Important MCQ colloction for part-1 MRCOG(3)

76. Genes on sex chromosomes are responsible for the inheritance of:

A- Glucose 6 phosphate dehydrogenase deficiency .............................T

B- Achondroplasia ..........................................................................F

C- Hairy ear rims ...........................................................................T

D- Homocystinuria .........................................................................F

E- Hurler's syndrome ......................................................................F




Genes on sex chromosomes would typically give rise to X-limked recessive and dominant conditions such as G6PD, haemophilia, vitamin D resistant rickets.

77. Beta-thalassaemia major (homozygous)

A- is characterised by persistance of HbF .........................................T

B- is associated with a chronic marked reticulocytosis .......................F

C- is always associated with a raised proportion of HbA2 ...................F

D- is very rarely associated with nucleated red cells .........................F

E- is a cause of pathological fracture of long bones ...........................T




nucleated red cells always seen, retics low. HbA2 raised in beta-thalassaemia trait.

78. In mitosis

A- the number of chromosomes is halved..........................................F

B- anaphase lag may produce Turner syndrome................................T

C- the stage of metaphase shows separation of whole chromosomes........F

D- nondisjunction increases with decreasing maternal age...................F

E- an abnormal plane of division of the chromatids produce isochromosomes...............T


Each time new cells are produced, there is a mitotic cycle it must go through. They are:
•Interphase (before mitosis)
•Prophase
•Metaphase
•Anaphase
•Telophase

79. Which of the following are adhesion molecules?

A- cadherin ...................................................................................T

B- laminin .....................................................................................T

C- fibronectin .................................................................................T

D- integrin ....................................................................................T

E- secretin .....................................................................................F




During an inflammatory response adhesion molecules serve to enhance pairing between many less avid receptors and their ligands and transmit signals that direct specific effector functions. At least four superfamilies of adhesion molecules participate in these events: the selectins, the integrins, certain members of the immunoglobulin superfamily and cadherins. Secretin is a duodenal hormone which stimulates pancreatic exocrine secretion.

80. In the T cell response to antigen:

A- A process of affinity maturation of the T cell receptor occurs............F

B- Intact antigen is presented in association with self MHC molecules.....F

C- Co-operation with other cell types is required for T cell recognition of antigen...............T

D- gamma/delta + T cells respond to antigen presented in association with MHC class II molecules...........F

E- Interactions of the TcR with an appropriate Ag/MHC complex activates a resting T cell..............F




a) Affinity maturation in an ongoing immune response is a feature of the antibody response. There is no evidence that a similar process occurs in the T cell response. b) MHC molecules present short antigen-derived peptides, not the intact antigen. c) T cells recognise antigen only when presented by (self) MHC molecules on an antigen presenting cell. d) MHC class II molecules present antigen to CD4+, alpha/beta+ T cells. It is still not clear how gamma/delta+ T cells recognise antigen, however most gamma/delta+ T cells do not appear to be restricted by (self) MHC molecules. e) Additional 'costimulatory' signals are required to activate a resting T cell. Interaction of the TcR of a resting T cell with an appropriate Ag/MHC complex in the absence of costimulatory signals may lead to the induction of anergy. (c) Dr Alan Cann

81. The following techniques are used to directly identify DNA:

A- Western blotting ..........................................................................F

B- Southern blotting .........................................................................T

C- Northern blotting ..........................................................................F

D- polymerase chain reaction (PCR) ..................................................T

E- denaturing gradient gel electrophoresis ..........................................T

Western blotting is used to identify proteins whereas northern blotting is used to identify mRNA.

82. The following are examples of lasers commonly used in surgery.

A- Silicon ........................................................................................F

B- Carbon dioxide ...........................................................................T

C- Helium .......................................................................................F

D- NdYAG ......................................................................................T

E- Magnesium ..................................................................................F

Carbon dioxide is an example of a gaseous lasing medium. Commonly being employed in colposcopy. NdYAG (Neodymium Yttrium Aluminium Garnet) is an example of a crystalline lasing medium. Commonly being employed in endoscopes.

83. The femoral nerve:

A- lies within the femoral sheath .......................................................F

B- lies lateral to the femoral vein ......................................................T

C- has a branch which supplies the skin of the scrotum .....................F

D- may supply part of the foot ........................................................T

E- shares its origin with the obturator nerve .....................................T


The femoral sheath contains the femoral artery and vein as well as lymphatics, but not the nerve. The femoral nerve lies behind and lateral to the sheath.
The femoral nerve gives off 3 cutaneous branches - 2 from its anterior division (medial and intermediate cutaneous nerves of thigh which supply the skin of the medial and anterior surfaces of the thigh) and one from its posterior division (saphenous nerve), it has no branches to the scrotum.
The spahenous nerve runs down the medial side of the leg and supplies the medial side of the calf as far as the medial malleolus, it terminates in the region of the ball of the big toe and may supply the medial side of the dorsum of the foot.
The femoral nerve is the largest branch of the lumbar plexus and comes from the same lumbar nerves as the obturator nerve, L2, 3 and 4.

84. The urogenital diaphragm is pierced by the

A- ureters ......................................................................................F

B- rectum ......................................................................................F

C- vagina .....................................................................................T

D- urethra ....................................................................................T

E- obturator nerve ..........................................................................F


It Lies inferior to the urogenital hiatus of the levator anti muscle and supports this potentially weak region of the pelvic floor. The urogenital diaphragm is pierced by the urethra and vagina.

85. The femoral artery

A- Is crossed anteriorly by the medial cutaneous nerve of the thigh .........T

B- Lies anteriorly to psoas muscle ......................................................T

C- Lies medial to the femoral vein .....................................................F

D- Is a branch of the internal iliac artery ............................................F

E- Lies medial to the lymphatic vessels ..............................................F

The femoral artery lies lateral to the vein and lymph vessels and medial to the nerve

86. Regarding Krebs' cycle (also known as the tricarboxylic acid cycle or citric acid cycle) the following statements are true:

A- oxidative phosphorylation occurs within the cytoplasm ...................F

B- alpha-ketoglutarate is a five carbon molecule ................................T

C- only carbohydrates and fats are oxidised in Krebs' cycle ................F

D- pyruvate condenses with oxaloacetate to form citrate ....................F

E- Krebs' cycle can function under anaerobic conditions .....................F




Krebs' cycle (tricarboxylic acid cycle or citric acid cycle) is a sequence of reactions in which acetyl coenzyme A (acetyl-CoA) is metabolised to carbon dioxide and hydrogen atoms. The sequence of reactions is known collectively as oxidative phosphorylation, which only occurs in the mitochondria (not cytoplasm). The cycle requires oxygen and does not function under anaerobic conditions. It is the common pathway for the oxidation of carbohydrate, fat and some amino acids, required for the formation of high energy phosphate bonds in adenosine triphosphate (ATP).
Pyruvate enters the mitochondria and is converted into acetyl-CoA, which represents the formation of a 2 carbon molecule from a 3 carbon molecule (with the loss of one CO2 and the formation of one NADH molecule). Acetyl-CoA is then condensed with the anion of a 4 carbon acid, oxaloacetate, to form citrate which is a 6 carbon molecule. Citrate is subsequently converted into isocitrate, alpha-ketoglutarate, succinyl-CoA, succinate, fumarate, malate and finally oxaloacetate. Alpha-ketoglutarate is the only 5 carbon molecule in the cycle.

87. The ovarian ligaments

A- Contain the ureters ......................................................................F

B- Contain the ovarian arteries ........................................................F

C- Are attached laterally to the pelvic wall ........................................F

D- Lie anterior to the broad ligament ................................................F

E- Are homologous to part of the gubernaculum testis in the male ......T



The ovarian ligament lies beneath the posterior layer of the broad ligament and passes from the medial pole of the ovary to the uterus just below the point of entry of the fallopian tube. As the ureter crosses the brim of the pelvis it lies in front of the bifurcation of the common iliac artery. It runs downwards and forwards on the lateral wall of the pelvis to reach the pelvic floor, and then passes inwards and forwards, attached to the perineum of the back of the broad ligament, to pass beneath the uterine artery. The ovarian artery arises from the aorta just below the renal artery and runs downwards on the anterior surface of the psoas muscle to the pelvic brim, where it crosses in front of the ureter and then passes into the infundibulopelvic fold of the broad ligament. Through the mesovarium the ovarian vessels and nerves enter the hilum The ovarian ligament passes from the medial pole of the ovary to the uterus just below the point of entry of the fallopian tube. The ovarian ligament lies beneath the posterior layer of the broad ligament. Together, the ovarian and round ligaments are homologous with the gubernaculum testis of the male.

88. The following are correct embryological associations

A- Germ cells and the wall of the yolk sac .........................................T

B- Mullerian duct and female genital tract ..........................................T

C- Mullerian duct and Gartner's cyst .................................................F

D- Genital tubercle and clitoris ...........................................................T

E- Metanephros and kidney ...............................................................T



The germ cells which eventually give rise to the ova migrate from the wall of the yolk sac into the genital ridge. The Mullerian ducts form the fallopian tubes, uterus and upper vagina. In the male the Wolffian duct forms the vas deferens, but it degenerates in the female fetus. It can sometimes still be traced in the adult female, when it is know as Gartner's duct. This runs medially through the broad ligament and down the side of the vagina, where cysts may form in it. After 10 weeks differentiation in the female the genital tubercle enlarges slightly to form the clitoris. The pronephros and mesonephros develop to form the primitive kidney but disappears subsequently, and finally the metanephros appears to form the definitive kidney.

89. Adenine

A- Is a pyrimidine base ....................................................................F

B- Forms base pairs with thymine in RNA ............................................F

C- Is synthesized attached to ribose phosphate ..................................F

D- Can be converted directly to a nucleotide by the action of phosphoribosyl-transferase enzymes ...................F

E- Is degraded by a pathway which involves the enzyme xanthine oxidase ......................T



Adenine is one of the two purine bases used in the formation of the nucleotide – adenosine in combination with ribose/deoxyribose. This binds to either Uracil in RNA or thymine in DNA. There is a complex process of conversion to the nucleotides from the nucleosides. Nucleoside = base + sugar DNA= deoxyribose, RNA = ribose. nucleotide = base + sugar + phosphate. Purines are metabolized to xanthine within which xanthine oxidase is involved.

90. The lymphatic drainage of the cervix goes

A- To the internal iliac nodes .............................................................T

B- To the external iliac nodes ..........................................................T

C- Directly to the para-aortic nodes .................................................T

D- To the superficial inguinal nodes ..................................................F

E- To the obturator node ..................................................................T



The lymphatics from the cervix pass either laterally in the base of the broad ligament or posteriorly along the uterosacral ligaments to reach the side wall of the pelvis. Most of the vessels drain to the internal iliac, obturator and external iliac nodes, but vessels also pass directly to the common iliac and lower para-aortic nodes.

91. In the vulva

A- The blood supply is partly derived from the middle rectal artery.........F

B- The blood supply is partly derived from the external pudendal artery..........T

C- Lymph drains to the inguinal group of nodes. .................................T

D- Sensory fibres from the skin travel via the pudendal nerve. ............T

E- Venous drainage on the right is directly to the inferior vena cava...........F



The internal pudendal artery is a branch of the internal iliac artery. It leaves the pelvic cavity through the sciatic foramen and, after winding round the ischial spine, enters the ischiorectal fossa where it gives off the inferior rectal artery. It terminates in branches which supply the perineal and vulval structures, including the erectile tissue of the vestibular bulbs and clitoris. Lymph draining from the lower extremities and the vulval and perineal regions is all filtered through the inguinal and superficial femoral nodes before continuing along the deep pathways on the side wall of the pelvis. As the pudendal nerve passes along the outer wall of the ischiorectal fossa it gives off an inferior rectal branch, and divides into the perineal nerve and the dorsal nerve of the clitoris. The perineal nerve gives the sensory supply to the vulva; it also innervates the anterior part of the external anal sphincter and levator ani, and the superficial perineal muscles. The dorsal nerve of the clitoris is sensory. The ovarian veins on the right ends in the inferior vena cava and that on the left in the left renal vein.

92. Raised aldosterone levels are found in

A- normal pregnancy ......................................................................T

B- renal artery stenosis ..................................................................T

C- therapy with loop diuretics ...........................................................T

D- polycystic ovary syndrome .........................................................F

E- Liddle's syndrome .......................................................................F



Aldosterone is elevated in association with reduced circulating volumes, pregnancy, Conn's syndrome, and raises with diuretic therapy (hence good combination of diuretics and ACEis). Liddle's syndrome is a renal tubular defect due to Na/K channels and is associated with hyporeninaemic hypoaldosteronism with hypokalaemic hypertension.

The risks of combined hormone contraception1

•Non-life-threatening adverse effects:
◦Breakthrough bleeding
◦Breast tenderness
◦Acne
◦Mood changes
•Venous thromboembolism:
◦Relative risk of venous thromboembolism with COC use can increase up to five-fold compared with non-users.
◦The absolute risk is still low, and considerably lower than the risk in pregnancy.
◦The risk of venous thrombosis is increased with obesity and is greatest in the first year of COC use. Approximate risks:1
■Healthy non-pregnant women - about 5-10 cases per 100,000 per year
■Second-generation pill users - about 15 per 100,000 per year
■Third-generation pill users - about 25 per 100,000 per year
■Pregnancy - estimated to be about 60 per 100,000 per year
◦To minimize the risk of venous thrombosis before pelvic surgery or procedures that may require extensive immobilisation, COCs should be stopped 2-4 weeks before the procedure, and should not be resumed until 2 weeks after complete mobility.1
•Myocardial infarction:
◦For COC users who are heavy smokers (more than 15 cigarettes per day) the relative risk of MI may be up to 10 times that of smokers who do not use COCs. Healthy non-smokers have no increased risk of myocardial infarction with COC use.1
◦COC users with hypertension have a three-fold increased risk of MI compared with COC users without hypertension.
•Stroke:
◦Very small increase in the absolute risk of ischaemic stroke with COC use.
•Breast cancer:
◦Any increased risk of breast cancer with COC use is likely to be small.
◦After 10 years since last use, the incidence of breast cancer is the same as in women who have never used COCs.1
•Cervical cancer:
◦The use of oral contraceptives for less than 5 years does not increase the risk of cervical cancer.
◦The risk of cervical cancer does increase with more than 5 years of COC use.1
•Liver cancer:
◦Primary liver cancer is rare in developed countries and, although COC use increases the risk, the absolute risk is very small.

92.
During human spermatogenesis:

A- Sperm production takes place within the Leydig cell ........................F

B- New sperms develop within 35 days ...............................................F

C- The primary spermatocytes undergo reduction division ....................T

D- Each diploid spermatocyte gives rise to four spermatids .................T

E- Grossly abnormal spermatozoa are never present in fertile semen ........F



Spermatogenesis takes place between the the Sertoli cells with leydig cells releasing testosterone to encourage the process. The time required for spermatogenesis in humans is approximately 75 days. Spermatozoa develop through a process of meiosis so diploid spermatocytes provide four spermatids. There is a certain percentage of abnormal sperm allowed to be present in a normal semen analysis.

93. Carbimazole:

A- May cause fetal hyperthyroidism ...................................................F

B- Can be used sublingually ............................................................F

C- Is secreted in significant quantities in breast milk .........................T

D- Is a cause of agranulocytosis .....................................................T

E- Is a thiourea derivative ..............................................................T


Carbimazole is a thionamide used in the treatment of thyrotoxicosis through blocking the iodination of thyroid hormone. It can be used in pregnancy for treating thyrotoxicosis but the dose is reduced to the smallest dose required to maintain euthyroidism as it crosses the placenta and may cause fetal hypothyroidism. Care has to be exercised with breast feeding. Side effects include rash, hair loss and rarely agranulocytosis.

94. Prolactin:

A- Release is stimulated by thyrotropin-releasing hormone ...............T

B- Plasma levels are raised in the first trimester of pregnancy ............T

C- Is identical to human placental lactogen .........................................F

D- Controls milk ejection ..................................................................F

E- Release is inhibited by Metoclopramide ..........................................F



Prolactin is produced from the anterior pituitary gland, A number of other hypothalamic releasing hormones induce increased prolactin secretion;
Prl rises throughout pregnancy.
PRL & HPL are peptide hormones but they are not identical. Human placental lactogen is a single-chain polypeptide with two intramolecular disulfide bridges. The structures of hPL, prolactin, and growth hormone are very similar. Eighty-five percent of its amino acids are identical to human pituitary growth hormone and human pituitary prolactin Furthermore, hPL shares biologic properties with both growth hormone and prolactin Thus, it has primarily lactogenic activity but also exhibits some growth hormone-like activity; therefore, it is also referred to as chorionic growth hormone (hCGH) or human chorionic somatomammotropin (hCS).
Oxytocin controls milk ejection.
The dopamine antagonist metaclopramide abolishes the pulsatility of prolactin release and increases serum prolactin levels

95.placebo in a clinical trial

A- has no effects .............................................................................F

B- is pharmacologically inert .............................................................T

C- should not be given to patients with carcinoma ..............................F

D- should be identical in appearance to the drug being studied ............T

E- is best administered by a person who is unaware of the drug's identity ...............T




Placebo controlled studies are most appropriately undertaken in a double blind fashion with both the observer and the patient blinded to treatment. Although you might think that placebo has no effect, in fact there may well be a huge placebo (psychological) effect. Placebo studies are undertaken in patients with cancer particularly to establish the palliative value of drugs or the effectiveness of a new treatment where none exists.

96. Beta-thalassaemia is characterised by

A- hepatosplenomegaly ..................................................................T

B- overgrowth of maxillary regions of face ......................................T

C- a lower incidence of infections than in the normal population ...........F

D- a normal reticulocyte count .........................................................F

E- characteristic changes on X-ray of the skull ..................................T

97. Nitric oxide:

A- is generated from glutamine ........................................................F

B- is produced by both inducible and constitutive forms of nitric oxide synthetase .................T

C- raises systemic vascular resistance .............................................F

D- is inactivated by oxygen free radicals ............................................T

E- is increased by cyclic AMP activation. ..............................................F

98. The following mechanisms are involved in the mediation of insulin action:

A- adenylate cyclase activation ........................................................F

B- cell membrane receptor interaction .............................................T

C- inhibition of hepatic glucose release ............................................T

D- receptor tyrosine kinase activity ..................................................T

E- hormone receptor DNA binding .....................................................F



Insulin acts through a disulfide-bonded heterotetrameric cell surface receptor comprised of an extracellular alpha subunit coupled via disulfide bonds to a transmembrane and intracellular beta subunit. Insulin inhibits gluconeogenesis and promotes glycogen synthesis. Signaling through the insulin receptor occurs through an intracellular tyrosine kinase domain and resultant phosphorylation of the receptor

99. The following statements concerning the uterus are correct:

A- It is formed from the mesonephric ducts ........................................F

B- The uterine artery is a branch of the internal iliac artery .................T

C- The uterine artery passes below the ureter ...................................F

D- The uterine veins communicate with the vesical plexus of veins .......T

E- Pain from the body of the uterus is carried by the pelvic splanchnic nerves ...............F




At the 10th week there is union of two mullerian ducts with uterus formation, with fusion beginning in the midline then caudally and cephalad. Uterine body formed from mesoderm. Uterine cavity formed as the septum dissolved slowly. The uterine artery is a branch of the anterior division of the internal iliac artery. The vessel gives origin to fundal, cervicovaginal, ovarian, tubal and distal ureteric branches. Cervicovaginal branches anastomose with vaginal arteries to form the azygos arteries of the vagina. The ureter passes under the uterine artery. Pain from the cervix is carried by pelvic splanchnic nerves hence bradycardia during cervical dilatation. Pain sensation from the body of the uterus is carried by sympathetic fibres in the hypogastric nerves.

100. Oxytocin is:

A- synthesised in the anterior hypothalamic nuclei ..............................T

B- stored in the anterior pituitary ......................................................F

C- an oligopeptide hormone .............................................................T

D- an anti-diuretic in action .............................................................T

E- important as a cause of uterine contractions in early pregnancy .......F

101. The femoral nerve:

A- lies within the femoral sheath ......................................................F

B- lies lateral to the femoral vein ......................................................T

C- has a branch which supplies the skin of the scrotum .......................F

D- may supply part of the foot ..........................................................T

E- shares its origin with the obturator nerve ......................................T

102. In X-linked recessive disease

A- mothers will always carry the affected gene ..................................T

B- fathers never transmit to their sons .............................................T

C- there is variable expression in females due to random inactivation ........T

D- 50% of daughters of carrier females will be carriers ......................T

E- incidence increases with maternal age ...........................................F

103. The corpus luteum of pregnancy produces:

A- Relaxin .......................................................................................T

B- Progesterone .............................................................................T

C- 17 Alpha-Hydroxyprogesterone ...................................................T

D- Human chorionic gonadotrophin ...................................................F

E- Oestradiol ...................................................................................T

104. The source of oestrogen in a postmenopausal woman is believed to be attributed to

A- Face cream with hormone content ................................................F

B- Ovarian stromal origin ................................................................T

C- Small amounts from the bone marrow ...........................................F

D- Adrenal origin .............................................................................F

E- Hepatic origin ..............................................................................F

105. The progestogenic side-effects of oral contraception include

A- Heavy menstrual flow ..................................................................F

B- Fluid retention ............................................................................T

C- Depression ..................................................................................T

D- Reduced libido ............................................................................F

E- Vaginal discharge ........................................................................F

106. Peritoneal ridges

A- The medial umbilical ligament is also called the urachus ..................F

B- The urachus is the remains of the fetal allantois ............................T

C- The urachus extends from the bladder to the umbilicus .................T

D- The lateral umbilical ligaments are the obliterated Umbilical veins .........F

E- The lateral umbilical ligaments pass from the internal Iliac arteries to the umbilicus ...........T


The median umbilical ligament (urachus) is the remains of the fetal allantois. The lateral umbilical ligaments are the obliterated umbilical arteries.

107. Insulin:

A- is secreted mainly as proinsulin ....................................................F

B- has equal biological activity to C-peptide .......................................F

C- release from the pancreatic beta cell is stimulated by biguanides ...........F

E- has a half life of less than 8 minutes when given intravenously ...................T

E- >80% is degraded by the liver and kidney .....................................T




Insulin (and C-peptide which is inactive) is secreted by the beta cells within the islets of Langherhan as the active molecule following cleavage from preproinsulin, then proinsulin. It is metabolised in the liver and undergoes renal excretion. Half life is roughly 4 mins.

108. The following are recognised carcinogens

A- nicotine ......................................................................................F

B- electromagnetic microwaves .......................................................F

C- Infra-red radiation .....................................................................F

D- beta-naphthylamine .....................................................................T

E- Arsenic .......................................................................................T

109. Concerning gonadal development:

A- The histological appearance of the primitive gonad is similar in both sexes until 42 days after fertilization .............................................T

B- The ovary develops in the medulla of the primitive gonad. ...............F

C- The histo-differentiation of the testis begins later than that of the ovary ...............F

D- Primary sex cells (gonocytes) have a haploid number of chromosomes ............F

E- Mitosis in oogonia is not completed by the end of the first year of life ................F




The appearance of the primitive gonad is similar in both sexes until 42 days after fertilization when seminiferous differentiation occurs. At 10 weeks conception there is meiotic entry of oocytes in the medulla of the primitive gonad of the developing foetus. Gonocytes are diploid and only become haploid in the gonad via meiosis. Mitosis in oogonia is completed 7th month of fetal life. The ovary develops from the primitive cortex not medulla.

110. The urinary system

A- develops from intermediate mesoderm .........................................T

B- During intra uterine life 3 overlapping kidney systems are formed .............T

C- The mesonephros develops as the metanephros regresses ..............F

D- Bowman's capsule develops in the metanephros ............................T

E- The glomerulus forms part of the mesonephros ...............................F




The urinary system develops from the intermediate mesoderm. During development of the fetus there are 3 overlapping kidney systems - the pro, meso, and metanephric systems. The metanephros forms the permanent kidney. Bowman's capsule and the glomerulus develop as part of the metanephros

111. Regarding Escherichia Coli

A- Is a gram positive rod ...................................................................F

B- grows anaerobically .....................................................................T

C- characteristically produces a malodourous infection ..........................F

D- Most strains are not pathogenic .....................................................F

E- produces an enterotoxin .............................................................T


E coli is a gram negative anaerobe and produces both endotoxins and enterotoxins (enterotoxigenic E Coli). It does not typically produce a malodourous infection as it is likely that other anaerobes are responsible for this - eg Bacteroides etc. Most strains have the potential to be pathogenic.

112. Hypokalaemia may be caused by:

A- Bendroflumethiazide ....................................................................T

B- Digoxin ......................................................................................F

C- Spironolactone ............................................................................F

D- Carbenoxolone ............................................................................T

E- Amiloride ..........................................................................................F



Carbenoxolone may cause hypokalaemic hypertension like liquorice through inhibition of 11beta hydroxysteroid dehydrogenase (11bHSD). Bendroflumethiazide is a thiazide diuretic and promotes potassium excretion. Amiloride, like spironolactone is a potassium sparing diuretic and causes hyperkalaemia. Digoxin toxicity is exacerbated by hypokalaemia but it does not cause hypokalaemia

113. Thrombocytopenia is a recognised adverse effect of the following drugs:

A- aspirin .........................................................................................T

B- oxymethalone .............................................................................F

C- thiazide diuretics .........................................................................F

D- gold ...............................................................................................T

E- dapsone .......................................................................................F
A - aspirin causes reduced platelet function, thrombocytopaenia and increased bleeding time.
For further details on thrombocytopaenia.

Thrombocytopaenia is a decrease in the number of platelets in the blood - it reduces the ability of the blood to clot and is thus a bleeding diathesis. It is defined as a platelet count less than 100 x 10^9/L (<100,000 per cubic mm).
In addition, it is important to consider also the causes of apparent thrombocytopaenia - i.e. conditions where there is platelet dysfunction.
Neonatal thrombocytopaenia has a modified differential diagnosis.

114. Which of the following are effective in the treatment of menopausal flushes?

A- Raloxifene ..................................................................................F

B- Clonidine .....................................................................................T

C- 17 beta-oestradiol .......................................................................T

D- Norethisterone ............................................................................F

E- Venlafaxine ..................................................................................T




There are numerous drugs other than oestrogens that are effective in the treatment of PM flushing. Venlafaxine the SSRI has some benefit in reducing fluches particularly in those subjects that are unable to use osestrogens. Clonidine is well established for this purpose also. Progestogens do not help flushes but are used in as combined HRT with estrogens in women with an intact uterus. Raloxifene, the SERM, may exacerbate flushes.

115. Glucocorticoid therapy may cause:

A- hypokalaemia .............................................................................T

B- lymphopenia ................................................................................T

C- hypertrichosis .............................................................................T

D- amenorrhoea .............................................................................T

E- aseptic necrosis of the femoral head ..............................................T




Glucocorticoids , steroids, may cause iatrogenic cushing's, with thin skin ease of bruising, glucose intolerance/diabetes, hypertension and hypokalaemia, hirsutism, osteoporosis and it may result in hypogonadotrophic hypogonadism (hence amenorrhoea). Therapy may also be associated with aseptic necrosis of the femoral head.

116. Which of the following are potassium sparing diuretics?

A- Triamterene ...............................................................................T

B- Bendroflumethiazide ...................................................................F

C- Furosemide .................................................................................F

D- Spironolactone ............................................................................T

E- Captopril .....................................................................................F



Potassium sparing diuretics include spironolactone, trimaterene and amiloride. They act on the distal convoluted tubule inhibiting through various mechanisms the loss of potassium in exchange for sodium. Furosemide is a loop diuretic and bendroflumethiazide a thiazide diuretic. Captopril is not a diuretic but an ACE inhibitor.

117. Wound healing by secondary intention takes place:

A- when the wound does not break apart ...........................................F

B- when the wound edges are brought together .................................F

C- when there is irrepairable skin loss ..............................................F

D- much more slowly than healing by first intention ...........................T

E- when the wound becomes infected ................................................T




Healing by secondary intention occurs when the wound edges are apart. Angiogenesis and fibroblast proliferation result in the formation of granulation tissue, which contracts to reduce the wound area and allows epithelialisation across it's surface to achieve wound closure.
Where the wound edges are apposed, healing proceeds rapidly to closure and this is known as primary healing.
If there is irrepairable skin loss then the process would be very slow and the resultant healed surface is a thin layer of epithelium on scar tissue that may not prove durable in the long-term.
Healing by secondary intention is a slower process due to the formation and contraction of granulation tissue resulting in a slow apposition of the opposing skin appendages.
When the wound is infected it should heal by secondary intention. Attempting to heal the wound by primary measures would leave an underlying infection, that would lead to wound breakdown.