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  • Question 1 - In which part of the body does clomiphene trigger ovulation by antagonising oestrogen...

    Incorrect

    • In which part of the body does clomiphene trigger ovulation by antagonising oestrogen receptors?

      Your Answer: Anterior pituitary

      Correct Answer: Hypothalamus

      Explanation:

      Clomiphene citrate is widely used in the induction of ovulation, especially in the treatment of anovulatory infertility and in conditions such as PCOS. The drug functions as a selective oestrogen receptor modulator, which acts in the hypothalamus to indicate low serum oestrogen levels. Reduced levels of negative feedback stimulate the secretion of GnRH from the hypothalamus, which in turn stimulate the production of gonadotropins (FSH and LH) from the anterior pituitary. These work to increase ovarian follicular activity.

    • This question is part of the following fields:

      • Pharmacology
      4
      Seconds
  • Question 2 - Which of the following statements regarding the vaginal artery is typically TRUE? ...

    Incorrect

    • Which of the following statements regarding the vaginal artery is typically TRUE?

      Your Answer:

      Correct Answer: It arises from the Internal iliac artery

      Explanation:

      The vaginal artery is the homolog to the inferior vesical artery in males. In most of the cases it arises from the internal iliac artery.

    • This question is part of the following fields:

      • Anatomy
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  • Question 3 - Evidence from a panel of experts is what level of evidence ...

    Incorrect

    • Evidence from a panel of experts is what level of evidence

      Your Answer:

      Correct Answer: IV

      Explanation:

      Level I: Evidence obtained from at least one properly designed randomized controlled trial. Level II-1: Evidence obtained from well-designed controlled trials without randomization. Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one centre or research group. Level II-3: Evidence obtained from multiple time series designs with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

    • This question is part of the following fields:

      • Epidemiology
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  • Question 4 - A 21-year old female, gravida 1 para 0, term pregnancy, comes in due...

    Incorrect

    • A 21-year old female, gravida 1 para 0, term pregnancy, comes in due to labour for eight hours. Two hours prior to onset of contractions, her membranes have allegedly ruptured. Fetal heart rate is at 144/min. Contractions are of good quality, noted every 2-3 minutes, with a duration of 45 seconds. On examination, her cervix is fully dilated and the patient has been pushing all throughout. Vertex is palpated in the occipito-anterior (OA) position and has descended to station 2 cm below the ischial spines in the previous hour. Which of the following most likely depicts the current condition of the patient?

      Your Answer:

      Correct Answer: Normal progress.

      Explanation:

      The patient’s condition can be described as a normal progress of labour. The scenario shows a normal descent of the head in the pelvic cavity, with a favourable position, and occurring within an hour of the second stage of labour. A normal second stage of labour in a nulliparous individual occurs at a maximum of two hours, which is consistent with this patient. Hence, there is no delay in the second stage.

      There is evident progress of labour in this patient, hence, obstructed labour or cephalopelvic disproportion is ruled out.

      No signs of maternal distress such as tachycardia or pyrexia is described in this patient.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 5 - A 32 year old women who is 25 weeks pregnant presents with vaginal...

    Incorrect

    • A 32 year old women who is 25 weeks pregnant presents with vaginal bleeding and cramping lower abdominal pain. On examination the cervix is closed. Fetal cardiac activity is noted on ultrasound. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Antepartum Haemorrhage

      Explanation:

      Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby.

    • This question is part of the following fields:

      • Clinical Management
      0
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  • Question 6 - Placental production of hPL, hCG, Oestrogen and Progesterone are examples of which type...

    Incorrect

    • Placental production of hPL, hCG, Oestrogen and Progesterone are examples of which type of mechanism

      Your Answer:

      Correct Answer: Endocrine

      Explanation:

      Hormones that are secreted into the circulation at one site but have effects on distal target organs are endocrine as is the case with the hormones above. Autocrine and Intracrine messengers act within the same cell. Exocrine glands secrete their products into ducts. Apocrine is a histological term used to describe some types of exocrine gland.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 7 - A patient is on the ward with a mechanical mitral valve. There is...

    Incorrect

    • A patient is on the ward with a mechanical mitral valve. There is no history of VTE. What is the target INR?

      Your Answer:

      Correct Answer: 2.5 - 3.5

      Explanation:

      With the use of warfarin, strict control of the INR is compulsory. After mitral valve replacement the INR should ideally be kept between 2.5-3.5. If the Ball and Cage or the Tilting Disc is used as a prosthetic valve then the target INR is 3.5, for bi-leaflets the target INR is 3.0 and for biological valves the target INR is 2.5.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 8 - A 20-year-old pregnant woman at 32 weeks gestation presents with a history of...

    Incorrect

    • A 20-year-old pregnant woman at 32 weeks gestation presents with a history of vaginal bleeding after intercourse. Pain is absent and upon examination, the following are found: abdomen soft and relaxed, uterus size is equal to dates and CTG reactive. What is the single most possible diagnosis?

      Your Answer:

      Correct Answer: Placenta previa

      Explanation:

      Placenta previa typically presents with painless bright red vaginal bleeding usually in the second to third trimester. Although it’s a condition that sometimes resolves by itself, bleeding may result in serious complications for the mother and the baby and so it should be managed as soon as possible.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 9 - All of the following factors are associated with umbilical cord prolapse, except? ...

    Incorrect

    • All of the following factors are associated with umbilical cord prolapse, except?

      Your Answer:

      Correct Answer: Anencephaly

      Explanation:

      Anencephaly means the missing of a particular portion of the scalp and brain tissue. The other factors listed are associated with umbilical cord prolapse like multiparity, twin birth, polyhydramnios, premature delivery, long umbilical cord or breech presentation.

    • This question is part of the following fields:

      • Physiology
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  • Question 10 - 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
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  • Question 11 - Which of the following describes Neisseria Gonorrhoea? ...

    Incorrect

    • Which of the following describes Neisseria Gonorrhoea?

      Your Answer:

      Correct Answer: Gram Negative Cocci

      Explanation:

      Neisseria Gonorrhoeae is a Gram negative diplococci.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 12 - What percentage of haemoglobin is HbF by 6 months of age? ...

    Incorrect

    • What percentage of haemoglobin is HbF by 6 months of age?

      Your Answer:

      Correct Answer:

      Explanation:

      HB gower 1 is the predominant embryonic haemoglobin when the foetus is 6 week old and is replaced by adult haemoglobin by the age of 5 months post natally. Only 2% of the haemoglobin is HbF.

      Embryonic Haemoglobin:
      Haemoglobin Gower 1 (HbE Gower-1)
      Haemoglobin Gower 2 (HbE Gower-2)
      Haemoglobin Portland I (HbE Portland-1)
      Haemoglobin Portland II (HbE Portland-2)

      Fetal Haemoglobin (haemoglobin F, HbF)

    • This question is part of the following fields:

      • Physiology
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  • Question 13 - Of the following, which one has the greatest effect on the relative risk...

    Incorrect

    • Of the following, which one has the greatest effect on the relative risk of developing endometrial carcinoma?

      Your Answer:

      Correct Answer: Polycystic ovary syndrome

      Explanation:

      The factor associated with the greatest relative risk for endometrial carcinoma is polycystic ovary syndrome, which has a relative risk of 75. The use of long-term high doses of postmenopausal oestrogen carries an estimated risk of 10-20. Living in North America or Europe also has an estimated risk of 10-20.

      A lower relative risk is associated with nulliparity, obesity, infertility, late menopause, older age, and white race- The relative risk associated with these factors falls into the range of 2-5. Early menarche, higher education or income levels, menstrual irregularities, and a history of diabetes, hypertension, gall bladder disease, or thyroid disease have a relative risk of around 1.5-2.0.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 14 - 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
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  • Question 15 - The first stage of labour: ...

    Incorrect

    • The first stage of labour:

      Your Answer:

      Correct Answer: Ends with fully dilation of the cervix

      Explanation:

      First stage of the labour starts with the contractions of the uterus. With time, the no. of contractions, its duration and intensity increases. It ends once the cervix is fully dilated.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 16 - A 32 year old patient with a 28 day menstrual cycle is offered...

    Incorrect

    • A 32 year old patient with a 28 day menstrual cycle is offered a Hysterosalpingogram (HSG) at an infertility clinic.
      At which point in her cycle should the HSG be performed?

      Your Answer:

      Correct Answer: Days 6-12

      Explanation:

      Hysterosalpingography is a radiological test used to investigate infertility especially in patients with no history suggesting tubal blockages such as pelvic surgery or PID, in which case a laparoscopy and dye is better suited. For the procedure, a contrast dye is inserted through the cervix, flows through the uterus and the fallopian tubes and should spill into the peritoneum. Fluoroscopy provides dynamic images of these structures to determine if there are any abnormalities or blockages. HSG is best performed on day 6-12 in the cycle, after the cessation of menses, and before ovulation, to avoid X Ray exposure in case of an unknown early pregnancy.

    • This question is part of the following fields:

      • Biophysics
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  • Question 17 - The femoral triangle is bounded medially by which of the following structures? ...

    Incorrect

    • The femoral triangle is bounded medially by which of the following structures?

      Your Answer:

      Correct Answer: Adductor longus

      Explanation:

      The femoral triangle is bounded superiorly by the inguinal ligament which forms the base of the triangle, medially by the lateral border of the adductor longus and laterally by the sartorius muscle.

    • This question is part of the following fields:

      • Anatomy
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  • Question 18 - A 27-year-old pregnant elementary school teacher presented to the medical clinic because she...

    Incorrect

    • A 27-year-old pregnant elementary school teacher presented to the medical clinic because she found out that one of her students has been recently diagnosed with rubella, but the diagnosis was not confirmed by serologic tests. Upon interview, it was noted that her last rubella vaccination was when she was 12 years old.
      Which of the following is considered the best management as the next step to perform?

      Your Answer:

      Correct Answer: Check rubella serology

      Explanation:

      Rubella infection during pregnancy may lead to miscarriage, intrauterine fetal demise, premature labour, intrauterine growth retardation, and congenital rubella syndrome. The risk of developing complications is highest if the infection is contracted within the first 12 weeks of gestation.

      In those cases in which a pregnant woman has been exposed to a suspected rubella case, a specimen of blood should be tested as soon as possible for the measurement of rubella-specific IgG antibodies. If it is positive, then the woman was likely to be immune and could be reassured. If it is negative, a determination rubella-specific IgG and rubella-specific IgM antibodies should be obtained in 3 weeks to exclude an asymptomatic primary rubella infection.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 19 - On the sixth day of her menstrual cycle, a 25-year-old lady comes to...

    Incorrect

    • On the sixth day of her menstrual cycle, a 25-year-old lady comes to your clinic with slight lower abdomen pain. She has no children and lives with her male companion. Her blood pressure is 110/70 mmHg, her pulse is 90 beats per minute, and her temperature is 37.5°C.
      On vaginal examination, no adnexal lump is palpated, however cervical motion pain is noticed.
      Which of the following is the most appropriate next step in management?

      Your Answer:

      Correct Answer: Cervical swabs for culture

      Explanation:

      Pain upon movement of the cervix with the health care provider’s gloved fingers is suggestive of an inflammatory process of the pelvic organs. CMT, when present, is classically found on bimanual examination of the cervix and uterus. While CMT is often associated with pelvic inflammatory disease, it can be present in other disease entities such as ectopic pregnancy, endometriosis, ovarian torsion, appendicitis, and perforated abdominal viscus.

      PID is not a singular disease entity but describes a spectrum of disease. It is an upper genital tract infection, which may affect the uterus, fallopian tubes, ovaries, and peritoneum. PID can begin as cervicitis, progress to endometritis, followed by involvement of the fallopian tubes as pyosalpinx, and ultimately involve the ovary as a tubo-ovarian abscess (TOA). The two most common causative pathogens are N. gonorrhoeae and C. trachomatis although the infection is often polymicrobial.

      Documentation of infection with either of these two organisms must be done by cervical swabs for culture.

      Transvaginal ultrasound or CT scan can be done to confirm diagnosis however the absence of findings in these investigations doesn’t rule out the possibility of PID.

      Urinalysis can be done to exclude urinary tract infection, one of the possible differential diagnosis for PID.

      Thyroid stimulating hormone has no role in the diagnosis of PID.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 20 - A 32-year-old woman came to your clinic in a small rural town of...

    Incorrect

    • A 32-year-old woman came to your clinic in a small rural town of New South Wales. She is 34 weeks pregnant and all her past 3 pregnancy has been uncomplicated.
      On examination her blood pressure is 140/95 mm of Hg today which is higher than her usual blood pressure of 110/70 mmHg. Urinalysis shows protein 2+ and the patient feels well generally.
      Among the following, which is the most appropriate next step in management of this patient?

      Your Answer:

      Correct Answer: Send her to the local hospital for urgent review

      Explanation:

      This patient has developed clinical features like hypertension and proteinuria consistent with Pre-eclampsia. So the patient should be sent to an obstetrician for urgent review, it is not appropriate in such cases to postpone urgent specialist reviews as it could lead to serious complications.

      Labetalol though is safe in pregnancy and is considered as an option to treat hypertension, it could be given in the emergency department.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 21 - A 25 year old unmarried female presented with dizziness, nausea and vomiting for...

    Incorrect

    • A 25 year old unmarried female presented with dizziness, nausea and vomiting for 1 week. According to her, she has been stressed recently and her usual menstrual period has been delayed by 4 weeks. Examination findings were normal. Which of the following is the most appropriate next step?

      Your Answer:

      Correct Answer: Dipstick for B-hCG

      Explanation:

      There is high possibility of her being pregnant. Urine B-hCG has to be checked to exclude pregnancy.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 22 - A young couple, both 26 years of age, presents to you with 11...

    Incorrect

    • A young couple, both 26 years of age, presents to you with 11 months’ duration of infertility. On investigation, she is found to be ovulating, and her hysterosalpingogram is normal. On semen analysis, the following results were found:
      Semen volume 5mL (2-6 mL)
      Sperm count 1 million/mL * (>20 million)
      Motility 15% (>40%)
      Abnormal forms 95% (<60%)
      A second specimen three months later confirms the above results.
      Which would be the most suitable next step in management?

      Your Answer:

      Correct Answer: Carry out in vitro fertilisation (IVF) using intracytoplasmic sperm injection (ICSI).

      Explanation:

      Achieving spontaneous pregnancy is rare in cases where a couple have been infertile with abnormal semen analysis (count <5million/mL and reduced motility), hence there is generally an indication for treatment. FSH injection usually would not be expected to improve the semen specimen. Rate of pregnancy would be much lower if at the time of intrauterine insemination, the total motile count is less 5 million. In this case, his count is 1 million. Pregnancy is likely to be achieved with donor sperm but as it would not contain the husband’s genetic material, it would be only considered later on once all other methods involving his own sperm have failed. Out of all the options, IVF would most likely result in a pregnancy, in which it allows the husband’s sperm to spontaneously fertilise the oocyte. Rate of pregnancy would roughly be 2% per treatment cycle. This rate would increase to roughly 20% if ISCI is also used.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 23 - Sertoli cells contain receptors to which hormone? ...

    Incorrect

    • Sertoli cells contain receptors to which hormone?

      Your Answer:

      Correct Answer: FSH

      Explanation:

      Sertoli cells contain receptors for FSH. In response to this Sertoli cells synthesize inhibin, androgen binding proteins and anti Mullerian hormone all which are connected to the reproduction cycle.

    • This question is part of the following fields:

      • Anatomy
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  • Question 24 - A patient who has been seen in fertility clinic phones regarding the timing...

    Incorrect

    • A patient who has been seen in fertility clinic phones regarding the timing of her progesterone blood test. She has regular 35 day menstrual cycles. When testing for ovulation what day of her cycle should she have the test on?

      Your Answer:

      Correct Answer: 28

      Explanation:

      The mid-luteal progesterone sample should be taken 7 days before the expected period i.e. day 21 in a 28-day cycle or day 28 of a 35 day cycle

    • This question is part of the following fields:

      • Data Interpretation
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  • Question 25 - Hypemesis gravidarum occurs in what percentage of pregnancies? ...

    Incorrect

    • Hypemesis gravidarum occurs in what percentage of pregnancies?

      Your Answer:

      Correct Answer: 1.50%

      Explanation:

      Nausea and vomiting experienced in 80% of pregnancies Hyperemesis gravidarum (HG) is an extreme form of nausea and vomiting which affects around 1.5% of women. Caused by high levels HCG. Definitions vary but most consider it to be defined by severe nausea and vomiting associated with weight loss greater than 5% of pre-pregnancy weight with metabolic disturbance (typically dehydration and/or ketosis).

    • This question is part of the following fields:

      • Clinical Management
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  • Question 26 - A 73-year-old woman presents with a complaint of blood-stained vaginal discharge.
    On speculum...

    Incorrect

    • A 73-year-old woman presents with a complaint of blood-stained vaginal discharge.
      On speculum examination, her ectocervix and vagina show signs of atrophy.
      No evidence of malignant cells is seen on cervical cytology, although no endocervical cells were visualised.
      Choose the most suitable next step for management of this patient.

      Your Answer:

      Correct Answer: Hysteroscopy and dilatation and curettage

      Explanation:

      Diagnostic hysteroscopy with dilatation and curettage (D&C) is the most suitable step for immediate management of this patient (correct answer). This would aid in determining if an endometrial lesion exists and enable histologic examination of any endometrium that may be present.
      Assessment of endometrial thickness via ultrasound examination is commonly used to decide if a patient requires D&C. In postmenopausal women, an endometrial thickness of more than 4mm indicates need for D&C.

      However, this method is more beneficial in younger postmenopausal women. In women who are 70 years or older, postmenopausal bleeding should be considered to be due to a malignancy until confirmed otherwise.

      In this patient, a vaginal swab for culture or a colposcopy would not be appropriate.

      Similarly, laparoscopy is not indicated unless the bleeding continued despite a normal hysteroscopy and D&C.

      If the endometrial thickness is less than 4mm, a malignancy is less likely to be present; however, the risk cannot be completely excluded.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 27 - Which of the following hormones inhibits Galactopoiesis and Lactogenesis postpartum? ...

    Incorrect

    • Which of the following hormones inhibits Galactopoiesis and Lactogenesis postpartum?

      Your Answer:

      Correct Answer: Dopamine

      Explanation:

      Galactopoiesis and Lactogenesis are stimulated by Prolactin. Dopamine released under hypothalamic control inhibits Prolactin production. Note oestrogen and progesterone inhibit lactogenesis up until term.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 28 - A 25-year-old woman at 39 weeks of gestation complaints of intermittent watery vaginal...

    Incorrect

    • A 25-year-old woman at 39 weeks of gestation complaints of intermittent watery vaginal discharge, which has started last night after she had sex with her husband.
      Speculum examination shows, pooling of straw-colored fluid in the posterior vaginal fornix. The cervical os is closed and there is leaking of liquor from cervical os when she is asked to cough or strain.
      Which among the following best explains these clinical findings?

      Your Answer:

      Correct Answer: Premature rupture of membranes (PROM)

      Explanation:

      Presentation in the given case is classic for premature rupture of membranes (PROM) which was probably caused due to trauma during intercourse.
      Premature rupture of membrane (PROM) is defined as the rupture of embryonic membranes before the onset of labor, regardless of the age of pregnancy. If occured before 37 weeks of gestation, it is termed as preterm PROM (PPROM.)

      A sudden gush of watery fluid per vagina is the classic presentation of rupture of the membranes (ROM), regardless of gestational age, however nowadays many women presents with continuous or intermittent leakage of fluid or a sensation of wetness within the vagina or on the perineum. Presence of liquor flowing from the cervical os or its pooling in the posterior vaginal fornix are considered as the pathognomonic symptom of ROM. Assessment of fetal well-being, the position of the fetus, placental location, estimated fetal weight and presence of any anomalies in PROM and PPROM are done with ultrasonographic studies.

      Retained semen will not result in the findings mentioned in this clinical scenario as it have a different appearance.

      Infections will not be a cause for this presentation as it will be associated with characteristic features like purulent cervical discharge, malodorous vaginal discharge, etc. Pooling of clear fluid in the posterior fornix is pathognomonic for ROM.

      Urine leakage is common during the pregnancy, but it is not similar to the clinical scenario mentioned above.

      Absence of findings like cervical dilation and bulging membranes on speculum exam makes cervical insufficiency an unlikely diagnosis in this case.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 29 - In girls what is the first sign of puberty? ...

    Incorrect

    • In girls what is the first sign of puberty?

      Your Answer:

      Correct Answer: Breast development

      Explanation:

      The first sign of puberty in females is the development of breasts.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 30 - 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
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  • Question 31 - What is the most common Type II congenital thrombophilia? ...

    Incorrect

    • What is the most common Type II congenital thrombophilia?

      Your Answer:

      Correct Answer: Factor V Leiden mutation

      Explanation:

      The most common congenital thrombophilia is Factor V Leiden mutation. Other congenital causes are JAK-2 mutations and the Prothrombin G20210A mutation. Protein C and S deficiencies are type 1 and antiphospholipid syndrome is not congenital it is an acquired thrombophilia.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 32 - You are asked to infiltrate a patients perineum with local anaesthetic prior to...

    Incorrect

    • You are asked to infiltrate a patients perineum with local anaesthetic prior to episiotomy. What is the maximum dose of lidocaine (without adrenaline)?

      Your Answer:

      Correct Answer: 3 mg/kg

      Explanation:

      The half-life of lidocaine is approximately 1.5 hours. It is a local anaesthetic and the maximum dose that can be given is 3mg/kg.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 33 - Ootidogenesis refers to which process during Oogenesis? ...

    Incorrect

    • Ootidogenesis refers to which process during Oogenesis?

      Your Answer:

      Correct Answer: 1st and 2nd Meiotic Divisions

      Explanation:

      During the early fetal life, oogonia proliferate by mitosis. They enlarge to form primary oocyte before birth. No primary oocyte is form after birth. The primary oocyte is dormant is the ovarian follicles until puberty. As the follicle matures, the primary oocyte completes its first meiotic division and gives rise to secondary oocyte. During ovulation the secondary oocytes starts the second meiotic division but is only completed if a sperm penetrates it. This 1st and 2nd meiotic division is known as ootidogenesis.

    • This question is part of the following fields:

      • Embryology
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  • Question 34 - 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 a SERM that is effective in treating hormone-responsive breast cancer, it acts as an antagonist to prevent receptor activation by endogenous oestrogen. As agonist of the endometrial receptors it promotes endometrial hyperplasia and hence increases the risk of endometrial cancer.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 35 - A 28-year-old woman who is at the 18th week of gestation presented to...

    Incorrect

    • A 28-year-old woman who is at the 18th week of gestation presented to the medical clinic due to a vaginal discharge. Upon history taking, it was revealed that she had a history of preterm labour at 24 weeks of gestation during her last pregnancy. Upon examination, the presence of a clear fluid coming out of the vagina was noted.
      Which of the following is considered to be the best in predicting pre-term labour?

      Your Answer:

      Correct Answer: Cervical length of 15mm

      Explanation:

      Preterm birth is the leading cause of neonatal morbidity and mortality not attributable to congenital anomalies or aneuploidy. It has been shown that a shortened cervix is a powerful indicator of preterm births in women with singleton and twin gestations – the shorter the cervical length, the higher the risk of spontaneous preterm birth. Ultrasound measurements of the cervix are a more accurate way of determining cervical length (CL) than using a digital method.

      25 mm has been chosen as the ‘cut off’ at above which a cervix can be regarded as normal, and below which can be called short. A cervix that is less than 25 mm may be indicative of preterm birth.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 36 - A 27-year-old G1P0 woman who is at 14 weeks of gestation presented to...

    Incorrect

    • A 27-year-old G1P0 woman who is at 14 weeks of gestation presented to the medical clinic complaining of persistent nausea and vomiting. Upon history taking and interview, she reported that she frequently had poor appetite and felt lethargic. From her pre-pregnancy weight, it was also noted that she had 3% weight loss in difference. Upon further clinical observation, she looked dry, accompanied with coated tongue.
      If the diagnosis of “hyperemesis gravidarum” is to be considered, which of the following will most likely confirm that diagnosis?

      Your Answer:

      Correct Answer: she looks dry with coated tongue

      Explanation:

      Hyperemesis gravidarum refers to intractable vomiting during pregnancy, leading to weight loss and volume depletion, resulting in ketonuria and/or ketonemia. There is no consensus on specific diagnostic criteria, but it generally refers to the severe end of the spectrum regarding nausea and vomiting in pregnancy.

      Hormone changes wherein hCG levels peak during the first trimester corresponds to the typical onset of hyperemesis symptoms. It is well-known that the lower oesophageal sphincter relaxes during pregnancy due to the elevations in estrogen and progesterone. This leads to an increased incidence of gastroesophageal reflux disease (GERD) symptoms in pregnancy, and one symptom of GERD is nausea.

      Hyperemesis gravidarum refers to extreme cases of nausea and vomiting during pregnancy. The criteria for diagnosis include vomiting that causes significant dehydration (as evidenced by ketonuria or electrolyte abnormalities, and the dry with coated tongue) and weight loss (the most commonly cited marker for this is the loss of at least five percent of the patient’s pre-pregnancy weight) in the setting of pregnancy without any other underlying pathological cause for vomiting.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 37 - A 33-year-old female, who is 14 weeks pregnant, presented to your office for...

    Incorrect

    • A 33-year-old female, who is 14 weeks pregnant, presented to your office for antenatal follow-up.
      On examination, the fundal height is found to be18 cm.
      which among the following would be the best next step in the management of this patient?

      Your Answer:

      Correct Answer: Perform an ultrasound scan

      Explanation:

      At 12 weeks gestation the fundus is expected to be palpable above the pubis symphysis and it is expected to be felt at the level of umbilicus by 20 weeks. Though the uterine fundus stands in between from 12 and 20 weeks, the height of the fundus in centimeters is equivalent to the weeks of pregnancy after 20 weeks.

      For 14-week pregnant uterus a fundal height of 18cm is definitely large and dating errors is considered as the most common cause for such a discrepancy. Hence, it is better to perform an ultrasound scan for more accurately estimating the gestational age. Also if the case is not a simple dating error, ultrasonography can provide definitive additional information about other possible conditions such as polyhydramnios, multiple gestation, etc that might have led to a large-for-date uterus.

      A large-for-gestational-age uterus are most commonly found in conditions like:
      – Dating errors which is the most common cause
      – Twin pregnancy
      – Gestational diabetes
      – Polyhydramnios
      – Gestational trophoblastic disease, also known as molar pregnancy

    • This question is part of the following fields:

      • Obstetrics
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  • Question 38 - Which of the following statements regarding management of obstetric anal sphincter injuries (OASIS)...

    Incorrect

    • Which of the following statements regarding management of obstetric anal sphincter injuries (OASIS) is true?

      Your Answer:

      Correct Answer: Broad-spectrum antibiotics should be given routinely following OASIS

      Explanation:

      After perineal repair, lactulose and a bulking agent should ideally be given for 5-10 days as well as broad spectrum antibiotics should be given that will cover all possible anaerobic bacteria. At 6-12 months a full evaluation should be done regarding the progress of healing. 60 to 80% of women are asymptomatic 12 months post delivery and external anal sphincter repair.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 39 - Which of the following contraceptives primary mode of action is inhibition of ovulation?...

    Incorrect

    • Which of the following contraceptives primary mode of action is inhibition of ovulation?

      Your Answer:

      Correct Answer: Cerazette®

      Explanation:

      Traditional POP main mode of contraceptive action: thickening of cervical mucus Desogestrel-only POP main mode of contraceptive action is inhibition of ovulation Cerazette® is the only Desogestrel-only POP in the options above. Other desogestrel brands include: Aizea® Cerelle® Nacrez® The other POPs listed are considered traditional POPs and have the following compositions: Norgeston® – Levonorgestrel 30 mcg Micronor® & Noriday® – Norethisterone 350 mcg Femulen® – Ethynediol diacetate 500 mcg

    • This question is part of the following fields:

      • Clinical Management
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  • Question 40 - What is the mode of action of Mefenamic acid? ...

    Incorrect

    • What is the mode of action of Mefenamic acid?

      Your Answer:

      Correct Answer: Inhibits Prostaglandin Synthesis

      Explanation:

      Activation of Antithrombin III and inactivation of factor Xa is the primary mechanism of action of Heparin.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 41 - You review a 28 year old patient in the fertility clinic. She has...

    Incorrect

    • You review a 28 year old patient in the fertility clinic. She has a diagnosis of PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2. She is a non-smoker. She has been taking Clomiphene and metformin for the past 6 months. What is the next most appropriate treatment?

      Your Answer:

      Correct Answer: Gonadotrophins

      Explanation:

      Clomiphene shouldn’t be continued for more than 6 months. The second line options are Gonadotrophins or ovarian drilling.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 42 - To avoid potential haemolysis, Anti D immunoglobulin should be administered to which of...

    Incorrect

    • To avoid potential haemolysis, Anti D immunoglobulin should be administered to which of the following?

      Your Answer:

      Correct Answer: Rhesus negative mother, non-sensitised, fetal cord blood Rh positive

      Explanation:

      The Rhesus status of a mother is important in pregnancy and even abortion. The exposure of an Rh-negative mother exposed to Rh antigens from a positive foetus, will influence the development of anti-Rh antibodies. This may cause problems in subsequent pregnancies leading to haemolysis in the newborn. Rh Anti RhD- globulin is therefore given to non-sensitised Rh-negative mothers who give birth to Rh-positive children to prevent the formation of anti-Rh antibodies. Anti RhD globulin is not useful for already sensitized, or RhD positive mothers; its administration could result in maternal blood being bound and taken out of circulation.

    • This question is part of the following fields:

      • Immunology
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  • Question 43 - Which of the following increases in pregnancy? ...

    Incorrect

    • Which of the following increases in pregnancy?

      Your Answer:

      Correct Answer: Th2

      Explanation:

      T-Helper cells type 2 increase during pregnancy. They secret cytokines IL-4,5,9,10 and 13.

    • This question is part of the following fields:

      • Immunology
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  • Question 44 - Regarding cardiac examination during pregnancy which of the following findings should be considered...

    Incorrect

    • Regarding cardiac examination during pregnancy which of the following findings should be considered pathological

      Your Answer:

      Correct Answer: Diastolic murmur

      Explanation:

      Diastolic murmurs should be considered pathological until proven otherwise. The following are common and typically benign findings in pregnancy: A third heart sound after mid-pregnancy. Systolic flow murmurs are common. Left axis deviation on ECG is common, Sagging ST segments and inversion or flattening of the T wave in lead III may also occur

    • This question is part of the following fields:

      • Physiology
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  • Question 45 - During early pregnancy, a pelvic examination may reveal that one adnexa is slightly...

    Incorrect

    • During early pregnancy, a pelvic examination may reveal that one adnexa is slightly enlarged. This is most likely due to:

      Your Answer:

      Correct Answer: Corpus luteal cyst

      Explanation:

      Adnexa refer to the anatomical area adjacent to the uterus, and contains the fallopian tube, ovary, and associated vessels, ligaments, and connective tissue. The reported incidence of adnexal masses in pregnancy ranges from 1 in 81 to 1 in 8000 pregnancies. Most of these adnexal masses are diagnosed incidentally at the time of dating or first trimester screening ultrasound (USS). Functional cyst is the most common adnexal mass in pregnancy, similar to the nonpregnant state. A corpus luteum persisting into the second trimester accounts for 13-17% of all cystic adnexal masses. Pain due to rupture, haemorrhage into the cyst, infection, venous congestion, or torsion may be of sudden onset or of a more chronic nature.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 46 - According to the RCOG Green-top guideline published in 2013 at what stage of...

    Incorrect

    • According to the RCOG Green-top guideline published in 2013 at what stage of gestation should pregnant patients with PCOS be offered screening for gestational diabetes

      Your Answer:

      Correct Answer: 24-28 weeks gestation

      Explanation:

      Screening for gestational diabetes should be offered and performed between 24-28 weeks. It should be noted PCOS alone does not make screening essential. It is advised for PCOS patients who are overweight or if not overweight but has other risk factors (age >40, personal history of gestational diabetes or family history of type II diabetes). Screening is via a 2-hour post 75 g oral glucose tolerance test.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 47 - What is the mechanism of action of Oxytetracycline? ...

    Incorrect

    • What is the mechanism of action of Oxytetracycline?

      Your Answer:

      Correct Answer: Binds to 30S subunit of microbial ribosomes blocking attachment of aminoacyl-tRNA to the A site on the ribosome

      Explanation:

      Tetracycline is classified as a broad spectrum antibiotic. It is a bacteriostatic inhibitor of protein synthesis acting at the ribosomal level. Tetracycline binds to the 30s ribosomal subunit preventing the binding of the aminoacidic charged T-RNA to the ribosome-mRNA complex.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 48 - The ureter is lined by what type of epithelium? ...

    Incorrect

    • The ureter is lined by what type of epithelium?

      Your Answer:

      Correct Answer: Transitional

      Explanation:

      Ureters are muscular tubes that run from the kidneys to the urinary bladder. It is lined by transitional epithelium.

    • This question is part of the following fields:

      • Anatomy
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  • Question 49 - Regarding molding of the fetal head, which one is true? ...

    Incorrect

    • Regarding molding of the fetal head, which one is true?

      Your Answer:

      Correct Answer: Does NOT have time to occur in breech delivery

      Explanation:

      Molding allows the skull bones of the fetal head some mobility during the normal delivery of foetus as the skull changes its shape to accommodate passage through the mothers pelvis. However this does not occur in breach delivery where the skull is in circular shape. Babies born breech typically have craniofacial and limb deformations resulting from their in utero position. These babies characteristically have a long, narrow head, (“dolichocephaly” or “type 1”), with a prominent occipital shelf, redundant skin over the neck, overlapping lambdoidal sutures, and an indentation below their ears (from shoulder compression).

    • This question is part of the following fields:

      • Anatomy
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  • Question 50 - A 23-year-old woman with diffuse pelvic pain and vaginal bleeding presents to the...

    Incorrect

    • A 23-year-old woman with diffuse pelvic pain and vaginal bleeding presents to the emergency room. She claims that it is around the time that she usually has her period. She has previously experienced defecation discomfort, dyspareunia, and dysmenorrhea. The patient claims that she has previously experienced similar symptoms, but that the agony has suddenly become unbearable.
      Her abdomen is soft, with normal bowel sounds and no rebound soreness, according to her physical examination. There is no costovertebral discomfort and the patient does not guard. Blood in the posterior vaginal vault, a closed os, and no palpable masses or cervical motion pain are all findings on her pelvic examination.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Endometriosis

      Explanation:

      Endometriosis is defined as the presence of normal endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Approximately 30-40% of women with endometriosis will be sub fertile. About one third of women with endometriosis remain asymptomatic. When they do occur, symptoms, such as the following, typically reflect the area of involvement:
      – Dysmenorrhea
      – Heavy or irregular bleeding
      – Pelvic pain
      – Lower abdominal or back pain
      – Dyspareunia
      – Dyschezia (pain on defecation) – Often with cycles of diarrhoea and constipation
      – Bloating, nausea, and vomiting
      – Inguinal pain
      – Pain on micturition and/or urinary frequency
      – Pain during exercise

      Pregnancy, appendicitis, ureteral colic and ruptured ectopic pregnancy all do not present with dysmenorrhea, pain on defecation and dyspareunia. Presence of a non tender, soft abdomen also rules out these conditions.

    • This question is part of the following fields:

      • Gynaecology
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