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Question 1
Incorrect
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The following are presumptive skin signs of pregnancy, except:
Your Answer: Linea nigra
Correct Answer: Maculo-papular rash
Explanation:Skin signs during pregnancy may include: dark spots on the breasts, nipples and inner thighs, melasma (chloasma), linea nigra, stretch marks, acne, spider telangiectasis and varicose veins.
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This question is part of the following fields:
- Physiology
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Question 2
Correct
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Which one of the following statements regarding fetal blood pH is correct?
Your Answer: Can be measured during labour
Explanation:A sample for fetal blood pH can be taken during the labour. The mother should be lying in a left lateral position.
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This question is part of the following fields:
- Physiology
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Question 3
Incorrect
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A 29-year-old nulliparous woman is admitted to the hospital at 37 weeks of gestation after losing about 200 mL of blood per vagina after having sexual intercourse. The bleeding has now ceased and her vitals are below:
Pulse rate: 64 beats/min,
Blood pressure: 120/80 mmHg,
Temperature: 36.8°C. On physical exam, the uterus is enlarged and is 37 cm above the pubic symphysis. The uterus is lax and non-tender. On ultrasound, the fetal presentation is cephalic with the head freely mobile above the pelvic brim. The fetal heart rate assessed by auscultation is 155 beats/min.
Which of the following is the most likely of bleeding in this patient?Your Answer:
Correct Answer: Placenta praevia.
Explanation:In this pregnant patient with an antepartum haemorrhage at 37 weeks of gestation, her clinical presentation points to a placenta previa. Her bleeding has stopped, the uterus is of the expected size and non-tender, and the fetal head is still mobile above the pelvic brim which are all findings that would be consistent with a placenta praevia. An ultrasound examination would be done to rule-out or diagnose the condition.
An Apt test on the blood is necessary to ensure that this is not fetal blood that would come from a ruptured vasa praevia. Although this diagnosis would be unlikely since the bleeding has stopped. If there was a vasa praevia, there would be fetal tachycardia or bradycardia, where a tachycardia is often seen first but then bradycardia takes over late as fetal exsanguination occurs.
In a placental abruption with concealment of blood loss, the uterus would be larger and some uterine tenderness would be found on exam.
A cervical polyp could bleed after sexual intercourse and a speculum examination would be done to exclude it. However, it would be unlikely for a cervical polyp to cause such a large amount of blood loss. A heavy show would also rarely have as heavy as a loss of 200mL.
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This question is part of the following fields:
- Obstetrics
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Question 4
Incorrect
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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.
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This question is part of the following fields:
- Physiology
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Question 5
Incorrect
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A 27-year-old woman complains of a lump in her right breast after a history of trauma to her right breast 2 weeks ago. What is the most probable diagnosis?
Your Answer:
Correct Answer: Fat necrosis
Explanation:Fat necrosis may occur following a traumatic injury to the breast. The lump is usually firm, round, and painless.
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This question is part of the following fields:
- Gynaecology
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Question 6
Incorrect
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What is the incidence of listeriosis in pregnancy?
Your Answer:
Correct Answer: 1 in 10,000
Explanation:The incidence of listeria infection in pregnant women is estimated at 12 per 100 000 compared to 0.7 per 100 000 in the general population.
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This question is part of the following fields:
- Microbiology
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Question 7
Incorrect
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A 27-year-old woman presented to the medical clinic due to infertility. Upon interview, it was noted that she has been having unprotected intercourse with her husband regularly for the past year but has not become pregnant. She mentioned that her last menstrual period was 3 weeks ago. Her menses occur every 28 to 30 days and they last 4 to 5 days. A day before her menses, she has episodes of severe lower abdominal pain that is only partially relieved by ibuprofen.
Further history taking was done and revealed that she was treated for gonococcal cervicitis at age 19. The patient also takes a prenatal vitamin every day and does not use tobacco, alcohol, or illicit drugs. Her 31-year-old husband recently had semen analysis and his results were normal.
Further examination was done and the following are her results:
Blood pressure is 126/70mmHg,
Pulse is 85/min,
BMI is 31 kg/m2.
Upon further examination and observation, it was revealed that she has a small uterus with a cervix that appears laterally displaced and there is accompanying pain upon cervical manipulation.
Which of the following is most likely considered the cause of the patient’s infertility?Your Answer:
Correct Answer: Endometriosis
Explanation:Endometriosis is a chronic gynaecologic disease characterized by the development and presence of histological elements like endometrial glands and stroma in anatomical positions and organs outside of the uterine cavity. The main clinical manifestations of the disease are chronic pelvic pain and impaired fertility. The localization of endometriosis lesions can vary, with the most commonly involved focus of the disease the ovaries followed by the posterior broad ligament, the anterior cul-de-sac, the posterior cul-de-sac, and the uterosacral ligament.
The clinical presentation of the disease differs in women and may be unexpected not only in the presentation but also in the duration. Clinicians usually suspect and are more likely to diagnose the disease in females presenting with the typical symptomatology such as dyspareunia, namely painful sexual intercourse, pelvic pain during menstruation (dysmenorrhea), pain in the urination (dysuria), defecation (dyschezia), and/or infertility. The pain is usually characterized as chronic, cyclic, and progressive (exacerbating over time). Furthermore, some women suffering from endometriosis experience hyperalgesia, a phenomenon, when even with the application of a nonpainful stimulus, an intolerable painful reaction is released. This condition indicates neuropathic pain.
Tenderness on vaginal examination, palpable nodules in the posterior fornix, adnexal masses, and immobility of the uterus are diagnostically indicating findings of endometriosis.
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This question is part of the following fields:
- Obstetrics
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Question 8
Incorrect
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A 39-year-woman visits a gynaecological clinic for fertility advice. She is unable to conceive for the last 2 years. Pelvic ultrasound shows 3-4 follicles in both ovaries. An endocrinological profile is ordered showing low oestrogen, elevated FSH, and LH.
What is the most suitable advice for her?Your Answer:
Correct Answer: In-vitro fertilization
Explanation:Premature menopause has been diagnosed biochemically in this patient. Menopause is considered premature when it happens without warning in a woman under the age of 40.
Follicular development is common in ultrasonography investigations of women with primary ovarian failure, but ovulation is rare. So this woman isn’t ovulating.Exogenous oestrogen treatment in physiologic amounts does not appear to improve the rate of spontaneous ovulation.
Women with primary ovarian failure from any cause may be candidates for donor oocyte in vitro fertilisation (IVF).Oestrogens, clomiphene citrate, and danazol are examples of treatment approaches that have been shown to be ineffective in patients with premature ovarian failure.
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This question is part of the following fields:
- Gynaecology
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Question 9
Incorrect
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Question 10
Incorrect
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What is the RCOG advice regarding timing of Rhesus Anti-D Immunoglobulin following abortion?
Your Answer:
Correct Answer: Anti-D IgG within 72 hours following abortion
Explanation:All non-sensitised RhD negative women should receive Anti-D IgG within 72 hours following abortion
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This question is part of the following fields:
- Clinical Management
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Question 11
Incorrect
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The resting pulse in pregnancy is:
Your Answer:
Correct Answer: Increased by 10 to 15 bpm
Explanation:During pregnancy cardiac output increases by 30 to 50%. As a result, the resting pulse speeds up from a normal of about 70 bpm to 80 or 90 bpm.
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This question is part of the following fields:
- Physiology
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Question 12
Incorrect
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A 25-year-old woman presents to your clinic for her routine annual check-up and Pap smear. She has a single partner who uses condoms during contraception. Her menstrual cycle is regular and around four weeks long. Her last menstrual period was 2 weeks ago. She is otherwise healthy with no symptoms suggesting a problem with her genital tract. Per vaginal examination is performed revealing a 4 cm cystic swelling in the right ovary. What would be the best next step of management?
Your Answer:
Correct Answer: See her again in six weeks and arrange an ultrasound examination if the cyst is still present.
Explanation:Because of the high possibility of spontaneous resolution and the fact that if the cystic mass was verified ultrasonically, a conservative policy would almost probably be proposed for at least another six weeks, an ultrasound examination is not necessary at this time. If the cyst is still present at the six-week check, an ultrasound examination is required, as it is likely that the cyst is a benign tumour or possibly endometriosis. It’s quite improbable that it’s cancer.
Additional tests, such as computed tomography (CT) examination and potentially surgical removal or drainage, may be required in the future, although not at this time.
This cyst in a young lady is almost probably of physiological origin, especially given its size. The woman should be informed, but a follow-up examination is required. The most suitable next action is to return in six weeks, as the cyst is most likely physiologic and will most likely dissipate naturally by then. The following appointment should not take place during the same menstrual cycle. -
This question is part of the following fields:
- Gynaecology
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Question 13
Incorrect
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A 23-year-old woman with diffuse pelvic pain and vaginal bleeding presents to the emergency room. She claims that it is around the time that she usually has her period. She has previously experienced defecation discomfort, dyspareunia, and dysmenorrhea. The patient claims that she has previously experienced similar symptoms, but that the agony has suddenly become unbearable.
Her abdomen is soft, with normal bowel sounds and no rebound soreness, according to her physical examination. There is no costovertebral discomfort and the patient does not guard. Blood in the posterior vaginal vault, a closed os, and no palpable masses or cervical motion pain are all findings on her pelvic examination.
What is the most likely diagnosis?Your Answer:
Correct Answer: Endometriosis
Explanation:Endometriosis is defined as the presence of normal endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Approximately 30-40% of women with endometriosis will be sub fertile. About one third of women with endometriosis remain asymptomatic. When they do occur, symptoms, such as the following, typically reflect the area of involvement:
– Dysmenorrhea
– Heavy or irregular bleeding
– Pelvic pain
– Lower abdominal or back pain
– Dyspareunia
– Dyschezia (pain on defecation) – Often with cycles of diarrhoea and constipation
– Bloating, nausea, and vomiting
– Inguinal pain
– Pain on micturition and/or urinary frequency
– Pain during exercisePregnancy, appendicitis, ureteral colic and ruptured ectopic pregnancy all do not present with dysmenorrhea, pain on defecation and dyspareunia. Presence of a non tender, soft abdomen also rules out these conditions.
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This question is part of the following fields:
- Gynaecology
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Question 14
Incorrect
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Which of the following best describes the mechanism of action of radiotherapy?
Your Answer:
Correct Answer: DNA damage via free radical generation
Explanation:Radiotherapy causes ionisation, primarily of water. This leads to hydroxyl and other free radicals being generated. Free radicals are highly reactive and cause DNA damage to cells via their reactions with them. Free radicals are relatively short lived and eventually form stable compounds. The DNA damage leads to cellular death.
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This question is part of the following fields:
- Biophysics
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Question 15
Incorrect
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In early pregnancy at what gestation does the Embryonic pole become visible on transvaginal ultrasound?
Your Answer:
Correct Answer: 5 weeks + 3 days
Explanation:The gestational sac can be visualized from as early as 4–5 weeks of gestation and the yolk sac at about 5 weeks (Figure 6.3). The embryo can be observed and measured at 5–6 weeks gestation.
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This question is part of the following fields:
- Biophysics
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Question 16
Incorrect
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The most common cause of abnormal vaginal discharge in a sexually active 19-year-old female is:
Your Answer:
Correct Answer: Mixed vaginal flora
Explanation:Bacterial vaginosis is the most common cause of acute vaginitis, accounting for up to 50% of cases in some populations. It is usually caused by a shift in normal vaginal flora- Mixed vaginal flora is considerably more common as a cause of vaginal discharge than – albicans and T. vaginalis.
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This question is part of the following fields:
- Gynaecology
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Question 17
Incorrect
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Regarding feto-maternal blood circulation, which of the following statements is false?
Your Answer:
Correct Answer: At term the placenta receives 70% of uterine blood flow
Explanation:The placenta is important for regulating feto-maternal blood circulation, ensuring that the two circulatory systems do not come into direct contact. The placenta receives 70-80% of the uterine blood flow into the decidual spiral arteries where nutrient, waste and gaseous exchange with fetal blood takes place via the villous core fetal vessels. Deoxygenated blood arrives at the placenta via two uterine arteries while oxygenated, nutrient-rich blood is circulated back to the foetus via a single umbilical vein. The pressure in the umbilical vein is about 20 mmHg.
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This question is part of the following fields:
- Embryology
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Question 18
Incorrect
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The femoral triangle is bounded medially by which of the following structures?
Your Answer:
Correct Answer: Adductor longus
Explanation:The femoral triangle is bounded superiorly by the inguinal ligament which forms the base of the triangle, medially by the lateral border of the adductor longus and laterally by the sartorius muscle.
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This question is part of the following fields:
- Anatomy
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Question 19
Incorrect
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A 29 year old women wants to speak to you regarding infections in pregnancy. Her two year old son has sensorineural deafness as a result of infection in her previous pregnancy. She tells you he was born with a 'blueberry muffin' rash. What was the most likely infection?
Your Answer:
Correct Answer: Rubella
Explanation:The ‘Blueberry muffin’ rash is a descriptor for the rash seen in Congenital Rubella Syndrome. A similar petechial rash may also occur in CMV infection but shouldn’t be termed ‘blueberry muffin’
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This question is part of the following fields:
- Microbiology
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Question 20
Incorrect
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All of the following statements are considered correct regarding Down syndrome screening in a 40-year-old pregnant woman, except:
Your Answer:
Correct Answer: Dating ultrasound along with second trimester serum screening test has detection rate of 97 percent
Explanation:Second-trimester ultrasound markers have low sensitivity and specificity for detecting Down syndrome, especially in a low-risk population.
The highest detection rate is acquired with ultrasound markers combined with gross anomalies. Although the detection rate with this combination of markers is high in a high-risk population (50 to 75 percent), false-positive rates are also high (22 percent for a 100 percent Down syndrome detection rate).
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This question is part of the following fields:
- Obstetrics
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Question 21
Incorrect
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From which of the following spinal segments do both the internal and external anal sphincters receive their innervation?
Your Answer:
Correct Answer: S4
Explanation:The anal sphincters are responsible for closing the anal canal to the passage of faeces and flatus. The smooth muscle of the involuntary internal sphincter sustains contraction to prevent the leakage of faeces between bowel movements and is innervated by the pelvic splanchnic nerves, which are a branch of the spinal segment 4. The external sphincter is made up of skeletal muscle and can therefore contract and relax voluntarily. Its innervation comes from the inferior rectal branch of the pudendal nerve, and the perineal branch of S4 nerve roots.
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This question is part of the following fields:
- Anatomy
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Question 22
Incorrect
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The ovaries produce androgen and progesterone. What is the common precursor for both of these hormones?
Your Answer:
Correct Answer: Cholesterol
Explanation:Both the female hormones, namely progesterone and oestrogen as well as the male hormones or androgens are lipid soluble. The common precursor of these is cholesterol.
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This question is part of the following fields:
- Endocrinology
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Question 23
Incorrect
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Several mechanisms have been proposed as to what causes closure of the Ductus Arteriosus (DA) at Parturition. Which of the following is the most important in maintaining the patency of the DA during pregnancy?
Your Answer:
Correct Answer: PGE2
Explanation:Prostaglandin E1 and E2 help maintain the patency of the DA during pregnancy. PGE2 is by far the most potent and important. It is produced in large quantities by the placenta and the DA itself.
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This question is part of the following fields:
- Embryology
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Question 24
Incorrect
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A 25-year-old pregnant woman presented to your clinic complaining of urinary symptoms at 19 weeks of gestation.
She is allergic to penicillin, with non-anaphylactic presentation.
Urine microscopy confirmed the diagnosis of urinary tract infection and culture result is pending.
From the options below, which is the most appropriate treatment for this patient?Your Answer:
Correct Answer: Cephalexin
Explanation:According to the laboratory reports, patient has developed urinary tract infection and should be treated with one week course of oral antibiotics.
As the patient is pregnant, antibiotics like cephalexin, co-amoxiclav and nitrofurantoin must be considered as these are safe during pregnancy.Due to this Patient’s allergic history to penicillin, cephalexin can be considered as the best option. Risk of cross allergy would have been higher if the patient had any history of anaphylactic reactions to penicillin.
In Australia, Amoxicillin is not recommended to treat UTI due to resistance.Tetracyclines also should be avoided during pregnancy due to its teratogenic property.
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This question is part of the following fields:
- Obstetrics
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Question 25
Incorrect
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Where is Glucagon produced?
Your Answer:
Correct Answer: Islet alpha cells
Explanation:The alpha cells in the islets of Langerhans are responsible for the production and secretion of glucagon. The B cells secrete insulin, the D cells secrete somatostatin, and the F cells secrete pancreatic polypeptide. The B cells, which are the most common and account for 60–75% of the cells in the islets, are generally located in the centre of each islet.
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This question is part of the following fields:
- Endocrinology
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Question 26
Incorrect
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Which of the following arteries branches directly from the aorta?
Your Answer:
Correct Answer: Ovarian
Explanation:The uterine and vaginal arteries branch from the internal iliac artery. The ovarian artery branches direct from the aorta.
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This question is part of the following fields:
- Anatomy
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Question 27
Incorrect
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A patient arrives on labour ward she is 38 weeks pregnant. Her last and only pregnancy ended with delivery via uncomplicated lower segment C-Section 3 years ago. Contractions are 6 minutes apart and on examination and the cervix is 6cm dilated. She wants to know the chances of a successful vaginal delivery if she proceeds with a vaginal delivery after C-section(VBAC). What is the chance of successful delivery with VBAC?
Your Answer:
Correct Answer: 75%
Explanation:There is 70% chance that a women who has had a C-section can deliver via spontaneous vaginal delivery.
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This question is part of the following fields:
- Epidemiology
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Question 28
Incorrect
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What is the maximum normal diameter of the yolk sac on transvaginal ultrasound?
Your Answer:
Correct Answer: 6mm
Explanation:The yolk sac increases in size up until the 10th week reaching a maximum diameter of 6mm in normal pregnancy. After the 10th week the yolk sac will gradually disappear. It is usually sonographically undetectable by 20 weeks. A yolk sac greater than 6mm diameter is suspicious of failed pregnancy.
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This question is part of the following fields:
- Biophysics
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Question 29
Incorrect
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A 25-year-old woman comes to your clinic for advice as she is 20 weeks pregnant and was found to have thyrotoxicosis with mild enlargement of the thyroid gland.
What other investigation will you consider to be done in this patient?Your Answer:
Correct Answer: Ultrasound thyroid gland
Explanation:A 20 weeks pregnant patient has developed goitre along with thyrotoxicosis, where the diagnosis of thyrotoxicosis has already been established.
Ultrasound of the thyroid and a radioisotope scan to differentiate between “hot” and “cold” nodules are the confirming investigations for goitre. A nodule composed of cells that do not make thyroid hormone and the nodule which produces too much thyroid hormone are respectively called as cold and “hot” nodules.Due to the risk of fetal uptake of the isotope which leads to the damage of fetal thyroid, radioisotope or radionuclide Technetium uptake scan is contraindicated in pregnancy.
Fine needle aspiration cytology is required to establish a histopathological diagnosis in case of all cold nodules.
So ultrasound of the thyroid gland is the mandatory investigation to be done in this case as it will show diffuse enlargement, characteristic of the autoimmune disease, or multinodularity, which is suggestive of autonomous multinodular goitre.
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This question is part of the following fields:
- Obstetrics
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Question 30
Incorrect
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Regarding miscarriage rates, which of the following statements is correct?
Your Answer:
Correct Answer: In women over 45 years of age miscarriage rate approximately 75%
Explanation:With increasing maternal age, the risk of miscarriage increases. For women between the ages of 40-44, the miscarriage rates sit at about 50% and increases to over 75% for women 45 years and over. The miscarriage rate for women between the ages of 35-39 is 25%.
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This question is part of the following fields:
- Epidemiology
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Question 31
Incorrect
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You are called to a delivery as the midwife is concerned about CTG changes. She suggests a fetal blood sample (FBS). You inspect the cervix. At what dilatation would you NOT perform FBS?
Your Answer:
Correct Answer: Less than 3cm
Explanation:Indications for FBS:
1. Pathological CTG in labour (cervix dilated >3 cm)
2. Suspected acidosis in labour (cervix dilated >3 cm)
Contraindications to FBS:
– Maternal infection e.g. HIV, HSV and Hepatitis
– Known fetal coagulopathy
– Prematurity (< 34 weeks gestation)
– Acute fetal compromise -
This question is part of the following fields:
- Data Interpretation
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Question 32
Incorrect
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Which of the following regarding the use of tocolytics is true?
Your Answer:
Correct Answer: Use of a tocolytic drug is not associated with a clear reduction in perinatal or neonatal mortality, or neonatal morbidity
Explanation:Tocolytics are used to suppress contractions. The Canadian preterm labour trial which remains a very influential tocolytic trial to date concluded that tocolytics such as a beta agonist have no significant benefit on perinatal mortality or morbidity or prolong pregnancy to term however it did reduce the number of women delivering within 2 days by 40%. This 48 hour window is the only reason for the use of tocolytics.
Choice of tocolytic (NICE)
1st line: Nifedipine
2nd line: Oxytocin receptor antagonists e.g. atosiban -
This question is part of the following fields:
- Clinical Management
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Question 33
Incorrect
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A 52-year-old female patient on HRT for the past two years wonders how often she should have breast cancer screenings.
Which of the following responses is the most appropriate?Your Answer:
Correct Answer: Mammogram every two years until the age of 70
Explanation:Some confusion regarding breast cancer screening arose in 2009 when the U.S. Preventive Services Task Force (USPSTF) issued new mammogram guidelines. The task force recommended that screening mammograms be conducted every two years, beginning at age 50, for women with an average risk of breast cancer. For women aged 40 to 49, the decision of whether to have annual mammograms should be based on a patient’s consideration of risks vs. benefits, according to the task force.
There is no evidence that frequent screening for women on HRT helps with early detection of malignancy.
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This question is part of the following fields:
- Gynaecology
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Question 34
Incorrect
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Question 35
Incorrect
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A patient is about to undergo an elective C-section. She wants to know how long it will take for her wound to completely heal.
How much time does it take for healing by primary intention to reach full tensile strength?Your Answer:
Correct Answer: 12 weeks
Explanation:Wound healing typically undergoes different stages that include haemostasis, inflammation, proliferation and remodelling. The phases are often shortened when healing occurs by primary intention such as in a surgical wound. Remodelling, which is the major strengthening phase, takes about 3 weeks, while it takes a total of 12 weeks to reach maximum tensile strength.
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This question is part of the following fields:
- Physiology
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Question 36
Incorrect
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A 65-year-old female patient complained of two months of painless vaginal bleeding. The endometrial thickness is 6mm, according to transvaginal ultrasound. To rule out endometrial cancer, you plan to send this patient to a gynaecologist for an endometrial biopsy with or without hysteroscopy.
Which of the following characteristics in your medical history is linked to a higher risk of endometrial cancer?Your Answer:
Correct Answer: Polycystic ovary syndrome associated with chronic anovulation
Explanation:Women with polycystic ovary syndrome (PCOS) have a 2.7-fold increased risk for developing endometrial cancer. A major factor for this increased malignancy risk is prolonged exposure of the endometrium to unopposed oestrogen that results from anovulation.
Additionally, secretory endometrium of some women with PCOS undergoing ovulation induction or receiving exogenous progestin exhibits progesterone resistance accompanied by dysregulation of gene expression controlling steroid action and cell proliferation.
Other risk factors include nulliparity, early menarche and late menopause, obesity and family history of endometrial cancer. Which rules out all the other options.
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This question is part of the following fields:
- Gynaecology
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Question 37
Incorrect
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Which of the following increases the risk of endometrial hyperplasia?
Your Answer:
Correct Answer: Tamoxifen
Explanation:Tamoxifen increases risk of endometrial hyperplasia Aromatase inhibitors such as Letrozole and Anastrozole are not associated and have not been shown to increase the risk of endometrial pathology Whereas unopposed oestrogens increase endometrial cancer risk combined oral contraceptive decrease risk
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This question is part of the following fields:
- Clinical Management
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Question 38
Incorrect
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A 27-year-old woman with primary infertility presents with secondary amenorrhoea that has been ongoing for twelve months. She states that she has been thinking about starting a family and was wondering if ovulation induction therapy was an option for her.
Which one of the following would be most valuable in predicting a poor response to ovulation induction therapy?Your Answer:
Correct Answer: Serum follicle-stimulating hormone (FSH).
Explanation:The tests listed can all be performed during the work-up of a woman with secondary amenorrhoea. They are useful in that they cam diagnosis the most likely cause for the amenorrhoea as well as guide the treatment required if the patient wanted to become pregnant. Of these, the hormone test best able to predict a poor response to ovulation-induction therapy is the follicle-stimulating hormone (FSH) assay. If there are high levels of FSH, most of the ovulation-induction therapies are ineffective, although the rare spontaneous pregnancy can occur.
To maximise the chance of pregnancy in patients with elevated FSH levels, the most effective technique is an ovum donation from a young woman. The ovum would be fertilised in the laboratory and transferred to the uterus of the woman with the high FSH level after administering hormonal preparation of her uterus.
If the FSH level is normal, ovulation-induction therapy is usually effective. For these patients, correction of thyroid function will be necessary if the thyroid function is not normal. Dopamine agonist therapy is indicated if the prolactin level is elevated. Clomiphene or gonadotrophin therapy can be used where the luteinising and oestradiol levels are low, normal, or minimally elevated.
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This question is part of the following fields:
- Gynaecology
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Question 39
Incorrect
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A patient undergoes medical abortion at 9 weeks gestation. What is the advice regarding Rhesus Anti-D Immunoglobulin?
Your Answer:
Correct Answer: All RhD-negative women who are not alloimmunized should receive Anti-D IgG
Explanation:All non-sensitised RhD negative women should receive Anti-D IgG within 72 hours following abortion
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This question is part of the following fields:
- Clinical Management
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Question 40
Incorrect
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High levels of alpha feto protein are found in all, EXCEPT?
Your Answer:
Correct Answer: Trisomy 21
Explanation:Pregnant maternal serum AFP levels elevated: Neural tube defects (e.g., spina bifida, anencephaly); Omphalocele; Gastroschisis.
Pregnant maternal serum AFP low levels: Down syndrome
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This question is part of the following fields:
- Endocrinology
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Question 41
Incorrect
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Regarding pelvic inflammatory disease, which of the following is the tubal factor infertility rate?
Your Answer:
Correct Answer: 12.50%
Explanation:Pelvic inflammatory disease (PID) is a known risk factor in causing tubal infertility due to its role in tubal damage. The tubal infertility rate after one episode of PID is thought to be about 12.5%. After two episodes the risk increases to 25%, and 50% after three episodes. The usual causative agents are chlamydia and gonorrhoea.
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This question is part of the following fields:
- Clinical Management
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Question 42
Incorrect
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Where is fetal DHEA produced?
Your Answer:
Correct Answer: Adrenals
Explanation:Dehydroepiandrosterone (DHEA) is a steroid hormone synthesised from cholesterol (via Pregnenolone) by the adrenal glands. The foetus manufactures DHEA, which stimulates the placenta to form oestrogen, thus keeping a pregnancy going. Production of DHEA stops at birth, then begins again around age seven and peaks when a person is in their mid-20s
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This question is part of the following fields:
- Endocrinology
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Question 43
Incorrect
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Question 44
Incorrect
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Delayed puberty in girls is defined as?
Your Answer:
Correct Answer: Absence of breast development in girls beyond 13 years old
Explanation:Breast development occurs from the age of 9-13 at the onset of puberty. Delayed puberty is defined as the absence of breast development after the age of 13.
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This question is part of the following fields:
- Endocrinology
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Question 45
Incorrect
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The β-hCG curve in maternal serum in a normal pregnancy peaks at:
Your Answer:
Correct Answer: 10 weeks of pregnancy
Explanation:During the first 8 weeks of pregnancy, concentrations of hCG in the blood and urine usually double every 24 hours. Levels of the hormone typically peak at around 10 weeks, decline until 16 weeks, then remain constant.
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This question is part of the following fields:
- Physiology
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Question 46
Incorrect
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A 23-year-old woman complains of a tender lump that is smooth and mobile in her left breast measuring 1-2 cm. What is the most likely diagnosis?
Your Answer:
Correct Answer:
Explanation:Fibroadenoma usually occurs in younger women. These non-tender masses can be removed for aesthetic purposes. Breast cysts are common shifting masses inside the breast tissue more common in women over the age of 35.
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This question is part of the following fields:
- Gynaecology
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Question 47
Incorrect
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A 21-year-old primigravida female presents to the emergency department at 41 weeks gestation.
She complains of a nine hour history of irregular painful contractions.
On examination of her pelvis, her cervix is fully effaced, but only 2 - 3 cm dilated. The fetal head is at the level of the ischial spines in a left occipito-posterior (LOP) position. The membranes ruptured an hour ago.
What would be the best next line of management?Your Answer:
Correct Answer: Oxytocic (Syntocinon4) infusion.
Explanation:The best next line of management is to administer an oxytocic (Syntocinon) infusion.
This is because the progress of labour is slow, and it necessary to augment it. As the membranes have already ruptured, the next step is to increase the contractions and induce labour using an infusion of oxytocic (Syntocinon) infusion.
Extra fluid is also required, but this will be administered alongside the Syntocinon infusion.
A lumbar epidural block is indicated in patients with an occipito-posterior (OP) position. This should not be attempted until more pain relief is required and the progress of labour is reassessed.
A Caesarean section may be necessary due to obstructed labour or fetal distress, it is not indicated at this stage.
Taking blood and holding it in case cross-matching is ultimately required is common, but most patients do not have blood cross-matched prophylactically in case there is a need to be delivered by Caesarean section and require a transfusion.
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This question is part of the following fields:
- Obstetrics
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Question 48
Incorrect
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A 32 year old patient develops painful ulcerated genital lesions and inguinal lymphadenopathy. She is 32 weeks pregnant. You suspect genital herpes and send swabs. Which of the following is appropriate management according to the 2014 BASHH/RCOG guidelines?
Your Answer:
Correct Answer: Send bloods to check antibody status. If this supports this is a first episode genital HSV then patient should be advised to have C-section delivery
Explanation:Although acyclovir should be given, this patient is in the 3rd trimester so the course should continue until delivery. Dose will be 400mg TDS unless disseminated disease. If this is a primary HSV infection (This should be confirmed by lesion swabs to confirm HSV infection and bloods to check no antibody response i.e. evidence previous infection) then C-section is indicated.
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This question is part of the following fields:
- Microbiology
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Question 49
Incorrect
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Which of the following arteries branches directly from the aorta?
Your Answer:
Correct Answer: Ovarian
Explanation:The ovarian artery takes its origin directly from the aorta. While the uterine and the vaginal arteries are all branches of the internal iliac artery.
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This question is part of the following fields:
- Anatomy
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Question 50
Incorrect
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Which of the following describes the change from cervical columnar epithelium to stratified squamous epithelium?
Your Answer:
Correct Answer: Metaplasia
Explanation:Cells adapt to external stressors in a variety of ways. A cell can either undergo hypertrophy or hyperplasia to overcome the stress, or atrophy if unable to overcome the stress. Metaplasia occurs when fully differentiated cell lines transform into another fully differentiated cell type to adapt to a new external environment. The replacement of columnar epithelium of the cervix to a stratified squamous epithelium occurs in the squamocolumnar transformation zone in response to the exposure of an everted ectocervix to the acidic pH of the vagina at puberty and first pregnancy. Carcinoma in situ is thought to involve the immature metaplastic cells in this region.
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This question is part of the following fields:
- Pathology
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