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Question 1
Incorrect
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What is the failure rate of tubal sterilization?
Your Answer: 1 in 1000
Correct Answer:
Explanation:Tubal sterilization is a safe and effective surgical procedure that permanently prevents pregnancy. However, pregnancy can occur in 1 in 200 cases, according to international sources. In the 1st year after tubal sterilization, the estimated failure rate is 0.1-0.8% respectively.
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This question is part of the following fields:
- Gynaecology
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Question 2
Correct
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A fibroid is a type of
Your Answer: Leiomyoma
Explanation:A fibroid is a benign smooth muscle tumour or Leiomyoma. As such it is something of a misnomer. Leiomyosarcoma and Angioleiomyoma are malignant tumours of smooth muscle under the WHO sort tissue tumour classification Rhabdomyoma is a skeletal muscle tumour Myofibroma is seen in fibromatosis
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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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A 31-year-old woman who is pregnant has a blood pressure reading of 160/87 mmHg. You considered Pre-eclampsia. What symptom might be expected in a patient with uncomplicated pre-eclampsia?
Your Answer: Headache
Correct Answer:
Explanation:Extreme headache, vision defects, such as blurring of the eyes, rib pain, sudden swelling of the face, hands or feet are all consistent with pre-eclampsia. Women with the mentioned symptoms should have their blood pressure checked immediately. They should also be checked for proteinuria. Diarrhoea is not related to pre-eclampsia. Pruritus would be more related to pregnancy cholestasis. Meanwhile, bruising and abnormal LFTs are common in complicated pre-eclampsia but not in an uncomplicated one.
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This question is part of the following fields:
- Obstetrics
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Question 4
Incorrect
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What is the definition of puberty in girls?
Your Answer: Development of secondary sexual characteristics
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 5
Correct
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Which of the following statements regarding prolactin is true?
Your Answer: Prolactin levels increase during stress
Explanation:Causes of Hyperprolactinemia: Prolactinomas, Medication (phenothiazines, metoclopramide, risperidone, selective serotonin reuptake inhibitors, oestrogens, verapamil), Stress, Pregnancy, Hypothyroidism, Kidney disease, Chest trauma
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This question is part of the following fields:
- Endocrinology
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Question 6
Correct
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The uterine vein drains where?
Your Answer: Internal iliac vein
Explanation:The venous drainage of the uterus is via the uterine veins which form a plexus passing below the artery within the base of the broad ligament communicating with the rectal and the vesical venous plexus before draining into the internal iliac veins.
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This question is part of the following fields:
- Anatomy
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Question 7
Correct
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The fetal head may undergo changes in shape during normal delivery. The most common aetiology listed is:
Your Answer: Molding
Explanation:With the help of molding, the fetal head changes its shape as the skull bones overlap. This helps in smooth delivery of the foetus through the birth canal.
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This question is part of the following fields:
- Obstetrics
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Question 8
Correct
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A couple present to the fertility clinic after failing to conceive despite trying for 2.5 years. The semen analysis shows azoospermia. You perform a full examination of the male partner which reveals Height 192cm, BMI 20.5, small testes and scant facial hair. You decide to organise karyotyping. What is the result likely to show?
Your Answer: 47XXY
Explanation:Klinefelter syndrome is associated with testicular atrophy, eunuchoid body shape, tall, long extremities, female hair distribution and gynaecomastia. It is a common cause of hypogonadism seen during fertility workup.
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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 26-year-old gravida 2 para 1 presents at 30 weeks gestation with a complaint of severe itching. She has excoriations from scratching in various areas. She says that she had the same problem during her last pregnancy, and her medical records reveal a diagnosis of intrahepatic cholestasis of pregnancy. Elevation of which one of the following ismost specific and sensitive markerof this disorder?
Your Answer: Alkaline phosphatase
Correct Answer: Bile acids
Explanation:Intrahepatic cholestasis of pregnancy (ICP) classically presents as severe pruritus in the third trimester. Characteristic findings include the absence of primary skin lesions and elevation of serum levels of total bile acids.
The most specific and sensitive marker of ICP is total serum bile acid (BA) levels greater than 10 micromol/L. In addition to the elevation in serum BA levels, the cholic acid level is significantly increased and the chenodeoxycholic acid level is mildly increased, leading to elevation in the cholic
henodeoxycholic acid level ratio. The elevation of aminotransferases associated with ICP varies from a mild increase to a 10- to 25-fold increase.Total bilirubin levels are also increased but usually the values are less than 5 mg/dL. Alkaline phosphatase (AP) is elevated in ICP up to 4-fold, but this is not helpful for diagnosis of the disorder since AP is elevated in pregnancy due to production by the placenta- Mild elevation of gamma glutamyl transferase (GGT) is seen with ICP but occurs in fewer than 30% of cases. However, if GGT is elevated in cases of ICP, that patient is more likely to have a genetic component of the liver disease.
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This question is part of the following fields:
- Obstetrics
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Question 10
Incorrect
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Which of the following factors causes the greatest increase in risk of developing bladder cancer?
Your Answer: Working as a painter
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 11
Correct
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Regarding urinary tract infection (UTI) in pregnancy. What is the most common causative organism of urinary tract infection?
Your Answer: Escherichia coli
Explanation:E.coli is the most common cause of UTI. Other organisms include pseudomonas, proteus and klebsiella.
NICE guidelines: UTI in pregnancy (updated in July 2015)
Send urine for culture and sensitivity from all women in whom UTI is suspected before starting empirical antibiotics and 7 days after antibiotic treatment is completed.
Prescribe an antibiotic to all women with suspected UTI (awaiting culture result is not advised)
Although local antibiotic resistance needs to be taken into account the following is advised in terms of antibiotic selection:
1. Nitrofurantoin 50 mg QDS (or 100 mg MR BD) for 7 days.
2. Trimethoprim 200 mg twice daily, for 7 days
Give folic acid 5 mg OD if it is the 1st trimester
Do not give trimethoprim if the woman is folate deficient, taking a folate antagonist, or has been treated with trimethoprim in the past year.
3. Cefalexin 500 mg BD (or 250 mg 6qds) for 7 days -
This question is part of the following fields:
- Clinical Management
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Question 12
Incorrect
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A 55-year-old female presents to her general practitioner. She complains of a three month history of amenorrhea, with recently added hot flushes 10 - 12 times a day, irritability and difficulty sleeping. What would be the best management strategy to relieve her symptoms, whilst minimising side effects?
Your Answer: Continuous therapy with oestrogen and MPA.
Correct Answer: Continuous daily oestrogen therapy, with medroxy progesterone acetate (MPA) given daily for 12 days each month.
Explanation:The best strategy is to commence cyclical hormone therapy using continuous daily oestrogen therapy, with medroxy progesterone acetate (MPA) given daily for 12 days each month.
This patient is most likely experiencing menopause, with symptoms caused by her oestrogen deficiency state.
Diazepam will help her to sleep and possibly alleviate her irritability, but would be unlikely to relieve the hot flushes.
Continuous therapy with oestrogen and MPA provides continuous progestogen therapy and has a high risk of causing unpredictable breakthrough vaginal bleeding, as it is only three months since the last menstrual period. This treatment is not recommended to be given within 1 – 2 years of the last period.
Oestrogen alone is not recommended for women who still have their uterus.
Progestogen alone would only be indicated in cases with contraindications to oestrogen administration.
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This question is part of the following fields:
- Gynaecology
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Question 13
Incorrect
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The roof of the femoral triangle is formed by which structure?
Your Answer: Transversalis fascia
Correct Answer: Fascia lata
Explanation:Boundaries of the Femoral Triangle: Superior: Inguinal ligament Medial: Medial border of the adductor longus Lateral: Medial border of the sartorius Floor: Pectineus, Adductor longus and Iliopsoas muscles Roof: Fascia Lata (cribriform fascia at the saphenous opening) Trasversalis fascia forms part of the roof of the inguinal canal
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This question is part of the following fields:
- Anatomy
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Question 14
Incorrect
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Hyperemesis gravidarum occurs in what percentage of pregnancies?
Your Answer: 15%
Correct Answer: 1.50%
Explanation:Hyperemesis Gravidarum effects around 0.3-2% of Pregnancies. It causes imbalances of fluid and electrolytes, disturbs nutritional intake and metabolism, causes physical and psychological debilitation and is associated with adverse pregnancy outcome, including an increased risk of preterm birth
and low birthweight babies. The aetiology is unknown however various potential mechanisms have been proposed including an association with high levels of serum human chorionic gonadotrophin (hCG), oestrogen and thyroxine. -
This question is part of the following fields:
- Clinical Management
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Question 15
Correct
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The second stage of labour involves:
Your Answer: Expulsion of the foetus
Explanation:First stage: The latent phase is generally defined as beginning at the point at which the woman perceives regular uterine contractions. A definition of active labour is having contractions more frequent than every 5 minutes, in addition to either a cervical dilation of 3 cm or more or a cervical effacement of 80% or more.
Second stage: fetal expulsion begins when the cervix is fully dilated, and ends when the baby is born.
Third stage: placenta delivery – The period from just after the foetus is expelled until just after the placenta is expelled is called the third stage of labour or the involution stage.
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This question is part of the following fields:
- Physiology
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Question 16
Incorrect
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A 35-year-old woman presented to the medical clinic for her first prenatal visit. Upon history-taking, it was noted that this was her first pregnancy and based on her last menstrual period, she is pregnant for 11 weeks already. There was also no mention of a history of medical problems. Upon further observation, the uterus was palpable midway between her pubic symphysis and the umbilicus. There was also no audible fetal heart tones using the Doppler stethoscope. Which of the following is considered the best management as the next step given the case above?
Your Answer: Reassure her that fetal heart tones are not yet audible with the Doppler stethoscope at this gestational age.
Correct Answer: Schedule an ultrasound as soon as possible to determine the gestational age and viability of the foetus.
Explanation:In pregnancy, the uterus increases in size to accommodate the developing foetus. At 16 weeks gestation, the fundus of the uterus must be palpated at the midpoint between the umbilicus and the pubic symphysis but the patient’s uterus was already palpable at just 11 weeks.
If less than seven weeks pregnant, it’s unlikely to find a heartbeat by ultrasound. Using transvaginal ultrasound, a developing baby’s heartbeat should be clearly visible by the time a woman is seven weeks pregnant. Abdominal ultrasound is considerably less sensitive, so it can take longer for the heartbeat to become visible. If past seven weeks pregnant, seeing no heartbeat may be a sign of miscarriage.
Fetal viability is confirmed by the presence of an embryo that has cardiac activity. Cardiac activity is often present when the embryo itself measures 2 mm or greater during the 6th week of gestation. If cardiac activity is not evident, other sonographic features of early pregnancy can predict viability.
It is recommended that all pregnant women undergo a routine ultrasound at 10 to 13 weeks of gestation to determine an accurate gestational age. Getting an accurate gestational age is highly important and pertinent for the optimal assessment of fetal growth later in pregnancy. Ultrasound is the most reliable method for establishing a true gestational age by measurement of crown-rump length, which can be measured either transabdominally or transvaginally.
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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 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: Serum prolactin.
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 18
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: Urine pregnancy test in 2 weeks
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 19
Correct
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Hypoplasia & yellow discoloration of the primary teeth has occurred in infants whose pregnant mothers were treated with which drug:
Your Answer: Tetracycline
Explanation:Tetracycline is a broad-spectrum antibiotic that crosses placental barrier. Tetracycline was the first line of therapy in treating infections caused by Mycoplasma pneumoniae, chlamydia, rickettsia, and some spirochaetes. It has a wide range of adverse effects and is known for a unique property of being incorporated into skeletal and dental tissues at sites of active mineralization and staining of these tissues.
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This question is part of the following fields:
- Pharmacology
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Question 20
Correct
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Aromatase is key to Oestradiol production in the ovaries. Which of the following statements is true?
Your Answer: FSH induces the granulosa cells to make aromatase
Explanation:The two main cell types of the ovaries:
1. The theca cells produce androgen in the form of androstenedione. The theca cells are not able to convert androgen to oestradiol themselves. The produced androgen is therefore taken up by granulosa cells.
2. The neighbouring granulosa cells then convert the androgen into oestradiol under the enzymatic action of aromatase FSH induces the granulosa cells to produce aromatase for this purpose -
This question is part of the following fields:
- Endocrinology
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Question 21
Incorrect
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A 33-year-old lady seeks counsel from your clinic since she has a history of deep vein thrombosis. She was on progesterone-only tablets (POP) until fivemonths ago, when she decided to get pregnant. However, the pregnancy turned out to be ectopic. Thankfully, she made it through. She doesn't want to get pregnant again and asks if she may resume taking the tablets. Which of the following is the best piece of advise you could give?
Your Answer: She can take progesterone only pills after 12 months of first ectopic pregnancy
Correct Answer: She cannot take progesterone only pills
Explanation:Oestrogen-containing contraceptives are not recommended for this woman since she has a history of DVT. This is most likely why she was started on POP instead of standard combination tablets prior. Progesterone is also contraindicated with a history of ectopic pregnancy and should never be used again. Barrier approaches, for example, could be applied in this woman’s case.
The following are absolute contraindications to taking just progesterone pills:
– Pregnancy
– Breast cancer
– Vaginal bleeding that hasn’t been diagnosed
– Ectopic pregnancy history or a high risk of ectopic pregnancyProgesterone-only pills have the following relative contraindications:
– Active viral hepatitis
– Severe chronic liver disease
– Malabsorption syndrome
– Severe arterial disease
– Successfully treated breast cancer more than 5 years ago
– Concomitant use of hepatic enzyme inducing medications. -
This question is part of the following fields:
- Gynaecology
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Question 22
Incorrect
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Warfarin embryopathy is typically the result of the mother taking warfarin during which stage of pregnancy?
Your Answer: 0-6 weeks
Correct Answer: 6-12 weeks
Explanation:Warfarin is teratogenic if it is used in the first trimester. It causes bone defects and haemorrhages in the developing foetus.
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This question is part of the following fields:
- Pharmacology
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Question 23
Incorrect
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Galactorrhoea (non-gestational lactation) may result from all of the following EXCEPT:
Your Answer: Renal failure
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 24
Correct
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Question 25
Correct
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What is the most common cause of hypercalcaemia?
Your Answer: Primary hyperparathyroidism
Explanation:Primary hyperparathyroidism is the most common cause of hypercalcemia. It is usually caused by a tumour of the parathyroid gland. Symptoms are related to increased calcium levels which can cause kidney stones, abdominal groans, psychiatric overtones and bones disease such as osteoporosis,osteomalacia and arthritis.
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This question is part of the following fields:
- Physiology
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Question 26
Incorrect
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Which one of the following dimensions relates to the greatest diameter of the fetal head?
Your Answer: Biparietal
Correct Answer: Occipitomental
Explanation:Occipitomental diameter is the greatest diameter of the fetal scalp and runs from chin to the prominent portion on the occiput. It measure about 12.5cm in diameter.
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This question is part of the following fields:
- Anatomy
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Question 27
Correct
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A 15 year old girl is being investigated for primary amenorrhoea. She has normal FSH,LH and E2 levels on hormone profiling and normal secondary sexual characteristics. An ultrasound shows no uterus. What is the likely diagnosis?
Your Answer: Rokitansky-Kuster-Hauser syndrome
Explanation:Mullerian agenesis occurs in 1 in 5000 to 1 in 40000 girls. The Mullerian system does not develop which results in an absent uterus and upper vagina. This condition is also known as Rokitansky-Kuster-Hauser syndrome, The ovarian function is normal and so the most common presentation is amenorrhea in the presence of an otherwise normal pubertal development.
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This question is part of the following fields:
- Embryology
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Question 28
Correct
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All of the following are considered complications related to cigarette smoking affecting mothers during pregnancy, except:
Your Answer: Less likely to die of sudden infant death syndrome
Explanation:The effects of smoking on the outcomes of pregnancy are well documented and include an increased risk of preterm premature rupture of the membranes (PPROM), preterm birth, low birth weight, placenta previa, and placental abruption. Many studies have shown that the risk of Sudden Infant Death Syndrome (SIDS) is increased by maternal smoking 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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A 29 year old female who is 32 weeks pregnant, has been admitted to hospital with very severe hypertension. This is her second pregnancy. In the United Kingdom, what is the first line of treatment for hypertension whilst pregnant?
Your Answer: Labetalol
Correct Answer:
Explanation:Atenolol is considered teratogenic and has two main risks: fetal bradycardia and neonatal apnoea. ACE inhibitors and angiotensin II receptor blockers are also known to be teratogenic (even though large-scale studies are difficult to conduct during pregnancies).
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This question is part of the following fields:
- Obstetrics
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Question 30
Incorrect
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Which of the following is known to increase the risk of endometrial cancer?
Your Answer: SLE
Correct Answer: PCOS
Explanation:The risk factors of endometrial cancer include obesity, diabetes, late menopause, unopposed oestrogen therapy, tamoxifen therapy, HRT and a family history of colorectal and ovarian carcinoma.
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This question is part of the following fields:
- Epidemiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
