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Question 1
Correct
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Regarding the foetus, which one of the following statements is true?
Your Answer: Fetal lie describes the long axis of the foetus to the long axis of the mother
Explanation:Fetal lie describes the relationship of the long axis of the foetus with respect to the long axis of the mother.
Coronal suture is the transverse suture separating the parietal bone from the frontal bone.
Umbilical cord is composed of two arteries and one vein. the vein carries the oxygenated blood, whereas the arteries contain the deoxygenated blood.
At the time of birth, the anterior fontanelle is open and appears as a soft jelly like structure. -
This question is part of the following fields:
- Anatomy
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Question 2
Correct
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A 28-year-old woman who recently got married presents to your clinic.
She has a history of extremely irregular menstrual cycles with the duration varying between four and ten weeks.
She had attended her routine review appointment one week prior to her current presentation.
At that time she had stated that her last period had occurred six weeks previously.
You had recommended the following tests for which the results are as shown below:
Serum follicle-stimulating hormone (FSH): 3 IU/L (<13)
Serum luteinising hormone (LH): *850 IU/L (4-10 in follicular phase, 20-100 at mid-cycle)
Serum prolactin (PRL): 475 mU/L (50-500)
Which one of the following is the most probable reason for her amenorrhoea?Your Answer: Early pregnancy.
Explanation:All of the options provided could cause amenorrhoea and therefore need to be evaluated.
The luteinising hormone (LH) level reported here is exceedingly elevated. A patient with polycystic ovarian syndrome (PCOS) is unlikely to have such a raised level, but it could be because of a LH-producing adenoma. Such tumours are, however, extremely rare.
Early pregnancy (correct answer) is the most likely cause of this woman’s elevated LH level. This would be due to the presence of beta human chorionic gonadotropin (hCG) hormone that is produced during pregnancy.
LH and beta-HCG both have similar beta-subunits and cross-reactions are commonly noted in LH assays.
The serum prolactin (PRL) level is at the upper end of the normal range and this correlates to the levels observed in the early stages of pregnancy.
The follicle-stimulating hormone (FSH) levels remain low during early pregnancy.
If her amenorrhea had been caused by stress from her recent marriage, the LH level would have been normal or low.
If the cause was premature ovarian failure, the FSH level would have been significantly higher.
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This question is part of the following fields:
- Gynaecology
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Question 3
Correct
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Which of the following prolongs Prothrombin time?
Your Answer: Factor V deficiency
Explanation:Prothrombin time is increased in:
– Factor V deficiency
– Vitamin K deficiency (which affects factors 2,7 and 10)
– Warfarin therapy
– Severe liver failure
Protein C is an anticoagulant and deficiency results in a hyper-coagulable state with tendency towards thrombosis. -
This question is part of the following fields:
- Biochemistry
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Question 4
Correct
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A 45 year old women is seen in clinic following hysteroscopy and biopsy due to irregular menstrual bleeding. Her BMI is 34 kg/m2. This shows atypical hyperplasia. Which of the following is the most appropriate 1st line management?
Your Answer: Laparoscopic hysterectomy
Explanation:Endometrial hyperplasia with atypia is at high risk of progression to cancer and hysterectomy is indicated There is high risk of progression to cancer with endometrial hyperplasia with atypia and hysterectomy is indicated. Although weight loss would be beneficial this shouldn’t delay surgical management.
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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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A 21-year-old woman at 39 weeks of gestation in her second pregnancy is admitted in the hospital for severe abdominal pain. She notes that also has been having vaginal bleeding of about one litre and uterine contractions are present. Her previous pregnancy was a vaginal, without any complications. Her current blood pressure is 95/50 mmHg with a pulse rate of 120 beats/min.
On physical examination, the uterus is palpable at the level of the xiphisternum and is firm. It is acutely tender to palpation. Fetal heart sounds cannot be heard on auscultation or with Doppler assessment. The cervix is 4 cm dilated and fully effaced. Immediate resuscitative measures are taken.
Which of the following is the most appropriate next step in management for this patient?Your Answer: Amniotomy
Explanation:This patient is presenting with a severe placental abruption causing fetal death and shock in the mother. The most appropriate initial management for the patient is to treat her shock with blood transfusions and exclude or treat any coagulation disorder resulting from the abruption. Delivery also needs to be expedited to remove the dead foetus. An amniotomy is usually all that is required to induce spontaneous labour as the uterus is usually very irritable. Spontaneous labour is likely to occur in this case, where the cervix is already 4 cm dilated and fully effaced.
Caesarean section is rarely needed to be done when the foetus is already dead.
Vaginal prostaglandin and an oxytocin (Syntocin®) infusion are not needed and unlikely to be required.
Ultrasound examination to confirm the diagnosis and fetal death is also unnecessary given the clinical and Doppler findings.
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This question is part of the following fields:
- Obstetrics
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Question 6
Correct
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Question 7
Incorrect
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Under which one of the following conditions is the pelvic inlet felt to be contracted?
Your Answer: The transverse diameter is only 10 cm
Correct Answer:
Explanation:Contracted pelvis occurs when one or more of its diameters is reduced so that it interferes with the normal mechanism of labour. A transverse diameter below 11 cm will result in difficult delivery of the foetus and C-section will be the better option in that case
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This question is part of the following fields:
- Anatomy
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Question 8
Correct
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According to the UK food standards agency which of the following RDIs (recommended daily intake) is 3 times higher in pregnancy than the non-pregnant state?
Your Answer: Folic Acid
Explanation:Folic Acid should be increased in diet of a pregnant women. Deficiency will lead to neural tube defects i.e. spina bifida.
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This question is part of the following fields:
- Physiology
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Question 9
Correct
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You are called to assist in an initially midwife led delivery. Upon delivering a female baby you notice the baby has partial fusion of the labioscrotal folds. You suspect congenital adrenal hyperplasia. Which of the following is the most common enzyme deficiency?
Your Answer: 21-hydroxylase
Explanation:Congenital Adrenal Hyperplasia leads to the virilization of the foetus. It occurs due to an enzyme deficiency in the corticosteroid production pathway i.e. 21-hydroxylase which converts progesterone to deoxycorticosterone. The reduced levels of corticosteroids results in the negative feedback loop that leads to adrenal hyperplasia.
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This question is part of the following fields:
- Genetics
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Question 10
Correct
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Branches V2 and V3 of the trigeminal nerve develop from which pharyngeal arch?
Your Answer: 1st
Explanation:Trigeminal nerve has three divisions, the first is the ophthalmic division that does not originate from any of the pharyngeal arches, the second and third divisions, namely, the maxillary and the mandibular region develop from the first pharyngeal arch.
Pharyngeal Arches:
1st = Trigeminal V2 & V3 (CN V)
2nd = Facial (CN VII)
3rd = Glossopharyngeal (CN IX)
4th and 6th = Vagus (CN X) -
This question is part of the following fields:
- Embryology
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Question 11
Correct
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A 62-year-old woman complains of urinary incontinence for the past 12 months after having four pregnancies before the age of 30. She has to wear a 'pad' inside her pants all of the time because of this condition. She isn't on any hormone replacement therapy at the moment. Which of the following signs indicates that the incontinence is most likely true stress incontinence?
Your Answer: Only small quantities of urine ore lost each time she is incontinent.
Explanation:Only little volumes of urine are lost when her intra-abdominal pressure is elevated during coughing, laughing, jumping, and straining, which is the only symptom associated with real stress incontinence.
The other reactions are significantly more compatible with a detrusor instability diagnosis (also called urge incontinence).
If she had incontinence throughout pregnancy, it would have been stress in nature, which is what her current incontinence is. -
This question is part of the following fields:
- Gynaecology
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Question 12
Correct
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A 29 year old patient who is 15 weeks pregnant comes to see you. She currently has chickenpox. She is concerned her baby may get congenital fetal varicella syndrome (FVS). What would you advise her the risk of this is?
Your Answer: 2.00%
Explanation:FVS has been reported to complicate maternal chickenpox that occurs as early as 3 weeks and up to 28 weeks of gestation. The risk appears to be lower in the first trimester (0.55 per cent). No case of FVS has been reported when maternal infection has occurred after 28 weeks.
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This question is part of the following fields:
- Microbiology
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Question 13
Correct
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Which of the following is the most appropriate for diagnosis of Bacterial Vaginosis (BV)?
Your Answer: Amsel's criteria
Explanation:Diagnosis can be made using the Amsel’s criteria:
1. Presence of clue cells on microscopic examination (these cells are epithelial cells covered with the bacteria).
2. Creamy greyish discharge.
3. Vaginal pH of more than 4.5.
5. Positive whiff test – release of fishy odour on addition of alkali solution. Other criteria include the nugent score and the Hay/Ison criteria. The Nugent score estimates the relative proportions of bacterial morphotypes to give a score between 0 and 10 (<4 = normal, 4-6 = intermediate, >6 = BV)
The Hay/Ison criteria
Grade 1 (Normal): Lactobacillus morphotypes predominate
Grade 2 (Intermediate): Mixed flora with some Lactobacilli present, but Gardnerella or Mobiluncus morphotypes also present
Grade 3 (BV): Predominantly Gardnerella and/or Mobiluncus morphotypes. Few or absent Lactobacilli. -
This question is part of the following fields:
- Clinical Management
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Question 14
Correct
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The ovarian artery is a branch of the:
Your Answer: Aorta
Explanation:The ovarian artery is an artery that supplies oxygenated blood to the ovary in females. It arises from the abdominal aorta below the renal artery. It can be found in the suspensory ligament of the ovary, anterior to the ovarian vein and ureter.
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This question is part of the following fields:
- Anatomy
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Question 15
Correct
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A 28 year old patient complains of vaginal soreness and discharge. Examination reveals vulval irritation and a 'strawberry' cervix. A wet smear is sent for microscopy which confirms trichomoniasis. What percentage of trichomoniasis cases would you expect to see a strawberry cervix?
Your Answer: 2%
Explanation:Trichomoniasis is caused by trichomonas. It is sexually transmitted. It is diagnosed on microscopy of vaginal discharge and cultured in Finn-Berg Whittington medium. It is characterised by valval itching, foul smelling discharge and appearance of strawberry cervix due to presence of punctate haemorrhages which occur in 2% of the cases.
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This question is part of the following fields:
- Clinical Management
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Question 16
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 17
Incorrect
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Question 18
Incorrect
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Among the following conditions, which is considered as the most common cause of postpartum hemorrhage requiring hysterectomy?
Your Answer:
Correct Answer: Placenta accreta
Explanation:Placental abnormalities such as placenta previa and placenta accreta are the most common reasons for considering hysterectomy as an inevitable treatment option in postpartum hemorrhage.
Placental villi normally invade only the superficial layers of endometrial deciduas basalis, but when the invasion is too deep into the uterine wall, the condition is termed as placenta accreta, increta or percreta depending on the depth of invasion.
– When the villi invade the deeper layers of the endometrial deciduus basalis, but not the myometrium it is called as Placenta accreta. This is the most common type of decidual invasion and accounts for approximately 75% of the cases.
– When the villi invade the myometrium, but do not reach the uterine serosa or the bladder is called Placenta increta. This type accounts for nearly 15% of cases.
– In cases were the villi invades into the uterine serosa or the bladder is it called as Placenta percreta and this happens in 5% of cases.Prior uterine surgery is the main risk factor for placenta accreta and the best management is elective cesarean hysterectomy.
postpartum hemorrhage can also be caused by conditions like genital lacerations, uterine atony, retained products of conception and uterine inversion. In most of these above mentioned cases, hysterectomy is not required and remains as the last resort in extremely desperate situations.NOTE– Though uterine atony is the most common cause of postpartum hemorrhage, it is often manageable medically.
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This question is part of the following fields:
- Obstetrics
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Question 19
Incorrect
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The ovaries produce androgen and progesterone. What is the common precursor for both of these hormones?
Your Answer:
Correct Answer: Cholesterol
Explanation:Both the female hormones, namely progesterone and oestrogen as well as the male hormones or androgens are lipid soluble. The common precursor of these is cholesterol.
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This question is part of the following fields:
- Endocrinology
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Question 20
Incorrect
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In which situation would you prescribe COCs?
Your Answer:
Correct Answer: A 20 year old woman with blood pressure 135/80mmHg
Explanation:Absolute contraindications to OCs include breast cancer, history of deep venous thrombosis or pulmonary embolism, active liver disease, use of rifampicin, familial hyperlipidaemia, previous arterial thrombosis, and pregnancy, while relative contraindications include smoking, age over 35, hypertension, breastfeeding, and irregular spontaneous menstruation.
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This question is part of the following fields:
- Gynaecology
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Question 21
Incorrect
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A 30-year-old female patient visits you for a cervical cancer screening. You inform her that while Pap smears are no longer performed, Cervical Screening tests are done five times a year.
She has a cervical screening test, which reveals that she has non-16/18 HPV and low-grade cytology alterations.
What's would you do next?Your Answer:
Correct Answer: Repeat cervical screening test in 12 months
Explanation:An LSIL Pap test shows mild cellular changes. The risk of a high-grade cervical precancer or cancer after an LSIL Pap test is as high as 19 percent.
As with an ASC-US Pap test, an LSIL Pap test is evaluated differently depending upon age. For women ages 25 or older, follow-up depends upon the results of human papillomavirus (HPV) testing:
– Women who test positive for HPV or who have not been tested for HPV should have colposcopy.
– Women who test negative for HPV can be followed up with a Pap test and HPV test in one year.Referral to an oncologist is not necessary since there is no established diagnosis of malignancy. All other options are unacceptable.
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This question is part of the following fields:
- Gynaecology
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Question 22
Incorrect
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A patient present to the clinic with a 1 day history of vaginal prolapse. Upon examination, the vagina is 1.5 cm below the vaginal plane. What grade is the prolapse according to the POP-Q classification?
Your Answer:
Correct Answer: Grade 3
Explanation:Pelvic organ prolapse is a common condition amongst ageing women where a weakness in the pelvic support structures of the pelvic floor allows pelvic viscera to descend.
The Pelvic Organ Prolapse Quantification system (POP-Q) is useful for describing and staging the severity of the pelvic organ prolapse.
Grade 1: the most distal portion of the prolapse is more than 1 cm above the level of the hymen
Grade 2: the most distal portion of the prolapse is 1 cm or less proximal or distal to the hymenal plane
Grade 3: the most distal portion of the prolapse protrudes more than 1 cm below the hymen but protrudes no farther than 2 cm less than the total vaginal length (for example, not all of the vagina has prolapsed)
Grade 4: vaginal eversion complete -
This question is part of the following fields:
- Anatomy
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Question 23
Incorrect
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Which of the following is probably responsible for physiologic hyperventilation during pregnancy?
Your Answer:
Correct Answer: Increased progesterone production
Explanation:Progesterone gradually increases during the course of pregnancy, from 25 ng⋅mL−1 at 6 weeks’ to 150 ng⋅mL−1 at 37 weeks’ gestation. Progesterone acts as trigger of the primary respiratory centre by increasing the sensitivity of the respiratory centre to carbon dioxide, as indicated by the steeper slope of the ventilation curve in response to alveolar carbon dioxide changes. Progesterone alters the smooth muscle tone of the airways resulting in a bronchodilator effect. It also mediates hyperaemia and oedema of mucosal surfaces, causing nasal congestion.
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This question is part of the following fields:
- Physiology
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Question 24
Incorrect
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Etiological factors in spontaneous abortion include:
Your Answer:
Correct Answer: All of the options given
Explanation:Spontaneous abortion is the loss of pregnancy naturally before twenty weeks of gestation. Colloquially, spontaneous abortion is referred to as a ‘miscarriage’ to avoid association with induced abortion. Early pregnancy loss refers only to spontaneous abortion in the first trimester. In 50% of cases, early pregnancy loss is believed to be due to fetal chromosomal abnormalities. Advanced maternal age and previous early pregnancy loss are the most common risk factors. For example, the incidence of early pregnancy loss in women 20-30 years of age is only 9 to 17%, while the incidence at 45 years of maternal age is 80%. Other risk factors include alcohol consumption, smoking, and cocaine use.
Several chronic diseases can precipitate spontaneous abortion, including diabetes, celiac disease, and autoimmune conditions, particularly anti-phospholipid antibody syndrome. Rapid conception after delivery and infections, such as cervicitis, vaginitis, HIV infection, syphilis, and malaria, are also common risk factors. Another important risk factor is exposure to environmental contaminants, including arsenic, lead, and organic solvents. Finally, structural uterine abnormalities, such as congenital anomalies, leiomyoma, and intrauterine adhesions, have been shown to increase the risk of spontaneous abortion.
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This question is part of the following fields:
- Obstetrics
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Question 25
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:
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 26
Incorrect
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Which group of beta haemolytic streptococci is associated with chorioamnionitis?
Your Answer:
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 27
Incorrect
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In which part of the body does clomiphene trigger ovulation by antagonising oestrogen receptors?
Your Answer:
Correct Answer: Hypothalamus
Explanation:Clomiphene citrate is widely used in the induction of ovulation, especially in the treatment of anovulatory infertility and in conditions such as PCOS. The drug functions as a selective oestrogen receptor modulator, which acts in the hypothalamus to indicate low serum oestrogen levels. Reduced levels of negative feedback stimulate the secretion of GnRH from the hypothalamus, which in turn stimulate the production of gonadotropins (FSH and LH) from the anterior pituitary. These work to increase ovarian follicular activity.
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This question is part of the following fields:
- Pharmacology
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Question 28
Incorrect
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Which of the following best describes the mechanism of action of Promethazine?
Your Answer:
Correct Answer: Histamine H1-receptor antagonist
Explanation:Promethazine is type of antihistamine that acts on the H1 receptor. In pregnancy NICE guidelines advise oral promethazine or oral cyclizine should be used as 1st line drug management of nausea and vomiting. Both are H1 antagonists.
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This question is part of the following fields:
- Pharmacology
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Question 29
Incorrect
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All of the following are characteristic features of normal labour, except:
Your Answer:
Correct Answer: Moderate bleeding
Explanation:Normal labour is characterized by spontaneous onset, rhythmical uterine contractions along with vertex presentation. Cervical dilatation starts from the 1st stage of labour and intensity of the uterine contractions increases with passing time. Bleeding occurs after the child is expelled and the average loss is about 250-500 ml in a normal vaginal delivery.
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This question is part of the following fields:
- Obstetrics
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Question 30
Incorrect
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A 29 year old patient who is 22 weeks pregnant seeks your advice as she was recently exposed to chickenpox. Regarding fetal varicella syndrome (FVS) which of the following statements is correct regarding maternal varicella infection?
Your Answer:
Correct Answer: FVS may result if there is maternal varicella infection within the 1st 20 weeks gestation
Explanation:(13-20 weeks). If a mother has chickenpox in late pregnancy (5 days prior to delivery) then there is risk of neonatal varicella infection which may be severe.
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This question is part of the following fields:
- Microbiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
