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Question 1
Incorrect
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Which of the following is known to increase the risk of endometrial cancer?
Your Answer: Aspirin use
Correct Answer: PCOS
Explanation:The risk factors of endometrial cancer include obesity, diabetes, late menopause, unopposed oestrogen therapy, tamoxifen therapy, HRT and a family history of colorectal and ovarian carcinoma.
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This question is part of the following fields:
- Epidemiology
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Question 2
Correct
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The best confirmatory test for Turner's syndrome is done by:
Your Answer: Chromosomal analysis (Karyotyping)
Explanation:Standard karyotyping is the best confirmatory test for the diagnosis of Turner syndrome among patients who have some doubtful clinical presentations. It is done on peripheral blood mononuclear cells.
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This question is part of the following fields:
- Embryology
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Question 3
Incorrect
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A couple comes to your clinic because they haven't been able to conceive despite having had frequent sexual activity in the previous 12 months. The female partner is 35 years old and has regular menstrual cycles. The male partner is 38years old and otherwise normal.
Which of the following studies would you do next to forecast ovulation?Your Answer:
Correct Answer: Serum progesterone
Explanation:This patient has a regular and long menstrual period. The most crucial thing in this case is to rule out anovulation.
Serum progesterone concentration is the best test for detecting ovulation.
Ovulation has occurred if the level is greater than 20nmol/L.
This test should be performed 3 to 10 days prior to the start of the next anticipated period. -
This question is part of the following fields:
- Gynaecology
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Question 4
Incorrect
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During early pregnancy, a pelvic examination may reveal that one adnexa is slightly enlarged. This is most likely due to:
Your Answer:
Correct Answer: Corpus luteal cyst
Explanation:Adnexa refer to the anatomical area adjacent to the uterus, and contains the fallopian tube, ovary, and associated vessels, ligaments, and connective tissue. The reported incidence of adnexal masses in pregnancy ranges from 1 in 81 to 1 in 8000 pregnancies. Most of these adnexal masses are diagnosed incidentally at the time of dating or first trimester screening ultrasound (USS). Functional cyst is the most common adnexal mass in pregnancy, similar to the nonpregnant state. A corpus luteum persisting into the second trimester accounts for 13-17% of all cystic adnexal masses. Pain due to rupture, haemorrhage into the cyst, infection, venous congestion, or torsion may be of sudden onset or of a more chronic nature.
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This question is part of the following fields:
- Obstetrics
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Question 5
Incorrect
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A 37-year-old woman visits your office seeking oral contraceptive guidance. She is currently taking Microgynon 30 and is pleased with the results. She is married with two children, does not smoke, and is in good health.
Her blood pressure is 150/100mmHg, according to your examination. The blood pressure remains the same after 20 minutes.
Which of the following is the most appropriate next step in management?Your Answer:
Correct Answer: Start her on progestogen-only pills (POPs)
Explanation:The progestogen-only pill (POP) is a contraceptive option for women who have high blood pressure either induced by use of combined oral pills or due to other causes; as long as it is well controlled and monitored. Combined oral contraception (COC) and Depo-Provera have been implicated in increased cardiovascular risk following use. High blood pressure has been theorized to be the critical path that leads to this increased risk. POP is the recommended method for women who are at risk of coronary heart disease due to presence of risk factors like hypertension.
Stopping OCP will risk in the patient getting pregnant. Cessation of oestrogen usually reverses the blood pressure back to normal, Hence, all other options are incorrect.
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This question is part of the following fields:
- Gynaecology
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Question 6
Incorrect
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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.
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This question is part of the following fields:
- Physiology
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Question 7
Incorrect
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Regarding the urinary bladder, what type of epithelium lines it?
Your Answer:
Correct Answer: Transitional
Explanation:The urinary bladder, and most of the urinary structures are lined by epithelium called the urothelium, or the transitional epithelium. This stratified lining is divided into three parts, an apical layer, an intermediate layer and a basal layer. The transitional epithelium is available to stretch to accommodate the increased volume when the bladder is distended, without structural damage.
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This question is part of the following fields:
- Anatomy
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Question 8
Incorrect
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A 50-year-old woman, who had her last menstrual period at age 49, presented with an episode of per vaginal bleeding two weeks ago. It lasted four days in duration. A reduction in the severity of hot flushes as well as some breast enlargement preceded the bleeding episode.
What is the most likely cause of the bleeding?Your Answer:
Correct Answer: An episode of ovarian follicular activity.
Explanation:It has been found that it is possible for premenopausal hormones to persist for a period of time after attaining menopause. If one or a few ovarian follicles remain, they could produce oestrogen in response to the very elevated levels of FSH typically seen in menopause. In doing so, the woman can then bleed as a result of this physiological response. The symptoms seen in this vignette are consistent with the rise in oestrogen levels, likely due to follicular activity.
In the absence of any pathological findings such as endometrial carcinoma, this phenomenon would be the most likely cause of this post-menopausal bleed. Furthermore, it is unlikely for cervical cancer and endometrial cancer to present during the first few years following menopause. Atrophic vaginitis is unlikely to be associated with the other symptoms the patient presented with i.e. reduction in the intensity of hot flushes and breast enlargement. This patient was not stated to have any risk factors for endometrial hyperplasia such as obesity, late menopause and early menarche, which makes it a less likely diagnosis.
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This question is part of the following fields:
- Gynaecology
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Question 9
Incorrect
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A 30-year-old woman presents to you for oral contraceptive pills. Her past medical history reveals that she has migraine headaches on occasions, associated with paraesthesia's in her right arm.
Examination reveals that she weighs 120kg and has a BMI of 36.
Which one of the following would be the most appropriate contraceptive methods for her?Your Answer:
Correct Answer: Condoms
Explanation:This woman suffers from a classic migraine with focused neurological symptoms. The use of any OCP preparation containing oestrogen in such patients is strictly prohibited. Androgenic consequences of progesterone include hirsutism, acne, and weight gain. Progesterone of any sort (norgestrel, drospirenone, cyproterone, etc.) should be avoided by a lady of her size; consequently, a barrier approach such as male condoms is the best option.
It is recommended that formulations containing 20-30 mcg ethinylestradiol be evaluated first when choosing a combined oral contraceptive pill (COCP). The progesterone component can be norgestrel, drospirenone, cyproterone, and so on; however, norgestrel-containing formulations are less expensive and more accessible to patients.
For specific cases, the type of progesterone should be considered:
– Patients who have unpleasant fluid retention and weight gain as a side effect of COCPs may be administered drospirenone (Yaz®. Yasmin®)-containing preparations.
– Drospirenone inhibits the production of mineralocorticoids and does not cause fluid retention. It may even be linked to a small amount of weight reduction.
– A preparation containing cyproterone acetate is preferable if the patient has suspected polycystic ovarian syndrome (PCOS). -
This question is part of the following fields:
- Gynaecology
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Question 10
Incorrect
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Which one of the following features indicates complete placental separation after delivery?
Your Answer:
Correct Answer: All of the options given
Explanation:At the time of delivery, the most important signs of complete placental separation are lengthening of the umbilical cord, per vaginal bleeding and change in shape of uterus from discoid to globular shape. The uterus contracts in size and rises upward.
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This question is part of the following fields:
- Obstetrics
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Question 11
Incorrect
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Regarding the closure of the ductus arteriosus (DA) after birth which of the following most accurately describes the mechanisms leading to closure of the DA?
Your Answer:
Correct Answer: Increased arterial pO2, increased bradykinin & decreased Prostaglandin E2
Explanation:Normal closure of the ductus arteriosus (DA) is brought about by a number of mechanisms. Upon delivery the new born babies first breath inflates the lungs and this causes a rise in pO2. Oxygen is known to cause constriction of the DA in vivo and in vitro. In addition the decreased vascular resistance means the pressure within the lumen of the DA drops aiding closure. In addition on inflation of the lungs, the lungs produce bradykinin which stimulates smooth muscle constriction of the ductus. The most important factor is thought to be the drop in Prostaglandin E2. Prostaglandin E2 maintains patency of the Ductus in the unborn child but after birth is metabolised in the lungs and its levels fall rapidly within 3 hours of birth.
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This question is part of the following fields:
- Embryology
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Question 12
Incorrect
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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.
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This question is part of the following fields:
- Clinical Management
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Question 13
Incorrect
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A 32-year-old woman at 33 weeks of gestation presents with vaginal bleeding.
A pelvic ultrasound was done, which confirms the diagnosis of placenta praevia and you are planning a cesarean section as it is the most appropriate mode of delivery.
Which among the following is considered a possible outcome of cesarean section delivery?Your Answer:
Correct Answer: Increase risk of adhesions
Explanation:Obstetric complications during or following a cesarean section delivery include:
-Increased risk of maternal mortality.
-Increased need for cesarean sections in the subsequent pregnancies.
-Increased risk for damage to adjacent visceral organs especially bowels and bladder.
-Increased risk of infections.Increased risk for formation of adhesions is a complication after cesarean section and this is the correct response for the given question.
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This question is part of the following fields:
- Obstetrics
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Question 14
Incorrect
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According to the WHO, maternal mortality ratio is defined as which of the following?
Your Answer:
Correct Answer: Maternal deaths per 100,000 live births
Explanation:The World Health Organisation defines the maternal mortality ratio as the number of maternal deaths during a given period per 100,000 live births during the same period. This measure indicates the risk of death in a single pregnancy.
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This question is part of the following fields:
- Epidemiology
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Question 15
Incorrect
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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.
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This question is part of the following fields:
- Gynaecology
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Question 16
Incorrect
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A 31-year-old woman who is pregnant has a blood pressure reading of 160/87 mmHg. You considered Pre-eclampsia. What symptom might be expected in a patient with uncomplicated pre-eclampsia?
Your Answer:
Correct Answer:
Explanation:Extreme headache, vision defects, such as blurring of the eyes, rib pain, sudden swelling of the face, hands or feet are all consistent with pre-eclampsia. Women with the mentioned symptoms should have their blood pressure checked immediately. They should also be checked for proteinuria. Diarrhoea is not related to pre-eclampsia. Pruritus would be more related to pregnancy cholestasis. Meanwhile, bruising and abnormal LFTs are common in complicated pre-eclampsia but not in an uncomplicated one.
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This question is part of the following fields:
- Obstetrics
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Question 17
Incorrect
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A 33 year old female patient with high grade abnormality on cervical screening test was referred to see a gynaecologist at your clinic. Colposcopy reveals abnormal cells higher in the cervical canal.
What is the next step in management of this patient?Your Answer:
Correct Answer: Cone biopsy
Explanation:If abnormal cells are found high up in the cervical canal, it is critical to consider doing a cone biopsy to rule out any cervical malignancy. A cone-shaped section of the cervix containing the abnormal cells is removed under general anaesthesia.
Loop Electrosurgical Excision Procedure is a way of removing the abnormal cells from the cervix using a wire loop. First a speculum is inserted to open the vagina so the uterus can be seen. Then a solution is applied to the surface of the cervix to make the areas of abnormal cells easier to see. It is done under local anaesthesia.Cone biopsy is the only acceptable option to rule out malignancy. Cryotherapy, chemotherapy and radiotherapy are management options once malignancy has been confirmed.
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This question is part of the following fields:
- Gynaecology
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Question 18
Incorrect
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You are asked to assess a patients perineal tear following labour by vaginal delivery. You note a laceration that extends approximately a quarter of the thickness through the external anal sphincter. How would you classify this tear?
Your Answer:
Correct Answer: 3a
Explanation:1. First-degree trauma corresponds to lacerations of the skin/vaginal epithelium alone.
2. Second-degree tears involve perineal muscles and therefore include episiotomies.
3. Third-degree extensions involve any part of the anal sphincter complex (external and internal sphincters):
i Less than 50 per cent of the external anal
sphincter is torn.
ii More than 50 per cent of the external anal
sphincter is torn.
iii Tear involves the internal anal sphincter
(usually there is complete disruption of the
external sphincter).
4. Fourth-degree tears involve injury to the anal sphincter complex extending into the rectal mucosa. -
This question is part of the following fields:
- Anatomy
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Question 19
Incorrect
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Relationship of the long axis of the mother to the long axis of foetus is known as:
Your Answer:
Correct Answer: Lie
Explanation:Fetal lie refers to the relationship between the long axis of the foetus relative to the long axis of the mother. If the foetus and maternal column are parallel (on the same long axis), the lie is termed vertical or longitudinal lie.
Fetal presentation means, the part of the foetus which is overlying the maternal pelvic inlet.
Position is the positioning of the body of a prenatal foetus in the uterus. It will change as the foetus develops. This is a description of the relation of the presenting part of the foetus to the maternal pelvis. In the case of a longitudinal lie with a vertex presentation, the occiput of the fetal calvarium is the landmark used to describe the position. When the occiput is facing the maternal pubic symphysis, the position is termed direct occiput anterior.
Fetal attitude is defined as the relation of the various parts of the foetus to each other. In the normal attitude, the foetus is in universal flexion. The anatomic explanation for this posture is that it enables the foetus to occupy the least amount of space in the intrauterine cavity. The fetal attitude is extremely difficult, if not impossible, to assess without the help of an ultrasound examination.
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This question is part of the following fields:
- Obstetrics
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Question 20
Incorrect
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Among the following conditions which is not a contraindication to tocolysis?
Your Answer:
Correct Answer: Maternal hypothyroidism
Explanation:Maternal hypothyroidism which is usually treated with thyroxine is not a contraindication for suppression of labour.
Suppression of labour known as tocolysis is contraindicated in situations like suspected foetal compromise, which is diagnosed by cardiotocograph warranting delivery, in cases of placental abruption, in chorioamnionitis, in severe pre-eclampsia, cases were gestational age is more than 34 weeks, in cases of foetal death in utero and in cases where palliative care is planned due to foetal malformations. -
This question is part of the following fields:
- Obstetrics
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Question 21
Incorrect
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We can detect the fetal heart beat by Sonography (transvaginal) at:
Your Answer:
Correct Answer: 6 weeks
Explanation:The earliest fetal heart rate detected transvaginally was at 6 weeks 0 days of gestation compared with 7 weeks 0 days transabdominally. The transvaginal Doppler method was also more successful in detecting the fetal heart rate in women with a retroverted uterus (p < or = 0.01).
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This question is part of the following fields:
- Physiology
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Question 22
Incorrect
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Question 23
Incorrect
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A young couple visited your clinic for taking your opinion. The woman has a history of rheumatoid arthritis, and is on methotrexate and sulfasalazine; and they are planning to have a baby in next three months.
What will be the most appropriate management in this patient during her pregnancy?Your Answer:
Correct Answer: Stop methotrexate and continue sulfasalazine
Explanation:Rheumatoid arthritis and its prognosis during pregnancy are highly unpredictable, as the disease can improve in 75% of the cases and gets worse in 25%. During conception and pregnancy, it is advisable to avoid those rheumatoid arthritis medications which possess high risk in causing congenital disabilities. Most common such contraindicated remedies include methotrexate and leflunomide.
Drugs like Prednisone, Non-steroidal anti-inflammatory drugs and TNF inhibitors are also not considered safe during pregnancy, so if required these should be used under specialist supervision.Sulfasalazine and Antimalarials such as hydroxychloroquine are safe and can be used without much complications during pregnancy. In this given case, the patient should be advised to stop methotrexate and to continue sulfasalazine during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 24
Incorrect
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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.
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This question is part of the following fields:
- Physiology
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Question 25
Incorrect
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A 33-year-old woman is under your care during her pregnancy.
She has had only one previous pregnancy in which her foetus had spina bifida.
Identify the most appropriate assessment, from the following choices, that would aid in detection of spina bifida in her current pregnancy.Your Answer:
Correct Answer: Ultrasound of the fetal spine at 16-18 weeks of gestation.
Explanation:An ultrasound of the foetal spine at 16-18 weeks of gestation is the most appropriate assessment (correct answer).
Ultrasound performed at 11-12 weeks of gestation can diagnose anencephaly, another neural tube defect, however; any vertebral column defect is unlikely to be detected.
In most cases of neural tube defects in the foetus, elevations will be noted in maternal alpha-fetoprotein levels at 12 to 15 weeks. However, it may not be possible to detect all such abnormalities and a confirmed diagnosis cannot be made.
Additionally, elevations in alpha-fetoprotein levels do not always correlate to the presence of foetal neural tube defects.
Nuchal translucency scans do not detect neural tube defects. They are performed to identify the risk of chromosomal abnormalities in the foetus.
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This question is part of the following fields:
- Obstetrics
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Question 26
Incorrect
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What is the anterior boundary of the pelvic outlet?
Your Answer:
Correct Answer: pubic arch
Explanation:Pelvic Outlet Boundaries Anteriorly: Pubic arch Laterally: Ischial tuberosities Posterolaterally: Inferior margin of the sacrotuberous ligament Posteriorly: Tip of the coccyx Note: The pelvis outlet is also called the inferior aperture. The pelvic brim is the superior aperture
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This question is part of the following fields:
- Anatomy
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Question 27
Incorrect
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Changes in the urinary tract system in pregnancy include:
Your Answer:
Correct Answer: Increase in the glomerular filtration rate (GFR)
Explanation:Pregnancy involves remarkable orchestration of physiologic changes. The kidneys are central players in the evolving hormonal milieu of pregnancy, responding and contributing to the changes in the environment for the pregnant woman and foetus. The functional impact of pregnancy on kidney physiology is widespread, involving practically all aspects of kidney function. The glomerular filtration rate increases 50% with subsequent decrease in serum creatinine, urea, and uric acid values.
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This question is part of the following fields:
- Physiology
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Question 28
Incorrect
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The femoral triangle is bounded superiorly by which of the following structures?
Your Answer:
Correct Answer: Inguinal ligament
Explanation:Boundaries of the Femoral Triangle:
Superior: Inguinal ligament
Medial: Medial border of the adductor longus
Lateral: Medial border of the sartorius
Floor: Pectineus, Adductor longus and Iliopsoas muscles
Roof: Fascia Lata -
This question is part of the following fields:
- Anatomy
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Question 29
Incorrect
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A pregnant patient with a chest infection is worried about the radiation risk of a chest X Ray. How many days of natural background radiation is equivalent to a chest X Ray?
Your Answer:
Correct Answer: 2.5
Explanation:X-rays carry low levels of risk during pregnancy and are not a significant cause for concern if the total exposure to ionising radiation is less than 5 rads throughout the pregnancy; a chest X-ray is about 0.00007 rads. The amount of radiation generated from a chest X-ray is equivalent to 2.4 days of natural background radiation. Non-urgent radiological tests should, however, be avoided between 10-17 weeks gestation as there is a higher risk of central nervous system teratogenesis during this time.
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This question is part of the following fields:
- Biophysics
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Question 30
Incorrect
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A 24-year-old on combined oral contraceptive pills for the last 3 years. She complains of migraine two to three times a month for the last 6 months.
What should be best appropriate advice to her?Your Answer:
Correct Answer: Stop combined oral contraceptive pills and prescribe progestogen only pills
Explanation:While on combination oral contraceptive tablets, this patient had a migraine. After a conversation about adverse effects, stop the combo medications and prescribe her progestogen-only pills.
The following are reasons why progestogen-only pills should be your first choice:
1-Age of 45 or more years
2-Smokers who are 45 years old or older
3-Oestrogen contraindications
4-Melitus Diabetes
5-A headache (combined oral contraceptive pills have absolute contraindication)
6-Hypertension under control
7-Lactation
8-Chloasma.Pregnancy, undetected genital tract bleeding, and concurrent use of enzyme-inducing medications are all contraindications to using progestogen-only pills.
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This question is part of the following fields:
- Gynaecology
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Question 31
Incorrect
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Which of the following hormones is produced by the hypothalamus in response to breastfeeding?
Your Answer:
Correct Answer: Oxytocin
Explanation:Nipple stimulation during breastfeeding triggers the production of oxytocin from the hypothalamus and its subsequent release from the posterior pituitary gland. The hormone causes the myoepithelial cells of the breast to contract causing milk to flow through the ducts.
Ergometrine and Prostaglandin E2 are used during labour to control uterine bleeding after delivery, or ripen the cervix, while Atosiban is an oxytocin antagonist.
Antidiuretic hormone is also released from the posterior pituitary, and acts on the kidneys to decrease fluid excretion.
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This question is part of the following fields:
- Clinical Management
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Question 32
Incorrect
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After six weeks of amenorrhoea, a 25-year-old woman appears with stomach discomfort and vaginal bleeding. If she has a tubal ectopic pregnancy, which of the following combinations of physical indications is most likely?
Your Answer:
Correct Answer: Little guarding but marked rebound tenderness in the suprapubic region.
Explanation:Blood in the peritoneal cavity rarely causes rigidity like that of a board (this is generally only found when chemical or purulent peritonitis is present).
When there is blood, there is usually a lot of rebound soreness and a lot of guarding.
A tubal ectopic pregnancy causes discomfort and tenderness in the lower abdomen, but it is not always localised to the side of the disease.
Shock is uncommon since the diagnosis is usually recognised before there is enough blood loss to elicit such signs.
Pelvic soreness is more prevalent than a pelvic mass that may be seen on a clinical exam.
Where a mass is visible, it could be an ectopic pregnancy, but it’s more likely to be a pregnancy surrounded by a blood clot caused by a leaking ectopic pregnancy. -
This question is part of the following fields:
- Gynaecology
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Question 33
Incorrect
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In threatened abortion, which one of the following items is TRUE?
Your Answer:
Correct Answer: More than 50% will abort
Explanation:Threatened abortion:
– Vaginal bleeding with closed cervical os during the first 20 weeks of pregnancy
– Occurs in 25% of 1st-trimester pregnancies
– 50% survival
More than half of threatened abortions will abort. The risk of spontaneous abortion, in a patient with a threatened abortion, is less if fetal cardiac activity is present. -
This question is part of the following fields:
- Obstetrics
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Question 34
Incorrect
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A 46 year old women with a BMI of 34 is seen in clinic following hysteroscopy and biopsy for irregular menstrual bleeding. Histology shows hyperplasia without atypia. Following a discussion the patient declines any treatment but agrees she will try and lose weight. What is the risk of progression to endometrial cancer over 20 years?
Your Answer:
Correct Answer:
Explanation:The risk of developing endometrial carcinoma is less than 5% over 20 years if the endometrium shows hyperplasia without atypia.
There are 2 types of Endometrial Hyperplasia:
1. Hyperplasia without atypia*
2. Atypical hyperplasiaMajor Risk Factors:
Oestrogen (HRT)
Tamoxifen
PCOS
Obesity
Immunosuppression (transplant) -
This question is part of the following fields:
- Clinical Management
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Question 35
Incorrect
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Question 36
Incorrect
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A 40 year old women who is 13 weeks pregnant is found to have be high risk for Downs following the combined screening test. What is the most appropriate further test to see if the foetus is affected?
Your Answer:
Correct Answer: Chorionic Villous Sampling
Explanation:Chorion villus sampling is an invasive procedure which aims to collect the rapidly dividing cells in the placenta. It is used for numerous reasons including detection of early pregnancy, viability of the foetus, singleton pregnancy, confirm gestation age and for prenatal diagnosis of the fetal chromosomal abnormalities including diagnosis of Down’s syndrome. However it hold a 2% chance of miscarriage during the procedure. Nuchal thickness and imaging are part of the combined test that must have been performed before.
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This question is part of the following fields:
- Genetics
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Question 37
Incorrect
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In the foetus, the most well oxygenated blood flows into which part of the heart:
Your Answer:
Correct Answer: Right atrium
Explanation:The placenta accepts the blue, unoxygenated blood from the foetus through blood vessels that leave the foetus through the umbilical cord (umbilical arteries, there are two of them). When blood goes through the placenta it picks up oxygen and becomes red. The red blood then returns to the foetus via the third vessel in the umbilical cord, the umbilical vein. The red blood that enters the foetus passes through the fetal liver and enters the right side of the heart.
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This question is part of the following fields:
- Physiology
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Question 38
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 39
Incorrect
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You see a patient who is 32 weeks pregnant. She complains of tingling to the right buttock and shooting pain down the leg. You suspect Piriformis syndrome. Regarding Piriformis which of the following statements are true?
Your Answer:
Correct Answer: Insertion is onto the greater trochanter
Explanation:The proximal attachment of the piriformis muscles is from the anterior surface of sacrum and it attaches distally to the superior border of the greater trochanter of the femur. It is innervated by the anterior rami of S1 and S2.
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This question is part of the following fields:
- Anatomy
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Question 40
Incorrect
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Which of the following contraceptives primary mode of action is inhibition of ovulation?
Your Answer:
Correct Answer: Cerazette®
Explanation:Traditional POP main mode of contraceptive action: thickening of cervical mucus Desogestrel-only POP main mode of contraceptive action is inhibition of ovulation Cerazette® is the only Desogestrel-only POP in the options above. Other desogestrel brands include: Aizea® Cerelle® Nacrez® The other POPs listed are considered traditional POPs and have the following compositions: Norgeston® – Levonorgestrel 30 mcg Micronor® & Noriday® – Norethisterone 350 mcg Femulen® – Ethynediol diacetate 500 mcg
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This question is part of the following fields:
- Clinical Management
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Question 41
Incorrect
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Question 42
Incorrect
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Which one of the following features indicates fetal asphyxia?
Your Answer:
Correct Answer: Type II (late) decelerations with tachycardia
Explanation:A type II deceleration is due to placental insufficiency which can result in fetal distress and asphyxia. The fetal heart rate is lowest at the start of the contraction and returns to normal after the contraction is complete.
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This question is part of the following fields:
- Physiology
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Question 43
Incorrect
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A 28-year-old presented with vaginal bleeding after a 6-week duration of amenorrhea. The bleeding was described to be heavier than ever compared with her previous periods. Upon interview, it was noted that her menstrual cycles was ranging from 4 to 6 weeks.
A urine pregnancy test was performed and the result was positive. Upon vaginal examination, it was noted that her cervical os is closed. An endovaginal ultrasound was performed and the results showed an endometrial thickness of 12mm and an empty uterus. There was also clear adnexa, and no fluid in the pouch of Douglas was seen. A cyst in the corpus luteum of the left ovary was also noted.
Which of the following is most likely the diagnosis of the patient?Your Answer:
Correct Answer: Complete abortion
Explanation:Complete abortion is defined as a ‘complete’ passage of all conception products.
The first day of the last menstrual period and findings on any prior ultrasounds should be determined to establish the gestational age and location of the pregnancy. An abdominal exam should be performed to assess for peritoneal signs that might indicate a ruptured ectopic pregnancy or extra-uterine extension of a septic abortion. Lastly, a pelvic exam is central to the evaluation of suspected miscarriage. It should include both speculum-facilitated visualization of the cervix and a bimanual examination to assess for cervical motion tenderness that may indicate a septic abortion or an adnexal mass that may herald ectopic pregnancy.
Early pregnancy loss takes many different forms. In missed abortion, there is asymptomatic or ‘missed’ death of the embryo or foetus without sufficient uterine contractions to push out the products of conception. In contrast, threatened abortion is characterized by symptomatic, ‘threatened’ expulsion of the products of conception, yet the cervical os remains closed, and the embryo or foetus remains viable.
Although there is a lack of consensus, complete abortion is often defined as the absence of a gestational sac on ultrasound with an endometrial stripe thickness of less than 30 mm.
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This question is part of the following fields:
- Obstetrics
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Question 44
Incorrect
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Adult Polycystic Kidney Disease (PKD) typically follows which pattern of inheritance
Your Answer:
Correct Answer: Autosomal Dominant
Explanation:PKD can follow either Autosomal dominant or recessive inheritance. Autosomal dominant is however the most common inheritance pattern and is seen in adult PKD. Infantile PKD is recessive
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This question is part of the following fields:
- Endocrinology
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Question 45
Incorrect
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Question 46
Incorrect
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During her first month on OCPs, a patient had minimal bleeding at mid cycle. What is the most appropriate management?
Your Answer:
Correct Answer: Continue pills as usual.
Explanation:Breakthrough bleeding, or spotting, refers to when vaginal bleeding occurs between menstrual cycles. It may look like light bleeding or brown discharge.
Spotting is the most common side effect of birth control pills. It happens because the body is adjusting to changing levels of hormones, and the uterus is adjusting to having a thinner lining.
Taking the pill as prescribed, usually every day and at the same time each day, can help prevent bleeding between periods.
All other options are incorrect as this is a common side effect and will resolve on its own.
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This question is part of the following fields:
- Gynaecology
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Question 47
Incorrect
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What is the typical weight of a term uterus?
Your Answer:
Correct Answer: 1200g
Explanation:Uterine blood flow increases 40-fold to approximately 700 mL/min at term, with 80 per cent of the blood distributed to the intervillous spaces of the placentae, and 20 per cent to the uterine myometrium. Weight of the uterus increases from 50–60 g prior to pregnancy to 1000 g by term.
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This question is part of the following fields:
- Physiology
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Question 48
Incorrect
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Tamoxifen is associated with an increased risk of which of the following?
Your Answer:
Correct Answer: Endometrial cancer
Explanation:Tamoxifen is an oestrogen antagonist in breast tissue but it acts as a partial oestrogen agonist on the endometrium increasing the risk of hyperplasia and has been linked to endometrial cancer. Tamoxifen improves bone density in post-menopausal women. It is an off license treatment for gynaecomastia. Reduced lactation is a potential side effect of Tamoxifen.
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This question is part of the following fields:
- Pharmacology
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Question 49
Incorrect
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A 29-year-old woman was admitted to the maternity unit of a hospital due to early labour. She is considered healthy and has experienced an uncomplicated pregnancy. She asked a question regarding fetal monitoring during labour and mentioned that she has heard about cardio tocography (CTG) being helpful for assessing the baby's wellbeing and in preventing fetal problems.
Which of the following is considered the most appropriate advice to give in counselling regarding the use of CTG as a predictor of fetal outcome and satisfactory labour compared with intermittent auscultation and whether CTG monitoring is able to reduce the risk of neonatal developmental abnormalities?Your Answer:
Correct Answer: There is no evidence to support admission CTG
Explanation:Continuous CTG produces a paper recording of the baby’s heart rate and the mother’s labour contractions. Although continuous CTG provides a written record, mothers cannot move freely during labour, change positions easily, or use a birthing pool to help with comfort and control during labour. It also means that some resources tend to be focused on the need to constantly interpret the CTG and not on the needs of a woman in labour.
Continuous CTG was associated with fewer fits for babies although there was no difference in cerebral palsy; both were rare events. However, continuous CTG was also associated with increased numbers of caesarean sections and instrumental births, both of which carry risks for mothers. Continuous CTG also makes moving and changing positions difficult in labour and women are unable to use a birthing pool. This can impact on women’s coping strategies. Women and their doctors need to discuss the woman’s individual needs and wishes about monitoring the baby’s wellbeing in labour.
Future research should focus on events that happen in pregnancy and labour that could be the cause of long term problems for the baby.
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This question is part of the following fields:
- Obstetrics
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Question 50
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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SESSION STATS - PERFORMANCE PER SPECIALTY
