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Nelson Textbook of Pediatrics, 2-Volume Set, 20e

After more than 75 years, Nelson Textbook of Pediatrics remains your indispensable source for definitive, state-of-the-art answers on every aspect of pediatric care. Embracing the new advances in science as well as the time-honored art of pediatric practice, this classic reference provides the essential information that practitioners and other care providers involved in pediatric health care throughout the world need to understand to effectively address the enormous range of biologic, psychologic, and social problems that our children and youth may face.

MRCPCH MasterCourse: Two Volume Set with DVD and website access

MRCPCH MasterCourse: Two Volume Set with DVD and website access, 1e (MRCPCH Study Guides) (Vol. 2) Pap/DVD/Ps Edition

Te Linde’s Operative Gynecology

Te Linde’s Operative Gynecology has been the premier text in the field of gynecologic surgery for more than 60 years. This text covers all of the aspects of gynecologic surgery – from the most general topics of surgical ethics to instruction on detailed surgical procedures. General background/pathology for surgical problems is covered as are patient/treatment selection, step-by-step surgical techniques and post-operative concerns.

Physiological Changes During pregnancy:

Physiological Changes During pregnancy: 

1. The following are presumptive skin signs of pregnancy except: A. Chloasma B. Maculo-papular rash C. Linea Nigra D. Stretch Marks C. Spider Telangiectases 

2. The resting pulse in pregnancy is: A. Decreased by 20 bpm. B. Decreased by 10 to 15bpm. C. Unchanged. D. Increased by 10 to 15 bpm. E. Increased by 20 bpm. 

3. Normally, pregnancy in 2ND trimester is characterized by all of the following EXCEPT: A. Elevated fasting plasma glucose. B. Decreased fasting plasma glucose. C. Elevated postprandial plasma insulin. D. Elevated postprandial plasma glucose. E. Elevated plasma triglycerides. 

4. All are CORRECT, EXCEPT, Pregnancy is associated with: A. Increase cardiac output B. Increase venous return C. Increase peripheral resistance D. Increase pulse rate E. Increase stroke volume 

5. During normal pregnancy: Which is true? A. Estradiol is the principal circulating estrogen B. The blood pressure increases in first and second trimester C. The tidal volume is reduced D. In The second half of pregnancy, amniotic fluid is mostly contributed fetal urine E. Maternal hydroureters should be taken always as a serious pelvic condition 

6. In normal pregnancy, all of the following are true EXCEPT: F. Glucosuria increases. G. Plasma aldosterone concentration falls. 

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H. Creatinine clearance is increased. I. Folate excretion is increased. J. The presence of less than 300mg of proteins in 24hours urine collection is considered normal 

7. In normal pregnancy, levels of all of the following hormones increases EXCEPT: A. Total thyroxine (T4) B. Parathyroid hormone (PTH) in the 2ND & 3RD trimesters. C. Free cortisol. D. Prolactin. G. Estradiol  

8. The increase in blood volume in normal pregnancy is made up of: A. Plasma only. B. Erythrocytes only. C. More plasma than erythroblasts. D. More Erythrocytes than plasma. E. All of the above. 

9. In the fetus, the most well oxygenated blood is allowed into the systemic circulation by the: A. Ductus arteriosus. B. Foramen ovale. C. Rt. Ventricle. D. Ligamentum teres. E. Ligamentum venosum  

10. Changes in the urinary tract system in pregnancy include: A. Increase the glomerular filtration rate (GFR). B. Decrease in renal plasma flow (RPF). C. Marked increase in both GFR & RPF when the patient is supine. D. Increase in the amount of dead space in the urinary tract. E. Increase in BUN & creatinine. 

11. Lowered Hemoglobin during normal pregnancy is a physiological finding. It's mainly due to: A. low iron stores in all women. B. Blood lost to the placenta C. Increased plasma volume. D. Increased cardiac output resulting in greater red cell destruction. E. Decreased reticulocytosis  

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12. The Maternal blood volume in normal pregnancy: A. remains stable. B. Decreases 10%. C. Increases 10% D. Increases up to 40% E. Decreases up to 40%. 

13. During pregnancy, maternal estrogen levels increases markedly. Most of this estrogen is produced by the: A. Ovaries. B. Adrenals. C. Testes. D. Placenta. E. Uterus. 

14. During normal pregnancy, the renal glomerular filtrate rate (GFR) can increase as much as: A. 10%. B. 25%. C. 50%. D. 75%. E. 100%. 

15. Fetal blood is returned to the umbilical arteries & the placenta through: A. Hypogastric arteries. B. Ductus venosus. C. Portal vein. D. Inferior vena cava. E. Foramen ovale. 

16. In normal physiological changes in pregnancy, all of the following are increased EXCEPT: A. Glomerular filtration rate. B. Stroke volume. C. Peripheral resistance. D. Plasma volume. E. White blood cells. 

17. Regarding Renal changes in pregnancy, all of the following are true EXCEPT: A. Blood flow is increased by 10%. B. Glomerular filtration rate is increased by 50%. C. Plasma urea will be reduced. D. Glycosuria could be normal. E. Mild hydronephrosis is normal. 

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18. Consequences of fluid retention, all of the following are CORRECT, EXCEPT: A. Hemoglobin concentration decreases. B. Hematocrit falls. C. Serum albumin falls. D. Stroke volume increases. E. Renal blood flow increases  

19. During Pregnancy, all of the following are CORRECT EXCEPT: A. There will be hyperplasia & hypertrophy of the uterine muscle. B. Estradiol will increase the columnar epithelial of the endocervix. C. Estrogen will increase the glandular duct. D. Progestin & HPL will decrease the number of glands. E. Prolactin will be antagonized by the effect of estrogen  

20. Regarding renal tract during pregnancy, the following are true EXCEPT: A. The ureters are dilated. B. The renal pelvis calyces are dilated. C. The right side is affected more then the left side. D. The primigravida shows more changes then multigravida. E. The bladder tone increases. 

21. As pregnancy advances, which of the following hematological changes occurs? A. Plasma volume increases proportionally more than red cell volume. B. Red cell volume increases proportionally more than plasma volume. C. Plasma volume increases & red cell volume remains constant. D. Red cell volume decreases & plasma volume remains constant. E. Neither plasma volume nor red blood cell volume changes. 

22. Which of the following would normally be expected to increase during pregnancy: A. Plasma creatinine. B. Thyroxin-binding globulin. C. Hematocrit. D. Core temperature. E. Hair growth. 

23. The supine position is important during late pregnancy because it may cause all of the following EXCEPT: A. Complete occlusion of the inferior vena cave. B. A significant decrease in maternal ventilatory capacity. C. Hypotension & syncope. D. A significant reduction in renal blood flow & glomerular filtration. E. Augmentation of the cardiovascular effects due to high conduction  

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24. Which of the following is probably responsible for physiologic hyperventilation during pregnancy? A. Large fluctuations in plasma bicarbonate. B. Increased estrogen production. C. Increased progesterone production. D. Decreased functional residual volume. E. Decreased plasma PO2 

25. Normally the pregnant woman hyperventilates. This is compensated by: A. Increased tidal volume. B. Respiratory alkalosis. C. Decreased Pco2 of the blood. D. Decreased plasma bicarbonate. E. Decreased serum pH. 

26. The resting pulse in pregnancy is : A. Decreased by 30 beats /min. B. Decreased by 10-15 beats/min. C. Unchanged. D. Increase by 30 beats/min. E. Increased by 10-15 beats/min. 

27. After birth, all of the following vessels constrict EXCEPT: A. Ductus arteriosus. B. Umbilical arteries. C. Ductus venosus. D. Hepatic portal vein. E. Umbilical vein. 

28. Select the most correct statement about fetal & neonatal IgM: A. It is almost entirely maternal in origin. B. It is approximately 75% maternal & 25% fetal in origin. C. It is 50% maternal, 50% fetal in origin. D. It is 25% maternal, 75% fetal in origin. E. It is almost entirely fetal in origin  

29. Which one is true about the placenta: A. 10% maternal contribution only B. U.C covered with chorion C. U.C contain wharlton jell D. Placental lobes are the functional units. 

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30. Spinnbarkheit is a term which means : A. Crystallization of the cervical mucous. B. Thickening of the cervical mucous. C. Mucous secretion of the cervix. D. Threading of the cervical mucous. E. Thinning of the cervical mucous. 

31. Regarding Placental function: A. hCG is a glycoprotein composed of alpha & β subunits. It's secreted by cytotrophoblast. B. Human placenta lactogen enhances insulin action & improves glucose tolerance. C. Placental Corticotropin releasing hormone increases ACTH & cortisol & causes vasoconstriction of the feto-placental blood vessels. D. Estrogen is secreted by the feto-placental unit responsible for the growth of the myometrium & angiogenesis. E. Progesterone causes vasodilatation of blood vessels & contraction of uterine smooth muscle. 

32. Regarding placental anatomy: A. The decidua capsularis forms part of the placenta. B. The fetal side of the placenta is divided into 30-40 cotyledons. C. The intervillous space contains fetal blood. D. Anatomically the placenta id fully formed by 30 weeks. E. Fetal blood vessels develop in the mesenchymal core of the chorionic villi. 

33. Which of the following does NOT accurately describes the placenta in humans: A. 15-20 cm in diameter. B. 2-4 cm thick. C. Weighs about 1/6 of what the term infant does. D. Delivered from maternal & fetal tissue. E. Umbilical cord originates from the center of the placenta in all most of the cases. 

34. Maternal serum Prolactin levels in pregnancy are highest: A. At the end of gestation just before delivery of the infant. B. Just after the delivery of the infant. C. As the placenta is released. D. The 3RD to 4TH day postpartum. E. During breast feeding. 

35. All of the following causes Oligohydromnios EXCEPT: A. Renal agenesis B. Poor placental perfusion 

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C. Post term pregnancy D. Anencephaly E. Urinary obstruction 

36. Placental insufficiency is caused by all the following, EXCEPT: A. Smoking in pregnancy. B. Post maturity. C. Dietary insufficiency in pregnancy. D. Hypertensive disorder in pregnancy. 

37. All the following hormones are products of placental synthesis, EXCEPT : A. HCG. B. HPL. C. Prolactin. D. Progesterone. E. Estriol. 

38. We can detect the fetal heart beat by Sonography (Transvaginal) at: A. 5 weeks B. 6 weeks C. 7 weeks D. 8 weeks E. 9 weeks 

39. Pregnant lady with polyhydramnios, the cause could be: A. Fetus with oesophageal-atresia B. Fetus with polycystic kidney disease C. Fetal growth restriction D. Hyperprolactinaemia during pregnancy E. Patient is taking anti epileptic drugs 

40. Polyhydramnios is associated with the following condition A. Intrauterine growth restriction B. Fetal kidney agenesis C. Diabetes insipidus D. Tracheo-oesophageal fistula E. Hind water leakage 

41. All the following are possible causes of Polyhydramnios, EXCEPT: A. Diabetes B. Multiple pregnancy C. Fetus with hydrops fetalis D. Fetus with duodenal atresia or neural tube defect E. IUGR 

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42. Which of the following causes of polyhydramnios is more common: A. Twin pregnancy. B. Diabetes. C. Hydrops fetalis. D. Anencephaly. E. Idiopathic. 

43. Using your knowledge of normal maternal physiology, which of the following would employ if a 38 weeks’ pregnant patient become faint while lying supine on your examination table: A. Blood transfusion. B. Turning the patient on her side. C. Oxygen by face mask. D. I.V. saline solution. 

1. Skin changes during pregnancy should include: A. Chloasma. B. Striae. C. Palmer erythema. D. Vascular spiders. E. All of the above

Embryology of Female genital tract, Malformations, intersexuality and Puberty:

Embryology of Female genital tract, Malformations, intersexuality and Puberty:

In patient with bicornuate uterus when getting pregnant can get all these complication, EXCEPT:

Polyhydramnios

Abortion

Preterm labor

Abnormal fetal lie

Retained placenta

In Turner's syndrome:

A chromosomal structure of 45 XY is characteristic

Secondary amenorrhea is usual

Ovaries are streak

The ovaries are multicystic

Phenotypically are male

Sexual differentiation

Development of male genitalia depends on the presence of functioning testes and responsive end organs

Due to the absence of testes XX fetus exposed to androgens in uteri will NOT be musculinized

The development of the female genital requires presence of the ovary

45 XO fetus will have normal ovaries

The development of the testes does not require presence of the Y chromosome

Turner syndrome: Which is true?

Genetically is 46 X O

Has testis in inguinal area

Usually presents with primary amenorrhea.

Has low I.Q

Usually tall

Androgen insensitivity syndrome: Which is true?

Genotype is 46 XX

Phenotype they are female but with ill-developed breast

Usually have secondary amenorrhea

They have testes that should be kept to produce hormones

They have no uterus

The karyotype of patient with Androgen insensitivity Syndrome is

46XX

46XY

47XXY

45XO

45 XY

In Turner syndrome the following are usually present EXCEPT:

the ovary are usually well developed.

The nipple are widely spaced

The girls are of short stature

Has web neck

The condition can be diagnosed by chromosomal

Regarding Androgen insensitivity syndrome all true EXCEPT:

The chromosomal sex is 46XX.

Scant or no pubic and axillary hair.

No uterus

Normal female external genetailia

Breast are usually well develop

Which is not true about Turner's syndrome:

Short stature

Buccal smear is chromatin positive

The majority are 45XO

Very low urinary estrogen titer

High pituitary gonadotropin titer.

Androgen Insensitivity Syndrome:

The characteristic features include normal uterus and breast development, and ambiguous genitalia.

The Karyotyping is 46XX.

They have normal female testosterone level.

Gonadectomy must be performed after puberty because of the increased risk of malignancy.

Estrogen replacement therapy is not indicated because they have enough estrogens to produce breast development.

While evaluating a 30-year-old woman for infertility, you diagnosed a bicornuate uterus. You explain that additional testing is necessary because of the woman's increased risk of congenital anomalies in which system?

Skeletal.

Hematopoietic.

Urinary.

Central nervous.

Tracheoesophageal.

Development stage:

Testosterone is secreted by Sertoli cells.

Anti-müllerian hormone is secreted by Leydig cells.

Anti-müllerian hormone is responsible for involution of normal müllerian system.

Bicornuate uterus can cause all of the following EXCEPT:

Abortions

Abnormal fetal lie.

Infertility.

Retained placenta.

Congenital anomalies of the baby.

In Turner’s syndrome patients, all of the following are true EXCEPT:

The streak ovaries should be removed surgically due to 25% tendency to be malignant.

Are usually less than 5 feet tall.

Have raised FSH levels.

Have female internal genitalia.

Have normal but infertile external genitalia.

The adenxea Uteri include all of the following EXCEPT:

Ovary.

Fallopian tubes.

Uterus.

Broad ligament.

Round ligament.

In the development of external genitalia:

Genital tubercles from the labia minora.

Genital smoothing from the labia majora.

Genital fold from scrotum in male.

Chlydrotestone is essential for muscularity of external genitalia.

Müllerian system develops to external genitalia.

Congenital uterine malformations causes all of the following EXCEPT:

Spontaneous abortions.

Premature labor.

Pregnancy induced hypertension.

Abnormal fetal lie.

May Obstruct labor.

Ovarian Dysgenesis is associated with the elevation of which of the following hormones.

Pituitary Gonadotropins.

Estradiol.

Estriol.

Pregnandiol.

Progesterone.

Confirmation of the diagnosis of Turner syndrome is best done by:

Gyn PV examination.

Pregnantriol estimation.

Hysterosalpingography (HSG)

Chromosomal analysis (Karyotyping).

Estimation of hypophyseal gonadotropins.

In cases of androgen insensitivity syndrome the following findings are true EXCEPT:

The chromosomal sex is 46 XX

Scant or no pubic or axillary hair.

No uterus.

Normal female external genitalia.

Breast are usually well developed.

In testicular feminization syndrome:

There are usually normal testes.

Kalman's syndrome is a recognized cause.

Breast development is usually lacking.

There's usually very low testosterone level.

The karyotype is 46 XX.

In Turner's syndrome, the following are usually observed EXCEPT:

The ovaries are usually well developed.

The nipples are widely spaced.

The girl is of short stature.

Has a webbed neck.

The condition can be diagnosed by chromosomal analysis.

Regarding the Development of internal genital organs:

The uterus, fallopian tubes, cervix & upper vagina develop from the mesophrenic duct.

The testes secretes testosterone which cause regression of the müllerian ducts in the male fetus.

The vagina is formed by the Urogenital sinus.

Müllerian agenesis (Mayer- Rokittanky - Kuster - Huser syndromes) is characterized by the absence of the uterus & upper vagina with normal female external genetailia & 46 XX.

Bicornuate uterus & uterus didelphus result from vertical fusion defects of the müllerian ducts.

Regarding puberty, all of the following are true EXCEPT:

It is the transitional period of development during which an individual matures from childhood to sexual & reproductive maturity.

Breast budding is the 1ST visible sign of puberty.

The maximum growth velocity occurs at 12 years.

The age of menarche has decreased over the last 3-4 decades due to improved nutrition, general health & lifestyle changes.

Thelarche marks the attainment of reproductive maturity.

Turner's syndrome is associated with :

Absent uterus

Normal breast development

Primary amenorrhea

Hirsutism

Normal height

Anomalies or the uterus can be associated with the following EXCEPT:

Urinary tract abnormalities.

Recurrent pregnancies loss.

Preterm labor.

Müllerian tract anomalies.

F.    Polycystic ovary.

First endocrine influence in 2ry sexual characters:

Secretion of delta-4 Androstenedione from the adrenal gland

Pineal body maturation

Pituitary maturation

Hypothalamic down regulation.

Follicular growth (in non-ovulating follicle) is usually followed by:

Ovulation.

Cyst formation.

Atresia.

Arrest.

Regression.

The normal sequence of pubertal changes in the female is:

Thelarche, Maximal growth velocity, menarche.

Maximal growth velocity, Thelarche, menarche.

Thelarche, menarche, maximal growth velocity.

Menarche, maximal growth velocity, Thelarche.

Menarche, body weight, Thelarche.

The barr body is:

The condensed nonfunctioning X chromosome.

The darkest, widest band found on chromosomes.

On extra lobe on the female polymorpholnuclear leukocytes.

Found only in females.

The largest chromosome in the female genotype.

The most common cause of precocious puberty is :

Idiopathic.

Gonadoblastoma.

Albright syndrome.

Abnormal skull development.

Granulosa cell tumor.

The normal sequence of puberty is :

Thelarche , adrenarche, growth, menarche.

Menarche, adrenarche, thelarche ,growth.

Growth. thelarche, adrenarche, menarche

Adrenarche , thelarche, growth, menarche

Thelarche , menarche, adrenarche, growth.