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  • Question 1 - The joint between the two pubic bones is called the: ...

    Incorrect

    • The joint between the two pubic bones is called the:

      Your Answer: Sacrococcygeal joint

      Correct Answer: Pubis symphysis

      Explanation:

      The pubic symphysis or symphysis pubis is the midline cartilaginous joint (secondary cartilaginous) uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to it.

    • This question is part of the following fields:

      • Anatomy
      2
      Seconds
  • Question 2 - Warfarin embryopathy is typically the result of the mother taking warfarin during which...

    Incorrect

    • Warfarin embryopathy is typically the result of the mother taking warfarin during which stage of pregnancy?

      Your Answer:

      Correct Answer: 6-12 weeks

      Explanation:

      Warfarin is teratogenic if it is used in the first trimester. It causes bone defects and haemorrhages in the developing foetus.

    • This question is part of the following fields:

      • Pharmacology
      6
      Seconds
  • Question 3 - Which of the following is/are needed by women in increased amounts during pregnancy?...

    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.

    • This question is part of the following fields:

      • Physiology
      0
      Seconds
  • Question 4 - The most common cause of perinatal death in mono-amniotic twin is: ...

    Incorrect

    • The most common cause of perinatal death in mono-amniotic twin is:

      Your Answer:

      Correct Answer: Cord entrapment

      Explanation:

      Cord entanglement, a condition unique to MoMo pregnancies, occurs in 42 to 80% of the cases and it has been traditionally related to high perinatal mortality. Umbilical cord entanglement is present in all monoamniotic twins when it is systematically evaluated by ultrasound and colour Doppler. Perinatal mortality in monoamniotic twins is mainly a consequence of conjoined twins, twin reversed arterial perfusion (TRAP), discordant anomaly and spontaneous miscarriage before 20 weeks’ gestation. Expectantly managed monoamniotic twins after 20 weeks have a very good prognosis despite the finding of cord entanglement. The practice of elective very preterm delivery or other interventions to prevent cord accidents in monoamniotic twins should be re-evaluated.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 5 - What is the life span of the corpus luteum in days? ...

    Incorrect

    • What is the life span of the corpus luteum in days?

      Your Answer:

      Correct Answer: 14-16

      Explanation:

      After the release of the oocyte, the theca and the granulosa cells form the corpus luteum which undergoes extensive vascularization for continued steroidogenesis. Progesterone is secreted by the luteal cells and is synthesized from cholesterol. The luteal phase lasts for 14 days and if implantation does not occurs the corpus luteum starts to degenerate. As B-HCG produced by the implanted embryo maintains it and without it luteolysis occurs.

    • This question is part of the following fields:

      • Embryology
      0
      Seconds
  • Question 6 - The followings are considered normal symptoms of pregnancy, EXCEPT: ...

    Incorrect

    • The followings are considered normal symptoms of pregnancy, EXCEPT:

      Your Answer:

      Correct Answer: Visual disturbance

      Explanation:

      Visual disturbances although very common during pregnancy are not a normal sign. Physicians should have a firm understanding of the various ocular conditions that might appear pregnancy or get modified by pregnancy. In addition, it is very important to be vigilant about the rare and serious conditions that may occur in pregnant women with visual complaints. Prompt evaluation may be required and the immediate transfer of care of the patient may help saving the lives of both the mother and the baby.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 7 - Regarding gestational diabetes which of the following is NOT a recognised risk factor...

    Incorrect

    • Regarding gestational diabetes which of the following is NOT a recognised risk factor

      Your Answer:

      Correct Answer: High polyunsaturated fat intake

      Explanation:

      There are several risk factors for gestational diabetes:
      Increasing age
      – Certain ethnic groups (Asian, African Americans, Hispanic/Latino Americans and Pima Indians)
      – High BMI before pregnancy (three-fold risk for obese women compared to non-obese women)
      – Smoking doubles the risk of GDM
      – Change in weight between pregnancies – an inter-pregnancy gain of more than three units (of BMI) doubles the risk of GDM
      – Short interval between pregnancies
      – Previous unexplained stillbirth
      – Previous macrosomia
      – Family history of type 2 diabetes or GDM – more relevant in nulliparous than parous women

      High polyunsaturated fat intake has been shown in some studies to be protective against gestational diabetes. Physical activity is also thought to be effective.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 8 - Beta and Delta Thalassemia are associated with abnormalities to which chromosome ...

    Incorrect

    • Beta and Delta Thalassemia are associated with abnormalities to which chromosome

      Your Answer:

      Correct Answer: Chromosome 11

      Explanation:

      Fetal haemoglobin (HBF) is the main haemoglobin type in the foetus and persists after birth for around 6 months. Fetal haemoglobin is composed of two alpha and two gamma subunits The alpha globulin chain is coded for by genes on Chromosome 16. Alpha Thalassemia are therefore associated with Chromosome16 defects The beta and delta globulin chains are coded for by genes on Chromosome 11. Beta and Delta Thalassemia are therefore associated with Chromosome 11 Defects

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 9 - Among the following situations which one is NOT considered a risk factor for...

    Incorrect

    • Among the following situations which one is NOT considered a risk factor for isolated spontaneous abortions?

      Your Answer:

      Correct Answer: Retroverted uterus

      Explanation:

      Most common risk factors for spontaneous abortion are considered to be:
      – Age above 35 years.
      – Smoking.
      – High intake of caffeine.
      – Uterine abnormalities like leiomyoma, adhesions.
      – Viral infections.
      – Thrombophilia.
      – Chromosomal abnormalities.
      Conditions like subclinical thyroid disorder, subclinical diabetes mellitus and retroverted uterus are not found to cause spontaneous abortions.
      The term retroverted uterus is used to denote a uterus that is tilted backwards instead of forwards.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 10 - How many days after fertilisation does the morula form? ...

    Incorrect

    • How many days after fertilisation does the morula form?

      Your Answer:

      Correct Answer: 4

      Explanation:

      When there are about 12-32 blastomeres, the developing human is referred to as morula. It enters the uterine cavity around the 4th day after fertilization.

    • This question is part of the following fields:

      • Embryology
      0
      Seconds
  • Question 11 - What is the average anteroposterior distance of the female pelvic outlet? ...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Anatomy
      0
      Seconds
  • Question 12 - Which of the following uterotonic drugs is most strongly associated with a transient...

    Incorrect

    • Which of the following uterotonic drugs is most strongly associated with a transient pyrexia occurring within 45 minutes of administration?

      Your Answer:

      Correct Answer: Dinoprostone

      Explanation:

      Induction of Labour is produced by the infusion of PGF-2 alpha or PGE2. Dinoprostone is a PGE2 and is associated with transient pyrexia that resolved within 4-5 hours of stopping the use of the drug.

    • This question is part of the following fields:

      • Clinical Management
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      Seconds
  • Question 13 - Which of the following is the most common cause of abnormal vaginal discharge...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 14 - A 26-year-old gravida 2 para 1 presents at 30 weeks gestation with a...

    Incorrect

    • A 26-year-old gravida 2 para 1 presents at 30 weeks gestation with a complaint of severe itching. She has excoriations from scratching in various areas. She says that she had the same problem during her last pregnancy, and her medical records reveal a diagnosis of intrahepatic cholestasis of pregnancy. Elevation of which one of the following ismost specific and sensitive markerof this disorder?

      Your Answer:

      Correct Answer: Bile acids

      Explanation:

      Intrahepatic cholestasis of pregnancy (ICP) classically presents as severe pruritus in the third trimester. Characteristic findings include the absence of primary skin lesions and elevation of serum levels of total bile acids.

      The most specific and sensitive marker of ICP is total serum bile acid (BA) levels greater than 10 micromol/L. In addition to the elevation in serum BA levels, the cholic acid level is significantly increased and the chenodeoxycholic acid level is mildly increased, leading to elevation in the cholic
      henodeoxycholic acid level ratio. The elevation of aminotransferases associated with ICP varies from a mild increase to a 10- to 25-fold increase.

      Total bilirubin levels are also increased but usually the values are less than 5 mg/dL. Alkaline phosphatase (AP) is elevated in ICP up to 4-fold, but this is not helpful for diagnosis of the disorder since AP is elevated in pregnancy due to production by the placenta- Mild elevation of gamma glutamyl transferase (GGT) is seen with ICP but occurs in fewer than 30% of cases. However, if GGT is elevated in cases of ICP, that patient is more likely to have a genetic component of the liver disease.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 15 - A 24-year-old pregnant female presented with severe pain in the lower abdomen and...

    Incorrect

    • A 24-year-old pregnant female presented with severe pain in the lower abdomen and excessive vaginal bleeding at 35 weeks gestation. Which of the following investigations should be done?

      Your Answer:

      Correct Answer: US abdomen

      Explanation:

      Ultrasound of abdomen should be done to rule out the cause of the excessive bleeding in this patient, this could confirm the very high suspicion of rupture of the placenta in this case.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 16 - A 34 year old patient is being investigated in the infertility clinic and...

    Incorrect

    • A 34 year old patient is being investigated in the infertility clinic and is offered Hysterosalpingography (HSG). She has 28 day cycles. Which of the following statements regarding HSG is correct?

      Your Answer:

      Correct Answer: Typically performed using iodine based water soluble contrast

      Explanation:

      Hysterosalpingography is used to assess the patency of the fallopian tubes. It is performed by injection of a radio-opaque iodine based contrast. This test is contraindicated in pelvic inflammatory disease and during pregnancy. Should be performed in Follicular phase of menstrual cycle after cessation of menstrual bleeding and prior to ovulation (days 6-12).

    • This question is part of the following fields:

      • Biophysics
      0
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  • Question 17 - Which of the following is the most likely anaesthetic or analgesic causing reduced...

    Incorrect

    • Which of the following is the most likely anaesthetic or analgesic causing reduced variability on cardiotocograph?

      Your Answer:

      Correct Answer: Intramuscular pethidine

      Explanation:

      Opiates and spinal anaesthetics reduce the variability of a CTG. Including some antihypertensives like labetalol and alpha methyl dopa.

    • This question is part of the following fields:

      • Obstetrics
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      Seconds
  • Question 18 - A 35-year-old woman from the countryside of Victoria comes to the hospital at...

    Incorrect

    • A 35-year-old woman from the countryside of Victoria comes to the hospital at 37 weeks of gestation after noticing a sudden gush of clear fluid from her vagina.
      Speculum examination shows pooling of liquor in the posterior fornix and patient developed fever, tachycardia and chills 12 hours after this episode.
      Apart from giving antibiotics, what will be your strategy in management of this case?

      Your Answer:

      Correct Answer: Induce labour now

      Explanation:

      Above mentioned patient presented with symptoms of premature rupture of membranes (PROM) which refers to membrane rupture before the onset of uterine contractions.

      A sudden gush of clear or pale yellow fluid from the vagina is the classic clinical presentation of premature rupture of membranes. Along with this the patient also developed signs of infection like fever, tachycardia and sweating which is suggestive of chorioamnionitis.

      Vaginal examination is never performed in patients with premature rupture of membrane, instead a speculum examination is the usually preferred method which will show fluid in the posterior fornix.

      The following are the steps in management of premature rupture of membrane:
      – Admitting the patient to hospital.
      – Take a vaginal
      ervical smears.
      – Measure and monitor both white cell count and C- reactive protein levels.
      – Continue pregnancy if there is no evidence of infection or fetal distress.
      – In presence of any signs of infection or if CTG showing fetal distress it is advisable to induce labour.
      – Corticosteroids must be administered if delivery is prior to 34 weeks of gestation.
      – Give antibiotics as prevention and for treatment of infection.

    • This question is part of the following fields:

      • Obstetrics
      0
      Seconds
  • Question 19 - Which of the following increases the risk of endometrial hyperplasia? ...

    Incorrect

    • Which of the following increases the risk of endometrial hyperplasia?

      Your Answer:

      Correct Answer: Tamoxifen

      Explanation:

      Tamoxifen increases risk of endometrial hyperplasia Aromatase inhibitors such as Letrozole and Anastrozole are not associated and have not been shown to increase the risk of endometrial pathology Whereas unopposed oestrogens increase endometrial cancer risk combined oral contraceptive decrease risk

    • This question is part of the following fields:

      • Clinical Management
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  • Question 20 - A 37-year-old woman has been taking Microgynon (oral contraceptive pill [OCP]).
    When she...

    Incorrect

    • A 37-year-old woman has been taking Microgynon (oral contraceptive pill [OCP]).
      When she presents for a repeat prescription, her BP is 160/100 mmHg.
      She mentions that she would like to stop the OCP in six months so that she can conceive.

      What is the most suitable advice for this woman?

      Your Answer:

      Correct Answer: Cease the OCP, use condoms for contraception, and reassess the BP in three months.

      Explanation:

      The woman’s blood pressure was elevated at her visit; therefore she should be advised to immediately cease the oral contraceptive pill (OCP) so that the hypertension can resolve without the need for any hypotensive treatment. The blood pressure can then be reassessed in three months. Alternative, non-hormonal birth control methods such as condoms should be used instead.

      If her high blood pressure does not resolve, any medication that would be commenced to reduce her blood pressure should be one that is safe to continue when she becomes pregnant.

      It is inappropriate to continue the OCP even at a lower dosage or in combination with a hypotensive agent.

      Methyldopa has been evaluated and used for treatment of hypertension during pregnancy. There is no clinical evidence to suggest that it causes harm to the foetus or neonate.

      Angiotensin converting enzyme (ACE) inhibitors are not approved for use in pregnancy as they have been associated with fetal death in utero. Other antihypertensive agents such as beta-blockers and diuretics are also problematic in pregnancy and should be avoided.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 21 - A 27-year-old female reports to the emergency department due to severe right lower...

    Incorrect

    • A 27-year-old female reports to the emergency department due to severe right lower quadrant pain. Complaints started yesterday, as the patient noticed intermittent right lower abdominal pain associated with increased activity. She rested for remainder of the day, but the pain still continued to increase. An hour ago, the pain suddenly became constant and severe, associated with nausea and vomiting.The patient does not complaint of any radiation of pain.
      On examination patient's temperature is noted to be 37.2 C (99 F), blood pressure is 130/80 mm Hg, and pulse rate is 98/min.On palpation of the right lower quadrant there is tenderness without rebounding or guarding.Urine pregnancy test conducted came to be negative.
      Considering the following additional informations, which would be most appropriate in establishing the diagnosis of this patient?

      Your Answer:

      Correct Answer: History of ovarian cysts

      Explanation:

      Common Risk factors for Ovarian torsion are presence of an ovarian mass, women who are in their reproductive age and history of infertility treatment with ovulation induction.
      Common clinical presentations include sudden onset of unilateral pelvic pain along with nausea & vomiting and presence of a palpable adnexal mass. An adnexal mass with absent Doppler flow to ovary can be noted in ultrasound.
      Laparoscopy with detorsion, ovarian cystectomy and oophorectomy if necrosis or malignancy is found are the common treatment options.

      Acute lower abdominal pain in a nonpregnant women can have various causes including pathologies of the gastrointestinal, gynecologic, or urologic systems due to the close proximity of these structures. All of these cases have classic presentations which help to characterize the disease process and thereby to differentiate the diagnosis.

      In the given case, patient presents with right lower quadrant pain which is classic for ovarian torsion, occurring due to rotation of the ovary around the infundibulopelvic ligament, causing ovarian vessel occlusion.  Although ovarian torsion can occur in any women in their reproductive-age, is seen more commonly in those with a history of ovarian cysts (eg, hemorrhagic cyst) or masses (eg, mature cystic teratoma) because of the greater size and density of the ovary which makes it prone to rotation and subsequent torsion. Patients will initially have intermittent pain associated with activity, as in this patient, due to partial ovarian torsion, this initial pain resolves when the adnexa spontaneously untwists and blood flow returns. When this progresses to complete ovarian torsion, patients typically develop sudden-onset, severe, nonradiating pain due to persistent ischemia, which is often associated with nausea and vomiting.

      Ovarian torsion can be clinically diagnosed, but a Doppler ultrasound is performed to evaluate ovarian blood flow and also to confirm the diagnosis. Surgical detorsion to prevent ovarian necrosis and cystectomy/oophorectomy are the usual treatment options.

      Any association of urinary symptoms will help to establish a urologic cause of acute right lower quadrant pain like pyelonephritis, nephrolithiasis, etc.  However, patients with urologic conditions typically presents with suprapubic or flank pain which radiates to the right lower quadrant, making this diagnosis less likely in the given case.

      A family history of malignancy usually does not aid in the diagnosis of acute lower abdominal pain. Although some ovarian cancers are inherited, patients with ovarian cancer typically have a chronic, indolent course with associated weight loss, early satiety, and abdominal distension.

      Having multiple sexual partners is considered a risk factor for sexually transmitted infections and pelvic inflammatory disease, which can be a cause for lower abdominal pain. However, patients will typically have fever, constant and diffused pelvic pain along with rebound and guarding.

      Recent sick contacts are a risk factor for gastroenteritis, which can present with nausea, vomiting and abdominal pain. However, in this case patient will typically have diffuse, cramping abdominal pain which will worsen gradually; along with persistent vomiting and diarrhea.

      Ovarian torsion typically causes intermittent lower abdominal pain followed by sudden-onset of severe, nonradiating unilateral pain with associated nausea and vomiting. Ovarian torsion can occur in women in their reproductive-age, particularly those with a history of ovarian cysts.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 22 - Regarding lymph drainage of the fallopian tubes where does the majority of lymph...

    Incorrect

    • Regarding lymph drainage of the fallopian tubes where does the majority of lymph drain to?

      Your Answer:

      Correct Answer: Para-aortic nodes

      Explanation:

      Lymphatic vessels from the ovaries, joined by vessels from the uterine tubes and most from the fundus of the uterus, follow the ovarian veins as they ascend to the right and left lumbar (caval/aortic) lymph nodes.

    • This question is part of the following fields:

      • Anatomy
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  • Question 23 - According to the RCOG Green-top guidelines on prevention and management of post-partum haemorrhage...

    Incorrect

    • According to the RCOG Green-top guidelines on prevention and management of post-partum haemorrhage (PPH) which of the following statements is true?

      Your Answer:

      Correct Answer: For women delivering by caesarean section, Oxytocin 5 iu by slow IV injection should be used

      Explanation:

      Misoprostol is not as effective as oxytocin but may be used if Oxytocin is not available e.g. home birth Recommended doses of Oxytocin For vaginal deliveries: 5 iu or 10 iu by intramuscular injection. For C-section: 5 iu by IV injection

    • This question is part of the following fields:

      • Clinical Management
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  • Question 24 - What is the anterior boundary of the pelvic outlet? ...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Anatomy
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  • Question 25 - A 30-year-old female patient visits you for a cervical cancer screening. You inform...

    Incorrect

    • A 30-year-old female patient visits you for a cervical cancer screening. You inform her that while Pap smears are no longer performed, Cervical Screening tests are done five times a year.
      She has a cervical screening test, which reveals that she has non-16/18 HPV and low-grade cytology alterations.
      What's would you do next?

      Your Answer:

      Correct Answer: Repeat cervical screening test in 12 months

      Explanation:

      An LSIL Pap test shows mild cellular changes. The risk of a high-grade cervical precancer or cancer after an LSIL Pap test is as high as 19 percent.

      As with an ASC-US Pap test, an LSIL Pap test is evaluated differently depending upon age. For women ages 25 or older, follow-up depends upon the results of human papillomavirus (HPV) testing:

      – Women who test positive for HPV or who have not been tested for HPV should have colposcopy.
      – Women who test negative for HPV can be followed up with a Pap test and HPV test in one year.

      Referral to an oncologist is not necessary since there is no established diagnosis of malignancy. All other options are unacceptable.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 26 - A 25 year old pregnant woman presents with constant abdominal pain, which has...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 27 - All of the following are considered elevated in the third trimester of pregnancy,...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 28 - A 32-year-old woman, gravida 2 para 1, at 40 weeks gestation is admitted...

    Incorrect

    • A 32-year-old woman, gravida 2 para 1, at 40 weeks gestation is admitted to the hospital due to contractions and spontaneous rupture of membranes.Patient underwent a cesarean delivery with her first child due to breech presentation, but this pregnancy has been uncomplicated.She has no chronic medical conditions and is taking only a prenatal vitamin.
      Her pre-pregnancy BMI was 20 kg/m2 and she has gained 15.9 kg (35 lb) during pregnancy. On examination her blood pressure is found to be 130/80 mm Hg.
      The patient is admitted and epidural anesthesia is administered with an intrauterine pressure catheter in place.She quickly dilates to 10 cm with the fetal vertex at 0 station, occiput transverse. Four hours later, the pelvic examination is unchanged but there is molding and caput on the fetal head. Fetal monitoring is category I. Contractions occur every 2-3 minutes and the patient pushes with each contraction. The contraction strength is an average of 210 MVU every 10 minutes.
      Which among the following is most likely the etiology for this patient’s clinical presentation?

      Your Answer:

      Correct Answer: Fetal malposition

      Explanation:

      Condition where there is insufficient fetal descent after pushing for ≥3 hours in nulliparous and ≥2 hours if multiparous women is defined as Second stage arrest of labor. Common risk factors for this presentation are maternal obesity, excessive weight gain during pregnancy and diabetes mellitus. Cephalopelvic disproportion, malposition, inadequate contractions and maternal exhaustion are the common etiologies of Second stage arrest of labor. Management includes Operative vaginal delivery or cesarean delivery as indicated in the case.

      The second stage of labor begins with the dilatation of cervix to 10 cm and will end with fetal delivery. Parity and use of neuraxial anesthesia are the two factors which will affect the duration of second stage of labor and fetal station, which measures the descent of the fetal head through the pelvis determines its progression.

      When there is no fetal descent after pushing for ≥3 hours or ≥2 hours in in nulliparous and multiparous patients respectively the condition is called an arrested second stage of labor. As her first delivery was a cesarean session due to breech presentation, this patient in the case is considered as nulliparous.

      Most common cause of a protracted or arrested second stage is fetal malposition, which is the relation between the fetal presenting part to the maternal pelvis. Occiput anterior is the optimal fetal position as it facilitates the cardinal movements of labor, any deviations from this position like in occiput transverse position, can lead to cephalopelvic disproportion resulting in second stage arrest.
      Inadequate contractions, that is less than 200 MVU averaged over 10 minutes, can lead to labor arrest but contractions are adequate in case of the patient mentioned.
      Second stage arrest can be due to maternal obesity and excessive weight gain during pregnancy but this patient had a normal pre-pregnancy BMI of 20 kg/m2 and an appropriate weight gain of 15.9 kg 35 lb. So this also cannot be the reason.

      Maternal expulsive efforts will change the fetal skull shape. This process called as molding helps to facilitate delivery by changing the fetal head into the shape of the pelvis. Whereas prolonged pressure on head can result in scalp edema which is called as caput, presence of both molding and caput suggest cephalopelvic disproportion, but is not suggestive of poor maternal effort.

      Patients with a prior history of uterine myomectomy or cesarean delivery are at higher risk for uterine rupture.  In cases of uterine rupture, the patient will present with fetal heart rate abnormalities, sudden loss of fetal station (eg, going from +1 to −3 station) along with fetal retreat upward and into the abdominal cavity through the uterine scar due to decreased intrauterine pressure. In the given case patient’s fetal heart rate tracing is category 1 and fetal station has remained 0 which are non suggestive of uterine rupture.

      When there is insufficient fetal descent after pushing ≥3 hours in nulliparous patients or ≥2 hours in multiparous patients is considered as second stage arrest of labor. The most common cause of second stage arrest is cephalopelvic disproportion, were the fetus presents in a nonocciput anterior position called as fetal malposition.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 29 - A 26 year old patient sustains a 4th degree perineal tear following delivery...

    Incorrect

    • A 26 year old patient sustains a 4th degree perineal tear following delivery of her 1st baby. Your consultant agrees to supervise you repair the tear. From the list below what is the most appropriate suture option for repairing the anal mucosa?

      Your Answer:

      Correct Answer: 3-0 polyglactin interrupted sutures

      Explanation:

      Repair the vaginal mucosa using rapidly absorbed suture material on a large, round body needle. Start above the apex of the cut or tear (as severed vessels retract slightly) and use a continuous stitch to close the vaginal mucosa.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 30 - HPV genotypes 6 and 11 are associated with which of the following? ...

    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.

    • This question is part of the following fields:

      • Microbiology
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SESSION STATS - PERFORMANCE PER SPECIALTY

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