Published on February 19, 2014
GYNECOLOGY & OBSTETRICS 03) A 32-year-old woman comes to the office 2 hours because of vulvar "itchiness" and a white vaginal discharge. She says that she is recently divorced and has had 3 different sexual partners in the past 4 months. She "usually" uses condoms as contraception. She is usually very healthy and has never had a sexually transmitted disease. She has been taking minocycline for 4 months because of acne. Physical examination is unremarkable. Pelvic examination shows erythematous vulvar and vaginal tissues and a thick, odorless, white vaginal discharge that is adherent to the vaginal walls. The pH of the discharge is 4.5. A wet-mount preparation of the vaginal secretions made with 10% KOH solution will most likely show A. epithelial cells with smudged borders B. Gram-negative intracellular diplococci C. hyphae and buds D. motile flagellated organisms E. no organisms; a culture would be required for diagnosis Model Paper - 02 Single Best Response 01) A pregnant southeast Asian immigrant presents for prenatal care. Her past medical history is significant for a severe illness 3 years ago characterized by fatigue, nausea, anorexia, vomiting, jaundice, joint pains, and generalized skin lesions that slowly disappeared. She has felt well recently. Which of the following laboratory tests should be ordered to investigate the patient's past illness? A. Hepatitis B surface antigen (HBsAg) B. IgG cytomegalovirus (CMV) antibody levels C. IgM antibody to HBsAg D. IgM antibody to hepatitis B core antigen E. Quantitation of hepatitis A virus (HAV) IgM antibody 02) You get a call from a pregnant hepatitis B surface antigen positive woman that you have been taking care of. She is frantic because she unexpectedly went into labor and delivered the baby in her bathtub 30 minutes earlier. She had her husband cut the cord with a clean kitchen knife and the baby appears to be doing well. She wants to know if you can see her immediately. She is concerned about how her hepatitis status affects breast-feeding. You tell her to bring the baby over to the office and 04) A 32-year-old pregnant woman comes to the office at 16-weeks gestation because of weakness and diarrhea for the past 4 weeks. She says that she had been well up until a month ago and all of her physical examinations have been normal to that date. She has also begun to feel as if her heart is "leaping out" of her chest. She has lost 2 pounds in the past 3 weeks. Her blood pressure is 120/80 mm Hg and pulse is 100/min. Physical examination shows warm, moist skin, mild periorbital edema, and a fine hand tremor. The remainder of the examination is unremarkable. Laboratory studies show: A. not to breast-feed until the baby received the proper immunizations B. that she can begin to breast-feed immediately if the baby is hungry C. that her newborn will need to be treated with alpha interferon D. that her breast milk does not contain hepatitis B surface antigen E. that she should not breast-feed the newborn because of her hepatitis status The most appropriate next step is to 1
A. do nothing because these are normal values during pregnancy B. do ultrasonography of the thyroid gland C. prescribe propylthiouracil, orally D. reassure her and reevaluate her in 1 month E. recommend radioactive iodine therapy 06) A 37-year-old woman comes to the clinic because of severe headaches. She is 38-weeks pregnant and has had headaches on and off throughout her pregnancy. In the past week the headaches have progressively worsened. Vital signs are: temperature 37.0 C (98.6 F), pulse 70/min, and blood pressure 180/100 mm Hg. Physical examination reveals moderate pitting edema in both lower extremities. Neurologic examination is normal. Fetal heart rate monitoring is performed in the office and it demonstrates a baseline heart rate of 120/min with variable decelerations to 70-80/min. The most appropriate management at this time is to A. admit her to hospital for induction of labor B. do a complete fetal sonographic survey C. order a CT scan of the head D. order serum liver function tests and a complete blood count E. order a urinalysis to evaluate for protein 05) A 38-year-old woman is brought to the emergency department by ambulance after being found moaning in the middle of the street near a shopping cart with her belongings. She is clutching her abdomen, moaning, and rocking back and forth. She is wearing tattered clothes, is unkempt and disheveled. After partially undressing her in the emergency department, she appears to be pregnant with a large gravid abdomen. Her underwear is stained with approximately 10cc of dark blood. The nurse finds drug paraphernalia in her jacket pocket. Her temperature is 37.3 C (99.1 F), blood pressure is 142/94 mm Hg, pulse is 125/min, and respirations are 26/min. On examination, she has pinpoint pupils and a tetanic (continuous) abdominal contraction. Her fundal height is 34 centimeters. No pelvic examination is performed. On brief ultrasonic evaluation, a fetus is visualized, but no fetal cardiac activity is visualized. A urine toxicology screen is positive for cocaine. Laboratory studies show: 07) A 63-year-old woman with type 2 diabetes comes to the office after 5 episodes of vaginal bleeding over the past 3 months. There is no discharge accompanying the bleeding. The patient has been postmenopausal for 12 years and has never experienced any bleeding since then. Her past medical history is significant for anxiety disorder, depression, hypertension, and gout. The patient refuses to give a sexual history. Her blood pressure is 140/90 mm Hg, pulse is 80/min, and her weight is 136 kg (300 lbs). You are concerned that her vaginal bleeding is caused by A. cervical cancer B. endometrial cancer C. endometriosis D. ovarian cancer E. vaginal cancer F. vulvar cancer The patient's vaginal bleeding is most likely caused by A. abruptio placenta B. bleeding associated with labor and cervical change C. vasa previa D. placenta previa E. preeclampsia 08) A 21-year-old college student comes to the clinic complaining of unusual vaginal discharge and persistent vaginal itching for the past week. 2
She describes the discharge as watery and nonfoul-smelling. She states that she has not been sexually active for several months. She goes to a gynecologist once a year when she goes home from college to her parent's house, and states that her last visit was two months ago. Other than an occasional ibuprofen for menstrual cramps, she does not take any medication. You perform a vaginal examination, which shows normal external genitalia. The vulva, vagina, and cervix are without lesions. There is a non foul-smelling, white, watery discharge within the vaginal vault. Bimanual examination reveals no cervical motion tenderness, a small retroverted uterus, and no masses in the adnexa. You decide to perform a wet mount, which reveals multiple epithelial cells with numerous bacteria attached to their surface. They have indistinct borders and a "ground-glass" cytoplasm. In addition, use of a Nitrazine strip shows the pH of the discharge to be greater than 4.5. At this time you should A. advise the patient that she has normal discharge, and that she should wear only cotton underwear for the next week or so B. advise the patient to douche twice weekly for 2 weeks, and return for follow up C. give the patient a prescription for fluconazole 150mg PO x one dose D. give the patient a prescription for metronidazole 2g PO x 2 doses, 48 hours apart E. give the patient a prescription for metronidazole 2g PO x 2 doses, 48 hours apart, and advise her that her most recent sexual partner be treated as well is a Pap smear, which returns 5 days later. The most appropriate next step in the management of this patient is to A. do a progesterone withdrawal test B. measure β-Human Chorionic Gonadotropin (β-HCG) levels C. perform a dilatation and curettage D. recommend a therapeutic trial of ibuprofen E. refer her to a psychiatrist F. send her for a diagnostic laparoscopy 10) You are called to the delivery room after a full-term male infant is born via cesarean section to a G2P1 mother. Under the radiant warmer, the baby is crying and has a heart rate of 90/min. There is some flexion of the extremities and he grimaces when the catheter is passed in the nostril. The baby's body is pink, but the extremities are blue. The baby's Apgar score at 1 minute is A. 5 B. 6 C. 7 D. 8 E. 9 11) 70—year-old woman presents with a blood—stained vaginal discharge. Both the ectocervix and the vagina look atrophic on speculum examination. Cervical cytology shows no evidence of malignant cells, although no endocervical cells were seen. Which one of the following is the most appropriate next step in management 1. Vaginal swab for microscopy and culture 2. Ultrasound assessment of endometrial thickness 3. Hysteroscopy and dilatation and curettage 4. Laparoscopy 5. Coloposcopy 09) A 21-year-old woman comes to the student health clinic complaining of “painful periods” for the past few years. She describes the pain as moderate to severe, crampy in nature, and located in her lower abdomen. She has never been sexually active because, as she tells you, she is waiting until she is married. The patient's physical and pelvic examinations are normal as 3
12) A 16—year—old girl is brought to the Emergency Department by her mother. The girl complains of persistent dull right-sided lower abdominal pain which has been recently increasing in severity. She also has spotting of blood per vaginam. Her last normal period was seven weeks ago. The mother informs you that her daughter has not been sexually active. On examination, the daughter looks unwell and is sweating with clammy cold skin, her temperature is 36.5°C, BP 80/50mml-lg and pulse l40/min.The lower abdomen shows rebound tenderness and guarding in the right iliac fossa. Which one of the following is the most appropriate immediate next step in her care? 1. 2. 3. 4. 5. 1. Pelvic examination under anaesthesia 2. Performance of a Poponicoloou (Pop) smear 3. Ultrasound examination of the uterus 4. induction of labour 5. immediate Caesarian section 14/ A 25—year-old primi gravid of 40 weeks of gestation presented because she had not felt any fetal movements for 24 hours. The fetal heart beats were clearly audible on auscultation at a rate of 140/min, and CTG was normal and reactive. Her cervix was 2cm dilated and fully effaced. You therefore reassured her and sent her home. She telephones you 24 hours later and tells you that she has still not felt any fetal movements. Now for 48 hours. Which one of the following is the most appropriate next step in management? Speak privately to the daughter about her sexual activity Perform a vaginal pelvic examination Commence intravenous fluid resuscitation Perform urinary beta-hCG pregnancy lest Arrange for urgent transvaginal ultrasound 1. 2. 3. 4. 5. 13/ A 26-year-old woman (gravida 3. para 2) whose only Papanicolaou [Pap) smear test was done five years ago and was normal, is admitted to hospital at 33 weeks of gestation, following an antepartum haemorrhage of 300ml. The bleeding has now ceased. Vital signs are as follows. Pulse 76/min, Blood pressure 120/80mmHg, Temperature 36.8°C, Fetal heart rate 144/min The uterus is lax and nontender, the fundal height is 34cm above the pubic symphysis , and the presenting part is high and mobile. Apart from fetal monitoring with a cardiotocogroph (CTG), which one of the following should be the immediate next step in management Admit for induction of labour Immediate Caesarean section Urgent oxytocin challenge test Urgent ultrasound scan of the fetus Amniotic fluid volume assessment 15/A 26—year—old woman at 36 weeks of gestation in her First pregnancy presents because of headache and right —sided upper abdominal pain of two days duration. The pregnancy has been normal until now. Her BP is l45/90mmHg, her ankles are slightly swollen and urinalysis shows protein ++. There is some tenderness under the right costal margin. Which one of the following is the most likely cause of her symptoms and examination findings? 1. Chronic renal disease 2. Biliary cholestasis. 3. Pre—eclampsia. 4. Cholecystitis. 5. Acute fatty liver of pregnancy 4
16/ A 24—year-oId woman of 30 weeks of gestation in her First pregnancy is noted to be mildly jaundiced, to have dark urine, and to have pruritus of her abdominal skin. Her BP is 130/8OmmHg, the fundal height measures 29cm above the pubic symphysis, and the liquor volume appears slightly less than would be expected. Blood tests were arranged and gave the following results; 1. The date when fetal movements were first felt 2. The size of the uterus in late pregnancy 3. The size of the uterus in the first trimester 4. When the uterine fundus reaches the umbilicus 5. The time of engagement of the fetal presenting part Serum bilirubin (unconjugated) 5 micro mol/L (O—10) Serum bilirubin (conjugated) 1l2umol/L (0-5) Serum alkaline phosphatase (ALP) *45OU/I (30-350) Serum alanine amino transferace (AST) 45U/L (<55] Serum bile acids 100 micromol/L (l—26) Which one of the following is the most likely cause for these symptoms and results? 19/A -37 year-old female patient who has recurrent cystitis which is clearly related to coitus comes to you for evaluation and treatment. Which one of the following statement is the most correct regarding this condition? 1. Alteration of the coital position will usually prevent the recurrence of infection 2. Cystoscopy is a necessary component of her evaluation 3. An intravenous urogram is a necessary component of her evaluation 4. The bacterial flora of her vagina plays no role in her infection 5. The prophylactic use of postcoital antibiotics is as effective as continuous therapy 1. Acute fatty liver of pregnancy 2. Obstetric cholestasis 3. Pre-eclampsia 4. Cholelithiasis 5. Viral hepatitis 17/ Most accurate estimation of fetal gestational age can be obtained from which of the following ? 1. X-ray examination of the fetus in the second trimester 2. Estimation of the fundal height of the uterus on abdominal palpation 3. Pelvic examination in the first trimester 4. The date on which fetal movements were felt by the for the first time 5. Ultrasound examination of the fetus in the last trimester 20/Concerning acute pyelonephritis complicating pregnancy and the puperium all of the following statement are correct except 1. It affects approximately 2% of patients 2. when unilateral it is most often right sided 3. Symptoms include anorexia ,nausea and vomiting 4. Escherichia coli is the predominant causative micro-organism 5. A change in the immune mechanism in pregnancy is the major cause of the infection 18/ The date of delivery in a primigravida is best predicted 5
21/The drug of choice for the treatment of Chlamydia trachomatis in pregnancy 1. Metronidazole. 2. Cephazolin 3. Erythromycin 4. Tetracycline. 5. Clindamycin 25/ If a pregnant patient has an exploratory laparotomy for possible appendicitis and the appendix and other abdominal contents appear normal for the stage of gestation what is the treatment of choice? 1. Close incision and observe 2. Close incision and administer appropriate antibiotics and tocolytics 3. Obtain peritoneal cytology and close incision 4. Appendicectomy and incision closure 5. Caesarean section if past 36 weeks gestation 22/Which of the following is correct concerning GROUP B streptococcus infection in pregnancy? 1. 2. 3. 4. 5. The usual mode of infection is transplacental. The risk of fetal infection decreases with rupture of the membranes. Neonatal mortality is high once systemic infection is established. The organism is usually resistant to penicillin. Mature babies (those delivered after 37 weeks gestation) are able to resist infection with this agent. 26/ Appendicitis in pregnancy is difficult to diagnose for all of the following reasons except 1. anorexia, nausea and vomiting are common in pregnancy 2. due to uterine enlargement the site of the vermiform appendix is changed in pregnancy 3. leucocytosis is the rule in normal pregnancy 4. there is immunological suppression in pregnancy, leading to the suppression of Iocalising signs 5. other diseases during pregnancy are readily confused with appendicitis 23/ The MOST common non bacterial fetal infection 1. Toxoplasmosis. 2. Rubella 3. CytomegaIovirus 4. Syphilis. 5. Herpes simplex. 27/A patient, who has had three successive spontaneous abortions, attends at l2 weeks of gestation in her fourth pregnancy. Her menstrual cycles have been regular and of 28 days duration. Just prior to presenting for assessment she passed a moderate amount of blood with clots per vaginum and had some intermittent lower abdominal pain. On vaginal examination, the cervical canal admitted one linger readily and bimanual palpation showed a uterus compatible in size with a pregnancy of only 8 24/Which one of the following bacteria produces an exotoxin causing „toxic shock syndrome` associated with tampon usage ? 1. Escherichia coli. 2. Group B streptococcus 3. Clostridium welchii 4. Staphylococcus aureus 5. Mycoplasma hominis 6
weeks duration. Which one of the following is the most appropriate next step in management Vaginal bleeding (900mL) and uterine contractions. Her previous baby was delivered vaginally without difficulty, after a 6-hour labour. At the time of her admission her BP is 95/50mml·lg. and pulse rate l20/min. The uterus is palpable at the level of the xiphisternum, is firm and acutely tender to palpation, and fetal heart beats cannot be heard on auscultation or Doppler assessment. The cervix is 3cm dilated and fully effaced. Which one of the following, in addition to immediate resuscitation, is the most appropriate next step in management? 1. Pregnancy test 2. serum beta-hCG level 3. Curettage 4. Vaginal ultrasound 5. Cervical ligation 28/A 25—year-old woman, who lives 50km from the nearest tertiary referral obstetric hospital, presents because of premature rupture of her membranes (PROM) at 26 weeks of gestation, two days ago. This is her first pregnancy and it had been progressing normally until the time the membranes ruptured. No contractions have occurred in the last 48 hours, she has been transferred to the tertiary referral obstetric hospital. Glucocorticoid therapy has been given, cervical swabs collected. Prophylactic antibiotics commenced and ultrasound and cordiotocograph (CTG) assessments made. The cervical swabs showed growth of normal vaginal flora only, the ultrasound showed almost no liquor was present, and the CTG was normal and reactive. Which one of the following options is most appropriate regarding her subsequent care? 1. CS 2. Oxytocin (Syntocinon") infusion 3. Amniotomy 4. Ultrasound examination of the uterus 5. Vaginal prostaglandin 30/ A 25—year—old nulliparous woman spontaneous labour at term has shown no progress during a six—hour period, despite having her membranes ruptured, syntocinon infused and epidural anaesthesia employed. The cervix has failed to dilate beyond 4cm. the fetal head is at the level of the ischial spines (IS) and she has been diagnosed to have obstructed labour. Which one of the features listed below is most consistent with this diagnosis? 1. Prophylactic antibiotic therapy should be continued until delivery occurs. 2. Contraction—inhibiting drugs should be administered from now until established labour occurs. 3. CTG assessments at the fetal heart rate should be repeated weekly. 4. The white cell count (WCC) and C— reactive protein (CRP) levels should be assessed every 2-3 days 5. Labour should be induced now 1. Lack of moulding but caput formation of the fetal head 2. Oedema at the cervix 3. A progressive increase in the fetal heart rate to a level now of 168/ min 4. The bony head is at the level of the ischial spines 5. There is 4cm of head palpable abdominally . 29/ A 19-year-old woman at 39 weeks of gestation in her second pregnancy, is admitted to hospital because of severe abdominal pain. True & Faults 7
1. a) b) c) d) e) b) c) d) e) Labour pain can be abolished by GA Epidural anaesthesia tranquiliser morphine psycological diabetic mother cord prolapse in first stage major degree P.P. Rh mother 08. Chorio CA a) trophoblastic malignancy b) increase HCG c) bilateral theca luteal cyst d) high mortality 02.W.O.F. are true a) from ovulation average POA is 40/52 b) if menstrual cycle is irregular add one day to EDD for each irregular cycle c) primi delivered at term 5% d) multi delivered after 4% 09. Indication for forcep delivary a) delay in 2nd stage b) prevention of extra maternal effort c) useful in after coming head of breech d) delivary of premature babies e) foetal distress 03.Patient presented with conceled haemorrhage a) Cyanosed b) Tender abdomen c) Maternal tachycardia d) Hypotension e) Difficult in feel fetal parts 10. Dipoprovera a) useful in Rx of CA endometrium b) delay return of fertility c) irregular cycles d) BP should be measured before each injection 11.Supportive structures of uterus a) broad ligament b) utero sacral ligament c) cardinal ligament d) levator ani muscle e) round ligament 04.Rupture of the uterus a) Bleeding PV b) Reduced FHS c) Maternal ketoacidosis d) Maternal tachycardia e) Abdominal tendrness 05.Direct occipito posterior position a) can feel posterior fontanella b) rarely can rotate to anterior position c) delivery by face to pubis d) 10% face to pubis delivery e) 20% artificial rotation 12. breech associated with a) prematurity b) Rh iso immunitation c) Lower segment tumours d) Uterine abnormalities e) Grand multi 06. Pelvic assessment CPD indicate a) feeling of promontory of sacrum b) prominent ischial spine c) android pelvis d) narrow supra pubic area 13. elderly primi a) prematurity b) malpresentation c) hyperemesis gravidarum d) premature rupture of membrane 07. Absolute indication for LSCS a) primi breech 8
14. T/F of grand multy a) includes women who have been > 5 times become pregnant b) they have a high incidence of preeclampsia c) megaloblastic anaemia d) multiple pregnancies are more commoner than primigravida e) hyperemesis gravidarum is relatively uncommon 19) The diagnosis of heart disease complicating pregnancy is to be made if, a. The mother complains of dyspnoea on exertion. b. Central cyanosis is present. c. She complains of heart burn. d. A teletadiogram shows alteration of cardiac axis. e. A systolic thrill is palpable at the apex. 15. Delay in delivaryof after coming a) head if diagnosed breech b) undiagnosed disproportion c) poor flexion of head d) insufficient uterine contraction e) incomplete dilatation of Cx f) episiotomy hasn‟t been performed 16. Characteristic signs &symptoms impending eclampsia include a) vomiting b) UOP< 400 ml in 24h c) Diminished reflex d) Diplopia e) APH 20) In occipito posterior position a. The occiput lies against the sacroiliac joint. b. The foetal back is most often directly posterior. c. The head is often not engaged at the term in a primigravida. d. A narrow fore-pelvis is causally related. e. Diagnosis often made by radiology. of 21). Indications for ante-natal radiology for diagnostic purposes include a. Diagnosis of perinatal pregnancy. b.Ovulation of foetal lung maturity. C.Recognition of foetal skeletal abnormalities. D.Assessment of foetal growth retardation. E.Establishment of death in utero over one week. 17. Diagnosis in a 28yr old women presented with bleeding PV following 8/52 of amenrrhoea a) abortion b) decidual bleeding c) ectopic gestation d) OCP e) CA endometrium 22). Non-neoplastic cysts of the ovary include a. Follicular cysts. b.Corpus luteum cysts. c. granulosa lutein cysts. d.Dermoid cysts. e. Simple serous cysts. 18.T/F of CA Cx a) invasive CA of the Cx is not common in the age of 40 yrs b) marriage & child bearing decreases the risk c) prevalent among lower socio economic group d) tumour is most often adeno CA e) more invasive than CA endometrium 23. Macroscopic appearance of the cut surface of the uterine myomausually shows a. A congested appearance. b. Fibrous tissue and muscle fibres in a whorled arrangement. c. Hyaline degeneration. d. Bulging at the centre. 9
e. A capsule adherent to the tumour. d)Arrange for vasectomy e)Perfome a loop resection of tubes 24. W.O.F. statements are true/false of septic abortion a. Mortailty from septic abortion is eight times as high as spontaneous abortion. b. The commonest cause of death is acute renal failure. c. The organisms responsible for sepsis is most often Escherichia coli. d. Clostridium infections are rare with criminal abortion. e. Deaths from septic abortion can be reduced by the prior use of pregnancy Termination in hospitals. 29. WOF complications are more common in women with high parity a) Accidental haemorrhage b )Ectopic pregnancy c) Uterine rupture d) Malpresentation e)Premature rupture of membranes 30. Important factors determining the likelihood of conception with coitus include a) The position if the uterus b) Orgasm if the female c) The pH of the vagina d) The sperm count of the semen e) The day of the menstrual cycle 25. Endometriotic tissue a. exhibits the cyclical changes of pregnancy. b. does not show decidual change in pregnancy. c. is an advanced stage nearly always occludes the tubes. d. is an active between 30-40 years of age. e. is associated with late marriage and infertility. 26. Stature (tallness) provides an indication of a. socio-economic status. b. pelvic size. c. risk of congenital abnormality of infant. d. risk of perinatal death of infant. e. fertility. 27. Low maternal weight gain in pregnancy is a warning sign of a. pre-eclampsia b. hydramnios. c. foetal growth retardation. d. chronic urinary infection. e. intra-uterine death. 28. Post natal Ex is an ideal time to a)Initiate the use of OCP b)Insert a IUCD c)Prescribed a non oetrpgeic contraceptive steroid 10
Calcification Inhibitors in CKD and Dialysis Patients
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Development of the heart-diagrams Health & Medicine presentation. ... Published on February 28, 2014. Author: samankaru. Source: slideshare.net
SBA for final MBBS in obstetrics with answers by Dr.Eranthi Samarakoon
At the stylomastoid foramen Correct D 2. A man blinked when the cornea was lightly touched with a wisp of cotton wool.