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Index
1- All gyna & obstetrics last year exams classified according to chapters..( 4 )
2- Examples of short questions.( 11 )
3- Mcqs & false or true questions on gyna & obstetrics classified according to chapters.( 18 )
4- Mcqs exams...(218)
Exam 1 ..(219)
Exam 2 ..( 227)
Exam 3 ..(232 )
Exam 4 ..(239)
2008
Contents
2- 2nd part
Examples of short questions
3- 3rd part
Mcqs & false or true questions on gyna & obstetrics classified according to chapters
4- 4th part
Mcqs exams
2008
1st part
A)Gynecology
1)Anatomy & Embryology
1-Congenital anomalies of Uters
96
99
2000
98
2002
2003
8-Embryology of Vulva
2003
98
99, 2001
2003
2006
2003
2004
98
2008
2007
96
14-Induction of ovulation
98
2003
98, 2007
2002
2000
2003
2002
98
2008
6-Uetrovaginal support
2002
7-Genital prolapse
-Recurrent Genital prolapse 2003, 2007
Causes of prolapse 96, 20048-Etiology & diagnosis of uterine prolapse 2006
9-Diagnosis & mang. Of old complete perineal tear
10-Pregnancy of RVF uterus
2006, 2007
2002
2001
2003, 2007
96
96
7)Oncology
1-Aetiological factors & diagnosis of uterine body carcinoma
95
95
2008
98, 2007
B)Obestetrics
1)Normal Pregnancy
1-Placental functions & morphology
2-D.D of Pregnancy
96
96
2003
2)Abnormal pregnancy
1-Ovarian pregnancy
95
2003
2003
2002
6-Accidental Hge
-Mang. 98
2008
2003
& Mang.
10-Polyhydramnios
98
98
11-Preeclampsia
-Cardiovascular changes in severe preeclampsia 2002
-Severe Preeclampsia 2002
-Diag. & TTT
2003
2006
3)Normal Labor
1-Mang. Of 2nd stage normal labor 96, 2004
2-Mang. Of 3rd stage normal labor 2007
3-Pain relief in labor 98
4)Malpresentation & Malpositioning.
1-Mang. Of persistent occipitotransverse
2-Deep transverse arrest of fetal head 96, 2003
3-Deep transverse arrest of fetal face.
2002
98
2008
2001
2000
2000
5)Abnormal Labor
1-Atonic postpartum haemorrage
2004
96
98, 2003
4-Retained placenta
2000
2002
2001
8-PROM
-Definition 2003, 2007
98
98, 2000
2002, 2007
2008
6)Fetus
1- IUFD
-Diag. & TTT 96
&
-Complications
2003
95
96
96
2006
2006
2003
7)Neonates
1-Neonatal asphyxia
2006
8)Operative
1-Epsiotomy
2-Indications & complications of craniotomy
96
96
2004, 2007
96
99
9)Miscellaneous
1-Amniocentesis, therapeutic & diagnostic values
10
2002
2008
2nd part
Short Questions
1-Differences between the upper and the lower uterine segments:
2-Cardiovascular changes with pregnancy
3-Urinary changes with pregnancy
4-Drug categories during pregnnacy according to FDA classification:
5-Causes of Bleeding in early pregnancy
6-AETIOLOGY OF SPONTANEOUS ABORTION
7-TYPES OF ABORTION
8-Management of:
- Threatened abortion:
- Inevitable abortion
- INCOMPLETE ABORTION
- missed abortion
- SEPTIC ABORTION
9-AETIOLOGY OF RECURRENT ABORTION (RPL)
10-Antiphospholipid Syndrome
11-MANAGEMENT OF CASES WITH RPL
12-Diagnosis of isthmic incompetence:
13-Treatment of isthmic incompetence:
14-AETIOLOGY of TUBAL PREGNANCY
15-PATHOLOGY of tubal Ectopic pregnancy
16-CLINICAL PICTURE of tubal Ectopic pregnancy
17-TREATMENT of TUBAL PREGNANCY
18-PATHOLOGY of hydatidiform mole:
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14
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15
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16
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3rd part
GYNa MCQs
Index
(1) *Anatomy & Embreology &Physiology 19
(2) * Amenorrhea . 29
(3) * Dysmenorrhea . 35
(4) *Abnormal genital tract bleeding 41
(5) * Ovulation and its disorders 51
(6) * Infertility & Hirsutism . 70
(7) * Displacements, traumatic lesions, urogynecology .. 76
*
Genitourinary fistula .. 76
URINARY INCONTINENCE . 82
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a)
b)
c)
d)
e)
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a)
Imperforate hymen
b)
Turner syndrome
c)
d)
Vaginal aplasia.
e)
Cervical atresia
26) What is the false about the congenital vaginal anomalies in females?
a)
b)
c)
d)
b)
c)
d)
b)
Has 5 ligaments.
c)
d)
e)
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g) Contain tubes, ligaments (round & ovarian), vessels, nerves and Wolffian remnants
h) All the contents are extraperitoneal
31) The ovary has the following characters except:
f)
j)
32) The non-pregnant cervix has the following anatomical features except:
e) One spindle shape canal with mucus folds [arbor vitae uteri]
f)
One cm length
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35) What is false in the effects of excess androgens in the adult female?
a) Atrophy of the secondary sex organs
b) Oligomenorrhea then amenorrhea
c) Hirsutism, deepening of the voice & clitoromegaly
d) All the above changes are irreversible
36) Normal menstruation is characterized by the followings except:
a) Regular every >3-5 weeks
b) Average duration 3-5 days (2-7 range)
c) Unclotted blood loss about 25-80 ml
d) The first one is menarche at age of 11-13 years
e) Usually it is asymptomatic [silent]
37) What is false in the following arteries of the genital organs ?
a)
b)
c)
The vaginal and the internal pudendal from the int. iliac [to the vagina
d)
The external pudendal from the int. iliac [to the vulva]
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b)
Enters the pelvis infront of the sacro-iliac joint and common iliac artery bifurcation
c)
At level of ischial spine passes medially and forwards under uterine artery
d)
g)
h)
i)
j)
b)
c)
d)
Has multiple blood supply [vaginal, uterine, vesical and rectal (mid. & inferior) arteries]
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a)
Uterine hypoplasia
b)
Cervical incompetence
c)
d)
Imperforate hymen
(2) * Amenorrhea,
1) The fallowings cause true amenorrhea [A] except:
(a) Alternations in hypothalamic-pituitary-ovarian axis
(b) Endometrial pathology
(c) Obstructed outflow tract
(d) Systemic disease [auxiliary factors]
2) What is false in the following definitions?
(a) Absence of menses up to age of 16 with developed secondary characters = primary one
(b) Absence of menses up to age of 14 without developed secondary sex characters = primary one
(c) Delayed period for 2 weeks = secondary type
(d) Missed periods for 3 cycles = secondary type
(e) Eumenorrhea means normal menstruation
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32
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28) A woman 38-year-old comes to gynecological clinic with amenorrhea 4 month, milky nipple discharge
with blurring of vision and persistent headache, by examination she has a normal sized uterus what is
the possibility?
(a) Pregnancy
(b) Pituitary macroadenoma
(c) Hypothalamic dysfunction
(d) Premature menopause
29) A woman 29 year old comes to you presented with uterine bleeding for 12 days after absent periods
for 3 cycles, by US examination she has an enlarged empty uterus with unilateral cystic ovary,
pregnancy test is negative what is the possibility?
(a) Ectopic pregnancy
(b) DUB (metropathia hemorrhagica)
(c) Threatened abortion
(d) Feminizing ovarian tumor
30) What is false in causes of galactorrhea [G]?
(a) Always pathological
(b) iatrogenic
(c) Prolactinoma
(d) Empty sella syndrome
31) Investigations of amenorrhea include:
(a) History and examination
(b) Laboratory
(c) Imaging technique
(d) Therapeutic tests
(e) All of above
32) What is false in evaluation of a girl with primary amenorrhea?
(a) Look for the height either normal or abnormal
(b) Look for the genital & somatic development
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(c) Do US, karyotyping pituitary necrosis due to severe g and hormonal assays
(d) Local examination is not needed
33) What is false in treatment of amenorrhea?
(a) Correction of the general factors as anemia ,obesity,
(b) Correction of the causal factors as removal of a tumor
(c) Cyclic estrogen and progestogen therapy for all cases
(d) Give ovulating drugs in cases with infertility
(3) * Dysmenorrhea,
1) Dysmenorrhea is:
(a) Heavy menstruation
(b) Painful menstruation
(c) Irregular menstruation
(d) Pain not related to menses
2) The common type of dysmenorrhea is:
(a) Crescendo (endometriosis)
(b) Membranous
(c) Spasmodic or congestive
(d) Ovarian
3) Spasmodic dysmenorrhea has the followings except:
(a) Intermittent lower abdominal colicky pain radiating to back
(b) Starts few hours premenstrual, persists for 1-3 days
(c) Maximum pains during the first menstrual day, then improves
(d) PV or PR examination pelvic pathology
4) Primary dysmenorrhea has the followings except:
(a) Starts with menarche
(b) Improves after labor
(c) Colicky pain may with low backache, nausea & vomiting an
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b- Excessive intake of aspirin and other anti-inflammatory drugs can increase the menstrual blood flow through coagulation
disturbance.
c- Luteal phase defect may present by infertility, habitual abortion or menorrhagia
d- Bleeding in cases of metropathia hemorrhagica is mild following period of amenorrhea.
e-The cycle length in a patient of menorrhagia is prolonged.
f- Pathological changes of the endometrium in cases of abnormal bleeding include endometrial polyps.
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E) Mental retardation.
11- A 50- year-old female complains of fewer periods recently. You might expect her:
A) FSH and LH to be high.
B) FSH and LH to be low.
C) FSH and estrogen to be high.
D) FSH and estrogen to be low.
E) FSH and progesterone to be low.
12- At the midpoint in the menstrual cycle, ovulation is triggered by a sudden seven-fold increase in the amount
of....................
A) estrogen
B) progesterone
C) LH
D) FSH
13- The average menstrual cycle is:
A) 14 days.
B) 18 days.
C) 24 days.
D) 28 days
14- Anovulatory cycles , all are true EXCEPT:
A) are typical of the early years after the menarche.
B) are associated with endometrial hyperplasia.
C) are a risk factor for ovarian cancer.
D) may be due to polycystic ovary syndrome.
E) are associated with menstrual cycles of variable length.
15- A Graafian follicle is one that:
A) is dormant, awaiting a signal to begin to develop
B) has already ruptured and released the ovum
C) is fully mature and ready to rupture
D) has been damaged through exposure to radiation or chemicals
16- What pituitary hormone(s) control ovulation and production of female hormones by the ovary?
A) estrogen
B) gonadotropin releasing hormone
C) human chorionic gonadotropin (HCG)
D) follicle stimulating hormone (FSH) and lutenizing hormone (LH)
E)progesterone
17- In a "typical" 28 day female reproductive cycle, on which day following the beginning of the menstrual period
is the level of luteinizing hormone most likely to be highest?
A) day 5
B) day 7
C) day 14
D) day 21
E) day 28
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D) The follicular phase of the menstrual cycle embraces menstruation and preovulation.
38- Which one of the following statements is false?
A) When the size of a secondary follicle becomes 2 cm, it is a Graafian follicle.
B) By day 6 of the menstrual cycle, usually one follicle is significantly larger than the others
C) A part of a Graafian follicle protrudes as a blister on the surface of an ovary.
D) Under the influence of an increasing concentration of LH, the preovulatory follicle produces estrogen at an
elevated rate.
E) Within 1-2 days prior to ovulation, the mature follicle produces a small amount of LH.
39- Which one of the following statements about preovulation and ovulation is false?
A) Follicles that secrete estrogens during preovulation stimulate cells of the stratum basalis to restore the stratum
functionalis via mitosis.
B) The endometrium and its arterioles and glands grow.
C) When the concentration of estrogens reaches a certain threshold, the hypothalamus is incited to release GnRH.
D) In response to GnRH, the adenohypophysis releases FSH, and not LH.
40- Which one of the following statements about day 14 of the menstrual cycle is false?
A) The surge of LH impels the preovulatory follicle to rupture and expel a 2nd polar body.
B) The surge of LH impels the preovulatory follicle to rupture and expel into the pelvic cavity a secondary oocyte that
is surrounded by a zona pellucida and corona radiata.
C) The secondary oocyte is usually swept into a uterine tube.
D) The positive feedback effect of estrogens on the hypothalamus and adenohypophysis is enhanced by
progesterone.
E) Following ovulation, the bleeding remnant of the Graafian follicle is a corpus hemorrhagicum.
41- Which one of the following statements is false?
A) Under the influence of LH, the corpus hemorrhagicum becomes a corpus luteum.
B) Postovulation typically continues from days 15-28 of the menstrual cycle.
C) The hormones that the corpus luteum secretes stimulates the secretion of GnRH, FSH, and LH.
D) Should the ovulated secondary oocyte not be fertilized, the corpus luteum regresses, and gonadotropins are
secreted. Hence, another menstrual cycle begins.
42- Which of these is an example of positive-feedback regulation in the endocrine system?
A) an increase in blood glucose causes an increase in insulin secretion; insulin moves glucose into cells
B) an increase in TSH causes an increase in thyroid hormone secretion; thyroid hormones inhibit TSH secretion
C) before ovulation, an increase in LH causes an increase in estrogen, which causes an increase in LH
D) an increase in TRH causes an increase in TSH secretion; thyroid hormone inhibits TRH secretion
E) an increase in blood calcium causes an increase in calcitonin secretion; calcitonin moves calcium into the blood.
43- Intracellular hormone receptors are located:
A) floating freely in the cytoplasm of target cells.
B) in the nucleus.
C) in the mitochondria.
D) in the endoplasmic reticulum.
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E) both a and b
44- Peptide hormones and protein hormones affect a cell by:
A) attaching to the chromosomes and altering the expression of the genes.
B) increasing the insulation provided by the myelin sheath.
C) attaching to receptors on the membrane of a cell.
D) entering the cell and being metabolized as a source of energy.
45- Which of the following is an Incorrect statement about human oogenesis.
A) One ovum is produced from each parent cell.
B) Primary oocytes can sit halted in prophase I for years.
C) After puberty begins, one primary oocyte, on average, reenters meiosis every 28 days.
D) One polar body is produced from each parent cell.
E) Meiosis II begins after a secondary oocyte is fertilized by sperm.
46- Which of the following statements about the menstrual cycle is False?
A) LH is produced by the pituitary in response to GnRH from the hypothalamus.
B) LH acts on the follicle, causing ovulation, around the 14th day of the cycle.
C) Birth control pills that contain estrogen and progesterone would inhibit the secretion of FSH by the pituitary.
D) The phase of menstruation at which pregnancy is most likely to occur is the secretory phase.
E) FSH and estrogen production are highest during days 25-28 of the menstrual cycle
47- Which structures controls the cyclic nature of the menstrual cycle?
A) oviducts and uterus
B) pituitary and testes
C) ovaries and umbilical cord
D) pituitary and ovaries
E) oviduct and thyroid
48- The primary function of progesterone in the menstrual cycle is to:
A) stimulate development of the egg.
B) stimulate development of the endometrium.
C) stimulate development of the corpus luteum.
D) stimulate development of the follicle.
E) trigger ovulation
49- What two hormones influence the development of the secondary sexual characteristics of the female?
A) testosterone and estrogen
B) androgen and estrogen
C) FSH and LH
D) progesterone and estrogen
E) testosterone and progesterone
50- Which one of the following statements about oogenesis is false?
A) Primordial germinal cells originate in ovarian epithelium.
B) Primordial germinal cells differentiate into oogonia.
C) Most oogonia experience atresia.
D) Oogonia develop into diploid oocytes.
E) <20% of the primary oocytes that exist in a newborn girl remain at puberty.
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days 1-5
days 6-13
day 14
days 15-28
56- Which of the following hormones is best associated with maturation of the egg?
A)
B)
C)
D)
E)
LH
FSH
HCG
testosterone
progesterone
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testes
ovary
pituitary
uterus
prostate gland
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65- The uterine cycle at day 12 would primarily be under the influence of:
A)
B)
C)
D)
E)
estrogen
progesterone
epinephrine
thyroxin
testosterone
66- When an egg erupts from a follicle, the chamber that remains and secretes hormones is the:
A)
B)
C)
D)
E)
oocyte
stroma
corpus luteum
primary follicle
corpus cavernosum
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C) gender identity
D) rearing
82- Which of the following causes a male mammal to develop an anatomy that looks like a female?
A) deficit of testosterone during puberty
B) deficit of testosterone during an early stage of development
C) exposure to a high level of estradiol during puberty
D) exposure to a high level of estradiol during an early stage of development
83- A female human fetus exposed to excess testosterone during the sensitive period for genital development:
A) is unaffected, since she has no receptors for testosterone.
B) will often develop without any sexual organs.
C) will often develop with genitals that appear intermediate between male and female genitals.
D) will often develop a complete, functioning, set of male reproductive organs.
84- Which of the following would cause a genetic female to develop a partly masculinized anatomy?
A) excessive levels of alpha-fetoprotein in her blood
B) exposure of her mother to stressful experiences late in pregnancy
C) exposure to less than the usual amount of estrogen during an early sensitive period
D) exposure to more than the usual amount of testosterone during an early sensitive period
85- Cryptomenorrhoea is associated with all EXCEPT:
A) Turners syndrome.
B) abdominal pain.
C) cone biopsy.
D) Manchester repair.
86- Which of the following is true of the menopause?
A) FSH & LH levels are elevated
B) FSH rises, while LH and oestradiol fall
C) Prolactin levels are elevated
D) HRT should always be offered
87- In testicular feminisation syndrome , all are true EXCEPT:
A) Karyotype XY
B) Secondary sexual characters include undeveloped pubic hair
C) Karyotype XXY and well developed uterus is a characteristic feature
D) Well developed breast is a characteristic feature
88- In idiopathic hirsutism, all are not true EXCEPT:
A) Clitoromegaly
B) Male type of baldness
C) Presence of uterus
D) Steroids are effective
89- In Klinefelter's syndrome, all karyotypes may be found EXCEPT:
A) XXYY
B) XY or XX
C) XXXY
D) XXY
90- Osteoporosis, all are not true EXCEPT:
A) Characteristically serum Ca is increased
B) Fracture Shaft of humerus is common
C) More common in women than in men
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E)
Uterus present
A)
B)
C)
D)
Sufficient estrogen
Normal ovarian function
Intact endometrium
Intact pituitary axis
113- In polycystic ovarian diseases, all of the following are seen except :
A) Increased LH/ FSH
B) Streak ovaries
C) Insulin resistance
D) Hirsutism
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114- Preferable treatment for 32 ys. old multipara with dysfunctional uterine bleeding (DUB) is :
A) Progestrogens
B) Danazol
C) Prostaglandins
D) Endometrial ablation
E) Hysteretomy
115- All are seen in testicular feminization syndrome except :
A) 46 XY
B) Primary amenorrhoea
C) Short stature
D) Vaginal pouch present
116- Among the following, which is a feature of testicular feminization syndrome :
A) XX pattern
B) Commonly reared as male
C) Well formed female internal genitalia
D) High testosterone levels
117- Which of the following is not typically associated with hirsutism:
A) panhypopituitarism
B) ovarian thecal cell carcinoma
C) elevated urinary 17-ketosteroids excretion in patients with adrenal carcinoma
D) elevated plasma levels of DHEA-S in patients with polycystic ovarian disease (PCOD)
118- Which of the following statements about congenital adrenal hyperplasia is not correct:
A) it never presents in adulthood
B) 21-hydroxylase deficiency is the most common defect
C) 21-hydroxylase deficiency can present as acute adrenal insufficiency
D) 17 -hydroxyprogesterone can be used to diagnose and monitor the treatment of 21- hydroxylase
deficiency
119- The following statements about the pituitary is not correct:
A) the posterior pituitary secrets oxytocin
B) LH, FSH, and TSH share the same common subunit
C) LH and FSH are secreted by the same cells in the pituitary
D) the most common tumour type in the pituitary secrets prolactin
120- Prolactinomas can be associated with the following except:
A) Oral Contraceptive pills
B) Excessive milk secretion
C) Increased size of sella tursica
D) Acromegaly
E) Infertility
121- Amenorrhoea can be seen in the following except:
A) Testicular feminization
B) Turner's syndrome
C) Pituitary tumours
D) Anorexia nervosa
E) Fibroid uterus
122- In Polycystic Ovary all are false except:
A) Decreased LH
B) Adrenal Hyperplasia
C) Failure of maturation of secondary sex characters
D) Oligomenorrhea
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123- A woman of 23 years presents with a 12 month history of amenorrhoea. Circulating FSH concentrations
measured at intervals of six weeks were 40 and 45 iu/L. The following statements are correct except:
A) The most likely diagnosis is premature ovarian failure.
B) The woman may conceive spontaneously.
C) The woman should be encouraged to take estrogen replacement to prevent osteoporosis.
D) There is an increased incidence of this condition following some forms of chemotherapy.
E) The woman may conceive following oocyte donation.
124- Concerning hormonal assessment in gynecological endocrinology ,the following statements are correct except:
A) Ovulation can be determined by measuring the circulating concentration of progesterone.
B) In a woman with a regular 35 day cycle, ovulation should be detected by measuring the
progesterone concentration on day 21.
C) Gonadotrophins (follicle stimulating hormone and luteinising hormone) should be measured in the
early follicular phase.
D) A prolactin concentration of > 200 ng/mL is suggestive of a pituitary macroadenoma
125- The following treatments are effective in reducing menstrual blood loss EXCEPT:
A) Non-steroidal anti-inflammatory agents.
B) Drugs that promote fibrinolysis.
C) Dilatation and curettage.
D) The levonorgestrel releasing intrauterine system.
126- Treatment with hormone replacement therapy, all are incorrect except:
A) Should always include a progestagen.
B) Reduces the incidence of cardiovascular disease in post-menopausal women.
C) Should not result in vaginal bleeding.
D) Is not given in presence of a uterus.
127- The typical sequence of pubertal events in adolescent girls is:
A) Thelarche, menarche accelerated growth, adernarche
B) Adrenarche, thelarche, menarche, accelerated growth
C) Thelarche, adernarche, accelerated growth, menarche
D) Adrenarche, accelerated growth, thelarche, menarche
E) Accelerated growth, thelarche, adrenarche, menarche
128- A 16 year-old girl is evaluated for primary amenorrhea. Physical examination reveals Tanner stage III breast and
pubic hair development with an absent vagina. The most likely diagnosis in this patient is:
A) Isolated gonadotropin deficiency
B) Androgen insensitivity syndrome
C) 5-reductase deficiency
D) XX pure gonadal dysgenesis
E) Mllerian agenesis
129- A 19-year-old nulligravid woman comes to you for evaluation. Her physical examination is significant for short
stature (height of 144 cm [57 in.]); a webbed neck; a high, arched palate, a broad chest with Tanner stage III
breast development, and Tanner state III pubic hair as well as secondary amenorrhea. You suspect a diagnosis of
Turners syndrome. This patients karyotype is most likely to be:
A) 45,X
B) 45,X/46,XX
C) 46,XY
D) 47,XXX
E) 46,XX
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130- A 53-year-old menopausal woman was prescribed combined estrogen-progestin therapy 1 year ago. She now
presents with a 1-month history of vaginal bleeding. On objective questioning, she says that she has taken only
the estrogen for the past 9 months because of fear of weight gain from taking the progestin. Her medical history
is significant for hypertension controlled with atenolol). Her hemoglobin is 12.3 g/dL. An endometrial biopsy
reveals adenomatous hyperplasia with moderate cytologic atypia .The most appropriate management for this
patient is:
A) observation off estrogen for 3 months
B) repeat endometrial biopsy in 3 months
C) oral medroxyprogesterone acetate therapy for 3 months
D) endometrial ablation
E) hysterectomy
131- A 57-year-old postmenopausal woman is referred for consultation after her primary care physician ordered
transvaginal ultrasonography to evaluate postmenopausal bleeding. Her Pap test result was normal. The
ultrasonogram reveals a maximal endometrial thickness of 3.7 mm. The best next step is:
A) endometrial biopsy
B) hysteroscopy
C) hysterosonogram
D) progestational therapy
E) observation
132- A 57-year-old woman with post-menopausal bleeding is referred by her family physician for assessment. Review
of her endometrial biopsy reveals simple hyperplasia without atypia. She is reluctant to have any medical or
surgical treatment unless it is absolutely necessary. You counsel her that the chances that this will progress to
endometrial cancer if left untreated is approximately:
A) 1-5%
B) 5-10%
C) 10-20%
D) 25-50%
E) >50%
133- Chromosomal configuration in Klinefelter's syndrome is:
A) 47, XY, + 21
B) 47, XXX
C) 47, XXY
D) 46, XY.
134- Conditions in which obesity is an associated feature include all, except:
A) Laurence Moon-Biedl syndoome .
B) Steven Leventhal syndrome
C) Grave's disease
D) Cushing's syndrome
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D) T.B. tubes.
(9)Neoplastic cysts of the ovary include:
A) Inclusion (Walthards) cysts.
B) Retention cysts.
C) Inflammatory cysts.
D) All of the above.
E) None of the above.
(10)Hirsutism in defined as:
A) Excessive growth of hair in an abnormal site for the female.
B) Increased muscle bulk.
C) Clitorial hypertrophy, breast atrophy and deepening of voice.
D) (A + B)
E) (A +B + C)
(11)Hair in the following areas is considered as hirsutism EXCEPT in:
A) Cheek.
B) Moustache area.
C) Arm.
D) Forearm.
E) Thigh.
(12)In a case of hirsutism with elevated serum DHEAS, one should suspect:
A) Ovarian neoplasm.
B) Polycystic ovary syndrome.
C) Suprarenal lesion.
D) Pituitary lesion.
(13)In luteal phase defect, the following procedure can be useful for diagnosis, Mark the WRONG statement:
A) Endometrial biopsy.
B) Basal body temperature.
C) Serum progesterone.
D) Ultrasonography.
E) None of the above.
(14)In Luteal phase defect the following drugs can be use for treatment, EXCEPT:
A) Progesterone.
B) Progesagens.
C) Clomphene citrati.
D) Human chorionic gonadotrophins.
E) Bromoergocriptine.
15. As regard of cervical factor of infertility, all are correct except :
a) Artificial insemination is a good treatment choice.
b) Clomiphene citrate therapy could be a cause.
c) Assessment of cervical mucus is done in day 18 of the cycle.
d) It is common in cases with secondary infertility.
16.As regard hyperprolactinemia, which is not true? :
a) Medication is a common cause
b) Bromocryptin is effective treatment
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30.Hirsutism:
A. Is excessive growth of androgen dependent hair.
B. Always reflects androgen overproduction.
C. The most common cause is androgen producing ovarian tumors.
D. Is commonly associated with oligohypomenorrhea or amenorrhea.
E. Hair removal has no place in treatment.
31. Hormonal measurement(s) required to differentiate ovarian from adrenal androgen:
A. Androstenedione
B. Free testosterone to total testosterone ratio.
C. Dihydrotestosterone (DHT).
D. Dehydroepiandrosterone (DHEA).
E. Dehydroepiandrosterone (DHEAS).
32. Treatment of hirsutism may include:
A. Combined oral contraceptive pills.
B. Danazol.
C. Progestins.
D. Cyproterone acetate.
E. Spironolactone.
33.A case of 2 years 1ry infertility of patient 22 years old with regular cycle, you will start work-up by:
a) Hysterosalpingography
b) Semen analysis
Laparoscopy
c)
d) Hysteroscopy
34.The followings are used in diagnosis of ovulation except:
a) Midluteal progesterone assay
b) Endometrial biopsy
Vaginal ultrasonography c)
d) Gysteroscopy
35. All of the following are correct for tubal infertility, except:
a) PID is a common cause.
b) Laparoscopy is a good diagnostic test.
c) Tuboplasty is the best treatment option.
d)
Enumerate :
1.Tests for detection of ovulation :
2.Criteria for normal semen analysis according to WHO :
3.Causes of luteal phase defect :
4.Investigations for a case with hyperprolactinemia with infertility :
5.Value of laparoscopy in infertile case :
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Give an account on :
Patients with PCOS at risk for development of luteal phase defect even if ovulating.
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21- A 43-year-old woman describes, dribbling of urine when standing up after completion of voiding. She says she
does not have urgency, frequency, or nocturia. She has had three episodes of cystitis diagnosed within the past
year. Physical examination reveals a 1 x 2- cm non tender swelling adjacent to the urethra approximately 2 cm
cephalad to the urethral meatus. The remainder of her examination is normal. Cystourethroscopy is performed
and does not identify an abnormality. The next step in the diagnosis of this patient is:
A) Voiding cystourethrography
B) Retrograde positive pressure urethrography
C) Intravenous pyelogram
D) Urethral pressure profilometry
E) Pessary
22- In the previous case , what is the possible diagnosis?
A) Cystocele
B) parauretheral abscess
C) Uretheral diverticulum
D) None of the above.
23- Urethral diverticulae, all are true EXCEPT:
A) Often multiple
B) Cause dyspareunia
C) Surgical excision is always required
D) May be congenital
E) May result from an abscess of the para-urethral tubules which bursts into the urethra
24- A 55 year old woman has recurrent urinary retention after a hysterectomy done for huge fibroid. The most likely
cause is:
A) Atrophic and stenotic urethra.
B) Lumbar disc prolapse.
C) Injury to the bladder neck.
D) Injury to the hypogastric plex.
25- Detrusor instability, all are false EXCEPT:
A) May occur de novo after bladder neck surgery
B) A pressure rise during filling of between 5-15 CmH2O
C) Always symptomatic
D) Implies a neurological disorder
26- The urethral syndrome , all are false EXCEPT:
A) Dysuria
B) Incontinence
C) Significant bacteriuria in over 50% of women
D) Urodynamic evaluation is useful
27- At the time of a difficult abdominal hysterectomy for fibroids and endometriosis, It is found that a clamp had been
Inadvertently placed on a ureter and that It had been there for at least 30 minutes before it was discovered:
A) The most frequent site of ureteral injury is at the infundibulopelvic ligament
B) Stricture or fistula formation is likely
C) If a high ureteric injury is found, direct end to end anastomosis is performed
D) Extraperitoneal drainage following repair
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28- The following may be used to assess the functioning of the proximal urethra and bladder neck EXCEPT:
A) Ultrasound
B) Uroflowmetry
C) Urethral electric conductance profile (UECP)
D) Bonney's test.
29- An extremely anxious 50-year-old woman presents to your office and complains of soaking her underpants when
arising in the morning. She also reveals that once initiated, she is unable to control micturition. The most likely
diagnosis is:
A) detrusor dyssynergia
B) urgency incontinence
C) urethral diverticulum
D) overflow incontinence
30- A woman has been anuric for the first 48 hours after undergoing abdominal hysterectomy. Bilateral ligation of the
ureters is suspected. Which of the following therapeutic measures should first be ordered?
A) Observation only
B) Ureteral catheterization
C) Rapid dialysis
D) Transabdominal deligation
E) Bilateral nephrostomy
31- If ureteral injury is recognized at the time of surgery, which of the following procedures could be recommended?
A) A longitudinal slit should be made in the ureter below the injury and a polyethylene tube threaded into the
bladder
B) If the ureter is not severed, the site of injury should be drained intraperitoneally
C) If the ureter is severed, ureteroureteral anastomosis should be attempted. regardless of the location of the injury
D) If possible, the severed ureter should be implanted into the bladder
32- During gynecological surgery, operative injuries to the ureter occur
A) more frequently in association with vaginal rather than abdominal hysterectomy
B) only rarely if periureteral tissue is dissected carefully
C) most commonly when the ureter lies between the anterior vaginal wall and the base of the bladder
D) often as a result of hasty reclamping of vessel clamps or ligatures
33- For each clinical description that follows, select the appropriate disorder:
1) A 45-year-old woman states that she has had increasing difficulty holding urine after feeling the need to void.
She occasionally loses urine when sitting down (E)
2) A 43-year-old woman, who recently underwent an anterior vaginal repair, complains of constant perineal
wetness and loss of urine while standing. She does not feel the urge to void ( D )
3) A 28-year-old diabetic woman reports that she loses large volumes of urine without warning. She says that she
can overcome the problem by frequent, voluntary emptying of the bladder ( A )
4) A 26-year-old woman, who has four children, is worried because her daily exercises seems to be causing
urinary dribbling ( C )
A) Neurogenic bladder
B) Overflow incontinence
C) Stress incontinence
D) Vesicovaginal fistula
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E) Urgency incontinence
34. A 60-year-old woman, gravida 5, para 5, presents with complaints of leaking urine
when she coughs and sneezes. She has not had constant wetness, urgency, or
frequency but has had some nocturia and several episodes of nocturnal enuresis. A
clean catch urine culture was negative for growth earlier this week at her internists
office. Her neurologic examination is within normal limits. A mild cystocele and
rectocele are noted on vaginal examination, and the vaginal epithelium appears
slightly atrophic. A cotton swab straining angle is 45 degrees. During the assessment, she leaks urine when coughing
with a full bladder Her post void residual volume is 30 mL. Initially, no fluctuation of the fluid level is noted on simple
office cystometry. However, during the bladder-filing phase, there is overflow of the water column soon
after the patient senses the urge to void. The clinical picture at this time is most consistent with
(A) Genuine stress urinary incontinence (GSUI)
(B) Overflow incontinence
(C) Mixed incontinence
(D) Detrusor instability
35.A 27year-old woman presents with a foul vaginal odor 7 days after a vaginal delivery complicated by a third-degree
perineal laceration. Examination reveals a 2-mm rectovaginal fistula 1.5 cm proximal to the vaginal introitus. The
correct initial management of this patient is
(A) Observation
(B) Closure of the rectovaginal fistula with a sliding rectal flap
(C) Fistulectomy with layered closure
(D) Closure with a bulbocavernosus fat pad (Martius) graft
(E) Diverting colostomy followed by a layered closure
36.A 43 year-old woman, gravida 2, para 2, undergoes a difficult total abdominal
hysterectomy for menorrhagia and an 18-week-sized leiomyomatous uterus.
Previous surgical history includes a myomectomy followed by 2 cesarean
deliveries. During dissection of the bladder off the lower uterine segment,
extravasation of urine is noted, and a 3-cm cystotomy is recognized above the
trigone. On completion of the hysterectomy, the gynecologist performs a 1-layer
cystotomy repair with absorbable suture. The most likely outcome over the next 8
weeks is
(A) Vesicovaginal fistula
(B) Ureteral obstruction
(C) A normal postoperative course
(D) Recurrent bouts of cystitis
(E) Intraperitoneal urinoma
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URINARY INCONTINENCE
1. Causes of urinary incontinence in the female include:
A. Stress incontinence.
B. True incontinence.
C. False incontinence.
D. Cervical incompetence.
E. Delayed puberty.
2. Normal mechanism of continence involves:
A. The sphincter at the uretero-vaginal junction.
B. The fascia around the sphincter.
C. Vascularity and edema of the urethral mucosa.
D. The intra-abdominal position of the lower urethra.
E. The intra-vesical pressure is higher than the intra-urethral pressure.
3. Incontinence of urine:
A. Is commonly associated with prolapse.
B. Stress incontinence is more common in older females.
C. May be related to repeated vaginal deliveries.
D. May be due to urethra-vaginal fistula.
E. Should be treated by surgery
4. Incontinence of urine may occur with:
A. A Vesico-vaginal fistula.
B. A uretero-vaginal fistula.
C. A urethra-vaginal fistula.
D. A urethral diverticulum.
E. Severe cystitis.
5. The most common cause of urinary incontinence in a menopausal female is:
A. Overflow incontinence.
B. Vesico-vaginal fistula.
C. Weakness of the fascia around the sphincter.
D. Urgency incontinence.
E. Nocturnal enuresis.
6. Stress incontinence:
A. Means that the patient has to strain to evacuate the bladder.
B. Is commonly associated with a stressful desire to micturate.
C. Is more common in multiparous women.
D. Occurs in all cases of prolapse.
E. Pelvic floor exercise is one of the lines of treatment.
7. Causes of stress incontinence include:
A. Repeated cesarean sections.
B. Postmenopausal atrophy of the fascia around the sphincter.
C. Excessive fibrosis around the bladder neck.
D. Prolonged stress.
E. Some antihypertensive drugs.
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(16)During cystoscopy, for true incontinence, the following is true, (Mark the WRONG statement:
A) Fistula appears as a hole in the bladder.
B) No hole is seen in the bladder wall in ureteric fistula.
C) Urine appears red-coloured after indigo-carmine test.
D) None of the above.
(17)Surgical operations for the repair of vesico-vaginal fistula include the following, ( Mark the WRONG
statement):
A) Dedoublement operation.
B) Saucerization operation.
C) Trans abdominal repair.
D) All of the above.
E) None of the above.
(18)The ureter is liable to injury in the following sites, EXCEPT:
A) During clamping of the infundibulo-pelvic ligament.
B) During clamping of the ovarian ligament.
C) During clamping of the uterine artery.
D) During clamping of the uterosacral ligament.
E) During clamping of the bladder pillars.
stress incontinence
1- The commonest cause of stress incontinence is:
A) Constipation
B) Raised intra abdominal pressure
C) Congenital weakness of sphincter
D) Childbirth trauma
E) Estrogen deficiency
2- Stress incontinence is recognised to occur with the following conditions EXCEPT:
A) Multiparity
B) Uterovaginal fistula
C) Previous pelvic surgery
D) Cystocoele
3- Stress urinary incontenence is characterized by involuntary loss of urine with all of the following EXCEPT:
A) Coughing
B) Exercising
C) Laughing
D) Sleeping
E) Sneezing
4- Diagnosis of genuine stress incontinence is made by which of the following before taking the patient for surgery:
A) History
B) Subjective demonstration of stress incontinence
C) Objective demonstration of stress incontinence
D) Urodynamic studies
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5- Treatment of choice for a 55 years old multipara with 3rd degree prolapse uterus with cystorectocele and stress
incontinence is:
A) Vaginal hysterectomy with pelvic floor repair
B) Kelly's repair
C) a) + b)
D) a) + colposuspension
6- Best treatment for severe stress incontinence without prolapse is:
A) Pelvic floor exercise
B) Kelly's repair
C) Burch colposuspension
D) MMK operation
E) Urethral collagen implant
7- In the treatment of stress incontinence, all are true EXCEPT:
A) Pelvic floor exercise.
B) An anterior repair may be useful in the presence of cystocele.
C) Colposuspension involves suturing the paravaginal tissues to the round ligaments.
D) The peritoneal cavity is not normally opened during colposuspension.
8- Stress incontinence in famales , all are false EXCEPT:
A) Is always due to urethral sphincter weakness
B) Is always associated with a cystocele
C) Physiotherapy may be indicated
D) An intravenous urogram is mandatory before surgery
9- A 35-year-old woman comes to the clinic for evaluation and management of her stress urinary incontinence
symptoms. She has a 9-month-old daughter, and would like to have another child in about 1 year. Her medical
history is significant only for hypertension. On evaluation, she has a mild cystocele, residual urine volume of 10
mL, normal urinalysis, a hypermobile urethra, and visible loss of urine in the standing position, with cough. She is
only interested in nonsurgical treatment options. The best management option is:
A) ring pessary
B) periurethral collagen injections
C) pelvic floor physiotherapy
10.A 36 years old lady presents with increasing leakage of urine since her last delivery which was 2 years ago leakage of
urine occurs on coughing ,sneezing or laughing . On examination there was no abdominal masses , vaginal examination
revealed mild uterine enlargement with 1st degree uterine prolapse and 1st degree R.V.F. uterus with moderate cystocele
and rectocele but failed to demonstrate any urinary leakage on coughing .
I) What others points should be evaluated by history taking:
a- patient gravidity & parity
b- mode of last delivery
c- the presence of rectal symptoms ( constipation).
d- The presence of chronic cough
e- All of the above.
II) What other points that should be evaluated by examination:
a- examination after reduction of the prolapsed structures.
b- Examination with partially full bladder
c- Examination in the standing position .
d- All of the above.
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4.M ark the wrong statement in the case of a third degree perineal tear:
A) Patient is incontinent to fluid and gaseous stools.
B) Vagina and anus are separated by a transverse band.
C) Patient complains of vagino uterine descent.
D) Corrugations around the anus are U-shaped ending is two lateral dimples.
5.During repair of a third degree perineal tear, the landmark of the torn external anal sphineter is:
A) Two dimples to the sides of the anus.
B) Lateral to the edges of the torn rectum.
C) The levator ani muscles.
D) None of the above.
6.Dieting, after repair of a third degree perineal tear, is:
A) Low-residue diet for three weeks.
B) High calorie/fibrous diet.
C) Routine diet.
D) Liquid diet for three weeks.
7.Repair of recto-vaginal fistula includes the of following:
A) Dedoublement operation.
B) Conversion to a third degree tear then repair.
C) Restin Noble operation.
D) Colostomy then repair.
E) All of the above.
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B. Chancroid.
C. Gonorrhea.
D. Tuberculosis.
E. Rodent ulcer.
16. Swellings of the vulva may be:
A. Congenital hypertrophy of the labia.
B. Imperforate hymen.
C. Hematoma of the vulva.
D. Edema due to pelvic congestion.
E. Bartholin's abscess.
17. Swellings arising in the vulva may be:
A. Condylomata acuminata.
B. Brenner tumor.
C. Sebaceous cyst.
D. Dermoid cyst.
E. Fibroid polyp.
18. Swellings arising in the vulva may be:
A. Endometrioma.
B. Fibroma.
C. Primary carcinoma of the vulva.
D. Metastases from choriocarcinoma.
E. Desmoid tumor.
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30- Malignant neoplasms of the vulva ,the following are true EXCEPT:
A) Most are squamous in type
B) There are suspicious groin nodes palpable in stage II disease
C) The verrucous type. has a poor prognosis
D) Groin node dissection can be dispensed in all lesions where the depth of invasion is less than 5 mm
40- Recognised complications of radical vulvectomy and bilateral groin dissection include all EXCEPT:
A) Osteitis pubis
B) Inguinal hernia
C) Paraesthesia over the anterior surface of the thigh
D) Thromboembolic disease
E) Varicose veins
41- In patients with carcinoma of the vulva, lymphatic drainage characteristically:
A) is to the periaortic nodes
B) is to the superficial inguinal lymph nodes and from the clitoral region to the deep femoral lymph nodes
C) bypasses the deep femoral lymph nodes
D) None of the above
42- Melanoma of the vulva, all are false EXCEPT:
A) constitutes 2 to 9 percent of most series of vulvar cancer
B) occurs mostly in the fifth decade
C) occurs mostly in premenopausal women
D) has an overall survival rate of 70 percent
E) is non aggressive
43- A woman is found to have a unilateral, invasive vulvar carcinoma that is 2 cm in diameter but that is not
associated with evidence of lymph node spread. Initial management of this woman most likely would consist of:
A) chemotherapy
B) radiation therapy
C) simple vulvectomy
D) radical vulvectomy
E) radical vulvectomy and bilateral inguinal lymphadenectomy
44- Which of the following statements can characterize epidermoid carcinoma of the vulva?
A) It is associated with an increased incidence of epidermoid carcinoma of the endocervix
B) It is seen less frequently than adenocarcinoma
C) It tends to develop in women who are younger than those affected by adenocarcinoma
D) It tends to be more advanced when diagnosed than adenocarcinoma
45- Lichen sclerosis is characterized by all EXCEPT:
A) blunting or loss of the rete ridges
B) development of a homogeneous subepithelial layer in the dennis
C) a band of chronic inflammatory infiltrate below the dermis
D) an increase in the number of cellular layers in the epidermis
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(9) * Endometriosis
(1)Endometriosis means the presence of endometrial tissue in the following, EXCEPT:
A) In the lining of the uterine cavity.
B) Within the muscle layer of uterus.
C) In an ovarian cyst.
D) Within the peritoneum.
(2)Adenomyosis may be Associated with the following, EXCEPT:
A) Dysmenorrhaea.
B) Menorrhogia.
C) Amenorrhoea.
D) Infertility.
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B) Postcoital bleeding.
C) Chronic pelvic pain.
D) Vaginal WET smear.
E) Abnormal Pap. Smear.
(6)In Schillers Iodine test, the following is true, EXCEPT:
A) Schillers positive areas are stained brown.
B) Schillers positive areas are not stained brown.
C) Not all positive areas are malignant or premalignant.
D) Schillers positive areas are to be biopsied.
(7)In CIN the following is true EXCEPT:
A) CIN I has irrigular enlarged nuclei with abnormal mitosis.
B) CIN III includes severe dysplasia and carcinoma in situ.
C) CIN III lesions gradually blend will the adjacent normal epithelium.
D) Histological examination is needed to exclude active metaplasia.
E) CIN may involve the cervical glands.
(8)Cellualr atypia involving the basal cervical epithelium and more than one half of epithelial thickness is:
A) Adenocarcinoma.
B) Microinvasive carcinoma.
C) CIN II.
D) Carcinoma in situ.
E) Invasive squamous cell carcinoma.
(9)In 40-year-old patient, clinically normal but with Pap. Smear High Grade Squamons lntraepithelial lesion, H-SIL,
is managed by:
A) Fractional curettage.
B) Reexamination with colposcope-directed biopsy.
C) Repeat Pap-smear.
D) Punch biopsy.
E) Immediate hysterectomy
(10)Unsatisfactory Pap. Smear may b e due to:
A) Missing endocervical sampling.
B) Severe vaginitis.
C) Extensive malignant necrosis.
D) Misreading.
E) All of the above.
(11)In Pap-smear, false-negative results are found in:
A) Less than 10%.
B) 25%.
C) 50%.
D) More than 50%.
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D) Endocervical involvement-detection
E) Suitable for large lesions.
F) All of the above.
(26)Following is true, about coinization, EXCEPT
A) Needs general anesthesia.
B) May be followed by cervical stenosis.
C) Compromizes cervical function.
D) Risky if done during pregnancy (abortion, bleeding).
E) Adequate for treatment of adenocarcinoma in-situ.
(27)Conization is not always curative. The risk of recurrence of cervical malignancy after conization is:
A) 5%.
B) 10%.
C) 20%.
D) 30%.
E) 50%.
(28)CIN may progress to invasive carcinoma, within ten years in up to which percentage of patients:
A) 5%.
B) 30%.
C) 60%.
D) 80%.
E) 100%.
(29)CIN, may regress spontaneously:
A) True
B) False
(30Most cervical cancers arise in:
A) Internal os.
B) Endocervical canal.
C) Squamocolumnar junction.
D) Isthmus.
E) External os.
(31)In cervical adenocarcinoma, there is.. EXCEPT:
A) Incidence 15 20% of all cervical carcinoma.
B) Manifests early in tumour-life.
C) Cervix is barrel-shaped, rock-hard on palpation.
D) May develop after DES exposure.
E) May be seen in children 12 years old.
(32)In clinical-stage I cervical carcinoma, lymph node involvement is present in:
A) Less than 1%.
B) 5%.
C) 15%.
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D) 25%.
E) 50%.
(33)In micro-invasive cancer cervix (Stage IA), lymph node involvement is found in:
A) Less than 1%.
B) 5%.
C) 15%.
D) 25%.
E) 50%.
(34)Cancer cervix with parametric involvement not reaching the pelvic wall, and bilateral hydronephrosis due to
ureteric obstruction by malignant tissue is staged as:
A) Stage O.
B) Stage IA
C) Stage IB.
D) Stage IIA
E) Stage IIB
F) None of the above.
(35)Cancer cervix with involvement of the upper third of vagina ONLY, and at cystoscopy, bullous oedema of the
bladder is found. It is stage:
A) O.
B) I
C) IIA.
D) IIB.
E) III.
F) IV.
(36)Prognosis and clinical behaviour of cervical adenocarcinoma as compared to squamous carcinoma, stage to stage
are:
A) Same.
B) Worse.
C) Better.
(37)Cancer cervix infilterating the stroma to a 7 mm depth with vascular space involvement is stage as:
A) O.
B) IA1.
C) IA2
D) II.
E) III.
F) IV.
(38)All following statements are true as regards prognosis of cervical corcinoma EXCEPT:
A) Age of patient.
B) Histological type.
C) Vascular space involvement.
D) Histological grade.
E) It depends only on staging of cancer cervix.
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B) T.B ulcer.
C) Ectopoy.
D) Ectropion.
E) Cancer.
F) All of the above.
(46)43-year old woman, with normal pelvic findings and suspicious Pap. Smear, shows invasive carcinoma of the
cervix on colposcopically-dircted biopsy. Next management is:
A) Cone biopsy.
B) Hysterectomy (radical).
C) Metastatic evaluation.
D) Irradiation.
E) Both irradiation and radical hysterectomy.
(47)Limitations of cryosurgery for CIN include the following EXCEPT:
A) Does not allow for histological tissue sampling
B) Does not deal with endocervical lesions.
C) Painful procedure.
D) Not suitable for lesions > 1 cm.
E) High failure rate (6 32%) and in CIN III it is 20 40%.
(48)Side Effects of Cryocautery are:
A) Uterine cramping.
B) Light headedness.
C) Dizziness.
D) Excessive watery discharge.
E) All of the above.
(49)Laser treatment of CIN suffers the following disadvantages:
A) High cost.
B) Special training.
C) Not superior to cryotherapy with lesions < 1 cm.
D) All of the above.
E) None of the above.
(50)Following statements are true as regards laser vaporization of CIN, EXCEPT:
A) Uses carbon dioxide.
B) Done without general anaesthesia.
C) Obviates the need for biopsy.
D) Can destroy up to 7 mm depth.
E) 90% cure rate.
(51)In LEEP (loop Electrosurgical Excision Procedure), the following statements are true, EXCEPT:
A) High power (35 55 watts) is used.
B) Tiny loop (0.5 mm).
C) There is little thermal damage.
D) Electron flow will create high velocity steam current which will cut in tissues.
E) Suitable for large CIN lesions.
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E) (a + b).
F) (a + C)
G) (b + c).
(59)Mark the true step in radical hysterectomy:
A) Dissection is carried down to the deep inginal nodes.
B) The uterine vessels are ligated medial to the ureters.
C) The common iliac nodes are removed.
D) Ureter is dissected FREE from pelvic brim to bladder.
(60)In radical hysterectomy, which statement in INAPPROPRIATE:
A) Suction drainage of the pelvic floor reduces the incidence of lymphocyst formation.
B) Bladder atony is common after operation.
C) The obturator nerve is rarely seen.
D) Genito-femoral nerve is frequently damaged.
E) The superior vesical artery is not ligated.
(61)In stage I cervical carcinoma, the ovaries SHOULD be removed:
A) Yes.
B) No.
(62)Radiotherapy of cancer cervix is associated with the following EXCEPT:
A) Reduced incidence of lymph-node involvement at subsequent lymphadenectomy.
B) More effective in cases of adenocarcinoma than in squamous cell carcinoma.
C) Megavoltage therapy has a lower incidence of skin damage than autovoltage (200 300 Kv).
D) Point A is 2 cm above the lateral fornix and 2 cm lateral to the central canal of the cervix.
E) Oestrogen therapy prevents vaginal atrophy.
(63)The most common post-operative complication of radical hysterectomy is:
A) Intra-operative death.
B) Genito-urinary fistula.
C) Bowel injury.
D) Premature menopouse.
(64)The following procedures can be performed for cases of cancer cervix with pregnancy less than 20 weeks EXCEPT:
A) Repeated Pap. Smear.
B) Expert colposcopy.
C) Conization.
D) I.V.P. for staging.
E) Cystoscopy for staging.
(65)During early pregnancy (less than 20 weeks), cancer cervix (stage Ib and more) is treated by:
A) Expectant treatment till viability.
B) Conization and follow-up till viability.
C) As in the none pregnant state.
D) All of the above.
E) None of the above.
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(66)Criteria to treat micro-invasive cervical carcinoma by conization include the following EXCEPT:
A) Microinvasim 3 mm.
B) No vascular space involvement.
C) Desire to preserve fertility.
D) Margins are free from CIN.
E) All of the above.
F) None of the above.
(67)In terminal carcinoma, which of the following is true:
A) It is painless.
B) Lung and/or liver secondaries are common.
C) Requires urinary diversion.
D) Pelvic exentraion is done.
E) Intrathecal alcohol injection is recommended.
68. Risk factors of cervical carcinoma include:
A. Prolonged unopposed effect of estrogen.
B. Nulliparity or low parity.
C. Infection with HPV.
D. Early age of marriage.
E. Late menopause.
69. Cervical intraepithelial neoplasia (CIN):
A. Arise from the squamo-columnar junction.
B. May regress spontaneously.
C. Usually become invasive within 1-2 years.
D. Appear as a red area on the ectocervix.
E. May be completely treated by conization.
70. Cervical intraepithelial neoplasia (CIN):
A. Is also known as ectropion.
B. Is usually asymptomatic.
C. May present with contact bleeding.
D. May present with intermenstrual bleeding.
E. May present with vaginal discharge.
71. Microinvasive carcinoma of the cervix:
A. May be diagnosed by cervical smear.
B. May invade to a depth of 5 mm.
C. Has a maximum width of 7 mm.
D. May invade lymphatic channels.
E. Is treated by Wertheim's operation.
72. Spread of carcinoma of the cervix commonly includes:
A. The ureter.
B. The parametrium.
C. The obturator lymph nodes.
D. The inguinal lymph nodes.
E. The vagina.
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87- Which one of the following is not associated with cervical carcinoma?
A) Multiple sexual partners
B) Human papilloma virus (HPV)
C) Young age at first sexual intercourse
D) Intrauterine contraceptive devices (IUCDs)
88- In cervical cancer Stage Ib, which of the following is true?
A) Tumor has spread to adjacent organs.
B) Tumor involves the lower one-third of the vagina
C) Clinically apparent lesion involving only the cervix.
D) Tumor has spread to the upper two-thirds of the vagina and does not involve the parametria.
89- A 42-year-old woman comes for her routine annual examination. She has recently been divorced, and she
acquired a new sexual partner within the past 6 months. She has no history of abnormal Pap test results. Her
examination is unremarkable, but her Pap tests result indicates atypical squamous cells of undetermined
significance (ASCUS). The most appropriate management is:
A) Repeat Pap test in 6 months
B) Colposcopy
C) Viral testing for human papillomavirus (HPV) subtype
D) Screening of new partner for HPV
90- A 26-year old woman who is at 12 weeks of gestation comes for a follow-up visit after her Pap test result at 8
weeks of gestation showed a low-grade squamous intraepithelial lesion (LSIL). The next step in management
should be :
A) Cone biopsy
B) Loop electrosurgical excision procedure (LEEP)
C) Colposcopy
D) No further procedure until after delivery
91- A 46-year-old woman presents with postcoital bleeding. Pelvic examination reveals a large fungating cervical
lesion, 8 cm in maximum diameter, with parametrial extension on the right. Cervical biopsy demonstrates
moderately differentiated squamous cell carcinoma with lymphovascular space involvement. Baseline laboratory
studies reveal a normal serum creatinine and normal blood urea nitrogen, serum hemoglobin of 11.2 mg/dL, and
normal liver function. Chest X-ray shows no evidence of disease, and computed tomography scan shows no
evidence of lymphadenopathy or liver disease. The patient is fully active and able to engage in her usual daily
activities. The currently recommended therapy for her is:
A) whole abdominal radiation therapy
B) pelvic radiation therapy followed by brachytherapy
C) cisplatin (Platinol) chemotherapy concurrent with pelvic radiation therapy followed by brachytherapy
D) pelvic radiation therapy followed by extrafascial hysterectomy
E) radical abdominal hysterectomy followed by pelvic radiation therapy followed by
Brachytherapy
92- Cancer of the cervix, all are true EXCEPT:
A) has reduced in incidence due to cervical screening programmes
B) cigarette smoking is a risk factor
C) the incidence is inversely related to social class
D) is usually adenocarcinoma
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100- The time scale within which the 50% of the patients with recurrent disease will present, following treatment for
stage IB cervical cancer. Choose the single most likely time or time-interval:
A) 12 months
B) 24-36 months
C) 3-10 yrs
D) 30 years
E) 45 years
101- Regarding Wertheim's hysterectomy
A) Only palpably enlarged lymph nodes are removed.
B) It is the treatment of choice for Stage III carcinoma of the cervix.
C) The ovaries can be conserved.
D) It can be followed by adjuvant radiotherapy.
102- Cervical Polyps, All are true except:
A) are commonly pre-malignant
B) are associated with abnormal bleeding
C) may be fibroids
D) can cause postcoital bleeding
103- The Cervical Smear, all are false EXCEPT:
A) should be performed routinely every five years
B) may show evidence of endometrial cancer
inflammatory" smears should be repeated after three years
D) accurately reflects cervical pathology
104- Early symptoms of invasive cancer of the cervix may include all EXCEPT:
A) Increased vaginal discharge
B) Leg pain
C) Postcoital bleeding
D) Metrorrhagia
105- Occult invasive cervical cancer, all are false EXCEPT:
A) Is stage Ib
B) Associated with microinvasive carcinoma on pathological assessment
C) Rarely is associated with lymph node metastasis
D) Cannot be diagnosed by colposcopy
106- In cervical cancer , all are true EXCEPT:
A) The potential of rnicroinvasion depends on confluence
B) The potential of rnicroinvasion depends on volume
C) If endothelial lined channels contain tumour, then lymphatic spread is likely to have occurred
D) Where the depth of invading nests of cells exceed 5 mm then cone biopsy is warranted
107- In the treatment of stage Ib carcinoma of the cervix by Wertheim's hysterectomy, all are not true EXCEPT:
A) associated with a urinary fistula rate of 10%
B) cause bladder atonia
C) associated with survival rates of about 80% if only one to four pelvic lymph nodes are involved
D) Not associated with femoral nerve damage
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108- A 25-year old nulliparous woman is referred from her general practitioner with an abnormal smear, This could
mean all of the following EXCEPT:
A) That the smear is unsatisfactory
B) That there are inflammatory changes
C) That there is cervical intraepithelial neoplasia (CIN)
D) That there is a human papilloma virus (HPV) type 3 infection
109- Colposcopy , all are not true EXCEPT:
A) Acetic acid coagulates protein in the nuclei and cytoplasm
B) Only areas of intraepithelial neoplasia appear white
C) In CIN grade III the intercapillary distance is decreased
D) An abnormal vascular pattern suggests invasive disease
E) Columnar epithelium stains dark brown with Schiller's iodine
110- The following are characteristic features of HPV infection EXCEPT:
A) Koilocytic atypia
B) Multinucleation
C) No abnormal mitotic figures
D) Nuclear abnormalities in the basal layers
111- The following statements are not true concerning treatment of CIN EXCEPT:
A) The best long-term success rates have been reported using laser therapy
B) To be effective local destruction to depth of 10 mm is required
C) Cone biopsy is indicated where there is colposcopic suspicion of an invasive lesion
D) No long-term follow-up is required if hysterectomy is performed
112- Management of invasive cancer of the cervix, all are not true EXCEPT:
A) In stage Ib tumours the size of the tumour has little relevance to the 5-Year survival
B) In stage II disease there is extension of the tumour from the cervix into the uterine cavity
C) Barrel-shaped endocervical lesions have a worse prognosis than cervical cancers of a similar stage
D) Adenocarcinoma of the cervix has a poorer survival stage for stage than squamous lesions
113- Pelvic exenteration is contraindicated where:
A) There is unilateral leg edema and sciatica
B) There is pelvic fibrosis
C) The patient is sexually active
D) There is central recurrence after radiotherapy
114- A patient in her first trimester of pregnancy is diagnosed with invasive cervical cancer. Treatment would include:
A) waiting until after delivery before treatment
B) frequent pap.smear through gestation
C) Termination of the pregnancy and concomitant or subsequent radiation or surgery as soon as possible)
D) delivery by cesarean section at term
E) radiation only
115- Most deaths from cervical carcinoma can be attributed to:
A) local extension
B) metastasis to the centra! Nervous system
C) metastasis to the liver and lungs
D) iatrogenic causes
E) none of the above
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116- An exentration procedure for recurrent cervical cancer would include all of the following EXCEPT:
A) removal of the bladder
B) removal of the uterus
C) removal of the symphysis
D) removal of the rectum
E) removal of the pelvic nodes
117- Carcinoma in situ of the cervix is characterized by all of the following EXCEPT
A) involvement of the entire thickness of the squamous epithelium
B) cells resembling those of invasive carcinoma
C) evidence of stromal invasion
D) complete loss of stratification
E) occasional regression and disappearance
118- An intravenous pyelogram showing hydronephrosis in the work-up of a cervical cancer otherwise confined to a
normal size cervix would mean
A) stage I
B) stage II
C) stage III
D) stage IV
E) none of the above
119- True statements about clear cell adenocarcinoma of the cervix and vagina include the following EXCEPT:
A) It has been related lo prenatal DBS exposure
B) It shows a hobnail pattern on microscopic examination
C) It usually appears as an exophytic lesion
D) Affected women are best treated with radiotherapy
120- A patient presents with a Pap smear showing mild dysplasia. The next steps in management would include which
of the following?
A) hysterectomy
B) repeat Pap smear
C) cone biopsy
D) colposcopy
121- Cervical carcinoma is considered invasive when there are all of the following EXCEPT:
A) a breakthrough of the basement membrane
B) penetration of the stroma
C) involvement of the lymphatics
D) involvementoftheendocervical glands
E) All of the above
123- Studies show that cervical cancer is associated with which of the following?
A) early first coitus
B) incidence of cigarette smoking
C) nulliparity
D) use of oral contraceptives
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124-As regarding cancer cervix Say true or false and explain why
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
s.
t.
u.
v.
w.
x.
y.
z.
aa.
bb.
cc.
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(3)The increased risk of developing cancer cervix in pill users is due to the following causes EXCEPT:
A) Early sexual life.
B) Multiple partners.
C) Glandular hyperplasia.
D) Sexual overactivity.
E) More susceptibility to contract sex-transmitted HSV2, HPV.
(4)When a cervical polyp is removed, the most important part to be examined is:
A) Tip
B) Base
C) Middle part..
(5)A pedunculated small reddish mass protruding outside the endocervix, may be:
A) Cancer cervix.
B) Granulomatous mass.
C) Adenomatons polyp.
D) All of the above.
E) None of the above.
(6)In a 50-year old patient, polypectomy is done for metrorrhagia, Which of the following is true.
A) Fracional curettage is not needed.
B) Fractional curettage is advisable.
C) Fractional curettage is mandatory.
(7)In acute cervicitis, the following treatment-modalities are true EXCEPT:
A) Limitation of sexual activity.
B) Proper antibiotics.
C) Analgesics.
D) Cauterization.
(8)With chronic cervicitis, which of the following is observed:
A) Angry red cervix.
B) Mucopurulent discharge.
C) Cervical erosion.
D) Nabothian follicle.
E) All of the above.
(9)Chronic cervicitIs, may be associated with the following EXCEPT:
A) Leucorrhoea.
B) Low abdominal pain.
C) Backache.
D) Menorrhagia.
E) Contact bleeding.
(10)Cervical T.B. is caused by which strain of T.B:
A) Bovine Mycobacterium.
B) Human mycobacterium.
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C) Avian mycobacterium.
D) Mycobacterium murine.
E) Mycobacterium vole.
(11)In Cervical T.B., which of the following is NOT TRUE:
A) The cervix is ulcerated, distorted and mimics malignancy.
B) There is slight bleeding precipitated by contact.
C) It predisposes to cancer cervix.
D) Pap. Smear and cervical biopsy are mandatory.
E) Endometrial curettage should be done.
(12)Cervical chancre is associated with the following EXCEP:
A) 2nd site of chancre in the female genital tract after vulva.
B) Ulcer with indurated base and punched-out edge.
C) Erosion covered with grey membranous exudates.
D) Painful.
E) Post-coital bleeding.
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33- Incidence of all of the following conditions are increased in tamoxifen users EXCEPT
A) Cervial dysplasia
B) Endometrial polyps
C) Endometrial hyperplasia
D) Uterine fibroids
E) Endometrial adenocarcinoma
34- Women with postmenopausal bleeding need endometrial sampling if the endometrium on TVS / USG is thicker
than:
A) 1mm
B) 2mm
C) 5mm
D) 8mm
E) 10mm
35- All of the following are known risk factors for development of endometrial carcinoma except:
A) Obesity.
B) Family History.
C) Use of Hormone Replacement Therapy
D) Early Menopause.
36- The peak age of presentation of endometrial carcinoma is:
A) 5-6 years
B) 10-20 years
C) 20-30 years
D) 50-60 years
E) 35-45 years 5 years
37- The times scale within which 80% of patients with recurrent disease will present following the treatment of a
Stage I tumour:
A) 5-6 years
B) 10-12 years
C) 2-3 years
D) 5 years
E) 2-3 months
38- Within this period, up to 80% of patients will be alive following radiotherapy for Stage I cancer of the
endometrium:
A) 5-6 years
B) 10-12 years
C) 5 years
D) 7 years
E) 2-3 months
39- The percentage of women who commonly present with both cervical and endometrial carcinoma:
A) <5%
B) <2%
C) 10-20%
D) 5-10%
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40- The percentage of women with stage IV cancer of the endometrium who will be alive after 5 years following
surgical exterentation:
A) <5%
B) 10-20%
C) <2%
D) 5-10%
41- Pyometra is a complication associated with all of the following conditions except:
A) Carcinoma of the vulva.
B) Carcinoma of the cervix.
C) Carcinoma of endometrium.
D) Pelvic radiotherapy.
42- Carcinoma of the uterine body, all are true EXCEPT:
A) The incidence is increasing
B) The prognosis for patients who develop endometrial cancer while on exogenous estrogen therapy is poor
C) 40% of cases of severe atypical hyperplasia will progress to an invasive carcinoma
D) Adenosquamous carcinoma has a poorer prognosis than a pure adenocarcinoma
43- Management of endometrial cancer, all are true EXCEPT:
A) stage II endometrial carcinoma should be managed by Wertheim hysterectomy
B) Peritoneal cytology is of no importance in this disease
C) Assessment must include fractional curettage
D) 5-10% of patients with a clinical stage I tumour have occult metastases in the ovary
E) The depth of myometrial invasion is associated with the grade of tumour
44- Cystic glandular hyperplasia of the endometrium, all are not true EXCEPT:
A) Progresses to endometrial cancer in 70% of cases
B) Crowding of glands is typically seen
C) There is no strormal proliferation
D) May be seen in dysfunctional uterine bleeding
45- In stage II carcinoma of the endometrium, all are false EXCEPT:
A) the length of the uterine cavity is less than 8 cm
B) the corpus and the cervix are involved
C) there is extension to involve the parametrium
D) there is extension to the ovaries
E) there is metastasis to the bladder
46- The primary mode of treatment for endometrial carcinoma confined to the uterine corpus is:
A) external beam radiation
B) intracavitary radium
C) hysterectomy
D) chemotherapy
E) progestin therapy
47- Fractional dilatation and curettage reveals endometrial carcinoma involving the cervix. This finding is:
A) of no prognostic significance
B) of some prognostic significance but does not require change in management
C) significant only if the cervical tumor is clinically obvious
D) significant even if the disease is present only microscopically
E) a contraindication for hysterectomy
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48- Women who have endometrial carcinoma most frequently present with which of the following symptoms?
A) Bloating
B) Weightless
C) Postmenopausal bleeding
D) Vaginal discharge
E) Hemoptysis
49- Young women whose mothers took diethylslilbesirol (DES) during pregnancy are most likely to develop which of
the following vaginal carcinomas?
A) Papillary adenocarcinoma
B) Squamous carcinoma
C) Carcinoma of the infantile vagina
D) Adenosquamous carcinoma
E) Clear cell adenocarcinoma
50- The class ofchemotherapeutic agents that is most effective in the management of women who have recurrent
endometrial carcinoma is:
A) antimelabolites
B) hormones
C) alkylating agents
D) Vinca alkaloids
E) antibiotics
51- Adenocarcinoma of the endometrium can be described by which of the following statements?
A) It is primarily a disease of postmenopausal women
B) The average age of affccied women is 10 years more than the average age of women who have cervical carcinoma
C) It has a more favorable prognosis than cervical cancer, with the 5 year survival rate approaching 75 percent
D) It is increasing in frequency relative to carcinoma of the cervix
E) All of the above
52- The spread of adenocarcinoma of the body of the uterus can be described by which of the following statements?
A) Distant organs, such as the liver are frequently involved
B) Dissemination is chiefly by way of the lymphatics
C) The tumor resembles cervical carcinoma in its frequency of disseminaiion
D) Direct extension is an important route ofdissemination
53- Women who have which of the following characteristics are at high risk for endometrial carcinoma?
A) Hypertension
B) Diabetes
C) Obesity
D) Familial history of endometrial carcinoma
E) All of the above
54- Evidence in evaluating cell types found in carcinoma of the endometrium suggests that:
A) poorly differentiated adenocarcinomas have a poor prognosis
B) adenoacanthomas have a poor prognosis
C) adenosquamous carcinomas have a good prognosis
D) adenosquamous tumors occur more often in young women
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55- For the management of women who have endometrial carcinoma, intracavitary radium has been employed
routinely
A) as a treatment for women who have ovarian metastases
B) as a treatment for women who have vaginal apical recurrences
C) as a treatment for women who have metastases of the pelvic sidewall
D) as primary therapy for operable patients
56- A 60 years old presented to a Gynecologist with an attack of post-menopausal bleeding for the 2nd time, the bleeding
attack was a mild one, she gave a history of liver problems, she is hypertensive 160/100 with echymotic patches. On pelvic
examination the uterus is symmetrically enlarged 8 weeks size of pregnancy.
57.What investigations should be done to this lady?
a) Blood sugar.
b) Abdominal ultrasound.
c) Liver functions.
d) Coagulations profile.
e) All of the above.
58.On doing vagianl ultrasound the endometrial thickness was found to be 8mm, give your recommendations about further
management.
a) Fractional curettage.
b) Hysterosalpingography.
c) Endometrial biopsy by Novak curette.
d) All of the above.
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w.
x.
y.
z.
aa.
bb.
cc.
(13) * Choriocarcinoma
1. Choriocarcinoma:
A. Usually follows an event of pregnancy.
B. A friable hemorrhagic polypoidal mass projects into the uterine cavity.
C. Shows early lymphatic spread.
D. The main presentation is bleeding.
E. The main method of investigation is ultrasonography.
2. Choriocarcinoma:
A. Is a malignant tumor of the trophoblast.
B. HCG always shows higher values than with vesicular mole.
C. Chest X ray is an essential investigative tool.
D. Cases following full term pregnancy are associated with poor prognosis.
E. Treatment always involves methotrexate.
3- Characteristic features of choriocarcinoma include which of the following:
A) Haematuria
B) Gastritis
C) Haemoptysis and vaginal bleeding
D) Haematemesis
4- All of the following are features of good-prognosis metastatic gestational trophoblastic disease except:
A) Serum beta-hCG of less than 40,000 mIU/mL.
B) Disease duration of less than four months.
C) Gestational trophoblastic disease following a normal term pregnancy.
D) No metastases to the brain or liver.
E) All of the above are features of good-prognosis gestational trophoblastic disease.
5- The treatment of choice for choriocarcinoma Is:
A) Methotrexate ,
B) Radical hysterectomy
C) Radium
D) External radiotherapy.
6- Exfoliative cytology, all are not true EXCEPT:
A) Involves the study of wax-embedded pieces of tissues.
B) Is performed on cells aspirated through a fine needle.
C) Is used to screen for Carcinoma of the uterine cervix.
D) May be used to diagnose carcinoma of the ovary.
E) Is often used in the diagnosis of breast lesions.
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C) presence of lactation
D) serial HCG titers
15- The most common sarcoma of the uterus is:
A) endometrial stromal sarcoma
B) carcinosarcoma
C) leiomyosarcoma
D) mixed mesodermal sarcoma
E) rhabdomyosarcoma
16- Mixed mesodermal tumors of the uterus can be described by which of the following statements?
A) They are more common than previously assumed and constitute about 17 to 18 percent of uterine malignancies
B) Microscopic examination may reveal the presence of bone, cartilage, muscle, or other elements
C) Their development has been associated with maternal intake of estrogen during pregnancy
D) Five-year survival rate is quite good (approximately 80 percent)
E) They are not known to occur before the menopausal years
17- The neoplasm most sensitive to appropriate chemotherapy is:
A) gestational irophoblastic disease
B) ovarian dysgerminoma
C) Burkitt's lymphyma
D) endomelrial carcinoma
E) ovarian serous carcinoma
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2.
3.
Strauma ovarii.
5.
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36- In a 55-year-old woman with stage II ovarian serous cystadenocarcinoma, the disease is most likely to recur in the:
A) Peritoneum
B) brain
C) lungs
D) skeleton
E) bone marrow
37- Primary malignant ovarian tumors include all of the following EXCEPT:
A) Krukenburgs tumor
B) Arrenoblastoma
C) Granulosa cell tumor
D) Endodermal sinus tumor
38- Alpha-fetoprotein marker is most commonly associated with which ovarian tumor:
A) Epithelial cell ovarian tumor
B) Endodermal sinus tumor
C) Dysgerminoma
D) Mature teratoma
39- During an elective Cesarean section at 39 weeks on a previously healthy 21 year G1P0 with breech
malpresentation, a 3 cm ovarian mass is noted on the left ovary with a very small streak-like right ovary. A biopsy
is taken and sent to pathology. In this patient, which of the following investigations would confirm the most
likely diagnosis?
A) AFP
B) chromosomal studies
C) beta HCG
D) estrogen
E) CA-125
40- Alpha fetprotein (AFP) is most often useful for monitoring the response to treatment of which germ cell tumor:
A) Dysgerminoma
B) Immature teratoma
C) Endodermal sinus tumor
D) Choriocarcinoma
41- Granulosa cell tumors are associated with all EXCEPT:
A) Isosexual precocious puberty
B) Endometrial hyperplasia & adenocarcinoma
C) Present most commonly before the age of 5
D) Vaginal bleeding
42- Combination chemotherapy regimen in Cancer ovary, all are not true EXCEPT:
A) Is the treatment of choice for most patients with residual disease following surgery
B) Less toxic than single agent therapy
C) Less expensive than single agent therapy
D) Produces better results if it is a combination containing cyclophosphamide
E) None of the above
43- Laporatomy performed in a case of ovarian tumor revealed unilateral ovarian tumor with ascities positive for
malignatn cells and positive pelvic lymph nodes. All other structures were free of disease. what is stage of the
disease:
A) Stage IIc. or Stage IIIc.
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B) Stage IIIa.
C) Stage IIIb
D) Stage IV
44- Which of the following is most reliable in diagnosing ovarian malignancy?
A) Medical history
B) Plain Xray
C) Physical examination
D) Ultrasonography
45- Which of the following is not associated with an increased risk for ovarian carcinoma ?
A) Nulliparity
B) Radiation exposure
C) A diet low in fibre and Vit A.
D) Familial tendency
E) Ovulation induction
46- Approximately 75 - 80% of ovarian tumors originate from:
A) Epithelium
B) Stroma
C) Germ cells
D) Mesoderm
E) Unclassified tissue
47- A 16 year old woman presents with a sudden onset of severe right iliac fossa pain. On vaginal ultrasound
examination a 6cm diameter echogenic cystic mass is seen in the region of the right adnexum. What is the single
most likely diagnosis?
A) Pelvic inflammatory disease
B) Renal colic
C) Septic abortion
D) Threatened miscarriage
E) Torsion of ovarian cyst
48- 30 year old woman is concern about her health and her chances of ovarian cancer.Her mother had ovarian cancer
in past and was operated.What is your advice?
A) annual pelvic examination
B) annual CA-125 +/- USG
C) annual CT scan
D) annual USG +pelvic examination
E) annual PAP smear only
49- A 26 year old nullipara presents with smooth , pedunculated ovarian mass anterior to the uterus. What is the
most likely diagnosis?
A) luteoma
B) cystic teratoma
C) theca lutein cyst
D) serous cystadenoma
E) brenner's tumor
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50- A 60-year-old woman is referred for annual gynecologic examination. She has no complaints. Her examination is
normal except for a mobile cystic mass in the left adnexa. The patient has no family history of cancer.
Ultrasonography revealed a simple, anechoic left ovarian cyst measuring 2.25 x 4.56 cm. In follow-up
ultrasonography in 4 months, the cyst is slightly smaller. The most appropriate management is:
A)continued observation with examinations and ultrasonography
B) cyst aspiration with ultrasound guidance and fluid cytologic evaluation
C) computerized tomography of abdomen and pelvis
D) laparoscopy and ovarian cystectomy
E) total abdominal hysterectomy and bilateral salpingo-oophorectomy
51- The following are not characteristics of a dermoid cyst EXCEPT:
A) They are most often bilateral
B) The commonest ovarian neoplasm to be found in pregnancy
C) Lies in the broad ligament
D) Psammona bodies
E) Pseudomyxoma peritonei
52- A unilateral ovariotomy for a presumed endometriotic cyst has been performed on a 38-year-old woman. At
operation, the ovarian mass measured 12 cm in diameter and there were a few filmy adhesions between tumour
and large bowel. The opposite ovary appeared normal. There was no ascites or spillage of the tumour. On the
seventh postoperative day the pathological report has suggested adenocarcinoma. The capsule appears intact
and there was no serosal involvement:
A) She has a stage Ia carcinoma
B) She can be treated conservatively
C) A laparoscopy should be performed to check for residual disease
D) Omental metastases may be present
53- The following are not true statements about ovarian cancer EXCEPT:
A) The prognosis is uniformly poor if large masses remain in the abdomen following surgery
B) A good response to chemotherapy rarely occurs in advanced disease
C) There are no advantages in using intraperitoneal chemotherapy
D) Radiotherapy has an established role in stage III disease
54- In the evaluation of ovarian cancer, all are false EXCEPT:
A) About 75% are of germinal epithelial origin
B) The tumour marker CA 125 is only associated with mucinous tumours
C) The histological type of the tumour is more important than the clinical extent of the tumour in determining
the prognosis
D) Lower abdominal pain is the commonest initial symptom
55- The FIGO classification of ovarian cancer, all are false EXCEPT:
A) Stage I is subdivided according to differentiation of the tumour
B) Ascites is not present in stage I disease
C) Stage IV disease is present if there are positive retroperitoneal lymph nodes
D) In stage III disease there may be seedlings on the surface of the liver
56- A second look' operation for ovarian cancer:
A) Applies to re-exploration of the abdomen because of failure to perform definitive surgery at the first
operation
B) Peritoneal washings should be taken
C) Laparoscopy is preferable to laparotomy
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D) If there is no evidence of disease at operation then there is a greater than 95% chance of 5-year survival
57- The following are not true concerning chemotherapy for ovarian carcinoma EXCEPT:
A) Permanent sterility is inevitable
B) There is a significant incidence of chronic lymphatic leukemia
C) Therapy should be interrupted if the neutrophil count falls to below 4000 neutrophils/mm3
D) Cyclophosphamide may be administered intraperitoneally
E) Cardiomyopathy is a complication
58- Germ cell tumours, all are true EXCEPT:
A) Are all malignant
B) Progress in patients with endodermal sinus tumours can be monitored using alpha-fetoprotein (AFP)
C) Etoposide is a useful agent for anaplastic tumours
D) Lactate denydrogenase (LDH) may be raised in some of these tumours
59- Metastatic tumours of the ovary, all are true EXCEPT:
A) Accounts for 10% of all malignant tumours
B) Many of the patients with Krukenberg tumours are less than 40 years
C) Krukenberg tumours are usually unilateral
D) Commonly comes from a targe bowel primary
60- Granulosa cell tumours of the ovary, all are not true EXCEPT:
A) Found in association with endometrial cancer in 50 % of cases
B) Usually highly malignant
C) Can cause hirsutism
D) Highly sensitive to radiotherapy
61- Dysgerminoma of the ovary, all are false EXCEPT:
A) Unilateral salpingo-oophorectomy is often sufficient surgery
B) Tends to occur in women over 30
C) Associated with 45, X gonadal dysgenesis
D) Is unresponsive to chemotherapy
62- The Brenner tumour of the ovary, all are false EXCEPT:
A) Is not hormonally active
B) Is classified as a germ cell tumour
C) Usually measures 6-10 cm in diameter
D) Contains nests of epithelial cells
63- Serous cystadenoma, all are true EXCEPT:
A) More frequently encountered than the mucinous cystadenomas
B) Usually multilocular
C) Commonly bilateral
D) commonly found to have papillary excrescences on the inner surface of the cyst wall
64- Pseudomyxoma pertonei ,all are true EXCEPT:
A) Patient usually dies of malignant cachexia
B) Chemotherapy can prevent re-accumulation of the mucoid material
C) Is impossible to completely remove at operation
D) Loculation in the peritoneal cavity often occurs
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135
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136
2008
137
2008
138
2008
139
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spermicides
male condoms
withdrawal
Female condom
7- Using a condom and spermicide concurrently has a method effectiveness rate of:
A)
50 percent
B)
75 percent
C)
85 percent
D)
>90 percent
8- Lactational amenorrhea is prolonged in association with:
A) Increased suckling of the infant
B) Decreased frequency of nursing
C) Low plasma prolactin
D) Ovulation
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9- In a woman exclusively breast-feeding, the risk of ovulation within the first 6 months postpartum is:
A) 1-5%
B) 5-10%
C) 10-20%
D) 20-30%
10- Coitus interruptus (withdrawal) often fails as a method of birth control, because:
A) prostatic secretions containing sperm are released during the excitement and plateau phases of sex response
B) many men start ejaculating before they realize it
C) Cowper's gland secretions often contain sperm
D) All of the above
11- Methods of contraception designed to help the woman determine when she will ovulate include all of the
following except :
A) calendar method
B) basal body temperature measurement
C) cervical mucus observation
D) combined oral contraceptives
12- A 24-year-old woman seeks information on contraceptive efficacy and mechanism of action. In discussing oral
contraceptives, you correctly advise her that the low-dose combination OCP's prevent
pregnancy primarily by altering:
A)
B)
C)
D)
gonadotropin secretion
cervical mucus thickness
endometrial maturation
Fallopian tube motility
13- All of the following are proven to be established benefits of the estrogen / progestogen oral contraceptive pill
EXCEPT:
A)
B)
C)
D)
E)
14- Which of the following is not a well-established health benefit of the oral contraceptive pill?
A)
B)
C)
D)
E)
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16- What hormone normally produced in the corpus luteum that inhibits development of ovarian follicles and is a
common component of oral contraceptives?
A)
B)
C)
D)
E)
testosterone
follicle-stimulating hormone (FSH)
lutenizing hormone (LH)
prolactin
progesterone
17- A combined birth control pill prevents pregnancy because the hormones in it do all of the following except:
A) inhibit ovulation
B) make cervical mucus impenetrable for the sperm
C) are spermicidal
D) Alter the endometrium
18- The following are side effects of oral contraceptives except:
A) Breast pain.
B) Break-through bleeding.
C) Increased libido
D) Depression
19- Female birth control pills act by inhibiting the production of:
A) CTH and LH
B) TSH and FSH
C) ACTH and LTH
D) FSH and LH
E) estrogen and progesterone
20 -The effectiveness of a combined oral contraceptive may be reduced by all EXCEPT:
A) Phenytoin
B) Rifampicin
C) Ampicillin
D) Digoxin
21- Oral contraceptives are contraindicated in patients with all EXCEPT:
A) Migraine headaches.
B) Past history of infectious hepatitis.
C) Past history of a benign breast cyst.
D) Past history of thrombophlebitis.
E) Dysmenorrhea.
22- low dose contraceptive pill is contraindicated in which of the following conditions:
A) regular menses
B) age over 35 and heavy smoker
C) menorrhagia
D) Dysmenorrheal
23- The greatest risk for healthy woman under 35 , who is on OCP is:
A) pregnancy from forgetting to take the pill
B) ovarian carcinoma
C) endometrial carcinoma
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C) an increase in triglycerides
D) All of the above
32- The manufacture of ethinyl estradiol was an important break-through in the development of oral contraceptives,
because the agent was discovered to be
A) an especially effective estrogen
B) orally active
C) less potent and therefore better tolerated than diethylstilbestrol
D) the endogenously active form of estrogen
E) an estrogen with a unique action on the hypothalamus
33- The major cause of oral contraceptive failure resulting in an unplanned pregnancy is:
A) breakthrough ovulation at midcycle
B) frequency of intercourse
C) incorrect use of oral contraceptives
D) gastrointestinal malabsorption
E) development of antibodies
34- Progestational agents in birth control pills have which of the following actions?
A) Inhibition of secretion of follicle stimulating hormone
B) Endometrial hyperplasia
C) Thickening of cervical mucus
D) Prevention of irregular menses
35- The contraceptive effect of birth control pills containing both synthetic estrogen and progestin is related to the:
A) inhibition of ovulation
B) impaired penetrability of sperm into the cervical mucus
C) atrophic changes of the endometrium impairing implantation
D) All of the above
36- For each situation listed below select the most appropriate response.
A) Stop pills and resume after 7 days
B) Continue pills as usual
C) Continue pills and use an additional form of contraception
D) Take an additional pill
E) Stop pills and seek a medical examination
1) Nausea during First cycle of pills
2) No menses during 7 days following 21 -day cycle of correct use
3) Forgot pill 1day
4) Forgot pill 10 continuous days
5) Light bleeding at midcycle during first month on pill
6) Hemoptysis
37- In a 29-year-old woman taking oral contraceptives, amenorrhea is most likely due to:
A) pregnancy
B) pituitary tumor
C) Asherman syndrome
D) relative progresterone excess in the contraceptive
E) relative estrogen excess in the contraceptive
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38- A 21-year-old woman with regular menses occurring at 26-29-day intervals is referred to you by her dermatologist
for treatment of acne and for contraception. You counsel her regarding therapy, and she elects to begin hormone
contraception. The most appropriate contraceptive for her is :
A)
B)
C)
D)
E)
39- A 28-year-old woman, gravida 2, para 2, has been taking an oral contraceptive containing 35 g ethinyl estradiol
and 1 mg norethindrone for 1 year. Her only concern is vaginal spotting, which has interfered with her daily
activities for several cycles. The spotting is most evident in the early part of her cycle. The most appropriate
option is to:
A)
B)
C)
D)
E)
40- If during OC pills intake severe abdominal pain occur. What is your possible diagnosis?
A)
B)
C)
D)
41- A 23 year old has a new sexual partner. She has been on the combined OC pill for last 6 yrs. She presents with a 2month history of breakthrough bleeding. What is the single most relevent next examination?
A) Endocervical swab
B) Endometrial sampling
C) Full blood count
D) Gonadotropin levels
E) Hysteroscopy
42- Which of the following statements is the best explanation for the mechanism of the action of the IUD?
A) Hyperperistalsis of the fallopian tubes accelerates the transport of the ovum. thereby preventing fertilization
B) The IUD causes a bacterial endometritis that interferes in implantation
C) The IUD produces menorrhagia and the embryo is aborted in the heavy menstrual flow
D) A sterile inflammatory reaction of the endometrium to the IUD prevents implantation
E) A hormonal imbalance is caused by the IUD.
43- Pick out the false information regarding Copper-T:
A)
B)
C)
D)
145
Best time of insertion is 2-3 days after the periods are over
Cu-T should not be inserted post abortal
Withdrawal technique is used for insertion of Cu-T.
In Cu-T 200, the numerical part stands for the surface area of copper wire.
2008
45- A lady with IUCD becomes pregnant with tail of IUCD being seen, next course of action is :
A)
B)
C)
D)
47- The standard (Cu T 380 A ) IUCD is appropriate for a uterus having uterocervical length of:
A) 5-6 cm
B) 6 - 8 cm
C) 9 - 10 cm
D) > 10 cm
48- An ideal candidate for the use of IUCD as a contraceptive method should not be:
A) Nulliparous
B) Multipara
C) Having normal menstrual cycle
D) Breast feeding
50- The best of the following choices of contraceptives for a woman who is 42 years old, smokes, and has four
children (and wants to be sure she has no more) is:
A) combined birth control pills
B) intrauterine device
C) natural fertility awareness
D) contraceptive foam
51- The risks of the intrauterine contraceptive device (lUCD), all are not true EXCEPT:
A) Higher incidence of pelvic infection amongst parous than nulliparous women
B) The majority of ectopic pregnancies seen with the IUCD are ovarian
C) The risk of perforation is increased by using a tenaculum
D) May cause endocarditis in patient with rheumatic heart disease
52- The following statements are true concerning the IUCD EXCEPT:
A) The risk of infection increases in the period following insertion
B) The uterine cavity remains colonised with bacteria while the IUCD remains in situ
C) Menorrhagia may be controlled by aminocaproic acid
D) If an 1UCD is still present at the start of the second trimester, abortion is increased by 50%
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53- The amount of progesterone released per day by the progesterone releasing IUCD ( Progestarest ) is:
A) 60 mugm
B) 65 mugm
C) 70 mugm
D) 75 mugm
54- Absolute contraindications to the IUCD is:
A) Uterine fibroids
B) Cervical ectopy
C) Immunosuppressive therapy
D) Previous caesarean section
E) Lactation
55- A pregnancy of approximately 10 weeks gestation is confirmed in a 30-year-oid woman (gravida 5, para 4) with an
intrauterine device (IUD) in place. The patient expresses a strong desire for the pregnancy to be continued. On
examination the strings of the IUD are protruding from the cervical os, The most appropriate course of act ion
would be:
A) leave the IUD in place without any other treatment
B) leave the IUD in place and continue prophylactic antibiotics throughout pregnancy
C) remove the IUD immediately
D) terminate the pregnancy because of the near certain risk of infection. abortion, or both
E) perform laparoscopy to rule out an ectopic pregnancy
56- The insertion of an IUD would not be contraindicated in a 24-year-old woman under which of the following
conditions?
A) A recent, unexplained, abnormal Papanicolaou (Pap) smear
B) Nulligravid with multiple partners
C) Previously treated epsiodes of pelvic inflammatory disease
D) The last day of menses
57- Depot Provera , all are not true EXCEPT:
A) contains levonorgestrel
B) is normally given monthly
C) may produce amenorrhoea
D) causes permanent infertility in a small % of patients
E) inhibits lactation
58- Depot-medroxypcogesterone acetates (DMPA), all are false EXCEPT:
A) Fertility usually returns within 2 months after the last injection
B) There is increase in the incidence of moniliasis
C) Weight gain usually occurs
D) After 1 year regular cycles usually return with increasing duration of use
59- Norplant implants work by slowly releasing ____________ over a period of years, which effectively prevents
conception.
A) progesterone
B) estrogen
C) a combination of both a and b
D) a combination of other hormone
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contains levonorgestrel
erratic bleeding is the commonest reason for stopping the method
pregnancy rate is <0.5 per 100 woman years
contraceptive effect persists for three months after removal
it is effective for up to five years
endometrium
urethra
ovaries
uterus
Fallopian tubes (oviduct)
65- The gynecologic complication which usually follows postpartum tubal ligation is:
A) Ovarian atrophy.
B) Ovarian cystic disease.
C) Metrorrhagia.
D) Pelvic inflammatory disease.
E) None of the above.
66- The commonest complication of laparoscopic ring tubal ligation is
A) Failure of sterilization
B) Menstrual abnormality
C) Mesosalpingeal bleeding
D) Bowel injury
E) Wound infection
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67- Which of the following cancidates will be immediately eligible for sterilization
A) Women having uncontrolled diabetes
B) Women having Hb < 8 gm %
C) Past history of treated pulmonary TB
D) Febrile patient
68- After vasectomy , a backup contraceptive method is required for how many weeks
A) 8 wks
B) 10 wks
C) 12 wks
D) 14 wks
68- Which of the following is Not true after a person has had a vasectomy?
A) Cowper's glands are not affected by the operation.
B) The vas deferens still transport sperm to the urethra.
C) The interstitial cells can still release hormones.
D) The semen will not contain sperm.
E) The oviduct will not be affected.
69- Sterilisation , all are false EXCEPT:
A) Sterilization of women is safer than Vasectomy
B) The commonest complication of laparoscopic sterilization is failure to obtain a pnemoperitoneum
C) The rate of pregnancy after female sterilization increases after the first year
D) Bowel trauma with sepsis is the commonest cause of death following laparoscopic sterilisaiion
70- Reversal of sterilisation
A) The rate of ectopic pregnancy is 10%
B) Falope rings destroy less tube than Filshie clips
C) Patients from the higher socioeconomic groups are more likely to request reversal
D) Likely to be requested in women sterilized below the age of 30
71- Procedures appropriate for postpartum sterilization at the time of cesarean section include all of the following
except:
A) Pomeroy tuba! ligation
B) Irving tubal ligation
C) Falope rings
D) Hysterectomy
72- Sequelae of vasectomy include one of the following:
A) varicocele
B) rupture testis
C) torsion of the testis
D) the production of sperm antibodies
73- True statements regarding operative procedures for sterilization include which of the following?
A) They can be performed immediately postpartum
B) They are permanent methods of contraception
C) They can be considered effective immediately in females (bilateral tubal ligation)
D) They can be considered effective immediately in males (vasectomy)
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74- For each method of surgical sterilization described below select the name of the procedure.
1) The distal segment of the fallopian tube is removed either vaginally or abdominally
2) A plain catgut ligature is placed around a knuckle of tube, which is then excised
3) The serosa of the tube is stripped from the muscular portion and 5 cm of tube is excised. The stump is ligated
and the edges of the serosa are tied around the distal tube
4) The tube is transected in the midpoition and the proximal stump is buried into the myometrium
A) Irving technique
B) Pomeroy method
C) Uchida method
D) Fimbriectomy
75- Menstrual regulation can be performed up to
A) 6 wks
B) 12 wks
C) 18 wk
D) 20 wks
76- Which method of contraceptive failure has the highest ectopic rate?
A)
B)
C)
D)
IUD.
Oral contraception.
Tubal sterilization.
Hysterectomy.
77- A 20-year-old woman, gravida 1, para 1, comes to the clinic for her postpartum examination. She is not
breastfeeding. She is undecided on contraception, and she does not want to gain weight. She has multiple sexual
partners. In addition to recommending the use of condoms, you suggest that the best contraceptive method for
her is
A)
B)
C)
D)
E)
78- A 25-year-old woman presents to the clinic 3 days after having had unprotected intercourse near midcycle. This
was her only pregnancy exposure during this cycle. A urine pregnancy test is negative, and she has no medical
problems and is taking no medication. Of the following options, the postcoital contraception regimen you would
recommend at this time is:
A) None because postcoital contraception must be initiated within the first 48 hours
B) Danazol (Danocrine), 200 mg
C) Two doses taken 12 hours apart, each dose consisting of two pills containing 50-g ethinyl estradiol and
0.5 mg norgestrel
D) Introduction of a copper intrauterine device
E) Emergency menstrual extraction
79- All of the follwing are mechanisms of action of emergency contraception except:
A) Delaying ovulation.
B) Inhibiting fertilization.
C) Preventing implantation of the fertilized egg.
D) Interrupting an early pregnancy.
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F.
G.
H.
I.
J.
IUCD
Rhythm method
Emergency contraception
OC pills and male condoms
Female condoms
86. The use of combined oral contraceptive pills reduces the incidence of the following, except:
a) Endometrial carcinoma.
b) Endometriosis.
c) Cervical carcinoma.
d) Dysmenorrhea.
e)
87. In a recently married woman, the most suitable contraceptive method is:
a) OC pills.
b) Minipills.
c) IUD.
d) Tubal sterilization.
88. Minipills contain :
a) Levonorgestrel
b) Medroxyprogesterone acetate
c) Natural progesterone
d) Estradiol + progestin
89.Condoms:
A. Have the additional benefit of reducing sexually transmitted diseases, including human immunodeficiency virus (HW)
disease.
B. Have a higher failure rate in circumcized men.
C. Have a reduced effectiveness in the presence of oestradiol creams.
D. Have a reduced effectiveness in the presence of K-Yjefly.
E. Have a quoted contraceptive efficacy of 323 per 100 woman-years.
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153
2008
154
2008
155
2008
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2008
114. Sterilization:
A. Tubal ligation is an easily reversible method of contraception.
B. Ectopic pregnancy may occur after tubal ligation.
C. Should be done when the use of IUD is contraindicated or has failed.
D. Tubal ligation may be done during cesarean section.
E. Tubal ligation may be done through laparoscopy.
A. False B. True C. False D. True E. True
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Obstetrics MCQs
Index
(1) * Antepartum haemorrhage .
160
(2) * Pre-eclampsia
165
(3) * Eclampsia
169
171
175
181
191
193
195
205
217
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Obstetrics MCQs
(1) * Antepartum haemorrhage
1.Ante-partum hemorrhage (APH) is
(a) Genital bleeding before labor
(b) Genital bleeding after viability & before labor
(c) Genital bleeding after fetal viability up to the 1st & 2nd stages of labor
2-Antepartum hemorrhage has the following characters except:
(a) Always is of placental origin (early separation)
(b) From a placenta of lower implantation
(c) From a placenta of normal implantation site
(d) Is considered high risk pregnancy
3. Placenta previa (PP) is a placenta with:
(a) Implantation in the fundus
(b) Implantation in the cervix
(c) Implantation in the lateral wall of the upper segment
(d) Low implantation (partially or completely) in the lower segment.
4. Placenta previa is more in the followings except:
(a) Twins pregnancy
(b) Multipara
(c) Primigravida (Pg) with normal singleton pregnancy
(d) Maternal diseases as diabetes, Rh
5. What is false about degrees of placenta previa?
(a) 1st degree (lateralis): low not reaches the internal os
(b) 2nd degree (marginalis): reaches internal os but not covers it
(c) 3rd&4th degrees (centralis): covers(partially or completely)the
internal os
(d) The dangerous PP is the lateralis
160
2008
161
2008
162
2008
163
2008
164
2008
(2) * Pre-eclampsia;
1. Hypertensive disorders of pregnancy include only one of the followings
(a) Pregnancy induced hypertension (PIH)
(b) Chronic nephritis
(c) Essential hypertension
(d) All of above
2. Pregnancy induced hypertension (PIH) does not include
(a) Preeclampsia (PE)
(b) Eclampsia
(c) Essential hypertension
(d) Gestational hypertension
3. The predisposing factors for preeclampsia (PE) include followings except:
(a) Multiparity
(b) Extremes of age (<20 & >35)
(c) Obstetric factors as mole, twins, hydramnios, & Rh disease
(d) Medical diseases as hypertension, diabetes, & nephritis
4. What is false in the pathophysiology of preeclampsia?
(a) Abn. placentation(deficient trophoblastic invasion of arteries)
(b) Vasodilatation
165
2008
166
2008
167
2008
168
2008
(3) * Eclampsia;
1. What is false in eclampsia?
(a) Severe preeclampsia complicated by fits
(b) The post-partum eclampsia is common and occurs after 2 weeks
(c) MgS04 is the drug of choice for control of the fits
(d) Termination of pregnancy is usually essential
2. Regarding eclampsia the followings are true except:
(a) An obstetric emergency needs special intensive care
(b) Must be differentiated from other causes of convulsions as epilepsy
(c) More than 3 fit -> bad prognosis
(d) Cerebral hemorrhage is a cause of maternal mortality
3. What is wrong in treatment of eclampsia?
(a) No prophylactic treatment
(b) Aims are to keep patent air passage with control of fits and hypertension
(c) MgS04, Valium & phenytoin for control of fits
(d) Delivery of the fetus by CS or induction after patient stabilization
4. What is false in general treatment of eclampsia?
(a) Keep the patient semisetting in a completely dark room
(b) Oxygen, mouth gag and airway, skilled nurse
(c) Close observation for the maternal vital signs in the ICU
(d) Give atropine to dry the bronchial secretion
5. What is wrong about use of MgS04 in eclampsia?
(a) Anticonvulsant, vasodilator, sedative & diuretic
(b) The initial dose is 8 mg (4 infusion + 4 IM), then 4 mg/4h
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(c) Check serum level, urine output, respiratory rate and knee jerk/4 h
(d) Antidote is calcium gluconate 10 ml 10%
6. Complications ofMgS04 include the followings except:
(a) Respiratory depression of both the mother & neonate
(b) Hypocalcemic tentany
(c) Neonatal hyperreflexia
(d) May maternal cardiac arrest & post-partum bleeding (tocolysis)
7. Alternatives to MgS04for control of the eclamptic fits include the followings except:
(a) Phenytoin (Dilantin)
(b) Diazepam (Valium)
(c) Morphine
(d) Lytic cocktail
8. Side actions of diazepam (Valium) include the followings except:
(a) Decrease Fetal beat to beat variability
(b) May affect the maternal liver
(c) Neonatal respiratory depression
(d) Maternal hypocalcemia
9. The used hypotensive drugs in eclampsia include the followings except:
(a) Oral methyl dopa (Aldomet)
(b) IV hydralazine
(c) Sublingual nifedipine (Epilat)
(d) IV labetalol (Trandate)
10. What is false about delivery in eclampsia
(a) Urgent CS even with a dead fetus
(b) Induction in a favorable cervix and presentation
(c) Shortening of the 2nd stage by ventouse (forceps)
(d) Giving oxytocin instead of methargin in the 3rd stage
170
2008
171
2008
172
2008
173
2008
174
2008
175
2008
8-The use of radiological pelvimetry in modern obstetrics is limited to some cases with:
A. Face presentation.
B. Preterm breech.
C. Previous cesarean section.
D. Fracture pelvis.
E. Hydrocephalus.
9-Radiological pelvimetry:
A. The lateral view shows the antero-posterior diameter of the inlet.
B. The lateral view shows the antero-posterior diameter of the outlet.
C. The inlet view is the most informative.
D. The outlet view shows the sub pubic angle.
E. The outlet view shows the bituberous diameter.
10-Cephalo-pelvic disproportion tests:
A. The fetal head is the best pelvimeter for the pelvis.
B. Pinard's method does not involve PV examination.
C. In Muller Kerr method, the thumb is put on the symphysis pubis.
D. If the head can be pushed into the pelvis, there is no disproportion.
E. Moderate degree of disproportion is diagnosed when the head is at the level of
the posterior surface of the symphysis pubis.
11-Management of labor in contracted pelvis:
A. Minor degree of disproportion requires a trial of labor.
B. Cesarean section is indicated if the case is associated with placenta previa.
C. Moderate degree of disproportion requires a cesarean section if trial of labor
is contraindicated.
D. Marked degree of disproportion requires a cesarean section.
E. Marked degree of disproportion requires craniotomy if the fetus is dead.
12-Trial of labor:
A. Is a test of the ability of uterine contractions to achieve vaginal delivery.
B. Is indicated in some cases of mild disproportion.
C. The presentation should be cephalic.
D. Requires repeated PV examinations.
E. May be conducted at home.
13-Trial of labor:
A. Is contraindicated in a primigravida.
B. Mild degree of outlet contraction is allowed.
C. The patient should be left in the second stage for 2 hours.
D. With successful trial, the head becomes engaged.
E. Is beneficial for some cases of post term.
14-Indications of cesarean section in cases with contracted pelvis:
A. Contracted outlet.
B. Marked degree of contracted pelvis if trial of labor fails.
C. Moderate degree of contracted pelvis if trial of labor is contraindicated.
D. Contracted pelvis in a multipara.
E. Mild degree of contracted pelvis associated with a malpresentation.
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15-Contracted outlet:
A. May be associated with rachitic pelvis.
B. May be associated with android pelvis.
C. May be associated with osteomalacia.
D. Extreme flexion and moulding occur at the outlet.
E. Is not associated with increased incidence of perineal lacerations.
16-Causes of contracted pelvis include the following:
1- Rickets.
2- Osteomalacia
3- Fractures of the pelvis.
4- T.B arthritis of the pelvic joints.
5- Osteomyelitis.
17-Which of the following disease or deformity of the lower limbs affects the pelvic capacity:
1- Poliomyelitis.
2- Hip joint disease.
3- Fracture femur.
4- Varicose veins.
5- Leg ulcer.
18-The following are complications of contracted pelvis during pregnancy:
1- Pyelonephritis.
2- Non engagement of the presenting part.
3- Mal presentation.
4- Spontaneous abortion.
5- Ectopic pregnancy.
19- Examination of the pelvis reveals prominent ischial spines, a narrow subpubic arch, a narrow high-arched
sacroscialic notch, a straight sacrum, and a shortened posterior sagittal diameter, select the pelvic type with
which it is most likely to be associated
A) Anthropoid
B) Android
C) Gynecoid
D) Platypelloid
E) None of the above
20- Examination of the pelvis reveals a wide subpubic arch, a curved sacrum, and a shortened anteroposterior
diameter, select the pelvic type with which it is most likely to be associated
A) Anthropoid
B) Android
C) Gynecoid
D) Platypelloid
E) None of the above
21- Examination of the pelvis reveals a lengthened anteroposterior diameter, a large sacrosciatic notch, prominent
ischial spines, and a straight, posteriorly inclined sacrum, select the pelvic type with which it is most likely to be
associated
A) Anthropoid
B) Android
C) Gynecoid
D) Platypelloid
E) None of the above
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C) Radiologic pelvimetry
D) Ultrasonic pelvimetry
(31)Tests used to detect cephalopelvic disproportion include the following, EXCEPT:
A) Pinards test
B) Internal pelvimetry
C) Mullers test
D) Muller- Kerrs test .
(32)Obstetric outlet measurement include the following EXCEPT :
A) Subpubic angle
B) Diagonal conjugate dimeter
C) Thoms dictum
D) Four knuckles inserted between ischial tuberosities .
(33)Outlet contraction is found in the following cases, EXCEPT :
A) Android pelvis
B) Anthropoid pelvis
C) Rachetic flat pelvis
D) Spondylolisthesis.
(34)Asynclitism may be encountered in:
A) Android pelvis.
B) Anthropoid pelvis
C) Flat pelvis
D) High assimilation pelvis .
(35)The undetermined factors of labour include :
A) Head moulding
B) Yielding of the pelvis
C) Cervical dilatation
D) Uterine force
E) All of the above.
(36)Contraindication to trial of labour include the following, EXCEPT :
A) Yuong primingravida with moderate disproportion
B) Multigravida with bad obesteric history .
C) Any degree of outlet contraction
D) Presence of malpresenttion .
(37)Caesarean section is indicated in cases of contracted pelvis with:
A) Extremely contracted pelvis
B) Marked disproportion
C) Moderate disproportion with contraindication to trial of labour .
D) All the above.
(38)In the cases of flat pelvis , which is MORE RISKY :
A) Simple flat pelvis
B) Rachetic flat pelvis .
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B. Ergometrine IV.
C. Exploration of birth canal.
D. Brandt Andrews method.
E. Hysterectomy.
11-Causes of secondary postpartum hemorrhage include:
A. Uterine atony.
B. Retained part of the placenta.
C. Choriocarcinoma.
D. Vaginal and perineal lacerations.
E. Infected CS wound.
12-Retained placenta:
A. Is defined as failure of delivery of the placenta for one hour after delivery of
the fetus.
B. It complicates 2% of all deliveries.
C. The main cause is atony.
D. Placenta accreta is more common with previous cesarean section.
E. Bleeding is an uncommon presentation.
13-Placenta accreta:
A. Is more common with placenta previa.
B. Is more common with cesarean section scar.
C. The villi commonly reach the peritoneal coat of the uterus.
D. May require hysterectomy.
E. Is easily managed by manual removal of the placenta.
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C. Placental insufficiency.
D. Post partum hemorrhage.
E. Ante partum hemorrhage.
15-Management of retained placenta:
A. Ergometrine should not be given.
B. The problem is not encountered with cesarean section.
C. Manual removal of the placenta is successful in the majority of cases.
D. Some cases of placenta accreta require hysterectomy.
E. The retained part of the placenta may form a placental polyp or
develop choriocarcinoma.
16-Hypofibrinogenemia and DIC:
A. Fibrinogen level normally decreases during pregnancy.
B. Important causes of hypofibrinogenemia include concealed accidental
hemorrhage and septic shock.
C. The process of DIC is initiated by release of thromboplastin into the
maternal circulation.
D. Bleeding time is prolonged while coagulation time remains within normal range.
E. Wiener test does not require a laboratory.
17-Hypofibrinogenemia and DIC:
A. FDPs are decreased.
B. The main line of treatment is fresh blood transfusion.
C. Fibrinogen is given in a dose of 4-10 mg. IV.
D. Antifibrinolytics are given if there is evidence of decreased fibrinolytic activity.
E. Heparin may be given prophylactically.
18-Acute puerperal inversion:
A. Is commonly iatrogenic.
B. Occurs only when the uterus is lax.
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C. Polycythemia.
D. Circulatory overload.
E. Transmission of hepatitis.
28-Amniotic fluid embolism:
A. Is not uncommon.
B. The majority of cases are associated with placental abruption.
C. Mortality reaches up to 30%.
D. Presents as dyspnea, cyanosis, tachypnea, tachycardia and hypotension.
E. Management requires correction of shock and treatment of DIC.
29-Primary postpartum hemorrhage is associated with:
1 - Placenta previa.
2- Polyhydramnios.
3- Forceps delivery.
4- The use of tocolytic agents.
5- Prolonged labor.
30-In the absence of an obvious vaginal hemorrhage, postpartum collapse may be due to:
1- A ruptured uterus.
2- Uterine inversion.
3- Amniotic fluid embolism.
4- A paravaginal hematoma.
5- Eclampsia.
31-Amniotic fluid embolism:
1 - Causes cyanosis.
2- Commonly caused by accidental hemorrhage.
3- Is complicated by disseminated intravascular coagulopathy.
4- Is a complication of the puerperium.
5- Commonly caused by placenta previa.
32-Coagulation failure is an important complication of:
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is defined as genital tract bleeding in excess of 500 ml from delivery of the fetus until six weeks after
the birth
B) is associated with placenta previa
C) is associated with placental abruption
D) is associated with hydramnios
36- Primary post-partum hemorrhage is associated with all EXCEPT:
A) Multiple pregnancy.
B) Retained placenta.
C) Ergometrine administration.
D) Polyhydramnios.
E) Cervical tear
37- Best immediate treatment of severe post-partum hemorrhage after delivery of a complete placenta:
A) IV Ergometrine
B) Blood transfusion
C) Evacuation of uterus without blood transfusion
D) Uterine artery ligation
E) Aortic compression
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E) (A+B+C).
39-The leading cause of maternal mortality in Egypt is:
A) Antepartum haemorrhage.
B) Postpartum haemorrhage.
C) Purperal sepsis.
D) Abortion- haemorrhage.
40-Placental- site postpartum haemorrhage is NOT caused by:
A) Constriction ring.
B) Atony of uterus.
C) Cervical laceration.
D) Adherent placenta.
41-Dissiminated intravascular clotting, is NOT encountered in:
A) Abruptio placenta.
B) Threatened abortion.
C) Missed abortion left for more than four weeks.
D) Amniotic fluid embolism.
42-Dissiminated intravascular clotting, is NOT diagnosed by:
A) Estimation of fibrinogen in blood.
B) Tube clotting test.
C) Total & differential white count.
D) Estimation of fibrinogen degradation products.
43-Dissiminated intravascular clotting is NOT TREATED by:
A) Fibringen injection.
B) Transfusion of double- strength plasma.
C) Uterine artery ligation/ or embolization.
D) Tranexemic acid (anti plasmin) injection.
44-Ecbolics, used in the managementof atonic postpartum haemorrhage, are the following, EXCEPT:
A) Oxytocin.
B) Methergin.
C) Mifeprestone.
D) Mesoprostol.
E) Prostaglandin F2.
45-In the treatment of postpartum haemorrhage, one of the following is to be discouraged:
A) Brandt- Andrew's technique.
B) Crede's manaeuvre.
C) Manual separation of the placenta.
D) Bimanual compression.
E) Uterine massage.
46-In dealing with the general condition of a case of postpartum haemorrhage, the following should be measured,
EXCEPT:
A) Haematocrit value.
B) Urine output.
C) Sedementation rate.
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D) Coagulation profile.
E) Liver function tests.
47-In manual separation of the placenta, the right hand is introduced through the vagina to the uterus. There it is:
A) Intrauterine intra- amniotic.
B) Intrauterine extra-amniotic.
C) Not important.
48-In the case of cervical laceration, which statement is NOT TRUE:
A) Lateral laceration may injure the uterine vessels.
B) Annular detatchment is associated with severe bleeding.
C) Bucket- handle tears often occur after intra-amniotic injection of postaglandins.
D) None of the above.
49-Cervical laceration may result in the following,(Mark the WRONG statement):
A) Excessive bleeding.
B) Cervical incompetence.
C) Broad ligament haematoma.
D) Involvement of the lower uterine segment.
E) None of the above.
50-Colporrhexis indicates:
A) Lateral cervical laceration.
B) Injury to the vaginal fornix or fornices.
C) Injury to the perineum with involvement of anal sphinter.
D) Injury to the vulva with involvement of the frenular artery.
51-In cervical laceration, the site affected is MOSTLY at:
A) 3 Oclock.
B) 6 Oclock.
C) 9 Oclock.
D) 12 Oclock.
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q.
r.
s.
t.
u.
v.
w.
x.
y.
z.
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A) 7.25
B) 7.30
C) 7.35
D) 7.40
E) 7-45
14- Late deceleration patterns on a fetal monitoring strip represent:
A) cord compression
B) pulmonary immaturity
C) fetal hypoxia secondary to decreased perfusion of the intervillous spaces
D) congenital cardiac conduction defects
E) entry of the fetal head into the pelvic brim
15- Fetal monitoring, all are not true EXCEPT:
A) Gives a reliable indication of the state of the fetus at birth
B) An abnormal fetal heart trace in the second stage is always associated with low Apgar scores
C) A good correlation exists between l-minute Apgar scores and acid base measurements
D) Cardiotocography (CTG) has a low false negative rate
E) Fetal distress is the commonest indication for caesarean section
16- Meconium in the amniotic fluid, all are not true EXCEPT:
A) The incidence of fetal distress is similar whether the meconium is thick or thin
B) Is not seen prior to 24 weeks gestation
C) Is more commonly seen in the preterm labour than in a full-term labour
D) Is a normal finding during examination of breech presentation.
E) Syntocinon during labour is contraindicated
17- Which of the following would NOT be a treatment for a non-reassuring FHR pattern:
A) Initiate oxytocin
B) Acoustic or scalp stimulation
C) Amnioinfusion
D) Plan immediate delivery
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D) lower birthweights
13- The Apgar primarily assesses a newborn's:
A) psychological status
B) reflexes
C) physiological health
D) responsivity to people
14- With regard to the Apgar Score, all are not true EXCEPT:
A) heart rate < 100 beats per minute scores 0
B) grimace in response to stimulation scores 2
C) some flexion of extremities scores 1
D) gasping, weak cry scores 0
E) is normally recorded at 1 and 10 minutes
15- The following factors positively influence high birth weight:
A) Maternal growth hormones.
B) Prolonged pregnancy (294) days.
C) Fetal hyperinsulinaemia.
D) Primiparity
E) Social class
16- Birthweight > 4.5 kg, all are true EXCEPT:
A) is always due to poorly controlled diabetes.
B) increases the risk of shoulder dystocia.
C) is a contra-indication to vaginal delivery of a baby presenting by the breech.
D) another large baby is likely in a subsequent pregnancy.
17- Cervical Incompetence, all are true EXCEPT:
A) usually manifests itself in late miscarriage
B) is treated with 2nd. trimester cervical cerclage
C) usually causes ante-partum hemorrhage
D)may present with premature rupture of membranes
18- In circlage operation stitch should be removed:
A) after delivery
B) at labour
C) at 38 weeks
D) at 28 weeks.
19- The following are recognized risk factors for preterm labour EXCEPT:
A) Maternal employment
B) Genital infection
C) Low pre-pregnancy maternal weight
D) Smoking
20- The following regimens will delay delivery in preterm labour EXCEPT:
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A)
B)
C)
D)
IV ritodrine
Progesterone supplementation
Nifedipine
Tndomethacin
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B) 50%
C) 75%
D) 90%
36- Very low-birth-weight refers to infants weighing less than:
A) 750 g
B) 1000g
C) 1.500 g
D) 2,000 g
37- All of the following factors have been consistently associated with preterm delivery except:
A) Previous first-trimester abortion
B) Low socioeconomic status
C) Non white race
D) Smoking
E) l.ow prepregnancy weight
38- A patient who has had a prior preterm birth presents for counseling. You should tell her that her risk of having a
second preitrm delivery is approximately:
A) 5%-10%
B) 20%-40%
C) 50%-75%
D) Over 75%
39- Which of the following uterine abnormalities is associated with the highest incidence of preterm delivery?
A) Unicornuate
B) Complete bicornuate
C) Arcuate
D) Complete septum
40- All of the following have been associated with an increased risk of preterm delivery in a current pregnancy except:
A) Placenta previa
B) Oligohydramnios
C) Hyperemesis gravidarum
D) First -trimester bleeding
E) Multiple gestation
41- Maternal complications of parenteral -mimetic tocolytic therapy include:
A) Hyperglycemia
B) Hypokalemia
C) Chest pain
D) Hypotension
E) All of the above
42- Which of the following statements correctly describes the use of magnesium sulfate as a tocolytic agent?
A) Magnesium sulfate is the preferred tocolytic in patients with myasthenia gravis
B) Serum magnesium levels correlate well with tocolytic effect
C) Pulmonary edema has not been reported in patients receiving magnesium sulfate tocolysis
D) Magnesium sulfate is the preferred tocolytic in patients with diabetes mellitus
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43- Which of the following is an absolute contraindication to the administration of -mimetic tocolytic agents?
A) Chorioamnionitis
B) Maternal chronic hypertension
C) Maternal history of severe migraine headaches
D) Multiple gestation
44- All of the following have been observed in association with indomethacin tocolysis except:
A) Oligohydramnios
B) Pulmonary hypertension in the neonate
C) Constriction of the ductus arteriosus
D) Fetal growth retardation
45- Fetal and neonatal complications associated with premature rupture of the membranes (PROM) include:
A) Neonatal sepsis
B) Pulmonary hypoplasia
C) Cord prolapse
D) Skeletal deformities
E) All of the above
46- Characteristics of infants with the postmaturity syndrome include all of the following except:
A) Skin maceration
B) Brownish green disco lor a lion of the skin
C) Increased subcutaneous fat deposits
D) Failure of intrauterine growth
47- Prolonged pregnancy is associated with an increased incidence of all of the following except:
A) Fetal hypoxia
B) Macrosomia
C) Meconium staining
D) Polyhydraninios
48- If the last menstrual period was withdrawal bleeding following oral contraceptives. the expected date of
confinement should be calculated later by at least:
A) 2 weeks
B) 4 weeks
C) 6 weeks
D) 8 weeks
49- Which of the following techniques for anteparturm fetal surveillance has been associated with the lowest falsenegative rate in the prolonged pregnancy?
A) Nonstress test
B) Biophysical profile
C) Contraction stress test
D) Maternal assessment of fetal activity
50- All of the following tests are useful in antepartum surveillance of prolonged pregnancy except:
A) Biophysical profile
B) Nonstress test
C) Contraction stress test
D) Amniocentesis for meconium
51- A post-date or post-term pregnancy is defined as one which has reached:
A) 40 weeks of gestation
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B) 41 weeks of gestation
C) 42 weeks of gestation
D) 43 weeks of gestation
52- In the prolonged pregnancy, the primary maternal risk is associated with:
A) Preeclampsia
B) Cesarean section
C) Gestational diabetes
D) Excessive weight gain
53- The possibility of RDS would be most reliably predicted by:
A) U/S measurement of BPD
B) U/S measurement of femur length
C) Creatinine concentration in amniotic fluid > 2
D) L/S ratio in amniotic fluid < 2
E) Decrease of bilirubin in amniotic fluid
54-Intracranial hemorrhage:
A. Is sometimes due to intrauterine asphyxia.
B. Is more common with preterm labor.
C. The intra-ventricular type is related to traumatic delivery.
D. With intra-cerebral hemorrhage, the anterior fontanelle is tense and bulging.
E. Magnesium sulfate is sometimes required to prevent convulsions.
55-Intracranial hemorrhage:
A. CT is essential in diagnosis and follow up.
B. Ultrasonography is essential in diagnosis and follow up.
C. Lumbar puncture may be used for diagnosis.
D. Lumbar puncture may be a part of the treatment.
E. Vitamin k 10 mg IM is given to improve coagulation.
56-Intracranial hemorrhage:
A. The majority of etiological factors are preventable.
B. Commonly causes asphyxia.
C. Neurological manifestations are uncommon.
D. Breast milk should be evacuated and given to the newborn by a dropper.
E. Antibiotics are given to prevent pulmonary infection.
57-Etiological factors of intracranial hemorrhage:
A. Rapid compression and decompression of the fetal head.
B. Cervical caput.
C. Moulding.
D. Excessive compression of the fetal head.
E. Rh incompatibility.
58-Sites of intracranial hemorrhage:
A. Subdural.
B. Subperiosteal.
C. Subarachnoid.
D. Intra-dural.
E. Intracerebral.
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59-Shortly after vaginal delivery of an infant in an occiput posterior position, a vaguely demarcated edematous area
over the midline of the skull was noted. This observed lesion is most likely:
a) A cephalhematoma.
b) A skull fracture.
c) Caput succedaneum.
d) A subdural hematoma.
e) Subgaleal hematoma.
60- Cut-off value of cervical length at 24 weeks of gestation for prediction of preterm delivery is:
A) 0.5cm.
B) 1.5cm
C) 2.5cm
D) 3.5cm
70- Neonatal intraventricular hemorrhage, all are TRUE EXCEPT:
A) is associated with prematurity
B) The incidence is more in babies delivered by CS
C) can be diagnosed by lumbar puncture
D) may lead to hydrocephalus
71- Respiratory Distress Syndrome, all TRUE EXCEPT:
A) is more common in the offspring of diabetic mothers
B) is due to deficient levels of surfactant
C) artificial surfactant can be administered via an endotracheal tube
D) more common in term than preterm fetus
72- Preterm labour, all TRUE EXCEPT:
A)
B)
C)
D)
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75- A neonate with asymmetrical intrauterine growth restriction, all are true EXCEPT:
A)
Is more likely to develop hypoglycaemia than a normally grown neonate.
B)
Has increased liver glycogen storage.
C)
Is at increased risk of hypothermia.
D)
Has a body length that is less restricted than its body weight.
76- Causes of neonatal hypoglycaemia include only one of the following:
A) cow milk allergy
B) urea cycle defects
C) glycine sensitivity
D) infants of diabetic mothers
77- Hyaline membrane disease, all are not true EXCEPT:
A) usually occurs within 12 hours of delivery
B) usually occurs after Caeserean section
C) has a better prognosis if steroids are given to the infant
D) is more common in multiple pregnancies
1. Say true or false
a. Post maturity is a common cause of placental insufficiency.
b. Mgso4 is used for tocolytic therapy.
c. R.D.S is common among infants of pre-eclamptic ladies.
d. Infant weighting less than 2.5 Kg are called S.G.A
e. Direct Comb's test is a very effective screening for pregnant RH-ve mothers.
f. Beat to beat variability is very important assessment of fetal wellbeing in utero.
g. Fetal scalp blood sampling is the most informative test for fetal condition in labor.
h. Miscalculation is the final diagnosis for many cases of suspected post-maturity.
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A) Hyperkalemia
B) Hypokalemia
C) Hyperglycemia
D) Hypotension
47- How much time is required for the full effect of an increase in oxytocin dosage to be evident?
A) 5 minutes
B) 10-15 minutes
C) 30-40 minutes
D) 60-80 minutes
48- Which of the following defines outlet forceps delivery?
A) Scalp visible at the introitus without separating the labia
B) Fetal head on the perineum
C) Angle between the AP line and the sagittal suture not more than 45 degrees
D) All of the above
49- Which one of the following forceps lacks a pelvic curve?
A) Simpson
B) Tucker-McLane
C) Elliot
D) Kielland
50- In the Bishop score of inducibilily, points are given for all of the following except:
A) Effacement
B) Station
C) Consistency
D) Contractions
51- Which of the following is a risk of amniotomy?
A) Prolapse of the cord
B) Adverse change in position of the head
C) Rupture of unsuspected vasa previa
D) All of the above
52- A patient is receiving an oxytocin infusion, and uterine hyperstimulation is noted. No FHR abnormalities are
noted. All of the following should be performed except:
A) Discontinue oxytocin
B) Turn patient on her left side
C) Give oxygen
D) Give tocolytic agents
53- All of the following increase the risk of uterine rupture and are relative contraindications to the use of oxytocin
except:
A) Grand multiparity
B) Previous fundal uterine surgery
C) Ovcrdisiended uterus
D) Myomata uteri
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54- If ECV for a transverse lie is unsuccessful, the next step would be:
A) Cesarean section
B) Internal podalic version
C) Breech extraction
D) None of the above
55- The characteristic feature of Piper forceps is its:
A) Ability to allow both traction and rotation
B) Ability to allow reversed traction
C) Capacity to be applied directly to the fetal head
D) Absence of fenestration on its blade
56- All of the following indications have contributed to the increase in the cesarean section rate except:
A) Electronic fetal heart rate monitoring
B) Dystocia
C) Breech
D) Prior cesarean section
E) Maternal infection with human papilloma virus
57- Match the skin incision type with the appropriate description.
1) Vertical
2) Transverse Pfanestiel
3) Transverse Maylard
4) Cherney
A) More rapid access lo the lower uterine segment
B) Requires incision of anterior rectus sheath and rectus muscles
C) Peritoneum incised transversely
D) Easily extended
E) Preferred cosmetic result
58- All of the following complications are more common with a vertical uterine incision than a transverse uterine
incision except:
A) Subsequent uterine rupture in labor
B) Lateral extension into uterine vessels
C) Extension inferiorly
D) Intraoperative bleeding
E) Subsequent adhesions
59- At the time of a cesarean section, management of a laceration of the dome of the bladder should include which of
the following?
A) A two-layer closure
B) Use of nonabsorbable suture
C) Drainage of the space of Retzius
D) Placement of an indwelling catheter for 48 hours
60- When delivery is accomplished by postmortem cesarean section, how long can one delay after cardiac arrest and
still expect fetal survival?
A) 5 minutes
B) 7 minutes
C) 10 minutes
D) 12 minutes
61- The most frequent complication arising from cesarean delivery is:
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Forceps-ventouse
1-The following are advantages of forceps over ventouse, except:
A. Less risky on the fetus.
B. Could be applied on medically diseased mother.
C. Less time for application.
D. Could not be applied in non-vertex presentation.
2-The maximal negative pressure of the ventouse should not exceed :
A. 0.6 Kgm/cm
B. 0.8 Kgm/cm
C. 1 Kgm/cm
D. 1.2 Kgm/cm
3-The obstetric forceps:
A. The blades are named right or left according to the side of the fetal head to
which the blade is applied.
B. The axis traction forceps is the most commonly used type in modern obstetrics.
C. With mid forceps, the biparietal diameter lies between the pelvic inlet and
the ischial spines.
D. Actions of the forceps include traction, rotation, compression and lever action.
E. With Scanzoni double application, the first application is cephalic.
4-Kielland forceps:
A. Blades are named right and left.
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VACUUM EXTRACTION
(1)Vacuum extraction is contraindicated in the following conditions, EXCEPT:
A) Non-vertex presentation.
B) Occipito posterior presentation.
C) Prematurity.
D) Fetal distress.
(2)To promote head flexion during vacuum delivery, the cup is applied centrally against the sagittal suture, but:
A) Nearer to the anterior fontanelle.
B) Nearer to the posterior fontanelle.
C) Midway between the two fontanelles.
(3)Advantages of vacuum extraction, over forceps delivery, include the following, EXCEPT:
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(6)Trial of vaginal delivery after C.S. is indicated, in the following conditions, EXCEPT:
A) Non- persistant indication.
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Mcqs exam 1
Answer all the following questions with True or False
1-
2-
5-
6-
7-
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For each evaluation, select the most appropriate day of a normal 28-day menstrual cycle:
a) Day 3. 5
1- Endometrial biopsy for evaluation of infertility.
b) Day 8. 3
2- Post-coital test.
c) Day 14. 2
3- Hysterosalpingogram.
d) Day 21. 4
e) Day 26. 1
5- Gonadotrophin evaluation.
11-
12-
13-
14-
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15-
16-
17-
18-
19- A 54-year-old woman is found to have endomertial hyperplasia on endometrial biopsy. A functional ovarian
tumor to be suspected is a:
a) Lipid cell tumor. F
b) Granulosa-theca cell tumor. T
c) Sertoli-Leydig yumor. F
d) Mucinous cystadenocarcinoma. F
e) Polycystic ovary. F
20-
21-
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22-
23-
24-
Mini pills. F
Combined contraceptive pills. T
I.U.D. F
Male condom. F
25-
26-
Fetal presentation:
a) Is the part of the fetus that enters the pelvis first. T
b) Is always cephalic. F
c) In cephalic presentation, it is more common to be face. F
d) In face presentation the occiput and back comes into contact. T
e) The denomintor is always the lowest part of the presenting area. F
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35-
The best contraceptive method for patients with gestational trophoblastic diseases:
a) Tubal ligaion. F
b) Hysterectomy. F
c) Combined oral contraceptive pills. T
d) Intra-uterine contraceptive device. F
e) Subcutaneous implants. F
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36-
37-
A couvelaire uterus:
a)
Is an indication for hysterectomy. F
b) Usually contracts well with stimulation. T
c)
Results from excessive oxytocin. F
d) Complications of severe abruption. T
38-
39-
40-
41-
42-
43-
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d)
e)
Postpartum hemorrhage. T
Malpresentations. T
44-
45-
46-
Obstructed labor:
a)
Commonly occurs in cardiac patients. F
b) Commonly occurs in primigravidas. F
c)
Is reduced by proper maternal care. T
d) Vaginal examination shows dry, warm vagina. T
e)
Best management is by instrumental delivery. F
47-
48-
49-
Maternal mortality refers to the number of maternal deaths that occur as the result of the reproductive
process per:
a) 1000 births. F
b) 10.000 births. F
c) 100.000 births. T
d) 10.000 live births. F
e) 100.000 live births. F
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52-
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Exam 2
Answer All the following Questions with True or False
1- Dysfunctional uterine bleeding (DUB) is frequently associated with:
o
o
o
o
o
Endometrial polyps.
Anovulation.
Cervicitis.
Systemic lupus erythematosus.
Von Willebrand's disease.
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Multiparity.
Prolonged second stage of labor.
Unrepaired hidden perineal tear.
Improperly applied forceps delivery.
More prevalent in white than in black women.
o
o
o
o
o
9-Infertility:
228
Increase LH level.
Increase in androgen levels.
Decrease in estrogen levels.
Oligomenorrhea.
Bilateral Ovarian wedge resection is the most accepted method of treatment
2008
Intrauterine adhesions.
Sub mucous fibroids.
Peritubal adhesions.
Cornual block.
Polycystic Ovarian Disease F
Ostetrical delivery.
Irradiation to the pelvis.
Carcinoma.
Hemorrhoidectomy.
Herpes vulvitis.
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19-
Fetal Demise
Tetanic uterine contractions
Retroplacental Clot
Extensive external bleeding
Severe abdominal Pain
Hypertension.
Diabetes mellitus.
Sickle cell anemia.
D.V. T.
Heavy smoking.
Depot provera.
Mini pills.
Combined contraceptive pills.
I.U.D.
Male condom.
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Umbilical artery.
Ductus venosus.
The inferior vena cava as it enters the right atrium.
Carotid artery.
Umbilical vein.
26-The following laboratory investigations are component of the routine antenatal care
o
o
o
o
o
HCG.
Rh typing.
Urine analysis for sugar and protein.
Urine culture.
Test for syphilis.
27-A pregnant uterus that is larger than the period of amenorrhea could be due to:
o
o
o
o
o
Generalized edema.
Obesity.
Intrauterine growth retardation.
Breech presentation.
Polyhydramnios.
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Exam 3
(Select ONLY ONE item)
1.The most common indication for cesarean section is:
A. Malprepresentations.
B. Ante partum hemorrhage.
C. Prematurity.
D. Previous cesarean section.
E. Contracted pelvis.
2.The following are etiological factors of atonic post partum hemorrhage except:
A. Prolonged labor.
B. Over distension of the uterus.
C. Accidental hemorrhage.
D. Cervical lacerations.
E. Full bladder.
3.The following are included in the management of hemorrhagic shock except:
A. Oxygen.
B. Magnesium sulfate.
C. Monitoring of urine output.
D. Corticosteroids.
E. Monitoring of CVP.
4.Pap smear:
A. The next step in dysplastic smear is colposcopy.
B. Is simple but inaccurate test.
C. Should be carried out every 5 years.
D. Has no role in screening of asymptomatic women.
E. All of the above.
5.All of the followings are histological types of endometrial cancer except:
A. Adeno-carcinoma
B. Transitional cell carcinoma
C. Adeno-squamous carcinoma
D. Papillary serous carcinoma
E. Clear cell carcinoma
Non-neoplastic cysts of the ovary include all of the followings except:
A. Follicular cyst.
B. Theca lutein cyst.
C. Dermoid cyst.
D. Corpus luteum cyst.
E. Endometrioid cyst.
6.Non-neoplastic cysts of the ovary include all of the following EXCEPT:
A. Follicular cysts.
B. Simple serous cysts.
C. Endometriotic cysts.
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D. Dermoid cysts.
E. Theca lutein cysts.
7.Indications of cesarean section in breech presentation include all of the following EXCEPT:
A. Large fetus.
B. Premature fetus.
C. Breech with extended legs.
D. Footling presentation.
E. Post term.
8.All of the following regarding cord presentation is true EXCEPT:
A. Is more common with malpresentations.
B. May be associated with abnormal shape of the pelvis.
C. Carries the risk of cord prolapse.
D. Can be diagnosed by PV.
E. Is associated with rupture of membranes.
9.With multiple pregnancy, there is a higher incidence of all of the following EXCEPT:
A. Abortion.
B. Vesicular mole.
C. Preeclampsia.
D. Placenta previa.
E. Polyhydramnios.
10.A 30 years old patient presented with moderate to severe post partum hemorrhage, the placenta was still not
delivered, management should include all of the following EXCEPT:
A. Correction of the general condition.
B. Monitoring of vital signs and urine output.
C. Crede method to deliver the placenta.
D. Oxytocin drip.
E. Prostaglandin F2 alpha IV.
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13-A 25 year old virgin presented with dull aching pain in the left iliac fossa, together with delayed menses for 18
days, abdominal ultrasonography revealed a unilocular ovarian cystic swelling of 6.2 cm in maximal diameter,
appropriate management alternatives include:
A. Follow up only.
B. Surgical excision.
C. Oral contraceptive pills and follow up.
D. Laparoscopic aspiration.
E. Laser therapy.
14-Causes of sub involution of the uterus include:
A. Infection.
B. Retained placental fragment.
C. Uterine over distension during pregnancy.
D. Non-suckling.
E. Prolapse.
15-Management options of occipito posterior position include:
A. The majority of cases are delivered by cesarean section.
B. Cases of direct occipito posterior may be delivered using the ventouse.
C. Cases of persistent occipito posterior may be delivered using the forceps.
D. Craniotomy is indicated if the fetus is dead.
E. Cases with long anterior rotation are delivered as normal labor.
Problem solving
(One or more items may be selected)
1-A 32 year old, third gravida, pregnant 38 weeks presented to the antenatal clinic, abdominal examination &
ultrasonography revealed complete breech presentation with no apparent anomalies, the estimated fetal weight
(EFW) was 3250 gm, appropriate management alternatives include:
A. Induction of labor.
B. External cephalic version.
C. External cephalic version followed by induction of labor.
D. Elective cesarean section.
E. Follow up, waiting for onset of labor.
2-A couple presented complaining of absence of pregnancy after 4 months of marriage, proper management
includes:
A. Waiting for another 8 months before starting any management.
B. Examination of the female.
C. Full history taking.
D. Semen analysis.
E. Induction of ovulation.
3-A 25 year old virgin presented with dull aching pain in the left iliac fossa, together with delayed menses for 18 days,
abdominal ultrasonography revealed a unilocular ovarian cystic swelling of 6.2 cm in maximal diameter, appropriate
management alternatives include:
A. Follow up only.
B. Surgical excision.
C. Oral contraceptive pills and follow up.
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D. Laparoscopic aspiration.
E. Laser therapy.
4-A 44 years lady presented asking to postpone menstruation before going to Mecca, she expects her menstruation
after 18 days, appropriate and reliable method(s) include:
A. Combined oral contraceptive pills.
B. Progestin only pills.
C. Norethisterone acetate.
D. Progesterone.
E. GnRH analogues.
5-A 58 years old lady G3 P2, menopausal since 5 years, complained of offensive vaginal discharge associated with
recurrent spotting, she is hypertensive since 20 years, occasionally uncontrolled, appropriate steps include:
A. Measurement of blood pressure.
B. Abdominal ultrasonography.
C. Treatment of vaginitis.
D. Fractional curettage.
E. Urine analysis.
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7-A 38 year old sixth gravida, had a pre term vaginal delivery, one
hour later, the placenta was still undelivered, manual removal of the
placenta under anesthesia was repeatedly attempted but failed,
proper management is:
..
8-. A 47 year old woman underwent a total abdominmal hysterectomy
for chronic pelvic pain due to endemetriosis, on the second post
operative day, she noticed leakage of watery fluid from the vaqgina,
and her blood pressure was 130/80, pulse 84 beats/min and
temperature 37 C.
The most likely diagnosis is:
.
The first line in management is:
..
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True/False questions
1-The mechanism of labor of occipito posterior position:
A. The degree of deflexion determines the outcome.
B. Deflexion is corrected in the great majority of cases.
C. The head always rotates 3/8 of a circle anteriorly.
D. With major deflexion, there is no mechanism and no labor is obstructed.
E. With direct occipito posterior, the head can be delivered in flexion.
2-Ultrasonography in diagnosis of multiple pregnancy:
A. Diagnosis early in pregnancy.
B. Detection of number of fetuses.
C. Detection of presentation and position.
D. Exclusion of congenital anomalies and conjoined twins.
E. Assessment of pelvic capacity.
3-Choriocarcinoma:
A. Usually follows an event of pregnancy.
B. A friable hemorrhagic polypoidal mass projects into the uterine cavity.
C. Shows early lymphatic spread.
D. The main presentation is bleeding.
E. The most significant method of investigation is ultrasonography.
4-Dysfunctional uterine bleeding:
A. May be associated with hypothyroidism.
B. May be associated with postmenopausal bleeding.
C. May be associated with functional ovarian cysts.
D. May present as menorrhagia.
E. May present as metropathia hemorrhagica.
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2-For each item below, choose the appropriate answer from the above list of options.
Each option may be used once, more than once or not at all.
A. More in primigravida.
B. Higher incidence of growth retardation.
C. Related to pre term labor.
D. Higher incidence of cesarean section.
E. Related to family history.
F. Higher incidence of preeclampsia.
G. Ultrasonography is essential in the diagnosis.
H. Over sized abdomen.
1. A couple presented complaining of failure of conception for 4 years. Semen analysis was subfertile, serum
progesterone was 9.4 ng/ml at day 22 of the cycle, hysterosalpingography revealed normal findings, further
management could include:
2. A 33 year old virgin presented with moderate lower abdominal pain lasting for the last 20 days, medical history was
irrelevant apart from troublesome dysmenorrheal partly relieved by strong analgesics, trans-abdominal
ultrasonography revealed no abnormality, further management could include:
3-For each management below, choose the appropriate answer from the above list of
options. Each option may be used once, more than once or not at all.
A. Laparoscopy.
B. Super ovulation induction.
C. Danazol.
D. HMG.
E. HCG.
F. GnRH analogues.
G. Progestins.
H. IUI.
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Exam 4
1. Excessive maternal weight gain is most strongly associated with which of the following?
a. fetal macrosomia
b. preterm delivery
c. placental praevia
d. oligohydramnios
2. Abortion include which of the following?
a. pregnancy intentionally ended prior to 20 weeks
b. pregnancy spontaneously ended prior to 20 weeks
c. pregnancy intentionally ended with a fetus weighing <500 g
d. all of the above
3. What is the term for no visible fetus in the gestational sac?
a. blighted ovum
b. miscarriage
c. septic abortion
d. polar body
4. Your patient has had two first-trimester and one second-trimester spontaneous abortions. Her screen for anticardiolipin
antibodies is positive. The most appropriate treatment option for this patient during her next pregnancy includes which of the
following?
a. low-dose aspirin plus heparin
b. low-dose aspirin plus plaquenil sulfate
c. low-dose aspirin plus steroids
d. reassurance
5. What causes pregnancy loss in women with antiphospholipid antibodies?
a. placental thrombosis and infarction
b. increased vascularization of decidua basalis
c. increased prostacyclin release
d. protein C activation
6. Which of the following is the most appropriate and accurate test to confirm the diagnosis of Asherman syndrome?
a. ultrasonography
b. antinuclear antibody assay
c. hysteroscopy
d. lupus anticoagulant assay
7. Optimally, when should prophylactic cerclage procedures be performed?
a. preconceptionally
b. between 6 to 12 weeks gestation
c. between 12 to 16 weeks gestation
d. at first sign of cervical dilatation
8. Your patient presents with bleeding at 6 weeks gestation. She is afebrile and isovolemic. Physical examination reveals
tissue protruding through her cervical os. Which of the following is the next best management step for this patient?
a. suction curettage
b. observation and bed rest
c. serial ultrasonographic examinations
d. intramuscular progesterone
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36. What is pigmentation of the midline, anterior abdominal skin during pregnancy called?
a. striae gravidarum
d. melasma
b. linea nigra T
c. chloasma
37. In which of the following positions is cardiac output most increased in the pregnant
patient?
a. left lateral recumbent T
c. standing
b. right lateral recumbent
d. supine
38. Alteration of the ratio of which of the following is thought to be important in the etiology of
preeclampsia?
a. atrial natriuretic peptide: B-type natriuretic peptides
b. angiotensin: angiotensinogen
c. progesterone: dihydroprogesterone
d. prostacyclin: thromboxane T
39. Maternal obesity is related to an increase in which of the following maternal complications?
a. hypertension
c. preeclampsia
b. gestational diabetes
d. all of the above T
40. The Naegele rule estimates gestational age based on which of the following formulas?
a. add 7 days to LMP and count back 3 months T
b. subtract 7 days from LMP and count back 3 months
C. add 21 days to LMP and count back 3 months
d. subtract 21 days from LMP and count back 3 months
41. Duration of pregnancy is most correctly measured clinically by which of the following
units?
a. completed weeks since first day of LMP T
b. number of weeks, rounded to the nearest whole week, since the first day of LMP
c. completed weeks since estimated date of conception
d. number of weeks, rounded to the nearest whole week, since the estimated date of
conception
42. The relation of the long axis of the fetus to that of the mother is called
a. presentation
b. lie
T
c. attitude
d. posture
43. What is the maneuver used to facilitate delivery of the fetal head over the perineum in a controlled manner?
a. MacRoberts
b. Ragu
c. Ritgen T
d. Woods
44. During the third stage of labor, which of the following is NOT a sign of placental separation?
a. a gush of blood
b. uterus rises in the abdomen
c. umbilical cord protrudes farther out of the vagina
d. uterus becomes flaccid
T
45. What is baseline fetal bradycardia?
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a. < 90 bpm
b. < 100 bpm
c. < 110 bpm
d. < 120 bpm
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54. The following findings are suggestive of contracted pelvis during examination except:
a. Height 170 cm. T
b. Limping gait.
c. Kyphosis.
d. Pendulous abdoment.
e. Non engagement of the head.
55. Indication of trial of labor in patient with contracted pelvis include:
a) Non vertex presentation.
b) Moderate degree of cephalo pelvic disproportion. T
c) Previous C.S.
d) El derly primigravida.
e) Heart disease with pregnancy.
56. Fetal complications of contracted pelvis during labor include the following except:
a. Caput saccedaneum.
b. Over moulding.
c. Intra cranial Hge.
d. Fetal malformation. T
e. Fetal death.
57. Causes of contracted pelvis include the following except:
a. Rickets.
b. Osteo malcia.
c. Fractures of the pelvis.
d. T.B arthritis of the pelvic joints.
e. Diabetes. T
58. Management of asymptomatic bacteruria includes:
a) Expectant management.
b) Induction of labor.
c) Antibiotics. T
d) Diuretics.
59. Which of the following factors does NOT contribute to an acute urinary tract infection during
pregnancy, delivery, and the puerperium?
a) Compression of the ureter by the large uterus at the pelvic brim.
b) Increased ureteral tone and peristalsis. T
c) Symptomatic bacteriuria.
d) Bladder catheterization following delivery.
60. The pathophysiology of preeclampsia is characterized by:
a. Vasodilatation.
b. Vasospasm. T
c. Hemodilution.
d. Hypervolemia.
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A cystocele:
Is always associated with stress incontinence.
Contains bladder. T
Is treated by fothergills operation.
Is best treated with a ring pessary.
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C) Oral contraceptives.
D) All of the above. T
80. Menstrual disorders encountered with uterine myomata include the following, EXCEPT:
A) Menorrhagia.
B) Metrorrhagia.
C) Hypomenorrhea. T
D) Polymenorrhea.
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Which of the following does NOT occur as a complication of diabetes mellitus in the pregnant
patient?
A) Increased risk of oligohydramnios T
B) Greater risk of fetal death in the third trimester
C) Progression of retinopathy
D) Increased CS rate
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