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Question 1
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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: 24 hours
Explanation:Induction of labour is appropriate approximately 24 hours after rupture of the membranes.
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This question is part of the following fields:
- Clinical Management
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Question 2
Incorrect
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A patient is seen in the gynaecology outpatient clinic and is noted to have large volume genital warts perianally and near the urethral meatus. You discuss treatment options and the patient opts for LASER therapy. Which of the following is the most appropriate type of LASER to use?
Your Answer:
Correct Answer: CO2
Explanation:Vulval intraepithelial neoplasia is a premalignant condition which is associated with HPV or lichen sclerosis. Biopsy is essential for diagnosis. Treatment depends of the patients choice and include surgical excision of the area or laser therapy with CO2. Other treatment modalities include immunomodulating creams.
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This question is part of the following fields:
- Biophysics
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Question 3
Incorrect
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Which one of the following statements regarding the fetal head is true?
Your Answer:
Correct Answer: Considered to be engaged when the biparietal diameter passes the level of the pelvic inlet
Explanation:The fetal head is engaged when the head of the foetus or the presenting part enters the pelvic inlet or pelvic brim. It usually occurs at 38 weeks of gestation.
The Spalding sign refers to the overlapping of the fetal skull bones caused by collapse of the fetal brain. It appears usually a week or more after fetal death in utero.
In brow presentation the scalp is deflexed as the foetus is looking upward. Normally the head is inflexed such that the chin is touching the chest. -
This question is part of the following fields:
- Anatomy
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Question 4
Incorrect
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A 26-year-old pregnant female in her first trimester was brought to the labour room with complaints of painless vaginal bleeding. On examination, her abdomen was non-tender and os was closed. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Threatened miscarriage
Explanation:Threatened miscarriage is a term used to describe any abnormal vaginal bleeding that occurs in first trimester, sometime associated with abdominal cramps. The cervix remains closed and the pregnancy may continue as normal.
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This question is part of the following fields:
- Obstetrics
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Question 5
Incorrect
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Question 6
Incorrect
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A couple present to the fertility clinic after failing to conceive despite trying for 2.5 years. The semen analysis shows azoospermia. You perform a full examination of the male partner which reveals Height 192cm, BMI 20.5, small testes and scant facial hair. You decide to organise karyotyping. What is the result likely to show?
Your Answer:
Correct Answer: 47XXY
Explanation:Klinefelter syndrome is associated with testicular atrophy, eunuchoid body shape, tall, long extremities, female hair distribution and gynaecomastia. It is a common cause of hypogonadism seen during fertility workup.
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This question is part of the following fields:
- Clinical Management
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Question 7
Incorrect
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What is the target INR in a patient who has just been started on warfarin therapy due to a pulmonary embolism?
Your Answer:
Correct Answer: 2.0-3.0
Explanation:Warfarin can be useful for management of thromboembolism. The target INR range for this medication is between 2.0-3.0 in patients with venous thromboembolism, pulmonary embolism etc. The INR range may increase to 3.0-4.0 in patients with mechanical valves. However, warfarin is not recommended in pregnancy, and Low Molecular Weight Heparin should be used for thromboprophylaxis instead.
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This question is part of the following fields:
- Pharmacology
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Question 8
Incorrect
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Question 9
Incorrect
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The performance of a cervical cerclage at 14 weeks of gestation is determined by which of the following indications?
Your Answer:
Correct Answer: 2 or more consecutive prior second trimester pregnancy losses
Explanation:Cervical cerclage is performed as an attempt to prolong pregnancy in certain women who are at higher risk of preterm delivery.
There are three well-accepted indications for cervical cerclage placement. According to the American College of Obstetricians and Gynaecologists (ACOG), a history-indicated or prophylactic cerclage may be placed when there is a “history of one or more second-trimester pregnancy losses related to painless cervical dilation and in the absence of labour or abruptio placentae,” or if the woman had a prior cerclage placed due to cervical insufficiency in the second trimester.
An ultrasound-indicated cerclage may be considered for women who have a history of spontaneous loss or preterm birth at less than 34 weeks gestation if the cervical length in a current singleton pregnancy is noted to be less than 25 mm before 24 weeks of gestation. It is important to note that this recommendation is invalidated without the history of preterm birth.
Physical examination-indicated cerclage (also known as emergency or rescue cerclage) should be considered for patients with a singleton pregnancy at less than 24 weeks gestation with advanced cervical dilation in the absence of contractions, intraamniotic infection or placental abruption.
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This question is part of the following fields:
- Obstetrics
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Question 10
Incorrect
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Question 11
Incorrect
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Regarding lymph drainage of the fallopian tubes where does the majority of lymph drain to?
Your Answer:
Correct Answer: Para-aortic nodes
Explanation:Lymphatic vessels from the ovaries, joined by vessels from the uterine tubes and most from the fundus of the uterus, follow the ovarian veins as they ascend to the right and left lumbar (caval/aortic) lymph nodes.
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This question is part of the following fields:
- Anatomy
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Question 12
Incorrect
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Question 13
Incorrect
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Several mechanisms have been proposed as to what causes closure of the Ductus Arteriosus (DA) at Parturition. Which of the following is the most important in maintaining the patency of the DA during pregnancy?
Your Answer:
Correct Answer: PGE2
Explanation:Prostaglandin E1 and E2 help maintain the patency of the DA during pregnancy. PGE2 is by far the most potent and important. It is produced in large quantities by the placenta and the DA itself.
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This question is part of the following fields:
- Embryology
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Question 14
Incorrect
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Question 15
Incorrect
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Lidiya is a 30-year-old hospital nurse in her nine weeks of pregnancy. She has no history of chickenpox, but by regularly attending the facial sores of an elderly patient with herpes zoster ophthalmicus she has been significantly exposed to shingles. What would you advise her as preventive management?
Your Answer:
Correct Answer: If she had chicken pox immunization in the past, she needs to have her Varicella-Zoster IgG antibodies checked to assure immunity
Explanation:Patient in the given case is nine weeks pregnant, and she has been exposed to a herpes zoster rash because she is working as a hospital nurse and has no prior history of chickenpox.
The most appropriate next step in this case would be checking for Varicella-Zoster IgG antibodies which assures immunity to varicella infections. If VZV IgG is present no further action is needed, but if VZV IgG antibodies are absent, then she will need Varicella Zoster Immunoglobulins within ten days from the exposure to shingles. -
This question is part of the following fields:
- Obstetrics
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Question 16
Incorrect
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A sure sign of pregnancy is:
Your Answer:
Correct Answer: Auscultation of fetal heart
Explanation:Classifications of Pregnancy Signs:
Presumptive signs — possibility of pregnancy
Probable signs — most likelihood of indicating pregnancy
Positive signs — confirmation of pregnancy
Auscultation of fetal heart is the only positive sign amongst the rest of the answers. -
This question is part of the following fields:
- Physiology
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Question 17
Incorrect
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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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This question is part of the following fields:
- Clinical Management
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Question 18
Incorrect
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Which of the following hormones is secreted by the corpus luteum in a non pregnant state?
Your Answer:
Correct Answer: Progesterone
Explanation:The corpus luteum is formed from the granulosa cells of the mature follicle. The structure functions as a transient endocrine organ which secretes mainly progesterone with additional secretion of oestradiol and inhibin, which serve to suppress FSH levels. In the event of no pregnancy, the corpus luteum stops producing progesterone and degenerates into the corpus albicans.
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This question is part of the following fields:
- Embryology
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Question 19
Incorrect
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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:
Correct 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 20
Incorrect
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A 25-year-old female, expecting twins, complains of decreased fetal movements in her 40th week of gestation. An hour ago, she experienced constant abdominal pain for an hour and passed blood in her urine. What is the next best investigation in this case?
Your Answer:
Correct Answer: Cardiotocograph
Explanation:Cardiotocography (CTG) helps to record the heartbeat of the foetus in parallel to measuring the contractions of the mother’s uterus, this is the most appropriate tool to assess this patient’s condition.
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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 one of the following statements regarding oestrogen is correct?
Your Answer:
Correct Answer: It is produced in the corpus luteum
Explanation:Oestrogen is secreted by the corpus luteum and is responsible for the proliferation of the endometrium to prepare it for the implantation of the zygote.
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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 26 year old lady comes to see you in the antenatal clinic. She is 8 weeks pregnant and is concerned as she has a new cat and her friend told her she shouldn't be changing cat litter when pregnant. You send bloods which show high IgM for toxoplasmosis gondii. Which of the following is an appropriate treatment option?
Your Answer:
Correct Answer: Spiramycin
Explanation:There are 2 treatment options: Spiramycin ASAP if foetus not infected or status of the foetus not known. This reduces risk of transplacental infection. This is continued until term, or until fetal infection is documented. Pyrimethamine, sulfadiazine and folic acid where fetal infection is known e.g. positive amniotic fluid PCR. Monitoring for haemotoxicity required. Pyrimethamine should be avoided in the 1st trimester as teratogenic
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This question is part of the following fields:
- Microbiology
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Question 23
Incorrect
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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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This question is part of the following fields:
- Clinical Management
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Question 24
Incorrect
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A 30-year-old woman presents to the clinic. She complains of a 6 week history of amenorrhoea and on diagnostic testing, has a positive pregnancy test. On past medical history, it is noted that she had a multiload (Cu375) intrauterine device inserted six months ago. On physical examination, The strings of the device are not visibly protruding through the external os, as would be expected. She is happy to proceed with the pregnancy, and asks what should be done next. What is the best next step in her management?
Your Answer:
Correct Answer: Ultrasound of the pelvis.
Explanation:The best next step is to order an ultrasound of the pelvis to locate the IUCD in the uterine cavity.
Once the device is located, appropriate advice can be given about the pregnancy proceeding.
Uterine sounding and hysteroscopy are contraindicated in the presence of a viable pregnancy due to risks of infection and abortion.
Pelvic X-ray is indicated if the device cannot be located during the pelvic ultrasound. It can show if the device is in the peritoneal cavity or has been expelled from the uterus. It should only be done after the pregnancy.
In cases where the device is in the peritoneal cavity, a laparoscopy is indicated for device removal.
Pregnancy termination is not indicated simply because of the presence of an intrauterine device (IUCD) in the uterus, unless other factors dictate that this is appropriate.
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This question is part of the following fields:
- Gynaecology
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Question 25
Incorrect
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A 28-year-old woman presents in early labour. She is healthy and at full-term. Her pregnancy has progressed well without any complications. She indicates that she would like to have a cardiotocograph (CTG) to assess her baby as she has read about its use for foetal monitoring during labour. What advice would you give her while counselling her regarding the use of CTG compared to intermittent auscultation during labour and delivery?
Your Answer:
Correct Answer: There is no evidence to support admission CTG.
Explanation:In high-risk pregnancies, continuous monitoring of foetal heart rate is considered mandatory.
However, in low-risk pregnancies, cardiotocograph (CTG) monitoring provides no benefits over intermittent auscultation.
A significant issue with CTG monitoring is that apparent abnormalities are identified that usually have minimal clinical significance, but can prompt the use of several obstetric interventions such as instrumental deliveries and Caesarean section. In low risk patients, such interventions may not even be required.
CTG monitoring has not been shown to reduce the incidence of cerebral palsy or other neonatal developmental abnormalities, nor does it accurately predict previous foetal oxygenation status unless the CTG is significantly abnormal when it is first connected.
Similarly, CTG cannot accurately predict current foetal oxygenation unless the readings are severely abnormal.
Therefore, there is no evidence to support routine admission CTG (correct answer).
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This question is part of the following fields:
- Obstetrics
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Question 26
Incorrect
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A woman in early pregnancy is worried because of several small raised nodules on the areola of both breasts. There are no other findings. Your immediate management should be:
Your Answer:
Correct Answer: Reassurance after thorough examination
Explanation:The correct answer is reassurance after thorough examination. Most breast lesions diagnosed during pregnancy and lactation, even some specific ones such as lactation and adenoma galactocele, are benign. The diagnosis of breast cancer, which is difficult to elucidate and is less common among women who are pregnant or lactating than among those of the same age who are not, continues to be a challenge for clinicians.
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This question is part of the following fields:
- Obstetrics
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Question 27
Incorrect
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A patient undergoes medical abortion at 9 weeks gestation. What is the advice regarding Rhesus Anti-D Immunoglobulin?
Your Answer:
Correct Answer: All RhD-negative women who are not alloimmunized should receive Anti-D IgG
Explanation:All non-sensitised RhD negative women should receive Anti-D IgG within 72 hours following abortion
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This question is part of the following fields:
- Clinical Management
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Question 28
Incorrect
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A 28-year -old lady in her 13th week of gestation comes to your clinic with a recent history of, four days ago, contact with a child suffering from parvovirus infection. She is concerned whether her baby might be affected. A serum analysis for lgM and lgG antibody for parvovirus came back as negative. Which among the following would be the most appropriate next step of management in this case?
Your Answer:
Correct Answer: Repeat serologic tests in two weeks
Explanation:Parvovirus B19 is a single-stranded DNA virus, which is the causative organism for erythema infectiosum, also known as fifth disease or slapped cheek syndrome.
Maternal infection with parvovirus B19 is almost always associated with an increased risk of transplacental fetal infection throughout the pregnancy. Fetal infection results in fetal parvovirus syndrome, which is characterized by anemia hydrops with cardiac failure and possibly death.
The earlier the exposure occurs, it is more likely to result in fetal parvovirus syndrome and stillbirth is the common outcome in case of third trimester infection.Women who have been exposed to parvovirus in early pregnancy should be informed on the possible risk of fetal infection and also should be screened for parvovirus B19 specific lgG.
– If parvovirus specific lgG is positive reassure that pregnancy is not at risk
– If parvovirus specific lgG is negative, serology for lgM should be performed
After infection with parvovirus, patient’s lgM is expected to become positive within 1 to 3 weeks and it will remain high for about 8-12 weeks. lgG levels will start to rise within 2 to 4 weeks after the infection.This woman has a negative lgG titer which indicates that she is not immune to the infection. Although her lgM titer is negative now, this does not exclude the chance of infection as it takes approximately 1 to 3 weeks after infection for lgM to become positive, and will then remain high for 8 to 12 weeks. In such cases, it is recommended the serologic tests be repeated in 2 weeks when the lgM may become positive while lgG starts to rise.
– Positive lgM titers confirm maternal parvovirus infection. If that is the case, the next step would be fetal monitoring with ultrasound for development of hydrops at 1-2 weeks intervals for the next 6-12 weeks(needs referral). Once the fetus is found to have hydrops, fetal umbilical cord sampling and intrauterine blood transfusion are considered the treatment options.
– Positive lgG and negative lgM indicates maternal immunity to parvovirus.Interpretation of serologic tests results and the further actions recommended are as follows:
If both IgM and IgG are negative, it means mother is not immune to parvovirus B19 infection, and an infection is possible. Further action will be Repetition of serological tests in 2 weeks.
If IgM is positive and IgG is negative, it means the infection is established. Fetal monitoring with ultrasound at 1- to 2-week intervals for the next 6- 12 weeks must be done.
If both IgM and IgG are positive, it means infection is established, and an infection is possible. Further action will be fetal monitoring with ultrasound at 1- to 2-week intervals for the next 6- 12 weeks.
If IgM is negative and IgG is positive, it means the mother is immune to parvovirus infection. In this case it is important to reassure the mother that the baby is safe.
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This question is part of the following fields:
- Obstetrics
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Question 29
Incorrect
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A 46-year-old mother of three teenagers has been using the combination oestrogen/progestogen contraceptive pill for ten years and has had regular light menstrual cycles during that time. She stopped taking it three months ago. She hasn't had a period since then, except the one she had right after she stopped. She is quite worried and believes she is pregnant, even though she has no additional symptoms that point to this conclusion. A large retroverted uterus is discovered during a vaginal examination. Which of the following is the most appropriate piece of advice?
Your Answer:
Correct Answer: A pregnancy test should be performed.
Explanation:Despite the fact that pregnancy at her age is uncommon, the best advise you can give her is to take a pregnancy test.
If the test results show she is not pregnant, she can next decide whether to restart the oral contraceptive pill (0CP) or simply weep until the post-pill amenorrhoea goes away.
Although an increased follicle-stimulating hormone (FSH) level may indicate ovarian failure, it does not guarantee that no more periods will occur and does not rule out the possibility of a future pregnancy.
Obviously, she should be recommended to use a contraceptive method like condoms until the cause of her amenorrhoea is determined.
Other hormonal tests, such as luteinizing hormone and prolactin testing, may be required. -
This question is part of the following fields:
- Gynaecology
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Question 30
Incorrect
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Which of the following is the most accurate estimate of mature breast milk composition?
Your Answer:
Correct Answer: Fat 4%, Protein 1%, Sugar 7%
Explanation:Breast milk contains around 4% fat, 7% sugar and 1% proteins. The rest is water and minerals.
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This question is part of the following fields:
- Clinical Management
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