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Question 1
Correct
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The second stage of labour involves:
Your Answer: Expulsion of the foetus
Explanation:First stage: The latent phase is generally defined as beginning at the point at which the woman perceives regular uterine contractions. A definition of active labour is having contractions more frequent than every 5 minutes, in addition to either a cervical dilation of 3 cm or more or a cervical effacement of 80% or more.
Second stage: fetal expulsion begins when the cervix is fully dilated, and ends when the baby is born.
Third stage: placenta delivery – The period from just after the foetus is expelled until just after the placenta is expelled is called the third stage of labour or the involution stage.
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This question is part of the following fields:
- Physiology
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Question 2
Correct
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A 26 year old lady comes to see you in the antenatal clinic. She is 8 weeks pregnant and is concerned as she has a new cat and her friend told her she shouldn't be changing cat litter when pregnant. You send bloods which show high IgM for toxoplasmosis gondii. Which of the following is an appropriate treatment option?
Your Answer: Spiramycin
Explanation:There are 2 treatment options: Spiramycin ASAP if foetus not infected or status of the foetus not known. This reduces risk of transplacental infection. This is continued until term, or until fetal infection is documented. Pyrimethamine, sulfadiazine and folic acid where fetal infection is known e.g. positive amniotic fluid PCR. Monitoring for haemotoxicity required. Pyrimethamine should be avoided in the 1st trimester as teratogenic
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This question is part of the following fields:
- Microbiology
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Question 3
Incorrect
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What is the incidence of listeriosis in pregnancy?
Your Answer: 25 in 1000
Correct Answer: 1 in 10,000
Explanation:The incidence of listeria infection in pregnant women is estimated at 12 per 100 000 compared to 0.7 per 100 000 in the general population.
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This question is part of the following fields:
- Microbiology
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Question 4
Incorrect
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Which of the following are required for Oxytocin to bind to its receptor?
Your Answer: Calcium and Sodium
Correct Answer: Magnesium and Cholesterol
Explanation:Oxytocin binds to G-protein-coupled receptors and requires Magnesium and cholesterol for this process to occur.
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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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The following drugs cross the placenta to the foetus, EXCEPT:
Your Answer: Heparin
Explanation:Standard heparin, an effective treatment for antepartum thromboembolic disease, is thought to be safe for the foetus since it does not cross the placenta.
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This question is part of the following fields:
- Pharmacology
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Question 6
Incorrect
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A 48-year-old woman presented to you with a breast mass. On examination, it is hard, irregular and ill defined. The surface of the breast is slightly bruised however, there is no discharge. The most probable diagnosis is?
Your Answer: Ca breast
Correct Answer: Fat necrosis
Explanation:Fat necrosis is often a result of a trauma or surgery. In fat necrosis the enzyme lipase releases fatty acids from triglycerides. The fatty acids combine with calcium to form soaps. These soaps appear as white chalky deposits which are firm lumps with no associated discharge. The given case has a bruise which indicates prior trauma.
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This question is part of the following fields:
- Gynaecology
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Question 7
Correct
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Question 8
Correct
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The uterine vein drains where?
Your Answer: Internal iliac vein
Explanation:The venous drainage of the uterus is via the uterine veins which form a plexus passing below the artery within the base of the broad ligament communicating with the rectal and the vesical venous plexus before draining into the internal iliac veins.
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This question is part of the following fields:
- Anatomy
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Question 9
Incorrect
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A 26-year-old woman presents with vulvar soreness and oedema. For the past three days, she has been suffering from dyspareunia and difficulty walking. She claims she has never had any sexually transmitted illnesses before. Her companion has no symptoms. She is afebrile and in good health.
On pelvic examination, a red, heated swelling measuring 4cm in diameter is discovered in the posterior end of the right labia majora. A speculum examination reveals normal-looking mucosa with no obvious discharge. There is no lymphadenopathy in the region.
Which of the following is the best initial treatment option?Your Answer: Hot compression with analgesics
Correct Answer: Word catheter
Explanation:The patient is suffering from Bartholin cyst abscess.
Insertion of an inflatable balloon is a non-surgical procedure that can be performed as an outpatient using a local anaesthetic (LA) injection to numb the area. It involves making a passage from the cyst or abscess through which the pus can drain over 4 weeks. After the LA injection, a small skin cut is made into the cyst or abscess, which allows drainage. A fluid/ pus swab sample may be taken to check for an infection at this stage. A cotton bud is used to break the pockets of abscess/ cyst fluid. A flexible tube (called a Word catheter) with a small, specially designed balloon at its tip is then inserted into the cyst or abscess to create a passage. The balloon is inflated with 3–4mls of sterile fluid to keep the catheter in place. Rarely, a stitch may be used to partly close the cut and hold the balloon in position. It is then left in place for up to 4 weeks; new skin to forms around the passage and the wound heals.Marsupialization can be done for drainage but is inferior or word catheter because of the technical challenges and complications. Hot compressions and analgesics alone do not suffice in the presence of an abscess. Antibiotics are given after drainage but are not effective alone when there is a large collection of pus.
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This question is part of the following fields:
- Gynaecology
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Question 10
Incorrect
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Lidocaine works by blocking which of the following ion channels?
Your Answer: fast voltage gated calcium channels
Correct Answer: fast voltage gated sodium channels
Explanation:It blocks the voltage gated sodium channels and reduce the influx of sodium ions preventing depolarization of the membrane and blocking the conduction of the action potential. The affinity of the receptor site in the sodium channels depends on whether it is resting, open or inactive.
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This question is part of the following fields:
- Pharmacology
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Question 11
Correct
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Which of the following dugs is a strong inducer of cytochrome P450?
Your Answer: Phenytoin
Explanation:It is important to be aware of which ant-epileptics induce cytochrome P450. Of the above Topiramate and Phenytoin are moderate and strong inducers respectively.
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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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The joint between the two pubic bones is called the:
Your Answer: Pubis symphysis
Explanation:The pubic symphysis or symphysis pubis is the midline cartilaginous joint (secondary cartilaginous) uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to it.
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This question is part of the following fields:
- Anatomy
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Question 13
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 14
Correct
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Which one of the following statements regarding fetal blood pH is correct?
Your Answer: Can be measured during labour
Explanation:A sample for fetal blood pH can be taken during the labour. The mother should be lying in a left lateral position.
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This question is part of the following fields:
- Physiology
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Question 15
Incorrect
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After 2 years of marriage, a 36-year-old morbidly obese lady with a BMI of 41 has been unable to conceive. Her husband's sperm analysis is normal, and he has no additional abnormalities. The fallopian tube looks to be blocked.
What is the best course of action for her management?Your Answer: In-vitro fertilization
Correct Answer: Suggest her to lose weight
Explanation:This patient has been unable to conceive for over a year, and her fallopian tubes are blocked. Her body mass index is 42.
Because she has obstructed Fallopian tubes, in-vitro fertilisation (IVF) is an alternative to getting pregnant for this patient.
A woman with a BMI over 35, on the other hand, will need twice as many IVF rounds to conceive as a woman of normal weight.
As a result, the greatest advise for successful IVF would be to decrease weight as the first step in management.
Obese (BMI less than 40) patients’ IVF success chances are reduced by 25% and 50%, respectively. -
This question is part of the following fields:
- Gynaecology
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Question 16
Correct
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Changes in the urinary tract system in pregnancy include:
Your Answer: Increase in the glomerular filtration rate (GFR)
Explanation:Pregnancy involves remarkable orchestration of physiologic changes. The kidneys are central players in the evolving hormonal milieu of pregnancy, responding and contributing to the changes in the environment for the pregnant woman and foetus. The functional impact of pregnancy on kidney physiology is widespread, involving practically all aspects of kidney function. The glomerular filtration rate increases 50% with subsequent decrease in serum creatinine, urea, and uric acid values.
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This question is part of the following fields:
- Physiology
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Question 17
Correct
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Which of the following structures does the broad ligament contain?
Your Answer: Uterine artery
Explanation:The broad ligament is one of the secondary supporting structures of the uterus which attaches the lateral portion of the uterus to the pelvic sidewall. The broad ligament primarily serves a protective layer for important structures including the fallopian tubes, the ovaries, the ovarian arteries, and the uterine arteries, the round and ovarian ligaments, and the infundibulopelvic ligaments.
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This question is part of the following fields:
- Anatomy
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Question 18
Correct
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Branches V2 and V3 of the trigeminal nerve develop from which pharyngeal arch?
Your Answer: 1st
Explanation:Trigeminal nerve has three divisions, the first is the ophthalmic division that does not originate from any of the pharyngeal arches, the second and third divisions, namely, the maxillary and the mandibular region develop from the first pharyngeal arch.
Pharyngeal Arches:
1st = Trigeminal V2 & V3 (CN V)
2nd = Facial (CN VII)
3rd = Glossopharyngeal (CN IX)
4th and 6th = Vagus (CN X) -
This question is part of the following fields:
- Embryology
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Question 19
Incorrect
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Which of the following is the most common cause of maternal mortality?
Your Answer: Haemorrhage
Correct Answer: Cardiac disease
Explanation:The most common cause of maternal mortality is Cardiovascular deaths due to post partum bleeding followed by hypertensive disorders of pregnancy, sepsis and complications of labour.
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This question is part of the following fields:
- Epidemiology
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Question 20
Correct
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Branches V2 and V3 of the Trigeminal nerve develop from which pharyngeal arch?
Your Answer: 1st
Explanation:1st Arch = Trigeminal V2 & V3 (CN V) 2nd Arch = Facial (CN VII) 3rd Arch = Glossopharyngeal (CN IX) 4th and 6th Arches = Vagus (CN X)
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This question is part of the following fields:
- Embryology
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Question 21
Incorrect
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Question 22
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 23
Incorrect
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A 35 year old lady presented in her 3rd trimester with severe features of pre-eclampsia. The drug of choice to prevent the patient going into impending eclampsia would be?
Your Answer: Intravenous magnesium sulphate
Correct Answer:
Explanation:The drug of choice for eclampsia and pre-eclampsia is magnesium sulphate. It is given as a loading dose of 4g i/v over 5 minutes, followed by an infusion for the next 24 hours at the rate of 1g/hr. If the seizures are not controlled, an additional dose of MgSO4 2-4gm i/v can be given over five minutes. Patients with eclampsia or pre-eclampsia can develop any of the following symptoms: persistent headache, visual abnormalities like photophobia, blurring of vison or temporary blindness, epigastric pain, dyspnoea and altered mental status.
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This question is part of the following fields:
- Obstetrics
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Question 24
Correct
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Question 25
Correct
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Which one of the following statements regarding Turner's syndrome is true?
Your Answer: Usually presents with primary amenorrhea
Explanation:Turner syndrome patients present with primary amenorrhea, have non functional or streak ovaries and cant conceive. They are 45X genetically.
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This question is part of the following fields:
- Embryology
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Question 26
Correct
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A 34-year-old woman presents to your clinic with a chief complaint of vague stomach pain. A unilocular cyst (3.8 x 4.3 x 3.0 cm) was discovered in the left ovary during a trans-abdominal ultrasound.
What is the best management strategy?Your Answer: Reassurance, no further action required
Explanation:In premenopausal women, watchful waiting usually involves monitoring for symptoms (pelvic pain or pressure) and repeating the pelvic ultrasound after six to eight weeks. If the ovarian cyst does not enlarge or if it resolves during the period of watchful waiting, it does not usually require surgical removal. Some premenopausal women will be advised to take a birth control pill during this time to help prevent new ovarian cysts from developing.
If a cyst decreases in size or does not change, the ultrasound is often repeated at regular intervals until your healthcare provider is certain that the cyst is not growing. If the cyst resolves, no further testing or follow-up is required.
Surgery may be recommended in the following situations:
– A cyst is causing persistent pain or pressure, or may rupture or twist.
– A cyst appears on ultrasound to be caused by endometriosis and is removed for fertility reasons.
– Large cysts (>5 to 10 cm) are more likely to require surgical removal compared to smaller cysts. However, a large size does not predict whether a cyst is cancerous.
– If the cyst appears suspicious for cancer. If you have risk factors for ovarian cancer or the cyst looks potentially cancerous on imaging studies, your healthcare provider may recommend surgery.
– If the suspicion for ovarian cancer is low but the cyst does not resolve after several ultrasounds, you may choose to have it removed after a discussion with your healthcare provider. However, surgical removal is not usually necessary in this case. -
This question is part of the following fields:
- Gynaecology
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Question 27
Correct
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A 33-year-old nulliparous pregnant female at the 21st week of pregnancy came to the gynaecological clinic for evaluation of vulval ulcer. A swab was taken revealing the herpes simplex type 2 virus. There is no prior history of such lesions and her partners of the last decade had no history of the infection. She's anxious about how she got the condition and the potential consequences for her and her unborn kid. Which of the following suggestions is the most appropriate?
Your Answer: The primary infection is commonly asymptomatic.
Explanation:Despite the fact that this question includes many true-false options, the knowledge examined is particularly essential in the treatment of women who have genital herpes.
It answers many of the questions that such women have regarding the disease, how it spreads, how it may be controlled, and how it affects an unborn or recently born child.
All of these issues must be addressed in a counselling question.
Currently, the most prevalent type of genital herpes is type 1, while in the past, type 2 was more common, as confirmed by serology testing.
Type 2 illness is nearly always contracted through sexual contact, but it can go undetected for years.
Acyclovir can be taken during pregnancy, and there are particular reasons for its usage.
Neonatal herpes is most usually diagnosed when the newborn has no cutaneous lesions, and past genital herpes in the mother is protective against neonatal infection, although not always.
Where the genital infection is the initial sign of the disease rather than a relapse of earlier disease, neonatal herpes is far more frequent.
Many patients and doctors are unaware that, while the original infection might be deadly, it is usually asymptomatic.
This explains how the illness spreads between sexual partners when neither has had any previous symptoms of the disease. -
This question is part of the following fields:
- Obstetrics
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Question 28
Correct
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In twin deliveries: Which is true?
Your Answer: There is increased risk of postpartum haemorrhage
Explanation:Twin gestations are at increased risk for postpartum haemorrhage (PPH). A number of maternal and peripartum factors are associated with PPH requiring blood transfusion in twin gestations. Reducing the rate of caesarean delivery in twin pregnancies may decrease maternal hemorrhagic morbidity.
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This question is part of the following fields:
- Obstetrics
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Question 29
Correct
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A mother typically becomes aware of fetal movements at what gestation?
Your Answer: 18-20 weeks
Explanation:Foetal movements often become apparent at about 18-20 weeks gestation. This phenomenon is also called quickening. The Foetal movements continue to increase in frequency and force until 32 weeks where they plateau. Foetal movements can be used to monitor the wellbeing of the foetus, alerting the mother and healthcare providers to a problem.
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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 20-year-old nulligravid woman comes to the office for a routine checkup, as she is concerned about having gained 4.5 kg over the last year. She believes that the gain is related to her oral contraceptive pills.
Patient takes low-dose ethinyl estradiol
orethindrone daily. Prior to starting the pills, she had regular but heavy periods lasting for 4-5 days. Patient used to miss her school every month, on the first day of her period, due to severe cramping. Her pain symptoms resolved 3 months after starting the pills and she takes no other medications. Patient's coitarche was at the age of 18 and she has had 2 partners since then. Patient and her current partner use condoms inconsistently.
On examination her vital signs are normal, with a BMI of 27 kg/m2 and physical examination is unremarkable.
Among the following which is the most appropriate advice for this patient?Your Answer: Recommend switching from combined OCPs to a copper intrauterine device
Correct Answer: Reassure that the weight gain is not related to combined OCPs
Explanation:Breakthrough bleeding, breast tenderness, nausea, bloating, amenorrhea, hypertension, venous thromboembolic disease, increased risk of cervical cancer with decreased risk of ovarian & endometrial cancer, liver disorders like hepatic adenoma and increase in triglycerides due to estrogen component are the common side effects & risks of using combination oral contraceptives.
Patient in the given case mentioned symptoms of primary dysmenorrhea, which is recurrent lower abdominal pain associated with menstruation. Combination estrogen-progestin oral contraceptive pills (OCPs) are considered as the first-line treatment for dysmenorrhea in sexually active patients as OCPs help to reduce pain by thinning the endometrial lining, reducing prostaglandin release and by decreasing uterine contractions.
Nausea, bloating and breast tenderness, are considered as the early side effects of OCPs and will usually improve with continued use. The most common side effect is breakthrough bleeding which is usually associated with lower estrogen doses and other adverse effects caused by the pills include hypertension, increased risk of cervical cancer and venous thromboembolism. Although common perception considers weight gain as a side effect, several studies have shown that no significant weight gain is associated with OCPs, particularly with low-dose formulations. Considering this, the patient should be reassured that her weight gain is not associated with regular use of OCPs.In patients who are not sexually active, nonsteroidal anti-inflammatory drugs are considered as the first-line treatment for primary dysmenorrhea. As stopping contraception will increase this Patient’s risk of unintended pregnancy this is not advisable to her.
Switching the patient to a copper intrauterine device (IUD) will decrease systemic side effects, but as its inflammatory reaction in the uterus may increase pain symptoms, copper IUD is not recommended for patients with dysmenorrhea.
As Medroxyprogesterone will increase body fat and decrease lean muscle mass resulting in weight gain is not a good option for this patient. Also medroxyprogesterone due to its risk of significant loss of bone mineral density, is not recommended for adolescents or young women. So it can be used in this age group only if other options are unacceptable.
Presence of estrogen component is the main reason behind the side effects of combination OCPs. Progesterone-only pills have relatively fewer side effects but as they do not inhibit ovulation, they are less effective for treating dysmenorrhea and for contraception.
Combination oral contraceptive pills are the first-line therapy for primary dysmenorrhea in sexually active patients. Its side effects include breakthrough bleeding, hypertension, and increased risk of venous thromboembolism. Researches proves that weight gain is usually not an adverse effect of OCPs.
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This question is part of the following fields:
- Obstetrics
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SESSION STATS - PERFORMANCE PER SPECIALTY
