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Question 1
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A 30-year-old female patient visits you for a cervical cancer screening. You inform her that while Pap smears are no longer performed, Cervical Screening tests are done five times a year.
She has a cervical screening test, which reveals that she has non-16/18 HPV and low-grade cytology alterations.
What's would you do next?Your Answer: Colposcopy
Correct Answer: Repeat cervical screening test in 12 months
Explanation:An LSIL Pap test shows mild cellular changes. The risk of a high-grade cervical precancer or cancer after an LSIL Pap test is as high as 19 percent.
As with an ASC-US Pap test, an LSIL Pap test is evaluated differently depending upon age. For women ages 25 or older, follow-up depends upon the results of human papillomavirus (HPV) testing:
– Women who test positive for HPV or who have not been tested for HPV should have colposcopy.
– Women who test negative for HPV can be followed up with a Pap test and HPV test in one year.Referral to an oncologist is not necessary since there is no established diagnosis of malignancy. All other options are unacceptable.
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This question is part of the following fields:
- Gynaecology
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Question 2
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WHO defines the perinatal mortality rate as
Your Answer: The number of stillbirths and deaths in the first week of life per 1000 births
Explanation:WHO defines perinatal death as the number of still births and death in the first week of life per 1000 births.
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This question is part of the following fields:
- Epidemiology
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Question 3
Correct
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Where did HIV-1 originate?
Your Answer: Central Africa
Explanation:HIV-1 originated in Central Africa in the first half of the 20th century from a closely related chimpanzee virus that first infected humans. The virus likely crossed over to humans through the hunting and consumption of chimpanzees, which are known to carry similar strains of the virus. The earliest known case of HIV-1 in humans dates back to 1959 in the Democratic Republic of Congo. From there, the virus spread throughout Central Africa and eventually to other parts of the world through various means such as migration, travel, and the global sex trade. Today, HIV-1 is a global pandemic affecting millions of people worldwide.
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This question is part of the following fields:
- Epidemiology
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Question 4
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: Immature teratoma
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 5
Incorrect
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A patient with a recent diagnosis of Hepatitis B would like to find out further information regarding his diagnosis and prognosis.
Which among the following statements is considered true regarding Hepatitis B?Your Answer: Approximately 30% of patients with hepatitis B develop chronic hepatitis
Correct Answer: 60-65% of patients that contract hepatitis B show subclinical disease
Explanation:As the immune response is activated, the virus is slowly cleared from the system, and most patients become non-infectious. In adults, about 50% of infections are asymptomatic; 20% to 30% of patients exhibit clinical jaundice but have a benign resolution of the infection. Therefore, about 80% of infections do not cause serious sequelae. The risk for chronic infection is inversely proportional to age at time of infection, with approximately 90% of infants and only 3% of adults developing a chronic infection.
Individuals with a chronic infection have a higher risk of liver disease, such as cirrhosis or hepatic carcinoma. -
This question is part of the following fields:
- Epidemiology
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Question 6
Correct
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A 37-year-old woman is planning to conceive this year. Upon history-taking and interview, it was noted that she was a regular alcohol drinker and has been using contraceptive pills for the past 3 years.
Which of the following is considered to be the most appropriate advice for the patient?Your Answer: Stop alcohol now
Explanation:Alcohol exposure during pregnancy results in impaired growth, stillbirth, and fetal alcohol spectrum disorder. Fetal alcohol deficits are lifelong issues with no current treatment or established diagnostic or therapeutic tools to prevent and/or ameliorate some of these adverse outcomes.
Alcohol readily crosses the placenta with fetal blood alcohol levels approaching maternal levels within 2 hours of maternal intake. As there is known safe level of alcohol consumption during pregnancy, and alcohol is a known teratogen that can impact fetal growth and development during all stages of pregnancy, the current recommendation from the American College of Obstetricians and Gynaecologists, Centre for Disease Control (CDC), Surgeon General, and medical societies from other countries including the Society of Obstetricians and Gynaecologists of Canada all recommend complete abstinence during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 7
Correct
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What is the International goal for ending the AIDS epidemic by the World Health Organization (WHO)?
Your Answer: By 2030
Explanation:The World Health Organization (WHO) has set a goal to end the AIDS epidemic by 2030 through its Fast-Track strategy. This strategy involves accelerating the scale-up of HIV prevention, treatment, and care services in order to reach key targets by 2020 and ultimately end the epidemic by 2030. This includes increasing access to HIV testing and treatment, reducing new HIV infections, and eliminating AIDS-related deaths. By focusing on key populations most affected by HIV, such as men who have sex with men, sex workers, people who inject drugs, and transgender individuals, the WHO aims to achieve these targets and ultimately end the AIDS epidemic by 2030.
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This question is part of the following fields:
- Epidemiology
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Question 8
Correct
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A 24-year-old college student comes to your clinic for contraception guidance. For the past three months, she has had migraine-like headaches once or twice a month. For the past two years, she has been taking combined oral contraceptive pills.
Which of the following suggestions is the most appropriate?Your Answer: Stopping the combined oral contraceptive pills and starting progesterone only pills (POP)
Explanation:Combined oral contraceptives are a safe and highly effective method of birth control, but they can also raise problems of clinical tolerability and/or safety in migraine patients. It is now commonly accepted that, in migraine with aura, the use of combined oral contraceptives is always contraindicated, and that their intake must also be suspended by patients suffering from migraine without aura if aura symptoms appear.
Discontinuation of contraception could risk in pregnancy. Barrier methods can be used but aren’t as effective as pills.
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This question is part of the following fields:
- Gynaecology
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Question 9
Correct
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What is the preferred antiretroviral regimen for pregnant women newly initiating ART?
Your Answer: Tenofovir (TDF), Lamivudine (3TC), and Dolutegravir (DTG)
Explanation:During pregnancy, it is important to provide effective antiretroviral therapy (ART) to prevent mother-to-child transmission of HIV. The preferred regimen for pregnant women newly initiating ART is Tenofovir (TDF), Lamivudine (3TC), and Dolutegravir (DTG) for several reasons.
Tenofovir (TDF) is a well-tolerated and effective antiretroviral drug that is safe to use during pregnancy. Lamivudine (3TC) is also considered safe and effective for use in pregnant women. Dolutegravir (DTG) is a newer antiretroviral drug that has shown high efficacy and a good safety profile in pregnant women.
This regimen is preferred over other options such as Zidovudine (AZT) due to potential side effects and resistance issues, and Efavirenz (EFV) due to concerns about potential birth defects. Tenofovir (TDF), Lamivudine (3TC), and Dolutegravir (DTG) is considered a safe and effective option for pregnant women to help reduce the risk of mother-to-child transmission of HIV.
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This question is part of the following fields:
- Pharmacology
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Question 10
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