Question 116#

Which one of the following is the most common cause of recurrent first trimester spontaneous miscarriage?

A. Factor V Leiden gene mutation

Correct Answer E: Antiphospholipid antibodies (aPL) are present in 15% of women with recurrent miscarriage, but in comparison, the prevalence of aPL in women with a low risk obstetric history is less than 2%.

Antiphospholipid syndrome: pregnancy:
Antiphospholipid syndrome is an acquired disorder characterized by a predisposition to both venous and arterial thromboses, recurrent fetal loss and thrombocytopenia. It may occur as a primary disorder or secondary to other conditions, most commonly systemic lupus erythematosus (SLE).

In pregnancy the following complications may occur:

• Recurrent miscarriage
• IUGR
• Pre-eclampsia
• Placental abruption
• Pre-term delivery
• Venous thromboembolism

Management: 

• Low-dose aspirin should be commenced once the pregnancy is confirmed on urine testing
• Low molecular weight heparin once a fetal heart is seen on ultrasound. This is usually discontinued at 34 weeks gestation
• These interventions increase the live birth rate seven-fold

Question 117#

Which foramen does the maxillary nerve go through?

A. Jugular foramen

Correct Answer E: 

Foramina of the skull:
Questions asking about foramina of the skull have come up in the exam in previous years. Below is a brief summary of the major foramina.

 

Question 118#

A 59-year-old man presents with a severe pain deep within his right ear. He feels dizzy and reports that the room 'is spinning'. Clinical examination shows a partial facial nerve palsy on the right side and vesicular lesions on the anterior two-thirds of his tongue.

What is the most likely diagnosis?

A. Meniere's disease

Correct Answer C: Ramsay Hunt syndrome:
Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.

Features:

• Auricular pain is often the first feature
• Facial nerve palsy
• Vesicular rash around the ear
• Other features include vertigo and tinnitus

Management:

• Oral acyclovir and corticosteroids are usually given

Question 119#

Which layer of the epidermis are melanocytes found in? 

A. Stratum lucidum

Correct Answer B: Epidermis - 5 layers - bottom layer = stratum germinativum which gives rise to keratinocytes and contains melanocytes.

Epidermis:
The epidermis is the outermost layer of the skin and is composed of a stratified squamous epithelium with an underlying basal lamina.

It may be divided in to five layers: 

Question 120#

Which one of the following foods is the best source of folic acid?

A. Cheese

Correct Answer C: Folic acid is also present in green vegetables and nuts.

Folate metabolism:
Drugs which interfere with metabolism:

• Trimethoprim
• Methotrexate
• Pyrimethamine

Drugs which can reduce absorption:

• Phenytoin