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Question 1
Incorrect
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In the earliest phase of wound healing platelets are held together by what?
Your Answer: Type 2 Collagen
Correct Answer: Fibrin
Explanation:The 1st stage of wound healing is haemostasis. Even in incised wounds a small haematoma forms. Here the clotting cascade is activated by tissue factor and endothelial cells resulting in activation of platelets. This results in platelet aggregation and the laying down of a fibrin mesh that is cross linked and holds the platelets in place.
Wound healing is typically divided into phases:
1. Haemostasis Phase
2. Inflammatory phase
3. Proliferation phase
4. Remodelling phase -
This question is part of the following fields:
- Physiology
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Question 2
Incorrect
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A 26 year old patient attends the maternity unit as her waters have broken but she hasn't had contractions. She is at 39+5 weeks gestation. Speculum examination confirms prelabour rupture of membranes (PROM). What is the risk of serious neonatal infection with PROM?
Your Answer: 1 in 1000
Correct Answer: 1 in 100
Explanation:In pregnancy, term refers to the gestational period from 37 to 41+6 weeks. Preterm births occur between 24 and 36+6 weeks. Only 1% of women who go into PROM have risk of having serious neonatal infections.
Management of PROM:
60% of patients with PROM will go into labour within 24 hrs
Induction is appropriate if >34 weeks gestation and more than 24 hours post rupture when labour hasn’t started.
If < 34 weeks, induction of labour should not be carried out unless there are additional obstetric indications e.g. infection -
This question is part of the following fields:
- Clinical Management
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Question 3
Correct
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Which two nerves provide the primary cutaneous sensory innervation to the labia majora?
Your Answer: Ilioinguinal and pudendal
Explanation:The Pudendal provides cutaneous innervation to the posterior external genitalia via one of its terminal branches called the perineal nerve (this further branches into the posterior labial nerves or posterior scrotal nerve in men). The ilioinguinal nerve provides anterior sensation via the anterior labial nerves (anterior scrotal nerve in men). The genital branch of the genitofemoral nerve contributes some fibres to the skin of the mons pubis and labia majora in females. The posterior cutaneous nerve of thigh sometimes overlaps sensory areas.
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This question is part of the following fields:
- Anatomy
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Question 4
Incorrect
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A 33-year -old G2Pl woman who is at 10 weeks gestation presented to the medical clinic for antenatal visit. It was revealed that she has a twin pregnancy. She was known to have had a complicated previous pregnancy with placental abruption at 34 weeks. Which of the following is considered the next step in best managing the patient in addition to routine antenatal care?
Your Answer: Hospital admission after 34 weeks
Correct Answer: Increased iron and folic acid supplementation
Explanation:Twin pregnancies are at risk for iron deficiency due to significant maternal, fetal, and placental demands. Recommendations regarding the optimal iron dose in twin pregnancies are based on clinical expert opinions, advocating doubling the dose of iron from 30 mg of elemental iron to 60 mg routinely during the second and third trimester, regardless of maternal iron stores.
If pregnant with twins, patient should take the same prenatal vitamins she would take for any pregnancy, but a recommendation of extra folic acid and iron will be made. The additional folic acid and extra iron will help ward off iron-deficiency anaemia, which is more common when patient is pregnant with multiples.
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This question is part of the following fields:
- Obstetrics
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Question 5
Correct
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Question 6
Correct
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What kind of biochemical changes occur during the follicular phase of menstrual cycle?
Your Answer: Endometrial gland proliferation
Explanation:During follicular phase, there is an increase in gonadotrophin hormones and a proliferation of the endometrium occurs. The duration of the cycle depends upon the overall length of the menstrual cycle. The progesterone levels are increased in the luteal phase and not in follicular phase.
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This question is part of the following fields:
- Physiology
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Question 7
Correct
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A 31 year old is being seen in EPU and you are asked to review her ultrasound. There is a solid collection of echoes with numerous small (3-10 mm) anechoic spaces. What is the likely diagnosis?
Your Answer: Molar Pregnancy
Explanation:This is typical appearance of molar pregnancy. This used to be referred to as ‘snowstorm sign’ as with older poorer resolution ultrasound the anechoic species looked like a snowstorm.
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This question is part of the following fields:
- Data Interpretation
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Question 8
Incorrect
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A 62-year-old woman complains of urinary incontinence for the past 12 months after having four pregnancies before the age of 30. She has to wear a 'pad' inside her pants all of the time because of this condition. She isn't on any hormone replacement therapy at the moment. Which of the following signs indicates that the incontinence is most likely true stress incontinence?
Your Answer: When she gets the feeling she has to void, she has to do so quickly or she wets herself.
Correct Answer: Only small quantities of urine ore lost each time she is incontinent.
Explanation:Only little volumes of urine are lost when her intra-abdominal pressure is elevated during coughing, laughing, jumping, and straining, which is the only symptom associated with real stress incontinence.
The other reactions are significantly more compatible with a detrusor instability diagnosis (also called urge incontinence).
If she had incontinence throughout pregnancy, it would have been stress in nature, which is what her current incontinence is. -
This question is part of the following fields:
- Gynaecology
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Question 9
Correct
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A 37-year-old woman visits your office seeking oral contraceptive guidance. She is currently taking Microgynon 30 and is pleased with the results. She is married with two children, does not smoke, and is in good health. Her blood pressure is 150/100mmHg, according to your examination. The blood pressure remains the same after 20 minutes. Which of the following is the most appropriate next step in management?
Your Answer: Start her on progestogen-only pills (POPs)
Explanation:The progestogen-only pill (POP) is a contraceptive option for women who have high blood pressure either induced by use of combined oral pills or due to other causes; as long as it is well controlled and monitored. Combined oral contraception (COC) and Depo-Provera have been implicated in increased cardiovascular risk following use. High blood pressure has been theorized to be the critical path that leads to this increased risk. POP is the recommended method for women who are at risk of coronary heart disease due to presence of risk factors like hypertension.
Stopping OCP will risk in the patient getting pregnant. Cessation of oestrogen usually reverses the blood pressure back to normal, Hence, all other options are incorrect.
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This question is part of the following fields:
- Gynaecology
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Question 10
Incorrect
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Which of the following ultrasound findings form part of the Rotterdam criteria for diagnosis of PCOS (Polycystic Ovary Syndrome) ?
Your Answer: 5 or more peripheral ovarian follicles
Correct Answer: Increased ovarian volume >10cm3
Explanation:The Rotterdam criteria for the diagnosis of PCOS is based on a score of two out of the three criteria:
1) Oligo or anovulation
2) Hyperandrogenism – clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone)
3) on ultrasound – contain 12 or more follicles measuring 2 to 9 mm in diameter and/or have an increased volume of 10 cm3 or greater. -
This question is part of the following fields:
- Clinical Management
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Question 11
Correct
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Hysterosalpingogram (HSG) is contraindicated in the following EXCEPT:
Your Answer: Congenital malformations of the uterus
Explanation:Anomalies of the cervico-uterus are widely diagnosed by HSG. The diagnostic value of HSG in the detection of anomalies varies, depending on the type of malformation.
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This question is part of the following fields:
- Obstetrics
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Question 12
Correct
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What is the normal maximum endometrial thickness on ultrasound assessment of a post menopausal uterus?
Your Answer: 4mm
Explanation:In post menopausal women the thickness of the endometrium should be 4mm or less or women on tamoxifen is should be less than 5mm. If it is more than this the patient should be worked up for endometrial carcinoma.
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This question is part of the following fields:
- Biophysics
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Question 13
Correct
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You see a patient in antenatal clinic who is concerned that she has never had chicken pox and may catch it during pregnancy. You check her Varicella status and she is non-immune. She asks you about vaccination. What type of vaccine is the varicella vaccine?
Your Answer: Attenuated
Explanation:Varicella is a live vaccine. The recent RCOG green top guidelines suggest vaccine can be considered postpartum or pre pregnancy but NOT whilst pregnant. In the non-immune pregnant woman they should be advised to avoid contact with people with chickenpox or shingles and to contact a healthcare professional promptly if exposed. If they have a significant exposure VZIG should be offered as soon as possible.
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This question is part of the following fields:
- Immunology
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Question 14
Incorrect
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Regarding ectopic pregnancy, where is the most common site of implantation?
Your Answer: Infundibular tubal
Correct Answer: Ampullary tubal
Explanation:Ectopic pregnancies can quickly become a gynaecological emergency if left untreated. The majority of ectopic pregnancies (95-97%) are tubal occurring in the fallopian tube as opposed to the abdomen, ovary or cervix. In tubal ectopics, the most common site of occurrence is in the ampulla (70%), followed by the isthmus, fimbria, and the cornua.
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This question is part of the following fields:
- Epidemiology
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Question 15
Incorrect
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A 26 year old women presents for her 12 week scan. She has been pregnant once before but had a 1st trimester miscarriage. She reports no problems with this pregnancy and has had no vaginal bleeding or spotting. The scan shows no fetal cardiac activity and a small gestational sac. What is the likely diagnosis?
Your Answer: Inevitable Miscarriage
Correct Answer: Missed Miscarriage
Explanation:As there has been no bleeding or expulsion of the products of conception this is a missed miscarriage
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This question is part of the following fields:
- Clinical Management
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Question 16
Incorrect
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At a family clinic, you're seeing a young lady. She came to talk about the many contraceptive alternatives available to her. She wants to begin using combined oral contraception tablets. She is concerned, however, about the risk of cancer associated with long-term usage of pills. Which of the following is the most likely side effect of oral contraceptive pills?
Your Answer: Endometrial cancer
Correct Answer: Cervical cancer
Explanation:Women who have used oral contraceptives for 5 years or more are more likely to get cervical cancer than women who have never used them. The longer a woman uses oral contraceptives, the higher her chances of developing cervical cancer become. According to one study, using marijuana for less than 5 years increases the risk by 10%, using it for 5–9 years increases the risk by 60%, and using it for 10 years or more increases the risk by double. After women cease using oral contraceptives, their risk of cervical cancer appears to decrease over time. Endometrial, ovarian, and colorectal cancer risks, on the other hand, are lowered.
Compared to women who had never used oral contraceptives, women who were taking or had just discontinued using oral combination hormone contraceptives had a slight (approximately 20%) increase in the relative risk of breast cancer. Depending on the type of oral combination hormone contraception used, the risk increased anywhere from 0% to 60%. The longer oral contraceptives were used, the higher the risk of breast cancer. -
This question is part of the following fields:
- Gynaecology
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Question 17
Incorrect
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A young woman complained of itching and discharge from her vaginal area. There is red vulva and yellowish discharge on inspection. What is the best course of action?
Your Answer: Ciprofloxacin
Correct Answer: Clotrimazole
Explanation:This patient has got thrush or a fungal infection in the vaginal area. Candida infection is most likely based on the white discharge and itching. A vaginal clotrimazole antifungal treatment is required.
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This question is part of the following fields:
- Gynaecology
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Question 18
Incorrect
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During early pregnancy, a pelvic examination may reveal that one adnexa is slightly enlarged. This is most likely due to:
Your Answer: A parovarian cyst
Correct Answer: Corpus luteal cyst
Explanation:Adnexa refer to the anatomical area adjacent to the uterus, and contains the fallopian tube, ovary, and associated vessels, ligaments, and connective tissue. The reported incidence of adnexal masses in pregnancy ranges from 1 in 81 to 1 in 8000 pregnancies. Most of these adnexal masses are diagnosed incidentally at the time of dating or first trimester screening ultrasound (USS). Functional cyst is the most common adnexal mass in pregnancy, similar to the nonpregnant state. A corpus luteum persisting into the second trimester accounts for 13-17% of all cystic adnexal masses. Pain due to rupture, haemorrhage into the cyst, infection, venous congestion, or torsion may be of sudden onset or of a more chronic nature.
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This question is part of the following fields:
- Obstetrics
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Question 19
Incorrect
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Question 20
Correct
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Which of the following tests for the detection of chlamydia is considered the gold standard?
Your 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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This question is part of the following fields:
- Clinical Management
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Question 21
Correct
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A patient undergoes medical abortion at 9 weeks gestation. What is the advice regarding Rhesus Anti-D Immunoglobulin?
Your 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 22
Correct
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A 24 year old woman presents to the clinic with foul smelling vaginal discharge. Which facultative anaerobic bacteria is most likely to be the cause?
Your Answer: Gardnerella vaginalis
Explanation:Bacterial vaginosis is a common infection of the vagina caused by the overgrowth of atypical bacteria, most commonly Gardnerella vaginalis, a gram indeterminate bacteria, which is also a facultative anaerobe. Patients often complain of foul-smelling fishy discharge and dysuria. In diagnosing BV, a swab is taken for microscopy, often revealing clue cells. Of the other organisms listed in the options, Neisseria is an obligate anaerobe, while Chlamydia trachomatis is an obligate intracellular aerobe. Treponema Pallidum is an aerophilic bacteria and Mycoplasma hominis is a pleomorphic parasitic bacterium.
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This question is part of the following fields:
- Microbiology
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Question 23
Incorrect
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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: Progestogen only pill (POP)
Correct 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 24
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 25
Incorrect
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Human papilloma virus (HPV) infection is associated with which of the following onco-proteins?
Your Answer: P53 and P55
Correct Answer: E6 and E7
Explanation:There are over 100 genotypes of HPV including several other high risk HPV types. HPV 16 and 18 are responsible for 70% of cases of HPV related cancers. HPV is thought to induce cancer via onco-proteins. The primary onco-proteins are E6 and E7 which inactivate two tumour suppressor proteins, p53 (inactivated by E6) and pRb (inactivated by E7)
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This question is part of the following fields:
- Microbiology
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Question 26
Correct
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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: 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 27
Incorrect
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A 24-year-old woman presented to the medical clinic for advice regarding pregnancy. Upon history taking and interview, it was noted that she had a history of valvular heart disease. She has been married to her boyfriend for the last 2 years and she now has plans for pregnancy. Which of the following can lead to death during pregnancy, if present?
Your Answer: Aortic stenosis
Correct Answer: Mitral stenosis
Explanation:Mitral stenosis is the most common cardiac condition affecting women during pregnancy and is poorly tolerated due to the increased intravascular volume, cardiac output and resting heart rate that predictably occur during pregnancy.
Young women may have asymptomatic mitral valve disease which becomes unmasked during the haemodynamic stress of pregnancy. Rheumatic mitral stenosis is the most common cardiac disease found in women during pregnancy. The typical increased volume and heart rate of pregnancy are not well tolerated in patients with more than mild stenosis. Maternal complications of atrial fibrillation and congestive heart failure can occur, and are increased in patients with poor functional class and severe pulmonary artery hypertension.
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This question is part of the following fields:
- Obstetrics
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Question 28
Correct
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A chronic alcoholic lady presented to the medical clinic with complaints of an increase in abdominal size. Ultrasound was performed and revealed a foetus in which parameters correspond to 32 weeks of gestation. Upon history taking, it was noted that she works in a pub and occasionally takes marijuana, cocaine, amphetamine and opioid. Which of the following is considered to have the most teratogenic effect to the foetus?
Your Answer: Alcohol
Explanation:All of the conditions that comprise fetal alcohol spectrum disorders stem from one common cause, which is prenatal exposure to alcohol. Alcohol is extremely teratogenic to a foetus. Its effects are wide-ranging and irreversible. Although higher amounts of prenatal alcohol exposure have been linked to increased incidence and severity of fetal alcohol spectrum disorders, there are no studies that demonstrate a safe amount of alcohol that can be consumed during pregnancy. There is also no safe time during pregnancy in which alcohol can be consumed without risk to the foetus. Alcohol is teratogenic during all three trimesters. In summary, any amount of alcohol consumed at any point during pregnancy has the potential cause of irreversible damage that can lead to a fetal alcohol spectrum disorder.
In general, diagnoses within fetal alcohol spectrum disorders have one or more of the following features: abnormal facies, central nervous system abnormalities, and growth retardation.
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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 36-year-old woman is being tested for a breast tumour she discovered last week during a routine physical examination. Two years ago, the patient had bilateral reduction mammoplasty for breast hyperplasia. Her paternal grandmother died of breast cancer at the age of 65, thus she doesn't take any drugs or have any allergies. A fixed lump in the upper outer quadrant of the right breast is palpated during a breast examination. In the upper outer quadrant of the right breast, mammography reveals a 3 × 3-cm spiculated tumour with coarse calcifications. A hyperechoic mass can be seen on ultrasonography of the breast. The mass is removed with concordant pathologic findings, and a core biopsy reveals foamy macrophages and fat globules. Which of the following is the best plan of action for this patient's management?
Your Answer: Simple mastectomy
Correct Answer: Reassurance and routine follow-up
Explanation:Fat necrosis is a benign (non-cancerous) breast condition that can develop when an area of fatty breast tissue is injured. It can also develop after breast surgery or radiation treatment.
There are different stages of fat necrosis. As the fat cells die, they release their contents, forming a sac-like collection of greasy fluid called an oil cyst. Over time, calcifications (small deposits of calcium) can form around the walls of the cyst, which can often be seen on mammograms. As the body continues to repair the damaged breast tissue, it’s usually replaced by denser scar tissue. Oil cysts and areas of fat necrosis can form a lump that can be felt, but it usually doesn’t hurt. The skin around the lump might look thicker, red, or bruised. Sometimes these changes can be hard to tell apart from cancers on a breast exam or even a mammogram. If this is the case, a breast biopsy (removing all or part of the lump to look at the tissue under the microscope) might be needed to find out if the lump contains cancer cells. These breast changes do not affect your risk for breast cancer.
Mastectomy, axillary node dissection and radiation therapy are all management options for malignancy which this patient doesn’t have.
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This question is part of the following fields:
- Gynaecology
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Question 30
Correct
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Where is Glucagon produced?
Your Answer: Islet alpha cells
Explanation:The alpha cells in the islets of Langerhans are responsible for the production and secretion of glucagon. The B cells secrete insulin, the D cells secrete somatostatin, and the F cells secrete pancreatic polypeptide. The B cells, which are the most common and account for 60–75% of the cells in the islets, are generally located in the centre of each islet.
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This question is part of the following fields:
- Endocrinology
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SESSION STATS - PERFORMANCE PER SPECIALTY
