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Question 1
Correct
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Completion of the 3rd stage of labour refers to:
Your Answer: Expulsion of the placenta and membranes
Explanation:The third stage of labours starts from the delivery of the foetus to the delivery of the placenta and 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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In early pregnancy at what gestation does the Gestational sac become visible on transvaginal ultrasound?
Your Answer: 5 weeks
Correct Answer: 4 weeks + 3 days
Explanation:The gestational sac is typically visible from 31 days gestation by transvaginal ultrasound and a week later (38 days) on transabdominal ultrasound.
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This question is part of the following fields:
- Biophysics
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Question 3
Incorrect
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A 32 year old primigravida in her 12th week of gestation, presents to her GP with concerns regarding the evolution of her pregnancy. She's afraid she might experience an obstetric cholestasis just like her older sister did in the past. What is the fundamental symptom of obstetric cholestasis?
Your Answer: Pruritus
Correct Answer:
Explanation:Cholestasis of pregnancy is associated with increased fetal morbidity and mortality and should be treated actively. The significance attached to pruritus in pregnancy is often minimal, but it is a cardinal symptom of cholestasis of pregnancy, which may have no other clinical features.
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This question is part of the following fields:
- Obstetrics
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Question 4
Correct
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Question 5
Incorrect
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Hyperemesis gravidarum occurs in what percentage of pregnancies?
Your Answer: 5%
Correct Answer: 1.50%
Explanation:Hyperemesis Gravidarum effects around 0.3-2% of Pregnancies. It causes imbalances of fluid and electrolytes, disturbs nutritional intake and metabolism, causes physical and psychological debilitation and is associated with adverse pregnancy outcome, including an increased risk of preterm birth
and low birthweight babies. The aetiology is unknown however various potential mechanisms have been proposed including an association with high levels of serum human chorionic gonadotrophin (hCG), oestrogen and thyroxine. -
This question is part of the following fields:
- Clinical Management
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Question 6
Incorrect
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A 46-year-old woman presents to your clinic with a complaint of irregular heavy menstruation. She had normal menstrual pattern 6 months back. Physical examination revealed no abnormality with a negative cervical smear. Laboratory investigation reveals a haemoglobin of 105g/L (Normal 115-165g/L). The most common cause of such menorrhagia is?
Your Answer: Submucous fibroids.
Correct Answer: Anovulatory cycles.
Explanation:Menorrhagia in a 45-year-old woman is most likely caused by an ovulation issue, most likely anovulatory cycles, particularly if the periods have grown irregular.
Endometrial carcinoma is a rare cause of menorrhagia that usually occurs after menopause.
Menorrhagia can be caused by fibroids, endometrial polyps, and adenomyosis, although the cycles are normally regular, and a dramatic change from normal cycles six months prior would be exceptional.
If fibroids or adenomyosis are the source of the menorrhagia, the uterus is usually enlarged. -
This question is part of the following fields:
- Gynaecology
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Question 7
Incorrect
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Question 8
Incorrect
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Which of the following drugs is associated with reduced milk production whilst breastfeeding?
Your Answer: Domperidone
Correct Answer: Cabergoline
Explanation:Domperidone and metoclopramide are D2 dopamine receptor antagonists. They are primarily used to promote gastric motility. They are also known as galactagogues and they promote the production of milk. Cabergoline and bromocriptine are prolactin inhibitors and they reduce milk production.
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This question is part of the following fields:
- Endocrinology
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Question 9
Correct
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A 43-year-old woman, with a history of bilateral tubal ligation, presents with regular but excessively heavy periods. She has a history of multiple uterine leiomyoma and her uterus is the size of a 12-week pregnancy. Pap smear is normal; haemoglobin level is 93 g/L. She underwent dilatation and curettage 8 months ago but it did not result in symptom improvement nor was it able to find the underlying cause of her symptoms. Which is the best next step in her management?
Your Answer: Total abdominal hysterectomy
Explanation:Oral progestogen therapy for 21 days (day 5-26) is considered effective but is only a short-term therapy for menorrhagia. Myomectomy should only be considered if the woman would like to conceive later on. Due to the recurrent nature of fibroids, it is likely that the woman would need more surgeries in the future, which is not ideal. Furthermore, if there is a large number of fibroids or the size of the fibroids are large, myomectomy would not be an option for reasons such as the feasibility. If myomectomy for multiple fibroids prove to be unsuccessful, the ultimate outcome would still have to be a hysterectomy.
In cases where there is significant enlargement of the uterus, endometrial ablation would be difficult and the long-term cure rate of symptoms would be considerably low. The best next step would be a total abdominal hysterectomy since it would solve her menorrhagia and within a few years’ time, she would be expected to attain menopause anyway. Ponstan or mefenamic acid has been found to be superior to tranexamic acid for menorrhagia. However, it can still prove to be ineffective in some cases and also not a long term solution.
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This question is part of the following fields:
- Gynaecology
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Question 10
Correct
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A 29 year old female presented at her 38th week of gestation to the ER with severe hypertension (210/100) and proteinuria (+++). Soon after admission, she developed generalized tonic clonic fits. What is the first line of management in this case?
Your Answer: Magnesium sulphate IV
Explanation:Magnesium Sulphate is the drug of choice in eclamptic patients. A loading dose of 4g magnesium sulphate in 100mL 0.9% saline IVI over 5min followed by maintenance IVI of 1g/h for 24h. Signs of toxicity include respiratory depression and jerky tendon reflexes. In recurrent fits additional 2g can be given. Magnesium should be stopped when the respiratory rate is <14/min, absent tendon reflexes, or urine output is <20mL/h.
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This question is part of the following fields:
- Obstetrics
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Question 11
Incorrect
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A 28-year-old woman at 35 weeks gestation who is gravida 2 para 1, presented to the labour and delivery department since she has been having regular, painful contractions over the past 3 hours. Upon interview and history-taking, it was noted that the patient has had no prenatal care during this pregnancy. She also has no chronic medical conditions, and her only surgery was a low transverse caesarean delivery 2 years ago. Upon admission, her cervix is 7 cm dilated and 100% effaced with the fetal head at +2 station. Fetal heart rate tracing is category 1. Administration of epidural analgesia was performed, and the patient was relieved from pain due to the contractions. There was also rupture of membranes which resulted in bright-red amniotic fluid. Further examination was done and her results were: Blood pressure is 130/80 mmHg, Pulse is 112/min. Which of the following is most likely considered as the cause of the fetal heart rate tracing?
Your Answer: Intraamniotic infection
Correct Answer: Fetal blood loss
Explanation:Fetal heart rate tracings (FHR) under category I include all of the following:
– baseline rate 110– 160 bpm
– baseline FHR variability moderate
– accelerations present or absent
– late or variable decelerations absent
– early decelerations present or absentThe onset of fetal bleeding is marked by a tachycardia followed by a bradycardia with intermittent accelerations or decelerations. Small amounts of vaginal bleeding associated with FHR abnormalities should raise the suspicion of fetal haemorrhage. This condition demands prompt delivery and immediate reexpansion of the neonatal blood volume.
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This question is part of the following fields:
- Obstetrics
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Question 12
Correct
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Question 13
Correct
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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: 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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This question is part of the following fields:
- Clinical Management
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Question 14
Correct
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A 23-year-old woman, G1PO comes to your clinic at 12 week of pregnancy. She is complaining of mild vaginal bleeding for the past 12 hours, along with bouts of mild cramping lower abdominal pain. On vaginal examination, the cervical os is closed with mild discharge containing blood clots and an ultrasonography confirms the presence of a live fetus with normal heart rate. Which among of the following is the most likely diagnosis?
Your Answer: Threatened abortion
Explanation:Uterine bleeding in the presence of a closed cervix along with sonographic visualization of an intrauterine pregnancy with detectable fetal cardiac activity are diagnostic of threatened abortion.
Abortion does not always follow a uterine bleeding in early pregnancy, sometimes not even after repeated episodes or large amounts of bleeding, that is why the term “threatened” is used in this case. In about 90 to 96% cases, the pregnancy continues after vaginal bleeding if occured in the presence of a closed os and a detectable fetal heart rate. Also as the gestational age advances its less likely the condition will end in miscarriage.
In cases of inevitable abortion, there will be dilatation of cervix along with progressive uterine bleeding and painful uterine contractions. The gestational tissue can be either felt or seen through the cervical os and the passage of this tissue occurs within a short time.
In case were the membranes have ruptured, partly expelling the products of conception with a significant amounts of placental tissue left in the uterus is called as incomplete abortion. During the late first and early second trimesters this will be the most common presentation of an abortion. Examination findings of this includes an open cervical os with gestational tissues observed in the cervix and a uterine size smaller than expected for gestational age and a partially contracted uterus. The amount of bleeding will vary but can be severe enough to cause hypovolemic shock, with painful contractions and an ultrasound revealing tissues in the uterus.
An in utero death of the embryo or fetus prior to 20 weeks of gestation is called as a missed abortion. In this case the women may notice that the symptoms associated with early pregnancy like nausea, breast tenderness, etc have disappeared and they don’t ‘feel pregnant’ anymore. Vaginal bleeding may occur but the cervix remains closed and the ultrasound done reveals an intrauterine gestational sac with or without an embryonic/fetal pole, but no embryonic/fetal cardiac activity will be noticed.
In case of complete abortion, miscarriage occurs before the 12th week and the entire contents of conception will be expelled out of uterus. If this case, the physical examination will show a small and well contracted uterus with an open or closed cervix. There is scant vaginal bleeding with only mild cramping and ultrasound will reveal an empty uterus without any extra-uterine pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 15
Incorrect
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Three days after a lower uterine Caesarean section delivery (LSCS) for fetal distress, a 24-year-old woman develops fever with a temperature of 37.9°C. Intraoperative notes show that she was administered one dose of prophylactic antibiotics. She had been afebrile during the post-partum period until today. Which is the least likely cause of her fever?
Your Answer: Acute endometritis.
Correct Answer: A deep venous thrombosis (DVT).
Explanation:This question is about the differential diagnoses that should be considered if a patient presents with postpartum fever. The work-up for such patients would usually involve vaginal swabs, midstream urine culture and sensitivity and an ultrasound scan of the wound to look for any presence of a haematoma. LSCS is a major surgery and one common cause of puerperal fever would be surgical site infection. It is not surprising that women who deliver via LSCS are at higher risk of developing post-partum fever compared to those who deliver vaginally. Other common causes include endometritis and UTI. Ultrasound examination of the pelvic deep venous system and the legs would also be done to look for any thrombosis. Deep vein thrombosis can occur due to immobility, however it is unlikely to present with fever.
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This question is part of the following fields:
- Obstetrics
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Question 16
Correct
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Which of the following pathology terms refers to programmed cell death?
Your Answer: Apoptosis
Explanation:Apoptosis is described as programmed cell death. The cell release certain proapoptotic mediators that regulate this cell death.
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This question is part of the following fields:
- Biochemistry
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Question 17
Correct
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Hypoplasia & yellow discoloration of the primary teeth has occurred in infants whose pregnant mothers were treated with which drug:
Your Answer: Tetracycline
Explanation:Tetracycline is a broad-spectrum antibiotic that crosses placental barrier. Tetracycline was the first line of therapy in treating infections caused by Mycoplasma pneumoniae, chlamydia, rickettsia, and some spirochaetes. It has a wide range of adverse effects and is known for a unique property of being incorporated into skeletal and dental tissues at sites of active mineralization and staining of these tissues.
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This question is part of the following fields:
- Pharmacology
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Question 18
Correct
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When is the earliest appropriate gestational age to perform amniocentesis?
Your Answer: 15+0 weeks
Explanation:The best time to perform amniocentesis is at the gestational age of 15 weeks or more. There is increased risk of abortion, respiratory problems and fetal talipes if amniocentesis is performed before the gestational age of 14 weeks.
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This question is part of the following fields:
- Clinical Management
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Question 19
Incorrect
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All of the following statements are true about Androgen insensitivity syndrome except:
Your Answer: Normal female external genetailia
Correct Answer: The chromosomal sex is 46XX
Explanation:Patients suffering from androgen insensitivity syndrome have 46XY chromosomes. Due to insensitivity to androgens, they have female characteristics e.g. scant pubic or body hairs, enlarged mammary glands, and a small penis.
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This question is part of the following fields:
- Embryology
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Question 20
Correct
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Which of the following prolongs Prothrombin time?
Your Answer: Factor V deficiency
Explanation:Prothrombin time is increased in:
– Factor V deficiency
– Vitamin K deficiency (which affects factors 2,7 and 10)
– Warfarin therapy
– Severe liver failure
Protein C is an anticoagulant and deficiency results in a hyper-coagulable state with tendency towards thrombosis. -
This question is part of the following fields:
- Biochemistry
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Question 21
Correct
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Relationship of the long axis of the mother to the long axis of foetus is known as:
Your Answer: Lie
Explanation:Fetal lie refers to the relationship between the long axis of the foetus relative to the long axis of the mother. If the foetus and maternal column are parallel (on the same long axis), the lie is termed vertical or longitudinal lie.
Fetal presentation means, the part of the foetus which is overlying the maternal pelvic inlet.
Position is the positioning of the body of a prenatal foetus in the uterus. It will change as the foetus develops. This is a description of the relation of the presenting part of the foetus to the maternal pelvis. In the case of a longitudinal lie with a vertex presentation, the occiput of the fetal calvarium is the landmark used to describe the position. When the occiput is facing the maternal pubic symphysis, the position is termed direct occiput anterior.
Fetal attitude is defined as the relation of the various parts of the foetus to each other. In the normal attitude, the foetus is in universal flexion. The anatomic explanation for this posture is that it enables the foetus to occupy the least amount of space in the intrauterine cavity. The fetal attitude is extremely difficult, if not impossible, to assess without the help of an ultrasound examination.
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This question is part of the following fields:
- Obstetrics
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Question 22
Correct
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Question 23
Correct
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The following drugs cross the placenta to the foetus, EXCEPT:
Your Answer: Heparin
Explanation:Standard heparin, an effective treatment for antepartum thromboembolic disease, is thought to be safe for the foetus since it does not cross the placenta.
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This question is part of the following fields:
- Pharmacology
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Question 24
Correct
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Which of the following hormones is produced by the hypothalamus in response to breastfeeding?
Your Answer: Oxytocin
Explanation:Nipple stimulation during breastfeeding triggers the production of oxytocin from the hypothalamus and its subsequent release from the posterior pituitary gland. The hormone causes the myoepithelial cells of the breast to contract causing milk to flow through the ducts.
Ergometrine and Prostaglandin E2 are used during labour to control uterine bleeding after delivery, or ripen the cervix, while Atosiban is an oxytocin antagonist.
Antidiuretic hormone is also released from the posterior pituitary, and acts on the kidneys to decrease fluid excretion.
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This question is part of the following fields:
- Clinical Management
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Question 25
Incorrect
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a 24 year old female patient comes to your office with a chief complaint of painless vaginal bleeding of 1 week duration. She had 3 episodes of bleeding and is on contraceptive pills. Her Pap smear screening is up to date with normal findings. Which is the cause for her bleeding?
Your Answer: A cervical polyp
Correct Answer: A cervical ectropion
Explanation:Cervical ectropion occurs when glandular cells develop on the outside of the cervix. Many individuals with cervical ectropion do not experience symptoms.
However, the primary symptom of cervical ectropion is a red, inflamed patch at the neck of the cervix.
The transformation zone appears this way because the glandular cells are delicate and irritate easily.
Other symptoms a woman may experience include:
pain and bleeding during or after sex
pain during or after cervical screening
light discharge of mucus
spotting between periods
Symptoms may range from mild to severe when they appear.This patient has normal pap smear and is unlikely to have cervical cancer. She has no fever and vaginal discharge which would be the presentation of Chlamydia infection.
Endometrial cancer affects mainly post menopausal women and presents with vaginal bleeding, weight loss, dysuria and dyspareunia.
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This question is part of the following fields:
- Gynaecology
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Question 26
Correct
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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. What is the likelihood of spontaneous labour starting within 24 hours?
Your Answer: 60%
Explanation:In pregnancy, term refers to the gestational period from 37 0 to 41 6 weeks. Preterm births occur between 24 0 and 36 6 weeks. 60% of the women will go into labour with in 24 hours in PPROM. After 24 hours have past without any contraction and the gestation age is more than 34 week than prostaglandins can be used to augment labour.
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This question is part of the following fields:
- Clinical Management
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Question 27
Correct
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A 29 year old obese woman presents complaining of difficult or painful sexual intercourse and dysmenorrhea. She is requesting a reversible contraceptive method. Which of the following would be most suitable?
Your Answer: Mirena
Explanation:Mirena is a form of contraception also indicated for the treatment of heavy menstrual bleeding and the management of dysmenorrhea, being able to reduce the latter considerably.
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This question is part of the following fields:
- Gynaecology
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Question 28
Incorrect
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What is the RCOG advice regarding timing of Rhesus Anti-D Immunoglobulin following abortion?
Your Answer: Anti-D IgG must be given at time of abortion
Correct Answer: Anti-D IgG within 72 hours following abortion
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 29
Correct
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Whilst reviewing a 34 year old patient with amenorrhoea in clinic they tell you they have gained over 10kg in weight in the past 8 weeks and have noticed worsening acne. Routine bloods taken that morning show a random glucose 11.1mmol/l, normal thyroid function tests and negative pregnancy test. BP is 168/96 mmHg. You suspect Cushing's. What would the most appropriate investigation be to conform the diagnosis?
Your Answer: Dexamethasone suppression test
Explanation:In Cushing’s syndrome there is excess cortisol. Causes are broadly divided into 2 types: ACTH dependent disease: excess ACTH from the pituitary (Cushing’s disease), ectopic ACTH-producing tumours or excess ACTH administration. Non-ACTH-dependent: adrenal adenomas, adrenal carcinomas, excess glucocorticoid administration. The recommended diagnostic tests for the presence of Cushing’s syndrome are 24-hour urinary free cortisol, 1 mg overnight dexamethasone suppression test and late-night salivary cortisol. There are several other tests that may also be performed to find the cause. ACTH and cortisol measured together may show if this is ACTH dependent or not. MRI pituitary and CT abdo and pelvis may show if tumour is the cause.
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This question is part of the following fields:
- Endocrinology
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Question 30
Incorrect
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A 28-year-old, 10-weeks pregnant woman comes to you complaining of right iliac fossa pain, which is more when she tries to stand up or cough. She also had a history of appendectomy, done 12 years ago. Physical examination reveals mild tenderness in right iliac fossa, without any rebound tenderness or guarding. Among the following options which will be the most likely diagnosis?
Your Answer: Unruptured ectopic pregnancy
Correct Answer: Round ligament pain
Explanation:The given case can be diagnosed as round ligament pain, which is common during pregnancy. This happens as a result to the stretching of round ligament in pelvis to occupy the growing uterus. The round ligament pain usually gets worse with movements or straining and will be relieved by rest or warm application.
As the abdominal examination of patient is unremarkable, conditions like ovarian cyst rupture, ectopic pregnancy and intestinal obstruction are a very unlikely to be the diagnosis.
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This question is part of the following fields:
- Obstetrics
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SESSION STATS - PERFORMANCE PER SPECIALTY
