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  • Question 1 - A 67 year old patient with endometrial carcinoma is to undergo staging investigations....

    Incorrect

    • A 67 year old patient with endometrial carcinoma is to undergo staging investigations. There is evidence of invasion into the vaginal wall, but the lymph nodes are spared, and there is no distant metastasis. According to FIGO, what stage is this?

      Your Answer: 3A

      Correct Answer: 3B

      Explanation:

      Endometrial cancer is one of the most common gynaecological malignancies present in postmenopausal women, with a peak incidence between the ages of 60-89. Factors associated with endometrial cancer include obesity, hypertension and diabetes. Full staging for endometrial cancer is surgical, including several other radiologic investigations. According to FIGO staging classifications:
      Stage 1 indicates a tumour confined to the uterine body
      Stage 2 indicates the invasion of the cervical stroma
      Stage 3 indicates local and regional spread, where the tumour invades the serosa in stage 3A, spreads to the vagina and parametrium in stage 3B, and metastasizes to the pelvic or para-aortic lymph nodes in stage 3C.
      Stage 4 indicates tumour invasion on the bladder or bowel mucosa, or distant metastasis.

    • This question is part of the following fields:

      • Clinical Management
      48.9
      Seconds

  • Question 2 - Which of the following contraceptives primary mode of action is inhibition of ovulation?...

    Correct

    • Which of the following contraceptives primary mode of action is inhibition of ovulation?

      Your Answer: Cerazette®

      Explanation:

      Desogestrel only POPs work mainly by inhibiting ovulation. Cerazette Is the only brand in this list which belongs to this group.

      Types of Progesterone Only Pills

      1. Traditional (e.g. Femulen®, Micronor®, Norgeston®)

      Main mode of action: thickening cervical mucus preventing sperm entry at neck of womb and may also cause anovulation but this effect variable and unreliable

      2. Desogestrel (e.g. Cerazette®)

      Main mode of action: inhibition of ovulation and also cause thickening of cervical mucus

    • This question is part of the following fields:

      • Clinical Management
      7.5
      Seconds

  • Question 3 - Your consultant agrees to supervise you performing a Caesarean Section (CS). When making...

    Incorrect

    • Your consultant agrees to supervise you performing a Caesarean Section (CS). When making a Joel Cohen incision where should this be placed?

      Your Answer:

      Correct Answer: 3 cm above the symphysis pubis

      Explanation:

      The Joel Cohen incision is superior to the Pffannenstiel incision. It is a straight incision that is 3 cm below the line joining the anterior iliac spines.

    • This question is part of the following fields:

      • Clinical Management
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      Seconds

  • Question 4 - A 29 year old patient presents due to the sensation of reduced fetal...

    Incorrect

    • A 29 year old patient presents due to the sensation of reduced fetal movements (RFM). From what gestation is CTG assessment of RFM advised?

      Your Answer:

      Correct Answer: 28+0 weeks

      Explanation:

      The cardiotocograph (CTG) is a continuous tracing of the fetal heart rate used to assess fetal wellbeing. The Doppler effect detects fetal heart motion and allows the interval between successive beats to be measured, thereby allowing a continuous assessment of fetal heart rate. The mother perceives the fetal movement by the 18-20 week of gestation and these increase until the 32 week. A mother should under go CTG if the fetal movements are reduced by the 28 week of gestation.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 5 - Mifepristone when used for management of abortion works via what mechanism? ...

    Incorrect

    • Mifepristone when used for management of abortion works via what mechanism?

      Your Answer:

      Correct Answer: Anti-progestogen

      Explanation:

      Mifepristone is a prostaglandin antagonist. It acts as a competitive inhibitor of the receptor.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 6 - Following parturition how long does involution of the uterus take? ...

    Incorrect

    • Following parturition how long does involution of the uterus take?

      Your Answer:

      Correct Answer: 4-6 weeks

      Explanation:

      Involution of the uterus takes 4-6 weeks

    • This question is part of the following fields:

      • Clinical Management
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  • Question 7 - A 26 year old patient attends the maternity unit as her waters have...

    Incorrect

    • A 26 year old patient attends the maternity unit as her waters have broken but she hasn't had contractions. She is at 39+5 weeks gestation. Speculum examination confirms prelabour rupture of membranes (PROM). What is the risk of serious neonatal infection with PROM?

      Your Answer:

      Correct Answer: 1 in 100

      Explanation:

      In pregnancy, term refers to the gestational period from 37 to 41+6 weeks. Preterm births occur between 24 and 36+6 weeks. Only 1% of women who go into PROM have risk of having serious neonatal infections.

      Management of PROM:
      60% of patients with PROM will go into labour within 24 hrs
      Induction is appropriate if >34 weeks gestation and more than 24 hours post rupture when labour hasn’t started.
      If < 34 weeks, induction of labour should not be carried out unless there are additional obstetric indications e.g. infection

    • This question is part of the following fields:

      • Clinical Management
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  • Question 8 - A 28 year old patient has a diagnosis of PCOS. She has been...

    Incorrect

    • A 28 year old patient has a diagnosis of PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2 and she is a non-smoker. She has been taking Clomiphene and metformin for the past 6 months. What is the next most appropriate treatment?

      Your Answer:

      Correct Answer: Gonadotrophins

      Explanation:

      Management of PCOS includes OCP, cyclical oral progesterone, metformin, clomiphene (which is more effective in inducing ovulation than metformin) and life-style changes. In women who are tolerant to these therapies Gonadotrophins should be trialled. However lifestyle changes should be able to improve the condition significantly. Clomiphene shouldn’t be continued for more than 6 months.

    • This question is part of the following fields:

      • Clinical Management
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      Seconds

  • Question 9 - At what gestation does the foetus typically start swallowing? ...

    Incorrect

    • At what gestation does the foetus typically start swallowing?

      Your Answer:

      Correct Answer: 12 weeks

      Explanation:

      From the 12th week of gestation the foetus starts yawning, sucking and swallowing.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 10 - What is the most common cause of sepsis in the puerperium? ...

    Incorrect

    • What is the most common cause of sepsis in the puerperium?

      Your Answer:

      Correct Answer: Endometritis

      Explanation:

      Significant puerperal pyrexia is defined as a temperature of 38ºC or higher on any two of the first 10 days postpartum, exclusive of the first 24 hours. A mixed flora normally colonizes the vagina with low virulence. Puerperal infection is usually polymicrobial and involves contaminants from the bowel that colonize the perineum and lower genital tract. Following delivery, natural barriers to infection are temporarily removed and therefore organisms with a pathogenic potential can ascend from the lower genital tract into the uterine cavity. Placental separation exposes a large raw area equivalent to an open wound, and retained products of conception and blood clots within the uterus can provide an excellent culture medium for infection.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 11 - A patient is being discharged following a termination of pregnancy at 14 weeks....

    Incorrect

    • A patient is being discharged following a termination of pregnancy at 14 weeks. She had been taking a combined oral contraceptive pill in the past but stopped taking this 6 months prior to falling pregnant as she wasn't in a serious relationship. When should she start again?

      Your Answer:

      Correct Answer: Start immediately

      Explanation:

      Following an abortion or miscarriage, combined oral contraceptive pills should be started immediately.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 12 - Which of the following is regarded as the current Gold standard in the...

    Incorrect

    • Which of the following is regarded as the current Gold standard in the diagnosis of Polycystic Ovary Syndrome?

      Your Answer:

      Correct Answer: Rotterdam

      Explanation:

      The Rotterdam criteria was developed and expanded by the European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine Rotterdam consensus (ESHRE/ASRM) in 2003 and is now the Gold standard in the diagnosis of PCOS. The criteria requires two of three features: anovulation, hyperandrogenism, and polycystic ovaries seen on ultrasound.

      The National Institute of Child Health and Human Development (NICHD) attempted to define PCOS in 1990 but omitted ultrasonographic evidence of polycystic ovaries which is considered to be diagnostic of PCOS.

      The Androgen Excess Society (AES) served to confirm hyperandrogenism as the central event in the development of PCOS.

      The ROME III criteria is used for Irritable Bowel Disease and is therefore not applicable to PCOS.

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      • Clinical Management
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  • Question 13 - Syphilis is caused by which one of the following organisms? ...

    Incorrect

    • Syphilis is caused by which one of the following organisms?

      Your Answer:

      Correct Answer: Treponema Pallidum

      Explanation:

      Syphilis is a sexually transmitted disease which is caused by spirochete called treponema pallidum. It can be divided into three stages. i.e. primary, secondary and tertiary syphilis.
      – Primary syphilis is characterized by chancre formation at the site of sexual contact.
      – Secondary syphilis ranges from maculopapular lesions to scaly lesions, inguinal lymphadenopathy, condylomata lata and split papules at the corner of mouth.
      – Tertiary syphilis is the late stage of syphilis which is characterized by gummas formation and general paresis along with signs and symptoms of visceral involvement.

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      • Clinical Management
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  • Question 14 - What percentage of infants will have permanent neurological dysfunction as a result of...

    Incorrect

    • What percentage of infants will have permanent neurological dysfunction as a result of brachial plexus injury secondary to shoulder dystocia?

      Your Answer:

      Correct Answer:

      Explanation:

      Shoulder dystocia occurs when the anterior or posterior fetal shoulder impacts on the maternal symphysis or sacrum and may require additional manevours to release the shoulders after gentle downward traction has failed. The most common injury that can occur, is to the brachial plexus due to lateral flexion of the head during traction. This may cause a neurological disability, Erb’s Palsy ( injury to C5 and C6 of the brachial plexus) in which there is a less than 10% chance that this injury would be permanent.

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      • Clinical Management
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  • Question 15 - A 38 year old women attends clinic follow up. You note pelvic ultrasound...

    Incorrect

    • A 38 year old women attends clinic follow up. You note pelvic ultrasound shows a 36mm simple cyst. What is the most appropriate course of action regarding this cyst according to the RCOG green top guidelines?

      Your Answer:

      Correct Answer: Discharge with no follow up

      Explanation:

      As this is a simple cyst less than 50mm in diameter the patient does not require further investigation or routine follow up

    • This question is part of the following fields:

      • Clinical Management
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  • Question 16 - You are reviewing a patient with a scan suggestive of partial molar pregnancy....

    Incorrect

    • You are reviewing a patient with a scan suggestive of partial molar pregnancy. What is the typical genotype of a partial molar pregnancy?

      Your Answer:

      Correct Answer: 69 XXY

      Explanation:

      The partial mole is produced when an egg is fertilized by two sperm producing genotype 69 XXY (triploid). It can also occur when one sperm reduplicates itself yielding the genotypes 92 XXXY (tetraploid) though this is less common The genotype of a complete mole is typically 46 XX (diploid) but can also be 46 XY (diploid)

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      • Clinical Management
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  • Question 17 - A 34 year old patient who has just undergone a C-section delivery has...

    Incorrect

    • A 34 year old patient who has just undergone a C-section delivery has lost almost 1 litre of blood. You suspect uterine atony as the likely cause, and have bimanually compressed the uterus. Which of the following pharmacological interventions should follow?

      Your Answer:

      Correct Answer: Syntocin 5u by slow intravenous injection

      Explanation:

      In the management of postpartum haemorrhage, it is essential that the bleeding is first mechanically prevented, followed by the administration of oxytocic drugs, which cause the uterine smooth muscle to contract and clamping off bleeding sites in the endometrium. The drug of choice in the treatment protocol of PPH is 5 units of syntocin, a synthetic oxytocin uterotonic, by slow intravenous infusion. This is particularly suitable in the case of uterine atony. Other uterotonics, misoprostol, carboprost, ergometrine, can be used, but are not as effective in an emergency setting.

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      • Clinical Management
      0
      Seconds

  • Question 18 - A patient attends the maternity unit as her waters have broken but she...

    Incorrect

    • A patient attends the maternity unit as her waters have broken but she hasn't had contractions. She is 39+6 weeks gestation. Speculum examination confirms prelabour rupture of membranes. What is the likelihood of spontaneous labour starting within 24 hours?

      Your Answer:

      Correct Answer: 60%

      Explanation:

      In pregnancy, term refers to the gestational period from 37 0 to 41 6 weeks. Preterm births occur between 24 0 and 36 6 weeks. 60% of the women will go into labour with in 24 hours in PPROM. After 24 hours have past without any contraction and the gestation age is more than 34 week than prostaglandins can be used to augment labour.

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      • Clinical Management
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  • Question 19 - The COCP (Combined Oral Contraceptive Pill) causes all of the following biochemical effects...

    Incorrect

    • The COCP (Combined Oral Contraceptive Pill) causes all of the following biochemical effects EXCEPT which one?

      Your Answer:

      Correct Answer: Elevate FSH

      Explanation:

      Remember patients with PCOS have elevated LH. COCPs suppress synthesis and secretion of FSH and the mid-cycle surge of LH, thus inhibiting the development of ovarian follicles and ovulation COCPs reduce hyperandrogenism as reduced LH secretion results in decreased ovarian synthesis of androgens. Furthermore they stimulate the liver to produce Sex Hormone Binding Globulin which leads to decreased circulating free androgens. Other mechanisms include reduction in adrenal androgen secretion and inhibition of peripheral conversion of testosterone to dihydrotestosterone and binding of dihydrotestosterone to androgen receptors

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      • Clinical Management
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  • Question 20 - A 30 year old patient attends for non-invasive pre-natal screening for Down's syndrome....

    Incorrect

    • A 30 year old patient attends for non-invasive pre-natal screening for Down's syndrome. You advise her that the result will take the form of a risk score and higher risk results will be offered CVS or amniocentesis. What is the cut-off figure between low and high risk?

      Your Answer:

      Correct Answer: 1 in 150

      Explanation:

      1 in 150 is the cut off. Where pre-natal screening shows a risk of 1 in 150 or greater invasive testing is typically offered.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 21 - You receive a swab result from a patient who had complained of odorous...

    Incorrect

    • You receive a swab result from a patient who had complained of odorous vaginal discharge. It confirms bacterial vaginosis (BV). Which pathogen is most commonly associated with BV?

      Your Answer:

      Correct Answer: Gardnerella vaginalis

      Explanation:

      BV typically presents as an increase in vaginal discharge and vaginal malodour caused by a change in vaginal bacterial flora. PV discharge due to BV is typically grey fluid that adheres to the vaginal mucosa. BV is a polymicrobial infection. Gardnerella is the most commonly associated pathogen. Other associated bacteria include Lactobacillus species, Prevotella, Mobiluncus, Bacteroides, Peptostreptococcus, Fusobacterium, Veillonella, Eubacterium species, Mycoplasma hominis, Urea plasma urealyticum and Streptococcus viridans.

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      • Clinical Management
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  • Question 22 - In patients with endometriosis what is the infertility rate? ...

    Incorrect

    • In patients with endometriosis what is the infertility rate?

      Your Answer:

      Correct Answer: 40%

      Explanation:

      Around 30-40% of women affected by this condition complain of difficulty in conceiving.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 23 - Which of the following is associated with use of a tocolytic drug? ...

    Incorrect

    • Which of the following is associated with use of a tocolytic drug?

      Your Answer:

      Correct Answer: Prolongation of pregnancy for up to 7 days

      Explanation:

      The WHO recommends that tocolytics can safely be used to prolong pregnancy for up to seven days. The tocolytic drugs are used to suppress contractions to allow for more favourable conditions in the case of preterm labour, such as transfer to a better-equipped health care facility with a neonatal intensive care unit, or for those who have not yet completed a full dose of corticosteroids. It is not however associated with better neonatal outcomes in the imminent delivery of preterms. Examples of tocolytics include calcium channel blockers, magnesium sulphate, and oxytocin antagonists.

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      • Clinical Management
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      Seconds

  • Question 24 - Which of the following tests for the detection of chlamydia is considered the...

    Incorrect

    • Which of the following tests for the detection of chlamydia is considered the gold standard?

      Your Answer:

      Correct Answer: Nucleic Acid Amplification Test

      Explanation:

      Chlamydia is one of the most prevalent STIs in the UK. Many infected individuals can be asymptomatic making it difficult to detect. The gold standard in the diagnosis of Chlamydia is the nucleic acid amplification test (NAAT). A sample is taken from a vulvovaginal self swab, or a cervical swab on speculum examination in women.

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      • Clinical Management
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  • Question 25 - Looking at the picture below what is the diagnosis?

    Incorrect

    • Looking at the picture below what is the diagnosis?

      Your Answer:

      Correct Answer: Linea Nigra

      Explanation:

      This is Linea Nigra. It occurs in 3/4 of pregnancies and is due to increased melanocyte-stimulating hormone production by the placenta. This also causes melasma and darkening of the nipples.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 26 - Which of the following are required for Oxytocin to bind to its receptor?...

    Incorrect

    • Which of the following are required for Oxytocin to bind to its receptor?

      Your Answer:

      Correct Answer: Magnesium and Cholesterol

      Explanation:

      Oxytocin binds to G-protein-coupled receptors and requires Magnesium and cholesterol for this process to occur.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 27 - Ulipristal is thought to prevent pregnancy by what primary mechanism? ...

    Incorrect

    • Ulipristal is thought to prevent pregnancy by what primary mechanism?

      Your Answer:

      Correct Answer: Inhibition of ovulation

      Explanation:

      Ulipristal is a progesterone receptor modulator that is used up to 120 hours following unprotected intercourse. It inhibits ovulation. The dose is 30 mg.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 28 - What percentage of pregnancies will be uncomplicated following a single episode of reduced...

    Incorrect

    • What percentage of pregnancies will be uncomplicated following a single episode of reduced fetal movements?

      Your Answer:

      Correct Answer: 70%

      Explanation:

      Reduced fetal movements can be the first indication of possible fetal abnormalities. Movements are first perceived by the mother from about 18-20 weeks gestation, increase in size and frequency until 32 weeks gestation when they plateau at about 31 movements per hour. Investigations for reduced fetal heart rate include auscultation of the fetal heart rate using a handheld doppler device, and a cardiotocograph or ultrasound if the foetus is above 28 weeks gestation. About 70% of women who experience one episode of reduced fetal movement have uncomplicated pregnancies. They are advised to report to a maternal unit if another episode occurs.

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      • Clinical Management
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  • Question 29 - A baby with shoulder dystocia suffers a brachial plexus injury. The mother asks...

    Incorrect

    • A baby with shoulder dystocia suffers a brachial plexus injury. The mother asks you if this will be permanent. What percentage of babies will have permanent neurological dysfunction as a result of brachial plexus injury secondary to shoulder dystocia?

      Your Answer:

      Correct Answer:

      Explanation:

      of cases there is no permanent neurological disability. Shoulder dystocia is the most common cause of Erb’s palsy (Erb-Duchenne palsy) where there is injury to C5 and C6 of the brachial plexus (C5 to T1)

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      • Clinical Management
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  • Question 30 - A 45 year old women is seen in clinic following hysteroscopy and biopsy...

    Incorrect

    • A 45 year old women is seen in clinic following hysteroscopy and biopsy due to irregular menstrual bleeding. Her BMI is 34 kg/m2. This shows atypical hyperplasia. Which of the following is the most appropriate 1st line management?

      Your Answer:

      Correct Answer: Laparoscopic hysterectomy

      Explanation:

      Endometrial hyperplasia with atypia is at high risk of progression to cancer and hysterectomy is indicated There is high risk of progression to cancer with endometrial hyperplasia with atypia and hysterectomy is indicated. Although weight loss would be beneficial this shouldn’t delay surgical management.

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      • Clinical Management
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  • Question 31 - Which species of candida is the most common cause of genital candida infection...

    Incorrect

    • Which species of candida is the most common cause of genital candida infection in pregnancy?

      Your Answer:

      Correct Answer: Candida albicans

      Explanation:

      Vulvovaginal candidiasis is the most common genital infection and it is caused by candida albicans in 80-92% of the cases. Other non albicans species include C.tropicalis, C.glabrata, C.krusei and C.parapsilosis. 20% of women of childbearing age are asymptotic colonisers of Candida species as part of their normal vaginal flora. This increases to 40% in pregnancy.

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      • Clinical Management
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  • Question 32 - A 30 year old women who is 24 weeks pregnant attends clinic due...

    Incorrect

    • A 30 year old women who is 24 weeks pregnant attends clinic due to suprapubic pain. Ultrasound shows a viable foetus and also a fibroid with a cystic fluid filled centre. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Cystic degeneration of fibroid

      Explanation:

      A fibroid is a benign tumour of the smooth muscles of the uterus also known as a leiomyoma. It has a typical whorled appearance and this may be altered following degeneration which occurs in four main types:
      1. Red degeneration, also known as carneous degeneration, of degeneration that can involve a uterine leiomyoma. While it is an uncommon type of degeneration, it is thought to be the most common form of degeneration of a leiomyoma during pregnancy. Red degeneration follows an acute disruption of the blood supply to the fibroid during growth typically in a mid-second trimester presenting as sudden onset of pain with tenderness localizing to the area of the uterus along with pyrexia and leucocytosis. On ultrasound it can have peripheral (rim).

      2. Hyaline degeneration is the most common form of degeneration that can occur in a uterine leiomyoma. It is thought to occur in up to 60% of uterine leiomyomasoccurs when the fibroid outgrows its blood supply. this may progresses to central necrosis leaving a cystic space in the centre knowns as cystic degeneration.

      3. Cystic degeneration is an uncommon type of degeneration that a uterine leiomyoma (fibroid) can undergo. This type of degeneration is thought to represent ,4% of all types of uterine leiomyoma degeneration. When the leiomyoma increases in size, the vascular supply to it becomes inadequate and leads to different types of degeneration: hyaline, cystic, myxoid, or red degeneration. Dystrophic calcification may also occur. Hyalinization is the commonest type of degeneration. Cystic degeneration is an extreme sequel of edema. Ultrasound may show a hypoechoic or heterogeneous uterine mass with cystic areas.

      4. Myxoid degeneration of leiomyoma is one of the rarer types of degeneration that can occur in a uterine leiomyoma. While this type of degeneration is generally considered rare, the highest prevalence for this type of degeneration has been reported as up to 50% of all degenerations of leiomyomas. Fibroids (i.e. uterine leiomyomas) that have undergone myxoid degeneration are filled with a gelatinous material and can be difficult to differentiate from cystic degeneration; however, they typically appear as more complex cystic masses. They appear hypocellular with a myxoid matrix.

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      • Clinical Management
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  • Question 33 - A patient admitted to the medical ward complains of a mild fever and...

    Incorrect

    • A patient admitted to the medical ward complains of a mild fever and vaginal discharge. Clue cells are seen on microscopy from a vaginal swab. Which of the following infections feature clue cells?

      Your Answer:

      Correct Answer: Bacterial Vaginosis

      Explanation:

      Bacterial vaginosis (BV) is a common infection of the vagina caused by the overgrowth of atypical bacteria, most commonly Gardnerella vaginalis, a gram-negative rod. In diagnosing BV, a swab is taken for microscopy, often revealing clue cells. Clue cells are cells of the vaginal epithelium which are covered by adherent Gardnerella, giving them a distinctive look under the microscope. Though many are asymptomatic, some infected women complain of a greyish, foul-smelling vaginal discharge. Their vaginal fluid pH may also become more alkaline. BV does not however present with pyrexia, so the lady’s fever could be attributed to another cause as she is still a patient on the medical ward.

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      • Clinical Management
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  • Question 34 - A 46 year old lady presents to the gynaecology clinic with a one...

    Incorrect

    • A 46 year old lady presents to the gynaecology clinic with a one month history of vulval soreness and lumps. She smokes several packs of tobacco cigarettes a day. A biopsy confirms vulvar intraepithelial neoplasia. What is her risk of developing squamous cell carcinoma?

      Your Answer:

      Correct Answer: 15%

      Explanation:

      Vulvar Intraepithelial Neoplasia (VIN) is a non-invasive squamous type lesion that carries a 15% chance of developing into squamous cell carcinoma of the vulva. Human Papillomavirus (HPV) infection, or chronic inflammatory conditions such as lichen sclerosis and lichen planus, can cause changes in the basal cells of the vulvar epithelium. Other risk factors of VIN include multiple sexual partners, cigarette smoking, and immunocompromised states. Diagnosis is by clinical examination and a biopsy confirms neoplasia.

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      • Clinical Management
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  • Question 35 - A mother typically becomes aware of fetal movements at what gestation? ...

    Incorrect

    • A mother typically becomes aware of fetal movements at what gestation?

      Your Answer:

      Correct Answer: 18-20 weeks

      Explanation:

      Foetal movements often become apparent at about 18-20 weeks gestation. This phenomenon is also called quickening. The Foetal movements continue to increase in frequency and force until 32 weeks where they plateau. Foetal movements can be used to monitor the wellbeing of the foetus, alerting the mother and healthcare providers to a problem.

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      • Clinical Management
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  • Question 36 - Regarding pelvic Gonorrhoea infection in women. What percentage of cases are asymptomatic? ...

    Incorrect

    • Regarding pelvic Gonorrhoea infection in women. What percentage of cases are asymptomatic?

      Your Answer:

      Correct Answer: 50%

      Explanation:

      Gonorrhoea is a sexually transmitted disease that is caused by Neisseria gonorrhoea. It infects the mucous membrane of the genital tract epithelium in the endocervical and the urethral mucosa. Around 50% of the women are asymptomatic. However it presents as increase vaginal discharge, dysuria, proctitis and pelvic tenderness.

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      • Clinical Management
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  • Question 37 - A 34 week pregnant patient complains of itching over the past 6 weeks...

    Incorrect

    • A 34 week pregnant patient complains of itching over the past 6 weeks particularly to the hands and feet which is worse at night. You order some blood tests. Which of the following would you normally expect to increase in the 3rd trimester?

      Your Answer:

      Correct Answer: ALP

      Explanation:

      Pruritus of pregnancy is a common disorder, which occurs in 1 in 300 pregnancies, and presents as excoriated papules on extensor limbs, abdomen
      and shoulders. It is more common in women with a history of atopy. Prurigo usually starts at around 25–30 weeks of pregnancy and resolves after delivery,
      with no effect on the mother or baby. Treatment is symptomatic with topical steroids and emollients. It occurs due to derangement in the LFTs. ALP can rise to up to 3 times the normal non-pregnant value in the 3rd trimester.
      All of the other tests above typically decrease during pregnancy.

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      • Clinical Management
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  • Question 38 - The midwife asks for your advice about a 33 year old woman who...

    Incorrect

    • The midwife asks for your advice about a 33 year old woman who she has just seen at her booking appointment. The patient had an uncomplicated pregnancy 10 years ago. This is her second pregnancy. There is no significant personal or family history. On examination the patients blood pressure is 120/75, BMI 32.5kg/m2. The midwife asks your advice on testing for gestational diabetes. What would you advise?

      Your Answer:

      Correct Answer: OGTT at 24-28 weeks

      Explanation:

      Gestational diabetes (GDM) occurs in 2–9 per cent of all pregnancies. Screening for diabetes in pregnancy can be justify ed to diagnose previously unrecognized cases of pre-existing diabetes and to identify a group of women who are at risk of developing NIDDM later in life. No single screening test has been shown to be perfect in terms of high sensitivity and specific city for gestational diabetes. Urinary glucose is unreliable, and most screening tests now rely on blood glucose estimation, with an oral glucose tolerance test commonly used. The aim of glucose control is to keep fasting levels between 3.5 and 5.5 mmol/L and postprandial levels 7.1 mmol/L, with insulin treatment usually indicated outside these ranges.

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  • Question 39 - A 24 year old lady is 9 weeks pregnant with her first child....

    Incorrect

    • A 24 year old lady is 9 weeks pregnant with her first child. She attends clinic complaining of severe vomiting and is unable to keep fluids down. The most likely diagnosis is hyperemesis gravidarum. Which of the following is the underlying cause?

      Your Answer:

      Correct Answer: Increased circulating HCG

      Explanation:

      Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy, associated with weight loss of more than 5% of pre-pregnancy weight, dehydration and electrolyte imbalance. HG is usually most severe during the first 12 weeks of pregnancy and is thought to be caused by high circulating levels of HCG.

      There is not yet any evidence that pregnancy itself increases the sensitivity of the area postrema, or that the hormones, oestradiol, or progesterone increase vomiting. Generally, higher concentrations of dopamine stimulates receptors in the chemoreceptor trigger zone leading to nausea and vomiting. Although this has not been demonstrated as the cause of hyperemesis gravidarum.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 40 - A patient is diagnosed with cervical cancer and staging investigations show there is...

    Incorrect

    • A patient is diagnosed with cervical cancer and staging investigations show there is parametrial involvement but it is confined within the pelvic wall and does not involve the lower 1/3 vagina. There is no evidence of hydronephrosis. What FIGO stage is this?

      Your Answer:

      Correct Answer: 2B

      Explanation:

      This is stage 2B.

      2010 FIGO classification of cervical carcinoma
      0 – Carcinoma in situ
      1 – Confined to the cervix (diagnosed microscopy)
      1A1 – Less than 3mm depth & 7mm lateral spread
      1A2 – 3mm to 5mm depth & less than 7mm lateral spread
      1B1 – Clinically visible lesion or greater than A2 & less than 4 cm in greatest dimension
      1B2 – Clinically visible lesion, Greater than 4 cm in greatest dimension 2 Invades beyond uterus but not to pelvic wall or lower 1/3 vagina
      2A1 – Involvement of the upper two-thirds of the vagina, without parametrical invasion & Less than 4cm
      2A2 – Greater than 4 cm in greatest dimension
      2B – Parametrial involvement
      3 – Extends to Pelvic side wall or lower 1/3 vagina or hydronephrosis
      3A – No pelvic side wall involvement
      3B – Pelvic side wall involved or hydronephrosis
      4 – Extends beyond true pelvis
      4A – Invades mucosa bladder and rectum
      4B – Distant Metastasis

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      • Clinical Management
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  • Question 41 - A 36 year old women attends clinic following laparotomy and unilateral oophorectomy. The...

    Incorrect

    • A 36 year old women attends clinic following laparotomy and unilateral oophorectomy. The histology shows Psammoma bodies. What type of tumour would this be consistent with?

      Your Answer:

      Correct Answer: Serous

      Explanation:

      Serous tumours of the ovaries are large, cystic and spherical to ovoid in shape. They can be benign or malignant. Malignant tumours are usually nodular with irregularities in the surface where the tumour penetrates into the serosa. Psammoma bodies are a histological identification for these tumours which appear in the tips of the papillae.

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      • Clinical Management
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  • Question 42 - A 28 year old patient is treated for hydatidiform mole with methotrexate. What...

    Incorrect

    • A 28 year old patient is treated for hydatidiform mole with methotrexate. What is the mechanism of action of methotrexate?

      Your Answer:

      Correct Answer: Inhibits dihydrofolate reductase

      Explanation:

      Methotrexate is a folic acid antagonist. It inhibits dihydrofolate reductase (DHFR). DHFR catalyses the conversion of dihydrofolate to the active tetrahydrofolate which is required for DNA synthesis. It is either administered as a single intramuscular injection or multiple fixed doses.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 43 - What is the main reason for the active management of the third stage...

    Incorrect

    • What is the main reason for the active management of the third stage of labour?

      Your Answer:

      Correct Answer: Prevent postpartum haemorrhage

      Explanation:

      According to the WHO, active management of the third stage of labour has been shown to decrease the risk of postpartum haemorrhage in vaginal births worldwide. Per the guidelines from the International Federation of Gynaecologists and Obstetricians (FIGO), the active management of the third stage is summarised as follows:
      1. The administration of a uterotonic (oxytocin, ergometrine or misoprostol), within one minute of fetal delivery,
      2.Controlled cord traction with manual support to the uterus until placental delivery
      3. Fundal massage immediately after placental delivery.

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      • Clinical Management
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  • Question 44 - A baby with shoulder dystocia suffers a brachial plexus injury. You diagnose Erb-Duchenne...

    Incorrect

    • A baby with shoulder dystocia suffers a brachial plexus injury. You diagnose Erb-Duchenne palsy. Which nerve roots are typically affected?

      Your Answer:

      Correct Answer: C5 and C6

      Explanation:

      Erb’s or Erb-Duchenne palsy is a type of brachial plexus injury. The brachial plexus comprises C5 to T1 nerve roots. In Erb’s palsy C5 and C6 are the roots primarily affected. Shoulder Dystocia is the most common cause of Erb’s palsy.

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      • Clinical Management
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  • Question 45 - Which of the following statements is true regarding management of caesarean section? ...

    Incorrect

    • Which of the following statements is true regarding management of caesarean section?

      Your Answer:

      Correct Answer: Uterine closure can be in 1 or 2 layers

      Explanation:

      Closure of the uterus should be performed in either single or double layers with continuous or interrupted sutures. The initial suture should be placed just lateral to the incision angle, and the closure continued to a point just lateral to the angle on the opposite side. A running stitch is often employed and this may be locked to improve haemostasis. If a second layer is used, an inverting suture or horizontal suture should overlap the myometrium. Once repaired, the incision is assessed for haemostasis and ‘figure-of-eight’
      sutures can be employed to control bleeding. Peritoneal closure is unnecessary. Abdominal closure is performed in the anatomical planes with high strength, low reactivity materials, such as polyglycolic acid or polyglactin. Diamorphine is advised for intra and post op analgesia and oxytocin is advised to reduce blood loss.

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      • Clinical Management
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  • Question 46 - A patient has had limited response to conservative measures for her overactive bladder...

    Incorrect

    • A patient has had limited response to conservative measures for her overactive bladder (OAB). Which of the following is the most appropriate pharmacological choice?

      Your Answer:

      Correct Answer: Darifenacin

      Explanation:

      Detrusor overactivity can be treated with anti-cholinergic agents such as oxybutynin or tolterodine, solifenacin, fesoterodine and darifenacin. They are used as first line agents. Imipramine is used for enuresis and desmopressin is used for nocturia.
      NICE pathway

      Prior to initiating anticholinergics:
      Bladder training
      Consider treating vaginal atrophy and nocturia with topical oestrogen and desmopressin respectively before commencing treatments below.
      Consider catheterisation if chronic retention
      1st line treatments:
      1. Oxybutynin (immediate release) – Do not offer to frail elderly patients
      2. Tolterodine (immediate release)
      3. Darifenacin (once daily preparation)
      DO NOT offer any of the 3 drugs below:
      1. Flavoxate
      2. Propantheline
      3. Imipramine
      2nd line treatment
      Consider transdermal anticholinergic (antimuscarinic)
      Mirabegron
      Adjuvant Treatments
      Desmopressin can be considered for those with nocturia
      Duloxetine may be considered for those who don’t want/unsuitable for surgical treatment
      Intravaginal oestrogen can be offered to postmenopausal women with OAB

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      • Clinical Management
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  • Question 47 - Regarding Venous Thromboembolism (VTE) in pregnancy which of the following statements is TRUE?...

    Incorrect

    • Regarding Venous Thromboembolism (VTE) in pregnancy which of the following statements is TRUE?

      Your Answer:

      Correct Answer: Relative risk of VTE in pregnancy is 4 to 6 fold

      Explanation:

      Venous thromboembolic disease (VTE) is the most common cause of direct maternal death in the UK. In the most recent triennium, there were 41 fatalities, giving a maternal mortality rate of 1.94 per 100 000 – more than twice that of the next most common cause, pre-eclampsia. As pregnancy is a hyper coagulable state. There are alterations in the fibrinolytics and thrombotic pathways. There is also an increased production of clotting factors during pregnancy.

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      • Clinical Management
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  • Question 48 - What is the mode of action of Mefenamic acid? ...

    Incorrect

    • What is the mode of action of Mefenamic acid?

      Your Answer:

      Correct Answer: Inhibits Prostaglandin Synthesis

      Explanation:

      Mefenamic acids is a NSAID. It works by inhibiting prostaglandin synthesis – It inhibits COX-1 and COX-2 hence reducing the process of inflammation. Activation of antithrombin III and inactivation of factor Xa is the primary mechanism of action of Heparin.

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      • Clinical Management
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  • Question 49 - Ovarian cancer is associated with which type of metastasis? ...

    Incorrect

    • Ovarian cancer is associated with which type of metastasis?

      Your Answer:

      Correct Answer: Transcoelomic

      Explanation:

      The common route of metastases of the ovarian cancer is transcoelomic route.

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      • Clinical Management
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  • Question 50 - You review a patient in the fertility clinic. The ultrasound and biochemical profile...

    Incorrect

    • You review a patient in the fertility clinic. The ultrasound and biochemical profile are consistent with PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2. She is a non-smoker. Which of the following is the most appropriate first line treatment?

      Your Answer:

      Correct Answer: Clomiphene

      Explanation:

      Clomiphene and/or Metformin are 1st line agents. Weight loss in the setting of subfertility is advised if BMI >30 kg/m2

    • This question is part of the following fields:

      • Clinical Management
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  • Question 51 - Hypemesis gravidarum occurs in what percentage of pregnancies? ...

    Incorrect

    • Hypemesis gravidarum occurs in what percentage of pregnancies?

      Your Answer:

      Correct Answer: 1.50%

      Explanation:

      Nausea and vomiting experienced in 80% of pregnancies Hyperemesis gravidarum (HG) is an extreme form of nausea and vomiting which affects around 1.5% of women. Caused by high levels HCG. Definitions vary but most consider it to be defined by severe nausea and vomiting associated with weight loss greater than 5% of pre-pregnancy weight with metabolic disturbance (typically dehydration and/or ketosis).

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      • Clinical Management
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  • Question 52 - The COCP (Combined Oral Contraceptive Pill) causes all of the following biochemical effects...

    Incorrect

    • The COCP (Combined Oral Contraceptive Pill) causes all of the following biochemical effects EXCEPT?

      Your Answer:

      Correct Answer: Elevate FSH

      Explanation:

      COCP’s act both centrally and peripherally. They inhibit ovulation. Both oestrogen and progestogen supress the release of FSH and LH hence preventing ovulation. Peripherally it acts by making the endometrium atrophic and hostile towards implantation. It also alters the cervical mucus and prevents the sperm from ascending the uterine cavity.

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      • Clinical Management
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  • Question 53 - A 21 year old patient presents to the clinic with a 48 hour...

    Incorrect

    • A 21 year old patient presents to the clinic with a 48 hour history of unprotected sexual intercourse. She is not on any form of contraception. After discussion you prescribe a dose of Ulipristal 30 mg stat. Which of the following would be the appropriate advice regarding vomiting?

      Your Answer:

      Correct Answer: If vomiting occurs within 3 hours a repeat dose should be taken

      Explanation:

      Ulipristal acetate is a selective progesterone receptor modulator which regulates the luteinizing hormone (LH) surge, preventing ovulation. This emergency contraceptive can be used up to five days after unprotected sexual intercourse and is given as a 30mg oral dose. If vomiting occurs within three hours, then a second tablet is needed to ensure its effects.

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      • Clinical Management
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  • Question 54 - Premature menopause is defined as cessation of menses before the age of: ...

    Incorrect

    • Premature menopause is defined as cessation of menses before the age of:

      Your Answer:

      Correct Answer: 40

      Explanation:

      Premature menopause occurs if menopause happens before the age of 40. It effects 1% of women under the age of 40 and 0.1% under 30.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 55 - Breast feeding stimulates the hypothalamus to produce which of the following hormones? ...

    Incorrect

    • Breast feeding stimulates the hypothalamus to produce which of the following hormones?

      Your Answer:

      Correct Answer: Oxytocin

      Explanation:

      Breast feeding facilitates the production of Oxytocin by the hypothalamus which is stored and secreted by the posterior pituitary.
      Ergometrine is an ergoline derivative that can be used to increase uterine tone.
      Atosiban is an antagonist of Oxytocin receptors
      ADH is another posterior pituitary hormone.
      Prostaglandin E2 plays an important role in cervical ripening.

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      • Clinical Management
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  • Question 56 - Stages of labour ...

    Incorrect

    • Stages of labour

      Your Answer:

      Correct Answer: The third stage ends with the delivery of the placenta and membranes

      Explanation:

      First stage: The latent phase is generally defined as beginning at the point at which the woman perceives regular uterine contractions. A definition of active labour in a British journal was having contractions more frequent than every 5 minutes, in addition to either a cervical dilation of 3 cm or more or a cervical effacement of 80% or more.

      Second stage: fetal expulsion begins when the cervix is fully dilated, and ends when the baby is born.

      Third stage: placenta delivery – The period from just after the foetus is expelled until just after the placenta is expelled is called the third stage of labour or the involution stage.

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  • Question 57 - You see a 28 year old woman who is 22 weeks pregnant. She...

    Incorrect

    • You see a 28 year old woman who is 22 weeks pregnant. She complains of vaginal soreness and yellow frothy discharge. Microscopy confirms Trichomoniasis. What percentage of infected pregnant women present with yellow frothy discharge?

      Your Answer:

      Correct Answer: 20%

      Explanation:

      Trichomoniasis is considered a sexually transmitted infection found both in men and women, and is caused by the flagellate protozoan Trichomonas vaginalis. The organism is mainly found in the vagina and the urethra. Though many infected women can be asymptomatic, they can also present with yellow frothy vaginal discharge, itching and vaginitis, dysuria or an offensive odour. About 20-30% of women with the infection however are asymptomatic. For the diagnosis of t. vaginalis in women, a swab is taken from the posterior fornix during speculum examination and the flagellates are detected under light-field microscopy. The recommended treatment for t. vaginalis during pregnancy and breastfeeding is 400-500mg of metronidazole twice daily for 5 -7 days. High dose metronidazole as a 2g single dose tablet is not advised during pregnancy. All sexual partners should also be treated and screened for other STIs.

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      • Clinical Management
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  • Question 58 - A 24 week pregnant patient complains of itching over the past 6 weeks...

    Incorrect

    • 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:

      Correct 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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      • Clinical Management
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  • Question 59 - At what week in pregnancy is testing for gestational diabetes (GD) advised ...

    Incorrect

    • At what week in pregnancy is testing for gestational diabetes (GD) advised

      Your Answer:

      Correct Answer: As soon as possible after booking if past history of GD

      Explanation:

      Testing for GD should use the 2 hour 75g oral glucose tolerance test (OGTT) to test for GD in women. Testing women who have had GD in a previous pregnancy: early self monitoring of blood glucose OR a 75 g 2 hour OGTT as soon as possible after booking (whether in the first or second trimester) and a further 75 g 2hour OGTT at 24-28 weeks if the results of the first OGTT are normal. Testing women with risk factors for GD: 75g 2 hour OGTT at 24-28 weeks

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      • Clinical Management
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  • Question 60 - What is the most common Type II congenital thrombophilia? ...

    Incorrect

    • What is the most common Type II congenital thrombophilia?

      Your Answer:

      Correct Answer: Factor V Leiden mutation

      Explanation:

      Factor V Leiden is the most common congenital thrombophilia. Named after the Dutch city Leiden where it was first discovered. Protein C and S deficiencies are type 1 (Not type 2) thrombophilias Antiphospholipid syndrome is an acquired (NOT congenital) thrombophilia

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      • Clinical Management
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  • Question 61 - You see a diabetic women in preconception clinic. Which of the following is...

    Incorrect

    • You see a diabetic women in preconception clinic. Which of the following is appropriate advice regarding folic acid supplementation?

      Your Answer:

      Correct Answer: 5 mg daily until week 12

      Explanation:

      The aim of pre-pregnancy counselling is to achieve the best possible glycaemic control before pregnancy and to educate diabetic women about the implications of pregnancy. Patient information leaflets about pregnancy should make clear the risks of pregnancy in diabetes, and include advice to take high dose (5 mg) folic acid pre-conception and for the first 12 weeks.

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  • Question 62 - Regarding urinary tract infection (UTI) in pregnancy. What is the most common causative...

    Incorrect

    • Regarding urinary tract infection (UTI) in pregnancy. What is the most common causative organism of urinary tract infection?

      Your Answer:

      Correct Answer: Escherichia coli

      Explanation:

      E.coli is the most common cause of UTI. Other organisms include pseudomonas, proteus and klebsiella.

      NICE guidelines: UTI in pregnancy (updated in July 2015)

      Send urine for culture and sensitivity from all women in whom UTI is suspected before starting empirical antibiotics and 7 days after antibiotic treatment is completed.
      Prescribe an antibiotic to all women with suspected UTI (awaiting culture result is not advised)
      Although local antibiotic resistance needs to be taken into account the following is advised in terms of antibiotic selection:
      1. Nitrofurantoin 50 mg QDS (or 100 mg MR BD) for 7 days.
      2. Trimethoprim 200 mg twice daily, for 7 days
      Give folic acid 5 mg OD if it is the 1st trimester
      Do not give trimethoprim if the woman is folate deficient, taking a folate antagonist, or has been treated with trimethoprim in the past year.
      3. Cefalexin 500 mg BD (or 250 mg 6qds) for 7 days

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  • Question 63 - Which of the following uterotonic drugs is most strongly associated with a transient...

    Incorrect

    • Which of the following uterotonic drugs is most strongly associated with a transient pyrexia occurring within 45 minutes of administration?

      Your Answer:

      Correct Answer: Dinoprostone

      Explanation:

      Induction of Labour is produced by the infusion of PGF-2 alpha or PGE2. Dinoprostone is a PGE2 and is associated with transient pyrexia that resolved within 4-5 hours of stopping the use of the drug.

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  • Question 64 - A patients MSU comes back showing heavy growth of E.coli that is resistant...

    Incorrect

    • A patients MSU comes back showing heavy growth of E.coli that is resistant to trimethoprim, amoxicillin and nitrofurantoin. You decide to prescribe a course of Cephalexin. What is the mechanism of action of Cephalexin?

      Your Answer:

      Correct Answer: inhibit peptidoglycan cross-links in bacterial cell wall

      Explanation:

      Cephalosporins are beta lactum drugs, like penicillin. They act by inhibiting the cross linkage of the peptidoglycan wall in bacteria.

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  • Question 65 - Which of the following is the most accurate estimate of mature breast milk...

    Incorrect

    • Which of the following is the most accurate estimate of mature breast milk composition?

      Your Answer:

      Correct Answer: Fat 4%, Protein 1%, Sugar 7%

      Explanation:

      Breast milk contains around 4% fat, 7% sugar and 1% proteins. The rest is water and minerals.

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  • Question 66 - What percentage of pregnant women have asymptomatic vaginal colonisation with candida? ...

    Incorrect

    • What percentage of pregnant women have asymptomatic vaginal colonisation with candida?

      Your Answer:

      Correct Answer: 40%

      Explanation:

      Vulvovaginal candidiasis is the most common genital infections and it is caused by candida albicans in 80-92% of the cases. It colonise the vaginal flora in 20% of non pregnant and 40% pregnant women.

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  • Question 67 - A 24 year old patient presents as 24 weeks pregnant with vaginal discharge....

    Incorrect

    • 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:

      Correct 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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  • Question 68 - A 25 year old prim gravida carrying a twin male pregnancy presents at...

    Incorrect

    • 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:

      Correct 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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  • Question 69 - A 34 weeks pregnant patient has a blood pressure of 149/98. Urine dipstick...

    Incorrect

    • A 34 weeks pregnant patient has a blood pressure of 149/98. Urine dipstick shows protein 3+. You send a for a protein:creatinine ratio. What level would be diagnostic of significant proteinuria?

      Your Answer:

      Correct Answer: >30 mg/mmol

      Explanation:

      Pre-eclampsia is defined as hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hour collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the sixth postpartum week. Significant proteinuria = urinary protein: creatinine ratio >30 mg/mmol or 24-hour urine collection result shows greater than 300 mg protein.

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  • Question 70 - According to the RCOG Green-top guidelines on prevention and management of post-partum haemorrhage...

    Incorrect

    • According to the RCOG Green-top guidelines on prevention and management of post-partum haemorrhage (PPH) which of the following statements is true?

      Your Answer:

      Correct Answer: For women delivering by caesarean section, Oxytocin 5 iu by slow IV injection should be used

      Explanation:

      Misoprostol is not as effective as oxytocin but may be used if Oxytocin is not available e.g. home birth Recommended doses of Oxytocin For vaginal deliveries: 5 iu or 10 iu by intramuscular injection. For C-section: 5 iu by IV injection

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  • Question 71 - You are called to see a 24 year old patient in A&E. She...

    Incorrect

    • You are called to see a 24 year old patient in A&E. She is 34 weeks gestation and her blood pressure is 149/98. Automated reagent strip testing shows protein 1+. What is the appropriate course of action regarding the urine result?

      Your Answer:

      Correct Answer: Send urine for protein:creatinine ratio

      Explanation:

      For a diagnosis of Preeclampsia to be established, hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hour collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the sixth postpartum week should be present.

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  • Question 72 - Which organism is the most common cause of puerperal sepsis? ...

    Incorrect

    • Which organism is the most common cause of puerperal sepsis?

      Your Answer:

      Correct Answer: Group A Streptococcus

      Explanation:

      Puerperal sepsis is defined as sepsis occurring after birth until 6 weeks postnatal. The most common cause of puerperal sepsis is Group A streptococcus. Until 1937, puerperal sepsis was the major cause of maternal mortality. The discovery of sulphonamides in 1935 and the simultaneous reduction in the virulence of the haemolytic streptococcus resulted in a dramatic fall in maternal mortality.

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  • Question 73 - A 32 year old lady with known stage III cervical cancer presents to...

    Incorrect

    • A 32 year old lady with known stage III cervical cancer presents to A&E with lower abdominal and unilateral flank pain. From the following list what is the likely diagnosis?

      Your Answer:

      Correct Answer: Ureteric Obstruction

      Explanation:

      In stage III cervical cancer there is involvement of the pelvic wall and ureter which may result in abdominal pain and hydronephrosis.

      2010 FIGO classification of cervical carcinoma

      Stage
      0 – Carcinoma in situ
      1 – Confined to the cervix (diagnosed microscopy)
      1A1 – Less than 3mm depth & 7mm lateral spread
      1A2 – 3mm to 5mm depth & less than 7mm lateral spread
      1B1 – Clinically visible lesion or greater than A2 & less than 4 cm in greatest dimension
      1B2 – Clinically visible lesion, Greater than 4 cm in greatest dimension
      2 – Invades beyond uterus but not to pelvic wall or lower 1/3 vagina
      2A1 – Involvement of the upper two-thirds of the vagina, without parametrical invasion & Less than 4cm
      2A2 – Greater than 4 cm in greatest dimension
      2B – Parametrial involvement
      3 – Extends to Pelvic side wall or lower 1/3 vagina or hydronephrosis
      3A – No pelvic side wall involvement
      3B – Pelvic side wall involved or hydronephrosis
      4 – Extends beyond true pelvis
      4A – Invades mucosa bladder and rectum
      4B – Distant Metastasis

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  • Question 74 - At what gestation does a mother typically first become aware of fetal movements?...

    Incorrect

    • At what gestation does a mother typically first become aware of fetal movements?

      Your Answer:

      Correct Answer: 18-20 weeks

      Explanation:

      Typically fetal movements become apparent by 18-20 weeks

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      • Clinical Management
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  • Question 75 - What is the average volume of blood loss during the menstrual cycle ...

    Incorrect

    • What is the average volume of blood loss during the menstrual cycle

      Your Answer:

      Correct Answer: 35-40ml

      Explanation:

      The average menstrual blood loss is 35-40ml The maximum normal blood loss is 80ml

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  • Question 76 - Which one of the following has the most significant effect on slowing drug...

    Incorrect

    • Which one of the following has the most significant effect on slowing drug metabolism in pregnancy?

      Your Answer:

      Correct Answer: Progesterone effect on gastric motility

      Explanation:

      Progesterone down regulates gastric motility meaning drugs are absorbed and metabolised more slowly, thus drugs are absorbed, metabolised and cleared more slowly. Most of the drugs are transported after binding to the albumin.
      Lower albumin levels mean a greater unbound drug fraction but as this may be thought to increase drug concentrations it actually leaves more available for hepatic clearance or renal excretion so overall drug concentrations are unchanged and metabolism increased.
      Increase in hepatic flow will increase the metabolism of the drug as the drug will be transported faster.
      Increased renal blood flow will result in the faster clearance of the drug from the body.

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  • Question 77 - Which vitamin deficiency leads to Wernicke's encephalopathy? ...

    Incorrect

    • Which vitamin deficiency leads to Wernicke's encephalopathy?

      Your Answer:

      Correct Answer: B1

      Explanation:

      Vitamin B1 deficiency can lead to Wernicke’s encephalopathy. Alcoholics are at particular risk. In obstetrics all women with hyperemesis gravidarum should receive thiamine supplementation to prevent Wernicke’s.

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  • Question 78 - A 30 year old women who is 24 weeks pregnant attends EPU due...

    Incorrect

    • A 30 year old women who is 24 weeks pregnant attends EPU due to suprapubic pain. Ultrasound shows a viable foetus and also a fibroid with a cystic fluid filled centre. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Red degeneration of fibroid

      Explanation:

      Red degeneration of fibroids is one of 4 methods of fibroid degeneration. Although uncommon outside pregnancy it is thought to be the most common form of fibroid degeneration during pregnancy and typically occurs in the 2nd trimester. It is thought to arise from the fibroid outgrowing its blood supply and haemorrhagic infarction occurs. Ultrasound will typically show a localised fluid collection (blood) within the fibroid.

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  • Question 79 - When consenting someone for laparoscopy you discuss the risk of vascular injury. The...

    Incorrect

    • When consenting someone for laparoscopy you discuss the risk of vascular injury. The incidence of vascular injury during laparoscopy according to the BSGE guidelines is?

      Your Answer:

      Correct Answer: 0.2/1000

      Explanation:

      Major vessel injury is the most important potential complication when undertaking laparoscopy. It’s incidence is 0.2/1000. Bowel Injury is more common at 0.4/1000

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  • Question 80 - According to the RCOG Green-top guideline published in 2013 at what stage of...

    Incorrect

    • According to the RCOG Green-top guideline published in 2013 at what stage of gestation should pregnant patients with PCOS be offered screening for gestational diabetes

      Your Answer:

      Correct Answer: 24-28 weeks gestation

      Explanation:

      Screening for gestational diabetes should be offered and performed between 24-28 weeks. It should be noted PCOS alone does not make screening essential. It is advised for PCOS patients who are overweight or if not overweight but has other risk factors (age >40, personal history of gestational diabetes or family history of type II diabetes). Screening is via a 2-hour post 75 g oral glucose tolerance test.

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  • Question 81 - A 53 year old lady presents to clinic due to vulval itch and...

    Incorrect

    • A 53 year old lady presents to clinic due to vulval itch and discolouration. examination reveals pale white discoloured areas to the vulva. A biopsy shows epidermal atrophy with sub-epidermal hyalinization and deeper inflammatory infiltrate. What is this characteristic of?

      Your Answer:

      Correct Answer: Lichen Sclerosus

      Explanation:

      Lichen sclerosus is characterized by hypopigmented atrophic plaque in the perineal region along with features of pruritis and dyspareunia.
      It is more common in post menopausal women and on histology there is epidermal atrophy, inflammatory infiltrate in the dermis and basal layer degeneration.

      Vitiligo is characterised by hypopigmentation but without any other symptoms.
      Extramammary Paget’s disease is characterized by erythematous plaque located mostly in the perianal region but its histology is different.
      Lichen simplex chronicus is a chronic scaly pruritic condition characterized by itchy papules and plaques plus lichenification and it mostly results from chronic irritation and itching of the area.

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  • Question 82 - A 24 year old lady is rushed to the emergency department complaining of...

    Incorrect

    • A 24 year old lady is rushed to the emergency department complaining of vaginal spotting and abdominal cramping. Her 6 week pregnancy was confirmed by ultrasound scan last week. On speculum examination, the cervical os is open with blood noted around it. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Inevitable Miscarriage

      Explanation:

      A miscarriage is defined as the spontaneous loss of a pregnancy before the age of viability at 24 weeks in the UK. An inevitable miscarriage occurs with the usual symptoms of a miscarriage such as menstrual-like cramping, vaginal bleeding and a dilated cervix. The gestational sac has ruptured but products of conception have not been passed. The products of conception will eventually pass.

      A missed miscarriage is described as a loss of pregnancy without vaginal bleeding, loss of tissue, cervical changes or abdominal pain. During a scan, a fetal heartbeat is not observed, and the gestational sac may be small.

      A threatened miscarriage is when the cervix dilates and uterine bleeding is seen; the pregnancy could still be viable.

      A complete miscarriage occurs when all the products of conception are expelled from the uterus, bleeding has stopped, and the cervix has closed up after dilation. Recurrent miscarriages are described as spontaneous pregnancy loss of more than 2 to 3 consecutive times.

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  • Question 83 - A 77 year old woman undergoes staging investigations for endometrial carcinoma. This shows...

    Incorrect

    • A 77 year old woman undergoes staging investigations for endometrial carcinoma. This shows invasion of the inguinal lymph nodes. What is this patients 5-year survival?

      Your Answer:

      Correct Answer: 15%

      Explanation:

      Lymph node involvement means that the carcinoma is stage 4. The 5 year survival of stage 4 endometrial carcinoma is 16%.

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  • Question 84 - Which hormone is responsible for contraction of myoepithelial cells in lactation? ...

    Incorrect

    • Which hormone is responsible for contraction of myoepithelial cells in lactation?

      Your Answer:

      Correct Answer: Oxytocin

      Explanation:

      Oxytocin is responsible for the let down mechanism that occurs during breast feeding in which the myothelial cells contract and push the milk into the ductules.

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  • Question 85 - You are asked to review a patient. They have attended for a scan...

    Incorrect

    • You are asked to review a patient. They have attended for a scan at 13 weeks following a positive pregnancy test. The patient has had 2 previous pregnancies for which she opted for termination on both occasions. The scan shows a large irregular haemorrhagic mass that appears to be invading into the myometrium. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Choriocarcinoma

      Explanation:

      Choriocarcinoma may arise as a complication of gestation or as spontaneous germ cell tumours. As this scenario depicts that the women has previous abortion points to the fact that these may have been molar pregnancies. As choriocarcinoma can arise from a molar pregnancy it can be differentiated from it by the presence of invasion into the uterus and metastasis to the lungs primarily.

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  • Question 86 - A patient at 15 weeks gestation undergoes an abortion. She has no known...

    Incorrect

    • A patient at 15 weeks gestation undergoes an abortion. She has no known drug allergies. Which of the following is the most appropriate regarding antibiotic prophylaxis?

      Your Answer:

      Correct Answer: Stat Azithromycin 1g and metronidazole 800 mg orally at time of abortion

      Explanation:

      First trimester abortions are performed using mifepristone 600 mg followed by insertion of 1 mg gemeprost vaginal pessary. The patients stays in the hospital for about 4-6 hours. At the time of abortion azithromycin 1 g and metronidazole 800 mg should be given to cover the gram positive and negative bacteria.

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  • Question 87 - Amongst women with a diagnosis of Gonorrhoea, what percentage will develop pelvic inflammatory...

    Incorrect

    • Amongst women with a diagnosis of Gonorrhoea, what percentage will develop pelvic inflammatory disease?

      Your Answer:

      Correct Answer: 15%

      Explanation:

      Gonorrhoea is a sexually transmitted diplococcus bacteria known to infect the female genital tract, which can cause an ascending infection in the uterus and fallopian tubes. About 15 percent of women with this infection may develop pelvic inflammatory disease (PID), which poses risks of long term consequences: ectopic pregnancy, infertility and chronic pelvic pain.

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  • Question 88 - Regarding the diagnosis of Gestational Diabetes which of the following tests is recommended...

    Incorrect

    • Regarding the diagnosis of Gestational Diabetes which of the following tests is recommended by the WHO for diagnosis?

      Your Answer:

      Correct Answer: 75g OGTT with 2 hour glucose

      Explanation:

      Gestational diabetes (GDM) occurs in 2–9 per cent of all pregnancies. Screening for diabetes in pregnancy can be justify ed to diagnose previously unrecognized cases of pre-existing diabetes and to identify a group of women who are at risk of developing NIDDM later in life. No single screening test has been shown to be perfect in terms of high sensitivity and specific city for gestational diabetes. Urinary glucose is unreliable, and most screening tests now rely on blood glucose estimation, with an oral 75g glucose tolerance test commonly used. The aim of glucose control is to keep fasting levels between 3.5 and 5.5 mmol/L and postprandial levels 7.1 mmol/L, with insulin treatment usually indicated outside these ranges.

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  • Question 89 - A 70 year old patient is being reviewed in clinic for post menopausal...

    Incorrect

    • A 70 year old patient is being reviewed in clinic for post menopausal bleeding. Examination reveals a lesion of the vaginal wall. Which is the most common type of primary vaginal cancer?

      Your Answer:

      Correct Answer: Squamous cell carcinoma

      Explanation:

      The vaginal epithelium is made of squamous cells. Hence the most common carcinoma that occurs in the Vagina is squamous cell carcinoma. Diagnosis is made with vaginal biopsy. Usually the pain only presents if the disease extends beyond the vagina involving the perineal nerves.

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  • Question 90 - Regarding uterine fibroids, which of the following statements is false? ...

    Incorrect

    • Regarding uterine fibroids, which of the following statements is false?

      Your Answer:

      Correct Answer: The risk of fibroids is increased by pregnancy

      Explanation:

      Fibroids are a common gynaecological condition found in many women above the age of 35. They are however uncommon before puberty. They are most common in black women vs white women, and its prevalence increases from puberty to menopause. Risk factors for fibroids include increasing age, obesity and infertility. Protective factors, on the other hand, include pregnancy, as the risk of fibroids decreases with increasing numbers of pregnancies.

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  • Question 91 - A 36 year old patient is seen in clinic for follow up of...

    Incorrect

    • A 36 year old patient is seen in clinic for follow up of a vaginal biopsy which confirms cancer. What is the most common type?

      Your Answer:

      Correct Answer: Squamous cell carcinoma

      Explanation:

      Squamous cell carcinoma is the most common type of vaginal cancer.

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  • Question 92 - Which of the following fasting plasma glucose (FPG) values for OGTT (Oral glucose...

    Incorrect

    • 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:

      Correct 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 >7.8

      Random 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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  • Question 93 - When is the earliest appropriate gestational age to perform amniocentesis? ...

    Incorrect

    • When is the earliest appropriate gestational age to perform amniocentesis?

      Your Answer:

      Correct Answer: 15+0 weeks

      Explanation:

      The best time to perform amniocentesis is at the gestational age of 15 weeks or more. There is increased risk of abortion, respiratory problems and fetal talipes if amniocentesis is performed before the gestational age of 14 weeks.

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  • Question 94 - A 16 year old girl has been referred as she has amenorrhoea. She...

    Incorrect

    • A 16 year old girl has been referred as she has amenorrhoea. She reports never having periods. Her mother and 2 sisters menarche was at age 12. On examination you note the patient is 152cm tall and BMI 29.0 and secondary sexual characteristics are not developed. Her FSH is elevated. Prolactin is normal. What is the suspected diagnosis?

      Your Answer:

      Correct Answer: Turner Syndrome

      Explanation:

      Turner syndrome is the most common chromosomal abnormality in females occurring in 1 in 2500 live births. It is characterised by short stature, webbed neck and wide carrying angle. It is also associated with renal, endocrine and CVS abnormalities. In this condition the ovaries do not completely develop and do not produce oestrogen or oocytes, thus no secondary sexual characteristic develop and neither does the girl starts menstruating.

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  • Question 95 - At what week in pregnancy is testing for gestational diabetes (GD) advised ...

    Incorrect

    • At what week in pregnancy is testing for gestational diabetes (GD) advised

      Your Answer:

      Correct Answer: As soon as possible after booking if past history of GD

      Explanation:

      Gestational diabetes (GDM) occurs in 2–9 per cent of all pregnancies. Screening for diabetes in pregnancy can be justified to diagnose previously unrecognized cases of pre-existing diabetes and to identify a group of women who are at risk of developing NIDDM later in life. No single screening test has been shown to be perfect in terms of high sensitivity and specificity for gestational diabetes. Urinary glucose is unreliable, and most screening tests now rely on blood glucose estimation, with an oral glucose tolerance test commonly used. The aim of glucose control is to keep fasting levels between 3.5 and 5.5 mmol/L and postprandial levels 7.1 mmol/L, with insulin treatment usually indicated outside these ranges. The women should be tested as soon as possible after booking if there is a history of GD.

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  • Question 96 - What is the most common causative organism in Fitzhugh Curtis syndrome and ophthalmic...

    Incorrect

    • What is the most common causative organism in Fitzhugh Curtis syndrome and ophthalmic neonatorum?

      Your Answer:

      Correct Answer: Chlamydia trachomatis

      Explanation:

      A rare complication of pelvic inflammatory disease is Fitz Hugh Curtis syndrome which is perihepatitis leading to the formation of adhesions between the liver and the peritoneal surface. It is most commonly caused by chlamydia and gonorrhoea. Ophthalmia neonatorum is conjunctivitis which is also caused by these pathogens.

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  • Question 97 - A 75 year old woman has a lesion biopsied from the cervix that...

    Incorrect

    • A 75 year old woman has a lesion biopsied from the cervix that is histologically confirmed as endometrial carcinoma. Further staging investigations shows no spread to the serosa or adnexa, no spread to the para-aortic, pelvic or inguinal lymph nodes and no evidence of distant metastasis. What FIGO stage is this?

      Your Answer:

      Correct Answer: 2

      Explanation:

      It is stage 2 of the disease.

      Staging:
      1 Confined to uterus
      1A < 50% myometrial invasion
      1B > 50% myometrial invasion
      2 Cervical stromal invasion but not beyond uterus
      3 Extension beyond the uterus
      3A Tumour invades the serosa or adnexa
      3B Vaginal and/or parametrial invasion
      3C1 Pelvic nodal involvement
      3C2 Para aortic nodal involvement
      4 Distant Metastasis
      4A Tumour invasion of the bladder and/or bowel mucosa
      4B Distant metastases including abdominal metastases and/or inguinal lymph nodes

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  • Question 98 - Endometrial tissue found within the myometrium is classed as: ...

    Incorrect

    • Endometrial tissue found within the myometrium is classed as:

      Your Answer:

      Correct Answer: Adenomyosis

      Explanation:

      Adenomyosis is a disorder characterised by the presence of endometrial glands deep within the myometrium. It presents with increasing severe secondary dysmenorrhoea and increased in the flow of menstrual blood.

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  • Question 99 - Hyperemesis gravidarum occurs in what percentage of pregnancies? ...

    Incorrect

    • Hyperemesis gravidarum occurs in what percentage of pregnancies?

      Your Answer:

      Correct Answer: 1.50%

      Explanation:

      Hyperemesis Gravidarum effects around 0.3-2% of Pregnancies. It causes imbalances of fluid and electrolytes, disturbs nutritional intake and metabolism, causes physical and psychological debilitation and is associated with adverse pregnancy outcome, including an increased risk of preterm birth
      and low birthweight babies. The aetiology is unknown however various potential mechanisms have been proposed including an association with high levels of serum human chorionic gonadotrophin (hCG), oestrogen and thyroxine.

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  • Question 100 - A 26 year old patient with a past medical history of 2 terminations...

    Incorrect

    • A 26 year old patient with a past medical history of 2 terminations of pregnancies over the past 2 years, presents to the emergency centre complaining of severe abdominal pain and some vaginal bleeding. She has a regular 28 day cycle, and is on an oral contraceptive pill, but missed last month's period. Her last termination was over 6 months ago. She smokes almost a pack of cigarettes a day. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Ectopic pregnancy

      Explanation:

      The clinical picture demonstrated is most likely that of a ruptured ectopic pregnancy. The period of amenorrhea may point to pregnancy, while the past medical history of 2 recent terminations of pregnancy may indicate a failure of her current contraceptive method. Smoking cigarettes have been shown to not only decrease the efficacy of OCPs, but also serve as a known risk factor for ectopic pregnancy. The lady is unlikely to have endometritis as her last termination was over 6 months ago. The lack of fever helps to make appendicitis, PID and pyelonephritis less likely, though they are still possible.

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