-
Question 1
Incorrect
-
Which of the following statements regarding the vaginal artery is typically TRUE?
Your Answer: It arises from the Ovarian artery
Correct Answer: It arises from the Internal iliac artery
Explanation:The vaginal artery is the homolog to the inferior vesical artery in males. In most of the cases it arises from the internal iliac artery.
-
This question is part of the following fields:
- Anatomy
-
-
Question 2
Incorrect
-
A 28-year-old, currently at 26 weeks’ gestation of her third pregnancy, presents with irregular uterine contractions for the past 24 hours and has concerns about premature delivery. She delivered her first child at 38 weeks of gestation and her second at 39 weeks gestation. On examination, BP and urinalysis have come back normal. Her symphysis-fundal height measures 27cm, the uterus is lax and non-tender. Fetal heart rate is 148/min. She also undergoes a pelvic examination along with other investigations.
Which findings would suggest that delivery is most likely going to happen before 30 weeks’ of gestation?
Your Answer:
Correct Answer: The cervix is closed, but the fetal fibronectin test on cervical secretions is positive.
Explanation:Predisposing factors of preterm delivery include a short cervix (or if it shortens earlier than in the third trimester), urinary tract or sexually transmitted infections, open cervical os, and history of a previous premature delivery. Increased uterine size can also contribute to preterm delivery and is seen with cases of polyhydramnios, macrosomia and multiple pregnancies. The shorter the cervical length, the greater the risk of a premature birth.
In this case, the risk of bacterial vaginosis and candidiasis contributing to preterm delivery would be lower than if in the context of an open cervical os. However, the risk of premature delivery is significantly increased if it is found that the fetal fibronectin test is positive, even if the os is closed. -
This question is part of the following fields:
- Obstetrics
-
-
Question 3
Incorrect
-
In early pregnancy at what gestation does the Gestational sac become visible on transvaginal ultrasound?
Your Answer:
Correct Answer: 4 weeks + 3 days
Explanation:The gestational sac is typically visible from 31 days gestation by transvaginal ultrasound and a week later (38 days) on transabdominal ultrasound.
-
This question is part of the following fields:
- Biophysics
-
-
Question 4
Incorrect
-
Which of the following is the most likely anaesthetic or analgesic causing reduced variability on cardiotocograph?
Your Answer:
Correct Answer: Intramuscular pethidine
Explanation:Opiates and spinal anaesthetics reduce the variability of a CTG. Including some antihypertensives like labetalol and alpha methyl dopa.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 5
Incorrect
-
A patient has returned to your clinic. She presented with painful periods 18 months earlier and laparoscopy confirmed endometriosis. She now gets pain on opening her bowels as well as low back pain. What structure is likely to be involved?
Your Answer:
Correct Answer: Uterosacral ligament
Explanation:Lower abdominal pain during menstrual periods and lower back or leg pain are associated with endometriosis in the uterosacral ligaments. Endometriosis can cause diarrhoea and IBS type symptoms. Note Endometriosis on the uterosacral ligament can cause tender nodules to form. These can be palpated during pelvic exam. Tender nodules are specific to endometriosis of the uterosacral ligament so if the question mentions feeling a tender nodule during PV exam think endometriosis of the Uterosacral ligaments!
-
This question is part of the following fields:
- Clinical Management
-
-
Question 6
Incorrect
-
What is the most common Type II congenital thrombophilia?
Your Answer:
Correct Answer: Factor V Leiden mutation
Explanation:Factor V Leiden is the most common congenital thrombophilia. Named after the Dutch city Leiden where it was first discovered. Protein C and S deficiencies are type 1 (Not type 2) thrombophilias Antiphospholipid syndrome is an acquired (NOT congenital) thrombophilia
-
This question is part of the following fields:
- Clinical Management
-
-
Question 7
Incorrect
-
You see a 23 year old women in clinic complaining of vaginal discharge. The lab phone to tell you microscopy and staining shows a gram negative diplococcus. Which organism is most likely to be responsible?
Your Answer:
Correct Answer: Neisseria gonorrhoeae
Explanation:The most common gram negative diplococci include Neisseria, haemophilus and Moraxella.
-
This question is part of the following fields:
- Microbiology
-
-
Question 8
Incorrect
-
A 66-year-old lady comes to your clinic complaining of a brownish vaginal discharge that has been bothering her for the previous three months. Atrophic vagina is seen on inspection.
Which of the following diagnoses is the most likely?Your Answer:
Correct Answer: Vaginal atrophy
Explanation:Endometrial cancer should always be the first diagnosis to rule out in a 65-year-old lady with brownish vaginal discharge. The inquiry focuses on the most likely source of the symptoms, rather than the most significant diagnosis to explore.
Blood typically causes the dark hue of vaginal discharge. The uterine cavity or the vagina can both be the source of bleeding. Only 5-10% of postmenopausal women with vaginal bleeding were found to have endometrial cancer. Around 60% of the women had atrophic vaginitis.Urogenital atrophy is caused by oestrogen insufficiency in postmenopausal women. Urogenital atrophy can cause the following symptoms:
– Dry vaginal skin
– Vaginal inflammation or burning
– Vaginal lubrication is reduced during sexual activity.
– Vulvar or vaginal pain, as well as dyspareunia (at the introitus or within the vagina)
– Vaginal or vulvar bleeding (e.g. postcoital bleeding. fissures)
– Vaginal discharge from the cervix (leukorrhea or yellow and malodorous)
– A vaginal bulge or pelvic pressure
– Symptoms of the urinary tract (e.g. urinary frequency, dysuria, urethral discomfort, haematuria). -
This question is part of the following fields:
- Gynaecology
-
-
Question 9
Incorrect
-
The femoral triangle is bounded superiorly by which of the following structures?
Your Answer:
Correct Answer: Inguinal ligament
Explanation:The femoral triangle is bounded superiorly by the inguinal ligament which forms the base of the triangle, medially by the lateral border of the adductor longus and laterally by the sartorius muscle.
-
This question is part of the following fields:
- Anatomy
-
-
Question 10
Incorrect
-
A woman visited the OPD with complaints of severe abdominal pain and light-headedness. There is history of fainting three days prior to consultation. She also has vaginal bleeding. In this case, which of the following investigations should be ordered to reach the diagnosis?
Your Answer:
Correct Answer:
Explanation:Testing for beta hCG should be the first test in this case. It will rule out any pregnancy that is strongly suspected based on the patient’s history and physical examination.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 11
Incorrect
-
Question 12
Incorrect
-
According to the RCOG Green-top guidelines on prevention and management of post-partum haemorrhage (PPH) which of the following statements is true?
Your Answer:
Correct Answer: For women delivering by caesarean section, Oxytocin 5 iu by slow IV injection should be used
Explanation:Misoprostol is not as effective as oxytocin but may be used if Oxytocin is not available e.g. home birth Recommended doses of Oxytocin For vaginal deliveries: 5 iu or 10 iu by intramuscular injection. For C-section: 5 iu by IV injection
-
This question is part of the following fields:
- Clinical Management
-
-
Question 13
Incorrect
-
Question 14
Incorrect
-
Which of the following is suggestive of ovulation:
Your Answer:
Correct Answer: Regular cycle with dysmenorrhea
Explanation:Ovulation in the menstrual cycle usually occurs over 4 days. There is an increase in basal body temperature at the time of ovulation due to the effect of progesterone.
A high Day 21 progesterone level indicates ovulation and the release of an egg.
Dysmenorrhea is described as painful menstruation. The symptoms start at the time of ovulation and persist till menstruation.
-
This question is part of the following fields:
- Physiology
-
-
Question 15
Incorrect
-
In which of the following situations are mini-pills unsafe to use?
Your Answer:
Correct Answer: Ovarian cysts
Explanation:Progestin only pills increase the risk of developing follicular cysts. Sonographic studies have observed that follicular cysts are more common in POP users than women not using hormones. The follicular changes tend to increase and regress over time. No intervention is required in asymptomatic women, other than reassurance. POP users who have persistent concerns about ovarian follicular changes should be offered another method of contraception.
All other options are not contraindications to the use of mini-pills.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 16
Incorrect
-
After birth, all of the following vessels constrict, EXCEPT the:
Your Answer:
Correct Answer: Hepatic portal vein
Explanation:Immediately after birth the liver is deprived of the large flow of blood supplied during foetal development via the umbilical vein and portal sinus. Simultaneously the blood pressure in the portal sinus, previously as high as in the umbilical vein, falls.
-
This question is part of the following fields:
- Physiology
-
-
Question 17
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 18
Incorrect
-
The following measures are usually performed during a routine antenatal visit for a healthy uncomplicated pregnancy at 36 weeks gestation, EXCEPT:
Your Answer:
Correct Answer: Mid-steam urine specimen (MSU) for culture & sensitivity
Explanation:At the 36‑week appointment, all pregnant women should be seen again. At this appointment: measure blood pressure and test urine for proteinuria; measure and plot symphysis–fundal height; check position of baby; for women whose babies are in the breech presentation, offer external cephalic version (ECV)
-
This question is part of the following fields:
- Obstetrics
-
-
Question 19
Incorrect
-
Which immunoglobulin provides passive immunity to the neonate?
Your Answer:
Correct Answer: IgG
Explanation:Passive immunity to the neonate is provided by immunoglobulin G (IgG) since it can be transferred through the placenta from mother to the foetus.
IgA is transferred from mothers to offspring through breast milk.
IgM molecular structure is too big to be filtered through the placental vasculature to the foetus. IgM is the first Ig to be synthesised by the neonate -
This question is part of the following fields:
- Immunology
-
-
Question 20
Incorrect
-
A 33-year-old female presents with 3 months of irregular vaginal bleeding. Prior to this her menstrual periods were normal.
Which one of the following is the most appropriate initial laboratory test for this patient?Your Answer:
Correct Answer: hCG
Explanation:In women of childbearing age, the most likely cause of abnormal vaginal bleeding is pregnancy; thus, the most appropriate initial test would be an hCG level. Once pregnancy has been excluded, patient history would guide further testing. Iatrogenic causes, usually resulting from certain medicines or supplements, are the next most common cause in this age group, followed by systemic disorders. Haemoglobin and haematocrit would be appropriate only if the patient seemed acutely anaemic due to the abnormal bleeding.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 21
Incorrect
-
Which of the following hormones are required for alveolar morphogenesis during pregnancy?
Your Answer:
Correct Answer: Progesterone, Prolactin and hPL
Explanation:The changes seen in breast tissue with the menstrual cycle are accentuated during pregnancy. Deposition of fat around glandular tissue occurs, and the number of glandular ducts is increased by oestrogen, while progesterone and human placental lactogen (hPL) increase the number of gland alveoli. Prolactin is essential for the stimulation of milk secretion and during pregnancy prepares the alveoli for milk production. Although prolactin concentration increases throughout pregnancy, it does not then result in lactation since it is antagonized at an alveolar receptor level by oestrogen.
-
This question is part of the following fields:
- Endocrinology
-
-
Question 22
Incorrect
-
Evidence from meta-analysis of RCTs is what level of evidence?
Your Answer:
Correct Answer: Ia
Explanation:The levels of evidence range from I-IV:
1a: Systematic reviews (with homogeneity) or metanalysis of randomized controlled trials: highest level of evidence.
1b: Individual randomized controlled trial (with narrow confidence interval)
1c: All or none randomized controlled trials
2a: Systematic reviews (with homogeneity) of cohort studies
2b: Individual cohort study or low quality randomized controlled trials (e.g. <80% follow-up)
2c: Outcomes Research; ecological studies
3a: Systematic review (with homogeneity) of case-control studies
3b: Individual case-control study
4: Case series (and poor quality cohort and case-control studies)
5: Expert opinion without explicit critical appraisal, or based on physiology, bench research or first principles. -
This question is part of the following fields:
- Epidemiology
-
-
Question 23
Incorrect
-
Which one of the following measurements is usually taken during clinical exam of the pelvis?
Your Answer:
Correct Answer: Shape of the pubic arch
Explanation:During pelvimetry, the shape of the pubic arch is usually examined. It helps in determining the outcome of the type of fetal delivery.
-
This question is part of the following fields:
- Anatomy
-
-
Question 24
Incorrect
-
A pregnant patient with a chest infection is worried about the radiation risk of a chest X Ray. How many days of natural background radiation is equivalent to a chest X Ray?
Your Answer:
Correct Answer: 2.5
Explanation:X-rays carry low levels of risk during pregnancy and are not a significant cause for concern if the total exposure to ionising radiation is less than 5 rads throughout the pregnancy; a chest X-ray is about 0.00007 rads. The amount of radiation generated from a chest X-ray is equivalent to 2.4 days of natural background radiation. Non-urgent radiological tests should, however, be avoided between 10-17 weeks gestation as there is a higher risk of central nervous system teratogenesis during this time.
-
This question is part of the following fields:
- Biophysics
-
-
Question 25
Incorrect
-
An 19-year old female came in at the clinic for her first prenatal visit. She claims to have had regular menstrual cycles even while she was on oral contraceptives (OCP). 20 weeks ago, she stopped taking her OCPs and had a menstrual period few days after. No vaginal bleeding or fluid loss were noted since then. On physical examination, the uterus is palpated right above pubic symphysis. Fetal heartbeats are evident on handheld Doppler ultrasound. Which of the statements can mostly explain the difference between the dates and uterine size?
Your Answer:
Correct Answer: Ovulation did not occur until 6-8 weeks after her last period.
Explanation:When the palpated uterine size is in discrepancy with the expected size based on the duration of amenorrhoea, it can have several causes including reduced fluid volume or fetal growth (both of which are more common when there is fetal malformation), or miscalculated age of gestation as a result of wrong dates or actual ovulation occurring at a later date than expected. Reduced fluid volume and fetal growth are the most likely aetiologies during the third trimester of pregnancy, unlike in this patient at 20 weeks age of gestation.
Premature rupture of membranes is less likely the cause when there is negative vaginal fluid loss like this patient.
The most likely cause in this case is that ovulation did not occur as expected, especially when the patient ceased her OCPs during this period. In some instances, ovulation can occur 2 weeks later in about 50% of women, 6 weeks later in 90%, and may still not occur 12 months later in 1% of women.
The other listed statements are unlikely to explain the discrepancies in dates and the observed uterine size in this patient.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 26
Incorrect
-
In which one of the following positions does hyperextension of the fetal head occur?
Your Answer:
Correct Answer: Face presentation
Explanation:Face presentation is the abnormal position of the fetal head in labour. In this position the neck is hyperextended.
Vertex position is the normal presentation of the foetus for delivery, in which the head is flexed and the position of the chin is towards the chest. -
This question is part of the following fields:
- Anatomy
-
-
Question 27
Incorrect
-
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 (PROM). What is the risk of serious neonatal infection with PROM?
Your Answer:
Correct Answer: 1 in 100
Explanation:Prelabour Rupture of Membranes:
– Risk of serious neonatal infection 1% (vs 0.5% for women with intact membranes)
– 60% of patients with PROM will go into labour within 24 hrs
– Induction appropriate if >34 weeks gestation and >24 hours post rupture and patients labour hasn’t started.
– If <34 weeks induction of labour should not be carried out unless there are additional obstetric indications e.g. infection -
This question is part of the following fields:
- Clinical Management
-
-
Question 28
Incorrect
-
Which of the following factors as shown to decrease ovarian cancer risk?
Your Answer:
Correct Answer: Taking statins
Explanation:Factors shown to decrease risk of ovarian cancer are:
– Oral contraceptive use
– Higher Parity
– Breast feeding
– Hysterectomy
– Tubal Ligation
– Statins
– SLE -
This question is part of the following fields:
- Epidemiology
-
-
Question 29
Incorrect
-
A 40-year-old white female lawyer sees you for the first time. When providing a history, she describes several problems, including anxiety, sleep disorders, fatigue, persistent depressed mood, and decreased libido. These symptoms have been present for several years and are worse prior to menses, although they also occur to some degree during menses and throughout the month. Her menstrual periods are regular for the most part.
The most likely diagnosis at this time is:Your Answer:
Correct Answer: Dysthymia
Explanation:Psychological disorders, including anxiety, depression, and dysthymia, are frequently confused with premenstrual syndrome (PMS), and must be ruled out before initiating therapy. Symptoms are cyclic in true PMS. The most accurate way to make the diagnosis is to have the patient keep a menstrual calendar for at least two cycles, carefully recording daily symptoms. Dysthymia consists of a pattern of ongoing, mild depressive symptoms that have been present for 2 years or more and are less severe than those of major depression. This diagnosis is consistent with the findings in the patient described here.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 30
Incorrect
SESSION STATS - PERFORMANCE PER SPECIALTY
