Practice Paper 1 2 3

Appendix 1
Practice Paper 1: 100 SBAs

3. There are two principal types of nuclear estro-
SBA Paper 1 gen receptors. On which chromosome is recep-
• Duration: 2.5 hours (150 minutes) tor ER alpha located?
• Number of questions: 100 SBAs a. Chromosome 6
b. Chromosome 8
Paper 1 Topics c. Chromosome 10
• Anatomy d. Chromosome 12
• Embryology e. Chromosome 16
• Physiology 4. There are two principal types of nuclear estrogen
• Biochemistry receptors. On which chromosome is receptor ER
• Genetics beta located?
• Statistics/epidemiology a. Chromosome 6
• Endocrinology b. Chromosome 8
Instructions: This practice paper is laid out in the c. Chromosome 10
same style as your examination. Attempt the d. Chromosome 12
paper just like you would in an examination set- e. Chromosome 14
ting. Go through your answers and revise any 5. 98% of the circulating progesterone is bound to
topics you get wrong. This will ensure you revise proteins. How is this bound?
the topics that you have not mastered or revised a. 10% to albumin and 88% is bound to corticos-
yet. Some questions are from topics that have not teroid-binding globulin
been covered in this book. Please revise these b. 20% to albumin and 78% is bound to corticos-
topics. Most questions adhere to the principles teroid-binding globulin
of SBA format, but just for the sake of knowl- c. 60% to albumin and 38% is bound to corticos-
edge, a few questions maybe worded slightly dif- teroid-binding globulin
ferently. This is to ensure that you study those d. 80% to albumin and 18% is bound to corticos-
topics. teroid-binding globulin
e. 90% to albumin and 8% is bound to corticos-
Practice Paper 1 teroid-binding globulin
1. During menstruation, vasospasm occurs in the 6. What kind of hormone is relaxin?
arterioles of the secretory endometrium. This is a. Glucosan
produced mainly by: b. Liposaccharide
a. Progesterone c. Peptidoglycan
b. Prostacyclin d. Polypeptide
c. Prostaglandin E1 e. Polysaccharide
d. Prostaglandin E2
e. Prostaglandin F2 7. A 25-year-old woman is breastfeeding her infant.
During suckling, what hormonal response/responses
2. Progesterone has an effect on the growth of breast may be triggered?
tissue. Which tissue is mainly affected? a. Decreased secretion of both oxytocin and
a. Adipose tissue antidiuretic hormone (ADH)
b. Capillaries b. Decreased secretion of neurophysin
c. Ducts c. Increased secretion of ADH
d. Glands d. Increased secretion of oxytocin
e. Lobules e. Increased secretion of prolactin
394
https://doi.org/10.1017/9781108644396.079 Published online by Cambridge University Press
Appendices
8. During pregnancy, the uterine smooth muscle a. Cloacal membrane

is quiescent. However, during the ninth month b. Genital tubercle
of gestation, the uterine muscle becomes pro- c. Labioscrotal folds
gressively more excitable. What is the main d. Urogenital folds
factor that contributes to the increase in e. Urogenital sinus
excitability?
13. Which structure develops embryologically
a. Activity of the fetus falls to low levels
from the paramesonephric ducts in the
b. Increase in maternal prolactin levels
male?
c. estrogen synthesis by the placenta decreases
a. Appendix of the testes
d. Progesterone synthesis by the placenta
b. Lower part of urethra
decreases
c. Prostate gland
e. Uterine blood flow reaches its highest rate
d. Seminal vesicles
9. The mere sound of the hungry baby’s cry is suffi- e. Vas deferens
cient to induce milk ejection from the nipples even
14. Which structure develops embryologically from
before the baby is placed to the breast. What is the
the mesonephric ducts in a male?
reason behind this phenomenon?
a. Cowper’s gland
a. Increased release of prolactin in the mother
b. Epididymis
that causes milk synthesis
c. Prostatic ducts
b. Reflex relaxation of the myoepithelial cells
d. Testes
c. Secretion of oxytocin from the posterior pitui-
e. Vas deferens
tary, which causes contraction of the myoe-
pithelial cells 15. By what factor is the testicular testosterone levels
d. Stimulation of the sympathetic nervous system higher compared to blood levels?
that causes contraction of the myoepithelial a. 1–5 times
cells b. 10–20 times
e. Surge of prolactin from the anterior pituitary, c. 20–50 times
which promptly stimulates milk production d. 60–80 times
from the breast e. 100–150 times
10. Women who are breastfeeding generally have 16. The hydatid of Morgagni is the remnant of which
amenorrhoea. What is the physiological basis of embryological structure?
lactational amenorrhoea? a. Gubernaculum
a. Lack of ovarian steroidogenesis during b. Mesonephric ducts
breastfeeding c. Müllerian ducts
b. Oxytocin induced inhibition of GnRH secretion d. Urogenital sinus
c. Oxytocin induced stimulation of GnRH e. Utriculus
secretion
17. Leydig cell tumours are diagnosed histologically
d. Prolactin-induced inhibition of GnRH secretion
by certain inclusion bodies. What are they called?
e. Prolactin induced stimulation of GnRH
a. Heinz bodies
secretion
b. Henderson Patterson bodies
11. What is the nerve innervation of the dartos c. Howell-Jolly bodies
muscle in males? d. Negri crystal bodies
a. Iliohypogastric e. Reinke crystal bodies
b. Ilioinguinal
18. In a woman with known epilepsy, high-dose folic
c. Genitofemoral
acid is recommended. How long should a preg-
d. Lateral cutaneous
nant woman continue this for?
e. Obturator
a. Can stop when she has a positive pregnancy
12. The prostate gland derives embryologically from test
the: b. Until 12 weeks
395
Appendices
c. Until 20 weeks b. Coagulopathies

d. Until delivery c. Eclampsia
e. Continue this until breastfeeding stops d. Fatty liver of pregnancy
e. Septicaemia
19. Maternal Vitamin K to prevent neonatal haemor-
rhagic disease of the newborn is recommended in 25. During wound healing, by what time does the
women taking enzyme-inducing antiepileptic drugs. tensile strength of the wound reach that of
At what gestation would you recommend this? a normal tissue?
a. 34 weeks a. Six weeks
b. 36 weeks b. Three months
c. 37 weeks c. Six months
d. At delivery d. One year
e. Not required e. Never
20. Which medication should be avoided in women 26. Management of an open wound seen 12 hours
on antiepileptic medication when in labour? after the injury is:
a. Codeine phosphate a. Debridement and suturing
b. Diamorphine b. Healing by granulation
c. Halothane c. Should be left open
d. Pethidine d. Sterile daily dressing
e. Remifentanil e. Suturing
21. Physiological hydronephrosis affects the kidneys 27. Many maternal systemic diseases contribute to
in a normal pregnancy. What is the average delayed wound healing. What is the commonest
increase in the kidney’s longitudinal length? condition that causes delayed healing?
a. 1 cm a. Diabetes
b. 2 cm b. HELLP Syndrome
c. 3 cm c. Hypertension
d. 4 cm d. Preeclampsia
e. 5 cm e. Pulmonary oedema
22. Isolated microscopic haematuria with structu- 28. In a sutured surgical wound, the process of
rally normal kidneys can be seen in a pregnant epithelisation is completed within:
woman. What is the first line of management? a. 30 minutes
a. Does not need to be investigated during b. 24 hours
pregnancy c. 36 hours
b. Low-dose antibiotics for two weeks d. 48 hours
c. PCR e. 4 days
d. Refer to the nephrologist
29. In a woman with sickle cell disease, for which blood
e. Renal scan
type should extended phenotype considered?
23. What percentage of women with recurrent pyelo- a. D Punjab type
nephritis have an underlying renal tract b. Duffy type
abnormality? c. Kell type
a. 10% d. Kidd type
b. 20% e. O Arab type
c. 30%
30. In a patient with a first-degree heart block,
d. 40%
what would be the normal value of the PR
e. 50%
interval?
24. The commonest cause of acute kidney injury in a. 6 seconds
pregnancy is: b. 10 seconds
a. Abruption c. 15 seconds
396
Appendices
d. 18 seconds b. Endothelin
e. 22 seconds c. Endothelium
d. L-NMMA
31. What is approximate percentage of the mixed
e. Nitrous oxide
venous oxygen saturation in the right atrium?
a. 10% 38. Where in the body is angiotensin II synthesised?
b. 20% a. Adrenals
c. 40% b. Endothelium
d. 60% c. Kidneys
e. 80% d. Lungs
e. Platelets
32. In a patient with congestive cardiac failure at 28
weeks of gestation, a decision to check the true 39. Angiotensin II has many effects in the body.
mixed venous sample is made by the cardiologist. Besides being a vasoconstrictor, what is its other
Where is this blood best sampled from? main action in the haematological system?
a. Carotid sinus a. Decreases renal blood flow
b. Left ventricle b. Hyperkalaemia
c. Pulmonary artery c. Neutrophilia
d. Pulmonary vein d. Lysis of collagen
e. Right atrium e. Prothrombotic
33. The QT interval is directly dependent on: 40. What is the commonest menstrual irregularity
a. Blood pressure caused by hypothyroidism?
b. Cardiac output a. Amenorrhoea
c. Heart rate b. Dysmenorrhoea
d. Peripheral vascular resistance c. Menorrhagia
e. Size of the left ventricle d. Oligomenorrhea
e. Polymenorrhoea
34. By what percentage does the cardiac output
increase in pregnancy? 41. Thyroid profile of a 25-year-old primigravid woman
a. 10% at 10 weeks of gestation was TSH 10 mIU/L, free T4
b. 20% 2.4 pmol/L, free T3 2.1 pmol/L. What is the most
c. 30% likely diagnosis?
d. 40% a. Hyperemesis gravidarum
e. 50% b. PIH
c. Polyhydramnios
35. What condition could reduce the QT interval?
d. Preterm labour
a. Cardiomyopathy
e. Recurrent miscarriage
b. Digoxin therapy
c. Hypocalcaemia 42. A young woman presents to your clinic with
d. Hypokalaemia insomnia and palpitations. You diagnose her to
e. Rheumatic carditis have hyperthyroidism. What is most likely
cause?
36. Which common factor decreases the SA node
a. Grave’s disease
discharge?
b. Thyroid nodule
a. Atropine
c. Thyroiditis
b. Beta-adrenergic activity
d. Toxic multinodular goitre
c. Ischaemia
e. Toxic thyroid adenoma
d. Pyrexia
e. Thyroxine 43. You are investigating a woman for a pituitary
adenoma. What is the first test that you would
37. Prostacyclin is a vasodilator. Which substrate is it
consider?
derived from?
a. Deranged hormonal profile
a. Arachidonic acid
397
Appendices
b. Fundoscopy 47. A 35-year-old woman underwent endometrial

c. Visual field testing biopsy. She had a history of regular menstrual
d. X-ray of the skull cycles of approximately 28 days duration. The
e. X-ray of the wrist for bone age biopsy specimen on histological examination
showed intact straight uterine glands confined
44. Pituitary adenomas can affect any cell type pre-
mostly to the superficial part of endometrium
sent in the pituitary. What is the most common
and intact surface epithelium. How long before
type of pituitary adenoma?
the biopsy did she last ovulate?
a. ACTH-producing tumour
a. 1–3 days
b. Cystic macroadenoma
b. 5–8 days
c. Gonadotroph adenomas
c. 7 to 10 days
d. Nonfunctional adenomas
d. 14 to 21 days
e. Prolactinomas
e. 42 days
45. A young girl of 9 years of age presents with
48. Early pregnancy brings about profound changes
thelarche. What structural change best describes
in the pelvic organs. What is the main change in
changes in mammary gland during puberty?
the cervix during pregnancy?
a. Appearance of Montgomery tubercles
a. Appearance of Döderlein’s bacilli for the first
b. Breast bud and papilla get elevated and there is
time
enlargement of sides of areola
b. Change in shape of the cervix
c. Fat deposition causes breast bud enlargement
c. Loss of elasticity in the cervix
d. The first noticeable change in the breast
d. Softening and cyanosis of the cervix
occurs during the last phase of menarche
e. Uterine body:cervix ratio becomes 3:1
e. The glandular component increases more in
proportion to the ductal system 49. What would be the most characteristic structure
on histopathological examination in the ovaries
46. At her booking visit to antenatal clinic, a woman
of a five-year-old girl?
complains of alteration in her breast size. What is
a. Corpus luteum
the main change in the mammary gland during
b. Extensive connecting tissue matrix
pregnancy?
c. Germ cells arrested in prophase of meiosis I
a. Increase in intralobular connective tissue
d. Ovarian follicles containing secondary oocytes
b. Increase in myoepithelial cells
e. Ovarian follicles in various stages of maturation
c. Increase in the adipose tissue content
d. Increase in the number and size of alveoli 50. What are the anatomical layers in the vaginal
e. Proliferation of the ducts wall? See table below.
Epithelium Muscle Lamina propria Adventitial layer

a. Stratified keratinised Inner longitudinal and outer Elastic fibres Loose connective tissue and
squamous circular blood vessels
b. Stratified squamous Outer longitudinal and inner Elastic fibres without glands Dense connective tissue and
circular blood vessels
c. Columnar Longitudinal only Loose connective tissue with Loose connective tissue with
glands lymphatics
d. Cuboidal Circular only Elastic fibres with glands Dense connective tissue with
lymphatics
e. Tall columnar Outer longitudinal, and inner Loose connective tissue Elastic fibres with lymphatics
oblique without glands
398
Appendices
51. What is the average weight of a normal adult d. Incomplete flexion

uterus? e. Partial flexion
a. 10–20 g
57. Anterior fontanelle is formed posteriorly by
b. 30–50 g
the:
c. 60–80 g
a. Coronal
d. 90–100 g
b. Frontal
e. 120–130 g
c. Lambdoid
52. What are the parts of the anatomical boundaries d. Mastoid
of the perineum? See table below. e. Sagittal
Anterior Posterior Lateral

A Pubic arch Anal margin Ischial rami
B Pubic symphysis Coccyx Sacrotuberous ligament
C Anterior pubic rami Pelvic floor Ischial tuberosity
D Clitoris Tip of coccyx Labia majora
E Anterior Fourchette Sacrotuberous ligament
53. Where are Paneth cells found in the body? 58. What is the name of the segment of pelvis where
a. Cerebellar gyri internal rotation occurs?
b. Large intestine a. Anatomical outlet
c. Oesophagus b. Obstetric outlet
d. Pancreas c. Pelvic cavity
e. Small intestine d. Pelvic inlet
e. Plane of least pelvic dimension
54. Cephalic presentation is the most common pre-
sentation of fetus at term. What factor is mainly 59. Several nerves can lead to entrapment syndromes
responsible for this? in pregnancy. What is the nerve involved in mer-
a. Gravitation algia paraesthetica?
b. Power of fetal movements a. Lateral cutaneous nerve of thigh
c. Power of Braxton-Hicks contractions b. Lateral femoral cutaneous nerve of groin
d. Preferential displacement of placenta towards c. Median nerve
the fundus d. Pudendal nerve
e. Sleeping in left lateral position in e. Ulnar nerve
pregnancy
60. Pressure on the genitofemoral nerve can cause
55. What is the presenting anterior-posterior dia- pain. Which area is mainly affected?
meter of fetus in a completely flexed vertex a. Anterior abdominal wall
position? b. Labia majora
a. Biparietal c. Lower back
b. Mentovertical d. Posterior perineum
c. Occipitofrontal e. Outer part of thigh
d. Submentovertical
e. Suboccipitobregmatic 61. In a patient who has ongoing major obstetric hae-
morrhage, blood has been requested. How much of
56. What is the attitude of fetal head when the pre-
crystalloid infusion is required for each litre of
senting diameter is submentovertical?
blood loss?
a. Complete extension
a. 1 litre
b. Complete flexion
b. 1.5 litres
c. Incomplete extension
399
Appendices
c. 2 litres d. Synthesis of fetal haemoglobin by secreting

d. 2.5 litres erythropoietin
e. 3 litres e. Synthesis of fetal urine which is excreted in the
amniotic fluid
62. Hartmann’s solution is commonly used in
labour for hydration. What is the main advan- 67. After birth, fetal breathing movements are estab-
tage of this solution as compared to normal lished within a few seconds. What is the main
saline? factor responsible for initiation of respiration?
a. Contains electrolytes and bicarbonate a. Cooling of fetal skin
b. Contains electrolytes and lactate b. Expansion of fetal chest wall
c. Contains less chloride c. fetal acidosis
d. Contains more Na than K d. fetal hypocapnia
e. Contains small amount of sugars e. fetal hypoxia
63. In the placenta, calcium is transported from the 68. A study uses the weight of 100 patients
maternal to fetal tissues during pregnancy. Which recorded in clinic. How can you best describe
structure is involved in this transport? this data?
a. Chorionic cells a. Categorical
b. Cytotrophoblast b. Continuous
c. Fibroblasts c. Discrete
d. Mesenchymal cells d. Ordinal
e. Syncytiotrophoblast e. Qualitative
64. There is facilitated transfer of oxygen from mater- 69. Changes in fetal circulation involve functional
nal to fetal blood during pregnancy. What is the closure of structures within 2–3 hours of birth.
main factor that contributes to this phenomenon? Which structure closes at around 7 days?
a. Increased 2,3 DPG concentration in fetal a. Closure of ductus arteriosus
blood b. Closure of ductus venosus
b. Increased circulation time of blood in fetal c. Closure of foramen ovale
tissues d. Closure of umbilical artery
c. Increased desaturation of fetal blood e. Closure of umbilical vein
d. Presence of fetal haemoglobin
e. Small difference in the pH of maternal and 70. A multiparous patient presents with placenta
fetal blood accreta and is rushed for an emergency caesar-
ean section. The abdomen is opened through
65. fetal haemoglobin (HbF) is different from a midline vertical incision to save time. What
adult haemoglobin as it binds less avidly to is the most common immediate complication
2,3-diphosphoglycerol. What is the structure of a midline vertical incision?
of HbF? a. High infection rate
a. 2α and 2β chains b. Incisional hernia
b. 2α and 2δ chains c. Keloid formation
c. 2α and 2θ chains d. Poor cosmetic result
d. 2α and 2λ chains e. Wound dehiscence
e. 2α and 2γ chains
71. Closure of a Pfannenstiel incision for caesarean
66. fetal kidneys have fully developed by the second section requires good approximation of the rectus
trimester of pregnancy. What is their main sheath. Which nerve is most likely to be
function? entrapped in lateral ends of this transverse
a. Synthesis of fetal red blood cells incision?
b. Maintains pH of fetal blood a. Genitofemoral nerve
c. Regulation of fetal blood pressure by produc- b. Ilioinguinal nerve
tion of angiotensin c. Lateral cutaneous nerve of thigh
400
Appendices
d. Lateral epigastric nerve b. Previous abruption

e. Ventral rami of subcostal nerve c. Previous pregnancy
d. Previous transfusion
72. Prolapse of the uterus and vagina is common in e. Previous transplantation
the postmenopausal age group in multiparous
patients. Which primary support of the vagina is 78. What is the commonest encountered antibody in
weakened to cause a prolapse? pregnancy?
a. Cardinal ligament a. Anti-C
b. Endopelvic fascia b. Anti-D
c. Levator ani muscle c. Anti-E
d. Uterosacral ligament d. Anti-K
e. Vaginal musculature e. Anti-M
73. Culdocentesis is rarely performed in clinical prac- 79. Which type of antibody causes severe anaemia at
tice. Which structure is pierced last by the needle to low titres?
reach the pouch of Douglas during this procedure? a. Anti-C
a. Mucous membrane of vagina b. Anti-D
b. Muscular layer of vagina c. Anti-E
c. Parietal layer of pelvic peritoneum d. Anti-K
d. Visceral layer of pelvic fascia e. Anti-M
e. Visceral layer of peritoneum 80. You performed an audit of 100 patients to check
74. Cephalopelvic disproportion is an indication for for gestational diabetes. Based on this, you cal-
caesarean section. Which type of maternal pelvis is culated the incidence of gestational diabetes in
the least favourable for normal vaginal delivery? your patient population. What kind of statistics
a. Androgynaecoid is this?
b. Android a. Advanced statistics
c. Anthropoid b. Bayesian statistics
d. Gynecoid c. Descriptive statistics
e. Platypelloid d. Inferential statistics
e. Probability statistics
75. The curvature of the spine changes during preg-
nancy. What is the commonest change seen in 81. The standard fetal growth charts use estimated
pregnancy? fetal weight plotted on customised charts. What is
a. Flatback syndrome the main statistical principle in creating this
b. Kyphosis chart?
c. Lordosis a. Dispersion
d. Scoliosis b. Interquartile range
e. Spondylosis c. Median
d. Range
76. Abnormal fetal presentation may be related to the e. Variance
type of maternal pelvis. What is the most com-
mon type of presentation during delivery in an 82. The liver converts the lactate in lactated Ringer’s
anthropoid pelvis? solution to:
a. Brow a. acetic acid
b. Direct occipito-posterior b. ammonia
c. Face to pubis c. bicarbonate
d. Occipito-anterior d. buffers
e. Occipito-transverse e. lactic acid
77. What is the most common cause of red cell anti- 83. Which vessel does the ureter cross at the pelvic
bodies in pregnancy? brim?
a. Idiopathic a. anterior division of the common iliac
401
Appendices
b. bifurcation of the common iliac d. Lateral femoral cutaneous nerve of groin

c. internal iliac artery e. Phrenic nerve
d. ovarian artery
90. A sick pregnant patient in the ICU has blood gas
e. uterine artery
analysis performed. Her pH is 7.32, pCO2 is
84. What histological feature is characteristic of inva- 30 mmHg and HCO3 is 14 mEq/L. What is the
sive carcinoma? diagnosis?
a. Increased nuclear/cytoplasmic ratio a. Metabolic acidosis
b. Koilocytosis b. Metabolic alkalosis
c. Mitotic figures c. Normal result
d. Nuclear disintegration d. Respiratory acidosis
e. Poikilocytosis e. Respiratory alkalosis
85. On which histological finding is the diagnosis of 91. A pregnant patient presents to emergency depart-
moderate dyskaryosis in a cervical smear test ment with a history of fainting. Her blood gas
made? analysis shows pH of 7.48, pCO2 of 28 mmHg and
a. Nucleus is enlarged >50% of cell size HCO3 level of 13 mEq/L. What is the diagnosis?
b. Nucleus is enlarged to <50% of the cell size a. Metabolic acidosis
c. Nucleus is normal, but cytoplasm is increased b. Metabolic alkalosis
d. Nucleus is normal in shape c. Normal result
e. Nucleus shows increased density d. Respiratory acidosis
e. Respiratory alkalosis
86. The second most common cause of haematologi-
cal disorder in pregnancy after anaemia is: 92. A pregnant patient with asthma shows a blood gas
a. Deep vein thrombosis analysis shows pH of 7.32, pCO2 of 50 mmHg and
b. Gestational thrombocytopenia HCO3 level of 30 mEq/L. What do her results
c. Immune thrombocytopenia indicate?
d. Iron deficiency anaemia a. Metabolic acidosis
e. Megaloblastic anaemia b. Metabolic alkalosis
c. Normal result
87. The commonest cause of thrombocytopenia in
d. Respiratory acidosis
pregnancy is:
a. Gestational
b. HELLP 93. A pregnant patient has taken an overdose of an
c. Immune unknown substance. She is admitted unconscious
d. Preeclampsia and her blood gas analysis shows pH of 7.49, pCO2
e. Sepsis of 48 mmHg and HCO3 of 32. What is the diagnosis?
a. Metabolic acidosis
88. Colloids are used frequently in hypovolaemic
b. Metabolic alkalosis
shock. What makes it expand the intravascular
c. Mixed metabolic and respiratory alkalosis
compartment?
d. Respiratory acidosis
a. High molecular weight
b. Hydrophilic
c. Hygroscopic 94. The blood gas analysis of a newborn with low
d. Lipid soluble Apgar scores shows pH of 7.31, pCO2 of
e. Low permeability 50 mmHg and pO2 of 35 mmHg. What should
be the next step in management?
89. Several nerves can lead to entrapment syndromes
a. Administer high flow oxygen via face mask
in pregnancy. What is the commonest nerve
b. Breastfeed immediately
involved in the thorax and abdomen?
c. Give more tactile stimulation
a. Anterior cutaneous nerve
d. Intubate and ventilate
b. Axillary nerve
e. Prevent hypothermia
c. Lateral cutaneous nerve of thigh
402
Appendices
95. Loss of a large portion of the uterine endome- pedicle. Which important structure is at risk dur-
trium is initiated at the beginning of the men- ing the ligation of uterine pedicle near the junc-
strual phase of the uterine cycle each month. This tion of the uterus and vagina?
happens due to a change in which structure? a. Obturator artery
a. Coiled arterioles of the endometrium b. Pudendal nerve
b. Contractility of myometrial cells c. Round ligament of uterus
c. Decidual cells of the endometrial stroma d. Ureter
d. Helical endometrial gland cells e. Uterine vein
e. Straight arterioles of the endometrium
99. An adolescent girl presents with primary
96. Digital vaginal examination is performed to amenorrhoea and is diagnosed to have Mayer-
assess the pelvic structures. During digital vaginal Rokitansky syndrome. Which of the following
examination, which of the following structures is pelvic organs is always present in this
normally palpable through the lateral fornices? syndrome?
a. Ischial spine a. Cervix
b. Ovary b. Fallopian tubes
c. Perineal body c. Ovaries
d. Ureter d. Uterus
e. Urethra e. Vagina
97. In a female with androgen insensitivity syn- 100. The ovary is suspended in the pelvis by the
drome, testicular cancer is common in an undes- mesovarium. What is the main function of the
cended gonad. To rule out metastases of testicular mesovarium?
cancer, which group of lymph nodes should be a. It carries ovarian blood vessels from the
biopsied in the first instance? broad ligament to the ovary
a. Deep inguinal b. It contains the branches of lumbar
b. External iliac nerves
c. Internal iliac c. It gives support to the ovary
d. Lumbar d. It has no function
e. Superficial inguinal e. It is a single layered fold of peritoneum
suspending the ovary and the fallopian
98. During hysterectomy, brisk haemorrhage is
tube
encountered prior to ligation of the uterine
403
Appendix 2

encapsulated bacteria. What is an example of a
• Duration: 2.5 hours (150 minutes) common encapsulated bacteria?
• Number of questions: 100 SBAs a. Gardnerella vaginalis
b. Legionella pneumophilia
Paper 2 Topics c. Neisseria meningitidis
• Biophysics d. Shigella dysenterae
• Clinical Management e. Staphylococcus aureus
• Data interpretation 5. Hydroxycarbamide (hydroxyurea) is used in women
• Immunology with sickle cell disease. This reduces sickle cell crises.
• Microbiology What is the recommendation for preconception
• Pathology counselling in women on this medication?
• Pharmacology a. Safe in pregnancy
b. Stop three months before conception
Practice Paper 2 c. Stop six months before conception
d. Stop only if breastfeeding
1. What is a commonly used enzyme-inducing anti- e. Stop when pregnant
epileptic in obstetrics?
a. Carbamazepine 6. Following a vaginal delivery, a 40-year-old woman
b. Eslicarbazepine is noted to have a gaping episiotomy. There are no
c. Pregabalin signs of infection. What factor is very likely to have
d. Valproate caused this?
e. Vigabatrin a. Advanced maternal age
b. Early ambulation after repair
2. What is a commonly used nonenzyme-inducing c. Inadequate haemostasis
antiepileptic in obstetrics? d. Protein deficiency
a. Carbamazepine e. Use of absorbable sutures
b. Lamotrigine
c. Phenobarbital 7. A 32-week-pregnant woman is admitted with
d. Pregabalin severe preeclampsia and signs of HELLP. The
e. Primidone plan is an immediate delivery with caesarean sec-
tion. What is the most life-threatening complica-
3. Several medications are contraindicated in preg- tion during surgery?
nancy. In a patient with rheumatoid arthritis, a. Bleeding within a body cavity
which commonly used drug is absolutely contra- b. Generalised petechiae and ecchymosis
indicated due to birth defects? c. Haematuria
a. Azathioprine d. Postpartum haemorrhage
b. Ciclosporin e. Wound haematoma
c. Mycophenolate
d. Prednisolone 8. A woman presents with deep vein thrombosis of
e. Tacrolimus her right leg during pregnancy. What is the com-
monest acquired cause of venous thrombosis?
4. Patients with sickle cell disease are hyposplenic a. Activated protein C resistance
and are at risk of infection, in particular from b. Antiphospholipid syndrome
404
Appendices
c. Antithrombin 3 deficiency 14. Heparin prevents blood clots. What is the main
d. Hyperhomocysteinemia mechanism of action?
e. Protein S deficiency a. It blocks conversion of prothrombin to
thrombin
9. Apoptosis is defined as physiological cell death.
b. It blocks the action of thrombin on fibrinogen
What is the most characteristic feature of
c. It dissolves fibrinogen in the clot
apoptosis?
d. It inactivates thromboplastin
a. Cell swelling
e. It reduces platelet adhesiveness
b. Cell vacuolation
c. Chromatin condensation 15. Antibiotics act by interfering with the synth-
d. Formation of apoptotic bodies esis of bacterial cell wall. What is the com-
e. Inflammatory response monly used antibiotic that acts on the bacterial
cell wall?
10. A woman with gestational hypertension presents
a. Clindamycin
at 24 weeks of gestation with poorly controlled
b. Fluconazole
blood pressures and massive pedal oedema. What
c. Gentamicin
would be the most likely diagnosis?
d. Metronidazole
a. High output cardiac failure of pregnancy
e. Vancomycin
b. Hypoalbuminemia
c. Nephrotic syndrome 16. Methyldopa is commonly used as an antihyper-
d. Physiological oedema of pregnancy tensive in pregnancy. What is its mechanism of
e. Preeclampsia action?
a. ACE inhibitor
11. A 40-year-old woman presents with itching in
b. Adrenergic receptor blocking agent
her vulva. A biopsy of the skin reveals meta-
c. Calcium channel blocker
plasia. What characteristic feature of the
d. Sympathomimetic
pathological progression of metaplasia deter-
e. Vasodilator
mines treatment?
a. It is a growth disorder 17. Diuretics are rarely used in pregnant women.
b. It is precancerous Which condition precludes the use of diuretics
c. It is reversible in pregnancy?
d. It causes inflammation a. As an adjunct to hydralazine/diazoxide in
e. It should be surgically removed treatment of hypertension
b. Prior to blood transfusion in severe anaemia
12. A 28-year-old nulliparous woman complains of a
c. Pulmonary oedema
painless firm lump in her right breast, which
d. Severe anaemia with heart failure
tends to grow during periods. The most likely
e. Severe hypertension in pregnancy
diagnosis is:
a. Blood good’s cyst 18. Magnesium sulphate, when used in the manage-
b. Fat necrosis of the breast ment of eclampsia, has effects on the neonate.
c. Fibroadenoma What is a serious side effect of prolonged use of
d. Intraductal papillary carcinoma magnesium sulphate on neonates in pregnant
e. Pyogenic abscess mothers?
a. Hypotonia
13. Six hours’ postvaginal delivery, a woman presents
b. Muscle wasting
with low blood pressure and hypovolaemic shock.
c. Osteopenia with fractures
What is the most likely diagnosis?
d. Pulmonary hypertension
a. Cardiac failure
e. Respiratory distress
b. Dehydration
c. Gram-negative septicaemia 19. Some medications taken by mothers during
d. Overdose of narcotic medication during breastfeeding make them more likely to be
labour excreted through breast milk. What pharmacoki-
e. Postpartum haemorrhage netic property predisposes to this?
405
Appendices
a. Ionised c. Mode
b. Low dose d. Range
c. Low molecular weight e. Standard deviation
d. Short half-life
25. Which of the following items describes the inter-
e. Water soluble
val on a frequency histogram within which the
20. The critical time of organ formation is also greatest number of observations fall?
known as the teratogenic period. With respect to a. Mean
the last menstrual period, which days does this b. Median
refer to? c. Mode
a. Before day 14 d. Range
b. Days 14–30 e. Standard deviation
c. Days 31–60
26. A 75-year-old woman presents with a 6 cm multi-
d. Days 61–90
loculated ovarian cyst on ultrasound scan. There
e. Days 91–120
are solid areas and some ascites seen. No evidence
21. Heparin does not cross the placenta and is safe to of any metastasis is noted. Her CA125 is 30. What
take during pregnancy. What characteristic fea- is the risk of malignancy index (RMI)?
ture of the heparin molecule makes this feasible? a. 90
a. High molecular weight b. 120
b. Lipid soluble c. 150
c. Low molecular weight d. 270
d. Negative charged ions e. 360
e. Water soluble
27. What are the characteristic features of a normally
22. Which medication used in pregnancy can cause distributed curve? See table overleaf.
the ‘grey baby syndrome’?
28. The type of information provided in a particular
a. Chloramphenicol
study is anecdotal to practising evidence-based
b. Chlorhexidine
medicine. What is the most superior level of evi-
c. Chloropicrin
dence among the following studies?
d. Chlorpheniramine
a. A well-designed randomised controlled trial
e. Cimetidine
b. Expert committee reports
23. Fetal alcohol syndrome is seen in mothers who c. Systematic review and meta-analysis of rando-
consume large amounts of alcohol in pregnancy. mised controlled trials
What are the three typical facial features that are d. Well-designed descriptive studies
seen? See table below. e. Well-designed quasiexperimental study
24. Which of the following items describes the mid- 29. In a trial, the alternative hypothesis is known to
dle value in a ranked data set? be true. Unfortunately, the trial being small was
a. Mean unable to find a statistically significant difference.
b. Median What error might be the most likely cause?
Microcephaly Thin vermilion Smooth philtrum Small palpebral Sprouting in dental

fissures gyrus
a. ✓ ✓ ✓
b. ✓ ✓ ✓
c. ✓ ✓ ✓
d. ✓ ✓ ✓
e. ✓ ✓ ✓
406
Appendices
Unimodal Asymptotic Binomial Bimodal Univariate

a. ✓ ✓
b. ✓ ✓
c. ✓ ✓
d. ✓ ✓
e. ✓ ✓
a. Distribution error c. Embryonal tumour

b. P-value error d. Endodermal sinus tumour
c. Type I error e. Sex cord stromal tumour
d. Type II error
35. Calcium level is typically elevated with certain
e. Validity error
tumours. Which malignant ovarian tumour
30. Reliability is often used in statistics. What best causes hypercalcaemia?
describes this? a. Small cell carcinoma
a. It can be repeated with minimal variation b. Endodermal sinus tumour
b. It gives the most genuine information about c. Mature cystic teratoma
what is being measured d. Metastatic ovarian carcinoma
c. It has a small random error of estimation e. Sex cord stromal tumour
d. It has an interval with a fixed zero
36. The most common functional cysts in the ovary
e. It matches the accepted standard
are:
31. What is a common statistical test used to test the a. Corpus luteum cysts
association between groups? b. Endometriotic cysts
a. ANOVA c. Follicular cysts
b. Chi-square test d. Para-ovarian cysts
c. Linear regression analysis e. Theca lutein cysts
d. Student t-test
37. Schiller–Duval bodies are characteristic features
e. Wilcoxon test
of:
32. What is the nonparametric equivalent of paired a. Endodermal sinus tumour
student t-test? b. Epithelial cell cancer
a. ANOVA c. Granulosa cell tumour
b. Chi-square test d. Leydig cell tumour
c. Kruskal–Wallis test e. Ovarian fibroma
d. Mann–Whitney U test
38. Call–Exner bodies are characteristic features
e. Wilcoxon test
of
33. What is the most common tumour marker seen a. Endodermal sinus tumour
with dysgerminoma? b. Epithelial cell cancer
a. AFP c. Granulosa cell tumour
b. hCG d. Leydig cell tumour
c. Inhibin e. Ovarian fibroma
d. LDH
39. Reinke’s crystals are characteristic features of:
e. Placental alkaline phosphatase
a. Endodermal sinus tumour
34. What is the commonest germ-cell tumour of the b. Epithelial cell cancer
ovary? c. Granulosa cell tumour
a. Brenner tumour d. Leydig cell tumour
b. Dysgerminoma e. Ovarian fibroma
407
Appendices
40. Rokitansky protuberance is a characteristic fea- d. Psammoma Body

ture of: e. Reinke’s crystal
a. Brenner tumour
45. What is the most common type of vulval cancer?
b. Dermoid cyst
a. Adenocarcinoma
c. Endometrioid tumours
b. Basal cell cancer
d. Mesonephroid tumours
c. Malignant melanoma
e. Serous cyst adenoma
d. Sarcoma
41. Coffee bean nuclei are found in: e. Squamous cell cancer
a. Brenner tumour
46. The most common cause of sexually transmitted
b. Dermoid cyst
infection in the UK is:
a. Chlamydia trachomatis
b. Hepatitis B
e. Serous cyst adenoma
c. Herpes simplex
42. Psammoma bodies are calcified structures found d. Neisseria gonorrhoea
in: e. Trichomonas vaginalis
a. Brenner tumour
47. The most common cause of viral sexually trans-
b. Dermoid cyst
mitted infection in the world is:
b. Hepatitis B
e. Papillary serous cystadenoma
c. Herpes simplex
43. Hobnail cells are found in d. HPV
a. Brenner tumour e. HIV
b. Clear cell carcinoma
48. The most common cause of bacterial sexually
c. Endometrioid tumour
transmitted infection in the UK is:
d. Mature cystic teratoma
e. Mesonephroid tumour
b. Hepatitis B
44. What kind of cell is depicted in this slide from an c. Herpes simplex
ovarian tumour? See Figure A2.1. d. Neisseria gonorrhoea
a. Call–Exner body e. Trichomonas vaginalis
b. Coffee bean nuclei
49. The commonest cause for serious neonatal sepsis is:
c. Hobnail cell
a. Escherichia coli
Figure A2.1
408
Appendices
b. Group A Streptococcus 55. Ison–Hay scoring is used for identification of

c. Group B Streptococcus infections. What kind of infection is this used for?
d. Herpes simplex virus a. Bacterial vaginosis
e. Parvovirus B19 b. Chlamydia trachomatis
c. Herpes simplex
50. What is the most common cause of neonatal
d. Neisseria gonorrhoea
mortality from sepsis?
e. Trichomonas vaginalis
a. Escherichia coli
b. Group A Streptococcus 56. Nugent scoring system is used in what kind of
c. Group B Streptococcus infection?
d. Herpes simplex virus a. Bacterial vaginosis
e. Parvovirus B19 b. Chlamydia trachomatis
c. Herpes simplex
51. A 34-year-old woman is admitted with severe
vulvar pain. The pain is so severe that she is
unable to pass urine and develops urinary reten-
tion. On examination, she has multiple ulcerated 57. Clue cell is found in bacterial vaginosis. What
lesions on the labia minora. What is the most kind of structure is this?
likely cause? a. Collection of bacteria
a. Chlamydia trachomatis b. Calcium deposition
b. Hepatitis B c. Degenerated mucosal cells
c. Herpes simplex d. Glandular cells
d. Neisseria gonorrhoea e. Squamous cells
58. What is the most appropriate treatment for a 28-
52. A 22-year-old woman complains of vaginal dis- year-old pregnant woman presenting with vagi-
charge and vulvar pruritis. On local inspection, nal discharge, which shows heavy growth of
there is copious greyish discharge with a fishy Neisseria gonorrhoea?
smell and vulvar erythema and excoriations. On a. Azithromycin 1 g single dose orally
speculum examination, a raw-looking cervix is b. Ceftriaxone 500 mg intramuscularly single
identified. What is the most likely causative dose with azithromycin 1 g as a single dose
organism? c. Ceftriaxone 500 mg intramuscularly single
a. Chlamydia trachomatis dose with oral doxycycline 100 mg twice
b. Hepatitis B daily and metronidazole 400 mg twice daily
c. Herpes simplex for 14 days
d. Neisseria gonorrhoea d. Ciprofloxacin 750 mg twice daily for 14
e. Trichomonas vaginalis days
e. Oral doxycycline 100 mg twice daily and
53. Which infection is the most recognised cause of a
metronidazole 400 mg twice daily for 14
midtrimester pregnancy loss?
days
a. Bacterial vaginosis
b. Group A Streptococcus 59. Strawberry vagina is caused by what kind of
c. Group B Streptococcus infection?
d. HIV a. Chlamydia trachomatis
e. Parvovirus B19 b. Hepatitis B
c. Herpes simplex
54. Which infection is defined by the presence of clue
cells?
b. Gardnerella vaginalis 60. Which organism causes fulminant hepatitis in
c. Herpes simplex pregnancy?
d. Neisseria gonorrhoea a. Hepatitis A
e. Trichomonas vaginalis b. Hepatitis B
409
Appendices
c. Hepatitis C 67. What is most common microorganism causing

d. Hepatitis D surgical-site infections?
e. Hepatitis E a. Coagulase negative Staphylococcus
b. Enterococcus
61. Vertical transmission of HIV is maximum at
c. Pseudomonas
which stage in pregnancy?
d. Staphylococcus aureus
a. Breastfeeding
e. Streptococcus
b. First trimester
c. Labour 68. An 18-year-old girl attends the gynaecology clinic
d. Second trimester with her mother. She presents with primary ame-
e. Third trimester norrhoea. On examination, her height is 1.78 m
with a BMI of 19 kg/m2. She has no axillary or
62. What kind of maternal antibodies cross the pla-
pubic hair with normal breast development. She
centa to cause haemolytic disease of the newborn?
has a short, blind vagina. What is the most likely
a. IgA
diagnosis?
b. IgG
a. Complete androgen insensitivity syndrome
c. IgD
b. Klinefelter syndrome
d. IgE
c. Mayer–Rokitansky–Küster–Hauser syndrome
e. IgM
d. Swyer syndrome
63. Which immunoglobulin is a pentamer? e. Turner syndrome
a. IgA
69. What is the karyotype of a woman with Mayer–
b. IgG
Rokitansky–Küster–Hauser syndrome?
c. IgD
a. 45,XO
d. IgE
b. 46,XY
e. IgM
c. 46,XX
64. Which immunoglobulin is a dimer? d. 47,XXX
a. IgA e. 47,XXY
b. IgG
70. A 50-year-old woman attends the postmenopau-
c. IgD
sal bleeding clinic with her third episode of post-
d. IgE
menopausal bleeding. Her haemoglobin is 120 g/
e. IgM
L. The pelvic scan shows an endometrial thick-
65. Regarding cytomegalovirus in pregnancy, what are ness of 2 mm. What is the next step in
the commonly presenting features? See table below. management?
a. Cervical smear
66. What is the most common source of microorgan-
b. Follow-up in six months
ism causing surgical-site infection?
c. Hysteroscopy and biopsy
a. Anaesthetist
d. MRI scan pelvis
b. Contaminated surgical equipment
e. Total abdominal hysterectomy and bilateral
c. Patient
salpingo-oophorectomy
d. Scrub nurse
e. Surgeon
Options Microcephaly Organomegaly Intracranial Cleft lip and Eye defects

calcifications palate
a. ✓ ✓ ✓
b. ✓ ✓ ✓
c. ✓ ✓ ✓
d. ✓ ✓ ✓
e. ✓ ✓ ✓
410
Appendices
71. Mirabegron is a treatment for overactive bladder. 76. A 36-year-old woman presents to the gynaecology
At which receptor does this drug act as an outpatient department with complaints of heavy
agonist? menstrual bleeding and dysmenorrhoea for three
a. Alpha-2 adrenergic receptor months. The rest of her history and examination
b. Beta-3 adrenergic receptor are unremarkable. She is not keen on hormonal
c. D-2 receptor treatment and she has a coil in situ. What treat-
d. Nicotinic receptor ment would you initially recommend?
e. Muscarinic receptor a. Combined oral contraceptive
b. Mefenamic acid
72. What is the recommended method of uterine
c. Levonorgestrel intrauterine system
evacuation for a suspected molar pregnancy at
d. Norethisterone
12 weeks in a 40-year-old woman?
e. Tranexamic acid
a. Medical evacuation with mifepristone and
misoprostol 77. A 38-year-old woman with Huntington’s disease
b. Medical evacuation with oxytocin drip wishes to know the risk of having an affected
c. Suction curettage with misoprostol priming child. Her partner is not known to have this con-
d. Suction curettage dition. What is the risk?
e. Total abdominal hysterectomy a. 1 in 2
b. 1 in 3
73. A 55-year-old woman underwent a laparoscopic
c. 1 in 4
bilateral salpingo-oophorectomy for a persistent
d. 1 in 8
right ovarian cyst and CA125 of 35. Histology
e. 1 in 16
showed a well-differentiated ovarian cancer con-
fined to the right ovary. She had a staging lapar- 78. A 52-year-old woman complains of urinary fre-
otomy and lymphadenectomy following the quency and nocturia, waking up five times in the
diagnosis. The peritoneal washings were negative night. Urine dipstick shows glucose and nitrites.
and stage was 1a. What chemotherapy is required She drinks 6 L per day. What is the most appro-
for her? priate next step?
a. Carboplatin a. Bladder scan
b. Cisplatin b. HbA1c
c. Etoposide c. MSU
d. No adjuvant chemotherapy d. Plasma antidiuretic hormone levels
e. Paclitaxel e. Urodynamic study
74. A 55-year-old woman attends the general practi- 79. A patient presents with muscle aches, weak-
tioner surgery with low abdominal pain, abdom- ness and fatigue, nausea and occasional vomit-
inal bloating and urinary urgency. Abdominal ing. Routine bloods are done including serum
examination was unremarkable. What is the calcium levels. The rest of the bloods are nor-
most appropriate next step? mal.
a. CA125 Serum calcium: 15 mmol/L (2.25–2.5 mmol/L)
b. CT scan of abdomen and pelvis TSH: 2 (0.4–4.5)
c. MRI pelvis FT3: 7 (4–8.3)
d. Reassure and discharge
FT4: 25 (10–24)
e. Refer to gastro-enterologist
What could be the possible cause?
75. What proportion of patients will develop a surgi- a. Hyperthyroidism
cal-site infection after a surgical procedure? b. Hypothyroidism
a. 5% c. Hyperparathyroidism
b. 10% d. Hypoparathyroidism
c. 15% e. Renal failure
d. 20%
e. 25% 80. A patient is seen by the general practitioner com-
plaining of excessive thirst and polyuria. The
411
Appendices
Full blood count

White cell count 16.3 109/L 4.0–11.0
Haemoglobin 78 g/L 115–165
Platelets 352 109/L 150–450
RBC 4.28 1012/L 3.5–5.8
Haematocrit 0.26 L/L 0.35–0.47
MCV 60.1 fl 76–98
Mean cell haemoglobin (MCH) 18.2 pg 27.0–32.0
MCHC 302 g/L 310–360
RDW 19.5 % 11.8–14.8
Neutrophils 11.69 109/L 2.0–7.0
Lymphocytes 2.35 109/L 1.0–3.0
Monocytes 1.43 109/L 0.2–1.0
Eosinophils 0.60 109/L 0.0–0.4
9
Basophils 0.23 10 /L 0–0.2
RBC: red blood cells; MCV: mean corpuscular volume; MCHC: mean corpuscular
haemoglobin concentration; RDW: red cell distribution width
general practitioner arranges a glucose tolerance Sperm concentration: 9 million/mL (15 million/
test. The results are as follows mL)
Fasting 6.5 mmol/L Progressive motility: 35% (32%)
Two hours 10.0 mmol/L Sperm morphology (normal): 4% (4%)
Vitality: 60% (58%)
What does the test indicate?
What does this semen analysis suggest?
a. Diabetes insipidus
a. Asthenozoospermia
b. Diabetes mellitus
b. Normozoopermia
c. Gestational diabetes mellitus
c. Oligoasthenozoospermia
d. Impaired glucose tolerance
d. Oligospermia
e. Sepsis
e. Teratozoospermia
81. A couple trying for pregnancy for >1 year is
83. At booking, a 32-year-old woman in her fourth
referred to fertility clinic. The woman has regular
pregnancy presents with chronic constipation
cycles of 25–29 days. Day 21 progesterone done
and feeling lethargic. She had the blood test
by the general practitioner shows:
results shown in the table above:
Day 21 progesterone: 37 nmol/L (10–30 nmol/L).
What would the next step in management be? See
What is the initial diagnosis about ovarian
table overleaf.
function?
a. Anovulatory cycles 84. In the above patient, the blood film is shown in
b. Normal ovulatory cycle Figure A2.2.
c. Polycystic ovarian syndrome What is the diagnosis?
d. Premature ovarian failure a. Anaemia of chronic disease
e. Unambiguous findings b. Iron deficiency
c. Sickle cell anaemia
82. A couple trying to conceive was seen in fertility
d. Sideroblastic anaemia
clinic. The semen analysis was done:
e. Thalassaemia
Semen volume –2.3 mL (1.5 mL)
Total sperm number: 15 million/ejaculate 85. A 28-year-old woman, G2 P1, comes to triage at 30
(>39 million/ejaculate) weeks of gestation complaining of unsightly dark
412
Appendices
Options Haematinics Folic acid Check LDH Hb electrophoresis Partner testing

a. ✓ ✓ ✓
b. ✓ ✓ ✓
c. ✓ ✓ ✓
d. ✓ ✓ ✓
e. ✓ ✓ ✓
Full blood count results are shown in the second

table overleaf.
What is the most likely diagnosis?
a. Bacterial vaginosis
b. Candidiasis
c. Chorioamnionitis
d. Early labour
e. Preterm premature rupture of membranes
(PPROM)
88. Normal saline is a secondary choice of fluid repla-
cement in labour. What is the undesirable effect
this can cause?
a. Hyperchloraemic acidosis
b. Hypernatraemia
c. Hypokalaemia
d. Hypomagnesaemia
Figure A2.2 e. Lactic acidosis
89. Amniotic fluid embolism is a rare cause of mater-
nal death. What is the mortality rate related to
marks on her limbs and frequent nose bleeds. this?
Full blood count results are shown in the first a. 30%
table overleaf. b. 50%
What is the likely provisional diagnosis? c. 70%
a. Acute fatty liver of pregnancy d. 90%
b. HELLP e. 100%
c. Idiopathic thromobocytopenic purpura
90. You are requested to review the antenatal bloods
d. Placental abruption with disseminated intra-
taken for a low risk primiparous woman at 28
vascular coagulation (DIC)
weeks. See table on page 415. The patient has
e. Streptococcal infection
noticed that her gums are bleeding regularly.
86. In the above case, what is the best management What is the next investigation that you should
plan? request?
a. IV immunoglobulin a. Amylase
b. Platelet transfusion b. Blood film
c. Start oral steroids c. Coagulation
d. Start tranexamic acid IV d. Liver function tests
e. Urgent haematology referral e. Thrombophilia
87. A 34 weeks’ pregnant primiparous woman com- 91. In the above scenario, what would the most likely
plains of feeling generally unwell. She noticed provisional diagnosis be?
some offensive vaginal discharge over last week. a. Chronic anaemia
413
Appendices
FBC
HGB 103 g/L 115–165
WBC 5.7 109/L 4.0–11.0
PLT 44 109/L 150–450
12
RBC 4.62 X10 3.50–5.80
HCT 0.322 L/L 0.370–0.470
MCV 69.6 fl 76.0–98.0
MCH 22.3 pg 27.0–32.0
MCHC 321 g/L 310–360
MEAN PV 8.9 fl 7.0–12.0
NEUT # 2.60 109/L 2.00–7.00
LYM # 2.40 109/L 1.00–3.00
MONO 0.60 109/L 0.20–1.00
EOS 0.10 109/L 0.00–0.50
9
BASO 0.00 10 /L 0.0–0.20
HGB: haemoglobin; PLT: platelets; HCT: haematocrit; MCH: mean cell haemoglo-
bin; MCHC: mean cell haemoglobin concentration; NEUT: neutrophils; LYM: lym-
phocytes; MONO: monocytes; EOS: eosinophils; BASO: basophils
FBC
HGB 127 g/L 115–165
WBC 18.9 109/L 4.0–11.0
PLT 165 109/L 150–450
RBC 4.42 X1012 3.50–5.80
HCT 0.385 L/L 0.370–
0.470
MCV 86.9 fl 76.0–98.0
MCH 28.7 pg 27.0–32.0
MCHC 330 g/L 310–360
Mean plasma viscosity 10.4 fl 7.0–12.0
NEUT # 12.90 109/L 2.00–7.00
LYM # 1.50 109/L 1.00–3.00
9
MONO 0.40 10 /L 0.20–1.00
EOS 0.10 109/L 0.00–0.50
BASO 0.00 109/L 0.0–0.20
b. Idiopathic thrombocytopenia Pulse is 130 BPM (weak and thready pulse)

c. Gestational thrombocytopenia Full blood count results are given in the table on
d. HELLP page 416.
e. Immune thrombocytopenia What is the immediate step in
92. A one-day postnatal woman following a caesar- management?
ean section feels unwell and dizzy. a. IV resuscitation/transfusion
Blood pressure is 70/40 mmHg b. Oxygen
c. Repeat bloods including coagulation
414
Appendices
FBC
White cell count 7.8 109/L 4.0 – 11.0
Haemoglobin 118 g/L 115 – 165
Platelets 100 109/L 150 – 450
RBC 3.77 1012/L 3.5 – 5.8
Haematocrit 0.39 L/L 0.35 – 0.47
MCV 81.5 fl 76 – 98
Mean cell haemoglobin 27.1 pg 27.0 – 32.0
MCHC 333 g/L 310 – 360
RDW 13.5 % 11.8 – 14.8
Neutrophils 5.80 109/L 2.0 – 7.0
Lymphocytes 1.48 9
10 /L 1.0 – 3.0
Monocytes 0.46 109/L 0.2 – 1.0
Eosinophils 0.02 109/L 0.0 – 0.4
Basophils 0.04 9
10 /L 0.0 – 0.2
NRBC <0.5 109/L <0.5
d. Catheterisation for input and output 96. Vicryl is a commonly used suture in surgery.
balance What material does it contain?
e. Tranexamic acid IV a. Polyglycolic acid
b. Polydioxanone
93. With laterally extended transverse incisions, the
c. Polyglactin
extensions should have sutures placed only in the
d. Polyglactin 910
external oblique fascia. What is the main risk with
e. Poliglecaprone
putting deep sutures in the external oblique
muscle? 97. What kind of current causes the cutting effect in
a. Abscess electrodiathermy?
b. Haematoma a. Alternating low and high
c. Neuroma b. High amplitude
d. Seroma c. High voltage
e. Urinoma d. Low duty cycle
e. Low voltage
94. What is the lowest temperature at which dena-
turation of proteins and coagulation occurs dur- 98. Vicryl rapide is used in suturing the perineum.
ing radiofrequency ablation? What is the time needed to dissolve?
a. 40 °C a. 7 days
b. 50 °C b. 7–14 days
c. 60 °C c. 20–40 days
d. 70 °C d. 60–90 days
e. 80 °C e. 90–120 days
95. What kind of current does radiofrequency 99. Latex allergy is a quite common condition seen in
ablation use? hospitals. What kind of allergic reaction is it?
a. Alternating current a. Type I
b. Continuous waveform current b. Type 2
c. Direct current c. Type 3
d. Mixed waveform current d. Type 4
e. Nonelectrical waveform current e. Type 5
415
Appendices
FBC
White cell count 11.3 109/L 4.0 – 11.0
Haemoglobin 82 g/L 115 – 165
Platelets 123 109/L 150 – 450
RBC 2.83 1012/L 3.5 – 5.8
Haematocrit 0.24 L/L 0.35 – 0.47
MCV 84.9 fl 76 – 98
Mean cell haemoglobin (MCH) 28.9 pg 27.0 – 32.0
MCHC 340 g/L 310 – 360
RDW 14.9 % 11.8 – 14.8
Neutrophils 9.12 109/L 2.0 – 7.0
Lymphocytes 1.32 9
10 /L 1.0 – 3.0
Monocytes 0.69 109/L 0.2 – 1.0
Eosinophils 0.14 109/L 0.0 – 0.4
Basophils 0.03 9
10 /L 0.0 – 0.2
NRBC <0.5 109/L <0.5
100. Mersilene tape is used in cervical cerclages.

What kind of material does this contain? c. Polyester
a. Dexon d. Polymethylene
b. Nylon e. Silk
416
Appendix 3

b. With high BMI
SBA Paper 3 c. With inverted umbilicus
• Duration: 2.5 hours (150 minutes). d. With normal BMI
• Number of questions: 100 SBAs e. With well-developed abdominal
musculature
Paper 3 Topics
Usually, the questions in the papers are as per the 5. Hirudin is a specific anticoagulant. What is the
curriculum and blueprinting. mechanism of action?
This is a mixed paper with questions from all a. Acts on circulating antithrombin
sections. Use this for practice and self-directed learn- b. Converts fibrinogen to fibrin
ing on topics that are not covered in the book and c. Converts prothrombin to thrombin
those areas that you get wrong. d. Direct thrombin block
e. Hydrophilic interaction
1. Ergometrine is used in cases of postpartum hae-
morrhage. How long is the duration of action after 6. Lepirudin is effective in the management of
intramuscular dose? venous thromboembolism (VTE) in patients
a. 30 minutes with thrombosis and heparin-associated throm-
b. 1 hour bocytopenia. What kind of drug is this?
c. 2 hours a. Indirect thrombin blocker
d. 3 hours b. Recombinant apixaban
e. 4 hours c. Recombinant hirudin
d. Recombinant heparin
2. Misoprostol is widely used in management of post- e. Unfractionated heparin
partum haemorrhage worldwide. What makes this
feasible? 7. Which vein is easily cannulated and lies in the
a. It is inexpensive anatomical snuffbox?
b. It is present in its active form a. Basilic vein
c. It is rapidly absorbed b. Cephalic vein
d. It is widely available c. Digital vein
e. It should be refrigerated d. Palmar vein
e. Princeps pollicis
3. Some of the bowel injuries might not be diagnosed
at the time of laparoscopy. Roughly how many 8. While cannulating in the cubital fossae, which
injuries go undiagnosed at surgery? nerve and artery are at risk of damage?
a. 2% a. Median nerve and basilic artery
b. 5% b. Median nerve and brachial artery
c. 10% c. Median nerve and median cubital artery
d. 15% d. Ulnar nerve and basilic artery
e. 25% e. Ulnar nerve and cephalic artery
4. When inserting the Veress needle or the primary 9. Intraosseous access is generally used in neonates.
trocar, there is a risk of vascular injury. Which What is the main site?
group of women are at the highest risk? a. Distal humerus
a. Multiparous b. Proximal femur
417
Appendices
c. Proximal tibia a. Analysis of variance

d. Sternum b. Fisher’s test
e. Ulna c. Pearson’s rho test
d. Student’s t-test
10. Lumbar epidural injections carry a low risk of
e. Wilcoxon’s test
injuring the spinal cord. At what level does the
spinal cord terminate in an adult? 15. What is a requirement for developing a screening
a. The disc between L1 and L2 programme?
b. The disc below L5 a. The disease has a short latent phase
c. The disc between L2 and L3 b. The disease has no acceptable treatment
d. The disc between L3 and L4 c. The natural history of the disease is not
e. The disc between L4 and L5 understood
d. The screening test has high sensitivity and
11. In evidence-based medicine, what level of evi-
specificity
dence is provided by a large case control study?
e. The screening test is expensive
a. 1a
b. 1b 16. One-hundred patients are booked at the new high
c. 2a BMI antenatal clinic. The average BMI at booking
d. 2b is 38. The standard deviation is 10. What is the
e. 3 standard error of the mean?
a. 1.0
12. What is the World Health Organization defini-
b. 1.2
tion of late neonatal death?
c. 2.4
a. Delivery of a 23+6 week live-born baby who
d. 2.6
died 5 days after birth
e. 3.8
b. Delivery of a 26+6 week live-born baby who
died 32 days after birth 17. A new test was developed for diagnosing tubercu-
c. Delivery of a 23+6 week live-born baby who losis (TB). Fifity patients with TB had positive
died 8 days after birth tests. Five patients with TB had negative tests.
d. Delivery of a 26+6 week live-born baby who Two-hundred patients without TB had negative
died 42 days after birth tests. Three patients without TB had positive
e. Delivery of a 23+6 week baby with no signs of tests. What is the specificity of the test?
life a. 86%
b. 92%
13. A new test to assess the risk of preterm labour was
c. 94%
developed. The test has a high positive predictive
d. 96%
value. What is the definition of positive predictive
e. 98%
value?
a. The proportion of patients with positive test 18. A new test was developed for diagnosing early
who have the disease gestational diabetes. Eighty patients with diabetes
b. The proportion of patients with the disease had positive tests. Twelve patients with diabetes
who have a positive test had negative tests. Six-hundred patients without
c. The proportion of patients with negative test diabetes had negative tests. Twenty patients with-
who do not have the disease out diabetes had positive tests. What is the nega-
d. The proportion of patients without the disease tive predictive value of the test?
who have a positive test a. 80%
e. The proportion of patients with positive test b. 87%
who do not have the disease c. 91%
d. 97%
14. You were given a set of data with skewed distri-
e. 98%
bution, which cannot be converted to normal
distribution. Which of the following tests is 19. A large case control study was used to determine
suitable to compare the variables? the association between vulval cancer and
418
Appendices
smoking. The odds ratio was 2.1 comparing vul- a. Perform a thrombophilia screen
val cancer to controls with 95% confidence inter- b. Reduce weight
val of 1.7 to 3.1. P-value was <0.05. How can this c. Start on 75 mg aspirin
be best described? d. Start on progesterone
a. Smokers are twice as likely to develop vulval e. Start steroids
cancer compared to controls
23. A baby was born by emergency caesarean section
b. The confidence interval suggests that there is
following an antepartum haemorrhage in the
no significant difference in development of
mother. The baby had a haemoglobin of 10 g/dL
vulval cancer between those who smoke and
at birth.
those who do not
What is the most likely cause of this haemoglobin
c. The larger the confidence interval the more
level?
likely the association between vulval cancer
a. Fetomaternal bleed
and smoking
b. Loss of blood when the cord was cut
d. The p-value suggests that the null hypothesis
c. Parvovirus
should be accepted
d. Thalassaemia
e. The results show that smoking causes vulval
e. Traumatic delivery
cancer
24. A 28-year-old woman has just booked at 30 weeks,
20. A medical student was asked to do an audit on the
having just moved into the area. You notice that
management of anal sphincter tear. How can the
her fundus is measuring small for dates. On further
audit methodology be designed?
questioning, she tells you that she has four children
a. Audits are the same as quality improvement
and they were all small or born early. She also had a
projects
stillbirth at term but does not recall the reason.
b. Audits are the same as research projects
What is the most useful investigation?
c. Audits can be performed retrospectively or
a. Blood group and antibody screen
prospectively
b. Blood pressure profile
d. Audits require patients and doctors to be
c. Growth scan
blinded to the intervention
d. Thrombophilia screen
e. Audits require two people to independently
e. Uterine artery Doppler
analyse the results
25. Midwife shows you some blood results taken from
21. A 32-year-old woman has been referred to clinic
a patient seen in day assessment. She is 30 weeks
by her general practitioner for counselling. She is
pregnant and presented with a temperature and
trying for a pregnancy and has had three miscar-
suspected food poisoning. Haemoglobin is 11,
riages within the last year. She has a 4-year-old
white cell count is 18, platelets are 160, blood
child from a previous relationship. She is a smo-
group A negative, but antibody screen positive.
ker, does not drink alcohol and has BMI 38. There
What is the first appropriate management plan?
is no other medical problem.
a. Admit patient for rehydration and IV
What is the most appropriate advice?
antibiotics
a. Advise her to stop smoking
b. Community midwife follow-up
b. Perform a thrombophilia screen
c. Growth scan
c. Reassure and continue trying
d. Refer to haematology
d. Start on 75 mg aspirin
e. Send stool sample
e. Start on progesterone
26. Teratogens are a group of substances like drugs,
22. A 38-year-old woman has been referred to clinic
radiation and viruses that cause aberrant fetal
by her general practitioner for counselling. She is
organogenesis. At what gestation is the maximum
trying for a pregnancy and has had three miscar-
risk of teratogenicity in the fetus when a mother is
riages within the last year. She is a nonsmoker,
exposed to teratogens?
does not drink alcohol and has BMI 28. There is
a. 4–6 weeks
no other medical problem.
b. 5–8 weeks
What is the most appropriate management?
419
Appendices
c. 6–10 weeks irregularities. She is concerned about her fertility.

d. 10–12 weeks Her BMI is 38. She is a type 1 diabetic and has
e. 12–20 weeks lupus. There is a strong family history of thyroid
dysfunction. What is the most appropriate next
27. A young woman is taking some medication for
step in management?
her acne and has a history of depression. She has
a. Check HBA1c
come to your clinic for prepregnancy counselling.
b. Reassure
Which group of drugs should be stopped if she is
c. Refer to fertility services
contemplating a pregnancy?
d. Start steroids
a. Alcohol
e. Take endometrial biopsy
b. Antibiotics
c. Retinoic acid derivatives 32. A 34-year-old woman is referred to antenatal
d. Selective serotonin uptake inhibitors clinic. She is now 20 weeks pregnant. This is an
e. Tricyclic antidepressants IVF pregnancy following six years of unexplained
infertility. As part of her fertility investigations
28. Under the effect of high progesterone concentra-
she was found to have high natural killer cells. She
tions during pregnancy, maternal gut motility is
has heard that steroids can improve her preg-
reduced. What effect is seen on pharmacokinetics
nancy outcome and wants to know if you can
of drugs?
prescribe. What advice do you give?
a. Bloated sensation after consuming any
a. Explain there is no evidence that steroids
medicine
improve pregnancy outcome
b. Immediate onset of action of oral medications
b. Measure serum natural killer cells and if high
c. Increase in bioavailability of most drugs
start on oral steroids
d. Lower drug levels in maternal circulation
c. Offer induction of labour at 39 weeks to reduce
e. Higher drug levels in maternal circulation
the risk of stillbirth
29. Many physiological changes in pregnancy lead to d. Offer prednisolone as there is level 2 evidence
lower drug concentrations in maternal blood dur- that steroids improve pregnancy outcome
ing second and third trimesters of pregnancy. e. Reassure her that she is in the second trimester
What is the main change? and therefore not at risk of miscarriage
a. Active transport of drugs by the fetoplacental
33. You see a couple referred to recurrent miscarriage
unit
clinic. The woman is 18 years old and had a deep
b. Increase in basal metabolic rate in the mother
vein thrombosis while taking oral contraceptives.
c. Increase in plasma concentrations of binding
There is a strong family history of diabetes and
proteins
her mother had preeclampsia while pregnant. She
d. Increase in renal clearance of drug due to 50%
has had two consecutive early pregnancy losses
increase in GFR
before 12 weeks of gestation. What is the next
e. Reduced maternal gut motility
investigation?
30. A 34-year-old woman is referred to antenatal a. Pelvic ultrasound
clinic. She has booked at 10 weeks following a b. GTT
fourth attempt at IVF. She was advised about c. Progesterone
high natural killer cells. She is anxious. What is d. Thrombophilia screen
the most appropriate management for her e. Nothing is required
pregnancy?
34. You are asked to review a growth scan report for a
a. Start fluoxetine
32-week scan for a woman with previous intrau-
b. Start immunoglobulins
terine growth restriction (IUGR). The scan looks
c. Start intralipid
normal and the estimated fetal weight is 2477 g.
d. Start prednisolone
What is the variance in the estimated fetal weight
e. Start vitamin D
measured on ultrasound?
31. A 39-year-old has been referred to gynaecology a. +/−5%
outpatient department (GOPD) with menstrual b. +/−10%
420
Appendices
c. +/−15% She has no other medical problems. She is hyper-

d. +/−20% ventilating. You are given the blood gas results.
e. +/−25% Please select the appropriate diagnosis.
pH 7.36
35. A scan report on a 58-year-old woman with post-
HCO3 14 mEq/L
menopausal bleeding shows an endometrial
thickness of 5 mm. What would your next step BE −3 mmol/L
in management be? pCO2 4.2 kPa
a. Offer a hysterectomy pO2 10.5 kPa
b. Offer a hysteroscopy K+
5.7 mmol/L
c. Reassure and discharge a. Acidosis with hyperkalaemia
d. Start progesterone b. Metabolic acidosis
e. Take a pipelle endometrial sample c. Metabolic acidosis superimposed on alkalosis
36. A 49-year-old woman had a total abdominal d. Mixed metabolic acidosis with respiratory
hysterectomy/bilateral salpingo-oophorectomy acidosis
for a fibroid uterus. She developed severe pain e. Respiratory acidosis
on the first postoperative day. A CT scan showed 40. A 40-year-old pregnant patient presents with hys-
a 2 x 2 cm collection at the vault. Her observa- teria in the postnatal period. She is hyperventilat-
tions and bloods are normal. What would you do ing and blood gases are provided. What is the
next? diagnosis?
a. Consider an ultrasound guided drainage pH 7.46
b. Consider surgical drainage
HCO3 23 mEq/L
c. Keep the catheter in for longer
BE 3 mmol/L
d. Reassure and watch
e. Repeat CT in three days pCO2 6 kPa
pO2 10.5 kPa
37. An MRI scan on a 35-year-old asymptomatic +
K 4.1 mmol/L
woman shows a 4–5 cm solid ovarian mass sug-
gestive of a mature cystic teratoma. What tumour a. Compensated combined alkalosis
markers should be requested for? See table below. b. Metabolic alkalosis
c. Metabolic alkalosis with respiratory
acidosis
Options CA125 LDH CA199 AFP hCG d. Metabolic alkalosis with respiratory alkalosis
a. ✓ ✓ ✓
b. ✓ ✓ ✓ 41. A 37-year-old pregnant woman with severe
c. ✓ ✓ ✓ asthma has a 3 L blood loss after delivery. Four
d. ✓ ✓ ✓ units of blood are transfused. Blood gases are
e. ✓ ✓ ✓ done. What do the results show?
pH 7.36
HCO3 14 mEq/L
38. What is the most appropriate management of BE −3 mmol/L
a 28-year-old woman with an asymptomatic pCO2 4.8 kPa
5–7 cm simple right ovarian cyst? pO2 10.5 kPa
a. Laparoscopic ovarian cystectomy K+
5.7 mmol/L
b. MRI scan
a. Acidosis with hyperkalaemia
c. Tumour markers
b. Metabolic acidosis
d. Ultrasound guided drainage
c. Metabolic acidosis superimposed on alkalosis
e. Yearly ultrasound scan
d. Mixed metabolic acidosis with respiratory
39. A 25-year-old woman attends Accident and acidosis
Emergency with tubo-ovarian abscess and sepsis. e. Respiratory acidosis
421
Appendices
42. A 13-week pregnant woman comes in with high 47. A 45-year-old woman is suspected to have a
fever, rigours and feeling unwell. She has a blood ureteric injury after a recent difficult hyster-
lactate level of 2.5 mmol/L. ectomy.
What is the most obvious diagnosis? What will be the best imaging modality to
a. Flu exclude ureteric injury in this instance?
b. Liver disease a. Abdominal X-ray
c. Pyelonephritis b. Intravenous urogram
d. Renal failure c. CT urogram
e. Sepsis d. MR urogram
e. Ultrasound abdomen
43. A 35-year-old woman had an IUD insertion two
months ago. She now presents with menorrhagia. 48. A pregnant patient is on the list for caesarean
An ultrasound pelvis is unable to identify an IUD. section under general anaesthetic and is
What will be the next management step in this anticipated to have a difficult intubation.
patient? What is the most important step to prevent
a. Book for an EUA under general anaesthetic hypoxia to mother and fetus during general
b. Hysteroscopy anaesthetic?
c. CT scan of the abdomen a. Attempting nasal intubation
d. MRI scan of the pelvis b. Giving a long-acting muscle relaxant to ensure
e. X-ray abdomen complete relaxation
c. Keeping the patient in the left lateral
44. A 13-year-old girl presents with pelvic pain loca-
position
lised to the right lower quadrant. Her serum
d. Preoxygenating the mother prior to induction
markers for infection are within normal limits.
of anaesthesia
What will be the next management step for this
e. Using a fibreoptic laryngoscope
patient?
a. CT scan 49. A pregnant patient with gestational diabetes, con-
b. Diagnostic laparoscopy trolled on insulin, is booked for elective caesarean
c. MRI pelvis section. What is the most likely outcome on blood
d. Transabdominal ultrasound of the pelvis sugars during surgery?
e. Transvaginal ultrasound of the pelvis a. Can be variable
b. Go up and then fall sharply
45. A 25-year-old woman presents with pelvic pain
c. Likely to fall due to preoperative fasting
localised to the right iliac fossa. Her serum mar-
d. Remain stable during surgery
kers for infection are within normal limits.
e. Rise due to the stress of surgery
What will be the next management step for this
patient? 50. Balance of nitric oxide levels is important during
a. Diagnostic laparoscopy pregnancy. Which isoform of the enzyme nitric
b. CT scan oxide synthase (NOS) is important during
c. MRI pelvis pregnancy?
d. Transvaginal ultrasound of the pelvis a. Endothelial NOS
e. Transabdominal ultrasound of the pelvis b. Fetal NOS
c. Inducible NOS
46. A 25-year-old woman at 24 weeks of gestation pre-
d. Neuronal NOS
sents with chest pain and shortness of breath. What
e. Placental NOS
will be the preferred imaging modality to exclude
pulmonary embolism in this clinical instance? 51. What is the main function of nitric oxide?
a. Chest X-ray a. Endocrinal modifications
b. MR angiogram of pulmonary arteries b. Increase in cell metabolism
c. CT angiogram of pulmonary arteries c. Reduction in mRNA synthesis
d. Ventilation/perfusion scintigraphy d. Vasoconstriction
e. Low-dose ventilation only scintigraphy e. Vasodilatation
422
Appendices
52. During the process of inflammation, the cell d. Interleukin 6

derives energy by: e. Transforming growth factor β
a. ATP produced by bacterial cells
58. What is the commonest outcome of complement
b. Gluconeogenesis
activation?
c. Glycogenolysis
a. Drop in body temperature
d. Glycolysis
b. Increased tissue perfusion
e. Krebs cycle
c. Microvascular thrombosis
53. The organisms most commonly implicated in d. Profuse sweating
puerperal sepsis after a postvaginal delivery e. Vasodilatation
include:
59. Vitamins play an important role in cell metabo-
a. Gram-negative and anaerobic bacteria
lism. Which one is a water-soluble vitamin pre-
b. Gram-negative and gram-positive bacteria
sent in the body?
c. Gram-negative bacteria and H1N1 virus
a. Vitamin A
d. Gram-negative bacteria and yeast
b. Vitamin B
e. Gram-positive and atypical bacteria
c. Vitamin D
54. What is the correct order of release of inflamma- d. Vitamin E
tory substances in the cascade of inflammation? e. Vitamin K
a. Complement activation leads to release of
60. Which vitamins help in release of energy in the
interferon γ which causes endothelial damage
cell?
b. Hypoxia causes endothelial cell necrosis and
a. Vitamin A
activation of complement system
b. Vitamin B
c. Release of interferon Υ leads to activation of
c. Vitamin C
complement which leads to endothelial
d. Vitamin D
damage
e. Vitamin K
d. Stasis of blood leads to microvascular throm-
bosis that causes endothelial damage and acti- 61. Which vitamin is the newborn often deficient
vation of complement in?
e. Bacteria adhere to the endothelial cells, caus- a. Vitamin A
ing their lysis and complement activation b. Vitamin B
c. Vitamin C
55. What is the systemic hallmark of clinical sepsis?
d. Vitamin D
a. Hypotension
e. Vitamin K
b. Increased ATP production in tissues
c. Increased oxygen supply to inflamed tissues 62. What are the erythropoietic vitamins in the
d. Release of anticoagulant factors body?
e. Vasoconstriction a. Vitamin A and K
b. Vitamin B and C
56. Which cells actively secrete proinflammatory
c. Vitamin B and folic acid
cytokines?
d. Vitamin C and folic acid
a. Bacterial cells
e. Vitamin D and folic acid
b. Macrophages
c. Megakaryocytes 63. Concomitant use of certain drugs requires the
d. Red blood cells supplementation of vitamin B6 during preg-
e. Thymocytes nancy. Which one would need Vitamin B6
supplementation?
57. During clinical sepsis, there is release of proin-
a. Gabapentin
flammatory cytokines. The most important of
b. Isoniazid
them is:
c. Ondansetron
a. Interferon γ
d. Phenytoin
b. Interleukin 10
e. SSRI
c. Interleukin 4
423
Appendices
64. Which B group vitamin plays a very important b. At bifurcation of the internal iliac
role during pregnancy and lactation? artery
a. B1 or thiamine c. At its entry into the urinary bladder
b. B2 or riboflavin d. At the pelvic brim
c. B3 or pantothenic acid e. Near the ovarian pedicle
d. B5 or niacin
71. The trigone of the urinary bladder is involved in
e. B6 or pyridoxine
trigonitis. What is the trigone?
65. Folic acid is supplemented universally to a. Area between the urethra and ureteric
pregnant patients. What does folic acid orifices
contain? b. Area covered by transitional epithelium
a. Folinic acid c. Culminates at the uvula
b. GABA and pyrimidine residues d. Posterior aspect of the dome
c. Histidine residues e. Structure above the urethra
d. PABA and glutamic acid residues
72. Proinflammatory cytokines are secreted mainly
e. Vitamin B8
by:
66. Which structure synthesises vitamin D during a. Helper T cells
pregnancy? b. Leucocytes
a. Amniotic membrane c. Mast cells
b. Fetal bones d. Phagocytes
c. Fetal skin e. Thrombocytes
d. Osteoclasts
73. In electrosurgery, several settings are used for
e. Placenta
diathermy. Which one uses low voltage, but con-
67. What might be a likely cause of hypervitaminosis stant waveform duty cycle?
A during pregnancy? a. Blended
a. Deficiency of retinol-binding protein b. Coagulation
b. Dehydration due to excessive nausea and c. Cutting
vomiting d. Desiccation
c. Excessive intake of carrots e. Fulgurating
d. Excessive intake of liver
74. In electrosurgical system, current passes from
e. Increased exposure to sunlight
the generator to the active electrode through
68. What can be the outcome of vitamin E deficiency the patient to the patient return electrode and
in pregnancy? returns to the generator. Which type of system
a. Brittle bones in the newborn is this?
b. Haemolysis in the newborn a. Alternating current system
c. Jaundice in the newborn b. Bipolar system
d. Petechiae c. Direct current system
e. Skin rash in the newborn d. High frequency system
e. Monopolar system
69. While performing a Pfannenstiel incision, which
muscles may need to be cut? 75. During laparoscopic salpingectomy, the surgeon
a. External oblique inadvertently activates the monopolar electrode
b. Internal oblique when it touched the camera. This led to a thermal
c. Lateral abdominis injury to the nearby bowel. What is this type of
d. Piriformis hazard called?
e. Pyramidalis a. Alternate path coupling
b. Capacitive coupling
70. Where in the pelvis is the ureter most vulnerable
c. Direct coupling
to surgical injury?
d. Indirect coupling
a. As it crosses under the uterine artery
e. Insulation failure
424
Appendices
76. Several gases are used in electrosurgery. Which is b. Laser does not cause retinal injury to the
a commonly used gas, but does not have laser surgeon
properties? c. Laser is cheaper
a. Argon d. Laser is safer to use
b. Carbon dioxide e. Laser seals nerve endings
c. Helium
81. Which commonly used diathermy instruments
d. Neodymium-doped yttrium aluminium gar-
use bipolar energy? See table below.
net (Nd:YAG)
e. Potassium titanyl phosphate (KTP)
77. There is a large area of bleeding on the uterus Blade Needle tip Forceps Roller ball Loop
during laparoscopic surgery. The surgeon wishes
a. ✓ ✓ ✓
to coagulate the entire area by using a larger
b. ✓ ✓ ✓
electrode penetrating deeper into the tissue.
c. ✓ ✓ ✓
Which is the tissue effect he or she intends to
d. ✓ ✓ ✓
create?
e. ✓ ✓ ✓
a. Blend
b. Coagulation
c. Cutting
d. Desiccation 82. What is the main function of the electrosurgery
e. Fulguration unit?
78. Which of the following is not a component of the a. Converts high frequency alternating current
electrosurgery unit? to low frequency alternating current
a. Active electrode b. Converts high frequency direct current to low
b. Generator frequency direct current
c. Passive electrode c. Converts low frequency alternating current to
d. Patient high frequency alternating current
e. Return electrode d. Converts low frequency direct current to high
frequency direct current
79. How does a bipolar system close the current e. Converts low frequency direct current to low
circuit? frequency alternating current
a. The current does not enter the patient at all as
the entire system is external 83. When the cutting mode on the monopolar system
b. The current enters the patient, exits via a is used, what is the characteristic feature of the
patient return electrode, then returns to the current?
generator a. Amplitude of the waveforms is high
c. The current enters the patient, exits via an b. Constant waveform with interruption
external return electrode, then returns to the c. High pitzels of current is used
generator d. Low voltage current
d. The current penetrates the tissue from one e. Passage of high voltage current
forceps blade to the other forceps blade, exits 84. The intracellular calcium ion concentration
via a patient return electrode, then returns to is:
the generator a. 10−3 M
e. The current penetrates the tissue from one b. 10−4 M
forceps blade to the other forceps blade, c. 10−5 M
exits into the return electrode inside the d. 10−6 M
generator e. 10−7 M
80. What is an important advantage of using laser 85. There are several cell membrane receptors.
compared to monopolar for electrosurgery? Which one is the largest family of cell surface
a. Laser beams are all visible to the eye receptors?
425
Appendices
a. Calcium ion b. Free radicals

b. Epidermal growth factor c. Glycerol
c. G protein d. Ions
d. Integrins e. Monosaccharides
e. Tyrosine kinases
92. Enzymes are extremely important in every meta-
86. In the cell, calcium ions are released into the bolic process in the body. They increase the reac-
cytoplasm from the: tion rate. How is this achieved?
a. Cytoplasmic membrane a. By increasing substrate concentration
b. Endoplasmic reticulum b. By increasing the metabolic equilibrium
c. Golgi bodies c. By increasing the surface area of the molecule
d. Mitochondria d. By lowering the activation energy
e. Nuclear body e. By reducing the surface tension of the molecule
87. Nitrous oxide is an important second messenger 93. A 38-year-old woman presents in labour for a
in the cells. It has a short half-life and is metabo- vaginal birth after caesarean section. She is 6 cm
lised to: dilated with an occipito-posterior vertex. This is
a. Ammonia and nitric acid the CTG.
b. Nitrates and nitrites What would the next action plan be? See
c. Nitrates and water Figure A3.1.
d. Nitric acid and water a. Continue with labour
e. Nitrites and ammonia b. Deliver by caesarean
c. Fetal blood sample
88. Fibronectin is a primary messenger that binds to
d. Fetal scalp electrode
cell receptors. Which receptor does fibronectin
e. Intravenous hydration
bind to?
a. Ephrin receptor 94. An irreversible inhibitor permanently inactivates
b. Fibroblast growth factor the enzyme, usually by forming a covalent bond
c. Hyaluronan to the protein of the enzyme. What is an example
d. Integrin of a common drug that works using this form of
e. NMDA receptor inhibition?
a. Bromocriptine
89. Enzymes exist in a three-dimensional struc-
b. Carboplatin
ture. What kind of bonds maintain the
c. Haloperidol
structure?
d. Penicillin
a. Strong hydrogen bonds
e. Teicoplanin
b. Strong peptide bonds
c. Weak carboxyl bonds 95. In the body, several enzymes work as competitive
d. Weak hydrogen bonds inhibitors. An example of a drug that acts as a
e. Weak peptide bonds competitive inhibitor is:
a. Amiodarone
90. When heated enzymes undergo change of
b. Methotrexate
shape and loss of action, what is this feature
c. Metoclopramide
called?
d. Na valproate
a. Coagulation
e. Omeprazole
b. Denaturation
c. Fragmentation 96. Which cells in the body secrete
d. Oxidation pepsinogen?
e. Peroxidation a. Brunner’s cells
b. Chief cells
91. Zwitterions are partially charged molecules in the
c. Goblet cells
body. The best example of a zwitterion in the body is:
d. Oxyntic cells
a. Amino acid
e. Parietal cells
426
Appendices
Figure A3.1
97. The lymph produced in the body finally enters the

bloodstream. Where does the thoracic duct drain
into?
a. Inferior vena cava
b. Internal jugular vein
c. Left subclavian vein
d. Right jugular vein
e. Superior vena cava
98. A 46-year-old woman undergoes a total
abdominal hysterectomy for heavy periods.
The uterus is sent for histological examina-
tion. The macroscopic cut section is shown
in Figure A3.2.
What is the diagnosis?
a. Adenocarcinoma of the uterus
b. Adenomyosis
c. Sarcoma
d. Uterine leiomyoma
e. Uterine polyposis
99. Figure A3.3 shows the transvaginal scan image in
Figure A3.2
a lady with six weeks’ amenorrhoea and slight
vaginal discharge. What is the most likely diag-
nosis based on this image?
a. Early intrauterine pregnancy
b. Heterotopic pregnancy d. Intrauterine pregnancy with right corpus
c. Intrauterine pregnancy with left ovarian luteum
cyst e. Left sided ectopic pregnancy
427
Appendices
Figure A3.3
100. Figure A3.4 depicts a laparoscopic image of a Figure A3.4

patient with abdominal pain and irregular peri-
ods. Beta hCG is 575 IU/L. Based on this image
what is your likely diagnosis? c. Fimbrial cyst
a. Left ectopic pregnancy d. Left corpus luteum
b. Right ectopic pregnancy e. Right corpus luteum
428

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Appendix 1

Practice Paper 1: 100 SBAs

8. During pregnancy, the uterine smooth muscle a. Cloacal membrane

c. Until 20 weeks b. Coagulopathies

b. Fundoscopy 47. A 35-year-old woman underwent endometrial

Epithelium Muscle Lamina propria Adventitial layer

51. What is the average weight of a normal adult d. Incomplete ﬂexion

Anterior Posterior Lateral

c. 2 litres d. Synthesis of fetal haemoglobin by secreting

d. Lateral epigastric nerve b. Previous abruption

b. bifurcation of the common iliac d. Lateral femoral cutaneous nerve of groin

Practice Paper 2: 100 SBAs

Microcephaly Thin vermilion Smooth philtrum Small palpebral Sprouting in dental

Unimodal Asymptotic Binomial Bimodal Univariate

a. Distribution error c. Embryonal tumour

40. Rokitansky protuberance is a characteristic fea- d. Psammoma Body

b. Group A Streptococcus 55. Ison–Hay scoring is used for identiﬁcation of

c. Hepatitis C 67. What is most common microorganism causing

Options Microcephaly Organomegaly Intracranial Cleft lip and Eye defects

Full blood count

Options Haematinics Folic acid Check LDH Hb electrophoresis Partner testing

Full blood count results are shown in the second

b. Idiopathic thrombocytopenia Pulse is 130 BPM (weak and thready pulse)

100. Mersilene tape is used in cervical cerclages.

Practice Paper 3: 100 SBAs

c. Proximal tibia a. Analysis of variance

c. 6–10 weeks irregularities. She is concerned about her fertility.

c. +/−15% She has no other medical problems. She is hyper-

52. During the process of inﬂammation, the cell d. Interleukin 6

a. Calcium ion b. Free radicals

97. The lymph produced in the body ﬁnally enters the

100. Figure A3.4 depicts a laparoscopic image of a Figure A3.4

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