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Question 1
Incorrect
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What epithelium cell type lines the ureters?
Your Answer: Pseudostratified Columnar
Correct Answer: Transitional
Explanation:Uterus is lines by a single layer of columnar epithelium. The endometrium goes through changes during the menstrual cycles.
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This question is part of the following fields:
- Pathology
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Question 2
Incorrect
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A woman in her 27 weeks of gestation presents to your clinic with gushing of clear yellow vaginal fluid.
Premature rupture of membrane (PPROM ) is confirmed on speculum examination, and the cervical os is closed.
Which of the following would be the most appropriate management, in addition to transfer to a tertiary center?Your Answer:
Correct Answer: Systemic corticosteroids
Explanation:Cases with spontaneous rupture of membrane before the onset of labour, prior to 37 weeks of gestation is defined as preterm premature rupture of membranes(PPROM). It complicates almost 2-4% of all singleton and 7- 20% of twin pregnancies and is commonly associated with more than 60% of all preterm births.
Management of PPROM In the absence of chorioamnionitis, depends on the gestational age. That is in cases of PPROM before 23 weeks, labor may be induced or the patient be sent home for bed rest and is asked to wait until any signs of spontaneous delivery to start. Between 23 and 34 + 0/7 weeks, the patient should be transferred to a tertiary hospital and be admitted there as it is very important to administer systemic corticosteroids, for the fetal lung to attain maturity. It is also mandatory the patient gets adequate bed rest, cervical and vaginal swabs for microscopy and culture, along with prophylactic antibiotics for prevention of chorioamnionitis.
NOTE – regardless of the gestational age, chorioamnionitis is said to be an absolute indication for the termination of pregnancy.In the given case, patient is currently in her 28th week of gestation, so she should be immediately transferred to a tertiary hospital and given systemic steroids to promote fetal lung maturation in case preterm delivery ensues.
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This question is part of the following fields:
- Obstetrics
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Question 3
Incorrect
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A 34 year old white primigravida in her first trimester had established moderate hypertension before becoming pregnant. She currently has a blood pressure of 168/108 mm Hg. You are considering how to best manage her hypertension during the pregnancy. Which one of the following is associated with the greatest risk of fetal growth retardation if used for hypertension throughout pregnancy?
Your Answer:
Correct Answer: Atenolol (Tenormin)
Explanation:Atenolol and propranolol are associated with intrauterine growth retardation when used for prolonged periods during pregnancy. They are class D agents during pregnancy. Other beta-blockers may not share this risk.
Methyldopa, hydralazine, and calcium channel blockers have not been associated with intrauterine growth retardation. They are generally acceptable agents to use for established, significant hypertension during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 4
Incorrect
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A 46 year old lady presents to the gynaecology clinic with a one month history of vulval soreness and lumps. She smokes several packs of tobacco cigarettes a day. A biopsy confirms vulvar intraepithelial neoplasia. What is her risk of developing squamous cell carcinoma?
Your Answer:
Correct Answer: 15%
Explanation:Vulvar Intraepithelial Neoplasia (VIN) is a non-invasive squamous type lesion that carries a 15% chance of developing into squamous cell carcinoma of the vulva. Human Papillomavirus (HPV) infection, or chronic inflammatory conditions such as lichen sclerosis and lichen planus, can cause changes in the basal cells of the vulvar epithelium. Other risk factors of VIN include multiple sexual partners, cigarette smoking, and immunocompromised states. Diagnosis is by clinical examination and a biopsy confirms neoplasia.
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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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After birth, all of the following vessels constrict, EXCEPT the:
Your Answer:
Correct Answer: Hepatic portal vein
Explanation:Immediately after birth the liver is deprived of the large flow of blood supplied during foetal development via the umbilical vein and portal sinus. Simultaneously the blood pressure in the portal sinus, previously as high as in the umbilical vein, falls.
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This question is part of the following fields:
- Physiology
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Question 6
Incorrect
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All of the following are features of the female bony pelvis, except?
Your Answer:
Correct Answer: It is funnel shaped
Explanation:The female bony pelvis is larger, broader and more of a funnel shape. The inlet is larger and oval in shape and the sides of the female pelvis are wider apart.
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This question is part of the following fields:
- Anatomy
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Question 7
Incorrect
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Yasmin®, which contains 3 mg of drospirenone and 30 mcg of ethinyl oestradiol, has been approved for usage in South Africa.
Which of the following factors has contributed to it becoming the most popular oral contraceptive pill among South African women?Your Answer:
Correct Answer: It has not weight gain as an adverse effect and may be associated with weight loss
Explanation:Yasmin has been linked to decreased fluid retention and weight gain as a side effect of COCs, which is why most women who experience this side effect prefer Yasmin®.
Due to its anti-mineralocorticoid properties, drospirenone, unlike earlier progestogens, is associated with no weight gain or even moderate weight loss.
Yasmin has a similar failure rate to other COCs. No evidence using Yasmin is linked to a lower risk of cervical cancer as a long-term side effect of COCs. Yasmin, like all COCs, can cause spotting and irregular bleeding in the first few months of use.
Drospirenone, a progesterone component, has antiandrogenic properties and is slightly more successful in treating acne, but the difference is not big enough to make it preferable in terms of acne therapy or prevention when compared to other COCs. -
This question is part of the following fields:
- Gynaecology
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Question 8
Incorrect
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A patient asks you in clinic when she can start trying to conceive again. She has just completed chemotherapy for gestational trophoblastic disease (GTD)?
Your Answer:
Correct Answer: 1 year from completion of treatment
Explanation:According to the RCOG greentop guidelines, a women who have underdone chemotherapy for GTD are advised not to conceive for 1 years after completion of the chemotherapy.
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This question is part of the following fields:
- Clinical Management
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Question 9
Incorrect
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In which situation would you prescribe COCs?
Your Answer:
Correct Answer: A 20 year old woman with blood pressure 135/80mmHg
Explanation:Absolute contraindications to OCs include breast cancer, history of deep venous thrombosis or pulmonary embolism, active liver disease, use of rifampicin, familial hyperlipidaemia, previous arterial thrombosis, and pregnancy, while relative contraindications include smoking, age over 35, hypertension, breastfeeding, and irregular spontaneous menstruation.
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This question is part of the following fields:
- Gynaecology
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Question 10
Incorrect
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A 55-year-old female presents to her general practitioner.
She complains of a three month history of amenorrhea, with recently added hot flushes 10 - 12 times a day, irritability and difficulty sleeping.
What would be the best management strategy to relieve her symptoms, whilst minimising side effects?Your Answer:
Correct Answer: Continuous daily oestrogen therapy, with medroxy progesterone acetate (MPA) given daily for 12 days each month.
Explanation:The best strategy is to commence cyclical hormone therapy using continuous daily oestrogen therapy, with medroxy progesterone acetate (MPA) given daily for 12 days each month.
This patient is most likely experiencing menopause, with symptoms caused by her oestrogen deficiency state.
Diazepam will help her to sleep and possibly alleviate her irritability, but would be unlikely to relieve the hot flushes.
Continuous therapy with oestrogen and MPA provides continuous progestogen therapy and has a high risk of causing unpredictable breakthrough vaginal bleeding, as it is only three months since the last menstrual period. This treatment is not recommended to be given within 1 – 2 years of the last period.
Oestrogen alone is not recommended for women who still have their uterus.
Progestogen alone would only be indicated in cases with contraindications to oestrogen administration.
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This question is part of the following fields:
- Gynaecology
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