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Question 1
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A 41-year-old G2P1 woman who is at 30 weeks gestational age presented to the medical clinic for a routine OB visit. Upon history taking, it was noted that her first pregnancy was uncomplicated and was delivered 10 years ago. At 40 weeks then, she had a normal vaginal delivery and the baby weighed 3.17kg.
In her current pregnancy, she has no complications and no significant medical history. She is a non-smoker and has gained about 11.3 kg to date. She also declined any testing for Down syndrome even if she is of advanced maternal age.
Upon further examination and observation, the following are her results:
Blood pressure range has been 100 to 120/60 to 70
Fundal height measures only 25 cm
Which of the following is most likely the reason for the patient’s decreased fundal height?Your Answer: Fetal growth restriction
Explanation:A fundal height measurement is typically done to determine if a baby is small for its gestational age. The measurement is generally defined as the distance in centimetres from the pubic bone to the top of the uterus. The expectation is that after week 24 of pregnancy the fundal height for a normally growing baby will match the number of weeks of pregnancy — plus or minus 2 centimetres.
A fundal height that measures smaller or larger than expected — or increases more or less quickly than expected — could indicate:
– Slow fetal growth (intrauterine growth restriction)
– A multiple pregnancy
– A significantly larger than average baby (fetal macrosomia)
– Too little amniotic fluid (oligohydramnios)
– Too much amniotic fluid (polyhydramnios). -
This question is part of the following fields:
- Obstetrics
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Question 2
Correct
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A 27-year-old G1P0 woman who is at 14 weeks of gestation presented to the medical clinic complaining of persistent nausea and vomiting. Upon history taking and interview, she reported that she frequently had poor appetite and felt lethargic. From her pre-pregnancy weight, it was also noted that she had 3% weight loss in difference. Upon further clinical observation, she looked dry, accompanied with coated tongue.
If the diagnosis of “hyperemesis gravidarum” is to be considered, which of the following will most likely confirm that diagnosis?Your Answer: she looks dry with coated tongue
Explanation:Hyperemesis gravidarum refers to intractable vomiting during pregnancy, leading to weight loss and volume depletion, resulting in ketonuria and/or ketonemia. There is no consensus on specific diagnostic criteria, but it generally refers to the severe end of the spectrum regarding nausea and vomiting in pregnancy.
Hormone changes wherein hCG levels peak during the first trimester corresponds to the typical onset of hyperemesis symptoms. It is well-known that the lower oesophageal sphincter relaxes during pregnancy due to the elevations in estrogen and progesterone. This leads to an increased incidence of gastroesophageal reflux disease (GERD) symptoms in pregnancy, and one symptom of GERD is nausea.
Hyperemesis gravidarum refers to extreme cases of nausea and vomiting during pregnancy. The criteria for diagnosis include vomiting that causes significant dehydration (as evidenced by ketonuria or electrolyte abnormalities, and the dry with coated tongue) and weight loss (the most commonly cited marker for this is the loss of at least five percent of the patient’s pre-pregnancy weight) in the setting of pregnancy without any other underlying pathological cause for vomiting.
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This question is part of the following fields:
- Obstetrics
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Question 3
Correct
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Question 4
Correct
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With regard to the cell cycle. In what phase do chromatids get cleaved into chromosomes and pulled apart?
Your Answer: Anaphase
Explanation:Mitosis is the process during which cell division occurs. It is divided into 4 stages:
– The first stage is the prophase during which the chromosomes condense, mitotic spindles form and the chromosomes pair which each other.
– The second stage is the metaphase during which the chromatids align at the equatorial plane.
– The third stage is the anaphase during which the chromatids are separated into 2 daughter chromosomes.
– The fourth phase is the telophase during which the chromatids decondense and a new nuclear envelop forms around the each of the daughter chromosomes. Cytokinesis is the process during which the cell cytoplasm divides. -
This question is part of the following fields:
- Biochemistry
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Question 5
Correct
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A 25-year old woman presented to the medical clinic for her first prenatal check-up. Upon interview, the patient revealed that she has been smoking one pack of cigarettes per day for the past five years.
All of the following are considered correct regarding the disadvantages of smoking during pregnancy, except:Your Answer: Increased risk of developing small teeth with faulty enamel
Explanation:Small teeth with faulty enamel is more associated with fetal alcohol syndrome (FAS).
In FAS, the most common orofacial changes are small eyelid fissures , flat facies, maxillary hypoplasia, short nose, long and hypoplastic nasal filter, and thin upper lip. The unique facial appearance of FAS patients is the result of changes in 4 areas: short palpebral fissures, flat nasal bridge with an upturned nasal tip, hypoplastic philtrum with a thin upper vermillion border, and a flat midface. Other facial anomalies include micrognathia, occasional cleft lip and/or palate and small teeth with defective enamel.
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This question is part of the following fields:
- Obstetrics
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Question 6
Correct
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Question 7
Incorrect
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Question 8
Correct
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Which of the following takes part in the arterial supply of the ovary?
Your Answer: Uterine arteries
Explanation:The ovarian arteries, arising from the abdominal aorta and the ascending uterine arteries which are branches of the internal iliac artery all supply the ovaries. They terminate by bifurcating into the ovarian and tubal branches and anastomose with the contralateral branches providing a collateral circulation.
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This question is part of the following fields:
- Anatomy
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Question 9
Correct
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A 34 weeks pregnant patient has a blood pressure of 149/98. Urine dipstick shows protein 3+. You send a for a protein:creatinine ratio. What level would be diagnostic of significant proteinuria?
Your Answer: >30 mg/mmol
Explanation:Pre-eclampsia is defined as hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hour collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the sixth postpartum week. Significant proteinuria = urinary protein: creatinine ratio >30 mg/mmol or 24-hour urine collection result shows greater than 300 mg protein.
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This question is part of the following fields:
- Clinical Management
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Question 10
Correct
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A 25-year-old high school teacher arrives for a prescription for a combination oral contraceptive tablet. She is new to your clinic, having recently relocated for a new position at a junior college. She does not smoke or consume alcoholic beverages. Sumatriptan 20mg intranasal spray has helped her with recurring headaches with aura in the past.
What are your plans for the future?Your Answer: Offer progestogen-only contraceptive options
Explanation:The combination oral contraceptive pill is an unequivocal contraindication for this patient (migraine with aura). Progestogen-only contraception, such as etonogestrel implant, levonorgestrel intrauterine device, and depot medroxyprogesterone, should be offered to her.
There is no need for a neurologist’s assessment or a brain MRI because her migraines are managed with sumatriptan nasal spray. -
This question is part of the following fields:
- Gynaecology
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Question 11
Incorrect
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Which of the following inhibit Glucagon?
Your Answer: Arginine
Correct Answer: Uraemia
Explanation:Glucagon release is inhibited by increased blood glucose, ketones, free fatty
acids, insulin, raised urea levels and somatostatin. Glucagon is produced by alpha cells of the pancreas and increases the plasma glucose level by stimulating glycogenolysis and gluconeogenesis. -
This question is part of the following fields:
- Endocrinology
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Question 12
Correct
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High levels of alpha feto protein are found in all, EXCEPT?
Your Answer: Trisomy 21
Explanation:Pregnant maternal serum AFP levels elevated: Neural tube defects (e.g., spina bifida, anencephaly); Omphalocele; Gastroschisis.
Pregnant maternal serum AFP low levels: Down syndrome
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This question is part of the following fields:
- Endocrinology
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Question 13
Correct
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You review a patient in the fertility clinic. The ultrasound and biochemical profile are consistent with PCOS. She 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:Clomiphene and/or Metformin are 1st line agents. Weight loss in the setting of subfertility is advised if BMI >30 kg/m2
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This question is part of the following fields:
- Clinical Management
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Question 14
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 15
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 16
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 17
Incorrect
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What is the failure rate of tubal sterilization?
Your Answer: 1 in 200
Correct Answer:
Explanation:Tubal sterilization is a safe and effective surgical procedure that permanently prevents pregnancy. However, pregnancy can occur in 1 in 200 cases, according to international sources. In the 1st year after tubal sterilization, the estimated failure rate is 0.1-0.8% respectively.
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This question is part of the following fields:
- Gynaecology
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Question 18
Correct
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Spinnbarkheit is a term which means:
Your Answer: Threading of the cervical mucous
Explanation:Spinnability (or Spinnbarkeit), which measures the capacity of fluids to be drawn into threads, represents an indirect measurement of the adhesive and elastic properties of mucus.
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This question is part of the following fields:
- Physiology
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Question 19
Incorrect
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Question 20
Correct
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The major cause of the increased risk of morbidity & mortality among twin gestation is:
Your Answer: Preterm delivery
Explanation:Twin pregnancy is associated with a number of obstetric complications, some of them with serious perinatal consequences, especially for the second twin. The rate of perinatal mortality can be up to six times higher in twin compared to singleton pregnancies, largely due to higher rates of preterm delivery and fetal growth restriction seen in twin pregnancies. Preterm birth and birth weight are also significant determinants of morbidity and mortality into infancy and childhood. More than 50% of twins and almost all triplets are born before 37 weeks of gestation and about 15–20% of admissions to neonatal units are associated with preterm twins and triplets.
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This question is part of the following fields:
- Obstetrics
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Question 21
Correct
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Regarding menstruation, which of the following is the maximum normal blood loss?
Your Answer: 80-85ml
Explanation:Most women lose about 35-40 ml of blood on average during each menstrual cycle. The maximum amount of blood loss is 80 ml after which blood loss of more than 80 ml is defined as heavy menstrual bleeding, formerly known as menorrhagia.
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This question is part of the following fields:
- Clinical Management
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Question 22
Correct
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A 46-year-old woman with regular menstrual cycles presents with a history of menorrhagia for the last 6 years. Her menstrual cycles are normal, but she has bled excessively for eight days every month, and her haemoglobin level was 90g/L one month ago. She's already on iron supplementation. She has a history of cervical intraepithelial neoplasia grade 3 (CIN3) in addition to the anaemia, albeit her yearly smear test has been normal since the laser treatment six years ago. She is also undergoing hypertension treatment. Physical examination is unremarkable. She is not willing for endometrial ablation or hysterectomy until her menopause. Which of the following medical therapies would be the best for her to utilize between now and the time she is expected to hit menopause, which is around the age of 50?
Your Answer: HRT given from the time of menopause at the age of approximately 50 years, reduces the decline of cognitive function, often seen as an early manifestation of AD
Explanation:Adenomyosis or dysfunctional uterine haemorrhage are the most likely causes of heavy periods.
Because she refuses to have a hysterectomy or endometrial ablation, hormonal therapy must be administered in addition to the iron therapy she is already receiving.
Any of the choices could be employed, but using therapy only during the luteal phase of the cycle in someone who is virtually surely ovulating (based on her typical monthly cycles) is unlikely to work.Danazol is prone to cause serious adverse effects (virilization), especially when used for a long period of time.
GnRH agonists would cause amenorrhoea but are more likely to cause substantial menopausal symptoms, and the °fa contraceptive pill (OCP) is generally best avoided in someone using hypertension medication.Treatment with norethisterone throughout the cycle is likely to be the most successful of the treatments available.
If a levonorgestrel-releasing intrauterine device (Mirena®) had been offered as an alternative, it would have been acceptable. -
This question is part of the following fields:
- Gynaecology
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Question 23
Correct
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A patient undergoes surgery for a vaginal vault prolapse. After surgery she complains of numbness of the anterior aspect of the labia. Which nerve has likely been damaged during surgery?
Your Answer: Ilioinguinal
Explanation:The anterior aspect of the vulva (mons pubis, anterior labia) is supplied by derivatives of the lumbar plexus: the anterior labial nerves, derived from the
ilio-inguinal nerve, and the genital branch of the genitofemoral nerve.
The posterior aspect of the vulva is supplied by derivatives of the sacral plexus: the perineal branch of the posterior cutaneous nerve of the thigh laterally, and the pudendal nerve centrally. -
This question is part of the following fields:
- Anatomy
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Question 24
Correct
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Regarding the study of the prognosis of a disease, which of the following studies is most appropriate?
Your Answer: Cohort Study
Explanation:Cohort studies are the most appropriate study design to study the prognosis of a disease. A group of patients with the same condition are chosen and their baseline information is taken. The group is then followed up over time to see which patients live or die.
Case-control studies can also be useful where a group of individuals that have survived a condition are compared with cases of those who have died. Prognostic factors that distinguish the two groups are identified. This method, however, is limited by bias and the accuracy of medical information present. -
This question is part of the following fields:
- Epidemiology
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Question 25
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:
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 26
Incorrect
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Endometrial tissue found within the myometrium is classed as
Your Answer:
Correct Answer: Adenomyosis
Explanation:Endometrial tissue found within the myometrium is Adenomyosis. If endometrial tissue is found at a distant site to the uterus it is termed endometriosis. Fibroids are smooth muscle tumours (Leiomyoma’s) sometimes called myoma’s.
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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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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:
Correct 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 28
Incorrect
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From which germ layer does the myenteric plexus of the GI tract developed:
Your Answer:
Correct Answer: Neural crest of Ectoderm
Explanation:During the 5th week, the neural crest cells migrate along each side of the spinal cord where they form ganglions located dorsolateral to the aorta. Some of these cells migrate ventrally and form neurons in the preaortic ganglia as the celiac and mesenteric ganglia.
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This question is part of the following fields:
- Embryology
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Question 29
Incorrect
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The most common cause of perinatal death in mono-amniotic twin is:
Your Answer:
Correct Answer: Cord entrapment
Explanation:Cord entanglement, a condition unique to MoMo pregnancies, occurs in 42 to 80% of the cases and it has been traditionally related to high perinatal mortality. Umbilical cord entanglement is present in all monoamniotic twins when it is systematically evaluated by ultrasound and colour Doppler. Perinatal mortality in monoamniotic twins is mainly a consequence of conjoined twins, twin reversed arterial perfusion (TRAP), discordant anomaly and spontaneous miscarriage before 20 weeks’ gestation. Expectantly managed monoamniotic twins after 20 weeks have a very good prognosis despite the finding of cord entanglement. The practice of elective very preterm delivery or other interventions to prevent cord accidents in monoamniotic twins should be re-evaluated.
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This question is part of the following fields:
- Obstetrics
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Question 30
Incorrect
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Antenatal booking investigations include all of the following, EXCEPT:
Your Answer:
Correct Answer: Thyroid function
Explanation:These are the six routine blood tests that every mum-to-be has to undergo around week 7 of pregnancy: Full Blood Count, Blood Typing, Hepatitis B Screening, Syphilis Screening, HIV Screening and Oral Glucose Tolerance Test (OGTT)
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This question is part of the following fields:
- Obstetrics
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SESSION STATS - PERFORMANCE PER SPECIALTY
