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  • Question 1 - A patient admitted to the medical ward complains of a mild fever and...

    Correct

    • A patient admitted to the medical ward complains of a mild fever and vaginal discharge. Clue cells are seen on microscopy from a vaginal swab. Which of the following infections feature clue cells?

      Your Answer: Bacterial Vaginosis

      Explanation:

      Bacterial vaginosis (BV) is a common infection of the vagina caused by the overgrowth of atypical bacteria, most commonly Gardnerella vaginalis, a gram-negative rod. In diagnosing BV, a swab is taken for microscopy, often revealing clue cells. Clue cells are cells of the vaginal epithelium which are covered by adherent Gardnerella, giving them a distinctive look under the microscope. Though many are asymptomatic, some infected women complain of a greyish, foul-smelling vaginal discharge. Their vaginal fluid pH may also become more alkaline. BV does not however present with pyrexia, so the lady’s fever could be attributed to another cause as she is still a patient on the medical ward.

    • This question is part of the following fields:

      • Clinical Management
      67.2
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  • Question 2 - A 75 year old woman has a lesion biopsied from the cervix that...

    Incorrect

    • A 75 year old woman has a lesion biopsied from the cervix that is histologically confirmed as endometrial carcinoma. Further staging investigations shows no spread to the serosa or adnexa, no spread to the para-aortic, pelvic or inguinal lymph nodes and no evidence of distant metastasis. What FIGO stage is this?

      Your Answer: 1B

      Correct Answer: 2

      Explanation:

      It is stage 2 of the disease.

      Staging:
      1 Confined to uterus
      1A < 50% myometrial invasion
      1B > 50% myometrial invasion
      2 Cervical stromal invasion but not beyond uterus
      3 Extension beyond the uterus
      3A Tumour invades the serosa or adnexa
      3B Vaginal and/or parametrial invasion
      3C1 Pelvic nodal involvement
      3C2 Para aortic nodal involvement
      4 Distant Metastasis
      4A Tumour invasion of the bladder and/or bowel mucosa
      4B Distant metastases including abdominal metastases and/or inguinal lymph nodes

    • This question is part of the following fields:

      • Clinical Management
      20.2
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  • Question 3 - You are called to see a patient in A&E who attended due to...

    Correct

    • You are called to see a patient in A&E who attended due to finger splinter that has been removed. The HCA took some routine obs that show her blood pressure to be 162/110. She is 32 weeks pregnant. According to the NICE guidelines which of the following is appropriate?

      Your Answer: Admit and start oral labetalol

      Explanation:

      BP over 159/109 is classed as Severe. NICE guidance advises admission and treatment with oral Labetalol as 1st Line. Patient should have BP checked QDS and shouldn’t be discharged until BP is below 159/109

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      • Clinical Management
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  • Question 4 - A patient is being discharged following a termination of pregnancy at 14 weeks....

    Correct

    • 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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      • Clinical Management
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  • Question 5 - According to the NICE guidelines on intrapartum care a multiparous women with intact...

    Incorrect

    • According to the NICE guidelines on intrapartum care a multiparous women with intact membranes should be offered amniotomy if there is inadequate progress of the active second stage of labour (in terms of rotation and/or descent of the presenting part) after how long?

      Your Answer: 2 hours

      Correct Answer: 30 minutes

      Explanation:

      Multiparous women active 2nd stage labour: Suspect delay if progress inadequate after 30 minutes Diagnose delay if progress inadequate after 1 hour If delay is suspected amniotomy should be offered if membranes are intact If delay diagnosed then preparations should be made for C-section Nulliparous women active 2nd stage labour: Suspect delay if progress inadequate after 1 hour Diagnose delay if progress inadequate after 2 hours If delay is suspected amniotomy should be offered if membranes are intact If delay diagnosed then preparations should be made for C-section

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      • Clinical Management
      33.8
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  • Question 6 - A 20 year old patient attends clinic for a medical abortion at 12...

    Incorrect

    • A 20 year old patient attends clinic for a medical abortion at 12 weeks gestation. She has no known drug allergies and her STI screen was negative. What drug should she be prescribed as antibiotic prophylaxis?

      Your Answer: No antibiotics required if STI screen negative

      Correct Answer: Metronidazole 1g PR stat dose

      Explanation:

      According to the Royal College of Obstetrics and Gynaecology guidelines for abortion care it advises dual antibiotic regimes for antibiotic prophylaxis.
      Metronidazole 1g per rectum or 800 mg orally can be given before or at the time of the abortion in women who have tested negative for Chlamydia trachomatis infection.

      Alternatively, Doxycycline (100mg oral, twice daily for 7 days) or Azithromycin 1g stat doses should be given in addition to metronidazole to be effective against Chlamydia trachomatis anaerobes.

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      • Clinical Management
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  • Question 7 - Which of the following fasting plasma glucose (FPG) values for OGTT (Oral glucose...

    Correct

    • Which of the following fasting plasma glucose (FPG) values for OGTT (Oral glucose tolerance test) is diagnostic of gestational diabetes according to the WHO criteria?

      Your Answer: FPG 6.1mmol/L; 2 hour 7.8mmol/L

      Explanation:

      There are several criteria that aid in the diagnosis of gestational diabetes in pregnancy including NICE, WHO and modified WHO:
      GDM Diagnostic Criteria:
      NICE: Immediate FBG >5.6, 2 hour glucose >7.8
      WHO: Immediate FBG >6.1, 2 hour glucose >7.8
      Modified WHO: Immediate FBG >7.1, 2 hour glucose >7.8

      Random glucose and OGTT 2 hour readings of >11.1 are diagnostic of diabetes in non-pregnant states but are not part of the gestational diabetes criteria.

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      • Clinical Management
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  • Question 8 - What is the average volume of blood loss during the menstrual cycle ...

    Incorrect

    • What is the average volume of blood loss during the menstrual cycle

      Your Answer: 150-200ml

      Correct Answer: 35-40ml

      Explanation:

      The average menstrual blood loss is 35-40ml The maximum normal blood loss is 80ml

    • This question is part of the following fields:

      • Clinical Management
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  • Question 9 - A 24 year old lady is 9 weeks pregnant with her first child....

    Correct

    • A 24 year old lady is 9 weeks pregnant with her first child. She attends clinic complaining of severe vomiting and is unable to keep fluids down. The most likely diagnosis is hyperemesis gravidarum. Which of the following is the underlying cause?

      Your Answer: Increased circulating HCG

      Explanation:

      Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy, associated with weight loss of more than 5% of pre-pregnancy weight, dehydration and electrolyte imbalance. HG is usually most severe during the first 12 weeks of pregnancy and is thought to be caused by high circulating levels of HCG.

      There is not yet any evidence that pregnancy itself increases the sensitivity of the area postrema, or that the hormones, oestradiol, or progesterone increase vomiting. Generally, higher concentrations of dopamine stimulates receptors in the chemoreceptor trigger zone leading to nausea and vomiting. Although this has not been demonstrated as the cause of hyperemesis gravidarum.

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      • Clinical Management
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  • Question 10 - Which of the following factors causes the greatest increase in risk of developing...

    Correct

    • Which of the following factors causes the greatest increase in risk of developing bladder cancer?

      Your 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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      • Clinical Management
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  • Question 11 - A 31 year old patient undergoes an elective c-section delivery. You estimate blood...

    Incorrect

    • A 31 year old patient undergoes an elective c-section delivery. You estimate blood loss has reached 1000ml and you suspect uterine atony is the likely cause. Following bimanual uterine compression what pharmacological intervention is advised?

      Your Answer: Misoprostol 1000 micrograms rectally

      Correct Answer: Syntocin 5u by slow intravenous injection

      Explanation:

      Syntocin 5u by slow intravenous injection is the first line pharmacological measurement in this scenario

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      • Clinical Management
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  • Question 12 - A 55 year old patient with a who has tried unsuccessful conservative measures...

    Incorrect

    • A 55 year old patient with a who has tried unsuccessful conservative measures for her overactive bladder, would like to consider Oxybutynin. She wants to know how common dry mouth is as a side effect, as her sister suffered from it on while on the same drug.

      Your Answer: approximately 5 in 100 patients

      Correct Answer: approximately 1 in 10 patients

      Explanation:

      Urinary incontinence can be divided into two main aetiologies, stress incontinence, or overactive bladder. Conservative management include lifestyle interventions, controlling fluid intake, or bladder exercises. If conservative management is no longer efficient, then medications may be indicated. Oxybutynin is an anticholinergic drug used in the treatment of urinary incontinence. As with other anticholinergic drugs, side effects include dry mouth, dry eyes, blurry vision and constipation. About 1 in 10 patients taking Oxybutynin will experience some of these side effects.

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      • Clinical Management
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  • Question 13 - At what gestational age does the luteo-placental shift occur? ...

    Incorrect

    • At what gestational age does the luteo-placental shift occur?

      Your Answer: 18-20 weeks

      Correct Answer: 6-8 weeks

      Explanation:

      Luteo-placental shifts occurs around 6-8 week when the placenta takes over from the corpus luteum as the main producer of oestrogen and progesterone.

    • This question is part of the following fields:

      • Clinical Management
      42.4
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  • Question 14 - Which of the following is a pro-thrombotic agent? ...

    Incorrect

    • Which of the following is a pro-thrombotic agent?

      Your Answer: Protein C

      Correct Answer: Thromboplastin

      Explanation:

      Protein C, protein S, plasminogen and anti thrombin III are all anti thrombotic agents. Thromboplastin is a pro-thrombotic.

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      • Clinical Management
      5.2
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  • Question 15 - You review a 28 year old patient in the fertility clinic. She has...

    Incorrect

    • You review a 28 year old patient in the fertility clinic. She has a diagnosis of PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2. She is a non-smoker. She has been taking Clomiphene and metformin for the past 6 months. What is the next most appropriate treatment?

      Your Answer: Continue current treatment for further 6 months

      Correct Answer: Gonadotrophins

      Explanation:

      Clomiphene shouldn’t be continued for more than 6 months. The second line options are Gonadotrophins or ovarian drilling.

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      • Clinical Management
      16.2
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  • Question 16 - You review a patient who is 34 weeks pregnant. She complains of gradually...

    Correct

    • You review a patient who is 34 weeks pregnant. She complains of gradually worsening itching over the past 6 weeks particularly to the hands and feet which is worse at night. You order some bloods. Which of the following would you normally expect to increase in the 3rd trimester?

      Your Answer: ALP

      Explanation:

      ALP can rise to up to 3 times the normal non-pregnant value in the 3rd trimester. All of the other tests above typically decrease during pregnancy.

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      • Clinical Management
      63.4
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  • Question 17 - In patients with endometriosis what is the infertility rate? ...

    Incorrect

    • In patients with endometriosis what is the infertility rate?

      Your Answer: 10%

      Correct Answer: 40%

      Explanation:

      Around 30-40% of women affected by this condition complain of difficulty in conceiving.

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      • Clinical Management
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  • Question 18 - What percentage of infants will have permanent neurological dysfunction as a result of...

    Incorrect

    • What percentage of infants will have permanent neurological dysfunction as a result of brachial plexus injury secondary to shoulder dystocia?

      Your Answer: 15%

      Correct Answer:

      Explanation:

      Shoulder dystocia occurs when the anterior or posterior fetal shoulder impacts on the maternal symphysis or sacrum and may require additional manevours to release the shoulders after gentle downward traction has failed. The most common injury that can occur, is to the brachial plexus due to lateral flexion of the head during traction. This may cause a neurological disability, Erb’s Palsy ( injury to C5 and C6 of the brachial plexus) in which there is a less than 10% chance that this injury would be permanent.

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      • Clinical Management
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  • Question 19 - What is the half life of Oxytocin? ...

    Incorrect

    • What is the half life of Oxytocin?

      Your Answer: 15 minutes

      Correct Answer: 5 minutes

      Explanation:

      The half-life of Oxytocin is approximately 5 minutes
      The half-life of Misoprostol is approximately 20-40 minutes
      The half-life of Ergometrine is approximately 30-120 minutes

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      • Clinical Management
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  • Question 20 - You see a diabetic women in preconception clinic. Which of the following is...

    Correct

    • You see a diabetic women in preconception clinic. Which of the following is appropriate advice regarding folic acid supplementation?

      Your Answer: 5 mg daily until week 12

      Explanation:

      The aim of pre-pregnancy counselling is to achieve the best possible glycaemic control before pregnancy and to educate diabetic women about the implications of pregnancy. Patient information leaflets about pregnancy should make clear the risks of pregnancy in diabetes, and include advice to take high dose (5 mg) folic acid pre-conception and for the first 12 weeks.

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      • Clinical Management
      10.4
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  • Question 21 - A 36 year old patient is diagnosed with cervical cancer and staging investigations...

    Correct

    • A 36 year old patient is diagnosed with cervical cancer and staging investigations show there is parametrial involvement but it is confined within the pelvic wall and does not involve the lower 1/3 vagina. There is no evidence of hydronephrosis. What FIGO stage is this?

      Your Answer: 2B

      Explanation:

      It is stage 2B. Stage I: is strictly confined to the cervix; extension to the uterine corpus should be disregarded. The diagnosis of both Stages IA1 and IA2 should be based on microscopic examination of removed tissue, preferably a cone, which must include the entire lesion.
      2010 FIGO classification of cervical carcinoma:
      Stage IA: Invasive cancer identified only microscopically. Invasion is limited to measured stromal invasion with a maximum depth of 5 mm and no wider than 7 mm.
      Stage IA1: Measured invasion of the stroma no greater than 3 mm in depth and no wider than 7 mm diameter.
      Stage IA2: Measured invasion of stroma greater than 3 mm but no greater than 5 mm in depth and no wider than 7 mm in diameter.

      Stage IB: Clinical lesions confined to the cervix or preclinical lesions greater than Stage IA. All gross lesions even with superficial invasion are Stage IB cancers.
      Stage IB1: Clinical lesions no greater than 4 cm in size.
      Stage IB2: Clinical lesions greater than 4 cm in size.

      Stage II: carcinoma that extends beyond the cervix, but does not extend into the pelvic wall. The carcinoma involves the vagina, but not as far as the lower third.
      Stage IIA: No obvious parametrial involvement. Involvement of up to the upper two-thirds of the vagina.
      Stage IIB: Obvious parametrial involvement, but not into the pelvic sidewall.

      Stage III: carcinoma that has extended into the pelvic sidewall. On rectal examination, there is no cancer-free space between the tumour and the pelvic sidewall. The tumour involves the lower third of the vagina. All cases with hydronephrosis or a non-functioning kidney are Stage III cancers.
      Stage IIIA: No extension into the pelvic sidewall but involvement of the lower third of the vagina.
      Stage IIIB: Extension into the pelvic sidewall or hydronephrosis or non-functioning kidney.

      Stage IV: carcinoma that has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum.
      Stage IVA: Spread of the tumour into adjacent pelvic organs.
      Stage IVB: Spread to distant organs.

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      • Clinical Management
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  • Question 22 - What is the incidence of hyperthyroidism in complete molar pregnancy? ...

    Incorrect

    • What is the incidence of hyperthyroidism in complete molar pregnancy?

      Your Answer:

      Correct Answer: 3%

      Explanation:

      As B-HCG and TSH have similar structures, increased B-HCG can lead to hyperthyroidism, however there is only a 3% chance of this happening.

    • This question is part of the following fields:

      • Clinical Management
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  • Question 23 - Which of the following hormones inhibits lactogenesis during pregnancy? ...

    Incorrect

    • Which of the following hormones inhibits lactogenesis during pregnancy?

      Your Answer:

      Correct 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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      • Clinical Management
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  • Question 24 - A 24 year old, 16 week pregnant patient presents with vaginal discharge. There...

    Incorrect

    • 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:

      Correct 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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      • Clinical Management
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  • Question 25 - What is the most common cause of sepsis in the puerperium? ...

    Incorrect

    • What is the most common cause of sepsis in the puerperium?

      Your Answer:

      Correct Answer: Endometritis

      Explanation:

      Significant puerperal pyrexia is defined as a temperature of 38ºC or higher on any two of the first 10 days postpartum, exclusive of the first 24 hours. A mixed flora normally colonizes the vagina with low virulence. Puerperal infection is usually polymicrobial and involves contaminants from the bowel that colonize the perineum and lower genital tract. Following delivery, natural barriers to infection are temporarily removed and therefore organisms with a pathogenic potential can ascend from the lower genital tract into the uterine cavity. Placental separation exposes a large raw area equivalent to an open wound, and retained products of conception and blood clots within the uterus can provide an excellent culture medium for infection.

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      • Clinical Management
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  • Question 26 - Which species of candida is the most common cause of genital candida infection...

    Incorrect

    • Which species of candida is the most common cause of genital candida infection in pregnancy?

      Your Answer:

      Correct Answer: Candida albicans

      Explanation:

      Vulvovaginal candidiasis is the most common genital infection and it is caused by candida albicans in 80-92% of the cases. Other non albicans species include C.tropicalis, C.glabrata, C.krusei and C.parapsilosis. 20% of women of childbearing age are asymptotic colonisers of Candida species as part of their normal vaginal flora. This increases to 40% in pregnancy.

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      • Clinical Management
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  • Question 27 - In a patient who undergoes a medical abortion at 10 weeks gestation, what...

    Incorrect

    • In a patient who undergoes a medical abortion at 10 weeks gestation, what advice would you give regarding Rhesus Anti-D Immunoglobulin?

      Your Answer:

      Correct Answer: All RhD-negative women who are not alloimmunized should receive Anti-D IgG

      Explanation:

      The Rhesus status of a mother is important in pregnancy and abortion. The exposure of an Rh-negative mother to Rh antigens from a positive foetus, will influence the development of anti-Rh antibodies. This may cause problems in subsequent pregnancies leading to haemolysis in the newborn. Rh Anti RhD- globulin is therefore given to non-sensitised Rh-negative mothers to prevent the formation of anti-Rh antibodies within 72 hours following abortion. Anti RhD globulin is not useful for already sensitized, or RhD positive mothers.

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      • Clinical Management
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  • Question 28 - A 26 year old patient sustains a 4th degree perineal tear following delivery...

    Incorrect

    • A 26 year old patient sustains a 4th degree perineal tear following delivery of her 1st baby. Your consultant agrees to supervise you repair the tear. From the list below what is the most appropriate suture option for repairing the anal mucosa?

      Your Answer:

      Correct Answer: 3-0 polyglactin interrupted sutures

      Explanation:

      Repair the vaginal mucosa using rapidly absorbed suture material on a large, round body needle. Start above the apex of the cut or tear (as severed vessels retract slightly) and use a continuous stitch to close the vaginal mucosa.

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      • Clinical Management
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  • Question 29 - Regarding menstruation, which of the following is the maximum normal blood loss? ...

    Incorrect

    • Regarding menstruation, which of the following is the maximum normal blood loss?

      Your Answer:

      Correct Answer: 80-85ml

      Explanation:

      Most women lose about 35-40 ml of blood on average during each menstrual cycle. The maximum amount of blood loss is 80 ml after which blood loss of more than 80 ml is defined as heavy menstrual bleeding, formerly known as menorrhagia.

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      • Clinical Management
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  • Question 30 - A 28 year old patient presents to clinic with a maculopapular rash to...

    Incorrect

    • A 28 year old patient presents to clinic with a maculopapular rash to the hands and soles of the feet. Examination reveals wart like lesions on the vagina and a diagnosis of condyloma latum is made. What stage of syphilis infection is this?

      Your Answer:

      Correct Answer: Secondary

      Explanation:

      Condylomas are warty neoplasms of the vulvar area. The most common type are condyloma acuminatum which occur due to HPV 6 or 11. Condyloma latum are also known as secondary syphilis are less common. Both of these are sexually transmitted.

      Stages of Syphilis:
      – Primary 3-90 days
      Chancre and lymphadenopathy
      – Secondary 4-10 weeks
      Widespread rash typically affecting hands and soles of feet.
      Wart lesions (condyloma latum) of mucus membranes
      – Latent Early <1 yr. after secondary stage
      – Late >2 yr. after secondary stage
      Asymptomatic
      – Tertiary 3+ years after primary infection
      Gummas or
      Neurosyphilis or
      Cardiovascular syphilis

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  • Question 31 - A 21 year old patient presents to the clinic with a 48 hour...

    Incorrect

    • A 21 year old patient presents to the clinic with a 48 hour history of unprotected sexual intercourse. She is not on any form of contraception. After discussion you prescribe a dose of Ulipristal 30 mg stat. Which of the following would be the appropriate advice regarding vomiting?

      Your Answer:

      Correct Answer: If vomiting occurs within 3 hours a repeat dose should be taken

      Explanation:

      Ulipristal acetate is a selective progesterone receptor modulator which regulates the luteinizing hormone (LH) surge, preventing ovulation. This emergency contraceptive can be used up to five days after unprotected sexual intercourse and is given as a 30mg oral dose. If vomiting occurs within three hours, then a second tablet is needed to ensure its effects.

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      • Clinical Management
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  • Question 32 - A 38 year old women attends clinic follow up. You note pelvic ultrasound...

    Incorrect

    • 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:

      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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      • Clinical Management
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  • Question 33 - A 24 year old who is 32 weeks pregnant presents with a rash...

    Incorrect

    • A 24 year old who is 32 weeks pregnant presents with a rash to the abdomen. Looking at the picture below what is the diagnosis?

      Your Answer:

      Correct Answer: Polymorphic Eruption of Pregnancy

      Explanation:

      This is Polymorphic Eruption of Pregnancy (PEP) also known as Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP). Papules and plaques form on the abdomen (commonly within striae). It is most common in women during their first pregnancy and typically occurs in the 3rd trimester.

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      • Clinical Management
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  • Question 34 - Regarding pelvic inflammatory disease, which of the following is the tubal factor infertility...

    Incorrect

    • Regarding pelvic inflammatory disease, which of the following is the tubal factor infertility rate?

      Your Answer:

      Correct Answer: 12.50%

      Explanation:

      Pelvic inflammatory disease (PID) is a known risk factor in causing tubal infertility due to its role in tubal damage. The tubal infertility rate after one episode of PID is thought to be about 12.5%. After two episodes the risk increases to 25%, and 50% after three episodes. The usual causative agents are chlamydia and gonorrhoea.

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      • Clinical Management
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  • Question 35 - Ovarian cancer is associated with which type of metastasis? ...

    Incorrect

    • Ovarian cancer is associated with which type of metastasis?

      Your Answer:

      Correct Answer: Transcoelomic

      Explanation:

      The common route of metastases of the ovarian cancer is transcoelomic route.

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      • Clinical Management
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  • Question 36 - Endometrial tissue found within the myometrium is classed as ...

    Incorrect

    • Endometrial tissue found within the myometrium is classed as

      Your Answer:

      Correct Answer: Adenomyosis

      Explanation:

      Endometrial tissue found within the myometrium is Adenomyosis. If endometrial tissue is found at a distant site to the uterus it is termed endometriosis. Fibroids are smooth muscle tumours (Leiomyoma’s) sometimes called myoma’s.

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  • Question 37 - A patient has had limited response to conservative measures for her overactive bladder...

    Incorrect

    • A patient has had limited response to conservative measures for her overactive bladder (OAB). Which of the following is the most appropriate pharmacological choice?

      Your Answer:

      Correct Answer: Darifenacin

      Explanation:

      Detrusor overactivity can be treated with anti-cholinergic agents such as oxybutynin or tolterodine, solifenacin, fesoterodine and darifenacin. They are used as first line agents. Imipramine is used for enuresis and desmopressin is used for nocturia.
      NICE pathway

      Prior to initiating anticholinergics:
      Bladder training
      Consider treating vaginal atrophy and nocturia with topical oestrogen and desmopressin respectively before commencing treatments below.
      Consider catheterisation if chronic retention
      1st line treatments:
      1. Oxybutynin (immediate release) – Do not offer to frail elderly patients
      2. Tolterodine (immediate release)
      3. Darifenacin (once daily preparation)
      DO NOT offer any of the 3 drugs below:
      1. Flavoxate
      2. Propantheline
      3. Imipramine
      2nd line treatment
      Consider transdermal anticholinergic (antimuscarinic)
      Mirabegron
      Adjuvant Treatments
      Desmopressin can be considered for those with nocturia
      Duloxetine may be considered for those who don’t want/unsuitable for surgical treatment
      Intravaginal oestrogen can be offered to postmenopausal women with OAB

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      • Clinical Management
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  • Question 38 - Regarding urinary tract infection (UTI) in pregnancy. What is the most common causative...

    Incorrect

    • Regarding urinary tract infection (UTI) in pregnancy. What is the most common causative organism of urinary tract infection?

      Your Answer:

      Correct 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:

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  • Question 39 - Which of the following is regarded as the current Gold standard in the...

    Incorrect

    • Which of the following is regarded as the current Gold standard in the diagnosis of Polycystic Ovary Syndrome?

      Your Answer:

      Correct Answer: Rotterdam

      Explanation:

      The Rotterdam criteria was developed and expanded by the European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine Rotterdam consensus (ESHRE/ASRM) in 2003 and is now the Gold standard in the diagnosis of PCOS. The criteria requires two of three features: anovulation, hyperandrogenism, and polycystic ovaries seen on ultrasound.

      The National Institute of Child Health and Human Development (NICHD) attempted to define PCOS in 1990 but omitted ultrasonographic evidence of polycystic ovaries which is considered to be diagnostic of PCOS.

      The Androgen Excess Society (AES) served to confirm hyperandrogenism as the central event in the development of PCOS.

      The ROME III criteria is used for Irritable Bowel Disease and is therefore not applicable to PCOS.

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  • Question 40 - A 37 year old lady attends clinic following laparotomy and unilateral oophorectomy. The...

    Incorrect

    • A 37 year old lady attends clinic following laparotomy and unilateral oophorectomy. The histology shows mucin vacuoles. What type of tumour would this be consistent with?

      Your Answer:

      Correct Answer: Mucinous

      Explanation:

      Mucinous tumours are cystic masses which are indistinguishable from the serous tumours on gross examination except by its contents. On histology it is lined with mucin producing epithelium – mucin vacuoles whereas serous tumours have psammoma bodies. Malignant tumours are characterised by the presence of architectural complexity, cellular stratification, stromal invasion and cytological atypia.

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  • Question 41 - A 28 year old woman presents for a scan at 13 weeks. Though...

    Incorrect

    • A 28 year old woman presents for a scan at 13 weeks. Though this is her second pregnancy, the first ended in a 1st trimester miscarriage. She has not reported any problems with the current pregnancy. The ultrasound scan showed a small gestational sac and no fetal cardiac activity. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Missed Miscarriage

      Explanation:

      A miscarriage is defined as the spontaneous loss of a pregnancy before the age of viability at 24 weeks in the UK.

      A missed miscarriage is described as a loss of pregnancy without vaginal bleeding, loss of tissue, cervical changes or abdominal pain. During a scan, a fetal heartbeat is not observed, and the gestational sac may be small.

      A threatened miscarriage is when the cervix dilates and uterine bleeding is seen; the pregnancy could still be viable. A complete miscarriage occurs when all the products of conception are expelled from the uterus, bleeding has stopped, and the cervix has closed up after dilation.

      An inevitable miscarriage occurs with the usual symptoms of a miscarriage and a dilated cervix, suggesting that the passage of the fetal tissue is inevitable.

      Recurrent miscarriages are described as spontaneous pregnancy loss of more than 2 to 3 consecutive times.

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  • Question 42 - A 36 year old patient is seen in clinic for follow up of...

    Incorrect

    • A 36 year old patient is seen in clinic for follow up of a vaginal biopsy which confirms cancer. What is the most common type?

      Your Answer:

      Correct Answer: Squamous cell carcinoma

      Explanation:

      Squamous cell carcinoma is the most common type of vaginal cancer.

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      • Clinical Management
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  • Question 43 - A 56 year old lady presents with a vulval itch and discolouration. A...

    Incorrect

    • 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:

      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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  • Question 44 - Oxytocin binds to what receptor type? ...

    Incorrect

    • Oxytocin binds to what receptor type?

      Your Answer:

      Correct Answer: G-protein-coupled receptors

      Explanation:

      Oxytocin binds to the G protein coupled receptors that triggers the IP3 mechanism leading to an elevated intracellular calcium ion.

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      • Clinical Management
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  • Question 45 - Which of the following uterotonic drugs is most strongly associated with a transient...

    Incorrect

    • Which of the following uterotonic drugs is most strongly associated with a transient pyrexia occurring within 45 minutes of administration?

      Your Answer:

      Correct Answer: Dinoprostone

      Explanation:

      Dinoprostone is associated with a transient pyrexia. This typically normalises within 4 hours of stopping treatment

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  • Question 46 - At what week in pregnancy is testing for gestational diabetes (GD) advised ...

    Incorrect

    • At what week in pregnancy is testing for gestational diabetes (GD) advised

      Your Answer:

      Correct Answer: As soon as possible after booking if past history of GD

      Explanation:

      Gestational diabetes (GDM) occurs in 2–9 per cent of all pregnancies. Screening for diabetes in pregnancy can be justified to diagnose previously unrecognized cases of pre-existing diabetes and to identify a group of women who are at risk of developing NIDDM later in life. No single screening test has been shown to be perfect in terms of high sensitivity and specificity for gestational diabetes. Urinary glucose is unreliable, and most screening tests now rely on blood glucose estimation, with an oral glucose tolerance test commonly used. The aim of glucose control is to keep fasting levels between 3.5 and 5.5 mmol/L and postprandial levels 7.1 mmol/L, with insulin treatment usually indicated outside these ranges. The women should be tested as soon as possible after booking if there is a history of GD.

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  • Question 47 - Regarding gestational diabetes which of the following statements is TRUE? ...

    Incorrect

    • Regarding gestational diabetes which of the following statements is TRUE?

      Your Answer:

      Correct Answer: it occurs in 2-5% of pregnancies

      Explanation:

      Gestational Diabetes occurs in 2-9% of all the pregnancies.

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      • Clinical Management
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  • Question 48 - You are called to see a 24 year old patient in A&E. She...

    Incorrect

    • You are called to see a 24 year old patient in A&E. She is 34 weeks gestation and her blood pressure is 147/96. Automated reagent strip testing shows protein 2+. You send for a protein:creatinine ratio and this shows a ratio of 36 mg/mmol. What is the appropriate course of action?

      Your Answer:

      Correct Answer: Admit for observation

      Explanation:

      It is important to be aware of the difference between management of simple hypertension and pre-eclampsia in pregnancy. A BP of 140/90 to 149/99 mmHg is classed as mild hypertension. Without proteinuria this can be monitored once weekly and the patient can be discharged. If proteinuria is present with any degree of hypertension the patient requires admission and BP should be monitored at least 4 times daily according to NICE guidance.

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  • Question 49 - A 70 year old patient is being reviewed in clinic for post menopausal...

    Incorrect

    • A 70 year old patient is being reviewed in clinic for post menopausal bleeding. Examination reveals a lesion of the vaginal wall. Which is the most common type of primary vaginal cancer?

      Your Answer:

      Correct Answer: Squamous cell carcinoma

      Explanation:

      The vaginal epithelium is made of squamous cells. Hence the most common carcinoma that occurs in the Vagina is squamous cell carcinoma. Diagnosis is made with vaginal biopsy. Usually the pain only presents if the disease extends beyond the vagina involving the perineal nerves.

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  • Question 50 - A 30 year old women who is 24 weeks pregnant attends EPU due...

    Incorrect

    • 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:

      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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  • Question 51 - Regarding Venous Thromboembolism (VTE) in pregnancy which of the following statements is TRUE?...

    Incorrect

    • Regarding Venous Thromboembolism (VTE) in pregnancy which of the following statements is TRUE?

      Your Answer:

      Correct Answer: Relative risk of VTE in pregnancy is 4 to 6 fold

      Explanation:

      Venous thromboembolic disease (VTE) is the most common cause of direct maternal death in the UK. In the most recent triennium, there were 41 fatalities, giving a maternal mortality rate of 1.94 per 100 000 – more than twice that of the next most common cause, pre-eclampsia. As pregnancy is a hyper coagulable state. There are alterations in the fibrinolytics and thrombotic pathways. There is also an increased production of clotting factors during pregnancy.

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  • Question 52 - A patient attends the maternity unit as her waters have broken but she...

    Incorrect

    • A patient attends the maternity unit as her waters have broken but she hasn't had contractions. She is 39+6 weeks gestation. Speculum examination confirms prelabour rupture of membranes (PROM). According to NICE guidelines after what time period should induction be offered?

      Your Answer:

      Correct Answer: 24 hours

      Explanation:

      Induction of labour is appropriate approximately 24 hours after rupture of the membranes.

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  • Question 53 - A 27 year old women presents with a history of vaginal spotting and...

    Incorrect

    • A 27 year old women presents with a history of vaginal spotting and cramping abdominal pain. She has an 8 week history of amenorrhoea. On examination urine pregnancy test is positive and the cervix is closed. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Threatened Miscarriage

      Explanation:

      Miscarriage is a pregnancy that ends spontaneously before the foetus reaches the age of viability i.e. before 24 weeks of gestation. In a threatened miscarriage the USG findings are of a foetus present in the uterus and on speculum examination the cervical OS is closed, in an inevitable miscarriage the cervical OS is opened. In an incomplete miscarriage the uterus contains the retained products of conception and the cervical OS is open. complete miscarriage contains no retained products of conception and the cervix is closed as the bleeding as resolved.

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  • Question 54 - You are consenting a patient for a diagnostic hysteroscopy. What is the approximate...

    Incorrect

    • You are consenting a patient for a diagnostic hysteroscopy. What is the approximate risk of uterine perforation in diagnostic hysteroscopy?

      Your Answer:

      Correct Answer: 0.10%

      Explanation:

      The risk of uterine perforation is 0.1% during therapeutic hysteroscopy.

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  • Question 55 - A 67 year old patient with endometrial carcinoma is to undergo staging investigations....

    Incorrect

    • A 67 year old patient with endometrial carcinoma is to undergo staging investigations. There is evidence of invasion into the vaginal wall, but the lymph nodes are spared, and there is no distant metastasis. According to FIGO, what stage is this?

      Your Answer:

      Correct Answer: 3B

      Explanation:

      Endometrial cancer is one of the most common gynaecological malignancies present in postmenopausal women, with a peak incidence between the ages of 60-89. Factors associated with endometrial cancer include obesity, hypertension and diabetes. Full staging for endometrial cancer is surgical, including several other radiologic investigations. According to FIGO staging classifications:
      Stage 1 indicates a tumour confined to the uterine body
      Stage 2 indicates the invasion of the cervical stroma
      Stage 3 indicates local and regional spread, where the tumour invades the serosa in stage 3A, spreads to the vagina and parametrium in stage 3B, and metastasizes to the pelvic or para-aortic lymph nodes in stage 3C.
      Stage 4 indicates tumour invasion on the bladder or bowel mucosa, or distant metastasis.

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  • Question 56 - A 77 year old woman undergoes staging investigations for endometrial carcinoma. This shows...

    Incorrect

    • A 77 year old woman undergoes staging investigations for endometrial carcinoma. This shows invasion of the inguinal lymph nodes. What is this patients 5-year survival?

      Your Answer:

      Correct Answer: 15%

      Explanation:

      Lymph node involvement means that the carcinoma is stage 4. The 5 year survival of stage 4 endometrial carcinoma is 16%.

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      • Clinical Management
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  • Question 57 - Regarding the diagnosis of Gestational Diabetes which of the following tests is recommended...

    Incorrect

    • Regarding the diagnosis of Gestational Diabetes which of the following tests is recommended by the WHO for diagnosis?

      Your Answer:

      Correct Answer: 75g OGTT with 2 hour glucose

      Explanation:

      Gestational diabetes (GDM) occurs in 2–9 per cent of all pregnancies. Screening for diabetes in pregnancy can be justify ed to diagnose previously unrecognized cases of pre-existing diabetes and to identify a group of women who are at risk of developing NIDDM later in life. No single screening test has been shown to be perfect in terms of high sensitivity and specific city for gestational diabetes. Urinary glucose is unreliable, and most screening tests now rely on blood glucose estimation, with an oral 75g glucose tolerance test commonly used. The aim of glucose control is to keep fasting levels between 3.5 and 5.5 mmol/L and postprandial levels 7.1 mmol/L, with insulin treatment usually indicated outside these ranges.

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  • Question 58 - A 19 year old patient on Lamotrigine 125 mg twice a day for...

    Incorrect

    • A 19 year old patient on Lamotrigine 125 mg twice a day for the past two years has recently been prescribed Microgynon 30 as a contraceptive before she leaves for Uni. What could the main concern be?

      Your Answer:

      Correct Answer: Combined contraceptive may reduce Lamotrigine levels and increase seizure risk

      Explanation:

      Lamotrigine, a drug used to treat epilepsy, is less effective when taken with combined oral contraceptives. The oestrogen component of the pill decreases the circulating levels of Lamotrigine, increasing the risk of seizures. The combination is therefore classified as a UKMEC 3, as the risk of the drug combination may outweigh the benefit. As an alternative, the progesterone-only pill, depo progesterone, Mirena or the copper IUD may be considered as there is no restriction on concomitant use. Lamotrigine is not metabolised through cytochrome P450 like other antiepileptic drugs such as carbamazepine and phenytoin, neither is it an enzyme inhibitor.

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  • Question 59 - An HIV positive woman who is 18 weeks pregnant complains of frothy yellow...

    Incorrect

    • An HIV positive woman who is 18 weeks pregnant complains of frothy yellow vaginal discharge and vaginal soreness. A wet mount and microscopy confirms a Trichomonas vaginalis infection. Which of the following is the most appropriate treatment regime?

      Your Answer:

      Correct Answer: Metronidazole 500mg BD 7 days

      Explanation:

      Trichomoniasis is considered a sexually transmitted infection found both in men and women caused by the flagellate protozoan Trichomonas vaginalis. The organism is mainly found in the vagina and the urethra. Though many infected women can be asymptomatic, they can also present with yellow frothy vaginal discharge, itching and vaginitis, dysuria or an offensive odour. For the diagnosis of t. vaginalis in women, a swab is taken from the posterior fornix during speculum examination and the flagellates are detected under light-field microscopy. The recommended treatment for t. vaginalis for a HIV positive woman who is pregnant is 500mg of metronidazole twice daily for 7 days. High dose metronidazole as a 2g single dose tablet is not advised during pregnancy. All sexual partners should also be treated, and screening for other STIs should be carried out.

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  • Question 60 - Which of the following hormones inhibits Galactopoiesis and Lactogenesis postpartum? ...

    Incorrect

    • Which of the following hormones inhibits Galactopoiesis and Lactogenesis postpartum?

      Your Answer:

      Correct Answer: Dopamine

      Explanation:

      Galactopoiesis and Lactogenesis are stimulated by Prolactin. Dopamine released under hypothalamic control inhibits Prolactin production. Note oestrogen and progesterone inhibit lactogenesis up until term.

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  • Question 61 - Renal cell carcinoma is associated with which type of metastasis? ...

    Incorrect

    • Renal cell carcinoma is associated with which type of metastasis?

      Your Answer:

      Correct Answer: Haematogenous

      Explanation:

      Most carcinomas spread primarily via lymphatic invasion. Renal cell is the exception spreading via the bloodstream.

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  • Question 62 - A 28 year old patient has a diagnosis of PCOS. She has been...

    Incorrect

    • A 28 year old patient has a diagnosis of PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2 and she is a non-smoker. She has been taking Clomiphene and metformin for the past 6 months. What is the next most appropriate treatment?

      Your Answer:

      Correct Answer: Gonadotrophins

      Explanation:

      Management of PCOS includes OCP, cyclical oral progesterone, metformin, clomiphene (which is more effective in inducing ovulation than metformin) and life-style changes. In women who are tolerant to these therapies Gonadotrophins should be trialled. However lifestyle changes should be able to improve the condition significantly. Clomiphene shouldn’t be continued for more than 6 months.

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  • Question 63 - You are called to see a 24 year old patient in A&E. She...

    Incorrect

    • You are called to see a 24 year old patient in A&E. She is 34 weeks gestation and her blood pressure is 149/98. Urine dip shows protein 3+. You send a for a protein:creatinine ratio. What level would be diagnostic of significant proteinuria?

      Your Answer:

      Correct Answer: >30 mg/mmol

      Explanation:

      Significant proteinuria = urinary protein:creatinine ratio >30 mg/mmol or 24-hour urine collection result shows greater than 300 mg protein

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  • Question 64 - You are reviewing a patient with a scan suggestive of partial molar pregnancy....

    Incorrect

    • You are reviewing a patient with a scan suggestive of partial molar pregnancy. What is the typical genotype of a partial molar pregnancy?

      Your Answer:

      Correct Answer: 69 XXY

      Explanation:

      The partial mole is produced when an egg is fertilized by two sperm producing genotype 69 XXY (triploid). It can also occur when one sperm reduplicates itself yielding the genotypes 92 XXXY (tetraploid) though this is less common The genotype of a complete mole is typically 46 XX (diploid) but can also be 46 XY (diploid)

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  • Question 65 - Following parturition uterine contractions called Afterpains may typically continue for how long? ...

    Incorrect

    • Following parturition uterine contractions called Afterpains may typically continue for how long?

      Your Answer:

      Correct Answer: None of the above

      Explanation:

      Afterpains may continue for 2-3 days (so none of the above). Breastfeeding may intensify pain due to stimulation of Oxytocin which causes uterine contractions

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  • Question 66 - A 24 year old female patient undergoes an STI screen due to development...

    Incorrect

    • A 24 year old female patient undergoes an STI screen due to development of dysuria 5 days earlier. The results are positive for chlamydia infection. With regard to contact tracing what is the recommended action regarding tracing and informing sexual partners in this case?

      Your Answer:

      Correct Answer: All sexual partners past 6 months

      Explanation:

      In case a person tests positive for chlamydia, all sexual partners over the period of 6 months should to contacted and started on appropriate antibiotics.

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  • Question 67 - A 34 week pregnant patient complains of itching over the past 6 weeks...

    Incorrect

    • A 34 week pregnant patient complains of itching over the past 6 weeks particularly to the hands and feet which is worse at night. You order some blood tests. Which of the following would you normally expect to increase in the 3rd trimester?

      Your Answer:

      Correct Answer: ALP

      Explanation:

      Pruritus of pregnancy is a common disorder, which occurs in 1 in 300 pregnancies, and presents as excoriated papules on extensor limbs, abdomen
      and shoulders. It is more common in women with a history of atopy. Prurigo usually starts at around 25–30 weeks of pregnancy and resolves after delivery,
      with no effect on the mother or baby. Treatment is symptomatic with topical steroids and emollients. It occurs due to derangement in the LFTs. ALP can rise to up to 3 times the normal non-pregnant value in the 3rd trimester.
      All of the other tests above typically decrease during pregnancy.

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  • Question 68 - Which of the following are required for Oxytocin to bind to its receptor?...

    Incorrect

    • Which of the following are required for Oxytocin to bind to its receptor?

      Your Answer:

      Correct Answer: Magnesium and Cholesterol

      Explanation:

      Oxytocin binds to G-protein-coupled receptors and requires Magnesium and cholesterol for this process to occur.

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  • Question 69 - A 34 weeks pregnant patient has a blood pressure of 149/98. Urine dipstick...

    Incorrect

    • A 34 weeks pregnant patient has a blood pressure of 149/98. Urine dipstick shows protein 3+. You send a for a protein:creatinine ratio. What level would be diagnostic of significant proteinuria?

      Your Answer:

      Correct Answer: >30 mg/mmol

      Explanation:

      Pre-eclampsia is defined as hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hour collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the sixth postpartum week. Significant proteinuria = urinary protein: creatinine ratio >30 mg/mmol or 24-hour urine collection result shows greater than 300 mg protein.

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  • Question 70 - Which of the following contraceptives primary mode of action is inhibition of ovulation?...

    Incorrect

    • Which of the following contraceptives primary mode of action is inhibition of ovulation?

      Your Answer:

      Correct Answer: Cerazette®

      Explanation:

      Traditional POP main mode of contraceptive action: thickening of cervical mucus Desogestrel-only POP main mode of contraceptive action is inhibition of ovulation Cerazette® is the only Desogestrel-only POP in the options above. Other desogestrel brands include: Aizea® Cerelle® Nacrez® The other POPs listed are considered traditional POPs and have the following compositions: Norgeston® – Levonorgestrel 30 mcg Micronor® & Noriday® – Norethisterone 350 mcg Femulen® – Ethynediol diacetate 500 mcg

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  • Question 71 - Ulipristal is thought to prevent pregnancy by what primary mechanism? ...

    Incorrect

    • Ulipristal is thought to prevent pregnancy by what primary mechanism?

      Your Answer:

      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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      • Clinical Management
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  • Question 72 - A 16 year old girl has been referred as she has amenorrhoea. She...

    Incorrect

    • A 16 year old girl has been referred as she has amenorrhoea. She reports never having periods. Her mother and 2 sisters menarche was at age 12. On examination you note the patient is 152cm tall and BMI 29.0 and secondary sexual characteristics are not developed. Her FSH is elevated. Prolactin is normal. What is the suspected diagnosis?

      Your Answer:

      Correct Answer: Turner Syndrome

      Explanation:

      Turner syndrome is the most common chromosomal abnormality in females occurring in 1 in 2500 live births. It is characterised by short stature, webbed neck and wide carrying angle. It is also associated with renal, endocrine and CVS abnormalities. In this condition the ovaries do not completely develop and do not produce oestrogen or oocytes, thus no secondary sexual characteristic develop and neither does the girl starts menstruating.

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  • Question 73 - What percentage of cervical cancers are HPV related? ...

    Incorrect

    • What percentage of cervical cancers are HPV related?

      Your Answer:

      Correct Answer: 99.70%

      Explanation:

      99.7% of cervical cancers among women are related to Human Papilloma virus infection (HPV).

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  • Question 74 - Syphilis is caused by which one of the following organisms? ...

    Incorrect

    • Syphilis is caused by which one of the following organisms?

      Your Answer:

      Correct Answer: Treponema Pallidum

      Explanation:

      Syphilis is a sexually transmitted disease which is caused by spirochete called treponema pallidum. It can be divided into three stages. i.e. primary, secondary and tertiary syphilis.
      – Primary syphilis is characterized by chancre formation at the site of sexual contact.
      – Secondary syphilis ranges from maculopapular lesions to scaly lesions, inguinal lymphadenopathy, condylomata lata and split papules at the corner of mouth.
      – Tertiary syphilis is the late stage of syphilis which is characterized by gummas formation and general paresis along with signs and symptoms of visceral involvement.

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  • Question 75 - A 28 year old women presents at 30 weeks complaining of intense itching...

    Incorrect

    • A 28 year old women presents at 30 weeks complaining of intense itching particularly on the hands and feet that is worse in the evenings. She has taken cetirizine but this hasn't settled her symptoms. Examination is unremarkable with no rash. What is the likely diagnosis

      Your Answer:

      Correct Answer: Intrahepatic Cholestasis of Pregnancy

      Explanation:

      The history is typical of Intrahepatic Cholestasis of Pregnancy, also known as obstetric cholestasis and prurigo gravidarum. The features are: Intense itching typically of the hands and feet Itch gets worse at night Responds poorly to antihistamines There is no rash. The mechanism is poorly understood but tests may show deranged LFTs. It usually resolves quickly after delivery. The other diagnoses listed are possible though less likely. Scabies normally has a rash

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  • Question 76 - Which hormone is responsible for contraction of myoepithelial cells in lactation? ...

    Incorrect

    • Which hormone is responsible for contraction of myoepithelial cells in lactation?

      Your Answer:

      Correct Answer: Oxytocin

      Explanation:

      Oxytocin is responsible for the let down mechanism that occurs during breast feeding in which the myothelial cells contract and push the milk into the ductules.

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  • Question 77 - During pregnancy which hormone(s) inhibit lactogenesis? ...

    Incorrect

    • During pregnancy which hormone(s) inhibit lactogenesis?

      Your Answer:

      Correct Answer: Oestrogen and Progesterone

      Explanation:

      Prolactin levels rise steadily during pregnancy during which time it promotes mammary growth (along with the other hormones mentioned below). Oestrogen and progesterone inhibit lactogenesis and it is only with the loss of these placental steroid hormones at term that Prolactin exhibits its lactogenic effect.

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  • Question 78 - Which of the following drugs is most associated with coronary artery spasm? ...

    Incorrect

    • Which of the following drugs is most associated with coronary artery spasm?

      Your Answer:

      Correct Answer: Ergometrine

      Explanation:

      Ergot alkaloids e.g. Ergometrine, produce marked and prolonged alpha receptor mediated vasoconstriction. Its overdose can cause ischemia and gangrene of the limbs and bowel. It also causes coronary artery spasm and has been used by cardiologist as a provocation test.

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  • Question 79 - You are attending the labour of a patient who has had a prolonged...

    Incorrect

    • You are attending the labour of a patient who has had a prolonged 1st stage of labour. You note the fetal head start to retract after being tightly applied to the vulva (turtle-neck sign). What is the next most appropriate management step?

      Your Answer:

      Correct Answer: McRoberts' manoeuvre

      Explanation:

      Signs of shoulder dystocia:
      – Difficulty with delivery of the face and chin
      – The head remaining tightly applied to the vulva or even retracting (turtle-neck sign)
      – Failure of restitution of the fetal head
      – Failure of the shoulders to descend
      Upon identifying shoulder dystocia additional help should be called and McRoberts manoeuvre (flexion and abduction of the maternal hips, positioning the maternal thighs on her abdomen) should be performed first. Fundal pressure is associated with uterine rupture and should not be used.

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  • Question 80 - Amongst women with a diagnosis of Gonorrhoea, what percentage will develop pelvic inflammatory...

    Incorrect

    • Amongst women with a diagnosis of Gonorrhoea, what percentage will develop pelvic inflammatory disease?

      Your Answer:

      Correct Answer: 15%

      Explanation:

      Gonorrhoea is a sexually transmitted diplococcus bacteria known to infect the female genital tract, which can cause an ascending infection in the uterus and fallopian tubes. About 15 percent of women with this infection may develop pelvic inflammatory disease (PID), which poses risks of long term consequences: ectopic pregnancy, infertility and chronic pelvic pain.

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  • Question 81 - Stages of labour ...

    Incorrect

    • Stages of labour

      Your Answer:

      Correct Answer: The third stage ends with the delivery of the placenta and membranes

      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 in a British journal was 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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  • Question 82 - Hypemesis gravidarum occurs in what percentage of pregnancies? ...

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    • Hypemesis gravidarum occurs in what percentage of pregnancies?

      Your Answer:

      Correct Answer: 1.50%

      Explanation:

      Nausea and vomiting experienced in 80% of pregnancies Hyperemesis gravidarum (HG) is an extreme form of nausea and vomiting which affects around 1.5% of women. Caused by high levels HCG. Definitions vary but most consider it to be defined by severe nausea and vomiting associated with weight loss greater than 5% of pre-pregnancy weight with metabolic disturbance (typically dehydration and/or ketosis).

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  • Question 83 - What is the male infertility rate in CF patients? ...

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    • What is the male infertility rate in CF patients?

      Your Answer:

      Correct Answer: 98%

      Explanation:

      Cystic fibrosis is the most common fetal genetic disease in Caucasians and has an autosomal recessive inheritance. It is caused by an abnormal chloride channel due to a defect in the CFTR gene. Complications range from haemoptysis, respiratory failure, biliary cirrhosis, diabetes and male infertility. Men with CF are infertile in 98% of the cases due to failure of development of the vas deference.

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  • Question 84 - Which of the following tests for the detection of chlamydia is considered the...

    Incorrect

    • Which of the following tests for the detection of chlamydia is considered the gold standard?

      Your Answer:

      Correct Answer: Nucleic Acid Amplification Test

      Explanation:

      Chlamydia is one of the most prevalent STIs in the UK. Many infected individuals can be asymptomatic making it difficult to detect. The gold standard in the diagnosis of Chlamydia is the nucleic acid amplification test (NAAT). A sample is taken from a vulvovaginal self swab, or a cervical swab on speculum examination in women.

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  • Question 85 - A patients MSU comes back showing heavy growth of E.coli that is resistant...

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    • A patients MSU comes back showing heavy growth of E.coli that is resistant to trimethoprim, amoxicillin and nitrofurantoin. You decide to prescribe a course of Cephalexin. What is the mechanism of action of Cephalexin?

      Your Answer:

      Correct Answer: inhibit peptidoglycan cross-links in bacterial cell wall

      Explanation:

      Cephalosporins are beta lactum drugs, like penicillin. They act by inhibiting the cross linkage of the peptidoglycan wall in bacteria.

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  • Question 86 - A 24 week pregnant patient complains of itching over the past 6 weeks...

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    • A 24 week pregnant patient complains of itching over the past 6 weeks particularly to the hands and feet which is worse at night. She has taken cetirizine but this hasn't settled her symptoms. Examination is unremarkable with no rash. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Intrahepatic Cholestasis of Pregnancy

      Explanation:

      The history is typical of Intrahepatic Cholestasis of Pregnancy, also known as obstetric cholestasis and prurigo gravidarum. It is characterised by itching without rash and abnormal LFTs beyond normal pregnancy ranges. Itching affects around 23% of pregnancies and can occur before biochemical changes.

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  • Question 87 - Regarding uterine fibroids, which of the following statements is false? ...

    Incorrect

    • Regarding uterine fibroids, which of the following statements is false?

      Your Answer:

      Correct Answer: The risk of fibroids is increased by pregnancy

      Explanation:

      Fibroids are a common gynaecological condition found in many women above the age of 35. They are however uncommon before puberty. They are most common in black women vs white women, and its prevalence increases from puberty to menopause. Risk factors for fibroids include increasing age, obesity and infertility. Protective factors, on the other hand, include pregnancy, as the risk of fibroids decreases with increasing numbers of pregnancies.

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  • Question 88 - Which one of the following has the most significant effect on slowing drug...

    Incorrect

    • Which one of the following has the most significant effect on slowing drug metabolism in pregnancy?

      Your Answer:

      Correct Answer: Progesterone effect on gastric motility

      Explanation:

      Progesterone down regulates gastric motility meaning drugs are absorbed and metabolised more slowly, thus drugs are absorbed, metabolised and cleared more slowly. Most of the drugs are transported after binding to the albumin.
      Lower albumin levels mean a greater unbound drug fraction but as this may be thought to increase drug concentrations it actually leaves more available for hepatic clearance or renal excretion so overall drug concentrations are unchanged and metabolism increased.
      Increase in hepatic flow will increase the metabolism of the drug as the drug will be transported faster.
      Increased renal blood flow will result in the faster clearance of the drug from the body.

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  • Question 89 - What is the most common Type II congenital thrombophilia? ...

    Incorrect

    • What is the most common Type II congenital thrombophilia?

      Your Answer:

      Correct Answer: Factor V Leiden mutation

      Explanation:

      Factor V Leiden is the most common congenital thrombophilia. Named after the Dutch city Leiden where it was first discovered. Protein C and S deficiencies are type 1 (Not type 2) thrombophilias Antiphospholipid syndrome is an acquired (NOT congenital) thrombophilia

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  • Question 90 - Which vitamin deficiency leads to Wernicke's encephalopathy? ...

    Incorrect

    • Which vitamin deficiency leads to Wernicke's encephalopathy?

      Your Answer:

      Correct Answer: B1

      Explanation:

      Vitamin B1 deficiency can lead to Wernicke’s encephalopathy. Alcoholics are at particular risk. In obstetrics all women with hyperemesis gravidarum should receive thiamine supplementation to prevent Wernicke’s.

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  • Question 91 - Which of the following conditions is associated with blunt trauma in a pregnant...

    Incorrect

    • Which of the following conditions is associated with blunt trauma in a pregnant woman?

      Your Answer:

      Correct Answer: Abruptio placentae

      Explanation:

      Abruptio placentae, defined as a premature separation of the placenta from the uterine wall, is commonly seen with blunt abdominal trauma and can cause fetal distress. It occurs in 1% to 3% of pregnant women with minor trauma and in 40% to 50% with major life-threatening trauma.8,9 Abruption may present with vaginal bleeding, abdominal pain and tenderness, uterine contractions, or fetal distress; however, it may be occult with no vaginal bleeding in up to 20% of cases.

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  • Question 92 - A 26 year old patient with a past medical history of 2 terminations...

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    • A 26 year old patient with a past medical history of 2 terminations of pregnancies over the past 2 years, presents to the emergency centre complaining of severe abdominal pain and some vaginal bleeding. She has a regular 28 day cycle, and is on an oral contraceptive pill, but missed last month's period. Her last termination was over 6 months ago. She smokes almost a pack of cigarettes a day. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Ectopic pregnancy

      Explanation:

      The clinical picture demonstrated is most likely that of a ruptured ectopic pregnancy. The period of amenorrhea may point to pregnancy, while the past medical history of 2 recent terminations of pregnancy may indicate a failure of her current contraceptive method. Smoking cigarettes have been shown to not only decrease the efficacy of OCPs, but also serve as a known risk factor for ectopic pregnancy. The lady is unlikely to have endometritis as her last termination was over 6 months ago. The lack of fever helps to make appendicitis, PID and pyelonephritis less likely, though they are still possible.

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  • Question 93 - Premature menopause is defined as cessation of menses before the age of: ...

    Incorrect

    • Premature menopause is defined as cessation of menses before the age of:

      Your Answer:

      Correct Answer: 40

      Explanation:

      Premature menopause occurs if menopause happens before the age of 40. It effects 1% of women under the age of 40 and 0.1% under 30.

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  • Question 94 - You review a patient in the fertility clinic. The ultrasound and biochemical profile...

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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. You plan to initiate Clomiphene. According to NICE guidance how long should treatment continue for (assuming patient remains non-pregnant)?

      Your Answer:

      Correct Answer: 6 months

      Explanation:

      Treatment with Clomiphene should not exceed 6 months.

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  • Question 95 - A 24 year old patient in A&E is 34 weeks pregnant and her...

    Incorrect

    • A 24 year old patient in A&E is 34 weeks pregnant and her blood pressure is 147/96. Dipstick shows protein 2+. You send for a protein:creatinine ratio and this shows a ratio of 36 mg/mmol. What is the appropriate course of action?

      Your Answer:

      Correct Answer: Admit for observation

      Explanation:

      The patient could be suffering from pre-eclampsia. A BP of 140/100 with proteinuria should be admitted immediately for observation and if the symptoms do not improve then managed immediately. According to the NICE guidelines BP should be monitored 4 times daily. A BP of 140/90 to 149/99 mmHg is classed as mild hypertension. Without proteinuria this can be monitored once weekly and the patient can be discharged.

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  • Question 96 - A patient at 15 weeks gestation undergoes an abortion. She has no known...

    Incorrect

    • A patient at 15 weeks gestation undergoes an abortion. She has no known drug allergies. Which of the following is the most appropriate regarding antibiotic prophylaxis?

      Your Answer:

      Correct Answer: Stat Azithromycin 1g and metronidazole 800 mg orally at time of abortion

      Explanation:

      First trimester abortions are performed using mifepristone 600 mg followed by insertion of 1 mg gemeprost vaginal pessary. The patients stays in the hospital for about 4-6 hours. At the time of abortion azithromycin 1 g and metronidazole 800 mg should be given to cover the gram positive and negative bacteria.

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  • Question 97 - At what gestation does a mother typically first become aware of fetal movements?...

    Incorrect

    • At what gestation does a mother typically first become aware of fetal movements?

      Your Answer:

      Correct Answer: 18-20 weeks

      Explanation:

      Typically fetal movements become apparent by 18-20 weeks

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  • Question 98 - A mother typically becomes aware of fetal movements at what gestation? ...

    Incorrect

    • A mother typically becomes aware of fetal movements at what gestation?

      Your Answer:

      Correct Answer: 18-20 weeks

      Explanation:

      Foetal movements often become apparent at about 18-20 weeks gestation. This phenomenon is also called quickening. The Foetal movements continue to increase in frequency and force until 32 weeks where they plateau. Foetal movements can be used to monitor the wellbeing of the foetus, alerting the mother and healthcare providers to a problem.

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  • Question 99 - How long does involution of the uterus take after parturition? ...

    Incorrect

    • How long does involution of the uterus take after parturition?

      Your Answer:

      Correct Answer: 4-6 weeks

      Explanation:

      In the period immediately after the delivery of the placenta, known as the puerperium, the female reproductive system begins to undergo some physiological changes to return to a non-pregnant state. One of these changes is uterine involution. The myometrium contracts, constricting blood vessels which impedes blood flow. It is thought that the uterine tissues then undergo apoptosis and autophagy. It takes about 4-6 weeks for the uterus to decrease is size from about 1 kg to 60 grams.

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  • Question 100 - What is the most common causative organism in Fitzhugh Curtis syndrome and ophthalmic...

    Incorrect

    • What is the most common causative organism in Fitzhugh Curtis syndrome and ophthalmic neonatorum?

      Your Answer:

      Correct Answer: Chlamydia trachomatis

      Explanation:

      A rare complication of pelvic inflammatory disease is Fitz Hugh Curtis syndrome which is perihepatitis leading to the formation of adhesions between the liver and the peritoneal surface. It is most commonly caused by chlamydia and gonorrhoea. Ophthalmia neonatorum is conjunctivitis which is also caused by these pathogens.

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Clinical Management (9/21) 43%
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