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Question 1
Incorrect
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A 24 year old lady is 9 weeks pregnant with her first child. She attends clinic complaining of severe vomiting and is unable to keep fluids down. The most likely diagnosis is hyperemesis gravidarum. Which of the following is the underlying cause?
Your Answer: Increased circulating progesterone
Correct Answer: Increased circulating HCG
Explanation:Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy, associated with weight loss of more than 5% of pre-pregnancy weight, dehydration and electrolyte imbalance. HG is usually most severe during the first 12 weeks of pregnancy and is thought to be caused by high circulating levels of HCG.
There is not yet any evidence that pregnancy itself increases the sensitivity of the area postrema, or that the hormones, oestradiol, or progesterone increase vomiting. Generally, higher concentrations of dopamine stimulates receptors in the chemoreceptor trigger zone leading to nausea and vomiting. Although this has not been demonstrated as the cause of hyperemesis gravidarum.
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This question is part of the following fields:
- Clinical Management
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Question 2
Incorrect
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A 30 year old woman with a history of two previous C section deliveries, is rushed to the hospital for an emergency c-section at 36 weeks gestation due to antenatal haemorrhage. Upon examination of the uterus, the placenta has invaded the myometrium but the serosa is spared. Which of the following identifies this condition?
Your Answer: Placenta Accreta
Correct Answer: Placenta Increta
Explanation:Abnormal placental adherence to the uterus, generally termed Placenta Accreta, is divided into 3 conditions.
– Placenta accreta: refers to the invasion of the chorionic villi beyond the decidual surface of the myometrium.
– Placenta increta: the villi invade deep into the myometrium but spare the serosa;
– Placenta percreta: the chorionic villi invade through the myometrium, penetrate the uterine serosa, and may invade surrounding pelvic structures.These conditions can predispose patients to obstetric bleeding in the third trimester, often requiring emergency intervention.
Risk factors in the development of an abnormal placental adherence include previous c-sections. Placenta Previa, is also a cause of antepartum haemorrhage and serves as a risk factor in the development of abnormal placental adherence.
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This question is part of the following fields:
- Clinical Management
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Question 3
Correct
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The midwife asks for your advice about a 33 year old woman who she has just seen at her booking appointment. The patient had an uncomplicated pregnancy 10 years ago. This is her second pregnancy. There is no significant personal or family history. On examination the patients blood pressure is 120/75, BMI 32.5kg/m2. The midwife asks your advice on testing for gestational diabetes. What would you advise?
Your Answer: OGTT at 24-28 weeks
Explanation:Gestational diabetes (GDM) occurs in 2–9 per cent of all pregnancies. Screening for diabetes in pregnancy can be justify ed to diagnose previously unrecognized cases of pre-existing diabetes and to identify a group of women who are at risk of developing NIDDM later in life. No single screening test has been shown to be perfect in terms of high sensitivity and specific city for gestational diabetes. Urinary glucose is unreliable, and most screening tests now rely on blood glucose estimation, with an oral glucose tolerance test commonly used. The aim of glucose control is to keep fasting levels between 3.5 and 5.5 mmol/L and postprandial levels 7.1 mmol/L, with insulin treatment usually indicated outside these ranges.
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This question is part of the following fields:
- Clinical Management
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Question 4
Incorrect
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You review a patient who is 34 weeks pregnant. She complains of gradually worsening itching over the past 6 weeks particularly to the hands and feet which is worse at night. You order some bloods. Which of the following would you normally expect to increase in the 3rd trimester?
Your Answer: Bilirubin
Correct Answer: ALP
Explanation:ALP can rise to up to 3 times the normal non-pregnant value in the 3rd trimester. All of the other tests above typically decrease during pregnancy.
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This question is part of the following fields:
- Clinical Management
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Question 5
Incorrect
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A patient attends the maternity unit as her waters have broken but she hasn't had contractions. She is 39+6 weeks gestation. Speculum examination confirms prelabour rupture of membranes (PROM). According to NICE guidelines after what time period should induction be offered?
Your Answer: Immediately
Correct Answer: 24 hours
Explanation:Induction of labour is appropriate approximately 24 hours after rupture of the membranes.
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This question is part of the following fields:
- Clinical Management
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Question 6
Correct
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A 30 year old women who is 24 weeks pregnant attends clinic due to suprapubic pain. Ultrasound shows a viable foetus and also a fibroid with a cystic fluid filled centre. What is the likely diagnosis?
Your Answer: Cystic degeneration of fibroid
Explanation:A fibroid is a benign tumour of the smooth muscles of the uterus also known as a leiomyoma. It has a typical whorled appearance and this may be altered following degeneration which occurs in four main types:
1. Red degeneration, also known as carneous degeneration, of degeneration that can involve a uterine leiomyoma. While it is an uncommon type of degeneration, it is thought to be the most common form of degeneration of a leiomyoma during pregnancy. Red degeneration follows an acute disruption of the blood supply to the fibroid during growth typically in a mid-second trimester presenting as sudden onset of pain with tenderness localizing to the area of the uterus along with pyrexia and leucocytosis. On ultrasound it can have peripheral (rim).2. Hyaline degeneration is the most common form of degeneration that can occur in a uterine leiomyoma. It is thought to occur in up to 60% of uterine leiomyomasoccurs when the fibroid outgrows its blood supply. this may progresses to central necrosis leaving a cystic space in the centre knowns as cystic degeneration.
3. Cystic degeneration is an uncommon type of degeneration that a uterine leiomyoma (fibroid) can undergo. This type of degeneration is thought to represent ,4% of all types of uterine leiomyoma degeneration. When the leiomyoma increases in size, the vascular supply to it becomes inadequate and leads to different types of degeneration: hyaline, cystic, myxoid, or red degeneration. Dystrophic calcification may also occur. Hyalinization is the commonest type of degeneration. Cystic degeneration is an extreme sequel of edema. Ultrasound may show a hypoechoic or heterogeneous uterine mass with cystic areas.
4. Myxoid degeneration of leiomyoma is one of the rarer types of degeneration that can occur in a uterine leiomyoma. While this type of degeneration is generally considered rare, the highest prevalence for this type of degeneration has been reported as up to 50% of all degenerations of leiomyomas. Fibroids (i.e. uterine leiomyomas) that have undergone myxoid degeneration are filled with a gelatinous material and can be difficult to differentiate from cystic degeneration; however, they typically appear as more complex cystic masses. They appear hypocellular with a myxoid matrix.
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This question is part of the following fields:
- Clinical Management
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Question 7
Correct
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What is the most common Type II congenital thrombophilia?
Your Answer: Factor V Leiden mutation
Explanation:Factor V Leiden is the most common congenital thrombophilia. Named after the Dutch city Leiden where it was first discovered. Protein C and S deficiencies are type 1 (Not type 2) thrombophilias Antiphospholipid syndrome is an acquired (NOT congenital) thrombophilia
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This question is part of the following fields:
- Clinical Management
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Question 8
Incorrect
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What is the mechanism of action of Oxytetracycline?
Your Answer: inhibit peptidoglycan cross-links in bacterial cell wall
Correct Answer: Binds to 30S subunit of microbial ribosomes blocking attachment of aminoacyl-tRNA to the A site on the ribosome
Explanation:Tetracycline is classified as a broad spectrum antibiotic. It is a bacteriostatic inhibitor of protein synthesis acting at the ribosomal level. Tetracycline binds to the 30s ribosomal subunit preventing the binding of the aminoacidic charged T-RNA to the ribosome-mRNA complex.
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This question is part of the following fields:
- Clinical Management
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Question 9
Incorrect
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A 26 year old primigravida woman attends A&E due to worsening vomiting. She is currently 10 weeks pregnant. For the past 4 weeks she has had morning sickness but for the last 4 days she has been unable to tolerate any oral fluids without vomiting and thinks she has lost weight. On questioning she has no significant past medical history prior to this pregnancy. She is currently taking the following medication:
Your Answer:
Correct Answer: Hyperemesis gravidarum
Explanation:This patient has severe nausea and vomiting with ketosis and evidence of dehydration (low BP and tachycardia) in the early part of pregnancy. There is no history of diabetes and the blood glucose doesn’t indicate hyperglycaemia. This is consistent with hyperemesis gravidarum (HG)
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This question is part of the following fields:
- Clinical Management
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Question 10
Incorrect
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A patient is diagnosed with cervical cancer and staging investigations show there is parametrial involvement but it is confined within the pelvic wall and does not involve the lower 1/3 vagina. There is no evidence of hydronephrosis. What FIGO stage is this?
Your Answer:
Correct Answer: 2B
Explanation:This is stage 2B.
2010 FIGO classification of cervical carcinoma
0 – Carcinoma in situ
1 – Confined to the cervix (diagnosed microscopy)
1A1 – Less than 3mm depth & 7mm lateral spread
1A2 – 3mm to 5mm depth & less than 7mm lateral spread
1B1 – Clinically visible lesion or greater than A2 & less than 4 cm in greatest dimension
1B2 – Clinically visible lesion, Greater than 4 cm in greatest dimension 2 Invades beyond uterus but not to pelvic wall or lower 1/3 vagina
2A1 – Involvement of the upper two-thirds of the vagina, without parametrical invasion & Less than 4cm
2A2 – Greater than 4 cm in greatest dimension
2B – Parametrial involvement
3 – Extends to Pelvic side wall or lower 1/3 vagina or hydronephrosis
3A – No pelvic side wall involvement
3B – Pelvic side wall involved or hydronephrosis
4 – Extends beyond true pelvis
4A – Invades mucosa bladder and rectum
4B – Distant Metastasis -
This question is part of the following fields:
- Clinical Management
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Question 11
Incorrect
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In the 3rd trimester anaemia is defined by?
Your Answer:
Correct Answer:
Explanation:Anaemia in pregnancy is defined by the British Committee for Standards in Haematology (BCSH) guidance: 1st trimester Hb < 110 g/l 2nd and 3rd trimester Hb < 105 g/l Postpartum Hb less than 100 g/l
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This question is part of the following fields:
- Clinical Management
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Question 12
Incorrect
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You are called to see a 24 year old patient in A&E. She is 34 weeks gestation and her blood pressure is 149/98. Automated reagent strip testing shows protein 1+. What is the appropriate course of action regarding the urine result?
Your Answer:
Correct Answer: Send urine for protein:creatinine ratio
Explanation:For a diagnosis of Preeclampsia to be established, hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hour collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the sixth postpartum week should be present.
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This question is part of the following fields:
- Clinical Management
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Question 13
Incorrect
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A 46 year old women with a BMI of 34 is seen in clinic following hysteroscopy and biopsy for irregular menstrual bleeding. Histology shows hyperplasia without atypia. Following a discussion the patient declines any treatment but agrees she will try and lose weight. What is the risk of progression to endometrial cancer over 20 years?
Your Answer:
Correct Answer:
Explanation:The risk of developing endometrial carcinoma is less than 5% over 20 years if the endometrium shows hyperplasia without atypia.
There are 2 types of Endometrial Hyperplasia:
1. Hyperplasia without atypia*
2. Atypical hyperplasiaMajor Risk Factors:
Oestrogen (HRT)
Tamoxifen
PCOS
Obesity
Immunosuppression (transplant) -
This question is part of the following fields:
- Clinical Management
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Question 14
Incorrect
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Question 15
Incorrect
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A 32 year old women who is 25 weeks pregnant presents with vaginal bleeding and cramping lower abdominal pain. On examination the cervix is closed. Fetal cardiac activity is noted on ultrasound. What is the likely diagnosis?
Your Answer:
Correct Answer: Antepartum Haemorrhage
Explanation:Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby.
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This question is part of the following fields:
- Clinical Management
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Question 16
Incorrect
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A 32 year old women who is 25 weeks pregnant presents with vaginal bleeding and cramping lower abdominal pain. On examination the cervix is closed. Fetal cardiac activity is noted on ultrasound. What is the likely diagnosis?
Your Answer:
Correct Answer: Antepartum Haemorrhage
Explanation:Antepartum haemorrhage is any bleeding that occurs from the female genital tract during the antenatal period after the 24+0 week of pregnancy and prior to the birth of the baby. The most common causes are placenta previa and placental abruption.
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This question is part of the following fields:
- Clinical Management
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Question 17
Incorrect
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A 28 year old patient is treated for hydatidiform mole with methotrexate. What is the mechanism of action of methotrexate?
Your Answer:
Correct Answer: Inhibits dihydrofolate reductase
Explanation:Methotrexate is a folic acid antagonist. It inhibits dihydrofolate reductase (DHFR). DHFR catalyses the conversion of dihydrofolate to the active tetrahydrofolate which is required for DNA synthesis. It is either administered as a single intramuscular injection or multiple fixed doses.
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This question is part of the following fields:
- Clinical Management
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Question 18
Incorrect
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A patient asks you in clinic when she can start trying to conceive again. She has just completed chemotherapy for gestational trophoblastic disease (GTD)?
Your Answer:
Correct Answer: 1 year from completion of treatment
Explanation:According to the RCOG greentop guidelines, a women who have underdone chemotherapy for GTD are advised not to conceive for 1 years after completion of the chemotherapy.
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This question is part of the following fields:
- Clinical Management
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Question 19
Incorrect
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What is the male infertility rate in CF patients?
Your Answer:
Correct Answer: 98%
Explanation:Cystic fibrosis is the most common fetal genetic disease in Caucasians and has an autosomal recessive inheritance. It is caused by an abnormal chloride channel due to a defect in the CFTR gene. Complications range from haemoptysis, respiratory failure, biliary cirrhosis, diabetes and male infertility. Men with CF are infertile in 98% of the cases due to failure of development of the vas deference.
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This question is part of the following fields:
- Clinical Management
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Question 20
Incorrect
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Lactogenesis at term is stimulated by which hormone?
Your Answer:
Correct Answer: Prolactin
Explanation:Prolactin is the hormone that is responsible for the production of milk (Lactogenesis). Oxytocin is responsible for the let down reflex during suckling.
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This question is part of the following fields:
- Clinical Management
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Question 21
Incorrect
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Question 22
Incorrect
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Regarding uterine fibroids, which of the following statements is false?
Your Answer:
Correct Answer: The risk of fibroids is increased by pregnancy
Explanation:Fibroids are a common gynaecological condition found in many women above the age of 35. They are however uncommon before puberty. They are most common in black women vs white women, and its prevalence increases from puberty to menopause. Risk factors for fibroids include increasing age, obesity and infertility. Protective factors, on the other hand, include pregnancy, as the risk of fibroids decreases with increasing numbers of pregnancies.
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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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What is the average volume of blood loss during the menstrual cycle?
Your Answer:
Correct Answer: 35-40ml
Explanation:Normal menstrual blood loss is about 40-45 ml. More than 80 ml per period is defined as heavy menstrual bleeding.
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This question is part of the following fields:
- Clinical Management
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Question 24
Incorrect
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You diagnose Erb-Duchenne palsy in a baby born with shoulder dystocia who suffered a brachial plexus injury. Which of the following nerve roots are likely to be affected?
Your Answer:
Correct Answer: C5 and C6
Explanation:Shoulder dystocia occurs when the fetal shoulder impacts on the maternal symphysis or sacrum during vaginal delivery. About 10% of babies with shoulder dystocia will suffer a brachial plexus injury, the most common one being Erb-Duchenne palsy. In Erb’s palsy, the upper nerve roots C5 and C6 are damaged due to excessive widening of the angle between the head and the shoulder. This causing temporary paralysis in the affected arm whereby the infant will present with its hand hanging limp by his side, internal rotation of the forearm, plus wrist and finger flexion. This sign is called the ‘waiter’s tip hand’. The palsy usually resolves spontaneously in a large proportion of cases.
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This question is part of the following fields:
- Clinical Management
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Question 25
Incorrect
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A patient is attending for medical abortion. She is 15 weeks gestation. She has no known drug allergies. Which of the following is the most appropriate regarding antibiotic prophylaxis?
Your Answer:
Correct Answer: Stat Azithromycin 1g and metronidazole 800 mg orally at time of abortion
Explanation:If the patient has a negative Chlamydia screen then a stat dose of metronidazole monotherapy is appropriate. You do not know this patients Chlamydia status and therefore dual therapy with metronidazole + doxycycline or azithromycin is appropriate.
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This question is part of the following fields:
- Clinical Management
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Question 26
Incorrect
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Your consultant agrees to supervise you performing a Caesarean Section (CS). When making a Joel Cohen incision where should this be placed?
Your Answer:
Correct Answer: 3 cm above the symphysis pubis
Explanation:The Joel Cohen incision is superior to the Pffannenstiel incision. It is a straight incision that is 3 cm below the line joining the anterior iliac spines.
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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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Which of the following contraceptives primary mode of action is inhibition of ovulation?
Your Answer:
Correct Answer: Cerazette®
Explanation:Traditional POP main mode of contraceptive action: thickening of cervical mucus Desogestrel-only POP main mode of contraceptive action is inhibition of ovulation Cerazette® is the only Desogestrel-only POP in the options above. Other desogestrel brands include: Aizea® Cerelle® Nacrez® The other POPs listed are considered traditional POPs and have the following compositions: Norgeston® – Levonorgestrel 30 mcg Micronor® & Noriday® – Norethisterone 350 mcg Femulen® – Ethynediol diacetate 500 mcg
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This question is part of the following fields:
- Clinical Management
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Question 28
Incorrect
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A 36 year old patient is diagnosed with cervical cancer and staging investigations show there is parametrial involvement but it is confined within the pelvic wall and does not involve the lower 1/3 vagina. There is no evidence of hydronephrosis. What FIGO stage is this?
Your Answer:
Correct Answer: 2B
Explanation:It is stage 2B. Stage I: is strictly confined to the cervix; extension to the uterine corpus should be disregarded. The diagnosis of both Stages IA1 and IA2 should be based on microscopic examination of removed tissue, preferably a cone, which must include the entire lesion.
2010 FIGO classification of cervical carcinoma:
Stage IA: Invasive cancer identified only microscopically. Invasion is limited to measured stromal invasion with a maximum depth of 5 mm and no wider than 7 mm.
Stage IA1: Measured invasion of the stroma no greater than 3 mm in depth and no wider than 7 mm diameter.
Stage IA2: Measured invasion of stroma greater than 3 mm but no greater than 5 mm in depth and no wider than 7 mm in diameter.Stage IB: Clinical lesions confined to the cervix or preclinical lesions greater than Stage IA. All gross lesions even with superficial invasion are Stage IB cancers.
Stage IB1: Clinical lesions no greater than 4 cm in size.
Stage IB2: Clinical lesions greater than 4 cm in size.Stage II: carcinoma that extends beyond the cervix, but does not extend into the pelvic wall. The carcinoma involves the vagina, but not as far as the lower third.
Stage IIA: No obvious parametrial involvement. Involvement of up to the upper two-thirds of the vagina.
Stage IIB: Obvious parametrial involvement, but not into the pelvic sidewall.Stage III: carcinoma that has extended into the pelvic sidewall. On rectal examination, there is no cancer-free space between the tumour and the pelvic sidewall. The tumour involves the lower third of the vagina. All cases with hydronephrosis or a non-functioning kidney are Stage III cancers.
Stage IIIA: No extension into the pelvic sidewall but involvement of the lower third of the vagina.
Stage IIIB: Extension into the pelvic sidewall or hydronephrosis or non-functioning kidney.Stage IV: carcinoma that has extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum.
Stage IVA: Spread of the tumour into adjacent pelvic organs.
Stage IVB: Spread to distant organs. -
This question is part of the following fields:
- Clinical Management
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Question 29
Incorrect
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Which of the following factors causes the greatest increase in risk of developing bladder cancer?
Your Answer:
Correct Answer: Smoking
Explanation:Transitional cell carcinoma of the bladder is most commonly caused by cigarette smoke. Other risk factors include naphthylamine, azodyes and long term cyclophosphamide use.
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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 29 year old patient presents due to the sensation of reduced fetal movements (RFM). From what gestation is CTG assessment of RFM advised?
Your Answer:
Correct Answer: 28+0 weeks
Explanation:The cardiotocograph (CTG) is a continuous tracing of the fetal heart rate used to assess fetal wellbeing. The Doppler effect detects fetal heart motion and allows the interval between successive beats to be measured, thereby allowing a continuous assessment of fetal heart rate. The mother perceives the fetal movement by the 18-20 week of gestation and these increase until the 32 week. A mother should under go CTG if the fetal movements are reduced by the 28 week of gestation.
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This question is part of the following fields:
- Clinical Management
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SESSION STATS - PERFORMANCE PER SPECIALTY
