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Question 1
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A 29 year old patient presents due to the sensation of reduced fetal movements (RFM). From what gestation is CTG assessment of RFM advised?
Your Answer: 28+0 weeks
Explanation:The cardiotocograph (CTG) is a continuous tracing of the fetal heart rate used to assess fetal wellbeing. The Doppler effect detects fetal heart motion and allows the interval between successive beats to be measured, thereby allowing a continuous assessment of fetal heart rate. The mother perceives the fetal movement by the 18-20 week of gestation and these increase until the 32 week. A mother should under go CTG if the fetal movements are reduced by the 28 week of gestation.
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This question is part of the following fields:
- Clinical Management
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Question 2
Correct
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Endometrial tissue found within the myometrium is classed as:
Your Answer: Adenomyosis
Explanation:Adenomyosis is a disorder characterised by the presence of endometrial glands deep within the myometrium. It presents with increasing severe secondary dysmenorrhoea and increased in the flow of menstrual blood.
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This question is part of the following fields:
- Clinical Management
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Question 3
Incorrect
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Regarding pelvic Gonorrhoea infection in women. What percentage of cases are asymptomatic?
Your Answer: 15%
Correct Answer: 50%
Explanation:Gonorrhoea is a sexually transmitted disease that is caused by Neisseria gonorrhoea. It infects the mucous membrane of the genital tract epithelium in the endocervical and the urethral mucosa. Around 50% of the women are asymptomatic. However it presents as increase vaginal discharge, dysuria, proctitis and pelvic tenderness.
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This question is part of the following fields:
- Clinical Management
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Question 4
Incorrect
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A 56 year old lady presents with a vulval itch and discolouration. A biopsy conforms Lichen Sclerosis (LS). What is the risk of developing squamous cell carcinoma compared to patients with a normal vulval biopsy?
Your Answer: <5%
Correct Answer:
Explanation:Lichen Sclerosis is a destructive inflammatory condition that effects the anogenital region of women. It effects around 1 in 300 women. It destroys the subdermal layers of the skin resulting in hyalinization of the skin leading to parchment paper appearance of the skin. It is associated with vulval cancer and it is estimated that the risk of developing vulval cancer after lichen sclerosis is around 3-5%.
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This question is part of the following fields:
- Clinical Management
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Question 5
Incorrect
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What is the mode of action of Mefenamic acid?
Your Answer: Inhibits fibrin
Correct Answer: Inhibits Prostaglandin Synthesis
Explanation:Activation of Antithrombin III and inactivation of factor Xa is the primary mechanism of action of Heparin.
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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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You review a patient in the fertility clinic. The ultrasound and biochemical profile are consistent with PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2. She is a non-smoker. Which of the following is the most appropriate first line treatment?
Your Answer: Weight loss
Correct Answer: Clomiphene
Explanation:Clomiphene and/or Metformin are 1st line agents. Weight loss in the setting of subfertility is advised if BMI >30 kg/m2
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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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A patient is attending for medical abortion. She is 15 weeks gestation. She has no known drug allergies. Which of the following is the most appropriate regarding antibiotic prophylaxis?
Your Answer: Cefalexin 500mg twice daily for 7 days starting on day of abortion and stat dose metronidazole 500mg orally at time of abortion
Correct Answer: Stat Azithromycin 1g and metronidazole 800 mg orally at time of abortion
Explanation:If the patient has a negative Chlamydia screen then a stat dose of metronidazole monotherapy is appropriate. You do not know this patients Chlamydia status and therefore dual therapy with metronidazole + doxycycline or azithromycin is appropriate.
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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 38 year old women attends clinic follow up. You note pelvic ultrasound shows a 36mm simple cyst. What is the most appropriate course of action regarding this cyst according to the RCOG green top guidelines?
Your Answer: Annual ultrasound follow up
Correct Answer: Discharge with no follow up
Explanation:As this is a simple cyst less than 50mm in diameter the patient does not require further investigation or routine follow up
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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 patient is being discharged following a termination of pregnancy at 14 weeks. She had been taking a combined oral contraceptive pill in the past but stopped taking this 6 months prior to falling pregnant as she wasn't in a serious relationship. When should she start again?
Your Answer: Start in 14 days
Correct Answer: Start immediately
Explanation:Following an abortion or miscarriage, combined oral contraceptive pills should be started immediately.
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This question is part of the following fields:
- Clinical Management
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Question 10
Incorrect
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A patient asks you in clinic when she can start trying to conceive again. She has just completed chemotherapy for gestational trophoblastic disease (GTD)?
Your Answer: 6 months from completion of treatment
Correct Answer: 1 year from completion of treatment
Explanation:According to the RCOG greentop guidelines, a women who have underdone chemotherapy for GTD are advised not to conceive for 1 years after completion of the chemotherapy.
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This question is part of the following fields:
- Clinical Management
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Question 11
Correct
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A 53 year old lady presents to clinic due to vulval itch and discolouration. examination reveals pale white discoloured areas to the vulva. A biopsy shows epidermal atrophy with sub-epidermal hyalinization and deeper inflammatory infiltrate. What is this characteristic of?
Your Answer: Lichen Sclerosus
Explanation:Lichen sclerosus is characterized by hypopigmented atrophic plaque in the perineal region along with features of pruritis and dyspareunia.
It is more common in post menopausal women and on histology there is epidermal atrophy, inflammatory infiltrate in the dermis and basal layer degeneration.Vitiligo is characterised by hypopigmentation but without any other symptoms.
Extramammary Paget’s disease is characterized by erythematous plaque located mostly in the perianal region but its histology is different.
Lichen simplex chronicus is a chronic scaly pruritic condition characterized by itchy papules and plaques plus lichenification and it mostly results from chronic irritation and itching of the area. -
This question is part of the following fields:
- Clinical Management
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Question 12
Incorrect
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Question 13
Correct
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The amniotic fluid volume peaks at around 900ml. At what gestation does the amniotic fluid reach its maximum volume?
Your Answer: 35 weeks
Explanation:The amniotic fluid volume increases up to week 35 of gestation and then decreases from then to term.
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This question is part of the following fields:
- Clinical Management
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Question 14
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: Cystic degeneration of fibroid
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 15
Correct
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A patient has returned to your clinic. She presented with painful periods 18 months earlier and laparoscopy confirmed endometriosis. She now gets pain on opening her bowels as well as low back pain. What structure is likely to be involved?
Your Answer: Uterosacral ligament
Explanation:Lower abdominal pain during menstrual periods and lower back or leg pain are associated with endometriosis in the uterosacral ligaments. Endometriosis can cause diarrhoea and IBS type symptoms. Note Endometriosis on the uterosacral ligament can cause tender nodules to form. These can be palpated during pelvic exam. Tender nodules are specific to endometriosis of the uterosacral ligament so if the question mentions feeling a tender nodule during PV exam think endometriosis of the Uterosacral ligaments!
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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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In the 3rd trimester anaemia is defined by?
Your Answer: Haemoglobin < 90 g/l
Correct Answer:
Explanation:Anaemia in pregnancy is defined by the British Committee for Standards in Haematology (BCSH) guidance: 1st trimester Hb < 110 g/l 2nd and 3rd trimester Hb < 105 g/l Postpartum Hb less than 100 g/l
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This question is part of the following fields:
- Clinical Management
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Question 17
Correct
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You receive a swab result from a patient who had complained of odorous vaginal discharge. It confirms bacterial vaginosis (BV). Which pathogen is most commonly associated with BV?
Your Answer: Gardnerella vaginalis
Explanation:Bacterial vaginosis is characterised by a foul smelling vaginal discharge without inflammation. The most common spp to cause this is gardnerella vaginalis. Other spp include mycoplasma hominis and bacteroides. It occurs due to growth and increase in anaerobic spp with simultaneous reduction in lactobacilli in vaginal flora causing an increase in vaginal pH. It is the most common cause of abnormal vaginal discharge in women of childbearing age.
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This question is part of the following fields:
- Clinical Management
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Question 18
Incorrect
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During pregnancy which one of the following laboratory parameters is decreased?
Your Answer: Fibrinogen
Correct Answer: Platelet count
Explanation:In pregnancy, although it is a hypercoagulable state with an increase in clotting factors, the platelet count is decreased. Fibrinogen and erythrocyte sedimentation rate (ESR) may be both increased.
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This question is part of the following fields:
- Clinical Management
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Question 19
Correct
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Question 20
Correct
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Looking at the picture below what is the diagnosis?
Your Answer: Linea Nigra
Explanation:This is Linea Nigra. It occurs in 3/4 of pregnancies and is due to increased melanocyte-stimulating hormone production by the placenta. This also causes melasma and darkening of the nipples.
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This question is part of the following fields:
- Clinical Management
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