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Question 1
Correct
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Question 2
Incorrect
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Normal physiological gut herniation occurs at how many weeks gestation?
Your Answer: 12 weeks
Correct Answer: 8 weeks
Explanation:At about 8-12 weeks gestation, normal physiological herniation of the fetal bowel occurs. The midgut protrudes into the base of the umbilicus, and undergoes a 90-degree anticlockwise rotation. When the abdominal cavity enlarges enough to fit the developing midgut, the intestines undergo another 180-degree rotation before returning to the abdominal cavity.
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This question is part of the following fields:
- Embryology
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Question 3
Correct
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Regarding Human Papillomavirus, what percentage of women develop antibodies?
Your 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 4
Correct
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A 21 year old patient presents to the clinic with a 48 hour history of unprotected sexual intercourse. She is not on any form of contraception. After discussion you prescribe a dose of Ulipristal 30 mg stat. Which of the following would be the appropriate advice regarding vomiting?
Your Answer: If vomiting occurs within 3 hours a repeat dose should be taken
Explanation:Ulipristal acetate is a selective progesterone receptor modulator which regulates the luteinizing hormone (LH) surge, preventing ovulation. This emergency contraceptive can be used up to five days after unprotected sexual intercourse and is given as a 30mg oral dose. If vomiting occurs within three hours, then a second tablet is needed to ensure its effects.
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This question is part of the following fields:
- Clinical Management
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Question 5
Incorrect
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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 6
Correct
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When the presenting part of the foetus is at the level of ischial spines, this level is known as?
Your Answer: Station 0
Explanation:Station 0 – This is when the baby’s head is even with the ischial spines. The baby is said to be engaged when the largest part of the head has entered the pelvis.
If the presenting part lies above the ischial spines, the station is reported as a negative number from -1 to -5. -
This question is part of the following fields:
- Obstetrics
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Question 7
Correct
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Which of the following is known to increase the risk of endometrial cancer?
Your Answer: PCOS
Explanation:The risk factors of endometrial cancer include obesity, diabetes, late menopause, unopposed oestrogen therapy, tamoxifen therapy, HRT and a family history of colorectal and ovarian carcinoma.
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This question is part of the following fields:
- Epidemiology
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Question 8
Incorrect
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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: Combined oral contraceptive pills
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 9
Correct
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You review a 28 year old patient in the fertility clinic. She has a diagnosis of PCOS. She has been trying to conceive for 2 years. Her BMI is 26 kg/m2. She is a non-smoker. She has been taking Clomiphene and metformin for the past 6 months. What is the next most appropriate treatment?
Your Answer: Gonadotrophins
Explanation:Clomiphene shouldn’t be continued for more than 6 months. The second line options are Gonadotrophins or ovarian drilling.
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This question is part of the following fields:
- Clinical Management
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Question 10
Correct
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A 27-year-old woman presents to the clinic. She explains she has had 2 episodes of postcoital bleeding. Her previous medical history reveals she is currently taking the oral contraceptive pill (OCP) and has never had an abnormal pap smear, including one that was performed a year ago. What is the most probable cause of her postcoital bleeding?
Your Answer: A cervical ectropion
Explanation:The most likely cause of her postcoital bleeding is cervical ectropion as suggested by her postcoital bleeding, normal pap smears and use of oral contraceptive pills.
Cervical ectropion is a benign condition that occurs as a result of overexposure to oestrogen. Here, glandular cells (the columnar epithelium) lining the endocervix, begin to grow on the ectocervix, leading to exposure of the columnar cells to the vaginal environment.
These columnar cells are prone to trauma and bleeding during coitus.
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This question is part of the following fields:
- Gynaecology
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Question 11
Correct
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A 28 year old patient is treated for hydatidiform mole with methotrexate. What is the mechanism of action of methotrexate?
Your Answer: Inhibits dihydrofolate reductase
Explanation:Methotrexate is a folic acid antagonist. It inhibits dihydrofolate reductase (DHFR). DHFR catalyses the conversion of dihydrofolate to the active tetrahydrofolate which is required for DNA synthesis. It is either administered as a single intramuscular injection or multiple fixed doses.
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This question is part of the following fields:
- Clinical Management
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Question 12
Correct
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A 24-year-old on combined oral contraceptive pills for the last 3 years. She complains of migraine two to three times a month for the last 6 months. What should be best appropriate advice to her?
Your Answer: Stop combined oral contraceptive pills and prescribe progestogen only pills
Explanation:While on combination oral contraceptive tablets, this patient had a migraine. After a conversation about adverse effects, stop the combo medications and prescribe her progestogen-only pills.
The following are reasons why progestogen-only pills should be your first choice:
1-Age of 45 or more years
2-Smokers who are 45 years old or older
3-Oestrogen contraindications
4-Melitus Diabetes
5-A headache (combined oral contraceptive pills have absolute contraindication)
6-Hypertension under control
7-Lactation
8-Chloasma.Pregnancy, undetected genital tract bleeding, and concurrent use of enzyme-inducing medications are all contraindications to using progestogen-only pills.
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This question is part of the following fields:
- Gynaecology
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Question 13
Correct
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Polyhydramnios is associated with which one of the following conditions?
Your Answer: Tracheo-oesophageal fistula
Explanation:Oesophageal atresia/TE fistula may be suspected prenatally with ultrasound findings of polyhydramnios, absence of fluid in the stomach, small sized abdomen, or the presence of a dilated proximal oesophageal pouch. 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 14
Incorrect
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In the 3rd trimester anaemia is defined by?
Your Answer: Haemoglobin < 110 g/l
Correct Answer:
Explanation:Anaemia in pregnancy is defined by the British Committee for Standards in Haematology (BCSH) guidance: 1st trimester Hb < 110 g/l 2nd and 3rd trimester Hb < 105 g/l Postpartum Hb less than 100 g/l
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This question is part of the following fields:
- Clinical Management
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Question 15
Incorrect
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A 30-year-old woman at 32 weeks of gestation is discovered to have a positive group B Streptococcus vaginal swab. Which of the following is considered the most appropriate treatment for the patient?
Your Answer: Penicillin
Correct Answer: No treatment needed before labour
Explanation:About 1 in 4 pregnant women carry GBS bacteria in their body. Doctors should test pregnant woman for GBS bacteria when they are 36 through 37 weeks pregnant.
Giving pregnant women antibiotics through the vein (IV) during labour can prevent most early-onset GBS disease in newborns. A pregnant woman who tests positive for GBS bacteria and gets antibiotics during labour has only a 1 in 4,000 chance of delivering a baby who will develop GBS disease. If she does not receive antibiotics during labour, her chance of delivering a baby who will develop GBS disease is 1 in 200.
Pregnant women cannot take antibiotics to prevent early-onset GBS disease in newborns before labour. The bacteria can grow back quickly. The antibiotics only help during labour.
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This question is part of the following fields:
- Obstetrics
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Question 16
Correct
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The most common aetiology for spontaneous abortion of a recognized first trimester gestation:
Your Answer: Chromosomal anomaly in 50-60% of gestations
Explanation:Chromosomal abnormalities are the most common cause of first trimester miscarriage and are detected in 50-85% of pregnancy tissue specimens after spontaneous miscarriage.
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This question is part of the following fields:
- Obstetrics
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Question 17
Correct
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The arterial blood supply to the bladder is via branches of which artery?
Your Answer: Internal Iliac
Explanation:The bladder is supplied by branches of the internal iliac artery, including the superior vesical artery, branches of the gluteal and obturator arteries and the inferior vesical artery in males and the vaginal and the uterine arteries in females.
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This question is part of the following fields:
- Anatomy
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Question 18
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 19
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 20
Correct
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A 19-year-old girl, with menarche at age 12, presents with a 2-year duration of severe dysmenorrhea. Analgesia with paracetamol, panadeine as well as indomethacin did not provide much relief. The girl is very concerned that the underlying cause could be something sinister. What is the most likely cause of her dysmenorrhea?
Your Answer: Endometrial prostaglandin release.
Explanation:It is less common for a girl of this age to develop fibroids, endometriosis and endometrial polyps, although these are all causes of severe dysmenorrhea. Chronic pelvic infection can be due to sexually transmitted disease but the history does not mention any previous episodes of pelvic pain or symptoms of infection such as fever. In this case, it is most likely that she has primary dysmenorrhea. Primary dysmenorrhea, in which no pathological cause can be identified, is believed to be due to the prostaglandins released by the secretory endometrium. If secondary dysmenorrhea is suspected, then endometriosis would be the most prominent cause.
While hysteroscopic and laparoscopic examinations are commonly done in adult women to rule out organic causes such as those mentioned earlier, in younger girls, they are usually only carried out if pain management with, for example, NSAIDs and the use of COCPs, have failed to either provide symptom relief or reduction.
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This question is part of the following fields:
- Gynaecology
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Question 21
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 22
Correct
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Raised FSH levels are found in all of the following conditions, EXCEPT:
Your Answer: Women on combined oral contraceptive pills
Explanation:Oestrogen- and progesterone-containing oral contraceptives inhibit LH, which suppresses the FSH and LH levels, preventing follicular development and ovulation. Combined pills suppress FSH and LH throughout the cycle, inhibit endometrial proliferation, and produce a scanty cervical mucus.Â
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This question is part of the following fields:
- Endocrinology
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Question 23
Correct
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Regarding oogenesis & ovulation:
Your 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 24
Correct
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The first stage of labour:
Your Answer: Ends with fully dilation of the cervix
Explanation:First stage of the labour starts with the contractions of the uterus. With time, the no. of contractions, its duration and intensity increases. It ends once the cervix is fully dilated.
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This question is part of the following fields:
- Obstetrics
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Question 25
Correct
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Where is fetal DHEA produced?
Your Answer: Adrenals
Explanation:Dehydroepiandrosterone (DHEA) is a steroid hormone synthesised from cholesterol (via Pregnenolone) by the adrenal glands. The foetus manufactures DHEA, which stimulates the placenta to form oestrogen, thus keeping a pregnancy going. Production of DHEA stops at birth, then begins again around age seven and peaks when a person is in their mid-20s
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This question is part of the following fields:
- Endocrinology
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Question 26
Correct
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A 27-year-old woman with primary infertility presents with secondary amenorrhoea that has been ongoing for twelve months. She states that she has been thinking about starting a family and was wondering if ovulation induction therapy was an option for her. Which one of the following would be most valuable in predicting a poor response to ovulation induction therapy?
Your Answer: Serum follicle-stimulating hormone (FSH).
Explanation:The tests listed can all be performed during the work-up of a woman with secondary amenorrhoea. They are useful in that they cam diagnosis the most likely cause for the amenorrhoea as well as guide the treatment required if the patient wanted to become pregnant. Of these, the hormone test best able to predict a poor response to ovulation-induction therapy is the follicle-stimulating hormone (FSH) assay. If there are high levels of FSH, most of the ovulation-induction therapies are ineffective, although the rare spontaneous pregnancy can occur.
To maximise the chance of pregnancy in patients with elevated FSH levels, the most effective technique is an ovum donation from a young woman. The ovum would be fertilised in the laboratory and transferred to the uterus of the woman with the high FSH level after administering hormonal preparation of her uterus.
If the FSH level is normal, ovulation-induction therapy is usually effective. For these patients, correction of thyroid function will be necessary if the thyroid function is not normal. Dopamine agonist therapy is indicated if the prolactin level is elevated. Clomiphene or gonadotrophin therapy can be used where the luteinising and oestradiol levels are low, normal, or minimally elevated.
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This question is part of the following fields:
- Gynaecology
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Question 27
Incorrect
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Fibrinogen is activated by which of the following?
Your Answer: Tissue Factor
Correct Answer: Thrombin
Explanation:Fibrinogen is activated by thrombin which converts it into fibrin which forms a mesh to trap red blood cells and form a clot.
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This question is part of the following fields:
- Biochemistry
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Question 28
Correct
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A 34-year-old woman presents with pelvic pain and complains of dysmenorrhea and menorrhagia. She has been using an IUCD for one year now and wants to know the cause of her current condition. What is the most likely cause?
Your Answer: PID
Explanation:IUCD is a risk factor for PID and PID has the clinical picture already described. However, fibroids should also be excluded since they may present in the same way.
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This question is part of the following fields:
- Gynaecology
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Question 29
Incorrect
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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 30
Incorrect
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All of the following statements are true regarding Turner's syndrome except?
Your Answer: Have female internal genitalia
Correct Answer: The streak ovaries should be removed surgically due to 25% tendency to be malignant
Explanation:Girls with Turner’s syndrome (45,X) are not at risk for malignancy. Patients with feminizing testicular syndrome with XY chromosome composition and patients with mixed gonadal dysgenesis are at risk for malignancy, and bilateral gonadectomy is performed.
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This question is part of the following fields:
- Embryology
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SESSION STATS - PERFORMANCE PER SPECIALTY
