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Question 1
Correct
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Premature menopause is defined as cessation of menses before the age of:
Your 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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Question 2
Incorrect
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What is the primary form of haemoglobin in a 6 week old foetus?
Your Answer: HbF
Correct Answer: Hb Gower 1
Explanation:HB gower 1 is the predominant embryonic haemoglobin when the foetus is 6 weeks old and is replaced by adult haemoglobin by the age of 5 months post natally.
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This question is part of the following fields:
- Physiology
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Question 3
Correct
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Which of the following tests is used to detect antibodies or complement bound to red blood cell antigens in vivo?
Your Answer: Direct Coombs
Explanation:When the red cells are coated with immune IgG antibody, the cells do not agglutinate but when anti-IgG antiserum is added to these sensitized cells visible agglutination occurs. This is known as a positive direct coombs test.
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This question is part of the following fields:
- Physiology
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Question 4
Correct
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Question 5
Correct
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When does ovulation occur?
Your Answer: 36 hours after LH surge
Explanation:Ovulation occurs in the mid stage of the menstrual cycle, usually 36 hours after the LH surge. It is this LH surge which is necessary for the ovulation to occur.
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This question is part of the following fields:
- Physiology
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Question 6
Correct
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Question 7
Correct
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A 33-year-old woman is under your care during her pregnancy.
She has had only one previous pregnancy in which her foetus had spina bifida.
Identify the most appropriate assessment, from the following choices, that would aid in detection of spina bifida in her current pregnancy.Your Answer: Ultrasound of the fetal spine at 16-18 weeks of gestation.
Explanation:An ultrasound of the foetal spine at 16-18 weeks of gestation is the most appropriate assessment (correct answer).
Ultrasound performed at 11-12 weeks of gestation can diagnose anencephaly, another neural tube defect, however; any vertebral column defect is unlikely to be detected.
In most cases of neural tube defects in the foetus, elevations will be noted in maternal alpha-fetoprotein levels at 12 to 15 weeks. However, it may not be possible to detect all such abnormalities and a confirmed diagnosis cannot be made.
Additionally, elevations in alpha-fetoprotein levels do not always correlate to the presence of foetal neural tube defects.
Nuchal translucency scans do not detect neural tube defects. They are performed to identify the risk of chromosomal abnormalities in the foetus.
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This question is part of the following fields:
- Obstetrics
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Question 8
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 9
Correct
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A 27-year-old woman comes to you during her first trimester seeking antenatal advice as she have a history of pre-eclampsia and obesity.
On examination her blood pressure is 130/80 mmHg and BMI is 38.
Administration of which among the following can reduce her risk of pre-eclampsia during this pregnancy?Your Answer: Calcium 1000mg daily
Explanation:This patient with a previous history of pre-eclampsia and obesity is at high risk for developing pre-eclampsia.
A daily intake of 1000mg of calcium is observed to be helpful in reducing the incidence of any hypertensive disorders and preterm labour.
Vitamin A should always be avoided during pregnancy as it is fetotoxic.
All other options are incorrect.
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This question is part of the following fields:
- Obstetrics
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Question 10
Correct
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A 17-year-old girl presented to the medical clinic for emergency contraception. Upon interview, it was revealed that she had unprotected sexual intercourse last night and is worried that she may become pregnant. She mentioned that her last menstrual period was 1 week ago, and she has regular menses since menarche.
Further physical examination was performed and results are normal and her urine pregnancy test is negative. After discussing various emergency contraceptive options, the patient asked for a pill option and requested to not inform her parents about this visit.
In most states, which of the following is considered the most appropriate step in managing this patient?Your Answer: Provide levonorgestrel pill
Explanation:Levonorgestrel, also known as the morning-after pill, is a first-line oral emergency contraceptive pill with approval from the World Health Organization to prevent pregnancy. It is FDA-approved to be used within 72 hours of unprotected sexual intercourse or when a presumed contraceptive failure has occurred.
A prescription is not needed, and it is available over the counter at local pharmacies. The FDA has also approved levonorgestrel availability for all age groups due to its lack of life-threatening contraindications and side-effect profile.
There are several contraindications for the emergency contraceptive form, including allergy, hypersensitivity, severe liver disease, pregnancy, and drug-drug interactions with liver enzyme-inducing drugs. The medication is not for use in women confirmed to be pregnant; however, there is no proof nor reports of adverse effects on the mother or foetus following inadvertent exposure during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 11
Correct
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A 44-year-old lady came to the clinic with a five-year history of urine incontinence. With a BMI of 34, she is fat. Her last child, weighing 4.2 kg, was born six years ago.
She has been using various over-the-counter medicines to treat constipation and gastric reflux for the past three years. She is a non-smoker with normal blood pressure.
Which of the following is not a risk factor for female urinary incontinence development?Your Answer: Gastro-oesophageal reflux disease
Explanation:Stress UI (SUI) is more common among puerperal women, followed by mixed UI (MUI) and urge UI (UUI). Generally, episodes of urine leakage are infrequent and the amount of urine leakage is small.
Maternal age greater than 35 years, UI during pregnancy, elevated body mass index (BMI), multiparity, and normal birth are considered risk factors for postpartum UI. A 10-year cohort study developed with the goal of assessing the effect of the first normal birth on urinary symptoms showed that it was associated with an increase in SUI, in addition to UUI, regardless of maternal age or number of births.
Other factors such as: colour or race, episiotomy, perineal tears, newborn’s head circumference, newborn’s weight, gestational age at birth, smoking, and constipation require further studies in order to prove their association with postpartum UI.
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This question is part of the following fields:
- Gynaecology
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Question 12
Incorrect
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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: 10-20%
Correct 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 13
Correct
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Hirsutism can be found in all of the following conditions, EXCEPT:
Your Answer: Patient on oral contraceptive pills
Explanation:Classically, hirsutism has been considered a marker of increased androgen levels in females from increased production of androgens (i.e. testosterone) either by the adrenals or due to an ovarian disease. The ovarian causes for hyperandrogenism are polycystic ovarian syndrome (PCOS) and ovarian tumours. Adrenal causes include Cushing’s syndrome, androgen-producing tumours, and congenital adrenal hyperplasia (CAH), most commonly due to 21-hydroxylase deficiency. Less common causes include the hyperandrogenic-insulin resistant-acanthosis nigricans syndrome (HAIRAN). Hyperprolactinemia by increasing adrenal dehydroepiandrosterone sulphate (DHEA-S) production may cause hirsutism. Androgenic drugs are also an important cause of hirsutism. About 20% of the patients may present with idiopathic hirsutism (IH) with normal androgen levels and ovarian function. The cause of increased hair in these women is thought to be related to disorders in peripheral androgen activity. Onset of IH occurs shortly after puberty with slow progression. PCOS and IH account for 90% of the hirsutism in women. Hirsutism can also occur in some premenopausal women and continue for a few years after menopause. This is due to decrease in ovarian oestrogen secretion with continuous androgen production.
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This question is part of the following fields:
- Endocrinology
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Question 14
Correct
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According to the RCOG Green-top guidelines on prevention and management of post-partum haemorrhage (PPH) which of the following statements is true?
Your Answer: For women delivering by caesarean section, Oxytocin 5 iu by slow IV injection should be used
Explanation:Misoprostol is not as effective as oxytocin but may be used if Oxytocin is not available e.g. home birth Recommended doses of Oxytocin For vaginal deliveries: 5 iu or 10 iu by intramuscular injection. For C-section: 5 iu by IV injection
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This question is part of the following fields:
- Clinical Management
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Question 15
Correct
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All of the following organs are involved in oestrogen production except:
Your 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.
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This question is part of the following fields:
- Endocrinology
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Question 16
Correct
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Adult Polycystic Kidney Disease (PKD) typically follows which pattern of inheritance
Your Answer: Autosomal Dominant
Explanation:Polycystic kidney disease (PKD) can either be autosomal dominant or recessive. The autosomal dominant variant is more common in adult PKD however, the recessive pattern is more common in infantile PKD.
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This question is part of the following fields:
- Endocrinology
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Question 17
Correct
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In normal physiological changes in pregnancy, all of the following are increased, EXCEPT:
Your Answer: Peripheral resistance
Explanation:The heart adapts to the increased cardiac demand that occurs during pregnancy in many ways:
Cardiac output increases throughout early pregnancy, and peaks in the third trimester, usually to 30-50% above baseline.
Oestrogen mediates this rise in cardiac output by increasing the pre-load and stroke volume, mainly via a higher overall blood volume (which increases by 40–50%).
The heart rate increases, but generally not above 100 beats/ minute.
Total systematic vascular resistance decreases by 20% secondary to the vasodilatory effect of progesterone. Overall, the systolic and diastolic blood pressure drops 10–15 mm Hg in the first trimester and then returns to the baseline in the second half of pregnancy.
All of these cardiovascular adaptations can lead to common complaints, such as palpitations, decreased exercise tolerance, and dizzinessA pregnant woman may experience an increase in the size of the kidneys and ureter due to the increased blood volume and vasculature.
Later in pregnancy, the woman might develop physiological hydronephrosis and hydroureteronephrosis, which are normal.
There is an increase in glomerular filtration rate associated with an increase in creatinine clearance, protein, albumin excretion, and urinary glucose excretion.
There is also an increase in sodium retention from the renal tube so oedema and water retention is a common sign in pregnant women -
This question is part of the following fields:
- Physiology
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Question 18
Correct
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A 25-year-old female, expecting twins, complains of decreased fetal movements in her 40th week of gestation. An hour ago, she experienced constant abdominal pain for an hour and passed blood in her urine. What is the next best investigation in this case?
Your Answer: Cardiotocograph
Explanation:Cardiotocography (CTG) helps to record the heartbeat of the foetus in parallel to measuring the contractions of the mother’s uterus, this is the most appropriate tool to assess this patient’s condition.
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This question is part of the following fields:
- Gynaecology
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Question 19
Correct
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What is the anatomical landmark used for gauging the station of the fetal head during labour?
Your Answer: Ischial Spine
Explanation:The ischial spine is the anatomical landmark for assessing the station of the fetal head and also placing pudendal nerve blocks. (the pudendal nerve runs posterior to the ischial spine). The ischial spine can be palpated approximately 8cm into the vagina, at 4 and 8 o’clock.
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This question is part of the following fields:
- Anatomy
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Question 20
Incorrect
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A 29-year-old woman presents to the emergency department of your hospital complaining of fever, she had given birth to a healthy male baby four days ago. During vaginal delivery, she sustained small vaginal laceration, suture repair was not done as the lesion were small. Presently she is breastfeeding her baby.
Physical examination shows no uterine tenderness and the rest of the examinations were unremarkable.
Which of the following can be the most likely cause of this Patient's fever?Your Answer: Breast engorgement
Correct Answer: Infection of the unrepaired vaginal laceration
Explanation:As the time of onset of fever is the 4th day of postpartum and absence of uterine tenderness on exam makes infection of vaginal laceration the most likely cause of this presentation.
Exquisite uterine tenderness will be experienced in case of endometritis and symptoms are expected to start much earlier like by 2-3 days of postpartum.
UTI is often expected on days one or two of postpartum, also there are no urinary symptoms suggestive of UTI
Breast engorgement usually develops by 7th -2st day of postpartum and in the given case it’s too soon for it to occur.
As it is expected during the first 2 hours postpartum, Atelectasis is unlikely to be the cause of symptoms in the given case.
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This question is part of the following fields:
- Obstetrics
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Question 21
Correct
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Regarding the biophysical profile:
Your Answer: Includes fetal movement, fetal tone, fetal breathing, fetal heart rate & amniotic fluid
Explanation:The biophysical profile is a composite test that collects 5 indicators of fetal well-being, including fetal heart rate reactivity, breathing movements, gross body movements, muscular tone, and quantitative estimation of amniotic fluid volume. The assessment of fetal heart rate is accomplished by performing a non-stress test, whereas the latter 4 variables are observed using real-time ultra-sonography.
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This question is part of the following fields:
- Biophysics
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Question 22
Incorrect
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Regarding the pelvic outlet, what structure marks the posterior boundary?
Your Answer: Ischial tuberosities
Correct Answer: Tip of the coccyx
Explanation:The bony pelvis is made up of a girdle with a central canal. The rim that surrounds the upper opening of the canal is called the pelvic inlet, while the lower rim is the called the pelvic outlet. The pelvic outlet is diamond-shaped and is bounded posteriorly by the tip of the sacrum, and anteriorly by the pubic symphysis, with its lateral boundaries being the ischial tuberosities and the sacrotuberous ligament.
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This question is part of the following fields:
- Anatomy
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Question 23
Incorrect
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From which germ layer does the myenteric plexus of the GI tract developed:
Your Answer: Mesoderm
Correct Answer: Neural crest of Ectoderm
Explanation:During the 5th week, the neural crest cells migrate along each side of the spinal cord where they form ganglions located dorsolateral to the aorta. Some of these cells migrate ventrally and form neurons in the preaortic ganglia as the celiac and mesenteric ganglia.
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This question is part of the following fields:
- Embryology
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Question 24
Incorrect
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During the filling phase of micturition. At what bladder volume is the first urge to void felt?
Your Answer: 50ml
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.
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This question is part of the following fields:
- Anatomy
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Question 25
Incorrect
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A 41-year-old G2P1 woman who is at 30 weeks gestational age presented to the medical clinic for a routine OB visit. Upon history taking, it was noted that her first pregnancy was uncomplicated and was delivered 10 years ago. At 40 weeks then, she had a normal vaginal delivery and the baby weighed 3.17kg.
In her current pregnancy, she has no complications and no significant medical history. She is a non-smoker and has gained about 11.3 kg to date. She also declined any testing for Down syndrome even if she is of advanced maternal age.
Upon further examination and observation, the following are her results:
Blood pressure range has been 100 to 120/60 to 70
Fundal height measures only 25 cm
Which of the following is most likely the reason for the patient’s decreased fundal height?Your Answer: Hydramnios
Correct Answer: Fetal growth restriction
Explanation:A fundal height measurement is typically done to determine if a baby is small for its gestational age. The measurement is generally defined as the distance in centimetres from the pubic bone to the top of the uterus. The expectation is that after week 24 of pregnancy the fundal height for a normally growing baby will match the number of weeks of pregnancy — plus or minus 2 centimetres.
A fundal height that measures smaller or larger than expected — or increases more or less quickly than expected — could indicate:
– Slow fetal growth (intrauterine growth restriction)
– A multiple pregnancy
– A significantly larger than average baby (fetal macrosomia)
– Too little amniotic fluid (oligohydramnios)
– Too much amniotic fluid (polyhydramnios). -
This question is part of the following fields:
- Obstetrics
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Question 26
Correct
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A 27-year-old woman with primary infertility presents with secondary amenorrhoea that has been ongoing for twelve months. She states that she has been thinking about starting a family and was wondering if ovulation induction therapy was an option for her.
Which one of the following would be most valuable in predicting a poor response to ovulation induction therapy?Your Answer: Serum follicle-stimulating hormone (FSH).
Explanation:The tests listed can all be performed during the work-up of a woman with secondary amenorrhoea. They are useful in that they cam diagnosis the most likely cause for the amenorrhoea as well as guide the treatment required if the patient wanted to become pregnant. Of these, the hormone test best able to predict a poor response to ovulation-induction therapy is the follicle-stimulating hormone (FSH) assay. If there are high levels of FSH, most of the ovulation-induction therapies are ineffective, although the rare spontaneous pregnancy can occur.
To maximise the chance of pregnancy in patients with elevated FSH levels, the most effective technique is an ovum donation from a young woman. The ovum would be fertilised in the laboratory and transferred to the uterus of the woman with the high FSH level after administering hormonal preparation of her uterus.
If the FSH level is normal, ovulation-induction therapy is usually effective. For these patients, correction of thyroid function will be necessary if the thyroid function is not normal. Dopamine agonist therapy is indicated if the prolactin level is elevated. Clomiphene or gonadotrophin therapy can be used where the luteinising and oestradiol levels are low, normal, or minimally elevated.
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This question is part of the following fields:
- Gynaecology
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Question 27
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: Grade 2
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 28
Incorrect
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What type of drug is clavulanic acid?
Your Answer: DNA gyrase inhibitor
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 29
Incorrect
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Which immunoglobulin is the first to be synthesised by the neonate?
Your Answer: IgD
Correct Answer: IgM
Explanation:Fetal production of immunoglobulin begins early on at about 10 weeks gestation with the production of IgM antibodies. Maternal IgG, which is a key component of fetal immunity is passed on to the foetus through the placenta from 12 weeks of gestation. Secretory IgA is not produced until after birth, through breast milk.
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This question is part of the following fields:
- Immunology
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Question 30
Incorrect
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A 52 years old patient wants to see her options of HRT for menopausal symptoms.
Which statement is true about continues use of combined HRT?Your Answer:
Correct Answer: It increases the risk of breast cancer
Explanation:Most types of HRT increase the risk of breast cancer. But the risk is higher for those using combined HRT, which uses both oestrogen and progestogen. Vaginal oestrogens are not linked to an increased risk of breast cancer, whereas tibolone is. Taking HRT for 1 year or less only slightly increases breast cancer risk. However, the longer you take HRT the greater the risks are, and the longer they last.
Evidence is insufficient to conclude that long-term oestrogen therapy or hormone therapy use improves cardiovascular outcomes.
HRT containing oestrogen alone increases risk of endometrial cancer. However, this is not the case when using combined HRT.
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This question is part of the following fields:
- Gynaecology
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SESSION STATS - PERFORMANCE PER SPECIALTY
