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Question 1
Incorrect
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A 28-year-old, 10-weeks pregnant woman comes to you complaining of right iliac fossa pain, which is more when she tries to stand up or cough. She also had a history of appendectomy, done 12 years ago. Physical examination reveals mild tenderness in right iliac fossa, without any rebound tenderness or guarding. Among the following options which will be the most likely diagnosis?
Your Answer: Unruptured ectopic pregnancy
Correct Answer: Round ligament pain
Explanation:The given case can be diagnosed as round ligament pain, which is common during pregnancy. This happens as a result to the stretching of round ligament in pelvis to occupy the growing uterus. The round ligament pain usually gets worse with movements or straining and will be relieved by rest or warm application.
As the abdominal examination of patient is unremarkable, conditions like ovarian cyst rupture, ectopic pregnancy and intestinal obstruction are a very unlikely to be the diagnosis.
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This question is part of the following fields:
- Obstetrics
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Question 2
Correct
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Which of the following statements is true regarding heart rate in pregnancy?
Your Answer: Heart rate increases by 15 beats per minute
Explanation:During the first 12 weeks of pregnancy, cardiac output increases by about 30-50%. To maintain this increase, systemic vascular resistance decreases by 20-30%, while stroke volume and the heart rate increase by 25-30% and 15 beats per minute respectively.
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This question is part of the following fields:
- Physiology
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Question 3
Incorrect
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Which increases the risk for developing endometrial cancer?
Your Answer: Age more than 30 years
Correct Answer: Early menarche
Explanation:Endometrioid endometrial carcinoma is oestrogen-responsive, and the main risk factor for this disease is long-term exposure to excess endogenous or exogenous oestrogen without adequate opposition by a progestin.
Early age at menarche is a risk factor for endometrial carcinoma in some studies; late menopause is less consistently associated with an increased risk of the disease. Both of these factors result in prolonged oestrogen stimulation and at times of the reproductive years during which anovulatory cycles are common
Other risk factors include
obesity,
nulliparity,
diabetes mellitus, and
hypertension.The risk of endometrial hyperplasia and carcinoma with oestrogen therapy can be significantly reduced by the concomitant administration of a progestin. In general, combined oestrogen-progestin preparations do not increase the risk of endometrial hyperplasia.
Endometrial carcinoma usually occurs in postmenopausal women (mean age at diagnosis is 62 years). Women under age 50 who develop endometrial cancer often have risk factors such as obesity or chronic anovulation.
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This question is part of the following fields:
- Gynaecology
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Question 4
Correct
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A 25 year old unmarried female presented with dizziness, nausea and vomiting for 1 week. According to her, she has been stressed recently and her usual menstrual period has been delayed by 4 weeks. Examination findings were normal. Which of the following is the most appropriate next step?
Your Answer: Dipstick for B-hCG
Explanation:There is high possibility of her being pregnant. Urine B-hCG has to be checked to exclude pregnancy.
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This question is part of the following fields:
- Gynaecology
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Question 5
Correct
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Etiological factors in spontaneous abortion include:
Your Answer: All of the options given
Explanation:Spontaneous abortion is the loss of pregnancy naturally before twenty weeks of gestation. Colloquially, spontaneous abortion is referred to as a ‘miscarriage’ to avoid association with induced abortion. Early pregnancy loss refers only to spontaneous abortion in the first trimester. In 50% of cases, early pregnancy loss is believed to be due to fetal chromosomal abnormalities. Advanced maternal age and previous early pregnancy loss are the most common risk factors. For example, the incidence of early pregnancy loss in women 20-30 years of age is only 9 to 17%, while the incidence at 45 years of maternal age is 80%. Other risk factors include alcohol consumption, smoking, and cocaine use.
Several chronic diseases can precipitate spontaneous abortion, including diabetes, celiac disease, and autoimmune conditions, particularly anti-phospholipid antibody syndrome. Rapid conception after delivery and infections, such as cervicitis, vaginitis, HIV infection, syphilis, and malaria, are also common risk factors. Another important risk factor is exposure to environmental contaminants, including arsenic, lead, and organic solvents. Finally, structural uterine abnormalities, such as congenital anomalies, leiomyoma, and intrauterine adhesions, have been shown to increase the risk of spontaneous abortion.
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This question is part of the following fields:
- Obstetrics
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Question 6
Correct
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Lowered haemoglobin during normal pregnancy is a physiological finding which is mainly due to:
Your Answer: Increased plasma volume
Explanation:During pregnancy, anaemia increases more than fourfold from the first to third trimester. It is a well established fact that there is a physiological drop in haemoglobin (Hb) in the mid trimester. This physiological drop is attributed to increase of plasma volume and hence decrease of blood viscosity lead to better circulation in placenta.
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This question is part of the following fields:
- Physiology
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Question 7
Incorrect
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In early pregnancy at what gestation does the Embryonic pole become visible on transvaginal ultrasound?
Your Answer: 5 weeks
Correct Answer: 5 weeks + 3 days
Explanation:The embryonic pole becomes visible on transvaginal ultrasound at around 5 and a half to 6 weeks gestation when it measures around 3mm.
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This question is part of the following fields:
- Biophysics
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Question 8
Correct
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A couple comes to your clinic because they haven't been able to conceive despite having had frequent sexual activity in the previous 12 months. The female partner is 35 years old and has regular menstrual cycles. The male partner is 38years old and otherwise normal. Which of the following studies would you do next to forecast ovulation?
Your Answer: Serum progesterone
Explanation:This patient has a regular and long menstrual period. The most crucial thing in this case is to rule out anovulation.
Serum progesterone concentration is the best test for detecting ovulation.
Ovulation has occurred if the level is greater than 20nmol/L.
This test should be performed 3 to 10 days prior to the start of the next anticipated period. -
This question is part of the following fields:
- Gynaecology
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Question 9
Incorrect
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A 28-year-old woman had a C-section due to pre-eclampsia. She now complains of right upper quadrant pain unrelated to the surgical wound. Which of the following investigations should be done immediately?
Your Answer: Coagulation profile
Correct Answer: LFT
Explanation:There is a high risk of developing HELLP syndrome in pre-eclamptic patients. Considering that she is complaining of right upper quadrant pain, a LFT should be done immediately.
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This question is part of the following fields:
- Obstetrics
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Question 10
Incorrect
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The arcuate line forms part of the border of the pelvic brim. Where is it located?
Your Answer: Coccyx
Correct Answer: Ilium
Explanation:The arcuate line is a smooth rounded border on the internal surface of the ilium just inferior to the iliac fossa. It forms the boundary of the pelvic inlet.
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This question is part of the following fields:
- Anatomy
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Question 11
Incorrect
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A 77 year old woman undergoes staging investigations for endometrial carcinoma. This shows invasion of the inguinal lymph nodes. What is this patients 5-year survival?
Your Answer: 45-60%
Correct Answer: 15%
Explanation:Lymph node involvement means that the carcinoma is stage 4. The 5 year survival of stage 4 endometrial carcinoma is 16%.
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This question is part of the following fields:
- Clinical Management
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Question 12
Correct
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A 30 year old women who is 24 weeks pregnant attends clinic due to suprapubic pain. Ultrasound shows a viable foetus and also a fibroid with a cystic fluid filled centre. What is the likely diagnosis?
Your Answer: Cystic degeneration of fibroid
Explanation:A fibroid is a benign tumour of the smooth muscles of the uterus also known as a leiomyoma. It has a typical whorled appearance and this may be altered following degeneration which occurs in four main types:
1. Red degeneration, also known as carneous degeneration, of degeneration that can involve a uterine leiomyoma. While it is an uncommon type of degeneration, it is thought to be the most common form of degeneration of a leiomyoma during pregnancy. Red degeneration follows an acute disruption of the blood supply to the fibroid during growth typically in a mid-second trimester presenting as sudden onset of pain with tenderness localizing to the area of the uterus along with pyrexia and leucocytosis. On ultrasound it can have peripheral (rim).2. Hyaline degeneration is the most common form of degeneration that can occur in a uterine leiomyoma. It is thought to occur in up to 60% of uterine leiomyomasoccurs when the fibroid outgrows its blood supply. this may progresses to central necrosis leaving a cystic space in the centre knowns as cystic degeneration.
3. Cystic degeneration is an uncommon type of degeneration that a uterine leiomyoma (fibroid) can undergo. This type of degeneration is thought to represent ,4% of all types of uterine leiomyoma degeneration. When the leiomyoma increases in size, the vascular supply to it becomes inadequate and leads to different types of degeneration: hyaline, cystic, myxoid, or red degeneration. Dystrophic calcification may also occur. Hyalinization is the commonest type of degeneration. Cystic degeneration is an extreme sequel of edema. Ultrasound may show a hypoechoic or heterogeneous uterine mass with cystic areas.
4. Myxoid degeneration of leiomyoma is one of the rarer types of degeneration that can occur in a uterine leiomyoma. While this type of degeneration is generally considered rare, the highest prevalence for this type of degeneration has been reported as up to 50% of all degenerations of leiomyomas. Fibroids (i.e. uterine leiomyomas) that have undergone myxoid degeneration are filled with a gelatinous material and can be difficult to differentiate from cystic degeneration; however, they typically appear as more complex cystic masses. They appear hypocellular with a myxoid matrix.
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This question is part of the following fields:
- Clinical Management
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Question 13
Correct
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You are asked to assess a patients perineal tear following labour by vaginal delivery. You note a laceration that extends approximately a quarter of the thickness through the external anal sphincter. How would you classify this tear?
Your Answer: 3a
Explanation:1. First-degree trauma corresponds to lacerations of the skin/vaginal epithelium alone.
2. Second-degree tears involve perineal muscles and therefore include episiotomies.
3. Third-degree extensions involve any part of the anal sphincter complex (external and internal sphincters):
i Less than 50 per cent of the external anal
sphincter is torn.
ii More than 50 per cent of the external anal
sphincter is torn.
iii Tear involves the internal anal sphincter
(usually there is complete disruption of the
external sphincter).
4. Fourth-degree tears involve injury to the anal sphincter complex extending into the rectal mucosa. -
This question is part of the following fields:
- Anatomy
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Question 14
Incorrect
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Engagement of the foetus can be defined as:
Your Answer: When the presenting part is level with the ischial spines
Correct Answer: When the greatest biparietal diameter of the fetal head passes the pelvic inlet
Explanation:Engagement means when the fetal head enters the pelvic brim/inlet and it usually takes place 2 weeks before the estimated delivery date i.e. at 38 weeks of pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 15
Correct
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At what gestational age does the luteo-placental shift occur?
Your Answer: 6-8 weeks
Explanation:Luteo-placental shifts occurs around 6-8 week when the placenta takes over from the corpus luteum as the main producer of oestrogen and progesterone.
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This question is part of the following fields:
- Clinical Management
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Question 16
Incorrect
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Question 17
Correct
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You see a 23 year old women in clinic complaining of vaginal discharge. The lab phone to tell you microscopy and staining shows a gram negative diplococcus. Which organism is most likely to be responsible?
Your Answer: Neisseria gonorrhoeae
Explanation:The most common gram negative diplococci include Neisseria, haemophilus and Moraxella.
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This question is part of the following fields:
- Microbiology
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Question 18
Incorrect
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Which of the following uterotonic drugs is most strongly associated with a transient pyrexia occurring within 45 minutes of administration?
Your Answer: Carboprost
Correct Answer: Dinoprostone
Explanation:Dinoprostone is associated with a transient pyrexia. This typically normalises within 4 hours of stopping treatment
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This question is part of the following fields:
- Clinical Management
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Question 19
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 20
Correct
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A 29 year old women wants to speak to you regarding infections in pregnancy. Her two year old son has sensorineural deafness as a result of infection in her previous pregnancy. She tells you he was born with a 'blueberry muffin' rash. What was the most likely infection?
Your Answer: Rubella
Explanation:The ‘Blueberry muffin’ rash is a descriptor for the rash seen in Congenital Rubella Syndrome. A similar petechial rash may also occur in CMV infection but shouldn’t be termed ‘blueberry muffin’
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This question is part of the following fields:
- Microbiology
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Question 21
Correct
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Gonadotropin-releasing hormone (GnRH) stimulates the release of:
Your Answer: Luteinizing hormone
Explanation:Gonadotropin-releasing hormone (GnRH) is the hormone responsible for the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary gland.
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This question is part of the following fields:
- Endocrinology
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Question 22
Correct
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In the earliest phase of wound healing platelets are held together by what?
Your Answer: Fibrin
Explanation:The 1st stage of wound healing is haemostasis. Even in incised wounds a small haematoma forms. Here the clotting cascade is activated by tissue factor and endothelial cells resulting in activation of platelets. This results in platelet aggregation and the laying down of a fibrin mesh that is cross linked and holds the platelets in place.
Wound healing is typically divided into phases:
1. Haemostasis Phase
2. Inflammatory phase
3. Proliferation phase
4. Remodelling phase -
This question is part of the following fields:
- Physiology
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Question 23
Incorrect
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In normal pregnancy, levels of all of the following hormones increases, EXCEPT:
Your Answer: Total thyroxine (T4)
Correct Answer: Parathyroid hormone (PTH) in the 2nd & 3rd trimesters
Explanation:In order to maintain fetal bone growth, the maternal compartment undergoes adjustments that provide a net transfer of sufficient calcium to the foetus. Maternal compartment changes that permit calcium accumulation include increases in maternal dietary intake, increases in maternal 1, 25-dihydroxyvitamin D3 levels, and increases in parathyroid hormone (PTH) levels. The levels of total calcium and phosphorus decline in maternal serum, but ionized calcium levels remain unchanged. During pregnancy, the placenta forms a calcium pump in which a gradient of calcium and phosphorus is established which favours the foetus. Thus, circulating fetal calcium and phosphorus levels increase steadily throughout gestation. Furthermore, fetal levels of total and ionized calcium, as well as phosphorus, exceed maternal levels at term. By 10-12 weeks’ gestation, the fetal parathyroid glands secrete PTH. Fetal plasma levels of PTH are low during gestation, but increase after delivery.
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This question is part of the following fields:
- Endocrinology
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Question 24
Incorrect
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Regarding the ECG, what does the P wave represent?
Your Answer: Ventricular repolarisation
Correct Answer: Atrial depolarisation
Explanation:P wave = Atrial depolarisation
QRS complex = Ventricular depolarisation
T wave = Ventricular repolarisation
U wave = repolarisation of the interventricular septum -
This question is part of the following fields:
- Biophysics
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Question 25
Correct
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A 47 year old women has a transvaginal ultrasound that shows a partially echogenic mass with posterior sound attenuation owing to sebaceous material and hair within the cyst cavity. What is the likely diagnosis?
Your Answer: Mature teratoma
Explanation:These are the most common ovarian tumours in young women. The most common form is the mature dermoid cyst (cystic teratoma). It can consist of a combination of all the type of tissues (mesenchymal, stromal and epithelial). Any mature tissue type can be present such as muscle, cartilage, bone, teeth and often hair. Treatment is cystectomy.
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This question is part of the following fields:
- Data Interpretation
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Question 26
Incorrect
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A 23-year-old gravida 1 para 0 at 36 weeks gestation presents to the office complaining of ankle swelling and occasional headache for the past 2 days. She denies any abdominal pain or visual disturbances. On examination you note a fundal height of 35 cm, a fetal heart rate of 140 beats/min, 2+ lower extremity oedema, and a blood pressure of 144/92 mm Hg. A urine dipstick shows 1+ proteinuria. Which one of the following is the most appropriate next step in the management of this patient?
Your Answer: Initiation of antihypertensive treatment
Correct Answer: Laboratory evaluation, fetal testing, and 24-hour urine for total protein
Explanation:This patient most likely has preeclampsia, which is defined as an elevated blood pressure and proteinuria after 20 weeks gestation. The patient needs further evaluation, including a 24-hour urine for quantitative measurement of protein, blood pressure monitoring, and laboratory evaluation that includes haemoglobin, haematocrit, a platelet count, and serum levels of transaminase, creatinine, albumin, LDH, and uric acid- A peripheral smear and coagulation profiles also may be obtained- Antepartum fetal testing, such as a nonstress test to assess fetal well-being, would also be appropriate.
→ Ultrasonography should be done to assess for fetal intrauterine growth restriction, but only after an initial laboratory and fetal evaluation.
→ It is not necessary to start this patient on antihypertensive therapy at this point. An obstetric consultation should be considered for patients with preeclampsia.
→ Delivery is the definitive treatment for preeclampsia- The timing of delivery is determined by the gestational age of the foetus and the severity of preeclampsia in the mother. Vaginal delivery is preferred over caesarean delivery, if possible, in patients with preeclampsia. -
This question is part of the following fields:
- Obstetrics
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Question 27
Incorrect
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48 hours after having unprotected intercourse, a 16-year-old female requested a pregnancy test from her GP. What advice can you give her regarding the reliability of pregnancy testing at this time?
Your Answer: Even if conception has already occurred, beta hCG is likely to be normal
Correct Answer:
Explanation:Even if conception has already occurred, beta hCG is likely to be normal. Beta hCG is made by syncytiotrophoblast cells following conception. It then activates the corpus luteum to continuously produce progesterone for implantation to happen. In week 10/40, levels of HCG peak and the placenta can produce adequate progesterone by itself. As a general rule, a beta HCG concentration >25 U/I or a doubling of levels of HCG within two days is required to diagnose pregnancy. A urine pregnancy test would only likely prove positive around 8 days to 2 weeks following conception.
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This question is part of the following fields:
- Gynaecology
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Question 28
Incorrect
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A 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: Nimodipine (Nimotop)
Correct 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.
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This question is part of the following fields:
- Obstetrics
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Question 29
Correct
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The best confirmatory test for Turner's syndrome is done by:
Your Answer: Chromosomal analysis (Karyotyping)
Explanation:Standard karyotyping is the best confirmatory test for the diagnosis of Turner syndrome among patients who have some doubtful clinical presentations. It is done on peripheral blood mononuclear cells.
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This question is part of the following fields:
- Embryology
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Question 30
Correct
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Which of the following hormones is produced by the hypothalamus in response to breastfeeding?
Your Answer: Oxytocin
Explanation:Nipple stimulation during breastfeeding triggers the production of oxytocin from the hypothalamus and its subsequent release from the posterior pituitary gland. The hormone causes the myoepithelial cells of the breast to contract causing milk to flow through the ducts.
Ergometrine and Prostaglandin E2 are used during labour to control uterine bleeding after delivery, or ripen the cervix, while Atosiban is an oxytocin antagonist.
Antidiuretic hormone is also released from the posterior pituitary, and acts on the kidneys to decrease fluid excretion.
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This question is part of the following fields:
- Clinical Management
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