-
Question 1
Incorrect
-
What is the male infertility rate in CF patients?
Your Answer: 40%
Correct Answer: 98%
Explanation:Cystic fibrosis is the most common fetal genetic disease in Caucasians and has an autosomal recessive inheritance. It is caused by an abnormal chloride channel due to a defect in the CFTR gene. Complications range from haemoptysis, respiratory failure, biliary cirrhosis, diabetes and male infertility. Men with CF are infertile in 98% of the cases due to failure of development of the vas deference.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 2
Correct
-
Which one will decrease the risk of acquiring uterine fibroids?
Your Answer: Smoking
Explanation:Risk factors of fibroids include early menarche, nulliparity, early exposure to oral contraceptives (one study showed 13-16 years old), diet rich in red meats and alcohol, vitamin D deficiency, hypertension, obesity, and/or history of sexual or physical abuse.
Smoking is associated with actual reduced risk due to an unknown mechanism.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 3
Correct
-
Which of the following hormones is produced by the hypothalamus in response to breastfeeding?
Your Answer: Oxytocin
Explanation:Nipple stimulation during breastfeeding triggers the production of oxytocin from the hypothalamus and its subsequent release from the posterior pituitary gland. The hormone causes the myoepithelial cells of the breast to contract causing milk to flow through the ducts.
Ergometrine and Prostaglandin E2 are used during labour to control uterine bleeding after delivery, or ripen the cervix, while Atosiban is an oxytocin antagonist.
Antidiuretic hormone is also released from the posterior pituitary, and acts on the kidneys to decrease fluid excretion.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 4
Correct
-
What are the branches of the pudendal nerves in women?
Your Answer: Perineal, inferior anal and dorsal nerve of clitoris
Explanation:The pudendal nerve provides sensory and motor innervation to regions of the anus, the perineum, the labia and the clitoris in women. The nerve is formed from the ventral rami of the S2-S4 sacral spinal nerves. The nerve is paired, each innervating the left and the right side of the body. The nerve gives the following branches in females: the inferior anal nerve, the perineal nerve and the dorsal nerve of the clitoris.
-
This question is part of the following fields:
- Anatomy
-
-
Question 5
Incorrect
-
A patients MSU comes back showing heavy growth of E.coli that is resistant to trimethoprim, amoxicillin and nitrofurantoin. You decide to prescribe a course of Cephalexin. What is the mechanism of action of Cephalexin?
Your Answer: Beta Lactamase
Correct Answer: inhibit peptidoglycan cross-links in bacterial cell wall
Explanation:Cephalosporins are beta lactum drugs, like penicillin. They act by inhibiting the cross linkage of the peptidoglycan wall in bacteria.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 6
Incorrect
-
A 40-year-old woman arrives at the hospital at eight weeks of her first pregnancy, anxious that her kid may have Down syndrome. Which of the following best reflects the risk of spontaneous abortion after an amniocentesis performed at 16 weeks?
Your Answer: 39%
Correct Answer: 18%
Explanation:This question assesses critical clinical knowledge, as this information must be presented to a patient prior to an amniocentesis to ensure that she has given her informed permission for the treatment.
Amniocentesis is most typically used for genetic counselling in the second trimester of pregnancy. Another option is to do a chorion-villus biopsy (CVB) between 10 and 11 weeks of pregnancy.
The chances of miscarriage after both operations are roughly 1 in 200 for amniocentesis and 1 in 100 for CVB, according to most experts.
The significance of this question is that professionals must be able to weigh the procedure’s danger against the risk of the sickness they are trying to identify. -
This question is part of the following fields:
- Obstetrics
-
-
Question 7
Incorrect
-
Which increases the risk for developing endometrial cancer?
Your Answer: Multiparity
Correct Answer: Early menarche
Explanation:Endometrioid endometrial carcinoma is oestrogen-responsive, and the main risk factor for this disease is long-term exposure to excess endogenous or exogenous oestrogen without adequate opposition by a progestin.
Early age at menarche is a risk factor for endometrial carcinoma in some studies; late menopause is less consistently associated with an increased risk of the disease. Both of these factors result in prolonged oestrogen stimulation and at times of the reproductive years during which anovulatory cycles are common
Other risk factors include
obesity,
nulliparity,
diabetes mellitus, and
hypertension.The risk of endometrial hyperplasia and carcinoma with oestrogen therapy can be significantly reduced by the concomitant administration of a progestin. In general, combined oestrogen-progestin preparations do not increase the risk of endometrial hyperplasia.
Endometrial carcinoma usually occurs in postmenopausal women (mean age at diagnosis is 62 years). Women under age 50 who develop endometrial cancer often have risk factors such as obesity or chronic anovulation.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 8
Incorrect
-
A 24-year-old woman presented to the medical clinic for advice regarding pregnancy. Upon history taking and interview, it was noted that she had a history of valvular heart disease. She has been married to her boyfriend for the last 2 years and she now has plans for pregnancy.
Which of the following can lead to death during pregnancy, if present?Your Answer: Aortic stenosis
Correct Answer: Mitral stenosis
Explanation:Mitral stenosis is the most common cardiac condition affecting women during pregnancy and is poorly tolerated due to the increased intravascular volume, cardiac output and resting heart rate that predictably occur during pregnancy.
Young women may have asymptomatic mitral valve disease which becomes unmasked during the haemodynamic stress of pregnancy. Rheumatic mitral stenosis is the most common cardiac disease found in women during pregnancy. The typical increased volume and heart rate of pregnancy are not well tolerated in patients with more than mild stenosis. Maternal complications of atrial fibrillation and congestive heart failure can occur, and are increased in patients with poor functional class and severe pulmonary artery hypertension.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 9
Correct
-
A 32-year-old female presented with a lump in the upper outer quadrant of her left breast, which is 1.5cm in size and tender. What is the initial investigation to be done?
Your Answer: Ultrasound
Explanation:Tenderness is usually suggestive of a benign breast mass such as a breast abscess. Ultrasound is used to distinguish solid from cystic structures and to direct needle aspiration for abscess drainage.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 10
Correct
-
Question 11
Incorrect
-
Which of the following statements regarding progesterone production in the ovary is true?
Your Answer: Synthesised from androgen by Theca cells
Correct Answer: Synthesised from cholesterol by Luteal cells
Explanation:After the release of the oocyte, the theca and the granulosa cells form the corpus luteum which undergoes extensive vascularization for continued steroidogenesis. Progesterone is secreted by the luteal cells and is synthesized from cholesterol.
-
This question is part of the following fields:
- Endocrinology
-
-
Question 12
Incorrect
-
A 29-year-old woman was admitted to the maternity unit of a hospital due to early labour. She is considered healthy and has experienced an uncomplicated pregnancy. She asked a question regarding fetal monitoring during labour and mentioned that she has heard about cardio tocography (CTG) being helpful for assessing the baby's wellbeing and in preventing fetal problems.
Which of the following is considered the most appropriate advice to give in counselling regarding the use of CTG as a predictor of fetal outcome and satisfactory labour compared with intermittent auscultation and whether CTG monitoring is able to reduce the risk of neonatal developmental abnormalities?Your Answer: CTG is a predictor of previous fetal oxygenation
Correct Answer: There is no evidence to support admission CTG
Explanation:Continuous CTG produces a paper recording of the baby’s heart rate and the mother’s labour contractions. Although continuous CTG provides a written record, mothers cannot move freely during labour, change positions easily, or use a birthing pool to help with comfort and control during labour. It also means that some resources tend to be focused on the need to constantly interpret the CTG and not on the needs of a woman in labour.
Continuous CTG was associated with fewer fits for babies although there was no difference in cerebral palsy; both were rare events. However, continuous CTG was also associated with increased numbers of caesarean sections and instrumental births, both of which carry risks for mothers. Continuous CTG also makes moving and changing positions difficult in labour and women are unable to use a birthing pool. This can impact on women’s coping strategies. Women and their doctors need to discuss the woman’s individual needs and wishes about monitoring the baby’s wellbeing in labour.
Future research should focus on events that happen in pregnancy and labour that could be the cause of long term problems for the baby.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 13
Incorrect
-
What is the average anteroposterior distance of the female pelvic outlet?
Your Answer: 11.5 cm
Correct Answer: 13 cm
Explanation:The pelvic outlet is bounded in front by the lower margin of the symphysis pubis, on each side by the descending ramus of the pubic bone, the ischial tuberosity and the sacrotuberous ligament, and posteriorly by the last piece of the sacrum. The AP diameter of the pelvic outlet is 13.5 cm and the transverse diameter is 11 cm.
-
This question is part of the following fields:
- Anatomy
-
-
Question 14
Incorrect
-
Oligohydramnios is defined as an amniotic fluid index of?
Your Answer: < 5 mm
Correct Answer:
Explanation:AFI involves measuring the depth of amniotic fluid pockets in all 4 quadrants.
Oligohydramnios AFI< 5cm or deepest amniotic fluid pocket < 2cm
Polyhydramnios AFI > 25cm or deepest amniotic fluid pocket > 8cm -
This question is part of the following fields:
- Biophysics
-
-
Question 15
Incorrect
-
A 24 year old patient presents as 24 weeks pregnant with vaginal discharge. Swabs show Chlamydia Trachomatis detected. Which of the following is the most appropriate treatment regime?
Your Answer: Azithromycin 1gm orally in a single dose
Correct Answer: Erythromycin 500 mg twice a day for 14 days
Explanation:The treatment of Chlamydia includes avoidance of intercourse, use of condoms and antibiotic treatment. Erythromycin 500mg orally QID for 7 days or Amoxicillin 500mg TDS for 7 days or Ofloxacin 200mg orally BD for 7 days.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 16
Correct
-
Question 17
Incorrect
-
What is the incidence of hyperthyroidism in complete molar pregnancy?
Your Answer: 30%
Correct Answer: 3%
Explanation:As B-HCG and TSH have similar structures, increased B-HCG can lead to hyperthyroidism, however there is only a 3% chance of this happening.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 18
Incorrect
-
Following parturition uterine contractions called Afterpains may typically continue for how long?
Your Answer: 7-14 days
Correct Answer: 2-3 days
Explanation:Oxytocin can also stimulate after pains that occur 2-3 following delivery.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 19
Correct
-
Question 20
Incorrect
-
What is the definition of hypertension in pregnancy?
Your Answer: A blood pressure above 140/90 mmHg
Correct Answer:
Explanation:The NICE guidelines on Hypertension in pregnancy define blood pressure in pregnancy as follows:
Mild hypertension: DBP=90-99 mmHg, SBP=140-149 mmHg. Moderate hypertension: DBP=100-109 mmHg, SBP=150-159 mmHg.
Severe hypertension: DBP=110 mmHg or greater, SBP=160 mmHg or greater. -
This question is part of the following fields:
- Obstetrics
-
-
Question 21
Incorrect
-
At the time of delivery, if there is a laceration of perineal body but not the anal sphincter, this type of laceration is classified as?
Your Answer: First degree
Correct Answer: Second degree
Explanation:Perineal tears are common at the time of child birth. First degree perineal laceration means that the wound is so small that it doesn’t require any stitches and usually heals on its own. 2nd degree means that skin and smooth muscles are both torn. 3rd degree tear means that the tear is beyond the perineal muscles and the muscles surrounding the anal canal, while in 4th degree, the perineal tear goes through the anal sphincter up to the rectum.
-
This question is part of the following fields:
- Anatomy
-
-
Question 22
Correct
-
Immediate therapy for infants with suspected meconium should routinely include:
Your Answer: Clearing of the airway
Explanation:Immediate treatment for infants with suspected meconium aspiration syndrome is to clear/suction the airway. Intubation and tracheal toileting have remained a matter of debate till the most recent times. All neonates at risk of MAS who show respiratory distress should be admitted to a neonatal intensive care unit and monitored closely. The treatment is mainly supportive and aims to correct hypoxemia and acidosis with the maintenance of optimal temperature and blood pressure.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 23
Incorrect
-
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:
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
-
-
Question 24
Incorrect
-
During pregnancy, maternal oestrogen levels increase markedly. Most of this oestrogen is produced by the:
Your Answer:
Correct Answer: Placenta
Explanation:The placenta does not have all the necessary enzymes to make oestrogens from cholesterol, or even progesterone. Human trophoblast lack 17-hydroxylase and therefore cannot convert C21-steroids to C19-steroids, the immediate precursors of oestrogen. To bypass this deficit, dehydroisoandrosterone sulphate (DHA) from the fetal adrenal is converted to estradiol-17ί by trophoblasts. In its key location as a way station between mother and foetus, placenta can use precursors from either mother or foetus to circumvent its own deficiencies in enzyme activities.
-
This question is part of the following fields:
- Physiology
-
-
Question 25
Incorrect
-
Regarding CTG (cardiotocography) analysis what is the normal range for variability?
Your Answer:
Correct Answer: 5-25 bpm
Explanation:Fetal hypoxia may cause absent, increased or decreased variability. Other causes of decreased variability include: normal fetal sleep-wake pattern, prematurity and following maternal administration of certain drugs including opioids.
Variability Range:
Normal – 5 bpm – 25bpm
Increased – >25 bpm
Decreased – <5 bpm
Absent – <2 bpm -
This question is part of the following fields:
- Data Interpretation
-
-
Question 26
Incorrect
-
A 29-year-old woman had just delivered a stillborn vaginally, following a major placental abruption. Choose the single most likely predisposing factor for developing PPH in this woman?
Your Answer:
Correct Answer: DIC
Explanation:Disseminated intravascular coagulation (DIC) in pregnancy is the most common cause of an abnormal haemorrhage tendency during pregnancy and the puerperium. Although pregnancy itself can cause DIC, its presence is invariably evidence of an underlying obstetric disorder such as abruptio placentae, eclampsia, retention of a dead foetus, amniotic fluid embolism, placental retention or bacterial sepsis.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 27
Incorrect
-
A 52-year-old lady comes to your office with vaginal bleeding 7 hours after sexual intercourse. She hasn't had a menstrual period in over a year. A year ago, she had a normal pap smear. She has no other symptoms and appears to be in good condition.
Which of the following is the most likely underlying cause of this woman's postcoital bleeding?Your Answer:
Correct Answer: Vaginal atrophy
Explanation:Vaginal atrophy (thinning of vaginal tissue): Oestrogen helps to keep this tissue healthy. After menopause, low oestrogen levels can cause your vaginal walls to become thin, dry, and inflamed. That often leads to bleeding after sex.
Vaginal atrophy is the most common cause of post menopausal vaginal bleeding.
With a normal pap smear a year ago, this patient is unlikely to develop cervical cancer.
Cervical ectropions are not common in post-menopausal women.
Endometrial cancer and cervical polyps are possible causes of postcoital bleeding, however, they are not as common as vaginal atrophy.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 28
Incorrect
-
Regarding amniotic fluid volume:
Your Answer:
Correct Answer: Maybe predicted by ultrasound
Explanation:Amniotic fluid can be measured with the help of ultrasound to gauge the amniotic fluid index. The normal value ranges between 8-18.
Amniocentesis is a procedure by which amniotic fluid is removed. In rhesus disease, it appears yellow due to raised bilirubin levels. -
This question is part of the following fields:
- Physiology
-
-
Question 29
Incorrect
-
What percentage of pregnant women have asymptomatic vaginal colonisation with candida?
Your Answer:
Correct Answer: 40%
Explanation:90% of genital candida infections are the result of Candida albicans. 20% of women of childbearing age are asymptotic colonisers of Candida species as part of their normal vaginal flora. This increases to 40% in pregnancy
-
This question is part of the following fields:
- Clinical Management
-
-
Question 30
Incorrect
-
The vulva is mainly supplied by which one of the following vessels?
Your Answer:
Correct 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
-
-
Question 31
Incorrect
-
All of the following factors increase the risk of endometrial cancer except which one?
Your Answer:
Correct Answer: High Coffee Consumption
Explanation:The risk factors for uterine carcinoma include obesity, diabetes, Nulliparity, late menopause, unopposed oestrogen therapy, tamoxifen therapy, HRT and a family history of ovarian or uterine carcinoma.
-
This question is part of the following fields:
- Epidemiology
-
-
Question 32
Incorrect
-
A 27-year-old woman presents for difficulty and pain in attempting sexual intercourse. She states that she never had such symptoms prior. The pain is not felt at the time of penetration, but appears to hurt deeper in the vagina.
She was recently pregnant with her first child and delivery was three months ago. She did not have an episiotomy or sustain any vaginal lacerations during delivery. She denies any vaginal bleeding since her lochia had stopped two months ago. She is still breastfeeding her child.
Which of the following is the most likely cause of her dyspareunia?Your Answer:
Correct Answer: Atrophic vaginal epithelium.
Explanation:This is a patient that recently gave birth and is still breastfeeding presenting with dyspareunia. The most likely cause would be a thin atrophic vaginal epithelium. This is very common presentation and is due to the low oestrogen levels due to the prolactin elevation from breastfeeding.
An unrecognised and unsutured vaginal tear should have healed by this time and should not be causing issues.
Endometriosis tends to resolve during a pregnancy, but if this was the issue, it would have caused dyspareunia prior to pregnancy.
Vaginal infective causes of dyspareunia, such as monilial or trichomonal infections, are rare in amenorrhoeic women.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 33
Incorrect
-
A 32 year old woman with a 6 month history of fatigue and some weight gain reports to clinic for a review. Her medical records show evidence of hypothyroidism. On examination, a non tender, hard goitre is palpated. Further tests reveal elevated anti TPO (anti thyroid peroxidase) and anti -Tg (anti thyroglobulin). Which of the following conditions is most likely to present like this?
Your Answer:
Correct Answer: Hashimoto's
Explanation:The case presented points to a diagnosis of an autoimmune thyroiditis leading to hypothyroidism. The most common form of autoimmune hypothyroidism, Hashimoto’s, often presents with a goitre, positive for antibody tests against thyroid components i.e. anti-TPO and anti-thyroglobulin. Graves disease and toxic diffuse goitre are more likely to cause hyperthyroidism. While De-Quervain’s and endemic goitre may cause hypothyroidism, they don’t result in positive antibody tests.
-
This question is part of the following fields:
- Endocrinology
-
-
Question 34
Incorrect
-
Question 35
Incorrect
-
During wound healing the clotting cascade is activated. Which of the following activates the extrinsic pathway?
Your Answer:
Correct Answer: Tissue Factor
Explanation:The extrinsic pathway is activated by the tissue factor, which converts factor VII to VIIa which later on converts factors X and II to their activated form finally leading to the conversion of fibrinogen to fibrin fibres.
-
This question is part of the following fields:
- Physiology
-
-
Question 36
Incorrect
-
Question 37
Incorrect
-
According to the WHO, maternal mortality ratio is defined as which of the following?
Your Answer:
Correct Answer: Maternal deaths per 100,000 live births
Explanation:The World Health Organisation defines the maternal mortality ratio as the number of maternal deaths during a given period per 100,000 live births during the same period. This measure indicates the risk of death in a single pregnancy.
-
This question is part of the following fields:
- Epidemiology
-
-
Question 38
Incorrect
-
A 19-year-old female patient with secondary amenorrhea visits your office. A urine pregnancy test is negative. As part of your work-up, you order a pelvic ultrasound, which reveals a fluid filled, thin walled cyst measuring 1.8 x 1.3 x 1 cm. She doesn't complain of pain or tenderness.
What is the most appropriate next step?Your Answer:
Correct Answer: Do nothing
Explanation:An ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. Although the discovery of an ovarian cyst causes considerable anxiety in women owing to fears of malignancy, the vast majority of these lesions are benign.
Many patients with simple ovarian cysts based on ultrasonographic findings do not require treatment.
In a postmenopausal patient, a persistent simple cyst smaller than 10cm in dimension in the presence of a normal CA125 value may be monitored with serial ultrasonographic examinations.However, meta-analyses have since shown that there is no difference between OCP use and placebo in terms of treatment outcomes in ovarian cysts and that these masses should be monitored expectantly for several menstrual cycles.
If a cystic mass does not resolve after this timeframe, it is unlikely to be a functional cyst, and further workup may be indicated.
Other methods of management maybe revisited if cyst increases in size or becomes complex upon follow up.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 39
Incorrect
-
A 30 year old female with a history of two first trimester miscarriages presented at 9 weeks of gestation with per vaginal bleeding. Which of the following is the most appropriate management?
Your Answer:
Correct Answer: Aspirin
Explanation:Antiphospholipid syndrome is the most important treatable cause of recurrent miscarriage. The mechanisms by which antiphospholipid antibodies cause pregnancy morbidity include inhibition of trophoblastic function and differentiation, activation of complement pathways at the maternal–fetal interface, resulting in a local inflammatory response and, in later pregnancy, thrombosis of the uteroplacental vasculature. This patient should be offered referral to a specialist clinic as she has had recurrent miscarriages. Low dose aspirin is one of the treatment options to prevent further miscarriage for patients with antiphospholipid syndrome.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 40
Incorrect
-
Missed abortion may cause one of the following complications:
Your Answer:
Correct Answer: Coagulopathy
Explanation:A serious complication with a miscarriage is DIC, a severe blood clotting condition and is more likely if there is a long time until the foetus and other tissues are passed, which is often the case in missed abortion.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 41
Incorrect
-
A 28 year old women presents at 30 weeks complaining of intense itching particularly on the hands and feet that is worse in the evenings. She has taken cetirizine but this hasn't settled her symptoms. Examination is unremarkable with no rash. What is the likely diagnosis
Your Answer:
Correct Answer: Intrahepatic Cholestasis of Pregnancy
Explanation:The history is typical of Intrahepatic Cholestasis of Pregnancy, also known as obstetric cholestasis and prurigo gravidarum. The features are: Intense itching typically of the hands and feet Itch gets worse at night Responds poorly to antihistamines There is no rash. The mechanism is poorly understood but tests may show deranged LFTs. It usually resolves quickly after delivery. The other diagnoses listed are possible though less likely. Scabies normally has a rash
-
This question is part of the following fields:
- Clinical Management
-
-
Question 42
Incorrect
-
A 40-year-old woman who is at 34 weeks of pregnancy presented to the medical clinic for advice since her other two children were diagnosed with whooping cough just 8 weeks ago, she is worried for her newborn about the risk of developing whooping cough.
Which of the following is considered the most appropriate advice to give to the patient?Your Answer:
Correct Answer: Give Pertussis vaccine booster DPTa now
Explanation:To help protect babies during this time when they are most vulnerable, women should get the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) during each pregnancy.
Pregnant women should receive Tdap anytime during pregnancy if it is indicated for wound care or during a community pertussis outbreak.
If Tdap is administered earlier in pregnancy, it should not be repeated between 27 and 36 weeks gestation; only one dose is recommended during each pregnancy.Optimal timing is between 27 and 36 weeks gestation (preferably during the earlier part of this period) to maximize the maternal antibody response and passive antibody transfer to the infant.
Fewer babies will be hospitalized for and die from pertussis when Tdap is given during pregnancy rather than during the postpartum period. -
This question is part of the following fields:
- Obstetrics
-
-
Question 43
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:
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 44
Incorrect
-
In evaluating a reproductive age woman who presents with amenorrhea, which of the following conditions will result in a positive (withdrawal) progesterone challenge test?
Your Answer:
Correct Answer: Polycystic ovarian syndrome
Explanation:In pregnancy, progesterone is produced by the corpus luteum followed by the placenta- Exogenous progesterone will not lead to withdrawal bleeding. In ovarian failure as well as pituitary failure, no oestrogen stimulation of the endometrium exists, and progesterone cannot cause withdrawal bleeding. With Mullerian agenesis, there is no endometrium. Polycystic ovarian syndrome has an abundance of circulating oestrogen, so the endometrium will proliferate.
→ In pregnancy progesterone withdrawal will not occur since the corpus luteum is producing progesterone- The placenta will take over, starting at 7 weeks, and will be the sole producer of progesterone by 12 weeks.
→ In ovarian failure no oestrogen will be produced; no proliferation of the endometrium will occur.
→ Pituitary failure is an incorrect answer because without gonadotropin stimulation, there will not be enough oestrogen to stimulate the endometrial lining.
→ Mullerian agenesis is an incorrect answer – there is no uterus, thus no bleeding. -
This question is part of the following fields:
- Gynaecology
-
-
Question 45
Incorrect
-
A 25-year-old pregnant woman presented to your clinic complaining of urinary symptoms at 19 weeks of gestation.
She is allergic to penicillin, with non-anaphylactic presentation.
Urine microscopy confirmed the diagnosis of urinary tract infection and culture result is pending.
From the options below, which is the most appropriate treatment for this patient?Your Answer:
Correct Answer: Cephalexin
Explanation:According to the laboratory reports, patient has developed urinary tract infection and should be treated with one week course of oral antibiotics.
As the patient is pregnant, antibiotics like cephalexin, co-amoxiclav and nitrofurantoin must be considered as these are safe during pregnancy.Due to this Patient’s allergic history to penicillin, cephalexin can be considered as the best option. Risk of cross allergy would have been higher if the patient had any history of anaphylactic reactions to penicillin.
In Australia, Amoxicillin is not recommended to treat UTI due to resistance.Tetracyclines also should be avoided during pregnancy due to its teratogenic property.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 46
Incorrect
-
What is the main biochemical buffer in blood?
Your Answer:
Correct Answer: Bicarbonate
Explanation:Bicarbonate serves as the main buffer in the blood. Other than this phosphate, ammonia and haemoglobin also act as buffers to some extent.
-
This question is part of the following fields:
- Biochemistry
-
-
Question 47
Incorrect
-
A 26-year -old woman, who underwent an episiotomy during labour, presented with severe vaginal pain 4 days after the procedure.
At the site of the episiotomy, an 8-cm hematoma is noted on examination. Also the woman is found to be hemodynamically stable.
Among the following, which is considered the most appropriate next step in management?Your Answer:
Correct Answer: Explore the hematoma
Explanation:In most cases reported, puerperal hematomas arise due to bleeding lacerations related to operative deliveries or episiotomy, and in rare cases from spontaneous injury to a blood vessel in the absence of any laceration/incision of the surrounding tissue. Vulval, vaginal/paravaginal area and retroperitoneum are considered the most common locations for puerperal hematomas.
Most puerperal hematomas are diagnosed based on the presence of characteristic symptoms and physical examination findings:
VuIvar hematoma usually presents as a rapidly developing, severely painful, tense and compressible mass which is covered by skin of purplish discoloration. A vulvar hematoma can also be an extension of a vaginal hematoma which was dissected through a loose subcutaneous tissue into the vulva.
Vaginal hematomas often present with rectal pressure, were hemodynamic instability caused due to bleeding into the ischiorectal fossa and paravaginal space are the first signs and can result in hypovolemic shock. In these cases a large mass protruding into the vagina is often found on physical examination.
Retroperitoneal hematomas are asymptomatic initially and extend between the folds of broad ligament. Patients suffering will often present with tachycardia, hypotension or shock due to the significant accumulated of blood in the retroperitoneal space. Unless the hematoma is associated with trauma, patients will not present with pain, only signs will be a palpable abdominal mass or fever.Treatment of hematoma depends mostly on the size and location:
Non-expanding hematomas which are <3cm in size can be managed conservatively with analgesics and application of ice packs. An expanding hematoma or those greater than 3cm is managed effectively with surgical exploration under anesthesia, were an incision is made to evacuate the hematoma. The surgical site should not be sutured and vagina is often packed for 12-24 hours, an indwelling urinary catheter also may be indicated. In the given case, patient presents with a large haematoma (>3cm) which needs surgical excision and evacuation.Aspiration of the hematoma is not an appropriate treatment. If surgical intervention is indicated excision and evacuation is the preferred option, followed by vaginal packing for 12-24 hours.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 48
Incorrect
-
A 25-year-old Aboriginal woman at ten weeks of gestation presents with a 2-week history of nausea, vomiting and dizziness. She has not seen any doctor during this illness.
On examination, she is found to be dehydrated, her heart rate is 135 per minute (sinus tachycardia), blood pressure 96/60 mm of Hg with a postural drop of more than 20 mm of Hg systolic pressure and is unable to tolerate both liquids and solids.Urine contains ketones and blood tests are pending.
How will you manage this case?Your Answer:
Correct Answer: Give metoclopramide and intravenous normal saline
Explanation:Analysis of presentation shows the patient has developed hyperemesis gravidarum.
She is in early shock, presented as sinus tachycardia and hypotension, with ketonuria and requires immediate fluid resuscitation and anti-emetics. The first line fluid of choice is administration of normal saline 0.9%, and should avoid giving dextrose containing fluids as they can precipitate encephalopathy and worsens hyponatremia.The most appropriate management of a pregnant patient in this situation is administration of metoclopramide as the first line and Ondansetron as second line antiemetic, which are Australian category A and B1 drugs respectively. The following also should be considered and monitored for:
1. More refractory vomiting.
2. Failure to improve.
3. Recurrent hospital admissions.Steroids like prednisolone are third line medications which are used in resistant cases of hyperemesis gravidarum after proper consultation.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 49
Incorrect
-
Which of the following factors shifts the oxygen dissociation curve to the right?
Your Answer:
Correct Answer: Increased [H+]
Explanation:The following shift the oxygen dissociation curve to the right: Increased temperature Increased H+ (i.e. acidosis) Increased 2,3 DPG Increased pCO2 The following shift the oxygen dissociation curve to the left: Increasing pCO shifts the curve to the left Decreased temperature Decreased [H+] (alkalosis) Decreased 2,3 DPG The Oxygen Dissociation Curve for fetal haemoglobin lies to the left of the normal adult Oxygen Dissociation Curve as it has a higher affinity for Oxygen.
-
This question is part of the following fields:
- Biochemistry
-
-
Question 50
Incorrect
-
APGAR's score includes all the following, EXCEPT:
Your Answer:
Correct Answer: Blood pH
Explanation:Elements of the Apgar score include colour, heart rate, reflexes, muscle tone, and respiration. Apgar scoring is designed to assess for signs of hemodynamic compromise such as cyanosis, hypoperfusion, bradycardia, hypotonia, respiratory depression or apnoea. Each element is scored 0 (zero), 1, or 2. The score is recorded at 1 minute and 5 minutes in all infants with expanded recording at 5-minute intervals for infants who score 7 or less at 5 minutes, and in those requiring resuscitation as a method for monitoring response. Scores of 7 to 10 are considered reassuring.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 51
Incorrect
-
Spinnbarkheit is a term which means:
Your Answer:
Correct Answer: Threading of the cervical mucous
Explanation:Spinnability (or Spinnbarkeit), which measures the capacity of fluids to be drawn into threads, represents an indirect measurement of the adhesive and elastic properties of mucus.
-
This question is part of the following fields:
- Physiology
-
-
Question 52
Incorrect
-
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:
Correct 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.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 53
Incorrect
-
In reducing the risk of blood transfusion in pregnancy and labour which of the following strategies is recommended?
Your Answer:
Correct Answer: A Hb of less than 10.5g/l should prompt haematinics and exclusion of haemoglobinopathies
Explanation:Anaemia in pregnancy is most frequently caused by iron or folate deficiency, however, a wide variety of other causes may be considered, especially if the haemoglobin value is below 9.0 g/dL. A haemoglobin level of 11 g/dL or more is considered normal early in pregnancy, with the upper limit of the ‘normal range’ dropping to 10.5 g/dL by 28 weeks gestation. Haemoglobin < 10.5 g/dl in the antenatal period, one should exclude haemoglobinopathies and consider haematinic deficiency. Oral iron is 1st line treatment for iron deficiency. Anaemia not due to haematinic deficiency will not respond to any form of iron. This should be managed with transfusion
-
This question is part of the following fields:
- Clinical Management
-
-
Question 54
Incorrect
-
A 36 year old woman has a pelvic ultrasound scan showing multiple fibroids. What is the most common form of fibroid degeneration?
Your Answer:
Correct Answer: Hyaline degeneration
Explanation:Hyaline degeneration is the most common form of fibroid degeneration. Fibroids:
Risk Factors
– Black Ethnicity
– Obesity
– Early Puberty
– Increasing age (from puberty until menopause)
Protective Factors
– Pregnancy
– Multiparity -
This question is part of the following fields:
- Clinical Management
-
-
Question 55
Incorrect
-
Which one of the following aetiological factors causes a reduction in the risk of fibroids?
Your Answer:
Correct Answer: Pregnancy
Explanation:Risk of fibroids is more common among African ethnicity and is also related to obesity and early puberty. The role of combined oral contraceptive pills is still debatable and its results are conflicting, whereas the risk of fibroids decreases with the increase in number of pregnancies. i.e. multiparous women have a lower risk of fibroids.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 56
Incorrect
-
A 29-year-old woman at 28 weeks of pregnancy was diagnosed with gestational diabetes. At a high-risk pregnancy clinic, she was considered to have been managed well until 38 weeks when she delivered a healthy 4-kg baby via vaginal delivery without any complications.
Which of the following is the next step in managing her gestational diabetes?Your Answer:
Correct Answer: 75g oral glucose tolerance test performed 6 to 8 weeks after delivery
Explanation:The Australasian Diabetes in Pregnancy Society recommends a 50 or 75 g glucose challenge at 26–28 weeks in all pregnant women. An OGTT should be performed if the test result is abnormal: 1 hour values after a 50 or 75 g glucose challenge exceeding 7.8 or 8.0 mmol/L respectively.
If a woman has had gestational diabetes, a repeat OGTT is recommended at 6–8 weeks and 12 weeks after delivery. If the results are normal, repeat testing is recommended between 1 and 3 years depending on the clinical circumstances.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 57
Incorrect
-
A 32-year-old woman at 37 weeks of gestation, who has been fine antenatally, presented with a history of sudden onset of severe abdominal pain with vaginal bleeding, and cessation of contractions after 18 hours of active pushing at home.
On examination, she is conscious and pale.
Her vital signs include blood pressure of 70/45 mm of Hg and a pulse rate of 115 beats per minute which is weak.
Her abdomen is irregularly distended, with both shifting dullness and fluid thrill present. Fetal heart sounds are not audible.
What will be the most likely diagnosis?Your Answer:
Correct Answer: Uterine rupture
Explanation:Patient’s presentation is classic for uterine rupture, were she developed sudden abdominal pain followed by cessation of contractions, termination of urge to push and vaginal bleeding.
Abdominal examination shows no fetal cardiac activity and signs of fluid collection like fluid thrill and shifting dullness. The fluid collected will be blood, which usually enters the peritoneum after the rupture of the uterus. In such patients vaginal examination will reveal a range of cervical dilatation with evidences of cephalopelvic disproportion.
Anterior lower transverse segment is the most common site for spontaneous uterine rupture. Patient in the case presenting with tachycardia and hypotension is in shock due to blood loss and will require urgent resuscitation.Placenta previa presents with painless bleeding from the vagina and Placental abruption will present with painful vaginal bleeding with tender and tense uterine wall, however, in contrary to that of uterine rupture, uterine contractions will continue in both these cases.
Shoulder dystocia is more likely to present in a prolonged labour with a significant delay in the progress of labour. However, in this case, there is no mention of shoulder dystocia.
Disseminated intravascular coagulation (DIC) is a condition which is causes due to abnormal and excessive generation of thrombin and fibrin in the circulating blood which results in bleeding from every skin puncture sites. It results in increased platelet aggregation and consumption of coagulation factors which results in bleeding at some sites and thromboembolism at other sites. Placental abruption, or retained products of conception in the uterine cavity are the causes for DIC.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 58
Incorrect
-
The most common cause of perinatal death in mono-amniotic twin is:
Your Answer:
Correct Answer: Cord entrapment
Explanation:Cord entanglement, a condition unique to MoMo pregnancies, occurs in 42 to 80% of the cases and it has been traditionally related to high perinatal mortality. Umbilical cord entanglement is present in all monoamniotic twins when it is systematically evaluated by ultrasound and colour Doppler. Perinatal mortality in monoamniotic twins is mainly a consequence of conjoined twins, twin reversed arterial perfusion (TRAP), discordant anomaly and spontaneous miscarriage before 20 weeks’ gestation. Expectantly managed monoamniotic twins after 20 weeks have a very good prognosis despite the finding of cord entanglement. The practice of elective very preterm delivery or other interventions to prevent cord accidents in monoamniotic twins should be re-evaluated.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 59
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:
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 60
Incorrect
-
Which vitamin deficiency leads to Wernicke's encephalopathy?
Your Answer:
Correct Answer: B1
Explanation:Vitamin B1 deficiency can lead to Wernicke’s encephalopathy. Alcoholics are at particular risk. In obstetrics all women with hyperemesis gravidarum should receive thiamine supplementation to prevent Wernicke’s.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 61
Incorrect
-
In normal physiological changes in pregnancy, all of the following are increased, EXCEPT:
Your Answer:
Correct 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
-
-
Question 62
Incorrect
-
A 32 year old patient has a transvaginal ultrasound scan that shows a mass in the left ovary. It is anechoic, thin walled, is without internal structures and measures 36mm in diameter. What is the likely diagnosis?
Your Answer:
Correct Answer: Functional cyst
Explanation:The diagnosis of functional ovarian cyst is made when the cyst measures more than 3 cm and rarely grows more than 10 cm. It appears as a simple anechoic unilocular cyst on USS. It is usually asymptomatic. If it is symptomatic then laparoscopic cystectomy should be performed.
-
This question is part of the following fields:
- Data Interpretation
-
-
Question 63
Incorrect
-
Which one of the following factors commonly indicate repetitive late decelerations on cardiography (CTG)?
Your Answer:
Correct Answer: Fetal hypoxia
Explanation:Repetitive late decelerations can be caused by fetal hypoxia which results in constriction of the vessels to circulate blood from the peripheries to more important organs of the body like the brain and heart etc.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 64
Incorrect
-
Which of the following ultrasound findings form part of the Rotterdam criteria for diagnosis of PCOS (Polycystic Ovary Syndrome) ?
Your Answer:
Correct Answer: Increased ovarian volume >10cm3
Explanation:The Rotterdam criteria for the diagnosis of PCOS is based on a score of two out of the three criteria:
1) Oligo or anovulation
2) Hyperandrogenism – clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone)
3) on ultrasound – contain 12 or more follicles measuring 2 to 9 mm in diameter and/or have an increased volume of 10 cm3 or greater. -
This question is part of the following fields:
- Clinical Management
-
-
Question 65
Incorrect
-
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:
Correct 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.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 66
Incorrect
-
A 20-year-old pregnant woman at 32 weeks gestation presents with a history of vaginal bleeding after intercourse. Pain is absent and upon examination, the following are found: abdomen soft and relaxed, uterus size is equal to dates and CTG reactive. What is the single most possible diagnosis?
Your Answer:
Correct Answer: Placenta previa
Explanation:Placenta previa typically presents with painless bright red vaginal bleeding usually in the second to third trimester. Although it’s a condition that sometimes resolves by itself, bleeding may result in serious complications for the mother and the baby and so it should be managed as soon as possible.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 67
Incorrect
-
Several mechanisms have been proposed as to what causes closure of the Ductus Arteriosus (DA) at Parturition. Which of the following is the most important in maintaining the patency of the DA during pregnancy?
Your Answer:
Correct Answer: PGE2
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 68
Incorrect
-
A patient is about to undergo an elective C-section. She wants to know how long it will take for her wound to completely heal.
How much time does it take for healing by primary intention to reach full tensile strength?Your Answer:
Correct Answer: 12 weeks
Explanation:Wound healing typically undergoes different stages that include haemostasis, inflammation, proliferation and remodelling. The phases are often shortened when healing occurs by primary intention such as in a surgical wound. Remodelling, which is the major strengthening phase, takes about 3 weeks, while it takes a total of 12 weeks to reach maximum tensile strength.
-
This question is part of the following fields:
- Physiology
-
-
Question 69
Incorrect
-
A 25-year-old lady is somewhat jaundiced, has black urine, and has pruritus of her abdomen skin at 30 weeks of pregnancy in her first pregnancy. Her blood pressure is 130/80 mmHg, her fundal height is 29 cm above the pubic symphysis, and her liquid volume is a little lower than expected. Laboratory investigations reveal:
Serum bilirubin (unconjugated): 5 mmol/L (0-10)
Serum bilirubin (conjugated): 12 mmol/L (0-5)
Serum alkaline phosphatase (ALP): 450U/L (30--350)
Serum alanine aminotransferase (ALT) 45U/L (<55)
Serum bile acids: 100 mmol/L (1-26)
The most likely cause for her presentation is?Your Answer:
Correct Answer: Obstetric cholestasis.
Explanation:The correct answer is Obstetric Cholestasis.
The characteristics (elevated bile acids, conjugated bilirubin, and alkaline phosphatase (ALP) levels) are typical with obstetric cholestasis, which affects roughly 3-4 percent of pregnant women in Australia. Obstetric cholestasis is diagnosed when otherwise unexplained pruritus occurs in pregnancy and abnormal liver function tests (LFTs) and/or raised bile acids occur in the pregnant woman and both resolve after delivery. Pruritus that involves the palms and soles of the feet is particularly suggestive.
Liver function tests and bile acid levels measurements are used to validate this diagnosis.
All of the other diagnoses are theoretically possible, but unlikely.
On liver function tests, hepatitis A and acute fatty liver of pregnancy (which is frequently associated with severe vomiting in late pregnancy) usually show substantially worse hepatocellular damage.
Pre-eclampsia is connected with hypertension and proteinuria (along with changes in renal function and, in certain cases, thrombocytopenia), while cholelithiasis is associated with obstructive jaundice and pale stools due to a stone in the CBD. -
This question is part of the following fields:
- Obstetrics
-
-
Question 70
Incorrect
-
A 62-year-old woman complains of urinary incontinence for the past 12 months after having four pregnancies before the age of 30. She has to wear a 'pad' inside her pants all of the time because of this condition. She isn't on any hormone replacement therapy at the moment. Which of the following signs indicates that the incontinence is most likely true stress incontinence?
Your Answer:
Correct Answer: Only small quantities of urine ore lost each time she is incontinent.
Explanation:Only little volumes of urine are lost when her intra-abdominal pressure is elevated during coughing, laughing, jumping, and straining, which is the only symptom associated with real stress incontinence.
The other reactions are significantly more compatible with a detrusor instability diagnosis (also called urge incontinence).
If she had incontinence throughout pregnancy, it would have been stress in nature, which is what her current incontinence is. -
This question is part of the following fields:
- Gynaecology
-
-
Question 71
Incorrect
-
A 30 year old primigravida with diabetes suffered a post partum haemorrhage following a vaginal delivery. Her uterus was well contracted during labour. Her baby's weight is 4.4 kg. Which of the following is the most likely cause for her post partum haemorrhage?
Your Answer:
Correct Answer: Cervical/vaginal trauma
Explanation:A well contracted uterus excludes an atonic uterus. Delivery of large baby by a primigravida can cause cervical +/- vaginal tears which can lead to PPH.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 72
Incorrect
-
The ureters receive autonomic supply from which spinal segments?
Your Answer:
Correct Answer: T11-L2
Explanation:The ureters receive innervation by a number of nerve plexuses. The nerves supplying the ureters originate from spinal segments T11 to L2. When you think about ureteric colic giving classic ‘loin to groin’ pain it is because the pain is referred to these dermatomes.
-
This question is part of the following fields:
- Anatomy
-
-
Question 73
Incorrect
-
A 32-year-old lady is two weeks postpartum and in good health. She has painful defecation that is accompanied by some new blood on the toilet paper. Which of the following diagnoses is the most likely?
Your Answer:
Correct Answer: Acute anal fissure.
Explanation:The history of acutely painful defecation associated with spotting of bright blood is very suggestive of an acute anal fissure. Typically, the patient reports severe pain during a bowel movement, with the pain lasting several minutes to hours afterward. The pain recurs with every bowel movement, and the patient commonly becomes afraid or unwilling to have a bowel movement, leading to a cycle of worsening constipation, harder stools, and more anal pain. Approximately 70% of patients note bright-red blood on the toilet paper or stool. Occasionally, a few drops may fall in the toilet bowl, but significant bleeding does not usually occur with an anal fissure.. After gently spreading the buttocks, a close check of the anal verge can typically confirm the diagnosis.
Rectal inspection is excruciatingly painful and opposed by sphincter spasm; however, if the fissure can be seen, it is not necessary to make the diagnosis at first.A perianal abscess, which presents as a sore indurated area lateral to the anus, or local trauma linked with anal intercourse or a foreign body, are two more painful anorectal disorders to rule out.
Anal fistulae do not appear in this way, but rather with perianal discharge, and the diagnosis is based on determining the external orifice of the fistula.
Although first-degree haemorrhoids bleed, they do not cause defecation to be unpleasant.
Although carcinoma of the anus or rectum can cause painful defecation, it would be exceptional in this situation.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 74
Incorrect
-
During the menstrual cycle which hormone typically reaches its peak level on day 21 (assuming a 28 day cycle)?
Your Answer:
Correct Answer: Progesterone
Explanation:LH, FSH and Oestrogen have their peaks just before ovulation on day 14 whereas progesterone peaks around day 21.
-
This question is part of the following fields:
- Endocrinology
-
-
Question 75
Incorrect
-
A patient at 15 weeks gestation undergoes an abortion. She has no known drug allergies. Which of the following is the most appropriate regarding antibiotic prophylaxis?
Your Answer:
Correct Answer: Stat Azithromycin 1g and metronidazole 800 mg orally at time of abortion
Explanation:First trimester abortions are performed using mifepristone 600 mg followed by insertion of 1 mg gemeprost vaginal pessary. The patients stays in the hospital for about 4-6 hours. At the time of abortion azithromycin 1 g and metronidazole 800 mg should be given to cover the gram positive and negative bacteria.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 76
Incorrect
-
Yasmin®, which contains 3 mg of drospirenone and 30 mcg of ethinyl oestradiol, has been approved for usage in South Africa.
Which of the following factors has contributed to it becoming the most popular oral contraceptive pill among South African women?Your Answer:
Correct Answer: It has not weight gain as an adverse effect and may be associated with weight loss
Explanation:Yasmin has been linked to decreased fluid retention and weight gain as a side effect of COCs, which is why most women who experience this side effect prefer Yasmin®.
Due to its anti-mineralocorticoid properties, drospirenone, unlike earlier progestogens, is associated with no weight gain or even moderate weight loss.
Yasmin has a similar failure rate to other COCs. No evidence using Yasmin is linked to a lower risk of cervical cancer as a long-term side effect of COCs. Yasmin, like all COCs, can cause spotting and irregular bleeding in the first few months of use.
Drospirenone, a progesterone component, has antiandrogenic properties and is slightly more successful in treating acne, but the difference is not big enough to make it preferable in terms of acne therapy or prevention when compared to other COCs. -
This question is part of the following fields:
- Gynaecology
-
-
Question 77
Incorrect
-
A women has undergone genetic testing due to her family history and has the BRCA 2 gene. What would you advise her lifetime risk of breast cancer is?
Your Answer:
Correct Answer: 45%
Explanation:The life time risk of breast cancer in BRCA 2 gene is 45% and of ovarian cancer is 15%.
-
This question is part of the following fields:
- Genetics
-
-
Question 78
Incorrect
-
Which of the following organisms causes Scarlet Fever?
Your Answer:
Correct Answer: Streptococcus pyogenes
Explanation:Streptococcus pyogenes, also known as group A beta-haemolytic streptococcus, is the organism responsible for scarlet fever. The bacteria is found in secretions from the nose, ears or the skin, and infections may be preceded by wounds, burns or respiratory infections. Symptoms may include a sore throat, fever, a red skin rash and cervical lymphadenopathy. Untreated scarlet fever in children and adolescents can lead to rheumatic fever, or post-streptococcal glomerulonephritis.
-
This question is part of the following fields:
- Microbiology
-
-
Question 79
Incorrect
-
WHO defines the perinatal mortality rate as
Your Answer:
Correct Answer: The number of stillbirths and deaths in the first week of life per 1000 births
Explanation:The number of stillbirths and deaths in the first week of life per 1000 births.
According to WHO the perinatal period commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth. -
This question is part of the following fields:
- Epidemiology
-
-
Question 80
Incorrect
-
A 58-year-old postmenopausal female sees you for an initial health maintenance visit. Her examination is normal and she has no complaints. You perform a Papanicolaou (Pap) test, which she has not had done in 15 years. The smear is read as “negative for intraepithelial lesion and malignancy, benign endometrial cells present.”
What would be the most appropriate follow-up for this finding?Your Answer:
Correct Answer: An endometrial biopsy
Explanation:This patient should have an endometrial biopsy (SOR C). Approximately 7% of postmenopausal women with benign endometrial cells on a Papanicolaou smear will have significant endometrial pathology. None of the other options listed evaluate the endometrium for pathology. An asymptomatic premenopausal woman with benign endometrial cells would not need an endometrial evaluation because underlying endometrial pathology is rare in this group.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 81
Incorrect
-
What is the RCOG advice regarding timing of Rhesus Anti-D Immunoglobulin following abortion?
Your Answer:
Correct Answer: Anti-D IgG within 72 hours following abortion
Explanation:All non-sensitised RhD negative women should receive Anti-D IgG within 72 hours following abortion
-
This question is part of the following fields:
- Clinical Management
-
-
Question 82
Incorrect
-
A 46 year old women with a BMI of 34 is seen in clinic following hysteroscopy and biopsy for irregular menstrual bleeding. Histology shows hyperplasia without atypia. Following a discussion the patient declines any treatment but agrees she will try and lose weight. What is the risk of progression to endometrial cancer over 20 years?
Your Answer:
Correct Answer:
Explanation:The risk of developing endometrial carcinoma is less than 5% over 20 years if the endometrium shows hyperplasia without atypia.
There are 2 types of Endometrial Hyperplasia:
1. Hyperplasia without atypia*
2. Atypical hyperplasiaMajor Risk Factors:
Oestrogen (HRT)
Tamoxifen
PCOS
Obesity
Immunosuppression (transplant) -
This question is part of the following fields:
- Clinical Management
-
-
Question 83
Incorrect
-
With regard to the cell cycle. In what phase do chromatids get cleaved into chromosomes and pulled apart?
Your Answer:
Correct Answer: Anaphase
Explanation:G0 is a resting phase. Interphase (G1,S,G2) is where the cell grows and DNA replication occurs forming chromatids. Mitosis is where cell division occurs and this happens in a the following phases: Prophase Chromatin condenses to chromosomes (paired as chromatids). Mitotic spindle forms Metaphase Chromatids align at the equatorial plane AKA the metaphase plate Anaphase Chromatids pulled apart into 2 constituent daughter chromosomes Telophase New nuclear envelopes form around each daughter chromosome Cytokinesis Cells divide Diagram illustrating Mitosis Image sourced from Wikipedia
-
This question is part of the following fields:
- Biochemistry
-
-
Question 84
Incorrect
-
The softening of the cervical isthmus that occurs early in gestation is called:
Your Answer:
Correct Answer: Hegar's sign
Explanation:Hegar’s sign: softening of womb (uterus) due to its increased blood supply, perceptible on gentle finger pressure on the neck (cervix). This is one of the confirmatory signs of pregnancy and is usually obvious by the 16th week.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 85
Incorrect
-
Question 86
Incorrect
-
Regarding Turner syndrome which of the following statements is true?
Your Answer:
Correct Answer: Only 1% of affected foetuses will survive to term
Explanation:The incidence of 45,XO turner syndrome is around 1 in 8000 live births. Approximately 1% of monosomy X female embryos survive. Phenotypically they are females and 90% do not develop secondary sexual characteristics and hormone replacement is required.
-
This question is part of the following fields:
- Genetics
-
-
Question 87
Incorrect
-
A 37 year old lady attends clinic following laparotomy and unilateral oophorectomy. The histology shows mucin vacuoles. What type of tumour would this be consistent with?
Your Answer:
Correct Answer: Mucinous
Explanation:Mucinous tumours are cystic masses which are indistinguishable from the serous tumours on gross examination except by its contents. On histology it is lined with mucin producing epithelium – mucin vacuoles whereas serous tumours have psammoma bodies. Malignant tumours are characterised by the presence of architectural complexity, cellular stratification, stromal invasion and cytological atypia.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 88
Incorrect
-
A 60-year-old lady is found to have a grossly palpable adnexal mass on her left side on pelvic examination. This is the first time it has been detected. She attained menopause at 52 years of age. The last pelvic examination, which was done 4 years ago, was normal.
What is her most likely diagnosis?Your Answer:
Correct Answer: Ovarian carcinoma.
Explanation:Her most likely diagnosis would be an ovarian carcinoma. Any palpable adnexal mass in a post-menopausal woman is a red flag for an ovarian malignancy and should be assumed so until proven otherwise.
Endometrial cancer typically presents with a post-menopausal bleed and although there might be uterine enlargement, an adnexal mass is generally absent.
It is very rare for follicular cysts to develop following menopause and it is uncommon for post-menopausal women to have a benign ovarian tumour, which is more common in younger women. A degenerating leiomyoma would be unlikely in this case, especially since her pelvic examination three years ago was normal (no history of leiomyoma noted).
-
This question is part of the following fields:
- Gynaecology
-
-
Question 89
Incorrect
-
From which germ cell layer does the GI tract initially develop?
Your Answer:
Correct 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 90
Incorrect
-
A 32-year-old gravida 3 para 2 presents for routine prenatal care. The patient is at 14 weeks estimated gestational age by last menstrual period, and ultrasonography at 8 weeks gestation was consistent with these dates. Fetal heart tones are not heard by handheld Doppler. Transvaginal ultrasonography reveals an intrauterine foetus without evidence of fetal cardiac activity. The patient has not had any bleeding or cramping, and otherwise feels fine. A pelvic examination reveals a closed cervix without any signs of bleeding or products of conception.
Which one of the following is the most likely cause of this presentation?Your Answer:
Correct Answer: A missed abortion
Explanation:In this case, the patient has a missed abortion, which is defined as a dead foetus or embryo without passage of tissue and with a closed cervix. This condition often presents with failure to detect fetal heart tones or a lack of growth in uterine size.
– By 14 weeks estimated gestational age, fetal heart tones should be detected by both handheld Doppler and ultrasonography.
– An inevitable abortion presents with a dilated cervix, but no passage of fetal tissue.
– A blighted ovum involves failure of the embryo to develop, despite the presence of a gestational sac and placental tissue. -
This question is part of the following fields:
- Obstetrics
-
-
Question 91
Incorrect
-
What is the normal range for variability in cardiotocography (CTG) analysis?
Your Answer:
Correct Answer: 5-25 bpm
Explanation:Cardiotocography, also known as the non-stress test is used to monitor fetal heartbeat and uterine contractions of the uterus. An abnormal CTG may indicate fetal distress and prompt an early intervention. Variability refers to the variation in the fetal heartbeat form one beat to another. Normal variability is between 5-25 beats per minute while an abnormal variability is less than 5 bpm for more than 50 minutes, or more than 25 bpm for more than 25 minutes.
-
This question is part of the following fields:
- Data Interpretation
-
-
Question 92
Incorrect
-
A 49-year-old lady presents with amenorrhea of 11-months’ duration. Her periods were previously normal and regular. She is planned for an assessment of her FSH (follicle-stimulating hormone) and oestradiol (E2) levels.
Assuming she has attained menopause, which pattern would most likely be found?Your Answer:
Correct Answer: High FSH and low E2.
Explanation:High FSH and low E2 levels would be expected in menopause. FSH levels would be raised as her body attempts to stimulate ovarian activity and E2 would be low due to reduced ovarian function. The other options would be possible if she was younger, and if occurring with amenorrhea, would warrant further hormonal tests.
It is often challenging to interpret hormone test results close to the time of menopause, especially if the woman is still experiencing irregular menstruation, as remaining ovarian follicles might still produce oestrogen, causing both bleeding and FSH suppression. Elevation of FSH then can be seen again once the oestrogen level drops. Hence, the results would be influenced by the timing of blood sample collection. Once amenorrhea occurs more consistently, it would be easier to interpret the results.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 93
Incorrect
-
Which of the following is known to increase the risk of endometrial cancer?
Your Answer:
Correct Answer: PCOS
Explanation:The risk factors of endometrial cancer include obesity, diabetes, late menopause, unopposed oestrogen therapy, tamoxifen therapy, HRT and a family history of colorectal and ovarian carcinoma.
-
This question is part of the following fields:
- Epidemiology
-
-
Question 94
Incorrect
-
Which is an absolute contraindication to contraceptive pills containing only progesterone?
Your Answer:
Correct Answer: Rifampicin
Explanation:Progestogen-only methods are contraindicated in suspected pregnancy, breast cancer and undiagnosed vaginal bleeding. Giving DMPA to a woman with a severe bleeding disorder may result in a large haematoma at the injection site.
Women who want to become pregnant within 18 months or who are afraid of injections should be discouraged from using DMPA. Progestogen-only methods are unsuitable for women unwilling to accept menstrual changes.
Relative contraindications are active viral hepatitis and severe chronic liver disease. For all progestogen-only methods, with the possible exception of DMPA, drug interactions are likely with many anticonvulsants, rifampicin, spironolactone and griseofulvin. This may result in lowered efficacy.
Migraine, malabsorption syndrome, smoking and history of liver disease have not been identified as contraindications to mini pills.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 95
Incorrect
-
Which of the following arteries branches directly from the aorta?
Your Answer:
Correct Answer: Ovarian
Explanation:The ovarian artery takes its origin directly from the aorta. While the uterine and the vaginal arteries are all branches of the internal iliac artery.
-
This question is part of the following fields:
- Anatomy
-
-
Question 96
Incorrect
-
At ovulation the surge in LH causes rupture of the mature oocyte via action on what?
Your Answer:
Correct Answer: Theca externa
Explanation:The luteinizing hormone (LH) surge during ovulation causes: Increases cAMP resulting in increased progesterone and PGF2 production PGF2 causes contraction of theca externa smooth muscle cells resulting in rupture of the mature oocyte
-
This question is part of the following fields:
- Endocrinology
-
-
Question 97
Incorrect
-
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:
Correct 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 98
Incorrect
-
Regarding the biophysical profile:
Your Answer:
Correct 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.
-
This question is part of the following fields:
- Biophysics
-
-
Question 99
Incorrect
-
In early pregnancy at what gestation does the Embryonic pole become visible on transvaginal ultrasound?
Your Answer:
Correct Answer: 5 weeks + 3 days
Explanation:The gestational sac can be visualized from as early as 4–5 weeks of gestation and the yolk sac at about 5 weeks (Figure 6.3). The embryo can be observed and measured at 5–6 weeks gestation.
-
This question is part of the following fields:
- Biophysics
-
-
Question 100
Incorrect
-
The second stage of labour involves:
Your Answer:
Correct Answer: Expulsion of the foetus
Explanation:First stage: The latent phase is generally defined as beginning at the point at which the woman perceives regular uterine contractions. A definition of active labour is having contractions more frequent than every 5 minutes, in addition to either a cervical dilation of 3 cm or more or a cervical effacement of 80% or more.
Second stage: fetal expulsion begins when the cervix is fully dilated, and ends when the baby is born.
Third stage: placenta delivery – The period from just after the foetus is expelled until just after the placenta is expelled is called the third stage of labour or the involution stage.
-
This question is part of the following fields:
- Physiology
-
-
Question 101
Incorrect
-
During pregnancy which hormone(s) inhibit lactogenesis?
Your Answer:
Correct Answer: Oestrogen and Progesterone
Explanation:Prolactin levels rise steadily during pregnancy during which time it promotes mammary growth (along with the other hormones mentioned below). Oestrogen and progesterone inhibit lactogenesis and it is only with the loss of these placental steroid hormones at term that Prolactin exhibits its lactogenic effect.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 102
Incorrect
-
You are asked to infiltrate a patients perineum with local anaesthetic prior to episiotomy. What is the maximum dose of lidocaine (without adrenaline)?
Your Answer:
Correct Answer: 3 mg/kg
Explanation:The half-life of lidocaine is approximately 1.5 hours. It is a local anaesthetic and the maximum dose that can be given is 3mg/kg.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 103
Incorrect
-
Question 104
Incorrect
-
Which ONE among the following factors does not increase the risk for developing postpartum endometritis?
Your Answer:
Correct Answer: Advanced maternal age
Explanation:The most common clinical findings in a postpartum women with endometritis are postpartum fever, with tachycardia relative to the rise in temperature, midline lower abdominal pain and uterine tenderness from the 2nd to 10th day of postpartum.
Most common risk factors for the development of postpartum endometritis are:
– Cesarean deliveries are considered as the most important risk factor for postpartum endometritis, especially those performed after the onset of labour.
– Young maternal age.
– Multiple digital cervical examinations.
– Prolonged rupture of membranes.
– Retention of placental products.
– Prolonged labour.
– Chorioamnionitis.
Advanced maternal age is not considered as a risk factor for development of postpartum endometritis. -
This question is part of the following fields:
- Obstetrics
-
-
Question 105
Incorrect
-
A 27-year-old woman presented to the medical clinic for antenatal advice because she plans to get pregnant soon. However, she is worried about how she should change her diet once she becomes pregnant already.
Which of the following is considered the best to give to the patient in addition to giving folic acid?Your Answer:
Correct Answer: Iodine
Explanation:There is evidence that folic acid, iodine and vitamin D are important for reproductive outcomes. Folic acid and iodine supplementation is recommended for women planning to conceive and in pregnancy.
The recommended dose of folic acid for women without special considerations planning to conceive is 400-500 mcg. The recommended dose of folic acid for women with special considerations is 2-5 mg per day.
Women planning a pregnancy, including those with thyroid disease, should take iodine supplements in the dose of 150 mcg per day prior to and during pregnancy.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 106
Incorrect
-
The following is a gram positive obligate anaerobe:
Your Answer:
Correct Answer: Clostridia
Explanation:Obligate anaerobes are a group of bacteria that cannot survive in an oxygen-rich environment. In the body, they are usually found on mucosal membranes such as that of the lower gastrointestinal system, or the vagina. Infection with these organisms is usually suprative and causes abscesses. Examples of gram-negative anaerobes include Bacteroides, Fusobacterium and Prevotella, while gram-positive anaerobes include Actinomyces and Clostridia. Staphylococcus and Streptococcus are both gram-positive facultative anaerobes.
-
This question is part of the following fields:
- Microbiology
-
-
Question 107
Incorrect
-
A 22-year-old nulliparous otherwise healthy woman presents with lower abdominal pain at 16 weeks of gestation. Her body temperature is 37.8 degrees Celsius. She appears to be in good health and is eating properly. Her uterus had been discovered to be retroverted but of normal size at her prior antenatal check at 11 weeks of pregnancy. Which of the following diagnoses is the most likely?
Your Answer:
Correct Answer: Urinary tract infection.
Explanation:Lower abdominal pain can be caused by any of the conditions listed in the answers.
A urinary tract infection is the most likely cause.
Unless it was an abdominal ectopic or an interstitial pregnancy, an ectopic pregnancy.
will almost definitely have shown up before the 15th week of pregnancy.
A retroverted gravid uterus may impinge at 15 weeks of pregnancy, however, this is unlikely to be linked to a temperature of 37.8°C.
It’s also possible that it’s the source of acute urine retention.
Complications of the corpus luteum cyst normally manifest themselves considerably earlier in pregnancy, and severe appendicitis is far less likely to be the source of discomfort than a urinary tract infection. -
This question is part of the following fields:
- Obstetrics
-
-
Question 108
Incorrect
-
Which of the following leaves the pelvis via the greater sciatic foramen?
Your Answer:
Correct Answer: Pudendal Nerve
Explanation:The pudendal nerve arises from the S2-S4 nerve roots and it lies medial to the internal pudendal artery while exiting the pelvis via the greater sciatic foramen. It curves around the sacrospinous ligament and re-enters the pelvis via the lesser sciatic foramen and from there it runs medial to the ischial tuberosity over the obturator internus in the pudendal canal to the deep perineal pouch.
-
This question is part of the following fields:
- Anatomy
-
-
Question 109
Incorrect
-
Regarding cardiac output in pregnancy which of the following statements is TRUE?
Your Answer:
Correct Answer: Cardiac output increases by approximately 40-50% during pregnancy
Explanation:In a non pregnant adult female the cardiac output is 4.5L/min, by the 20 week of pregnancy the cardiac output increases by 40% to 6.3L/min. During early stages of labour it increases further still by 17% to 7.3L/min.
-
This question is part of the following fields:
- Physiology
-
-
Question 110
Incorrect
-
Question 111
Incorrect
-
Regarding menstruation, which of the following is the maximum normal blood loss?
Your Answer:
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 112
Incorrect
-
A 35-year-old female patient, gravida 1 para 1, visits the clinic to have her contraception method evaluated. The patient has had unpredictable bleeding for the past 8 months since receiving a subdermal progestin implant and begs that it be removed. She used to use combined oral contraceptives and would like to go back to it. The patient has primary hypertension, which she was diagnosed with last year and is effectively controlled on hydrochlorothiazide. She does not take any other medications or have any allergies. Her father and brother both suffer from type 2 diabetes. The patient does not smoke, drink, or use illegal drugs.
24 kg/m2 is her BMI. Blood pressure is 130/75 millimetres of mercury. Physical examinations are all normal. Which of the following is increased by using combination oral contraceptives?Your Answer:
Correct Answer: Worsening hypertension
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.
COCs do not increase the risk of developing breast and endometrial cancer, Type 2 DM or breast fibroadenoma.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 113
Incorrect
-
In the foetus, the most well oxygenated blood flows into which part of the heart:
Your Answer:
Correct Answer: Right atrium
Explanation:The placenta accepts the blue, unoxygenated blood from the foetus through blood vessels that leave the foetus through the umbilical cord (umbilical arteries, there are two of them). When blood goes through the placenta it picks up oxygen and becomes red. The red blood then returns to the foetus via the third vessel in the umbilical cord, the umbilical vein. The red blood that enters the foetus passes through the fetal liver and enters the right side of the heart.
-
This question is part of the following fields:
- Physiology
-
-
Question 114
Incorrect
-
A 27-year-old G2P1 visits the gynaecologist with complaints of increased hair growth on her face, breast, and belly, but hair loss in the temporal regions of her head. She has also struggled with acne.
On physical examination, the patient's face, chest, and belly are covered in coarse, dark hair. Her clitoris is swollen on pelvic examination. Her left adnexal mass is 7 cm in diameter.
What is the most likely ovarian tumour to be associated with this clinical picture?Your Answer:
Correct Answer: Sertoli-Leydig cell tumour
Explanation:Sertoli-Leydig cell tumours constitute less than 0.5 percent of ovarian neoplasms. They may behave in a benign or malignant fashion, which correlates with the degree of differentiation in an individual case. Approximately 75 percent occur in women under the age of 40 years (mean age at diagnosis is 25), but they occur in all age groups. The neoplasms are characterized by the presence of testicular structures that produce androgens. This can result in virilization, although not all of these neoplasms are functionally active.
Pure Sertoli cell tumours are usually estrogenic and may also secrete renin, leading to refractory hypertension and hypokalaemia. In addition, these tumours may be associated with Peutz-Jeghers syndrome.
Pure Leydig cell tumours are androgen secreting; only a few cases have been reported. Virtually all of these rare tumours are unilateral and confined to the ovary at diagnosis.
Granulosa cell tumours typically present as large masses; the mean diameter is 12 cm. Women may present with an asymptomatic mass noted on abdominal or pelvic examination. Granulosa cell tumours often produce oestrogen and/or progesterone; consequently, symptoms related to hyperestrogenism are common at diagnosis.
Krukenberg tumour, also known as carcinoma mucocellulare, refers to the signet ring subtype of metastatic tumour to the ovary. The stomach followed by colon are the two most common primary tumours to result in ovarian metastases, pursued by the breast, lung, and contralateral ovary.
A rare tumour that is made up of more than one type of cell found in the gonads (testicles and ovaries), including germ cells, stromal cells, and granulosa cells. Gonadoblastomas are usually benign (not cancer), but they may sometimes become malignant (cancer) if not treated.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 115
Incorrect
-
An 80 year old female patient comes to the hospital with stress urinary incontinence. Pelvic organ prolapse is not apparent on physical exam.
What is the most appropriate next step in management?Your Answer:
Correct Answer: Pelvic floor muscle exercise
Explanation:Stress incontinence is characterized by the involuntary loss of urine with increases in intra-abdominal pressure. It is the most common type of incontinence in younger women, but also occurs in older women. Key risk factors include childbirth, medications that relax the urethral sphincter, obesity, lung disease (from chronic cough), and prior pelvic surgeries. Numerous treatments are available, although few studies compare one treatment with another.
Pelvic floor muscle exercises are the mainstay of behavioural therapy for stress incontinence. Up to 38 percent of patients with stress incontinence alone who follow a pelvic floor muscle exercise regimen for at least three months experience a cure.
Routine urodynamic tests are not recommended for urinary incontinence. Surgery is reserved for refractory incontinence.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 116
Incorrect
-
The inguinal canal is reinforced anterolaterally by which structure?
Your Answer:
Correct Answer: Internal oblique
Explanation:The Conjoint tendon AKA Inguinal falx reinforces the posterior wall of the inguinal canal. The inguinal ligament is part of the floor.
The aponeurosis of external oblique is the major component of the anterior wall with fibres of internal oblique reinforcing the lateral part -
This question is part of the following fields:
- Anatomy
-
-
Question 117
Incorrect
-
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:
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
-
-
Question 118
Incorrect
-
You have been asked to perform a pudendal nerve block on a patient by your consultant. The pudendal nerve is formed from which spinal segments?
Your Answer:
Correct Answer: S2,S3 and S4
Explanation:The pudendal nerve has its origins form S2, S3 and S4 spinal segments. It provides sensation to the clitoris and labia along with the ilioinguinal nerve.
-
This question is part of the following fields:
- Anatomy
-
-
Question 119
Incorrect
-
Which of the following is the most appropriate for diagnosis of Bacterial Vaginosis (BV)?
Your Answer:
Correct Answer: Amsel's criteria
Explanation:Diagnosis can be made using the Amsel’s criteria:
1. Presence of clue cells on microscopic examination (these cells are epithelial cells covered with the bacteria).
2. Creamy greyish discharge.
3. Vaginal pH of more than 4.5.
5. Positive whiff test – release of fishy odour on addition of alkali solution. Other criteria include the nugent score and the Hay/Ison criteria. The Nugent score estimates the relative proportions of bacterial morphotypes to give a score between 0 and 10 (<4 = normal, 4-6 = intermediate, >6 = BV)
The Hay/Ison criteria
Grade 1 (Normal): Lactobacillus morphotypes predominate
Grade 2 (Intermediate): Mixed flora with some Lactobacilli present, but Gardnerella or Mobiluncus morphotypes also present
Grade 3 (BV): Predominantly Gardnerella and/or Mobiluncus morphotypes. Few or absent Lactobacilli. -
This question is part of the following fields:
- Clinical Management
-
-
Question 120
Incorrect
-
You are called to see a 24 year old patient who is currently in labour but is failing to progress. A fetal blood sample is sent for analysis. pH is 7.22. Which of the following is the appropriate course of action?
Your Answer:
Correct Answer: Consider delivery
Explanation:A normal pH value is above 7.25. A pH below 7.20 is confirmation of fetal compromise. Values between 7.20 and 7.25 are ‘borderline’.
The base deficit can also be useful in interpretation of the fetal scalp pH. A base excess of more than -10 demonstrates a significant metabolic acidosis, with increasing risk of fetal neurological injury beyond this level. Delivery should be considered.
-
This question is part of the following fields:
- Data Interpretation
-
-
Question 121
Incorrect
-
Question 122
Incorrect
-
A 36-year-old obese woman presents to your office for advice regarding pregnancy.
Her body mass index is 40, and she is normotensive and has a normal serum glucose level. On examination she was tested positive for glucose in urine.
What would be your advice to her?Your Answer:
Correct Answer: She will be checked for pre-existing diabetes in early pregnancy and, for gestational diabetes at 26 weeks
Explanation:Counselling her about the risks associated with obesity during pregnancy will be the best possible advice to give this patient. A combined follow up by an obstetrician and a diabetes specialist at a high-risk pregnancy clinic is required to formulate the best ways in management of gestation with obesity.
An oral glucose tolerance test should be done at 26 weeks of her pregnancy, along with advising her on controlling her weight by diet and lifestyle modifications. During the early weeks of their pregnancy all obese patients must be routinely tested for pre-existing diabetes.It is highly inappropriate to advice her not to get pregnant.
Without making a proper diagnosis of diabetes, it is wrong to ask her to start oral hypoglycemic agent and/or insulin.
Checking urinary proteins is not indicated at this stage, but can be considered as a part of antenatal check up.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 123
Incorrect
-
HPV genotypes 6 and 11 are associated with which of the following?
Your Answer:
Correct Answer: Low grade squamous intraepithelial lesions of the cervix (LSIL)
Explanation:HPV types 6 and 11 are associated with low risk, low grade squamous intraepithelial lesion. While types 16,18,31 and 33 are associated with high risk, high grade neoplasia.
-
This question is part of the following fields:
- Microbiology
-
-
Question 124
Incorrect
-
You are consenting a patient for a diagnostic hysteroscopy. What is the approximate risk of uterine perforation in diagnostic hysteroscopy?
Your Answer:
Correct Answer: 0.10%
Explanation:The risk of uterine perforation is 0.1% during therapeutic hysteroscopy.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 125
Incorrect
-
A 24 year old patient decides to take a Chlamydia screening test whilst in the GP surgery. He is asymptomatic. The results are positive for chlamydia infection. His partner attends for testing and wants to know the risk of contracting Chlamydia. What is the risk of chlamydia infection following intercourse with an asymptomatic chlamydia positive partner?
Your Answer:
Correct Answer: 65%
Explanation:The chances of transmitting chlamydia from an asymptomatic partner through sexual intercourse is 65%.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 126
Incorrect
-
What is the main reason for the active management of the third stage of labour?
Your Answer:
Correct Answer: Prevent postpartum haemorrhage
Explanation:According to the WHO, active management of the third stage of labour has been shown to decrease the risk of postpartum haemorrhage in vaginal births worldwide. Per the guidelines from the International Federation of Gynaecologists and Obstetricians (FIGO), the active management of the third stage is summarised as follows:
1. The administration of a uterotonic (oxytocin, ergometrine or misoprostol), within one minute of fetal delivery,
2.Controlled cord traction with manual support to the uterus until placental delivery
3. Fundal massage immediately after placental delivery. -
This question is part of the following fields:
- Clinical Management
-
-
Question 127
Incorrect
-
A patient is diagnosed with cervical cancer and staging investigations show there is parametrial involvement but it is confined within the pelvic wall and does not involve the lower 1/3 vagina. There is no evidence of hydronephrosis. What FIGO stage is this?
Your Answer:
Correct Answer: 2B
Explanation:This is stage 2B.
2010 FIGO classification of cervical carcinoma
0 – Carcinoma in situ
1 – Confined to the cervix (diagnosed microscopy)
1A1 – Less than 3mm depth & 7mm lateral spread
1A2 – 3mm to 5mm depth & less than 7mm lateral spread
1B1 – Clinically visible lesion or greater than A2 & less than 4 cm in greatest dimension
1B2 – Clinically visible lesion, Greater than 4 cm in greatest dimension 2 Invades beyond uterus but not to pelvic wall or lower 1/3 vagina
2A1 – Involvement of the upper two-thirds of the vagina, without parametrical invasion & Less than 4cm
2A2 – Greater than 4 cm in greatest dimension
2B – Parametrial involvement
3 – Extends to Pelvic side wall or lower 1/3 vagina or hydronephrosis
3A – No pelvic side wall involvement
3B – Pelvic side wall involved or hydronephrosis
4 – Extends beyond true pelvis
4A – Invades mucosa bladder and rectum
4B – Distant Metastasis -
This question is part of the following fields:
- Clinical Management
-
-
Question 128
Incorrect
-
A 27-year-old primigravida female presents to the emergency department at full term.
6 hours ago, she spontaneously began labour. The membranes ruptured two hours ago and the liquor was stained with meconium.
On cardiotocography (CTG) was conducted and it showed some intermittent late decelerations, from 140 to 110 beats/min.
On vaginal examination, her cervix id 5 cm dilated. The foetus is in cephalic presentation, in the left occipitotransverse (LOT) position, with the bony head at the level of the ischial spines (IS).
Due to the deceleration pattern, a fetal scalp pH estimation was performed and the pH was measured at 7.32.
An hour later, the CTG showed the following pattern over a period of 30 minutes:
Baseline 140/min
Baseline variability 1/min
Accelerations None evident
Decelerations Two decelerations were evident, with the heart rate falling to 80/min, and with each lasting 4 minutes
Another vaginal examination is conducted and her cervix is now 8cm dilated, but otherwise unchanged from one hour previously.
What would be the next best line management?Your Answer:
Correct Answer: Immediate delivery by Caesarean section.
Explanation:The next best line of management is immediate delivery via Caesarean section ( C section).
This is because of the change in cardiotocography (CTG). The pattern became much more severe with a virtual lack of short-term variability and prolonged decelerations. These changes indicate the necessity for an immediate C section as the cervix is not fully dilated.
As immediate delivery is indicated, another pH assessment is unnecessary as it would delay delivery and increase the likelihood of fetal hypoxia.
Delivery by ventose, in a primigravida where the cervix is only 8cm dilated is not indicated as it would allow the labour to proceed or augmenting with Syntocinon.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 129
Incorrect
-
Question 130
Incorrect
-
Among the following which will not be elevated in the third trimester of pregnancy?
Your Answer:
Correct Answer: Serum free T4
Explanation:Normally, there will be a slight raise in prolactin level throughout pregnancy even despite estrogen stimulating and progesterone inhibiting prolactin secretion.
Serum alkaline phosphatase levels will be increased in pregnancy due to placental ALP.
During the first trimester of pregnancy there is a physiological mechanism by hCG causing cross-stimulation of the TSH receptors and as a result of this the concentration of thyroid stimulating hormone (TSH) normally decreases. During second trimester TSH concentration will again return back to its pre-pregnancy levels and then rises slightly by the third trimester. However, most of the changes still occur within the normal non-pregnant range, and the serum free T3 and T4 concentrations remain unchanged throughout pregnancy. But the total concentrations, which include both free and protein-bound fractions, elevates significantly due to an increase in the circulating binding globulins.
Iron binding capacity reflects transferrin, a protein used for iron transportation, which is a globulin found in the beta band on electrophoresis. To counteract the reduction of plasma iron during pregnancy both transferrin and iron binding capacity are elevated during this period.
When compared to the non-pregnant level, cortisol levels are been elevated up to three times than normal.
-
This question is part of the following fields:
- Obstetrics
-
SESSION STATS - PERFORMANCE PER SPECIALTY
