Self Assessment in Obstetrics and Gynaecology by Ten Teachers 2E EMQs, MCQs, SAQs & OSCEs

161 Pages·2012·4.69 MB·English

by  Jeremy C Brockelsby

Self-ASSeSSment in ObStetricS
And GynAecOlOGy
by Ten Teachers
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Self ASSeSSment in
ObStetricS And GynAecOlOGy
by Ten Teachers
emQ , mcQ , SbA , SAQ and OSce
s s s s s
2nd edition
Catherine E. M. Aiken mb/bchir ma phd mrcp
Academic Clinical Fellow, Department of Obstetrics and Gynaecology, The Rosie Maternity
Hospital, Addenbrooke’s University Hospital NHS Trust, Cambridge, UK
Jeremy C. Brockelsby mrcog phd
Consultant in Obstetrics and Fetal-Maternal Medicine, The Rosie Maternity Hospital,
Addenbrooke’s University Hospital NHS Trust, Cambridge, UK
Christian Phillips dm mrcog
Consultant Obstetrician and Gynaecologist and Clinical Director, Maternity and Gynaecology,
The North Hampshire Hospital, Basingstoke and North Hampshire NHS Foundation Trust,
Basingstoke, UK
Louise C. Kenny mrcog phd
Professor of Obstetrics and Consultant Obstetrician and Gynaecologist, The Anu Research
Centre, Cork University Maternity Hospital, Department of Obstetrics and Gynaecology,
University College Cork, Cork, Ireland
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CRC Press
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Contents
Acknowledgements vii
Commonly used abbreviations ix
SECTION 1 OBSTETRICS
CHAPTER 1 Extended Matching Questions 3
Answers 18
CHAPTER 2 Multiple Choice Questions 29
Answers 40
CHAPTER 3 Single Best Answer Questions 51
Answers 57
CHAPTER 4 Short Answer Questions 62
CHAPTER 5 Objective Structured Clinical Examination Questions 76
Answers 82
SECTION 2 GYNAECOLOGY
CHAPTER 6 Extended Matching Questions 91
A nswers 98
CHAPTER 7 Multiple Choice Questions 103
Answers 110
CHAPTER 8 Single Best Answer Questions 116
A nswers 120
CHAPTER 9 Short Answer Questions 122
CHAPTER 10 Objective Structured Clinical Examination Questions 133

Answers 144
Index 153
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Acknowledgements
The Editor (LCK) would like to acknowledge the help of Mr Fred English, BSc (Hons) with the preparation of
this text.
This book is dedicated to my sons, Conor and Eamon (LCK)
To my Father and to Oscar (CA)

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Commonly used abbreviations
ABO ABO blood group IVP intravenous pyelogram
AC abdominal circumference LDL low-density lipoprotein
ACTH adrenocorticotrophin horome LFT liver function test
ADH antidiuretic hormone LH luteinizing hormone
AFP alpha-fetoprotein LLETZ large loop excision of the transformation
AIDS acquired immunodeficiency syndrome zone
ALT alanine aminotransferase LMP last menstrual period
AMH anti-Müllerian hormone LNG-IUS levonorgestrel intrauterine system
AP anterior–posterior MCV mean corpuscular volume
BMI body mass index MSU mid-stream specimen of urine
BP blood pressure NHS National Health Service
BPD biparietal diameter NICE National Institute for Health and Clinical
BSO bilateral salpingo-oophorectomy Excellence
BV bacterial vaginosis NIDDM non-insulin dependent diabetes mellitus
CAH congenital adrenal hyperplasia NSAID non-steroidal anti-inflammatory drug
CGIN cervical glandular intraepithelial neoplasia NTD neural tube defect
CIN cervical intraepithelial neoplasia OAB over active bladder
CMV congenital cytomegalovirus PCOS polycystic ovarian syndrome
COCP combined oral contraceptive pill PE pulmonary embolism
CPD cephalopelvic disproportion PID pelvic inflammatory disease
CT computed tomography PR per rectum
CTG cardiotocography PROM preterm rupture of the membranes
CVS chorionic villus sampling REM rapid eye movement
DFA direct fluorescent antibody RMI relative malignancy index
DVT deep vein thrombosis RCOG Royal College of Obstetricians and
ECG electrocardiogram Gynaecologists
ECV external cephalic version sb-hCG s erum beta-human chorionic
EDD expected date of delivery gonadotrophin
ELISA enzyme-linked immunosorbent assay SSRIs selective serotonin reuptake inhibitors
FBC full blood count TAH total abdominal hysterectomy
FL femur length TCRE transcervical resection of the
FSH follicle-stimulating hormone endometrium
FTA fluorescent treponemal antibody TDF testicular development factor
GFR glomerular filtration rate TFT thyroid function test
GnRH gonadotrophin-releasing hormone TPHA Treponema pallidum haemagglutination
GP general practitioner assay
HbF haemoglobin F TPPA Treponema pallidum particle
HC head circumference agglutination
HCG human chorionic gonadotrophin TSH thyroid-stimulating hormone
HDL high-density lipoprotein TTTS twin-to-twin transfusion syndrome
HELLP haemolysis, elevated liver enzymes and TVT tension-free vaginal tape
low platelets U&Es urea and electrolytes
HIV human immunodeficiency virus USI urodynamic-proven stress incontinence
HPV human papillomavirus USS ultrasound scan
HRT hormone replacement therapy UTI urinary tract infection
HVS high vaginal swab VDRL Venereal Disease Research Laboratory
IUCD intrauterine contraceptive device VKDB vitamin K deficiency bleeding
IUGR intrauterine growth restriction VMA vanillylmandelic acid
IUS intrauterine system V/Q ventilation/perfusion
IV intravenous VTE venous thromboembolism
IVF in-vitro fertilization
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SECTION 1
OBSTETRICS
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CHAPTER 1
EXTENDED MATCHING
QUESTIONS
Questions .....................................................................3 the clinical management of hypertension in
Pre-existing maternal conditions .....................................3 pregnancy ..............................................................10
Gravidity/parity ...............................................................4 Features of abnormal placentation ................................10
Maternal and perinatal mortality: the confidential Late miscarriage ...........................................................10
enquiry .....................................................................4 Risk factors for preterm labour......................................11
standards in maternity care ............................................4 Diagnosis and management of preterm delivery ............11
Physiological changes in pregnancy: uterus and Drugs used in pregnancy ..............................................12
cervix .......................................................................5 shortness of breath in pregnancy ..................................12
Haematological changes in pregnancy ............................5 Perinatal infection (1) ....................................................12
normal fetal development: the fetal heart .......................5 Perinatal infection (2) ....................................................13
normal fetal development: the urinary tract ....................5 Mechanism of labour ....................................................13
Antenatal care ................................................................6 stages of labour ............................................................13
niCe guidelines on routine antenatal care .......................6 interventions in the second stage ..................................14
Antenatal imaging and assessment of fetal well-being ....6 Complications of Caesarean section ..............................14
ultrasound measurements ..............................................7 obstetric emergencies (1) .............................................14
Prenatal diagnosis ..........................................................7 obstetric emergencies (2) .............................................15
Modes of prenatal testing ...............................................7 Postpartum pyrexia .......................................................15
Antepartum haemorrhage ...............................................7 Postpartum contraception .............................................16
Fetal malpresentations ....................................................8 Psychiatric disorders in pregnancy and the
thromboprophylaxis .......................................................8 puerperium ............................................................16
Common problems of pregnancy ....................................9 neonatology ..................................................................16
twins and higher order multiple gestations .....................9 neonatal care ...............................................................17
Management of multiple pregnancy ................................9 neonatal screening .......................................................17
AnsweRs .....................................................................18
QUESTIONS
1 Pre-existing maternal conditions
A Diabetes E Factor V Leiden deficiency I Crohn’s disease
B Hypertension F HIV J Mitral valve stenosis
C Epilepsy G Asthma K Myasthenia gravis
D Vitiligo H Smoking L Glomerulonephritis
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each
option may be used once, more than once, or not at all.
1 Reduces intrauterine growth in a dose-dependent manner.
2 Increases risk of venous thromboembolism (VTE) in the puerperium.
3 Increased frequency of episodes during pregnancy.
4 Risk of fetal macrosomia if condition not well controlled.
5 Maternal muscle fatigue in labour.
6 Requires prophylactic antibiotics for instrumental delivery.
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4 Obstetrics
2 Gravidity/parity
A G1 P0 E G2 P1 I G1 P1
B G4 P2 F G1 P2 J G3 P1
C G0 P0 G G6 P0 K G4 P3
D G3 P3 H G5 P2 L G2 P0
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each
option may be used once, more than once, or not at all.
1 A woman currently pregnant who has had a previous term delivery.
2 A woman not currently pregnant who has had one previous termination, one early miscarriage and one still-
birth at 36/40.
3 A woman who attends for pre-conception counselling, never having been pregnant.
4 A woman currently pregnant with twins who has had one previous early miscarriage.
5 A woman not currently pregnant who previously had a twin delivery at 28/40.
3 Maternal and perinatal mortality: the confidential enquiry
A Maternal death D Maternal mortality rate G Stillbirth
B Direct maternal death E Perinatal death H None of the above
C Indirect maternal death F Perinatal mortality rate
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each
option may be used once, more than once, or not at all.
1 Death of a woman while pregnant, or within 42 days of termination of pregnancy, from any cause related to,
or aggravated by, the pregnancy or its management, but not from accidental or incidental death.
2 The number of stillbirths and early neonatal deaths per 1000 live births and stillbirths.
3 Fetal death occurring between 20 + 0 weeks and 23 + 6 weeks. If the gestation is not certain all births of at
least 300 g are reported.
4 Death resulting from previous existing disease, or disease that developed during pregnancy and which was
not due to direct obstetric cause, but which was aggravated by the effects of pregnancy that are due to direct
or indirect maternal causes.
4 Standards in maternity care
A Royal College of Obstetricians E National Childbirth I Maternity Services Liaison
and Gynaecologists Trust Committee
B Clinical Negligence Scheme for F National Institute for Health J Confidential Enquiry into
Trusts and Clinical Excellence Maternal and Child Health
C The Cochrane Library G World Health Organization K National Screening Committee
D Maternity Matters H National Library for Health L National Health Service
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each
option may be used once, more than once, or not at all.
1 Publishes national guidelines on all aspects of clinical care, including obstetric practice.
2 National consumer group representing the views of women on maternity care.
3 Sets standards for provision of care, training and revalidation of obstetric doctors in the UK.
4 An insurance scheme to help hospital Trusts fund ligation claims and manage risk.
5 Unifies and progresses standards for screening across the UK.
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Extended matching questions 5
5 Physiological changes in pregnancy: uterus and cervix
A Oestradiol E Collagenase H Adrenocorticotrophic hormone
B Prostaglandins F Prolactin (ACTH)
C Progesterone G Human chorionic I Oxytocin
D Cortisol gonadotrophin (HCG)
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each
option may be used once, more than once, or not at all.
1 Levels approximately x15 higher in third trimester than in non-pregnant state.
2 Induces the process of cervical remodelling.
3 Regulates local uterine blood flow through endothelial effects.
4 Utilized in triple test.
5 Released from posterior pituitary gland.
6 Haematological changes in pregnancy
A Haematocrit D Plasma folate concentration G Fibrinogen
B Bilirubin E White blood cells H Alkaline phosphatase
C Triglycerides F Tissue plasminogen activator I Lactate dehydrogenase
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each
option may be used once, more than once, or not at all.
1 Levels rise through pregnancy due to increased production of placental isoform.
2 Falls in pregnancy due to dilutional effect.
3 Increased by 50 per cent in pregnancy, contributing to hypercoagulable state.
4 Routine supplementation advised during pregnancy due to fall in level.
7 Normal fetal development: the fetal heart
A The ductus venosus E Right atrium I Umbilical artery
B The ductus arteriosus F Mitral valve J Atrial septum
C Foramen ovale G Tricuspid valve K Intraventricular septum
D Left atrium H Umbilical vein L None of the above
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each
option may be used once, more than once, or not at all.
1 Location of the patent foramen ovale.
2 Vessel that carries oxygenated blood from the placenta and, in adult life, forms part of the falciform
ligament.
3 Connects the pulmonary artery to the descending aorta.
4 Vessel that shunts blood away from the liver.
8 Normal fetal development: the urinary tract
A Mesonephric duct D Collecting duct system G Nephronic units
B Glomeruli E Ectoderm H Renal agenesis
C Ureteric bud F Mesoderm I Pronephros
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