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Question 1
Incorrect
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The following drugs cross the placenta to the foetus, EXCEPT:
Your Answer: Aspirin
Correct Answer: Heparin
Explanation:Standard heparin, an effective treatment for antepartum thromboembolic disease, is thought to be safe for the foetus since it does not cross the placenta.
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This question is part of the following fields:
- Pharmacology
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Question 2
Incorrect
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What is the typical weight of a non-pregnant premenopausal uterus?
Your Answer:
Correct Answer: 40g
Explanation:Uterine blood flow increases 40-fold to approximately 700 mL/min at term, with 80 per cent of the blood. The uterus is 50–60 g prior to pregnancy and 1000 g by term. The volume increases from 10 ml to 5000ml approx. It is around 40g at menopause.
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This question is part of the following fields:
- Physiology
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Question 3
Incorrect
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A 24 year old woman presents to the clinic with foul smelling vaginal discharge. Which facultative anaerobic bacteria is most likely to be the cause?
Your Answer:
Correct Answer: Gardnerella vaginalis
Explanation:Bacterial vaginosis is a common infection of the vagina caused by the overgrowth of atypical bacteria, most commonly Gardnerella vaginalis, a gram indeterminate bacteria, which is also a facultative anaerobe. Patients often complain of foul-smelling fishy discharge and dysuria. In diagnosing BV, a swab is taken for microscopy, often revealing clue cells. Of the other organisms listed in the options, Neisseria is an obligate anaerobe, while Chlamydia trachomatis is an obligate intracellular aerobe. Treponema Pallidum is an aerophilic bacteria and Mycoplasma hominis is a pleomorphic parasitic bacterium.
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This question is part of the following fields:
- Microbiology
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Question 4
Incorrect
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During normal pregnancy, a weight gain is anticipated. The average weight gain is approximately:
Your Answer:
Correct Answer: 10-15 kg
Explanation:Institute of Medicine Weight Gain Recommendations for Pregnancy: Recommends a gestational weight gain of 16.8–24.5 kg (37–54 lb) for women of normal weight, 14.1–22.7 kg (31–50 lb) for overweight women, and 11.3–19.1 kg (25–42 lb) for obese women.
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This question is part of the following fields:
- Physiology
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Question 5
Incorrect
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Regarding the biophysical profile:
Your Answer:
Correct Answer: Includes fetal movement, fetal tone, fetal breathing, fetal heart rate & amniotic fluid
Explanation:The biophysical profile is a composite test that collects 5 indicators of fetal well-being, including fetal heart rate reactivity, breathing movements, gross body movements, muscular tone, and quantitative estimation of amniotic fluid volume. The assessment of fetal heart rate is accomplished by performing a non-stress test, whereas the latter 4 variables are observed using real-time ultra-sonography.
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This question is part of the following fields:
- Biophysics
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Question 6
Incorrect
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Question 7
Incorrect
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A 29 year old patient has a transvaginal ultrasound scan that shows a mass in the left ovary. It is anechoic, thin walled, is without internal structures and measures 36mm in diameter. What is the likely diagnosis?
Your Answer:
Correct Answer: Functional cyst
Explanation:Features of functional ovarian cysts on ultrasound are: Thin walled and unilocular Must be >3cm diameter (if <3cm described as follicle) Anechoic (absence of internal echoes) No colour flow No solid components
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This question is part of the following fields:
- Data Interpretation
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Question 8
Incorrect
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A 26 year old primigravida woman attends A&E due to worsening vomiting. She is currently 10 weeks pregnant. For the past 4 weeks she has had morning sickness but for the last 4 days she has been unable to tolerate any oral fluids without vomiting and thinks she has lost weight. On questioning she has no significant past medical history prior to this pregnancy. She is currently taking the following medication:
Your Answer:
Correct Answer: Hyperemesis gravidarum
Explanation:This patient has severe nausea and vomiting with ketosis and evidence of dehydration (low BP and tachycardia) in the early part of pregnancy. There is no history of diabetes and the blood glucose doesn’t indicate hyperglycaemia. This is consistent with hyperemesis gravidarum (HG)
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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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A 27-year-old G2P1 visits the gynaecologist with complaints of increased hair growth on her face, breast, and belly, but hair loss in the temporal regions of her head. She has also struggled with acne.
On physical examination, the patient's face, chest, and belly are covered in coarse, dark hair. Her clitoris is swollen on pelvic examination. Her left adnexal mass is 7 cm in diameter.
What is the most likely ovarian tumour to be associated with this clinical picture?Your Answer:
Correct Answer: Sertoli-Leydig cell tumour
Explanation:Sertoli-Leydig cell tumours constitute less than 0.5 percent of ovarian neoplasms. They may behave in a benign or malignant fashion, which correlates with the degree of differentiation in an individual case. Approximately 75 percent occur in women under the age of 40 years (mean age at diagnosis is 25), but they occur in all age groups. The neoplasms are characterized by the presence of testicular structures that produce androgens. This can result in virilization, although not all of these neoplasms are functionally active.
Pure Sertoli cell tumours are usually estrogenic and may also secrete renin, leading to refractory hypertension and hypokalaemia. In addition, these tumours may be associated with Peutz-Jeghers syndrome.
Pure Leydig cell tumours are androgen secreting; only a few cases have been reported. Virtually all of these rare tumours are unilateral and confined to the ovary at diagnosis.
Granulosa cell tumours typically present as large masses; the mean diameter is 12 cm. Women may present with an asymptomatic mass noted on abdominal or pelvic examination. Granulosa cell tumours often produce oestrogen and/or progesterone; consequently, symptoms related to hyperestrogenism are common at diagnosis.
Krukenberg tumour, also known as carcinoma mucocellulare, refers to the signet ring subtype of metastatic tumour to the ovary. The stomach followed by colon are the two most common primary tumours to result in ovarian metastases, pursued by the breast, lung, and contralateral ovary.
A rare tumour that is made up of more than one type of cell found in the gonads (testicles and ovaries), including germ cells, stromal cells, and granulosa cells. Gonadoblastomas are usually benign (not cancer), but they may sometimes become malignant (cancer) if not treated.
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This question is part of the following fields:
- Gynaecology
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Question 10
Incorrect
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The most common cause of abnormal vaginal discharge in a sexually active 19-year-old female is:
Your Answer:
Correct Answer: Mixed vaginal flora
Explanation:Bacterial vaginosis is the most common cause of acute vaginitis, accounting for up to 50% of cases in some populations. It is usually caused by a shift in normal vaginal flora- Mixed vaginal flora is considerably more common as a cause of vaginal discharge than – albicans and T. vaginalis.
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This question is part of the following fields:
- Gynaecology
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Question 11
Incorrect
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A 23-year-old woman at 36 weeks of gestation in her first pregnancy presents for headache and right upper quadrant abdominal pain for three days. The pregnancy has been normal and unremarkable until now.
Her blood pressure is 145/90 mmHg and urinalysis shows protein ++. On physical exam, her ankles are slightly swollen. There is slight tenderness to palpation under the right costal margin.
Which one of the following is the most likely diagnosis?Your Answer:
Correct Answer: Pre-eclampsia.
Explanation:There are a few differential diagnoses to think of in a patient that presents such as this one. Pre-eclampsia, cholecystitis, and fatty liver could all cause pain and tenderness, but cholecystitis would not normally cause the hypertension and proteinuria seen in this patient and neither would acute fatty liver of pregnancy. The more likely explanation is pre-eclampsia which must always be considered in the presence of these symptoms and signs. This process is particularly severe in the presence of pain and tenderness under the right costal margin due to liver capsule distension.
Chronic renal disease could cause the hypertension and mild proteinuria seen, but it would not usually produce the pain and tenderness that this patient has unless it was complicated by severe pre-eclampsia.
Biliary cholestasis does not usually produce pain.
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This question is part of the following fields:
- Obstetrics
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Question 12
Incorrect
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If a sample of cervical mucus is taken on the 12th day of the menstrual cycle and examined under the microscope, what kind of findings would be observed?
Your Answer:
Correct Answer: A fern pattern characteristic of oestrogen
Explanation:Fern test looks for a specific fern like pattern of cervical mucus when observed under light microscope after the sample is dried. It occurs due to the presence of sodium chloride under oestrogen influence whereas progesterone opposes it.
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This question is part of the following fields:
- Physiology
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Question 13
Incorrect
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Regarding the uterine artery which of the following statements are FALSE?
Your Answer:
Correct Answer: It crosses the Ureter posteriorly
Explanation:The Uterine artery typically arises from the anterior branch of the internal iliac artery. It crosses the ureter ANTERIORLY. It is the primary source of arterial supply to the uterus and its branches anastomose with branches of the ovarian and vaginal arteries.
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This question is part of the following fields:
- Anatomy
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Question 14
Incorrect
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The number of chromosomes in the human somatic cell is:
Your Answer:
Correct Answer: 46
Explanation:In eukaryotes, the genome comprises several double-stranded, linear DNA molecules bound with proteins to form complexes called chromosomes. Each species of eukaryote has a characteristic number of chromosomes in the nuclei of its cells. Human body cells (somatic cells) have 46 chromosomes.
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This question is part of the following fields:
- Cell Biology
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Question 15
Incorrect
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Which of the following increases the risk of endometrial hyperplasia?
Your Answer:
Correct Answer: Tamoxifen
Explanation:Tamoxifen increases risk of endometrial hyperplasia Aromatase inhibitors such as Letrozole and Anastrozole are not associated and have not been shown to increase the risk of endometrial pathology Whereas unopposed oestrogens increase endometrial cancer risk combined oral contraceptive decrease risk
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This question is part of the following fields:
- Clinical Management
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Question 16
Incorrect
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A 24-year-old primigravida at 16 weeks of gestation, presented with a history of vaginal pressure, vaginal spotting and lower back pain.
Transvaginal ultrasound finding shows cervical shortening to 2 cm, cervical dilation, and protrusion of fetal membranes into the cervical canal.
Which among the following risk factors is not related to the development of this condition?Your Answer:
Correct Answer: Alcohol abuse
Explanation:This woman has developed non-specific symptoms of cervical insufficiency, is a painless dilation of cervix resulting in the delivery of a live fetus during the 2nd trimester or premature delivery.
The following has been identified as the risk factors associated with increased incidence of cervical insufficiency:
– Congenital disorders of collagen synthesis like Ehlers-Danlos syndrome.
– Prior cone biopsies.
– Prior deep cervical lacerations, which is secondary to vaginal or cesarean delivery.
-Müllerian duct defects like bicornuate or septate uterus.
– More than three prior fetal losses during the 2nd trimesterFrom the given options, alcohol abuse is the only one not associated with increased incidence of cervical insufficiency.
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This question is part of the following fields:
- Obstetrics
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Question 17
Incorrect
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A 29-year-old single lady comes to your clinic with two days history of minor left-sided lower abdomen ache. Her blood pressure is 125/90 mmHg, her pulse rate is 90 beats per minute, and her temperature is 37.3°C.
She is otherwise in perfect health. There is no discomfort, rebound, or guarding on the abdominal exam. On the left side of the uterus, an ultrasonographic examination reveals a 6cm solid mass lateral to the uterus.
Which of the following diagnoses is the most likely?Your Answer:
Correct Answer: Ovarian teratoma
Explanation:Mature cystic teratomas of the ovary are often discovered as incidental findings on physical examination, during radiographic studies, or during abdominal surgery performed for other indications.
When symptoms are present, they may include abdominal pain, mass or swelling, and abnormal uterine bleeding. Bladder symptoms, gastrointestinal disturbances, and back pain are less frequent. When abdominal pain is present, it usually is constant and ranges from slight to moderate in intensity.
Mucinous cystadenomas are relatively common (12% to 15% of all ovarian tumours). They can become massive. These tumours usually develop in the third to fifth decades of life and typically cause vague symptoms, such as increasing abdominal girth, abdominal or pelvic pain, emesis, fatigue, indigestion, constipation, and urinary incontinence.
Corpus luteal cysts present with irregular menses, abdominal fullness due to fluid build up and pelvic pressure.
Endometriosis mainly presents with cyclic pain at site of involvement and dysmenorrhea.
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This question is part of the following fields:
- Gynaecology
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Question 18
Incorrect
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A 30 year old women who is 24 weeks pregnant attends EPU due to suprapubic pain. Ultrasound shows a viable foetus and also a fibroid with a cystic fluid filled centre. What is the likely diagnosis?
Your Answer:
Correct Answer: Red degeneration of fibroid
Explanation:Red degeneration of fibroids is one of 4 methods of fibroid degeneration. Although uncommon outside pregnancy it is thought to be the most common form of fibroid degeneration during pregnancy and typically occurs in the 2nd trimester. It is thought to arise from the fibroid outgrowing its blood supply and haemorrhagic infarction occurs. Ultrasound will typically show a localised fluid collection (blood) within the fibroid.
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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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Which one of the following features is associated with Turner's syndrome?
Your Answer:
Correct Answer: Primary amenorrhea
Explanation:Turner syndrome patients present with primary amenorrhea. These ladies have non functional or streak ovaries and they cant conceive. Their genetic traits is 45X. They have a shielded chest, webbed neck and low height. These patients suffer from primary amenorrhea.
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This question is part of the following fields:
- Embryology
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Question 20
Incorrect
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In the foetus, the most well oxygenated blood flows into which part of the heart:
Your Answer:
Correct Answer: Right atrium
Explanation:The placenta accepts the blue, unoxygenated blood from the foetus through blood vessels that leave the foetus through the umbilical cord (umbilical arteries, there are two of them). When blood goes through the placenta it picks up oxygen and becomes red. The red blood then returns to the foetus via the third vessel in the umbilical cord, the umbilical vein. The red blood that enters the foetus passes through the fetal liver and enters the right side of the heart.
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This question is part of the following fields:
- Physiology
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Question 21
Incorrect
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The testicular arteries are branches of what?
Your Answer:
Correct Answer: Aorta
Explanation:The testicular artery arises from the aorta and supplies the testis and the epididymis. The testis is supplied by 3 arteries.: Testicular artery, cremasteric artery that arises from the inferior hypogastric artery and the artery to the vas deferens from the internal iliac artery.
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This question is part of the following fields:
- Anatomy
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Question 22
Incorrect
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Where are ADH (vasopressin) and Oxytocin synthesised?
Your Answer:
Correct Answer: Hypothalamus
Explanation:ADH and vasopressin are synthesized in the supraoptic and periventricular nuclei of the hypothalamus, they are eventually transported to the posterior pituitary where they are stored to be released later.
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This question is part of the following fields:
- Endocrinology
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Question 23
Incorrect
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In which one of the following positions does hyperextension of the fetal head occur?
Your Answer:
Correct Answer: Face presentation
Explanation:Face presentation is the abnormal position of the fetal head in labour. In this position the neck is hyperextended.
Vertex position is the normal presentation of the foetus for delivery, in which the head is flexed and the position of the chin is towards the chest. -
This question is part of the following fields:
- Anatomy
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Question 24
Incorrect
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Which immunoglobulin is the first to be synthesised by the neonate?
Your Answer:
Correct Answer: IgM
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, through breast milk.
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This question is part of the following fields:
- Immunology
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Question 25
Incorrect
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The inferior 1/3 of the rectum is principally supplied by which artery?
Your Answer:
Correct Answer: Middle rectal artery
Explanation:Remember the inferior rectal artery supplies the anus. The middle rectal artery is the principle supply to the lower 1/3 rectum. The rectal arteries do form an anastomosis.
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This question is part of the following fields:
- Anatomy
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Question 26
Incorrect
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Among the following which is the most likely finding of placental abruption in a pregnant woman?
Your Answer:
Correct Answer: Vaginal bleeding
Explanation:Placental abruption is defined as the premature separation of placenta from uterus and the condition usually presents with bleeding, uterine contractions and fetal distress. It is one of the most significant cause of third-trimester bleeding and is often associated with fetal and maternal mortality and morbidity. In all pregnant women with vaginal bleeding in the second half of the pregnancy, this condition should be considered as a differential diagnoses.
Though vaginal bleeding is the most common presenting symptom reported by almost 80% of women with placental abruption, vaginal bleeding is concealed in 20% of women with placental abruption, therefore, absence of vaginal bleeding does not exclude placental abruption.Symptoms and complications of placental abruption varies according to patient, frequency of appearance of some common features is as follows:
- Vaginal bleeding is the common presentation in 80% of patients.
- Abdominal or lower back pain with uterine tenderness is found in 70%
- Fetal distress is seen in 60% of women.
- Abnormal uterine contractions like hypertonic, high frequency contractions are seen in 35% cases.
- Idiopathic premature labor in 25% of patients.
- Fetal death in about 15% of cases.Examination findings include vaginal bleeding, uterine contractions with or without tenderness, shock, absence of fetal heart sounds and increased fundal height due to an expanding hematoma. Shock is seen in class 3 placental abruption which represents almost 24% of all cases of placental abruption.
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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 contraceptives primary mode of action is inhibition of ovulation?
Your Answer:
Correct Answer: Cerazette®
Explanation:Desogestrel only POPs work mainly by inhibiting ovulation. Cerazette Is the only brand in this list which belongs to this group.
Types of Progesterone Only Pills
1. Traditional (e.g. Femulen®, Micronor®, Norgeston®)
Main mode of action: thickening cervical mucus preventing sperm entry at neck of womb and may also cause anovulation but this effect variable and unreliable
2. Desogestrel (e.g. Cerazette®)
Main mode of action: inhibition of ovulation and also cause thickening of cervical mucus
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This question is part of the following fields:
- Clinical Management
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Question 28
Incorrect
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Which of the following takes part in the arterial supply of the ovary?
Your Answer:
Correct Answer: Uterine arteries
Explanation:The ovarian arteries, arising from the abdominal aorta and the ascending uterine arteries which are branches of the internal iliac artery all supply the ovaries. They terminate by bifurcating into the ovarian and tubal branches and anastomose with the contralateral branches providing a collateral circulation.
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This question is part of the following fields:
- Anatomy
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Question 29
Incorrect
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Galactorrhoea (non-gestational lactation) may result from all of the following EXCEPT:
Your Answer:
Correct Answer: Intrapartum haemorrhage
Explanation:Pituitary tumours, the most common pathologic cause of galactorrhoea can result in hyperprolactinemia by producing prolactin or blocking the passage of dopamine from the hypothalamus to the pituitary gland. Approximately 30 percent of patients with chronic renal failure have elevated prolactin levels, possibly because of decreased renal clearance of prolactin. Primary hypothyroidism is a rare cause of galactorrhoea in children and adults. In patients with primary hypothyroidism, there is increased production of thyrotropin-releasing hormone, which may stimulate prolactin release. Nonpituitary malignancies, such as bronchogenic carcinoma, renal adenocarcinoma and Hodgkin’s and T-cell lymphomas, may also release prolactin.
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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 22-year-old G2P2 who is on her 7th day postpartum called her physician due to her concern of bleeding from the vagina. Upon interview, she described the bleeding to be light pink to bright red and compared with the first few days post-delivery, the bleeding was less heavy. There was also no fever or cramping pain reported by the patient.
Upon examination, it was observed that she is afebrile and her uterus is appropriately sized and non-tender. There was also the presence of about 10cc old, dark blood in her vagina and her cervix was closed.
Which of the following is considered the most appropriate treatment for the patient?Your Answer:
Correct Answer: Reassurance
Explanation:The postpartum period begins soon after the baby’s delivery and usually lasts six to eight weeks and ends when the mother’s body has nearly returned to its pre-pregnant state.
Bloody vaginal discharge (lochia rubra) is heavy for the first 3-4 days, and slowly it becomes watery in consistency and colour changes to pinkish-brown (lochia serosa). After the next 10-12 days, it changes to yellowish-white (lochia alba). Advise women to seek medical attention if heavy vaginal bleeding persists (soaking a pad or more in less than an hour). Women with heavy, persistent postpartum bleeding should be evaluated for complications such as retained placenta, uterine atony, rarely invasive placenta, or coagulation disorders. Endometritis may also occur, presenting as fever with no source, maybe accompanied by uterine tenderness and vaginal discharge. This usually requires intravenous antibiotics. This also should be explained and advise the mother to seek immediate medical attention.
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This question is part of the following fields:
- Obstetrics
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SESSION STATS - PERFORMANCE PER SPECIALTY
