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Question 1
Incorrect
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A patient in a high-risk pregnancy clinic has a past obstetrical history of placenta previa and caesarean section has a breech presentation at 36 weeks gestation. Which of the following is considered a risk factor in increasing the chance of term breech presentation?
Your Answer: Polyhydramnios
Correct Answer: All of the above
Explanation:Breech presentation refers to the foetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first.
Clinical conditions associated with breech presentation include those that may increase or decrease fetal motility, or affect the vertical polarity of the uterine cavity. Prematurity, multiple gestations, aneuploidies, congenital anomalies, Mullerian anomalies, uterine leiomyoma, and placental polarity as in placenta previa are most commonly associated with a breech presentation. Also, a previous history of breech presentation at term increases the risk of repeat breech presentation at term in subsequent pregnancies.
Conditions that change the vertical polarity or the uterine cavity, or affect the ease or ability of the foetus to turn into the vertex presentation in the third trimester include:
– Mullerian anomalies
– Placentation
– Uterine leiomyoma
– Prematurity
– Aneuploidies and fetal neuromuscular disorders
– Congenital anomalies
– Polyhydramnios and oligohydramnios
– Laxity of the maternal abdominal wall. -
This question is part of the following fields:
- Obstetrics
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Question 2
Incorrect
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From which germ cell layer does the GI tract initially develop?
Your Answer: Paraxial Mesoderm
Correct Answer: Endoderm
Explanation:The GI tract forms from the endoderm. The endoderm grows laterally and then ventrally finally folding on its self to form the gut tube.
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This question is part of the following fields:
- Embryology
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Question 3
Correct
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Question 4
Incorrect
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You diagnose Erb-Duchenne palsy in a baby born with shoulder dystocia who suffered a brachial plexus injury. Which of the following nerve roots are likely to be affected?
Your Answer: C6 and C7
Correct Answer: C5 and C6
Explanation:Shoulder dystocia occurs when the fetal shoulder impacts on the maternal symphysis or sacrum during vaginal delivery. About 10% of babies with shoulder dystocia will suffer a brachial plexus injury, the most common one being Erb-Duchenne palsy. In Erb’s palsy, the upper nerve roots C5 and C6 are damaged due to excessive widening of the angle between the head and the shoulder. This causing temporary paralysis in the affected arm whereby the infant will present with its hand hanging limp by his side, internal rotation of the forearm, plus wrist and finger flexion. This sign is called the ‘waiter’s tip hand’. The palsy usually resolves spontaneously in a large proportion of cases.
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This question is part of the following fields:
- Clinical Management
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Question 5
Incorrect
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A 33-year-old 'grand multiparous' woman, who has previously delivered seven children by normal vaginal delivery, spontaneously delivers a live baby weighing 4750gm one hour ago after a three-hour long labour period. Shortly after, an uncomplicated third stage of labour, she goes into shock (pulse 140/min, BP 80/50 mmHg). At the time of delivery, total blood loss was noted at 500mL, and has not been excessive since then. What is the most probable diagnosis of this patient?
Your Answer:
Correct Answer: Uterine rupture.
Explanation:The patient most likely suffered a uterine rupture. It occurs most often in multiparous women and is less often associated with external haemorrhage. Shock develops shortly after rupture due to the extent of concealed bleeding.
Uterine inversion rarely occurs when after a spontaneous and normal third stage of labour. Although it can lead to shock, it is usually associated with a history of controlled cord traction or Dublin method of placenta delivery before the uterus has contracted. This diagnosis is also strongly considered when shock is out of proportion to the amount of blood loss.
An overwhelming infection is unlikely in this case when labour occurred for a short period of time. Uterine atony and amniotic fluid embolism are more associated with excessive vaginal bleeding, which is not evident in this case.
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This question is part of the following fields:
- Obstetrics
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Question 6
Incorrect
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According to the UK food standards agency which of the following RDIs (recommended daily intake) is 3 times higher in pregnancy than the non-pregnant state?
Your Answer:
Correct Answer: Folic Acid
Explanation:Folic Acid should be increased in diet of a pregnant women. Deficiency will lead to neural tube defects i.e. spina bifida.
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This question is part of the following fields:
- Physiology
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Question 7
Incorrect
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During the filling phase of micturition. At what bladder volume is the first urge to void felt?
Your Answer:
Correct Answer: 150ml
Explanation:The normal functional bladder capacity is around 400-600ml. First urge to void is typically felt when the bladder is approximately 150ml full.
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This question is part of the following fields:
- Anatomy
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Question 8
Incorrect
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A 29 year old female who is 32 weeks pregnant, has been admitted to hospital with very severe hypertension. This is her second pregnancy. In the United Kingdom, what is the first line of treatment for hypertension whilst pregnant?
Your Answer:
Correct Answer:
Explanation:Atenolol is considered teratogenic and has two main risks: fetal bradycardia and neonatal apnoea. ACE inhibitors and angiotensin II receptor blockers are also known to be teratogenic (even though large-scale studies are difficult to conduct during pregnancies).
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This question is part of the following fields:
- Obstetrics
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Question 9
Incorrect
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Which of the following has been shown to increase ovarian cancer risk?
Your Answer:
Correct Answer: Hormone replacement therapy (oestrogen only)
Explanation:Factors that increase the risk of ovarian cancer include nulliparity, IUD, endometriosis, cigarette smoking, HRT and obesity.
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This question is part of the following fields:
- Epidemiology
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Question 10
Incorrect
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A patient undergoes oophorectomy and the ovarian veins are ligated. Which vein does the left ovary drain into?
Your Answer:
Correct Answer: Left renal
Explanation:The right ovarian vein ascends and enters the inferior vena cava and the left ovarian vein drains into the longer left renal vein.
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This question is part of the following fields:
- Anatomy
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