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Question 1
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A 32-year-old woman, who is 18 weeks pregnant, is diagnosed with antiphospholipid syndrome and positive anticardiolipin antibodies. She has a history of three miscarriages, each one during the first trimester. What would be the next most appropriate step?
Your Answer: Aspirin
Correct Answer: Aspirin & heparin
Explanation:The syndrome with which the woman was diagnosed is an autoimmune, hypercoagulable state which most possibly was the reason of her previous miscarriages. This is the reason why she should be on aspirin and heparin in order to prevent any future miscarriage.
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This question is part of the following fields:
- Obstetrics
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Question 2
Incorrect
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A 25 year old prim gravida carrying a twin male pregnancy presents at 31 weeks gestation. She is lethargic, clinically jaundiced and complains of abdominal pain with frequent vomiting. You suspect acute fatty liver of pregnancy (AFLP). What is the maternal mortality rate with AFLP?
Your Answer: 2%
Correct Answer: 20%
Explanation:Acute fatty liver of pregnancy occurs in 1-10000 pregnancies and presents as jaundice with abdominal pain. The maternal mortality is around 20%
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This question is part of the following fields:
- Clinical Management
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Question 3
Correct
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Question 4
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Prenatal screening is recommended if ultrasound scan at 16 weeks confirms that the foetus is male and the mother has had an affected son previously. Choose the single most likely condition from the following list of options. 7
Your Answer: Duchene muscular dystrophy
Explanation:The condition should be an X-linked recessive condition, as it affects only male offspring. Duchene muscular dystrophy is an X-linked recessive condition. Cystic fibrosis is an autosomal recessive disorder. Spina bifida is a multifactorial condition. Down syndrome is caused by trisomy of chromosome 21. Spinal muscular atrophies are inherited in an autosomal-recessive pattern.
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This question is part of the following fields:
- Obstetrics
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Question 5
Correct
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Human papilloma virus (HPV) infection is associated with which of the following onco-proteins?
Your 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 6
Incorrect
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The main support of the uterus is provided by:
Your Answer: The round ligament
Correct Answer: The cardinal ligament
Explanation:The cardinal ligament (or Mackenrodt’s ligament, lateral or transverse cervical ligament) is a major ligament of the uterus. It is located at the base of the broad ligament of the uterus. It attaches the cervix to the lateral pelvic wall by its attachment to the Obturator fascia of the Obturator internus muscle, and is continuous externally with the fibrous tissue that surrounds the pelvic blood vessels. It thus provides support to the uterus.
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This question is part of the following fields:
- Anatomy
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Question 7
Correct
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Which structure is the primary mechanism for shunting blood away from the fetal pulmonary circulation?
Your Answer: Foramen Ovale
Explanation:Blood enters the right atrium of the fetal heart and most passes through the foramen ovale into the left atrium. From there it is pumped through the aorta. The foramen ovale is the major structure for bypassing the fetal pulmonary circulation. Some of the blood in the right atrium does enters the right ventricle and then into the pulmonary artery however most of this passes through the ductus arteriosus into the aorta thus bypassing the fetal pulmonary circulation.
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This question is part of the following fields:
- Embryology
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Question 8
Correct
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Question 9
Incorrect
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A 22-year-old woman presented to the medical clinic for her first-trimester pregnancy counselling. Upon interview and history-taking, it was noted that she was previously an intravenous drug abuser. There were unremarkable first-trimester investigations, except for her chronic Hepatitis B infection. All of the following statements is considered true regarding Hepatitis B infection during pregnancy, except:
Your Answer: Caesarean section does not reduce the risk of hepatitis B transmission
Correct Answer: A Screening for HBV is not recommended for a pregnant woman with previous vaccination
Explanation:The principal screening test for detecting maternal HBV infection is the serologic identification of HBsAg. Screening should be performed in each pregnancy, regardless of previous HBV vaccination or previous negative HBsAg test results.
A test for HBsAg should be ordered at the first prenatal visit. Women with unknown HBsAg status or with new or continuing risk factors for HBV infection (e.g., injection drug use or a sexually transmitted infection) should be screened at the time of admission to a hospital or other delivery setting.
Interventions to prevent perinatal transmission of HBV infection include screening all pregnant women for HBV, vaccinating infants born to HBV-negative mothers within 24 hours of birth, and completing the HBV vaccination series in infants by age 18 months.
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This question is part of the following fields:
- Obstetrics
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Question 10
Correct
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What is the mode of action of Mefenamic acid?
Your Answer: Inhibits Prostaglandin Synthesis
Explanation:Mefenamic acids is a NSAID. It works by inhibiting prostaglandin synthesis – It inhibits COX-1 and COX-2 hence reducing the process of inflammation. Activation of antithrombin III and inactivation of factor Xa is the primary mechanism of action of Heparin.
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This question is part of the following fields:
- Clinical Management
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Question 11
Correct
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A 33-year-old female patient walks into your office to speak with you about her recent pap smear result. A low-grade squamous intraepithelial lesion was discovered (LSIL). Her most recent pap smear, performed two years ago, came back normal. Which of the following is the most appropriate course of action?
Your Answer: Repeat the pap smear in one year
Explanation:An LSIL Pap test shows mild cellular changes. The risk of a high-grade cervical precancer or cancer after an LSIL Pap test is as high as 19 percent.
As with an ASC-US Pap test, an LSIL Pap test is evaluated differently depending upon age.
For women ages 25 or older, follow-up depends upon the results of human papillomavirus (HPV) testing:
– Women who test positive for HPV or who have not been tested for HPV should have colposcopy.
– Women who test negative for HPV can be followed up with a Pap test and HPV test in one year.Referring the patient to an oncologist is not acceptable since there is no established diagnosis of malignancy that has been made. All other options are unacceptable since Pap smear must be done in 12 months.
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This question is part of the following fields:
- Gynaecology
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Question 12
Correct
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You see a patient in fertility clinic who you suspect has Klinefelters. What is the likely karyotype?
Your Answer: 47XXY
Explanation:Klinefelter syndrome occurs in 1:1000 individuals. They are phenotypically male and genotypically they have 47,XXY chromosomes. These individuals have small testes, are tall with disproportionate long lower limbs.40% will also have gynecomastia.
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This question is part of the following fields:
- Genetics
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Question 13
Incorrect
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A patient is about to undergo a pudendal nerve block after vaginal delivery to repair an episiotomy. Which spinal segments form the pudendal nerve?
Your Answer: S1 and S2
Correct Answer: S2, S3 and S4
Explanation:The pudendal nerve provides sensory innervation to regions of the anus, the perineum, the labia and the clitoris in women. The nerve is formed from the ventral rami of the S2-S4 sacral spinal nerves. The nerve is paired, each innervating the left and the right side of the body. Pudendal nerve blocks are indicated for analgesia of the second stage of labour, repair of an episiotomy or perineal laceration, and for minor surgeries of the lower vagina and perineum.
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This question is part of the following fields:
- Anatomy
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Question 14
Incorrect
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Regarding uterine fibroids, which of the following statements is false?
Your Answer: Approximately 40% of white women had detectable fibroids by 35 years of age
Correct Answer: The risk of fibroids is increased by pregnancy
Explanation:Fibroids are a common gynaecological condition found in many women above the age of 35. They are however uncommon before puberty. They are most common in black women vs white women, and its prevalence increases from puberty to menopause. Risk factors for fibroids include increasing age, obesity and infertility. Protective factors, on the other hand, include pregnancy, as the risk of fibroids decreases with increasing numbers of pregnancies.
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This question is part of the following fields:
- Clinical Management
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Question 15
Correct
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Lactogenesis at term is stimulated by which hormone?
Your Answer: Prolactin
Explanation:Prolactin is the hormone that is responsible for the production of milk (Lactogenesis). Oxytocin is responsible for the let down reflex during suckling.
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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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A 34-year-old woman presents with a two-year history of secondary infertility. She has a three year old child who was fathered by the same partner. This first child was conceived spontaneously and delivered normally following a short labour. Her medical history includes irregular menstrual cycles, with periods occurring every three to four months. A pelvic ultrasound reveals 15-20 small cysts (4- 6 mm in diameter) in each ovary. Semen analysis, of her partner, shows a sperm count of ten million per mL, with 50% motility and 30% abnormal forms. Which one of the following is the best next step to treat her infertility?
Your Answer: Ovulation induction with gonadotrophins.
Correct Answer: Treatment with metformin.
Explanation:The clinical diagnosis of polycystic ovaries (PCO) is confirmed by the ultrasound. Therefore, the best next step to treat this woman’s infertility is to start treatment with metformin (correct answer). Patients with polycystic ovaries, frequently develop insulin resistance and metformin has been shown to be beneficial in this situation. Metformin treatment corrects any metabolic abnormalities and decreases insulin resistance resulting in a return of normal ovulatory menstrual cycles and a rapid improvement in fertility.
Additional treatment with clomiphene citrate may be required in some patients but gonadotrophin therapy is no longer commonly used.
Clomiphene citrate could also have been recommended as a possible next treatment option since the available data indicate that both clomiphene and metformin are equally effective.
Laparoscopic ovarian drilling has been used previously to treat polycystic ovaries; however, it is only used nowadays when all other treatment methods have been ineffective.
Similarly, gonadotrophin therapy or in vitro fertilisation would not be the best next step to treat the infertility and they are used when other treatment options have not provided the required results.
Even though changes in the semen analysis have been noted since the first pregnancy was achieved, these are not likely to be the cause of the secondary infertility, particularly because the current semen analysis is not significantly abnormal. Therefore, it is unlikely that donor insemination would be needed.
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This question is part of the following fields:
- Gynaecology
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Question 17
Incorrect
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Question 18
Incorrect
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A 38-year-old female patient comes to your office complaining of a foul-smelling grey vaginal discharge. Bacteria adhering to vaginal epithelial cells are visible under light microscopy using a wet mount preparation. Which of the following creatures is most likely to be a pathogen?
Your Answer: Trichomonas
Correct Answer: Gardnerella vaginalis
Explanation:Gardnerella vaginalis is one of the bacteria implicated in the development of bacterial vaginosis , many women (>50%) with this vaginal infection have no signs or symptoms, when these are present they are most often :
Vaginal discharge, grey, white or green, with a strong unpleasant odour
Strong vaginal odour and fishy smell after sex
Vaginal itching
Burning during urination
Vaginal bleeding after sex
Gardnerella vaginalis can also be responsible for serious infections (sepsis, wound infections) in locations other than those associated with the genital tract or obstetrics, these cases are very rare but have been reported, including in men.Mycoplasma Hominis is one of the organisms involved in the pathogenesis of BV but it appears normal on wet mount.
Candida presents with white cottage cheese like discharge.
Chlamydia is not seen on wet mount and produces clear vaginal discharge.
Trichomonas shows clue cells on wet mount.
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This question is part of the following fields:
- Gynaecology
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Question 19
Incorrect
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A patient, in her third pregnancy with a history of two consecutive spontaneous abortions, presents at 12 weeks of gestation. She has had regular menstrual cycles, lasting 30 days in duration. Just prior to coming for her assessment, she reports passing a moderate amount of blood with clots per vaginally along with some intermittent lower abdominal pain. On examination, her cervical canal readily admitted one finger. Bimanual palpation found a uterus corresponding to the size of a pregnancy of 8 weeks duration. Which is the most appropriate next step in managing this patient?
Your Answer: Cervical ligation.
Correct Answer: Vaginal ultrasound.
Explanation:It is essential to notice the important details mentioned in the case scenario. These would be the details about her menstruation, a smaller than dates uterus and an open cervix. A smaller than expected uterine size could be caused by her passing out some tissue earlier or it could be due to the foetus having been dead for some time. The finding of an open cervix would be in line with the fact that she had passed out some fetal tissue or it could signify that she is experiencing an inevitable miscarriage (while all fetal tissue is still kept within her uterus).
The likely diagnoses that should be considered for this case would be miscarriage (threatened, incomplete, complete and missed), cervical insufficiency, and ectopic pregnancy. A smaller than dates uterus and an open cervix makes threatened abortion an unlikely diagnosis. Her clinical findings could be expected in both an incomplete abortion and a complete abortion.
In ectopic pregnancy, although there would be a smaller than dates uterus, the cervical os would usually be closed. Cervical insufficiency is probable due to an open os but the uterine size would be expected to correspond to her dates, making it also less likely than a miscarriage.Since she most likely has had a miscarriage (be it incomplete or complete), the next best step would be to do a per vaginal ultrasound scan which could show whether or not products of conception are still present within the uterine cavity. If present, it would be an incomplete miscarriage which would warrant a dilatation and curettage; if absent, it is a complete miscarriage so D&C would not be needed.
In view of her open cervix and 12 weeks of amenorrhea, there is no indication for a pregnancy test nor assessment of her beta-hCG levels. Cervical ligation would only be indicated if the underlying issue was cervical incompetence, which is not in this case.
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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 24-year-old lady, who has not been able to conceive even after 2 years of unprotected intercourse, has come with concerns that she might have endometriosis. She is concerned because she has a friend who recently was diagnosed with it. Which symptom profile would be expected if this woman actually has endometriosis?
Your Answer: Dysmenorrhoea from the time of the menarche.
Correct Answer: No abnormal bleeding or pain.
Explanation:The clinical features of endometriosis include dyspareunia, dysmenorrhea, dysuria, dyschezia as well as infertility. Pain is characteristically long-term, cyclic (often occurring the same time as menses) and can get progressively worse over time. Laparoscopy remains the standard for diagnosis. There are many cases in which endometriosis is only discovered at the time of the workup for infertility.
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This question is part of the following fields:
- Gynaecology
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Question 21
Correct
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Question 22
Incorrect
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A patient is seen in clinic 6 weeks postpartum. The pregnancy was complicated by intrapartum haemorrhage requiring fluid resuscitation and a 2 unit blood transfusion. Mum reports feeling very tired, struggling to lose baby weight and needing to bottle feed due to very low volume lactation. What is the suspected diagnosis?
Your Answer: Idiopathic hypothyroidism
Correct Answer: Sheehan's Syndrome
Explanation:Sheehan syndrome is the pregnancy related infarction of the pituitary gland. During pregnancy the gland doubles in size but the blood supply does not increase significantly and during delivery due to the loss of blood it principates infarction. This results in fatigue, poor lactation and loss of pubic hair.
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This question is part of the following fields:
- Pathology
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Question 23
Correct
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While evaluating a 33-year-old woman for infertility, you diagnose a bicornuate uterus. You explain that additional testing is necessary because of the woman's increased risk of congenital anomalies in which system?
Your Answer: Urinary
Explanation:Bicornuate uterus is associated with an increased chance of urinary tract anomalies. Urinary tract anomalies were present in about 23.6% of cases of bicornuate uterus patients.
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This question is part of the following fields:
- Embryology
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Question 24
Correct
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A foetus is noted to be small for gestational age (SGA) on the 20 week scan. One of the mothers medications is stopped at this time. Follow up scans reveal renal dysgenesis. Which of the below medications was stopped?
Your Answer: Ramipril
Explanation:Use of angiotensin II receptors blocks and ACE inhibitors are known to result in renal dysgenesis. Due to renal dysgenesis oligohydramnios occurs that leads to IUGR.
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This question is part of the following fields:
- Pharmacology
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Question 25
Incorrect
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A 22-year-old pregnant woman attends clinic for a fetal scan at 31 weeks. She complains of difficulty breathing and a distended belly. U/S scan was done showing polyhydramnios and an absent gastric bubble. What is the most likely diagnosis?
Your Answer: Duodenal atresia
Correct Answer: Oesophageal atresia
Explanation:Oesophageal atresia of the foetus interrupts the normal circulation of the amniotic fluid. This causes polyhydramnios and subsequent distension of the uterus impacting proper expansion of the lungs. This would explain the difficulty breathing.
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This question is part of the following fields:
- Obstetrics
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Question 26
Incorrect
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Maternal serum prolactin levels in pregnancy are highest:
Your Answer: Just after the delivery of the infant
Correct Answer: On the 3rd to 4th day postpartum
Explanation:Prolactin is necessary for the secretion of milk by the cells of the alveoli. The level of prolactin in the blood increases markedly during pregnancy, and stimulates the growth and development of the mammary tissue, in preparation for the production of milk. However, milk is not secreted then, because progesterone and oestrogen, the hormones of pregnancy, block this action of prolactin. After delivery, levels of progesterone and oestrogen fall rapidly, prolactin is no longer blocked, and milk secretion begins.
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This question is part of the following fields:
- Physiology
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Question 27
Incorrect
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A 32 year old women who is 25 weeks pregnant presents with vaginal bleeding and cramping lower abdominal pain. On examination the cervix is closed. Fetal cardiac activity is noted on ultrasound. What is the likely diagnosis?
Your Answer: Threatened Miscarriage
Correct Answer: Antepartum Haemorrhage
Explanation:Antepartum haemorrhage is any bleeding that occurs from the female genital tract during the antenatal period after the 24+0 week of pregnancy and prior to the birth of the baby. The most common causes are placenta previa and placental abruption.
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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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All of the following statements is considered incorrect regarding the management of deep vein thrombosis in pregnancy, except:
Your Answer: Both warfarin and heparin are can be used to treat deep vein thrombosis in pregnancy
Correct Answer: Warfarin therapy is contraindicated throughout pregnancy but safe during breast feeding
Explanation:Anticoagulant therapy is the standard treatment for deep vein thrombosis (DVT) but is mostly used in non-pregnant patients. In pregnancy, unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are commonly used. Warfarin therapy is generally avoided in pregnancy because of its fetal toxicity.
Warfarin is contraindicated during pregnancy, but is safe to use postpartum and is compatible with breastfeeding. Low-molecular-weight heparin has largely replaced unfractionated heparin for prophylaxis and treatment in pregnancy.
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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 26 year old patient sustains a 4th degree perineal tear following delivery of her 1st baby. Your consultant agrees to supervise you repair the tear. From the list below what is the most appropriate suture option for repairing the anal mucosa?
Your Answer: 3-0 PDS interrupted sutures
Correct Answer: 3-0 polyglactin interrupted sutures
Explanation:Repair the vaginal mucosa using rapidly absorbed suture material on a large, round body needle. Start above the apex of the cut or tear (as severed vessels retract slightly) and use a continuous stitch to close the vaginal mucosa.
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This question is part of the following fields:
- Clinical Management
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Question 30
Correct
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A patient undergoes surgery for a vaginal vault prolapse. After surgery she complains of numbness and groin pain. You assess her and find the numb area is the anterior aspect of the labia. Which nerve has likely been damaged during surgery?
Your Answer: Ilioinguinal
Explanation:This describes the sensory area supplied by the ilioinguinal nerve. This is a potential complication with pelvic surgery.
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This question is part of the following fields:
- Anatomy
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SESSION STATS - PERFORMANCE PER SPECIALTY
