1. A 32 year old woman is 15 weeks pregnant with her second pregnancy.

She opts to have antenatal

screening and has blood taken as part of quadruple test. The result shows reduced level of a-fetoprotein
and unconjugated oestriol with elevated b-human chorionic gonadotropin.
Which of the following is the most likely explanation for the screening results ?
a. Down syndrome
b. Edward’s syndrome
c. Multiple pregnanct
d. Neural tube defect
e. Normal pregnanct

2. A 39 year old multiparous woman is 13 weeks pregnant. She has serum screening as part of the
combined test. Analysis shows an elevated level of a-fetoprotein and a normal level of pregnanct
associated plasma protein A.
What diagnosis are the screening results suggestive for ?
a. Down’s syndrome
b. Edward’s syndrome
c. Multiple pregnancy
d. Neural tube defect
e. Normal pregnancy

3. Which of the following describes the mode used in creating standard grey scale ultrasound images ?
a. A-Mode
b. B- Mode
c. Doppler Mode
d. M – Mode
e. None of above

4. Which of the following is a recognised parameter used in a fetal biophysical profiling ?

a. Abdominal circumference
b. Amniotic fluid index
c. Biparietal diameter
d. Head circumference
e. Femur length

5. A 28 year old patient attends out patient clinic with primary subfertility. Her partner’s semen analysis
and hysterosalpinogram are normal. Her follicle stimulating hormone is 2.3 IU/mL, lutenising hormone is
6.8 IU/mL, and her day 21 progesterone is 19 ng/mL.
What is the most likely cause for her subfertility ?
a. Asherman’s syndrome
b. Ovulation
c. Endometriosis
d. Hypogonadotropic hypogonadism
e. Polycystic ovaries

6. A 21 year old woman undergoes a laparoscopic ovarian cystectomy as to removed a dermoid cyst. Three
days after operation, she presents to emergency department feeling unwell and her hemoglobin level is
found to be 6 g/dl. Damaged to a blood vessel is suspected from the laparoscopic procedure.
Which vessels crosses the common and external illiac artery in the infundibulopelvic fold?
a. Femoral artery
b. Inferior mesenteric artery
c. Median sacral artery
d. Ovarian artery
e. Renal artery

7. A 27 year old woman has a cervical smear results which shows borderline changes. Which cells line the
ectocervix ?
a. Ciliated cells
b. Columna epithelium
c. Cuboidal epithelum
d. Smooth muscle cells
e. Stratified squamous epithelium

8. An 18 year old woman attends the gynecology clinic complaining of urinary incontinence, 3 months
after suffering a third degree perineal tear during a normal vaginal delivery.
Which muscles forms the main bulk of the levator anii muscle ?
a. Bulbocavernosus
b. Iliococcygeus
c. Ischiococcygeus
d. Pubococcygeus
e. Urogenital diaphragm

9. An 82 year old woman attends her general practitioner surgery complaining of a painful lump in the
groin.
Which of the following does not form a boundary of the femoral triangle ?
a. Adductor longus
b. Inguinal ligament
c. Obturatori internus
d. Pectineus
e. Sartorius

10. A 47 year old woman undergoes a routine transabdominal hysterectomy to remove a large fibroid
uterus. She is found to have a fibroid in the broad ligament and there I concern that her ureter may have
been damaged due to difficult operation.
With regard to the path of the ureter, which of the following is correct ?
a. In the broad ligament , both ureters passs over their respective uterine artery
b. Runs lateral to the internal illiac artery
c. Ovarian vessels enter the pelvis posterior to the ureters
d. Upper one third of the ureters lie in the abdomen
e. Ureters cross close to the bifurcation of the common illiac vessels

11. A 35 year old multiparous woman has presented to labor ward in spontaneous labor. You see from
her antenatal notes that she is HIV positive. She is currently using highly active antiretroviral therapy and
has a viral load of 43 copies/mL.
Which of the following is associated with increased risk of vertical transmission of HIV ?
a. Co-exixtent group B streptococcus carriage
b. Chorioamnionitis
c. Paternal HIV Infection
d. Post dates gestation
e. Vaginal examination during labor.

12. A 32 year old woman suffers a 1500 mL pospartum hemorrhage 15 minutes after delivery. She is given
several drugs to contract the uterus and the bleeding stops. One hour later, she is found to have blood
pressure of 178/110 mmHg. Which drug is most likely to be responsible for this clinical finding ?
a. Carboprost
b. Ergometrine
c. Misoprostol
d. Oxytocin
e. Ritodrine

13. A 39 year old woman attends the gynecology clinic complaining of increasingly irregular menstrual
cycle and mood swings with weight gain. Hormone profile shows the following:
FSH 32 IU/L
LH 4 IU/L
Oestradiol 52 IU/L
Prolactin 215 mIU/L
Thyroid function test Normal
What is the most likely diagnosis ?
a. Asherman syndrome
b. Addison disease
c. Polycystic ovarian syndrome
d. Pregnancy
e. Premature ovarian failurer

14. A 33 year old woman attends the gynecology clinic for the investigation of her recurrent first trimester
miscarriages. A thrombophillia screen has been performed as part of routine investigation.
Which of the following positive results would most likely suggest an acquired thrombophilia, rather than
inherited one ?
a. Activated protein C resistance
b. Anticardiolipin antibodies
c. Antithrombin III deficiency
d. Protein C deficiency

15. One hundred women with postmenopausal bleeding have pelvic ultrasound scans to measure
endomterial thickness and have a pipelle biopsy taken.
The findings of the scan - normal or thickened endometrial thickness – and the subsequent histology of
Pipelle biopsies – normal or showing endometrial cancer are shown in the table below
Pelvic scan result Endometrial cancer on Norml endometrium on Total
Pipelle Pipelle
Abnormal 10 8 18
Normal 2 80 82
Jumlah 12 88 100
What is the sensitivity (to the closest percent) of the pelvic scan in determining endometrial cancer ?
a. 25%
b. 55%
c. 83%
d. 91%
e. 98%
16. A 32 year old woman is readmitted to the postnatal ward 10 days after an emergenct caesarean
section with a swollen painful calf. Her observation are stable. Her body mass index is 37. You want to
rule out deept vein thrombosis.
Which of the following clotting factors are increased in normal pregnancy?
a. Factor VII
b. Factor VII and VII
c. Factors VII, VIII, X
d. Facotrs VII, VIII, X, XI
e. Factors VII, VIII, X, XI, and XIII

17. A 2 week old neonate is admitted to the hospital with failure to thrive, tachypnea, and diffculty
feeding. He is thought to have a circulatory defect. Administration of prostaglandin antagaonist soon after
birth can be used therapeutically which patent structure fetal organ ?
a. Ductus arterious
b. Ductus venosus
c. Foramen ovale
d. Fossa ovale
e. Ligamentum venosum

18. A 28 year old woman is referred to the gynecology clinic with primary infertility. On examination, she
has a round face, prominent stretch mark on her abdomen and hirsutism.
Which of the following is not a feature of Cushing’s syndrome ?
a. Diabetes insipidus
b. Depression
c. Irregular menstrual cycles
d. Osteoporosis
e. Weight gain

19. A 52 year old woman with Cushing’s syndrome is referred to the preassessment clinic prior to vaginal
hysterectomy.
Which of the following is a feature of Cushing’s syndrome ?
a. Decreased plasma lactate dehydrogenase
b. Hypoglycemia
c. Hypokalemia
d. Hyponatremia
e. Metabolic alkalosis

20. An 18 year old woman is seen in the gynecology clinic for investigation of amenorrhea. You notice that
she is overweight with hirsutism, a round face and acne. Although looking up recent blood tests, you
notice that her plasma cortisol is high and her ACTH is undetectable.
What is the most likely cause of these results?
a. Cushing’s syndrome (adrenal organ )
b. Cushing’s syndrome ( ectopic ACTH production)
c. Cushing’s syndrome (pituitary organ )
d. Polycystic ovarian syndrome
e. Primary adrenal failure

21. A 60 year old woman with a chronic disease is admitted to hospital acutely unwell. She has severe
diarrhea and vomitting. She is hypotensive with a blodd pressure of 85/45 mmHg. You suspect addison
disease.
Which of the following is a recognised cause of Addison disease?
a. Diabetes insipidus
b. HIV
c. Hyperparathyroidism
d. Pregnancy
e. Sarcoidosis

22. An early pregnancy unit undertakes a study to look at the average serum b-hcg level of women
presenting to their unit with vaginal spotting over 2 month period. The data collected has a normal
distribution. The following values ar obtained. Mean = 500 IU/L, N = 200, variance = 16.
What is the data’s set standard deviation ?
a. 2
b. 3
c. 4
d. 9
e. 12

23. A 27 year old woman has a forceps delivery under regional block. She suffers multiple degree tears to
the lateral vaginal wall. Sensory innervation of the vagina is provided by which nerve ?
a. Dorsal nerve of the clitoris
b. Inferior hypogastric plexus
c. Inferior rectal nerve
d. Obturator nerve
e. Pudendal nerve

24. A 32 year old woman has an episiotomy repaired following forceps delivery. Which of the following
does not insert into perineal body ?
a. Bulbocavernosus
b. External anal sphincter
c. Ischiocavernosus
d. Levator ani
e. Transverse perineal

25. Which of the following best describes the process of compaction ?

a. It leads to the formation of trophopblast
b. It leads to the formation of the cytotrophoblast
c. It is a reaction of the chromosomes during meiosis
d. It leads to the formation of the morula after the 16 cell stage
e. It refers to the reaction of the sperm head on penetration of the ovum

26. Which of the following is correct regarding germ cell layer ?

a. Endoderm: endocrine glands
b. Endoderm: nervous system
c. Ectoderm: most proximal layer
d. Mesoderm: lung cells
e. Mesoderm : Skin epidermis

27. During her pregnancy a 38 year old woman is diagnosed with gestational diabetes requiring insulin
treatment at 28 weeks gestation.
Which of the following statements best describes the function of human placental lactogen ?
a. It enhances amino acid transfer across placenta
b. It has insulin like properties
c. It increases glucose utilisation
d. It increases insulin sensitivity in pregnancy
e. It is a growth hormone antagonist

28. Which one of the following constitutes the parameters for a normal sperm count ?
Volume (mL) Motility (% progressive) Count (millions.mL Morphology (%normal
forms)
A 2.0 – 5.0 20 20 < 10
B 1.5 – 5.0 90 20 < 20
C 1.5 – 5.0 40 15 <5
D 1.0 – 3.0 80 60 < 10
E 1.0 – 3.0 90 20 <5

29. Which of the following hormones is secreted by acidophils of the anterior pituitary gland ?
a. Adrecorticotropine hormone
b. Follicle stimulating hormone
c. Growth hormone
d. Oxytocin
e. Thyroid stimulating hormone

30. Following fertility investigations, a man is found to have idiopathic oligozoospermia. He enquires if
there is any treatment he can take to improve his sperm count. What would you recommend ?
a. Androstenedione
b. Clompihene citrate
c. Ethynil estradiol
d. No treatment is proven of benefit
e. Mestranol

31. In the united kingdom, which synthetic estrogen is contained in most combined oral contraceptive
(COC) pills ?
a. cyproterone acetate
b. Drospirenone
c. Ethynil estradiol
d. Oestradiol valerate
e. Mestranol
32. Vasectomy failure rate is quoted as approximately 1 in 2000 (0.05 %) after clearance has been given.
By how many months post procedure should the vasectomy be considered a failure if motile spermare
still observed in a fresh semen sample ?
a. 3 months
b. 4 months
c. 5 months
d. 6 months
e. 7 months

33. More and more women are leaving childbearing to a later age. What is the most common reason given
by women for making the choice ?
a. availability of reliable contraceptives
b. Career concerns
c. Finacial reasons
d. Finding a suitable partner
e. Other causes

34. What investigation is indicated for women following a second trimester miscariage which is not
indicated in recurrent first trimester loss ?
a. Anticardiolipin antibodies
b. Karyotyping of products of conception
c. Lupus anticoagulant
d. Pelvic ultrasound scan
e. Thrombophilia screen

35.