MCQ Gynecology

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MCQ Gynecology

MCQ Gynecology 20 2007-08-11 23:48:00

An 18 year old woman develops a vaginal mass that on biopsy shows invasive glandular structures composed of cells with abundant clear cytoplasm and small round nuclei. which of the following clinical features would most likely be present?a) Coexistent squamous cell Ca of the cervixb) exposure to DES in uteroc) gonorrhea infectiond) herpes virus infectione) HPV infectionAnswer Written by: PG Preparation

MCQ Gynecology 19 2007-03-28 11:19:00

More than 90% of women with this lesion are smokersA. Fat necrosisB. Periductal mastitisC. Acute mastitisD. Mammary duct ectasiaAnswerTags: MCQ, Gynecology, Smoking Written by: PG Preparation

MCQ Gynecology 18 2007-03-28 11:05:00

The hallmark of pubertal breast developement isA. The formation of lobulesB. Ductular proliferationC. Reversal of the stromal-epithelial ratioAnswerTags: MCQ, Gynecology, Puberty, Breast Development Written by: PG Preparation

MCQ Gynecology 17 2007-03-21 06:13:00

A 20 year old female who recently delivered had a dilatation and curettage peformed for retained placental fragments. Three days after the procedure she developed lower abdominal tenderness, pain on wiggling the cervix, and spiking fever. The causative agent least likely to be the cause of these signs and symptoms is:a. group B streptococcusb. E. colic. bacteroidesd. Neisseria gonorrheae. ClostridiumAnswerTags: MCQ, gynecology, Dilatation and curettage Written by: PG Preparation

MCQ Gynecology 16 2007-03-05 07:38:00

A 40-year-old woman comes to the physician for an annual examination. She has no complaints. She has menses every 28-30 days that last for 3 days. She has no intermenstrual bleeding. She has asthma, for which she uses an occasional inhaler. She had a tubal ligation 10 years ago. She has no known drug allergies. Examination is unremarkable, including a normal pelvic examination. One of her friends was recently diagnosed with endometrial cancer, and the patient wants to know when and if she needs to be screened for this. Which of the following is the most appropriate response?A. Screening for endometrial cancer is not cost effective or warrantedB. Screening is with endometrial biopsy and starts at age 40C. Screening is with endometrial biopsy and starts at age 50D. Screening is with ultrasound and starts at age 40E. Screening is with ultrasound and starts at age 50AnswerTags: MCQ, Gynecology, Endometrial Cancer Written by: PG Preparation

MCQ Gynecology 14 2007-03-05 06:02:00

A 38-year-old woman, gravida 4, para 4, comes to the physician 8 days after a cesarean delivery complaining of redness and pain at the leftmost aspect of her incision. Her cesarean delivery was performed secondary to a non-reassuring fetal heart rate tracing. She was feeling well after the operation until 4 days ago, when she developed pain and redness around her incision. Her temperature is 37 C (98.6 F), blood pressure is 118/78 mm Hg, pulse is 88/min, and respirations are 12/min. There is marked erythema and induration around the incision. At the left margin of the incision there is a fluctuant mass. Which of the following is most appropriate next step in management?A. Expectant managementB. Oral antibiotics onlyC. IV antibiotics onlyD. Incision and drainageE. LaparotomyAnswerTags: MCQ, Gynecology, Wound abcess Written by: PG Preparation

MCQ Gynecology 12 2007-03-04 17:05:00

A 16-year-old nulligravid woman comes to the emergency department because of heavy vaginal bleeding. She states that she normally has heavy periods every month but missed a period last month and this period has been unusually heavy with the passage of large clots. She has no medical problems, has no history of bleeding difficulties, and takes no medications. Her temperature is 37 C (98.6 F), blood pressure is 110/70 mm Hg, pulse is 96/minute and respirations are 12/minute. Pelvic examination shows a moderate amount of blood in the vagina, a closed cervix, and a normal uterus and adnexae. Hematocrit is 30%. Urine hCG is negative. Which of the following is the most appropriate management?A. Expectant managementB. HysteroscopyC. Oral contraceptive pillsD. LaparoscopyE. LaparotomyAnswerTags: MCQ, Gynecology, Irregular Menses Written by: PG Preparation

MCQ Gynecology 10 2007-03-04 13:41:00

A 31-year-old woman comes to the physician for follow-up after an abnormal Pap test and cervical biopsy. The patient's Pap test showed a high-grade squamous intraepithelial lesion (HGSIL). This was followed by colposcopy and biopsy of the cervix. The biopsy specimen also demonstrated HGSIL. The patient was counseled to undergo a loop electrosurgical excision procedure (LEEP). Which of the following represents the potential long-term complications from this procedure?A. Abscess and chronic pelvic inflammatory diseaseB. Cervical incompetence and cervical stenosisC. Constipation and fecal incontinenceD. Hernia and intraperitoneal adhesionsE. Urinary incontinence and urinary retentionAnswerTags: MCQ, Gynecology, LEEP, loop electrosurgical excision procedure Written by: PG Preparation

MCQ Gynecology 9 2007-03-04 11:19:00

Cells from the endometrial lining of the uterus are detected in a Pap smear. This finding is abnormal in a. a 70 year old woman b. a 26 year old woman who is menstruating c. a 34 year old woman on Day 9 of her menstrual cycle d. a 47 year old woman on Day 18 of her menstrual cycle e. a and dAnswer Tags: MCQ, Gynecology, PAP Smear Written by: PG Preparation

MCQ Gynecology 7 1970-01-01 00:59:59

THE FOLLOWING ARE TRUE OF PRE MENSTRUAL SYNDROME A. caffeine restriction has been shown to decrease symptoms.B. fertility is decreased in those who suffer from severe symptoms.C. the majority of women seek help from their doctor with symptoms related to the condition.D. suppression of ovulation typically relieves symptoms.E. None Of The AboveAnswerTags: MCQ, Gynecology, Pre Menstrual Syndrome

Gynecology Mcq collections 1 Shortest Diameter Of The Pelvic Outlet Is: A Interspinous Diameter B Antero Posterior Diameter C Posterior Saggital Diameter D None Of The Baove

2 The Main Source Of Progesterone In Early Pregnancy Is From A Placenta B Corpus Luteum C Adrenal D None Of The Abvoe

3 All Of The Following Are Harmone Dependent Carcinoma Except : A Prostate Ca B Endometrium Ca C Breast Ca D Ovary Ca

4 Predicatiction Of Preterm Labor In Women Done With: A Fetal Fibronectin B Salivary Progesterone C Cervical Length D Uterine Height

5 The Left Ovarian Vein Terminates In A Inferior Vena Cava B Internal Iliac Vein C Left Renal Vein D None Of The Above

6 In Vitro Fertilization Is Indicated In A Tubal Pathology B Uterine Dysfunction C Ovarian Pathology D Azoospermia

7 A 18 Wks Pregnant Lady With Previous History Of Downs Syndrome Should

Be Best Evaluated By A Chorionic Villus Sampling B Beta H C4 +alpha Fetoprotein C Riple Test D Amniocentesis

8 Ccf Is Most Likely In Pregnancy At: A 32 Weeks B 1st Stage Of Labour C 3rd Stage Of Labour D 4th Stage Of Labour

9 The Commonest Presentation Of Anencephaly Is By A Vertex B Face C Brow D Shoulder

10 The Uncommon Change To Occur In A Myoma Is A Calcification B Red Degeneration C Malignant Change D Hyaline Change

11 Laparoscopic Sterilisation Is Contraindicated In: A Post Partum B Gynaecologic Tumours C Following Mtp D If The Patient Has More Than 3 Children

12 Which Is Used To Detect Anti Sperm Antibodies? A Fern Test B Spinn Barkiet Test C Palm Leaf Test D Post -coital Test

13 Dna Analysis Of Chorionic Villous Biopsy Is Done In All Except A Hemophilia B Duchennes Muscle Dystrophy C Sickle Cell Anaemia D Tay Sachs Disease

14 Kleihuer Count Is Useful To Detect The Following A Maternal Anaemia B Abo-incompatibility C Foetomaternal Transfusion D Rhisoimmunization

15 Most Commonintrauterine Infection Is A Cytomegalovirus B Rubella C Toxoplasmosis D Herpes

16 Most Commoncause Of Intrauterine Infetion A Rubella B Toxoplasma

C Hepatiis D Cytomegalovirus

17 Earliest Engagement Takes Place In A Frank Breech B Fiexed Breech C Incomplete Breech D Complete Breech

18 In A Vertex Delivery, The Babys Head Is Born Out By A Process Of A Flexion B Efxtension C Restitution D Lateral Flexion

19 Percentage Of Pregnant Females With Significant Bacteriuria A 2-10% B 11% C 21% D 30%

20 Most Common Ovarian Tumor In Less Than 20 Year Age Group Is A Epithelial Tumour B Germ Cell Tumour C Metastatic Tumour D Sexcord Stromal Tumour

21 Arm Is Contraindicated In A Previa B Hydramios C Acc.hem D Twins

22 Most Important Diameter Of The Pelvic Inlet Is: A Diagonal Conjugate B Obstetrical Conjugate C Anatomical Conjugate D Transverse Diameter

23 Which Of The Following Can Occurs In Ovary, Rectum And Appendix A Metastasis B Nebothian Follicles C Para Ovarian Cyst D Endometriosis

24 Pelvic Examination Is Advised In A Pelvic Tuberculosis Patient A As Routine B After 2 Months Of Treatment C When There Is Resistant D After 12 Months Of Treatment

25 All The Following Att Are Given In Preganacy Except A Rifampicin B Ethambutol C Inh D Streptomycin

26 All Of The Following Are Mechanisms Of Action Of Emergency Contraception Except : A Delaying Ovulation B Inhibiting Fertilization C Preventing Implantation Of The Fertilizd Egg D Interrupting An Early Pregnancy

27 Correct Statement Regarding Rh Incompatibility Is A Serial U S G Can Diagnose Hydrops Early B Antibody Titre > 4 I U/ml In Mother Indicate Serve C Prognosis Does Not Depend On Parity D Increase With A B O Incompatibility

28 A Lady Withprolapsed Uterus After Fothergills Repair Will Complain Of Following Except A First Trimester Abortion B Cervical Dystocia C Premature Laboure D Premature Rupture Of Membrane

29 The Most Common Malignancy To Metastaize To The Placenta Is: A Melanoma B Breast Carcinoma C Uterine Adenocarcinoma D Lymphoma

30 Precocious Puberty Is Seen With Which Ovarian Tumour: A Dermoid B Gynandroblastoma C Granulosa Cell Tumour D Arrhenoblastoma Reply With Quote

2.

1. c 2. B 3. D 4. C 5. c 6. A 7. D 8. A 9. B 10. C 11.B 12. D 13. D 14 D 15. A 16. D

17. 18. 19. 20. 21.

A B A B B

22. A 23. D 24. A 25. D 26. D 27. A 28. A 29 A 30. C

MCQ Gynecology 1 A married 52 year old woman who has a FHx of breast cancer has been experiencing mild discomfort for a few hours following intercourse for the last month. She is worried about using hormones. The most helpful treatment would be a) Clonidine J Vaginal lubricant b) Combined Oestrogen and progestogen replacement therapy c) vaginal estrogens d) vaginal lubricant e) Mineral supplements

MCQ Gynecology 2 Amenorrhea in a 28 year-old with a high LH and high LH/FSH ratio is a most recognised feature of: a) ovarian failure b) hyperprolactinemia c) Sheehans syndrome d) Hypothyroidism e) Asherman's syndrome

MCQ Gynecology 3 Genital warts: A. are due to herpes virus infection B. may be treated with Diflucan C. are grounds for Caesarean section to prevent neonatal infection D. podophyllin therapy should be avoided in pregnancy E. are grounds for more frequent than normal cervical smears Gynecology MCQs 4 You diagnose Trichomonas vaginitis in a 25-year-old white female, and treat her and her partner with metronidazole (Flagyl), 2 g in a single dose. She returns 1 week later and is still symptomatic, and a saline wet prep again shows Trichomonas. Which one of the following is the most appropriate treatment at this time? A) Metronidazole gel 0.75% (Metro Gel) intravaginally for 5 days B) Metronidazole, 2 g orally, plus metronidazole gel 0.75 % intravaginally for 5 days C) Metronidazole, 500 mg orally twice a day for 7 days D) Clindamycin cream (Cleocin) 2 % intra vaginally for 7 days E) Sulfadiazine (Microsulfon), 4 g orally in a single dose, plus pyrimethamine (Daraprim), 200 mg orally in a single dose

Gynecology MCQs 5 A 19-year-old married white female complains of vaginal discharge, odor, and itching. Speculum examination reveals a homogeneous yellow discharge, vulvar and vaginal erythema, and a "strawberry" cervix. The most likely diagnosis is: A) candidal vaginitis. B) bacterial vaginosis. C) trichomonal vaginitis. D) chlamydial infection. E) herpes simplex type 2

EXPLANATIONS Contract All | Expand All

MCQ 01 ANSWER The correct answer is D

A vaginal lubricant would be appropriate since although most of the estrogen acts locally, some of it is rapidly absorbed into the systemic circulation.Considerable experimental and epidemiological evidence suggests that elevated endogenous sex steroids (oestrogens) — promote breast tumour development.About 60 percent of all breast cancers are oestrogen-positive or progesterone-positive. And additionally she has a family history of breast cancer too.

MCQ 02 ANSWER The Correct Answer is A This is defined as menopause occurring in women prior to the age of 40 years.It is also known as premature ovarian insufficiency, primary ovarian insufficiency , premature menopause, primary ovarian failure, hypergonadotropic hypogonadism, as well as gonadal dysgenes. It is a not uncommon cause of amenorrhoea. The cause of POF is usually idiopathic. Some cases of POF are attributed to autoimmune disorders, others to genetic disorders such as Turner syndrome and Fragile X syndrome.Chemotherapy and radiation treatments for cancer can sometimes cause ovarian failure. Diagnosis requires elevated gonadotrophins - FSH above 40 IU per litre together with raised LH and low oestradiol (less than 100 pmol per litre) on at least two occasions. Ultrasound usually reveals small ovaries, a small uterus and a thin endometrium MCQ 03 ANSWER The Correct Answer is D Genital warts are due to the human papilloma virus, particularly types 6, 11, 16 and 18.It is a highly contagious sexually transmitted disease.It is spread through direct skin-to-skin contact during oral, genital, or anal sex with an infected partner. There is no cure for HPV, but there are methods to treat visible warts, which could reduce infectivity A 0.15% – 0.5% podophyllotoxin (also called podofilox) solution in a gel or cream is the tandard treatment,which can be applied by the patient to the affected area and is not washed off.It is the purified and standardized active ingredient of the podophylli .Podofilox is safer and more effective than podophyllin. Podophyllin and podofilox should not be used during pregnancy, as they are absorbed by the skin and could cause birth defects in the fetus. Other Treatment Options are Imiquimod (Aldara) is a topical immune response cream,Liquid nitrogen cryosurgery,Surgical excision,Laser

ablation and Electrocauterization Liquid nitrogen cryosurgery is safe for pregnancy. Cervical cancer is believed to be due to the wart virus, so patients with proven infection, be it clinical warts or evidence of wart infection on cytology, are at increased risk. So patients should be subjected to annual smears. There is debate about the role of Caesarean section for patients with active herpes, but not for patients with warts. MCQ 04 ANSWER The Correct Answer is C The preferred treatment for Trichomonas vaginitis is metronidazole, 2 g given in a single oral dose. Certain strains of Trichomonas vaginalis, however, have diminished sensitivity to metronidazole. Patients who fail initial treatment with metronidazole should be retreated with 500 mg orally twice a day for 7 days. If treatment fails again, the patient should be treated with 2 g daily for 3-5 days. Metronidazole gel and clindamycin cream are useful for treating bacterial vaginosis, but are not effective in the treatment of Trichomonas vaginitis. Sulfadiazine and pyrimethamine are used to treat toxoplasmosis. MCQ 05 ANSWER The Correct Answer is C Discharge that is yellow/green, offensive, frothy discharge - suggestive of trichonomiasis And Colpitis macularis (strawberry cervix) is often present Bacterial vaginosis is suggested by a thin, offensive(fishy odour), greywhite, adherent discharge Erythema and oedema of the vulvovaginal area, excoriation of the vulva and presence of curd-like discharge with white plaques- suggestive of candidiasis Chlamydia may cause a yellowish cervical discharge and symptoms of pelvic inflammatory disease or, alternatively, may be totally asymptomatic Herpes simplex type 2 causes ulcerations on the vulva and vaginal mucosa which are exquisitely tender, often with marked surrounding erythema and edema

MCQ Gynecology 10 A 16-year-old female comes to the physician because of an increased vaginal discharge. She developed this symptom 2 days ago. She also complains of dysuria. She is sexually active with one partner and uses condoms intermittently. Examination reveals some erythema of the cervix but is otherwise unremarkable. A urine culture is sent which comes back negative. Sexually transmitted disease testing is performed and the patient is found to have gonorrhea. While treating this patient's gonorrhea infection, treatment must also be given for which of the following? A. Bacterial vaginosis B. Chlamydia C. Herpes D. Syphilis E. Trichomoniasis MCQ Gynecology 11 A 16-year-old nulligravid woman comes to the emergency department because of heavy vaginal bleeding. She states that she normally has heavy periods every month but missed a period last month and this period has been unusually heavy with the passage of large clots. She has no medical problems, has no history of bleeding difficulties, and takes no medications. Her temperature is 37 C (98.6 F), blood pressure is 110/70 mm Hg, pulse is 96/minute and respirations are 12/minute. Pelvic examination shows a moderate amount of blood in the vagina, a closed cervix, and a normal uterus and adnexae. Hematocrit is 30%. Urine hCG is negative. Which of the following is the most appropriate management? A. Expectant management B. Hysteroscopy C. Oral contraceptive pills D. Laparoscopy E. Laparotomy MCQ Gynecology 12 A 12-year-old female comes to the physician because of a vaginal discharge. The discharge started about 2 months ago and is whitish in color. There is no odor. The patient has no complaints of itching, burning, or pain. The patient started breast development at 9 years of age and her pubertal development has proceeded normally to this point. She has not had her first menses and she is not sexually active. She has no medical problems. Examination is normal for a 12-year-old female. Microscopic examination of the discharge shows no evidence of

pseudohyphae, clue cells, or trichomonads. Which of the following is the most likely diagnosis? A. Bacterial vaginosis B. Candida vulvovaginitis C. Physiologic leukorrhea D. Syphilis E. Trichomoniasis

MCQ 10 ANSWER Correct Answer is B This patient has a gonorrhea infection.Gonorrhea is one of the most common sexual transmitted diseases Infection with gonorrhea is more common in certain groups of people. The highest reported infection rates occur in the following groups: Adolescents and young adults People (often poor) living in urban areas and Southern states African Americans Drug users Gonorrhea is caused by the Neisseria gonorrhoeae bacteria. Up to 80% of women infected with the organism are asymptomatic or only have vague symptoms. In Women • • • • • • • •

No symptoms 30-40% of the time Gonorrhea may cause pelvic inflammatory disease Infection and irritation of the cervix Need to urinate often Itching and burning of the vagina Usually with a thick yellow/green vaginal discharge Infection and irritation of the vagina Postcoital spotting or intermenstrual bleeding

Previously, fluoroquinolones [ciprofloxacin , ofloxacin , and levofloxacin (Levaquin)] was widely used in the treatment of gonorrheal infection. Because of increasing resistance of many tested samples of N. gonorrheae to the fluoroquinolone drugs, the CDC now recommends that

only one class of antibiotics, the cephalosporins, be used to treat gonorrheal infections. However, because Chlamydia trachomatis can be isolated in 25%-40% of women with gonorrhea and because women treated for gonorrhea only may soon go on to develop Chlamydia or pelvic inflammatory disease (PID), any woman receiving treatment for gonorrhea should also be treated for Chlamydia.Either Azithromycin (Zithromax) or doxycycline can be used to treat chlamydia infections.The sexual partners of women who have had either gonorrhea or chlamydia must receive treatment for both infections since their partners may be

MCQ 11 ANSWER Correct Answer is C This patient has menorrhagia.menorrhagia is defined as total blood loss exceeding 80 mL per cycle or menses lasting longer than 7 days.(A normal menstrual cycle is 21-35 days in duration, with bleeding lasting an average of 7 days and flow measuring 25-80 mL) The endometrial changes in normal menstrual cycle 1. During the follicular phase, estrogen stimulation results in an increase in endometrial thickness 2. The luteal phase or secretory phase, progesterone causes endometrial maturation 3. If fertilization occurs, the implantation phase is maintained 4. Without fertilization, estrogen and progesterone withdrawal results in menstruation

This patient menorrhagia is more likely due to dysfunctional uterine bleeding (DUB) secondary to anovulation as history and examination findings didnot provide any clues to the etiology of the menorrhagia.During the first few years after menarche, it is common for women to have some anovulatory cycles and irregular menses. Without ovulation, the corpus luteum fails to form, resulting in no progesterone secretion. Unopposed estrogen allows the endometrium to

proliferate and thicken. The endometrium finally outgrows its blood supply and degenerates. The end result is asynchronous breakdown of the endometrial lining at different levels. This also is why anovulatory bleeding is heavier than normal menstrual flow. Combination OCP is the common treatment for DUB. They contain the hormones estrogen and progestin, and are taken daily.Progestin works as an antiestrogen by minimizing the effects of estrogen on target cells, thereby maintaining the endometrium in a state of down-regulation. Other treatment Options are Intrauterine Device,hysterectomy and endometrial ablation Other Common causes of Mennorragia •

Organic Causes

Genitourinary infections -Simple vaginitis (eg, candidal, bacterial vaginosis) may cause intermenstrual bleeding, while gonorrhea and chlamydia may present with heavier bleeding Coagulation disorders - von Willebrand disease, factor II, V, VII, and IX deficiencies, prothrombin deficiency; idiopathic thrombocytopenia purpura (ITP) hepatic or renal failure

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Endocrine causes

Hypothyroidism and Hyperthyroidism Prolactin-producing pituitary tumors Polycystic Ovary Syndrome - hallmarks are anovulation, irregular menses, obesity, and hirsutism Imbalance between the thromboxane A2 and prostaglandin E2

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Anatomical causes

Pregnancy - most common cause of irregular bleeding in women of reproductive age.In this case to note that pregnancy was ruled out with a negative urine hCG test. uterine fibroids endometrial polyps Endometrial hyperplasia Endometrial cancer

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Iatrogenic causes of menorrhagia

IUDs, steroid hormones, chemotherapy agents, and anticoagulants Significance of Blood Clots in menstrual blood!!! Normally body releases anticoagulants to keep menstrual blood from clotting as it's being released. But when your period is heavy and blood is being rapidly expelled, there's not enough time for anticoagulants to work. That enables clots to form.In mennorharia therefore large blood clots are formed. Expectant management would not be appropriate. This patient is losing enough blood to have dropped her hematocrit to 30%. If one does not intervene, there is the risk that the patient will continue to bleed and to drop her hematocrit even further. Hysteroscopy would not be the most appropriate option. With such severe vaginal bleeding, hysteroscopy will likely not provide sufficient visualization of the endometrium. Also, hysteroscopy exposes the patient to the risks of surgery (e.g. perforation of the uterus, damage to internal organs) for a problem that can be managed effectively medically. Laparoscopy and laparotomy will provide a view of only the exterior of the uterus (the serosal surface) and thus will not be an effective approach to this problem

MCQ 12 ANSWER Correct Answer is C Physiologic leukorrhea can be seen during 2 different periods of childhood. Some female neonates develop a physiologic leukorrhea shortly after birth as maternal circulating estrogens stimulate the newborn's endocervical glands and vaginal epithelium. The discharge in these neonates is often gray and gelatinous. Physiologic leukorrhea can also be seen during the months preceding menarche. During this time, rising estrogen levels lead to a whitish discharge not associated with any symptoms of irritation. This patient has a whitish discharge, no other symptoms, and she has had normal pubertal development up to this point. The discharge itself has no characteristics of infection. Therefore, physiologic leukorrhea is the most likely diagnosis

In pregnancy Which of the following statements are correct a.Renal blood flow increases by more than 20 % b.GFR increases c.Serum urea levels fall d.Serum creatinine levels fall e.Tubular reabsorption of glucose declines, causing glycosuria in the presence of normal blood glucose levels

Shoulder dystocia a.associated with high maternal weight b.associated with diabetes c.associated with mid-cavity forceps delivery d.associated with premature labour e.has been successfully managed by Caesarean section Secondary amenorrhoea a.is defined as cessation of menstruation for more than 12 months b.should be not be investigated unless persisting for more than 12 months c.may be due to Asherman’s syndrome d.is commonly due to stress e.may be due to hyperprolactinaemia Contract All | Expand All

ANSWER MCQ 01 Correct Answer - T T T T F Physiology of pregnacy psecentation

Renal blood flow increases by about 25 % from 1.2 to 1.5 litres perminute.This occurs early in pregnancy. Changes in renal functionroughly parallel those in cardiac function. GFR increases 30 to 50%,peaks between 16 and 24 wk gestation, and remains at that level until nearly term, when it may decrease slightly because uterine pressure onthe vena cava often causes venous stasis in the lower extremities.Renal plasma flow increases in proportion to GFR. As a result, BUNdecreases, usually to less than 10 mg/dL (less than 3.6 mmol urea/L), and creatinine levels decrease proportionally to 0.5 to 0.7 mg/dL (44 to 62 μmol/L). Marked dilation of the ureters (hydroureter) is caused by hormonal influences (predominantly progesterone) and by backup due to pressure from the enlarged uterus on the ureters, which can also cause hydronephrosis. Postpartum, the urinary collecting system may take as long as 12 wk to return to normal. Glucose transfers in bulk through the glomerulus and is then reabsorbed by the proximal tubule.With the increased GFR, much more sugar is dumped on the tubule and may swamp its reabsorptive capacity. The result is the common pregnancy finding of glycosuria in the presence of normal blood glucose levels. MCQ 02 Correct Answer - T T T F T Shoulder dystocia presentation Shoulder dystocia occurs in approximately 1% of vaginal births.There are well-recognised risk factors, such as diabetes, fetal macrosomia, and maternal obesity. Premature labour means small babies and a reduced risk. Mid-cavity forceps suggests some difficulty in descent of the head. Zavanelli's maneuver, which involves pushing the fetal head back in with performing a cesarean section is one way of managing Shoulder Dystocia. MCQ 03 Correct Answer -F F T F T Secondary amenorrhea presentation It is defined as the absence of menses for three months in a woman with previously normal menstruation or nine months for women with a history of oligomenorrhea. Causes 1. 2. 3. 4. 5. 6.

Intrauterine adhesions (Asherman's Syndrome) Pregnancy (most common cause) Anovulation Premature menopause Menopause Polycystic ovary syndrome (PCOS)

7. Hypothalamic: Exercise amenorrhoea, related to physical exercise, Stress amenorrhoea, Eating disorders and weight loss (obesity, anorexia nervosa, or bulimia 8. Pituitary: Sheehan syndrome, Hyperprolactinemia, Hemochromatosis 9. Other central regulatory: hypothyroidism, hyperthyroidism

01. Neural Tube Defect A.Occurs in one pregnancy in 200 B.Is more common after maternal consumption of sodium valproate C.Is more common in the white than the black population DIs prevented by pre and early pregnancy folic acid E.Is suggested by the pineapple sign 02. Hyperprolactinaemia A.May cause male infertility B.Is associated with elevated levels of LH-RH C.May be associated with phenothiazine therapy D.Always causes galactorrhoea E.Adenomas should be sought with a lateral skull x-ray to examine the pituitary fossa

03. Normal Labour A.The latent phase may last for more than four hours B.The active phase should be associated with cervical dilatation at a rate of at least 1 cm. per hour C.The active phase starts when the cervix is effaced and 2 cm. dilated D.Is best charted using a partogram E.Epidural anaesthesia has an adverse effect on the rate of progress in the 1st. stage of labour

Neural Tube Defects Correct Answer - F T T F F

Neural tube defects (NTDs) are one of the most common birth defects.The incidence in the UK is ~ 1.5 per 1,000 pregnancies. An affected parent or sibling gives about a 5% risk. Two affected siblings increases the risk to about 10%. The incidence in the black population is about half that of the white.

During the first 3-4 weeks of development, specific cells in an embryo forms a narrow tube that becomes the foundation of the spinal cord, brain, and the bone and tissues that surround it. This neural tube fusing process usually is complete by 28 days of gestation.When the neural tube does not close completely, an NTD develops. The cause of NTDs is not known. It is thought that there are genetic, environmental, and nutritional components.

Risk factors • • •

Folic acid deficiency Seizure medications, such as Valproic acid Maternal diabetes, maternal obesity

Types of NTDs Anencephaly(absence of a major portion of the brain and skull) • Encephaloceles(sac-like protrusion of the brain though through the opening in the skull) • Spina Bifida - Spina Bifida Cystica(meningocele and myelomeningocele),Spina Bifida Occulta •

Treatments Adequate folate/folic acid is the primary prevention tool. Recent evidence suggests that folic acid supplementation could reduce the incidence of NTDs by up to 70%, but the protection it provides must be in place at the time of conception. It is recommended that all women of childbearing age get at least 400 micrograms of folic acid/folate a day

Hyperprolactinaemia,Normal Labor MCQ 2 ANSWER Correct Answer - T F T F F Symptoms of Hyperprolactinaemia 1. Headache 2. Growth failure and delayed puberty 3. Up to 90% of women and 10-20% of men present with galactorrhoea 4. Oligomenorrhoea, amenorrhoea, or irregular menstrual cycles 5. Reduced libido 6. Erectile dysfunction 7. Infertility High prolactin level inhibits the GnRH in the Hypothalamus therefore Low LH and FSH levels in the circulation. Drug causes: Dopamine receptor antagonists e.g. domperidone, phenothiazines, methyldopa

Endocrinology MCQs_Prolactinaemia Causes Investigations Serum prolactin level Thyroid and renal function Plain X-ray of the bones surrounding the pituitary may reveal the presence of a large macro-adenoma, the small micro-adenoma will not be apparent. • MRI is the most sensitive test for detecting pituitary tumors and determining their • • •

size.Microadenomas usually appear within the pituitary as hypointense lesions on T1-weighted images • Thyroid and renal function Treatment - Dopamine agonists cabergoline and bromocriptine MCQ 3 ANSWER Correct Answer - T T F T F

Browse > Home / OBSTETRICS / Obstetrics MCQ_Part 04

Obstetrics MCQ_Part 04 4 comments Labels: OBSTETRICS Recognised associations with hypermesis gravidarum include: A. Hydatidiform mole B. Age More than 30 years C. Smoking D. Primiparous women under 20 years of age E. Pre-eclampsia

You are called to attend the delivery of a 24-year-old primiparous female. After a prolonged 18-hour labor requiring oxytocin agumentation, she delivered a 4200 gm male infant. A vacuum-assisted delivery was performed , and the mother required repair of a third degree perineal laceration.Few minutes after the delivery you were reported that the mother’s blood pressure is 80 mmHg systolic and her bed is soaked with blood.The most likely cause of this problem is: A.occult cervical lacerations. B.hematoma. C.uterine atony. D.uterine rupture. E.disseminated intravascular coagulopathy.

Treating preterm labor with beta agonists has been shown to decrease the rate of which one of the following? A.Perinatal deaths B.Preterm delivery C.Low birth weight infants D.Delivery within 48 hours of treatment

EXPLANATIONS Contract All | Expand All MCQ 01 ANSWER The Correct Answer is A The cause of severe nausea and vomiting in pregnancy has not been identified. Hyperemesis Gravidarum may also have a genetic component. Hyperemesis is also associated with hyperemesis in prior pregnancy, female gestation, multiple gestation, triploidy, trisomy 21, current or prior molar pregnancy, and hydrops fetalis. Women with history of motion sickness, migraine headaches, psychiatric illness, pregestational diabetes, high or low pregestational weight, hyperthyroidism, pyridoxine deficiency, and gastrointestinal disorders are also at an increased risk. Cigarette smoking and maternal age older than 30 years appear to be protective. MCQ 02 ANSWER The Correct Answer is C Ninety percent of early and immediate postpartum hemorrhage is due to failure of the uterus to contract satisfactorily (uterine atony). Other less frequent causes are lacerations of the cervix, vagina, or perineum; hematomas, usually located near lacerations or episiotomy repairs; and uterine rupture, either spontaneous or iatrogrenic. All of these occur in the immediate postpartum period. Delayed hemorrhage, occurring beyond the first 24 hours after delivery, is usually caused by retained placental fragments. Interestingly, placenta accrete is among the most common causes of postpartum hemorrhage necessitating hysterectomy.

MCQ 03 ANSWER The Correct Answer is D In women with premature labor, beta-adrenergic agonists have been clearly shown to reduce the incidence of delivery within 24 and 48 hours of administration. These tocolytic agents have not been shown to consistently reduce the rates of preterm delivery, low birth weight, severe respiratory distress, or perinatal death. A statistically non-significant trend toward reduced perinatal mortality has been suggested in women given beta-adrenergic agonists earlier in pregnancy, for preterm labor before 28 weeks gestation. It appears that more effective use of the 24-48 hours gained by tocolysis with beta-adrenergic agonists holds promise for reducing perinatal morbidity and mortality, perhaps through more liberal use of predelivery glucocorticoid therapy.

The pressure on the urinarybladder is more common with A. Cervical Myomata B. Intramural fibroids C. Submucous fibroids D. Subserous fibroids The correct answer is D Submucosal (or Submucous) fibroid - This type is located beneath the lining of the uterus. The .fibroid can develop a thin stalk or even enter the vagina .Intramural fibroid - They stay mostly embedded within the middle of the wall of the uterus Subserosal (or Subserous) fibroid - This type grows towards the outside of the uterus and can press .on the organs surrounding the uterus such as the bladder or rectum Pedunculated fibroid - This type of fibroid can develop when a fibroid grows on a stalk, which is called a pedicle. This can be a subserosal fibroid growing out into the abdomen or a submucosal fibroid growing into the endometrial cavity. The stalk can get twisted which can cause severe pain, although .this is extremely rare Interligamentous fibroid - It can grow sideways between the layers of the broad ligament (a band of fibrous connective tissue that supports the uterus