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Question 1
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 2
Incorrect
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Which one of the following dimensions relates to the greatest diameter of the fetal head?
Your Answer: Suboccipit bregmatic
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 3
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 4
Correct
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A 33 year old lady presented with complaints of heavy menstrual bleeding. She is otherwise well and her US abdomen is normal. What is the best treatment option?
Your Answer: Mirena coil
Explanation:Mirena coil is used for contraception and for long term birth control. It causes stoppage of menstrual bleeding however, in a few cases there may be inter-menstrual spotting.
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This question is part of the following fields:
- Gynaecology
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Question 5
Incorrect
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The main support of the uterus is provided by:
Your Answer: The broad ligament
Correct Answer: The cardinal ligament
Explanation:The cardinal ligament (or Mackenrodt’s ligament, lateral or transverse cervical ligament) is a major ligament of the uterus. It is located at the base of the broad ligament of the uterus. It attaches the cervix to the lateral pelvic wall by its attachment to the Obturator fascia of the Obturator internus muscle, and is continuous externally with the fibrous tissue that surrounds the pelvic blood vessels. It thus provides support to the uterus.
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This question is part of the following fields:
- Anatomy
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Question 6
Incorrect
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Which of the following best describes the mechanism of action of radiotherapy?
Your Answer: Cell death via oxidative phosphorylation
Correct Answer: DNA damage via free radical generation
Explanation:Radiotherapy causes ionisation, primarily of water. This leads to hydroxyl and other free radicals being generated. Free radicals are highly reactive and cause DNA damage to cells via their reactions with them. Free radicals are relatively short lived and eventually form stable compounds. The DNA damage leads to cellular death.
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This question is part of the following fields:
- Biophysics
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Question 7
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 8
Incorrect
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If a hyalinised mass is formed from an involuted corpus leuteum, it is known as:
Your Answer: Graafian follicle
Correct Answer: Corpus albicans
Explanation:Corpus albicans is the regressed form of the corpus leuteum. It is formed when the corpus leuteum is engulfed by macrophages and a scar or fibrous tissue is formed, called the corpus albicans.
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This question is part of the following fields:
- Physiology
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Question 9
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 10
Correct
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A 25-year old woman presented to the medical clinic for her first prenatal check-up. Upon interview, the patient revealed that she has been smoking one pack of cigarettes per day for the past five years. All of the following are considered correct regarding the disadvantages of smoking during pregnancy, except:
Your Answer: Increased risk of developing small teeth with faulty enamel
Explanation:Small teeth with faulty enamel is more associated with fetal alcohol syndrome (FAS).
In FAS, the most common orofacial changes are small eyelid fissures , flat facies, maxillary hypoplasia, short nose, long and hypoplastic nasal filter, and thin upper lip. The unique facial appearance of FAS patients is the result of changes in 4 areas: short palpebral fissures, flat nasal bridge with an upturned nasal tip, hypoplastic philtrum with a thin upper vermillion border, and a flat midface. Other facial anomalies include micrognathia, occasional cleft lip and/or palate and small teeth with defective enamel.
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This question is part of the following fields:
- Obstetrics
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Question 11
Correct
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Which of the following is an appropriate treatment for Diazepam overdose?
Your Answer: Flumazenil
Explanation:Flumazenil is used for benzodiazepine overdose.
Naloxone is used for opioid overdose.
Parvolex (N-acetyl cysteine) is used for paracetamol overdose.
Protamine can be used for Heparin reversal.
Beriplex can be used for Warfarin reversal. -
This question is part of the following fields:
- Pharmacology
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Question 12
Correct
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Which of the following hormones inhibits lactogenesis during pregnancy?
Your Answer: Oestrogen and Progesterone
Explanation:Under the influence of prolactin, oestrogen and progesterone and human placental lactogen (hPL), the mammary epithelium proliferates but remains presecretory during mammogenesis. Lactogenesis is inhibited by high circulating levels of progesterone and oestrogen which block cortisol binding sites. Cortisol would have otherwise have worked synergistically with prolactin in milk production. A sharp decrease in progesterone levels after delivery allows prolactin and oxytocin to stimulate milk production and the milk ejection reflex in response to suckling. Prolactin continues to maintain milk production in galactopoiesis.
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This question is part of the following fields:
- Clinical Management
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Question 13
Incorrect
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At ovulation the surge in LH causes rupture of the mature oocyte via action on what?
Your Answer: Granulosa externa
Correct Answer: Theca externa
Explanation:The luteinizing hormone (LH) surge during ovulation causes: Increases cAMP resulting in increased progesterone and PGF2 production PGF2 causes contraction of theca externa smooth muscle cells resulting in rupture of the mature oocyte
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This question is part of the following fields:
- Endocrinology
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Question 14
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: Ectopic pregnancy
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 15
Incorrect
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Which of the following tests is used to detect antibodies or complement bound to red blood cell antigens in vivo?
Your Answer: Indirect Coombs
Correct Answer: Direct Coombs
Explanation:When the red cells are coated with immune IgG antibody, the cells do not agglutinate but when anti-IgG antiserum is added to these sensitized cells visible agglutination occurs. This is known as a positive direct coombs test.
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This question is part of the following fields:
- Physiology
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Question 16
Incorrect
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Oestrogen have all of the following actions, EXCEPT:
Your Answer: Produce proliferation of the endometrium
Correct Answer: Prevention of thrombosis
Explanation:The properties of oestrogen:
Structure: Stimulates endometrial growth, maintenance of vessels and skin,
reduces bone resorption, increases bone formation, increases uterine growth
Protein synthesis: Increases hepatic synthesis of binding proteins
Coagulation: Increases circulating levels of factors II, VII, IX, X, antithrombin III and plasminogen; increases platelet adhesiveness
Lipid: Increases HDL and reduces LDL,increases triglycerides, reduces
ketone formation, increases fat deposition
Fluid balance: Salt and water retention
Gastrointestinal: Reduces bowel motility, increases cholesterol in bile -
This question is part of the following fields:
- Endocrinology
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Question 17
Incorrect
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Which of the following arteries branches directly from the aorta?
Your Answer: Femoral
Correct Answer: Ovarian
Explanation:The uterine and vaginal arteries branch from the internal iliac artery. The ovarian artery branches direct from the aorta.
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This question is part of the following fields:
- Anatomy
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Question 18
Correct
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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 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 19
Incorrect
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If the presenting part of the foetus is the large fontanel, this presentation is known as?
Your Answer: Brow
Correct Answer: Sinciput
Explanation:Sinciput means the head is neither flexed nor extended. It is the area between forehead and crown and in this case the anterior fontanel is the presenting part.
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This question is part of the following fields:
- Anatomy
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Question 20
Incorrect
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A 33-year-old female patient walks into your office to speak with you about her recent pap smear result. A low-grade squamous intraepithelial lesion was discovered (LSIL). Her most recent pap smear, performed two years ago, came back normal. Which of the following is the most appropriate course of action?
Your Answer: Refer for colposcopy
Correct Answer: Repeat the pap smear in one year
Explanation:An LSIL Pap test shows mild cellular changes. The risk of a high-grade cervical precancer or cancer after an LSIL Pap test is as high as 19 percent.
As with an ASC-US Pap test, an LSIL Pap test is evaluated differently depending upon age.
For women ages 25 or older, follow-up depends upon the results of human papillomavirus (HPV) testing:
– Women who test positive for HPV or who have not been tested for HPV should have colposcopy.
– Women who test negative for HPV can be followed up with a Pap test and HPV test in one year.Referring the patient to an oncologist is not acceptable since there is no established diagnosis of malignancy that has been made. All other options are unacceptable since Pap smear must be done in 12 months.
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This question is part of the following fields:
- Gynaecology
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Question 21
Incorrect
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Which of the following would normally be expected to increase during pregnancy:
Your Answer: Core temperature
Correct Answer: Thyroxin-binding globulin
Explanation:Thyroid function in pregnancy is altered in two ways; the circulating levels of the thyroid binding proteins are increased, resulting in an increase in the total circulating levels of thyroid hormones (but a slight fall in the free component).
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This question is part of the following fields:
- Physiology
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Question 22
Incorrect
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A 22 year old woman had a C-section two hours ago. However, she has not urinated since then and claims she had no urinary complaints before the operation. Upon inspection she appears unwell and her abdomen is distended and tender suprapubically and in the left flank. Auscultation reveals no bowel sounds. Further examination reveals the following: Temp=37.5C, BP=94/73mmHg, Pulse=116bpm, Sat=97%. What's the most likely complication?
Your Answer: Paralytic ileus
Correct Answer: Urinary tract injury
Explanation:Urologic injury is the most common injury at the time of either obstetric or gynaecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during caesarean section include previous caesarean delivery, adhesions, emergency caesarean delivery, and caesarean section performed during the second stage of labour.
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This question is part of the following fields:
- Obstetrics
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Question 23
Incorrect
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Ulipristal is thought to prevent pregnancy by what primary mechanism?
Your Answer: Prevention of endometrial implantation via endometrial membrane alteration
Correct Answer: Inhibition of ovulation
Explanation:Ulipristal is a progesterone receptor modulator that is used up to 120 hours following unprotected intercourse. It inhibits ovulation. The dose is 30 mg.
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This question is part of the following fields:
- Clinical Management
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Question 24
Correct
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Regarding heart rate in pregnancy which of the following statements is true?
Your Answer: Heart rate increases by 15 beats per minute
Explanation:The following cardiovascular changes occur during pregnancy:
– Blood volume slowly increases by 40-50%
– Heart rate rises by 15 beats/min above baseline
– Stroke volume increases by 25-30%
– Cardiac output increases by approximately 30-50%
– Systemic vascular resistance (SVR) decreases by 20-30%
– Diastolic blood pressure consequently decreases between 12 and 26 weeks but increases again to pre-pregnancy levels by 36 weeks.
As most of the changes occur in the first 12 weeks of gestation cardiac problems are likely to present in early pregnancy -
This question is part of the following fields:
- Physiology
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Question 25
Incorrect
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Which one of the following statements is related to testicular feminization syndrome?
Your Answer: There's usually very low testosterone levels
Correct Answer: There are usually normal testes
Explanation:Androgen insensitivity (testicular feminization) syndrome is a rare inherited form of male pseudo hermaphroditism that occurs in phenotypically normal women with adequate breast development, normal external genitalia, a vagina of variable depth, absent uterus, and sparse or absent pubic hair and axillary hair. Testosterone levels are normal or elevated.
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This question is part of the following fields:
- Embryology
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Question 26
Incorrect
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A 27-year-old woman presents to her general practitioner because of secondary amenorrhoea since the last 12 months. She has a history of primary infertility. Of the hormone assays listed in the options, identify the assay that would indicate pregnancy if its result is significantly elevated.
Your Answer: Serum progesterone.
Correct Answer: Serum luteinising hormone {LH).
Explanation:The levels of oestradiol (E2), progesterone, and prolactin (PRL) are all elevated during early pregnancy. However these elevations cannot be solely relied on to determine if pregnancy has occurred since increased levels of these hormones can also occur in pathologic states in non-pregnant women or, in some cases, even during menstrual cycles.
The levels of follicle stimulating hormone (FSH) are suppressed in pregnancy because of the elevated E2 and progesterone levels.
The correct answer is elevated levels of luteinising hormone (LH). This is because the beta sub-units of LH and human chorionic gonadotrophin (hCG) are almost identical and therefore, hCG is measured as LH in almost all LH assays (correct answer).
The LH levels can be slightly raised in polycystic ovarian syndrome; however, it is unlikely that the levels would increase above 30 mIU/mL in this condition.
The mid-cycle levels of LH can go up to 100-150 mIU/mL. If the levels are more than 200 mlU/mL, it usually indicates pregnancy.
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This question is part of the following fields:
- Gynaecology
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Question 27
Correct
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Anna, a 39-year-old medical receptionist presents to your gynaecologic clinic for a refill of her Microgynin 30 (combined oral contraceptive pill). Her history is significant for smoking around 1 pack per day. Her BMI is 37. What should be the next management step?
Your Answer: Offer her progestogen-only contraceptive options
Explanation:This patient is above 35 and smokes more than 15 cigarettes per day, which is an absolute contraindication to using a combined oral contraceptive pill. A BMI of greater than 35 is a relative contraindication to the usage of the combined oral contraceptive pill.
Progestogen-only contraception, such as etonogestrel implant, levonorgestrel intrauterine device, and depot medroxyprogesterone, should be offered to her.
Without initially attempting lifestyle changes, a referral for weight loss surgery is not required. Also, nicotine replacement therapy may aid in quitting smoking, but it may take time. -
This question is part of the following fields:
- Gynaecology
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Question 28
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 luteinising hormone.
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 29
Incorrect
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You see a patient in fertility clinic who you suspect has Klinefelters. What is the likely karyotype?
Your Answer: 47XXX
Correct Answer: 47XXY
Explanation:Klinefelter syndrome occurs in 1:1000 individuals. They are phenotypically male and genotypically they have 47,XXY chromosomes. These individuals have small testes, are tall with disproportionate long lower limbs.40% will also have gynecomastia.
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This question is part of the following fields:
- Genetics
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Question 30
Incorrect
SESSION STATS - PERFORMANCE PER SPECIALTY
