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

161 Pages·2012·4.69 MB·English
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Self-ASSeSSment in ObStetricS And GynAecOlOGy by Ten Teachers Book Interior Layout.indb 1 15/06/12 8:57 PM 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 Book Interior Layout.indb 3 15/06/12 8:57 PM CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2012 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed in the United States of America on acid-free paper Version Date: 20121026 International Standard Book Number: 978-1-4441-7051-1 (Paperback) This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to pub- lish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copy- right.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com 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 Book Interior Layout.indb 5 15/06/12 8:57 PM 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) Book Interior Layout.indb 7 15/06/12 8:57 PM 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 Book Interior Layout.indb 9 15/06/12 8:57 PM SECTION 1 OBSTETRICS Book Interior Layout.indb 1 15/06/12 8:57 PM 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. Book Interior Layout.indb 3 15/06/12 8:57 PM 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. Book Interior Layout.indb 4 15/06/12 8:57 PM 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 Book Interior Layout.indb 5 15/06/12 8:57 PM

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This book presents medical students and those preparing for postgraduate examinations with an ideal opportunity to assess their levels of knowledge and understanding in obstetrics and gynaecology, and to practice their exam technique across a range of question formats. It can be used as a standalone
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