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Question 1
Incorrect
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With regard to the cell cycle. In which part of the cycle does DNA replication occur?
Your Answer: G0
Correct Answer: Interphase
Explanation:DNA replication occurs during S phase but that isn’t one of the options. Remember Interphase comprises G1,S and G2 phases!
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This question is part of the following fields:
- Biochemistry
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Question 2
Correct
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A 24 year old, 16 week pregnant patient presents with vaginal discharge. There is heavy growth of N. gonorrhoea as shown on swabs taken. Which treatment course is most advisable?
Your Answer: Ceftriaxone 1 mg intramuscularly as a single dose with azithromycin 2g oral as a single dose
Explanation:Gonorrhoea is a diplococcus bacteria known to infect the female genital tract. The bacteria is sexually transmitted and can cause an ascending infection in the uterus and fallopian tubes. According to the BASHH guidelines (British Association for Sexual Health and HIV), indication for therapy include confirmation of intracellular diplococci on microscopy or a confirmed positive NAAT. Treatment of gonorrhoea in pregnancy is as follows: Ceftriaxone 1g intramuscularly as a single dose with azithromycin 2g oral as a single dose. Pregnant individuals are not to be treated with quinolones or tetracyclines.
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This question is part of the following fields:
- Clinical Management
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Question 3
Incorrect
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You are reviewing a patient who is complaining of pain and numbness to the right anterior aspect of her labia following abdominal hysterectomy. You suspect ilioinguinal nerve injury. What spinal segment is the ilioinguinal nerve derived from?
Your Answer: T12
Correct Answer: L1
Explanation:Ilioinguinal nerve injury is one of the most common nerve injuries associated with pelvic surgery.
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This question is part of the following fields:
- Anatomy
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Question 4
Correct
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Which of the following is known to increase the risk of endometrial cancer?
Your Answer: PCOS
Explanation:The risk factors of endometrial cancer include obesity, diabetes, late menopause, unopposed oestrogen therapy, tamoxifen therapy, HRT and a family history of colorectal and ovarian carcinoma.
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This question is part of the following fields:
- Epidemiology
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Question 5
Correct
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You receive a swab result from a patient who had complained of odorous vaginal discharge. It confirms bacterial vaginosis (BV). Which pathogen is most commonly associated with BV?
Your Answer: Gardnerella vaginalis
Explanation:BV typically presents as an increase in vaginal discharge and vaginal malodour caused by a change in vaginal bacterial flora. PV discharge due to BV is typically grey fluid that adheres to the vaginal mucosa. BV is a polymicrobial infection. Gardnerella is the most commonly associated pathogen. Other associated bacteria include Lactobacillus species, Prevotella, Mobiluncus, Bacteroides, Peptostreptococcus, Fusobacterium, Veillonella, Eubacterium species, Mycoplasma hominis, Urea plasma urealyticum and Streptococcus viridans.
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This question is part of the following fields:
- Clinical Management
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Question 6
Correct
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Which of the following regarding the use of tocolytics is true?
Your Answer: Use of a tocolytic drug is not associated with a clear reduction in perinatal or neonatal mortality, or neonatal morbidity
Explanation:Tocolytics are used to suppress contractions. The Canadian preterm labour trial which remains a very influential tocolytic trial to date concluded that tocolytics such as a beta agonist have no significant benefit on perinatal mortality or morbidity or prolong pregnancy to term however it did reduce the number of women delivering within 2 days by 40%. This 48 hour window is the only reason for the use of tocolytics.
Choice of tocolytic (NICE)
1st line: Nifedipine
2nd line: Oxytocin receptor antagonists e.g. atosiban -
This question is part of the following fields:
- Clinical Management
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Question 7
Correct
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Which one of the following changes are in the correct sequence regarding female puberty?
Your Answer: Thelarche, maximal growth velocity, menarche
Explanation:Thelarche means appearance of the breast tissue under the influence of oestrogen from the ovaries. It heralds the onset of puberty among girls. It is followed by an increase in growth velocity followed by menarche which is the time of first menstrual bleeding.
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This question is part of the following fields:
- Embryology
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Question 8
Incorrect
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Raised FSH levels are found in all of the following conditions, EXCEPT:
Your Answer: Gonadal dysgenesis
Correct Answer: Women on combined oral contraceptive pills
Explanation:Oestrogen- and progesterone-containing oral contraceptives inhibit LH, which suppresses the FSH and LH levels, preventing follicular development and ovulation. Combined pills suppress FSH and LH throughout the cycle, inhibit endometrial proliferation, and produce a scanty cervical mucus.
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This question is part of the following fields:
- Endocrinology
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Question 9
Incorrect
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A 61-year-old woman comes to the office for a breast cancer follow-up visit. She recently underwent right mastectomy for a node-negative, estrogen- and progesterone-receptor-positive tumor. She was on an aromatase inhibitor as adjuvant therapy, which was discontinued due to severe fatigue and poor sleep. At present, she is scheduled for a 5-year course of adjuvant therapy with tamoxifen. Patient has no other chronic medical conditions and her only medication is a daily multivitamin. Her last menstrual period was 8 years ago. Patient's father had a myocardial infarction at the age 64; otherwise her family history is noncontributory. She does not use tobacco, alcohol, or any other illicit drugs.
On examination her vital signs seems stable, with a BMI of 21 kg/m2.
Patient has many concerns about tamoxifen therapy and asks about potential side effects. Which among the following complications mentioned below is this patient at greatest risk of developing, due to tamoxifen therapy?Your Answer: Intimal thickening of the coronary arteries
Correct Answer: Hyperplasia of the endometrium
Explanation:Tamoxifen and Raloxifene are drugs which acts as selective estrogen receptor modulators.
Their mechanisms of action are competitive inhibitor of estrogen binding and mixed agonist/antagonist action respectively.
Commonly indicated in prevention of breast cancer in high-risk patients. Tamoxifen as adjuvant treatment of breast cancer and Raloxifene in postmenopausal osteoporosis.
Adverse effects include:
– Hot flashes
– Venous thromboembolism
– Endometrial hyperplasia & carcinoma (tamoxifen only)
– Uterine sarcoma (tamoxifen only)
Adjuvant endocrine therapy is commonly used option for treatment of nonmetastatic, hormone-receptor-positive breast cancer; and the most commonly used endocrine agents include tamoxifen, aromatase inhibitors, and ovarian suppression via GnRH agonists or surgery.Tamoxifen is a selective estrogen receptor modulator which is an estrogen receptor antagonist in the breast. It is the most preferred adjuvant treatment for pre-menopausal women at low risk of breast cancer recurrence. Tamoxifen is also a second-line endocrine adjuvant agent for postmenopausal women who cannot use aromatase inhibitor therapy due to intolerable side effects.
Tamoxifen acts as an estrogen agonist in the uterus and stimulates excessive proliferation of endometrium. Therefore, tamoxifen use is associated with endometrial polyps in premenopausal women, and endometrial hyperplasia and cancer in postmenopausal women. These effects will continue throughout the duration of therapy and resolves once the treatment is discontinued. Even with all these possible complications, benefits of tamoxifen to improve the survival from breast cancer outweighs the risk of endometrial cancer.In postmenopausal women, tamoxifen has some estrogen-like activity on the bone, which can increase bone mineral density and thereby reduce the incidence of osteoporosis significantly. However, tamoxifen is generally not a first-line agent for osteoporosis in treatment due to the marked risk of endometrial cancer.
Dysplasia of the cervical transformation zone is typically caused due to chronic infection by human papillomavirus, and tamoxifen has no known effects on the cervix.
Tamoxifen is not associated with any increased risk for adenomyosis, which is characterised by ectopic endometrial tissue in the myometrium.
Intimal thickening of the coronary arteries is a precursor lesion for atherosclerosis. Tamoxifen helps to decrease blood cholesterol level and thereby protect against coronary artery disease.
Tamoxifen is an estrogen antagonist on breast tissue and is used in the treatment and prevention of breast cancer, but it also acts as an estrogen agonist in the uterus and increases the risk of development of endometrial polyps, hyperplasia, and cancer.
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This question is part of the following fields:
- Obstetrics
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Question 10
Correct
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Which of the following does not cause an increased risk of cervical cancer?
Your Answer: Alcohol
Explanation:Consuming alcohol and risk of cervical cancer are not associated. Not even drinking often and in large amounts are risk factors for developing cervical cancer.
So drinking alcohol and risk of cervical cancer aren’t associated. Based on their analyses of the scientific research evidence, that is the conclusion of, among many others, the:
American Cancer Society.
Centres for Disease Control and Prevention (CDC).
National Cancer Institute.
UK’s National Health Service.
Canadian Cancer Society.
Cancer Council Australia.
World Health Organization (WHO).All other options can increase the risk of acquiring cervical cancer.
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This question is part of the following fields:
- Gynaecology
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Question 11
Correct
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Hypemesis gravidarum occurs in what percentage of pregnancies?
Your Answer: 1.50%
Explanation:Nausea and vomiting experienced in 80% of pregnancies Hyperemesis gravidarum (HG) is an extreme form of nausea and vomiting which affects around 1.5% of women. Caused by high levels HCG. Definitions vary but most consider it to be defined by severe nausea and vomiting associated with weight loss greater than 5% of pre-pregnancy weight with metabolic disturbance (typically dehydration and/or ketosis).
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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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Lactogenesis at term is stimulated by which hormone?
Your 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 13
Incorrect
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A couple comes to your clinic because they haven't been able to conceive despite having had frequent sexual activity in the previous 12 months. The female partner is 35 years old and has regular menstrual cycles. The male partner is 38 years old and otherwise normal.
Which of the following studies would you do next to forecast ovulation?Your Answer: Semen analysis
Correct Answer: Serum progesterone
Explanation:This patient has a regular and long menstrual period. The most crucial thing in this case is to rule out anovulation.
Serum progesterone concentration is the best test for detecting ovulation.
Ovulation has occurred if the level is greater than 20nmol/L.
This test should be performed 3 to 10 days prior to the start of the next anticipated period. -
This question is part of the following fields:
- Gynaecology
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Question 14
Correct
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An ultrasound in the 1st trimester of pregnancy is done for?
Your Answer: Dating of the pregnancy
Explanation:Early ultrasound improves the early detection of multiple pregnancies and improved gestational dating may result in fewer inductions for post maturity.
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This question is part of the following fields:
- Obstetrics
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Question 15
Correct
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If your patient is 8 weeks pregnant which one of the following USS measurements is most useful?
Your Answer: Crown rump length
Explanation:Fetal crown-rump length (CRL) is recommended over last menstrual period for estimating GA when measured in early pregnancy i.e. before 9 to 13+6 weeks.
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This question is part of the following fields:
- Anatomy
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Question 16
Correct
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Question 17
Incorrect
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The posterior scrotal artery is a branch of which artery?
Your Answer: Ilioinguinal
Correct Answer: Internal Pudendal
Explanation:The posterior scrotal artery is a terminal branch of the perineal artery which is a branch of the internal pudendal artery.
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This question is part of the following fields:
- Anatomy
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Question 18
Correct
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Examination of endometrial tissue obtained from a biopsy reveals simple columnar epithelium with no sub-nuclear vacuoles. The stroma is oedematous, & a tortuous gland contains secretions. These findings are consistent with which stage of the menstrual cycle?
Your Answer: Mid-secretory
Explanation:During mid secretory phase, the endometrium cells undergo distension, become more tortuous and are lined by columnar cells.
In the early proliferative phase, the glandular epithelium is cubo-columnar, while in the late proliferative phase, the glands increase in size, becoming tortuous and there is pseudostratification of the epithelium. -
This question is part of the following fields:
- Physiology
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Question 19
Correct
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A 27-year-old woman presents for difficulty and pain in attempting sexual intercourse. She states that she never had such symptoms prior. The pain is not felt at the time of penetration, but appears to hurt deeper in the vagina.
She was recently pregnant with her first child and delivery was three months ago. She did not have an episiotomy or sustain any vaginal lacerations during delivery. She denies any vaginal bleeding since her lochia had stopped two months ago. She is still breastfeeding her child.
Which of the following is the most likely cause of her dyspareunia?Your Answer: Atrophic vaginal epithelium.
Explanation:This is a patient that recently gave birth and is still breastfeeding presenting with dyspareunia. The most likely cause would be a thin atrophic vaginal epithelium. This is very common presentation and is due to the low oestrogen levels due to the prolactin elevation from breastfeeding.
An unrecognised and unsutured vaginal tear should have healed by this time and should not be causing issues.
Endometriosis tends to resolve during a pregnancy, but if this was the issue, it would have caused dyspareunia prior to pregnancy.
Vaginal infective causes of dyspareunia, such as monilial or trichomonal infections, are rare in amenorrhoeic women.
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This question is part of the following fields:
- Obstetrics
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Question 20
Incorrect
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A 32-year-old woman visited your clinic at her 30th week of gestation, complaining of left lower limb pain.
The doppler ultrasound findings had confirmed proximal deep vein thrombosis and she was treated with low molecular weight heparin.
Now she is at her 34 weeks of gestation, and is expecting delivery in next four weeks. What would be your advice for her today?Your Answer: Continue low molecular weight heparin until delivery
Correct Answer: Low molecular weight heparin should be switched to unfractionated heparin
Explanation:This patient has developed deep vein thrombosis during pregnancy and required anti-coagulation as part of treatment for up to 3-6 months. Enoxaparin, which is a low molecular weight heparin, is preferred over heparin due to the once or twice a day therapeutic dosing. Also monitoring of aPTT is not required in this case.
There is an association between Enoxaparin and an increased risk for epidural hematoma in women receiving epidural anaesthesia during labour. Considering that the patient mentioned is expected to go for delivery in 4 weeks and the possibility of her needing an epidural anaesthesia or general anaesthesia in case of undergoing a cesarean section, enoxaparin should be switched to unfractionated heparin, four weeks prior to the anticipated delivery. This is because of the fact that heparin can be antidoted with protamine sulphate.
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This question is part of the following fields:
- Obstetrics
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Question 21
Correct
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A 60-year-old lady is found to have a grossly palpable adnexal mass on her left side on pelvic examination. This is the first time it has been detected. She attained menopause at 52 years of age. The last pelvic examination, which was done 4 years ago, was normal.
What is her most likely diagnosis?Your Answer: Ovarian carcinoma.
Explanation:Her most likely diagnosis would be an ovarian carcinoma. Any palpable adnexal mass in a post-menopausal woman is a red flag for an ovarian malignancy and should be assumed so until proven otherwise.
Endometrial cancer typically presents with a post-menopausal bleed and although there might be uterine enlargement, an adnexal mass is generally absent.
It is very rare for follicular cysts to develop following menopause and it is uncommon for post-menopausal women to have a benign ovarian tumour, which is more common in younger women. A degenerating leiomyoma would be unlikely in this case, especially since her pelvic examination three years ago was normal (no history of leiomyoma noted).
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This question is part of the following fields:
- Gynaecology
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Question 22
Correct
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Regarding twin pregnancies all of the following are correct EXCEPT:
Your Answer: Identical or monozygotic twins arise from fertilization of two ovum
Explanation:Monozygotic (MZ) twins originate when a single egg is fertilized to form one zygote, which then divides into two embryos. Although they share the same genotype they are not phenotypically identical.
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This question is part of the following fields:
- Genetics
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Question 23
Correct
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A 61-year-old woman presents to OBGYN clinic with a complaint of irregular bleeding per vagina for the last 3 months. Her past medical history is not significant and she went through menopause around a decade ago.
A cervical screening test is performed and comes back normal. PCR for chlamydia is also negative. Endometrial thickness of around 8mm is seen on transvaginal ultrasound.
What would be the next step of management?Your Answer: Referral to the gynaecologist for endometrial biopsy
Explanation:This patient had postmenopausal vaginal haemorrhage and an 8mm endometrial thickness. Endometrial thickness of 4mm or more in a postmenopausal woman with vaginal bleeding necessitates an endometrial biopsy to rule out endometrial cancer, and this patient should be referred to a gynaecologist for this procedure.
All of the other choices are incorrect. -
This question is part of the following fields:
- Gynaecology
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Question 24
Correct
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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: 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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Question 25
Correct
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In which situation would you prescribe COCs?
Your 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 26
Incorrect
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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: 20.00%
Correct 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 27
Correct
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Question 28
Correct
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A 24 year old lady is 9 weeks pregnant with her first child. She attends clinic complaining of severe vomiting and is unable to keep fluids down. The most likely diagnosis is hyperemesis gravidarum. Which of the following is the underlying cause?
Your Answer: Increased circulating HCG
Explanation:Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy, associated with weight loss of more than 5% of pre-pregnancy weight, dehydration and electrolyte imbalance. HG is usually most severe during the first 12 weeks of pregnancy and is thought to be caused by high circulating levels of HCG.
There is not yet any evidence that pregnancy itself increases the sensitivity of the area postrema, or that the hormones, oestradiol, or progesterone increase vomiting. Generally, higher concentrations of dopamine stimulates receptors in the chemoreceptor trigger zone leading to nausea and vomiting. Although this has not been demonstrated as the cause of hyperemesis gravidarum.
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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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In the 3rd trimester anaemia is defined by?
Your Answer: Haemoglobin < 105 g/l
Correct Answer:
Explanation:Anaemia in pregnancy is defined by the British Committee for Standards in Haematology (BCSH) guidance: 1st trimester Hb < 110 g/l 2nd and 3rd trimester Hb < 105 g/l Postpartum Hb less than 100 g/l
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This question is part of the following fields:
- Clinical Management
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Question 30
Correct
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Among the below given options, which is NOT associated with an increased risk for preeclampsia?
Your Answer: Age between 18 and 40 years
Explanation:Any new onset of hypertension associated with proteinuria after 20 weeks of gestation in a previously normotensive woman is referred to as Preeclampsia.
Most commonly found risk factors for pre-eclampsia are:
– Preeclampsia in a previous pregnancy
– Family history of preeclampsia
– a prior pregnancy with poor outcome like placental abruption, IUGR, fetal death in utero, etc
– An interdelivery interval greater than 10 years
– Nulliparity, increases risk by 8 times
– Pre-existing chronic medical conditions or chronic hypertension
– pre-existing or gestational Diabetes
– chronic Renal disease
– Thrombophilias g. protein C and S deficiency, antithrombin Ill deficiency, or Factor V Leiden mutation
– Antiphospholipid syndrome
– Systemic lupus erythematous
– Maternal age greater than or equal to 40 years
– Body Mass Index (BMI) greater than 30 kg/m2
– Multiple pregnancy
– Raised blood pressure at booking
– Gestational trophoblastic disease
– Fetal triploidyMaternal age between 18 and 40 years is found to be associated with a decreased risk for developing preeclampsia, and not an increased risk.
NOTE– Previously, age 16 years or younger was thought to be a risk factor for developing preeclampsia; however, recent studies conducted had failed to establish any meaningful relationship between the two. -
This question is part of the following fields:
- Obstetrics
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SESSION STATS - PERFORMANCE PER SPECIALTY
