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Question 1
Incorrect
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Which structure reinforces the inguinal canal anterolaterally?
Your Answer: Inguinal ligament
Correct Answer: Internal oblique
Explanation:The anatomy of the inguinal canal is of surgical importance. In the male, the inguinal canal carries the spermatic cord, ilioinguinal nerve and important blood vessels, while in females the inguinal canal holds the round ligament, ilioinguinal nerve and blood vessels. The floor of the inguinal canal is made of the inguinal ligament (a thickened portion of the inguinal ligament), while the posterior wall is made of the transversalis muscle. The anterior wall is made of the external oblique aponeurosis, and the roof is made up of fibres of the internal oblique, transversus abdominis and its aponeurosis, and the conjoint tendon. This means that the anterolateral support structure of the inguinal canal would be the fibres of the internal oblique.
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This question is part of the following fields:
- Anatomy
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Question 2
Incorrect
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All of the following statements are true about Androgen insensitivity syndrome except:
Your Answer:
Correct Answer: The chromosomal sex is 46XX
Explanation:Patients suffering from androgen insensitivity syndrome have 46XY chromosomes. Due to insensitivity to androgens, they have female characteristics e.g. scant pubic or body hairs, enlarged mammary glands, and a small penis.
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This question is part of the following fields:
- Embryology
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Question 3
Incorrect
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A 40 year old women has a transvaginal ultrasound reported as showing a 6cm x 5cm cystic mass of the right ovary with multiple septa noted and varying degrees of echogenicity within locules. What is the likely diagnosis?
Your Answer:
Correct Answer: Mucinous cystadenoma
Explanation:The characteristics of the mucinous cystic adenoma of the ovaries is the presence of a large tumour which is multicystic and the penetration of the peritoneum into the cavities forming septas. The serous tumours can only be differentiated on the bases of the contents.
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This question is part of the following fields:
- Data Interpretation
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Question 4
Incorrect
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Oxytocin binds to what receptor type?
Your Answer:
Correct Answer: G-protein-coupled receptors
Explanation:Oxytocin binds to the G protein coupled receptors that triggers the IP3 mechanism leading to an elevated intracellular calcium ion.
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This question is part of the following fields:
- Clinical Management
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Question 5
Incorrect
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What is the average anteroposterior distance of the female pelvic outlet?
Your Answer:
Correct Answer: 13 cm
Explanation:The pelvic outlet is bounded in front by the lower margin of the symphysis pubis, on each side by the descending ramus of the pubic bone, the ischial tuberosity and the sacrotuberous ligament, and posteriorly by the last piece of the sacrum. The AP diameter of the pelvic outlet is 13.5 cm and the transverse diameter is 11 cm.
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This question is part of the following fields:
- Anatomy
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Question 6
Incorrect
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You review a patient in the fertility clinic. The ultrasound and biochemical profile are consistent with PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2. She is a non-smoker. You plan to initiate Clomiphene. According to NICE guidance how long should treatment continue for (assuming patient remains non-pregnant)?
Your Answer:
Correct Answer: 6 months
Explanation:Treatment with Clomiphene should not exceed 6 months.
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This question is part of the following fields:
- Clinical Management
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Question 7
Incorrect
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The expected date of delivery of a human pregnancy can be calculated as:
Your Answer:
Correct Answer: 40 weeks after last menstrual period
Explanation:Expected date of delivery/estimated due date (EDD) is a calculated date (i.e., an estimation), determined by counting forward 280 days (40 weeks) from the first day of the woman’s last menstrual period.
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This question is part of the following fields:
- Physiology
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Question 8
Incorrect
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The ovaries produce androgen and progesterone. What is the common precursor for both of these hormones?
Your Answer:
Correct Answer: Cholesterol
Explanation:Both the female hormones, namely progesterone and oestrogen as well as the male hormones or androgens are lipid soluble. The common precursor of these is cholesterol.
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This question is part of the following fields:
- Endocrinology
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Question 9
Incorrect
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A 65-year-old female patient complained of two months of painless vaginal bleeding. The endometrial thickness is 6mm, according to transvaginal ultrasound. To rule out endometrial cancer, you plan to send this patient to a gynaecologist for an endometrial biopsy with or without hysteroscopy.
Which of the following characteristics in your medical history is linked to a higher risk of endometrial cancer?Your Answer:
Correct Answer: Polycystic ovary syndrome associated with chronic anovulation
Explanation:Women with polycystic ovary syndrome (PCOS) have a 2.7-fold increased risk for developing endometrial cancer. A major factor for this increased malignancy risk is prolonged exposure of the endometrium to unopposed oestrogen that results from anovulation.
Additionally, secretory endometrium of some women with PCOS undergoing ovulation induction or receiving exogenous progestin exhibits progesterone resistance accompanied by dysregulation of gene expression controlling steroid action and cell proliferation.
Other risk factors include nulliparity, early menarche and late menopause, obesity and family history of endometrial cancer. Which rules out all the other options.
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This question is part of the following fields:
- Gynaecology
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Question 10
Incorrect
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Regarding cardiac output in pregnancy which of the following statements is TRUE?
Your Answer:
Correct Answer: Cardiac output increases by approximately 40-50% during pregnancy
Explanation:In a non pregnant adult female the cardiac output is 4.5L/min, by the 20 week of pregnancy the cardiac output increases by 40% to 6.3L/min. During early stages of labour it increases further still by 17% to 7.3L/min.
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This question is part of the following fields:
- Physiology
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Question 11
Incorrect
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A 26-year-old woman with irregular menstrual cycle has a positive pregnancy test. She wants to know the age of her baby.
Which of the following methods is considered the most accurate for estimating gestational age?Your Answer:
Correct Answer: Transvaginal ultrasound at 8 weeks
Explanation:Ultrasound has emerged as the more accurate method of assessing fetal gestational age, especially in the first trimester. Both transvaginal and transabdominal probe assessments are used to obtain a more accurate measurement of gestational age. Transvaginal is more helpful in first trimester pregnancies.
A transvaginal ultrasound exam should not be performed in a pregnant patient with vaginal bleeding and known placenta previa, a pregnant patient with premature rupture of membranes, and a patient who refuses exam despite informed discussion.
Sonographic assessment within the first 13 weeks and 6 days will provide the most accurate estimate of gestational age. Both transvaginal and transabdominal approaches may be used. However, the transvaginal approach may provide a more clear and accurate view of early embryonic structures. Although the gestational sac and yolk sac are the first measurable markers visible on ultrasound, these poorly correlate with gestational age.
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This question is part of the following fields:
- Obstetrics
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Question 12
Incorrect
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Which ONE among the following factors does not increase the risk for developing postpartum endometritis?
Your Answer:
Correct Answer: Advanced maternal age
Explanation:The most common clinical findings in a postpartum women with endometritis are postpartum fever, with tachycardia relative to the rise in temperature, midline lower abdominal pain and uterine tenderness from the 2nd to 10th day of postpartum.
Most common risk factors for the development of postpartum endometritis are:
– Cesarean deliveries are considered as the most important risk factor for postpartum endometritis, especially those performed after the onset of labour.
– Young maternal age.
– Multiple digital cervical examinations.
– Prolonged rupture of membranes.
– Retention of placental products.
– Prolonged labour.
– Chorioamnionitis.
Advanced maternal age is not considered as a risk factor for development of postpartum endometritis. -
This question is part of the following fields:
- Obstetrics
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Question 13
Incorrect
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A 28 year old primigravida carrying a twin pregnancy presents at 32 weeks gestation. She is lethargic, clinically jaundiced and complains of abdominal pain with frequent vomiting. A summary of her blood results are as follows:
Your Answer:
Correct Answer: Acute fatty liver of pregnancy
Explanation:This patients bloods and symptoms suggest she has hepatic impairment. Acute fatty liver of pregnancy typically presents after the 30th week and she has risk factors for acute fatty liver of pregnancy: Multiple pregnancy Primigravida
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This question is part of the following fields:
- Clinical Management
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Question 14
Incorrect
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Question 15
Incorrect
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A 28-year-old woman presents for an antenatal visit in her first pregnancy. The pregnancy has been progressing normally thus far. Her routine mid-trimester ultrasound examination, performed at 18 weeks of gestation, shows that the placenta occupies the lower part of the uterus. It is noted that the placenta is reaching to within 1 cm of the internal cervical os. The patient is wondering what this means for her pregnancy and what needs to be done about it.
Which one of the following would be the most appropriate management?Your Answer:
Correct Answer: Repeat the ultrasound at 34 weeks of gestation.
Explanation:This patient is presenting with a low-lying placenta at 18 weeks of gestation. This is a common finding on ultrasound at 18-20 weeks. If there is not bleeding, there is an 80-90% chance that by late pregnancy, the placenta will have moved and is no longer occupying the lower uterine segment. For this reason, the repeat ultrasound examination is usually performed at 32-34 weeks of gestation. Further discussions about management can then be made after obtaining those results.
Leaving the repeat ultrasound until term would be inappropriate as intervention would be needed prior. If the placenta praevia is still present, it is typically advisable to deliver prior to term.
Cardiotocographic (CT) fetal heart rate monitoring is not required in the absence of bleeding or other symptoms.
Delivery by Caesarean section would not be necessary if the placenta was no longer praevia by the time the repeat ultrasound is done.
Repeat ultrasound examination at 22 weeks of gestation would also unnecessary and inappropriate as it is too close in time for the change to occur.
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This question is part of the following fields:
- Obstetrics
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Question 16
Incorrect
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A pregnant patient with a chest infection is worried about the radiation risk of a chest X Ray. How many days of natural background radiation is equivalent to a chest X Ray?
Your Answer:
Correct Answer: 2.5
Explanation:X-rays carry low levels of risk during pregnancy and are not a significant cause for concern if the total exposure to ionising radiation is less than 5 rads throughout the pregnancy; a chest X-ray is about 0.00007 rads. The amount of radiation generated from a chest X-ray is equivalent to 2.4 days of natural background radiation. Non-urgent radiological tests should, however, be avoided between 10-17 weeks gestation as there is a higher risk of central nervous system teratogenesis during this time.
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This question is part of the following fields:
- Biophysics
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Question 17
Incorrect
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In normal pregnancy, levels of all of the following hormones increases, EXCEPT:
Your Answer:
Correct Answer: Parathyroid hormone (PTH) in the 2nd & 3rd trimesters
Explanation:In order to maintain fetal bone growth, the maternal compartment undergoes adjustments that provide a net transfer of sufficient calcium to the foetus. Maternal compartment changes that permit calcium accumulation include increases in maternal dietary intake, increases in maternal 1, 25-dihydroxyvitamin D3 levels, and increases in parathyroid hormone (PTH) levels. The levels of total calcium and phosphorus decline in maternal serum, but ionized calcium levels remain unchanged. During pregnancy, the placenta forms a calcium pump in which a gradient of calcium and phosphorus is established which favours the foetus. Thus, circulating fetal calcium and phosphorus levels increase steadily throughout gestation. Furthermore, fetal levels of total and ionized calcium, as well as phosphorus, exceed maternal levels at term. By 10-12 weeks’ gestation, the fetal parathyroid glands secrete PTH. Fetal plasma levels of PTH are low during gestation, but increase after delivery.
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This question is part of the following fields:
- Endocrinology
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Question 18
Incorrect
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A 30 year old patient attends for non-invasive pre-natal screening for Down's syndrome. You advise her that the result will take the form of a risk score and higher risk results will be offered CVS or amniocentesis. What is the cut-off figure between low and high risk?
Your Answer:
Correct Answer: 1 in 150
Explanation:1 in 150 is the cut off. Where pre-natal screening shows a risk of 1 in 150 or greater invasive testing is typically offered.
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This question is part of the following fields:
- Clinical Management
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Question 19
Incorrect
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Bladder contraction during voiding (micturating) is mediated via innervation of which of the following pathways?
Your Answer:
Correct Answer: Parasympathetic fibres from S2,S3,S4 nerve roots
Explanation:Detrusor contraction is via Parasympathetic innervation of pelvic splanchnic nerves (S2-4). This also causes relaxation of the internal urethral sphincter Note contraction and relaxation of the external urethral sphincter is under somatic control.
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This question is part of the following fields:
- Anatomy
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Question 20
Incorrect
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A 27-year-old woman comes to you during her first trimester seeking antenatal advice as she have a history of pre-eclampsia and obesity.
On examination her blood pressure is 130/80 mmHg and BMI is 38.
Administration of which among the following can reduce her risk of pre-eclampsia during this pregnancy?Your Answer:
Correct Answer: Calcium 1000mg daily
Explanation:This patient with a previous history of pre-eclampsia and obesity is at high risk for developing pre-eclampsia.
A daily intake of 1000mg of calcium is observed to be helpful in reducing the incidence of any hypertensive disorders and preterm labour.
Vitamin A should always be avoided during pregnancy as it is fetotoxic.
All other options are incorrect.
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This question is part of the following fields:
- Obstetrics
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Question 21
Incorrect
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The arcuate line forms part of the border of the pelvic brim. Where is it located?
Your Answer:
Correct Answer: Ilium
Explanation:The arcuate line is a smooth rounded border on the internal surface of the ilium just inferior to the iliac fossa. It forms the boundary of the pelvic inlet.
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This question is part of the following fields:
- Anatomy
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Question 22
Incorrect
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A 25-year-old woman at her 26 weeks of gestation visits your office after she has noticed intermittent leakage of watery liquor per vagina for the past eight hours, especially after straining, coughing or sneezing.
Speculum vaginal exam reveals clear fluid in the posterior vaginal fornix, with flow of liquid through the cervical os. Further evaluation establishes preterm premature rupture of the membranes (PPROM) as the diagnosis. No uterine contraction is felt and there is a tertiary hospital 50 km away.
Which of the following is the most appropriate next step in management of this patient?Your Answer:
Correct Answer: Administration of corticosteroids
Explanation:The case above gives a classic presentation of preterm premature rupture of membranes(PPROM). In term or near term women rupture of membrane harbingers labor, so if ROM does not end up in established labor in 4 hours, is called as premature ROM (PROM). In other words, PROM is defined as ROM before the onset of labor and if it occurs before 37 weeks, the preferred term is PPROM. In both these scenarios treatment approach will be different.
A sudden gush of watery fluid per vagina, continuous or intermittent leakage of fluid, a sensation of wetness within the vagina or perineum are the classic presentation of rupture of the membranes(ROM), regardless of the gestational age. Pathognomonic symptoms symptoms of ROM are presence of liquor flowing from the cervical os or pooling in the posterior vaginal fornix.
PPROM is associated with many risk factors and some of them are as follows:
– Preterm labor
– Cord prolapse
– Placental abruption
– Chorioamnionitis
– Fetal pulmonary hypoplasia and other features of prematurity
– Limb positioning defects
– Perinatal mortality
Once the diagnosis is confirmed the following measures should be considered in the management plan:
a) Maternal corticosteroids
Adverse perinatal outcomes like respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis can be effectively reduced using corticosteroids. The duration of using neonatal respiratory support, in case of respiratory distress, can be significantly reduced by the administration of corticosteroids. If preterm labor is a concern in cases were gestational age is between 23•0d and 34•6d weeks or if preterm birth is planned or expected within the next 7 days corticosteroids are indicated.
Recommended regimens to the woman are IM betamethasone in two doses of 11.4 mg, given 24 hours apart and if betamethasone is unavailable, IM dexamethasone given 24 hours apart in two doses of 12 mg.
A single repeat dose of corticosteroid given seven days or more after the first dose is suggestive in cases were the gestational age is less than 32• 6d, if the woman is still considered to be at risk of preterm labor, up to 3 repeated doses can be considered.
Another option is Tocolysis using nifedipine and is indicated if the woman is in labor. This helps in cessation of labor for at least 48 hours, providing a window for corticosteroid to establish its effects. Tocolysis is not indicated in cases with absence of uterine contractions suggestive of labor.
It is appropriate to transfer this woman to a tertiary hospital after administering the first doses of corticosteroid and antibiotics. This ensures optimal neonatal care in case of premature delivery.
As the patient needs investigations and fetal monitoring along with close observation for development of any signs of infection and preterm labor, it is not appropriate to discharge this patient on oral antibiotics
Admitting to a primary care center without neonatal ICU (NICU) does no good to the outcome of this patient. -
This question is part of the following fields:
- Obstetrics
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Question 23
Incorrect
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Question 24
Incorrect
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How long does involution of the uterus take after parturition?
Your Answer:
Correct Answer: 4-6 weeks
Explanation:In the period immediately after the delivery of the placenta, known as the puerperium, the female reproductive system begins to undergo some physiological changes to return to a non-pregnant state. One of these changes is uterine involution. The myometrium contracts, constricting blood vessels which impedes blood flow. It is thought that the uterine tissues then undergo apoptosis and autophagy. It takes about 4-6 weeks for the uterus to decrease is size from about 1 kg to 60 grams.
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This question is part of the following fields:
- Clinical Management
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Question 25
Incorrect
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At the time of delivery, if there is a laceration of perineal body but not the anal sphincter, this type of laceration is classified as?
Your Answer:
Correct Answer: Second degree
Explanation:Perineal tears are common at the time of child birth. First degree perineal laceration means that the wound is so small that it doesn’t require any stitches and usually heals on its own. 2nd degree means that skin and smooth muscles are both torn. 3rd degree tear means that the tear is beyond the perineal muscles and the muscles surrounding the anal canal, while in 4th degree, the perineal tear goes through the anal sphincter up to the rectum.
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This question is part of the following fields:
- Anatomy
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Question 26
Incorrect
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A woman has undergone genetic testing due to her family history and has the BRCA 1 gene. What would you advise her lifetime risk of ovarian cancer is?
Your Answer:
Correct Answer: 40%
Explanation:The most common hereditary cancer in the breast ovarian cancer syndrome accounts for 90% of the hereditary cancers. It is due to mutations in the BRCA 1 and BRCA 2 genes, most commonly the BRCA 1 gene accounting for 70% life time risk of breast cancer and 40% life time risk of ovarian cancer.
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This question is part of the following fields:
- Genetics
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Question 27
Incorrect
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Which of the following hormones is secreted by the corpus luteum in a non pregnant state?
Your Answer:
Correct Answer: Progesterone
Explanation:The corpus luteum is formed from the granulosa cells of the mature follicle. The structure functions as a transient endocrine organ which secretes mainly progesterone with additional secretion of oestradiol and inhibin, which serve to suppress FSH levels. In the event of no pregnancy, the corpus luteum stops producing progesterone and degenerates into the corpus albicans.
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This question is part of the following fields:
- Embryology
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Question 28
Incorrect
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A 25-year-old female presents to a gynaecologist with a complaint of abnormal vaginal bleeding, usually postcoital. On pelvic examination, the cervix of was found to be of an unusually bright red colour and its texture was rougher than normal. Which of the following will you choose as the next step in the management of this condition?
Your Answer:
Correct Answer: Cervical smear (2nd line)
Explanation:Before considering invasive procedures, a cervical smear must first be performed. Antibiotics can only be given when inflammation has been confirmed and culture results have identified the organism causing the inflammation. Endometrial ablation, colposcopy and vaginal US are all invasive procedures that are not relevant in the immediate management of this patient.
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This question is part of the following fields:
- Gynaecology
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Question 29
Incorrect
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Which species of candida is the most common cause of genital candida infection in pregnancy?
Your Answer:
Correct Answer: Candida albicans
Explanation:Vulvovaginal candidiasis is the most common genital infection and it is caused by candida albicans in 80-92% of the cases. Other non albicans species include C.tropicalis, C.glabrata, C.krusei and C.parapsilosis. 20% of women of childbearing age are asymptotic colonisers of Candida species as part of their normal vaginal flora. This increases to 40% in pregnancy.
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This question is part of the following fields:
- Clinical Management
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Question 30
Incorrect
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All of the following are considered elevated in the third trimester of pregnancy, except:
Your Answer:
Correct Answer: Serum free T4
Explanation:Free T3 (FT3) and free T4 (FT4) levels are slightly lower in the second and third trimesters. Thyroid-stimulating hormone (TSH) levels are low-normal in the first trimester, with normalization by the second trimester.
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This question is part of the following fields:
- Obstetrics
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SESSION STATS - PERFORMANCE PER SPECIALTY
