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Question 1
Correct
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During pregnancy which one of the following laboratory parameters is decreased?
Your Answer: Platelet count
Explanation:In pregnancy, although it is a hypercoagulable state with an increase in clotting factors, the platelet count is decreased. Fibrinogen and erythrocyte sedimentation rate (ESR) may be both increased.
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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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Human papilloma virus (HPV) infection is associated with which of the following onco-proteins?
Your Answer: P53 and P55
Correct Answer: E6 and E7
Explanation:There are over 100 genotypes of HPV including several other high risk HPV types. HPV 16 and 18 are responsible for 70% of cases of HPV related cancers. HPV is thought to induce cancer via onco-proteins. The primary onco-proteins are E6 and E7 which inactivate two tumour suppressor proteins, p53 (inactivated by E6) and pRb (inactivated by E7)
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This question is part of the following fields:
- Microbiology
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Question 3
Correct
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A 32-year-old female at 28 weeks of pregnancy presented with heavy vaginal bleeding. On examination, she was tachycardic, hypotensive and her uterus was tender. She was resuscitated. Which of following is the most important investigation to arrive at a diagnosis?
Your Answer: US
Explanation:The presentation is antepartum haemorrhage. Ultrasound should be performed to find the reason for bleeding and assess the fetal well being.
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This question is part of the following fields:
- Obstetrics
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Question 4
Correct
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During wound healing collagen alignment along tension lines is part of which phase?
Your Answer: Remodelling
Explanation:Realignment of collagen is part of the remodelling phase. Remodelling is usually underway by week 3. Maximum tensile wound strength is typically achieved by week 12.
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This question is part of the following fields:
- Physiology
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Question 5
Incorrect
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Evidence from meta-analysis of RCTs is what level of evidence?
Your Answer: III
Correct Answer: Ia
Explanation:The levels of evidence range from I-IV:
1a: Systematic reviews (with homogeneity) or metanalysis of randomized controlled trials: highest level of evidence.
1b: Individual randomized controlled trial (with narrow confidence interval)
1c: All or none randomized controlled trials
2a: Systematic reviews (with homogeneity) of cohort studies
2b: Individual cohort study or low quality randomized controlled trials (e.g. <80% follow-up)
2c: Outcomes Research; ecological studies
3a: Systematic review (with homogeneity) of case-control studies
3b: Individual case-control study
4: Case series (and poor quality cohort and case-control studies)
5: Expert opinion without explicit critical appraisal, or based on physiology, bench research or first principles. -
This question is part of the following fields:
- Epidemiology
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Question 6
Incorrect
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What is the average anteroposterior distance of the female pelvic outlet?
Your Answer: 10.5 cm
Correct Answer: 13 cm
Explanation:The pelvic outlet is bounded in front by the lower margin of the symphysis pubis, on each side by the descending ramus of the pubic bone, the ischial tuberosity and the sacrotuberous ligament, and posteriorly by the last piece of the sacrum. The AP diameter of the pelvic outlet is 13.5 cm and the transverse diameter is 11 cm.
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This question is part of the following fields:
- Anatomy
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Question 7
Correct
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Which of the following hormones is secreted by the corpus luteum in a non pregnant state?
Your Answer: Progesterone
Explanation:The corpus luteum is formed from the granulosa cells of the mature follicle. The structure functions as a transient endocrine organ which secretes mainly progesterone with additional secretion of oestradiol and inhibin, which serve to suppress FSH levels. In the event of no pregnancy, the corpus luteum stops producing progesterone and degenerates into the corpus albicans.
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This question is part of the following fields:
- Embryology
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Question 8
Correct
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What is the main reason for the active management of the third stage of labour?
Your Answer: Prevent postpartum haemorrhage
Explanation:According to the WHO, active management of the third stage of labour has been shown to decrease the risk of postpartum haemorrhage in vaginal births worldwide. Per the guidelines from the International Federation of Gynaecologists and Obstetricians (FIGO), the active management of the third stage is summarised as follows:
1. The administration of a uterotonic (oxytocin, ergometrine or misoprostol), within one minute of fetal delivery,
2.Controlled cord traction with manual support to the uterus until placental delivery
3. Fundal massage immediately after placental delivery. -
This question is part of the following fields:
- Clinical Management
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Question 9
Incorrect
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A 30-year-old woman living in England had a cervical smear test one month ago. There were no cervical abnormalities visualised at the time of the smear. She has no symptoms of unusual vaginal bleeding and her previous smear results have always been negative. She received the following report: 'Your recent smear was negative with no evidence of nuclear abnormalities.' When will she be routinely recalled for her next smear?
Your Answer: 5 years
Correct Answer:
Explanation:Women aged 25-49 years living in England are routinely recalled for screening every three years. Women receive their first invitation for cervical screening at 25 years of age. They are not invited earlier as changes in the young cervix can be normal and result in unnecessary treatment. Provided the smears remain negative and there are no symptoms to suggest cervical cancer, the routine recall is three years for women aged 25-49 years. Women aged 50-64 years old are routinely recalled for a smear every five years. After the age of 65 years, women are only screened if they have not had a smear since the age of 50 years (including those who have never had a smear) or those who have had recent abnormal smears. This is because due to the natural history and progression of cervical cancer, it is highly unlikely that women over 65 years old will go on to develop the disease.
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This question is part of the following fields:
- Gynaecology
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Question 10
Incorrect
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A 29-year-old gravida 6, para 5 woman at 36 weeks of gestation arrives in the ED via ambulance and precipitously delivers a male child. The child coughs and has a strong cry. He is very active. Acrocyanosis is noted. Heart rate is 98 bpm and breathing is strong. What is this child’s Apgar score?
Your Answer: 9
Correct Answer: 5
Explanation:The Apgar test scores appearance, pulse, grimace, activity, and respiration and is generally done at 1 and 5 minutes after birth but may be repeated if the child continues to score low (Table). This child’s score is as follows: Appearance, 1; Pulse, 1; Grimace, 2; Activity, 2; Respiration, 2 (APGAR score = 8). A score of 3 or less is generally regarded as critically low, 4 to 6 is fairly low, and 7 to 10 is generally normal. Contrary to common belief, the Apgar score is not used to decide if a neonate requires resuscitation. Decisions about resuscitation are based on emergency assessment of airway, breathing, and circulation.5,6
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This question is part of the following fields:
- Physiology
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Question 11
Correct
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All of the following may result from a bicornuate uterus except:
Your Answer: Congenital anomalies of the baby
Explanation:Literature review shows that bicornuate uterus is associated with increase risk of spontaneous abortion in about 36% of patients. There is also an increased risk of preterm birth, malpresentation and fetal growth retardation.
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This question is part of the following fields:
- Embryology
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Question 12
Correct
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Which one of the following statements is related to testicular feminization syndrome?
Your Answer: There are usually normal testes
Explanation:Androgen insensitivity (testicular feminization) syndrome is a rare inherited form of male pseudo hermaphroditism that occurs in phenotypically normal women with adequate breast development, normal external genitalia, a vagina of variable depth, absent uterus, and sparse or absent pubic hair and axillary hair. Testosterone levels are normal or elevated.
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This question is part of the following fields:
- Embryology
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Question 13
Incorrect
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A 19-year-old female patient with secondary amenorrhea visits your office. A urine pregnancy test is negative. As part of your work-up, you order a pelvic ultrasound, which reveals a fluid filled, thin walled cyst measuring 1.8 x 1.3 x 1 cm. She doesn't complain of pain or tenderness.
What is the most appropriate next step?Your Answer: Repeat the ultrasound in 6 weeks
Correct Answer: Do nothing
Explanation:An ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. Although the discovery of an ovarian cyst causes considerable anxiety in women owing to fears of malignancy, the vast majority of these lesions are benign.
Many patients with simple ovarian cysts based on ultrasonographic findings do not require treatment.
In a postmenopausal patient, a persistent simple cyst smaller than 10cm in dimension in the presence of a normal CA125 value may be monitored with serial ultrasonographic examinations.However, meta-analyses have since shown that there is no difference between OCP use and placebo in terms of treatment outcomes in ovarian cysts and that these masses should be monitored expectantly for several menstrual cycles.
If a cystic mass does not resolve after this timeframe, it is unlikely to be a functional cyst, and further workup may be indicated.
Other methods of management maybe revisited if cyst increases in size or becomes complex upon follow up.
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This question is part of the following fields:
- Gynaecology
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Question 14
Incorrect
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A 24-year-old lady, who has not been able to conceive even after 2 years of unprotected intercourse, has come with concerns that she might have endometriosis. She is concerned because she has a friend who recently was diagnosed with it.
Which symptom profile would be expected if this woman actually has endometriosis?Your Answer: Dysmenorrhoea from the time of the menarche.
Correct Answer: No abnormal bleeding or pain.
Explanation:The clinical features of endometriosis include dyspareunia, dysmenorrhea, dysuria, dyschezia as well as infertility. Pain is characteristically long-term, cyclic (often occurring the same time as menses) and can get progressively worse over time. Laparoscopy remains the standard for diagnosis. There are many cases in which endometriosis is only discovered at the time of the workup for infertility.
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This question is part of the following fields:
- Gynaecology
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Question 15
Incorrect
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What is the half life of Oxytocin?
Your Answer: 5 hours
Correct Answer: 5 minutes
Explanation:The half-life of Oxytocin is approximately 5 minutes
The half-life of Misoprostol is approximately 20-40 minutes
The half-life of Ergometrine is approximately 30-120 minutes -
This question is part of the following fields:
- Clinical Management
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Question 16
Incorrect
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The broad ligament contains which of the following structures?
Your Answer: Ureters
Correct Answer: Uterine artery
Explanation:The contents of the broad ligament:
Fallopian tubes
Ovarian artery
Uterine artery
Ovarian ligament
Round ligament of uterus -
This question is part of the following fields:
- Anatomy
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Question 17
Incorrect
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Which of the following regarding the use of tocolytics is true?
Your Answer: Use of a tocolytic drug reduces neonatal morbidity but not mortality
Correct Answer: Use of a tocolytic drug is not associated with a clear reduction in perinatal or neonatal mortality, or neonatal morbidity
Explanation:Tocolytics are used to suppress contractions. The Canadian preterm labour trial which remains a very influential tocolytic trial to date concluded that tocolytics such as a beta agonist have no significant benefit on perinatal mortality or morbidity or prolong pregnancy to term however it did reduce the number of women delivering within 2 days by 40%. This 48 hour window is the only reason for the use of tocolytics.
Choice of tocolytic (NICE)
1st line: Nifedipine
2nd line: Oxytocin receptor antagonists e.g. atosiban -
This question is part of the following fields:
- Clinical Management
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Question 18
Incorrect
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A pregnant woman with a history of osteoarthritis presents to her antenatal clinic. She is complaining of restricted joint movement and severe pain in her joints. Choose the most appropriate medication for her from the list below.
Your Answer: Paracetamol + dihydrocodeine
Correct Answer: Paracetamol
Explanation:Paracetamol is safe to take during pregnancy and has shown no harm to unborn children during studies. It is the treatment of choice for mild to moderate pain during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 19
Incorrect
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The typical female breast contains how many lobes?
Your Answer: 40-50
Correct Answer: 15-20
Explanation:The female breast is made of about 15 to 20 individual lobes. The lobules each consists of alveoli which drain into a single lactiferous duct. The ductal system leads to lactiferous sinuses and collecting ducts which expel milk from openings in the nipple.
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This question is part of the following fields:
- Anatomy
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Question 20
Incorrect
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The second stage of labour involves:
Your Answer: Effacement of the cervix
Correct 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 21
Incorrect
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A 31 year old patient undergoes an elective c-section delivery. You estimate blood loss has reached 1000ml and you suspect uterine atony is the likely cause. Following bimanual uterine compression what pharmacological intervention is advised?
Your Answer: Direct intramyometrial injection of carboprost 0.5 mg
Correct Answer: Syntocin 5u by slow intravenous injection
Explanation:Syntocin 5u by slow intravenous injection is the first line pharmacological measurement in this scenario
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This question is part of the following fields:
- Clinical Management
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Question 22
Incorrect
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With regard to the cell cycle. In which part of the cycle does DNA replication occur?
Your Answer: Telophase
Correct Answer: Interphase
Explanation:DNA replication occurs during S phase but that isn’t one of the options. Remember Interphase comprises G1,S and G2 phases!
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This question is part of the following fields:
- Biochemistry
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Question 23
Incorrect
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The joint between the two pubic bones is called the:
Your Answer: Intervertebral joint
Correct 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 24
Incorrect
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Which one of the following features best describes the role of prostaglandins?
Your Answer: Have no role in the development of dysmenorrhea
Correct Answer: Are involved in the onset of labour
Explanation:Prostaglandins are involved in the uterine contraction and cervical dilatation during labour. Higher prostaglandin concentrations can also lead to severe menstrual cramps.
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This question is part of the following fields:
- Physiology
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Question 25
Incorrect
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The external carotid artery develops from which pharyngeal arch?
Your Answer: 4th
Correct Answer: 1st
Explanation:The maxillary arteries and the external carotid arteries develop from the first pharyngeal arch. The stapedial arteries arise from the second, the common carotid artery and the internal carotid arteries from the third and the arch of the aorta and the right subclavian artery from the forth arch.
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This question is part of the following fields:
- Embryology
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Question 26
Incorrect
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A 27-year-old G2P1 visits the gynaecologist with complaints of increased hair growth on her face, breast, and belly, but hair loss in the temporal regions of her head. She has also struggled with acne.
On physical examination, the patient's face, chest, and belly are covered in coarse, dark hair. Her clitoris is swollen on pelvic examination. Her left adnexal mass is 7 cm in diameter.
What is the most likely ovarian tumour to be associated with this clinical picture?Your Answer: Krukenberg tumour
Correct Answer: Sertoli-Leydig cell tumour
Explanation:Sertoli-Leydig cell tumours constitute less than 0.5 percent of ovarian neoplasms. They may behave in a benign or malignant fashion, which correlates with the degree of differentiation in an individual case. Approximately 75 percent occur in women under the age of 40 years (mean age at diagnosis is 25), but they occur in all age groups. The neoplasms are characterized by the presence of testicular structures that produce androgens. This can result in virilization, although not all of these neoplasms are functionally active.
Pure Sertoli cell tumours are usually estrogenic and may also secrete renin, leading to refractory hypertension and hypokalaemia. In addition, these tumours may be associated with Peutz-Jeghers syndrome.
Pure Leydig cell tumours are androgen secreting; only a few cases have been reported. Virtually all of these rare tumours are unilateral and confined to the ovary at diagnosis.
Granulosa cell tumours typically present as large masses; the mean diameter is 12 cm. Women may present with an asymptomatic mass noted on abdominal or pelvic examination. Granulosa cell tumours often produce oestrogen and/or progesterone; consequently, symptoms related to hyperestrogenism are common at diagnosis.
Krukenberg tumour, also known as carcinoma mucocellulare, refers to the signet ring subtype of metastatic tumour to the ovary. The stomach followed by colon are the two most common primary tumours to result in ovarian metastases, pursued by the breast, lung, and contralateral ovary.
A rare tumour that is made up of more than one type of cell found in the gonads (testicles and ovaries), including germ cells, stromal cells, and granulosa cells. Gonadoblastomas are usually benign (not cancer), but they may sometimes become malignant (cancer) if not treated.
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This question is part of the following fields:
- Gynaecology
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Question 27
Incorrect
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What kind of epithelium lines the endocervix?
Your Answer: Stratified Squamous, keratinised
Correct Answer: Columnar
Explanation:Its important to note the endo and ectocervix have 2 epithelial types. Where columnar and squamous epithelia meet is the transformation zone (or squamous-columnar junction, SCJ). This is relevant as it is the primary site for dysplasia and is where smears are taken from.
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This question is part of the following fields:
- Pathology
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Question 28
Correct
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What is the normal pH value of an umbilical arterial sample of a new born term baby?
Your Answer: 7.2
Explanation:The normal range for a term baby is pH: 7.18 – 7.38, and preterm pH: 7.14 – 7.4. A pH below 7.1 therefore indicates acidosis.
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This question is part of the following fields:
- Physiology
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Question 29
Incorrect
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Which of the following increases during pregnancy?
Your Answer: Total Lung Capacity
Correct Answer: Tidal Volume
Explanation:Ventilation begins to increase significantly at around 8 weeks of gestation, most likely in response to progesterone-related sensitization of the respiratory centre to carbon dioxide and the increased metabolic rate. Significant alterations occur in the mechanical aspects of ventilation during pregnancy. Minute ventilation (or the amount of air moved in and out of the lungs in 1 minute) is the product of tidal volume and respiratory rate and increases by approximately 30–50 per cent with pregnancy. The increase is primarily a result of tidal volume, which increases by 40 per cent (from 500 to 700 mL), because the respiratory rate remains unchanged. The increase in minute ventilation is perceived by the pregnant woman as shortness of breath, which affects 60–70 per cent of women. This physiological dyspnoea is usually mild and affects 50 per cent of women before 20 weeks gestation, but resolves immediately postpartum.
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This question is part of the following fields:
- Physiology
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Question 30
Incorrect
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You're looking after a 24-year-old woman who is experiencing pelvic pain. She has one-sided pain that is widespread and mild, but can be intense at times. Menstruation has been regular. She denies having fever.
With the exception of a smooth movable adnexal mass on the right side, her pelvic examination seems normal.
Which of the following is the most likely reason for your discomfort?Your Answer:
Correct Answer: Ovarian cyst
Explanation:An ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. Although the discovery of an ovarian cyst causes considerable anxiety in women owing to fears of malignancy, the vast majority of these lesions are benign. Most patients with ovarian cysts are asymptomatic, with the cysts being discovered incidentally during ultrasonography or routine pelvic examination. Some cysts, however, may be associated with a range of symptoms, sometimes severe, including the following:
Pain or discomfort in the lower abdomen
Severe pain from torsion (twisting) or rupture – Cyst rupture is characterized by sudden, sharp, unilateral pelvic pain; this can be associated with trauma, exercise, or coitus. Cyst rupture can lead to peritoneal signs, abdominal distention, and bleeding (which is usually self-limited)
Discomfort with intercourse, particularly deep penetration
Changes in bowel movements such as constipation
Pelvic pressure causing tenesmus or urinary frequency
Menstrual irregularities
Precocious puberty and early menarche in young children
Abdominal fullness and bloating
Indigestion, heartburn, or early satiety
Endometriomas – These are associated with endometriosis, which causes a classic triad of painful and heavy periods and dyspareunia
Tachycardia and hypotension – These may result from haemorrhage caused by cyst rupture
Hyperpyrexia – This may result from some complications of ovarian cysts, such as ovarian torsion
Adnexal or cervical motion tendernessUnderlying malignancy may be associated with early satiety, weight loss
achexia, lymphadenopathy, or shortness of breath related to ascites or pleural effusionThe absence of fever or vaginal discharge rules out PID
The absence of pain on the right lower quadrant, fever, nausea and vomiting rule out appendicitis.
The patient has regular menses, no vaginal bleeding no signs of shock that rules out ectopic pregnancy.
her symptoms are also not consistent with the presentation of leiomyoma. Leiomyoma presents with enlarged uterus, pelvic pressure. It early causes pain when it is complicated with red degeneration which usually occurs in pregnancy.
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This question is part of the following fields:
- Gynaecology
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SESSION STATS - PERFORMANCE PER SPECIALTY
