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Question 1
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Warfarin is contraindicated during pregnancy.
Which of the following complications are possible to develop if warfarin is used in second trimester of pregnancy?Your Answer: Fetal optic atrophy
Explanation:Administration of warfarin should be avoided throughout pregnancy and especially during the first and third trimesters as it have the ability to cross placenta. Intake of warfarin during 6-12 weeks of gestation can results in fetal warfarin syndrome which is characterized by the following features:
– A characteristic nasal hypoplasia
– Short fingers with hypoplastic nails
– Calcified epiphyses, namely chondrodysplasia punctata, which is evident on X-ray as stippling of the epiphyses.
– Intellectual disability
– Low birth weightAs these effects are usually dose dependent, recent estimates shows that the risk of fetal warfarin syndrome is around 5% in babies of women who requires warfarin throughout pregnancy.
Later exposure as after 12 weeks, is associated with symptoms like central nervous system anomalies, including microcephaly, hydrocephalus, agenesis of corpus callosum, Dandy-Walker malformation which is presented with complete absence cerebellar vermis and enlarged fourth ventricle, and mental retardation, as well as eye anomalies such as optic atrophy, microphthalmia and Peter anomaly (anterior segment dysgenesis).
Those newborns exposed to warfarin in all three trimesters there will be blindness and other complication of exposed to warfarin in neonates include perinatal intracranial and other major bleeding episodes. -
This question is part of the following fields:
- Obstetrics
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Question 2
Correct
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The following drugs cross the placenta to the foetus, EXCEPT:
Your Answer: Heparin
Explanation:Standard heparin, an effective treatment for antepartum thromboembolic disease, is thought to be safe for the foetus since it does not cross the placenta.
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This question is part of the following fields:
- Pharmacology
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Question 3
Correct
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Which of the following is an appropriate treatment for Diazepam overdose?
Your Answer: Flumazenil
Explanation:Flumazenil is used for benzodiazepine overdose.
Naloxone is used for opioid overdose.
Parvolex (N-acetyl cysteine) is used for paracetamol overdose.
Protamine can be used for Heparin reversal.
Beriplex can be used for Warfarin reversal. -
This question is part of the following fields:
- Pharmacology
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Question 4
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Oxytocin binds to what receptor type?
Your Answer: G-protein-coupled receptors
Explanation:Oxytocin binds to the G protein coupled receptors that triggers the IP3 mechanism leading to an elevated intracellular calcium ion.
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This question is part of the following fields:
- Clinical Management
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Question 5
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Antenatal booking investigations include all of the following, EXCEPT:
Your Answer: Thyroid function
Explanation:These are the six routine blood tests that every mum-to-be has to undergo around week 7 of pregnancy: Full Blood Count, Blood Typing, Hepatitis B Screening, Syphilis Screening, HIV Screening and Oral Glucose Tolerance Test (OGTT)
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This question is part of the following fields:
- Obstetrics
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Question 6
Correct
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What is the typical volume increase of a non-pregnant uterus to term uterus?
Your Answer: 10ml to 5000ml
Explanation:Uterine blood flow increases 40-fold to approximately 700 mL/min at term. The uterus is 50–60 g with a volume of approximately 10ml prior to pregnancy and 1000 – 1200 g with a volume of 5000ml by term.
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This question is part of the following fields:
- Physiology
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Question 7
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Where is fetal DHEA produced?
Your Answer: Adrenals
Explanation:DHEA is formed in the mother’s adrenal gland as well as the fetal adrenal glands. These weak androgens are transported by the blood to the placenta and are converted into oestradiol, estrone and estriol in the trophoblast.
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This question is part of the following fields:
- Endocrinology
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Question 8
Correct
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Question 9
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A patient in a high-risk pregnancy clinic has a past obstetrical history of placenta previa and caesarean section has a breech presentation at 36 weeks gestation.
Which of the following is considered a risk factor in increasing the chance of term breech presentation?Your Answer: All of the above
Explanation:Breech presentation refers to the foetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first.
Clinical conditions associated with breech presentation include those that may increase or decrease fetal motility, or affect the vertical polarity of the uterine cavity. Prematurity, multiple gestations, aneuploidies, congenital anomalies, Mullerian anomalies, uterine leiomyoma, and placental polarity as in placenta previa are most commonly associated with a breech presentation. Also, a previous history of breech presentation at term increases the risk of repeat breech presentation at term in subsequent pregnancies.
Conditions that change the vertical polarity or the uterine cavity, or affect the ease or ability of the foetus to turn into the vertex presentation in the third trimester include:
– Mullerian anomalies
– Placentation
– Uterine leiomyoma
– Prematurity
– Aneuploidies and fetal neuromuscular disorders
– Congenital anomalies
– Polyhydramnios and oligohydramnios
– Laxity of the maternal abdominal wall. -
This question is part of the following fields:
- Obstetrics
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Question 10
Correct
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A 25 year old unmarried female presented with dizziness, nausea and vomiting for 1 week. According to her, she has been stressed recently and her usual menstrual period has been delayed by 4 weeks. Examination findings were normal. Which of the following is the most appropriate next step?
Your Answer: Dipstick for B-hCG
Explanation:There is high possibility of her being pregnant. Urine B-hCG has to be checked to exclude pregnancy.
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This question is part of the following fields:
- Gynaecology
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Question 11
Correct
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A 20-year-old female patient who is experiencing pelvic pain is being cared for at your clinic. She describes bilateral pain that began gradually and was accompanied by fever, vaginal discharge, and mild dysuria.
Her pelvic examination demonstrates uterine, adnexal, and cervical motion tenderness.
Which of the following is the most likely cause of the pain?Your Answer: PID
Explanation:Pelvic inflammatory disease (PID) refers to acute and subclinical infection of the upper genital tract in women, involving any or all of the uterus, fallopian tubes, and ovaries; this is often accompanied by involvement of the neighbouring pelvic organs. It results in endometritis, salpingitis, oophoritis, peritonitis, perihepatitis, and/or tubo-ovarian abscess.
Lower abdominal pain is the cardinal presenting symptom in women with PID. The abdominal pain is usually bilateral and rarely of more than two weeks’ duration. The character of the pain is variable, and in some cases, may be quite subtle. The recent onset of pain that worsens during coitus or with jarring movement may be the only presenting symptom of PID. The onset of pain during or shortly after menses is particularly suggestive.
Other non-specific complaints include urinary frequency and abnormal vaginal discharge.
Ovarian cyst, uterine leiomyoma, appendicitis or ectopic pregnancy do not present with fever and vaginal discharge although tenderness is noted in appendicitis and ectopic pregnancy. Therefore, these options do not explain the patient’s symptoms.
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This question is part of the following fields:
- Gynaecology
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Question 12
Incorrect
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What percentage of haemoglobin is HbF by 6 months of age?
Your Answer: <2%
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)
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This question is part of the following fields:
- Physiology
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Question 13
Correct
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A 43-year-old woman complains of a greenish foul smelling discharge from her left nipple. She has experienced the same case before. What is the most likely diagnosis?
Your Answer: Duct ectasia
Explanation:Mammary duct ectasia occurs when the lactiferous duct becomes blocked or clogged. This is the most common cause of greenish discharge. Mammary duct ectasia can mimic breast cancer. It is a disorder of peri- or post-menopausal age.
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This question is part of the following fields:
- Gynaecology
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Question 14
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Which one of the following features is associated with Turner's syndrome?
Your Answer: Primary amenorrhea
Explanation:Turner syndrome patients present with primary amenorrhea. These ladies have non functional or streak ovaries and they cant conceive. Their genetic traits is 45X. They have a shielded chest, webbed neck and low height. These patients suffer from primary amenorrhea.
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This question is part of the following fields:
- Embryology
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Question 15
Correct
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A women in her 21-weeks of pregnancy, complaints of palpitations, sweating of palms, and increased nervousness.
Along with TSH what other investigations should be done for this patient?Your Answer: Free T4
Explanation:Patient mentioned in the case has developed thyrotoxicosis during pregnancy. TSH level should be tested, and if the result shows any suppressed or elevated TSH level, then it is mandatory to check for free T4 level.
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This question is part of the following fields:
- Obstetrics
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Question 16
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 17
Correct
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Among the below mentioned conditions which is not a contraindication to tocolysis?
Your Answer: Maternal hypothyroidism
Explanation:Contraindications to tocolysis in preterm labor are as follows:
– Gestational age > 34 weeks or <24 weeks
– Labor is too advanced with an advanced cervical dilation of >4 cm
– Abnormal CTG suggesting a non-reassuring fetal status
– Lethal fetal anomalies
– Intrauterine fetal demise
– Suspected fetal compromise
– Significant antepartum hemorrhage, such as placental abruption/ active vaginal bleeding with hemodynamic instability
– Any suspected intrauterine infections like chorioamnionitis
– Maternal hypotension
– Pregnancy-induced hypertension/ eclampsia/ pre-eclampsia
– Placenta previa
– Placental insufficiency
– Intrauterine growth retardation
– Maternal allergy to specific tocolytic agents or cases where tocolytics are contraindicated due to specific comorbidities like in case of cardiac disease, were beta agonists cannot be administered.As there are nonpulmonary morbidities associated with preterm birth, fetal pulmonary maturity, known or suspected, is not an absolute contraindication for tocolysis. These fetuses could potentially benefit from prolongation of pregnancy and from the nonpulmonary benefits of glucocorticoid therapy.
When cervical dilation is greater than 3 cm inhibition of preterm labor is less likely to be successful. In such cases Tocolysis can be considered when the goal is to administer antenatal corticosteroids or to safely transport the mother to a tertiary care center.
Maternal hypothyroidism which is usually treated with thyroxine is not a contraindication to suppression of labor.
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This question is part of the following fields:
- Obstetrics
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Question 18
Correct
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A 24-year-old college student comes to your clinic for contraception guidance. For the past three months, she has had migraine-like headaches once or twice a month. For the past two years, she has been taking combined oral contraceptive pills.
Which of the following suggestions is the most appropriate?Your Answer: Stopping the combined oral contraceptive pills and starting progesterone only pills (POP)
Explanation:Combined oral contraceptives are a safe and highly effective method of birth control, but they can also raise problems of clinical tolerability and/or safety in migraine patients. It is now commonly accepted that, in migraine with aura, the use of combined oral contraceptives is always contraindicated, and that their intake must also be suspended by patients suffering from migraine without aura if aura symptoms appear.
Discontinuation of contraception could risk in pregnancy. Barrier methods can be used but aren’t as effective as pills.
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This question is part of the following fields:
- Gynaecology
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Question 19
Correct
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The vulva is mainly supplied by which one of the following vessels?
Your Answer: Pudendal artery
Explanation:Vulva is defined by the area which is located outside the female vagina and comprises of the labia majora, labia minora, clitoris, mons pubis and Bartholin glands. It is supplied by the vestibula branch of pudental artery.
Inferior hemorrhoidal artery supplies the lower part of the rectum.
Femoral artery is the continuation of external iliac artery and supplies most of the leg. -
This question is part of the following fields:
- Anatomy
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Question 20
Correct
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A 24 year old female patient undergoes an STI screen due to development of dysuria 5 days earlier. The results are positive for chlamydia infection. With regard to contact tracing what is the recommended action regarding tracing and informing sexual partners in this case?
Your Answer: All sexual partners past 6 months
Explanation:In case a person tests positive for chlamydia, all sexual partners over the period of 6 months should to contacted and started on appropriate antibiotics.
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This question is part of the following fields:
- Clinical Management
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Question 21
Correct
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A 23-year-old lady comes to you for hirsutism therapy. She is overweight, with hirsutism and facial pimples on her face and peri areolar areas, as well as a masculine escutcheon. Serum LH levels range from 1.9 to 12.5 IU/L, whereas FSH levels range from 4.5 to 21.5 IU/L. The levels of androstenedione and testosterone are somewhat higher, while the serum DHAS is normal. The patient does not want to start a family right now.
Which of the single medications listed below is the best therapy for her condition?Your Answer: Oral contraceptives
Explanation:The clinical picture, unusually high LH-to-FSH ratio (which should ordinarily be around 1:1), and higher androgens but normal DHAS all point to polycystic ovarian syndrome (PCOS). DHAS is an indicator of adrenal androgen production; when normal, it rules out adrenal hyperandrogenism. Several drugs have been used to treat PCOS-related hirsutism. Contraceptives were the most often used medications for many years; they can decrease hair growth in up to two-thirds of individuals. They work by decreasing ovarian steroid production and increasing hepatic-binding globulin production, which binds circulating hormones and lowers metabolically active (unbound) androgen concentrations. Clinical improvement, on the other hand, can take up to 6 months to show.
Medroxyprogesterone acetate, spironolactone, cimetidine, and GnRH agonists, all of which decrease ovarian steroid synthesis, have also shown potential. GnRH analogues, on the other hand, are costly and have been linked to severe bone demineralization in some patients after only 6 months of treatment. Given the efficacy of pharmacologic medications and the ovarian adhesions that were usually linked with this surgery, surgical wedge resection is no longer regarded as an appropriate therapy for PCOS. -
This question is part of the following fields:
- Gynaecology
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Question 22
Correct
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You see a patient in antenatal clinic who is concerned that she has never had chicken pox and may catch it during pregnancy. You check her Varicella status and she is non-immune. She asks you about vaccination. What type of vaccine is the varicella vaccine?
Your Answer: Attenuated
Explanation:Varicella is a live vaccine. The recent RCOG green top guidelines suggest vaccine can be considered postpartum or pre pregnancy but NOT whilst pregnant. In the non-immune pregnant woman they should be advised to avoid contact with people with chickenpox or shingles and to contact a healthcare professional promptly if exposed. If they have a significant exposure VZIG should be offered as soon as possible.
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This question is part of the following fields:
- Immunology
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Question 23
Correct
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Question 24
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 25
Incorrect
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All of the following statements are considered correct regarding Down syndrome screening in a 40-year-old pregnant woman, except:
Your Answer: Chorionic villus sampling has miscarriage risk of 1 in 100
Correct Answer: Dating ultrasound along with second trimester serum screening test has detection rate of 97 percent
Explanation:Second-trimester ultrasound markers have low sensitivity and specificity for detecting Down syndrome, especially in a low-risk population.
The highest detection rate is acquired with ultrasound markers combined with gross anomalies. Although the detection rate with this combination of markers is high in a high-risk population (50 to 75 percent), false-positive rates are also high (22 percent for a 100 percent Down syndrome detection rate).
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This question is part of the following fields:
- Obstetrics
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Question 26
Correct
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Question 27
Correct
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A patient undergoes medical abortion at 9 weeks gestation. What is the advice regarding Rhesus Anti-D Immunoglobulin?
Your Answer: All RhD-negative women who are not alloimmunized should receive Anti-D IgG
Explanation:All non-sensitised RhD negative women should receive Anti-D IgG within 72 hours following abortion
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This question is part of the following fields:
- Clinical Management
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Question 28
Correct
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A 28-year-old woman presents in early labour. She is healthy and at full-term.
Her pregnancy has progressed well without any complications.
She indicates that she would like to have a cardiotocograph (CTG) to assess her baby as she has read about its use for foetal monitoring during labour.
What advice would you give her while counselling her regarding the use of CTG compared to intermittent auscultation during labour and delivery?Your Answer: There is no evidence to support admission CTG.
Explanation:In high-risk pregnancies, continuous monitoring of foetal heart rate is considered mandatory.
However, in low-risk pregnancies, cardiotocograph (CTG) monitoring provides no benefits over intermittent auscultation.
A significant issue with CTG monitoring is that apparent abnormalities are identified that usually have minimal clinical significance, but can prompt the use of several obstetric interventions such as instrumental deliveries and Caesarean section. In low risk patients, such interventions may not even be required.
CTG monitoring has not been shown to reduce the incidence of cerebral palsy or other neonatal developmental abnormalities, nor does it accurately predict previous foetal oxygenation status unless the CTG is significantly abnormal when it is first connected.
Similarly, CTG cannot accurately predict current foetal oxygenation unless the readings are severely abnormal.
Therefore, there is no evidence to support routine admission CTG (correct answer).
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This question is part of the following fields:
- Obstetrics
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Question 29
Correct
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A 41-year-old lady visits your clinic to talk about the results of her cervical screening test. According to the study, she has a low-grade squamous intraepithelial lesion as well as HPV non-16 and 18 subtypes. She had never previously had a cervical screening.
What is the best course of action for her management?Your Answer: Repeat HPV test in 12 months
Explanation:An LSIL Pap test shows mild cellular changes. The risk of a high-grade cervical precancer or cancer after an LSIL Pap test is as high as 19 percent.
As with an ASC-US Pap test, an LSIL Pap test is evaluated differently depending upon age. For women ages 25 or older, follow-up depends upon the results of human papillomavirus (HPV) testing:
– Women who test positive for HPV or who have not been tested for HPV should have colposcopy.
– Women who test negative for HPV can be followed up with a Pap test and HPV test in one year.All other options are not acceptable for the above mentioned reasons.
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This question is part of the following fields:
- Gynaecology
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Question 30
Correct
SESSION STATS - PERFORMANCE PER SPECIALTY
