Welcome to your Recall 2

1. What percentage of lymphocytes is present in peripheral blood?

2. A 65-year-old woman has a sudden onset loss of speech and hemiparesis. On arrival in hospital her symptoms and neurological examination is suggestive of a cerebrovascular incident. Subsequent imaging supports the diagnosis of an ischaemic stroke, affecting her left cerebral hemisphere. Which of the following forms of tissue necrosis is associated with her loss of function?

3. Which of the following immunoglobulin class has a dimeric structure?

4. Which of the following is the main cellular origin of clotting factor VIII (antihemophilic factor)?

5. Which class I major histocompatibility complex human leucocyte antigen (HLA) is expressed only in extravillous trophoblast?

6. How many sperm are produced in the testes each day?

7. Clomifene citrate is a commonly used drug for the induction of ovulation. What type of drug is clomifene citrate?

8. The complement system consists of a number of small proteins found in the blood. Which of the following is the major site of synthesis of complement proteins?

9. Botulinum toxin is now used to treat neurogenic bladder because of its ability to

10. Which of the following structures passes through the lesser sciatic foramen?

11. A 50-year-old woman, recently diagnosed with ovarian cancer, started her first cycle of chemotherapy. Several days after a treatment, she notes that she has blood in her urine. Cystoscopy reveals haemorrhagic cystitis. Which of the following antineoplastic drugs is most likely responsible for this side effect?

12. Luteinizing hormone (LH) is structurally related to what other glycoprotein hormones? 

13. Approximately what percentage of the total human DNA is mitochondrial DNA?

14. Your consultant asks you to prescribe a 3 month course of ulipristal acetate to a patient with fibroids prior to having a hysterectomy. To which class of drugs does ulipristal acetate belong?

15. Which of the following arteries supplies foregut derivatives of the digestive system?

16. What of the following is the major buffer in urine?

17. Glucocorticoids are secreted from which region of the adrenal gland?

18. How many carbon atoms do androgens contain?

19. From which germ cell layer is the allantois derived?

20. Which process establishes the three definitive germ layers? 

21. Which one of the following is the termination of round ligament? 

22. Ductus venosus is completely obliterated after birth to form what adult structure?

23. An inherited metabolic disorder called phenylketonuria (PKU) can result in serious problems in infancy. Via which pattern of inheritance is the PKU? 

24. The ureteric bud is derived from which of the following embryonic structures?

25. Which part of the endometrium is deep to the fetus and forms the maternal component of the placenta?  

26. Choriocarcinoma is a malignant form of gestational trophoblastic disease. When choriocarcinoma metastasises, it has a propensity for which type of spread?

27. Ondansetron is an effective antiemetic. Which of the following best describes the mechanism of action of Ondansetron?

28. What type of joint is formed at the sacroiliac joint?

29. Which one of the following stages of the cell cycle is cell prepared for DNA synthesis?

30. The formation of uric acid from purines is catalyzed by the action of 

31. A 19-year-old woman gives birth to her first child. She begins breast feeding the infant. She continues breast feeding for almost a year with no difficulties and no complications. Which of the following cellular processes that occurred in the breast during pregnancy allowed her to nurse the infant for this period of time? 

32. What is the embryonic origin of the trigone of urinary bladder?

33. Misoprostol is a commonly used drug in the medical treatment of miscarriage. What type of drug is misoprostol?

34. What is the most common contrast agent used for MRI examinations?

35. Defective feedback control of calcium hemostasis may lead to secondary hyperparathyroidism. It is usually associated with 

36. What is the mechanism of action of labetalol? 

37. The deep circumflex iliac artery is a branch of which artery? 

38. What is the SI unit for the absorbed dose of ionizing radiation?

39. Which organ is the principal site of urea synthesis via the urea cycle?

40. What is the most common cause of caushing's syndrome? 

41. Which of the following is a remnant of the mesonephric duct in the female? 

42. What is the most common cause of hyperprolactinemia?

43. Where in the kidney is the majority of bicarbonate reabsorbed? 

44. What type of inheritance pattern does duchenne muscular dystrophy follow?

45. What is the Lymphatic drainage of cervix and upper vagina? 

46. Vertical transmission of HIV infection mostly occurs 

47. From what parent compound are most eicosanoids derived? 

48. What kind of epithelium lines the ectocervix?

49. A patient asks you how long it will be before her C-section wound is "at maximum strength." What is the typical time taken for wounds closed by primary intention to reach maximum tensile strength?    

50. In the developing foetal testis, the cells that produce mullerian-inhibiting substance are the

51. A 27-year-old woman who is 8 weeks' gestation presents to your clinic with increased sweating on her face. On examination there are no remarkable findings. Which of the following endocrine glands is related to increase activity of sweat glands during pregnancy? 

52. A 60-year-old woman presents with an erythematous erosive lichen planus on the vulva. What type of cancer is linked to lichen planus?

53. Which of the following hormones enhances urinary excretion of calcium?

54. Which immunoglobulin is a key to passive neonatal immunity?

55. Which of the following tocolytic agents exert their effects by blocking the function of the oxytocin receptor?

56. Which of the following hormones increase after ovulation and decrease the proliferation of endometrium? 

57. You are assessing a patient with an ovarian mass and are using the Risk of Malignancy Index (RMI) score. Which of the following is used to calculate the RMI?

58. What is the most common adverse effect experienced by women using depot medroxyprogesterone acetate (DMPA)?

59. A 30-years-old primigravida presents in a spontinous labour at 41 weeks of gestation. On vaginal examination the cervix is 8 cm dilated and the position of the vertex is left occipto-posterior. What is the presenting diameter?

60. A neoplasm of the female genital tract occurring in an 18-year-old girl whose mother was treated with diethylstilbestrol during the pregnancy is likely to be a

61. Six hours after undergoing a laparoscopic tubal ligation, a 32-year-old woman complains of suprapubic pain and oozing. On examination there is a tender palpable suprapubic mass rising up to the umbilicus that is dull to percussion. Her hemoglobin level is 11 g/dl. What is the most likely diagnosis? 

62. A grand multiparous woman has a postpartum haemorrhage soon after delivery. One liter of a colloid solution has already been given intravenously. She has a pulse rate of 140 beats per min, is anxious, confused and hypotensive with a capillary refill time of 3 seconds. What do you think is the estimated blood loss as a percentage of blood volume thus far based on clinical findings?

63. A 31-year-old nulliparous woman has heavy bleeding at 8 weeks’ gestation. An early pregnancy scan is suggestive of a molar pregnancy, and no fetus is observed. What is the most likely genotype of a complete molar pregnancy? 

64. Mechanism of action of Neostigmine is 

65. Which term best describes a homogeneously black area on an ultrasound image?

66. Which of the following arteries may occasionally arise as a branch of the external iliac artery or inferior epigastric artery instead of as a branch of the internal iliac artery? 

67. Blood supply to the medial part of the anterior abdominal wall below the umbilicus

68. Some-town in the UK, has a population of 350,000. During 2010, data pertaining to deliveries and there outcome is as follows:  Total number of live births: 20000  Total number of in utero deaths delivered bet. 22+0 and 23+6 weeks gestation: 200 Total number of stillbirths: 140 Total number of neonatal deaths during first week after birth: 40 Total number of neonatal deaths during second to fourth weeks after birth: 80 Which of the following represents the perinatal mortality rate in this town during 2009? 

69. A 30-year-old woman with bipolar disorder is 12-week pregnant. She has been taken her lithium every night. Which of the following abnormality may occur if she continues to take lithium?

70. Which part of the cell cycle is noted for sister chromatids separating and moving to opposite sides of the cell?

71. Remifentanil is an ideal controlled analgesia for management of labour pain because

72. In the development of the oocyte, when does the second meiotic division occur? 

73. A 48-year-old woman visits her GP complaining of pain on the inner surface of her right thigh. A detailed history reveals that she has recently experienced some dull, diffuse pain in the lower right abdominal wall. She is sent for a CT scan which reveals an inflamed right ovary. Which nerve is referring pain from the parietal peritoneum near the ovary to the inner thigh?

74. The following cell contain haploid number of chromosomes and results after completion of the 1st meiotic division

75. Which of the following techniques is used to increase the number of copies of a specific DNA sequences?

76. A 40-year-old female suffers from a 2 x 2-cm vulval lesion. Biopsy demonstrates a malignant melanoma. The prognosis of this tumour best depends upon

77. The estrogen receptor is an example of a

78. A 28-year-old woman has undergone emergency hysterectomy due to obstetric haemorrhage during her 3rd pregnancy. The previous pregnancies were both term C-section deliveries. Examination of the uterus shows the placenta had invaded the myometrium up to the serosa. What is the most likely diagnosis? 

79. Which of the following metabolic processes produces the most energy needed for uterine contraction during parturition?

80. A couple with primary subfertility, who have been trying to conceive for over 12 months, attends a reproductive medicine clinic. The male partner has already given a semen sample for analysis with the following results: Progressive motility: 35%  Total sperm number: 32 million spermatozoa  Normal morphology: 5%  Vitality: 63% live spermatozoa Liquefaction time: 30 min  pH: 7.3  What is the correct interpretation of this semen analysis? 

81. What is the most common inherited bleeding disorder?

82. Which of the following structure consists of two bands of connective tissue and also support the bladder?

83. A 40-year-old woman complains of heavy menstrual bleeding for five years. Ultrasound scan has revealed no abnormality. Her family is complete. She desires an endometrial ablation. Which part of the uterus must be destructed to stop bleeding?

84. The rate of growth hormone secretion follows a circardian rhythm. When is the highest peak of growth hormone release?   

85. The optimal ratio between suture and wound length that is associated with a lower rate of incisional hernia is

86. Which nerve is identified by its position on the anterior surface of the psoas major muscle?

87. How many days does it take from the resting follicle stage to ovulation?

88. The capsule of the developing Graafian follicle is 

89. The probability of sarcomatous change occurring in uterine fibroids is

90. After an elective caesarean section the anesthetic team decided to perform an ultrasound-guided transversus abdominis plane block for analgesia. If the needle is correctly positioned where will be deposit the local anesthetic

91. The most common in uetro infection causing fetal anemia in the UK is 

92. A 25-year-old woman has a routine smear test for the first time. She complains of discomfort during the procedure. Which nerve or nerve plexus provided sensory innervations to the cervix? 

93. In a female who has BRCA 1 gene, besides hereditary breast and ovarian cancer, what is the next most common cancer she may develop?

94. What is the most common clinically significant congenital heart disease?

95. Warfarin inhibits which clotting factors?

96. The enzyme which builds an mRNA strand complimentary to the DNA transcription unit is called?

97. Haemophilus ducreyi is the causative agent of

98. Which of the following divisions of cell growth precedes Mitosis in the cell cycle?

99. A 26-year-old pregnant woman is found to have an Hb of 11 g/dL on a routine blood test, with an MCV of 70. Serum electrophoresis reveals an Hb F of 0.5 per cent, Hb A1 of 60 per cent, Hb A2 of 2 per cent and Hb S of 40 per cent. Her ferritin levels are normal. The most likely diagnosis is 

100. A 22-year-old primiparous woman books her pregnancy at 11 weeks’ gestation. Her booking blood tests reveal a haemoglobin level of 10.1 g/dL. Haemoglobin electrophoresis reveals homozygous for HbS, she has no HbA

101. A 28-year-old Asian woman G2P2 is 26 weeks pregnant. Her BMI is 30 kg/m2.  Her oral glucose tolerance test reports (75 g load) are as follows:  Fasting serum glucose: 4.2 mmol/l  2-hour serum glucose: 7.4 mmol/l  What is the diagnosis?

102. You see a patient on the ward who is acutely short of breath and perform an arterial blood gases (ABG). The results are as follows:  pH 7.25  pO2 8.6 kPa  pCO2 8.4 kPa HCO3- 28 mmol/l   What is the acid-base disturbance? 

103. Which hemoglobin (Hgb) result represents the lowest acceptable value for a woman in the second trimester of pregnancy?

104. Terbutaline is a β-adrenergic receptor stimulator that is used to arrest preterm labor. Which of the following is a major maternal risk of its use?

105. A 32-year old woman complains of amenorrhea since delivery of a baby 15 months ago. The delivery was complicated by excessive hemorrhage that required transfusion of 2.5 liters of blood. Few days later she complained of failure to produce any breast milk. The most likely cause for this is damage to which of the following endocrine glands?

106. During which week of pregnancy are normal cardiovascular and hematological changes early begin?

107. Which of the following eicosanoids cause arteriolar vasospasm before menstruation?

108. One month after cesarean section, a 25 year old woman palpates a small nodule beneath the skin at the site of the healed incision. The skin was closed using absorbable sutures. The nodule is excised, and polarizable refractile material is seen in the nodule. Which of the following cell types is most likely to be most characteristic in this inflammatory response?

109. Which two HPV subtypes are responsible for around 90% of genital warts and are targeted in HPV vaccines?

110. A 16-year-old girl has recently become sexually active. She complains of intensely irritating greenish frothy vaginal discharge. The organism is seen under microscope in a drop of saline and PH is 6. What is the most likely causative organism?

111. Caput medusae are due to engorgement of which of the following vessels?

112. Regarding cardiac changes during pregnancy. Which of the following ECG findings during pregnancy should be considered normal? 

113. A woman is 8 weeks pregnant attends for genetic counseling. She is known to be a carrier of cystic fibrosis and her sister has a child with cystic fibrosis. Her husband is Caucasian and the carrier rate for cystic fibrosis in the Caucasian descent is 1 in 25. What is the risk of the child having cystic fibrosis? 

114. A woman and her husband are known carriers of cystic fibrosis. What is the probability of them having an affected child?

115. A 30-year-old woman primiparous at 34 weeks' gestation comes to the prenatal facility concerned about reddish purple striae she has increasingly developed on her breast and abdomen. Which of the following hormones is the most likely responsible for her symptoms?

116. The process of programmed gene directed cell death characterized by blebbing, cell shrinkage, nuclear condensation and fragmentation is known as

117. You see a 21-year-old woman in clinic complaining of vaginal discharge for the last 3 days. She has recently become sexually active with a new boyfriend. Analysis of the discharge reveals gram-negative intracellular diplococci with scant neutrophils. Which organism is most likely to be responsible?  

118. The most biologically active form of vitamin D is

119. You review a 65-year-old woman with known urinary urgency and prescribe oxybutynin. Which of the following diseases is aggravated by the use of this drug?

120. Which of the following drugs is most appropriate for treating uncomplicated Chlamydia?

121. A 26-year-old woman has just given birth and her newborn baby undergoes assessment. His body is pink with blue extremities and has a pulse of 105 bpm. He appears to be limp and taking slow, gasping breaths. He also grimaces in response to stimuli. What is his APGAR score?

122. A 23-year-old primigravida is booked with midwife at 21 weeks. She reveals that she had female circumcision done when she was a child. On examination the clitoris is completely absent. You are to document the type of female genital mutilation. What type of female genital mutilation is this best described as?

123. The most common cause of delay in puberty in males is

124. What is the mechanism of antibacterial action of penicillin?

125. The ratio between indirect to direct maternal cause of death in UK is 

126. What type of joint is formed at the symphysis pubis?

127. Which muscles form the pelvic diaphragm?

128. Biological actions of progesterone on estrogen include which of the following? 

129. Which is the commonest type of malignant ovarian neoplasm?

130. At the end of surgery you notice an area of burn near the attached diathermy plate. The diathermy plate seems to be partially detached. Which of the following would be the most likely aetiology?

131. Which type of pituitary gland tumors increase growth hormone secretion lead to acromegaly? 

132. The ovarian artery is a branch of

133. A 62-year-old postmenopausal woman presents for her annual physical exam. On exam of you find a small pink exophytic lesion outgrowth out of the urethra. Otherwise there is no remarkable finding. What is the most likely diagnosis?

134. Which type of cell junctions helps in transmission of small molecules or ions from one cell to another?

135. A 15-year-old girl attends the genitourinary medicine clinic complaining of frothy yellow vaginal discharge. She is sexually active with her 17-year-old boyfriend and uses the oral contraceptive pill. Speculum examination reveals haemorrhages on her cervix. A urine pregnancy test is negative. Considering the most likely diagnosis, what is the most appropriate first line antibiotic?

136. Which of the following investigations is used to determine hormone receptor expression 'receptor status' of the breast cancer? 

137. A 24-year-old female presents with severe pain during menses. To treat her symptoms, you advise her to take indomethacin in the hopes that it will reduce her pain. What type of drug is indomethacin?

138. Which neurotransmitter is secreted onto the adrenal medulla?

139. Which of the following defines perinatal mortality using the International classification of diseases-10 (ICD-10)?

140. A 27-year-old woman has a smear test as part of the UK screening programme. Following an abnormal result she attends a colposcopy clinic. On colposcopy, the whitened appearance of her cervix on application of acetic acid is suggestive of a human papilloma virus (HPV) infection. Which of the following HPV subtypes is high-risk for the development of cervical intraepithelial neoplasia?