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Question 1
Incorrect
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Which of the following are required for Oxytocin to bind to its receptor?
Your Answer: Sodium and Potassium
Correct Answer: Magnesium and Cholesterol
Explanation:Oxytocin binds to G-protein-coupled receptors and requires Magnesium and cholesterol for this process to occur.
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This question is part of the following fields:
- Clinical Management
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Question 2
Incorrect
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A 33-year-old woman was admitted to a hospital's maternity unit for labour. Her pregnancy has been unremarkable so far and she had regular antenatal visits. Meconium liquor passage was noted during the labour. Cardiotocography was done and revealed a fetal heart rate (FHR) of 149bpm. There were no noted decelerations or accelerations. The beat-to-beat variability is established at 15 bpm. Upon vaginal examination, there were no reported abnormalities.
Which of the following is considered to be the next most appropriate step in managing this patient?Your Answer:
Correct Answer: The CTG is normal and close monitoring until delivery is all required for now
Explanation:Meconium is the earliest stool of a newborn. Occasionally, newborns pass meconium during labour or delivery, resulting in a meconium-stained amniotic fluid (MSAF).
No particular cardio-tocograph pattern can be considered to have a poor prognostic value in the presence of thick MSAF and the decision to deliver and the mode of delivery should be based on the overall assessment and the stage and progress of labour. While management should be individualized, a higher Caesarean section rate in thick MSAF can be justified to ensure a better outcome for the neonate even in the presence of a normal CTG trace.
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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 19 year old patient on Lamotrigine 125 mg twice a day for the past two years has recently been prescribed Microgynon 30 as a contraceptive before she leaves for Uni. What could the main concern be?
Your Answer:
Correct Answer: Combined contraceptive may reduce Lamotrigine levels and increase seizure risk
Explanation:Lamotrigine, a drug used to treat epilepsy, is less effective when taken with combined oral contraceptives. The oestrogen component of the pill decreases the circulating levels of Lamotrigine, increasing the risk of seizures. The combination is therefore classified as a UKMEC 3, as the risk of the drug combination may outweigh the benefit. As an alternative, the progesterone-only pill, depo progesterone, Mirena or the copper IUD may be considered as there is no restriction on concomitant use. Lamotrigine is not metabolised through cytochrome P450 like other antiepileptic drugs such as carbamazepine and phenytoin, neither is it an enzyme inhibitor.
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This question is part of the following fields:
- Clinical Management
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Question 4
Incorrect
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Which of the following is an appropriate treatment for Diazepam overdose?
Your Answer:
Correct Answer: Flumazenil
Explanation:Flumazenil is used for benzodiazepine overdose.
Naloxone is used for opioid overdose.
Parvolex (N-acetyl cysteine) is used for paracetamol overdose.
Protamine can be used for Heparin reversal.
Beriplex can be used for Warfarin reversal. -
This question is part of the following fields:
- Pharmacology
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Question 5
Incorrect
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Among the following which is incorrect regarding hypothyroidism in pregnancy?
Your Answer:
Correct Answer: Thyroxine requirement does not increase in pregnancy and maintenance dose must be continued
Explanation:Thyroxine requirement during pregnancy will increases by 25 to 30 percent, which is seen as early as fifth week of pregnancy.
Children born to those women whose hypothyroidism was inadequately treated during pregnancy, are at higher risk for developing neuropsychiatric impairments.
When a woman who is on thyroxine is planning to conceive, they are advised to increase their thyroxine dose by 30 percent at the time of confirmation of pregnancy.
During pregnancy TSH also should be monitored at every 8 to 10 weeks, with necessary dose adjustments.
Dose requirements of thyroxine will return to pre-pregnancy level soon after delivery and it will not change according to whether the mother is breastfeeding or not.
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This question is part of the following fields:
- Obstetrics
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Question 6
Incorrect
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You are reviewing a patient who is complaining of pain and numbness to the proximal medial thigh following abdominal hysterectomy. You suspect genitofemoral nerve injury. What spinal segment(s) is the genitofemoral nerve derived from?
Your Answer:
Correct Answer: L1,L2
Explanation:The genitofemoral nerves takes its origin from the L1 and L2 spinal segments.
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This question is part of the following fields:
- Anatomy
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Question 7
Incorrect
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Question 8
Incorrect
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A 26 year old patient with PCOS has been trying to conceive for 2 years. Her BMI is 26 kg/m2. She is a non-smoker. Which of the following is the most appropriate first line treatment?
Your Answer:
Correct Answer: Clomiphene
Explanation:Firstline medical management of PCOS is with clomiphene.
Ovulation Disorders
WHO Group I : Hypothalamic pituitary failure (Stress, anorexia, exercise induced)
Management:
Increase BMI if <19 kg/m2
Reduce exercise if high levels
Pulsatile GnRH or Gonadotrophins with LH activity to induce ovulationWHO Group II : Hypothalamic-pituitary-ovarian dysfunction (PCOS)
Management:
Weight reduction if BMI >30
Clomiphene/Clomiphene (1st line)
Metformin (1st line)
Clomiphene & Metformin (1st/2nd line)
Laparoscopic drilling (2nd line)
Gonadotrophins (2nd line)WHO Group III : Ovarian failure
Management:
Consider IVF with donor eggs -
This question is part of the following fields:
- Clinical Management
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Question 9
Incorrect
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A 32-year-old gravida 3 para 2 presents for routine prenatal care. The patient is at 14 weeks estimated gestational age by last menstrual period, and ultrasonography at 8 weeks gestation was consistent with these dates. Fetal heart tones are not heard by handheld Doppler. Transvaginal ultrasonography reveals an intrauterine foetus without evidence of fetal cardiac activity. The patient has not had any bleeding or cramping, and otherwise feels fine. A pelvic examination reveals a closed cervix without any signs of bleeding or products of conception.
Which one of the following is the most likely cause of this presentation?Your Answer:
Correct Answer: A missed abortion
Explanation:In this case, the patient has a missed abortion, which is defined as a dead foetus or embryo without passage of tissue and with a closed cervix. This condition often presents with failure to detect fetal heart tones or a lack of growth in uterine size.
– By 14 weeks estimated gestational age, fetal heart tones should be detected by both handheld Doppler and ultrasonography.
– An inevitable abortion presents with a dilated cervix, but no passage of fetal tissue.
– A blighted ovum involves failure of the embryo to develop, despite the presence of a gestational sac and placental tissue. -
This question is part of the following fields:
- Obstetrics
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Question 10
Incorrect
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What frequency is used for trans-abdominal ultrasound?
Your Answer:
Correct Answer: 3.0 MHz
Explanation:The transabdominal ultrasound uses a frequency of 3.5-7 MHz emitted from a transducer. Transvaginal 5-7.5 MHz (post bladder void.
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This question is part of the following fields:
- Data Interpretation
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Question 11
Incorrect
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All of the following statements are true regarding Turner's syndrome except?
Your Answer:
Correct Answer: The streak ovaries should be removed surgically due to 25% tendency to be malignant
Explanation:Girls with Turner’s syndrome (45,X) are not at risk for malignancy. Patients with feminizing testicular syndrome with XY chromosome composition and patients with mixed gonadal dysgenesis are at risk for malignancy, and bilateral gonadectomy is performed.
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This question is part of the following fields:
- Embryology
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Question 12
Incorrect
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A 31-year-old woman at her 18th week of pregnancy presented to the emergency department with complaints of fishy, thin, white homogeneous vaginal discharge accompanied with an offensive odour. The presence of clue cells was noted during a microscopic test on the discharge.
All of the following statements are considered false regarding her condition, except:Your Answer:
Correct Answer: Relapse rate > 50 percent within 3 months
Explanation:Bacterial vaginosis (BV) affects women of reproductive age and can either be symptomatic or asymptomatic. Bacterial vaginosis is a condition caused by an overgrowth of normal vaginal flora. Most commonly, this presents clinically with increased vaginal discharge that has a fish-like odour. The discharge itself is typically thin and either grey or white.
Although bacterial vaginosis is not considered a sexually transmitted infection, women have an increased risk of acquiring other sexually transmitted infections (STI), and pregnant women have an increased risk of early delivery.
Though effective treatment options do exist, metronidazole or clindamycin, these methods have proven not to be effective long term.
BV recurrence rates are high, approximately 80% three months after effective treatment.
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This question is part of the following fields:
- Obstetrics
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Question 13
Incorrect
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Which of the following structures does the broad ligament contain?
Your Answer:
Correct Answer: Uterine artery
Explanation:The broad ligament is one of the secondary supporting structures of the uterus which attaches the lateral portion of the uterus to the pelvic sidewall. The broad ligament primarily serves a protective layer for important structures including the fallopian tubes, the ovaries, the ovarian arteries, and the uterine arteries, the round and ovarian ligaments, and the infundibulopelvic ligaments.
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This question is part of the following fields:
- Anatomy
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Question 14
Incorrect
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You see a diabetic women in preconception clinic. Which of the following is appropriate advice regarding folic acid supplementation?
Your Answer:
Correct Answer: 5 mg daily until week 12
Explanation:The aim of pre-pregnancy counselling is to achieve the best possible glycaemic control before pregnancy and to educate diabetic women about the implications of pregnancy. Patient information leaflets about pregnancy should make clear the risks of pregnancy in diabetes, and include advice to take high dose (5 mg) folic acid pre-conception and for the first 12 weeks.
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This question is part of the following fields:
- Clinical Management
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Question 15
Incorrect
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A 51-year-old woman comes to your doctor's office for a breast cancer screening. For the past year, she has been on combination hormone replacement treatment (HRT). Mammography is the sole accessible form of breast cancer screening, and she is predicted to have dense breast tissue due to HRT.
Which of the following is the best HRT and breast cancer screening suggestion for this patient?Your Answer:
Correct Answer: Continue HRT and perform mammography as recommended for other women
Explanation:Among a variety of imaging modalities developed for breast cancer screening, mammography is the best-studied and the only imaging technique that has been shown to decrease mortality as demonstrated in multiple randomized trials. However, it is important to know that, even in the best circumstances, mammography may miss up to 20 percent of underlying breast cancers.
Women on HRT are likely to have dense breast. Dense breasts are associated with an increased risk of breast cancer and can decrease the sensitivity of mammography for small lesions. Nevertheless, we do not alter our general approach to age- and risk-based screening based on breast density. However, for women with dense breasts, we do prefer digital mammography over film mammography, due to greater sensitivity; digital mammography is the modality typically used for mammography in most locations in the United States.
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This question is part of the following fields:
- Gynaecology
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Question 16
Incorrect
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Fetal immunoglobulin production begins at what gestation?
Your Answer:
Correct Answer: Week 10
Explanation:Fetal production of immunoglobulin begins early on, at about 10 weeks gestation with the production of IgM antibodies. Maternal IgG, which is a key component of fetal immunity, is passed on to the foetus through the placenta from 12 weeks of gestation. Secretory IgA is not produced until after birth.
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This question is part of the following fields:
- Immunology
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Question 17
Incorrect
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A 29-year-old lady taking oral contraceptives came to your clinic with her boyfriend. She got severe diarrhoea and vomiting after eating a hamburger at a local eatery while on the road. She has taken her pills as prescribed.
What is your contraception advice?Your Answer:
Correct Answer: Use condoms for 7 days and continue usual pills
Explanation:The CDC recommends that:
If diarrhoea occurs within 24 hours of taking oral birth control or continues for 24 to 48 hours after taking a pill, an additional dose is not needed.
If diarrhoea lasts more than 48 hours Use backup birth control, such as condoms, or avoid sexual intercourse until pills have been taken for seven diarrhoea-free days.All other options are incorrect.
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This question is part of the following fields:
- Gynaecology
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Question 18
Incorrect
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The fetal head may undergo changes in shape during normal delivery. The most common aetiology listed is:
Your Answer:
Correct Answer: Molding
Explanation:With the help of molding, the fetal head changes its shape as the skull bones overlap. This helps in smooth delivery of the foetus through the birth canal.
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This question is part of the following fields:
- Obstetrics
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Question 19
Incorrect
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Which structure is the primary mechanism for shunting blood away from the fetal pulmonary circulation?
Your Answer:
Correct Answer: Foramen Ovale
Explanation:Oxygenation of fetal blood occurs in the placenta before it returns in the umbilical vein which joins the left branch of the portal vein. It bypasses the capillaries of the liver by going through the ductus venosus, which is obliterated after birth and becomes the ligamentum venosum. The oxygenated blood enters the inferior vena cava and is transported to the right atrium and
then through the patent foramen ovale to the left atrium and on to the left ventricle. From the left ventricle, the blood flows into the aorta and through the fetal vascular network. Blood returning from the head of the foetus passes through the superior vena cava to the right atrium and straight on to the right ventricle and pulmonary artery. However, it does not enter the pulmonary
circulation, being short-circuited by the ductus arteriosus to the aorta. Aortic blood is carried via the umbilical arteries back to the placenta for reoxygenation. At birth, the three short circuits, the ductus venosus, foramen ovale and ductus arteriosus, close. -
This question is part of the following fields:
- Embryology
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Question 20
Incorrect
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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 exercisePregnancy, 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.
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This question is part of the following fields:
- Gynaecology
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SESSION STATS - PERFORMANCE PER SPECIALTY
