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Question 1
Incorrect
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What percentage of haemoglobin is HbF by 6 months of age?
Your Answer: <2%
Correct Answer:
Explanation:HB gower 1 is the predominant embryonic haemoglobin when the foetus is 6 week old and is replaced by adult haemoglobin by the age of 5 months post natally. Only 2% of the haemoglobin is HbF.
Embryonic Haemoglobin:
Haemoglobin Gower 1 (HbE Gower-1)
Haemoglobin Gower 2 (HbE Gower-2)
Haemoglobin Portland I (HbE Portland-1)
Haemoglobin Portland II (HbE Portland-2)Fetal Haemoglobin (haemoglobin F, HbF)
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This question is part of the following fields:
- Physiology
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Question 2
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A 26-year-old woman came in with a two-year history of amenorrhea and excessive facial hair growth. She had previously given birth to two children. FSH, LH, Prolactin, and oestrogen levels in the blood are all normal. The amount of testosterone in the blood is somewhat higher. More than 12 tiny cysts can be seen on a transvaginal pelvic ultrasonography. Which of the following is the most likely diagnosis?
Your Answer: Polycystic ovarian syndrome
Explanation:This patient has experienced polycystic ovarian syndrome-like symptoms.
At least two out of three of the following criteria must be met to diagnose polycystic ovarian syndrome:
1- Hyperandrogenism suggesting an excess of androgens e.g. excess hair growth, acne etc.
2- Menstrual irregularities e.g. dysmenorrhea, oligomenorrhea, and amenorrhea.
3-The ovaries are polycystic if one ovary has 12 or more follicles or if the size of one or both ovaries has risen.Low FSH, LH, and pituitary hormones are typically associated with hypothalamic dysfunction, however this is not the case here.
Similarly, with premature ovarian failure, FSH/LH levels rise while oestrogen levels decrease.All of the other choices are incorrect.
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This question is part of the following fields:
- Gynaecology
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Question 3
Correct
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Question 4
Incorrect
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One year ago, Pap smear was done at your clinic for a 53 year old female patient. HPV type 42 was detected and reported as LSIL. A repeat pap smear after 12 months shows no change. What is the next best step in management?
Your Answer: Repeat the pap smear in 12 months
Correct Answer: Refer for colposcopy
Explanation:The management of low-grade squamous intraepithelial lesions (LSIL) on cervical cytology in women ages 25 years or older depends upon whether the patient underwent high-risk human papillomavirus (HPV) testing.
Women in this age group comprise two different populations in terms of cervical cancer screening strategies. Professional organizations recommend that women ages 25 to 29 years be screened with cytology alone, while women 30 years or older should be screened with cytology and HPV co-testing. Thus, the American Society for Colposcopy and Cervical Pathology (ASCCP) prefers that women ages 25 to 29 years are not managed based upon HPV results, even if an HPV test was performed at the time of screening. For women with ages 30 years or older and HPV positive, colposcopy must be performed.
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This question is part of the following fields:
- Gynaecology
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Question 5
Incorrect
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A patient who is 36 weeks pregnant comes to see you as she has developed tingling to the right lateral thigh over the past 3 weeks. On examination there are no skin changes and no muscle weakness. What is the likely diagnosis?
Your Answer: Obturator nerve entrapment
Correct Answer: Meralgia Paraesthetica
Explanation:Raised pressure with the pelvis can cause a number of nerve entrapment syndromes. This is entrapment of the lateral cutaneous nerve of the thigh (or lateral femoral cutaneous nerve) also known as Meralgia Paraesthetica. Pregnancy is a risk factor. Shingles can effect this nerve but the rash would usually present itself within 14days.
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This question is part of the following fields:
- Anatomy
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Question 6
Incorrect
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A 32 year old patient develops painful ulcerated genital lesions and inguinal lymphadenopathy. She is 32 weeks pregnant. You suspect genital herpes and send swabs. Which of the following is appropriate management according to the 2014 BASHH/RCOG guidelines?
Your Answer: Give Acyclovir 400mg TDS orally for 5 days
Correct Answer: Send bloods to check antibody status. If this supports this is a first episode genital HSV then patient should be advised to have C-section delivery
Explanation:Although acyclovir should be given, this patient is in the 3rd trimester so the course should continue until delivery. Dose will be 400mg TDS unless disseminated disease. If this is a primary HSV infection (This should be confirmed by lesion swabs to confirm HSV infection and bloods to check no antibody response i.e. evidence previous infection) then C-section is indicated.
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This question is part of the following fields:
- Microbiology
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Question 7
Correct
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A 34 week pregnant patient complains of itching over the past 6 weeks particularly to the hands and feet which is worse at night. You order some blood tests. Which of the following would you normally expect to increase in the 3rd trimester?
Your Answer: ALP
Explanation:Pruritus of pregnancy is a common disorder, which occurs in 1 in 300 pregnancies, and presents as excoriated papules on extensor limbs, abdomen
and shoulders. It is more common in women with a history of atopy. Prurigo usually starts at around 25–30 weeks of pregnancy and resolves after delivery,
with no effect on the mother or baby. Treatment is symptomatic with topical steroids and emollients. It occurs due to derangement in the LFTs. ALP can rise to up to 3 times the normal non-pregnant value in the 3rd trimester.
All of the other tests above typically decrease during pregnancy. -
This question is part of the following fields:
- Clinical Management
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Question 8
Correct
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Maternal blood flow through the uterine artery at term is approximately
Your Answer: 750ml/min
Explanation:Uterine blood flow increases 40-fold to approximately 700 mL/min at term, with 80 per cent of the blood distributed to the intervillous spaces of the placentae, and 20 per cent to the uterine myometrium.
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This question is part of the following fields:
- Endocrinology
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Question 9
Incorrect
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During normal pregnancy, a weight gain is anticipated. The average weight gain is approximately:
Your Answer: 5-10 kg
Correct Answer: 10-15 kg
Explanation:Institute of Medicine Weight Gain Recommendations for Pregnancy: Recommends a gestational weight gain of 16.8–24.5 kg (37–54 lb) for women of normal weight, 14.1–22.7 kg (31–50 lb) for overweight women, and 11.3–19.1 kg (25–42 lb) for obese women.
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This question is part of the following fields:
- Physiology
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Question 10
Incorrect
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A 28 year old primigravida carrying a twin pregnancy presents at 32 weeks gestation. She is lethargic, clinically jaundiced and complains of abdominal pain with frequent vomiting. A summary of her blood results are as follows: Elevated aspartate transaminase (AST) and alanine transaminase (ALT) levels · Decreased blood glucose levels · Elevated levels of blood ammonia. What is the likely diagnosis?
Your Answer: Hepatitis A
Correct Answer: Acute fatty liver of pregnancy
Explanation:This patients bloods and symptoms suggest she has hepatic impairment. Acute fatty liver of pregnancy typically presents after the 30th week. The usual symptoms in the mother are non-specific including nausea, vomiting, anorexia (or lack of desire to eat) and abdominal pain; excessive thirst may be the earliest symptom without overlap with otherwise considered normal pregnancy symptoms; however, jaundice and fever may occur in as many as 70% of patients.
Many laboratory abnormalities are seen in acute fatty liver of pregnancy. Liver enzymes are elevated, with the AST and ALT enzymes ranging from minimal elevation to 1000 IU/L, but usually staying in the 300-500 range. Bilirubin is almost universally elevated. Alkaline phosphatase is often elevated in pregnancy due to production from the placenta, but may be additionally elevated. Other abnormalities may include an elevated white blood cell count, hypoglycemia, elevated coagulation parameters, including the international normalized ratio, and decreased fibrinogen. There may be increases of ammonia, uric acid aswell.
Recent studies have shown that being a primigravida, multiple pregnancies, carrying a male fetus, other liver diseases during pregnancy, previous history of AFLP, and pre-eclampsia are the potential risk factors for AFLP
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This question is part of the following fields:
- Clinical Management
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