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  • Question 1 - A 34 year old white primigravida in her first trimester had established moderate...

    Correct

    • A 34 year old white primigravida in her first trimester had established moderate hypertension before becoming pregnant. She currently has a blood pressure of 168/108 mm Hg. You are considering how to best manage her hypertension during the pregnancy. Which one of the following is associated with the greatest risk of fetal growth retardation if used for hypertension throughout pregnancy?

      Your Answer: Atenolol (Tenormin)

      Explanation:

      Atenolol and propranolol are associated with intrauterine growth retardation when used for prolonged periods during pregnancy. They are class D agents during pregnancy. Other beta-blockers may not share this risk.

      Methyldopa, hydralazine, and calcium channel blockers have not been associated with intrauterine growth retardation. They are generally acceptable agents to use for established, significant hypertension during pregnancy.

    • This question is part of the following fields:

      • Obstetrics
      9.2
      Seconds
  • Question 2 - Regarding listeria infection during pregnancy, what is the fetal case mortality rate? ...

    Incorrect

    • Regarding listeria infection during pregnancy, what is the fetal case mortality rate?

      Your Answer: 10%

      Correct Answer: 25%

      Explanation:

      Listeria Monocytogenes is a cause of congenital infection. The most common source of the bacteria is food, especially unpasteurised milk. Congenital listeriosis can lead to spontaneous abortions, premature birth and chorioamnionitis. At birth, neonates may present with septicaemia, respiratory distress and inflammatory granulomatosis. The case mortality rate for listeriosis is thought to be between 20-30%.

    • This question is part of the following fields:

      • Microbiology
      6.7
      Seconds
  • Question 3 - Which of the following is the most likely anaesthetic or analgesic causing reduced...

    Incorrect

    • Which of the following is the most likely anaesthetic or analgesic causing reduced variability on cardiotocograph?

      Your Answer: General anaesthetic

      Correct Answer: Intramuscular pethidine

      Explanation:

      Opiates and spinal anaesthetics reduce the variability of a CTG. Including some antihypertensives like labetalol and alpha methyl dopa.

    • This question is part of the following fields:

      • Obstetrics
      22.1
      Seconds
  • Question 4 - A 37-year-old woman has been taking Microgynon (oral contraceptive pill [OCP]). When she...

    Correct

    • 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, 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.

    • This question is part of the following fields:

      • Gynaecology
      39.7
      Seconds
  • Question 5 - A 28-year-old female patient comes in for a prenatal appointment. She eats only...

    Correct

    • A 28-year-old female patient comes in for a prenatal appointment. She eats only vegetables. Which of the following is the most appropriate suggestion for folic acid supplementation?

      Your Answer: She should be started on folic acid 0.5 mg per day

      Explanation:

      Folate has been in the news because of its connection with a type of birth defect called neural tube defect. Studies have shown that women who have infants with neural tube defects have lower intakes of folate and lower blood folate levels than other women. Folate is needed early in pregnancy (before many women know they are pregnant) for normal neural tube development.

      Many vegan foods including enriched bread, pasta, and cold cereal; dried beans; green leafy vegetables; and orange juice are good sources of folate. Vegan diets tend to be high in folate, however, to be on the safe side, women capable of becoming pregnant should take a supplement or use fortified foods that provide 400 micrograms of folate daily.

      For the above mentioned reasons, all other options are incorrect.

    • This question is part of the following fields:

      • Gynaecology
      3.7
      Seconds
  • Question 6 - You are called to see a 24 year old patient in A&E. She...

    Correct

    • You are called to see a 24 year old patient in A&E. She is 34 weeks gestation and her blood pressure is 149/98. Urine dip shows protein 3+. You send a for a protein:creatinine ratio. What level would be diagnostic of significant proteinuria?

      Your Answer: >30 mg/mmol

      Explanation:

      Significant proteinuria = urinary protein:creatinine ratio >30 mg/mmol or 24-hour urine collection result shows greater than 300 mg protein

    • This question is part of the following fields:

      • Clinical Management
      4.9
      Seconds
  • Question 7 - The source of progesterone that maintains the pregnancy during early 1st trimester: ...

    Correct

    • 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.

    • This question is part of the following fields:

      • Endocrinology
      4.8
      Seconds
  • Question 8 - A 24-year-old nulliparous lady has lately started having sexual encounters. She seeks your...

    Correct

    • A 24-year-old nulliparous lady has lately started having sexual encounters. She seeks your advice since she is experiencing painful coitus at the vaginal introitus. It's accompanied by painful involuntary pelvic muscular contractions. The pelvic examination is normal except for confirmation of these findings. The most prevalent cause of this ailment is one of the following?

      Your Answer: Psychogenic causes

      Explanation:

      Vaginismus is an uncontrollable painful spasm of the pelvic muscles and vaginal exit that this patient has. It’s mainly caused by psychological factors. It’s important to distinguish it from frigidity, which indicates a lack of sexual desire, and dyspareunia, which is characterized as pelvic and/or back pain or other discomfort linked with sexual activity. Endometriosis, pelvic adhesions, and ovarian neoplasms are all common causes of dyspareunia. Vaginismus pain can be psychogenic, or it might be caused by pelvic diseases like adhesions, endometriosis, or leiomyomas. Organic vulvar or pelvic reasons (such as atrophy, Bartholin gland cyst, or abscess) are extremely rare, hence vaginismus is mostly treated with psychotherapy.

    • This question is part of the following fields:

      • Gynaecology
      9.8
      Seconds
  • Question 9 - What is the definition of premature menopause? ...

    Correct

    • What is the definition of premature menopause?

      Your Answer: Menopause at or before 40 years of age

      Explanation:

      Menopause is defined as the cessation of menstruation for a period of 12 months. Premature menopause is defined as cessation of menstruation before the age of 40.

    • This question is part of the following fields:

      • Endocrinology
      2.9
      Seconds
  • Question 10 - A 22-year-old nulliparous otherwise healthy woman presents with lower abdominal pain at 16...

    Correct

    • A 22-year-old nulliparous otherwise healthy woman presents with lower abdominal pain at 16 weeks of gestation. Her body temperature is 37.8 degrees Celsius. She appears to be in good health and is eating properly. Her uterus had been discovered to be retroverted but of normal size at her prior antenatal check at 11 weeks of pregnancy. Which of the following diagnoses is the most likely?

      Your Answer: Urinary tract infection.

      Explanation:

      Lower abdominal pain can be caused by any of the conditions listed in the answers.
      A urinary tract infection is the most likely cause.
      Unless it was an abdominal ectopic or an interstitial pregnancy, an ectopic pregnancy.
      will almost definitely have shown up before the 15th week of pregnancy.
      A retroverted gravid uterus may impinge at 15 weeks of pregnancy, however, this is unlikely to be linked to a temperature of 37.8°C.
      It’s also possible that it’s the source of acute urine retention.
      Complications of the corpus luteum cyst normally manifest themselves considerably earlier in pregnancy, and severe appendicitis is far less likely to be the source of discomfort than a urinary tract infection.

    • This question is part of the following fields:

      • Obstetrics
      15.9
      Seconds
  • Question 11 - Regarding uterine fibroids, which of the following statements is false? ...

    Correct

    • Regarding uterine fibroids, which of the following statements is false?

      Your Answer: The risk of fibroids is increased by pregnancy

      Explanation:

      Fibroids are a common gynaecological condition found in many women above the age of 35. They are however uncommon before puberty. They are most common in black women vs white women, and its prevalence increases from puberty to menopause. Risk factors for fibroids include increasing age, obesity and infertility. Protective factors, on the other hand, include pregnancy, as the risk of fibroids decreases with increasing numbers of pregnancies.

    • This question is part of the following fields:

      • Clinical Management
      20.8
      Seconds
  • Question 12 - A woman visited the OPD with complaints of severe abdominal pain and light-headedness....

    Incorrect

    • A woman visited the OPD with complaints of severe abdominal pain and light-headedness. There is history of fainting three days prior to consultation. She also has vaginal bleeding. In this case, which of the following investigations should be ordered to reach the diagnosis?

      Your Answer: Beta HCG

      Correct Answer:

      Explanation:

      Testing for beta hCG should be the first test in this case. It will rule out any pregnancy that is strongly suspected based on the patient’s history and physical examination.

    • This question is part of the following fields:

      • Gynaecology
      23.1
      Seconds
  • Question 13 - You're looking after a 24-year-old woman who is experiencing pelvic pain. She has...

    Correct

    • You're looking after a 24-year-old woman who is experiencing pelvic pain. She has one-sided pain that is widespread and mild, but can be intense at times. Menstruation has been regular. She denies having fever. With the exception of a smooth movable adnexal mass on the right side, her pelvic examination seems normal. Which of the following is the most likely reason for your discomfort?

      Your Answer: Ovarian cyst

      Explanation:

      An ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. Although the discovery of an ovarian cyst causes considerable anxiety in women owing to fears of malignancy, the vast majority of these lesions are benign. Most patients with ovarian cysts are asymptomatic, with the cysts being discovered incidentally during ultrasonography or routine pelvic examination. Some cysts, however, may be associated with a range of symptoms, sometimes severe, including the following:

      Pain or discomfort in the lower abdomen

      Severe pain from torsion (twisting) or rupture – Cyst rupture is characterized by sudden, sharp, unilateral pelvic pain; this can be associated with trauma, exercise, or coitus. Cyst rupture can lead to peritoneal signs, abdominal distention, and bleeding (which is usually self-limited)
      Discomfort with intercourse, particularly deep penetration
      Changes in bowel movements such as constipation
      Pelvic pressure causing tenesmus or urinary frequency
      Menstrual irregularities
      Precocious puberty and early menarche in young children
      Abdominal fullness and bloating
      Indigestion, heartburn, or early satiety
      Endometriomas – These are associated with endometriosis, which causes a classic triad of painful and heavy periods and dyspareunia
      Tachycardia and hypotension – These may result from haemorrhage caused by cyst rupture
      Hyperpyrexia – This may result from some complications of ovarian cysts, such as ovarian torsion
      Adnexal or cervical motion tenderness

      Underlying malignancy may be associated with early satiety, weight loss
      achexia, lymphadenopathy, or shortness of breath related to ascites or pleural effusion

      The absence of fever or vaginal discharge rules out PID

      The absence of pain on the right lower quadrant, fever, nausea and vomiting rule out appendicitis.

      The patient has regular menses, no vaginal bleeding no signs of shock that rules out ectopic pregnancy.

      her symptoms are also not consistent with the presentation of leiomyoma. Leiomyoma presents with enlarged uterus, pelvic pressure. It early causes pain when it is complicated with red degeneration which usually occurs in pregnancy.

    • This question is part of the following fields:

      • Gynaecology
      24.9
      Seconds
  • Question 14 - A 24 week pregnant patient complains of itching over the past 6 weeks...

    Correct

    • A 24 week pregnant patient complains of itching over the past 6 weeks particularly to the hands and feet which is worse at night. She has taken cetirizine but this hasn't settled her symptoms. Examination is unremarkable with no rash. What is the likely diagnosis?

      Your Answer: Intrahepatic Cholestasis of Pregnancy

      Explanation:

      The history is typical of Intrahepatic Cholestasis of Pregnancy, also known as obstetric cholestasis and prurigo gravidarum. It is characterised by itching without rash and abnormal LFTs beyond normal pregnancy ranges. Itching affects around 23% of pregnancies and can occur before biochemical changes.

    • This question is part of the following fields:

      • Clinical Management
      6.1
      Seconds
  • Question 15 - A 32-year-old lady is two weeks postpartum and in good health. She has...

    Correct

    • A 32-year-old lady is two weeks postpartum and in good health. She has painful defecation that is accompanied by some new blood on the toilet paper. Which of the following diagnoses is the most likely?

      Your Answer: Acute anal fissure.

      Explanation:

      The history of acutely painful defecation associated with spotting of bright blood is very suggestive of an acute anal fissure. Typically, the patient reports severe pain during a bowel movement, with the pain lasting several minutes to hours afterward. The pain recurs with every bowel movement, and the patient commonly becomes afraid or unwilling to have a bowel movement, leading to a cycle of worsening constipation, harder stools, and more anal pain. Approximately 70% of patients note bright-red blood on the toilet paper or stool. Occasionally, a few drops may fall in the toilet bowl, but significant bleeding does not usually occur with an anal fissure.. After gently spreading the buttocks, a close check of the anal verge can typically confirm the diagnosis.
      Rectal inspection is excruciatingly painful and opposed by sphincter spasm; however, if the fissure can be seen, it is not necessary to make the diagnosis at first.

      A perianal abscess, which presents as a sore indurated area lateral to the anus, or local trauma linked with anal intercourse or a foreign body, are two more painful anorectal disorders to rule out.

      Anal fistulae do not appear in this way, but rather with perianal discharge, and the diagnosis is based on determining the external orifice of the fistula.

      Although first-degree haemorrhoids bleed, they do not cause defecation to be unpleasant.

      Although carcinoma of the anus or rectum can cause painful defecation, it would be exceptional in this situation.

    • This question is part of the following fields:

      • Obstetrics
      7.9
      Seconds
  • Question 16 - A pregnant woman who is a heavy smoker, observed some thick white patches...

    Correct

    • 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.

    • This question is part of the following fields:

      • Obstetrics
      6
      Seconds
  • Question 17 - What epithelium cell type lines the endometrium? ...

    Incorrect

    • What epithelium cell type lines the endometrium?

      Your Answer: Stratified Squamous

      Correct Answer: Columnar

      Explanation:

      The endometrium is lined by columnar epithelium

    • This question is part of the following fields:

      • Pathology
      16.5
      Seconds
  • Question 18 - A 26-year old woman, 36 weeks age of gestation, is admitted for deep...

    Correct

    • A 26-year old woman, 36 weeks age of gestation, is admitted for deep venous thrombosis (DVT) of the right calf. She receives heparin treatment. Which of the following is true regarding the use of heparin rather than a coumarin derivative for anticoagulation?

      Your Answer: Reversal of the anticoagulant effect of heparin in the mother can be achieved more quickly than that of coumarin, should labour occur.

      Explanation:

      Heparin is a large-sized molecule and does not cross the placenta; it can provide anticoagulation in the mother, however, has no effect on the baby. Heparin is the preferred anticoagulant therapy during pregnancy.
      Moreover, the anticoagulant effect of heparin can be rapidly reversed by protamine sulphate.
      Warfarin, a coumarin derivative, takes much longer to be reversed compared to heparin. This can be given to the mother between 13 and 36 weeks of pregnancy, however, should be avoided in the first trimester due to its teratogenic effects.
      The anticoagulant effect of coumarin derivatives on the baby also takes longer to be reversed.

    • This question is part of the following fields:

      • Obstetrics
      17.9
      Seconds
  • Question 19 - A 24-year-old primigravida at 16 weeks of gestation, presented with a history of...

    Correct

    • A 24-year-old primigravida at 16 weeks of gestation, presented with a history of vaginal pressure, vaginal spotting and lower back pain. Transvaginal ultrasound finding shows cervical shortening to 2 cm, cervical dilation, and protrusion of fetal membranes into the cervical canal. Which among the following risk factors is not related to the development of this condition?

      Your Answer: Alcohol abuse

      Explanation:

      This woman has developed non-specific symptoms of cervical insufficiency, is a painless dilation of cervix resulting in the delivery of a live fetus during the 2nd trimester or premature delivery.

      The following has been identified as the risk factors associated with increased incidence of cervical insufficiency:
      – Congenital disorders of collagen synthesis like Ehlers-Danlos syndrome.
      – Prior cone biopsies.
      – Prior deep cervical lacerations, which is secondary to vaginal or cesarean delivery.
      -Müllerian duct defects like bicornuate or septate uterus.
      – More than three prior fetal losses during the 2nd trimester

      From the given options, alcohol abuse is the only one not associated with increased incidence of cervical insufficiency.

    • This question is part of the following fields:

      • Obstetrics
      22.5
      Seconds
  • Question 20 - A 25-year-old female, expecting twins, complains of decreased fetal movements in her 40th...

    Correct

    • A 25-year-old female, expecting twins, complains of decreased fetal movements in her 40th week of gestation. An hour ago, she experienced constant abdominal pain for an hour and passed blood in her urine. What is the next best investigation in this case?

      Your Answer: Cardiotocograph

      Explanation:

      Cardiotocography (CTG) helps to record the heartbeat of the foetus in parallel to measuring the contractions of the mother’s uterus, this is the most appropriate tool to assess this patient’s condition.

    • This question is part of the following fields:

      • Gynaecology
      10.3
      Seconds
  • Question 21 - A patient attends the maternity unit as her waters have broken but she...

    Correct

    • A patient attends the maternity unit as her waters have broken but she hasn't had contractions. She is 39+6 weeks gestation. Speculum examination confirms prelabour rupture of membranes (PROM). According to NICE guidelines after what time period should induction be offered?

      Your Answer: 24 hours

      Explanation:

      Induction of labour is appropriate approximately 24 hours after rupture of the membranes.

    • This question is part of the following fields:

      • Clinical Management
      8.8
      Seconds
  • Question 22 - Oxytocin causes increased myometrial contractions via which of the following messenger pathways? ...

    Correct

    • Oxytocin causes increased myometrial contractions via which of the following messenger pathways?

      Your Answer: Activates phospholipase-C which produces IP3 which triggers intracellular Calcium ion release

      Explanation:

      Oxytocin activates phospholipase C to produce inositol 1,4,5-trisphosphate (IP3), which releases Ca2+ from intracellular stores. There are thought to be other mechanisms by which myometrium is stimulated by Oxytocin including increased sensitisation of the myometrium and increased calcium entry into cells. cAMP and Protein Kinase A inhibit myometrial contractility.

    • This question is part of the following fields:

      • Endocrinology
      5.7
      Seconds
  • Question 23 - A 22-year-old G2P2 who is on her 7th day postpartum called her physician...

    Correct

    • A 22-year-old G2P2 who is on her 7th day postpartum called her physician due to her concern of bleeding from the vagina. Upon interview, she described the bleeding to be light pink to bright red and compared with the first few days post-delivery, the bleeding was less heavy. There was also no fever or cramping pain reported by the patient. Upon examination, it was observed that she is afebrile and her uterus is appropriately sized and non-tender. There was also the presence of about 10cc old, dark blood in her vagina and her cervix was closed. Which of the following is considered the most appropriate treatment for the patient?

      Your Answer: Reassurance

      Explanation:

      The postpartum period begins soon after the baby’s delivery and usually lasts six to eight weeks and ends when the mother’s body has nearly returned to its pre-pregnant state.

      Bloody vaginal discharge (lochia rubra) is heavy for the first 3-4 days, and slowly it becomes watery in consistency and colour changes to pinkish-brown (lochia serosa). After the next 10-12 days, it changes to yellowish-white (lochia alba). Advise women to seek medical attention if heavy vaginal bleeding persists (soaking a pad or more in less than an hour). Women with heavy, persistent postpartum bleeding should be evaluated for complications such as retained placenta, uterine atony, rarely invasive placenta, or coagulation disorders. Endometritis may also occur, presenting as fever with no source, maybe accompanied by uterine tenderness and vaginal discharge. This usually requires intravenous antibiotics. This also should be explained and advise the mother to seek immediate medical attention.

    • This question is part of the following fields:

      • Obstetrics
      18.7
      Seconds
  • Question 24 - A 34 year old patient is being investigated in the infertility clinic and...

    Correct

    • A 34 year old patient is being investigated in the infertility clinic and is offered Hysterosalpingography (HSG). She has 28 day cycles. Which of the following statements regarding HSG is correct?

      Your Answer: Typically performed using iodine based water soluble contrast

      Explanation:

      Hysterosalpingography is used to assess the patency of the fallopian tubes. It is performed by injection of a radio-opaque iodine based contrast. This test is contraindicated in pelvic inflammatory disease and during pregnancy. Should be performed in Follicular phase of menstrual cycle after cessation of menstrual bleeding and prior to ovulation (days 6-12).

    • This question is part of the following fields:

      • Biophysics
      16.8
      Seconds
  • Question 25 - A 50-year-old menopausal woman complained of regular hot flushes that interfered with her...

    Correct

    • A 50-year-old menopausal woman complained of regular hot flushes that interfered with her sleep and job. She had a ten-year history of oestrogen-dependent breast cancer. What is the most effective treatment for her symptoms?

      Your Answer: Paroxetine

      Explanation:

      Paroxetine is an SSRI used for hot flushes in women with contraindication for hormonal therapy.

      Hormonal or other pharmacotherapy is usually needed for women with bothersome hot flashes. For most women with moderate to very severe hot flashes and no contraindications, we suggest MHT. Women with an intact uterus need both oestrogen and a progestin, while those who have undergone hysterectomy can receive oestrogen only. For women interested in MHT, the first step is to determine the potential risks for the specific individual.

      The majority of perimenopausal and recently menopausal women are good candidates for short-term hormone therapy for symptom relief. However, for women with a history of breast cancer, coronary heart disease (CHD), a previous venous thromboembolic event (VTE) or stroke, or those at moderate or high risk for these complications, alternatives to hormone therapy should be suggested. For women with moderate to severe hot flashes who are not candidates for hormone therapy based upon their breast cancer, CHD, or VTE risk and for those who choose not to take MHT, we suggest nonhormonal agents. The agents most commonly used include SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), antiepileptics, and centrally acting drugs.

      Black Cohosh is found to be no more significant than placebo.
      Long-term use of mefenamic acid is controversial and not recommended.

    • This question is part of the following fields:

      • Gynaecology
      8.9
      Seconds
  • Question 26 - Which of the following takes part in the arterial supply of the ovary?...

    Correct

    • Which of the following takes part in the arterial supply of the ovary?

      Your Answer: Uterine arteries

      Explanation:

      The ovarian arteries, arising from the abdominal aorta and the ascending uterine arteries which are branches of the internal iliac artery all supply the ovaries. They terminate by bifurcating into the ovarian and tubal branches and anastomose with the contralateral branches providing a collateral circulation.

    • This question is part of the following fields:

      • Anatomy
      15.9
      Seconds
  • Question 27 - A 27-year-old woman presented to the clinic for advice because she is planning...

    Correct

    • A 27-year-old woman presented to the clinic for advice because she is planning to conceive and has never been pregnant before. Upon history taking, it was noted that she has no history of diabetes, mental health issues, and is not taking any regular medication. Which of the following is considered the best recommendation to give to the patient for the prevention of neural tube defects?

      Your Answer: Folic acid 0.4 mg daily for a minimum of one month before conception to first 12 weeks of pregnancy

      Explanation:

      CDC urges all women of reproductive age to take 400 micrograms (mcg) of folic acid each day, in addition to consuming food with folate from a varied diet, to help prevent some major birth defects of the baby’s brain (anencephaly) and spine (spina bifida).

      Women who are at high risk of having babies with neural tube defects and who would benefit from higher doses of folic acid include those with certain folate-enzyme genotypes, previous pregnancies with neural tube defects, diabetes, malabsorption disorders, or obesity, or those who take antifolate medications or smoke. Such women should take 5 mg/d of folic acid for the 2 months before conception and during the first trimester.

    • This question is part of the following fields:

      • Obstetrics
      22.9
      Seconds
  • Question 28 - A 46 year old women with a BMI of 34 is seen in...

    Incorrect

    • 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: 20-30%

      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 hyperplasia

      Major Risk Factors:
      Oestrogen (HRT)
      Tamoxifen
      PCOS
      Obesity
      Immunosuppression (transplant)

    • This question is part of the following fields:

      • Clinical Management
      14.6
      Seconds
  • Question 29 - Regarding the structure of the detrusor muscle. Which of the following is true?...

    Incorrect

    • Regarding the structure of the detrusor muscle. Which of the following is true?

      Your Answer: The detrusor is a single layer of circular smooth muscle

      Correct Answer: The detrusor is divided into 3 layers consisting of inner and outer layers of longitudinal smooth muscle with a middle circular smooth muscle layer

      Explanation:

      The urinary bladder is composed of the transitional epithelium, followed by the lamina propria made up of the fibroelastic connective tissue. The muscularis layer covers the lamina propria which is made up of three poorly defined layers of smooth muscles; the inner longitudinal, middle circular and the outer longitudinal layer. The bladder is covered on the superior surface and the lateral surface by the peritoneum.

    • This question is part of the following fields:

      • Anatomy
      21.2
      Seconds
  • Question 30 - A 33-year-old lady seeks counsel from your clinic since she has a history...

    Incorrect

    • A 33-year-old lady seeks counsel from your clinic since she has a history of deep vein thrombosis. She was on progesterone-only tablets (POP) until fivemonths ago, when she decided to get pregnant. However, the pregnancy turned out to be ectopic. Thankfully, she made it through. She doesn't want to get pregnant again and asks if she may resume taking the tablets. Which of the following is the best piece of advise you could give?

      Your Answer: She can take progesterone only pills after 12 months of first ectopic pregnancy

      Correct Answer: She cannot take progesterone only pills

      Explanation:

      Oestrogen-containing contraceptives are not recommended for this woman since she has a history of DVT. This is most likely why she was started on POP instead of standard combination tablets prior. Progesterone is also contraindicated with a history of ectopic pregnancy and should never be used again. Barrier approaches, for example, could be applied in this woman’s case.
      The following are absolute contraindications to taking just progesterone pills:
      – Pregnancy
      – Breast cancer
      – Vaginal bleeding that hasn’t been diagnosed
      – Ectopic pregnancy history or a high risk of ectopic pregnancy

      Progesterone-only pills have the following relative contraindications:
      – Active viral hepatitis
      – Severe chronic liver disease
      – Malabsorption syndrome
      – Severe arterial disease
      – Successfully treated breast cancer more than 5 years ago
      – Concomitant use of hepatic enzyme inducing medications.

    • This question is part of the following fields:

      • Gynaecology
      47.5
      Seconds
  • Question 31 - A 25-year-old woman at 39 weeks of gestation complaints of intermittent watery vaginal...

    Correct

    • 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.

    • This question is part of the following fields:

      • Obstetrics
      11.2
      Seconds
  • Question 32 - A 26 year old lady comes to see you in the antenatal clinic....

    Correct

    • A 26 year old lady comes to see you in the antenatal clinic. She is 8 weeks pregnant and is concerned as she has a new cat and her friend told her she shouldn't be changing cat litter when pregnant. You send bloods which show high IgM for toxoplasmosis gondii. Which of the following is an appropriate treatment option?

      Your Answer: Spiramycin

      Explanation:

      There are 2 treatment options: Spiramycin ASAP if foetus not infected or status of the foetus not known. This reduces risk of transplacental infection. This is continued until term, or until fetal infection is documented. Pyrimethamine, sulfadiazine and folic acid where fetal infection is known e.g. positive amniotic fluid PCR. Monitoring for haemotoxicity required. Pyrimethamine should be avoided in the 1st trimester as teratogenic

    • This question is part of the following fields:

      • Microbiology
      6.9
      Seconds
  • Question 33 - All of the following factors are associated with umbilical cord prolapse, except? ...

    Correct

    • All of the following factors are associated with umbilical cord prolapse, except?

      Your Answer: Anencephaly

      Explanation:

      Anencephaly means the missing of a particular portion of the scalp and brain tissue. The other factors listed are associated with umbilical cord prolapse like multiparity, twin birth, polyhydramnios, premature delivery, long umbilical cord or breech presentation.

    • This question is part of the following fields:

      • Physiology
      4.7
      Seconds
  • Question 34 - A fibroid is a type of ...

    Incorrect

    • A fibroid is a type of

      Your Answer: Leiomyosarcoma

      Correct Answer: Leiomyoma

      Explanation:

      A fibroid is a benign smooth muscle tumour or Leiomyoma. As such it is something of a misnomer. Leiomyosarcoma and Angioleiomyoma are malignant tumours of smooth muscle under the WHO sort tissue tumour classification Rhabdomyoma is a skeletal muscle tumour Myofibroma is seen in fibromatosis

    • This question is part of the following fields:

      • Clinical Management
      4.7
      Seconds
  • Question 35 - The broad ligament contains which of the following structures? ...

    Correct

    • The broad ligament contains which of the following structures?

      Your Answer: Uterine artery

      Explanation:

      The contents of the broad ligament:
      Fallopian tubes
      Ovarian artery
      Uterine artery
      Ovarian ligament
      Round ligament of uterus

    • This question is part of the following fields:

      • Anatomy
      2.6
      Seconds
  • Question 36 - Which of the following hormones are required for alveolar morphogenesis during pregnancy? ...

    Correct

    • Which of the following hormones are required for alveolar morphogenesis during pregnancy?

      Your Answer: Progesterone, Prolactin and hPL

      Explanation:

      The changes seen in breast tissue with the menstrual cycle are accentuated during pregnancy. Deposition of fat around glandular tissue occurs, and the number of glandular ducts is increased by oestrogen, while progesterone and human placental lactogen (hPL) increase the number of gland alveoli. Prolactin is essential for the stimulation of milk secretion and during pregnancy prepares the alveoli for milk production. Although prolactin concentration increases throughout pregnancy, it does not then result in lactation since it is antagonized at an alveolar receptor level by oestrogen.

    • This question is part of the following fields:

      • Endocrinology
      3.1
      Seconds
  • Question 37 - A patient who is 12 weeks pregnant is being seen in the antenatal...

    Correct

    • A patient who is 12 weeks pregnant is being seen in the antenatal clinic. Urinalysis shows protein ++. A 24 hour urine collection is organised. Greater than what level would indicate significant proteinuria?

      Your Answer: 300 mg over 24 hours

      Explanation:

      pre-eclampsia is defined as hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hour collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the sixth postpartum week.

    • This question is part of the following fields:

      • Data Interpretation
      8.8
      Seconds
  • Question 38 - A couple has decided to practice the daily basal body temperature assessment (BBT)...

    Correct

    • A couple has decided to practice the daily basal body temperature assessment (BBT) as a means of contraception. Over the past year, her cycles varied in length from 24 to 30 days with menses lasting 4 days. They do not have sexual intercourse when she is on her period. Which regimen would be the most suitable to minimise the chances of getting pregnant?

      Your Answer: No intercourse in the follicular phase of the cycle, commence intercourse two days after temperature elevation of 0.3°C and continue thereafter.

      Explanation:

      The best regimen would be to have no intercourse in the follicular phase of the cycle and then commence it two days after a temperature rise of 0.3C and continue then onwards. When deciding the best contraceptive method, one has to consider two factors-the duration of survival of sperm in the uterus and body temperature in relation to ovulation. For this case, since her cycle length varies from 24 to 30 days, the earliest time in which ovulation would occur would be 14 days before her shortest cycle i.e. day 10. Intercourse has to be avoided from day 4 of her cycle just in case the current cycle is short because sperm can survive up to 6 days in the uterus. Day 4 would be the day her menses would end and as this couple avoids intercourse during her menstruation, there would be no intercourse during the follicular phase of her cycle.

      During ovulation, her serum progesterone levels would start to increase, causing a 0.3°C to 0.4°C increase in her body temperature within 2-3 days of ovulating. This elevation in temperature would remain until close to when her period starts. The ovum can only be fertilised for roughly 24 hours after ovulation has taken place. Resuming sexual intercourse once her temperature has risen for 2 days would suggest that ovulation had already taken place 3-4 days earlier and so it is unlikely for pregnancy to occur.

      Options that include intercourse during any part of her follicular phase is not correct. Hence, the only option that satisfies the above criteria would be intercourse avoidance during her follicular phase and to resume 2 days following a rise of 0.03°C in body temperature.

    • This question is part of the following fields:

      • Gynaecology
      12.9
      Seconds
  • Question 39 - Looking at the picture below what is the diagnosis?

    Correct

    • Looking at the picture below what is the diagnosis?

      Your Answer: Linea Nigra

      Explanation:

      This is Linea Nigra. It occurs in 3/4 of pregnancies and is due to increased melanocyte-stimulating hormone production by the placenta. This also causes melasma and darkening of the nipples.

    • This question is part of the following fields:

      • Clinical Management
      2.2
      Seconds
  • Question 40 - A 28-year-old female presented with acute migraine accompanied with headache and vomiting. She...

    Correct

    • A 28-year-old female presented with acute migraine accompanied with headache and vomiting. She was noted to be at 33 weeks of gestation. Which of the following is considered the safest treatment for the patient?

      Your Answer: Paracetamol and metoclopramide

      Explanation:

      The occurrence of migraine in women is influenced by hormonal changes throughout the lifecycle. A beneficial effect of pregnancy on migraine, mainly during the last 2 trimesters, has been observed in 55 to 90% of women who are pregnant, irrespective of the type of migraine.

      For treatment of acute migraine attacks, 1000 mg of paracetamol (acetaminophen) preferably as a suppository is considered the first choice drug treatment. The risks associated with use of aspirin (acetylsalicylic acid) and ibuprofen are considered to be small when the agents are taken episodically and if they are avoided during the last trimester of pregnancy.

      Paracetamol 500 mg alone or in combination with metoclopramide 10 mg are recommended as first choice symptomatic treatment of a moderate-to-severe primary headache during pregnancy.

    • This question is part of the following fields:

      • Obstetrics
      10.1
      Seconds
  • Question 41 - A lady who is 29-weeks pregnant, comes to a general practice, complaining of...

    Correct

    • A lady who is 29-weeks pregnant, comes to a general practice, complaining of a sudden gush of clear fluid. On Speculum examination, premature rupture of membranes is confirmed with closed cervix. In addition to transferring patient to a tertiary care, what is the most appropriate in the management of this case?

      Your Answer: Betamethasone

      Explanation:

      This patient who is at her 29 weeks of pregnancy, presented with sudden gush of clear fluid and Speculum examination has confirmed premature rupture of membrane (PROM).

      Approximately, 50% of PROM progress to labour within 24 hours and in the remaining, 80% within seven days. The most important next step of management in this case is transferring this patient to tertiary care hospital as soon as possible. It is equally important to give corticosteroid therapy, like Betamethasone, if delivery prior to 34 weeks is likely to occur, as it will help in fetal lung maturity.

      Cardiotocography (CTG) is usually not available in general practice settings and it can be done only while in the hospital. If CTG shows any abnormality or if there is any presence of infection it is better to induce labor.

      Salbutamol and nifedipine are of no use in this case, as the patient is not in labour and does not require tocolytics.

    • This question is part of the following fields:

      • Obstetrics
      15
      Seconds
  • Question 42 - HPV genotypes 6 and 11 are associated with which of the following? ...

    Correct

    • HPV genotypes 6 and 11 are associated with which of the following?

      Your Answer: Low grade squamous intraepithelial lesions of the cervix (LSIL)

      Explanation:

      HPV types 6 and 11 are associated with low risk, low grade squamous intraepithelial lesion. While types 16,18,31 and 33 are associated with high risk, high grade neoplasia.

    • This question is part of the following fields:

      • Microbiology
      18.2
      Seconds
  • Question 43 - You review a 28 year old patient in the fertility clinic. She has...

    Correct

    • You review a 28 year old patient in the fertility clinic. She has a diagnosis of PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2. 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:

      Clomiphene shouldn’t be continued for more than 6 months. The second line options are Gonadotrophins or ovarian drilling.

    • This question is part of the following fields:

      • Clinical Management
      8.7
      Seconds
  • Question 44 - Regarding the urinary bladder, what type of epithelium lines it? ...

    Correct

    • Regarding the urinary bladder, what type of epithelium lines it?

      Your Answer: Transitional

      Explanation:

      The urinary bladder, and most of the urinary structures are lined by epithelium called the urothelium, or the transitional epithelium. This stratified lining is divided into three parts, an apical layer, an intermediate layer and a basal layer. The transitional epithelium is available to stretch to accommodate the increased volume when the bladder is distended, without structural damage.

    • This question is part of the following fields:

      • Anatomy
      2.8
      Seconds
  • Question 45 - A 28-year-old woman presents in early labour. She is healthy and at full-term....

    Incorrect

    • A 28-year-old woman presents in early labour. She is healthy and at full-term. Her pregnancy has progressed well without any complications. She indicates that she would like to have a cardiotocograph (CTG) to assess her baby as she has read about its use for foetal monitoring during labour. What advice would you give her while counselling her regarding the use of CTG compared to intermittent auscultation during labour and delivery?

      Your Answer: The CTG is a good predictor of the fetal outcome.

      Correct Answer: There is no evidence to support admission CTG.

      Explanation:

      In high-risk pregnancies, continuous monitoring of foetal heart rate is considered mandatory.

      However, in low-risk pregnancies, cardiotocograph (CTG) monitoring provides no benefits over intermittent auscultation.

      A significant issue with CTG monitoring is that apparent abnormalities are identified that usually have minimal clinical significance, but can prompt the use of several obstetric interventions such as instrumental deliveries and Caesarean section. In low risk patients, such interventions may not even be required.

      CTG monitoring has not been shown to reduce the incidence of cerebral palsy or other neonatal developmental abnormalities, nor does it accurately predict previous foetal oxygenation status unless the CTG is significantly abnormal when it is first connected.

      Similarly, CTG cannot accurately predict current foetal oxygenation unless the readings are severely abnormal.

      Therefore, there is no evidence to support routine admission CTG (correct answer).

    • This question is part of the following fields:

      • Obstetrics
      53
      Seconds
  • Question 46 - At birth, approximately how many oocytes are present in the ovaries? ...

    Correct

    • At birth, approximately how many oocytes are present in the ovaries?

      Your Answer: 1 million

      Explanation:

      Female infants are thought to be born with the total number of gametes they will posses in their lifetime. About 1 million healthy oocytes are present at birth. However, only about 300,000 of these oocytes survive to puberty, a number which continues to decline until all the oocytes are depleted triggering menopause.

    • This question is part of the following fields:

      • Embryology
      2.3
      Seconds
  • Question 47 - A 38 year old women attends clinic follow up. You note pelvic ultrasound...

    Correct

    • A 38 year old women attends clinic follow up. You note pelvic ultrasound shows a 36mm simple cyst. What is the most appropriate course of action regarding this cyst according to the RCOG green top guidelines?

      Your Answer: Discharge with no follow up

      Explanation:

      As this is a simple cyst less than 50mm in diameter the patient does not require further investigation or routine follow up

    • This question is part of the following fields:

      • Clinical Management
      4.2
      Seconds
  • Question 48 - A 10 day old infant present with signs of disseminated Herpes Simplex Virus...

    Incorrect

    • A 10 day old infant present with signs of disseminated Herpes Simplex Virus (HSV) infection. Her mother had her first episode of HSV three weeks prior to delivery. The infant was treated with antivirals upon clinical suspicion. What is the case fatality rate of infants who develop disseminated HSV despite treatment?

      Your Answer: 80%

      Correct Answer: 30%

      Explanation:

      Congenital Herpes Simplex Virus infection may cause high levels of morbidity and mortality in neonates. Risk of infection with HSV 1 and 2 is highest within 6 weeks of delivery and is transferred to the neonate via maternal secretions at birth. Affected babies can present as skin manifestations, CNS infection, or disseminated infection, which carries an 85% risk of mortality if left untreated. Treatment with high dose antivirals such as acyclovir can help decrease the case mortality rate to 30% in cases of disseminated infection.

    • This question is part of the following fields:

      • Microbiology
      12.6
      Seconds
  • Question 49 - A 33-year-old woman was admitted to a hospital's maternity unit for labour. Her...

    Correct

    • A 33-year-old woman was admitted to a hospital's maternity unit for labour. Her pregnancy has been unremarkable so far and she had regular antenatal visits. Meconium liquor passage was noted during the labour. Cardiotocography was done and revealed a fetal heart rate (FHR) of 149bpm. There were no noted decelerations or accelerations. The beat-to-beat variability is established at 15 bpm. Upon vaginal examination, there were no reported abnormalities. Which of the following is considered to be the next most appropriate step in managing this patient?

      Your Answer: The CTG is normal and close monitoring until delivery is all required for now

      Explanation:

      Meconium is the earliest stool of a newborn. Occasionally, newborns pass meconium during labour or delivery, resulting in a meconium-stained amniotic fluid (MSAF).

      No particular cardio-tocograph pattern can be considered to have a poor prognostic value in the presence of thick MSAF and the decision to deliver and the mode of delivery should be based on the overall assessment and the stage and progress of labour. While management should be individualized, a higher Caesarean section rate in thick MSAF can be justified to ensure a better outcome for the neonate even in the presence of a normal CTG trace.

    • This question is part of the following fields:

      • Obstetrics
      41.6
      Seconds
  • Question 50 - A lactating mother has developed a breast abscess. Which organism is the most...

    Correct

    • A lactating mother has developed a breast abscess. Which organism is the most common?

      Your Answer: Staph aureus

      Explanation:

      Staph aureus is the most common causative organism of skin and soft tissue infections.

    • This question is part of the following fields:

      • Gynaecology
      8.4
      Seconds
  • Question 51 - Which organism is the most common cause of puerperal sepsis? ...

    Correct

    • Which organism is the most common cause of puerperal sepsis?

      Your 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.

    • This question is part of the following fields:

      • Clinical Management
      3.6
      Seconds
  • Question 52 - A 32-year-old gravida 3 para 2 presents for routine prenatal care. The patient...

    Correct

    • A 32-year-old gravida 3 para 2 presents for routine prenatal care. The patient is at 14 weeks estimated gestational age by last menstrual period, and ultrasonography at 8 weeks gestation was consistent with these dates. Fetal heart tones are not heard by handheld Doppler. Transvaginal ultrasonography reveals an intrauterine foetus without evidence of fetal cardiac activity. The patient has not had any bleeding or cramping, and otherwise feels fine. A pelvic examination reveals a closed cervix without any signs of bleeding or products of conception. Which one of the following is the most likely cause of this presentation?

      Your Answer: A missed abortion

      Explanation:

      In this case, the patient has a missed abortion, which is defined as a dead foetus or embryo without passage of tissue and with a closed cervix. This condition often presents with failure to detect fetal heart tones or a lack of growth in uterine size.

      – By 14 weeks estimated gestational age, fetal heart tones should be detected by both handheld Doppler and ultrasonography.
      – An inevitable abortion presents with a dilated cervix, but no passage of fetal tissue.
      – A blighted ovum involves failure of the embryo to develop, despite the presence of a gestational sac and placental tissue.

    • This question is part of the following fields:

      • Obstetrics
      71
      Seconds
  • Question 53 - The round ligament develops from which structure? ...

    Correct

    • The round ligament develops from which structure?

      Your Answer: Gubernaculum

      Explanation:

      The round ligament develops from the lower end of the gubernaculum in females. In the males it persists as the scrotal ligament.

    • This question is part of the following fields:

      • Anatomy
      12.2
      Seconds
  • Question 54 - A 27-year-old woman who is 18 weeks pregnant presented to the emergency department...

    Correct

    • A 27-year-old woman who is 18 weeks pregnant presented to the emergency department due to a sudden onset of dyspnoea and pleuritic chest pain. She is known to have a previous history of deep venous thrombosis (DVT). Which of the following is considered to be the most appropriate examination for this patient?

      Your Answer: Ventilation/perfusion scan

      Explanation:

      Pulmonary embolism (PE) is a treatable disease caused by thrombus formation in the lung-vasculature, commonly from the lower extremity’s deep veins compromising the blood flow to the lungs.
      Computed tomography of pulmonary arteries (CTPA) and ventilation-perfusion (V/Q) scan are the two most common and widely practiced testing modalities to diagnose pulmonary embolism.

      Pulmonary ventilation (V) and Perfusion (Q) scan, also known as lung V/Q scan, is a nuclear test that uses the perfusion scan to delineate the blood flow distribution and ventilation scan to measure airflow distribution in the lungs. The primary utilization of the V/Q scan is to help diagnose lung clots called pulmonary embolism. V/Q scan provides help in clinical decision-making by evaluating scans showing ventilation and perfusion in all areas of the lungs using radioactive tracers.

      Ventilation-perfusion V/Q scanning is mostly indicated for a patient population in whom CTPA is contraindicated (pregnancy, renal insufficiency CKD stage 4 or more, or severe contrast allergy) or relatively inconclusive.

    • This question is part of the following fields:

      • Obstetrics
      8
      Seconds
  • Question 55 - What frequency is used for trans-vaginal ultrasound? ...

    Correct

    • What frequency is used for trans-vaginal ultrasound?

      Your Answer: 7.0 MHz

      Explanation:

      The ultrasound used a frequency of 3.5-7 MHz emitted from a transducer.

    • This question is part of the following fields:

      • Data Interpretation
      3.2
      Seconds
  • Question 56 - Herpes Simplex is which type of virus ...

    Correct

    • Herpes Simplex is which type of virus

      Your Answer: double stranded DNA

      Explanation:

      Herpes simplex is a double stranded DNA virus. There are two viral types, HSV-1 and HSV-2. The majority of orolabial infections are caused by HSV-1. These infections are usually acquired during childhood through direct physical contact such as kissing. Genital herpes is a sexually transmitted infection and is most commonly caused by HSV-2.

    • This question is part of the following fields:

      • Microbiology
      10.2
      Seconds
  • Question 57 - Which of the following is a pro-thrombotic agent? ...

    Correct

    • Which of the following is a pro-thrombotic agent?

      Your Answer: Thromboplastin

      Explanation:

      Protein C, protein S, plasminogen and anti thrombin III are all anti thrombotic agents. Thromboplastin is a pro-thrombotic.

    • This question is part of the following fields:

      • Clinical Management
      3.9
      Seconds
  • Question 58 - While evaluating a 33-year-old woman for infertility, you diagnose a bicornuate uterus. You...

    Incorrect

    • While evaluating a 33-year-old woman for infertility, you diagnose a bicornuate uterus. You explain that additional testing is necessary because of the woman's increased risk of congenital anomalies in which system?

      Your Answer: Skeletal

      Correct Answer: Urinary

      Explanation:

      Bicornuate uterus is associated with an increased chance of urinary tract anomalies. Urinary tract anomalies were present in about 23.6% of cases of bicornuate uterus patients.

    • This question is part of the following fields:

      • Embryology
      11.9
      Seconds
  • Question 59 - A 61-year-old woman presents to OBGYN clinic with a complaint of irregular bleeding...

    Correct

    • A 61-year-old woman presents to OBGYN clinic with a complaint of irregular bleeding per vagina for the last 3 months. Her past medical history is not significant and she went through menopause around a decade ago. A cervical screening test is performed and comes back normal. PCR for chlamydia is also negative. Endometrial thickness of around 8mm is seen on transvaginal ultrasound. What would be the next step of management?

      Your Answer: Referral to the gynaecologist for endometrial biopsy

      Explanation:

      This patient had postmenopausal vaginal haemorrhage and an 8mm endometrial thickness. Endometrial thickness of 4mm or more in a postmenopausal woman with vaginal bleeding necessitates an endometrial biopsy to rule out endometrial cancer, and this patient should be referred to a gynaecologist for this procedure.
      All of the other choices are incorrect.

    • This question is part of the following fields:

      • Gynaecology
      18.5
      Seconds
  • Question 60 - What is the incubation period for Varicella Zoster infection? ...

    Incorrect

    • What is the incubation period for Varicella Zoster infection?

      Your Answer: 5-7 days

      Correct Answer: 10-21 days

      Explanation:

      The incubation period of varicella is 10-21 days.

    • This question is part of the following fields:

      • Microbiology
      8.5
      Seconds
  • Question 61 - A 30-year-old woman is already in her second pregnancy and is 22 weeks...

    Correct

    • A 30-year-old woman is already in her second pregnancy and is 22 weeks pregnant. She presented to the medical clinic for evaluation of a vulval ulcer. A swab was taken and revealed a diagnosis of herpes simplex type II (HSV-2) infection. She was surprised about this diagnosis since neither she nor her husband has ever had this infection before. She insisted on knowing the source of the infection and was very concerned about her baby’s well-being and she asked how her condition may affect the baby. Which of the following statements is considered true regarding her situation?

      Your Answer: The primary infection is commonly asymptomatic

      Explanation:

      Genital herpes can be asymptomatic or have mild symptoms that go unrecognized. When symptoms occur, genital herpes is characterised by one or more genital or anal blisters or ulcers. Additionally, symptoms of a new infection often include fever, body aches and swollen lymph nodes.

      HSV-2 is mainly transmitted during sex through contact with genital or anal surfaces, skin, sores or fluids of someone infected with the virus. HSV-2 can be transmitted even if the skin looks normal and is often transmitted in the absence of symptoms.

      In rare circumstances, herpes (HSV-1 and HSV-2) can be transmitted from mother to child during delivery, causing neonatal herpes. Neonatal herpes can occur when an infant is exposed to HSV during delivery. Neonatal herpes is rare, occurring in an estimated 10 out of every 100 000 births globally. However, it is a serious condition that can lead to lasting neurologic disability or death. The risk for neonatal herpes is greatest when a mother acquires HSV for the first time in late pregnancy.

    • This question is part of the following fields:

      • Obstetrics
      15
      Seconds
  • Question 62 - Which of the following is the leading cause of Down Syndrome? ...

    Correct

    • Which of the following is the leading cause of Down Syndrome?

      Your Answer: Nondisjunction maternal gamete

      Explanation:

      Most of the cases of down syndrome occur due to non disjunction trisomy 21 which is associated with increased maternal age. The non disjunction occurs in the maternal gametes.

    • This question is part of the following fields:

      • Genetics
      3.4
      Seconds
  • Question 63 - You are called to see a patient in A&E who attended due to...

    Correct

    • You are called to see a patient in A&E who attended due to finger splinter that has been removed. The HCA took some routine obs that show her blood pressure to be 162/110. She is 32 weeks pregnant. According to the NICE guidelines which of the following is appropriate?

      Your Answer: Admit and start oral labetalol

      Explanation:

      BP over 159/109 is classed as Severe. NICE guidance advises admission and treatment with oral Labetalol as 1st Line. Patient should have BP checked QDS and shouldn’t be discharged until BP is below 159/109

    • This question is part of the following fields:

      • Clinical Management
      15.1
      Seconds
  • Question 64 - Regarding oogenesis & ovulation: ...

    Incorrect

    • Regarding oogenesis & ovulation:

      Your Answer: The ova survive for 3 days after ovulation

      Correct Answer: The 1st meiotic division is arrested in the diplotene stage until just before ovulation

      Explanation:

      The oocyte (eggs, ova, ovum) is arrested at an early stage of the first meiosis (first meiotic) division as a primary oocyte (primordial follicle) within the ovary. Following puberty, during each menstrual cycle, pituitary gonadotrophin stimulates completion of meiosis 1 the day before ovulation.

    • This question is part of the following fields:

      • Cell Biology
      23.7
      Seconds
  • Question 65 - A 28-year-old presented with vaginal bleeding after a 6-week duration of amenorrhea. The...

    Correct

    • A 28-year-old presented with vaginal bleeding after a 6-week duration of amenorrhea. The bleeding was described to be heavier than ever compared with her previous periods. Upon interview, it was noted that her menstrual cycles was ranging from 4 to 6 weeks. A urine pregnancy test was performed and the result was positive. Upon vaginal examination, it was noted that her cervical os is closed. An endovaginal ultrasound was performed and the results showed an endometrial thickness of 12mm and an empty uterus. There was also clear adnexa, and no fluid in the pouch of Douglas was seen. A cyst in the corpus luteum of the left ovary was also noted. Which of the following is most likely the diagnosis of the patient?

      Your Answer: Complete abortion

      Explanation:

      Complete abortion is defined as a ‘complete’ passage of all conception products.

      The first day of the last menstrual period and findings on any prior ultrasounds should be determined to establish the gestational age and location of the pregnancy. An abdominal exam should be performed to assess for peritoneal signs that might indicate a ruptured ectopic pregnancy or extra-uterine extension of a septic abortion. Lastly, a pelvic exam is central to the evaluation of suspected miscarriage. It should include both speculum-facilitated visualization of the cervix and a bimanual examination to assess for cervical motion tenderness that may indicate a septic abortion or an adnexal mass that may herald ectopic pregnancy.

      Early pregnancy loss takes many different forms. In missed abortion, there is asymptomatic or ‘missed’ death of the embryo or foetus without sufficient uterine contractions to push out the products of conception. In contrast, threatened abortion is characterized by symptomatic, ‘threatened’ expulsion of the products of conception, yet the cervical os remains closed, and the embryo or foetus remains viable.

      Although there is a lack of consensus, complete abortion is often defined as the absence of a gestational sac on ultrasound with an endometrial stripe thickness of less than 30 mm.

    • This question is part of the following fields:

      • Obstetrics
      41
      Seconds
  • Question 66 - Which one of the following has the most significant effect on slowing drug...

    Correct

    • Which one of the following has the most significant effect on slowing drug metabolism in pregnancy?

      Your Answer: Progesterone effect on gastric motility

      Explanation:

      Progesterone down regulates gastric motility meaning drugs are absorbed and metabolised more slowly, thus drugs are absorbed, metabolised and cleared more slowly. Most of the drugs are transported after binding to the albumin.
      Lower albumin levels mean a greater unbound drug fraction but as this may be thought to increase drug concentrations it actually leaves more available for hepatic clearance or renal excretion so overall drug concentrations are unchanged and metabolism increased.
      Increase in hepatic flow will increase the metabolism of the drug as the drug will be transported faster.
      Increased renal blood flow will result in the faster clearance of the drug from the body.

    • This question is part of the following fields:

      • Clinical Management
      12.6
      Seconds
  • Question 67 - A 29 year old patient has a transvaginal ultrasound scan that shows a...

    Correct

    • A 29 year old patient has a transvaginal ultrasound scan that shows a mass in the left ovary. It is anechoic, thin walled, is without internal structures and measures 36mm in diameter. What is the likely diagnosis?

      Your Answer: Functional cyst

      Explanation:

      Features of functional ovarian cysts on ultrasound are: Thin walled and unilocular Must be >3cm diameter (if <3cm described as follicle) Anechoic (absence of internal echoes) No colour flow No solid components

    • This question is part of the following fields:

      • Data Interpretation
      10.9
      Seconds
  • Question 68 - A 23-year-old woman presents to the local hospital clinic for her first antenatal...

    Correct

    • A 23-year-old woman presents to the local hospital clinic for her first antenatal visit. She is primigravid at 39 weeks of gestation (exact dates uncertain). She has just arrived from overseas, and no antenatal care had been available in her origin country. On examination, BP is 120/80 mmHg. The fundal height is 30cm above the pubic symphysis. Fetal heart sounds are present at a rate of 144/min. Pelvic examination indicates a long, closed cervix. The baby is noted to be in cephalic presentation. What is the appropriate choice for initial management of this woman?

      Your Answer: Ultrasound examination.

      Explanation:

      In this case, the fundus height appears to be smaller than the suggested dates of gestation. However, this is uncertain as the exact gestation dates are not known. Head-sparing intrauterine growth restriction needs to be excluded or managed appropriately if detected.

      The best initial management step would be to perform an ultrasound examination (correct answer). This would enable complete assessment of the foetus and all the measurable parameters can be determined. This would aid in identifying any discrepancy in size of the abdomen, limbs and head, and the liquor volume (amniotic fluid index) could be evaluated.

      If asymmetrical growth restriction was detected via ultrasound examination, further evaluations such as cardiotocography (CTG) and umbilical arterial wave form analysis by Doppler could be initiated.

      Additionally, foetal movement counting could then be commenced and evaluation of foetal lung maturity by amniocentesis could be considered.

      If the ultrasound was normal (no evidence of asymmetrical growth restriction, normal amniotic fluid), repeat ultrasound should be performed after two weeks to evaluate the foetal growth.

      If normal growth is observed on the repeat ultrasound, the estimated due date can be calculated (assuming normal foetal growth around the 50th percentile for the population).

    • This question is part of the following fields:

      • Gynaecology
      37.2
      Seconds
  • Question 69 - A 35-year-old female patient, gravida 1 para 1, visits the clinic to have...

    Correct

    • A 35-year-old female patient, gravida 1 para 1, visits the clinic to have her contraception method evaluated. The patient has had unpredictable bleeding for the past 8 months since receiving a subdermal progestin implant and begs that it be removed. She used to use combined oral contraceptives and would like to go back to it. The patient has primary hypertension, which she was diagnosed with last year and is effectively controlled on hydrochlorothiazide. She does not take any other medications or have any allergies. Her father and brother both suffer from type 2 diabetes. The patient does not smoke, drink, or use illegal drugs. Her BMI is 24 kg/m2. Blood pressure is 130/75. Physical examinations are all normal. Which of the following is increased by using combination oral contraceptives?

      Your Answer: Worsening hypertension

      Explanation:

      Overt hypertension, developing in about 5% of Pill users, and increases in blood pressure (but within normal limits) in many more is believed to be the result of changes in the renin-angiotensin-aldosterone system, particularly a consistent and marked increase in the plasma renin substrate concentrations. The mechanisms for the hypertensive response are unclear since normal women may demonstrate marked changes in the renin system. A failure of the kidneys to fully suppress renal renin secretion could thus be an important predisposing factor. These observations provide guidelines for the prescription of oral contraceptives. A baseline blood pressure measurement should be obtained, and blood pressure and weight should be followed at 2- or 3-month intervals during treatment. Oral contraceptive therapy should be contraindicated for individuals with a history of hypertension, renal disease, toxaemia, or fluid retention. A positive family history of hypertension, women for whom long-term therapy is indicated, and groups such as blacks, especially prone to hypertensive phenomena, are all relative contraindications for the Pill.

      COCs do not increase the risk of developing breast and endometrial cancer, Type 2 DM or breast fibroadenoma.

    • This question is part of the following fields:

      • Gynaecology
      34.4
      Seconds
  • Question 70 - An 8 week pregnant female presents to the ob-gyn with bleeding from the...

    Correct

    • 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 pregnancy

      This 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.

    • This question is part of the following fields:

      • Obstetrics
      10.7
      Seconds
  • Question 71 - Which pharyngeal arch is closest to the head of the embryo? ...

    Correct

    • Which pharyngeal arch is closest to the head of the embryo?

      Your Answer: 1st

      Explanation:

      The arches are numbered according to their proximity to the head i.e. the 1st is the closest to the head end of the embryo and the 6th closest to the tail end as shown by the diagram below the table

    • This question is part of the following fields:

      • Embryology
      8.5
      Seconds
  • Question 72 - A 22 year old woman is being followed up 6 weeks after a...

    Correct

    • A 22 year old woman is being followed up 6 weeks after a surgical procedure to evacuate the uterus following a miscarriage. The histology has shown changes consistent with a hydatidiform mole. What is the single most appropriate investigation in this case?

      Your Answer: Serum B-HCG

      Explanation:

      The most appropriate test for a hydatiform mole is serum beta hCG levels, which are consistently raised in these patients. The levels return to normal when the pregnancy is terminated.

    • This question is part of the following fields:

      • Gynaecology
      12
      Seconds
  • Question 73 - A 19-year-old female patient with secondary amenorrhea visits your office. A urine pregnancy...

    Correct

    • A 19-year-old female patient with secondary amenorrhea visits your office. A urine pregnancy test is negative. As part of your work-up, you order a pelvic ultrasound, which reveals a fluid filled, thin walled cyst measuring 1.8 x 1.3 x 1 cm. She doesn't complain of pain or tenderness. What is the most appropriate next step?

      Your Answer: Do nothing

      Explanation:

      An ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. Although the discovery of an ovarian cyst causes considerable anxiety in women owing to fears of malignancy, the vast majority of these lesions are benign.

      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.

      However, meta-analyses have since shown that there is no difference between OCP use and placebo in terms of treatment outcomes in ovarian cysts and that these masses should be monitored expectantly for several menstrual cycles.

      If a cystic mass does not resolve after this timeframe, it is unlikely to be a functional cyst, and further workup may be indicated.

      Other methods of management maybe revisited if cyst increases in size or becomes complex upon follow up.

    • This question is part of the following fields:

      • Gynaecology
      12.8
      Seconds
  • Question 74 - All the following are possible causes of polyhydramnios, EXCEPT: ...

    Correct

    • All the following are possible causes of polyhydramnios, EXCEPT:

      Your Answer: IUGR

      Explanation:

      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.

    • This question is part of the following fields:

      • Physiology
      16
      Seconds
  • Question 75 - Which is the most useful tumour marker for monitoring of ovarian cancer patients?...

    Incorrect

    • Which is the most useful tumour marker for monitoring of ovarian cancer patients?

      Your Answer: CA 125

      Correct Answer:

      Explanation:

      CA-125 has found application as a tumour marker or biomarker that may be elevated in the blood of some patients with specific types of cancers, or other conditions that are benign. Increased level of CA125 appears in fifty percent of stage 1 ovarian cancer patients and more than 90% with stages 2-4 ovarian cancer. CA-125 is therefore a useful tool for detecting ovarian cancer after the onset of symptoms as well as monitoring response to treatment and for predicting a patient’s prognosis after treatment.

    • This question is part of the following fields:

      • Gynaecology
      2.8
      Seconds
  • Question 76 - A 28-year-old G1P0 patient at 24 weeks of gestation visits your office complaining...

    Incorrect

    • A 28-year-old G1P0 patient at 24 weeks of gestation visits your office complaining of some shortness of breath that is more intense with exertion and denies any chest pain. She is concerned as she has always been very athletic and is unable to maintain the same degree of exercise she was accustomed prior to becoming pregnant. Patient also informed she has no significant past medical history and is not on any medication. On physical examination, her pulse is 72 beats per minute, with a blood pressure of 100/70 mm Hg. Cardiac examination is normal and her lungs are clear to auscultation and percussion. Which among the following is considered the most appropriate next step to pursue in the workup of this patient?

      Your Answer: Order an ECG

      Correct Answer: Reassure the patient

      Explanation:

      Patient’s presentation and physical examination findings are most consistent with physiologic dyspnea, which is common during pregnancy. This breathing difficulty which is due to an increase in the tidal volume of lung will present itself as an increased awareness of breathing and can occur as early as the end of first trimester. Any minute increase in the ventilation occurs during pregnancy can make patients feel as if they are hyperventilating and contribute to the feeling of dyspnea.

      Patient should be reassured and educated regarding these normal changes of pregnancy, also should be counselled to modify her exercise regimen accordingly to her changed tolerance.

      Systolic ejection murmurs are due to increased blood flow across the aortic and pulmonic valves which is a normal finding in a pregnancy. So there is no need for this patient to be referred to a cardiologist or to order an ECG.
      About 1 in 6400 pregnancies present with pulmonary embolism and there will be clinical evidence of DVT in many of these cases. Dyspnea, chest pain, apprehension, cough, hemoptysis, and tachycardia are the most common symptoms of PE and physical examination shows accentuated pulmonic closure sound, rales, or a friction rub. If there is a strong suspicion for PE, the patient should be followed up with a ventilation-perfusion scan, which will confirm PE if presented with large perfusion defects and ventilation mismatches.

    • This question is part of the following fields:

      • Obstetrics
      27.5
      Seconds
  • Question 77 - You are attending the labour of a patient who has had a prolonged...

    Correct

    • You are attending the labour of a patient who has had a prolonged 1st stage of labour. You note the fetal head start to retract after being tightly applied to the vulva (turtle-neck sign). What is the next most appropriate management step?

      Your Answer: McRoberts' manoeuvre

      Explanation:

      Call for help.
      • Ensure personnel are available to ‘scribe’.
      Document the time the head delivered, which shoulder is anterior (this is the arm most vulnerable to injury) and the times at which each manoeuvre is employed.
      • Drop the level of the delivery bed as low as it will go, and flatten the back of the bed so the woman is completely flat. Remove the foot of the bed to allow access.
      • Assess for and perform an episiotomy, if needed.
      • Using one assistant on each of the mother’s legs, flex and abduct the legs at the hip (thighs to abdomen, known as McRoberts manoeuvre). This flattens the lumbosacral spine and will facilitate delivery is around 90 per cent of cases.
      • If this fails, suprapubic pressure should be
      applied by another assistant. This should be
      applied over the posterior aspect of the anterior fetal shoulder and will act to push the shoulders together. It can be used in a constant and then rocking motion.
      • If both these fail, then internal manoeuvres are necessary. The order of these will depend on the skill and experience of the person conducting the delivery and the individual case. These manoeuvres have been named after famous obstetricians, but it is the process rather than the name that is important:
      • An attempt can be made to rotate the baby, so that the shoulders enter the diagonal to allow delivery. The first procedure is usually to insert a hand behind the anterior shoulder, and push it towards the chest (Rubin II). This will adduct the shoulders then push them into the diagonal. This can be combined with pressure on the
      anterior aspect of the posterior shoulder
      to aid rotation (Woods’ screw). If this fails,
      an attempt can be made to rotate the baby
      in the opposite direction (reverse Woods’
      screw). Delivery of the posterior arm can be
      attempted passing a hand into the vagina, in
      front of the posterior shoulder and deliver
      the posterior arm by swinging it in front of
      the fetal chest.
      If these all fail, the patient can be moved on to all fours as this increases the anterior–posterior diameter of the inlet. In this position, the posterior arm can be delivered.
      After this, manoeuvres of last resort include a symphysiotomy, in which the maternal symphysis is divided, Zavanelli’s, in which the head is reduced back into the vagina and a Caesarean section performed and intentional fracture of the fetal
      clavicle.

    • This question is part of the following fields:

      • Clinical Management
      5.6
      Seconds
  • Question 78 - A 30-year-old primigravida woman presented to the clinic for her first antenatal check-up....

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • Obstetrics
      49.6
      Seconds
  • Question 79 - A 29 year old female presented at her 38th week of gestation to...

    Correct

    • A 29 year old female presented at her 38th week of gestation to the ER with severe hypertension (210/100) and proteinuria (+++). Soon after admission, she developed generalized tonic clonic fits. What is the first line of management in this case?

      Your Answer: Magnesium sulphate IV

      Explanation:

      Magnesium Sulphate is the drug of choice in eclamptic patients. A loading dose of 4g magnesium sulphate in 100mL 0.9% saline IVI over 5min followed by maintenance IVI of 1g/h for 24h. Signs of toxicity include respiratory depression and jerky tendon reflexes. In recurrent fits additional 2g can be given. Magnesium should be stopped when the respiratory rate is <14/min, absent tendon reflexes, or urine output is <20mL/h.

    • This question is part of the following fields:

      • Obstetrics
      6.1
      Seconds
  • Question 80 - A 38 year old woman in early pregnancy is rushed to the emergency...

    Correct

    • 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%.

    • This question is part of the following fields:

      • Epidemiology
      12.9
      Seconds
  • Question 81 - A 29-year-old obese lady weighing 130 kilograms, is requesting for a prescription for...

    Correct

    • A 29-year-old obese lady weighing 130 kilograms, is requesting for a prescription for the oral contraceptive pill (OCP). She has hirsutism and acne. She has also expressed that she occasionally suffers from migraines along with pins and needles in her left arm. Which is the best contraceptive for her?

      Your Answer: A barrier method of contraception.

      Explanation:

      OCPs which contain oestrogen and progesterone are contraindicated in women who have migraines associated with a neurological deficit or aura (pins and needles in this case). In such cases, the alternative would be Implanon (etonogestrel), however, there are mixed reviews and opinions regarding whether or not there is a decreased efficacy in heavier women. The absolute contraindication for Implanon is active breast cancer. Therefore, the best advice for her case would be some form of barrier contraceptive.

      When choosing a COCP (combined oral contraceptive pill), it is recommended that a formulation containing 20-30ug of ethinyl oestradiol is chosen. The progestogen part is responsible for prevention of conception and can be norgestrel or any other progestogens although the formulations containing norgestrel tend to be cheaper than more novel progestins such as cyproterone acetate as well as drospirenone. If the patient is known to have issues with excessive fluid retention, OCPs that has drospirenone would be the most suitable. However, if the patient is suspected to have PCOS, the best choice would be one that contains cyproterone acetate.

    • This question is part of the following fields:

      • Gynaecology
      16.4
      Seconds
  • Question 82 - What is the typical weight of a term uterus? ...

    Correct

    • What is the typical weight of a term uterus?

      Your Answer: 1200g

      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. Weight of the uterus increases from 50–60 g prior to pregnancy to 1000 g by term.

    • This question is part of the following fields:

      • Physiology
      12.2
      Seconds
  • Question 83 - What is the definition of hypertension in pregnancy? ...

    Incorrect

    • What is the definition of hypertension in pregnancy?

      Your Answer: A blood pressure above 140/90 mmHg

      Correct Answer:

      Explanation:

      The NICE guidelines on Hypertension in pregnancy define blood pressure in pregnancy as follows:
      Mild hypertension: DBP=90-99 mmHg, SBP=140-149 mmHg. Moderate hypertension: DBP=100-109 mmHg, SBP=150-159 mmHg.
      Severe hypertension: DBP=110 mmHg or greater, SBP=160 mmHg or greater.

    • This question is part of the following fields:

      • Obstetrics
      7.2
      Seconds
  • Question 84 - A patient admitted to the medical ward complains of a mild fever and...

    Correct

    • A patient admitted to the medical ward complains of a mild fever and vaginal discharge. Clue cells are seen on microscopy from a vaginal swab. Which of the following infections feature clue cells?

      Your Answer: Bacterial Vaginosis

      Explanation:

      Bacterial vaginosis (BV) is a common infection of the vagina caused by the overgrowth of atypical bacteria, most commonly Gardnerella vaginalis, a gram-negative rod. In diagnosing BV, a swab is taken for microscopy, often revealing clue cells. Clue cells are cells of the vaginal epithelium which are covered by adherent Gardnerella, giving them a distinctive look under the microscope. Though many are asymptomatic, some infected women complain of a greyish, foul-smelling vaginal discharge. Their vaginal fluid pH may also become more alkaline. BV does not however present with pyrexia, so the lady’s fever could be attributed to another cause as she is still a patient on the medical ward.

    • This question is part of the following fields:

      • Clinical Management
      6.1
      Seconds
  • Question 85 - What is the incidence of hyperthyroidism in complete molar pregnancy? ...

    Correct

    • What is the incidence of hyperthyroidism in complete molar pregnancy?

      Your Answer: 3%

      Explanation:

      As B-HCG and TSH have similar structures, increased B-HCG can lead to hyperthyroidism, however there is only a 3% chance of this happening.

    • This question is part of the following fields:

      • Clinical Management
      3.8
      Seconds
  • Question 86 - What is the incubation period for Rubella? ...

    Correct

    • What is the incubation period for Rubella?

      Your Answer: 12-23 days

      Explanation:

      The incubation period of rubella is 12-23 days.

    • This question is part of the following fields:

      • Microbiology
      3.4
      Seconds
  • Question 87 - The performance of a cervical cerclage at 14 weeks of gestation is determined...

    Correct

    • The performance of a cervical cerclage at 14 weeks of gestation is determined by which of the following indications?

      Your Answer: 2 or more consecutive prior second trimester pregnancy losses

      Explanation:

      Cervical cerclage is performed as an attempt to prolong pregnancy in certain women who are at higher risk of preterm delivery.

      There are three well-accepted indications for cervical cerclage placement. According to the American College of Obstetricians and Gynaecologists (ACOG), a history-indicated or prophylactic cerclage may be placed when there is a “history of one or more second-trimester pregnancy losses related to painless cervical dilation and in the absence of labour or abruptio placentae,” or if the woman had a prior cerclage placed due to cervical insufficiency in the second trimester.

      An ultrasound-indicated cerclage may be considered for women who have a history of spontaneous loss or preterm birth at less than 34 weeks gestation if the cervical length in a current singleton pregnancy is noted to be less than 25 mm before 24 weeks of gestation. It is important to note that this recommendation is invalidated without the history of preterm birth.

      Physical examination-indicated cerclage (also known as emergency or rescue cerclage) should be considered for patients with a singleton pregnancy at less than 24 weeks gestation with advanced cervical dilation in the absence of contractions, intraamniotic infection or placental abruption.

    • This question is part of the following fields:

      • Obstetrics
      17.1
      Seconds
  • Question 88 - A 35-year-old woman from the countryside of Victoria comes to the hospital at...

    Correct

    • A 35-year-old woman from the countryside of Victoria comes to the hospital at 37 weeks of gestation after noticing a sudden gush of clear fluid from her vagina. Speculum examination shows pooling of liquor in the posterior fornix and patient developed fever, tachycardia and chills 12 hours after this episode. Apart from giving antibiotics, what will be your strategy in management of this case?

      Your Answer: Induce labour now

      Explanation:

      Above mentioned patient presented with symptoms of premature rupture of membranes (PROM) which refers to membrane rupture before the onset of uterine contractions.

      A sudden gush of clear or pale yellow fluid from the vagina is the classic clinical presentation of premature rupture of membranes. Along with this the patient also developed signs of infection like fever, tachycardia and sweating which is suggestive of chorioamnionitis.

      Vaginal examination is never performed in patients with premature rupture of membrane, instead a speculum examination is the usually preferred method which will show fluid in the posterior fornix.

      The following are the steps in management of premature rupture of membrane:
      – Admitting the patient to hospital.
      – Take a vaginal
      ervical smears.
      – Measure and monitor both white cell count and C- reactive protein levels.
      – Continue pregnancy if there is no evidence of infection or fetal distress.
      – In presence of any signs of infection or if CTG showing fetal distress it is advisable to induce labour.
      – Corticosteroids must be administered if delivery is prior to 34 weeks of gestation.
      – Give antibiotics as prevention and for treatment of infection.

    • This question is part of the following fields:

      • Obstetrics
      21.1
      Seconds
  • Question 89 - A 26 year old patient sustains a 4th degree perineal tear following delivery...

    Correct

    • A 26 year old patient sustains a 4th degree perineal tear following delivery of her 1st baby. Your consultant agrees to supervise you repair the tear. From the list below what is the most appropriate suture option for repairing the anal mucosa?

      Your Answer: 3-0 polyglactin interrupted sutures

      Explanation:

      Repair the vaginal mucosa using rapidly absorbed suture material on a large, round body needle. Start above the apex of the cut or tear (as severed vessels retract slightly) and use a continuous stitch to close the vaginal mucosa.

    • This question is part of the following fields:

      • Clinical Management
      15.4
      Seconds
  • Question 90 - Which one of the following statements regarding the fetal head is true? ...

    Correct

    • Which one of the following statements regarding the fetal head is true?

      Your Answer: Considered to be engaged when the biparietal diameter passes the level of the pelvic inlet

      Explanation:

      The fetal head is engaged when the head of the foetus or the presenting part enters the pelvic inlet or pelvic brim. It usually occurs at 38 weeks of gestation.
      The Spalding sign refers to the overlapping of the fetal skull bones caused by collapse of the fetal brain. It appears usually a week or more after fetal death in utero.
      In brow presentation the scalp is deflexed as the foetus is looking upward. Normally the head is inflexed such that the chin is touching the chest.

    • This question is part of the following fields:

      • Anatomy
      71.6
      Seconds
  • Question 91 - What is the most common cause of hypercalcaemia? ...

    Correct

    • 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.

    • This question is part of the following fields:

      • Physiology
      3.4
      Seconds
  • Question 92 - A 32 year old woman who is 14 weeks pregnant presents to the...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • Clinical Management
      24.5
      Seconds
  • Question 93 - Regarding lymph drainage of the ovary where does the majority of lymph drain...

    Correct

    • Regarding lymph drainage of the ovary where does the majority of lymph drain to?

      Your Answer: para-aortic nodes

      Explanation:

      The Ovaries lymph drains primarily to the lateral para-aortic lymph nodes

    • This question is part of the following fields:

      • Anatomy
      3.8
      Seconds
  • Question 94 - A patient asks you in clinic when she can start trying to conceive...

    Correct

    • A patient asks you in clinic when she can start trying to conceive again. She has just completed chemotherapy for gestational trophoblastic disease (GTD)?

      Your Answer: 1 year from completion of treatment

      Explanation:

      According to the RCOG greentop guidelines, a women who have underdone chemotherapy for GTD are advised not to conceive for 1 years after completion of the chemotherapy.

    • This question is part of the following fields:

      • Clinical Management
      4.8
      Seconds
  • Question 95 - A 28-year-old, currently at 26 weeks’ gestation of her third pregnancy, presents with...

    Correct

    • A 28-year-old, currently at 26 weeks’ gestation of her third pregnancy, presents with irregular uterine contractions for the past 24 hours and has concerns about premature delivery. She delivered her first child at 38 weeks of gestation and her second at 39 weeks gestation. On examination, BP and urinalysis have come back normal. Her symphysis-fundal height measures 27cm, the uterus is lax and non-tender. Fetal heart rate is 148/min. She also undergoes a pelvic examination along with other investigations. Which findings would suggest that delivery is most likely going to happen before 30 weeks’ of gestation?

      Your Answer: The cervix is closed, but the fetal fibronectin test on cervical secretions is positive.

      Explanation:

      Predisposing factors of preterm delivery include a short cervix (or if it shortens earlier than in the third trimester), urinary tract or sexually transmitted infections, open cervical os, and history of a previous premature delivery. Increased uterine size can also contribute to preterm delivery and is seen with cases of polyhydramnios, macrosomia and multiple pregnancies. The shorter the cervical length, the greater the risk of a premature birth.
      In this case, the risk of bacterial vaginosis and candidiasis contributing to preterm delivery would be lower than if in the context of an open cervical os. However, the risk of premature delivery is significantly increased if it is found that the fetal fibronectin test is positive, even if the os is closed.

    • This question is part of the following fields:

      • Obstetrics
      23.6
      Seconds
  • Question 96 - Which hormone is responsible for contraction of myoepithelial cells in lactation? ...

    Correct

    • Which hormone is responsible for contraction of myoepithelial cells in lactation?

      Your Answer: Oxytocin

      Explanation:

      Oxytocin is responsible for the let down mechanism that occurs during breast feeding in which the myothelial cells contract and push the milk into the ductules.

    • This question is part of the following fields:

      • Clinical Management
      6.7
      Seconds
  • Question 97 - 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
      3.6
      Seconds
  • Question 98 - Regarding pelvic Gonorrhoea infection in women. What percentage of cases are asymptomatic? ...

    Incorrect

    • Regarding pelvic Gonorrhoea infection in women. What percentage of cases are asymptomatic?

      Your Answer: 30%

      Correct Answer: 50%

      Explanation:

      Gonorrhoea is a sexually transmitted disease that is caused by Neisseria gonorrhoea. It infects the mucous membrane of the genital tract epithelium in the endocervical and the urethral mucosa. Around 50% of the women are asymptomatic. However it presents as increase vaginal discharge, dysuria, proctitis and pelvic tenderness.

    • This question is part of the following fields:

      • Clinical Management
      7.3
      Seconds
  • Question 99 - What is the male infertility rate in CF patients? ...

    Correct

    • What is the male infertility rate in CF patients?

      Your Answer: 98%

      Explanation:

      Cystic fibrosis is the most common fetal genetic disease in Caucasians and has an autosomal recessive inheritance. It is caused by an abnormal chloride channel due to a defect in the CFTR gene. Complications range from haemoptysis, respiratory failure, biliary cirrhosis, diabetes and male infertility. Men with CF are infertile in 98% of the cases due to failure of development of the vas deference.

    • This question is part of the following fields:

      • Clinical Management
      3.9
      Seconds
  • Question 100 - What percentage of pregnancies will be uncomplicated following a single episode of reduced...

    Incorrect

    • What percentage of pregnancies will be uncomplicated following a single episode of reduced fetal movements?

      Your Answer: 50%

      Correct Answer: 70%

      Explanation:

      Reduced fetal movements can be the first indication of possible fetal abnormalities. Movements are first perceived by the mother from about 18-20 weeks gestation, increase in size and frequency until 32 weeks gestation when they plateau at about 31 movements per hour. Investigations for reduced fetal heart rate include auscultation of the fetal heart rate using a handheld doppler device, and a cardiotocograph or ultrasound if the foetus is above 28 weeks gestation. About 70% of women who experience one episode of reduced fetal movement have uncomplicated pregnancies. They are advised to report to a maternal unit if another episode occurs.

    • This question is part of the following fields:

      • Clinical Management
      8.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Obstetrics (22/26) 85%
Microbiology (4/7) 57%
Gynaecology (14/17) 82%
Clinical Management (19/23) 83%
Endocrinology (4/4) 100%
Pathology (0/1) 0%
Biophysics (1/1) 100%
Anatomy (6/7) 86%
Physiology (5/5) 100%
Data Interpretation (3/3) 100%
Embryology (2/3) 67%
Genetics (1/1) 100%
Cell Biology (0/1) 0%
Epidemiology (1/1) 100%
Passmed