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Question 1
Correct
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A 29-year-old lady taking oral contraceptives came to your clinic with her boyfriend. She got severe diarrhoea and vomiting after eating a hamburger at a local eatery while on the road. She has taken her pills as prescribed.
What is your contraception advice?Your Answer: Use condoms for 7 days and continue usual pills
Explanation:The CDC recommends that:
If diarrhoea occurs within 24 hours of taking oral birth control or continues for 24 to 48 hours after taking a pill, an additional dose is not needed.
If diarrhoea lasts more than 48 hours Use backup birth control, such as condoms, or avoid sexual intercourse until pills have been taken for seven diarrhoea-free days.All other options are incorrect.
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This question is part of the following fields:
- Gynaecology
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Question 2
Correct
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What is the incidence of hyperthyroidism in complete molar pregnancy?
Your Answer: 3%
Explanation:As B-HCG and TSH have similar structures, increased B-HCG can lead to hyperthyroidism, however there is only a 3% chance of this happening.
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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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Several mechanisms have been proposed as to what causes closure of the Ductus Arteriosus (DA) at Parturition. Which of the following is the most important in maintaining the patency of the DA during pregnancy?
Your Answer: PGE2
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 4
Correct
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The following is a gram positive obligate anaerobe:
Your Answer: Clostridia
Explanation:Obligate anaerobes are a group of bacteria that cannot survive in an oxygen-rich environment. In the body, they are usually found on mucosal membranes such as that of the lower gastrointestinal system, or the vagina. Infection with these organisms is usually suprative and causes abscesses. Examples of gram-negative anaerobes include Bacteroides, Fusobacterium and Prevotella, while gram-positive anaerobes include Actinomyces and Clostridia. Staphylococcus and Streptococcus are both gram-positive facultative anaerobes.
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This question is part of the following fields:
- Microbiology
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Question 5
Correct
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Haemolytic Disease of the New-born falls into what type of hypersensitivity reaction?
Your Answer: Type II
Explanation:It is classified under type II hypersensitivity reaction. Antibodies are formed against the rhesus antigen i.e. D antigen. Hence when the Antibody reacts with the antigen on the RBC it results in activation of the complement cascade leading to lysis.
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This question is part of the following fields:
- Immunology
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Question 6
Correct
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Regarding the uterine artery which of the following statements are FALSE?
Your Answer: It crosses the Ureter posteriorly
Explanation:The Uterine artery typically arises from the anterior branch of the internal iliac artery. It crosses the ureter ANTERIORLY. It is the primary source of arterial supply to the uterus and its branches anastomose with branches of the ovarian and vaginal arteries.
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This question is part of the following fields:
- Anatomy
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Question 7
Correct
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A 33-year-old woman was admitted to a hospital's maternity unit for labour. Her pregnancy has been unremarkable so far and she had regular antenatal visits. Meconium liquor passage was noted during the labour. Cardiotocography was done and revealed a fetal heart rate (FHR) of 149bpm. There were no noted decelerations or accelerations. The beat-to-beat variability is established at 15 bpm. Upon vaginal examination, there were no reported abnormalities.
Which of the following is considered to be the next most appropriate step in managing this patient?Your Answer: The CTG is normal and close monitoring until delivery is all required for now
Explanation:Meconium is the earliest stool of a newborn. Occasionally, newborns pass meconium during labour or delivery, resulting in a meconium-stained amniotic fluid (MSAF).
No particular cardio-tocograph pattern can be considered to have a poor prognostic value in the presence of thick MSAF and the decision to deliver and the mode of delivery should be based on the overall assessment and the stage and progress of labour. While management should be individualized, a higher Caesarean section rate in thick MSAF can be justified to ensure a better outcome for the neonate even in the presence of a normal CTG trace.
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This question is part of the following fields:
- Obstetrics
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Question 8
Correct
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A 24 week pregnant patient complains of itching over the past 6 weeks particularly to the hands and feet which is worse at night. She has taken cetirizine but this hasn't settled her symptoms. Examination is unremarkable with no rash. What is the likely diagnosis?
Your Answer: Intrahepatic Cholestasis of Pregnancy
Explanation:The history is typical of Intrahepatic Cholestasis of Pregnancy, also known as obstetric cholestasis and prurigo gravidarum. It is characterised by itching without rash and abnormal LFTs beyond normal pregnancy ranges. Itching affects around 23% of pregnancies and can occur before biochemical changes.
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This question is part of the following fields:
- Clinical Management
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Question 9
Correct
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You are asked to review a patient. They have attended for a scan at 13 weeks following a positive pregnancy test. The patient has had 2 previous pregnancies for which she opted for termination on both occasions. The scan shows a large irregular haemorrhagic mass that appears to be invading into the myometrium. What is the likely diagnosis?
Your Answer: Choriocarcinoma
Explanation:Choriocarcinoma may arise as a complication of gestation or as spontaneous germ cell tumours. As this scenario depicts that the women has previous abortion points to the fact that these may have been molar pregnancies. As choriocarcinoma can arise from a molar pregnancy it can be differentiated from it by the presence of invasion into the uterus and metastasis to the lungs primarily.
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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 43-year-old woman, with a history of bilateral tubal ligation, presents with regular but excessively heavy periods. She has a history of multiple uterine leiomyoma and her uterus is the size of a 12-week pregnancy.
Pap smear is normal; haemoglobin level is 93 g/L. She underwent dilatation and curettage 8 months ago but it did not result in symptom improvement nor was it able to find the underlying cause of her symptoms.
Which is the best next step in her management?Your Answer: Endometrial ablation.
Correct Answer: Total abdominal hysterectomy
Explanation:Oral progestogen therapy for 21 days (day 5-26) is considered effective but is only a short-term therapy for menorrhagia. Myomectomy should only be considered if the woman would like to conceive later on. Due to the recurrent nature of fibroids, it is likely that the woman would need more surgeries in the future, which is not ideal. Furthermore, if there is a large number of fibroids or the size of the fibroids are large, myomectomy would not be an option for reasons such as the feasibility. If myomectomy for multiple fibroids prove to be unsuccessful, the ultimate outcome would still have to be a hysterectomy.
In cases where there is significant enlargement of the uterus, endometrial ablation would be difficult and the long-term cure rate of symptoms would be considerably low. The best next step would be a total abdominal hysterectomy since it would solve her menorrhagia and within a few years’ time, she would be expected to attain menopause anyway. Ponstan or mefenamic acid has been found to be superior to tranexamic acid for menorrhagia. However, it can still prove to be ineffective in some cases and also not a long term solution.
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This question is part of the following fields:
- Gynaecology
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Question 11
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: Cefalexin 500mg twice daily for 7 days starting on day of abortion and stat dose metronidazole 500mg orally at time of abortion
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 12
Correct
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Urinary incontinence has brought a 69-year-old woman to your clinic. When she laughs, sneezes, or coughs, as well as during activity, she experiences minor quantities of urine incontinence.
Which of the following is the most appropriate management next step?Your Answer: Pelvic floor muscles exercise
Explanation:Pelvic floor muscle exercises are the mainstay of behavioural therapy for stress incontinence. Up to 38 percent of patients with stress incontinence alone who follow a pelvic floor muscle exercise regimen for at least three months experience a cure.
Weighted cones or topical steroids can be used as adjuvants but are not sufficient when used alone.
Tension free vaginal tape and Burch’s colposuspension are considered for patients who fail to respond to conservative management strategies.
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This question is part of the following fields:
- Gynaecology
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Question 13
Incorrect
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The relation of different fetal parts to each other determines?
Your Answer: Position of the foetus
Correct Answer: Attitude of the foetus
Explanation:Fetal attitude is defined as the relation of the various parts of the foetus to each other. In the normal attitude, the foetus is in universal flexion. The anatomic explanation for this posture is that it enables the foetus to occupy the least amount of space in the intrauterine cavity. The fetal attitude is extremely difficult, if not impossible, to assess without the help of an ultrasound examination.
Fetal lie refers to the relationship between the long axis of the foetus relative to the long axis of the mother. If the foetus and maternal column are parallel (on the same long axis), the lie is termed vertical or longitudinal lie.
Fetal presentation means, the part of the foetus which is overlying the maternal pelvic inlet.
Position is the positioning of the body of a prenatal foetus in the uterus. It will change as the foetus develops. This is a description of the relation of the presenting part of the foetus to the maternal pelvis. In the case of a longitudinal lie with a vertex presentation, the occiput of the fetal calvarium is the landmark used to describe the position. When the occiput is facing the maternal pubic symphysis, the position is termed direct occiput anterior.
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This question is part of the following fields:
- Obstetrics
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Question 14
Incorrect
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Commonest cause of precocious puberty is:
Your Answer: Granulosa cell tumour
Correct Answer: Idiopathic
Explanation:Precocious puberty can be defined as secondary sexual characteristics that occur before the age of 8 years in females and 9 years in males. In 80-90% of individuals it is idiopathic. Other causes include CNS anomalies and tumours, increased exposure to sex hormones/steroids, pituitary gonadotrophin secreting tumours and ovarian tumours etc.
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This question is part of the following fields:
- Embryology
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Question 15
Incorrect
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Which one of the following statements regarding Turner's syndrome is true?
Your Answer: Genetically is 46 XO
Correct Answer: Usually presents with primary amenorrhea
Explanation:Turner syndrome patients present with primary amenorrhea, have non functional or streak ovaries and cant conceive. They are 45X genetically.
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This question is part of the following fields:
- Embryology
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Question 16
Incorrect
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During her first month on OCPs, a patient had minimal bleeding at mid cycle. What is the most appropriate management?
Your Answer: Stop pills and seek a medical examination.
Correct Answer: Continue pills as usual.
Explanation:Breakthrough bleeding, or spotting, refers to when vaginal bleeding occurs between menstrual cycles. It may look like light bleeding or brown discharge.
Spotting is the most common side effect of birth control pills. It happens because the body is adjusting to changing levels of hormones, and the uterus is adjusting to having a thinner lining.
Taking the pill as prescribed, usually every day and at the same time each day, can help prevent bleeding between periods.
All other options are incorrect as this is a common side effect and will resolve on its own.
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This question is part of the following fields:
- Gynaecology
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Question 17
Incorrect
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Which of the following are required for Oxytocin to bind to its receptor?
Your Answer: Sodium and Potassium
Correct Answer: Magnesium and Cholesterol
Explanation:Oxytocin binds to G-protein-coupled receptors and requires Magnesium and cholesterol for this process to occur.
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This question is part of the following fields:
- Clinical Management
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Question 18
Correct
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The femoral triangle contains all of the following structures EXCEPT which one?
Your Answer: Genital branch of the genitofemoral nerve
Explanation:The contents of the femoral triangles are femoral nerve, artery and the vein. Along with the femoral sheath and lymphatics.
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This question is part of the following fields:
- Anatomy
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Question 19
Correct
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Completion of the 3rd stage of labour refers to:
Your Answer: Expulsion of the placenta and membranes
Explanation:The third stage of labours starts from the delivery of the foetus to the delivery of the placenta and the membranes.
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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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What is the RCOG advice regarding timing of Rhesus Anti-D Immunoglobulin following abortion?
Your Answer: Anti-D IgG must be given at time of abortion
Correct Answer: Anti-D IgG within 72 hours following abortion
Explanation:All non-sensitised RhD negative women should receive Anti-D IgG within 72 hours following abortion
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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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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: Vitamin D toxicity
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 22
Incorrect
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You are asked to assess a patients perineal tear following labour by vaginal delivery. You note a laceration that extends through the vaginal mucosa into the perineal muscle and fascia. The external anal sphincter appears to be in tact. How would you classify this tear?
Your Answer: 3rd type A
Correct Answer: 2nd
Explanation:If the external anal sphincter is in tact then this is a 1st or 2nd degree tear. As the perineal muscles are involved this is 2nd degree tear.
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This question is part of the following fields:
- Anatomy
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Question 23
Incorrect
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A 22-year-old pregnant woman attends clinic for a fetal scan at 31 weeks. She complains of difficulty breathing and a distended belly. U/S scan was done showing polyhydramnios and an absent gastric bubble. What is the most likely diagnosis?
Your Answer: Duodenal atresia
Correct Answer: Oesophageal atresia
Explanation:Oesophageal atresia of the foetus interrupts the normal circulation of the amniotic fluid. This causes polyhydramnios and subsequent distension of the uterus impacting proper expansion of the lungs. This would explain the difficulty breathing.
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This question is part of the following fields:
- Obstetrics
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Question 24
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: Inevitable Miscarriage
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 25
Incorrect
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The external carotid artery develops from which pharyngeal arch?
Your Answer: 2nd
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 patient who has been seen in fertility clinic phones regarding the timing of her progesterone blood test. She has regular 35 day menstrual cycles. When testing for ovulation what day of her cycle should she have the test on?
Your Answer: 21
Correct Answer: 28
Explanation:When testing for ovulation the best test is to check the progesterone level. The mid luteal progesterone levels should be checked 7 days prior to the next period. That will be the 28th day in a 35 day cycle.
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This question is part of the following fields:
- Data Interpretation
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Question 27
Incorrect
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A 36-year-old lady comes into your office complaining of post-coital bleeding. Each sexual activity results in 5-6 mL of blood. She had never had a cervical cancer screening. Ultrasound of the abdomen and pelvis is normal.
What is the best course of action?Your Answer: Transvaginal ultrasound
Correct Answer: Do a Cervical Screening test as well liquid base cytology
Explanation:Postcoital bleeding refers to spotting or bleeding unrelated to menstruation that occurs during or after sexual intercourse. It can be a sign of serious underlying pathology and is usually alarming for patients. About one-third of patients also have abnormal uterine bleeding that is not associated with coitus and about 15 percent have dyspareunia. The most serious cause of postcoital bleeding is cervical cancer. About 11 percent of women with cervical cancer present with postcoital bleeding. The patient should undergo cervical cancer screening according to local guidelines. Postcoital bleeding is not an indication for cervical cytology if previous screening tests are up-to-date and normal.
Cervical screening and liquid based cytology are superior to transvaginal ultrasound.
Coagulation profile can be done if cytology is normal to rule out bleeding diathesis.
Tranexamic acid can be considered once malignancy is ruled out and cause of bleeding has been established.
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This question is part of the following fields:
- Gynaecology
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Question 28
Incorrect
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A pregnant female who is a known diabetic presents to the clinic for a consultation and enquires about the harmful effects of vitamin deficiencies. A deficiency of which vitamin can lead to teratogenic effects in the child?
Your Answer: Riboflavin
Correct Answer: Folic acid
Explanation:Pregnant women need to get enough folic acid. The vitamin is important to the growth of the foetus’s spinal cord and brain. Folic acid deficiency can cause severe birth defects known as neural tube defects. The Recommended Dietary Allowance (RDA) for folate during pregnancy is 600 micrograms (µg)/day.
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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 group of beta haemolytic streptococci is associated with chorioamnionitis?
Your Answer: F
Correct Answer: B
Explanation:Chorioamnionitis is a complication of pregnancy caused by bacterial infection of the fetal amnion and chorion membranes. Group B Streptococcus is associated with chorioamnionitis
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This question is part of the following fields:
- Microbiology
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Question 30
Incorrect
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The major cause of the increased risk of morbidity & mortality among twin gestation is:
Your Answer:
Correct Answer: Preterm delivery
Explanation:Twin pregnancy is associated with a number of obstetric complications, some of them with serious perinatal consequences, especially for the second twin. The rate of perinatal mortality can be up to six times higher in twin compared to singleton pregnancies, largely due to higher rates of preterm delivery and fetal growth restriction seen in twin pregnancies. Preterm birth and birth weight are also significant determinants of morbidity and mortality into infancy and childhood. More than 50% of twins and almost all triplets are born before 37 weeks of gestation and about 15–20% of admissions to neonatal units are associated with preterm twins and triplets.
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This question is part of the following fields:
- Obstetrics
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SESSION STATS - PERFORMANCE PER SPECIALTY
