GENITOURINARY SUSAN TUCKER

1.Which is the most likely organism to cause a UTI?a) staph saprophyticusb) e colic) pseudomonasd) klebsiellae) strep faecalis

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

a) trimethoprim 300 mg orally daily for 5 daysb) augmentin duo orally b.d for 5 daysc) cephalexin 500 mg orally b.d for 5 daysd) nitrofurantoin 50 mg qid for 5 dayse) all of the above are correct

3.For what length of time should a man with a UTI be treated for?a) 3 daysb) 5 daysc) 7daysd) 10-14 dayse) 20 days

4.Which statement is incorrect regarding the treatment of UTI in pregnant women?a) regardless of the antibiotic chosen, the duration of treatment should be 10-14 daysb) augmentin duo b.dc) nitrofurantoin 50mg qidd) cephalexin 250mg qide) trimethoprin 300mg daily

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

a) 1000 per mm3b) 10000c) 50000d) 100000e) 500000

6.Regarding urinalysis which is incorrect?a) the haematuria square will also be positive for myoglobinuria and

haemoglobinuriab) pyuria has is nearly always present in a UTIc) nitrates are not present in all UTIs, only those caused by coagulase splitting

bacteriad) nitrates are not seen if the UTI is caused by gm+ve or pseudomonase) Vitamin C gives many false positives – nitrites,bilirubin,ketonuria

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

a) yesb) noc) no, but repeat culture in 2 weeksd) only if two such results in two specimens two days aparte) just ural sachets

8.What is the most common age group for testicular torsion?a) <10 yearsb) 12-18 yearsc) 20-25 yearsd) 30-50 yearse) >60 years

9.Which is not a cause of epididimoorchitis?a) amioderoneb) mumpsc) pseudamonasd) cryptococcuse) eruthromycin

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

a) pregnant womenb) young childrenc) non pregnant womend) men under 60 years of agee) noenates

11.Which is an correct statement regarding treatment of a torted appendix testis?a) analgesia alone is all that is requiredb) analgesia plus antibiotics for 10 daysc) surgical resection is mandatoryd) local anaesthetic infiltration into the appendix is often usede) methotrexate has been shown to be beneficial

12.Which size renal stones have a 90% chance of passing?a) <3mmb) <5mmc) <7mmd) <8mme) it is not size dependant

13.Which agent has been shown to be highly effective in treatment of renal colic pain?a) Hyoscine butylbromideb) atropinec) nifedipined) NSAID, no one in particular is superiore) GTN

14.What percentage of kidneys stones have micrscopic haematuria?a) 100%b) 20%c) 50%d) 70%e) 90%

15.At what rate should IV fluids be given in acute renal colic?a) so as to get 200ml/hr urineb) 2 litres over 2hours unless CVS contraindicatedc) maintenanced) 1 litre over 1hour unless CVS contraindicatede) it is relatively contraindicated

16.What is the role of plain AXR in diagnosis of renal colic?a) it should always be doneb) it is of marginal value and not cost effective, therefore should not be done

routinelyc) it will show the majority of renal calculid) its sensitivity is too low to be of great valuee) B,C,D are correct

17.Which statement is incorrect regarding prostatitis?a) it is usually due to the organisms of sexually transmitted diseasesb) there is a tender enlarged prostate on PR examinationc) if sytemically unwell use iv gentamicin and ampicillind) co trimoxazole is a good oral agent as it concentrates in prostatic fluide) urine culture usually reveals the organism

18.Which grade of renal injury involves a deep laceration into the collecting system?a) 1b) 2c) 3d) 4e) 5

19.Which is the imaging modality of choise in suspected renal haematuria?a) IVPb) CTc) Angiographyd) Retrograde ureteroscopye) ultrasound

20.Which statement is incorrect regarding renal trauma?a) blunt trauma with microscopic haematuria and no other signs of injury does not

need imagingb) blunt trauma with microscopic haematuria and fracture 11/12 ribs and flank

tenderness warrants imagingc) a major renal injury cannot occur without macroscopic haematuriad) penetrating trauma in the region of the kidney with macroscopic haematuria

warrants imaginge) penetrating trauma in the region of the kidney with microscopic haematuria

warrants imaging

21.Which statement regarding bladder injury is incorrect?a) they usually rupture intraperitoneally rather than extraperitonealb) they are usually associated with a pelvic fracturec) inability to void and macroscopic haematuria and meatal blood are symptomsd) investigation of choise is retrograde cystograme) the rupture can be both intra and extraperitoneal

22.Which is the most common cause of these renal causes of acute renal failure?a) ischemic ATNb) nephrotoxic ATNc) acute tubulointerstitial nephritisd) renal artery stenosise) acute glomerulonephritis

23.Haematuria, hypertension, protenuria and red cell casts in the urine are indicative of?a) nephrotic syndromeb) hepatorenal syndromec) nephritic conditionsd) rhabdomyolysise) aminita phylloides poisoning

24.What percentage renal function can be lost but still have a creatinine in the normal range?

a) 20%b) 35%c) 50%d) 60%e) 70%

25.Which of these finding would not suggest CRF as opposed to ARF?a) normochromic, normocytic anaemiab) radiologic evidence of renal osteodystrophyc) polyuria, nocturiad) 10cm size kidneyse) family history of renal disease

26.Which of these is not a feature of pre renal ARF?a) decreased GFRb) high specific gravityc) urinary sodium<10d) blood urea:creatinine ratio >100:1e) urine osmolality<500

27.Which is not a principal of treatment in ATN due to rhabdomyolysis?a) correct hyperkaleamiab) give normal saline to correct hypovolemiac) give frusemide or mannitol to encourage a diuresisd) fasciotomy as indicatede) aim for pH<6

28.Which statement is true?a) trials of high dose frusemide have not proven it to be of benefit in ARF, unless the

pt is fluid overloadedb) dopamine at 1-5mg/kg/min is only indicated where hypovolemia has been

corrected but the pt is still oliguric despite the use of diureticsc) both A and B are incorrectd) both A and B are correct

29.Which is the most common world wide cause of haematuria?a) neoplasiab) infectionc) shistosomiasisd) BPHe) calculi

30.Which statement is incorrect regarding post streptococcal GN?a) it is seen especially in childrenb) it usually occurs 7-14 days post throat infectionsc) it usually occurs 7-14 days post skin infectionsd) treatment of the primary illness with antibiotics will prevent GNe) the disease can range from isolated haematuria to severe GN

31.Which is the most common cause of CRF?a) diabetes mellitusb) hypertensionc) glomerulonephritisd) polycystic kidney diseasee) analgesic nephropathy

32.What is the cause of most common cause of death in pts with CRF?a) infection/sepsisb) cardiac causesc) CVAd) Malignancye) Self withdrawal from dialysis

33.Which biochemical abnormality is not seen in CRF?a) Hyperparathyroidism (secondary)b) hypocalcemiac) hyperphostphatemiad) increased erythropoietin (secondary)e) anaemia

34.Which is not a false cause of haematuria?a) beetrootb) raspberriesc) rhubarbd) cimetidinee) NSAID

ANSWERS1)B 2)A 3)D 4)E 5)B 6)B 7)A 8)B 9)E 10)C 11)A 12)B13)D 14)E 15)C 16)E 17)A 18)D 19)B 20)C 21)A 22)A 23)C 24)D25)D 26)E 27)E 28)D 29)C 30)D 31)A 32)B 33)D 34)D

OBSTETRICS AND GYNAECOLOGY SUSAN TUCKER

1.Which is not required for the diagnosis of pregnancy induced hypertension?a) systolic BP rise of > 30mmHg above pre pregnancy levelb) diastolic BP rise of > 15mmHg above pre pregnancy levelc) an absolute BP of >140/90d) occur after the 20th week of gestatione) proteinuria

2.Which is not a risk factor for preeclampsia?a) molar pregnancyb) multigravidac) age < 20 yearsd) multiple pregnancye) family history

3.Which statement is not true with regards to preeclampsia?a) it is due to a state of fluid overloadb) the oedema must be generalizedc) the proteinuria often occurs after the odema and hypertensiond) if left untreated it can progress to eclampsia and the HELLP syndromee) it is characterized by ischemia and thrombosis of end organs

4.Which is not accurate with regard to management of Eclampsia?a) seizures are usually self terminating if left untreated but will recurb) magnesium sulphate 4gm should be given over 15 minutes for seizure control,

then infused at 1gm per hourc) the desired BP is a diastolic BP of 90mmHgd) magnesium sulphate does not lower BPe) hydrallazine is the agent of choice to lower BP, 5mg every 20 minutes

5.Which would be consistant with a seizure due to eclampsia?a) there is status epilepticusb) no proteinuria or hypertensionc) focal neurological signsd) it responds to benzodiazapinese) there is a persistently decreased conscious post seizure

6.Which is not a risk factor for an ectopic pregnancy?a) fertility treatment

b) IUD in situc) Endometriosisd) Previous tubal infectione) Family history

7..At what bHCG would the chance of an ectopic pregnancy be 90% if a transvaginal ultrasound showed an empty uterus?

a) 500b) 900c) 1200d) 1600e) 2000

8.At what bHCG can you reliably see an intrauterine pregnancy with a transabdominal ultrasound?

a) 4000b) 5000c) 5500d) 6500e) 7500

9.Which is incorrect with regards to ectopic pregnancy?a) incidence in the standard population is 20/1000b) the incidence of a hetertopic pregnancy in the standard polulation is 1:4000c) the presence of abdominal or pelvic pain is the most sensitive symptom or signd) an intruterine gestational sac can usually be seen at 5 weeks on a TV ultrasound

and at 6 weeks on a transabdominal ultrasounde) the ectopic rate is subsequent pregnancies is 10%

10.Which is incorrect with regards to Rhesus isoimmunisation?a) The chance of a Rh-ve mother developing antiD antibodies to a Rh+ve fetus is

less than 20% (even if not given antiD)b) Anti D must be given within 24 hours to have any substantial effectc) The risk of maternofetal transfusion is very small in a first trimester abortion and

thus a smaller dose of anti D could be givend) The IgM anti D antibodies cannot cross the placenta but the IgG antibodies cane) It is a blood product.

11.Which is incorrect with regards to anti D?a) it is given IVb) The Kleihauer test is done to determine to quantify the fetomaternal hemorrhage

and thus the amount of anti D requiredc) If the mother’s serum has antiD antibodies detected in her serum at 24-48 hours

after injection then the dosage is adequate

d) If given from 3-10 days after fetomaternal transfusion is still has some effecte) 1ml protects against 6ml of fetal RBC’s

12.with regards to the different categories of abortion which is incorrect?a) in an incomplete abortion the cervix may be open or closedb) in an inevitable abortion the cervix is openc) in a complete abortion the cervix is closed and bleeding and pain minimald) in a threatened abort the cervix is opene) in a septic abortion the pt is characteristically febrile with PV bleeding and

crampy pain

13.Which statement is incorrect?a) in the normal pregnancy the bHCG increases by 66% every two daysb) the bHCG should plateau at when it reaches 1-2 million at 20 weeks gestationc) the current serum test can detect bHCG at 2-3 days post implantationd) a falling bHCG does not rule out the chance of rupture in an ectopic pregnancye) approximately 50% of patients with a threatened abort will go on to complete the

pregnancy

14.Which is not a true statement with regards to a normal pregnancy?a) the resting heart rate increases by 15-20 beats / min by the end of the third

trimesterb) the blood volume increases by 45%c) polycythemia developsd) there is a leucocytosis up to 18 000e) the bladder becomes an abdominal organ

15.Which statement is incorrect with regards to radiation exposure to the fetus?a) the minimum exposure known to cause risk o the fetus is <0.1Gy (1000microGy)b) a CXR and Pelvic Xray are well below the minimum toxic levelc) a VQ scan falls well below the toxic leveld) a CT abdomen falls well below the toxic levele) a CXR has the same radiation as one transatlantic air flight

16.Which is not true with regards to placental abruption and trauma in pregnancy?a) it is the most common cause of death if the mother survivesb) the incidence in minor trauma is up to 5% and up to 50% in major traumac) it can occur up to 4 hours post accidentd) CTG monitoring for a 4 hours is thought to predict nearly all pts of minor trauma

who will develop placental abruptione) It is characterized by pelvic pain uterine contractions and vaginal bleeding

17.Which statement is incorrect with regards to dysfunctional uterine bleeding

a) it is very rare in the teenage yearsb) it is usually due to anovulatory cyclesc) oestrogen is used acutely to slow bleeding by contracting the uterine arteriesd) cyclical progesterone is used if it is a chronic probleme) in patients over 35 years endometrail biopsy should precede oetrogen

administration 18.Which three must be present to make the diagnosis of PID?

a) temp >38.3, abdo pain, vaginal dischargeb) temp > 38.3, abdominal pain, cervical excitationc) abdo pain, adnexal tenderness, increased CRPd) adnexal tenderness, vaginal discharge and increased CRPe) abdominal pain, cervical excitation and adnexal tenderness

19.Which agent is not one recommended in the 2000 antibiotic guidelines for the treatment of outpatient sexually acquired PID?

a) Metronidazole 400mg b.d orally for 14 daysb) ceftriaxone 250 mg IM stat dosec) augmenten duo forte 875/125 b.d orally for 14 daysd) doxycycline 100mg b.d orally for 14 dayse) roxithromycin 300mg o daily for 14 days if breast feeding

20.The risk of infertility after a single episode of PID is approximately?a) 5%b) 10%c) 20%d) 25%e) 35%

21.Non sexually acquired PID should be treated with doxycycline and what according to the 2000 Antibiotic Guidelines?

a) metronidazoleb) ciprofloxacinc) ceftriaxoned) augmented duo fortee) cephalexin

22.Which is an incorrect statement with regards to ovarian torsion?a) 70% of cases occur in women less than 30 years of ageb) 20% of cases in women less than 30 are associated with pregnancyc) it has an increased incidence in women receiving ovarian stimulation treatmentd) a tender mass is felt in 10% of casese) when it occurs in post menopausal women, neoplasm should be excluded

23.Which of the below is not consistent with trichamonas vaginitis?a) flagella are seen on a wet prepb) copious frothy grey green discharge

c) a strawberry cervix on examinationd) evidence of other sexually transmitted diseasese) treated with doxycycline

24.Which is not a risk factor for vaginal candidiasis?a) prepubertalb) diabetesc) immunosuppressiond) pregnancye) hormone replacement therapy

25.Which is not true with regard to bacterial vaginitis?a) it is the most common cause of vulvovagintis in women of childbearing ageb) clue cells are seenc) it can be a normal commensald) it is not sexually transmittede) treatment is with metronidazole

ANSWERS1.E 2.B 3.C 4.D 5.D 6.E 7.C 8)D 9.E 10.B 11.A 12.D13.B 14.C 15.D 16.C 17.A 18.E 19.C 20.B 21.D 22.D 23.E 24.A25.D

12. Regarding ectopic pregnancy

a. Ectopic pregnancy represents ~ 2% of pregnancies.b. Vaginal bleeding occurs in up to 50% of cases of ectopic pregnancy.c. Ectopic pregnancy remains the second leading cause of maternal death in

the first trimester.d. A serum BhCG that fails to double in 48 hours is diagnostic of an ectopic

pregnancy.e. If an intrauterine pregnancy exists on ultrasound scan – the diagnosis of an

ectopic pregnancy has been reliably ruled out.

13. Patients presenting with PV bleeding > 20/40 gestation needs to be attended to emergently. Which of the following statements is correct?

a. Speculum examination is always safe in these patients.b. Placenta previa accounts for 40% of bleeding episodes in pregnancy.c. ½ of foetuses die when vaginal bleeding occurs after 20 weeks of

gestation.d. Placental abruption is frequently misdiagnosed as preterm labour.e. Traumatic placental abruption is more common than spontaneous placental

abruption.

14. All of the following are contraindicated in pregnancy, except

a. Ondansetronb. Erythromycin estolatec. Aspirind. ACE inhibitorse. Fluoroquinolones

15. The radiological procedure in the list below that exposes the foetus to the most radiation is:

a. Cerebral angiography

b. Chest xrayc. Pelvimetry CTd. Mammographye. Lumbar spine CT

1. A woman presents at 34/40 gestation with PV bleeding. The diagnosis of placenta praevia is more likely if she also has:

a) a history of a normal scan at 15/40 b) abdominal pain

c) shock out of keeping with the degree of observed blood loss d) a history of recent trauma

e) a history of previous caesarean section.

20Risk factors for developing hypertension during pregnancy include the following EXCEPT:

a) Chronic renal diseaseb) Age > 40 yearsc) Multiple gestationd) Diabetes mellituse) Multiparity

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

A. threatened miscarriageB. inevitable miscarriageC. complete miscarriageD. missed abortionE. incomplete miscarriage

11 B

14. Regarding ectopic pregnancy:a) 15% of all pregnancies are ectopicb) Up to 50% of pregnancies following tubal sterilisation are ectopicc) A 19 yo girl with abdominal pain who denies she’s pregnant does NOT need a pregnancy

testd) Rhesus negative women with ectopic pregnancies do not need anti D immune globuline) Most patients with ectopic pregnancy present to ED with haemodynmamic instability

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

a) Post mortem caesarean section is only indicated if foetal heart sounds are presentb) If the patient is hypotensive, a pillow should be placed under the left hipc) Coagulation abnormalities suggest placental injuryd) CTG is indicated even in relatively minor traumae) Anti-D should be administered routinely

54. With regards to drug administration in pregnancy, which of the following is TRUE:a) Warfarin can cause abnormal foetal syndromesb) Maintaining therapeutic maternal gentamicin levels minimizes foetal toxicityc) Pregnancy following failure of “the morning after pill” is associated with increased incidence

of foetal urogenital abnormalitiesd) Quinolones are the lowest risk category for foetal toxicitye) Sulphonamides are safe in the third trimesterWarfarin is class D in pregnancy

In first trimester (weeks 6-9) can cause specific embryopathy syndrome In last few weeks can cause perinatal and intracerebral CNS bleeding and should be avoided in later

pregnancyGentamicin is completely contraindicated in pregnancy (class D) and cause ototoxic and nephrotoxicity, monitoring levels will not helpPregnancy after MAP is unaffectedQuinolones are category B3Sulphonamides are class C drugs and can cause jaundice and haemolytic anaemia in the newborn and should be avoided in third trimester

14. B 53. B 54. A

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

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

b) The βHCG level is concordant with dates.c) If there is no intrauterine pregancy on transvaginal ultrasound, she is

likely to have an ectopic pregnancy.d) There is a significant risk of a hydatidiform mole.e) An ultrasound is unlikely to provide a definitive diagnosis currently.Tint 689-690

36. The following antibiotics are considered relatively safe in pregnancy except:a) penicillinb) trimethoprimc) erythromycind) cephalothine) ceftriaxoneTint 1028

1) Normal Pregnancya. Red cell size increase at the same rate as blood volumeb. Blood volume increases by 40% by 28 weeks

c. HR increases significantly

14. Which ONE of the following is TRUE, regarding ectopic pregnancy:a) 15% of all pregnancies are ectopic

b) Up to 50% of pregnancies following tubal sterilisation are ectopicc) A 19 yo girl with abdominal pain who denies she’s pregnant does NOT need a pregnancy

testd) Rhesus negative women with ectopic pregnancies do not need anti D immune globuline) Most patients with ectopic pregnancy present to ED with haemodynmamic instability

53. Regarding blunt abdominal trauma in the 3rd trimester of pregnancy, which ONE of the following is FALSE:a) Post mortem caesarean section is only indicated if foetal heart sounds are presentb) If the patient is hypotensive, a pillow should be placed under the left hipc) Coagulation abnormalities suggest placental injuryd) CTG is indicated even in relatively minor traumae) Anti-D should be administered routinely

54. Regarding drug administration in pregnancy, which ONE of the following is TRUE:a) Warfarin can cause abnormal foetal syndromesb) Maintaining therapeutic maternal gentamicin levels minimizes foetal toxicityc) Pregnancy following failure of “the morning after pill” is associated with increased

incidence of foetal urogenital abnormalitiesd) Quinolones are the lowest risk category for foetal toxicitye) Sulphonamides are safe in the third trimester

33A woman in the third trimester of pregnancy presents to the ED complaining of abdominal pain without vaginal bleeding. Vital signs are remarkable for a systolic blood pressure of 160, heart rate of 105, and a respiratory rate of 18. Which one of the following statements is TRUE concerning this patient?A. A normal ultrasound excludes the diagnosis of placental abruption.B. Lack of vaginal bleeding excludes the diagnosis of placental abruption.C. A pelvic examination should be avoided.D. A CBC, electrolytes, and renal and liver function tests should be obtained.E. Immediate delivery is indicated.

35When a gravid female presents in cardiac arrest, all of the following statements are TRUE, EXCEPTF. the “human wedge” is useful in bystander CPR.G. ideally, a Cardiff wedge should be placed under the patient’s left hip and

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

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

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

2. 24year female with syncope and abdo pain

Which exludes ectopica) Negative betaHCGb) USS with intrauterine sacc) Absence of shoulder tip paind) ?e) None of the above

9. 34/40 with abdo pain, PV bleeding, BP 90/-Which is wrong?

a) Praevia unlikelyb) PV should be donec) Blood loss <1Ld) 40% DICe) association with ATN

Praevia 0.5% of pregnanciesPV should NOT be performed, use a speculum, ideally a SimsBlood loss 2-4 litresDIC commonATN can occur

19. During pregnancy:

a) CVP gradually decreasesb) oxygen reserve increases by about 20%c) diastolic blood pressure rises in the first trimesterd) gastrointestinal motif ity increases e) blood volume increases by about 20% by term

19 A

20) In the treatment of eclampsia, which is most truea. Magnesium is >90% effectiveb. LSCS must be urgently booked in all casesc. Phenytoin is ineffectived.e.

20) In the treatment of eclampsia which is true

a. *Magnesium is >90% effective – sounds about rightb. LUSCS must be urgently booked in all cases. Bosh – never allc. Phenytoin is ineffective. Bosh- it is effective but considered second line

7) In a female patient at 10 weeks gestation presenting with PV bleeding and an open cervical os which of the following best describes the situationa. Threatened miscarriageb. Complete miscarriagec. Missed miscarriaged. Incomplete miscarriagee.

7) In a female patient at 10 weeks gestation with PV bleeding and an open cervix which of the following best describes the situation?a. Threatened abort. Flase – os closedb. Complete abort. False – os closedc. Missed abort. False os closed with dead fetus insided. *Incomplete abort. True os can remain openOpen os is typical of an inevitable abortion.

5. Use of tocolytics in pregnancy is indicated in which of the followingDistressed fetus22/4034/40 For preterm labour between 24 weeks and 36 weeks TRUEchorioamnionitispain from protracted contraction

19. A young female presents after a syncopal episode and is still pre-syncopal on sitting up. The following exclude ectopic pregnancy:Tubal ligationPast history of PIDUSS demonstrating intrauterine sacUrine HCG < 25None of the above