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Question 1
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Question 2
Incorrect
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Bladder neck closure and relaxation of the bladder is mediated by?
Your Answer: Parasympathetic Fibres T11,L1,L2
Correct Answer: Sympathetic Fibres L1,L2
Explanation:The neck of the bladder is surrounded by the internal sphincter. It is supplied by the sympathetic and parasympathetic nerves of the splanchnic nerve. Parasympathetic stimulation causes the detrusor muscle to contract and the internal urethral sphincter to relax. It Is predominantly by the parasympathetic nerves S2-S4. Relaxation of the bladder is caused by inhibiting the sacral parasympathetic preganglionic neurons and exciting the lumbar sympathetic preganglionic neurons. Remember SYMPATHETIC is for STORAGE and PARASYMPATHETIC is for PEEING.
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This question is part of the following fields:
- Anatomy
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Question 3
Incorrect
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An HIV positive woman who is 18 weeks pregnant complains of frothy yellow vaginal discharge and vaginal soreness. A wet mount and microscopy confirms a Trichomonas vaginalis infection. Which of the following is the most appropriate treatment regime?
Your Answer: Metronidazole 2g orally single dose
Correct Answer: Metronidazole 500mg BD 7 days
Explanation:Trichomoniasis is considered a sexually transmitted infection found both in men and women caused by the flagellate protozoan Trichomonas vaginalis. The organism is mainly found in the vagina and the urethra. Though many infected women can be asymptomatic, they can also present with yellow frothy vaginal discharge, itching and vaginitis, dysuria or an offensive odour. For the diagnosis of t. vaginalis in women, a swab is taken from the posterior fornix during speculum examination and the flagellates are detected under light-field microscopy. The recommended treatment for t. vaginalis for a HIV positive woman who is pregnant is 500mg of metronidazole twice daily for 7 days. High dose metronidazole as a 2g single dose tablet is not advised during pregnancy. All sexual partners should also be treated, and screening for other STIs should be carried out.
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This question is part of the following fields:
- Clinical Management
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Question 4
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An 20-year-old woman presents to you 6 hours after she was raped on day-12 of her menses which usually lasts for 28 days. You have decided to give her Postinor-2 (levonorgestrel 0.75 mg) as a post-intercourse contraceptive. She is requesting information about any potential adverse effects as well as its efficacy. Which of the following statements is correct?
Your Answer: The treatment fails to prevent pregnancy in 2-3% of women treated.
Explanation:Postinor-2 (levonorgestrel 750pg) is only an emergency contraceptive and is not designed to be a regular form of contraception. If taken within 24 hours, it is estimated to be able to prevent up 97-98% of pregnancies and 58% if given between 48-72 hours post-unprotected intercourse. It can cause vaginal bleeding within a few days of its administration if it is given before day 8-10 of her menstrual cycle. However, if given mid-cycle, it typically doesn’t affect the timing of her next period unless conception occurs. Nausea and vomiting were common when high doses of OCP were used as a post-intercourse contraceptive. Nausea and vomiting still can occur with Postinor-2, but not up to 50% of women. There is currently no evidence to suggest that the levonorgestrel dose would cause a virilising effect on female foetuses.
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This question is part of the following fields:
- Gynaecology
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Question 5
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WHO defines the perinatal mortality rate as
Your 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 6
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A 29-year-old woman presented to the emergency department with severe nausea and vomiting at 8 weeks of being pregnant. She is unable to take solid food but is capable of drinking small sips of liquids. She is concerned that she might have gastroenteritis because her partner was noted to have recently been diagnosed with it. Which of the following is considered the next best step to investigate given the situation?
Your Answer: Pelvic ultrasound
Explanation:Hyperemesis gravidarum refers to intractable vomiting during pregnancy, leading to weight loss and volume depletion, resulting in ketonuria and/or ketonemia.
The exact cause of hyperemesis gravidarum remains unclear. However, there are several theories for what may contribute to the development of this disease process such as:
1. Hormone changes – hCG levels peak during the first trimester, corresponding to the typical onset of hyperemesis symptoms. Estrogen is also thought to contribute to nausea and vomiting in pregnancy.
2. Changes in the Gastrointestinal System – the lower oesophageal sphincter relaxes during pregnancy due to the elevations in estrogen and progesterone. This leads to an increased incidence of gastroesophageal reflux disease (GERD) symptoms in pregnancy, and one symptom of GERD is nausea.
3. Genetics – an increased risk of hyperemesis gravidarum has been demonstrated among women with family members who also experienced hyperemesis gravidarum.The average onset of symptoms happens approximately 5 to 6 weeks into gestation. The physical exam should include fetal heart rate (depending on gestational age) and an examination of fluid status, including an examination of blood pressure, heart rate, mucous membrane dryness, capillary refill, and skin turgor. A patient weight should be obtained for comparison to previous and future weights. If indicated, abdominal examination and pelvic examination should occur to determine the presence or absence of tenderness to palpation.
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This question is part of the following fields:
- Obstetrics
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Question 7
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An 18 year old and has yet to begin her period. She stands at 4'10. She shows no signs of breast development. She has no pubic hair on pelvic examination. The patient has a cervix and uterus, according to digital inspection. The ovaries cannot be felt. Serum FSH and LH levels are drawn as part of the workup, and both are elevated. Which of the following is the most likely cause of this patient's delayed puberty and sexual infantilism?
Your Answer: Gonadal dysgenesis
Explanation:In girls, delayed puberty and primary amenorrhea may be subdivided according to associated changes in stature. If the affected girl is short, the likely causes are gonadal dysgenesis (Turner syndrome) or hypopituitarism (with both gonadotropin and growth hormone deficiency). Gonadal dysgenesis results from the absence of a sex chromosome or other abnormality of a sex chromosome. In affected girls the gonads are streaks of fibrous tissue and contain no follicles, and these girls may have a variety of congenital anomalies, including a webbed neck, a shieldlike chest, or a small jaw.
Kallmann syndrome presents with amenorrhea, infantile sexual development, low gonadotropins, normal female karyotype, and anosmia (the inability to perceive odours).
In Müllerian agenesis, the Müllerian ducts either fail to develop or regress early in fetal life. These patients have normal ovarian development and normal secondary sexual characteristics. They present with a blind vaginal pouch and no upper vagina, cervix, or uterus, and primary amenorrhea.
The McCune-Albright syndrome rather presents with precocious puberty.
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This question is part of the following fields:
- Gynaecology
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Question 8
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Question 9
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A 27-year-old nulliparous woman presents with the complaint of malodorous vaginal discharge for the past one month. Patient has tried various over-the-counter vaginal douche products without any improvement. Her last menstrual period was 2 weeks ago, during which she noticed no change in her symptoms. In addition to the discharge, patient also experiences intermittent, crampy abdominal pain along with a feeling of gas passing through her vagina. Patient has had no history of surgeries in the past. On examination her vital signs seems to be normal. Speculum examination shows a malodorous, tan vaginal discharge with an erythematous patch over the posterior vaginal wall.The cervix is nulliparous and has no visible lesions or areas of friability.A sinus with purulent drainage is found in the perianal skin. Which among the following conditions will be the most likely underlying cause for this patient’s presentation?
Your Answer: Transmural inflammation of the bowel
Explanation:Common risk factors for Rectovaginal fistula are Pelvic radiation, Obstetric trauma, Pelvic surgery, Colon cancer, Diverticulitis and Crohn disease. Uncontrollable passage of gas &/or feces from the vagina is considered the common clinical feature of Rectovaginal fistula.
Diagnosis is done with the help of physical examination, fistulography, Magnetic resonance imaging and Endosonography.This patient, mentioned in the case, presents with malodorous vaginal discharge (ie, stool), gas passing through the vagina, and a posterior vaginal lesion most likely has a rectovaginal fistula, which is an aberrant connection between bowel and vagina. Although development of rectovaginal fistula is commonly associated with obstetric trauma or pelvic surgery, patients without these risk factors are recommended to be evaluated for other additional causes like gastrointestinal conditions.
This patient’s intermittent, crampy abdominal pain and perianal sinus in the setting of a rectovaginal fistula is most likely due to an underlying Crohn disease. Crohn disease, is a transmural inflammation of the gastrointestinal tract, which predisposes patients to bowel abscess, fissure, and fistula formation. Although the rectum is typically spared in Crohn disease, a non-healing, transmural ulcer present in the anal canal can progress to form a rectovaginal fistula.
In addition to standard Crohn disease management like anti-TNF inhibitors, glucocorticoids, etc patients with a rectovaginal fistula may require surgical correction.Bartholin gland cysts or abscesses can present with malodorous vaginal discharge; however, patients typically have a posterior vulvar mass located at the 4 or 8 o’clock position. In addition, Bartholin gland cysts will not present with crampy abdominal pain or passage of flatus or stool through the vagina.
Hidradenitis which is the chronic occlusion and inflammation of hair follicles, can cause groin abscesses with sinus tracts and associated purulent drainage. However, it is not associated with abdominal pain or malodorous vaginal discharge. In addition, this condition is typically multifocal and located in more than one intertriginous areas like axillary, inguinal or gluteal regions.
Cervical cancer or a retained foreign body in the vagina can cause malodorous vaginal discharge and abdominal pain. However, patients will typically have visible findings like cervical lesion, foreign body etc on speculum examination, and these neither are associated with the passage of flatus through the vagina.
Complications of Crohn disease include perianal disease like abscess, fissure and fistula like rectovaginal fistula, due to transmural inflammation of the gastrointestinal tract. Patients with a rectovaginal fistula typically presents with malodorous, tan vaginal discharge, passage of flatus through the vagina and a posterior vaginal lesion.
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This question is part of the following fields:
- Obstetrics
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Question 10
Incorrect
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A sexually active young woman comes in with frothy, foul-smelling vaginal discharge. Dysuria and dyspareunia are also present. The genital region seems to be quite reddish. What is the potential danger associated with this presentation?
Your Answer: Increased risk of irritable bowel syndrome
Correct Answer: Increased risk of cervical cancer
Explanation:TV infection is associated with both LR and HR-HPV infection of the cervix, as well as with ASC-US and HSIL. The signs and symptoms of trichomoniasis are present in this patient. Trichomonas vaginalis is the reason.
Increased vaginal discharge that is frothy, yellowish, and has an unpleasant odour are among the symptoms. It’s frequently linked to dyspareunia and dysuria. Normally, the genital area is red and painful.In both men and women, trichomoniasis can cause preterm labour and raise the risk of infertility. Both the patient and the partner must be treated at the same time.
The active infection can be treated with a single oral dose of metronidazole 2 g taken with food.
To avoid disulfiram-like symptoms, alcohol should be avoided during the first 24-48 hours after treatment. -
This question is part of the following fields:
- Gynaecology
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