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Question 1
Incorrect
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A 27-year-old woman complains of a hard, irregular lump in her right breast that presented after a car accident 2 weeks ago. Which is the most likely diagnosis?
Your Answer: Fat necrosis
Correct Answer:
Explanation:Since the car crash happened two weeks prior, breast trauma is suggested and thus fat necrosis is the most probable diagnosis. Phyllodes tumours are typically a firm, palpable mass. These tumours are very fast-growing, and can increase in size in just a few weeks. Occurrence is most common between the ages of 40 and 50, prior to menopause.
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This question is part of the following fields:
- Gynaecology
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Question 2
Correct
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Which of the following does not cause an increased risk of cervical cancer?
Your Answer: Alcohol
Explanation:Consuming alcohol and risk of cervical cancer are not associated. Not even drinking often and in large amounts are risk factors for developing cervical cancer.
So drinking alcohol and risk of cervical cancer aren’t associated. Based on their analyses of the scientific research evidence, that is the conclusion of, among many others, the:
American Cancer Society.
Centres for Disease Control and Prevention (CDC).
National Cancer Institute.
UK’s National Health Service.
Canadian Cancer Society.
Cancer Council Australia.
World Health Organization (WHO).All other options can increase the risk of acquiring cervical cancer.
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This question is part of the following fields:
- Gynaecology
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Question 3
Correct
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A serum progesterone value less than 5ng/ml can exclude the diagnosis of viable pregnancy with a certainty of:
Your Answer: 100%
Explanation:Serum progesterone has been proposed as a useful test to distinguish a viable pregnancy from a miscarriage or ectopic pregnancy. Low progesterone values are associated with miscarriages and ectopic pregnancies, both considered non-viable pregnancies, and high progesterone concentrations with viable pregnancies. A single progesterone measurement for women in early pregnancy presenting with bleeding or pain and inconclusive ultrasound assessments can rule out a viable pregnancy. The probability of a non-viable pregnancy was raised from 62.9% to 96.8%.
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This question is part of the following fields:
- Physiology
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Question 4
Correct
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A 27 year old patient is maintained on warfarin during pregnancy due to a mechanical mitral valve. She has read about warfarin embryopathy. Which of the following is a typical feature?
Your Answer: Stippled epiphyses
Explanation:Warfarin is teratogenic if it is used in the first trimester. It causes bone defects and haemorrhages in the developing foetus. It causes the formation of multiple ossification centres in the long bones. Resulting in stippled epiphyses and hence deform long bones.
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This question is part of the following fields:
- Pharmacology
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Question 5
Correct
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Which one of the following features best describes the role of prostaglandins?
Your Answer: Are involved in the onset of labour
Explanation:Prostaglandins are involved in the uterine contraction and cervical dilatation during labour. Higher prostaglandin concentrations can also lead to severe menstrual cramps.
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This question is part of the following fields:
- Physiology
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Question 6
Correct
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A young female patient presents at a family clinic seeking advice about her options for contraception. She is considering taking combined OCPS but is worried about the risk of cancer with long term use.
Which of the following is increased by OCPs?Your Answer: Cervical cancer
Explanation:The risks of breast and cervical cancers are increased in women who use oral contraceptives, whereas the risks of endometrial, ovarian, and colorectal cancers are reduced.
Women who have used oral contraceptives for 5 or more years have a higher risk of cervical cancer than women who have never used oral contraceptives. The longer a woman uses oral contraceptives, the greater the increase in her risk of cervical cancer.
One study found a 10% increased risk for less than 5 years of use, a 60% increased risk with 5–9 years of use, and a doubling of the risk with 10 or more years of use. However, the risk of cervical cancer has been found to decline over time after women stop using oral contraceptives.
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This question is part of the following fields:
- Gynaecology
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Question 7
Correct
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A 24-year-old college student comes to your clinic for contraception guidance. For the past three months, she has had migraine-like headaches once or twice a month. For the past two years, she has been taking combined oral contraceptive pills.
Which of the following suggestions is the most appropriate?Your Answer: Stopping the combined oral contraceptive pills and starting progesterone only pills (POP)
Explanation:Combined oral contraceptives are a safe and highly effective method of birth control, but they can also raise problems of clinical tolerability and/or safety in migraine patients. It is now commonly accepted that, in migraine with aura, the use of combined oral contraceptives is always contraindicated, and that their intake must also be suspended by patients suffering from migraine without aura if aura symptoms appear.
Discontinuation of contraception could risk in pregnancy. Barrier methods can be used but aren’t as effective as pills.
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This question is part of the following fields:
- Gynaecology
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Question 8
Incorrect
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An HIV positive woman who is 18 weeks pregnant complains of frothy yellow vaginal discharge and vaginal soreness. A wet mount and microscopy confirms a Trichomonas vaginalis infection. Which of the following is the most appropriate treatment regime?
Your Answer: Metronidazole 400mg BD 5 days
Correct Answer: Metronidazole 500mg BD 7 days
Explanation:Trichomoniasis is considered a sexually transmitted infection found both in men and women caused by the flagellate protozoan Trichomonas vaginalis. The organism is mainly found in the vagina and the urethra. Though many infected women can be asymptomatic, they can also present with yellow frothy vaginal discharge, itching and vaginitis, dysuria or an offensive odour. For the diagnosis of t. vaginalis in women, a swab is taken from the posterior fornix during speculum examination and the flagellates are detected under light-field microscopy. The recommended treatment for t. vaginalis for a HIV positive woman who is pregnant is 500mg of metronidazole twice daily for 7 days. High dose metronidazole as a 2g single dose tablet is not advised during pregnancy. All sexual partners should also be treated, and screening for other STIs should be carried out.
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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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A 65-year-old woman comes to your office for routine well-woman exam. Her last menstrual period was 15 years ago. She has not been on oestrogen replacement therapy and now desires to start due to concerns about osteoporosis. On routine pelvic exam, you palpate a small uterus and cervix along with palpable ovaries bilaterally. Of the following, your next step in the management of this patient should be:
Your Answer: Pelvic ultrasound
Explanation:In a postmenopausal woman, the ovaries should not be palpable; if they are, it should raise the concern that an ovarian malignancy is present. Before one would perform an operative evaluation, radiologic assessment should be done.
– Although this is an accepted regimen for oestrogen replacement therapy, the palpable ovaries need to be evaluated to rule out malignancy.
– Dual photon densitometry will give a reliable measure of bone density. Again, however, the palpable ovary is the first thing that needs to be worked up.
– Although surgical exploration may be warranted, initial workup of the adnexal mass should include an ultrasound along with tumour markers. A CT scan may also be warranted. -
This question is part of the following fields:
- Gynaecology
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Question 10
Correct
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A midwife is concerned regarding CTG changes and suggests a fetal blood sample (FBS). At what dilatation would you NOT perform FBS?
Your Answer: Less than 3cm
Explanation:Fetal Blood Sampling (FBS) should only be performed when the cervix is >3cm dilated.
Indications for FBS:
1. Pathological CTG in labour
2. Suspected acidosis in labourContraindications to FBS
– Maternal infection e.g. HIV, HSV and Hepatitis
– Known fetal coagulopathy
– Prematurity (< 34 weeks gestation)
– Acute fetal compromiseInterpretation of FBS results:
pH >7.25 = Normal -Repeat in 1 hour if CTG remains abnormal
7.21 to 7.24 = Borderline – Repeat in 30 minutes
<7.20 = Abnormal - Consider delivery -
This question is part of the following fields:
- Data Interpretation
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Question 11
Correct
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Hypoplasia & yellow discoloration of the primary teeth has occurred in infants whose pregnant mothers were treated with which drug:
Your Answer: Tetracycline
Explanation:Tetracycline is a broad-spectrum antibiotic that crosses placental barrier. Tetracycline was the first line of therapy in treating infections caused by Mycoplasma pneumoniae, chlamydia, rickettsia, and some spirochaetes. It has a wide range of adverse effects and is known for a unique property of being incorporated into skeletal and dental tissues at sites of active mineralization and staining of these tissues.
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This question is part of the following fields:
- Pharmacology
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Question 12
Correct
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You see a patient in antenatal clinic who is concerned that she has never had chicken pox and may catch it during pregnancy. You check her Varicella status and she is non-immune. She asks you about vaccination. What type of vaccine is the varicella vaccine?
Your Answer: Attenuated
Explanation:Varicella is a live vaccine. The recent RCOG green top guidelines suggest vaccine can be considered postpartum or pre pregnancy but NOT whilst pregnant. In the non-immune pregnant woman they should be advised to avoid contact with people with chickenpox or shingles and to contact a healthcare professional promptly if exposed. If they have a significant exposure VZIG should be offered as soon as possible.
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This question is part of the following fields:
- Immunology
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Question 13
Correct
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Bishop scoring is used for:
Your Answer: The success rate of induction of the labour
Explanation:The Bishop score is a system used by medical professionals to decide how likely it is that you will go into labour soon. They use it to determine whether they should recommend induction, and how likely it is that an induction will result in a vaginal birth.
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This question is part of the following fields:
- Obstetrics
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Question 14
Correct
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A 39-week pregnant patient presents with acute epigastric pain and general signs of malaise. She has a normal body temperature but clinical examination shows RUQ tenderness. Blood tests revealed a mild anaemia, high liver enzyme values, low platelets and haemolysis. What is the most possible diagnosis?
Your Answer: HELLP syndrome
Explanation:HELLP syndrome stands for haemolysis, elevated liver enzyme levels, and low platelet levels and is a very severe condition that can happen during pregnancy. Management of this condition requires immediate delivery of the baby.
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This question is part of the following fields:
- Obstetrics
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Question 15
Correct
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Adult Polycystic Kidney Disease (PKD) typically follows which pattern of inheritance
Your Answer: Autosomal Dominant
Explanation:Polycystic kidney disease (PKD) can either be autosomal dominant or recessive. The autosomal dominant variant is more common in adult PKD however, the recessive pattern is more common in infantile PKD.
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This question is part of the following fields:
- Endocrinology
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Question 16
Correct
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A 24-year-woman, gravida 2 para 1, 37 weeks of gestation, was admitted due to spontaneous rupture of membranes. Her previous pregnancy was uncomplicated and delivered at term via vaginal delivery. 24 hours since rupture of her membranes, no spontaneous labour was noted, hence a syntocinon/oxytocin infusion (10 units in 1L of Hartmann solution) was started at 3DmL/hour and increased to 120 mL over 9 hours. After 10 hours of infusion, during which Syntocinon dosage was increased to 30 units per litre, contractions were noted. Which is the most common complication of Syntocinon infusion?
Your Answer: Fetal distress.
Explanation:In this case, induction of labour at 37 weeks of gestation was necessary due to the absence of spontaneous of labour 24 hours after rupture of membranes. High doses of Syntocin and large volume of fluids may be required particularly when induction is done before term.
Syntocin infusion can lead to uterine hypertonus and tetany which can result in fetal distress at any dosage. This is a common reason to decrease or stop the infusion and an indication for Caesarean delivery due to fetal distress
Uterine rupture can occur as a result of Syntocin infusion especially when the accompanying fluids do not contain electrolytes, which puts the patient at risk for water intoxication.
Maternal hypotension results from Syntocin infusion, not hypertension.
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This question is part of the following fields:
- Obstetrics
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Question 17
Incorrect
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Which group of beta haemolytic streptococci is associated with chorioamnionitis?
Your Answer: A
Correct Answer: B
Explanation:Chorioamnionitis is a complication of pregnancy caused by bacterial infection of the fetal amnion and chorion membranes. Group B Streptococcus is associated with chorioamnionitis
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This question is part of the following fields:
- Microbiology
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Question 18
Correct
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What is the life span of the corpus luteum in days?
Your Answer: 14-16
Explanation:After the release of the oocyte, the theca and the granulosa cells form the corpus luteum which undergoes extensive vascularization for continued steroidogenesis. Progesterone is secreted by the luteal cells and is synthesized from cholesterol. The luteal phase lasts for 14 days and if implantation does not occurs the corpus luteum starts to degenerate. As B-HCG produced by the implanted embryo maintains it and without it luteolysis occurs.
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This question is part of the following fields:
- Embryology
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Question 19
Incorrect
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The vulva is mainly supplied by which one of the following vessels?
Your Answer: Ilioinguinal artery
Correct Answer: Pudendal artery
Explanation:Vulva is defined by the area which is located outside the female vagina and comprises of the labia majora, labia minora, clitoris, mons pubis and Bartholin glands. It is supplied by the vestibula branch of pudental artery.
Inferior hemorrhoidal artery supplies the lower part of the rectum.
Femoral artery is the continuation of external iliac artery and supplies most of the leg. -
This question is part of the following fields:
- Anatomy
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Question 20
Correct
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A 22-year-old Asian woman with a background history of primary pulmonary hypertension attends your clinic. She is planning for a pregnancy in the next few months and feels well generally.
What would be your advice?Your Answer: Pregnancy is contraindicated in her condition
Explanation:From the options given, option A is correct as primary pulmonary hypertension is considered a contraindication to pregnancy.
The patient should be educated about the possible risks and increased maternal mortality in such cases. This restriction is due to the fact that symptoms of Pulmonary hypertension gets worse during pregnancy which results in high maternal mortality.
Termination of pregnancy may be advisable in these circumstances mostly to preserve the life of the mother.
Sudden death secondary to hypotension is also a commonly dreaded complication among patients with pulmonary hypertension during pregnancy. -
This question is part of the following fields:
- Obstetrics
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Question 21
Incorrect
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What is the incidence of hyperthyroidism in complete molar pregnancy?
Your Answer: 30%
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 22
Incorrect
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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: Central nervous
Correct 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 23
Correct
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Question 24
Correct
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Regarding listeria infection during pregnancy, what is the fetal case mortality rate?
Your Answer: 25%
Explanation:Listeria Monocytogenes is a cause of congenital infection. The most common source of the bacteria is food, especially unpasteurised milk. Congenital listeriosis can lead to spontaneous abortions, premature birth and chorioamnionitis. At birth, neonates may present with septicaemia, respiratory distress and inflammatory granulomatosis. The case mortality rate for listeriosis is thought to be between 20-30%.
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This question is part of the following fields:
- Microbiology
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Question 25
Correct
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Among the following, which is the most common method used for termination of a pregnancy before 20 weeks in Australia?
Your Answer: Suction and curettage
Explanation:Medical abortion is preferred from 4 to 9 weeks of gestation and in Australia, suction curettage is the most frequently used method of abortion as it is considered useful from 6 to 14 weeks of gestation.
Mifepristone is a synthetic anti-progesterone, which is found to be effective for abortion when combined with misoprostol. There are evidences which suggest the effectiveness of misoprostol and mifepristone in both first and second trimesters. It is most commonly administered as a single dose of mifepristone followed by misoprostol, a prostaglandin, given orally or vaginally two days later. Prostaglandin can be repeated at an interval of 4 hours if required.
As the vaginal use shows only few gastrointestinal side effects Misoprostol is more effective and better tolerated vaginally than orally. Misoprostol is not approved for its use in termination of pregnancy, but is available in the market due to its indications in other conditions.
Methotrexate can be used orally or as an intramuscular injection followed by misoprostol up to seven days later, but this also is not a preferred method for termination of pregnancy in Australia. -
This question is part of the following fields:
- Obstetrics
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Question 26
Correct
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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: 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 27
Correct
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Which of the following ultrasound findings form part of the Rotterdam criteria for diagnosis of PCOS (Polycystic Ovary Syndrome) ?
Your Answer: Increased ovarian volume >10cm3
Explanation:The Rotterdam criteria for the diagnosis of PCOS is based on a score of two out of the three criteria:
1) Oligo or anovulation
2) Hyperandrogenism – clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone)
3) on ultrasound – contain 12 or more follicles measuring 2 to 9 mm in diameter and/or have an increased volume of 10 cm3 or greater. -
This question is part of the following fields:
- Clinical Management
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Question 28
Correct
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Question 29
Correct
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An 18 year old girl presented with dysmenorrhea and irregular cycles. The most appropriate management in this case would be?
Your Answer: Combined pill
Explanation:Combined oral contraceptive pills have an anti ovulatory function and also reduce the pain of menstruation.
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This question is part of the following fields:
- Gynaecology
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Question 30
Incorrect
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From which germ cell layer does the GI tract initially develop?
Your Answer:
Correct Answer: Endoderm
Explanation:GI Tract initially forms via gastrulation from the endoderm of the trilaminar embryo around week 3. It extends from the buccopharyngeal membrane to the cloacal membrane. Later in development there are contributions from all three germ cell layers.
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This question is part of the following fields:
- Embryology
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SESSION STATS - PERFORMANCE PER SPECIALTY
