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Question 1
Correct
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A 20-year-old primigravida at her 16 weeks of gestation, presented with the history of lower vaginal pressure, vaginal spotting and lower back pain. Transvaginal ultrasound shows cervical shortening to 2 cm, cervical dilation, and protrusion of fetal membranes into the cervical canal. Findings confirms the woman has developed non-specific symptoms of cervical insufficiency which may lead to premature delivery. Which among the following is the most appropriate management in this case?
Your Answer: Reinforcement of the cervical ring with nonabsorbable suture material
Explanation:Patient mentioned in the given case has developed clinical features of cervical insufficiency and the possible treatment options include:
1- Cerclage, which is the technique used for the reinforcement of cervical ring with nonabsorbable suture material and is indicated based on ultrasonographic findings. It is the treatment of choice when cervical shortening is detected by ultrasonography before 22 to 24 weeks of gestation.2- Vaginal progesterone is used to reduce the risk of preterm delivery in women who have a prior history of idiopathic preterm delivery or cervical shortening, which is confirmed in the current pregnancy also by ultrasonography.This method is applicable only to those women who do not meet the criteria for Cerclage.
All the other options of management are incorrect in the given case.
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This question is part of the following fields:
- Obstetrics
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Question 2
Incorrect
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Beta and Delta Thalassemia are associated with abnormalities to which chromosome
Your Answer: Chromosome 16
Correct Answer: Chromosome 11
Explanation:Fetal haemoglobin (HBF) is the main haemoglobin type in the foetus and persists after birth for around 6 months. Fetal haemoglobin is composed of two alpha and two gamma subunits The alpha globulin chain is coded for by genes on Chromosome 16. Alpha Thalassemia are therefore associated with Chromosome16 defects The beta and delta globulin chains are coded for by genes on Chromosome 11. Beta and Delta Thalassemia are therefore associated with Chromosome 11 Defects
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This question is part of the following fields:
- Endocrinology
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Question 3
Correct
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Which of the following is the leading cause of Down Syndrome?
Your Answer: Nondisjunction maternal gamete
Explanation:Most of the cases of down syndrome occur due to non disjunction trisomy 21 which is associated with increased maternal age. The non disjunction occurs in the maternal gametes.
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This question is part of the following fields:
- Genetics
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Question 4
Incorrect
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A 27-year-old woman would usually take her oral contraceptive pill (ethinyl oestradiol 30µg, levonorgestrel 150 µg) each night at around 11 pm. One day, she presents at 7pm and says that she had forgotten to take her pill the evening before and would like some advice as to what she should do. Last sexual intercourse was last night and she is now on day-27 of her cycle. She is due to take her last pill tonight and then start the first of seven lactose tablets tomorrow night. What would be the best advice to give her?
Your Answer: Take her next contraceptive pill tonight and forget about the one she missed.
Correct Answer: Stop the current course of contraceptive pills, and start the next course of hormone tab lets in five days’ time.
Explanation:Taking into consideration that she had only missed one pill and that they were going to be stopped the next day anyway, the rate of pregnancy would be low; hence all of the responses would be acceptable and effective. However, the most appropriate step would be to initiate her hormone-free interval starting from the time she missed her pill i.e. 11pm the night before. This would make tonight the 2nd lactose pill day and hence she should commence the next course of hormone pills on the 5 nights from tonight. In doing this, her hormone-free period would be the usual length of 7 days. Although the risk of pregnancy is low after missing only one pill, this opposite occurs when the missed pill causes a longer than normal hormone-free duration between the end of the current cycle and the starting of the subsequent one.
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This question is part of the following fields:
- Gynaecology
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Question 5
Correct
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A 28 year old patient complains of vaginal soreness and discharge. Examination reveals vulval irritation and a 'strawberry' cervix. A wet smear is sent for microscopy which confirms trichomoniasis. What percentage of trichomoniasis cases would you expect to see a strawberry cervix?
Your Answer: 2%
Explanation:Trichomoniasis is caused by trichomonas. It is sexually transmitted. It is diagnosed on microscopy of vaginal discharge and cultured in Finn-Berg Whittington medium. It is characterised by valval itching, foul smelling discharge and appearance of strawberry cervix due to presence of punctate haemorrhages which occur in 2% of the cases.
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This question is part of the following fields:
- Clinical Management
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Question 6
Correct
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A pregnant woman with a history of osteoarthritis presents to her antenatal clinic. She is complaining of restricted joint movement and severe pain in her joints. Choose the most appropriate medication for her from the list below.
Your Answer: Paracetamol
Explanation:Paracetamol is safe to take during pregnancy and has shown no harm to unborn children during studies. It is the treatment of choice for mild to moderate pain during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 7
Correct
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Looking at the picture below what is the diagnosis?
Your Answer: Linea Nigra
Explanation:This is Linea Nigra. It occurs in 3/4 of pregnancies and is due to increased melanocyte-stimulating hormone production by the placenta. This also causes melasma and darkening of the nipples.
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This question is part of the following fields:
- Clinical Management
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Question 8
Incorrect
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Which of the following dugs is a strong inducer of cytochrome P450?
Your Answer: Sodium Valproate
Correct Answer: Phenytoin
Explanation:It is important to be aware of which ant-epileptics induce cytochrome P450. Of the above Topiramate and Phenytoin are moderate and strong inducers respectively.
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This question is part of the following fields:
- Clinical Management
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Question 9
Correct
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Which of the following hormones is secreted by the corpus luteum in a non pregnant state?
Your 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 10
Correct
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A 25-year-old high school teacher arrives fora prescription for a combination oral contraceptive tablet. She is new to your clinic, having recently relocated for a new position at a junior college. She does not smoke or consume alcoholic beverages. Sumatriptan 20mg intranasal spray has helped her with recurring headaches with aura in the past. What are your plans for the future?
Your Answer: Offer progestogen-only contraceptive options
Explanation:The combination oral contraceptive pill is an unequivocal contraindication for this patient (migraine with aura). Progestogen-only contraception, such as etonogestrel implant, levonorgestrel intrauterine device, and depot medroxyprogesterone, should be offered to her.
There is no need for a neurologist’s assessment or a brain MRI because her migraines are managed with sumatriptan nasal spray. -
This question is part of the following fields:
- Gynaecology
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SESSION STATS - PERFORMANCE PER SPECIALTY
