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Question 1
Incorrect
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Regarding Venous Thromboembolism (VTE) in pregnancy which of the following statements is TRUE?
Your Answer: Relative risk of VTE in pregnancy is 2 to 3 fold
Correct Answer: Relative risk of VTE in pregnancy is 4 to 6 fold
Explanation:Venous thromboembolic disease (VTE) is the most common cause of direct maternal death in the UK. In the most recent triennium, there were 41 fatalities, giving a maternal mortality rate of 1.94 per 100 000 – more than twice that of the next most common cause, pre-eclampsia. As pregnancy is a hyper coagulable state. There are alterations in the fibrinolytics and thrombotic pathways. There is also an increased production of clotting factors during pregnancy.
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This question is part of the following fields:
- Clinical Management
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Question 2
Incorrect
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Which of the following statements is true regarding renal blood flow in pregnancy?
Your Answer: Increases by approximately 25%
Correct Answer: Increases by approximately 50%
Explanation:Glomerular filtration rate (GFR) rises immediately after conception and increases by about 50 per cent overall, reaching its maximum at the end of the first trimester. GFR then falls by about 20 per cent in the third trimester, returning to pre-pregnancy levels within 12 weeks of delivery.
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This question is part of the following fields:
- Physiology
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Question 3
Incorrect
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Question 4
Incorrect
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A 35-year-old female went to a contraception clinic because she does not want to conceive for the next 2 years. She also has a history of heavy menstrual bleeding and pelvic pain. Imaging revealed fibroids. What is the best method of contraception for the patient in this case?
Your Answer: COCP
Correct Answer: IUS
Explanation:IUS or Intra Uterine System/Device releases progestin. The progestin thickens the cervix, preventing the sperm from penetrating the cervix, and it also causes the uterine lining to become thinner, preventing any implantation. IUS may also prevent excessive bleeding and can help women with fibroids.
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This question is part of the following fields:
- Gynaecology
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Question 5
Incorrect
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You review a patient in the fertility clinic. The ultrasound and biochemical profile are consistent with PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2. She is a non-smoker. You plan to initiate Clomiphene. According to NICE guidance how long should treatment continue for (assuming patient remains non-pregnant)?
Your Answer: 12 months
Correct Answer: 6 months
Explanation:Treatment with Clomiphene should not exceed 6 months.
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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 presented with nausea and vomiting along with headache during pregnancy. She also has a past medical history of a migraine.
What among the following will be the most appropriate management in this case?Your Answer: Codein and metoclopramide
Correct Answer: Codein and promethazine
Explanation:This patient should be given promethazine and codeine as she presents with severe migraine.
Usage of metoclopramide is safe during pregnancy and for increasing effectiveness it can be added to paracetamol. However, because of its risk for causing extrapyramidal effects it should be used only as a second-line therapy and Promethazine should be considered as the first line choice of remedy. So the answer is Codeine and promethazine.
Opioid pain relievers such as codeine are not been reported of having any associated with increased birth defects or miscarriage, but its long-term use can lead to dependency in mother and withdrawal signs in the baby.
Paracetamol alone or combined with codeine is not found to be useful in controlling vomiting.
It is advised to completely avoid dihydroergotamine and the triptans throughout pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 7
Correct
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Regarding Turner syndrome which of the following statements is true?
Your Answer: Only 1% of affected foetuses will survive to term
Explanation:The incidence of 45,XO turner syndrome is around 1 in 8000 live births. Approximately 1% of monosomy X female embryos survive. Phenotypically they are females and 90% do not develop secondary sexual characteristics and hormone replacement is required.
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This question is part of the following fields:
- Genetics
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Question 8
Correct
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A 30 year old woman with a history of two previous C section deliveries, is rushed to the hospital for an emergency c-section at 36 weeks gestation due to antenatal haemorrhage. Upon examination of the uterus, the placenta has invaded the myometrium but the serosa is spared. Which of the following identifies this condition?
Your Answer: Placenta Increta
Explanation:Abnormal placental adherence to the uterus, generally termed Placenta Accreta, is divided into 3 conditions.
– Placenta accreta: refers to the invasion of the chorionic villi beyond the decidual surface of the myometrium.
– Placenta increta: the villi invade deep into the myometrium but spare the serosa;
– Placenta percreta: the chorionic villi invade through the myometrium, penetrate the uterine serosa, and may invade surrounding pelvic structures.These conditions can predispose patients to obstetric bleeding in the third trimester, often requiring emergency intervention.
Risk factors in the development of an abnormal placental adherence include previous c-sections. Placenta Previa, is also a cause of antepartum haemorrhage and serves as a risk factor in the development of abnormal placental adherence.
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This question is part of the following fields:
- Clinical Management
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Question 9
Incorrect
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A 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: Free T3
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 10
Correct
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A 25-year-old primigravida presents to your office for a routine OB visit at 34 weeks of gestational age. She voices concern as she has noticed an increasing number of spidery veins appearing on her face, upper chest and arms and is upset with the unsightly appearance of these veins. She wants to know what you recommend to get rid of them.
Which of the following is the best advice you can give to this patient?Your Answer: Tell her that the appearance of these blood vessels is a normal occurrence with pregnancy
Explanation:Vascular spiders or angiomas, are of no clinical significance during pregnancy as these are common findings and are form as a result of hyperestrogenemia associated with normal pregnancies. These angiomas, as they will resolve spontaneously after delivery, does not require any additional workup or treatment.
Reassurance to the patient is all that is required in this case. -
This question is part of the following fields:
- Obstetrics
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Question 11
Correct
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What percentage of pregnant women have asymptomatic vaginal colonisation with candida?
Your Answer: 40%
Explanation:90% of genital candida infections are the result of Candida albicans. 20% of women of childbearing age are asymptotic colonisers of Candida species as part of their normal vaginal flora. This increases to 40% in pregnancy
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This question is part of the following fields:
- Clinical Management
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Question 12
Incorrect
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A 28-year-old woman who recently got married presents to your clinic.
She has a history of extremely irregular menstrual cycles with the duration varying between four and ten weeks.
She had attended her routine review appointment one week prior to her current presentation.
At that time she had stated that her last period had occurred six weeks previously.
You had recommended the following tests for which the results are as shown below:
Serum follicle-stimulating hormone (FSH): 3 IU/L (<13)
Serum luteinising hormone (LH): *850 IU/L (4-10 in follicular phase, 20-100 at mid-cycle)
Serum prolactin (PRL): 475 mU/L (50-500)
Which one of the following is the most probable reason for her amenorrhoea?Your Answer: An LH-producing pituitary adenoma.
Correct Answer: Early pregnancy.
Explanation:All of the options provided could cause amenorrhoea and therefore need to be evaluated.
The luteinising hormone (LH) level reported here is exceedingly elevated. A patient with polycystic ovarian syndrome (PCOS) is unlikely to have such a raised level, but it could be because of a LH-producing adenoma. Such tumours are, however, extremely rare.
Early pregnancy (correct answer) is the most likely cause of this woman’s elevated LH level. This would be due to the presence of beta human chorionic gonadotropin (hCG) hormone that is produced during pregnancy.
LH and beta-HCG both have similar beta-subunits and cross-reactions are commonly noted in LH assays.
The serum prolactin (PRL) level is at the upper end of the normal range and this correlates to the levels observed in the early stages of pregnancy.
The follicle-stimulating hormone (FSH) levels remain low during early pregnancy.
If her amenorrhea had been caused by stress from her recent marriage, the LH level would have been normal or low.
If the cause was premature ovarian failure, the FSH level would have been significantly higher.
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This question is part of the following fields:
- Gynaecology
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Question 13
Correct
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A patient is about to undergo a pudendal nerve block after vaginal delivery to repair an episiotomy. Which spinal segments form the pudendal nerve?
Your Answer: S2, S3 and S4
Explanation:The pudendal nerve provides sensory innervation to regions of the anus, the perineum, the labia and the clitoris in women. The nerve is formed from the ventral rami of the S2-S4 sacral spinal nerves. The nerve is paired, each innervating the left and the right side of the body. Pudendal nerve blocks are indicated for analgesia of the second stage of labour, repair of an episiotomy or perineal laceration, and for minor surgeries of the lower vagina and perineum.
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This question is part of the following fields:
- Anatomy
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Question 14
Incorrect
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What is meant by a barr body?
Your Answer: Located on the extra lobe on the female polymorphonuclear leukocytes
Correct Answer: It is the condensed non-functioning X chromosome
Explanation:Barr body is an inactive and non functioning X chromosome found in female somatic cells and is presents with a rim around the nucleus
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This question is part of the following fields:
- Cell Biology
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Question 15
Incorrect
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Which of the following hormones are required for alveolar morphogenesis during pregnancy?
Your Answer: Prolactin and GH
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 16
Incorrect
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During difficult labour, mediolateral episiotomy is favoured to midline episiotomy because?
Your Answer: Reduced dyspareunia
Correct Answer: Less extension of the incision
Explanation:Mediolateral episiotomy is favoured to midline episiotomy because there is less extension of the incision and decreased chances of injury to the anal sphincter and rectum.
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This question is part of the following fields:
- Obstetrics
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Question 17
Incorrect
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APGAR's score includes all the following, EXCEPT:
Your Answer: Heart rate
Correct Answer: Blood pH
Explanation:Elements of the Apgar score include colour, heart rate, reflexes, muscle tone, and respiration. Apgar scoring is designed to assess for signs of hemodynamic compromise such as cyanosis, hypoperfusion, bradycardia, hypotonia, respiratory depression or apnoea. Each element is scored 0 (zero), 1, or 2. The score is recorded at 1 minute and 5 minutes in all infants with expanded recording at 5-minute intervals for infants who score 7 or less at 5 minutes, and in those requiring resuscitation as a method for monitoring response. Scores of 7 to 10 are considered reassuring.
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This question is part of the following fields:
- Obstetrics
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Question 18
Correct
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Tamoxifen is associated with an increased risk of which of the following?
Your Answer: Endometrial cancer
Explanation:Tamoxifen is a SERM that is effective in treating hormone-responsive breast cancer, it acts as an antagonist to prevent receptor activation by endogenous oestrogen. As agonist of the endometrial receptors it promotes endometrial hyperplasia and hence increases the risk of endometrial cancer.
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This question is part of the following fields:
- Pharmacology
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Question 19
Incorrect
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A 30-year-old woman presents to the clinic.
She complains of a 6 week history of amenorrhoea and on diagnostic testing, has a positive pregnancy test.
On past medical history, it is noted that she had a multiload (Cu375°) intrauterine device inserted six months ago.
On physical examination, The strings of the device are not visibly protruding through the external os, as would be expected.
She is happy to proceed with the pregnancy, and asks what should be done next.
What is the best next step in her management?Your Answer: Laparoscopy.
Correct Answer: Ultrasound of the pelvis.
Explanation:The best next step is to order an ultrasound of the pelvis to locate the IUCD in the uterine cavity.
Once the device is located, appropriate advice can be given about the pregnancy proceeding.
Uterine sounding and hysteroscopy are contraindicated in the presence of a viable pregnancy due to risks of infection and abortion.
Pelvic X-ray is indicated if the device cannot be located during the pelvic ultrasound. It can show if the device is in the peritoneal cavity or has been expelled from the uterus. It should only be done after the pregnancy.
In cases where the device is in the peritoneal cavity, a laparoscopy is indicated for device removal.
Pregnancy termination is not indicated simply because of the presence of an intrauterine device (IUCD) in the uterus, unless other factors dictate that this is appropriate.
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This question is part of the following fields:
- Gynaecology
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Question 20
Incorrect
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During wound healing the clotting cascade is activated. Which of the following activates the extrinsic pathway?
Your Answer: Thromboxane A2
Correct Answer: Tissue Factor
Explanation:The extrinsic pathway is activated by the tissue factor, which converts factor VII to VIIa which later on converts factors X and II to their activated form finally leading to the conversion of fibrinogen to fibrin fibres.
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This question is part of the following fields:
- Physiology
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Question 21
Incorrect
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A 28-year-old G1P0 patient at 24 weeks of gestation visits your office complaining of some shortness of breath that is more intense with exertion and denies any chest pain. She is concerned as she has always been very athletic and is unable to maintain the same degree of exercise she was accustomed prior to becoming pregnant. Patient also informed she has no significant past medical history and is not on any medication.
On physical examination, her pulse is 72 beats per minute, with a blood pressure of 100/70 mm Hg. Cardiac examination is normal and her lungs are clear to auscultation and percussion.
Which among the following is considered the most appropriate next step to pursue in the workup of this patient?Your Answer: Perform an arterial blood gas
Correct Answer: Reassure the patient
Explanation:Patient’s presentation and physical examination findings are most consistent with physiologic dyspnea, which is common during pregnancy. This breathing difficulty which is due to an increase in the tidal volume of lung will present itself as an increased awareness of breathing and can occur as early as the end of first trimester. Any minute increase in the ventilation occurs during pregnancy can make patients feel as if they are hyperventilating and contribute to the feeling of dyspnea.
Patient should be reassured and educated regarding these normal changes of pregnancy, also should be counselled to modify her exercise regimen accordingly to her changed tolerance.
Systolic ejection murmurs are due to increased blood flow across the aortic and pulmonic valves which is a normal finding in a pregnancy. So there is no need for this patient to be referred to a cardiologist or to order an ECG.
About 1 in 6400 pregnancies present with pulmonary embolism and there will be clinical evidence of DVT in many of these cases. Dyspnea, chest pain, apprehension, cough, hemoptysis, and tachycardia are the most common symptoms of PE and physical examination shows accentuated pulmonic closure sound, rales, or a friction rub. If there is a strong suspicion for PE, the patient should be followed up with a ventilation-perfusion scan, which will confirm PE if presented with large perfusion defects and ventilation mismatches. -
This question is part of the following fields:
- Obstetrics
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Question 22
Incorrect
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What is the RCOG advice regarding timing of Rhesus Anti-D Immunoglobulin following abortion?
Your Answer: Anti-D IgG within 24 hours following 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 23
Incorrect
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What is the lower reference limit for sperm concentration according to the WHO criteria?
Your Answer: 50 million spermatozoa per ml
Correct Answer: 15 million spermatozoa per ml
Explanation:WHO guidelines
Semen volume: Greater than or equal to 1.5 ml
pH: Greater than or equal to 7.2
Sperm concentration: Greater than or equal to 15 million spermatozoa per ml
Total sperm number: 39 million spermatozoa per ejaculate or more
Total motility (% of progressive motility and nonprogressive motility): 40% or more motile or 32% or more with progressive motility
Vitality: 58% or more live spermatozoa
Sperm morphology (percentage of normal forms): 4% or more -
This question is part of the following fields:
- Data Interpretation
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Question 24
Incorrect
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All of the following factors are associated with an unstable lie of the foetus except?
Your Answer: Placenta previa
Correct Answer: Cervical fibroids
Explanation:Unstable lie means that the foetus is still changing its position even at 36 weeks of gestation. A number of factors are responsible for this positioning such as multi gravida, placenta previa, prematurity and fibroids present in the fundus. Cervical fibroids have little association with unstable lie of the foetus.
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This question is part of the following fields:
- Obstetrics
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Question 25
Incorrect
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Bishop scoring is used for:
Your Answer: The maternal well being in labour
Correct Answer: The success rate of induction of the labour
Explanation:The Bishop score is a system used by medical professionals to decide how likely it is that you will go into labour soon. They use it to determine whether they should recommend induction, and how likely it is that an induction will result in a vaginal birth.
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This question is part of the following fields:
- Obstetrics
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Question 26
Incorrect
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A 23-year-old pregnant woman, in her 19 weeks of pregnancy, presents to your office complaining of increased frequency and urgency along with dysuria.
Further investigations established the diagnosis of urinary tract infection and the culture results are pending. The patient also mentioned a history of allergic reaction to penicillin which manifest as a rash.
For treating this patient, which one of the following would be the antibiotic of choice?Your Answer: Amoxicillin
Correct Answer: Cephalexin
Explanation:The best antibiotic of choice for empirical treatment of a urinary tract infection (UTI) during pregnancy is cephalexin. Nitrofurantoin and amoxicillin-clavulanate are second and third in-line respectively.
Patients allergic to penicillin, which is manifested as a rash can also be safely treated with cephalexin. But cephalosporins are not recommended if the presentation of allergic reaction to penicillin was anaphylactic, instead they should be treated with nitrofurantoin.NOTE– Asymptomatic bacteriuria, such as >10 to power of 5 colony count in urine culture of an asymptomatic woman in pregnancy, should best be treated with a one week course of antibiotics, followed by confirming the resolution of infection via a urine culture repeated 48 hours after the completion of treatment.
Amoxicillin without clavulanate is recommended only in cases were the susceptibility of the organism is proven.
Macrolides like clarithromycin are usually not recommended for the treatment of UTI.
Aminoglycosides are coming under category D drugs should be avoided during pregnancy, unless there is a severe indication of gram negative sepsis.
Tetracycline, due to their potential teratogenic effects, are contraindicated in pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 27
Incorrect
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Regarding the female breast how many lobes does the typical breast contain?
Your Answer: 1
Correct Answer: 15-20
Explanation:The basic components of the mammary gland are the alveoli. These are lined with milk-secreting cuboidal cells surrounded by myoepithelial cells. The alveoli join to form groups known as lobules. The lobules form lobes. Each lobe has a lactiferous duct that drains into openings in the nipple. Each breast typically contains 15-20 lobes.
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This question is part of the following fields:
- Anatomy
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Question 28
Incorrect
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Where is Glucagon produced?
Your Answer:
Correct Answer: Islet alpha cells
Explanation:The alpha cells in the islets of Langerhans are responsible for the production and secretion of glucagon. The B cells secrete insulin, the D cells secrete somatostatin, and the F cells secrete pancreatic polypeptide. The B cells, which are the most common and account for 60–75% of the cells in the islets, are generally located in the centre of each islet.
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This question is part of the following fields:
- Endocrinology
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Question 29
Incorrect
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Pregnant patients are at higher risk of thromboembolism due to a hypercoagulable state. Which of the following clotting factors reduces during pregnancy?
Your Answer:
Correct Answer: Factor XI
Explanation:Pregnancy is a hypercoagulable state, which means that risk of thromboembolism is increased. The main reason is an increase in clotting factors II, factor VII, fibrinogen, factor X and factor XII, whereas factors XI and factor XIII are reduced. Naturally occurring anticoagulants i.e. protein C and protein S are both decreased thus increasing the risk of thrombus formation.
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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 transvaginal ultrasound of a 37 year old woman reveals a left ovarian mass. The mass is a unilocular cyst with diffuse homogenous ground glass echoes as a result of hemorrhagic debris. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Endometrioma
Explanation:An endometrioma, also known as a chocolate cyst is a benign ovarian cyst that occurs as a result of the trapping of endometriosis tissue inside the ovary. The findings on transvaginal ultrasound are often a unilocular cyst, with ground glass echogenicity due to haemorrhage. Other benign masses that can be evaluated using transvaginal ultrasound are functional cysts, serous and mucinous cystadenomas and mature teratomas.
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This question is part of the following fields:
- Data Interpretation
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Question 31
Incorrect
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Levels of which of the following hormones are increased in ovarian dysgenesis?
Your Answer:
Correct Answer: Pituitary gonadotropins
Explanation:There is marked elevation of FSH and LH in ovarian dysgenesis, produced by the pituitary.
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This question is part of the following fields:
- Embryology
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Question 32
Incorrect
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At what week in pregnancy is testing for gestational diabetes (GD) advised
Your Answer:
Correct Answer: As soon as possible after booking if past history of GD
Explanation:Testing for GD should use the 2 hour 75g oral glucose tolerance test (OGTT) to test for GD in women. Testing women who have had GD in a previous pregnancy: early self monitoring of blood glucose OR a 75 g 2 hour OGTT as soon as possible after booking (whether in the first or second trimester) and a further 75 g 2hour OGTT at 24-28 weeks if the results of the first OGTT are normal. Testing women with risk factors for GD: 75g 2 hour OGTT at 24-28 weeks
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This question is part of the following fields:
- Clinical Management
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Question 33
Incorrect
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Which one of the following features best describes the role of prostaglandins?
Your Answer:
Correct Answer: Are involved in the onset of labour
Explanation:Prostaglandins are involved in the uterine contraction and cervical dilatation during labour. Higher prostaglandin concentrations can also lead to severe menstrual cramps.
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This question is part of the following fields:
- Physiology
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Question 34
Incorrect
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Breast feeding stimulates the hypothalamus to produce which of the following hormones?
Your Answer:
Correct Answer: Oxytocin
Explanation:Breast feeding facilitates the production of Oxytocin by the hypothalamus which is stored and secreted by the posterior pituitary.
Ergometrine is an ergoline derivative that can be used to increase uterine tone.
Atosiban is an antagonist of Oxytocin receptors
ADH is another posterior pituitary hormone.
Prostaglandin E2 plays an important role in cervical ripening. -
This question is part of the following fields:
- Clinical Management
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Question 35
Incorrect
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A 36-year-old woman is being tested for a breast tumour she discovered last week during a routine physical examination. Two years ago, the patient had bilateral reduction mammoplasty for breast hyperplasia. Her paternal grandmother died of breast cancer at the age of 65, thus she doesn't take any drugs or have any allergies.
A fixed lump in the upper outer quadrant of the right breast is palpated during a breast examination. In the upper outer quadrant of the right breast, mammography reveals a 3 × 3-cm spiculated tumour with coarse calcifications. A hyperechoic mass can be seen on ultrasonography of the breast. The mass is removed with concordant pathologic findings, and a core biopsy reveals foamy macrophages and fat globules.
Which of the following is the best plan of action for this patient's management?Your Answer:
Correct Answer: Reassurance and routine follow-up
Explanation:Fat necrosis is a benign (non-cancerous) breast condition that can develop when an area of fatty breast tissue is injured. It can also develop after breast surgery or radiation treatment.
There are different stages of fat necrosis. As the fat cells die, they release their contents, forming a sac-like collection of greasy fluid called an oil cyst. Over time, calcifications (small deposits of calcium) can form around the walls of the cyst, which can often be seen on mammograms. As the body continues to repair the damaged breast tissue, it’s usually replaced by denser scar tissue. Oil cysts and areas of fat necrosis can form a lump that can be felt, but it usually doesn’t hurt. The skin around the lump might look thicker, red, or bruised. Sometimes these changes can be hard to tell apart from cancers on a breast exam or even a mammogram. If this is the case, a breast biopsy (removing all or part of the lump to look at the tissue under the microscope) might be needed to find out if the lump contains cancer cells. These breast changes do not affect your risk for breast cancer.
Mastectomy, axillary node dissection and radiation therapy are all management options for malignancy which this patient doesn’t have.
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This question is part of the following fields:
- Gynaecology
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Question 36
Incorrect
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What is the half life of Oxytocin?
Your Answer:
Correct Answer: 5 minutes
Explanation:The half-life of Oxytocin is approximately 5 minutes
The half-life of Misoprostol is approximately 20-40 minutes
The half-life of Ergometrine is approximately 30-120 minutes -
This question is part of the following fields:
- Clinical Management
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Question 37
Incorrect
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You are asked to speak to a 27 year old patient who is pregnant for the first time. She is concerned as her friend recently gave birth and the baby was found to have profound hearing loss. Her friend was told this was due to an infection whilst she was pregnant. What is the most common infective cause of congenital hearing loss?
Your Answer:
Correct Answer: Cytomegalovirus
Explanation:CMV is the most common congenital infection causing sensorineural deafness.
10-15% of infected infants will be symptomatic at birth. A further 10-15% who are asymptomatic at birth will develop symptoms later in life. Transmission can also be via breastmilk and the incubation period for CMV is 3-12 weeks. Diagnosis of fetal CMV infection is via amniocentesis however this should not be performed for at least 6 weeks after maternal infection and not until the 21st week of gestation -
This question is part of the following fields:
- Microbiology
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Question 38
Incorrect
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A 30 year old female with a history of two first trimester miscarriages presented at 9 weeks of gestation with per vaginal bleeding. Which of the following is the most appropriate management?
Your Answer:
Correct Answer: Aspirin
Explanation:Antiphospholipid syndrome is the most important treatable cause of recurrent miscarriage. The mechanisms by which antiphospholipid antibodies cause pregnancy morbidity include inhibition of trophoblastic function and differentiation, activation of complement pathways at the maternal–fetal interface, resulting in a local inflammatory response and, in later pregnancy, thrombosis of the uteroplacental vasculature. This patient should be offered referral to a specialist clinic as she has had recurrent miscarriages. Low dose aspirin is one of the treatment options to prevent further miscarriage for patients with antiphospholipid syndrome.
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This question is part of the following fields:
- Obstetrics
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Question 39
Incorrect
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You are asked to see a 26 year old patient following her first visit to antenatal clinic. She is 9 weeks pregnant and bloods have shown her to be non-immune to Rubella. She is concerned about congenital rubella syndrome (CRS). What is the most appropriate advice to give?
Your Answer:
Correct Answer: Advise vaccination after birth regardless of breast feeding status
Explanation:Congenital rubella infection that occurs after 16 weeks gestation does not typically cause fetal abnormalities. This however plays no part in vaccination advice. Rubella vaccine is live and should not be given during pregnancy. The mother should be offered vaccination after giving birth. It is safe for the vaccine (typically given as combined MMR) to be administered if the mother is breastfeeding.
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This question is part of the following fields:
- Microbiology
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Question 40
Incorrect
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A 26 year old patient with PCOS has been trying to conceive for 2 years. Her BMI is 26 kg/m2. She is a non-smoker. Which of the following is the most appropriate first line treatment?
Your Answer:
Correct Answer: Clomiphene
Explanation:Firstline medical management of PCOS is with clomiphene.
Ovulation Disorders
WHO Group I : Hypothalamic pituitary failure (Stress, anorexia, exercise induced)
Management:
Increase BMI if <19 kg/m2
Reduce exercise if high levels
Pulsatile GnRH or Gonadotrophins with LH activity to induce ovulationWHO Group II : Hypothalamic-pituitary-ovarian dysfunction (PCOS)
Management:
Weight reduction if BMI >30
Clomiphene/Clomiphene (1st line)
Metformin (1st line)
Clomiphene & Metformin (1st/2nd line)
Laparoscopic drilling (2nd line)
Gonadotrophins (2nd line)WHO Group III : Ovarian failure
Management:
Consider IVF with donor eggs -
This question is part of the following fields:
- Clinical Management
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Question 41
Incorrect
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The followings are considered normal symptoms of pregnancy, EXCEPT:
Your Answer:
Correct Answer: Visual disturbance
Explanation:Visual disturbances although very common during pregnancy are not a normal sign. Physicians should have a firm understanding of the various ocular conditions that might appear pregnancy or get modified by pregnancy. In addition, it is very important to be vigilant about the rare and serious conditions that may occur in pregnant women with visual complaints. Prompt evaluation may be required and the immediate transfer of care of the patient may help saving the lives of both the mother and the baby.
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This question is part of the following fields:
- Obstetrics
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Question 42
Incorrect
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A 25 year old female patient comes in the first trimester of her pregnancy. Pap smear reveals that she has HSIL. What is the next best step in management?
Your Answer:
Correct Answer: Colposcopy
Explanation:Pregnant women with high-grade squamous intraepithelial lesions (HSIL) on cervical cytology should be evaluated with colposcopy. Principles of management of pregnant women include the following:
– An immediate diagnostic excisional procedure should NOT be performed.
– When colposcopy is performed during pregnancy:
– Endocervical sampling with a curette and endometrial sampling should NOT be performed, as there is a risk of disturbing the pregnancy; however, the endocervical canal may be sampled gently with a cytobrush.
– Cervical biopsy should be performed only if a lesion is present that appears to be high grade or suspicious for cancer.
– If the examination is unsatisfactory, repeating the colposcopy after 6 to 12 weeks should allow visualization of the entire squamocolumnar junction.There is no indication for inducing abortion or performing a hysterectomy.
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This question is part of the following fields:
- Gynaecology
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Question 43
Incorrect
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A 14-year-old female presents with complaints of intermittent lower abdominal pain episodes that last for about three days each month.
These symptoms have been ongoing for the past 12 months.
She reports that pubertal breast changes started about four years ago, however she has not yet had her first period.
On examination of her abdomen there is no evidence of any suprapubic mass or tenderness when she is not in pain.
Blood tests indicate that she is ovulating.
From the following developmental abnormalities, identify the one that is most likely to be the cause of her abdominal pain.Your Answer:
Correct Answer: Mullerian (paramesonephric) agenesis.
Explanation:The clinical evaluation indicates that the patient is ovulating but has not started menstruating. These observations suggest that the pain she is experiencing on a monthly basis could be related to ovulation or there could be an obstruction preventing the flow of menstrual blood from the uterus.
Uterine or vaginal anomalies that can obstruct menstrual flow include imperforate hymen, absent vagina, a transverse vaginal septum, or cervical obstruction.
If the cause was an obstruction to the flow, the retained menstrual products would have developed into a suprapubic mass (hematometra/ haematocolpos). However, no palpable mass was detected on abdominal examination.
Mullerian (paramesonephric) agenesis (correct answer) is the only condition that would result in no endometrial development; consequently there was no palpable mass observed and no menstrual loss that could be shed was present. A pelvic (lower abdominal) ultrasound examination can confirm the diagnosis.
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This question is part of the following fields:
- Gynaecology
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Question 44
Incorrect
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Anna, a 39-year-old medical receptionist presents to your gynaecologic clinic for a refill of her Microgynin 30 (combined oral contraceptive pill). Her history is significant for smoking around 1 pack per day. Her BMI is 37.
What should be the next management step?Your Answer:
Correct Answer: Offer her progestogen-only contraceptive options
Explanation:This patient is above 35 and smokes more than 15 cigarettes per day, which is an absolute contraindication to using a combined oral contraceptive pill. A BMI of greater than 35 is a relative contraindication to the usage of the combined oral contraceptive pill.
Progestogen-only contraception, such as etonogestrel implant, levonorgestrel intrauterine device, and depot medroxyprogesterone, should be offered to her.
Without initially attempting lifestyle changes, a referral for weight loss surgery is not required. Also, nicotine replacement therapy may aid in quitting smoking, but it may take time. -
This question is part of the following fields:
- Gynaecology
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Question 45
Incorrect
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A 27 year old women presents with a history of vaginal spotting and cramping abdominal pain. She has an 8 week history of amenorrhoea. On examination urine pregnancy test is positive and the cervix is closed. What is the likely diagnosis?
Your Answer:
Correct Answer: Threatened Miscarriage
Explanation:Miscarriage is a pregnancy that ends spontaneously before the foetus reaches the age of viability i.e. before 24 weeks of gestation. In a threatened miscarriage the USG findings are of a foetus present in the uterus and on speculum examination the cervical OS is closed, in an inevitable miscarriage the cervical OS is opened. In an incomplete miscarriage the uterus contains the retained products of conception and the cervical OS is open. complete miscarriage contains no retained products of conception and the cervix is closed as the bleeding as resolved.
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This question is part of the following fields:
- Clinical Management
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Question 46
Incorrect
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A 46-year-old woman presents to your clinic with a complaint of irregular heavy menstruation. She had normal menstrual pattern 6 months back. Physical examination revealed no abnormality with a negative cervical smear. Laboratory investigation reveals a haemoglobin of 105g/L (Normal 115-165g/L). The most common cause of such menorrhagia is?
Your Answer:
Correct Answer: Anovulatory cycles.
Explanation:Menorrhagia in a 45-year-old woman is most likely caused by an ovulation issue, most likely anovulatory cycles, particularly if the periods have grown irregular.
Endometrial carcinoma is a rare cause of menorrhagia that usually occurs after menopause.
Menorrhagia can be caused by fibroids, endometrial polyps, and adenomyosis, although the cycles are normally regular, and a dramatic change from normal cycles six months prior would be exceptional.
If fibroids or adenomyosis are the source of the menorrhagia, the uterus is usually enlarged. -
This question is part of the following fields:
- Gynaecology
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Question 47
Incorrect
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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:
Correct Answer: Second degree
Explanation:Perineal tears are common at the time of child birth. First degree perineal laceration means that the wound is so small that it doesn’t require any stitches and usually heals on its own. 2nd degree means that skin and smooth muscles are both torn. 3rd degree tear means that the tear is beyond the perineal muscles and the muscles surrounding the anal canal, while in 4th degree, the perineal tear goes through the anal sphincter up to the rectum.
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This question is part of the following fields:
- Anatomy
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Question 48
Incorrect
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HPV genotypes 6 and 11 are associated with which of the following?
Your Answer:
Correct Answer: Low grade squamous intraepithelial lesions of the cervix (LSIL)
Explanation:6 and 11 are considered low risk and are commonly associated with genital warts and low-grade squamous intraepithelial lesions of the cervix (can correspond cytologically to CIN 1)
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This question is part of the following fields:
- Microbiology
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Question 49
Incorrect
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A 32 year old patient with a 28 day menstrual cycle is offered a Hysterosalpingogram (HSG) at an infertility clinic.
At which point in her cycle should the HSG be performed?Your Answer:
Correct Answer: Days 6-12
Explanation:Hysterosalpingography is a radiological test used to investigate infertility especially in patients with no history suggesting tubal blockages such as pelvic surgery or PID, in which case a laparoscopy and dye is better suited. For the procedure, a contrast dye is inserted through the cervix, flows through the uterus and the fallopian tubes and should spill into the peritoneum. Fluoroscopy provides dynamic images of these structures to determine if there are any abnormalities or blockages. HSG is best performed on day 6-12 in the cycle, after the cessation of menses, and before ovulation, to avoid X Ray exposure in case of an unknown early pregnancy.
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This question is part of the following fields:
- Biophysics
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Question 50
Incorrect
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Which one of the following factors will most likely increase the chances of ovulation in female?
Your Answer:
Correct Answer: LH surge
Explanation:Different changes can occur during the menstrual cycle including an increased body temperature at the time of ovulation, thinning of the cervical mucus and few other changes, but it is the LH surge which is the most important factor necessary for ovulation.
Mittelschmerz is characterised by recurrent midcycle pain which occurs around the time of ovulation. -
This question is part of the following fields:
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
