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Question 1
Correct
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A 28 year old patient presents to clinic with a maculopapular rash to the hands and soles of the feet. Examination reveals wart like lesions on the vagina and a diagnosis of condyloma latum is made. What stage of syphilis infection is this?
Your Answer: Secondary
Explanation:Condylomas are warty neoplasms of the vulvar area. The most common type are condyloma acuminatum which occur due to HPV 6 or 11. Condyloma latum are also known as secondary syphilis are less common. Both of these are sexually transmitted.
Stages of Syphilis:
– Primary 3-90 days
Chancre and lymphadenopathy
– Secondary 4-10 weeks
Widespread rash typically affecting hands and soles of feet.
Wart lesions (condyloma latum) of mucus membranes
– Latent Early <1 yr. after secondary stage
– Late >2 yr. after secondary stage
Asymptomatic
– Tertiary 3+ years after primary infection
Gummas or
Neurosyphilis or
Cardiovascular syphilis -
This question is part of the following fields:
- Clinical Management
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Question 2
Correct
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Which of the following regarding the use of tocolytics is true?
Your Answer: Use of a tocolytic drug is not associated with a clear reduction in perinatal or neonatal mortality, or neonatal morbidity
Explanation:Tocolytics are used to suppress contractions. The Canadian preterm labour trial which remains a very influential tocolytic trial to date concluded that tocolytics such as a beta agonist have no significant benefit on perinatal mortality or morbidity or prolong pregnancy to term however it did reduce the number of women delivering within 2 days by 40%. This 48 hour window is the only reason for the use of tocolytics.
Choice of tocolytic (NICE)
1st line: Nifedipine
2nd line: Oxytocin receptor antagonists e.g. atosiban -
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
Correct
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Which of the following is the most common cause of abnormal vaginal discharge in patients of childbearing age?
Your Answer: Bacterial vaginosis
Explanation:Bacterial Vaginosis is a common condition which results in a foul smelling discharge from the vagina without any inflammation. It is the most common cause of abnormal PV discharge. Most of the women are asymptomatic carriers.
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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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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 6
Correct
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Which of the following hormones inhibits lactogenesis during pregnancy?
Your Answer: Oestrogen and Progesterone
Explanation:Under the influence of prolactin, oestrogen and progesterone and human placental lactogen (hPL), the mammary epithelium proliferates but remains presecretory during mammogenesis. Lactogenesis is inhibited by high circulating levels of progesterone and oestrogen which block cortisol binding sites. Cortisol would have otherwise have worked synergistically with prolactin in milk production. A sharp decrease in progesterone levels after delivery allows prolactin and oxytocin to stimulate milk production and the milk ejection reflex in response to suckling. Prolactin continues to maintain milk production in galactopoiesis.
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This question is part of the following fields:
- Clinical Management
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Question 7
Correct
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A 24 year old lady is rushed to the emergency department complaining of vaginal spotting and abdominal cramping. Her 6 week pregnancy was confirmed by ultrasound scan last week. On speculum examination, the cervical os is open with blood noted around it.
Which of the following is the most likely diagnosis?Your Answer: Inevitable Miscarriage
Explanation:A miscarriage is defined as the spontaneous loss of a pregnancy before the age of viability at 24 weeks in the UK. An inevitable miscarriage occurs with the usual symptoms of a miscarriage such as menstrual-like cramping, vaginal bleeding and a dilated cervix. The gestational sac has ruptured but products of conception have not been passed. The products of conception will eventually pass.
A missed miscarriage is described as a loss of pregnancy without vaginal bleeding, loss of tissue, cervical changes or abdominal pain. During a scan, a fetal heartbeat is not observed, and the gestational sac may be small.
A threatened miscarriage is when the cervix dilates and uterine bleeding is seen; the pregnancy could still be viable.
A complete miscarriage occurs when all the products of conception are expelled from the uterus, bleeding has stopped, and the cervix has closed up after dilation. Recurrent miscarriages are described as spontaneous pregnancy loss of more than 2 to 3 consecutive times.
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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 called to see a 24 year old patient in A&E. She is 34 weeks gestation and her blood pressure is 149/98. Automated reagent strip testing shows protein 1+. What is the appropriate course of action regarding the urine result?
Your Answer: Send urine for protein:creatinine ratio
Explanation:For a diagnosis of Preeclampsia to be established, 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 should be present.
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This question is part of the following fields:
- Clinical Management
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Question 9
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: Misoprostol
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 10
Correct
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A 26 year old patient with PCOS has been trying to conceive for 2 years. Her BMI is 26 kg/m2. She is a non-smoker. Which of the following is the most appropriate first line treatment?
Your Answer: Clomiphene
Explanation:Firstline medical management of PCOS is with clomiphene.
Ovulation Disorders
WHO Group I : Hypothalamic pituitary failure (Stress, anorexia, exercise induced)
Management:
Increase BMI if <19 kg/m2
Reduce exercise if high levels
Pulsatile GnRH or Gonadotrophins with LH activity to induce ovulationWHO Group II : Hypothalamic-pituitary-ovarian dysfunction (PCOS)
Management:
Weight reduction if BMI >30
Clomiphene/Clomiphene (1st line)
Metformin (1st line)
Clomiphene & Metformin (1st/2nd line)
Laparoscopic drilling (2nd line)
Gonadotrophins (2nd line)WHO Group III : Ovarian failure
Management:
Consider IVF with donor eggs -
This question is part of the following fields:
- Clinical Management
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Question 11
Correct
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In a patient who undergoes a medical abortion at 10 weeks gestation, what advice would you give regarding Rhesus Anti-D Immunoglobulin?
Your Answer: All RhD-negative women who are not alloimmunized should receive Anti-D IgG
Explanation:The Rhesus status of a mother is important in pregnancy and abortion. The exposure of an Rh-negative mother to Rh antigens from a positive foetus, will influence the development of anti-Rh antibodies. This may cause problems in subsequent pregnancies leading to haemolysis in the newborn. Rh Anti RhD- globulin is therefore given to non-sensitised Rh-negative mothers to prevent the formation of anti-Rh antibodies within 72 hours following abortion. Anti RhD globulin is not useful for already sensitized, or RhD positive mothers.
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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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A 24 year old patient presents as 24 weeks pregnant with vaginal discharge. Swabs show Chlamydia Trachomatis detected. Which of the following is the most appropriate treatment regime?
Your Answer: Azithromycin 1gm orally in a single dose
Correct Answer: Erythromycin 500 mg twice a day for 14 days
Explanation:The treatment of Chlamydia includes avoidance of intercourse, use of condoms and antibiotic treatment. Erythromycin 500mg orally QID for 7 days or Amoxicillin 500mg TDS for 7 days or Ofloxacin 200mg orally BD for 7 days.
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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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You are reviewing a patient with a scan suggestive of partial molar pregnancy. What is the typical genotype of a partial molar pregnancy?
Your Answer: 46 XY
Correct Answer: 69 XXY
Explanation:The partial mole is produced when an egg is fertilized by two sperm producing genotype 69 XXY (triploid). It can also occur when one sperm reduplicates itself yielding the genotypes 92 XXXY (tetraploid) though this is less common The genotype of a complete mole is typically 46 XX (diploid) but can also be 46 XY (diploid)
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This question is part of the following fields:
- Clinical Management
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Question 14
Incorrect
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Regarding gestational diabetes which of the following is NOT a recognised risk factor
Your Answer: Smoking
Correct Answer: High polyunsaturated fat intake
Explanation:There are several risk factors for gestational diabetes:
Increasing age
– Certain ethnic groups (Asian, African Americans, Hispanic/Latino Americans and Pima Indians)
– High BMI before pregnancy (three-fold risk for obese women compared to non-obese women)
– Smoking doubles the risk of GDM
– Change in weight between pregnancies – an inter-pregnancy gain of more than three units (of BMI) doubles the risk of GDM
– Short interval between pregnancies
– Previous unexplained stillbirth
– Previous macrosomia
– Family history of type 2 diabetes or GDM – more relevant in nulliparous than parous womenHigh polyunsaturated fat intake has been shown in some studies to be protective against gestational diabetes. Physical activity is also thought to be effective.
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This question is part of the following fields:
- Clinical Management
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Question 15
Incorrect
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A 34 year old patient who has just undergone a C-section delivery has lost almost 1 litre of blood. You suspect uterine atony as the likely cause, and have bimanually compressed the uterus. Which of the following pharmacological interventions should follow?
Your Answer: Misoprostol 1000 micrograms rectally
Correct Answer: Syntocin 5u by slow intravenous injection
Explanation:In the management of postpartum haemorrhage, it is essential that the bleeding is first mechanically prevented, followed by the administration of oxytocic drugs, which cause the uterine smooth muscle to contract and clamping off bleeding sites in the endometrium. The drug of choice in the treatment protocol of PPH is 5 units of syntocin, a synthetic oxytocin uterotonic, by slow intravenous infusion. This is particularly suitable in the case of uterine atony. Other uterotonics, misoprostol, carboprost, ergometrine, can be used, but are not as effective in an emergency setting.
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This question is part of the following fields:
- Clinical Management
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Question 16
Correct
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Regarding anti-epileptic use in the 1st trimester of pregnancy, which of the following is closely associated with the development of congenital malformations?
Your Answer: Sodium valproate
Explanation:Sodium Valproate is known to be the most teratogenic when used in the first trimester of pregnancy. This antiepileptic increases the risk of congenital malformations including a 10-20 fold risk of neurodevelopmental defects. Though the use of antiepileptics should generally be avoided during pregnancy, carbamazepine, or newer drugs such as Lamotrigine are thought to carry less of a risk of teratogenicity.
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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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In reducing the risk of blood transfusion in pregnancy and labour which of the following strategies is recommended?
Your Answer: A Hb of less than 10.5g/l should prompt haematinics and exclusion of haemoglobinopathies
Explanation:Anaemia in pregnancy is most frequently caused by iron or folate deficiency, however, a wide variety of other causes may be considered, especially if the haemoglobin value is below 9.0 g/dL. A haemoglobin level of 11 g/dL or more is considered normal early in pregnancy, with the upper limit of the ‘normal range’ dropping to 10.5 g/dL by 28 weeks gestation. Haemoglobin < 10.5 g/dl in the antenatal period, one should exclude haemoglobinopathies and consider haematinic deficiency. Oral iron is 1st line treatment for iron deficiency. Anaemia not due to haematinic deficiency will not respond to any form of iron. This should be managed with transfusion
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This question is part of the following fields:
- Clinical Management
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Question 18
Incorrect
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The amniotic fluid volume progressively increases during pregnancy. At which of the following gestational ages will amniotic fluid volume reach a maximum?
Your Answer: 32 weeks
Correct Answer: 35 weeks
Explanation:Amniotic fluid volume begins to increase rapidly in the second and third trimester as the fetal kidneys continue to develop. By 35 weeks gestation the amniotic fluid volume reaches a maximum average of about 800 ml after which it decreases slightly to term.
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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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Mifepristone when used for management of abortion works via what mechanism?
Your Answer: Oxytocin receptor agonist
Correct Answer: Anti-progestogen
Explanation:Mifepristone is a prostaglandin antagonist. It acts as a competitive inhibitor of the receptor.
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This question is part of the following fields:
- Clinical Management
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Question 20
Correct
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Which of the following dugs is a strong inducer of cytochrome P450?
Your Answer: Phenytoin
Explanation:Antiepileptic, phenytoin more so than topiramate are inducers of cytochrome P450. They should not be given with COCPs. The metabolism of oestrogen and progestogen is increased by anti-epileptic drugs that induce cytochrome P450 leading to a loss of contraceptive effect.
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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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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 22
Incorrect
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When consenting someone for laparoscopy you discuss the risk of vascular injury. The incidence of vascular injury during laparoscopy according to the BSGE guidelines is?
Your Answer: 4/100
Correct Answer: 0.2/1000
Explanation:Major vessel injury is the most important potential complication when undertaking laparoscopy. It’s incidence is 0.2/1000. Bowel Injury is more common at 0.4/1000
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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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You are consenting a patient for a diagnostic hysteroscopy. What is the approximate risk of uterine perforation in diagnostic hysteroscopy?
Your Answer: 0.10%
Explanation:The risk of uterine perforation is 0.1% during therapeutic hysteroscopy.
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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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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 25
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 26
Incorrect
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What is the most common Type II congenital thrombophilia?
Your Answer: Prothrombin G20210A mutation
Correct Answer: Factor V Leiden mutation
Explanation:Factor V Leiden is the most common congenital thrombophilia. Named after the Dutch city Leiden where it was first discovered. Protein C and S deficiencies are type 1 (Not type 2) thrombophilias Antiphospholipid syndrome is an acquired (NOT congenital) thrombophilia
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This question is part of the following fields:
- Clinical Management
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Question 27
Incorrect
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Question 28
Incorrect
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A patient has had limited response to conservative measures for her overactive bladder (OAB). Which of the following is the most appropriate pharmacological choice?
Your Answer: Propantheline
Correct Answer: Darifenacin
Explanation:Detrusor overactivity can be treated with anti-cholinergic agents such as oxybutynin or tolterodine, solifenacin, fesoterodine and darifenacin. They are used as first line agents. Imipramine is used for enuresis and desmopressin is used for nocturia.
NICE pathwayPrior to initiating anticholinergics:
Bladder training
Consider treating vaginal atrophy and nocturia with topical oestrogen and desmopressin respectively before commencing treatments below.
Consider catheterisation if chronic retention
1st line treatments:
1. Oxybutynin (immediate release) – Do not offer to frail elderly patients
2. Tolterodine (immediate release)
3. Darifenacin (once daily preparation)
DO NOT offer any of the 3 drugs below:
1. Flavoxate
2. Propantheline
3. Imipramine
2nd line treatment
Consider transdermal anticholinergic (antimuscarinic)
Mirabegron
Adjuvant Treatments
Desmopressin can be considered for those with nocturia
Duloxetine may be considered for those who don’t want/unsuitable for surgical treatment
Intravaginal oestrogen can be offered to postmenopausal women with OAB -
This question is part of the following fields:
- Clinical Management
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Question 29
Incorrect
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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:
Correct Answer: 24 hours
Explanation:Induction of labour is appropriate approximately 24 hours after rupture of the membranes.
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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 32 year old women who is 25 weeks pregnant presents with vaginal bleeding and cramping lower abdominal pain. On examination the cervix is closed. Fetal cardiac activity is noted on ultrasound. What is the likely diagnosis?
Your Answer:
Correct Answer: Antepartum Haemorrhage
Explanation:Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby.
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This question is part of the following fields:
- Clinical Management
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SESSION STATS - PERFORMANCE PER SPECIALTY
