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Question 1
Correct
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Stages of labour
Your Answer: The third stage ends with the delivery of the placenta and membranes
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 in a British journal was 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.
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This question is part of the following fields:
- Clinical Management
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Question 2
Correct
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A 24 week pregnant patient complains of itching over the past 6 weeks particularly to the hands and feet which is worse at night. She has taken cetirizine but this hasn't settled her symptoms. Examination is unremarkable with no rash. What is the likely diagnosis?
Your Answer: Intrahepatic Cholestasis of Pregnancy
Explanation:The history is typical of Intrahepatic Cholestasis of Pregnancy, also known as obstetric cholestasis and prurigo gravidarum. It is characterised by itching without rash and abnormal LFTs beyond normal pregnancy ranges. Itching affects around 23% of pregnancies and can occur before biochemical changes.
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This question is part of the following fields:
- Clinical Management
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Question 3
Incorrect
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Question 4
Incorrect
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When consenting a patient for abdominal hysterectomy what would you advise regarding the risk?
Your Answer: Overall risk of serious complications 1%
Correct Answer: Injury to ureter or bladder is approximately 1%
Explanation:Abdominal hysterectomy is performed through a Pfannenstiel incision. There are certain complications associated with hysterectomy including haemorrhage, injury to the ureter(1%) and less commonly bladder and bowel (0.04%).
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This question is part of the following fields:
- Clinical Management
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Question 5
Correct
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A 26 year old patient who is currently 24 weeks pregnant presents with vaginal discharge. Swabs show Chlamydia Trachomatis detected. Which of the following is the most appropriate treatment regime?
Your Answer: Erythromycin 500 mg twice a day for 14 days
Explanation:The following treatment regimes are recommended for the treatment of Chlamydia in Pregnancy: Erythromycin 500mg four times a day for 7 days or Erythromycin 500 mg twice a day for 14 days or Amoxicillin 500 mg three times a day for 7 days or Azithromycin 1 gm stat (only if no alternative, safety in pregnancy not fully assessed) The following treatment regimes are recommended for the treatment of Chlamydia in NON-PREGNANT patients: Doxycycline 100mg bd for 7 days OR Azithromycin 1gm orally in a single dose NOTE: Doxycycline and Ofloxacin are contraindicated in pregnancy
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This question is part of the following fields:
- Clinical Management
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Question 6
Correct
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A 26 year old primigravida woman attends A&E due to worsening vomiting. She is currently 10 weeks pregnant. For the past 4 weeks she has had morning sickness but for the last 4 days she has been unable to tolerate any oral fluids without vomiting and thinks she has lost weight. On questioning she has no significant past medical history prior to this pregnancy. She is currently taking the following medication:
Your Answer: Hyperemesis gravidarum
Explanation:This patient has severe nausea and vomiting with ketosis and evidence of dehydration (low BP and tachycardia) in the early part of pregnancy. There is no history of diabetes and the blood glucose doesn’t indicate hyperglycaemia. This is consistent with hyperemesis gravidarum (HG)
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This question is part of the following fields:
- Clinical Management
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Question 7
Incorrect
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At what gestational age does the luteo-placental shift occur?
Your Answer: 18-20 weeks
Correct Answer: 6-8 weeks
Explanation:Luteo-placental shifts occurs around 6-8 week when the placenta takes over from the corpus luteum as the main producer of oestrogen and progesterone.
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This question is part of the following fields:
- Clinical Management
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Question 8
Incorrect
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Oxytocin binds to what receptor type?
Your Answer: GABA B receptors
Correct Answer: G-protein-coupled receptors
Explanation:Oxytocin binds to the G protein coupled receptors that triggers the IP3 mechanism leading to an elevated intracellular calcium ion.
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This question is part of the following fields:
- Clinical Management
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Question 9
Incorrect
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A 20 year old patient attends clinic for a medical abortion at 12 weeks gestation. She has no known drug allergies and her STI screen was negative. What drug should she be prescribed as antibiotic prophylaxis?
Your Answer: Doxycycline 100mg BD for 7 days
Correct Answer: Metronidazole 1g PR stat dose
Explanation:According to the Royal College of Obstetrics and Gynaecology guidelines for abortion care it advises dual antibiotic regimes for antibiotic prophylaxis.
Metronidazole 1g per rectum or 800 mg orally can be given before or at the time of the abortion in women who have tested negative for Chlamydia trachomatis infection.Alternatively, Doxycycline (100mg oral, twice daily for 7 days) or Azithromycin 1g stat doses should be given in addition to metronidazole to be effective against Chlamydia trachomatis anaerobes.
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This question is part of the following fields:
- Clinical Management
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Question 10
Correct
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A 27 year old women presents with a history of vaginal spotting and cramping abdominal pain. She has an 8 week history of amenorrhoea. On examination urine pregnancy test is positive and the cervix is closed. What is the likely diagnosis?
Your Answer: Threatened Miscarriage
Explanation:Miscarriage is a pregnancy that ends spontaneously before the foetus reaches the age of viability i.e. before 24 weeks of gestation. In a threatened miscarriage the USG findings are of a foetus present in the uterus and on speculum examination the cervical OS is closed, in an inevitable miscarriage the cervical OS is opened. In an incomplete miscarriage the uterus contains the retained products of conception and the cervical OS is open. complete miscarriage contains no retained products of conception and the cervix is closed as the bleeding as resolved.
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This question is part of the following fields:
- Clinical Management
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Question 11
Incorrect
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Which of the following are required for Oxytocin to bind to its receptor?
Your Answer: Sodium and Potassium
Correct Answer: Magnesium and Cholesterol
Explanation:Oxytocin binds to G-protein-coupled receptors and requires Magnesium and cholesterol for this process to occur.
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This question is part of the following fields:
- Clinical Management
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Question 12
Correct
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You are called to see a 24 year old patient in A&E. She is 34 weeks gestation and her blood pressure is 149/98. Automated reagent strip testing shows protein 1+. What is the appropriate course of action regarding the urine result?
Your Answer: Send urine for protein:creatinine ratio
Explanation:For a diagnosis of Preeclampsia to be established, 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 should be present.
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This question is part of the following fields:
- Clinical Management
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Question 13
Correct
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You are attending the labour of a patient who has had a prolonged 1st stage of labour. You note the fetal head start to retract after being tightly applied to the vulva (turtle-neck sign). What is the next most appropriate management step?
Your Answer: McRoberts' manoeuvre
Explanation:Call for help.
• Ensure personnel are available to ‘scribe’.
Document the time the head delivered, which shoulder is anterior (this is the arm most vulnerable to injury) and the times at which each manoeuvre is employed.
• Drop the level of the delivery bed as low as it will go, and flatten the back of the bed so the woman is completely flat. Remove the foot of the bed to allow access.
• Assess for and perform an episiotomy, if needed.
• Using one assistant on each of the mother’s legs, flex and abduct the legs at the hip (thighs to abdomen, known as McRoberts manoeuvre). This flattens the lumbosacral spine and will facilitate delivery is around 90 per cent of cases.
• If this fails, suprapubic pressure should be
applied by another assistant. This should be
applied over the posterior aspect of the anterior fetal shoulder and will act to push the shoulders together. It can be used in a constant and then rocking motion.
• If both these fail, then internal manoeuvres are necessary. The order of these will depend on the skill and experience of the person conducting the delivery and the individual case. These manoeuvres have been named after famous obstetricians, but it is the process rather than the name that is important:
• An attempt can be made to rotate the baby, so that the shoulders enter the diagonal to allow delivery. The first procedure is usually to insert a hand behind the anterior shoulder, and push it towards the chest (Rubin II). This will adduct the shoulders then push them into the diagonal. This can be combined with pressure on the
anterior aspect of the posterior shoulder
to aid rotation (Woods’ screw). If this fails,
an attempt can be made to rotate the baby
in the opposite direction (reverse Woods’
screw). Delivery of the posterior arm can be
attempted passing a hand into the vagina, in
front of the posterior shoulder and deliver
the posterior arm by swinging it in front of
the fetal chest.
If these all fail, the patient can be moved on to all fours as this increases the anterior–posterior diameter of the inlet. In this position, the posterior arm can be delivered.
After this, manoeuvres of last resort include a symphysiotomy, in which the maternal symphysis is divided, Zavanelli’s, in which the head is reduced back into the vagina and a Caesarean section performed and intentional fracture of the fetal
clavicle. -
This question is part of the following fields:
- Clinical Management
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Question 14
Correct
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You are called to see a 24 year old patient in A&E. She is 34 weeks gestation and her blood pressure is 149/98. Urine dip shows protein 3+. You send a for a protein:creatinine ratio. What level would be diagnostic of significant proteinuria?
Your Answer: >30 mg/mmol
Explanation:Significant proteinuria = urinary protein:creatinine ratio >30 mg/mmol or 24-hour urine collection result shows greater than 300 mg protein
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This question is part of the following fields:
- Clinical Management
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Question 15
Incorrect
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You review a patient who is 34 weeks pregnant. She complains of gradually worsening itching over the past 6 weeks particularly to the hands and feet which is worse at night. You order some bloods. Which of the following would you normally expect to increase in the 3rd trimester?
Your Answer: Calcium
Correct Answer: ALP
Explanation:ALP can rise to up to 3 times the normal non-pregnant value in the 3rd trimester. All of the other tests above typically decrease during pregnancy.
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This question is part of the following fields:
- Clinical Management
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Question 16
Incorrect
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A 46 year old women with a BMI of 34 is seen in clinic following hysteroscopy and biopsy for irregular menstrual bleeding. Histology shows atypical hyperplasia. Which of the following is the most appropriate 1st line management?
Your Answer: Levonorgestrel intra-uterine system (IUS)
Correct Answer: Laparoscopic hysterectomy
Explanation:There is an increase risk of developing carcinoma of the uterus, if the endometrium shows hyperplasia with atypia. The standard surgery is total hysterectomy with bilateral salpingectomy which can be performed abdominally or laparoscopically If the disease is grade 1-2 and less than 1B i.e. less than 50% invasion of the uterine body.
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This question is part of the following fields:
- Clinical Management
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Question 17
Incorrect
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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: 2A
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
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Question 18
Incorrect
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What is the mode of action of Mefenamic acid?
Your Answer: Activates Antithrombin III
Correct Answer: Inhibits Prostaglandin Synthesis
Explanation:Mefenamic acids is a NSAID. It works by inhibiting prostaglandin synthesis – It inhibits COX-1 and COX-2 hence reducing the process of inflammation. Activation of antithrombin III and inactivation of factor Xa is the primary mechanism of action of Heparin.
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This question is part of the following fields:
- Clinical Management
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Question 19
Incorrect
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A patient attends the maternity unit as her waters have broken but she hasn't had contractions. She is 39+6 weeks gestation. Speculum examination confirms prelabour rupture of membranes. What is the likelihood of spontaneous labour starting within 24 hours?
Your Answer: 40%
Correct Answer: 60%
Explanation:In pregnancy, term refers to the gestational period from 37 0 to 41 6 weeks. Preterm births occur between 24 0 and 36 6 weeks. 60% of the women will go into labour with in 24 hours in PPROM. After 24 hours have past without any contraction and the gestation age is more than 34 week than prostaglandins can be used to augment labour.
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This question is part of the following fields:
- Clinical Management
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Question 20
Incorrect
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A 28 year old patient has a diagnosis of PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2 and she is a non-smoker. She has been taking Clomiphene and metformin for the past 6 months. What is the next most appropriate treatment?
Your Answer: IVF
Correct Answer: Gonadotrophins
Explanation:Management of PCOS includes OCP, cyclical oral progesterone, metformin, clomiphene (which is more effective in inducing ovulation than metformin) and life-style changes. In women who are tolerant to these therapies Gonadotrophins should be trialled. However lifestyle changes should be able to improve the condition significantly. Clomiphene shouldn’t be continued for more than 6 months.
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This question is part of the following fields:
- Clinical Management
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Question 21
Correct
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A 26 year old women presents for her 12 week scan. She has been pregnant once before but had a 1st trimester miscarriage. She reports no problems with this pregnancy and has had no vaginal bleeding or spotting. The scan shows no fetal cardiac activity and a small gestational sac. What is the likely diagnosis?
Your Answer: Missed Miscarriage
Explanation:As there has been no bleeding or expulsion of the products of conception this is a missed miscarriage
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This question is part of the following fields:
- Clinical Management
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Question 22
Incorrect
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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: Stat dose metronidazole 1g rectally at time of abortion
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.
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This question is part of the following fields:
- Clinical Management
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Question 23
Incorrect
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A 56 year old lady presents with a vulval itch and discolouration. A biopsy conforms Lichen Sclerosis (LS). What is the risk of developing squamous cell carcinoma compared to patients with a normal vulval biopsy?
Your Answer: 25%
Correct Answer:
Explanation:Lichen Sclerosis is a destructive inflammatory condition that effects the anogenital region of women. It effects around 1 in 300 women. It destroys the subdermal layers of the skin resulting in hyalinization of the skin leading to parchment paper appearance of the skin. It is associated with vulval cancer and it is estimated that the risk of developing vulval cancer after lichen sclerosis is around 3-5%.
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This question is part of the following fields:
- Clinical Management
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Question 24
Correct
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Question 25
Correct
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A patient is being discharged following a termination of pregnancy at 14 weeks. She had been taking Microgynon in the past but stopped taking this 6 months prior to falling pregnant as she wasn't in a serious relationship.
Your Answer: Start immediately
Explanation:Combined oral contraceptive pills (COCPs) can be started immediately following abortion or miscarriage. Note following childbirth COCPs should not be restarted for 3 weeks (assuming the patient is not breastfeeding).
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This question is part of the following fields:
- Clinical Management
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Question 26
Correct
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Which of the following is the most appropriate for diagnosis of Bacterial Vaginosis (BV)?
Your 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
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Question 27
Correct
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According to the RCOG Green-top guideline published in 2013 at what stage of gestation should pregnant patients with PCOS be offered screening for gestational diabetes
Your Answer: 24-28 weeks gestation
Explanation:Screening for gestational diabetes should be offered and performed between 24-28 weeks. It should be noted PCOS alone does not make screening essential. It is advised for PCOS patients who are overweight or if not overweight but has other risk factors (age >40, personal history of gestational diabetes or family history of type II diabetes). Screening is via a 2-hour post 75 g oral glucose tolerance test.
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This question is part of the following fields:
- Clinical Management
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Question 28
Incorrect
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What percentage of pregnancies will be uncomplicated following a single episode of reduced fetal movements?
Your Answer: 50%
Correct Answer: 70%
Explanation:Reduced fetal movements can be the first indication of possible fetal abnormalities. Movements are first perceived by the mother from about 18-20 weeks gestation, increase in size and frequency until 32 weeks gestation when they plateau at about 31 movements per hour. Investigations for reduced fetal heart rate include auscultation of the fetal heart rate using a handheld doppler device, and a cardiotocograph or ultrasound if the foetus is above 28 weeks gestation. About 70% of women who experience one episode of reduced fetal movement have uncomplicated pregnancies. They are advised to report to a maternal unit if another episode occurs.
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This question is part of the following fields:
- Clinical Management
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Question 29
Correct
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A 31 year old patient undergoes an elective c-section delivery. You estimate blood loss has reached 1000ml and you suspect uterine atony is the likely cause. Following bimanual uterine compression what pharmacological intervention is advised?
Your Answer: Syntocin 5u by slow intravenous injection
Explanation:Syntocin 5u by slow intravenous injection is the first line pharmacological measurement in this scenario
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This question is part of the following fields:
- Clinical Management
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Question 30
Incorrect
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Which of the following contraceptives primary mode of action is inhibition of ovulation?
Your Answer: Norgeston®
Correct Answer: Cerazette®
Explanation:Desogestrel only POPs work mainly by inhibiting ovulation. Cerazette Is the only brand in this list which belongs to this group.
Types of Progesterone Only Pills
1. Traditional (e.g. Femulen®, Micronor®, Norgeston®)
Main mode of action: thickening cervical mucus preventing sperm entry at neck of womb and may also cause anovulation but this effect variable and unreliable
2. Desogestrel (e.g. Cerazette®)
Main mode of action: inhibition of ovulation and also cause thickening of cervical mucus
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This question is part of the following fields:
- Clinical Management
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SESSION STATS - PERFORMANCE PER SPECIALTY
