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Question 1
Correct
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Which vitamin deficiency leads to Wernicke's encephalopathy?
Your Answer: B1
Explanation:Vitamin B1 deficiency can lead to Wernicke’s encephalopathy. Alcoholics are at particular risk. In obstetrics all women with hyperemesis gravidarum should receive thiamine supplementation to prevent Wernicke’s.
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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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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: Repeat the ultrasound in 6 weeks
Correct 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.
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This question is part of the following fields:
- Gynaecology
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Question 3
Incorrect
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A 35-year-old lady with a 4-year history of hypertension is planning to conceive. She has never been pregnant before and has stopped using contraception recently. She has a past medical history of asthma and the only medication she is on is ramipril 10 mg daily. On examination her blood pressure is found to be 130/85 mm/Hg. From the following which is the most appropriate initial management of her hypertension?
Your Answer: Cease ramipril and start atenolol
Correct Answer: Cease ramipril and start methyldopa
Explanation:In the given case pre-pregnancy counselling and management of chronic hypertension is very much essential.
Some commonly prescribed antihypertensive drugs like ACE inhibitors, angiotensin receptor antagonists, diuretics and most beta blockers are contraindicated or is best to be avoided before conception and during pregnancy.
Methyldopa is considered as the first line drug for the management of mild to moderate hypertension in pregnancy and is the most commonly prescribed antihypertensive for this indication.
Hydralazine can be used during any hypertensive emergencies in pregnancy.
Intake of Angiotensin receptor blockers and ACE inhibitors during the first trimester can lead to complications as they are both teratogenic; use of these drugs during second and third trimesters can result in foetal renal dysfunction, oligohydramnios and skull hypoplasia.
Diuretics can cause foetal electrolyte disturbances and significant reduction in maternal blood volume.
All beta blockers, except labetalol, can result in foetal bradycardia, and growth restriction in case its long-term use.
Calcium channel antagonists, except nifedipine, are avoided during pregnancy due to its high risk for maternal hypotension and foetal hypoxia. -
This question is part of the following fields:
- Obstetrics
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Question 4
Incorrect
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Which of the following statements regarding prolactin is true?
Your Answer: Prolactin levels decrease shortly after sleep
Correct Answer: Prolactin levels increase during stress
Explanation:Causes of Hyperprolactinemia: Prolactinomas, Medication (phenothiazines, metoclopramide, risperidone, selective serotonin reuptake inhibitors, oestrogens, verapamil), Stress, Pregnancy, Hypothyroidism, Kidney disease, Chest trauma
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This question is part of the following fields:
- Endocrinology
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Question 5
Correct
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A women has undergone genetic testing due to her family history and has the BRCA 1 gene. What would you advise her lifetime risk of breast cancer is?
Your Answer: 70%
Explanation:The life time risk of breast cancer in BRCA 1 gene is 70% and of ovarian cancer is 40%.
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This question is part of the following fields:
- Genetics
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Question 6
Incorrect
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The inguinal canal is reinforced posteriorly by which structure?
Your Answer: Inguinal ligament
Correct Answer: Conjoint tendon
Explanation:The Inguinal Canal
– Anterior wall: formed by the external oblique aponeurosis throughout the length of the canal; its lateral part is reinforced by muscle fibres of the internal oblique.
– Posterior wall: formed by the transversalis fascia; its medial part is reinforced by pubic attachments of the internal oblique and transversus abdominis aponeuroses that frequently merge to variable extents into a common tendon—the inguinal falx (conjoint tendon)—and the reflected inguinal ligament.
– Roof: formed laterally by the transversalis fascia, centrally by musculo-aponeurotic arches of the internal oblique and transversus abdominis, and medially by the medial crus of the external oblique aponeurosis.
– Floor: formed laterally by the iliopubic tract, centrally by gutter formed by the infolded inguinal ligament, and medially by the lacunar ligament. -
This question is part of the following fields:
- Anatomy
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Question 7
Correct
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A woman has undergone genetic testing due to her family history and has the BRCA 1 gene. What would you advise her lifetime risk of ovarian cancer is?
Your Answer: 40%
Explanation:The most common hereditary cancer in the breast ovarian cancer syndrome accounts for 90% of the hereditary cancers. It is due to mutations in the BRCA 1 and BRCA 2 genes, most commonly the BRCA 1 gene accounting for 70% life time risk of breast cancer and 40% life time risk of ovarian cancer.
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This question is part of the following fields:
- Genetics
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Question 8
Correct
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Question 9
Incorrect
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Regarding the uterine artery which of the following statements are FALSE?
Your Answer: Travels through the Broad Ligament of the Uterus
Correct Answer: It crosses the Ureter posteriorly
Explanation:The Uterine artery typically arises from the anterior branch of the internal iliac artery. It crosses the ureter ANTERIORLY. It is the primary source of arterial supply to the uterus and its branches anastomose with branches of the ovarian and vaginal arteries.
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This question is part of the following fields:
- Anatomy
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Question 10
Correct
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Presence of anisocytosis, poikilocytosis and hyperchromatism on cervical smear indicates?
Your Answer: Dysplasia
Explanation:Dysplasia has 4 microscopic characteristics:
Anisocytosis (unequal cell size)
Poikilocytosis (abnormal cell shape)
Hyperchromatism (pigmentation)
Mitotic figures (increased cells currently dividing)Hyperplasia and hypertrophy is characterised by increase in cell number and increase in cell size respectively, whereas atrophy means decrease in cell size.
Metaplasia is characterised by change of one form of cell to another type e.g. changes of columnar epithelium to squamous epithelium. -
This question is part of the following fields:
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
