Important MCQ colloction for part-1 MRCOG(1))

drsaima2000 wrote:1- 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

2- The antiphosphopholipid syndrome is associated with:

A- myocardial infarction ...............................T

B- venous thrombosis ..................................T

C- left ventricular thrombus ..........................T

D- pulmonary hypertension ..........................T

E- recurrent abortion ...................................T

Antiphospholipid syndrome is the association of arterial and venous thrombosis with antibodies directed against phospholipids. Originally noted as a complication in approximately 30% of patients with systemic lupus erythematosus, it is now also diagnosed in patients with thrombotic episodes and anti-phospholipid antibodies (aPL) but without clinical features of SLE - primary antiphospholipid syndrome. It is associated with MI, Recurrent miscarriages, DVT, Stroke, pulmonary hypertension (due to thromboembolic disease) and LV thrombus rarely reported.

3- Natural Killer cells .......

A- are a type of T lymphocyte ...................T

B- are predominantly found in lymph nodes ..............................F

C- express cell surface CD-3 ...................................................F

D- kill antibody coated cells ....................................................T

E- release tumour necrosis factor ...........................................T

a) Natural Killer cells are a lymphocytic lineage discrete from T + B lymphocytes and are involved in defence against malignancy, viruses and probably bacteria and parasites. b) rarely found in thymus / lymph nodes - unlike T cells c) NK cells are CD3-ve and CD16 and CD56 +ve (the opposite is true of T cells). d) NK cells kill spontaneously, are stimulated by IL-2 or antibody coated cells through binding to their CD16 receptors. e) and IFN gamma, granulocyte-macrophage colony stimulating factor and colony stimulating factor 1.....

Natural Killer (NK) cells are yet another type of lethal lymphocyte. Like cytotoxic T cells, they contain granules filled with potent chemicals. They are called "natural" killers because they, unlike cytotoxic T cells, do not need to recognize a specific antigen before swinging into action. They target tumor cells and protect against a wide variety of infectious microbes. In several immunodeficiency diseases, including AIDS, natural killer cell function is abnormal. Natural killer cells may also contribute to immunoregulation by secreting high levels of influential lymphokines.


Both cytotoxic T cells and natural killer cells kill on contact. The killer binds to its target, aims its weapons, and then delivers a lethal burst of chemicals that produces holes in the target cell's membrane. Fluids seep in and leak out, and the cell bursts.

4- Regarding Immunoglobulin:

A- Immunoglobulins are secreted from T-lymphocytes. ...................F

B- An immunoglobulin G (IgG) comprises 2 antigen-binding sites and a site for the binding of complement. .................T

C- The molecular structure of IgG is a Y shape ................T

D- IgG constitute approximately 25% of all immunoglobulis in a healthy individual...................F

E- IgMs can cross the placenta to the foetus. ...................F

Immunoglobulins (antibodies) are secreted from B-lymphocytes (plasma cells) in response to a specific antigen. Both antigen-binding sites are identical and consist of a long and heavy chain. IgGs constitute approximately 75% of all immunoglobulis in a healthy individual. Only IgGs can cross the placenta. This is important as they provide immune protection for the newborn in the first few months of life

5- Disinfectant solutions may become contaminated with:

A- Enterobacter species ....................T

B- Streptococcus species ................F

C- Escherichia coli .........................F

D- Pseudomonas aeruginosa (pyocyanea) ...................T

E- Staphylococcus pyogenes ........................F

6- Polymerase chain reaction :

A- can amplify RNA but not DNA........................F

B- It is of no value in prenatal diagnosis .............F

C- depends on thermostable Taq DNA polymerase .................T

D- requires primer bits either side ........................................T

E- uses heat to separate two strands of DNA .........................T
The Polymerase Chain Reaction (PCR) allows scientists to directly and exponentially amplify small samples of DNA and through reverse transcriptase PCR - RNA. The test may be used for the prenatal diagnosis of conditions such as Cystic fibrosis. d-this is a disadvantage because the primers have to be known

7- Under which circumstances would the efficacy of the combined oral contraceptive be reduced?

A- Oral tetracycline two months into treatment for acne .................F

B- Oral Rifampicin given as acute prophylaxis for meningitis ..........T

C- Oral Omeprazole given for Gastritis ..............F

D- Oral metronidazole given for trichomoniasis .............................T

E- Oral sodium valproate for epilepsy ...........................................F


Certain drugs are known to reduce the effectiveness of the OCP. Hepatic enzymeinducing antiepileptic drugs lower oral contraceptive pill hormone levels by approximately 40 percent. These include carbamazepine, rifampicin, phenytoin. Also antibiotics like ampicillin, tetracyclines and metrondazole may reduce the efficicay of the OCP. After taking tetracyclines for some time (as in acne) the bowel flora adapt and normal efficacy of COCP is reinstated, however, acute courses will result in reduced efficacy. In contrast, valproic acid (Depakene) and gabapentin (Neurontin) do not interfere with the effectiveness of oral contraceptive pills ....

Drug decreases effectiveness of oral contraceptive pills

Amoxicillin
Ampicillin
Carbamazepine (Tegretol)
Ethosuximide (Zarontin)
Metronidazole (Flagyl)
Phenobarbital
Phenytoin (Dilantin)
Primidone (Mysoline)
Rifampin (Rifadin)
Tetracycline
Troglitazone (Rezulin)

Oral contraceptive pills decrease effectiveness of drug

Clofibrate (Atromid-S)
Lorazepam (Ativan)
Oxazepam (Serax)
Salicylates
Temazepam (Restoril)


Oral contraceptive pills potentiate effect of drug

Benzodiazepines
Beta blockers
Caffeine
Corticosteroids
Theophylline
Tricyclic antidepressants

8- With regard to the DNA structures:


A- adenine (A) and guanine (G) are purine bases ...................T



B- guanine (G) always pairs with thymidine (T) and adenine (A) with cytosine (C) ...............F


C- each DNA strands have a pentose-phosphate backbone with projecting bases ..................T



D- there are 64 possible codons ....................T



E- each amino acids may be coded by more than one codon. ......T
Pyrimidine bases are thymidine (T) and Cytosine (C). G always pairs with C and T with A.

9- The adductor canal :



A- contains an artery which contributes to the genicular anastomosis .........T

B- contains a nerve supplying the tensor fascia lata muscle .................F

C- contains the deep femoral artery ...........................F

D- contains the nerve to the vastus medialis muscle ................T

E- contains the saphenous nerve .....................T

The adductor canal is a gutter shaped groove between the vastus medialis muscle and in front of the adductor muscle. The gutter is roofed by the sartorius muscle, underneath which a fascia contains the subsartorial plexus. The calan transmits the femoral artery and veing, saphenous nerve and, in the upper part, the nerve to the vastus medialis muscle. The tensor fascia lata muscle is supplied by the superior gluteal nerve (L4, L5, S1), which crosses the buttock and ends in the muscle.

10- Characteristic findings in anorexia nervosa are:

A- a decrease in Cortisol levels ...............................F

B- an increase in LH levels ......................................F

C- impaired glucose tolerance .............................T

D- raised androgen levels .....................................F

E- hyperkalaemia ..................................................F

a-Cortisol and growth hormone are elevated. b-LH and FSH low and LH response to LHRH is impaired when weight loss is severe. e-Hypokalaemia, hypoalbuminaemia, anaemia, leukopenia, raised serum carotene.

11- Mitochondrial DNA :

A- is inherited from both parents .........................F

B- is present in spermatozoa ..............................T

C- have their own genome .................................T

D- are expressed in neuronal tissue ..................T

E- only daughters of an affected mother could transmit the trait .........T

the mitochondria are in the tail but not transferred to the ovum and hence the mitochondrial DNA is not inherited from the father c - which code for cytochrome oxidase enzymes d - and other tissues rich in mitochondra resulting in neurological syndromes, myopathies and cardiomyopathies

12- In the human female :

A- one of the X chromosomes is activated .........................T

B- an inactivated X chromosome occurs in neutrophils as a drumstick on the nucleus ...............T

C- X chromosomes carry the gene for glucose-6-phosphate dehydrogenase ....T

D- the number of Barr bodies seen is eqivalent to the number of X chromosomes present .....F

E- clinically apparent haemophilia A cannot occur ................F

The chromatin nodule is the second (inactive) X chromosome; hence its absence in males. In polymorphonuclear leucocytes, a tiny nodule of chromatin (the Barr body, or nuclear drumstick) can be seen near the nuclear membrane of many cells in normal females, but not in normal males. G6PD deficiency is inherited as an X-linked disorder. 1 Barr body is seen in females and represents the one inactivated X chromosome of the pair. Haemophilia A is an X-linked recessive disorder and so it is possible for a female to be affected if a carrier female marries an affected male.

13- The following are true of genes :

A- The rate of DNA replication is directly under the control of enhancer sequences. .......F

B- Mitochondrial genes are inherited from the mother......................T

C- Transcription factors are mainly made of RNA...............................T

D- Introns are the portions of a gene which code for protein. .............F

E- Most of the human genome encodes polypeptide.........................F



A gene is a length of DNA that carries information to make a single peptide chain. However, it is estimated that only a few percent of DNA comprising the whole human genome consists of genes encoding protein. Introns are intervening sequences of unknown function in mammalian genes. Regulatory elements of gene transcription include promoters (regions of DNA to which RNA polymerase bind and initiate transcription), enhancer sequences (modify activity of genes on the same chromosome) and transacting proteins (modify genes on both pairs of homologous chromosomes). mRNA are transcripts of DNA, which are attached to transfer RNA and then translated in ribosomes to protein, which then undergo considerable post-translational changes. Mitochondrial inheritance is exclusively maternal, as none of the mitochondria from sperm survives fertilization.

14- C - reactive protein :

A- Is produced primarily in the affected tissue ........................F

B- Synthesis is initiated by the release of Adrenocorticotropic Hormone (ACTH) ........T

C- Is functionally analogous to immunoglobulin G (IgG) ...........................T

D- Shows an earlier and more intense increase than the erythrocyte sedimentation rate (ESR) in an acute inflammatory change.......F

E- Are increased when a patient is taking non-steroidal anti-inflammatory drugs ......F

CRP is an abnormal protein produced by the liver during an acute inflammatory response. Antigen-immune complexes to infecting agents and trauma initiate the synthesis of CRP. Although functionally analogous to IgG it is not antigen specific. CRP is more sensitive and responds more rapidly than ESR. NSAID's reduce the CRP response.

15- Labetalol:

A- Has alpha blocking action ............................................................T

B- Causes bronchodilation ...............................................................F

C- Decreases bile secretion ..............................................................T

D- Is 70% protein bound ..................................................................F

E- Has a half-life of 2 hours ..............................................................F


Labetalol is a combined beta and alpha adrenergic receptor antagonist with a ratio of activity between 2:1 and 5:1 respectively. It is selective for alpha-1 receptors but is non-selective for beta receptors. It is used to treat severe hypertension and pre-eclampsia and in hypotensive anaesthesia. Labetalol has a half-life of approximately four hours (not 2) and is approximately 50% protein bound. It has been shown to cross the placental barrier, but not the blood brain barrier. It is metabolised in the liver and excreted in the urine and faeces. Oral administration of the drug undergoes extensive first-pass metabolism. Severe hepatocellular damage has been reported after both short and long term use and the reduction of bile secretion may rarely lead to jaundice.

16- Which of the following are true about the Y chromosome?

A- the long arm is referred to as the p arm ........................................F

B- the long arm has variable length ..................................................T

C- it demonstrates fluorescence with quinacrine .................................T

D- the short arm contains gene for testicular formation .......................T

E- fragile Y chromosome is associated with mental retardation..............F


Fragile X syndrome is associated with mental retardation. The long arm of the Y chromosome is referred to as q, the short arm as p.

17- Autosomal dominant inheritance :

A- 25% of offspring are affected with an affected parent .....................F

B- is the mode of inheritance in multiple neurofibromatosis. ................T

C- affects both sexes equally..............................................................T

D- shows a pattern of vertical inheritance in a pedigree.....................T

E- always manifests at birth................................................................F
Autosomal dominant conditions include Huntingdon's, achondroplasia, MEN type 1. It affects both sexes equally, and 50% of offspring are affected with an affected parent.
e- nonsense as illustrated by the disorders mentioned.

18- Regarding the normal human nucleus:

A- The chromatin is arranged as 46 Chromosomes ...........................T

B- When the centromere is placed off centre, the chromosome is acrocentric ........F

C- Chromosomes which are metacentric have long and short arms ......F

D- Barbodies are present in males only ............................................F

E- The Y chromosome is smaller than the X chromosome ...................T

In the normal human there are 46 chromosomes. Metacentric refers to a centrally placed centromere submetacentric refers to a centromere near the end of one arm of the chromosome. Barbodies are found in female cells. The Y chromosome is half the size of the X chromosome.

19- Diazepam :

A- has a hypnotic effect ..................................................................T

B- has an anticonvulsant effect ........................................................T

C- has an antidepressant effect........................................................F

D- is a respiratory depressant .........................................................T

E- effects may be antagonised by naloxone .......................................F


Diazepam is a benzodiazepine and acts as a hypnotic, amnesic and anticonvulsnat through agonism at the cerebral GABA receptors. It may cause respiratory depression and these effects can be antagonised by Flumazenil

20- In a laser control area (LCA) :

A- Only a laser safety officer (LSO) is permitted to use the Laser.........F

B- Must be cleared of all personnel bar the person firing the laser.......F

C- Must be coated matt black surfaces. ............................................F

D- Eye protection must be worn........................................................T

E- Adequate ventilation must be provided...........................................T

An LSO is appointed from the staff of each department using the laser and has custody of the laser key. All persons using a laser should de suitable trained and be aware of all safety precautions. There should be control of personnel allowed to enter the area and the entrance
should be marked with appropriate illuminated warning signs. Reflective surfaces should be avoided. However, matt black surfaces are not necessary. Eye protection must be appropriate to the type of laser being used. The ventilation should include an extraction system to vent the fumes produced.


21- The human X chromosome :

A- has the gene for Duchenne Muscular Dystrophy on its short arm......T

B- is associated with the Y chromosome side by side during synapse formation in spermatogenesis..........F

C- in the female somatic cell is never completely inactivated...............T

D- is a metacentric chromosome........................................................F

E- in normal females may be seen as a chromatin body in a buccal smear analysis........T

Normally, the female complement is two X sex chromosomes. One is derived from each parent and one of the pair is also randomly inactivated by a process called lyonization at an early developmental stage. A chromtin body may be seen in buccal smears in normal females. It is cleaved from the Y chromosome during spermatogenesis.

22- Human immunodeficiency virus :

A- Is a single stranded DNA retrovirus ..............................................F

B- Induces a fall in CD4 lymphocytes, monocytes and antigen-presenting cells .........T

C- Increases the risk of opportunistic infection ................................T

D- Patients can be infective prior to seroconversion illness at about three months ...................T

E- The median survival with AIDS is greater than 10 years ..............F

HIV is a single stranded RNA retrovirus. It induces immunodeficeincy and increases the risk of opportunitsic infection (e.g. histoplasmosis, Pneumocystis carinii) and malignancy (e.g. Kaposi's sarcoma). Patients may have asymptomatic or symptomatic disease for several years before developing AIDS. The median survival with full AIDS is less than two years

23- The following statements about metronidazole are true.

A- It may produce a disulfiram-like action with alcohol .......................T

B- It may cause peripheral neuropathy with prolonged therapy............T

C- It is the treatment of choice for Trichomonas vaginalis infection.......T

D- Circulating concentrations may be affected by concomitant cimetidine administration.........T

E- It is suitable for the treatment of bacterial vaginosis.......................T

Advice should be given to patients to avoid alcohol when taking metronidazole due to a disulphiram reaction - sickness, abdominal pains, headache. Its metabolism is inhobited by cimetidine, which is a hepatic enzyme inhibitor. Other side effects include peripheral neuropathy, discolouration of urine and a metallic taste in the mouth. It is the treatment of choice for trichomonas and bacterial vaginosis.

24- The posterior pituitary gland:

A- Releases decapeptide hormones .................................................F

B- Synthesizes somatomedins .........................................................F

C- Secretes oxytocin .......................................................................T

D- Vasopressin release is controlled by the osmotic pressure of extracellular fluid ............T

E- Function is inhibited by alcohol ......................................................T

ADH, Oxytocin (synthesissed within the hypothalamus and released from the posterior pituitary) are nonapeptides. Somatomedins, IGF-1 and II are produced mostly by the liver under the influence of growth hormone. Vasopressin/ ADH release is controlled by the plasma osmolality and secretion is inhibted by alcohol.

25- 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.

26- By four weeks after fertilization the embryo:

A- Is about 2cm in length .................................................................F

B- Has a circulation of blood ............................................................T

C- Has a closed neural tube .............................................................F

D- Has developed limb buds .............................................................F

E- Has completed facial development ................................................F

At 4 weeks the embryo has a tail, open neural tube, gill arches, a primitive heart, which generates its own electrical rhythm, is located outside the body, allowing the growing organism to circulate nutrients and waste products and is about 0.5 cm in length. Limb buds have developed by about 8 weeks and facial development begins at this stage .

27- The Barr body

A- arises from the Y chromosome .............................................F

B- is present in subjects with Turner's syndrome ..............................F

C- is present in 20% of cells in the male ..........................................F

D- appears as a dense rod close to the cell wall ...............................F

E- is present in males with Klinefelter's syndrome .............................T


The chromatin nodule is the second (inactive) X chromosome. Normal women are thromatin positive. Normal men are chromatin negative. In polymorphonuclear leucocytes, a tiny nodule of chromatin (the Barr body, or nuclear drumstick) can be seen near the nuclear membrane of many cells in normal females, but not in normal males. Turner's XO does not have a Barr body. In Klinefelter's syndrome the sex chromosomal structure is XXY, and in them a chromatin nodule is seen.

28- Regarding surgical infection:

A- Primary refers to a planned surgical trauma.................................F

B- Always have a focus of infection....................................................T

C- Are always associated with tissue necrosis....................................T

D- Inflammation is the response to tissue necrosis..............................T

E- Antibiotics are advised once a septic focus has been drained...........F

Primary surgical infections refer to surgical wounds which appear spontaneously e.g. a skin abscess.
Surgical wounds differ from non-surgical wounds in that they always have a source of infection, which can be drained surgically.
Tissue necrosis results from trauma or through a pathophysiological process. Inflammation leads to the events visible at the surface. Once the source of infection has been drained, antibiotics are usually unnecessary unless the surrounding tissues are infected.

29- Regarding the obturator nerve:

A- it emerges from the lateral border of psoas major ..........................F

B- is formed from the ventral divisions of 2nd,3rd and 4th lumbar nerves .......T

C- supplies the lateral margin of the knee .........................................F

D- has a branch separated by adductor brevis ..................................T

E- lies below the obturator artery in the obturator foramen ................F

The obturator nerve arises from the ventral divisions of the second, third, and fourth lumbar nerves; the branch from the third is the largest, while that from the second is often very small. It descends through the fibers of the Psoas major, and emerges from its medial border near the brim of the pelvis; it then passes behind the common iliac vessels, and on the lateral side of the hypogastric vessels and ureter, which separate it from the ureter, and runs along the lateral wall of the lesser pelvis, above and in front of the obturator vessels, to the upper part of the obturator foramen. Here it enters the thigh, and divides into an anterior and a posterior branch, which are separated at first by some of the fibers of the Obturator externus, and lower down by the Adductor brevis.

30- The greater sciatic foramen transmits the following :

A- piriformis muscle .......................................................................T

B- internal pudendal vessels ...........................................................T

C- Sciatic nerve .............................................................................T

D- Posterior femoral cutaneous nerve ..............................................T

E- sacrospinous ligament .................................................................F

The greater sciatic foramen transmits all of the above, apart from the sacrospinous ligament which forms part of the foramen itself and the tendon of the obturator internus muscle which passes through the lesser sciatic foramen.