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Question 1
Incorrect
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Yasmin®, which contains 3 mg of drospirenone and 30 mcg of ethinyl oestradiol, has been approved for usage in South Africa.
Which of the following factors has contributed to it becoming the most popular oral contraceptive pill among South African women?Your Answer: It has a failure rate of less than other OCPs
Correct Answer: It has not weight gain as an adverse effect and may be associated with weight loss
Explanation:Yasmin has been linked to decreased fluid retention and weight gain as a side effect of COCs, which is why most women who experience this side effect prefer Yasmin®.
Due to its anti-mineralocorticoid properties, drospirenone, unlike earlier progestogens, is associated with no weight gain or even moderate weight loss.
Yasmin has a similar failure rate to other COCs. No evidence using Yasmin is linked to a lower risk of cervical cancer as a long-term side effect of COCs. Yasmin, like all COCs, can cause spotting and irregular bleeding in the first few months of use.
Drospirenone, a progesterone component, has antiandrogenic properties and is slightly more successful in treating acne, but the difference is not big enough to make it preferable in terms of acne therapy or prevention when compared to other COCs. -
This question is part of the following fields:
- Gynaecology
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Question 2
Incorrect
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The ascending colon drains into the superior mesenteric vein (SMV). What vein does the SMV drain into?
Your Answer:
Correct Answer: Hepatic portal vein
Explanation:The superior mesenteric vein joins the splenic vein to form the hepatic portal vein.
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This question is part of the following fields:
- Anatomy
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Question 3
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 4
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 5
Incorrect
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What is the role of DHEA produced by the fetal adrenal glands?
Your Answer:
Correct Answer: Stimulate placenta to form oestrogen
Explanation:Dehydroepiandrosterone (DHEA) is a steroid hormone synthesised from cholesterol (via Pregnenolone) by the adrenal glands. The foetus manufactures DHEA, which stimulates the placenta to form oestrogen, thus keeping a pregnancy going. Production of DHEA stops at birth, then begins again around age seven and peaks when a person is in their mid-20s
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This question is part of the following fields:
- Endocrinology
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Question 6
Incorrect
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The midwife asks for your advice about a 33 year old woman who she has just seen at her booking appointment. The patient had an uncomplicated pregnancy 10 years ago. This is her second pregnancy. There is no significant personal or family history. On examination the patients blood pressure is 120/75, BMI 32.5kg/m2. The midwife asks your advice on testing for gestational diabetes. What would you advise?
Your Answer:
Correct Answer: OGTT at 24-28 weeks
Explanation:Gestational diabetes (GDM) occurs in 2–9 per cent of all pregnancies. Screening for diabetes in pregnancy can be justify ed to diagnose previously unrecognized cases of pre-existing diabetes and to identify a group of women who are at risk of developing NIDDM later in life. No single screening test has been shown to be perfect in terms of high sensitivity and specific city for gestational diabetes. Urinary glucose is unreliable, and most screening tests now rely on blood glucose estimation, with an oral glucose tolerance test commonly used. The aim of glucose control is to keep fasting levels between 3.5 and 5.5 mmol/L and postprandial levels 7.1 mmol/L, with insulin treatment usually indicated outside these ranges.
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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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A 29-year-old primigravida presented with vaginal bleeding at 16 weeks of gestation. She is Rh-negative, and her baby is Rh-positive.
Speculum examination shows a dilated cervix with visible products of conception. Pelvic ultrasound confirmed the diagnosis of spontaneous abortion.
In this case, what will you do regarding Anti-D administration?Your Answer:
Correct Answer: Give anti-D now
Explanation:As the mother is found to be rhesus negative while her baby being rhesus positive, the given case is clinically diagnosed as spontaneous abortion due to Rh incompatibility. The mother should be administered anti-D for prophylaxis for avoiding future complications.
Rhesus (Rh) negative women who deliver a Rh-positive baby or who comes in contact with Rh positive red blood cells are at high risk for developing anti-Rh antibodies. The Rh positive fetuses
eonates of such mothers are at high risk of developing hemolytic disease of the fetus and newborn, which can be lethal or associated with serious morbidity.
In such situations both spontaneous and threatened abortion after 12 weeks of gestation, are indications to use anti-D in such situations.All the other options are incorrect.
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This question is part of the following fields:
- Obstetrics
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Question 8
Incorrect
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The softening of the cervical isthmus that occurs early in gestation is called:
Your Answer:
Correct Answer: Hegar's sign
Explanation:Hegar’s sign: softening of womb (uterus) due to its increased blood supply, perceptible on gentle finger pressure on the neck (cervix). This is one of the confirmatory signs of pregnancy and is usually obvious by the 16th week.
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This question is part of the following fields:
- Obstetrics
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Question 9
Incorrect
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Which of the following best describes the mechanism of action of radiotherapy?
Your Answer:
Correct Answer: DNA damage via free radical generation
Explanation:Radiotherapy works on the principle of ionisation. In particularly that of water leading to the formation of free radicals, these radicals are highly reactive and they react with the DNA leading to damage and cell death.
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This question is part of the following fields:
- Biophysics
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Question 10
Incorrect
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During her first month on OCPs, a patient had minimal bleeding at mid cycle. What is the most appropriate management?
Your Answer:
Correct Answer: Continue pills as usual.
Explanation:Breakthrough bleeding, or spotting, refers to when vaginal bleeding occurs between menstrual cycles. It may look like light bleeding or brown discharge.
Spotting is the most common side effect of birth control pills. It happens because the body is adjusting to changing levels of hormones, and the uterus is adjusting to having a thinner lining.
Taking the pill as prescribed, usually every day and at the same time each day, can help prevent bleeding between periods.
All other options are incorrect as this is a common side effect and will resolve on its own.
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This question is part of the following fields:
- Gynaecology
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Question 11
Incorrect
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Fetal distress commonly occurs when the head is in the occipito-posterior (OP) position during labour. Which of the following statements is the most probable explanation for this?
Your Answer:
Correct Answer: Incoordinate uterine action.
Explanation:Incoordinate uterine action almost always results in fetal distress due to increased resting intrauterine pressure. All other statements can also cause fetal distress, however, these are not as common as incoordinate uterine action. Syntocin infusion for labour augmentation and administration of epidural anaesthetic for pain relief can also increase the risk of fetal distress.
Cardiotocograph (CTG) monitoring during labour is highly recommended in patients where the fetal head is found in the OP position. Moreover, it is mandatory when there is Syntocin infusion or epidural anaesthesia. -
This question is part of the following fields:
- Obstetrics
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Question 12
Incorrect
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What is the most common causative organism in Fitzhugh Curtis syndrome and ophthalmic neonatorum?
Your Answer:
Correct Answer: Chlamydia trachomatis
Explanation:A rare complication of pelvic inflammatory disease is Fitz Hugh Curtis syndrome which is perihepatitis leading to the formation of adhesions between the liver and the peritoneal surface. It is most commonly caused by chlamydia and gonorrhoea. Ophthalmia neonatorum is conjunctivitis which is also caused by these pathogens.
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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 24 year old lady is rushed to the emergency department complaining of vaginal spotting and abdominal cramping. Her 6 week pregnancy was confirmed by ultrasound scan last week. On speculum examination, the cervical os is open with blood noted around it.
Which of the following is the most likely diagnosis?Your Answer:
Correct Answer: Inevitable Miscarriage
Explanation:A miscarriage is defined as the spontaneous loss of a pregnancy before the age of viability at 24 weeks in the UK. An inevitable miscarriage occurs with the usual symptoms of a miscarriage such as menstrual-like cramping, vaginal bleeding and a dilated cervix. The gestational sac has ruptured but products of conception have not been passed. The products of conception will eventually pass.
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. Recurrent miscarriages are described as spontaneous pregnancy loss of more than 2 to 3 consecutive times.
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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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After 18 months of frequent sexual activity, a young couple was unable to conceive.
Which of the following conditions has the best prognosis for infertility treatment?Your Answer:
Correct Answer: Stein-Leventhal syndrome
Explanation:Approximately 75–80% of patients with PCOS will ovulate after Clomiphene citrate. Although there appears to be discrepancy between ovulation and pregnancy rates, life-table analysis of the largest and most reliable studies indicates a conception rate of up to 22% per cycle in those ovulating on CC.
Pelvic TB causes tubal occlusion by scarring leading to infertility. Once occlusion occurs, IVF is usually the only option for conception. This is also the case for women with Turner syndrome.
Azoospermia maybe treated with surgery or hormonal therapy based on the cause but the success rate is low.
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This question is part of the following fields:
- Gynaecology
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Question 15
Incorrect
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With sneezing, a 45-year-old mother of two reported leaking a small bit of urine. It started to happen with exercising recently. She denies having experienced recent life pressures.
Which of the following best characterizes the incontinence she's dealing with?Your Answer:
Correct Answer: Stress incontinence
Explanation:Overflow incontinence typically presents with continuous urinary leakage or dribbling in the setting of incomplete bladder emptying. Associated symptoms can include weak or intermittent urinary stream, hesitancy, frequency, and nocturia. When the bladder is very full, stress leakage can occur or low-amplitude bladder contractions can be triggered resulting in symptoms similar to stress or urgency incontinence.
Women with urgency incontinence experience the urge to void immediately preceding or accompanied by involuntary leakage of urine
Individuals with stress incontinence have involuntary leakage of urine that occurs with increases in intraabdominal pressure (e.g., with exertion, sneezing, coughing, laughing) in the absence of a bladder contraction.
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This question is part of the following fields:
- Gynaecology
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Question 16
Incorrect
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Regarding monozygotic twins, all of the following are correct, EXCEPT:
Your Answer:
Correct Answer: Has a constant incidence 1:600 births
Explanation:The incidence of monozygotic twins is constant worldwide (approximately 4 per 1000 births). Approximately two thirds of twins are dizygotic.
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This question is part of the following fields:
- Genetics
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Question 17
Incorrect
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A 41-year-old woman (gravida 2, para 1) presents at eight weeks gestation for her first antenatal visit.
This is her second pregnancy.
She is worried about Down syndrome risk in her foetus.
From the following options listed, select the safest test (i.e., the one with least risk of causing adverse consequences in the pregnancy) that will provide an accurate diagnosis regarding the presence or absence of Trisomy 21 in the foetus.Your Answer:
Correct Answer: Amniocentesis at 16 weeks of gestation.
Explanation:Nuchal translucency scans and maternal screening tests simply aid in determining a risk percentage for the presence of Trisomy 21, but an accurate diagnosis cannot be reached.
Chorionic villous biopsy (CVB), amniocentesis, and cordocentesis, are all prenatal diagnostic tests that can provide a definitive diagnosis regarding the presence of foetal abnormalities.
Amniocentesis performed at 16 weeks of gestation is associated with the lowest risk for miscarriage and hence is the safest test and should be recommended to the mother (correct answer).
The miscarriage risk from a CVB is at least double the risk following amniocentesis.
Nowadays, cordocentesis is rarely used for sampling of foetal material to detect chromosomal abnormalities as the test poses an even higher risk of miscarriage compared to the other procedures discussed above.
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This question is part of the following fields:
- Obstetrics
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Question 18
Incorrect
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You see a patient in antenatal clinic who is concerned that she has never had chicken pox and may catch it during pregnancy. You check her Varicella status and she is non-immune. She asks you about vaccination. What type of vaccine is the varicella vaccine?
Your Answer:
Correct Answer: Attenuated
Explanation:Varicella is a live vaccine. The recent RCOG green top guidelines suggest vaccine can be considered postpartum or pre pregnancy but NOT whilst pregnant. In the non-immune pregnant woman they should be advised to avoid contact with people with chickenpox or shingles and to contact a healthcare professional promptly if exposed. If they have a significant exposure VZIG should be offered as soon as possible.
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This question is part of the following fields:
- Immunology
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Question 19
Incorrect
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Sertoli cells contain receptors to which hormone?
Your Answer:
Correct Answer: FSH
Explanation:Sertoli cells contain receptors for FSH. In response to this Sertoli cells synthesize inhibin, androgen binding proteins and anti Mullerian hormone all which are connected to the reproduction cycle.
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This question is part of the following fields:
- Anatomy
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Question 20
Incorrect
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A 23 year old patient presents to the emergency department with sudden onset of severe lower abdominal and pelvic pain. History reveals she normally has regular 28 day cycles but she missed her last period. Past medical history reveals 2 termination of pregnancy procedures in the past 3 years. The most recent one 6 months ago. She smokes 5 cigarettes per day.
Your Answer:
Correct Answer: Ectopic pregnancy
Explanation:This patient is most likely to have a ruptured ectopic pregnancy. The history of multiple TOPs suggests her contraceptive methods are not reliable and her missed period is suggestive she may currently be pregnant. There is no temperature or vaginal discharge to suggest PID though this is of course possible as is appendicitis. The last termination was 6 months ago so endometritis is unlikely.
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This question is part of the following fields:
- Clinical Management
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Question 21
Incorrect
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In early pregnancy at what gestation does the Embryonic pole become visible on transvaginal ultrasound?
Your Answer:
Correct Answer: 5 weeks + 3 days
Explanation:The gestational sac can be visualized from as early as 4–5 weeks of gestation and the yolk sac at about 5 weeks (Figure 6.3). The embryo can be observed and measured at 5–6 weeks gestation.
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This question is part of the following fields:
- Biophysics
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Question 22
Incorrect
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At ovulation the surge in LH causes rupture of the mature oocyte via action on what?
Your Answer:
Correct Answer: Theca externa
Explanation:The luteinizing hormone (LH) surge during ovulation causes: Increases cAMP resulting in increased progesterone and PGF2 production PGF2 causes contraction of theca externa smooth muscle cells resulting in rupture of the mature oocyte
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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 30-year-old G2P1 woman presented to the maternity unit, in labour at 38 weeks gestation. During her previous pregnancy she delivered a healthy baby through caesarean section. The current pregnancy had been uneventful without any remarkable problems in antenatal visits except for the first trimester nausea and vomiting.
On arrival, she had a cervical dilation of 4 cm and the fetal head was at -1 station. After 5 hours, the cervical length and fetal head station are still the same despite regular uterine contractions. Suddenly, there is a sudden gush of blood, which is approximately 1000 ml and the fetal heart rate have dropped to 80 bpm on CTG.
Which of the following could be the most likely cause for this presentation?Your Answer:
Correct Answer: Ruptured uterus
Explanation:Due to the previous history of caesarean section, uterine rupture would be the most likely cause of bleeding in this patient who is at a prolonged active phase of first stage of labour.
Maternal manifestations of uterine rupture are highly variable but some of its common features includes:
– Constant abdominal pain, where the pain may not be present in sufficient amount, character, or location suggestive of uterine rupture and may be masked partially or completely by use of regional analgesia.
– Signs of intra abdominal hemorrhage is a strong indication. Although hemorrhage is common feature, but signs and symptoms of intra-abdominal bleeding in cases of uterine rupture especially in those cases not associated with prior surgery may be subtle.
– Vaginal bleeding is not considered as a cardinal symptom as it may be modest, despite major intra-abdominal hemorrhage.
– Maternal tachycardia and hypotension
– Cessation of uterine contractions
– Loss of station of the fetal presenting part
– Uterine tenderness
As seen in this case, fetal bradycardia is the most common and characteristic clinical manifestation of uterine rupture, preceded by variable or late decelerations, but there is no other fetal heart rate pattern pathognomonic of rupture. Furthermore, fetal heart rate changes alone have a low sensitivity and specificity for diagnosing a case as uterine rupture.
Pain and persistent vaginal bleeding despite the use of uterotonic agents are characteristic for postpartum uterine rupture. If the rupture extends into the bladder hematuria may also occur.
A definite diagnosis of uterine rupture can be made only after laparotomy. Immediate cesarean section should be performed to save both the mother and the baby in cases where uterine rupture is suspected. -
This question is part of the following fields:
- Obstetrics
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Question 24
Incorrect
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Regarding anti-epileptic use in the 1st trimester of pregnancy, which of the following is closely associated with the development of congenital malformations?
Your Answer:
Correct Answer: Sodium valproate
Explanation:Sodium Valproate is known to be the most teratogenic when used in the first trimester of pregnancy. This antiepileptic increases the risk of congenital malformations including a 10-20 fold risk of neurodevelopmental defects. Though the use of antiepileptics should generally be avoided during pregnancy, carbamazepine, or newer drugs such as Lamotrigine are thought to carry less of a risk of teratogenicity.
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This question is part of the following fields:
- Clinical Management
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Question 25
Incorrect
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A 35-year-old woman from the countryside of Victoria comes to the hospital at 37 weeks of gestation after noticing a sudden gush of clear fluid from her vagina.
Speculum examination shows pooling of liquor in the posterior fornix and patient developed fever, tachycardia and chills 12 hours after this episode.
Apart from giving antibiotics, what will be your strategy in management of this case?Your Answer:
Correct Answer: Induce labour now
Explanation:Above mentioned patient presented with symptoms of premature rupture of membranes (PROM) which refers to membrane rupture before the onset of uterine contractions.
A sudden gush of clear or pale yellow fluid from the vagina is the classic clinical presentation of premature rupture of membranes. Along with this the patient also developed signs of infection like fever, tachycardia and sweating which is suggestive of chorioamnionitis.
Vaginal examination is never performed in patients with premature rupture of membrane, instead a speculum examination is the usually preferred method which will show fluid in the posterior fornix.
The following are the steps in management of premature rupture of membrane:
– Admitting the patient to hospital.
– Take a vaginal
ervical smears.
– Measure and monitor both white cell count and C- reactive protein levels.
– Continue pregnancy if there is no evidence of infection or fetal distress.
– In presence of any signs of infection or if CTG showing fetal distress it is advisable to induce labour.
– Corticosteroids must be administered if delivery is prior to 34 weeks of gestation.
– Give antibiotics as prevention and for treatment of infection. -
This question is part of the following fields:
- Obstetrics
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Question 26
Incorrect
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In which of the following situations are mini-pills unsafe to use?
Your Answer:
Correct Answer: Ovarian cysts
Explanation:Progestin only pills increase the risk of developing follicular cysts. Sonographic studies have observed that follicular cysts are more common in POP users than women not using hormones. The follicular changes tend to increase and regress over time. No intervention is required in asymptomatic women, other than reassurance. POP users who have persistent concerns about ovarian follicular changes should be offered another method of contraception.
All other options are not contraindications to the use of mini-pills.
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This question is part of the following fields:
- Gynaecology
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Question 27
Incorrect
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A patient present to the clinic with a 1 day history of vaginal prolapse. Upon examination, the vagina is 1.5 cm below the vaginal plane. What grade is the prolapse according to the POP-Q classification?
Your Answer:
Correct Answer: Grade 3
Explanation:Pelvic organ prolapse is a common condition amongst ageing women where a weakness in the pelvic support structures of the pelvic floor allows pelvic viscera to descend.
The Pelvic Organ Prolapse Quantification system (POP-Q) is useful for describing and staging the severity of the pelvic organ prolapse.
Grade 1: the most distal portion of the prolapse is more than 1 cm above the level of the hymen
Grade 2: the most distal portion of the prolapse is 1 cm or less proximal or distal to the hymenal plane
Grade 3: the most distal portion of the prolapse protrudes more than 1 cm below the hymen but protrudes no farther than 2 cm less than the total vaginal length (for example, not all of the vagina has prolapsed)
Grade 4: vaginal eversion complete -
This question is part of the following fields:
- Anatomy
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Question 28
Incorrect
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Syphilis is caused by which one of the following organisms?
Your Answer:
Correct Answer: Treponema Pallidum
Explanation:Syphilis is a sexually transmitted disease which is caused by spirochete called treponema pallidum. It can be divided into three stages. i.e. primary, secondary and tertiary syphilis.
– Primary syphilis is characterized by chancre formation at the site of sexual contact.
– Secondary syphilis ranges from maculopapular lesions to scaly lesions, inguinal lymphadenopathy, condylomata lata and split papules at the corner of mouth.
– Tertiary syphilis is the late stage of syphilis which is characterized by gummas formation and general paresis along with signs and symptoms of visceral involvement. -
This question is part of the following fields:
- Clinical Management
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Question 29
Incorrect
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A 27-year-old woman presents to the clinic.
She explains she has had 2 episodes of postcoital bleeding.
Her previous medical history reveals she is currently taking the oral contraceptive pill (OCP) and has never had an abnormal pap smear, including one that was performed a year ago.
What is the most probable cause of her postcoital bleeding?Your Answer:
Correct Answer: A cervical ectropion
Explanation:The most likely cause of her postcoital bleeding is cervical ectropion as suggested by her postcoital bleeding, normal pap smears and use of oral contraceptive pills.
Cervical ectropion is a benign condition that occurs as a result of overexposure to oestrogen. Here, glandular cells (the columnar epithelium) lining the endocervix, begin to grow on the ectocervix, leading to exposure of the columnar cells to the vaginal environment.
These columnar cells are prone to trauma and bleeding during coitus.
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This question is part of the following fields:
- Gynaecology
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Question 30
Incorrect
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A 32-year-old woman visited your clinic at her 30th week of gestation, complaining of left lower limb pain.
The doppler ultrasound findings had confirmed proximal deep vein thrombosis and she was treated with low molecular weight heparin.
Now she is at her 34 weeks of gestation, and is expecting delivery in next four weeks. What would be your advice for her today?Your Answer:
Correct Answer: Low molecular weight heparin should be switched to unfractionated heparin
Explanation:This patient has developed deep vein thrombosis during pregnancy and required anti-coagulation as part of treatment for up to 3-6 months. Enoxaparin, which is a low molecular weight heparin, is preferred over heparin due to the once or twice a day therapeutic dosing. Also monitoring of aPTT is not required in this case.
There is an association between Enoxaparin and an increased risk for epidural hematoma in women receiving epidural anaesthesia during labour. Considering that the patient mentioned is expected to go for delivery in 4 weeks and the possibility of her needing an epidural anaesthesia or general anaesthesia in case of undergoing a cesarean section, enoxaparin should be switched to unfractionated heparin, four weeks prior to the anticipated delivery. This is because of the fact that heparin can be antidoted with protamine sulphate.
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This question is part of the following fields:
- Obstetrics
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