Sep 2015 To Cont

======================================
:jamil johar

.Share solved recall march 2017, if any one have it

:mrcog shabnam. naaz

:Khaled Elmansi

Answers of recalls march 2017

c1

a2

c3

c4

b5

e6

a7

b8

a9

b 10

a 11

e 12

a 13

b 14

d 15

e 16

b 17

b 18

e 19

b 20

e 21

c 22

b 23

e 24
b 25

a 26

c 27

c 28

c 29

f 30

d 31

a 32

c 33

d 34

e 35

c 36

f 37

b 38

e 39

e 40

d 41

b 42

b 43

e 44

d 45

syphilis b 46

MCDA b 46

c 47

c 48

a 49

b 50

a 51

b 52

b 53

a 54
c 55

d 56

b 57

e 58

b 59

c 60

a 61

c 62

ç 63

a 64

a 65

b 67

d 68

c 69

d 70

b 71

d 72

b 73

b 74

c 75

f 76

a 77

c 78

a 79

c 80

a 81

b 82

c 83

a 84

a 85
no question 86

d 87

c 88

e 89

a 90

b 91

b 92

d 93

a 94

d 95

c 96

b 97

b 98

b 99

b 100

lahey 101

allis 102

b 103

c 104

b 105

c 106

a 107

h 108

d 109

e 110

i 111

c 112

c 113

d 114

b 115

e 116
a 117

c 118

d 119

a 120

b 121

d 122

a 123

c 124

b 125

d 126

c 127

b 128

G 129

e 130

d 131

a 132

d 133

a 134

c 135

b 136

a 137

c 138

c 139

a 140

e 141

inferior epigastric 142

e 143

e 144

g 145

c 146
b 147

g 148

h 149

a 150

b 151

SNRI 152

a 153

b 154

a 155

a 156

d 157

c 158

a 159

f 160

g 161

h 162

b 163

c 164

a 165

d 166

c 167

d 168

a 169

a 170

e 171

c 172

a 173

b 174

========================================
.Yes this is from succeeding or Mastering SBA

I think shd be cat 2

----------------------------------
Dear i got it clarified from fatima- it should be cat 1 as btb less since 50 min - 1 abnormal
feature -patjological - need emergency section

==========================
No re of c section or early induction just because LGA - if prev history of SD then consider c
sec after assessing post sequelae

Zeplline
Laheys
Vaginal

------------------------
=

===================================
Lahey's right-angle forceps•

Metzenbaum scissor•

Adson's right-angle clamp•

All these are used to free the ureter in ureteric channel during Werthiem hysterectomy

=======================================
Gtg 69 " managment of nvp and HG in pregnancy "incidences and percentage

incidence of nvp ----- 80% of preg women 1

Incidence of HG --- 0.3-3.6% .2

recurrence rate of HG 15.2%-81% 3

nvp dx ----- in first trimester after 10+6 weeks other causes consideration 4

nvp start at 3-7weeks peaks at 9th week and resolve by 20 weeks in 90% cases 5

Nvp triad 5% prepreg wt loss, dehydration and electrlyte imbalance .6

Lft abnormal in 40% of women with HG .7

. of wanted pregnancy complicated by HG ends in Termination %10 8

incidence of HG in second preg after change in parternity 10.6% as compare to 16% 9

=========================================
So low risk for hyst...... Coamxi

They want the quickest and longest action , According to tog vaginal and rectal routes share
same highest duration of action (240min) , so oral and lingual out and we will choose
between vaginal and rectal ,vaginal has the quickest action than rectal so answer will be
vaginal

=========================================
But high risk mrsa we have to add genta... Hyst......no need

.Thanks

??But recall question was for bacterial endocarditis which antibiotic

=================================
.It's all inj benzylpeni.,Inj Cepha

Amoxy. Doxicy, no need antibiotics........etc

==============================
So the answer no need antibiotics may be according to nice see above

============================

...Pregnancy should be deferred after

MMR......... one month

Retinoids ........... One month

After bariatric surgery...........12 months

Radioiodine therapy .........,,,,,4 months

VZ immunization............ 4 weeks

Mycophenolate mofetil........women. 6 weeks

Men. 3 months

TNF inhibitor( infiximab).....,,,6 months

After organ transplant.............2 years

Hydroxycarbamide( hydroxyurea)........3 months

After breast cancer tx...............,2 years

.Fertility sparing (MGCOC).........2 years

iron chelating agent (deferisirox) -- 4 mnth

biphosphonates -- 4 month

Mefloquine -- 3month

proguanil, doxy -- 1wk

Malarone -- 2wk

=======================
A pregnant woman came from Zimbabwe, had contact with her husband who have .171
.shingles. She said she may got chickenpox in the past

‫دددددددددددددددددددددددددددددددددددددددددد‬
:EMQ. Most appropriate action. Options

.A. VZIG ASAP

.B. Acyclovir

C. Counsel about TOP

.D. Reassure

.E. Refer for FMU

.F. Test for immunity ASAP [compare booking and current sample for IgG] G. Check for IgM

.H. Hospital admission

.I. ? Many others

====================
Q 32 2015 march

Q 72 2016 march

Please see these q

=====================

For pco testerone range is 2-5

Other picture goes with pco.but again to make diagnosis of pco we have to
exclude cah....so 17 ohp is right option Acc to tog 2013

----------------------------------------

Dheas use to differentiate between ovarian or adrenal source of tumour

========================
Yes if onset is sudden then first Usg or CT
and if progressive then blood testing first
---------------------------------------------
Sorry for interruption##
I thought this may help so will post
.Some imp.tips in Down's inheritance ••
Some figures varied according to references but in general these are ••
minor
When either of the parents carries a balanced translocation t(21/21) •
. Recurrence risk is 100%
When the mother is a carrier of other balanced translocation eg •
.((karyotype46XX or XY,t(14/21))the recurrence risk is 12-15%
When the father is the carrier of other translocations eg((karyotype •
46XX,or XY,t(14/21))the recurrence risk is 3-5%
If previous baby with Regular Trisomy 21 due to non-disjunction •
.,karyotype (47XX+21 or 47XY+21)Recurrence risk is 1%
.Recurrence risk is not increased if previous baby is mosaic•
of Down's result from non-disjunction,4% translocations & 1% due %95•
.to mosaicism
In general the incidence of all trisomies increase with increasing •
maternal age
The risk of Down's due to non-disjunction is increased with increasing •
matrnal age. Down's due to translocation or mosaic is not associated
.with maternal age
====================
Please see q 72 in march 2016 in exam that you dont slove it
Q72 young lady presented with irregular periods , progressive hirsutism ,
us polycystic ovaries testeroneone with normal free androgen index the
most apporiate next investigation
A dhea
B dheas
C 17ohp
Answer c to exclude late onset cah
=================
Please see q 72 in march 2016 in exam that you dont slove it
Q72 young lady presented with irregular periods , progressive hirsutism ,
us polycystic ovaries testeroneone with normal free androgen index the
most apporiate next investigation
A dhea
B dheas
C 17ohp
Answer c to exclude late onset cah
================================
Testosterone level 7 in this q sorry I forget
=================================
Hi all
Q 32 march 2015
Women came with hirsutism , irregular periods , lh was higher than fsh ,
testosterone was 6.5 they asked about next test to help reach adiagnosis
.Options included us,tft , dhea ,17ohp,, dexametazone suppresion test
I see that all answered us , why not 17 oh to exclude congenital adrenal
hyperplasia
------------------------------- An 8 year old presenting with well-developed
axillary and pubic hair and breast for the past six months. She is yet to
start menstruating. On examination, she is 1.45m tall with breast
developed to Tanner’s stage 4 and normal pubic and axillary hair. Her
hormone profile is as follows: FSH= 1.0 iu/L, LH+ 0.5miu/L, free
T4+10mmol/L, 17- hydroxyprogesterone+ > 95th percentile for
gestational age
==================================
Adrenarche B. Irradiation C. Autoimmune hypothyroidism D. .
Neurofibromatosis E. Congenital adrenal hyperplasia F. Ovarian tumor G.
Constitutional H. Polyostotic fibrous dysplasia (McCune- Albright
syndrome) I. Cushing’s syndrome J. Testicular tumour K. Ectopic
gonadotrophin production L. Third ventricle cyst M. Empty sella turcica
syndrome N. Encephalitis O. Exogenous oestrogen
 Sorry I didnt read
up
But in hirsutism when he give you FAI he want to direct you towards or
away from PCO,as FAI is inreased in pco.In tumors of adren or ovary or
CAH its, expected to be normal as both T & SHBG are elevated
In late CAH you can find picture similar to pco like uss features of
pco,oligomen or infertility
In general tumours cause a very high T level indeed not just 7th or 10th
=====================================
I think this is the most common to exclude here.T is elev but not to
extent to make you strongly suspect tumors although possible.Irregular
periods & LH higher is a clue to pco although not reliable or
universal.pelvic uss will detect pco & also any suspicious ovarian tumor
so its helpful.If he mentioned any feature of virilisation ,progressive
symptoms or very high level of T then I will think of other ominous
diagnoses
=========================
Yes CAH can be progressive & if untreated will become worse
===========================
It's mentioned that late onset CAH is frequently misdiagnosed as PCO
due to similar presentation
=================================
For q32, since testosterone is more than 5, we have to exclude androgen
secreting tumor, so most of us choosed US. But in the gtg late onset CAH
.should also be excluded so 17-0hp also sounds
Hopefully in exam the may either give one of them (US or 17-ohp) or
may give a hint (ET family history which may point to CAH, or abdominal
)pain/bloating which may point to a tumor
===============================
TO CONT RECALL SEP 2015

74. EMQ asking about management of different presentations of

st
PCO: 1 is a young lady not in a relationship, main complain is
irregular periods. She has normal BMI but her BP was 140/90.
[options: high dose progesteron, Cocs, metformin, Cocs+metformin,
clomit citrate,….]

75. As above but lady is p3, with↑ BMI. Cocs+metformin ???

high dose progesteron, ????

 nd 0
76. Cause of 2 ry A : 8 months after delivery with ↓FSH/LH & ↑↑
PRL(2000)
[options: pregnancy, sheehan’s, prolactinoma,…]

77. What is the commonest cause of POF

[?autoimmune, genetic,…]
Please see q 112 recall 2017
Q112 recall 2017 answer cyclical progesterone
It is the same q of q 74

oligomenorrhea A. ocp
B.vaginal progesterone dialy C.cyclical progesterone D.merina
E.induction of ovulation F.CC

112.Young concerned about her period .irregular last was 9month ago.BP 150/104
not in sexual relation ship cyclical progesterone
113. same scenario with high BP and adult polycystic kidney PCO and not in sexaual
relation. 114. 28yrs in relationship not want pregnancy concerned about her
irregular perioD..
Last one is coc
1st /2nd may be mirena?
We chose cyclical pg for the first two cyclical progesterone

Gehad/Nedal & others

Solve & agree about pco & irreg bleeding qs
They re v important & repeating
You see for pco to prevent endom hyper and cancer either
1-Cyclical oral prog for at least 12 days
2-Ocp
3-mirena
Ref gtg
You see if irreg periods or dysmenorr coc is better than mirena because here shes
concerned about irreg periods
But for efficacy as contraception mirena is better
=======================================================
rd
78. Lady on Cocs developed diarrhea for 1 day in 3 wk. Advise?
[options: reassure & no action, continue+1wk extra cc, ommit pill free
interval,…]
 79. Lady on DMPA, came 3 wks post-due. Action?
[?give DMPA+ extra CC for 1 wk]

80. An epilyptic lady. What contraceptive measure is (?not)

suitable?
[options?????]
Coc pop implant
Yes . Only dmpa n iucd

81. Sexualy active women 19 yrs old asking for Cocs. When to start ?
[ options: start immediately, start & continue barriers for 7 days, start in
the next cycle day 1-5 e out barriers,…..]

82. From the list, what is the hormonal profile for Cat-3 WHO
anovulatory disorders?
[hyper..hypo:↑FSH/LH, ↓E ]

83. A lady on Cu IUD for 3 yrs. Her routine Cx smear showed

actinomyces. What to do?

[options: leave in-situ, remove,…..]

If symptomatic {(Remove) culture treat}
? (Treat first If not respond to treatment remove)
If symptom you refer
Smear test is not sensitive for diagnosis

Smear detects : BV , herpes , actino , neisseria ,,

but neisseria needs confirmation .
 84. A woman on continuous combined HRT, came after 2m C/O
spotting. Advice?
[options?????]
Reassure
months 6 then action

85. A girl on Coc pill ,came after 2m with irregular bleeds. Advice?
[options: increase estrogen from25 to 35, reassure, change pil,….]

86. The most suitable drug: a woman needs a drug for PMS. She has
a PH of Ca breast & currently on tamoxifine. B6 failed to improve
her symptoms.
[? Options:?????SSRI?] No ssri with tamoxifen ???CBT or low dose ssri
Same as 152 in 2017

st
87. From the following, what is considered 1 line therapy for
severe PMS:
[options: Cocs, SSRI, Amytriptaline, CBT,..]
--------------------------------------------------------------
6.3.1.1 Which COC has the best evidence for managing PMS, including regimens delivering
ethinylestradiol?
When treating women with PMS, drospirenone-containing COCs may represent effective
treatment for PMS and should be considered as a first-line pharmaceutical intervention.

----
When treating women with severe PMS, CBT should be considered routinely as a treatment
option.

-----------------------------------------------------------

 
STATISTICS:
88. Someone is studying about PMS, wants to know the prevalence,
made questionnaires & distributed among young girls. What
type of study is this?
‫ ؟؟‬Case control study‫[ ؟؟‬cross-sectional]
Yes👍
Any study looking at prevalence should be cross sectional
?(If rare diseases)
Cohort??
Prevelance cross sectional
Cohort is prospective Not retrospective .

,Case control could be prospective , But cohort can be retrospective.

89. 4 cell table given.. what is the possitive predictive value?

[a/a+b]
 90. Because of full beds & increased admissions of PTL, a hospital is
thinking of a test for PTL . For PTL to be more accurately
diagnosed, what is the best predictor of the test?
[?specificity, that is, a test with the least false +ve]
negative predictive value???

91. Details of a? RCT were given (one group given m.dopa, other
group given another drug.) RR & P value were given & they
asked for interpretation. There was another Q. (? NNT or
something).
[Options were :Convencing evidence of bennifits.. Convencing evidence of
harm .. non ethical trial... floughded trial e an trustable results ...]
Trend of benefit with trend of harm
Kaplan epidemiolgy

Same q of 96 sep 2016

.EMQ. Interpretation • ---------
:Options
.A. Convincing evidence of benefit
.B. Convincing evidence of harm
.C. No benefit & no harm
.D. A trend for benefit with concern of harm
.E. Unethical study. Should be terminated
.F. Underpowered. Repeat study with n=10000
.G. Underpowered. Repeat study with n=20000
H. ? Odd results that can't be counted upon
? .I
Lead in: A RCT study was carried to evaluate a new drug for the
treatment of hypertension in pregnancy. 2 groups; study group of 1000
women on the new drug & a control group of 1000 women on methyl
.dopa. Both groups were matched for age & BMI
In a preliminary analysis in a 50 women in the study group, the BP of .96
23 women has dropped but 13 of them developed drug induced
hepatitis



OBS: 
92. 32 yrs , last pregnancy ended in c/s at 28wks with GA due to
severe PE, birth wt was 650g. NOW she is pregnant at ?24 Wks. ?
what intervention to reduce the risk of PE/IUGR?
[Option varies from aspirin, folic, scan, vitamin c, nothing] *May be the
question was that she specifically asked for aspirin, whether it’ll be of
.value at this GA or not.
Nothing

Yes i think umb doppl at 26 & afv as 2 wks before previous insult
93. ?As above but GA 12 wks
Aspirin
 94. A lady was referred from midwife for anxiety.
[options: CBT, refere to psychologist,….]
Facilitated self help , if not progress then CBT
Gad 2 score
. As per guideline : facilitated self help first line then no response CBT
CBT as first line only for PTSD and social anxiety disorders

95. Type I Dm with nephropathy now 12 weeks. Interventions?

[options???]
Assessment of Renal function of not done prior
 96. DM + IUGR at 34wks. Management?
[options???? Dopplers,….]
Doppler + serial growth scan

Serial scan dropler

97. Diabetic lady 36 weeks became unwell. Investigations showed

ketosis & glucose is raised . Management?
[? admit for fluids and insulin sliding scale]
DKA ttt
Ns

98. From the following list, what biochemical figures are going with
DKA?
[? ↓oxygen +↑ co2 +↓ bicarb]

99. Cystic hygroma on scan. what is the likely cause/association

[?turner]

100.Short femur length on scan. Likely cause. (or may be next step of
action)
[?Down syndrome, many others,….]
Same q as 64 recall 2017

101.Mother has anti-kell titer of 1:64, father is heterozygous for

kell. Next step?
[options: repeat titers 2wkly, test maternal cFFDNA, refere to FM
specialist, …..]

102.Rh-ve lady with 20 week pregnancy. U/S: Hydropic fetus.Ab

titer of 1/64. Next step?
[?refere her to fetal medicine specialist.]
Any case of anti k refer regardless
You see any titre of kell>zero is significant
Kell= killer
It is anti k u dont need to know rhesus status of baby . Has nothing to do with
baby BG

Even if cffdna show baby -verh

 103.Thallasaemia ?major with Hb 98%, came for preconception
session
[options: offer echo, offer MRI???, offer chelation, give oral iron, give
iron iron infusion, give packed RBC, offer TOP,..….]

104.Thallasaemia ? intermedia + anemia. Management?

[options: as above] give packed RBC??? give oral
Yes transfusion for thalassemia intermedia

105.Thallasemia, GA 8wks, C/O SOB at rest, ejection fraction↓

[options: as above] TOP???