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Question 1
Incorrect
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A 36-year-old woman is being tested for a breast tumour she discovered last week during a routine physical examination. Two years ago, the patient had bilateral reduction mammoplasty for breast hyperplasia. Her paternal grandmother died of breast cancer at the age of 65, thus she doesn't take any drugs or have any allergies.
A fixed lump in the upper outer quadrant of the right breast is palpated during a breast examination. In the upper outer quadrant of the right breast, mammography reveals a 3 × 3-cm spiculated tumour with coarse calcifications. A hyperechoic mass can be seen on ultrasonography of the breast. The mass is removed with concordant pathologic findings, and a core biopsy reveals foamy macrophages and fat globules.
Which of the following is the best plan of action for this patient's management?Your Answer: Radiation therapy
Correct Answer: Reassurance and routine follow-up
Explanation:Fat necrosis is a benign (non-cancerous) breast condition that can develop when an area of fatty breast tissue is injured. It can also develop after breast surgery or radiation treatment.
There are different stages of fat necrosis. As the fat cells die, they release their contents, forming a sac-like collection of greasy fluid called an oil cyst. Over time, calcifications (small deposits of calcium) can form around the walls of the cyst, which can often be seen on mammograms. As the body continues to repair the damaged breast tissue, it’s usually replaced by denser scar tissue. Oil cysts and areas of fat necrosis can form a lump that can be felt, but it usually doesn’t hurt. The skin around the lump might look thicker, red, or bruised. Sometimes these changes can be hard to tell apart from cancers on a breast exam or even a mammogram. If this is the case, a breast biopsy (removing all or part of the lump to look at the tissue under the microscope) might be needed to find out if the lump contains cancer cells. These breast changes do not affect your risk for breast cancer.
Mastectomy, axillary node dissection and radiation therapy are all management options for malignancy which this patient doesn’t have.
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This question is part of the following fields:
- Gynaecology
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Question 2
Incorrect
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You see a patient who is 32 weeks pregnant. She complains of tingling to the right buttock and shooting pain down the leg. You suspect Piriformis syndrome. Regarding Piriformis which of the following statements are true?
Your Answer:
Correct Answer: Insertion is onto the greater trochanter
Explanation:The proximal attachment of the piriformis muscles is from the anterior surface of sacrum and it attaches distally to the superior border of the greater trochanter of the femur. It is innervated by the anterior rami of S1 and S2.
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This question is part of the following fields:
- Anatomy
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Question 3
Incorrect
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Where is Glucagon produced?
Your Answer:
Correct Answer: Islet alpha cells
Explanation:The alpha cells in the islets of Langerhans are responsible for the production and secretion of glucagon. The B cells secrete insulin, the D cells secrete somatostatin, and the F cells secrete pancreatic polypeptide. The B cells, which are the most common and account for 60–75% of the cells in the islets, are generally located in the centre of each islet.
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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 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 5
Incorrect
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A 29 year old obese woman presents complaining of difficult or painful sexual intercourse and dysmenorrhea. She is requesting a reversible contraceptive method. Which of the following would be most suitable?
Your Answer:
Correct Answer: Mirena
Explanation:Mirena is a form of contraception also indicated for the treatment of heavy menstrual bleeding and the management of dysmenorrhea, being able to reduce the latter considerably.
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This question is part of the following fields:
- Gynaecology
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Question 6
Incorrect
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A 26 year old women presents for her 12 week scan. She has been pregnant once before but had a 1st trimester miscarriage. She reports no problems with this pregnancy and has had no vaginal bleeding or spotting. The scan shows no fetal cardiac activity and a small gestational sac. What is the likely diagnosis?
Your Answer:
Correct Answer: Missed Miscarriage
Explanation:As there has been no bleeding or expulsion of the products of conception this is a missed miscarriage
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This question is part of the following fields:
- Clinical Management
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Question 7
Incorrect
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Question 8
Incorrect
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A patient is seen in clinic 6 weeks postpartum. The pregnancy was complicated by intrapartum haemorrhage requiring fluid resuscitation and a 2 unit blood transfusion. Mum reports feeling very tired, struggling to lose baby weight and needing to bottle feed due to very low volume lactation. What is the suspected diagnosis?
Your Answer:
Correct Answer: Sheehan's Syndrome
Explanation:Sheehan syndrome is the pregnancy related infarction of the pituitary gland. During pregnancy the gland doubles in size but the blood supply does not increase significantly and during delivery due to the loss of blood it principates infarction. This results in fatigue, poor lactation and loss of pubic hair.
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This question is part of the following fields:
- Pathology
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Question 9
Incorrect
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During the filling phase of micturition. At what bladder volume is the first urge to void felt?
Your Answer:
Correct Answer: 150ml
Explanation:The normal functional bladder capacity is around 400-600ml. First urge to void is typically felt when the bladder is approximately 150ml full.
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This question is part of the following fields:
- Anatomy
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Question 10
Incorrect
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A 25-year old woman presented to the medical clinic for her first prenatal check-up. Upon interview, the patient revealed that she has been smoking one pack of cigarettes per day for the past five years.
All of the following are considered correct regarding the disadvantages of smoking during pregnancy, except:Your Answer:
Correct Answer: Increased risk of developing small teeth with faulty enamel
Explanation:Small teeth with faulty enamel is more associated with fetal alcohol syndrome (FAS).
In FAS, the most common orofacial changes are small eyelid fissures , flat facies, maxillary hypoplasia, short nose, long and hypoplastic nasal filter, and thin upper lip. The unique facial appearance of FAS patients is the result of changes in 4 areas: short palpebral fissures, flat nasal bridge with an upturned nasal tip, hypoplastic philtrum with a thin upper vermillion border, and a flat midface. Other facial anomalies include micrognathia, occasional cleft lip and/or palate and small teeth with defective enamel.
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This question is part of the following fields:
- Obstetrics
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Question 11
Incorrect
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A diminishing blood volume within the first 4 hours post-partum may be seen when a warning sign occurs.
Which of the following is considered the single most important warning sign for the said situation?Your Answer:
Correct Answer: Tachycardia
Explanation:Postpartum haemorrhage (PPH) is a cumulative blood loss greater than 1000 mL with signs and symptoms of hypovolemia within 24 hours of the birth process, regardless of the route of delivery.
The first step in managing hemorrhagic shock is recognition. This should occur before the development of hypotension. Close attention should be paid to physiological responses to low blood volume. Tachycardia, tachypnoea, and narrowing pulse pressure may be the initial signs.
Tachycardia is typically the first abnormal vital sign of hemorrhagic shock. As the body attempts to preserve oxygen delivery to the brain and heart, blood is shunted away from extremities and nonvital organs. This causes cold and modelled extremities with delayed capillary refill. This shunting ultimately leads to worsening acidosis.
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This question is part of the following fields:
- Obstetrics
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Question 12
Incorrect
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What are the branches of the pudendal nerves in females?
Your Answer:
Correct Answer: Perineal, inferior rectal and dorsal nerve of clitoris
Explanation:The pudendal nerve provides sensory and motor innervation to regions of the anus, the perineum, the labia and the clitoris in women. The nerve is formed from the ventral rami of the S2-S4 sacral spinal nerves. The nerve is paired, each innervating the left and the right side of the body. The nerve gives the following branches in females: the inferior anal nerve, the perineal nerve and the dorsal nerve of the clitoris.
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This question is part of the following fields:
- Anatomy
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Question 13
Incorrect
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A mother typically becomes aware of fetal movements at what gestation?
Your Answer:
Correct Answer: 18-20 weeks
Explanation:Foetal movements often become apparent at about 18-20 weeks gestation. This phenomenon is also called quickening. The Foetal movements continue to increase in frequency and force until 32 weeks where they plateau. Foetal movements can be used to monitor the wellbeing of the foetus, alerting the mother and healthcare providers to a problem.
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This question is part of the following fields:
- Clinical Management
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Question 14
Incorrect
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Which immunoglobulin is the first to be synthesised by the neonate?
Your Answer:
Correct Answer: IgM
Explanation:Fetal production of immunoglobulin begins early on at about 10 weeks gestation with the production of IgM antibodies. Maternal IgG, which is a key component of fetal immunity is passed on to the foetus through the placenta from 12 weeks of gestation. Secretory IgA is not produced until after birth, through breast milk.
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This question is part of the following fields:
- Immunology
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Question 15
Incorrect
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A 32-year-old woman, who is 18 weeks pregnant, is diagnosed with antiphospholipid syndrome and positive anticardiolipin antibodies. She has a history of three miscarriages, each one during the first trimester. What would be the next most appropriate step?
Your Answer:
Correct Answer: Aspirin & heparin
Explanation:The syndrome with which the woman was diagnosed is an autoimmune, hypercoagulable state which most possibly was the reason of her previous miscarriages. This is the reason why she should be on aspirin and heparin in order to prevent any future miscarriage.
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This question is part of the following fields:
- Obstetrics
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Question 16
Incorrect
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Among the following which is the most likely finding of placental abruption in a pregnant woman?
Your Answer:
Correct Answer: Vaginal bleeding
Explanation:Placental abruption is defined as the premature separation of placenta from uterus and the condition usually presents with bleeding, uterine contractions and fetal distress. It is one of the most significant cause of third-trimester bleeding and is often associated with fetal and maternal mortality and morbidity. In all pregnant women with vaginal bleeding in the second half of the pregnancy, this condition should be considered as a differential diagnoses.
Though vaginal bleeding is the most common presenting symptom reported by almost 80% of women with placental abruption, vaginal bleeding is concealed in 20% of women with placental abruption, therefore, absence of vaginal bleeding does not exclude placental abruption.Symptoms and complications of placental abruption varies according to patient, frequency of appearance of some common features is as follows:
- Vaginal bleeding is the common presentation in 80% of patients.
- Abdominal or lower back pain with uterine tenderness is found in 70%
- Fetal distress is seen in 60% of women.
- Abnormal uterine contractions like hypertonic, high frequency contractions are seen in 35% cases.
- Idiopathic premature labor in 25% of patients.
- Fetal death in about 15% of cases.Examination findings include vaginal bleeding, uterine contractions with or without tenderness, shock, absence of fetal heart sounds and increased fundal height due to an expanding hematoma. Shock is seen in class 3 placental abruption which represents almost 24% of all cases of placental abruption.
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This question is part of the following fields:
- Obstetrics
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Question 17
Incorrect
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The amniotic fluid volume peaks at around 900ml. At what gestation does the amniotic fluid reach its maximum volume?
Your Answer:
Correct Answer: 35 weeks
Explanation:The amniotic fluid volume increases up to week 35 of gestation and then decreases from then to term.
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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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You are called to assist in an initially midwife led delivery. Upon delivering a female baby you notice the baby has partial fusion of the labioscrotal folds. You suspect congenital adrenal hyperplasia. Which of the following is the most common enzyme deficiency?
Your Answer:
Correct Answer: 21-hydroxylase
Explanation:Congenital Adrenal Hyperplasia leads to the virilization of the foetus. It occurs due to an enzyme deficiency in the corticosteroid production pathway i.e. 21-hydroxylase which converts progesterone to deoxycorticosterone. The reduced levels of corticosteroids results in the negative feedback loop that leads to adrenal hyperplasia.
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This question is part of the following fields:
- Genetics
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Question 19
Incorrect
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A 27-year-old woman who is 18 weeks pregnant presented to the emergency department due to a sudden onset of dyspnoea and pleuritic chest pain. She is known to have a previous history of deep venous thrombosis (DVT).
Which of the following is considered to be the most appropriate examination for this patient?Your Answer:
Correct Answer: Ventilation/perfusion scan
Explanation:Pulmonary embolism (PE) is a treatable disease caused by thrombus formation in the lung-vasculature, commonly from the lower extremity’s deep veins compromising the blood flow to the lungs.
Computed tomography of pulmonary arteries (CTPA) and ventilation-perfusion (V/Q) scan are the two most common and widely practiced testing modalities to diagnose pulmonary embolism.Pulmonary ventilation (V) and Perfusion (Q) scan, also known as lung V/Q scan, is a nuclear test that uses the perfusion scan to delineate the blood flow distribution and ventilation scan to measure airflow distribution in the lungs. The primary utilization of the V/Q scan is to help diagnose lung clots called pulmonary embolism. V/Q scan provides help in clinical decision-making by evaluating scans showing ventilation and perfusion in all areas of the lungs using radioactive tracers.
Ventilation-perfusion V/Q scanning is mostly indicated for a patient population in whom CTPA is contraindicated (pregnancy, renal insufficiency CKD stage 4 or more, or severe contrast allergy) or relatively inconclusive.
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This question is part of the following fields:
- Obstetrics
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Question 20
Incorrect
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According to the UK food standards agency which of the following RDIs (recommended daily intake) is 3 times higher in pregnancy than the non-pregnant state?
Your Answer:
Correct Answer: Folic Acid
Explanation:Folic Acid should be increased in diet of a pregnant women. Deficiency will lead to neural tube defects i.e. spina bifida.
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This question is part of the following fields:
- Physiology
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Question 21
Incorrect
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Question 22
Incorrect
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Which hormone is responsible for contraction of myoepithelial cells in lactation?
Your Answer:
Correct Answer: Oxytocin
Explanation:Oxytocin is responsible for the let down mechanism that occurs during breast feeding in which the myothelial cells contract and push the milk into the ductules.
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This question is part of the following fields:
- Clinical Management
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Question 23
Incorrect
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Question 24
Incorrect
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Missed abortion may cause one of the following complications:
Your Answer:
Correct Answer: Coagulopathy
Explanation:A serious complication with a miscarriage is DIC, a severe blood clotting condition and is more likely if there is a long time until the foetus and other tissues are passed, which is often the case in missed abortion.
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This question is part of the following fields:
- Obstetrics
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Question 25
Incorrect
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A 35 year old female presented with complaints of a 3 cm lump in her right breast, which was firm & irregular. O/E there was also some colour change over the breast. The most likely diagnosis would be?
Your Answer:
Correct Answer:
Explanation:Breast carcinoma is one of the most common malignancies in women. It presents as an irregular, firm consistency nodule/lump, which is attached to the skin most of the time. The overlying skin also exhibits a peau d’ orange appearance, along with dimpling. A sebaceous cyst is a small cystic swelling with no colour change and can occur anywhere over the skin. A lipoma is a benign tumour of fats which is soft in consistency.
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This question is part of the following fields:
- Gynaecology
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Question 26
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:
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 27
Incorrect
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A 27-year-old woman presents to her general practitioner because of secondary amenorrhoea since the last 12 months.
She has a history of primary infertility.
Of the hormone assays listed in the options, identify the assay that would indicate pregnancy if its result is significantly elevated.Your Answer:
Correct Answer: Serum luteinising hormone {LH).
Explanation:The levels of oestradiol (E2), progesterone, and prolactin (PRL) are all elevated during early pregnancy. However these elevations cannot be solely relied on to determine if pregnancy has occurred since increased levels of these hormones can also occur in pathologic states in non-pregnant women or, in some cases, even during menstrual cycles.
The levels of follicle stimulating hormone (FSH) are suppressed in pregnancy because of the elevated E2 and progesterone levels.
The correct answer is elevated levels of luteinising hormone (LH). This is because the beta sub-units of LH and human chorionic gonadotrophin (hCG) are almost identical and therefore, hCG is measured as LH in almost all LH assays (correct answer).
The LH levels can be slightly raised in polycystic ovarian syndrome; however, it is unlikely that the levels would increase above 30 mIU/mL in this condition.
The mid-cycle levels of LH can go up to 100-150 mIU/mL. If the levels are more than 200 mlU/mL, it usually indicates pregnancy.
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This question is part of the following fields:
- Gynaecology
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Question 28
Incorrect
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Question 29
Incorrect
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In which one of the following circumstances, is it least likely for a foetus to be in a transverse lie?
Your Answer:
Correct Answer: A normal term foetus
Explanation:Normal position of the foetus in relationship to the mother is always a longitudinal lie and a cephalic presentation. Transverse lie means that the baby is sideways. The foetus lies transverse till 26-28th week of gestation, after which it usually changes its position from transverse to a longitudinal lie with head down. A transverse lie can occur in conditions like grand multiparity, preterm foetus, placenta previa and pelvic contraction.
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This question is part of the following fields:
- Obstetrics
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Question 30
Incorrect
SESSION STATS - PERFORMANCE PER SPECIALTY
