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Question 1
Correct
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A 39-year-old woman who is 8 weeks pregnant presented to the medical clinic for consultation regarding the chance of her baby having Down syndrome. She mentioned that she has read somewhere that one of the risk factors for Down syndrome is advanced maternal age. She is concerned and asks if there are ways in which she can know whether her baby will be affected.
Which of the following is considered as both the safest and the most accurate diagnostic tool for the exclusion of Down syndrome?Your Answer: Amniocentesis at 16 weeks gestation
Explanation:Amniocentesis is a prenatal procedure performed on a pregnant woman to withdraw a small amount of amniotic fluid from the sac surrounding the foetus.
The goal of amniocentesis is to examine a small amount of this fluid to obtain information about the baby, including its sex, and to detect physical abnormalities such as Down syndrome or spina bifida.
Amniocentesis is only performed on women thought to be at higher risk of delivering a child with a birth defect.Amniocentesis is performed between 16 and 20 weeks into the pregnancy. By around this time, the developing baby is suspended in about 130ml of amniotic fluid, which the baby constantly swallows and excretes. A thin needle is used to withdraw a small amount of this fluid from the sac surrounding the foetus.
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This question is part of the following fields:
- Obstetrics
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Question 2
Incorrect
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Regarding the female breast how many lobes does the typical breast contain?
Your Answer:
Correct Answer: 15-20
Explanation:The basic components of the mammary gland are the alveoli. These are lined with milk-secreting cuboidal cells surrounded by myoepithelial cells. The alveoli join to form groups known as lobules. The lobules form lobes. Each lobe has a lactiferous duct that drains into openings in the nipple. Each breast typically contains 15-20 lobes.
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This question is part of the following fields:
- Anatomy
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Question 3
Incorrect
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All of the following statements regarding human chorionic gonadotrophin are true except::
Your Answer:
Correct Answer: It's level doubles every 48 hours in ectopic pregnancy
Explanation:In normal pregnancy the levels of hCG doubles after every 48-72 hours but in case of ectopic pregnancy the levels of hCG are lower than the normal. It is produced by the placenta and its main role is nourishment of the egg after implantation. Its levels reached a peak at 8-10 weeks of pregnancy and after that the levels decreases for the remainder of pregnancy. In hydatiform mole and trophoblastic diseases its the main hormone for diagnosis of the disease because the levels are highly elevated.
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This question is part of the following fields:
- Physiology
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Question 4
Incorrect
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What is the typical weight of a term uterus?
Your Answer:
Correct Answer: 1200g
Explanation:Uterine blood flow increases 40-fold to approximately 700 mL/min at term, with 80 per cent of the blood distributed to the intervillous spaces of the placentae, and 20 per cent to the uterine myometrium. Weight of the uterus increases from 50–60 g prior to pregnancy to 1000 g by term.
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This question is part of the following fields:
- Physiology
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Question 5
Incorrect
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What is the half life of Oxytocin?
Your Answer:
Correct Answer: 5 minutes
Explanation:The half-life of Oxytocin is approximately 5 minutes
The half-life of Misoprostol is approximately 20-40 minutes
The half-life of Ergometrine is approximately 30-120 minutes -
This question is part of the following fields:
- Clinical Management
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Question 6
Incorrect
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You see a 23 year old women in clinic complaining of vaginal discharge. The lab phone to tell you microscopy and staining shows a gram negative diplococcus. Which organism is most likely to be responsible?
Your Answer:
Correct Answer: Neisseria gonorrhoeae
Explanation:The most common gram negative diplococci include Neisseria, haemophilus and Moraxella.
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This question is part of the following fields:
- Microbiology
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Question 7
Incorrect
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Which of the following is the most likely anaesthetic or analgesic causing reduced variability on cardiotocograph?
Your Answer:
Correct Answer: Intramuscular pethidine
Explanation:Opiates and spinal anaesthetics reduce the variability of a CTG. Including some antihypertensives like labetalol and alpha methyl dopa.
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This question is part of the following fields:
- Obstetrics
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Question 8
Incorrect
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When a 75-year-old lady laughs, sneezes, coughs, or lifts big weights, she leaks pee. She also claims that she has the urge to pass pee 10-12 times a day, and that she can't go to the restroom half of the time. She appears to have a harder time with urgency. Infections are not found in a urine test. Except for a residual amount of 125cc, an ultrasound scan of the bladder, ureter, and kidneys is inconclusive.
Which of the following treatment options is the best fit for her?Your Answer:
Correct Answer: Bladder training
Explanation:This woman has mixed incontinence, which includes signs and symptoms of both stresses and urges incontinence. The urge, on the other hand, irritates her. Bladder training would be the most appropriate management approach to investigate first for women with urge incontinence as the most troublesome symptom. The objectives are:
– Using a bladder diary to establish a baseline
– Creating a voiding schedule
– Over a long period, gradually increase the voiding interval in increments of 2- 5 minutes, to void every 3 hours.
– Other important strategies to consider are lifestyle changes like reducing fluid intake, losing weight, and avoiding diuretics-producing foods and beverages (e.g., alcoholic beverages, caffeine, etc).When urge incontinence does not respond to physical or behavioural therapy, anticholinergics along with ongoing bladder training are an alternative. A 4- to 6-week trial is employed. At six months, risk and benefit are weighed to see if treatment should be continued for those who react. Patients should be informed about anticholinergic side effects such as dry mouth and constipation, as well as how to control them.
Anterior colporrhaphy is a treatment for cystocele that involves repairing the front vaginal wall. It can help people with urine incontinence. If you don’t have a cystocele, bladder neck suspension is the best option.
Retropubic bladder suspension is a more intrusive surgery for treating stress urinary incontinence in patients who haven’t responded to less invasive treatments like pelvic floor exercise.The most essential initial conservative therapy to explore for patients with real stress incontinence and mixed (both stress and urge) urine incontinence when stress incontinence is the more prominent symptom is pelvic floor muscle exercise (e.g. Kegel exercise). For urge incontinence, more difficult training can be applied.
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This question is part of the following fields:
- Gynaecology
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Question 9
Incorrect
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A 24-year-old college student comes to your clinic for contraception guidance. For the past three months, she has had migraine-like headaches once or twice a month. For the past two years, she has been taking combined oral contraceptive pills.
Which of the following suggestions is the most appropriate?Your Answer:
Correct Answer: Stopping the combined oral contraceptive pills and starting progesterone only pills (POP)
Explanation:Combined oral contraceptives are a safe and highly effective method of birth control, but they can also raise problems of clinical tolerability and/or safety in migraine patients. It is now commonly accepted that, in migraine with aura, the use of combined oral contraceptives is always contraindicated, and that their intake must also be suspended by patients suffering from migraine without aura if aura symptoms appear.
Discontinuation of contraception could risk in pregnancy. Barrier methods can be used but aren’t as effective as pills.
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This question is part of the following fields:
- Gynaecology
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Question 10
Incorrect
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A 26 year old lady comes to see you in the antenatal clinic. She is 8 weeks pregnant and is concerned as she has a new cat and her friend told her she shouldn't be changing cat litter when pregnant. You send bloods which show high IgM for toxoplasmosis gondii. Which of the following is an appropriate treatment option?
Your Answer:
Correct Answer: Spiramycin
Explanation:There are 2 treatment options: Spiramycin ASAP if foetus not infected or status of the foetus not known. This reduces risk of transplacental infection. This is continued until term, or until fetal infection is documented. Pyrimethamine, sulfadiazine and folic acid where fetal infection is known e.g. positive amniotic fluid PCR. Monitoring for haemotoxicity required. Pyrimethamine should be avoided in the 1st trimester as teratogenic
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This question is part of the following fields:
- Microbiology
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Question 11
Incorrect
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A 47 year old women has a transvaginal ultrasound that shows a partially echogenic mass with posterior sound attenuation owing to sebaceous material and hair within the cyst cavity. What is the likely diagnosis?
Your Answer:
Correct Answer: Mature teratoma
Explanation:These are the most common ovarian tumours in young women. The most common form is the mature dermoid cyst (cystic teratoma). It can consist of a combination of all the type of tissues (mesenchymal, stromal and epithelial). Any mature tissue type can be present such as muscle, cartilage, bone, teeth and often hair. Treatment is cystectomy.
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This question is part of the following fields:
- Data Interpretation
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Question 12
Incorrect
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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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This question is part of the following fields:
- Clinical Management
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Question 13
Incorrect
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A 25 year old female who was on sodium valproate for epilepsy came for the advice about contraception. Which of the following is accurate?
Your Answer:
Correct Answer: She can use COCP
Explanation:There are no interactions between the combined oral contraceptive pill, progesterone-only pill, medroxyprogesterone injections or levonorgestrel implants and the AEDs valproic acid (sodium valproate), vigabatrin, lamotrigine, gabapentin, tiagabine, levetiracetam, zonisamide, ethosuximide and the benzodiazepines. So she can use COCP along with Sodium valproate.
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This question is part of the following fields:
- Gynaecology
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Question 14
Incorrect
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A 28-year -old lady in her 13th week of gestation comes to your clinic with a recent history of, four days ago, contact with a child suffering from parvovirus infection. She is concerned whether her baby might be affected.
A serum analysis for lgM and lgG antibody for parvovirus came back as negative.
Which among the following would be the most appropriate next step of management in this case?Your Answer:
Correct Answer: Repeat serologic tests in two weeks
Explanation:Parvovirus B19 is a single-stranded DNA virus, which is the causative organism for erythema infectiosum, also known as fifth disease or slapped cheek syndrome.
Maternal infection with parvovirus B19 is almost always associated with an increased risk of transplacental fetal infection throughout the pregnancy. Fetal infection results in fetal parvovirus syndrome, which is characterized by anemia hydrops with cardiac failure and possibly death.
The earlier the exposure occurs, it is more likely to result in fetal parvovirus syndrome and stillbirth is the common outcome in case of third trimester infection.Women who have been exposed to parvovirus in early pregnancy should be informed on the possible risk of fetal infection and also should be screened for parvovirus B19 specific lgG.
– If parvovirus specific lgG is positive reassure that pregnancy is not at risk
– If parvovirus specific lgG is negative, serology for lgM should be performed
After infection with parvovirus, patient’s lgM is expected to become positive within 1 to 3 weeks and it will remain high for about 8-12 weeks. lgG levels will start to rise within 2 to 4 weeks after the infection.This woman has a negative lgG titer which indicates that she is not immune to the infection. Although her lgM titer is negative now, this does not exclude the chance of infection as it takes approximately 1 to 3 weeks after infection for lgM to become positive, and will then remain high for 8 to 12 weeks. In such cases, it is recommended the serologic tests be repeated in 2 weeks when the lgM may become positive while lgG starts to rise.
– Positive lgM titers confirm maternal parvovirus infection. If that is the case, the next step would be fetal monitoring with ultrasound for development of hydrops at 1-2 weeks intervals for the next 6-12 weeks(needs referral). Once the fetus is found to have hydrops, fetal umbilical cord sampling and intrauterine blood transfusion are considered the treatment options.
– Positive lgG and negative lgM indicates maternal immunity to parvovirus.Interpretation of serologic tests results and the further actions recommended are as follows:
If both IgM and IgG are negative, it means mother is not immune to parvovirus B19 infection, and an infection is possible. Further action will be Repetition of serological tests in 2 weeks.
If IgM is positive and IgG is negative, it means the infection is established. Fetal monitoring with ultrasound at 1- to 2-week intervals for the next 6- 12 weeks must be done.
If both IgM and IgG are positive, it means infection is established, and an infection is possible. Further action will be fetal monitoring with ultrasound at 1- to 2-week intervals for the next 6- 12 weeks.
If IgM is negative and IgG is positive, it means the mother is immune to parvovirus infection. In this case it is important to reassure the mother that the baby is safe.
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This question is part of the following fields:
- Obstetrics
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Question 15
Incorrect
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What is the mode of action of Mefenamic acid?
Your Answer:
Correct Answer: Inhibits Prostaglandin Synthesis
Explanation:Activation of Antithrombin III and inactivation of factor Xa is the primary mechanism of action of Heparin.
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This question is part of the following fields:
- Clinical Management
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Question 16
Incorrect
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A 33-year-old woman presented to the medical clinic with a history of type 2 diabetes mellitus. She plans to conceive in the next few months and asks for advice. Her fasting blood sugar is 10.5 mmol/L and her HbA1c is 9%.
Which of the following is considered the best advice to give to the patient?Your Answer:
Correct Answer: Achieve HbA1c value less than 7% before she gets pregnant
Explanation:Women with diabetes have increased risk for adverse maternal and neonatal outcomes and similar risks are present for either type 1 or type 2 diabetes. Both forms of diabetes require similar intensity of diabetes care. Preconception planning is very important to avoid unintended pregnancies, and to minimize risk of congenital defects. Haemoglobin A1c goal at conception is <6.5% and during pregnancy is <6.0%.
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This question is part of the following fields:
- Obstetrics
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Question 17
Incorrect
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Warfarin embryopathy is typically the result of the mother taking warfarin during which stage of pregnancy?
Your Answer:
Correct Answer: 6-12 weeks
Explanation:Warfarin is teratogenic if it is used in the first trimester. It causes bone defects and haemorrhages in the developing foetus.
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This question is part of the following fields:
- Pharmacology
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Question 18
Incorrect
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A 28 year old primigravida carrying a twin pregnancy presents at 32 weeks gestation. She is lethargic, clinically jaundiced and complains of abdominal pain with frequent vomiting. A summary of her blood results are as follows:
Your Answer:
Correct Answer: Acute fatty liver of pregnancy
Explanation:This patients bloods and symptoms suggest she has hepatic impairment. Acute fatty liver of pregnancy typically presents after the 30th week and she has risk factors for acute fatty liver of pregnancy: Multiple pregnancy Primigravida
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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 23-year-old gravida 1 para 0 at 36 weeks gestation presents to the office complaining of ankle swelling and occasional headache for the past 2 days. She denies any abdominal pain or visual disturbances. On examination you note a fundal height of 35 cm, a fetal heart rate of 140 beats/min, 2+ lower extremity oedema, and a blood pressure of 144/92 mm Hg. A urine dipstick shows 1+ proteinuria.
Which one of the following is the most appropriate next step in the management of this patient?Your Answer:
Correct Answer: Laboratory evaluation, fetal testing, and 24-hour urine for total protein
Explanation:This patient most likely has preeclampsia, which is defined as an elevated blood pressure and proteinuria after 20 weeks gestation. The patient needs further evaluation, including a 24-hour urine for quantitative measurement of protein, blood pressure monitoring, and laboratory evaluation that includes haemoglobin, haematocrit, a platelet count, and serum levels of transaminase, creatinine, albumin, LDH, and uric acid- A peripheral smear and coagulation profiles also may be obtained- Antepartum fetal testing, such as a nonstress test to assess fetal well-being, would also be appropriate.
→ Ultrasonography should be done to assess for fetal intrauterine growth restriction, but only after an initial laboratory and fetal evaluation.
→ It is not necessary to start this patient on antihypertensive therapy at this point. An obstetric consultation should be considered for patients with preeclampsia.
→ Delivery is the definitive treatment for preeclampsia- The timing of delivery is determined by the gestational age of the foetus and the severity of preeclampsia in the mother. Vaginal delivery is preferred over caesarean delivery, if possible, in patients with preeclampsia. -
This question is part of the following fields:
- Obstetrics
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Question 20
Incorrect
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APGAR's score includes all the following, EXCEPT:
Your Answer:
Correct Answer: Blood pH
Explanation:Elements of the Apgar score include colour, heart rate, reflexes, muscle tone, and respiration. Apgar scoring is designed to assess for signs of hemodynamic compromise such as cyanosis, hypoperfusion, bradycardia, hypotonia, respiratory depression or apnoea. Each element is scored 0 (zero), 1, or 2. The score is recorded at 1 minute and 5 minutes in all infants with expanded recording at 5-minute intervals for infants who score 7 or less at 5 minutes, and in those requiring resuscitation as a method for monitoring response. Scores of 7 to 10 are considered reassuring.
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This question is part of the following fields:
- Obstetrics
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Question 21
Incorrect
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A 41-year-old G2P1 woman who is at 30 weeks gestational age presented to the medical clinic for a routine OB visit. Upon history taking, it was noted that her first pregnancy was uncomplicated and was delivered 10 years ago. At 40 weeks then, she had a normal vaginal delivery and the baby weighed 3.17kg.
In her current pregnancy, she has no complications and no significant medical history. She is a non-smoker and has gained about 11.3 kg to date. She also declined any testing for Down syndrome even if she is of advanced maternal age.
Upon further examination and observation, the following are her results:
Blood pressure range has been 100 to 120/60 to 70.
Fundal height measures only 25 cm.
Which of the following is most likely the reason for the patient’s decreased fundal height?Your Answer:
Correct Answer: Fetal growth restriction
Explanation:A fundal height measurement is typically done to determine if a baby is small for its gestational age. The measurement is generally defined as the distance in centimetres from the pubic bone to the top of the uterus. The expectation is that after week 24 of pregnancy the fundal height for a normally growing baby will match the number of weeks of pregnancy — plus or minus 2 centimetres.
A fundal height that measures smaller or larger than expected — or increases more or less quickly than expected — could indicate:
– Slow fetal growth (intrauterine growth restriction)
– A multiple pregnancy
– A significantly larger than average baby (fetal macrosomia)
– Too little amniotic fluid (oligohydramnios)
– Too much amniotic fluid (polyhydramnios). -
This question is part of the following fields:
- Obstetrics
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Question 22
Incorrect
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Which of the following Oestrogens (Oestrogens) becomes the predominant circulating oestrogen during pregnancy?
Your Answer:
Correct Answer: Estriol
Explanation:Oestradiol is the predominant form of oestrogen during the reproductive life of a female. The estrogenic potency of oestradiol is 12 times more than estrone and 80 times that of estriol.
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This question is part of the following fields:
- Endocrinology
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Question 23
Incorrect
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You are reviewing a patient who is complaining of pain and numbness to the proximal medial thigh following abdominal hysterectomy. You suspect genitofemoral nerve injury. What spinal segment(s) is the genitofemoral nerve derived from?
Your Answer:
Correct Answer: L1,L2
Explanation:The genitofemoral nerves takes its origin from the L1 and L2 spinal segments.
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This question is part of the following fields:
- Anatomy
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Question 24
Incorrect
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A 27-year-old nulliparous woman presents with the complaint of malodorous vaginal discharge for the past one month. Patient has tried various over-the-counter vaginal douche products without any improvement. Her last menstrual period was 2 weeks ago, during which she noticed no change in her symptoms. In addition to the discharge, patient also experiences intermittent, crampy abdominal pain along with a feeling of gas passing through her vagina. Patient has had no history of surgeries in the past.
On examination her vital signs seems to be normal. Speculum examination shows a malodorous, tan vaginal discharge with an erythematous patch over the posterior vaginal wall.The cervix is nulliparous and has no visible lesions or areas of friability.A sinus with purulent drainage is found in the perianal skin.
Which among the following conditions will be the most likely underlying cause for this patient’s presentation?Your Answer:
Correct Answer: Transmural inflammation of the bowel
Explanation:Common risk factors for Rectovaginal fistula are Pelvic radiation, Obstetric trauma, Pelvic surgery, Colon cancer, Diverticulitis and Crohn disease. Uncontrollable passage of gas &/or feces from the vagina is considered the common clinical feature of Rectovaginal fistula.
Diagnosis is done with the help of physical examination, fistulography, Magnetic resonance imaging and Endosonography.This patient, mentioned in the case, presents with malodorous vaginal discharge (ie, stool), gas passing through the vagina, and a posterior vaginal lesion most likely has a rectovaginal fistula, which is an aberrant connection between bowel and vagina. Although development of rectovaginal fistula is commonly associated with obstetric trauma or pelvic surgery, patients without these risk factors are recommended to be evaluated for other additional causes like gastrointestinal conditions.
This patient’s intermittent, crampy abdominal pain and perianal sinus in the setting of a rectovaginal fistula is most likely due to an underlying Crohn disease. Crohn disease, is a transmural inflammation of the gastrointestinal tract, which predisposes patients to bowel abscess, fissure, and fistula formation. Although the rectum is typically spared in Crohn disease, a non-healing, transmural ulcer present in the anal canal can progress to form a rectovaginal fistula.
In addition to standard Crohn disease management like anti-TNF inhibitors, glucocorticoids, etc patients with a rectovaginal fistula may require surgical correction.Bartholin gland cysts or abscesses can present with malodorous vaginal discharge; however, patients typically have a posterior vulvar mass located at the 4 or 8 o’clock position. In addition, Bartholin gland cysts will not present with crampy abdominal pain or passage of flatus or stool through the vagina.
Hidradenitis which is the chronic occlusion and inflammation of hair follicles, can cause groin abscesses with sinus tracts and associated purulent drainage. However, it is not associated with abdominal pain or malodorous vaginal discharge. In addition, this condition is typically multifocal and located in more than one intertriginous areas like axillary, inguinal or gluteal regions.
Cervical cancer or a retained foreign body in the vagina can cause malodorous vaginal discharge and abdominal pain. However, patients will typically have visible findings like cervical lesion, foreign body etc on speculum examination, and these neither are associated with the passage of flatus through the vagina.
Complications of Crohn disease include perianal disease like abscess, fissure and fistula like rectovaginal fistula, due to transmural inflammation of the gastrointestinal tract. Patients with a rectovaginal fistula typically presents with malodorous, tan vaginal discharge, passage of flatus through the vagina and a posterior vaginal lesion.
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This question is part of the following fields:
- Obstetrics
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Question 25
Incorrect
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What is the typical weight of a non-pregnant premenopausal uterus?
Your Answer:
Correct Answer: 40g
Explanation:Uterine blood flow increases 40-fold to approximately 700 mL/min at term, with 80 per cent of the blood. The uterus is 50–60 g prior to pregnancy and 1000 g by term. The volume increases from 10 ml to 5000ml approx. It is around 40g at menopause.
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This question is part of the following fields:
- Physiology
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Question 26
Incorrect
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In normal physiological changes in pregnancy, all of the following are increased, EXCEPT:
Your Answer:
Correct Answer: Peripheral resistance
Explanation:The heart adapts to the increased cardiac demand that occurs during pregnancy in many ways:
Cardiac output increases throughout early pregnancy, and peaks in the third trimester, usually to 30-50% above baseline.
Oestrogen mediates this rise in cardiac output by increasing the pre-load and stroke volume, mainly via a higher overall blood volume (which increases by 40–50%).
The heart rate increases, but generally not above 100 beats/ minute.
Total systematic vascular resistance decreases by 20% secondary to the vasodilatory effect of progesterone. Overall, the systolic and diastolic blood pressure drops 10–15 mm Hg in the first trimester and then returns to the baseline in the second half of pregnancy.
All of these cardiovascular adaptations can lead to common complaints, such as palpitations, decreased exercise tolerance, and dizzinessA pregnant woman may experience an increase in the size of the kidneys and ureter due to the increased blood volume and vasculature.
Later in pregnancy, the woman might develop physiological hydronephrosis and hydroureteronephrosis, which are normal.
There is an increase in glomerular filtration rate associated with an increase in creatinine clearance, protein, albumin excretion, and urinary glucose excretion.
There is also an increase in sodium retention from the renal tube so oedema and water retention is a common sign in pregnant women -
This question is part of the following fields:
- Physiology
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Question 27
Incorrect
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A 22-year-old female in her 18th week of pregnancy presented with right iliac fossa pain while getting up from a chair and has been coughing and sneezing.
On examination, there is no palpable mass or rebound tenderness.
What will be the most likely cause for patient's complaint?Your Answer:
Correct Answer: Round ligament strain
Explanation:Patient’s symptoms and signs are suggestive of round ligament strain, which is a normal finding during pregnancy, especially in the 2nd trimester, and it does not require any medical intervention.
Round ligament is a rope-like fibromuscular band which extends from the anterolateral aspect of uterus anteriorly between the layers of the broad ligament, and passing through the deep inguinal ring into the inguinal canal.
A sharp, sudden spasm in the right iliac fossa which lasts for a few seconds which is usually triggered by sneezing, coughing, laughing and rolling over in bed are the common presentations of a round ligament pain.Ectopic pregnancy and rupture of ectopic pregnancy are two unlikely diagnosis in this patient as she is in the second trimester of her pregnancy, whereas both the mentioned conditions occur during the first trimester.
Although appendicitis presents with pain in right iliac fossa, the pain is not causes by coughing or sneezing. Also, there will be other symptoms like tenderness and rebound tenderness in right iliac fossa in case of appendicitis.
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This question is part of the following fields:
- Obstetrics
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Question 28
Incorrect
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A 29-year-old nulliparous woman is admitted to the hospital at 37 weeks of gestation after losing about 200 mL of blood per vagina after having sexual intercourse. The bleeding has now ceased and her vitals are below:
Pulse rate: 64 beats/min,
Blood pressure: 120/80 mmHg,
Temperature: 36.8°C. On physical exam, the uterus is enlarged and is 37 cm above the pubic symphysis. The uterus is lax and non-tender. On ultrasound, the fetal presentation is cephalic with the head freely mobile above the pelvic brim. The fetal heart rate assessed by auscultation is 155 beats/min.
Which of the following is the most likely of bleeding in this patient?Your Answer:
Correct Answer: Placenta praevia.
Explanation:In this pregnant patient with an antepartum haemorrhage at 37 weeks of gestation, her clinical presentation points to a placenta previa. Her bleeding has stopped, the uterus is of the expected size and non-tender, and the fetal head is still mobile above the pelvic brim which are all findings that would be consistent with a placenta praevia. An ultrasound examination would be done to rule-out or diagnose the condition.
An Apt test on the blood is necessary to ensure that this is not fetal blood that would come from a ruptured vasa praevia. Although this diagnosis would be unlikely since the bleeding has stopped. If there was a vasa praevia, there would be fetal tachycardia or bradycardia, where a tachycardia is often seen first but then bradycardia takes over late as fetal exsanguination occurs.
In a placental abruption with concealment of blood loss, the uterus would be larger and some uterine tenderness would be found on exam.
A cervical polyp could bleed after sexual intercourse and a speculum examination would be done to exclude it. However, it would be unlikely for a cervical polyp to cause such a large amount of blood loss. A heavy show would also rarely have as heavy as a loss of 200mL.
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This question is part of the following fields:
- Obstetrics
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Question 29
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 30
Incorrect
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A 36-year-old woman presents to the gynaecology clinic with a complaint of headache, irritability, abdominal bloating, anxiety, and breast tenderness around 4 to 5 days before menstruation for the last 8 months. There's also a limitation on daily activities and she has to take a week off from work. The patient's symptoms are relieved completely with the onset of menstruation.
Which of the following suggests an appropriate diagnosis?Your Answer:
Correct Answer: Premenstrual syndrome
Explanation:This patient meets the diagnostic criteria for premenstrual syndrome.
Affective and somatic symptoms over the five days before menses in each of the three previous menstrual cycles are diagnostic criteria for premenstrual syndrome.
Affective symptoms include:
– Depression.
– Anger outbursts.
– Irritability.
– Anxiety.
– Confusion.
– social withdrawal.
Somatic symptoms include:
– breast tenderness
– abdominal bloating
– headache and swelling of extremities.
Symptoms normally disappear within four days of menstruation and are present even when no medical therapy, drugs, or alcohol are used.Premenstrual dysphoric disorder is a severe form of premenstrual syndrome marked by intense melancholy, emotional lability with frequent crying, loss of interest in daily activities, reduced focus, exhaustion, sleeplessness, and a sense of being overwhelmed or out of control.
Symptoms must have been present for the majority of the previous 12 months, interfering with daily activities.The diagnoses of generalised anxiety disorder and depression alone are doubtful.
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This question is part of the following fields:
- Gynaecology
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