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Question 1
Correct
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A patient is being discharged following a termination of pregnancy at 14 weeks. She had been taking a combined oral contraceptive pill in the past but stopped taking this 6 months prior to falling pregnant as she wasn't in a serious relationship. When should she start again?
Your Answer: Start immediately
Explanation:Following an abortion or miscarriage, combined oral contraceptive pills should be started immediately.
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This question is part of the following fields:
- Clinical Management
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Question 2
Correct
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A 70 year old patient is being reviewed in clinic for post menopausal bleeding. Examination reveals a lesion of the vaginal wall. Which is the most common type of primary vaginal cancer?
Your Answer: Squamous cell carcinoma
Explanation:The vaginal epithelium is made of squamous cells. Hence the most common carcinoma that occurs in the Vagina is squamous cell carcinoma. Diagnosis is made with vaginal biopsy. Usually the pain only presents if the disease extends beyond the vagina involving the perineal nerves.
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This question is part of the following fields:
- Clinical Management
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Question 3
Correct
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Ulipristal is thought to prevent pregnancy by what primary mechanism?
Your 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 4
Incorrect
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A 23 year old patient presents to the emergency department with sudden onset of severe lower abdominal and pelvic pain. History reveals she normally has regular 28 day cycles but she missed her last period. Past medical history reveals 2 termination of pregnancy procedures in the past 3 years. The most recent one 6 months ago. She smokes 5 cigarettes per day.
Your Answer: Pelvic inflammatory disease
Correct Answer: Ectopic pregnancy
Explanation:This patient is most likely to have a ruptured ectopic pregnancy. The history of multiple TOPs suggests her contraceptive methods are not reliable and her missed period is suggestive she may currently be pregnant. There is no temperature or vaginal discharge to suggest PID though this is of course possible as is appendicitis. The last termination was 6 months ago so endometritis is unlikely.
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This question is part of the following fields:
- Clinical Management
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Question 5
Correct
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Which of the following has been shown to improve pruritus and liver function in patients with obstetric cholestasis?
Your Answer: Ursodeoxycholic acid
Explanation:Intrahepatic cholestasis characterized by reversible cholestasis typically occurring in the second or third trimester of pregnancy, elevated serum aminotransferases and bile acid level and resolution of symptoms by 2 to 3 weeks after delivery. Ursodeoxycholic acid has shown to reduce the symptoms of this condition.
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This question is part of the following fields:
- Clinical Management
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Question 6
Incorrect
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A 46 year old lady presents to the gynaecology clinic with a one month history of vulval soreness and lumps. She smokes several packs of tobacco cigarettes a day. A biopsy confirms vulvar intraepithelial neoplasia. What is her risk of developing squamous cell carcinoma?
Your Answer: 0.5-5%
Correct Answer: 15%
Explanation:Vulvar Intraepithelial Neoplasia (VIN) is a non-invasive squamous type lesion that carries a 15% chance of developing into squamous cell carcinoma of the vulva. Human Papillomavirus (HPV) infection, or chronic inflammatory conditions such as lichen sclerosis and lichen planus, can cause changes in the basal cells of the vulvar epithelium. Other risk factors of VIN include multiple sexual partners, cigarette smoking, and immunocompromised states. Diagnosis is by clinical examination and a biopsy confirms neoplasia.
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This question is part of the following fields:
- Clinical Management
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Question 7
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 8
Correct
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You are asked to review a patient. They have attended for a scan at 13 weeks following a positive pregnancy test. The patient has had 2 previous pregnancies for which she opted for termination on both occasions. The scan shows no identifiable fetal tissue or gestational sac and you note the radiologist has reported a 'bunch of grapes sign'. What is the likely diagnosis?
Your Answer: Complete molar pregnancy
Explanation:Gestational trophoblastic disorder is abnormal conception that is characterised by swollen and oedematous villi with proliferation of the trophoblasts. In a complete mole there is absence of fetal tissue, there is diffuse proliferation of trophoblastic tissue around hydropic villi and on USG it appears as a bunch of grapes or snow storm appearance.
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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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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.
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This question is part of the following fields:
- Clinical Management
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Question 10
Incorrect
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Hypemesis gravidarum occurs in what percentage of pregnancies?
Your Answer: <0.5%
Correct Answer: 1.50%
Explanation:Nausea and vomiting experienced in 80% of pregnancies Hyperemesis gravidarum (HG) is an extreme form of nausea and vomiting which affects around 1.5% of women. Caused by high levels HCG. Definitions vary but most consider it to be defined by severe nausea and vomiting associated with weight loss greater than 5% of pre-pregnancy weight with metabolic disturbance (typically dehydration and/or ketosis).
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This question is part of the following fields:
- Clinical Management
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Question 11
Correct
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Which of the following increases the risk of endometrial hyperplasia?
Your Answer: Tamoxifen
Explanation:Tamoxifen increases risk of endometrial hyperplasia Aromatase inhibitors such as Letrozole and Anastrozole are not associated and have not been shown to increase the risk of endometrial pathology Whereas unopposed oestrogens increase endometrial cancer risk combined oral contraceptive decrease risk
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This question is part of the following fields:
- Clinical Management
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Question 12
Incorrect
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When consenting a patient for abdominal hysterectomy what would you advise regarding the risk?
Your Answer: Haemorrhage requiring transfusion approximately 1%
Correct Answer: Injury to ureter or bladder is approximately 1%
Explanation:Abdominal hysterectomy is performed through a Pfannenstiel incision. There are certain complications associated with hysterectomy including haemorrhage, injury to the ureter(1%) and less commonly bladder and bowel (0.04%).
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This question is part of the following fields:
- Clinical Management
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Question 13
Incorrect
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Which one of the following has the most significant effect on slowing drug metabolism in pregnancy?
Your Answer: Increased renal blood flow
Correct 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
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Question 14
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 15
Correct
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Oxytocin binds to what receptor type?
Your Answer: G-protein-coupled receptors
Explanation:Oxytocin binds to the G protein coupled receptors that triggers the IP3 mechanism leading to an elevated intracellular calcium ion.
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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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A 55 year old patient with a who has tried unsuccessful conservative measures for her overactive bladder, would like to consider Oxybutynin. She wants to know how common dry mouth is as a side effect, as her sister suffered from it on while on the same drug.
Your Answer: approximately 5 in 100 patients
Correct Answer: approximately 1 in 10 patients
Explanation:Urinary incontinence can be divided into two main aetiologies, stress incontinence, or overactive bladder. Conservative management include lifestyle interventions, controlling fluid intake, or bladder exercises. If conservative management is no longer efficient, then medications may be indicated. Oxybutynin is an anticholinergic drug used in the treatment of urinary incontinence. As with other anticholinergic drugs, side effects include dry mouth, dry eyes, blurry vision and constipation. About 1 in 10 patients taking Oxybutynin will experience some of these side effects.
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This question is part of the following fields:
- Clinical Management
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Question 17
Correct
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Question 18
Incorrect
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What is the incidence of hyperthyroidism in complete molar pregnancy?
Your Answer: 10%
Correct 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.
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This question is part of the following fields:
- Clinical Management
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Question 19
Incorrect
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Regarding menstruation, which of the following is the maximum normal blood loss?
Your Answer: 60-65ml
Correct Answer: 80-85ml
Explanation:Most women lose about 35-40 ml of blood on average during each menstrual cycle. The maximum amount of blood loss is 80 ml after which blood loss of more than 80 ml is defined as heavy menstrual bleeding, formerly known as menorrhagia.
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This question is part of the following fields:
- Clinical Management
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Question 20
Incorrect
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A 30 year old women who is 24 weeks pregnant attends EPU 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
Correct Answer: Red degeneration of fibroid
Explanation:Red degeneration of fibroids is one of 4 methods of fibroid degeneration. Although uncommon outside pregnancy it is thought to be the most common form of fibroid degeneration during pregnancy and typically occurs in the 2nd trimester. It is thought to arise from the fibroid outgrowing its blood supply and haemorrhagic infarction occurs. Ultrasound will typically show a localised fluid collection (blood) within the fibroid.
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This question is part of the following fields:
- Clinical Management
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Question 21
Correct
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A 34 weeks pregnant patient has a blood pressure of 149/98. Urine dipstick 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: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. Significant proteinuria = urinary protein: creatinine ratio >30 mg/mmol or 24-hour urine collection result shows greater than 300 mg protein.
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This question is part of the following fields:
- Clinical Management
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Question 22
Correct
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Question 23
Correct
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Lactogenesis at term is stimulated by which hormone?
Your Answer: Prolactin
Explanation:Prolactin is the hormone that is responsible for the production of milk (Lactogenesis). Oxytocin is responsible for the let down reflex during suckling.
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This question is part of the following fields:
- Clinical Management
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Question 24
Correct
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At what week in pregnancy is testing for gestational diabetes (GD) advised
Your Answer: As soon as possible after booking if past history of GD
Explanation:Testing for GD should use the 2 hour 75g oral glucose tolerance test (OGTT) to test for GD in women. Testing women who have had GD in a previous pregnancy: early self monitoring of blood glucose OR a 75 g 2 hour OGTT as soon as possible after booking (whether in the first or second trimester) and a further 75 g 2hour OGTT at 24-28 weeks if the results of the first OGTT are normal. Testing women with risk factors for GD: 75g 2 hour OGTT at 24-28 weeks
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This question is part of the following fields:
- Clinical Management
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Question 25
Correct
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A 29 year old patient presents due to the sensation of reduced fetal movements (RFM). From what gestation is CTG assessment of RFM advised?
Your Answer: 28+0 weeks
Explanation:The cardiotocograph (CTG) is a continuous tracing of the fetal heart rate used to assess fetal wellbeing. The Doppler effect detects fetal heart motion and allows the interval between successive beats to be measured, thereby allowing a continuous assessment of fetal heart rate. The mother perceives the fetal movement by the 18-20 week of gestation and these increase until the 32 week. A mother should under go CTG if the fetal movements are reduced by the 28 week of gestation.
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This question is part of the following fields:
- Clinical Management
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Question 26
Correct
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Endometrial tissue found within the myometrium is classed as:
Your Answer: Adenomyosis
Explanation:Adenomyosis is a disorder characterised by the presence of endometrial glands deep within the myometrium. It presents with increasing severe secondary dysmenorrhoea and increased in the flow of menstrual blood.
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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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Completion of the 3rd stage of labour refers to:
Your Answer: Expulsion of the placenta and membranes
Explanation:The third stage of labours starts from the delivery of the foetus to the delivery of the placenta and the membranes.
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This question is part of the following fields:
- Clinical Management
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Question 28
Correct
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Premature menopause is defined as cessation of menses before the age of:
Your Answer: 40
Explanation:Premature menopause occurs if menopause happens before the age of 40. It effects 1% of women under the age of 40 and 0.1% under 30.
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This question is part of the following fields:
- Clinical Management
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Question 29
Correct
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A couple present to the fertility clinic after failing to conceive despite trying for 2.5 years. The semen analysis shows azoospermia. You perform a full examination of the male partner which reveals Height 192cm, BMI 20.5, small testes and scant facial hair. You decide to organise karyotyping. What is the result likely to show?
Your Answer: 47XXY
Explanation:Klinefelter syndrome is associated with testicular atrophy, eunuchoid body shape, tall, long extremities, female hair distribution and gynaecomastia. It is a common cause of hypogonadism seen during fertility workup.
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This question is part of the following fields:
- Clinical Management
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Question 30
Incorrect
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A 26 year old primigravida woman attends A&E due to worsening vomiting. She is currently 10 weeks pregnant. For the past 4 weeks she has had morning sickness but for the last 4 days she has been unable to tolerate any oral fluids without vomiting and thinks she has lost weight. On questioning she has no significant past medical history prior to this pregnancy. She is currently taking the following medication:
Your Answer: Vitamin D toxicity
Correct Answer: Hyperemesis gravidarum
Explanation:This patient has severe nausea and vomiting with ketosis and evidence of dehydration (low BP and tachycardia) in the early part of pregnancy. There is no history of diabetes and the blood glucose doesn’t indicate hyperglycaemia. This is consistent with hyperemesis gravidarum (HG)
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This question is part of the following fields:
- Clinical Management
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SESSION STATS - PERFORMANCE PER SPECIALTY
