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Question 1
Correct
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The following ultrasonic measurements may be used to confirm or establish gestational age:
Your Answer: Crown rump length
Explanation:Fetal ultrasound scanning is considered an essential part of routine antenatal care with first trimester scans recommended for confirming viability, accurate estimation of gestational age and determining the number of foetuses. Fetal crown-rump length (CRL) is measured in early pregnancy primarily to determine the gestation age (GA) of a foetus and is most reliable between 9+0 to 13+6 weeks’ gestation, but not beyond.
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This question is part of the following fields:
- Physiology
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Question 2
Correct
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The vulva is mainly supplied by which one of the following vessels?
Your Answer: Pudendal artery
Explanation:Vulva is defined by the area which is located outside the female vagina and comprises of the labia majora, labia minora, clitoris, mons pubis and Bartholin glands. It is supplied by the vestibula branch of pudental artery.
Inferior hemorrhoidal artery supplies the lower part of the rectum.
Femoral artery is the continuation of external iliac artery and supplies most of the leg. -
This question is part of the following fields:
- Anatomy
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Question 3
Incorrect
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A 22-year-old Asian woman with a background history of primary pulmonary hypertension attends your clinic. She is planning for a pregnancy in the next few months and feels well generally.
What would be your advice?Your Answer:
Correct Answer: Pregnancy is contraindicated in her condition
Explanation:From the options given, option A is correct as primary pulmonary hypertension is considered a contraindication to pregnancy.
The patient should be educated about the possible risks and increased maternal mortality in such cases. This restriction is due to the fact that symptoms of Pulmonary hypertension gets worse during pregnancy which results in high maternal mortality.
Termination of pregnancy may be advisable in these circumstances mostly to preserve the life of the mother.
Sudden death secondary to hypotension is also a commonly dreaded complication among patients with pulmonary hypertension during pregnancy. -
This question is part of the following fields:
- Obstetrics
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Question 4
Incorrect
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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.
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This question is part of the following fields:
- Endocrinology
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Question 5
Incorrect
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You are reviewing a patient with a scan suggestive of partial molar pregnancy. What is the typical genotype of a partial molar pregnancy?
Your Answer:
Correct Answer: 69 XXY
Explanation:The partial mole is produced when an egg is fertilized by two sperm producing genotype 69 XXY (triploid). It can also occur when one sperm reduplicates itself yielding the genotypes 92 XXXY (tetraploid) though this is less common The genotype of a complete mole is typically 46 XX (diploid) but can also be 46 XY (diploid)
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This question is part of the following fields:
- Clinical Management
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Question 6
Incorrect
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A 28-year-old woman presents in early labour. She is healthy and at full-term.
Her pregnancy has progressed well without any complications.
She indicates that she would like to have a cardiotocograph (CTG) to assess her baby as she has read about its use for foetal monitoring during labour.
What advice would you give her while counselling her regarding the use of CTG compared to intermittent auscultation during labour and delivery?Your Answer:
Correct Answer: There is no evidence to support admission CTG.
Explanation:In high-risk pregnancies, continuous monitoring of foetal heart rate is considered mandatory.
However, in low-risk pregnancies, cardiotocograph (CTG) monitoring provides no benefits over intermittent auscultation.
A significant issue with CTG monitoring is that apparent abnormalities are identified that usually have minimal clinical significance, but can prompt the use of several obstetric interventions such as instrumental deliveries and Caesarean section. In low risk patients, such interventions may not even be required.
CTG monitoring has not been shown to reduce the incidence of cerebral palsy or other neonatal developmental abnormalities, nor does it accurately predict previous foetal oxygenation status unless the CTG is significantly abnormal when it is first connected.
Similarly, CTG cannot accurately predict current foetal oxygenation unless the readings are severely abnormal.
Therefore, there is no evidence to support routine admission CTG (correct answer).
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This question is part of the following fields:
- Obstetrics
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Question 7
Incorrect
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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:
Correct 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 8
Incorrect
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In her first pregnancy, a 27-year-old lady suffered a fever and malaise around 10 weeks of pregnancy. She had come into touch with a youngster who had been diagnosed with rubella two weeks prior. Which of the following would be the best next step in your management career?
Your Answer:
Correct Answer: Serial blood samples for rubella antibody assessment.
Explanation:If the patient already has immunity (IgG positive) and if maternal rubella infection is the cause of the current symptoms (initial lgG and IgM negative, but IgM positive on a second sample 2-3 weeks later), amniocentesis may be required to confirm fetal infection.
Ultrasound may reveal growth limitation in late pregnancy, but a fetal congenital defect is rare when the infection begins at 10 weeks of pregnancy, and ultrasound testing at 12 weeks of pregnancy is unlikely to detect abnormalities, while it may discover one from 18-20 weeks. Given the well-known deleterious fetal effects of rubella infection in early pregnancy, gamma-globulin is unlikely to be beneficial at this point in the infective process, and pregnancy termination would certainly be considered by some individuals.
On the basis of prenatal rubella infection, this would not be recommended unless the infection was shown to have occurred. -
This question is part of the following fields:
- Obstetrics
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Question 9
Incorrect
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You see a patient on the ward who is acutely short of breath and perform an ABG. The results are as follows
Your Answer:
Correct Answer: Respiratory Acidosis
Explanation:This patient has acidosis as the pH is low <7.35 The pO2 is irrelevant. The pCO2 is raised i.e. the respiratory system is causing acidosis. The patient is acidotic so this is a respiratory acidosis The Base Excess is normal. You would typically expect the base excess to rise but metabolic compensation is slower than respiratory compensation so this picture may be seen acutely.
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This question is part of the following fields:
- Biochemistry
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Question 10
Incorrect
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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.
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This question is part of the following fields:
- Obstetrics
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Question 11
Incorrect
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What is the contraception of choice for epileptics on enzyme inducing antiepileptic drugs?
Your Answer:
Correct Answer: Levonorgestrel-releasing intrauterine contraceptive device
Explanation:Clinical decision making which contraceptive regimen is optimal for an individual woman with epilepsy is one of the most challenging tasks when taking care of women with epilepsy. The bidirectional interactive potential of antiepileptic drugs (AEDs) and hormonal contraceptives needs to be taken into account. Enzyme inducing (EI)-AEDs may reduce the contraceptive efficacy of hormonal contraceptives.
If combined oral contraceptives (COCs) are used in combination with EI-AEDs, it is recommended to choose a COC containing a high progestin dose, well above the dose needed to inhibit ovulation, and to take the COC pill continuously (“long cycle therapy”). But even with the continuous intake of a COC containing a higher progestin dose contraceptive safety cannot be guaranteed, thus additional contraceptive protection may be recommended.
Progestin-only pills (POPs) are likely to be ineffective, if used in combination with EI-AEDs.
Subdermal progestogen implants are not recommended in patients on EI-AEDs, because of published high failure rates.
Depot medroxyprogesterone-acetate (MPA) injections appear to be effective, however they may not be first choice due to serious side effects (delayed return to fertility, impaired bone health).
The use of intrauterine devices is an alternative method of contraception in the majority of women, with the advantage of no relevant drug–drug interactions. The levonorgestrel intrauterine system (IUS) appears to be effective, even in women taking EI-AEDs. Likelihood of serious side effects is low in the IUS users.
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This question is part of the following fields:
- Gynaecology
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Question 12
Incorrect
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A patient is attending for medical abortion. She is 15 weeks gestation. 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:If the patient has a negative Chlamydia screen then a stat dose of metronidazole monotherapy is appropriate. You do not know this patients Chlamydia status and therefore dual therapy with metronidazole + doxycycline or azithromycin is appropriate.
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This question is part of the following fields:
- Clinical Management
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Question 13
Incorrect
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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.
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This question is part of the following fields:
- Clinical Management
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Question 14
Incorrect
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Question 15
Incorrect
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A young woman came to your clinic seeking help. She has been married for two years and has yet to conceive. The following are the findings of blood tests:
Luteinizing hormone levels are low.
Low levels of follicle stimulating hormone.
Thyroid stimulating hormone (TSH) levels are low.
Prolactin-high.
What is the most effective way to deal with infertility?Your Answer:
Correct Answer: Bromocriptine
Explanation:The most common treatment approach is with the dopamine receptor agonists, bromocriptine, and cabergoline. Bromocriptine normalizes prolactin and decreases tumour size in 80%–90% of patients with microadenomas. Bromocriptine should be given to this patient who has developed hyperprolactinemia anovulation.
Women with hyperprolactinaemic anovulation are treated with dopamine agonists such as bromocriptine.
This patient has also developed symptoms of a low-functioning pituitary gland tumour, which bromocriptine will assist to shrink. Before starting bromocriptine, a head MRI scan should be considered to confirm the suspected diagnosis.Clomiphene is an oestrogen receptor modulator that is selective. It works by competing with oestrogen receptors in the hypothalamus. This disrupts normal negative feedback mechanisms, causing the release of pituitary gonadotropins, particularly LH, to rise, triggering ovulation.
When the levels of gonadotropins and oestrogen are normal but the women still have ovulatory dysfunction, it is successful in inducing ovulation. In hypogonadotropic hypogonadism and hypogonadotropic hypogonadism patients, clomiphene is frequently ineffective. -
This question is part of the following fields:
- Gynaecology
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Question 16
Incorrect
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Which of the following tests is used to detect antibodies or complement bound to red blood cell antigens in vivo?
Your Answer:
Correct Answer: Direct Coombs
Explanation:When the red cells are coated with immune IgG antibody, the cells do not agglutinate but when anti-IgG antiserum is added to these sensitized cells visible agglutination occurs. This is known as a positive direct coombs test.
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This question is part of the following fields:
- Physiology
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Question 17
Incorrect
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A patient in the first trimester of pregnancy has just learned that her husband has acute hepatitis B. She feels well, and her screening test for hepatitis B surface antigen (HBsAg) was negative last month. She has not been immunized against hepatitis B.
Which one of the following would be the most appropriate management of this patient?Your Answer:
Correct Answer: Administration of both HBIG and hepatitis B vaccine now
Explanation:Hepatitis B immune globulin (HBIG) should be administered as soon as possible to patients with known exposure to hepatitis – Hepatitis B vaccine is a killed-virus vaccine and can be used safely in pregnancy, with no need to wait until after organogenesis. This patient has been exposed to sexual transmission for at least 6 weeks, given that the incubation period is at least that long, so it is too late to use condoms to prevent infection. The patient is unlikely to be previously immune to hepatitis B, given that she has no history of hepatitis B infection, immunization, or carriage- Because the patient’s HBsAg is negative, she is not the source of her husband’s infection. Full treatment for this patient has an efficacy of only 75%, so follow-up testing is still needed.
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This question is part of the following fields:
- Obstetrics
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Question 18
Incorrect
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A women in her 21-weeks of pregnancy, complaints of palpitations, sweating of palms, and increased nervousness.
Along with TSH what other investigations should be done for this patient?Your Answer:
Correct Answer: Free T4
Explanation:Patient mentioned in the case has developed thyrotoxicosis during pregnancy. TSH level should be tested, and if the result shows any suppressed or elevated TSH level, then it is mandatory to check for free T4 level.
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This question is part of the following fields:
- Obstetrics
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Question 19
Incorrect
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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:
Correct 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 20
Incorrect
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A patient comes to your office with her last menstrual period 4 weeks ago. She thinks that she may be pregnant because she has not had her period yet, but denies any symptoms such as nausea, fatigue, urinary frequency, or breast tenderness.
As she has a history of previous ectopic pregnancy, she is very anxious to find out and wants to be sure to get early prenatal care.
Among the following actions which is most appropriate at this time?Your Answer:
Correct Answer: Order a serum quantitative pregnancy test.
Explanation:Nausea, fatigue, breast tenderness, and increased frequency of urination are the most common symptoms of pregnancy, but their presence is not considered definitive as they are nonspecific symptoms which are not consistently found in early pregnancy, also these symptoms can occur even prior to menstruation.
In pregnancy a physical examination will reveal an enlarged uterus which is more boggy and soft, but these findings are not apparent until after 6th week of gestation. In addition, other conditions like adenomyosis, fibroids, or previous pregnancies can also result in an enlarged uterus which is palpable on physical examination.
An abdominal ultrasound will not demonstrate a gestational sac until a gestational age of 5 to 6 weeks, nor will it detect an ectopic pregnancy soon after a missed menstrual period, therefore it is not indicated in this patient.
A Doppler instrument will detect fetal cardiac action usually after 10 weeks of gestation.
A sensitive serum quantitative pregnancy test can detect placental HCG levels by 8 to 9 days post-ovulation and is considered as the most appropriate next step in evaluation of this patient.
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This question is part of the following fields:
- Obstetrics
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Question 21
Incorrect
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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.
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This question is part of the following fields:
- Obstetrics
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Question 22
Incorrect
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The fetal head may undergo changes in shape during normal delivery. The most common aetiology listed is:
Your Answer:
Correct Answer: Molding
Explanation:With the help of molding, the fetal head changes its shape as the skull bones overlap. This helps in smooth delivery of the foetus through the birth canal.
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This question is part of the following fields:
- Obstetrics
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Question 23
Incorrect
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Question 24
Incorrect
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A 32 year old women who is 25 weeks pregnant presents with vaginal bleeding and cramping lower abdominal pain. On examination the cervix is closed. Fetal cardiac activity is noted on ultrasound. What is the likely diagnosis?
Your Answer:
Correct Answer: Antepartum Haemorrhage
Explanation:Antepartum haemorrhage is any bleeding that occurs from the female genital tract during the antenatal period after the 24+0 week of pregnancy and prior to the birth of the baby. The most common causes are placenta previa and placental abruption.
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This question is part of the following fields:
- Clinical Management
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Question 25
Incorrect
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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.
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This question is part of the following fields:
- Microbiology
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Question 26
Incorrect
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Question 27
Incorrect
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Question 28
Incorrect
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What type of virus is the Rubella virus?
Your Answer:
Correct Answer: Single stranded RNA (ssRNA)
Explanation:Rubella virus is the only member of the genus Rubivirus and is a type of Togavirus (Togaviridae). It is a single stranded RNA virus. Note for the exam if you are unsure – most RNA viruses encountered in clinical practice are single stranded. The exception is rotavirus which is dsRNA virus. RNA viruses that use DNA during their replication are classed as retroviruses (HIV is an example)
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This question is part of the following fields:
- Microbiology
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Question 29
Incorrect
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Which of the following are required for Oxytocin to bind to its receptor?
Your Answer:
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 30
Incorrect
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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%.
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This question is part of the following fields:
- Genetics
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Question 31
Incorrect
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A 23-year-old primigravida who is at 41 weeks has been pushing for the past 2 and a half ours. The fetal head is at the introitus and is beginning to crown already. An episiotomy was seen to be necessary. The tear was observed to extend through the sphincter of the rectum but her rectal mucosa remains intact.
Which of the following is the most appropriate type of episiotomy to be performed?Your Answer:
Correct Answer: Third-degree
Explanation:The episiotomy is a technique originally designed to reduce the incidence of severe perineal tears (third and fourth-degree) during labour. The general idea is to make a controlled incision in the perineum, for enlargement of the vaginal orifice, to facilitate difficult deliveries.
Below is the classification scale for the definitions of vaginal tears:
First degree involves the vaginal mucosa and perineal skin with no underlying tissue involvement.
Second degree includes underlying subcutaneous tissue and perineal muscles.
Third degree is where the anal sphincter musculature is involved in the tear. The third-degree tear can be further broken down based on the total area of anal sphincter involvement.
Fourth degree is where the tear extends through the rectal muscle into rectal mucosa. -
This question is part of the following fields:
- Obstetrics
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Question 32
Incorrect
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Question 33
Incorrect
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A pregnant woman who is a heavy smoker, observed some thick white patches on the inside of her mouth. Her oral cavity appears inflamed on examination. Which diagnosis is most likely correct?
Your Answer:
Correct Answer: Candidiasis
Explanation:During pregnancy, the chances for a woman to develop oral candidiasis double. An aphthous ulcer has a yellowish floor which is surrounded by an erythematous halo while in lichen planus, the lesions do not have the appearance of a thick white mark but are more or less lace-like. The lesions in leucoplakia have raised edges and they appear as bright white patches which are sharply defined and cannot be rubbed out. Smoking may affect the tongue, producing tongue coating. In this case the tongue is just inflamed which is a sign of infection.
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This question is part of the following fields:
- Obstetrics
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Question 34
Incorrect
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Which of the following hormones is secreted by the corpus luteum in a non pregnant state?
Your Answer:
Correct Answer: Progesterone
Explanation:The corpus luteum is formed from the granulosa cells of the mature follicle. The structure functions as a transient endocrine organ which secretes mainly progesterone with additional secretion of oestradiol and inhibin, which serve to suppress FSH levels. In the event of no pregnancy, the corpus luteum stops producing progesterone and degenerates into the corpus albicans.
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This question is part of the following fields:
- Embryology
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Question 35
Incorrect
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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).
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This question is part of the following fields:
- Gynaecology
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Question 36
Incorrect
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A 30-year-old woman living in England had a cervical smear test one month ago. There were no cervical abnormalities visualised at the time of the smear. She has no symptoms of unusual vaginal bleeding and her previous smear results have always been negative. She received the following report: 'Your recent smear was negative with no evidence of nuclear abnormalities.' When will she be routinely recalled for her next smear?
Your Answer:
Correct Answer:
Explanation:Women aged 25-49 years living in England are routinely recalled for screening every three years. Women receive their first invitation for cervical screening at 25 years of age. They are not invited earlier as changes in the young cervix can be normal and result in unnecessary treatment. Provided the smears remain negative and there are no symptoms to suggest cervical cancer, the routine recall is three years for women aged 25-49 years. Women aged 50-64 years old are routinely recalled for a smear every five years. After the age of 65 years, women are only screened if they have not had a smear since the age of 50 years (including those who have never had a smear) or those who have had recent abnormal smears. This is because due to the natural history and progression of cervical cancer, it is highly unlikely that women over 65 years old will go on to develop the disease.
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This question is part of the following fields:
- Gynaecology
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Question 37
Incorrect
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What is the inferior border of the deep perineal pouch?
Your Answer:
Correct Answer: Perineal membrane
Explanation:The perineal membrane (also known as the inferior fascia of the urogenital diaphragm) separates the deep and superficial perineal pouches i.e. it is the inferior border of the deep pouch and superior border of the superficial pouch. The deep perineal pouch is the space therefore between superior and inferior layers of the urogenital diaphragm The superior fascia of the urogenital diaphragm is the superior border
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This question is part of the following fields:
- Anatomy
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Question 38
Incorrect
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A 24-year-old gravida 3 para 1 is admitted to the hospital at 29 weeks gestation with a high fever, flank pain, and an abnormal urinalysis. You order blood and urine cultures, a CBC, electrolyte levels, and a serum creatinine level. You also start her on intravenous fluids and intravenous cefazolin. After 24 hours of antibiotic treatment she is clinically improved but continues to have fever spikes. What would be the most appropriate management at this time?
Your Answer:
Correct Answer: Continue current management
Explanation:Pyelonephritis is the most common serious medical problem that complicates pregnancy. Infection is more common after midpregnancy, and is usually caused by bacteria ascending from the lower tract. Escheria coli is the offending bacteria in approximately 75% of cases. About 15% of women with acute pyelonephritis are bacteraemia- A common finding is thermoregulatory instability, with very high spiking fevers sometimes followed by hypothermia- Almost 95% of women will be afebrile by 72 hours. However, it is common to see continued fever spikes up until that time- Thus, further evaluation is not indicated unless clinical improvement at 48-71 hours is lacking. If this is the case, the patient should be evaluated for urinary tract obstruction, urinary calculi and an intrarenal or perinephric abscess. Ultrasonography, plain radiography, and modified intravenous pyelography are all acceptable methods, depending on the clinical setting.
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This question is part of the following fields:
- Obstetrics
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Question 39
Incorrect
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Which of the following is indicated for the treatment of chlamydial urethritis in pregnancy?
Your Answer:
Correct 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 40
Incorrect
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Regarding the closure of the ductus arteriosus (DA) after birth which of the following most accurately describes the mechanisms leading to closure of the DA?
Your Answer:
Correct Answer: Increased arterial pO2, increased bradykinin & decreased Prostaglandin E2
Explanation:Normal closure of the ductus arteriosus (DA) is brought about by a number of mechanisms. Upon delivery the new born babies first breath inflates the lungs and this causes a rise in pO2. Oxygen is known to cause constriction of the DA in vivo and in vitro. In addition the decreased vascular resistance means the pressure within the lumen of the DA drops aiding closure. In addition on inflation of the lungs, the lungs produce bradykinin which stimulates smooth muscle constriction of the ductus. The most important factor is thought to be the drop in Prostaglandin E2. Prostaglandin E2 maintains patency of the Ductus in the unborn child but after birth is metabolised in the lungs and its levels fall rapidly within 3 hours of birth.
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This question is part of the following fields:
- Embryology
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Question 41
Incorrect
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A 38-year-old woman presents to the gynaecologic clinic with a complaint of headache, irritability, insomnia, abdominal bloating, anxiety, and breast tenderness around 4 to 5 days before menstruation for the last 8 months. There's also a limitation on daily activities and she has to take a week off from work. The patient's symptoms are relieved with the onset of menstruation. She does not smoke or drink alcohol. There is no other significant past medical history.
Which of the following is the best treatment?Your Answer:
Correct Answer: Fluoxetine
Explanation:The signs and symptoms of premenstrual dysmorphic disorder are well-known in this patient. Fluoxetine is the greatest therapeutic option among the available options.
For severe symptoms, clomipramine and danazol can be used interchangeably.
Bromocriptine, like oral contraceptives and evening primrose, has no scientific evidence to support its use in this syndrome.
NSAIDs are helpful for painful symptoms, but they only address a limited number of them. -
This question is part of the following fields:
- Gynaecology
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Question 42
Incorrect
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Which of the following best describes the mechanism of action of radiotherapy?
Your Answer:
Correct Answer: DNA damage via free radical generation
Explanation:Radiotherapy works on the principle of ionisation. In particularly that of water leading to the formation of free radicals, these radicals are highly reactive and they react with the DNA leading to damage and cell death.
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This question is part of the following fields:
- Biophysics
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Question 43
Incorrect
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How many days after fertilisation does the morula form?
Your Answer:
Correct Answer: 4
Explanation:When there are about 12-32 blastomeres, the developing human is referred to as morula. It enters the uterine cavity around the 4th day after fertilization.
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This question is part of the following fields:
- Embryology
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Question 44
Incorrect
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A 45 year old women has a transvaginal ultrasound that is reported as showing a partially echogenic mass with posterior sound attenuation owing to sebaceous material and hair within the cyst cavity. What is the likely diagnosis?
Your Answer:
Correct Answer: Mature teratoma
Explanation:Dermoid cysts and teratomas contain elements from multiple germ cell layers. They are often considered the same entity (even in medical texts) however a dermoid is composed only of dermal and epidermal elements. A teratoma has mesodermal and endodermal elements Mature teratomas are composed of well-differentiated derivations from at least 2/3 germ cell layers (i.e. ectoderm, mesoderm, and endoderm). They contain developmentally mature skin complete with hair follicles, sweat glands, sometimes hair, and sometimes sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue.
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This question is part of the following fields:
- Data Interpretation
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Question 45
Incorrect
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In a pregnant lady with polyhydramnios, the cause could be:
Your Answer:
Correct Answer: Foetus with oesophageal-atresia
Explanation:An underlying disease is only found in 17 % of cases in mild polyhydramnios. In contrast, an underlying disease is detected in 91 % of cases in moderate to severe polyhydramnios. The literature lists the following potential aetiologies: fetal malformations and genetic anomalies (8–45 %), maternal diabetes mellitus (5–26 %), multiple pregnancies (8–10 %), fetal anaemia (1–11 %), other causes, e.g. viral infections, Bartter syndrome, neuromuscular disorders, maternal hypercalcemia. Viral infections which can lead to polyhydramnios include parvovirus B19, rubella, and cytomegalovirus. Other infections, e.g. toxoplasmosis and syphilis, can also cause polyhydramnios.
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This question is part of the following fields:
- Physiology
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Question 46
Incorrect
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The arcuate line forms part of the border of the pelvic brim. Where is it located?
Your Answer:
Correct Answer: Ilium
Explanation:The arcuate line is a smooth rounded border on the internal surface of the ilium just inferior to the iliac fossa. It forms the boundary of the pelvic inlet.
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This question is part of the following fields:
- Anatomy
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Question 47
Incorrect
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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.
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This question is part of the following fields:
- Epidemiology
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Question 48
Incorrect
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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:
Correct 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 49
Incorrect
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A young patient presented with foul smelling greyish vaginal discharge. She also has burning and itching. She is sexually active.
What is the most likely diagnosis?Your Answer:
Correct Answer: Gardnerella vaginalis
Explanation:Bacterial vaginosis (BV) is a clinical condition characterized by a shift in vaginal flora away from Lactobacillus species toward more diverse bacterial species, including facultative anaerobes. The altered microbiome causes a rise in vaginal pH and symptoms that range from none to very bothersome. Future health implications of BV include, but are not limited to, increased susceptibility to other sexually transmitted infections and preterm birth. Fifty to 75 percent of women with BV are asymptomatic. Symptomatic women typically present with vaginal discharge and/or vaginal odour. The discharge is off-white, thin, and homogeneous; the odour is an unpleasant fishy smell that may be more noticeable after sexual intercourse and during menses.
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This question is part of the following fields:
- Gynaecology
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Question 50
Incorrect
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A 35 year old primigravida was in labour for 24 hours and delivered after an induction. She developed postpartum haemorrhage. Which of the following is the most likely cause for PPH?
Your Answer:
Correct Answer: Atonic uterus
Explanation:Uterine atony and failure of contraction and retraction of myometrial muscle fibres can lead to rapid and severe haemorrhage and hypovolemic shock. Poor myometrial contraction can result from fatigue due to prolonged labour or rapid forceful labour, especially if stimulated.
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This question is part of the following fields:
- Obstetrics
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Question 51
Incorrect
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Question 52
Incorrect
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A pregnant patient who is needle phobic has her nuchal translucency (NT) scan but refuses serum markers. You advise her the False Positive Rate of the scan is 5%. What would you advise the mother regarding the detection rate of Down Syndrome using NT alone?
Your Answer:
Correct Answer: 70%
Explanation:The nuchal lucency measurement is the measure of the nuchal pad thickness. Children with down syndrome have an increased thickness of the nuchal pad. The risk of down’s syndrome increases with maternal age. The nuchal lucency test has an accuracy rate of 70%.
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This question is part of the following fields:
- Genetics
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Question 53
Incorrect
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If the presenting part of the foetus is the large fontanel, this presentation is known as?
Your Answer:
Correct Answer: Sinciput
Explanation:Sinciput means the head is neither flexed nor extended. It is the area between forehead and crown and in this case the anterior fontanel is the presenting part.
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This question is part of the following fields:
- Anatomy
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Question 54
Incorrect
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Which of the following factors is fetal nutrition dependant on?
Your Answer:
Correct Answer: All of the options given
Explanation:Fetal nutrition is dependant upon multiple factors such as maternal nutritional state, quality of maternal diet, malnutrition, anorexia nervosa, metabolic rate of the mother or whether they suffer from malabsorption syndrome or other related conditions.
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This question is part of the following fields:
- Physiology
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Question 55
Incorrect
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The β-hCG curve in maternal serum in a normal pregnancy peaks at:
Your Answer:
Correct Answer: 10 weeks of pregnancy
Explanation:During the first 8 weeks of pregnancy, concentrations of hCG in the blood and urine usually double every 24 hours. Levels of the hormone typically peak at around 10 weeks, decline until 16 weeks, then remain constant.
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This question is part of the following fields:
- Physiology
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Question 56
Incorrect
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A 48-year-old woman presents to the clinic complaining of a one week history of light vaginal bleeding.
Her past medical history reveals she had a lumpectomy, postoperative radiotherapy, adjuvant chemotherapy and tamoxifen therapy 3 years ago as treatment for an oestrogen receptor-positive breast malignancy.
She was prescribed tamoxifen in a dose of 10mg per day to take for the next five years.
Since she completed her chemotherapy three years ago, she has no menstrual periods.
What is the most probable cause of her current bleeding?Your Answer:
Correct Answer: Endometrial polyp formation due to the tamoxifen.
Explanation:The most likely cause of her bleeding is an endometrial polyp formation due to the tamoxifen.
Tamoxifen is often prescribed to decrease risk of breast cancer recurrence in premenopausal women with oestrogen receptor-positive cancers.
As with any medication, it has known side effects, which include endometrial polyp formation, subendometrial oedema and, rarely, endometrial carcinoma.
A polyp or carcinoma can cause uterine bleeding, but a polyp is more likely to occur.
Routine endometrial thickness screening is not recommended in all women taking tamoxifen. However, in cases of abnormal bleeding, ultrasound assessment of endometrial thickness, hysteroscopy and curettage are indicated to assess the endometrium in more detail.
Tamoxifen is not associated with endometrial atrophy.
Endometrial metastasis from a breast cancer is rare, and tamoxifen would not usually induce follicular development in a woman who has had chemotherapy and resultant amenorrhoea.
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This question is part of the following fields:
- Gynaecology
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Question 57
Incorrect
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Adult Polycystic Kidney Disease (PKD) typically follows which pattern of inheritance
Your Answer:
Correct Answer: Autosomal Dominant
Explanation:Polycystic kidney disease (PKD) can either be autosomal dominant or recessive. The autosomal dominant variant is more common in adult PKD however, the recessive pattern is more common in infantile PKD.
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This question is part of the following fields:
- Endocrinology
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Question 58
Incorrect
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A 32-year-old woman who is multigravida and with breech presentation presented to the emergency department for vaginal delivery. Upon spontaneous rupture of the membranes, bradycardia and variable deceleration was noted on the fetal heart rate monitoring.
Vaginal examination was performed and revealed cord prolapse that is still pulsating.
Which of the following is considered the most appropriate next step in managing the patient?Your Answer:
Correct Answer: Arrange for emergency caesarean delivery
Explanation:Umbilical cord prolapse (UCP) occurs when the umbilical cord exits the cervical opening before the fetal presenting part. It is a rare obstetric emergency that carries a high rate of potential fetal morbidity and mortality. Resultant compression of the cord by the descending foetus during delivery leads to fetal hypoxia and bradycardia, which can result in fetal death or permanent disability.
Certain features of pregnancy increase the risk for the development of umbilical cord prolapse by preventing appropriate engagement of the presenting part with the pelvis. These include fetal malpresentation, multiple gestations, polyhydramnios, preterm rupture of membranes, intrauterine growth restriction, preterm delivery, and fetal and cord abnormalities.
The occurrence of fetal bradycardia in the setting of ruptured membranes should prompt immediate evaluation for potential cord prolapse.
In overt prolapse, the cord is palpable as a pulsating structure in the vaginal vault. In occult prolapse, the cord is not visible or palpable ahead of the fetal presenting part. The definitive management of umbilical cord prolapse is expedient delivery; this is usually by caesarean section.
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This question is part of the following fields:
- Obstetrics
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Question 59
Incorrect
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What is the maximum normal diameter of the yolk sac on transvaginal ultrasound?
Your Answer:
Correct Answer: 6mm
Explanation:The yolk sac increases in size up until the 10th week reaching a maximum diameter of 6mm in normal pregnancy. After the 10th week the yolk sac will gradually disappear. It is usually sonographically undetectable by 20 weeks. A yolk sac greater than 6mm diameter is suspicious of failed pregnancy.
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This question is part of the following fields:
- Biophysics
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Question 60
Incorrect
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The following hormones are secreted from the anterior pituitary gland, EXCEPT:
Your Answer:
Correct Answer: HCG
Explanation:The following hormones are excreted from the anterior pituitary gland: TSH, GN, ACTH, LH, FSH, MSH, PRL.
Human chorionic gonadotropin (hCG, or human chorionic gonadotrophin) is a placental hormone secreted by syncitiotrophoblasts during the second week of gestation. -
This question is part of the following fields:
- Endocrinology
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