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Question 1
Correct
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Prognathism and macroglossia are features of which of the following?
Your Answer: Acromegaly
Explanation:These are features of excess growth hormone i.e. Acromegaly. Down’s and Cri du chat typically cause Micrognathia (small jaw)
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This question is part of the following fields:
- Endocrinology
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Question 2
Correct
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What form is 99% of body calcium found in?
Your Answer: Calcium Phosphate
Explanation:Calcium phosphate salts are the most abundant form of calcium in the body, making up 99%. The majority of these salts are stored in the skeleton in different forms, mostly, hydroxyapatite, a lattice-like crystal composed of calcium, phosphates and hydroxide. The remaining calcium can be found in the extracellular fluid, tissues and skeletal muscle.
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This question is part of the following fields:
- Physiology
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Question 3
Correct
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From which germ cell layer does the GI tract initially develop?
Your Answer: Endoderm
Explanation:The GI tract forms from the endoderm. The endoderm grows laterally and then ventrally finally folding on its self to form the gut tube.
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This question is part of the following fields:
- Embryology
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Question 4
Correct
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A 28 year old patient has a diagnosis of PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2 and she is a non-smoker. She has been taking Clomiphene and metformin for the past 6 months. What is the next most appropriate treatment?
Your Answer: Gonadotrophins
Explanation:Management of PCOS includes OCP, cyclical oral progesterone, metformin, clomiphene (which is more effective in inducing ovulation than metformin) and life-style changes. In women who are tolerant to these therapies Gonadotrophins should be trialled. However lifestyle changes should be able to improve the condition significantly. Clomiphene shouldn’t be continued for more than 6 months.
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This question is part of the following fields:
- Clinical Management
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Question 5
Correct
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Regarding blood volume in pregnancy which of the following statements is TRUE?
Your Answer: Blood volume slowly increases by 40-50%
Explanation:Maternal blood volume expands during pregnancy to allow adequate perfusion of vital organs, including the placenta and foetus, and to anticipate blood loss associated with delivery. The rapid expansion of blood volume begins at 6–8 weeks gestation and plateaus at 32–34 weeks gestation. While there is some increase in intracellular water, the most marked expansion occurs in extracellular fluid volume, especially circulating plasma volume. This expanded extracellular fluid volume accounts for between 8 and 10 kg of the average maternal weight gain during pregnancy. Overall, total body water increases from 6.5 to 8.5 L by the end of pregnancy.
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This question is part of the following fields:
- Physiology
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Question 6
Incorrect
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Regarding cardiac output in pregnancy which of the following statements is TRUE?
Your Answer: Cardiac output increases by approximately 10-15% during pregnancy
Correct Answer: Cardiac output increases by approximately 40-50% during pregnancy
Explanation:In a non pregnant adult female the cardiac output is 4.5L/min, by the 20 week of pregnancy the cardiac output increases by 40% to 6.3L/min. During early stages of labour it increases further still by 17% to 7.3L/min.
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This question is part of the following fields:
- Physiology
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Question 7
Correct
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Which of the following is a double stranded RNA virus?
Your Answer: Rotavirus
Explanation:RNA viruses are almost always single stranded whilst DNA viruses are almost always double stranded. The exceptions are rotavirus and Parvovirus B19 respectively.
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This question is part of the following fields:
- Microbiology
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Question 8
Correct
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Congenital Cytomegalovirus (CMV) infection effects how many pregnancies?
Your Answer: 1 in 150
Explanation:CMV effects 1 in 200 pregnancies of which 30% will transmit the virus to the foetus and of which 30% foetus will be effected.
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This question is part of the following fields:
- Microbiology
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Question 9
Correct
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In which one of the following positions does hyperextension of the fetal head occur?
Your Answer: Face presentation
Explanation:Face presentation is the abnormal position of the fetal head in labour. In this position the neck is hyperextended.
Vertex position is the normal presentation of the foetus for delivery, in which the head is flexed and the position of the chin is towards the chest. -
This question is part of the following fields:
- Anatomy
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Question 10
Correct
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Which of the following structures does the broad ligament contain?
Your Answer: Uterine artery
Explanation:The broad ligament is one of the secondary supporting structures of the uterus which attaches the lateral portion of the uterus to the pelvic sidewall. The broad ligament primarily serves a protective layer for important structures including the fallopian tubes, the ovaries, the ovarian arteries, and the uterine arteries, the round and ovarian ligaments, and the infundibulopelvic ligaments.
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This question is part of the following fields:
- Anatomy
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Question 11
Correct
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A 39-year-woman visits a gynaecological clinic for fertility advice. She is unable to conceive for the last 2 years. Pelvic ultrasound shows 3-4 follicles in both ovaries. An endocrinological profile is ordered showing low oestrogen, elevated FSH, and LH. What is the most suitable advice for her?
Your Answer: In-vitro fertilization
Explanation:Premature menopause has been diagnosed biochemically in this patient. Menopause is considered premature when it happens without warning in a woman under the age of 40.
Follicular development is common in ultrasonography investigations of women with primary ovarian failure, but ovulation is rare. So this woman isn’t ovulating.Exogenous oestrogen treatment in physiologic amounts does not appear to improve the rate of spontaneous ovulation.
Women with primary ovarian failure from any cause may be candidates for donor oocyte in vitro fertilisation (IVF).Oestrogens, clomiphene citrate, and danazol are examples of treatment approaches that have been shown to be ineffective in patients with premature ovarian failure.
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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 are asked to assess a patients perineal tear following labour by vaginal delivery. You note a laceration that extends through the vaginal mucosa into the perineal muscle and fascia. The external anal sphincter appears to be in tact. How would you classify this tear?
Your Answer: 2nd
Explanation:If the external anal sphincter is in tact then this is a 1st or 2nd degree tear. As the perineal muscles are involved this is 2nd degree tear.
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This question is part of the following fields:
- Anatomy
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Question 13
Correct
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Pregnant patients are at higher risk of thromboembolism due to a hypercoagulable state. Which of the following clotting factors reduces during pregnancy?
Your Answer: Factor XI
Explanation:Pregnancy is a hypercoagulable state, which means that risk of thromboembolism is increased. The main reason is an increase in clotting factors II, factor VII, fibrinogen, factor X and factor XII, whereas factors XI and factor XIII are reduced. Naturally occurring anticoagulants i.e. protein C and protein S are both decreased thus increasing the risk of thrombus formation.
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This question is part of the following fields:
- Clinical Management
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Question 14
Correct
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Question 15
Correct
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Which of the following statements regarding management of obstetric anal sphincter injuries (OASIS) is true?
Your Answer: Broad-spectrum antibiotics should be given routinely following OASIS
Explanation:After perineal repair, lactulose and a bulking agent should ideally be given for 5-10 days as well as broad spectrum antibiotics should be given that will cover all possible anaerobic bacteria. At 6-12 months a full evaluation should be done regarding the progress of healing. 60 to 80% of women are asymptomatic 12 months post delivery and external anal sphincter repair.
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This question is part of the following fields:
- Clinical Management
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Question 16
Correct
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The source of progesterone that maintains the pregnancy during early 1st trimester:
Your Answer: Corpus luteum
Explanation:In early pregnancy Progesterone is produced by the corpus luteum.. This organ is fundamental for pregnancy maintenance until the placenta (syncytiotrophoblast) takes over its function at the 7-9th week of gestation, just after the expression of major histocompatibility complex antigens is suppressed in extra-embryonic fetal tissue.
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This question is part of the following fields:
- Endocrinology
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Question 17
Incorrect
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A 13-year-old girl, whose first period began three weeks ago, presents with very heavy bleeding that requires her to use twelve sanitary pads per day, and the bleeding does not appear to be decreasing. Which of the following investigations is most likely to identify the root cause of this issue?
Your Answer: Bleeding
oagulation profile.Correct Answer:
Explanation:It is usual to experience heavy, continuous bleeding around the time of menarche.
Haemoglobin and ferritin levels are used to determine the severity of bleeding and its impact on the haemoglobin level.
These analyses do not pinpoint the source of the problem, but they do pinpoint its consequences.
A haematologic reason, such as thrombocytopenia, acute leukaemia, or a coagulation/bleeding issue, affects about one-third of girls with pubertal menorrhagia (e.g. von Willebrand disease).
A complete blood examination and a bleeding
lotting profile are required to rule out these illnesses.
The results of a haemoglobin estimation or a ferritin level evaluation are insufficient, and the results of dilatation and curettage (D&C) or magnetic resonance imaging (MRI) will rarely reveal the reason for the bleeding. -
This question is part of the following fields:
- Gynaecology
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Question 18
Correct
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Which of the following is the primary host for Toxoplasma Gondii?
Your Answer: Cats
Explanation:Toxoplasma gondii, an intracellular protozoan, is the main causative agent for Toxoplasmosis. The primary host for the organism is the domestic cat. Humans can become infected by eating undercooked meat of animals harbouring cysts, consuming water or food contaminated with cat faeces, or through maternal-fetal transmission. Toxoplasmosis can cause complications in pregnancy such as miscarriages and congenital infection can lead to hydrocephalus, microcephaly, mental disability and vision loss.
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This question is part of the following fields:
- Microbiology
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Question 19
Correct
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The arcuate line forms part of the border of the pelvic brim. Where is it located?
Your Answer: Ilium
Explanation:The arcuate line is a smooth rounded border on the internal surface of the ilium just inferior to the iliac fossa. It forms the boundary of the pelvic inlet.
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This question is part of the following fields:
- Anatomy
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Question 20
Correct
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A 29 year old patient presents due to the sensation of reduced fetal movements (RFM). From what gestation is CTG assessment of RFM advised?
Your Answer: 28+0 weeks
Explanation:The cardiotocograph (CTG) is a continuous tracing of the fetal heart rate used to assess fetal wellbeing. The Doppler effect detects fetal heart motion and allows the interval between successive beats to be measured, thereby allowing a continuous assessment of fetal heart rate. The mother perceives the fetal movement by the 18-20 week of gestation and these increase until the 32 week. A mother should under go CTG if the fetal movements are reduced by the 28 week of gestation.
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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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What is the most common cause of hypercalcaemia?
Your Answer: Primary hyperparathyroidism
Explanation:Primary hyperparathyroidism is the most common cause of hypercalcaemia with incidence rates in the UK approximately 30 per 100,000 The majority of patients are postmenopausal women.
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This question is part of the following fields:
- Physiology
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Question 22
Correct
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A 36 year old woman has a pelvic ultrasound scan showing multiple fibroids. What is the most common form of fibroid degeneration?
Your Answer: Hyaline degeneration
Explanation:Hyaline degeneration is the most common form of fibroid degeneration. Fibroids:
Risk Factors
– Black Ethnicity
– Obesity
– Early Puberty
– Increasing age (from puberty until menopause)
Protective Factors
– Pregnancy
– Multiparity -
This question is part of the following fields:
- Clinical Management
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Question 23
Correct
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A 28-year-old woman at 35 weeks gestation who is gravida 2 para 1, presented to the labour and delivery department since she has been having regular, painful contractions over the past 3 hours. Upon interview and history-taking, it was noted that the patient has had no prenatal care during this pregnancy. She also has no chronic medical conditions, and her only surgery was a low transverse caesarean delivery 2 years ago. Upon admission, her cervix is 7 cm dilated and 100% effaced with the fetal head at +2 station. Fetal heart rate tracing is category 1. Administration of epidural analgesia was performed, and the patient was relieved from pain due to the contractions. There was also rupture of membranes which resulted in bright-red amniotic fluid. Further examination was done and her results were: Blood pressure is 130/80 mmHg, Pulse is 112/min. Which of the following is most likely considered as the cause of the fetal heart rate tracing?
Your Answer: Fetal blood loss
Explanation:Fetal heart rate tracings (FHR) under category I include all of the following:
– baseline rate 110– 160 bpm
– baseline FHR variability moderate
– accelerations present or absent
– late or variable decelerations absent
– early decelerations present or absentThe onset of fetal bleeding is marked by a tachycardia followed by a bradycardia with intermittent accelerations or decelerations. Small amounts of vaginal bleeding associated with FHR abnormalities should raise the suspicion of fetal haemorrhage. This condition demands prompt delivery and immediate reexpansion of the neonatal blood volume.
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This question is part of the following fields:
- Obstetrics
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Question 24
Correct
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A 38-year-old woman presents to the gynaecologic clinic with a complaint of headache, irritability, insomnia, abdominal bloating, anxiety, and breast tenderness around 4 to 5 days before menstruation for the last 8 months. There's also a limitation on daily activities and she has to take a week off from work. The patient's symptoms are relieved with the onset of menstruation. She does not smoke or drink alcohol. There is no other significant past medical history. Which of the following is the best treatment?
Your Answer: Fluoxetine
Explanation:The signs and symptoms of premenstrual dysmorphic disorder are well-known in this patient. Fluoxetine is the greatest therapeutic option among the available options.
For severe symptoms, clomipramine and danazol can be used interchangeably.
Bromocriptine, like oral contraceptives and evening primrose, has no scientific evidence to support its use in this syndrome.
NSAIDs are helpful for painful symptoms, but they only address a limited number of them. -
This question is part of the following fields:
- Gynaecology
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Question 25
Correct
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A 31 year old is being seen in EPU and you are asked to review her ultrasound. There is a solid collection of echoes with numerous small (3-10 mm) anechoic spaces. What is the likely diagnosis?
Your Answer: Molar Pregnancy
Explanation:This is typical appearance of molar pregnancy. This used to be referred to as ‘snowstorm sign’ as with older poorer resolution ultrasound the anechoic species looked like a snowstorm.
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This question is part of the following fields:
- Data Interpretation
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Question 26
Correct
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In which of the following situations are mini-pills unsafe to use?
Your Answer: Ovarian cysts
Explanation:Progestin only pills increase the risk of developing follicular cysts. Sonographic studies have observed that follicular cysts are more common in POP users than women not using hormones. The follicular changes tend to increase and regress over time. No intervention is required in asymptomatic women, other than reassurance. POP users who have persistent concerns about ovarian follicular changes should be offered another method of contraception.
All other options are not contraindications to the use of mini-pills.
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This question is part of the following fields:
- Gynaecology
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Question 27
Correct
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From which germ cell layer does the GI tract initially develop?
Your Answer: Endoderm
Explanation:GI Tract initially forms via gastrulation from the endoderm of the trilaminar embryo around week 3. It extends from the buccopharyngeal membrane to the cloacal membrane. Later in development there are contributions from all three germ cell layers.
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This question is part of the following fields:
- Embryology
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Question 28
Correct
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A patient is diagnosed with cervical cancer and staging investigations show there is parametrial involvement but it is confined within the pelvic wall and does not involve the lower 1/3 vagina. There is no evidence of hydronephrosis. What FIGO stage is this?
Your Answer: 2B
Explanation:This is stage 2B.
2010 FIGO classification of cervical carcinoma
0 – Carcinoma in situ
1 – Confined to the cervix (diagnosed microscopy)
1A1 – Less than 3mm depth & 7mm lateral spread
1A2 – 3mm to 5mm depth & less than 7mm lateral spread
1B1 – Clinically visible lesion or greater than A2 & less than 4 cm in greatest dimension
1B2 – Clinically visible lesion, Greater than 4 cm in greatest dimension 2 Invades beyond uterus but not to pelvic wall or lower 1/3 vagina
2A1 – Involvement of the upper two-thirds of the vagina, without parametrical invasion & Less than 4cm
2A2 – Greater than 4 cm in greatest dimension
2B – Parametrial involvement
3 – Extends to Pelvic side wall or lower 1/3 vagina or hydronephrosis
3A – No pelvic side wall involvement
3B – Pelvic side wall involved or hydronephrosis
4 – Extends beyond true pelvis
4A – Invades mucosa bladder and rectum
4B – Distant Metastasis -
This question is part of the following fields:
- Clinical Management
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Question 29
Correct
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Polyhydramnios is associated with which one of the following conditions?
Your Answer: Tracheo-oesophageal fistula
Explanation:Oesophageal atresia/TE fistula may be suspected prenatally with ultrasound findings of polyhydramnios, absence of fluid in the stomach, small sized abdomen, or the presence of a dilated proximal oesophageal pouch. An underlying disease is only found in 17 % of cases in mild polyhydramnios. In contrast, an underlying disease is detected in 91 % of cases in moderate to severe polyhydramnios. The literature lists the following potential aetiologies: fetal malformations and genetic anomalies (8–45 %), maternal diabetes mellitus (5–26 %), multiple pregnancies (8–10 %), fetal anaemia (1–11 %), other causes, e.g. viral infections, Bartter syndrome, neuromuscular disorders, maternal hypercalcemia. Viral infections which can lead to polyhydramnios include parvovirus B19, rubella, and cytomegalovirus. Other infections, e.g. toxoplasmosis and syphilis, can also cause polyhydramnios.
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This question is part of the following fields:
- Physiology
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Question 30
Correct
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Which of the following tests is used to detect antibodies or complement bound to red blood cell antigens in vivo?
Your Answer: Direct Coombs
Explanation:When the red cells are coated with immune IgG antibody, the cells do not agglutinate but when anti-IgG antiserum is added to these sensitized cells visible agglutination occurs. This is known as a positive direct coombs test.
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This question is part of the following fields:
- Physiology
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Question 31
Correct
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Which of the following organisms causes Scarlet Fever?
Your Answer: Streptococcus pyogenes
Explanation:Streptococcus pyogenes, also known as group A beta-haemolytic streptococcus, is the organism responsible for scarlet fever. The bacteria is found in secretions from the nose, ears or the skin, and infections may be preceded by wounds, burns or respiratory infections. Symptoms may include a sore throat, fever, a red skin rash and cervical lymphadenopathy. Untreated scarlet fever in children and adolescents can lead to rheumatic fever, or post-streptococcal glomerulonephritis.
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This question is part of the following fields:
- Microbiology
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Question 32
Correct
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Sensory supply to the clitoris is via branches of which nerve?
Your Answer: Pudendal nerve
Explanation:The pudenal nerves has three branches, namely the inferior rectal, perineal and the dorsal nerve of the clitoris. The perineal nerve has two branches: The superficial perineal nerve gives rise to posterior scrotal or labial (cutaneous) branches, and the deep perineal nerve supplies the muscles of the deep and superficial perineal pouches, the skin of the vestibule, and the mucosa of the inferior most part of the vagina. The inferior rectal nerve communicates with the posterior scrotal or labial and perineal nerves. The dorsal nerve of the penis or clitoris is the primary sensory nerve serving the male or female organ, especially the sensitive glans at the distal end.
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This question is part of the following fields:
- Anatomy
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Question 33
Correct
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An 18-year-old woman came into your office looking for contraception assistance. Her new partner and she are arranging a trip to Thailand. She has no contraindications. What is the best piece of advice?
Your Answer: Oral contraceptive pills and condoms
Explanation:OCPs should be started in this patient as well as condoms to prevent likely sexually transmitted infections.
Condoms alone are not effective for prevention of pregnancy.
OCPs alone do not prevent from sexually transmitted infections.
It is not appropriate to inform the parents and the patient hasn’t refused any advice.
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This question is part of the following fields:
- Gynaecology
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Question 34
Correct
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Among the following situations which one is NOT considered a risk factor for isolated spontaneous abortions?
Your Answer: Retroverted uterus
Explanation:Most common risk factors for spontaneous abortion are considered to be:
– Age above 35 years.
– Smoking.
– High intake of caffeine.
– Uterine abnormalities like leiomyoma, adhesions.
– Viral infections.
– Thrombophilia.
– Chromosomal abnormalities.
Conditions like subclinical thyroid disorder, subclinical diabetes mellitus and retroverted uterus are not found to cause spontaneous abortions.
The term retroverted uterus is used to denote a uterus that is tilted backwards instead of forwards. -
This question is part of the following fields:
- Obstetrics
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Question 35
Correct
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We can detect the fetal heart beat by Sonography (transvaginal) at:
Your Answer: 6 weeks
Explanation:The earliest fetal heart rate detected transvaginally was at 6 weeks 0 days of gestation compared with 7 weeks 0 days transabdominally. The transvaginal Doppler method was also more successful in detecting the fetal heart rate in women with a retroverted uterus (p < or = 0.01).
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This question is part of the following fields:
- Physiology
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Question 36
Correct
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Which of the following is the primary source of oestrogen ?
Your Answer: Granulosa cells
Explanation:Ovarian granulosa cells (GC) are the major source of oestradiol synthesis. Induced by the preovulatory luteinizing hormone (LH) surge, cells of the theca and, in particular, of the granulosa cell layer profoundly change their morphological, physiological, and molecular characteristics and form the progesterone-producing corpus luteum that is responsible for maintaining pregnancy.Â
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This question is part of the following fields:
- Endocrinology
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Question 37
Correct
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A 53 year old female presents with hot flushes and night sweats. Her last menstrual period was last year. She had MI recently. Choose the most appropriate management for this patient.
Your Answer: Clonidine
Explanation:With a history of MI, oestrogen and COCP should be avoided. Evening primrose is also not suitable for post-menopausal symptoms. Raloxifene is a SERM – these make hot flushes worse. Clonidine will help improve the hot flushes and the vasomotor symptoms.
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This question is part of the following fields:
- Gynaecology
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Question 38
Correct
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WHO defines the perinatal mortality rate as
Your Answer: The number of stillbirths and deaths in the first week of life per 1000 births
Explanation:WHO defines perinatal death as the number of still births and death in the first week of life per 1000 births.
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This question is part of the following fields:
- Epidemiology
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Question 39
Correct
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Question 40
Correct
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A 25 year old unmarried female presented with dizziness, nausea and vomiting for 1 week. According to her, she has been stressed recently and her usual menstrual period has been delayed by 4 weeks. Examination findings were normal. Which of the following is the most appropriate next step?
Your Answer: Dipstick for B-hCG
Explanation:There is high possibility of her being pregnant. Urine B-hCG has to be checked to exclude pregnancy.
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This question is part of the following fields:
- Gynaecology
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Question 41
Correct
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A 30-year-old pregnant woman, at her 29th week of gestation, presents to physician with flu-like symptoms for the past 3 days along with runny nose, mild headache and she feels achy. She also has mild fever and diffuse rash all over her body. She is concerned about the health of her baby and wants to know if there are any safe medications which will make her feel better in a short time. She has received tetanus vaccination as part of antenatal care program since she immigrated at the end of her first trimester from Romania. Patient is otherwise healthy. Considering the symptoms and travel history of this patient, she is at higher risk of giving birth to a newborn with which of the following options?
Your Answer: Wide pulse pressure
Explanation:This pregnant woman likely has an infection with the rubella virus, which increases the risk of congenital rubella syndrome in her newborn. congenital heart diseases, particularly patent ductus arteriosus (PDA) is a part of this syndrome. Persistence of a patent vessel between the left pulmonary artery and aorta which is supposed to closes in the first 18 hours functionally and in the first 2–3 days of life anatomically is called as PDA.
Normally there is right to left shunting in utero, but in case of PDA blood is shunted from the left (aorta) to the right (pulmonary artery) due to the decrease in pulmonary vascular resistance after birth. This causes right ventricular hypertrophy, if left untreated it can lead to left ventricular hypertrophy and heart failure. There will be a continuous machine-like murmur, heard over the left upper sternal border, as the blood is shunted throughout cardiac cycle. Diastolic BP becomes lower than normal, leading to a higher pulse pressure which is felt as a bounding pulse due to the lost volume from aorta. Though PDA is a non-cyanotic condition, it may lead to Eisenmenger’s syndrome in which R to L shunting persists, resulting in cyanosis, clubbing and polycythemia. Treatment with nonsteroidal anti-inflammatory drugs like indomethacin can close patent PDA. Other symptoms in infants born with rubella syndrome are microcephaly and cataract.
The characteristic feature of an atrial septal defect or ASD, which is a congenital heart disease presenting as an opening in the septa between right and left atria, is a single fixed S2. There will be a delay in closure of the pulmonic valve, due to the excess amount of blood diverted to the right side.
Brachial-femoral delay is a finding in coarctation of aorta, which presents as hypertension in the upper extremities and hypotension in the lower extremities.
A double split S2 is a physiological finding caused by the closure of pulmonary and aortic valves on inspiration.
PDA and pulmonary artery stenosis are the most common cardiac defects reported along with congenital rubella syndrome (CRS), whereas tricuspid valve regurgitation is never reported along with it.
Learning objective: is associated with a continuous machine-like murmur heard over the left upper sternal border, bounding pulse and an increased pulse pressure are the usual symptoms associated with patent ductus arteriosus (PDA), which is mostly seen along with congenital rubella syndrome.
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This question is part of the following fields:
- Obstetrics
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Question 42
Correct
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A 25-year-old woman at 39 weeks of gestation complaints of intermittent watery vaginal discharge, which has started last night after she had sex with her husband. Speculum examination shows, pooling of straw-colored fluid in the posterior vaginal fornix. The cervical os is closed and there is leaking of liquor from cervical os when she is asked to cough or strain. Which among the following best explains these clinical findings?
Your Answer: Premature rupture of membranes (PROM)
Explanation:Presentation in the given case is classic for premature rupture of membranes (PROM) which was probably caused due to trauma during intercourse.
Premature rupture of membrane (PROM) is defined as the rupture of embryonic membranes before the onset of labor, regardless of the age of pregnancy. If occured before 37 weeks of gestation, it is termed as preterm PROM (PPROM.)A sudden gush of watery fluid per vagina is the classic presentation of rupture of the membranes (ROM), regardless of gestational age, however nowadays many women presents with continuous or intermittent leakage of fluid or a sensation of wetness within the vagina or on the perineum. Presence of liquor flowing from the cervical os or its pooling in the posterior vaginal fornix are considered as the pathognomonic symptom of ROM. Assessment of fetal well-being, the position of the fetus, placental location, estimated fetal weight and presence of any anomalies in PROM and PPROM are done with ultrasonographic studies.
Retained semen will not result in the findings mentioned in this clinical scenario as it have a different appearance.
Infections will not be a cause for this presentation as it will be associated with characteristic features like purulent cervical discharge, malodorous vaginal discharge, etc. Pooling of clear fluid in the posterior fornix is pathognomonic for ROM.
Urine leakage is common during the pregnancy, but it is not similar to the clinical scenario mentioned above.
Absence of findings like cervical dilation and bulging membranes on speculum exam makes cervical insufficiency an unlikely diagnosis in this case.
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This question is part of the following fields:
- Obstetrics
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Question 43
Correct
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Maternal serum prolactin levels in pregnancy are highest:
Your 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 44
Correct
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When a 75-year-old lady laughs, sneezes, coughs, or lifts big weights, she leaks pee. She also claims that she has the urge to pass pee 10-12 times a day, and that she can't go to the restroom half of the time. She appears to have a harder time with urgency. Infections are not found in a urine test. Except for a residual amount of 125cc, an ultrasound scan of the bladder, ureter, and kidneys is inconclusive. Which of the following treatment options is the best fit for her?
Your Answer: Bladder training
Explanation:This woman has mixed incontinence, which includes signs and symptoms of both stresses and urges incontinence. The urge, on the other hand, irritates her. Bladder training would be the most appropriate management approach to investigate first for women with urge incontinence as the most troublesome symptom. The objectives are:
– Using a bladder diary to establish a baseline
– Creating a voiding schedule
– Over a long period, gradually increase the voiding interval in increments of 2- 5 minutes, to void every 3 hours.
– Other important strategies to consider are lifestyle changes like reducing fluid intake, losing weight, and avoiding diuretics-producing foods and beverages (e.g., alcoholic beverages, caffeine, etc).When urge incontinence does not respond to physical or behavioural therapy, anticholinergics along with ongoing bladder training are an alternative. A 4- to 6-week trial is employed. At six months, risk and benefit are weighed to see if treatment should be continued for those who react. Patients should be informed about anticholinergic side effects such as dry mouth and constipation, as well as how to control them.
Anterior colporrhaphy is a treatment for cystocele that involves repairing the front vaginal wall. It can help people with urine incontinence. If you don’t have a cystocele, bladder neck suspension is the best option.
Retropubic bladder suspension is a more intrusive surgery for treating stress urinary incontinence in patients who haven’t responded to less invasive treatments like pelvic floor exercise.The most essential initial conservative therapy to explore for patients with real stress incontinence and mixed (both stress and urge) urine incontinence when stress incontinence is the more prominent symptom is pelvic floor muscle exercise (e.g. Kegel exercise). For urge incontinence, more difficult training can be applied.
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This question is part of the following fields:
- Gynaecology
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Question 45
Correct
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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: 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 46
Correct
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A 35 year old primigravida was in labour for 24 hours and delivered after an induction. She developed postpartum haemorrhage. Which of the following is the most likely cause for PPH?
Your Answer: Atonic uterus
Explanation:Uterine atony and failure of contraction and retraction of myometrial muscle fibres can lead to rapid and severe haemorrhage and hypovolemic shock. Poor myometrial contraction can result from fatigue due to prolonged labour or rapid forceful labour, especially if stimulated.
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This question is part of the following fields:
- Obstetrics
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Question 47
Correct
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Which of the following statements regarding Management of Beta Thalassaemia in Pregnancy is not part of the RCOG guidelines?
Your Answer: Folic acid 5 mg daily should be commenced 12 months prior to conception
Explanation:Women with Beta-Thalassaemia require significant extra input during pregnancy. Folic acid 5 mg daily should be commenced 3 months prior to conception in these patients. NOTE Women with thalassaemia who have undergone splenectomy OR have a platelet count >600 should continue or be commenced on Aspirin (75 mg/day)
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This question is part of the following fields:
- Genetics
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Question 48
Correct
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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: 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 49
Correct
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Question 50
Correct
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All of the following are autosomal recessive conditions EXCEPT which one?
Your Answer: Osteogenesis Imperfecta
Explanation:Osteogenesis imperfect is an autosomal dominant condition. All the rest of the options are autosomal recessive conditions.
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This question is part of the following fields:
- Endocrinology
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SESSION STATS - PERFORMANCE PER SPECIALTY
