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  • Question 1 - Which of the following is the primary host for Toxoplasma Gondii? ...

    Incorrect

    • Which of the following is the primary host for Toxoplasma Gondii?

      Your Answer: Sheep

      Correct Answer: Cats

      Explanation:

      Toxoplasma gondii, an intracellular protozoan, is the main causative agent for Toxoplasmosis. The primary host for the organism is the domestic cat. Humans can become infected by eating undercooked meat of animals harbouring cysts, consuming water or food contaminated with cat faeces, or through maternal-fetal transmission. Toxoplasmosis can cause complications in pregnancy such as miscarriages and congenital infection can lead to hydrocephalus, microcephaly, mental disability and vision loss.

    • This question is part of the following fields:

      • Microbiology
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  • Question 2 - A 25-year-old gravida 1 para 0 woman, at her 36 weeks of gestation,...

    Incorrect

    • A 25-year-old gravida 1 para 0 woman, at her 36 weeks of gestation, is brought to the emergency department by her mother due to a seizure. Patient was sitting outside when she suddenly had a 2-minute seizure with loss of urinary continence and is still confused when she arrived at the emergency department.Her mother reports that the patient had severe anxiety and had been acting out for the past several days.Her only surgery was a splenectomy after a motor vehicle collision last year.
      On physical examination patient's temperature is 37.7 C (99.9 F), blood pressure is 158/98 mm Hg, and pulse is 120/min.Patient seems agitated and diaphoretic with bilaterally dilated pupils.
      On systemic examination:
      Cranial nerves are intact, neck is supple and nontender.
      Cardiopulmonary examination is normal.
      The abdomen is gravid without any rebound or guarding and the uterus is nontender.
      There is 2+ pitting pedal edema bilaterally. Sensations and strength are normal in the bilateral upper and lower extremities.
      Laboratory results are as follows:
      a) Complete blood count shows
      - Hematocrit: 33%,
      - Platelets: 140,000/mm3,
      - Leukocytes: 13,000/mm3.
      b) Serum chemistry
      - Sodium: 124 mmol/L,
      - Potassium: 3.4 mmol/L,
      - Chloride: 96 mmol/L,
      - Bicarbonate: 21 mmol/L,
      - Blood urea nitrogen: 6.43 umol/L,
      - Creatinine: 70.7 umol/L,
      - Glucose: 4.4 mmol/L.
      Urinalysis
      - Protein: none,
      - Ketones: present.
      CT scan of the head is normal.
      Which of the following is most likely the diagnosis in this patient?

      Your Answer:

      Correct Answer: Amphetamine intoxication

      Explanation:

      This patient at 36 weeks of gestation likely had a generalized tonic-clonic seizure. A new-onset seizures in pregnancy can be due to either due to eclampsia which is pregnancy-specific or due to other non-obstetric causes like meningitis, intracranial bleeding etc.

      In pregnant and postpartum women eclampsia is the most common cause for seizures which is classically associated with preeclampsia, a new-onset hypertension at ≥20 weeks gestation, with proteinuria and/or signs of end-organ damage. Although this patient has hypertension, absence of proteinuria and the additional findings like agitation, dilated pupils, hyponatremia and normal head CT scan are suggestive of another etiology. Patients with eclampsia will show white matter edema in head CT scan.

      Amphetamine intoxication, which causes overstimulation of the alpha-adrenergic receptors resulting in tachycardia, hypertension and occasional hyperthermia, might be the cause for this patient’s seizures. Some patients will also have diaphoresis and minimally reactive, dilated pupils and severe intoxication can lead to electrolyte abnormalities, including significant hyponatremia (possibly serotonin-mediated) and resultant seizure activity.
      Confirmation of Amphetamine intoxication can be done by a urine drug testing. it is essential to distinguishing between eclampsia and other causes of seizure in this case, as it will help to determine whether or not there is need for an emergency delivery.

      Altered mental status and electrolyte abnormalities can be due to heat stroke, however, patients affected this way will have an elevated temperature of >40 C /104 F associated with hemodynamic instabilities like hypotension.

      Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is a hypertensive disorder of pregnancy which can result in seizures (ie, eclampsia), but this patient’s hematocrit level is normal without any hemolysis, also patients with HELLP syndrome typically presents with a platelet count <100,000/mm3. Seizures and altered mental status in patients with prior splenectomy can be due to pneumococcal meningitis however, such patients will present with high fever and nuchal rigidity, making this diagnosis less likely in the given case. Amphetamine intoxication can present with hypertension, agitation, diaphoresis, dilated pupils, and a generalized tonic-clonic seizure due to hyponatremia, which is most likely to be the case here.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 3 - A 31 year old patient undergoes an elective c-section delivery. You estimate blood...

    Incorrect

    • A 31 year old patient undergoes an elective c-section delivery. You estimate blood loss has reached 1000ml and you suspect uterine atony is the likely cause. Following bimanual uterine compression what pharmacological intervention is advised?

      Your Answer:

      Correct Answer: Syntocin 5u by slow intravenous injection

      Explanation:

      Syntocin 5u by slow intravenous injection is the first line pharmacological measurement in this scenario

    • This question is part of the following fields:

      • Clinical Management
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  • Question 4 - Changes in the urinary tract system in pregnancy include: ...

    Incorrect

    • Changes in the urinary tract system in pregnancy include:

      Your Answer:

      Correct Answer: Increase in the glomerular filtration rate (GFR)

      Explanation:

      Pregnancy involves remarkable orchestration of physiologic changes. The kidneys are central players in the evolving hormonal milieu of pregnancy, responding and contributing to the changes in the environment for the pregnant woman and foetus. The functional impact of pregnancy on kidney physiology is widespread, involving practically all aspects of kidney function. The glomerular filtration rate increases 50% with subsequent decrease in serum creatinine, urea, and uric acid values. 

    • This question is part of the following fields:

      • Physiology
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  • Question 5 - In evaluating a reproductive age woman who presents with amenorrhea, which of the...

    Incorrect

    • In evaluating a reproductive age woman who presents with amenorrhea, which of the following conditions will result in a positive (withdrawal) progesterone challenge test?

      Your Answer:

      Correct Answer: Polycystic ovarian syndrome

      Explanation:

      In pregnancy, progesterone is produced by the corpus luteum followed by the placenta- Exogenous progesterone will not lead to withdrawal bleeding. In ovarian failure as well as pituitary failure, no oestrogen stimulation of the endometrium exists, and progesterone cannot cause withdrawal bleeding. With Mullerian agenesis, there is no endometrium. Polycystic ovarian syndrome has an abundance of circulating oestrogen, so the endometrium will proliferate.

      → In pregnancy progesterone withdrawal will not occur since the corpus luteum is producing progesterone- The placenta will take over, starting at 7 weeks, and will be the sole producer of progesterone by 12 weeks.
      → In ovarian failure no oestrogen will be produced; no proliferation of the endometrium will occur.
      → Pituitary failure is an incorrect answer because without gonadotropin stimulation, there will not be enough oestrogen to stimulate the endometrial lining.
      → Mullerian agenesis is an incorrect answer – there is no uterus, thus no bleeding.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 6 - A 36-year-old woman arrived at the clinic complaining of stomach discomfort and vaginal...

    Incorrect

    • A 36-year-old woman arrived at the clinic complaining of stomach discomfort and vaginal bleeding. A pregnancy test in the urine came back positive. An ultrasonography of the right fallopian tube revealed a gestational sac.
      Which of the following is NOT a risk factor for the ailment you've just read about?

      Your Answer:

      Correct Answer: Type 2 Diabetes Mellitus

      Explanation:

      An ectopic pregnancy is definitely present in this patient. An extrauterine pregnancy is referred to as an ectopic pregnancy. The fallopian tube accounts for 96% of ectopic pregnancies, but other sites include the cervical, interstitial (also called cornual; a pregnancy located in the proximal segment of the fallopian tube that is embedded within the muscular wall of the uterus), hysterotomy (caesarean) scar, intramural, ovarian, or abdominal. Furthermore, multiple gestations may be heterotopic in rare situations (including both a uterine and extrauterine pregnancy). Diabetes mellitus is not considered a risk factor for the development of an ectopic pregnancy.

      Risk factors for ectopic pregnancy are summarized below:
      High Risk: (Risk factors & Odds ratio)
      Previous ectopic pregnancy 2.7 to 8.3
      Previous tubal surgery 2.1 to 21
      Tubal pathology 3.5 to 25
      Sterilization 5.2 to 19
      IUD – Past use 1.7 – Current use 4.2 to 16.4
      Levonorgestrel IUD 4.9
      In vitro fertilization in current pregnancy 4.0 to 9.3

      Moderate:
      Current use of oestrogen/progestin oral contraceptives 1.7 to 4.5
      Previous sexually transmitted infections (gonorrhoea, chlamydia) 2.8 to 3.7
      Previous pelvic inflammatory disease 2.5 to 3.4
      In utero diethylstilbesterol (DES) exposure 3.7
      Smoking – Past smoker 1.5 to 2.5 – Current smoker 1.7 to 3.9
      Previous pelvic/abdominal surgery 4.0
      Previous spontaneous abortion 3.0

      Low:
      Previous medically induced abortion 2.8
      Infertility 2.1 to 2.7
      Age ≥40 years 2.9
      Vaginal douching 1.1 to 3.1
      Age at first intercourse <18 years 1.6
      Previous appendectomy 1.6

    • This question is part of the following fields:

      • Gynaecology
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  • Question 7 - A 40-year-old woman arrives at the hospital at eight weeks of her first...

    Incorrect

    • A 40-year-old woman arrives at the hospital at eight weeks of her first pregnancy, anxious that her kid may have Down syndrome. Which of the following best reflects the risk of spontaneous abortion after an amniocentesis performed at 16 weeks?

      Your Answer:

      Correct Answer: 18%

      Explanation:

      This question assesses critical clinical knowledge, as this information must be presented to a patient prior to an amniocentesis to ensure that she has given her informed permission for the treatment.
      Amniocentesis is most typically used for genetic counselling in the second trimester of pregnancy. Another option is to do a chorion-villus biopsy (CVB) between 10 and 11 weeks of pregnancy.
      The chances of miscarriage after both operations are roughly 1 in 200 for amniocentesis and 1 in 100 for CVB, according to most experts.
      The significance of this question is that professionals must be able to weigh the procedure’s danger against the risk of the sickness they are trying to identify.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 8 - 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 9 - A 35-year-old woman presents to your gynaecologic clinic with complaints of abdominal bloating,...

    Incorrect

    • A 35-year-old woman presents to your gynaecologic clinic with complaints of abdominal bloating, headaches, insomnia, mood swings, and reduced sexual desire. These symptoms usually get worse a few days before the onset of menstruation and get better with menstruation.
      The most appropriate treatment strategy for such a patient is?

      Your Answer:

      Correct Answer: Sertraline

      Explanation:

      Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). PMS causes bloating, headaches, and breast tenderness a week or two before your period.

      With PMDD, you might have PMS symptoms along with extreme irritability, anxiety, or depression. These symptoms improve within a few days after your period starts, but they can be severe enough to interfere with your life.

      PMDD symptoms appear a week or two before menstruation and go away within a few days after your period starts. In addition to PMS symptoms, you may have:

      Anger or irritability.
      Anxiety and panic attacks.
      Depression and suicidal thoughts.
      Difficulty concentrating.
      Fatigue and low energy.
      Food cravings or binge eating.
      Headaches.
      Insomnia.
      Mood swings.

      The following treatments have been shown to relieve symptoms:

      Sertraline, escitalopram, paroxetine, and fluoxetine are SSRIs (selective serotonin reuptake inhibitors). SSRIs are the first-line treatment and are extremely effective.
      The second line of defence is alprazolam (a short course recommended due to its addictive potential).
      The use of temazepam has little advantage because it only aids with sleep and is relatively short-acting.
      Lifestyle modifications-weight loss, exercise, quitting smoking, and relaxation therapies for less severe PMS.
      Danazol-suppresses the ovulation and helps with mastalgias associated with PMS.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 10 - A 27-year-old woman complains of a lump in her right breast after a...

    Incorrect

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

      Your Answer:

      Correct Answer: Fat necrosis

      Explanation:

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

    • This question is part of the following fields:

      • Gynaecology
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