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Question 1
Correct
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Question 2
Incorrect
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What is the most common Type II congenital thrombophilia?
Your Answer: Antiphospholipid syndrome
Correct Answer: Factor V Leiden mutation
Explanation:The most common congenital thrombophilia is Factor V Leiden mutation. Other congenital causes are JAK-2 mutations and the Prothrombin G20210A mutation. Protein C and S deficiencies are type 1 and antiphospholipid syndrome is not congenital it is an acquired thrombophilia.
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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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You are attending the labour of a patient who has had a prolonged 1st stage of labour. You note the fetal head start to retract after being tightly applied to the vulva (turtle-neck sign). What is the next most appropriate management step?
Your Answer: McRoberts' manoeuvre
Explanation:Signs of shoulder dystocia:
– Difficulty with delivery of the face and chin
– The head remaining tightly applied to the vulva or even retracting (turtle-neck sign)
– Failure of restitution of the fetal head
– Failure of the shoulders to descend
Upon identifying shoulder dystocia additional help should be called and McRoberts manoeuvre (flexion and abduction of the maternal hips, positioning the maternal thighs on her abdomen) should be performed first. Fundal pressure is associated with uterine rupture and should not be used. -
This question is part of the following fields:
- Clinical Management
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Question 4
Correct
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Which species of candida is the most common cause of genital candida infection in pregnancy?
Your Answer: Candida albicans
Explanation:Vulvovaginal candidiasis is the most common genital infection and it is caused by candida albicans in 80-92% of the cases. Other non albicans species include C.tropicalis, C.glabrata, C.krusei and C.parapsilosis. 20% of women of childbearing age are asymptotic colonisers of Candida species as part of their normal vaginal flora. This increases to 40% in pregnancy.
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This question is part of the following fields:
- Clinical Management
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Question 5
Correct
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How long does involution of the uterus take after parturition?
Your Answer: 4-6 weeks
Explanation:In the period immediately after the delivery of the placenta, known as the puerperium, the female reproductive system begins to undergo some physiological changes to return to a non-pregnant state. One of these changes is uterine involution. The myometrium contracts, constricting blood vessels which impedes blood flow. It is thought that the uterine tissues then undergo apoptosis and autophagy. It takes about 4-6 weeks for the uterus to decrease is size from about 1 kg to 60 grams.
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This question is part of the following fields:
- Clinical Management
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Question 6
Incorrect
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You see a 28 year old woman who is 22 weeks pregnant. She complains of vaginal soreness and yellow frothy discharge. Microscopy confirms Trichomoniasis. What percentage of infected pregnant women present with yellow frothy discharge?
Your Answer: 70%
Correct Answer: 20%
Explanation:Trichomoniasis is considered a sexually transmitted infection found both in men and women, and is caused by the flagellate protozoan Trichomonas vaginalis. The organism is mainly found in the vagina and the urethra. Though many infected women can be asymptomatic, they can also present with yellow frothy vaginal discharge, itching and vaginitis, dysuria or an offensive odour. About 20-30% of women with the infection however are asymptomatic. For the diagnosis of t. vaginalis in women, a swab is taken from the posterior fornix during speculum examination and the flagellates are detected under light-field microscopy. The recommended treatment for t. vaginalis during pregnancy and breastfeeding is 400-500mg of metronidazole twice daily for 5 -7 days. High dose metronidazole as a 2g single dose tablet is not advised during pregnancy. All sexual partners should also be treated and screened for other STIs.
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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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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: Palmers point entry in a very thin patient (BMI 17.5)
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 8
Incorrect
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A patient is diagnosed with cervical cancer and staging investigations show there is parametrial involvement but it is confined within the pelvic wall and does not involve the lower 1/3 vagina. There is no evidence of hydronephrosis. What FIGO stage is this?
Your Answer: 3A
Correct Answer: 2B
Explanation:This is stage 2B.
2010 FIGO classification of cervical carcinoma
0 – Carcinoma in situ
1 – Confined to the cervix (diagnosed microscopy)
1A1 – Less than 3mm depth & 7mm lateral spread
1A2 – 3mm to 5mm depth & less than 7mm lateral spread
1B1 – Clinically visible lesion or greater than A2 & less than 4 cm in greatest dimension
1B2 – Clinically visible lesion, Greater than 4 cm in greatest dimension 2 Invades beyond uterus but not to pelvic wall or lower 1/3 vagina
2A1 – Involvement of the upper two-thirds of the vagina, without parametrical invasion & Less than 4cm
2A2 – Greater than 4 cm in greatest dimension
2B – Parametrial involvement
3 – Extends to Pelvic side wall or lower 1/3 vagina or hydronephrosis
3A – No pelvic side wall involvement
3B – Pelvic side wall involved or hydronephrosis
4 – Extends beyond true pelvis
4A – Invades mucosa bladder and rectum
4B – Distant Metastasis -
This question is part of the following fields:
- Clinical Management
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Question 9
Incorrect
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A 28 year old patient has a diagnosis of PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2 and she is a non-smoker. She has been taking Clomiphene and metformin for the past 6 months. What is the next most appropriate treatment?
Your Answer: Continue current treatment for further 6 months
Correct Answer: Gonadotrophins
Explanation:Management of PCOS includes OCP, cyclical oral progesterone, metformin, clomiphene (which is more effective in inducing ovulation than metformin) and life-style changes. In women who are tolerant to these therapies Gonadotrophins should be trialled. However lifestyle changes should be able to improve the condition significantly. Clomiphene shouldn’t be continued for more than 6 months.
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This question is part of the following fields:
- Clinical Management
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Question 10
Correct
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Question 11
Incorrect
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Regarding gestational diabetes which of the following is NOT a recognised risk factor
Your Answer: Previous unexplained stillbirth
Correct Answer: High polyunsaturated fat intake
Explanation:There are several risk factors for gestational diabetes:
Increasing age
– Certain ethnic groups (Asian, African Americans, Hispanic/Latino Americans and Pima Indians)
– High BMI before pregnancy (three-fold risk for obese women compared to non-obese women)
– Smoking doubles the risk of GDM
– Change in weight between pregnancies – an inter-pregnancy gain of more than three units (of BMI) doubles the risk of GDM
– Short interval between pregnancies
– Previous unexplained stillbirth
– Previous macrosomia
– Family history of type 2 diabetes or GDM – more relevant in nulliparous than parous womenHigh polyunsaturated fat intake has been shown in some studies to be protective against gestational diabetes. Physical activity is also thought to be effective.
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This question is part of the following fields:
- Clinical Management
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Question 12
Incorrect
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Which of the following contraceptives primary mode of action is inhibition of ovulation?
Your Answer: Noriday®
Correct Answer: Cerazette®
Explanation:Traditional POP main mode of contraceptive action: thickening of cervical mucus Desogestrel-only POP main mode of contraceptive action is inhibition of ovulation Cerazette® is the only Desogestrel-only POP in the options above. Other desogestrel brands include: Aizea® Cerelle® Nacrez® The other POPs listed are considered traditional POPs and have the following compositions: Norgeston® – Levonorgestrel 30 mcg Micronor® & Noriday® – Norethisterone 350 mcg Femulen® – Ethynediol diacetate 500 mcg
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This question is part of the following fields:
- Clinical Management
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Question 13
Incorrect
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A 25 year old prim gravida carrying a twin male pregnancy presents at 31 weeks gestation. She is lethargic, clinically jaundiced and complains of abdominal pain with frequent vomiting. You suspect acute fatty liver of pregnancy (AFLP). What is the maternal mortality rate with AFLP?
Your Answer: 70%
Correct Answer: 20%
Explanation:Acute fatty liver of pregnancy occurs in 1-10000 pregnancies and presents as jaundice with abdominal pain. The maternal mortality is around 20%
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This question is part of the following fields:
- Clinical Management
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Question 14
Correct
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You are called to see a 24 year old patient in A&E. She is 34 weeks gestation and her blood pressure is 149/98. Automated reagent strip testing shows protein 1+. What is the appropriate course of action regarding the urine result?
Your Answer: Send urine for protein:creatinine ratio
Explanation:For a diagnosis of Preeclampsia to be established, hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hour collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the sixth postpartum week should be present.
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This question is part of the following fields:
- Clinical Management
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Question 15
Incorrect
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A 34 year old patient who has just undergone a C-section delivery has lost almost 1 litre of blood. You suspect uterine atony as the likely cause, and have bimanually compressed the uterus. Which of the following pharmacological interventions should follow?
Your Answer: Ergometrine 0.5mg by intramuscular injection
Correct Answer: Syntocin 5u by slow intravenous injection
Explanation:In the management of postpartum haemorrhage, it is essential that the bleeding is first mechanically prevented, followed by the administration of oxytocic drugs, which cause the uterine smooth muscle to contract and clamping off bleeding sites in the endometrium. The drug of choice in the treatment protocol of PPH is 5 units of syntocin, a synthetic oxytocin uterotonic, by slow intravenous infusion. This is particularly suitable in the case of uterine atony. Other uterotonics, misoprostol, carboprost, ergometrine, can be used, but are not as effective in an emergency setting.
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This question is part of the following fields:
- Clinical Management
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Question 16
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 17
Incorrect
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A patient has had limited response to conservative measures for her overactive bladder (OAB). Which of the following is the most appropriate pharmacological choice?
Your Answer: Duloxetine
Correct Answer: Darifenacin
Explanation:Detrusor overactivity can be treated with anti-cholinergic agents such as oxybutynin or tolterodine, solifenacin, fesoterodine and darifenacin. They are used as first line agents. Imipramine is used for enuresis and desmopressin is used for nocturia.
NICE pathwayPrior to initiating anticholinergics:
Bladder training
Consider treating vaginal atrophy and nocturia with topical oestrogen and desmopressin respectively before commencing treatments below.
Consider catheterisation if chronic retention
1st line treatments:
1. Oxybutynin (immediate release) – Do not offer to frail elderly patients
2. Tolterodine (immediate release)
3. Darifenacin (once daily preparation)
DO NOT offer any of the 3 drugs below:
1. Flavoxate
2. Propantheline
3. Imipramine
2nd line treatment
Consider transdermal anticholinergic (antimuscarinic)
Mirabegron
Adjuvant Treatments
Desmopressin can be considered for those with nocturia
Duloxetine may be considered for those who don’t want/unsuitable for surgical treatment
Intravaginal oestrogen can be offered to postmenopausal women with OAB -
This question is part of the following fields:
- Clinical Management
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Question 18
Incorrect
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Question 19
Incorrect
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A patients MSU comes back showing heavy growth of E.coli that is resistant to trimethoprim, amoxicillin and nitrofurantoin. You decide to prescribe a course of Cephalexin. What is the mechanism of action of Cephalexin?
Your Answer:
Correct Answer: inhibit peptidoglycan cross-links in bacterial cell wall
Explanation:Cephalosporins are beta lactum drugs, like penicillin. They act by inhibiting the cross linkage of the peptidoglycan wall in bacteria.
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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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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 of the following ultrasound findings form part of the Rotterdam criteria for diagnosis of PCOS (Polycystic Ovary Syndrome) ?
Your Answer:
Correct Answer: Increased ovarian volume >10cm3
Explanation:The Rotterdam criteria for the diagnosis of PCOS is based on a score of two out of the three criteria:
1) Oligo or anovulation
2) Hyperandrogenism – clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone)
3) on ultrasound – contain 12 or more follicles measuring 2 to 9 mm in diameter and/or have an increased volume of 10 cm3 or greater. -
This question is part of the following fields:
- Clinical Management
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Question 22
Incorrect
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A 36 year old women attends clinic following laparotomy and unilateral oophorectomy. The histology shows Psammoma bodies. What type of tumour would this be consistent with?
Your Answer:
Correct Answer: Serous
Explanation:Serous tumours of the ovaries are large, cystic and spherical to ovoid in shape. They can be benign or malignant. Malignant tumours are usually nodular with irregularities in the surface where the tumour penetrates into the serosa. Psammoma bodies are a histological identification for these tumours which appear in the tips of the papillae.
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This question is part of the following fields:
- Clinical Management
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Question 23
Incorrect
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Endometrial tissue found within the myometrium is classed as
Your Answer:
Correct Answer: Adenomyosis
Explanation:Endometrial tissue found within the myometrium is Adenomyosis. If endometrial tissue is found at a distant site to the uterus it is termed endometriosis. Fibroids are smooth muscle tumours (Leiomyoma’s) sometimes called myoma’s.
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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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What is the average volume of blood loss during the menstrual cycle?
Your Answer:
Correct Answer: 35-40ml
Explanation:Normal menstrual blood loss is about 40-45 ml. More than 80 ml per period is defined as heavy menstrual bleeding.
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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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Lactogenesis at term is stimulated by which hormone?
Your Answer:
Correct Answer: Prolactin
Explanation:Prolactin is the hormone that is responsible for the production of milk (Lactogenesis). Oxytocin is responsible for the let down reflex during suckling.
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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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Regarding the diagnosis of Gestational Diabetes which of the following tests is recommended by the WHO for diagnosis?
Your Answer:
Correct Answer: 75g OGTT with 2 hour glucose
Explanation:Gestational diabetes (GDM) occurs in 2–9 per cent of all pregnancies. Screening for diabetes in pregnancy can be justify ed to diagnose previously unrecognized cases of pre-existing diabetes and to identify a group of women who are at risk of developing NIDDM later in life. No single screening test has been shown to be perfect in terms of high sensitivity and specific city for gestational diabetes. Urinary glucose is unreliable, and most screening tests now rely on blood glucose estimation, with an oral 75g glucose tolerance test commonly used. The aim of glucose control is to keep fasting levels between 3.5 and 5.5 mmol/L and postprandial levels 7.1 mmol/L, with insulin treatment usually indicated outside these ranges.
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This question is part of the following fields:
- Clinical Management
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Question 27
Incorrect
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A patient is being discharged following a termination of pregnancy at 14 weeks. She had been taking Microgynon in the past but stopped taking this 6 months prior to falling pregnant as she wasn't in a serious relationship.
Your Answer:
Correct Answer: Start immediately
Explanation:Combined oral contraceptive pills (COCPs) can be started immediately following abortion or miscarriage. Note following childbirth COCPs should not be restarted for 3 weeks (assuming the patient is not breastfeeding).
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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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What is the most common cause of sepsis in the puerperium?
Your Answer:
Correct Answer: Endometritis
Explanation:Significant puerperal pyrexia is defined as a temperature of 38ºC or higher on any two of the first 10 days postpartum, exclusive of the first 24 hours. A mixed flora normally colonizes the vagina with low virulence. Puerperal infection is usually polymicrobial and involves contaminants from the bowel that colonize the perineum and lower genital tract. Following delivery, natural barriers to infection are temporarily removed and therefore organisms with a pathogenic potential can ascend from the lower genital tract into the uterine cavity. Placental separation exposes a large raw area equivalent to an open wound, and retained products of conception and blood clots within the uterus can provide an excellent culture medium for infection.
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This question is part of the following fields:
- Clinical Management
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Question 29
Incorrect
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What type of drug is clavulanic acid?
Your Answer:
Correct Answer: Beta-lactamase inhibitor
Explanation:Clavulanic acid is a beta-lactamase inhibitor that is most often combined with a penicillin to form Augmentin or Co-amoxiclav for greater antibiotic efficacy. The drug works by irreversibly binding to enzymes present in bacteria which posses the Beta-lactamase enzyme. This enzyme is responsible for inactivating Beta-Lactam antibiotics such as penicillin.
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This question is part of the following fields:
- Clinical Management
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Question 30
Incorrect
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Premature menopause is defined as cessation of menses before the age of:
Your Answer:
Correct Answer: 40
Explanation:Premature menopause occurs if menopause happens before the age of 40. It effects 1% of women under the age of 40 and 0.1% under 30.
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This question is part of the following fields:
- Clinical Management
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SESSION STATS - PERFORMANCE PER SPECIALTY
