-
Question 1
Incorrect
-
A 28 year old woman presents for a scan at 13 weeks. Though this is her second pregnancy, the first ended in a 1st trimester miscarriage. She has not reported any problems with the current pregnancy. The ultrasound scan showed a small gestational sac and no fetal cardiac activity.
Which of the following is the most likely diagnosis?Your Answer: Recurrent Miscarriage
Correct Answer: Missed Miscarriage
Explanation:A miscarriage is defined as the spontaneous loss of a pregnancy before the age of viability at 24 weeks in the UK.
A missed miscarriage is described as a loss of pregnancy without vaginal bleeding, loss of tissue, cervical changes or abdominal pain. During a scan, a fetal heartbeat is not observed, and the gestational sac may be small.
A threatened miscarriage is when the cervix dilates and uterine bleeding is seen; the pregnancy could still be viable. A complete miscarriage occurs when all the products of conception are expelled from the uterus, bleeding has stopped, and the cervix has closed up after dilation.
An inevitable miscarriage occurs with the usual symptoms of a miscarriage and a dilated cervix, suggesting that the passage of the fetal tissue is inevitable.
Recurrent miscarriages are described as spontaneous pregnancy loss of more than 2 to 3 consecutive times.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 2
Incorrect
-
Which of the following dugs is a strong inducer of cytochrome P450?
Your Answer:
Correct Answer: Phenytoin
Explanation:Antiepileptic, phenytoin more so than topiramate are inducers of cytochrome P450. They should not be given with COCPs. The metabolism of oestrogen and progestogen is increased by anti-epileptic drugs that induce cytochrome P450 leading to a loss of contraceptive effect.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 3
Incorrect
-
Question 4
Incorrect
-
What is the mode of action of Mefenamic acid?
Your Answer:
Correct Answer: Inhibits Prostaglandin Synthesis
Explanation:Mefenamic acids is a NSAID. It works by inhibiting prostaglandin synthesis – It inhibits COX-1 and COX-2 hence reducing the process of inflammation. Activation of antithrombin III and inactivation of factor Xa is the primary mechanism of action of Heparin.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 5
Incorrect
-
Question 6
Incorrect
-
A 31-year-old female patient seeks your opinion on an abnormal Pap smear performed by a nurse practitioner at a family planning facility. A high-grade squamous intraepithelial lesion is visible on the Pap smear (HGSIL).
Colposcopy was performed in the office. The impression is of acetowhite alterations, which could indicate infection by HPV. Chronic cervicitis is present in your biopsies, but there is no indication of dysplasia.
Which of the following is the most suitable next step in this patient's care?Your Answer:
Correct Answer: Conization of the cervix
Explanation:When cervical biopsy or colposcopy doesn’t explain the severity of the pap smear results cone biopsy is done. In 10% of biopsies, results will be different from that of the pap smear as in this patient with pap smear showing HSIL and colposcopy showing chronic cervicitis.
In such cases conization is indicated. Repeating the pap smear could risk prompt management of a serious problem. No destructive procedure, ablation or cryotherapy, should be done before diagnosis is certain.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 7
Incorrect
-
Question 8
Incorrect
-
An 18 year old girl presented with dysmenorrhea and irregular cycles. The most appropriate management in this case would be?
Your Answer:
Correct Answer: Combined pill
Explanation:Combined oral contraceptive pills have an anti ovulatory function and also reduce the pain of menstruation.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 9
Incorrect
-
A 32 year old woman with a 6 month history of fatigue and some weight gain reports to clinic for a review. Her medical records show evidence of hypothyroidism. On examination, a non tender, hard goitre is palpated. Further tests reveal elevated anti TPO (anti thyroid peroxidase) and anti -Tg (anti thyroglobulin). Which of the following conditions is most likely to present like this?
Your Answer:
Correct Answer: Hashimoto's
Explanation:The case presented points to a diagnosis of an autoimmune thyroiditis leading to hypothyroidism. The most common form of autoimmune hypothyroidism, Hashimoto’s, often presents with a goitre, positive for antibody tests against thyroid components i.e. anti-TPO and anti-thyroglobulin. Graves disease and toxic diffuse goitre are more likely to cause hyperthyroidism. While De-Quervain’s and endemic goitre may cause hypothyroidism, they don’t result in positive antibody tests.
-
This question is part of the following fields:
- Endocrinology
-
-
Question 10
Incorrect
-
In the earliest phase of wound healing platelets are held together by what?
Your Answer:
Correct Answer: Fibrin
Explanation:The 1st stage of wound healing is haemostasis. Even in incised wounds a small haematoma forms. Here the clotting cascade is activated by tissue factor and endothelial cells resulting in activation of platelets. This results in platelet aggregation and the laying down of a fibrin mesh that is cross linked and holds the platelets in place.
Wound healing is typically divided into phases:
1. Haemostasis Phase
2. Inflammatory phase
3. Proliferation phase
4. Remodelling phase -
This question is part of the following fields:
- Physiology
-
-
Question 11
Incorrect
-
Leydig cells contain receptors to which hormone?
Your Answer:
Correct Answer: LH
Explanation:The Leydig cells contain receptors to the luteinizing hormone which in turn is responsible for the production of testosterone. This circulates in the body predominantly bound to transport proteins and to a lesser extent to albumin.
-
This question is part of the following fields:
- Anatomy
-
-
Question 12
Incorrect
-
Lidocaine works by blocking which of the following ion channels?
Your Answer:
Correct Answer: fast voltage gated sodium channels
Explanation:It blocks the voltage gated sodium channels and reduce the influx of sodium ions preventing depolarization of the membrane and blocking the conduction of the action potential. The affinity of the receptor site in the sodium channels depends on whether it is resting, open or inactive.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 13
Incorrect
-
A 50-year-old woman presents with moderately severe pain in her left groin and thigh. She had recently travelled by airplane from overseas and is at 18 weeks of gestation of her second pregnancy. The only incidence of trauma she can think of is when she hit her left knee on a table yesterday.
On physical examination, it is found that she has some swelling of her left ankle that is not present on the right side. Her first pregnancy was unremarkable except for development of some symptoms that were believed to be related to pelvic symphyseal separation around 28 weeks of gestation.
Which one of the following is the mostly cause for this patient's pain?Your Answer:
Correct Answer: deep venous Thrombosis (DVT) in her left leg
Explanation:For this pregnant patient who recently travelled overseas most likely has a deep venous thrombosis (DVT). It would also be expected that the patient would have oedema in the symptomatic leg and account for the swelling described.
Though they could cause unilateral leg pain, neither symphyseal separation nor sciatica due to a prolapsed intervertebral disc usually occur as early as 18 weeks of gestation. This patient’s symptoms also do not suggest either diagnosis.
Pain due to trauma would usually be maximal at the site where the trauma took place, which would be in the knee for this patient. Traumatic pain and house cleaning also would not cause the pain described or result in ankle swelling.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 14
Incorrect
-
Which of the following factors is fetal nutrition dependant on?
Your Answer:
Correct Answer: All of the options given
Explanation:Fetal nutrition is dependant upon multiple factors such as maternal nutritional state, quality of maternal diet, malnutrition, anorexia nervosa, metabolic rate of the mother or whether they suffer from malabsorption syndrome or other related conditions.
-
This question is part of the following fields:
- Physiology
-
-
Question 15
Incorrect
-
Regarding the uterine artery which of the following statements are TRUE?
Your Answer:
Correct Answer: It arises from the internal iliac artery
Explanation:The uterine artery arises from the internal iliac artery, in particular the anterior division of the internal iliac artery. Some older texts refer to the internal iliac as the hypogastric artery. The vaginal artery typically arises as its own branch of the internal iliac artery. The ovarian arteries are branches of the aorta
-
This question is part of the following fields:
- Anatomy
-
-
Question 16
Incorrect
-
The main support of the uterus is provided by:
Your Answer:
Correct Answer: The cardinal ligament
Explanation:The cardinal ligament (or Mackenrodt’s ligament, lateral or transverse cervical ligament) is a major ligament of the uterus. It is located at the base of the broad ligament of the uterus. It attaches the cervix to the lateral pelvic wall by its attachment to the Obturator fascia of the Obturator internus muscle, and is continuous externally with the fibrous tissue that surrounds the pelvic blood vessels. It thus provides support to the uterus.
-
This question is part of the following fields:
- Anatomy
-
-
Question 17
Incorrect
-
A 66-year-old lady comes to your clinic complaining of a brownish vaginal discharge that has been bothering her for the previous three months. Atrophic vagina is seen on inspection.
Which of the following diagnoses is the most likely?Your Answer:
Correct Answer: Vaginal atrophy
Explanation:Endometrial cancer should always be the first diagnosis to rule out in a 65-year-old lady with brownish vaginal discharge. The inquiry focuses on the most likely source of the symptoms, rather than the most significant diagnosis to explore.
Blood typically causes the dark hue of vaginal discharge. The uterine cavity or the vagina can both be the source of bleeding. Only 5-10% of postmenopausal women with vaginal bleeding were found to have endometrial cancer. Around 60% of the women had atrophic vaginitis.Urogenital atrophy is caused by oestrogen insufficiency in postmenopausal women. Urogenital atrophy can cause the following symptoms:
– Dry vaginal skin
– Vaginal inflammation or burning
– Vaginal lubrication is reduced during sexual activity.
– Vulvar or vaginal pain, as well as dyspareunia (at the introitus or within the vagina)
– Vaginal or vulvar bleeding (e.g. postcoital bleeding. fissures)
– Vaginal discharge from the cervix (leukorrhea or yellow and malodorous)
– A vaginal bulge or pelvic pressure
– Symptoms of the urinary tract (e.g. urinary frequency, dysuria, urethral discomfort, haematuria). -
This question is part of the following fields:
- Gynaecology
-
-
Question 18
Incorrect
-
Pelvic ligaments can change at term resulting in?
Your Answer:
Correct Answer: Enlargement of the pelvic cavity
Explanation:The pelvis is supported by a variety of ligaments. At term, these ligaments allow for variation in its structure such that the overall size of the pelvic cavity is increased in order to accommodate the upcoming foetus into the cavity.
-
This question is part of the following fields:
- Anatomy
-
-
Question 19
Incorrect
-
Question 20
Incorrect
-
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.
-
This question is part of the following fields:
- Physiology
-
-
Question 21
Incorrect
-
A 26-year-old female G2P1 is in labour at the 38th week of gestation. Her membranes ruptured about 8 hours ago. At the moment, she is having contractions lasting 60 seconds every 4 minutes and is 8 cm dilated. The fetal heart tone baseline is currently 80/min with absent variability. The pregnancy was uneventful and she had regular prenatal check-ups.
Which of the following is the most appropriate next step in management?Your Answer:
Correct Answer: Maternal position change and oxygen
Explanation:This patient is towards the end of the first stage of labour and is having complications. Labour is divided into 3 stages. The first stage begins at regular uterine contractions and ends with complete cervical dilatation at 10 cm. It has a latent phase and an active phase- The active phase is usually considered to have begun when cervical dilatation reaches 4 cm. So this patient is in the active phase of the first stag- The second stage begins with complete cervical dilatation and ends with the delivery of the foetus. The third stage of labour is the period between the delivery of the foetus and the delivery of the placenta and fetal membranes.
This patient’s contractions seem adequate and yet the fetal heart tone with baseline 80/min and absent variability suggests fetal distress. This is category III of the fetal heart rate pattern because the baseline rate is < 110/min with absent variability. It is usually predictive of abnormal acid-base status. The recommended actions are maternal position change and oxygen administration, discontinuation of labour stimulus such as oxytocin, treatment of possible underlying conditions, and expedited delivery.
→ Magnesium sulphate infusion is mainly used to prevent eclamptic seizures and despite no evidence of its effectiveness as a tocolytic agent, it is used sometimes to reduce risks of preterm birth.
→ Fetal scalp pH monitoring would help determine if there is indeed an acidosis and should be done before deciding whether a Caesarean section is necessary, but maternal position change and oxygen administration should be done first.
→ Ultrasonography may be used for preinduction cervical length measurement or if the active stage has already started- It is considered more accurate than digital pelvic exam in the assessment of fetal descent; however, at this point maternal position change and oxygen administration should be done first.
→ Immediate Caesarean section would be done if fetal scalp pH monitoring revealed a pH < 7.20. At this point, the best next step is maternal position change and oxygen administration. -
This question is part of the following fields:
- Obstetrics
-
-
Question 22
Incorrect
-
The following hormones are secreted from the anterior pituitary gland, EXCEPT:
Your Answer:
Correct Answer: HCG
Explanation:The following hormones are excreted from the anterior pituitary gland: TSH, GN, ACTH, LH, FSH, MSH, PRL.
Human chorionic gonadotropin (hCG, or human chorionic gonadotrophin) is a placental hormone secreted by syncitiotrophoblasts during the second week of gestation. -
This question is part of the following fields:
- Endocrinology
-
-
Question 23
Incorrect
-
With regard to the cell cycle. In which part of the cycle does DNA replication occur?
Your Answer:
Correct Answer: Interphase
Explanation:DNA replication occurs during S phase but that isn’t one of the options. Remember Interphase comprises G1,S and G2 phases!
-
This question is part of the following fields:
- Biochemistry
-
-
Question 24
Incorrect
-
Question 25
Incorrect
-
A 60-year-old lady is found to have a grossly palpable adnexal mass on her left side on pelvic examination. This is the first time it has been detected. She attained menopause at 52 years of age. The last pelvic examination, which was done 4 years ago, was normal.
What is her most likely diagnosis?Your Answer:
Correct Answer: Ovarian carcinoma.
Explanation:Her most likely diagnosis would be an ovarian carcinoma. Any palpable adnexal mass in a post-menopausal woman is a red flag for an ovarian malignancy and should be assumed so until proven otherwise.
Endometrial cancer typically presents with a post-menopausal bleed and although there might be uterine enlargement, an adnexal mass is generally absent.
It is very rare for follicular cysts to develop following menopause and it is uncommon for post-menopausal women to have a benign ovarian tumour, which is more common in younger women. A degenerating leiomyoma would be unlikely in this case, especially since her pelvic examination three years ago was normal (no history of leiomyoma noted).
-
This question is part of the following fields:
- Gynaecology
-
-
Question 26
Incorrect
-
A 46-year-old woman with regular menstrual cycles presents with a history of menorrhagia for the last 6 years. Her menstrual cycles are normal, but she has bled excessively for eight days every month, and her haemoglobin level was 90g/L one month ago. She's already on iron supplementation. She has a history of cervical intraepithelial neoplasia grade 3 (CIN3) in addition to the anaemia, albeit her yearly smear test has been normal since the laser treatment six years ago. She is also undergoing hypertension treatment. Physical examination is unremarkable. She is not willing for endometrial ablation or hysterectomy until her menopause. Which of the following medical therapies would be the best for her to utilize between now and the time she is expected to hit menopause, which is around the age of 50?
Your Answer:
Correct Answer: HRT given from the time of menopause at the age of approximately 50 years, reduces the decline of cognitive function, often seen as an early manifestation of AD
Explanation:Adenomyosis or dysfunctional uterine haemorrhage are the most likely causes of heavy periods.
Because she refuses to have a hysterectomy or endometrial ablation, hormonal therapy must be administered in addition to the iron therapy she is already receiving.
Any of the choices could be employed, but using therapy only during the luteal phase of the cycle in someone who is virtually surely ovulating (based on her typical monthly cycles) is unlikely to work.Danazol is prone to cause serious adverse effects (virilization), especially when used for a long period of time.
GnRH agonists would cause amenorrhoea but are more likely to cause substantial menopausal symptoms, and the °fa contraceptive pill (OCP) is generally best avoided in someone using hypertension medication.Treatment with norethisterone throughout the cycle is likely to be the most successful of the treatments available.
If a levonorgestrel-releasing intrauterine device (Mirena®) had been offered as an alternative, it would have been acceptable. -
This question is part of the following fields:
- Gynaecology
-
-
Question 27
Incorrect
-
Screening for Group B Streptococcus (GBS) at around 36 weeks of gestation now is common practice as up to 20% of women carry the organism in the vagina.
If a pregnant woman is found to have GBS at this stage, which treatment would be most appropriate?Your Answer:
Correct Answer: Parenteral penicillin given six-hourly in labour.
Explanation:Up to 20% of women have been found to have Group B streptococcus (GBS). GBS is considered a normal flora of the gastrointestinal tract. GBS infection is generally asymptomatic although some women might end up having a UTI. Infants born to mothers who are colonised with GBS during labour are at a higher risk of developing early-onset GBS infection. If a pregnant woman develops a UTI due to GBS, it is suggestive of significant GBS colonisation. IV penicillin would be the drug of choice and is to be administered to the mother during labour which would provide sufficient protection for the foetus and would be effective enough. If penicillin is unavailable, ampicillin is a reasonable alternative. If a patient has penicillin allergy, vancomycin can be used. If not for penicillin, roughly 50% of babies delivered vaginally to women who are GBS positive would be colonised with the organism and out of this percentage, 1-2% can go on to develop a severe infection such as septicaemia and meningitis which could often be fatal.
IM penicillin can be administered to the newborn immediately post-delivery would be an effective prophylaxis in most cases but one should not wait until signs of infection are present to give the injection. Many newborns would still have an immature immune system which could cause some to die. Hence, it is more suitable to treat all women who tested positive during labour and the newborn as well if any signs of infection do appear. The majority of babies don’t need antibiotic treatment if their mother has been treated.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 28
Incorrect
-
Placental production of hPL, hCG, Oestrogen and Progesterone are examples of which type of mechanism
Your Answer:
Correct Answer: Endocrine
Explanation:Hormones that are secreted into the circulation at one site but have effects on distal target organs are endocrine as is the case with the hormones above. Autocrine and Intracrine messengers act within the same cell. Exocrine glands secrete their products into ducts. Apocrine is a histological term used to describe some types of exocrine gland.
-
This question is part of the following fields:
- Endocrinology
-
-
Question 29
Incorrect
-
Ulipristal is thought to prevent pregnancy by what primary mechanism?
Your Answer:
Correct Answer: Inhibition of ovulation
Explanation:Ulipristal is a progesterone receptor modulator that is used up to 120 hours following unprotected intercourse. It inhibits ovulation. The dose is 30 mg.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 30
Incorrect
-
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.
-
This question is part of the following fields:
- Obstetrics
-
SESSION STATS - PERFORMANCE PER SPECIALTY
