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Question 1
Correct
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A 33-year-old 'grand multiparous' woman, who has previously delivered seven children by normal vaginal delivery, spontaneously delivers a live baby weighing 4750gm one hour ago after a three-hour long labour period. Shortly after, an uncomplicated third stage of labour, she goes into shock (pulse 140/min, BP 80/50 mmHg). At the time of delivery, total blood loss was noted at 500mL, and has not been excessive since then. What is the most probable diagnosis of this patient?
Your Answer: Uterine rupture.
Explanation:The patient most likely suffered a uterine rupture. It occurs most often in multiparous women and is less often associated with external haemorrhage. Shock develops shortly after rupture due to the extent of concealed bleeding.
Uterine inversion rarely occurs when after a spontaneous and normal third stage of labour. Although it can lead to shock, it is usually associated with a history of controlled cord traction or Dublin method of placenta delivery before the uterus has contracted. This diagnosis is also strongly considered when shock is out of proportion to the amount of blood loss.
An overwhelming infection is unlikely in this case when labour occurred for a short period of time. Uterine atony and amniotic fluid embolism are more associated with excessive vaginal bleeding, which is not evident in this case.
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This question is part of the following fields:
- Obstetrics
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Question 2
Correct
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The main function of the cilia of the fallopian tube is?
Your Answer: Transport the ovum towards the uterus
Explanation:Cilia are small hair line projections in the fallopian tube. Their main function is to transport the egg through he fallopian tube towards the uterus. It is present in many other tubular organs and its function varies accordingly to the organ.
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This question is part of the following fields:
- Anatomy
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Question 3
Correct
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A 31-year-old female patient seeks your opinion on an abnormal Pap smear performed by a nurse practitioner at a family planning facility. A high-grade squamous intraepithelial lesion is visible on the Pap smear (HGSIL).
Colposcopy was performed in the office. The impression is of acetowhite alterations, which could indicate infection by HPV. Chronic cervicitis is present in your biopsies, but there is no indication of dysplasia.
Which of the following is the most suitable next step in this patient's care?Your Answer: Conization of the cervix
Explanation:When cervical biopsy or colposcopy doesn’t explain the severity of the pap smear results cone biopsy is done. In 10% of biopsies, results will be different from that of the pap smear as in this patient with pap smear showing HSIL and colposcopy showing chronic cervicitis.
In such cases conization is indicated. Repeating the pap smear could risk prompt management of a serious problem. No destructive procedure, ablation or cryotherapy, should be done before diagnosis is certain.
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This question is part of the following fields:
- Gynaecology
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Question 4
Correct
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Evidence from meta-analysis of RCTs is what level of evidence?
Your Answer: Ia
Explanation:The levels of evidence range from I-IV:
1a: Systematic reviews (with homogeneity) or metanalysis of randomized controlled trials: highest level of evidence.
1b: Individual randomized controlled trial (with narrow confidence interval)
1c: All or none randomized controlled trials
2a: Systematic reviews (with homogeneity) of cohort studies
2b: Individual cohort study or low quality randomized controlled trials (e.g. <80% follow-up)
2c: Outcomes Research; ecological studies
3a: Systematic review (with homogeneity) of case-control studies
3b: Individual case-control study
4: Case series (and poor quality cohort and case-control studies)
5: Expert opinion without explicit critical appraisal, or based on physiology, bench research or first principles. -
This question is part of the following fields:
- Epidemiology
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Question 5
Incorrect
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Question 6
Incorrect
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A couple in their mid-twenties has chosen the 'Rhythm Strategy' calculation as their contraception method, refraining from sexual activity when a pregnancy might otherwise be possible. They want to avoid having a child for the next two years. For the past twelve months, the lady has kept track of her cycles, which have ranged from 26 to 29 days in duration. Which of the following abstinence durations is the most appropriate?
Your Answer:
Correct Answer: From day 6 to day 17,
Explanation:To provide suitable advice to this couple, the candidate must be aware of the following facts:
Because the luteal phase is 14 days long, regardless of the follicular phase length, ovulation happens 14 days before the period.
As a result, ovulation in this lady might have occurred as early as day 12 or as late as day 15 of her cycle.
In the presence of adequate and normal cervical mucus, sperm survival has been demonstrated to be far longer than previously thought, with intercourse occurring up to 6 days before the known period of ovulation, resulting in pregnancy.
Intercourse should be stopped six days before the earliest ovulation in this woman (i.e. on day six).
– It is generally accepted that the ovulated egg can be fertilised for approximately 24-36 hours.
Intercourse should not be restarted for at least two days after the most recent ovulation.
This would be day 17 for this woman.
Between days 6 and 17 of the cycle, abstinence is required. -
This question is part of the following fields:
- Gynaecology
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Question 7
Incorrect
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Which one of the following has the most significant effect on slowing drug metabolism in pregnancy?
Your Answer:
Correct Answer: Progesterone effect on gastric motility
Explanation:Progesterone down regulates gastric motility meaning drugs are absorbed and metabolised more slowly, thus drugs are absorbed, metabolised and cleared more slowly. Most of the drugs are transported after binding to the albumin.
Lower albumin levels mean a greater unbound drug fraction but as this may be thought to increase drug concentrations it actually leaves more available for hepatic clearance or renal excretion so overall drug concentrations are unchanged and metabolism increased.
Increase in hepatic flow will increase the metabolism of the drug as the drug will be transported faster.
Increased renal blood flow will result in the faster clearance of the drug from the body. -
This question is part of the following fields:
- Clinical Management
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Question 8
Incorrect
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When the presenting part of the foetus is at the level of ischial spines, this level is known as?
Your Answer:
Correct Answer: Station 0
Explanation:Station 0 – This is when the baby’s head is even with the ischial spines. The baby is said to be engaged when the largest part of the head has entered the pelvis.
If the presenting part lies above the ischial spines, the station is reported as a negative number from -1 to -5. -
This question is part of the following fields:
- Obstetrics
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Question 9
Incorrect
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During her first month on OCPs, a patient had minimal bleeding at mid cycle. What is the most appropriate management?
Your Answer:
Correct Answer: Continue pills as usual.
Explanation:Breakthrough bleeding, or spotting, refers to when vaginal bleeding occurs between menstrual cycles. It may look like light bleeding or brown discharge.
Spotting is the most common side effect of birth control pills. It happens because the body is adjusting to changing levels of hormones, and the uterus is adjusting to having a thinner lining.
Taking the pill as prescribed, usually every day and at the same time each day, can help prevent bleeding between periods.
All other options are incorrect as this is a common side effect and will resolve on its own.
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This question is part of the following fields:
- Gynaecology
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Question 10
Incorrect
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Ootidogenesis refers to which process during Oogenesis?
Your Answer:
Correct Answer: 1st and 2nd Meiotic Divisions
Explanation:During the early fetal life, oogonia proliferate by mitosis. They enlarge to form primary oocyte before birth. No primary oocyte is form after birth. The primary oocyte is dormant is the ovarian follicles until puberty. As the follicle matures, the primary oocyte completes its first meiotic division and gives rise to secondary oocyte. During ovulation the secondary oocytes starts the second meiotic division but is only completed if a sperm penetrates it. This 1st and 2nd meiotic division is known as ootidogenesis.
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This question is part of the following fields:
- Embryology
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Question 11
Incorrect
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Regarding the structure of the detrusor muscle. Which of the following is true?
Your Answer:
Correct Answer: The detrusor is divided into 3 layers consisting of inner and outer layers of longitudinal smooth muscle with a middle circular smooth muscle layer
Explanation:The urinary bladder is composed of the transitional epithelium, followed by the lamina propria made up of the fibroelastic connective tissue. The muscularis layer covers the lamina propria which is made up of three poorly defined layers of smooth muscles; the inner longitudinal, middle circular and the outer longitudinal layer. The bladder is covered on the superior surface and the lateral surface by the peritoneum.
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This question is part of the following fields:
- Anatomy
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Question 12
Incorrect
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A 29-year-old woman presented to the emergency department with severe nausea and vomiting at 8 weeks of being pregnant. She is unable to take solid food but is capable of drinking small sips of liquids. She is concerned that she might have gastroenteritis because her partner was noted to have recently been diagnosed with it.
Which of the following is considered the next best step to investigate given the situation?Your Answer:
Correct Answer: Pelvic ultrasound
Explanation:Hyperemesis gravidarum refers to intractable vomiting during pregnancy, leading to weight loss and volume depletion, resulting in ketonuria and/or ketonemia.
The exact cause of hyperemesis gravidarum remains unclear. However, there are several theories for what may contribute to the development of this disease process such as:
1. Hormone changes – hCG levels peak during the first trimester, corresponding to the typical onset of hyperemesis symptoms. Estrogen is also thought to contribute to nausea and vomiting in pregnancy.
2. Changes in the Gastrointestinal System – the lower oesophageal sphincter relaxes during pregnancy due to the elevations in estrogen and progesterone. This leads to an increased incidence of gastroesophageal reflux disease (GERD) symptoms in pregnancy, and one symptom of GERD is nausea.
3. Genetics – an increased risk of hyperemesis gravidarum has been demonstrated among women with family members who also experienced hyperemesis gravidarum.The average onset of symptoms happens approximately 5 to 6 weeks into gestation. The physical exam should include fetal heart rate (depending on gestational age) and an examination of fluid status, including an examination of blood pressure, heart rate, mucous membrane dryness, capillary refill, and skin turgor. A patient weight should be obtained for comparison to previous and future weights. If indicated, abdominal examination and pelvic examination should occur to determine the presence or absence of tenderness to palpation.
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This question is part of the following fields:
- Obstetrics
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Question 13
Incorrect
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Which of the following muscles does NOT receive innervation from the pudendal nerve?
Your Answer:
Correct Answer: Internal anal sphincter
Explanation:The internal anal sphincter is innervated by the splanchnic nerves. Sympathetic nerve supply from the inferior hypogastric plexus (for contraction) and parasympathetic supply from nervi erigentes (for relaxation).
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This question is part of the following fields:
- Anatomy
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Question 14
Incorrect
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When consenting a patient for abdominal hysterectomy what would you advise regarding the risk?
Your Answer:
Correct Answer: Injury to ureter or bladder is approximately 1%
Explanation:Abdominal hysterectomy is performed through a Pfannenstiel incision. There are certain complications associated with hysterectomy including haemorrhage, injury to the ureter(1%) and less commonly bladder and bowel (0.04%).
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This question is part of the following fields:
- Clinical Management
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Question 15
Incorrect
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Regarding the foetus, which one of the following statements is true?
Your Answer:
Correct Answer: Fetal lie describes the long axis of the foetus to the long axis of the mother
Explanation:Fetal lie describes the relationship of the long axis of the foetus with respect to the long axis of the mother.
Coronal suture is the transverse suture separating the parietal bone from the frontal bone.
Umbilical cord is composed of two arteries and one vein. the vein carries the oxygenated blood, whereas the arteries contain the deoxygenated blood.
At the time of birth, the anterior fontanelle is open and appears as a soft jelly like structure. -
This question is part of the following fields:
- Anatomy
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Question 16
Incorrect
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If both parents have beta-thalassaemia minor, what is the chance of their male offspring having beta thalassemia major?
Your Answer:
Correct Answer: 25%
Explanation:This is not an X-linked condition so the sex of the child makes no difference to the inheritance. Any child will have a 1 in 4 chance of having beta thalassaemia major.
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This question is part of the following fields:
- Genetics
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Question 17
Incorrect
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What is the definition of premature menopause?
Your Answer:
Correct Answer: Menopause at or before 40 years of age
Explanation:Menopause is defined as the cessation of menstruation for a period of 12 months. Premature menopause is defined as cessation of menstruation before the age of 40.
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This question is part of the following fields:
- Endocrinology
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Question 18
Incorrect
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A patient attends the maternity unit as her waters have broken but she hasn't had contractions. She is 39+6 weeks gestation. Speculum examination confirms prelabour rupture of membranes (PROM). What is the risk of serious neonatal infection with PROM?
Your Answer:
Correct Answer: 1 in 100
Explanation:Prelabour Rupture of Membranes:
– Risk of serious neonatal infection 1% (vs 0.5% for women with intact membranes)
– 60% of patients with PROM will go into labour within 24 hrs
– Induction appropriate if >34 weeks gestation and >24 hours post rupture and patients labour hasn’t started.
– If <34 weeks induction of labour should not be carried out unless there are additional obstetric indications e.g. infection -
This question is part of the following fields:
- Clinical Management
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Question 19
Incorrect
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The testicular arteries are branches of what?
Your Answer:
Correct Answer: Aorta
Explanation:The testicular artery arises from the aorta and supplies the testis and the epididymis. The testis is supplied by 3 arteries.: Testicular artery, cremasteric artery that arises from the inferior hypogastric artery and the artery to the vas deferens from the internal iliac artery.
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This question is part of the following fields:
- Anatomy
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Question 20
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 21
Incorrect
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The inguinal canal is reinforced anterolaterally by which structure?
Your Answer:
Correct Answer: Internal oblique
Explanation:The Conjoint tendon AKA Inguinal falx reinforces the posterior wall of the inguinal canal. The inguinal ligament is part of the floor.
The aponeurosis of external oblique is the major component of the anterior wall with fibres of internal oblique reinforcing the lateral part -
This question is part of the following fields:
- Anatomy
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Question 22
Incorrect
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A 33-year-old woman presented to the medical clinic with a history of type 2 diabetes mellitus. She plans to conceive in the next few months and asks for advice. Her fasting blood sugar is 10.5 mmol/L and her HbA1c is 9%.
Which of the following is considered the best advice to give to the patient?Your Answer:
Correct Answer: Achieve HbA1c value less than 7% before she gets pregnant
Explanation:Women with diabetes have increased risk for adverse maternal and neonatal outcomes and similar risks are present for either type 1 or type 2 diabetes. Both forms of diabetes require similar intensity of diabetes care. Preconception planning is very important to avoid unintended pregnancies, and to minimize risk of congenital defects. Haemoglobin A1c goal at conception is <6.5% and during pregnancy is <6.0%.
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This question is part of the following fields:
- Obstetrics
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Question 23
Incorrect
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An 18-year-old woman came into your office looking for contraception assistance. Her new partner and she are arranging a trip to Thailand. She has no contraindications.
What is the best piece of advice?Your Answer:
Correct Answer: Oral contraceptive pills and condoms
Explanation:OCPs should be started in this patient as well as condoms to prevent likely sexually transmitted infections.
Condoms alone are not effective for prevention of pregnancy.
OCPs alone do not prevent from sexually transmitted infections.
It is not appropriate to inform the parents and the patient hasn’t refused any advice.
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This question is part of the following fields:
- Gynaecology
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Question 24
Incorrect
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A 29 year old is diagnosed with stage 1A2 cervical cancer. Which of the following is the most appropriate treatment option?
Your Answer:
Correct Answer: LLETZ
Explanation:The treatment of stage 1A cervical cancer is excision of the margins using the Loop electrical excision procedure (LLETZ). Hysterectomy is not necessary. This treatment enables fertility to be preserved.
2010 FIGO classification of cervical carcinoma
0 – Carcinoma in situ
1 – Confined to the cervix (diagnosed microscopy)
1A1 – Less than 3mm depth & 7mm lateral spread
1A2 – 3mm to 5mm depth & less than 7mm lateral spread
1B1 – Clinically visible lesion or greater than A2 & less than 4 cm in greatest dimension
1B2 – Clinically visible lesion, greater than 4 cm in greatest dimension
2 – Invades beyond uterus but not to pelvic wall or lower 1/3 vagina
2A1 – Involvement of the upper two-thirds of the vagina, without parametrical invasion & Less than 4cm
2A2 – Greater than 4 cm in greatest dimension
2B – Parametrial involvement
3 – Extends to Pelvic side wall or lower 1/3 vagina or hydronephrosis
3A – No pelvic side wall involvement
3B – Pelvic side wall involved or hydronephrosis
4 – Extends beyond true pelvis 4A Invades mucosa bladder and rectum
4B – Distant Metastasis -
This question is part of the following fields:
- Clinical Management
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Question 25
Incorrect
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A patient has returned to your clinic. She presented with painful periods 18 months earlier and laparoscopy confirmed endometriosis. She now gets pain on opening her bowels as well as low back pain. What structure is likely to be involved?
Your Answer:
Correct Answer: Uterosacral ligament
Explanation:Lower abdominal pain during menstrual periods and lower back or leg pain are associated with endometriosis in the uterosacral ligaments. Endometriosis can cause diarrhoea and IBS type symptoms. Note Endometriosis on the uterosacral ligament can cause tender nodules to form. These can be palpated during pelvic exam. Tender nodules are specific to endometriosis of the uterosacral ligament so if the question mentions feeling a tender nodule during PV exam think endometriosis of the Uterosacral ligaments!
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This question is part of the following fields:
- Clinical Management
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Question 26
Incorrect
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A 47-year-old woman is concerned about the use of hormone replacement therapy(HRT) after her menopause. She's still having normal menstrual cycles and hasn't experienced any hot flashes or other issues. She is especially concerned about Alzheimer's disease (AD), as her mother was diagnosed with the condition at the age of 75 and is now confined to a nursing facility. Which of the following is the best piece of advice about using HRT and the risk of Alzheimer's disease?
Your Answer:
Correct Answer: HRT given from the time of menopause at the age of approximately 50 years, reduces the decline of cognitive function, often seen as an early manifestation of AD.
Explanation:Although there have been some mixed results regarding the use of hormone replacement therapy (HRT) and the prevalence of Alzheimer’s disease (AD), there is little question that HRT started during menopause lowers cognitive decline, which is a common early symptom of AD.
This is in contrast to the effect shown when HRT is started at the age of 60-65, when the risk of Alzheimer’s disease rises.
There are no statistics on the effect of HRT on the incidence of Alzheimer’s disease when it is started before menopause, but it is apparent that it does not slow the progression of the disease or make advanced dementia less severe. -
This question is part of the following fields:
- Gynaecology
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Question 27
Incorrect
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A 25 year old female with her LRMP 8 weeks ago, presented with severe abdominal pain and per vaginal bleeding. On examination there was tenderness over her left iliac region. Her pulse rate was 110 bpm and blood pressure was 90/65mmHg. Which of the following is the most appropriate management?
Your Answer:
Correct Answer: Immediate laparotomy
Explanation:A ruptured ectopic pregnancy is the most probable diagnosis. As she is in shock (tachycardia and hypotension) immediate laparotomy is needed.
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This question is part of the following fields:
- Gynaecology
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Question 28
Incorrect
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Yasmin®, which contains 3 mg of drospirenone and 30 mcg of ethinyl oestradiol, has been approved for usage in South Africa.
Which of the following factors has contributed to it becoming the most popular oral contraceptive pill among South African women?Your Answer:
Correct Answer: It has not weight gain as an adverse effect and may be associated with weight loss
Explanation:Yasmin has been linked to decreased fluid retention and weight gain as a side effect of COCs, which is why most women who experience this side effect prefer Yasmin®.
Due to its anti-mineralocorticoid properties, drospirenone, unlike earlier progestogens, is associated with no weight gain or even moderate weight loss.
Yasmin has a similar failure rate to other COCs. No evidence using Yasmin is linked to a lower risk of cervical cancer as a long-term side effect of COCs. Yasmin, like all COCs, can cause spotting and irregular bleeding in the first few months of use.
Drospirenone, a progesterone component, has antiandrogenic properties and is slightly more successful in treating acne, but the difference is not big enough to make it preferable in terms of acne therapy or prevention when compared to other COCs. -
This question is part of the following fields:
- Gynaecology
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Question 29
Incorrect
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Which of the following is the most accurate estimate of mature breast milk composition?
Your Answer:
Correct Answer: Fat 4%, Protein 1%, Sugar 7%
Explanation:Breast milk contains around 4% fat, 7% sugar and 1% proteins. The rest is water and minerals.
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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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Regarding lymph drainage of the fallopian tubes where does the majority of lymph drain to?
Your Answer:
Correct Answer: Para-aortic nodes
Explanation:Lymphatic vessels from the ovaries, joined by vessels from the uterine tubes and most from the fundus of the uterus, follow the ovarian veins as they ascend to the right and left lumbar (caval/aortic) lymph nodes.
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This question is part of the following fields:
- Anatomy
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SESSION STATS - PERFORMANCE PER SPECIALTY
