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Question 1
Incorrect
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During the menstrual cycle which hormone typically reaches its peak level on day 21 (assuming a 28 day cycle)?
Your Answer: FSH
Correct Answer: Progesterone
Explanation:LH, FSH and Oestrogen have their peaks just before ovulation on day 14 whereas progesterone peaks around day 21.
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This question is part of the following fields:
- Endocrinology
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Question 2
Incorrect
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Question 3
Incorrect
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Question 4
Incorrect
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All of the following may result from a bicornuate uterus except:
Your Answer:
Correct Answer: Congenital anomalies of the baby
Explanation:Literature review shows that bicornuate uterus is associated with increase risk of spontaneous abortion in about 36% of patients. There is also an increased risk of preterm birth, malpresentation and fetal growth retardation.
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This question is part of the following fields:
- Embryology
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Question 5
Incorrect
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A 31-year-old woman presented with abdominal pain and vaginal bleeding of around 600 ml at 40 weeks of gestation.
On examination, her vital signs were found to be stable, with a tender abdomen and there were no fetal heart sounds heard on auscultation.
Which among the following is considered the most appropriate next step?Your Answer:
Correct Answer: Amniotomy
Explanation:Placental abruption is commonly defined as the premature separation of the placenta, which complicates approximately 1% of births. During the second half of pregnancy abruption is considered an important cause for vaginal bleeding and is mostly associated with significant perinatal mortality and morbidity.
Clinical presentation of abruption varies from asymptomatic cases to those complicated with fetal death and severe maternal morbidity. Classical symptoms of placental abruption are vaginal bleeding and abdominal pain, but at times severe cases might occur with neither or just of one of these signs. In some cases the amount of vaginal bleeding may not correlates with the degree of abruption, this is because the severity of symptoms is always depend on the location of abruption, whether it is revealed or concealed and the degree of abruption.
Diagnosis of abruption is clinical and the condition should be suspected in every women who presents with vaginal bleeding, abdominal pain or both, with a history of trauma, and in those women who present with an unexplained preterm labor. All causes of abdominal pain and bleeding, like placenta previa, appendicitis, urinary tract infections, preterm labor, fibroid degeneration, ovarian pathology and muscular pain are considered as differential diagnosis of abruption.In the given case patient has developed signs and symptoms of placental abruption, like severe vaginal bleeding with abdominal pain, whose management depends on its presentation, gestational age and the degree of maternal and fetal compromise. As the presentation is widely variable, it is important to individualize the management on a case-by-case basis. More aggressive management is desirable in cases of severe abruption, which is not appropriate in milder cases of abruption. In cases of severe abruption with fetal death, as seen in the given case, it is reasonable to allow the patient to have a vaginal delivery,regardless of gestational age, as long as the mother is stable and there are no other contraindications.
The uterus is contracting vigorously, and labor occurs rapidly and progresses, so amniotomy is mostly sufficient to speed up delivery. There is a significant risk for coagulopathy and hypovolemic shock so intravenous access should be established with aggressive replacement of blood and coagulation factors. Meticulous attention should be paid to the amount of blood loss; general investigations like complete blood count, coagulation studies and type and crossmatch should be done and the blood bank should be informed of the potential for coagulopathy. A Foley catheter should be placed and an hourly urine output should be monitored.
It is prudent to involve an anesthesiologist in the patient’s care, because if labor does not progress rapidly as in cases like feto-pelvic disproportion, fetal malpresentation, or a prior classical cesarean delivery, it will be necessary to conduct a cesarean delivery to avoid worsening of the coagulopathy.
Bleeding from surgical incisions in the presence of DIC may be difficult to control, and it is equally important to stabilize the patient and to correct any coagulation derangement occuring during surgery. The patient should be monitored closely after delivery, with particular attention paid to her vital signs, amount of blood loss, and urine output. In addition, the uterus should be observed closely to ensure that it remains contracted and is not increasing in size.
Immediate delivery is indicated in cases of abruption at term or near term with a live fetus. In such cases the main question is whether vaginal delivery can be achieved without fetal or maternal death or severe morbidity. In cases where there is evidence of fetal compromise, delivery is not imminent and cesarean delivery should be performed promptly, because total placental detachment could occur without warning. -
This question is part of the following fields:
- Obstetrics
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Question 6
Incorrect
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A 30-year-old woman with histories of obesity and type 2 diabetes Mellitus comes to you for advice as she is planning to conceive in next three months. Her blood sugar levels are under control with a HBA1C value of 6%.
Among the following which is an essential supplement for her?Your Answer:
Correct Answer: Folic acid
Explanation:Patient mentioned above is a known case of type 2 diabetes which makes her at high risk of having neural tube defects. She should be advised to start taking a high dose of (5mg) folic acid supplement daily for at least 1-month prior to conception and it should be continued upto 12 weeks of her pregnancy.
Folate, which is a water-soluble B vitamin, is usually obtained from diet or through supplementation. For those patients with a history of type 2 diabetes mellitus, who are planning for pregnancy, high doses are recommended to prevent any possible neural tube defects.
Vitamin A is not safe and should be avoided in pregnancy due to chances for toxicity.
Vitamin C and iron are not considered as essential vitamins to be taken during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 7
Incorrect
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A 28 year old patient has a diagnosis of PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2 and she is a non-smoker. She has been taking Clomiphene and metformin for the past 6 months. What is the next most appropriate treatment?
Your Answer:
Correct Answer: Gonadotrophins
Explanation:Management of PCOS includes OCP, cyclical oral progesterone, metformin, clomiphene (which is more effective in inducing ovulation than metformin) and life-style changes. In women who are tolerant to these therapies Gonadotrophins should be trialled. However lifestyle changes should be able to improve the condition significantly. Clomiphene shouldn’t be continued for more than 6 months.
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This question is part of the following fields:
- Clinical Management
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Question 8
Incorrect
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A 27-year-old woman, at 27 weeks of gestation, who lives 40 kilometres from the nearest tertiary obstetric hospital, is referred due to premature rupture of membranes (PROM) which occurred 2 days ago. This is her first pregnancy, which had been progressing normally until the rupture of membranes. Over the last 48 hours, she did not have any contractions. Transfer was made to the tertiary referral obstetric hospital where she was started on glucocorticoid therapy. Cervical swabs were taken and she underwent ultrasound and cardiotocography assessments. She was also started on prophylactic antibiotics. Cervical swabs only showed growth of normal vaginal flora whereas the abdominal ultrasound found almost no liquor. CTG was normal and reactive.
Which is the most appropriate next step in her management?Your Answer:
Correct Answer: The white cell count (WCC) and C-reactive protein (CRP) levels should be assessed every 2-3 days.
Explanation:If a patient presents with PROM at 27 weeks of gestation, her management plan would have to include:
1) Cervical swabs to rule out infection
2) Commencement of prophylactic antibiotics such as erythromycin until results from the swabs are available
-If only normal vaginal flora are seen, prophylactic antibiotics can be stopped.
3) Administration of glucocorticoid- usually for 48 hours to promote maturity of the fetal lung and lower the chance of intracranial bleeding if the foetus has to be delivered prematurely
4) Transfer to a healthcare centre that has neonatal intensive care facilities to ensure if intensive care is needed post-delivery, the healthcare staff are prepared
5) Blood profile (particularly white cell count) and inflammatory markers (CRP) to look for any signs of chorioamnionitis
6) CTG assessment every 2-3 days. Abnormalities found on the CTG tracing are often the first evidence of problems such as a subclinical chorioamnionitis
7) Tocolysis with tocolytics such as IV salbutamol or nifedipine if contractions start before the course of glucocorticoid therapy is finished. Post-glucocorticoid therapy, tocolysis would not be often employed since there is a risk of masking contractions that occur due to an infection. In those cases, it is better to deliver the baby rather than to prolong the pregnancy. If there is no infection, the management plan should aim to prolong the pregnancy and delay delivery of a very premature baby. -
This question is part of the following fields:
- Obstetrics
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Question 9
Incorrect
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A 30 year old primigravida with diabetes suffered a post partum haemorrhage following a vaginal delivery. Her uterus was well contracted during labour. Her baby's weight is 4.4 kg. Which of the following is the most likely cause for her post partum haemorrhage?
Your Answer:
Correct Answer: Cervical/vaginal trauma
Explanation:A well contracted uterus excludes an atonic uterus. Delivery of large baby by a primigravida can cause cervical +/- vaginal tears which can lead to PPH.
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This question is part of the following fields:
- Obstetrics
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Question 10
Incorrect
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A 50-year-old menopausal woman complained of regular hot flushes that interfered with her sleep and job. She had a ten-year history of oestrogen-dependent breast cancer.
What is the most effective treatment for her symptoms?Your Answer:
Correct Answer: Paroxetine
Explanation:Paroxetine is an SSRI used for hot flushes in women with contraindication for hormonal therapy.
Hormonal or other pharmacotherapy is usually needed for women with bothersome hot flashes. For most women with moderate to very severe hot flashes and no contraindications, we suggest MHT. Women with an intact uterus need both oestrogen and a progestin, while those who have undergone hysterectomy can receive oestrogen only. For women interested in MHT, the first step is to determine the potential risks for the specific individual.
The majority of perimenopausal and recently menopausal women are good candidates for short-term hormone therapy for symptom relief. However, for women with a history of breast cancer, coronary heart disease (CHD), a previous venous thromboembolic event (VTE) or stroke, or those at moderate or high risk for these complications, alternatives to hormone therapy should be suggested. For women with moderate to severe hot flashes who are not candidates for hormone therapy based upon their breast cancer, CHD, or VTE risk and for those who choose not to take MHT, we suggest nonhormonal agents. The agents most commonly used include SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), antiepileptics, and centrally acting drugs.
Black Cohosh is found to be no more significant than placebo.
Long-term use of mefenamic acid is controversial and not recommended. -
This question is part of the following fields:
- Gynaecology
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Question 11
Incorrect
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Question 12
Incorrect
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CTG showing early decelerations is :
Your Answer:
Correct Answer: From increased vagal tone secondary to head compression
Explanation:Early decelerations: a result of increased vagal tone due to compression of the fetal head during contractions. Monitoring usually shows a symmetrical, gradual decrease and return to baseline of FHR, which is associated with a uterine contraction.
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This question is part of the following fields:
- Physiology
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Question 13
Incorrect
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The relation of different fetal parts to each other determines?
Your Answer:
Correct Answer: Position of the foetus
Explanation:Fetal attitude is defined as the relation of the various parts of the foetus to each other. In the normal attitude, the foetus is in universal flexion. The anatomic explanation for this posture is that it enables the foetus to occupy the least amount of space in the intrauterine cavity. The fetal attitude is extremely difficult, if not impossible, to assess without the help of an ultrasound examination.
Fetal lie refers to the relationship between the long axis of the foetus relative to the long axis of the mother. If the foetus and maternal column are parallel (on the same long axis), the lie is termed vertical or longitudinal lie.
Fetal presentation means, the part of the foetus which is overlying the maternal pelvic inlet.
Position is the positioning of the body of a prenatal foetus in the uterus. It will change as the foetus develops. This is a description of the relation of the presenting part of the foetus to the maternal pelvis. In the case of a longitudinal lie with a vertex presentation, the occiput of the fetal calvarium is the landmark used to describe the position. When the occiput is facing the maternal pubic symphysis, the position is termed direct occiput anterior.
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This question is part of the following fields:
- Obstetrics
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Question 14
Incorrect
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Galactopoiesis is maintained by which hormone?
Your Answer:
Correct Answer: Prolactin
Explanation:The production of milk is regulated by the hormone Prolactin. Oxytocin on the other hand is responsible for the let down reflex that occurs during breast feeding.
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This question is part of the following fields:
- Clinical Management
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Question 15
Incorrect
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48 hours after having unprotected intercourse, a 16-year-old female requested a pregnancy test from her GP. What advice can you give her regarding the reliability of pregnancy testing at this time?
Your Answer:
Correct Answer:
Explanation:Even if conception has already occurred, beta hCG is likely to be normal. Beta hCG is made by syncytiotrophoblast cells following conception. It then activates the corpus luteum to continuously produce progesterone for implantation to happen. In week 10/40, levels of HCG peak and the placenta can produce adequate progesterone by itself. As a general rule, a beta HCG concentration >25 U/I or a doubling of levels of HCG within two days is required to diagnose pregnancy. A urine pregnancy test would only likely prove positive around 8 days to 2 weeks following conception.
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This question is part of the following fields:
- Gynaecology
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Question 16
Incorrect
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There are increasing rates of pregnancies among teenagers especially in low socioeconomic rural areas.
What is the contraception method of choice for teenagers with high risk of unplanned pregnancy?Your Answer:
Correct Answer: Intrauterine Contraceptive Device
Explanation:The use of long-acting reversible contraceptives (LARCs) is globally accepted as a strategy that is successful in decreasing rates of unintended pregnancy, especially in very young women.
Long-acting reversible contraceptives (LARCs) are defined as any contraceptive that requires administration less than once per cycle (i.e. per month). This includes copper and progestogen-only intrauterine devices (IUDs), and progestogen subdermal implants and injections. However, subdermal implants and IUDs, which have a life of at least three years, have superior efficacy over injections, which require administration every three months. Implants and IUDs are highly cost-effective when compared with other contraceptive methods.LARCs are widely recommended by professional bodies and the World Health Organization (WHO) as first-line contraception for young women as they are safe, effective and reversible. Young women should be offered the choice of a LARC as part of a fully informed decision for their first form of contraception.
LARCs surpass barrier methods and contraceptive pills in effectiveness and safety therefore all other options are incorrect.
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This question is part of the following fields:
- Gynaecology
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Question 17
Incorrect
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Which of the following is the leading cause of Down Syndrome?
Your Answer:
Correct Answer: Nondisjunction maternal gamete
Explanation:Most of the cases of down syndrome occur due to non disjunction trisomy 21 which is associated with increased maternal age. The non disjunction occurs in the maternal gametes.
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This question is part of the following fields:
- Genetics
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Question 18
Incorrect
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An 18-year-old woman came into your office looking for contraception assistance. Her new partner and she are arranging a trip to Thailand. She has no contraindications.
What is the best piece of advice?Your Answer:
Correct Answer: Oral contraceptive pills and condoms
Explanation:OCPs should be started in this patient as well as condoms to prevent likely sexually transmitted infections.
Condoms alone are not effective for prevention of pregnancy.
OCPs alone do not prevent from sexually transmitted infections.
It is not appropriate to inform the parents and the patient hasn’t refused any advice.
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This question is part of the following fields:
- Gynaecology
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Question 19
Incorrect
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A 30 year old patient is due for delivery in about two weeks. She has some concerns after a family member recently gave birth to a baby with profound hearing loss due to an infection. Which of the following would you describe to her as the most common infective cause of congenital hearing loss?
Your Answer:
Correct Answer: Cytomegalovirus
Explanation:Congenital cytomegalovirus infections are the most common cause of sensorineural hearing loss in babies. Cytomegalovirus infection during the perinatal period can be transferred to the foetus especially if the primary infection is during pregnancy. Babies born with congenital CMV are either symptomatic or develop symptoms later in life. Some of the features of CMV infection include sensorineural hearing loss, visual impairment, cerebral palsy, microcephaly and seizures. Other causes of infective congenital sensorineural hearing loss include: Rubella, HIV, Herpes Simplex Virus, Measles, Varicella Zoster virus, Mumps and West Nile Virus.
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This question is part of the following fields:
- Microbiology
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Question 20
Incorrect
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You see a 28 year old woman who is 22 weeks pregnant. She complains of vaginal soreness and yellow frothy discharge. Microscopy confirms Trichomoniasis. What percentage of infected pregnant women present with yellow frothy discharge?
Your Answer:
Correct Answer: 20%
Explanation:Trichomoniasis is considered a sexually transmitted infection found both in men and women, and is caused by the flagellate protozoan Trichomonas vaginalis. The organism is mainly found in the vagina and the urethra. Though many infected women can be asymptomatic, they can also present with yellow frothy vaginal discharge, itching and vaginitis, dysuria or an offensive odour. About 20-30% of women with the infection however are asymptomatic. For the diagnosis of t. vaginalis in women, a swab is taken from the posterior fornix during speculum examination and the flagellates are detected under light-field microscopy. The recommended treatment for t. vaginalis during pregnancy and breastfeeding is 400-500mg of metronidazole twice daily for 5 -7 days. High dose metronidazole as a 2g single dose tablet is not advised during pregnancy. All sexual partners should also be treated and screened for other STIs.
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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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Regarding fertilization & implantation:
Your Answer:
Correct Answer: The sperm head penetrates through the corona radiata & zona pellucida while the tail remains outside
Explanation:During fertilization, a sperm must first fuse with the plasma membrane and then penetrate the female egg cell to fertilize it. Fusing to the egg cell usually causes little problem, whereas penetrating through the egg’s hard shell or extracellular matrix can be more difficult. Therefore, sperm cells go through a process known as the acrosome reaction, which is the reaction that occurs in the acrosome of the sperm as it approaches the egg. The acrosome is a cap-like structure over the anterior half of the sperm’s head. Upon penetration, if all is normally occurring, the process of egg-activation occurs, and the oocyte is said to have become activated. This is thought to be induced by a specific protein phospholipase c zeta. It undergoes its secondary meiotic division, and the two haploid nuclei (paternal and maternal) fuse to form a zygote. To prevent polyspermy and minimize the possibility of producing a triploid zygote, several changes to the egg’s cell membranes render them impenetrable shortly after the first sperm enters the egg.
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This question is part of the following fields:
- Embryology
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Question 22
Incorrect
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A 25 year old female patient comes in the first trimester of her pregnancy. Pap smear reveals that she has HSIL. What is the next best step in management?
Your Answer:
Correct Answer: Colposcopy
Explanation:Pregnant women with high-grade squamous intraepithelial lesions (HSIL) on cervical cytology should be evaluated with colposcopy. Principles of management of pregnant women include the following:
– An immediate diagnostic excisional procedure should NOT be performed.
– When colposcopy is performed during pregnancy:
– Endocervical sampling with a curette and endometrial sampling should NOT be performed, as there is a risk of disturbing the pregnancy; however, the endocervical canal may be sampled gently with a cytobrush.
– Cervical biopsy should be performed only if a lesion is present that appears to be high grade or suspicious for cancer.
– If the examination is unsatisfactory, repeating the colposcopy after 6 to 12 weeks should allow visualization of the entire squamocolumnar junction.There is no indication for inducing abortion or performing a hysterectomy.
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This question is part of the following fields:
- Gynaecology
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Question 23
Incorrect
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What is the Gold standard investigation to diagnose abnormal uterine bleeding?
Your Answer:
Correct Answer: Hysteroscopy along with dilatation and curettage
Explanation:During the last decade hysteroscopy has become the tool of choice for the evaluation of the endometrial cavity, including for assessment of abnormal uterine bleeding (AUB). Many clinicians would consider that, in most patients, the combination of transvaginal sonography and out-patient endometrial biopsy with diagnostic hysteroscopy could replace the need for dilation and curettage. Hysteroscopy was reported to have sensitivity, specificity, negative predictive value and positive predictive value of 94.2, 88.8, 96.3 and 83.1% respectively, in predicting normal or abnormal endometrial histopathology.
The highest accuracy of hysteroscopy was in diagnosing endometrial polyps, whereas the worst result was in estimating hyperplasia. Therefore, since the incidence of focal lesions in patients with AUB is high, it seems that the most beneficial approach is to proceed with hysteroscopy complemented by endometrial biopsy early in the assessment of AUB.
Transabdominal and transvaginal ultrasounds can be used but are inferior to hysteroscopy.
Coagulation profile can only diagnose possible coagulopathies and pregnancy test can only diagnose pregnancy. All other causes can not be identified with these laboratory investigations.
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This question is part of the following fields:
- Gynaecology
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Question 24
Incorrect
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Which ONE among the following factors does not increase the risk for developing postpartum endometritis?
Your Answer:
Correct Answer: Advanced maternal age
Explanation:The most common clinical findings in a postpartum women with endometritis are postpartum fever, with tachycardia relative to the rise in temperature, midline lower abdominal pain and uterine tenderness from the 2nd to 10th day of postpartum.
Most common risk factors for the development of postpartum endometritis are:
– Cesarean deliveries are considered as the most important risk factor for postpartum endometritis, especially those performed after the onset of labour.
– Young maternal age.
– Multiple digital cervical examinations.
– Prolonged rupture of membranes.
– Retention of placental products.
– Prolonged labour.
– Chorioamnionitis.
Advanced maternal age is not considered as a risk factor for development of postpartum endometritis. -
This question is part of the following fields:
- Obstetrics
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Question 25
Incorrect
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Question 26
Incorrect
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According to the NICE guidelines on intrapartum care a multiparous women with intact membranes should be offered amniotomy if there is inadequate progress of the active second stage of labour (in terms of rotation and/or descent of the presenting part) after how long?
Your Answer:
Correct Answer: 30 minutes
Explanation:Multiparous women active 2nd stage labour: Suspect delay if progress inadequate after 30 minutes Diagnose delay if progress inadequate after 1 hour If delay is suspected amniotomy should be offered if membranes are intact If delay diagnosed then preparations should be made for C-section Nulliparous women active 2nd stage labour: Suspect delay if progress inadequate after 1 hour Diagnose delay if progress inadequate after 2 hours If delay is suspected amniotomy should be offered if membranes are intact If delay diagnosed then preparations should be made for C-section
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This question is part of the following fields:
- Clinical Management
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Question 27
Incorrect
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Which of the following drugs is associated with reduced milk production whilst breastfeeding?
Your Answer:
Correct Answer: Cabergoline
Explanation:Domperidone and metoclopramide are D2 dopamine receptor antagonists. They are primarily used to promote gastric motility. They are also known as galactagogues and they promote the production of milk. Cabergoline and bromocriptine are prolactin inhibitors and they reduce milk production.
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This question is part of the following fields:
- Endocrinology
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Question 28
Incorrect
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A 30-year-old woman with a 10-year history of schizophrenia, accompanied by her husband, presents to your hospital with amenorrhea lasting two months. She is currently taking clozapine with appropriate control of her symptoms.
Which of the following is the most crucial step in management?Your Answer:
Correct Answer: Urine pregnancy test
Explanation:Pregnancy is the most common cause of secondary amenorrhea worldwide. As a result, the first thing to check in every woman of reproductive age who has amenorrhea is a urine pregnancy test.
Once pregnancy has been ruled out, an ultrasound or measuring FSH and LH may be done to assess the condition (if required).
FBC is used to track clozapine side effects such as neutropenia and agranulocytosis. It is not recommended for the assessment of amenorrhea. -
This question is part of the following fields:
- Gynaecology
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Question 29
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 30
Incorrect
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If both parents have beta-thalassaemia minor, what is the chance of their male offspring having beta thalassemia major?
Your Answer:
Correct Answer: 25%
Explanation:This is not an X-linked condition so the sex of the child makes no difference to the inheritance. Any child will have a 1 in 4 chance of having beta thalassaemia major.
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This question is part of the following fields:
- Genetics
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