Mini Mock Test 1-module Part 2
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1) MRI provides high contrast between different
You are called to see a woman to assess her perineum after a normal delivery. You diagnose a fourth degree perineal tear. How will you repair the internal anal sphincter (IAS)?
The correct answer is the IAS should be repaired using interrupted PDS sutures. It is crucial to identify whether the internal sphincter is involved. Once identified, it should be sutured separately from the external sphincter using 3/0 polydiaxanone (PDS). The external anal sphincter can be sutured with PDS: the technique of 'overlapping' or 'end to end approximation' has been shown to have the same outcome.
3) Which of the following is the most related to endometrial carcinoma?
4) A 15-year-old girl is seen in the paediatric gynaecology clinic due to persistent vaginal discharge. Examination reveals the following: Partial removal of the clitoris and the prepuce is noted. The hymen is intact. The possibility of female genital mutilation (FGM) is raised. What type of FGM is this?
Partial or total removal of the clitoris and/or the prepuce (clitoridectomy). Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).
5) All the following are correct on the ruptured uterus except:
The management options include total or subtotal hysterectomy or a simple repair of the dehiscence.
Lower uterine segment rupture is the most common site and it may extend to the bladder or laterally into the broad ligament. Posterior rupture of the uterus is uncommon.
6) a lady who as type 1 fgm currently pregnant in her 2nd trimester , she is requesting cs because she is worried of the sight of bld and make her recall the fgm incident , what would be your action ?
7) 17 years old lady presented to gynae ER with incomplete miscarriage , on examination she has mild pain but bleeding has settled , you noticed that she has fgm with infibulation , what would be your action ?
If FGM is confirmed (on examination or if the patient or parent says it has been done), refer as a matter of urgency to the police and this should be done within 1 month of confirmation.
8) A woman attends the antenatal clinic at 36 weeks of gestation. It is her first baby and she wants to know if she will have an episiotomy and what are the potential benefits. Compared with second degree tear, what is the benefit of mediolateral episiotomy?
Correct answer: It may decrease the incidence of third degree perineal trauma during instrumental deliveries The correct answer is it may decrease the incidence of third degree perineal trauma during instrumental deliveries. Note that: there is some suggestion that episiotomy increases the risk of anterior perineal tears. Selective use of episiotomy compared with its routine use during a vaginal birth is associated with lower rates of posterior perineal trauma, less suturing and fewer healing complications but can be associated with higher rates of anterior vaginal and labial trauma episiotomy can require less suturing material and time when compared with a second degree perineal tear
9) Misoprostol is a commonly used drug in the medical management of miscarriage. What type of drug ismisoprostol?
10) which organ/system involved with krukenberg tumor of the ovary?
11) A woman presents to delivery suite in active labour at 40 weeks of gestation. She mentions that she had an elective caesarean section with her last child for breech presentation. The cardiotocograph is normal for 40 minutes, followed by fetal bradycardia. What clinical feature is most likely to be present in uterine rupture?
The correct answer is haematuria, which occurs in 25% of cases. Pain is the classical symptom but only occurs in 8% of cases. Blood-stained liquor is present in 4% of cases. Uterine hyperstimulation is a risk factor for uterine rupture but cessation of contractions is more likely when rupture has occurred. Elevation of a previously engaged presenting part occurs in uterine rupture.
12) A 17-year-old girl attends the gynaecology outpatient with complaints of irregular periods. She migrated to the UK with her family a year back and gives history suggestive of female genital mutilation (FGM). As a doctor practising in the UK, which of the following is an appropriate action for you as a gynaecologist?
Explanation Before defibulation, identification of the urethra should be attempted and a catheter passed. Incision should be made along the vulval excision scar. Cutting diathermy reduces the amount of bleeding. The use of fine absorbable suture material such as polyglactin 910 (Vicryl® Rapide, Ethicon) is recommended. Prophylactic antibiotic therapy should be considered. Defibulation can be carried out in the antenatal period or intrapartum. The decision should be made by a senior obstetrician with adequate experience in this field. If necessary, guidance should be sought from a centre that has developed expertise in the assessment and management of affected women. The technique for defibulation is described in the WHO document, management of pregnancy, childbirth and the postpartum period in the presence of female genital mutilation, which includes diagrams and photographs. Antenatal surgical correction should ideally be performed around 20 weeks of gestation to reduce the risk of miscarriage and allow time for healing before the birth. Women should be recommended to undergo defibulation before conception, especially if difficult surgery is anticipated. Gynaecology and maternity units with little experience of genital mutilation should consult with a centre that has developed expertise in the assessment and management of affected women. It must be remembered that defi bulation does not restore physical or emotional normality. Urine should be screened for bacteriuria before surgery. Blood should be sent for group and serum save because of the risk of haemorrhage. Defibulation may be carried out in any suitable outpatient room equipped for minor procedures or in an operating theatre. Ideally, the surgeon or midwife should have personal experience of defibulation. In emergency situations, senior obstetric help must be called.
13) 28 years old primigravida at 37 weeks of gestation came to ER with SROM , you noticed she had FGM type 3 , vaginal examination pass only 1 finger , her CTG is normal and she has no labour pain , what would be the most appropriate management ?
The health professional must be familiar with the requirements of the HSCIC FGM Enhanced Dataset and explain its purpose to the woman. The requirement for her personal data to be submitted without anonymisation to the HSCIC, in order to prevent duplication of data, should be explained. However, she should also be told that all personal data are anonymised at the point of statistical analysis and publication.
14) A 17-year-old girl attends the gynaecology outpatient with complaints of irregular periods. She migrated to the UK with her family a year back and gives history suggestive of female genital mutilation (FGM). As a doctor practising in the UK, which of the following is an appropriate action for you as a gynaecologist?
15) Which of the following dugs is a strong inducer of cytochrome P450?
16) You are the specialist registrar covering the labour ward. A 23-year-old patient had a history of female gennal mutilation with a deinfibulation at 25 weeks' gestation. You have just been informed that she is now insistlng that you reinfibulate her because otherwise she will not be accepted back into her society. What action will you take?
ans is A , reinfibulation is prohibited in UK
17) Which of the following is true?
The external anal sphincter contributes to 25% of the inherent anal tone. Button hole tears need to be documented as a separate entity. There is a role for conservative management if the patient is stable and the haematoma is non-expanding and small.
18) . Which two HPV types are found in 70% of cervical cancers and are targeted in HPV vaccines?
19) A 13 year old attends the Accident & Emergency department with bleeding, pain and urinary retention following a recent FGM.which vaccine would you advice the patient to receive?
Females admitted acutely after FGM should be assessed quickly for signs of acute blood loss and sepsis, offered analgesia and tetanus toxoid vaccination if this had not previously been administered.
20) patient asks you in clinic when she can start trying to conceive again. She has just completed chemotherapy for gestational trophoblastic disease (GTD)?
A 30-year-old woman presents to the antenatal clinic at 36 weeks of gestation. She had a previous vaginal delivery that was complicated by grade 3a perineal tear, which was repaired under spinal anaesthesia. She is asymptomatic and follow-up anorectal studies revealed no sphincter defects. She is concerned that she will sustain a further anal sphincter injury if she attempts a vaginal birth for delivery of this baby. How will you counsel her about the risks of delivery in her current pregnancy?
Correct answer: Anal incontinence may develop without overt sphincter injury at this delivery The correct answer is anal incontinence may develop without overt sphincter injury at this delivery. Current RCOG guidance for counselling women with respect to future birth recommends offering caesarean for women who are symptomatic or who have abnormal postnatal investigations. Elective episiotomy is not protective. Birthweight above 4000 g is a risk factor for anal sphincter injury. Studies suggest that incontinence may develop or worsen with subsequent vaginal delivery though it is undetermined whether previous sphincter injury is an independent risk factor in future vaginal birth.
A 22- year- old Sudanese is seen for booking in the antenatal clinic at 12 weeks. She is a primigravida and an ultrasound scan revealed a singleton pregnancy appropriate for gestation. She has history of female genital mutilation (FGM) and examination reveals Type II FGM. What would be the he most appropriate management?
Defibulation can be carried out in the antenatal or intra-partum. Antenatal defibrillation should be carried out around 20 weeks and is preferred as it reduces risk of inexperienced care as an emergency in labour. A senior obstetrician with adequate experience should perform the defibulation.
23) Which of the following will show hypertrophy:
36 years Old from Caribbean origin , she c/o of recurrent UTI while taking her sexual history she said she was never involved in a sexual relation before as she feels like that something blocking her from down below ! and this is making her fell (less of a women) ! she was very anxious during examination, there was a Type 2 FGM noticed while no introitus narrowing . otherwise her examination normal , investigations came back with no abnormality detected . infection rolled out . Next step in management?
Explanation FGM is illegal unless it is a surgical operation on a girl or woman irrespective of her age: a. Which is necessary for her physical or mental health.
b. She is in any stage of labour, or has just given birth, for purposes connected with the labour or birth. It is illegal to arrange, or assist in arranging, for a UK national or UK resident to be taken overseas for the purpose of FGM. It is an offence for those with parental responsibility to fail to protect a girl from the risk of FGM. If FGM is confirmed in a girl under 18 years of age (either on examination or because the patient or parent says it has been done), reporting to the police is mandatory, and this must be within 1 month of confirmation Which of The following are obstetric complications associated with female genital mutilation:
26) What is the most common site for tubal ectopic gestation? ( march 2015 )
27) You are seeing a Somalian woman in her fi rst pregnancy at 24 weeks of gestation. She has migrated to UK 5 years back with her husband. You are worried about the possibility of female genital mutilation. What would be an appropriate approach to this case?
Explanation Maternity units should adopt a process for questioning all women born in (or with recent ancestry of) those parts of the world associated with female genital mutilation.
This can be based on the family origin questioning (FOQ) used for haemoglobinopathy screening. Discussions must take into account language diffi culties, psychological vulnerability and cultural differences. Healthcare workers should actively demonstrate knowledge and respect. The consultation should include a psychological assessment, and referral to a psychologist should be discussed with the woman. Physical examination by an obstetrician or appropriately trained midwife or nurse should be strongly recommended to identify whether antenatal surgery would be beneficial. Physical examination should also be recommended to reassess women who have had a previous defi bulation, as some may have undergone a further infibulation. A diagram or medical photography (with consent) can be used to limit repetitive examinations, to aid explanations to the woman and to communicate with a hospital or clinic that has developed expertise in the assessment and management of women with genital mutilation. A preformatted sheet, including a predrawn diagram, should be considered for the identifi cation of the type of genital mutilation, need for antenatal defi bulation and planning of intrapartum care. Genital mutilation is not an absolute indication for caesarean birth unless the woman has such an extreme form of mutilation with anatomical distortion that makes defi bulation impossible. Decisions about delivery must take into account the psychological needs of the woman. Episiotomy should be recommended if inelastic scar tissue appears to be preventing progress, but careful placement is essential to avoid severe trauma to surrounding tissues, including bowel.
28) 34 yrs old with FGM has delivered vaginally, giving birth to a healthy baby boy. There was a tear at FGM scar tissue without bleeding. The woman requested to re-suture? With the meaning of restoring original infibulated shape) the most appropriate action. Options:
ans is F , TAKE CARE THAT if this lady had a baby girl you should then refuse her request and inform child safeguard service as well , as this baby girl is at risk of having fgm too
29) Which type of epithelium lines the lower urethra near the external urethral orifice? ( sept.2014 )
30) a lady presented with her 12 years old daughter complaining from menorrhagia that started after receiving some treatment , she mentioned that she is leaving for short vacation to one of the countries where fgm practice is common , she was asking if its safe to travel with her daughter , while you was taking your consultant advice you found our she has left , what should you do ?
Local Safeguarding Children Boards (LSCBs) have responsibility for developing inter-agency protocols and procedures for safeguarding. If in any doubt, health professionals must contact their named lead for safeguarding who will advise. The urgency of the referral will vary depending on the type of risk.
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