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Question 1
Incorrect
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A 52-year-old female patient on HRT for the past two years wonders how often she should have breast cancer screenings.
Which of the following responses is the most appropriate?Your Answer:
Correct Answer: Mammogram every two years until the age of 70
Explanation:Some confusion regarding breast cancer screening arose in 2009 when the U.S. Preventive Services Task Force (USPSTF) issued new mammogram guidelines. The task force recommended that screening mammograms be conducted every two years, beginning at age 50, for women with an average risk of breast cancer. For women aged 40 to 49, the decision of whether to have annual mammograms should be based on a patient’s consideration of risks vs. benefits, according to the task force.
There is no evidence that frequent screening for women on HRT helps with early detection of malignancy.
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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 39-year-old woman comes to your clinic for assessment and advice as she is planning to conceive over past three months with no success.
She has a history of obesity with BMI 40 and type 2 diabetes mellitus with latest HbA1c value of 11%. She had her last eye check six months ago which shows no evidence of retinopathy, and she does not have diabetic nephropathy.
Among the following which is a contraindication to pregnancy in this case?Your Answer:
Correct Answer: History of type 2 diabetes mellitus with HBA1C above 10
Explanation:In patients who have an HbA1C value above 10%, it is better to postpone pregnancy until diabetes is under control. Also in those patients with type 2 diabetes mellitus, who are suffering from severe gastroparesis, those with advanced retinopathy, with severe diabetic renal disease and severe ischemic heart disease with uncontrolled hypertension pregnancy is contraindicated.
All the other options mentioned are incorrect.
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This question is part of the following fields:
- Obstetrics
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Question 3
Incorrect
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You are asked to see a 26 year old patient following her first visit to antenatal clinic. She is 9 weeks pregnant and bloods have shown her to be non-immune to Rubella. She is concerned about congenital rubella syndrome (CRS). What is the most appropriate advice to give?
Your Answer:
Correct Answer: Advise vaccination after birth regardless of breast feeding status
Explanation:For pregnant women who are screened and rubella antibody is not detected, rubella vaccination after pregnancy should be advised. Vaccination during pregnancy is contraindicated because of a theoretical risk that the vaccine itself could be teratogenic, as it is a live vaccine. No cases of congenital rubella syndrome resulting from vaccination during pregnancy have been reported. However, women who are vaccinated postpartum should be advised to use contraception for three months.
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This question is part of the following fields:
- Microbiology
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Question 4
Incorrect
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A 22 year old woman miscarries at 6 weeks gestation. At checkup, she shows no obvious signs of complication. What would you advise regarding further pregnancy testing?
Your Answer:
Correct Answer: Urine pregnancy test in 3 weeks
Explanation:In the management of a miscarriage, after the completion of 7-14 days of expectant management, the woman is advised to take a pregnancy test after 3 weeks. In case of a positive result she is to return for further care.
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This question is part of the following fields:
- Biochemistry
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Question 5
Incorrect
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HPV genotypes 6 and 11 are associated with which of the following?
Your Answer:
Correct Answer: Low grade squamous intraepithelial lesions of the cervix (LSIL)
Explanation:HPV types 6 and 11 are associated with low risk, low grade squamous intraepithelial lesion. While types 16,18,31 and 33 are associated with high risk, high grade neoplasia.
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This question is part of the following fields:
- Microbiology
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Question 6
Incorrect
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A 24 year old lady is rushed to the emergency department complaining of vaginal spotting and abdominal cramping. Her 6 week pregnancy was confirmed by ultrasound scan last week. On speculum examination, the cervical os is open with blood noted around it.
Which of the following is the most likely diagnosis?Your Answer:
Correct Answer: Inevitable Miscarriage
Explanation:A miscarriage is defined as the spontaneous loss of a pregnancy before the age of viability at 24 weeks in the UK. An inevitable miscarriage occurs with the usual symptoms of a miscarriage such as menstrual-like cramping, vaginal bleeding and a dilated cervix. The gestational sac has ruptured but products of conception have not been passed. The products of conception will eventually pass.
A missed miscarriage is described as a loss of pregnancy without vaginal bleeding, loss of tissue, cervical changes or abdominal pain. During a scan, a fetal heartbeat is not observed, and the gestational sac may be small.
A threatened miscarriage is when the cervix dilates and uterine bleeding is seen; the pregnancy could still be viable.
A complete miscarriage occurs when all the products of conception are expelled from the uterus, bleeding has stopped, and the cervix has closed up after dilation. Recurrent miscarriages are described as spontaneous pregnancy loss of more than 2 to 3 consecutive times.
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This question is part of the following fields:
- Clinical Management
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Question 7
Incorrect
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What is the mechanism of action of Oxytetracycline?
Your Answer:
Correct Answer: Binds to 30S subunit of microbial ribosomes blocking attachment of aminoacyl-tRNA to the A site on the ribosome
Explanation:Tetracycline is classified as a broad spectrum antibiotic. It is a bacteriostatic inhibitor of protein synthesis acting at the ribosomal level. Tetracycline binds to the 30s ribosomal subunit preventing the binding of the aminoacidic charged T-RNA to the ribosome-mRNA complex.
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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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An 19-year old female came in at the clinic for her first prenatal visit. She claims to have had regular menstrual cycles even while she was on oral contraceptives (OCP). 20 weeks ago, she stopped taking her OCPs and had a menstrual period few days after. No vaginal bleeding or fluid loss were noted since then. On physical examination, the uterus is palpated right above pubic symphysis. Fetal heartbeats are evident on handheld Doppler ultrasound. Which of the statements can mostly explain the difference between the dates and uterine size?
Your Answer:
Correct Answer: Ovulation did not occur until 6-8 weeks after her last period.
Explanation:When the palpated uterine size is in discrepancy with the expected size based on the duration of amenorrhoea, it can have several causes including reduced fluid volume or fetal growth (both of which are more common when there is fetal malformation), or miscalculated age of gestation as a result of wrong dates or actual ovulation occurring at a later date than expected. Reduced fluid volume and fetal growth are the most likely aetiologies during the third trimester of pregnancy, unlike in this patient at 20 weeks age of gestation.
Premature rupture of membranes is less likely the cause when there is negative vaginal fluid loss like this patient.
The most likely cause in this case is that ovulation did not occur as expected, especially when the patient ceased her OCPs during this period. In some instances, ovulation can occur 2 weeks later in about 50% of women, 6 weeks later in 90%, and may still not occur 12 months later in 1% of women.
The other listed statements are unlikely to explain the discrepancies in dates and the observed uterine size in this patient.
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This question is part of the following fields:
- Obstetrics
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Question 9
Incorrect
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Regarding Human Papillomavirus, what percentage of women develop antibodies?
Your Answer:
Correct Answer: 50%
Explanation:Human Papillomavirus has been is implicated in the development of genital warts as well as, head and neck, anogenital and cervical cancers, with the most important high-risk strains being 16 and 18. Over 50% of women worldwide are thought to possess antibodies against various strains of HPV after natural infection. Many infections are asymptomatic and are cleared within 2 years. Several vaccines have been formulated against HPV, one of which is Gardasil, a quadrivalent vaccine against HPV types 6,11, 16,18.
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This question is part of the following fields:
- Microbiology
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Question 10
Incorrect
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A 27-year-old woman with primary infertility presents with secondary amenorrhoea that has been ongoing for twelve months. She states that she has been thinking about starting a family and was wondering if ovulation induction therapy was an option for her.
Which one of the following would be most valuable in predicting a poor response to ovulation induction therapy?Your Answer:
Correct Answer: Serum follicle-stimulating hormone (FSH).
Explanation:The tests listed can all be performed during the work-up of a woman with secondary amenorrhoea. They are useful in that they cam diagnosis the most likely cause for the amenorrhoea as well as guide the treatment required if the patient wanted to become pregnant. Of these, the hormone test best able to predict a poor response to ovulation-induction therapy is the follicle-stimulating hormone (FSH) assay. If there are high levels of FSH, most of the ovulation-induction therapies are ineffective, although the rare spontaneous pregnancy can occur.
To maximise the chance of pregnancy in patients with elevated FSH levels, the most effective technique is an ovum donation from a young woman. The ovum would be fertilised in the laboratory and transferred to the uterus of the woman with the high FSH level after administering hormonal preparation of her uterus.
If the FSH level is normal, ovulation-induction therapy is usually effective. For these patients, correction of thyroid function will be necessary if the thyroid function is not normal. Dopamine agonist therapy is indicated if the prolactin level is elevated. Clomiphene or gonadotrophin therapy can be used where the luteinising and oestradiol levels are low, normal, or minimally elevated.
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This question is part of the following fields:
- Gynaecology
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Question 11
Incorrect
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Question 12
Incorrect
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Question 13
Incorrect
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Which structure is the primary mechanism for shunting blood away from the fetal pulmonary circulation?
Your Answer:
Correct Answer: Foramen Ovale
Explanation:Oxygenation of fetal blood occurs in the placenta before it returns in the umbilical vein which joins the left branch of the portal vein. It bypasses the capillaries of the liver by going through the ductus venosus, which is obliterated after birth and becomes the ligamentum venosum. The oxygenated blood enters the inferior vena cava and is transported to the right atrium and
then through the patent foramen ovale to the left atrium and on to the left ventricle. From the left ventricle, the blood flows into the aorta and through the fetal vascular network. Blood returning from the head of the foetus passes through the superior vena cava to the right atrium and straight on to the right ventricle and pulmonary artery. However, it does not enter the pulmonary
circulation, being short-circuited by the ductus arteriosus to the aorta. Aortic blood is carried via the umbilical arteries back to the placenta for reoxygenation. At birth, the three short circuits, the ductus venosus, foramen ovale and ductus arteriosus, close. -
This question is part of the following fields:
- Embryology
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Question 14
Incorrect
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Which of the following uterotonic drugs is most strongly associated with a transient pyrexia occurring within 45 minutes of administration?
Your Answer:
Correct Answer: Dinoprostone
Explanation:Dinoprostone is associated with a transient pyrexia. This typically normalises within 4 hours of stopping treatment
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This question is part of the following fields:
- Clinical Management
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Question 15
Incorrect
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An ultrasound in the 1st trimester of pregnancy is done for?
Your Answer:
Correct Answer: Dating of the pregnancy
Explanation:Early ultrasound improves the early detection of multiple pregnancies and improved gestational dating may result in fewer inductions for post maturity.
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This question is part of the following fields:
- Obstetrics
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Question 16
Incorrect
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A 22-year-old female in her 18th week of pregnancy presented with right iliac fossa pain while getting up from a chair and has been coughing and sneezing.
On examination, there is no palpable mass or rebound tenderness.
What will be the most likely cause for patient's complaint?Your Answer:
Correct Answer: Round ligament strain
Explanation:Patient’s symptoms and signs are suggestive of round ligament strain, which is a normal finding during pregnancy, especially in the 2nd trimester, and it does not require any medical intervention.
Round ligament is a rope-like fibromuscular band which extends from the anterolateral aspect of uterus anteriorly between the layers of the broad ligament, and passing through the deep inguinal ring into the inguinal canal.
A sharp, sudden spasm in the right iliac fossa which lasts for a few seconds which is usually triggered by sneezing, coughing, laughing and rolling over in bed are the common presentations of a round ligament pain.Ectopic pregnancy and rupture of ectopic pregnancy are two unlikely diagnosis in this patient as she is in the second trimester of her pregnancy, whereas both the mentioned conditions occur during the first trimester.
Although appendicitis presents with pain in right iliac fossa, the pain is not causes by coughing or sneezing. Also, there will be other symptoms like tenderness and rebound tenderness in right iliac fossa in case of appendicitis.
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This question is part of the following fields:
- Obstetrics
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Question 17
Incorrect
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All of the following statements are considered correct regarding Down syndrome screening in a 40-year-old pregnant woman, except:
Your Answer:
Correct Answer: Dating ultrasound together with second trimester serum screening test has detection rate of 97%
Explanation:Second-trimester ultrasound markers have low sensitivity and specificity for detecting Down syndrome, especially in a low-risk population.
The highest detection rate is acquired with ultrasound markers combined with gross anomalies. Although the detection rate with this combination of markers is high in a high-risk population (50 to 75 percent), false-positive rates are also high (22 percent for a 100 percent Down syndrome detection rate).
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This question is part of the following fields:
- Obstetrics
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Question 18
Incorrect
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Question 19
Incorrect
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A patients MSU comes back showing heavy growth of E.coli that is resistant to trimethoprim, amoxicillin and nitrofurantoin. You decide to prescribe a course of Cephalexin. What is the mechanism of action of Cephalexin?
Your Answer:
Correct Answer: inhibit peptidoglycan cross-links in bacterial cell wall
Explanation:Cephalosporins are beta lactum drugs, like penicillin. They act by inhibiting the cross linkage of the peptidoglycan wall in bacteria.
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This question is part of the following fields:
- Clinical Management
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Question 20
Incorrect
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You're delivering contraception counselling to a young couple. They chose the 'rhythm approach' after hearing about several methods (calendar calculation).
Menstrual periods last between 26 and 29 days for the woman. Which of the following abstinence durations is the most appropriate?Your Answer:
Correct Answer: From day 6 to day 17
Explanation:Luteal phase is always fixed to 14 days. In this patient, ovulation will occur between days 12-15. Sexual encounter must be ceased until 24-36 hours before day 15 (day 17). The start date of abstinence, calculated by decreasing 6 days (life span of the sperm) from the earliest possible day of ovulation (12-6=6). Hence from day 6-17, sexual encounter must be avoided.
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This question is part of the following fields:
- Gynaecology
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Question 21
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 22
Incorrect
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The UK childhood vaccination schedule includes vaccination against HPV for girls aged 12 to 13. What HPV subtypes are vaccinated against with the vaccine Gardasil®?
Your Answer:
Correct Answer: 6, 11, 16, and 18
Explanation:HPV Gardasil® is a quadrivalent vaccine against HPV Types 6, 11, 16, and 18. HPV types16 and 18 are responsible for 70% of cases of HPV related cancers. They are considered the most important high risk genotypes of HPV.
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This question is part of the following fields:
- Microbiology
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Question 23
Incorrect
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A 50-year-old woman, who had her last menstrual period at age 49, presented with an episode of per vaginal bleeding two weeks ago. It lasted four days in duration. A reduction in the severity of hot flushes as well as some breast enlargement preceded the bleeding episode.
What is the most likely cause of the bleeding?Your Answer:
Correct Answer: An episode of ovarian follicular activity.
Explanation:It has been found that it is possible for premenopausal hormones to persist for a period of time after attaining menopause. If one or a few ovarian follicles remain, they could produce oestrogen in response to the very elevated levels of FSH typically seen in menopause. In doing so, the woman can then bleed as a result of this physiological response. The symptoms seen in this vignette are consistent with the rise in oestrogen levels, likely due to follicular activity.
In the absence of any pathological findings such as endometrial carcinoma, this phenomenon would be the most likely cause of this post-menopausal bleed. Furthermore, it is unlikely for cervical cancer and endometrial cancer to present during the first few years following menopause. Atrophic vaginitis is unlikely to be associated with the other symptoms the patient presented with i.e. reduction in the intensity of hot flushes and breast enlargement. This patient was not stated to have any risk factors for endometrial hyperplasia such as obesity, late menopause and early menarche, which makes it a less likely diagnosis.
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This question is part of the following fields:
- Gynaecology
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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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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 26
Incorrect
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What is the definition of puberty in girls?
Your Answer:
Correct Answer: Becoming capable of sexual reproduction
Explanation:Puberty is the process of reproductive and sexual development and the maturation which changes a child into an adult.
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This question is part of the following fields:
- Endocrinology
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Question 27
Incorrect
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Regarding the foetus, which one of the following statements is true?
Your Answer:
Correct Answer: Fetal lie describes the long axis of the foetus to the long axis of the mother
Explanation:Fetal lie describes the relationship of the long axis of the foetus with respect to the long axis of the mother.
Coronal suture is the transverse suture separating the parietal bone from the frontal bone.
Umbilical cord is composed of two arteries and one vein. the vein carries the oxygenated blood, whereas the arteries contain the deoxygenated blood.
At the time of birth, the anterior fontanelle is open and appears as a soft jelly like structure. -
This question is part of the following fields:
- Anatomy
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Question 28
Incorrect
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All of the following causes oligohydramnios, EXCEPT:
Your Answer:
Correct Answer: Anencephaly
Explanation:Oligohydramnios is a complication of high risk pregnancy which is associated with poor outcome, specially in the 2nd trimester. The causes of oligohydramnios are fetal asphyxia diseases, rupture of fetal membranes and developmental anomalies involving the genito-urinary system.
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This question is part of the following fields:
- Physiology
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Question 29
Incorrect
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Question 30
Incorrect
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Galactopoiesis is maintained by which hormone?
Your Answer:
Correct Answer: Prolactin
Explanation:The production of milk is regulated by the hormone Prolactin. Oxytocin on the other hand is responsible for the let down reflex that occurs during breast feeding.
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This question is part of the following fields:
- Clinical Management
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SESSION STATS - PERFORMANCE PER SPECIALTY
