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Question 1
Incorrect
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From which of the following spinal segments do both the internal and external anal sphincters receive their innervation?
Your Answer: S5
Correct Answer: S4
Explanation:The anal sphincters are responsible for closing the anal canal to the passage of faeces and flatus. The smooth muscle of the involuntary internal sphincter sustains contraction to prevent the leakage of faeces between bowel movements and is innervated by the pelvic splanchnic nerves, which are a branch of the spinal segment 4. The external sphincter is made up of skeletal muscle and can therefore contract and relax voluntarily. Its innervation comes from the inferior rectal branch of the pudendal nerve, and the perineal branch of S4 nerve roots.
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This question is part of the following fields:
- Anatomy
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Question 2
Incorrect
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Which of the following best describes the mechanism of action of Promethazine?
Your Answer: Serotonin 5-HT3 receptor antagonist
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 3
Correct
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All of the following may result from a bicornuate uterus except:
Your Answer: Congenital anomalies of the baby
Explanation:Literature review shows that bicornuate uterus is associated with increase risk of spontaneous abortion in about 36% of patients. There is also an increased risk of preterm birth, malpresentation and fetal growth retardation.
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This question is part of the following fields:
- Embryology
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Question 4
Correct
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A patient asks you in clinic when she can start trying to conceive again. She has just completed chemotherapy for gestational trophoblastic disease (GTD)?
Your Answer: 1 year from completion of treatment
Explanation:According to the RCOG greentop guidelines, a women who have underdone chemotherapy for GTD are advised not to conceive for 1 years after completion of the chemotherapy.
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This question is part of the following fields:
- Clinical Management
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Question 5
Incorrect
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Which cell type of the testis secrete inhibin?
Your Answer: Leydig cells
Correct Answer: Sertoli cells
Explanation:Summary points of the two key testicular cell types:
1. Sertoli Cells = Secrete Inhibin. Forms blood-testis barrier. Have FSH receptors
2. Leydig Cells = Secrete testosterone. Have LH receptors -
This question is part of the following fields:
- Anatomy
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Question 6
Correct
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Regarding implantation, how many days after fertilisation does it typically occur?
Your Answer: 8
Explanation:Fertilization usually occurs in the fallopian tubes after ovulation. The zygote moves through the fallopian tube and implants in the endometrium about 7-9 days after fertilisation, or 6-12 days after ovulation.
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This question is part of the following fields:
- Embryology
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Question 7
Incorrect
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An 18 year old girl presented with dysmenorrhea and irregular cycles. The most appropriate management in this case would be?
Your Answer: Anti-prostaglandins
Correct Answer: Combined pill
Explanation:Combined oral contraceptive pills have an anti ovulatory function and also reduce the pain of menstruation.
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This question is part of the following fields:
- Gynaecology
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Question 8
Incorrect
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A 29-year-old lady comes to your clinic for a refill on her oral contraceptive tablets (Microgynon 30®). You discover she has a blood pressure of 160/100mmHg during your examination, which is confirmed by a second reading 20 minutes later. Her husband and she are expecting a child in six months.
Which of the following recommendations is the best for her?Your Answer: She can continue the same OCP but should use methyldopa for hypertension
Correct Answer: She should stop OCP, use condoms for contraception and reassess her blood pressure in 3 months
Explanation:Overt hypertension, developing in about 5% of Pill users, and increases in blood pressure (but within normal limits) in many more is believed to be the result of changes in the renin-angiotensin-aldosterone system, particularly a consistent and marked increase in the plasma renin substrate concentrations. The mechanisms for the hypertensive response are unclear since normal women may demonstrate marked changes in the renin system. A failure of the kidneys to fully suppress renal renin secretion could thus be an important predisposing factor.
These observations provide guidelines for the prescription of oral contraceptives. A baseline blood pressure measurement should be obtained, and blood pressure and weight should be followed at 2- or 3-month intervals during treatment. Oral contraceptive therapy should be contraindicated for individuals with a history of hypertension, renal disease, toxaemia, or fluid retention. A positive family history of hypertension, women for whom long-term therapy is indicated, and groups such as blacks, especially prone to hypertensive phenomena, are all relative contraindications for the Pill.
All other options are incorrect.
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This question is part of the following fields:
- Gynaecology
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Question 9
Incorrect
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Which of the following medications, when given before & during pregnancy may help to protect neural tube defects?
Your Answer: Iron
Correct Answer: Folic acid
Explanation:Maternal exposure to dietary factors during pregnancy can influence embryonic development and may modulate the phenotype of offspring through epigenetic programming. Folate is critical for nucleotide synthesis, and preconceptional intake of dietary folic acid (FA) is credited with reduced incidences of neural tube defects in infants.
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This question is part of the following fields:
- Pharmacology
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Question 10
Incorrect
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You are asked to assess a patients perineal tear following labour by vaginal delivery. You note a laceration that extends approximately a quarter of the thickness through the external anal sphincter. How would you classify this tear?
Your Answer: 1st
Correct Answer: 3a
Explanation:1. First-degree trauma corresponds to lacerations of the skin/vaginal epithelium alone.
2. Second-degree tears involve perineal muscles and therefore include episiotomies.
3. Third-degree extensions involve any part of the anal sphincter complex (external and internal sphincters):
i Less than 50 per cent of the external anal
sphincter is torn.
ii More than 50 per cent of the external anal
sphincter is torn.
iii Tear involves the internal anal sphincter
(usually there is complete disruption of the
external sphincter).
4. Fourth-degree tears involve injury to the anal sphincter complex extending into the rectal mucosa. -
This question is part of the following fields:
- Anatomy
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Question 11
Incorrect
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A 30 year old patient is due for delivery in about two weeks. She has some concerns after a family member recently gave birth to a baby with profound hearing loss due to an infection. Which of the following would you describe to her as the most common infective cause of congenital hearing loss?
Your Answer: Mycobacteria
Correct Answer: Cytomegalovirus
Explanation:Congenital cytomegalovirus infections are the most common cause of sensorineural hearing loss in babies. Cytomegalovirus infection during the perinatal period can be transferred to the foetus especially if the primary infection is during pregnancy. Babies born with congenital CMV are either symptomatic or develop symptoms later in life. Some of the features of CMV infection include sensorineural hearing loss, visual impairment, cerebral palsy, microcephaly and seizures. Other causes of infective congenital sensorineural hearing loss include: Rubella, HIV, Herpes Simplex Virus, Measles, Varicella Zoster virus, Mumps and West Nile Virus.
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This question is part of the following fields:
- Microbiology
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Question 12
Incorrect
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Which of the following statements regarding the vaginal artery is typically TRUE?
Your Answer: It arises from the Uterine artery
Correct Answer: It arises from the Internal iliac artery
Explanation:The vaginal artery is the homolog to the inferior vesical artery in males. In most of the cases it arises from the internal iliac artery.
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This question is part of the following fields:
- Anatomy
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Question 13
Incorrect
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An 8-year-old girl presents with a history of a bright red bloodstain in her underpants one day prior to consultation. Her mother reports that the girl started cycling lessons one week ago. How will you proceed with the investigation in this case?
Your Answer: Local Examination
Correct Answer: Examination under Anaesthesia
Explanation:A local exam might not help in locating the cause of the bleeding because it might be underneath the superficial structures. A thorough examination should be done under GA to accurately locate the source of bleeding.
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This question is part of the following fields:
- Gynaecology
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Question 14
Incorrect
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A 42 year old smoker attends clinic due to vulval soreness and shows you a number of vulval lumps. Biopsy is taken and reported as showing
Your Answer: Lichen Sclerosus
Correct Answer: Vulval intraepithelial neoplasia (VIN)
Explanation:This is VIN. Smoking is a risk factor. It is also more common in immunocompromised patients.
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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 32 year old primigravida in her 12th week of gestation, presents to her GP with concerns regarding the evolution of her pregnancy. She's afraid she might experience an obstetric cholestasis just like her older sister did in the past. What is the fundamental symptom of obstetric cholestasis?
Your Answer: Pruritus
Correct Answer:
Explanation:Cholestasis of pregnancy is associated with increased fetal morbidity and mortality and should be treated actively. The significance attached to pruritus in pregnancy is often minimal, but it is a cardinal symptom of cholestasis of pregnancy, which may have no other clinical features.
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This question is part of the following fields:
- Obstetrics
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Question 16
Incorrect
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A 25 year old female with her LRMP 8 weeks ago, presented with severe abdominal pain and per vaginal bleeding. On examination there was tenderness over her left iliac region. Her pulse rate was 110 bpm and blood pressure was 90/65mmHg. Which of the following is the most appropriate management?
Your Answer: Salpingotomy
Correct Answer: Immediate laparotomy
Explanation:A ruptured ectopic pregnancy is the most probable diagnosis. As she is in shock (tachycardia and hypotension) immediate laparotomy is needed.
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This question is part of the following fields:
- Gynaecology
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Question 17
Incorrect
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A 22-year-old woman who is 28 weeks pregnant presented to the emergency department due to premature uterine contractions. Upon interview, it was noted the she has history of untreated mitral valve stenosis. Tocolysis was then planned after a necessary evaluation was performed and revealed that there is absence of contraindications.
Which of the following would be considered the drug of choice for tocolysis?Your Answer: Magnesium sulphate
Correct Answer: Oxytocin antagonists
Explanation:Tocolysis is an obstetrical procedure to prolong gestation in patients, some of which are experiencing preterm labour. This is achieved through various medications that work to inhibit contractions of uterine smooth muscle.
There is no definitive first-line tocolytic agent by the American College of Obstetrics and Gynecology (ACOG) but nifedipine is most commonly used. However, in severe aortic stenosis, nifedipine can cause ventricular collapse and dysfunction.
The therapeutic target in the treatment of preterm labour is currently the pharmacological inhibition of uterine contractions with the use of various tocolytic agents. Tocolytic agents are used to maintain pregnancy for 24–48 hours to allow corticosteroids administration to act and to permit the transfer of the mother to a centre with a neonatal intensive care unit.
Oxytocin inhibitors work by competitively acting at the oxytocin receptor site. Oxytocin acts to increase the intracellular levels of inositol triphosphate. The medications currently in this class are atosiban and retosiban. Maternal nor fetal side effects have not been described for this tocolytic.
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This question is part of the following fields:
- Obstetrics
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Question 18
Incorrect
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Endometriosis is an example of which of the following?
Your Answer: Pathological hypertrophy
Correct Answer: Pathological hyperplasia
Explanation:Endometriosis is a condition in which the endometrial tissue lies outside the endometrial cavity. There are 4 theories which explain this. First is pathological hyperplasia resulting in menstrual regurgitation and implantation, second is the coelomic epithelium transformation, third is immunogical factors and the fourth is via the lymphatic or vascular spread.
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This question is part of the following fields:
- Clinical Management
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Question 19
Correct
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Which of the following statements is true regarding heart rate in pregnancy?
Your Answer: Heart rate increases by 15 beats per minute
Explanation:During the first 12 weeks of pregnancy, cardiac output increases by about 30-50%. To maintain this increase, systemic vascular resistance decreases by 20-30%, while stroke volume and the heart rate increase by 25-30% and 15 beats per minute respectively.
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This question is part of the following fields:
- Physiology
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Question 20
Incorrect
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Regarding the female breast how many lobes does the typical breast contain?
Your Answer: 1
Correct Answer: 15-20
Explanation:The basic components of the mammary gland are the alveoli. These are lined with milk-secreting cuboidal cells surrounded by myoepithelial cells. The alveoli join to form groups known as lobules. The lobules form lobes. Each lobe has a lactiferous duct that drains into openings in the nipple. Each breast typically contains 15-20 lobes.
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This question is part of the following fields:
- Anatomy
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Question 21
Incorrect
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What percentage of testosterone is bound to SHBG?
Your Answer: 100%
Correct Answer: 70%
Explanation:About 97% of the testosterone that is secreted loosely binds to the SHBG and circulates in the blood for several hours in this bound state until it is transported to the target organs.
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This question is part of the following fields:
- Endocrinology
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Question 22
Incorrect
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A 21 year old married gravida 1 para 1 has not used her oral contraceptives for 6 months. She comes to your office for evaluation because her menstrual period is 2 weeks late. Her menses had been regular since discontinuing the oral contraceptives. A urine hCG is negative. Which one of the following is true regarding this situation?
Your Answer: A serum progesterone level should be drawn
Correct Answer: It is unlikely that she is pregnant
Explanation:With the high level of sensitivity and specificity of current tests to measure hCG in serum and urine, pregnancy can now be diagnosed before the time of the first missed menstrual period- For current serum hCG assays, the low threshold for detection is 10-25 IU/L, while for urine assays it is 25-50 IU/L, which corresponds to approximately the seventh day after conception. Because the levels of hCG in the blood and urine are very similar, the tests are equivalent. Urine testing may reveal a positive result as early as 3-4 days after implantation. By the time of the expected menstrual period, the test will be positive 98% of the time- If a test is negative more than 1 week after the expected time of the menstrual period, it is almost certain the patient is not pregnant. To cover these rare instances where a woman has a low hCG and conceived later than expected, the test should be repeated in 1 week for a definitive result.
Since ectopic pregnancy is not a life-threatening problem for the mother until 2 months after conception, a patient with a negative urine hCG does not require ultrasonography to exclude ectopic pregnancy. Patients with a suspected ectopic pregnancy and a negative urine hCG should be followed closely, as early laparoscopic intervention can improve the chances of future fertility.
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This question is part of the following fields:
- Gynaecology
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Question 23
Incorrect
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All of the following are features of Turner's syndrome except:
Your Answer: The nipples are widely spaced
Correct Answer: The ovaries are usually well developed
Explanation:Turner syndrome patients have malfunctioning or streak ovaries due to which they can never conceive. It affects females, who will have a short stature, widely spaced nipples, webbed neck and karyotyping shows 45XO.
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This question is part of the following fields:
- Embryology
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Question 24
Incorrect
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Among the following conditions which is not a contraindication to tocolysis?
Your Answer: Suspected fetal compromise as determined by cardiotocograph
Correct Answer: Maternal hypothyroidism
Explanation:Maternal hypothyroidism which is usually treated with thyroxine is not a contraindication for suppression of labour.
Suppression of labour known as tocolysis is contraindicated in situations like suspected foetal compromise, which is diagnosed by cardiotocograph warranting delivery, in cases of placental abruption, in chorioamnionitis, in severe pre-eclampsia, cases were gestational age is more than 34 weeks, in cases of foetal death in utero and in cases where palliative care is planned due to foetal malformations. -
This question is part of the following fields:
- Obstetrics
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Question 25
Incorrect
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A 31-year-old female patient seeks your opinion on an abnormal Pap smear performed by a nurse practitioner at a family planning facility. A high-grade squamous intraepithelial lesion is visible on the Pap smear (HGSIL).
Colposcopy was performed in the office. The impression is of acetowhite alterations, which could indicate infection by HPV. Chronic cervicitis is present in your biopsies, but there is no indication of dysplasia.
Which of the following is the most suitable next step in this patient's care?Your Answer: Hysterectomy
Correct Answer: Conization of the cervix
Explanation:When cervical biopsy or colposcopy doesn’t explain the severity of the pap smear results cone biopsy is done. In 10% of biopsies, results will be different from that of the pap smear as in this patient with pap smear showing HSIL and colposcopy showing chronic cervicitis.
In such cases conization is indicated. Repeating the pap smear could risk prompt management of a serious problem. No destructive procedure, ablation or cryotherapy, should be done before diagnosis is certain.
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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 of the following factors is fetal nutrition dependant on?
Your Answer: Maternal metabolism
Correct Answer: All of the options given
Explanation:Fetal nutrition is dependant upon multiple factors such as maternal nutritional state, quality of maternal diet, malnutrition, anorexia nervosa, metabolic rate of the mother or whether they suffer from malabsorption syndrome or other related conditions.
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This question is part of the following fields:
- Physiology
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Question 27
Incorrect
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A 25-year-old Aboriginal lady presents to antenatal clinic at 19 weeks of her gestation.
This is considered as the best time for which one of the following?Your Answer: Maternal serum screening for Down syndrome
Correct Answer: Ultrasound
Explanation:Between 18-20 weeks of gestation is the best time to perform an ultrasound for the identification of any physical or anatomical abnormalities including neural tube defects.
Maternal serum screening for Down syndrome is best performed between 15-17 weeks of pregnancy and this screening includes analysis of alpha fetoprotein, estriol, and beta-HCG in maternal blood. Conducting tests on accurate dates is necessary to obtain reliable results.
Amniocentesis which is very accurate for the diagnosis of chromosomal anomalies including Down syndrome, is best performed between 16-18 weeks of gestation and it carries a risk of 1 in 200 for miscarriage. Rh negative women will need Rh D immunoglobulin (anti-D).
Chorionic villus sampling is best performed between 10-12 weeks of gestation and carries a 1 in 100 risk of miscarriage, this test is also very much accurate for diagnosis of chromosomal anomalies. Rh negative women need Rh D immunoglobulin (anti-D).
It is best to perform rubella screen before conception than during pregnancy, this is because rubella vaccine is not recommended to be given to a pregnant mother as its a live vaccine.
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This question is part of the following fields:
- Obstetrics
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Question 28
Incorrect
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A 23 year old female patient with DVT on anticoagulant came to your clinic for advice. She is on combined OCPs.
What would you advice her?Your Answer: Discontinue anti-coagulants
Correct Answer: Progesterone only pill
Explanation:Women with medical conditions associated with increased risk for thrombosis generally should not use oestrogen-containing contraceptives.
The majority of evidence identified does not suggest an increase in odds for venous or arterial events with use of most POCs. Limited evidence suggested increased odds of VTE with use of injectables (three studies) and use of POCs for therapeutic indications (two studies, one with POCs unspecified and the other with POPs).
Discontinuing anticoagulants increases her risk of recurrent DVT.
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This question is part of the following fields:
- Gynaecology
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Question 29
Incorrect
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What is the most common Type II congenital thrombophilia?
Your Answer: Protein S deficiency
Correct Answer: Factor V Leiden mutation
Explanation:Factor V Leiden is the most common congenital thrombophilia. Named after the Dutch city Leiden where it was first discovered. Protein C and S deficiencies are type 1 (Not type 2) thrombophilias Antiphospholipid syndrome is an acquired (NOT congenital) thrombophilia
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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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Lidocaine works by blocking which of the following ion channels?
Your Answer:
Correct Answer: fast voltage gated sodium channels
Explanation:It blocks the voltage gated sodium channels and reduce the influx of sodium ions preventing depolarization of the membrane and blocking the conduction of the action potential. The affinity of the receptor site in the sodium channels depends on whether it is resting, open or inactive.
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This question is part of the following fields:
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
