-
Question 1
Incorrect
-
Lactogenesis at term is stimulated by which hormone?
Your Answer: hPL
Correct Answer: Prolactin
Explanation:Prolactin is the hormone that is responsible for the production of milk (Lactogenesis). Oxytocin is responsible for the let down reflex during suckling.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 2
Incorrect
-
Which of the following fasting plasma glucose (FPG) values for OGTT (Oral glucose tolerance test) is diagnostic of gestational diabetes according to the WHO criteria?
Your Answer: FPG 7.1mmol/L; 2 hour 11.1mmol/L
Correct Answer: FPG 6.1mmol/L; 2 hour 7.8mmol/L
Explanation:There are several criteria that aid in the diagnosis of gestational diabetes in pregnancy including NICE, WHO and modified WHO:
GDM Diagnostic Criteria:
NICE: Immediate FBG >5.6, 2 hour glucose >7.8
WHO: Immediate FBG >6.1, 2 hour glucose >7.8
Modified WHO: Immediate FBG >7.1, 2 hour glucose >7.8Random glucose and OGTT 2 hour readings of >11.1 are diagnostic of diabetes in non-pregnant states but are not part of the gestational diabetes criteria.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 3
Incorrect
-
A 28 year old patient is treated for hydatidiform mole with methotrexate. What is the mechanism of action of methotrexate?
Your Answer: DNA gyrase inhibitor
Correct Answer: Inhibits dihydrofolate reductase
Explanation:Methotrexate is a folic acid antagonist. It inhibits dihydrofolate reductase (DHFR). DHFR catalyses the conversion of dihydrofolate to the active tetrahydrofolate which is required for DNA synthesis. It is either administered as a single intramuscular injection or multiple fixed doses.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 4
Incorrect
-
When consenting a patient for abdominal hysterectomy what would you advise regarding the risk?
Your Answer: Overall risk of serious complications 1%
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%).
-
This question is part of the following fields:
- Clinical Management
-
-
Question 5
Correct
-
A 29 year old is diagnosed with stage 1A2 cervical cancer. Which of the following is the most appropriate treatment option?
Your 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
-
-
Question 6
Correct
-
A 36 year old women attends clinic following laparotomy and unilateral oophorectomy. The histology shows Psammoma bodies. What type of tumour would this be consistent with?
Your Answer: Serous
Explanation:Serous tumours of the ovaries are large, cystic and spherical to ovoid in shape. They can be benign or malignant. Malignant tumours are usually nodular with irregularities in the surface where the tumour penetrates into the serosa. Psammoma bodies are a histological identification for these tumours which appear in the tips of the papillae.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 7
Correct
-
A patient is attending for medical abortion. She is 15 weeks gestation. She has no known drug allergies. Which of the following is the most appropriate regarding antibiotic prophylaxis?
Your Answer: Stat Azithromycin 1g and metronidazole 800 mg orally at time of abortion
Explanation:If the patient has a negative Chlamydia screen then a stat dose of metronidazole monotherapy is appropriate. You do not know this patients Chlamydia status and therefore dual therapy with metronidazole + doxycycline or azithromycin is appropriate.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 8
Correct
-
A patient admitted to the medical ward complains of a mild fever and vaginal discharge. Clue cells are seen on microscopy from a vaginal swab. Which of the following infections feature clue cells?
Your Answer: Bacterial Vaginosis
Explanation:Bacterial vaginosis (BV) is a common infection of the vagina caused by the overgrowth of atypical bacteria, most commonly Gardnerella vaginalis, a gram-negative rod. In diagnosing BV, a swab is taken for microscopy, often revealing clue cells. Clue cells are cells of the vaginal epithelium which are covered by adherent Gardnerella, giving them a distinctive look under the microscope. Though many are asymptomatic, some infected women complain of a greyish, foul-smelling vaginal discharge. Their vaginal fluid pH may also become more alkaline. BV does not however present with pyrexia, so the lady’s fever could be attributed to another cause as she is still a patient on the medical ward.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 9
Incorrect
-
A 24 year old patient presents as 24 weeks pregnant with vaginal discharge. Swabs show Chlamydia Trachomatis detected. Which of the following is the most appropriate treatment regime?
Your Answer: Azithromycin 1gm orally in a single dose
Correct Answer: Erythromycin 500 mg twice a day for 14 days
Explanation:The treatment of Chlamydia includes avoidance of intercourse, use of condoms and antibiotic treatment. Erythromycin 500mg orally QID for 7 days or Amoxicillin 500mg TDS for 7 days or Ofloxacin 200mg orally BD for 7 days.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 10
Correct
-
A 24 year old lady is 9 weeks pregnant with her first child. She attends clinic complaining of severe vomiting and is unable to keep fluids down. The most likely diagnosis is hyperemesis gravidarum. Which of the following is the underlying cause?
Your Answer: Increased circulating HCG
Explanation:Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy, associated with weight loss of more than 5% of pre-pregnancy weight, dehydration and electrolyte imbalance. HG is usually most severe during the first 12 weeks of pregnancy and is thought to be caused by high circulating levels of HCG.
There is not yet any evidence that pregnancy itself increases the sensitivity of the area postrema, or that the hormones, oestradiol, or progesterone increase vomiting. Generally, higher concentrations of dopamine stimulates receptors in the chemoreceptor trigger zone leading to nausea and vomiting. Although this has not been demonstrated as the cause of hyperemesis gravidarum.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 11
Incorrect
-
A 19 year old patient on Lamotrigine 125 mg twice a day for the past two years has recently been prescribed Microgynon 30 as a contraceptive before she leaves for Uni. What could the main concern be?
Your Answer: Combined contraceptive may increase Lamotrigine levels and increase risk of side effects/toxicity
Correct Answer: Combined contraceptive may reduce Lamotrigine levels and increase seizure risk
Explanation:Lamotrigine, a drug used to treat epilepsy, is less effective when taken with combined oral contraceptives. The oestrogen component of the pill decreases the circulating levels of Lamotrigine, increasing the risk of seizures. The combination is therefore classified as a UKMEC 3, as the risk of the drug combination may outweigh the benefit. As an alternative, the progesterone-only pill, depo progesterone, Mirena or the copper IUD may be considered as there is no restriction on concomitant use. Lamotrigine is not metabolised through cytochrome P450 like other antiepileptic drugs such as carbamazepine and phenytoin, neither is it an enzyme inhibitor.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 12
Incorrect
-
You are called to see a 24 year old patient in A&E. She is 34 weeks gestation and her blood pressure is 147/96. Automated reagent strip testing shows protein 2+. You send for a protein:creatinine ratio and this shows a ratio of 36 mg/mmol. What is the appropriate course of action?
Your Answer: Discharge with plans for daily BP monitoring
Correct Answer: Admit for observation
Explanation:It is important to be aware of the difference between management of simple hypertension and pre-eclampsia in pregnancy. A BP of 140/90 to 149/99 mmHg is classed as mild hypertension. Without proteinuria this can be monitored once weekly and the patient can be discharged. If proteinuria is present with any degree of hypertension the patient requires admission and BP should be monitored at least 4 times daily according to NICE guidance.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 13
Incorrect
-
Following parturition uterine contractions called Afterpains may typically continue for how long?
Your Answer: 12-24 hours
Correct Answer: None of the above
Explanation:Afterpains may continue for 2-3 days (so none of the above). Breastfeeding may intensify pain due to stimulation of Oxytocin which causes uterine contractions
-
This question is part of the following fields:
- Clinical Management
-
-
Question 14
Incorrect
-
Regarding urinary tract infection (UTI) in pregnancy. What is the most common causative organism of urinary tract infection?
Your Answer: Candida albicans
Correct Answer: Escherichia coli
Explanation:E.coli is the most common cause of UTI. Other organisms include pseudomonas, proteus and klebsiella.
NICE guidelines: UTI in pregnancy (updated in July 2015)
Send urine for culture and sensitivity from all women in whom UTI is suspected before starting empirical antibiotics and 7 days after antibiotic treatment is completed.
Prescribe an antibiotic to all women with suspected UTI (awaiting culture result is not advised)
Although local antibiotic resistance needs to be taken into account the following is advised in terms of antibiotic selection:
1. Nitrofurantoin 50 mg QDS (or 100 mg MR BD) for 7 days.
2. Trimethoprim 200 mg twice daily, for 7 days
Give folic acid 5 mg OD if it is the 1st trimester
Do not give trimethoprim if the woman is folate deficient, taking a folate antagonist, or has been treated with trimethoprim in the past year.
3. Cefalexin 500 mg BD (or 250 mg 6qds) for 7 days -
This question is part of the following fields:
- Clinical Management
-
-
Question 15
Incorrect
-
A 32 year old women who is 25 weeks pregnant presents with vaginal bleeding and cramping lower abdominal pain. On examination the cervix is closed. Fetal cardiac activity is noted on ultrasound. What is the likely diagnosis?
Your Answer: None of the above
Correct Answer: Antepartum Haemorrhage
Explanation:Antepartum haemorrhage is any bleeding that occurs from the female genital tract during the antenatal period after the 24+0 week of pregnancy and prior to the birth of the baby. The most common causes are placenta previa and placental abruption.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 16
Incorrect
-
The midwife asks for your advice about a 33 year old woman who she has just seen at her booking appointment. The patient had an uncomplicated pregnancy 10 years ago. This is her second pregnancy. There is no significant personal or family history. On examination the patients blood pressure is 120/75, BMI 32.5kg/m2. The midwife asks your advice on testing for gestational diabetes. What would you advise?
Your Answer: OGTT at 16-18 weeks
Correct Answer: OGTT at 24-28 weeks
Explanation:Gestational diabetes (GDM) occurs in 2–9 per cent of all pregnancies. Screening for diabetes in pregnancy can be justify ed to diagnose previously unrecognized cases of pre-existing diabetes and to identify a group of women who are at risk of developing NIDDM later in life. No single screening test has been shown to be perfect in terms of high sensitivity and specific city for gestational diabetes. Urinary glucose is unreliable, and most screening tests now rely on blood glucose estimation, with an oral glucose tolerance test commonly used. The aim of glucose control is to keep fasting levels between 3.5 and 5.5 mmol/L and postprandial levels 7.1 mmol/L, with insulin treatment usually indicated outside these ranges.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 17
Incorrect
-
Which of the following dugs is a strong inducer of cytochrome P450?
Your Answer: Lamotrigine
Correct Answer: Phenytoin
Explanation:Antiepileptic, phenytoin more so than topiramate are inducers of cytochrome P450. They should not be given with COCPs. The metabolism of oestrogen and progestogen is increased by anti-epileptic drugs that induce cytochrome P450 leading to a loss of contraceptive effect.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 18
Incorrect
-
Regarding gestational diabetes which of the following statements is TRUE?
Your Answer: it occurs in >25% of pregnancies
Correct Answer: it occurs in 2-5% of pregnancies
Explanation:Gestational Diabetes occurs in 2-9% of all the pregnancies.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 19
Incorrect
-
What is the prevalence of antiphospholipid syndrome in patients with recurrent miscarriage?
Your Answer: 7.50%
Correct Answer: 15%
Explanation:Anti phospholipid syndrome is an autoimmune disorder in which abnormal antibodies are formed which increases the risk of blood clots to develop in vessels and leads to recurrent miscarriages to occurs. The changes of recurrent miscarriage in a previously known case of APL is 15%.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 20
Correct
-
Question 21
Incorrect
-
Which of the following statements is true regarding management of caesarean section?
Your Answer: Co-amoxiclav 1.2g IV should be given prior to skin incision
Correct Answer: Uterine closure can be in 1 or 2 layers
Explanation:Closure of the uterus should be performed in either single or double layers with continuous or interrupted sutures. The initial suture should be placed just lateral to the incision angle, and the closure continued to a point just lateral to the angle on the opposite side. A running stitch is often employed and this may be locked to improve haemostasis. If a second layer is used, an inverting suture or horizontal suture should overlap the myometrium. Once repaired, the incision is assessed for haemostasis and ‘figure-of-eight’
sutures can be employed to control bleeding. Peritoneal closure is unnecessary. Abdominal closure is performed in the anatomical planes with high strength, low reactivity materials, such as polyglycolic acid or polyglactin. Diamorphine is advised for intra and post op analgesia and oxytocin is advised to reduce blood loss. -
This question is part of the following fields:
- Clinical Management
-
-
Question 22
Incorrect
-
What is the most common Type II congenital thrombophilia?
Your Answer: Protein C deficiency
Correct Answer: Factor V Leiden mutation
Explanation:The most common congenital thrombophilia is Factor V Leiden mutation. Other congenital causes are JAK-2 mutations and the Prothrombin G20210A mutation. Protein C and S deficiencies are type 1 and antiphospholipid syndrome is not congenital it is an acquired thrombophilia.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 23
Correct
-
Which of the following is the most accurate estimate of mature breast milk composition?
Your 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.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 24
Incorrect
-
What is the mode of action of Tranexamic acid?
Your Answer: Activates Antithrombin III
Correct Answer: Inhibits Plasminogen Activation
Explanation:Tranexamic acid is an antifibrinolytic drug which is one of the treatment options in menorrhagia i.e. heavy menstrual bleeding. It acts by binding to the receptor sites on plasminogen thus preventing plasmin from attaching to those receptors thus inhibiting plasminogen activation.
If pharmaceutical treatment is appropriate NICE advise treatments should be considered in the following order:
1. levonorgestrel-releasing intrauterine system (LNG-IUS) provided at least 12 months use is anticipated
2. tranexamic acid or NSAIDs* or combined oral contraceptives (COCs) or cyclical oral progestogens
3. Consider progesterone only contraception e.g. injected long-acting progestogens*When heavy menstrual bleeding (HMB) coexists with dysmenorrhoea NSAIDs should be preferred to tranexamic acid. Also note NSAIDs and tranexamic are appropriate to use if treatment needed pending investigations.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 25
Incorrect
-
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: 5%
Correct 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 26
Incorrect
-
What percentage of infants will have permanent neurological dysfunction as a result of brachial plexus injury secondary to shoulder dystocia?
Your Answer: 15%
Correct Answer:
Explanation:Shoulder dystocia occurs when the anterior or posterior fetal shoulder impacts on the maternal symphysis or sacrum and may require additional manevours to release the shoulders after gentle downward traction has failed. The most common injury that can occur, is to the brachial plexus due to lateral flexion of the head during traction. This may cause a neurological disability, Erb’s Palsy ( injury to C5 and C6 of the brachial plexus) in which there is a less than 10% chance that this injury would be permanent.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 27
Incorrect
-
An HIV positive woman who is 18 weeks pregnant complains of frothy yellow vaginal discharge and vaginal soreness. A wet mount and microscopy confirms a Trichomonas vaginalis infection. Which of the following is the most appropriate treatment regime?
Your Answer: Metronidazole 2g orally single dose
Correct Answer: Metronidazole 500mg BD 7 days
Explanation:Trichomoniasis is considered a sexually transmitted infection found both in men and women caused by the flagellate protozoan Trichomonas vaginalis. The organism is mainly found in the vagina and the urethra. Though many infected women can be asymptomatic, they can also present with yellow frothy vaginal discharge, itching and vaginitis, dysuria or an offensive odour. For the diagnosis of t. vaginalis in women, a swab is taken from the posterior fornix during speculum examination and the flagellates are detected under light-field microscopy. The recommended treatment for t. vaginalis for a HIV positive woman who is pregnant is 500mg of metronidazole twice daily for 7 days. High dose metronidazole as a 2g single dose tablet is not advised during pregnancy. All sexual partners should also be treated, and screening for other STIs should be carried out.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 28
Incorrect
-
A 28 year old patient complains of vaginal soreness and discharge. Examination reveals vulval irritation and a 'strawberry' cervix. A wet smear is sent for microscopy which confirms trichomoniasis. What percentage of trichomoniasis cases would you expect to see a strawberry cervix?
Your Answer: 10-20%
Correct Answer: 2%
Explanation:Trichomoniasis is caused by trichomonas. It is sexually transmitted. It is diagnosed on microscopy of vaginal discharge and cultured in Finn-Berg Whittington medium. It is characterised by valval itching, foul smelling discharge and appearance of strawberry cervix due to presence of punctate haemorrhages which occur in 2% of the cases.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 29
Incorrect
-
Stages of labour
Your Answer: Forceps or ventose may be useful in slow progress of the 1st stage
Correct Answer: The third stage ends with the delivery of the placenta and membranes
Explanation:First stage: The latent phase is generally defined as beginning at the point at which the woman perceives regular uterine contractions. A definition of active labour in a British journal was having contractions more frequent than every 5 minutes, in addition to either a cervical dilation of 3 cm or more or a cervical effacement of 80% or more.
Second stage: fetal expulsion begins when the cervix is fully dilated, and ends when the baby is born.
Third stage: placenta delivery – The period from just after the foetus is expelled until just after the placenta is expelled is called the third stage of labour or the involution stage.
-
This question is part of the following fields:
- Clinical Management
-
-
Question 30
Incorrect
-
What is the most common Type II congenital thrombophilia?
Your Answer:
Correct Answer: Factor V Leiden mutation
Explanation:Factor V Leiden is the most common congenital thrombophilia. Named after the Dutch city Leiden where it was first discovered. Protein C and S deficiencies are type 1 (Not type 2) thrombophilias Antiphospholipid syndrome is an acquired (NOT congenital) thrombophilia
-
This question is part of the following fields:
- Clinical Management
-
SESSION STATS - PERFORMANCE PER SPECIALTY
