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Question 1
Incorrect
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You are asked to review the early pregnancy ultrasound scan of a 27 year old lady. The transvaginal ultrasound results show a gestational sac of 26mm with no fetal pole and no fetal heartbeat. Which of the following is the most likely diagnosis?
Your Answer: Pregnancy of uncertain viability
Correct Answer: Miscarriage
Explanation:Ultrasound findings in early pregnancy can help determine the viability of an intrauterine pregnancy. In the absence of a fetal heartbeat and no visible fetal pole, the mean gestational sac diameter should be measured. A sac diameter of less than 25mm on a transvaginal ultrasound scan is likely an indication of a miscarriage. In the presence of a fetal heartbeat, the crown-rump length should be less than 7mm according to NICE guidelines. Further scans are indicated 14 days later to confirm the diagnosis. The diagnosis of ‘pregnancy of uncertain viability’ is given in situations where there is inadequate ultrasound evidence to diagnose a miscarriage, such as a developing sac but no visualisation of a foetus with a heartbeat.
Ultrasound findings for partial molar pregnancy are an enlarged placenta with multiple diffuse anechogenic patches, while findings in a complete molar pregnancy include an enlarged uterus with multiple small anechogenic spaces (snowstorm appearance), or the bunch of grapes sign representing hydropic trophoblastic villi. -
This question is part of the following fields:
- Data Interpretation
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Question 2
Correct
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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 3
Correct
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A 32 year old patient has a transvaginal ultrasound scan that shows a mass in the left ovary. It is anechoic, thin walled, is without internal structures and measures 36mm in diameter. What is the likely diagnosis?
Your Answer: Functional cyst
Explanation:The diagnosis of functional ovarian cyst is made when the cyst measures more than 3 cm and rarely grows more than 10 cm. It appears as a simple anechoic unilocular cyst on USS. It is usually asymptomatic. If it is symptomatic then laparoscopic cystectomy should be performed.
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This question is part of the following fields:
- Data Interpretation
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Question 4
Incorrect
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The transvaginal ultrasound of a 37 year old woman reveals a left ovarian mass. The mass is a unilocular cyst with diffuse homogenous ground glass echoes as a result of hemorrhagic debris. Which of the following is the most likely diagnosis?
Your Answer: Germ cell tumour
Correct Answer: Endometrioma
Explanation:An endometrioma, also known as a chocolate cyst is a benign ovarian cyst that occurs as a result of the trapping of endometriosis tissue inside the ovary. The findings on transvaginal ultrasound are often a unilocular cyst, with ground glass echogenicity due to haemorrhage. Other benign masses that can be evaluated using transvaginal ultrasound are functional cysts, serous and mucinous cystadenomas and mature teratomas.
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This question is part of the following fields:
- Data Interpretation
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Question 5
Incorrect
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A 31 year old is being seen in EPU and you are asked to review her ultrasound. There is a solid collection of echoes with numerous small (3-10 mm) anechoic spaces. What is the likely diagnosis?
Your Answer: Partial Molar Pregnancy
Correct Answer: Molar Pregnancy
Explanation:This is typical appearance of molar pregnancy. This used to be referred to as ‘snowstorm sign’ as with older poorer resolution ultrasound the anechoic species looked like a snowstorm.
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This question is part of the following fields:
- Data Interpretation
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Question 6
Correct
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Question 7
Correct
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Regarding CTG (cardiotocography) analysis what is the normal range for variability?
Your Answer: 5-25 bpm
Explanation:Fetal hypoxia may cause absent, increased or decreased variability. Other causes of decreased variability include: normal fetal sleep-wake pattern, prematurity and following maternal administration of certain drugs including opioids.
Variability Range:
Normal – 5 bpm – 25bpm
Increased – >25 bpm
Decreased – <5 bpm
Absent – <2 bpm -
This question is part of the following fields:
- Data Interpretation
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Question 8
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 9
Incorrect
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A patient who has been seen in fertility clinic phones regarding the timing of her progesterone blood test. She has regular 35 day menstrual cycles. When testing for ovulation what day of her cycle should she have the test on?
Your Answer: 21
Correct Answer: 28
Explanation:When testing for ovulation the best test is to check the progesterone level. The mid luteal progesterone levels should be checked 7 days prior to the next period. That will be the 28th day in a 35 day cycle.
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This question is part of the following fields:
- Data Interpretation
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Question 10
Incorrect
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Question 11
Correct
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A 16 week pregnant patient presents to the antenatal clinic. Protein values of ++ are found on urinalysis. Significant proteinuria is indicated in which of the following protein:creatinine values?
Your Answer: 30 mg/mmol
Explanation:Proteinuria of more than 1+ on dipstick should be investigated to quantify the amount of proteinuria. A protein: creatinine ratio can be used to determine the severity of proteinuria, where levels of more than 30 mg/mmol indicate significant proteinuria.
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This question is part of the following fields:
- Data Interpretation
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Question 12
Correct
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A 29 year old patient has a transvaginal ultrasound scan that shows a mass in the left ovary. It is anechoic, thin walled, is without internal structures and measures 36mm in diameter. What is the likely diagnosis?
Your Answer: Functional cyst
Explanation:Features of functional ovarian cysts on ultrasound are: Thin walled and unilocular Must be >3cm diameter (if <3cm described as follicle) Anechoic (absence of internal echoes) No colour flow No solid components
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This question is part of the following fields:
- Data Interpretation
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Question 13
Correct
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What is the lower reference limit for sperm concentration according to the WHO criteria?
Your Answer: 15 million spermatozoa per ml
Explanation:WHO guidelines
Semen volume: Greater than or equal to 1.5 ml
pH: Greater than or equal to 7.2
Sperm concentration: Greater than or equal to 15 million spermatozoa per ml
Total sperm number: 39 million spermatozoa per ejaculate or more
Total motility (% of progressive motility and nonprogressive motility): 40% or more motile or 32% or more with progressive motility
Vitality: 58% or more live spermatozoa
Sperm morphology (percentage of normal forms): 4% or more -
This question is part of the following fields:
- Data Interpretation
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Question 14
Correct
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A patient who is 12 weeks pregnant is being seen in the antenatal clinic. Urinalysis shows protein ++. A 24 hour urine collection is organised. Greater than what level would indicate significant proteinuria?
Your Answer: 300 mg over 24 hours
Explanation:pre-eclampsia is defined as hypertension of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hour collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive woman and resolving completely by the sixth postpartum week.
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This question is part of the following fields:
- Data Interpretation
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Question 15
Incorrect
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A patient who has been seen in fertility clinic phones regarding the timing of her progesterone blood test. She has regular 35 day menstrual cycles. When testing for ovulation what day of her cycle should she have the test on?
Your Answer: 21
Correct Answer: 28
Explanation:The mid-luteal progesterone sample should be taken 7 days before the expected period i.e. day 21 in a 28-day cycle or day 28 of a 35 day cycle
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This question is part of the following fields:
- Data Interpretation
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Question 16
Correct
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A midwife is concerned regarding CTG changes and suggests a fetal blood sample (FBS). At what dilatation would you NOT perform FBS?
Your Answer: Less than 3cm
Explanation:Fetal Blood Sampling (FBS) should only be performed when the cervix is >3cm dilated.
Indications for FBS:
1. Pathological CTG in labour
2. Suspected acidosis in labourContraindications to FBS
– Maternal infection e.g. HIV, HSV and Hepatitis
– Known fetal coagulopathy
– Prematurity (< 34 weeks gestation)
– Acute fetal compromiseInterpretation of FBS results:
pH >7.25 = Normal -Repeat in 1 hour if CTG remains abnormal
7.21 to 7.24 = Borderline – Repeat in 30 minutes
<7.20 = Abnormal - Consider delivery -
This question is part of the following fields:
- Data Interpretation
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Question 17
Correct
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Question 18
Correct
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Question 19
Correct
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What is the normal range for variability in cardiotocography (CTG) analysis?
Your Answer: 5-25 bpm
Explanation:Cardiotocography, also known as the non-stress test is used to monitor fetal heartbeat and uterine contractions of the uterus. An abnormal CTG may indicate fetal distress and prompt an early intervention. Variability refers to the variation in the fetal heartbeat form one beat to another. Normal variability is between 5-25 beats per minute while an abnormal variability is less than 5 bpm for more than 50 minutes, or more than 25 bpm for more than 25 minutes.
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This question is part of the following fields:
- Data Interpretation
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Question 20
Correct
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A 45 year old women has a transvaginal ultrasound that is reported as showing 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:Dermoid cysts and teratomas contain elements from multiple germ cell layers. They are often considered the same entity (even in medical texts) however a dermoid is composed only of dermal and epidermal elements. A teratoma has mesodermal and endodermal elements Mature teratomas are composed of well-differentiated derivations from at least 2/3 germ cell layers (i.e. ectoderm, mesoderm, and endoderm). They contain developmentally mature skin complete with hair follicles, sweat glands, sometimes hair, and sometimes sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue.
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This question is part of the following fields:
- Data Interpretation
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Question 21
Correct
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You are called to a delivery as the midwife is concerned about CTG changes. She suggests a fetal blood sample (FBS). You inspect the cervix. At what dilatation would you NOT perform FBS?
Your Answer: Less than 3cm
Explanation:Indications for FBS:
1. Pathological CTG in labour (cervix dilated >3 cm)
2. Suspected acidosis in labour (cervix dilated >3 cm)
Contraindications to FBS:
– Maternal infection e.g. HIV, HSV and Hepatitis
– Known fetal coagulopathy
– Prematurity (< 34 weeks gestation)
– Acute fetal compromise -
This question is part of the following fields:
- Data Interpretation
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Question 22
Correct
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A 31 year old is being seen in EPU and you are asked to review her ultrasound. There is a solid collection of echoes with numerous small (3-10 mm) anechoic spaces. What is the likely diagnosis?
Your Answer: Molar Pregnancy
Explanation:Gestational trophoblastic disorder is characterized by an abnormal trophoblastic proliferation and include a complete and partial mole. It is characterized by persistently elevated BHCG levels after pregnancy and on ultrasound a snow storm appearance. These appear as anechoic areas on ultrasound.
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This question is part of the following fields:
- Data Interpretation
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Question 23
Correct
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Question 24
Incorrect
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You are called to see a 24 year old patient who is currently in labour but is failing to progress. A fetal blood sample is sent for analysis. pH is 7.22. Which of the following is the appropriate course of action?
Your Answer: Repeat in 30 minutes if CTG remains abnormal
Correct Answer: Consider delivery
Explanation:A normal pH value is above 7.25. A pH below 7.20 is confirmation of fetal compromise. Values between 7.20 and 7.25 are ‘borderline’.
The base deficit can also be useful in interpretation of the fetal scalp pH. A base excess of more than -10 demonstrates a significant metabolic acidosis, with
increasing risk of fetal neurological injury beyond this level. Delivery should be considered. -
This question is part of the following fields:
- Data Interpretation
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SESSION STATS - PERFORMANCE PER SPECIALTY
