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Question 1
Incorrect
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Warfarin is contraindicated during pregnancy.
Which of the following complications are possible to develop if warfarin is used in second trimester of pregnancy?Your Answer:
Correct Answer: Fetal optic atrophy
Explanation:Administration of warfarin should be avoided throughout pregnancy and especially during the first and third trimesters as it have the ability to cross placenta. Intake of warfarin during 6-12 weeks of gestation can results in fetal warfarin syndrome which is characterized by the following features:
– A characteristic nasal hypoplasia
– Short fingers with hypoplastic nails
– Calcified epiphyses, namely chondrodysplasia punctata, which is evident on X-ray as stippling of the epiphyses.
– Intellectual disability
– Low birth weightAs these effects are usually dose dependent, recent estimates shows that the risk of fetal warfarin syndrome is around 5% in babies of women who requires warfarin throughout pregnancy.
Later exposure as after 12 weeks, is associated with symptoms like central nervous system anomalies, including microcephaly, hydrocephalus, agenesis of corpus callosum, Dandy-Walker malformation which is presented with complete absence cerebellar vermis and enlarged fourth ventricle, and mental retardation, as well as eye anomalies such as optic atrophy, microphthalmia and Peter anomaly (anterior segment dysgenesis).
Those newborns exposed to warfarin in all three trimesters there will be blindness and other complication of exposed to warfarin in neonates include perinatal intracranial and other major bleeding episodes. -
This question is part of the following fields:
- Obstetrics
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Question 2
Incorrect
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Which of the following best describes the muscles assessed by urodynamic testing?
Your Answer:
Correct Answer: Detrusor and urethral sphincter muscles
Explanation:Urodynamics is a broad term that comprises cytometry, urethral pressure measurement, leak point pressure, pressure flow studies, EMG and videourodynamics. They assess the function of the bladder and urethra as a functional unit. This may provide information such as the site of bladder outlet obstruction, overactivity of the detrusor and sphincter weakness. In muscular terms the detrusor and sphincter muscles are being assessed.
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This question is part of the following fields:
- Biophysics
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Question 3
Incorrect
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What form is 99% of body calcium found in?
Your Answer:
Correct Answer: Calcium Phosphate
Explanation:Calcium phosphate salts are the most abundant form of calcium in the body, making up 99%. The majority of these salts are stored in the skeleton in different forms, mostly, hydroxyapatite, a lattice-like crystal composed of calcium, phosphates and hydroxide. The remaining calcium can be found in the extracellular fluid, tissues and skeletal muscle.
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This question is part of the following fields:
- Physiology
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Question 4
Incorrect
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A 53 year old lady presents to clinic due to vulval itch and discolouration. examination reveals pale white discoloured areas to the vulva. A biopsy shows epidermal atrophy with sub-epidermal hyalinization and deeper inflammatory infiltrate. What is this characteristic of?
Your Answer:
Correct Answer: Lichen Sclerosus
Explanation:Lichen sclerosus is characterized by hypopigmented atrophic plaque in the perineal region along with features of pruritis and dyspareunia.
It is more common in post menopausal women and on histology there is epidermal atrophy, inflammatory infiltrate in the dermis and basal layer degeneration.Vitiligo is characterised by hypopigmentation but without any other symptoms.
Extramammary Paget’s disease is characterized by erythematous plaque located mostly in the perianal region but its histology is different.
Lichen simplex chronicus is a chronic scaly pruritic condition characterized by itchy papules and plaques plus lichenification and it mostly results from chronic irritation and itching of the area. -
This question is part of the following fields:
- Clinical Management
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Question 5
Incorrect
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A 36-year-old woman presents to the gynaecology clinic with a complaint of headache, irritability, abdominal bloating, anxiety, and breast tenderness around 4 to 5 days before menstruation for the last 8 months. There's also a limitation on daily activities and she has to take a week off from work. The patient's symptoms are relieved completely with the onset of menstruation.
Which of the following suggests an appropriate diagnosis?Your Answer:
Correct Answer: Premenstrual syndrome
Explanation:This patient meets the diagnostic criteria for premenstrual syndrome.
Affective and somatic symptoms over the five days before menses in each of the three previous menstrual cycles are diagnostic criteria for premenstrual syndrome.
Affective symptoms include:
– Depression.
– Anger outbursts.
– Irritability.
– Anxiety.
– Confusion.
– social withdrawal.
Somatic symptoms include:
– breast tenderness
– abdominal bloating
– headache and swelling of extremities.
Symptoms normally disappear within four days of menstruation and are present even when no medical therapy, drugs, or alcohol are used.Premenstrual dysphoric disorder is a severe form of premenstrual syndrome marked by intense melancholy, emotional lability with frequent crying, loss of interest in daily activities, reduced focus, exhaustion, sleeplessness, and a sense of being overwhelmed or out of control.
Symptoms must have been present for the majority of the previous 12 months, interfering with daily activities.The diagnoses of generalised anxiety disorder and depression alone are doubtful.
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This question is part of the following fields:
- Gynaecology
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Question 6
Incorrect
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A 25 year old pregnant woman presents with constant abdominal pain, which has been present for the last few hours. Before the pain started she admits experiencing vaginal blood loss. She's a primigravida in her 30th week of gestation. Upon abdominal examination the uterus seems irritable. CTG is, however, reactive. What is the most probable diagnosis?
Your Answer:
Correct Answer: Antepartum haemorrhage
Explanation:Antepartum haemorrhage presents with bleeding, which may or may not be accompanied by pain. Uterine irritability would suggest abruptio, however contractions are present which may be confused with uterine irritability and in this case, there are no signs of pre-eclampsia present.
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This question is part of the following fields:
- Obstetrics
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Question 7
Incorrect
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Regarding the diagnosis of Gestational Diabetes which of the following tests is recommended by the WHO for diagnosis?
Your Answer:
Correct Answer: 75g OGTT with 2 hour glucose
Explanation:Gestational diabetes (GDM) occurs in 2–9 per cent of all pregnancies. Screening for diabetes in pregnancy can be justify ed to diagnose previously unrecognized cases of pre-existing diabetes and to identify a group of women who are at risk of developing NIDDM later in life. No single screening test has been shown to be perfect in terms of high sensitivity and specific city for gestational diabetes. Urinary glucose is unreliable, and most screening tests now rely on blood glucose estimation, with an oral 75g glucose tolerance test commonly used. The aim of glucose control is to keep fasting levels between 3.5 and 5.5 mmol/L and postprandial levels 7.1 mmol/L, with insulin treatment usually indicated outside these ranges.
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This question is part of the following fields:
- Clinical Management
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Question 8
Incorrect
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What is the prevalence of antiphospholipid syndrome in patients with recurrent miscarriage?
Your Answer:
Correct Answer: 15%
Explanation:Anti phospholipid syndrome is an autoimmune disorder in which abnormal antibodies are formed which increases the risk of blood clots to develop in vessels and leads to recurrent miscarriages to occurs. The changes of recurrent miscarriage in a previously known case of APL is 15%.
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This question is part of the following fields:
- Clinical Management
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Question 9
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 10
Incorrect
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A 32 year old lady with known stage III cervical cancer presents to A&E with lower abdominal and unilateral flank pain. From the following list what is the likely diagnosis?
Your Answer:
Correct Answer: Ureteric Obstruction
Explanation:In stage III cervical cancer there is involvement of the pelvic wall and ureter which may result in abdominal pain and hydronephrosis.
2010 FIGO classification of cervical carcinoma
Stage
0 – Carcinoma in situ
1 – Confined to the cervix (diagnosed microscopy)
1A1 – Less than 3mm depth & 7mm lateral spread
1A2 – 3mm to 5mm depth & less than 7mm lateral spread
1B1 – Clinically visible lesion or greater than A2 & less than 4 cm in greatest dimension
1B2 – Clinically visible lesion, Greater than 4 cm in greatest dimension
2 – Invades beyond uterus but not to pelvic wall or lower 1/3 vagina
2A1 – Involvement of the upper two-thirds of the vagina, without parametrical invasion & Less than 4cm
2A2 – Greater than 4 cm in greatest dimension
2B – Parametrial involvement
3 – Extends to Pelvic side wall or lower 1/3 vagina or hydronephrosis
3A – No pelvic side wall involvement
3B – Pelvic side wall involved or hydronephrosis
4 – Extends beyond true pelvis
4A – Invades mucosa bladder and rectum
4B – Distant Metastasis -
This question is part of the following fields:
- Clinical Management
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Question 11
Incorrect
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A 50-year-old menopausal woman complained of regular hot flushes that interfered with her sleep and job. She had a ten-year history of oestrogen-dependent breast cancer.
What is the most effective treatment for her symptoms?Your Answer:
Correct Answer: Paroxetine
Explanation:Paroxetine is an SSRI used for hot flushes in women with contraindication for hormonal therapy.
Hormonal or other pharmacotherapy is usually needed for women with bothersome hot flashes. For most women with moderate to very severe hot flashes and no contraindications, we suggest MHT. Women with an intact uterus need both oestrogen and a progestin, while those who have undergone hysterectomy can receive oestrogen only. For women interested in MHT, the first step is to determine the potential risks for the specific individual.
The majority of perimenopausal and recently menopausal women are good candidates for short-term hormone therapy for symptom relief. However, for women with a history of breast cancer, coronary heart disease (CHD), a previous venous thromboembolic event (VTE) or stroke, or those at moderate or high risk for these complications, alternatives to hormone therapy should be suggested. For women with moderate to severe hot flashes who are not candidates for hormone therapy based upon their breast cancer, CHD, or VTE risk and for those who choose not to take MHT, we suggest nonhormonal agents. The agents most commonly used include SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), antiepileptics, and centrally acting drugs.
Black Cohosh is found to be no more significant than placebo.
Long-term use of mefenamic acid is controversial and not recommended. -
This question is part of the following fields:
- Gynaecology
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Question 12
Incorrect
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A 35 year old lady presented in her 3rd trimester with severe features of pre-eclampsia. The drug of choice to prevent the patient going into impending eclampsia would be?
Your Answer:
Correct Answer:
Explanation:The drug of choice for eclampsia and pre-eclampsia is magnesium sulphate. It is given as a loading dose of 4g i/v over 5 minutes, followed by an infusion for the next 24 hours at the rate of 1g/hr. If the seizures are not controlled, an additional dose of MgSO4 2-4gm i/v can be given over five minutes. Patients with eclampsia or pre-eclampsia can develop any of the following symptoms: persistent headache, visual abnormalities like photophobia, blurring of vison or temporary blindness, epigastric pain, dyspnoea and altered mental status.
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This question is part of the following fields:
- Obstetrics
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Question 13
Incorrect
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A 26-year-old pregnant female in her first trimester was brought to the labour room with complaints of painless vaginal bleeding. On examination, her abdomen was non-tender and os was closed. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Threatened miscarriage
Explanation:Threatened miscarriage is a term used to describe any abnormal vaginal bleeding that occurs in first trimester, sometime associated with abdominal cramps. The cervix remains closed and the pregnancy may continue as normal.
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This question is part of the following fields:
- Obstetrics
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Question 14
Incorrect
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Following parturition uterine contractions called Afterpains may typically continue for how long?
Your Answer:
Correct Answer: 2-3 days
Explanation:Oxytocin can also stimulate after pains that occur 2-3 following delivery.
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This question is part of the following fields:
- Clinical Management
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Question 15
Incorrect
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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)
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This question is part of the following fields:
- Microbiology
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Question 16
Incorrect
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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.
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This question is part of the following fields:
- Data Interpretation
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Question 17
Incorrect
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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.
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This question is part of the following fields:
- Microbiology
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Question 18
Incorrect
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A 22-year-old pregnant woman attends clinic for a fetal scan at 31 weeks. She complains of difficulty breathing and a distended belly. U/S scan was done showing polyhydramnios and an absent gastric bubble. What is the most likely diagnosis?
Your Answer:
Correct Answer: Oesophageal atresia
Explanation:Oesophageal atresia of the foetus interrupts the normal circulation of the amniotic fluid. This causes polyhydramnios and subsequent distension of the uterus impacting proper expansion of the lungs. This would explain the difficulty breathing.
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This question is part of the following fields:
- Obstetrics
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Question 19
Incorrect
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A 27-year-old woman presents to her general practitioner because of secondary amenorrhoea since the last 12 months.
She has a history of primary infertility.
Of the hormone assays listed in the options, identify the assay that would indicate pregnancy if its result is significantly elevated.Your Answer:
Correct Answer: Serum luteinising hormone {LH).
Explanation:The levels of oestradiol (E2), progesterone, and prolactin (PRL) are all elevated during early pregnancy. However these elevations cannot be solely relied on to determine if pregnancy has occurred since increased levels of these hormones can also occur in pathologic states in non-pregnant women or, in some cases, even during menstrual cycles.
The levels of follicle stimulating hormone (FSH) are suppressed in pregnancy because of the elevated E2 and progesterone levels.
The correct answer is elevated levels of luteinising hormone (LH). This is because the beta sub-units of LH and human chorionic gonadotrophin (hCG) are almost identical and therefore, hCG is measured as LH in almost all LH assays (correct answer).
The LH levels can be slightly raised in polycystic ovarian syndrome; however, it is unlikely that the levels would increase above 30 mIU/mL in this condition.
The mid-cycle levels of LH can go up to 100-150 mIU/mL. If the levels are more than 200 mlU/mL, it usually indicates pregnancy.
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This question is part of the following fields:
- Gynaecology
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Question 20
Incorrect
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An 19-year-old woman comes to your clinic complaining of painful menses for the past year. She was given NSAIDs at first, then OCPs after the NSAIDs failed to control her symptoms. OCP has also struggled to regulate the painful menses.
Which of the following would be the best next step in your management?Your Answer:
Correct Answer: Transvaginal ultrasound
Explanation:Adolescents who fail to respond to first- or second-line treatment and have recurrent symptoms or have symptoms that worsen over time should be re-evaluated for other possible and serious causes of secondary dysmenorrhea such as endometriosis, uterine leiomyomas, polyps, or pelvic pathologies.
When pelvic pathology is suspected, abdominal and transvaginal ultrasonography should be used as first-line investigation. However, transvaginal ultrasound is more accurate and the preferred option if possible.
CT scan is not indicated in the assessment of dysmenorrhea.
D&C and laparoscopy can be considered as treatment options once a diagnosis has been established but can not be used as primary steps in diagnosis of dysmenorrhea.
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This question is part of the following fields:
- Gynaecology
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Question 21
Incorrect
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What is the anterior boundary of the pelvic outlet?
Your Answer:
Correct Answer: pubic arch
Explanation:The pelvic outlet is bounded anteriorly by the inferior border of the pubic arch, posteriorly by the sacrotuberous ligament and the tip of the coccyx and laterally by the ischial tuberosities.
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This question is part of the following fields:
- Anatomy
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Question 22
Incorrect
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What is the mode of action of Mefenamic acid?
Your Answer:
Correct Answer: Inhibits Prostaglandin Synthesis
Explanation:Mefenamic acids is a NSAID. It works by inhibiting prostaglandin synthesis – It inhibits COX-1 and COX-2 hence reducing the process of inflammation. Activation of antithrombin III and inactivation of factor Xa is the primary mechanism of action of Heparin.
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This question is part of the following fields:
- Clinical Management
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Question 23
Incorrect
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A 35 year old female presented with complaints of a 3 cm lump in her right breast, which was firm & irregular. O/E there was also some colour change over the breast. The most likely diagnosis would be?
Your Answer:
Correct Answer:
Explanation:Breast carcinoma is one of the most common malignancies in women. It presents as an irregular, firm consistency nodule/lump, which is attached to the skin most of the time. The overlying skin also exhibits a peau d’ orange appearance, along with dimpling. A sebaceous cyst is a small cystic swelling with no colour change and can occur anywhere over the skin. A lipoma is a benign tumour of fats which is soft in consistency.
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This question is part of the following fields:
- Gynaecology
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Question 24
Incorrect
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A 35 year old primigravida was in labour for 24 hours and delivered after an induction. She developed postpartum haemorrhage. Which of the following is the most likely cause for PPH?
Your Answer:
Correct Answer: Atonic uterus
Explanation:Uterine atony and failure of contraction and retraction of myometrial muscle fibres can lead to rapid and severe haemorrhage and hypovolemic shock. Poor myometrial contraction can result from fatigue due to prolonged labour or rapid forceful labour, especially if stimulated.
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This question is part of the following fields:
- Obstetrics
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Question 25
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 26
Incorrect
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When consenting someone for laparoscopy you discuss the risk of vascular injury. The incidence of vascular injury during laparoscopy according to the BSGE guidelines is?
Your Answer:
Correct Answer: 0.2/1000
Explanation:Major vessel injury is the most important potential complication when undertaking laparoscopy. It’s incidence is 0.2/1000. Bowel Injury is more common at 0.4/1000
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This question is part of the following fields:
- Clinical Management
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Question 27
Incorrect
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Regarding heart rate in pregnancy which of the following statements is true?
Your Answer:
Correct Answer: Heart rate increases by 15 beats per minute
Explanation:The following cardiovascular changes occur during pregnancy:
– Blood volume slowly increases by 40-50%
– Heart rate rises by 15 beats/min above baseline
– Stroke volume increases by 25-30%
– Cardiac output increases by approximately 30-50%
– Systemic vascular resistance (SVR) decreases by 20-30%
– Diastolic blood pressure consequently decreases between 12 and 26 weeks but increases again to pre-pregnancy levels by 36 weeks.
As most of the changes occur in the first 12 weeks of gestation cardiac problems are likely to present in early pregnancy -
This question is part of the following fields:
- Physiology
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Question 28
Incorrect
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A 30-year-old primigravida was admitted to the hospital in active labor. On admission, her cervix was 7 cm dilated and 100% effaced. She received epidural anesthesia and proceeded to complete cervical dilation with fetal head at +3 station within a few hours.Patient who has been pushing for 4 hours is exhausted now and says she cannot feel her contractions, nor knows when to push because of the epidural anesthesia.Patient had no complications during the pregnancy and has no chronic medical conditions.
Estimated fetal weight by Leopold maneuvers is 3.4 kg (7.5 lb), patient's vital signs are normal and fetal heart rate tracing is category 1.Tocodynamometer indicates contractions every 2-3 minutes and a repeat cervical examination shows complete cervical dilation with the fetal head at +3 station, in the left occiput anterior position with no molding or caput.
Among the following, which is considered the best next step in management of this patient?Your Answer:
Correct Answer: Perform vacuum-assisted vaginal delivery
Explanation:The period from attaining a complete cervical dilation of 10 cm to fetal delivery is considered as the second stage of labor. In the given case patient have achieved an excellent fetal descent to +3 due to her average-sized infant of 3.4 kg, suitable pelvis (no fetal molding or caput, suggesting no resistance against the bony maternal pelvis), and a favorable fetal position of left occiput anterior.
But with no further fetal descent the patient fulfills the following criterias suggestive of second-stage arrest like:
≥3 hours of pushing in a primigravida without an epidural or ≥4 hours pushing with an epidural, as in this patient
OR
≥2 hours of pushing in a multigravida without an epidural or ≥3 hours pushing with an epidural.As continued pushing without any effect will lead to complications like postpartum hemorrhage, limiting the chances of spontaneous vaginal delivery, it is better to manage this case by operative vaginal delivery procedures like vacuum-assisted delivery, to expedite delivery. maternal exhaustion, fetal distress, and maternal conditions like hypertrophic cardiomyopathy, in which the Valsalva maneuver is not recommended are the other indications for performing an operative vaginal delivery.
Fundal pressure is the technique were external pressure is applied to the most cephalad portion of the uterus, were the applied force is directed toward the maternal pelvis. The maneuver was not found to be useful in improving the rate of spontaneous vaginal deliveries.
Epidurals will not arrest or affect spontaneous vaginal delivery rates, instead they just lengthen the second stage of labor. Also an appropriate analgesia is a prerequisite to use in operative vaginal delivery.
Manual rotation of an infant to a breech presentation for breech vaginal delivery is called as internal podalic version. It is contraindicated in singleton deliveries due to the high risk associated with breech vaginal delivery in regards to neonatal mortality and morbidity.
The ideal fetal head position in vaginal delivery is occiput anterior (OA) as the flexed head in this provides a smaller diameter and facilitates the cardinal movements of labor. The occiput posterior (OP) position, in contrast to OA, presents with a larger-diameter head due to the deflexed position. So the chance for spontaneous vaginal delivery will be decreased if fetal head is rotated to OP position.
A lack of fetal descent after ≥4 hours of pushing in a primigravida with an epidural (≥3 hours without) or ≥3 hours in a multigravida with an epidural (≥2 hours without) is defined as second stage arrest of labor. The condition is effectively managed with operative vaginal delivery procedures like vacuum-assisted delivery. Other common indications for operative vaginal delivery are maternal exhaustion, fetal distress, and maternal conditions where the Valsalva maneuver is not recommended.
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This question is part of the following fields:
- Obstetrics
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Question 29
Incorrect
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What type of virus is the Rubella virus?
Your Answer:
Correct Answer: Single stranded RNA (ssRNA)
Explanation:Rubella virus is the only member of the genus Rubivirus and is a type of Togavirus (Togaviridae). It is a single stranded RNA virus. Note for the exam if you are unsure – most RNA viruses encountered in clinical practice are single stranded. The exception is rotavirus which is dsRNA virus. RNA viruses that use DNA during their replication are classed as retroviruses (HIV is an example)
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This question is part of the following fields:
- Microbiology
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Question 30
Incorrect
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What is the male infertility rate in CF patients?
Your Answer:
Correct Answer: 98%
Explanation:Cystic fibrosis is the most common fetal genetic disease in Caucasians and has an autosomal recessive inheritance. It is caused by an abnormal chloride channel due to a defect in the CFTR gene. Complications range from haemoptysis, respiratory failure, biliary cirrhosis, diabetes and male infertility. Men with CF are infertile in 98% of the cases due to failure of development of the vas deference.
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This question is part of the following fields:
- Clinical Management
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Question 31
Incorrect
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The typical female breast contains how many lobes?
Your Answer:
Correct Answer: 15-20
Explanation:The female breast is made of about 15 to 20 individual lobes. The lobules each consists of alveoli which drain into a single lactiferous duct. The ductal system leads to lactiferous sinuses and collecting ducts which expel milk from openings in the nipple.
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This question is part of the following fields:
- Anatomy
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Question 32
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 33
Incorrect
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All of the following are characteristic features of normal labour, except:
Your Answer:
Correct Answer: Moderate bleeding
Explanation:Normal labour is characterized by spontaneous onset, rhythmical uterine contractions along with vertex presentation. Cervical dilatation starts from the 1st stage of labour and intensity of the uterine contractions increases with passing time. Bleeding occurs after the child is expelled and the average loss is about 250-500 ml in a normal vaginal delivery.
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This question is part of the following fields:
- Obstetrics
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Question 34
Incorrect
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A 30-year-old woman has a vaginal discharge with pH <4.5 and a very foul smell. What is the single most likely diagnosis?
Your Answer:
Correct Answer: Trichomoniasis
Explanation:Trichomoniasis is a common sexually transmitted infection caused by a parasite. In women, trichomoniasis can cause a foul-smelling vaginal discharge which might be white, grey, yellow or green, genital itching and painful urination.
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This question is part of the following fields:
- Gynaecology
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Question 35
Incorrect
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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.
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This question is part of the following fields:
- Microbiology
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Question 36
Incorrect
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A 29-year-old woman presents to the emergency department of your hospital complaining of fever, she had given birth to a healthy male baby four days ago. During vaginal delivery, she sustained small vaginal laceration, suture repair was not done as the lesion were small. Presently she is breastfeeding her baby.
Physical examination shows no uterine tenderness and the rest of the examinations were unremarkable.
Which of the following can be the most likely cause of this Patient's fever?Your Answer:
Correct Answer: Infection of the unrepaired vaginal laceration
Explanation:As the time of onset of fever is the 4th day of postpartum and absence of uterine tenderness on exam makes infection of vaginal laceration the most likely cause of this presentation.
Exquisite uterine tenderness will be experienced in case of endometritis and symptoms are expected to start much earlier like by 2-3 days of postpartum.
UTI is often expected on days one or two of postpartum, also there are no urinary symptoms suggestive of UTI
Breast engorgement usually develops by 7th -2st day of postpartum and in the given case it’s too soon for it to occur.
As it is expected during the first 2 hours postpartum, Atelectasis is unlikely to be the cause of symptoms in the given case.
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This question is part of the following fields:
- Obstetrics
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Question 37
Incorrect
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What is the Gold standard investigation to diagnose abnormal uterine bleeding?
Your Answer:
Correct Answer: Hysteroscopy along with dilatation and curettage
Explanation:During the last decade hysteroscopy has become the tool of choice for the evaluation of the endometrial cavity, including for assessment of abnormal uterine bleeding (AUB). Many clinicians would consider that, in most patients, the combination of transvaginal sonography and out-patient endometrial biopsy with diagnostic hysteroscopy could replace the need for dilation and curettage. Hysteroscopy was reported to have sensitivity, specificity, negative predictive value and positive predictive value of 94.2, 88.8, 96.3 and 83.1% respectively, in predicting normal or abnormal endometrial histopathology.
The highest accuracy of hysteroscopy was in diagnosing endometrial polyps, whereas the worst result was in estimating hyperplasia. Therefore, since the incidence of focal lesions in patients with AUB is high, it seems that the most beneficial approach is to proceed with hysteroscopy complemented by endometrial biopsy early in the assessment of AUB.
Transabdominal and transvaginal ultrasounds can be used but are inferior to hysteroscopy.
Coagulation profile can only diagnose possible coagulopathies and pregnancy test can only diagnose pregnancy. All other causes can not be identified with these laboratory investigations.
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This question is part of the following fields:
- Gynaecology
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Question 38
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:Wound healing is initiated when inflammation begins. Macrophages predominate after neutrophils and peak 3-4 days after inflammation begins. They destroy and phagocytose the organism and debris using enzymes. The next step is the resolution of inflammation and healing of the wound.
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This question is part of the following fields:
- Physiology
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Question 39
Incorrect
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A 28 year old patient complains of vaginal soreness and discharge. Examination reveals vulval irritation and a 'strawberry' cervix. A wet smear is sent for microscopy which confirms trichomoniasis. What percentage of trichomoniasis cases would you expect to see a strawberry cervix?
Your Answer:
Correct Answer: 2%
Explanation:Trichomoniasis is caused by trichomonas. It is sexually transmitted. It is diagnosed on microscopy of vaginal discharge and cultured in Finn-Berg Whittington medium. It is characterised by valval itching, foul smelling discharge and appearance of strawberry cervix due to presence of punctate haemorrhages which occur in 2% of the cases.
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This question is part of the following fields:
- Clinical Management
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Question 40
Incorrect
-
Prognathism and macroglossia are features of which of the following?
Your Answer:
Correct Answer: Acromegaly
Explanation:These are features of excess growth hormone i.e. Acromegaly. Down’s and Cri du chat typically cause Micrognathia (small jaw)
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This question is part of the following fields:
- Endocrinology
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Question 41
Incorrect
-
A 36 year old patient is diagnosed with cervical cancer and staging investigations show there is parametrial involvement but it is confined within the pelvic wall and does not involve the lower 1/3 vagina. There is no evidence of hydronephrosis. What FIGO stage is this?
Your Answer:
Correct Answer: 2B
Explanation:It is stage 2B. Stage I: is strictly confined to the cervix; extension to the uterine corpus should be disregarded. The diagnosis of both Stages IA1 and IA2 should be based on microscopic examination of removed tissue, preferably a cone, which must include the entire lesion.
2010 FIGO classification of cervical carcinoma:
Stage IA: Invasive cancer identified only microscopically. Invasion is limited to measured stromal invasion with a maximum depth of 5 mm and no wider than 7 mm.
Stage IA1: Measured invasion of the stroma no greater than 3 mm in depth and no wider than 7 mm diameter.
Stage IA2: Measured invasion of stroma greater than 3 mm but no greater than 5 mm in depth and no wider than 7 mm in diameter.Stage IB: Clinical lesions confined to the cervix or preclinical lesions greater than Stage IA. All gross lesions even with superficial invasion are Stage IB cancers.
Stage IB1: Clinical lesions no greater than 4 cm in size.
Stage IB2: Clinical lesions greater than 4 cm in size.Stage II: carcinoma that extends beyond the cervix, but does not extend into the pelvic wall. The carcinoma involves the vagina, but not as far as the lower third.
Stage IIA: No obvious parametrial involvement. Involvement of up to the upper two-thirds of the vagina.
Stage IIB: Obvious parametrial involvement, but not into the pelvic sidewall.Stage III: carcinoma that has extended into the pelvic sidewall. On rectal examination, there is no cancer-free space between the tumour and the pelvic sidewall. The tumour involves the lower third of the vagina. All cases with hydronephrosis or a non-functioning kidney are Stage III cancers.
Stage IIIA: No extension into the pelvic sidewall but involvement of the lower third of the vagina.
Stage IIIB: Extension into the pelvic sidewall or hydronephrosis or non-functioning kidney.Stage IV: carcinoma that has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum.
Stage IVA: Spread of the tumour into adjacent pelvic organs.
Stage IVB: Spread to distant organs. -
This question is part of the following fields:
- Clinical Management
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Question 42
Incorrect
-
Pregnant patients are at higher risk of thromboembolism due to a hypercoagulable state. Which of the following clotting factors reduces during pregnancy?
Your Answer:
Correct Answer: Factor XI
Explanation:Pregnancy is a hypercoagulable state, which means that risk of thromboembolism is increased. The main reason is an increase in clotting factors II, factor VII, fibrinogen, factor X and factor XII, whereas factors XI and factor XIII are reduced. Naturally occurring anticoagulants i.e. protein C and protein S are both decreased thus increasing the risk of thrombus formation.
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This question is part of the following fields:
- Clinical Management
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Question 43
Incorrect
-
A 26 year old patient who is currently 24 weeks pregnant presents with vaginal discharge. Swabs show Chlamydia Trachomatis detected. Which of the following is the most appropriate treatment regime?
Your Answer:
Correct Answer: Erythromycin 500 mg twice a day for 14 days
Explanation:The following treatment regimes are recommended for the treatment of Chlamydia in Pregnancy: Erythromycin 500mg four times a day for 7 days or Erythromycin 500 mg twice a day for 14 days or Amoxicillin 500 mg three times a day for 7 days or Azithromycin 1 gm stat (only if no alternative, safety in pregnancy not fully assessed) The following treatment regimes are recommended for the treatment of Chlamydia in NON-PREGNANT patients: Doxycycline 100mg bd for 7 days OR Azithromycin 1gm orally in a single dose NOTE: Doxycycline and Ofloxacin are contraindicated in pregnancy
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This question is part of the following fields:
- Clinical Management
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Question 44
Incorrect
-
What is the lower reference limit for sperm concentration according to the WHO criteria?
Your Answer:
Correct Answer: 15 million spermatozoa per ml
Explanation:WHO guidelines
Semen volume: Greater than or equal to 1.5 ml
pH: Greater than or equal to 7.2
Sperm concentration: Greater than or equal to 15 million spermatozoa per ml
Total sperm number: 39 million spermatozoa per ejaculate or more
Total motility (% of progressive motility and nonprogressive motility): 40% or more motile or 32% or more with progressive motility
Vitality: 58% or more live spermatozoa
Sperm morphology (percentage of normal forms): 4% or more -
This question is part of the following fields:
- Data Interpretation
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Question 45
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.
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This question is part of the following fields:
- Physiology
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Question 46
Incorrect
-
A 23-year-old woman, G1PO comes to your clinic at 12 week of pregnancy. She is complaining of mild vaginal bleeding for the past 12 hours, along with bouts of mild cramping lower abdominal pain.
On vaginal examination, the cervical os is closed with mild discharge containing blood clots and an ultrasonography confirms the presence of a live fetus with normal heart rate.
Which among of the following is the most likely diagnosis?Your Answer:
Correct Answer: Threatened abortion
Explanation:Uterine bleeding in the presence of a closed cervix along with sonographic visualization of an intrauterine pregnancy with detectable fetal cardiac activity are diagnostic of threatened abortion.
Abortion does not always follow a uterine bleeding in early pregnancy, sometimes not even after repeated episodes or large amounts of bleeding, that is why the term “threatened” is used in this case. In about 90 to 96% cases, the pregnancy continues after vaginal bleeding if occured in the presence of a closed os and a detectable fetal heart rate. Also as the gestational age advances its less likely the condition will end in miscarriage.
In cases of inevitable abortion, there will be dilatation of cervix along with progressive uterine bleeding and painful uterine contractions. The gestational tissue can be either felt or seen through the cervical os and the passage of this tissue occurs within a short time.
In case were the membranes have ruptured, partly expelling the products of conception with a significant amounts of placental tissue left in the uterus is called as incomplete abortion. During the late first and early second trimesters this will be the most common presentation of an abortion. Examination findings of this includes an open cervical os with gestational tissues observed in the cervix and a uterine size smaller than expected for gestational age and a partially contracted uterus. The amount of bleeding will vary but can be severe enough to cause hypovolemic shock, with painful contractions and an ultrasound revealing tissues in the uterus.
An in utero death of the embryo or fetus prior to 20 weeks of gestation is called as a missed abortion. In this case the women may notice that the symptoms associated with early pregnancy like nausea, breast tenderness, etc have disappeared and they don’t ‘feel pregnant’ anymore. Vaginal bleeding may occur but the cervix remains closed and the ultrasound done reveals an intrauterine gestational sac with or without an embryonic/fetal pole, but no embryonic/fetal cardiac activity will be noticed.
In case of complete abortion, miscarriage occurs before the 12th week and the entire contents of conception will be expelled out of uterus. If this case, the physical examination will show a small and well contracted uterus with an open or closed cervix. There is scant vaginal bleeding with only mild cramping and ultrasound will reveal an empty uterus without any extra-uterine pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 47
Incorrect
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A 40-year-old woman arrives at the hospital at eight weeks of her first pregnancy, anxious that her kid may have Down syndrome. Which of the following best reflects the risk of spontaneous abortion after an amniocentesis performed at 16 weeks?
Your Answer:
Correct Answer: 18%
Explanation:This question assesses critical clinical knowledge, as this information must be presented to a patient prior to an amniocentesis to ensure that she has given her informed permission for the treatment.
Amniocentesis is most typically used for genetic counselling in the second trimester of pregnancy. Another option is to do a chorion-villus biopsy (CVB) between 10 and 11 weeks of pregnancy.
The chances of miscarriage after both operations are roughly 1 in 200 for amniocentesis and 1 in 100 for CVB, according to most experts.
The significance of this question is that professionals must be able to weigh the procedure’s danger against the risk of the sickness they are trying to identify. -
This question is part of the following fields:
- Obstetrics
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Question 48
Incorrect
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A 24 week pregnant patient complains of itching over the past 6 weeks particularly to the hands and feet which is worse at night. She has taken cetirizine but this hasn't settled her symptoms. Examination is unremarkable with no rash. What is the likely diagnosis?
Your Answer:
Correct Answer: Intrahepatic Cholestasis of Pregnancy
Explanation:The history is typical of Intrahepatic Cholestasis of Pregnancy, also known as obstetric cholestasis and prurigo gravidarum. It is characterised by itching without rash and abnormal LFTs beyond normal pregnancy ranges. Itching affects around 23% of pregnancies and can occur before biochemical changes.
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This question is part of the following fields:
- Clinical Management
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Question 49
Incorrect
-
In early pregnancy at what gestation does the Gestational sac become visible on transvaginal ultrasound?
Your Answer:
Correct Answer: 4 weeks + 3 days
Explanation:The gestational sac is typically visible from 31 days gestation by transvaginal ultrasound and a week later (38 days) on transabdominal ultrasound.
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This question is part of the following fields:
- Biophysics
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Question 50
Incorrect
-
Which of the following statements regarding BRCA gene mutations is true?
Your Answer:
Correct Answer: They account for around 25% of inherited breast cancers
Explanation:Hereditary breast cancers account for 10 % of the cases. BRCA gene mutations account for 25 % of these cancers.
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This question is part of the following fields:
- Genetics
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Question 51
Incorrect
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Which of the following is the most common cause of abnormal vaginal discharge in patients of childbearing age?
Your Answer:
Correct Answer: Bacterial vaginosis
Explanation:Bacterial Vaginosis is a common condition which results in a foul smelling discharge from the vagina without any inflammation. It is the most common cause of abnormal PV discharge. Most of the women are asymptomatic carriers.
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This question is part of the following fields:
- Clinical Management
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Question 52
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 53
Incorrect
-
Which group of beta haemolytic streptococci is associated with chorioamnionitis?
Your Answer:
Correct Answer: B
Explanation:Chorioamnionitis is a complication of pregnancy caused by bacterial infection of the fetal amnion and chorion membranes. Group B Streptococcus is associated with chorioamnionitis
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This question is part of the following fields:
- Microbiology
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Question 54
Incorrect
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A 33-year-old woman presented to the medical clinic with a history of type 2 diabetes mellitus. She plans to conceive in the next few months and asks for advice. Her fasting blood sugar is 10.5 mmol/L and her HbA1c is 9%.
Which of the following is considered the best advice to give to the patient?Your Answer:
Correct Answer: Achieve HbA1c value less than 7% before she gets pregnant
Explanation:Women with diabetes have increased risk for adverse maternal and neonatal outcomes and similar risks are present for either type 1 or type 2 diabetes. Both forms of diabetes require similar intensity of diabetes care. Preconception planning is very important to avoid unintended pregnancies, and to minimize risk of congenital defects. Haemoglobin A1c goal at conception is <6.5% and during pregnancy is <6.0%.
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This question is part of the following fields:
- Obstetrics
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Question 55
Incorrect
-
All of the following statements regarding episiotomy are true, except?
Your Answer:
Correct Answer: The earlier the episiotomy is done during delivery, generally the more beneficial it will be in speeding up delivery
Explanation:The best time of the episiotomy is when the presenting part becomes visible during the contractions. If the episiotomy is performed at the proper time, less time will be required for the delivery. However, if its done too late, it causes excessive stretching of the pelvic floor and further potential lacerations.
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This question is part of the following fields:
- Obstetrics
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Question 56
Incorrect
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Which of the following increases during pregnancy?
Your Answer:
Correct Answer: Tidal Volume
Explanation:Ventilation begins to increase significantly at around 8 weeks of gestation, most likely in response to progesterone-related sensitization of the respiratory centre to carbon dioxide and the increased metabolic rate. Significant alterations occur in the mechanical aspects of ventilation during pregnancy. Minute ventilation (or the amount of air moved in and out of the lungs in 1 minute) is the product of tidal volume and respiratory rate and increases by approximately 30–50 per cent with pregnancy. The increase is primarily a result of tidal volume, which increases by 40 per cent (from 500 to 700 mL), because the respiratory rate remains unchanged. The increase in minute ventilation is perceived by the pregnant woman as shortness of breath, which affects 60–70 per cent of women. This physiological dyspnoea is usually mild and affects 50 per cent of women before 20 weeks gestation, but resolves immediately postpartum.
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This question is part of the following fields:
- Physiology
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Question 57
Incorrect
-
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 58
Incorrect
-
A 35-year-old lady is diagnosed with high-grade squamous intraepithelial lesion (HSIL) of the cervix after standard pap smear testing. She was referred to a gynaecologist, who effectively treated her. This patient has now been returned to you.
Which of the following is the most appropriate next step in management?Your Answer:
Correct Answer: Colposcopy and cervical cytology at 4 to 6 months
Explanation:Monitoring after treatment for HSIL includes:
– colposcopy and cervical cytology at 4 to 6 months followed by HPV typing at 12 months and annually until a negative test is obtained on 2 subsequent check ups.
-2 yearly screening interval can be done afterwards. -
This question is part of the following fields:
- Gynaecology
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Question 59
Incorrect
-
At what week in pregnancy is testing for gestational diabetes (GD) advised
Your Answer:
Correct Answer: As soon as possible after booking if past history of GD
Explanation:Gestational diabetes (GDM) occurs in 2–9 per cent of all pregnancies. Screening for diabetes in pregnancy can be justified to diagnose previously unrecognized cases of pre-existing diabetes and to identify a group of women who are at risk of developing NIDDM later in life. No single screening test has been shown to be perfect in terms of high sensitivity and specificity for gestational diabetes. Urinary glucose is unreliable, and most screening tests now rely on blood glucose estimation, with an oral glucose tolerance test commonly used. The aim of glucose control is to keep fasting levels between 3.5 and 5.5 mmol/L and postprandial levels 7.1 mmol/L, with insulin treatment usually indicated outside these ranges. The women should be tested as soon as possible after booking if there is a history of GD.
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This question is part of the following fields:
- Clinical Management
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Question 60
Incorrect
-
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 61
Incorrect
-
A 23 year old patient presents to the emergency department with sudden onset of severe lower abdominal and pelvic pain. History reveals she normally has regular 28 day cycles but she missed her last period. Past medical history reveals 2 termination of pregnancy procedures in the past 3 years. The most recent one 6 months ago. She smokes 5 cigarettes per day.
Your Answer:
Correct Answer: Ectopic pregnancy
Explanation:This patient is most likely to have a ruptured ectopic pregnancy. The history of multiple TOPs suggests her contraceptive methods are not reliable and her missed period is suggestive she may currently be pregnant. There is no temperature or vaginal discharge to suggest PID though this is of course possible as is appendicitis. The last termination was 6 months ago so endometritis is unlikely.
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This question is part of the following fields:
- Clinical Management
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Question 62
Incorrect
-
After 18 months of frequent sexual activity, a young couple was unable to conceive.
Which of the following conditions has the best prognosis for infertility treatment?Your Answer:
Correct Answer: Stein-Leventhal syndrome
Explanation:Approximately 75–80% of patients with PCOS will ovulate after Clomiphene citrate. Although there appears to be discrepancy between ovulation and pregnancy rates, life-table analysis of the largest and most reliable studies indicates a conception rate of up to 22% per cycle in those ovulating on CC.
Pelvic TB causes tubal occlusion by scarring leading to infertility. Once occlusion occurs, IVF is usually the only option for conception. This is also the case for women with Turner syndrome.
Azoospermia maybe treated with surgery or hormonal therapy based on the cause but the success rate is low.
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This question is part of the following fields:
- Gynaecology
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Question 63
Incorrect
-
Regarding the structure of the detrusor muscle. Which of the following is true?
Your Answer:
Correct Answer: The detrusor is divided into 3 layers consisting of inner and outer layers of longitudinal smooth muscle with a middle circular smooth muscle layer
Explanation:The urinary bladder is composed of the transitional epithelium, followed by the lamina propria made up of the fibroelastic connective tissue. The muscularis layer covers the lamina propria which is made up of three poorly defined layers of smooth muscles; the inner longitudinal, middle circular and the outer longitudinal layer. The bladder is covered on the superior surface and the lateral surface by the peritoneum.
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This question is part of the following fields:
- Anatomy
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Question 64
Incorrect
-
A 50-year-old woman presents with moderately severe pain in her left groin and thigh. She had recently travelled by airplane from overseas and is at 18 weeks of gestation of her second pregnancy. The only incidence of trauma she can think of is when she hit her left knee on a table yesterday.
On physical examination, it is found that she has some swelling of her left ankle that is not present on the right side. Her first pregnancy was unremarkable except for development of some symptoms that were believed to be related to pelvic symphyseal separation around 28 weeks of gestation.
Which one of the following is the mostly cause for this patient's pain?Your Answer:
Correct Answer: deep venous Thrombosis (DVT) in her left leg
Explanation:For this pregnant patient who recently travelled overseas most likely has a deep venous thrombosis (DVT). It would also be expected that the patient would have oedema in the symptomatic leg and account for the swelling described.
Though they could cause unilateral leg pain, neither symphyseal separation nor sciatica due to a prolapsed intervertebral disc usually occur as early as 18 weeks of gestation. This patient’s symptoms also do not suggest either diagnosis.
Pain due to trauma would usually be maximal at the site where the trauma took place, which would be in the knee for this patient. Traumatic pain and house cleaning also would not cause the pain described or result in ankle swelling.
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This question is part of the following fields:
- Obstetrics
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Question 65
Incorrect
-
A 37 year old lady attends clinic following laparotomy and unilateral oophorectomy. The histology shows mucin vacuoles. What type of tumour would this be consistent with?
Your Answer:
Correct Answer: Mucinous
Explanation:Mucinous tumours are cystic masses which are indistinguishable from the serous tumours on gross examination except by its contents. On histology it is lined with mucin producing epithelium – mucin vacuoles whereas serous tumours have psammoma bodies. Malignant tumours are characterised by the presence of architectural complexity, cellular stratification, stromal invasion and cytological atypia.
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This question is part of the following fields:
- Clinical Management
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Question 66
Incorrect
-
Which one of the following is true regarding routine prenatal screening ultrasonography before 24 weeks gestation?
Your Answer:
Correct Answer: It has not been proven to have any significant benefits
Explanation:Routine ultrasonography at around 18-22 weeks gestation has become the standard of care in many communities. Acceptance is based on many factors, including patient preference, medical-legal pressure, and the perceived benefit by physicians. However, rigorous testing has found little scientific benefit for, or harm from, routine screening ultrasonography.
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This question is part of the following fields:
- Obstetrics
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Question 67
Incorrect
-
Following parturition uterine contractions called Afterpains may typically continue for how long?
Your Answer:
Correct Answer: None of the above
Explanation:Afterpains may continue for 2-3 days (so none of the above). Breastfeeding may intensify pain due to stimulation of Oxytocin which causes uterine contractions
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This question is part of the following fields:
- Clinical Management
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Question 68
Incorrect
-
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 69
Incorrect
-
A 34 year old female presents to the ob-gyn for a regular antenatal visit. Her previous pregnancy was complicated by pre-eclampsia and later eclampsia. What are the chances of her pre-eclampsia recurring in a later pregnancy?
Your Answer:
Correct Answer:
Explanation:Research suggests the risk of having preeclampsia again is approximately 20%, however experts cite a range from 5% to 80% depending on when you had it in a prior pregnancy, how severe it was, and additional risk factors you may have. If you had preeclampsia during your first pregnancy, you may get it again. HELLP is related to preeclampsia and about 4 to 12 percent of women diagnosed with preeclampsia develop HELLP. HELLP syndrome can also cause complications in pregnancy, and if you had HELLP in a previous pregnancy, regardless of the time of onset, you have a greater risk for developing it in future pregnancies.
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This question is part of the following fields:
- Obstetrics
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Question 70
Incorrect
-
A 29 year old obese woman presents complaining of difficult or painful sexual intercourse and dysmenorrhea. She is requesting a reversible contraceptive method. Which of the following would be most suitable?
Your Answer:
Correct Answer: Mirena
Explanation:Mirena is a form of contraception also indicated for the treatment of heavy menstrual bleeding and the management of dysmenorrhea, being able to reduce the latter considerably.
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This question is part of the following fields:
- Gynaecology
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Question 71
Incorrect
-
Which of the following is the leading cause of Down Syndrome?
Your Answer:
Correct Answer: Nondisjunction maternal gamete
Explanation:Most of the cases of down syndrome occur due to non disjunction trisomy 21 which is associated with increased maternal age. The non disjunction occurs in the maternal gametes.
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This question is part of the following fields:
- Genetics
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Question 72
Incorrect
-
A 50-year-old woman comes to the clinic complaining she is “urinating all the time. It started initially as some leakage of urine with sneezing or coughing, but now she leaks while walking to the bathroom.She voids frequently during the day and several times each night, also sometimes patient feels an intense urge to urinate but passes only a small amount when she tries to void. She now wears a pad every day and plans her social outings based on bathroom access.Patient had no history of dysuria or hematuria and had 2 vaginal deliveries in her 20s.She drinks alcohol socially, takes 2 or 3 cups of coffee each morning, and “drinks lots of water throughout the day.” When asked about which urinary symptoms are the most troublesome, the patient is unsure.
Among the following which is the best next step in management of this patient?Your Answer:
Correct Answer: Voiding diary
Explanation:This patient experiences a stress based mixed urinary incontinence presented as leakage of urine while sneezing or coughing and urgency which is an intense urge to urinate with small voiding volume as her symptoms. Urinary incontinence is common and may cause significant distress in some, as seen in this patient who wears a pad every day. Initial evaluation of mixed incontinence includes maintaining a voiding diary, which helps to classify the predominant type of urinary incontinence and thereby to determine an optimal treatment by tracking the fluid intake, urine output and leaking episodes.
All patients with mixed incontinence generally require bladder training along with lifestyle changes like weight loss, smoking cessation, decreased alcohol and caffeine intake and practicing pelvic floor muscle exercises like Kegels. Depending on the predominant type, patients who have limited or incomplete symptom relief with bladder training may benefit from pharmacotherapy or surgery.
In patients with urgency-predominant incontinence, timed voiding practice like urinating on a fixed schedule rather than based on a sense of urgency along with oral antimuscarinics are found to be useful.
Surgery with a mid-urethral sling is performed in patients with stress-predominant incontinence which is due to a weakened pelvic floor muscles as in cystocele.
In patients with a suspected urethral diverticulum or vesicovaginal fistula, a cystoscopy is usually indicated but is not used in initial evaluation of urinary incontinence due to its cost and invasiveness.
Urodynamic testing involves measurement of bladder filling and emptying called as cystometry, urine flow, and pressure (eg, urethral leak point). This testing is typically reserved for those patients with complicated urinary incontinence, who will not respond to treatment or to those who are considering surgical intervention.
Initial evaluation of mixed urinary incontinence is done by maintaining a voiding diary, which helps to classify predominant type of urinary incontinence into stress predominant or urgency predominant and thereby to determine the optimal treatment required like bladder training, surgical intervention, etc.
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This question is part of the following fields:
- Obstetrics
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Question 73
Incorrect
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Rubella belongs to which of the following family of viruses?
Your Answer:
Correct Answer: Togaviruses
Explanation:The Rubella virus, also known as German measles, is found in the Togavirus family and is a single-stranded RNA virus. The virus, which is acquired through contact with respiratory secretions, primarily replicates in the nasopharynx and lymph nodes, and produces a mild and self-limiting illness. Congenital infection, however, is associated with several anomalies including sensorineural deafness, cataracts and cardiac abnormalities.
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This question is part of the following fields:
- Microbiology
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Question 74
Incorrect
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A 25-year-old Aboriginal lady presents to antenatal clinic at 19 weeks of her gestation.
This is considered as the best time for which one of the following?Your Answer:
Correct Answer: Ultrasound
Explanation:Between 18-20 weeks of gestation is the best time to perform an ultrasound for the identification of any physical or anatomical abnormalities including neural tube defects.
Maternal serum screening for Down syndrome is best performed between 15-17 weeks of pregnancy and this screening includes analysis of alpha fetoprotein, estriol, and beta-HCG in maternal blood. Conducting tests on accurate dates is necessary to obtain reliable results.
Amniocentesis which is very accurate for the diagnosis of chromosomal anomalies including Down syndrome, is best performed between 16-18 weeks of gestation and it carries a risk of 1 in 200 for miscarriage. Rh negative women will need Rh D immunoglobulin (anti-D).
Chorionic villus sampling is best performed between 10-12 weeks of gestation and carries a 1 in 100 risk of miscarriage, this test is also very much accurate for diagnosis of chromosomal anomalies. Rh negative women need Rh D immunoglobulin (anti-D).
It is best to perform rubella screen before conception than during pregnancy, this is because rubella vaccine is not recommended to be given to a pregnant mother as its a live vaccine.
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This question is part of the following fields:
- Obstetrics
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Question 75
Incorrect
-
What is the typical volume increase of a non-pregnant uterus to term uterus?
Your Answer:
Correct Answer: 10ml to 5000ml
Explanation:Uterine blood flow increases 40-fold to approximately 700 mL/min at term. The uterus is 50–60 g with a volume of approximately 10ml prior to pregnancy and 1000 – 1200 g with a volume of 5000ml by term.
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This question is part of the following fields:
- Physiology
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Question 76
Incorrect
-
What percentage of children does delayed puberty occur in?
Your Answer:
Correct Answer: 3%
Explanation:Delayed puberty is defined as the absence of breast development in girls beyond the age of 13, and the absence of testicular development in boys beyond the age of 14. The incidence of delayed puberty is 3%, with the condition being more common in boys.
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This question is part of the following fields:
- Endocrinology
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Question 77
Incorrect
-
Regarding placental anatomy:
Your Answer:
Correct Answer: Fetal blood vessels develop in the mesenchymal core of the chorionic villi
Explanation:The chorionic plate represents the fetal surface of the placenta, which in turn is covered by the amnion. The amnion is composed of a single layered epithelium and the amnionic mesenchyme, an avascular connective tissue. The amnionic mesenchyme is only weakly attached to the chorionic mesenchyme and can easily be removed from the delivered placenta. The chorionic mesenchyme contains the chorionic vessels that are continuous with the vessels of the umbilical cord. Within the mesoderm of secondary villi, haematopoietic progenitor cells develop and start to differentiate. At about day 20 post-conception, first placental blood cells and endothelial cells develop independent of the vascular system of the embryo proper.13 14 The development of first placental vessels transforms the respective villi into tertiary villi.
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This question is part of the following fields:
- Endocrinology
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Question 78
Incorrect
-
Which increases the risk for developing endometrial cancer?
Your Answer:
Correct Answer: Early menarche
Explanation:Endometrioid endometrial carcinoma is oestrogen-responsive, and the main risk factor for this disease is long-term exposure to excess endogenous or exogenous oestrogen without adequate opposition by a progestin.
Early age at menarche is a risk factor for endometrial carcinoma in some studies; late menopause is less consistently associated with an increased risk of the disease. Both of these factors result in prolonged oestrogen stimulation and at times of the reproductive years during which anovulatory cycles are common
Other risk factors include
obesity,
nulliparity,
diabetes mellitus, and
hypertension.The risk of endometrial hyperplasia and carcinoma with oestrogen therapy can be significantly reduced by the concomitant administration of a progestin. In general, combined oestrogen-progestin preparations do not increase the risk of endometrial hyperplasia.
Endometrial carcinoma usually occurs in postmenopausal women (mean age at diagnosis is 62 years). Women under age 50 who develop endometrial cancer often have risk factors such as obesity or chronic anovulation.
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This question is part of the following fields:
- Gynaecology
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Question 79
Incorrect
-
Which of the following is/are needed by women in increased amounts during pregnancy?
Your Answer:
Correct Answer: All of the options given
Explanation:The nutritional status of a woman before and during pregnancy is important for a healthy pregnancy outcome. Pregnancy is a state of increased requirement of macro and micronutrients, and malnourishment or inadequate dietary intake before and during pregnancy, can lead to adverse perinatal outcomes. Many nutritional interventions have been proposed for pregnant mothers. These include multiple micronutrients (MMN), iron/folate, balanced protein energy, calcium, zinc and folic acid supplementation.
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This question is part of the following fields:
- Physiology
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Question 80
Incorrect
-
An 8-year-old girl presents with a history of a bright red bloodstain in her underpants one day prior to consultation. Her mother reports that the girl started cycling lessons one week ago. How will you proceed with the investigation in this case?
Your Answer:
Correct Answer: Examination under Anaesthesia
Explanation:A local exam might not help in locating the cause of the bleeding because it might be underneath the superficial structures. A thorough examination should be done under GA to accurately locate the source of bleeding.
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This question is part of the following fields:
- Gynaecology
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Question 81
Incorrect
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The following measures are usually performed during a routine antenatal visit for a healthy uncomplicated pregnancy at 36 weeks gestation, EXCEPT:
Your Answer:
Correct Answer: Mid-steam urine specimen (MSU) for culture & sensitivity
Explanation:At the 36‑week appointment, all pregnant women should be seen again. At this appointment: measure blood pressure and test urine for proteinuria; measure and plot symphysis–fundal height; check position of baby; for women whose babies are in the breech presentation, offer external cephalic version (ECV)
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This question is part of the following fields:
- Obstetrics
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Question 82
Incorrect
-
A 67 year old patient with endometrial carcinoma is to undergo staging investigations. There is evidence of invasion into the vaginal wall, but the lymph nodes are spared, and there is no distant metastasis. According to FIGO, what stage is this?
Your Answer:
Correct Answer: 3B
Explanation:Endometrial cancer is one of the most common gynaecological malignancies present in postmenopausal women, with a peak incidence between the ages of 60-89. Factors associated with endometrial cancer include obesity, hypertension and diabetes. Full staging for endometrial cancer is surgical, including several other radiologic investigations. According to FIGO staging classifications:
Stage 1 indicates a tumour confined to the uterine body
Stage 2 indicates the invasion of the cervical stroma
Stage 3 indicates local and regional spread, where the tumour invades the serosa in stage 3A, spreads to the vagina and parametrium in stage 3B, and metastasizes to the pelvic or para-aortic lymph nodes in stage 3C.
Stage 4 indicates tumour invasion on the bladder or bowel mucosa, or distant metastasis. -
This question is part of the following fields:
- Clinical Management
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Question 83
Incorrect
-
A 62-year-old woman complains of urinary incontinence for the past 12 months after having four pregnancies before the age of 30. She has to wear a 'pad' inside her pants all of the time because of this condition. She isn't on any hormone replacement therapy at the moment. Which of the following signs indicates that the incontinence is most likely true stress incontinence?
Your Answer:
Correct Answer: Only small quantities of urine ore lost each time she is incontinent.
Explanation:Only little volumes of urine are lost when her intra-abdominal pressure is elevated during coughing, laughing, jumping, and straining, which is the only symptom associated with real stress incontinence.
The other reactions are significantly more compatible with a detrusor instability diagnosis (also called urge incontinence).
If she had incontinence throughout pregnancy, it would have been stress in nature, which is what her current incontinence is. -
This question is part of the following fields:
- Gynaecology
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Question 84
Incorrect
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A 29-year-old gravida 6, para 5 woman at 36 weeks of gestation arrives in the ED via ambulance and precipitously delivers a male child. The child coughs and has a strong cry. He is very active. Acrocyanosis is noted. Heart rate is 98 bpm and breathing is strong. What is this child’s Apgar score?
Your Answer:
Correct Answer: 5
Explanation:The Apgar test scores appearance, pulse, grimace, activity, and respiration and is generally done at 1 and 5 minutes after birth but may be repeated if the child continues to score low (Table). This child’s score is as follows: Appearance, 1; Pulse, 1; Grimace, 2; Activity, 2; Respiration, 2 (APGAR score = 8). A score of 3 or less is generally regarded as critically low, 4 to 6 is fairly low, and 7 to 10 is generally normal. Contrary to common belief, the Apgar score is not used to decide if a neonate requires resuscitation. Decisions about resuscitation are based on emergency assessment of airway, breathing, and circulation.5,6
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This question is part of the following fields:
- Physiology
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Question 85
Incorrect
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All of the following factors are associated with umbilical cord prolapse, except?
Your Answer:
Correct Answer: Anencephaly
Explanation:Anencephaly means the missing of a particular portion of the scalp and brain tissue. The other factors listed are associated with umbilical cord prolapse like multiparity, twin birth, polyhydramnios, premature delivery, long umbilical cord or breech presentation.
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This question is part of the following fields:
- Physiology
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Question 86
Incorrect
-
A 25-year old woman presented to the medical clinic for her first prenatal check-up. Upon interview, the patient revealed that she has been smoking one pack of cigarettes per day for the past five years.
All of the following are considered correct regarding the disadvantages of smoking during pregnancy, except:Your Answer:
Correct Answer: Increased risk of developing small teeth with faulty enamel
Explanation:Small teeth with faulty enamel is more associated with fetal alcohol syndrome (FAS).
In FAS, the most common orofacial changes are small eyelid fissures , flat facies, maxillary hypoplasia, short nose, long and hypoplastic nasal filter, and thin upper lip. The unique facial appearance of FAS patients is the result of changes in 4 areas: short palpebral fissures, flat nasal bridge with an upturned nasal tip, hypoplastic philtrum with a thin upper vermillion border, and a flat midface. Other facial anomalies include micrognathia, occasional cleft lip and/or palate and small teeth with defective enamel.
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This question is part of the following fields:
- Obstetrics
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Question 87
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.
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This question is part of the following fields:
- Anatomy
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Question 88
Incorrect
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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.
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This question is part of the following fields:
- Obstetrics
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Question 89
Incorrect
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What is the role of DHEA produced by the fetal adrenal glands?
Your Answer:
Correct Answer: Stimulate placenta to form oestrogen
Explanation:Dehydroepiandrosterone (DHEA) is a steroid hormone synthesised from cholesterol (via Pregnenolone) by the adrenal glands. The foetus manufactures DHEA, which stimulates the placenta to form oestrogen, thus keeping a pregnancy going. Production of DHEA stops at birth, then begins again around age seven and peaks when a person is in their mid-20s
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This question is part of the following fields:
- Endocrinology
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Question 90
Incorrect
-
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 91
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:HPV types 6 and 11 are associated with low risk, low grade squamous intraepithelial lesion. While types 16,18,31 and 33 are associated with high risk, high grade neoplasia.
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This question is part of the following fields:
- Microbiology
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Question 92
Incorrect
-
Under which one of the following conditions is the pelvic inlet felt to be contracted?
Your Answer:
Correct Answer:
Explanation:Contracted pelvis occurs when one or more of its diameters is reduced so that it interferes with the normal mechanism of labour. A transverse diameter below 11 cm will result in difficult delivery of the foetus and C-section will be the better option in that case
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This question is part of the following fields:
- Anatomy
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Question 93
Incorrect
-
What is the anatomical landmark used for gauging the station of the fetal head during labour?
Your Answer:
Correct Answer: Ischial Spine
Explanation:The ischial spine is the anatomical landmark for assessing the station of the fetal head and also placing pudendal nerve blocks. (the pudendal nerve runs posterior to the ischial spine). The ischial spine can be palpated approximately 8cm into the vagina, at 4 and 8 o’clock.
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This question is part of the following fields:
- Anatomy
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Question 94
Incorrect
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Question 95
Incorrect
-
Which of the following microorganisms is considered the most frequently associated with septic shock in obstetrics and gynecology?
Your Answer:
Correct Answer: Escherichia coli
Explanation:Organisms frequently associated with obstetric sepsis include: beta haemolytic streptococci, Gram-negative rods such as Escherichia coli, Streptococcus pneumoniae and influenza A and B.
E. coli is the most common sepsis pathogen in pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 96
Incorrect
-
A 32-year-old woman at 37 weeks of gestation, who has been fine antenatally, presented with a history of sudden onset of severe abdominal pain with vaginal bleeding, and cessation of contractions after 18 hours of active pushing at home.
On examination, she is conscious and pale.
Her vital signs include blood pressure of 70/45 mm of Hg and a pulse rate of 115 beats per minute which is weak.
Her abdomen is irregularly distended, with both shifting dullness and fluid thrill present. Fetal heart sounds are not audible.
What will be the most likely diagnosis?Your Answer:
Correct Answer: Uterine rupture
Explanation:Patient’s presentation is classic for uterine rupture, were she developed sudden abdominal pain followed by cessation of contractions, termination of urge to push and vaginal bleeding.
Abdominal examination shows no fetal cardiac activity and signs of fluid collection like fluid thrill and shifting dullness. The fluid collected will be blood, which usually enters the peritoneum after the rupture of the uterus. In such patients vaginal examination will reveal a range of cervical dilatation with evidences of cephalopelvic disproportion.
Anterior lower transverse segment is the most common site for spontaneous uterine rupture. Patient in the case presenting with tachycardia and hypotension is in shock due to blood loss and will require urgent resuscitation.Placenta previa presents with painless bleeding from the vagina and Placental abruption will present with painful vaginal bleeding with tender and tense uterine wall, however, in contrary to that of uterine rupture, uterine contractions will continue in both these cases.
Shoulder dystocia is more likely to present in a prolonged labour with a significant delay in the progress of labour. However, in this case, there is no mention of shoulder dystocia.
Disseminated intravascular coagulation (DIC) is a condition which is causes due to abnormal and excessive generation of thrombin and fibrin in the circulating blood which results in bleeding from every skin puncture sites. It results in increased platelet aggregation and consumption of coagulation factors which results in bleeding at some sites and thromboembolism at other sites. Placental abruption, or retained products of conception in the uterine cavity are the causes for DIC.
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This question is part of the following fields:
- Obstetrics
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Question 97
Incorrect
-
One week after the delivery of her baby at the 38th week of pregnancy, a 33-year-old woman developed deep vein thrombosis (DVT). She has been on enoxaparin therapy for DVT. Upon discharge, there is a plan to start her on warfarin. When this was explained, the patient was reluctant to take warfarin since she thinks it might cause problems to the baby because she is planning to breastfeed.
Which of the following is considered correct regarding warfarin and breastfeeding?Your Answer:
Correct Answer: She should continue to breastfeed her baby while she is on warfarin
Explanation:No adverse reactions in breastfed infants have been reported from maternal warfarin use during lactation, even with a dose of 25 mg daily for 7 days. There is a consensus that maternal warfarin therapy during breastfeeding poses little risk to the breastfed infant.
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This question is part of the following fields:
- Obstetrics
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Question 98
Incorrect
-
A patient has had limited response to conservative measures for her overactive bladder (OAB). Which of the following is the most appropriate pharmacological choice?
Your Answer:
Correct Answer: Darifenacin
Explanation:Detrusor overactivity can be treated with anti-cholinergic agents such as oxybutynin or tolterodine, solifenacin, fesoterodine and darifenacin. They are used as first line agents. Imipramine is used for enuresis and desmopressin is used for nocturia.
NICE pathwayPrior to initiating anticholinergics:
Bladder training
Consider treating vaginal atrophy and nocturia with topical oestrogen and desmopressin respectively before commencing treatments below.
Consider catheterisation if chronic retention
1st line treatments:
1. Oxybutynin (immediate release) – Do not offer to frail elderly patients
2. Tolterodine (immediate release)
3. Darifenacin (once daily preparation)
DO NOT offer any of the 3 drugs below:
1. Flavoxate
2. Propantheline
3. Imipramine
2nd line treatment
Consider transdermal anticholinergic (antimuscarinic)
Mirabegron
Adjuvant Treatments
Desmopressin can be considered for those with nocturia
Duloxetine may be considered for those who don’t want/unsuitable for surgical treatment
Intravaginal oestrogen can be offered to postmenopausal women with OAB -
This question is part of the following fields:
- Clinical Management
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Question 99
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.
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This question is part of the following fields:
- Gynaecology
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Question 100
Incorrect
-
The roof of the femoral triangle is formed by which structure?
Your Answer:
Correct Answer: Fascia lata
Explanation:The femoral triangle is bounded:
– Superiorly by the inguinal ligament that forms the base of the femoral triangle.
– Medially by the lateral border of the adductor longus.
– Laterally by the sartorius; the apex of the femoral triangle is formed where the borders of the sartorius and the adductor muscles meet.
– The floor of the femoral triangle is formed by the iliopsoas laterally and the pectineus muscle medially.
– The roof of the femoral triangle is formed by the fascia lata and cribriform
fascia, subcutaneous tissue, and skin. -
This question is part of the following fields:
- Anatomy
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