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1.

At the time of a routine prenatal examination at 26 weeks' gestation,


a 23 year old primigravid woman has a fetal heart rate of 220 bpm.
Echocardiography confirms a supraventricular tachyarrhythmia. The
fetus has a small pericardial effusion and a moderate amount of
ascites. The next step in management should be:
A. continued observation.
B. fetal paracentisis.
C. administration of betamethasone to the woman.
D. adminstration of digoxin to the woman.
E. delivery.
2. A 26 year old, gravida 4, para 2, woman at 33 weeks is admitted in
early labour and draining copious amounts of greenish-brown liquor.
Her cervix is 2-3 cm dilated but not effaced. Urgent management
should include:A. examination of the liquor for gram positive rods suggestive of
Listeria.
B. examination of the liquor for lamellar bodies.
C. an attempt to measure the fetal scalp pH.
D. an ultrasound examination of the fetus to exclude oesophageal
atresia.
E. the administation of glucocorticoids to accelerate fetal lung
maturation.

4. A multigravid patient is known to have a grossly hydrocephalic baby.


She has been in spontaneous labour at 38 weeks for six hours, the
cervix is 3 cm dilated and there has been no progress during the last
three hours. The appropriate management is:
A. Syntocinon infusion with a view to performing ventriculocentesis
when the cervix is at or near full dilatation.
B. transabdominal ventriculocentesis.
C. transvaginal ventriculocentesis.
D. lower uterine segment caesarean section.
E. classical caesarean section.5. A 32 year old woman with a history of two previous
normal deliveries
is in spontaneous labour at term gestation. The cervix is 5 cm dilated.
Intermittent auscultation of the fetal heart rate has suggested
decelerations during contractions. Electronic fetal heart rate
monitoring has been commenced which reveals variable decelerations
down to 80 beats per minutes, lasting 20 seconds, and associated
with good baseline variability. The most appropriate action is:
A. perform a scalp pH measurement.
B. administer 500 ml saline intravenously.
C. perform a caesarean section.
D. perform Doppler studies of the umbilical circulation.
E. reposition the patient and continue observation.
6. You are about to perform a non-elective caesarean section for failure
to progress in a healthy 19 year old primigravida at term. There is no
fetal distress. Your anaesthetist is unable to intubate the patient. The
best course of action is to:
A. continue as normal using a mask anaesthetic.
B. continue using a mask anaesthetic, with the patient on her side
and head down.
C. perform a tracheostomy.
D. stop and wait for a regional anaesthetic.
E. stop and transfer the patient to a major centre.
7. A 24 year old Australian woman, gravida 2, para 1, previously
delivered an anencephalic infant. She now is at 8 weeks' gestation
and seeks your advice concerning the possibility of having a second
affected infant. You should inform her that the risk of a neural tube
defect in the next pregnancy is:
A. less than 0.5%.
B. 1 to 2%.
C. 4 to 5%.
D. 8 to 9%.
E. 12 to 13%.8. A 19-year-old nulliparous patient with last menstrual period 6 weeks
ago presents to the emergency department with sudden onset of
pelvic pain and genital spotting. Pelvic examination reveals bilateral
adnexal tenderness. Pelvic ultrasound reveals no gestational sac in
the uterus. The quantitative serum hCG is 6000 IU. The next
appropriate step is:
A. laparotomy.
B. laparoscopy.
C. repeat ultrasound in one week.
D. serial hCG determinations.
E. endocervical culture for Chlamydia.
9. If the parents of a stillborn fetus with major malformations view the
fetus after delivery, the likely outcome is:
A. facilitation of the grieving process.
B. an out-pouring of anger.
C. delay and difficulty with grieving.
D. a high probability they will not try for another child.
E. development of difficulties in their relationship with their existing
children.
10. The optimum treatment for early stage, but symptomatic,
endometriosis in a young married woman aged 25 is:
A. encourage pregnancy as soon as possible, but otherwise offer no
treatment.
B. ablate the endometriosis visible by laser laparoscopy.
C. treat with Danazol 200 mg daily for 12 months.
D. perform exploratory laparotomy and resect endometriotic
deposits.
E. give GnRH agonist therapy for three months and then encourage
pregnancy.
11. A 35 year old woman complains of a white malododourous vaginal
discharge especially evident postcoitally. The most likely cause is:
A. Chlamydia trachomatis infection.
B. Gardnerella vaginalis infection.C. Neisseria gonorrhoea infection.
D. florid cervical erosion.
E. Candida albicans infection.
12. A 30 year old patient undergoes a simple abdominal hysterectomy for
intraepithelial carcinoma of the cervix. Twelve hours postoperatively
you are notified that her temperature is 39.4oC. She appears flushed
and acutely ill. Her pulse is 140 per minute and weak, and the
respirations are 24 per minute. Her chest is clear to ausculation.
Which of the following is the most likely diagnosis?
A. Pulmonary embolus.
B. Pelvic cellulitis secondary to Bacteroides fragilis.
C. b-haemolytic streptococcal septicaemia.
D. Pelvic vein thrombosis.
E. Reaction to blood transfused during surgery.
Type 2
The following set of instructions appear at the begining of the section containing
the type 2 questions. Three examples of type 2 questions follow the instructions.
NOTE: Questions 13 to 15 inclusive require you to identify a SINGLE
INCORRECT OPTION or LEAST LIKELY OPTION. Marks will NOT be
subtracted for wrong answers.
13. A significant reduction in neonatal and infant mortality in developing
countries can be achieved by all the following EXCEPT:
A. Breastfeeding of the infant.
B. Tetanus toxoid immunisation of the mother antenatally.
C. Improving maternal nutrition during pregnancy.
D. Anti-malarial prophylaxis during the antenatal period.
E. Provision of neonatal intensive care facilities in the capital cities.
14. All of the following are proven to be established benefits of the
oestrogen/progestogen oral contraceptive pill EXCEPT:A. Reduction in incidence of
cervical carcinoma.
B. Reduction in incidence of menorrhagia.
C. Reduction in incidence of benign breast disease.
D. Reduction in incidence of pelvic inflammatory disease.
E. Reduction in incidence of ovarian carcinoma.
15. Recognised causes of erectile impotence in the male include all of the
following EXCEPT:
A. spinal cord lesions.
B. administration of methyldopa.
C. chronic renal failure.
D. sulphasalazine therapy.
E. hyperprolactinaemia.
Type 3
The following set of instruction appear of the beginning of the section containing
the type 3 questions. Three examples of type 3 questions follow the instructions.
NOTE: Questions 16 to 18 inclusive are of a different type. Each set of
questions consists of a list of lettered options (A, B, C, etc.) followed by a
number of statements or questions. Select the SINGLE MOST CORRECT
OPTION from the option list for EACH question. Each option may be
selected once, more than once or not at all. Marks will NOT be subtracted
for wrong answers.
16-18. After 2 hours in the second stage of labour, a primigravid woman
has an arrest of descent at +2 station and 1/5 head palpable
abdominally. In responding to Questions 16 to 18 inclusive on the
advantages and disadvantages of these methods of delivery in this
situation, select one of the following choices (A-D):
A. Vacuum extractor.
B. Midforceps.
C. Both vacuum extractor and midforceps.
D. Neither vacuum extractor nor midforceps.16. Which is/are likely to result in
significan fetal trauma?
17. Which is/are likely to result in maternal pelvic trauma?
18. Which may be safely used at a higher fetal station?
END OF PAPER
CORRECT ANSWERS
Question no. Correct Option Question no. Correct Option
1 D 10 B
2 A 11 B
3 E 12 C
4 C 13 E
5 E 14 A
6 D 15 D
7 C 16 D
8 B 17 B
9 A 18 B
(c) RANZCOG