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Question 1
Correct
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Question 2
Incorrect
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Which is the most useful tumour marker for monitoring of ovarian cancer patients?
Your Answer: CA 125
Correct Answer:
Explanation:CA-125 has found application as a tumour marker or biomarker that may be elevated in the blood of some patients with specific types of cancers, or other conditions that are benign. Increased level of CA125 appears in fifty percent of stage 1 ovarian cancer patients and more than 90% with stages 2-4 ovarian cancer. CA-125 is therefore a useful tool for detecting ovarian cancer after the onset of symptoms as well as monitoring response to treatment and for predicting a patient’s prognosis after treatment.
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This question is part of the following fields:
- Gynaecology
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Question 3
Incorrect
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A 30-year-old woman at her 18th week of pregnancy has been diagnosed with deep vein thrombosis of iliofemoral veins.
Which of the following is considered the best management for the patient's condition?Your Answer:
Correct Answer: Therapeutic dose of low molecular weight heparin for 6 months
Explanation:Deep venous thrombosis (DVT) during pregnancy is associated with high mortality, morbidity, and costs. Pulmonary embolism (PE), its most feared complication, is the leading cause of maternal death in the developed world. DVT can also result in long-term complications that include post thrombotic syndrome (PTS) adding to its morbidity. Women are up to 5 times more likely to develop DVT when pregnant. The current standard of care for this condition is anticoagulation.
Low molecular weight heparin (LMWH) is the preferred agent for prophylaxis and treatment of DVT during pregnancy. A disadvantage of LMWH over unfractionated heparin (UFH) is its longer half-life, which may be a problem at the time of delivery.
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This question is part of the following fields:
- Obstetrics
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Question 4
Incorrect
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A 25-year-old lady is somewhat jaundiced, has black urine, and has pruritus of her abdomen skin at 30 weeks of pregnancy in her first pregnancy. Her blood pressure is 130/80 mmHg, her fundal height is 29 cm above the pubic symphysis, and her liquid volume is a little lower than expected. Laboratory investigations reveal:
Serum bilirubin (unconjugated): 5 mmol/L (0-10)
Serum bilirubin (conjugated): 12 mmol/L (0-5)
Serum alkaline phosphatase (ALP): 450U/L (30--350)
Serum alanine aminotransferase (ALT) 45U/L (<55)
Serum bile acids: 100 mmol/L (1-26)
The most likely cause for her presentation is?Your Answer:
Correct Answer: Obstetric cholestasis.
Explanation:The correct answer is Obstetric Cholestasis.
The characteristics (elevated bile acids, conjugated bilirubin, and alkaline phosphatase (ALP) levels) are typical with obstetric cholestasis, which affects roughly 3-4 percent of pregnant women in Australia. Obstetric cholestasis is diagnosed when otherwise unexplained pruritus occurs in pregnancy and abnormal liver function tests (LFTs) and/or raised bile acids occur in the pregnant woman and both resolve after delivery. Pruritus that involves the palms and soles of the feet is particularly suggestive.
Liver function tests and bile acid levels measurements are used to validate this diagnosis.
All of the other diagnoses are theoretically possible, but unlikely.
On liver function tests, hepatitis A and acute fatty liver of pregnancy (which is frequently associated with severe vomiting in late pregnancy) usually show substantially worse hepatocellular damage.
Pre-eclampsia is connected with hypertension and proteinuria (along with changes in renal function and, in certain cases, thrombocytopenia), while cholelithiasis is associated with obstructive jaundice and pale stools due to a stone in the CBD. -
This question is part of the following fields:
- Obstetrics
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Question 5
Incorrect
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A woman visited the OPD with complaints of severe abdominal pain and light-headedness. There is history of fainting three days prior to consultation. She also has vaginal bleeding. In this case, which of the following investigations should be ordered to reach the diagnosis?
Your Answer:
Correct Answer:
Explanation:Testing for beta hCG should be the first test in this case. It will rule out any pregnancy that is strongly suspected based on the patient’s history and physical examination.
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This question is part of the following fields:
- Gynaecology
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Question 6
Incorrect
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When is the earliest appropriate gestational age to perform amniocentesis?
Your Answer:
Correct Answer: 15+0 weeks
Explanation:The best time to perform amniocentesis is at the gestational age of 15 weeks or more. There is increased risk of abortion, respiratory problems and fetal talipes if amniocentesis is performed before the gestational age of 14 weeks.
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This question is part of the following fields:
- Clinical Management
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Question 7
Incorrect
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A biophysical profile includes all of the following assessment parameters EXCEPT:
Your Answer:
Correct Answer: Fetal weight
Explanation:The biophysical profile is a composite test that collects 5 indicators of fetal well-being, including fetal heart rate reactivity, breathing movements, gross body movements, muscular tone, and quantitative estimation of amniotic fluid volume. The assessment of fetal heart rate is accomplished by performing a nonstress test, whereas the latter 4 variables are observed using real-time ultra-sonography.
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This question is part of the following fields:
- Biophysics
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Question 8
Incorrect
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A 32 year old patient develops painful ulcerated genital lesions and inguinal lymphadenopathy. She is 32 weeks pregnant. You suspect genital herpes and send swabs. Which of the following is appropriate management according to the 2014 BASHH/RCOG guidelines?
Your Answer:
Correct Answer: Send bloods to check antibody status. If this supports this is a first episode genital HSV then patient should be advised to have C-section delivery
Explanation:Although acyclovir should be given, this patient is in the 3rd trimester so the course should continue until delivery. Dose will be 400mg TDS unless disseminated disease. If this is a primary HSV infection (This should be confirmed by lesion swabs to confirm HSV infection and bloods to check no antibody response i.e. evidence previous infection) then C-section is indicated.
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This question is part of the following fields:
- Microbiology
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Question 9
Incorrect
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Which structure is the primary mechanism for shunting blood away from the fetal pulmonary circulation?
Your Answer:
Correct Answer: Foramen Ovale
Explanation:Blood enters the right atrium of the fetal heart and most passes through the foramen ovale into the left atrium. From there it is pumped through the aorta. The foramen ovale is the major structure for bypassing the fetal pulmonary circulation. Some of the blood in the right atrium does enters the right ventricle and then into the pulmonary artery however most of this passes through the ductus arteriosus into the aorta thus bypassing the fetal pulmonary circulation.
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This question is part of the following fields:
- Embryology
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Question 10
Incorrect
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A 29-year-old woman presents to her local Emergency Department with the complaint of feeling unwell.
Her last menstrual period was eight weeks ago. Normally, she has regular monthly periods.
She reports that she had heavy vaginal bleeding on the previous day; the bleeding had reduced today.
On examination, she appears unwell, her pulse rate is 130 beats/min, BP is 110/60 mmHg, and temperature is 39.5°C
Suprapubic tenderness and guarding is noted on abdominal examination.
There is no evidence of a pelvic mass.
Speculum examination shows that the cervix is open and apparent products of conception are present in the upper vagina.
From the following, choose the most appropriate treatment option for optimal management of this patient.
Your Answer:
Correct Answer: Cervical swabs for microscopic assessment and culture.
Explanation:This woman has experienced a septic abortion. Therefore the first step is commencement of intensive antibiotic treatment as soon as cervical swabs have been taken.
The next step is evacuation of the uterus. Curettage can be performed after a few hours, to extract any remaining infected products of conception from the uterine cavity.
The choice of antibiotics depends on the most likely microorganism involved. Therefore, prior to commencing any other procedure, it is vital to take cervical swabs for microscopic examination to guide further antibiotic therapy (correct answer).
If curettage is performed immediately there is a risk that the infection would spread.
However, if Clostridium welchii infection is suspected from the cervical smear (particularly if encapsulation of the microorganisms is present), then curettage should be performed immediately along with commencing antibiotic treatment.
Curettage can be delayed for up to 12-24 hours if other microorganisms are suspected; unless a significant increase in bleeding occurs.
Ergometrine is not essential as an immediate treatment measure as the patient is not bleeding heavily and reports that her bleeding has decreased. However, ergometrine is commonly given when curettage is performed.
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This question is part of the following fields:
- Gynaecology
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Question 11
Incorrect
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Regarding the closure of the ductus arteriosus (DA) after birth which of the following most accurately describes the mechanisms leading to closure of the DA?
Your Answer:
Correct Answer: Increased arterial pO2, increased bradykinin & decreased Prostaglandin E2
Explanation:Functional closure of the ductus arteriosus is neonates is completed within the first few days after birth. It normally occurs by the 12th postnatal week. It has been suggested that persistent patency of DA results from a failure of the TGF-B induction after birth. Due to increased arterial pO2, constriction of the DA occurs. In addition to this on inflation the bradykinin system is activated with cause the smooth muscles in the DA to constrict. A decrease in the E2 prostaglandin is also an important factor as raised levels have been indicated in keeping the patency of the DA.
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This question is part of the following fields:
- Embryology
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Question 12
Incorrect
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Which one of the following statements is true regarding the development of external genitalia?
Your Answer:
Correct Answer: The genital fold forms the scrotum in males
Explanation:Genital folds lead to the formation of the scrotum in males while in females they form the posterior labial commissure. Genital tubercles form the labia majora whereas the tubercle itself becomes the mons pubis. The labia minora is formed by the urogenital folds.
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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 29 year old female presented at her 38th week of gestation to the ER with severe hypertension (210/100) and proteinuria (+++). Soon after admission, she developed generalized tonic clonic fits. What is the first line of management in this case?
Your Answer:
Correct Answer: Magnesium sulphate IV
Explanation:Magnesium Sulphate is the drug of choice in eclamptic patients. A loading dose of 4g magnesium sulphate in 100mL 0.9% saline IVI over 5min followed by maintenance IVI of 1g/h for 24h. Signs of toxicity include respiratory depression and jerky tendon reflexes. In recurrent fits additional 2g can be given. Magnesium should be stopped when the respiratory rate is <14/min, absent tendon reflexes, or urine output is <20mL/h.
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This question is part of the following fields:
- Obstetrics
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Question 14
Incorrect
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Question 15
Incorrect
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Which one of the following statements best suits Androgen insensitivity syndrome?
Your Answer:
Correct Answer: Gonadectomy must be performed after puberty because of the increased risk of malignancy
Explanation:Androgen insensitivity syndrome patients have 46XY chromosomes. They are males by genotype but appear as female because of insensitivity to male hormones. It is advisable to perform gonadectomy in these patients after puberty because these patients are at increased risk of developing malignancy.
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This question is part of the following fields:
- Embryology
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Question 16
Incorrect
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Question 17
Incorrect
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When deciding on entry method for laparoscopy a patients build is important. Which of the following entry methods is inappropriately matched to the patient?
Your Answer:
Correct Answer: Varess needle entry in a very thin patient (BMI 16)
Explanation:In patients with normal BMI there is no preferential entry method. The Varess technique is not appropriate for morbidly obese or very thin patients for the reasons set out below: Morbid Obesity (BMI>40): Hasson technique or entry at Palmers point Reason: difficult penetration with Varess needle Very Thin Patients: Hasson technique or insertion at Palmers point Reason: higher risk of vascular injury
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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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Immediate delivery of the foetus is recommended at which fetal scalp pH?
Your Answer:
Correct Answer: 7.18
Explanation:A pH value below than 7.18 indicates acidosis which can result in hypoxic brain injury. In order to prevent brain injury, immediate delivery of the foetus should be planned. The normal range for a term baby is pH: 7.18 – 7.38, preterm pH: 7.14 – 7.4.
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This question is part of the following fields:
- Physiology
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Question 19
Incorrect
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A sure sign of pregnancy is:
Your Answer:
Correct Answer: Auscultation of fetal heart
Explanation:Classifications of Pregnancy Signs:
Presumptive signs — possibility of pregnancy
Probable signs — most likelihood of indicating pregnancy
Positive signs — confirmation of pregnancy
Auscultation of fetal heart is the only positive sign amongst the rest of the answers. -
This question is part of the following fields:
- Physiology
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Question 20
Incorrect
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Which of the following is a pro-thrombotic agent?
Your Answer:
Correct Answer: Thromboplastin
Explanation:Protein C, protein S, plasminogen and anti thrombin III are all anti thrombotic agents. Thromboplastin is a pro-thrombotic.
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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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Which one of the following has the most significant effect on slowing drug metabolism in pregnancy?
Your Answer:
Correct Answer: Progesterone effect on gastric motility
Explanation:Progesterone down regulates gastric motility meaning drugs are absorbed and metabolised more slowly, thus drugs are absorbed, metabolised and cleared more slowly. Most of the drugs are transported after binding to the albumin.
Lower albumin levels mean a greater unbound drug fraction but as this may be thought to increase drug concentrations it actually leaves more available for hepatic clearance or renal excretion so overall drug concentrations are unchanged and metabolism increased.
Increase in hepatic flow will increase the metabolism of the drug as the drug will be transported faster.
Increased renal blood flow will result in the faster clearance of the drug from the body. -
This question is part of the following fields:
- Clinical Management
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Question 22
Incorrect
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A 27-year-old woman comes to you during her first trimester seeking antenatal advice as she have a history of pre-eclampsia and obesity.
On examination her blood pressure is 130/80 mmHg and BMI is 38.
Administration of which among the following can reduce her risk of pre-eclampsia during this pregnancy?Your Answer:
Correct Answer: Calcium 1000mg daily
Explanation:This patient with a previous history of pre-eclampsia and obesity is at high risk for developing pre-eclampsia.
A daily intake of 1000mg of calcium is observed to be helpful in reducing the incidence of any hypertensive disorders and preterm labour.
Vitamin A should always be avoided during pregnancy as it is fetotoxic.
All other options are incorrect.
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This question is part of the following fields:
- Obstetrics
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Question 23
Incorrect
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Pregnant patients are at higher risk of thromboembolism due to a hypercoagulable state. Which of the following clotting factors reduces during pregnancy?
Your Answer:
Correct Answer: Factor XI
Explanation:Pregnancy is a hypercoagulable state, which means that risk of thromboembolism is increased. The main reason is an increase in clotting factors II, factor VII, fibrinogen, factor X and factor XII, whereas factors XI and factor XIII are reduced. Naturally occurring anticoagulants i.e. protein C and protein S are both decreased thus increasing the risk of thrombus formation.
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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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A 22 year old woman had a C-section two hours ago. However, she has not urinated since then and claims she had no urinary complaints before the operation. Upon inspection she appears unwell and her abdomen is distended and tender suprapubically and in the left flank. Auscultation reveals no bowel sounds. Further examination reveals the following: Temp=37.5C, BP=94/73mmHg, Pulse=116bpm, Sat=97%. What's the most likely complication?
Your Answer:
Correct Answer: Urinary tract injury
Explanation:Urologic injury is the most common injury at the time of either obstetric or gynaecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during caesarean section include previous caesarean delivery, adhesions, emergency caesarean delivery, and caesarean section performed during the second stage of labour.
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This question is part of the following fields:
- Obstetrics
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Question 25
Incorrect
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When consenting someone for laparoscopy you discuss the risk of vascular injury. The incidence of vascular injury during laparoscopy according to the BSGE guidelines is?
Your Answer:
Correct Answer: 0.2/1000
Explanation:Major vessel injury is the most important potential complication when undertaking laparoscopy. It’s incidence is 0.2/1000. Bowel Injury is more common at 0.4/1000
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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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During normal pregnancy, the renal glomerular filtrate rate (GFR) can increase as much as:
Your Answer:
Correct Answer: 50%
Explanation:Pregnancy involves remarkable orchestration of physiologic changes. The kidneys are central players in the evolving hormonal milieu of pregnancy, responding and contributing to the changes in the environment for the pregnant woman and foetus. The functional impact of pregnancy on kidney physiology is widespread, involving practically all aspects of kidney function. The glomerular filtration rate increases 50% with subsequent decrease in serum creatinine, urea, and uric acid values.
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This question is part of the following fields:
- Physiology
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Question 27
Incorrect
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Which of the following increases the risk of endometrial hyperplasia?
Your Answer:
Correct Answer: Tamoxifen
Explanation:Tamoxifen increases risk of endometrial hyperplasia Aromatase inhibitors such as Letrozole and Anastrozole are not associated and have not been shown to increase the risk of endometrial pathology Whereas unopposed oestrogens increase endometrial cancer risk combined oral contraceptive decrease risk
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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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Among the below mentioned conditions which is not a contraindication to tocolysis?
Your Answer:
Correct Answer: Maternal hypothyroidism
Explanation:Contraindications to tocolysis in preterm labor are as follows:
– Gestational age > 34 weeks or <24 weeks
– Labor is too advanced with an advanced cervical dilation of >4 cm
– Abnormal CTG suggesting a non-reassuring fetal status
– Lethal fetal anomalies
– Intrauterine fetal demise
– Suspected fetal compromise
– Significant antepartum hemorrhage, such as placental abruption/ active vaginal bleeding with hemodynamic instability
– Any suspected intrauterine infections like chorioamnionitis
– Maternal hypotension
– Pregnancy-induced hypertension/ eclampsia/ pre-eclampsia
– Placenta previa
– Placental insufficiency
– Intrauterine growth retardation
– Maternal allergy to specific tocolytic agents or cases where tocolytics are contraindicated due to specific comorbidities like in case of cardiac disease, were beta agonists cannot be administered.As there are nonpulmonary morbidities associated with preterm birth, fetal pulmonary maturity, known or suspected, is not an absolute contraindication for tocolysis. These fetuses could potentially benefit from prolongation of pregnancy and from the nonpulmonary benefits of glucocorticoid therapy.
When cervical dilation is greater than 3 cm inhibition of preterm labor is less likely to be successful. In such cases Tocolysis can be considered when the goal is to administer antenatal corticosteroids or to safely transport the mother to a tertiary care center.
Maternal hypothyroidism which is usually treated with thyroxine is not a contraindication to suppression of labor.
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This question is part of the following fields:
- Obstetrics
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Question 29
Incorrect
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Which two nerves provide the primary cutaneous sensory innervation to the labia majora?
Your Answer:
Correct Answer: Ilioinguinal and pudendal
Explanation:The Pudendal provides cutaneous innervation to the posterior external genitalia via one of its terminal branches called the perineal nerve (this further branches into the posterior labial nerves or posterior scrotal nerve in men). The ilioinguinal nerve provides anterior sensation via the anterior labial nerves (anterior scrotal nerve in men). The genital branch of the genitofemoral nerve contributes some fibres to the skin of the mons pubis and labia majora in females. The posterior cutaneous nerve of thigh sometimes overlaps sensory areas.
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This question is part of the following fields:
- Anatomy
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Question 30
Incorrect
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As a locum GP at a rural hospital, you are serving female patients at the OBGYN department. You have become an expert in diagnosing endometriosis early.
Which would you say is the most common symptom of endometriosis?Your Answer:
Correct Answer: Dysmenorrhoea
Explanation:The following are the most common symptoms for endometriosis, but each woman may experience symptoms differently or some may not exhibit any symptoms at all. Symptoms of endometriosis may include:
Pain, especially excessive menstrual cramps that may be felt in the abdomen or lower back
Pain during intercourse
Abnormal or heavy menstrual flow
Infertility
Painful urination during menstrual periods
Painful bowel movements during menstrual periods
Other gastrointestinal problems, such as diarrhoea, constipation and/or nauseaAll options can be symptoms of endometriosis but the commonest one is dysmenorrhea.
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This question is part of the following fields:
- Gynaecology
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SESSION STATS - PERFORMANCE PER SPECIALTY
