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Question 1
Correct
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In which one of the following circumstances, is it least likely for a foetus to be in a transverse lie?
Your Answer: A normal term foetus
Explanation:Normal position of the foetus in relationship to the mother is always a longitudinal lie and a cephalic presentation. Transverse lie means that the baby is sideways. The foetus lies transverse till 26-28th week of gestation, after which it usually changes its position from transverse to a longitudinal lie with head down. A transverse lie can occur in conditions like grand multiparity, preterm foetus, placenta previa and pelvic contraction.
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This question is part of the following fields:
- Obstetrics
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Question 2
Correct
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Regarding implantation, how many days after fertilisation does it typically occur?
Your Answer: 8
Explanation:Fertilization usually occurs in the fallopian tubes after ovulation. The zygote moves through the fallopian tube and implants in the endometrium about 7-9 days after fertilisation, or 6-12 days after ovulation.
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This question is part of the following fields:
- Embryology
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Question 3
Correct
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The best confirmatory test for Turner's syndrome is done by:
Your Answer: Chromosomal analysis (Karyotyping)
Explanation:Standard karyotyping is the best confirmatory test for the diagnosis of Turner syndrome among patients who have some doubtful clinical presentations. It is done on peripheral blood mononuclear cells.
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This question is part of the following fields:
- Embryology
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Question 4
Incorrect
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A 24-year-old pregnant female presented with severe pain in the lower abdomen and excessive vaginal bleeding at 35 weeks gestation. Which of the following investigations should be done?
Your Answer: Coagulation profile
Correct Answer: US abdomen
Explanation:Ultrasound of abdomen should be done to rule out the cause of the excessive bleeding in this patient, this could confirm the very high suspicion of rupture of the placenta in this case.
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This question is part of the following fields:
- Gynaecology
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Question 5
Incorrect
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A 33-year-old 'grand multiparous' woman, who has previously delivered seven children by normal vaginal delivery, spontaneously delivers a live baby weighing 4750gm one hour ago after a three-hour long labour period. Shortly after, an uncomplicated third stage of labour, she goes into shock (pulse 140/min, BP 80/50 mmHg). At the time of delivery, total blood loss was noted at 500mL, and has not been excessive since then. What is the most probable diagnosis of this patient?
Your Answer: Uterine atony.
Correct Answer: Uterine rupture.
Explanation:The patient most likely suffered a uterine rupture. It occurs most often in multiparous women and is less often associated with external haemorrhage. Shock develops shortly after rupture due to the extent of concealed bleeding.
Uterine inversion rarely occurs when after a spontaneous and normal third stage of labour. Although it can lead to shock, it is usually associated with a history of controlled cord traction or Dublin method of placenta delivery before the uterus has contracted. This diagnosis is also strongly considered when shock is out of proportion to the amount of blood loss.
An overwhelming infection is unlikely in this case when labour occurred for a short period of time. Uterine atony and amniotic fluid embolism are more associated with excessive vaginal bleeding, which is not evident in this case.
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This question is part of the following fields:
- Obstetrics
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Question 6
Correct
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Regarding urinary tract infection (UTI) in pregnancy. What is the most common causative organism of urinary tract infection?
Your Answer: Escherichia coli
Explanation:E.coli is the most common cause of UTI. Other organisms include pseudomonas, proteus and klebsiella.
NICE guidelines: UTI in pregnancy (updated in July 2015)
Send urine for culture and sensitivity from all women in whom UTI is suspected before starting empirical antibiotics and 7 days after antibiotic treatment is completed.
Prescribe an antibiotic to all women with suspected UTI (awaiting culture result is not advised)
Although local antibiotic resistance needs to be taken into account the following is advised in terms of antibiotic selection:
1. Nitrofurantoin 50 mg QDS (or 100 mg MR BD) for 7 days.
2. Trimethoprim 200 mg twice daily, for 7 days
Give folic acid 5 mg OD if it is the 1st trimester
Do not give trimethoprim if the woman is folate deficient, taking a folate antagonist, or has been treated with trimethoprim in the past year.
3. Cefalexin 500 mg BD (or 250 mg 6qds) for 7 days -
This question is part of the following fields:
- Clinical Management
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Question 7
Correct
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Which of the following is indicated for the treatment of chlamydial urethritis in pregnancy?
Your Answer: Azithromycin 1gram as single dose
Explanation:The best treatment option for chlamydial urethritis in pregnancy is Azithromycin 1g as a single dose orally. This is the preferred option as the drug is coming under category B1 in pregnancy.
Tetracycline antibiotics, including doxycycline, should never be used in pregnant or breastfeeding women.
Erythromycin Estolate is contraindicated in pregnancy due to its increased risk for hepatotoxicity. Ciprofloxacin is not commonly used for treating chlamydial urethritis and its use is not safe during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 8
Incorrect
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A foetus is noted to be small for gestational age (SGA) on the 20 week scan. One of the mothers medications is stopped at this time. Follow up scans reveal renal dysgenesis. Which of the below medications was stopped?
Your Answer: Phenytoin
Correct Answer: Ramipril
Explanation:Use of angiotensin II receptors blocks and ACE inhibitors are known to result in renal dysgenesis. Due to renal dysgenesis oligohydramnios occurs that leads to IUGR.
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This question is part of the following fields:
- Pharmacology
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Question 9
Correct
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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: 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.
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This question is part of the following fields:
- Anatomy
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Question 10
Incorrect
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A 41 year old woman is referred to EPAU with spotting in early pregnancy. What is the risk of miscarriage in women in this age group?
Your Answer: 75%
Correct Answer: 50%
Explanation:Miscarriage rates:
20-24 – 9%
25-29 – 11%
30-34 – 15%
35-39 – 25%
40-44 – 51%
>45 – 75% -
This question is part of the following fields:
- Epidemiology
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Question 11
Correct
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Oestrogen have all of the following actions, EXCEPT:
Your Answer: Prevention of thrombosis
Explanation:The properties of oestrogen:
Structure: Stimulates endometrial growth, maintenance of vessels and skin,
reduces bone resorption, increases bone formation, increases uterine growth
Protein synthesis: Increases hepatic synthesis of binding proteins
Coagulation: Increases circulating levels of factors II, VII, IX, X, antithrombin III and plasminogen; increases platelet adhesiveness
Lipid: Increases HDL and reduces LDL,increases triglycerides, reduces
ketone formation, increases fat deposition
Fluid balance: Salt and water retention
Gastrointestinal: Reduces bowel motility, increases cholesterol in bile -
This question is part of the following fields:
- Endocrinology
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Question 12
Correct
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A fibroid is a type of
Your Answer: Leiomyoma
Explanation:A fibroid is a benign smooth muscle tumour or Leiomyoma. As such it is something of a misnomer. Leiomyosarcoma and Angioleiomyoma are malignant tumours of smooth muscle under the WHO sort tissue tumour classification Rhabdomyoma is a skeletal muscle tumour Myofibroma is seen in fibromatosis
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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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A woman in her 27 weeks of gestation presents to your clinic with gushing of clear yellow vaginal fluid.
Premature rupture of membrane (PPROM ) is confirmed on speculum examination, and the cervical os is closed.
Which of the following would be the most appropriate management, in addition to transfer to a tertiary center?Your Answer: Systemic corticosteroids
Explanation:Cases with spontaneous rupture of membrane before the onset of labour, prior to 37 weeks of gestation is defined as preterm premature rupture of membranes(PPROM). It complicates almost 2-4% of all singleton and 7- 20% of twin pregnancies and is commonly associated with more than 60% of all preterm births.
Management of PPROM In the absence of chorioamnionitis, depends on the gestational age. That is in cases of PPROM before 23 weeks, labor may be induced or the patient be sent home for bed rest and is asked to wait until any signs of spontaneous delivery to start. Between 23 and 34 + 0/7 weeks, the patient should be transferred to a tertiary hospital and be admitted there as it is very important to administer systemic corticosteroids, for the fetal lung to attain maturity. It is also mandatory the patient gets adequate bed rest, cervical and vaginal swabs for microscopy and culture, along with prophylactic antibiotics for prevention of chorioamnionitis.
NOTE –  regardless of the gestational age, chorioamnionitis is said to be an absolute indication for the termination of pregnancy.In the given case, patient is currently in her 28th week of gestation, so she should be immediately transferred to a tertiary hospital and given systemic steroids to promote fetal lung maturation in case preterm delivery ensues.
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This question is part of the following fields:
- Obstetrics
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Question 14
Correct
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What is the anatomical landmark used for gauging the station of the fetal head during labour?
Your Answer: Ischial Spine
Explanation:The ischial spines and palpable through the vagina and are used as landmarks to assess the decent of the fetal head from the cervix. It also serves as a landmark for giving the pudendal block.
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This question is part of the following fields:
- Anatomy
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Question 15
Correct
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A 24-year-old on combined oral contraceptive pills for the last 3 years. She complains of migraine two to three times a month for the last 6 months.
What should be best appropriate advice to her?Your Answer: Stop combined oral contraceptive pills and prescribe progestogen only pills
Explanation:While on combination oral contraceptive tablets, this patient had a migraine. After a conversation about adverse effects, stop the combo medications and prescribe her progestogen-only pills.
The following are reasons why progestogen-only pills should be your first choice:
1-Age of 45 or more years
2-Smokers who are 45 years old or older
3-Oestrogen contraindications
4-Melitus Diabetes
5-A headache (combined oral contraceptive pills have absolute contraindication)
6-Hypertension under control
7-Lactation
8-Chloasma.Pregnancy, undetected genital tract bleeding, and concurrent use of enzyme-inducing medications are all contraindications to using progestogen-only pills.
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This question is part of the following fields:
- Gynaecology
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Question 16
Correct
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A 42 year old smoker attends clinic due to vulval soreness and shows you a number of vulval lumps. Biopsy is taken and reported as showing
Your Answer: Vulval intraepithelial neoplasia (VIN)
Explanation:This is VIN. Smoking is a risk factor. It is also more common in immunocompromised patients.
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This question is part of the following fields:
- Clinical Management
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Question 17
Correct
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A diminishing blood volume within the first 4 hours post-partum may be seen when a warning sign occurs.
Which of the following is considered the single most important warning sign for the said situation?Your Answer: Tachycardia
Explanation:Postpartum haemorrhage (PPH) is a cumulative blood loss greater than 1000 mL with signs and symptoms of hypovolemia within 24 hours of the birth process, regardless of the route of delivery.
The first step in managing hemorrhagic shock is recognition. This should occur before the development of hypotension. Close attention should be paid to physiological responses to low blood volume. Tachycardia, tachypnoea, and narrowing pulse pressure may be the initial signs.
Tachycardia is typically the first abnormal vital sign of hemorrhagic shock. As the body attempts to preserve oxygen delivery to the brain and heart, blood is shunted away from extremities and nonvital organs. This causes cold and modelled extremities with delayed capillary refill. This shunting ultimately leads to worsening acidosis.
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This question is part of the following fields:
- Obstetrics
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Question 18
Correct
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A lady who is 29-weeks pregnant, comes to a general practice, complaining of a sudden gush of clear fluid.
On Speculum examination, premature rupture of membranes is confirmed with closed cervix.
In addition to transferring patient to a tertiary care, what is the most appropriate in the management of this case?Your Answer: Betamethasone
Explanation:This patient who is at her 29 weeks of pregnancy, presented with sudden gush of clear fluid and Speculum examination has confirmed premature rupture of membrane (PROM).
Approximately, 50% of PROM progress to labour within 24 hours and in the remaining, 80% within seven days. The most important next step of management in this case is transferring this patient to tertiary care hospital as soon as possible. It is equally important to give corticosteroid therapy, like Betamethasone, if delivery prior to 34 weeks is likely to occur, as it will help in fetal lung maturity.
Cardiotocography (CTG) is usually not available in general practice settings and it can be done only while in the hospital. If CTG shows any abnormality or if there is any presence of infection it is better to induce labor.
Salbutamol and nifedipine are of no use in this case, as the patient is not in labour and does not require tocolytics.
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This question is part of the following fields:
- Obstetrics
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Question 19
Incorrect
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Which of the following Oestrogens (Oestrogens) becomes the predominant circulating oestrogen during pregnancy?
Your Answer: Oestradiol
Correct Answer: Estriol
Explanation:Oestradiol is the predominant form of oestrogen during the reproductive life of a female. The estrogenic potency of oestradiol is 12 times more than estrone and 80 times that of estriol.
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This question is part of the following fields:
- Endocrinology
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Question 20
Incorrect
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Regarding menstruation, which of the following is the maximum normal blood loss?
Your Answer: 150-200ml
Correct Answer: 80-85ml
Explanation:Most women lose about 35-40 ml of blood on average during each menstrual cycle. The maximum amount of blood loss is 80 ml after which blood loss of more than 80 ml is defined as heavy menstrual bleeding, formerly known as menorrhagia.
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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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What is the primary form of haemoglobin in a 6 week old foetus?
Your Answer: Hb Gower 1
Explanation:HB gower 1 is the predominant embryonic haemoglobin when the foetus is 6 weeks old and is replaced by adult haemoglobin by the age of 5 months post natally.
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This question is part of the following fields:
- Physiology
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Question 22
Correct
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A 26 year old female patient comes to a GP asking to see a gynaecologist for cervical screening test. She has no history of sexual intercourse and is not a lesbian.
What would you do next?Your Answer: Reassure her there is no need for cervical screening test at this stage
Explanation:Women, who have never had sexual encounter, do not need cervical screening. However, any sort of sexual encounter (Lesbian or heterosexual) is considered a risk and the patient must be screened. Otherwise, routine cervical screening test can be performed every five years for woman 25-74 years who ever had sex with no evidence of cervical pathology. Perform a cervical screening test at the age of 25 or 2 years after first sexual intercourse-whichever is later in sexually active women. Perform cervical screening test in patients above 75 years if they request or if they never had any symptoms.
All other options are unacceptable.
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This question is part of the following fields:
- Gynaecology
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Question 23
Correct
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Galactorrhoea (non-gestational lactation) may result from all of the following EXCEPT:
Your Answer: Intrapartum haemorrhage
Explanation:Pituitary tumours, the most common pathologic cause of galactorrhoea can result in hyperprolactinemia by producing prolactin or blocking the passage of dopamine from the hypothalamus to the pituitary gland. Approximately 30 percent of patients with chronic renal failure have elevated prolactin levels, possibly because of decreased renal clearance of prolactin. Primary hypothyroidism is a rare cause of galactorrhoea in children and adults. In patients with primary hypothyroidism, there is increased production of thyrotropin-releasing hormone, which may stimulate prolactin release. Nonpituitary malignancies, such as bronchogenic carcinoma, renal adenocarcinoma and Hodgkin’s and T-cell lymphomas, may also release prolactin.
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This question is part of the following fields:
- Obstetrics
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Question 24
Incorrect
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Which one of the following statements is related to testicular feminization syndrome?
Your Answer: Breast development is usually lacking
Correct Answer: There are usually normal testes
Explanation:Androgen insensitivity (testicular feminization) syndrome is a rare inherited form of male pseudo hermaphroditism that occurs in phenotypically normal women with adequate breast development, normal external genitalia, a vagina of variable depth, absent uterus, and sparse or absent pubic hair and axillary hair. Testosterone levels are normal or elevated.
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This question is part of the following fields:
- Embryology
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Question 25
Correct
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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 (PROM). According to NICE guidelines after what time period should induction be offered?
Your Answer: 24 hours
Explanation:Induction of labour is appropriate approximately 24 hours after rupture of the membranes.
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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 pharyngeal arch is closest to the head of the embryo?
Your Answer: 1st
Explanation:The arches are numbered according to their proximity to the head i.e. the 1st is the closest to the head end of the embryo and the 6th closest to the tail end as shown by the diagram below the table
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This question is part of the following fields:
- Embryology
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Question 27
Incorrect
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Regarding listeria infection during pregnancy, what is the fetal case mortality rate?
Your Answer: 10%
Correct Answer: 25%
Explanation:Listeria Monocytogenes is a cause of congenital infection. The most common source of the bacteria is food, especially unpasteurised milk. Congenital listeriosis can lead to spontaneous abortions, premature birth and chorioamnionitis. At birth, neonates may present with septicaemia, respiratory distress and inflammatory granulomatosis. The case mortality rate for listeriosis is thought to be between 20-30%.
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This question is part of the following fields:
- Microbiology
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Question 28
Incorrect
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A 34 year old white primigravida in her first trimester had established moderate hypertension before becoming pregnant. She currently has a blood pressure of 168/108 mm Hg. You are considering how to best manage her hypertension during the pregnancy. Which one of the following is associated with the greatest risk of fetal growth retardation if used for hypertension throughout pregnancy?
Your Answer: Nifedipine (Procardia, Adalat)
Correct Answer: Atenolol (Tenormin)
Explanation:Atenolol and propranolol are associated with intrauterine growth retardation when used for prolonged periods during pregnancy. They are class D agents during pregnancy. Other beta-blockers may not share this risk.
Methyldopa, hydralazine, and calcium channel blockers have not been associated with intrauterine growth retardation. They are generally acceptable agents to use for established, significant hypertension during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 29
Incorrect
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What is the RCOG advice regarding timing of Rhesus Anti-D Immunoglobulin following abortion?
Your Answer: Anti-D IgG must be given at time of abortion
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
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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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The femoral triangle contains all of the following structures EXCEPT which one?
Your Answer: Saphenofemoral Junction
Correct Answer: Genital branch of the genitofemoral nerve
Explanation:The contents of the femoral triangles are femoral nerve, artery and the vein. Along with the femoral sheath and lymphatics.
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This question is part of the following fields:
- Anatomy
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SESSION STATS - PERFORMANCE PER SPECIALTY
