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Question 1
Incorrect
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A 32-year-old woman gave birth to a baby of normal weight through vaginal delivery, which was complicated by a small perianal tear that was taken care of without stitching. On the fifth day of postpartum patient presents with heavy bright red vaginal bleeding and mentions that lochia was in scant amounts compared to her previous pregnancy.
On examination, her temperature was 38.8°C and uterus is mildly tender to palpation.
Which one of the following would most likely be her diagnosis?Your Answer: Cervical tear
Correct Answer: Retained products of conception
Explanation:Secondary postpartum hemorrhage of bright red character accompanied with fever, between 24 hours to 12 weeks of postpartum is suggestive of retained products of conception (RPOC).
The basal portion of the decidua may remain after separation of placenta in many cases. This decidua will then divides into two layers, the superficial layer which will be shed spontaneously and the deep layer which will regenerates and covers the entire endometrial cavity with in 16 days of postpartum.
Normal shedding of blood and decidua is referred to as lochia rubra, which is red / reddish brown in colour and it lasts for few days following delivery. This vaginal discharge gradually becomes watery and pinkish brown in colour, lasting for 2 to 3 weeks and is called as lochia serosa. Ultimately, this discharge becomes yellowish-white called as lochia alba.Scanty lochia in the first few days after delivery is suggestive of the placental site not undergoing involution, which occurs mostly due to RPOC. Later these retained products will undergo necrosis resulting in fibrin deposition which will eventually form a placental polyp. Detachment of this scar of polyp will result in brisk hemorrhage and the remaining necrotic products will get infected resulting in uterine infection which will present with fever, lower abdominal pain and uterine tenderness.
Endometritis can lead to fever, offensive lochia and abdominal pain with tenderness. It is the most common cause of postpartum fever, but occurs within the first 5 days of postpartum with the peak incidence between days 2 and 3. Though vaginal bleeding is a presenting feature, bright red bleeding is unlikely of endometritis.
Another cause of postpartum fever is genital lacerations which have a peak incidence of wound infection between 4th and 5th days. Although fever as a temporal symptom favours wound infection, this diagnosis is less likely in the given case as wound infection will not affect the normal course of lochia, also it does not present as heavy bright red bleeding. Moreover, there are no symptoms like erythema, tenderness or discharge in history suggestive of wound infection.
Another cause of bleeding and fever can be cervical tear but this tends to present as primary postpartum hemorrhage rather than secondary, which occurs after 24 hours of postpartum. An overlooked and infected minor cervical laceration can cause fever but ii will not result in bright red bleeding, also genital tract lacerations do not affect lochia.
It is very unlikely for uterine rupture to occur 24 hours after delivery.
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This question is part of the following fields:
- Obstetrics
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Question 2
Incorrect
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Of the following, which one has the greatest effect on the relative risk of developing endometrial carcinoma?
Your Answer:
Correct Answer: Polycystic ovary syndrome
Explanation:The factor associated with the greatest relative risk for endometrial carcinoma is polycystic ovary syndrome, which has a relative risk of 75. The use of long-term high doses of postmenopausal oestrogen carries an estimated risk of 10-20. Living in North America or Europe also has an estimated risk of 10-20.
A lower relative risk is associated with nulliparity, obesity, infertility, late menopause, older age, and white race- The relative risk associated with these factors falls into the range of 2-5. Early menarche, higher education or income levels, menstrual irregularities, and a history of diabetes, hypertension, gall bladder disease, or thyroid disease have a relative risk of around 1.5-2.0.
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This question is part of the following fields:
- Gynaecology
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Question 3
Incorrect
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All the following hormones are products of placental synthesis, EXCEPT:
Your Answer:
Correct Answer: Prolactin
Explanation:The metabolic adaptations of pregnancy are orchestrated by hormones produced by the placenta and maternal pituitary gland, which undergo dramatic changes during gestation. After involution of ovarian sex steroid production by wk 6, placental oestrogen and progesterone production increases exponentially to term. Concurrently, there are progressive increases in prolactin (PRL), produced by the maternal pituitary gland and decidua, and human chorionic somatomammotropin (CSH, also called human placental lactogen), which has structural similarities to GH and PRL.
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This question is part of the following fields:
- Endocrinology
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Question 4
Incorrect
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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.
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This question is part of the following fields:
- Clinical Management
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Question 5
Incorrect
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A 27-year-old woman comes to you during her first trimester seeking antenatal advice as she have a history of pre-eclampsia and obesity.
On examination her blood pressure is 130/80 mmHg and BMI is 38.
Administration of which among the following can reduce her risk of pre-eclampsia during this pregnancy?Your Answer:
Correct Answer: Calcium 1000mg daily
Explanation:This patient with a previous history of pre-eclampsia and obesity is at high risk for developing pre-eclampsia.
A daily intake of 1000mg of calcium is observed to be helpful in reducing the incidence of any hypertensive disorders and preterm labour.
Vitamin A should always be avoided during pregnancy as it is fetotoxic.
All other options are incorrect.
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This question is part of the following fields:
- Obstetrics
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Question 6
Incorrect
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During early pregnancy, a pelvic examination may reveal that one adnexa is slightly enlarged. This is most likely due to:
Your Answer:
Correct Answer: Corpus luteal cyst
Explanation:Adnexa refer to the anatomical area adjacent to the uterus, and contains the fallopian tube, ovary, and associated vessels, ligaments, and connective tissue. The reported incidence of adnexal masses in pregnancy ranges from 1 in 81 to 1 in 8000 pregnancies. Most of these adnexal masses are diagnosed incidentally at the time of dating or first trimester screening ultrasound (USS). Functional cyst is the most common adnexal mass in pregnancy, similar to the nonpregnant state. A corpus luteum persisting into the second trimester accounts for 13-17% of all cystic adnexal masses. Pain due to rupture, haemorrhage into the cyst, infection, venous congestion, or torsion may be of sudden onset or of a more chronic nature.
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This question is part of the following fields:
- Obstetrics
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Question 7
Incorrect
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A 24-year-old primigravida at 16 weeks of gestation, presented with a history of vaginal pressure, vaginal spotting and lower back pain.
Transvaginal ultrasound finding shows cervical shortening to 2 cm, cervical dilation, and protrusion of fetal membranes into the cervical canal.
Which among the following risk factors is not related to the development of this condition?Your Answer:
Correct Answer: Alcohol abuse
Explanation:This woman has developed non-specific symptoms of cervical insufficiency, is a painless dilation of cervix resulting in the delivery of a live fetus during the 2nd trimester or premature delivery.
The following has been identified as the risk factors associated with increased incidence of cervical insufficiency:
– Congenital disorders of collagen synthesis like Ehlers-Danlos syndrome.
– Prior cone biopsies.
– Prior deep cervical lacerations, which is secondary to vaginal or cesarean delivery.
-Müllerian duct defects like bicornuate or septate uterus.
– More than three prior fetal losses during the 2nd trimesterFrom the given options, alcohol abuse is the only one not associated with increased incidence of cervical insufficiency.
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This question is part of the following fields:
- Obstetrics
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Question 8
Incorrect
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Levels of which of the following hormones are increased in ovarian dysgenesis?
Your Answer:
Correct Answer: Pituitary gonadotropins
Explanation:There is marked elevation of FSH and LH in ovarian dysgenesis, produced by the pituitary.
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This question is part of the following fields:
- Embryology
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Question 9
Incorrect
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All of the following statements are true about Androgen insensitivity syndrome except:
Your Answer:
Correct Answer: The chromosomal sex is 46XX
Explanation:Patients suffering from androgen insensitivity syndrome have 46XY chromosomes. Due to insensitivity to androgens, they have female characteristics e.g. scant pubic or body hairs, enlarged mammary glands, and a small penis.
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This question is part of the following fields:
- Embryology
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Question 10
Incorrect
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Which of the following statements is true regarding heart rate in pregnancy?
Your Answer:
Correct Answer: Heart rate increases by 15 beats per minute
Explanation:During the first 12 weeks of pregnancy, cardiac output increases by about 30-50%. To maintain this increase, systemic vascular resistance decreases by 20-30%, while stroke volume and the heart rate increase by 25-30% and 15 beats per minute respectively.
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This question is part of the following fields:
- Physiology
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Question 11
Incorrect
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Luteal phase deficiency is characterised by:
Your Answer:
Correct Answer: Has inadequate luteal progesterone production
Explanation:Luteal phase occurs after the ovulation. Luteal defect means that the luteal phase is shorter than 10 days and women will find it difficult to sustain the pregnancy. There is decreased progesterone, LH and FSH production in this case.
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This question is part of the following fields:
- Physiology
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Question 12
Incorrect
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A 31-year-old woman at her 18th week of pregnancy presented to the emergency department with complaints of fishy, thin, white homogeneous vaginal discharge accompanied with an offensive odour. The presence of clue cells was noted during a microscopic test on the discharge.
All of the following statements are considered false regarding her condition, except:Your Answer:
Correct Answer: Relapse rate > 50 percent within 3 months
Explanation:Bacterial vaginosis (BV) affects women of reproductive age and can either be symptomatic or asymptomatic. Bacterial vaginosis is a condition caused by an overgrowth of normal vaginal flora. Most commonly, this presents clinically with increased vaginal discharge that has a fish-like odour. The discharge itself is typically thin and either grey or white.
Although bacterial vaginosis is not considered a sexually transmitted infection, women have an increased risk of acquiring other sexually transmitted infections (STI), and pregnant women have an increased risk of early delivery.
Though effective treatment options do exist, metronidazole or clindamycin, these methods have proven not to be effective long term.
BV recurrence rates are high, approximately 80% three months after effective treatment.
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This question is part of the following fields:
- Obstetrics
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Question 13
Incorrect
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A 60-year-old lady complains of a mild discomfort in her lower abdomen. She attained menopause 6 years ago whereas her last vaginal examination 2 years prior, was normal. She now has a palpable mass measuring 8cm in diameter in the left ovarian area.
Which is the best next step in her management?Your Answer:
Correct Answer: Admission to hospital for early surgical exploration.
Explanation:This lady should be admitted to hospital for early surgical exploration. Taking into account her age, mild abdominal discomfort and a palpable lower abdominal mass, it is imperative that ovarian malignancy be ruled out as soon as possible. Patients with ovarian malignancy often present in advanced stages of cancer as the symptoms tend to be occult and non-specific. Other things to include in her workup would be her CA125 level. Any form of hormonal therapy is contraindicated until ovarian malignancy has been ruled out. A pap smear is not relevant here since we are suspecting an ovarian malignancy rather than cervical. Evaluation of her mass takes priority over an assessment for osteoporosis.
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This question is part of the following fields:
- Gynaecology
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Question 14
Incorrect
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In the 3rd trimester anaemia is defined by?
Your Answer:
Correct Answer:
Explanation:Anaemia in pregnancy is defined by the British Committee for Standards in Haematology (BCSH) guidance: 1st trimester Hb < 110 g/l 2nd and 3rd trimester Hb < 105 g/l Postpartum Hb less than 100 g/l
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This question is part of the following fields:
- Clinical Management
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Question 15
Incorrect
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Branches V2 and V3 of the Trigeminal nerve develop from which pharyngeal arch?
Your Answer:
Correct Answer: 1st
Explanation:1st Arch = Trigeminal V2 & V3 (CN V) 2nd Arch = Facial (CN VII) 3rd Arch = Glossopharyngeal (CN IX) 4th and 6th Arches = Vagus (CN X)
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This question is part of the following fields:
- Embryology
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Question 16
Incorrect
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A 33 year old female patient with high grade abnormality on cervical screening test was referred to see a gynaecologist at your clinic. Colposcopy reveals abnormal cells higher in the cervical canal.
What is the next step in management of this patient?Your Answer:
Correct Answer: Cone biopsy
Explanation:If abnormal cells are found high up in the cervical canal, it is critical to consider doing a cone biopsy to rule out any cervical malignancy. A cone-shaped section of the cervix containing the abnormal cells is removed under general anaesthesia.
Loop Electrosurgical Excision Procedure is a way of removing the abnormal cells from the cervix using a wire loop. First a speculum is inserted to open the vagina so the uterus can be seen. Then a solution is applied to the surface of the cervix to make the areas of abnormal cells easier to see. It is done under local anaesthesia.Cone biopsy is the only acceptable option to rule out malignancy. Cryotherapy, chemotherapy and radiotherapy are management options once malignancy has been confirmed.
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This question is part of the following fields:
- Gynaecology
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Question 17
Incorrect
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A 40-year-old woman who is at 34 weeks of pregnancy presented to the medical clinic for advice since her other two children were diagnosed with whooping cough just 8 weeks ago, she is worried for her newborn about the risk of developing whooping cough.
Which of the following is considered the most appropriate advice to give to the patient?Your Answer:
Correct Answer: Give Pertussis vaccine booster DPTa now
Explanation:To help protect babies during this time when they are most vulnerable, women should get the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) during each pregnancy.
Pregnant women should receive Tdap anytime during pregnancy if it is indicated for wound care or during a community pertussis outbreak.
If Tdap is administered earlier in pregnancy, it should not be repeated between 27 and 36 weeks gestation; only one dose is recommended during each pregnancy.Optimal timing is between 27 and 36 weeks gestation (preferably during the earlier part of this period) to maximize the maternal antibody response and passive antibody transfer to the infant.
Fewer babies will be hospitalized for and die from pertussis when Tdap is given during pregnancy rather than during the postpartum period. -
This question is part of the following fields:
- Obstetrics
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Question 18
Incorrect
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An 8 week pregnant female presents to the ob-gyn with bleeding from the vagina for the last two days. Bimanual examination reveals the uterus to be 8 weeks in size. On speculum examination, the cervical os is closed. How would the fetal viability be confirmed?
Your Answer:
Correct Answer: Transvaginal ultrasound
Explanation:Indication for a transvaginal ultrasound during pregnancy include:
– to monitor the heartbeat of the foetus
– look at the cervix for any changes that could lead to complications such as miscarriage or premature delivery
– examine the placenta for abnormalities
– identify the source of any abnormal bleeding
– diagnose a possible miscarriage
– confirm an early pregnancyThis is an ultrasound examination that is usually carried out vaginally at 6-10 weeks of pregnancy.
The aims of this scan are to determine the number of embryos present and whether the pregnancy is progressing normally inside the uterus.
This scan is useful for women who are experiencing pain or bleeding in the pregnancy and those who have had previous miscarriages or ectopic pregnancies.
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This question is part of the following fields:
- Obstetrics
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Question 19
Incorrect
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What percentage of haemoglobin is HbF by 6 months of age?
Your Answer:
Correct Answer:
Explanation:HB gower 1 is the predominant embryonic haemoglobin when the foetus is 6 week old and is replaced by adult haemoglobin by the age of 5 months post natally. Only 2% of the haemoglobin is HbF.
Embryonic Haemoglobin:
Haemoglobin Gower 1 (HbE Gower-1)
Haemoglobin Gower 2 (HbE Gower-2)
Haemoglobin Portland I (HbE Portland-1)
Haemoglobin Portland II (HbE Portland-2)Fetal Haemoglobin (haemoglobin F, HbF)
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This question is part of the following fields:
- Physiology
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Question 20
Incorrect
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With regard to the cell cycle. In what phase do chromatids get cleaved into chromosomes and pulled apart?
Your Answer:
Correct Answer: Anaphase
Explanation:G0 is a resting phase. Interphase (G1,S,G2) is where the cell grows and DNA replication occurs forming chromatids. Mitosis is where cell division occurs and this happens in a the following phases: Prophase Chromatin condenses to chromosomes (paired as chromatids). Mitotic spindle forms Metaphase Chromatids align at the equatorial plane AKA the metaphase plate Anaphase Chromatids pulled apart into 2 constituent daughter chromosomes Telophase New nuclear envelopes form around each daughter chromosome Cytokinesis Cells divide Diagram illustrating Mitosis Image sourced from Wikipedia
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This question is part of the following fields:
- Biochemistry
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Question 21
Incorrect
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According to the WHO, maternal mortality ratio is defined as which of the following?
Your Answer:
Correct Answer: Maternal deaths per 100,000 live births
Explanation:The World Health Organisation defines the maternal mortality ratio as the number of maternal deaths during a given period per 100,000 live births during the same period. This measure indicates the risk of death in a single pregnancy.
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This question is part of the following fields:
- Epidemiology
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Question 22
Incorrect
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Oxytocin causes increased myometrial contractions via which of the following messenger pathways?
Your Answer:
Correct Answer: Activates phospholipase-C which produces IP3 which triggers intracellular Calcium ion release
Explanation:Oxytocin activates phospholipase C to produce inositol 1,4,5-trisphosphate (IP3), which releases Ca2+ from intracellular stores. There are thought to be other mechanisms by which myometrium is stimulated by Oxytocin including increased sensitisation of the myometrium and increased calcium entry into cells. cAMP and Protein Kinase A inhibit myometrial contractility.
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This question is part of the following fields:
- Endocrinology
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Question 23
Incorrect
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A patient who has been seen in fertility clinic phones regarding the timing of her progesterone blood test. She has regular 35 day menstrual cycles. When testing for ovulation what day of her cycle should she have the test on?
Your Answer:
Correct Answer: 28
Explanation:The mid-luteal progesterone sample should be taken 7 days before the expected period i.e. day 21 in a 28-day cycle or day 28 of a 35 day cycle
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This question is part of the following fields:
- Data Interpretation
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Question 24
Incorrect
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A 29-year-old lady comes to your clinic for a refill on her oral contraceptive tablets (Microgynon 30®). You discover she has a blood pressure of 160/100mmHg during your examination, which is confirmed by a second reading 20 minutes later. Her husband and she are expecting a child in six months.
Which of the following recommendations is the best for her?Your Answer:
Correct Answer: She should stop OCP, use condoms for contraception and reassess her blood pressure in 3 months
Explanation:Overt hypertension, developing in about 5% of Pill users, and increases in blood pressure (but within normal limits) in many more is believed to be the result of changes in the renin-angiotensin-aldosterone system, particularly a consistent and marked increase in the plasma renin substrate concentrations. The mechanisms for the hypertensive response are unclear since normal women may demonstrate marked changes in the renin system. A failure of the kidneys to fully suppress renal renin secretion could thus be an important predisposing factor.
These observations provide guidelines for the prescription of oral contraceptives. A baseline blood pressure measurement should be obtained, and blood pressure and weight should be followed at 2- or 3-month intervals during treatment. Oral contraceptive therapy should be contraindicated for individuals with a history of hypertension, renal disease, toxaemia, or fluid retention. A positive family history of hypertension, women for whom long-term therapy is indicated, and groups such as blacks, especially prone to hypertensive phenomena, are all relative contraindications for the Pill.
All other options are incorrect.
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This question is part of the following fields:
- Gynaecology
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Question 25
Incorrect
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Which of the following procedures allow the earliest retrieval of DNA for prenatal diagnosis in pregnancy:
Your Answer:
Correct Answer: Chorionic Villi Sampling (CVS)
Explanation:CVS has decreased in frequency with the recent increased uptake of cell-free DNA screening. It remains the only diagnostic test available in the first trimester and allows for diagnostic analyses, including fluorescence in situ hybridization (FISH), karyotype, microarray, molecular testing, and gene sequencing. CVS is performed between 10 and 14 weeks’ gestation. CVS has been performed before 9 weeks in the past, though this has shown to increase the risk of limb deformities and, therefore, is no longer recommended.
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This question is part of the following fields:
- Obstetrics
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Question 26
Incorrect
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The vulva is mainly supplied by which one of the following vessels?
Your Answer:
Correct Answer: Pudendal artery
Explanation:Vulva is defined by the area which is located outside the female vagina and comprises of the labia majora, labia minora, clitoris, mons pubis and Bartholin glands. It is supplied by the vestibula branch of pudental artery.
Inferior hemorrhoidal artery supplies the lower part of the rectum.
Femoral artery is the continuation of external iliac artery and supplies most of the leg. -
This question is part of the following fields:
- Anatomy
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Question 27
Incorrect
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The inguinal canal is reinforced posteriorly by which structure?
Your Answer:
Correct Answer: Conjoint tendon
Explanation:The Inguinal Canal
– Anterior wall: formed by the external oblique aponeurosis throughout the length of the canal; its lateral part is reinforced by muscle fibres of the internal oblique.
– Posterior wall: formed by the transversalis fascia; its medial part is reinforced by pubic attachments of the internal oblique and transversus abdominis aponeuroses that frequently merge to variable extents into a common tendon—the inguinal falx (conjoint tendon)—and the reflected inguinal ligament.
– Roof: formed laterally by the transversalis fascia, centrally by musculo-aponeurotic arches of the internal oblique and transversus abdominis, and medially by the medial crus of the external oblique aponeurosis.
– Floor: formed laterally by the iliopubic tract, centrally by gutter formed by the infolded inguinal ligament, and medially by the lacunar ligament. -
This question is part of the following fields:
- Anatomy
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Question 28
Incorrect
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All the following are possible causes of polyhydramnios, EXCEPT:
Your Answer:
Correct Answer: IUGR
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 29
Incorrect
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All of the following factors increase the risk of endometrial cancer except which one?
Your Answer:
Correct Answer: High Coffee Consumption
Explanation:The risk factors for uterine carcinoma include obesity, diabetes, Nulliparity, late menopause, unopposed oestrogen therapy, tamoxifen therapy, HRT and a family history of ovarian or uterine carcinoma.
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This question is part of the following fields:
- Epidemiology
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Question 30
Incorrect
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A 38-year-old lady appears with a 7-month history of secondary amenorrhea. She has a BMI of 24. Her FSH level is 55 U/L (2-8 U/L in luteal phase; >25 U/L in menopause), LH is 54 U/L, and oestradiol is low, according to laboratory tests. The level of serum prolactin is likewise normal. Her urine pregnancy test came out negative.
Each ovary had 3-4 cysts on ultrasonography. She hopes to get pregnant in the near future.
Which of the following would be the best treatment option for her condition?Your Answer:
Correct Answer: Menopausal hormone replacement therapy (HRT)
Explanation:Ovarian insufficiency is a failure of the ovary to function adequately in a woman younger than 40 years, in its role either as an endocrine organ or as a reproductive organ. In women aged 40 years or older, the expected physiologic decline of ovarian function that takes place with aging is termed perimenopause or the menopausal transition.
Medical treatment of patients with primary ovarian insufficiency should address the following aspects:Ovarian hormone replacement
Restoration of fertility
Psychological well-being of the patientIt is not appropriate to give this patient contraceptive pills since she desires pregnancy.
There is no evidence that Danazol or Metformin would improve ovarian follicle function.
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This question is part of the following fields:
- Gynaecology
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