00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - Endometriosis is an example of which of the following? ...

    Incorrect

    • Endometriosis is an example of which of the following?

      Your Answer: Pathological metaplasia

      Correct Answer: Pathological hyperplasia

      Explanation:

      Endometriosis is a condition in which the endometrial tissue lies outside the endometrial cavity. There are 4 theories which explain this. First is pathological hyperplasia resulting in menstrual regurgitation and implantation, second is the coelomic epithelium transformation, third is immunogical factors and the fourth is via the lymphatic or vascular spread.

    • This question is part of the following fields:

      • Clinical Management
      3
      Seconds
  • Question 2 - The transvaginal ultrasound of a 37 year old woman reveals a left ovarian...

    Incorrect

    • The transvaginal ultrasound of a 37 year old woman reveals a left ovarian mass. The mass is a unilocular cyst with diffuse homogenous ground glass echoes as a result of hemorrhagic debris. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Endometrioma

      Explanation:

      An endometrioma, also known as a chocolate cyst is a benign ovarian cyst that occurs as a result of the trapping of endometriosis tissue inside the ovary. The findings on transvaginal ultrasound are often a unilocular cyst, with ground glass echogenicity due to haemorrhage. Other benign masses that can be evaluated using transvaginal ultrasound are functional cysts, serous and mucinous cystadenomas and mature teratomas.

    • This question is part of the following fields:

      • Data Interpretation
      0
      Seconds
  • Question 3 - Which of the following drugs is most appropriate to use to stimulate lactation?...

    Incorrect

    • Which of the following drugs is most appropriate to use to stimulate lactation?

      Your Answer:

      Correct Answer: Domperidone

      Explanation:

      Domperidone and metoclopramide are D2 dopamine receptor antagonists. They are primarily used to promote gastric motility. They are also known as galactagogues and they promote the production of milk. Cabergoline and bromocriptine are prolactin inhibitors and they reduce milk production.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 4 - A newborn male infant, born to a 30-year-old gravida 3 para 0 aborta...

    Incorrect

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

      Your Answer:

      Correct Answer: Phenytoin use

      Explanation:

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

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

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

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

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

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

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

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 5 - Regarding the study of the prognosis of a disease, which of the following...

    Incorrect

    • Regarding the study of the prognosis of a disease, which of the following studies is most appropriate?

      Your Answer:

      Correct Answer: Cohort Study

      Explanation:

      Cohort studies are the most appropriate study design to study the prognosis of a disease. A group of patients with the same condition are chosen and their baseline information is taken. The group is then followed up over time to see which patients live or die.
      Case-control studies can also be useful where a group of individuals that have survived a condition are compared with cases of those who have died. Prognostic factors that distinguish the two groups are identified. This method, however, is limited by bias and the accuracy of medical information present.

    • This question is part of the following fields:

      • Epidemiology
      0
      Seconds
  • Question 6 - During vertex presentation, the position is determined by relationship of which part of...

    Incorrect

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

      Your Answer:

      Correct Answer: Occiput

      Explanation:

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

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 7 - Regarding the pelvic outlet, what structure marks the posterior boundary? ...

    Incorrect

    • Regarding the pelvic outlet, what structure marks the posterior boundary?

      Your Answer:

      Correct Answer: Tip of the coccyx

      Explanation:

      The bony pelvis is made up of a girdle with a central canal. The rim that surrounds the upper opening of the canal is called the pelvic inlet, while the lower rim is the called the pelvic outlet. The pelvic outlet is diamond-shaped and is bounded posteriorly by the tip of the sacrum, and anteriorly by the pubic symphysis, with its lateral boundaries being the ischial tuberosities and the sacrotuberous ligament.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 8 - What is the definition of premature menopause? ...

    Incorrect

    • What is the definition of premature menopause?

      Your Answer:

      Correct Answer: Menopause at or before 40 years of age

      Explanation:

      Menopause is defined as the cessation of menstruation for a period of 12 months. Premature menopause is defined as cessation of menstruation before the age of 40.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 9 - A 29-year-old single lady comes to your clinic with two days history of...

    Incorrect

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

      Your Answer:

      Correct Answer: Ovarian teratoma

      Explanation:

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

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

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

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

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

    • This question is part of the following fields:

      • Gynaecology
      0
      Seconds
  • Question 10 - Endometrial tissue found within the myometrium is classed as: ...

    Incorrect

    • Endometrial tissue found within the myometrium is classed as:

      Your Answer:

      Correct Answer: Adenomyosis

      Explanation:

      Adenomyosis is a disorder characterised by the presence of endometrial glands deep within the myometrium. It presents with increasing severe secondary dysmenorrhoea and increased in the flow of menstrual blood.

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 11 - After 2yearsof marriage, a 36-year-old morbidly obese lady with a BMI of 41has...

    Incorrect

    • After 2yearsof marriage, a 36-year-old morbidly obese lady with a BMI of 41has been unable to conceive. Her husband's sperm analysis is normal, and he has no additional abnormalities. The fallopian tube looks to be blocked.
      What is the best course of action for her management?

      Your Answer:

      Correct Answer: Suggest her to lose weight

      Explanation:

      This patient has been unable to conceive for over a year, and her fallopian tubes are blocked. Her body mass index is 42.
      Because she has obstructed Fallopian tubes, in-vitro fertilisation (IVF) is an alternative to getting pregnant for this patient.
      A woman with a BMI over 35, on the other hand, will need twice as many IVF rounds to conceive as a woman of normal weight.
      As a result, the greatest advise for successful IVF would be to decrease weight as the first step in management.
      Obese (BMI less than 40) patients’ IVF success chances are reduced by 25% and 50%, respectively.

    • This question is part of the following fields:

      • Gynaecology
      0
      Seconds
  • Question 12 - Delayed puberty in girls is defined as? ...

    Incorrect

    • Delayed puberty in girls is defined as?

      Your Answer:

      Correct Answer: Absence of breast development in girls beyond 13 years old

      Explanation:

      Breast development occurs from the age of 9-13 at the onset of puberty. Delayed puberty is defined as the absence of breast development after the age of 13.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 13 - A 30 year old woman with a history of two previous C section...

    Incorrect

    • A 30 year old woman with a history of two previous C section deliveries, is rushed to the hospital for an emergency c-section at 36 weeks gestation due to antenatal haemorrhage. Upon examination of the uterus, the placenta has invaded the myometrium but the serosa is spared. Which of the following identifies this condition?

      Your Answer:

      Correct Answer: Placenta Increta

      Explanation:

      Abnormal placental adherence to the uterus, generally termed Placenta Accreta, is divided into 3 conditions.
      – Placenta accreta: refers to the invasion of the chorionic villi beyond the decidual surface of the myometrium.
      – Placenta increta: the villi invade deep into the myometrium but spare the serosa;
      – Placenta percreta: the chorionic villi invade through the myometrium, penetrate the uterine serosa, and may invade surrounding pelvic structures.

      These conditions can predispose patients to obstetric bleeding in the third trimester, often requiring emergency intervention.

      Risk factors in the development of an abnormal placental adherence include previous c-sections. Placenta Previa, is also a cause of antepartum haemorrhage and serves as a risk factor in the development of abnormal placental adherence.

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 14 - Regarding lymph drainage of the lower vagina where does the majority of lymph...

    Incorrect

    • Regarding lymph drainage of the lower vagina where does the majority of lymph drain to?

      Your Answer:

      Correct Answer: Inguinal nodes

      Explanation:

      The lower vagina drains to the inguinal nodes where as the upper vagina drains to the internal and external iliacs

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 15 - Physiological changes in the reproductive system include: ...

    Incorrect

    • Physiological changes in the reproductive system include:

      Your Answer:

      Correct Answer: The uterus 1st enlarges by hyperplasia then by hypertrophy

      Explanation:

      Although uterine growth during the first few weeks of pregnancy is accomplished by increased numbers of smooth muscle cells (i.e. hyperplasia) and a smaller contribution from increased cell size (i.e. hypertrophy), the predominant growth of the uterus during pregnancy is by way of stretch‐induced myometrial hypertrophy. This ongoing process of stretch‐induced tissue remodelling and smooth muscle hypertrophy is accompanied by the lack of uterine contractions during most of gestation to accommodate the developing foetus (phase 0 of parturition). Phase 1 of parturition represents myometrial activation. The final stages of pregnancy are characterized by increases in spontaneous low‐amplitude contractions that gradually increase in frequency, rhythmicity and strength, normally culminating in labour and delivery of the foetus at term (phase 2 of parturition).

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 16 - A 46-year-old woman presents to your clinic with a complaint of irregular heavy...

    Incorrect

    • A 46-year-old woman presents to your clinic with a complaint of irregular heavy menstruation. She had normal menstrual pattern 6 months back. Physical examination revealed no abnormality with a negative cervical smear. Laboratory investigation reveals a haemoglobin of 105g/L (Normal 115-165g/L). The most common cause of such menorrhagia is?

      Your Answer:

      Correct Answer: Anovulatory cycles.

      Explanation:

      Menorrhagia in a 45-year-old woman is most likely caused by an ovulation issue, most likely anovulatory cycles, particularly if the periods have grown irregular.

      Endometrial carcinoma is a rare cause of menorrhagia that usually occurs after menopause.

      Menorrhagia can be caused by fibroids, endometrial polyps, and adenomyosis, although the cycles are normally regular, and a dramatic change from normal cycles six months prior would be exceptional.
      If fibroids or adenomyosis are the source of the menorrhagia, the uterus is usually enlarged.

    • This question is part of the following fields:

      • Gynaecology
      0
      Seconds
  • Question 17 - What is the typical volume increase of a non-pregnant uterus to term uterus?...

    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.

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 18 - Tamoxifen is associated with an increased risk of which of the following? ...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 19 - Among the statements given below which one is correct regarding shoulder dystocia? ...

    Incorrect

    • Among the statements given below which one is correct regarding shoulder dystocia?

      Your Answer:

      Correct Answer: Erb palsy is common fetal injury

      Explanation:

      Shoulder dystocia occurs when the bisacromial diameter, which is the breadth of the shoulders, exceed the diameter of pelvic inlet. This typically results in a bony impaction of the anterior shoulder against the maternal symphysis pubis, instead of an arrest at the pelvic inlet. Brachial plexus palsies including Erb’s palsy is the most common foetal injury associated with shoulder dystocia.

      It is not hyper-extension but the hyper-flexion of maternal legs tightly on her abdomen, called as McRoberts manoeuvre, which facilitates delivery during shoulder dystocia. This technique is effective as it increases the mobility of sacroiliac joint during pregnancy, which allows the rotation of pelvis and thereby facilitating the release of fetal shoulder.
      If this manoeuvre does not succeed, another technique called suprapubic pressure is done where an assistant applies pressure on the lower abdomen and gently pulls the delivered head. This technique is useful in about 42% of cases with shoulder dystocia.

      Maternal diabetes mellitus and foetal macrosomia both are a risk factor for shoulder dystocia.

      Administration of epidural anaesthesia during labour increases the possibility of shoulder dystocia.

      Risk of shoulder dystocia may increase with Oxytocin augmentation also.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 20 - What percentage of infants will have permanent neurological dysfunction as a result of...

    Incorrect

    • What percentage of infants will have permanent neurological dysfunction as a result of brachial plexus injury secondary to shoulder dystocia?

      Your Answer:

      Correct Answer:

      Explanation:

      Shoulder dystocia occurs when the anterior or posterior fetal shoulder impacts on the maternal symphysis or sacrum and may require additional manevours to release the shoulders after gentle downward traction has failed. The most common injury that can occur, is to the brachial plexus due to lateral flexion of the head during traction. This may cause a neurological disability, Erb’s Palsy ( injury to C5 and C6 of the brachial plexus) in which there is a less than 10% chance that this injury would be permanent.

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 21 - A 33 year old female patient with high grade abnormality on cervical screening...

    Incorrect

    • A 33 year old female patient with high grade abnormality on cervical screening test was referred to see a gynaecologist at your clinic. Colposcopy reveals abnormal cells higher in the cervical canal.
      What is the next step in management of this patient?

      Your Answer:

      Correct Answer: Cone biopsy

      Explanation:

      If abnormal cells are found high up in the cervical canal, it is critical to consider doing a cone biopsy to rule out any cervical malignancy. A cone-shaped section of the cervix containing the abnormal cells is removed under general anaesthesia.
      Loop Electrosurgical Excision Procedure is a way of removing the abnormal cells from the cervix using a wire loop. First a speculum is inserted to open the vagina so the uterus can be seen. Then a solution is applied to the surface of the cervix to make the areas of abnormal cells easier to see. It is done under local anaesthesia.

      Cone biopsy is the only acceptable option to rule out malignancy. Cryotherapy, chemotherapy and radiotherapy are management options once malignancy has been confirmed.

    • This question is part of the following fields:

      • Gynaecology
      0
      Seconds
  • Question 22 - A 40-year-old woman arrives at the hospital at eight weeks of her first...

    Incorrect

    • 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
      0
      Seconds
  • Question 23 - A 21 year old married gravida 1 para 1 has not used her...

    Incorrect

    • A 21 year old married gravida 1 para 1 has not used her oral contraceptives for 6 months. She comes to your office for evaluation because her menstrual period is 2 weeks late. Her menses had been regular since discontinuing the oral contraceptives. A urine hCG is negative. Which one of the following is true regarding this situation?

      Your Answer:

      Correct Answer: It is unlikely that she is pregnant

      Explanation:

      With the high level of sensitivity and specificity of current tests to measure hCG in serum and urine, pregnancy can now be diagnosed before the time of the first missed menstrual period- For current serum hCG assays, the low threshold for detection is 10-25 IU/L, while for urine assays it is 25-50 IU/L, which corresponds to approximately the seventh day after conception. Because the levels of hCG in the blood and urine are very similar, the tests are equivalent. Urine testing may reveal a positive result as early as 3-4 days after implantation. By the time of the expected menstrual period, the test will be positive 98% of the time- If a test is negative more than 1 week after the expected time of the menstrual period, it is almost certain the patient is not pregnant. To cover these rare instances where a woman has a low hCG and conceived later than expected, the test should be repeated in 1 week for a definitive result.

      Since ectopic pregnancy is not a life-threatening problem for the mother until 2 months after conception, a patient with a negative urine hCG does not require ultrasonography to exclude ectopic pregnancy. Patients with a suspected ectopic pregnancy and a negative urine hCG should be followed closely, as early laparoscopic intervention can improve the chances of future fertility.

    • This question is part of the following fields:

      • Gynaecology
      0
      Seconds
  • Question 24 - A 27-year-old woman complains of a lump in her right breast after a...

    Incorrect

    • A 27-year-old woman complains of a lump in her right breast after a history of trauma to her right breast 2 weeks ago. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Fat necrosis

      Explanation:

      Fat necrosis may occur following a traumatic injury to the breast. The lump is usually firm, round, and painless.

    • This question is part of the following fields:

      • Gynaecology
      0
      Seconds
  • Question 25 - You see a diabetic women in preconception clinic. Which of the following is...

    Incorrect

    • You see a diabetic women in preconception clinic. Which of the following is appropriate advice regarding folic acid supplementation?

      Your Answer:

      Correct Answer: 5 mg daily until week 12

      Explanation:

      The aim of pre-pregnancy counselling is to achieve the best possible glycaemic control before pregnancy and to educate diabetic women about the implications of pregnancy. Patient information leaflets about pregnancy should make clear the risks of pregnancy in diabetes, and include advice to take high dose (5 mg) folic acid pre-conception and for the first 12 weeks.

    • This question is part of the following fields:

      • Clinical Management
      0
      Seconds
  • Question 26 - A 40-year-old woman who is at 34 weeks of pregnancy presented to the...

    Incorrect

    • A 40-year-old woman who is at 34 weeks of pregnancy presented to the medical clinic for advice since her other two children were diagnosed with whooping cough just 8 weeks ago, she is worried for her newborn about the risk of developing whooping cough.
      Which of the following is considered the most appropriate advice to give to the patient?

      Your Answer:

      Correct Answer: Give Pertussis vaccine booster DPTa now

      Explanation:

      To help protect babies during this time when they are most vulnerable, women should get the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) during each pregnancy.

      Pregnant women should receive Tdap anytime during pregnancy if it is indicated for wound care or during a community pertussis outbreak.
      If Tdap is administered earlier in pregnancy, it should not be repeated between 27 and 36 weeks gestation; only one dose is recommended during each pregnancy.

      Optimal timing is between 27 and 36 weeks gestation (preferably during the earlier part of this period) to maximize the maternal antibody response and passive antibody transfer to the infant.
      Fewer babies will be hospitalized for and die from pertussis when Tdap is given during pregnancy rather than during the postpartum period.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 27 - During difficult labour, mediolateral episiotomy is favoured to midline episiotomy because? ...

    Incorrect

    • During difficult labour, mediolateral episiotomy is favoured to midline episiotomy because?

      Your Answer:

      Correct Answer: Less extension of the incision

      Explanation:

      Mediolateral episiotomy is favoured to midline episiotomy because there is less extension of the incision and decreased chances of injury to the anal sphincter and rectum.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 28 - A 27-year-old woman presented to the medical clinic due to infertility. Upon interview,...

    Incorrect

    • A 27-year-old woman presented to the medical clinic due to infertility. Upon interview, it was noted that she has been having unprotected intercourse with her husband regularly for the past year but has not become pregnant. She mentioned that her last menstrual period was 3 weeks ago. Her menses occur every 28 to 30 days and they last 4 to 5 days. A day before her menses, she has episodes of severe lower abdominal pain that is only partially relieved by ibuprofen.
      Further history taking was done and revealed that she was treated for gonococcal cervicitis at age 19. The patient also takes a prenatal vitamin every day and does not use tobacco, alcohol, or illicit drugs. Her 31-year-old husband recently had semen analysis and his results were normal.
      Further examination was done and the following are her results:
      Blood pressure is 126/70mmHg,
      Pulse is 85/min,
      BMI is 31 kg/m2.
      Upon further examination and observation, it was revealed that she has a small uterus with a cervix that appears laterally displaced and there is accompanying pain upon cervical manipulation.
      Which of the following is most likely considered the cause of the patient’s infertility?

      Your Answer:

      Correct Answer: Endometriosis

      Explanation:

      Endometriosis is a chronic gynaecologic disease characterized by the development and presence of histological elements like endometrial glands and stroma in anatomical positions and organs outside of the uterine cavity. The main clinical manifestations of the disease are chronic pelvic pain and impaired fertility. The localization of endometriosis lesions can vary, with the most commonly involved focus of the disease the ovaries followed by the posterior broad ligament, the anterior cul-de-sac, the posterior cul-de-sac, and the uterosacral ligament.

      The clinical presentation of the disease differs in women and may be unexpected not only in the presentation but also in the duration. Clinicians usually suspect and are more likely to diagnose the disease in females presenting with the typical symptomatology such as dyspareunia, namely painful sexual intercourse, pelvic pain during menstruation (dysmenorrhea), pain in the urination (dysuria), defecation (dyschezia), and/or infertility. The pain is usually characterized as chronic, cyclic, and progressive (exacerbating over time). Furthermore, some women suffering from endometriosis experience hyperalgesia, a phenomenon, when even with the application of a nonpainful stimulus, an intolerable painful reaction is released. This condition indicates neuropathic pain.

      Tenderness on vaginal examination, palpable nodules in the posterior fornix, adnexal masses, and immobility of the uterus are diagnostically indicating findings of endometriosis.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 29 - A 30-year-old woman, gravida 2 para 1, at 10 weeks of gestation comes...

    Incorrect

    • A 30-year-old woman, gravida 2 para 1, at 10 weeks of gestation comes to your office for an initial prenatal visit. Patient has had no vaginal bleeding or cramping and her first pregnancy was uncomplicated which ended with a spontaneous term vaginal delivery.She has no chronic medical conditions and has had no previous surgeries. Patient takes a daily dose of prenatal vitamin and does not use tobacco, alcohol, or any other illicit drugs.
      On examination her blood pressure is 122/80 mm of Hg and pulse is 70/min and BMI is 24 kg/m2. The uterine fundus is palpated above the pubic symphysis.
      Pelvic ultrasound shows 2 viable intrauterine gestations, a single fundal placenta, and a thin intertwin membrane that meets the placenta at a 90-degree angle.
      Among the below mentioned complications, this patient is at highest risk for which one to occur?

      Your Answer:

      Correct Answer: Twin-twin transfusion syndrome

      Explanation:

      Twin gestations are generally at increased risk of complications and this risk is further stratified based on the chorionicity ie. number of placentas and amnionicity, the number of amniotic sacs of the gestation. In the given case patient has monochorionic diamniotic twins, which means 1 placenta and 2 amniotic sacs, based on the presence of 2 embryos, a single placenta and a thin intertwin membrane composed of 2 amniotic sacs that meets the placenta at a 90-degree angle (“T sign”). In patients who appear to have a single placenta, the base shape of the intertwin membrane distinguishes between a monochorionic (“T sign”) and fused dichorionic (“lambda sign”) gestation.
      Monochorionic twins are at high risk for twin-twin transfusion syndrome (TTTS), which is a complication that can result in heart failure and fetal
      eonatal mortality in both twins. In TTTS, unbalanced arteriovenous anastomoses are present between the shared placental vessels that supply the twins, because of these anastomoses, blood from the placental arteries from one twin (donor), which is of high resistance/pressure, is shunted into the placental veins of the other twin (recipient) with low resistance/pressure. This shunting of blood away from the donor twin causes anemia that leads to renal failure, oligohydramnios, low-output heart failure, and fetal growth restriction. In contrast, the shunting of blood toward the recipient twin causes polycythemia, which leads to polyhydramnios, cardiomegaly, high-output heart failure and hydrops fetalis. This in turn makes both twins at high risk for intrauterine and neonatal death.
      Mild TTTS is expectantly managed with serial ultrasounds to evaluate for worsening clinical features, whereas moderate-to-severe cases are treated with laser coagulation of the placental anastomoses.

      In monozygotic twins, placentation type is determined by timing of the twinning.  Twinning that occurs shortly after fertilization yields a dichorionic diamniotic gestation.  In contrast, the incomplete division (ie, fission) that can lead to conjoined twins occurs later in development and yields a monochorionic monoamniotic gestation. As the twins are in the same sac, monochorionic monoamniotic gestations can be complicated by cord entanglement but not possible in the given case as this patient has diamniotic twins.

      Risk factors for placenta accreta, implantation of the placenta directly into the myometrium, include placenta previa and prior uterine surgeries like cesarean delivery, myomectomy, etc

      Twin pregnancies are at increased risk of placenta previa (placental tissue that covers the internal cervical os); however, this patient has a fundal placenta, making this complication unlikely.

      Monochorionic twin gestations can be complicated by twin-twin transfusion syndrome, which is potentially a fatal condition that results from unbalanced vascular anastomoses between the vessels supplying umbilical cords of each twin.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 30 - A 22-year-old woman presented to the medical clinic for her first-trimester pregnancy counselling....

    Incorrect

    • A 22-year-old woman presented to the medical clinic for her first-trimester pregnancy counselling. Upon interview and history-taking, it was noted that she was previously an intravenous drug abuser. There were unremarkable first-trimester investigations, except for her chronic Hepatitis B infection.
      All of the following statements is considered true regarding Hepatitis B infection during pregnancy, except:

      Your Answer:

      Correct Answer: A Screening for HBV is not recommended for a pregnant woman with previous vaccination

      Explanation:

      The principal screening test for detecting maternal HBV infection is the serologic identification of HBsAg. Screening should be performed in each pregnancy, regardless of previous HBV vaccination or previous negative HBsAg test results.

      A test for HBsAg should be ordered at the first prenatal visit. Women with unknown HBsAg status or with new or continuing risk factors for HBV infection (e.g., injection drug use or a sexually transmitted infection) should be screened at the time of admission to a hospital or other delivery setting.

      Interventions to prevent perinatal transmission of HBV infection include screening all pregnant women for HBV, vaccinating infants born to HBV-negative mothers within 24 hours of birth, and completing the HBV vaccination series in infants by age 18 months.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Passmed