120 E) 140‐210Q33.According to the NICE guidelines on intrapartum care a multiparous women with intact membranes should be offered amniotomy if there is inadequate progress of the active second stage of labour (in terms of rotation and/or descent of the presenting part) after how long? A) 30 minutes B) 1 hour C) 90 minutes D) 2 hours E) 3 hoursQ34. A 37-year-old woman who presented with vaginal bleeding at 19 weeks of gestation was investigated and found to have an invasive squamous cell carcinoma. What would be the best test to assess local and regional spread of her cancer at this stage of the pregnancy?Computed tomographyUltrasound scan of the pelvisExamination under anaesthesia, cystoscopy and protosygmoidoscopyPositron emission tomography (PET) scanMRIMRI is the best imaging modality for the assessment of local and regional spread of cervical cancer and is safe in pregnancy. CT scanning carries a risk of radiation to the fetus in pregnancy and so is not used in assessing pregnant women with cervical cancer. PET scanning on the other hand is better for the assessment of recurrence after treatment.Q35. A 25-year-old woman attends for her booking visit at 10 weeks of gestation. On questioning you find that she has never had a cervical smear. Why is it not recommended for her to have a smear test at this time?The management of any abnormal smear will have to be delayed until after pregnancy anywayThere is an increased risk of having a false-negative reportThere is an increased risk of having a false-positive resultThere is an increased risk of having an inadequate report on the smearThere is an increased risk of her having a miscarriagePerforming a cervical smear during pregnancy is not recommended unless it is being performed as the first followed up smear after treatment and if this is the case, it should be performed in the second trimester. Cervical smears performed during pregnancy frequently cause concern as the presence of decidual cells can be mistaken for atypia (i.e. there is an increased risk of false-positive smears).Q36. Approximately what percentage of benign hysterectomies in the UK are still performed by laparotomy?>20% >30% >40% >50% >60%Over 60% of benign hysterectomies in the UK are still performed by an open abdominal approach. This was also the incidence in the USA 10 years ago and in the UK 20 years ago.Q37. How many tendinous intersections are there in each rectus abdorninismuscle?A 1B 2C 3D 4E 5The rectus abdominis muscle is crossed by three fibrous bands called the tendinous intersections or tendinous inscriptions. One is usually situated at the level of the umbilicus, one at the extremity of the xiphoid process, and the third about midway between the two.These intersections pass transversely or obliquely across the muscle; they rarely extend completely through its substance and may pass only halfway across it; they are intimately adherent in front to the sheath of the muscle.Sometimes one or two additional intersections, generally incomplete, are present below the umbilicus.Q38. Derivatives of the primitive midgut in the adult are suppJied by which artery?A Coeliac trunkB Common iliac arteryc Femoral arteryD Inferior mesenteric arteryE Superior mesenteric arteryQ39. What type of compound is human placental lactogen?A CarbohydrateB Fatty acidC.SteroidD ProteinE. ProstaglandinHuman placental lactogen (hPL), also called human chorionic somatomammotropin (HCS), is a polypeptide placental hormone, the human form of placental lactogen (chorionic somatomammotropin). Its structure and function are similar to those of human growth hormone. It modifies the metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus. hPL has anti-insulin properties. hPL is a hormone secreted by the syncytiotrophoblast during pregnancy. Like human growth hormone, hPL is encoded by genes on chromosome 17q22-24. It was identified in 1963Q40. From which embryonic structure does the penis develop in the male?A Genital foldB Genital swellingC Genital tubercleD Paramesonephric ductE Urogenital sinusQ41. Patient in labour with occipito posterior what is the presenting part? a. Suboccipitofrontal b. Suboccipitobregmatic c. Occipitofrontal d. MentofrontalQ42. MRSA infections may respond to which antibiotic?VancomycinClindamycinsCephalosporinsCarbapenemsAugmentinQ43. Which types of cells are phagocytic for residual bodies left over from theprocess of spermiogenesis?A. Testicular mesenchymal cellsB. Testicular macrophagesC. Fibroblast cellsD. Interstitial cells of leydigE. Sertoli cellsQ44. What is the most common cause of hyperprolactinemia? ( sept. 2014 )A. MacroprolactinomaB. MicroprolactinomaC. Primary hypothyroidismD. Chronic renal failureE. Pituitary stalk interruption syndrome (PSIS)Q45. Free level of t4 ( march 2014 )a. 0.1 %b. 0.5 %c. 1 % d. 1.5 %Q46. (Sep 2016). Glucose transported across the placenta thru:A.Facilitated diffusion. B.Active transportC.Passive diffusionD.EndocytosisQ47. (Sep 2016)Transfer of free fatty acid thru placenta:A. ActiveB. PassiveC. FacilitatedD. EndocytosisE. PinocytosisQ48. Sara Elmahir:Q49. Women aborting after corpus luteum removal is due to loss this hormone: ( 2013 both exams )a. HCGb. Estrogenc. Progesteroned. ProlactineQ50. Vasopressin act on increasing water re-absorption at ( 2013 )a. Proximal tubuleb. Loop of henlec. Distal convoluted tubules and collecting ductQ51. a patient with primary infertility, presents with 3 months amenorrhea, elevated FSH and prolacten, Bhcg positive ( 2013 )a. Overian failureb. PCOSc. Pregnantd. MenopauseQ52. (Sep 2016)Physiological variation of the menstrual cycle between 21-35 days due toA. Aberrant LH surgeB. Estrogen fails to produce negative feedback on pituitaryC. Estrogen fails to produce positive feedback on pituitaryD. Luteal phase varies in duration by time taken for corpus luteum to degenerateE. Loss of progesterone secretionQ53.(sep 2016) Cloasma in pregnancy is due to:A. CortisolB. MSHQ54. (Sep2016)Which enzyme is present in granulosa cells but not in theca cells?A. AromataseB. 17 B hydroxylaseQ55. Androgen structure ( 2013 )A. C18 B. C19C. C21Androgen 19 carbon Oestrogen 18 carbonProgesterone 21 carbonQ56. .:Aromatase is key to Estradiol production in the ovaries. Which of the following statements is true?FSH induces the theca cells to make aromataseProgesterone induces the granulosa cells to make aromataseFSH induces the granulosa cells to make aromataseLH induces the granulosa cells to make aromataseLH induces the theca cells to make aromatase NextIt is important to have a good understanding of the two main cell types of the ovaries. ? The theca cells produce androgen in the form of androstenedione.The theca cells are not able to convert androgen to estradiol themselves. The produced androgen is therefore taken up by granulosa cells. ? The neighbouring granulosa cells then convert the androgen into estradiol under the enzymatic action of aromatase ? FSH induces the granulosa cells to produce aromatase for this purposeQ57. Sep2016). Androgen secreted through which layer of adrenal ?Zona fasciculataZona reticularisZona glomerulosaQ58. You are asked to review a patient with known adrenal insufficiency. Which of the following causes of adrenal insufficiency would you NOT expect hyper pigmentation to be a clinical feature of?Waterhouse Friderichsen syndromeAdrenal dysgenesisAutoimmune adrenalitisPrimary adrenal insufficiencySecondary adrenal insufficiencyQ59. (Sep2016). Which hormone causes rupture of graffian follicle and release of esrtogen and progesterone?LHFSHTSHGnRHHcgQ60. Sep2016). HPL similar to?FSHGHQ61. Sep2016). What is the second common cause of congenital adrenal hyperplasia (CAH)?A. 17-hydroxylase deficiencyB. 21-hydroxylase deficiencyC. 11-Beta hydroxylase deficiencyD. 3 Beta- hydroxysteroid dehydrogenase deficiencyE. 17 Beta-hydroxysteroid dehydrogenase deficiency 21-hydroxylase deficiency is the 1st cause of CAH w is an autosomal recessive disease It is due to deficiency of enzymes involved in mediating production of cortisol & aldosteron 1st cause Which act about 90 % of cases are due to deficiency of 21hydroxylase enzyme and its defect on cyp11 B1 gene 2nd cause which act about 5% of cases is due to deficiency of 11hydroxylase enzyme Q62. (2012)What is the mot important function of progesteron in the cycle-Creation of corpus luteum.-Decidua formation-Mobility of the fallopian tubesQ63. Gartner's cyst is seen in -1) Fallopian tube2) Uterus3) Vagina4) LabiaQ64. 2012-Estrogens sequence according to increasing efficacyE1-E3-E2 E2-E1-E3E3-E1-E2Q65. In statistics, which of the following statements regarding the mean value is true? a/The mean is equal to the value of the modeb/The mean is the most frequently occurring valuec/The mean refers to the mid value when all values are listed in ascending orderd/The mean refers to the sum of the values divided by the number of valuese/The mean refers to the mid value when all values are listed in descending orderQ66. .:If TP = true positive and FP = false positive, what is represented by the equation TP / (TP + FP)?Likelihood ratioNegative predictive valuePositive predictive valueSensitivitySpecificityQ67. A patient with a previous caesarean section arrives at term to your unit in spontaneous labour. The midwife reports the cervix is 6 cm dilated, there is a longitudinal lie and the vertex is well applied to the cervix. The patient is contracting three times in 10 minutes. What would you tell this woman her risk of scar rupture was? 1 in 50 1 in 100 1 in 1000 2 in 1000 2 in 10 000Q68. Squamous cell carcinoma accounts for approximately how many cases of vulval cancer?10% 30% 50% 70% 90%The correct answer is 90%. The vulva is lined by squamous epithelium. Squamous cell carcinoma accounts for 90% of malignancies at the site and approximately 5% of all female genital tract cancers.Q69. The following cells are connected to each other via gap junctions:A. Granulosa cells and oocyte?B. Granulosa cells and theca cellsC. Small intestine cellsD. Sertoli and Leydig cellsE. Oocyte and polar bodyQ70. Histone is formed mainly of:A. Lysine and glycineB. Arginine and alanineC. Leucine and arginineD. Lysine and arginine ?E. Proline and isoleucineQ71. The following cell organelle contains DNA and RNA and surrounded by trilaminar membrane:A. NucleusB. NucleolusE. Mitochondria?C. Rough endoplasmic reticulumD. Smooth endoplasmic reticulumQ72. What is the inheritance of sickle cell disease(SCD)?single gene autosomal dominantpolygenic autosomal dominantsingle gene autosomal recessivepolygenic autosomal recessiveX-linked dominantQ73. What is the smallest human chromosome? ( march 2015 )A. Chromosome 20B. Chromosome 21C. Chromosome 22D. Chromosome XE. Chromosome YQ74. The following cell organelle is responsible for steroid synthesis and detoxification inside the cellA. Smooth endoplasmic reticulum ??B. Golgi apparatusC. LysosomesD. Rough endoplasmic reticulumE. PeroxisomesQ75. .:What happens to systolic &diastolic BP in the first trimester.? A.systolic doesn't change,diastolic Dec B.systolic dec,diastolic Dec.?C.systolic Inc ,diastolic Inc. D.systolic Inc.diastolic doesn't change. E. Systolic Inc diastolic Inc.Explanation: BP is directly related to systemic vascular resistance and cardiac output, and follows a distinct course during pregnancy:↓ In early pregnancy until 24wks due to ↓ in vascular resistance.↑ After 24wks until delivery via ↑ in stroke volume.↓ After delivery, but may peak again 3–4 days post-partum.Q76. Warfarin embryopathy is typically the result of the mother taking warfarin during which stage of pregnancy?A) 0‐6 weeks B) 6‐12 weeks??C) 12‐18 weeksD) 18‐24 weeksE) 24‐32 weeksQ77. a patient with primary infertility, presents with 3 months amenorrhea, elevated FSH and prolacten, Bhcg positive ( 2013 )a. Overian failureb. PCOSc. Pregnant??d. MenopauseQ78. 2013 march 51- Alkylating agents like vincristine act againsta. Cell membraneb. Mitochondriac. DNAd TubulesQ79. a patient who is BRCA 1 positive has the following riska. 30% breast ca 10% ovarianb. 70% breast ca 30% ovarianc. 80% breast ca 40%ovariand. 90% breast ca 60%ovarianQ80. DMPA is associated loss of bone mass in first 6 months of:a. 1%b. 5%c. 10%d. 20%e. 50%Q81. 54- most important anion in urinea. Albuminb. Phosphatec. Chlorided. BicarbonateQ82. active form of vitamin D:a. 1,25 cholcalciferol b. Calcitriolc. 1-cholcaciferoQ83. the renal tubules develop froma. Pronephrosb. Metanephrosc. PMDd. MesonephrosQ84. The sperm at fertilization penetrates the:a. Tunica albuginab. Corona radiatec. Zona pellucidaQ85. Women aborting after corpus luteum removal is due to loss this hormone:a. HCGb. Estrogenc. Progesterone??Q86. Treatment for MRSA by VancomycinQ87. Cytokine involved in ovarian hyperstimulation syndrome ? a. VEGF (Vascular endothelial growth factor )? b. IL2 c. tnf ,Q88. Patient came with rt illiac fossa pain , left adenexal mass , b hcg 850 ? What ll b next stepA) Admit and repeat usg in next 24 hrsB) Admit and repeat b hcg in next 24. Hrs?C) Admit and do urgent laparotomyD) Call her next time in opdQ89. What about HIV pt with screening weakly positive HIV Ag/Abx ratio =1.51 confirmatiry test = negative2 cimfirmatiry test specimen not adequateWhat will be your next step ?A. Counsell her that she may have admit her to GUM for further tests??B. Ask abt risk factorsC. Te her she has no diseaseSexual health or genitourinary medicine (GUM) clinics: offer a range of services, including: 1. testing and treatment for sexually transmitted infections (STIs)2. advice and information about sexual health3. free condoms4. contraception – including emergency contraception, such as the morning after pill5. pregnancy testing6. HIV testing – including rapid tests that give results in about 30 minutes and counselling for people who are HIV-positive7. PEP (post-exposure prophylaxis) – medication that can help prevent people from developing HIV if they've been exposed to it8. hepatitis B vaccination 9. advice about abortion10.help for people who have been sexually assaulted if necessary, a referral to a specialistQ90. Nifedipine belongs to which class of drugs? ( march 2015 )A. K+ channel blockers B. Na+ channel blockersC. Ca++ channel blockersD. Angiotensin receptor blockersE. Angiotensin-converting enzyme inhibitorsQ91. Sacro iliac joint isA) synovial??B) Primary CartiigenousC) Secondry CartiligenousQ92. The?World?Health?Organisation?define?the?maternal?mortality?ratio?as?A)?Maternal?deaths?per?10,000?live?births?&?still?births?B)?Maternal?deaths?per?100,000?live? births?&?still ?births?C)?Maternal? deaths?per?10,000?live?births?D)?Maternal?deaths?per?100,000?live? births?E)?Ratio?of?maternal?deaths?to?live?births?Q93. .Superior vesicle artery is direct branch fromA. Ant.division of int.illiac artB. External illiac art. C. Umbilical art.Q94. The ureter is lined by what type of epithelium?A) StratifiedB) PseudostratifiedC) TransitionalD) Simple CuboidalE) Simple ColumnarQ95..Midazolam is an effective anxiolytic drug, used for preoperative sedation. Which receptor is responsible for its action?( march 2015 )A. 5-HT1aB. 5-HT3C. D2D. GABAE. N-methyl-D-aspartate (NMDA)Q96. Misoprostol is a commonly used drug in the medical treatment of miscarriage. What type of drug is misoprostol? ( march 2015 )A. Cyclooxygenase inhibitorB. Prostaglandin f2αC. Progesterone antagonistD. Prostaglandin E2E. Prostaglandin E1Q97. .Suxamethonium does not readily cross the placenta because of ( march 2015 )A. Placental cholinesteraseB. High protein bindingC. Elongated molecular configurationD. High degree of ionizationE. Insufficient maternal concentrationQ98.Which antiemetic drug can cause uncontrolled muscle movements? ( march 2015 )A. MeclizineB. ScopolamineC. OndansetronD. GranisteronE. MetoclopramideQ99. What drug can be given to reverse myelosuppression in methotrexate toxicity? ( march 2015 )A. Folic acidB. Vitamin B12C. PyridoxineD. ThymidineE. Folonic acidQ100. A-19-year-old woman who is 28 weeks pregnant requests treatment for acne and is prescribed antibiotic by her general practitioner (GP). She goes on to deliver a healthy baby girl at term. Two years later her daughter is noted to have unusually gray discoloration of teeth.Which treatment for acne did her GP prescribed for acne? ( march 2015 )A. ChloramphenicolB. SulphonamideC. QuinoloneD. AminoglycosidesE. TetracyclinGROUP 6Q1. Which of the following is due to genetic imprinting?Prader Willi syndromeFragile XKallmann syndromeHuntingtons diseaseNiemann Pick diseasePrader Willi syndrome correct answerNormally both alleles are expressed simultaneously. Genetic imprinting is one allele is mostly expressed and the other allele contributes very little. IGF2 for example is only expressed from the allele from the father. With Prader Willi syndrome, the child has inherited a defective gene from the father and the maternal gene cannot compensate.Q2 . What is the chance of a healthy adult being a carrier of cystic fibrosis if his brother is affected by the condition?2 in 31 in 41 in 2100%1 in 3Cystic fibrosis is autosomal recessive. His brother must have inherited the gene from both of his parents who were both carriers. There will be a 1 in 4 chance that the parents children would have had the condition, a 1 in 4 chance that they had inherited none of the genes, and a 2 in 4 chance that they inherit only one of the genes and become a carrier. If the adult is healthy, then inheriting 2 genes have been ruled out, leaving a 2 in 3 chance of being a carrier.Q3. .How is hereditary haemorrhagic telangiectasia inherited?X linked dominantAutosomal DominantX linked recessiveMitochondrialAutosomal RecessiveQ4. A 13-year-old adolescent is brought into his pediatrician's clinic by his concerned mother. The boy was slow to meet physical milestones such as sitting up,crawling, and walking. He is shy He has now grown tall and skinny, with small testicles and penis, and slight breast development. The boy has a great deal of troubleboth reading and expressing himself in school. The mother would like the school district to provide him with special educational resources. The school district claimshe is no different than lots of other inattentive boys. A blood test is ordered to determine his karyotype. What abnormal karyotype do you suspect the boy will haveand what do you call this genetic condition?a. 45X; Turner syndromeb. 45Y; Turner syndromec. 47XXY; Klinefelter syndromed. 47XYY; super male syndromee. 48XYYY; super male syndrome The answer is c. (Sadler, pp 20, 258. Fauci, pp 2340-2341.) Individuals with Klinefelter syndrome have an extra X chromosome compared to other males and thiscondition is common. It occurs about 1 in 500 to 1000 male births. At birth, Klinefelter boys appear no different than boys with XY chromosomes. Klinefelter is sometimes detected in elementary school due to learning (language in particular) disabilities. Klinefelter boys are more often detected at puberty when they fail toundergo complete masculinization and may develop gynecomastia. Less often Klinefelter males are discovered during work up for infertility as adults. 45, X, Turner syndrome females are infertile with a single X chromosome. Physically, Turner syndrome females have shortened stature, with webbed neckline and small, wide setbreasts. Super male syndrome may be 47, XYY or 48, XYYY. Those individuals are tall with language learning disabilities, but at puberty they have typical male development and are more likely to suffer from acne due to excess androgens.Q5. You are in clinic and see a couple for preconception counselling.Their son, who is now 4, has cystic fibrosis and has had multiple hospital admissions for chest infections.They are keen to extend their family, but are concerned about a further child having the disease. Neitherparent has any previous family history of the condition.What is the risk of each further child developing the disease?1 in 21 in 4 All boys will be affectedAll future children will be affectedNo riskQ6. In which of the following malignancies are tumour suppressor genes MLH1 and MSH2 affected?Familial adenomatous polyposisHereditary non-polyposis colonic carcinoma (HNPCC) RetinoblastomaWilms' tumourXeroderma pigmentosaQ7. Which one of the following conditions is inherited in an autosomal dominant manner and is associated with multiple colonic polyps?Familial adenomatous polyposis Hereditary non-polyposis colonic carcinoma (HNPCC)RetinoblastomaWilms' tumourXeroderma pigmentosaQ8. Which of the following statements best describes the action of DNA polymerase?Bacterial enzyme which cleaves foreign DNA at a specific recognition siteEnzyme producing cDNAEnzyme responsible for DNA replicationEnzyme responsible for DNA transcriptionEnzyme used in the polymerase chain reactionQ9. Which of the following is the risk that an unaffected full sibling of a patient with cystic fibrosis (CF) carries a mutated CF gene?(A) 1 in 2(B) 1 in 4(C) 3 in 4(D) 2 in 3The answer is (D). If the full sibling’s status was unknown, he would have a 1 in 4 risk of being unaffected and not carrying a CF mutation gene, a 2 in 4 risk of being unaffected but a carrier of a CF mutation and a 1 in 4 risk of having CF. Because he is unaffected, there are 3 possible independent outcomes. He now has a 1 in 3 chance of not carrying a mutated CF gene, but a 2 in 3 chance of being a carrier of a CF mutation.Q10. What is III-1’s risk to be a carrier of Alport syndrome, an X-linked recessive condition?(A) 0(B) 25%(C) 50%(D) 100%The answer is (C). Because her mother is an obligate carrier of Alport syndrome, there is a 50% chance that she passed on the X chromosome with the mutation and a 50% chance that she passed on the normal X chromosome.Q11. What is the risk that the child of a mother with cystic fibrosis will be a carrier of the disease?(A) 100% (B) 75% (C) 50%(D) 25%(E) 0%The answer is (A). The mother is homozygous for a CF mutation (aa) so she can only pass along a mutated gene (a). The father is presumably homozygous for the normal gene (AA), so he can only pass on a normal gene (A). Therefore, all their children will be heterozygotes (Aa), or carriers of a CF mutation.Q12. .In X-linked recessive lethal disorders, the mutant gene is not always inherited from a carrier female (Haldane’s rule). What approximate percentage of affected males is attributableto a new mutation?(A) 100%(B) 75%(C) 66%(D) 33%(E) 67%The answer is (D). In lethal disorders, all the mutated genes are lost in each generation and these represent a third of the alleles for that mutated gene. In a population at equilibrium, the number of new mutations equals the number of genes lost, so that number of new mutations replacing those lost is one-third, or 33%.Q13. .Mutations in different autosomal recessively inherited genes may result in the development of leukemia in Fanconi anemiapatients. Which of the following best describes why this can happen?(A) locus heterogeneity(B) allelic heterogeneity(C) genotype-phenotype correlation(D) de novo mutations(E) variable expressivityThe answer is (A). Because different genes (loci) can be involved in the development of leukemia, there is locus heterogeneity.Q14. What inheritance pattern for the disease is occurring in this family?(A) autosomal dominant(B) autosomal recessive(C) X-lined dominant(D) X-linked recessive(E) multifactorialThe answer is (A). Neurofibromatosis 1 (NF1) is an autosomal dominant disease with variable expressivity. The family history and the clinical findings in the patient confirm the diagnosis of NF1. The fact that the patient’s brother had it means that it probably was notdue to a new mutation. One of the parents would probably be found to have some mild manifestation of the disease upon examination, as it is fully penetrant.Q15.Baby John was diagnosed with achondroplasiashortly after birth. What inheritance pattern should be discussed with the parents?(A) autosomal dominant. (B) autosomal recessive(C) X-linked dominant(D) X-linked recessive(E) multifactorialThe answer is (A). Achondroplasia is an autosomal dominant disease. There is no family history because achondroplasia is often caused by a new mutation. Achondroplasia is a disorder of bone growth. ... Achondroplasia is caused by a gene alteration (mutation) in the FGFR3 gene. The FGFR3 gene makes a protein called fibroblast growth factor receptor 3 that is involved in converting cartilage to bone. FGFR3 is the only gene known to be associated with achondroplasia.Q16. What is the recurrence risk for the couple to have another child with achondroplasia?(A) 50%(B) 25%(C) 3%–5%(D) 1%–2%(E) 0%The answer is (E). Because the cause of achondroplasia in John is a new mutation, it is extremely unlikely to happen again so the risk is 0.Q17. Sally has a paternal uncle with hemophilia B, an X-linked recessive disease. Her risk of having a child with hemophilia B isbest described as which of the following?(A) near 100%(B) near 0%(C) 50% with all male children(D) 50% for all childrenThe answer is (B). Because Sally’s father does not have hemophilia B, he does not have the X chromosome with the mutated gene to pass on to Sally. Therefore, the risk for Sally to have a child with hemophilia B is near 0.Q18. Female carriers of X-linked recessive diseases sometimes exhibit some symptoms of the disease. The cause of this is which of the following?(A) variable expressivity of the X-linked gene(B) mitochondrial inheritance(C) skewed X chromosome inactivation(D) incomplete penetrance of the X-linked geneThe answer is (C). If sufficient numbers of normal X chromosomes are inactivated, there may not be enough of the normal gene product present for proper functioning. In these cases, there may be a partial or complete disease phenotype due to the fact that the majority of the gene product produced will be defective or nonfunctional.Q19. Fragile X syndrome is one of the most common causes of mental retardation in humans. It generally acts like an X-linkedrecessive disease, but some males do not have the disease yet they can pass it on, and some females are affected. The cause of thedisease explains these observations. Fragile X syndrome is caused by which one of the following mechanisms?(A) a deletion of the Prader-Willi/Angelmangene on the father’s X chromosome(B) a triplet repeat expansion(C) chromosome breakage(D) having two X chromosomesThe answer is (B). In Fragile X syndrome the triplet repeat expansion, CGG, must reach a certain number of repeats before there is clinical manifestation of the disease. The repeat expands with succeeding generations and eventually will reach the critical number. That iswhy males without the disease can pass it on to subsequent generations where it appears because the threshold number of repeats has been reached. Females with a high number of repeats may also express some manifestations of the disease because of skewed X inactivation.Q20. In myotonic dystrophy, the severity of the disease increases with each succeeding generation. This phenomenon is called:(A) anticipation(B) incomplete penetrance(C) genomic imprinting(D) variable expressivityThe answer is (A). Myotonic dystrophy is caused by a triplet repeat expansion that expands with each succeeding generation. The larger the repeat, the earlier the onset and the more severe the disease is. This phenomenon is called anticipation and differs from incomplete penetrance and variable expressivity in that once the critical repeat threshold is reached, the disease is manifested with severity depending on the number of repeats.Q21. Genetic testing for which one of the following may result in the prevention of disease in the individual tested?(A) Huntington disease(B) cystic fibrosis(C) Duchenne muscular dystrophy(D) familial adenomatous polyposisThe answer is (D). Identification of a mutation in the APC gene would indicate that increased monitoring of the intestinal epithelium is warranted in that individual. Any polyps identified that could potentially progress to a malignancy would be removed.Q22. The major barrier to population cystic fibrosis carrier screening has been which one of the following?(A) The mutations responsible for the disease have not been identified.(B) The technology to identify mutations in the gene did not exist.(C) Heterozygotes in various ethnic groups could not be identified.(D) There are a large number of mutations responsible for the disease and they vary by ethnic group.The answer is (D). There are over 1,000 mutations responsible for cystic fibrosis and the ones that are responsible for most of the cases vary by ethnic group. The mutations responsible for cystic fibrosis are well characterized and new technologies may eventually allow for population screening for cystic fibrosis.Q23. What is the mode of inheritance of TaySachsdisease?Autosomal dominantAutosomal recessive Mitochondrial diseaseX linked dominantX linked recessivedisease, along with cystic fibrosis and sickle cell disease, are examples of recessive diseases. Both copies of the defective gene must be possessed by the patient, and should each parent possess one affected gene, then there is a onequarter chance of inheritance.Autosomal dominant disease requires only one copy of the defective gene, in order to inherit the disease. Examples include polycystic kidneys, Huntington's and Marfan's syndrome.Leber's hereditary optic neuropathy is an example of mitochondrial disease? these conditions are only inherited from the mother, as it is the egg cells that contain mitochondria.Q24. .Which of the following statements best describes the action of reverse transcriptase?a/Bacterial enzyme which cleaves foreign DNA at a specific recognition siteb/Enzyme producing cDNA c/Enzyme responsible for DNA replicationd/Enzyme responsible for DNA transcriptione/Enzyme used in the polymerase chain reactionEnzyme used in the polymerase chain reactionThe reverse transcriptase enzyme produces complementary DNA (cDNA).The retrovirus family is characterised by reverse transcription of the viral RNA genome to cDNA and its integration into the host cell genome which is mediated by the viral integrase enzyme.1Q25. Which of the following conditions is characterised by abnormal chromosome patterns?Cleft lip palateCongenital renal agenesisDuchenne muscular dystrophyHaemophiliaPatau syndromeBoth cleft lip and renal agenesis (absence of one or both kidneys) are often caused by a congenital malformation, the former having a multifactoral inheritance.Haemophilia is an X linked inherited disorder and usually involves deficiency of one factor only.Duchenne muscular dystrophy, another X linked disorder, results from a deletion of chromosome material on the short arm of the X chromosome.Patau syndrome is a chromosomal abnormality (trisomy 13) leading to structural defects of the brain, scalp lesions, small eyes, polydactyl and cardiac and renal malformationsQ26. In which syndrome would a single Barr body be found?Females of genotype XXX Klinefelter's syndrome Males with Down's syndromeMost cases of Turner's syndromeSubjects with testicular feminisation syndromeBarr bodies are the inactivated X chromosomes seen in the nucleus in females (XX). Chromosome analysis in testicular feminisation syndrome will reveal XY karyotype, hence no Barr body, despite the patient being phenotypically female. In Turner's syndrome there is only one X chromosome, and there is no visible nuclearnodule.Males with Down's have a karyotype 47, XY, and hence no Barr body. The chromosomal abnormality here is trisomy chromosome 21.In Klinefelter's syndrome the sex chromosomal structure is XXY, and in them a chromatin nodule is seen.In very rare instances mentally retarded, but otherwise apparently normal, females may have an XXX sex chromosomal structure, and such persons have two chromatin nodules.Q27. A 46 XY karyotype associated with a female phenotype is found in which of the following?A child whose mother has been treated with stilboestrolA patient with testicular feminisation syndrome (androgen insensitivity) An infant whose mother has thyrotoxicosisAn infant whose mother is treated with prednisoloneNoonan's syndromeA female phenotype can occur in testicular feminisation, a condition associated with androgen insensitivity due to an androgen receptor defect.Stilboestrol therapy has been associated with the induction of latent tumours and influencing sexual behaviour but is not associated with abnormalities of sexual identity.Noonan's syndrome affects males and females equally? the sexual phenotype matches the karyotype in both sexes.Neither prednisolone nor maternal thyrotoxicosis would cause gender malassignment problems.Q28. A 26 year old primigravida attends for her 12 week dating scan with her partner. The scan findings show a single live fetus, the crown rump length (CRL) is 49 mm, and the nuchal fold(NT) measures 6 mm. She is very upset because the sonographer has suggested she may need further testing.The obstetrician counsels her regarding the findings, and explains that she needs further testing in the way of a chorion villus biopsy (CVS). One of the possibilities for the findings isTurner's syndrome.Which of the following is true of Turner's syndrome?It has an autosomal recessive pattern of inheritanceIt increases in incidence with maternal age It is associated with neonatal oedema of the feet It affects 1 in 6000 female birthsVentricular septal defect is the commonest cardiac abnormalityPeripheral lymphoedema presents dorsally on the hands and feet and is found in approximately onethird of affected infants.There is growing evidence that abnormal lymphatic development, including lymphoedema and cystic hygroma, is important in the pathogenesis of a number of physical manifestationsof Turner's syndrome. Although the lymphoedema is permanent, it tends to improve with age. 12% of all conceptuses have Turner's syndrome, but as there is a very high spontaneous abortion rate, it occurs in about 1 in 2500 female births in the UK.It is not inherited? this condition results from monosomy of the X chromosome as a random event.Bicuspid aortic valve is the commonest abnormality. Coarctation of the aorta is the other common serious cardiac abnormality? atrial septal defect and aortic stenosis may also occur.Down's syndrome, not Turner's syndrome, increases in incidence with maternal age.Q29.What type of cells are sertoli cells as defined by shape?A.Circular cells B.Cubodial cells C.Epithelia with gap junctionsD.Flat columnarE.Tall columnarQ30. How many days after conception is the earliest time at which HCG (human chorionic gonadotrophin) can be detected in maternal blood?Day 1 Day 8 Day 14Day 20Day 28Q31. Which genetic variants of luteinising hormone (LH) have been reported in adults with polycystic ovary syndrome (PCOS)?Genetic variants of the LH alphasubunit have been reported Genetic variants of the LH betasubunit have been reported Genetic variants of the LH deltasubunit have been reportedGenetic variants of the LH gammasubunit have been reportedGenetic variants of the LH lambdasubunit have been reportedAltered action of luteinising hormone (LH) may be involved in the pathogenesis of polycystic ovary syndrome (PCOS).Genetic variants of the LH betasubunit have been reported.Q32. From which of the following structures is the eustachian tube derived?Mesoderm of first pharyngeal archMesoderm of second pharyngeal arch Pouch of first pharyngeal arch Pouch of second pharyngeal archPouch of third pharyngeal archQ33. A 20 year old primigravid woman is admitted at 32+3 weeks gestation with painful progressive abdominal tightening, now occurring 34 times every ten minutes. Contractions are clearly palpable abdominally, and speculum examination reveals a closedcervical os. A fetal fibronectin test is positive. What is the regime of steroid administration?Betamethasone 12 mg IM 2 doses 24 hours apart Betamethasone 12 mg IM 2 doses 12 hours apart Dexamethasone 6 mg IM 2 doses 12 apartDexamethasone 12 mg IM 2 doses 24 hours apartNone of the aboveRCOG Green Top Guideline #7 states that the steroids of choice to enhance lung maturation are betamethasone 12 mg given intramuscularly 24 hours apart or dexamethasone 6 mg given intramuscularly in four doses, 12 hours apat.Q34. A routine ultrasound at 18 weeks' gestation in a diabetic mother reveals a male fetus withan endocardial cushion defect.Other abnormalities include increased nuchal thickening and a 'double bubble' sign.Which of the following conditions is most likely to have contributed to this set of findings?Congenital syphilisMarfan's syndrome Trisomy 21Maternal folate deficiencyMaternal use of ACE inhibitorDiabetic mothers are more likely to have children with congenital abnormalities depending on preconception, and first trimester blood sugar control.Forty percent of Down's syndrome babies have atrioventricular septal defects, as in this fetus.The double bubble sign suggests duodenal atresia, which again suggests Down's syndrome.Gastrointestinal (GI) malformations occur in 6% of Down's patients most commonly duodenal atresia and Hirschsprung's disease.Q35. You are in clinic and see a couple for preconception counselling.Their son, who is now 4, has cystic fibrosis and has had multiple hospital admissions for chest infections. They are keen to extend their family, but are concerned about a further child having the disease. Neither parent has any previous family history of the condition.What is the risk of each further child developing the disease?1 in 21 in 4 All boys will be affectedAll future children will be affected No riskQ36. A 27 year old female developed insulin dependent diabetes mellitus? her uncle and grandmother also had diabetes mellitus.Which of the following options best describes the mode of inheritance?Autosomal codominantAutosomal dominantAutosomal recessivePolygenic Single gene defectThere is no specific mode of inheritance associated with diabetes mellitus. The inheritance is therefore considered polygenic manygenes contributing rather than one single gene defect.There are a few rare exceptions such as the DIDMOAD syndrome (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and nerve Deafness otherwise known as Wolfram syndrome) which is an autosomal recessive condition.Q37. Which one of the following options best describes the chromosomal abnormality in a male neonate born with cleft lip and palate, low set ears and polydactyly and where the child survives for only three weeks?Edwards' syndromeFragile X syndromeKlinefelter's syndromePatau's syndrome Turner's syndromeQ38. Which of the following statements best describes the action of DNA polymerase?Bacterial enzyme which cleaves foreign DNA at a specific recognition siteEnzyme producing cDNAEnzyme responsible for DNA replication Enzyme responsible for DNA transcriptionEnzyme used in the polymerase chain reaction DNA polymerase enzymes are required for DNA replication and repair of DNA in living organisms.Many of the DNA polymerases are multifactorial and different enzymes are responsible for different stages of DNA metabolism.Q39. Which of the following statements best describes the action of TAQ polymerase?Bacterial enzyme which cleaves foreign DNA at a specific recognition siteEnzyme producing cDNAEnzyme responsible for DNA replicationEnzyme responsible for DNA transcriptionEnzyme used in the polymerase chain reactionTAQ polymerase is the enzyme used in polymerase chain reaction (PCR).Using the PCR with TAQ DNA polymerase, fragments of genomic DNA can be amplified.Q40.Which of the following is not a tumour suppressor gene?APC BRAC1cmycp53VHLMutations in tumour suppressor genes have been implicated in malignancy as down regulation of these genes can result in the unrestricted growth of cells and hence predispose to malignancy. These genes include VHL (von HippelLindau),p53, Rb1 (retinoblastoma), BRAC and APC (adenomatous polyposis coli) genes. Oncogenes, on the other hand are associated with the promotion of cell division and include myc, erb, ras and retQ41. A 41yearold man undergoing an elective inguinal hernia repair develops a marked pyrexia intraoperatively.Malignant hyperthermia is a recognised complication with the use of which drug?DantroleneDiclofenacLidocainePropofolSuxamethoniumMalignant hyperthermia is a serious autosomal dominantly acquired condition linked with other myotonic disorders.Intracellular calcium transport is deranged and generalised muscular contractions generating heat may be precipitated by anaesthetic agents.It is treated with dantrolene. Propofol is used in the management of malignant hyperthermia patients.Q42.Increased numbers of chromosomes occur in which of the following?FragileX syndrome Jacobsen syndrome Klinefelter's syndrome Turner's syndromeRetinoblastomaQ43. Concerning the conversion of glucose to lactic acid which of the following applies? a/Anaerobic glycolysis produces energy at a rate 10 times faster than the aerobic pathway. b/Is a reversible process in skeletal musclec/Is accelerated by high cellular concentrations of ATPd/Is the only pathway for the synthesis of ATP in the red blood cell e/Occurs in a single enzymatic reaction Due to erythrocytes having no nucleus they lack a Krebs cycle and rely on glycolysis via the EmbdenMeyerhof and pentose pathways for energy production.In glycolysis, the reactions catalyzed by the enzymes, hexokinase, phosphofructokinase, and pyruvate kinase are effectively irreversible?Metformin reduces pyruvate dehydrogenase activity and mitochondrial transport of reducing , gaga gents, and thus enhances anaerobic metabolism. This shift to anaerobic metabolism, results in increased metabolism of pyruvate to lactate and increases net lactic acid productionGlycolysis through the anaerobic pathway is relatively energy inefficient compared with the aerobic tricarboxylic acid (TCA) pathway resulting in the end formation of lactate that needs to be metabolised further. Anaerobic glycolysis produces energy at a rate 100 times fasterthan aerobic pathway.Conversion of glucose to lactic acid is inhibited by high cellular concentration of ATP.Q44. A 22yearold female comes into the genitourinary medicine clinic for a sexual health check. She started a new relationship three weeks ago, and wants to have the 'all clear' before having unprotected sex with this partner. She has had unprotected sex with a previous partner in the past six months, but has no genitourinary symptoms. You receive a sexual history and perform triple swabs. Light microscopy shows paired cocci with a pink colouring on Gram staining. You send the swabs for culture and start antibiotics. What is the most likely diagnosis?Bacterial vaginosisCandidiasisChlamydiaGonorrhoeaTrichomoniasisNeisseria gonorrhoea is a Gram negative intracellular diplococcus which can be seen on the Gram stained slide (Gram negative organisms stain pink and Gram positive organisms stain violet).The organism affects columnar cells, therefore affecting the endocervical canal not the vagina.Fifty per cent of women are asymptomatic (though this is far less common in males ~10% are asymptomatic).Symptoms include:Increased vaginal discharge , Dysuria , Intermenstrual bleeding , Pelvic painUntreated long term sequelae of gonorrhoea are pelvic inflammatory disease and infertility.Q45. An 18yearold female underwent a tooth extraction and developed profuse bleeding. The history revealed she suffers from menorrhagia.Her mother and her grandfather also have the same underlying diagnosis.Which of the following options best described the mode of inheritance? Autosomal codominantAutosomal dominant Autosomal recessivePolygenic Single gene defectThis young woman with a bleeding tendency following a dental procedure, together with menorrhagia, suggests von Willebrand disease.This disease is due to a deficiency of von Willebrand factor and is inherited in an autosomal dominant pattern with variable penetrance most commonly, but rarely can be recessive.von Willebrand disease is the most common hereditary bleeding disorder. It affects both sexes approximately equally. Most cases are mild, and bleeding may occur after a surgical procedure/tooth extraction. It is also associated with menorrhagia.Q46. Which one of the following options best describes the chromosome abnormality in an infant girl born with a webbed neck, hypertension and an audible ejection systolic murmur?Edwards' syndromeFragile X syndromeKlinefelter's syndromePatau's syndromeTurner's syndromeA female with webbed neck, short stature and delayed puberty is a classic description of a person with Turner's syndrome (XO). Ejection systolic murmur together with the hypertension may be associated with coarctation of the aorta. WIth regard to the incorrect answer options:Edwards' syndrome trisomy 18Fragile X affects. the FMR 1 (fragile X mental retardation 1 gene)Klinefelter's XXYPatau's trisomy 13Q47 .Which one of the following options best describes the chromosomal abnormality in a male infant born with hypotonia, epicanthic folds and single palm creases?Double Y syndromeDown's syndrome Edwards' syndromeFragile X syndromeKlinefelter's syndromeQ48. Which of the following is an autosomal dominant cancer affecting the eye?Familial adenomatous polyposisHereditary nonpolyposis colonic carcinoma (HNPCC)Retinoblastoma Wilms' tumourXeroderma pigmentosaPatients who suffer from retinoblastoma are found to have the autosomal dominant tumour suppressor gene RB1.Also it is the Most common tumor of the eye in childern.Q49. Which of the following is the commonest intraabdominal childhood malignancy of primitive renal tubules and mesenchymal cells?Familial adenomatous polyposisHereditary nonpolyposiscolonic carcinoma (HNPCC)RetinoblastomaWilms' tumourXeroderma pigmentosaWilms' tumour occurs in children alone. It is treated well by surgery and chemotherapy.Q50. In which of the following malignancies are tumour suppressor genes MLH1 and MSH2 affected?Familial adenomatous polyposisHereditary nonpolyposiscolonic carcinoma (HNPCC)RetinoblastomaWilms' tumourXeroderma pigmentosaMLH1 and MSH2 are found in patients who are suffering from hereditary nonpolyposis colon cancer, and also some cases of endometrial cancerQ51. Which one of the following conditions is inherited in an autosomal dominant manner and is associated with multiple colonic polyps?a/Familial adenomatous polyposis b/Retinoblastomac/Hereditary nonpolyposis colonic carcinoma (HNPCC) d/Wilms' tumour. e/Xeroderma pigmentosaFamilial adenomatous polyposis (FAP) sufferers have the APC tumour suppressor gene. FAP affects the colon.Q52. A 38yearold woman with a strong familial history of breast cancer has been diagnosed with a breast malignancy.Which oncogene is associated with the development of breast cancer?BCL2 BRAC3HER2NMYCRETBRAC1 and 2 together with HER (human epidermal growth factor receptor) mutations have well recognised associations with breast cancer.The loss of the tumour suppressor gene p53 is also associated with many carcinomas.RET is associated with thyroid malignancy, whilst BCL2 is associated with lymphomas.Nmyc (unlike cmyc which is associated with breast neoplasia) is associated with cerebral malignancy.Q53. A woman presents at approximately 40 weeks’ gestation in spontaneous labour; she is unbooked and has received no antenatal care. On abdominal palpation, she feels large of her reported gestational age. A small male infant is born by emergency caesarean section due to fetal distress. The baby is found to have microcephaly, a prominent occiput, a cleft lip and palate, clenched hands and polydactyl. Soon after birth, he has apnoeic episodes and has difficulty feeding.What chromosomal abnormality is the most likely cause of this baby’s presentation?A Microdeletion of chromosome 15 B Microdeletion of chromosome 22C Trisomy 13D Trisomy 18E Trisomy 21Q54. A 32-year-old woman is 15 weeks pregnant with her second pregnancy. She opts to have antenatal screening and has blood taken as part of the quadruple test.The result shows reduced levels of α-fetoprotein and unconjugated oestriol with elevated β-human chorionic gonadotrophin.Which of the following is the most likely explanation for the screening results:A Down’s syndromeB Edwards’ syndromeC Multiple pregnancyD Neural tube defectE Normal pregnancyQ55. A 39-year-old multiparous woman is 13 weeks pregnant. She has serum screening as part of the combined test. Analysis shows an elevated level of α-fetoprotein and a normal level of pregnancy-associated plasma protein A.What diagnosis are the screening results suggestive of?A Down’s syndrome. B Edwards’ syndromeC Multiple pregnancyD Neural tube defectE Normal pregnancyThe combined test uses serum markers together with fetal nuchal translucency measurement in order to obtain an estimate as to how likely it is that a particular fetus is affected by a chromosomal or genetic disorder. Alpha-fetoprotein (AFP) is produced by the fetal liver and yolk sac. High levels of AFP are suggestive of neural tube defects, such as spina bifida, or more rarely anencephaly. This raised level is a consequence of flow of AFP from the open neural tube of the fetus, into the amniotic fluid (and secondarily maternal serum). Pregnancy-associated plasma protein A (PAPP-A) is produced by the fetus and also by the placenta. Reduced levels of PAPP-A in maternal serum can be suggestive of a fetus with an aneuploidy, suchas Down’s syndrome. Intrauterine growth restriction has also been associated with reduced levels of PAPP-A.Q56. A 37-year-old primiparous woman is 14 weeks pregnant. Following serum screening, the pregnancy is found to have an increased risk of trisomy 21. She wishes to have further testing to confirm whether the fetus is affected. In view of her current gestation what is the most appropriate diagnostic test?A Cell-free fetal DNA samplingC Chorionic villus samplingD CordocentesisB AmniocentesisE Nuchal translucency imagingQ57. A 34-year-old woman delivers a male baby with Down’s syndrome. Chromosomal analysis following his birth is suggestive of familial Down’s syndrome.What chromosomal event best describes the aetiology of Familial Down’ssyndrome?A MicrodeletionB Nonsense mutationC Reciprocal translocationD Robertsonian translocationE Triplet repeat expansionQ58. A 29-year-old woman seeks genetic counselling as she has a number of her female relatives who have had either breast or ovarian cancer. Both her mother and her sister have been diagnosed with breast cancer. DNA sequencing subsequently shows that she carries a mutated form of the BRCA1 gene.Via which mode of inheritance is the BRCA1 gene mutation transmitted?A Autosomal dominant inheritance B Autosomal recessive inheritanceC Mitochondrial inheritanceD X-linked dominant inheritanceE X-linked recessive inheritanceBRCA stands for breast cancer susceptibility gene. The BRCA1 gene is found on chromosome 17, whereas the BRCA2 gene is found on chromosome 13. Both the BRCA1 and BRCA2 genes are in fact tumour suppressor genes which code for the DNA repair proteins BRCA1 protein and BRCA2 protein. Mutations in each gene lead to a defective form of the DNA repair protein, with the consequence of increased tumorigenesis. Both BRCA genes are passed on via autosomal dominant inheritance.This means that only one defective copy of the gene is required for the gene to be expressed. An individual with a parent carrying the mutated BRCA1 gene has a one in two chance of inheriting the gene themselves. See Figure 6.2 for diagrammatic representation of autosomal inheritance.Families that carry either BRCA1 or BRCA2 mutations have a high incidence of breast and ovarian cancers (particularly of early onset), with individuals with the defective genes having an estimated 80% lifetime risk of breast cancer and up to a 40% lifetime risk of ovarian cancer.Q59. What are the three leading three causes of maternal death in the UK from the 2003-2005 Confidential Enquiry into Maternal and Child Health (CEMACH) report? a/Thrombosis, pre-eclampsia and infection b/Thrombosis, pre-eclampsia and amniotic fluid embolism c/Thrombosis, haemorrhage and fatty liver d/Pre-eclampsia, haemorrhage and infection e/Infection, pre-eclampsia and The answer is Thrombosis, pre-eclampsia and infection. The rates of maternal deaths are often quoted per 100,000 maternities. The maternal mortality rates for the top three cause were; thrombosis 1.94, pre-eclampsia 0.85 and infection 0.85. Interestingly, haemorrhage had a rate of 0.66, fatty liver 0.05 and ectopic pregnancy 0.47.Q60. If the mean booking weight of an antenatal population of 125 women was 80 kg and the standard error of the mean was 5 kg, what is the 95% confidence interval? 75-85 kg 70-90 kg 65-95 kg60-100 kg 40-120 kgThe answer is 70-90 kg. The 95% confidence interval (CI) is ± 2 multiplied by the standard error of the mean.95% CI = mean ± 2 x SEM95% CI = 80 ± 2 x 595% CI = 70-90 kgQ61. Which of following use ionizing form of radiation:a) Electrocauteryb) Laser c) X-rayd) Magnetic resonance imagininge) UltrasoundQ62. A 16-year-old primiparous woman presents to the Early Pregnancy Unit with a two-day history of PV bleeding. She is approximately 7 weeks in to a spontaneous unplanned pregnancy. She is otherwise fit and well. Her serum HCG is 94 000 iu/l. An ultrasound scan is performed on this patient which shows no evidence of a fetal pole, but does show a placental mass in the uterus, containing multiple echoes with a 'bunch of grapes' appearance. These ultrasound findings are characteristic of which condition?A. Complete hydatidiform mole. ?B. EndometriomaC. Live intrauterine pregnancy ?D. Missed miscarriageE. Partial hydatidiform moleQ63. 53-year-old woman presents with chronic renal failure and a potassium concentration of 5.8 mmol/l. An electrocardiography (ECG) has been requested. What ECG feature can occur with this potassium concentration?A Tall U waves, ST depressionB Tall T waves, wide QRS complexC Tall T waves, ST depressionD Flattened T waves, ST elevationE Flattened T Waves, ST depressionQ64.With regard to the jugular venous pressure (JVP) waveform, what can cause an elevated JVP reading with a normal waveform?Tricuspid stenosisTricuspid regurgitationRight-sided heart failureLeft-sided heart failureAtrial fibrillationQ65. which laser can be used in gynaecological surgery, is invisible without an aim beam and cannot be transmitted down a fibre optic cable?Potassium titanyl phosphate. Neodymium:YAGHelium–neon ArgonCarbon dioxide answer is Carbon dioxide. The CO2 laser generates an invisible light and requires an aiming beam, usually helium–neon. It cannot be transmitted down a fibre optic cable and is absorbed by water. It is used in cervical treatment but is limited by the fact that it does not work in the presence of blood.Q66. You review a 26 year old patient in clinic. She has been taking Phenytoin for 6 years and has good seizure control at her current dose. She has started a new relationship and wants contraceptive advice. She doesn't mind any form of contraception but doesn't want to use condoms/barrier methods. According to the UKMEC criteria which of the following would be most appropriate? A.Progestrone only pill (POP) bined oral contraceptive pill (COCP) C.Progesterone implant D. Levonorgestrel intrauterine system bined oral contraceptive pill (COCP) without pill free weekQ67. An 18 yr old pt comes to see u in clinic , her BMI is 25 and her BP 122/80. she is non smoker and there is no H/O VTE or migraine she would like to start pill for her acne . she has used topical Zineryt inthe past but still has moderate acne . what is most appropriate option ? A. Cerazette (desogestrell)B. Marvelon ( ethinylestradiol/desogestrel )C. Dianette (Co-cyprindiol) D.Norimin( ethinylestradiol/NoresthisteroneE. Yasmin (ethinylestradiol/droperinone )Q68. You are asked to prescribe VTE prophylaxis for a 26 year old patient who is 37 weeks pregnant. She is 72Kg. What dose of Dalteparin would you use? A.2500 units daily B.4500 units daily C. 5000 units daily D.7500 units daily E.5400 units dailyQ69. Regarding the Progesterone-nnly Pill (POP) which of the following statements regarding its mechanism of action is FALSE? A. With Desogestrel-only pills the primary mode of action is via inhibition of ovulation B.All types of POP thicken cervical mucus C.Up to 97% of cycles in women using a levonorgestrel-only pill are anovulatoryD.Blood pressure and weight should be measured prior to prescribing a POP E.The only UKMEC 4 criteria for POP prescription is Breast Cancer within the past 5 yearsQ 70. With regard to semen analysis:a) Men should abstain for 7 days before sample collectionb) Collected sample should be deposited in laboratory within 48 hourc) Sperm should be collected in normal condomd) Semen analysis should be done to evaluate cause of infertilitye) If it is abnormal should be repeated after 6 monthQ71. A 26-year-old woman attends the emergency department feeling unwell and complaining of lower abdominal pain. On examination she has a temperature of 39 °C and a pulse rate of 110 beats per minute. She has lower abdominal tenderness with guarding and cervical excitation. A speculum examination reveals profuse discharge.What is the most appropriate management?A Admit for intravenous antibiotics and supportive careB Book for a diagnostic laparoscopyC Organise a pelvic ultrasound scanD Refer for a surgical reviewE Refer to a sexual health clinic for screening and partner contact tracingPelvic inflammatory disease (PID) is a common problem in young women. Untreated PID can lead to long-term subfertility, be associated with chronic pelvic pain and increase the risk of ectopic pregnancy. Hence, a low threshold for treatment is required. Admission to hospital may be necessary in clinically severe cases, and when other surgical emergencies need to be excluded. Intravenous antibiotics for at least 24 hours are recommended. Women should be given a detailed explanation of the diagnosis and its possible long term implications, and the importance of contact tracing reinforced.Q72. Primigravid 38 weeek presented with perceiving lessfetal movement. What should be the first step to do:a) Hear fetal heart sound using hand held dopler deviceb) Do cardiotocographyc) Fetal blood samplingd) Biophysical profile e) UltrasoundQ73. Mid wife unable to deliver baby after delivery of head.You are called for help. You made diagnosis of shoulderdystocia. What is most appropriate step:a) Episiotomyb) Fundal pressurec) Traction on neckd) McRobert`s manoeuvree) Zavanelli manoeuvreQ74. 29 years old with history of pelvic inflammatory disease with known case of primary infertility , presently on clomiphene citrate for ovulation induction presented with pain in abdomen with bleeding per vaginum with pulse rate of 130 beats per minute and blood pressure 70/50mmhg. Urine pregnancy test positive most probable diagnosis is:a) Acute pelvic inflammatory diseaseb) Acute appendicitisc) Ruptured ectopic pregnancyd) Threatened miscarriagee) Urinary tract infectionQ75. between 20 and 49 years screening for cervical cancer every ??A.1yrB.2yrC.3yrD.4yrE.5yrQ76.You are discussing a planned Caesarean Section (CS) with a patient. Which of the following risks is reduced with CS? A) Cardiac arrest B) Endometritis C) Hysterectomy due to postpartum haemorrhage D) Early postpartum haemorrhage E) Neonatal intensive care admissionCaesarian Section (CS) Key Points There is reduced risk following planned CS of: Perineal and abdominal pain during birth and 3 days postpartum ? Vaginal injury Early postpartum haemorrhage Obstetric shock There is increased risk following planned CS of: Longer hospital stay Hysterectomy due to PPH ?Cardiac arrest Neonatal ICU admission ? Endometritis Increased risk VTE ? If patient has multiple CS inc risk stillbirth and visceral injuryQ77.When diagnosing a delay in the first stage of labour in primigravida patients which of the following is suggested in the NICE criteria? A) Cervical dilatation of less than 1 cm in 4 hours B) Cervical dilatation of less than 1 cm in 2 hoursC) Cervical dilatation of less than 1 cm in 1 hours D) Cervical dilatation of less than 2 cm in 4 hours E) Cervical dilatation of less than 2 cm in 2 hoursdiagnosis of delay in the established first stage of labour needs to take into consideration all aspects of progress in labour and should include: Cervical dilatation of less than 2 cm in 4 hours for first labours Cervical dilatation of less than 2 cm in 4 hours or a slowing in the progress of labour for second or subsequent labours Descent and rotation of the fetal head Changes in the strength, duration and frequency of uterine contractionsQ78. Progestogen used in the combined oral contraceptive pill and associated with a higher risk of thrombo-embolic diseaseA Medroxyprogesterone acetateB NorethisteroneC LevonorgestrelD Gestodene E DrospirenoneQ79. Early amniocentesis has ahigher fetal loss rate and increased incidence of fetal talipes and respiratory morbidity compared with other CVS. When is the earliest appropriate gestational age to perform amniocentesis?A) 10+0 weeks B) 11+0 weeks C) 13+6 weeks D) 14+0 weeks E) 15+0 weeks Q80.You review a patient in the fertility clinic. The ultrasound and biochemical profile are consistent with PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2. She is a nonsmoker. Which of the following is the most appropriate first line treatment? A) Pulsatile GnRH B) Clomifene C ) Weight loss D) Gonadotrophin therapy E) Laparoscopic drilling Q81.You are asked to review a patient in the first stage of labour as the midwife is concerned about her progress. This is her first pregnancy. She has dilated from4cm to 6cm in 4 hours. At your initial assessment she is 6cm dilated with membranes intact. You review her again 2 hours later and the cervix is now 6.5cm dilated with membranes in tact. What is the most appropriate management? A) Advise C‐section delivery B) Advise amniotomy C) Administer oxytocin . D) Review again in 1 hour E) Administer prostaglandins Q82.A 45 year old women is seen in clinic following hysteroscopy and biopsy due to irregular menstrual bleeding. Her BMI is 34 kg/m2. This shows hyperplasia without atypia. Following a discussion the patient declines any treatment but agrees she will try and lose weight. Which of the following is the most appropriate regarding follow up?A) No follow up required B) Annual hysteroscopy +/‐ biopsy C) Hysteroscopy +/‐ biopsy every 3 years D) Hysteroscopy +/‐ biopsy every 2 years E) Hysteroscopy +/‐ biopsy every 6 months Q83. A 26 year old women presents for her 12 week scan. She has been pregnant once before but had a 1st trimester miscarriage. She reports no problems with this pregnancy and has had no vaginal bleeding or spotting. The scan shows no fetal cardiac activity and a small gestational sac. What is the likely diagnosis? A) Recurrent Miscarriage B) Complete Miscarriage C) Missed Miscarriage D) Inevitable Miscarriage E) Threatened Miscarriage Q84.You are asked to review a 44 year old patient with her partner in fertility clinic. She reports her last period was 5 months ago and the one prior to that 4 months earlier. She hasn't taken contraception of any form for 4 years. Her BMI is 29 kg/m2. She is a non-smoker. The results of initial investigations are below: ? ?Partners semen analysis: All parameters within normal fertile range on 2 samples ? ?Sexual health screen: Negative for HIV, syphilis, gonorrhoea and chlamydia ? ?Ultrasound: ?left ovary measures 1.9 x 1.8 cm. ?The right ovary wasn't clearly seen. ? ?FSH 36 IU/L (Reference Range 5-25 IU/L female ovulation) ? ?LH 44 IU/L (Reference Range Mid-cycle: 20-105 mIU/mL)?HBA1C 39 mmol/mol (Refernece range: <42mmol/mol)?Progesterone 3 nmol/l (Reference range: Day 21 >16 nmol/l)?Prolactin 4 ng/ml (reference range: 2 - 29 ng/ml) ? What is the likely diagnosis?A) WHO Group I ovulation disorderB) WHO Group II ovulation disorderC) WHO Group III ovulation disorderD) Hyperprolactinaemic amenorrhoeaE) Tubal infertility Q85. What guidelines apply specifically to contraceptive advice and treatment in under 16's? A) GillickB) WolffC) PurvisD) FraserE) Smith Q86. patient has been seeing you due to itching during pregnancy and you have diagnosed cholestatic jaundice. What is the most appropriate advice regarding testing LFTs postnatally?A) No postnatal testing required B) Test 24 hours postnatally C) Test 48 hours postnatally D) Test 7 days postnatally E) Test 10 days postnatally Q87.You review a 28 year old patient in the fertility clinic. She has a diagnosis of PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2. She is a non‐smoker. She has been taking Clomiphene and metformin for the past 6 months. What is the next most appropriate treatment??A) GonadotrophinsB) Pulsatile GnRHC) Dopamine agonistD) IVFE) Continue current treatment for further 6 months Q88.patient attends the maternity unit as her waters have broken but she hasn't had contractions. She is 39+6 weeks gestation. Speculum examination confirms prelabour rupture of membranes (PROM). According to NICE guidelines after what time period should induction be offered? A) Immediately B) 12 hours C) 24 hours D) 36 hours E) 48 hours Q89.In monochorionic twin pregnancy complicated by single fetal death what test is used to asses fetal anaemia in the surviving twin? A) Fetal blood sampling B) Technetiun 99m red blood cell scan C) Middle cerebral artery peak systolic velocity using Doppler sonography D) Umbilical artery doppler E) Chorionic villous samplingQ90.29 year old patient, para 2 and smokes 5 cigarettes per day is referred to the early pregnancy unit (EPU) by her GP. She had presented with lower abdominal pain and spotting having missed her usual period 3 weeks earlier. Urinary pregnancy test was positive. A Serum bHCG measurement on EPU is 2850 IU/ml. Ultrasound shows an empty uterine cavity and free fluid in the pouch of Douglas A.Ectopic pregnancy B.Missed miscarriage C.Inevitable Miscarriage D.Threatened miscarriage plete miscarriage F.Viable pregnancy G.Pregnancy of unknown location plete molar pregnancy I.Partial molar pregnancyExplanation: It may be difficult to decide between choosing pregnancy of unknown location or ectopic pregnancy here. You should be familiar with the concept of the discriminatory zone i.e. the bHCG level above which a viable pregnancy should be visible on TVS. If a patient has a bHCG level above the discriminatory zone (typically set at 1000‐2400 IU) but no features of intrauterine pregnancy then an ectopic pregnancy is likely. (sources: Association of Early Pregnancy Units UK, AAFP). In addition RCOG green top guideline 21 states: "When serum hCG levels are below the discriminatory zone (<1000 iu) and there is no pregnancy (intra‐ or extrauterine) visible on transvaginal ultrasound scan, the pregnancy can be described as being of unknown location" That is clearly not the case here as the bHCG is well above the discriminatory zone so describing this as a PUL would not fit the RCOG criteria. In addition the fluid in the POD is a radiological adnexal finding consistent with ectopic. Radiologically the presence of free intraperitoneal fluid in the context of a +ve bHCG and empty uterus is? 70% specific for an ectopic pregnancy 63% sensitive for ectopic pregnancyQ91. Recognised risk factors for postpartum haemorrhage are:A Multiple pregnancyB Young ageC Previous caesarean section with a low lying placentaD Antepartum haemorrhageE PolyhydramniosQ92. you are called to see a 19 year old primigravida woman in A&E who is 11 weeks pregnant, has severe vomiting and is unable to keep fluids down. For the previous 3 weeks she has been nauseated with occasional vomiting but this has gradually deteriorated over the past 5 days.Her observations and U&Es are as follows:BP: 102/60HR: 96RR: 16Sats: 98%OAUrinalysis: Ketones ++, protein+, leucocytes negative, nitrites negative, glucose negativeNa+ 131 mmol/lK+ 3.3 mmol/lUrea 14.0 mmol/lCreatinine 99 μmol/lWhich of the following is NOT an appropriate part of her initial treatment?A) IV Cyclizine 50mgB) IV Hartmann's 1L over 2 hoursC) Antiembolic stockingsD) IV Pabrinex 10ml in 100ml salineE) IV Calcium Gluconate 10mg in 10mlQ93. Regarding health risks associated with PCOS which of the following statements relating to PCOS patients are true (as advised by the RCOG)?A) It is good practice to recommend treatment with gestogens to induce a withdrawal bleed at least every 3 to 4 monthsB) Due to the increased risk of ovarian cancer patients with PCOS require additional s urveillance.C) Due to the increased risk of breast cancer patients with PCOS require additional surveillance.D) Insulin‐sensitising agents are licensed in the UK for use in patients without diabetesE) Bariatric surgery may be an option for morbidly obese women with PCOS (BMI of 35Explanation: The following statements are taken from the RCOG Green‐top guideline 2013 reading management of PCOS:Oligo‐ or amenorrhoea in women with PCOS may predispose to endometrial hyperplasia and later carcinoma.It is good practice to recommend treatment with gestogens to induce a withdrawal bleed at least every 3 to 4 monthsThere does not appear to be an association with breast or ovarian cancer and no additional surveillance is required.Insulin‐sensitising agents have not been licensed in the UK for use in patients without diabetesBariatric surgery may be an option for morbidly obese women with PCOS (BMI of 40 kg/m2 or more or 35 kg/m2 or more with a high‐riskobesity‐related condition)It is recommended that lifestyle changes, including diet, exercise and weight loss, are initiated as the first line of treatment for women with PCOS for improvement of long‐term outcomes and should precede and/or accompany pharmacological treatmentQ94. Regarding preconception management of women with pre-existing diabetes:A She should be taking 800 mg of folic acid FB She should be commenced on a statin to lower her cholesterol FC She should have monthly haemoglobin A1C (HbA1C) measurement TD She should be discouraged from pregnancy if her HbA1C is 8% TE Metformin should be stopped prior to conception FQ95.Regarding caesarean section:A Approximately 1 in 6 women will have a caesarean section in the UnitedKingdom FB Body mass an index of >50 is a clear indication for elective caesarean section FC Women with an uncomplicated singleton breech at 34 weeks’ gestation should be recommended to have an elective caesarean section FD All preterm and small for gestational age babies need an elective caesareansection delivery FE Risk of a hysterectomy at a caesarean section is roughly 5% FAt the time of writing, the caesarean section rate in the United Kingdom wasaround 25%. A raised body mass index alone should not be an indicator for elective caesarean section. An external cephalic version should be offered to women with an uncomplicated singleton breech pregnancy at 36 weeks’ gestation, rather than automatically recommending an elective caesarean section. Small for gestational age babies do not require delivery by elective caesarean. The risk of hysterectomy, due to a postpartum haemorrage, at a caesarean section is very low, at around 0.03%.Q96. With regard to the management of HIV positive women presenting in active labour and wishing to have a vaginal delivery:A A recent viral load result should be confirmed as < 50 copies/mLB Highly active antiretroviral treatment should be administered throughout the labourC Fetal blood sampling can be performed to assess fetal wellbeingD The membranes should be ruptured as early as possible to expedite deliveryE An induction of labour is contraindicatedTTFFFQ97. With regards to the diagnosis of malaria in pregnancy:A Severe malaria is defined as parasitaemia of > 50 %B Her full blood count will show normal haemoglobin but low plateletsC She is not likely to have the disease if she has been compliant with prophylaxisD A rapid detection test should be performed to exclude malariaE Three negative malaria smears 12–24 hours apart will rule out malaria if the patient is febrileExplanation : Malaria can be difficult to diagnose and may present as a flu-like illness. Pregnant women with parasitaemia of 2% or more are at risk of developing severe malaria which can manifest with respiratory distress, impaired consciousness or pulmonary oedema. Laboratory investigation may reveal severe anaemia, thrombocytopaenia,hypoglycaemia and impaired renal function.Malaria in pregnancy requires microscopic diagnosis. The current gold standard for the detection of malaria is the preparation of thick and thin blood films. Although less sensitive, rapid detection techniques can be used, but they can miss the low levels of parasitaemia that may be present in pregnant women, and they are less able to detect the presence of Plasmodium vivax. In a febrile patient, three negative malaria smears 12–24 hours apart are needed to exclude diagnosis of malaria.Pregnant women with malaria should be admitted to hospital for treatment.Choloroquine is used for treatment of P. vivax, P. ovale or P. malariae. All newborns of mothers who have had malaria in pregnancy should be screened as there is a risk of vertical transmission.Q98.A patient in her first trimester of pregnancy found to have HIV Ab weakly positive, the first confirmative was negative while the second was inconclusive. Your next step would be:a. a.reassure her that she does not have HIVb. b.tell her she has HIVc. c.repeat confirmative testd. 1refer her to GUC e. e.repeat at termQ99. A patient pregnant doing her 20-24 weeks screening for diabetes, she is Asian with BMI 36, FBS 5. mmol/l, 2 hrs ppr 7.1 mmol/l. How you interpret her OGTT ?a. Normal b. Impaired fastingc. Frank diabetesd. Impaired glucose tolerancee. Gestational diabetesQ100. the 2 oncogenes HPV 16 and HPV 18 are responsible for this percentage of cervical cancer:a. 20%b. 30%c. 50%d. 70%e. 100%Group 8 Q1. Which antibiotic is effective against staph exotoxin? ( sept. 2014 )A. VancomycinB. Co-amoxiclaveC. MetronidazoleD. MethicillinE. ClindamycinQ2. Which drug is used for suppressing breast milk after stillbirth? ( sept. 2014 ) ( 2013 )A. QuetiapineB. QuinagolideC. QuinergolineD. LeuprolideE. LysergideQ3. Which one of the following drugs cause neonatal kernicterus ? ( sept. 2014 )A. SulphonamidesB. AminoglyosidesC. ChloramphenicolD. DoxycyclineE. ErytromycinQ4. .:Warfarin disrupts the formation of vitamin K-dependent clotting factor. What are the vitamin K-dependent clotting factors? Factors I, II, V, XFactors II, VII, IX, XFactors II, IV, IX, XIFactors II, V, IV, XFactors III, IV, VI, XThe answer is Factors II, VII, IX, X. Warfarin’s full effect is delayed for 3 days and has a half life of 40 hoursQ5. .:Which of the agents inhibit dihydrofolate reductase?BleomycinCisplatinFlurouracilMethotrexateMechlorethamineThe answer is Methotrexate. Fluorouracil inhibits thymidylate synthase.Q6. .:What is the primary mechanism of tranexamic acid in the treatment of heavy menstrual bleeding? Inhibits the activation of fibrinInhibits the activation of fibrinogenInhibits the activation of plasminInhibits the activation of plasminogenInhibits the activation of thrombin Q7. .:Which drug prevents the peripheral deiodination of thyroxine?CarbimazoleIodineLabetalolPotassium perchloratePropylthiouracilThe answer is Propylthiouracil. Although propylthiourcil, like carbimazole, prevents the peroxidase oxidation of iodide to iodine in the thyroid gland, it also has a peripheral action.Q8. .:Ciprofloxacin is a quinolone antibiotic. What is its mode of action? Inhibits cross linkage of the peptidoglycan polymer chainsInhibits dihydrofolate reductaseInhibits dihydropteroate synthetaseInhibits DNA gyraseInhibits transpeptidationThe answer is it inhibits DNA gyrase. Although quinolones act on the same pathway as sulphonamides, they act on the final pathway that converts relaxed DNA to supercoiled DNA. DNA gyrase is an essential enzyme for this step.Q9. .:How can the mechanism of action of ranitidine best be described?It delays gastric emptyingIt hastens the gastric emptyingIt mainly has an antiemetic actionIt neutralises the acidic content of the stomachIt reduces the acid content and production by gastric parietal cellsThe answer is It reduces the acid content and production by gastric parietal cells. It is used preoperatively to reduce the risk of aspiration pneumonia and Mendelson’s syndrome.Q10..: Which medication may be used to reduce the symptom of stress incontinence?DesmopressinDuloxetineFluoxetineImipramineTolterodineThe answer is Duloxetine. Duloxetine is a balanced serotonin and noradrenaline reuptake inhibitor. It increases urinary sphincter tone and has been shown to reduce incontinence by about 50%, with improvements in quality of life. Tolterodine and oxybutynin are muscarinic receptor antagonists and are used in urge incontinence.Q11. You have been asked to prescribe a combined oral contraceptive pill to a woman with acne and hirsutism. She is known to have polycystic ovary syndrome (PCOS). What is the best available option?Cerazette (desogestrel) Cilest (ethinylestradiol / norgestimate) Loestrin 30 (ethinylestradiol / norethisterone) Microgynon (ethinylestradiol / levonorgestrel) Yasmin (ethinylestradiol / drosperinone)The answer is Yasmin. From the options provided Yasmin is more beneficial in terms of management of acne and hirsuitism, along with PCOS. Women with PCOS may be further maintained on Marvelon (ethinylestradiol, desogestrel) or Mercilon (ethinylestradiol, desogestrel) for contraception.Yasmin contains 3 mg of drosperinone, which has some antiandrogenic properties. Dianette (cyproterone acetate, ethinylestradiol) is also useful because it contains cyproterone acetate, which is also an antiandrogenic agent. Care must be taken for women with a high body mass index.Mirena (levonorgestrel) is a good option for contraception in women with PCOS because it provides protection to the endometrium (by opposing the unopposed estrogen in PCOS).Q12. A 25-year-old woman with a history of type I diabetes attends the preconception clinic. What pharmacological advice should be offered?Commence an oral hypoglycaemic agentCommence angiotensin-converting-enzyme (ACE) inhibitors Commence folic acidCommence statinsReduce the dose of insulinThe answer is Commence folic acid. Folic acid is essential for the prevention of neural tube defects. Women with type I diabetes are at high risk of developing neural tube defects.Folic acid should be prescribed at a dose of 5 mg per day in high-risk groups. Other high-risk group patients include women with previously affected children and women on antiepileptic drugs. Insulin is the drug of choice for the patient described above and in most cases, the dosage would not be required to be reduced.Q13. .:A 34-year-old woman attends her obstetrics ultrasound appointment. Her medical history noted mechanical prosthetic valves. The scan reveals the presence of depressed nasal bridge, stippling of non-calcified epiphyses and microcephaly. No other neural tube defect, cardiac problem or orofacial defect was noted. A history of taking which drug is likely to explain the aetiology? LabetalolMetforminPropylthiouracilSodium valproateWarfarinThe answer is Warfarin. Both sodium valproate and warfarin can cause depressed nasal bridge and microcephaly. Sodium valproate is commonly associated with neural tube defects, cardiac defects and other dysmorphic features.Stippling of non-calcified epiphyses is commonly associated with warfarin. Neurological abnormalities may be seen with warfarin usage in the second or third trimester. Teratogenic risk with warfarin is overestimated and should always be balanced with the risk versus the benefit profile. In women with a prosthetic heart valve replacement, there is are an undisputed indication for warfarin usageQ14. .: A 23-year-old woman is newly diagnosed with thyrotoxicosis. She is 20 weeks pregnant. Which medication will be the most appropriate treatment?CarbimazolePropranololThyroxinePropylthiouracilRadioactive iodineThe answer is Propylthiouracil (PTU). Carbimazole and PTU are the most commonly used antithyroid drugs in the UK. Most patients are treated for 12–18 weeks. Both drugs cross the placenta.Very little PTU is excreted in breast milk and it is safer to breast feed with PTU. There is no need to change carbimazole dosage if the woman is already well maintained on it. However PTU is the drug of choice for all newly diagnosed cases. Propranolol may be used in the early management of thyrotoxicosis or during relapse to improve the symptoms of palpitations and tremors, but it is not the main treatment or drug of choice.Q15. Which of the following drug can cause hemolytic anaemia , hyperbillirubinaemia and kernicterus in neonate if given in third trimester of pregancancy:a) Sulfonamides. b) Erythromycinc) Metronidazoled) Quinolonese) TetracyclineQ16. How can the action of cyclizine be described? 5-HT3 antagonist H1 agonistH1 antagonistH2 agonistH2 antagonistThe answer is H1 antagonist. Cyclizine is a antihistamine so it is a histamine receptor anagonist. H2 receptors are found mainly in gastric parietal cells and H2 antagonists include cimetidine and ranitidineQ17. Which agent is a selective alpha 2 agonist?CocaineDobutamineMethyldopaPhenylephrineSalbutamolThe answer is Methyldopa. This antihypertensive is a centrally acting alpha 2 receptor agonist. Phenylephrine is an alpha 1 agonist, and cocaine acts indirectly by inactivating the reuptake of noradrenaline.Q18. Which agent is a neurotransmitter used by the sympathetic preganglionic neuron? γ-aminobutyric acid (GABA)AcetylcholineAdrenalineIsoprenalineNoradrenalineThe answer is Acetylcholine. Both the parasympathetic and sympathetic preganglionic neurons use acetylcholine as a neurotransmitter.Q19. A primiparous 18-year-old patient presents to the maternity assessment unit at 39 weeks of gestation. Urinalysis reveals a proteinuria value of 3+. The patient has a blood pressure of 170/110 and she is suffering from a headache. What antihypertensive would you use on MAU initially?Candesartan HydralazineLabetalolMethyldopaNifedipine immediate releaseThe best answer is labetalol. You would not want to use nifedipine immediate release as this drug can dramatically drop blood pressure and you would not want to use hydralazine as the woman is currently in the assessment unit and there may be a delay in treating her.Q20. A 28-year-old primiparous woman is induced at 39+2 for raised BP and proteinuria. She progresses well to full dilatation, but after pushing for 2 hours there is no vertex visible. On examination, the head is felt to be OA, at +1 station. A decision is made for an instrumental delivery, and the baby is delivered via assisted vaginal delivery in theatre. When the anterior shoulder is delivered, the midwife administers an intramuscular oxytocic agent to aid active management of the third stage of labour. What drug is the most appropriate in this case? CarboprostErgometrineMisoprostolSyntocinonSyntometrineThe best answer is Syntocinon. The other possible options are inappropriate. You would not want to use syntometrine as this can increase the blood pressure and the woman was induced due to raised BP.Q21. Maternal use of metronidazole whilst breastfeeding is associated with the infant displaying one of the following features. AnaemiaDiarrhoeaOral cleft palateVomitingWeight lossThe correct answer is diarrhoea. Metronidazole commonly causes diarrhoea and lactose intolerance. Historically it was believed to cause oral cleft palates but after a large meta-analysis, there was no significant link found.Q22. Alpha methyl dopa is a commonly used antihypertensive in pregnancy. The following is true about this drug:Can cause severe gastroenteritisIs relatively contraindicated in the puerperal periodShould not be used along with a calcium channel blocker The dose range is 1–3 mg per dayWorks by acting at the smooth muscle receptors in the peripheral blood vessels.Q23. A 22 year woman is seen on the postnatal ward round 2 days after normal delivery. She is breastfeeding and wishes to discuss contraception as her pregnancy was unplanned. She has a history of pelvic inflammatory disease. What is the most appropriate contraceptive in her case? Combined oral contraceptive pillsCondomDiaphragmIUCD Progesterone only contraceptive pillsThe correct answer is progestagen only contraceptive pills. IUCD is contraindicated because of the history of pelvic inflammatory disease. Combined oral contraceptive pills are not the contraceptives of choice in breastfeeding mothers because of their potential effect on the volume of breast milk (although evidence is insufficient) and risk of thromboembolism especially when taken within 3 weeks of childbirth. Barrier methods are less reliable contraceptive methods and may not be the most appropriate contraceptive in someone whose recent pregnancy was unplanned.Q24. . Which of these drugs undergoes cytochrome p450-dependent hydroxylation?AspirinLidocaine MethadoneProcaineWarfarinThe answer is Warfarin. Other important drugs that undergo hydroxylation include phenobarbital, propranolol, phenytoin and amphetamines.Q25.A?patient?has?self?referred?to?the?antenatal?booking?clinic.?This?is?her?first?pregnancy.?She?is?25?and?based?on?her?LMP?is?around?6?months?pregnant.?She?takes?iron?as?her?iron?levels?were?borderline?low?in?the?past.?Apart?from?that?she?has?no?significant?past?medical?problems.?She?tells?you?she?is?taking?the?following?medications:? Halibut?liver?oil?capsules?2‐3?daily? Pregnacare?tablets?1?daily? Ferrous?sulphate?200mg?OD? Ascorbic?acid?50mg?OD? Which?of?the?following?is?the?most?appropriate?advice?regarding?her?medications? ?A)?Stop?Ferrous?Sulphate? B)?Increase?ferrous?sulphate?to?200mg?TDS? C)?No?changes?required? D)?Stop?Halibut?liver?oil?capsules?immediately? E)?Stop?Ascorbic?acid?immediately?Explanation:?Pregnacare?is?appropriate?to?take?during?pregnancy?and?has?the?standard? requirements?of?Folic?acid?and?Vitamin?D?(see?below).?? It?may?be?worth?repeating?a?full?blood?count?and?iron?studies?to?see?if?ferrous?sulphate?is? required?but?this?isn't?likely?to?cause?any?harm.?? The?Ascorbic?acid?(vitamin?C)?is?probably?not?required?but?doesn't?typically?cause?verse?effects? unless?taken?in?very?high?doses?(>1000mg)? The?halibut?liver?oil?capsules?are?a?rich?source?of?vitamin?A?(each?capsule?contains?around?4000?iu).?Vitamin?A?(Retinol)?in?high?doses?is?considered?teratogenic?and?this?should?be?stopped? immediately? Q26.Which?of?the?following?women?would?you?advise?to?take?400mcg?of?folic?acid?during?the?first?12? weeks?of?pregnancy??A)?25?year?old?type?1?diabetic? B)?26?year?old?recently?diagnosed?with?coeliac?disease? C)?31?year?old?taking?sodium?valproate? D)?24?year?old?with?sickle?cell?anaemia? E)?None?of?the?above? Explanation:?All?of?the?above?fall?into?the?high?risk?category?so?should?receive?5mg?folic?acid?Q27.Which?of?the?following?dugs?is?a?strong?inducer?of?cytochrome?P450?? ?A)?Phenytoin? B)?Lamotrigine? ???C)?Sodium?Valporate? ?D)?Levetiracetam? ??E)?Topiramate Q28. A woman who has been taking the combined oral contraceptive pill for many years is commenced on phenytoin following a seizure. She then becomes pregnant. Through what mechanism is the contraceptive pill likely to have failed?A Alteration of gut flora by phenytoinB Antagonistic effects of phenytoin at the estrogen receptorC Increased renal clearance of the contraceptive pillD Liver enzyme induction by phenytoinE Liver enzyme inhibition by phenytoinQ29. To reduce surgical-site infections, prophylactic antibiotics are often used. When is the ideal time to administer such prophylaxis?A Six hours before surgeryB Three hours before surgeryC At induction of anaesthesiaD Four hours after surgeryE Six hours after surgeryQ30. A woman experiences a postpartum haemorrhage after delivery and is administered ergometrine topromote uterine contraction. What class of compound is ergometrine?A Alkaloid. B EicosanoidC PolypepetideD ProteinE SteroidQ31. Tranexamic acid is a first-line treatment for menorrhagia. What is the mechanism of action of tranexamic acid?A AntifibrinolyticB Cyclooxygenase inhibitorC GnRH analogueD Oxytocin antagonistE ProgestogenQ32. Misoprostol is a commonly used drug in the medical management of miscarriage. What type of drug ismisoprostol?A Cyclooxygenase inhibitorB Oxytocin antagonistC Progesterone antagonistD ProgestogenE Synthetic prostaglandinQ33. A woman who is 28 weeks pregnant with a fibroid uterus is admitted to the antenatal ward withsevere abdominal pain. An ultrasound scan is arranged with shows a normally grown fetus and placenta, with no evidence of bleeding. Several large fibroids are noted. What is the pathological change in fibroids that can occur in pregnancy?A Decidual degenerationB Fibrous degenerationC Hyaline degenerationD Macular degenerationE Red degenerationQ34. A 33-year-old woman is undergoing an elective repeat caesarean section at term. The infant is delivered without any difficulties, but the placenta cannot be removed easily because a clear plane between the placenta and uterine wall cannot be identified. The placenta is removed in pieces. What is the single most likely placental abnormality here?A Membranaceus placentaB Placenta accretaC Placenta praeviaD Placental abruptionE Succenturiate lobeQ35. A 25-year-old woman presents as an emergency with severe left-sided pelvic pain and vomiting. An ultrasound scan is arranged which shows a 5 cm cystic lesion in the left adnexa with mixed echoes. Alaparotomy is performed and an ovarian cyst that has undergone torsion is removed. The histology of the cyst is reported as 5 cm ovary containing a cystic structure that has undergone partial necrosis. The cyst containssebaceous material and hair. A solid element is identified that contains teeth cartilage and thyroid tissue. What type of cyst has torted?A Benign cystic teratomaB Endodermal sinus tumourC EndometriomaD Mucinous cystadenomaE Serous cystadenomaQ36. A 32-year-old woman attends the fertility clinic. She has a four-year history of infertility, severe dysmenorrhoea and increasing pain with sexual intercourse. On pelvic examination, an adnexal mass is felt and nodules are palpated along the uterosacral ligaments. The single most likely cause for the pathological basis of these physical symptoms is:A Corpus luteum cystB EndometriosisC Ovarian carcinomaD Ovarian dermoid cystE Pelvic inflammatory diseaseQ37. A 28-year-old woman is referred to the early pregnancy unit. She had been taking norethisterone for several weeks to delay a menstrual period while she went on holiday. She has since stopped the medication and has experienced some bleeding. She is concerned as she has passed a ‘pregnancy sac’ vaginally, although her pregnancy test is negative. The tissue is sent for histopathological analysis. What is the most likely diagnosis?A Complete miscarriageB Decidual castC Ectopic pregnancyD Incomplete miscarriageE Molar pregnancyThe appearance of the normal lining of the uterus, by the effect of progesterone, can become decidualized .When an area of decidua is shed, it is called a decidual cast because it frequently comes out in the shape of the uterine cavity. Decidual casts have a well-known association with ectopic pregnancies.Q38. A 20-year-old woman is admitted to the gynaecology ward. It is six weeks since her last menstrual period and her pregnancy test is strongly positive. She is vomiting profusely and has had some vaginal bleeding. An ultrasound scan is organised and the report is as follows:The uterus is very enlarged. No gestational sac is seen but the cavity is filled with tissue with a honeycombed texture. Cysts are noted on both ovaries. What is the most likely diagnosis?A ChoriocarcinomaB Complete hydatidiform moleC Endometrial carcinomaD Endometrial hyperplasiaE Partial hydatidiform moleQ39. Which two HPV types are found in 70% of cervical cancers and are targeted in HPV vaccines?A 6 and 11B 16 and 18C 31 and 35D 31 and 45E 73 and 82Q40. What type of epithelial tissue undergoes malignant change in the majority of bladder cancers?A ColumnarB PseudostratifiedC SquamousD StratifiedE TransitionalQ41. Regarding the diagnosis of Gestational Diabetes which of the following tests is recommended by the WHO for diagnosis?A) random serum glucoseB) fasting serum glucoseC) 50g glucose challengeD) HBA1CE) 75g OGTT with 2 hour glucoseExplanation: WHO advise the 75g OGTT for diagnosis. Although the interpretation is not as straight forward as would be expected as there are WHO and modified WHO values for diagnosis.Q42. The type of necrosis that occurs in Peripancreatic tissue in Acute Pancreatitis is:a) Liquefactionb) Fatc) Coagulationd) Gummatouse) FibrinoidQ43. Which of the following will show hypertrophy:a) The uterine myometrium in pregnancyb) The female breast at pubertyc) The liver following partial resectiond) The ovary following menopausee) The cervix with chronic inflammationQ44. The microscopic appearance of an increased cell size of multiple cells in a tissue, due to an increase in the amount of cytoplasm, with nuclei remaining uniform in size, is best illustrated by:a) The uterine myometrium in pregnancyb) The female breast at pubertyc) The liver following partial resectiond) The ovary following menopausee) The cervix with chronic inflammationQ45. A 30 year old patient has a cervical smear. The report shows anisocytosis, poikilocytosis and hyperchromatism. What are these features suggestive of?A) AtrophyB) MetaplasiaC) HypertrophyD) HyperplasiaE) DysplasiaExplanation: Dysplasia has 4 microscopic characteristics:Anisocytosis (unequal cell size)Poikilocytosis (abnormal cell shape)Hyperchromatism (pigmentation)Mitotic figures (increased cells currently dividing)Q46. patient asks you in clinic when she can start trying to conceive again. She has just completed chemotherapy for gestational trophoblastic disease (GTD)?A) No restriction advisedB) 6 weeks from completion of treatmentC) 6 months from completion of treatmentD) 1 year from completion of treatmentE) 3 years from completion of treatmentExplanation: RCOG Greentop guideline 38 states:'Women who undergo chemotherapy are advised not to conceive for 1 year after completion of treatment'RCOG Greentop guideline 38 states:'Women who undergo chemotherapy are advised not to conceive for 1 year after completion of treatment' Molar Pregnancy & ChoriocarcinomaPartial molar pregnancy, complete molar pregnancy and Choriocarcinoma are often discussed together as Gestational trophoblastic disease (GTD)DefinitionsComplete Molar: Abnormal diploid conceptus with absence of foetus (typically 46XX)Partial Molar: Abnormal triploid conceptus that may have fetal tissue typically 69XXY)Choriocarcinoma: Malignant tumour of trophoblastStatistics1 in 1000 pregnancies per year are molar1 in 45,000 pregnancies effected by choriocarcinoma70% of choriocarcinoma occurs after molar pregnancy (20% after TOP & 10% after normal pregnancy)Classic Clinical FeaturesIrregular vaginal bleedingHyperemesisLarge for gestational age uterusEarly MiscarriageBiochemical FeaturesExcessive HCG productionIn 3% of cases excess HCG sufficient to trigger hyperthyroidismDiagnosisUltrasound assessmentFormal diagnosis is on histopathological assessment following evacuationQ47. Which pathological process increases the production of uric acid? Acute renal failureChronic renal failure. Hodgkin lymphomaHyperparathyroidismHypothyroidismThe answer is Hodgkin lymphoma. All the other processes increase uric acid concentration but do this by reducing renal excretion.Q48. Which tumour marker is the most specific for pancreatic carcinoma? AlphafetoproteinHuman chorionic gonadotropinCA125CA15-3CA19-9 For CA19-9 consider pancreatic carcinoma, although this is not suitable as a screening tool. CA125 is a frequently used biomarker for epithelial ovarian malignancy, and CA15-3 is a biomarker used for breast carcinoma.Q 49. A 45-year-old woman underwent staging laparotomy for ovarian cysts that had a risk of malignancy index (RMI) of 200. The histopathology showed the presence of psammoma bodies. Which ovarian cancer is associated with psammoma bodies? Endometrioid tumourGranulosa cell tumourMucinous tumourSerous tumourTeratomaPsammoma bodies are concentric, laminated, calcified concretions, typically seen in serous epithelial ovarian tumour. An RMI of 200 is highly suspicious of malignancyQ50. The failure of closure of a patent ductus arteriosus in preterm infants can be effectively treated with? AspirinCalcium supplementIndomethacinHigh concentration oxygenProstaglandin infusionIn full term babies, the ductus arteriosus constricts in response to a rise in oxygen tension. Infants who have congenital malformations and need surgery at birth are treated with prostaglandin infusions, in order to keep the ductus open until the surgery for the other defects has been performed.However, preterm infants in whom the ductus fails to fuse are treated with prostaglandin inhibitors. The most commonly used is indomethacin. Ibuprofen is also used and has a lesser side effect profile. Symptomatic infants with large patent ductus arteriosus need surgical treatment.Q51. How can a fibroid best be described?Benign growth of fibroblastsBenign growth of skeletal musclesBenign growth of smooth musclesCancerous growth of fibroblastCancerous growth of smooth muscles Contrary to the name, fibroids are not composed of connective tissues. They are smooth muscle, which grows abnormally in a well-defined whorled pattern.Q52. A 30-year-old woman presents with abdominal pain, a high fever and has been feeling generally unwell for 10 days since her caesarean section. On examination, a red, warm and swollen area is noted on her abdominal wall around the scar. She reports that the area of redness has rapidly increased in size. Blisters have developed around the margins. What is the likely diagnosis?CellulitisErysipelasHerpes zosterGangreneNecrotising fasciitisThe above description is apt for necrotising fasciitis, which develops rapidly in the deep tissues and spreads along the fascia. Cellulitis is a diffuse inflammation of dermis. It mainly affect limbs. Erysipelas is more superficial but well defined.Q53. which vitamin would u give an alcoholic pregnant woman at ?32 wks with obstetric cholestasisAB1KEQ54. Unwanted effect of pregnancy not related to physiological changes :BackacheDysuriaConstipationTirednessQ55. Reaclls 2013 march There was a question on urine output... A).0.25ml/kg/hr. B).0.5 mi/kg/hrC).1ml/kg/hrD).2ml/kg/hrE).5ml/kg/hrQ56. .What is the most common heritable thrombophilia?Antithrombin III deficiencyFactor V LeidenProtein C deficiencyProten S deficiencyProthrombin G20210AHeritable thrombophilia is a major risk factor for venous thromboembolism (VTE) in pregnancy. Activated protein C resistance (caused by factor V mutation) is five times more common and up to 5% more prevalent than in the normal population. Up to 25% prevalence is seen with VTE. Though uncommon, antithrombin III deficiency has a very high risk of recurrence. The patient may require higher doses of low-molecular-weight heparin.Q57. A 14-year-old child presents to the adolescent gynaecology clinic. She has a history of virilisation after undergoing pubertal changes. The karyotype reveals 46XY. An ultrasound scan does not show the presence of a uterus and ovaries. Which enzyme deficiency may be associated with these clinical features?5-alpha-reductase deficiencyComplete androgen insensitivity syndromeKallmann syndromePolycystic ovary syndromeTurner syndromeTurner syndrome is 45 XO. Polycystic ovarian syndrome has a normal female karyotype. The child described above is genetically male. However, testosterone is not converted to dihydrotestosterone in target tissues. Five-alpha-reductase deficiency prevents conversion of androgen to estrogen. The child may have been born with ambiguous genitalia and raised as a female. At puberty, elevated levels of androgen lead to masculinisation including virilisation. Complete androgen insensitivity is not the answer because increased androgens are converted to estrogen and do not show any virilisation. It involves phenotypic females and an unresponsiveness to androgens.Kalman's syndrome is a form of hypogonadotropic hypogonadism and anosmia.Q77. A 30 year old patient has a cervical smear. The report shows anisocytosis, poikilocytosis and hyperchromatism. What are these features suggestive of?Atrophy Metaplasia HypertrophyHyperplasia DysplasiaCellular AdaptationCellular adaptation refers to cellular changes that occur in response to environmental changes. The may be physiological or pathological. There are 5 types:AtrophyDecrease in cell size.May be physiological such as thymus atrophy in childhood or pathological such as disuse atrophy in neurological injury.HypertrophyIncrease in cell sizeTypically result of increased intracellular protein rather cytosolMay be physiological such as muscle hypertrophy in weightlifters or pathological such as cardiac hypertrophy following MI, The uterine myometrium in pregnancyHyperplasiaIncrease in cell numberPhysiological endometrial hyperplasia occurs in pregnancy whereas pathological hyperplasia occurs in endometriosisMetaplasiaReversible change of one differentiated cell type with another One example is cervical metaplasia where glandular epithelium is replaced by stratified squamous epithelium.DysplasiaAbnormal change to cellular size, shape and/or organisationSometimes referred to as atypical hyperplasiaCan progress to cancerCervix tissue is prone to dysplasiaNote: neoplasia refers to abnormal growth of cells typically resulting in tumour formation and may comprise a number of the cellular adaptations referred to aboveQ78. Paraneoplastic Cushing's syndrome is most commonly associated with which of the following malignancies?Squamous cell carcinoma Small cell lung cancerSeminoma Renal cell cancer Ovarian cancerParaneoplastic Cushing's syndrome is caused by tumours secreting ACTH and is most commonly seen in small cell lung cancerQ79. A 23-year-old woman presents to her GP. She is currently nine weeks pregnant. She is requesting an immediate termination as her partner is threatening to leave her if she goes ahead with the pregnancy. She is notably low in mood and threatening to selfharm. She has a fear of anaesthetic medication. What is the next most appropriate stepin management?a Suction curettagee Copper coilb Antiprogesterone tablets with prostaglandin pessariesc Dilatation of the cervix and evacuation of the uterine contentsd Prostaglandin inductionQ80. A middle-aged woman presents to her GP. She has been trying to get pregnant, but despite regular intercourse with her partner has been unable to do so. She enquires about when in her menstrual cycle she is likely to conceive. What is the most likely time frame in an average 28-day cycle when women are most likely to conceive?a Day 2-4b Day -1-6c Day 8-10d Day 8-14e Dav 16-20Q81. The following are all common fetal complications associated with smoking in pregnancy EXCEPT:a Prematurityd Cot deathb Respiratory disease c Intrauterine growth retardationae Cystic fibrosisQ82. A patient attends the maternity unit as her waters have broken but she hasn't had contractions. She is 39+6 weeks gestation. Speculum examination confirms prelabour rupture of membranes (PROM). What is the risk of serious neonatal infection with PROM?1 in 10001 in 1005 in 10010 in 100 5 in 1000Prelabour Rupture of Membranes: Risk of serious neonatal infection 1% (vs 0.5% for women with intact membranes)60% of patients with PROM will go into labour within 24 hrsInduction appropriate if >24 hours post rupture and patients labour hasn't started.Q83. The following are all common fetal complications associated with excessive alcohol consumption in pregnancy EXCEPT:a Neurological damageb Facial deformitiesc Fetal growth retardationd Increased birth weighte Spontaneous miscarriageQ84. A 69 year old patient undergoes staging investigations for endometrial carcinoma. This shows invasion of the vaginal wall but no nodal involvement or distant metastasis. What FIGO stage is this?2 3A3B3C4AQ85. A 28 year old primigravida carrying a twin pregnancy presents at 32 weeks gestation. She is lethargic, clinically jaundiced and complains of abdominal pain with frequent vomiting. Her bloods are as follows:Bilirubin 62 μmol/lALP 640 u/lALT 196 u/lγGT 185 u/lAlbumin 24 g/lINR 3.2What is the likely diagnosis?Obstetric cholestasisAcute fatty liver of pregnancyHepatitis AHepatic infarctionBudd-ChiariThis patients bloods and symptoms suggest she has hepatic impairment. Acute fatty liver of pregnancy typically presents after the 30th week and she has risk factors for acute fatty liver of pregnancy:Multiple pregnancy? PrimigravidaPresentation of Acute Fatty Liver of PregancyAbdominal painLethargy/Malaise? JaundiceDerranged liver function?CoagulopathyHypoglycaemia/hyperuricaemiaRisk Factors: Primigravida Male fetusMultiple pregnancy? ObesityPrevalence : 1 in 10,000 to 20,000 pregnanciesMortality: Fetal & Maternal mortality approximately 20%Cause: Fetal deficiency of long-chain 3-hydroxyl-CoA dehydrogenase (LCHAD)Q86. A patients MSU comes back showing heavy growth of E.Coli that is resistant to trimethoprim, amoxicillin and nitrofurantoin. You decide to prescribe a course of Cefalexin. What is the mechanism of action of Cefalexin?inhibit peptidoglycan cross-links in bacterial cell wallDNA Gyrase InhibitorBeta LactamaseDihydrofolate Reductase InhibitorPeptidyltransferase InhibitorCephalosporins, like penicillins, are active via Beta-Lactams which inhibit peptidoglycan cross-links in bacterial cell walls.Note Beta Lactamase enzymes are produced by bacteria resistant to Beta-Lactam antibiotics.Q87. The probability of sarcomatous change occurring in fibroid is ( march 2015 )A. 0.1%B. 1%C. 5%D. 10%E. 15%Q88. The most common site of endometriosis is ( march 2015 )A. OvaryB. OviductC. VaginaD. RectumE. Uterosacral ligamentQ89. What is the most common site for tubal ectopic gestation? ( march 2015 )A. AmpullaB. IsthmusC. InfundibulumD. Interstitial portionE. Fimbrial endQ90. The non pregnant uterus of a 20-year-old female measured 7 x 4 x 3 cm. She became pregnant, and just before delivery of a term infant, the uterus measured 34 x 18 x 12 cm.Which of the following cellular processes was the major reason for the increase in the size of the uterus? A. Endometrial glandular hyperplasiaB. Myometrial fibroblast proliferationC. Endometrial stromal hypertrophyD. Myometrial smooth muscle hypertrophyE. Vascular endothelial hyperplasiaQ91. Two days after undergoing total abdominal hysterectomy and bilateral salpingo- oophorectomy a 60-year-old woman develops high temperature and confusion. On examination; She has a temperature of 38.2°C, a respiratory rate of 28/min, a pulse of 103 beats/min, a blood pressure of 130/80 and a urine output of 10 ml/hr after catheterization. Which of the following is the most likely diagnosis? ( march 2015 )A. SepsisB. Septic shockC. Severe sepsisD. SepticemiaE. Systemic inflammatory response syndrome Q92. Which of the following is the most related to endometrial carcinoma? A. Simple hyperplasiaB. Complex hyperplasiaC.Polypoid adenomaD. Simple atypical hyperplasiaE. Complex atypical hyperplasiaQ93. which organ/system involved with krukenberg tumor of the ovary? A. GIT. B. RespiratoryC. RenalD. UterusE. Q94. Chest x ray findings of a tuberculosis patient showing T.B granuloma at the apex of the lung. Which of the following cells is responsible for caseous necrosis? ( sept.2014 ) ( 2013 )A. LymphocytesB. Plasma cellsC. MacrophagesD. FibroblastE. NeutrophilsQ95..Which type of tissues consists chiefly the resting non pregnant female breast? ( sept.2014 )A. FattyB. GlandularC. FibrousD. MuscleE. LymphoidQ96. Which type of epithelium lines the lower urethra near the external urethral orifice? ( sept.2014 )A. TransitionalB. Stratified columnarC. Simple columnarD. Stratified squamous non-keratinizedE.Stratified squamous keratinizedQ97. What is the most likely histological subtype of endometriosis associated with ovarian cancer? ( sept.2014 )A. Clear cell carcinomaB. Serous adenocarcinomaC. Borderline serous tumoursD. Muscinous cystadenocarcinomaE. Granulosa cell tumorQ98. Physiological anemia of pregnancy is due to ( sept.2014 )A. Decrease in plasma iron binding capacityB. Decrease in iron storesC. Hypoactivity of bone marrowD. Disproportionate increase in plasma volumeE. Deficiency of vitamin B12Q99..inflammation release of all except?( march 2014 )a. von willebrand ?b. nitric oxidec. prostacycline. plasminogen activator d. bradykininQ100. Which antigen-presenting cells (APCs) are mainly found in the cervix? ( march 2015 ) ( 2013 both exams) ☆ important question ☆A. Plasma cellsB. Hofbauer cellsC. T cellsE. Langerhans cellsD. B cellsGroup 9 Q1. What is the pathophysiology explain that vitamin A can cause birth defects of the child during pregnancy? ( march 2015 )A. Accumulation of free radicalsB. Oxidative stressC. Excessive carotenoidsD. Hypervitaminosis AE. Deficiency of vitamin AQ2. .A 26-year-old pregnant woman is found to have an Hb of 11 g/dL on a routine blood test , with an MCV of 70. Serum electrophoresis reveals an Hb F of 0.5 percent, Hb A1 of 60 percent, Hb A2 of 2 percent and Hb S of 40 percent. Her ferritin levels are normal. The most likely diagnosis is: ( march 2015 )A. Iron deficiency anemiaB. α-thalassemiaC. β-thalassemiaD. Sickle cell traitE. Sickle cell diseaseQ3-year-old woman after normal vaginal birth develops shortness of birth and seizures. Despite resuscitation she dies within 20 minutes. At autopsy squamous cells and fetal hair are found in lungs. What is the most likely cause of death? ( march 2015 )A. Amniotic fluid embolismB. Placental abruptionC. EclampsiaD. Pulmonary embolismE. Postpartum hemorrhageQ4. most common type of degeneration in fibroid of non pregnant woman ( march 2014 )a. red degenerationb. hyaline degenerationc. sarcomatous changesQ5. A woman presents to the Accident and Emergency department with a painful swelling on the left side of the vaginal introitus. She was recently treated for pelvic inflammatory disease. Which gland is most likely to be infected?A Bartholin’s glandB Nabothian glandC. Sweat glandD. Sebaceous glandE. Skene’s glandQ6. .Which organism causes tubal infection that is responsible for the majority of cases of secondary infertility?A Chlamydia trachomatisB Mycobacterium tuberculosisC Neisseria gonorrhoeaeD Treponema pallidum pallidumE Treponema pallidum pertenueQ7. From which germ cell layer are the ureters derived?A EctodermB EndodermC MesodermD TrophoblastE Yolk sacQ8. A woman who is 16 weeks pregnant calls the gynaecology clinic. She is a primary school teacher and there is an outbreak of chicken pox in her class. Her GP sent some bloods for testing. VZV-IgG came back positive and the VZV- IgM was negative. The best management plan is:Administration of VZV immunoglobulinExpectant managementFollow up with ultrasoundInvasive prenatal testingVZV vaccinationQ9. A 25-year-old, para 2, attended the antenatal clinic at 20 weeks of gestation. She was concerned as in her previous pregnancy she had an infection that caused deafness and delayed the development of her child. The baby had become jaundiced shortly after birth. What infection did she have in her previous pregnancy?ChickenpoxCytomegalovirusRubellaHerpes simplex virusHuman papilloma virusQ10. A patient presents with condyloma lata. At what stage of syphilis does this feature occur?NeurosyphilisPrimaryQuaternary Secondary TertiaryQ11. A pregnant woman at 18 weeks of gestation presents with bloody diarrhoea. Stool microscopy and culture identifies Gram-negative, facultative anaerobic rods. Which organism is most likely to be responsible?Borrelia Campylobacter Salmonella Staphylococcus StreptococcusQ12. Two days after undergoing total abdominal hysterectomy and bilateral salpingo- oophorectomy a 60-year-old woman develops high temperature and confusion. On examination; She has a temperature of 38.2°C, a respiratory rate of 28/min, a pulse of 103 beats/min, a blood pressure of 130/80 and a urine output of 10 ml/hr after catheterization. Which of the following is the most likely diagnosis? ( march 2015 )A. Sepsis. B. Septic shockC. Severe sepsisD. SepticemiaE. Systemic inflammatory response syndromeWe only say septic shock if lactate more than 4 or patient stillhypotensive despite fluids resuscitation of 2 litter or moreQ13. Which organism is not classically associated with bacterial vaginosis?Bacteroides speciesGardnerella vaginalisHistoplasma capsulatumMobiluncus speciesMycoplasma hominisThe answer is Histoplasma capsulatum. Histoplasma capsulatum is a fungal infection. The other four options are the classical causes of bacterial vaginosis.Q14. .:What is the incubation period of rubella? 5–7 days10–14 days13–20 days14–21 days14–28 daysThe answer is 13–20 days. Rubella is caused by a single-stranded RNA togavirus.Q15. What type of fungus is Candida albicans?Dimorphic fungus. Filamentous fungusTrimorphic fungusTrue yeast. Yeast-like fungusUnlike true yeasts, Candida forms long-branching filaments and therefore, it is classified as a yeastlikeQ16. MRSA infections may respond to which antibiotic?AugmentinCarbapenemsCephalosporinsClindamycinsVancomycinStaphylococcus aureus can gain resistance to all beta-lactam antibiotics through mutation in the cellular proteins. The patients may be asymptomatic, carriers of MRSA or develop active infection. These will not respond to flucloxacillin, cephalosporin or carbapenems.MRSA may respond to vancomycin, teicoplanin, tetracyclines, rifampicin and fusidic acid.Q17. A 29-year-old woman who is 39 weeks pregnant presents to the delivery suite in labour. Her previous child was affected by group B streptococcus (GBS) infection. She is allergic to penicillin. Which antibiotic should be prescribed for her as a prophylaxis for GBS?Ampicillin CephalosporinsClindamycinGentamycinMetronidazoleAmpicillin may be used as an alternative to penicillin, however, it should be avoided because it covers a broader spectrum and may be associated with Gram-negative sepsis. Cephalosporins may have 10% cross reactivity with penicillin allergy. Gentamycin is not relevant in this situation. Vancomycin and erythromycin can potentially be used when clindamycin is notrecommended.Q18. A 30-year-old woman presents to the antenatal clinic with a history of cytomegalovirus (CMV) infection. Which test would be the most sensitive for diagnosis of congenital infection in pregnancy?Amniotic fluid PCRAntenatal serologyCMV-specific IgGCMV-specific IgMUltrasound scan of the fetusThere is no method of antenatal diagnosis that will reliably identify infected fetuses at risk of adverse outcome. Serological diagnosis of primary CMV infection during pregnancy can be difficult because CMV IgM, while suggestive of recent infection, can remain positive for many months and can also represent reactivation of past infection. The quantitative PCR detection of the CMV virus in the amniotic fluid has good sensitivity for fetal infection.Q19. A pregnant woman is diagnosed with toxoplasmosis. What is the drug of choice for reducing the risk of fetal infection? AciclovirSpiramycinMetronidazolePenicillinIntrauterine blood transfusionToxoplasmosis gondii is an obligate intracellular protozoan.Aciclovir is an antiviral agent. Metronidazole may be used in protozoan infections but is not considered useful with toxoplasmosis.Spiramycin is a macrolide antibiotic and has been shown to reduce the risk of mother-to-child transmission in pregnant woman by up to 70% but there is insufficient evidence that it reduces the severity of the disease.Q20. .:A cervical smear report shows the presence of 'clue cells'. Otherwise the smear was reported as normal. 'Clue cells' are associated with which organisms?ActinomysisCandida speciesGardenerella vaginalisHerpes genitalisHuman papillomavirusClue cells may be identified in the presence of GV. Fungal spores/hyphae may be noted with candidiasis. Human papillomavirus is associated with koilocytes. The presence of clue cells does not always indicate the need for treatment. Bacterial vaginosis is often noted in sexually active women; however, it is not sexually transmitted.Q21. Which pathogen is commonly responsible for cellulitis?Clostridium perfringens Pseudomonas aeruginosaStaphylococcus aureusStaphylococcus epidermidisStreptococcus pyogenesStreptococcus pyogenes is responsible for approximately two-thirds of cellulitis infections and Staphylococcus aureus approximately one-third. Pseudomonas aeruginosa is a rare cause.Q22. What is the incubation period for varicella infection?5–7 days7–10 days10–14 days10–20 days14–21 daysThe answer is 10–20 days. The infectious period lasts from about 5 days before the rash develops until all of the lesions have crusted over.Q23. Which infection is known to produce an aplastic crisis in people with sickle cell disease?CytomegalovirusHerpes virusParamyxovirusParvovirusRubella virusParvovirus B19 infections lead to an aplastic crisis if there is a marrow strain, and hydrops fetalis and fetal death are complications of intrauterine parvovirus B19 infection.Q24. What is the potential cause of small white umbilicated white papules on the labia majora?Chlamydia D–KHaemophilus ducreyiHuman papillomavirusMolluscum contagiosumTrichomonas vaginalisThis description is classical for molluscum. Haemophilus ducreyi often presents with multiple painful genital ulcers and lymphadenopathy.Q25. Which organism causes lymphogranuloma venereum?Chlamydia pneumoniaChlamydia psittaciChlamydia trachomatis A–CChlamydia trachomatis D–K Chlamydia trachomatis L1–L3The answer is Chlamydia trachomatis L1–L3. Chlamydia trachomatis A–C causes ocular trachoma and Chlamydia trachomatis D–K causes cervicitis, pelvic inflammatory disease and urethritis.26. Which group of viruses cause chicken pox?AdenovirusHerpes virusPapovavirusParvovirus Pox virusThe answer is Herpes virus. Chicken pox is caused by varicella zoster virus, which is one of eight herpes viruses. The other viruses in the Herpes virus group are herpes simplex virus 1, herpes simplex virus 2, Epstein-Barr virus, cytomegalovirus, roseolovirus, pityriasis rosea, Kaposi's sarcoma-associated herpes virus.Q27. Which organisms contain ribosomes, do not have a rigid cell wall but cannot be grown on inanimate culture?BacteriaChlamydiaMycoplasmaRickettsiaeVirusesThe answer is Chlamydia. Bacteria and mycoplasma can be grown on culture, rickettsiae have a rigid cell wall and viruses do not have ribosomes.Q28. Which bacteria are Gram-negative aerobic rods?Haemophilus influenzaeNeisseria gonorrhoeaePseudomonas aeruginosaStreptococcus pyogenesTreponema pallidumThe answer is Pseudomonas aeruginosa. Gram-negative aerobic rods are rare, with the exception of Pseudomonas.Haemophilus is a genus of Gram-negative, pleomorphic, coccobacilli bacteria. Neisseria is a genus of Gram-negative diplococcus.Streptococcus is a genus of spherical Gram-positive bacteria. Treponema is a genus of Gram-negative spirochaetes.Q29. Which organisms contain ribosomes, do not have a rigid cell wall but cannot be grown on inanimate culture?BacteriaChlamydiaMycoplasmaRickettsiaeVirusesThe answer is Chlamydia. Bacteria and mycoplasma can be grown on culture, rickettsiae have a rigid cell wall and viruses do not have ribosomes.Q30. Which white blood cell type is elevated in an acute cytomegalovirus infection?BasophilsEosinophilsLymphocytesMonocytesNeutrophilsClassically, lymphocytes are elevated in a viral infection.Q31. Which one of the following drugs is unlikely to cause direct renal impairment :CefuroximeDiclofenacLisinopril RamiprilSimvastatinQ32. A 65-year-old woman underwent vaginal surgery for which she was in the lithotomy position for 2 ? hours. Postoperatively you have noticed parasthesia of the lateral side of the leg, foot and foot drop. The compression of which nerve is likely to be responsible?Common peroneal nerveGreat saphenous nerveFemoral nerveObturator nervePudendal nerveThe answer is common peroneal nerve. The injury is thought to be secondary to compression of the nerve between the lateral head of the fibula and the bar holding the legs. When the stirrups are used, specialattention must be paid in order to avoid compression. Injury to the femoral nerve will cause hypoesthesia in the anterior and anteromedial area on the thigh below the inguinal ligament.Q33. Which artery is a direct branch of the aorta?Inferior vesical Internal iliac Ovarian Uterine VaginalQ34. A 28-year-old woman presents to the gynaecology clinic with a history of dysmenorrhoea, dysparunia and menorrhagia. A vaginal examination reveals a thickened nodule in the posterior fornix. Which anatomical structure is most likely to be affected?Constipated bowelOvaries UreterPectineal ligaments Uterosacral ligamentsThe answer is the uterosacral ligament. The above trio of symptoms is characteristic of endometriosis. It is possible to palpate the affected uterosacral ligament by vaginal examination.Q35. The inferior hypogastric plexus is an important plexus supplying the hind gut. What are its nerve root origins?L3–L5L4–L5 and S1–S4S2–S4T8–T12 and L1–L3T10–12 and L1–L2The answer is T10–12 and L1–L2. The inferior hypogastric plexus is a continuation of both hypogastric nerves. It is derived from the lower three thoracic and upper two lumbar segments. The parasympatheticand sympathetic supply of this plexus effects uterine contractions and vasoconstriction.Q36. Which group of nerves all constitute branches of the pudendal nerve?Internal pudendal nerve, perineal nerve, dorsal clitoral nerveMid rectal nerve, dostal clitoral nerve, perineal nervePerineal nerve and posterior clitoral nervePerineal nerve, dorsal clitoral nerve, inferior rectal nerve Perineal nerve, inferior clitoral nerve, mid rectal nerveThe answer is D the perineal nerve, dorsal clitoral nerve and inferior rectal nerve. These are the three important branches of the pudendal nerve.Inside the pudendal canal, the nerve divides into branches, first giving off the inferior rectal nerve, then the perineal nerve, before continuing as the dorsal nerve of the penis (in males) or the dorsal nerve of the clitoris (in females).Q37. From which germ cell layer derivative do the autonomic ganglia develop?A EndodermB Neural crestC Neural tubeD Paraxial mesodermE Surface ectodermNeuroectoderm - CNS and brain:brain - all neurons within brain and spinal cord/CNSneurohypophysisoligodendrocytes astrocytesependymal cells pineal gland retinaNeural Crest - PNS and nearby non-neural structures: ANScranial nervesceliac ganglionganglia (dorsal root, cranial, and autonomic)melanocytes chromaffin cells of adrenal medullaenterochromaffin cellsparafollicular (C) cells of thyroidSchwann cellspia and arachnoidbones of the skullodontoblastslaryngeal cartilageaorticopulmonary septumQ38. A bicornuate uterus is the result of the failure of which embryonic structures to correctly fuse?A Genital tuberclesB Mesonephric ductsC Metanephric ductsD Paramesonephric ductsE Pronephric ductsQ39. Which embryonic cell type secretes hCG?A AmnionB CytotrophoblastC MesodermD SyncytiotrophoblastE Yolk sacHuman chorionic gonadotropin (hCG, or human chorionic gonadotrophin) is a placental hormone initially secreted by cells (syncitiotrophoblasts) from the implanting conceptus during week 2, supporting the ovarian corpus luteum, which in turn supports the endometrial lining and therefore maintains pregnancy. Q40. What is the origin and genetics of a complete molar pregnancy?Most cases (90%) are diploid, as a result of an empty ovum being fertilised by one spermMost cases (90%) are diploid, as a result of an empty ovum being fertilised by two spermMost cases (90%) are mosaic Most cases (90%) are tetraploid Most cases (90%) are triploid, as a result of an ovum being fertilised by two spermA complete mole is caused by a single (incidence is about 90%) or two (incidence is about 10%) sperm combining with an egg which has lost its DNA (the sperm then reduplicates forming a "complete" 46 chromosome set).The genotype is typically 46,XX (diploid) due to subsequent mitosis of the fertilizing sperm, but can also be 46,XY (diploid). 46,YY (diploid) is not observed. In contrast, a partial mole occurs when a haploid egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid) or 92,XXXY (tetraploid).Complete hydatidiform moles have 2.5% risk of developing into choriocarcinoma, but also a 10% chance of becoming an invasive mole. Incomplete moles can become invasive (<5% risk) but are not associated with plete hydatidiform moles account for 50% of all cases of choriocarcinoma.Q41. Floopy infant syndrome : Diazepam or phenytoin ?DiazepamQ42. Hpv genotypes 6 & 11 are associated with. ...?Genital wartsQ43. What is the type of hpv vaccine Live attenuated ToxoidQ44. A 68-year-old woman with uterine carcinoma undergoes surgical resection. This cancer can spread directly to the labia majora in lymphatics that follow which of the following structures?A. Pubic arcuate ligamentB. Suspensory ligament of the ovaryC. Cardinal (transverse cervical) ligamentD. Suspensory ligament of the clitorisE. Round ligament of the uterusThe round ligament of the uterus runs laterally from the uterus through the deep inguinal ring, inguinal canal, and superficial inguinal ring and becomes lost in the subcutaneous tissues of the labium majus. Thus, carcinoma of the uterus can spread directly to the labium majus by traveling in lymphatics that follow the ligament. The pubic arcuate ligament attaches across the inferior aspect of the pubic symphysis and attaches to the medial borders of the inferior pubic rami. The suspensory ligament of the ovary runs from the ovary to the pelvic wall and transmits the ovarian vessels. The cardinal (transverse cervical) ligament runs from the cervix and the vagina to the pelvic walls. The suspensory ligament of the clitoris runs from the pubic symphysis and the arcuate pubic ligament to the deep fascia of the body of the clitoris.Q45. [mechanism of action of letrozole is on this enzyme: a. Hydroxylase b. Aromatase Letrazolis an oral non-steroidal aromatase inhibitorfor the treatment of hormonally-responsive breast cancer after surgery.Q46. A diabetic women attends your preconception clinic. You have checked her HBA1C. what HBA1C level would prompt you to strongly advise this women NOT to get pregnant due to the signifiant risks it presents?>6.5% or 48mmol/mol>7.6% or 60mmol/mol>10.0% or 86mmol/mol?>11.1% or 98mmol/mol>12.6% or 114mmol/molPatients with HBA1C of 10.0% or greater should be strongly advised to use contraception and improve glycemic control prior to getting pregnant.Diabetes In Pregnancy : NICE updated its guidance on management of diabetes in pregnancy in 2015. The current guidelines advise the following regarding management including new HBA1C targets:Advise women with diabetes who are planning to become pregnant to aim to keep their HbA1c level below 48 mmol/mol (6.5%), if this is achievable without causing problematic hypoglycaemia.Reassure women that any reduction in HbA1c level towards the target of 48 mmol/mol (6.5%) is likely to reduce the risk of congenital malformations in the baby.Strongly advise women with diabetes whose HbA1c level is above 86 mmol/mol (10%) not to get pregnant because of the associated risks.Q47. During a caesarean section, the rectus sheath is divided to reveal the rectus muscle. The combinedaponeuroses of which muscles form the anterior component of the rectus sheath?A External and internal oblique?B External oblique and transversus abdominisC Internal oblique and transversus abdominisD Pyramidalis and serratus anteriorE Pyramidalis and transversus abdominisThe rectus sheath is formed by the aponeuroses of the transverse abdominal and the external and internal oblique musclesQ48. What type of joint is formed at the symphysis pubis?A Cartilaginous?B CondyloidC FibrousD SynarthrodialE SynovialQ49. Which tumour suppressor protein is mutated in the majority of cancers?A APCB INK4aC p53?D p57E TGFβQ50. The uterine artery is a direct branch of which major artery in the pelvis?A External iliacB Internal iliac?C FemoralD ObturatorE PudendalQ51. A woman with advanced cervical cancer presents to hospital with worsening left loin pain. Which structure is most likely to have become obstructed?A CervixB Ureter?C UrethraD Uterine arteryE VaginaQ52. The motor supply of the levator ani muscle is derived predominantly from which spinal segment?A L5B S1C S2D S3E S4?Q53. The pituitary gland sits in a small bony cavity in the skull known as . .?A Diaphragma sellaeB Optic chiasmC Sella turcicaD Sphenoid sinusE Third ventricleQ54. The lactating breast is divided into lobules, each of which contains a lactiferous duct. Approximately how many lobules does each breast contain?A 1B 2C 5D 10E 20?Q55. Which cell organelle is responsible for the enzymatic modification of secreted proteins?A Golgi complex?B MitochondriaC NucleusD Rough endoplasmic reticulumE Smooth endoplasmic reticulum Which fetal gland is responsible for generating dehydroepiandrosterone (DHEA) during estrogen synthesis?A Adrenal?B PancreasC ParathroidD PituiaryE ThyroidQ56. Which compound inhibits hormone-sensitive lipase-mediated hydrolysis of triacylglycerol into fatty acids and glycerol?A AdrenalineB GastrinC GlucagonD Insulin?E NoradrenalineQ57. Which cellular ‘second messenger’ signalling molecule is generated by oxytocin stimulation of myometrial myocytes and stimulates intracellular calcium release?A Calcium ions (Ca2+)B Cyclic adenosine monophosphate (cAMP)C Cyclic guanosine monophosphate (cGMP)D Inositol-1,4,5,-triphosphate (IP3)?E Nitric oxide (NO)Q58. What type of acid–base disturbance may result from the chronic use of spironolactone (an aldosterone antagonist)?A Metabolic acidosis?B Metabolic alkalosisC No effectD Respiratory acidosisE Respiratory alkalosisQ59. A woman undergoes a surgical evacuation of retained products of conception following a miscarriage. She telephones two days later to say that her pregnancy test is still positive. What would you advise her about the length of time for which her test may remain positive? A 5 daysB 10 daysC 12 daysD 15 daysE 21 days?Q60. A 36-year-old woman with type 1 diabetes on insulin is seen as an emergency at 34 weeks of gestation with severe vomiting, polyuria and blurred vision. She is examined and found to be drowsy, hyperventilating, tachypnoeic and hypotensive. You suspect that she has diabetic ketoacidosis. What test value will help you confirm the diagnosis?Bicarbonate level of less than 10 mmol/lBlood glucose of more than 11mmol/lBlood ketone of more than 2.0 mmol/lBlood pH of less than 7.4Urinalysis that shows ketonuriaWhen a pregnant diabetic presents with features highly suggestive of diabetic ketoacidosis (DKA) a series of investigations have to be performed to confirm the diagnosis. These include a blood glucose level of more than 11 mmol/l, a blood ketonuria of at least 3.0 mmol/l or urinary ketonuria of more than 2+ and a bicarbonate of less than 15 mmol/l or a pH of less than 7.3.Q61.what is the main .intracellelar cation ?Sodium Chloride CalciumPotassium PhosphateKnowledge of basic biochemistry is a requirementCompartment Main Cation Main IonECF Sodium ChloridePlasma Sodium ChlorideICF Potassium PhosphateIt is important to know that in non-excitable cells a membrane potential is set up and maintained by the Na+/K+/ATPase pumps which transport Potassium inside the cell in exchange for sodiumQ62. A 28 year old women is seen in the early pregnancy unit. She has had a positive pregnancy test but is uncertain of her LMP. Ultrasound doesn't visualise a pregnancy. You perform bHCG tests 48 hours apart. The first bHCG is 400mIU/ml. The second is 690mIU/ml.What is the likelydiagnosisViable intrauterine pregnancyEctopic PregnancyTwin PregnancyMolar PregnancyNon-Viable intrauterine pregnancyIn normal pregnancy hCG levels should rise by around 66% every 2 days. NICE advise >63% rise consistent with likely viable intrauterine pregnancy. In the example above there has been a 72% rise in 2 days - consistent with viable pregnancy. In the exam if you are asked to interpret 2 hCG results you are likely to be given either viable or non-viable pregnancy scenarios as ectopic/molars/multigestation shouldn't be diagnosed from hCG (+/- progesterone) results alone. In molar pregnancy a very high hCG is typically seen. In partial molar pregnancy the hCG typically rises at a slower rate and to a lower level than seen in normal pregnancy.In ectopic pregnancy hCG levels tend to plateau or have a doubling time of greater than 7 days (doubling time 3 days in normal pregnancy)In twin pregnancies hCG levels are typically higher than for single intrauterine pregnancy.Q63. Which of the following is used in protein analysis?Northern Blotting Eastern Blotting Southern BlottingWestern Blotting Southwestern BlottingQ64. A diagnosis of a caesarean scar pregnancy has been made in a 23-year-old woman who had an elective caesarean section for breech presentation last year. She has been counselled and elects to have methotrexate. What baseline investigations should be performed prior to administering this systemic treatment?Full blood countFull blood count and liver function test Full blood count, liver, lung and renal function testsFull blood count, renal and liver function tests Lung, liver and renal function testMethotrexate is the drug of choice for the medical treatment of caesarean scar pregnancy. Systemic administration of methotrexate is commonly used alone to successfully resolve human chorionic gonadotropin levels and caesarean scar pregnancy mass. Prior to its administration, all women should have a baseline full blood count, liver function and renal function tests. Q65. A 57-year-old postmenopausal woman is referred to clinic with a six-month history of bloating. Ultrasound reveals a 7 cm multilocular unilateral ovarian cyst with solid areas. There is no ascites. Her CA-125 is 80 IU/ml. What is her risk of malignancy index score (RMI)?A. 240 B. 320C. 400D. 480E. 720CA - 125=80menopaual score = 3 UC features more than one take score 3So it will be 3×3×80=720.Q66. You are following up in fertility clinic and note the male partners karytype has come back as 47xyy .what phenotype would you expect to see in a male with 47 xyy? A)Turner syndromeB)klinefelter syndromeC)Edwards syndrome D)NormalQ67.Relaxin in pregnancy produced by:1/ corpus letum2/breast3/decidua4/placenta5/fetusQ68. A 16-year-old primiparous woman presents to the Early Pregnancy Unit with a two-day history of PV bleeding. She is approximately 7 weeks in to a spontaneous unplanned pregnancy. She is otherwise fit and well. Her serum HCG is 94 000 iu/l. An ultrasound scan is performed on this patient which shows no evidence of a fetal pole, but does show a placental mass in the uterus, containing multiple echoes with a 'bunch of grapes' appearance. These ultrasound findings are characteristic of which condition?Complete hydatidiform mole EndometriomaLive intrauterine pregnancy Missed miscarriagePartial hydatidiform moleQ69. Regarding methods of contraception, ALL the following are true exceptA The levonorgestrel intrauterine system works by preventing sperm fertilising an eggB Male sterilisation involves cutting the vas deferensC The contraceptive implant works by preventing ovulationD The contraceptive patch is NOT suitable for those with a body mass index >40E The combined oral contraceptive pill is contraindicated in migraine with auraThe levonorgestrel intrauterine system is a plastic device containing progesterone,which works by releasing hormone slowly into the system. The progesterone worksto thin the endometrium and so preventing implantation. It also thickens thecervical mucus. Male sterilisation is a permanent form of contraception caused bycutting, sealing or tying the vas deferens, which carries the sperm from testicles to the penis. It is very effective, with less than a 1% failure rate.The contraceptive implant is placed into the non-dominant upper arm. It releasesprogesterone and causes the usual progesterone effects as well as preventingovulation. It can be left in situ for 3 years, but can be taken out sooner with a potential return to fertility immediately. The contraceptive patch is not suitable for those women with a large body mass index or smokers. The combined oral contraceptive pill is contraindicated for use as a contraceptive in patients with migraine with aura..Q70. What is the main mechanism of action of the copper _ lUD? 1/lnhibtion of fertilization 2/local inflammatory reaction preventing inplantationMechanisms of Action of Copper IUDsPrevents fertilization by Impairing the viability of the spermInterfering with sperm movementCopper IUD in uterusAll the mechanisms of action of copper-bearing IUDs are still not completely understood. However, researchers believe that the main mechanism of action of copper-bearing IUDs is the prevention of fertilization. The presence of the IUD in the uterine cavity creates a local inflammatory reaction thatappears to prevent sperm from reaching the fallopian tubes. In addition, copper-bearing IUDs release copper inside the uterus and the fallopian tubes, enhancing the debilitating effect on sperm. Studies have generally found that sperm are not as viable among IUD users, compared to other women.Q71.The most common in Utero infection causing fetal anemia in the UK isA. Syphilis B. Toxoplasmosis C. RubellaD. Parvovirus B19E. CytomegalovirusQ72. You are asked to review a patient. They have attended for a scan at 13 weeks following a positive pregnancy test. The patient has had 2 previous pregnancies for which she opted for termination on both occasions. The scan shows no identifiable fetal tissue or gestational sac and you note the radiologist has reported a 'bunch of grapes sign'. What is the likely diagnosis?Missed miscarriageIncomplete miscarriagePartial molar pregnancyComplete molar pregnancyChoriocarcinomaQ73. Endometrial tissue found within the myometrium is classed asEndometriosisFibroidMyomaAdenomyosisLeiomyomaEndometrial tissue found within the myometrium is Adenomyosis. If endometrial tissue is found at a distant site to the uterus it is termed endometriosis. Fibroids are smooth muscle tumours (Leiomyoma's) sometimes called myoma's.Q74. A 30 year old women who is 24 weeks pregnant attends EPU due to suprapubic pain. Ultrasound shows a viable foetus and also a fibroid with a cystic fluid filled centre. What is the likely diagnosis?AdenomyosisLeiomyosarcomaCystic degeneration of fibroidAppendicitisRed degeneration of fibroidRed degeneration of fibroids is one of 5 methods of fibroid degeneration. Although uncommon outside pregnancy it is thought to be the most common form of fibroid degeneration during pregnancy and typically occurs in the 2nd trimester. It is thought to arise from the fibroid outgrowing its blood supply and haemorrhagic infarction occurs. Ultrasound will typically show a localised fluid collection (blood) within the fibroid.Risk Factors for Fibroids Risk FactorsBlack Ethnicity? ?Early PubertyProtective Factors ObesityIncreasing number of pregnanciesPregnancyIncreasing age (from puberty until menopause)Note Hormonal contraception has not been proven to have an effect on fibroid prevalence though evidence is conflictingQ75. The UK childhood vaccination schedule includes vaccination against HPV for girls aged 12 to 13. What HPV subtypes are vaccinated against with the vaccine Gardasil??6 , 8 and 116, 11 and 186 and 186, 11, 16, and 1812, 16, 18 and 36HPVGardasil? is a quadrivalent vaccine against HPV Types 6, 11, 16, and 18 HPV types16 and 18 are responsible for 70% of cases of HPV related cancers. They are considered the most important high risk genotypes of HPV. As well as cervical cancer they are associated with cancers of the oropharynx and anogenital region. There are over 100 genotypes of HPV including several other high risk HPV types. HPV is thought to induce cancer via onco-proteins. The primary once-proteins are E6 and E7 which inactivate two tumor suppressor proteins, p53 (inactivated by E6) and pRb (inactivated by E7) HPV genotypes 6 and 11 are low risk and cause anogenital warts.Q76. A 38 year old women attends clinic follow up. You note pelvic ultrasound shows a 60mm simple cyst. What is the most appropriate course of action regarding this cyst according to the RCOG green top guidelines?Discharge with no follow up Order Ca125List for laparotomyOrder MRI assessmentAdvise yearly ultrasound follow upRCOG Greentop Guidline Number 62 states the following "Women with simple ovarian cysts of 50-70 mm in diameter should have yearly ultrasound follow-up and those with larger simple cysts should be considered for either further imaging (MRI) or surgical intervention" "A serum CA-125 assay does not need to be undertaken in all premenopausal women when an ultrasonographic diagnosis of a simple ovarian cyst has been made"Q77. Which age group has the highest rates of chlamydia infection?15-19 year olds20-24 year olds25-30 year olds30-40 year olds40+The most commonly diagnosed STI was chlamydia with 208,755 new cases representing 47% of STI diagnoses in GUM clinics. The under 25 age group has the highest rates with the 20-24 age subgroup the highest among them. Prevalence of chlamydia of those screened in the under 25's in the UK is 5-10%Chlamydia....... Chamydia Key PointsMost prevalent STI in the UK? >50% men and 80% of women asymptomatic after initial infection? Obligate intracellular bacteriaQ78. You are assessing a patient with an ovarian mass and are using the Risk of Malignancy Index 1 (RMI) score. Which of the following is used to calculate the RMI?AgeCa125Years since menarcheOvarian volume on ultrasoundCyst volume on ultrasoundQ79. In Congenital absence of the uterus :A Has an incidence of 1:1000 birthsB Has a chromosomal pattern of 45XXC Hirsutism is commonD known as Mayer–Rokitansky–Küster–Hauser syndromeE The ovaries are normally affectedMayer–Rokitansky–Küster–Hauser (MRKH) syndrome occurs in approximately1 in 5000 females. The cause is unknown and it is not known to have a geneticinheritance. Women affected have a female chromosomal pattern of 46XX andnormally-functioning ovaries. MRKH syndrome occurs as a result of abnormaldevelopment of the Müllerian system which forms the uterus, fallopian tubes and upper part of the vagina. There is a spectrum of abnormalities ranging from absence of the proximal two-thirds of the vagina to more significant genital abnormalities including absence of the uterus. It is not associated with hirsutism, but may be found alongside abnormalities of the skeleton, kidneys and other organs.Q80..All the following is TRUE about Choriocarcinoma except:A Is a malignant conditionB Is more common in women over 70 years oldC Can follow a normal pregnancyD Most commonly metastasises to the lungsE Syncytiotrophoblasts are filled with eosinophilicChoriocarcinoma is a malignant form of gestational trophoblastic disease which most commonly occurs after a complete molar pregnancy. It is more common at extremes of fertility: teenagers and those over 40 years of age. Pathology reveals sheets ofsyncytiotrophoblasts and cytotrophoblasts with evidence of necrosis, haemorrhage and intravascular growth.Treatment is carried out at specialist units and often requires chemotherapy, however overall survival is good if metastasis has not yet occurred.Q81. You review a patients blood results and find the following: Na+ 123 mmol/l K+ 5.0 mmol/l Urea 2.5 mmol/l Creatinine 70 μmol/l You diagnose SIADH. Which malignancy is most commonly associated with SIADH?Squamous Cell CarcinomaSmall Cell Lung CancerRenal Cell CancerPancreatic CancerSyndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by excessive release of antidiuretic hormone from the posterior pituitary gland or another source. The increase in blood volume (hypervolemia) often results in true hyponatremia in which the plasma sodium levels are lowered and total body fluid is increased. Although the sodium level is low, SIADH is brought about by an excess of water rather than a deficit of sodium.It was originally described in people with small-cell carcinoma of the lung, but it can be caused by a number of underlying medical conditions. The treatment may consist of fluid intake restriction, various medicines, and management of the underlying cause. Salt administration may help prevent brain swelling by increasing attractive force to keep water in the bloodstream, preventing fluid buildup in tissue.Q82. During pre-op assessment for hysterectomy and oophorectomy a patients chest XRAY shows a Ghon focus suggestive of past tuberculosis infection. What kind of necrosis is seen in tuberculosis infection?ColliquativeLiquefactiveCaseousCoagulativeGangrenousQ83. A 42 year old smoker attends clinic due to vulval soreness and shows you a number of vulval lumps. Biopsy is taken and reported as showing epithelial nuclear atypia, loss of surface differentiation and increased mitosis. What is the diagnosis?Lichen SclerosusChronic atrophic vulvitisLichen SimplexVulval intraepithelial neoplasia (VIN)Extramammary Paget's diseaseQ84. A couple have been referred to the infertility clinic. The male partner Is 25 and has CF, his semen analysis shows azoospermia. What is the likely underlying cause?a/ Epididymal obstruction by thickened secretions due to chloride channel dysfunctionb/ Oligospermiac/ Congenital absence of vas deferensd/ Obstruction of vas deferens by thick secretions due to chloride channel dysfunctiond/ Congenital absence of epididymal tailIn CF the thickened intraluminal secretions lead to progressive obstruction and destruction of the vas deferens in utero leading to congenital absence of the vas deferens in most cases. In treating such patients for infertility sperm can be retrieved from the epididymis.Q85. Regarding Gestational Diabetes which of the following statements is TRUE?it occurs in <2% of pregnanciesit occurs in 2-5% of pregnanciesit occurs in 5-10% of pregnanciesit occurs in 15-25% of pregnanciesit occurs in >25% of pregnanciesEpidemiology of gestational diabetes is part of MRCOGs Module 9 syllabus. It effects 2-5% of pregnancies.Q86.Which of the following cancer types is the most strongly associated with (Acanthosis Nigricans)?1/Uterin2/breast 3/ovarian4/pancreatic5/stomachAcanthosis nigricans is a fairly common skin pigmentation disorder. The most notable sign of acanthosis nigricans is dark patches of skin with a thick, velvety texture. The affected areas of skin may also itch or have an odor.Acanthosis nigricans may be a sign of a more serious health problem, such as prediabetes.In rare cases, acanthosis nigricans can be caused by :stomach cancer, or gastric adenocarcinoma ,adrenal gland disorders, such as Addison’s diseasedisorders of the pituitary glandlow levels of thyroid hormoneshigh doses of niacinQ87. A 27-year-old nulliparous woman and her husband have a series of routine investigations to investigate primary subfertility. She has a hysterosalpingogram which shows she has a bicornuate uterus.Which obstetric phenomenon is of increased prevalence in women with abicornuate uterus?A Breech presentationB Stillbirth C.Placenta accretaC Postpartum haemorrhage E. Placenta praeviaQ88. A 31-year-old nulliparous woman has heavy bleeding at 8 weeks’ gestation. An early pregnancy scan is suggestive of a molar pregnancy, and no fetus is observed. What is the typical genotype of a complete molar pregnancy?A 45 XOB 46 XXC 46 XXXD 69 XXYE 92 XXXYQ89. A 50-year-old woman is admitted to hospital following a myocardial infarction.She remains hypotensive for several days. Her serum lactate becomes elevated and her serum urea nitrogen and creatinine are also increased. Microscopic urinalysis reveals granular and hyaline casts.Which of the following renal pathologies is most likely to be the cause?A Acute tubular necrosis B Chronic pyelonephritisC Minimal change glomerulonephritisD Nodular glomerulosclerosisE Renal vein thrombosisAcute tubular necrosis (ATN) is a medical condition involving the death of tubular epithelial cells that form the renal tubules of the kidneys. ATN presents with acute kidney injury (AKI) and is one of the most common causes of AKI. Common causes of ATN include low blood pressure and use of nephrotoxic drugs.Q90. Regarding Venous Thomboembolism (VTE) in pregnancy which of the following statements are TRUE?1 Obesity increases DVT risk by 2 times2 Obesity increases DVT risk by 4 to 5 times3 Inherited thrombophilia is present is present in 3-5% of cases of pregnancy associated VTE4 Inherited thrombophilia is present is present in 10-15% of cases of pregnancy associated VTE5 30-40% of VTEs in pregnancy are Pulmonary EmboliRegarding VTE in pregnancy* 10-20% of VTEs are PE's. The majority are DVT* Inherited Thrombophilia is present in approximately 40% of women with pregnancy associated VTE* Obesity (BMI >30) increases DVT risk by 4 to 5 times* Relative risk of VTE in pregnancy is increased 4 to 6 fold compared to non-pregnancy* Absolute risk of VTE in pregnancy and the puerperium is 1-2/1000 pregnancies* Incidence of Pulmonary Embolism in the UK is 1.3/10,000 maternities* Absolute Risk is the risk of developing the disease over a time period. This can be expressed as a fraction or decimal. For example if you have a risk of VTE of 1/1000 pregnancies this may be expressed as 0.001 Relative risk is used to compare the risk in two different groups of people e.g. pregnant and non-pregnant women. If the risk of VTE in a healthy non-pregnant women is 2 per 10,000 vs 8-10 per 10,000 in pregnancy then the relative risk is 4 to 5 times (In large US studies figure works out at 4.3) Note Some sources such as SIGN quote relative risk of VTE in pregnancy as high as 10 fold that for non-pregnant patients. This is higher than the RCOG figure and may reflect the risk variation amongst those with other VTE risk factors e.g. age, smoking, obesity. Diagram illustrating Risk Factor stratification for VTE.Q91.In addition to mast cells, which of the following cells produces histamine?A BasophilsB ErythrocytesC MacrophagesD MonocytesE Neutrophilshistamine is typically store mast cell granules and released during a process called degranulation following mast cell activation. but also basophils and platelets produce it.Q92.Within what timeframe from injury do macrophages replace neutrophils incutaneous wound healing?A 1–2 hoursB 6–12 hoursC 18–24 hoursD 48–92 hoursE 7–10 daysQ93. 40-year-old primiparous woman is admitted to the labour ward at 36 weeks’ gestation with severe pre-eclampsia and presumed renal involvement. Her blood pressure on arrival is 184/95 mmHg. Her urine contains protein +++. Her serum creatinine is 92 ?mol/L and serum urea 5.3 mg/dL. She has an emergency caesarean section. Which of the following best describes the renal pathology of pre-eclampsia?A Atheromatous plaquesB Glomerular capillary endotheliosisC Glomerular hypertrophyD Mesangial cell hypertrophyE Tubular vacuolizationQ94. A 35 year old women attends clinic following laparotomy and unilateral oophorectomy. The histology shows Psammoma bodies. What type of tumour would this be consistent with?SerousMucinousEndometrialTransitionalClear cellThere are general histopathological features of ovarian tumours that are suspicious of malignancy such as irregular cell surface, irregular cystic regions, necrosis and haemorrhage. There are also 2 histological features specific to Serous and Mucinous tumour types that lend themselves well to exam questions (see below)! Serous tumours = Psammoma bodies while Mucinous tumours = Mucin vacoulesOvarian CancerRisk of Malignancy Index RMI = ultrasound score x menopausal score x CA-125 level in U/mlHigh-grade serous carcinoma (HGSC) is a type of tumour that arises from the serous epithelial layer in the abdominopelvic cavity and is mainly found in the ovary. HGSCs make up the majority of ovarian cancer cases and have the lowest survival rates. HGSC is distinct from low-grade serous carcinoma (LGSC) which arises from ovarian tissue, is less aggressive and is present in stage I ovarian cancer where tumours are localised to the ovary.Although originally thought to arise from the squamous epithelial cell layer covering the ovary, HGSC is now thought to originate in the Fallopian tube epithelium. HGSC is much more invasive than LGSC with a higher fatality rate - although it is more sensitive to platinum-based chemotherapy possibly due to its rapid growth rate. In rare cases, HGSCs can develop from LGSCs,[5][6] but generally the two types arise independently of each otherGenetic risk factors: More than 20% of ovarian cancer tumours have hereditary origin. The majority of these feature mutations in the tumour suppressor BRCA genes, which tend to give rise to HGSC.[15] A mutation in BRCA1 or BRCA2 can confer a lifetime ovarian cancer risk of 40-50% and 10-20% respectively,with BRCA2 mutations strongly associated with better clinical outcomes.A specific tumour protein 53 (TP53) expression pattern in the Fallopian tube epithelium – the ‘p53 signature’ - is thought to be a precursor marker of HGSC. TP53-/- mice (in which the TP53 gene has been deleted) do not develop ovarian carcinomas. However, TP53 mutations were found in 96% of HGSC cases. A local abnormal TP53 expression may thus be indicative of HGSC.In women, pelvic HGSC show either a complete absence of P53 expression, or overexpression, suggesting that any aberration of P53 leads to tumour development. Additionally, overexpression of TP53 is associated with better clinical outcome whereas an absence of the p53 protein is linked to an increased risk of HGSC tumour recurrence.A recent mouse model suggest that a p53 mutation may induce HGSC arising from the ovary rather than the Fallopian tube.Q95. A patient has returned to your clinic. She presented with painful periods 18 months earlier and laparoscopy confirmed endometriosis. She now gets pain on opening her bowels as well as low back pain. What structure is likely to be involved?Psoas muscleMesovariumIliacus muscleSuspensory ligamentUterosacral ligamentLower abdominal pain during menstrual periods and lower back or leg pain are associated with endometriosis in the uterosacral ligaments. Endometriosis can cause diarrhoea and IBS type symptoms. Note Endometriosis on the uterosacral ligament can cause tender nodules to form. These can be palpated during pelvic exam. Tender nodules are specific to endometriosis of the uterosacral ligament so if the question mentions feeling a tender nodule during PV exam think endometriosis of the Uterosacral ligaments!Q96. You are reviewing a patient with a scan suggestive of partial molar pregnancy. What is the typical genotype of a partial molar pregnancy?46 XX46 XY69 XXY92 XXXY92 XXXXQ97. An example of a tissue or organ composed of Permenant Parenchymal cells is: a) Liver b) Bone Marrow c) Heart d) Small Intestinal Mucosa e) Renal TubulesQ98. Chest x ray findings of a tuberculosis patient showing nodules which of the following cells is responsible? A) lymphocytes B) plasma cells C. Mast cells C) macrophages D)Fibroblast.Q99. 24-year-old woman presents with severe pain during menses (dysmenorrhea). To treat her symptoms, you advise her to take indomethacin. This drug may reduce her pain because it interferes with the production of which one of the following substances? a. Bradykinin b. Histamine c. Leukotrienes d. Phospholipase A2 e. Prostaglandin F2Q100. A young woman in late pregnancy presents with swelling around her ankles that indents on pressure. She is otherwise well. The single best cause for the pathological basis of this physical symptom Is A Abnormal blood coagulationB Fractured ankleC Low plasma oncotic pressurD. Low blood pressureE Low PO, of arterial bloodOncotic pressure, or colloid osmotic pressure, is a form of osmotic pressure exerted by proteins, notably albumin, in a blood vessel's plasma (blood/liquid) that usually tends to pull water into the circulatory system. It is the opposing force to hydrostatic pressure. It has a major effect on the pressure across the glomerular filter. Group 10Q1. Which one of the listed cytokines is secreted by macrophages and functions as a major mediator of acute inflammation by stimulating acute-phase reactions such as fever production along with increasing vascular permeability and stimulating fibroblasts? a. Interleukin-1 b. Interleukin-2 c. Interleukin-3 d. Interleukin-5 e. Interleukin-12Q2. The following tumors spread early by lymphatic exceptA. SeminomaB. MedulloblastomaC. PlasmacytomaD. Choriocarcinoma E. Adenocarcinoma of the colonQ3.An 18-year-old female with alpha1-antitrypsin deficiency attends clinic 12 weeks pregnant. She wants to know if her child will be affected.What is the mode of inheritance of this Autosomal dominant Autosomal recessive Polygenic X-linked dominant X-linked recessive Alpha-1-antitrypsin deficiency is inherited in an autosomal recessive pattern, which causes emphysema and cirrhosis and has a prevalence of 1 in 2500.Q4. The presence of Columnar Epithelium with Goblet cells in the Lower Oesophagus is most consistent with:a) Dysplasiab) Hyperplasiac) Carcinomad) Ischaemiae)?MetaplasiaQ5. Which of the following processes explain the appearance of Calcium deposition in Tuberculous Lymph Nodes:a)?Dystrophic calcification???b) Apoptosis????????????c) Hypercalcaemiad) Metastatic calcification????????????e) Neoplastic changeDystrophic calcification (DC) is the calcification occurring in degenerated or necrotic tissue, as in hyalinized scars, degenerated foci in leiomyomas, and caseous nodules. This occurs as a reaction to tissue damage,including as a consequence of medical device implantation. Dystrophic calcification can occur even if the amount of calcium in the blood is not elevated. (A systemic mineral imbalance would elevate calcium levels in the blood and all tissues and cause metastatic calcification.Q6. Which of the following processes that occur in the breast allows a mother to feed the infant:a) Stromal hypertrophyb) Epithelial dysplasiac) Steatocyte atrophyd) Lobular hyperplasiae) Ductul epithelial metaplasiaQ7. In autoimmune haemolytic anaemia, the following type of immunologic tissue injury is involved: A. Type I (anaphylactic) C.Type IV (cell mediated) B. Type II (cytotoxic) D. Type III (immune complex) Q8. Which of the following is the definition of an allograft? a. A graft between a human and an animal b. A graft between two individuals of different species c. A graft between two individuals of the same species d. A graft between two individuals of the same inbred strain e. A graft between identical twinsAn allograft is also called a homograft and refers to a graft between members of the same species. An autograft is a tissue graft taken from one site and placed in a different site in the same individual. Isografts are grafts between individuals from an inbred strain of animals. A graft between individuals of two different species is a xenograft or heterograft.Q9.This phagocytic antigen presenting cell in the cervix:g. Hofbauerh. T-lymphocytei. Plasma cellj. Kuppfer cellk. NeutrophilAn antigen-presenting cell (APC) or accessory cell is a cell that displays antigen complexed with major histocompatibility complexes (MHCs) on their surfaces; this process is known as antigen presentation. T cells may recognize these complexes using their T cell receptors (TCRs).Q10. A 32-year-old woman attends the fertility clinic. She has a four-year history of infertility, severe dysmenorrhoea and increasing pain with sexual intercourse. On pelvic examination, an adnexal mass is felt and nodules are palpated along the uterosacral ligaments. The single most likely cause for the pathological basis of these physical symptoms is:A Corpus luteum cyst B Endometriosis C Ovarian carcinomaD Ovarian dermoid cyst E Pelvic inflammatory diseaseQ11.a patient postoperative serum electrolytes showed normal sodium elevatedpotassium:a. Addisonb. Conn’s C. Cusing diseaseAddison's disease, also known as primary adrenal insufficiency and hypocortisolism, is a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones. Symptoms generally come on slowly and may include abdominal pain, weakness, and weight loss.Q12. you have posted a patient for elective caesarean section who has a past history of PPH. during this pregnancy she has placenta accreta. which vessel would u like to ligate prophylactically during caesarean hysterectomya. external iliac b. ovarian c. internal iliac d. internal pudendalQ13. Regarding Influenza vaccine , what type of vaccine? A. Killed vaccine B. Toxoid vaccine C. Conjugate vaccine D. Live attenuated vaccine E. Organism Subunit vaccineQ14. After receiving incompatible blood, a patient develops a transfusion reaction in the form of back pain, fever, shortness of breath, and hematuria. Which one of the following statements best classifies this type of immunologic reaction? a. Systemic anaphylactic reaction b. Systemic immune complex reaction c. Delayed type hypersensitivity reaction d. Complement-mediated cytotoxicity reaction e. T-cell-mediated cytotoxicity reactionQ15. 55-year-old male alcoholic presents with symptoms of liver disease and is found to have mildly elevated liver enzymes. A liver biopsy examined with a routine hematoxylin and eosin (H&E) stain reveals abnormal clear spaces in the cytoplasm of most of the hepatocytes. Which of the following materials is most likely forming these cytoplasmic spaces? a. Calcium b. Cholesterol c. Hemosiderin d. Lipofuscin e. TriglycerideQ16. What percentage of patients with breast cancer have hypercalcaemia<1% 2-3% 5% 20% >50%Hypercalcaemia effects 10-30% of cancer patients. The main mechanism is through osteoclastic bone resorption which can occur with or without bony mets. It is usually associated with disseminated disease and has a poor prognosis. 80% of patients with malignancy associated hypercalcaemia will die within 1 year.Q17. A couple come to see you in clinic. The male partner reveals he has cystic fibrosis and wants to know what his likelihood of being infertile is. What is the male infertility rate in CF patients?98%90%75%40%18%In males with CF 98% are infertile. This is typically due to failure of the vas deferens to develop properlyQ18. year-old woman presents with a solitary, cold nodule in the right lobe of her thyroid gland. Physical examination reveals a 2.5-cm mass in her thyroid gland. Histologic sections from this tumor mass reveal multiple papillary structures and scattered small, round, laminated (layered) calcifications. These abnormal structures, called psammoma bodies are formed in some tissues (eg, papillary thyroid carcinoma) by the deposition of calcium salts in necrotic cells. This is an example of which one of the listed processes? a. Degenerative calcification b. Dystrophic calcification c. Enzymatic calcification d. Liquefactive calcification e. Metastatic calcification Q19 A 39-year-old woman has a forceps delivery. She is diagnosed as having a fourth degree tear of the perineum, which is repaired in theatre. She is readmitted 5 days later with wound dehiscence and it is noted that faecal matter is draining per vaginam. She has a temperature, is tachycardic and is feeling unwell. She is in septic shock soon after arrival.Which of the below pathogens is the most likely causative agent?A Actinomyces israeliiB Clostridium perfringensC Staphylococcus aureusD Listeria monocytogenesE Escherichia coliMost cases of septic shock are caused by infection with Gram-negative bacteria, although Gram-positive bacterium, viruses and fungi can be causative agents.E. coli is the only Gram-negative bacteria of the options given and therefore themost likely cause of this patient’s life-threatening condition. Gram-negative bacilli release endotoxins which are bacterial wall lipopolysaccharides (LPS). LPS can lead to the systemic activation of macrophages, neutrophils, natural killer cells and the widespread release of cytokines and inflammatory mediators such as tumour necrosis factor and interleukins. The consequences of this immune system activation include vasodilation, increased vascular permeability and endothelial injury.Inflammatory mediators may activate the coagulation system leading to deranged clotting and in extreme cases disseminated intravascular coagulation. Untreated, septic shock may lead to death.Q20. this structure is attached to anterior superior iliac spinea. Inguinal ligamentB. Sacrotuberous ligamentC.Lateral lumbosacral ligament.Q21. A grand multiparous woman has a postpartum haemorrhage soon after delivery. She is tachycardic, hypotensive, with a capillary refill time of 3 seconds and she appears confused. She has grade IV haemorrhagic shock.What do you think is the estimated blood loss thus far based on clinical findings?A 500 mLB 750 mLC 1000 mLD 1300 mLE 2000 mLThis patient is obviously compromised by her blood loss and needs rapid fluidresuscitation and is likely also to need blood products. Haemorrhagic shock can be classified according to the amount of blood lost and the subsequent derangement in vital signs as the body tries to compensate for the blood loss. In addition to tachycardia, hypotension and tachypnea, there may be altered consciousness and reduced urine output reflecting reduced organ perfusion. This patient’s condition is suggestive a massive loss of blood volume, equivalent to around 2000 mL. This is classified as class IV haemorrhagic shock:? Class I haemorrhage: up to 15% blood volume, up to around 750 mL blood loss? Class II haemorrhage: 15–30% blood volume lost? Class III haemorrhage: 30–40% blood volume lost? Class IV haemorrhage: over 40% blood volume lostQ22. Which of the following is a risk factor for the development of ovarian cancer?A Early menopauseB NulliparityE Physical activityB History of breastfeedingE Oral contraceptive useQ23. Which of the following paraneoplastic syndromes is paired with a recognised causal malignancy?A Acanthosis nigricans and bowel cancerB Carcinoid and uterine cancerC Cushing’s syndrome and small cell lung cancerD Dermatomyositis and renal cancerE Syndrome of inappropriate antidiuretic hormone secretion and fibromaCushing’s syndrome and small cell lung cancerParaneoplastic syndromes are groups of symptoms which may present in patients with malignancy; they are not directly caused by the tumour itself. Paraneoplastic syndromes may present as pathologies of the endocrinological, dermatological, rheumatological, haematological, renal, gastrointestinal and neuromuscular systems .Q24. Which of the following vulval skin disorders is associated with the highest risk of developing malignant disease?A PsoriasisB Lichen planus C Lichen sclerosusD Squamous cell hyperplasiaEContact irritant dermatitisAll options given are non-neoplastic skin conditions of the vulva. Vulval cancer is a rare form of cancer (1.7/100,000 women) usually affecting women around 70–80 years old; the majority of cases are squamous carcinomas (90%). Risk factors for the development of vulval cancer include: smoking, chronic skin conditions such as lichen sclerosus, vulval intraepithelial neoplasia (VIN), Paget’s disease and the presence of melanoma in situ.Lichen sclerosus is an inflammatory condition affecting the anogenital area; themajority of sufferers are postmenopausal women. Patients often present withitching. Treatments include use of potent topical corticosteroids. Five–seven percent of women may go on to develop vulval cancer. Vulval cancer spreads by direct extension to surrounding structures, local lymph nodes and by the blood stream.Q25. Which of the following is characteristic of the cellular changes seen in dysplasia?A Absence of mitotic figures on microscopyB Decreased mitotic activityC HyperchromatismD IrreversibilityE Uniformity in cell shapeDysplasia is a term used to describe abnormal development of immature cells in a tissue, whereby there are abnormalities in the cellular architecture and appearance.Dysplastic cells can be thought of as showing some of cellular changes that occur in cancer cells. These atypical features infer malignant potential although not all dysplastic tissue will go on to become malignant. In dysplastic cells a series of visible characteristic changes occur which include:? Increased mitotic activity? Hyperchromatism: prominent cell nucleus due to increased chromatin? Nuclear pleomorphism: abnormalities in the shape and size of the nucleus? Anisocytosis: increased cell size? Poikilocytosis: unusually shaped cellsDysplasia may be reversible if in its early stages, especially if any causative stimulus is removed. A potentially reversible form of dysplasia is present in CIN I, where dysplastic changes are only seen in the basal third of the squamous epithelium; in these cases there is high likelihood of reversible changes and monitoring may be appropriate.Q26. A 55-year-old woman is admitted to the emergency department 1 week after a work-related crush injury. On physical examination, she is febrile and appears dehydrated. After catheterisation, she passes a small amount of very dark urine.The urine dipstick test for blood is positive but no red blood cells are seen onmicroscopy. Her serum biochemistry shows:Creatinine = 120 μmol/LSerum potassium = 5.7 mmol/LCreatinine kinase = > 50,000 U/LWhich of the following is the most likely diagnosis?A Poststreptococcal glomerulonephritisB Renal infarctionC Renal papillary necrosisD RhabdomyolysisE Ureteral lithiasisThis woman’s urinalysis shows myoglobinuria, which typically follows significant trauma to muscle tissue. Although its presence may have minimal sequelae in severe cases, there may be rhabdomyolysis. Myoglobin is normally renally-excreted, but in excessive amounts it causes obstruction of the distal tubule and acute renal failure. In rhabdomyolysis there is excessive release of the intracellular contents of muscle cells leading to hyperkalaemia and metabolic acidosis. Hypocalaemia may also occur. In severe cases there may be disseminated intravascular coagulation.Q27. A woman who had a total abdominal hysterectomy, according to recent protocols, urinary catheter should be removed for at leastA. 6 hrsB. 12 hrsC. 24 hrsD. 48 hrsE. 72 hrsQ28. Which chromosomes are capable of robertsonian translocations?A. X, YB. 15, 17, 19C. 16, 18, 20D. 9, 10, 11, 12E. 13, 14, 15, 21, 22Q29. When the body is in the upright position, the expected angle between the brim of the pelvis to the horizontal plane of approximately:A. 15 degreesB. 40 degreesC. 60 degreesD. 90 degreesE. 120 degreesQ30. Which of the following nerves enters the thigh by passing beneath the inguinal ligament, just medial to the anterior superior iliac spine?A. Femoral nerveB. Iliohypogastric nerveC. Ilioinguinal nerveD. Genitofemoral nerveE. Lateral cutaneous nerve of thighQ31. ventouse delivery was performed for maternal exhaustion. At the ventouse cup application area, the baby's head is left with a "chignon". In which layer of the skull chignon is found?A. SubcutaneousD. SubduralE. ExtraduralB. SubaponeuroticC. SubperiostealQ32. Pregnant women, in the second or third trimester, may develop diabetesinsipidus due to excessive placental elaboration ofA. VasopressinaseB. ReninC. NeurophysinD. Antidiuretic hormoneE. Arginine-vasopressinQ33. Which types of cells are phagocytic for residual bodies left over from theprocess of spermiogenesis?A. Testicular mesenchymal cellsB. Testicular macrophagesC. Fibroblast cellsD. Interstitial cells of leydigE. Sertoli cellsQ34. Inhibin is secreted by which cell type of the ovary?A. Theca externa cellsB. Theca interna cellsC. Ovarian Stromal cellsD. Sustentacular cellsE. Granulosa cellsQ35. What is the most common adverse effect experienced by women taking thprogestogen-only pill?A. AcneB. Weight gainC. Erratic bleedingD. Reduced libidoE. Mood swingsProgestagen-only pills Side effects? Menstrual disturbance—regular (40%), irregular (40%), or amenorrhoea (20%).? H eadaches, nausea, mood swings, abdominal bloating, and breasttenderness—usually subside after a few months.Q36. The tissue in which most lymphocytes are produced is theA. LiverB. SpleenC. ThymusD. Bones marrowE. Lymph nodesQ37. What is the single best description for the histological appearance of thesecretory endometrium?A. Simple columnar B. Stratified columnarC. Stratified cuboidal D. Simple cuboidal epitheliumE. Simple columnar with subnuclear vacuolationQ38. . Which of the following cell types lyses cells that have been infected with viruses?A. CD4+ T cells B. B cells C. CD8+ T cellsD. Killer cells. E. MacrophagesQ39. A 27-year-old woman complains of amenorrhoea for 12 months with increased facial hair growth and weight gain since she quit smoking. Her urine pregnancy test is negative. Her serum hormonal levels are as follows:FSH 5 lU/LLH 15 IU/LProlactin 300 mmol/lSerum oestradiol 350 pmol/LWhat is the most likely diagnosis?A. Gonadotropin-producing pituitary adenomaB. Congenital adrenal hyperplasiaC. Polycystic ovarian diseaseD. Premature ovarian failureE. Ovarian neoplasmPolycystic ovarian syndrome:? PCOS is the most common endocrine disorder in women.? Responsible for 80% of all cases of anovulatory subfertility.? Estimated prevalence is 6–10% of women of childbearing age.? USS evidence of polycystic ovaries is seen in 20–30% of women investigation _? Basal (day 2–5): LH, FSH, TFTs, prolactin, and testosterone.? If hyperandrogenisim:? dehydroepiandrosterone sulphate (DHEAS)? androstenedione? SHBG.? Pelvic USS? Exclude other causes of s amenorrhoea.Q40. A 30-year-old woman has had increasing malaise with fever, abdominal pain, and weight loss of 3 kg over the past 3 weeks. On physical examination, her blood pressure is 160/110 mmHg. She has a stool positive for occult blood. Urinalysis reveals haematuria. She has no serum antineutrophil cytoplasmic autoantibodies and her antinuclear antibody test is negative. Aneurysmal arterial dilations and occlusions are seen in the medium-sized renal and mesenteric arteries with angiography. She improves with corticosteroid therapy.Which of the following is the most likely diagnosis?A Benign nephrosclerosisB Nodular glomerulosclerosisC Polyarteritis nodosaD Systemic lupus erythematosusE Wegener granulomatosisPolyarteritis nodosa (PAN): is a systemic vasculitis of unknown aetiology whichaffects the small and medium-sized arteries. Necrotising transmural inflammation is typical in affected vessels. There is associated microaneurysm formation, tissue infarction and necrosis.Lesions can affect thegastrointestinal tract, the kidneys, the heart and the liver. There may be resultant hypertension due to renal involvement, melaena due to gastrointestinal lesions alongside abdominal pain, malaise, fever and weight loss. PAN affects men more then women and typically presents in young adulthood. Diagnosis is usually made by renal biopsy or by mesenteric angiography.Although the aetiology of PAN is uncertain there appears to be an associationwith chronic hepatitis B infection, with around 30% of individuals with PAN having hepatitis B antibody complexes present in affected arteries. Corticosteroids and cyclophosphamide form the mainstay of treatment.Q41. A 59-year-old man presents with a 1-week history of frank haematuria. On physical examination, there are no abnormal findings. Urinalysis confirms the presence of blood, but no proteinuria or glucosuria. Urine culture is negative. A cystoscopy is performed, and a 3 cm exophytic mass is seen in the dome of the bladder. A biopsy of this mass is performed and microscopic examination reveals fibrovascular cores covered by a thick layer of transitional cells.Which of the following risk factors is most likely to have led to developmentof this lesion?A Obesity. B Cigarette smokingC Diabetes mellitusD Recurrent urinary tract infectionE Chronic use of nonsteroidal anti-inflammatory drugsCigarette smoking is known to be the greatest risk factor for the developmentof bladder cancer, and is thought to be associated with around 50% of cases.The disease is also more common in individuals who have worked in industrialsettings and been exposed to carcinogens, such as aniline dyes. Exposure tocyclophosphamide is a further risk factor. An exophytic mass is a lesion that grows out of the surface of an organ. In this patient the mass represents a transitional cell carcinoma of the bladder. The patient has frank haematuria, which is the most common presenting symptom of this tumour of the urothelium. Management strategies of transitional cell carcinoma of this kind include bladder resection, cystectomy, chemotherapy and radiotherapy.Q42. Expected T score in a 90 yr old femalea. 2.5 b. +1 c. 0 d. -1 e. -2.5Osteoporosis: DEXA scanBasicsT score: based on bone mass of young reference populationT score of -1.0 means bone mass of one standard deviation below that of young reference populationZ score is adjusted for age, gender and ethnic factorsT score> -1.0 = normal-1.0 to -2.5 = osteopaenia< -2.5 = osteoporosisQ43. Which test is most sensitive in detecting pelvic inflammatory disease (PID)a. Cell culture b. Microscopy c.Endocervical biopsy d. Enzyme immunoassay e. Nucleic acid amplification test Q44. What is the chemical structure of Renin? Polypeptide Oligopeptide GlycoproteinSteroidProstaglandinQ45. A 43-year-old woman was diagnosed at 15 years of age with type 1 diabetes mellitus. Her disease has been poorly controlled. She develops a non-healing ulcer of her foot at age 35 years. By 40 years of age, she has an increasing serum ureaand a urinalysis shows a specific gravity of 1.012, pH 6.5, 1+ protein, no blood, 1+ glucose, negative leukocyte esterase, negative nitrite, and no ketones.Which of the following renal diseases is she most likely to have?A Crescentic glomerulonephritisB Hyperplastic arteriolosclerosisC Nodular glomerulosclerosisD Papillary necrosisE PyelonephritisNodular glomerulosclerosis, also known as diabetic nephropathy, is a commoncomplication of diabetes mellitus. The disease is characterised by thickening of the glomerulus basement membrane, mesangial sclerosis and glomerulosclerosis. These features are the sequelae of the known end-organ damage associated with diabetes mellitus as a consequence of microvascular disease and chronic hyperglycaemia.This form of nephropathy is typically diagnosed in individuals with knowndiabetes mellitus, non-healing ulcers, proteinuria and retinopathy. The diagnosis is characterised by a progressively declining glomerular filtration rate, long-standing albuminuria and hypertension. The mainstay of treatment is improved glycaemic control, management of hypertension (often with the use of ACE inhibitors), dietary protein restriction and in some cases renal dialysis.Q46. The placenta in which umbilical cord is attached to the margin of the placenta is called?placenta membranaceaBattledore placentaVelamentous placentaCircumvallate placentaSuccenturiate placentaQ47. What sexually transmitted disease (STD) is caused by Haemophilus ducreyi? A.Chancre B.Chancroid C.Granuloma inguinale D. Condyloma acuminatum E.Molluscum contagiosumQ48.A 50-year-old woman is admitted to hospital following a myocardial infarction. She remains hypotensive for several days. Her serum lactate becomes elevated and her serum urea nitrogen and creatinine are also increased. Microscopic urinalysis 3reveals granular and hyaline casts.Which of the following renal pathologies is most likely to be the cause?A Acute tubular necrosisB Chronic pyelonephritisC Minimal change glomerulonephritisD Nodular glomerulosclerosisE Renal vein thrombosisAcute tubular necrosis (ATN) is the commonest cause of acute renal failure, and is a renal cause (as opposed to prerenal and postrenal causes). Acute tubular necrosis can be caused by a variety of insults including ischaemia, infection, toxins and drugs. Typically, ATN is characterised by injury to the tubular epithelial cells of the renal parenchyma leading to necrotic lesions and the formation of epithelial casts.Initially, ATN may present with a slightly reduced urine output, followed by profoundoliguria, metabolic acidosis, uraemia and hyperkalaemia. When recovery beginsthere is a polyuria and an associated osmotic diuresis. Appropriately managed (i.e.using dialysis if needed), ATN can be reversible and there can be complete recoveryif the cause is removed. Q49. Site of hematopiosis in embryo is: a) Yolk sac b) liver c) Bone marrowd) Vertebrae e) SkullQ50. A 45-year-old woman is seen in the gynaecology outpatients’ clinic with a history of severe menorrhagia. She has a body mass index of 42. An endometrial biopsy is taken at hysteroscopy which shows evidence of simple endometrial hyperplasia. Which of the following describes the type of cellular change that occurs in hyperplasia?A Increase in the number of cellsB Increase in the number of mitotic figuresC Increase in the number of nuclei in each cellD Increase in the size of cellsE Increase in the thickness of the cellHyperplasia is an increase in the number of cells as a response to a specific stimulus.Hypertrophy is an increase in the size of the cells. Hyperplasia is often benign, as in benign prostatic hyperplasia, but can sometimes manifest as a premalignant condition. The microscopic and macroscopic appearance of the cells remains the same, but there are an increased number of them present. Other examples of cellular hyperplasia include the growth of glandular breast tissue during pregnancy, endometrial hyperplasia and the hyperplasia of the adrenal cortex seen in Cushing’s disease.Q51-A 40-year-old primiparous woman is admitted to the labour ward at 36 weeks’ gestation with severe pre-eclampsia and presumed renal involvement. Her blood pressure on arrival is 184/95 mmHg. Her urine contains protein +++. Her serum creatinine is 92 μmol/L and serum urea 5.3 mg/dL. She has an emergency caesarean section.Which of the following best describes the renal pathology of pre-eclampsia?A Atheromatous plaquesB Glomerular capillary endotheliosisC Glomerular hypertrophyD Mesangial cell hypertrophyE Tubular vacuolization.Pre-eclampsia is a complex condition which affects many body systems, including the kidneys, and affects both function and morphology. It leads to the glomerulus becoming hypertrophied with reduced perfusion as a result of hypertrophy of intracapillary cells. The reactive changes of the kidney are described as glomerular capillary endotheliosis. The extent to which the kidneys are affected varies according to the location of the lesion but in severe cases may involve the whole of the renal cortex.Q52. A 65-year-old woman presents with several bruises on her skin and a prolonged nosebleed. She does not recall any trauma that caused the skin bruises, and she also states that her urine now appears bloody. Recently she has been taking a broad-spectrum sulfonamide for a urinary tract infection, but she says that she borrowed “a few extra pills” from her neighbor. Laboratory tests demonstrate a prolonged PT and PTT. This woman most likely has a deficiency of which one of the following vitamins? a. Vitamin A b. Vitamin B1 c. Vitamin B6 d. Vitamin C e. Vitamin KQ53. A 65-year-old woman presents with several bruises on her skin and a prolonged nosebleed. She does not recall any trauma that caused the skin bruises, and she also states that her urine now appears bloody. Recently she has been taking a broad-spectrum sulfonamide for a urinary tract infection, but she says that she borrowed “a few extra pills” from her neighbor. Laboratory tests demonstrate a prolonged PT and PTT. This woman most likely has a deficiency of which one of the following vitamins? a. Vitamin A b. Vitamin B1 c. Vitamin B6 d. Vitamin C e. Vitamin KQ54. Which bacteria are Gram-negative aerobic rods?Haemophilus influenzaeNeisseria gonorrhoeaeStreptococcus pyogenesTreponema pallidumPseudomonas aeruginosaThe answer is Pseudomonas aeruginosa. Gram-negative aerobic rods are rare, with the exception of Pseudomonas.Haemophilus is a genus of Gram-negative, pleomorphic, coccobacilli bacteria. Neisseria is a genus of Gram-negative diplococcus.Streptococcus is a genus of spherical Gram-positive bacteria. Treponema is a genus of Gram-negative spirochaetes.Q55. What is the potential cause of small white umbilicated white papules on the labia majora?Chlamydia D–K Haemophilus ducreyi Trichomonas vaginalisHuman papillomavirusMolluscum contagiosumQ56. Addison’s disease is characterised by:Hypokalemia. Increased glucoseIncreased neutrophilsIncreased lymphocytesPsychiatric disturbance except lethargyQ57. Which pathological process increases the production of uric acid?Acute renal failureChronic renal failureHypothyroidismHodgkin lymphoma. HyperparathyroidismThe answer is Hodgkin lymphoma. All the other processes increase uric acid concentration but do this by reducing renal excretion.Q58.Which tumour marker is the most specific for pancreatic carcinoma?CA125CA15-3CA19-9Human chorionic gonadotropinAlphafetoproteinThe answer is CA19-9. For CA19-9 consider pancreatic carcinoma, although this is not suitable as a screening tool. CA125 is a frequently used biomarker for epithelial ovarian malignancy, and CA15-3 is a biomarker used for breast carcinomaQ59. The failure of closure of a patent ductus arteriosus in preterm infants can be effectively treated with?AspirinIndomethacinCalcium supplementHigh concentration oxygenProstaglandin infusionThe answer is Indomethacin. In full term babies, the ductus arteriosus constricts in response to a rise in oxygen tension. Infants who have congenital malformations and need surgery at birth are treated with prostaglandin infusions, in order to keep the ductus open until the surgery for the other defects has been performed.However, preterm infants in whom the ductus fails to fuse are treated with prostaglandin inhibitors. The most commonly used is indomethacin. Ibuprofen is also used and has a lesser side effect profile. Symptomatic infants with large patent ductus arteriosus need surgical treatment.Q60. A 38 year old women attends clinic follow up. You note pelvic ultrasound shows a 36mm simple cyst. What is the most appropriate course of action regarding this cyst according to the RCOG green top guidelines?Discharge with no follow upOrder MRI assessementOrder Ca125List for laparoscopyAnnual ultrasound follow upAs this is a simple cyst less than 50mm in diameter the patient does not require further investigation or routine follow upOvarian CystRCOG Greentop Guidline Number 62 states the following "Women with simple ovarian cysts of 50-70 mm in diameter should have yearly ultrasound follow-up and those with larger simple cysts should be considered for either further imaging (MRI) or surgical intervention" "A serum CA-125 assay does not need to be undertaken in all premenopausal women when an ultrasonographic diagnosis of a simple ovarian cyst has been made"Q61. A patient is being seen in the uro-gynaecology clinic due to persistent microscopic haematuria. Cystoscopy and biopsy have confirmed bladder cancer. What is the most likely type?AdenocarcinomaSquamous CellClear CellTransitionalSarcoma>90% of bladder cancers are Transitional cellBladder CancerTypes of bladder cancer? Transitional Cell>90%? Squamous Cell 5%? Adenocarcinoma 1-2%? Other Rare forms <1%Q62. What is the single best description for the histological appearance of the endometrium soon after ovulation?A Glands containing eosinophilic secretions with stromal breakdown and polymorphsB Glands with subnuclear vacuolation in oedematous stromaC Tortuous glands with cells containing high numbers of mitotic figuresD Tubular glands in compact stroma containing plasma cellsE Tubular mitotically active glands in compact stromaEndometrial cycle histologyThe endometrial cycle follows the changes in the endometrium during the 'menstrual' cycle. It is divided into phases with characteristic histological changes:Proliferative phase (pre-ovulatory) - can be thought of as building the endometrium at the same time as the follicle is maturing for ovulation (need to grow before it can secrete)Interval phaseSecretory (post-ovulatory)- can be thought of as preparing for implantation (secretory in order to support implantation)Menstrual phaseTraditionally, the first day of menstruation is taken as day 1 of an idealised 28-day cycle while ovulation is conventionally timed at day 14. Variation in the cycle is usually due to differences in the proliferative phase as collapse of the secretory phase into menstruation if fertilisation does not take place is relatively more predictable than the proliferative phase.Q63. Change of Columnar Epithelium of the Bronchi into Mature Squamous Epithelium is called: a) Metaplasia b) Dysplasia c) Hyperplasia d) Neoplasia e) HypertrophyQ64. Metastatic Calcification: a) Is due to hypercalcemia b) Is due to hypocalcemia c) Occurs in Necrotic Tissue d) Is due to malignancy e) Occurs at sites of Chronic InflammationQ65. Which of the following is a feature of Irreversible Cell Injury: a) Glycogen stores are depleted b) Cytoplasmic sodium increases c) Nuclei undergo karyorrhexis d) Intracellular pH diminishes e) Blebs form on cell membranesQ66. An Amputated lower limb from a diabetic patient showing black discoloration of the skin and soft tissues with areas of yellowish exudates is characterized as: a) Neoplasia b) Coagulopathy c) Gas gangrened) Gangrenous Necrosis e) Hemosiderosis Q67. Focal fat necrosis, with flecks of chalky tan-white material seen in the omentum is most often associated with the following: a) Hepatitis d) Acute gastritis b) Chronic salpingitis c) Acute pancreatitis e) Gangrenous appendicitisQ68. In a 60 year old male, Gangrene of toes is most likely associated with: a) Diabetes Mellitus b) Heart Failure c) AIDS d)Blunt force trauma e) Type III hypersensitivity reactionQ69.The presence of Columnar Epithelium with Goblet cells in the Lower Oesophagus is most consistent with: a) Dysplasia b) Hyperplasia c) Carcinoma d) Ischaemia e) MetaplasiaQ70.Which of the following processes explain the appearance of Calcium deposition in Tuberculous Lymph Nodes: a) Apoptosis b) Neoplastic change c) Hypercalcaemia d) Metastatic calcification e) Dystrophic calcificationQ71. Each of the following is an example of hyperplasia except: a) Enlargement of one kidney after surgical removal of the other kidney b) Changes in the thyroid gland in response to increased demand for thyroid hormones c) Changes in breast tissue during pregnancy d) Enlargement of lymph nodes during a viral infection e) Enlargement of skeletal muscles after weight trainingQ72. Apoptosis: a) Massive necrosis b) Wet gangrene c) Lipoprotein synthesis d) Programmed cell death e)Foreign body phagocytosisQ73. A 17-year-old boy infected with hepatitis A experiences mild nausea for about 1 week and develops very mild scleral icterus. On physical examination, he has minimal right upper quadrant tenderness. Laboratory findings include a serum AST of 68 U/L, ALT of 75 U/L, and total bilirubin of 5.1 mg/dL. The increase in this patient's serum enzyme levels most likely results from which of the following changes in the hepatocytes?(A) Autophagy by lysosomes(B) Clumping of nuclear chromatin(C) Defects in the cell membrane(D) Dispersion of ribosomes(E) Swelling of the mitochondria(C) Irreversible cell injury is associated with loss of membrane integrity. This allows intracellular enzymes to leak into the serum. All other morphologic changes listed are associated with reversible cell injury, in which the cell membrane remains intactQ74. In the process of necrosis, a reduction in the size of the nucleus and a condensation of nuclear material is known as:a. Pyknosis b. Karyolysisc. Karyorrhexisd. Metachromasiae. HypochromasiaQ75. Chronic granulomatous inflammation is characterized by all these except:a. Macrophagesb. Neutrophils c. Epitheliod cellsd. Giant cells e. LymphocytesQ76. Cervical tissue from a 24 year old woman shows squamous epithelium of the endocervicalcanal which is normally lined by mucous secreting columnar epithelium. This is felt to be caused by:a. Bacterial infectionb. Chronic irritationc. Congenital defectd. Genetic mutatione. Immunologic disorderQ77. Most pulmonary thromboemboli originate from:a. Deep leg veinsb. Inferior vena cavac. Portal veind.Pelvic venous plexuse. Cavernous sinusQ78. A patient comes to see you as she is considering pregnancy and wants advice regarding VTE prophylaxis. She has undergone private thrombophilia screening as her father was found to have the factor V Leiden. Her PCR has shown she is homozygous for the factor V Leidenmutation. What is her relative risk of thrombosis compared to the general population?A) 1.5B) 2C) 4D) 8E) 80Explanation: The risk of VTE in the general population is around 1 in 1000In factor V leiden heterozygotes it is around 4‐8 in 1000In factor V leiden homozygotes it is around 80 in 1000RCOG guidelines advise she should be referred to a local specialistQ79. What is the approximate lifetime risk of endometrial cancer in patients with HNPCC (Lynch syndrome)?A) 20%B) 40%C) 60%D) 80%E) 99%Explanation: HNPCCHereditary Non‐polyposis Colorectal Cancer? Autosomal dominant inheritance? Increases risk of colon, gastric and endometrial cancer? 78% lifetime risk colorectal cancer? 43% lifetime risk endometrial cancerQ80. A 42 year old smoker attends clinic due to vulval soreness and shows you a number of vulval lumps. Biopsy confirms VIN. What is the approximate risk of developing squamous cell carcinoma?A) <0.5%B) 0.5‐5%C) 15%D) 25%E) 70%Explanation: 2014 BASHH guidelines quote the risk of developing SCC (squamous cell carcinoma) from VIN as between 9% and 18.5%Q81. Regarding PCOS, which standarised scoring system is usefull to evaluate efficacy of treatment ?A. Rotterdam's criteriaB. Nutmeg's CriteriaC. Ferrima Galleway D. both A & CE. All of themRotterdam criteria for diagnosing PCOSRequires the presence of two out of the following three variables andexclusion of other disorders:? I rregular or absent ovulations (cycle >42 days).? C linical or biochemical signs of hyperandrogenism:? a cne? h irsutism? a lopecia.? P olycystic ovaries on pelvic USS: ≥ 12 antral follicles on one ovary.? O varian volume >10mLQ82. Which of the following has the correct association regarding development of urogenital system? A Genital fold – clitoris B Genital tubercle – labia minora C Ureteric bud – urinary bladder D Mesonephric ducts – vagina E Metanephros – kidneyGenital tubercle: labia minora &penile urethra Genital swelling : labia majora & scrotumMesonephric duct persist in male Regress in female Give : ductus deference ,Epididymis , seminal vesicles , prostatic utricle , trigoneUreteric bud:-definitive ureter-renal pelvis -calyces -collecting ductsQ83. Following Ectopic pregnancy, what percentage of medically treated women with single dose regimen of methotrexate will require surgical intervention?A. 10%B. 15%C. 20%D. 30%E. 40%Q84. During a difficult delivery an obstetrician uses forceps to extract the infant. Upon examining the baby you notice forceps impressions posteroinferior to the ear. Which of the following is very likely to be damaged?A. Trigeminal nerveB. Facial nerveC. Abducens nerveD. Brachial plexusE. C8 T1 nerveQ85. It is estimated that surgical-site infections account for 9°lo of all hospital-acquired infections. Which bacteria are most commonly associated with such infections?A Candida albicansB Cryptococcus neoformansc Plasmodium falciparumD Staphylococcus aureusE Trichomonas vaginalisQ86. Roughly 60% of babies born to mothers who carry group B Streptococcus (GBS) will also become colonized as they pass through the vagina at birth. Which strain of Streptococcus is responsible for the majority of GBS infections?A Streptococcus agalactiaeB Streptococcus angiosusC Streptococcus bovisD Streptococcus pneumoniaeE Streptococcus pyogenesQ87Ascending infection of the vagina can induce premature labour. Whichpathogen is most commonly associated with bacterial vaginosis?A Candida albicansB Chlamydia trachomatisC Gardnerella vaginalisD Listeria monocytogenesE Neisseria meningitidisQ88. A woman in the outpatient clinic tells you that she has been diagnosed with Trichomonas vaginalis.What kind of organism is Trichomonas vaginalis?A. YeastB. Pox virus C. PhthiriasisD. Intracellular diplococcusE.Flagellated protozoan Trichomonas vaginalis is a flagellated protozoan which is best diagnosed when a swab is used to sample the fluid in the posterior fornix of the vagina and examined on a slide using a microscope as a "wetprep". Women typically present with a malodorous "frothy" discharge.Trichomonas vaginalis is a flagellated protozoan, thus whilst options C, D and E describe other types of sexually transmitted infections, only option B correctly categorises Trichomonas vaginalis.Examples of the other options include:Candida albicans is yeast which may be identified by culture or by the presence of hyphae, pseudohyphae and spores on microscopy (option A). Current evidence does not suggest that candida is sexually transmitted.Phthiriasis (option C) or Phthirus pubis describes pubic lice, which can be diagnosed with the naked eye in the pubic hair. Appropriate treatment includes malathion lotion and permethrin cream (unlicensed).All extra-genital body hair should also be treated and all bedding should be washed at a high temperature. Sexual partners should also be notified and treated.Neisseria gonorrhoea is a Gram negative intracellular diplococcus (option D).Molluscum contagiosum is a pox virus (option E) which is transmitted by skin-to-skin contact and often presents with umbilicated smooth papules in the genital region. Q88. Which organism causes tubal infection that is responsible for the majority of cases of secondary infertility?A Chlamydia trachomatisB Mycobacterium tuberculosisC Neisseria gonorrhoeaeD Treponema pallidum pallidumE Treponema pallidum pertenueQ89. Which pathogen underlies late congenital infection during childhood and presents with eighth-nerve (vestibulocochlear nerve or auditory vestibular nerve) deafness, interstitial keratitis and abnormal teeth?A Chlamydia trachomatisB Mycobacterium tuberculosisC Neisseria gonorrhoeaeD Treponema pallidum pallidumE Treponema pallidum pertenueQ90. Chorioamnionitis infections increase the risk of preterm birth by two- to three-fold.What is the azithromycin-sensitive pathogen which can causechorioamnionitis?A Chlamydia trachomatisB Clostridium botμlinumc Listeria monocytogenesD Streptococcus mutansE Vibrio choleraeQ91. Which organism is implicated in the majority of urinary tract infections in pregnancy?A Escherichia coliB Group B Streptococcusc Pseudomonas aeruginosaD Staphylococcus aureusE Trichomonas vaginalisQ92. Which group of viruses causes molluscum contagiosum?A. AdenovirusB. Herpes virusC. PapovavirusD. Parovirus E. Pox virusQ93. Regarding urinary tract infections, which micro-organism is most likely to be associated with bladder catheterisation?A. BacteroidesB. Escherichia coliC. Proteus mirabilisD. Pseudomonas aeruginosaE. Staphylococcus saprophyticusQ94. Infection with which one of the following human papillomaviruses (HPVs) is associated with an increased risk of cervical cancerA. HPV 6B. HPV 11C. HPV 17D. HPV 30E. HPV 33HPVs represent a group of more than 100 related viruses, which are sexually transmitted and a common cause of genital infection. Most cases are asymptomatic and the virus will be completely cleared. However some HPV infections can persist long term and in the case of "high-risk" viruses can lead to the development of cervical cancer. High-risk viral subtypes include HPV 16 and 18, which together cause about 70% of cervical cancers, as well as 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 and 73.The remaining subtypes are considered to be "low-risk" and of these HPV 6 and 11 are the cause of approximately 90% of cases of genital warts.Q95. A mother in the antenatal clinic is being screened for infections which may be transmitted vertically to her baby.Which one of the following infections is not screened?Malaria Rubella virusSyphilisToxoplasmosisCytomegalovirusThese were previously called the 'TORCH' infections - Toxoplasmosis, Others (for example, syphilis, varicella), Rubella Cytomegalovirus and Herpes, as they were all said to be acquired antenatally.Herpes is more likely transmitted perinatally however and with the exception of syphilis and rubella (because they are very treatable with simple antibiotics and puerperal vaccination respectively), routine screening in the asymptomatic mother is no longer seen as mandatory, though local guidelines may differ.All these infections may be ordered when investigating a small for dates fetus, and the earlier in pregnancy they occur - particularly in the first trimester where organogenesis is incomplete - the more serious the effects.Malaria is generally transmitted by a vector (the Anopheles mosquito) and is not routinely screened for antenatally, although if there were a clinical suspicion (for example,fever after travel to an affected area) itwould be sensible to investigate the mother further and optimise her treatment before delivery.Q96. Which one of the following statements concerning vulval cancer is correct?a. Chemotherapy is given if lymph nodes are positiveb. Clinical staging is reliablec. Vulval cancer comprises 25% of female genital tract malignanciesd. Vulval inflammatory disorders are common in the younger age groupe. Younger women tend to develop HPV associated cancersPersistent human papilloma virus (HPV) infection is linked to one subset of vulval cancers. High risk HPV 16 and 18 subsets have been found in 70-80% of vulvar intraepithelial neoplasm (VIN) and associated vulval cancers.These are common in younger women 35- to 65-years-old.High association exists between cervical neoplasia, cigarette smoking and vulval cancer in the younger age group.A degree of protection from VIN can be offered with a prophylactic HPV-quadrivalent vaccine.Q97 . A 50-year-old woman has ongoing pelvic pain; she has had a coil in situ for the last 8 years. She has a pelvic mass; histological sampling of the mass at laparoscopy shows a suppurative and granulomatous inflammatory process with the presence of sulphur granules.Which is the most likely causative agent?A Actinomyces israeliiB Chlamydia trachomatisC Gardnerella vaginalisD Neisseria gonorrhoeaeE Neisseria meningitidisThe Gram-positive bacteria Actinomyces israelii is a commensal of the colon, mouth and vagina. It is the commonest cause of actinomycosis, a chronic, suppurative and granulomatous inflammatory infection. The majority of cases of actinomycosis affect the cervicofacial area, classically presenting as painless facial lumps; however, thoracic, abdominal and pelvic forms do occasionally occur. Diagnosis of pelvic actinomycosis isusually made from histological samples taken during surgery and has been associated with intrauterine contraceptive devices which have been in situ for long periods of time. The presence of sulphur granules is characteristic of actinomyces infection.Q98. An 18-year-old woman presents to a sexual health clinic requesting a sexually transmitted infection screen; she is asymptomatic, however she is concerned as her new boyfriend is complaining of dysuria, penile discharge and scrotal pain.What is the most likely cause of his symptoms?A Actinomyces israeliiB Candida albicansC Chlamydia trachomatisD Toxoplasma gondiiE Treponema pallidum pallidumThe boyfriend’s symptoms are suggestive of a urethritis, which from the list of given options, the cause is most likely to be Chlamydia infection. It is caused by Chlamydia trachomatis, a Gram-negative intracellular bacterium which infects squamocolumnar epithelial cells. Chlamydia infection is often asymptomatic, especially in women.Women may notice postcoital or intermenstrual bleeding, dysuria and lowabdominal pain, whereas men may experience dysuria, penile discharge and scrotal pain. Chlamydia infection is the commonest cause of pelvic inflammatory disease and may go on to cause subfertility and increased risk of ectopic pregnancy.Treatment regimens for uncomplicated Chlamydial infection include azithromycin, doxycycline and erythromycin.Q99. A 35-year-old man presents at a sexual health clinic with a new painless round lesion on his penis; he also has non-tender inguinal lymphadenopathy.What is the most likely causative agent of his symptoms? A Chlamydia trachomatisB Neisseria gonorrhoeaeC Treponema pallidum carateumD Treponema pallidum pallidumE Treponema pallidum pertenueSyphilis is caused by the spirochete Treponema pallidum pallidum. Primary syphilis typically presents with a painless genital ulcer (a chancre) alongside inguinal lymphadenopathy, occurring 10–90 days after infection. Secondary syphilis develops within 2 years of infection and tertiary syphilis after this period.Screening tests for syphilis include the venereal disease research laboratory (VDRL) carbon antigen test and the rapid plasma regain test, both of which can give false positives. More specific tests for syphilis include fluorescent treponema antibody absorption test; however, these tests can give a positive result when there is infection from other treponema, such as the causative agents of yaw, bejel and pinta. Syphilis in pregnancy is associated with stillbirth, preterm delivery andcongenital defects.Q100. A 63-year-old man with an open fracture of the femur develops the rare complication of gas gangrene and requires leg amputation.What is the most likely causative agent?A Clostridium botulinumB Clostridium perfringensC Clostridium tetaniD Escherichia coliE Klebsiella pneumoniaeGas gangrene is most commonly caused by Clostridium perfringens; however, it can also be caused by other species of anaerobic bacteria including Clostridium septicum, Klebsiella pneumoniae and Escherichia coli.Exotoxins produced by the bacteria lead to necrotic tissue damage and sepsis often requiring amputation of the affected tissue. Gas gangrene was historically associated with war injuries, where open wounds were exposed to these soil-loving bacterium. Today, risk factors for the development of gas gangrene include trauma such as open fractures and burns, alongside malignancy of the gastrointestinal tract, diabetes mellitus, chronic alcohol abuse and as a rare post-surgical complication. All I ask is to pray to my father and mother with mercy and forgiveness ................
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