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Question 1
Correct
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The following ultrasonic measurements may be used to confirm or establish gestational age:
Your Answer: Crown rump length
Explanation:Fetal ultrasound scanning is considered an essential part of routine antenatal care with first trimester scans recommended for confirming viability, accurate estimation of gestational age and determining the number of foetuses. Fetal crown-rump length (CRL) is measured in early pregnancy primarily to determine the gestation age (GA) of a foetus and is most reliable between 9+0 to 13+6 weeks’ gestation, but not beyond.
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This question is part of the following fields:
- Physiology
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Question 2
Correct
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Androgen insensitivity syndrome is characterised by which one of the following karyotypes?
Your Answer: 46XY
Explanation:Genetically, patients suffering from androgen insensitivity syndrome are 46XY. They are males but insensitive to male hormones i.e. androgens.
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This question is part of the following fields:
- Embryology
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Question 3
Incorrect
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In early pregnancy at what gestation does the Embryonic pole become visible on transvaginal ultrasound?
Your Answer: 4 weeks + 3 days
Correct Answer: 5 weeks + 3 days
Explanation:The embryonic pole becomes visible on transvaginal ultrasound at around 5 and a half to 6 weeks gestation when it measures around 3mm.
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This question is part of the following fields:
- Biophysics
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Question 4
Correct
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Placental production of hPL, hCG, Oestrogen and Progesterone are examples of which type of mechanism
Your Answer: Endocrine
Explanation:Hormones that are secreted into the circulation at one site but have effects on distal target organs are endocrine as is the case with the hormones above. Autocrine and Intracrine messengers act within the same cell. Exocrine glands secrete their products into ducts. Apocrine is a histological term used to describe some types of exocrine gland.
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This question is part of the following fields:
- Endocrinology
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Question 5
Correct
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All of the following are characteristic features of normal labour, except:
Your Answer: Moderate bleeding
Explanation:Normal labour is characterized by spontaneous onset, rhythmical uterine contractions along with vertex presentation. Cervical dilatation starts from the 1st stage of labour and intensity of the uterine contractions increases with passing time. Bleeding occurs after the child is expelled and the average loss is about 250-500 ml in a normal vaginal delivery.
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This question is part of the following fields:
- Obstetrics
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Question 6
Correct
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The risk of postpartum uterine atony is associated with:
Your Answer: Twin pregnancy
Explanation:Multiple studies have identified several risk factors for uterine atony such as polyhydramnios, fetal macrosomia, twin pregnancies, use of uterine inhibitors, history of uterine atony, multiparity, or prolonged labour.
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This question is part of the following fields:
- Obstetrics
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Question 7
Incorrect
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A patient is seen in the gynaecology outpatient clinic and is noted to have large volume genital warts perianally and near the urethral meatus. You discuss treatment options and the patient opts for LASER therapy. Which of the following is the most appropriate type of LASER to use?
Your Answer: ND:YAG
Correct Answer: CO2
Explanation:Vulval intraepithelial neoplasia is a premalignant condition which is associated with HPV or lichen sclerosis. Biopsy is essential for diagnosis. Treatment depends of the patients choice and include surgical excision of the area or laser therapy with CO2. Other treatment modalities include immunomodulating creams.
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This question is part of the following fields:
- Biophysics
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Question 8
Correct
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A 29-year-old G1P0 presents to your office at her 18 weeks gestational age for an unscheduled visit due to right-sided groin pain. She describes the pain as sharp in nature, which is occurring with movement and exercise and that the pain will be alleviated with application of a heating pad. She denies any change in urinary or bowel habits and there is no fever or chills.
What would be the most likely etiology of pain in this patient?Your Answer: Round ligament pain
Explanation:The patient is presenting with classic symptoms of round ligament pain.
Round ligaments are structures which extends from the lateral portion of the uterus below to the oviduct and will travel downward in a fold of peritoneum to the inguinal canal to get inserted in the upper portion of the labium majus. As the gravid uterus grows out of pelvis during pregnancy, these ligaments will stretch, mostly during sudden movements, resulting in a sharp pain. Due to dextrorotation of uterus, which occurs commonly in pregnancy, the round ligament pain is experienced more frequently over the right side. Usually this pain improves by avoiding sudden movements, by rising and sitting down gradually, by the application of local heat and by using analgesics.As the patient is not experiencing any symptoms like fever or anorexia a diagnosis of appendicitis is not likely. Also in pregnant women appendicitis often presents as pain located much higher than the groin area as the growing gravid uterus pushes the appendix out of pelvis.
As the pain is localized to only one side of groin and is alleviated with a heating pad the diagnosis of preterm labor is unlikely. In addition, the pain would persist even at rest and not with just movement in case of labor.
As the patient has not reported of any urinary symptoms diagnosis of urinary tract infection is unlikely.
Kidney stones usually presents with pain in the back and not lower in the groin. In addition, with a kidney stone the pain would occur not only with movement, but would persist at rest as well. So a diagnosis of kidney stone is unlikely in this case.
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This question is part of the following fields:
- Obstetrics
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Question 9
Correct
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Question 10
Correct
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The rectus sheath is formed by which of the following?
Your Answer: aponeuroses of transversus abdominis, external and internal oblique
Explanation:The rectus sheath is formed by the decussation and interweaving of the aponeuroses of the fl at abdominal muscles. The external oblique aponeurosis contributes to the anterior wall of the sheath throughout its length. The superior two thirds of the internal oblique aponeurosis splits into two layers (laminae) at the lateral border of the rectus abdominis; one lamina passing anterior to the muscle and the other passing posterior to it. The anterior lamina joins the aponeurosis of the external oblique to form the anterior layer of the rectus sheath. The posterior lamina joins the aponeurosis of the transversus abdominis to form the posterior layer of the rectus sheath.
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This question is part of the following fields:
- Anatomy
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Question 11
Correct
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A 32-year-old female presented with a lump in the upper outer quadrant of her left breast, which is 1.5cm in size and tender. What is the initial investigation to be done?
Your Answer: Ultrasound
Explanation:Tenderness is usually suggestive of a benign breast mass such as a breast abscess. Ultrasound is used to distinguish solid from cystic structures and to direct needle aspiration for abscess drainage.
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This question is part of the following fields:
- Gynaecology
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Question 12
Correct
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According to NICE guidance what should be used for wound cleansing for the first 48 hours postoperatively?
Your Answer: Sterile saline
Explanation:NICE guidelines (CG74) advise the following regarding postoperative wound management Use sterile saline for wound cleansing up to 48 hours after surgery. Advise patients that they may shower safely 48 hours after surgery. Use tap water for wound cleansing after 48 hours if the surgical wound has separated or has been surgically opened to drain pus. Do not use topical antimicrobial agents for surgical wounds that are healing by primary intention to reduce the risk of surgical site infection
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This question is part of the following fields:
- Microbiology
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Question 13
Incorrect
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You are asked to see a 26 year old patient following her first visit to antenatal clinic. She is 9 weeks pregnant and bloods have shown her to be non-immune to Rubella. She is concerned about congenital rubella syndrome (CRS). What is the most appropriate advice to give?
Your Answer: Advise vaccination as soon as possible
Correct Answer: Advise vaccination after birth regardless of breast feeding status
Explanation:Congenital rubella infection that occurs after 16 weeks gestation does not typically cause fetal abnormalities. This however plays no part in vaccination advice. Rubella vaccine is live and should not be given during pregnancy. The mother should be offered vaccination after giving birth. It is safe for the vaccine (typically given as combined MMR) to be administered if the mother is breastfeeding.
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This question is part of the following fields:
- Microbiology
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Question 14
Correct
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A 29 year old obese woman presents complaining of difficult or painful sexual intercourse and dysmenorrhea. She is requesting a reversible contraceptive method. Which of the following would be most suitable?
Your Answer: Mirena
Explanation:Mirena is a form of contraception also indicated for the treatment of heavy menstrual bleeding and the management of dysmenorrhea, being able to reduce the latter considerably.
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This question is part of the following fields:
- Gynaecology
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Question 15
Correct
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Which two nerves provide the primary cutaneous sensory innervation to the labia majora?
Your Answer: Ilioinguinal and pudendal
Explanation:The Pudendal provides cutaneous innervation to the posterior external genitalia via one of its terminal branches called the perineal nerve (this further branches into the posterior labial nerves or posterior scrotal nerve in men). The ilioinguinal nerve provides anterior sensation via the anterior labial nerves (anterior scrotal nerve in men). The genital branch of the genitofemoral nerve contributes some fibres to the skin of the mons pubis and labia majora in females. The posterior cutaneous nerve of thigh sometimes overlaps sensory areas.
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This question is part of the following fields:
- Anatomy
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Question 16
Correct
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Which of the following causes of polyhydramnios is more common?
Your Answer: Idiopathic
Explanation:Maternal disorders, such as diabetes, in-utero infections, drug usage, placental abnormalities and fetal conditions as congenital and chromosomal abnormalities, Rh iso-immunization, and multiple gestations, are generally associated with polyhydramnios. Congenital abnormalities such as duodenal, oesophageal, or intestinal atresia of the foetus are the most common malformations that typically cause gastro-intestinal obstruction and interfere with fetal swallowing and/or absorption resulting with polyhydramnios. However, in about 70% of cases, none of the aforementioned aetiologies are causes of polyhydramnios, and it is referred to as idiopathic or isolated.
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This question is part of the following fields:
- Physiology
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Question 17
Incorrect
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Which one of the following measurements is usually taken during clinical exam of the pelvis?
Your Answer: Bi-ischial diameter
Correct Answer: Shape of the pubic arch
Explanation:During pelvimetry, the shape of the pubic arch is usually examined. It helps in determining the outcome of the type of fetal delivery.
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This question is part of the following fields:
- Anatomy
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Question 18
Correct
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What is the target INR in a patient who has just been started on warfarin therapy due to a pulmonary embolism?
Your Answer: 2.0-3.0
Explanation:Warfarin can be useful for management of thromboembolism. The target INR range for this medication is between 2.0-3.0 in patients with venous thromboembolism, pulmonary embolism etc. The INR range may increase to 3.0-4.0 in patients with mechanical valves. However, warfarin is not recommended in pregnancy, and Low Molecular Weight Heparin should be used for thromboprophylaxis instead.
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This question is part of the following fields:
- Pharmacology
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Question 19
Correct
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A 25 year-old lady presented with complaints of generalised pruritis during the 3rd trimester of her pregnancy. She was diagnosed as a case of intrahepatic cholestasis of pregnancy. Which one of the following factors carries the greatest risk to the foetus in this disease?
Your Answer: Perinatal mortality
Explanation:Intrahepatic cholestasis of pregnancy can affect both mother and foetus, however it is more harmful for the foetus. Amongst foetuses, there is an increased risk of perinatal mortality, meconium aspiration, premature delivery and post partum haemorrhage. Exact cause of fetal death cannot be predicted accurately but it is not related to intra uterine growth retardation or placental insufficiency. The liver can be affected in the mother leading to generalized pruritis but no evidence of fetal hepatic dysfunction has been found.
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This question is part of the following fields:
- Obstetrics
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Question 20
Correct
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What is the inferior border of the deep perineal pouch?
Your Answer: Perineal membrane
Explanation:The perineal membrane (also known as the inferior fascia of the urogenital diaphragm) separates the deep and superficial perineal pouches i.e. it is the inferior border of the deep pouch and superior border of the superficial pouch. The deep perineal pouch is the space therefore between superior and inferior layers of the urogenital diaphragm The superior fascia of the urogenital diaphragm is the superior border
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This question is part of the following fields:
- Anatomy
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Question 21
Correct
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An 19-year old female came in at the clinic for her first prenatal visit. She claims to have had regular menstrual cycles even while she was on oral contraceptives (OCP). 20 weeks ago, she stopped taking her OCPs and had a menstrual period few days after. No vaginal bleeding or fluid loss were noted since then. On physical examination, the uterus is palpated right above pubic symphysis. Fetal heartbeats are evident on handheld Doppler ultrasound. Which of the statements can mostly explain the difference between the dates and uterine size?
Your Answer: Ovulation did not occur until 6-8 weeks after her last period.
Explanation:When the palpated uterine size is in discrepancy with the expected size based on the duration of amenorrhoea, it can have several causes including reduced fluid volume or fetal growth (both of which are more common when there is fetal malformation), or miscalculated age of gestation as a result of wrong dates or actual ovulation occurring at a later date than expected. Reduced fluid volume and fetal growth are the most likely aetiologies during the third trimester of pregnancy, unlike in this patient at 20 weeks age of gestation.
Premature rupture of membranes is less likely the cause when there is negative vaginal fluid loss like this patient.
The most likely cause in this case is that ovulation did not occur as expected, especially when the patient ceased her OCPs during this period. In some instances, ovulation can occur 2 weeks later in about 50% of women, 6 weeks later in 90%, and may still not occur 12 months later in 1% of women.
The other listed statements are unlikely to explain the discrepancies in dates and the observed uterine size in this patient.
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This question is part of the following fields:
- Obstetrics
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Question 22
Correct
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At ovulation the surge in LH causes rupture of the mature oocyte via action on what?
Your Answer: Theca externa
Explanation:The luteinizing hormone (LH) surge during ovulation causes: Increases cAMP resulting in increased progesterone and PGF2 production PGF2 causes contraction of theca externa smooth muscle cells resulting in rupture of the mature oocyte
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This question is part of the following fields:
- Endocrinology
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Question 23
Correct
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Regarding oogenesis & ovulation:
Your Answer: The 1st meiotic division is arrested in the diplotene stage until just before ovulation
Explanation:The oocyte (eggs, ova, ovum) is arrested at an early stage of the first meiosis (first meiotic) division as a primary oocyte (primordial follicle) within the ovary. Following puberty, during each menstrual cycle, pituitary gonadotrophin stimulates completion of meiosis 1 the day before ovulation.
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This question is part of the following fields:
- Cell Biology
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Question 24
Correct
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Which of the following hormones are required for alveolar morphogenesis during pregnancy?
Your Answer: Progesterone, Prolactin and hPL
Explanation:The changes seen in breast tissue with the menstrual cycle are accentuated during pregnancy. Deposition of fat around glandular tissue occurs, and the number of glandular ducts is increased by oestrogen, while progesterone and human placental lactogen (hPL) increase the number of gland alveoli. Prolactin is essential for the stimulation of milk secretion and during pregnancy prepares the alveoli for milk production. Although prolactin concentration increases throughout pregnancy, it does not then result in lactation since it is antagonized at an alveolar receptor level by oestrogen.
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This question is part of the following fields:
- Endocrinology
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Question 25
Correct
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A 30-year-old woman is already in her second pregnancy and is 22 weeks pregnant. She presented to the medical clinic for evaluation of a vulval ulcer. A swab was taken and revealed a diagnosis of herpes simplex type II (HSV-2) infection. She was surprised about this diagnosis since neither she nor her husband has ever had this infection before. She insisted on knowing the source of the infection and was very concerned about her baby’s well-being and she asked how her condition may affect the baby.
Which of the following statements is considered true regarding her situation?Your Answer: The primary infection is commonly asymptomatic
Explanation:Genital herpes can be asymptomatic or have mild symptoms that go unrecognized. When symptoms occur, genital herpes is characterised by one or more genital or anal blisters or ulcers. Additionally, symptoms of a new infection often include fever, body aches and swollen lymph nodes.
HSV-2 is mainly transmitted during sex through contact with genital or anal surfaces, skin, sores or fluids of someone infected with the virus. HSV-2 can be transmitted even if the skin looks normal and is often transmitted in the absence of symptoms.
In rare circumstances, herpes (HSV-1 and HSV-2) can be transmitted from mother to child during delivery, causing neonatal herpes. Neonatal herpes can occur when an infant is exposed to HSV during delivery. Neonatal herpes is rare, occurring in an estimated 10 out of every 100 000 births globally. However, it is a serious condition that can lead to lasting neurologic disability or death. The risk for neonatal herpes is greatest when a mother acquires HSV for the first time in late pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 26
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 27
Correct
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A 51-year-old woman comes to your doctor's office for a breast cancer screening. For the past year, she has been on combination hormone replacement treatment (HRT). Mammography is the sole accessible form of breast cancer screening, and she is predicted to have dense breast tissue due to HRT.
Which of the following is the best HRT and breast cancer screening suggestion for this patient?Your Answer: Continue HRT and perform mammography as recommended for other women
Explanation:Among a variety of imaging modalities developed for breast cancer screening, mammography is the best-studied and the only imaging technique that has been shown to decrease mortality as demonstrated in multiple randomized trials. However, it is important to know that, even in the best circumstances, mammography may miss up to 20 percent of underlying breast cancers.
Women on HRT are likely to have dense breast. Dense breasts are associated with an increased risk of breast cancer and can decrease the sensitivity of mammography for small lesions. Nevertheless, we do not alter our general approach to age- and risk-based screening based on breast density. However, for women with dense breasts, we do prefer digital mammography over film mammography, due to greater sensitivity; digital mammography is the modality typically used for mammography in most locations in the United States.
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This question is part of the following fields:
- Gynaecology
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Question 28
Incorrect
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Question 29
Incorrect
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The external anal sphincter is innervated by which nerves?
Your Answer: Pelvic Splanchnic
Correct Answer: Inferior rectal
Explanation:The external anal sphincter is innervated by the inferior rectal branch of the pudendal nerve (S2-4) while the internal anal sphincter is innervated by autonomic nerves.
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This question is part of the following fields:
- Anatomy
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Question 30
Incorrect
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The femoral triangle is bounded superiorly by which of the following structures?
Your Answer:
Correct Answer: Inguinal ligament
Explanation:The femoral triangle is bounded superiorly by the inguinal ligament which forms the base of the triangle, medially by the lateral border of the adductor longus and laterally by the sartorius muscle.
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This question is part of the following fields:
- Anatomy
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SESSION STATS - PERFORMANCE PER SPECIALTY
