-
Question 1
Correct
-
A 29 year old female presented at her 38th week of gestation to the ER with severe hypertension (210/100) and proteinuria (+++). Soon after admission, she developed generalized tonic clonic fits. What is the first line of management in this case?
Your Answer: Magnesium sulphate IV
Explanation:Magnesium Sulphate is the drug of choice in eclamptic patients. A loading dose of 4g magnesium sulphate in 100mL 0.9% saline IVI over 5min followed by maintenance IVI of 1g/h for 24h. Signs of toxicity include respiratory depression and jerky tendon reflexes. In recurrent fits additional 2g can be given. Magnesium should be stopped when the respiratory rate is <14/min, absent tendon reflexes, or urine output is <20mL/h.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 2
Correct
-
All of the following factors are associated with an unstable lie of the foetus except?
Your 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.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 3
Correct
-
Question 4
Correct
-
When is the earliest appropriate gestational age to perform amniocentesis?
Your Answer: 15+0 weeks
Explanation:The best time to perform amniocentesis is at the gestational age of 15 weeks or more. There is increased risk of abortion, respiratory problems and fetal talipes if amniocentesis is performed before the gestational age of 14 weeks.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 5
Incorrect
-
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: Increased arterial pO2, increased bradykinin & increased Prostaglandin E2
Correct Answer: Increased arterial pO2, increased bradykinin & decreased Prostaglandin E2
Explanation:Functional closure of the ductus arteriosus is neonates is completed within the first few days after birth. It normally occurs by the 12th postnatal week. It has been suggested that persistent patency of DA results from a failure of the TGF-B induction after birth. Due to increased arterial pO2, constriction of the DA occurs. In addition to this on inflation the bradykinin system is activated with cause the smooth muscles in the DA to constrict. A decrease in the E2 prostaglandin is also an important factor as raised levels have been indicated in keeping the patency of the DA.
-
This question is part of the following fields:
- Embryology
-
-
Question 6
Correct
-
You see a patient in antenatal clinic who is concerned that she has never had chicken pox and may catch it during pregnancy. You check her Varicella status and she is non-immune. She asks you about vaccination. What type of vaccine is the varicella vaccine?
Your Answer: Attenuated
Explanation:Varicella is a live vaccine. The recent RCOG green top guidelines suggest vaccine can be considered postpartum or pre pregnancy but NOT whilst pregnant. In the non-immune pregnant woman they should be advised to avoid contact with people with chickenpox or shingles and to contact a healthcare professional promptly if exposed. If they have a significant exposure VZIG should be offered as soon as possible.
-
This question is part of the following fields:
- Immunology
-
-
Question 7
Incorrect
-
A 33-year -old G2Pl woman who is at 10 weeks gestation presented to the medical clinic for antenatal visit. It was revealed that she has a twin pregnancy. She was known to have had a complicated previous pregnancy with placental abruption at 34 weeks.
Which of the following is considered the next step in best managing the patient in addition to routine antenatal care?Your Answer: Serial CTGs after 34 weeks
Correct Answer: Increased iron and folic acid supplementation
Explanation:Twin pregnancies are at risk for iron deficiency due to significant maternal, fetal, and placental demands. Recommendations regarding the optimal iron dose in twin pregnancies are based on clinical expert opinions, advocating doubling the dose of iron from 30 mg of elemental iron to 60 mg routinely during the second and third trimester, regardless of maternal iron stores.
If pregnant with twins, patient should take the same prenatal vitamins she would take for any pregnancy, but a recommendation of extra folic acid and iron will be made. The additional folic acid and extra iron will help ward off iron-deficiency anaemia, which is more common when patient is pregnant with multiples.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 8
Incorrect
-
Regarding monozygotic twins, all of the following are correct, EXCEPT:
Your Answer: Has a constant incidence of 1:250 births
Correct Answer: Has a constant incidence 1:600 births
Explanation:The incidence of monozygotic twins is constant worldwide (approximately 4 per 1000 births). Approximately two thirds of twins are dizygotic.
-
This question is part of the following fields:
- Genetics
-
-
Question 9
Incorrect
-
A patient is diagnosed with cervical cancer and staging investigations show there is parametrial involvement but it is confined within the pelvic wall and does not involve the lower 1/3 vagina. There is no evidence of hydronephrosis. What FIGO stage is this?
Your Answer: 2A
Correct Answer: 2B
Explanation:This is stage 2B.
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
-
-
Question 10
Incorrect
-
A baby with shoulder dystocia suffers a brachial plexus injury. The mother asks you if this will be permanent. What percentage of babies will have permanent neurological dysfunction as a result of brachial plexus injury secondary to shoulder dystocia?
Your Answer: 25%
Correct Answer:
Explanation:of cases there is no permanent neurological disability. Shoulder dystocia is the most common cause of Erb’s palsy (Erb-Duchenne palsy) where there is injury to C5 and C6 of the brachial plexus (C5 to T1)
-
This question is part of the following fields:
- Clinical Management
-
-
Question 11
Correct
-
Which one of the following dimensions relates to the greatest diameter of the fetal head?
Your Answer: Occipitomental
Explanation:Occipitomental diameter is the greatest diameter of the fetal scalp and runs from chin to the prominent portion on the occiput. It measure about 12.5cm in diameter.
-
This question is part of the following fields:
- Anatomy
-
-
Question 12
Incorrect
-
A 27-year-old woman, at 27 weeks of gestation, who lives 40 kilometres from the nearest tertiary obstetric hospital, is referred due to premature rupture of membranes (PROM) which occurred 2 days ago. This is her first pregnancy, which had been progressing normally until the rupture of membranes. Over the last 48 hours, she did not have any contractions. Transfer was made to the tertiary referral obstetric hospital where she was started on glucocorticoid therapy. Cervical swabs were taken and she underwent ultrasound and cardiotocography assessments. She was also started on prophylactic antibiotics. Cervical swabs only showed growth of normal vaginal flora whereas the abdominal ultrasound found almost no liquor. CTG was normal and reactive.
Which is the most appropriate next step in her management?
Your Answer: CTG assessments of the fetal heart rate should be repeated weekly.
Correct Answer: The white cell count (WCC) and C-reactive protein (CRP) levels should be assessed every 2-3 days.
Explanation:If a patient presents with PROM at 27 weeks of gestation, her management plan would have to include:
1) Cervical swabs to rule out infection
2) Commencement of prophylactic antibiotics such as erythromycin until results from the swabs are available
-If only normal vaginal flora are seen, prophylactic antibiotics can be stopped.
3) Administration of glucocorticoid- usually for 48 hours to promote maturity of the fetal lung and lower the chance of intracranial bleeding if the foetus has to be delivered prematurely
4) Transfer to a healthcare centre that has neonatal intensive care facilities to ensure if intensive care is needed post-delivery, the healthcare staff are prepared
5) Blood profile (particularly white cell count) and inflammatory markers (CRP) to look for any signs of chorioamnionitis
6) CTG assessment every 2-3 days. Abnormalities found on the CTG tracing are often the first evidence of problems such as a subclinical chorioamnionitis
7) Tocolysis with tocolytics such as IV salbutamol or nifedipine if contractions start before the course of glucocorticoid therapy is finished. Post-glucocorticoid therapy, tocolysis would not be often employed since there is a risk of masking contractions that occur due to an infection. In those cases, it is better to deliver the baby rather than to prolong the pregnancy. If there is no infection, the management plan should aim to prolong the pregnancy and delay delivery of a very premature baby. -
This question is part of the following fields:
- Obstetrics
-
-
Question 13
Correct
-
Question 14
Incorrect
-
According to the WHO, maternal mortality ratio is defined as which of the following?
Your Answer: Maternal deaths per 10,000 live births
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.
-
This question is part of the following fields:
- Epidemiology
-
-
Question 15
Correct
-
Question 16
Incorrect
-
Which one of the following statements is related to testicular feminization syndrome?
Your Answer: There's usually very low testosterone levels
Correct Answer: There are usually normal testes
Explanation:Androgen insensitivity (testicular feminization) syndrome is a rare inherited form of male pseudo hermaphroditism that occurs in phenotypically normal women with adequate breast development, normal external genitalia, a vagina of variable depth, absent uterus, and sparse or absent pubic hair and axillary hair. Testosterone levels are normal or elevated.
-
This question is part of the following fields:
- Embryology
-
-
Question 17
Correct
-
Question 18
Incorrect
-
An 19-year-old woman comes to your clinic complaining of painful menses for the past year. She was given NSAIDs at first, then OCPs after the NSAIDs failed to control her symptoms. OCP has also struggled to regulate the painful menses.
Which of the following would be the best next step in your management?Your Answer: Transabdominal ultrasound
Correct Answer: Transvaginal ultrasound
Explanation:Adolescents who fail to respond to first- or second-line treatment and have recurrent symptoms or have symptoms that worsen over time should be re-evaluated for other possible and serious causes of secondary dysmenorrhea such as endometriosis, uterine leiomyomas, polyps, or pelvic pathologies.
When pelvic pathology is suspected, abdominal and transvaginal ultrasonography should be used as first-line investigation. However, transvaginal ultrasound is more accurate and the preferred option if possible.
CT scan is not indicated in the assessment of dysmenorrhea.
D&C and laparoscopy can be considered as treatment options once a diagnosis has been established but can not be used as primary steps in diagnosis of dysmenorrhea.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 19
Correct
-
In early pregnancy at what gestation does the Embryonic pole become visible on transvaginal ultrasound?
Your Answer: 5 weeks + 3 days
Explanation:The gestational sac can be visualized from as early as 4–5 weeks of gestation and the yolk sac at about 5 weeks (Figure 6.3). The embryo can be observed and measured at 5–6 weeks gestation.
-
This question is part of the following fields:
- Biophysics
-
-
Question 20
Correct
-
Endometrial tissue found within the myometrium is classed as
Your Answer: Adenomyosis
Explanation:Endometrial tissue found within the myometrium is Adenomyosis. If endometrial tissue is found at a distant site to the uterus it is termed endometriosis. Fibroids are smooth muscle tumours (Leiomyoma’s) sometimes called myoma’s.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 21
Correct
-
During pregnancy, maternal oestrogen levels increase markedly. Most of this oestrogen is produced by the:
Your Answer: Placenta
Explanation:The placenta does not have all the necessary enzymes to make oestrogens from cholesterol, or even progesterone. Human trophoblast lack 17-hydroxylase and therefore cannot convert C21-steroids to C19-steroids, the immediate precursors of oestrogen. To bypass this deficit, dehydroisoandrosterone sulphate (DHA) from the fetal adrenal is converted to estradiol-17ί by trophoblasts. In its key location as a way station between mother and foetus, placenta can use precursors from either mother or foetus to circumvent its own deficiencies in enzyme activities.
-
This question is part of the following fields:
- Physiology
-
-
Question 22
Correct
-
A 77 year old woman undergoes staging investigations for endometrial carcinoma. This shows invasion of the inguinal lymph nodes. What is this patients 5-year survival?
Your Answer: 15%
Explanation:Lymph node involvement means that the carcinoma is stage 4. The 5 year survival of stage 4 endometrial carcinoma is 16%.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 23
Incorrect
-
When a 75-year-old lady laughs, sneezes, coughs, or lifts big weights, she leaks pee. She also claims that she has the urge to pass pee 10-12 times a day, and that she can't go to the restroom half of the time. She appears to have a harder time with urgency. Infections are not found in a urine test. Except for a residual amount of 125cc, an ultrasound scan of the bladder, ureter, and kidneys is inconclusive.
Which of the following treatment options is the best fit for her?Your Answer: Anticholinergic medications
Correct Answer: Bladder training
Explanation:This woman has mixed incontinence, which includes signs and symptoms of both stresses and urges incontinence. The urge, on the other hand, irritates her. Bladder training would be the most appropriate management approach to investigate first for women with urge incontinence as the most troublesome symptom. The objectives are:
– Using a bladder diary to establish a baseline
– Creating a voiding schedule
– Over a long period, gradually increase the voiding interval in increments of 2- 5 minutes, to void every 3 hours.
– Other important strategies to consider are lifestyle changes like reducing fluid intake, losing weight, and avoiding diuretics-producing foods and beverages (e.g., alcoholic beverages, caffeine, etc).When urge incontinence does not respond to physical or behavioural therapy, anticholinergics along with ongoing bladder training are an alternative. A 4- to 6-week trial is employed. At six months, risk and benefit are weighed to see if treatment should be continued for those who react. Patients should be informed about anticholinergic side effects such as dry mouth and constipation, as well as how to control them.
Anterior colporrhaphy is a treatment for cystocele that involves repairing the front vaginal wall. It can help people with urine incontinence. If you don’t have a cystocele, bladder neck suspension is the best option.
Retropubic bladder suspension is a more intrusive surgery for treating stress urinary incontinence in patients who haven’t responded to less invasive treatments like pelvic floor exercise.The most essential initial conservative therapy to explore for patients with real stress incontinence and mixed (both stress and urge) urine incontinence when stress incontinence is the more prominent symptom is pelvic floor muscle exercise (e.g. Kegel exercise). For urge incontinence, more difficult training can be applied.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 24
Correct
-
Which of the following is an acute complication of radiotherapy?
Your Answer: Moist skin desquamation
Explanation:Tissues with actively dividing cells, such as bone marrow and gastrointestinal mucosa, are particularly sensitive to ionising radiation. Lymphocyte depletion is the most sensitive marker of bone marrow injury, and after exposure to
a fatal dose, marrow aplasia is a common cause of death. The gonads are highly radiosensitive and radiation may result in temporary or permanent sterility. Stochastic (chance) effects occur with increasing probability
as the dose of radiation increases. Carcinogenesis represents a stochastic effect. With acute exposures, leukaemias may arise after an interval of around 2–5 years and solid tumours after an interval of about 10–20 years. Moist skin desquamation can be an acute reaction to both radio and chemotherapy whereas fibrosis and lymphoedema are late complications. -
This question is part of the following fields:
- Biophysics
-
-
Question 25
Correct
-
Maternal mortality rate is lowest in which age group?
Your Answer: 20 - 30
Explanation:The maternal mortality rate starts low and raises steeply after the age of 30 years. The lowest mortality rate recorded among women is between 19-30 years of age group.
-
This question is part of the following fields:
- Physiology
-
-
Question 26
Correct
-
A 30 year old patient is due for delivery in about two weeks. She has some concerns after a family member recently gave birth to a baby with profound hearing loss due to an infection. Which of the following would you describe to her as the most common infective cause of congenital hearing loss?
Your Answer: Cytomegalovirus
Explanation:Congenital cytomegalovirus infections are the most common cause of sensorineural hearing loss in babies. Cytomegalovirus infection during the perinatal period can be transferred to the foetus especially if the primary infection is during pregnancy. Babies born with congenital CMV are either symptomatic or develop symptoms later in life. Some of the features of CMV infection include sensorineural hearing loss, visual impairment, cerebral palsy, microcephaly and seizures. Other causes of infective congenital sensorineural hearing loss include: Rubella, HIV, Herpes Simplex Virus, Measles, Varicella Zoster virus, Mumps and West Nile Virus.
-
This question is part of the following fields:
- Microbiology
-
-
Question 27
Correct
-
In a patient who undergoes a medical abortion at 10 weeks gestation, what advice would you give regarding Rhesus Anti-D Immunoglobulin?
Your Answer: All RhD-negative women who are not alloimmunized should receive Anti-D IgG
Explanation:The Rhesus status of a mother is important in pregnancy and abortion. The exposure of an Rh-negative mother to Rh antigens from a positive foetus, will influence the development of anti-Rh antibodies. This may cause problems in subsequent pregnancies leading to haemolysis in the newborn. Rh Anti RhD- globulin is therefore given to non-sensitised Rh-negative mothers to prevent the formation of anti-Rh antibodies within 72 hours following abortion. Anti RhD globulin is not useful for already sensitized, or RhD positive mothers.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 28
Incorrect
-
A 34 year old female presents to the ob-gyn for a regular antenatal visit. Her previous pregnancy was complicated by pre-eclampsia and later eclampsia. What are the chances of her pre-eclampsia recurring in a later pregnancy?
Your Answer: The risk is 1 in 20 (5%)
Correct Answer:
Explanation:Research suggests the risk of having preeclampsia again is approximately 20%, however experts cite a range from 5% to 80% depending on when you had it in a prior pregnancy, how severe it was, and additional risk factors you may have. If you had preeclampsia during your first pregnancy, you may get it again. HELLP is related to preeclampsia and about 4 to 12 percent of women diagnosed with preeclampsia develop HELLP. HELLP syndrome can also cause complications in pregnancy, and if you had HELLP in a previous pregnancy, regardless of the time of onset, you have a greater risk for developing it in future pregnancies.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 29
Incorrect
-
What percentage of haemoglobin is HbF by 6 months of age?
Your Answer: <2%
Correct Answer:
Explanation:HB gower 1 is the predominant embryonic haemoglobin when the foetus is 6 week old and is replaced by adult haemoglobin by the age of 5 months post natally. Only 2% of the haemoglobin is HbF.
Embryonic Haemoglobin:
Haemoglobin Gower 1 (HbE Gower-1)
Haemoglobin Gower 2 (HbE Gower-2)
Haemoglobin Portland I (HbE Portland-1)
Haemoglobin Portland II (HbE Portland-2)Fetal Haemoglobin (haemoglobin F, HbF)
-
This question is part of the following fields:
- Physiology
-
-
Question 30
Correct
-
Which of the following statements regarding management of obstetric anal sphincter injuries (OASIS) is true?
Your Answer: Broad-spectrum antibiotics should be given routinely following OASIS
Explanation:After perineal repair, lactulose and a bulking agent should ideally be given for 5-10 days as well as broad spectrum antibiotics should be given that will cover all possible anaerobic bacteria. At 6-12 months a full evaluation should be done regarding the progress of healing. 60 to 80% of women are asymptomatic 12 months post delivery and external anal sphincter repair.
-
This question is part of the following fields:
- Clinical Management
-
SESSION STATS - PERFORMANCE PER SPECIALTY
