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Question 1
Incorrect
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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: MRI brain
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.
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This question is part of the following fields:
- Gynaecology
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Question 2
Incorrect
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A 32-year-old white female comes to your office complaining of dysuria. She denies fever, back pain, and urinary frequency. She appears to be well otherwise and has a normal abdominal examination. A clean-catch urinalysis shows 15-20 WBC/hpf and a dipstick test for leukocyte esterase is positive. You send a urine sample for culture and start the patient on nitrofurantoin (Macrodantin), as she is allergic to sulpha.
Three days later, the patient returns with persistent dysuria despite taking the medication as prescribed. Her urine culture has returned with no growth. A pelvic examination is normal and the rest of the physical examination is unchanged. A wet prep is normal and tests for sexually transmitted diseases are pending. Which one of the following antibiotics is most appropriate for this patient now?Your Answer:
Correct Answer: Doxycycline
Explanation:Urethral syndrome is characterized by dysuria and pyuria in the presence of a negative culture for uropathogens. Frequency and urgency are often absent. The infecting organism is typically Chlamydia trachomatis although other organisms such as Urea plasma urealyticum and Mycoplasma species may be involve- Effective medication choices include doxycycline, ofloxacin, levofloxacin, and macrolides such as erythromycin and azithromycin.
-Amoxicillin
lavulanate and cephalexin are incorrect. These would cover gram-positive bacteria but it would not cover gram-negative bacteria nor bacteria without a cell wall, which are the most common causes of this condition.
– Metronidazole is best for treating anaerobic infections and protozoa such as trichomonas vaginalis, it would not be the best for treating this condition, given the most likely causes.
-Pyridium is a phenazopyridine often used to alleviate the pain, irritation, discomfort, or urgency caused by urinary tract infections. While it would be beneficial for symptomatic relief, it is unlikely to completely resolve this patient’s condition, given her recent history. -
This question is part of the following fields:
- Gynaecology
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Question 3
Incorrect
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A 49-year-old lady presents with amenorrhea of 11-months’ duration. Her periods were previously normal and regular. She is planned for an assessment of her FSH (follicle-stimulating hormone) and oestradiol (E2) levels.
Assuming she has attained menopause, which pattern would most likely be found?Your Answer:
Correct Answer: High FSH and low E2.
Explanation:High FSH and low E2 levels would be expected in menopause. FSH levels would be raised as her body attempts to stimulate ovarian activity and E2 would be low due to reduced ovarian function. The other options would be possible if she was younger, and if occurring with amenorrhea, would warrant further hormonal tests.
It is often challenging to interpret hormone test results close to the time of menopause, especially if the woman is still experiencing irregular menstruation, as remaining ovarian follicles might still produce oestrogen, causing both bleeding and FSH suppression. Elevation of FSH then can be seen again once the oestrogen level drops. Hence, the results would be influenced by the timing of blood sample collection. Once amenorrhea occurs more consistently, it would be easier to interpret the results.
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This question is part of the following fields:
- Gynaecology
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Question 4
Incorrect
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A 45 year old women has a transvaginal ultrasound that is reported as showing a partially echogenic mass with posterior sound attenuation owing to sebaceous material and hair within the cyst cavity. What is the likely diagnosis?
Your Answer:
Correct Answer: Mature teratoma
Explanation:Dermoid cysts and teratomas contain elements from multiple germ cell layers. They are often considered the same entity (even in medical texts) however a dermoid is composed only of dermal and epidermal elements. A teratoma has mesodermal and endodermal elements Mature teratomas are composed of well-differentiated derivations from at least 2/3 germ cell layers (i.e. ectoderm, mesoderm, and endoderm). They contain developmentally mature skin complete with hair follicles, sweat glands, sometimes hair, and sometimes sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue.
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This question is part of the following fields:
- Data Interpretation
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Question 5
Incorrect
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A 33-year-old woman at 37 weeks of gestation presented to the emergency department due to breech presentation which was confirmed on ultrasound. There is also a failed external cephalic version.
Which of the following is considered the most appropriate next step in managing the patient's condition?Your Answer:
Correct Answer: Elective caesarean delivery at 38 weeks of gestation
Explanation:Breech presentation refers to the foetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first.
The current recommendation for the breech presentation at term includes offering external cephalic version (ECV) to those patients that meet criteria, and for those whom are not candidates or decline external cephalic version, a planned caesarean section for delivery sometime after 39 weeks.
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This question is part of the following fields:
- Obstetrics
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Question 6
Incorrect
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The ovarian artery is a branch of the:
Your Answer:
Correct Answer: Aorta
Explanation:The ovarian artery is an artery that supplies oxygenated blood to the ovary in females. It arises from the abdominal aorta below the renal artery. It can be found in the suspensory ligament of the ovary, anterior to the ovarian vein and ureter.
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This question is part of the following fields:
- Anatomy
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Question 7
Incorrect
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A 36-year-old obese woman presents to your office for advice regarding pregnancy.
Her body mass index is 40, and she is normotensive and has a normal serum glucose level. On examination she was tested positive for glucose in urine.
What would be your advice to her?Your Answer:
Correct Answer: She will be checked for pre-existing diabetes in early pregnancy and, for gestational diabetes at 26 weeks
Explanation:Counselling her about the risks associated with obesity during pregnancy will be the best possible advice to give this patient. A combined follow up by an obstetrician and a diabetes specialist at a high-risk pregnancy clinic is required to formulate the best ways in management of gestation with obesity.
An oral glucose tolerance test should be done at 26 weeks of her pregnancy, along with advising her on controlling her weight by diet and lifestyle modifications. During the early weeks of their pregnancy all obese patients must be routinely tested for pre-existing diabetes.It is highly inappropriate to advice her not to get pregnant.
Without making a proper diagnosis of diabetes, it is wrong to ask her to start oral hypoglycemic agent and/or insulin.
Checking urinary proteins is not indicated at this stage, but can be considered as a part of antenatal check up.
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This question is part of the following fields:
- Obstetrics
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Question 8
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 9
Incorrect
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Question 10
Incorrect
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The source of progesterone that maintains the pregnancy during early 1st trimester:
Your Answer:
Correct Answer: Corpus luteum
Explanation:In early pregnancy Progesterone is produced by the corpus luteum.. This organ is fundamental for pregnancy maintenance until the placenta (syncytiotrophoblast) takes over its function at the 7-9th week of gestation, just after the expression of major histocompatibility complex antigens is suppressed in extra-embryonic fetal tissue.
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This question is part of the following fields:
- Endocrinology
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Question 11
Incorrect
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An 26 year old patient currently 9 weeks pregnant. This is her 1st pregnancy. She has been suffering with nausea and vomiting that has failed to respond to conservative measures including ginger, dietary changes and acupuncture. She wants to start medical therapy. Which of the following is 1st line drug treatment according to NICE guidance?
Your Answer:
Correct Answer: Promethazine
Explanation:Promethazine or Cyclizine are 1st choice options for management of nausea and vomiting in pregnancy according to NICE. Prochlorperazine is also appropriate 1st line.
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This question is part of the following fields:
- Pharmacology
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Question 12
Incorrect
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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.
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This question is part of the following fields:
- Embryology
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Question 13
Incorrect
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Several mechanisms have been proposed as to what causes closure of the Ductus Arteriosus (DA) at Parturition. Which of the following is the most important in maintaining the patency of the DA during pregnancy?
Your Answer:
Correct Answer: PGE2
Explanation:Functional closure of the ductus arteriosus is neonates is completed within the first few days after birth. It normally occurs by the 12th postnatal week. It has been suggested that persistent patency of DA results from a failure of the TGF-B induction after birth. Due to increased arterial pO2, constriction of the DA occurs. In addition to this on inflation the bradykinin system is activated with cause the smooth muscles in the DA to constrict. A decrease in the E2 prostaglandin is also an important factor as raised levels have been indicated in keeping the patency of the DA.
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This question is part of the following fields:
- Embryology
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Question 14
Incorrect
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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.
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This question is part of the following fields:
- Obstetrics
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Question 15
Incorrect
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Which of the following statements regarding BRCA gene mutations is true?
Your Answer:
Correct Answer: They account for around 25% of inherited breast cancers
Explanation:Hereditary breast cancers account for 10 % of the cases. BRCA gene mutations account for 25 % of these cancers.
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This question is part of the following fields:
- Genetics
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Question 16
Incorrect
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Where is fetal DHEA produced?
Your Answer:
Correct Answer: Adrenals
Explanation:DHEA is formed in the mother’s adrenal gland as well as the fetal adrenal glands. These weak androgens are transported by the blood to the placenta and are converted into oestradiol, estrone and estriol in the trophoblast.
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This question is part of the following fields:
- Endocrinology
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Question 17
Incorrect
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The following ultrasonic measurements may be used to confirm or establish gestational age:
Your Answer:
Correct Answer: Crown rump length
Explanation:Fetal ultrasound scanning is considered an essential part of routine antenatal care with first trimester scans recommended for confirming viability, accurate estimation of gestational age and determining the number of foetuses. Fetal crown-rump length (CRL) is measured in early pregnancy primarily to determine the gestation age (GA) of a foetus and is most reliable between 9+0 to 13+6 weeks’ gestation, but not beyond.
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This question is part of the following fields:
- Physiology
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Question 18
Incorrect
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What percentage of pregnant women have asymptomatic vaginal colonisation with candida?
Your Answer:
Correct Answer: 40%
Explanation:90% of genital candida infections are the result of Candida albicans. 20% of women of childbearing age are asymptotic colonisers of Candida species as part of their normal vaginal flora. This increases to 40% in pregnancy
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This question is part of the following fields:
- Clinical Management
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Question 19
Incorrect
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Pelvic ligaments can change at term resulting in?
Your Answer:
Correct Answer: Enlargement of the pelvic cavity
Explanation:The pelvis is supported by a variety of ligaments. At term, these ligaments allow for variation in its structure such that the overall size of the pelvic cavity is increased in order to accommodate the upcoming foetus into the cavity.
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This question is part of the following fields:
- Anatomy
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Question 20
Incorrect
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An 8-year-old girl presents with a history of a bright red bloodstain in her underpants one day prior to consultation. Her mother reports that the girl started cycling lessons one week ago. How will you proceed with the investigation in this case?
Your Answer:
Correct Answer: Examination under Anaesthesia
Explanation:A local exam might not help in locating the cause of the bleeding because it might be underneath the superficial structures. A thorough examination should be done under GA to accurately locate the source of bleeding.
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This question is part of the following fields:
- Gynaecology
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Question 21
Incorrect
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A 62-year-old woman complains of urinary incontinence for the past 12 months after having four pregnancies before the age of 30. She has to wear a 'pad' inside her pants all of the time because of this condition. She isn't on any hormone replacement therapy at the moment. Which of the following signs indicates that the incontinence is most likely true stress incontinence?
Your Answer:
Correct Answer: Only small quantities of urine ore lost each time she is incontinent.
Explanation:Only little volumes of urine are lost when her intra-abdominal pressure is elevated during coughing, laughing, jumping, and straining, which is the only symptom associated with real stress incontinence.
The other reactions are significantly more compatible with a detrusor instability diagnosis (also called urge incontinence).
If she had incontinence throughout pregnancy, it would have been stress in nature, which is what her current incontinence is. -
This question is part of the following fields:
- Gynaecology
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Question 22
Incorrect
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Regarding Venous Thromboembolism (VTE) in pregnancy which of the following statements is TRUE?
Your Answer:
Correct Answer: Relative risk of VTE in pregnancy is 4 to 6 fold
Explanation:Venous thromboembolic disease (VTE) is the most common cause of direct maternal death in the UK. In the most recent triennium, there were 41 fatalities, giving a maternal mortality rate of 1.94 per 100 000 – more than twice that of the next most common cause, pre-eclampsia. As pregnancy is a hyper coagulable state. There are alterations in the fibrinolytics and thrombotic pathways. There is also an increased production of clotting factors during pregnancy.
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This question is part of the following fields:
- Clinical Management
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Question 23
Incorrect
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A 27-year-old female reports to the emergency department due to severe right lower quadrant pain. Complaints started yesterday, as the patient noticed intermittent right lower abdominal pain associated with increased activity. She rested for remainder of the day, but the pain still continued to increase. An hour ago, the pain suddenly became constant and severe, associated with nausea and vomiting.The patient does not complaint of any radiation of pain.
On examination patient's temperature is noted to be 37.2 C (99 F), blood pressure is 130/80 mm Hg, and pulse rate is 98/min.On palpation of the right lower quadrant there is tenderness without rebounding or guarding.Urine pregnancy test conducted came to be negative.
Considering the following additional informations, which would be most appropriate in establishing the diagnosis of this patient?Your Answer:
Correct Answer: History of ovarian cysts
Explanation:Common Risk factors for Ovarian torsion are presence of an ovarian mass, women who are in their reproductive age and history of infertility treatment with ovulation induction.
Common clinical presentations include sudden onset of unilateral pelvic pain along with nausea & vomiting and presence of a palpable adnexal mass. An adnexal mass with absent Doppler flow to ovary can be noted in ultrasound.
Laparoscopy with detorsion, ovarian cystectomy and oophorectomy if necrosis or malignancy is found are the common treatment options.Acute lower abdominal pain in a nonpregnant women can have various causes including pathologies of the gastrointestinal, gynecologic, or urologic systems due to the close proximity of these structures. All of these cases have classic presentations which help to characterize the disease process and thereby to differentiate the diagnosis.
In the given case, patient presents with right lower quadrant pain which is classic for ovarian torsion, occurring due to rotation of the ovary around the infundibulopelvic ligament, causing ovarian vessel occlusion. Although ovarian torsion can occur in any women in their reproductive-age, is seen more commonly in those with a history of ovarian cysts (eg, hemorrhagic cyst) or masses (eg, mature cystic teratoma) because of the greater size and density of the ovary which makes it prone to rotation and subsequent torsion. Patients will initially have intermittent pain associated with activity, as in this patient, due to partial ovarian torsion, this initial pain resolves when the adnexa spontaneously untwists and blood flow returns. When this progresses to complete ovarian torsion, patients typically develop sudden-onset, severe, nonradiating pain due to persistent ischemia, which is often associated with nausea and vomiting.
Ovarian torsion can be clinically diagnosed, but a Doppler ultrasound is performed to evaluate ovarian blood flow and also to confirm the diagnosis. Surgical detorsion to prevent ovarian necrosis and cystectomy/oophorectomy are the usual treatment options.
Any association of urinary symptoms will help to establish a urologic cause of acute right lower quadrant pain like pyelonephritis, nephrolithiasis, etc. However, patients with urologic conditions typically presents with suprapubic or flank pain which radiates to the right lower quadrant, making this diagnosis less likely in the given case.
A family history of malignancy usually does not aid in the diagnosis of acute lower abdominal pain. Although some ovarian cancers are inherited, patients with ovarian cancer typically have a chronic, indolent course with associated weight loss, early satiety, and abdominal distension.
Having multiple sexual partners is considered a risk factor for sexually transmitted infections and pelvic inflammatory disease, which can be a cause for lower abdominal pain. However, patients will typically have fever, constant and diffused pelvic pain along with rebound and guarding.
Recent sick contacts are a risk factor for gastroenteritis, which can present with nausea, vomiting and abdominal pain. However, in this case patient will typically have diffuse, cramping abdominal pain which will worsen gradually; along with persistent vomiting and diarrhea.
Ovarian torsion typically causes intermittent lower abdominal pain followed by sudden-onset of severe, nonradiating unilateral pain with associated nausea and vomiting. Ovarian torsion can occur in women in their reproductive-age, particularly those with a history of ovarian cysts.
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This question is part of the following fields:
- Obstetrics
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Question 24
Incorrect
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The second meiotic division of the oocyte is normally completed:
Your Answer:
Correct Answer: After the sperm penetrates the secondary oocyte
Explanation:Upon penetration, if all is normally occurring, the process of egg-activation occurs, and the oocyte is said to have become activated. This is thought to be induced by a specific protein phospholipase c zeta. It undergoes its secondary meiotic division, and the two haploid nuclei (paternal and maternal) fuse to form a zygote.
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This question is part of the following fields:
- Embryology
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Question 25
Incorrect
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Physiological changes in the reproductive system include:
Your Answer:
Correct Answer: The uterus 1st enlarges by hyperplasia then by hypertrophy
Explanation:Although uterine growth during the first few weeks of pregnancy is accomplished by increased numbers of smooth muscle cells (i.e. hyperplasia) and a smaller contribution from increased cell size (i.e. hypertrophy), the predominant growth of the uterus during pregnancy is by way of stretch‐induced myometrial hypertrophy. This ongoing process of stretch‐induced tissue remodelling and smooth muscle hypertrophy is accompanied by the lack of uterine contractions during most of gestation to accommodate the developing foetus (phase 0 of parturition). Phase 1 of parturition represents myometrial activation. The final stages of pregnancy are characterized by increases in spontaneous low‐amplitude contractions that gradually increase in frequency, rhythmicity and strength, normally culminating in labour and delivery of the foetus at term (phase 2 of parturition).
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This question is part of the following fields:
- Physiology
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Question 26
Incorrect
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A 27-year-old woman presents for difficulty and pain in attempting sexual intercourse. She states that she never had such symptoms prior. The pain is not felt at the time of penetration, but appears to hurt deeper in the vagina.
She was recently pregnant with her first child and delivery was three months ago. She did not have an episiotomy or sustain any vaginal lacerations during delivery. She denies any vaginal bleeding since her lochia had stopped two months ago. She is still breastfeeding her child.
Which of the following is the most likely cause of her dyspareunia?Your Answer:
Correct Answer: Atrophic vaginal epithelium.
Explanation:This is a patient that recently gave birth and is still breastfeeding presenting with dyspareunia. The most likely cause would be a thin atrophic vaginal epithelium. This is very common presentation and is due to the low oestrogen levels due to the prolactin elevation from breastfeeding.
An unrecognised and unsutured vaginal tear should have healed by this time and should not be causing issues.
Endometriosis tends to resolve during a pregnancy, but if this was the issue, it would have caused dyspareunia prior to pregnancy.
Vaginal infective causes of dyspareunia, such as monilial or trichomonal infections, are rare in amenorrhoeic women.
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This question is part of the following fields:
- Obstetrics
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Question 27
Incorrect
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Which of the following conditions are the most common cause in post-partum haemorrhage?
Your Answer:
Correct Answer: Uterine atony
Explanation:Uterine atony is the most common cause for postpartum haemorrhage and the conditions like multiple pregnancy, polyhydramnions, macrosomia, prolonged labour and multiparity are the most common risk factor for uterine atony.
Whereas less common causes for postpartum haemorrhage are laceration of genital tract, uterine rupture, uterine inversion and coagulopathy.
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This question is part of the following fields:
- Obstetrics
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Question 28
Incorrect
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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.
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This question is part of the following fields:
- Pharmacology
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Question 29
Incorrect
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A 32-year-old mother with a 9-year-old child is considering having a second child. Her first pregnancy was complicated by puerperal psychosis. Following electroconvulsive therapy (ECT), she promptly recovered and has been well until now. She is in excellent health and her husband has been very supportive. According to patient files, she was noted to be an excellent mother.
What would be the most appropriate advice?Your Answer:
Correct Answer: There is a 15-20% chance of recurrence of psychosis postpartum.
Explanation:Puerperal psychosis seems to be mainly hereditary and closely associated with bipolar disorder especially the manic type, rather than being a distinct condition with a group of classical symptoms or course. Postpartum psychoses typically have an abrupt onset within 2 weeks of delivery and may have rapid progression of symptoms. Fortunately, it is generally a brief condition and responds well to prompt management. If the condition is threatening the mother and/or baby’s safety, hospital admission is warranted. A patient can present with a wide variety of psychotic symptoms ranging from delusion, passivity phenomenon, catatonia, and hallucinations. While depression and mania may be the predominating features, it is not surprising to see symptoms such as confusion and stupor. Although the rate of incidence is about 1 in 1000 pregnancies, it is seen in about 20% of women who previously had bipolar episodes prior to pregnancy. It has not been shown to be linked with factors such as twin pregnancies, stillbirth, breastfeeding or being a single parent. However, it might be more commonly seen in women who are first-time mothers and pregnancy terminations.
The risk of recurrence is 20%. Unfortunately, there is no specific treatment guideline but organic causes should first be ruled out. First generation/typical anti-psychotics are often associated with extrapyramidal symptoms. Nowadays, atypical antipsychotics such as risperidone or olanzapine can be used along with lithium which is a mood stabiliser. As of now, there hasn’t been any significant side effects as a result of second generation antipsychotic use in pregnancy. While women are usually advised to stop breast-feeding, it might be unnecessary except if the mother is being treated with lithium which has been reported to cause side effects on the infants in a few instances. ECT is considered to be highly efficacious for all types of postpartum psychosis and may be necessary if the mother’s condition is life-threatening to herself or/and the baby. If untreated, puerperal psychosis might persist for 6 months or even longer.
The options of saying ‘in view of her age and previous problem, further pregnancies are out of the question’ and so is ‘By all means start another pregnancy and see how she feels about it. If she has misgivings, then have the pregnancy terminated.’ are inappropriate.
As mentioned earlier, considering there is a 20% chance of recurrence it is not correct to say that since she had good outcomes with her first pregnancy, the risk of recurrence is minimal.
Anti-psychotics are not recommended to be used routinely both during pregnancy and lactation due to the absence of long-term research on children with intrauterine and breastmilk exposure to the drugs. Hence it is not right to conclude that ‘if she gets pregnant then she should take prophylactic antipsychotics throughout the pregnancy’ as it contradicts current guidelines. Each case should be individualised and the risks compared with the benefits to decide whether anti-psychotics should be given during pregnancy. It is important to obtain informed consent from both the mother and partner with documentation.
Should the mother deteriorates during the pregnancy that she no longer is capable of making decisions about treatment, then an application for temporary guardianship should be carried out to ensure that she can be continued on the appropriate treatment.
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This question is part of the following fields:
- Obstetrics
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Question 30
Incorrect
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A 53 year old female presents with hot flushes and night sweats. Her last menstrual period was last year. She had MI recently. Choose the most appropriate management for this patient.
Your Answer:
Correct Answer: Clonidine
Explanation:With a history of MI, oestrogen and COCP should be avoided. Evening primrose is also not suitable for post-menopausal symptoms. Raloxifene is a SERM – these make hot flushes worse. Clonidine will help improve the hot flushes and the vasomotor symptoms.
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This question is part of the following fields:
- Gynaecology
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