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Question 1
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 2
Incorrect
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A 22-year-old Asian woman with a background history of primary pulmonary hypertension attends your clinic. She is planning for a pregnancy in the next few months and feels well generally. What would be your advice?
Your Answer: Sudden death is a rare complication
Correct Answer: Pregnancy is contraindicated in her condition
Explanation:From the options given, option A is correct as primary pulmonary hypertension is considered a contraindication to pregnancy.
The patient should be educated about the possible risks and increased maternal mortality in such cases. This restriction is due to the fact that symptoms of Pulmonary hypertension gets worse during pregnancy which results in high maternal mortality.
Termination of pregnancy may be advisable in these circumstances mostly to preserve the life of the mother.
Sudden death secondary to hypotension is also a commonly dreaded complication among patients with pulmonary hypertension during pregnancy. -
This question is part of the following fields:
- Obstetrics
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Question 3
Correct
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All of the following factors are associated with an unstable lie of the foetus except?
Your Answer: Cervical fibroids
Explanation:Unstable lie means that the foetus is still changing its position even at 36 weeks of gestation. A number of factors are responsible for this positioning such as multi gravida, placenta previa, prematurity and fibroids present in the fundus. Cervical fibroids have little association with unstable lie of the foetus.
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This question is part of the following fields:
- Obstetrics
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Question 4
Correct
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What kind of epithelium lines the endocervix?
Your Answer: Columnar
Explanation:Its important to note the endo and ectocervix have 2 epithelial types. Where columnar and squamous epithelia meet is the transformation zone (or squamous-columnar junction, SCJ). This is relevant as it is the primary site for dysplasia and is where smears are taken from.
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This question is part of the following fields:
- Pathology
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Question 5
Correct
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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 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 6
Incorrect
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Which of the following is the leading cause of Down Syndrome?
Your Answer: Mitotic Nondisjunction after conception
Correct Answer: Nondisjunction maternal gamete
Explanation:Most of the cases of down syndrome occur due to non disjunction trisomy 21 which is associated with increased maternal age. The non disjunction occurs in the maternal gametes.
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This question is part of the following fields:
- Genetics
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Question 7
Incorrect
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A 32-year-old white female comes to your office complaining of dysuria. She denies fever, back pain, and urinary frequency. She appears to be well otherwise and has a normal abdominal examination. A clean-catch urinalysis shows 15-20 WBC/hpf and a dipstick test for leukocyte esterase is positive. You send a urine sample for culture and start the patient on nitrofurantoin (Macrodantin), as she is allergic to sulpha. Three days later, the patient returns with persistent dysuria despite taking the medication as prescribed. Her urine culture has returned with no growth. A pelvic examination is normal and the rest of the physical examination is unchanged. A wet prep is normal and tests for sexually transmitted diseases are pending. Which one of the following antibiotics is most appropriate for this patient now?
Your Answer: Cephalexin (Keflex)
Correct Answer: Doxycycline
Explanation:Urethral syndrome is characterized by dysuria and pyuria in the presence of a negative culture for uropathogens. Frequency and urgency are often absent. The infecting organism is typically Chlamydia trachomatis although other organisms such as Urea plasma urealyticum and Mycoplasma species may be involve- Effective medication choices include doxycycline, ofloxacin, levofloxacin, and macrolides such as erythromycin and azithromycin.
-Amoxicillin
lavulanate and cephalexin are incorrect. These would cover gram-positive bacteria but it would not cover gram-negative bacteria nor bacteria without a cell wall, which are the most common causes of this condition.
– Metronidazole is best for treating anaerobic infections and protozoa such as trichomonas vaginalis, it would not be the best for treating this condition, given the most likely causes.
-Pyridium is a phenazopyridine often used to alleviate the pain, irritation, discomfort, or urgency caused by urinary tract infections. While it would be beneficial for symptomatic relief, it is unlikely to completely resolve this patient’s condition, given her recent history. -
This question is part of the following fields:
- Gynaecology
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Question 8
Correct
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You are asked to consult on a young woman with a pre-existing cardiac defect. She wants to become pregnant in the near future and seeks advice about what risks to her health that this will create. You tell that the highest maternal mortality rates are associated with which of the following cardiac defects:
Your Answer: Eisenmenger syndrome
Explanation:Eisenmenger’s syndrome is one where there is communication between the systemic and pulmonary system, along with increased pulmonary vascular resistance, either to systemic level or above systemic level (right to left shunt). A would-be mother must be informed that to become pregnant would incur a 50% risk of dying. Even if she survives, fetal mortality approaches 50% as well.
– Severe symptomatic aortic stenosis has a mortality in pregnancy of about 20%. Prevention of reduction in preload is necessary in all obstructive cardiac lesions. Balloon valvuloplasty can be done in pregnancy.
– Due to the increased blood volume and cardiac output in pregnancy, mitral stenosis can lead to severe pulmonary oedema. Balloon valvuloplasty can be done in pregnancy.
– Ebstein anomaly is a malformation of the tricuspid valve- It is usually not associated with maternal mortality.
– Atrial-septal defects rarely cause complications in pregnancy, labour, or delivery. -
This question is part of the following fields:
- Gynaecology
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Question 9
Correct
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Missed abortion may cause one of the following complications:
Your Answer: Coagulopathy
Explanation:A serious complication with a miscarriage is DIC, a severe blood clotting condition and is more likely if there is a long time until the foetus and other tissues are passed, which is often the case in missed abortion.
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This question is part of the following fields:
- Obstetrics
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Question 10
Correct
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A 24 year old, 16 week pregnant patient presents with vaginal discharge. There is heavy growth of N. gonorrhoea as shown on swabs taken. Which treatment course is most advisable?
Your Answer: Ceftriaxone 1g intramuscularly as a single dose with azithromycin 2 g oral as a single dose
Explanation:Gonorrhoea is a diplococcus bacteria known to infect the female genital tract. The bacteria is sexually transmitted and can cause an ascending infection in the uterus and fallopian tubes. According to the BASHH guidelines (British Association for Sexual Health and HIV), indication for therapy include confirmation of intracellular diplococci on microscopy or a confirmed positive NAAT. Treatment of gonorrhoea in pregnancy is as follows: Ceftriaxone 1g intramuscularly as a single dose with azithromycin 2g oral as a single dose. Pregnant individuals are not to be treated with quinolones or tetracyclines.
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This question is part of the following fields:
- Clinical Management
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Question 11
Incorrect
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Question 12
Incorrect
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Regarding Human Papillomavirus, what percentage of women develop antibodies?
Your Answer: 75%
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 13
Incorrect
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At a family clinic, you're seeing a young lady. She came to talk about the many contraceptive alternatives available to her. She wants to begin using combined oral contraception tablets. She is concerned, however, about the risk of cancer associated with long-term usage of pills. Which of the following is the most likely side effect of oral contraceptive pills?
Your Answer: Colorectal cancer
Correct Answer: Cervical cancer
Explanation:Women who have used oral contraceptives for 5 years or more are more likely to get cervical cancer than women who have never used them. The longer a woman uses oral contraceptives, the higher her chances of developing cervical cancer become. According to one study, using marijuana for less than 5 years increases the risk by 10%, using it for 5–9 years increases the risk by 60%, and using it for 10 years or more increases the risk by double. After women cease using oral contraceptives, their risk of cervical cancer appears to decrease over time. Endometrial, ovarian, and colorectal cancer risks, on the other hand, are lowered.
Compared to women who had never used oral contraceptives, women who were taking or had just discontinued using oral combination hormone contraceptives had a slight (approximately 20%) increase in the relative risk of breast cancer. Depending on the type of oral combination hormone contraception used, the risk increased anywhere from 0% to 60%. The longer oral contraceptives were used, the higher the risk of breast cancer. -
This question is part of the following fields:
- Gynaecology
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Question 14
Incorrect
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Which of the following is the most accurate estimate of mature breast milk composition?
Your Answer: Fat 18% Protein 15% Sugar 1%
Correct Answer: Fat 4%, Protein 1%, Sugar 7%
Explanation:Breast milk contains around 4% fat, 7% sugar and 1% proteins. The rest is water and minerals.
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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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Regarding oogenesis & ovulation:
Your Answer: The 1st meiotic division is arrested in the diplotene stage until just before ovulation
Explanation:The oocyte (eggs, ova, ovum) is arrested at an early stage of the first meiosis (first meiotic) division as a primary oocyte (primordial follicle) within the ovary. Following puberty, during each menstrual cycle, pituitary gonadotrophin stimulates completion of meiosis 1 the day before ovulation.
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This question is part of the following fields:
- Cell Biology
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Question 16
Correct
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During the menstrual cycle which hormone typically reaches its peak level on day 21 (assuming a 28 day cycle)?
Your Answer: Progesterone
Explanation:LH, FSH and Oestrogen have their peaks just before ovulation on day 14 whereas progesterone peaks around day 21.
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This question is part of the following fields:
- Endocrinology
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Question 17
Correct
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With regard to the cell cycle. In which part of the cycle does DNA replication occur?
Your Answer: Interphase
Explanation:DNA replication occurs during S phase but that isn’t one of the options. Remember Interphase comprises G1,S and G2 phases!
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This question is part of the following fields:
- Biochemistry
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Question 18
Correct
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A 26 year old female patient comes to a GP asking to see a gynaecologist for cervical screening test. She has no history of sexual intercourse and is not a lesbian. What would you do next?
Your Answer: Reassure her there is no need for cervical screening test at this stage
Explanation:Women, who have never had sexual encounter, do not need cervical screening. However, any sort of sexual encounter (Lesbian or heterosexual) is considered a risk and the patient must be screened. Otherwise, routine cervical screening test can be performed every five years for woman 25-74 years who ever had sex with no evidence of cervical pathology. Perform a cervical screening test at the age of 25 or 2 years after first sexual intercourse-whichever is later in sexually active women. Perform cervical screening test in patients above 75 years if they request or if they never had any symptoms.
All other options are unacceptable.
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This question is part of the following fields:
- Gynaecology
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Question 19
Correct
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Placental production of hPL, hCG, Oestrogen and Progesterone are examples of which type of mechanism
Your Answer: Endocrine
Explanation:Hormones that are secreted into the circulation at one site but have effects on distal target organs are endocrine as is the case with the hormones above. Autocrine and Intracrine messengers act within the same cell. Exocrine glands secrete their products into ducts. Apocrine is a histological term used to describe some types of exocrine gland.
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This question is part of the following fields:
- Endocrinology
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Question 20
Correct
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Question 21
Correct
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A 27-year-old G1P0 woman who is at 14 weeks of gestation presented to the medical clinic complaining of persistent nausea and vomiting. Upon history taking and interview, she reported that she frequently had poor appetite and felt lethargic. From her pre-pregnancy weight, it was also noted that she had 3% weight loss in difference. Upon further clinical observation, she looked dry, accompanied with coated tongue. If the diagnosis of “hyperemesis gravidarum” is to be considered, which of the following will most likely confirm that diagnosis?
Your Answer: she looks dry with coated tongue
Explanation:Hyperemesis gravidarum refers to intractable vomiting during pregnancy, leading to weight loss and volume depletion, resulting in ketonuria and/or ketonemia. There is no consensus on specific diagnostic criteria, but it generally refers to the severe end of the spectrum regarding nausea and vomiting in pregnancy.
Hormone changes wherein hCG levels peak during the first trimester corresponds to the typical onset of hyperemesis symptoms. It is well-known that 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.
Hyperemesis gravidarum refers to extreme cases of nausea and vomiting during pregnancy. The criteria for diagnosis include vomiting that causes significant dehydration (as evidenced by ketonuria or electrolyte abnormalities, and the dry with coated tongue) and weight loss (the most commonly cited marker for this is the loss of at least five percent of the patient’s pre-pregnancy weight) in the setting of pregnancy without any other underlying pathological cause for vomiting.
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This question is part of the following fields:
- Obstetrics
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Question 22
Incorrect
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All of the following organs are involved in oestrogen production except:
Your Answer: Testes
Correct Answer: Anterior pituitary
Explanation:Oestrogen can be produced by variety of organs including the corpus leuteum, placenta, adrenal glands and testes. However it is not produced by the anterior pituitary. The anterior pituitary produces LH and FSH which in turn causes oestrogen secretion.
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This question is part of the following fields:
- Endocrinology
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Question 23
Correct
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A patient who is 36 weeks pregnant comes to see you as she has developed tingling to the right lateral thigh over the past 3 weeks. On examination there are no skin changes and no muscle weakness. What is the likely diagnosis?
Your Answer: Meralgia Paraesthetica
Explanation:Raised pressure with the pelvis can cause a number of nerve entrapment syndromes. This is entrapment of the lateral cutaneous nerve of the thigh (or lateral femoral cutaneous nerve) also known as Meralgia Paraesthetica. Pregnancy is a risk factor. Shingles can effect this nerve but the rash would usually present itself within 14days.
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This question is part of the following fields:
- Anatomy
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Question 24
Correct
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With sneezing, a 45-year-old mother of two reported leaking a small bit of urine. It started to happen with exercising recently. She denies having experienced recent life pressures. Which of the following best characterizes the incontinence she's dealing with?
Your Answer: Stress incontinence
Explanation:Overflow incontinence typically presents with continuous urinary leakage or dribbling in the setting of incomplete bladder emptying. Associated symptoms can include weak or intermittent urinary stream, hesitancy, frequency, and nocturia. When the bladder is very full, stress leakage can occur or low-amplitude bladder contractions can be triggered resulting in symptoms similar to stress or urgency incontinence.
Women with urgency incontinence experience the urge to void immediately preceding or accompanied by involuntary leakage of urine
Individuals with stress incontinence have involuntary leakage of urine that occurs with increases in intraabdominal pressure (e.g., with exertion, sneezing, coughing, laughing) in the absence of a bladder contraction.
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This question is part of the following fields:
- Gynaecology
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Question 25
Incorrect
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Which of the following Oestrogens (Oestrogens) becomes the predominant circulating oestrogen during pregnancy?
Your Answer: Oestradiol
Correct Answer: Estriol
Explanation:Oestradiol is the predominant form of oestrogen during the reproductive life of a female. The estrogenic potency of oestradiol is 12 times more than estrone and 80 times that of estriol.
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This question is part of the following fields:
- Endocrinology
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Question 26
Correct
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Question 27
Incorrect
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Which organism is the most common cause of puerperal sepsis?
Your Answer: Staphylococcus aureus
Correct Answer: Group A Streptococcus
Explanation:Puerperal sepsis is defined as sepsis occurring after birth until 6 weeks postnatal. The most common cause of puerperal sepsis is Group A streptococcus. Until 1937, puerperal sepsis was the major cause of maternal mortality. The discovery of sulphonamides in 1935 and the simultaneous reduction in the virulence of the haemolytic streptococcus resulted in a dramatic fall in maternal mortality.
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This question is part of the following fields:
- Clinical Management
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Question 28
Incorrect
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During the filling phase of micturition. At what bladder volume is the first urge to void felt?
Your Answer: 500ml
Correct Answer: 150ml
Explanation:Micturition is defined as a process of expelling urine from the body. It is caused by the reflex contraction of detrusor muscle. Urinary bladder is a hollow muscular organ which can store 400-600ml of urine until it is expelled from the body. The first urge to urinate is felt when the bladder is filled with around 150ml of urine. The reflex action is initiated when the stretch receptors located in the bladder wall are stimulated. The afferent fibres pass to the pelvic splanchnic nerves to the 2nd, 3rd, and 4th sacral segments and some pass through the hypogastric plexus to the first and second lumbar segments of the spinal cord. Efferent pathways from the 2nd, 3rd, and 4th sacral segments leave the cords and through the splanchnic nerves and inferior hypogastric plexus supplies the smooth muscle of the bladder i.e. detrusor muscle. Detrusor muscle contracts and the sphincters are relaxed.
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This question is part of the following fields:
- Anatomy
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Question 29
Correct
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Which of the following statements is FALSE regarding Turner's syndrome?
Your Answer: Buccal smear is chromatin positive
Explanation:Turner syndrome patients have high FSH levels and low oestrogen levels. They have a short stature and buccal smear is chromatin negative.
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This question is part of the following fields:
- Embryology
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Question 30
Incorrect
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The performance of a cervical cerclage at 14 weeks of gestation is determined by which of the following indications?
Your Answer: Short cervix at <24 weeks with no prior preterm birth
Correct Answer: 2 or more consecutive prior second trimester pregnancy losses
Explanation:Cervical cerclage is performed as an attempt to prolong pregnancy in certain women who are at higher risk of preterm delivery.
There are three well-accepted indications for cervical cerclage placement. According to the American College of Obstetricians and Gynaecologists (ACOG), a history-indicated or prophylactic cerclage may be placed when there is a “history of one or more second-trimester pregnancy losses related to painless cervical dilation and in the absence of labour or abruptio placentae,” or if the woman had a prior cerclage placed due to cervical insufficiency in the second trimester.
An ultrasound-indicated cerclage may be considered for women who have a history of spontaneous loss or preterm birth at less than 34 weeks gestation if the cervical length in a current singleton pregnancy is noted to be less than 25 mm before 24 weeks of gestation. It is important to note that this recommendation is invalidated without the history of preterm birth.
Physical examination-indicated cerclage (also known as emergency or rescue cerclage) should be considered for patients with a singleton pregnancy at less than 24 weeks gestation with advanced cervical dilation in the absence of contractions, intraamniotic infection or placental abruption.
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This question is part of the following fields:
- Obstetrics
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SESSION STATS - PERFORMANCE PER SPECIALTY
