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Question 1
Correct
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The major cause of the increased risk of morbidity & mortality among twin gestation is:
Your Answer: Preterm delivery
Explanation:Twin pregnancy is associated with a number of obstetric complications, some of them with serious perinatal consequences, especially for the second twin. The rate of perinatal mortality can be up to six times higher in twin compared to singleton pregnancies, largely due to higher rates of preterm delivery and fetal growth restriction seen in twin pregnancies. Preterm birth and birth weight are also significant determinants of morbidity and mortality into infancy and childhood. More than 50% of twins and almost all triplets are born before 37 weeks of gestation and about 15–20% of admissions to neonatal units are associated with preterm twins and triplets.
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This question is part of the following fields:
- Obstetrics
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Question 2
Correct
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A 27-year-old woman who is 18 weeks pregnant presented to the emergency department due to a sudden onset of dyspnoea and pleuritic chest pain. She is known to have a previous history of deep venous thrombosis (DVT).
Which of the following is considered to be the most appropriate examination for this patient?Your Answer: Ventilation/perfusion scan
Explanation:Pulmonary embolism (PE) is a treatable disease caused by thrombus formation in the lung-vasculature, commonly from the lower extremity’s deep veins compromising the blood flow to the lungs.
Computed tomography of pulmonary arteries (CTPA) and ventilation-perfusion (V/Q) scan are the two most common and widely practiced testing modalities to diagnose pulmonary embolism.Pulmonary ventilation (V) and Perfusion (Q) scan, also known as lung V/Q scan, is a nuclear test that uses the perfusion scan to delineate the blood flow distribution and ventilation scan to measure airflow distribution in the lungs. The primary utilization of the V/Q scan is to help diagnose lung clots called pulmonary embolism. V/Q scan provides help in clinical decision-making by evaluating scans showing ventilation and perfusion in all areas of the lungs using radioactive tracers.
Ventilation-perfusion V/Q scanning is mostly indicated for a patient population in whom CTPA is contraindicated (pregnancy, renal insufficiency CKD stage 4 or more, or severe contrast allergy) or relatively inconclusive.
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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 patient present to the clinic with a 1 day history of vaginal prolapse. Upon examination, the vagina is 1.5 cm below the vaginal plane. What grade is the prolapse according to the POP-Q classification?
Your Answer: Grade 3
Explanation:Pelvic organ prolapse is a common condition amongst ageing women where a weakness in the pelvic support structures of the pelvic floor allows pelvic viscera to descend.
The Pelvic Organ Prolapse Quantification system (POP-Q) is useful for describing and staging the severity of the pelvic organ prolapse.
Grade 1: the most distal portion of the prolapse is more than 1 cm above the level of the hymen
Grade 2: the most distal portion of the prolapse is 1 cm or less proximal or distal to the hymenal plane
Grade 3: the most distal portion of the prolapse protrudes more than 1 cm below the hymen but protrudes no farther than 2 cm less than the total vaginal length (for example, not all of the vagina has prolapsed)
Grade 4: vaginal eversion complete -
This question is part of the following fields:
- Anatomy
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Question 4
Incorrect
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Which of the following prolongs Prothrombin time?
Your Answer: Von Willebrand disease
Correct Answer: Factor V deficiency
Explanation:Prothrombin time is increased in:
– Factor V deficiency
– Vitamin K deficiency (which affects factors 2,7 and 10)
– Warfarin therapy
– Severe liver failure
Protein C is an anticoagulant and deficiency results in a hyper-coagulable state with tendency towards thrombosis. -
This question is part of the following fields:
- Biochemistry
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Question 5
Correct
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A 24 year old woman presents to the clinic with foul smelling vaginal discharge. Which facultative anaerobic bacteria is most likely to be the cause?
Your Answer: Gardnerella vaginalis
Explanation:Bacterial vaginosis is a common infection of the vagina caused by the overgrowth of atypical bacteria, most commonly Gardnerella vaginalis, a gram indeterminate bacteria, which is also a facultative anaerobe. Patients often complain of foul-smelling fishy discharge and dysuria. In diagnosing BV, a swab is taken for microscopy, often revealing clue cells. Of the other organisms listed in the options, Neisseria is an obligate anaerobe, while Chlamydia trachomatis is an obligate intracellular aerobe. Treponema Pallidum is an aerophilic bacteria and Mycoplasma hominis is a pleomorphic parasitic bacterium.
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This question is part of the following fields:
- Microbiology
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Question 6
Correct
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A 24-year-old gravida 3 para 1 is admitted to the hospital at 29 weeks gestation with a high fever, flank pain, and an abnormal urinalysis. You order blood and urine cultures, a CBC, electrolyte levels, and a serum creatinine level. You also start her on intravenous fluids and intravenous cefazolin. After 24 hours of antibiotic treatment she is clinically improved but continues to have fever spikes. What would be the most appropriate management at this time?
Your Answer: Continue current management
Explanation:Pyelonephritis is the most common serious medical problem that complicates pregnancy. Infection is more common after midpregnancy, and is usually caused by bacteria ascending from the lower tract. Escheria coli is the offending bacteria in approximately 75% of cases. About 15% of women with acute pyelonephritis are bacteraemia- A common finding is thermoregulatory instability, with very high spiking fevers sometimes followed by hypothermia- Almost 95% of women will be afebrile by 72 hours. However, it is common to see continued fever spikes up until that time- Thus, further evaluation is not indicated unless clinical improvement at 48-71 hours is lacking. If this is the case, the patient should be evaluated for urinary tract obstruction, urinary calculi and an intrarenal or perinephric abscess. Ultrasonography, plain radiography, and modified intravenous pyelography are all acceptable methods, depending on the clinical setting.
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This question is part of the following fields:
- Obstetrics
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Question 7
Correct
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Sensory supply to the clitoris is via branches of which nerve?
Your Answer: Pudendal nerve
Explanation:The Pudendal nerve divides into inferior rectal, perineal and dorsal nerve of the clitoris (or penis in males). The dorsal nerve of clitoris supplies sensory innervation to the clitoris. The perineal branch supplies sensory innervation to the skin of the labia majora and minora and the vestibule.
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This question is part of the following fields:
- Anatomy
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Question 8
Correct
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A 30-year-old woman presents to the clinic.
She complains of a 6 week history of amenorrhoea and on diagnostic testing, has a positive pregnancy test.
On past medical history, it is noted that she had a multiload (Cu375°) intrauterine device inserted six months ago.
On physical examination, The strings of the device are not visibly protruding through the external os, as would be expected.
She is happy to proceed with the pregnancy, and asks what should be done next.
What is the best next step in her management?Your Answer: Ultrasound of the pelvis.
Explanation:The best next step is to order an ultrasound of the pelvis to locate the IUCD in the uterine cavity.
Once the device is located, appropriate advice can be given about the pregnancy proceeding.
Uterine sounding and hysteroscopy are contraindicated in the presence of a viable pregnancy due to risks of infection and abortion.
Pelvic X-ray is indicated if the device cannot be located during the pelvic ultrasound. It can show if the device is in the peritoneal cavity or has been expelled from the uterus. It should only be done after the pregnancy.
In cases where the device is in the peritoneal cavity, a laparoscopy is indicated for device removal.
Pregnancy termination is not indicated simply because of the presence of an intrauterine device (IUCD) in the uterus, unless other factors dictate that this is appropriate.
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This question is part of the following fields:
- Gynaecology
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Question 9
Correct
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A 22 year old woman is being followed up 6 weeks after a surgical procedure to evacuate the uterus following a miscarriage. The histology has shown changes consistent with a hydatidiform mole. What is the single most appropriate investigation in this case?
Your Answer: Serum B-HCG
Explanation:The most appropriate test for a hydatiform mole is serum beta hCG levels, which are consistently raised in these patients. The levels return to normal when the pregnancy is terminated.
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This question is part of the following fields:
- Gynaecology
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Question 10
Incorrect
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Regarding oogenesis & ovulation:
Your Answer: Ovulation occurs 36 hours after FSH surge
Correct Answer: The 1st meiotic division is arrested in the diplotene stage until just before ovulation
Explanation:The oocyte (eggs, ova, ovum) is arrested at an early stage of the first meiosis (first meiotic) division as a primary oocyte (primordial follicle) within the ovary. Following puberty, during each menstrual cycle, pituitary gonadotrophin stimulates completion of meiosis 1 the day before ovulation.
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This question is part of the following fields:
- Cell Biology
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Question 11
Incorrect
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All of the following statements are considered correct regarding Down syndrome screening in a 40-year-old pregnant woman, except:
Your Answer: Dating ultrasound together with second trimester serum screening test has detection rate of 75%
Correct Answer: Dating ultrasound together with second trimester serum screening test has detection rate of 97%
Explanation:Second-trimester ultrasound markers have low sensitivity and specificity for detecting Down syndrome, especially in a low-risk population.
The highest detection rate is acquired with ultrasound markers combined with gross anomalies. Although the detection rate with this combination of markers is high in a high-risk population (50 to 75 percent), false-positive rates are also high (22 percent for a 100 percent Down syndrome detection rate).
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This question is part of the following fields:
- Obstetrics
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Question 12
Incorrect
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Regarding Human Papillomavirus, what percentage of women develop antibodies?
Your Answer: 75%
Correct Answer: 50%
Explanation:Human Papillomavirus has been is implicated in the development of genital warts as well as, head and neck, anogenital and cervical cancers, with the most important high-risk strains being 16 and 18. Over 50% of women worldwide are thought to possess antibodies against various strains of HPV after natural infection. Many infections are asymptomatic and are cleared within 2 years. Several vaccines have been formulated against HPV, one of which is Gardasil, a quadrivalent vaccine against HPV types 6,11, 16,18.
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This question is part of the following fields:
- Microbiology
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Question 13
Incorrect
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If the presenting part of the foetus is the large fontanel, this presentation is known as?
Your Answer: Face
Correct Answer: Sinciput
Explanation:Sinciput means the head is neither flexed nor extended. It is the area between forehead and crown and in this case the anterior fontanel is the presenting part.
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This question is part of the following fields:
- Anatomy
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Question 14
Incorrect
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All of the following factors are associated with an unstable lie of the foetus except?
Your Answer: Fundal fibroid
Correct Answer: Cervical fibroids
Explanation:Unstable lie means that the foetus is still changing its position even at 36 weeks of gestation. A number of factors are responsible for this positioning such as multi gravida, placenta previa, prematurity and fibroids present in the fundus. Cervical fibroids have little association with unstable lie of the foetus.
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This question is part of the following fields:
- Obstetrics
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Question 15
Correct
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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: 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 16
Correct
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A 28-year-old white female consults you with a complaint of irregular heavy menstrual periods. Her general physical examination, pelvic examination, and HPV test are normal and she has a negative pregnancy test. A CBC and chemistry profile are also normal. The next step in her workup should be:
Your Answer: Cyclic administration of progesterone for 3 months
Explanation:Abnormal uterine bleeding is a relatively common disorder which may be due to functional disorders of the hypothalamus, pituitary, or ovary, as well as uterine lesions. However, the patient who is younger than 30 years of age will rarely be found to have a structural uterine defect. Once pregnancy, hematologic disease, and renal impairment are excluded, administration of intramuscular or oral progesterone will usually produce definitive flow and control the bleeding. No further evaluation should be necessary unless the bleeding recurs.
Endometrial aspiration, dilatation and curettage, and other diagnostic procedures are appropriate for recurrent problem or for older women. Oestrogen would only increase the problem, which is usually due to anovulation with prolonged oestrogen secretion, producing a hypertrophic endometrium.
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This question is part of the following fields:
- Gynaecology
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Question 17
Correct
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Which of the following uterotonic drugs is most strongly associated with a transient pyrexia occurring within 45 minutes of administration?
Your Answer: Dinoprostone
Explanation:Induction of Labour is produced by the infusion of PGF-2 alpha or PGE2. Dinoprostone is a PGE2 and is associated with transient pyrexia that resolved within 4-5 hours of stopping the use of the drug.
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This question is part of the following fields:
- Clinical Management
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Question 18
Correct
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You are discussing a planned Caesarean Section (CS) with a patient. Which of the following risks is reduced with CS?
Your Answer: Early postpartum haemorrhage
Explanation:There are many different reasons for performing a delivery by Caesarean section. The four major indications accounting for greater than 70 per cent of operations are: 1. previous Caesarean section 2. dystocia 3. malpresentation 4. suspected acute fetal compromise. Other indications, such as multifetal pregnancy, abruptio placenta, placenta praevia, fetal disease and maternal disease are less common. The chances of early postpartum haemorrhage are greatly reduced in C-section deliveries.
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This question is part of the following fields:
- Clinical Management
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Question 19
Correct
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The inferior 1/3 of the rectum is principally supplied by which artery?
Your Answer: Middle rectal artery
Explanation:Remember the inferior rectal artery supplies the anus. The middle rectal artery is the principle supply to the lower 1/3 rectum. The rectal arteries do form an anastomosis.
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This question is part of the following fields:
- Anatomy
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Question 20
Correct
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Question 21
Correct
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Which of the following factors is fetal nutrition dependant on?
Your Answer: All of the options given
Explanation:Fetal nutrition is dependant upon multiple factors such as maternal nutritional state, quality of maternal diet, malnutrition, anorexia nervosa, metabolic rate of the mother or whether they suffer from malabsorption syndrome or other related conditions.
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This question is part of the following fields:
- Physiology
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Question 22
Correct
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Question 23
Correct
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Regarding miscarriage rates, which of the following statements is correct?
Your Answer: In women over 45 years of age miscarriage rate approximately 75%
Explanation:With increasing maternal age, the risk of miscarriage increases. For women between the ages of 40-44, the miscarriage rates sit at about 50% and increases to over 75% for women 45 years and over. The miscarriage rate for women between the ages of 35-39 is 25%.
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This question is part of the following fields:
- Epidemiology
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Question 24
Correct
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Regarding lymph drainage of the lower vagina where does the majority of lymph drain to?
Your Answer: Inguinal nodes
Explanation:The lower vagina drains to the inguinal nodes where as the upper vagina drains to the internal and external iliacs
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This question is part of the following fields:
- Anatomy
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Question 25
Correct
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From which germ cell layer does the GI tract initially develop?
Your Answer: Endoderm
Explanation:GI Tract initially forms via gastrulation from the endoderm of the trilaminar embryo around week 3. It extends from the buccopharyngeal membrane to the cloacal membrane. Later in development there are contributions from all three germ cell layers.
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This question is part of the following fields:
- Embryology
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Question 26
Correct
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A 28 year old women is seen in the early pregnancy unit. She has had a positive pregnancy test but is uncertain of her LMP. Ultrasound doesn't visualise a pregnancy. You perform bHCG tests 48 hours apart. The first bHCG is 400mIU/ml. The second is 190mIU/ml. What is the likely diagnosis
Your Answer: Non-viable pregnancy
Explanation:B-HCG levels almost double every 48 hours. A B-HCG levels of less than 5 mIU/ml is considered negative and anything above 25 is considered positive. As the foetus was not visualized on ultrasound in the uterus, there is possibility that this might be an ectopic pregnancy. But since the B-HCG levels also continued to fall the pregnancy becomes non-viable.
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This question is part of the following fields:
- Biochemistry
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Question 27
Correct
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Which one of the following statements regarding the fetal head is true?
Your Answer: Considered to be engaged when the biparietal diameter passes the level of the pelvic inlet
Explanation:The fetal head is engaged when the head of the foetus or the presenting part enters the pelvic inlet or pelvic brim. It usually occurs at 38 weeks of gestation.
The Spalding sign refers to the overlapping of the fetal skull bones caused by collapse of the fetal brain. It appears usually a week or more after fetal death in utero.
In brow presentation the scalp is deflexed as the foetus is looking upward. Normally the head is inflexed such that the chin is touching the chest. -
This question is part of the following fields:
- Anatomy
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Question 28
Correct
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Regarding cardiac output in pregnancy which of the following statements is TRUE?
Your Answer: Cardiac output increases by approximately 40-50% during pregnancy
Explanation:In a non pregnant adult female the cardiac output is 4.5L/min, by the 20 week of pregnancy the cardiac output increases by 40% to 6.3L/min. During early stages of labour it increases further still by 17% to 7.3L/min.
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This question is part of the following fields:
- Physiology
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Question 29
Correct
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Lowered haemoglobin during normal pregnancy is a physiological finding which is mainly due to:
Your Answer: Increased plasma volume
Explanation:During pregnancy, anaemia increases more than fourfold from the first to third trimester. It is a well established fact that there is a physiological drop in haemoglobin (Hb) in the mid trimester. This physiological drop is attributed to increase of plasma volume and hence decrease of blood viscosity lead to better circulation in placenta.
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This question is part of the following fields:
- Physiology
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Question 30
Correct
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The followings are considered normal symptoms of pregnancy, EXCEPT:
Your Answer: Visual disturbance
Explanation:Visual disturbances although very common during pregnancy are not a normal sign. Physicians should have a firm understanding of the various ocular conditions that might appear pregnancy or get modified by pregnancy. In addition, it is very important to be vigilant about the rare and serious conditions that may occur in pregnant women with visual complaints. Prompt evaluation may be required and the immediate transfer of care of the patient may help saving the lives of both the mother and the baby.
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This question is part of the following fields:
- Obstetrics
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Question 31
Correct
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A biophysical profile includes all of the following assessment parameters EXCEPT:
Your Answer: Fetal weight
Explanation:The biophysical profile is a composite test that collects 5 indicators of fetal well-being, including fetal heart rate reactivity, breathing movements, gross body movements, muscular tone, and quantitative estimation of amniotic fluid volume. The assessment of fetal heart rate is accomplished by performing a nonstress test, whereas the latter 4 variables are observed using real-time ultra-sonography.
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This question is part of the following fields:
- Biophysics
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Question 32
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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Question 33
Correct
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Uterine Cervix:
Your Answer: Is the portion of the uterus below the isthmus
Explanation:The uterus is divisible into two portions. The portion above the isthmus is termed the body, and that below, the cervix. The uterine cervix is the narrow inferior segment of the uterus, which projects into the vaginal cavity. It is a fibromuscular organ lined by a mucous membrane and measures approximately 3cm in length and 2.5cm in diameter. The cervix is continuous at its superior margins with the body of the uterus and at its inferior margins with the vagina.
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This question is part of the following fields:
- Anatomy
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Question 34
Incorrect
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Intrapartum antibiotics prophylaxis is required in which of the following conditions?
Your Answer: Elective Caesarean section
Correct Answer: A previous infant with Group B streptococcus disease regardless of present culture
Explanation:Group B Streptococcus (GBS) or Streptococcus agalactiae is a Gram-positive bacteria which colonizes the gastrointestinal and genitourinary tract. In the United States of America, GBS is known to be the most common infectious cause of morbidity and mortality in neonates. GBS is known to cause both early onset and late onset infections in neonates, but current interventions are only effective in the prevention of early-onset disease.
The main risk factor for early-onset GBS infection is colonization of the maternal genital tract with Group B Streptococcus during labour. GBS is a normal flora of the gastrointestinal (GI) tract, which is thought to be the main source for maternal colonization.
The principal route of neonatal early onset GBS infection is vertical transmission from colonized mothers during passage through the vagina during labour and delivery.
Intravenous penicillin G is the treatment of choice for intrapartum antibiotic prophylaxis against Group B Streptococcus.
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This question is part of the following fields:
- Obstetrics
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Question 35
Correct
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A 24-year-old college student comes to your clinic for contraception guidance. For the past three months, she has had migraine-like headaches once or twice a month. For the past two years, she has been taking combined oral contraceptive pills.
Which of the following suggestions is the most appropriate?Your Answer: Stopping the combined oral contraceptive pills and starting progesterone only pills (POP)
Explanation:Combined oral contraceptives are a safe and highly effective method of birth control, but they can also raise problems of clinical tolerability and/or safety in migraine patients. It is now commonly accepted that, in migraine with aura, the use of combined oral contraceptives is always contraindicated, and that their intake must also be suspended by patients suffering from migraine without aura if aura symptoms appear.
Discontinuation of contraception could risk in pregnancy. Barrier methods can be used but aren’t as effective as pills.
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This question is part of the following fields:
- Gynaecology
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Question 36
Correct
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A 37-year-old woman visits your office seeking oral contraceptive guidance. She is currently taking Microgynon 30 and is pleased with the results. She is married with two children, does not smoke, and is in good health.
Her blood pressure is 150/100mmHg, according to your examination. The blood pressure remains the same after 20 minutes.
Which of the following is the most appropriate next step in management?Your Answer: Start her on progestogen-only pills (POPs)
Explanation:The progestogen-only pill (POP) is a contraceptive option for women who have high blood pressure either induced by use of combined oral pills or due to other causes; as long as it is well controlled and monitored. Combined oral contraception (COC) and Depo-Provera have been implicated in increased cardiovascular risk following use. High blood pressure has been theorized to be the critical path that leads to this increased risk. POP is the recommended method for women who are at risk of coronary heart disease due to presence of risk factors like hypertension.
Stopping OCP will risk in the patient getting pregnant. Cessation of oestrogen usually reverses the blood pressure back to normal, Hence, all other options are incorrect.
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This question is part of the following fields:
- Gynaecology
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Question 37
Correct
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During normal pregnancy, the renal glomerular filtrate rate (GFR) can increase as much as:
Your Answer: 50%
Explanation:Pregnancy involves remarkable orchestration of physiologic changes. The kidneys are central players in the evolving hormonal milieu of pregnancy, responding and contributing to the changes in the environment for the pregnant woman and foetus. The functional impact of pregnancy on kidney physiology is widespread, involving practically all aspects of kidney function. The glomerular filtration rate increases 50% with subsequent decrease in serum creatinine, urea, and uric acid values.Â
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This question is part of the following fields:
- Physiology
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Question 38
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 39
Incorrect
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Which cell type of the testis secrete inhibin?
Your Answer: Leydig cells
Correct Answer: Sertoli cells
Explanation:Summary points of the two key testicular cell types:
1. Sertoli Cells = Secrete Inhibin. Forms blood-testis barrier. Have FSH receptors
2. Leydig Cells = Secrete testosterone. Have LH receptors -
This question is part of the following fields:
- Anatomy
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Question 40
Incorrect
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Fetal distress commonly occurs when the head is in the occipito-posterior (OP) position during labour. Which of the following statements is the most probable explanation for this?
Your Answer: Prolonged labour.
Correct Answer: Incoordinate uterine action.
Explanation:Incoordinate uterine action almost always results in fetal distress due to increased resting intrauterine pressure. All other statements can also cause fetal distress, however, these are not as common as incoordinate uterine action. Syntocin infusion for labour augmentation and administration of epidural anaesthetic for pain relief can also increase the risk of fetal distress.
Cardiotocograph (CTG) monitoring during labour is highly recommended in patients where the fetal head is found in the OP position. Moreover, it is mandatory when there is Syntocin infusion or epidural anaesthesia. -
This question is part of the following fields:
- Obstetrics
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Question 41
Correct
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Question 42
Correct
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The fetal head may undergo changes in shape during normal delivery. The most common aetiology listed is:
Your Answer: Molding
Explanation:With the help of molding, the fetal head changes its shape as the skull bones overlap. This helps in smooth delivery of the foetus through the birth canal.
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This question is part of the following fields:
- Obstetrics
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Question 43
Incorrect
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Regarding gestational diabetes which of the following is NOT a recognised risk factor
Your Answer: Smoking
Correct Answer: High polyunsaturated fat intake
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. There are various risk factors for gestational diabetes including increasing age, ethnicity, previous still births etc.
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This question is part of the following fields:
- Clinical Management
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Question 44
Correct
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A 28-year-old, currently at 26 weeks’ gestation of her third pregnancy, presents with irregular uterine contractions for the past 24 hours and has concerns about premature delivery. She delivered her first child at 38 weeks of gestation and her second at 39 weeks gestation. On examination, BP and urinalysis have come back normal. Her symphysis-fundal height measures 27cm, the uterus is lax and non-tender. Fetal heart rate is 148/min. She also undergoes a pelvic examination along with other investigations.
Which findings would suggest that delivery is most likely going to happen before 30 weeks’ of gestation?
Your Answer: The cervix is closed, but the fetal fibronectin test on cervical secretions is positive.
Explanation:Predisposing factors of preterm delivery include a short cervix (or if it shortens earlier than in the third trimester), urinary tract or sexually transmitted infections, open cervical os, and history of a previous premature delivery. Increased uterine size can also contribute to preterm delivery and is seen with cases of polyhydramnios, macrosomia and multiple pregnancies. The shorter the cervical length, the greater the risk of a premature birth.
In this case, the risk of bacterial vaginosis and candidiasis contributing to preterm delivery would be lower than if in the context of an open cervical os. However, the risk of premature delivery is significantly increased if it is found that the fetal fibronectin test is positive, even if the os is closed. -
This question is part of the following fields:
- Obstetrics
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Question 45
Correct
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A 50-year-old woman, who had her last menstrual period at age 49, presented with an episode of per vaginal bleeding two weeks ago. It lasted four days in duration. A reduction in the severity of hot flushes as well as some breast enlargement preceded the bleeding episode.
What is the most likely cause of the bleeding?
Your Answer: An episode of ovarian follicular activity.
Explanation:It has been found that it is possible for premenopausal hormones to persist for a period of time after attaining menopause. If one or a few ovarian follicles remain, they could produce oestrogen in response to the very elevated levels of FSH typically seen in menopause. In doing so, the woman can then bleed as a result of this physiological response. The symptoms seen in this vignette are consistent with the rise in oestrogen levels, likely due to follicular activity.
In the absence of any pathological findings such as endometrial carcinoma, this phenomenon would be the most likely cause of this post-menopausal bleed. Furthermore, it is unlikely for cervical cancer and endometrial cancer to present during the first few years following menopause. Atrophic vaginitis is unlikely to be associated with the other symptoms the patient presented with i.e. reduction in the intensity of hot flushes and breast enlargement. This patient was not stated to have any risk factors for endometrial hyperplasia such as obesity, late menopause and early menarche, which makes it a less likely diagnosis.
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This question is part of the following fields:
- Gynaecology
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Question 46
Correct
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Placental production of hPL, hCG, Oestrogen and Progesterone are examples of which type of mechanism
Your Answer: Endocrine
Explanation:Endocrine hormones are released from their site of origin and travel through the blood to act on other distant target organs. Autocrine hormones act within the same cell and exocrine glands secrete their products into ducts.
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This question is part of the following fields:
- Endocrinology
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Question 47
Correct
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A patient undergoes surgery for a vaginal vault prolapse. After surgery she complains of numbness and groin pain. You assess her and find the numb area is the anterior aspect of the labia. Which nerve has likely been damaged during surgery?
Your Answer: Ilioinguinal
Explanation:This describes the sensory area supplied by the ilioinguinal nerve. This is a potential complication with pelvic surgery.
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This question is part of the following fields:
- Anatomy
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Question 48
Incorrect
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A 22 year old woman miscarries at 6 weeks gestation. At checkup, she shows no obvious signs of complication. What would you advise regarding further pregnancy testing?
Your Answer: None of the above
Correct Answer: Urine pregnancy test in 3 weeks
Explanation:In the management of a miscarriage, after the completion of 7-14 days of expectant management, the woman is advised to take a pregnancy test after 3 weeks. In case of a positive result she is to return for further care.
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This question is part of the following fields:
- Biochemistry
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Question 49
Correct
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What type of drug is clavulanic acid?
Your Answer: Beta-lactamase inhibitor
Explanation:Clavulanic acid is a beta-lactamase inhibitor that is most often combined with a penicillin to form Augmentin or Co-amoxiclav for greater antibiotic efficacy. The drug works by irreversibly binding to enzymes present in bacteria which posses the Beta-lactamase enzyme. This enzyme is responsible for inactivating Beta-Lactam antibiotics such as penicillin.
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This question is part of the following fields:
- Clinical Management
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Question 50
Correct
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You see a patient who is 32 weeks pregnant. She complains of tingling to the right buttock and shooting pain down the leg. You suspect Piriformis syndrome. Regarding Piriformis which of the following statements are true?
Your Answer: Insertion is onto the greater trochanter
Explanation:The proximal attachment of the piriformis muscles is from the anterior surface of sacrum and it attaches distally to the superior border of the greater trochanter of the femur. It is innervated by the anterior rami of S1 and S2.
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This question is part of the following fields:
- Anatomy
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Question 51
Correct
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A 33-year-old woman was admitted to a hospital's maternity unit for labour. Her pregnancy has been unremarkable so far and she had regular antenatal visits. Meconium liquor passage was noted during the labour. Cardiotocography was done and revealed a fetal heart rate (FHR) of 149bpm. There were no noted decelerations or accelerations. The beat-to-beat variability is established at 15 bpm. Upon vaginal examination, there were no reported abnormalities.
Which of the following is considered to be the next most appropriate step in managing this patient?Your Answer: The CTG is normal and close monitoring until delivery is all required for now
Explanation:Meconium is the earliest stool of a newborn. Occasionally, newborns pass meconium during labour or delivery, resulting in a meconium-stained amniotic fluid (MSAF).
No particular cardio-tocograph pattern can be considered to have a poor prognostic value in the presence of thick MSAF and the decision to deliver and the mode of delivery should be based on the overall assessment and the stage and progress of labour. While management should be individualized, a higher Caesarean section rate in thick MSAF can be justified to ensure a better outcome for the neonate even in the presence of a normal CTG trace.
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This question is part of the following fields:
- Obstetrics
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Question 52
Correct
-
The relation of different fetal parts to each other determines?
Your Answer: Attitude of the foetus
Explanation:Fetal attitude is defined as the relation of the various parts of the foetus to each other. In the normal attitude, the foetus is in universal flexion. The anatomic explanation for this posture is that it enables the foetus to occupy the least amount of space in the intrauterine cavity. The fetal attitude is extremely difficult, if not impossible, to assess without the help of an ultrasound examination.
Fetal lie refers to the relationship between the long axis of the foetus relative to the long axis of the mother. If the foetus and maternal column are parallel (on the same long axis), the lie is termed vertical or longitudinal lie.
Fetal presentation means, the part of the foetus which is overlying the maternal pelvic inlet.
Position is the positioning of the body of a prenatal foetus in the uterus. It will change as the foetus develops. This is a description of the relation of the presenting part of the foetus to the maternal pelvis. In the case of a longitudinal lie with a vertex presentation, the occiput of the fetal calvarium is the landmark used to describe the position. When the occiput is facing the maternal pubic symphysis, the position is termed direct occiput anterior.
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This question is part of the following fields:
- Obstetrics
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Question 53
Correct
-
A 39-year-old woman comes to your clinic for assessment and advice as she is planning to conceive over past three months with no success.
She has a history of obesity with BMI 40 and type 2 diabetes mellitus with latest HbA1c value of 11%. She had her last eye check six months ago which shows no evidence of retinopathy, and she does not have diabetic nephropathy.
Among the following which is a contraindication to pregnancy in this case?Your Answer: History of type 2 diabetes mellitus with HBA1C above 10
Explanation:In patients who have an HbA1C value above 10%, it is better to postpone pregnancy until diabetes is under control. Also in those patients with type 2 diabetes mellitus, who are suffering from severe gastroparesis, those with advanced retinopathy, with severe diabetic renal disease and severe ischemic heart disease with uncontrolled hypertension pregnancy is contraindicated.
All the other options mentioned are incorrect.
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This question is part of the following fields:
- Obstetrics
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Question 54
Correct
-
A 61 year old patient undergoes laparotomy for a suspicious left sided ovarian mass. Following histology the patient is diagnosed with a stage 1A ovarian epithelial cancer. What is the 5 year survival for stage 1 ovarian cancers?
Your Answer: 90%
Explanation:The five year survival of stage 1 ovarian cancer is 70-90%
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This question is part of the following fields:
- Epidemiology
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Question 55
Correct
-
A 23-year-old woman with diffuse pelvic pain and vaginal bleeding presents to the emergency room. She claims that it is around the time that she usually has her period. She has previously experienced defecation discomfort, dyspareunia, and dysmenorrhea. The patient claims that she has previously experienced similar symptoms, but that the agony has suddenly become unbearable.
Her abdomen is soft, with normal bowel sounds and no rebound soreness, according to her physical examination. There is no costovertebral discomfort and the patient does not guard. Blood in the posterior vaginal vault, a closed os, and no palpable masses or cervical motion pain are all findings on her pelvic examination.
What is the most likely diagnosis?Your Answer: Endometriosis
Explanation:Endometriosis is defined as the presence of normal endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Approximately 30-40% of women with endometriosis will be sub fertile. About one third of women with endometriosis remain asymptomatic. When they do occur, symptoms, such as the following, typically reflect the area of involvement:
– Dysmenorrhea
– Heavy or irregular bleeding
– Pelvic pain
– Lower abdominal or back pain
– Dyspareunia
– Dyschezia (pain on defecation) – Often with cycles of diarrhoea and constipation
– Bloating, nausea, and vomiting
– Inguinal pain
– Pain on micturition and/or urinary frequency
– Pain during exercisePregnancy, appendicitis, ureteral colic and ruptured ectopic pregnancy all do not present with dysmenorrhea, pain on defecation and dyspareunia. Presence of a non tender, soft abdomen also rules out these conditions.
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This question is part of the following fields:
- Gynaecology
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Question 56
Correct
-
Oxytocin binds to what receptor type?
Your Answer: G-protein-coupled receptors
Explanation:Oxytocin binds to the G protein coupled receptors that triggers the IP3 mechanism leading to an elevated intracellular calcium ion.
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This question is part of the following fields:
- Clinical Management
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Question 57
Correct
-
A 23 year old female patient with DVT on anticoagulant came to your clinic for advice. She is on combined OCPs.
What would you advice her?Your Answer: Progesterone only pill
Explanation:Women with medical conditions associated with increased risk for thrombosis generally should not use oestrogen-containing contraceptives.
The majority of evidence identified does not suggest an increase in odds for venous or arterial events with use of most POCs. Limited evidence suggested increased odds of VTE with use of injectables (three studies) and use of POCs for therapeutic indications (two studies, one with POCs unspecified and the other with POPs).
Discontinuing anticoagulants increases her risk of recurrent DVT.
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This question is part of the following fields:
- Gynaecology
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Question 58
Correct
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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.
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This question is part of the following fields:
- Physiology
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Question 59
Incorrect
-
A 42 year old woman in early pregnancy is rushed to the emergency department complaining of vaginal bleeding and abdominal pain. What percentage of women her age have miscarriages?
Your Answer: 75%
Correct Answer: 50%
Explanation:With increasing maternal age, the risk of miscarriage increases. For women between the ages of 40-44, the miscarriage rates sit at about 50% and increases to over 75% for women 45 years and over. The miscarriage rate for women between the ages of 35-39 is 25%.
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This question is part of the following fields:
- Epidemiology
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Question 60
Correct
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A 24 week pregnant patient complains of itching over the past 6 weeks particularly to the hands and feet which is worse at night. She has taken cetirizine but this hasn't settled her symptoms. Examination is unremarkable with no rash. What is the likely diagnosis?
Your Answer: Intrahepatic Cholestasis of Pregnancy
Explanation:The history is typical of Intrahepatic Cholestasis of Pregnancy, also known as obstetric cholestasis and prurigo gravidarum. It is characterised by itching without rash and abnormal LFTs beyond normal pregnancy ranges. Itching affects around 23% of pregnancies and can occur before biochemical changes.
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This question is part of the following fields:
- Clinical Management
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Question 61
Correct
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You are asked to infiltrate a patients perineum with local anaesthetic prior to episiotomy. What is the maximum dose of lidocaine (without adrenaline)?
Your Answer: 3 mg/kg
Explanation:The half-life of lidocaine is approximately 1.5 hours. It is a local anaesthetic and the maximum dose that can be given is 3mg/kg.
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This question is part of the following fields:
- Pharmacology
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Question 62
Correct
-
Regarding lymph drainage of the fallopian tubes where does the majority of lymph drain to?
Your 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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Question 63
Incorrect
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A 46-year-old woman presents to your clinic with a complaint of irregular heavy menstruation. She had normal menstrual pattern 6 months back. Physical examination revealed no abnormality with a negative cervical smear. Laboratory investigation reveals a haemoglobin of 105g/L (Normal 115-165g/L). The most common cause of such menorrhagia is?
Your Answer: Endometrial carcinoma.
Correct Answer: Anovulatory cycles.
Explanation:Menorrhagia in a 45-year-old woman is most likely caused by an ovulation issue, most likely anovulatory cycles, particularly if the periods have grown irregular.
Endometrial carcinoma is a rare cause of menorrhagia that usually occurs after menopause.
Menorrhagia can be caused by fibroids, endometrial polyps, and adenomyosis, although the cycles are normally regular, and a dramatic change from normal cycles six months prior would be exceptional.
If fibroids or adenomyosis are the source of the menorrhagia, the uterus is usually enlarged. -
This question is part of the following fields:
- Gynaecology
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Question 64
Correct
-
All of the following complications can be found in a pregnant patient with a bicornuate uterus, except?
Your Answer: Polyhydramnios
Explanation:Women with a bicornuate uterus are at increased risk of recurrent abortions, premature birth, fetal malpositioning, placenta previa and retained products of placenta leading to post partum haemorrhage.
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This question is part of the following fields:
- Embryology
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Question 65
Incorrect
-
Which of the following has been shown to improve pruritus and liver function in patients with obstetric cholestasis?
Your Answer: Cholestyramine
Correct Answer: Ursodeoxycholic acid
Explanation:Intrahepatic cholestasis characterized by reversible cholestasis typically occurring in the second or third trimester of pregnancy, elevated serum aminotransferases and bile acid level and resolution of symptoms by 2 to 3 weeks after delivery. Ursodeoxycholic acid has shown to reduce the symptoms of this condition.
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This question is part of the following fields:
- Clinical Management
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Question 66
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.
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This question is part of the following fields:
- Clinical Management
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Question 67
Correct
-
WHO defines the perinatal mortality rate as
Your Answer: The number of stillbirths and deaths in the first week of life per 1000 births
Explanation:The number of stillbirths and deaths in the first week of life per 1000 births.
According to WHO the perinatal period commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth. -
This question is part of the following fields:
- Epidemiology
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Question 68
Incorrect
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Question 69
Correct
-
What is the half life of Oxytocin?
Your Answer: 5 minutes
Explanation:The half-life of Oxytocin is approximately 5 minutes
The half-life of Misoprostol is approximately 20-40 minutes
The half-life of Ergometrine is approximately 30-120 minutes -
This question is part of the following fields:
- Clinical Management
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Question 70
Correct
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Question 71
Correct
-
A 25-year-old female presents to a gynaecologist with a complaint of abnormal vaginal bleeding, usually postcoital. On pelvic examination, the cervix of was found to be of an unusually bright red colour and its texture was rougher than normal. Which of the following will you choose as the next step in the management of this condition?
Your Answer: Cervical smear (2nd line)
Explanation:Before considering invasive procedures, a cervical smear must first be performed. Antibiotics can only be given when inflammation has been confirmed and culture results have identified the organism causing the inflammation. Endometrial ablation, colposcopy and vaginal US are all invasive procedures that are not relevant in the immediate management of this patient.
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This question is part of the following fields:
- Gynaecology
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Question 72
Correct
-
Branches V2 and V3 of the trigeminal nerve develop from which pharyngeal arch?
Your Answer: 1st
Explanation:Trigeminal nerve has three divisions, the first is the ophthalmic division that does not originate from any of the pharyngeal arches, the second and third divisions, namely, the maxillary and the mandibular region develop from the first pharyngeal arch.
Pharyngeal Arches:
1st = Trigeminal V2 & V3 (CN V)
2nd = Facial (CN VII)
3rd = Glossopharyngeal (CN IX)
4th and 6th = Vagus (CN X) -
This question is part of the following fields:
- Embryology
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Question 73
Correct
-
Which of the following is an appropriate treatment for Diazepam overdose?
Your Answer: Flumazenil
Explanation:Flumazenil is used for benzodiazepine overdose.
Naloxone is used for opioid overdose.
Parvolex (N-acetyl cysteine) is used for paracetamol overdose.
Protamine can be used for Heparin reversal.
Beriplex can be used for Warfarin reversal. -
This question is part of the following fields:
- Pharmacology
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Question 74
Incorrect
-
During the inflammatory phase of wound healing what is the predominant cell type found in the wound during days 3-4?
Your Answer: NK Cells
Correct Answer: Macrophages
Explanation:Wound healing is initiated when inflammation begins. Macrophages predominate after neutrophils and peak 3-4 days after inflammation begins. They destroy and phagocytose the organism and debris using enzymes. The next step is the resolution of inflammation and healing of the wound.
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This question is part of the following fields:
- Physiology
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Question 75
Correct
-
All of the following statements is considered incorrect regarding the management of deep vein thrombosis in pregnancy, except:
Your Answer: Warfarin therapy is contraindicated throughout pregnancy but safe during breast feeding
Explanation:Anticoagulant therapy is the standard treatment for deep vein thrombosis (DVT) but is mostly used in non-pregnant patients. In pregnancy, unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are commonly used. Warfarin therapy is generally avoided in pregnancy because of its fetal toxicity.
Warfarin is contraindicated during pregnancy, but is safe to use postpartum and is compatible with breastfeeding. Low-molecular-weight heparin has largely replaced unfractionated heparin for prophylaxis and treatment in pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 76
Correct
-
In fetal circulation:
Your Answer: Most of the blood entering the right atrium flows into the left atrium
Explanation:Circulation in the foetus: 1. Deoxygenated fetal blood is conducted to the placenta via the two umbilical arteries. The umbilical arteries arise from the internal iliac arteries.
2. Gas exchange occurs in placenta.
3. Oxygenated blood from the placenta passes through the single umbilical vein and enters the inferior vena cava (IVC).
4. About 50% of the blood in the IVC passes through the liver and the rest bypasses the liver via the ductus venosus. The IVC also drains blood returning from the lower trunk and extremities.
5. On reaching the heart, blood is effectively divided into two streams by the edge of the interatrial septum (crista dividens) (1) a larger stream is shunted to the left atrium through the foramen ovale (lying between IVC and left atrium) (2) the other stream passes into right atrium where it is joined by blood from SVC which is blood returning from the myocardium and upper parts of body. This stream therefore has a lower partial pressure of oxygen.
6. Because of the large pulmonary vascular resistance and the presence of the ductus arteriosus most of the right ventricular output passes into the aorta at a point distal to the origin of the arteries to the head and upper extremities. The diameter of the ductus arteriosus is similar to the descending aorta. The patency of the ductus arteriosus is maintained by the low oxygen tension and the vasodilating effects of prostaglandin E2;
7. Blood flowing through the foramen ovale and into left atrium passes into the left ventricle where it is ejected into the ascending aorta. This relatively oxygen rich blood passes predominantly to the head and upper extremities. -
This question is part of the following fields:
- Embryology
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Question 77
Incorrect
-
There are increasing rates of pregnancies among teenagers especially in low socioeconomic rural areas.
What is the contraception method of choice for teenagers with high risk of unplanned pregnancy?Your Answer: Condoms and other barrier methods
Correct Answer: Intrauterine Contraceptive Device
Explanation:The use of long-acting reversible contraceptives (LARCs) is globally accepted as a strategy that is successful in decreasing rates of unintended pregnancy, especially in very young women.
Long-acting reversible contraceptives (LARCs) are defined as any contraceptive that requires administration less than once per cycle (i.e. per month). This includes copper and progestogen-only intrauterine devices (IUDs), and progestogen subdermal implants and injections. However, subdermal implants and IUDs, which have a life of at least three years, have superior efficacy over injections, which require administration every three months. Implants and IUDs are highly cost-effective when compared with other contraceptive methods.LARCs are widely recommended by professional bodies and the World Health Organization (WHO) as first-line contraception for young women as they are safe, effective and reversible. Young women should be offered the choice of a LARC as part of a fully informed decision for their first form of contraception.
LARCs surpass barrier methods and contraceptive pills in effectiveness and safety therefore all other options are incorrect.
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This question is part of the following fields:
- Gynaecology
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Question 78
Correct
-
Which of the following statements regarding progesterone production in the ovary is true?
Your Answer: Synthesised from cholesterol by Luteal cells
Explanation:After the release of the oocyte, the theca and the granulosa cells form the corpus luteum which undergoes extensive vascularization for continued steroidogenesis. Progesterone is secreted by the luteal cells and is synthesized from cholesterol.
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This question is part of the following fields:
- Endocrinology
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Question 79
Incorrect
-
A 30-year-old female patient visits you for a cervical cancer screening. You inform her that while Pap smears are no longer performed, Cervical Screening tests are done five times a year.
She has a cervical screening test, which reveals that she has non-16/18 HPV and low-grade cytology alterations.
What's would you do next?Your Answer: Colposcopy
Correct Answer: Repeat cervical screening test in 12 months
Explanation:An LSIL Pap test shows mild cellular changes. The risk of a high-grade cervical precancer or cancer after an LSIL Pap test is as high as 19 percent.
As with an ASC-US Pap test, an LSIL Pap test is evaluated differently depending upon age. For women ages 25 or older, follow-up depends upon the results of human papillomavirus (HPV) testing:
– Women who test positive for HPV or who have not been tested for HPV should have colposcopy.
– Women who test negative for HPV can be followed up with a Pap test and HPV test in one year.Referral to an oncologist is not necessary since there is no established diagnosis of malignancy. All other options are unacceptable.
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This question is part of the following fields:
- Gynaecology
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Question 80
Incorrect
-
A serum progesterone value less than 5ng/ml can exclude the diagnosis of viable pregnancy with a certainty of:
Your Answer: 80%
Correct Answer: 100%
Explanation:Serum progesterone has been proposed as a useful test to distinguish a viable pregnancy from a miscarriage or ectopic pregnancy. Low progesterone values are associated with miscarriages and ectopic pregnancies, both considered non-viable pregnancies, and high progesterone concentrations with viable pregnancies. A single progesterone measurement for women in early pregnancy presenting with bleeding or pain and inconclusive ultrasound assessments can rule out a viable pregnancy. The probability of a non-viable pregnancy was raised from 62.9% to 96.8%.
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This question is part of the following fields:
- Physiology
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Question 81
Incorrect
-
A 35 year old lady presented in her 3rd trimester with severe features of pre-eclampsia. The drug of choice to prevent the patient going into impending eclampsia would be?
Your Answer: Intravenous magnesium sulphate
Correct Answer:
Explanation:The drug of choice for eclampsia and pre-eclampsia is magnesium sulphate. It is given as a loading dose of 4g i/v over 5 minutes, followed by an infusion for the next 24 hours at the rate of 1g/hr. If the seizures are not controlled, an additional dose of MgSO4 2-4gm i/v can be given over five minutes. Patients with eclampsia or pre-eclampsia can develop any of the following symptoms: persistent headache, visual abnormalities like photophobia, blurring of vison or temporary blindness, epigastric pain, dyspnoea and altered mental status.
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This question is part of the following fields:
- Obstetrics
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Question 82
Incorrect
-
A 30 year old female with a history of two first trimester miscarriages presented at 9 weeks of gestation with per vaginal bleeding. Which of the following is the most appropriate management?
Your Answer: Trans-vaginal sonography (TVS)
Correct Answer: Aspirin
Explanation:Antiphospholipid syndrome is the most important treatable cause of recurrent miscarriage. The mechanisms by which antiphospholipid antibodies cause pregnancy morbidity include inhibition of trophoblastic function and differentiation, activation of complement pathways at the maternal–fetal interface, resulting in a local inflammatory response and, in later pregnancy, thrombosis of the uteroplacental vasculature. This patient should be offered referral to a specialist clinic as she has had recurrent miscarriages. Low dose aspirin is one of the treatment options to prevent further miscarriage for patients with antiphospholipid syndrome.
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This question is part of the following fields:
- Obstetrics
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Question 83
Correct
-
One year ago, Pap smear was done at your clinic for a 53 year old female patient. HPV type 42 was detected and reported as LSIL. A repeat pap smear after 12 months shows no change.
What is the next best step in management?Your Answer: Refer for colposcopy
Explanation:The management of low-grade squamous intraepithelial lesions (LSIL) on cervical cytology in women ages 25 years or older depends upon whether the patient underwent high-risk human papillomavirus (HPV) testing.
Women in this age group comprise two different populations in terms of cervical cancer screening strategies. Professional organizations recommend that women ages 25 to 29 years be screened with cytology alone, while women 30 years or older should be screened with cytology and HPV co-testing. Thus, the American Society for Colposcopy and Cervical Pathology (ASCCP) prefers that women ages 25 to 29 years are not managed based upon HPV results, even if an HPV test was performed at the time of screening. For women with ages 30 years or older and HPV positive, colposcopy must be performed.
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This question is part of the following fields:
- Gynaecology
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Question 84
Correct
-
A 34 year old patient who has just undergone a C-section delivery has lost almost 1 litre of blood. You suspect uterine atony as the likely cause, and have bimanually compressed the uterus. Which of the following pharmacological interventions should follow?
Your Answer: Syntocin 5u by slow intravenous injection
Explanation:In the management of postpartum haemorrhage, it is essential that the bleeding is first mechanically prevented, followed by the administration of oxytocic drugs, which cause the uterine smooth muscle to contract and clamping off bleeding sites in the endometrium. The drug of choice in the treatment protocol of PPH is 5 units of syntocin, a synthetic oxytocin uterotonic, by slow intravenous infusion. This is particularly suitable in the case of uterine atony. Other uterotonics, misoprostol, carboprost, ergometrine, can be used, but are not as effective in an emergency setting.
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This question is part of the following fields:
- Clinical Management
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Question 85
Incorrect
-
A 30-year-old primigravida woman presented to the clinic for her first antenatal check-up. Upon interview, it was noted that she was taking folic acid along with some other nutritional supplements as medication.
All of the following are considered correct regarding neural tube defects and folate before and during pregnancy, except:Your Answer: Folate intake should be increased at least one month before and three months after conception
Correct Answer: Prevalence of neural tube defects among non-indigenous population is almost double than that in Aboriginal and Torres Strait Islander babies
Explanation:Neural tube defects (NTDs) are common complex congenital malformations resulting from failure of the neural tube closure during embryogenesis. It is established that folic acid supplementation decreases the prevalence of NTDs, which has led to national public health policies regarding folic acid.
Neural tube defects (NTD) were 43% more common in Indigenous than in non-Indigenous infants in Western Australia in the 1980s, and there has been a fall in NTD overall in Western Australia since promotion of folate and voluntary fortification of food has occurred.
Women should take 5 mg/d of folic acid for the 2 months before conception and during the first trimester.
Women planning pregnancy might be exposed to medications with known antifolate activities affecting different parts of the folic acid metabolic cascade. A relatively large number of epidemiologic studies have shown an increased risk of NTDs among babies exposed in early gestation to antiepileptic drugs (carbamazepine, valproate, barbiturates), sulphonamides, or methotrexate. Hence, whenever women use these medications, or have used them near conception, they should take 5 mg/d of folic acid until the end of the first trimester of pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 86
Correct
-
You are asked to see a 26 year old patient following her first visit to antenatal clinic. She is 9 weeks pregnant and bloods have shown her to be non-immune to Rubella. She is concerned about congenital rubella syndrome (CRS). What is the most appropriate advice to give?
Your Answer: Advise vaccination after birth regardless of breast feeding status
Explanation:Congenital rubella infection that occurs after 16 weeks gestation does not typically cause fetal abnormalities. This however plays no part in vaccination advice. Rubella vaccine is live and should not be given during pregnancy. The mother should be offered vaccination after giving birth. It is safe for the vaccine (typically given as combined MMR) to be administered if the mother is breastfeeding.
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This question is part of the following fields:
- Microbiology
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Question 87
Correct
-
A 28-year-old woman at 35 weeks gestation who is gravida 2 para 1, presented to the labour and delivery department since she has been having regular, painful contractions over the past 3 hours. Upon interview and history-taking, it was noted that the patient has had no prenatal care during this pregnancy. She also has no chronic medical conditions, and her only surgery was a low transverse caesarean delivery 2 years ago.
Upon admission, her cervix is 7 cm dilated and 100% effaced with the fetal head at +2 station. Fetal heart rate tracing is category 1.
Administration of epidural analgesia was performed, and the patient was relieved from pain due to the contractions. There was also rupture of membranes which resulted in bright-red amniotic fluid.
Further examination was done and her results were:
Blood pressure is 130/80 mmHg
Pulse is 112/min
Which of the following is most likely considered as the cause of the fetal heart rate tracing?Your Answer: Fetal blood loss
Explanation:Fetal heart rate tracings (FHR) under category I include all of the following:
– baseline rate 110– 160 bpm
– baseline FHR variability moderate
– accelerations present or absent
– late or variable decelerations absent
– early decelerations present or absentThe onset of fetal bleeding is marked by a tachycardia followed by a bradycardia with intermittent accelerations or decelerations. Small amounts of vaginal bleeding associated with FHR abnormalities should raise the suspicion of fetal haemorrhage. This condition demands prompt delivery and immediate reexpansion of the neonatal blood volume.
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This question is part of the following fields:
- Obstetrics
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Question 88
Incorrect
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In the 3rd trimester anaemia is defined by?
Your Answer: Haemoglobin < 115 g/l
Correct Answer:
Explanation:Haemoglobin decreases from 13.3 g/dL to 10.5 g/dL from the start of pregnancy i.e. First trimester till the 3rd trimester.
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This question is part of the following fields:
- Clinical Management
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Question 89
Incorrect
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A woman visited the OPD with complaints of severe abdominal pain and light-headedness. There is history of fainting three days prior to consultation. She also has vaginal bleeding. In this case, which of the following investigations should be ordered to reach the diagnosis?
Your Answer: Haemoglobin
Correct Answer:
Explanation:Testing for beta hCG should be the first test in this case. It will rule out any pregnancy that is strongly suspected based on the patient’s history and physical examination.
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This question is part of the following fields:
- Gynaecology
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Question 90
Correct
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Where are ADH (vasopressin) and Oxytocin synthesised?
Your Answer: Hypothalamus
Explanation:ADH and vasopressin are synthesized in the supraoptic and periventricular nuclei of the hypothalamus, they are eventually transported to the posterior pituitary where they are stored to be released later.
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This question is part of the following fields:
- Endocrinology
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Question 91
Correct
-
A couple present to the fertility clinic after failing to conceive despite trying for 2.5 years. The semen analysis shows azoospermia. You perform a full examination of the male partner which reveals Height 192cm, BMI 20.5, small testes and scant facial hair. You decide to organise karyotyping. What is the result likely to show?
Your Answer: 47XXY
Explanation:Klinefelter syndrome is associated with testicular atrophy, eunuchoid body shape, tall, long extremities, female hair distribution and gynaecomastia. It is a common cause of hypogonadism seen during fertility workup.
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This question is part of the following fields:
- Clinical Management
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Question 92
Incorrect
-
Which of the following is indicated for the treatment of chlamydial urethritis in pregnancy?
Your Answer: Metronidazole
Correct Answer: Azithromycin 1gram as single dose
Explanation:The best treatment option for chlamydial urethritis in pregnancy is Azithromycin 1g as a single dose orally. This is the preferred option as the drug is coming under category B1 in pregnancy.
Tetracycline antibiotics, including doxycycline, should never be used in pregnant or breastfeeding women.
Erythromycin Estolate is contraindicated in pregnancy due to its increased risk for hepatotoxicity. Ciprofloxacin is not commonly used for treating chlamydial urethritis and its use is not safe during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 93
Correct
-
A 36-year-old woman arrived at the clinic complaining of stomach discomfort and vaginal bleeding. A pregnancy test in the urine came back positive. An ultrasonography of the right fallopian tube revealed a gestational sac.
Which of the following is NOT a risk factor for the ailment you've just read about?Your Answer: Type 2 Diabetes Mellitus
Explanation:An ectopic pregnancy is definitely present in this patient. An extrauterine pregnancy is referred to as an ectopic pregnancy. The fallopian tube accounts for 96% of ectopic pregnancies, but other sites include the cervical, interstitial (also called cornual; a pregnancy located in the proximal segment of the fallopian tube that is embedded within the muscular wall of the uterus), hysterotomy (caesarean) scar, intramural, ovarian, or abdominal. Furthermore, multiple gestations may be heterotopic in rare situations (including both a uterine and extrauterine pregnancy). Diabetes mellitus is not considered a risk factor for the development of an ectopic pregnancy.
Risk factors for ectopic pregnancy are summarized below:
High Risk: (Risk factors & Odds ratio)
Previous ectopic pregnancy 2.7 to 8.3
Previous tubal surgery 2.1 to 21
Tubal pathology 3.5 to 25
Sterilization 5.2 to 19
IUD – Past use 1.7 – Current use 4.2 to 16.4
Levonorgestrel IUD 4.9
In vitro fertilization in current pregnancy 4.0 to 9.3Moderate:
Current use of oestrogen/progestin oral contraceptives 1.7 to 4.5
Previous sexually transmitted infections (gonorrhoea, chlamydia) 2.8 to 3.7
Previous pelvic inflammatory disease 2.5 to 3.4
In utero diethylstilbesterol (DES) exposure 3.7
Smoking – Past smoker 1.5 to 2.5 – Current smoker 1.7 to 3.9
Previous pelvic/abdominal surgery 4.0
Previous spontaneous abortion 3.0Low:
Previous medically induced abortion 2.8
Infertility 2.1 to 2.7
Age ≥40 years 2.9
Vaginal douching 1.1 to 3.1
Age at first intercourse <18 years 1.6
Previous appendectomy 1.6 -
This question is part of the following fields:
- Gynaecology
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Question 94
Correct
-
All of the following are features of the female bony pelvis, except?
Your Answer: It is funnel shaped
Explanation:The female bony pelvis is larger, broader and more of a funnel shape. The inlet is larger and oval in shape and the sides of the female pelvis are wider apart.
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This question is part of the following fields:
- Anatomy
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Question 95
Correct
-
A 36 year old patient is seen in clinic for follow up of a vaginal biopsy which confirms cancer. What is the most common type?
Your Answer: Squamous cell carcinoma
Explanation:Squamous cell carcinoma is the most common type of vaginal cancer.
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This question is part of the following fields:
- Clinical Management
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Question 96
Correct
-
A mother typically becomes aware of fetal movements at what gestation?
Your Answer: 18-20 weeks
Explanation:Foetal movements often become apparent at about 18-20 weeks gestation. This phenomenon is also called quickening. The Foetal movements continue to increase in frequency and force until 32 weeks where they plateau. Foetal movements can be used to monitor the wellbeing of the foetus, alerting the mother and healthcare providers to a problem.
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This question is part of the following fields:
- Clinical Management
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Question 97
Incorrect
-
A 27-year-old pregnant woman visits to you at 17 weeks of gestation with complaint of eruption or rash, followed by a 2-day history of malaise, low grade fever and rhinorrhea. You suspect measles and order serology tests for her.
Serology report shows that lgM against measles is positive with a negative lgG.
Among the following which is the most appropriate next step in management of this case?Your Answer: Repeat the serology in 2 weeks
Correct Answer: Contact tracing
Explanation:The given case scenario describes a typical case of measles in a pregnant woman, which is confirmed by serologic studies. Positive lgM in serology is suggestive of acute infection, while a negative lgG confirms that the infection is in early phase without any seroconversion.
Conservative management of the symptoms and its potential complications is the only management plan therapeutically available after contracting measles. ‘Notification’ and contact tracing are the other very important issues to be considered.
Measles is a notifiable disease and healthcare professionals are mandated on reporting all the identified cases of measles to the authorized public health units. The main objective of this notification is to conduct a contact tracing.MMR vaccine is not useful once measles is contracted, as the vaccine is used for prevention of measles and as prophylaxis in post-exposure cases. For those with contact to a case of measles, MMR vaccine within 72 hours of contact may have a protective effect, but all measles-containing vaccines like MMR and MM RV are contraindicated throughout pregnancy even as prophylaxis.
As the circulating maternal antibodies will cross placenta and enters into the fetal circulation, a positive test does not confirm infection in the fetus. So serologic testing of the fetus is not useful.
NHIG is not useful in treating an established case of measles, as it is used as a post-measles exposure prophylactic for patients such as pregnant women, premature babies, etc who are contraindicated to MMR vaccine.
As both symptoms and lgM levels indicate measles infection, repeating measles-specific serologic test is not useful in this case. In general no test is indicated, unless its result has an impact on the further management of the case or any prognostic value.
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This question is part of the following fields:
- Obstetrics
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Question 98
Correct
-
Adult Polycystic Kidney Disease (PKD) typically follows which pattern of inheritance
Your Answer: Autosomal Dominant
Explanation:Polycystic kidney disease (PKD) can either be autosomal dominant or recessive. The autosomal dominant variant is more common in adult PKD however, the recessive pattern is more common in infantile PKD.
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This question is part of the following fields:
- Endocrinology
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Question 99
Correct
-
The external carotid artery develops from which pharyngeal arch?
Your Answer: 1st
Explanation:The maxillary arteries and the external carotid arteries develop from the first pharyngeal arch. The stapedial arteries arise from the second, the common carotid artery and the internal carotid arteries from the third and the arch of the aorta and the right subclavian artery from the forth arch.
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This question is part of the following fields:
- Embryology
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Question 100
Correct
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If a hyalinised mass is formed from an involuted corpus leuteum, it is known as:
Your Answer: Corpus albicans
Explanation:Corpus albicans is the regressed form of the corpus leuteum. It is formed when the corpus leuteum is engulfed by macrophages and a scar or fibrous tissue is formed, called the corpus albicans.
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This question is part of the following fields:
- Physiology
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Question 101
Incorrect
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A 40 year old women has a transvaginal ultrasound reported as showing a 6cm x 5cm cystic mass of the right ovary with multiple septa noted and varying degrees of echogenicity within locules. What is the likely diagnosis?
Your Answer: Endometrioma
Correct Answer: Mucinous cystadenoma
Explanation:The characteristics of the mucinous cystic adenoma of the ovaries is the presence of a large tumour which is multicystic and the penetration of the peritoneum into the cavities forming septas. The serous tumours can only be differentiated on the bases of the contents.
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This question is part of the following fields:
- Data Interpretation
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Question 102
Correct
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After eating a burger at a local restaurant, a 27-year-old lady comes to your office with nausea, vomiting, and diarrhoea. She's taking oral contraceptives. Even when she was quite unwell, she did not miss her pills.
Which of the following would be the best piece of contraceptive and pill advise you could give her?Your Answer: She should continue the pills and use condom for 7 days
Explanation:If diarrhoea occurs within 24 hours of taking oral birth control or continues for 24 to 48 hours after taking a pill, an additional dose is not needed.
If diarrhoea lasts more than 48 hours the patient should use backup birth control, such as condoms, or avoid sexual intercourse until pills have been taken for seven diarrhoea-free days.
Options to stop pills are incorrect as it increases risk of pregnancy.
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This question is part of the following fields:
- Gynaecology
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Question 103
Correct
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Galactorrhoea (non-gestational lactation) may result from all of the following EXCEPT:
Your Answer: Intrapartum haemorrhage
Explanation:Pituitary tumours, the most common pathologic cause of galactorrhoea can result in hyperprolactinemia by producing prolactin or blocking the passage of dopamine from the hypothalamus to the pituitary gland. Approximately 30 percent of patients with chronic renal failure have elevated prolactin levels, possibly because of decreased renal clearance of prolactin. Primary hypothyroidism is a rare cause of galactorrhoea in children and adults. In patients with primary hypothyroidism, there is increased production of thyrotropin-releasing hormone, which may stimulate prolactin release. Nonpituitary malignancies, such as bronchogenic carcinoma, renal adenocarcinoma and Hodgkin’s and T-cell lymphomas, may also release prolactin.
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This question is part of the following fields:
- Obstetrics
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Question 104
Correct
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Which hormone is responsible for contraction of myoepithelial cells in lactation?
Your Answer: Oxytocin
Explanation:Oxytocin is responsible for the let down mechanism that occurs during breast feeding in which the myothelial cells contract and push the milk into the ductules.
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This question is part of the following fields:
- Clinical Management
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Question 105
Correct
-
From which of the following spinal segments do both the internal and external anal sphincters receive their innervation?
Your Answer: S4
Explanation:The anal sphincters are responsible for closing the anal canal to the passage of faeces and flatus. The smooth muscle of the involuntary internal sphincter sustains contraction to prevent the leakage of faeces between bowel movements and is innervated by the pelvic splanchnic nerves, which are a branch of the spinal segment 4. The external sphincter is made up of skeletal muscle and can therefore contract and relax voluntarily. Its innervation comes from the inferior rectal branch of the pudendal nerve, and the perineal branch of S4 nerve roots.
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This question is part of the following fields:
- Anatomy
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Question 106
Correct
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Which of the following drugs is associated with reduced milk production whilst breastfeeding?
Your Answer: Cabergoline
Explanation:Domperidone and metoclopramide are D2 dopamine receptor antagonists. They are primarily used to promote gastric motility. They are also known as galactagogues and they promote the production of milk. Cabergoline and bromocriptine are prolactin inhibitors and they reduce milk production.
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This question is part of the following fields:
- Endocrinology
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Question 107
Correct
-
Tamoxifen is associated with an increased risk of which of the following?
Your Answer: Endometrial cancer
Explanation:Tamoxifen is a SERM that is effective in treating hormone-responsive breast cancer, it acts as an antagonist to prevent receptor activation by endogenous oestrogen. As agonist of the endometrial receptors it promotes endometrial hyperplasia and hence increases the risk of endometrial cancer.
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This question is part of the following fields:
- Pharmacology
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Question 108
Incorrect
-
A 39-year-woman visits a gynaecological clinic for fertility advice. She is unable to conceive for the last 2 years. Pelvic ultrasound shows 3-4 follicles in both ovaries. An endocrinological profile is ordered showing low oestrogen, elevated FSH, and LH.
What is the most suitable advice for her?Your Answer: Clomiphene
Correct Answer: In-vitro fertilization
Explanation:Premature menopause has been diagnosed biochemically in this patient. Menopause is considered premature when it happens without warning in a woman under the age of 40.
Follicular development is common in ultrasonography investigations of women with primary ovarian failure, but ovulation is rare. So this woman isn’t ovulating.Exogenous oestrogen treatment in physiologic amounts does not appear to improve the rate of spontaneous ovulation.
Women with primary ovarian failure from any cause may be candidates for donor oocyte in vitro fertilisation (IVF).Oestrogens, clomiphene citrate, and danazol are examples of treatment approaches that have been shown to be ineffective in patients with premature ovarian failure.
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This question is part of the following fields:
- Gynaecology
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Question 109
Correct
-
Changes in the urinary tract system in pregnancy include:
Your Answer: Increase in the glomerular filtration rate (GFR)
Explanation:Pregnancy involves remarkable orchestration of physiologic changes. The kidneys are central players in the evolving hormonal milieu of pregnancy, responding and contributing to the changes in the environment for the pregnant woman and foetus. The functional impact of pregnancy on kidney physiology is widespread, involving practically all aspects of kidney function. The glomerular filtration rate increases 50% with subsequent decrease in serum creatinine, urea, and uric acid values.Â
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This question is part of the following fields:
- Physiology
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Question 110
Correct
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A sexually active young woman comes in with frothy, foul-smelling vaginal discharge. Dysuria and dyspareunia are also present. The genital region seems to be quite reddish.
What is the potential danger associated with this presentation?Your Answer: Increased risk of cervical cancer
Explanation:TV infection is associated with both LR and HR-HPV infection of the cervix, as well as with ASC-US and HSIL. The signs and symptoms of trichomoniasis are present in this patient. Trichomonas vaginalis is the reason.
Increased vaginal discharge that is frothy, yellowish, and has an unpleasant odour are among the symptoms. It’s frequently linked to dyspareunia and dysuria. Normally, the genital area is red and painful.In both men and women, trichomoniasis can cause preterm labour and raise the risk of infertility. Both the patient and the partner must be treated at the same time.
The active infection can be treated with a single oral dose of metronidazole 2 g taken with food.
To avoid disulfiram-like symptoms, alcohol should be avoided during the first 24-48 hours after treatment. -
This question is part of the following fields:
- Gynaecology
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Question 111
Correct
-
Which of the following leaves the pelvis via the greater sciatic foramen?
Your Answer: Pudendal Nerve
Explanation:The pudendal nerve is formed by sacral nerve roots S2, S3 and S4 almost immediately as they exit the spinal foramina. The pudendal nerve exits the pelvis via the greater sciatic foramen, travels behind the sacrospinous ligament before re-entering the pelvis via the lesser sciatic foramen. It is an important nerve to be aware of as it supplies sensation to the genitalia and can also be damaged/compressed at a number of places along its course. Image sourced from Wikipedia
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This question is part of the following fields:
- Anatomy
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Question 112
Incorrect
-
A 56 year old lady presents with a vulval itch and discolouration. A biopsy conforms Lichen Sclerosis (LS). What is the risk of developing squamous cell carcinoma compared to patients with a normal vulval biopsy?
Your Answer: 5-15%
Correct Answer:
Explanation:Lichen Sclerosis is a destructive inflammatory condition that effects the anogenital region of women. It effects around 1 in 300 women. It destroys the subdermal layers of the skin resulting in hyalinization of the skin leading to parchment paper appearance of the skin. It is associated with vulval cancer and it is estimated that the risk of developing vulval cancer after lichen sclerosis is around 3-5%.
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This question is part of the following fields:
- Clinical Management
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Question 113
Incorrect
-
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: PGE1
Correct 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 114
Correct
-
A 24-year-old lady, who has not been able to conceive even after 2 years of unprotected intercourse, has come with concerns that she might have endometriosis. She is concerned because she has a friend who recently was diagnosed with it.
Which symptom profile would be expected if this woman actually has endometriosis?Your Answer: No abnormal bleeding or pain.
Explanation:The clinical features of endometriosis include dyspareunia, dysmenorrhea, dysuria, dyschezia as well as infertility. Pain is characteristically long-term, cyclic (often occurring the same time as menses) and can get progressively worse over time. Laparoscopy remains the standard for diagnosis. There are many cases in which endometriosis is only discovered at the time of the workup for infertility.
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This question is part of the following fields:
- Gynaecology
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Question 115
Incorrect
-
A patient has had limited response to conservative measures for her overactive bladder (OAB). Which of the following is the most appropriate pharmacological choice?
Your Answer: Imipramine
Correct Answer: Darifenacin
Explanation:Detrusor overactivity can be treated with anti-cholinergic agents such as oxybutynin or tolterodine, solifenacin, fesoterodine and darifenacin. They are used as first line agents. Imipramine is used for enuresis and desmopressin is used for nocturia.
NICE pathwayPrior to initiating anticholinergics:
Bladder training
Consider treating vaginal atrophy and nocturia with topical oestrogen and desmopressin respectively before commencing treatments below.
Consider catheterisation if chronic retention
1st line treatments:
1. Oxybutynin (immediate release) – Do not offer to frail elderly patients
2. Tolterodine (immediate release)
3. Darifenacin (once daily preparation)
DO NOT offer any of the 3 drugs below:
1. Flavoxate
2. Propantheline
3. Imipramine
2nd line treatment
Consider transdermal anticholinergic (antimuscarinic)
Mirabegron
Adjuvant Treatments
Desmopressin can be considered for those with nocturia
Duloxetine may be considered for those who don’t want/unsuitable for surgical treatment
Intravaginal oestrogen can be offered to postmenopausal women with OAB -
This question is part of the following fields:
- Clinical Management
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Question 116
Correct
-
Which of the following is the leading cause of Down Syndrome?
Your Answer: Nondisjunction maternal gamete
Explanation:Most of the cases of down syndrome occur due to non disjunction trisomy 21 which is associated with increased maternal age. The non disjunction occurs in the maternal gametes.
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This question is part of the following fields:
- Genetics
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Question 117
Correct
-
Pregnancy is associated with all of the following, EXCEPT:
Your Answer: Increased peripheral resistance
Explanation:A variety of changes in the cardiovascular system occur during normal pregnancy, including increases in cardiac output, arterial compliance, extracellular fluid volume and decreases in blood pressure (BP) and total peripheral resistance.
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This question is part of the following fields:
- Physiology
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Question 118
Incorrect
-
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: Mucinous
Correct 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.
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This question is part of the following fields:
- Clinical Management
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Question 119
Correct
-
What is the inferior border of the deep perineal pouch?
Your Answer: Perineal membrane
Explanation:The perineal membrane (also known as the inferior fascia of the urogenital diaphragm) separates the deep and superficial perineal pouches i.e. it is the inferior border of the deep pouch and superior border of the superficial pouch. The deep perineal pouch is the space therefore between superior and inferior layers of the urogenital diaphragm The superior fascia of the urogenital diaphragm is the superior border
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This question is part of the following fields:
- Anatomy
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Question 120
Correct
-
A 21-year-old primigravida female presents to the emergency department at 41 weeks gestation.
She complains of a nine hour history of irregular painful contractions.
On examination of her pelvis, her cervix is fully effaced, but only 2 - 3 cm dilated. The fetal head is at the level of the ischial spines in a left occipito-posterior (LOP) position. The membranes ruptured an hour ago.
What would be the best next line of management?Your Answer: Oxytocic (Syntocinon4) infusion.
Explanation:The best next line of management is to administer an oxytocic (Syntocinon) infusion.
This is because the progress of labour is slow, and it necessary to augment it. As the membranes have already ruptured, the next step is to increase the contractions and induce labour using an infusion of oxytocic (Syntocinon) infusion.
Extra fluid is also required, but this will be administered alongside the Syntocinon infusion.
A lumbar epidural block is indicated in patients with an occipito-posterior (OP) position. This should not be attempted until more pain relief is required and the progress of labour is reassessed.
A Caesarean section may be necessary due to obstructed labour or fetal distress, it is not indicated at this stage.
Taking blood and holding it in case cross-matching is ultimately required is common, but most patients do not have blood cross-matched prophylactically in case there is a need to be delivered by Caesarean section and require a transfusion.
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This question is part of the following fields:
- Obstetrics
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Question 121
Incorrect
-
All of the following statements regarding human chorionic gonadotrophin are true except::
Your Answer: Reaches a peak concentration in maternal serum by 10 weeks gestation
Correct Answer: It's level doubles every 48 hours in ectopic pregnancy
Explanation:In normal pregnancy the levels of hCG doubles after every 48-72 hours but in case of ectopic pregnancy the levels of hCG are lower than the normal. It is produced by the placenta and its main role is nourishment of the egg after implantation. Its levels reached a peak at 8-10 weeks of pregnancy and after that the levels decreases for the remainder of pregnancy. In hydatiform mole and trophoblastic diseases its the main hormone for diagnosis of the disease because the levels are highly elevated.
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This question is part of the following fields:
- Physiology
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Question 122
Correct
-
A 47 year old women has a transvaginal ultrasound that shows a partially echogenic mass with posterior sound attenuation owing to sebaceous material and hair within the cyst cavity. What is the likely diagnosis?
Your Answer: Mature teratoma
Explanation:These are the most common ovarian tumours in young women. The most common form is the mature dermoid cyst (cystic teratoma). It can consist of a combination of all the type of tissues (mesenchymal, stromal and epithelial). Any mature tissue type can be present such as muscle, cartilage, bone, teeth and often hair. Treatment is cystectomy.
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This question is part of the following fields:
- Data Interpretation
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Question 123
Incorrect
-
Which of the following has been shown to increase ovarian cancer risk?
Your Answer: Polycystic ovarian syndrome
Correct Answer: Hormone replacement therapy (oestrogen only)
Explanation:Factors that increase the risk of ovarian cancer include nulliparity, IUD, endometriosis, cigarette smoking, HRT and obesity.
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This question is part of the following fields:
- Epidemiology
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Question 124
Correct
-
In pregnancy, the following lung function value remains unchanged:
Your Answer: FEV1
Explanation:The biochemical and mechanical effects of progesterone and the enlarging uterus are responsible for some changes in lung function during pregnancy.
Progesterone increases the sensitivity of the respiratory centre to arterial carbon dioxide while also causing hyperaemia in the airway leading to nasal obstruction. As a result, minute ventilation and tidal volume increase by 50% to allow greater arterial oxygen saturation.
The enlarging uterus displaces the diaphragm upwards, and also limits the movement of the thoracic cage, thereby decreasing the functional residual capacity (FRC) and the expiratory reserve volume (ERV) by 20%.
Functional Expiratory Volume in 1 second (FEV1) and Forced Vital Capacity (FVC) remain unchanged in pregnancy.
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This question is part of the following fields:
- Physiology
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Question 125
Incorrect
-
Among the following situations which one is NOT considered a risk factor for isolated spontaneous abortions?
Your Answer: High doses of caffeine
Correct Answer: Retroverted uterus
Explanation:Most common risk factors for spontaneous abortion are considered to be:
– Age above 35 years.
– Smoking.
– High intake of caffeine.
– Uterine abnormalities like leiomyoma, adhesions.
– Viral infections.
– Thrombophilia.
– Chromosomal abnormalities.
Conditions like subclinical thyroid disorder, subclinical diabetes mellitus and retroverted uterus are not found to cause spontaneous abortions.
The term retroverted uterus is used to denote a uterus that is tilted backwards instead of forwards. -
This question is part of the following fields:
- Obstetrics
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Question 126
Incorrect
-
A 37-year-old primigravid woman is admitted to labor unit at 39 weeks of gestation, due to regular uterine contractions. Her cervix is 8 cm dilated and 100% effaced, with the fetus’ vertex at +1 station. Initially the fetal heart rate was 150 bpm, as the labor progressed, it falls to 80 bpm without any changes in the mother’s general condition.
Which among the following options would be the best next step in management of this case?Your Answer: Emergency delivery by cesarean section
Correct Answer: Cardiotocography
Explanation:Bradycardia of <100 bpm for more than 5 minutes or <80 for more than 3 minutes is always considered abnormal. The given case describes fetal bradycardia detected on fetal heart auscultation and the most common causes for severe bradycardia are prolonged cord compression, cord prolapse, epidural and spinal anesthesia, maternal seizures and rapid fetal descent. Immediate management including identification of any reversible causes for the abnormality and initiation of appropriate actions like maternal repositioning, correction of maternal hypotension, rehydration with intravenous fluid, cessation of oxytocin, tocolysis for excessive uterine activity, and initiation or maintenance of continuous CTG should be considered in clinical situations where abnormal fetal heart rate patterns are noticed. Consideration of further fetal evaluation and delivery if a significant abnormality persists are very important. The next step in this scenario where the baby is in 1+ station, with an abnormal fetal heart rate detected on auscultation would be to perform a confirmatory cardiotocography (CTG) and if the CTG findings confirm the condition despite initial measures obtained, prompt action should be taken. Cord compression or prolapse should come on the top of the differential diagnoses list as the the mother shows normal general conditions, but since the cervix is 8 cm dilated, 100% effaced and the fetal head is already engaged, cord prolapse would be unlikely; therefore, repeating vaginal exam is not as important as confirmatory CTG. However a vaginal exam should be done, if the scenario indicates any possibility of cord prolapse, to exclude cord compression or prolapse. NOTE– In cases of severe prolonged bradycardia, immediate delivery is recommended, if the cause cannot be identified and corrected.
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This question is part of the following fields:
- Obstetrics
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Question 127
Correct
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Question 128
Incorrect
-
A 20 year old patient attends clinic for a medical abortion at 12 weeks gestation. She has no known drug allergies and her STI screen was negative. What drug should she be prescribed as antibiotic prophylaxis?
Your Answer: Doxycycline 100mg BD for 7 days
Correct Answer: Metronidazole 1g PR stat dose
Explanation:According to the Royal College of Obstetrics and Gynaecology guidelines for abortion care it advises dual antibiotic regimes for antibiotic prophylaxis.
Metronidazole 1g per rectum or 800 mg orally can be given before or at the time of the abortion in women who have tested negative for Chlamydia trachomatis infection.Alternatively, Doxycycline (100mg oral, twice daily for 7 days) or Azithromycin 1g stat doses should be given in addition to metronidazole to be effective against Chlamydia trachomatis anaerobes.
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This question is part of the following fields:
- Clinical Management
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Question 129
Correct
-
A 26-year-old gravida 2 para 1 presents at 30 weeks gestation with a complaint of severe itching. She has excoriations from scratching in various areas. She says that she had the same problem during her last pregnancy, and her medical records reveal a diagnosis of intrahepatic cholestasis of pregnancy. Elevation of which one of the following is most specific and sensitive marker of this disorder?
Your Answer: Bile acids
Explanation:Intrahepatic cholestasis of pregnancy (ICP) classically presents as severe pruritus in the third trimester. Characteristic findings include the absence of primary skin lesions and elevation of serum levels of total bile acids.
The most specific and sensitive marker of ICP is total serum bile acid (BA) levels greater than 10 micromol/L. In addition to the elevation in serum BA levels, the cholic acid level is significantly increased and the chenodeoxycholic acid level is mildly increased, leading to elevation in the cholic
henodeoxycholic acid level ratio. The elevation of aminotransferases associated with ICP varies from a mild increase to a 10- to 25-fold increase.Total bilirubin levels are also increased but usually the values are less than 5 mg/dL. Alkaline phosphatase (AP) is elevated in ICP up to 4-fold, but this is not helpful for diagnosis of the disorder since AP is elevated in pregnancy due to production by the placenta- Mild elevation of gamma glutamyl transferase (GGT) is seen with ICP but occurs in fewer than 30% of cases. However, if GGT is elevated in cases of ICP, that patient is more likely to have a genetic component of the liver disease.
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This question is part of the following fields:
- Obstetrics
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Question 130
Correct
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Which one will decrease the risk of acquiring uterine fibroids?
Your Answer: Smoking
Explanation:Risk factors of fibroids include early menarche, nulliparity, early exposure to oral contraceptives (one study showed 13-16 years old), diet rich in red meats and alcohol, vitamin D deficiency, hypertension, obesity, and/or history of sexual or physical abuse.
Smoking is associated with actual reduced risk due to an unknown mechanism.
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This question is part of the following fields:
- Gynaecology
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Question 131
Incorrect
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You see a diabetic women in preconception clinic. Which of the following is appropriate advice regarding folic acid supplementation?
Your Answer: 400 mcg daily until week 12
Correct Answer: 5 mg daily until week 12
Explanation:The aim of pre-pregnancy counselling is to achieve the best possible glycaemic control before pregnancy and to educate diabetic women about the implications of pregnancy. Patient information leaflets about pregnancy should make clear the risks of pregnancy in diabetes, and include advice to take high dose (5 mg) folic acid pre-conception and for the first 12 weeks.
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This question is part of the following fields:
- Clinical Management
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Question 132
Correct
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A 26 year old female patient comes to a GP asking to see a gynaecologist for cervical screening test. She has no history of sexual intercourse and is not a lesbian.
What would you do next?Your Answer: Reassure her there is no need for cervical screening test at this stage
Explanation:Women, who have never had sexual encounter, do not need cervical screening. However, any sort of sexual encounter (Lesbian or heterosexual) is considered a risk and the patient must be screened. Otherwise, routine cervical screening test can be performed every five years for woman 25-74 years who ever had sex with no evidence of cervical pathology. Perform a cervical screening test at the age of 25 or 2 years after first sexual intercourse-whichever is later in sexually active women. Perform cervical screening test in patients above 75 years if they request or if they never had any symptoms.
All other options are unacceptable.
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This question is part of the following fields:
- Gynaecology
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Question 133
Correct
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What is the anatomical landmark used for gauging the station of the fetal head during labour?
Your Answer: Ischial Spine
Explanation:The ischial spines and palpable through the vagina and are used as landmarks to assess the decent of the fetal head from the cervix. It also serves as a landmark for giving the pudendal block.
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This question is part of the following fields:
- Anatomy
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Question 134
Correct
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A 46-year-old woman with regular menstrual cycles presents with a history of menorrhagia for the last 6 years. Her menstrual cycles are normal, but she has bled excessively for eight days every month, and her haemoglobin level was 90g/L one month ago. She's already on iron supplementation. She has a history of cervical intraepithelial neoplasia grade 3 (CIN3) in addition to the anaemia, albeit her yearly smear test has been normal since the laser treatment six years ago. She is also undergoing hypertension treatment. Physical examination is unremarkable. She is not willing for endometrial ablation or hysterectomy until her menopause. Which of the following medical therapies would be the best for her to utilize between now and the time she is expected to hit menopause, which is around the age of 50?
Your 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:Adenomyosis or dysfunctional uterine haemorrhage are the most likely causes of heavy periods.
Because she refuses to have a hysterectomy or endometrial ablation, hormonal therapy must be administered in addition to the iron therapy she is already receiving.
Any of the choices could be employed, but using therapy only during the luteal phase of the cycle in someone who is virtually surely ovulating (based on her typical monthly cycles) is unlikely to work.Danazol is prone to cause serious adverse effects (virilization), especially when used for a long period of time.
GnRH agonists would cause amenorrhoea but are more likely to cause substantial menopausal symptoms, and the °fa contraceptive pill (OCP) is generally best avoided in someone using hypertension medication.Treatment with norethisterone throughout the cycle is likely to be the most successful of the treatments available.
If a levonorgestrel-releasing intrauterine device (Mirena®) had been offered as an alternative, it would have been acceptable. -
This question is part of the following fields:
- Gynaecology
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Question 135
Correct
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The amniotic fluid volume progressively increases during pregnancy. At which of the following gestational ages will amniotic fluid volume reach a maximum?
Your Answer: 35 weeks
Explanation:Amniotic fluid volume begins to increase rapidly in the second and third trimester as the fetal kidneys continue to develop. By 35 weeks gestation the amniotic fluid volume reaches a maximum average of about 800 ml after which it decreases slightly to term.
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This question is part of the following fields:
- Clinical Management
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Question 136
Incorrect
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A 67 year old patient with endometrial carcinoma is to undergo staging investigations. There is evidence of invasion into the vaginal wall, but the lymph nodes are spared, and there is no distant metastasis. According to FIGO, what stage is this?
Your Answer: 3A
Correct Answer: 3B
Explanation:Endometrial cancer is one of the most common gynaecological malignancies present in postmenopausal women, with a peak incidence between the ages of 60-89. Factors associated with endometrial cancer include obesity, hypertension and diabetes. Full staging for endometrial cancer is surgical, including several other radiologic investigations. According to FIGO staging classifications:
Stage 1 indicates a tumour confined to the uterine body
Stage 2 indicates the invasion of the cervical stroma
Stage 3 indicates local and regional spread, where the tumour invades the serosa in stage 3A, spreads to the vagina and parametrium in stage 3B, and metastasizes to the pelvic or para-aortic lymph nodes in stage 3C.
Stage 4 indicates tumour invasion on the bladder or bowel mucosa, or distant metastasis. -
This question is part of the following fields:
- Clinical Management
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Question 137
Correct
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A baby with shoulder dystocia suffers a brachial plexus injury. You diagnose Erb-Duchenne palsy. Which nerve roots are typically affected?
Your Answer: C5 and C6
Explanation:Erb’s or Erb-Duchenne palsy is a type of brachial plexus injury. The brachial plexus comprises C5 to T1 nerve roots. In Erb’s palsy C5 and C6 are the roots primarily affected. Shoulder Dystocia is the most common cause of Erb’s palsy.
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This question is part of the following fields:
- Clinical Management
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Question 138
Incorrect
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What is the mode of action of Mefenamic acid?
Your Answer: Inhibits Plasminogen Activation
Correct Answer: Inhibits Prostaglandin Synthesis
Explanation: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 139
Correct
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Regarding amniotic fluid volume:
Your Answer: Maybe predicted by ultrasound
Explanation:Amniotic fluid can be measured with the help of ultrasound to gauge the amniotic fluid index. The normal value ranges between 8-18.
Amniocentesis is a procedure by which amniotic fluid is removed. In rhesus disease, it appears yellow due to raised bilirubin levels. -
This question is part of the following fields:
- Physiology
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Question 140
Incorrect
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A 44-year-old woman underwent a cervical screening test at your clinic a week ago revealing Invasive squamous cell carcinoma.
What is the best course of action for her management?Your Answer: Colposcopy at your clinic
Correct Answer: Refer to a gynaecologist at tertiary hospital
Explanation:If a cervical screening test reveals invasive squamous cell carcinoma or adenocarcinoma, refer the patient to a gynaecologist at a tertiary hospital right once for further treatment.
Colposcopy at a GP practice is not appropriate in these situations. When it comes to the prospect of cancer, reassurance isn’t enough. -
This question is part of the following fields:
- Gynaecology
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Question 141
Incorrect
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A 32 year old primigravida in her 12th week of gestation, presents to her GP with concerns regarding the evolution of her pregnancy. She's afraid she might experience an obstetric cholestasis just like her older sister did in the past. What is the fundamental symptom of obstetric cholestasis?
Your Answer: Pruritus
Correct Answer:
Explanation:Cholestasis of pregnancy is associated with increased fetal morbidity and mortality and should be treated actively. The significance attached to pruritus in pregnancy is often minimal, but it is a cardinal symptom of cholestasis of pregnancy, which may have no other clinical features.
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This question is part of the following fields:
- Obstetrics
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Question 142
Incorrect
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When consenting someone for laparoscopy you discuss the risk of vascular injury. The incidence of vascular injury during laparoscopy according to the BSGE guidelines is?
Your Answer: 0.4/1000
Correct Answer: 0.2/1000
Explanation:Major vessel injury is the most important potential complication when undertaking laparoscopy. It’s incidence is 0.2/1000. Bowel Injury is more common at 0.4/1000
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This question is part of the following fields:
- Clinical Management
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Question 143
Correct
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A 49-year-old lady presents with amenorrhea of 11-months’ duration. Her periods were previously normal and regular. She is planned for an assessment of her FSH (follicle-stimulating hormone) and oestradiol (E2) levels.
Assuming she has attained menopause, which pattern would most likely be found?Your Answer: High FSH and low E2.
Explanation:High FSH and low E2 levels would be expected in menopause. FSH levels would be raised as her body attempts to stimulate ovarian activity and E2 would be low due to reduced ovarian function. The other options would be possible if she was younger, and if occurring with amenorrhea, would warrant further hormonal tests.
It is often challenging to interpret hormone test results close to the time of menopause, especially if the woman is still experiencing irregular menstruation, as remaining ovarian follicles might still produce oestrogen, causing both bleeding and FSH suppression. Elevation of FSH then can be seen again once the oestrogen level drops. Hence, the results would be influenced by the timing of blood sample collection. Once amenorrhea occurs more consistently, it would be easier to interpret the results.
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This question is part of the following fields:
- Gynaecology
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Question 144
Correct
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In a pregnant lady with polyhydramnios, the cause could be:
Your Answer: Foetus with oesophageal-atresia
Explanation:An underlying disease is only found in 17 % of cases in mild polyhydramnios. In contrast, an underlying disease is detected in 91 % of cases in moderate to severe polyhydramnios. The literature lists the following potential aetiologies: fetal malformations and genetic anomalies (8–45 %), maternal diabetes mellitus (5–26 %), multiple pregnancies (8–10 %), fetal anaemia (1–11 %), other causes, e.g. viral infections, Bartter syndrome, neuromuscular disorders, maternal hypercalcemia. Viral infections which can lead to polyhydramnios include parvovirus B19, rubella, and cytomegalovirus. Other infections, e.g. toxoplasmosis and syphilis, can also cause polyhydramnios.
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This question is part of the following fields:
- Physiology
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Question 145
Correct
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Question 146
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: Pseudomonas aeruginosa
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 147
Incorrect
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What is the typical volume increase of a non-pregnant uterus to term uterus?
Your Answer: 10ml to 1000ml
Correct Answer: 10ml to 5000ml
Explanation:Uterine blood flow increases 40-fold to approximately 700 mL/min at term. The uterus is 50–60 g with a volume of approximately 10ml prior to pregnancy and 1000 – 1200 g with a volume of 5000ml by term.
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This question is part of the following fields:
- Physiology
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Question 148
Correct
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Sensory supply to the clitoris is via branches of which nerve?
Your Answer: Pudendal nerve
Explanation:The pudenal nerves has three branches, namely the inferior rectal, perineal and the dorsal nerve of the clitoris. The perineal nerve has two branches: The superficial perineal nerve gives rise to posterior scrotal or labial (cutaneous) branches, and the deep perineal nerve supplies the muscles of the deep and superficial perineal pouches, the skin of the vestibule, and the mucosa of the inferior most part of the vagina. The inferior rectal nerve communicates with the posterior scrotal or labial and perineal nerves. The dorsal nerve of the penis or clitoris is the primary sensory nerve serving the male or female organ, especially the sensitive glans at the distal end.
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This question is part of the following fields:
- Anatomy
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Question 149
Correct
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A pregnant woman with a history of osteoarthritis presents to her antenatal clinic. She is complaining of restricted joint movement and severe pain in her joints. Choose the most appropriate medication for her from the list below.
Your Answer: Paracetamol
Explanation:Paracetamol is safe to take during pregnancy and has shown no harm to unborn children during studies. It is the treatment of choice for mild to moderate pain during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 150
Correct
SESSION STATS - PERFORMANCE PER SPECIALTY
