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Question 1
Incorrect
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Ulipristal is thought to prevent pregnancy by what primary mechanism?
Your Answer: Environmental changes resulting in decreased sperm motility
Correct Answer: Inhibition of ovulation
Explanation:Ulipristal is a progesterone receptor modulator that is used up to 120 hours following unprotected intercourse. It inhibits ovulation. The dose is 30 mg.
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This question is part of the following fields:
- Clinical Management
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Question 2
Incorrect
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From which of the following spinal segments do both the internal and external anal sphincters receive their innervation?
Your Answer: S3
Correct Answer: S4
Explanation:The anal sphincters are responsible for closing the anal canal to the passage of faeces and flatus. The smooth muscle of the involuntary internal sphincter sustains contraction to prevent the leakage of faeces between bowel movements and is innervated by the pelvic splanchnic nerves, which are a branch of the spinal segment 4. The external sphincter is made up of skeletal muscle and can therefore contract and relax voluntarily. Its innervation comes from the inferior rectal branch of the pudendal nerve, and the perineal branch of S4 nerve roots.
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This question is part of the following fields:
- Anatomy
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Question 3
Incorrect
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How long does involution of the uterus take after parturition?
Your Answer: 1-2 weeks
Correct Answer: 4-6 weeks
Explanation:In the period immediately after the delivery of the placenta, known as the puerperium, the female reproductive system begins to undergo some physiological changes to return to a non-pregnant state. One of these changes is uterine involution. The myometrium contracts, constricting blood vessels which impedes blood flow. It is thought that the uterine tissues then undergo apoptosis and autophagy. It takes about 4-6 weeks for the uterus to decrease is size from about 1 kg to 60 grams.
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This question is part of the following fields:
- Clinical Management
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Question 4
Correct
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A 33-year-old female presents with 3 months of irregular vaginal bleeding. Prior to this her menstrual periods were normal. Which one of the following is the most appropriate initial laboratory test for this patient?
Your Answer: hCG
Explanation:In women of childbearing age, the most likely cause of abnormal vaginal bleeding is pregnancy; thus, the most appropriate initial test would be an hCG level. Once pregnancy has been excluded, patient history would guide further testing. Iatrogenic causes, usually resulting from certain medicines or supplements, are the next most common cause in this age group, followed by systemic disorders. Haemoglobin and haematocrit would be appropriate only if the patient seemed acutely anaemic due to the abnormal bleeding.
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This question is part of the following fields:
- Gynaecology
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Question 5
Incorrect
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A 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: 50%
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.
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This question is part of the following fields:
- Microbiology
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Question 6
Correct
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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
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Question 7
Correct
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All of the following factors increase the risk of endometrial cancer except which one?
Your Answer: High Coffee Consumption
Explanation:The risk factors for uterine carcinoma include obesity, diabetes, Nulliparity, late menopause, unopposed oestrogen therapy, tamoxifen therapy, HRT and a family history of ovarian or uterine carcinoma.
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This question is part of the following fields:
- Epidemiology
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Question 8
Incorrect
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According to the RCOG Green-top guidelines on prevention and management of post-partum haemorrhage (PPH) which of the following statements is true?
Your Answer: Prophylactic oxytocics reduce the risk of PPH by about 30%
Correct Answer: For women delivering by caesarean section, Oxytocin 5 iu by slow IV injection should be used
Explanation:Misoprostol is not as effective as oxytocin but may be used if Oxytocin is not available e.g. home birth Recommended doses of Oxytocin For vaginal deliveries: 5 iu or 10 iu by intramuscular injection. For C-section: 5 iu by IV injection
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This question is part of the following fields:
- Clinical Management
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Question 9
Correct
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What is the target INR in a patient who has just been started on warfarin therapy due to a pulmonary embolism?
Your Answer: 2.0-3.0
Explanation:Warfarin can be useful for management of thromboembolism. The target INR range for this medication is between 2.0-3.0 in patients with venous thromboembolism, pulmonary embolism etc. The INR range may increase to 3.0-4.0 in patients with mechanical valves. However, warfarin is not recommended in pregnancy, and Low Molecular Weight Heparin should be used for thromboprophylaxis instead.
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This question is part of the following fields:
- Pharmacology
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Question 10
Correct
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A 33 year old female patient with high grade abnormality on cervical screening test was referred to see a gynaecologist at your clinic. Colposcopy reveals abnormal cells higher in the cervical canal. What is the next step in management of this patient?
Your Answer: Cone biopsy
Explanation:If abnormal cells are found high up in the cervical canal, it is critical to consider doing a cone biopsy to rule out any cervical malignancy. A cone-shaped section of the cervix containing the abnormal cells is removed under general anaesthesia.
Loop Electrosurgical Excision Procedure is a way of removing the abnormal cells from the cervix using a wire loop. First a speculum is inserted to open the vagina so the uterus can be seen. Then a solution is applied to the surface of the cervix to make the areas of abnormal cells easier to see. It is done under local anaesthesia.Cone biopsy is the only acceptable option to rule out malignancy. Cryotherapy, chemotherapy and radiotherapy are management options once malignancy has been confirmed.
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This question is part of the following fields:
- Gynaecology
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Question 11
Incorrect
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During her first month on OCPs, a patient had minimal bleeding at mid cycle. What is the most appropriate management?
Your Answer: Continue pills and use an additional form of contraception.
Correct Answer: Continue pills as usual.
Explanation:Breakthrough bleeding, or spotting, refers to when vaginal bleeding occurs between menstrual cycles. It may look like light bleeding or brown discharge.
Spotting is the most common side effect of birth control pills. It happens because the body is adjusting to changing levels of hormones, and the uterus is adjusting to having a thinner lining.
Taking the pill as prescribed, usually every day and at the same time each day, can help prevent bleeding between periods.
All other options are incorrect as this is a common side effect and will resolve on its own.
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This question is part of the following fields:
- Gynaecology
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Question 12
Incorrect
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A patient who is 36 weeks pregnant comes to see you as she has developed tingling to the right lateral thigh over the past 3 weeks. On examination there are no skin changes and no muscle weakness. What is the likely diagnosis?
Your Answer: Femoral Nerve entrapment
Correct Answer: Meralgia Paraesthetica
Explanation:Raised pressure with the pelvis can cause a number of nerve entrapment syndromes. This is entrapment of the lateral cutaneous nerve of the thigh (or lateral femoral cutaneous nerve) also known as Meralgia Paraesthetica. Pregnancy is a risk factor. Shingles can effect this nerve but the rash would usually present itself within 14days.
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This question is part of the following fields:
- Anatomy
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Question 13
Correct
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A pregnant female recently underwent her antenatal screening for HIV and Hepatitis B. Which of the following additional tests should she be screened for?
Your Answer: Rubella, Toxoplasma and Syphilis
Explanation:A screening blood test for the infectious diseases HIV, Syphilis, Rubella, Toxoplasmosis and Hepatitis B is offered to all pregnant females so as to reduce the chances of transmission to the neonate.
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This question is part of the following fields:
- Obstetrics
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Question 14
Incorrect
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A 32 year old patient develops painful ulcerated genital lesions and inguinal lymphadenopathy. She is 32 weeks pregnant. You suspect genital herpes and send swabs. Which of the following is appropriate management according to the 2014 BASHH/RCOG guidelines?
Your Answer: Give Acyclovir 400mg TDS orally for 5 days
Correct Answer: Send bloods to check antibody status. If this supports this is a first episode genital HSV then patient should be advised to have C-section delivery
Explanation:Although acyclovir should be given, this patient is in the 3rd trimester so the course should continue until delivery. Dose will be 400mg TDS unless disseminated disease. If this is a primary HSV infection (This should be confirmed by lesion swabs to confirm HSV infection and bloods to check no antibody response i.e. evidence previous infection) then C-section is indicated.
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This question is part of the following fields:
- Microbiology
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Question 15
Correct
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Question 16
Incorrect
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A 26 year old patient attends the maternity unit as her waters have broken but she hasn't had contractions. She is at 39+5 weeks gestation. Speculum examination confirms prelabour rupture of membranes (PROM). What is the risk of serious neonatal infection with PROM?
Your Answer: 1 in 1000
Correct Answer: 1 in 100
Explanation:In pregnancy, term refers to the gestational period from 37 to 41+6 weeks. Preterm births occur between 24 and 36+6 weeks. Only 1% of women who go into PROM have risk of having serious neonatal infections.
Management of PROM:
60% of patients with PROM will go into labour within 24 hrs
Induction is appropriate if >34 weeks gestation and more than 24 hours post rupture when labour hasn’t started.
If < 34 weeks, induction of labour should not be carried out unless there are additional obstetric indications e.g. infection -
This question is part of the following fields:
- Clinical Management
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Question 17
Correct
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A 53 year old lady presents to clinic due to vulval itch and discolouration. examination reveals pale white discoloured areas to the vulva. A biopsy shows epidermal atrophy with sub-epidermal hyalinization and deeper inflammatory infiltrate. What is this characteristic of?
Your Answer: Lichen Sclerosus
Explanation:Lichen sclerosus is characterized by hypopigmented atrophic plaque in the perineal region along with features of pruritis and dyspareunia.
It is more common in post menopausal women and on histology there is epidermal atrophy, inflammatory infiltrate in the dermis and basal layer degeneration.Vitiligo is characterised by hypopigmentation but without any other symptoms.
Extramammary Paget’s disease is characterized by erythematous plaque located mostly in the perianal region but its histology is different.
Lichen simplex chronicus is a chronic scaly pruritic condition characterized by itchy papules and plaques plus lichenification and it mostly results from chronic irritation and itching of the area. -
This question is part of the following fields:
- Clinical Management
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Question 18
Incorrect
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A 34-year-old woman presents to your clinic with a chief complaint of vague stomach pain. A unilocular cyst (3.8 x 4.3 x 3.0 cm) was discovered in the left ovary during a trans-abdominal ultrasound. What is the best management strategy?
Your Answer: Take Ca125 and refer gynaecologist
Correct Answer: Reassurance, no further action required
Explanation:In premenopausal women, watchful waiting usually involves monitoring for symptoms (pelvic pain or pressure) and repeating the pelvic ultrasound after six to eight weeks. If the ovarian cyst does not enlarge or if it resolves during the period of watchful waiting, it does not usually require surgical removal. Some premenopausal women will be advised to take a birth control pill during this time to help prevent new ovarian cysts from developing.
If a cyst decreases in size or does not change, the ultrasound is often repeated at regular intervals until your healthcare provider is certain that the cyst is not growing. If the cyst resolves, no further testing or follow-up is required.
Surgery may be recommended in the following situations:
– A cyst is causing persistent pain or pressure, or may rupture or twist.
– A cyst appears on ultrasound to be caused by endometriosis and is removed for fertility reasons.
– Large cysts (>5 to 10 cm) are more likely to require surgical removal compared to smaller cysts. However, a large size does not predict whether a cyst is cancerous.
– If the cyst appears suspicious for cancer. If you have risk factors for ovarian cancer or the cyst looks potentially cancerous on imaging studies, your healthcare provider may recommend surgery.
– If the suspicion for ovarian cancer is low but the cyst does not resolve after several ultrasounds, you may choose to have it removed after a discussion with your healthcare provider. However, surgical removal is not usually necessary in this case. -
This question is part of the following fields:
- Gynaecology
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Question 19
Correct
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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.
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This question is part of the following fields:
- Anatomy
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Question 20
Correct
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A 26-year-old pregnant female in her first trimester was brought to the labour room with complaints of painless vaginal bleeding. On examination, her abdomen was non-tender and os was closed. Which of the following is the most likely diagnosis?
Your Answer: Threatened miscarriage
Explanation:Threatened miscarriage is a term used to describe any abnormal vaginal bleeding that occurs in first trimester, sometime associated with abdominal cramps. The cervix remains closed and the pregnancy may continue as normal.
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This question is part of the following fields:
- Obstetrics
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Question 21
Correct
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A 75 year old woman has a lesion biopsied from the cervix that is histologically confirmed as endometrial carcinoma. Further staging investigations shows no spread to the serosa or adnexa, no spread to the para-aortic, pelvic or inguinal lymph nodes and no evidence of distant metastasis. What FIGO stage is this?
Your Answer: 2
Explanation:It is stage 2 of the disease.
Staging:
1 Confined to uterus
1A < 50% myometrial invasion
1B > 50% myometrial invasion
2 Cervical stromal invasion but not beyond uterus
3 Extension beyond the uterus
3A Tumour invades the serosa or adnexa
3B Vaginal and/or parametrial invasion
3C1 Pelvic nodal involvement
3C2 Para aortic nodal involvement
4 Distant Metastasis
4A Tumour invasion of the bladder and/or bowel mucosa
4B Distant metastases including abdominal metastases and/or inguinal lymph nodes -
This question is part of the following fields:
- Clinical Management
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Question 22
Correct
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During pregnancy which hormone(s) inhibit lactogenesis?
Your Answer: Oestrogen and Progesterone
Explanation:Prolactin levels rise steadily during pregnancy during which time it promotes mammary growth (along with the other hormones mentioned below). Oestrogen and progesterone inhibit lactogenesis and it is only with the loss of these placental steroid hormones at term that Prolactin exhibits its lactogenic effect.
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This question is part of the following fields:
- Clinical Management
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Question 23
Correct
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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: 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.
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This question is part of the following fields:
- Embryology
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Question 24
Correct
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According to NICE guidance what should be used for wound cleansing for the first 48 hours postoperatively?
Your Answer: Sterile saline
Explanation:NICE guidelines (CG74) advise the following regarding postoperative wound management Use sterile saline for wound cleansing up to 48 hours after surgery. Advise patients that they may shower safely 48 hours after surgery. Use tap water for wound cleansing after 48 hours if the surgical wound has separated or has been surgically opened to drain pus. Do not use topical antimicrobial agents for surgical wounds that are healing by primary intention to reduce the risk of surgical site infection
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This question is part of the following fields:
- Microbiology
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Question 25
Correct
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Which one of the following features indicates fetal asphyxia?
Your Answer: Type II (late) decelerations with tachycardia
Explanation:A type II deceleration is due to placental insufficiency which can result in fetal distress and asphyxia. The fetal heart rate is lowest at the start of the contraction and returns to normal after the contraction is complete.
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This question is part of the following fields:
- Physiology
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Question 26
Correct
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What is the RCOG advice regarding timing of Rhesus Anti-D Immunoglobulin following abortion?
Your Answer: Anti-D IgG within 72 hours following abortion
Explanation:All non-sensitised RhD negative women should receive Anti-D IgG within 72 hours following abortion
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This question is part of the following fields:
- Clinical Management
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Question 27
Correct
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All of the following are autosomal recessive conditions EXCEPT which one?
Your Answer: Osteogenesis Imperfecta
Explanation:Osteogenesis imperfect is an autosomal dominant condition. All the rest of the options are autosomal recessive conditions.
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This question is part of the following fields:
- Endocrinology
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Question 28
Incorrect
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Regarding implantation, how many days after fertilisation does it typically occur?
Your Answer: 3
Correct Answer: 8
Explanation:Fertilization usually occurs in the fallopian tubes after ovulation. The zygote moves through the fallopian tube and implants in the endometrium about 7-9 days after fertilisation, or 6-12 days after ovulation.
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This question is part of the following fields:
- Embryology
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Question 29
Incorrect
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A 32-year-old woman visited your clinic at her 30th week of gestation, complaining of left lower limb pain. The doppler ultrasound findings had confirmed proximal deep vein thrombosis and she was treated with low molecular weight heparin. Now she is at her 34 weeks of gestation, and is expecting delivery in next four weeks. What would be your advice for her today?
Your Answer: Cease all anti-coagulants
Correct Answer: Low molecular weight heparin should be switched to unfractionated heparin
Explanation:This patient has developed deep vein thrombosis during pregnancy and required anti-coagulation as part of treatment for up to 3-6 months. Enoxaparin, which is a low molecular weight heparin, is preferred over heparin due to the once or twice a day therapeutic dosing. Also monitoring of aPTT is not required in this case.
There is an association between Enoxaparin and an increased risk for epidural hematoma in women receiving epidural anaesthesia during labour. Considering that the patient mentioned is expected to go for delivery in 4 weeks and the possibility of her needing an epidural anaesthesia or general anaesthesia in case of undergoing a cesarean section, enoxaparin should be switched to unfractionated heparin, four weeks prior to the anticipated delivery. This is because of the fact that heparin can be antidoted with protamine sulphate.
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This question is part of the following fields:
- Obstetrics
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Question 30
Incorrect
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A 27-year-old woman presented to the medical clinic due to infertility. Upon interview, it was noted that she has been having unprotected intercourse with her husband regularly for the past year but has not become pregnant. She mentioned that her last menstrual period was 3 weeks ago. Her menses occur every 28 to 30 days and they last 4 to 5 days. A day before her menses, she has episodes of severe lower abdominal pain that is only partially relieved by ibuprofen. Further history taking was done and revealed that she was treated for gonococcal cervicitis at age 19. The patient also takes a prenatal vitamin every day and does not use tobacco, alcohol, or illicit drugs. Her 31-year-old husband recently had semen analysis and his results were normal. Further examination was done and the following are her results: Blood pressure is 126/70mmHg, Pulse is 85/min, BMI is 31 kg/m2. Upon further examination and observation, it was revealed that she has a small uterus with a cervix that appears laterally displaced and there is accompanying pain upon cervical manipulation. Which of the following is most likely considered the cause of the patient’s infertility?
Your Answer: Intrauterine adhesions
Correct Answer: Endometriosis
Explanation:Endometriosis is a chronic gynaecologic disease characterized by the development and presence of histological elements like endometrial glands and stroma in anatomical positions and organs outside of the uterine cavity. The main clinical manifestations of the disease are chronic pelvic pain and impaired fertility. The localization of endometriosis lesions can vary, with the most commonly involved focus of the disease the ovaries followed by the posterior broad ligament, the anterior cul-de-sac, the posterior cul-de-sac, and the uterosacral ligament.
The clinical presentation of the disease differs in women and may be unexpected not only in the presentation but also in the duration. Clinicians usually suspect and are more likely to diagnose the disease in females presenting with the typical symptomatology such as dyspareunia, namely painful sexual intercourse, pelvic pain during menstruation (dysmenorrhea), pain in the urination (dysuria), defecation (dyschezia), and/or infertility. The pain is usually characterized as chronic, cyclic, and progressive (exacerbating over time). Furthermore, some women suffering from endometriosis experience hyperalgesia, a phenomenon, when even with the application of a nonpainful stimulus, an intolerable painful reaction is released. This condition indicates neuropathic pain.
Tenderness on vaginal examination, palpable nodules in the posterior fornix, adnexal masses, and immobility of the uterus are diagnostically indicating findings of endometriosis.
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This question is part of the following fields:
- Obstetrics
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