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  • Question 1 - The test used to diagnose ovulation on day 21 in a 28 days...

    Incorrect

    • The test used to diagnose ovulation on day 21 in a 28 days menstrual cycle is:

      Your Answer: FSH

      Correct Answer: Progesterone

      Explanation:

      After ovulation, the dominant follicle turns into a corpus luteum and begins to secrete progesterone. To confirm ovulation, serum progesterone or its metabolite in urine, can be measured. A single serum progesterone level >3 ng/ml in mid‐luteal phase has been used to retrospectively detect ovulation.

    • This question is part of the following fields:

      • Physiology
      19.2
      Seconds
  • Question 2 - Which ONE among the following factors does not increase the risk for developing...

    Incorrect

    • Which ONE among the following factors does not increase the risk for developing postpartum endometritis?

      Your Answer: Cesarean delivery after the onset of labour

      Correct Answer: Advanced maternal age

      Explanation:

      The most common clinical findings in a postpartum women with endometritis are postpartum fever, with tachycardia relative to the rise in temperature, midline lower abdominal pain and uterine tenderness from the 2nd to 10th day of postpartum.

      Most common risk factors for the development of postpartum endometritis are:
      – Cesarean deliveries are considered as the most important risk factor for postpartum endometritis, especially those performed after the onset of labour.
      – Young maternal age.
      – Multiple digital cervical examinations.
      – Prolonged rupture of membranes.
      – Retention of placental products.
      – Prolonged labour.
      – Chorioamnionitis.
      Advanced maternal age is not considered as a risk factor for development of postpartum endometritis.

    • This question is part of the following fields:

      • Obstetrics
      53
      Seconds
  • Question 3 - Which is not a risk factor for endometrial cancer? ...

    Incorrect

    • Which is not a risk factor for endometrial cancer?

      Your Answer: Tamoxifen

      Correct Answer: Norethisterone

      Explanation:

      Multiple epidemiological risk factors have been identified in patients who have adenocarcinoma of the endometrium.
      – Endogenous factors
      – Obesity
      – Nulliparity
      – An individual who has had a late menopause (aged >52 y)
      – Unopposed oestrogen
      – Tamoxifen
      – Family history
      – Individuals with a family history of endometrial cancer appear to be at increased risk.

    • This question is part of the following fields:

      • Gynaecology
      25
      Seconds
  • Question 4 - Following parturition how long does involution of the uterus take? ...

    Correct

    • Following parturition how long does involution of the uterus take?

      Your Answer: 4-6 weeks

      Explanation:

      Involution of the uterus takes 4-6 weeks

    • This question is part of the following fields:

      • Clinical Management
      14.8
      Seconds
  • Question 5 - A 46-year-old woman presents to your clinic with a complaint of irregular heavy...

    Correct

    • A 46-year-old woman presents to your clinic with a complaint of irregular heavy menstruation. She had normal menstrual pattern 6 months back. Physical examination revealed no abnormality with a negative cervical smear. Laboratory investigation reveals a haemoglobin of 105g/L (Normal 115-165g/L). The most common cause of such menorrhagia is?

      Your Answer: Anovulatory cycles.

      Explanation:

      Menorrhagia in a 45-year-old woman is most likely caused by an ovulation issue, most likely anovulatory cycles, particularly if the periods have grown irregular.

      Endometrial carcinoma is a rare cause of menorrhagia that usually occurs after menopause.

      Menorrhagia can be caused by fibroids, endometrial polyps, and adenomyosis, although the cycles are normally regular, and a dramatic change from normal cycles six months prior would be exceptional.
      If fibroids or adenomyosis are the source of the menorrhagia, the uterus is usually enlarged.

    • This question is part of the following fields:

      • Gynaecology
      74.6
      Seconds
  • Question 6 - A 47 year old women has a transvaginal ultrasound that shows a partially...

    Incorrect

    • A 47 year old women has a transvaginal ultrasound that shows a partially echogenic mass with posterior sound attenuation owing to sebaceous material and hair within the cyst cavity. What is the likely diagnosis?

      Your Answer: Germ Cell Tumour

      Correct Answer: Mature teratoma

      Explanation:

      These are the most common ovarian tumours in young women. The most common form is the mature dermoid cyst (cystic teratoma). It can consist of a combination of all the type of tissues (mesenchymal, stromal and epithelial). Any mature tissue type can be present such as muscle, cartilage, bone, teeth and often hair. Treatment is cystectomy.

    • This question is part of the following fields:

      • Data Interpretation
      64.2
      Seconds
  • Question 7 - Which vitamin deficiency leads to Wernicke's encephalopathy? ...

    Incorrect

    • Which vitamin deficiency leads to Wernicke's encephalopathy?

      Your Answer: C

      Correct Answer: B1

      Explanation:

      Vitamin B1 deficiency can lead to Wernicke’s encephalopathy. Alcoholics are at particular risk. In obstetrics all women with hyperemesis gravidarum should receive thiamine supplementation to prevent Wernicke’s.

    • This question is part of the following fields:

      • Clinical Management
      25.9
      Seconds
  • Question 8 - Which of the following Oestrogens (Oestrogens) becomes the predominant circulating oestrogen during pregnancy?...

    Incorrect

    • Which of the following Oestrogens (Oestrogens) becomes the predominant circulating oestrogen during pregnancy?

      Your Answer: Oestradiol

      Correct Answer: Estriol

      Explanation:

      Oestradiol is the predominant form of oestrogen during the reproductive life of a female. The estrogenic potency of oestradiol is 12 times more than estrone and 80 times that of estriol.

    • This question is part of the following fields:

      • Endocrinology
      19.8
      Seconds
  • Question 9 - All of the following are autosomal recessive conditions EXCEPT which one? ...

    Incorrect

    • All of the following are autosomal recessive conditions EXCEPT which one?

      Your Answer: Wilsons disease

      Correct Answer: Osteogenesis Imperfecta

      Explanation:

      Osteogenesis imperfect is an autosomal dominant condition. All the rest of the options are autosomal recessive conditions.

    • This question is part of the following fields:

      • Endocrinology
      70.3
      Seconds
  • Question 10 - During the filling phase of micturition. At what bladder volume is the first...

    Incorrect

    • During the filling phase of micturition. At what bladder volume is the first urge to void felt?

      Your Answer: 300ml

      Correct Answer: 150ml

      Explanation:

      The normal functional bladder capacity is around 400-600ml. First urge to void is typically felt when the bladder is approximately 150ml full.

    • This question is part of the following fields:

      • Anatomy
      28.4
      Seconds
  • Question 11 - A 32-year-old gravida 3 para 2 presents for routine prenatal care. The patient...

    Incorrect

    • A 32-year-old gravida 3 para 2 presents for routine prenatal care. The patient is at 14 weeks estimated gestational age by last menstrual period, and ultrasonography at 8 weeks gestation was consistent with these dates. Fetal heart tones are not heard by handheld Doppler. Transvaginal ultrasonography reveals an intrauterine foetus without evidence of fetal cardiac activity. The patient has not had any bleeding or cramping, and otherwise feels fine. A pelvic examination reveals a closed cervix without any signs of bleeding or products of conception.

      Which one of the following is the most likely cause of this presentation?

      Your Answer: Placentae previa

      Correct Answer: A missed abortion

      Explanation:

      In this case, the patient has a missed abortion, which is defined as a dead foetus or embryo without passage of tissue and with a closed cervix. This condition often presents with failure to detect fetal heart tones or a lack of growth in uterine size.

      – By 14 weeks estimated gestational age, fetal heart tones should be detected by both handheld Doppler and ultrasonography.
      – An inevitable abortion presents with a dilated cervix, but no passage of fetal tissue.
      – A blighted ovum involves failure of the embryo to develop, despite the presence of a gestational sac and placental tissue.

    • This question is part of the following fields:

      • Obstetrics
      11
      Seconds
  • Question 12 - A 35-year-old woman from the countryside of Victoria comes to the hospital at...

    Incorrect

    • A 35-year-old woman from the countryside of Victoria comes to the hospital at 37 weeks of gestation after noticing a sudden gush of clear fluid from her vagina.

      Speculum examination shows pooling of liquor in the posterior fornix and patient developed fever, tachycardia and chills 12 hours after this episode.

      Apart from giving antibiotics, what will be your strategy in management of this case?

      Your Answer: Give corticosteroids

      Correct Answer: Induce labour now

      Explanation:

      Above mentioned patient presented with symptoms of premature rupture of membranes (PROM) which refers to membrane rupture before the onset of uterine contractions.

      A sudden gush of clear or pale yellow fluid from the vagina is the classic clinical presentation of premature rupture of membranes. Along with this the patient also developed signs of infection like fever, tachycardia and sweating which is suggestive of chorioamnionitis.

      Vaginal examination is never performed in patients with premature rupture of membrane, instead a speculum examination is the usually preferred method which will show fluid in the posterior fornix.

      The following are the steps in management of premature rupture of membrane:
      – Admitting the patient to hospital.
      – Take a vaginal
      ervical smears.
      – Measure and monitor both white cell count and C- reactive protein levels.
      – Continue pregnancy if there is no evidence of infection or fetal distress.
      – In presence of any signs of infection or if CTG showing fetal distress it is advisable to induce labour.
      – Corticosteroids must be administered if delivery is prior to 34 weeks of gestation.
      – Give antibiotics as prevention and for treatment of infection.

    • This question is part of the following fields:

      • Obstetrics
      17.9
      Seconds
  • Question 13 - What is the half life of Oxytocin? ...

    Incorrect

    • What is the half life of Oxytocin?

      Your Answer: 15 minutes

      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
      73
      Seconds
  • Question 14 - In patients with endometriosis what is the infertility rate? ...

    Incorrect

    • In patients with endometriosis what is the infertility rate?

      Your Answer: 10%

      Correct Answer: 40%

      Explanation:

      Around 30-40% of women affected by this condition complain of difficulty in conceiving.

    • This question is part of the following fields:

      • Clinical Management
      55.4
      Seconds
  • Question 15 - A 23-year-old G1P0 female presents to your department with a complaint of not...

    Incorrect

    • A 23-year-old G1P0 female presents to your department with a complaint of not having menstrual periods over the last 6 months. She had her first menstrual periods at the age of 13 and they have been consistent since then with a cycle of 28 days. She reports that she had an unplanned pregnancy 8 months ago and did an elective abortion at the 8th week of gestation. Since that time she has not had menstrual periods. She is sexually active with her boyfriend and they use condoms consistently. The pregnancy test is negative.
      Which of the following diagnostic tests is most likely to confirm the diagnosis?

      Your Answer: Pelvic ultrasound

      Correct Answer: Hysteroscopy

      Explanation:

      This patient presents with secondary amenorrhea, most likely caused by Asherman’s syndrome- Secondary amenorrhea is defined as absence of menstruation for – 3 months in a patient who had regular menstruation previously or absence of menstruation for 9 months in a patient who had oligomenorrhea- Asherman’s syndrome as the cause of her amenorrhea is suggested by its beginning shortly after undergoing elective abortion. It is an outflow tract obstruction caused by intrauterine synechiae resulting from the procedure.

      The best diagnostic test to confirm this diagnosis is hysteroscopy. It can allow visualization of the uterine cavity, the nature and extent of intrauterine synechiae.

      → Progesterone withdrawal test is one of the diagnostic studies done in the early work-up of secondary amenorrhoea- It is usually followed by the estrogen-progesterone challenge test and other tests. Progesterone withdrawal test alone would not confirm Asherman’s syndrome.
      → Pelvic ultrasound is more useful in primary amenorrhea work-up when the presence or absence of the uterus is to be confirmed- It is not very useful in the evaluation of intrauterine adhesions.
      → Brain MRI is useful in confirming the presence of pituitary tumours in patients, who are found to have high levels of prolactin. This patient’s most likely cause of secondary amenorrhea is Asherman’s syndrome.
      → TSH and prolactin levels should be the next step in the work-up of secondary amenorrhea after pregnancy has been ruled out; however, these studies cannot confirm Asherman’s syndrome.

    • This question is part of the following fields:

      • Obstetrics
      37
      Seconds
  • Question 16 - A 29-year-old pregnant woman in her first trimester of pregnancy presented to the...

    Correct

    • A 29-year-old pregnant woman in her first trimester of pregnancy presented to the medical clinic for routine antenatal care. Upon interview and history taking, it revealed that she is positive for Hepatitis C virus antibody (HCVAb). She is now concerned about transmitting the virus to her baby.

      Which of the following is considered correct about the patient's condition?

      Your Answer: Fetal scalp blood sampling should be avoided

      Explanation:

      Invasive procedures as fetal scalp blood sampling or internal electrode and episiotomy increase vertical transmission of HCV, especially in patients with positive HCV RNA virus load at delivery that is why it should be avoided.

    • This question is part of the following fields:

      • Obstetrics
      17.5
      Seconds
  • Question 17 - A 29-year-old lady taking oral contraceptives came to your clinic with her boyfriend....

    Correct

    • 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.

    • This question is part of the following fields:

      • Gynaecology
      37
      Seconds
  • Question 18 - What is the anterior boundary of the pelvic outlet? ...

    Correct

    • What is the anterior boundary of the pelvic outlet?

      Your Answer: pubic arch

      Explanation:

      Pelvic Outlet Boundaries Anteriorly: Pubic arch Laterally: Ischial tuberosities Posterolaterally: Inferior margin of the sacrotuberous ligament Posteriorly: Tip of the coccyx Note: The pelvis outlet is also called the inferior aperture. The pelvic brim is the superior aperture

    • This question is part of the following fields:

      • Anatomy
      14
      Seconds
  • Question 19 - During pregnancy which hormone(s) inhibit lactogenesis? ...

    Incorrect

    • During pregnancy which hormone(s) inhibit lactogenesis?

      Your Answer: Prolactin and hPL (human Placental Lactogen)

      Correct Answer: Oestrogen and Progesterone

      Explanation:

      Prolactin levels rise steadily during pregnancy during which time it promotes mammary growth (along with the other hormones mentioned below). Oestrogen and progesterone inhibit lactogenesis and it is only with the loss of these placental steroid hormones at term that Prolactin exhibits its lactogenic effect.

    • This question is part of the following fields:

      • Clinical Management
      16.1
      Seconds
  • Question 20 - All of the following organs are involved in oestrogen production except: ...

    Incorrect

    • All of the following organs are involved in oestrogen production except:

      Your Answer: Placenta

      Correct Answer: Anterior pituitary

      Explanation:

      Oestrogen can be produced by variety of organs including the corpus leuteum, placenta, adrenal glands and testes. However it is not produced by the anterior pituitary. The anterior pituitary produces LH and FSH which in turn causes oestrogen secretion.

    • This question is part of the following fields:

      • Endocrinology
      4815
      Seconds
  • Question 21 - What is the definition of premature menopause? ...

    Incorrect

    • What is the definition of premature menopause?

      Your Answer: Menopause at or before 50 years of age

      Correct Answer: Menopause at or before 40 years of age

      Explanation:

      Menopause is defined as the cessation of menstruation for a period of 12 months. Premature menopause is defined as cessation of menstruation before the age of 40.

    • This question is part of the following fields:

      • Endocrinology
      22.6
      Seconds
  • Question 22 - A 30-year-old pregnant woman presents to the emergency department.

    She is at 38 weeks...

    Incorrect

    • A 30-year-old pregnant woman presents to the emergency department.

      She is at 38 weeks gestation and has gone into labour.

      On examination, her cervix is 7cm dilated.

      Which of the following would be indicative of obstructed labour and the need for delivery by Caesarean section?

      Your Answer: Early fetal heart decelerations from 160 to 120/min on the cardiotocograph (CTG).

      Correct Answer: A brow presentation in a nulliparous woman.

      Explanation:

      A brow presentation in a nulliparous woman is associated with high risk of obstructed labour and the need for delivery by Caesarean section.

      Brow presentation occurs when the presenting part of the fetal head is the part between the orbital ridge and anterior fontanelle.

      In multiparous women, the indications differ as vaginal manipulation or spontaneous flexion to a vertex presentation or extension to a face presentation can occur after full cervical dilatation.

      Early fetal heart decelerations are indicative of a mild abnormality on cardiotocograph (CTG). It does not indicate obstructive labour or need for delivery by Caesarean section.

      The slow descent of the fetal head can be controlled subsequently by good uterine contractions and allow for vaginal birth.

      Prolonged labour can cause maternal fever, but that in isolation is not an indication for Caesarean section.

      Caput and head moulding are associated with a ‘tight fit’ of the fetal head in the pelvis, but does not contraindicate vaginal birth.

    • This question is part of the following fields:

      • Obstetrics
      218.5
      Seconds
  • Question 23 - You are asked to assess a patients perineal tear following labour by vaginal...

    Correct

    • You are asked to assess a patients perineal tear following labour by vaginal delivery. You note a laceration that extends approximately a quarter of the thickness through the external anal sphincter. How would you classify this tear?

      Your Answer: 3a

      Explanation:

      1. First-degree trauma corresponds to lacerations of the skin/vaginal epithelium alone.
      2. Second-degree tears involve perineal muscles and therefore include episiotomies.
      3. Third-degree extensions involve any part of the anal sphincter complex (external and internal sphincters):
      i Less than 50 per cent of the external anal
      sphincter is torn.
      ii More than 50 per cent of the external anal
      sphincter is torn.
      iii Tear involves the internal anal sphincter
      (usually there is complete disruption of the
      external sphincter).
      4. Fourth-degree tears involve injury to the anal sphincter complex extending into the rectal mucosa.

    • This question is part of the following fields:

      • Anatomy
      20.2
      Seconds
  • Question 24 - A 26-year -old woman, who underwent an episiotomy during labour, presented with severe...

    Incorrect

    • A 26-year -old woman, who underwent an episiotomy during labour, presented with severe vaginal pain 4 days after the procedure.

      At the site of the episiotomy, an 8-cm hematoma is noted on examination. Also the woman is found to be hemodynamically stable.

      Among the following, which is considered the most appropriate next step in management?

      Your Answer: Aspirate the mass

      Correct Answer: Explore the hematoma

      Explanation:

      In most cases reported, puerperal hematomas arise due to bleeding lacerations related to operative deliveries or episiotomy, and in rare cases from spontaneous injury to a blood vessel in the absence of any laceration/incision of the surrounding tissue. Vulval, vaginal/paravaginal area and retroperitoneum are considered the most common locations for puerperal hematomas.

      Most puerperal hematomas are diagnosed based on the presence of characteristic symptoms and physical examination findings:
      VuIvar hematoma usually presents as a rapidly developing, severely painful, tense and compressible mass which is covered by skin of purplish discoloration. A vulvar hematoma can also be an extension of a vaginal hematoma which was dissected through a loose subcutaneous tissue into the vulva.
      Vaginal hematomas often present with rectal pressure, were hemodynamic instability caused due to bleeding into the ischiorectal fossa and paravaginal space are the first signs and can result in hypovolemic shock. In these cases a large mass protruding into the vagina is often found on physical examination.
      Retroperitoneal hematomas are asymptomatic initially and extend between the folds of broad ligament. Patients suffering will often present with tachycardia, hypotension or shock due to the significant accumulated of blood in the retroperitoneal space. Unless the hematoma is associated with trauma, patients will not present with pain, only signs will be a palpable abdominal mass or fever.

      Treatment of hematoma depends mostly on the size and location:
      Non-expanding hematomas which are <3cm in size can be managed conservatively with analgesics and application of ice packs. An expanding hematoma or those greater than 3cm is managed effectively with surgical exploration under anesthesia, were an incision is made to evacuate the hematoma. The surgical site should not be sutured and vagina is often packed for 12-24 hours, an indwelling urinary catheter also may be indicated. In the given case, patient presents with a large haematoma (>3cm) which needs surgical excision and evacuation.

      Aspiration of the hematoma is not an appropriate treatment. If surgical intervention is indicated excision and evacuation is the preferred option, followed by vaginal packing for 12-24 hours.

    • This question is part of the following fields:

      • Obstetrics
      27.4
      Seconds
  • Question 25 - Which of the following are required for Oxytocin to bind to its receptor?...

    Incorrect

    • Which of the following are required for Oxytocin to bind to its receptor?

      Your Answer: Calcium and Cholesterol

      Correct Answer: Magnesium and Cholesterol

      Explanation:

      Oxytocin binds to G-protein-coupled receptors and requires Magnesium and cholesterol for this process to occur.

    • This question is part of the following fields:

      • Clinical Management
      19.8
      Seconds
  • Question 26 - Regarding lymph drainage of the ovary where does the majority of lymph drain...

    Correct

    • Regarding lymph drainage of the ovary where does the majority of lymph drain to?

      Your Answer: para-aortic nodes

      Explanation:

      Majority of the lymph from the ovaries drain into the para-aortic lymph nodes.

    • This question is part of the following fields:

      • Anatomy
      31.1
      Seconds
  • Question 27 - The uterine vein drains where? ...

    Incorrect

    • The uterine vein drains where?

      Your Answer: Splenic vein

      Correct Answer: Internal iliac vein

      Explanation:

      The venous drainage of the uterus is via the uterine veins which form a plexus passing below the artery within the base of the broad ligament communicating with the rectal and the vesical venous plexus before draining into the internal iliac veins.

    • This question is part of the following fields:

      • Anatomy
      58
      Seconds
  • Question 28 - A 35 year old primigravida was in labour for 24 hours and delivered...

    Incorrect

    • A 35 year old primigravida was in labour for 24 hours and delivered after an induction. She developed postpartum haemorrhage. Which of the following is the most likely cause for PPH?

      Your Answer: Age of mother

      Correct Answer: Atonic uterus

      Explanation:

      Uterine atony and failure of contraction and retraction of myometrial muscle fibres can lead to rapid and severe haemorrhage and hypovolemic shock. Poor myometrial contraction can result from fatigue due to prolonged labour or rapid forceful labour, especially if stimulated.

    • This question is part of the following fields:

      • Obstetrics
      200.6
      Seconds
  • Question 29 - Which of the following best describes the mechanism of action of radiotherapy? ...

    Correct

    • Which of the following best describes the mechanism of action of radiotherapy?

      Your Answer: DNA damage via free radical generation

      Explanation:

      Radiotherapy causes ionisation, primarily of water. This leads to hydroxyl and other free radicals being generated. Free radicals are highly reactive and cause DNA damage to cells via their reactions with them. Free radicals are relatively short lived and eventually form stable compounds. The DNA damage leads to cellular death.

    • This question is part of the following fields:

      • Biophysics
      141.2
      Seconds
  • Question 30 - Which of the following is/are needed by women in increased amounts during pregnancy?...

    Incorrect

    • Which of the following is/are needed by women in increased amounts during pregnancy?

      Your Answer: Calcium

      Correct Answer: All of the options given

      Explanation:

      The nutritional status of a woman before and during pregnancy is important for a healthy pregnancy outcome. Pregnancy is a state of increased requirement of macro and micronutrients, and malnourishment or inadequate dietary intake before and during pregnancy, can lead to adverse perinatal outcomes. Many nutritional interventions have been proposed for pregnant mothers. These include multiple micronutrients (MMN), iron/folate, balanced protein energy, calcium, zinc and folic acid supplementation.

    • This question is part of the following fields:

      • Physiology
      84.4
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Physiology (0/1) 0%
Obstetrics (1/5) 20%
Gynaecology (1/3) 33%
Clinical Management (3/4) 75%
Data Interpretation (0/1) 0%
Endocrinology (1/3) 33%
Anatomy (1/2) 50%
Passmed