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Question 1
Correct
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Missed abortion may cause one of the following complications:
Your Answer: Coagulopathy
Explanation:A serious complication with a miscarriage is DIC, a severe blood clotting condition and is more likely if there is a long time until the foetus and other tissues are passed, which is often the case in missed abortion.
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This question is part of the following fields:
- Obstetrics
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Question 2
Correct
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Which of the following regarding the use of tocolytics is true?
Your Answer: Use of a tocolytic drug is not associated with a clear reduction in perinatal or neonatal mortality, or neonatal morbidity
Explanation:Tocolytics are used to suppress contractions. The Canadian preterm labour trial which remains a very influential tocolytic trial to date concluded that tocolytics such as a beta agonist have no significant benefit on perinatal mortality or morbidity or prolong pregnancy to term however it did reduce the number of women delivering within 2 days by 40%. This 48 hour window is the only reason for the use of tocolytics.
Choice of tocolytic (NICE)
1st line: Nifedipine
2nd line: Oxytocin receptor antagonists e.g. atosiban -
This question is part of the following fields:
- Clinical Management
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Question 3
Correct
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Lactogenesis at term is stimulated by which hormone?
Your Answer: Prolactin
Explanation:Prolactin is the hormone that is responsible for the production of milk (Lactogenesis). Oxytocin is responsible for the let down reflex during suckling.
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This question is part of the following fields:
- Clinical Management
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Question 4
Correct
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Which of the following Oestrogens (Oestrogens) becomes the predominant circulating oestrogen during pregnancy?
Your Answer: Estriol
Explanation:Oestradiol is the predominant form of oestrogen during the reproductive life of a female. The estrogenic potency of oestradiol is 12 times more than estrone and 80 times that of estriol.
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This question is part of the following fields:
- Endocrinology
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Question 5
Correct
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Question 6
Correct
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A 42 year old woman in early pregnancy is rushed to the emergency department complaining of vaginal bleeding and abdominal pain. What percentage of women her age have miscarriages?
Your Answer: 50%
Explanation:With increasing maternal age, the risk of miscarriage increases. For women between the ages of 40-44, the miscarriage rates sit at about 50% and increases to over 75% for women 45 years and over. The miscarriage rate for women between the ages of 35-39 is 25%.
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This question is part of the following fields:
- Epidemiology
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Question 7
Correct
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A 36-year-old woman is being tested for a breast tumour she discovered last week during a routine physical examination. Two years ago, the patient had bilateral reduction mammoplasty for breast hyperplasia. Her paternal grandmother died of breast cancer at the age of 65, thus she doesn't take any drugs or have any allergies. A fixed lump in the upper outer quadrant of the right breast is palpated during a breast examination. In the upper outer quadrant of the right breast, mammography reveals a 3 × 3-cm spiculated tumour with coarse calcifications. A hyperechoic mass can be seen on ultrasonography of the breast. The mass is removed with concordant pathologic findings, and a core biopsy reveals foamy macrophages and fat globules. Which of the following is the best plan of action for this patient's management?
Your Answer: Reassurance and routine follow-up
Explanation:Fat necrosis is a benign (non-cancerous) breast condition that can develop when an area of fatty breast tissue is injured. It can also develop after breast surgery or radiation treatment.
There are different stages of fat necrosis. As the fat cells die, they release their contents, forming a sac-like collection of greasy fluid called an oil cyst. Over time, calcifications (small deposits of calcium) can form around the walls of the cyst, which can often be seen on mammograms. As the body continues to repair the damaged breast tissue, it’s usually replaced by denser scar tissue. Oil cysts and areas of fat necrosis can form a lump that can be felt, but it usually doesn’t hurt. The skin around the lump might look thicker, red, or bruised. Sometimes these changes can be hard to tell apart from cancers on a breast exam or even a mammogram. If this is the case, a breast biopsy (removing all or part of the lump to look at the tissue under the microscope) might be needed to find out if the lump contains cancer cells. These breast changes do not affect your risk for breast cancer.
Mastectomy, axillary node dissection and radiation therapy are all management options for malignancy which this patient doesn’t have.
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This question is part of the following fields:
- Gynaecology
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Question 8
Correct
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A 25 year old female with her LRMP 8 weeks ago, presented with severe abdominal pain and per vaginal bleeding. On examination there was tenderness over her left iliac region. Her pulse rate was 110 bpm and blood pressure was 90/65mmHg. Which of the following is the most appropriate management?
Your Answer: Immediate laparotomy
Explanation:A ruptured ectopic pregnancy is the most probable diagnosis. As she is in shock (tachycardia and hypotension) immediate laparotomy is needed.
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This question is part of the following fields:
- Gynaecology
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Question 9
Correct
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A women has undergone genetic testing due to her family history and has the BRCA 1 gene. What would you advise her lifetime risk of breast cancer is?
Your Answer: 70%
Explanation:The life time risk of breast cancer in BRCA 1 gene is 70% and of ovarian cancer is 40%.
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This question is part of the following fields:
- Genetics
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Question 10
Correct
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A 20-year-old pregnant woman at 32 weeks gestation presents with a history of vaginal bleeding after intercourse. Pain is absent and upon examination, the following are found: abdomen soft and relaxed, uterus size is equal to dates and CTG reactive. What is the single most possible diagnosis?
Your Answer: Placenta previa
Explanation:Placenta previa typically presents with painless bright red vaginal bleeding usually in the second to third trimester. Although it’s a condition that sometimes resolves by itself, bleeding may result in serious complications for the mother and the baby and so it should be managed as soon as possible.
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This question is part of the following fields:
- Obstetrics
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Question 11
Correct
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A 26-year old woman, 36 weeks age of gestation, is admitted for deep venous thrombosis (DVT) of the right calf. She receives heparin treatment. Which of the following is true regarding the use of heparin rather than a coumarin derivative for anticoagulation?
Your Answer: Reversal of the anticoagulant effect of heparin in the mother can be achieved more quickly than that of coumarin, should labour occur.
Explanation:Heparin is a large-sized molecule and does not cross the placenta; it can provide anticoagulation in the mother, however, has no effect on the baby. Heparin is the preferred anticoagulant therapy during pregnancy.
Moreover, the anticoagulant effect of heparin can be rapidly reversed by protamine sulphate.
Warfarin, a coumarin derivative, takes much longer to be reversed compared to heparin. This can be given to the mother between 13 and 36 weeks of pregnancy, however, should be avoided in the first trimester due to its teratogenic effects.
The anticoagulant effect of coumarin derivatives on the baby also takes longer to be reversed. -
This question is part of the following fields:
- Obstetrics
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Question 12
Correct
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Question 13
Correct
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In a patient who undergoes a medical abortion at 10 weeks gestation, what advice would you give regarding Rhesus Anti-D Immunoglobulin?
Your Answer: All RhD-negative women who are not alloimmunized should receive Anti-D IgG
Explanation:The Rhesus status of a mother is important in pregnancy and abortion. The exposure of an Rh-negative mother to Rh antigens from a positive foetus, will influence the development of anti-Rh antibodies. This may cause problems in subsequent pregnancies leading to haemolysis in the newborn. Rh Anti RhD- globulin is therefore given to non-sensitised Rh-negative mothers to prevent the formation of anti-Rh antibodies within 72 hours following abortion. Anti RhD globulin is not useful for already sensitized, or RhD positive mothers.
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This question is part of the following fields:
- Clinical Management
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Question 14
Correct
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The following hormones are secreted from the anterior pituitary gland, EXCEPT:
Your Answer: HCG
Explanation:The following hormones are excreted from the anterior pituitary gland: TSH, GN, ACTH, LH, FSH, MSH, PRL.
Human chorionic gonadotropin (hCG, or human chorionic gonadotrophin) is a placental hormone secreted by syncitiotrophoblasts during the second week of gestation. -
This question is part of the following fields:
- Endocrinology
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Question 15
Correct
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After birth, all of the following vessels constrict, EXCEPT the:
Your Answer: Hepatic portal vein
Explanation:Immediately after birth the liver is deprived of the large flow of blood supplied during foetal development via the umbilical vein and portal sinus. Simultaneously the blood pressure in the portal sinus, previously as high as in the umbilical vein, falls.
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This question is part of the following fields:
- Physiology
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Question 16
Correct
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Hysterosalpingogram (HSG) is contraindicated in the following EXCEPT:
Your Answer: Congenital malformations of the uterus
Explanation:Anomalies of the cervico-uterus are widely diagnosed by HSG. The diagnostic value of HSG in the detection of anomalies varies, depending on the type of malformation.
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This question is part of the following fields:
- Obstetrics
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Question 17
Correct
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All of the following complications can be found in a pregnant patient with a bicornuate uterus, except?
Your Answer: Polyhydramnios
Explanation:Women with a bicornuate uterus are at increased risk of recurrent abortions, premature birth, fetal malpositioning, placenta previa and retained products of placenta leading to post partum haemorrhage.
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This question is part of the following fields:
- Embryology
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Question 18
Correct
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Which of the following statements regarding management of obstetric anal sphincter injuries (OASIS) is true?
Your Answer: Broad-spectrum antibiotics should be given routinely following OASIS
Explanation:After perineal repair, lactulose and a bulking agent should ideally be given for 5-10 days as well as broad spectrum antibiotics should be given that will cover all possible anaerobic bacteria. At 6-12 months a full evaluation should be done regarding the progress of healing. 60 to 80% of women are asymptomatic 12 months post delivery and external anal sphincter repair.
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This question is part of the following fields:
- Clinical Management
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Question 19
Correct
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Which of the following fasting plasma glucose (FPG) values for OGTT (Oral glucose tolerance test) is diagnostic of gestational diabetes according to the WHO criteria?
Your Answer: FPG 6.1mmol/L; 2 hour 7.8mmol/L
Explanation:There are several criteria that aid in the diagnosis of gestational diabetes in pregnancy including NICE, WHO and modified WHO:
GDM Diagnostic Criteria:
NICE: Immediate FBG >5.6, 2 hour glucose >7.8
WHO: Immediate FBG >6.1, 2 hour glucose >7.8
Modified WHO: Immediate FBG >7.1, 2 hour glucose >7.8Random glucose and OGTT 2 hour readings of >11.1 are diagnostic of diabetes in non-pregnant states but are not part of the gestational diabetes criteria.
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This question is part of the following fields:
- Clinical Management
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Question 20
Correct
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A 29-year-old woman at 28 weeks of pregnancy was diagnosed with gestational diabetes. At a high-risk pregnancy clinic, she was considered to have been managed well until 38 weeks when she delivered a healthy 4-kg baby via vaginal delivery without any complications. Which of the following is the next step in managing her gestational diabetes?
Your Answer: 75g oral glucose tolerance test performed 6 to 8 weeks after delivery
Explanation:The Australasian Diabetes in Pregnancy Society recommends a 50 or 75 g glucose challenge at 26–28 weeks in all pregnant women. An OGTT should be performed if the test result is abnormal: 1 hour values after a 50 or 75 g glucose challenge exceeding 7.8 or 8.0 mmol/L respectively.
If a woman has had gestational diabetes, a repeat OGTT is recommended at 6–8 weeks and 12 weeks after delivery. If the results are normal, repeat testing is recommended between 1 and 3 years depending on the clinical circumstances.
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This question is part of the following fields:
- Obstetrics
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Question 21
Correct
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The femoral triangle is bounded superiorly by which of the following structures?
Your Answer: Inguinal ligament
Explanation:The femoral triangle is bounded superiorly by the inguinal ligament which forms the base of the triangle, medially by the lateral border of the adductor longus and laterally by the sartorius muscle.
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This question is part of the following fields:
- Anatomy
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Question 22
Correct
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Which of the following is indicated for the treatment of chlamydial urethritis in pregnancy?
Your Answer: Azithromycin 1gram as single dose
Explanation:The best treatment option for chlamydial urethritis in pregnancy is Azithromycin 1g as a single dose orally. This is the preferred option as the drug is coming under category B1 in pregnancy.
Tetracycline antibiotics, including doxycycline, should never be used in pregnant or breastfeeding women.
Erythromycin Estolate is contraindicated in pregnancy due to its increased risk for hepatotoxicity. Ciprofloxacin is not commonly used for treating chlamydial urethritis and its use is not safe during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 23
Correct
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A 25 year old prim gravida carrying a twin male pregnancy presents at 31 weeks gestation. She is lethargic, clinically jaundiced and complains of abdominal pain with frequent vomiting. You suspect acute fatty liver of pregnancy (AFLP). What is the maternal mortality rate with AFLP?
Your Answer: 20%
Explanation:Acute fatty liver of pregnancy occurs in 1-10000 pregnancies and presents as jaundice with abdominal pain. The maternal mortality is around 20%
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This question is part of the following fields:
- Clinical Management
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Question 24
Correct
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Which of the following structures does the broad ligament contain?
Your Answer: Uterine artery
Explanation:The broad ligament is one of the secondary supporting structures of the uterus which attaches the lateral portion of the uterus to the pelvic sidewall. The broad ligament primarily serves a protective layer for important structures including the fallopian tubes, the ovaries, the ovarian arteries, and the uterine arteries, the round and ovarian ligaments, and the infundibulopelvic ligaments.
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This question is part of the following fields:
- Anatomy
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Question 25
Correct
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In early pregnancy at what gestation does the Embryonic pole become visible on transvaginal ultrasound?
Your Answer: 5 weeks + 3 days
Explanation:The embryonic pole becomes visible on transvaginal ultrasound at around 5 and a half to 6 weeks gestation when it measures around 3mm.
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This question is part of the following fields:
- Biophysics
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Question 26
Correct
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Which of the following does not cause an increased risk of cervical cancer?
Your Answer: Alcohol
Explanation:Consuming alcohol and risk of cervical cancer are not associated. Not even drinking often and in large amounts are risk factors for developing cervical cancer.
So drinking alcohol and risk of cervical cancer aren’t associated. Based on their analyses of the scientific research evidence, that is the conclusion of, among many others, the:
American Cancer Society.
Centres for Disease Control and Prevention (CDC).
National Cancer Institute.
UK’s National Health Service.
Canadian Cancer Society.
Cancer Council Australia.
World Health Organization (WHO).All other options can increase the risk of acquiring cervical cancer.
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This question is part of the following fields:
- Gynaecology
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Question 27
Correct
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In threatened abortion, which one of the following items is TRUE?
Your Answer: More than 50% will abort
Explanation:Threatened abortion:
– Vaginal bleeding with closed cervical os during the first 20 weeks of pregnancy
– Occurs in 25% of 1st-trimester pregnancies
– 50% survival
More than half of threatened abortions will abort. The risk of spontaneous abortion, in a patient with a threatened abortion, is less if fetal cardiac activity is present. -
This question is part of the following fields:
- Obstetrics
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Question 28
Correct
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Yasmin®, which contains 3 mg of drospirenone and 30 mcg of ethinyl oestradiol, has been approved for usage in South Africa. Which of the following factors has contributed to it becoming the most popular oral contraceptive pill among South African women?
Your Answer: It has not weight gain as an adverse effect and may be associated with weight loss
Explanation:Yasmin has been linked to decreased fluid retention and weight gain as a side effect of COCs, which is why most women who experience this side effect prefer Yasmin®.
Due to its anti-mineralocorticoid properties, drospirenone, unlike earlier progestogens, is associated with no weight gain or even moderate weight loss.
Yasmin has a similar failure rate to other COCs. No evidence using Yasmin is linked to a lower risk of cervical cancer as a long-term side effect of COCs. Yasmin, like all COCs, can cause spotting and irregular bleeding in the first few months of use.
Drospirenone, a progesterone component, has antiandrogenic properties and is slightly more successful in treating acne, but the difference is not big enough to make it preferable in terms of acne therapy or prevention when compared to other COCs. -
This question is part of the following fields:
- Gynaecology
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Question 29
Correct
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When deciding on entry method for laparoscopy a patients build is important. Which of the following entry methods is inappropriately matched to the patient?
Your Answer: Varess needle entry in a very thin patient (BMI 16)
Explanation:In patients with normal BMI there is no preferential entry method. The Varess technique is not appropriate for morbidly obese or very thin patients for the reasons set out below: Morbid Obesity (BMI>40): Hasson technique or entry at Palmers point Reason: difficult penetration with Varess needle Very Thin Patients: Hasson technique or insertion at Palmers point Reason: higher risk of vascular injury
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This question is part of the following fields:
- Clinical Management
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Question 30
Incorrect
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What is the failure rate of tubal sterilization?
Your Answer: 1 in 500
Correct Answer:
Explanation:Tubal sterilization is a safe and effective surgical procedure that permanently prevents pregnancy. However, pregnancy can occur in 1 in 200 cases, according to international sources. In the 1st year after tubal sterilization, the estimated failure rate is 0.1-0.8% respectively.
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This question is part of the following fields:
- Gynaecology
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Question 31
Correct
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Question 32
Incorrect
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Under which one of the following conditions is the pelvic inlet felt to be contracted?
Your Answer: The transverse diameter is only 10 cm
Correct Answer:
Explanation:Contracted pelvis occurs when one or more of its diameters is reduced so that it interferes with the normal mechanism of labour. A transverse diameter below 11 cm will result in difficult delivery of the foetus and C-section will be the better option in that case
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This question is part of the following fields:
- Anatomy
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Question 33
Correct
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Question 34
Correct
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A 31-year-old female patient seeks your opinion on an abnormal Pap smear performed by a nurse practitioner at a family planning facility. A high-grade squamous intraepithelial lesion is visible on the Pap smear (HGSIL). Colposcopy was performed in the office. The impression is of acetowhite alterations, which could indicate infection by HPV. Chronic cervicitis is present in your biopsies, but there is no indication of dysplasia. Which of the following is the most suitable next step in this patient's care?
Your Answer: Conization of the cervix
Explanation:When cervical biopsy or colposcopy doesn’t explain the severity of the pap smear results cone biopsy is done. In 10% of biopsies, results will be different from that of the pap smear as in this patient with pap smear showing HSIL and colposcopy showing chronic cervicitis.
In such cases conization is indicated. Repeating the pap smear could risk prompt management of a serious problem. No destructive procedure, ablation or cryotherapy, should be done before diagnosis is certain.
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This question is part of the following fields:
- Gynaecology
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Question 35
Incorrect
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In the 3rd trimester anaemia is defined by?
Your Answer: Haemoglobin < 110 g/l
Correct Answer:
Explanation:Haemoglobin decreases from 13.3 g/dL to 10.5 g/dL from the start of pregnancy i.e. First trimester till the 3rd trimester.
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This question is part of the following fields:
- Clinical Management
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Question 36
Correct
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The inguinal canal is reinforced anterolaterally by which structure?
Your Answer: Internal oblique
Explanation:The Conjoint tendon AKA Inguinal falx reinforces the posterior wall of the inguinal canal. The inguinal ligament is part of the floor.
The aponeurosis of external oblique is the major component of the anterior wall with fibres of internal oblique reinforcing the lateral part -
This question is part of the following fields:
- Anatomy
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Question 37
Correct
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A 28-year-old female patient comes in for a prenatal appointment. She eats only vegetables. Which of the following is the most appropriate suggestion for folic acid supplementation?
Your Answer: She should be started on folic acid 0.5 mg per day
Explanation:Folate has been in the news because of its connection with a type of birth defect called neural tube defect. Studies have shown that women who have infants with neural tube defects have lower intakes of folate and lower blood folate levels than other women. Folate is needed early in pregnancy (before many women know they are pregnant) for normal neural tube development.
Many vegan foods including enriched bread, pasta, and cold cereal; dried beans; green leafy vegetables; and orange juice are good sources of folate. Vegan diets tend to be high in folate, however, to be on the safe side, women capable of becoming pregnant should take a supplement or use fortified foods that provide 400 micrograms of folate daily.
For the above mentioned reasons, all other options are incorrect.
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This question is part of the following fields:
- Gynaecology
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Question 38
Correct
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A 24 week pregnant patient complains of itching over the past 6 weeks particularly to the hands and feet which is worse at night. She has taken cetirizine but this hasn't settled her symptoms. Examination is unremarkable with no rash. What is the likely diagnosis?
Your Answer: Intrahepatic Cholestasis of Pregnancy
Explanation:The history is typical of Intrahepatic Cholestasis of Pregnancy, also known as obstetric cholestasis and prurigo gravidarum. It is characterised by itching without rash and abnormal LFTs beyond normal pregnancy ranges. Itching affects around 23% of pregnancies and can occur before biochemical changes.
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This question is part of the following fields:
- Clinical Management
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Question 39
Correct
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A 30-year-old woman presents to you for oral contraceptive pills. Her past medical history reveals that she has migraine headaches on occasions, associated with paraesthesia's in her right arm. Examination reveals that she weighs 120kg and has a BMI of 36. Which one of the following would be the most appropriate contraceptive methods for her?
Your Answer: Condoms
Explanation:This woman suffers from a classic migraine with focused neurological symptoms. The use of any OCP preparation containing oestrogen in such patients is strictly prohibited. Androgenic consequences of progesterone include hirsutism, acne, and weight gain. Progesterone of any sort (norgestrel, drospirenone, cyproterone, etc.) should be avoided by a lady of her size; consequently, a barrier approach such as male condoms is the best option.
It is recommended that formulations containing 20-30 mcg ethinylestradiol be evaluated first when choosing a combined oral contraceptive pill (COCP). The progesterone component can be norgestrel, drospirenone, cyproterone, and so on; however, norgestrel-containing formulations are less expensive and more accessible to patients.
For specific cases, the type of progesterone should be considered:
– Patients who have unpleasant fluid retention and weight gain as a side effect of COCPs may be administered drospirenone (Yaz®. Yasmin®)-containing preparations.
– Drospirenone inhibits the production of mineralocorticoids and does not cause fluid retention. It may even be linked to a small amount of weight reduction.
– A preparation containing cyproterone acetate is preferable if the patient has suspected polycystic ovarian syndrome (PCOS). -
This question is part of the following fields:
- Gynaecology
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Question 40
Correct
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A 22-year-old woman who is 28 weeks pregnant presented to the emergency department due to premature uterine contractions. Upon interview, it was noted the she has history of untreated mitral valve stenosis. Tocolysis was then planned after a necessary evaluation was performed and revealed that there is absence of contraindications. Which of the following would be considered the drug of choice for tocolysis?
Your Answer: Oxytocin antagonists
Explanation:Tocolysis is an obstetrical procedure to prolong gestation in patients, some of which are experiencing preterm labour. This is achieved through various medications that work to inhibit contractions of uterine smooth muscle.
There is no definitive first-line tocolytic agent by the American College of Obstetrics and Gynecology (ACOG) but nifedipine is most commonly used. However, in severe aortic stenosis, nifedipine can cause ventricular collapse and dysfunction.
The therapeutic target in the treatment of preterm labour is currently the pharmacological inhibition of uterine contractions with the use of various tocolytic agents. Tocolytic agents are used to maintain pregnancy for 24–48 hours to allow corticosteroids administration to act and to permit the transfer of the mother to a centre with a neonatal intensive care unit.
Oxytocin inhibitors work by competitively acting at the oxytocin receptor site. Oxytocin acts to increase the intracellular levels of inositol triphosphate. The medications currently in this class are atosiban and retosiban. Maternal nor fetal side effects have not been described for this tocolytic.
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This question is part of the following fields:
- Obstetrics
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Question 41
Correct
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A patient with amenorrhoea is seen in clinic. History and examination reveal the patient runs 10-20 miles every day and her BMI is 17.8. Which of the following is likely to explain her symptoms?
Your Answer: WHO type I Ovulation Disorders
Explanation:World Health Organization (WHO) Group I ovulation disorder is due to hypothalamic pituitary failure. This is sometimes termed hypothalamic amenorrhoea or hypogonadotropic hypogonadism. Women can improve frequency of ovulation, conception and an uncomplicated pregnancy by increasing their body weight (if BMI of <19) and/or moderating their exercise levels (if they undertake high levels of exercise). GnRH and LH may be administered in these patients. PCOS falls under type II ovulation disorders. WHO Group III ovulation disorder is due to ovarian failure.
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This question is part of the following fields:
- Endocrinology
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Question 42
Correct
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A midwife is concerned regarding CTG changes and suggests a fetal blood sample (FBS). At what dilatation would you NOT perform FBS?
Your Answer: Less than 3cm
Explanation:Fetal Blood Sampling (FBS) should only be performed when the cervix is >3cm dilated.
Indications for FBS:
1. Pathological CTG in labour
2. Suspected acidosis in labourContraindications to FBS
– Maternal infection e.g. HIV, HSV and Hepatitis
– Known fetal coagulopathy
– Prematurity (< 34 weeks gestation)
– Acute fetal compromiseInterpretation of FBS results:
pH >7.25 = Normal -Repeat in 1 hour if CTG remains abnormal
7.21 to 7.24 = Borderline – Repeat in 30 minutes
<7.20 = Abnormal - Consider delivery -
This question is part of the following fields:
- Data Interpretation
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Question 43
Correct
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If your patient is 8 weeks pregnant which one of the following USS measurements is most useful?
Your Answer: Crown rump length
Explanation:Fetal crown-rump length (CRL) is recommended over last menstrual period for estimating GA when measured in early pregnancy i.e. before 9 to 13+6 weeks.
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This question is part of the following fields:
- Anatomy
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Question 44
Correct
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You see a patient who gave birth earlier in the day. She was taken off warfarin during pregnancy and is currently on LMWH. She intends to breastfeed for the first 6-8 weeks and wants advice regarding restarting warfarin. Which of the following is appropriate?
Your Answer: Recommence warfarin in 5-7 days
Explanation:The use of anticoagulants during pregnancy is a complicated issue because warfarin is teratogenic if used in the first trimester, and is linked with fetal intracranial haemorrhage in the third trimester (mainly at doses 5 mg daily). Low molecular weight heparin may be insufficient at preventing thrombosis in women with mechanical prosthetic heart valves, where the risk of valve thrombus is 10 per cent. Anticoagulation is essential in patients with congenital heart disease who have pulmonary hypertension, or artificial valve replacements, and in those in or at risk of atrial fibrillation. The options are either to continue warfarin for the pregnancy, or replace it with heparin between 6 and 12 weeks gestation to avoid the teratogenic risk. Warfarin should be started a week after delivery.
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This question is part of the following fields:
- Pharmacology
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Question 45
Correct
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You are asked to assess a patients perineal tear following labour by vaginal delivery. You note a laceration that extends approximately a quarter of the thickness through the external anal sphincter. How would you classify this tear?
Your Answer: 3a
Explanation:1. First-degree trauma corresponds to lacerations of the skin/vaginal epithelium alone.
2. Second-degree tears involve perineal muscles and therefore include episiotomies.
3. Third-degree extensions involve any part of the anal sphincter complex (external and internal sphincters):
i Less than 50 per cent of the external anal
sphincter is torn.
ii More than 50 per cent of the external anal
sphincter is torn.
iii Tear involves the internal anal sphincter
(usually there is complete disruption of the
external sphincter).
4. Fourth-degree tears involve injury to the anal sphincter complex extending into the rectal mucosa. -
This question is part of the following fields:
- Anatomy
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Question 46
Correct
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You are called to see a patient in A&E who attended due to finger splinter that has been removed. The HCA took some routine obs that show her blood pressure to be 162/110. She is 32 weeks pregnant. According to the NICE guidelines which of the following is appropriate?
Your Answer: Admit and start oral labetalol
Explanation:BP over 159/109 is classed as Severe. NICE guidance advises admission and treatment with oral Labetalol as 1st Line. Patient should have BP checked QDS and shouldn’t be discharged until BP is below 159/109
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This question is part of the following fields:
- Clinical Management
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Question 47
Correct
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What is the anatomical landmark used for gauging the station of the fetal head during labour?
Your Answer: Ischial Spine
Explanation:The ischial spine is the anatomical landmark for assessing the station of the fetal head and also placing pudendal nerve blocks. (the pudendal nerve runs posterior to the ischial spine). The ischial spine can be palpated approximately 8cm into the vagina, at 4 and 8 o’clock.
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This question is part of the following fields:
- Anatomy
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Question 48
Correct
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Etiological factors in spontaneous abortion include:
Your Answer: All of the options given
Explanation:Spontaneous abortion is the loss of pregnancy naturally before twenty weeks of gestation. Colloquially, spontaneous abortion is referred to as a ‘miscarriage’ to avoid association with induced abortion. Early pregnancy loss refers only to spontaneous abortion in the first trimester. In 50% of cases, early pregnancy loss is believed to be due to fetal chromosomal abnormalities. Advanced maternal age and previous early pregnancy loss are the most common risk factors. For example, the incidence of early pregnancy loss in women 20-30 years of age is only 9 to 17%, while the incidence at 45 years of maternal age is 80%. Other risk factors include alcohol consumption, smoking, and cocaine use.
Several chronic diseases can precipitate spontaneous abortion, including diabetes, celiac disease, and autoimmune conditions, particularly anti-phospholipid antibody syndrome. Rapid conception after delivery and infections, such as cervicitis, vaginitis, HIV infection, syphilis, and malaria, are also common risk factors. Another important risk factor is exposure to environmental contaminants, including arsenic, lead, and organic solvents. Finally, structural uterine abnormalities, such as congenital anomalies, leiomyoma, and intrauterine adhesions, have been shown to increase the risk of spontaneous abortion.
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This question is part of the following fields:
- Obstetrics
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Question 49
Correct
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Katherine, 28 years old at her 37 weeks of pregnancy, presents at your office with soreness down below. Physical exam is highly suggestive of genital herpes, and patient says she never had such lesions before and this is the first time she is experiencing such a problem. Laboratory investigations like PCR and culture results confirm the diagnosis of primary herpes simplex infection. Which of the following would be the most appropriate next step in management of the case?
Your Answer: Prophylactic antiviral therapy
Explanation:If a pregnant woman develops primary herpes simplex infection after 30 weeks gestation, her risk for transmission of herpes simplex virus to the neonate leading to neonatal infection increases significantly.
Below mentioned are the most common risk factors resulting in intrapartum herpes simplex infection of the baby:
– Premature labor
– Premature rupture of membrane
-Primary herpes simplex infection near the time of delivery
– Multiple lesions in the genital area
The most appropriate management for such case includes:
– Checking for herpes simplex infection with PCR testing (cervical swab)
– Prophylactic antiviral therapy of the mother from 36th week until delivery
– Cesarean section deliveryIn the case above mentioned, it is better to start antiviral therapy immediately and consider cesarean section to minimize the risk of vertical transmission of infection to the neonate.
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This question is part of the following fields:
- Obstetrics
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Question 50
Correct
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A 24 year old patient presents as 24 weeks pregnant with vaginal discharge. Swabs show Chlamydia Trachomatis detected. Which of the following is the most appropriate treatment regime?
Your Answer: Erythromycin 500 mg twice a day for 14 days
Explanation:The treatment of Chlamydia includes avoidance of intercourse, use of condoms and antibiotic treatment. Erythromycin 500mg orally QID for 7 days or Amoxicillin 500mg TDS for 7 days or Ofloxacin 200mg orally BD for 7 days.
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This question is part of the following fields:
- Clinical Management
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SESSION STATS - PERFORMANCE PER SPECIALTY
