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Questions for FRACP Candidates 2009

 Question 1

In a 30 year old woman of normal body habitus the most likely cause of a high prolactin 2000 (RR <500) is

  1. Pituitary microadenoma
  2. Pituitary macroadenoma
  3. Premature ovarian failure
  4. Renal impairment
  5. Illicit drug use

 Question 2

Effective agents for the treatment of hyperprolactinemia for which there is good evidence of safety in pregnancy are

  1. Cabergoline
  2. Bromocriptine
  3. Quinagolide
  4. 1 and 2
  5. All of the above

 Question 3

Which of the following are mandatory as part of the investigation of hyperprolactinemia in a woman?

  1.  MRI pituitary
  2. BMD
  3. TSH
  4. Examination of the breasts
  5. All of the above

 Question 4

In relations to polycystic ovarian syndrome   (PCOS) which of the following are true?

  1. PCOS has a proven increased risk of symptomatic cardiovascular disease              
  2. PCOS occurs in 25% of women
  3. PCOS is associated with increased risk of diabetes mellitus in obese women
  4. 1 and 3 are true
  5. All of the above are true

Question 5

The efficacy of metformin in PCOS has been demonstrated in randomised controlled trials for each of the following outcomes and conditions:

  1. Weight loss in obesity
  2. Reduced Ferriman and Gallwey score in hirsutism
  3. Reduced progression to diabetes mellitus from impaired glucose tolerance
  4. Improved ovulation in anovulatory women
  5. Both 3 and 4

Question 6

 Which of the following statements about the  association between epilepsy and polycystic ovarian syndrome  (PCOS)is false.

  1.  Neurological conditions which predispose to epilepsy may also predispose to PCOS
  2. Anti-convulsant therapy such as valoproic acid may produce a reversible PCOS like phenotype.
  3. Women with epilepsy have a higher congenital abnormality rate compared to women without epilepsy.
  4. High dose folic acid does not reduce the increased neural tube defects seen with valproic acid.
  5. Changes in pregnancy may result on changed pharmacokinetics of anticonvulsants and result in worsened seizure control.

Question 7

The combined oral contraceptive pill is frequently prescribed for women with polycystic ovary syndrome.  The use of the combined oral contraceptive pill with polycystic ovary syndrome is associated with which one of the following:

  1.  Reduction in the risk of diabetes mellitus.
  2. Weight gain.
  3. Reduced manifestations of hyperandrogenaemia. 
  4. Improved insulin sensitivity
  5. Increased risk of osteoporosis

Question 8

The proven indications of the use of metformin with polycystic ovary syndrome include:

  1. To facilitate weight loss.
  2. To reduce the risk of transmission from impaired glucose tolerance to diabetes mellitus.
  3. To reduce hirsutism.
  4. To reduce of the risk of ischaemic heart disease.
  5. To reduce the risk of early miscarriage.

Question 9

Components of the metabolic syndrome include:

  1.  Hypertriglyceridaemia
  2. Hypertension
  3. Android obesity
  4. Diabetes mellitus
  5. Impaired glucose tolerance
  6. All of the above

Question 10

Diagnosis of polycystic ovary syndrome requires exclusion of:             

  1. Cushing’s syndrome
  2. Adrenal tumours
  3. Hyperprolactinaemia
  4. Late onset congenital adrenal hyperplasia
  5. All of the above

 Question 11

In relation to the use of metformin, the following statements are true except

  1. Slow introduction. (reduced initial dosage) is required
  2. metformin is associated with dose related diarrhoea.
  3. metformin is associated with B12 deficiency.
  4. metformin causes hypoglycemia.
  5. dose should not exceed 3g per day.

Question 12

Which of the following is NOT helpful for the treatment of hirsutism in women with PCOS   

  1. Spironolactone.  
  2. Finasteride.  
  3. Cyproterone acetate
  4. Topical eflornithine.  
  5. Clomiphene.  

Question 13

Methods which reduce the progression of impaired glucose tolerance to diabetes include the following except:

  1. Metformin
  2. Bariatric surgery
  3. Bilateral salpingo-oophorectomy
  4. Intensive lifestyle programme to induce weight loss

 Question 14

A 16 year old nulligravid is referred with oligomenorrhea.  Menarche occurred at the age of 14 and she has had 4 periods a year since.   She competes in athletics at State level and denies weight change.  She has no excess body hair and has not been sexually active.

The most likely cause is

  1. Lean PCOS
  2. Hypothalamic amenorrhoea
  3. Premature ovarian failure
  4. Drug induced

Question 15

Polycystic ovary syndrome is known to be associated with an increased risk of diabetes mellitus.  The following comments about the risk of diabetes mellitus are true:

  1. Obese women with polycystic ovary syndrome have an risk of developing diabetes mellitus of approximately  700% compared to age matched  and weight matched controls.
  2. Lean women with polycystic ovary syndrome have an elevated risk of diabetes roughly 3 fold compared with age matched  and weight matched controls.
  3. The risk of progression to diabetes mellitus from impaired glucose tolerance is reduced with the taking of metformin in the dose of 850mgs  daily. 
  4. The risk of diabetes mellitus is reduced  slightly by a lifestyle of reduced dietary intake and increased exercise.

Question 16

You are asked to see a 25 year old woman who has recently had an IVF cycle  in the emergency department.   She is worried that she has ovarian hyperstimulation syndrome and her gynaecologist has left town to attend a conference.  She has dyspnea and has been vomiting over the last 4 hours.    She has abdominanal distension and discomfort reequiring narcotics.  She is tachycardic 120 with a BP 100/50.  She had an oocyte collection under general anaesthesia six days ago and had a single blastocyst transferred to the uterine cavity yesterday.

Which of the following is true?

  1.  Her greatest risk is thrombotic complications
  2. She is likely to get recurrence of symptoms in 10 days time if she gets pregnant
  3. If she has a pleural effusion, drainage of the effusion will be curative
  4. Both 1 and 2 are correct
  5. 1 2 and 3 are correct


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