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  • Question 1 - Which of the following causes an increase in Sex Hormone Binding Globulin (SHBG)?...

    Correct

    • Which of the following causes an increase in Sex Hormone Binding Globulin (SHBG)?

      Your Answer: Liver cirrhosis

      Explanation:

      Liver cirrhosis is known to lead to decreased levels of SHBG. Other causes of high SHBG are:
      Oestrogens e.g. oral contraceptives
      Pregnancy
      Hyperthyroidism
      Liver cirrhosis
      Anorexia nervosa
      Drugs e.g. anticonvulsants

    • This question is part of the following fields:

      • Endocrinology
      3.4
      Seconds
  • Question 2 - A 38-year-old female patient comes to your office complaining of a foul-smelling grey...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Gynaecology
      10.9
      Seconds
  • Question 3 - A 35-year-old lady complained of pelvic pain for three months. A tumour in...

    Incorrect

    • A 35-year-old lady complained of pelvic pain for three months. A tumour in her right iliac fossa was discovered during an examination. An ovarian cyst measuring 8 cm x 12 cm is visible on ultrasonography. What is the next management step?

      Your Answer: Reassurance

      Correct Answer: Refer to a gynaecologist

      Explanation:

      Many patients with simple ovarian cysts based on ultrasonographic findings do not require treatment.
      In a postmenopausal patient, a persistent simple cyst smaller than 10cm in dimension in the presence of a normal CA125 value may be monitored with serial ultrasonographic examinations.

      Premenopausal women with asymptomatic simple cysts smaller than 8cm on sonograms in whom the CA125 value is within the reference range may be monitored, with a repeat ultrasonographic examination in 8-12 weeks.

      Persistent simple ovarian cysts larger than 5-10 cm, especially if symptomatic, and complex ovarian cysts should be considered for surgical removal.

      For this patient, a premenopausal woman, with an ovarian cyst size 8 cm x 12cm. Surgical management is indicated, hence referral to gynaecologist is appropriate.

      Laparotomy or laparoscopic excision of cyst should be considered and performed by the gynaecologist not general practitioner.

    • This question is part of the following fields:

      • Gynaecology
      33.2
      Seconds
  • Question 4 - A 35-year-old lady with a 4-year history of hypertension is planning to conceive....

    Correct

    • A 35-year-old lady with a 4-year history of hypertension is planning to conceive. She has never been pregnant before and has stopped using contraception recently. She has a past medical history of asthma and the only medication she is on is ramipril 10 mg daily. On examination her blood pressure is found to be 130/85 mm/Hg. From the following which is the most appropriate initial management of her hypertension?

      Your Answer: Cease ramipril and start methyldopa

      Explanation:

      In the given case pre-pregnancy counselling and management of chronic hypertension is very much essential.
      Some commonly prescribed antihypertensive drugs like ACE inhibitors, angiotensin receptor antagonists, diuretics and most beta blockers are contraindicated or is best to be avoided before conception and during pregnancy.
      Methyldopa is considered as the first line drug for the management of mild to moderate hypertension in pregnancy and is the most commonly prescribed antihypertensive for this indication.
      Hydralazine can be used during any hypertensive emergencies in pregnancy.
      Intake of Angiotensin receptor blockers and ACE inhibitors during the first trimester can lead to complications as they are both teratogenic; use of these drugs during second and third trimesters can result in foetal renal dysfunction, oligohydramnios and skull hypoplasia.
      Diuretics can cause foetal electrolyte disturbances and significant reduction in maternal blood volume.
      All beta blockers, except labetalol, can result in foetal bradycardia, and growth restriction in case its long-term use.
      Calcium channel antagonists, except nifedipine, are avoided during pregnancy due to its high risk for maternal hypotension and foetal hypoxia.

    • This question is part of the following fields:

      • Obstetrics
      11.9
      Seconds
  • Question 5 - A 29 year old obese woman presents complaining of difficult or painful sexual...

    Incorrect

    • 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: Barrier method

      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.

    • This question is part of the following fields:

      • Gynaecology
      44.3
      Seconds
  • Question 6 - You see a 28 year old woman who is 22 weeks pregnant. She...

    Incorrect

    • You see a 28 year old woman who is 22 weeks pregnant. She complains of vaginal soreness and yellow frothy discharge. Microscopy confirms Trichomoniasis. What percentage of infected pregnant women present with yellow frothy discharge?

      Your Answer: 2%

      Correct Answer: 20%

      Explanation:

      Trichomoniasis is considered a sexually transmitted infection found both in men and women, and is caused by the flagellate protozoan Trichomonas vaginalis. The organism is mainly found in the vagina and the urethra. Though many infected women can be asymptomatic, they can also present with yellow frothy vaginal discharge, itching and vaginitis, dysuria or an offensive odour. About 20-30% of women with the infection however are asymptomatic. For the diagnosis of t. vaginalis in women, a swab is taken from the posterior fornix during speculum examination and the flagellates are detected under light-field microscopy. The recommended treatment for t. vaginalis during pregnancy and breastfeeding is 400-500mg of metronidazole twice daily for 5 -7 days. High dose metronidazole as a 2g single dose tablet is not advised during pregnancy. All sexual partners should also be treated and screened for other STIs.

    • This question is part of the following fields:

      • Clinical Management
      10.9
      Seconds
  • Question 7 - The expected date of delivery of a human pregnancy can be calculated as:...

    Correct

    • The expected date of delivery of a human pregnancy can be calculated as:

      Your Answer: 40 weeks after last menstrual period

      Explanation:

      Expected date of delivery/estimated due date (EDD) is a calculated date (i.e., an estimation), determined by counting forward 280 days (40 weeks) from the first day of the woman’s last menstrual period.

    • This question is part of the following fields:

      • Physiology
      5.1
      Seconds
  • Question 8 - Which immunoglobulin provides passive immunity to the neonate? ...

    Incorrect

    • Which immunoglobulin provides passive immunity to the neonate?

      Your Answer: IgM

      Correct Answer: IgG

      Explanation:

      Passive immunity to the neonate is provided by immunoglobulin G (IgG) since it can be transferred through the placenta from mother to the foetus.
      IgA is transferred from mothers to offspring through breast milk.
      IgM molecular structure is too big to be filtered through the placental vasculature to the foetus. IgM is the first Ig to be synthesised by the neonate

    • This question is part of the following fields:

      • Immunology
      5.5
      Seconds
  • Question 9 - When does ovulation occur? ...

    Incorrect

    • When does ovulation occur?

      Your Answer: 6-8 hours after LH surge

      Correct Answer: 36 hours after LH surge

      Explanation:

      Ovulation occurs in the mid stage of the menstrual cycle, usually 36 hours after the LH surge. It is this LH surge which is necessary for the ovulation to occur.

    • This question is part of the following fields:

      • Physiology
      6.5
      Seconds
  • Question 10 - During a speculum examination, a lady was found to have a firm, 12mm...

    Incorrect

    • During a speculum examination, a lady was found to have a firm, 12mm ulcerated, indurated lesion on her cervix. She was otherwise asymptomatic. Most likely cause would be?

      Your Answer: Herpes Simplex Type 2

      Correct Answer: Treponema pallidum

      Explanation:

      This lady is most likely suffering from primary syphilis. Since the chancre is asymptomatic, it is often only found on deep examination of the vulvo-vaginal mucosa. The chief organism causing syphilis is Treponema Pallidum which is a spirochete and one of the most widely distributed sexually transmitted infections.

    • This question is part of the following fields:

      • Microbiology
      13.8
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Endocrinology (1/1) 100%
Gynaecology (0/3) 0%
Obstetrics (1/1) 100%
Clinical Management (0/1) 0%
Physiology (1/2) 50%
Immunology (0/1) 0%
Microbiology (0/1) 0%
Passmed