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Question 1
Incorrect
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Which of the following factors causes the greatest increase in risk of developing bladder cancer?
Your Answer: Polycystic ovaries
Correct Answer: Smoking
Explanation:Transitional cell carcinoma of the bladder is most commonly caused by cigarette smoke. Other risk factors include naphthylamine, azodyes and long term cyclophosphamide use.
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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 40-year-old white female lawyer sees you for the first time. When providing a history, she describes several problems, including anxiety, sleep disorders, fatigue, persistent depressed mood, and decreased libido. These symptoms have been present for several years and are worse prior to menses, although they also occur to some degree during menses and throughout the month. Her menstrual periods are regular for the most part.
The most likely diagnosis at this time is:Your Answer:
Correct Answer: Dysthymia
Explanation:Psychological disorders, including anxiety, depression, and dysthymia, are frequently confused with premenstrual syndrome (PMS), and must be ruled out before initiating therapy. Symptoms are cyclic in true PMS. The most accurate way to make the diagnosis is to have the patient keep a menstrual calendar for at least two cycles, carefully recording daily symptoms. Dysthymia consists of a pattern of ongoing, mild depressive symptoms that have been present for 2 years or more and are less severe than those of major depression. This diagnosis is consistent with the findings in the patient described here.
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This question is part of the following fields:
- Gynaecology
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Question 3
Incorrect
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A 35-year-old lady complained of pelvic pain for three months. A tumour in her right iliac fossa was discovered during an examination. An ovarian cyst measuring 8 cm x 12 cm is visible on ultrasonography.
What is the next management step?Your Answer:
Correct Answer: Refer to a gynaecologist
Explanation:Many patients with simple ovarian cysts based on ultrasonographic findings do not require treatment.
In a postmenopausal patient, a persistent simple cyst smaller than 10cm in dimension in the presence of a normal CA125 value may be monitored with serial ultrasonographic examinations.Premenopausal women with asymptomatic simple cysts smaller than 8cm on sonograms in whom the CA125 value is within the reference range may be monitored, with a repeat ultrasonographic examination in 8-12 weeks.
Persistent simple ovarian cysts larger than 5-10 cm, especially if symptomatic, and complex ovarian cysts should be considered for surgical removal.
For this patient, a premenopausal woman, with an ovarian cyst size 8 cm x 12cm. Surgical management is indicated, hence referral to gynaecologist is appropriate.
Laparotomy or laparoscopic excision of cyst should be considered and performed by the gynaecologist not general practitioner.
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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 39-year-old woman presents with a history of menorrhagia for 2 years. Her symptoms started after laparoscopicfilshie clip sterilization was performed 3 years ago. She has three children aged eleven, seven, and six years. Her periods used to last 10 days before she was sterilized because she didn't use any form of contraception. Her periods lasted only four days when she was on the oral contraceptive pill (OCP), which was the case right before the sterilization. At the time of sterilization, a hysteroscopic check revealed a normal uterine cavity, and no abnormalities were found during the laparoscopic surgery. Which of the following would be the best next step in management?
Your Answer:
Correct Answer: A nonsteroidal anti-inflammatory drug (NSAID).
Explanation:Although a dilatation and curettage (D&C) is frequently recommended as part of a woman’s menorrhagia examination.
D&C is not indicated in a woman who had a normal hysteroscopy and laparoscopy only two years ago, and who experienced comparable symptoms when not taking the OCP in the past, especially after the age of 40.
The Filshie clips should not be removed because they will not improve the symptoms.Although an endometrial ablation or possibly a hysterectomy may be required in the future to address the symptoms, the first line of treatment should be a nonsteroidal anti-inflammatory drug (NSAID), which will reduce the loss in up to half of the women treated.
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This question is part of the following fields:
- Gynaecology
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Question 5
Incorrect
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A 34 weeks pregnant patient has a blood pressure of 149/98. Urine dipstick shows protein 3+. You send a for a protein:creatinine ratio. What level would be diagnostic of significant proteinuria?
Your Answer:
Correct Answer: >30 mg/mmol
Explanation:Pre-eclampsia is defined as hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hour collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the sixth postpartum week. Significant proteinuria = urinary protein: creatinine ratio >30 mg/mmol or 24-hour urine collection result shows greater than 300 mg protein.
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This question is part of the following fields:
- Clinical Management
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Question 6
Incorrect
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Question 7
Incorrect
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A patient undergoes medical abortion at 9 weeks gestation. What is the advice regarding Rhesus Anti-D Immunoglobulin?
Your Answer:
Correct Answer: All RhD-negative women who are not alloimmunized should receive Anti-D IgG
Explanation:All non-sensitised RhD negative women should receive Anti-D IgG within 72 hours following abortion
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This question is part of the following fields:
- Clinical Management
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Question 8
Incorrect
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A 25 year old pregnant woman presents with constant abdominal pain, which has been present for the last few hours. Before the pain started she admits experiencing vaginal blood loss. She's a primigravida in her 30th week of gestation. Upon abdominal examination the uterus seems irritable. CTG is, however, reactive. What is the most probable diagnosis?
Your Answer:
Correct Answer: Antepartum haemorrhage
Explanation:Antepartum haemorrhage presents with bleeding, which may or may not be accompanied by pain. Uterine irritability would suggest abruptio, however contractions are present which may be confused with uterine irritability and in this case, there are no signs of pre-eclampsia present.
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This question is part of the following fields:
- Obstetrics
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Question 9
Incorrect
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All of the following factors increase the risk of endometrial cancer except which one?
Your Answer:
Correct Answer: High Coffee Consumption
Explanation:The risk factors for uterine carcinoma include obesity, diabetes, Nulliparity, late menopause, unopposed oestrogen therapy, tamoxifen therapy, HRT and a family history of ovarian or uterine carcinoma.
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This question is part of the following fields:
- Epidemiology
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Question 10
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 11
Incorrect
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A 38-year-old lady appears with a 7-month history of secondary amenorrhea. She has a BMI of 24. Her FSH level is 55 U/L (2-8 U/L in luteal phase; >25 U/L in menopause), LH is 54 U/L, and oestradiol is low, according to laboratory tests. The level of serum prolactin is likewise normal. Her urine pregnancy test came out negative.
Each ovary had 3-4 cysts on ultrasonography. She hopes to get pregnant in the near future.
Which of the following would be the best treatment option for her condition?Your Answer:
Correct Answer: Menopausal hormone replacement therapy (HRT)
Explanation:Ovarian insufficiency is a failure of the ovary to function adequately in a woman younger than 40 years, in its role either as an endocrine organ or as a reproductive organ. In women aged 40 years or older, the expected physiologic decline of ovarian function that takes place with aging is termed perimenopause or the menopausal transition.
Medical treatment of patients with primary ovarian insufficiency should address the following aspects:Ovarian hormone replacement
Restoration of fertility
Psychological well-being of the patientIt is not appropriate to give this patient contraceptive pills since she desires pregnancy.
There is no evidence that Danazol or Metformin would improve ovarian follicle function.
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This question is part of the following fields:
- Gynaecology
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Question 12
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 13
Incorrect
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A 29-year-old pregnant woman in her first trimester of pregnancy presented to the medical clinic for routine antenatal care. Upon interview and history taking, it revealed that she is positive for Hepatitis C virus antibody (HCVAb). She is now concerned about transmitting the virus to her baby.
Which of the following is considered correct about the patient's condition?Your Answer:
Correct Answer: Fetal scalp blood sampling should be avoided
Explanation:Invasive procedures as fetal scalp blood sampling or internal electrode and episiotomy increase vertical transmission of HCV, especially in patients with positive HCV RNA virus load at delivery that is why it should be avoided.
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This question is part of the following fields:
- Obstetrics
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Question 14
Incorrect
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Regarding the structure of the detrusor muscle. Which of the following is true?
Your Answer:
Correct Answer: The detrusor is divided into 3 layers consisting of inner and outer layers of longitudinal smooth muscle with a middle circular smooth muscle layer
Explanation:The urinary bladder is composed of the transitional epithelium, followed by the lamina propria made up of the fibroelastic connective tissue. The muscularis layer covers the lamina propria which is made up of three poorly defined layers of smooth muscles; the inner longitudinal, middle circular and the outer longitudinal layer. The bladder is covered on the superior surface and the lateral surface by the peritoneum.
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This question is part of the following fields:
- Anatomy
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Question 15
Incorrect
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Which of the following best describes the mechanism of action of Promethazine?
Your Answer:
Correct Answer: Histamine H1-receptor antagonist
Explanation:Promethazine is type of antihistamine that acts on the H1 receptor. In pregnancy NICE guidelines advise oral promethazine or oral cyclizine should be used as 1st line drug management of nausea and vomiting. Both are H1 antagonists.
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This question is part of the following fields:
- Pharmacology
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Question 16
Incorrect
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A 26-year old woman, 36 weeks age of gestation, is admitted for deep venous thrombosis (DVT) of the right calf. She receives heparin treatment. Which of the following is true regarding the use of heparin rather than a coumarin derivative for anticoagulation?
Your Answer:
Correct Answer: Reversal of the anticoagulant effect of heparin in the mother can be achieved more quickly than that of coumarin, should labour occur.
Explanation:Heparin is a large-sized molecule and does not cross the placenta; it can provide anticoagulation in the mother, however, has no effect on the baby. Heparin is the preferred anticoagulant therapy during pregnancy.
Moreover, the anticoagulant effect of heparin can be rapidly reversed by protamine sulphate.
Warfarin, a coumarin derivative, takes much longer to be reversed compared to heparin. This can be given to the mother between 13 and 36 weeks of pregnancy, however, should be avoided in the first trimester due to its teratogenic effects.
The anticoagulant effect of coumarin derivatives on the baby also takes longer to be reversed. -
This question is part of the following fields:
- Obstetrics
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Question 17
Incorrect
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WHO defines the perinatal mortality rate as
Your Answer:
Correct Answer: The number of stillbirths and deaths in the first week of life per 1000 births
Explanation:The number of stillbirths and deaths in the first week of life per 1000 births.
According to WHO the perinatal period commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth. -
This question is part of the following fields:
- Epidemiology
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Question 18
Incorrect
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A patient undergoes oophorectomy and the ovarian veins are ligated. Which vein does the right ovary drain into?
Your Answer:
Correct Answer: Inferior vena cava
Explanation:The right ovarian vein travels through the suspensory ligament of the ovary and generally joins the inferior vena cava whereas the left ovarian vein drains into the left renal vein.
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This question is part of the following fields:
- Anatomy
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Question 19
Incorrect
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Which of the following would normally be expected to increase during pregnancy:
Your Answer:
Correct Answer: Thyroxin-binding globulin
Explanation:Thyroid function in pregnancy is altered in two ways; the circulating levels of the thyroid binding proteins are increased, resulting in an increase in the total circulating levels of thyroid hormones (but a slight fall in the free component).
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This question is part of the following fields:
- Physiology
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Question 20
Incorrect
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You are asked to infiltrate a patients perineum with local anaesthetic prior to episiotomy. What is the maximum dose of lidocaine (without adrenaline)?
Your Answer:
Correct Answer: 3 mg/kg
Explanation:The half-life of lidocaine is approximately 1.5 hours. It is a local anaesthetic and the maximum dose that can be given is 3mg/kg.
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This question is part of the following fields:
- Pharmacology
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Question 21
Incorrect
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You are called to see a 24 year old patient in A&E. She is 34 weeks gestation and her blood pressure is 149/98. Automated reagent strip testing shows protein 1+. What is the appropriate course of action regarding the urine result?
Your Answer:
Correct Answer: Send urine for protein:creatinine ratio
Explanation:For a diagnosis of Preeclampsia to be established, hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hour collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the sixth postpartum week should be present.
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This question is part of the following fields:
- Clinical Management
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Question 22
Incorrect
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A 30-year-old primigravida woman presented to the clinic for her first antenatal check-up. Upon interview, it was noted that she was taking folic acid along with some other nutritional supplements as medication.
All of the following are considered correct regarding neural tube defects and folate before and during pregnancy, except:Your Answer:
Correct Answer: Prevalence of neural tube defects among non-indigenous population is almost double than that in Aboriginal and Torres Strait Islander babies
Explanation:Neural tube defects (NTDs) are common complex congenital malformations resulting from failure of the neural tube closure during embryogenesis. It is established that folic acid supplementation decreases the prevalence of NTDs, which has led to national public health policies regarding folic acid.
Neural tube defects (NTD) were 43% more common in Indigenous than in non-Indigenous infants in Western Australia in the 1980s, and there has been a fall in NTD overall in Western Australia since promotion of folate and voluntary fortification of food has occurred.
Women should take 5 mg/d of folic acid for the 2 months before conception and during the first trimester.
Women planning pregnancy might be exposed to medications with known antifolate activities affecting different parts of the folic acid metabolic cascade. A relatively large number of epidemiologic studies have shown an increased risk of NTDs among babies exposed in early gestation to antiepileptic drugs (carbamazepine, valproate, barbiturates), sulphonamides, or methotrexate. Hence, whenever women use these medications, or have used them near conception, they should take 5 mg/d of folic acid until the end of the first trimester of pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 23
Incorrect
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A 28-year-old woman presented with nausea and vomiting along with headache during pregnancy. She also has a past medical history of a migraine.
What among the following will be the most appropriate management in this case?Your Answer:
Correct Answer: Codein and promethazine
Explanation:This patient should be given promethazine and codeine as she presents with severe migraine.
Usage of metoclopramide is safe during pregnancy and for increasing effectiveness it can be added to paracetamol. However, because of its risk for causing extrapyramidal effects it should be used only as a second-line therapy and Promethazine should be considered as the first line choice of remedy. So the answer is Codeine and promethazine.
Opioid pain relievers such as codeine are not been reported of having any associated with increased birth defects or miscarriage, but its long-term use can lead to dependency in mother and withdrawal signs in the baby.
Paracetamol alone or combined with codeine is not found to be useful in controlling vomiting.
It is advised to completely avoid dihydroergotamine and the triptans throughout pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 24
Incorrect
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A 24-year-old gravida 3 para 1 is admitted to the hospital at 29 weeks gestation with a high fever, flank pain, and an abnormal urinalysis. You order blood and urine cultures, a CBC, electrolyte levels, and a serum creatinine level. You also start her on intravenous fluids andintravenous cefazolin. After 24 hours of antibiotic treatment she is clinically improved but continues to have fever spikes. What would be the most appropriate management at this time?
Your Answer:
Correct Answer: Continue current management
Explanation:Pyelonephritis is the most common serious medical problem that complicates pregnancy. Infection is more common after midpregnancy, and is usually caused by bacteria ascending from the lower tract. Escheria coli is the offending bacteria in approximately 75% of cases. About 15% of women with acute pyelonephritis are bacteraemia- A common finding is thermoregulatory instability, with very high spiking fevers sometimes followed by hypothermia- Almost 95% of women will be afebrile by 72 hours. However, it is common to see continued fever spikes up until that time- Thus, further evaluation is not indicated unless clinical improvement at 48-71 hours is lacking. If this is the case, the patient should be evaluated for urinary tract obstruction, urinary calculi and an intrarenal or perinephric abscess. Ultrasonography, plain radiography, and modified intravenous pyelography are all acceptable methods, depending on the clinical setting.
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This question is part of the following fields:
- Obstetrics
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Question 25
Incorrect
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Question 26
Incorrect
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A 30-year-old woman presents to you for oral contraceptive pills. Her past medical history reveals that she has migraine headaches on occasions, associated with paraesthesia's in her right arm.
Examination reveals that she weighs 120kg and has a BMI of 36.
Which one of the following would be the most appropriate contraceptive methods for her?Your Answer:
Correct Answer: Condoms
Explanation:This woman suffers from a classic migraine with focused neurological symptoms. The use of any OCP preparation containing oestrogen in such patients is strictly prohibited. Androgenic consequences of progesterone include hirsutism, acne, and weight gain. Progesterone of any sort (norgestrel, drospirenone, cyproterone, etc.) should be avoided by a lady of her size; consequently, a barrier approach such as male condoms is the best option.
It is recommended that formulations containing 20-30 mcg ethinylestradiol be evaluated first when choosing a combined oral contraceptive pill (COCP). The progesterone component can be norgestrel, drospirenone, cyproterone, and so on; however, norgestrel-containing formulations are less expensive and more accessible to patients.
For specific cases, the type of progesterone should be considered:
– Patients who have unpleasant fluid retention and weight gain as a side effect of COCPs may be administered drospirenone (Yaz®. Yasmin®)-containing preparations.
– Drospirenone inhibits the production of mineralocorticoids and does not cause fluid retention. It may even be linked to a small amount of weight reduction.
– A preparation containing cyproterone acetate is preferable if the patient has suspected polycystic ovarian syndrome (PCOS). -
This question is part of the following fields:
- Gynaecology
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Question 27
Incorrect
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A 34 year old patient is being investigated in the infertility clinic and is offered Hysterosalpingography (HSG). She has 28 day cycles. Which of the following statements regarding HSG is correct?
Your Answer:
Correct Answer: Typically performed using iodine based water soluble contrast
Explanation:Hysterosalpingography is used to assess the patency of the fallopian tubes. It is performed by injection of a radio-opaque iodine based contrast. This test is contraindicated in pelvic inflammatory disease and during pregnancy. Should be performed in Follicular phase of menstrual cycle after cessation of menstrual bleeding and prior to ovulation (days 6-12).
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This question is part of the following fields:
- Biophysics
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Question 28
Incorrect
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A 34 year old white primigravida in her first trimester had established moderate hypertension before becoming pregnant. She currently has a blood pressure of 168/108 mm Hg. You are considering how to best manage her hypertension during the pregnancy. Which one of the following is associated with the greatest risk of fetal growth retardation if used for hypertension throughout pregnancy?
Your Answer:
Correct Answer: Atenolol (Tenormin)
Explanation:Atenolol and propranolol are associated with intrauterine growth retardation when used for prolonged periods during pregnancy. They are class D agents during pregnancy. Other beta-blockers may not share this risk.
Methyldopa, hydralazine, and calcium channel blockers have not been associated with intrauterine growth retardation. They are generally acceptable agents to use for established, significant hypertension during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 29
Incorrect
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Which of the following contraceptives primary mode of action is inhibition of ovulation?
Your Answer:
Correct Answer: Cerazette®
Explanation:Traditional POP main mode of contraceptive action: thickening of cervical mucus Desogestrel-only POP main mode of contraceptive action is inhibition of ovulation Cerazette® is the only Desogestrel-only POP in the options above. Other desogestrel brands include: Aizea® Cerelle® Nacrez® The other POPs listed are considered traditional POPs and have the following compositions: Norgeston® – Levonorgestrel 30 mcg Micronor® & Noriday® – Norethisterone 350 mcg Femulen® – Ethynediol diacetate 500 mcg
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This question is part of the following fields:
- Clinical Management
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Question 30
Incorrect
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A 25-year-old primigravida presents to your office for a routine OB visit at 34 weeks of gestational age. She voices concern as she has noticed an increasing number of spidery veins appearing on her face, upper chest and arms and is upset with the unsightly appearance of these veins. She wants to know what you recommend to get rid of them.
Which of the following is the best advice you can give to this patient?Your Answer:
Correct Answer: Tell her that the appearance of these blood vessels is a normal occurrence with pregnancy
Explanation:Vascular spiders or angiomas, are of no clinical significance during pregnancy as these are common findings and are form as a result of hyperestrogenemia associated with normal pregnancies. These angiomas, as they will resolve spontaneously after delivery, does not require any additional workup or treatment.
Reassurance to the patient is all that is required in this case. -
This question is part of the following fields:
- Obstetrics
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SESSION STATS - PERFORMANCE PER SPECIALTY
