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Question 1
Incorrect
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Regarding cardiac output in pregnancy which of the following statements is TRUE?
Your Answer: Cardiac output decreases by approximately 10-15% during pregnancy
Correct Answer: Cardiac output increases by approximately 40-50% during pregnancy
Explanation:In a non pregnant adult female the cardiac output is 4.5L/min, by the 20 week of pregnancy the cardiac output increases by 40% to 6.3L/min. During early stages of labour it increases further still by 17% to 7.3L/min.
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This question is part of the following fields:
- Physiology
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Question 2
Incorrect
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Which of the following best describes the mechanism of action of radiotherapy?
Your Answer:
Correct Answer: DNA damage via free radical generation
Explanation:Radiotherapy causes ionisation, primarily of water. This leads to hydroxyl and other free radicals being generated. Free radicals are highly reactive and cause DNA damage to cells via their reactions with them. Free radicals are relatively short lived and eventually form stable compounds. The DNA damage leads to cellular death.
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This question is part of the following fields:
- Biophysics
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Question 3
Incorrect
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All of the following factors are associated with an unstable lie of the foetus except?
Your Answer:
Correct Answer: Cervical fibroids
Explanation:Unstable lie means that the foetus is still changing its position even at 36 weeks of gestation. A number of factors are responsible for this positioning such as multi gravida, placenta previa, prematurity and fibroids present in the fundus. Cervical fibroids have little association with unstable lie of the foetus.
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This question is part of the following fields:
- Obstetrics
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Question 4
Incorrect
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Macrophages are derived from what type of white blood cell?
Your Answer:
Correct Answer: Monocytes
Explanation:Macrophages are derived from monocytes. When monocytes come across a pathogen they differentiate into macrophages for phagocytosis to occur.
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This question is part of the following fields:
- Immunology
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Question 5
Incorrect
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All are true about monozygotic pregnancy, EXCEPT:
Your Answer:
Correct Answer: The 1st commonly presents as breech
Explanation:The 1st commonly presents as cephalic. Monozygotic (MZ) twins originate when a single egg is fertilized to form one zygote, which then divides into two embryos. Although they share the same genotype they are not phenotypically identical.
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This question is part of the following fields:
- Genetics
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Question 6
Incorrect
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A 33 year old female patient with high grade abnormality on cervical screening test was referred to see a gynaecologist at your clinic. Colposcopy reveals abnormal cells higher in the cervical canal.
What is the next step in management of this patient?Your Answer:
Correct Answer: Cone biopsy
Explanation:If abnormal cells are found high up in the cervical canal, it is critical to consider doing a cone biopsy to rule out any cervical malignancy. A cone-shaped section of the cervix containing the abnormal cells is removed under general anaesthesia.
Loop Electrosurgical Excision Procedure is a way of removing the abnormal cells from the cervix using a wire loop. First a speculum is inserted to open the vagina so the uterus can be seen. Then a solution is applied to the surface of the cervix to make the areas of abnormal cells easier to see. It is done under local anaesthesia.Cone biopsy is the only acceptable option to rule out malignancy. Cryotherapy, chemotherapy and radiotherapy are management options once malignancy has been confirmed.
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This question is part of the following fields:
- Gynaecology
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Question 7
Incorrect
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Question 8
Incorrect
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A 32-year-old woman, at 37 weeks of gestation, presents to the emergency department due to sudden onset of severe abdominal pain with vaginal bleeding of approximately 1200 cc and cessation of contractions after 18 hours of active pushing at home. Her pregnancy has been uneventful until the event.
On examination, patient is conscious and pale, with a blood pressure of 70/45 mm of Hg and pulse rate of 115 bpm. Abdomen is found to be irregularly distended with shifting dullness and fluid thrill. Fetal heart sounds are not audible.
Which among of the following will most likely be her diagnosis?Your Answer:
Correct Answer: Uterine rupture
Explanation:The given case where the patient presents with sudden abdominal pain, cessation of uterine contraction and the urge to push along with vaginal bleeding is typical for uterine rupture. Examination shows a decreased or lost fetal heart rate, along with signs of fluid collection including fluid thrill and shifting dullness due to the entry of blood into the peritoneal cavity.
Other common manifestations of uterine rupture include:
– Loss of the station of the fetal presenting part
– Vaginal bleeding which is not be proportionate to the hemodynamic status
-Maternal tachycardia and hypotension ranging from subtle to severer shock
– Uterine tenderness
– Change in uterine shape and contour
– Easily palpable fetal parts
– No fetal presentation on vaginal examination
– Hematuria if the rupture extends to the bladder
Anterior lower transverse segment is the most common site of spontaneous uterine rupture.Placenta previa usually presents as painless vaginal bleeding, which rules it out as the diagnosis in given case.
Vaginal bleeding with a tender and tense uterus is the presentation in placental abruption, also contrary to uterine rupture, uterine contractions will continue in case of placental abruption.
Cervical laceration can be a possibility, but in such cases more amount of vaginal blood loss was expected in this patient with hemodynamic instability. Also symptoms like deformed uterus, abdominal distention and cessation of contractions are inconsistent with cervical laceration.
Excessive generation of thrombin and fibrin in the circulating blood results in Disseminated intravascular coagulation (DIC) which leads to increased platelets aggregation and consumption of coagulation factors resulting in consequent bleeding at one site and thromboembolism at another. Placental abruption and retained products of conception in the uterine cavity are the most common obstetric causes of DIC. The condition will not fit as diagnosis in this clinical scenario.
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This question is part of the following fields:
- Obstetrics
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Question 9
Incorrect
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In the foetus where is the principle site of alpha fetoprotein (AFP) production
Your Answer:
Correct Answer: Liver
Explanation:AFP is a glycoprotein that is synthesized in the fetal liver (primarily), umbilical vesicles and the gut. It is found in elevated quantities in the fetal serum and peaks at around 14 week of gestation.
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This question is part of the following fields:
- Biochemistry
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Question 10
Incorrect
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Which of the following statements is true regarding heart rate in pregnancy?
Your Answer:
Correct Answer: Heart rate increases by 15 beats per minute
Explanation:During the first 12 weeks of pregnancy, cardiac output increases by about 30-50%. To maintain this increase, systemic vascular resistance decreases by 20-30%, while stroke volume and the heart rate increase by 25-30% and 15 beats per minute respectively.
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This question is part of the following fields:
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
