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Question 1
Correct
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Question 2
Incorrect
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Which of the following microorganisms is considered the most frequently associated with septic shock in obstetrics and gynecology?
Your Answer: Staphylococcus aureus
Correct Answer: Escherichia coli
Explanation:Organisms frequently associated with obstetric sepsis include: beta haemolytic streptococci, Gram-negative rods such as Escherichia coli, Streptococcus pneumoniae and influenza A and B.
E. coli is the most common sepsis pathogen in pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 3
Correct
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A 33 year old lady presented with complaints of heavy menstrual bleeding. She is otherwise well and her US abdomen is normal. What is the best treatment option?
Your Answer: Mirena coil
Explanation:Mirena coil is used for contraception and for long term birth control. It causes stoppage of menstrual bleeding however, in a few cases there may be inter-menstrual spotting.
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This question is part of the following fields:
- Gynaecology
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Question 4
Incorrect
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Which of the following statements regarding Management of Beta Thalassaemia in Pregnancy is not part of the RCOG guidelines?
Your Answer: All women with thalassaemia major should be receiving blood transfusions on a regular basis aiming for a pretransfusion haemoglobin of 100 g/l
Correct Answer: Folic acid 5 mg daily should be commenced 12 months prior to conception
Explanation:Women with Beta-Thalassaemia require significant extra input during pregnancy. Folic acid 5 mg daily should be commenced 3 months prior to conception in these patients. NOTE Women with thalassaemia who have undergone splenectomy OR have a platelet count >600 should continue or be commenced on Aspirin (75 mg/day)
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This question is part of the following fields:
- Genetics
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Question 5
Correct
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A 28-year-old woman had a C-section due to pre-eclampsia. She now complains of right upper quadrant pain unrelated to the surgical wound. Which of the following investigations should be done immediately?
Your Answer: LFT
Explanation:There is a high risk of developing HELLP syndrome in pre-eclamptic patients. Considering that she is complaining of right upper quadrant pain, a LFT should be done immediately.
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This question is part of the following fields:
- Obstetrics
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Question 6
Correct
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The external anal sphincter is innervated by which nerves?
Your Answer: Inferior rectal
Explanation:The external anal sphincter is innervated by the inferior rectal branch of the pudendal nerve (S2-4) while the internal anal sphincter is innervated by autonomic nerves.
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This question is part of the following fields:
- Anatomy
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Question 7
Incorrect
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What is the average lifespan of a basophil (white blood cell)?
Your Answer: 10-14 days
Correct Answer: 3-4 days
Explanation:Basophils are granulocytic white blood cells. They express IgE antibody on their surface and react to release prostaglandins and leukotrienes to mediate an inflammatory, allergic reaction.
Blood Cell Lifespans:
Red Blood Cells 120 days
Platelets 5-9 days
White blood cells 2-5 daysNeutrophils (up to 5 days)
Basophils (2 to 3 days)
Eosinophils (2 to 5 days)
Monocytes (1 to 5 days)
Lymphocytes (variable) -
This question is part of the following fields:
- Physiology
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Question 8
Incorrect
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A 25-year-old woman presents to your clinic for her routine annual check-up and Pap smear. She has a single partner who uses condoms during contraception. Her menstrual cycle is regular and around four weeks long. Her last menstrual period was 2 weeks ago. She is otherwise healthy with no symptoms suggesting a problem with her genital tract. Per vaginal examination is performed revealing a 4 cm cystic swelling in the right ovary. What would be the best next step of management?
Your Answer: Arrange an ultrasound examination now.
Correct Answer: See her again in six weeks and arrange an ultrasound examination if the cyst is still present.
Explanation:Because of the high possibility of spontaneous resolution and the fact that if the cystic mass was verified ultrasonically, a conservative policy would almost probably be proposed for at least another six weeks, an ultrasound examination is not necessary at this time. If the cyst is still present at the six-week check, an ultrasound examination is required, as it is likely that the cyst is a benign tumour or possibly endometriosis. It’s quite improbable that it’s cancer.
Additional tests, such as computed tomography (CT) examination and potentially surgical removal or drainage, may be required in the future, although not at this time.
This cyst in a young lady is almost probably of physiological origin, especially given its size. The woman should be informed, but a follow-up examination is required. The most suitable next action is to return in six weeks, as the cyst is most likely physiologic and will most likely dissipate naturally by then. The following appointment should not take place during the same menstrual cycle. -
This question is part of the following fields:
- Gynaecology
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Question 9
Correct
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Question 10
Correct
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A 32-year-old woman gave birth to a baby of normal weight through vaginal delivery, which was complicated by a small perianal tear that was taken care of without stitching. On the fifth day of postpartum patient presents with heavy bright red vaginal bleeding and mentions that lochia was in scant amounts compared to her previous pregnancy.
On examination, her temperature was 38.8°C and uterus is mildly tender to palpation.
Which one of the following would most likely be her diagnosis?Your Answer: Retained products of conception
Explanation:Secondary postpartum hemorrhage of bright red character accompanied with fever, between 24 hours to 12 weeks of postpartum is suggestive of retained products of conception (RPOC).
The basal portion of the decidua may remain after separation of placenta in many cases. This decidua will then divides into two layers, the superficial layer which will be shed spontaneously and the deep layer which will regenerates and covers the entire endometrial cavity with in 16 days of postpartum.
Normal shedding of blood and decidua is referred to as lochia rubra, which is red / reddish brown in colour and it lasts for few days following delivery. This vaginal discharge gradually becomes watery and pinkish brown in colour, lasting for 2 to 3 weeks and is called as lochia serosa. Ultimately, this discharge becomes yellowish-white called as lochia alba.Scanty lochia in the first few days after delivery is suggestive of the placental site not undergoing involution, which occurs mostly due to RPOC. Later these retained products will undergo necrosis resulting in fibrin deposition which will eventually form a placental polyp. Detachment of this scar of polyp will result in brisk hemorrhage and the remaining necrotic products will get infected resulting in uterine infection which will present with fever, lower abdominal pain and uterine tenderness.
Endometritis can lead to fever, offensive lochia and abdominal pain with tenderness. It is the most common cause of postpartum fever, but occurs within the first 5 days of postpartum with the peak incidence between days 2 and 3. Though vaginal bleeding is a presenting feature, bright red bleeding is unlikely of endometritis.
Another cause of postpartum fever is genital lacerations which have a peak incidence of wound infection between 4th and 5th days. Although fever as a temporal symptom favours wound infection, this diagnosis is less likely in the given case as wound infection will not affect the normal course of lochia, also it does not present as heavy bright red bleeding. Moreover, there are no symptoms like erythema, tenderness or discharge in history suggestive of wound infection.
Another cause of bleeding and fever can be cervical tear but this tends to present as primary postpartum hemorrhage rather than secondary, which occurs after 24 hours of postpartum. An overlooked and infected minor cervical laceration can cause fever but ii will not result in bright red bleeding, also genital tract lacerations do not affect lochia.
It is very unlikely for uterine rupture to occur 24 hours after delivery.
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This question is part of the following fields:
- Obstetrics
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Question 11
Incorrect
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A 31-year-old woman at her 18th week of pregnancy presented to the emergency department with complaints of fishy, thin, white homogeneous vaginal discharge accompanied with an offensive odour. The presence of clue cells was noted during a microscopic test on the discharge.
All of the following statements are considered false regarding her condition, except:Your Answer: Partner should also be treated
Correct Answer: Relapse rate > 50 percent within 3 months
Explanation:Bacterial vaginosis (BV) affects women of reproductive age and can either be symptomatic or asymptomatic. Bacterial vaginosis is a condition caused by an overgrowth of normal vaginal flora. Most commonly, this presents clinically with increased vaginal discharge that has a fish-like odour. The discharge itself is typically thin and either grey or white.
Although bacterial vaginosis is not considered a sexually transmitted infection, women have an increased risk of acquiring other sexually transmitted infections (STI), and pregnant women have an increased risk of early delivery.
Though effective treatment options do exist, metronidazole or clindamycin, these methods have proven not to be effective long term.
BV recurrence rates are high, approximately 80% three months after effective treatment.
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This question is part of the following fields:
- Obstetrics
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Question 12
Correct
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A patient undergoes oophorectomy and the ovarian veins are ligated. Which vein does the right ovary drain into?
Your Answer: Inferior vena cava
Explanation:The right ovarian vein travels through the suspensory ligament of the ovary and generally joins the inferior vena cava whereas the left ovarian vein drains into the left renal vein.
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This question is part of the following fields:
- Anatomy
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Question 13
Incorrect
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The median umbilical ligament is a remnant of what structure?
Your Answer: Umbilical arteries
Correct Answer: Urachus
Explanation:MEDIAL umbilical ligament = remnant fetal umbilical arteries
MEDIAN umbilical ligament = remnant of urachus -
This question is part of the following fields:
- Anatomy
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Question 14
Correct
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What is the mode of action of Mefenamic acid?
Your Answer: Inhibits Prostaglandin Synthesis
Explanation:Mefenamic acids is a NSAID. It works by inhibiting prostaglandin synthesis – It inhibits COX-1 and COX-2 hence reducing the process of inflammation. Activation of antithrombin III and inactivation of factor Xa is the primary mechanism of action of Heparin.
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This question is part of the following fields:
- Clinical Management
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Question 15
Correct
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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. Which of the following is the most appropriate first line treatment?
Your Answer: Clomiphene
Explanation:Clomiphene and/or Metformin are 1st line agents. Weight loss in the setting of subfertility is advised if BMI >30 kg/m2
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This question is part of the following fields:
- Clinical Management
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Question 16
Incorrect
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Which of the following is associated with use of a tocolytic drug?
Your Answer: Prolongation of pregnancy for up to 72 hours
Correct Answer: Prolongation of pregnancy for up to 7 days
Explanation:The WHO recommends that tocolytics can safely be used to prolong pregnancy for up to seven days. The tocolytic drugs are used to suppress contractions to allow for more favourable conditions in the case of preterm labour, such as transfer to a better-equipped health care facility with a neonatal intensive care unit, or for those who have not yet completed a full dose of corticosteroids. It is not however associated with better neonatal outcomes in the imminent delivery of preterms. Examples of tocolytics include calcium channel blockers, magnesium sulphate, and oxytocin antagonists.
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This question is part of the following fields:
- Clinical Management
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Question 17
Correct
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In twin deliveries: Which is true?
Your Answer: There is increased risk of postpartum haemorrhage
Explanation:Twin gestations are at increased risk for postpartum haemorrhage (PPH). A number of maternal and peripartum factors are associated with PPH requiring blood transfusion in twin gestations. Reducing the rate of caesarean delivery in twin pregnancies may decrease maternal hemorrhagic morbidity.
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This question is part of the following fields:
- Obstetrics
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Question 18
Correct
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Which of the following muscles does NOT receive innervation from the pudendal nerve?
Your 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 19
Correct
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What percentage of children does delayed puberty occur in?
Your Answer: 3%
Explanation:Delayed puberty is defined as the absence of breast development in girls beyond the age of 13, and the absence of testicular development in boys beyond the age of 14. The incidence of delayed puberty is 3%, with the condition being more common in boys.
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This question is part of the following fields:
- Endocrinology
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Question 20
Correct
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According to the WHO, maternal death is defined as which of the following?
Your Answer: The death of a women whilst pregnant or within 42 days of termination of pregnancy
Explanation:The WHO defines maternal death as female death from any cause related to pregnancy or its management, including childbirth or within 42 days of termination of pregnancy. This is irrespective of the duration or site of the pregnancy.
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This question is part of the following fields:
- Epidemiology
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Question 21
Correct
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A 21-year-old woman has been stable on medicating with lamotrigine after developing epilepsy 2 years ago. She is planning to conceive but is concerned about what her medications may do to her baby.
Which of the following is considered to reduce the incidence of neural tube defects?Your Answer: High dose folic acid for one month before conception and during first trimester
Explanation:CDC urges all women of reproductive age to take 400 micrograms (mcg) of folic acid each day, in addition to consuming food with folate from a varied diet, to help prevent some major birth defects of the baby’s brain (anencephaly) and spine (spina bifida).
The use of lamotrigine during pregnancy has not been associated with an increased risk of neural tube defects; however, the recommendation regarding higher doses of folic acid supplementation is often, but not always, broadened to include women taking any anticonvulsant, including lamotrigine.
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This question is part of the following fields:
- Obstetrics
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Question 22
Incorrect
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In the absence of any gross pelvic abnormality, cephalopelvic disproportion can be correctly diagnosed by?
Your Answer: Pelvic examination
Correct Answer: Trial of labour
Explanation:Cephalo-pelvic disproportion exists when the capacity of the pelvis is inadequate to allow the foetus to negotiate the birth canal. This may be due to a small pelvis, a nongynecoid pelvic formation, a large foetus, an unfavourable orientation of the foetus, or a combination of these factors. Diagnosis of CPD may be made when there is failure to progress, but not all cases of prolonged labour are the result of CPD. Use of ultrasound to measure the size of the foetus in the womb is controversial, as these methods are often inaccurate and may lead to unnecessary caesarean section; a trial of labour is often recommended even if size of the foetus is estimated to be large.
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This question is part of the following fields:
- Physiology
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Question 23
Correct
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A 22-year-old female is at her second trimester of pregnancy and she presented to the medical clinic to receive human papillomavirus vaccination.
Which of the following is considered the best step to do?Your Answer: Postpone vaccination until after delivery
Explanation:Genital HPV is a common virus that is passed from one person to another through direct skin-to-skin contact during sexual activity. Most HPV types cause no symptoms and go away on their own, but some types can cause cervical cancer in women and other less common cancers — like cancers of the anus, penis, vagina, and vulva and oropharynx. Other types of HPV can cause warts in the genital areas of men and women, called genital warts.
HPV vaccination is recommended for 11 and 12 year-old girls. It is also recommended for girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series; HPV vaccine can also be given to girls beginning at age 9 years. CDC recommends 11 to 12 year olds get two doses of HPV vaccine to protect against cancers caused by HPV.
The vaccine is not recommended for pregnant women. Studies show that the HPV vaccine does not cause problems for babies born to women who were vaccinated while pregnant, but more research is still needed. A pregnant woman should not get any doses of the HPV vaccine until her pregnancy is completed.
Getting the HPV vaccine when pregnant is not a reason to consider ending a pregnancy. If a woman realizes that she got one or more shots of an HPV vaccine while pregnant, she should wait until after her pregnancy to finish any remaining HPV vaccine doses.
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This question is part of the following fields:
- Obstetrics
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Question 24
Correct
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Warfarin embryopathy is typically the result of the mother taking warfarin during which stage of pregnancy?
Your Answer: 6-12 weeks
Explanation:Warfarin is teratogenic if it is used in the first trimester. It causes bone defects and haemorrhages in the developing foetus.
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This question is part of the following fields:
- Pharmacology
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Question 25
Correct
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Several mechanisms have been proposed as to what causes closure of the Ductus Arteriosus (DA) at Parturition. Which of the following is the most important in maintaining the patency of the DA during pregnancy?
Your Answer: PGE2
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.
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This question is part of the following fields:
- Embryology
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Question 26
Correct
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Which of the following best describes the mechanism of action of radiotherapy?
Your Answer: DNA damage via free radical generation
Explanation:Radiotherapy works on the principle of ionisation. In particularly that of water leading to the formation of free radicals, these radicals are highly reactive and they react with the DNA leading to damage and cell death.
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This question is part of the following fields:
- Biophysics
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Question 27
Correct
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You see a 23 year old women in clinic complaining of vaginal discharge. The lab phone to tell you microscopy and staining shows a gram negative diplococcus. Which organism is most likely to be responsible?
Your Answer: Neisseria gonorrhoeae
Explanation:The most common gram negative diplococci include Neisseria, haemophilus and Moraxella.
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This question is part of the following fields:
- Microbiology
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Question 28
Correct
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Which of the following nerves passes through the inguinal canal?
Your Answer: Ilioinguinal nerve
Explanation:The contents of the inguinal canal is the ilioinguinal nerves, the round ligament of uterus in the females and the spermatic cord with its contents in males.
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This question is part of the following fields:
- Anatomy
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Question 29
Incorrect
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A 39-year-old woman who is 8 weeks pregnant presented to the medical clinic for consultation regarding the chance of her baby having Down syndrome. She mentioned that she has read somewhere that one of the risk factors for Down syndrome is advanced maternal age. She is concerned and asks if there are ways in which she can know whether her baby will be affected.
Which of the following is considered as both the safest and the most accurate diagnostic tool for the exclusion of Down syndrome?Your Answer: Triple marker screen test
Correct Answer: Amniocentesis at 16 weeks gestation
Explanation:Amniocentesis is a prenatal procedure performed on a pregnant woman to withdraw a small amount of amniotic fluid from the sac surrounding the foetus.
The goal of amniocentesis is to examine a small amount of this fluid to obtain information about the baby, including its sex, and to detect physical abnormalities such as Down syndrome or spina bifida.
Amniocentesis is only performed on women thought to be at higher risk of delivering a child with a birth defect.Amniocentesis is performed between 16 and 20 weeks into the pregnancy. By around this time, the developing baby is suspended in about 130ml of amniotic fluid, which the baby constantly swallows and excretes. A thin needle is used to withdraw a small amount of this fluid from the sac surrounding the foetus.
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This question is part of the following fields:
- Obstetrics
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Question 30
Correct
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Breast feeding stimulates the hypothalamus to produce which of the following hormones?
Your 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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SESSION STATS - PERFORMANCE PER SPECIALTY
