Important MCQ colloction for part-1 MRCOG(5)

150.The following have an anti-emetic action:

A- Hyoscine hydrobromide .................................................................T

B- Morphine sulphate .........................................................................F

C- Chloropropamide .........................................................................T

D- Promethazine hydrochloride ..........................................................T

E- Perphenazine ...............................................................................T



Hyoscine is an alkaloid, Promethazine is an antihistamine, Perphenazine is an antipsychotic and all 3 have antiemetic properties. The sulphonyl urea chloropropramide may have antiemetic properties and has thus been marked as true. Morphine has an emetic action.

An antiemetic is a drug that is effective against vomiting and nausea. Anti-emetics are typically used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics and chemotherapy directed against cancer.

1- Promethazine

Promethazine is also known as phenergan and mepergan. It is also used to treat motion sickness, reduce allergic symptoms, and for sedation. It is one of the drugs of the phenothiazine type. In addition to other qualities, it is an antihistamine


2- Prochlorperazine

Prochlorperazine is also known as compazine. Like promethazine, it is a member of the class of phenothiazines. Unlike promethazine, however, prochlorperazine also belongs to the class of drugs known as antipsychotics, or neuroleptics. Antipsychotic drugs are used to treat psychoses and other psychiatric disorders. In addition to its use as an antiemetic and anti-psychotic drug, prochlorperazine is also used to treat non-psychotic anxiety.

3- Serotonin Receptor Antagonists

The serotonin receptor antagonists include granisetron (kytril), dolasetron (anzemet), and ondansetron (zofran). These drugs are used for postoperative nausea and emesis as well as nausea and vomiting associated with chemotherapy, and are often used in combination with a corticosteroid. Ondansetron is approved for nausea and vomiting associated with radiation therapy.

4- Neurokinin Receptor Antagonists

The Neurokinin receptor antagonists are a new class of antiemetics. Aprepitant (Emend) was approved in 2004 for use in cancer patients. It is used in combination with other antiemetics for relief of acute and delayed nausea and vomiting caused by high-dose chemotherapy, most often caused by the chemotherapy drug cisplatin.

5- Dronabinol

Dronabinol (marinol) is used to combat anorexia in AIDS patients, and emesis in cancer patients who haven't responded to other antiemetics. Marinol is the synthetic or extracted form of the active ingredient found in marijuana.

6- Other Antipsychotic (Neuroleptic) Drugs

The other neuroleptic (antipsychotic) drugs used to treat nausea and emesis are droperidol (inapsine), halo-peridol (haldol), chlorpromazine (thorazine), and perphenazine (trilafon). One other antipsychotic, triethylperazine (torecan or norzine), was used as an antiemetic, but is no longer widely available. Some of the antipsychotics are also used to treat aggressive or violent behavior or incontrollable hiccups (chlorpromazine). These drugs are similar to prochlorperazine in terms of their actions and potentially severe side effects.

151. Beta sympathomimetic drugs may:

A- Cause bronchospasm ....................................................................F

B- Reduce the frequency of uterine contractions ..................................T

C- Cause heart block ........................................................................T

D- Reduce diastolic blood pressure .....................................................F

E- Increase blood glucose concentration ............................................T



These drugs have the following effects vasodilation, bronchial relaxation, intestinal and genitourinary wall relaxation, cardiac stimulation, renin release, glycogenolysis, gluconeogenesis, lipolysis

152. Thiopentone sodium administration intravenously:

A- Is a potent muscle relaxant ...........................................................F

B- Is predominantly excreted by the kidney .......................................F

C- Binds to protein ...........................................................................T

D- Is fat soluble ...............................................................................T

E- Crosses the placenta ....................................................................T




Thiopentone sodium produces general anaesthesia. Although bound to plasma proteins thiopentone sodium rapidly crosses the blood-brain barrier. Thiopentone sodium is slowly metabolised by the liver. Only a small proportion of the active drug is excreted in the urine.

153. The following antibiotics act on bacterial walls:

A- Penicillin .....................................................................................T

B- Ceftazidime ................................................................................T

C- Metronidazole ..............................................................................F

D- Clindamycin ................................................................................F

E- Gentamicin ..................................................................................F




Mode of action of antibiotics can be classified as below
1.Inhibition of nucleic acid synthesis- Metronidazole
2.Inhibition of protein synthesis - Clindamycin, Gentamicin
3.Action on cell membrane - Polymyxin
4.Interference with enzyme system (antimetabolites) - Trimethoprim
5.Action on cell wall - Penicillins and Cephalosporins

154. Isoprenaline

A- Is potentiated by Propranolol .........................................................F

B- Can be used sublingually ...............................................................T

C- Has a minimal action on alpha receptors .........................................T

D- Causes bradycardia .....................................................................F

E- Is a bronchodilator ........................................................................T


Isoprenaline is an beta adrenoreceptor agonist whose effects are antagonized by propranolol. It improves cardiac output, causes bronchodilatation and induces a tachycardia, but its use is generally limited to the treatment of low output states associated with heart block. It is usually used as an IV infusion but can be administered SL or Orally.

Isoprenaline ...1- is a sympathomimetic beta adrenergic agonist medication.
It is structurally similar to epinephrine (adrenaline) but acts selectively on beta receptors, activating β1 and β2 receptors equally Acts almost exclusively on b-adrenergic receptors

• Causes
i) Inotrope [b1-receptors
ii) Chronotrope [b1-receptors]

iii) Vasodilator [b2-receptors]—potent effect

iv) Bronchodilation [b2-receptors]

• Reduces SVR & PVR via vasodilation & pulmonic vasodilation



2) Indications

• Ventricular dysfunction especially RV(combination of pulmonary dilation & inotropic support)

• Bronchoconstriction

• Bradycardias

• Pulmonary hypertension (inotrope of choice if require inotropic support in such a patient)



3) Effects on organs—side effects

• Also increases venous return to heart


4) Toxic effects/ precautions with administration

• Tachycardias, dysrythmias (due to b1 effects)

• Reduced coronary diastolic perfusion pressures (due to b2 effects)

• Increased MVO2 (due to tachycardia) plus reduced myocardial O2 supply (due to reduced coronary diastolic perfusion pressures) may extend ischaemic areas


5) Contraindications

• Idiopathic hypertrophic subaortic stenosis

• Tetralogy of Fallot with RV outflow tract obstruction (as may constrict pulmonary vasculature exacerbating preexisting pulmonary hypertension or right ventricular dysfunction


6) Important drug interactions

• Should not be administered concommitantll with adrenaline as will dangerously exacerbate adrenergic effects resulting in arrythmias

• Risk of arrythmias with volatile anaesthetics

155. Prostaglandins

A- Synthesized from cholesterol .........................................................F

B- Are small polypeptides ..................................................................F

C- Secreted by the pituitary gland .....................................................T

D- Secreted by the prostate gland .....................................................T

E- Associated with gastrointestinal side effects ...................................T




Prostaglandins are long-chain hydroxy fatty acids derived from arachidonic acid, which is released from cell membrane phospholipids and catalysed by the enzymes cyclo-oxygenase and endoperoxidase. Prostaglandins are produced locally. The original source was the prostate. GI side effects include diarrhoea and abdominal pains.


Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring. They are mediators and have a variety of strong physiological effects.
Prostaglandins are found in most tissues and organs. They are produced by all nucleated cells except lymphocytes. They are autocrine and paracrine lipid mediators that act upon platelets, endothelium, uterine and mast cells. They are synthesized in the cell from the essential fatty acids ..........


Function
cause constriction or dilation in vascular smooth muscle cells
cause aggregation or disaggregation of platelets
sensitize spinal neurons to pain
decrease intraocular pressure
regulate inflammatory mediation
regulate calcium movement
control hormone regulation
control cell growth
Prostaglandins are potent but have a short half-life before being inactivated and excreted. Therefore, they send only paracrine (locally active) or autocrine (acting on the same cell from which it is synthesized) signals.

There are a variety of physiological effects including:
1. Activation of the inflammatory response, production of pain, and fever. When tissues are damaged, white blood cells flood to the site to try to minimize tissue destruction. Prostaglandins are produced as a result.

2. Blood clots form when a blood vessel is damaged. A type of prostaglandin called thromboxane stimulates constriction and clotting of platelets. Conversely, PGI2, is produced to have the opposite effect on the walls of blood vessels where clots should not be forming.

3. Certain prostaglandins are involved with the induction of labor and other reproductive processes. PGE2 causes uterine contractions and has been used to induce labor.

4. Prostaglandins are involved in several other organs such as the gastrointestinal tract (inhibit acid synthesis and increase secretion of protective mucus), increase blood flow in kidneys, and leukotriens promote constriction of bronchi associated with asthma.

156. Prostaglandins

A- Are involved in the onset of labour .................................................T

B- Maintain the corpus luteum in early pregnancy ................................F

C- Have a role in causing dysmenorrhoea ..........................................T

D- May be important in the development of menorrhagia .....................T

E- Are Oxytocic ................................................................................T



Prostaglandins are believed to be important mediators of uterine contractions in women. Furthermore, there appears to be good correlation between the amount of prostaglandin production and cramps associated with dysmenorrhoea. It is now thought that as prostaglandin production increases, there is increased uterine cramping that results in uterine ischaemia and pain. Studies have shown that prostaglandin production increased during the first 48-72 hours of menstrual flow. Decreasing prostaglandin production with medications can decrease the pain. Since the arteriolar contraction and endometrial necrosis are caused by prostaglandins, it is apparent that prostaglandins play a pivotal role in controlling menstrual blood loss. PGF2a and PGE2 cause myometrial contraction and hence oxytocic. Prostaglandins are useful in obstetrics for induction of labour and termination of pregnancy

157. Which of the following antibiotics are considered bactericidal?

A- Clindamycin .................................................................................F

B- Amoxicillin ...................................................................................T

C- Erythromycin ...............................................................................F

D- Tetracycline .................................................................................F

E- Gentamicin ...................................................................................T



Both penicillins and the aminoglycosides such as gentamicin are bactericidal whereas the others are bacteriostatic

158. Following are characteristics of hypoxic cell death
a- apoptosis

b- Phagocytosis

c -Pyknosis

d- Poiklocytosis

e- Release of Phospholipids

159. Oestrogen receptors .......

A- Is localised to the nucleus only following ligand binding

B- Does not undergo nucleocytoplasmic shuttling

C- Binds heat shock protein 90 on activation

D- Is regulated by phosphorylation

E- Is similar to the androgen receptor

160. Copper-containing IUCDs

A- Should be changed every year

B- Have a higher incidence of actinomycosis colonization than plastic devices

C- Causes a relative increase in ectopic pregnancies

D- Have been implicated as a cause of fatal infection in pregnancies

E- Do not cause menorrhagia

Copper-containing IUDs

**The copper IUD has been approved for use for up to 10 years and can be effective for up to 12 years .

**The advantage of the copper IUD is that it is hormone-free providing a suitable option for women who experience problems with hormonal methods. Another role of the copper IUD is as an emergency contraceptive. It can prevent up to 99% of pregnancies when inserted within 5 days of unprotected sex.



The mechanism of IUDs is not well understood. It's known however that the presence of a device in the uterus prompts the release of leukocytes and prostaglandins by the endometrium.

Copper IUDs act by impairing sperm function and movement through the uterus, as copper is toxic to sperm. They do this by instigating a reaction which induces cellular and humoural inflammatory response to the presence of the copper within the cervical mucous, uterine cavity and fallopian tube. The copper and the inflammatory response are both spermicidal. They also cause changes in the lining of the uterus which prevents an egg attaching to the endometrium if it does happens to get fertilised. It is this irritation that leads to the increased bleeding and heavier periods. The more modern copper IUDs are associated with less blood loss and are also more efficacious

1- Copper releasing IUDs can cause cramps, longer and heavier menstrual periods, and spotting between periods.

2- The intrauterine system does NOT provide protection against the transmission of sexually transmitted diseases .On average, menstrual blood loss increases by 20–50% after insertion of a copper-T IUD; increased menstrual discomfort is the most common medical reason for IUD removal.

3- Development of PID is very rare despite earlier beliefs that they occur commonly in women using IUDs. The risk of PID is highest within the first 3 weeks following insertion, while after that the risk is minimal. Women with cervical infections caused by chlamydia or gonorrhoea at the time of insertion have a 3-5% chance of developing an infection in the first 20 days. Screening for vaginal and cervical infections should be carried out prior to insertion to reduce risk of infection being passed to the uterus.
Symptoms of infection :
•Pain or tenderness in lower abdomen;
•Unusual bleeding from vagina;
•Fever or chills;
•Discharge from vagina;
•Pain during intercourse;
•Burning sensation when passing urine.


4- The risk of ectopic pregnancy to a woman using an IUD is lower than the risk of ectopic pregnancy to a woman using no form of birth control. However, of pregnancies that do occur during IUD use, a higher than expected percentage (3–4%) are ectopic .

5- The pregnancy rate during IUD use is very low (less than 1% per year). If pregnancy does occur, the IUD should be removed. Although IUDs are not teratogenic , presence of the IUD increases the risk of miscarriage, particularly during the second trimester. It also increases the risk of premature delivery. Although the Dalkon Shield IUD was associated with septic abortions (infections associated with miscarriage), other brands of IUD are not. IUDs are also not associated with birth defects ...

6- expulsion and uterine perforation. Uterine perforation is generally caused by an inexperienced provider and is very rare. Expulsion is more common in younger women, women who have not had children, and when an IUD is inserted immediately after childbirth or abortion. Women should check the string of the IUD at least once per menstrual cycle to verify that it is still in place /

161. The following increase insulin secretion:

A- Glucagon --------------------------------------------------------------------T

B- Glibenclamide ---------------------------------------------------------------T

C- Propranolol -----------------------------------------------------------------F

D- Bendroflumethiazide -------------------------------------------------------T

E- Arginine ----------------------------------------------------------------------T



Insulin secretion is stimulated by glucose, amino acids (arginine) and triglycerides. Pharmacologically its secretion is stimulated by sulphonylureas such as glibenclamide, and also glucagon (stimulating glucose release). Bendroflumethiazide may produce a deterioration in insulin sensitivity and hene increase insulin secretion. Propanolol may inhibit insulin secretion.

162. 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


Nitric oxide is produced from l-arginine by nitric oxide synthase and is produced by the vascular endothelium in response to haemodynamic stress and produces smooth muscle relaxation and reduced vascular resistance. Nitric oxide is a free radical and may be inactivated through interaction with other oxygen free radicals e.g. oxidised LDL. It causes the production of cGMP as a second messenger

163. Insulin action:

A- increases liver glycogenolysis ---------------------------------------------F

B- increases muscle glycogen synthesis -------------------------------------T

C- increases liver gluconeogenesis ------------------------------------------F

D- increases liver fatty acid synthesis ---------------------------------------T

E- facilitates red blood cell glucose uptake ----------------------------------F


Insulin acts to inhibit lipolysis and gluconeogenesis by promoting glycogenesis. Insulin promotes synthesis of fatty acids in the liver.
e-Does not increase uptake into brain or liver either.

164. Concerning the female breast:


A- It is firmly attached to the pectoralis major muscle --------------------F

B- There is a subareolar lymph plexus --------------------------------------T

C- Axillary lymph nodes receive more than half the lymph from the breast --------------------T

D- Lymph from the lateral part of breast may drain to the para-sternal nodes ------------------T

E- Approximately 90% of the lymph passes to the posterior infraclavicular nodes --------F




The female breast extends from the 2nd to the 6th rib in the mid clavicular line, overlying pectoralis major. Beneath the breast there is a condensation of superficial fascia, which acts as a posterior capsule for the breast. There is a subareloar lymphatic plexus. Most of the lymph of the breast drains to the axilla, with lymph from the lateral breast draining into the axillary and infraclavicular nodes. Medially the lymph drains through the intercostal spaces into the parasternal (internal thoracic) nodes. However lymph from the breast may drain into any of the lymphatic basins and if one pathway becomes blocked, another is utilized.

165. Recognised features of acromegaly include

A- hypocalciuria ----------------------------------------------------------------F

B- intestinal polyposis --------------------------------------------------------T

C- splenomegaly --------------------------------------------------------------T

D- palpable peripheral nerves ----------------------------------------------T

E- proximal myopathy --------------------------------------------------------T


Features of acromegaly include large hands, feet, macroglossia, organomegaly and prognathism. a-hypercalciuria. Compression of the optic chiasm may produce a bitemporal hemianopia. Proximal myopathy can occur as well as diabetes mellitus, glucose intolerance and hypertension. Diagnosed on basis of non suppression of GH concentrations with the oral glucose tolerance testThe following congenital

166. abnormalities are associated with a characteristic karyotype

A- Klinefelter syndrome ------------------------------------------------------T

B- cri-du-chat syndrome -----------------------------------------------------T

C- ovarian dysgenesis --------------------------------------------------------T

D- Pierre-Robin syndrome ---------------------------------------------------F

E- meningomyelocoele --------------------------------------------------------F


Klinefleter's - XXY, Cri-du-Chat Deletion Chromosome 5p, Turner's/gonadal dysgenesis - XO.

167. The long-term treatment of acne with tetracycline:

A- is unsuccessful in 75% of patients ----------------------------------------F

B- may predispose to scarring of the skin ----------------------------------F

C- predisposes to Candida infection -----------------------------------------T

C- may damage the fetus in utero -------------------------------------------T

D- may predispose to gram negative folliculitis ----------------------------T


Tetracyclines are a frequent and successful treatment of acne but are associated with side effects including staining of teeth in utero and should be used with caution in renal impairment. Similarly they may predispose to fungal infection.


1- When used for acne vulgaris, skin can be extremely dry and flaky if overused
2- May interfere with methotrexate by displacing it from the various protein binding sites
3- Can cause breathing complications as well as anaphylactic shock in some individuals
4- Should be avoided during pregnancy as it may affect bone growth of fetus.
5- Passes into breast milk and is harmful to breast-fed infants, and should therefore be avoided during breastfeeding if possible

168. The following drugs are unsafe in the last 4 weeks of pregnancy

A- warfarin ---------------------------------------------------------------------T

B- cotrimoxazole --------------------------------------------------------------T

C- paracetamol ----------------------------------------------------------------F

D- methylpenecillin ------------------------------------------------------------F

E- tetracycline ------------------------------------------------------------------T





a-crosses placenta and cause haemorrhage. Warfarin is also teratogenic in the first trimester.
b-neonatal haemolysis and methaemoglobinaemia. Also teratogenic in 1st trimester.
c,d-safe
e-dental discolouration, maternal hepatotoxicity (in large doses). Beware of the exact wording - tetracycline best avoided but not 'unsafe' in limited doses.

169. Prostaglandin PGI2 (prostacyclin)

A- reduces arterial smooth muscle tone -------------------------------------T

B- is a product of arachidonic acid metabolism -----------------------------T

C- production is inhibited by non-steroidal anti-inflammatory drugs ------T

D- increases platelet cyclic AMP concentration ------------------------------T

E- inhibits platelet aggregation to damaged vessel walls ------------------T


Prostacyclins reduce arterial tone, is produced from arachidonic acid and this synthesis is inhiobited by NSAIDs. It is involved in platelet aggregation through increasing cAMP concentration.

170. Bromocriptine:

A- will suppress lactation in the puerperium --------------------------------T

B- may be a useful adjunct in acromegaly ----------------------------------T

C- may cause enlargement of the pituitary in a patient with a prolactinoma ------------T

D- inhibits dopamine receptors -----------------------------------------------F

E- is an ergot derivative ------------------------------------------------------T



b - Reduces growth hormone levels in the majority of patients. Improves visual fields, diabetes and may even shrink tumour. High doses needed - 10-20mg per day. Usually produces marked reduction in size of prolactinoma but Tumour enlargement and apoplexy has rarely been associated with bromocriptine use. d - Dopamine (DA 2) receptor agonist.

171.Common features of phaeochromocytoma include:

A- panic attacks ---------------------------------------------------------------T

B- bradycardia ----------------------------------------------------------------F

C- diarrhoea -------------------------------------------------------------------T

D- hypoglycaemia -------------------------------------------------------------F

E- hypokalaemia ---------------------------------------------------------------F



Typical features of phaeochromocytoma include paroxysmal panic attacks, sweats, anxiety, tremor, palpitations associated with variable hypertension - postural hypotension can also occur but is not common. Diabetes is a biochemical feature as is hypokalaemia. It is detected usually through elevated urine free metaadrenaline/normetadrenaline with a high sensitivoty and specificity. b-Reflex bradycardia. d-Hyperglycaemia.

172. In congenital adrenal hyperplasia caused by 21-hydroxylase deficiency the following are seen in increased amounts in the serum:

A- 17 alpha hydroxyprogesterone -------------------------------------------T

B- cortisol ----------------------------------------------------------------------F

C- aldosterone ----------------------------------------------------------------F

D- 11-deoxy corticosterone -------------------------------------------------F

E- ACTH ------------------------------------------------------------------------T



The characteristic biochemical abnormalities in 21 OHase deficiency CAH
are reduced cortisol plus aldosterone at the expense of elevated testosterone, 17OHP and as the pituitary detects a deficiency of cortisol there is increased ACTH. Plasma renin activity may also be elevated. 11 deoxycorticosterone may be increased in the much rarer 11-Hydroxylase deficiency

173.Regarding diagnostic ultrasound:

A- Is pulsatile ------------------------------------------------------------------T

B- Is ionising ------------------------------------------------------------------T

C- Is associated with a 1oC rise in body temperature after 15 mins of scanning -------------------F

D- High frequency ultrasound has greatest tissue penetration --------------------F

E- Cavitation is a recognised effect ----------------------------------------------------T





As a sound beam passes through tissue, some of the energy of this sound wave is absorbed by the tissue. However for low intensities of ultrasound, the heat deposited is quickly dissipated and does not build up. Cavitation is due to the generation, growth, vibration and possible collapse of microbubbles in the tissue. These microbubbles are generated by the ultrasound waves. These bubbles may “move” with the sound beam or some may oscillate so strongly that the bubbles collapse suddenly producing local effects

174. Concerning radiation physics:

A- An electron has a greater mass than a proton ---------------------------F

B- A positron has the same charge as an electron -------------------------F

C- A proton has a positive charge -------------------------------------------T

D- A neutron has almost the same mass as a proton ---------------------T

E- The hydrogen nucleus is a neutron ---------------------------------------F



The atom is composed of a nucleus containing the positively charged protons and neutral neutrons of roughly equal mass orbited by the smaller negatively charged electrons. A positron is an elementary particle of roughly equal size to an electron but positively charged. Hydrogen atomic weight 1 is composed of a proton in its nucleus.

175. In experimental conditions, ultrasound may produce biological effects on tissue by the following means:

A- Acceleration of cell division -----------------------------------------------F

B- Heat generation ------------------------------------------------------------T

C- Cavitation ------------------------------------------------------------------T

D- Duplication of chromosome numbers ------------------------------------F

E- Microstreaming -------------------------------------------------------------T


There are two principle bioeffects of ultrasound: Thermal and mechanical. Thermal is created through the impact of acoustic energy upon tissue. Mechanical bioeffects include cavitation through particulate streaming associated with the violent agitation of particles within the medium.

176. A 30-year-old female undergoes a Chest and abdominal X-ray arranged by her GP and does not realise that she is 7 weeks pregnant. Increased risk to which of the following are found in those children exposed in utero to such X irradiation

A- Acute lymphoblastic Leukaemia ------------------------------------------T

B- Intra-uterine growth retardation -----------------------------------------F

C- Mental retardation -------------------------------------------------------F

D- Diabetes -------------------------------------------------------------------F

E- Cerebral gliomas ---------------------------------------------------------T




It should be appreciated that the risks to the fetus are small following exposure to chest X-rays but the far more with direct exposure following abdominal exposure. Generally there is an increased risk of childhood leukaemias and cancers. There appears to be no evidence for IUGR, diabetes nor mental retardation - although IQ on a population basis is significantly lower.

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