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  • Question 1 - A 56 year old lady presents with a vulval itch and discolouration. A...

    Incorrect

    • A 56 year old lady presents with a vulval itch and discolouration. A biopsy conforms Lichen Sclerosis (LS). What is the risk of developing squamous cell carcinoma compared to patients with a normal vulval biopsy?

      Your Answer: 5-15%

      Correct Answer:

      Explanation:

      Lichen Sclerosis is a destructive inflammatory condition that effects the anogenital region of women. It effects around 1 in 300 women. It destroys the subdermal layers of the skin resulting in hyalinization of the skin leading to parchment paper appearance of the skin. It is associated with vulval cancer and it is estimated that the risk of developing vulval cancer after lichen sclerosis is around 3-5%.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 2 - A 23-year-old gravida 1 para 0 at 36 weeks gestation presents to the...

    Incorrect

    • A 23-year-old gravida 1 para 0 at 36 weeks gestation presents to the office complaining of ankle swelling and occasional headache for the past 2 days. She denies any abdominal pain or visual disturbances. On examination you note a fundal height of 35 cm, a fetal heart rate of 140 beats/min, 2+ lower extremity oedema, and a blood pressure of 144/92 mm Hg. A urine dipstick shows 1+ proteinuria.
      Which one of the following is the most appropriate next step in the management of this patient?

      Your Answer:

      Correct Answer: Laboratory evaluation, fetal testing, and 24-hour urine for total protein

      Explanation:

      This patient most likely has preeclampsia, which is defined as an elevated blood pressure and proteinuria after 20 weeks gestation. The patient needs further evaluation, including a 24-hour urine for quantitative measurement of protein, blood pressure monitoring, and laboratory evaluation that includes haemoglobin, haematocrit, a platelet count, and serum levels of transaminase, creatinine, albumin, LDH, and uric acid- A peripheral smear and coagulation profiles also may be obtained- Antepartum fetal testing, such as a nonstress test to assess fetal well-being, would also be appropriate.

      → Ultrasonography should be done to assess for fetal intrauterine growth restriction, but only after an initial laboratory and fetal evaluation.
      → It is not necessary to start this patient on antihypertensive therapy at this point. An obstetric consultation should be considered for patients with preeclampsia.
      → Delivery is the definitive treatment for preeclampsia- The timing of delivery is determined by the gestational age of the foetus and the severity of preeclampsia in the mother. Vaginal delivery is preferred over caesarean delivery, if possible, in patients with preeclampsia.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 3 - A 32-year-old lady is two weeks postpartum and in good health. She has...

    Incorrect

    • A 32-year-old lady is two weeks postpartum and in good health. She has painful defecation that is accompanied by some new blood on the toilet paper. Which of the following diagnoses is the most likely?

      Your Answer:

      Correct Answer: Acute anal fissure.

      Explanation:

      The history of acutely painful defecation associated with spotting of bright blood is very suggestive of an acute anal fissure. Typically, the patient reports severe pain during a bowel movement, with the pain lasting several minutes to hours afterward. The pain recurs with every bowel movement, and the patient commonly becomes afraid or unwilling to have a bowel movement, leading to a cycle of worsening constipation, harder stools, and more anal pain. Approximately 70% of patients note bright-red blood on the toilet paper or stool. Occasionally, a few drops may fall in the toilet bowl, but significant bleeding does not usually occur with an anal fissure.. After gently spreading the buttocks, a close check of the anal verge can typically confirm the diagnosis.
      Rectal inspection is excruciatingly painful and opposed by sphincter spasm; however, if the fissure can be seen, it is not necessary to make the diagnosis at first.

      A perianal abscess, which presents as a sore indurated area lateral to the anus, or local trauma linked with anal intercourse or a foreign body, are two more painful anorectal disorders to rule out.

      Anal fistulae do not appear in this way, but rather with perianal discharge, and the diagnosis is based on determining the external orifice of the fistula.

      Although first-degree haemorrhoids bleed, they do not cause defecation to be unpleasant.

      Although carcinoma of the anus or rectum can cause painful defecation, it would be exceptional in this situation.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 4 - A 30-year-old woman living in England had a cervical smear test one month...

    Incorrect

    • A 30-year-old woman living in England had a cervical smear test one month ago. There were no cervical abnormalities visualised at the time of the smear. She has no symptoms of unusual vaginal bleeding and her previous smear results have always been negative. She received the following report: 'Your recent smear was negative with no evidence of nuclear abnormalities.' When will she be routinely recalled for her next smear?

      Your Answer:

      Correct Answer:

      Explanation:

      Women aged 25-49 years living in England are routinely recalled for screening every three years. Women receive their first invitation for cervical screening at 25 years of age. They are not invited earlier as changes in the young cervix can be normal and result in unnecessary treatment. Provided the smears remain negative and there are no symptoms to suggest cervical cancer, the routine recall is three years for women aged 25-49 years. Women aged 50-64 years old are routinely recalled for a smear every five years. After the age of 65 years, women are only screened if they have not had a smear since the age of 50 years (including those who have never had a smear) or those who have had recent abnormal smears. This is because due to the natural history and progression of cervical cancer, it is highly unlikely that women over 65 years old will go on to develop the disease. 

    • This question is part of the following fields:

      • Gynaecology
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  • Question 5 - A 30 year old women who is 24 weeks pregnant attends clinic due...

    Incorrect

    • A 30 year old women who is 24 weeks pregnant attends clinic due to suprapubic pain. Ultrasound shows a viable foetus and also a fibroid with a cystic fluid filled centre. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Cystic degeneration of fibroid

      Explanation:

      A fibroid is a benign tumour of the smooth muscles of the uterus also known as a leiomyoma. It has a typical whorled appearance and this may be altered following degeneration which occurs in four main types:
      1. Red degeneration, also known as carneous degeneration, of degeneration that can involve a uterine leiomyoma. While it is an uncommon type of degeneration, it is thought to be the most common form of degeneration of a leiomyoma during pregnancy. Red degeneration follows an acute disruption of the blood supply to the fibroid during growth typically in a mid-second trimester presenting as sudden onset of pain with tenderness localizing to the area of the uterus along with pyrexia and leucocytosis. On ultrasound it can have peripheral (rim).

      2. Hyaline degeneration is the most common form of degeneration that can occur in a uterine leiomyoma. It is thought to occur in up to 60% of uterine leiomyomasoccurs when the fibroid outgrows its blood supply. this may progresses to central necrosis leaving a cystic space in the centre knowns as cystic degeneration.

      3. Cystic degeneration is an uncommon type of degeneration that a uterine leiomyoma (fibroid) can undergo. This type of degeneration is thought to represent ,4% of all types of uterine leiomyoma degeneration. When the leiomyoma increases in size, the vascular supply to it becomes inadequate and leads to different types of degeneration: hyaline, cystic, myxoid, or red degeneration. Dystrophic calcification may also occur. Hyalinization is the commonest type of degeneration. Cystic degeneration is an extreme sequel of edema. Ultrasound may show a hypoechoic or heterogeneous uterine mass with cystic areas.

      4. Myxoid degeneration of leiomyoma is one of the rarer types of degeneration that can occur in a uterine leiomyoma. While this type of degeneration is generally considered rare, the highest prevalence for this type of degeneration has been reported as up to 50% of all degenerations of leiomyomas. Fibroids (i.e. uterine leiomyomas) that have undergone myxoid degeneration are filled with a gelatinous material and can be difficult to differentiate from cystic degeneration; however, they typically appear as more complex cystic masses. They appear hypocellular with a myxoid matrix.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 6 - Gonadotropin-releasing hormone (GnRH) stimulates the release of: ...

    Incorrect

    • Gonadotropin-releasing hormone (GnRH) stimulates the release of:

      Your Answer:

      Correct Answer: Luteinizing hormone

      Explanation:

      Gonadotropin-releasing hormone (GnRH) is the hormone responsible for the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary gland.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 7 - Which of the following is the primary host for Toxoplasma Gondii? ...

    Incorrect

    • Which of the following is the primary host for Toxoplasma Gondii?

      Your Answer:

      Correct Answer: Cats

      Explanation:

      Toxoplasma gondii, an intracellular protozoan, is the main causative agent for Toxoplasmosis. The primary host for the organism is the domestic cat. Humans can become infected by eating undercooked meat of animals harbouring cysts, consuming water or food contaminated with cat faeces, or through maternal-fetal transmission. Toxoplasmosis can cause complications in pregnancy such as miscarriages and congenital infection can lead to hydrocephalus, microcephaly, mental disability and vision loss.

    • This question is part of the following fields:

      • Microbiology
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  • Question 8 - At what age does meconium first appear in the fetal terminal ilium? ...

    Incorrect

    • At what age does meconium first appear in the fetal terminal ilium?

      Your Answer:

      Correct Answer: 10-16 weeks gestation

      Explanation:

      Meconium first appears in the fetal ilium at 10-16 weeks.

    • This question is part of the following fields:

      • Embryology
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  • Question 9 - Lidocaine works by blocking which of the following ion channels? ...

    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
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  • Question 10 - A 29-year-old pregnant woman, at 26 weeks of gestation, is involved in a...

    Incorrect

    • A 29-year-old pregnant woman, at 26 weeks of gestation, is involved in a car accident while wearing a seatbelt.
      On examination there are visible bruises on the abdomen but patient is otherwise normal. Fetal heart sounds are audible and are within normal parameters and CTG is reassuring.
      Which of the following will be the best next step in management of this case?

      Your Answer:

      Correct Answer: Admit her and observe for 24 hours

      Explanation:

      Trauma is a major contributor for maternal mortality and is one of the leading causes of pregnancy-associated maternal deaths.

      As a result of maternal hypotension or hypoxemia, placental abruption, uterine rupture or fetal trauma a maternal trauma can compromise the fetus also.
      Patient’s bruises on the abdomen which are seatbelt marks, are indications that this woman has positioned the seat belt incorrectly over the uterus. So there is a good chance that the uterus and its contents, including the fetus, has been affected by the impact. In a pregnant woman, the correct position of seat belt is when the lap belt is placed on the hip below uterus and the sash is placed between breasts and above the uterus.

      A minimum of 24-hour period monitoring is recommended for all pregnant women, apart from the routine trauma workup indicated in non-pregnant women, in case they have sustained trauma in the presence of any of the following:
      – Regular uterine contractions
      – Vaginal bleeding
      – A non-reassuring fetal heart rate tracing
      – Abdominal/uterine pain
      – Significant trauma to the abdomen

      Considering the bruises over her abdomen this patient should be considered as having significant abdominal trauma and must be kept under observation for a minimum of 24 hours. Such patients should not be discharged unless the clinician makes sure they do not have any complications like abruption or preterm labor.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 11 - Which one of the following features is associated with Turner's syndrome? ...

    Incorrect

    • Which one of the following features is associated with Turner's syndrome?

      Your Answer:

      Correct Answer: Primary amenorrhea

      Explanation:

      Turner syndrome patients present with primary amenorrhea. These ladies have non functional or streak ovaries and they cant conceive. Their genetic traits is 45X. They have a shielded chest, webbed neck and low height. These patients suffer from primary amenorrhea.

    • This question is part of the following fields:

      • Embryology
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  • Question 12 - A 41 year old woman is referred to EPAU with spotting in early...

    Incorrect

    • A 41 year old woman is referred to EPAU with spotting in early pregnancy. What is the risk of miscarriage in women in this age group?

      Your Answer:

      Correct Answer: 50%

      Explanation:

      Miscarriage rates:
      20-24 – 9%
      25-29 – 11%
      30-34 – 15%
      35-39 – 25%
      40-44 – 51%
      >45 – 75%

    • This question is part of the following fields:

      • Epidemiology
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  • Question 13 - What is the mode of action of Tranexamic acid? ...

    Incorrect

    • What is the mode of action of Tranexamic acid?

      Your Answer:

      Correct Answer: Inhibits Plasminogen Activation

      Explanation:

      Tranexamic acid is an antifibrinolytic drug which is one of the treatment options in menorrhagia i.e. heavy menstrual bleeding. It acts by binding to the receptor sites on plasminogen thus preventing plasmin from attaching to those receptors thus inhibiting plasminogen activation.

      If pharmaceutical treatment is appropriate NICE advise treatments should be considered in the following order:

      1. levonorgestrel-releasing intrauterine system (LNG-IUS) provided at least 12 months use is anticipated
      2. tranexamic acid or NSAIDs* or combined oral contraceptives (COCs) or cyclical oral progestogens
      3. Consider progesterone only contraception e.g. injected long-acting progestogens

      *When heavy menstrual bleeding (HMB) coexists with dysmenorrhoea NSAIDs should be preferred to tranexamic acid. Also note NSAIDs and tranexamic are appropriate to use if treatment needed pending investigations.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 14 - A 14-year-old female presents with complaints of intermittent lower abdominal pain episodes...

    Incorrect

    • A 14-year-old female presents with complaints of intermittent lower abdominal pain episodes that last for about three days each month.
      These symptoms have been ongoing for the past 12 months.
      She reports that pubertal breast changes started about four years ago, however she has not yet had her first period.
      On examination of her abdomen there is no evidence of any suprapubic mass or tenderness when she is not in pain.
      Blood tests indicate that she is ovulating.
      From the following developmental abnormalities, identify the one that is most likely to be the cause of her abdominal pain.

      Your Answer:

      Correct Answer: Mullerian (paramesonephric) agenesis.

      Explanation:

      The clinical evaluation indicates that the patient is ovulating but has not started menstruating. These observations suggest that the pain she is experiencing on a monthly basis could be related to ovulation or there could be an obstruction preventing the flow of menstrual blood from the uterus.

      Uterine or vaginal anomalies that can obstruct menstrual flow include imperforate hymen, absent vagina, a transverse vaginal septum, or cervical obstruction.

      If the cause was an obstruction to the flow, the retained menstrual products would have developed into a suprapubic mass (hematometra/ haematocolpos). However, no palpable mass was detected on abdominal examination.

      Mullerian (paramesonephric) agenesis (correct answer) is the only condition that would result in no endometrial development; consequently there was no palpable mass observed and no menstrual loss that could be shed was present. A pelvic (lower abdominal) ultrasound examination can confirm the diagnosis.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 15 - Which of the following causes of polyhydramnios is more common? ...

    Incorrect

    • Which of the following causes of polyhydramnios is more common?

      Your Answer:

      Correct Answer: Idiopathic

      Explanation:

      Maternal disorders, such as diabetes, in-utero infections, drug usage, placental abnormalities and fetal conditions as congenital and chromosomal abnormalities, Rh iso-immunization, and multiple gestations, are generally associated with polyhydramnios. Congenital abnormalities such as duodenal, oesophageal, or intestinal atresia of the foetus are the most common malformations that typically cause gastro-intestinal obstruction and interfere with fetal swallowing and/or absorption resulting with polyhydramnios. However, in about 70% of cases, none of the aforementioned aetiologies are causes of polyhydramnios, and it is referred to as idiopathic or isolated.

    • This question is part of the following fields:

      • Physiology
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  • Question 16 - Which one of the following features best describes the role of prostaglandins? ...

    Incorrect

    • Which one of the following features best describes the role of prostaglandins?

      Your Answer:

      Correct Answer: Are involved in the onset of labour

      Explanation:

      Prostaglandins are involved in the uterine contraction and cervical dilatation during labour. Higher prostaglandin concentrations can also lead to severe menstrual cramps.

    • This question is part of the following fields:

      • Physiology
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  • Question 17 - Which of the following statements regarding prolactin is true? ...

    Incorrect

    • Which of the following statements regarding prolactin is true?

      Your Answer:

      Correct Answer: Prolactin levels increase during stress

      Explanation:

      Causes of Hyperprolactinemia: Prolactinomas, Medication (phenothiazines, metoclopramide, risperidone, selective serotonin reuptake inhibitors, oestrogens, verapamil), Stress, Pregnancy, Hypothyroidism, Kidney disease, Chest trauma

    • This question is part of the following fields:

      • Endocrinology
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  • Question 18 - A 24-year-old pregnant female presented with severe pain in the lower abdomen and...

    Incorrect

    • A 24-year-old pregnant female presented with severe pain in the lower abdomen and excessive vaginal bleeding at 35 weeks gestation. Which of the following investigations should be done?

      Your Answer:

      Correct Answer: US abdomen

      Explanation:

      Ultrasound of abdomen should be done to rule out the cause of the excessive bleeding in this patient, this could confirm the very high suspicion of rupture of the placenta in this case.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 19 - Consider you are looking after a male baby in neonatal unit. Case chart...

    Incorrect

    • Consider you are looking after a male baby in neonatal unit. Case chart shows that his mother has been abusing intravenous drugs until late this pregnancy.
      You will not discharge this baby home after delivery in all of the following conditions except?

      Your Answer:

      Correct Answer: Weight loss greater than two percent of birth weight

      Explanation:

      If a mother has been abusing drugs during antenatal period, there are some contraindications to discharge her baby home. These conditions includes:
      – excessive weight loss, which is greater than ten percent of birth weigh
      – suspected baby neglect or abuse
      – suspected domestic violence
      – a court order preventing baby from being discharged home or if there is requirement for further assessment of withdrawal symptoms.

      A 2-3 percentages weight loss during the early neonatal period is considered to be a normal finding and is therefore not considered as a contraindication to discharge the baby home.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 20 - Which of the following leaves the pelvis via the greater sciatic foramen? ...

    Incorrect

    • Which of the following leaves the pelvis via the greater sciatic foramen?

      Your Answer:

      Correct Answer: Pudendal Nerve

      Explanation:

      The pudendal nerve arises from the S2-S4 nerve roots and it lies medial to the internal pudendal artery while exiting the pelvis via the greater sciatic foramen. It curves around the sacrospinous ligament and re-enters the pelvis via the lesser sciatic foramen and from there it runs medial to the ischial tuberosity over the obturator internus in the pudendal canal to the deep perineal pouch.

    • This question is part of the following fields:

      • Anatomy
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  • Question 21 - Galactorrhoea (non-gestational lactation) may result from all of the following EXCEPT: ...

    Incorrect

    • Galactorrhoea (non-gestational lactation) may result from all of the following EXCEPT:

      Your Answer:

      Correct Answer: Intrapartum haemorrhage

      Explanation:

      Pituitary tumours, the most common pathologic cause of galactorrhoea can result in hyperprolactinemia by producing prolactin or blocking the passage of dopamine from the hypothalamus to the pituitary gland. Approximately 30 percent of patients with chronic renal failure have elevated prolactin levels, possibly because of decreased renal clearance of prolactin. Primary hypothyroidism is a rare cause of galactorrhoea in children and adults. In patients with primary hypothyroidism, there is increased production of thyrotropin-releasing hormone, which may stimulate prolactin release. Nonpituitary malignancies, such as bronchogenic carcinoma, renal adenocarcinoma and Hodgkin’s and T-cell lymphomas, may also release prolactin.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 22 - The test used to diagnose ovulation on day 21 in a 28 days...

    Incorrect

    • The test used to diagnose ovulation on day 21 in a 28 days menstrual cycle is:

      Your Answer:

      Correct Answer: Progesterone

      Explanation:

      After ovulation, the dominant follicle turns into a corpus luteum and begins to secrete progesterone. To confirm ovulation, serum progesterone or its metabolite in urine, can be measured. A single serum progesterone level >3 ng/ml in mid‐luteal phase has been used to retrospectively detect ovulation.

    • This question is part of the following fields:

      • Physiology
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  • Question 23 - What is the incubation period for CMV? ...

    Incorrect

    • What is the incubation period for CMV?

      Your Answer:

      Correct Answer: 3-12 weeks

      Explanation:

      The incubation period of CMV is 3-12 weeks.

    • This question is part of the following fields:

      • Microbiology
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  • Question 24 - Which of the following takes part in the arterial supply of the ovary?...

    Incorrect

    • Which of the following takes part in the arterial supply of the ovary?

      Your Answer:

      Correct Answer: Uterine arteries

      Explanation:

      The ovarian arteries, arising from the abdominal aorta and the ascending uterine arteries which are branches of the internal iliac artery all supply the ovaries. They terminate by bifurcating into the ovarian and tubal branches and anastomose with the contralateral branches providing a collateral circulation.

    • This question is part of the following fields:

      • Anatomy
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  • Question 25 - HPV genotypes 6 and 11 are associated with which of the following? ...

    Incorrect

    • HPV genotypes 6 and 11 are associated with which of the following?

      Your Answer:

      Correct Answer: Low grade squamous intraepithelial lesions of the cervix (LSIL)

      Explanation:

      6 and 11 are considered low risk and are commonly associated with genital warts and low-grade squamous intraepithelial lesions of the cervix (can correspond cytologically to CIN 1)

    • This question is part of the following fields:

      • Microbiology
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  • Question 26 - A patient is seen in clinic 6 weeks postpartum. The pregnancy was complicated...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Pathology
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  • Question 27 - A 48-year-old woman presented to you with a breast mass. On examination, it...

    Incorrect

    • A 48-year-old woman presented to you with a breast mass. On examination, it is hard, irregular and ill defined. The surface of the breast is slightly bruised however, there is no discharge. The most probable diagnosis is?

      Your Answer:

      Correct Answer: Fat necrosis

      Explanation:

      Fat necrosis is often a result of a trauma or surgery. In fat necrosis the enzyme lipase releases fatty acids from triglycerides. The fatty acids combine with calcium to form soaps. These soaps appear as white chalky deposits which are firm lumps with no associated discharge. The given case has a bruise which indicates prior trauma.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 28 - A 30-year-old woman who is at 38 weeks gestation presented to the emergency...

    Incorrect

    • A 30-year-old woman who is at 38 weeks gestation presented to the emergency department due to complaints of not feeling fetal movements since yesterday. Upon investigations, fetal demise was confirmed. Induced delivery was done and she gave birth to a dead foetus.
      Which of the following is least likely to reveal the cause of the fetal death?

      Your Answer:

      Correct Answer: Chromosomal analysis of the mother

      Explanation:

      Stillbirth has many causes: intrapartum complications, hypertension, diabetes, infection, congenital and genetic abnormalities, placental dysfunction, and pregnancy continuing beyond forty weeks.

      In 5% of normal-appearing stillborns, a chromosomal abnormality will be detectable. With an autopsy and a chromosomal study, up to 35% of stillborns are found to have a major structural pathology, and 8% have abnormal chromosomes. After a complete evaluation, term stillbirth remains unexplained about 30% of the time. The chance of finding a cause is impacted by the age of the foetus, the experience of the caregiver, and the thoroughness of the exam. Chromosome testing for aneuploidy should be offered for all stillbirths to confirm or to seek a cause of the stillbirth. Genetic amniocentesis or chorionic villus sampling before delivery offers the highest yield.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 29 - A 46 year old women with a BMI of 34 is seen in...

    Incorrect

    • A 46 year old women with a BMI of 34 is seen in clinic following hysteroscopy and biopsy for irregular menstrual bleeding. Histology shows atypical hyperplasia. Which of the following is the most appropriate 1st line management?

      Your Answer:

      Correct Answer: Laparoscopic hysterectomy

      Explanation:

      There is an increase risk of developing carcinoma of the uterus, if the endometrium shows hyperplasia with atypia. The standard surgery is total hysterectomy with bilateral salpingectomy which can be performed abdominally or laparoscopically If the disease is grade 1-2 and less than 1B i.e. less than 50% invasion of the uterine body.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 30 - What are the branches of the pudendal nerves in females? ...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Anatomy
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  • Question 31 - A 29-year-old lady presents to your clinic at her 26 weeks of gestation....

    Incorrect

    • A 29-year-old lady presents to your clinic at her 26 weeks of gestation. She is worried as she came in contact with a child having chicken pox 48 hours ago and she has no symptoms.
      You checked her pre-pregnancy IgG level for chicken pox which was negative, as she missed getting vaccinated for chickenpox before pregnancy.
      What is the best next step in managing this patient?

      Your Answer:

      Correct Answer: Give varicella zoster immunoglobulins

      Explanation:

      This woman who is 26 weeks pregnant, has come in contact with a child having chickenpox 48 hours ago. As her IgG antibodies were negative during prenatal testing, she has no immunity against Varicella which makes her susceptible to get chickenpox.

      Prophylactic treatment is required if a susceptible pregnant woman is exposed to chickenpox, which includes administration of varicella zoster immune globulin (VZIG), within 72 hours of exposure to infection.

      As the patient has already checked for and was found to be negative, checking IgG level again is not relevant. Also, it was already revealed that she is not vaccinated against varicella before pregnancy.

      If the patient had any symptoms typical of chickenpox, measuring IgM would have been helpful, but patient is completely asymptomatic in this case so measuring IgM is not indicated.

      Vaccine for chickenpox is contraindicated during pregnancy as it is a live vaccine.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 32 - Polyhydramnios is associated with which one of the following conditions? ...

    Incorrect

    • Polyhydramnios is associated with which one of the following conditions?

      Your Answer:

      Correct Answer: Tracheo-oesophageal fistula

      Explanation:

      Oesophageal atresia/TE fistula may be suspected prenatally with ultrasound findings of polyhydramnios, absence of fluid in the stomach, small sized abdomen, or the presence of a dilated proximal oesophageal pouch. An underlying disease is only found in 17 % of cases in mild polyhydramnios. In contrast, an underlying disease is detected in 91 % of cases in moderate to severe polyhydramnios. The literature lists the following potential aetiologies: fetal malformations and genetic anomalies (8–45 %), maternal diabetes mellitus (5–26 %), multiple pregnancies (8–10 %), fetal anaemia (1–11 %), other causes, e.g. viral infections, Bartter syndrome, neuromuscular disorders, maternal hypercalcemia. Viral infections which can lead to polyhydramnios include parvovirus B19, rubella, and cytomegalovirus. Other infections, e.g. toxoplasmosis and syphilis, can also cause polyhydramnios.

    • This question is part of the following fields:

      • Physiology
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  • Question 33 - A 55 year old patient with a who has tried unsuccessful conservative measures...

    Incorrect

    • A 55 year old patient with a who has tried unsuccessful conservative measures for her overactive bladder, would like to consider Oxybutynin. She wants to know how common dry mouth is as a side effect, as her sister suffered from it on while on the same drug.

      Your Answer:

      Correct Answer: approximately 1 in 10 patients

      Explanation:

      Urinary incontinence can be divided into two main aetiologies, stress incontinence, or overactive bladder. Conservative management include lifestyle interventions, controlling fluid intake, or bladder exercises. If conservative management is no longer efficient, then medications may be indicated. Oxybutynin is an anticholinergic drug used in the treatment of urinary incontinence. As with other anticholinergic drugs, side effects include dry mouth, dry eyes, blurry vision and constipation. About 1 in 10 patients taking Oxybutynin will experience some of these side effects.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 34 - Which of the following factors causes the greatest increase in risk of developing...

    Incorrect

    • Which of the following factors causes the greatest increase in risk of developing bladder cancer?

      Your Answer:

      Correct Answer: Smoking

      Explanation:

      Transitional cell carcinoma of the bladder is most commonly caused by cigarette smoke. Other risk factors include naphthylamine, azodyes and long term cyclophosphamide use.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 35 - A 28 year old women is seen in the early pregnancy unit. She...

    Incorrect

    • A 28 year old women is seen in the early pregnancy unit. She has had a positive pregnancy test but is uncertain of her LMP. Ultrasound doesn't visualise a pregnancy. You perform bHCG tests 48 hours apart. The first bHCG is 400mIU/ml. The second is 190mIU/ml. What is the likely diagnosis

      Your Answer:

      Correct Answer: Non-viable pregnancy

      Explanation:

      B-HCG levels almost double every 48 hours. A B-HCG levels of less than 5 mIU/ml is considered negative and anything above 25 is considered positive. As the foetus was not visualized on ultrasound in the uterus, there is possibility that this might be an ectopic pregnancy. But since the B-HCG levels also continued to fall the pregnancy becomes non-viable.

    • This question is part of the following fields:

      • Biochemistry
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  • Question 36 - A 29-year-old single lady comes to your clinic with two days history of...

    Incorrect

    • A 29-year-old single lady comes to your clinic with two days history of minor left-sided lower abdomen ache. Her blood pressure is 125/90 mmHg, her pulse rate is 90 beats per minute, and her temperature is 37.3°C.
      She is otherwise in perfect health. There is no discomfort, rebound, or guarding on the abdominal exam. On the left side of the uterus, an ultrasonographic examination reveals a 6cm solid mass lateral to the uterus.
      Which of the following diagnoses is the most likely?

      Your Answer:

      Correct Answer: Ovarian teratoma

      Explanation:

      Mature cystic teratomas of the ovary are often discovered as incidental findings on physical examination, during radiographic studies, or during abdominal surgery performed for other indications.

      When symptoms are present, they may include abdominal pain, mass or swelling, and abnormal uterine bleeding. Bladder symptoms, gastrointestinal disturbances, and back pain are less frequent. When abdominal pain is present, it usually is constant and ranges from slight to moderate in intensity.

      Mucinous cystadenomas are relatively common (12% to 15% of all ovarian tumours). They can become massive. These tumours usually develop in the third to fifth decades of life and typically cause vague symptoms, such as increasing abdominal girth, abdominal or pelvic pain, emesis, fatigue, indigestion, constipation, and urinary incontinence.

      Corpus luteal cysts present with irregular menses, abdominal fullness due to fluid build up and pelvic pressure.

      Endometriosis mainly presents with cyclic pain at site of involvement and dysmenorrhea.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 37 - Which of the following is a pro-thrombotic agent? ...

    Incorrect

    • Which of the following is a pro-thrombotic agent?

      Your Answer:

      Correct Answer: Thromboplastin

      Explanation:

      Protein C, protein S, plasminogen and anti thrombin III are all anti thrombotic agents. Thromboplastin is a pro-thrombotic.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 38 - A 33-year-old primigravida at 33 weeks of gestation comes to the emergency department...

    Incorrect

    • A 33-year-old primigravida at 33 weeks of gestation comes to the emergency department complaining of having headache for the past two week.
      On examination her blood pressure is 148/100 and heart rate is 90/min.There is swelling over both her ankles, hands and eyes. The rest of the examination is normal. CTG tracing is reassuring and urine dipstick showed proteinuria.
      Which of the following is considered as the best next step in managing this patient?

      Your Answer:

      Correct Answer: Observation,steroids and antihypertensives

      Explanation:

      Patient in the given case has developed clinical features of mild preeclampsia presented as hypertension, ankle and facial oedema along with proteinuria.

      As the fetal lungs are not yet matured, best management in this case would be observing the patient frequently, starting her on steroids and antihypertensive drugs like methyldopa, or labetalol. 31 to 34 weeks of gestation is the optimal gestational age for starting dexamethasone therapy which will help in controlling blood pressure, helps in the maturation of lungs and will also gives time to organise delivery when the lungs are matured.

      Immediate C-section is not required at this stage of pregnancy, however a plan for cesarean section must be made to carry it out if the patient develops eclampsia during her stay in the hospital. Immediate vaginal delivery is also not indicated as the pregnancy is far from term. Induced labour will result in fetal demise soon after birth due to the fetal lung immaturity, but immediate delivery has to be considered once the fetal lung attains maturity.

      Magnesium Sulphate is indicated only in women with severe pre-eclampsia and even in such cases primary importance is given to blood pressure controlling. Magnesium sulphate is not indicated on this case as the patient is in mild eclampsia.

      Even though Paracetamol and deep vein thrombosis prophylaxis are indicated in this case, anticoagulants should be avoided considering the emergency need for surgery.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 39 - Which of the following has been shown to increase ovarian cancer risk? ...

    Incorrect

    • Which of the following has been shown to increase ovarian cancer risk?

      Your Answer:

      Correct Answer: Hormone replacement therapy (oestrogen only)

      Explanation:

      Factors that increase the risk of ovarian cancer include nulliparity, IUD, endometriosis, cigarette smoking, HRT and obesity.

    • This question is part of the following fields:

      • Epidemiology
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  • Question 40 - All of the following are considered complications related to cigarette smoking affecting mothers...

    Incorrect

    • All of the following are considered complications related to cigarette smoking affecting mothers during pregnancy, except:

      Your Answer:

      Correct Answer: Less likely to die of sudden infant death syndrome

      Explanation:

      The effects of smoking on the outcomes of pregnancy are well documented and include an increased risk of preterm premature rupture of the membranes (PPROM), preterm birth, low birth weight, placenta previa, and placental abruption. Many studies have shown that the risk of Sudden Infant Death Syndrome (SIDS) is increased by maternal smoking during pregnancy.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 41 - A newborn male infant, born to a 30-year-old gravida 3 para 0 aborta...

    Incorrect

    • A newborn male infant, born to a 30-year-old gravida 3 para 0 aborta 2 woman, who did not receive any prenatal care, is evaluated in the neonatal intensive care unit for growth restriction.The mother who presented for labor at approximately 38 weeks of gestation, had a forceps-assisted vaginal delivery due to fetal heart rate abnormalities.
      The newborn's Apgar scores were 6 and 8 at 1 and 5 minutes, respectively and his weight was 2.5 kg. Physical examination shows microcephaly, a wide anterior fontanelle, cleft palate and hypoplasia of the distal phalanges.
      A history of which of the following will be obtained on further evaluation of the mother?

      Your Answer:

      Correct Answer: Phenytoin use

      Explanation:

      This infant will most likely be diagnosed as having fetal hydantoin syndrome, which occurs due to an in utero exposure to antiepileptic drugs like phenytoin, carbamazepine, valproate etc. 

      Multiple antiepileptics, due to their ability to cross placenta, have teratogenic effects which will result in low folate and high oxidative metabolite levels in the fetus. This likely combined effect results deformities like cleft lip and palate, wide anterior fontanelle, distal phalangeal hypoplasia and cardiac anomalies like pulmonary stenosis, aortic stenosis etc in the fetus. There will be developmental delay and poor cognitive outcomes as a result of neural tube defects and microcephaly associated with this. Therefore, prior to conception, those patients who require antiepileptics for seizure control during pregnancy should titrate it to the lowest dose and must started on high-dose (4 mg) folic acid supplementation to minimize the risk of such congenital malformations.

      Fetal alcohol syndrome commonly presents with microcephaly and midfacial hypoplasia, but is not association with cleft lip or palate.

      Cocaine use during pregnancy can be associated with preterm delivery, abruptio placentae and fetal growth restriction; but there is no evidence to prove its association with congenital defects.

      Fetal renal failure with associated oligohydramnios that results in pulmonary hypoplasia, growth restriction, and limb defects are the complications associated with the use of lisinopril and other angiotensin-converting enzyme inhibitors during pregnancy; but it does not cause cleft lip or palate.

      Most infants with congenital syphilis are asymptomatic at birth and those with symptoms typically have rhinitis or “snuffles, hepatomegaly and a maculopapular rash none of which are seen in this patient.

      Fetal hydantoin syndrome results from the in-utero exposure to antiepileptic drugs like phenytoin, carbamazepine etc and is usually presented with microcephaly, a wide anterior fontanelle, cleft lip and palate, and distal phalangeal hypoplasia.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 42 - Which of the following statements is FALSE regarding Turner's syndrome? ...

    Incorrect

    • Which of the following statements is FALSE regarding Turner's syndrome?

      Your Answer:

      Correct Answer: Buccal smear is chromatin positive

      Explanation:

      Turner syndrome patients have high FSH levels and low oestrogen levels. They have a short stature and buccal smear is chromatin negative.

    • This question is part of the following fields:

      • Embryology
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  • Question 43 - A 24-year-old primigravida at 16 weeks of gestation, presented with a history of...

    Incorrect

    • A 24-year-old primigravida at 16 weeks of gestation, presented with a history of vaginal pressure, vaginal spotting and lower back pain.
      Transvaginal ultrasound finding shows cervical shortening to 2 cm, cervical dilation, and protrusion of fetal membranes into the cervical canal.
      Which among the following risk factors is not related to the development of this condition?

      Your Answer:

      Correct Answer: Alcohol abuse

      Explanation:

      This woman has developed non-specific symptoms of cervical insufficiency, is a painless dilation of cervix resulting in the delivery of a live fetus during the 2nd trimester or premature delivery.

      The following has been identified as the risk factors associated with increased incidence of cervical insufficiency:
      – Congenital disorders of collagen synthesis like Ehlers-Danlos syndrome.
      – Prior cone biopsies.
      – Prior deep cervical lacerations, which is secondary to vaginal or cesarean delivery.
      -Müllerian duct defects like bicornuate or septate uterus.
      – More than three prior fetal losses during the 2nd trimester

      From the given options, alcohol abuse is the only one not associated with increased incidence of cervical insufficiency.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 44 - Which of the following inhibit Glucagon? ...

    Incorrect

    • Which of the following inhibit Glucagon?

      Your Answer:

      Correct Answer: Uraemia

      Explanation:

      Glucagon release is inhibited by increased blood glucose, ketones, free fatty
      acids, insulin, raised urea levels and somatostatin. Glucagon is produced by alpha cells of the pancreas and increases the plasma glucose level by stimulating glycogenolysis and gluconeogenesis.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 45 - Which of the following is indicated for the treatment of chlamydial urethritis in...

    Incorrect

    • Which of the following is indicated for the treatment of chlamydial urethritis in pregnancy?

      Your Answer:

      Correct Answer: Azithromycin 1gram as single dose

      Explanation:

      The best treatment option for chlamydial urethritis in pregnancy is Azithromycin 1g as a single dose orally. This is the preferred option as the drug is coming under category B1 in pregnancy.

      Tetracycline antibiotics, including doxycycline, should never be used in pregnant or breastfeeding women.

      Erythromycin Estolate is contraindicated in pregnancy due to its increased risk for hepatotoxicity. Ciprofloxacin is not commonly used for treating chlamydial urethritis and its use is not safe during pregnancy.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 46 - Which of the following statements regarding management of obstetric anal sphincter injuries (OASIS)...

    Incorrect

    • Which of the following statements regarding management of obstetric anal sphincter injuries (OASIS) is true?

      Your Answer:

      Correct Answer: Broad-spectrum antibiotics should be given routinely following OASIS

      Explanation:

      After perineal repair, lactulose and a bulking agent should ideally be given for 5-10 days as well as broad spectrum antibiotics should be given that will cover all possible anaerobic bacteria. At 6-12 months a full evaluation should be done regarding the progress of healing. 60 to 80% of women are asymptomatic 12 months post delivery and external anal sphincter repair.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 47 - A 30-year-old primigravida woman presented to the clinic for her first antenatal check-up....

    Incorrect

    • A 30-year-old primigravida woman presented to the clinic for her first antenatal check-up. Upon interview, it was noted that she was taking folic acid along with some other nutritional supplements as medication.
      All of the following are considered correct regarding neural tube defects and folate before and during pregnancy, except:

      Your Answer:

      Correct Answer: Prevalence of neural tube defects among non-indigenous population is almost double than that in Aboriginal and Torres Strait Islander babies

      Explanation:

      Neural tube defects (NTDs) are common complex congenital malformations resulting from failure of the neural tube closure during embryogenesis. It is established that folic acid supplementation decreases the prevalence of NTDs, which has led to national public health policies regarding folic acid.

      Neural tube defects (NTD) were 43% more common in Indigenous than in non-Indigenous infants in Western Australia in the 1980s, and there has been a fall in NTD overall in Western Australia since promotion of folate and voluntary fortification of food has occurred.

      Women should take 5 mg/d of folic acid for the 2 months before conception and during the first trimester.

      Women planning pregnancy might be exposed to medications with known antifolate activities affecting different parts of the folic acid metabolic cascade. A relatively large number of epidemiologic studies have shown an increased risk of NTDs among babies exposed in early gestation to antiepileptic drugs (carbamazepine, valproate, barbiturates), sulphonamides, or methotrexate. Hence, whenever women use these medications, or have used them near conception, they should take 5 mg/d of folic acid until the end of the first trimester of pregnancy.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 48 - A young woman came to your clinic seeking help. She has been married...

    Incorrect

    • A young woman came to your clinic seeking help. She has been married for two years and has yet to conceive. The following are the findings of blood tests:
      Luteinizing hormone levels are low.
      Low levels of follicle stimulating hormone.
      Thyroid stimulating hormone (TSH) levels are low.
      Prolactin-high.
      What is the most effective way to deal with infertility?

      Your Answer:

      Correct Answer: Bromocriptine

      Explanation:

      The most common treatment approach is with the dopamine receptor agonists, bromocriptine, and cabergoline. Bromocriptine normalizes prolactin and decreases tumour size in 80%–90% of patients with microadenomas. Bromocriptine should be given to this patient who has developed hyperprolactinemia anovulation.

      Women with hyperprolactinaemic anovulation are treated with dopamine agonists such as bromocriptine.
      This patient has also developed symptoms of a low-functioning pituitary gland tumour, which bromocriptine will assist to shrink. Before starting bromocriptine, a head MRI scan should be considered to confirm the suspected diagnosis.

      Clomiphene is an oestrogen receptor modulator that is selective. It works by competing with oestrogen receptors in the hypothalamus. This disrupts normal negative feedback mechanisms, causing the release of pituitary gonadotropins, particularly LH, to rise, triggering ovulation.
      When the levels of gonadotropins and oestrogen are normal but the women still have ovulatory dysfunction, it is successful in inducing ovulation. In hypogonadotropic hypogonadism and hypogonadotropic hypogonadism patients, clomiphene is frequently ineffective.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 49 - What is the contraception of choice for epileptics on enzyme inducing antiepileptic drugs?...

    Incorrect

    • What is the contraception of choice for epileptics on enzyme inducing antiepileptic drugs?

      Your Answer:

      Correct Answer: Levonorgestrel-releasing intrauterine contraceptive device.

      Explanation:

      Clinical decision making which contraceptive regimen is optimal for an individual woman with epilepsy is one of the most challenging tasks when taking care of women with epilepsy. The bidirectional interactive potential of antiepileptic drugs (AEDs) and hormonal contraceptives needs to be taken into account. Enzyme inducing (EI)-AEDs may reduce the contraceptive efficacy of hormonal contraceptives.

      If combined oral contraceptives (COCs) are used in combination with EI-AEDs, it is recommended to choose a COC containing a high progestin dose, well above the dose needed to inhibit ovulation, and to take the COC pill continuously (“long cycle therapy”). But even with the continuous intake of a COC containing a higher progestin dose contraceptive safety cannot be guaranteed, thus additional contraceptive protection may be recommended.

      Progestin-only pills (POPs) are likely to be ineffective, if used in combination with EI-AEDs.

      Subdermal progestogen implants are not recommended in patients on EI-AEDs, because of published high failure rates.

      Depot medroxyprogesterone-acetate (MPA) injections appear to be effective, however they may not be first choice due to serious side effects (delayed return to fertility, impaired bone health).

      The use of intrauterine devices is an alternative method of contraception in the majority of women, with the advantage of no relevant drug–drug interactions. The levonorgestrel intrauterine system (IUS) appears to be effective, even in women taking EI-AEDs. Likelihood of serious side effects is low in the IUS users.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 50 - Which of the following factors as shown to decrease ovarian cancer risk? ...

    Incorrect

    • Which of the following factors as shown to decrease ovarian cancer risk?

      Your Answer:

      Correct Answer: Taking statins

      Explanation:

      Factors shown to decrease risk of ovarian cancer are:
      – Oral contraceptive use
      – Higher Parity
      – Breast feeding
      – Hysterectomy
      – Tubal Ligation
      – Statins
      – SLE

    • This question is part of the following fields:

      • Epidemiology
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  • Question 51 - Evidence from meta-analysis of RCTs is what level of evidence? ...

    Incorrect

    • Evidence from meta-analysis of RCTs is what level of evidence?

      Your Answer:

      Correct Answer: Ia

      Explanation:

      The levels of evidence range from I-IV:
      1a: Systematic reviews (with homogeneity) or metanalysis of randomized controlled trials: highest level of evidence.
      1b: Individual randomized controlled trial (with narrow confidence interval)
      1c: All or none randomized controlled trials
      2a: Systematic reviews (with homogeneity) of cohort studies
      2b: Individual cohort study or low quality randomized controlled trials (e.g. <80% follow-up)
      2c: Outcomes Research; ecological studies
      3a: Systematic review (with homogeneity) of case-control studies
      3b: Individual case-control study
      4: Case series (and poor quality cohort and case-control studies)
      5: Expert opinion without explicit critical appraisal, or based on physiology, bench research or first principles.

    • This question is part of the following fields:

      • Epidemiology
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  • Question 52 - What percentage of pregnant women have asymptomatic vaginal colonisation with candida? ...

    Incorrect

    • What percentage of pregnant women have asymptomatic vaginal colonisation with candida?

      Your Answer:

      Correct Answer: 40%

      Explanation:

      Vulvovaginal candidiasis is the most common genital infections and it is caused by candida albicans in 80-92% of the cases. It colonise the vaginal flora in 20% of non pregnant and 40% pregnant women.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 53 - Regarding the pubic symphysis, what type of joint is it ...

    Incorrect

    • Regarding the pubic symphysis, what type of joint is it

      Your Answer:

      Correct Answer: Secondary Cartilaginous

      Explanation:

      The pubic symphysis is a cartilaginous joint. The cartilaginous joints are divided further into primary and secondary joints. The primary joint is called the synchondrosis. It articulates with the pubis of the other side.

    • This question is part of the following fields:

      • Anatomy
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  • Question 54 - A 22 year old woman is being followed up 6 weeks after a...

    Incorrect

    • A 22 year old woman is being followed up 6 weeks after a surgical procedure to evacuate the uterus following a miscarriage. The histology has shown changes consistent with a hydatidiform mole. What is the single most appropriate investigation in this case?

      Your Answer:

      Correct Answer: Serum B-HCG

      Explanation:

      The most appropriate test for a hydatiform mole is serum beta hCG levels, which are consistently raised in these patients. The levels return to normal when the pregnancy is terminated.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 55 - Congenital Cytomegalovirus (CMV) infection effects how many pregnancies? ...

    Incorrect

    • Congenital Cytomegalovirus (CMV) infection effects how many pregnancies?

      Your Answer:

      Correct Answer: 1 in 150

      Explanation:

      CMV effects 1 in 200 pregnancies of which 30% will transmit the virus to the foetus and of which 30% foetus will be effected.

    • This question is part of the following fields:

      • Microbiology
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  • Question 56 - A biophysical profile includes all of the following assessment parameters EXCEPT: ...

    Incorrect

    • A biophysical profile includes all of the following assessment parameters EXCEPT:

      Your Answer:

      Correct Answer: Fetal weight

      Explanation:

      The biophysical profile is a composite test that collects 5 indicators of fetal well-being, including fetal heart rate reactivity, breathing movements, gross body movements, muscular tone, and quantitative estimation of amniotic fluid volume. The assessment of fetal heart rate is accomplished by performing a nonstress test, whereas the latter 4 variables are observed using real-time ultra-sonography.

    • This question is part of the following fields:

      • Biophysics
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  • Question 57 - A 49-year-old lady presents with amenorrhea of 11-months’ duration. Her periods were previously...

    Incorrect

    • A 49-year-old lady presents with amenorrhea of 11-months’ duration. Her periods were previously normal and regular. She is planned for an assessment of her FSH (follicle-stimulating hormone) and oestradiol (E2) levels.
      Assuming she has attained menopause, which pattern would most likely be found?

      Your Answer:

      Correct Answer: High FSH and low E2.

      Explanation:

      High FSH and low E2 levels would be expected in menopause. FSH levels would be raised as her body attempts to stimulate ovarian activity and E2 would be low due to reduced ovarian function. The other options would be possible if she was younger, and if occurring with amenorrhea, would warrant further hormonal tests.

      It is often challenging to interpret hormone test results close to the time of menopause, especially if the woman is still experiencing irregular menstruation, as remaining ovarian follicles might still produce oestrogen, causing both bleeding and FSH suppression. Elevation of FSH then can be seen again once the oestrogen level drops. Hence, the results would be influenced by the timing of blood sample collection. Once amenorrhea occurs more consistently, it would be easier to interpret the results.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 58 - During vertex presentation, the position is determined by relationship of which part of...

    Incorrect

    • During vertex presentation, the position is determined by relationship of which part of the fetal vertex to the mother's pelvis?

      Your Answer:

      Correct Answer: Occiput

      Explanation:

      A cephalic presentation is the one where head of the foetus enters the pelvic cavity at the time of delivery. The commonest form of cephalic presentation is the vertex presentation in which the occiput of the foetus enters the birth canal.

    • This question is part of the following fields:

      • Anatomy
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  • Question 59 - A 24 year old, 16 week pregnant patient presents with vaginal discharge. There...

    Incorrect

    • A 24 year old, 16 week pregnant patient presents with vaginal discharge. There is heavy growth of N. gonorrhoea as shown on swabs taken. Which treatment course is most advisable?

      Your Answer:

      Correct Answer: Ceftriaxone 1 mg intramuscularly as a single dose with azithromycin 2g oral as a single dose

      Explanation:

      Gonorrhoea is a diplococcus bacteria known to infect the female genital tract. The bacteria is sexually transmitted and can cause an ascending infection in the uterus and fallopian tubes. According to the BASHH guidelines (British Association for Sexual Health and HIV), indication for therapy include confirmation of intracellular diplococci on microscopy or a confirmed positive NAAT. Treatment of gonorrhoea in pregnancy is as follows: Ceftriaxone 1g intramuscularly as a single dose with azithromycin 2g oral as a single dose. Pregnant individuals are not to be treated with quinolones or tetracyclines.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 60 - A 29-year-old lady comes to your clinic for a refill on her oral...

    Incorrect

    • A 29-year-old lady comes to your clinic for a refill on her oral contraceptive tablets (Microgynon 30®). You discover she has a blood pressure of 160/100mmHg during your examination, which is confirmed by a second reading 20 minutes later. Her husband and she are expecting a child in six months.
      Which of the following recommendations is the best for her?

      Your Answer:

      Correct Answer: She should stop OCP, use condoms for contraception and reassess her blood pressure in 3 months

      Explanation:

      Overt hypertension, developing in about 5% of Pill users, and increases in blood pressure (but within normal limits) in many more is believed to be the result of changes in the renin-angiotensin-aldosterone system, particularly a consistent and marked increase in the plasma renin substrate concentrations. The mechanisms for the hypertensive response are unclear since normal women may demonstrate marked changes in the renin system. A failure of the kidneys to fully suppress renal renin secretion could thus be an important predisposing factor.

      These observations provide guidelines for the prescription of oral contraceptives. A baseline blood pressure measurement should be obtained, and blood pressure and weight should be followed at 2- or 3-month intervals during treatment. Oral contraceptive therapy should be contraindicated for individuals with a history of hypertension, renal disease, toxaemia, or fluid retention. A positive family history of hypertension, women for whom long-term therapy is indicated, and groups such as blacks, especially prone to hypertensive phenomena, are all relative contraindications for the Pill.

      All other options are incorrect.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 61 - A 33-year-old female patient walks into your office to speak with you about...

    Incorrect

    • A 33-year-old female patient walks into your office to speak with you about her recent pap smear result. A low-grade squamous intraepithelial lesion was discovered (LSIL). Her most recent pap smear, performed two years ago, came back normal.
      Which of the following is the most appropriate course of action?

      Your Answer:

      Correct Answer: Repeat the pap smear in one year

      Explanation:

      An LSIL Pap test shows mild cellular changes. The risk of a high-grade cervical precancer or cancer after an LSIL Pap test is as high as 19 percent.

      As with an ASC-US Pap test, an LSIL Pap test is evaluated differently depending upon age.

      For women ages 25 or older, follow-up depends upon the results of human papillomavirus (HPV) testing:

      – Women who test positive for HPV or who have not been tested for HPV should have colposcopy.
      – Women who test negative for HPV can be followed up with a Pap test and HPV test in one year.

      Referring the patient to an oncologist is not acceptable since there is no established diagnosis of malignancy that has been made. All other options are unacceptable since Pap smear must be done in 12 months.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 62 - Which two nerves provide the primary cutaneous sensory innervation to the labia majora?...

    Incorrect

    • Which two nerves provide the primary cutaneous sensory innervation to the labia majora?

      Your Answer:

      Correct Answer: Ilioinguinal and pudendal

      Explanation:

      The Pudendal provides cutaneous innervation to the posterior external genitalia via one of its terminal branches called the perineal nerve (this further branches into the posterior labial nerves or posterior scrotal nerve in men). The ilioinguinal nerve provides anterior sensation via the anterior labial nerves (anterior scrotal nerve in men). The genital branch of the genitofemoral nerve contributes some fibres to the skin of the mons pubis and labia majora in females. The posterior cutaneous nerve of thigh sometimes overlaps sensory areas.

    • This question is part of the following fields:

      • Anatomy
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  • Question 63 - Which of the following is a double stranded RNA virus? ...

    Incorrect

    • Which of the following is a double stranded RNA virus?

      Your Answer:

      Correct Answer: Rotavirus

      Explanation:

      RNA viruses are almost always single stranded whilst DNA viruses are almost always double stranded. The exceptions are rotavirus and Parvovirus B19 respectively.

    • This question is part of the following fields:

      • Microbiology
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  • Question 64 - Which of the following is the most likely anaesthetic or analgesic causing reduced...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 65 - The performance of a cervical cerclage at 14 weeks of gestation is determined...

    Incorrect

    • The performance of a cervical cerclage at 14 weeks of gestation is determined by which of the following indications?

      Your Answer:

      Correct Answer: 2 or more consecutive prior second trimester pregnancy losses

      Explanation:

      Cervical cerclage is performed as an attempt to prolong pregnancy in certain women who are at higher risk of preterm delivery.

      There are three well-accepted indications for cervical cerclage placement. According to the American College of Obstetricians and Gynaecologists (ACOG), a history-indicated or prophylactic cerclage may be placed when there is a “history of one or more second-trimester pregnancy losses related to painless cervical dilation and in the absence of labour or abruptio placentae,” or if the woman had a prior cerclage placed due to cervical insufficiency in the second trimester.

      An ultrasound-indicated cerclage may be considered for women who have a history of spontaneous loss or preterm birth at less than 34 weeks gestation if the cervical length in a current singleton pregnancy is noted to be less than 25 mm before 24 weeks of gestation. It is important to note that this recommendation is invalidated without the history of preterm birth.

      Physical examination-indicated cerclage (also known as emergency or rescue cerclage) should be considered for patients with a singleton pregnancy at less than 24 weeks gestation with advanced cervical dilation in the absence of contractions, intraamniotic infection or placental abruption.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 66 - A 35-year-old woman from the countryside of Victoria comes to the hospital at...

    Incorrect

    • 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
      0
      Seconds
  • Question 67 - Maternal mortality rate is lowest in which age group? ...

    Incorrect

    • Maternal mortality rate is lowest in which age group?

      Your Answer:

      Correct Answer: 20 - 30

      Explanation:

      The maternal mortality rate starts low and raises steeply after the age of 30 years. The lowest mortality rate recorded among women is between 19-30 years of age group.

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 68 - Which of the following is a DNA virus? ...

    Incorrect

    • Which of the following is a DNA virus?

      Your Answer:

      Correct Answer: Hepatitis B

      Explanation:

      Hepatitis B is a DNA virus. All the others are RNA viruses

    • This question is part of the following fields:

      • Microbiology
      0
      Seconds
  • Question 69 - A 26 year old lady comes to see you in the antenatal clinic....

    Incorrect

    • A 26 year old lady comes to see you in the antenatal clinic. She is 8 weeks pregnant and is concerned as she has a new cat and her friend told her she shouldn't be changing cat litter when pregnant. You send bloods which show high IgM for toxoplasmosis gondii. Which of the following is an appropriate treatment option?

      Your Answer:

      Correct Answer: Spiramycin

      Explanation:

      Toxoplasma gondii is a protozoan parasite found in cat faeces, soil or uncooked meat. Infection occurs by ingestion of the parasite from undercooked meat or from unwashed hands. Spiramycin treatment can be used in pregnancy (a 3-week course of 2–3 g per day). This reduces the incidence of transplacental infection but has not been shown to definitively reduce the incidence of clinical congenital disease. If toxoplasmosis is found to be the cause of abnormalities detected on ultrasound scan of the foetus, then termination of pregnancy can be offered.

    • This question is part of the following fields:

      • Microbiology
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      Seconds
  • Question 70 - A 22-year-old primigravid woman present to the emergency department.
    She is at 40...

    Incorrect

    • A 22-year-old primigravid woman present to the emergency department.
      She is at 40 weeks gestation and complains of a 24-hour history of no fetal movements.
      On auscultation, fetal heart beats are clearly audible with a measurement of 140/min.
      On diagnostic testing, the cardiotocograph (CTG) is normal and reactive.
      On physical examination, her cervix is 2cm dilated and fully effaced.
      She is reassured and allowed to return home.
      24 hours later, she calls to complain she has still felt no fetal movements, adding up to a 48 hour history.
      What is the best next step in management?

      Your Answer:

      Correct Answer: Admit for induction of labour.

      Explanation:

      Labour induction is indicated as no fetal movements have been felt for 24 hours, with a normal cardiotocograph (CTG) and the pregnancy is at near/full term with a favourable cervix.

      Amniotic fluid volume assessment would have been indicated 24 hours earlier as, if it was low, induction would have been indicated then, despite a normal CTG.

      Ultrasound examination of the foetus is not indicated as it is necessary to expedite delivery.

      Carrying out another CTG, with or without oxytocin challenge, is not indicated, although MG monitoring during induced labour would be mandatory.

      Delivery immediately by Caesarean section is not indicated unless the lack of fetal movements is due to fetal hypoxia. This can result in fetal distress during labour, necessitating an emergency Caesarean section if the cervix is not fully dilated.

    • This question is part of the following fields:

      • Obstetrics
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      Seconds
  • Question 71 - What is the incidence of hyperthyroidism in complete molar pregnancy? ...

    Incorrect

    • What is the incidence of hyperthyroidism in complete molar pregnancy?

      Your Answer:

      Correct Answer: 3%

      Explanation:

      As B-HCG and TSH have similar structures, increased B-HCG can lead to hyperthyroidism, however there is only a 3% chance of this happening.

    • This question is part of the following fields:

      • Clinical Management
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      Seconds
  • Question 72 - Luteal phase deficiency is characterised by: ...

    Incorrect

    • Luteal phase deficiency is characterised by:

      Your Answer:

      Correct Answer: Has inadequate luteal progesterone production

      Explanation:

      Luteal phase occurs after the ovulation. Luteal defect means that the luteal phase is shorter than 10 days and women will find it difficult to sustain the pregnancy. There is decreased progesterone, LH and FSH production in this case.

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 73 - What is the most common Type II congenital thrombophilia? ...

    Incorrect

    • What is the most common Type II congenital thrombophilia?

      Your Answer:

      Correct Answer: Factor V Leiden mutation

      Explanation:

      Factor V Leiden is the most common congenital thrombophilia. Named after the Dutch city Leiden where it was first discovered. Protein C and S deficiencies are type 1 (Not type 2) thrombophilias Antiphospholipid syndrome is an acquired (NOT congenital) thrombophilia

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 74 - The testis receive innervation from which spinal segment ...

    Incorrect

    • The testis receive innervation from which spinal segment

      Your Answer:

      Correct Answer: T10

      Explanation:

      The T10 spinal segment provides the sympathetic nerve fibres that innervate the testes

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 75 - During wound healing the clotting cascade is activated. Which of the following activates...

    Incorrect

    • During wound healing the clotting cascade is activated. Which of the following activates the extrinsic pathway?

      Your Answer:

      Correct Answer: Tissue Factor

      Explanation:

      The extrinsic pathway is activated by the tissue factor, which converts factor VII to VIIa which later on converts factors X and II to their activated form finally leading to the conversion of fibrinogen to fibrin fibres.

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 76 - A pregnant patient who is needle phobic has her nuchal translucency (NT) scan...

    Incorrect

    • A pregnant patient who is needle phobic has her nuchal translucency (NT) scan but refuses serum markers. You advise her the False Positive Rate of the scan is 5%. What would you advise the mother regarding the detection rate of Down Syndrome using NT alone?

      Your Answer:

      Correct Answer: 70%

      Explanation:

      The nuchal lucency measurement is the measure of the nuchal pad thickness. Children with down syndrome have an increased thickness of the nuchal pad. The risk of down’s syndrome increases with maternal age. The nuchal lucency test has an accuracy rate of 70%.

    • This question is part of the following fields:

      • Genetics
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      Seconds
  • Question 77 - What is the average lifespan of a basophil (white blood cell)? ...

    Incorrect

    • What is the average lifespan of a basophil (white blood cell)?

      Your Answer:

      Correct Answer: 3-4 days

      Explanation:

      Basophils are granulocytic white blood cells. They express IgE antibody on their surface and react to release prostaglandins and leukotrienes to mediate an inflammatory, allergic reaction.
      Blood Cell Lifespans:
      Red Blood Cells 120 days
      Platelets 5-9 days
      White blood cells 2-5 days

      Neutrophils (up to 5 days)
      Basophils (2 to 3 days)
      Eosinophils (2 to 5 days)
      Monocytes (1 to 5 days)
      Lymphocytes (variable)

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 78 - At birth, approximately how many oocytes are present in the ovaries? ...

    Incorrect

    • At birth, approximately how many oocytes are present in the ovaries?

      Your Answer:

      Correct Answer: 1 million

      Explanation:

      Female infants are thought to be born with the total number of gametes they will posses in their lifetime. About 1 million healthy oocytes are present at birth. However, only about 300,000 of these oocytes survive to puberty, a number which continues to decline until all the oocytes are depleted triggering menopause.

    • This question is part of the following fields:

      • Embryology
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      Seconds
  • Question 79 - What is the primary form of haemoglobin in a 6 week old foetus?...

    Incorrect

    • What is the primary form of haemoglobin in a 6 week old foetus?

      Your Answer:

      Correct Answer: Hb Gower 1

      Explanation:

      HB gower 1 is the predominant embryonic haemoglobin when the foetus is 6 weeks old and is replaced by adult haemoglobin by the age of 5 months post natally.

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 80 - From what does the blastocyst hatch? ...

    Incorrect

    • From what does the blastocyst hatch?

      Your Answer:

      Correct Answer: Zona Pellucida

      Explanation:

      The blastocyst hatchs from the Zona Pellucida

    • This question is part of the following fields:

      • Embryology
      0
      Seconds
  • Question 81 - A 33-year-old female presents with 3 months of irregular vaginal bleeding. Prior to...

    Incorrect

    • A 33-year-old female presents with 3 months of irregular vaginal bleeding. Prior to this her menstrual periods were normal.
      Which one of the following is the most appropriate initial laboratory test for this patient?

      Your Answer:

      Correct Answer: hCG

      Explanation:

      In women of childbearing age, the most likely cause of abnormal vaginal bleeding is pregnancy; thus, the most appropriate initial test would be an hCG level. Once pregnancy has been excluded, patient history would guide further testing. Iatrogenic causes, usually resulting from certain medicines or supplements, are the next most common cause in this age group, followed by systemic disorders. Haemoglobin and haematocrit would be appropriate only if the patient seemed acutely anaemic due to the abnormal bleeding.

    • This question is part of the following fields:

      • Gynaecology
      0
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  • Question 82 - Human papilloma virus (HPV) infection is associated with which of the following onco-proteins?...

    Incorrect

    • Human papilloma virus (HPV) infection is associated with which of the following onco-proteins?

      Your Answer:

      Correct Answer: E6 and E7

      Explanation:

      There are over 100 genotypes of HPV including several other high risk HPV types. HPV 16 and 18 are responsible for 70% of cases of HPV related cancers. HPV is thought to induce cancer via onco-proteins. The primary onco-proteins are E6 and E7 which inactivate two tumour suppressor proteins, p53 (inactivated by E6) and pRb (inactivated by E7)

    • This question is part of the following fields:

      • Microbiology
      0
      Seconds
  • Question 83 - Haemolytic Disease of the New-born falls into what type of hypersensitivity reaction? ...

    Incorrect

    • Haemolytic Disease of the New-born falls into what type of hypersensitivity reaction?

      Your Answer:

      Correct Answer: Type II

      Explanation:

      It is classified under type II hypersensitivity reaction. Antibodies are formed against the rhesus antigen i.e. D antigen. Hence when the Antibody reacts with the antigen on the RBC it results in activation of the complement cascade leading to lysis.

    • This question is part of the following fields:

      • Immunology
      0
      Seconds
  • Question 84 - The ascending colon drains into the superior mesenteric vein (SMV). What vein does...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 85 - Oxytocin causes increased myometrial contraction via which of the following messenger pathways? ...

    Incorrect

    • Oxytocin causes increased myometrial contraction via which of the following messenger pathways?

      Your Answer:

      Correct Answer: Activates phospholipase-C which produces IP3 which triggers intracellular Calcium ion release

      Explanation:

      Oxytocin acts via the G protein receptors and the calcium-calmodulin complex. It activates phospholipase C which produces IP3 to further trigger the calcium-calmodulin complex increasing intracellular Ca ion release.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 86 - 48 hours after having unprotected intercourse, a 16-year-old female requested a pregnancy test...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Gynaecology
      0
      Seconds
  • Question 87 - Regarding the foetus, which one of the following statements is true? ...

    Incorrect

    • Regarding the foetus, which one of the following statements is true?

      Your Answer:

      Correct Answer: Fetal lie describes the long axis of the foetus to the long axis of the mother

      Explanation:

      Fetal lie describes the relationship of the long axis of the foetus with respect to the long axis of the mother.
      Coronal suture is the transverse suture separating the parietal bone from the frontal bone.
      Umbilical cord is composed of two arteries and one vein. the vein carries the oxygenated blood, whereas the arteries contain the deoxygenated blood.
      At the time of birth, the anterior fontanelle is open and appears as a soft jelly like structure.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 88 - In normal pregnancy, levels of all of the following hormones increases, EXCEPT: ...

    Incorrect

    • In normal pregnancy, levels of all of the following hormones increases, EXCEPT:

      Your Answer:

      Correct Answer: Parathyroid hormone (PTH) in the 2nd & 3rd trimesters

      Explanation:

      In order to maintain fetal bone growth, the maternal compartment undergoes adjustments that provide a net transfer of sufficient calcium to the foetus. Maternal compartment changes that permit calcium accumulation include increases in maternal dietary intake, increases in maternal 1, 25-dihydroxyvitamin D3 levels, and increases in parathyroid hormone (PTH) levels. The levels of total calcium and phosphorus decline in maternal serum, but ionized calcium levels remain unchanged. During pregnancy, the placenta forms a calcium pump in which a gradient of calcium and phosphorus is established which favours the foetus. Thus, circulating fetal calcium and phosphorus levels increase steadily throughout gestation. Furthermore, fetal levels of total and ionized calcium, as well as phosphorus, exceed maternal levels at term. By 10-12 weeks’ gestation, the fetal parathyroid glands secrete PTH. Fetal plasma levels of PTH are low during gestation, but increase after delivery.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 89 - A 31 year old is being seen in EPU and you are asked...

    Incorrect

    • A 31 year old is being seen in EPU and you are asked to review her ultrasound. There is a solid collection of echoes with numerous small (3-10 mm) anechoic spaces. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Molar Pregnancy

      Explanation:

      Gestational trophoblastic disorder is characterized by an abnormal trophoblastic proliferation and include a complete and partial mole. It is characterized by persistently elevated BHCG levels after pregnancy and on ultrasound a snow storm appearance. These appear as anechoic areas on ultrasound.

    • This question is part of the following fields:

      • Data Interpretation
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      Seconds
  • Question 90 - A 32-year-old woman, who is 18 weeks pregnant, is diagnosed with antiphospholipid syndrome...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 91 - A 39-year-old woman comes to your clinic for assessment and advice as she...

    Incorrect

    • A 39-year-old woman comes to your clinic for assessment and advice as she is planning to conceive over past three months with no success.
      She has a history of obesity with BMI 40 and type 2 diabetes mellitus with latest HbA1c value of 11%. She had her last eye check six months ago which shows no evidence of retinopathy, and she does not have diabetic nephropathy.
      Among the following which is a contraindication to pregnancy in this case?

      Your Answer:

      Correct Answer: History of type 2 diabetes mellitus with HBA1C above 10

      Explanation:

      In patients who have an HbA1C value above 10%, it is better to postpone pregnancy until diabetes is under control. Also in those patients with type 2 diabetes mellitus, who are suffering from severe gastroparesis, those with advanced retinopathy, with severe diabetic renal disease and severe ischemic heart disease with uncontrolled hypertension pregnancy is contraindicated.

      All the other options mentioned are incorrect.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 92 - A 30 year old patient attends for non-invasive pre-natal screening for Down's syndrome....

    Incorrect

    • A 30 year old patient attends for non-invasive pre-natal screening for Down's syndrome. You advise her that the result will take the form of a risk score and higher risk results will be offered CVS or amniocentesis. What is the cut-off figure between low and high risk?

      Your Answer:

      Correct Answer: 1 in 150

      Explanation:

      1 in 150 is the cut off. Where pre-natal screening shows a risk of 1 in 150 or greater invasive testing is typically offered.

    • This question is part of the following fields:

      • Clinical Management
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      Seconds
  • Question 93 - Fetal blood is returned to the umbilical arteries & the placenta via the:...

    Incorrect

    • Fetal blood is returned to the umbilical arteries & the placenta via the:

      Your Answer:

      Correct Answer: Hypogastric arteries

      Explanation:

      In the foetus, the hypogastric artery ascends along the side of the bladder, and runs upward on the back of the anterior wall of the abdomen to the umbilicus, converging toward its fellow of the opposite side. Having passed through the umbilical opening, the two arteries, now termed umbilical, enter the umbilical cord, where they are coiled around the umbilical vein, and ultimately ramify in the placenta.

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 94 - The inferior 1/3 of the rectum is principally supplied by which artery? ...

    Incorrect

    • The inferior 1/3 of the rectum is principally supplied by which artery?

      Your Answer:

      Correct Answer: Middle rectal artery

      Explanation:

      Remember the inferior rectal artery supplies the anus. The middle rectal artery is the principle supply to the lower 1/3 rectum. The rectal arteries do form an anastomosis.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 95 - Urinary incontinence has brought a 69-year-old woman to your clinic. When she laughs,...

    Incorrect

    • Urinary incontinence has brought a 69-year-old woman to your clinic. When she laughs, sneezes, or coughs, as well as during activity, she experiences minor quantities of urine incontinence.
      Which of the following is the most appropriate management next step?

      Your Answer:

      Correct Answer: Pelvic floor muscles exercise

      Explanation:

      Pelvic floor muscle exercises are the mainstay of behavioural therapy for stress incontinence. Up to 38 percent of patients with stress incontinence alone who follow a pelvic floor muscle exercise regimen for at least three months experience a cure.

      Weighted cones or topical steroids can be used as adjuvants but are not sufficient when used alone.

      Tension free vaginal tape and Burch’s colposuspension are considered for patients who fail to respond to conservative management strategies.

    • This question is part of the following fields:

      • Gynaecology
      0
      Seconds
  • Question 96 - During the inflammatory phase of wound healing what is the predominant cell type...

    Incorrect

    • During the inflammatory phase of wound healing what is the predominant cell type found in the wound during days 3-4?

      Your Answer:

      Correct Answer: Macrophages

      Explanation:

      PMNs phagocytise debris and kill bacteria via free radicals (AKA respiratory burst). They also break down damaged tissue. PMNs typically undergo apoptosis after 48 hours. They are then engulfed and degraded by macrophages. Macrophages therefore become the predominant cell type in the wound on days 3-4.

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 97 - From which germ layer does the myenteric plexus of the GI tract developed:...

    Incorrect

    • From which germ layer does the myenteric plexus of the GI tract developed:

      Your Answer:

      Correct Answer: Neural crest of Ectoderm

      Explanation:

      During the 5th week, the neural crest cells migrate along each side of the spinal cord where they form ganglions located dorsolateral to the aorta. Some of these cells migrate ventrally and form neurons in the preaortic ganglia as the celiac and mesenteric ganglia.

    • This question is part of the following fields:

      • Embryology
      0
      Seconds
  • Question 98 - A 29-year-old woman presents to her local Emergency Department with the complaint of...

    Incorrect

    • A 29-year-old woman presents to her local Emergency Department with the complaint of feeling unwell.
      Her last menstrual period was eight weeks ago. Normally, she has regular monthly periods.
      She reports that she had heavy vaginal bleeding on the previous day; the bleeding had reduced today.
      On examination, she appears unwell, her pulse rate is 130 beats/min, BP is 110/60 mmHg, and temperature is 39.5°C
      Suprapubic tenderness and guarding is noted on abdominal examination.
      There is no evidence of a pelvic mass.
      Speculum examination shows that the cervix is open and apparent products of conception are present in the upper vagina.
      From the following, choose the most appropriate treatment option for optimal management of this patient.

      Your Answer:

      Correct Answer: Cervical swabs for microscopic assessment and culture.

      Explanation:

      This woman has experienced a septic abortion. Therefore the first step is commencement of intensive antibiotic treatment as soon as cervical swabs have been taken.

      The next step is evacuation of the uterus. Curettage can be performed after a few hours, to extract any remaining infected products of conception from the uterine cavity.

      The choice of antibiotics depends on the most likely microorganism involved. Therefore, prior to commencing any other procedure, it is vital to take cervical swabs for microscopic examination to guide further antibiotic therapy (correct answer).

      If curettage is performed immediately there is a risk that the infection would spread.

      However, if Clostridium welchii infection is suspected from the cervical smear (particularly if encapsulation of the microorganisms is present), then curettage should be performed immediately along with commencing antibiotic treatment.

      Curettage can be delayed for up to 12-24 hours if other microorganisms are suspected; unless a significant increase in bleeding occurs.

      Ergometrine is not essential as an immediate treatment measure as the patient is not bleeding heavily and reports that her bleeding has decreased. However, ergometrine is commonly given when curettage is performed.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 99 - Which is the most useful tumour marker for monitoring of ovarian cancer patients?...

    Incorrect

    • Which is the most useful tumour marker for monitoring of ovarian cancer patients?

      Your Answer:

      Correct Answer:

      Explanation:

      CA-125 has found application as a tumour marker or biomarker that may be elevated in the blood of some patients with specific types of cancers, or other conditions that are benign. Increased level of CA125 appears in fifty percent of stage 1 ovarian cancer patients and more than 90% with stages 2-4 ovarian cancer. CA-125 is therefore a useful tool for detecting ovarian cancer after the onset of symptoms as well as monitoring response to treatment and for predicting a patient’s prognosis after treatment.

    • This question is part of the following fields:

      • Gynaecology
      0
      Seconds
  • Question 100 - You are called to review a baby with cyanosis when feeding immediately after...

    Incorrect

    • You are called to review a baby with cyanosis when feeding immediately after birth. Subsequent investigation and imaging reveals choanal atresia. Upon questioning the mother reveals she had been getting repeat prescriptions from her GP in Poland without her UK GPs' or your knowledge. Which of the following medication was most likely to cause this?

      Your Answer:

      Correct Answer: Carbimazole

      Explanation:

      This is one of the defects attributable to Carbimazole use.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

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