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Question 1
Incorrect
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What kind of epithelium lines the endocervix?
Your Answer: Stratified Squamous, non keratinised
Correct Answer: Columnar
Explanation:Its important to note the endo and ectocervix have 2 epithelial types. Where columnar and squamous epithelia meet is the transformation zone (or squamous-columnar junction, SCJ). This is relevant as it is the primary site for dysplasia and is where smears are taken from.
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This question is part of the following fields:
- Pathology
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Question 2
Correct
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A 32 year old women who is 25 weeks pregnant presents with vaginal bleeding and cramping lower abdominal pain. On examination the cervix is closed. Fetal cardiac activity is noted on ultrasound. What is the likely diagnosis?
Your Answer: Antepartum Haemorrhage
Explanation:Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby.
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This question is part of the following fields:
- Clinical Management
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Question 3
Incorrect
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Which stage of the menstrual cycle in best suited for the insertion of IUD?
Your Answer: During menstrual bleeding
Correct Answer: During the first 7 days of your menstrual cycle, which starts with the first day of bleeding
Explanation:it is imperative to elucidate the patient’s risk for current pregnancy and time within her current menstrual cycle prior to IUD insertion. A negative urine pregnancy test is a prerequisite to placement of an IUD. Pregnancies occurring with IUDs in place have an increased incidence of complications, including spontaneous abortion and septic abortion.
For this reason, many providers prefer to time IUD insertion within the first 5-7 days of the menstrual cycle, further assuring that the patient is not newly pregnant.
All other options take risk of the patient being pregnant.
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This question is part of the following fields:
- Gynaecology
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Question 4
Correct
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A 25 year old pregnant woman presents with constant abdominal pain, which has been present for the last few hours. Before the pain started she admits experiencing vaginal blood loss. She's a primigravida in her 30th week of gestation. Upon abdominal examination the uterus seems irritable. CTG is, however, reactive. What is the most probable diagnosis?
Your Answer: Antepartum haemorrhage
Explanation:Antepartum haemorrhage presents with bleeding, which may or may not be accompanied by pain. Uterine irritability would suggest abruptio, however contractions are present which may be confused with uterine irritability and in this case, there are no signs of pre-eclampsia present.
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This question is part of the following fields:
- Obstetrics
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Question 5
Incorrect
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Which one of the following statements regarding oestrogen is correct?
Your Answer: It is responsible for secretory changes in endometrium
Correct Answer: It is produced in the corpus luteum
Explanation:Oestrogen is secreted by the corpus luteum and is responsible for the proliferation of the endometrium to prepare it for the implantation of the zygote.
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This question is part of the following fields:
- Physiology
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Question 6
Correct
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Which of the following muscles is NOT a constituent of the pelvic floor (diaphragm)?
Your Answer: Piriformis
Explanation:The pelvic floor or diaphragm is composed of Coccygeus and Levator Ani. Levitator Ani is composed of 3 muscles: puborectalis, pubococcygeus and iliococcygeal. Although Piriformis assists in closing the posterior pelvic outlet it is not considered a component of the pelvic floor
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This question is part of the following fields:
- Anatomy
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Question 7
Incorrect
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Fibrinogen is activated by which of the following?
Your Answer: Factor Xa
Correct Answer: Thrombin
Explanation:Fibrinogen is activated by thrombin which converts it into fibrin which forms a mesh to trap red blood cells and form a clot.
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This question is part of the following fields:
- Biochemistry
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Question 8
Correct
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A 13-year-old woman is complaining of a lot of acne in her face. Her BMI is 37. She does not have her period yet. She has high insulin levels in her labs. What is the most likely diagnosis?
Your Answer: Polycystic Ovarian Syndrome (PCOS)
Explanation:The best answer is Polycystic Ovarian Syndrome (PCOS), supported by amenorrhea, obesity and acne. High insulin levels are indicative of PCOS and exclude Cushing syndrome (as this is associated with low insulin levels).
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This question is part of the following fields:
- Gynaecology
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Question 9
Correct
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With sneezing, a 45-year-old mother of two reported leaking a small bit of urine. It started to happen with exercising recently. She denies having experienced recent life pressures. Which of the following best characterizes the incontinence she's dealing with?
Your Answer: Stress incontinence
Explanation:Overflow incontinence typically presents with continuous urinary leakage or dribbling in the setting of incomplete bladder emptying. Associated symptoms can include weak or intermittent urinary stream, hesitancy, frequency, and nocturia. When the bladder is very full, stress leakage can occur or low-amplitude bladder contractions can be triggered resulting in symptoms similar to stress or urgency incontinence.
Women with urgency incontinence experience the urge to void immediately preceding or accompanied by involuntary leakage of urine
Individuals with stress incontinence have involuntary leakage of urine that occurs with increases in intraabdominal pressure (e.g., with exertion, sneezing, coughing, laughing) in the absence of a bladder contraction.
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This question is part of the following fields:
- Gynaecology
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Question 10
Correct
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Question 11
Correct
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Regarding ectopic pregnancy, where is the most common site of implantation?
Your Answer: Ampullary tubal
Explanation:Ectopic pregnancies can quickly become a gynaecological emergency if left untreated. The majority of ectopic pregnancies (95-97%) are tubal occurring in the fallopian tube as opposed to the abdomen, ovary or cervix. In tubal ectopics, the most common site of occurrence is in the ampulla (70%), followed by the isthmus, fimbria, and the cornua.
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This question is part of the following fields:
- Epidemiology
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Question 12
Correct
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Question 13
Correct
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Question 14
Incorrect
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Regarding Venous Thromboembolism (VTE) in pregnancy which of the following statements is TRUE?
Your Answer: Relative risk of VTE in pregnancy is 2 to 3 fold
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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This question is part of the following fields:
- Clinical Management
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Question 15
Correct
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A 39 years old female patient comes to your office seeking contraceptive advice. She is a cigarette smoker. What would your advice be?
Your Answer: Progesterone only pills
Explanation:Absolute contraindications to OCs include breast cancer, history of deep venous thrombosis or pulmonary embolism, active liver disease, use of rifampicin, familial hyperlipidaemia, previous arterial thrombosis, and pregnancy, while relative contraindications include smoking, age over 35, hypertension, breastfeeding, and irregular spontaneous menstruation.
Progestin only pills are the safest and most effective contraceptive methods than the rest of the options.
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This question is part of the following fields:
- Gynaecology
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Question 16
Incorrect
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A 32-year-old woman, gravida 2 para 1, at 40 weeks gestation is admitted to the hospital due to contractions and spontaneous rupture of membranes.Patient underwent a cesarean delivery with her first child due to breech presentation, but this pregnancy has been uncomplicated.She has no chronic medical conditions and is taking only a prenatal vitamin. Her pre-pregnancy BMI was 20 kg/m2 and she has gained 15.9 kg (35 lb) during pregnancy. On examination her blood pressure is found to be 130/80 mm Hg. The patient is admitted and epidural anesthesia is administered with an intrauterine pressure catheter in place.She quickly dilates to 10 cm with the fetal vertex at 0 station, occiput transverse. Four hours later, the pelvic examination is unchanged but there is molding and caput on the fetal head. Fetal monitoring is category I. Contractions occur every 2-3 minutes and the patient pushes with each contraction. The contraction strength is an average of 210 MVU every 10 minutes. Which among the following is most likely the etiology for this patient’s clinical presentation?
Your Answer:
Correct Answer: Fetal malposition
Explanation:Condition where there is insufficient fetal descent after pushing for ≥3 hours in nulliparous and ≥2 hours if multiparous women is defined as Second stage arrest of labor. Common risk factors for this presentation are maternal obesity, excessive weight gain during pregnancy and diabetes mellitus. Cephalopelvic disproportion, malposition, inadequate contractions and maternal exhaustion are the common etiologies of Second stage arrest of labor. Management includes Operative vaginal delivery or cesarean delivery as indicated in the case.
The second stage of labor begins with the dilatation of cervix to 10 cm and will end with fetal delivery. Parity and use of neuraxial anesthesia are the two factors which will affect the duration of second stage of labor and fetal station, which measures the descent of the fetal head through the pelvis determines its progression.
When there is no fetal descent after pushing for ≥3 hours or ≥2 hours in in nulliparous and multiparous patients respectively the condition is called an arrested second stage of labor. As her first delivery was a cesarean session due to breech presentation, this patient in the case is considered as nulliparous.
Most common cause of a protracted or arrested second stage is fetal malposition, which is the relation between the fetal presenting part to the maternal pelvis. Occiput anterior is the optimal fetal position as it facilitates the cardinal movements of labor, any deviations from this position like in occiput transverse position, can lead to cephalopelvic disproportion resulting in second stage arrest.
Inadequate contractions, that is less than 200 MVU averaged over 10 minutes, can lead to labor arrest but contractions are adequate in case of the patient mentioned.
Second stage arrest can be due to maternal obesity and excessive weight gain during pregnancy but this patient had a normal pre-pregnancy BMI of 20 kg/m2 and an appropriate weight gain of 15.9 kg 35 lb. So this also cannot be the reason.Maternal expulsive efforts will change the fetal skull shape. This process called as molding helps to facilitate delivery by changing the fetal head into the shape of the pelvis. Whereas prolonged pressure on head can result in scalp edema which is called as caput, presence of both molding and caput suggest cephalopelvic disproportion, but is not suggestive of poor maternal effort.
Patients with a prior history of uterine myomectomy or cesarean delivery are at higher risk for uterine rupture. In cases of uterine rupture, the patient will present with fetal heart rate abnormalities, sudden loss of fetal station (eg, going from +1 to −3 station) along with fetal retreat upward and into the abdominal cavity through the uterine scar due to decreased intrauterine pressure. In the given case patient’s fetal heart rate tracing is category 1 and fetal station has remained 0 which are non suggestive of uterine rupture.
When there is insufficient fetal descent after pushing ≥3 hours in nulliparous patients or ≥2 hours in multiparous patients is considered as second stage arrest of labor. The most common cause of second stage arrest is cephalopelvic disproportion, were the fetus presents in a nonocciput anterior position called as fetal malposition.
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This question is part of the following fields:
- Obstetrics
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Question 17
Incorrect
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Endometrial tissue found within the myometrium is classed as
Your Answer:
Correct Answer: Adenomyosis
Explanation:Endometrial tissue found within the myometrium is Adenomyosis. If endometrial tissue is found at a distant site to the uterus it is termed endometriosis. Fibroids are smooth muscle tumours (Leiomyoma’s) sometimes called myoma’s.
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This question is part of the following fields:
- Clinical Management
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Question 18
Incorrect
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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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This question is part of the following fields:
- Clinical Management
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Question 19
Incorrect
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A couple comes to your clinic because they haven't been able to conceive despite having had frequent sexual activity in the previous 12 months. The female partner is 35 years old and has regular menstrual cycles. The male partner is 38years old and otherwise normal. Which of the following studies would you do next to forecast ovulation?
Your Answer:
Correct Answer: Serum progesterone
Explanation:This patient has a regular and long menstrual period. The most crucial thing in this case is to rule out anovulation.
Serum progesterone concentration is the best test for detecting ovulation.
Ovulation has occurred if the level is greater than 20nmol/L.
This test should be performed 3 to 10 days prior to the start of the next anticipated period. -
This question is part of the following fields:
- Gynaecology
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Question 20
Incorrect
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A 30 year old woman with a history of two previous C section deliveries, is rushed to the hospital for an emergency c-section at 36 weeks gestation due to antenatal haemorrhage. Upon examination of the uterus, the placenta has invaded the myometrium but the serosa is spared. Which of the following identifies this condition?
Your Answer:
Correct Answer: Placenta Increta
Explanation:Abnormal placental adherence to the uterus, generally termed Placenta Accreta, is divided into 3 conditions.
– Placenta accreta: refers to the invasion of the chorionic villi beyond the decidual surface of the myometrium.
– Placenta increta: the villi invade deep into the myometrium but spare the serosa;
– Placenta percreta: the chorionic villi invade through the myometrium, penetrate the uterine serosa, and may invade surrounding pelvic structures.These conditions can predispose patients to obstetric bleeding in the third trimester, often requiring emergency intervention.
Risk factors in the development of an abnormal placental adherence include previous c-sections. Placenta Previa, is also a cause of antepartum haemorrhage and serves as a risk factor in the development of abnormal placental adherence.
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This question is part of the following fields:
- Clinical Management
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Question 21
Incorrect
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A 29-year-old pregnant woman in her first trimester of pregnancy presented to the medical clinic for routine antenatal care. Upon interview and history taking, it revealed that she is positive for Hepatitis C virus antibody (HCVAb). She is now concerned about transmitting the virus to her baby. Which of the following is considered correct about the patient's condition?
Your Answer:
Correct Answer: Fetal scalp blood sampling should be avoided
Explanation:Invasive procedures as fetal scalp blood sampling or internal electrode and episiotomy increase vertical transmission of HCV, especially in patients with positive HCV RNA virus load at delivery that is why it should be avoided.
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This question is part of the following fields:
- Obstetrics
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Question 22
Incorrect
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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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This question is part of the following fields:
- Clinical Management
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Question 23
Incorrect
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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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This question is part of the following fields:
- Clinical Management
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Question 24
Incorrect
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In a pregnant lady with polyhydramnios, the cause could be:
Your Answer:
Correct Answer: Foetus with oesophageal-atresia
Explanation:An underlying disease is only found in 17 % of cases in mild polyhydramnios. In contrast, an underlying disease is detected in 91 % of cases in moderate to severe polyhydramnios. The literature lists the following potential aetiologies: fetal malformations and genetic anomalies (8–45 %), maternal diabetes mellitus (5–26 %), multiple pregnancies (8–10 %), fetal anaemia (1–11 %), other causes, e.g. viral infections, Bartter syndrome, neuromuscular disorders, maternal hypercalcemia. Viral infections which can lead to polyhydramnios include parvovirus B19, rubella, and cytomegalovirus. Other infections, e.g. toxoplasmosis and syphilis, can also cause polyhydramnios.
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This question is part of the following fields:
- Physiology
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Question 25
Incorrect
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A 24-year-old woman presented to the medical clinic for advice regarding pregnancy. Upon history taking and interview, it was noted that she had a history of valvular heart disease. She has been married to her boyfriend for the last 2 years and she now has plans for pregnancy. Which of the following can lead to death during pregnancy, if present?
Your Answer:
Correct Answer: Mitral stenosis
Explanation:Mitral stenosis is the most common cardiac condition affecting women during pregnancy and is poorly tolerated due to the increased intravascular volume, cardiac output and resting heart rate that predictably occur during pregnancy.
Young women may have asymptomatic mitral valve disease which becomes unmasked during the haemodynamic stress of pregnancy. Rheumatic mitral stenosis is the most common cardiac disease found in women during pregnancy. The typical increased volume and heart rate of pregnancy are not well tolerated in patients with more than mild stenosis. Maternal complications of atrial fibrillation and congestive heart failure can occur, and are increased in patients with poor functional class and severe pulmonary artery hypertension.
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This question is part of the following fields:
- Obstetrics
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Question 26
Incorrect
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Macrophages are derived from what type of white blood cell?
Your Answer:
Correct Answer: Monocytes
Explanation:Macrophages are derived from monocytes. When monocytes come across a pathogen they differentiate into macrophages for phagocytosis to occur.
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This question is part of the following fields:
- Immunology
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Question 27
Incorrect
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Question 28
Incorrect
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A 22-year-old pregnant woman attends clinic for a fetal scan at 31 weeks. She complains of difficulty breathing and a distended belly. U/S scan was done showing polyhydramnios and an absent gastric bubble. What is the most likely diagnosis?
Your Answer:
Correct Answer: Oesophageal atresia
Explanation:Oesophageal atresia of the foetus interrupts the normal circulation of the amniotic fluid. This causes polyhydramnios and subsequent distension of the uterus impacting proper expansion of the lungs. This would explain the difficulty breathing.
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This question is part of the following fields:
- Obstetrics
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Question 29
Incorrect
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A 42 year old smoker attends clinic due to vulval soreness and shows you a number of vulval lumps. Biopsy is taken and reported as showing
Your Answer:
Correct Answer: Vulval intraepithelial neoplasia (VIN)
Explanation:This is VIN. Smoking is a risk factor. It is also more common in immunocompromised patients.
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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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A young woman came to your clinic seeking help. She has been married for two years and has yet to conceive. The following are the findings of blood tests: Luteinizing hormone levels are low. Low levels of follicle stimulating hormone. Thyroid stimulating hormone (TSH) levels are low. Prolactin-high. What is the most effective way to deal with infertility?
Your Answer:
Correct Answer: Bromocriptine
Explanation:The most common treatment approach is with the dopamine receptor agonists, bromocriptine, and cabergoline. Bromocriptine normalizes prolactin and decreases tumour size in 80%–90% of patients with microadenomas. Bromocriptine should be given to this patient who has developed hyperprolactinemia anovulation.
Women with hyperprolactinaemic anovulation are treated with dopamine agonists such as bromocriptine.
This patient has also developed symptoms of a low-functioning pituitary gland tumour, which bromocriptine will assist to shrink. Before starting bromocriptine, a head MRI scan should be considered to confirm the suspected diagnosis.Clomiphene is an oestrogen receptor modulator that is selective. It works by competing with oestrogen receptors in the hypothalamus. This disrupts normal negative feedback mechanisms, causing the release of pituitary gonadotropins, particularly LH, to rise, triggering ovulation.
When the levels of gonadotropins and oestrogen are normal but the women still have ovulatory dysfunction, it is successful in inducing ovulation. In hypogonadotropic hypogonadism and hypogonadotropic hypogonadism patients, clomiphene is frequently ineffective. -
This question is part of the following fields:
- Gynaecology
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SESSION STATS - PERFORMANCE PER SPECIALTY
