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Question 1
Incorrect
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A 27-year-old woman comes to you during her first trimester seeking antenatal advice as she have a history of pre-eclampsia and obesity. On examination her blood pressure is 130/80 mmHg and BMI is 38. Administration of which among the following can reduce her risk of pre-eclampsia during this pregnancy?
Your Answer: Folic acid 0.5mg daily
Correct Answer: Calcium 1000mg daily
Explanation:This patient with a previous history of pre-eclampsia and obesity is at high risk for developing pre-eclampsia.
A daily intake of 1000mg of calcium is observed to be helpful in reducing the incidence of any hypertensive disorders and preterm labour.
Vitamin A should always be avoided during pregnancy as it is fetotoxic.
All other options are incorrect.
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This question is part of the following fields:
- Obstetrics
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Question 2
Correct
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A 30-year-old woman at her 18th week of pregnancy has been diagnosed with deep vein thrombosis of iliofemoral veins. Which of the following is considered the best management for the patient's condition?
Your Answer: Therapeutic dose of low molecular weight heparin for 6 months
Explanation:Deep venous thrombosis (DVT) during pregnancy is associated with high mortality, morbidity, and costs. Pulmonary embolism (PE), its most feared complication, is the leading cause of maternal death in the developed world. DVT can also result in long-term complications that include post thrombotic syndrome (PTS) adding to its morbidity. Women are up to 5 times more likely to develop DVT when pregnant. The current standard of care for this condition is anticoagulation.
Low molecular weight heparin (LMWH) is the preferred agent for prophylaxis and treatment of DVT during pregnancy. A disadvantage of LMWH over unfractionated heparin (UFH) is its longer half-life, which may be a problem at the time of delivery.
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This question is part of the following fields:
- Obstetrics
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Question 3
Incorrect
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A 29-year-old woman presents to her local Emergency Department with the complaint of feeling unwell. Her last menstrual period was eight weeks ago. Normally, she has regular monthly periods. She reports that she had heavy vaginal bleeding on the previous day; the bleeding had reduced today. On examination, she appears unwell, her pulse rate is 130 beats/min, BP is 110/60 mmHg, and temperature is 39.5°C Suprapubic tenderness and guarding is noted on abdominal examination. There is no evidence of a pelvic mass. Speculum examination shows that the cervix is open and apparent products of conception are present in the upper vagina. From the following, choose the most appropriate treatment option for optimal management of this patient.
Your Answer: Curettage after twelve hours of antibiotic therapy.
Correct Answer: Cervical swabs for microscopic assessment and culture.
Explanation:This woman has experienced a septic abortion. Therefore the first step is commencement of intensive antibiotic treatment as soon as cervical swabs have been taken.
The next step is evacuation of the uterus. Curettage can be performed after a few hours, to extract any remaining infected products of conception from the uterine cavity.
The choice of antibiotics depends on the most likely microorganism involved. Therefore, prior to commencing any other procedure, it is vital to take cervical swabs for microscopic examination to guide further antibiotic therapy (correct answer).
If curettage is performed immediately there is a risk that the infection would spread.
However, if Clostridium welchii infection is suspected from the cervical smear (particularly if encapsulation of the microorganisms is present), then curettage should be performed immediately along with commencing antibiotic treatment.
Curettage can be delayed for up to 12-24 hours if other microorganisms are suspected; unless a significant increase in bleeding occurs.
Ergometrine is not essential as an immediate treatment measure as the patient is not bleeding heavily and reports that her bleeding has decreased. However, ergometrine is commonly given when curettage is performed.
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This question is part of the following fields:
- Gynaecology
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Question 4
Correct
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Question 5
Correct
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Regarding anti-epileptic use in the 1st trimester of pregnancy, which of the following is closely associated with the development of congenital malformations?
Your Answer: Sodium valproate
Explanation:Sodium Valproate is known to be the most teratogenic when used in the first trimester of pregnancy. This antiepileptic increases the risk of congenital malformations including a 10-20 fold risk of neurodevelopmental defects. Though the use of antiepileptics should generally be avoided during pregnancy, carbamazepine, or newer drugs such as Lamotrigine are thought to carry less of a risk of teratogenicity.
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This question is part of the following fields:
- Clinical Management
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Question 6
Incorrect
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Which organism is the most common cause of puerperal sepsis?
Your Answer: Group B Streptococcus
Correct Answer: Group A Streptococcus
Explanation:Puerperal sepsis is defined as sepsis occurring after birth until 6 weeks postnatal. The most common cause of puerperal sepsis is Group A streptococcus. Until 1937, puerperal sepsis was the major cause of maternal mortality. The discovery of sulphonamides in 1935 and the simultaneous reduction in the virulence of the haemolytic streptococcus resulted in a dramatic fall in maternal mortality.
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This question is part of the following fields:
- Clinical Management
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Question 7
Correct
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Which cell type of the testis secrete inhibin?
Your Answer: Sertoli cells
Explanation:Summary points of the two key testicular cell types:
1. Sertoli Cells = Secrete Inhibin. Forms blood-testis barrier. Have FSH receptors
2. Leydig Cells = Secrete testosterone. Have LH receptors -
This question is part of the following fields:
- Anatomy
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Question 8
Correct
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A 35-year-old female went to a contraception clinic because she does not want to conceive for the next 2 years. She also has a history of heavy menstrual bleeding and pelvic pain. Imaging revealed fibroids. What is the best method of contraception for the patient in this case?
Your Answer: IUS
Explanation:IUS or Intra Uterine System/Device releases progestin. The progestin thickens the cervix, preventing the sperm from penetrating the cervix, and it also causes the uterine lining to become thinner, preventing any implantation. IUS may also prevent excessive bleeding and can help women with fibroids.
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This question is part of the following fields:
- Gynaecology
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Question 9
Correct
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What is the maximum normal diameter of the yolk sac on transvaginal ultrasound?
Your Answer: 6mm
Explanation:The yolk sac increases in size up until the 10th week reaching a maximum diameter of 6mm in normal pregnancy. After the 10th week the yolk sac will gradually disappear. It is usually sonographically undetectable by 20 weeks. A yolk sac greater than 6mm diameter is suspicious of failed pregnancy.
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This question is part of the following fields:
- Biophysics
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Question 10
Correct
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Question 11
Incorrect
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A 33-year-old woman is under your care during her pregnancy. She has had only one previous pregnancy in which her foetus had spina bifida. Identify the most appropriate assessment, from the following choices, that would aid in detection of spina bifida in her current pregnancy.
Your Answer: Maternal alpha-fetoprotein at 11-12 weeks of gestation,
Correct Answer: Ultrasound of the fetal spine at 16-18 weeks of gestation.
Explanation:An ultrasound of the foetal spine at 16-18 weeks of gestation is the most appropriate assessment (correct answer).
Ultrasound performed at 11-12 weeks of gestation can diagnose anencephaly, another neural tube defect, however; any vertebral column defect is unlikely to be detected.
In most cases of neural tube defects in the foetus, elevations will be noted in maternal alpha-fetoprotein levels at 12 to 15 weeks. However, it may not be possible to detect all such abnormalities and a confirmed diagnosis cannot be made.
Additionally, elevations in alpha-fetoprotein levels do not always correlate to the presence of foetal neural tube defects.
Nuchal translucency scans do not detect neural tube defects. They are performed to identify the risk of chromosomal abnormalities in the foetus.
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This question is part of the following fields:
- Obstetrics
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Question 12
Incorrect
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Question 13
Incorrect
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In the absence of any gross pelvic abnormality, cephalopelvic disproportion can be correctly diagnosed by?
Your Answer: Pelvic examination
Correct Answer: Trial of labour
Explanation:Cephalo-pelvic disproportion exists when the capacity of the pelvis is inadequate to allow the foetus to negotiate the birth canal. This may be due to a small pelvis, a nongynecoid pelvic formation, a large foetus, an unfavourable orientation of the foetus, or a combination of these factors. Diagnosis of CPD may be made when there is failure to progress, but not all cases of prolonged labour are the result of CPD. Use of ultrasound to measure the size of the foetus in the womb is controversial, as these methods are often inaccurate and may lead to unnecessary caesarean section; a trial of labour is often recommended even if size of the foetus is estimated to be large.
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This question is part of the following fields:
- Physiology
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Question 14
Correct
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A 27-year-old primigravida female presents to the emergency department at full term. 6 hours ago, she spontaneously began labour. The membranes ruptured two hours ago and the liquor was stained with meconium. On cardiotocography (CTG) was conducted and it showed some intermittent late decelerations, from 140 to 110 beats/min. On vaginal examination, her cervix is 5 cm dilated. The foetus is in cephalic presentation, in the left occipitotransverse (LOT) position, with the bony head at the level of the ischial spines (IS). Due to the deceleration pattern, a fetal scalp pH estimation was performed and the pH was measured at 7.32. An hour later, the CTG showed the following pattern over a period of 30 minutes: Baseline 140/min, Baseline variability 1/min, Accelerations None evident, Decelerations: Two decelerations were evident, with the heart rate falling to 80/min, and with each lasting 4 minutes. Another vaginal examination is conducted and her cervix is now 8cm dilated, but otherwise unchanged from one hour previously. What would be the next best line management?
Your Answer: Immediate delivery by Caesarean section.
Explanation:The next best line of management is immediate delivery via Caesarean section ( C section).
This is because of the change in cardiotocography (CTG). The pattern became much more severe with a virtual lack of short-term variability and prolonged decelerations. These changes indicate the necessity for an immediate C section as the cervix is not fully dilated.
As immediate delivery is indicated, another pH assessment is unnecessary as it would delay delivery and increase the likelihood of fetal hypoxia.
Delivery by ventose, in a primigravida where the cervix is only 8cm dilated is not indicated as it would allow the labour to proceed or augmenting with Syntocinon.
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This question is part of the following fields:
- Obstetrics
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Question 15
Incorrect
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A 37-year-old woman has been taking Microgynon (oral contraceptive pill [OCP]). When she presents for a repeat prescription, her BP is 160/100 mmHg. She mentions that she would like to stop the OCP in six months so that she can conceive. What is the most suitable advice for this woman?
Your Answer: Cease the OCP and commence hypotensive treatment with methyldopa.
Correct Answer: Cease the OCP, use condoms for contraception, and reassess the BP in three months.
Explanation:The woman’s blood pressure was elevated at her visit; therefore she should be advised to immediately cease the oral contraceptive pill (OCP) so that the hypertension can resolve without the need for any hypotensive treatment. The blood pressure can then be reassessed in three months. Alternative, non-hormonal birth control methods such as condoms should be used instead.
If her high blood pressure does not resolve, any medication that would be commenced to reduce her blood pressure should be one that is safe to continue when she becomes pregnant.
It is inappropriate to continue the OCP even at a lower dosage or in combination with a hypotensive agent.
Methyldopa has been evaluated and used for treatment of hypertension during pregnancy. There is no clinical evidence to suggest that it causes harm to the foetus or neonate.
Angiotensin converting enzyme (ACE) inhibitors are not approved for use in pregnancy as they have been associated with fetal death in utero. Other antihypertensive agents such as beta-blockers and diuretics are also problematic in pregnancy and should be avoided.
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This question is part of the following fields:
- Gynaecology
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Question 16
Incorrect
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A 46 year old women with a BMI of 34 is seen in clinic following hysteroscopy and biopsy for irregular menstrual bleeding. Histology shows hyperplasia without atypia. Following a discussion the patient declines any treatment but agrees she will try and lose weight. What is the risk of progression to endometrial cancer over 20 years?
Your Answer: 10-15%
Correct Answer:
Explanation:The risk of developing endometrial carcinoma is less than 5% over 20 years if the endometrium shows hyperplasia without atypia.
There are 2 types of Endometrial Hyperplasia:
1. Hyperplasia without atypia*
2. Atypical hyperplasiaMajor Risk Factors:
Oestrogen (HRT)
Tamoxifen
PCOS
Obesity
Immunosuppression (transplant) -
This question is part of the following fields:
- Clinical Management
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Question 17
Correct
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Which one of the following statements regarding Turner's syndrome is true?
Your Answer: Usually presents with primary amenorrhea
Explanation:Turner syndrome patients present with primary amenorrhea, have non functional or streak ovaries and cant conceive. They are 45X genetically.
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This question is part of the following fields:
- Embryology
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Question 18
Correct
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A pregnant woman who is a heavy smoker, observed some thick white patches on the inside of her mouth. Her oral cavity appears inflamed on examination. Which diagnosis is most likely correct?
Your Answer: Candidiasis
Explanation:During pregnancy, the chances for a woman to develop oral candidiasis double. An aphthous ulcer has a yellowish floor which is surrounded by an erythematous halo while in lichen planus, the lesions do not have the appearance of a thick white mark but are more or less lace-like. The lesions in leucoplakia have raised edges and they appear as bright white patches which are sharply defined and cannot be rubbed out. Smoking may affect the tongue, producing tongue coating. In this case the tongue is just inflamed which is a sign of infection.
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This question is part of the following fields:
- Obstetrics
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Question 19
Incorrect
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You are consenting a patient for a diagnostic hysteroscopy. What is the approximate risk of uterine perforation in diagnostic hysteroscopy?
Your Answer: 1.50%
Correct Answer: 0.10%
Explanation:The risk of uterine perforation is 0.1% during therapeutic hysteroscopy.
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This question is part of the following fields:
- Clinical Management
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Question 20
Incorrect
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A 32 year old woman who is 14 weeks pregnant presents to the clinic with yellow, frothy vaginal discharge and vaginal soreness. Trichomoniasis is confirmed after microscopy on a wet smear. Which of the following is the most appropriate treatment?
Your Answer: Spiramycin 1.5g BD 14 days
Correct Answer: Metronidazole 400mg TDS 7 days
Explanation:Trichomoniasis is considered a sexually transmitted infection found both in men and women 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.
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 screening for other STIs should be carried out.
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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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An 8 week pregnant female presents to the ob-gyn with bleeding from the vagina for the last two days. Bimanual examination reveals the uterus to be 8 weeks in size. On speculum examination, the cervical os is closed. How would the fetal viability be confirmed?
Your Answer: Transvaginal ultrasound
Explanation:Indication for a transvaginal ultrasound during pregnancy include:
– to monitor the heartbeat of the foetus
– look at the cervix for any changes that could lead to complications such as miscarriage or premature delivery
– examine the placenta for abnormalities
– identify the source of any abnormal bleeding
– diagnose a possible miscarriage
– confirm an early pregnancyThis is an ultrasound examination that is usually carried out vaginally at 6-10 weeks of pregnancy.
The aims of this scan are to determine the number of embryos present and whether the pregnancy is progressing normally inside the uterus.
This scan is useful for women who are experiencing pain or bleeding in the pregnancy and those who have had previous miscarriages or ectopic pregnancies.
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This question is part of the following fields:
- Obstetrics
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Question 22
Correct
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A 38 year old woman in early pregnancy is rushed to the emergency department complaining of vaginal bleeding and abdominal pain. What percentage of women her age have miscarriages?
Your Answer: 25%
Explanation:With increasing maternal age, the risk of miscarriage increases. For women between the ages of 40-44, the miscarriage rates sit at about 50% and increases to over 75% for women 45 years and over. The miscarriage rate for women between the ages of 35-39 is 25%.
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This question is part of the following fields:
- Epidemiology
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Question 23
Incorrect
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After six weeks of amenorrhoea, a 25-year-old woman appears with stomach discomfort and vaginal bleeding. If she has a tubal ectopic pregnancy, which of the following combinations of physical indications is most likely?
Your Answer: Tenderness in the pouch of Douglas and a tender adnexal mass.
Correct Answer: Little guarding but marked rebound tenderness in the suprapubic region.
Explanation:Blood in the peritoneal cavity rarely causes rigidity like that of a board (this is generally only found when chemical or purulent peritonitis is present).
When there is blood, there is usually a lot of rebound soreness and a lot of guarding.
A tubal ectopic pregnancy causes discomfort and tenderness in the lower abdomen, but it is not always localised to the side of the disease.
Shock is uncommon since the diagnosis is usually recognised before there is enough blood loss to elicit such signs.
Pelvic soreness is more prevalent than a pelvic mass that may be seen on a clinical exam.
Where a mass is visible, it could be an ectopic pregnancy, but it’s more likely to be a pregnancy surrounded by a blood clot caused by a leaking ectopic pregnancy. -
This question is part of the following fields:
- Gynaecology
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Question 24
Correct
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You receive a swab result from a patient who had complained of odorous vaginal discharge. It confirms bacterial vaginosis (BV). Which pathogen is most commonly associated with BV?
Your Answer: Gardnerella vaginalis
Explanation:BV typically presents as an increase in vaginal discharge and vaginal malodour caused by a change in vaginal bacterial flora. PV discharge due to BV is typically grey fluid that adheres to the vaginal mucosa. BV is a polymicrobial infection. Gardnerella is the most commonly associated pathogen. Other associated bacteria include Lactobacillus species, Prevotella, Mobiluncus, Bacteroides, Peptostreptococcus, Fusobacterium, Veillonella, Eubacterium species, Mycoplasma hominis, Urea plasma urealyticum and Streptococcus viridans.
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This question is part of the following fields:
- Clinical Management
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Question 25
Correct
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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: 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 26
Correct
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A 25 year old female patient comes in the first trimester of her pregnancy. Pap smear reveals that she has HSIL. What is the next best step in management?
Your Answer: Colposcopy
Explanation:Pregnant women with high-grade squamous intraepithelial lesions (HSIL) on cervical cytology should be evaluated with colposcopy. Principles of management of pregnant women include the following:
– An immediate diagnostic excisional procedure should NOT be performed.
– When colposcopy is performed during pregnancy:
– Endocervical sampling with a curette and endometrial sampling should NOT be performed, as there is a risk of disturbing the pregnancy; however, the endocervical canal may be sampled gently with a cytobrush.
– Cervical biopsy should be performed only if a lesion is present that appears to be high grade or suspicious for cancer.
– If the examination is unsatisfactory, repeating the colposcopy after 6 to 12 weeks should allow visualization of the entire squamocolumnar junction.There is no indication for inducing abortion or performing a hysterectomy.
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This question is part of the following fields:
- Gynaecology
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Question 27
Incorrect
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A 25 year old female with her LRMP 8 weeks ago, presented with severe abdominal pain and per vaginal bleeding. On examination there was tenderness over her left iliac region. Her pulse rate was 110 bpm and blood pressure was 90/65mmHg. Which of the following is the most appropriate management?
Your Answer: Salpingotomy
Correct Answer: Immediate laparotomy
Explanation:A ruptured ectopic pregnancy is the most probable diagnosis. As she is in shock (tachycardia and hypotension) immediate laparotomy is needed.
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This question is part of the following fields:
- Gynaecology
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Question 28
Incorrect
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A 30-year-old primigravida woman presented to the clinic for her first antenatal check-up. Upon interview, it was noted that she was taking folic acid along with some other nutritional supplements as medication. All of the following are considered correct regarding neural tube defects and folate before and during pregnancy, except:
Your Answer: Women taking carbamazepine should take high-dose folate supplement
Correct Answer: Prevalence of neural tube defects among non-indigenous population is almost double than that in Aboriginal and Torres Strait Islander babies
Explanation:Neural tube defects (NTDs) are common complex congenital malformations resulting from failure of the neural tube closure during embryogenesis. It is established that folic acid supplementation decreases the prevalence of NTDs, which has led to national public health policies regarding folic acid.
Neural tube defects (NTD) were 43% more common in Indigenous than in non-Indigenous infants in Western Australia in the 1980s, and there has been a fall in NTD overall in Western Australia since promotion of folate and voluntary fortification of food has occurred.
Women should take 5 mg/d of folic acid for the 2 months before conception and during the first trimester.
Women planning pregnancy might be exposed to medications with known antifolate activities affecting different parts of the folic acid metabolic cascade. A relatively large number of epidemiologic studies have shown an increased risk of NTDs among babies exposed in early gestation to antiepileptic drugs (carbamazepine, valproate, barbiturates), sulphonamides, or methotrexate. Hence, whenever women use these medications, or have used them near conception, they should take 5 mg/d of folic acid until the end of the first trimester of pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 29
Correct
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Which of the following Oestrogens (Oestrogens) becomes the predominant circulating oestrogen during pregnancy?
Your Answer: Estriol
Explanation:Oestradiol is the predominant form of oestrogen during the reproductive life of a female. The estrogenic potency of oestradiol is 12 times more than estrone and 80 times that of estriol.
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This question is part of the following fields:
- Endocrinology
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Question 30
Incorrect
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A 41 year old woman is referred to EPAU with spotting in early pregnancy. What is the risk of miscarriage in women in this age group?
Your Answer: 25%
Correct Answer: 50%
Explanation:Miscarriage rates:
20-24 – 9%
25-29 – 11%
30-34 – 15%
35-39 – 25%
40-44 – 51%
>45 – 75% -
This question is part of the following fields:
- Epidemiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
