-
Question 1
Correct
-
Which pharyngeal arch is closest to the head of the embryo?
Your Answer: 1st
Explanation:The arches are numbered according to their proximity to the head i.e. the 1st is the closest to the head end of the embryo and the 6th closest to the tail end as shown by the diagram below the table
-
This question is part of the following fields:
- Embryology
-
-
Question 2
Incorrect
-
Which of the following drugs is associated with reduced milk production whilst breastfeeding?
Your Answer: Domperidone
Correct Answer: Cabergoline
Explanation:Domperidone and metoclopramide are D2 dopamine receptor antagonists. They are primarily used to promote gastric motility. They are also known as galactagogues and they promote the production of milk. Cabergoline and bromocriptine are prolactin inhibitors and they reduce milk production.
-
This question is part of the following fields:
- Endocrinology
-
-
Question 3
Correct
-
A 16 year old girl has been referred as she has amenorrhoea. She reports never having periods. Her mother and 2 sisters menarche was at age 12. On examination you note the patient is 152cm tall and BMI 29.0 and secondary sexual characteristics are not developed. Her FSH is elevated. Prolactin is normal. What is the suspected diagnosis?
Your Answer: Turner Syndrome
Explanation:Turner syndrome is the most common chromosomal abnormality in females occurring in 1 in 2500 live births. It is characterised by short stature, webbed neck and wide carrying angle. It is also associated with renal, endocrine and CVS abnormalities. In this condition the ovaries do not completely develop and do not produce oestrogen or oocytes, thus no secondary sexual characteristic develop and neither does the girl starts menstruating.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 4
Correct
-
Gonadotropin-releasing hormone (GnRH) stimulates the release of:
Your Answer: Luteinizing hormone
Explanation:Gonadotropin-releasing hormone (GnRH) is the hormone responsible for the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary gland.
-
This question is part of the following fields:
- Endocrinology
-
-
Question 5
Correct
-
Regarding urinary tract infection (UTI) in pregnancy. What is the most common causative organism of urinary tract infection?
Your Answer: Escherichia coli
Explanation:E.coli is the most common cause of UTI. Other organisms include pseudomonas, proteus and klebsiella.
NICE guidelines: UTI in pregnancy (updated in July 2015)
Send urine for culture and sensitivity from all women in whom UTI is suspected before starting empirical antibiotics and 7 days after antibiotic treatment is completed.
Prescribe an antibiotic to all women with suspected UTI (awaiting culture result is not advised)
Although local antibiotic resistance needs to be taken into account the following is advised in terms of antibiotic selection:
1. Nitrofurantoin 50 mg QDS (or 100 mg MR BD) for 7 days.
2. Trimethoprim 200 mg twice daily, for 7 days
Give folic acid 5 mg OD if it is the 1st trimester
Do not give trimethoprim if the woman is folate deficient, taking a folate antagonist, or has been treated with trimethoprim in the past year.
3. Cefalexin 500 mg BD (or 250 mg 6qds) for 7 days -
This question is part of the following fields:
- Clinical Management
-
-
Question 6
Correct
-
From which germ cell layer does the GI tract initially develop?
Your Answer: Endoderm
Explanation:GI Tract initially forms via gastrulation from the endoderm of the trilaminar embryo around week 3. It extends from the buccopharyngeal membrane to the cloacal membrane. Later in development there are contributions from all three germ cell layers.
-
This question is part of the following fields:
- Embryology
-
-
Question 7
Incorrect
-
A 28-year-old, currently at 26 weeks’ gestation of her third pregnancy, presents with irregular uterine contractions for the past 24 hours and has concerns about premature delivery. She delivered her first child at 38 weeks of gestation and her second at 39 weeks gestation. On examination, BP and urinalysis have come back normal. Her symphysis-fundal height measures 27cm, the uterus is lax and non-tender. Fetal heart rate is 148/min. She also undergoes a pelvic examination along with other investigations.
Which findings would suggest that delivery is most likely going to happen before 30 weeks’ of gestation?
Your Answer: The cervix is closed, but the vaginal swab shows evidence of bacterial vaginosis.
Correct Answer: The cervix is closed, but the fetal fibronectin test on cervical secretions is positive.
Explanation:Predisposing factors of preterm delivery include a short cervix (or if it shortens earlier than in the third trimester), urinary tract or sexually transmitted infections, open cervical os, and history of a previous premature delivery. Increased uterine size can also contribute to preterm delivery and is seen with cases of polyhydramnios, macrosomia and multiple pregnancies. The shorter the cervical length, the greater the risk of a premature birth.
In this case, the risk of bacterial vaginosis and candidiasis contributing to preterm delivery would be lower than if in the context of an open cervical os. However, the risk of premature delivery is significantly increased if it is found that the fetal fibronectin test is positive, even if the os is closed. -
This question is part of the following fields:
- Obstetrics
-
-
Question 8
Correct
-
A women has undergone genetic testing due to her family history and has the BRCA 1 gene. What would you advise her lifetime risk of breast cancer is?
Your Answer: 70%
Explanation:The life time risk of breast cancer in BRCA 1 gene is 70% and of ovarian cancer is 40%.
-
This question is part of the following fields:
- Genetics
-
-
Question 9
Incorrect
-
A 18-year-old girl arrives at the ER with severe abdominal pain. When it started, she was in the school band. She says the pain began 30 minutes ago in the left lower region and didn't radiate. On a scale of 1 to 10, the discomfort is a 7 and is not accompanied by nausea, vomiting, or diarrhoea. Menarche began at the age of thirteen. Her menses were erratic at first, but she has had regular periods for the past six months.
Her vital signs are stable, and she has no fever. She uses combination oral contraceptives and is sexually active. She denies taking any other drugs. A flat abdomen with regular peristalsis is revealed on physical examination. Pelvic examination indicates a regular vagina with a normal-appearing cervix. There is no mucopurulent cervical discharge. Bimanual examination is remarkable with a tender 5-cm mass in the left adnexa.
A pregnancy test result is negative. A pelvic sonogram exhibits a normal intrauterine pregnancy and a 5 X 6 cm complex mass of the left ovary, with focal areas of calcification.
Which of the following is the most likely diagnosis?Your Answer: Serous cystadenoma
Correct Answer: Cystic teratoma
Explanation:Mature cystic teratomas of the ovary are often discovered as incidental findings on physical examination, during radiographic studies, or during abdominal surgery performed for other indications.
Most mature cystic teratomas can be diagnosed at ultrasonography (US) but may have a variety of appearances, characterized by echogenic sebaceous material and calcification.
Follicular cysts are simple fluid-filled cysts and never have calcifications.
Mucinous cystadenoma usually develop in the third to fifth decades of life and typically cause vague symptoms, such as increasing abdominal girth, abdominal or pelvic pain, emesis, fatigue, indigestion, constipation, and urinary incontinence However, calcifications are not usually seen.
Brenner tumour is also a benign epithelial ovarian tumour but it is solid, occurring most often in women over 50 years of age.
Serous cystadenoma also does not show calcifications.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 10
Incorrect
-
An 18 year old and has yet to begin her period. She stands at 4'10. She shows no signs of breast development. She has no pubic hair on pelvic examination. The patient has a cervix and uterus, according to digital inspection. The ovaries cannot be felt. Serum FSH and LH levels are drawn as part of the workup, and both are elevated. Which of the following is the most likely cause of this patient's delayed puberty and sexual infantilism?
Your Answer: Adrenogenital syndrome (testicular feminization)
Correct Answer: Gonadal dysgenesis
Explanation:In girls, delayed puberty and primary amenorrhea may be subdivided according to associated changes in stature. If the affected girl is short, the likely causes are gonadal dysgenesis (Turner syndrome) or hypopituitarism (with both gonadotropin and growth hormone deficiency). Gonadal dysgenesis results from the absence of a sex chromosome or other abnormality of a sex chromosome. In affected girls the gonads are streaks of fibrous tissue and contain no follicles, and these girls may have a variety of congenital anomalies, including a webbed neck, a shieldlike chest, or a small jaw.
Kallmann syndrome presents with amenorrhea, infantile sexual development, low gonadotropins, normal female karyotype, and anosmia (the inability to perceive odours).
In Müllerian agenesis, the Müllerian ducts either fail to develop or regress early in fetal life. These patients have normal ovarian development and normal secondary sexual characteristics. They present with a blind vaginal pouch and no upper vagina, cervix, or uterus, and primary amenorrhea.
The McCune-Albright syndrome rather presents with precocious puberty.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 11
Incorrect
-
Question 12
Incorrect
-
Which of the following is contained within the deep perineal pouch?
Your Answer: Superficial transverse perineal muscle
Correct Answer: Proximal portion of urethra
Explanation:The deep perineal pouch contains the external urethral sphincter, proximal urethra in females and membranous urethra in males, deep transverse perineal muscles and the glands of cowper.
-
This question is part of the following fields:
- Anatomy
-
-
Question 13
Incorrect
-
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 oestradiol
Correct 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.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 14
Incorrect
-
Regarding the closure of the ductus arteriosus (DA) after birth which of the following most accurately describes the mechanisms leading to closure of the DA?
Your Answer: None of the above
Correct Answer: Increased arterial pO2, increased bradykinin & decreased Prostaglandin E2
Explanation:Functional closure of the ductus arteriosus is neonates is completed within the first few days after birth. It normally occurs by the 12th postnatal week. It has been suggested that persistent patency of DA results from a failure of the TGF-B induction after birth. Due to increased arterial pO2, constriction of the DA occurs. In addition to this on inflation the bradykinin system is activated with cause the smooth muscles in the DA to constrict. A decrease in the E2 prostaglandin is also an important factor as raised levels have been indicated in keeping the patency of the DA.
-
This question is part of the following fields:
- Embryology
-
-
Question 15
Correct
-
A 33 year old lady presented with complaints of heavy menstrual bleeding. She is otherwise well and her US abdomen is normal. What is the best treatment option?
Your Answer: Mirena coil
Explanation:Mirena coil is used for contraception and for long term birth control. It causes stoppage of menstrual bleeding however, in a few cases there may be inter-menstrual spotting.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 16
Correct
-
What kind of epithelium lines the endocervix?
Your Answer: Columnar
Explanation:Its important to note the endo and ectocervix have 2 epithelial types. Where columnar and squamous epithelia meet is the transformation zone (or squamous-columnar junction, SCJ). This is relevant as it is the primary site for dysplasia and is where smears are taken from.
-
This question is part of the following fields:
- Pathology
-
-
Question 17
Incorrect
-
A 23-year-old woman complains of a tender lump that is smooth and mobile in her left breast measuring 1-2 cm. What is the most likely diagnosis?
Your Answer: Breast abscess
Correct Answer:
Explanation:Fibroadenoma usually occurs in younger women. These non-tender masses can be removed for aesthetic purposes. Breast cysts are common shifting masses inside the breast tissue more common in women over the age of 35.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 18
Incorrect
-
Question 19
Incorrect
-
A 34 weeks pregnant patient has a blood pressure of 149/98. Urine dipstick shows protein 3+. You send a for a protein:creatinine ratio. What level would be diagnostic of significant proteinuria?
Your Answer: >130 mg/mmol
Correct Answer: >30 mg/mmol
Explanation:Pre-eclampsia is defined as hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hour collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the sixth postpartum week. Significant proteinuria = urinary protein: creatinine ratio >30 mg/mmol or 24-hour urine collection result shows greater than 300 mg protein.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 20
Incorrect
-
A 31 year old is being seen in EPU and you are asked to review her ultrasound. There is a solid collection of echoes with numerous small (3-10 mm) anechoic spaces. What is the likely diagnosis?
Your Answer: Ectopic Pregnancy
Correct Answer: Molar Pregnancy
Explanation:Gestational trophoblastic disorder is characterized by an abnormal trophoblastic proliferation and include a complete and partial mole. It is characterized by persistently elevated BHCG levels after pregnancy and on ultrasound a snow storm appearance. These appear as anechoic areas on ultrasound.
-
This question is part of the following fields:
- Data Interpretation
-
-
Question 21
Incorrect
-
Regarding menstruation, which of the following is the maximum normal blood loss?
Your Answer: 150-200ml
Correct Answer: 80-85ml
Explanation:Most women lose about 35-40 ml of blood on average during each menstrual cycle. The maximum amount of blood loss is 80 ml after which blood loss of more than 80 ml is defined as heavy menstrual bleeding, formerly known as menorrhagia.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 22
Incorrect
-
A 33-year-old 'grand multiparous' woman, who has previously delivered seven children by normal vaginal delivery, spontaneously delivers a live baby weighing 4750gm one hour ago after a three-hour long labour period. Shortly after, an uncomplicated third stage of labour, she goes into shock (pulse 140/min, BP 80/50 mmHg). At the time of delivery, total blood loss was noted at 500mL, and has not been excessive since then. What is the most probable diagnosis of this patient?
Your Answer: Overwhelming infection.
Correct Answer: Uterine rupture.
Explanation:The patient most likely suffered a uterine rupture. It occurs most often in multiparous women and is less often associated with external haemorrhage. Shock develops shortly after rupture due to the extent of concealed bleeding.
Uterine inversion rarely occurs when after a spontaneous and normal third stage of labour. Although it can lead to shock, it is usually associated with a history of controlled cord traction or Dublin method of placenta delivery before the uterus has contracted. This diagnosis is also strongly considered when shock is out of proportion to the amount of blood loss.
An overwhelming infection is unlikely in this case when labour occurred for a short period of time. Uterine atony and amniotic fluid embolism are more associated with excessive vaginal bleeding, which is not evident in this case.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 23
Incorrect
-
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: Enterococcus
Correct 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.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 24
Incorrect
-
Androgen insensitivity syndrome is characterised by which one of the following karyotypes?
Your Answer: 46XX
Correct Answer: 46XY
Explanation:Genetically, patients suffering from androgen insensitivity syndrome are 46XY. They are males but insensitive to male hormones i.e. androgens.
-
This question is part of the following fields:
- Embryology
-
-
Question 25
Incorrect
-
The major cause of the increased risk of morbidity & mortality among twin gestation is:
Your Answer: Placenta previa
Correct Answer: Preterm delivery
Explanation:Twin pregnancy is associated with a number of obstetric complications, some of them with serious perinatal consequences, especially for the second twin. The rate of perinatal mortality can be up to six times higher in twin compared to singleton pregnancies, largely due to higher rates of preterm delivery and fetal growth restriction seen in twin pregnancies. Preterm birth and birth weight are also significant determinants of morbidity and mortality into infancy and childhood. More than 50% of twins and almost all triplets are born before 37 weeks of gestation and about 15–20% of admissions to neonatal units are associated with preterm twins and triplets.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 26
Correct
-
You are asked to assess a patients perineal tear following labour by vaginal delivery. You note a laceration that extends through the vaginal mucosa into the perineal muscle and fascia. The external anal sphincter appears to be in tact. How would you classify this tear?
Your Answer: 2nd
Explanation:If the external anal sphincter is in tact then this is a 1st or 2nd degree tear. As the perineal muscles are involved this is 2nd degree tear.
-
This question is part of the following fields:
- Anatomy
-
-
Question 27
Incorrect
-
What percentage of haemoglobin is HbF by 6 months of age?
Your Answer: 70-90%
Correct Answer:
Explanation:HB gower 1 is the predominant embryonic haemoglobin when the foetus is 6 week old and is replaced by adult haemoglobin by the age of 5 months post natally. Only 2% of the haemoglobin is HbF.
Embryonic Haemoglobin:
Haemoglobin Gower 1 (HbE Gower-1)
Haemoglobin Gower 2 (HbE Gower-2)
Haemoglobin Portland I (HbE Portland-1)
Haemoglobin Portland II (HbE Portland-2)Fetal Haemoglobin (haemoglobin F, HbF)
-
This question is part of the following fields:
- Physiology
-
-
Question 28
Correct
-
A 32-year-old woman, who is 18 weeks pregnant, is diagnosed with antiphospholipid syndrome and positive anticardiolipin antibodies. She has a history of three miscarriages, each one during the first trimester. What would be the next most appropriate step?
Your Answer: Aspirin & heparin
Explanation:The syndrome with which the woman was diagnosed is an autoimmune, hypercoagulable state which most possibly was the reason of her previous miscarriages. This is the reason why she should be on aspirin and heparin in order to prevent any future miscarriage.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 29
Incorrect
-
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: Enterococcus
Correct Answer: Gardnerella vaginalis
Explanation:Bacterial vaginosis is characterised by a foul smelling vaginal discharge without inflammation. The most common spp to cause this is gardnerella vaginalis. Other spp include mycoplasma hominis and bacteroides. It occurs due to growth and increase in anaerobic spp with simultaneous reduction in lactobacilli in vaginal flora causing an increase in vaginal pH. It is the most common cause of abnormal vaginal discharge in women of childbearing age.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 30
Incorrect
-
You diagnose Erb-Duchenne palsy in a baby born with shoulder dystocia who suffered a brachial plexus injury. Which of the following nerve roots are likely to be affected?
Your Answer:
Correct Answer: C5 and C6
Explanation:Shoulder dystocia occurs when the fetal shoulder impacts on the maternal symphysis or sacrum during vaginal delivery. About 10% of babies with shoulder dystocia will suffer a brachial plexus injury, the most common one being Erb-Duchenne palsy. In Erb’s palsy, the upper nerve roots C5 and C6 are damaged due to excessive widening of the angle between the head and the shoulder. This causing temporary paralysis in the affected arm whereby the infant will present with its hand hanging limp by his side, internal rotation of the forearm, plus wrist and finger flexion. This sign is called the ‘waiter’s tip hand’. The palsy usually resolves spontaneously in a large proportion of cases.
-
This question is part of the following fields:
- Clinical Management
-
SESSION STATS - PERFORMANCE PER SPECIALTY
