MCQ Notes Dr.nadineنسا

1.
ROUND TESTS
I. GYNECOLOGY
TEST 1: ENDOCRINOLOGY ………………………………………………..….. PAGE 6
- Physiology of menstruation - Anovulation/ Induction of ovulation
- Amenorrhea - Hirsuitism
- Puberty and menopause
TEST 2: ENDOCRINOLOGY CONT. ……..………………………………..… PAGE 15
- Infertility - Endometriosis / Adenomyosis
- Fibroid - AUB / DUB
TEST 3: GENERAL …………………………………………………………..…….. PAGE 26
- Contraception - SUI & fistula
- Prolapse
TEST 4: ONCOLOGY ……………………………….….…….…………….…….. PAGE 36
- Uterine cancer and its premalignant lesions
- Cervical cancer and its premalignant lesions
TEST 5: ONCOLOGY CONT. …………………………………………….…….. PAGE 47
- Benign ovarian cancer - Non neoplastic cysts of ovary
- Malignant ovarian cancer - Vulva and vaginal cancer
TEST 6: INFECTION ………….……………………………………..………….… PAGE 60
- Lower genital infection - STDS
- Upper genital infection - Benign vulva and vagina
TEST 7: BASIC GYNECOLOGY …………………………………………….….. PAGE 71
- Anatomy of the female genital system - Imaging / Endoscopy / DD / Operative
- Development of f. Genital organs
II. OBSTETRICS
TEST 1: BLEEDING IN EARLY PREGNANCY ……..…………………………… PAGE 74
- Spontaneous abortion - Molar pregnancy
- Ectopic gestation
TEST 2: NORMAL LABOR AND DELIVERY …………………….……………… PAGE 82
- Anatomy of fetal skull and female - Management of normal labor and
pelvis delivery
- Physiology and stages of labor
TEST 3: ABNORMAL LABOR AND DELIVERY …………………………….…. PAGE 89
- Mechanism of delivery in cephalic presentation (occipito-posterior / face and brow)
- Mechanism of delivery in fetal malpresentation (breech / shoulder and cord)
- Multiple gestations
TEST 4: COMPLICATIONS OF THIRD STAGE ………………….………..…… PAGE 96
- Antepartum hemorrhage - Complications of third stage
- Cephalopelvic disproportion - Obstetric trauma during labor and
- Abnormal / obstructed labor delivery
TEST 5: LATE OBSTETRIC COMPLICATIONS ………………….……….……. PAGE 108
- Fetal surveillance during pregnancy and - PTL / Post-term pregnancy
labor - Fetal growth disorders (IUGR/
- PROM / Amniotic fluid disorders Macrosomia)
TEST 6: MEDICAL AND SURGICAL COMPLICATIONS …..…..………….. PAGE 117
- Preeclampsia and hypertensive - Thyroid diseases / Seizures / Diabetes
disorders - Anemia / DVT / CVS disorders
- Rh isoimmunization / GIT, hepatic /
UTI, renal disorders
TEST 7: NEW BORN AND PUERPURIUM …………………………………….. PAGE 131
- Fetal and neonatal asphyxia / Fetal birth injuries
- Puerpurium and puerpural complications
- Analgesia and anesthesia in labor / Induction of labour and abortion
- Operative vaginal delivery
- CS and prior CS delivery
TEST 8: BASIC OBSTETRICS ………….…………………………………………….. PAGE 143
- Prenatal screening - Fertilization / Implantation / Placenta /
- History taking / Examination / Membranes
Diagnosis of pregnancy - Maternal changes during pregnancy /
ANC / High risk pregnancy
2. REVISION TESTS
I. GYNECOLOGY
REVISION 1: ENDOCRINOLOGY ………….…………..……..………………….. PAGE 151
REVISION 2: GENERAL ……………………….…………………..……..………….. PAGE 168
REVISION 3: ONCOLOGY ………………..….…………………….……………….. PAGE 186
REVISION 4: INFECTIONS ………..………….………………..….……………….. PAGE 205
REVISION 5: ALL GYNECOLOGY …………….…………………....…………….. PAGE 218
REVISION 6: ALL GYNECOLOGY …………….…………………...…….……….. PAGE 243
II. OBSTETRICS
REVISION 1: BLEEDING IN EARLY PREGNANCY ….…….….…………….. PAGE 255
REVISION 2: BLEEDING IN LATE PREGNANCY…………….……………….. PAGE 264
REVISION 3: NORMAL & ABNORMAL LABOUR + MALPRESENT .... PAGE 274
REVISION 4: MEDICAL DISORDERS ………..………….………………………. PAGE 292
REVISION 5: FETOLOGY ………….…………………….………….……………….. PAGE 300
REVISION 6: ALL OBSTETRICS ………….……………………….……………….. PAGE 309
REVISION 7: ALL OBSTETRICS ………………………………………….…………. PAGE 331
3. OBGYN TESTS
OBGYN (100 Q.) ...…………………………………………….…….….…………….. PAGE 344
OBGYN (150 Q.) ……………………………………………………….……………….. PAGE 360
You can find explanation of answers on YouTube channel
Dr.Nadine Alaa Sherif , OBGYN Lectures 2019 / 2020 ( section ) , Round tests ( playlist )
DR. NADINE MCQ PAGE 6
Gyn 1: Endocrinology 1 (80 marks)

I. Choose the most correct answer: 6. A 32years old woman presented with
2ry amenorrhea for 3months. Her
1 .The last step in estrogen synthesis pregnancy test was negative. She noticed
requires the following enzyme: vaginal dryness and episodes of sweating
a) 5α reductase by night, her FSH: 45 IU/L, her LH: 30 IU/L,
b) 21 hydroxylase her PRL: 25ng/ml. The most probable
c) aromatase cause of amenorrhea is:
d) 11 β hydroxylase a) hyperprolactinemia
b) microadenoma
2. The following androgen is produced by c) POI
the ovary: d) PCO
a) testosterone
b) androstendione 7. A 24years old woman presented with
c) dihydrotestosterone 2ry amenorrhea for 9months. She had
d) dehydroepiandrosterone sulfate headache for the last few months, she has
never been pregnant. Her FSH: 7 IU/L, her
3. AII the following are anterior pituitary LH: 4 IU/L, her PRL: 750ng/mL. The most
hormones EXCEPT: probable cause of amenorrhea is:
a) prolactin a) PCO
b) growth hormone b) Kallman syndrome
c) thyrotropin releasing hormone c) Microadenoma
d) follicle-stimulating hormone d) estrogen secreting ovarian tumour
4. 27years old female presents by bilateral 8. Which of the following meets the
nipple discharge, no breast masses, she definition of amenorrhea?
has history of Schizophrenia and mildly a) 12years old girl wz no breast
elevated prolactin level. The most likely development
cause of prolactinemia is: b) 16years old girl wz well developed
a) renal disease breast
b) medication side effect c) 14years old girl wz w ell developed
c) prolactin producing pituitary breast
adenoma d) 18years old wz well developed breast
d) breast tumour and cessation of menses for 2 cycles
5. Steroidogenesis in the corpus luteum is 9. Inhibin inhibits the synthesis and

mainly under the control of: secretion of the following hormone:
a) LH a) LH
b) FSH b) FSH
c) Activin c) CRH
d) inhibin d) GnRH
Dr.Nadine Alaa Sherif COLLECTED BY: HOSSAM SALAH & ABDELRAHMAN GAMAL
10. An 18years old female presented with 15. the most common medical complaint
1ry amenorrhea. She had well developed of women during menopausal transition is:
breast, sparse pubic and axillary hairs, and a) depression
blind ending vagina. What is the most b) painful intercourse
likely diagnosis? c) urinary incontinence
a) Mullerian agenesis d) vasomotor flushes
b) POI
c) AIS 16. HRT is contraindicated in all the
d) Congenital adrenal hyperplasia (CAH) following EXCEPT:
a) vasomotor flushes
11. An 18years old presented with b) active liver disease
amenorrhea, she had previous regular c) known or suspected breast cancer
menses, and she was also diagnosed with d) abnormal genital bleeding of
anorexia nervosa. The following will be unknown origin
elevated in this woman:
17. An 18years old presents with 1ry
a) LH
amenorrhea. She reports vaginal bleeding
b) GnRH
following a progesterone withdrawal test.
c) FSH The following conditions is most likely
d) neuropeptide EXCLUDED:
a) Mullerian agenesis
12. A 14 years old girl wz 1ry amenorrhea b) hypothalamic amenorrhea
had non developed pubic and axillary hair, c) POI
and no breast development. Her FSH: 24 d) PCO
IU/L, LH: 20 IU/L, Karyotype: 45X0. She is
most likely: 18. A 7years old girl presented to GP as she
a) Kailman syndrome got her menses. She had no medical
b) AIS history or intake of medications, her
c) MRKH Syndrome physical height has been normal, but now
d) Turner syndrome becoming the tallest of her class, she has
well developed breasts & pubic hair, no
13. During the reproductive life, GnRH is axillary hair. Most probable diagnosis:
released in a pulsatile manner from: a) constitutional precocious puberty
a) corpus lutcum b) hypothyroidism
b) ovarian follicle c) androgen secreting ovarian tumour
c) pituitary gonadotropes d) neurofibromatosis
d) arcuate nucleus of the hypothalamus
19. Postmenopausal women:
14. ln a postmenopausal woman, the cut- a) Malignancy is the commonest cause
off value for the endometrial thickness by of postmenopausal bleeding.
TVS is: b) FSH and LH are charaeteristically low.
a) 1mm c) Fibroid uterus tends to grow bigger.
b) 5mm d) Hormonal replacement therapy
c) 7mm increases the risk of breast cancer
d) 10mm e) Endometrium is characteristically
thick on US.
20. Which of the following is an indication 24. Ovulation occurs:

for estrogen treatment? a) Immediately after LH surge.
a) Fibroid. b) 6-8 hours after LH surge.
b) Threatened abortion. c) After Prolactin surge.
c) Endometriosis. d) After follicles ripened in the ovary.
d) Postmenopausal atrophic vaginitis e) 36 hours after LH surge.
e) Induction of ovulation for
anovulatory cycle. 25. A 17-year-old girl attends the
adolescent gynaecology clinic with a
21. The following is a symptom of history of primary amenorrhoea. She has
Climacteric menopause: normal secondary sexual characteristics
a) Obesity. and is of average height and normal BMI.
b) Premenstrual tension. Other investigations show normal FSH, LH
c) Hot flushes. and estrogen levels. Most likely diagnosis?
d) Menorrhagia. a) Androgen insensitivity syndrome
e) Ectopic pregnancy. b) Congenital adrenal hyperplasia
c) Kleinfelter syndrome
22. The normal sequence of pubertal d) Rokitansky syndrome
changes in the female is: e) Turner syndrome
a) Thelarche, Pubarche, Maximal
growth velocity, menarche. 26. A 17-year-old girl is brought to the
b) Maximal growth velocity, Pubarche, gynaecology clinic by her mother as she
Thelarche, menarche. has not yet started menstruation. She has
c) Thelarche, menarche, Pubarche, a short stature. Blood tests show high FSH
maximal growth velocity. and LH. Secondary sexual characteristics
d) Menarche, maximal growth velocity, have not yet developed. What is the most
Thelarche, pubarche. likely diagnosis?
e) Menarche, body weight, pubarche,
Thelarche. a) Anorexia
b) Craniopharyngioma
23. The luteal phase of the menstrual cycle c) Male karyotype
is associated with: d) Rokitansky syndrome
a) High luteinizing hormone level e) Turner syndrome
b) High progesterone levels
c) High prolactin level 27. A 16-year-old girl presents with
d) Low basal body temperature primary amenorrhoea. She has normal
e) Proliferative changes in the external genitalia and normal secondary
endometrium. sexual characteristics appropriate for her
age. An ultrasound scan. FSH and LH are
normal and karyotyping shows 46XX. Her
BMI is 22. Most likely reason for 1ry
amenorrhoea?
a) Androgen insensitivity syndrome athletic. There is similar history of

b) Familial delayed puberty amenorrhoea in her sister who is 38 years
c) Polycystic ovary syndrome of age. What is the most likely diagnosis?
d) Premature ovarian failure a) Hyperprolactinaemia
e) Turner syndrome b) Hypergonadotrophic hypogonadism
c) Hypogonadtrophic hypogonadism
28. A 16-vear-old girl attends the d) Pregnancy
gynaecology clinic accompanied by her e) Premature ovarian failure
mother. The mother is concerned that her
daughter's periods have not commenced 32. A 68yrs old woman presents with
yet. The girl is short. O/E both pubic hair recurrent episodes of small amounts of
and breast development are sparse. postmenopausal bleeding often after
Investigation that helps to obtain a intercourse, she has no positive medical
diagnosis: history and her previous cervical smears
a) Prolactin level were normal, she is not taking any
b) US pelvis medications or HRT. TVS and endometrial
c) MRI pelvis biopsy were normal. PY shows dryness,
d) Karyotyping small petichiae and loss of rugae. Most
e) FSH LH level appropriate next step:
a) outpatient hysteroscopy to assess the
29. The following are likely diagnoses in a endometrium
16-year-old woman with primary b) transdermal continuous combined
amenorrhoea but normal breast, pelvic HRT
and axillary hair development EXCEPT: c) water based vaginal lubricants
a) Androgen insensitivity syndrome d) estrogen containing vaginal pessaries
b) Uterine agenesis e) flexible cystourethroscopy
c) Kallman’s syndrome
d) Vaginal atresia 33. Regarding hormonal changes with
e) Imperforate hymen menopause, the following is true:
a) as ovarian function fails, serum FSH
30. The following are characteristics of levels increase.
Turner's syndrome EXCEPT: b) 12months after the LMP, serum
a) Secondary amenorrhoea levels of testosterone are close to
b) Hypergonadotrophic hypogonadism zero
c) Short stature c) secretion of GnRH from the
d) Streak ovaries hypothalamus increases significantly
e) Wide carrying angle in the late menopause to drive
ovarian activity
31. A 35-year-old woman with regular d) progesterone levels are undetectable
periods until 3 months previously suddenly in the perimenopause
develops amenorrhoea. Her hormone e) High levels of peripherally-produced
levels show increased FSH levels of 16. estrogens reduce the frequency and
With reduced oestradiol and normal severity of hot flushes in obese
prolactin levels. Her BMI is 20 and she is women.
34. A 25yrs old girl presents with mid-cycle 39. An 18y old with 1ry amenorrhoea is
pain on a regular monthly basis, she is complaining of a Rt inguinal mass. O/E: a
sexually active and does not take any normal breast development, while axillary
contraception, the pain quickly resolves and pubic hair are sparse. The vulva
after 24hrs. She has a regular 28day cycle, appears normal but the vagina ends in a
the likely cause of pain is: blind pouch. The uterus is not palpable by
a) PID PR. The RT inguinal mass is:
b) endometriosis a) Lymph node
c) Mittelschmertz syndrome b) Gonad
d) adenomyosis c) Endomctrioma
e) PCOS d) A metastatic lesion
e) Inguinal hernia
35. At the onset of puberty, what is the
estimated number of follicles in a woman's 40. In the previous pt, the following
ovaries? tumour is most likely to occur in the Rt
a) 2million inguinal mass:
b) 7million a) Endodcrmal sinus tumour
c) 1000 b) Dysgerminoma
d) 400000 c) Gonadoblastoma
d) Choriocarcinoma
36. The effect of which hormone causes e) Sertoli Leydig cell tumour
arborization on Fern test:
a) Estrone 41. In PCO, increased testosterone
b) Estradiol production from the ovaries is secondary
c) Progesterone to stimulation by:
d) Testosterone a) Inhibin
b) Estradiol
37. The peak seeretion of progesterone c) LH
occurs on: d) FSH
a) 1st day of cycle
b) 7th day of cycle 42. All the following hormones are
c) 14th day of cycle increased in PCOS, EXCEPT:
d) 21st day of cycle a) LH
e) 28th day of cycle. b) FSH
c) Estrone
38. A patient with high FSH and LH levels d) Testosterone
and low AMH probably suffers from:
a) PCOS 43. A 22yrs old obese NG presents with
b) Endometriosis long history of irregular cycles and
c) Premature ovarian failure amenorrhea. She was diagnosed as having
d) Hypogonadotropic hypogonadism PCOS. The following is the LEAST likely to
e) Sheehan Syndrome be seen in her condition:
a) Abnormal glucose tolerance test 48. A 22 years old recently married female
results is seeking pregnancy, she was diagnosed as
b) Thickened, dark skin on the inner having PCOS. The recommended first line
thighs of management for anovulation in this
c) High serum levels of HDL case:
d) Male pattern hair growth on the a) Gonadotrophins
lower abdomen b) Clomiphene citrate
c) Weight loss and exercise
44. The following can be added to improve d) Insulin-sensitizing agents
the clomiphene citrate response in women
with PCOS: 49. Compared to clomiphene citrate
a) Dehydroepiandrosterone (DHEA) therapy, gonadotrophin therapy has the
b) Insulin following characteristics:
c) Metformin a) Higher ovulation rate
d) Progesterone b) Lower multiple pregnancy rate
c) Lower ovarian hyperstimulation rate
45. The following is LEAST likely true d) Greater negative effect on the
regarding BBT chart measurement: endometrium
a) It can be an insensitive test in many
women 50. The following are long-term
b) With ovulation, the temperature rises consequences of the polycyctic ovary
roughly 0.2degrees syndrome except:
c) It is an inexpensive and easy test for a) Increased risk of cardiovascular
ovulation monitoring disease
d) Once the temperature rises, b) Increased risk of breast cancer
ovulation is expected in the next c) Increased risk of endometrial cancer
12hrs d) Increased risk of type I diabetes
mellitus
46. The following midluteal progesterone e) Lipid abnormalities
level value signifies ovulation:
a) 0.5ng/ml 51. The following drugs are associated with
b) 1.0ng/ml hyperprolactinemia EXCEPT:
c) 2.5ng/ml a) Opiates
d) 5.0ng/ml b) Phenothiazines
c) L-Dopa
47. The gold standard for tubal evaluation d) Metoclopramide
for an infertile couple: e) Antidepressants
a) HSG
b) Laparoscopy 52. A 22-year-old woman consults you for
c) Hysteroscopy treatment of hirsutism. She is obese and
d) SIS has facial acne and hirsutism on her face
and periareolar regions. Serum LH level is
35mIU/mL and FSH is 9mIU/mL. c) Has no effect on quality of cervical

Androstenedione and testosterone levels mucus
are mildly elevated, but serum DHAS Is d) Drug of choice in hypergonadotrophic
normal. The patient does not wish to anovulation
conceive at this time. Most appropriate ttt e) Inhibits prolactin secretion
of her condition?
a) Oral contraceptives 57. Tests to detect ovulation include all of
b) Corticosteroids the following except:
c) GnRH a) Midluteal serum progesterone
d) clomiphene citrate b) Basal body temperature
e) ovarian drilling c) Detection of LH surge in urine
dipstick
53. Drugs that can cause hirsutism include d) Folliculometry
all of the following Except: e) postmenstrual Endometrial biopsy
a) Methyltestosterone.
b) Phenytoin. 58. Which of the following conditions is
c) Cyproterone acetate. suitable for clomtphene citrate
d) Diazoxide. stimulation?
e) Danazol. a) Asherman's syndrome.
b) Polycystic ovarian syndrome.
54. Polycystic ovarian syndrome is c) Resistant ovary syndrome.
characterized by: d) Sheehan syndrome.
a) breast atrophy e) Turner syndrome.
b) Uterine hypoplasia
c) Oligoanovulation 59. Which of the following best describes
d) Reduced serum free testosterone PCOS?
level a) Occurs in married women only
e) Hypoprolactinemia b) All must have amenorrhea
c) Hirsutism is unlikely
55. PCOS can be associated by all of the d) It is a disease of no ovulation
following hormonal changes EXCEPT: e) Steroids is a major line of therapy
a) Inverted FSH LH ratio
b) Elevated serum AMH 60. The following is true about PCOS:
c) Reduced level of total and free a) Commonest cause of ovarian factor
testosterone b) Those complaining of infertility are
d) Hyperinsulinemia best managed by oral contraception
e) Reduced serum progesterone c) Laparoscopic drilling is the best line
of treatment for oligomenorrhea
56. Clomiphene citrate: d) Are less likely to develop diabetes
a) Has no effect on ovarian function mellitus
b) Causes increase secretion of FSH e) Hirsutism is unlikely
61. The hormone best used as a 74. The following are absolute
measurement of ovarian reserve is: contraindications to take HRT: endometrial
a) FSH cancer.
b) Estradiol 75. The following are absolute
c) LH contraindications to take HRT: active liver
d) inhibin disease.
e) AMH
76. The following are absolute
II. For each of the statements below, mark contraindications to take HRT: migraine
True (T) or False (F): with aura.
62. FSH stimulates the granulose cells to 77. The vaginal index in the luteal phase is:
produce estrogen. 0/ 70/ 30.
63. Follicles over 20mm need to be drained 78. Individuals with AIS, should receive
with ultrasound guidance. HMG replacement to get their menses.
64. Estrogen and inhibin have a positive 79. The commonest endocrinal disorder
feedback on the pituitary to release FSH that causes amenorrhea is PCO.
and LH. 80. The first sign of puberty is growth spur
65. Ovulation occurs 4days after LH surge.
66. The release of an oocyte from the
follicle requires a sperm to lyse the follicle
membrane and results in ovulation.
67. Ovulation can be confirmed by
measurement of LH on day 14.
68. The predominant hormone in the luteal
phase is progesterone.
69. The luteal phase varies in duration
depending on the time taken for the corpus
luteum to degenerate.
70. After fertilization, the corpus luteum
continues to degenerate in early
pregnancy.
71. Low levels of estrogen and
progesterone are the best indicators of the
perimenopause.
72. The following are associated with
menstrual disorders: thyroid disease
73. The following are associated with
menstrual disorders: controlled diabetes
ANSWERS
1 C 36 B 71 F
2 B 37 D 72 T
3 C 38 C 73 F
4 B 39 B 74 T
5 A 40 C 75 T
6 C 41 C 76 F
7 C 42 B 77 T
8 B 43 C 78 F
9 B 44 C 79 T
10 C 45 D 80 T
11 D 46 D
12 D 47 B
13 D 48 C
14 B 49 A
15 D 50 D
16 A 51 C
17 A 52 A
18 A 53 C
19 D 54 C
20 D 55 C
21 C 56 B
22 A 57 E
23 B 58 B
24 E 59 D
25 D 60 A
26 E 61 E
27 B 62 T
28 D 63 F
29 C 64 F
30 A 65 F
31 E 66 F
32 D 67 F
33 A 68 T
34 C 69 F
35 D 70 F
Gyn 2: Endocrinology 2 (90 marks)

I. Choose the most correct answer: 5. The following is the best treatment for a
woman with absolute decline in ovarian
1. In couples attempting pregnancy, what % reserve:
of women are expected to conceive within 1 a) Donor egg
year? b) Clomid ovulation induction
a) 15 c) Gonadotrophin ovulation induction
b) 30 d) IVF - ICSI
c) 60
d) 85 6. During IVF, prevention of premature LH
surge is important. The following achieves
2. How long does the spermatogenesis this goal:
process take? a) Recombinant LH
a) 10 days b) Recombinant FSH
b) 30 days c) GnRh agonist
c) 60 days d) HMG
d) 90 days
7. Which of the following infertility
3. With regard to a varicocele, which of the scenarios would warrant ICSI:
following is most likely true? a) Infertility secondary to anovulation
a) It should be repaired once b) Infertility secondary to diminished
encountered ovarian reserve
b) It is a frequent cause of male infertility c) Infertility secondary to distal Fallopian
c) Repair of a subclinical varicoceles leads lube obstruction
to correction of semen abnormalities d) Infertility secondary to severe male
d) Its negative effect on fertility is oligospermia
secondary to elevated scrotal
temperatures 8. A couple has 1ry infertility for 2years, the
semen analysis showed a count of 3million/
4. Which of the following is LEAST likely mL a total motility of 9%, living sperms of
required in the treatment of OHSS? 45%, normal sperm morphology of 3%. This
a) Oopherectomy semen shows:
b) Paracentesis a) Oligospermia
c) Fluid rescussitation b) Terato-oligospermia
d) Thromboembolism prophylaxis c) Oligo-athenospermia
d) Oligo-terato-athenospermia
9. 37 years old female has 2ry infertility for 12. The first investigation to be done in a 26
3yrs, her periods are irregular, and she had a years female patient with history of
missed period for 3months, her husband is infertility, headache and white discharge
34years old, fit and free from medical from the breast is:
troubles. Her labs are: FSH: 13 IU/L, her LH a) Endometrial biopsy
6.8 IU/L and her prolactin: 22 ng/ml. Next b) Serum FSH and LH
investigation:
c) Hysteroscopy
a) THS
d) Serum prolactin
b) AMH
c) Free testosterone e) Hysterosalpingiogram
d) Androstendione
13. A 22 years female with history of 4 years
10. A 28-year-old with PCOS & 1ry infertility primary infertility suffering from recurrent
of 4 yrs, has very irregular cycle & is attacks of fever, iliac fossa pain and
currently on metformin (BMI 28), but she offensive vaginal discharge:
still is amenorrhoeaic. She is very keen to a) Ovarian factor
commence fertility treatment. HSG shows b) Vaginal factor
bilaterally patent tubes. Best next step for c) Tubal factor
management of her subfertility? d) Uterine factor
a) Advice on weight loss review in 6 e) Cervical factor
months
b) Intrauterine insemination for six cycles
14. During the evaluation of infertility in a
c) Laparoscopic diathermy to ovaries
25 years old female, a HSG showed
d) Ovulation induction with clomifene 50
mg for 6 months Asherman syndrome. The following
e) Recommend one cycle of IVF symptoms would you expect this patient to
treatment have:
a) Oligomenorrhea.
11. A 28-year-old with a BMl of 38 & 2ry b) Hypomenorrhea.
infertility for 4 years comes to see you. She c) Menorrhagia.
had been diagnosed with PCOS previously d) Metrorrhagia.
and conceived her first child with e) Leucorrhea.
clomiphene citrate induction. She is now
keen to achieve another pregnancy. Most 15. If you suspect luteal phase defect as a
appropriate initial management: cause of infertility, endometrial biopsy
a) Diagnostic laparoscopy with ovarian should be done on which day of the
diathermy
menstrual cycle?
b) IVF
a) Day 3.
c) Metformin
d) Ovulation induction with b) Day 8.
gonadotrophin c) Day 14.
e) Weight loss followed by clomifene d) Day 21.
citrate induction e) Day 26.
16. Which day of menstrual cycle is the best 20. Which of the following b NOT true about
to perform HSG? endometriosis?
a) Day 2. a) commonly presents with infertility and
b) Day 7. pain
c) Day 14. b) CA-125 can be elevated
d) Day 21. c) Dyspareunia can be the chief complaint
e) Day 26. d) Only presents after marriage
e) Can cause fallopian tube block
17. Which day of menstrual ode is the best
to perform Serum progesterone? 21. Which of the following h true about
a) Day 2 hysterogram?
b) Day 8 a) Best performed after menstruation
c) Day 14 b) Can be used to diagnose adenomyosis
d) Day 21 c) Can be done using lipidol and
e) Day 26 methylene blue dyes
d) Can be used to diagnose chocolate
18. A 26 year old lady with 1ry infertility for ovarian cysts
1 year has irregular cycles, BMI 35, mild e) Cannot diagnose hydrosalpinx
hirsutism and normal HSG and semen
analysis. The next best management to help For each description in questions 22-25,
her get pregnant is: choose the SINGLE most appropriate answer
a) Perform laparoscopic drilling from the below list of options, each option
b) Give steroids and oral contraception to may be used once, more than once or not at
regulate her cycle all.
c) Prescribe spironolactone for hirsutism a) adenomyosis
d) Lose weight and start induction of b) endometrial polyp
ovulation c) malignancy of the cervix
e) Wait for another year for spontaneous d) fibroids
pregnancy to occur e) endometrial malignancy
22. Intermenstrual bleeding.
19. A 30 year old lady presented to you with
3 years 1ry infertility. She did a recent HSG 23. Post-coital bleeding.
showing bilateral proximal tubal block. Best 24. Post-menopausal bleeding.
management for her?
a) Perform laparoscopy and hysteroscopy 25. Painful periods.
to confirm the tubal block
b) Start induction of ovulation after For each description in questions 26-29,
performing semen analysis choose the SINGLE most appropriate answer
c) Repeat hysterogram to confirm from the below list of options, each option
diagnosis of tubal block may be used once, more than once or not at
d) Offer her IUI all.
e) Prepare her for ICSI
a) clomid 34. the most suitable treatment for a 34yrs

b) anovulation old woman with minimal endometriosis on
c) oligospermia laparoscopy who has been trying to
d) azospermia conceive for 2years and has pelvic pain is:
e) PCOS a) laser ablation of
f) Chlamydia
endometriosis/excision of the
g) androgen secreting tumour
h) HMG induction (puregon) endometriosis
b) GnRH analogues
26. Associated with raised free androgen, low
c) danazol
set hormone binding globulin and raised.
d) progesterone
27. Most common cause of tubal disease. e) COCPs
28. Only treatment is donor insemination.
29. An oral treatment for anovulation. For each description in questions 35-38,
choose the SINGLE most appropriate answer
For each description in questions 30-33, from the below list of options, each option
choose the SINGLE most appropriate answer may be used once, more than once or not at
from the below list of options, each option all.
may be used once, more than one or not at a) transcervical resection of the
all. endometrium
a) transcervical resection of the b) vaginal hysterectomy
endometrium c) endometrial ablation
b) laser ablation of endometrial deposits d) hysteroscopy and curettage
c) hydrothermal ablation
e) Myomectomy
d) TAH+ BSO
f) abdominal hysterectomy
e) COCPs
f) vaginal hysterectomy g) Mirena
g) conservative management 35. A procedure for the investigation of
h) GnRH antagonists. menorrhagia rather than a treatment.
30. Treatment for minimal endometriosis to 36. A procedure that destroys the
improve chances in patients with infertility. endometrium.
31. Definitive treatment for severe
37. A procedure for women with fibroids who
endometriosis, obliterated rectovaginal
septum and bilateral endometriosis. want to retain their fertility.
32. Asymptomatic endometriosis found on 38. A definitive treatment for menorrhagia

routine laparoscopy for sterilization. refractive to other treatments, if the uterus is
not enlarged and ovarian conservation is
33. Symptomatic endometriosis in a 23yrs old
woman who wants children but is currently required.
not wanting pregnancy.
39. Which of the following is true regarding a) COCP

the pathology of leiomyomas? b) DMPA
c) GnRH agonist
a) Presence of leiomyoma is a rare finding d) LNG-IUD
in hysterectomy specimens
b) Mitotic activities are very common 44. A 47yrs old patient wz fibroid uterus
c) Leiomyomas possess a distinct complains of severe menorrhagia, she
autonomy from their surrounding refused all surgical interventions and
myometrium accepted using GnRh agonist. She should be
d) Necrosis and degeneration develop counseled about:
infrequently in leiomyomas a) Ttt can result in trabecular bone loss
b) She may suffer of vasomotor flushes,
40. The following factor decreases the risk of libido changes and vaginal dryness
c) Once therapy stopped, symptoms may
development of fibroid:
recur
a) Early menarche
d) All of the above
b) Cigarette smoking
c) Increased BMI 45. Advantages of laparoscopic versus open
d) PCOS myomectomy include:
a) Equivalent febrile morbidity rates
41. Symptoms of fibroid is correctly b) Less adhesion formation
corresponding in all the following EXCEPT: c) Improved pregnancy rates
a) Asymptomatic- pedunculated fibroid d) Equivalent hospital stays
b) Menorrhagia- dilatation of endometrial
venules 46. A 29yrs old woman had recurrent first
c) Pelvic pressure- mechanical trimesteric abortions. She was diagnosed to
compression have uterine fibroids as an etiology of these
d) Acute pelvic pain- degenerated myoma abortions. These fibroids are most likely:
a) submucous
42. Which of the following mechanisms b) intramural
describes the fibroid related infertility? c) subserous
a) Occlusion of the tubal ostia d) pedunculated
b) Distortion of normal uterine
47. A 65yrs old woman is noted to have
contractions
uterine fibroids on examination. Over 1
c) Disruption of implantation secondary
year, her fibroid enlarged from 12wks to
to distortion of endometrial cavity
20wks size. The best management for her
d) All of the above condition is:
a) continued careful observation and
43. A 48yrs olf female presented with severe monitor by US
menorrhagia. TVS revealed a large b) exploratory laparotomy with
submucous myoma. All the following can be hysterectomy
used as a medical ttt EXCEPT: c) GnRh agonist
d) Progestin therapy
48. Add back therapy is used to minimise the 52. A 65-year-old woman is noted to have
side effects of: suspected uterine fibroids on physical
a) Combined oral contraceptive pills examination. Over the course of 1 year, she
b) Danazol is noted to have an enlargement of her
c) Long acting GnRH agonists uterus from 12 weeks size to 20 weeks size.
d) GnRH antagonists Which is the best management?
e) progesterone a) Continued careful observation
b) GnRH agonist
49. A 32 years old woman, 3rdG P2 of Africo-
c) Exploratory laparotomy with
American origin, presents to labor ward at
32 weeks gestation with severe constant left hysterectomy
sided abdominal pain. This is a singleton d) Progestins therapy
pregnancy. On examination: Symphysio- e) Mirena insertion
fundal height is 36 cm. Her uterus is soft but
irregular, with marked tenderness over left 53. Interstitial uterine myomas most often
side of the uterus. Maternal pulse is 114 cause menorrhagia due to:
bpm. BP is 119/62 and Temp is 37 ᵒC. FHS is a) Secondary degeneration
146. Urine analysis is negative. What is the b) Rupture into endometrial cavity
most likely diagnosis? c) Pressure necrosis
a) Choriocarcinoma d) Affection of uterine contractility
b) Red degeneration in fibroid e) Prolapse
c) Polyhydramnios
d) Complicated ovarian cyst. For each of the descriptions in questions 54-
e) twin pregnancy 59, choose the SINGLE most appropriate
answer from the below list of options, each
50. The most common symptom in fibroid
option can be used once, more than once or
uterus is:
a) Asymptomatic not at all.
b) localized abdominal pain a) endometrial biopsy
c) torsion b) saline infusion sonography (SIS)
d) impaction c) hysteroscopy
e) metrorrhagia d) TVS
e) TAS
51. A 36-year-old nultiparons woman is f) MRI
being evaluated for 2ry infertility. She has g) genital tract swabs
regular heavy periods lasting for 7 days h) laparoscopy
every month. Ultrasound shows a 4-cm i) CT Scan
pedunculated fibroid bulging into the j) cervical smear
uterine cavity. What is the best k) colposcopy +/- cervical biopsy
management? l) HSG
a) GnRH agonist
b) GnRH antagonist 54. An obese diabetic 49yrs old woman
c) laparoscopic myomectomy presenting with disturbing heavy and
d) Hysteroseopic resection of the myoma prolonged menstrual bleeding by US, her ET
e) laparoscopic hysterectomy is 12mm.
55. A 32yrs old woman with irregular 61. This occurs as a result of disruption of
menstrual bleeding, subfertility and blood supply (typically pregnancy related).
suspected 2cm endometrial polyp by pelvic 62. Necrosis and cystic formation due to
US. outgrowth of blood supply.
56. A 22yrs old virgin with heavy menstrual 63. Fibroid change that is usually a
bleeding and pelvic mass palpated on postmenopausal manifestation.
abdominal examination.
64. Malignant change that accounts for >1%
57. An obese 44yrs old woman with regular of fibroids.
heavy and painful menstrual bleeding and
some postcoital bleeding. Examination of the
65. A 43years old woman presented with
genital tract appears normal and has normal
painful heavy periods for the last 2-3years.
and up-to-date cervical smear history.
The pain started before the menses and
58. A 32yrs old woman with a history of lasts until 5days. She had 4 normal vaginal
amenorrhea and 2ry subfertility since a deliveries, and her husband had vasectomy.
postpartum D&C for retained products of On PV: the uterus is enlarged, bulky and
conceptions 2yrs ago. tender. The likely diagnosis be:
59. A 44yrs old woman considering UAE for a a) incomplete abortion
34 weeks fibroid uterus. b) adenomyosis
c) appendicular mass
d) none of the above
60. The LEAST symptom to be associated
with submucous fibroids: 66. Which of the following theories is the
a) intermenstrual bleeding most likely accepted as a cause of
b) subfertility endometriosis?
c) pregnancy loss a) lymphatic spread
d) heavy menstrual bleeding b) hormonal induction
e) pressure and pain c) coelomic metaplasia
d) retrograde menstruation
For each description in questions 61-64,
choose the SINGLE most appropriate answer 67. Persistence of endometriosis is directly
from the below list of options, each option dependent on the following hormone:
may be used once, more than once or not at a) estrogen
all. b) testosterone
a) leiomyosarcoma c) progesterone
b) pedunculated leiomyoma d) androstenedione
c) hyaline degeneration 68. Which of the following locations is
d) adenomyosis endometriosis most likely to be found?
e) red degeneralion a) bladder
f) endometriosis b) small bowel
g) Brenner's tumour c) large bowel
h) calcified degeneration d) Douglas pouch
69. Which of the following is the most likely benign gynaecological surgery in your
etiology for infertility in women with hospital is 4 months. Most appropriate step:
endometriosis? a) Add on to the waiting list for
a) tubal obstruction laparoscopic-assisted vaginal
b) implantation defect hysterectomy
c) ovulatory dysfunction b) Arrange for pre operative assessment
d) abnormalities in the endocervical for total abdominal hysterectomy
mucus c) Counsel regarding endometrial
ablation
70. Medical treatment for endometriosis d) Insert Mirena intrauterine system and
may indude all the following EXCEPT: follow up in 6 months
a) progestins e) Perform endometrial sampling
b) oral contraceptives
c) aromatase inhibitors 73. AII the following regarding AUB are true
d) androgen receptor blockers EXCEPT:
a) Metrorrhagia describes intermcnstrual
71. A 55-year-old woman has been referred bleeding
to the postmenopausal bleeding clinic b) Oligomenorrhea refers to cycles with
following an US for abdominal bloating. intervals shorter than 35days
There are cystic spaces in the endometrium c) Hypomenorrhea refers to menses with
and ET: 15 mm. She has previously used diminished flow
tamoxifen for 5 years for breast cancer. Best d) Menorrhagia is defined as prolonged or
management option: heavy cyclic menstruation
a) High dose oral progestogens
b) Do nothing as she did not have any 74. A 60years old presents with uterine
bleeding bleeding. First diagnostic procedure for her
c) Hysteroscopy and endometrial biopsy evaluation is:
d) Mirena IUS insertion a) Colposcopy
e) MRI b) Diagnostic hysteroscopy
c) Transvaginal sonography
72. A 48-year-old woman complains of a 3- d) Saline infusion sonography (SIS)
year history of heavy menstrual bleeding.
She is a mother of four children, all born by 75. A patient presents with endometrial
NVD. Her menstrual index is 6/29 days, polyp, risk factor for malignant
recently associated with clots. Cervical transformation is:
smears are up-to-date and her BMI is 39.
TVS reveals bulky uterus, ET: 11 mm and a) Tamoxifen use
three intramural fibroids of 2, 4 and 5 cm b) Postmenopausal status
respectively. PV shows mild cystocele, c) Endometrial thickness more than
moderate rectocele and second degree 1.5cm
uterine descent. The current waiting list for d) All of the above
76. A 50 year old woman had a Mirena IUS 79. A 38yrs old woman underwent TAH for
inserted 2 years ago for heavy menstrual heavy menstrual bleeding yesterday. with
periods. She was initially amenorrhoeic but ovariun preservation, on your morning ward
has now developed heavy menstrual round, you find her pale with BP: 110/68,
bleeding again. Endometrial biopsy shows pulse: 88, T: 36.8. Her abdomen is soft, but
complex endometrial hyperplasia with there is considerable tenderness in the left
atypia. Best treatment option: lower quadrant, her urine output since
a) Oral contraceptive pills in addition to surgery has been 350ml. The nurse caring for
Mirena in situ the patient reports that the patient was very
b) Reinsert a Mirena coil dim and light headed and vomited when she
c) Total abdominal hysterectomy and was taken out of bed that morning. The
bilateral salpingo-oophrectomy most appropriate management:
d) Total abdominal hysterectomy a) ensure the patient has adequate
e) Tranexamic acid in addition to Mirena analgesics and prescribe extra IV fluids
coil and antiemetic
b) take a urine sample and start IV
77. A 46-year-old para 2 who completed her antibiotics
family, presents with painful heavy c) arrange for CBC and ask for review by
menstrual bleeding for 1 year. Her BMI is 44. your consultant
She is currently on iron supplements for d) explain that the patient docs not
anaemia. Pelvic US shows ET: 12 mm with a require HRT and review her that
bulky uterus and normal ovaries with no afternoon
pelvic pathology. A pipelle biopsy suggests a
proliferative endometrium. Most suitable to For each description in questions 80-83,
her? choose the SINGLE most appropriate answer
a) Combined oral contraceptive pill from the below list of options, each option
b) GnRH Analogues may be used once, more than once or not at
c) Mefenamic acid all.
d) Mirena IUS a) cyclical norethisterone
e) Tranexamic acid b) COCPs
c) LNG-IUS
78. A 32yrs old woman comes to gynecology d) mefenamic acid
clinic complains of heavy menstrual e) tranexamic acid
bleeding. O/E, uterus is AVF and bulky. f) GnRH agonist
What is the best imaging modality for g) danazol
further investigation? 80. The five year prolonged exposure of the
a) abdominal US endometrium to progesterone to cause
b) CT scan thinning of the endometrium and lighter
c) HSG menses.
d) MRI
e) TVS 81. This reduces production of PGE2 and
reduces loss by up to 25%.
82. This is to be taken from days 5 to 26 in II. For each of the statements below, mark
anovulatory DUB; it regulates the cycle and True (T) or False (F):
promotes secretory endometrium in the
second half of the cycle. 87. A semen analysis should be performed
83. This promotes coagulation and reduces prior to laparoscopy and dye to test for tubal
menstrual loss by 40%. patency.
88. HSG and laparoscopy plus dye instillation,

84. Best treatment of a 40vrs old sexually will give similar information and either can be
active woman with regular heavy periods
used to assess tubal patency in all patients.
who smokes 20cigarettes a day, has a BMI of
40 and has normal size AVF uterus and 89. The commonest cause of irregular
endometrial biopsy showing irregular bleeding in childbearing period is fibroid.
proliferative endometrium is:
a) TAH 90. Commonest cause of postmenopausal
b) TAH + BSO bleeding is endometrial hyperplasia.
c) transcervical resection of the
endoemtrium
d) COCPs
e) Mirena
85. A 17yrs old NG complains of severe pain

with menses for 3yrs. She has tried COCPs
and NSAIDs for 2yrs without relief. Her
pregnancy test is negative. The best next
step is:
a) GnRH agonist therapy
b) opiate medical therapy
c) psychiatric evaluation
d) laparoscopy
86. A 16yrs old G0P0 female complains of

severe pain with menses which began within
her first year menses, the physical
examination is normal. The most likely
mechanism:
a) pelvic adhesions
b) high prostaglandin levels
c) tubal inflammation
d) endometriosis
ANSWERS
1 D 36 C 71 C
2 D 37 E 72 E
3 D 38 B 73 B
4 A 39 C 74 C
5 A 40 B 75 D
6 C 41 A 76 C
7 D 42 D 77 D
8 D 43 D 78 E
9 B 44 D 79 C
10 D 45 B 80 C
11 E 46 A 81 D
12 D 47 B 82 A
13 C 48 C 83 E
14 B 49 B 84 E
15 E 50 A 85 D
16 B 51 D 86 B
17 D 52 C 87 T
18 D 53 D 88 F
19 A 54 A 89 F
20 D 55 C 90 F
21 A 56 E
22 B 57 D
23 C 58 C
24 E 59 F
25 A 60 E
26 E 61 E
27 F 62 C
28 D 63 H
29 A 64 A
30 B 65 B
31 D 66 D
32 G 67 A
33 E 68 D
34 A 69 A
35 D 70 D
Gyn 3: General (85 marks)

I. Choose the most correct answer: 4. A 24 years old patient has just started
using COCP, is coming to you complaining
1. 34yrs old multipara presents for IUD of light, irregular vaginal bleeding but it is
removal. Her LMP was 8wks ago. getting better. Your diagnosis and plan of
Pregnancy test is positive. She wishes to management:
continue pregnancy. O/E: you can feel the a) COCP intolerance requiring
IUD threads. Best Option: discontinuation of this method
a) Perform IUD removal and evacuation b) Breakthrough bleeding requiring
of uterine contents. counseling and reassurance
b) Perform IUD removal and plan c) Endometrial pathology requiring
pregnancy management
endometrial biopsy
c) Leave IUD in place and plan
d) Hormonal imbalance requiring
pregnancy management
different method of contraception
d) Leave IUD in place and administer
broad spectrum antibiotics for
5. A 28years old female, having a bad
4weeks.
history wz condom slippage, presents for
2. A patient has history of ectopic contraception. She had a DVT 4years ago.
pregnancy. This contraception is She also bled heavily wz copper IUD. Best
contraindicated for her: option for her:
a) Copper IUD a) LNG- IUD
b) Progestin containing subdermal b) Implanon
implant c) Progesterone only pills
c) Depot medroxy progesterone d) All of the above
acetate injection
d) Levonorgestrel-releasing IUD 6. A 27years old patient has just delivered
4weeks ago, she wants to start using
3. Disadvantage of Progesterone only pills contraceptive method. She is breast
in comparison to combined oral feeding exclusively. The following is not
contraceptive pills: recommended for her:
a) High failure rate a) Progesterone only pills
b) High rate of irregular bleeding b) DMPA
c) High relative rate of ectopic
c) Combined oral contraceptive pills
pregnancy
d) IUD
d) All of the above
7. A 22-year-old breast feeding woman who has had a peritonitis secondary to

(who delivered 6wks ago) presents for appendicitis in the past:
contraception. She wants to space by 2-3 a) Combined oral contraceptive pill.
yrs but has difficulty in remembering b) Laparoscopic clip sterilization.
medications. Most appropriate is: c) Mirena.
d) Progesterone only pill.
a) Combined contraceptive vaginal ring e) Hysteroscopic sterilization
b) Combined oral contraceptive pill
c) Condoms 11. The woman starts taking the birth
d) Lactational amenorrhoea control pills on which day of the cycle?
e) Progestogen only implant a) 1
b) 5
8. A 22-year-old woman presents to her c) 10
GP for postnatal contraception. She had a d) 14
NVD at 40 weeks gestation 3 weeks prior. e) 28
She is bottle feeding her baby. She and her
partner are keen to space out child 12. Side effects associated with use of the
bearing by 1-2 years and wishing a reliable vaginal diaphragm include:
form of contraception. She has a history of a) increased menstrual flow
irregular menstrual cycles and polycystic b) abdominal pain
ovarian syndrome. Most appropriate: c) high blood pressure
a) Combined oral contraceptive pill d) all of the above
b) Copper intrauterine device e) none of the above
a) Levonorgestrel-releasing intrauterine
system (Mirena) 13. A 26-year-old woman sought
b) Progestogen only pill contraceptive advice and after considering
c) Progestogen only injectable all her options, she decided to start on the
combined oral contraceptive pill. As you
9. The contraceptive injection, which lasts have to advise her on the best method of
for 3 months, contains which one of the using these pills, you are giving her some
following? directions. The following are true EXCEPT:
a) Depot medroxyprogesterone acetate a) If you start the pill on the first day of
b) Ethinyl estradiol your period, you will be protected
c) Etonogestrel from pregnancy immediately.
d) Levonorgestrel b) If you start the pill at any other time
e) Norethindrone in your menstrual cycle, you will
need to use additional contraception,
10. Best contraceptive method for a 45yrs such as condoms for the first 7 days
old woman with a BMI of 40, smoker with of pill taking.
multiple fibroids, who is in a stable c) If you miss one pill anywhere in your
relationship, whose family is complete and pack, you will need to use additional
contraception, such as condoms for 17. Amenorrhea is often seen in women

the next 7 days. using which one of the following?
d) You can also start the pill up to the a) Copper IUD.
fifth day of your period and you will b) Combined oral contraceptive pill
be protected from pregnancy c) Depot medroxyprogesterone acetate
immediately. d) Vaginal contraceptive ring.
e) You can start the pill any time in your e) Contraceptive transdermal patch.
menstrual cycle if you are sure you 18. The following are contraindications to
are not pregnant. the use of copper IUD EXCEPT:
a) Unexplained uterine bleeding.
14. 26 years old woman presents for b) Suspected pregnancy.
emergency contraception. She had c) Current breast cancer.
unprotected sex 5 days ago. She has a d) Uterine anomalies.
regular 28 day menstrual cycle, which can e) Past history of pelvic infection.
be heavy. The first day of her last period
was 15 days ago. What emergency 19. A 24 yrs old lady had unprotected
contraception option would you advise? intercourse 24 hrs ago. Her LMP was 7
a) A copper bearing intrauterine device days ago. Best option:
b) A Mirena IUD
a) Give her 1.5 mg of levenorgestrel.
c) It is too late for emergency
b) Insertion of Mirena coil.
contraception
c) Perform a pregnancy test.
d) Ievonorgestrel
e) Progesterone only injectable. d) Reassurance that she may not be
ovulating.
15. The absolute contraindications to e) Start combined oral contraceptive
COCPs include all of the following EXCEPT: pill.
a) Blood pressure <140/90
b) Smoking cigarettes (40/day) 20. As regard COCPs; their primary
c) Diabetic retinopathy mechanism of action is:
d) Migraine with aura a) Cervical mucus changes.
e) Body mass index >40 b) Prevents implantation
c) Prevents ovulation
16. With regards to levonorgestrel IUS, all d) Spermicidal.
the following are correct EXCEPT: e) Decrease sperm motility.
a) It reduces menstrual loss by an
average of 90% after 3 months 21. Primary mechanism of action for
b) Breakthrough bleeding is common progestogen-only contraceptive pills is:
post-insertion a) Cervical mucus changes.
c) It increases weight gain when used
b) Prevents implantation
for contraceptive use
c) Prevents ovulation
d) It can cause mood swings in some
d) Spermicidal.
women.
e) It can cause mastalgia in some e) Decrease sperm motility.
women.
22. As regard copper intrauterine devices; and is fit and healthy. Best contraceptive
their primary mechanism of action is: option for her:
a) Cervical mucus changes. a) IUD
b) Prevents implantation b) Implants
c) Prevents ovulation c) COCP
d) Spermicidal. d) progesterone only injectables
e) Decrease sperm motility. e) LNG-IUS
23. Absolute contraindications to the use 27. A parous 35yrs old woman complains
of the combined oral contraceptive pill: of cyclical heavy and painful menstrual
a) Prosthetic heart valves. bleeding. O/E: she is found to have an
b) Sickle cell disease. enlarged bulky uterus and TVS suggests
c) Active liver disease. adenomyosis. She has completed her
d) Age under 14 years. family and currently relies on condoms for
e) Bronchial asthma. contraception. She smokes 10 cigarettes
per day but is otherwise fit and well. The
24. Absolute contraindications to the most appropriate treatment for her:
combined oral contraceptive pill include: a) LNG-IUS
a) Severe thrombotic disease. b) COCP
b) Diabetes mellitus. c) Hysterectomy
c) Hypothyroidism. d) GnRH analogues
d) Sickle cell disease. e) endometrial ablation
e) Heavy smoking.
28. A 24yrs old PG will undergo CS due to
25. A 19yrs old woman who previously placenta previa and is planning to breast
had a medical abortion, attends a clinic feed, prior to her operation, she asks your
requesting contraception. She is advice on effective contraception. The
overweight and has acne, but no other appropriate advice is:
medical history. Her mother had a DVT a) she could start COCPs at 3wecks
after childbirth. Which is NOT suitable postnatal
method for her? b) IUD could be insertedat time of CS
a) depo-provera c) no contraception is needed until she
b) POP stops breastfeeding
c) Contraceptive patch d) no contraception is needed until
d) LNG-IUS periods return
e) implants e) she could start the progesterone
onlypill at 3weeks postnatal
26. A 29yrs old female presents requesting
contraception, she is known to have PCO 29. The best contraceptive method for a
and struggles with acne and hirsuitism. 45yrs old woman with BMI: 40, smoker
She would like to have a baby in 12months with multiple fibroids, in a stable
time. She has no other medical conditions relationship, family complete and had
peritonitis 2ry to appendicitis in the past:
a) laparoscopic clip sterilization 34. Regarding TVT and TOT, all the
b) Mirena following are true EXCEPT:
c) POPs a) Long term cure rates are 75-85%
d) COCPs b) It is usually performed as a day case
e) hysteroscopic sterilization surgery
c) Bladder injury is more common in
30. Hypoestrogenism is linked to a greater TOT compared to TVT
risk of incontinence through: d) Possible complications include mesh
a) Increased urethral collagen volume erosion, retention and vascular injury
35. The following are risk factors for the
b) Atrophy of the urethral mucosal seal
development of pelvic organ prolapse:
c) Increased compliance of urethral
a) spina bifida
sphincter
b) hypoestrogenism
d) All of the above
c) prior hysterectomy
d) all of the above
31. Repeated child birth contributes to
urinar incontinence through: 36. Effective procedure for ttt of vault
a) Nerve damage from stretch injury prolapsed include all the following
b) Prolonged pudendal nerve latency EXCEPT:
c) Direct injury of connective tissue a) simple hysterectomy
attachments b) abdominal sacrocolpopexy
d) All of the above c) sacrospinous ligament fixation
d) uterosacral ligament vault
32. When the patient's history suggests an suspension
overlap in both stress and urge
incontinence. Which of the following 37. What is the most common rectovaginal
terms is used? fistula location?
a) Overflow incontinence a) high (upper third of the vaginal wall)
b) Mixed urinary incontinence b) mid (middle third of the vaginal wall)
c) Complex urinary incontinence c) low (distal third of the vaginal wall)
d) Augmented urinary incontinence d) these three occur with approximately
equivalent frequency
33. Which of the following techniques
38. Which of the following anatomical
describes the Burch operation?
communication be the most rare to occur?
a) Midurethral sling procedure
a) vesicocervical
b) Periurethral bulking technique b) ureterouterine
c) Retropubic urethropexy procedure c) urethrouterine
d) Transvaginal needle suspension d) ureterocervical
procedure
39. In developing countries, most a) cystometric examination

genitourinary fistulas are attributed to: b) dye instillation into bladder
a) malignancy c) postvoid catheterization of the
b) pelvic surgery bladder
c) obstetric trauma d) neurological profile of the sacral
d) sexual trauma or foreign body nerves
40. In developed countries most 44. A 69yrs old woman is brought to the
genitourinary fistulas are attributed to: clinic with urinary incontinence. She has
a) malignancy severe coronary artery disease, COPD,
b) pelvic surgery renal insufficiency. On examination, she
c) obstetric trauma has a large cystocele and 2nd degree
d) sexual trauma or foreign body uterine prolapsed. What is the best ttt for
this patient?
41. A 48yrs old G3P3 female is complaining a) artificial sphincter
of urine leakage upon coughing. She b) intermittent self-catheterization
denies dysuria or urgency. On physical c) midurethral sling procedure
examination it is likely to find: d) pessary device
a) hypermobile urethra
b) rectocele 45. A 61 yrs old woman complains of
c) hypertrophic bladder involuntary loss of urine, her urine
d) paravaginal defect analysis is normal. Her urodynamics
showed the first urge to void at 150ml
42. A 62yrs old woman complains of bladder filling, involuntary detrusor
constipation and difficulty having bowel contractions were noted while the patient
movements. She states that she often was attempting to inhibit micturition.
needs to use her fingers to push her There was no loss of urine on coughing.
vagina backward to achieve a bowel What is your diagnosis?
movement. The best ttt for this patient is: a) Urge incontinence
a) hysterectomy b) Genuine stress urinary incontinence
b) anterior colporrhaphy c) Retention with overflow
c) posterior colporrhaphy d) Urethrovaginal fistula
d) resection and repair of enterocele
46. The commonest cause of stress
43. A 55yrs old woman notes wetness incontinence is:
from her vagina following total vaginal a) Constipation
hysterectomy procedure, which was done b) Raised intra abdominal pressure
2months ago. She denies dysuria or c) Congenital weakness of sphincter
urgency to void. Her urine analysis is d) Childbirth trauma
normal. Best investigation for the etiology e) Estrogen deficiency
of this type of urinary incontinence:
47. All of the following are supports of the reducible. What is the most appropriate
uterus EXCEPT: management?
a) Mackenrodt’s ligaments a) Cell horn pessary
b) Uterosacral ligaments b) Kegel exercises (Pelvic floor
c) Broad ligament strengthening exercises)
d) Pubocervical fascia c) Topical application of estrogen
e) Rectovaginal fascia d) Vaginal hysterectomy
e) abdominal hysterectomy and vaginal
48. All of the following are complications classical repair
associated with pessary EXCEPT:
a) B.vaginitis, ulceration of vaginal wall 52. The most common cause of
b) Cervicitis rectovaginal fistula in developing
c) Carcinoma of vaginal wall countries is:
d) Impaction of pessary a) Obstetric injuries.
e) Reduction of prolapse b) Irradiation of the pelvis.
c) Carcinoma.
49. Management of 3rd degree prolapse in d) Crohn's disease.
a 27yrs P1+0 can be all EXCEPT: e) Endometriosis.
a) Vaginal hysterectomy
b) Fothergill’s surgery 53. In developed countries, urethra-
c) Sling surgery vaginal fistulas are most common due to:
d) Ring pessary a) Pelvic infection
e) sacrospinous fixation b) Obstetric trauma
c) Prior anterior colporrhaphy or
50. Main uterine support that prevents uretheral diverliculectomy
prolapse is: d) Prior hysterectomy
a) Utero-sacral ligaments e) none of the above
b) Round ligaments
c) Transverse cervical ligaments For each description in questions 54-57,
d) Ovarian ligaments choose the SINGLE most appropriate
e) Broad ligaments answer from the below list of options.
Each option may be used once, more than
51. An 88-year-old female presents to the once or not at all.
clinic with a prolapsed uterus. She says a) urodynamic assessment
that one week ago she had a bout of b) urgent cystoscopy
coughing and felt a mass in the genital c) renal tract ultrasound
area. Initially she was able to push the d) insertion of mid-urethral tape
mass back in the vagina. She has difficulty e) oxybutynin
urinating and defecating. She has a history f) topical estrogen
of heart failure and chronic obstruction g) oral antibiotics
pulmonary disease. On examination, she h) botulinum toxin injection
has a palpable mass in the vagina, which is
54. Immediate management of a 73yrs old 61. The treatment of choice for a
woman with frequency, urgency and symptomatic cystocele with no history of
hematuria. incontinence in a 50yrs old sexually active
55. Management of a 38yrs old woman woman.
with symptoms of only stress incontinence 62. Amputation of the cervical stump and
who has completed a course of pelvic floor placation of the uterosacral and cardinal
exercises without improvement. ligaments.
56. Should be performed after failed 63. Treatment of vault prolapsed in an
conservative and medical management elderly woman with multiple previous
before second line treatments for abdominal surgery.
incontinence.
57. First line drug treatment for overactive 64. Management of a 38yrs old woman wz
bladder. completed family, BMI: 30, wz proven
stress incontinence is:
For each description in questions 58-63, a) pelvic floor exercise

choose the SINGLE most appropriate b) bladder neck injections
answer from the below list of options, c) anterior repair
each option may be used once, more than d) colposuspension
once or not at all. e) TVT
a) urodynamic stress incontinence
b) normal bladder function 65. Management of an 89yrs old woman
c) poor detrusor contraction wz IHDs, not sexually active but wz
d) bladder diverticulum procidentia is:
e) bladder outflow obstruction a) shelf pessary
f) detrusor overactivity b) pelvic floor exercise
g) anterior repair c) vaginal hysterectomy
h) shelf pessary d) hysteroscopy
i) sacrospinous fixation e) total vaginal mesh procedure
j) posterior repair
k) vaginal hysterectomy 66. Regarding contraception in breast
l) Manchester operation feeding women, the following is correct:
58. Detrusor pressure rises of more than a) DMPA lowers the quality of breast
15cm water during filling associated with milk
urgency. b) COCPs affect the quality of breast
59. Leakage on coughing in the absence of milk
detrusor contraction. c) POPs do not affect the quantity of
breast milk
60. The treatment for vault prolapsed in a d) COCPs do not affect the quantity of
frail elderly woman who would not be breast milk
suitable for surgery.
II. For each of the statements below, mark 83. The following are risk factors for
True (T) or False (F): development of prolapsed: genetic factors.
67. POPs have higher failure rate than 84. Estrogen containing contraceptions are
COCPs. the best choice in lactating females.
68. POPs have a lower risk of ectopic 85. Male vasectomy is done under general
pregnancy. anesthesia.
69. POPs have a 2-3hrs window.
70. POPs have a quicker reversibility
compared to COCPs.
71. The intrauterine system (IUS) contains
norethisterone.
72. The intrauterine system (Mirena) is
licensed for 10 yrs.
73. Heavy bleeding is the most common
side effect with Mirena.
74. There is an increased risk of ectopic
pregnancy with IUCD use.
75. COCPs inhibit ovulation.
76. COCPs improve cycle control.
77. COCPs have a 2-3 hour window.
78. COCPs are relatively contraindicated in
patients with acute/severe liver diseases.
79. The following are risk factors for
development of prolapse: nulliparity.
development of prolapse: forceps delivery.
development of prolapse: menopause.
82. The following arc risk factors for
development of prolapse: caserean section.
ANSWERS
1 B 36 A 71 F
2 D 37 C 72 F
3 D 38 C 73 F
4 B 39 C 74 T
5 D 40 B 75 T
6 C 41 A 76 T
7 E 42 C 77 F
8 A 43 B 78 F
9 A 44 D 79 F
10 D 45 A 80 T
11 B 46 D 81 T
12 E 47 C 82 F
13 C 48 E 83 T
14 A 49 A 84 F
15 A 50 C 85 F
16 C 51 A
17 C 52 A
18 C 53 C
19 A 54 B
20 C 55 D
21 A 56 A
22 B 57 E
23 C 58 F
24 A 59 A
25 C 60 H
26 C 61 G
27 A 62 H
28 E 63 C
29 C 64 E
30 B 65 A
31 D 66 C
32 B 67 T
33 C 68 F
34 C 69 T
35 D 70 T
Gyn 4: Oncology (90 marks)

I. Choose the most correct answer: 4. Based on ACOG guidelines, at what
Interval a 52years old woman undergo
cervical cancer screening if she has an
1. Which two HPV types together account average risk for cancer with 3 previous
for approximately 70 % of cervical cancers consecutive negative Pap tests:
worldwide? a) annually
b) every 2 years
a) 6 and 11
c) every 3 years
b) 11 and 45 d) every 5 years
c) 16 and 18
d) 18 and 31 5. A 45years old patient had a Pap smear
result of HSIL subsequent colposcopy is
unsatisfactory due to incomplete
2. A 40yrs old woman has been in a stable visualization of the SCJ. Cervical biopsy
relationship for 25yrs. Her recent Pap confirms CIN 3, there is also CIN 2 in the
smear showed LSIL and HPV changes. HPV endocervical curettage. The most
appropriate for further diagnosis/ttt:
infection is reliably diagnosed by the a) cryosurgery
following clinical tests: b) hysterectomy
a) cytology c) loop excision
b) histology d) laser ablation
c) colposcopy 6. A woman has a 6cm adenocarcinoma of
d) HPV DNA testing the cervix, positive para-aortic nodes
found on CT scan and hydronephosis.
Which FIGO staging is she assigned?
3. A 42yrs old multipara has negative Pap
a) IB 2
smear test and positive HPV DNA test, one b) IIB
year later, she had the same results. She is c) IIIC
a cigarette smoker and has had six lifetime d) IVB
partners but didn't have a new sexual
7. What is the most appropriate surgical
partner for 7yrs. Her strongest risk factor procedure for a woman who has
for cervical cancer is: completed childbearing with a stage IA
a) parity squamous cell carcinoma of the cervix?
a) cold knife conization
b) tobacco use b) extrafasciaI hysterectomy
c) persistent HPV Infection c) radical hysterectomy
d) multiple lifetime sexual partners d) pelvic excentration
8. Most appropriate treatment for a 12. What is the commonest genetic

30years old G1P1 with stage IA syndrome associated with endometrial
adenocarcinoma of the cervix who desires cancer?
future fertility: a) Li-Fraumeni syndrome
a) trachelectomy b) hereditary nonpolyposis colorectal
b) cold knife conization
cancer (HNPCC)
c) extrafascial hysterectomy and later
gestational surrogacy c) hereditary breast ovarian cancer
d) radical hysterectomy syndrome (BRCA 1/BRCA 2)
d) Cowden syndrome (phosphatase and
9. A 37years old woman has completed tensin homolog PTEN mutation)
childbearing, you perform cold knife
conization for CIN 3 found in ectocervical 13. Appropriate ttt of a 35yrs old woman
biopsies and in endocervical curettage with the diagnosis of complex hyperplasia
samples. The final pathologic analysis without atypia:
reveals a grade 2 invasive squamous cell a) medroxyprogesterone acetate
carcinoma with a depth of invasion of
b) combined OCPs
2mm and a width of 8mm and CIN 3 at the
margins. The most appropriate next step: c) levonorgestrel releasing IUD
a) extrafascial hysterectomy d) all of the above
b) radical hysterectomy
c) repeat cold knife conization and ECC 14. What is the commonest way of spread
d) radiation with concomitant of endometrial carcinoma?
chemotherapy a) lymphatic
b) hematogenous
10. The following does not increase a c) Intraperitoneal
woman's risk for endometrial cancer: d) direct extension
a) obesity
b) smoking
c) tamoxifen 15. A 60 yrs old woman undergoes TAH
d) unopposed estrogen and BSO with bilateral pelvic and
paraaortic lymph node dissection. Her
11. The mechanism by which obesity pathology reveals grade 2 endometrial
increases the risk of endometrial cancer: carcinoma with more than 50%
a) androstenedione is aromatized by myometrial invasion. All the other
adipose tissue to estrone pathology is benign. What is her FIGO
b) androstenedione is aromatized by staging?
adipose tissue to estradiol a) IA
c) higher levels of insulin-like growth
b) IB
factor lead to anovulation
d) none of the above c) IIIA
d) IIIB
16. A 60yrs old woman with a grade I 20. A 52years old woman who has
endometrial carcinoma has a BMI of 45, hypertension and diabetes is diagnosed
uncontrolled type 2 DM and a myocardial with endometrial cancer. Her diseases are
infarction within the past 3 months. She well controlled. Her physician has
has undergone stenting of two coronary diagnosed the condition as tentatively
arteries and takes plavix. The most stage I. The most important therapeutic
appropriate management: measure for this patient:
a) tamoxifen a) radiation therapy
b) progesterone b) chemotherapy
c) progestin therapy
c) vaginal hysterectomy
d) surgical therapy
d) Laparoscopic TAH+BSO, bilateral
pelvic and paraaortic lymph node
21. A 35years old woman is diagnosed
dissection, pelvic washings with endometrial cancer. The most likely
to be present:
17. The commonest presenting symptom a) Ascites
for uterine sarcoma is: b) BRCA 1 mutation
a) infertility c) Galactorrhea
b) shortness of breath d) PCOS
c) abnormal uterine bleeding
d) abnormal screening PAP smear result 22. A 39yrs old woman is diagnosed with
cervical cancer that spreaded to her right
18. A 60years old woman has pelvic sidewall. She has right
postmenopausal bleeding. She undergoes hydronephosis. The following is true
FC that shows endometrial cancer. Risk regarding this patient’s condition:
factor for endometrial cancer is: a) the best therapy for her is surgical
a) multiparity excision
b) HSV infection b) Both brachytherapy and teletherapy
c) diabetes mellitus are important in her treatment.
d) smoking c) radical hysterectomy is an option in
the therapy of this patient
d) the majority of cervical cancers are
19. A 48years old healthy postmenopausal
of adenomatous cell type
woman has a Pap smear with atypia. She
does not have a history of abnormal Pap 23. A 45yrs old woman is diagnosed with
smears. The best next step is: an early cervical cancer, confined to the
a) repeat Pap smear in 3 months cervix, 3cm in diameter. The following is a
b) colposcopy, endocervical curettage, risk factor for cervical cancer:
endometrial sampling a) early age of coitus
c) HRT b) nulliparity
d) vaginal sampling c) obesity
d) late menopause
24. A 33yrs old woman has a Pap smear 28. Schiller’s iodine applied the cervix will
showing HSIL. She denies smoking and stain:
does not recall having any STDs. Which of a) dysplastic area
the following is the best next step? b) carcinoma
a) repeat Pap smear in 3months c) erosion
b) conization of the cervix d) normal columnar epithelium
c) colposcopy directed biopsies e) mature squamous epithelium
d) radical hysterectomy 29. The following is the most common
method used to diagnose CIN:
25. A Pap smear of 40yrs old female shows a) complaint of abnormal discharge
HSIL. This means that: b) postcoital bleeding
a) routine cytology is recommended if c) chronic pelvic pain
HPV subtyping reveals no high-risk d) vaginal wet preparation
virus e) abnormal pap smear
b) no further analysis is needed if the 30. A 34yrs old woman is 16wks pregnant,
entire transformation zone was seen. her Pap smear suspicious for cancer, your
c) an excisional biopsy of the cervix is advice to her is:
needed a) Have a colposcopy with biopsy
d) cervical cancer is highly unlikely due b) Have colposcopy but biopsy is too
to Pap smear revealing only HSIL risky in pregnancy
c) Have a repeat PaP smear at 3 months
26. Risk factors of cervical carcinoma d) Undergo a termination of pregnancy
include: and then undergo complete
a) prolonged unopposed effect of evaluation
estrogen e) Have cervical conization
b) nulliparity or low parity
31. The following associated with
c) infection with HPV
increased risk of endometrial cancer:
d) late age of marriage
a) multiparity
e) late menopause
b) use of combined oral contraceptive
pill
27. Cervical smears: c) family history of cervical cancer
a) should be taken every 10 years d) polycystic ovary syndrome
b) could be fixed 2 days later e) early menopause
c) should be stained with Schiller’s
iodine 32. What in the personal history is a
d) cases showing inflammatory changes protective factor for endometrial cancer?
a) early menarche
should be referred for colposcopy
b) obesity
e) cases showing dysplastic changes
c) nulliparity
should be referred for guided biopsy
d) early menopause
e) old age
33. The LEAST common outcome of 36. A G2P1 35yrs old has a Pap test of
cervical human papillomavirus (HPV) HSIL. Colposcopy shows incomplete
Infection is: visualization of SCI. Cervical biopsy
a) asymptomatic confirms a CIN 3, there is also histologic
b) Condytomata
CIN 2 present in the endocervical
c) Latent infection
d) Subclinical Infection curettage specimen. The most appropriate
e) Neoplasia (dysplasia or cancer) procedure for further diagnosis and or
treatment:
34. A 42-year-old multipara has -ve Pap a) Cryosurgery
test & +ve HPV DMA test results. These b) Hysterectomy
were repeated 1 year later with same c) Loop excision
results. She is a long-time cigarette d) Laser ablation
smoker and has had six lifetime sexual
e) Hysteroscopic endometrial ablation
partners. She has not had a new sexual
partner for 7 years. Her strongest risk
factor for cervical cancer: 37. Based on 2009 ACOG guidelines, at
a) Parity what interval should a 52-year-old woman
b) Tobacco use undergo cervical cancer cytologic
c) Persistent HPV Infection screening if she has an average risk for this
d) Multiple lifetime sexual partners cancer and if her three previous
e) Age consecutive Pap test results are negative?
a) Annually
35. If all of their Pap tests are negative and
b) Every 2 years
performed at per guidelines intervals.
Which of the following women would c) Every 3 years
discontinuation of cervical cancer d) Every 5 years
screening be acceptable? e) Every 10 years
a) 35-year-old nulligravida with multiple
sexual partners 38. A woman is concerned about her risks
b) 42-year-old woman with past for developing cervical cancer. Which of
hysterectomy for leiomyomas the following factors poses the largest risk
c) 72-year-old woman in good health
for developing cervical cancer?
with one longstanding sexual partner
d) 55-year-old woman with metastatic a) Alcoholism
breast cancer refusing further b) Early sexual activity
therapeutic interventions c) Low-fiber diet
e) All of the above are reasonable d) Nulliparity
candidates for discontinuation of e) Prolonged estrogen use
cervical cancer screening
39. Regarding cervical cancer, which is the 43. A mildly obese 62yrs old woman
true statement? complains of bleeding per vagina. Her LMP
a) HPV types 6 and 12 are high risk for was 11yrs ago, she had no bleeding since
developing cervical cancer. then. She has hypertension and type 2
b) The new vaccines can prevent DM. An endometrial biopsy shows grade I
invasive carcinoma but not CIN. endometrial adenocarcinoma. The most
c) When the new vaccination is appropriate next step is:
introduced, cervical screening
a) Chemotherapy
programmes can cease.
b) Cone biopsy
d) HPV types 16 and 18 account for the
c) Dilation and curettage
majority of cervical cancer.
d) Hysteroscopy
e) HPV is an oncogenic virus for
squamous cell but not e) Hysterectomy
adenocarcinoma of the cervix. 44. Cervical carcinoma characteristically
spreads in the:
40. Woman with postmenopausal a) Tissue
bleeding need endometrial biopsy if ET on b) Lymph
US is thicker than: c) Bone
a) 1mm d) Blood
b) 2mm e) Mucus
c) 5mm
d) 8mm 45. Cervical cancer invading lower vagina
e) 10mm or pelvic wall or causing ureteric
obstruction is:
41. The commonest cause of death in a) Stage 1a
cancer cervix is: b) Stage 4
a) Infection
c) Stage 3
b) Uraemia
d) Stage 2a
c) Haemorrhage
e) Stage 1b
d) Cachexia
e) Distant metastasis
46. Pap smear:
42. The following are the factors a) the next step in dysplastic smear is
associated with CIN EXCEPT: colposcopy
a) Onset of coitus at early stage b) is simple but inaccurate
b) Multiple sexual partners c) should be carried out every 5years
c) Lower socioeconomic status d) has no role in screening of
d) Nulliparity asymptomatic women
e) History of veneral disease e) all of the above
47. A 39yrs old para 6, complains of 51. The most productive diagnostic
postcoital bleeding. Your first procedure of this stage would be:
investigation should be: a) Ultrasonography, colour doppler, CT ,
a) D & C MRI
b) Cone biopsy of the cervix b) Endometrial biopsy and fractional
c) Pap smear curettage
d) Colposcopy c) Vaginal cytology
e) Laparoscopy d) A+B
e) all of the above
48. A 58 years old woman complains of
postmenopausal bleeding for 2 weeks. 52. Investigations done in previous step
Most essential investigation: revealed free cervix, vagina, lymph nodes
a) Colposcopy and only endometrial involvement. The
b) Pap smear stage of carcinoma is:
c) Cone biopsy a) 0
d) D & C
b) 1
e) Hysteroscopy
c) 2
d) 3
49. the most common symptom of
e) 4
endometrial hyperplasia is:
53. The appropriate operation would be:
a) Vaginal discharge
a) Radical hysterectomy alone
b) Vaginal bleeding
b) Radical hysterectomy with pelvic
c) Amenorrhea
lymphadenectomy
d) Pelvic pain
e) Abdominal distention c) Hysterectomy with pelvic
lymphadenectomy
Questions 50-54: A 65 year old para 1 who d) Hysterectomy with bilateral salpingo-
had her LMP at 50 years of age, comes oopherectomy
with sudden bleeding per vagina. She is e) subtotal hysterectomy
obese and hypertensive. The uterus is
slightly enlarged. 54. Five years survival for the patient with
proper therapy is estimated to be:
50. The most probable diagnosis is: a) 85%
a) Carcinoma of vulva b) 65%
b) Carcinoma of vagina c) 45%
c) Cervical cancer d) 25%
d) Endometrial carcinoma e) 5%
e) Endometrial hyperplasia
55. Most appropriate surgical procedure 59. Patients with which of the following
for a woman who has completed would not require adjuvant
chiIdbearing with a stage IA1 squamous chemoradiation after radical hysterectomy
cell carcinoma of the cervix: and lymph node dissection?
a) Cold knife conization a) Positive parametria
b) Extrafascial hysterectomy b) Positive lymph nodes
c) Radical hysterectomy c) 3-cm tumor with deep-third stromal
d) Schauta operation invasion and lymphovascular space
e) Total pelvic excentration invasion
d) 4-cm tumor with inner- third stromal
56. The following does not increase a invasion and no lymphovascular
woman's risk of developing endometrial space invasion
cancer: e) all of the above
a) Obesity
b) Smoking 60. The following best describes the
c) Tamoxifen transformation tone of the cervix?
d) Unopposed estrogen a) glandular transformation of
e) Early menarche squamous epithelium
b) metaplastic transformation of
57. The appropriate ttt of a 35yrs old columnar to squamous epithelium
woman with complex hyperplasia without c) precancerous transformation of
atypia is: squamous epithelium
a) Medroxyprogesterone acetate
b) Combination oral contraceptive pills d) transformation from columnar to
c) Progesterone implants transitional epithelium
d) Levonorgestrel-releasing intrauterine e) tramformation from squamous to
system (IUD) transitional epithelium
e) All of the above
58. Most appropriate ttt for 30yrs old choose the SINGLE most appropriate
G1P1 with stage IA1 adenocarcinoma of answer from the below list of options,
cervix who desires fertility: each option can be used once, more than
a) Trachelectomy once or not at all.
b) Cold knife conization a) simple hyperplasia of the
c) Extra fascial hysterectomy and later endometrium
gestational surrogacy b) complex hyperplasia of the
d) Modified (type II) radical endometrium with atypia
hysterectomy and later gestational c) adenocarcinoma of the endometrium
surrogacy d) serous uterine carcinoma
e) Total pelvic excentration and later e) clear cell carcinoma of the uterus
gestational surrogacy
f) carcinosarcoma of the uterus 67. A 48yrs old woman attends the

g) leiomyosarcoma of the uterus gynecology clinic with prolonged vaginal
h) endometrial stromal sarcomas bleeding, her last cervical smear was 8yrs
i) rhabdomyosarcoma ago. Speculum examination reveals a
61. Most common uterine malignancy. suspicious cervix that bleeds on contact.
Most appropriate initial investigation:
62. Rare tumour of the myometrium. a) Cervical biopsy
63. Rare uterine tumour derived from b) LLETZ
skeletal muscle. c) Hysteroscopy
d) MRI for her pelvis
64. Precursor lesion of adenocarcinoma of e) TAS
the endometrium.
65. A 54yrs old woman attends the choose the SINGLE most appropriate
gynecology clinic with postmenopausal answer from the below list of options,
bleeding. TVS shows an endometrial each option may be used once, more than
once or not at all.
thickness of 8mm. Endometrial biopsy
a) squamous metaplasia
shows moderately differentiated
b) columnar epithelium
adenocarcinoma cells. The most c) moderate dyskaryosis
appropriate staging investigation: d) severe dyskaryosis
a) Chest X-Ray e) border line nuclear change
b) CT scan of her thorax, abdomen and f) mild dyskaryosis
pelvis g) glandular atypia
c) Hysteroscopy h) arias-stella changes
d) MRI of her pelvis
e) TAS 68. CIN1.
69. CIN2.
66. A fit 72yrs old woman has an MRI after
endometrial biopsy shows endometrioid 70. CIN3.
adenocarcinoma of the endometrium. 71. CGIN (Cervical glandular intraepithelial
Staging from the MRI is stage II. neoplasia).
Management is:
a) carboplatin- based chemotherapy For each description in questions 72-75,
b) TAH+BSO choose the SINGLE most appropriate
c) external beam radiotherapy to the answer from the below list of options,
pelvis each option may be used once, more than
d) modified radical hysterectomy once or not at all.
e) brachytherapy a) subtotal hysterectomy
b) cold coagulation
c) Wertheim's operation
d) large loop excision of the 80. The following are risk factors for
transformation zone development of cancer cervix: family
e) bilateral salpingo-oopherectomy history of cervical cancer.
f) Wertheim's operation and
radiotherapy 81. The following are risk factors for
72. CIN2. development of cancer cervix: smoking.
73. Ectopy. 82. The following are risk factors for

development of cancer cervix: previous
74. Stage 1B cervical cancer.
chlamydia infections.
75. Stage 2 cervical cancer.
76. The most appropriate treatment for an development of cancer endometrium:
80yrs old woman with BMI: 25 presenting obesity.
with postmenopausal bleeding and found 84. The following are risk factors for
stage 1a endometrial adenocarcinoma on
development of cancer endometrium:
MRI is:
a) polypectomy and mirena diabetes.
b) TAH+ BSO 85. The following are risk factors for
c) TAH+ BSO and chemotherapy development of cancer endometrium:
d) TAH+ BSO and radiotherapy multiparity.
e) radiotherapy alone
77. Management of a cervical smear development of cancer endometrium: early
showing HSIL: menopause.
a) repeat smear in 6 months
b) HPV vaccination 87. The following are risk factors for
c) colposcopy and biopsy development of cancer endometrium:
d) LLETZ tamoxifen.
e) Wertheim’s hysterectomy
development of cancer endometrium: late
II. For each of the statements below, mark
menopause.
True (T) or False (F):
89. Cancer cervix is more common in
multipara.
development of cancer cervix: HPV 14, 17,
31. 90. Cancer endometrium is more common
in nulligravida.
development of cancer cervix: HPV 16, 18.
ANSWERS
1 C 36 C 71 G
2 D 37 C 72 D
3 C 38 B 73 B
4 C 39 D 74 C
5 C 40 C 75 F
6 C 41 B 76 B
7 B 42 D 77 C
8 B 43 E 78 F
9 B 44 B 79 T
10 B 45 C 80 F
11 A 46 A 81 T
12 B 47 C 82 F
13 D 48 D 83 T
14 D 49 B 84 T
15 B 50 D 85 F
16 B 51 D 86 F
17 C 52 B 87 T
18 C 53 D 88 T
19 B 54 A 89 T
20 D 55 B 90 T
21 D 56 B
22 B 57 E
23 A 58 B
24 C 59 D
25 C 60 B
26 C 61 C
27 E 62 G
28 E 63 I
29 E 64 B
30 A 65 D
31 D 66 D
32 D 67 A
33 E 68 F
34 C 69 C
35 C 70 D
Gyn 5: Oncology 2 (140 marks)

I. Choose the most correct answer: 4. Which of the following is NOT a
characteristic of Krukenberg tumours?
1. Which of the following is not a risk a) they are bilateral
b) they usually arise from primary
factor for ovarian cancer?
gastric tumours
a) nulliparity c) they are usually the only site of
b) late menopause metastatic disease
c) COCPs d) they are comprised of mucinous and
d) Hereditary nonpolyposis colon signet ring cells
cancer (HNPCC)
5. What is the most common method of
2. A 27yrs old NG who desires future ovarian cancer spread?
fertility underwent a laparoscopic left a) lymphatic
salpingo oophercctomy (LSO) for a 7cm b) hematogenous
cyst. The cyst was removed intact and c) direct extension
washings were negative. Pathology shows d) tumour exfoliation
serous low malignant potential tumour.
6. Which of the following is not a tumour
Most appropriate management: marker for germ cell tumours?
a) close observation a) inhibin
b) right salpingo-oopherectomy b) alpha-fetoprotein (AFP)
omentectomy and multiple c) lactate dehydrogenase (LDH)
peritoneal biopsies d) human chorionic gonadotrophin
c) RSO, omentectomy, peritoneal (HCG)
biopsies, pelvic and para aortic LN
dissection 7. Which of the following malignant germ
d) TAH, RSO, omentectomy, peritoneal cell tumours has the worst prognosis?
biopsies, bilateral pelvic & para- a) dysgermmoma
b) yolk sac tumour
aortic LN dissection
c) immature teratoma
d) nongestational choriocarcinoma
3. The following woman does not need
referral to a gynecologic oncologist: 8. An 18yrs old female has a history of a
a) 35yrs old with a complex 7cm stage IC grade 3 immature teratoma and
adnexal mass and CA125 level of 75 received chemotherapy. At 6month
b) 60yrs old with a complex 7cm follow-up, she is noted an enlarging pelvic
adnexal mass and CA125 level of 75 mass. Next step is:
c) 35yrs old with a complex 7cm a) chemotherapy
adnexal mass, ascites and CA125 b) radiation therapy
level of 75 c) continued observation
d) 50yrs old with a complex 7cm fixed d) exploratory laparotomy with removal
of masses
adnexal ass and CA 125 level of 25
9. The following patients does NOT need 14. You perform a radical vulvectomy and
adjuvant chemotherapy after unilateral bilateral inguinofemoral LN dissection for
salpingo-oopherectomy with surgical a 3cm invasive vulval squamous cell
staging: carcinoma involving the lower third of the
a) stage IA dysgerminoma vagina. Final pathology reveals free
b) stage IA yolk sac tumour margins and LN. FIGO stage is:
c) stage IA grade 3 immature teratoma a) I
d) all of the above b) II
c) III
10. The presenting symptom of a sex cord-
d) IV
stromal tumour in a prepubescent girl:
a) hirsuitism
b) abdominal pain 15. The following is not associated with
c) primary amenorrhea increased risk of lymph node metastasis:
d) isosexual precocious puberty a) high grade
b) increasing age
11. The following tumors are hormonally c) clitoridal lesion
active and most often secrete estrogen: d) Iymphovascular space invasion
a) thecoma
b) fibroma 16. A 54yrs old woman presents with Rt
c) sertoli-leydig tumor Bartholin abscess. She denies similar
d) none of the above condition in the past. The most
appropriate management is:
12. What is the most accurate description a) antibiotics
of Cloquet node? b) resection of the Bartholin gland
a) it is a deep inguinifemoral node c) marsupialization
b) it is the most superior node in the d) incision and drainage
femoral triangle
c) if negative no pelvic lymph node
17. Percentage of primary vaginal cancer
dissection is indicated
comprises from gynecologic malignancies:
d) all of the above
a) 1-2%
13. A 62yrs old woman presents for her b) 5-7%
annual examination and complains of c) 9-11%
vulvar pruritis. You note an area of d) 13-15%
thickened white plaque. The next step is:
a) biopsy the lesion in your office 18. The commonest presenting complaint
b) prescribe estrogen cream and follow in women with primary vaginal cancer:
up in 3months a) bleeding
c) perform a wide local excision in the b) constipation
operating room c) vaginal mass
d) prescribe clobetasol cream and d) urinary retention
follow up in 3months
19. Most vaginal cancers develop in which 24. Best treatment for a suspected
part of the vagina: dermoid cyst found in an 18year old
a) upper third nulliparous woman:
b) middle third a) total abdominal hysterectomy
c) lower third b) unilateral salpingo-oopherectomy
d) none of the above c) ovarian cystectomy
d) observation
20. In a woman with vaginal cancer, FIGO
staging is determined through: Questions from 25-27, match the
a) vaginectomy sonographic findings with the ovarian
b) physical examination tumour type.
c) CT alone a) completely solid echogenic mass
d) vaginectomy with pelvic b) simple echoluscent cyst
lymphadenectomy c) complex cyst with heterogenous
echogenecity
21. A Schiller Duvall body, found during d) ascites and fluid in hepatorenal
histologic evaluation and an elevated AFP pouch
level may be found with which type of 25. Granulosa cell tumour
vaginal cancer:
a) yolk sac tumor 26. Benign cystic teratoma (dermoid cyst)
b) Ieiomyosarcoma 27. Follicular cyst
c) clear cell adenocarcinoma
d) embryonal rhabdomyosarcoma 28. A 44yrs old woman is having a 30cm
tumour of the ovary, it is most likely:
22. A 5yrs old girl is noted to have breast a) dermoid cyst
enlargement, vaginal bleeding and an 8cm b) granulosa cell tumour
pelvic mass. Which of the following is the c) serous tumour
most likely etiology? d) mucinous tumour
a) benign cystic teratoma (dermoid)
b) endodermal sinus tumour 29. A 56yrs old woman is seen for a 2cm
c) choriocarcinoma ulcerating lesion of the Rt labia majora
d) granulosa theca cell tumour that has been present for 5months, you
perform a punch biopsy of the lesion
23. A 25yrs old woman is noted to have a which reveals moderately differentiated
4cm simple cyst of the right ovary. She squamous cell carcinoma. The most likely
denies any abdominal pain, nausea or location of the metastasis:
vomiting. The next step is: a) left labia majora
a) expectant management b) uterosacral ligament
b) laparoscopy c) inguinal lymph nodes
c) exploratory laparotomy d) pelvic lymph nodes
d) chemotherapy
30. A 29yrs old woman with PCOS is 34. Vulval cancer <2cm and confined to
counseled about the possibility of vulva with stroma invasion >1mm will be
developing metabolic syndrome. The most staged as:
significant one is: a) 1a
a) hyperthyroidism b) 1b
b) cardiovascular disease c) 1c
c) breast cancer d) 2a
d) renal insufficiency e) 2b
31. A 34-year-old woman is diagnosed to 35. Vulval carcinoma more than 2cm and
have vulval intraepithelial neoplasia grade confined to vulva will be staged as:
3 on a punch biopsy from a vulval lesion. a) 1a
What is the recommended treatment for b) 1b
this condition? c) 2
a) interferon therapy d) 2a
b) laser ablation of the lesion e) 2b
c) local surgical excision
d) simple vulvectomy 36. Which of the following ovarian tumor
e) topical imiquimod cream is most prone to undergo torsion during
pregnancy?
32. What does leukoplakia refer to? a) Serous cystadenoma
a) microscopic lesion b) Mucinous cystadenoma
b) atrophy c) Dermoid cyst
c) cancer d) Theca lutein cyst
d) white patch e) Simple serous cyst
e) ulcer
37. A unilocular ovarian cyst measuring
33. A 27yrs old NG had Pap test showing 4x5cm found on US during the 8th week of
LSIL. Colposcopy is negative for lesions but gestation. Best management for this case:
vaginal lesions are observed after
application of 5% acetic acid. A biopsy a) observation and repeated
shows features of HPV infection and low- ultrasonography
grade VaIN 1. The patient is b) laparoscopic aspiration of the cyst
asymptomatic. The best option is: c) immediate laparotomy and
a) Observation cystectomy
b) Laser ablation d) immediate laparotomy and
c) HPV vaccination ovariectomy
d) Intravaginal fluorouracil (5-FU) cream e) laparotomy and cystectomy
e) Vaginectomy and radical postponed to 14 weeks
hysterectomy
38. A 54yrs woman have endometrial 42. The preferred treatment of ruptured
hyperplasia on endometrial biopsy, tubo-ovarian abscess in old patient is:
ovarian tumor to be suspected: a) Cul-de-sac drainage
a) Lipid cell tumor. b) Removal of uterus, tubes and
b) Granulosa-theca cell tumor. involved ovary
c) Sertoli-Leydig tumor. c) Removal of uterus tubes and ovaries
d) Mucinous cystadenocarcinoma. d) Removal of ruptured tube and ovary
e) Polycystic ovary e) Removal of adnexae and drainage
39. Patient wz history of molar pregnancy,
43. Myxoma peritonei may occur as a
complains of lower abdominal pain wz
consequence of rupture of which ovarian
tenderness on palpation and HCG shows
high levels, US shows ovarian cysts, these cysts:
cysts are most likely: a) Dermoid
a) follicular cyst b) Struma ovarii
b) theca lutein cyst c) Serous cystadenoma
c) corpus lutcum cyst d) Mucinous cystadenoma
d) endometriomas e) Cystadenofibroma
e) tubo-ovarian abscesses
44. A 4-year-old girl has breast
40. 19yrs old female complains of left enlargement and vaginal bleeding. O/E
lower quadrant pain for 2 months & she has a 9cm pelvic mass. This mass is
worsening. She has had no changes in most likely:
bowel or bladder function, no fevers or a) Cystic teratoma
chills, no nausea, vomiting or diarrhea. PV b) Dysgerminoma
shows left adnexal mildly tender mass. c) Endodermal sinus tumor
Urine HCG is negative. TVS shows a 6cm d) Granulosa cell tumor
complex left adnexal mass, suggestive of e) Mucinous tumor
dermoid. Most appropriate next step in
management:
45. A 47yrs old woman has a pressure
a) Repeal pelvic examination in 1 year
sensation in her pelvis for the past 5
b) Repeal pelvic ultrasound in 6 weeks
c) Prescribe the oral contraceptive pill months. O/E, there is Rt adnexal mass. US
d) Perform hysteroscopy show a 10 cm fluid-filled cystic mass in Rt
e) Perform laparotomy ovary. FNAC reveals clusters of malignant
epithelial cells surrounding psammoma
41. Lutein and theca lutein cysts may be bodies, she is most likely to have:
associated with all the following EXCEPT: a) Endometrial adenocarcinoma
a) Mole b) Ovarian serous cystadenoma
b) Chorioepithelioma c) Mesothelioma
c) Stein-leventhal syndrome (PCO) d) Ovarian mature cystic teratoma
d) Pregnancy e) Adenocarcinoma of fallopian tube
e) Placental site tumours
46. A 48yrs old woman noted minimal 49. Exploratory laparotomy shows a
irregular vaginal bleeding for the past 2 tumour involving the right ovary. Several
months. PV reveals no cervical lesions. Pap tumour implants are present on the
smear shows no abnormal cells. peritoneum of the small bowel and
Endometrial biopsy shows endometrial omentum. The liver appears normal and
hyperplasia. An abdominal US reveals a there are no distant metastases. What is
solid Rt ovarian mass. This is most likely: the initial intraoperative assessment of
stage?
a) Mature cystic teratoma
a) 0
b) Choriocarcinoma
b) I
c) Sertoli-Leydig cell tumor c) II
d) Fibrothecoma d) Ill
e) Krukenberg tumor e) IV
Questions 47- 50: A 65y old woman has 50. The 1ry tumour and all metastases are
abdominal distention of 3 months wz removed. You meet the patient
shifting dullness. PV reveals Rt adnexal postoperatively to discuss her prognosis.
mass that is fixed in the pelvis. Lt ovary is How do you advise her?
not palpable. CA125 is 250U/mL (N = a) The five year survival rate with no
35U/mL). Blood chemistries, urine postoperative chemotherapy is 70%.
analysis, PAP smear, mammography and b) Response to chemotherapy is related
chest X-Ray are normal. GIT studies are to the amount of residual disease.
normal. c) Older women’s response to
chemotherapy is superior to that of
younger women.
47. Which of the following is the most
d) Serum CA125 is not important during
likely diagnosis?
follow up.
a) Gonadoblastoma e) The woman is completely cured and
b) Meigs' syndrome follow up is not required.
c) Krukenberg tumour
d) Serous cystadenocarcinoma 51. The following postmenopausal women
e) Endodermal sinus tumour is protected from epithelial ovarian
48. Her surgical treatment should include malignancy:
which of the following? a) Married woman using perineal talc
a) Removal of all gross disease more powder.
than 1cm. b) Nun with a history of late
b) Avoid resection of bowel menopause.
c) Be done laparoscopically c) Nulliparous with a history of regular
d) Be done through a Pfannestiel menses.
incision d) Unmarried woman with a history of
breast cancer.
e) Be done without bowel preparation
e) Multiparous who used OCPs.
52. A 67y old woman presents with 55. A 17y old complains of left lower
abdominal discomfort, bloating, fatigue quadrant pain. O/E: a pelvic mass is felt.
and loss of weight. Her vital signs are An ovarian neoplasm is identified by US.
stable. O/E: a large Lt adnexal mass is felt. Most common ovarian tumour in this
US shows a 10cm complex mass with solid patient:
and cystic components and mild fluid in a) Germ cell tumour
Douglas Pouch. Most likely management: b) Papillary serous epithelial
a) Chemotherapy c) Brenner tumour
b) Abdominal exploration with surgical d) Fibrosarcoma
resection e) Sarcoma botryoides
c) Chemotherapy followed by
56. A 50y old undergoes an exploratory
abdominal exploration and surgical
laparotomy for a persistent pelvic mass.
resection
Frozen section diagnosis is serous cyst
d) Abdominal exploration with surgical
adenocarcinoma. Likelihood that the other
resection followed by chemotherapy
ovary is involved:
e) Abdominal exploration with surgical a) 5%
resection followed by radiotherapy b) 15%
c) 25%
53. Ovarian neoplasms most commonly d) 50%
arise from which of the following cell e) 75%
lines?
a) Ovarian epithelium 57. A 54y old woman undergoes a
b) Ovarian stroma laparotomy for a pelvic mass. There is a
c) Ovarian germ cells unilateral ovarian neoplasm with omental
d) Ovarian sex cords metastases. Frozen section diagnosis
e) Metastatic disease confirms metastatic serous cyst
adenocarcinoma. What is the most
54. A 76y old wz H/O of cancer 6y ago appropriate intraoperative course of
presents wz abdominal discomfort, action?
bloating and loss of weight. Symptoms a) Excision of omental metastases and
have been increasing for about 3 months. ovarian cystectomy
O/E: masses are palpable bilaterally. b) Omentectomy and ovarian
Assuming the masses are malignant. Most cystectomy
likely 1ry source of the tumours: c) Omentectomy and unilateral
oophorectomy
a) Bone
d) Omentectomy and bilateral salpingo-
b) Liver
oophorectomy
c) Breast
e) Omentectomy, total abdominal
d) GIT
hysterectomy and bilateral salpingo-
e) Lymph node
oophorectomy
58. Which ovarian neoplasm has the 63. Which of the following ovarian
lowest malignancy rate? tumours is the most common?
a) Serous tumours a) Granulosa cell tumour
b) Mucinous tumours b) Sertoli-Leydig cell tumour
c) Endometriod tumours c) Yolk sac tumour
d) Clear cell carcinoma d) Gonadoblastoma
e) Brenner tumours e) Mucinous cystadenoma
59. Which ovarian neoplasm has the 64. A 32y old woman attends the fertility
highest rate of bilaterality? clinic complaining of a 4 year history of
a) Brenner tumours infertility, severe dysmenorrhoea and
b) Endometrioid tumours increasing pain with sexual intercourse. PV
c) Serous cyst adenocarcinoma shows an adnexal mass and nodules in the
d) Mucinous cyst adenocarcinoma Douglas Pouch. Most likely cause for these
e) Dysgerminoma symptoms is:
a) Corpus lutcum cyst
60. Which ovarian neoplasm is similar in b) Ovarian dermoid cyst
histologic appearance to primary tubal c) Ovarian carcinoma
carcinoma? d) Endometriosis
a) Clear cell carcinoma e) Pelvic inflammatory disease
b) Sex cord stromal tumours
c) Mucinous cyst adenocarcinoma
65. A woman has a mutation in BRCA1
d) Serous cyst adenocarcinoma
gene. She is at increased risk of
e) Endodermal sinus tumour
developing:
a) Breast and ovarian cancers
61. The staging of ovarian carcinoma is
b) Endometrial and breast cancers
based upon:
c) Endometrial and colon cancers
a) Pelvic examination
b) Paracentesis of ascitic fluid d) Ovarian and colon cancers
c) C.T. imaging of abdomen and pelvis e) Ovarian and endometrial cancers
d) Surgical evaluation of the extent of
intrapelvic and intraabdominal 66. A 27y old woman with regular cycles
disease has 6 months H/O of Rt sided abdominal
e) Barium enema pain. US on Day 13 shows ET: 13mm and
normal Lt ovary. A cystic structure
62. Which of the following ovarian 20x18mm is seen within the Rt ovary. The
tumours is derived from germinal most likely nature of the structure in Rt
epithelium? ovary:
a) Dysgerminoma a) Dermoid cyst
b) Fibroma b) Endometrioma
c) Theca cell tumour c) Ovulatory follicle
d) Endometrioid tumour d) Corpus lutcum cyst
e) Germ cell tumour e) Follicular cyst
67. A 26y old NG presents to ER with acute 70. A 32yrs old woman has a pelvic TVS as
abdominal pain and Rt lower quadrant part of Investigation of 1ry subfertility,
tenderness. BP: 90/50. Pulse: 120. T: showing bilateral 5cm “kissing” ovarian
afebrile. PV shows 10cm Rt adnexal mass. cysts in the Douglas Pouch, both
Serum pregnancy test is -ve and hct is containing diffuse, low level echoes giving
24%. Exploratory laparotomy confirms a a solid “ground-glass” appearance, she
haemoperitoneum. A smooth Rt ovarian reports severe dysmenorrhea and
tumour is bleeding from its ruptured
dyspareunia. These ovarian cysts are most
capsule, uterus, fallopian tubes and Lt
likely:
ovary are normal. Right salpingo-
oophorectomy is performed. Frozen a) hemorrhagic functional ovarian cysts
section shows primitive germ cells with b) dermoid cysts
intervening connective tissue infiltrated by c) endometriomas
lymphocytes. The tumour is most likely: d) tubo-ovarian abscesses
a) Dysgerminoma e) serous cystadenomas
b) Endodermal sinus tumour
c) Choriocarcinoma For each description in questions 71- 78,
d) Granulosa cell tumour choose the SINGLE most appropriate
e) Dermoid cyst answer from the below list of options,
each option may be used once, more than
68. Vaginal adenocarcinoma in children is once or not at all.
caused by: a) serous adenocarcinoma
a) HPV virus
b) border line mucinous epithelial
b) Administration of DES to pregnant
tumour
mothers
c) Hormonal changes c) endometrioid ovarian cancer
d) HSV d) immature teratoma
e) All of the above e) dysgerminoma
f) granulosa cell rumour
69. A 25yrs old parous woman is admitted g) choriocarcinoma of the ovary
to hospital with acute left sided colicky h) sertoli-leydig ovarian tumour
pain, she has no abnormal vaginal i) dermoid cyst
discharge nor urinary or bowel symptoms, j) krukenberg tumour
she is apyrexical and tachycardic. O/E: her
abdomen is soft not distended and non- 71. Commonly associated with BRCA
tender, she has not missed a menstrual mutation carrier status.
period and her urinary pregnancy test is 72. May present with amenorrhea, deep
negative, she requires morphine for pain voice, hirsuitism and acne.
relief. Which diagnostic test you consider
first-line in this situation? 73. May provoke precocious puberty in
a) serum B-HCG young girls.
b) MRI 74. Associated with endometriosis.
c) CT Scan
75. Secretes inhibin.
d) transabdominal and TVS
e) laparoscopy
76. Associated with appendiceal tumours d) endometroid tumour

and pseudomyxoma peritoneii. e) clear cell tumour
77. May contain hair, teeth, bone, cartilage f) granulosa cell tumour
and sebum. g) Brenner tumour
h) mucinous cystadenoma
78. Metastatic ovarian tumour from
colorectal or breast primary. 80. A unilocular cyst with papillous
processes usually occurring unilaterally.
79. A 58yrs old woman presents with a 81. A large unilateral multilocular cyst lined
large pelviabdominal mass extending to by columnar epithelium and complicated
the level of the xiphisternum. It has a with pseudomyxoma peritoneii.
heterogenous appearance on scan with 82. A large cyst usually containing
solid and cystic components, the rest of unclotted blood with a ground glass
the pelvis and abdomen appears normal appearance on ultrasound.
and there is no free fluid. CA125 is 430
Units. She is asymptomatic. How would 83. This has a solid appearance with islands
you manage this patient? of transitional epithelium in dense fibrotic
a) laparoscopic ovarian cystectomy stroma.
b) Laparotomy, TAH+BSO, pelvic and
para-aortic lymph node sampling, For each description in questions 84-87,
omentectomy and debulking of choose the SINGLE most appropriate
tumour deposits. answer from the below list of options,
c) repeat scan and CA125 in 3months to each option may be used once, more than
check for interval change once or not at all.
d) six cycles of neoadjuvant carboplatin a) laser laparoscopy
and paclitaxel-based chemotherapy b) vaginal hysterectomy
followed by restaging CT scan at c) TAH + BSO
3months d) subtotal hysterectomy and
e) US guided transcutaneous aspiration carboplatin
of ovarian cyst fluid and cytological e) unilateral salpingo-oopherectomy
assessment and peritoneal washings
f) Wertheim's hysterectomy
For each description in questions 80-83, g) Debulking surgery and subsequent
choose the SINGLE most appropriate cisplatin paclitaxel chemotherapy.
answer from the below list of options, 84. Stage 1B ovarian cancer.
once or not at all. 85. Stage 3 epitheliod tumour.
a) fibroma 86. Unilateral borderline tumour.
b) serous cystadenoma 87. Endometriosis.
c) teratoma
88. A 17yrs old girl who is not sexually 99. A single loculated cyst of 7cm diameter
active presents with left iliac fossa pain. on US is suspicious for malignancy.
US shows a 5cm complex solid cyst with
calcified and fatty elements on the left 100. Multiple cysts around the periphery of
ovary, the likely diagnosis: the ovary with a dense stroma on US are
a) theca lutein cyst suspicious for malignancy.
b) tuboovarian abscess
c) serous cystadenoma 101. Papillae found floating within a cyst
d) fibroma are suspicious for malignancy.
e) dermoid cyst
102. Solid elements and septae on US are
suspicious of malignancy.
103. Calcification and fats are suspicious for
malignancy.
89. In dermoid cyst, malignancy rate is low.
104. Endodermal yolk sac tumours have
90. In dermoid cyst, 60% are bilateral. raised alpha fetoprotein.
91. In dermoid cyst, they are often lined by 105. Granulosa cell tumours have raised
embryonic mesodermal structures. alpha fetoprotein.
92. In dermoid cyst, struma ovarii are 106. Epithelial ovarian cancer have raised
predominantly made of thyroid tissue. alpha fetoprotein.
93. In dermoid cyst, complications include 107. Dysgerminomas have raised alpha
torsion, chemical peritonitis and rupture. fetoprotein.
94. All granulosa cell tumours are 108. Choriocarcinoma has raised alpha
malignant but are usually confined to the fetoprotein.
ovary and have a good prognosis.
109. Carcinoma of ovary is most common in
95. Call-Exner bodies are pathognomonic of developing countries.
theca cell tumours.
110. Incidence of carcinoma of ovary is
96. Many theca cell tumours cause similar to carcinoma of the endometrium
postmenopausal bleeding and endometrial with similar prognosis.
carcinoma.
111. The peak age of ovarian cancer is 80-
97. Meig's syndrome is the combination of 90yrs old.
fibroma, ascites and pleural effusions.
112. Majority of ovarian tumours are
98. Virilization is seen in 75% of Sertoli- epithelial in origin.
Leydig cell tumours.
113. Mainstay of treatment of ovarian 127. The following are appropriate

carcinoma is surgery and radiotherapy investigations for ovarian cancer: US.
combined.
128. The following are appropriate
114. The following primary malignancies investigations for ovarian cancer: CA125.
metastasize to ovary: lung.
129. The following are epithelial tumours:
115. The following primary malignancies mucinous tumour.
metastasize to ovary: stomach.
116. The following primary malignancies theca cell tumour.
metastasize to ovary: breast.
117. The following primary malignancies teratoma.
metastasize to ovary: thyroid.
118. The following primary malignancies Brenner cell tumour.
metastasize to ovary: bone.
119. The following are risk factors for androblastoma.
ovarian cancer: early menarche.
134. Considering Dysgerminoma: the peak
120. The following are risk factors for age is over 45yrs old.
ovarian cancer: early menopause.
135. Considering Dysgerminoma: CA 125 is
121. The following are risk factors for elevated in 50% of cases.
ovarian cancer: COCPs use.
136. Considering Dysgerminoma: they are
122. The following are risk factors for mainly solid rather than cystic in nature.
ovarian cancer: infertility.
137. Considering Dysgerminoma: they
123. The following are risk factors for cause rise in LDH.
ovarian cancer: implanon implants.
138. Considering Dysgerminoma: immature
124. The following are appropriate teratomas are benign and are commonly
investigations for ovarian cancer: CT called dermoid tumour.
abdomen and pelvis.
139. The commonest pelviabdominal mass
125. The following are appropriate in the child bearing period is dermoid cyst.
investigations for ovarian cancer: barium
enema. 140. Mortality rate from ovarian cancer is
more than the mortality rates of
126. The following are appropriate endometrial and cervical cancers grouped
investigations for ovarian cancer: IVP. together.
ANSWERS
1 C 36 C 71 A 106 F
2 A 37 A 72 H 107 F
3 A 38 B 73 F 108 F
4 C 39 B 74 C 109 F
5 D 40 E 75 F 110 F
6 A 41 C 76 B 111 F
7 B 42 C 77 I 112 T
8 D 43 D 78 J 113 F
9 A 44 D 79 B 114 F
10 D 45 B 80 B 115 T
11 A 46 D 81 H 116 T
12 D 47 D 82 D 117 F
13 A 48 A 83 G 118 F
14 B 49 C 84 C 119 T
15 C 50 B 85 G 120 F
16 D 51 E 86 E 121 F
17 A 52 D 87 A 122 T
18 A 53 A 88 E 123 F
19 A 54 D 89 T 124 T
20 B 55 A 90 F 125 T
21 A 56 D 91 F 126 T
22 D 57 E 92 T 127 T
23 A 58 E 93 T 128 T
24 C 59 C 94 T 129 T
25 A 60 D 95 F 130 F
26 C 61 D 96 T 131 F
27 B 62 D 97 T 132 T
28 D 63 E 98 F 133 F
29 C 64 D 99 F 134 F
30 B 65 A 100 F 135 F
31 C 66 C 101 T 136 T
32 D 67 A 102 T 137 T
33 A 68 B 103 F 138 F
34 B 69 D 104 T 139 F
35 B 70 C 105 F 140 T
Gyn 6: Infections (95 marks)

I. Choose the most correct answer: 5. A 45yrs old patient wz 1ry syphilis,
refuses penicillin. The alternative oral
1. Vaginal flora of a normal reproductive antibiotic:
aged woman includes multiple bacterial a) doxycyclin
species. Anaerobes predominates over b) azithromycin
aerobic species by approximately what c) erythromycin
factor? d) ciprofloxacin
a) 5
b) 10 6. A 24yrs old woman presents with
c) 50 painless vulvar nodule that developed into
d) 100 a red ulcer that bleeds easily. O/E: inguinal
lymphadenopathy was detected. She is
2. The following is NOT one of the sexually active. Wright giemsa stain swab
diagnostic criteria for bacterial vaginosis: from the lesion shows Donovan bodies.
a) abnormally high vaginal pH What is her diagnosis?
b) presence of an abnormal discharge a) chancroid
and erythema of the vagina b) primary syphilis
c) clue cells seen on vaginal saline c) granuloma inguinale
preparation d) lymphogranuloma venerum
d) characteristic fishy odor release with
addition of KOH to vaginal secretion 7. A 32yrs old patient is coming for routine
check up. O/E: abnormal vaginal discharge
3. The following is NOT a treatment option was found that showed a flagellated
by CDC for bacterial vaginosis in non organism on microscopy. The patient is at
pregnant women: highest risk for:
a) oral clindamycin a) infertility
b) oral metronidazole b) cervical neoplasia
c) intravaginal clindamycin c) acute PID
d) intravaginal metronidazole d) coinfection with other STDs
4. What is the typical range of normal 8. The recommended CDC regimen for
vaginal pH? treatment of uncomplicated gonorrhea is:
a) 3-3.5 a) erythromycin
b) 4-4.5 b) ciprofloxacin
c) 5-5.5 c) ceftrioxone plus azithromycin
d) 6-6.5 d) ciprofloxacin plus azithromycin
9. A 20yrs old patient, sexually active, has 13. An 18yrs old presents to ER with 36hrs
lower quadrant abdominal pain, vaginal history of abdominal pain and nausea.
discharge, anorexia, fever: 39 and chills. T: 38.5. O/E: tenderness in Rt lower
O/E: diffuse tenderness with bilateral quadrant with rebound tenderness. PV
lower quadrant guarding. Her cervix shows shows some cervical motion tenderness
mucopurulent discharge. Movement of and Rt adnexal tenderness. Pregnancy test
the cervix elicits severe pain. The is negative. Considering DDx of
following tests would be LEAST likely to appendicitis vs PID, the most accurate
aid the diagnosis: method of making the diagnosis:
a) urine analysis a) following serial abdominal
b) pelvic ultrasound examinations
c) complete blood count b) sonography of the pelvis and
d) endometrial biopsy for bacterial abdomen
culture c) serum total and differential
leucocytic count
10. The following preparations provide d) laparoscopy
first-line therapy for lichen sclerosus:
a) estrogen cream 14. A 24yrs old G0P0 woman is seen at the
b) testosterone cream STDs clinic. Chlamydia is discovered
c) ultrapotent topical corticosteroid colonizing the endocervix. The patient is
d) all of the above given oral azithromycin therapy and
warned about the dangers of upper genital
11. Bartholin duct cysts form in direct tract infection and PID. The following is a
response to which of the following? risk factor for developing PID:
a) vulvar irritation a) nulliparity
b) cervical gonorrhea b) candida vaginitis
c) gland duct obstruction c) oral contraceptive pills
d) chronic lichen sclerosus d) depot medroxyprogesterone acetate
12. An 18yrs old adolescent female 15. An 18yrs old G0P0 adolescent female is
undergoes laparoscopy for an acute being seen for vaginal discharge. A
abdomen. Erythematous fallopian tubes presumptive diagnosis of bacterial
are noted and a diagnosis of PID is made. vaginosis is made. The following is a
Cultures of the purulent drainage would finding with BV:
most likely reveal: a) pH less than 4.5
a) multiple organisms b) frothy vaginal discharge
b) neisseria gonorrhea c) predominance of anaerobes
c) chlamydia trachomatis d) flagellated organisms
d) treponema pallidum
16. A 26yrs old woman completed a 2.4million units IM. Six months after
course of oral antibiotics for cystitis 1week therapy, she is noted to have a RPR titer of
ago. She complains of a day history of 1:2. At 12months, the titer is 1:1. Two
itching, burning and whitish vaginal months later, the repeat RPR is noted to
discharge. Best therapy: be 1:32. The most likely diagnosis:
a) metronidazole a) resistant organism
b) erythromycin b) laboratory error
c) fluconazole c) reinfection
d) hydrocortisone d) systemic lupus erythematosus
17. Organisms that may be isolated from a 21. Which of the following statements
wet surface 6hrs after inoculation: about T. pallidum is correct?
a) candida albicans a) it is a protozon
b) trichomonus vaginalis b) gram stain is a very sensitive method
c) gardnerella species of diagnosis
d) peptostreptococci c) the spirochete does not cross the
placenta during pregnancy
18. A 27yrs old woman complains of a d) penicillin is the recommended
fishy odor and vaginal discharge. treatment for all stages of syphilis
Speculum examination reveals an
erythematous vagina and punctuations of 22. An 18yrs old G1P0 at 14weeks
the cervix. The most likely treatment: gestation is noted to have a positive RPR
a) oral fluconazole with a positive confirmatory TPH test. The
b) metronidazole gel applied vaginally patient states that she is allergic to
c) metronidazole taken orally in a single penicillin with swelling of the tongue and
dose throat in the past. The most appropriate
d) intramuscular ceftrioxone and oral next step:
doxycycline a) desensitization and treat with
penicillin
19. A 29yrs old woman had been treated b) oral erythromycin
for bacterial vaginosis with metronidazole, c) oral doxycyclin
she notes abdominal discomfort, bloating d) pretreat with prednisone then
and diarrhea. The most likely explanation: administer penicillin
a) alcohol use
b) clostridium difficile colitis 23. A 35yrs old woman is seen for sore in
c) medication side effect the groin area for 8days. O/E: tender
d) undiagnosed salpingitis fluctuant mass above and below the Rt
inguinal ligament. The best treatment is:
20. A 19yrs old woman is having a RPR a) acyclovir
titer of 1:16 and the confirmatory TPA test b) ceftrioxone
is +ve. She had no history of syphilis. She is c) doxycycline
treated with benzathine penicillin G d) penicillin
Questions from 24-28, match the following 30. Which of the following is most likely to
vulvar lesions to the clinical presentation: cause vulvar pruritis?
a) lichen sclerosis a) Vaginal trichomoniasis
b) psoriasis b) Leukemia.
c) vulvar cancer c) Personal hygiene products
d) vulvar candidiasis d) Secondary syphilis
e) postmenopausal vulvar atrophy e) Hidradenitis suppurativa
24. A 60yrs old postmenopausal woman is
recently remarried and has superficial 31. the most effective treatment of vulvar
dyspareunia pruritis associated with atrophic vulvitis:
a) Antihistamines
25. A 52yrs old postmenopausal woman b) Hydrocortisone
complains of intense itching around her c) Alcohol injections.
vagina and anus makes intercourse and d) Tranquilizers
defecation painful e) Topical estrogen therapy.
26. A 45yrs old woman with poorly
controlled diabetes reports that she has 32. A 63yrs old patient presents with
tears on her vagina causing pain with vaginal itching, dryness and dyspareunia.
intercourse and defecation Treatment will be:
27. A 59yrs old postmenopausal woman a) Oral administered DES
presents with a 10year history of vaginal b) Vaginal estrogen cream daily
itching and she scratches frequently with a c) Oral administered progesterone
nodule near the clitoris d) Testosterone tablets 10mg/day
e) Estrogen 20mg IV
28. A 54yrs old postmenopausal woman
complains of itching in her vagina and the For questions 33-38, each lettered option
physician notices scaly lesions on both of may be used once, more than once or not
her elbows at all.
a) Candidiasis
29. An 18yrs old woman complains wz
b) Trichomonas
painful swelling of her left labium that has
c) Bacterial vaginosis
progressively worsened over the past
d) Atrophic vaginitis
3days. She has been treating the
discomfort with analgesics and warm sitz e) Chlamydia trachomatis
baths. O/E: 6cm swollen, red, tender, f) Foreign body.
tense and cystic mass in the base of the Lt 33. Most common type of vaginitis with a
labium majus is detected. Next step in the high pH in the sexually active mature
care of this patient: patient.
a) Excision of the mass
b) Dry heat 34. In cases of treatment failure, combined
c) Oral antibiotics and oral metronidazole may be indicated.
d) IM or IV antibiotics
e) Incision and drainage of the mass.
35. The patient complains of white, curdy 42. Bacterial vaginosis occurs when
discharge and vaginal burning and itching. normal bacterial flora are overgrown by:
On examination, the copious discharge is a) Mycoplasma hominis
confirmed. PH is 3.0. b) Gardnerella
36. Diagnosis may require vaginoscopy. c) Lactobacillus
37. The treatment should include d) A & B
intravaginal estrogen therapy. e) All of the above
38. Causative organism that is highly
associated with upper genital tract 43. The normal vagina is richly colonized
infection. by a bacterial flora predominantly:
a) Mycoplasma hominis
39. Treatment for condylomata b) Gardnerella
accuminata is: c) Actinomyces viscosus
a) Metronidazole d) Chlamydia trachomatis
b) Ceftriaxone e) Lactobacillus
c) Aciclovir
d) Topical podophyllin or imiquimod 44. The development of opportunistic
cream infections or a CD4 count <200 are
e) Doxycyclin or azithromycin diagnostic of:
a) Genital herpes
40. Diagnosis is established by a raised
vaginal pH, the typical discharge, +ve b) Condylomata accuminata
“whiff test” and the presence of clue cells c) AIDS
on microscopy: d) Chlamydia
a) Bacterial vaginosis e) Gonorrhoea
b) Lichen vaginosis
c) Candida albicans 45. Concerning trichomonas infection, all
d) Lichen sclerosis are true EXCEPT:
e) Trichomonas vaginalis a) Usually co-exists with bacterial
vaginosis
41. Commonly asymptomatic in women
b) Characterized by a purulent offensive
although vaginal discharge, urethritis,
bartholinitis and cervicitis can occur. Men discharge and a strawberry cervix
usually develop urethritis: c) Dark ground microscopy readily
a) Syphilis identifies the clue cells
b) Chlamydia d) Can be asymptomatic for several
c) Condylomata accuminata months after being acquired
d) Gonorrhoea e) Management is usually with
e) Genital herpes metronidazole and contact tracing
Questions from 46-49: A 24yrs old patient 50. A 42yrs old patient with proven
with spiking temperature, pelvic endometrial and tubal tuberculosis with
peritonitis, mild ileus and an endocervical bilateral mass but otherwise in generally
culture of gonococcus has left-sided good health and does not desire future
enlarging pelvic mass. child bearing. Therapy is:
a) Immediate TAH.
46. The most likely diagnosis is: b) Immediate TAH and BSO.
a) Diverticulitis. c) Antituberculosis drug therapy only.
b) Appendicitis. d) Antituberculosis drug therapy
c) Ovarian cyst. followed by TAH
d) Ruptured ectopic. e) Antituberculosis drug therapy
e) Tubo-ovarian abscess. followed by TAH and bilateral
salpingectomy.
47. Treatment at this time should be:
a) Exploratory laparotomy. 51. The most pathogenic HPV subtypes
b) Rest and antibiotics. that are responsible for most cancers?
c) Colpotomy and drainage. a) 12 and 16
d) Retroperitoneal drainage above the b) 14 and 15
inguinal ligament. c) 16 and 18
e) Hysterectomy and BSO. d) 31 and 33
e) 36 and 45
48. Treatment is instituted and the patient
appears to be doing better then, suddenly 52. What is the current first line treatment
the patient gets worse with temperature for gonorrhoea?
over 40°C and a rigid abdomen. PV reveals a) Azithromycin 1g orally as a single
no pelvic mass. Most likely diagnosis is: dose
a) Pyelitis b) Cefixime 400mg orally three times
b) Ruptured tubo-ovarian abscess. daily for 14days
c) Ruptured infected dermoid cyst. c) Ceftriaxone 500mg IM as a single
d) Ruptured diverticula. dose with azithromycin 1g single oral
e) Ruptured appendix. dose
d) Erythromycin 500mg four times daily
49. Your management should be: for 14days
a) Increased antibiotics. e) Penicillin 1.2g IM as a single dose
b) Exploratory laparotomy and deal
accordingly. 53. A 21-year-old female attends clinic
c) Colostomy. with a 3-day history of a single, painless
d) Unilateral salpingo-oophorectomy. and genital ulcer. She has just returned
e) Appendectomy. from backpacking around South East Asia
where she had two sexual partners. What
is the most likely causative organism?
a) Chlamydia trachomatis 57. A patient is found to have bilaterally

b) Haemophylus ducreyi equal adnexal pain, cervical motion
c) Herpes simplex virus type 2 tenderness, direct abdominal tenderness,
d) Human papillomavirus T: 38.3 and WBC: 12000/ml. The most
e) Treponema pallidum likely diagnosis:
a) Ectopic.
54. A patient complaints of recurrent, b) PID.
painful and draining vulvar lesions. O/E: c) Endometritis.
multiple abscesses and deep scars in the d) UTI
labia wz foul smelling discharge from the e) Ruptured corpus luteum cyst of the
lesions. The patient reports the occasional ovary.
appearance of similar lesions in the axilla.
The most likely diagnosis: 58. An 18 years old woman with history of
a) herpetic vulvitis PID undergoes a laparoscopic ovarian
b) hidradenitis suppurativa
cystectomy for a 5cm ovarian mass
c) lymphogranuloma venereum
containing a tooth. The contents of the
d) granuloma inguinale
cyst spill during removal and contain thick
e) secondary syphilis
sebaceous material and hair. Copious
55. A 21yrs old patient is seen for a irrigation was used to remove this
physical examination prior to her return to material. She is noted to have marked
college. She has been healthy and is using bowel adhesions in the pelvis which
OCs for the past 3 years. On physical require dissection to reach the cyst. Four
examination, you note a 2mm pigmented days postoperatively she returns to ER
flat lesion with irregular margins on the with temp 39, abdominal pain, nausea,
left labia. The most appropriate next step: vomiting and TLC 15000. Your most
a) follow up in 6-12 months probable diagnosis:
b) discontinue OCPs a) Ileus
c) excisional biopsy of the lesion b) Narcotic induced constipation
d) wide local excision of lesion with c) Chemical peritonitis
5mm margins d) Influenza
e) electrodessication of the lesion e) Bowel perforation
56. A 63yrs old patient is seen for routine 59. A 36yrs old obese woman presents
examination. An excoriated 2cm lesion is
with recurrent thrush, increased thirst and
found on her Lt labium major which has
frequency of urination. What test is
been present for at least 3 months. Next
essential in this case?
best step is:
a) prescribe hydrocortisone cream a) serum ferritin
b) schedule colposcopy b) high vaginal swab
c) perform excisional biopsy c) vulval biopsy
d) prescribe Burow's solution soaks d) fasting blood sugar
e) paint the area with toluidine blue e) skin prick allergy testing
stain
60. An antenatal patient tests positive for 65. Treatment for 1ry genital herpes
syphilis using VDRL screening test. Which infection in pregnancy.
of the following is a definitive test for
syphilis? For each description in questions 66-69,
a) cholesterol- lecithin- cardiolipin test choose the SINGLE most appropriate
b) FTA- abs test answer from the below list of options,
c) PCR each option may be used once, more than
d) RPR test once or not at all.
e) Ziel-Neelsen stain a) candida
b) chlamydia
61. Which class of white cells are c) bacterial vaginosis
preferentially depleted by HIV? d) trichomoniasis
a) CD4 e) herpes
b) CD8 f) syphilis
c) CD16 g) HIV
d) CD25 h) gonorrhea
e) CD68
66. A sexually transmitted disease
For each of the descriptions in questions characterized by genital ulcers and painful
62- 65, choose the SINGLE most vesicles.
appropriate answer from the below list of 67. A non-sexually transmitted infection
options. Each option can be used once, which is itchy white curdy with sore vagina.
more than once or not at all. 68. A non-sexually transmitted disease
a) acyclovir characterized with offensive fishy
b) ampicillin discharge.
c) azithromycin
d) cefotaxime 69. A sexually transmitted disease
e) doxycycline characterized by Gram-negative diplococcic
f) HAART (Highly Active Anti-Retroviral and colonizing columnar and cuboidal
Therapy) epithelium and 50% asymptomatic.
g) penicillin
h) zidovudine 70. A patient presents with vulval itching,
62. Treatment for syphilis in pregnancy that sore vagina and white curdy discharge
prevents 98% of congenital infections. with erythema and redness at the
introitus. The likely diagnosis is:
63. Treatment to prevent neonatal a) bacterial vaginosis
infection with Group B streptococcal b) trichomonus vaginalis
infection. c) candida
64. Treatment to reduce the vertical d) chlamydia
transmission of HIV from 28weeks e) HPV
gestation.
71. The procedure most suitable for the 75. A 24yrs old woman presents with a long
investigation of pelvic pain is: standing pelvic pain. Her periods are
a) cystoscopy painful for the first day but are regular and
b) hysteroscopy light. She has occasional pain with sexual
c) HSG intercourse. She admits to being an anxious
d) laparoscopy person and weight conscious and she
e) hysterectomy exercises daily. She opens her bowels on
For each description from questions 72- alternative days and sometimes has loose
76, choose the SINGLE most appropriate stools as well as feeling bloated especially
answer from the below list of options. prior to her period.
Each option may be used once, more than 76. A 38yrs old woman complains of pelvic
once or not at all. pain for the last 5yrs. The pain can be
a) endometriosis worse cyclically but she has not noted a
b) adenomyosis definite pattern to it. She has been treated
c) bladder pain syndrome for recurrent UTI by her GP because of pain
d) irritable bowel syndrome and pressure on voiding urine along with
e) constipation urgency and frequency. However, many of
f) depression these infections have not been confirmed
g) nerve entrapement on microbiological examination and mid-
h) torted ovarian cyst stream urine specimens. Lapasoscopy 3yrs
i) endometrioma ago was normal.
j) dermoid cyst (benign teratoma)
k) functional ovarian cyst
l) tubo-ovarian abscess II. For each of the statements below, mark
72. A recently divorced 36yrs old woman
presents with 6months of generalized 77. The following are causes of pruritis
pelvic pain, insomnia, fatigue, constipation vulvae: Lichen sclerosus.
and headaches. She also admits that she is 78. The following are causes of pruritis
anxious and tearful. vulvae: atrophy.
73. A parous 30yrs old woman complains of 79. The following are causes of pruritis
increasing heavy menstrual periods that are vulvae: diabetes.
painful throughout their 5day duration. She 80. The following apply to Lichen sclerosus:
is pain free for the rest of the month. O/E: white plaques.
enlarged bulky uterus.
81. Lichen sclerosus is commonly
74. A 22yrs old woman presents with a associated with autoimmune disorders
history of chronic pelvic pain and such as diabetes and pernicious anemia.
dyspareunia. She has a history of chlamydia
82. The following are causes of benign
infection when she was 19yrs old. On PV, a
vulval ulcers: tertiary syphilis.
tender mass is palpable and pelvic US
confirms the presence of bilateral complex 83. The following are causes of benign
adnexal masses. vulval ulcers: chancroid.

vulval ulcers: herpes.
vulval ulcers: HPV infection.
vulval ulcers: ulcerative colitis.
87. Vaginal pH is increased under the
influence of estrogen.
88. Candidal infection is increased in
pregnancy with COCPs usage and broad
spectrum antibiotic usage.
89. Candida is the most common cause of
abnormal vaginal discharge in women of
childbearing age.
90. The diagnosis of HSV is made on
endocervical swabs.
91. Urine retention and perineal pain are
common presentations of HSV.
92. The causative organism of 1ry syphilis is
treponema pallidum.
93. 1ry infection of syphilis usually presents
with a painful ulcer on the perineum.
94. 1ry and 2ry syphilis are not life
threatening. However, 3ry neurosyphilis is
life threatening hence the importance of
making the diagnosis.
95. The commonest pathology detected in
laparoscopy for chronic pelvic pain is
endometriosis.
ANSWERS
1 B 36 F 71 D
2 B 37 D 72 F
3 A 38 E 73 B
4 B 39 D 74 L
5 A 40 A 75 D
6 C 41 D 76 C
7 D 42 B 77 T
8 C 43 E 78 T
9 D 44 C 79 T
10 C 45 C 80 T
11 C 46 E 81 T
12 A 47 B 82 F
13 D 48 B 83 T
14 A 49 B 84 T
15 C 50 E 85 F
16 C 51 C 86 F
17 B 52 C 87 F
18 C 53 E 88 T
19 C 54 B 89 F
20 C 55 C 90 F
21 D 56 C 91 T
22 A 57 B 92 T
23 C 58 E 93 F
24 E 59 D 94 T
25 A 60 B 95 F
26 D 61 A
27 C 62 G
28 B 63 G
29 E 64 F
30 C 65 A
31 E 66 E
32 B 67 A
33 C 68 C
34 B 69 H
35 A 70 C
Gyn 7: Basic (30 marks)

I. Choose the most correct answer: For each description in questions 6-9,
choose the SINGLE most appropriate
1. Regarding the round ligament, choose answer from the below list of options,
the best answer: each option may be used once, more than
once or not at all.
a) it is posterior to the uterus
a) mesonephric ducts
b) it supports the fundus of the uterus
b) paramesonephric ducts
c) it is a vestigial structure c) mullerian system
d) it passes through the inguinal canal d) sinovaginal bulbs
e) it contains the neuromuscular bundle e) genital tubercle
supplying the ovary f) genital folds
g) genital swelling
For each description in questions 2-5, h) genital ridge
choose the SINGLE most appropriate 6. Develops into the uterus, cervix and
answer from the below list of options, proximal 2/3 of the vagina.
each option may be used once, more than 7. Forms the ovary.
once or not at all.
8. Develops into the distal one third of the
a) internal iliac artery vagina.
b) uterus
9. Develops into the labia minora.
c) fallopian tubes
d) uterine artery
e) ovaries For each description in questions 10-13,
choose the SINGLE most appropriate
f) pudendal artery
answer from the below list of options,
g) aorta
h) ovarian artery once or not at all.
i) cervix a) aorta
2. Contained in the infundibulopelvic b) internal iliac vein
ligament. c) renal vein
d) vena cava
3. The origin of the uterine artery. e) superficial inguinal and femoral
4. Should always be removed at nodes
hysterectomy to cure endoemetriosis. f) obturator, internal and external iliac
nodes
5. The ureter is at surgical risk where it runs g) para-aortic nodes
close to this structure. h) external iliac vein
10. Lymphatic drainage of the ovary. 26. The following have an XX karyotype:
11. Lymphatic drainage of the lower vagina Congenital adrenal hyperplasia.
and vulva. 27. The following have an XX karyotype:
12. Lymphatic drainage of the upper vagina Rokitansky’s syndrome.
and cervix. 28. The following have an XX karyotype:
13. Venous drainage from left ovarian vein. Turner's syndrome.
29. The following have an XX karyotype:
Androgen insensitivity svndrome.
True (T) or False (F): 30. PR examination is a MUST in all
gynecological cases.
14. Abdominal examination is mandatory as
part of the gynecological examination.
15. A chaperone in always needed for
intimate examination.
16. Bimanual examination can determine
whether a pelvic mass is ovarian or uterine
in origin.
17. Fallopian tubes are lined by cilia to add
ova transport.
18. In its upper portion the ureter lies
anterior to the ovary.
19. The ovary is attached to the uterus by
the round ligament.
20. The ovary has a central medulla of
loose connective tissue and an outer cortex
covered by cuboidal germinal epithelium.
21. The peritoneum overlies the following
structure in whole or in part: bladder.
structure in whole or in part: rectum.
structure in whole or in part: uterus.
structure in whole or in part: ovary.
structure in whole or in part: ureter.
ANSWERS
1 D
2 H
3 A
4 E
5 D
6 B
7 H
8 D
9 F
10 G
11 E
12 F
13 C
14 T
15 T
16 T
17 T
18 F
19 F
20 T
21 T
22 T
23 T
24 F
25 T
26 T
27 T
28 F
29 F
30 F
Obs 1: Bleeding In Early Preg. (70 marks)

I. Choose the most correct answer: 5. The same patient presented the next
day with passage of tissue, her bleeding
1. The percentage of spontaneous and pain have subsided significantly.
abortion in the first trimester is about: Her cervical os is closed. Your diagnosis:
a) 20% a) Missed abortion
b) 40% b) Complete abortion
c) 60% c) Threatened abortion
d) 80% d) None of the above
2. Which of the following is the most 6. Appropriate management of such

common cause of first trimesteric patient includes:
abortion? a) Diagnostic laparoscopy
a) Uterine anomalies b) TransvaginaI sonography
b) Incompetent cervix c) Dilatation and curettage
c) Intrauterine infection d) Administration of anti-D if Rh-ve
d) Fetal chromosomal abnormalities
7. An 18yrs old GIP0 presents with 12wks
3. A 24yrs old patient G3P0A2, presents wz amenorrhea and heavy vaginal bleeding.
8weeks amenorrhea followed by vaginal Her pregnancy test is +ve. Placenta is seen
bleeding. Her B-HCG is 16.000, cervical through an open cervical os. Your
internal os is closed and adnexae are free. management plan:
Most probable diagnosis: a) Threatened abortion, plan bed rest
a) Missed abortion b) Incomplete abortion, plan dilatation
b) Incomplete abortion and curettage
c) Threatened abortion c) Ectopic tubal pregnancy, plan
d) Inevitable abortion laparoscopic resection
d) Complete abortion, plan subsequent
4. The same patient presents 2weeks later B-HCG testing after 48hrs
with light vaginal bleeding and strong
painful cramps, US shows the sac in the 8. Anti-D immunoglobulin should be
cervical canal. The most appropriate considered for Rh-ve women in:
management includes: a) Threatened abortion
a) Perform rescue cerclage b) Following complete vesicular mole
b) Await spontaneous abortion evacuation
c) Excision of cesarean scar pregnancy c) After first trimesteric elective
d) Administer intramuscular injection of pregnancy termination
methotrexate d) All of the above
9. Which of the following tests is the most 13. Which of the following most accurately
effective in identifying RPL? defines ectopic pregnancy?
a) Antithrombin III a) Composed only of cytotrophoblast
b) Serum progesterone level b) implantation within the Fallopian
c) Lupus anticoagulant assay tube
d) LH assay c) Implantation outside the uterine
cavity
10. All the following regarding cervical d) Abnormally rising maternal serum B-
incompetence are true EXCEPT: HCG level
a) Prior cervical conization is a risk
factor 14. Which of the following defines
b) it is characterized by painless, heterotopic pregnancy?
second-trimesteric cervical dilatation a) One tubal and one abdominal
c) Rupture of membranes is not a pregnancy
contraindication to rescue cerclage b) One ectopic and one intrauterine
d) It may be suspected by US, by pregnancy
funneling of the membranes and c) Two pregnancies, one in each
cervical canal shorter than 25mm Fallopian tube
d) Two ectopic pregnancies in one
11. A 40yrs old G3P2 presents wz 10wks Fallopian tube
amenorrhea, B-HCG: 5000Miu/ml, her
internal cervical os is closed. The US shows 15. Which of the following is least likely to
a 2cm gestational sac wz no fetal pole. increase the risk of ectopic pregnancy?
Your diagnosis is: a) Prior pelvic infection
a) Missed abortion b) Prior vesicular mole
b) Complete abortion c) Prior ectopic pregnancy
c) Threatened abortion d) Salpingitis isthmica nodosa
d) Complete vesicular mole
16. Methotrexate therapy failure during
12. Postoperatively, abortion is associated ectopic pregnancy treatment may be due
with increased rates of: to:
a) Infertility a) Increased parity
b) Mental illness b) Ectopic size of 2.5cm
c) Ectopic pregnancy c) Prior ectopic pregnancy
d) None of the above d) Serum B-HCG level of 9000miu/ml
17. The management of an abdominal 22. Patients with complete molar

pregnancy of 16wks gestation includes: pregnancy frequently present with all the
a) Intragestational sac methotrexate following EXCEPT:
b) Laparotomy with delivery of the a) Vaginal bleeding
fetus b) Multiple simple ovarian cysts
c) Expectant management until fetal c) Increased TSH levels
viability
d) Greater than expected serum B-HCG
d) Uterine artery embolization then
levels
await fetal and placental separation
18. The preferred ttt for a cervical ectopic
pregnancy in a hemodynamically stable 23. Prior to molar pregnancy evacuation
patient is: and chest X-Ray is typically needed to
a) Methotrexate exclude:
b) Hysterectomy a) Cardiomegaly
c) Trachelectomy b) Pleural effusion
d) Cerclage followed by dilatation and c) Hilar lymphadenopathy
curettage d) Trophoblastic metastasis
19. Gestational trophoblastic neoplasia 24. A 28yrs old G2P1 with 20weeks size
includes all the following EXCEPT: molar pregnancy is best treated by:
a) Invasive mole a) Hysterectomy
b) Choriocarcinoma b) Hysterotomy and evacuation
c) Partial vesicular mole c) Dilatation and suction evacuation
d) Placental site trophoblastic tumour d) Intramuscular systemis methotrexate
20. A woman with prior history of
25. Which of the following uterotonics are
vesicular mole, has a risk of recurrence of:
a) 2% contraindicated in molar pregnancy
b) 13% evacuation?
c) 26% a) Misoprostol
d) 42% b) Synthetic oxytocin
c) Carboprost
21. As regard molar pregnancy; the term d) None of the above
androgenesis refer to:
a) Increased placental androgen 26. Your patient is diagnosed with a
production that promotes villous complete vesicular mole, in US, the
edema ovaries show multiple large cysts and this
b) Development of a zygote that condition is due to the increased
contains only maternal production of the following hormone:
chromosomes a) Estrogen
c) Increased placental androgen b) Thyroxine
production that leads to maternal c) Progesterone
virilization d) B-HCG
d) None of the above
27. The condition above is best managed a) Preparation for dilatation and
by: curettage
a) Oopherectomy b) Initiation of intramuscular
b) Oopheropexy methotrexate therapy
c) Ovarian cystectomy c) Repeat B-HCG level after 48hrs
d) Molar pregnancy uterine evacuation d) Do FIGO staging
31. The same patient presents after 48hrs
28. The following are true regarding the with a B-HCG level 6000miu/ml. Your next
follow up after evacuation of a molar step is:
pregnancy: a) Transvaginal sonography
a) Endometrial biopsy and chest X-Ray b) Preparation for dilatation and
should be performed every 3months curettage
for a year c) Initiation of intramuscular
b) Endometrial biopsy, chest X-Ray and methotrexate therapy
B-HCG levels are obtained serially d) Chest and abdominal CT and brain
but each at different interval MRI
c) B-HCG levels should be monitored
every 1-2 weeks until undetectable 32. The same patient underwent TVS,
then monthly for 6 months revealing no intrauterine or adnexal
d) None of the above gestation. Best step is:
a) Hysterectomy
29. A 24yrs old G3P2 presents with vaginal b) Initiation of intravenous
bleeding, B-HCG: 300.000miu/ml, uterine actinomycin-D therapy
size is 12wks, US shows snow storm c) Initiation of intramuscular
appearance in the uterus. Most methotrexate therapy
appropriate management is: d) Do FIGO staging
a) Plan for hysterectomy
b) Anti-D and bed rest 33. Criteria for the diagnosis of GTN
c) Plan for dilatation and suction include:
evacuation a) Rising B-HCG levels
d) Repeat B-HCG after 48hrs b) Plateaued B-HCG levels
c) Persistent B-HCG levels
30. A 32yrs old patient G1P0A1 has d) All of the above
undergone a molar pregnancy evacuation
and is on COPs now. During her follow up, 34. Which of the following are used in the
her B-HCG levels dropped to undetectable, FIGO staging score for GTN?
then today during her monthly a) Parity
surveillance the B- HCG is 900miu/ml. b) Severity of thyrotoxicosis
What would you like to do for your c) Number of months from the
patient? antecedent pregnancy
d) Presence and diameter of largest
theca lutein cysts
35. the most common route for metastatic 40. The major cause of first trimester
spread of choriocarcinoma is: abortion is:
a) Lymphatic a) Maternal trauma
b) Hematogenous b) Progesterone insufficiency
c) Peritoneal fluid c) Maternal infection by toxoplasmosis
d) Cerebrospinal fluid d) Exposure to teratogens
e) Chromosomal anomalies of the
36. The most common site from fertilized ovum
metastatic spread of choriocarcinoma is:
41. A 7 weeks pregnant patient presents
a) Brain
with vaginal spotting, lower abdominal
b) Liver
cramps. US shows a single fetus with +ve
c) Lungs
pulsations. PV shows a closed cervix.
d) Spleen Appropriate management:
a) Admit to hospital to follow the case
37. Chemotherapeutic agents in EMA-CO b) Bed rest at home, prohibit
regimen include all the following EXCEPT: intercourse & administer a progestin
a) Cisplatin c) Bed rest at home, prohibit
b) Etoposide intercourse & administer a
c) Methotrexate progesterone
d) Actinomycin-D d) Bed rest at home and administer a
tocolytic
38. Evidenced based risks of future e) Repeat ultasonography and
pregnancy following treated GTD include: pregnancy test after 2 days
a) Decreased fertility
b) Increased preterm labor 42. the most consistent symptom of
c) Increased risk of placenta accreta ectopic pregnancy is:
d) Increased risk of second molar a) Amenorrhea
pregnancy b) Severe vaginal bleeding
c) Pain
d) Fainting
39. Which of the following characteristics
e) None of the above
are most typical of invasive moles?
a) Follows a term pregnancy
43. An intrauterine gestational sac can be
b) Penetrates deeply into the detected by TVS at a serum HCG level of:
myometrium a) 100 to 200 miu/ml
c) Displays minimal trophoblastic b) 400 to 500 miu/mI
growth c) 1000 to 2000 miu/ml
d) Is almost invariably associated with d) 3000 to 4000 miu/ml
widespread pulmonary metastasis e) 5000 to 6000 miu/ml
44. The genetic composition of a complete 47. A 23yrs old woman presents at 21 wks
molar pregnancy is: complaining of low backache and
a) 45X0 suprapubic discomfort and tenderness. BP
b) 46YY is normal, HR: 90, T: 37.7. Cx is closed.
c) 47XXY Urine dipstick shows leucocytes and
d) 47XYY nitrites.
e) None of the above 48. A 23yrs old woman presents at 23wks
in her second pregnancy, the first
45. Regarding the Fallopian tube, choose pregnancy ended in an abortion due to
the best answer: PPROM. She is now complaining of low
a) it is 20cm long backache, feeling hot and slight vaginal
b) it has a glandular submucosa loss. T: 38, HR: 98. There is suprapubic
c) it is independent of hormonal tenderness and speculum examination
influence reveals a slightly open cervix and fluid
d) it is lined by ciliated epithelium draining.
e) it lies in the round ligament
49. A 23yrs old woman presents at 21 wks
46. A 25yrs old woman presents with with vaginal bleeding, low backache and
vaginal bleeding and +ve pregnancy test. suprapubic discomfort and tenderness.
TVS shows a non-living intrauterine Vital signs are normal. Cervix is closed and
pregnancy. What would be most urine dipstick normal.
reasonable to offer her? 50. A 32yrs old woman presents in her first
a) laparoscopy pregnancy at 20wks with minor discomfort
b) serum HCG measurement in lower abdomen. Vital signs are normal.
c) misoprostol Cervix is 4cm dilated with bulging
d) methotrexate membranes, US shows cervical canal of
e) progesterone 2cm length.
For each of the descriptions in questions For each description in questions 52-55,
47-50, choose the SINGLE most choose the SINGLE most appropriate
appropriate answer from the below list of answer from the below list of options,
options. Each option can be used once, each option may be used once, more than
more than once or not at all. once or not at all.
a) threatened abortion a) threatened abortion
b) inevitable abortion b) missed abortion
c) missed abortion c) incomplete abortion
d) stillbirth d) ectopic pregnancy
e) complete abortion e) hydatidiform mole
f) chorioamnionitis f) heterotopic pregnancy
g) urinary tract infection g) choriocarcinoma
h) none of the above h) septic abortion
51. The abnormal proliferation of 60. In second trimesteric abortion,

trophoblasts with or without embryonic antibiotic prophylaxis is usually given.
tissue.
61. Abortion is much greater before
52. The partial expulsion of products of
6weeks than after 9weeks.
conception with products of conception
seen measuring 65mm in diameter on US. 62. The rate of abortion is the same in
53. Bleeding in pregnancy <24wks with women over 40yrs then with women under
fetal heart visible on US and closed cervical forty.
os. 63. The most common cause of
54. Light bleeding, pelvic pain, shoulder tip spontaneous abortion is infection.
pain, 7weeks gestation, empty uterus on
US and fluid in DP. 64. The following are associated with molar
pregnancy: dermoid cyst.
55. A 19yrs old girl with pelvic pain, +ve 65. The following are associated with molar
pregnancy test and a 3cm living ectopic pregnancy: large abdomen for gestational
pregnancy in Rt fallopian tube, she had Lt age.
salpingectomy for a previous ectopic. Best
management is: 66. The following are associated with molar
a) laparoscopic salpingectomy pregnancy: hyperemesis.
b) laparoscopic salptngostomy
67. The following are associated with molar
c) conservative management with serial
B-HCG pregnancy: pre-eclampsia.
d) laparotomy 68. Ectopic pregnancy has a higher risk of
e) methotrexate persistent trophoblast if the patient has a
laparoscopic salpingotomy rather than
II. For each of the statements below, mark salpingectomy.
True (T) or False (F): 69. Ectopic pregnancy can not be managed
56. Second trimesteric abortion is typically with methotrexate if the mass is 1cm in
painless. diameter on ultrasound.
57. Second trimesteric abortion occurs 70. The commonest cause of first
between 12-24wks gestation. trimesteric spontaneous abortion is
58. Second trimesteric abortion can be antiphosoholipid syndrome.
associated with ROM.
59. Second trimesteric abortion may be
associated with hemorrhage, infection and
multiple pregnancy.
ANSWERS
1 A 36 C
2 D 37 A
3 C 38 D
4 B 39 B
5 B 40 E
6 D 41 C
7 B 42 C
8 D 43 C
9 C 44 E
10 C 45 D
11 A 46 C
12 D 47 G
13 C 48 F
14 B 49 A
15 B 50 B
16 D 51 E
17 B 52 C
18 A 53 A
19 C 54 D
20 A 55 B
21 D 56 F
22 C 57 T
23 D 58 T
24 C 59 T
25 D 60 F
26 D 61 T
27 D 62 F
28 C 63 F
29 C 64 F
30 C 65 T
31 A 66 T
32 D 67 T
33 D 68 T
34 C 69 F
35 B 70 F
Obs 2: Normal Labor (70 marks)

I. Choose the most correct answer: 4. The most important for placental
separation from its implantation site:
1. Which of the following are considered
causes of uterine contraction pain? a) maternal pushing
b) gentle cord traction
a) myometrial hypoxia
c) uterine smooth muscle contraction
b) uterine peritoneum stretching
d) hematoma formation between the
c) compression of nerve ganglia in the uterine wall and placenta
cervix
d) all of the above 5. The relation of the fetal long axis to that
of the mother is termed:
2. Which of the following best defines a) fetal lie
Fergusson reflex? b) fetal angle
a) mechanical stretch of the cervix c) fetal position
enhances uterine activity d) fetal engagement
b) maternal ambulation augments
6. In shoulder presentation, the portion of
contraction intensity and frequency
the fetus chosen for orientation is:
c) fetal scalp stimulation leads to fetal a) head
heart rate acceleration b) breech
d) maternal shift to the left lateral c) scapula
recumbent position increases venous d) umbilicus
return
7. The following is the correct order for
3. The following aids development of the the cardinal movements of labor:
lower uterine segment during labor: a) descent, engagement, internal
fixation, flexion, extension, external
a) progressive thickening of the upper
rotation, expulsion
uterine segment with labor
b) descent, flexion, engagement,
progression external fixation, extension, internal
b) smooth muscle fibers of fundus relax rotation, expulsion
to their original length after c) engagement, descent, flexion,
contraction internal rotation, extension, external
c) smooth muscle fibers of the LUS rotation, expulsion
relax to their original length after d) engagement, flexion, descent,
each contraction internal rotation, straightening,
d) all of the above expulsion
8. On palpation of the fetal head during 13. Stage of labor begins with complete
PV, you note that the sagittal suture is cervical dilatation and ends with delivery
transverse and close to the symphysis of the fetus:
pubis. The posterior ear can be easily
a) first stage
palpated. This orientation is:
a) anterior asynclitism b) second stage
b) posterior asynclitism c) third stage
c) mento-anterior position d) fourth stage
d) mento-posterior position
14. Station describes the relationship
9. Of the cardinal movements of labor, between which of the following?
internal rotation achieves which goal:
a) BPD and the pelvic outlet
a) flexes the fetal neck
b) brings the occiput to an anterior b) BPD and the ischial spines
position c) the lowermost portion of the
c) brings the anterior fontanel through presenting fetal part and the pelvic
the pelvic inlet inlet
d) none of the above d) the lowermost portion of the
presenting fetal part and the ischial
10. When does the latent phase of labor
spines
end for most women?
a) 2cm
b) 2-3cm 15. A 24yrs old G2P1 at 39wks presents
c) 3-5cm with painful uterine contractions. She also
d) 7-8cm complains of dark vaginal blood mixed
with some mucus. The most likely etiology
11. A 20yrs old G1P0 at 39wks presents
of her bleeding:
with strong contractions, cx is 1cm dilated,
she is given sedation. 4hrs later, her a) placenta previa
contractions stopped. Cx is still 1cm b) placental abruption
dilated. Most likely diagnosis is: c) bloody show
a) false labor d) vasa previa
b) prolonged latent phase
c) prolonged active phase 16. The greatest diameter of the normal
d) arrest of the active phase
fetal head is which of the following?
12. According to Friedmann, the normal a) Occipitofrontal
rate of active-phase labor in a multipara is: b) Occipitomental
a) 1cm/hr c) Subocciputbregmatic
b) 2cm/hr d) Bitemporal
c) 3cm/hr e) Biparital
d) 4cm/hr
17. The relation of the fetal parts to one 21. A 24yrs old G2P1 at 39 wks presents
another determines which of the with painful uterine contractions. She also
following? complains of dark, vaginal blood mixed
a) Presentation of the fetus with some mucous, she is vitally normal,
b) Lie of the fetus FHS are normal, abdominal ultrasound
c) Attitude of the fetus shows no abnormality. The most likely
d) Position of the fetus etiology of her bleeding is:
e) Intention of the fetus a) Placenta previa
b) Placental abruption
18. The following about the importance of
c) Bloody show
the level of the ischial spine is true
d) Vasa previa
EXCEPT:
a) It is the level of the levator ani e) Cervical lacerations
b) The internal os of the cervix lie at this
level 22. The interspinous diameter of a normal
c) The obstetric axis changes its pelvis should be at least:
direction at this level a) 5 cm
d) The head is considered engaged if b) 8 cm
the vault is felt at or below this level c) 10 cm
e) Forceps should not be applied when d) 11 cm
the fetal head is above that level e) 12 cm
19. The average blood loss during normal For questions 23-27, each lettered option
deliveries is how many milliliters? may be used once, more than once or not
a) 700 ml at all.
b) 500 ml a) First stage of labor
c) 250 ml b) Second stage of labour
d) 100 ml c) Third stage of labour
e) 5O ml
d) Effacement
e) Lightening
20. Which options describes the proper
f) Fourth stage of labour
order of the cardinal movements of
labour? g) Postpartum period
a) Engagement, internal rotation, h) Engagement
descent, flexion 23. Dropping of the fetal head into the
b) Engagement, external rotation, pelvis.
descent, extension
24. Ends with complete dilatation of the
c) Engagement, extension, internal
rotation, flexion cervix.
d) Engagement, extension, descent, 25. Begin with the delivery of the baby
flexion
26. Ends with the delivery of the foetus
e) Engagement, flexion, extension,
external rotation 27. The thinning out and shortening of the
cervical canal.
28. Means the head is at the level of 33. The head is usually delivered with the:
ischial spine: a) Bregma anterior
a) Station +1 b) Occipito-transverse
b) Station -1 c) Occipito-posterior
c) Station -2 d) Brow anterior
d) Station 0 e) Occipito-anterior
e) Station +2
34. Causes of non-engagement in the last
4 weeks in PG, includes all the following
29. This stage of labour lasts from delivery
EXCEPT:
of the foetus to delivery of the placenta:
a) Contracted pelvis
a) 5th
b) Pelvic tumors
b) 2nd c) Previous CS scar
c) 4th d) Hydramnios
d) 1st e) Multiple pregnancy
e) 3rd
35. Which of the following is not a
30. When the cervix usually dilates slowly characteristic finding of gynecoid pelvis:
for the first 4 cm, may take several hours? a) The sacrum is short and concave
a) Labour b) Wide sub-pubic angle (90-100
b) Active phase degree)
c) Passive phase c) Wide sacro-sciatic notch
d) Latency period d) Projecting ischial spines
e) Latent phase e) The inlet is slightly transverse oval
31. Cervical dilatation of 1.2 cm/h in 36. Maximum normal time for second
nulliparous women and 1.5 cm/h in stage of PG without epidural anesthesia is:
multiparous women: a) 20 minutes
b) 60 minutes
a) Labour
c) 120 minutes
b) Latent phase
d) 240 minutes
c) Passive stage
e) There is no normal maximum
d) Active phase
e) Latency period 37. Crowning is best defined as:
a) When the greatest diameter of the
32. The head can be compressed as fetal head comes through the vulva
sutures allow the bones to come together b) When the presenting part reaches
and even overlap: the pelvic floor
a) Retention c) When the perineum bulges in front
b) Caput of the fetal head
c) Distension d) When the fetal head is delivered
d) Moulding e) When the fetal head is visible at the
e) Occipitus vulva
38. In a cephalic presentation, the position For each of the descriptions in questions
is determined by which fetal part? 44-47, choose the SINGLE most
a) Mentum appropriate answer from the below list of
b) Sacrum options. Each option can be used once,
c) Acromion more than once or not at all.
d) Occiput a) latent phase
e) Sinciput b) third stage
c) transition
39. A partogram is used for assessment of: d) passive descent
a) Maternal wellbeing e) Braxton Hicks
b) Fetal wellbeing during labour f) effacement
c) Fetal condition after delivery g) active second stage of labor
d) Placental insuffuciency h) none of the above
e) Progress of labour 44. Should be considered abnormal if
lasting more than 30 minutes.
For each of the descriptions in questions
40-43, choose the SINGLE most 45. The cervix shortens in length until it
appropriate answer from the below list of becomes included in the lower segment of
options. Each option can be used once, the uterus
more than once or not at all. 46. Conventionally should last no longer
a) descent than 2 hours in a primiparopus women.
b) extension 47. Time between onset of labor and 3-4cm
c) engagement cervical dilatation.
d) flexion
e) external rotation
f) restitution II. For each of the statements below, mark
g) internal rotation True (T) or False (F):
h) none of the above
48. Lie: cephalic.
40. After the head delivers through the
49. Position: flexed.
vulva, it immediately aligns with the
shoulders. 50. Station: at the level of ischial spines.
41. The occiput escapes from underneath 51. Engagement: two fifths.
the symphisis pubis, which acts as a 52. Presenting part: shoulder.
fulcrum.
53. The pudendal nerve passes in front of
42. The anterior shoulder lies inferior to the the ischial spine.
symphysis pubis and delivers first and then
54. The antero-posterior diameter of the
the posterior shoulder delivers
pelvic inlet is 11cm.
subsequently.
55. The antero-posterior diameter of the
43. Terminology for when the widest part
pelvic outlet is 11cm.
of the presenting part has passed
successfully through the pelvic inlet.
56. The levator ani muscles form the pelvic

floor.
57. The anterior fontanelte is diamond in
shape.
58. The sutures of the vault are ossified.
59. The vertex presentation longitudinal
diameter is the suboccipito-frontal
diameter.
60. The occipito-mental diameter is
normally too large to pass through the
maternal pelvis.
61. Moulding of the fetal skull is a normal
physiological process.
62. Engagement is said to occur when the
widest part of the fetal head has passed
through the false pelvis.
63. Restitution occurs after external
rotation.
64. Extension occurs after internal rotation.
65. Extension occurs after crowning.
66. Descent of the fetal head is needed
before flexion, internal rotation and
extension can occur.
67. The second stage of labor Is preceded
by delivery of the whole fetus.
68. The first stage of labor starts by full
effacement of the cervix.
69. The maximum duration of third stage of
labor is 30 minutes in primigravida and half
this time in multipara.
70. The whole stages of labor may take
5hours and still to be considered as normal
labor.
ANSWERS
1 D 36 C
2 A 37 C
3 A 38 D
4 C 39 E
5 A 40 F
6 C 41 B
7 C 42 H
8 A 43 C
9 B 44 B
10 C 45 F
11 B 46 G
12 C 47 A
13 B 48 F
14 D 49 F
15 C 50 T
16 B 51 T
17 C 52 T
18 B 53 F
19 B 54 T
20 E 55 F
21 C 56 T
22 C 57 T
23 E 58 F
24 A 59 F
25 C 60 T
26 B 61 T
27 D 62 F
28 D 63 F
29 E 64 T
30 E 65 T
31 D 66 T
32 D 67 F
33 E 68 F
34 C 69 F
35 D 70 T
Obs 3: Abnormal Labor (75 marks)

I. Choose the most correct answer: 4. Regarding vaginal delivery of term
breech fetus compared to CS, the
following is true:
1. During evaluation of a persistent OP, a) neonatal mortality rates are lower
the fetal scalp is noted at the introitus and with cesarean delivery
the fetal head is palpated above the b) neonatal morbidity rates are lower
symphysis pubis. The following is with cesarean delivery
c) after vaginal breech birth, children at
appropriate action: age 2years have lower IQ
a) ventouse delivery with appropriate d) none of the above
anesthesia
b) manual rotation of the fetal head to 5. The following is false regarding the
cardinal movements of breech delivery:
occipito-anterior position
a) the fetal head is born by flexion
c) rotation to turn the head to an b) the back of the fetus is directed
occipito-anterior position then posteriorly
deliver c) the anterior hip usually descends
more rapidly than the posterior hip
d) engagement usually occur with the
bitrochanteric diameter in an oblique
2. In the absence of a pelvic abnormality, plane
for a transverse fetal head position, the
6. The following describes a breech fetus
following is true:
that delivers spontaneously up to the
a) is usually transitory umbilicus but whose remaining body is
b) will usually rotate to an occiput delivered with operator traction?
anterior position a) breech decomposition
c) will usually rotate to an occiput b) total breech extraction
c) partial breech extraction
posterior position d) spontaneous breech delivery
d) A and B
7. A 24yrs old G4P2 presents at term with
3. Percentage of single breech pregnancy breech presentation. She wishes to
attempt vaginal delivery. US shows that
at term is: her fetus has both hips flexed and both
a) 1-2% knees extended. This is:
b) 3-4% a) frank breech
c) 5-6% b) total breech
c) complete breech
d) 7-8% d) incomplete breech
8. A 26yrs old G2P1 presents for a routine 13. Which of the following factors
visit at 32wks. She is worried because her increases the risk for monozygotic
fetus was breech. Which of the following twinning?
is true while counseling for ECV? a) increased parity
a) the success rate is 80% b) increased maternal age
b) it can be performed when she c) the father is an identical twin
presents in labor d) none of the above
c) it should be performed after 36wks
gestation 14. The first trimesteric US shows two
d) amniotic fluid volume is unrelated to fetal head arising from a shared body.
the success How many days after fertilization must the
division of this zygote have occurred?
9. In the previous pt before proceeding a) 0-3 days
with ECV, you counsel him for its potential b) 4-7 days
risks: c) 8-12 days
a) uterine rupture d) more than 12 days
b) placental abruption
c) emergency cesarean delivery 15. Which of the following is true
d) all of the above regarding the rate of monozygotic
twinning?
10. All the following are absolute a) it approximates 1:250 worldwide
contraindications to ECV EXCEPT: b) it is increased with maternal age and
a) placenta previa parity
b) prior cesarean section c) it is lower for Hispanic women than
c) multifetal gestation for white women
d) non reassuring fetal status d) it can be modified by FSH treatment
11. Internal podalic version is usually 16. The strongest risk factor for multifetal
reserved for the following situation: pregnancy includes:
a) frank breech deliveries a) advanced maternal age
b) complete breech deliveries b) use of clomiphene citrate
c) delivery of a second twin c) African american ethnicity
d) preterm breech deliveries, regardless d) maternal history of being a twin
the presentation herself
12. Compared to singleton pregnancies, 17. The differential diagnosis of suspected

multifetal gestations have a higher risk of twins includes all the following EXCEPT:
all EXCEPT: a) obesity
a) pre-eclampsia b) hydramnios
b) hysterectomy c) Ieiomyomas
c) maternal death d) blighted ovum
d) post term pregnancy
18. Which is the most common 23. Breech presentations occur in ……… of
presentation of twins in labor? term pregnancies:
a) vertex/vertex a) 1 %
b) vertex/breech b) 3%
c) breech/vertex
c) 8%
d) vertex/transverse
d) 4-10%
19. A 25yrs old G2P1 at 27wks had e) 5-6%
undergone US showing twin pregnancy,
EFW of twin A: 500gm, twin B: 1100gm. 24. A 26-year-old G2P1 presents for a
AFI of twin A: 2cm, twin B: 26cm. The best routine visit at 32wks, she is worried
next step is: because her fetus was breech during US
a) chorionic villus sampling examination, the following is correct
b) repeat ultrasound in 3weeks during your counseling for ECV:
c) Laser ablation of vessels a) the success rale is 80%
d) revision of dates for twin B
b) it can be performed when she
20. A 32yrs old G1P0 has triplets after IVT. presents in labour
She presents at 30wks with BP 150/100, c) it is best performed at 36 weeks
albumin +2, dyspnea and epigastric pain. gestation
She is contracting every 4minutes. Best d) amniolic fluid volume is unrelated to
management is: success rate.
a) await spontaneous labor e) Fetal size is unrelated to success rate
b) immediate cesarean delivery
c) cesarean at 34wks 25. The incidence of occipito-posterior
d) cesarean at 39wks
malposition in early labour is:
21. In which of the following condition a) 35%
vaginal delivery is contraindicated? b) 55%
a) Extended breech c) 25%
b) Mento-anterior d) 70%
c) Twins with one vertex and one e) 80%
breech
d) Occipto-posterior 26. In occipito-posterior position in labour,
e) premature rupture of membranes the BPD enters the pelvic inlet in which
diameter?
22. Engagement in fully extended head
a) true conjugate
occurs by which diameter:
a) Mento-occipital b) bituberous
b) Submento-bregmatic c) bispinous
c) Biparietal d) anterior saggital
d) Mento-vertical e) sacrocotyloid
e) Occipto-frontal
27. Factors that favor long anterior For each of the descriptions in questions
rotation in OP include all of the following 32-35, choose the SINGLE most
EXCEPT: appropriate answer from the below list of
a) epidural anesthesia options. Each option can be used once,
b) strong uterine contractions more than once or not at all.
c) adequate liquor a) ECV
d) strong pelvic floor b) emergency CS
e) adequate pelvis c) IPV
d) allow spontaneous delivery
28. In occipito-posterior malposition e) start oxytocin infusion
during labour, obstructed labour occurs in: f) elective CS at 32-34wks
a) long anterior rotation g) administer corticosteroid injection
b) posterior rotation h) refer to tertiary referral opinion
c) no rotation i) recommend septostomy
d) face to pubis j) refer for laser ablation therapy
e) correction of head deflexion k) delivery by CS at 37wks
29. Indications of cesarean section in OP 32. You review a woman who is 18weeks
include all of the following EXCEPT: pregnant with monochorionic diamniotic
a) persistent oblique occipito-posterior twins. US reported the deepest pocket of
b) deep transverse arrest first twin <2cm while that of second twin is
c) previous three cesarean sections >10cm. The bladder of first twin is not
d) face to pubis visualized.
e) fetal distress 33. You review a woman who is 20weeks
pregnant with monochorionic diamniotic
30. Causes of face presentation include all twins, she asks your opinion regarding
of the following EXCEPT: timing and mode of delivery. How could u
a) flexor neck muscle hypertonicity advise her?
b) anencephaly
c) dolicocephaly 34. You are called to labor ward for the
d) goitre delivery of 37weeks dichorionic diamniotic
e) coils of cord around neck twins, first twin was delivered cephalic,
second twin is shoulder but high up in the
31. Labour is obstructed in all the pelvis with membranes intact. When you
following in face presentation EXCEPT: arrive, there are decelerations in CTG.
a) deep transverse arrest
b) persistent mento-posterior 35. You are on duty in ER and a woman
c) direct mento-posterior presents at 32weeks gestation in twins,
d) posterior rotation of the chin both cephalic. She is contracting every
e) anterior rotation of the chin 15minutes. Examination reveals a long
closed cervix with a reassuring fetal heart
trace.
36. The following pregnancy complications c) HELLP syndrome

does NOT increase in incidence in multiple d) uterine atony
pregnancy: e) pulmonary embolus
f) uterine inversion
a) pre-eclampsia g) uterine rupture
b) obstetric cholestasis h) eclamptic seizure
c) preterm delivery i) shoulder dystocia
d) macrosomia
e) IUGR 41. A 38yrs old gestational diabetic with
BMI 35 is induced at 42wks. After a long
For each of the descriptions in questions labor, the obstetric resident plans to deliver
37-40, choose the SINGLE most with forceps.
appropriate answer from the below list of 42. A 27yrs old woman is admitted with
options. Each option can be used once, spontaneous ROM and mild contractions at
more than once or not at all. 30wks. US reveals footling breech.
a) transverse 43. A 34yrs old woman is fully dilated and
b) frank breech pushing during her second labor. Her
c) extended breech contractions have been augmented with
d) footling breech oxytocin, her first child was born by
e) cephalic emergency CS.
f) oblique
g) unstable lie 44. After delivery, 36yrs old woman has
h) complete breech failed to complete the third stage. The
obstetrician is anxious to avoid taking her
37. Longitudinal lie where the presenting to theater.
part is a foot.
38. The fetal long axis runs perpendicular to II. For each of the statements below, mark
the maternal long axis. True (T) or False (F):
39. Women should routinely be admitted 45. Kielland forceps have a sliding lock.
to the antenatal ward at term.
46. Kielland forceps are used to rotate to
40. The position intended to be achieved by
an occipito posterior position.
external cephalic version.
47. Regarding face presentation: it occurs
For each description in questions 41-44, in 1:50 labors.
choose the SINGLE most appropriate 48. Regarding face presentation: the
answer from the below list of options.
presenting diameter is submento-
Each option may be used once, more than
once or not at all. bregmatic which is 9.5cm.
a) cord prolapsed 49. Regarding face presentation: it is most
b) amniotic fluid embolism commonly due to fetal thryoid tumours.
50. Regarding face presentation: the face 63. In vaginal twin delivery, the first twin is
can deliver vaginally with the chin mento- at greater risk than the second.
anterior. 64. In vaginal twin delivery, the second twin
51. Regarding face presentation: oxytocin must be delivered within 15minutes of the
should always be used to augment the slow first twin.
progress of labor. 65. In vaginal twin delivery, labor usually
52. Concerning brow presentation: it is the occurs prior to term.
least common malposition. 66. In vaginal twin delivery, IPV is a usual
53. Concerning brow presentation: the strategy for delivery of the first twin.
presenting diameter is mento-vertical. 67. In vaginal twin delivery, there is an
54. Concerning brow presentation: it may increased risk of postpartum hemorrhage.
be managed in labor by cesarean section. 68. In monozygotic twins, there is always a
55. Concerning brow presentation: this is risk of cord entanglement.
incompatible with vaginal delivery. 69. In monozygotic twins If monochorionic,
56. During assisted breech delivery, twins have a 15% chanace of developing
Pinard's maneuver can be used to deliver TTTT.
the legs when they are extended. 70. In monozygotic twins, it can not be a
57. In breech delivery, Mauricean Smellie dichorionic diamniotic.
Viet is used to deliver extended arms. 71. Replacement of only two embryos in
58. In breech delivery, forceps should not IVF protocol prevents the risk of triplet
be applied to the fetal head. pregnancy.
59. Contraindications to ECV include: 72. The median gestational age of delivery
polyhydramnios. of triplets is 33weeks.
60. Contraindications to ECV include: 73. The commonest cause of term breech
complete breech position. presentation is anencephaly.
61. Contraindications to ECV include: pre- 74. The commonest cause of term breech
elmapsia. presentation is hydrocephalus.
62. Contraindications to ECV include: twins. 75. Best way to deliver a neglected
shoulder is by IPV and breech extraction.
ANSWERS
1 D 36 D 71 F
2 D 37 D 72 T
3 B 38 A 73 F
4 D 39 G 74 T
5 B 40 E 75 F
6 C 41 I
7 A 42 A
8 C 43 G
9 D 44 F
10 B 45 T
11 C 46 F
12 D 47 F
13 D 48 T
14 D 49 F
15 A 50 T
16 B 51 F
17 D 52 F
18 A 53 T
19 C 54 T
20 B 55 T
21 A 56 T
22 C 57 F
23 B 58 F
24 C 59 T
25 C 60 F
26 E 61 T
27 A 62 T
28 C 63 F
29 D 64 F
30 A 65 T
31 E 66 F
32 J 67 T
33 F 68 F
34 C 69 T
35 G 70 F
Obs 4: Comp. Of 3rd Stage (85 marks)

I. Choose the most correct answer: 4. Which obstetric conditions can lead to
significant consumptive coagulopathy?
1. What might delay a practitioner from a) Placental abruption
recognizing dangerous postpartum
b) Amniotic fluid embolism
hemorrhage?
a) Initial cathecolamine release after c) Gram-negative bacterial sepsis
hemorrhage d) All of the above
b) A normal blood pressure in a
severely preeclamptic woman 5. Above which level serum fibrinogen is
c) Persistent light bleeding during considered adequate to promote
fourth degree vaginal laceration
coagulation?
repair
d) All of the above a) 50mg%
b) 150mg%
2. 32yrs old G3P2 with chronic c) 250mg%
hypertension had a normal labor that d) 400mg%
arrested during the second stage and
required forceps delivery. Completion of
the third stage followed quickly, the 6. A 32yrs old woman is brought to ER
fundus was firm. Brisk vaginal bleeding 6days following her VD at 39wks. Her
was then noted. The most likely cause of pregnancy and labour were normal. She
bleeding: reported having heavy lochia for the first
a) Uterine atony
2days and today she felt severe crampy
b) Uterine rupture
c) Retained placenta abdominal pain with gush of fluid then
d) Genital tract laceration heavy bleeding. She feels dizzy and
nauseating. She is pale with cold clammy
3. In the above patient, the genital tract extremities. Speculum revealed large clots
was carefully examined and no lacerations
in the vagina, when removed the cervix
were noted. Prophylactic oxytocin was
administered. The examiner noted the was seen dilated. What is your most
lower uterine segment was boggy and the probable diagnosis?
uterus Is slightly softer. The suitable a) 1ry postpartum haemorrhage
treatment in this situation: b) 2ry postpartum haemorrhage
a) Bimanual compression
c) Uterine inversion
b) Intramuscular methergine
c) Carboprost d) DIC
d) All are suitable
7. A 32years old G1P0 woman at 40wks 10. The following is the most reliable
gestation undergoes 2 VD. Delivery of the clinical symptom or sign of uterine
placenta is compticated by an inverted rupture:
uterus, with subsequent hemorrhage of a) Sudden tearing uterine pain
1500ml. She is managed with transfusion b) Vaginal bleeding
of packed RBCs. Best explanation of the c) Loss of uterine tone
mechanism of hemorrhage: d) Fetal distress
a) inverted uterus stretches the uterus e) Maternal bradycardia
causing trauma to blood vessels
leading to bleeding 11. A woman at 33wks is brought to ER
b) inverted uterus leads to inability for due to RTA. T: 36.7, pulse: 110, BP: 80/50.
adequate myometrial contraction She is conscious, skin is cool and clammy
effect and no obvious head injury. The lower
c) inverted uterus causes a local abdomen is tense and tender. Uterine
coagulopathy reaction to the uterus contractions are absent, bowel sounds are
and endometrium
decreased and FHS are absent. Most likely
d) inverted uterus causes muscular
diagnosis:
abrasions and lacerations leading to
a) Rupture spleen
bleeding
b) Rupture uterus
c) Perforated viscus
8. A 26yrs G2P2 wz NVD 40 days ago. She
d) Abruptio Placentae
comes complaining of a large amount of
e) Rupture bladder
bright red bleeding the previous day. The
most likely diagnosis:
a) uterine atomy 12. The second degree perineal tear
b) vaginal laceration involve the following EXCEPT:
c) subinvolution of the uterus a) Skin
d) normal menses b) Vaginalnbmucosa
c) Anal sphincter
9. A G2P1 with history of previous CS for d) Superficial perineal muscle
CPD presents with onset of labor. While e) None of the above
she was pushing, a gush of blood is seen
coming from vagina. Patient was in severe 13. Management of primary postpartum
pain. Likely cause: hemorrhage indudes air EXCEPT:
a) Placenta previa a) Correction of the general condition.
b) Breech presentation b) Bimanual compression.
c) Bloody show c) Panhysterectomy.
d) Rupture uterus d) Ligation of the internal iliac artery.
e) Rupture of membranes e) None of the above
14. What is the first surgical step in a case 18. A patient sustained a laceration of the
of retractable uterine atony? perineum during delivery. It involved the
a) Ligation of uterine and ovarian muscles, the perineal body but not the
anal sphincter. Such laceration would be
arteries.
classified as:
b) Ligation of hypogastric arteries. a) First degree
c) Ligation of external iliac arteries b) Second degree
d) Subtotal hysterectomy c) Third degree
e) Uterine artery embolization. d) Fourth degree
e) Fifth degree
15. Which obstetrical conditions can lead
to significant consumption coagulation? For each description in questions 19-22,
a) Placental abruption choose the SINGLE most appropriate
answer from the below list of options.
b) Amniotic fluid embolism
Each option maybe used once, more than
c) Gram-negative bacterial sepsis once or not at all.
d) Retained dead fetus for more than a) 5-10units IV/IM oxytocin
4weeks b) carbaprost IM in repeated doses
e) All of the above every 15minutes till maximum
8doses (not in asthmatics)
c) hysterectomy
16. In the recovery room one hour after
d) B-lynch suture
outlet forceps delivery, your patient is e) 40 units oxytocin in 100 ml normal
found to have a 6x5cm expanding bluish saline over 4hrs
tense painful right labia majora. Most f) Syntometrine (ergometrine
appropriate management: 500microgm and syntocinone 5units)
a) Vaginal pack g) Uterine massage
b) Incision and drainage h) 800-1000 microgm rectal
misoprostol
c) Exploratory laparotomy
i) observe the patient
d) Observation and ice pack j) indwelling catheter
e) Analgesia
19. You are called to review a patient who
delivered vaginaIly 12minutes previously,
17. the most dangerous consequence of she is bleeding moderately vaginally and
delivering the placenta by cord traction is: the midwife said her uterus is boggy and
a) endometritis not well contracted, your first step in the
b) uterine inversion management of her uterine atony:
c) cord avulsion 20. Despite uterine compressions, the
d) cervical laceration patient continues to bleed, she has already
e) vaginal laceration received 5units IV oxytocin. What
medication would you next administer?
21. While rubbing up the uterine 27. A 32-year-old woman G2P1 of 38

contraction, you notice a palpable bladder. weeks gestation is having efficient
The midwife says urine was last passed contractions. The cervix has been fully
2hours previously, your next management
step: dilated for one hour and on examination
the head is felt at -1 station with caput
22. At the end of a CS on swabbing the
vagina 40units oxytocin in 100ml normal succedaneum and severe moulding. The
saline over 4hours and is hypertensive. most probable cause is:
What would your next drug option be? a) Hypotonic inertia
b) Hydrops foetalis
23. Which of the following is NOT a likely c) Inadequate analgesia
finding in a woman with uterine d) Cervical dystocia
inversion?
e) Cephalo-pelvic disproportion
a) lower abdominal pain
b) mass in vagina 28. The following are true regarding
c) well contracted uterus cephalopelvic disproportion tests EXCEPT:
d) hemorrhage a) The fetal head is the best pelvimeter
e) unpalpable fundus for the pelvis
24. The following is NOT a factor classically b) Emptying maternal bladder is an
implicated in postpartum hemorrhage: important prerequisite for doing
a) tone these tests
b) trauma c) In moderate disproportion, vaginal
c) tamponade
delivery is expected
d) thrombin
e) tissue d) If the fetal head overrides symphysis
pubis, CS is the best mode of delivery
25. In absence of gross pelvic abnormality, e) In Pinard’s test, the right hand is
CPD can be diagnosed by: placed on the symphysis pubis
a) Ultrasound
b) Trial of labour
c) X-ray pelvimetry 29. Which of the following may be
d) CT pelvimetry responsible for dystocia in labor?
e) MRI a) bony-pelvis abnormalities
b) inadequate expulsive forces
26. Cephalo-pelvic disproportion tests are:
c) soft-tissue abnormalities of the
a) Radiographic tests
b) Sonographic tests reproductive tract
c) Clinical tests d) all of the above
d) All of the above
e) Non ofthe above
30. For the diagnosis of arrest of second 34. Prolonged labor can result in which of
stage of labor, the following statements the following maternal complications:
are correct: a) uterine rupture
a) arrest of labor should not be b) fistula formation
diagnosed until adequate time has c) symphyseal necrosis
elapsed d) A and B
b) before this diagnosis, nulliparas
should be allowed 1hour without 35. Characteristics of Braxton Hicks
progress contractions include all the following
c) before this diagnosis, nulliparas
EXCEPT:
should be allowed 2hours without
a) painful
progress
b) nonrythmical
d) A and C
c) Irregular pattern
31. Where are the greatest contraction d) associated with cervical change
forces during normal labor?
a) fundus 36. A 16yrs old patient G1P0 presents at
b) lower uterine segment 40wks with decrease DFMC, has PV: 1cm
c) midzone of the posterior uterine wall dilated cervix, cephalic presentation,
d) forces are equal throughout the station 0, EFW 3.5kg. What is the
uterus reasonable next step?
a) non stress test
32. The following is true regarding b) labor induction
precipitous labor: c) cesarean section
a) defined as delivery within 3hours of d) reassure and wait till 42 weeks.
labor onset
b) may result from diminished pelvic 37. A 30yrs old woman comes in active
soft tissue resistance labor at 40wks. Delivery of the fetal head
c) may result from a decreased occurs but the fetal shoulders do not
sensation and awareness of active deliver with the normal traction. The fetal
labor head is retracted toward the maternal
d) all of the above
introitus. Which of the following is a
useful maneuver for this situation?
33. In which of the following is prolonged
a) hyperflexion of the maternal thighs
labor associated with uterine rupture?
b) fundal pressure
a) high parity
b) previous cesarean delivery c) intentional fracture of the fetal
c) transverse lie humerus
d) all of the above d) delivery of the anterior arm
38. A 3800gm infant is delivered vaginally. 42. Cervical dystocia is associated with:
A shoulder dystocia was encountered. If a a) Turtle sign
neonatal injury is suspected, what is the b) Prolonged 1st stage of labour
likely finding in the infant? c) Prolonged 2nd stage of labour
d) Prolonged 3rd stage of labour
a) arm that is fixed and flexed and
e) Precipitate labour
hypertonic
b) arm that is at its side and internally 43. Which of the following is NOT done in
rotated the management of shoulder dystocia:
c) depressed skull fracture a) McRobert’s manoeuvre
d) dislocated elbow b) Corkscrew manoeuvre
c) Fundal pressure
39. Regarding a contraction ring, all of the d) Delivery of posterior arm
following is true EXCEPT: e) Zavinelli manoeuvre
a) It is felt vaginally
44. A 38yrs G4P3 of 41wks is delivering a
b) It is seen abdominally
3.8kg infant. After delivery of the head,
c) It is relieved by deep anaesthesia
you note a turtle sign. What is your next
d) It is associated with retained procedure?
placenta a) Caesarean section
e) It can occur at any part of the uterus b) Lovset’s manoeuvre
c) Mauricau-Smellie-Viet manoeuvre
40. A 35yrs G4P3 of 36 wks, presents to ER d) Delivery of the posterior arm
with frequent painful contractions of 2hrs e) McRobert’s manoeuvre
duration. PV: cx is fully dilated, head at +2
station, labour may be associated with all 45. McRobert’s manoeuvre entails:
a) Delivery of the posterior arm
EXCEPT:
b) Internal rotation of the foetal
a) Higher incidence of Caesarean shoulders to the oblique plane
section c) Fundal pressure
b) Foetal intracranial haemorrhage d) Jaw flexion
c) Foetal birth injuries e) Maternal thigh flexion
d) Atonic postpartum haemorrhage
e) Traumatic postpartum haemorrhage 46. A 35yrs G4P3 finally delivers a 4kg
baby after certain manoeuvers. Rt arm is
41. The commonest cause of prolonged hanging limply to the side with forearm
extended and internally rotated. Most
third stage of labour is:
likely diagnosis:
a) Abnormally long umbilical cord
a) Clavicle fracture
b) Uterine atony b) Humerus fracture
c) Placenta membranacea c) Klumpke’s palsy
d) Placenta accreta d) Erb’s palsy
e) Placenta praevia e) Shoulder dislocation
47. A retraction ring of Bandl is commonly 51. Shoulder dystocia:

associated with: a) Common complication.
a) Preterm labour b) Associated with maternal obesity.
b) Precipitate labour c) Turtle sign is not present.
c) Obstructed labour d) Rubin manoeuvre can be done to
d) Twin pregnancy hyperflex the arms.
e) Functional ovarian cysts e) McRobert manoeuvre can solve
about most of cases.
48. A retraction ring of Bandl is NOT:
a) Associated with atonically contracted Q 52-55: A 23yrs PG at 38wks, delivered in
uterus a taxi, she was admitted while the
b) Felt and seen abdominally placenta was delivering. She was OK then
c) Present between the upper uterine she started to develop severe PPH so she
segment and the lower uterine was referred to OR.
segment 52. If this lady delivered within 3hrs of
d) Associated with foetal distress
onset of labor, this is called:
e) Relieved by deep anaesthesia
a) Normal labor
b) Precipitate labor
49. A 34 yrs G3P2 has a prolonged 2nd
c) Spontaneous labor
stage of labour. O/E: cx is fully dilated, the
d) Prolonged labor.
head is LOA, station -1. Caput
e) Arrested labor
succedaneum and severe moulding are
noted. FHR is 120/min and the mother is
53. This case is prone to all of the
exhausted. The most appropriate
management is: following EXCEPT:
a) Forceps application a) Maternal genital lacerations
b) Vacuum extraction b) Puerperal sepsis
c) Emergency caesarean section c) Complications of preterm fetus
d) Start oxytocin infusion d) Neonatal ICH
e) Wait and watch policy e) Neonatal birth injuries
50. All of the following may cause labor 54. All following drugs could be used in
dystocia EXCEPT: management of this case EXCEPT:
a) Hydrocephalus a) Misoprostol
b) Occipto-anterior b) Methergine
c) Face presentation c) RU486
d) Occipito-posterior d) Oxytocin
e) Ovarian mass e) Antibiotics
55. Least complications of this type of 59. A PG presented with vaginal bleeding
labor includes: at 39wks. Her BP is 150/90, HR: 85. She
a) Vulval tears and hematoma has moderate uterine tenderness. Her
speculum examination revealed closed
b) Neonatal Erb's palsy
cervical os and moderate amount of
c) Maternal cervical incompetence vaginal bleeding. Her US is normal. Your
d) 2ry postpartum hemorrhage most probable diagnosis is:
e) Maternal perineal lacerations a) Placental abruption
b) Placenta praevia
56. Placentae that lie within close c) Cervical polyp
proximity of the internat cervical os but do d) DIC
not reach it, are termed low-lying. What is
60. Management of placental abruption
the boundary threshold that defines a with severe vaginal bleeding include all
low-lying placenta? EXCEPT:
a) 1.0cm a) coagulation profile order
b) 2.0cm b) tocolytic drugs if the fetus is
c) 3.0cm premature
d) 4.0cm c) artificial rupture of membranes
d) intensive intravenous fluid
replacement
57. The incidence of placenta previa
increases with which of the following 61. An 18yrs old lady is having low-lying
factors? placenta on US at 24weeks. Best
a) Increasing parity management:
b) Increasing maternal age a) schedule cesarean delivery at
38weeks
c) Increasing number of cesarean
b) reassess placental position at 32-
deliveries 34weeks by ultrasound
d) All of the above c) recommend termination of
pregnancy
58. Management of placenta accreta d) reassess placental position digitally at
typically requires which of the following? 32-34weeks
62. A PG presents at term wz placenta

a) Classical cesarean, hysterectomy
praevia and major fetal congenital
b) LSCS, hysterectomy anomalies. Best management:
c) Classical cesarean, myometrial a) Cesarean section
resection b) Oxytocin induction of labor
d) LSCS, myometrial resection c) forceps delivery
d) rupture of membranes and expectant
management
63. Antepartum haemorrhage is defined 67. Expectant management for accidental

as: haemorrhage is contraindicated if:
a) A gush of blood which occurs before a) Mild bleeding
b) No signs of hypertension
onset of labor.
c) Pregnancy >37weeks
b) A gush of blood which occurs before d) Foetus is dead
the second stage of labor e) Poor general condition
c) Vaginal bleeding occurring after the
20th week of gestation 68. When is placenta accreta likely to
d) Vaginal bleeding occurring anytime cause bleeding?
during pregnancy a) During the first stage of labor
b) Prior to labor
c) Because of consumption
coagulopathy
64. Causes of antepartum hemorrhage d) After amniotic membrane rupture
include all of the following EXCEPT: e) During attempts to remove it
a) Placental abruption
b) Subserous uterine fibroids 69. Bleeding from placenta previa is NOT
c) Cervical polyps characterised by:
a) Painless.
d) Placenta previa
b) Bright red.
e) Vasa previa c) Recurrent.
d) May be triggered by examination
65. All of the following regarding placenta e) Accompanied by tonic uterus.
previa marginalis is correct EXCEPT:
a) It is called marginal placenta. 70. A 33yrs old woman who is known to
b) Its anterior variety is more dangerous have a major placenta previa, has been an
than the posterior. inpatient since 34weeks gestation. She is
now 36 weeks and complains of sudden
c) It reaches the margin of the internal onset of painless heavy vaginal bleeding.
os but does not cover it. Her BP is 90/60, HR: 110, RR: 16, T: 36.7.
d) It can cause foetal asphyxia during Abdomen is soft, not tender and FHR is
labor. normal. Most appropriate management:
e) It delays engagement of the head. a) repeat antenatal corticosteroid as
the previous course would not be
66. Risk factors for the occurrence of effective
b) administer tocolysis as this would
placenta previa include all of the below help to stop the bleeding and
EXCEPT: prolong pregnancy
a) Advancing maternal age. c) deliver by emergency CS and involve
b) Prior C.S. delivery. senior obstetrician and anesthetic
c) Placental abnormalities. staff.
d) Diabetes mellitus. d) speculum examination should be
e) Multifoetal pregnancy. performed to help find a cause for
the bleeding.
71. A 25yrs old G1P0 at 39wks presents in 74. A 31yrs old G2P1 at 40weeks gestation
active labor, cx is 4cm and fully effaced. has progressed in labor from 5 to 7cm
The presenting part is station 0 and cervical dilatation over 2hrs. The following
membranes are intact. 2hrs later, cx is still best describes labor:
4cm. The best management is: a) prolonged latent phase
a) cesarean section
b) prolonged active phase
b) rupture of membranes
c) arrest of active phase
c) insertion bladder catheter to assist
fetal head descent d) normal labor
d) rupture of membranes, placement of
internal monitors and oxytocin 75. A 32yrs old G1P0 at 40wks presents
augmentation with frequent strong uterine contractions.
She has been seen 24hrs previously with
72. A 31yrs old G2P1 woman at 39wks 2cm cervical dilatation, 70% effaced and
complains of painful uterine contractions vertex at -1. She was admitted now at 3cm
occurring every 5minutes. Cx not changed cx, 80% effaced and station -1. Amniotomy
from 6cm dilatation over 3hrs. Best done and oxytocin started. After 4hrs, she
management plan is:
is still 3cm dilatation, 90% effacement and
a) cesarean section
station -1. The best management is:
b) oxytocin augmentation
c) fetal scalp ph monitoring a) Cesarean section
d) intranasal gonadotropin therapy b) Continued observation on oxytocin
c) discharge home with follow up in
73. A 26yrs old G2P1 at 41wks has been 3days
pushing for 3hrs without progress. PV d) foley bulb dilatation of the cervix
remained fully dilated, fully effaced,
station 0 with the head occipitoposterior. 76. A 31yrs G2P1 at 39wks complains of
Best description is: painful uterine contractions every 3-5
a) the occipitop-osterior position is mins. She had epidural, her cx changed
frequently associated with a
from 1 to 2cm over 2hours. Most
gynecoid pelvis
appropriate management plan:
b) misoprostol for cervical ripening
c) the patient is best described as a) Cesarean delivery
having an arrest of descent b) Intravenous oxytocin
d) the bony part of the fetal head is c) Observation for uterine contractions
likely to be at the plane of the pelvic d) Gonadotropin administration
inlet e) Fetal PH monitoring
77. A 32yrs old woman is admitted to the 84. Consequences of placental abruption
labor ward at 39+2weeks in her second include: fetal anemia.
pregnancy. She is having regular painful
85. Consequences of placental abruption
contractions and O/E: cx is 4cm dilated.
include: increased perinatal mortality.
Her membranes are intact. She wishes a
natural birth as much as possible. The
midwife is intermittently auscultating FHR
which is normal. 2hrs later, her cervix is
6cm dilated. What would you plan for care
for this lady?
a) AROM (artificial rupture of
membranes)
b) Cesarean Section
c) Continue current management
d) Commence CTG
e) IV antibiotics

78. Progress in labor is measured by:

frequency of uterine contractions.
79. Progress in labor is measured by: the

force of uterine contractions.

descent of the presenting part.

dilatation of the cervix.
82. Progress in labor is measured by: the

length of time since rupture of the
membranes.
83. Consequences of placental abruption

include: hypovolemic shock.
ANSWERS
1 D 36 A 71 B
2 D 37 A 72 B
3 D 38 B 73 C
4 D 39 B 74 D
5 B 40 A 75 B
6 B 41 B 76 C
7 B 42 B 77 C
8 D 43 C 78 F
9 D 44 E 79 F
10 D 45 E 80 T
11 B 46 D 81 T
12 C 47 C 82 F
13 C 48 E 83 T
14 A 49 C 84 F
15 E 50 B 85 T
16 B 51 E
17 B 52 B
18 B 53 C
19 G 54 C
20 F 55 B
21 J 56 B
22 H 57 D
23 C 58 A
24 C 59 A
25 B 60 B
26 C 61 B
27 E 62 A
28 C 63 C
29 D 64 B
30 D 65 B
31 A 66 D
32 D 67 C
33 D 68 E
34 D 69 E
35 D 70 C
Obs 5: Late Complications (90 marks)

I. Choose the most correct answer: 5. A 20yrs old PC had PROM at 18wks. US
shows anhydramnios. If she remains
1. The following are related to decrease undelivered till viability, perinatal survival
AFV during fetal development EXCEPT: will be affected due to underdevelopment:
a) contractures
b) pulmonary hypoplasia a) brain
c) abdominal wall defects b) lungs
d) gastrointestinal tract c) heart
development d) kidneys
2. AFV is a balance between production 6. What is the only reliable indicator of

and resorption. Primary mechanism of clinical chorioamnionitis in women with
resorption: PROM?
a) fetal breathing a) fever
b) fetal swallowing b) leukocytosis
c) absorption across fetal skin c) fetal tachycardia
d) absorption and filtration by fetal d) positive cervical or vaginal cultures
kidneys
7. Corticosteroids administered in risk for
3. Oligohydramnios is associated with all PTL decrease rates of RDS if birth is
the following complications EXCEPT: delayed at least:
a) stillbirth a) 12hours
b) neonatal sepsis b) 24hours
c) congenital malformations c) 36hours
d) meconium aspiration syndrome d) 48hours
4. If ROM occurs between 24-34wks, the 8. The completed weeks after which a
percentage of delivery within 48hrs from pregnancy is considered prolonged is:
ROM: a) 40weeks
a) 20% b) 41weeks
b) 40% c) 42weeks
c) 70% d) 43weeks
d) 90%
9. In the presence of macrosomia, which 13. A 31yrs old G1P0 at 33wks gestation is
of the following is true? admitted for PROM. The following is
a) early induction decreases maternal correct:
a) magnesium sulfate should be given
and fetal morbidity rates
for neuroprotection
b) cesarean delivery should be b) broad spectrum antibiotic therapy is
performed for estimated fetal weight indicated only with maternal fever
>4000gm c) labor is the most common acute
c) CS is recommended for FFW squeal to be expected
>4500gm if there is prolonged d) vaginal candidiasis is a risk factor for
second stage of labor preterm PROM
14. Using AFI measurement, what is the
lower threshold for diagnosing
10. A 32yrs old G3P2 at 40wks +5days had polyhydramnios?
PV or 1cm dilated cervix, cephalic a) 18cm
presentation and good fetal movement. b) 20cm
What is the best next step in the c) 24cm
management of this patient? d) 28cm
a) Cesarean section e) 30cm
b) labor induction
15. The term SGA is generally used to
c) oxytocin challenge test
designate newborns whose birth weight is
d) ultrasound estimation of AFI less than:
a) 3%
11. One week later, the previous patient b) 5%
returns to your office. O/E: cx is 2cm c) 10%
dilatation, cephalic presentation and d) 15%
station -1. Your management plan should e) 90%
include:
16. In sonographic evaluation of the cervix
a) non stress test as part of the assessment for preterm
b) labor induction birth risk:
c) oxytocin challenge test a) Transabdominal approach is
d) Cesarean section preferred to avoid cervical
manipulation
12. A 25yrs PG delivers a 4kg infant and b) Women with progressively shorter
encounters shoulder dystocia. Risk factor cervices had increased preterm labor
rates
for this condition:
c) Women with prior PTL and cervical
a) maternal gestational diabetes lengths = 35mm will benefit from
b) fetal hydrocephalus cerclage
c) fetal prematurity d) All of the above
d) precipitous labor e) None of the above
17. Woman is found to have 21. A 21yrs old G1P0 woman is seen for
oligohydramnios at 30wks. The following her first ANC at 36wks. On US, the
measurements indicate 32wks for HC, AC
is the most likely cause: and FL. The best management for this
a) duodenal atresia patient:
b) placental chorioangioma a) antenatal steroids for probably IUGR
c) diabetes b) recommend amniocentesis for
karyotype
d) oesophageal atresia c) delivery in 1week (at term)
e) renal agenesis d) continued monitoring and repeat
ultrasound
18. An infant is delivered at 27wks and
22. A 27yrs old woman at 37wks by LMP
taken to NICU. Which problem is the most and 10week ultrasound. EFW is 2000gm
likely to be experienced? which is less than 3rd percentile for GA.
a) incomplete formation of the Doppler studies indicate the presence of
forward end diastolic flow. You
epidermis from the mesoderm recommend delivery for this patient. The
b) excessive vernix formation best reason for your recommendation is:
c) lanugo shedding a) a fetal weight of 2000gm correlates
d) thermoregulation due to thin skin with a high survival in the nursery
b) IUGR carries a significant risk of fetal
e) lack of hair follicle development death
c) Doppler studies indicate a concern
19. Asymmetrical growth restriction is for continuing the pregnancy
d) to allow further diagnostic studies as
characterized by a reduction in:
karyotype and viral studies
a) head size
b) body size 23. An 18yrs old G1P0 woman at 38wks
c) both body and head size confirmed by 12wks US, has a fundal
height of 34cm. The patient has gained
d) both body and femur length 10kg during the pregnancy. She denies
smoking or alcohol or drug use. Her BP is
20. In pregnancies with EFW >4kg after 110/70. The best management of this
patient:
37wks, prophylactic labor induction has
a) perform a basic ultrasound study
which effect? b) schedule for delivery since the
a) increases the cesarean delivery rate patient has reached a term
b) decreases the shoulder dystocia rate gestational age
c) schedule BBP and Doppler studies for
c) decreases the postpartum
this patient
hemorrhage rates d) send her urine for a drug screen and
d) all of the above consider ordering TORCH titers
24. Stillbirth is defined as delivery of a 28. All of the following are correct about
dead fetus after: management of IUFD except:
a) 20weeks a) Fibrinogen level should be monitored
b) 21weeks weekly during the period of watchful
c) 22weeks expectancy
b) Cesarean section should be done
d) 24weeks
immediately after diagnosis of IUFD
e) 28weeks
c) Platelet count should be monitored
with watchful expectancy
25. All of the followings are correct about d) Hematocrite should be monitored
symmetrical IUGR EXCEPT: during watchful expectancy
a) Usually results from fetal injury very e) Misoprostol followed by oxytocin can
early in development be used for termination of pregnancy
b) Constitutes 20% of IUGR cases in IUFD
c) The fetus is <10th percentile weight
according to fetal growth curves 29. All of the following are risk factors for
d) Chromosomal abnormalities may be fetal macrosomia EXCEPT:
the etiology a) Chronic maternal hypertension
e) Chronic placental insufficiency is b) Maternal diabetes
usually present c) Post-term pregnancy
d) Maternal obesity
e) Multiparity
26. One of the causes of asymmetrical
IUGR is:
30. All of the following are correct about
a) Chronic maternal hypertension macrosomia EXCEPT:
b) Fetal infections a) Fetal birth trauma may occur
c) Congenital malformations b) Decreased incidence of CS deliveries
d) Chromosomal abnormalities c) Traumatic injuries to maternal birth
e) Skeletal anomalies canal may occur
d) Hypoglycemia and polycythemia are
27. All of the following ultrasound findings common neonatal complications
may be present in cases of IUGR except: e) It is more common with history of
a) Congenital anomalies prior macrosomic infant
b) Estimated fetal weight <10th
percentile for gestational age 31. BPP are composed of all the following
c) Decreased BPD and AC measurement EXCEPT:
a) fetal tone
<10th percentile for gestational age
b) fetal breathing
d) Oligohydramnios
c) contraction stress test
e) Polyhydramnios d) amniotic fluid volume measurement
32. For low risk pregnancies, continuous 37. Abnormal fetal heart rate tracing on
fetal monitoring at admission has the CTG include:
following outcome:
a) Baseline bradycardia (<100 b/m)
a) increases cesarean delivery rates
b) decreases perinatal mortality rates b) Absence of beat to beat variability
c) decreases perinatal morbidity rates c) Late decelerations
d) all of the above d) Variable decelerations
33. The following are tests for antepartum e) All of the above
fetal surveillance for fetal wellbeing
EXCEPT: 38. All of the following are parameters of
a) Daily total movement count. intrapartum fetal surveillance EXCEPT:
b) Fetal scalp blood sampling
c) Non-stress test a) Passage of meconium after ROM in
d) Biophysiscal profile cephalic presentation
e) Color Doppler study of fetal blood b) Abnormal fetal heart rate by sonicaid
flow
c) Fetal scalp blood sampling
34. The minimum accepted fetal d) Daily fetal movement count
movement count after 30weeks per e) CTG
12hours is:
a) 20-22
39. If CTG records abnormal FHR patterns
b) 30 32
c) 15-20 during labour, all should be done EXCEPT:
d) 10-12 a) Stop oxytocin if it has been infused
e) 25-30 b) Change position of the mother to the
left lateral position
35. If daily fetal movement count is
decreased: c) mask to the mother
a) Immediate termination of pregnancy d) IV fluids
is indicated e) Repeat CTG after 2 hours without
b) Amniocentesis is indicated
c) Fetal scalp blood sampling is interference
indicated
d) Non-stress test is indicated 40. The following is NOT an indicator of
e) None of the above fetal wellbeing:
36. On CTG, the normal baseline fetal a) CTG
heart rate is: b) fetal lie
a) 100-120 b/m c) fetal movements
b) 160-180 b/m
d) fetal breathing movements
c) 120-140 b/m
d) >200 b/m e) Umbilical artery Doppler.
e) <100 b/m
For each of the descriptions in questions d) baseline variability

41-45, choose the SINGLE most e) fetal heart rate accelerations
appropriate answer from the below list of f) antenatal Doppler
options. Each option can be used once, g) Doppler in labor
more than once or not at all. h) diagnostic ultrasound
a) transvaginal cervical length i) BPP
measurement j) None of the above
b) ultrasound assessment of fetal 46. Reflection of the normal fetal
growth autonomic nervous system.
c) middle cerebral artery Doppler
examination 47. Assessment of fetal breathing, gross
d) uterine artery Doppler examination body movements, fetal tone, reactive FHR
e) CTG and amniotic fluid.
f) BPP 48. Transient reduction in the FHR of
g) DFMC 15b/m or more lasting for more than 15
h) Umbilical artery Doppler seconds.
41. A woman with previous severe pre- 49. Transient increase in the FHR of 15b/m
eclampsia presents at 22weeks concerned or more lasting for more than 15seconds.
about her risk of recurrence. Her anomaly
scan was normal.
50. The obstetrician on call is asked to
42. A woman at 16weeks who review a CTG performed prior to induction
spontaneously delivered in her last of labor in a 39wks multigravida, the
pregnancy at 26weeks gestation. following helps to reassure that this
43. A woman at 28weeks has been exposed tracing is a normal trace:
to parvovirus and the baby is suspected to a) the baseline heart rate is 100/min
be anemic. b) the baseline variability is <5b/m
c) an acceleration of 15b/m for
44. A woman at 36weeks has a symphysis- 15seconds is present on the trace
fundal height of 32cm. d) there are no significant acceleration
45. A woman at 34weeks has had a growth of the fetal heart on the 30min
scan showing that the EFW is on the 5th recording
centile for gestation. She presents 1week e) the CTG is picking up regular
later with reduced fetal movements. contractions
For each of the descriptions in questions 51. Which of the following fetal scalp pH
46-50, choose the SINGLE most results should prompt immediate
appropriate answer from the below list of delivery?
options. Each option can be used once, a) 7.30
more than once or not at all. b) 7.22
a) variable decelerations c) 7.18
b) late decelerations d) 7.26
c) early decelerations e) 7.25
II. For each of the statements below, mark 67. Antenatal steroid administration is of
True (T) or False (F): no benefit if delivery does not occur within
52. Oligohydramnios is associated with: 1week of administration.
trachea-oesophageal fistula. 68. Antenatal steroid administration should
53. Oligohydramnios is associated with: not be performed unless the diagnosis of
talipes. PTL is confirmed.
54. Oligohydramnios is associated with: 69. Antenatal steroid administration has

IUGR. not been shown to cause development
problems following single dose.
55. Oligohydramnios is associated with:
anencephaly. 70. Tocolysis may be indicated to allow
antenatal steroids to take effect in PTL.
56. Oligohydramnios is associated with:
premature rupture of fetal membranes. 71. The following drugs have been shown
to be effective in ttt of PTL: atosiban.
57. Polyhydramnios is associated with:
maternal diabetes. 72. The following drugs have been shown
to be effective in ttt of PTL: pethidine.
neuromuscular fetal conditions. 73. The following drugs have been shown
to be effective in ttt of PTL: nifedipine.
maternal NSAID. 74. The following drugs have been shown
to be effective in ttt of PTL: lahetalol.
postmaturity. 75. The following drugs have been shown
to be effective in ttt of PTL: ritodrine.
61. Polyhydramnios is associated with
chorioangioma of the placenta. 76. Risks of PPROM include: PTL.
62. Risk factors for IUGR include: multiple 77. Risks of PPROM include: cord
pregnancy. prolapsed.
63. Risk factors for KJGR include: aspirin use 78. Risks of PPROM include: pre-eclapmsia.
in pregnancy. 79. Abnormal uterine artery Doppler
64. Risk factors for IUGR include: indicates fetal hypoxia.
antiphospholipid syndrome. 80. Abnormal umbilical artery Doppler
65. Risk factors for IUGR include: fetal indicates poor placental perfusion.
karyotype anomalies. 81. Fetal hypoxia is associated with
66. Antenatal steroid administration is redistribution of blood flow.
indicated in threatened PTL from 24-34wks.
82. Fetal anemia is best assessed using

measurements from MCA (Middle cerebral
artery).
83. When performing Biophysical Profile
(BPP), EFW is evaluated.
(BPP), fetal tone is evaluated.
(BPP), maternal BP is evaluated.
(BPP), AFI (amniotic fluid index) is
evaluated.
(BPP), placental blood flow is evaluated.
88. In evaluating a patient with suspected
PPROM, maternal baseline blood tests
should be performed.
89. In evaluating a patient with suspected
PPROM, TAS may help decide whether the
membranes have been ruptured.
90. In evalualing a patient with suspected
PPROM, a fetal CTG should always be
performed.
ANSWERS
1 C 36 C 71 T
2 B 37 E 72 F
3 B 38 D 73 T
4 D 39 E 74 F
5 B 40 B 75 T
6 A 41 D 76 T
7 B 40 A 77 T
8 C 43 C 78 F
9 C 44 B 79 F
10 D 45 E 80 T
11 A 46 D 81 T
12 A 47 I 82 T
13 C 48 J 83 F
14 C 49 E 84 T
15 C 50 C 85 F
16 B 51 C 86 T
17 E 52 F 87 F
18 D 53 T 88 T
19 D 54 T 89 T
20 A 55 F 90 F
21 D 56 T
22 B 57 T
23 A 58 T
24 D 59 F
25 E 60 F
26 A 61 T
27 E 62 T
28 B 63 F
29 A 64 T
30 B 65 T
31 C 66 T
32 A 67 F
33 B 68 F
34 D 69 T
35 D 70 T
Obs 6: Med. & Surg. Comp. (130 marks)

I. Choose the most correct answer: 5. The target BP you want to achieve in a
hypertensive pregnant female:
1. Which of the following is never a a) <120/90
normal finding in pregnancy? b) <130/80
c) <140/90
a) Dyspnea
d) <150/100
b) Systolic murmur
c) Diastolic murmur 6. The diagnosis of chronic hypertension is
d) Exercise intolerance supported when hypertension is present
prior to:
2. A pregnant woman with cardiac disease a) 8weeks
is comfortable at rest but can't stand up to b) 14weeks
brush her teeth without feeling chest pain, c) 20weeks
her NYHA classification: d) 24weeks
a) I
7. For women with chronic hypertension,
b) II the risk of placental abruption is increased
c) III with:
d) IV a) Oligohydramnios
b) Maternal smoking
3. The following is true regarding c) Multiple gestation
antepartum and intrapartum care of d) Pregestational diabetes
patients with CVD:
a) Vaginal delivery is preferred 8. A 30yrs old G3P2 presents for ANC. Both
pregnancies were complicated by mild
b) Spinal blockage is the recommended
gestational HTN near term. She is
anesthetic
currently 12wks, BP: 145/85. Most
c) These patients should avoid appropriate next step:
pneumococcal vaccination a) Continuous observation
d) Invasive monitoring with pulmonary b) Begin treatment
artery catheter is required c) Begin treatment with thiazide
4. Which of the following anticoagulants is
not compatible with breast feeding? 9. The following pregnancy complication is
a) Warfarin reduced when antihypertensive therapy is
started:
b) Unfractionated heparin
a) Preterm delivery
c) Low-molecular weight heparin b) Neonatal morbidity
d) All are compatible c) Development of severe hypertension
d) Neonatal intensive care admissions
10. All the following support the diagnosis 16. Above which levels proteinuria is
of superimposed pre-eclampsia EXCEPT: considered pathological in pregnancy?
a) Decreased platelet count a) 50mg/day
b) Increased serum creatinine level
b) 100mg/day
c) Elevated alkaline phosphatase
d) Elevated AST c) 200mg/day
d) 300mg/day
11. Which of the following is preferred for
intrapartum prevention of eclampsia? 17. An asymptomatic 17yrs old G1P0 at
a) Phenytoin 16wks GA, presents for her first ANC, urine
b) Midazolam
culture revealed >100. 000 gram-negative
c) Phenobarbital
d) Magnesium sulphate bacteria, your diagnosis is:
a) Cystitis
12. The following predispose to venous b) Pyelonephritis
thrombosis in pregnancy EXCEPT: c) Diverticulitis
a) Lower extremity venous stasis d) Asymptomatic bacteriuria
b) Decreased plasminogen activity
c) Endothelial cell injury at delivery
18. If the previous patient is not treated,
d) Increased synthesis of clotting
factors the chance she develops symptoms are:
a) 5%
13. The most important risk factors for b) 10%
developing thromboembolism in c) 25%
pregnancy is: d) 50%
a) Cesarean delivery
b) Multifetal gestation
c) Postpartum hemorrhage 19. A 24yrs old G1P0 at 37wks GA presents
d) Personal history of thrombosis to labor, she has headache, lower
abdominal pain and decreased DFMC. Her
14. Epidural anasthesia can be given after BP: 140/90 and protein in urine 4+. There
how many hours from last dose of LMWH: is suspicious placental abruption. She had
a) 12hrs
prompt VD with estimated blood loss
b) 24hrs
c) 36hrs 1liter. Postpartum, her urine output is
d) 48hrs 20ml/hour. HR: 120 and her BP: 90/60.
Your plan of management:
15. the most common presenting a) Initial dopamine drip
symptom in patients with a pulmonary b) Administer loop diuretic
embolus: c) Provide one time intravenous bolus
a) Cough
of crystalloid solution
b) Dyspnea
c) Syncope d) Replace intravascular volume with
d) Chest pain crystalloid solution and blood
20. AII the following are complications of 25. The following clinical features are
hyperemesis gravidarum EXCEPT: characteristics of intrahepatic cholestasis
a) Acidosis of pregnancy:
b) Dehydration a) Maculopapular rash
c) Hypokalemia b) Nausea and vomiting
d) Mild transaminitis c) Generalized pruritis
d) Serum transaminase levels >500U/L
21. Development of confusion, ocular
findings and ataxia in hyperemesis 26. In the previous patient, which of the
gravidarum is due to: following is most appropriate medications
a) Thiamine deficiency to initiate?
b) Vitamin A deficiency a) Hydroxyzine
c) Vitamin D deficiency b) Cholestyramine
d) Vitamin K deficiency c) Diphenhydramine
d) Ursodeoxycholic acid
22. The preferred initial treatment of
hyperemesis gravidarum is:
27. The following regarding breast feeding
a) Glucocorticoids
with HBV infected women is correct:
b) Enteral nutrition
a) It is contraindicated
c) Hyperalimentation
b) It is not contraindicated
d) Antiemetics and intravenous
c) It is contraindicated only in
hydration
purpuerium
d) It is indicated only in purpuerium
23. The followings are safe to use in
pregnancy for ttt of reflux oesophagitis
28. An Hb level below which, anemia in
EXCEPT:
any trimester is diagnosed?
a) Cimetidine
b) Omeprazole a) 9.0g/dl
c) Misoprostol b) 9.5g/dl
d) Calcium carbonate c) 10.0g/dl
d) 10.5g/dl
24. What is the underlying
pathophysiology of intrahepatic 29. What is the most common cause of
cholestasis? antepartum anemia in pregnant women?
a) Acute hepatocellular destruction a) Thalassemia
b) Incomplete clearance of bile acids b) Iron deficiency
c) Microvascular thrombus c) Folic acid deficiency
accumulation d) Anemia of chronic disease
d) Eosinophilic infiltration of the liver
30. By the White classification: a woman 35. Women with type I diabetes should
with proliferative retinopathy is: achieve glycemic control with:
a) R diabetes a) Insulin
b) H diabetes b) Diet alone
c) Insulin and diet
c) D diabetes
d) Oral hypoglycemic agents
d) A2 gestational diabetes
36. A 31yrs old female diagnosed with
31. Fetuses of overtly diabetic mothers gestational diabetes that is controlled only
have an increased risk for: by diet, at term, the following is important
a) Preterm delivery for management of her pregnancy:
b) Spontaneous abortion a) Induction at 37weeks gestation
b) Daily umbilical artery Doppler
c) Congenital malformation
c) Cesarean delivery is a must
d) All of the above
32. The incidence of stillbirth is highest in 37. A 32yrs old at 34wks has felt unwell for
pregnancies complicated by: 24hrs. She has headache, epigastic pain
a) Overt diabetes with abnormal visual manifestations,
b) Gestational diabetes swollen legs & hands and puffy face. There
c) Overt diabetes and hypertension is no abdominal pain, gush of fluid or
d) Gestational diabetes and vaginal bleeding. BP: 140/85 and HR:
hypertension 98/min. Uterus is not tender. Her Hb is
9.0g/dl. Htc is 44%, platelets 50. 000, AST:
175 and ALT: 230. Your provisional
33. Which of the following infections is diagnosis:
increased in gravidas with overt diabetes? a) Hypertension with pregnancy
a) Pyelonephritis b) Acute fatty liver of pregnancy
b) Respiratory infections c) DIC
c) Wound infection after cesarean d) HELLP
delivery
38. A pregnant woman is brought to ER wz
d) All of the above
a seizure in the parking 20min ago. She
34. Concerning the preconceptional had been alone but the seizure was
witnessed by another woman who said
period, what can be said of care for the
that she had stood up from a bench and
diabetic woman? then suddenly dropped to the ground.
a) Should achieve euglycemia When the fit stopped, BP: 140/95 and HR:
b) Should begin daily folate 104. The reflexes were brisk. Still no labs
c) Should have an ophthalmological available. Your provisional diagnosis:
appointment to screen for a) eclampsia
retinopathy b) epilepsy
d) All of the above c) intracranial haemorrhage
d) hysterical
39. The husband of the previous woman 44. Which of the following is
arrives shortly and explains that she is contraindicated in pregnancy with pre-
known to be epileptic who has grand-mal eclampsia?
seizures few days ago. How should your a) Nifedipine
management alter now? b) Angiotensin converting enzyme
a) immediate termination of pregnancy inhibitor
b) discharge with neurological follow up c) Labetalol
c) hospitalization and follow up d) Hydralazine
d) start antihypertensive medications e) Methyldopa
40. All of the following can be used in 45. Which of the following is correct as
severe pre-eclampsia EXCEPT: regards materno-fetal Rh incompatibility?
a) Outlet forceps a) Less likely to happen in first
b) Oxytocin pregnancy
c) CTG b) Occurs more common in Rh positive
mothers
d) Ergometrine
c) Occurs more common if the fetus is
e) Antihypertensives
Rh negative
d) Can be prevented by vaccination
41. Pre-eclampsia is “cured” by:
before pregnancy
a) Antihypertensives
e) May lead to thalassaemia
b) Diet alone
c) Diuretics 46. Mother-fetus incompatibility problems
d) Termination of the pregnancy result from:
e) Magnesium sulphate a) The mother’s antibodies
agglutinating the fetus’ Rh positive
42. When BP is higher than 140/90 before red blood cells.
20weeks, this is a case of: b) The fetus’ antibodies agglutinating its
a) Pre-eclampsia own red blood cells.
b) Pre-existing hypertension c) The fetus’ antibodies agglutinating its
c) Eclampsia mother’s red blood cells.
d) Pregnancy induced hypertension d) All of the above
e) Physiological change in pregnancy e) None of the above
43. Which of the following is NOT a part of 47. Which of the following accounts for
HELLP syndrome? proteinuria in pre-eclampsia?
a) Hemolysis a) Increased vascular resistance
b) Low platelet count b) Reduced placental blood flow
c) Elevated liver enzymes c) Reduced cerebral perfusion
d) Elevated platelet count d) Clotting dysfunction
e) Elevated uric acid e) Increased vascular permeability
48. A 30yrs old G1 presents at 8wks. She 52. Infants of diabetic mothers are at
has a history of DM since the age of 12. increased risk of:
She uses insulin and denies any a) Anemia
complications. Most common birth defect b) Hypercalcaemia
associated with diabetes? c) Hyperglycaemia
a) Anencephaly d) Microsomia
b) Spina bifida e) RDS
c) Sacral agenesis
d) Meningomyelocele 53. A pregnant woman not known to be
e) Ventricular septal defect diabetic at 27wks GA had a routine 50g
OGTT with 1hour glucose value of
49. Regarding gestational diabetes: 144mg/dL. A follow up 100g OGTT
a) It is the most common cause of IUGR revealed values of FBS: 102, 1hour: 180,
b) Random blood sugar is the best 2hours: 163 and 3hours: 144. What is the
screening test. appropriate management?
c) 100g OGTT is diagnostic. a) Begin diet control and daily glucose
d) All patients should be treated with monitoring
insulin as diet alone is not enough. b) Administer oral hypoglycaemic drugs
e) All patients should be delivered c) Repeat OGTT after 2 weeks
before term to avoid complications. d) Perform contraction stress test
e) Reassure the patient and treat as one
50. Gestational diabetes is associated with with normal gestation
increased risk of all of the following
EXCEPT: 54. Which of the following in a pregnant
a) Shoulder dystocia patient's history is suggestive of DM?
b) Foetal macrosomia a) Twin pregnancy
c) IUFD b) IUGR
d) IUGR c) 1st trimesteric bleeding
e) Caesarean section d) Unexplained still births
e) Diabetic husband
51. Pregnancy is considered diabetogenic
because of: 55. The commonest cause of diabetes with
a) Decreased insulin pregnancy is:
b) Increased glucose absorption from a) Gestational DM
the GIT b) Uncomplicated Type I DM
c) Increased Placental Lactogen c) Uncomplicated Type II DM
d) Haemoconcentration d) Complicated Type I DM
e) Polyphagia e) Complicated Type II DM
56. Commonest cause of cardiac disease 60. Drug strategy in the 3 trimesters
with pregnancy in developed countries is: respectively of pregnancy for
a) Congenital heart disease anticoagulant therapy is:
b) Cardiomyopathy a) heparin-heparin-heparin
c) Coronary artery disease b) heparin-warfarin-heparin
d) Ischaemic heart disease c) heparin-warfarin-warfarin
d) warfarin-warfarin-heparin
e) Rheumatic heart disease
e) warfarin-heparin-warfarin
57. Commonest cause of cardiac disease
61. the most sensitive test for detection of
with pregnancy in developing countries is: iron depletion in pregnancy:
a) Congenital heart disease a) serum iron
b) Cardiomyopathy b) serum transferrin
c) Coarctation of the aorta c) serum ferritin
d) Rheumatic heart disease d) serum erythropoetin
e) Coronary artery disease e) none of the above
58. On routine follow up of a 20yrs old 62. AII of the following are complications
primigravida at term you elicit: a split SI, of infant of diabetic except:
normal S2, easily audible S3 and an a) hyperbilirubinemia
ejection systolic murmur. You immediately b) hyperglycemia
c) hypocalcemia
recognize that:
d) hypomagnesemia
a) The presence of S3 is abnormal.
e) none of the above
b) The combination of S3 and a systolic
murmur is abnormal. 63. A woman receives VTE prophylaxis
c) Echocardigraphy is required to make antenatally. How long it is continued
a final diagnosis. following delivery?
d) The patient is in need of immediate a) no continuation needed
admission to the ICU. b) 1wk
e) All findings are normal changes with c) 4wks
pregnancy. d) 6wks
e) 10wks
59. The commonest endocrinal disorder in
pregnant women is: 64. Which point during pregnancy carries
a) thyroid dysfunction the greatest risk of developing VTE?
b) adrenal dysfunction a) first trimester
b) second trimester
c) parathyroid dysfunction
c) third trimester
d) pituitary dysfunction
d) intrapartum
e) none of the above e) postnatal
65. Thyrotoxicosis in pregnancy is treated e) discussion with hematologist for

with: specialist advice
a) Partial thyroidectomy f) LMWH for 10days postnatally
b) Radioactive iodine g) early mobilization and hydration
c) Oral neomercazole h) antenatal prophylaxis with LMWH
d) Iodine drops and B-blockers i) none of the above
e) Left till after pregnancy ends 69. A woman attends for booking at
6weeks gestation and she has had a
66. Diabetic control is important before previous metallic mitral valve replacement.
pregnancy to reduce the incidence of:
a) Maternal nephropathy 70. A 28yrs old woman who has had an
emergency CS in labor for fetal distress and
b) Diabetic ketoacidosis
she had DVT in a previous pregnancy.
c) Congenital anomalies
d) Maternal retinopathy 71. A healthy 30yrs old woman with a
e) Cesarean section normal BMI who had a NVD for her fourth
child 4hrs ago.
67. Which of the following is NOT a risk 72. A healthy 36yrs old woman with a
factor for screening for GDM: normal BMI who had a NVD of her fourth
a) previous GDM child 4hrs ago.
b) previous macrosomia (>4. 5kg)
c) maternal raised BMI (>30) 73. The following is NOT useful in the
d) European race treatment of pre-eclampsia:
a) hydralazine
68. The following is NOT a risk factor for b) aspirin
developing pre-eclampsia: c) labetalol
a) chronic kidney disease d) methyldopa
b) autoimmune disease such as SLE or e) rantidine
antiphospholipid syndrome
c) thyroid disease For each of the descriptions in questions
d) chronic hypertension 74-77, choose the SINGLE most
appropriate answer from the below list of
For each of the descriptions in questions options. Each option can be used once,
69-72, choose the SINGLE most more than once or not at all.
appropriate answer from the below list of a) HELLP syndrome
options. Each option can be used once, b) pre-eclampsia
more than once or not at all. c) eclampsia
a) no intervention required d) DIC
b) lifelong anticoagulant e) glomerulonephritis
c) IV unfractionated heparin for 24 f) gestational hypertension
hours g) chronic hypertension
d) LMWH for 6weeks postnatally h) placental abruption
i) none of the above
74. A 40year old woman in her first 80. You are asked by a midwife to review
pregnancy presents in labor, her BP is an overweight 42yrs old woman 6weeks
145/90. Shortly after beginning regular after her third child. Her booking BP was
contractions, she has a tonic clonic seizure. 145/85. But it reduced during pregnancy
75. A 32yrs old woman presents with and she went on a spontaneous labor and
epigastric pain at 38 weeks in her second normal birth at term. Her BP raised again
pregnancy, her first pregnancy has been during labor with 1+ proteinuria and she
complicated by pre-eclampsia and her BP is was treated with labetalol. Despite
130/86. Her ALT is 170. Her platelet count continuing this therapy, her BP has
is 40.000.000. continued to be raised averaging 150/95.
The most likely cause of her high BP:
76. A 24yrs old woman in her first a) pre-eclampsia
pregnancy presents at 32 weeks with b) essential hypertension
sudden onset severe abdominal pain and c) Cushing's disease
vaginal bleeding and her BP is 160/95. d) coarctation of aorta
77. A 36yrs old woman in her first e) superimposed pregnancy induced
pregnancy is noted to have a BP of 140/96 hypertension
at 32weeks gestation. There is no protein in
her urine and she is asymptomatic. For each of the descriptions in questions
81-86, choose the SINGLE most
78. A woman with history of Grave's appropriate answer from the below list of
disease & thyroidectomy 5yrs ago and had options. Each option can be used once,
her thyroid function tests at her 7th wks more than once or not at all.
gestations showing elevated TSH and a) diabetes
normal T4. Appropriate action is: b) hypertension
a) repeat thyroid function tests in c) epilepsy
6weeks d) vitiligo
b) repeat TFTs in 12weeks e) factor V Leiden deficiency
c) commence carbimazole f) HIV
d) commence propylthiouracil g) asthma
e) commence thyroxine h) smoking
i) Crohn's disease
79. Administration of the following in first j) Mitral valve stenosis
trimester is typically associated with k) myasthenia gravis
neural tube defects: l) glomerulonephritis
a) enalapril 81. Reduces intrauterine growth in a dose-
b) lithium dependent manner.
c) nitorfurantoin 82. Increases risk of VTE in puerpurium.
d) sodium valproate
e) warfarin 83. Increased frequency of episodes during
pregnancy.
84. Risk of fetal macrosomia if the 90. A 32yrs old woman in her second
condition is not well controlled. pregnancy presents to her GP at 12weeks
85. Maternal muscle fatigue in labor. gestation, she was mildly hypertensive in
86. Requires prophylactic antibiotics for her previous pregnancy and her BP is
instrumental delivery. 150/100. 2weeks later at the hospital ANC,
her BP is 155/100.
87-90, choose the SINGLE most For each of the descriptions in questions
appropriate answer from the below list of 91-94, choose the SINGLE most
options. Each option can be used once, appropriate answer from the below list of
more than once or not at all. options. Each option can be used once,
a) MgSo4 more than once or not at all.
b) oral antihypertensive
a) calcium supplements
c) oral diuretic
d) outpatient monitoring of BP b) erythromycin
e) renal function tests c) nifedipine
f) 24hrs urine protein collection d) ritodrine
g) admission for observation and e) ursodeoxycholic acid
investigation f) MgSo4
h) fetal ultrasound g) oral labetalol
i) immediate CS h) ferrous sulphate
j) induction of labor i) none of the above
k) IV antihypertensive
l) none of the above 91. A 27yrs old woman presents at
33weeks in her first pregnancy. She is
87. At 34weeks, an 80kg woman complains
of intercurrent headaches, there is no complaining of generalized itching worse
hyperreflexia and her BP is 155/90. on the palms of her hands and soles of her
feet. Abdominal examination is
88. At 33weeks, a 31year old PG is found to
unremarkable. Blood investigations reveal
have BP of 145/95. At her visit at 12weeks,
the BP was 145/85. She has no proteinuria that she has increased bile acids.
but she is found to have edema to her
92. A 23years old PG woman presents at
knees and her renal function tests are
31weeks. At her 12weeks booking visit she
normal.
was normo-tensive and had no history of
89. A 29yrs old woman has an uneventful epilepsy. She is admitted as an emergency
first pregnancy to 31weeks. She is then
having had a seizure. On admission, her BP
admitted as an emergency with epigastric
pain during the first 3hours and her BP rises is 150/110 and dipstick urine analysis
from 150/100 to 170/120. A dipstick test reveals 3+ proteinuria.
reveals she has 3+ proteinuria and the fetal
CTG is normal.
93. A 32yrs old woman presents in her 96. A 23yrs old woman who is 32weeks
second pregnancy at 39weeks. Her first pregnant presents to delivery room and she
pregnancy had been uncomplicated. complains of feeling generally unwell.
However, she had delivered at 36weeks. Clinical examination reveals a 28week size
She is admitted with a history of sudden fetus, her BP was noted to be 120/90 and
gush of fluid per vagina. O/E: her abdomen
on urine analysis 2+ protein was present.
is consistent with a 29weeks pregnancy.
During the clinical examination, she has a
Speculum examination reveals copious
amounts of clear fluid. Temperature and seizure.
pulse are normal. 97. A 32yrs old woman who has had an
94. A 25yrs old Asian woman in her third emergency CS is on the postnatal ward, she
pregnancy presents to clinic at 24weeks of suddenly becomes breathless and
her pregnancy. She is complaining of complains of central chest pain. She
tiredness and lethargy. Abdominal subsequently loses consciousness.
examination is unremarkable. Dipstick
urine analysis demonstrates 3+ glycosuria.
Full blood count reveals Hb: 11g/dl. An oral 98. Which of the following is correct
glucose tolerance test shows FBS of regarding hyperthyroidism in pregnancy?
300mg%. a) should be treated surgically rather
than with carbimazole
b) can be diagnosed by total T4
95-97, choose the SINGLE most
measurements
appropriate answer from the below list of
options. Each option can be used once, c) more than half are due to Grave's
more than once or not at all. disease
a) simple faint d) the main complications for the fetus
b) epileptic fit include growth restriction and fetal
c) subarachnoid hemorrhage bradycardia
d) pulmonary embolism e) therapy should maintain free T4 and
e) eclampsia T3 levels in the low normal range
f) hemorrhage
g) hypoglycemia 99. A pregnant woman with gestational
h) ectopic pregnancy diabetes asks you about the increased
risks to her fetus, you describe all the
95. A 37years old woman in her second following EXCEPT:
pregnancy has delivered a live male infant a) polycythemia
and she has no medical history. 10 minutes b) hypercalcemia
after delivery, she complains of a sudden of
c) traumatic delivery
a sudden onset severe occipital headache
d) neonatal jaundice
that is associated with vomiting. Shortly
after this, she loses consciousness and is e) hypoglycemia
unresponsive to any stimuli.
100. You are councelling a pregnant 110. Management of pre-eclampsia may

woman in the ANC clinic who has hepatitis include: early delivery.
about the fetal risks. Which form of
hepatitis has the highest rate of fetal 111. Management of pre-eclampsia may
transmission? include: frusemide.
a) Hepatitis A
b) Hepatitis B 112. Management of pre-eclampsia may
c) Hepatitis C include: magnesium sulfate.
d) Hepatitis B+D
e) Hepatitis E 113. Symptoms of pre-eclampsia may
include: restlessness.
114. Symptoms of pre-eclampsia may
include: sleepiness.
101. The resistance of the spiral arterioles
of the placenta increases significantly in the
include: flashing of light vision.
second trimester.
102. Abnormally increased bore of the
include: rash.
spiral arteries of the placenta contributes
to pathogenesis in pre-eclampsia. 117. Symptoms of pre-eclampsia may
include: epigastric pain.
103. Pre-eclampsia is more common in
multigravida. 118. Patients with mitral stenosis usually
have been diagnosed prior to pregnancy.
women with congenital cardiac diseases. 119. Patients with mitral stenosis should
not take beta blockers during pregnancy.
multiple pregnancy. 120. Patients with mitral stenosis should
not have diuretic therapy during
pregnancy.
women with diabetes insipidus.
121. Patients with mitral stenosis could be
considered for mitral valvotomy during
women with pre-existing renal disease.
pregnancy.
108. Management of pre-eclampsia may
122. Iron demands during normal
include: hospital assessment.
pregnancy increases.
109. Management of pre-eclampsia may
include: labetalol.
123. High levels of serum ferritin confirms

the diagnosis of iron deficiency anemia
during pregnancy.
124. Iron deficiency anemia during

pregnancy is more common in multiple
pregnancy.
125. Iron deficiency anemia during

pregnancy is usually treated with oral iron.
126. Carbamazepine in pregnancy is

associated with fetal neural tube defects.
127. Breastfeeding is contraindicated in

mothers taking anticonvulsants.
128. Women on multiple drug therapy for

epilepsy should be changed to
monotherapy (if possible) during
pregnancy.
129. Intravenous magnesium sulphate is

the best management of status epilepticus
in labor.
130. The pathology of pre-eclampsia ends

by delivery of the fetus.
ANSWERS
1 C 36 D 71 G 106 F
2 C 37 D 72 F 107 T
3 A 38 A 73 E 108 T
4 D 39 B 74 C 109 T
5 C 40 D 75 A 110 T
6 C 41 D 76 H 111 F
7 B 42 B 77 F 112 T
8 A 43 D 78 E 113 T
9 C 44 B 79 D 114 F
10 C 45 A 80 B 115 T
11 D 46 A 81 H 116 F
12 B 47 E 82 E 117 T
13 D 48 E 83 C 118 T
14 B 49 C 84 A 119 F
15 B 50 D 85 K 120 F
16 D 51 C 86 J 121 T
17 D 52 E 87 G 122 T
18 C 53 A 88 D 123 F
19 D 54 D 89 K 124 T
20 A 55 A 90 B 125 T
21 A 56 A 91 E 126 T
22 D 57 D 92 F 127 F
23 C 58 E 93 B 128 T
24 B 59 A 94 I 129 F
25 C 60 B 95 C 130 F
26 D 61 C 96 E
27 B 62 B 97 D
28 D 63 D 98 C
29 B 64 E 99 B
30 A 65 C 100 B
31 D 66 C 101 F
32 C 67 D 102 F
33 D 68 C 103 F
34 D 69 B 104 F
35 C 70 D 105 T
Obs 7: NewBorn-Puerpurium (100 marks)

I. Choose the most correct answer: 4. In the previous patient, the FHR
respond to conservative measures and a
scalp electrode is applied. During the next
1. In the presence of critical FHS change, to
2hrs, she progresses to full cervical
resuscitate the fetus, the obstetrician: dilatation. Fetal station + 1 and fetal head
a) stops oxytocin infusion position is LOT. The FHR has lost all
b) examines the cervix to exclude variability and recurrent late decelerations
umbilical cord prolapsed are present. The patient has now
developed chorioamnionitis. Your
c) moves the patient to a left lateral appropriate next response is:
position a) prepare for cesarean section
d) all of the above b) perform midforceps rotation and
delivery
c) begin maternal pushing and apply
2. A 34yrs old nullipara is undergoing
low forceps once head descends
oxytocin induction, cx is 6-7cm dilated and d) clinical judgment guide your actions
fetus is cephalic. She has been having 6 and all the responses are acceptable
contractions per 10minutes for the past
45minutes. These contraction are: 5. The nerve primarily involved with pain
associated with perineal stretching is:
a) normal
a) ischial nerve
b) hypotonic contractions b) pudendal nerve
c) hypertonic contractions c) hypogastric nerve
d) hyperstimulation syndrome d) frankenhauser ganglion
6. The most common complication during

3. In the previous patient, a prolonged
epidural anesthesia is:
fetal deceleration is noted. An acceptable a) fever
response: b) hypotension
a) prepare for cesarean section c) total spinal blockage
b) rehydration and analgesics d) ineffective analgesia
c) stop oxytocin, move the patient to 7. Compared with the induction of labor,
the left lateral position and give the augmentation of labor differs in:
oxygen a) the fetal membranes are intact
d) clinical judgement should guide your b) oxytocin is titrated to effect
c) contractions are pharmacologically
actions and all responses are
stimulated
acceptable d) previously commenced labor fails to
effect cervical change
8. The risk for CS is increased in women 14. Misoprostol (PGE1) is approved by FDA
undergoing induction of labor with: for:
a) low Bishop score a) labor induction
b) engaged fetal head b) cervical ripening
c) multiparous parturient c) cholelithiasis pain
d) all of the above d) peptic ulcer prevention
9. Labor induction or augmentation 15. The recommended dose of PGE1
increases the likelihood of peripartum:
administered vaginally for labor induction
a) hysterectomy
is:
b) uterine atony
a) 25 microgm
c) postpartum hemorrhage
d) all of the above b) 25mg
c) 100 microgm
10. The following women would most d) 100mg
likely have a successful induction of labor:
a) G2P1 with BMI 34 and EFW 3250gm 16. Which of the following can follow
b) G1P0 with BMI 25 and EFW 3800gm amniotomy?
c) G2P1 with BMI 27 and EFW 3150gm a) cord prolapsed
d) G1P0 with BMI 31 and EFW 2900gm b) placental abruption
c) variable fetal heart rate deceleration
11. The following routes are acceptable for d) all of the above
cervical ripening with PGE2:
a) sublingual 17. Which of the following is true
b) intravaginal regarding midline episiotomy?
c) oral a) they increase the incidence of anal
d) all of the above sphincter tears
b) they should never be used instead of
12. The use of cervical ripening agents is
spontaneous laceration
associated with:
c) they should be routinely cut during
a) labor initiation
the delivery of nulliparous patient
b) decreased cesarean delivery rate
c) decreased maternal morbidity rate d) A and C
d) all of the above
18. Kielland forceps are ideally suited for
13. A 22yrs PG with severe PIH at 39wks, is the following:
on induction, MgSo4 is initiated, cx is 3cm a) delivery of a fetus with a round head
dilated, 50% effaced, slightly soft and b) delivery of a fetus with a moulded
located anterior. The fetal head is station - head
1. Her Bishop is: c) delivery of a fetus with
a) 6 mentoposterior position
b) 7 d) rotation of the fetal head from
c) 8 occiput transverse to occiput
d) 9 anterior
19. Ideally, traction during vacuum a) transvaginal sonography

extraction should be applied: b) analgesia administration and
a) continuously reassure
b) intermittent and with contractions c) hematocrit assessment and initiation
of uterotonics
c) intermittent and in between
d) hematocrit assessment and initiation
contractions of broad spectrum antibiotics
d) intermittent with cycles of 20seconds
of traction 24. 2ry PPH is defined as bleeding from
e) followed of 1minute of rest 24hrs to 6weeks postpartum. It is due to
all EXCEPT:
20. Cesarean delivery includes abdominal a) endometritis
delivery in all the following EXCEPT: b) placental abruption
a) delivery of a stillborn infant c) abnormal involution
d) retained placental tissue
b) delivery of a twin pregnancy
c) delivery of an abdominal pregnancy 25. Your patient had VD yesterday
d) delivery in a mother who has just complicated by 1st degree perineal
died laceration. After 12hrs, she is
asymptomatic, afebrile, has normal vital
21. The following contributes to signs, her uterus is firm and non tender.
postoperative adhesions formation: She voided several times and total urine
a) infection output is 1400ml. Hb: 9.8gm%,
b) local tissue ischemia Hematocrit: 31, WBCs: 16.000 and PLT:
118.000. The best next management step:
c) failure to achieve hemostasis
a) chest X-Ray
d) all of the above b) urine analysis and urine culture
c) continue routine postpartum care
22. SC tissue greater than what depth d) blood culture and IV broad spectrum
should be sutured to avoid wound antibiotics
disruption?
a) 2cm 26. A 22yrs old woman who had CS has
b) 4cm persistent fever (38.8) despite the use of
c) 6cm triple antibiotic therapy (ampicillin,
gentaniycin and clindamycin). Urine
d) 10cm
analysis, wound, breasts and uterine
fundus are normal O/E. CT of the pelvis is
23. A multigravida delivered 12hrs ago wz suggestive of septic pelvic
500ml blood loss without perineal thrombophlebitis. Best treatment is:
lacerations. Her epidural catheter has a) hysterectomy
been removed and she is now complaining b) discontinue antibiotic therapy and
of strong uterine contractions. T: 37, HR: initiate intravenous heparin
84, BP: 100/70 and she voided twice with c) continue antibiotic therapy and
total amount of 800ml. Her fundus is firm begin intravenous heparin
d) surgical embolectomy
and minimal blood is noted on her
perineal pad. Your plan is:
27. A 28yrs old G1P1 had VD 3weeks ago. 31. The most likely cause of a fever in a
She is breast-feeding mostly from Rt woman on the second day postpartum is:
breast. On Lt breast, she notes a 3day a) Pneumonia
history of a tender mass on the upper b) Endometritis.
outer quadrant. O/E: patient is afebrile. c) Mastitis
The Lt breast has a fluctuant mass of d) Cholecystitis
e) Thrombophlebitis
4x8cm of the upper outer quadrant
without redness. It is somewhat tender.
32. Postpartum, the decidua becomes
The best treatment for this condition:
necrotic and is normally cast off as:
a) oral antibiotic therapy a) Decidual cast
b) oral anifungal therapy b) Placental remnants
c) bromocriptine therapy c) Lochia
d) aspiration d) Carunculae myrtiforms
e) None of the above.
28. The most common complication of
breast feeding is: 33. Immediately after the completion of a
a) Amenorrhea. normal labor, the uterus should be:
b) Pregnancy. a) Firm and contracted at the level of
c) Excessive weight loss. the umbilicus.
d) Puerperal mastitis. b) At the level of the symphysis pubis.
c) Immobile.
e) Breast abscess.
d) Atonic.
e) Boggy
29. Oxytocin in the puerperium is
associated with: 34. After parturition, endometrium
a) Involution of the uterus regenerates from the decidual:
b) Initiation of lactation a) Basal zone.
c) Resumption of menses b) Compact zone.
d) Subinvolution of the uterus c) Functional zone.
e) Post partum mastitis d) Parietal layer.
e) Spongy zone.
30. Of the following, the greatest
predisposing cause of puerperal infection 35. Symptoms and signs of puerperal
is: endometritis include all the following
a) Retained placental tissue. EXCEPT:
b) Iron deficiency a) Malodorous vaginal discharge.
b) Lower abdominal pain.
c) Coitus during late pregnancy
c) Fever.
d) Poor nutrition
d) Involution of the uterus.
e) Maternal exhaustion e) Uterine tenderness on palpation.
36. Breast feeding accelerates the 41. Pethidine injections more than two
involution of the uterus through: hours before delivery maybe complicated
a) The increased level of prolactin. by:
b) The release of oxytocin. a) Neonatal jaundice
c) The increased level of estrogen. b) Motor block with weakness of lower
d) The decreased level of progesterone. limbs
e) The decreased level of HPL. c) Neonatal respiratory depression
d) Postpartum hemorrhage
37. APGAR score includes all the e) Inborn error of metabolism
followings EXCEPT:
a) Skin color.
42. The antidote used in neonatal
b) Muscle tone.
respiratory depression caused by
c) Blood pH.
d) Heart rate. pethidine injectious is:
e) Respirations. a) Morphine sulphate
b) Konakion
38. Immediate therapy for infants with c) Diazepam
suspected meconium should routinely d) Naloxone
include: e) Phenothiazine derivatives
a) Corticosteroid
b) Antibiotics 43. Indications of induction of labor may
c) Sodium bicarbonate include all the following EXCEPT:
d) Clearing of the airway a) Maternal diabetes mellitus
e) Giving O2 under positive pressure b) Eclampsia
c) Prelabor rupture of membrane
39. Regional analgesia for pain relief d) Placenta praevia incomplete centralis
during labor and delivery includes the e) Post date pregnancy
following EXCEPT:
a) Epidural analgesia 44. Concerning the Bishop score, all the
b) Para cervical block following are correct EXCEPT:
c) Pethidine administration
a) Used to assess the favorability of the
d) Local infiltration anaesthesia
cervix before induction of tabor
e) Pudendal nerve block
b) A total score of <5 indicates
40. Nowadays the first choice for cesarean favorability of the cervix
section analgesia is: c) Firm consistency takes the score of
a) Inhalation of nitrous oxide gas zero
b) General anesthesia d) It takes account of cervical dilatation
c) Local infiltration anethesia e) An unfavorable cervix increases the
d) Subarachnoid anaethesia (Spinal chances for Cesarean section
anesthesia)
e) Epidural analgesia
45. Methods of induction of labor includes 49. Which of the following is not an
all the following EXCEPT: indication for induction of abortion?
a) Prostaglandin vaginal tablets a) Malignancy needing surgery and
b) Oxytocin drip irradiation.
c) Amniotomy b) Severe cardiac disease uncontrolled
d) Oral anti-progesterone with pregnancy.
e) Amniotomy followed by oxytocin c) Exposure to diagnostic dental X-ray
drip during the first trimester.
d) Vesicular mole.
46. Complications of oxytocin infusion e) Lethal congenital anomalies.
include all of the following EXCEPT:
a) Hyperactive uterine action 50. A 24 yrs old PG is admitted to the
b) Rupture of the uterus labour ward. PV: cx is soft, central, effaced
c) Fetal hypoxia >80% and 6cm dilated. The presentation is
d) Failure of induction cephalic, vertex, LOA and station 0. Her
Bishop score is:
e) Cephalo-pelvic disproportion
a) 5
b) 7
47. Complications of surgical vaginal
c) 9
evacuation includes all of the following
d) 11
EXCEPT:
e) 13
a) Introduction of infection
b) Uterine perforation
51. A 32yrs old G3P3 is admitted to ER wz
c) Asherman syndrome missed abortion. She is 14wks by sure
d) Hyperactive uterine action dates. All her previous deliveries were
e) Cervical stenosis NVD in hospitals. She is in good general
condition. PV: cx is closed, formed and
48. The following is considered a soft in consistency. Induction of abortion
disadvantage of epidural analgesia during is best done by:
labour EXCEPT: a) Uterine massage under epidural
a) Accidental puncture of the dura. analgesia.
b) Loss of the urge for straining. b) Cervical dilatation using surgical
c) Increasing the need for forceps dilators followed by forceps
delivery. extraction.
d) May cause neonatal respiratory c) Abdominal hysterotomy under
depression if given less than 2 hours general anaesthesia.
before delivery. d) Oral and/or vaginal PGE2 in repeated
e) Motor block with weakness of the doses.
lower limbs. e) D&C under general anaesthesia.
52. Which of the following is not a possible 56. The following statements concerning
complication of amniotomy? caesarian section scars are true EXCEPT:
a) Fundal uterine perforation a) The scar in the lower segment is
b) Placental abruption stronger than in the upper segment
c) Vaginal bleeding
b) The uterus is usually closed in layers
d) Prolapse of the cord
c) The scar in LUS carries a higher risk
e) infection
of infection than in the upper
53. The following statements are segment
considered as advantages of episiotomy d) It could be performed through a
EXCEPT: Pfannensteil or longitudinal
a) Clean cut incision that is easy to subumbilical suprapubic incision.
repair e) Doyen retractor is used in the lower
b) Acceleration of cervical dilatation abdominal incision to retract the
c) Shorter second stage of labour
urinary bladder and protect it
d) Reduces intracranial haemorrhage in
preterm fetuses
e) Reduces damage to the maternal 57. The forceps used to deliver the after-
pelvic floor coming head in breech is called:
a) Kielland forceps
54. The following statements are known b) McLane-Tucker forceps
complications of episiotomy EXCEPT: c) Piper's forceps
a) Infection d) Simpson forceps
b) Dyspareunia e) Luikart forceps
c) Haematoma formation
d) Lacerations of the cervix
58. Induction of Labor (IOL) is considered
e) Increased blood loss during the
second stage when the maternal or fetal condition
suggests that a better outcome will be
55. Absolute indications of caesarian achieved by intervening in the pregnancy
section include all of the following EXCEPT: than allowing it to continue, the following
a) Contracted pelvis is a contraindication for IOL:
b) Twin pregnancy a) pre-eclampsia
c) Large condylomata accuminata of b) placenta previa
HPV in the vagina
c) IUFD
d) Placenta praevia complete centralis
d) previous CS
e) Cervical dystocia
e) IUGR
For each of the descriptions in questions For each of the descriptions in questions
59-63, choose the SINGLE most 65-68, choose the SINGLE most
appropriate answer from the below list of appropriate answer from the below list of
options. Each option can be used once, options. Each option can be used once,
more than once or not at all.
a) emergency CS in the second stage of
labor a) tonsillitis
b) emergency CS for failure of progress b) chronic bronchitis
c) emergency CS for fetal distress c) atelectasis
d) cesarean hysterectomy d) cholecystitis
e) elective repeated CS e) pancreatitis
59. A 40yrs old woman at antenatal f) tubo-ovarian abscess
booking with a history of emergency CS 1yr g) appendicitis
ago for fetal distress and neonatal death h) chonoamnionitis
from meconium aspiration. i) endometritis
60. Fetal bradycardia after pushing for j) infected products of conception
40minutes. Ventouse delivers commenced k) pelvic abscess
but cup slipped out. l) wound infection
61. Spontaneous labor. Good progress up m) DVT
to 8cm dilatation. No further progress over
the next 4hours. 65. A 38yrs old woman had ruptured
membranes at 28weeks. She was given
62. All previous babies delivered by CS
today’s course of prophylactic antibiotics
placenta previa. Major Antepartum
hemorrhage followed by uncontrolled and monitored as inpatient. At 32weeks,
massive hemorrhage during delivery. her TLC and C-Reactive protein levels rose
and she went into spontaneous labor.
63. First pregnancy, 42weeks gestation,
induction of labor, meconium stained When 6cm dilated in active labor, she
liquor. Persistent late decelerations and spikes a temperature of 39 and has soft
cervix is 1cm dilated. tender uterus.
66. A severely overweight 18yrs old is

64. The following are essential pre-
induced for pre-eclampsia but ends up with
requisites prior attempting operative
vaginal delivery EXCEPT: emergency CS due to failure of progress,
a) bladder should be empty she is given prophylactic antibiotics at time
b) head must be palpable in the of CS and discharged 2days later feeling
abdomen well. 18 days later, her midwife admits with
c) cervix should be fully dilated a low grade fever 37.5. She has chest
d) position of the fetal head must be symptoms and uterus is palpable above the
known pelvic brim, both legs remain markedly
e) Fetal head must be at or below the
swollen but the left calf is also tender.
level of the ischial spines.
67. A 24yrs old smoker with no medical For each of the descriptions in questions
history is 5days after the normal delivery of 70-72, choose the SINGLE most
her third child. She develops central appropriate answer from the below list of
abdominal pain, anorexia, nausea and fever options.Each option can be used once,
of 38. On admission to hospital for more than once or not at all.
observation, she remains intermittently a) pyelonephritis
b) mastitis
pyrexial but the pain has localized to the
c) pneumonia
right iliac fossa, the uterus is firm and
d) DVT
equivalent to a 14weeks size and the lochia e) meningitis
is normal. On palpation of the lower f) endometritis
abdomen, there is rebound tenderness in g) wound infection
the right iliac fossa. h) retained products of conception
i) breast abscess
68. A 28yrs old smoker has a history of j) none of the above
asthma for which she takes regular inhaled
70. A 30yrs old woman is admitted as she
steroids, she labors spontaneously in her
feels unwell with passage of clots and
first pregnancy at term but delivers by
heavy vaginal bleeding, she delivered 4days
emergency CS due to marked CTG ago, uncomplicated pregnancy and labor.
abnormalities. Spinal anesthesia is tried but There is suprapubic tenderness and PV
failed and she took GA. 4hrs reveals blood clots with enlarged bulky
postoperatively, she had fever 37. 5 and is uterus and cx admitting one finger.
short of breath, her RR: 28, her oxygen
71. A 26yrs old woman is admitted 7days
saturation 93%. On auscultation, her chest after having a CS which was performed for
shows no wheezes but fine inspiratory failure of progress after augmentation for
crepitations at both lung bases. prolonged rupture of membranes. She is
unwell with foul smelling vaginal discharge.
T: 39 and suprapubic tenderness. PV
69. A male baby born at 37weeks confirms offensive discharge and uterine
gestation is 2minutes old. He is floppy and tenderness.
blue with HR: 80. The first step to take to
72. A 32yrs old woman is seen 3days after
help him is:
having an emergency CS (under GA) for
a) external cardiac massage placental abruption, she is unwell and
b) airway positioning “sniffing the coughing green sputum. T: 38, HR: 90, RR:
morning air” 30 with using accessory respiratory
c) put him in a plastic bag muscles. Abdominal and pelvic examination
d) position the airway in a neutral are unremarkable and chest examination
position reveals purulent sputum and coarse
e) intubate crepitations on ausculatation.
For each of the descriptions in questions 77. A 34yrs old woman underwent CS 24hrs
73-76, choose the SINGLE most ago is complaining now of abdominal pain
appropriate answer from the below list of and distension. Her vital signs are all stable.
options. Each option can be used once, 78. A 34yrs old woman who underwent CS
more than once or not at all. 3days ago complains of severe abdominal
a) episiotomy pain and distension. She is tachycardic and
b) ventouse delivery febrile.
c) emergency CS
d) oxytocin post delivery 79. A 38yrs old woman who underwent CS
e) outlet forceps 24hrs ago complains of sharp pain in the
f) kielland long forceps shoulder tip and pain on deep inspiration.
g) none of the above Her vital signs are stable.
73. PG in spontaneous labor at 34wks and 80. A 42yrs old woman who underwent CS
has abnormal CTG. Fetal head is at station 48hrs ago is diagnosed with the condition
+2 and occipito-anterior. that is the leading cause of maternal
mortality.
74. Multigravida has been induced at
42wks. She is brow presentation in the
second stage. 81. The following is the main advantage to
perform a mediolateral episiotomy:
75. PG in spontaneous labor at 39wks+2, a) less blood loss
has been pushing for 30minutes. The fetal b) reduced incidence of dvspareunia
head is at station 0, occipito- transverse c) less anal sphincter damage
and no maternal or fetal distress. d) less pain in the postpartum period
76. PG in spontaneous labor at 39w ks+2, e) it is easier to repair
has been actively pushing for 2hrs and is
exhausted. FHS is normal, the fetal head is 82. The components of Apgar score
at +2 station and occipito-transverse. include all EXCEPT:
a) appearance
For each of the descriptions in questions b) pulse rate
77-80, choose the SINGLE most c) good eye opening
appropriate answer from the below list of d) activity
options. Each option can be used once, e) respiratory effort
a) pulmonary embolism 83. Absolute contraindication for vaginal
b) wound infection delivery for a patient with previous CS is:
c) cesarean hysterectomy
a) previous classical uterine incision
d) bladder trauma
e) endometritis b) previous transverse uterine incision
f) uterine atony c) twin gestation
g) bowel injury d) non cephalic presentation
h) ileus e) patient's age >40years
84. Contraindications to vaginal delivery II. For each of the statements below, mark
include all the following EXCEPT: True (T) or False (F):
a) previous classical cesarean section
b) carcinoma in situ of the cervix 88. Risk factors for puepural infections
c) total placenta previa include: prolonged rupture of membranes.
d) transverse lie with rupture
membranes 89. Risk factors for puepural infections
e) HSV with active genital lesions include: prolonged pregnancy.
85. A 28yrs at 37wks has been in 2nd stage 90. Risk factors for puepural infections
for 45 min and pelvis is adequate with include: prolonged second stage of labor.
ROM. The head is ROP at +2 station. FHS:
91. With instrumental delivery, prolonged
120/min. Mother is exhausted. Most
appropriate management is: perineal discomfort is more common.
a) Wait and watch policy
92. With instrumental delivery, mastitis is
b) Application of outlet forceps
more common.
c) Application of Piper's forceps
d) Vacuum extraction 93. With instrumental delivery, obstetric
e) McRobert's manoeuvre
palsy is more common.
86. A risk factor wz the highest association
with the uterine rupture in a woman with 94. With instrumental delivery, puerperal
a previous CS: infection is more common.
a) spontaneous onset of labor
b) severe pelvic girdle pain 95. Considering Bishop score, it includes
c) the use of oxytocin in labor the station of the presenting part.
d) prostaglandin E2 induction of labor
e) women with SLE 96. Considering Bishop score, it includes
the length of the cervical canal.
87. A 29-year-old G2P1 woman which
history of previous myomectomy. She is 97. Considering Bishop score, it includes
pregnant at 39weeks and presented to the gestation of the fetus.
labor ward in the 2nd stage of labor. While
pushing, she is noted to have fetal 98. Considering Bishop score, it includes
bradycardia with regression of fetal head the parity of the mother.
from station +2 to station -3.
a) Accidental hemorrhage 99. Considering Bishop score, a score of 3
b) Uterine rupture indicates that the cervix is unfavorable.
c) Umbilical cord compression
100. Forceps use if contraindicated on dead
d) Vasa previa
e) Placental separation fetuses.
ANSWERS
1 D 36 B 71 F
2 C 37 C 72 C
3 D 38 D 73 E
4 A 39 C 74 C
5 B 40 D 75 G
6 B 41 C 76 B
7 D 42 D 77 H
8 A 43 D 78 G
9 D 44 B 79 I
10 C 45 D 80 A
11 D 46 E 81 C
12 A 47 D 82 C
13 D 48 D 83 A
14 D 49 C 84 B
15 A 50 D 85 D
16 D 51 D 86 D
17 A 52 A 87 B
18 D 53 B 88 T
19 B 54 D 89 F
20 C 55 B 90 T
21 D 56 C 91 T
22 A 57 C 92 F
23 B 58 B 93 T
24 B 59 E 94 T
25 C 60 A 95 T
26 C 61 B 96 T
27 D 62 D 97 F
28 D 63 C 98 F
29 A 64 B 99 T
30 A 65 H 100 F
31 C 66 M
32 C 67 G
33 A 68 C
34 A 69 D
35 D 70 H
Obs 8: Basic (90 marks)

I. Choose the most correct answer: 3. A woman currently pregnant and has had
a previous term delivery.
1. Which of the following regarding 4. A woman not currently pregnant and has
physiologic changes of pregnancy is true? had one previous first trimesteric
a) Glomerular filtration decreases termination, one early miscarriage and one
b) Effective renal plasma flow increases still birth at 36wks.
c) Serum creatinine concentration
increases 5. A woman who attends for pre-
d) Glomeruli become larger because of conception counseling never having been
an increased number of cells pregnant.
6. A woman currently pregnant with twins
2. Cardiac output and blood volume is who has had one previous early
maximum during which weeks of miscarriage.
pregnancy? 7. A woman not currently pregnant and has
a) 12-14 previously had a twin delivery at 28wks.
b) 20-24
c) 30-32
d) at delivery For each of the descriptions in questions8-
e) 32-36 12, choose the SINGLE most appropriate
answer from the below list of options.Each
For each of the descriptions in questions 3- option can be used once, more than once
7, choose the SINGLE most appropriate or not at all.
answer from the below list of options. a) estradiol
Each option can be used once, more than b) progesterone
once or not at all. c) HCG
a) G1P0 d) prolactin
b) G4P2 e) oxytocin
c) G0P0 f) hacmatocrite
d) G3P3 g) plasma folate concentration
e) G2P1 h) white blood cells
f) G1P2 i) fibrinogen
g) G6P2 j) bilirubin
h) G1P1 8. Used in triple test.
i) G3P1 9. Released from posterior pituitary gland.
j) G4P3
k) G2P0 10. Fall in pregnancy due to dilutional
effect.
11. Increased by 50% in pregnancy e) 25weeks

contributing to hypercoagulable state. f) 28weeks
12. Routine supplement advised during g) 31weeks
pregnancy due to fall in level. h) 34weeks
i) 36weeks
j) 38weeks
For each of the descriptions in questions k) 40weeks
13-16, choose the SINGLE most l) 41weeks
appropriate answer from the below list of 17. Attend for ultrasound to detect
options. Each option can be used once, structural abnormalities.
a) ductus venosus 18. Folic acid and lifestyle issues discussed.
b) ductus arteriosus 19. Offer membrane sweeping.
c) foramen ovale 20. First dose of anti-D prophylaxis for Rh-
d) left atrium ve women.
e) right atrium
f) mitral valve
g) tricuspid valve 21. Which statement is correct regarding
h) umbilical vein calculating the EDD?
i) umbilical artery a) pregnancy is dated from conception
j) atrial septum b) the LMP is reliable if the cycles are
k) intraventricular septum irregular
l) none of the above c) the average length of pregnancy is
280days
13. Location of the patent foramen ovale. d) LMP defined dates are more accurate
14. Vessel that carries oxygenated blood than those calculated by first
from the placenta and in adult life forms trimesteric US.
part of the falciform ligament. e) Head circumference may be used to
15. Connects the pulmonary artery to the date a pregnancy until 25weeks.
descending aorta.
22. A woman contacts her midwife with
16. Vessel that shunts blood away from the concerns regarding fetal wellbeing at
liver. 32wks in a previously normal pregnancy.
What is the best management?
For each of the descriptions in questions a) auscultation of the fetal heart at
17-20, choose the SINGLE most home by the midwife
appropriate answer from the below list of b) encourage the patient to record a
options. Each option can be used once, 24hrs kick chart
more than once or not at all. c) book a growth scan within 2days
a) booking visit d) attend hospital if fetal movements
b) 10-14weeks are decreased
c) 16th week e) advise nuchal translucency scan.
d) 18-20weeks
23. A 37yrs old woman attends for a 27. A woman attends your booking clinic at
routine dating scan. She asks what 18weeks gestation. She recently discovered
information will be obtained from the she was pregnant and is concerned about
scan. Which of the following will be trisomy 21.
possible?
a) accurate dating of the pregnancy 28. There are 2 screening tests for Down's
b) the detection of placenta previa syndrome offered to pregnant women in
c) the early detection of twin UK: first combined screening and the
pregnancy quadruple test. These rely on the
d) the detection of failed pregnancy measurement of a number of factors in
e) the detection of uterine order for an estimation of the risk of that
abnormalities pregnancy being affected by Down's
syndrome. The following result in a low
For each of the descriptions in questions chance result:
24-27, choose the SINGLE most a) B-HCG levels above average for the
appropriate answer from the below list of gestation
options, each option may be used once, b) AFP levels above average for
more than once or not at all. gestation
a) quadruple test c) High maternal age
b) anatomy scan d) NT above average for gestation
c) OGTT e) PAPP-A levels below average for
d) CBC gestation
e) Ferritin
f) urine analysis For each of the descriptions in questions
g) cervical length and fetal fibronectin 29-34, choose the SINGLE most
h) sickle cell testing appropriate answer from the below list of
i) refer to fetal medicine unit options. Each option can be used once,
j) observe the pregnant woman more than once or not at all.
k) 75mg aspirin a) amniocentesis
24. You review a pregnant woman at b) CVS
booking visit who previously was delivered c) both amniocentesis and CVS
at 32weeks gestation for severe d) neither amniocentesis nor CVS
preeclampsia. e) cordocentesis
25. A woman attends your clinic following 29. Procedure performed under continuous
first trimester screening that has shown the ultrasound guidance.
fetus to have 1 in 25 risk trisomy 21. 30. Test can be performed at 9weeks
26. A woman attends for booking visit gestation.
having had previous GDM. 31. Test used to diagnose spina bifida.
32. Test used to diagnose single gene
disorder in the fetus.
33. Test used to diagnose fetal anemia. 41. A woman who has had a previous
34. Test can be performed at 11weeks ectopic pregnancy should be offered an
gestation. early pregnancy ultrasound.
42. Antenatal screening test is
For each of the descriptions in questions recommended for: Down’s syndrome.
35-37, choose the SINGLE mostappropriate
answer from the below list ofoptions. Each
option can be used once,more than once recommended for: Hepatitis C.
or not at all. 44. Antenatal screening test is
a) amniocentesis recommended for: Rubella.
b) viral serology
c) nuchal translucency
d) ultrasound scan recommended for: Fetal anomalies.
e) cordocentesis 46.I n normal pregnancy, BP falls in the
f) fetal RNA profile second trimester.
g) chorionic villus sampling
h) free fetal DNA 47. In normal pregnancy, plasma volume
i) none of the above decreases throughout gestation.
35. Most suitable diagnostic test where a 48. In normal pregnancy, there is 50%
woman wishes to know fetal karyotype as reduction in erythrocyte production.
early in the pregnancy as possible. 49. In normal pregnancy, 80% of women
36. Most suitable diagnostic test where have a transient diastolic murmur.
fetal alloimmune thrombocytopenia is
50. In normal pregnancy, there is an
suspected.
increase in polymorphonuclear leukocytes.
37. Most suitable non-invasive test when
an X-linked disorder is suspected. 51. In normal pregnancy, there is an
increase in glomerular filtration rate.
52. In normal pregnancy, the urea and
creatinine are higher than in non-pregnant
state.
38. It is recommended that women are
53. In normal pregnancy, glycosuria
seen on their own at least once during ANC.
indicates likely development of diabetes.
39. A family history of pre-eclampsia should
54. In normal pregnancy, there is increase
trigger increased antenatal surveillance.
transit time.
40. A history of sub-fertility is important
55. In normal pregnancy, there is increased
even if the patient is currently pregnant.
dental caries.
56. In normal pregnancy, there is decreased 72. Regarding fetal liver, the enzymes
oesophageal sphincter tone. required to conjugate bilirubin are not
57. In normal pregnancy, there is decreased present.
albumin production by the liver. 73. Fetal liver development derives from
58. In normal pregnancy, average the mesoderm.
gestational weight gain is 13kg. 74. The aim of the 18-22wks anomaly scan
59. In normal pregnancy, calcium is less is to determine the chorionicity of a twin
readily absorbed from the gut. pregnancy.
60. In normal pregnancy, there is skin 75. The aim of the 18-22wks anomaly scan
hypopigmentation. is to promote bonding with the fetus.
61. In normal pregnancy, there is increased 76. The aim of the 18-22wks anomaly scan
skin bruising. is to identify fetal structural defects.
62. In normal pregnancy, there is 77. Maternal serum alpha fetoprotein is a
appearance of striae gravidarum. diagnostic test for neural tube defects.
63. In normal pregnancy, there is increased 78. Amniocentesis has a higher pregnancy
hirsutism. loss rate than chorionic villus sampling.
64. In normal pregnancy, there is decreased 79. Tests using DKA technology can be
acne. performed on amniocentesis specimens.
65. Fetal birth weight is affected by the 80. Neural tube defects occur as a result of
parity of the mother. a poor periconceptual maternal diet.
66. Fetal birth weight is affected by gentle 81. The majority of neural tube defects
exercise habits of the mother. occur at the end of the spine.
67. Fetal birth weight is affected by the sex 82. The prognosis of spina bifida depends
of the fetus. on the level of the lesion.
68. Fetal birth weight is affected by the 83. A supplement of 5mg folic acid
maternal folate supplementation. significantly reduces the risk of neural tube
defects
69. During lung development, surfactant
production occurs from about 20weeks. 84. CVS may show a placental mosaic
phenotype.
70. The majority of infants born at 27wks
gestation experience some degree of RDS. 85. CVS may be unsuccessful in obtaining a
sample.
71. Regarding fetal liver, glycogen is stored
in large quantities in the third trimester. 86. CVS may be carried out <11weeks
gestation.
87. The placenta receives the highest blood

flow of any fetal organ.
88. The placenta is a major endocrine
organ.
89. Each cotelydon of the placenta contains
a primary villus.
90. Screening for Down is recommended if
the father's age is >35yrs old at the time of
conception.
ANSWERS
1 B 36 E 71 T
2 C 37 H 72 T
3 E 38 T 73 F
4 I 39 T 74 F
5 C 40 T 75 F
6 K 41 T 76 T
7 F 42 T 77 F
8 C 43 F 78 F
9 E 44 T 79 T
10 F 45 T 80 F
11 I 46 T 81 T
12 G 47 F 82 T
13 J 48 F 83 T
14 H 49 F 84 T
15 B 50 T 85 T
16 A 51 T 86 F
17 D 52 F 87 T
18 A 53 F 88 T
19 L 54 T 89 T
20 F 55 T 90 F
21 C 56 T
22 D 57 F
23 B 58 T
24 K 59 F
25 I 60 F
26 C 61 F
27 A 62 T
28 B 63 T
29 C 64 F
30 D 65 T
31 D 66 F
32 C 67 T
33 E 68 F
34 B 69 F
35 G 70 T
Dr.Nadine Alaa Sherif , OBGYN Lectures 2019 / 2020 ( section ) , Revision tests ( playlist )
Gyn 1: Endocrinology (100 marks)

Choose the most correct answer: 4. An 18yrs old adolescent female with
infantile breast development and has not
1. A 51yrs old patient is complaining of started her menses yet. She has also some
amerorrhea, she gave history of
webbing of the neck. The most likely cause
oligomenorrhea and hot flushes. Her most
probable cause of amenorrhea is: of her amenorrhea is:
a) Gonadotrophin receptor a) Ovarian failure
insensitivity b) Hypothalamic dysfunction
b) Pituitary dysfunction c) Resistant ovary syndrome
c) Ovarian failure d) Estrogen excess
d) Gonadal dysgenesis e) Immune downregulation of ovary
e) Hypothalamic dysfunction
2. A 22yrs old non pregnant woman is on 5. A 19yrs old non pregnant woman is a
psychotropic medication and is having marathon runner and is complaining of
hyperprolactinemia. She is also amenorrhea which is most likely due to:
complaining of amenorrhea. The most a) Gonadotrophin receptor
likely cause of the later is:
insensitivity
a) Pituitary dysfunction
b) Pituitary dysfunction
b) Gonadotropic receptor
insensitivity c) Hypothalamic dysfunction
c) Hypothalamic dysfunction d) Immune downregulation of ovary
d) Ovarian failure e) Ovarian failure
e) Immune downregulation of the
ovary 6. A 33yrs old woman has amenorrhea 1yr
ago since her last VD that was complicated
3. A 23yrs old obese woman is having by severe PPH. She was also unable to
hirsuitism, irregular cycles with periods of
breast feed her baby. The most likely
amenorrhea. The most likely cause of her
symptoms is: cause of this condition is:
a) Ovarian failure a) Gonadotropin receptor insensitivity
b) Ovarian cortical atrophy syndrome b) Pituitary dysfunction
c) Estrogen excess c) Hypothalamic dysfunction
d) Hypothalamic failure d) Ovarian failure
e) Immune down-regulation of ovary e) Hyperprolactinemia
7. A 29yrs old G2P0 woman (who had 9. If the previous patient is to have a
history of regular menses) is undergoing diagnostic work-up. The most likely to be
an evaluation for amenorrhea of noted is:
10months duration. Pregnancy test is a) Obliterated uterine cavity on saline
negative, her TSH, PRL, FSH and LH are infusion sonography
normal. She had estrogen and b) No bleeding with progestin
progesterone intake but with no
challenge test
withdrawal. Her diagnosis was
c) Normal level estradiol
intrauterine adhesions which was
d) Abnormal HSG
confirmed by imaging. Most accurate
statement is: e) Abnormal MRI of the brain
a) Her condition usually occurs after
uterine curettage for a pregnancy 10. A 41yrs old woman is suspected of
related process having intrauterine adhesions. The
b) She would best be diagnosed by following historical or laboratory
laparoscopy information would support your diagnosis:
c) The patient likely has severe a) Presence of hot flushes
cramping pain every month b) FSH level too low to be measured
d) The patient has hypothalamic c) Normal estradiol levels for her
dysfunction reproductive age
e) Her treatment includes endometrial
d) Monophasic basal body
ablation
temperature chart
e) Abnormal sella turcica on CT brain
8. A 32yrs old G1P1 woman presents with
an 8months amenorrhea. A pregnancy test
is negative. TSH and PRL are normal. FSH is 11. A 25yrs old woman presents with
above 40IU/L. Most likely complication for galactorrhea and irregular menses of
this patient: 10months duration. Her pregnancy test is
a) She is at significant risk for negative. Laboratory tests reveal normal
endometrial cancer TSH and serum T4 and
b) She is at significant risk for ovarian hyperprolactinemia. The most likely to be
cancer a cause of her condition:
c) She is at significant risk for a) Posterior pituitary adenoma
osteoporosis b) Abdominal wall trauma
d) She is at significant risk of breast c) Psychotropic medication
cancer
d) Hyperthyroidism
e) She is at significant risk for multiple
e) Ovarian failure
gestations
12. A 47yrs old woman is being evaluated 15. A 24yrs old woman G1P1 is
for a possible pituitary tumour. She complaining of secondary amenorrhea
complains of headaches and has some since her last delivery. She is given the
visual difficulties. The MRI shows a mass in diagnosis of Sheehan syndrome. The
the posterior pituitary gland which the following is consistent with her diagnosis:
radiologist notes unusual. The following a) Usually associated with
hormone is in the posterior pituitary:
hypertensive crisis at or soon after
a) FSH
delivery
b) LH
b) Caused by an ischemic necrosis of
c) PRL
d) TSH the posterior pituitary gland
e) Oxytocin c) Associated with decreased prolactin
levels
13. A 33yrs old woman with a d) Often associated with elevated TSH
microadenoma of the pituitary gland e) Associated with elevated FSH and LH
becomes pregnant. When she reaches
28weeks gestation, she complains of 16. A 32yrs old G2P1A1 woman presents
headaches and visual disturbances. The with 6months amenorrhea. The best
best therapy: description of the mechanism of
a) Craniotomy and pituitary resection Asherman syndrome:
b) Tamoxifen therapy
a) Trophoblastic hyperplasia
c) Oral bromocriptine therapy
b) Myometrial scarring
d) Lumbar puncture
c) Decidual hypertrophy
e) No therapy is needed
d) Cervical atresia
14. A 34yrs old woman had no menses e) Endometrial disruption
since she had uterine curettage and cone
biopsy of the cervix 1year ago. Since then, 17. A 25yrs old woman presents with a
she complains of severe cramping lower 6months amenorrhea. Her pregnancy test
abdominal pain for 5days each month. Her is negative. She is diagnosed as PCOS. The
BBT chart is biphasic. The most likely following is consistent with her disorder:
etiology of secondary amenorrhea: a) Estrogen deficiency and vaginal
a) Hypothalamic etiology atrophy
b) Pituitary etiology b) Osteoporosis
c) Ovarian etiology c) Endometrial hyperplasia
d) Cervical etiology
d) Hypoglycemia
e) Cachexia
18. A 15yrs old adolescent female is 21. A 6yrs old Caucasian girl is noted to
diagnosed with gonadal dysgenesis. She have normal breast development and
has delayed puberty, short stature and menses otherwise all her examination and
investigations are normal. The probable
elevated gonadotropin levels. The treatment for this patient:
following is generally present: a) Adrenal tumour excision
a) Secondary amenorrhea b) Brain tumour excision
b) 69XXY karyotype c) GnRH agonist therapy
c) Osteoporosis d) Replacement of thyroid hormone
e) Bilateral oopherectomy
d) Polycystic ovaries
e) None of the above 22. An 18yrs old nulliparous adolescent
woman complains of primary amenorrhea.
19. A 16year old adolescent female is She has normal breast development, blind
evaluated for lack of pubertal ended vaginal pouch and no cervix. The
most likely diagnosis is:
development. She is diagnosed with a) Mullerian agenesis
gonadal dysgenesis. The following is likely b) Kallman syndrome
to be elevated: c) Sheehan syndrome
a) FSH d) Gonadal dysgenesis
b) Estrogen levels e) PCOS
c) Progesterone levels 23. A 19yrs old woman with primary
d) Thyroxine levels amenorrhea and normal breast
e) GnRH development. She has a pelvic kidney. The
most likely diagnosis is:
20. A 20yrs old individual with a 46XY a) Mullerain agenesis
karyotype is noted to be sexually infantile b) Androgen insensitivity
c) Gonadal dysgenesis
phenotypic woman and is diagnosed as
d) Kallman syndrome
having gonadal dysgenesis. The most e) PCOS
important treatment for this patient:
a) Progestin therapy to reduce 24. The following is the best explanation
osteoporosis for breast development in a patient with
b) Estrogen and androgen therapy to AIS:
a) Gonadal production of estrogen
enhance height
b) Adrenal production of estrogen
c) Progesterone therapy to prevent c) Breast tissue sensitivity to
endometrial cancer progesterone
d) Gonadectomy d) Peripheral conversion of androgens
e) Vaginoplasty e) None of the above
25. A mother brings her 14yrs old 28. A 68yrs old healthy woman presents
daughter for consultation, the mother is for advice regarding the risk of developing
concerned as her daughter is shorter than
osteoporosis. Her height is 155 cm, her
her peers and has not get her period yet.
O/E: the girl is 130cm tall with evidence of weight is 45kg with regulkar treadmill
breast development but no axillary or walks. She was menopausal at 42yrs old.
pubic hair. Your advice is: She doesn't take HRT nor medication. Her
a) the daughter will start her period
mother died at 72yrs from complicated
with more breast development
b) the daughter will start her period, spontaneous hip fracture. What is the best
then have her growth spurt method to screen her for osteoporosis?
c) the daughter’s period will start soon a) peripheral measurement of her heel
since she has breast development with photon absorptiometry
d) the daughter will have her growth
spurt, then pubic hair, then menses b) standard X-Ray for her spine
e) the daughter’s period will start at c) Dual-Energy X-Ray Absorptiometry
18yrs, if not, return for further (DEXA)
evaluation d) measure biochemical markers of
26. A mother brings her 12yrs old bone remodeling
daughter for consultation. She is e) CT scan to measure the bone density
concerned because most of her class
mates had started their menses while she 29. The above patient has a DEXA
hasn't. Knowing the usual first sign of
puberty, you should ask the mother about: demonstrating osteoporosis. Next step is:
a) Has your daughter had any acne? a) begin a biphosphonate
b) Has your daughter started to develop b) encourage her to engage in weight
breasts? bearing exercise and take calcium
c) Does your daughter have any pubic
c) repeat the study in 1year
hair?
d) Does your daughter have any axillary d) begin raloxifen therapy
hair? e) recommend she begin combined HRT
e) Has your daughter had any vaginal For each of the patients in questions 30-
spotting?
31, select the SINGLE most ideal treatment
27. A 9yrs old girl presents with regular for dysmenorrheal. Each lettered option
vaginal bleeding. History reveals thelarche may be used once, more than once or not
at 7 and menarche at 8. The most common at all.
cause of this condition in girls: a) acupuncture
a) idiopathic
b) gonadal tumours b) prostaglandin inhibitors
c) Mc-Cune Albright syndrome c) GnRH analogues
d) hypothyroidism d) oral contraceptives
e) tumours of the central nervous e) narcotic analgesic
system
30. A 17years old consults you for 33. A 7year old girl is brought in to you by
evaluation of disabling pain with her her mother as she has developed breasts
menstrual periods. The pain has been and few pubic hairs. Her hormonal profile
present since menarche and is shows follicular level of FSH and LH. These
accompanied by nausea and headache. Her findings are with:
a) theca cell tumour
medical history is otherwise unremarkable
b) iatrogenic sexual precocious puberty
and pelvic examination is normal. She is not c) premature thelarche
currently sexually active and she has not d) granulose cell tumours
tried any therapy for her dysmenorrhea. e) central precocious puberty
34. In the previous girl, which of the

31. A 19years old college student is seen following is the best treatment?
for severe primary dysmenorrhea. She has a) exogenous gonadotropins
no medical problems and a normal pelvic b) ethinyl estradiol
examination. She has recently become c) GnRH agonists
sexually active and doesn't currently desire d) climphene citrate
pregnancy. e) no ttt and reassure the mother that
pubertal symptoms at the age of
7years are normal
32. An 18yrs old patient presents to you
for evaluation because she has not yet 35. A 17years old patient hasn't started
started her period. On physical her period. She is 125cm tall with no
examination, she is 175cm tall. She has breast buds or pubic hair. Her pelvic
minimal breast development and no examination reveals a uterus and cervix
axillary or pubic hair. On pelvic but the ovaries are not palpable. FSH and
examination, she has a normally LH are high. The most likely diagnosis is:
developed vagina. A cervix is visible. The a) Testicular feminization
b) Mc-Cune Albright syndrome
uterus is palpable and normal ovaries are
c) Kallman syndrome
felt. The best next step is:
d) Gonadal dysgenesis
a) draw her blood for karyotype e) Mullerian agenesis
b) test her sense of smell
c) draw her blood for TSH, FSH, and LH 36. While evaluating a 30years old woman
levels for infertility, you diagnose a bicornuate
d) order MRI of the brain to evaluate uterus. The woman has increased risk of
the pituitary gland congenital anomalies in:
e) prescribes a progesterone challenge a) skeletal
to see if she will have a withdrawal b) hematopoietic
c) urinary
bleed
d) central nervous
e) tracheoeosophageal
37. A 45years old woman with two kids 15 40. Which of the following is associated
and 18years ago, presents with with galactorrhea?
amenorrhea of 7months duration. She a) hypothyroidism
wants to become pregnant. After b) breast cancer
c) fibrocystic breast disease
exclusion of pregnancy, the following test
d) adrenal insufficiency
is indicated:
e) Grave's disease
a) HSG
b) endometrial biopsy 41. A 17yrs old girl complains of severe
c) thyroid function tests bleeding during her menstrual cycle, she
d) testosterone and DHEA-S levels uses 20 tampoons per cycle and it lasts for
e) FHS level 7days. She denies being sexually active.
What is the first line of medical therapy
38. A 19years old patient presents with 1ry for this patient?
amenorrhea. She has normal breast and a) NSAIDS
b) Iron
pubic hair. But the uterus and vagina are
c) Use more tampons/ PADS
absent. Diagnostic possibilities: d) OCP
a) XXY syndrome e) Dilatation and curettage
b) Gonadal dysgenesis
c) Mullerian agenesis 42. A 28yrs old white female consults you
d) Klinefelter syndrome for irregular heavy menstrual periods, her
e) Turner syndrome general and pelvic examination as well as
Pap test examination are normal and she
39. A 28yrs old G2P2 notes bilateral milky has a negative pregnancy test. CBC and
chemistry are normal. The next step
discharge from her breasts. She delivered
should be:
her last child 2yrs ago and breastfed
a) endometrial aspiration
exclusively for 8months and at night for a b) dilatation and curettage
few more months. She totally stopped c) LH and FSH assays
breastfeeding several months ago but can d) administration of estrogen
still express milk from both breasts daily. e) cyclic administration of progesterone
She takes no medications and uses for 3months
diaphragm for contraception. The physical
examination is unremarkable except that a 43. You are evaluating a 28yrs old
milky discharge is easily expressible from primigravida who is pregnant 8weeks for
abnormal Pap test, the following
both nipples. The most likely diagnosis is:
procedure is contraindicated:
a) intraductal papillomatosis a) colposcopy
b) mammary duct ectasia b) endocervical curettage
c) empty sella syndrome c) HPV Testing
d) illicit drug ingestion d) cervical staining
e) physiologic galactorrhea e) cervical biopsy
44. A 17yrs old white female presents with 47. A 31yrs old woman has a D&C done.
a left sided lower abdominal pain color Some months later, she comes back
complaining that she has amenorrhea but
Doppler in addition to ultrasound would
pain monthly around the time she usually
be most useful for evaluating: has her periods. No menstrual flow is seen
a) adnexal torsion with estrogen and progesterone challenge.
b) pelvic abscess Most likely diagnosis is:
c) PID a) Asherman syndrome
b) Uterine fibroids
d) ruptured ovarian cyst c) Ectopic pregnancy
e) broad ligamentary fibroid d) Bicornuate uterus
e) Rokitansky syndrome
45. A 27yrs old sexually active woman
48. A woman develops severe postpartum
presents to your office for evaluation, she
hemorrhage. 6weeks later, she presents
hasn't had her period for the last 3months. with fatigue and inability to breast feed.
Prior to that, periods were regular every All the following hormones could be
28days lasting for 4days. For initial decreased EXCEPT:
evaluation of her condition, which is the a) Prolactin
b) TSH
most important? c) LH
a) Prolactin d) Aldosterone
b) LH assay e) FSH
c) Estimated free thyroxine
49. The following may occur as a result of
d) HCG assay
Sheehan syndrome EXCEPT:
e) FSH assay a) pallor
b) galactorrhea
46. Due to abnormal Pap smear suggestive c) bradycardia
of dysplasia, a 36yrs old woman is referred d) amenorrhea
e) asthenia
for evaluation. Your colposcopic exam is
unsatisfactory since the entire 50. A 13yrs old patient has had regular
transformation zone can't be seen. The menses for 1year with severe pain
endocervical curettage result is negative beginning in the lower abdomen few
hours before the flow and lasting 24hrs.
for dysplasia and the biopsy sample
Physical examination is normal. Optimal
reveals CIN III. Your next step is: management is:
a) repeat Pap smear a) psychiatric referral
b) repeat endocervical curettage b) diagnostic laparoscopy
c) repeat colposcopy and biopsy c) trial of oral contraceptives
d) trial of prostaglandin synthetase
d) perform conization of cervix inhibitors
e) perform total abdominal e) reassurance with follow-up
hysterectomy evaluation in 6months
51. A 16yrs old female complains of pelvic a) fluoxetine

cramping pain with her menses over the b) black cohosh
past 2years. She describes her periods as c) red clover
heavy, occurring once a month and lasting d) soy protein
for 7days with no spotting inbetween. She e) vitamin E
has never been sexually active and does
not expect this to change in the near 55. A 52yrs old woman undergoing
future. Abdominal examination is normal. menopause is complaining of vaginal pain
The most appropriate next step is: during intercourse (without bleeding).
a) pelvic examination Your best initial treatment is:
b) ultrasponography a) HRT
c) TSH level b) Estrogen cream
d) NSAIDS prior to and during menses c) SERMs
e) laparoscopy d) Referral for sex therapy counseling
e) SSRIs (selective serotonin reuptakes
52. A 32yrs old woman presents with a inhibitors)
7months history of amenorrhea and hot
flushes. She denies any symptoms of 56. If the woman is not breast feeding,
pregnancy and the uterus is normal size. menstruation could return soon after
Appropriate test to diagnose POF: delivery. After what period of time 70-90%
a) diagnostic laparoscopy of women will menstruate?
b) serum testosterone a) 4weeks
c) karyotype b) 2months
d) serum FSH c) 3months
e) medroxyprogesterone withdrawal d) 6months
test e) >8months
53. A 55yrs old woman comes to your 57. When taking a patient history, the
office to discuss menopause, you tell her following questions will most accurately
that all the following are part of this stage ascertain the length of the patient's
EXCEPT: menstrual cycle:
a) hot flushes a) How often do you menstruate?
b) vaginal dryness b) Do you menstruate every month?
c) mood swings c) How many days are there between
d) insomnia your periods?
e) breast tissue hyperplasia d) How many days are there from
beginning of one period to the
54. A 52yrs old recently menopausal beginning of the next?
female has developed hot flushes that she e) How many days are there from end
describes as severe. She recently takes no of one period to beginning of the
medications nor ERT. The following is most next?
effective to relieve her symptoms:
58. A 20yrs old female long-distance 61. An absolute contraindication to HRT is:
runner with BMI 19, presents with a a) hypertriglyceridemia
3months history of amenorrhea, a b) uncontrolled hypertension
pregnancy test is negative and other blood c) migraine headaches
work is normal. She has no other medical d) uterine fibroids
problems and takes no medications. With e) acute/severe liver disease
respect to her amenorrhea, you advise
her: 62. A postmenopausal woman comes to
a) to increase caloric intake discuss HRT. She has history of migraine
b) that this is normal response to and strong family history of osteoporosis.
training An appropriate choice would be:
c) to begin an estrogen containing oral a) offer combination oral
contraceptive estrogen/progesterone HRT
d) to stop running b) offer progesterone only
e) to take cyclic HRT c) offer biphosphonate only
d) offer oral estrogen only
59. An 18yrs old woman who has a height e) offer reassurance only
of 158cm, normal breast development,
presents with 1ry amenorrhea. Physical 63. A 56yrs old female has been on
exam demonstrates small uterus. The combined hormone therapy for 6months.
following should be done EXCEPT: This is associated with a reduced risk for
a) TSH and PRL levels which of the following:
b) progesterone withdrawal test a) bone fracture
c) FSH and LH levels b) myocardial infarction
d) laparoscopy c) stroke
e) karyotype d) breast cancer
e) venous thromboembolism
60. A 30yrs old black female is being
evaluated for amenorrhea for 6months. 64. The probability of pregnancy after
Menarche was at 12. Her menstrual unprotected intercourse is the highest at:
periods were frequently irregular and a) 3days before ovulation
accompanied occasionally by b) 1day before ovulation
dysmenorrhea. She had her first child 4yrs c) the day of ovulation
ago but has not been able to become d) 1day after ovulation
pregnant since. Her physical and pelvic e) 3days after ovulation
examination is normal. Serum pregnancy
test is negative and prolactin level is 65. A 33yrs old female presents with
normal. LH and FSH are both elevated 3months irregular vaginal bleeding. Prior,
(3times normal) on two occasions. These her menstrual periods were normal. The
findings are consistent with: most appropriate initial laboratory test is:
a) hypothalamic amenorrhea a) Hemoglobin and hematocrite
b) ovarian failure b) TSH
c) pituitary macroadenoma c) LH and FSH
d) pituitary microadenoma d) Estradiol
e) PCOD e) HCG
66. You are asked to evaluate a 6yrs old scanty pubic and axillary hair. PV is
girl who has fallen from her brother's bike difficult and you are unable to identify a
and is complaining of severe vulvar pain. cervix nor palpate a uterus. Most likely
The girl will not permit anyone to touch diagnosis:
her vulva. However, on inspection, the a) congenital adrenal hyperplasia
upper labia majus is blue and there is b) imperforate hymen
vaginal bleeding. Next step: c) Turner syndrome
a) perform the examination under d) complete androgen insensitivity
syndrome
anesthesia
e) Mayer-Rokitansky-Kuster Hauser
b) have her mother restrain her during
syndrome
the examination
c) have a medical assistant restrain her 69. A 17yrs old female presents for
during the examination evaluation for primary amenorrhea. Her
d) send her home to use ice packs and pubic hair appeared at 8yrs of age. Her
re-examine her for the next day karyotype is 45X0. The following is
e) perform a laparotomy to evaluate for characteristic of this patient:
penetrating trauma a) elevated FSH
b) decreased LH
67. A 15yrs old patient is evaluated for c) increased estrogen
masculanization and amenorrhea. She has d) elevated testosterone
been taller than her peers in childhood. e) decreased TSH
Pubic hair growth began at 6yrs, excessive
facial hair growth began at 10yrs. She is 70. the most frequent cause of
150cm tall and her BP: 120/80. She has dyspareunia is:
prominent musculature and under- a) vaginismus
developed breasts. Pelvic examination b) endometriosis
reveals enlarged clitoris, moderate c) retroverted uterus
d) inadequate vaginal lubrication
posterior labial-scrotal fusion and the
e) pelvic inflammatory disease
cervix is seen in the vaginal vault. There
are no pelvic masses on bimanual
71. A 25yrs old female is concerned about
examination. This patient's chromosomes recurrent psychological and physical
are most likely: symptoms that occur during the luteal
a) XX phase and resolve by the end of
b) XXY menstruation. She wants help managing
c) XO/XY these symptoms but does not want
d) XX/XY hormonal therapy. Best option for her:
e) XYY a) celecoxib
b) spironolactone
68. A concerned mother brings in her c) fluoxetine
16years old daughter because she hasn't d) alprazolam
ever had menses. O/E: the girl is 173 tall e) black cohosh
with mature adult breast development,
72. A 41yrs old woman presents with 75. Most individuals with PCO have:
obesity, hirsuitism and oligomenorrhea. a) decreased estrogen level
The following tests gives the LEAST useful b) decreased androgen level
information regarding her condition: c) elevated FSH level
a) ultrasound d) elevated TSH level
b) blood glucose e) insulin resistance
c) testosterone
d) LH/FSH
76. The direct biochemical evidence of
e) DHEAS
hyperandrogenism is obtained by
73. A 29yrs old NG presents with irregular measuring:
infrequent menses. Over the past few a) Androstenedione
years, she has noted increased dark hair b) AMH
growth on her chin and above the upper c) DHEAS
lip. O/E: BP is normal and she is d) Levonorgestrel
moderately overweight. The skin reveals e) Free testosterone
acne and abdominal striae. Otherwise she
is normal. Labs show TSH: 2.1U/ml, FSH: 77. WHO classification of ovulation
8U/L, LH: 38U/L, Prolactin: 28ng/ml and disorders describes three classes. Which
DHEAS: 2ng/dl. Most likely diagnosis: one of the following is characteristically
associated with low FSH and low
a) Cushing’s syndrome
estrogen?
b) PCOD
c) Virilizing adrenal tumour
a) hyperprolactinemia
d) Prolactinoma
e) Adult onset CAH b) ovarian endometriosis
c) ovarian failure
74. A 36yrs old white female presents with d) PCO
chief complain of infertility associated e) weight loss (very low BMI)
with a history of a menstrual period every
3-4months since menarche at age 12. 78. WHO classification of ovulation
Physical examination is normal except for disorders describes three classes. Which of
moderate obesity, acne, and coarse facial the following is characteristically
hair. Urine HCG is negative. Evaluation to associated with high FSH and low
confirm PCO include: estrogen?
a) elevated testosterone a) hyperprolactinemia
b) elevated TSH b) ovarian endometriosis
c) markedly elevated prolactin
c) ovarian failure
d) elevated 17(OH) progesterone
d) PCO
e) elevated FSH
e) weight loss (very low BMI)
79. A 53yrs old woman who is 82. Women with POI are not at increased
amenorrheic for the past year, complains risk of:
of vaginal dryness, superficial dyspareunia a) atherosclerosis
and urinary urgency. She has been treated b) breast cancer
for urinary infection 2months back. There c) cerebrovascular accidents
is no active UTI now, although symptoms d) osteoporosis
persist. She has been on HRT for the past e) vulvovaginitis
6months due to severe palpitations, hot
flushes and night sweats. She is relieved of 83. From an outflow tract perspective, the
those symptoms. Most appropriate for only uterine anomaly that may cause a
her: problem is:
a) low-dose steroids are the most a) arcuate uterus
effective ttt in this case b) bicornuate uterus
b) reassure her as she is already on HRT c) complete septate uterus
that these symptoms will also d) noncommunicating functioning horn
subside gradually e) unicornuate uterus
c) start ttt with vaginal estrogen for
relief of symptoms 84. A worried mother gets her 16yrs old
d) these symptoms can't be due to girl to GP as she hasn't had her menses
estrogen deficiency as she is already yet. O/E: there is poor development of 2ry
on HRT sexual characters, cubitus valgus, webbed
e) urodynamic study should be advised neck and short stature. The following
investigations will help to confirm your
80. All the following are causes of POI diagnosis:
EXCEPT: a) Serum FSH:LH
a) Fragile X syndrome b) Karyotyping
b) Kallman syndrome c) MRI of the pelvis
c) Mumps oophoritis d) US of the pelvis
d) Pelvic irradiation e) X-Ray of the limbs
e) Turner syndrome
85. A 45yrs old woman with BMI: 48, is
81. The growth factor implicated in requesting hysterectomy in order to have
mediating the effect of OHSS is: permanent solution for her menorrhagia
a) insulin like growth factor that started 6months ago. Her Hb is
b) placental growth factor 10gm%. You are relactant for surgery due
c) transforming growth factor A to the high risks associated with surgery in
d) transforming growth factor B obese women. The following approach is
e) vascular endothelial growth factor NOT recommended:
a) explain that both laparoscopic and 88. A male patient presents with history of
open surgery would carry serious anosmia, azospermia, bilateral small
risks in her case testes and gynecomastia. Best treatment
b) if she insists, plan for the modality:
hysterectomy asap with adequate a) bromocryptine
precautions b) clomiphene
c) offer advice regarding weigh loss c) gonadotrophins
(food intake, exercise, support, d) letrozole
e) testosterone replacement
medication and bariatric surgery)
d) offer alternative ttt like LNG-IUS
89. A 60yrs old para 4 on continuous
e) tell her that she should consider
combined HRT, presents with a 2weeks
alternate therapy options if it can history of irregular vaginal bleeding. Best
help her avoid surgery next step:
a) dilatation and curettage
86. The following is correct in relation to b) norethisterone 5mg tds
PCOS: c) pipelle endometrial biopsy
a) increased risk of type II DM and d) sequential combined HRT
gestational DM e) TVS
b) increased risk of uterine polyps
c) no induction of uterine bleeding 90. A 16yrs old girl presents with 1ry
following 5days of oral progesterone amenorrhea, she has Tanner V breast and
therapy pubic hair development. O/E: She has
d) resistant to clomiphene citrate blind ending vagina and karyotype is 46XX.
induction in 50% of cases Most likely diagnosis:
e) virilization is common a) congenital adrenal hyperplasia
b) constitutional delay
87. A 25yrs old athlete with BMI: 18 c) Mayer-Rokitansky-Kuster-Hauser
syndrome
presents to the fertility clinic after trying
d) Mc-Cune Albright syndrome
for pregnancy for 2yrs. She has
e) complete androgen insensitivity
oligomenorrhea and her partner's semen
syndrome
analysis is within normal. She has low FSH,
LH and estrogen levels while androgen 91. A 50yrs old patient is due to have a
profile is normal. Best strategy for ovarian major abdominal surgery. She is currently
stimulation: taking combined continuous HRT for
a) clomiphene citrate vasomotor symptoms. When should she
b) lifestyle intervention (normalize stop HRT before surgery?
weight and exercise) + HMG a) 2weeks
c) pulsatile GnRH b) 4weeks
d) norethisterone 10mg for 5-7days and c) 6weeks
clomiphene citrate 50mg on day 2- 6. d) 8weeks
e) recombinant FSH+LH preparations e) 10weeks
92. A 17yrs old girl presents with crampy 95. A 35yrs nulliparous old diabetic obese
lower abdominal pain radiating to her lady has a family history of premature
legs. For the past year, the pain has menopause, attends the clinic as she is
coincided with the first 3days of her
anxious having not getting her period for
menses. She is not sexually active and her
history and general examination are 11months. She had long cylces but never
unremarkable. Optimum management been amenorrheic for so long, she is
approach: otherwise fit and well and her estradiol
a) NSAIDs level is normal. Most likely provisional
b) COPs diagnosis:
c) Laparoscopic uterine nerve ablation
a) hyperprolactenemia
d) POPs in a continuous fashion
e) Transcutaneous nerve stimulation b) premature ovarian failure
c) kallman syndrome
93. A 56yrs old woman with BMI: 38 and d) hypothyroidism
type 2 DM, presents with daily dark brown e) PCO
staining on her underwear for the past
week. She underwent menopause at 53yrs
96. A 24yrs old patient presents with 2ry
and has had no further bleeding or
discharge since then. There was no vaginal amenorrhea, she has a recent history of
or vulval trauma and her cervical smear anorexia. The most likely diagnosis:
6months ago was normal. O/E: her cx a) premature ovarian failure
appears normal and no evidence of b) hypoprolactenemia
external piles and urine test is negative.
c) PCO
Best next step is:
d) hypogonadotrophic hypogonadism
a) dilatation and curettage e) hyperthyroidism
b) outpatient hysteroscopy
c) pipelle biopsy 97. A 29yrs old lady has 1ry infertility, she
d) transvaginal ultrasound attends the fertility clinic and her cycles
e) hysteroscopic biopsy
are very irregular for the last 10yrs. What
94. What is the commonest cause of would be the most reliable test to check
postmenopausal bleeding? for ovulation?
a) endometrial polyp a) basal body temperature chart
b) endometrial hyperplasia b) antral follicle count
c) endometrial cancer c) serum progesterone
d) endometrial atrophy
d) FSH
e) endometritis
e) inhibin B
98. A 39yrs old lady with 1ry infertility has

been trying to conceive for the past
6months and is being investigated. There
are concerns about her ovarian reserve.
Which test from the routine workup will
give an idea about ovarian reserve?
a) ovarian volume
b) ovarian blood flow
c) inhibin B
d) oestradiol
e) FSH
99. A 45yrs old woman had irregular

vaginal bleeding, an endometrial biopsy
through a pipelle was insufficient. Her BMI
is 55 and US shows ET of 7mm. What is
your next step of management?
a) reassure and see again if further
bleeding
b) arrange for hysteroscopy under
general anesthesia
c) arrange outpatient hysteroscopy
d) arrange a repeat endometrial biopsy
e) repeat scan in 6months
100. A 32yrs old complains of heavy

menstrual bleeding for 8months. O/E: no
abnormality and she feels very fatigued.
Which investigation you consider first?
a) CBC
b) ferritin
c) thyroid profile
d) day 2 hormone profile
e) coagulation profile
ANSWERS
1 C 36 C 71 C
2 C 37 E 72 B
3 C 38 C 73 B
4 A 39 E 74 A
5 C 40 A 75 E
6 B 41 A 76 E
7 A 42 E 77 E
8 C 43 B 78 C
9 B 44 A 79 C
10 C 45 D 80 B
11 C 46 D 81 E
12 E 47 A 82 B
13 C 48 D 83 D
14 D 49 B 84 B
15 C 50 D 85 B
16 E 51 D 86 A
17 C 52 D 87 B
18 C 53 E 88 C
19 A 54 A 89 E
20 D 55 B 90 C
21 C 56 C 91 B
22 A 57 D 92 A
23 A 58 A 93 D
24 D 59 D 94 D
25 C 60 B 95 E
26 B 61 E 96 D
27 A 62 C 97 C
28 C 63 A 98 E
29 A 64 B 99 A
30 B 65 E 100 A
31 D 66 A
32 B 67 A
33 E 68 D
34 C 69 A
35 D 70 D
Gyn 2: General (100 marks)

Choose the most correct answer: 4. A 44yrs old woman has undergone a
right laparoscopic salpingo-oopherectomy.
1. A 55yrs old woman had undergone a Bipolar cautery was used to ligate the
total laparoscopic hysterectomy and infundibular pelvic ligament. The next day,
developed fever and flank tenderness. The she complains of fever and flank
most likely clinical diagnosis is: tenderness. Your most probable diagnosis
a) Vesicovaginal fistula is:
b) Ureteral ligation a) Vesicovaginal fistula
c) Ureteral ischemia leading to injury b) Ureterovaginal fistula
d) Ureteral thermal injury c) Ureteral ligation
e) Uretrovaginal fistula d) Ureteral ischemia leading to injury
e) Ureteral thermal injury
2. A 33yrs old woman had undergone
pelvic lymphadenopathy for cervical 5. A 42yrs old woman with long standing
cancer during which meticulous dissection DM complains of small amounts of
of the right ureter was done. On her 10th constant dribbling of urine. The best
postoperative day, she developed nausea, therapy for her is:
vomiting and ascites. The most probable a) Oxybutynin
diagnosis is: b) Propranolol
a) Vesicovaginal fistula c) Placement of an artificial urethral
b) Ureteral ligation sphincter
c) Ureteral ischemia leading to injury d) Sling operation
d) Bladder perforation injury e) Intermittent self-catheterization
e) Ureterovaginal fistula
6. A 39yrs old woman wets her underpants
3. A 55yrs old woman who undergone a many times each day and she said she
vaginal hysterectomy for third degree needs to void but she can't make it to the
uterine prolapsed one month ago is restroom in time. The best therapy is:
complaining now of constant fluid leakage a) Oxybutinin
per vagina. Your most likely diagnosis is: b) Surgical repair of fistulous tract
a) Vesicovaginal fistula c) Placement of an artificial urethral
b) Ureterovaginal fistula sphincter
c) Ureteral ligation d) Intermittent self-catheterization
d) Ureteral ischemia leading to injury e) Sling operation
e) Bladder perforation injury
7. A 35yrs old woman had undergone 4VD. 11. A 34yrs old infertile woman is noted to
She notes urinary loss many times per day have bilateral tubal block by HSG. The best
with coughing and sneezing. She doesn't as next step:
have dysuria or urge to void. Her urine
a) FSH therapy
culture is negative. The best therapy is:
a) Suburethral sling procedure b) Clomiphene citrate therapy
b) Oxybutynin c) Laparoscopy
c) Surgical repair of fistulous tract d) Hysteroscopy
d) Intermittent self-catheterization e) IUI
e) Hodge-Smith pessary
12. A 47years old G3P3 complains of
8. A 25yrs old nulliparous woman is being
severe menstrual cramps and heavy
evaluated for possible IUD insertion. The
following is not a contraindication for IUD menstrual bleeding. PV reveals tender,
use: diffusely enlarged uterus and no adnexal
a) Current sexually transmitted disease tenderness. Endometrial biopsy is normal.
b) Nulliparity Most likely diagnosis:
c) Recent Pelvic inflammatory disease a) endometriosis
d) Severe menorrhagia b) endometritis
e) Enlarged uterus with an irregular
c) adenomyosis
cavity
d) uterine sarcoma
9. A 22yrs old G0P0 woman complains of e) leiomyoma
irregular menses every 30 to 65days.
Semen analysis and HSG are normal. The 13. In the evaluation of a 26years old
most likely treatment for her: patient with 4months 2ry amenorrhea,
a) Laparoscopy
you order prolactin and B-HCG. B-HCG test
b) Hysteroscopy
c) IUI is positive and prolactin level is 100ng/ml.
d) IVF This patient requires:
e) Clomiphene citrate a) routine obstetric care
b) CT scan of her brain to rule out
10. A 28yrs old G1P1 woman complains of pituitary adenoma
severe painful regular menses and severe c) repeat measurements of prolactin to
dyspareunia. She has no history of STDs or
ensure that values do not increase
PID. The following most likely identify the
etiology of her infertility: more than 300ng/ml
a) Lapasoscopy d) bromocryptine to suppress prolactin
b) Hysteroscopy e) exaluation for possible
c) BBT chart hypothyroidism
d) HSG
e) Progesterone assay
14. On a laparoscopy for a 28years old 17. During the evaluation of infertility in a
patient, multiple implants of 25yrs old woman, a HSG showed evidence
endometriosis on the uterosacral of Asherman syndrome. You expect this
ligaments and ovaries were detected. You patient to have:
ablated all the visible lesions with CO2 a) amenorrhea
laser. You recommended postoperative b) menometrorrhagia
medical ttt due to extensive lesions c) menorrhagia
intraoperatively. Best method to follow up d) metrorrhagia
prognosis: e) dysmenorrhea
a) CT Scan 18. A 36yrs old morbidly obese woman
b) ultrasound presents to your office for evaluation of
c) hysteroscopy irregular heavy menses occurring every 3-
d) laparoscopy 6months. An office endometrial biopsy
e) CA 125 shows complex hyperplasia of the
endometrium without atypia. The
15. A 28yrs old NG complains of bleeding hyperplasia is most likely related to the
between periods and heavy menses. She excess formation of which of the following
tried OCPs and NSAIDs with no effect. The hormone in the patient’s adipose tissue:
most appropriate at this time: a) estriol
a) perform a hysterectomy b) estradiol
b) perform a hyspteroscopy c) estrone
c) perform endometrial ablation d) androstenidione
d) treat with a GnRH agonist e) dehydroepiandrosterone
e) start the patient on a high dose
progestational agent 19. A couple presents for evaluation of
primary infertility. Upon examination, the
16. A 26years old female presents with a woman is completely normal. The
history of 1ry infertility for 2years. Semen husband has left varicocele. What do you
analysis is normal. She has history of expect in the semen analysis?
endometriosis with ovarian implants a) decreased sperm count with an
diagnosed by laparoscopy at the age of increase in the number of abnormal
17yrs. She had also left ovarian cyst, filmy forms
adnexal adhesions and several subserous b) decreased sperm count with an
fibroids. You asked for HSG. The following increase in motility
conditions can be diagnosed with a HSG: c) increased sperm count with an
a) endometriosis increase in the number of abnormal
b) ovarian cyst forms
c) subserosal fibroids d) increased sperm count with absent
d) minimal pelvic adhesions motility
e) hydrosalpinx e) azospermia
20. A 22years old woman consults you for d) the sample is abnormal due to
the treatment of hirsuitism. Physical inadequate number of sperm per
examination revealed facial acne, dark milliliter
course hair on upper lip, chin and e) the sample is abnormal due to low
midsternum. BMI is 35. Serum LH is percentage of forwardly motile
35miu/ml and FSH is 9miu/ml. sperm
Androstenedione and testosterone levels
are mildly elevated but serum DHEAS is 23. You ask a patient to call your office
normal. The patient does not wish to during her next menstrual cycle to
conceive at this time. Most appropriate schedule a HSG as part of her infertility
single treatment of her condition: evaluation. Which day of the menstrual
a) oral contraceptives cycle is best for performing HSG?
b) cortecosteroids a) day 3
c) GnRH agonist b) day 8
d) metformin c) day 14
e) spironolactone d) day 21
e) day 26
21. The above patient returns 3years later
with desire to conceive. She stopped the 24. You have recommended that your
pills. Her periods have been unpredictable infertility patient return during her next
usually every 3-6months. Best line therapy menstrual cycle to have her serum
to help her to conceive: progesterone level checked. Best day of
a) IUI the menstrual cycle for progesterone
b) IVF level:
c) metformin a) day 3
d) clomiphene citrate b) day 8
e) laparoscopic ovarian drilling c) day 14
d) day 21
22. An infertile couple presents to you for e) day 26
evaluation. Semen shows a count of
25million/ml. 65% of normal morphology 25. Your 43years old patient is concerned
and 20% show progressive forward that she may be too close to menopause
motility. You tell the couple: to get pregnant. You recommend that her
a) the sample is normal but of no FHS level be tested. Best day to check for
clinical value due to the low sample FSH:
volume a) day 3
b) the sample is normal and should not b) day 8
be a factor in the couple's infertility c) day 14
c) the sample is abnormal due to the d) day 21
percentage of normal morphology is e) day 26
low
26. A 46yrs old P3003 presents to your 29. A 46years old woman presents with
office with a chief complaint of leakage of “something bulging” from her vagina for
urine upon coughing or sneezing. She is 1year but progressively worse. She has
otherwise healthy, does not smoke and urine leakage upon coughing. She has
takes no medications. Her 3 deliveries regular periods & husband had vasectomy.
were vaginal. Most common cause of
O/E : moderate cystocele and no rectocele
urinary incontinence in this lady:
a) functional incontinence or uterine prolapsed. Best plan is:
b) urge incontinence a) anticholinergic medications
c) stress urinary incontinence (SUI) b) antibiotic therapy
d) urethral diverticulum c) Le Fort colpocleisis
e) overflow incontinence d) anterior colporrhaphy and mid-
urethral sling
27. A 53years old postmenopausal woman e) use of vaginal estrogen cream
G3P3 presents for evaluation of new onset
urinary leakage for the past 6weeks. Most 30. A 42years old G3P3 presents 2weeks
appropriate first step in this patient’s after vaginal hysterectomy, anterior
evaluation:
colporrhaphy and mid-urethral sling. She
a) urine analysis and culture test
b) urethral pressure profiles is concerned as she constantly leaks
c) intravenous pyelogram throughout the day. She reports no
d) cystourethrogram urgency or dysuria. The most likely
e) urethrocysoscopy explanation for her complaint is:
a) failure of the procedure
28. You are discussing surgical options b) urinary tract infection
with the family of an elderly patient with c) vesicovaginal fistula
symptomatic POP. Le Fort colpocleisis may d) detrusor instability
be more appropriate than vaginal e) diabetic neuropathy
hysterectomy for this patient in the
following circumstances:
a) the patient is debilitated and in a 31. In the previous patient, what is the
nursing home next step to try to confirm your diagnosis?
b) the patient has had postmenopausal a) order an intravenous pyelogram
bleeding b) perform a cystoscopy
c) the patient has had endometrial c) refer her to urology for further
hyperplasia evaluation
d) the patient has had cervical dysplasia d) perform a physical examination and
that requires colposcopic evaluation an in-office dye study
e) the patient has a history of urinary e) order a CT of the pelvis with contrast
incontinence
32. A 90years old G5P5 widow with HTN, drink several glasses of iced tea and water
chronic anemia, coronary heart disease, on a daily basis. The patient is otherwise
osteoporosis is brought by her grand- healthy and doesn't take any medication.
daughter. She is alert and oriented and She delivered all vaginally. An office
lives in an assisted living facility. She dipstick of her urine does not indicate any
complains of heaviness and pressure in blood, bacteria, WBCs or protein. Her
the vagina with no significant urinary or urine culture is negative
bowel problems. O/E: cervix is seen just
inside the introitus. This is most likely: 35. Based on her office presentation and
a) normal examination history, the most likely diagnosis is:
b) first degree uterine prolapsed a) stress urinary incontinence
c) second degree uterine prolapsed b) urinary tract infection
d) third degree uterine prolapsed c) urge incontinence
e) complete procedentia d) vesicovaginal fistula
e) mixed incontinence
33. In the previous patient, what is the
best next step in her management? 36. As next step in management, you
a) reassurance recommend to the patient:
b) placement of a pessary a) instruct her to start performing Kegel
c) Le Fort colpocleisis exercise
d) vaginal hysterectomy with apical b) tell her to hold her urine for 6hours
repair to enlarge her bladder capacity
e) anterior colporrhaphy c) instruct her to eliminate excess
water and caffeine from her daily
34. If instead of the scenario described intake
earlier, this patient told you that she was d) prescribe an anticholinergic
asymptomatic from this POP, what would e) schedule a cystoscopy
be the best management?
a) reassurance 37. This patient returns to your office
b) placement of a pessary 3months later and continues to be
c) vaginal hysterectomy symptomatic after following your advice
d) Le Fort colpocleisis for conservative self-treatment. Best next
e) anterior colporrhaphy step in management:
a) prescribe oxybutynin
Questions 35-37: 40 years old G3P3 b) prescribe estrogen therapy
presents for a routine annual examination, c) schedule a mid-urethral sling
she reports getting up several times by d) refer her to an urologist for urethral
night to void. During the day time, she has dilatation
urge to void but can't quite make it to the e) schedule a voiding cystourethrogram
bathroom. She doesn't leak when she
coughs or sneezes. She also reports to
38. An 18years old G0 comes to see you 40. You have diagnosed a healthy sexually
due to a 3days history of urinary active 24years old female with an
frequency, urgency and dysuria. She uncomplicated acute UTI. Which of the
panicked this morning as she noticed following is the most likely organism?
bright red blood in her urine. She also a) Chlamydia
reports some midline lower abdominal b) Pseudomonas
c) Klebsiella
discomfort. She had intercourse for the
d) Eshrichia coli
first time 5days ago with condom. On
e) Candida albicans
physical examination, there are no
lacerations of external genitalia and no 41. A 23years old woman presents for her
discharge from the cervix or in the vagina. postpartum visit and contraception
Bimanual examination is normal except management. She delivered vaginally
for mild suprapubic tenderness. There is 6weeks ago and is breast feeding now.
no flank tenderness and the patient’s After reviewing her physical examination
temperature is normal. The most likely and discussing all contraceptive methods.
diagnosis is: She chooses DMPA. Disadvantage of
a) chlamydia cervicitis DMPA:
b) pyelonephritis a) impairment of lactation
c) acute cystitis b) increased risk of hepatic cancer
c) iron deficiency anemia
d) acute appendicitis d) irreversible bone loss
e) monilia vaginitis e) prolonged anovulation
42. A 22years old woman presents to your
39. A 28years old woman presents to your office for contraception. She has no
office with symptoms of a UTI. This is her medical problems or prior surgeries. She
second infection in 2months. Her doesn't drink or smoke. Her vital signs and
symptoms never really improved. Now she physical examination are normal. You
has worsening lower abdominal explain the risks and benefits of COCPs.
discomfort, dysuria and frequency. She She wants to know how they will keep her
reports no fever or flank pain. Physical from getting pregnant. The following
examination shows mild suprapubic mechanisms explain COCPs action:
tenderness. Best next step for evaluation a) direct inhibition of oocyte
maturation
of this patient:
b) inhibition of ovulation
a) urine culture
c) production of uterine secretions that
b) intravenous pyelography are toxic to developing embyos
c) cystoscopy d) impairement of implantation
d) wet smear hyperplastic changes of the
e) treat her with a different antibiotic endometrium
e) impairement of sperm transport
caused by uterotubal obstruction.
43. A patient who is 8wks pregnant has 47. A 25yrs old white female is counseled
been using a copper IUD. On vaginal regarding birth control. She has had
examination, the string is seen. Most compliance problems with oral
appropriate management of this patient: contraceptives and asks about
a) cut the string high in the endocervix alternatives. You discuss various options
allowing the device to retract as including the vaginal contraceptive ring
pregnancy develops (NuvaRing) and she asks for more
b) perform laparoscopy to rule out information. The following are advantages
ectopic pregnancy and disadvantages of this form of
c) recommend therapeutic abortion contraception:
d) remove the device if signs of a) it protects against STDs
infection develop b) for maximum protection, it should be
e) remove the device immediately replaced every 3months
c) it is associated with a higher
incidence of breakthrough bleeding
44. The main contraceptive action of the
than COCPs
copper IUD is:
d) up to 50% of women have significant
a) prevention of implantation of the
difficulty inserting the device
fertilized ovum correctly
b) cessation of ovulation e) if the device is expelled from the
c) induced abortion vaginal for more than 3hours, backup
d) production of a spermicidal contraception should be used
environment
e) elevation of serum copper level 48. Which of the following is true
regarding the use of a contraceptive
45. A copper IUD has a contraception diaphragm?
efficacy rate of: a) it must be refitted if the patient gains
a) 99% more than 7kg
b) 80% b) use of nonoxynol-9 will prevent HIV
c) 50% c) diaphragms are made only of latex
d) 10% d) diaphragms are recommended for
e) 1% women with a history of toxic shock
syndrome
46. The following represents an advantage e) the diaphragm should be removed
of injectable medroxyprogesterone immediately after intercourse
acetate (depo-provera):
a) there is a general lack of menstrual 49. After fitting a 30yrs old G2P2 for a
irregularities diaphragm, you advise her not to leave the
b) it is not causally linked with diaphragm in place for longer than 24hrs
thromboembolic events because of the risk of:
c) there is no weight gain a) loss of contraceptive effectiveness
d) there is no measurable effect on b) STDs
blood lipid levels c) toxic shock syndrome
e) the cost is half that of generic d) HPV
combination oral contraceptives e) adhesions
50. A 39yrs old presents for emergency 53. The gold standard for the diagnosis of
contraception after having unprotected endometriosis is:
intercourse last night. She has two a) laparoscopy
previous normal deliveries. Six months b) ultrasound
ago, she had a lower leg DVT. The c) vaginal exam
following would be appropriate advice for d) Pap smear
this patient: e) hysteroscopy
a) if hormonal contraceptives are 54. A 28yrs old woman has a 3yrs history
prescribed there is an increased risk
of primary infertility, she presents with
of adverse fetal development
increasing symptoms of steady aching
b) high dose estrogen only
lower abdominal pain at the time of
contraceptives given for 2days are as
effective as estrogen/progestin menses that persists throughout
c) copper IUD inserted within 5days of menstruation and often after and radiates
intercourse would be comparable to into the rectum. Tender nodules in the
hormonal methods uterosacral ligaments are noted on pelvic
d) H/O venous thrombosis is an examination. Best investigation is:
absolute contraindication to the use a) postcoital test
of emergency hormonal method b) diagnostic laparoscopy
e) contraception is unlikely to be c) HSG on day 9 of the cycle
effective at this point d) endometrial biopsy on day 26 of the
cycle
51. Which of the following is seen in e) BBT chart
patients injectable DMPA?
a) more regular and predictable 55. A 23yrs old woman regularly has
menstrual periods episodes of pain associated with
b) improvement in acne menstrual periods. After investigations,
c) fewer migraine headaches compared you diagnose endometriosis. Commonest
to patients using combination oral
site of this disease outside of the pelvis:
contraceptives
a) GIT
d) increased bone density
b) lung
e) minor weight loss
c) pleura
52. A 37yrs old woman who complains of d) kidney
heavy painful menses requests e) spleen
contraception. She smokes a pack of
cigarettes a day. Best choice of 56. A 37yrs old woman has severe pain
contraception for this patient: during menses which radiates into the
a) a copper-T IUD anal region. On bimanual exam, she has a
b) low dose COCPs small retroverted uterus and tender
c) progesterone implant nodules can be felt on palpation of the
d) endometrial ablation uterosacral ligaments. Which of the
e) hysterectomy following does she most likely have:
a) chronic PID daily multivitamins. Vitals are within

b) adenomyosis normal limits. Physical exam reveals a non
c) fibroids specific pelvic tenderness, a left adnexal
d) endometriosis mass and multiple tender nodular masses
e) uterine carcinoma along the thickened uterosacral ligaments.
Heart, lung and abdominal examinations
57. A 30yrs old female complains of are unremarkable. Gold standard for
painful sexual intercourse for the past few diagnosis of the patient's:
weeks. The pain was getting progressively a) endometrial biopsy
worse until it became unbearable. Her b) laparoscopy
past medical history is significant for c) MRI of the abdomen and pelvis
infertility for 3yrs. She has cramping pain d) pelvic ultrasound
that usually begins few days prior to and e) serum prolactin level
resolves after her period. She denies any
STDs or PID. Physical exam is significant 59. A 32yrs old G5P4 presents with an
for immobile uterus with nodularity along 8week history of amenorrhea and
the uterosacral ligaments and palpable suggestive symptoms of pregnancy.
tender right adnexal mass. US shows a Physical examination reveals enlarged
homogenous content of the right ovary. uterus 16weeks. US confirms the presence
The most likely diagnosis: of an 8week viable pregnancy and a
a) endometriosis multiple fibroid uterus. The correct
b) pelvic congestion syndrome management for this patient is:
c) PID a) termination of pregnancy with
d) PCOD elective myomectomy 2months later
e) vaginismus b) termination of pregnancy with
concomitant myomectomy
58. A 35yrs old GO presents with her c) prudent observation with elective C-
husband to the infertility clinic for a follow section at term
up visit. The couple has been trying to get d) prudent observation anticipating
pregnant for the past 2yrs but has not had probable vaginal delivery
any success. Semen analysis, HSG as well e) myomectomy and follow pregnancy
as estrogen, progesterone, FSH and LH in usual way
blood levels were all normal. Her
menarche was at the age of 13yrs and her 60. The commonest type of bleeding
cycles have been always regular occurring encountered with uterine leimyomas is:
every 30days. The patient’s past medical a) postcoital spotting
history is significant for dysmenorrheal of b) mid-cycle bleeding
5yrs duration and dyschezia for the last c) hypermenorrhea
few months. Her LMP was 1 week ago. She d) oligomenorrhea
is taking no medications except for her e) post-coital staining
61. A 36yrs old G1P1 presents with pain 64. A 35yrs old female is planning a second
and bleeding due to a large uterine fibroid pregnancy. Her last pregnancy was
confirmed by US. The patient requests complicated by placental abruption
treatment but wants to preserve her caused by a large fibroid which is still
fertility. The best treatment is: present. The most appropriate treatment:
a) oral contraceptives a) myomectomy
b) uterine artery embolisation b) myolysis with endometrial ablation
c) metformin c) observation
d) uterine artery embolisation
d) myomectomy
e) GnRHa therapy
e) GnRHa
62. A 40yrs old multiparous patient
65. A 72yrs old woman complains of a
presents with a 10day history of heavy lump protruding through the vagina with
vaginal bleeding and lower abdominal local pressure symptoms. O/E: visible
cramping that began at the expected time uterine prolapse. All the following may be
of her menses. Pelvic examination reveals etiologic factors EXCEPT:
a 6cm mass judged to be a prolapsed a) multiparity
submucosal myoma protruding from the b) chronic smoking
cervix on a 1.5cm stalk. The uterus is c) history of large babies
enlarged to twice normal size and is d) hyperestrogenism
mobile. Active bleeding is present and the e) postmenopausal status
patient's hematocrit is 26%. The following
is optimal management: 66. Oral contraceptive pills have been
a) transfusion and vaginal hysterectomy shown to raise the risk of:
b) transfusion and abdominal a) ovarian cancer
hysterectomy b) breast cancer
c) biopsy of the mass and transfusion is c) endometrial cancer
necessary d) thromboembolic events
e) ovarian cysts
d) transvaginal myomectomy and
transfusion if necessary
67. A 38yrs old widow consults you 2yrs
e) high dose birth control pills
after her husband’s accidental death. She
is planning to remarry and asks about the
63. At the time of her annual examination, possibility of resuming the low-dose oral
you find an approximately 10week-sized contraceptives she took before she was
irregular uterus on an asymptomatic 40yrs widowed. The following may
old woman. Her last exam 1year ago was contraindicate resumption of oral
normal. Your next step is: contraceptives:
a) hysterectomy a) her 42yrs old sister has breast cancer
b) endometrial biopsy b) her BP is 135/85
c) abdominal ultrasound and c) she smokes a pack of cigarettes a day
reexamination in 6months d) negative pregnancy test
d) fractional dilatation and curettage e) her LDL/HDL is 2.8
e) GnRHa therapy
68. A 19yrs old white female presents for a) prescribe an oral contraceptive and
an initial family planning evaluation. have her return in 2weeks for a
Specifically, she is interested in oral pelvic examination
contraception. She is not presently b) delay prescribing an oral
sexually active but has a steady boyfriend. contraceptive until after you can
She has no contraindications to oral complete a pelvic examination
contraceptive use. She has mild acne c) delay prescribing an oral
vulgaris. You discuss possible side effects contraceptive until the result of a
and benefits of COCPs including Pap smear is known
improvement of her acne. Which of the d) delay prescribing an oral
following is also associated with oral contraceptive until a pregnancy test
contraceptive use? is negative
a) increased risk of ovarian cancer e) delay prescribing oral contraceptive
b) decreased risk of ovarian cysts until the first sexual relation
c) increased risk for ectopic pregnancy
d) increased incidence of 71. COCPs would be contraindicated in:
dysmenorrheal a) 25yrs old female whose BMI is >30
e) increased risk of menorrhagia b) 26yrs old female with migraine
headaches without focal neurologic
69. A 33yrs old female requests COCPs for symptoms
birth control. Which of the following c) 28yrs old smoker
would be a contraindication to prescribing d) 30yrs old female with previous
OCPS for this patient? history of deep venous thrombosis
a) history of controlled hypertension e) 42yrs old smoker
b) family history of ovarian cancer
c) history of thromboembolic disease 72. A 19yrs old female comes to see you
d) current history of smoking because she found a tear in her diaphragm
e) history of hepatitis C infection with contraceptive device. She had intercourse
no liver disease with her boyfriend only once (the previous
day) since the diaphragm insertion. She is
70. An 18yrs old female college student worried about unwanted pregnancy. What
says she has never been sexually active. is the appropriate action?
She has just begun a serious relationship a) do pregnancy test
with a 19yrs old man. Although they have b) reassurance
not yet engaged in sexual intercourse, she c) oral contraceptive pills daily for
wants to begin oral contraception. Her 2weeks
periods are regular. She began her current d) levonorgestrel, one pill now and
menses 2days ago and would prefer to another in 12hrs
delay a pelvic examination until her period e) call for OBGYN consult
has ended. Her BP is normal. Most
appropriate plan for this visit:
73. A 25yrs old female has unprotected demonstrates blocked fallopian tubes
intercourse and chooses to take Plan B bilaterally and a laparoscope notes dense
(two 0.75mg tablets of levonorgestrel and profuse peritubal and pelvic
taken 12hours apart) as emergency adhesions along with bilateral clubbed
contraception. Plan B has been shown to: tubes. The most appropriate fertility
a) disrupt ovulation treatment would be:
b) protect against STDs a) IUI
c) can be effective routine b) ICSI
contraceptive c) Gonadotrophin induction of
d) be teratogenic to an already ovulation
established pregnancy d) IVF
e) be effective only if used within 24hrs e) GIFT
of unprotective intercourse
Each clinical scenario from questions 76-
74. A young couple undergo a postcoital 82, refers to women seeking contraception
test as part of an infertility evaluation. in particular situation, there is a list of
Several hours after coitus, the cervical option to be used for the scenarios. Each
mucus is thick and tenacious. No sperm option can be used once, more than once
are seen in the mucus although they are or not at all.
present in the vagina. Semen analysis is a) COCP
normal. Eight days later, the patient b) transdermal patch
menstruates. Her BBT record for that cycle c) vaginal ring
indicates ovulation and a normal luteal d) copper IUD
phase. The most appropriate management e) progesterone only implants
of this patient: f) hysteroscopic sterilization
a) perform antisperm antibody studies g) laparoscopic sterilization
b) attempt intrauterine insemination h) Depot-provera injection
with washed sperm i) LNG-IUS (Mirena)
c) prescribe low dose estrogen for days 76. A 24yrs old with strong family H/O of
7-14days of the cycle ovarian cancer (BRCA gene +ve) has had
d) repeat the postcoital test 6-7days one child and is planning to have bilateral
earlier in the next cycle oopherectomy following birth of second
e) start clomiphene citrate therapy on child. She seeks effective contraception
days 5-9 of the cycle that would be beneficial to her long-term
health.
75. A 35yrs old woman presents to your
office, she and her 32yrs old husband have 77. A 30yrs old always forgetful with
been unsuccessful in their attempts to get contraception. She wishes the longest
pregnant for the last 6yrs. He has fathered possible interval between needing to
two children in a prior marriage and has a renew contraception. She is in a stable
normal semen analysis and her BBT chart relationship, nulliparous and not keen on
is biphasic. Her past history notes multiple having things inserted in her vagina or
episodes of chlamydia and gonorrhea. HSG uterus.
78. A 48yrs old with infrequent cycle heavy 84. A 57yrs old postmenopausal woman
menstrual bleeding, fed up with heavy complains of “something coming out of
periods and current contraception of POP. her vagina” and difficulty in opening her
She is in stable relationship, family bowels. She had 4 children by normal
complete and considers starting HRT when vaginal deliveries. Her last child birth was
menopause occurs. 18yrs ago. The most likely diagnosis:
a) anterior vaginal wall prolapse
79. A 40yrs old smoker obese (BMI: 40), 3
b) genuine stress incontinence
previous LSCS, family complete and seeks
c) overflow incontinence
permanent effective contraception. Partner
d) posterior vaginal wall prolapse
refuses to take contraceptive precautions.
e) stress incontinence
80. An 18yrs old with painful periods,
irregular menstrual cycles and wishes 85. The contraceptive injection which lasts
contraception that can help normalize her for 3months contains which of the
periods. She is NG. She doesn't like tablets, following:
injections, implants or wishes to insert a) depot medroxyprogesterone acetate
things in her vagina. b) ethinyl estradiol
c) etonorgestrel
81. A 20yrs old with sickle cell disease,
d) levonorgestrel
experiences painful sickle cell crises with
e) norethindrone
menstruation. She is nulliparous. She has
had some symptoms alleviation when using
86. The following is associated with the
POP but she is occasionally forgetful with
pill taking. She wants to start a family in use of COCPs:
1year. a) contraceptive failure is more likely if
miss 2pills mid-packet than beginning
82. A 26yrs old with infrequent periods, or end of packet
mild hirsuitism, mild acne and PCO by US. b) contraindicated if previous personal
She wishes effective contraception that history of vesicular mole
may also reduce her hirsuitism and acne. c) decreases the risk of ovarian and
endometrial cancer
d) reduces the risk of breast and
83. The following is not a problem arising
cervical cancer
from pelvic floor dysfunction:
e) routine thrombophilia testing is
a) fecal incontinence
b) incompetent cervix required prior to commencing COC
c) pelvic organ prolapsed because of it increasing the risk of
d) sexual dysfunction thromboembolism
e) urinary incontinence
87. A 36yrs old woman is diagnosed with She has history of irregular menstrual
mild stage pelvic endometriosis at cycles and PCO. The SINGLE most
laparoscopy. She has regular cycles and appropriate contraceptive option for her:
her partner has normal semen analysis. a) COCPs
The couple have been trying to conceive b) copper IUD
for 2yrs. Which of the following c) LNG-IUS
management options is the preferred d) POPs
initial ttt choice? e) progesterone only injectable
a) clomiphene citrate induction
b) GnRH agonist 90. A 38yrs old woman suffers from 1ry
c) GnRH antagonist
infertility and endometriosis. Her recent
d) laparoscopic excision/ablation of
TVS suggests presence of 2.5cm
peritoneal endometriosis
endometrioma. Her pain is well controlled
e) selective progesterone receptor
using simple analgesics and she is due to
modulator
undergo IVF. Best ttt for this
88. A 22yrs old woman asks her GP for endometrioma expectant management:
most appropriate postnatal contraception a) laparoscopic ovarian cystectomy
for her. She had uncomplicated vaginal b) laparoscopic ovarian cyst aspiration
delivery 6weeks ago at 40wks GA. She is c) laparoscopic ovarian cyst
intermittently breast feeding and bottle fenestration and drainage
feeding her baby. She and her partner are d) laparoscopic salpingoophorectomy
keen to space out childbearing by 2-3yrs
and requesting the most reliable 91. A 30yrs old woman with her 26yrs old
contraception. She admits having difficulty male partner have been trying to conceive
in remembering to take contraceptive naturally for the last 3years. They have
medication. The SINGLE most appropriate had infertility investigations over the last
option for her: year, these include a normal semen
a) COCPs analysis, normal US pelvis, normal HSG,
b) combined contraceptive vaginal ring normal TSH, prolactin, d3 FSH/LH and
c) condoms normal AMH. Her day 21 progesterone
d) lactational amenorrhea suggest ovulation. She is rubella immune,
e) progesterone only implant has negative swabs for STDs and her
recent cervical smear is normal. The
89. A 22yrs old woman presents to her GP following ttt option best suits her:
for advice regarding the most appropriate a) clomiphene citrate
postnatal contraception. She had an b) IUI
uncomplicated vaginal delivery at 40wks c) IVF
gestation 3weeks ago. She is bottle d) testicular biopsy and IVF
feeding. She and her partner are keen to e) letrozole
space out child bearing by 1-2years and
wishing a reliable form of contraception.
92. in cases of infertility: d) low serum progesterone in the mid-

a) all mild to moderate endometriosis luteal phase of their cycle confirms
patients with infertility should have ovulation
laparoscopy + adhesiolysis with an e) there is a need for an endometrial
expert before IVF biopsy to exclude luteal phase defect
b) gonadotrophins can be offered as
2nd line ttt in cases of clomiphene 95. A 30yrs old woman has been trying to
citrate resistant PCO patients conceive for 3yrs. She has infrequent
c) in cases of mild male factor menstrual cycles. US confirms a normal
infertility, it is recommended that uterus and PCO. HSG confirms bilateral
sperm concentration and IUI should patent Fallopian tubes. Her partner’s
be done for three cycles semen analysis is reported as within
d) in cases of unexplained infertility, normal limits. Her BMI is 25. She has
stimulated IUI is better than no ttt. normal prolactin, FSH, estradiol and
e) NICE recommends IVF as ttt of choice testosterone. Of the options listed, which
in cases of unexplained infertility if is the most appropriate initial therapy?
not conceived after 1year of a) bromocryptine
unprotected intercourse b) clomiphene citrate
c) gonadotrophin
93. A 40yrs old man undergoes semen d) laparoscopic ovarian drilling
analysis, which of the following is e) metformin
ABNORMAL?
a) progressive motility 25% 96. A 43yrs old woman is having a DHL as
b) sperm concentration 50million/ml part of investigation of AUB. During
c) total progressive and non laparoscopy, you see a left ovarian cyst
progressive motility 75% possibly endometrioma. You have taken a
d) total sperm count 200million per consent only for DHL. Most appropriate is:
ejaculate a) complete the diagnostic procedure
e) volume 4ml now and discuss with her ttt for
ovarian cyst later
94. A 34yrs old woman has been trying to b) do an ovarian cystectomy as you
conceive for 3yrs. She is referred now to have anyway put her under
fertility clinic. The following is appropriate anesthesia
in her counseling: c) proceed for an exploratory
a) altering smoking, alcohol and laparotomy as it may complicate if
caffeine intake has no impact on done laparoscopically
spontaneous or IVF pregnancy d) proceed to hysterectomy as she was
success considering this as an option when u
b) despite having regular monthly discussed the ttt of AUB with her
menstrual cycles, a mid-luteal serum e) take consent from her relatives for
progesterone test is recommended ovarian cyst/ovary removal then
in order to confirm ovulation debrief her later
c) laparoscopy is the only method to
screen for tubal abnormalities
97. A 34yrs old nulliparous is undergoing 99. A 45yrs old patient presents to ER
ttt for 1ry infertility. She has irregular 2days after UAE (Uterine Artery
periods with a cycle length 45-60days. Her Embolisation) for a 20weeks size fibroid
LMP was 7weeks ago. She posted for DHL. uterus. She has diffuse abdominal pain,
During laparoscopy, you find unexpected generalized malaise, anorexia, nausea,
ectopic pregnancy in Lt tube and Rt tube vomiting, low-grade fever and
appears healthy. She is hemodynamically leucocytosis. Most likely diagnosis:
stable. You have taken consent only for a) arterial dissection
DHL. Most appropriate course of action: b) bowel perforation
a) abandon the procedure now and c) endometritis
discuss with her ttt for ectopic d) myoma expulsion
pregnancy later e) reactionary to embolisation (post-
b) do bilateral salpingectomy to prevent embolisation syndrome)
further pregnancies and plan fertility 100. A 29yrs old with 1ry infertility and
ttt later BMI: 30, is known to have PCO based on
c) proceed for an exploratory anovulation, raised testosterone and TVS
laparotomy picture. She remains anovulatory despite
d) remove the ectopic pregnancy increasing doses of clomiphene citrate
through salpingostomy at same over six cycles. Best next step:
setting and debrief her later a) unstimulated IUI
e) report your junior staff for b) continue further 3 cycles on
negligence for not ruling out clomiphene citrate
pregnancy prior to procedure c) continue further six cycles on
clomiphene citrate
98. Medical management of fibroids is d) gonadotrophin induction
best indicated when: e) metformin
a) fibroif less than 3cm, not distorting
the cavity and asymptomatic
b) fibroid less than 3cm, distorting the
cavity and asymptomatic
c) fibroid less than 3cm, not distorting
the cavity and causing heavy
bleeding
d) fibroid more than 3cm, distorting the
cavity and asymptomatic
e) fibroid more than 3cm, not distorting
the cavity and asymptomatic
ANSWERS
1 B 36 C 71 D
2 C 37 A 72 D
3 A 38 C 73 A
4 E 39 A 74 D
5 E 40 D 75 D
6 A 41 E 76 A
7 A 42 B 77 E
8 B 43 E 78 I
9 E 44 A 79 F
10 A 45 A 80 B
11 C 46 B 81 H
12 C 47 E 82 A
13 A 48 A 83 B
14 E 49 C 84 D
15 B 50 C 85 A
16 E 51 C 86 C
17 A 52 C 87 D
18 C 53 A 88 E
19 A 54 B 89 A
20 A 55 A 90 A
21 D 56 D 91 C
22 E 57 A 92 B
23 B 58 B 93 A
24 D 59 D 94 B
25 A 60 C 95 B
26 C 61 D 96 A
27 A 62 D 97 D
28 A 63 C 98 C
29 D 64 A 99 E
30 C 65 D 100 D
31 D 66 D
32 C 67 C
33 B 68 B
34 A 69 C
35 C 70 A
Gyn 3: Oncology (120 marks)

Choose the most correct answer: 4. A large ovarian mass is removed in a
perimenopausal patient. Signet ring cells
1. The following ovarian tumours is most are characteristic findings in which tumour
likely to result in virilization of a 35yrs old of the ovary:
woman: a) Brenner tumour
a) Brenner tumour
b) Krukenberg tumour
b) dysgerminoma
c) dermoid cyst
c) sertoli-leydig cell tumour
d) thecoma d) dysgerminoma
e) fibroma e) fibroma
2. A young girl presents with abdominal Questions from 5-9 are preceded by a list
distension and a mass. US & tumour of options. Select the SINGLE letter which
markers confirm a neoplastic origin. is most closely associated with the
Childhood neoplastic ovarian masses most condition. Each letter can be used once,
commonly originate from: multiple or not at all.
a) gonadal epithelium
a) adnexal torsion
b) germ cells
b) benign cystic teratoma
c) sex cords
c) leiomyoma
d) metastatic disease
e) none of the above d) endometrioma
e) ovarian fibroma
3. A 6yrs old girl has history of 2weeks f) theca lutein cysts
abdominal pain. She is taller than her g) distended bladder
peers with early breast development and
blood coming from introitus. Serum 5. A 35yrs old woman complains of
gonadotropin levels are in the prepubertal constant deep pelvic pain that worsens
range. Abdominal US shows a 7cm solid during menstruation and sexual
adnexal mass. The most likely diagnosis is: intercourse. Her vital signs are normal.
a) granulosa cell tumour Abdominal examination revealed
b) corpus luteum cyst tenderness with no rebound. Her PV
c) endometrioma revealed a tender 6cm left adnexal mass
d) fibroma
fixed to the uterus.
e) thecoma
6. A 25yrs old woman has an intense right Questions 12- 14: 40yrs old woman is seen
lower abdominal pain, nausea and for routine examination. Her menses are
vomiting. Her vital signs are normal. regular and she has no complaints. Pelvic
Abdominal examination shows right lower examination is normal. Her pap smear
quadrant tenderness. PV shows a tender shows HSIL:
5cm right adnexal mass. Uterus and left
adnexa are normal. Pregnancy test is
negative. 12. Which of the following options is the
best course of action?
7. A 35yrs old woman is seen for her annual a) immediate wide cuff hysterectomy
examination. Her menses are heavier now b) repeated pap smears at 3months
but regular. She experienced 3 intervals
sponteneous abortions in the last 5yrs. PV c) punch biopsy of anterior cervical lip
showed enlarged firm uterus.
d) colposcopy with biopsy
8. A 30yrs old woman with twin gestation is e) endocervical curettage
found to have bilateral adnexal masses at
26wks GA. 13. The colposcope permits one to do
which of the following:
9. A 45yrs old woman is found to have a
4cm adnexal mass, ascites and right pleural a) view the cervix at 1-4 power
effusion. magnification
b) see the entire transition zone in all
patients
10. Which of the following is the most c) choose the most suspicious areas on
common method used to diagnose CIN? the cervical portion to biopsy
a) complaints of abdominal discharge
d) treat invasive cancer with a biopsy
b) postcoital bleeding
c) chronic pelvic pain e) all of the above
d) congestive dysmenorrhea
e) abnormal Pap smear 14. This patient has biopsy proven CIN III.
She requests cryotherapy for treatment.
11. Which of the following reflects the Cryotherapy is appropriate to consider in
etiology of CIN and cervical cancer: which clinical circumstance:
a) HPV is the major causal agent a) CIN III
b) they are associated with obesity b) patient with well-circumscribed small
c) they are associated with nulliparity lesion of mild dysplasia CIN I
d) there is a strong genetic component
c) invasive carcinoma
to the development of cervical
d) HIV positive patient
cancer
e) all of the above e) patient desiring fertility
15. When sampling the cervix for a pap 18. The majority of deaths from cervical
smear, it is critical to sample which area carcinoma are due to which of the
since it is the most likely source of cervical following:
cancer: a) local spread obstructing the ureters
a) at the internal os causing renal failure
b) at the isthmus b) brain metastasis with resultant
c) in the endocervix cerebral hemorrhage
d) at the squamocolumnar junction c) hemorrhage into the pelvis from
e) at the external os
erosion of vessels by the tumour
Questions 16-17: 48yrs old woman d) pulmonary failure secondary to
presents for her routine annual metastatic disease filling the lungs
examination. Her previous pap smears e) liver metastasis and liver failure
were within normal. She is mildly
hypertensive on ttt. Her pelvic Questions from 19-20: 44yrs old
examination is within normal. Her last pap multiparous woman complaints of
smear reveals high grade squamous abnormal vaginal bleeding of 5months
intraepithelial lesion. A colposcopically duration. Pelvic examination
directed biopsy reveals invasive squamous demonstrates a small AVF uterus and a
cell carcinoma. normal appearing cervix. No adnexal
masses present. Pregnancy test is
16. Which of the following should be the negative. A cervical pap smear is normal.
most appropriate next step in the care of PRL and TSH are normal.
the patient?
a) metastatic evaluation 19. Which of the following is the most
b) conization
efficient next step in the evaluation of this
c) radical hysterectomy
d) radiation therapy patient?
e) palliative therapy a) endometrial biopsy
b) endometrial cytology
17. The woman had a negative metastatic c) transvaginalsonography
workup. Her clinical examination shows d) hysteroscopy
cancer growth. Which of the following is e) MRI
her preliminary clinical stage?
20. Tissue sampling in this patient reveals
endometrial hyperplasia. What is the most
common symptom associated with this
condition?
a) vaginal discharge
a) IA b) vaginal bleeding
b) IB c) amenorrhea
c) IIA d) pelvic pain
d) IIB e) contact bleeding
e) IIIA
21. A 49yrs old woman experiences 23. A 40 yrs old woman is found on PV to
irregular vaginal bleeding of 3months have enlarged uterus. US reveals well
duration. You perform an endometrial circumscribed intramural leiomyoma. The
patient asks about the incidence of
biopsy that showed proliferation of sarcomatous changes in leiomyoma:
glandular and stromal elements with a) <1%
dilated endometrial glands, consistent b) 3%
with simple hyperplasia & no cytologic c) 10%
atypia. Best way to advise her: d) 15%
e) 25%
a) she should be treated to estrogen
and progestin hormone therapy 24. The following postmenopausal women
b) the tissue will progress to cancer in is most protected from ovarian epithelial
approximately 10% carcinoma:
c) the tissue will progress to cancer in a) unmarried woman with a history of
breast cancer
approximately 25% b) nun with a history of late menopause
d) the tissue may be weakly c) nulliparous woman with a history of
premalignant and progresses to regular menses
cancer in approximately 1%
e) she requires a hysterectomy d) infertile woman with frequent use of
induction of ovulation medications
e) multiparous woman who used OCPs
22. A 58yrs old woman develops and now postmenopausal
postmenopausal bleeding. An endometrial
biopsy shows adenocarcinoma. She Questions from 25-30: Which germ cell
tumour is likely to produce the following?
undergoes a total abdominal
a) dysgerminoma
hysterectomy with pelvic lymph node b) endodermal sinus tumour
sampling. The final pathology shows c) choriocarcinoma
tumour extending from the uterus into the d) mature teratoma
e) strumaovarii
cervix but no other invasion. Lymph nodes f) f.granulosa cell tumour
were negative for metastasis. The cancer g) sertoli- leydig cell tumour
is classified as stage: 25. Thyroxine
a) CIS 26. Alpha-fetoprotein
b) I
27. HCG
c) II
28. Lactate dehydrogenase
d) III
29. Inhibin
e) IV
30. Androgens
31. A 32 yrs old sexually active female has 34. A 56yrs old female presents for a
ASCUS on Pap smear. Next step is: health maintenance examination, she has
a) colposcopic examination a history of a total hysterectomy for a
b) cone biopsy benign disease 4yrs ago. Pathology was
c) laser ablation of the cervix benign and that she had normal Pap smear
d) repeat Pap smear in 4-6months tests for 10yrs. The patient asks about
e) HPV testing regular Pap smears. Most appropriate
recommendations:
32. At routine physical examination, the a) routine Pap smear should be
Pap smear of a 27yrs old woman shows continued until 70
evidence of HSIL. Her last Pap smear b) Pap smear should be done every 3yrs
2years ago was normal. Pelvic c) Pap smear should be done every year
examination today is normal. She has d) Pap smear is not indicated
never been pregnant and her menstrual e) Pap smear should be done yearly for
periods are regular. She has been in a 3yrs and only if indicated thereafter
stable relationship with the same man for
3yrs and she uses a diaphragm with
35. 17yrs old sexually active female comes
spermicidal gel for contraception. Best
for routine visit. She has never had a Pap
next step is to:
test. You provide counseling regarding
a) advise the patient for condoms and
contraception and STDs and perform Pap
repeat the Pap smear in 3months
test (as insisted by the patient). The
b) do colposcopic examination of the
cervix after application of 5% acetic results show ASCUS. According of the
acid guidelines of Colposcopy and cervical
c) do conization of the cervix pathology. The most appropriate with
d) reassure the patient and repeat the regard the abnormal smear if HPV testing
Pap smear in 3months is unavailable:
e) treat patient with metronidazole for a) repeat Pap test in 6months
2weeks and repeat Pap smear in b) repeat Pap test in 12months
3months c) HPV DNA testing
d) colposcopy
33. A 27yrs old white female sees you for e) LEEP
the first time for a routine evaluation, a
Pap test reveals ASCUS. Which of the 36. A G3P2 woman at 8wks GA is found to
following is the most commonly found in have an ovarian cyst 6cm in size.
this situation? Appropriate management is:
a) CIN a) laparotomy
b) endometrial hyperplasia b) observation
c) endocervical polyp c) medications to shrink the cyst
d) endometrial cancer d) aspiration
e) ectopic decidua e) induction of abortion
37. A 5cm right ovarian cyst is found 41. A 65yrs old woman comes for routine
incidentally in a 22yrs old PG at 12wks GA. exam. Her LMP was 15yrs ago. She has not
Most likely diagnosis: been on ERT and now desires to start due
a) dermoid cyst to concerns about osteoporosis. O/E: you
b) mucinous cystadenoma
palpate a small uterus and palpable
c) endometrioma
d) follicular cyst ovaries bilaterally. Your next step in the
e) corpus luteum cyst management of this patient is:
a) start cyclic HRT for 16-25days
38. A 24yrs old female presents with b) start continuous HRT
abdominal discomfort. B-HCG is negative. c) pelvic ultrasound
Pelvic US shows a 5cm right ovarian d) DEXA
echolucent cyst with a uniformly thin e) exploratory laparotomy
rounded wall. What will be your next
step?
42. A 23yrs old asymptomatic woman is
a) perform immediate laparotomy
b) perform immediate laparoscopy seen for routine examination wz a 4cm
c) aspirate the cyst under diameter right sided cystic adnexal mass.
ultrasonographic guidance The appropriate management is:
d) order CBC and CA125 a) laparoscopy
e) expectant management and repeat b) transvaginal aspiration
ultrasound in 4-8weeks c) pelvic ultrasound examination
d) monophasic oral contraceptive
39. A 19yrs old healthy nuligravida comes e) reassessment in lmonth
to see you for her annual Pap smear. On
routine pelvic exam, you note that she has
a 5cm cystic non-tender mobile mass in 43. During routine physical examination of
her left adnexa. No abnormalities in the a 35yrs old female, you note a right
cul-de-sac. TVS results are consistent with adnexal fullness. She has had no
pelvic exam findings. Most appropriate symptoms of pain or bloating. Her menses
next step: occur 30days and her next period is
a) laparotomy with ovarian cystectomy expected in 1week. Pelvic US reveals a
b) repeat ultrasound in 2months thin walled simple cyst 5cm in diameter.
c) MRI scan of the pelvis Best management for this condition:
d) serum CA125
a) reassurance only
e) laparoscopy with ovarian cystectomy
b) checking for any increase in adnexal
40. A 60yrs old female with 5x5cm adnexal fullness at her next annual
mass. After a workup she is diagnosed examination
with ovarian cancer. Most appropriate c) repeat US in 2-3months to confirm
next step in management: resolution of the cyst
a) surgery d) referral for ultrasound guided
b) chemotherapy aspiration of the cyst
c) radiotherapy e) referral for laparoscopic removal of
d) hormone treatment
the cyst
e) expectant follow up
44. Which of the following concerning the 48. A 55yrs old postmenopausal female
diagnosis of an adnexal mass is false? presents with “period-like” vaginal
a) the diagnosis varies with the age of bleeding for 5days that stop
the patient spontaneously. Best approach to diagnosis
b) in childbearing age pt, a cystic mass
of this patient’s problem would be to:
of 5cm or less should be explored
immediately a) reassure the patient and manage
c) in young childbearing patients, most expectantly
neoplasms are germ cell in origin b) administer provera
requiring surgical exploration (medroxyprogesterone) 10mg for
d) in postmenopausal women, an 15days
adnexal mass should be considered c) administer cyclic estrogen plus
malignant until proven otherwise
progesterone
e) in patients in the reproductive age
d) order endometrial biopsy
period, a solid mass larger than 8cm
should be explored e) perform a Pap smear plus
endocervical curettage
45. A 6yrs old girl presents with vaginal
bleeding. Vaginal inspection reveals the 49. A 52yrs old woman presents to your
presence of a multicystic grape-like lesion. office complaining of vaginal bleeding. Her
What is the most likely diagnosis? last bleeding episode was 2years ago. She
a) sexual abuse
is not on HRT. Her hemoglobin is 13gm/dl.
b) DES exposure
c) sarcoma botryoids TVS shows her uterus and adnexae to be
d) clear cell adenocarcinoma of normal size and an endometrial stripe
e) exposure to exogenous estrogen of 11mm. Next step is:
a) hysterectomy
46. Risk factors of cervical carcinoma b) dilatation and curettage
include all the following EXCEPT: c) endometrial biopsy
a) HPV type 16-18 d) endometrial ablation
b) early age of first intercourse
e) intermittent progestin therapy
c) smoking
d) nulliparity
e) multiple sexual partners 50. A 52yrs old menopausal female sees
you because of vaginal bleeding for 3days
47. The only non sexual behavior that is in the preceding month since developing
consistently and strongly correlated with hot flushes 12months ago. She has taken
cervical dysplasia is: ERT. You perform an endometrial biopsy
a) alcohol consumption and the pathologist reports a histological
b) caffeine consumption
diagnosis of adenomatous hyperplasia
c) cigarette smoking
d) cocaine abuse with atypia. At this point, which one of the
e) high fat diet following would be most appropriate?
a) convert the patient to continuous control pills and takes no other

combined HRT by adding MPA on day medications, the following would be most
1 for 14days each month appropriate at this point:
b) convert patient to continuous a) pelvic ultrasound
combined HRT by adding MPA daily b) increasing the dosage of oral
while continuing estrogen daily contraceptive
c) discontinue the estrogen and c) changing to POPs
observe for recurrence of bleeding d) reassurance that the problem will
d) discontinue estrogen and prescribe resolve on its own
MPA for the next 3 months then e) laparoscopy
repeat the endometrial biopsy
e) hysterectomy 54. A 36yrs old G4P4 presents to your
office due to irregular vaginal bleeding.
51. The most frequently reported Her last delivery was 2yrs ago and
symptom for vulvar cancer is: uncomplicated. Since then, she has had
a) longstanding pruritis two normal periods but only intermittent
b) bleeding spotting and bleeding for the last
c) pain 7months. Pelvic exam demonstrates a
d) discharge normal sized uterus and adnexa. You
e) dysuria perform an endometrial biopsy to rule out
the possibility of malignancy. The biopsy is
52. When a woman less than 50yrs most likely to show:
develops vulvar cancer, the following is a) endometrial adenocarcinoma
most frequently present: b) adenomatous heperplasia with
a) HPV atypia
b) Lichen sclerosus c) adenomatous hyperplasia without
c) Diabetes mellitus atypia
d) Syphilis d) proliferative endometrium
e) LGV e) Arias Stella reaction
53. A 35yrs old white female presents with 55. Which of the following has the
a 6months history of irregular menstrual greatest effect on the relative risk of
bleeding. Before this, her periods occurred developing endometrial carcinoma?
every 30days and lasted 5days. Now they a) nulliparity
occur every 20days and last for 10days and b) infertility
are heavier than were previously. Physical c) obesity
examination and a Pap test are normal. A d) high socioeconomic status
pregnancy test is negative and a blood e) polycystic ovary syndrome
workup for organic causes of irregular
menses is also negative. She is on birth
56. A postmenopausal woman comes to 59. A 36yrs old female who was scheduled
your office for advice because her best to do routine Pap smear was reported to
friend has been diagnosed with
have ASCUS. Best next step in
endometrial cancer. The patient is
concerned that she too may develop the management:
disease. You tell her that risk factors a) repeat Pap smear at 6 and 12months
associated with endometrial cancer b) HPV testing and typing
include all the following EXCEPT: c) LEEP
a) nulliparity d) Cold-knife excision procedure
b) late menopause
c) DES exposure e) colposcopy with endocervical
d) obesity curettage
e) PCOD
60. A 30yrs old female presents to your
57. On routine yearly exam of an clinic for a follow-up. She recently did a
otherwise healthy 45yrs old woman, you
note a 1cm erosive ulceration on the lower pelvic ultrasound that revealed a 4cm
portion of the ectocervix. Which of the right-sided ovarian cyst. The patient is
following is the most appropriate next asymptomatic. Most appropriate next step
step? in management:
a) punch biopsy of the lesion a) ovarian biopsy
b) viral culture of the lesion for HSV
c) Pap smear of the cervix b) next month re-evaluation
d) dark field microscopy of a scraping of c) laparoscopy
the lesion d) order CA 125
e) cold knofe conization of the cervix e) repeat ultrasound in 8- 12weeks
58. An asymptomatic 24yrs old white

61. A 21yrs old woman presents with left
female comes to refill oral contraceptive
pills. A speculum examination is normal lower quadrant pain. An anterior 7cm firm
with the exception of a slightly friable well adnexal mass is palpated. Ultrasound
demarcated 1.4cm raised lesion involving confirms a complex left adnexal mass with
portion of the cervix. All previous Pap solid components that appears to contain
tests have been normal and she has no
a tooth. What percentage of these tumors
history of abnormal bleeding or
leukorrhea. Which of the following would is bilateral?
be most appropriate at this point? a) less than 1%
a) Pap test including a scraping of the b) 2-3%
erosion with routine follow-up till the c) 10%
patient is symptomatic
d) 50%
b) Pap test with follow-up in 3months if
results are normal e) greater than 75%
c) colposcopically directed biopsy
d) cone biopsy
e) topical antibiotic cream
62. A 54yrs old woman is scheduled for a) IIa

laparotomy due to a pelvic mass. At the b) IIb
time of exploratory laparotomy, a c) IIIa
unilateral ovarian neoplasm is discovered d) IIIb
that is accompanied by a large omental e) IV
metastasis. Frozen section diagnosis
confirms metastatic serous Questions 65-68: A 45yrs old G1P1
cystadenocarcinoma. Most appropriate presents for her routine annual
intraoperative course of action: examination. The patient is a healthy
a) excision of omental metastasis and smoker who has no medical problems. Her
ovarian cystectomy surgical H/O: cesarean delivery with
b) omentectomy and ovarian bilateral tubal ligation. You perform Pap
cystectomy smear which shows HSIL. She undergoes
c) excision of the omental metastasis colposcopy which is inadequate.
65. What is the next step in management?
and unilateral oopherectomy
a) repeat Pap smear in 6months
d) omentectomy and bilateral salpingo-
b) HPV testing
oopherectomy
c) cone biopsy
e) omentectomy, TAH and bilateral d) repeat Pap smear with co-testing in
salpingo-oopherectomy. lyear
63. A 68yrs old woman is seen for e) repeat colposcopy in 4-6months
evaluation of a swelling in the right
posterior aspect of her vaginal opening. 66. Cone biopsy of the cervix shows
She has noted pain in this area when squamous cell carcinoma that invades
walking and during intercourse. At the 2mm beyond the basement membrane
time of pelvic examination, a mildly with a lateral spread of 5mm. There is no
tender firm mass is noted just outside the evidence of lymphatic or blood spread.
introitus in the right vulva at The margins of the cone biopsy are free.
approximately 8 o'clock. Most appropriate What is the staging of this patient?
treatment:
a) marsupialization a) carcinoma in situ
b) administration of antibiotics b) microinvasive cancer stage la
c) surgical excision c) invasive cancer stage Ib
d) incision and drainage d) invasive cancer stage IIa
e) observation
67. Which LN would be the first involved
in metastatic spread of this disease
64. A 51yrs old woman is diagnosed with
beyond the cervix & uterus?
invasive cervical carcinoma by cone a) common iliac nodes
biopsy. PV & PR reveal the parametrium b) sacral nodes
to be free but the upper portion of the c) external iliac nodes
vagina is involved with the tumor. IVP and d) paracervical nodes
sigmoidoscopy are negative. This patient is e) para-aortic nodes
classified as stage:
68. This pt now asks for ur advice on how sonographic criteria would warrant further
to treat her cervical cancer, best evaluation for possible ovarian
recommendation is to undergo: malignancy:
a) treatment with external beam a) lack of pelvic ascites
radiation b) the presence of unilocular cyst in one
b) implantation of radioactive cesium ovary
into the cervical canal c) papillary projections within a cystic
c) extrafascial hysterectomy ovary
d) radical hysterectomy with pelvic d) an ovarian cyst with a diameter of
lymphadenectomy 4cm
e) treatment with adjuvant e) demonstration of arterial and venous
chemoradiation flow by Doppler imaging
69. A woman is found to have a unilateral 72. A 70yrs old woman presents for
vulvar carcinoma that is 3cm in diameter evaluation of a pruritic lesion on the vulva.
but not associated with LN spread. Initial Examination shows a white friable 3cm
management consist of: lesion on the Rt labia majorum.
a) chemotherapy No other suspicious areas. Biopsy of the
b) radiation therapy lesion confirms squamous cell carcinoma.
c) simple vulvectomy In this patient, lymphatic spread would be
d) radical vulvectomy with bilateral for:
lymphadenectomy a) external iliac lymph nodes
e) radical local excision and ipsilateral b) superficial inguinal lymph nodes
inguinal lymphadenectomy c) deep femoral lymph nodes
d) para-aortic lymph nodes
70. If the previous woman has medical e) internal iliac lymoh nodes
morbidities, the best management is:
a) chemotherapy 73. A 17yrs old girl is evaluated for a left
b) radiation therapy lower quadrant pain. The physician felt a
c) she should still undergo the same pelvic mass and ordered ultrasound. You
surgery recommended for a healthy are consulted because an ovarian
patient neoplasm is identified by US. The
d) simple vulvectomy commonest ovarian tumour in this
e) she should not receive any treatment patient:
and should be referred to hospice a) germ cell tumor
b) papillary serous epithelial
71. A 54yrs old woman presents for c) fibrosarcoma
routine checkup. On PV, you palpate an d) Brenner tumor
enlarged tender right adnexal mass and e) sarcoma botryoides
you order a pelvic US. The following
74. A 41yrs old woman undergoes 78. Call Exner bodies are found in:
exploratory laparotomy for a persistent a) dermoid tumours
adnexal mass. Frozen section reveals a b) granulosa cell tumours
serous carcinoma. Likelihood that the c) mature teratomas
contralateral ovary is involved is: d) serous cystadenoma
a) 5% e) theca cell tumours
b) 15%
c) 33% 79. A 64yrs old postmenopausal had a
d) 50% recent TVS revealing a 4cm right ovarian
e) 75% cyst that is multilocular with solid areas,
no free fluid, left ovary is normal and
75. A postmenopausal woman presents CA125 is 50. She has been explained of her
with a pruritic white lesion on the vulva. RMI is 450. The following ttt option best
Punch biopsy is obtained revealing lichen suits her:
sclerosus. Most appropriate treatment for
a) laparoscopy and bilateral salpingo-
this patient:
oopherectomy
a) topical estrogen
b) laparoscopy and righ salpingo-
b) wide local excision of the lesion
c) intralesional injection of oopherectomy
corticosteroids c) laparotomy and staging procedure
d) skinning vulvectomy (TAH+BSO+infracolic omentectomy)
e) topical corticosteroids d) MRI abdomen and pelvis
e) PET scan
76. The first malignancy that was
recognized linked to obesity is: 80. A 64yrs old postmenopausal had a
a) cervical adenocarcinomas recent US revealing a 4cm right echolucent
b) endometrial cancers ovarian cyst with no solid areas, no free
c) epithelial ovarian tumours fluid, left ovary is normal and her CA 125 is
d) germ cell tumours 5. best treatment option for her is:
e) gestational trophoblastic tumours a) discharge from carer
b) laparoscopy and unilateral or
77. The following about adenocarcinoma bilateral salpingo-oopherectomy
of the cervix are true EXCEPT: c) repeat TVS and CA125 after 3months
a) adenocarcinoma account for around d) repeat TVS and CA125 after one year
20% of cervical cancers e) US guided cyst aspiration
b) they are likely to be diagnosed in
younger women 81. The risk of contralateral LN
c) they are associated with delay in involvement in a laterally placed lesion of
diagnosis compared to squamous vulval cancer is:
carcinoma a) <1%
d) they are associated with a poorer b) 1-2%
prognosis in comparison to c) 2-4%
squamous type d) 3-5%
e) HPV 16 is commonly related to e) 5%
adenocarcinoma
82. The role of sentinel LN mapping is 87. Lichen sclerosus commonly presents in
most established in which gynecological the following age group:
malignancy: a) adolescent
a) cervical cancer b) postmenopausal
b) endometrial cancer c) premenarchal
c) ovarian cancer d) premenopausal
d) vaginal cancer e) reproductive age group
e) vulval cancer
For each of the clinical scenarios in
83. In the female pelvis, the ureter forms questions 88-90, choose the most useful
an important relation with the ovaries and investigations from the list of options,
lies: each option can be used once, more than
a) anterior to ovary once or not at all.
b) inferior to ovary a) CA 125
c) medial to ovary
b) cervical smear
d) lateral to ovary
c) CT scan
e) posterior to ovary
d) diagnostic laparoscopy
e) endometrial biopsy
84. Commonest cause of death from
f) FSH, LH, estradiol
gynecological malignancy in developed
countries: g) CBC
a) cervical cancer h) hysteroscopy
b) endometrial cancer i) MRI
c) ovarian cancer 88. A 55yrs old woman presents with
d) vaginal cancer postmenopausal bleeding. US shows a
e) vulval cancer normal uterus and ovaries with ET: 6mm.
89. A 42yrs old woman presents with an
85. The risk of endometrial cancer is
irregular cycle, her last cervical smear 1year
increased in the following condition:
ago was normal, no menorrhagia, US is
a) Asherman syndrome
normal and she wishes fertility.
b) Behcet syndrome
c) Ehlers-Danlos syndrome 90. A 45yrs old woman with HIV infection
d) Lynch syndrome presents with intermenstrual bleeding and
e) Marfan’s syndrome occasional contact bleeding.
86. The recommended first line of 91. A 64yrs old menopausal female has
treatment in Lichen sclerosus is: recently shown a 4cm ovarian cyst on TAS
a) antifingals (done for gall stones), the scan couldn’t
b) local antibiotics identify the other ovary as the bowel
c) local anesthetic creams obscured it. She is anxious that this may
d) tacrolimus be an ovarian cancer. The following
e) ultrapotent corticosteroids investigations are best done to investigate
this ovarian cyst:
a) CA125 95. In cases of cervical cancer, radical

b) CT abdomen and pelvis hysterectomy with bilateral pelvic
c) MRI lymphadenectomy can potentially be used
d) TVS with Doppler studies
e) TVS + CA125 to treat all the following stages of cervical
cancer EXCEPT:
92. A 32yrs old fit and well woman is using a) stage IA1
POPs for contraception, she has recently b) stage IA2 with lymphovascular space
diagnosed incidently with a 5.5cm right involvement
ovarian echolucent cyst. CA 125 is 5. She is c) stage IB1
very anxious about the prospect of
d) stage IIA
surgery. She has been risk assessed for
VTE and is at low risk for using COPs. Best e) stage IIB
ttt for her:
a) offer COPs for 3 cycles then repeat 96. A 47yrs old patient with a history of
US severe endometriosis is found to have a
b) offer laparoscopic ovarian left sided 10cm unilocular cystic mass with
cystectomy
a solid component arising from its wall. CT
c) repeat US 3-6months later unless
symptomatic supports this finding and CA125 is 300.
d) reassure and discharge from care These findings raise suspicion of:
e) stop POPs as it is associated with a) endometrioid carcinoma
ovarian cysts. b) mucinous cystadenoma
c) mucinous cystadenocarcinoma
93. The preferred period of intervention
d) serous cystadenoma
for an ovarian mass in pregnancy is:
a) 8weeks e) granulosa cell tumour
b) 10weeks
c) 12weeks 97. A 40yrs old patient has had a cervical
d) 14weeks smear showing moderate/severe
e) 20weeks dysplasia. Colposcopic examination and
history confirms CIN2 and she opts for TAH
94. A 60yrs old patient who underwent
TAH+ BSO for a benign disease is found to as her family is complete. Histopathology
have an exophytic 1cm nodule in the confirms completely excised CIN. Most
upper vagina. Biopsies obtained appropriate follow up:
demonstrates an adenocarcinoma. This is a) no cytology follow up required
most likely: b) vault smear 6 and 12months after
a) primary vaginal cancer
treatment
b) DES associated clear cell
adenocarcinoma c) vault smear 6, 18months after
c) metastasis treatment
d) Paget’s cells are most likely present d) vault smear 3, 6 and 12months after
upon review of the microscopic treatment
pathology slides e) vault smear annually for 9years
e) previous gynecologic cancer was
missed at the time of TAH+ BSO
98. A 66yrs old patient presented with 101. A 55yrs old patient has had a
vulval pruritis. O/E there was a 1.5cm colposcopic examination for a suspicious
lesion on her right labia majora with an well circumscribed vulval lesion. VIN3 is
irregular border and it was tender to identified at histopathology. Best next
touch. An excision biopsy showed
step:
squamous cell carcinoma with positive
margins and invasive disease to 0.8mm. a) 5-flurouracil cream
Most appropriate next step: b) imiquimod cream 5%
a) chemotherapy c) local excision
b) radiotherapy d) local destruction by Laser
c) right hemivulvectomt with ipsilateral e) vulvectomy
groin lymphadenectomy
d) wide local excision 102. A 65yrs old patient underwent TAH+
e) wide local excision plus sentinel BSO for a suspicious 8cm right ovarian
lymph node biopsy
mass and normal CA125. She had
99. A 60yrs old patient presents with originally presented with postmenopausal
3months history of intermittent vaginal bleeding. Frozen section shows Call-Exner
bleeding, she has been menopausal since bodies. Likely the pathology specimen will
55yrs old. She is fit and well. Vaginal demonstrate:
bleeding was sudden in onset heavy with a) Brenner cell tumour
passage of blood clots and intermittent b) clear cell carcinoma of the cervix
lower abdominal pain, no potcoital c) endometrial hyperplasia
bleeding, weight loss or anorexia and she d) mucinous ovarian carcinoma
is not on HRT. TVS shows ET: 15mm,
e) serous adenocarcinoma
pipelle biopsy confirms endometrial
adenocarcinoma. At TAH+ BSO, the left
ovary was nooted to contain solid tumour. 103. A 25yrs old nulliparous who wishes to
Most likely diagnosis: preserve future fertility, underwent
a) granulosa cell tumour cervical conization after an unsatisfactory
b) dysgerminoma colposcopy. Conization specimen
c) embryonal cell carcinoma demonstrates an invasive carcinoma of
d) endodermal sinus tumour the cervix infiltrating 2.5mm below the
e) mucinous cystadenoma basement membrane. There was no
evidence of lymphovascular space
100. A 15yrs old patient presents with left
lower abdominal pain. US show a 10cm involvement and the margins of the cone
solid ovarian mass. LDH is elevated with a were free of dysplasia or carcinoma. Best
normal AFP and HCG. Most likely management:
diagnosis: a) external beam radiotherapy
a) dysgerminoma b) external beam radiotherapy followed
b) embryonal cell carcinoma by brachytherapy
c) mucinous cystadenocarcinoma c) no further therapy
d) serous cystadenocarcinoma d) radical hysterectomy
e) yolk sac tumour
e) simple hysterectomy
104. A 45yrs old patient is found to have a a) ascites

large cervical cancer infiltrating into the b) at least four papillary structures
right parametrium. PV and PR suggests c) irregular solid tumour
parametrial involvement although not d) presence of acoustic shadowing
reaching the lateral pelvic wall. Chest X- e) very strong blood flow
Ray and cystoscopy were clear. What
stage of disease is that?
a) stage IIA 107. A 14yrs old girl is diagnosed with an
b) stage IIB early stage yolk sac tumour, she
c) stage IIIB undergoes surgery and is completely
d) stage IVA treated. Which tumour marker is used for
e) stage IVB surveillance?
a) CA125
105. A 24yrs old para 1 presents with 6hrs b) CEA
history of Rt lower quadrant (RLQ)
c) AFP
intermittent severe pain with nausea and
vomiting. She denies change in bowel d) CA19.9
habits and she is currently menstruating. e) LDH
O/E: she is mildly tachycardic and has
tenderness on RLQ. Urine pregnancy test 108. In a woman undergoing exploratory
is negative and urine dipstick is negative surgery for staging of ovarian cancer,
for blood and white cells. PV: normal biopsies from the retroperitoneal lymph
cervix, normal sized uterus, no cervical
nodes are taken. What is the site of 1ry
motion tenderness and there is palpable
mass in the right adnexa which is tender lymphatic drainage from the ovaries?
on palpation. TVS: normal uterus and left a) external iliac LN
ovary and right ovary measures 7x5cm b) superficial inguinal LN
with cystic and solid component and c) deep inguinal LN
calcification. Color Doppler is inconclusive. d) para-aortic LN
Next best step:
e) hypogastric LN
a) laparoscopy
b) laparotomy
c) MRI 109. A 60yrs old nulliparous woman is
d) observation and symptom relief incidently found to have an ovarian cyst
e) repeat TVS 5cm on US. Next step is:
a) repat scan in 6months
106. In 2013, the international ovarian
b) CA 125
tumour analysis group published the
largest study investigating the use of US to c) surgery by general gynecologist
differentiate between benign and d) laparoscopic surgery
malignant ovarian masses. The following e) oncology tema consultation
rule would NOT suggest a malignant
process:
110. What kind of personal or family 114. A 30yrs old nulliparous woman has
history would you expect to find in a cervical smear showing LSIL, this is her
woman with lichen sclerosus? first abnormal smear, appropriate
a) cancers management is:
b) abnormal cervical cytology a) offer prophylactic vaccination
c) cystic fibrosis b) refer to a colposcopy clinic
d) autoimmune diseases c) refer to colposcopy clinic if she tests
e) gluten intolerance positive for HPV
d) repeat smear in 6months
111. A woman is diagnosed with VIN on e) repeat smear in 24months
skin biopsy of her vulva. What kind of
lesion could this develop into long term? 115. A 35yrs old woman presents to OPD
a) squamous cell carcinoma with left iliac fossa pain. TVS shows a 9cm
b) adenocarcinoma unilateral left ovarian mass septated with
c) basal cell carcinoma echogenic foci. The right ovary can't be
d) Kaposi sarcoma indentified separately and the uterus
e) T-cell lymphoma appears normal. Most appropriate tumour
markers to be done:
112. Which type of HPV is strongly related a) CA125, AFP, HCG
to cervical cancer? b) CA125, AFP, HCG, CEA
a) HPV type 16 c) CA125, AFP, HCG, LDH
b) HPV type 2 d) CA125, CEA, CA19.9
c) HPV type 11 e) CA125, CEA, LDH
d) HPV type 6
e) HPV type 21 116. A 32yrs old woman with dull lower
abdominal pain and bloating had pelvic US
113. Certain factors are protective for the showing echolucent 3cm right sided
occurrence of endometrial cancer. What in ovarian cyst. Best next step is:
the personal history is a protective factor a) arrange for repeat scan in 4months
for endometrial cancer? b) arrange for repeat scan in one year
a) early menarche c) arrange further imaging with MRI/CT
b) obesity d) check serum CA125
c) early menopause e) reassure and discharge
d) nulliparity
e) old age
117. A 52yrs old woman has recently been

diagnosed with CIN3 following severe HSIL
on cervical smear. LLETZ shows CIN3
incompletely excised at the endocervical
margin. Best next step:
a) colposcopy and smear in 6months
b) loop excision immediately
c) loop excision in 6months
d) smear in 6months
e) smear and HPV DNA testing in
6months
Questions 118-120: select management

option from the list that is most
appropriate as the next step in the ttt of
the patient described. Each lettered
option may be used once, more than once
or not at all.
a) perform a cone biopsy of the cervix
b) repeat the Pap smear to obtain
endocervical cells
c) perform hysterectomy
d) perform colposcopically directed
biopsy
e) repeat Pap smear in one year
f) perform colposcopy, endometrial
biopsy and endocervical curettage
118. A 23yrs old woman presents for a

routine annual examination. Her Pap smear
shows HSIL.
119. A 55yrs old postmenopausal woman

has a Pap smear that returns as ASCUS.
120. A 28yrs old NG with a LSIL Pap smear

undergoes colposcopy directed biopsies
showing CIN III.
ANSWERS
1 C 36 B 71 C 106 D
2 B 37 E 72 B 107 C
3 A 38 E 73 A 108 D
4 B 39 B 74 D 109 B
5 D 40 A 75 E 110 D
6 A 41 C 76 B 111 A
7 C 42 C 77 E 112 A
8 F 43 C 78 B 113 C
9 E 44 B 79 C 114 C
10 E 45 C 80 C 115 C
11 A 46 D 81 A 116 E
12 D 47 C 82 E 117 B
13 C 48 D 83 E 118 D
14 B 49 C 84 C 119 F
15 D 50 E 85 D 120 A
16 A 51 A 86 E
17 C 52 A 87 B
18 A 53 A 88 E
19 A 54 D 89 F
20 B 55 E 90 B
21 D 56 C 91 E
22 C 57 A 92 C
23 A 58 C 93 D
24 E 59 E 94 C
25 E 60 E 95 E
26 B 61 C 96 A
27 C 62 E 97 C
28 A 63 C 98 D
29 F 64 A 99 A
30 G 65 C 100 A
31 A-E 66 B 101 C
32 B 67 D 102 C
33 A 68 C 103 C
34 D 69 E 104 B
35 A 70 B 105 A
Gyn 4: Infections (70 marks)

I. Choose the most correct answer: 3. A 29yrs old G0 complains of thin grayish
white vaginal discharge with slight fishy
1. On annual examination, a patient odor. She reports no vulvar pruritis or
expresses concern regarding possible burning. She admits to be sexually active
exposure to STDs. PV shows a single in the past but has not had intercourse
indurated non tender ulcer on the vulva. during the past year. She has no STDs and
VDRL and FTA tests are positive. Without the only medication she takes are OCPs.
treatment. The next stage of this disease is Last month, she took a course of
clinically characterized by: amoxicillin for the ttt of sinusitis. O/E:
a) optic nerve atrophy and generalized vulva appears normal. There is a discharge
paresis at the introitus. A copious thin whitish
b) tabes dorsalis discharge at the vaginal vault. The vaginal
c) gummas ph is 5.5. The cervix is not inflamed and
d) macular rash over the hands and feet there is no cervical discharge. Wet smear
indicates the presence of clue cells. Most
e) aortic aneurysm
likely diagnosis:
a) candidiasis
2. A 24yrs old patient recently emigrated
b) bacterial vaginosis
from the tropics. Four weeks ago she
c) trichomoniasis
noted vulvar ulceration that
d) physiological discharge
spontaneously healed. Now there is
e) chlamydia
painful inguinal adenopathy associated
with malaise and fever. You are
4. In the patient described earlier, the best
considering the diagnosis of LGV.
treatment is:
Diagnosis can be established by:
a) reassurance
a) staining for Donovan bodies
b) oral diflucan
b) the presence of serum antibodies to
c) doxycycline 100mg PO twice daily for
Chlamydia trachomatis 1week
c) positive Frei skin test d) ampicillin 500mg PO twice daily for
d) culturing Haemophilus ducreyi 1week
e) culturing Calymmatobacterium e) metronidazole 500mg PO twice daily
granulomatis for 1week
5. A 20yrs old G2P0 (0020) with a LMP 7. A 23yrs old woman presents with foul
5days ago presents to ER with increasing smelling vaginal discharge. She is not
pelvic pain of a day duration. This morning sexually active. A wet mount/KOH prep
she experienced chills and fever but show clue cells. The likely diagnosis is:
temperature is not recorded. No changes a) Candida
in her bladder or bowel habits. She has b) Bacterial vaginosis
had no vomiting but has not been able to c) Trichomonas
tolerate liquids. No medical problems but d) Chlamydia
only laparoscopy last year for an ectopic e) Gonorrhea
pregnancy. She reports regular menses
without dysmenorrhea. She is currently 8. You see an asymptomatic pregnant
sexually active and had intercourse just woman at 14wks wz history of preterm
prior her LMP. No history of abnormal Pap labor at 33wks. Vaginal swab show
smear or STDs and urine pregnancy test is bacterial vaginosis. Appropriate ttt is:
negative. Urine analysis is normal. WBC is a) oral metronidazole
18.000. Temperature is 38.8. O/E: her b) vaginal clindamycin
abdomen is diffusely tender in the lower c) no treatment
quadrants with rebound and voluntary d) oral tinidazole
guarding. Bowel sounds are present but e) IV ceftrioxone
diminished. The most likely diagnosis:
a) ovarian torsion 9. Vaginal discharge which is fishy odor
b) endometriosis with >20% clue cells on microscopy will
c) PID NOT be associated with which of the
d) kidney stone following?
e) ruptured ovarian cyst a) due to Gardenerella vaginalis
overgrowth
6. For this patient, the most appropriate b) can be treated with metronidazole or
initial antibiotic treatment regimen: clindamycin
a) doxycycline 100mg PO twice daily for c) may see hyphae or spores with
14days additional of KOH
b) clindamycin 450mg IV/ 8hrs + d) vaginal ph is higher than 4. 5
gentamycin 1mg/kg load followed by e) is rarely associated with inflamed or
1mg/kg every 12hrs itchy vulva
c) ceftrioxone 250mg IM plus
doxycycline 100mg PO twice daily for 10. A 30yrs old black female presents with
14days a vaginal discharge. On examination the
d) cefoxitine 2g IV every 6hrs with discharge is homogenous with a pH of 5.5,
doxycycline 100mg IV twice daily a positive whiff test and many clue cells.
e) ofloxacin 400mg PO twice daily for Which is most specific for bacterial
14days plus flagyl 500mg PO twice vaginosis?
daily for 14days
a) ph of discharge 14. A 31yrs old female complains of

b) presence of clue cells malodorous itchy vaginal discharge.
c) character of the discharge Speculum show yellow discharge, vaginal
d) whiff test erythema and strawberry cervix. The most
e) age of the patient likely diagnosis is:
a) candida vaginitis
11. The most useful in preventing vertical b) bacterial vaginosis
transmission of HIV infection is: c) trichomonal vaginitis
a) zidovudine for both mother and d) chlamydia infection
fetus e) herpes simplex type 2
b) vitamin A supplementation for both
mother and fetus 15. A 20yrs old college student presents
c) vaginal cleaning with chlorhexidine with lower abdominal pain and fever. O/E:
d) minimizing the frequency of bilateral abdominal tenderness. PV shows
cesarean section tenderness with cervical mobilization and
e) breastfeeding for the first month of her pregnant test is negative. What is the
life most likely diagnosis?
a) acute salpingitis
12. A 24yrs old sexually active woman b) ectopic pregnancy
presents with frothy vaginal discharge, a
c) UTI
wet mount and it shows trichomonas
d) trichomonas
vaginalis. What is the best treatment?
e) appendicitis
a) metronidazole
b) ceftrioxone
c) doxycycline 16. A 16yrs old sexually active NG
d) topical antifungal complains of pelvic pain and vaginal
e) miconazole discharge. O/E: her temp is 39.8, pain on
moving cervix, mass and tenderness in
13. You diagnose trichomonus vaginitis in right adnexa. According to CDC, most
a 25yrs old white female and treat her and appropriate treatment is:
her partner with metronidazole 2g single a) outpatient ttt with penicillin IM,
dose. Most appropriate treatment at this doxycycline oral for 14days and
time: reexamine in 3days
a) metronidazole gel 0.75% b) outpatient ttt with ceftrioxone IM,
intravaginally for 5days doxycycline bid/14days and
b) metronidazole 2g orally plus reexamine in one week
metronidazole gel 0.75% c) outpatient ttt with ceftrioxone IM,
intravaginally for 5days doxycycline bid/14days and
c) metronidazole 500mg orally twice reexamine in 10days
daily for 5days d) hospitalization for ttt with cefoxitine
d) sulfadiazine 4g orally single dose plus IV and doxycycline oral twice daily
pyrimethamine 200mg orally single for 14days
dose e) hospitalization for ttt with
e) clindamycin cream 2% intravaginally ceftrioxone IM single dose,
for 7days doxycycline oral for 14days
17. A 24yrs old female wz multiple sex 20. A 32yrs old woman wz many sex
partners, presents with lower abdominal partners, presents in ER with fever, nausea
pain, dyspareunia and vaginal discharge. and vomiting for 1week. Her LMP was six
There is tender cervix on motion, 8wks weeks ago. Temp: 39, HR: 82, BP: 90/60
enlarged uterus. No adnexal masses. An and RR: 24. On exam, there is tenderness
indication for hospitalization and parentral and rebound on lower abdomen and
therapy is:
pelvis. US shows abscess in pelvic region.
a) no improvement with 24hrs
Best next step in management is:
outpatient antibiotics
a) admit and give IV cefoxitine and
b) a previous history of PID
c) and elevated ESR and WBC count doxycycline
d) laboratory confirmation of gonorrhea b) admit and give ceftrioxone and oral
or chlamydia infection doxycycline
e) pregnancy c) discharge the patient and advise
follow up in one week
18. PID is characterized by all the following d) discharge the patient and prescribe
EXCEPT: IM cefoxitine and oral doxycycline
a) leukocytosis e) prepare for laparoscopy
b) pelvic pain
c) fever 21. Vaginismus is:
d) anemia a) vaginal tightness causing pain and
e) cervical motion tenderness
inability to have intercourse
b) painful sexual intercourse
19. A 26yrs old female presents with dull
c) pain during menstruation
aches in lower abdomen and pelvis for
2wks. There is no discharge. She had d) pain during introduction
multiple sexual partners and does not use e) when no hymenal opening is present
condoms. BP: 110/65, pulse: 80/min and
temp: 38.5. On PV there is tenderness on 22. Which of the following best describes
moving cx but no masses. Pregnancy test vaginismus?
is positive. The best next step in a) dyspareunia caused by a structurally
management of this patient is: small vagina
a) treat her with penicillin as outpatient b) voluntary contraction of the vaginal
b) admit the patient and treat with muscles to prevent penetration
levofloxacin and doxycycline c) involuntary contraction of the vaginal
c) admit the patient for laparoscopy and pelvic floor muscles
d) treat her with IM ceftrioxone and d) condition associated with general
azithromycin as outpatient
sexual and orgasmic inhibition
e) admit her and treat her with IV
e) superficial dyspareunia
cefoxitin and oral azithromycin
23. A cyclist woman develops swelling in 27. A patient with gonorrhea was treated
posterolateral aspect of her labia. The with ceftrioxone. No improvement of
area is painful and red. The most likely symptoms. What is the most likely reason
diagnosis is: and most appropriate management?
a) hematoma a) chlamydia, doxycycline
b) syphilis, penicillin
b) Bartholin cyst
c) herpes, acyclovir
c) Gartner duct cyst d) UTI, ciprofloxacin
d) lipoma e) reinfection, same treatment
e) sebaceous cyst
28. A 23yrs old female has her partner
24. Mixing vaginal discharge with KOH recently treated for gonorrhea. Her LMP
creates an odor that is helpful in was 6wks ago. Her testing for Chlamydia is
diagnosing: negative but positive for gonococcal.
a) bacterial vaginosis Pregnancy test is positive. According to
b) trichomoniasis guidelines, the best treatment plan for
gonococcal infection is:
c) candidiasis
a) ofloxacin 400 mg orally
d) gonorrhea b) ceftrioxone 250 mg IM single dose
e) chlamydia c) azithromycin 2g orally single dose
d) doxycycline 100mg twice daily for
25. A sexually active woman presents with 7days
dysuria and vaginal discharge. All the e) doxycycline 100mg wtwice daily for
following may be the cause EXCEPT: 14day
a) gonorrhea
b) chlamydia 29. You have just treated gonorrhea
cervicitis in a 24yrs old female in her
c) trichomoniasis
second trimester. The patient is concerned
d) condyloma acuminate that the gonorrhea may predispose her to
e) polymicobial infection stillbirth. Most appropriate:
a) stillbirth related to gonorrhea is very
26. The best site for smear to diagnose rare and special monitoring is not
gonorrhea in a woman with vaginal needed
b) perform fetal monitoring and serial
discharge is:
vaginal cultures starting at 32weeks
a) vulva gestation
b) vagina c) perform monthly vaginal cultures for
c) cervix gonorrhea starting at 24weeks
d) endometrium gestation
e) anus d) administer ciprofloxacin weekly until
delivery
e) termination of pregnancy
30. A 20yrs old patient has frequency and 34. A 24yrs old female presents for her
dysuria. PV reveals yellow cervical annual examination. She is single and had
discharge and mild adnexal tenderness. several male sexual partners during the
The best test to aid diagnosis is: past year. The screening for chlamydia is
a) culture and Gram stain of a cervical positive but she is asymptomatic. Which of
smear
the following is true concerning her
b) peripheral leukocyte count
situation?
c) neuclic acid amplification tests
(NAAT) a) failure to treat this patient would
d) cervical culture on Thayer Martin place her at risk of later infertility
medium b) only sexual partners during the last
e) dipstick urine analysis of specimen week need to be treated
obtained by bladder catheterization c) she should avoid sexual intercourse
for 1month of treatment
31. A 25yrs old woman is 17wks pregnant. d) use barrier methods for
She had positive history of genital HSV contraception increases her risk for
infection. The current best management of repeat infection
this patient is: e) follow up and if symptoms appear,
a) daily application of topical acyclovir
treatment may be given
to site of previous lesions
b) cesarean section only if herpes
culture is positive 35. Appropriate treatment for chlamydia
c) cesarean section if lesions are infection during second trimester:
present at time of labor a) azithromycin
d) elective cesarean section at 38weeks b) doxycycline
in all cases c) metronidazole
e) vaginal delivery in all cases d) levofloxacin
e) tinidazole
32. TTT of uncomplicated cervical infection
caused by chlamydia trachomatis is: 36. A 24yrs old female has genital herpes
a) azithromycin 1g orally in her 25th week gestation. The following
b) doxycycline 200mg orally
is true:
c) amoxicillin 2g orally
a) she has a high likelihood of
d) cefixime 400mg orally
e) metronidazole 2g orally miscarriage
b) she should be treated with antiviral
33. The following is indicated for therapy for 7-14days
treatment of chlamydia urethritis during c) she should be scheduled for cesarean
pregnancy: section at term
a) ciprofloxacin d) she should be advised against
b) doxycycline breastfeeding her infant
c) erythromycin base e) she should terminate her pregnancy
d) ofloxacin immediately
e) metronidazole
37. A 28yrs old female presents with 40. The commonest cause of abnormal
severely painful mass on her vulva. Vital vaginal discharge in a sexually active 19yrs
signs are normal. She has a tender red 6cm old is:
mass in the post right labia majora. TTT of a) candida albicans
choice is: b) trichomonas vaginalis
a) marsupialization of the lesion c) staphylococcus
b) surgical excision d) group B streptococcus
c) surgical gland removal e) mixed vaginal flora
d) incision and packing with iodoform
gauze 41. A 54yrs old female presents with
e) incision and drainage with a word intense pruritis vulvae which didn't
catheter improve with topical antifungal ttt. O/E:
there is a white thickened excoriated skin.
38. A 17yrs old girl presents for routine Punch biopsy reveals lichen sclerosus. TTT
examination. O/E: you note several raised of choice of this condition is topical
fleshy flat topped lesions on vulva and application of:
vaginal. No discharge. Her inguinal nodes a) conjugated estrogens
are slightly tender. She has generalized b) fluorinated contricosteroids
maculopapular rash. She gives history of a c) petroleum
painless labial ulcer that resolved 2months d) 2% testosterone
ago. The best treatment for this patient is: e) fluorouracil
a) laser ablation of the vulvar and
vaginal lesions 42. 24yrs old woman presents to ER with
b) trichloroacetic acid application of the pelvic pain and vaginal discharge. O/E: she
vulvar and vaginal lesions has fever 38 with moderate lower
c) benzathice penicillin G 2.4million abdominal tenderness. PV confirms
units IM one dose bilateral adnexal and cervical motion
d) benzathice penicillin G 2.4million tenderness. The following clinical features
units IM weekly for 3doses are NOT suggestive of PID:
e) acyclovir 400mg PO 5times per day a) lower abdominal pain which is
for 14days typically bilateral
b) deep dyspareunia
39. The following HPV types are commonly c) congestive dysmenorrhea
associated with condyloma accuminata: d) abnormal vaginal or cervical
a) 6/11 discharge which is often purulent
b) 16/18 e) lower abdominal pain which is
c) 31/33 typically unilateral.
d) 39/45
e) 1/3
43. Some procedures are recommended in 45. A 26yrs old woman has recently been
routine gynecological examination. The diagnosed with HIV. Her GP notices her
following is not appropriate: first smear last year was negative and asks
you about the frequency of cervical
a) presence of a chaperone is
smears for this woman. How often should
considered essential her cervical smears be undertaken?
b) if the patient decline the presence of a) every 6 months
a chaperone, the doctor should send b) every 6 months for 2 years, then
the chaperone out of the room routine recall
c) the consent for the examination c) annually
d) every 3 years
should be obtained in the presence
e) every 5 years
of the chaperone
d) verbal consent should be obtained in 46. A 40yrs old woman underwent LLETZ.
the presence of the chaperone Histology report showed incomplete
e) whenever there is an indication for removal of CIN3. Antibiotic ttt given and
breast examination, verbal consent follow up smear and HPV testing at
6months are negative. The correct follow
should be obtained in the presence
up:
of a chaperone a) annual smear for 10years
b) smear and HPV testing at 6months
44. A 26yrs old woman presents wz new c) smear and HPV testing at 12months
onset vaginal discharge. She is sexually d) smear and HPV testing at 3years
e) smear and HPV testing at 5years
active and uses condoms for protection
against STDs although she is using pills 47. A 37yrs old woman presents with
regularly for the last 6months. She has 2 metrorrhagia and chronic pelvic pain. She
partners and she is worried because she is sexually active and reports one new
has spotting after sexual intercourse in the sexual partner in the last year. She uses
last few weeks. Her Pap smear done last condom for contraception. US is normal,
endometrial biopsy performed revealing
year was normal and speculum
leukocytic infiltration with plasma cells.
examination reveals an erythematous The most appropriate course of action:
raw-looking cervix. Most likely diagnosis: a) doxycycline 100 mg orally twice daily
a) aphthous ulcer for 14days
b) bacterial vaginosis b) insertion of LNG-IUS
c) cervical polyp c) hysteroscopy
d) total abdominal hysterectomy
d) chlamydia
e) cefoxitine 2g IV every 6hours
e) ectropion
48. A 21yrs old sexually active woman inner labia majora and minora with small
comes for her first gynecological areas of excoriation. You recommend:
examination. She has regular menses with a) punch biopsy of vulvar skin
some mild dysmenorrhea. During b) topical high-potency steroids
speculum examination, you observe a c) laser vaporization of affected area
small raised 5mm lesion on her non tender d) prolong course of antifungal
cervix, lesion is smooth, light-bluish and e) topical estrogen cream
looks like a bubble under the cervical
epithelium. She has no medical problems. 51. The following is not true regarding
Most likely diagnosis: Neisseria gonorrhea:
a) Bartholin cyst a) almost half of the cases with
b) Cervical dysplasia gonorrhea may be asymptomatic
c) Nabothian cyst b) heavy menstrual bleeding is a known
d) Skene gland cyst symptom
e) Chlamydial cervicitis c) Neisseria gonorrhea is Gram-
negative bacilli
49. A 68yrs old woman presents with d) pharyngitis, meningitis and
vulvar pruritis for lyear. She tried anti- endocarditis are known
fungal ttt with partial improvement but presentations
recurrence of symptoms. She had e) postcoital or intermenstrual bleeding
menopause at 49yrs old and not sexually can be seen in cases with cervicitis
active for 10yrs. She does not use
douching products and not taking 52. In evaluation and management of
antibiotics. O/E: thin white epithelium of women with vaginal discharge, the
the labia minora with red oval-shaped following is INCORRECT:
erosions of 0.5- 1.5cm. Next step:
a) culture the vagina and treat with a) allergic reactions can cause excessive
high dose antifungal vaginal discharge
b) wide local excision of the lesions b) douching the vagina as part of daily
c) cryotherapy to eradicate the lesion hygiene helps reduce vaginal
d) punch biopsy of the vulvar lesion discharge
e) prescription of moderate-high c) exclusion of infective and other
potency topical sterioids causes can help confirm that a
vaginal discharge is physiological
50. A 40yrs old woman complains of vulvar d) there is some association between
pruritis for 1year and increasing severity in methods of contraception and
last 3months. She took oral and topical vaginal discharge
antifungal and had vulvar biopsy 3months e) women with cervical ectopy may
ago showing lichen simplex with no complain of increased physiological
infection, VIN or malignancy and she discharge
applied low-potency steroids with partial
improvement. O/E: thick epithelium of the
Questions from 53- 57 represents clinical 58. The following is correct in relation to
characteristics to particular STDs, from the syphilis:
list of options, choose the most fitting a) identified preferentially by culture of
organisms from the list of options, each genital ulcer exudates in artificial
option can be used once, more than once media
or not at all: b) dark field microscopy of genital ulcer
(chancre) exudates is non-diagnostic
a) candida albicans c) antibacterial ttt in early pregnancy
b) gardnerella vaginalis does not prevent congenital syphilis
c) chlamydia trachomatis d) 1ry syphilis is associated with
d) group B streptococcus mucocutaneous rash
e) hemophilus ducreyi e) 2ry syphilis is associated with
f) hepatitis B generalized lymphadenopathy
g) herpes simplex virus
h) HIV 59. The single largest cause of acquired
i) HPV tubal pathology is:
j) LGV a) acinobacter
k) mycoplasma hominis b) bacterial vaginosis
l) neisseria gonorrhea c) chlamydia trachomatis
m) syphilis d) group A streptococcus
n) trichomonas vaginalis e) mycobacterium tuberculosis
53. Specifically targeted by national 60. A 26yrs old woman complains of

vaccination programme with vaccine given dyspareunia. She has painful period for
to girls aged 12-13yrs the past year, the pain increased lately
and she has some vaginal dischager that is
54. Vesicular lesions appear within 7days
not foul smelling and not associated with
and lead to painful shallow ulcers
pruritis. She is becoming irritable during
55. Associated with vaginal ph>4. 5, clue her periods. Speculum examination
cells and fishy amine odour reveals blue nodules in the vagina. Most
likely diagnosis:
56. Associated with microscopic motile a) bacterial vaginosis
throphozoites and vaginal ph>4. 5 b) cervicitis
c) endometriosis
57. Itchy white vaginal discharge with
d) pelvic inflammatory disease
vaginal ph<4. 5
e) vulvovaginitis
61. A 25yrs old para 0 who has recently 64. Bacterial vaginosis infection can cause
become sexually active, is complaining of a smelly vaginal discharge. A patient is
new onset vulval pain, she descreibes pain keen to know more about this. What
with light touch particularly on intercourse would you advise about nature of
and when using tampons and she localizes infection?
it to around the vulva. The pain is not a) it is a sexually transmitted infection
present at other times. She does not b) it is rare in women in the same sex
report any itching, soreness or unusual relationship
c) it increases the risks of acquiring
discharge. Most likely diagnosis:
other STDs
a) lichen sclerosus et atrophicus
d) most women will experience vaginal
b) candidiasis
soreness and itching
c) vestibulodynia e) it tends to recur and is difficult to
d) vulval endometriosis treat
e) vulval cancer
65. Trichomonus vaginalis is a common
62. A 25yrs old patient presents with curable STD. What is the causative
sudden onset lower iliac fossa pain with organism?
nausea and vomiting. She is sexually a) anaerobic bacteria
active, uses the Mirena IUD and is b) gram-negative bacteria
otherwise healthy. O/E: she is tachycardic c) protozon
and there is tenderness over left iliac fossa d) atypical fungus
with no rebound. PV: normal cervix with e) diploid fungus
no abnormal discharge but fullness and
tenderness on left adnexa on bimanual 66. A 32yrs old woman is a heavy smoker,
examination. Pregnancy test is negative. her cervical smear result showed LSIL. HPV
Most likely diagnosis: test is positive. What is the best course of
a) diverticulitits action in this situation?
b) ectopic pregnancy a) repeat smear in 3months
c) ovarian torsion b) repeat HPV test
d) ruptured corpus luteum c) repeat smear and HPV test as soon
e) tubo-ovarian abscess as possible
d) organize a colposcopy
63. A 28yrs old para 3 with vulval pruritis e) routine recall in three yrs
and burning, reports dyspareunia and
copious foul-smelling green vaginal 67. A 28yrs old woman with history of
discharge. O/E: erythema of the vulva, repeated vaginal infections and multiple
petechiae of upper vagina and cervix. sexual partners had her smear result
Most likely diagnosis: showing HSIL. Your next advice is:
a) chlamydia a) repeat smear in 3 months
b) gonorrhea b) do HPV test to support diagnosis
c) syphilis c) repeat smear as soon as possible
d) trichomonus vaginalis d) organize colposcopy
e) candidiasis e) routine recall in 3months
68. A 34yrs old woman is diagnosed VIN3

on a punch biopsy from a vulval lesion.
Best ttt is:
a) interferon therapy
b) laser ablation of the lesion
c) local surgical excision
d) simple vulvectomy
e) topical chemotherapeutic cream
69. A 25yrs old NG comes to gynecologist

for STDs screening. She has been sexually
active since 16yrs and reports 8 new
partners in the last year. She is currently
asymptomatic. Testing results include
Hepatitis B surface antigen negative,
RPR+ve, HIV antibody -ve, NAAT for
Chlamydia and gonorrhea -ve. Next best
step:
a) VDRL testing
b) ttt with benzathine penicillin G
2.4million units IM once
c) fluorescent treponemal antibody
absorption testing
d) serial RPR titers
e) ttt with benzathine penicillin G
2.4million units IM weekly for 3doses
70. A 25yrs old G1P1 woman presents to

urgent care with a 4day history of
suprapubic pain and increased vaginal
discharge. She reports a history of similar
symptoms 1month ago when she was
treated empirically for UTI. All the
following are appropriate in management
EXCEPT:
a) administer trimethoprim-
sulfamethoxazole PO twice daily for
3days
b) send urine specimen for urine
analysis
c) send urine specimen for urine
culture
d) perform microscopy for the vaginal
discharge
e) perform NAAT for chamydia and
gonorrhea
ANSWERS
1 D 36 B
2 B 37 E
3 B 38 C
4 E 39 A
5 C 40 E
6 D 41 B
7 B 42 E
8 A 43 B
9 C 44 E
10 B 45 C
11 A 46 A
12 A 47 A
13 C 48 C
14 C 49 D
15 A 50 B
16 D 51 C
17 E 52 B
18 D 53 I
19 E 54 G
20 E 55 B
21 A 56 N
22 C 57 A
23 B 58 E
24 A 59 C
25 D 60 C
26 C 61 C
27 A 62 C
28 B 63 D
29 A 64 C
30 C 65 C
31 C 66 D
32 A 67 D
33 C 68 C
34 A 69 C
35 A 70 A
Gyn 5: All (150 marks)

Choose the most correct answer: 4. A 79yrs old woman presents to your
office with a 1cm fleshy outgrowth from
1. A 21yrs old G0P0 healthy student her urethra. It bleeds on touch. You
presents with severe vulvar pruritis and no perform a biopsy that states “transitional
discharge. Her BMI is 24 and uses condom and stratified squamous epithelium”.
with coitus. Her LMP was 4days ago. Last Most likely diagnosis:
month she was treated for monilia a) urethral leiyomyoma
vaginitis. The most likely diagnosis: b) hidradenitis suppurativa
a) vaginal trichomoniasis c) senile urethritis
b) leukemia d) urethral caruncle
c) personal hygiene products e) urethrocele
d) secondary syphilis
e) VIN 5. A patient consults you for recurrent
painful draining vulvar lesions.
2. A 63yrs old patient is seen for routine Examination shows multiple abscesses and
check up. An excoriated 2cm lesion is deep scars in the labia with foul smelling
found on her left labium majus with discharge from the lesions. The patient
3months duration. The best next step is: reports the occasional appearance of
a) prescribe hydrocortisone cream similar lesions in the axilla. Most likely
b) schedule colposcopy diagnosis is:
c) perform excisional biopsy a) herpetic vulvitis
d) paint the area with acetic acid b) hidradenitis suppurativa
e) radical vulvectomy c) lymphogranuloma venerum
d) secondary syphilis
3. An 18yrs old woman consults for a e) condyloma accuminata
painful swelling on her Lt labium. She was
treated with analgesics and warm sitz 6. A 20yrs old patient complains of painful
baths. O/E: 6cm swollen red tender tense vulvar ulcers. O/E: tender, punched out
cystic mass is seen in the base of the Lt lesions with a yellow exudates & no
labium majus. Your next step is: induration are seen. They are most likely:
a) excision of the mass a) chancroid
b) dry heat b) granuloma inguinale
c) IV antibioitics c) syphilis
d) laser ablation d) lymphogranuloma venerum
e) incision and drainage of the mass e) condyloma accuminata
7. A 17yrs old girl desires contraception. 11. An obese otherwise healthy 63yrs old
O/E: an ulcerative tender lesion with woman presents with mild vaginal
rolled, irregular edge and reddish granular bleeding. No use of HRT. Pap smear is
base is seen in the vaginal fornix. This negative. The next step is:
lesion is most likely: a) begin estrogen replacement therapy
a) vaginal intraepithelial neoplasia b) sample the endometrium
b) syphilis c) perform colposcopic evaluation of
c) an ulcer caused by the use of the cervix
tampons d) obtain serum FSH, LH, E2 and PRL
d) genital herpes e) perform hysterectomy
e) vulvar carcinoma
12. A 35yrs old patient being treated for
8. The commonest benign neoplasm of the prothrombin deficiency develops AUB.
cervix and endocervix is: There is no anatomical lesion. Control of
a) polyp the bleeding should begin with:
b) leiyomyoma a) GnRH agonist
c) nabothian cyst b) medroxyprogesterone acetate
d) endometriosis c) OCPs
e) CIN d) transdermal estradiol
e) NSAID
9. A 15yrs old patient has had irregular
menstrual bleeding every 2-4weeks since 13. A 24yrs old patient complains of heavy
menarche 1year ago. The bleeding can be regular menstrual periods. No anatomical
both heavy and light. It sometimes lasts as cause. The most effective in reducing her
long as 2weeks. Next step in the menstrual flow is:
management: a) tranexemic acid
a) perform an endometrial biopsy b) dilatation and curettage
b) perform laparoscopy c) DEMPA
c) initiate NSAID d) misoprostol
d) initiate cyclic progestin therapy e) methergine
e) endometrial ablation
14. A 40yrs old patient presents with DUB.
10. A 47yrs old woman complains of You want to perform an endometrial
postcoital heavy bleeding, the most likely biopsy. The risk factor for endometrial
casue is: hyperplasia in this patient is:
a) cervical polyp a) obesity
b) cervical nabothian follicle b) postmenopausal
c) cervical carcinoma c) using DMPA
d) cervical infection d) using copper IUD
e) cervical fibroid e) being multipara
15. A 35yrs old accountant complains of 19. A 45yrs old patient with uterine fibroid
episodic bloating, breast tenderness, complains of irregular excessive vaginal
dyspareunia, irritability and depression bleeding. The next step in management of
which leave her with “only one good week this patient is:
a month”. PV is normal. Best diagnostic a) myomectomy
course: b) hysterectomy
a) begin a prospective diary of c) endometrial biopsy
symptoms for the next 2months d) HSG
b) obtain a serum progesterone level
e) endometrial ablation
during the last half of her menstrual
cycle
20. A 26yrs old patient is found to have an
c) obtain a serum estrogen level during
the first half of her menstrual cycle 8weeks size irregular uterus. She does not
d) perform a TVS complain of pain or bleeding. Pregnancy
e) perform MRI pelvis test is negative. The best step is:
a) continued observation
16. In the previous patient, which b) endometrial biopsy
symptom is most consistent with her c) cervical conization
diagnosis? d) hysterectomy
a) PCOS e) myomectomy
b) luteal phase defect
c) normal menstrual cycle 21. A 23yrs old woman complains of heavy
d) anovulatory DUB menstrual periods every 2weeks. And
e) none of the above every other episode, there is very brief
painful spotting that lasts for only 2days.
17. A 33yrs old patient has been diagnosed While the heavy episodes are associated
as having adenomyosis. The following with cramping pain. Her BBT is biphasic.
symptoms is most consistent with this Her physical examination is normal. The
diagnosis:
most likely diagnosis:
a) infertility
a) anovulatory bleeding
b) mood swings
b) progressive endometriosis
c) painful defecation
d) amenorrhea c) chronic constipation
e) secondary dysmenorrhea d) mittelscherz
e) fibroid uterus
18. The commonest indication for ttt of
uterine fibroid in a 42yrs old woman is: 22. A 25yrs old patient with her LMP
a) interference with the reproductive 3weeks ago is being followed for a 5cm
function right ovarian cystic mass. She comes to the
b) rapid enlargement ER with sudden severe right sided lower
c) excessive uterine bleeding abdominal pain associated with nausea
d) pain and constant for 2hours. For the past
e) dyspareunia week, she had intermittent episodes of
pain that resolved spontaneously. O/E:
there was a severely tender 10cm right 26. A 19yrs old presents to ER with 8wks
pelvic mass. TLC: 12.500. The patient amenorrhea and unilateral adnexal pain.
undergoes laparoscopy and a black mass is She has acute abdomen. Pregnancy test is
seen replacing the entire ovary. The most +ve and Htc is 24%. This is most likely:
appropriate management of the patient is: a) ectopic pregnancy
a) removal of the ovary b) PID
b) antibiotic therapy c) endometriosis
c) reverse the torsion and oophoropexy d) appendicitis
d) anticoagulation e) abortion
e) TAH+BSO
27. A 23yrs old G1P1 patient is using
23. A 58yrs old G2P2 patient menopausal barrier contraception and is 1weeks past
for 10yrs presents with severe pruritis her LMP. She is having bilateral adnexal
vulvae. Examination shows atrophic pain, cervical motion, abdominal
vulvitis. The most effective ttt for her is: tenderness and fever. TLC: 12.000. The
a) antihistaminics most likely diagnosis is:
b) hydrocortisone a) ectopic pregnancy
c) tranquilizers b) PID
d) antibiotics c) endometriosis
e) topical estrogen therapy d) UTI
e) colitis
24. A 53yrs old woman is diagnosed with
anovulatory DUB. Best medical therapy: 28. A 16yrs old patient reports delayed
a) Oral estrogen for the first 25days of menses with sudden severe pain and
the cycle syncope. Pregnancy test is negative. TLC is
b) vaginal estrogen cream 2-3times per 8000 and Htc is 42. The likely diagnosis:
week a) ectopic pregnancy
c) oral progesterone 5-10mg daily for b) PID
10days each month c) appendicitis
d) estrogen 20mg administered IV d) endometriosis
e) endometrial ablation e) ruptured corpus luteum cyst
25. A 63yrs old patient presents with 29. A 21yrs old healthy female using OCP
vaginal itching, dryness and dyspareunia. is seen for a routine physical examination.
The most appropriate medical therapy is: O/E: a 2mm pigmented flat lesion with
a) oral estrogen for the first 25days of irregular margins is seen on the left labia.
each month Most appropriate next step:
b) vaginal estrogen cream daily a) follow up in 6-12months
c) oral progesterone 5-10mg daily for b) discontinue OCPs
10days each month c) excisional biopsy of the lesion
d) testosterone tablets 10mg per day d) electrodessicaction of the lesion
e) corticosteroid therapy e) perform vulvectomy
30. A 32yrs old G0P0 patient presents 33. On pelvic examination of a 28yrs old
complaining of secondary dysmenorrhea multiparous patient, several 3-5mm
that is increasing in severity. The pain is yellowish translucent or opaque raised
triggered with coitus. Most common cause cystic structures are seen on the surface of
of deep dyspareunia: the cervix. The patient is asymptomatic.
a) endometriosis
Next best step:
b) depression
a) excisional biopsy
c) vaginismus
d) atrophic changes b) incision and drainage of the cysts
e) vulvar ulcers c) oral antibiotics
d) conization
31. Treatments of primary dysmenorrhea e) counseling and reassurance
are directed toward addressing the cause.
Which is associated with elevations in 34. A 25yrs old sexually active woman
which of the following? complains of fishy greyish vaginal
a) estrogen discharge. Wet mount shows clusters of
b) progesterone
bacteria obscuring the cell borders.
c) prostaglandin E2
Vaginal pH is 5.5. Complication of this
d) prostaglandin F2 alpha
e) prostacyclin infection on pregnancy is:
a) IUGR
32. A 20yrs old woman at 12weeks b) IUFD
gestation is involved in a serious car c) Preterm birth
accident and is brought to the emergency d) congenital cataract
department with multiple traumas. The e) preeclampsia
emergency department physician believes
that imaging studies of the abdomen are 35. A 45yrs old woman complains of
needed to assess the patient’s acute intermenstrual bleeding. O/E: the pelvis is
injuries. Regarding this imaging, what
firmly fixed. Endometrial biopsy shows
should you counsel the managing team?
frequent giant cells, caseous necrosis and
a) imaging at this stage of pregnancy
should not be carried out granuloma formation. Most likely
b) imaging should be limited to no more diagnosis:
than two views of the abdomen a) syphilis
c) only imaging above the level of the b) chlamydia
uterine fundus should be carried out c) tuberculosis
d) only back imaging can be carried out d) gonorrhea
e) all the needed imaging should be e) HPV
carried out
36. A 51yrs old woman presents with Questions 43-50 are preceded by a list of
painful swelling under urethra, dysuria, lettered options. Select the SINGLE letter
dyspareunia and dribbling of urine when that is most closely associated with it.
stands after voiding. It is most likely: Each letter may be used once, multiple
a) simple cystitis times or not at all
b) infected Skene’s glands a) uncomplicated anogenital gonorrhea
c) infected urethral diverticulum b) disseminated gonococcal infection
d) urethral carcinoma c) syphilis
e) cystocele d) chancroid
e) lymphogranuloma venerum
Questions 37-42 are preceded by a list of f) donovanosis
lettered options. Select the SINGLE letter g) pediculosis pubis
that is most closely associated with it. h) genital herpes infection
Each letter may be used once, multiple i) HPV infection
times or not at all.
a) candida infection 43. Diagnosis can be made from culture on
b) trichomonas Thayer-Martin medium.
c) bacterial vaginosis
44. The causative organism for genital
d) atrophic vaginitis
condyloma, an etiologic agent or cofactor
e) mucopurulent cervicitis
for the development of most intraepithelial
f) foreign body
neoplasias of the genital tract.
37. Most common type of vaginitis with a
high pH in sexually active patient 45. A 44years old schoolteacher returns
from a vacation in Haiti where she had
38. In cases of treatment failure, combined unprotected intercourse with a native
oral and intravenous therapy with Haitian approximately 3weeks previously.
metronidazole may be indicated She now has a painless vulvar ulver.
39. The patient complains of a white curdy 46. A 48yrs Nigerian woman presents with
discharge and vaginal burning and itching vesicular and pustular lesions with
on examination. The vaginal pH is 3.0
ulceration of the vulvar areas. She also has
40. Associated most commonly with painful elevated inguinal nodes.
chlamydia or gonorrhea
47. One of the most infectious STDs.
41. Diagnosis may require vaginoscopy Lesions are found at the base of hair
follicles.
42. The treatment should include
intravaginal estrogen therapy
48. A patient reports having had a) lifestyle modification only

intercourse with a new sexual partner b) lifestyle modification and
8days ago and now complains of general pioglytazone
malaise and fever, vulvar pain, pruritis and c) lifestyle modification and metformin
vaginal discharge. Genital examination d) lifestyle modification and an oral
shows tender inguinal lymphadenopathy contraceptive
and vesicles and ulcers on the labia majora e) lifestyle modification and oral
bilaterally. testosterone
49. A 41yrs old woman returns from a job 53. A 34yrs old female with a history of
on a Caribbean cruise ship. She had several bilateral tubal ligation consults you
new sexual partneres during the 3week because of excessive body and facial hair.
cruise. A few days before coming to see She has a normal body weight no other
you, she noticed the growth of an signs of virilization and regular menses.
asymptomatic vulvar nodule. The skin Most appropriate treatment for her mild
ulcerated over the nodule and she now has hirsuitism is:
a beefy red ulcer. She thinks additional a) spironolactone
nodules may be developing. The ulcer is b) leuprolide
painless and there are no associated groin c) prednisone
lesions or enlarged lymph nodes. d) metformin
50. Caused by Hemophilus ducreyi, the e) gestagens
disease is characterized by a painful ulcer
most commonly of the vaginal vestibule. 54. X-rays on a 35yrs old female after a
motor car accident revealed fracture base
of the skull. This may cause a decline in
51. In evaluating a reproductive age which of the following:
woman who presents with secondary a) dopamine
amenorrhea, the following conditions will b) gonadotrophins
result in positive (withdrawal) c) oxytocin
progesterone challenge test: d) prolactin
a) pregnancy e) all of the above
b) Turner (45XO)
c) pituitary failure 55. A patient presents with amenorrhea-
d) Mullerian agenesis galactorrhea. Her PRL is elevated and she
e) PCOD is not pregnant. The following should be
evaluated for possible increase:
52. A 30yrs old female is concerned about a) Corticotrophin-releasing hormone
irregular menses (fewer than 9/year), acne (CRH)
and hirsuitism. Her BMI is 36. She has no b) FSH
other medical problems and would like to c) dopamine
have a baby. Her FBS is 135mg/dl. Most d) Gamma-aminobutyric acid (GABA)
appropriate treatment for this patient is: e) thyrotropin releasing hormone (TRH)
56. Which statement best describes 61. In a young obese chronically

estrogen positive feed-back on LH release? anovulatory with elevated LH/FSH ratio
a) it is affected by the level of and PCO. The preferred initial method of
circulating estrogen induction of ovulation:
b) it is enhanced by testosterone a) metformin
c) it is unaffected by progesterone b) HMG
d) it is unaffected by the duration of c) pulsatile GnRH
estrogen stimulation d) clomiphene citrate
e) ovarian drilling
e) all of the above
62. A 28yrs old woman, presented with
57. Upon an endometrial biopsy to her partner who is 35yrs old, both are fit
evaluate the quality of ovulation, the and healthy, they have regular sexual life
optimal development of the corpus but havn’t conceived for a year now. What
luteum is most closely associated with: is the percentage of reproductive age
a) follicular phase of the endometrium couple who are unable to conceive after
b) proliferative phase of the one year of coitus?
endometrium a) 5%
c) secretory phase of the endometrium b) 15%
d) shedding phase of the endometrium c) 40%
e) hyperplastic endometrium d) 85%
e) 90%
58. The presence of ferning of the cervical
mucus is an indicator: 63. A patient with hypogonadotropic
a) estrogen hypogonadism desires ovulation. The
b) progesterone initial treatment of choice:
c) FSH a) low dose estrogen therapy
b) combined oral contraceptive pills
d) LH
c) HMG therapy
e) HCG d) cyclic progesterone
e) clomiphene citrate
59. The most common cause of female
infertility is: 64. A 31yrs old patient is preparing to start
a) ovulatory disorders IVF due to obstructed tubes. Her HSG
b) endometriosis shows bilateral hydrosalpinx, what should
c) pelvic adhesions be your next step?
d) cervical pathology a) the patient should begin her IVF
e) uterine pathology treatment cycle
b) the patient should not be offered the
60. Which of the following is not an initial opportunity of IVF
screening investigation for infertility? c) bilateral salpingectomies should be
a) history and physical examination done prior to strating IVF
b) semen analysis d) hydrosalpinx should be drained via
c) BBT chart transvaginal aspiration prior to IVF
d) hysteroscopy e) her hydrosalpinx should be drained
e) hormonal profile via laparoscopy prior to IVF
65. A 32yrs old G3P0A3 woman is 68. The physical stigmata of Turner
counseled to have HSG for further syndrome are due to loss of chromosomal
evaluation of her recurrent pregnancy loss material from:
and infertility. She has previous 3 a) chromosome 21
b) chromosome 13
abortions requiring D&C. Otherwise she is
c) chromosome 18
healthy. She has been trying to get d) short arm of X chromosome
pregnant for 13months. Which of the e) the Y chromosome
following HSG is most likely?
a) unicornuate uterus 69. A 24yrs old G2P2 is requesting
b) proximal tubal obstruction contraception 6wks postpartum. Her
c) hydrosalpinx history is unremarkable except for
significant 1ry dysmenorrhea. The
d) Mullerian agenesis
following contraceptive methods may
e) intrauterine synechia
increase dysmenorrhea:
a) COCPs
66. A 22yrs old woman with amenorrhea b) POPs
6weeks duration undergoes surgery for c) male condoms
acute appendicitis. At the time of surgery, d) Copper IUD
a 3cm left ovarian cyst is discovered. It is e) none of the above
vascular and appears to contain a blood
70. A 90yrs old woman comes to your
filled central cavity. A serum pregnancy
office complaining that she feels as though
test is positive. Best next step: she is “sitting on a ball”. On examination,
a) ovarian wedge resection you find that the vagina is turned inside
b) ovarian cystectomy out and the entire uterus lies outside the
c) oopherectomy vaginal introitus. This condition is known
d) salpingo-oopherectomy as which of the following:
e) no additional therapy indicated a) first degree uterine prolapsed
b) second degree uterine prolapsed
c) complete procedentia
67. A 33yrs old woman who underwent
d) vaginal evisceration
normal puberty describes an 18months e) uterine inversion
history of secondary amenorrhea and hot
flushes. Her pregnancy test is negative. Questions from 71-73 are preceded by a
Her FSH: 98miu/ml, her LH: 68miu/ml. She list of options, select the SINGLE letter
desires pregnancy with her current which is most closely associated with the
partner. The most appropriate next step: condition. Each letter can be used once,
a) karyotype multiple or not at all.
a) cystocele
b) clomiphene citrate therapy
b) rectocele
c) gonadotropin stimulation therapy c) enterocele
d) IVF d) complete uterine propapse
e) estrogen replacement therapy e) UTI
71. A 49yrs old woman complains that “her 76. A 22yrs old woman comes for
organs are progressively falling out of her evaluation of abnormal Pap smear that
vagina” with losing urine on coughing and reported HSIL. Colposcopic biopsy
feeling incomplete emptying of her bladder confirms severe dysplasia CIN III. The
with voiding. following HPV is most often associated
with this lesion:
72. A 56yrs old woman complains that she a) HPV type 6
is “sitting on a ball”. She says constipation b) HPV type 11
is a significant problem. Sometimes she c) HPV type 16
needs to press in her vagina to allow stool d) HPV type 35
to come out of the rectum. e) HPV type 44
73. A 68yrs old woman complains of 77. A 20yrs old woman presents
something falling out of her vagina. She complaining of warts around the vaginal
feels constant backache. 4yrs ago, she had opening. The warts appeared several
abdominal hysterectomy & Burch months ago and are enlarging. Her
operation. Her ability to hold urine is boyfriend has the same warts on his penis.
excellent now. O/E: multiple 2- 10mm lesions are seen
around the introitus. Her cervix shows no
gross lesion. Pap smear performed
74. A woman complains of post-voiding revealing ASCUS. The following HPV type
dribbling of urine when she stands, painful is responsible for this:
intercourse and dysuria. She has no other a) HPV type 11
symptoms. She most likely has: b) HPV type 16
a) urinary fistula c) HPV type 18
b) detrusor instability d) HPV type 45
c) genuine stress incontinence e) HPV type 56
d) urethral dicverticulum
e) neurogenic bladder 78. A 57yrs old menopausal patient
presents for evaluation of post-
menopausal bleeding. She is morbidly
75. A 38yrs old woman is complaining of
obese and has chronic hypertension and
painless loss of urine upon coughing,
adult onset diabetes. An office
laughing, lifting or straining. Immediate
endometrial biopsy shows complex
cessation of the activity stops urine loss. endometrial hyperplasia with atypia and a
This history most suggestive of: pelvic US shows multiple uterine fibroids.
a) fistula Best management:
b) stress incontinence a) myomectomy
c) urge incontinence b) TAH
d) urethral diverticulum c) hysteroscopic endometrial ablation
e) neurogenic blader d) uterine artery embolization
e) oral progesterone
Questions 79-84: select the ovarian tumor 83. A 29yrs old woman is undergoing
from the list that is most likely to be diagnostic laparoscopy for a 9cm right
associated with the clinical picture. Each ovarian mass. The final pathology report
lettered option may be used once, more shows evidence of glial tissue and
than once or not at all. immature cerebellar and cortical tissue.
a) granulosa cell tumor
b) sertolli-leydig cell tumor 84. A 51yrs old menopausal woman is
c) immature teratoma undergoing exploratory laparotomy for
d) gonadoblastoma bilateral adnexal masses. A frozen section
e) krukengerg tumor on the excised ovaries and shows
significant numbers of signet cells.
79. A 26yrs old G2P1 presents to the
gynecologist complaining of increasing hair
growth on her face, chest and abdomen. 85. A 32yrs old G3P0 (0030) obese woman
But hair on her head is receding in the comes for a routine gynecologic
temporal regions. She also has had examination. She is single & currently
problems with acne. O/E: the patient has sexually active. She has a history of five
significant amounts of coarse dark hair on sexual partners in the past and became
face, chest and abdomen with enlarged sexually active at the age of 15yrs. She has
clitoris. She has a 7cm left adnexal mass. 3 first trimesteric abortions, used Depo-
provera for birth control and reports
80. A 56yrs old postmenopausal woman occasionally using condoms. She has a
presents with vaginal bleeding. Uterus is history of genital warts but has never had
slightly enlarged and she has a 6cm Rt an abnormal Pap smear. The patient says
adnexal mass. Endometrial biopsy shows she does not use illicit drugs but admits to
endometrial adenocarcinoma. smoke about one pack of cigarettes a day.
Her physical examination is normal. Three
81. A 67yrs old woman is found to have weeks later, you receive the results of her
bilateral adnexal masses while undergoing Pap smear which reported HSIL. The
evaluation of her recently diagnosed colon following factor in her history does NOT
cancer. increase her risk for cervical dysplasia:
82. A 17yrs old woman is referred for the a) young age at initiation of sexual
evaluation of primary amenorrhea. On activity
physical examination, the patient has b) multiple sexual partners
evidence of virilization. She also has a c) history of genital warts
pelvic mass. During the workup of the d) use of Depot-provera
patient, she is found to have sex e) smoking
chromosome mosaicism (45XO/ 46XY).
86. A 55yrs old G3P3 with a history of 88. You performed hysteroscopy to
fibroids presents to you complaining of investigate postmenopausal bleeding with
irregular vaginal bleeding. Until last an office hysteroscopy. While performing
month, she had not had a period in over the curettage, you suspect uterine
9months. She thought she was in
perforation. Best next step:
menopause but because she started
bleeding again last month she is not sure. a) administration of antibiotics and
Over the past month she has irregular observation
spotty vaginal bleeding. The last time she b) hysteroscopic repair
bled was 1week ago. She also complains of c) laparoscopy
frequent hot flushes and emotional d) laparotomy
lability. She does not have any medical e) urgent postoperative imaging
problems and is not taking any
medications. She is non smoker and does 89. A 25yrs old woman requests
not consume alcohol or drugs. Her
emergency contraceptionafter
gynecologic history is significant for
cryotherapy of the cervix 10yrs ago for unprotected intercourse on an occasion
mild dysplasia. She has had three cesarean 4days ago. What would you recommend?
deliveries and a tubal ligation. On physical a) IUCD
examination, her uterus is 12weeks in size, b) LNG
mobile, non tender and irregularly shaped. c) LNG-IUS
Her ovaries are not palpable. A urine d) mifepristone
pregnancy test is negative. Most e) plan B tablets
reasonable next step in evaluation is:
a) schedule her for a hysterectomy
90. A 28yrs old P1 with H/O of PCO
b) insert a progesterone containing IUD
c) arrange for an outpatient presents to ER with 6hrs history of severe
endometrial ablation intermittent left iliac fossa pain, nausea,
d) perform an office endometrial biopsy vomiting and low grade pyrexia. TVS
e) arrange for outpatient conization of shows enlarged edematous left ovary with
the cervix abnormal colour Doppler flow. Her WBCs
is 16.000.000 and CRP is 70. She has been
87. 36yrs old woman presents with rescussitated and received IM opioid
intermenstrual bleeding as well as analgesics. Ideal management is:
subfertility. Her US shows: AVF uterus
a) admit to the inpatient ward for close
with picture suggestive of adenomyosis.
ET: 7mm with 10x15mm fundal polyp. observation
Both ovaries are normal and no fluid in b) diagnostic laparoscopy and de-
DP. Which of the following is gold torsion of left ovary
standard for endometrial polyp diagnosis? c) diagnostic laparoscopy and left
a) CT scan of pelvis oopherectomy
b) hysteroscopy d) diagnostic laparoscopy and left
c) pelvic US partial oopherectomy
d) saline infusion sonogram e) explorative laparotomy
e) TVS
91. A 20yrs old woman has had side 94. A 28yrs old nulliparous woman
effects to various hormonal presents with infrequent periods occurring
contraceptives. She is not keen on IUD. every 3-4months since menarche at 13yrs.
She wants to try cervical cap with Her BMI is 32. She suffers from mild
asthma and no other medical or surgical
spermicides. The optimum duration of
history. Most likely this is due to:
application of the cap:
a) excessive physical exercise
a) just before intercourse and remove b) hyperthyroidism
immediately c) ovarian cysts
b) just before intercourse and remove d) PCO
2hrs later e) prolactinoma
c) an hour before intercourse and
remove an hour later 95. Symptoms of severe dyschezia in a
d) an hour before intercourse and patient with endometriosis. Where could
remove 3hrs later be the lesion?
a) uterovesical fold
e) an hour before intercourse and
b) widespread large bowel
remove after 12hrs c) disseminated to the diaphragm
d) deep rectovaginal septum
92. A 16yrs old girl with 1ry amenorrhea is e) lateral pelvic wall
found to have normal 2ry sexual
characteristics but small blindending 96. A 32yrs old woman underwent TVS for
vagina. US reveals normal ovaries. She is Rt sided pelvic pain. US shows Rt ovarian
XX on karyotyping. She has: cyst 5x4x6cm with ground glass
a) 5-alpha reductase deficiency appearance and no papillary structures.
Likely diagnosis:
b) complete AIS
a) dermoid cyst
c) congenital adrenal hyperplasia
b) endometrioma
d) Mayer Rokitansky Kuster Hauser c) mixed serous cystadenoma
syndrome d) adhesions
e) Swyer syndrome e) hydrosalpinx
93. A 15yrs old girl presents with 1ry 97. A 52yrs old woman is started
amenorrhea with normally developed 2ry combined HRT for vasomotor symptoms
sexual characters. She complains of after careful counseling about risks of
cyclical abdominal pain over the previous thromboembolism. When does she have
the highest risk of venous
6months. This is mostly:
thromboembolism?
a) AIS a) after 5yrs of use
b) constitutional delay b) after 4yrs of use
c) hyperprolactenemia c) after 3yrs of use
d) imperforate hymen d) in the second year of use
e) pregnancy e) in the first year of use
98. A 42yrs old lady who completed her 101. A 24yrs old woman has 1ry infertility.
family comes complaining of heavy She is fit but is unable to conceive despite
menstrual bleeding. US shows multiple regular unprotected intercourse for the
fibroids around 3cm. She has some past year. Investigations: normal semen,
pressure symptoms. First ttt option: patent tubes and evidence of ovulation.
Your advice is:
a) tranexemic acid and mefenamic acid
a) referral for IVF
b) UAE
b) ovulation induction with clomiphene
c) myomectomy citrate
d) hysterectomy c) continue to try with timed
e) LNG- IUS intercourse for another year
d) offer IUI
99. A 35yrs old woman presents with e) offer metformin
irregular bleeding for 3months. Her
periods are heavy. She has had 3 children 102. A 37yrs old nulliparous who is fit, is
by CS. she is using condoms for unable to conceive despite regular
contraception and pregnancy test is unprotected intercourse for the past
6months. She attends her GP’s surgery for
negative. The most likely cause of her
advice and is refered to the secondary
intermenstrual bleeding is:
care. Your advice is:
a) vaginal cancer a) referral to IVF
b) submucous polyp b) ovulation induction with clomiphene
c) vaginitis citrate
d) vaginal adenoma c) continue to try to conceive naturally
e) condyloma accuminata for another 12months
d) offer IUI
100. A 32yrs old mulliparous woman has e) offer further investigations for
been diagnosed with 2 fibroids: 8x7cm and infertility
7x6cm. She would like to know about the 103. In a 65yrs old healthy woman with
vault prolapsed, the most effective ttt is:
benefit of UAE. The main benefit in her
a) ring pessary
case:
b) pelvic floor exercises
a) shorter hospital stay c) anterior and posterior repair with
b) decreased likelihood of surgery obliteration of enterocele
c) improved quality of life d) intravaginal slingoplasty
d) better fertility outcome e) abdominal sacrocolpopexy
e) better satisfaction rate
104. A 39yrs old P2 with 3yrs history of 107. A 36yrs old G4P4004 comes for
heavy painful period 7/28 cycle. This contraceptive advice. She has IUD placed
started after laparoscopic tubal ligation. last year. However, perforation occurred
Her BMI: 39 and smokes 10/day. She has
type 2 DM and is hypertensive on Beta and IUD removed. She doesn’t want
blockers. Her US is normal. Most another IUD. She asks if she can have pills.
appropriate management option: She has significant history of DVT during
a) abdominal hysterectomy her last pregnancy. BMI: 42 and type 2 DM
b) endometrial ablation controlled with an oral agent. She has
c) LNG-IUS
d) progesterone only pills occasional tension headache relieved by
e) tranexemic acid NSAIDs. She is non smoker and all her
deliveries were uncomplicated vaginal
105. A 35yrs old para3 underwent TAH+ ones. The following is an absolute
BSO for severe pelvic endometriosis that contraindication to start COCPs in this
had not responded to medical and
conservative surgical treatment. She patient:
attends for her follow up appointment a) age more than 35yrs
complaining of hot flushes and sweating. b) history of DVT
Which HRT regime you consider? c) DM
a) combined continuous estrogen/ d) history of tension headache
progestagen
b) estradiol patches e) obesity
c) oral estradiol valerate
d) progesterone only HRT 108. A 34yrs old patient diagnosed with
e) topical estradiol endometriosis 10yrs ago comes with her
husband being unable to conceive after
106. A 35yrs old patient presents 6months
after a NVD. The pregnancy was 1.5yrs of unprotected intercourse. This is
uncomplicated but following delivery, a most likely to improve their chance of
piece of placenta was apparently retained conception:
in the uterus. She was treated with a) NSAIDs
antibiotics and later underwent a b) COCPS
dilatation and curettage procedure. Now
she presents with amenorrhea. She is no c) oral medroxyprogesterone acetate
longer breast feeding and is concerned. d) depot lupron with add back therapy
Best next step: e) surgery for lysis of adhesions and
a) hysterosalpingo-contrast sonography fulgration of endometriosis
b) HSG
c) hysteroscopy
d) hysterosonography
e) saline sonography
109. A 57yrs old G3P3 nurse presents with 111. A 32yrs old NG comes for
6months history of pelvic discomfort, consultation for an enlarged fibroid
increased abdominal girth and early uterus. She and her husband are planning
satiety. O/E: large abdominipelvic mass. conception and she wants her fibroid
US and CT show bilateral ovarian masses, treated before getting pregnant. TVS: 7cm
ascites and studding of the peritoneum. uterus with 1x2cm intramural fibroid, no
You predict it is most likely a malignant adenomyosis, endometrial lining and
ovarian. She asks about the 1ry method of ovaries are normal. She has mild
ttt for her condition: dysmenorrheal, no AUB, no postcoital or
a) radiation therapy only intermenstrual bleeding. Her examination
b) surgery only is unremarkable. Your recommended ttt
c) surgery followed by chemotherapy for her condition:
d) surgery followed by radiation a) LNG-IUS
therapy b) endometrial ablation
e) chemoradiation alone c) hysteroscopic resection
d) uterine artery embolization
110. A 13yrs old girl presents with severe e) expectant management
lower abdominal pain of 24hrs duration.
Pain is sharp constant and recurring 112. A 48yrs old G3P3 comes complaining
monthly for several days in the last of heavier and longer menses. She is
4months. She has no vomiting or diarrhea healthy with no major medical problems
but constipating frequently and has bowel and her BMI: 27. Her only medications are
movement every 3-4days. She feels her daily multivitamins. She has always had
jeans getting tighter around her waist regular menses until recently. She also
although she remains active and playing experiences increased pain with her
soccer daily. She had never had menses cycles. Her last Pap and HPV screen less
and denies being sexually active. Her vital than a year, were negative. She denies
signs and stature are normal with Tanner 3 postcoital bleeding but has episodes of
breast and pubic hair development. intermenstrual bleeding. TVS: normal
Abdominal examination reveals a firm myometrium and ET: 22mm. endometrial
tender midline mass below the umbilicus. biopsy revealed proliferative
She refuses PV. Most likely diagnosis: endometrium without glandular crowding
a) pregnancy or atypia. Most likely diagnosis:
b) fibroid uterus a) fibroid
c) hematocolpos b) adenomyosis
d) endometriosis c) perimenopause
e) ovarian cyst d) endometrial polyp
e) endometrial intraepithelial neoplasia
113. A 62yrs old G2P2 menopausal for a) NSAIDs

10yrs is referred by her GP due to b) oral progestins
occasiaonal right lower quadrant c) selective serotonin reuptake
discomfort. US: 15cm complex ovarian inhibitors (SSRIs)
mass with cystic and solid components, d) gonadotropin-releasing agonist
two internal nodules, septations and (GnRH)
increased Doppler flow. O/E: normal e) LNG-IUS
except for the mass and fluid wave. CT
confirmed the mass and ascites. Next best 116. A 43yrs old G3P3 presents concerned
step: about adenomyosis as her friend had
a) surgical evaluation hysterectomy for adenomyosis. Which of
b) repeat US in 3months the following on history and examination
c) colposcopy is not suggestive of adenomyosis?
d) pregnancy test a) heavy menstrual bleeding
e) expectant management b) prolonged menstrual bleeding
c) secondary dysmenorrheal
114. A 24yrs old Caucasian NG comes d) enlarged firm uterus with distinct
complaining of worsening dysmenorrhea masses on ultrasound
for the last 6months. She was recently e) boggy globular and tender uterus
married and stopped her OCPs that was with indistinct endometrial-
started when she was teenager for severe myometrial junction
dysmenorrhea. She also complains of deep
dyspareunia. Her mother had history of 117. A 46yrs old G2P2 returns for follow
endometriosis. You suspect that she may up after endometrial biopsy for heavy
also have endometriosis. You should menstrual bleeding over the last 6months.
counsel her about the potential results of Her biopsy revealed secretory
endometriosis as: endometrium. You suspect adenomyosis.
a) PID The following most accurately describes
b) AUB the condition:
c) hirsuitism a) presence of endometrial cells outside
d) infertility the endometrium with cyclic pelvic
e) endometrial cancer pain
b) an extension of endometrial tissue
115. A 32yrs old G1P1 with endometriosis into the uterine myometrium leading
comes to your visit. She is on continuous to heavy menstrual bleeding and
OCPs to manage her pelvic pain. Over the dysmenorrhea
last months, she experienced more pelvic c) local proliferation of smooth muscle
pain and dyspareunia. She wants to know cells within the uterus, often
what other medications can she take to surrounded by pseudocapsule
manage her condition. All may be used potentially leading to heavy
EXCEPT: menstrual bleeding
d) a cystic collection of endometrial 120. You are consulted on an 89yrs old

cells on the ovary possibly causing inpatient in a nursing facility. She has
pelvic pain and infertility complete vaginal eversion. What is
e) inflammation or irritation of the another term of this?
lining of the uterus (endometrium) a) procedentia
typically caused by infection
b) cystocele
118. A 32yrs old woman comes c) rectocele
complaining of 1week history vulval d) urethrocele
ulcers. She first noticed two red “bumps” e) enterocele
that subsequently opened up, and now
extremely painful. She is sexually active 121. A 45yrs old G5P4 was referred by her
and reports 3 new sexual partners in the GP for evaluation of POP. She denies any
last month. She had past history of
pelvic pressure, bulge or difficult
gonorrhea which was treated. O/E: two
1.5cm ulcers on left labia minora. Ulcers urination. Her only medical comorbidity is
bases are erythematous and the borders obesity. She has asymptomatic mild
are irregular but well demarcated. There is degree POP (grade 1). What do u
tender inguinal LNs on left side. VDRL and recommend?
HSV tests are negative. Best initial ttt: a) conservative management with
a) benzathine penicillin G 2.4million
pelvic floor muscle exercise and
units IM once
b) ceftrioxone 250mg IM once weight loss
c) doxycycline 100mg orally twice daily b) colpocleisis obliterative procedure
for 2weeks c) Gellhorn pessary
d) erythromycin 500mg orally twice d) round ligament suspension
daily for 2weeks e) hysterectomy
e) acyclovir 200mg five times daily for
7days
122. A 62yrs old G2P2 presents with
119. A 67yrs old patient presents with complaint of urinary incontinence. She has
pelvic pressure, low back pain, vaginal urgency and can’t make it to the toilet.
bulge that worsens by prolonged standing She gets up 2-3times per night to urinate.
or vigorous activity. You suspect POP that Urine analysis and culture were negative.
is confirmed by examination. All the Most likely diagnosis and most
following may contribute to this pathology
appropriate ttt:
EXCEPT:
a) genetic predisposition a) stree incontinence, mid-urethral sling
b) chronic constipation with a long b) urge incontinence, oxybutynin
standing straining to defecate c) overflow incontinence, oxybutynin
c) postmenopausal status d) urinary fistula, surgical repair
d) COPD e) functional incontinence, bladder
e) sexual inactivity
suspencion
123. A 42yrs old G2P2 complains of urinary 127. A 37yrs old G2P2 reports irregular
leakage when excercising. She recently menses, intermittent pelvic pain and
began jogging to loose weight. She wears recent increase in facial and body hair.
a pad upon jogging and it is 75% soaked O/E: patient had acne, facial hair and
when she finishes her run. She denies loss
10cm left adnexal mass. PV confirms 10cm
of urine at any other time. Urine analysis
and culture were negative. BMI: 38. Your mass arising from the left ovary. The
initial ttt plan is: following serum concentration is most
a) mid-urethral sling likely elevated:
b) detrusitol a) LDH
c) tibial nerve stimulation b) estradiol and FSH
d) pelvic floor muscle exercise c) testosterone and androstenedione
e) vaginal hysterectomy d) AFP
e) CA125
124. A 62yrs oldG2P2 with biopsy proven
vulvar HSIL returns for discussing the
result. While counseling her, you explain 128. A 33yrs old G2P1 presents with nipple
the risk for development VIN that include: discharge which is milky, coming from
a) immunosupression both breasts and is present even if she
b) smoking doesn’t express it. You examine and
c) high-risk HPV infection confirm galactorrhea. Which condition is
d) asian ethnicity not associated with galactorrhea?
e) a, b and c a) pregnancy
b) breast abscess
125. The most commonly diagnosed
c) pituitary adenoma
gynecological malignancy in developed
countries is: d) psychotropic medications
a) endometrial e) hypothyroidism
b) cervical
c) ovarian 129. The following is not a protective
d) fallopian tube factor against the development of
e) vulvar endometrial cancer:
a) parity
126. A 22yrs old NG presents for routine b) smoking
examination with no complain. Her LMP
c) physical activity
was 3weeks ago and was normal. O/E: you
detect a large mobile mass in right lower d) oral contraceptive use
quadrant. Pregnancy test is negative. US: e) tamoxifen use
8cm right ovarian cystic mass with solid
component and calcifications and teeth. 130. Staging of endometrial cancer entails:
Next step: a) clinical staging with physical
a) repeat US in 6weeks examination, pyelogram, chest X-Ray
b) exploratory laparotomy, TAH+ BSO and anoscopy
c) right ovarian cystectomy b) clinical staging with physical
d) right salpingo-oopherectomy
examination, pyelogram, chest X-Ray
e) expectant management
and CT scan
c) surgical staging with TAH+ BSO, 134. A 38yrs old G2P2 comes for her
pelvic washings and pelvic and para- annual examination and Pap test. Her
aortic lymphadenectomy periods are very light and infrequent since
d) surgical staging with TAH+ BSO, she had Mirena 3yrs ago. She is recently
pelvic nodes, pelvic washing and divorced and has a new partner. Her Pap
omentectomy test was normal 3yrs ago. Her cytology is
e) surgical staging with hysterectomy negative for atypia and malignancy, and
only HPV is positive for genotype 16. What do
you recommend?
131. A 73yrs old woman presents with a a) coloscopy
chief complaint of scanty vaginal spotting. b) repeat Pap test and HPV in 1year
She has had no other abnormal bleeding. c) repeat Pap test in 3months
She has regular Pap tests her entire life. d) repeat HPV test only in 1year
Her Pap tests have all been normal and e) LEEP conization of the cervix
her last one was at the age of 65. After
thorough history and physical 135. a 28yrs old had a LSIL Pap at 26yrs old
examination, what test would u likely followed by colposcopic examination
order as next step for her postmenopausal findings of CIN1. Twelve months later, her
bleeding evaluation? repeat Pap test was normal but HPV test
a) FSH and estradiol level was positive and colposcopy again showed
b) TVS CIN1. Twelve months later, her Pap test
c) CA 125 still normal and repeated HPV remains
d) CBC/PT & PTT positive. On colposcopy, proper
e) Pap smear and HPV screen visualization of SCJ and biopsy taken was
CIN1. She is smoker otherwise healthy but
132. Potential ttt of unseexplained very concerned and wants to know what is
infertility include: next. Which option is NOT recommended
a) ovulation induction with clomiphene for her?
citrate and IUI a) repeat Pap every 3months for 1year
b) ovulation induction with injectable b) cryotherapy
gonadotropins and IUI c) excisional procedure (LEEP)
c) IVF d) Repeat Pap and HPV test in 1year
d) expectant management e) encourage smoking cessation
e) all of the above
136. The following is NOT a major cause of
133. The following are potential causes for infertility:
male factor of infertility: a) PCOS
a) anabolic steroid use b) endometriosis
b) erectile dysfunction c) PID and pelvic adhesions
c) varicocele d) uterine fibroids
d) a and c e) advanced maternal age
e) all of the above
137. A 35yrs old woman has been your 139. You are covering the postpartum
patient for the past 5yrs. You recently ward and are asked to perform an
placed her on POP given her history of examination of a 1day old female
smoking one PPD for nearly 20yrs. All the neoborn. The examination is normal with
following are mechanism of action of POP the exception of an enlarged clitoris and
EXCEPT: only one opening other than the anus.
a) suppression of ovulation What is the most common cause of
b) thickening of the cervical mucus ambiguous genitalia in females?
c) making the endometrium unsuitable a) PCOS
for implantation b) Mullerain agenesis
d) inhibiting sperm motility c) transverse vaginal septum
e) stimulating regression of corus d) congenital adrenal hyperplasia
luteum e) Turner syndromee
138. A 27yrs old G1P1 woman comes to 140. A 30yrs old patient with PCO returns
to your clinic for a follow up visit after
your office 8months after an
starting OCPs to reduce her symptoms of
uncomplicated vaginal delivery of a
acne and hirsuitism. After 6months of use,
healthy male newborn. She and her
she is pleased with the aesthetic
husband have been trying to conceive a
improvement of her appearance. She
2nd child for 3months but failed and she is
wonders how the birth control pill works
very anxious about this. She is still breast
to improve her symptoms. You explain
feeding routinely and is not menstruating.
that the effects are due to the oral
Assuming that she is not yet ovulated,
contraceptive causing:
what is the likely underlying cause of the a) increased 5α reductase activity in the
findings in this patient? skin
a) thyroid hormone suppression of the b) lower sex hormone binding globulin
anterior pituitary and therefore lowering coirculating
b) abnormal endometrial regeneration testosterone
causing failure of implantation c) increased sex hormone binding
c) prolactin-induced inhibition of globulin and therefore higher
pulsatile GnRH from the circulating testosterone
hypothalamus d) increased sex hormone binding
d) reduced tubal motility 2ry to globulin and therefore lower
subclinical inflammation after vaginal circulating testosterone
delivery e) stimulation of LH production leading
e) pathological decreased sperm count to lower circulating testosterone
of the male partner
141. A 52yrs old G3P2 comes to see u for 143. You are consulted in ER to see a 16yrs
management of her hot flushes and night old girl with 1ry amenorrhea and cyclic
sweats. She stopped having menses 1.5yrs abdominal pain that worsened over the
ago and still have her uterus and ovaries in last 6months. US: normal appearing uterus
situ. Her complains interfere with her
with a 4cm cystic heterogenous mass in
quality of life. She hoped to avoid HRT but
her symptoms havn’t improved over the the vagina below the cervix and bilateral
past 1.5yrs, and is now ready for ttt. adnexal masses with low echogenicity.
Which of the following is NOT appropriate O/E: normally developed breasts, normal
option for her ttt? distribution of pubic hair, tender non
a) oral estrogen and progesterone acute abdomen and vital signs normal.
b) topical estrogen and progesterone Pelvic examination: normal hymenal ring
patch with no visible cervix instead a bluish
c) low dose vaginal estrogen cream bulging purple pouch is seen at the apex of
d) SSRI such as paroxetine or fluoxetine
the vagina. Most likely diagnosis:
e) oral gabapentin (neurotin)
a) uterine didelphys
142. A 28yrs old NG comes with her b) uterine agenesis
husband to inquire about attempting of c) transverse vaginal septum
pregnancy. She has regular cycles every d) imperforate hymen
28/30days without heavy menstrual cycles e) uterine septum
or dysmenorrhea. Her last Pap 6months
ago was normal. Both she and her 144. A long term patient of urs brings her
husband are healthy and have no major 14yrs old daughter as she is concerned
medical disorders. She is uptodate on her
about her irregular periods. Daughter
immunizations and has had a recent flu
shot. She has started prenatal vitamin and started menses at 13yrs, her cycles are
take no other medications. She is excited irregular and she often skips a month. She
to learn about their most fertile time of is normal weight without hirsuitism,
the month would be. The following is true abnormal acne or acanthosis. Her breast
about ovulation and fertilization: development and height are normal for
a) fertilization occurs in the uterine her age. She is a high school soccer player
cavity and practices twice weekly. She also does
b) fertilization must occur within 72hrs yoga and light weight lifting 2-3times a
of ovulation or lese it degenerates
week. They want your opinion about how
c) ovulation is trigerred by the
production of estrogen which to proceed:
triggers an LH spike from anterior a) checking FSH, LH, estradiol and
pituitary progesterone to look for etiology of
d) she will be most fertile during the her menstrual irregularities
luteal phase and they should b) you recommend pelvic US to verify
increase sexual activity during this normal anatomy and rule out
time structural anomalies and PCO
e) it is impossible to predict the most c) you recommend hysteroscopy to
fertile time period for a given patient
better evaluate the endometrial
cavity and lining
d) you advise expectant management her compliance to iron supplements. She

now with completion of menstrual also bruises easily and has history of
calendar over the upcoming year gingival bleeding with tooth brushing and
e) you refer to reproductive frequent nose bleeds. Her mother also
endocrinology because this issue is reports she had difficult bleeding with her
beyond the scope of ur practice wisdom tooth extraction and after
tonsillectomy. Next step in evaluation:
145. A 29yrs old G2P0 presents with a) pregnancy testr, CBC, TFT, PRL and if
irregular menses for the past 6months. normal, start OCPs to decrease heavy
She denies any medical problems. She is menstrual bleeding
taking multivitamins, using no b) pregnancy test, CBC, TFT, PT, PTT,
contraception and denies sexual activity von Willebrand antigen, ristocetin
for the past year. Her 2 prior abortions co-factor and refer to hematology to
were therapeutic induced with rule out bleeding disorder
misoprostol. She previously had normal c) pelvic US to rule out congenital
menses monthly not heavy or too painful malformation, fibroids and if normal,
till 6months ago. Since then, she only had recommend Mirena IUD to control
2 menses: first seemed normal and 2nd her bleeding
was light during which she spotted for d) recommend trial of tranexemic acid
2weeks. For the past 2months, she had no to be taken with each menstrual
menses. No history of STDs and her Pap period
tests were normal. No excessive hair e) get saline sonohysterogram to
growth or acne, there is small amount of evaluate endometrial cavity and
bilateral nipple discharge and occasional consider endometrial ablation
headaches. O/E: normal vital signs,
bilateral clear white nipple discharge. 147. There is a risk of premature
Pregnancy test negative. Next test you like menopause in some women having
to perform: hysterectomy at young age. The reason is
a) karyotype that part of the blood supply to the ovary
b) urinary LH kit comes from uterine artery but majority
c) pelvic US and pelvic MRI from the ovarian artery. Ovarian artery is
d) TSH and PRL a branch of which artery:
e) FSH and serum estradiol a) renal artery
b) anterior branch of internal iliac
146. A mother brings her 17yrs old artery
daughter for heavy painful menses. Her c) inferior epigastric artery
menarche was at 13yrs. Her menses last d) abdominal aorta
for 7-9 days, changing soaked pads every e) external iliac artery
2-3hrs. She is chronically anemic despite
148. The commonest pathology identified

at diagnostic laparoscopy in patients with
chronic pelvic pain is:
a) adhesions
b) endometriosis
c) fibroids
d) no pathology detected
e) PID
149. Among the following, select the

strongest progmnostic factor associated
with recurrent miscarriages:
a) fibroids
b) increased maternal age
c) PCO
d) structural uterine anomalies
e) smoking
150. The following drug if used in

combination with COPs will reduce the
contraceptive efficacy of COPs:
a) ampicillin
b) doxycilline
c) erythromycin
d) rifampicin
e) sodium valproate
ANSWERS
1 C 41 F 81 E 121 A
2 C 42 D 82 D 122 B
3 E 43 A 83 C 123 D
4 D 44 I 84 E 124 E
5 B 45 C 85 D 125 A
6 A 46 E 86 D 126 C
7 C 47 G 87 B 127 C
8 A 48 H 88 A 128 B
9 D 49 F 89 A 129 E
10 C 50 D 90 B 130 C
11 B 51 E 91 B 131 B
12 C 52 C 92 D 132 E
13 A 53 A 93 D 133 E
14 A 54 B 94 D 134 B
15 A 55 E 95 D 135 A
16 C 56 A 96 B 136 D
17 E 57 C 97 E 137 E
18 C 58 A 98 B 138 C
19 C 59 A 99 B 139 D
20 A 60 D 100 A 140 D
21 D 61 D 101 C 141 C
22 A 62 B 102 E 142 C
23 E 63 C 103 E 143 C
24 C 64 C 104 C 144 D
25 B 65 E 105 A 145 D
26 A 66 E 106 C 146 B
27 B 67 E 107 B 147 D
28 E 68 D 108 E 148 D
29 C 69 D 109 C 149 B
30 A 70 C 110 C 150 D
31 D 71 A 111 E
32 E 72 B 112 D
33 E 73 C 113 A
34 C 74 D 114 D
35 C 75 B 115 C
36 C 76 C 116 D
37 C 77 A 117 B
38 B 78 C 118 B
39 A 79 B 119 E
40 E 80 A 120 A
Gyn 6: All (100 marks)

Choose the most correct answer: 6. The karyotype of patient with androgen
insensitivity syndrome is:
1. The main support of the uterus is a) 46XX
provided by:
a) the round ligament b) 46XY
b) the cardinal ligament c) 47XXY
c) the infandibulo-pelvic ligament d) 45XO
d) the integrity of the pelvis e) 45XY
e) the broad ligament
7. While evaluating a 30yrs old woman for
2. The most important muscle of the pelvic
floor is: infertility, you diagnose a bicornuate
a) bulbo cavernosus uterus. You explain that additional testing
b) ischiocavernosus is necessary because of the woman’s
c) levator ani increased risk of:
d) superficial transverse perineal a) skeletal anomalies
muscle b) hematopoietic disorders
e) deep transverse perineal muscle
c) urinary anomalies
3. The main blood supply of the vulva is: d) central nervous anomalies
a) inferior hemorrhoidal artery e) tracheoesophageal anomalies
b) pudendal artery
c) ilioinguinal artery 8. Bicornuate uterus can cause all the
d) femoral artery following EXCEPT:
e) inferior hypogastric artery
a) abortions
4. The ovarian artery is a branch of: b) abnormal fetal lie
a) common iliac artery c) infertility
b) internal iliac artery d) retained placenta
c) aorta e) congenital anomalies of the baby
d) hypogastric artery
e) sacral artery
9. Ovarian dysgenesis is associated with
5. Regarding Turner syndrome, which is the elevation of:
true? a) pituitary gonadotropins
a) genetically is 46XO b) estradiol
b) has testis in inguinal area c) pregnandiol
c) usually presents with primary d) progesterone
amenorrhea
d) has low IQ e) estriol
e) usually tall
10. The most common cause of precocious 15. Raised FSH levels are found in all the
puberty is: following conditions EXCEPT:
a) idiopathic a) postmenopausal women
b) gonadoblastoma b) Turner syndrome
c) women on combined oral
c) Albright syndrome
contraceptive pills
d) abnormal skull development d) gonadal dysgenesis
e) granulose cell tumor e) peri-menopausal women who had
hysterectomy with bilateral salpingo-
11. Which of the following is suggestive of oopherectomy
ovulation?
a) BBT drop at least 0.5 degree in the 16. The most common symptom of luteal
second half of the cycle phase defect is:
b) day 21 estrogen level is elevated a) vaginal dryness
b) early abortion
c) progesterone level on day ten of the
c) tubal occlusion
cycle is elevated d) breast tenderness
d) regular cycles with dysmenorrheal e) ovarian enlargement
e) oligomenorrhea
17. Spinnbarkeit is a term which means:
12. The luteal phase of the menstrual cycle a) crystallization of the cervical mucus
is associated with: b) thickening of the cervical mucus
a) high luteinizing hormone level c) mucus secretion of the cervix
b) high progesterone level d) threading of the cervical mucus
e) thinning of the cervical mucus
c) high prolactin level
d) low basal body temperature 18. The following contraceptive methods
e) proliferative changes in the should not be used by a patient with
endometrium coronary heart disease:
a) combined oral contraceptive pills
13. An involuted corpus luteum becomes a b) male condom
hyalinized mass known as a: c) female condom
a) corpus delicti d) diaphragm
b) corpus granulasa e) spermicidal agent
c) graafian follicle
19. For injectable progesterone
d) corpus atretica contraception, all the following is true
e) corpus albicans EXCEPT:
a) medroxyprogesterone acetate is the
14. Ovulation occurs: most commonly used
a) immediately after LH surge b) may cause irregular uterine bleeding
b) 6-8hours after LH surge c) may cause amenorrhea
c) after prolactin surge d) should not be given in lactating
d) after follicles ripened in the ovary mother
e) does not carry a risk of venous
e) 36hours after LH surge
thrombosis
20. Combined oral contraceptive pills are 25. Bacterial vaginosis:

associated with: a) is rare vaginal infection
a) dysmenorrhea b) is always symptomatic
b) menorrhagia c) is usually associated with profound
c) polymenorrhea inflammatory reaction
d) ovarian cyst d) causes fishy discharge which results
e) intermenstrual bleeding from bacterial amine production
e) is treated wwith clotrimazole
21. Side effect of OCP include all the
26. Chlamydia trachomatis infection:
following EXCEPT:
a) are commonly manifested as vaginal
a) break through bleeding
discharge
b) dysmenorrhea
b) Pap smear usually suggest
c) nausea inflammatory changes
d) mastalgia c) infection in the male partner present
e) chloasma as urethritis
d) may ascend into the upper genital
22. A contraceptive method that prevents tract resulting in tubal occlusion
transmission of STD is: e) all of the above
a) condom
b) OCP 27. All the following can be transmitted
c) IUCD sexually EXCEPT:
d) spermicide a) HIV
e) injectable b) chlamydia
c) gonorrhea
23. COCP can be used to treat all the d) vaginal candidiasis
following EXCEPT: e) HSV2
a) endometriosis
b) ovulation pain 28. Genital tract candida occurs more
c) menorrhagia frequently in all these patients EXCEPT:
a) diabetics
d) dysmenorrhea
b) on long term antibiotic therapy
e) mucinous ovarian cyst
c) thyrotoxicosis
d) on oral contraceptive pills
24. IUCD may prevent pregnancy by all the e) pregnant
following mechanism EXCEPT: 29. Treatment of PID include the following
a) creating chronic endometritis EXCEPT:
b) inducing endometrial atrophy a) oral doxyclycline
c) inhibiting ovulation b) removal of IUCD
d) altering tubal motility c) clindamycin
e) destroying sperm d) tetracycline
e) dilatation and curettage
30. The differential diagnosis of vulvar 35. The initial evaluation in an infertile
swelling includes all the following EXCEPT: couple should include:
a) Bartholin cyst a) ovarian biopsy
b) hematoma b) semen analysis
c) condyloma c) D&C
d) nabothian cyst d) laparoscopy
e) papilloma e) sperm penetration assay
31. The terminology PID indicates: 36. A 32yrs old woman with PCO has
a) infection of the vagina infertility for 1year. Her menses are
b) infection of Bartholin gland irregular & BBT is monophasic. An
c) infection of Skene glands endometrial biopsy shows endometrial
d) infection of the urinary bladder hyperplasia without atypia. Most
e) endometritis and salpingo-oopheritis appropriate therapy is:
a) danazol
32. The mechanism of infertility in PID b) megestrol acetate
include the following EXCEPT: c) oral contraceptive
a) polycystic ovary d) clomiphene citrate
b) peritubal adhesions e) human gonadotropins
c) hydrosalpinx
d) pyosalpinx 37. The following agents are used in
e) frozen pelvis ovulation induction in patients undergoing
ART EXCEPT:
33. All the following are possible causes of a) Clomiphene citrate
anovulation EXCEPT: b) HMG
a) high BMI c) GnRH analogues
b) anorexia nervosa d) HCG
c) PCO e) Aspirin
d) premature ovarian failure
e) Sickle cell trait 38. Ovulation can be diagnosed by the
following measures EXCEPT:
34. In PCO, all the following can be seen a) measuring day 14 serum
EXCEPT: progesterone
a) acne b) observing a rise in BBT in the 2nd half
b) streak ovaries of the cycle
c) insulin resistance c) study of the cervical mucus
d) hirsuitism d) endometrial biopsy
e) galactorrhea e) ultrasound
39. HSG is contraindicated in all the 44. Features characteristically associated

following EXCEPT: with imperforate hymen in a 16yrs old girl
a) suspicious pregnancy include:
b) PID a) acute urine retention
c) congenital malformation of the b) absence of secondary sexual
uterus characteristics
d) presence of abnormal uterine c) hirsuitism
bleeding d) short stature
e) uterine malignancy e) present with secondary amenorrhea
40. Recognized feature of Sheehan 45. A 46yrs old woman who had two
syndrome: normal pregnancies 13 and 15yrs ago,
a) menorrhagia presents with 7months amenorrhea. She
b) galactorrhea expresses the desire to become pregnant
c) insulin resistance again. After exclusion of pregnancy, the
d) hypothyroidism following tests are indicated in evaluation
e) dwarfism of this patient:
a) HSG
41. The earliest sign of Sheehan syndrome b) endometrial biopsy
is: c) thyroid function test
a) secondary amenorrhea d) testosterone and DHEAS levels
b) failure of lactation e) LH and FSH levels
c) loss of axillary and pubic hair
d) PV bleeding 46. In PCO:
e) increase appetite a) estradiol levels are high
b) there is increased sensitivity to
42. In Sheehan syndrome, changes that insulin
take place include the following EXCEPT: c) has no change in FSH:LH ratio
a) complete lactation failure d) androstendione levels are high
b) feeling of lethary e) sex hormone binding globulin are
c) genital atrophy increased
d) amenorrhea
e) increased basal metabolic rate 47. Commonest mass associated with
amenorrhea in reproductive age women
43. A 26yrs old lady presented with 2ry is:
amenorrhea, FSH and LH are high. Most a) follicular cyst
probable diagnosis: b) corpus luteal cyst
a) Sheehan syndrome c) benign cystic teratoma
b) Asherman syndrome d) leiomyoma
c) premature ovarian failure e) pregnancy
d) imperforate hymen
e) pituitary adenoma
48. Secondary amenorrhea may be related 53. Recently the main risk of HRT after
to: menopause is:
a) emotional factor a) fracture neck of femur
b) systemic disease b) cancer colon
c) nutrition c) hirsuitism
d) specific endocrine disorder d) cancer breast
e) all of the above e) genital atrophy
54. Which of the following is an indication

49. Which of the following factors
for estrogen treatment?
predispose to genital prolapsed?
a) fibroid
a) repeated LSCS
b) threatened abortion
b) multiparity c) endometriosis
c) PID d) postmenopausal atrophic vaginitis
d) endometriosis e) induction of ovulation for
e) repeated candidiasis anovulatory cycle
50. 38yrs old multipara complains of 55. Recognized feature in menopausal

painless loss of urine immediately after women is:
coughing, laughing, lifting or straining. a) low LH
Cessation of the activity stops the urine b) increased bone mineral density
loss. This history is suggestive of: c) high FHS
a) fistula d) high level of estrogen
b) stress incontinence e) increase the incidence of uterine
c) urge incontinence fibroid
d) urethral incontinence
e) UTI 56. After menopause, which of the
following is true?
a) there is increase vaginal acidity
51. Clinical symptoms of uteine prolapsed
b) gonadotropins secretion falls
include the following EXCEPT:
c) recurrent vaginal bleeding should be
a) cervical ulcer
investigated by endometrial biopsy
b) dyspareunia d) malignancy is the leading cause of
c) amenorrhea postmenopausal bleeding
d) urinary retention e) bone mineral density increases
e) low back ache
57. All the following are possible causes of
52. The use of estrogen alone in menorrhagia EXCEPT:
menopausal women increase the risk of: a) uterine fibroid
a) endometrial cancer b) adenomyosis
b) ovarian cancer c) PID
c) bone cancer d) endometrial hyperplasia
d) bowel cancer e) COCP
e) all of the above
58. An obese 63yrs old woman present 63. Secondary dysmenorrhea can be
with a 3months history of continuous caused by all the following EXCEPT:
scanty bleeding. Physical examination is a) endometrial polyp
normal. Your recommendation is: b) endometriosis
a) cervical cone biopsy c) PID
b) D&C d) uterine leiomyoma
c) cycling with progestin e) OCP
d) laparoscopy
64. Woman with endometriosis is likely to
e) official visit every 6months for
complain of all the following EXCEPT:
evaluation
a) dyspareunia
b) mood swings
59. The commonest cause of menstrual c) painful defecation
abnormality in reproductive age women: d) severe dysmenorrheal
a) ectopic pregnancy e) infertility
b) uterine leiomyomas
c) adenomyosis 65. The following are theories for
d) anovulation endometriosis EXCEPT:
e) coagulopathy a) coelomic metaplasia
b) endometrial hyperplasia
60. Regarding adenomyosis: c) retrograde menstruation
a) it is the presence of endometrial d) immunological factor
glands and stroma outside the uterus e) lymphatic spread of endometrial
b) can be diagnosed by D& C fragments
c) can be detected by hysteroscopy
d) can cause severe dysmenorrhea 66. Regarding endometriosis, all the
e) can cause infertility following are correct EXCEPT:
a) is frequently associated with
61. The treatment of endometriosis infertility
include all the following EXCEPT: b) causes deep dyspareunia
a) birth control pills c) is often asymptomatic
b) oral progesterone d) causes postcoital bleeding
c) estrogen e) causes dysmenorrheal
d) depot provera
e) GnRh analogue 67. A 40yrs old woman complains of
menorrhagia and dysmenorrhea that
62. These are possible sites for
progressed gradually. The most likely
endometriosis deposits EXCEPT:
diagnosis is:
a) brain
a) endometrial cacncer
b) peritoneum
b) adenomyosis
c) uterosacral ligaments c) cervical cancer
d) ovaries d) ovarian cyst
e) scars e) endometrial polyps
68. Premenstrual tension should be 73. Acceptable treatment for uterine

initially treated with: fibroids include all the following EXCEPT:
a) COCP a) no treatment
b) hysterectomy b) myomectomy during pregnancy if
c) aldosterone red degeneration occurs
d) diuretics c) myomectomy
e) D&C d) hysterectomy
e) GnRh agonist
69. Which of the following tumours is least
likely to be hormonally active: 74. Uterine fibroid: which is true?
a) sertolli-lydig cell tumor a) is commoner in white people than
b) granulosa cell tumor black races
c) struma ovarii b) all should be treated immediately
d) fibroma c) sarcomatous change occurs in 1%
e) thecoma d) can cause obstructed labor
e) in pregnancy, this indicates cesarean
70. the most common malignancy in the section
female reproductive organs:
a) carcinoma of the cervix 75. Regarding red degeneration in fibroids,
b) carcinoma of the ovary all are true EXCEPT:
c) carcinoma of the breast
a) common during pregnancy
d) carcinoma of the uterine corpus
b) causes acute abdominal pain
e) leiomyosarcoma
c) surgery is the first line of treatment
d) caused by ischemic necrosis
71. Laparoscopy is used in the diagnosis of
e) can occur in postmenopausal women
the following EXCEPT:
on HRT
a) ectopic pregnancy
b) endometriosis
76. A patient has uterine leiomyoma
c) ovarian cyst
accompanied by excessive uterine
d) tubal patency
bleeding, TVS showed thick endometrium
e) submucous fibroid
of 13mm. The initial evaluation should be
72. The commonest uterine fibroid to by:
cause excessive bleeding is: a) myomectomy
a) submucous fibroid b) hysterectomy
b) subserous fibroid c) irradiation
c) intramural fibroid d) high dose of estrogen
d) cervical fibroid e) hysteroscopy with endometrial
e) broad ligament fibroid biopsy
77. A 20yrs old lady pregnant in first 81. Suggestive US features of ovarian
trimester came complaining of lower malignancy include all the following
EXCEPT:
abdominal pain. In examination a mass
a) bilateral
continuous with the uterus was found. The b) presence of ascites
most probable diagnosis is: c) contain solid component
a) red degeneration in a fibroid d) unilocular
b) ectopic pregnancy e) capsule integrity is disrupted with
projection
c) uterine rupture
d) rupture placenta 82. Which of the following tumors
e) placenta previa produces estrogen?
a) endodermal sinus tumor
78. Ovarian neoplasm most commonly b) choriocarcinoma
c) granulosa cell tumor
arise from:
d) dysgerminoma
a) ovarian epithelium e) serous cyst adenoma
b) ovarian stroma
c) ovarian germ cells 83. The tumor marker secreted by
d) ovarian sex cords endodermal sinus (yolk sac) tumor is:
a) alpha fetoprotein
e) metastatic disease b) HCG
c) LDH
79. Metastatic tumors to the ovary rarely d) estrogen
originate from the: e) androgen
a) breast
84. Which of the following gynecological
b) stomach cancers is a leading cause of death?
c) large intestine a) ovarian
d) uterus b) uterine
e) vagina c) cervical
d) vaginal
e) vulvar
80. Ovarian cancer is more likely to occur
in all the following EXCEPT: 85. Staging of ovarian carcinoma is based
a) nulliparous women on:
b) women who have breast cancer a) pelvic examination
b) CT imaging of the abdomen and
c) patient with history of prolonged use
pelvis
of oral contraceptive pills c) paracentesis of ascetic fluid
d) women with a family history of d) surgical evaluation of the extent of
ovarian cancer intra-abdominal disease
e) high socioeconomic class e) barium enema
86. The commonest site for metastasis 91. Risk factors of cervical cancer include
from ovarian cancer is: all the following EXCEPT:
a) Douglas pouch a) nulliparity
b) liver b) multiple sexual partner
c) uterus c) history of HPV infection
d) peritoneum d) smoking
e) bone e) sexual activity at early age
92. The most common clinical

87. An increased incidence of endometrial
presentation of early cervical cancer is:
hyperplasia has been described in patients
a) foul smelling vaginal discharge
with:
b) asymptomatic
a) multiparity c) post coital bleeding
b) Crohn’s disease d) pelvic pain with leg edema
c) delayed menarche e) lower back pain
d) PCO
e) COCP 93. Definitive initial therapy for
hydatidiform mole commonly is:
88. The most common uterine tumor in a) evacuation
the reproductive age is: b) abdominal hysterectomy
a) sarcoma c) evacuation followed by
b) adenocarcinoma methotrexate therapy
c) adenomyosis d) evacuation followed by
d) choriocarcinoma hysterectomy
e) leiomyoma e) radiation
89. Screening is most effective in 94. After B-HCG titer becomes

preventing which of the following cancers: undetectable, the patient treated for
hydatidiform mole should be followed
a) vulva
with monthly titers for a period of:
b) cervix
a) 3months
c) endometrial
b) 6months
d) ovary c) 1year
e) fallopian tube d) 2years
e) 5years
90. Untreated patients with cancer of the
cervix usually die with: 95. The most frequent site for metastasis
a) cachexia and starvation from a malignant GTD is:
b) bowel obstruction a) brain
c) renal failure and uremia b) liver
d) multiorgan failure c) kidneys
e) cerebrovascular accident d) vulva
e) lung
96. Symptoms and signs of hydatidiform 100. The differential diagnosis of vulvar
mole include all the following EXCEPT: swelling includes all the following EXCEPT:
a) first trimester bleeding a) Bartholin cyst
b) a uterus larger than expected b) hematoma
gestational age c) condyloma
c) hypothyroidism d) nabothian cyst
d) pre-eclampsia e) papilloma
e) nausea and vomiting
97. Androgen insensitivity syndrome:

a) the characteristic feature include
normal uterus and breast
development and ambiguous
genitalia
b) karyotyping is 46XX
c) they have normal female
testosterone level
d) gonadectomy must be performed
after puberty because of the
increased risk of malignancy
e) ERT is not indicated because they
have enough estrogens to produce
breast development
98. In postmenopausal women:

a) malignancy is the commonest cause
of postmenopausal bleeding
b) FSH and LH are characteristically low
c) fibroid uterus tends to grow bigger
d) HRT increases the risk of breast
cancer
e) endometrium is characteristically
thick on US
99. Which of the following is an indication

for estrogen treatment?
a) fibroid
b) threatened abortion
c) endometriosis
d) postmenopausal atrophic vaginitis
e) induction of ovulation for
anovulatory cycle
ANSWERS
1 B 36 D 71 E
2 C 37 E 72 A
3 B 38 A 73 B
4 C 39 C 74 D
5 C 40 D 75 C
6 B 41 B 76 E
7 C 42 E 77 A
8 E 43 C 78 A
9 A 44 A 79 E
10 A 45 E 80 C
11 D 46 D 81 D
12 B 47 E 82 C
13 E 48 E 83 A
14 E 49 B 84 A
15 C 50 B 85 D
16 B 51 C 86 D
17 D 52 A 87 D
18 A 53 D 88 E
19 D 54 D 89 B
20 E 55 C 90 C
21 B 56 C 91 A
22 A 57 E 92 C
23 E 58 B 93 A
24 C 59 D 94 E
25 D 60 D 95 C
26 E 61 C 96 C
27 D 62 A 97 D
28 C 63 E 98 D
29 E 64 B 99 D
30 D 65 B 100 D
31 E 66 D
32 A 67 B
33 E 68 A
34 B 69 D
35 B 70 C
Obs 1: Bleeding In Early Pregnancy (50 marks)

Choose the most correct answer: 4. An 18yrs old adolescent female is
brought to the emergency complaining of
1. A 33yrs old woman at 10weeks mild vaginal spotting and mild lower
abdominal pain. Her abdominal and pelvic
gestation complains of vaginal bleeding
examinations were normal. HCG is
and passage of a whitish “meat-like”
700miu/ml. Transvaginal ultrasound
substance. She continues to have reveals no intrauterine gestational sac and
cramping and her cervix is 2cm dilated. no adnexal masses. Which of the following
Her best management is: is most accurate regarding this patient
a) laparoscopy situation?
b) follow up HCG after 48hrs a) she has unruptured ectopic
c) cervical cerclage pregnancy
b) she has a viable intrauterine
d) trachelorraphe
pregnancy that is too early to assess
e) dilatation and curettage of the on US
uterus c) she has no viable intrauterine
pregnancy
2. A 20yrs old G2P1 at 12wks gestation d) she has pseudocyesis
complains of some slight vaginal spotting. e) there is insufficient information to
No uterine gestational sac and no adnexal draw a conclusion about the viability
masses are detected by TVS. HCG is of this pregnancy
700miu/ml. Best management is:
5. A 22yrs old pregnant woman at 5wks
a) laparoscopy gestation, complains of severe lower
b) hysteroscopy abdominal pain. On examination, she is
c) follow up HCG after 48hrs noted to have a BP: 85/45 and HR:
d) dilatation and curettage 120bpm. Her abdomen is tender. Pelvic
e) expectant management examination is difficult to perform due to
garding. HCG is 500miu/ml. TVS shows no
3. A 28yrs old G3P2 woman at 22wks intrauterine gestational sac and no
adnexal masses. There is some free fluid in
gestation is noted to have vaginal spotting
the Douglas Pouch. Best management for
and fetal heart beats are 140-145b/min. this patient:
What is your best management plan? a) repeat HCG level in 48hrs and assess
a) laparoscopy for a rise of 66%
b) follow up with HCG after 48hrs b) repeat ultrasound after one week
c) cervical cerclage c) check the serum progesterone level
d) hysterotomy d) immediate surgery
e) expectant management e) intramuscular methotrexate
6. The commonest indication for women 10. A 19yrs old 2nd GP0 patient complains
attending OBGYN emergency is: of spotting and right side pain. She had a
a) bleeding in early pregnancy positive urine pregnancy test 3weeks ago.
Ultrasound does not identify an
b) missing IUD
intrauterine pregnancy. On laparoscopy,
c) pain in lower abdomen 125cc blood is seen in the pelvis. There is
d) pelvic organ prolapsed minimal blood from the tube and a small
e) urinary incontinence bit of tissue is recovered floating free in
the peritoneal cavity. This pregnancy is
7. A 34yrs old woman undergoes an likely:
elective termination of pregnancy at a) spontaneous abortion
12wks. She develops fever, uterine b) delivery
c) tubal abortion
tenderness and is diagnosed with septic
d) decidual cast
abortion. Most likely mechanism of her e) vesicular mole
infection:
a) ascending infection Questions 11-13: A 26yrs old woman
b) skin organisms whose LMP was 2.5months ago, develops
c) urinary tract penetration bleeding, uterine cramps and passes tissue
d) hematogenous infection per vagina. Two hours later, she is still
bleeding heavily.
11. What is the most likely diagnosis?
8. During PV of an 8wks pregnant lady, a) threatened abortion
one adnexa is found slightly enlarged. This b) inevitable abortion
is most commonly: c) premature labor
a) corpus luteum cyst d) incomplete abortion
b) ectopic pregnancy e) complete abortion
c) follicular cyst
12. The bleeding is most likely due to
d) ovarian neoplasm which of the following:
e) broad ligamentary fibroid a) retained products of conception
b) ruptured uterus
9. A friend mentions to you, she just had a c) systemic coagulopathy
positive pregnancy test. Knowing that her d) vaginal lacerations
LMP was June 30, can tell her when will be e) rupture uterus
her due date?
13. What is the indicated procedure?
a) March 23 a) hysterectomy
b) April 7 b) vaginal packing
c) April 23 c) IV fibrinogen
d) March 7 d) uterine curettage
e) September 7 e) hemostatics
14. A 26yrs old G2P1 at 7wks was seen one 17. When evaluating the results of HCG
week ago with lower abdominal pain and level in the maternal blood, the peak value
occurs at:
vaginal spotting. HCG is 1000miu/ml.
a) 3-4wks
Today, she has no abdominal pain nor b) 8-11wks
passage of tissue per vagina. Her repeat c) 14-16wks
HCG is 1100miu/ml. TVS shows no clear d) 24-26wks
pregnancy in the uterus and no adnexal e) 36-42wks
masses. You conclude: 18. The following sonographic
a) she had spontaneous abortion and measurements is most accurate for
needs D&C estimating gestational age:
b) she has normal pregnancy a) amniotic sac size at 5weeks of
pregnancy
c) no clear conclusion and we need to
b) crown- rump length at 10weeks of
repeat HCG after 48hrs pregnancy
d) she has a non viable pregnancy but c) femur length at 16weeks of
its location is unclear pregnancy
e) she had complete abortion and no d) biparietal diameter at 20weeks of
pregnancy
further management needed
e) abdominal circumference at 24weeks
of pregnancy
15. A 19yrs old G1P0 at 18wks GA had a
prior cervical conization, comes now for 19. A 39yrs old lady who had severe
ANC. She has no abdominal cramping. PV endometriosis and no children, is now
6weeks pregnant. TVS confirms right sided
shows 2cm dilated cervix and 40% effaced. ectopic pregnancy with fetal pole but no
Best ttt is: pulsations. She is vitally stable and her B-
a) laparoscopy HCG: 3030 IU/L. Your safest recommended
b) cervical cerclage plan of management:
a) laparoscopic salpingostomy
c) dilatation and curettage
b) conservative management
d) expectant management c) systemic methotrexate
e) hysterotomy d) repeat scan in 7days
e) surgical or medical: give her the
16. Which fetal US measurements gives choice
the most accurate estimate of GA in the 20. Based on epidemiology, which group
first trimester? of women are more affected with molar
a) femur length pregnancy?
b) biparietal diameter a) women in their 30s
b) infertile women
c) abdominal circumference
c) caucasians
d) crown-rump length d) smokers
e) sacral length e) extremes of ages
21. How a complete mole differs from a a) consider McDonald's cerclage

partial mole? b) reassure her and call her back for
a) they are usually triploid repeat scan
b) they have a better prognosis c) take a high vaginal swab and
c) they arise mostly from duplication of reassure her
a single sperm d) consider Shirodkar cerclage
d) they usually contain fetal blood cells e) admit for observation
e) the fetus develops when there is a
25. A 23yrs old PG at 6wks GA presents to
maternal chromosome
ER with threatened abortion. O/E: vital
signs are normal, abdomen is soft with
22. A 25yrs old woman presents to ER with mild tenderness on deep palpation.
vomiting, she has also right sided Speculum examination shows small
abdominal pain but no diarrhea. Urine amount of brown blood. TVS shows
analysis shows 3+ ketones but no intrauterine gestational sac 38x25x20mm,
leukocytes. The first test to be done: yolk sac is visible, no fetal heart activity
a) CBC and a small area of subchorionioc
b) pregnancy test hemorrhage. Best management:
c) CRP a) arrange for scan at 12weeks
d) culture and sensitivity of mid-stream b) arrange for repeat scan after 1week
urine c) arrange for serum B-HCG level
d) arrange for serum progesterone level
e) urea and electrolytes
e) arrange for surgical evacuation of
this abortion.
23. A 22yrs old PG presents to ER at 26wks
GA with painless bleeding. Best 26. A 37yrs old woman is seen after her
investigation to be done: third consecutive early pregnancy loss.
a) MRI scan Most likely cause of recurrent miscarriage:
b) transabdominal scan a) antiphospholipid syndrome
c) CTG b) cervical factors
d) transvaginal scan c) genetic causes
e) CT scan d) genital infections
e) uterine anatomical abnormality
24. A 22yrs old 2nd gravid at 14wks GA,
27. A 23yrs old woman undergoes a
comes with slight increased vaginal
surgical evacuation for a suspected molar
discharge for the past week. She is anxious pregnancy. Histology confirms partial
as she had miscarriage at 16wks in her last mole. The commonest chromosomal
pregnancy due to ROM, which was composition of partial mole:
followed by induction 72hrs later due to a) 1 paternal and 1 maternal gamete
anhydramnios. On speculum examination, b) 1 paternal and 2 maternal gametes
cx is long and closed with no evidence of c) 2 paternal and 1 maternal gamete
liquor. TVS: cx is 3cm length. Best d) 2 paternal and no maternal gametes
management is: e) 3 paternal and 1 maternal gamete
28. A 31yrs old woman is diagnosed with 30. A 28yrs old patient attends an early
missed abortion at 11wks in her first pregnancy unit for a routine scan at 8wks.
pregnancy. Her BMI is 26 and she has no TVS shows a sac of 3.5cm, CRL of 1cm with
no visible heartbeat. The internal os is
medical history. She wants to know the closed and no vaginal bleeding. The scan
reason for this miscarriage. The likely suggests:
commonest cause of first-trimesteric
miscarriage is: a) early fetal demise
a) fetal aneuploidy b) incomplete miscarriage
c) inevitable miscarriage
b) infection d) normal ongoing intrauterine
c) smoking pregnancy
d) thrombophilia e) ectopic pregnancy
e) uterine anomaly
31. A 29yrs old patient presents at 12wks
GA with abdominal distension and vaginal
29. A 25yrs old woman will undergo bleeding. TVS suggests molar pregnancy
laparoscopic management of her ectopic with bilateral enlarged multicystic ovaries.
pregnancy but she asks whether The cysts are thin walled with clear
salpingectomy is essential. In counseling contents and no fluid in Douglas pouch.
her about salpingostomy vs Most likely diagnosis:
a) mucinous cystadenoma
salpingectomy, which statement is b) struma ovarii
correct? c) serous cystadenoma
a) one in 5 women may need further ttt d) lutoma of pregnancy
including methotrexate and/or e) theca lutein cyst
salpingectomy
In questions 32-36, for each of the
b) there is higher risk of surgical following clinical scenarios involving early
complications with salpingostomy vs pregnancy, select the SINGLE most
salpingectomy appropriate management action from the
c) the chance of recurrent ectopic is list shown, each option can be used once,
higher if she undergoes more than once or not at all.
a) admission to hospital ward for
salpingectomy observation
d) the chance of subsequent b) diagnostic laparoscopy and proceed
intrauterine pregnancy is higher if according to pathology
she undergoes salpingectomy c) intramuscular methotrexate
e) the risk of needing blood transfusion d) intravenous fluid rescussitation
e) intravenous antibiotics
is higher with salpingostomy f) measure B-HCG and serum
progesterone
g) measure CBC and determine blood 38. An 18yrs old G1P0 comes to ER with
group type progressive nausea and vomiting, she has
h) vaginal misoprostol not been able to keep anything down and
i) pelvic ultrasound vomited seven times in the last day. She
j) speculum for vaginal and cervical has no diarrhea, fever, chills, dysuria but
examination urine analysis showed mild ketonuria and
k) speculum and cervical smear test she is tachycardic. CBC is normal and B-
l) surgical evacuation of the uterus HCG is 150.000 IU/L. You admit for IV
32. A 28yrs old G1P0 is 12wks GA. She fluids, antiemetics and electrolyte
complains of vaginal bleeding after replacement. Next step is:
intercourse and her last smear 6months a) order an obstetric ultrasound
ago was normal. b) place N/G tube for nutritional
33. A 19yrs old has undergone termination supplementation
of pregnancy at 9wks GA. She presents c) order blood cultures and chest X-Ray
2weeks later with heavy vaginal bleeding. to evaluate an infectious etiology
34. A 34yrs old is diagnosed by US to have d) consult general surgery for concern
complete molar pregnancy at 10wks GA. about bowel obstruction
e) start total parentral nutrition
35. A 17yrs old is brought by an ambulance
after collapsing in a shop. Her BP is 90/60,
39. A 35yrs old 4th GP0 (0030) comes for
HR: 115b/min and oxygen saturation 98%.
She complains of severe abdominal pain her first ANC visit, she is 8wks GA with
and shoulder pain and feels faint. history of elective termination when she
was a teenage and 2 losses at 16wks in the
36. A 22yrs old is diagnosed with a 1.5cm past 3years. In both losses, there was a
left tubal ectopic pregnancy by US. Her B-
history of mild vaginal bleeding. She
HCG is 1500 IU/L and has increased to 1600
presents to hospital and was found 4-5cm
IU/L in 48hrs. She is asymptomatic and has
dilated and delivered shortly after genetic
no evidence of hemoperitoneum on US.
analysis of both fetuses were normal. She
has no history of bleeding or clotting
37. A 39yrs old woman presents to ER with disorders but gives history of LEEP at 27yrs
irregular vaginal bleeding for the past for cervical dysplasia. Next step is:
1year. She had a D&C outside the country
a) she and her husband should undergo
1year ago for “abnormal pregnancy” and
karyotyping
had no follow up since then and was not
b) she should have HSG after this
sexually active for this year. She has also
coughing of blood for the past week. Her pregnancy for uterine abnormalities
B-HCG is 112.000 IU/L. The most likely c) she should undergo CVS to evaluate
diagnosis: the chromosomes of the fetus
a) complete molar pregnancy d) she should start progesterone
b) partial molar pregnancy supplementation for presumed LPD
c) metastatic persistent GTD e) she should have prophylactic
d) placental site trophoblastic tumour cerclage around 12wks GA for
e) ectopic pregnancy presumed cervical incompetence
40. A 28yrs old G1P0 comes for ANC. She 43. A 33yrs old G2P1 presents at 15wks GA
had regular menses and her early dating with trisomy 18 for termination. You
US showed her pregnancy in left horn of a discuss the options including induction
bicornuate uterus. This diagnosis is new and D&E. You decide for induction. Which
for her and she is concerned about the would NOT be included in her consent
pregnancy-related risk associated with a risks?
bicornuate uterus. The commonest risk is: a) infection
b) bleeding
a) infertility
c) uterine perforation
b) antepartum bleeding
d) possible need for additional
c) recurrent first trimesteric miscarriage procedures
d) cervical insufficiency e) transfusion
e) preterm labor and delivery
44. Two weeks ago, your colleague
41. Historically, before development of performed a medical evacuation on a
standard pregnancy test, which of the 26yrs old G1P0 woman at 6wks GA. She
following was NOT a sign to diagnose now presents for follow up with mild
pregnancy? bleeding. O/E: she is afebrile, abdomen is
a) Chadwick sign non tender, cx is closed with mild vaginal
b) Goodell sign bleeding and uterus is non tender. TVS
c) Hegar sign shows an intrauterine gestational sac. The
d) Development of linea nigra patient is mildly anemic on iron
e) Cullen sign supplement. Your best next step:
a) repeat dose of misoprostol
b) repeat dose of mefipristone
42. An 18yrs old woman presents to ER
c) serial ultrasounds
with abdominal cramps and vaginal
d) perform D&C
bleeding. T: 37.3, BP: 110/70, HR: 82b/min e) perform hysterotomy
and RR: 18/min. O/E: mild lower
abdominal tenderness without rebound. 45. A 20yrs old woman presents to ER with
PV: mildly enlarged uterus with right new onset vaginal bleeding. She is found
adnexal fullness. Urine pregnancy test is pregnant with B-HCG 300.000 IU/L. Both
positive. B-HCG: 9000 IU/L, CBC is normal her BP and HR are elevated. O/E: uterus is
and blood group: A negative. US reveals felt near umbilicus although she is 8wks
ectopic pregnancy with mild fluid in the GA. US showed snow storm appearance.
pelvis. Best next step: The following is NOT part of immediate
a) multidose methotrexate initial management plan:
b) emergency laparotomy for a) determination of Rh-blood group
evacuation of ectopic pregnancy status
c) laparoscopic evacuation of ectopic b) surgical intervention (suction
pregnancy evacuation)
c) methotrexate administration
d) misoprostol therapy
d) evaluation of thyroid status
e) administer anti-D
e) CBC
In questions 46-50, for each of the

following clinical scenarios involving early
pregnancy, select the SINGLE most likely
diagnosis from the list shown. Each option
can be used once, more than once or notat
all.
a) complete miscarriage
b) early fetal demise
c) pregnancy of uncertain location and
vitality
d) inevitable miscarriage
e) incomplete miscarriage
f) late miscarriage
g) ongoing intrauterine pregnancy
h) ectopic pregnancy
i) recurrent miscarriage
j) ruptured tubal ectopic pregnancy
46.F ive wks GA, B-HCG: 600 IU/l.
Intrauterine gestational sac can’t be seen
by US and no adnexal masses.
47.S ix wks GA, B-HCG: 1000 IU/l.

Intrauterine sac with CRL of 1cm is seen
and no fetal heart activity.
48. Six wks GA, B-HCG: 1800 IU/l. No

evidence of intrauterine pregnancy and no
fluid in DP.
49. Ten wks GA with cramping pelvic pain

and vaginal bleeding. US shows
intrautrerine CRL 25mm and positive fetal
cardiac activity. PV: 3cm dilated cervix with
active bleeding.
50. Nine wks GA, B-HCG: 2500 IU/L with left

pelvic tenderness. US shows empty uterus
with free fluid in DP and left adnexal mass
containing a sac-like structure.
ANSWERS
1 E 36 C
2 C 37 C
3 E 38 A
4 E 39 E
5 D 40 E
6 A 41 E
7 A 42 C
8 A 43 C
9 B 44 D
10 C 45 C
11 D 46 C
12 A 47 B
13 D 48 H
14 D 49 D
15 B 50 J
16 D
17 B
18 B
19 C
20 E
21 C
22 B
23 B
24 C
25 B
26 A
27 C
28 A
29 A
30 A
31 E
32 G
33 I
34 L
35 D
Obs 2: Complications Of 3rd Stage (50 marks)

Choose the most correct answer 4. A 24yrs old G1P0 woman at 39wks
gestation had induction of labor due to
1. A 23yrs old G1P0 who is pregnant gestational hypertension. She was placed
38wks, delivered a 3kg male. Upon on MgSo4 for seizure prophylaxis. She was
delivery of the placenta, the uterus placed on oxytocin for 15hrs but arrest of
inverted but was successfully managed dilatation occurred and CS was performed.
including replacement of the uterus. The The baby was delivered without difficulty
following placental implantation site most through a LSCS. Upon delivery of the
likely predispose to an inverted uterus: placenta, profuse bleeding was noted
a) fundal reaching 1500cc. Which of the following is
b) posterior the most likely cause of hemorrhage?
c) lateral a) uterine atony
d) lower segment b) uterine laceration
e) none of the above c) uterine rupture
d) coagulopathy
2. A 24yrs old woman underwent a normal e) retained placenta
vaginal delivery of a term infant female.
After delivery, the placenta wasn't 5. A 26 yrs old G2P1 woman underwent a
delivered even after 30minutes. The next normal vaginal delivery. A viable 3.5kg
step for this patient: male baby was delivered. The placenta
a) wait for an additional 30minutes delivered spontaneously. The obstetrician
b) hysterectomy noted significant blood loss from the
c) attempt a manual extraction of the vagina approximately 700ml. The uterine
placenta fundus appeared well contracted. The
d) misoprostol intravaginally most common etiology for the bleeding in
e) bilateral internal iliac arteries ligation this patient:
a) retained placenta
3. A 33yrs old G5P5 woman, who is being b) genital tract laceration
induced for pre-eclampsia, delivers a 4kg c) uterine atony
baby. Upon delivery of the placenta, d) coagulopathy
uterine inversion is noted. The physician e) uterine inversion
attempts to replace the uterus but the
cervix is tightly contracted, preventing 6. A 32yrs old woman has severe
reposition. Best therapy for this patient: postpartum hemorrhage that does not
a) vaginal hysterectomy respond to medical therapy. The
b) abdominal hysterectomy obstetrician states that surgical
c) halothane anesthesia management is the best therapy. The
d) discontinue the magnesium sulfate patient desires future fertility. The most
e) infuse oxytocin intravenously appropriate to achieve the therapeutic
goals:
a) unilateral internal iliac artery ligation 10. A 33year old woman at 37wks
b) bilateral internal iliac artery ligation gestation presents with moderate to
c) supracervical hysterectomy severe vaginal bleeding. She is noted on
d) ligation of the external iliac artery sonography to have a placenta previa.
e) cervical cerclage Best management for this patient:
a) induction of labor
7. A 34yrs old woman is noted to have b) tocolysis of labor
significant uterine bleeding after a vaginal c) cesarean delivery
delivery complicated by placenta d) cesarean hysterectomy
abruption. She is bleeding from multiple e) expectant management
venipuncture sites. Best therapy:
a) immediate hysterectomy 11. A 22yrs old G1P0 woman at 34wks
b) packing of the uterus gestation presents with moderate vaginal
c) internal iliac artery ligation bleeding and no uterine contractions. Her
d) external iliac artery ligation BP is 110/60 and HR: 105b/min. The
e) correction of coagulopathy abdomen is not tender. The most
appropriate sequence of examinations is:
8. A 28yrs old woman at 32wks gestation a) speculum examination, ultrasound,
is seen in obstetrical triage for vaginal digital examination
bleeding with passage of blood clots. She b) ultrasound, digital examination,
denies cramping or pain. An ultrasound is speculum examination
performed revealing that the placenta is c) digital examination, ultrasound,
covering the internal os of the cervix. Risk speculum examination
factor for this patient's condition: d) ultrasound, speculum examination,
a) prior salpingitis digital examination
b) hypertension e) digital examination, speculum
c) rupture of membranes examination, ultrasound
d) multiple gestations
e) polyhydramnios 12. An 18yrs old adolescent female is
noted to have a low lying placenta on US
9. A 21yrs old patient at 28wks gestation at 22wks gestation. She does not have
with vaginal bleeding is diagnosed with vaginal bleeding or spotting. Most
placenta praevia. The following is a typical appropriate management:
feature of this condition: a) schedule cesarean delivery at 38wks
a) painful bleeding b) schedule MRI at 35wks to assess for
b) commonly associated with possible percreta involving the
coagulopathy bladder
c) first episode of bleeding is usually c) reassess placental position at 32wks
profuse gestation by ultrasound
d) first episode happens in the first d) recommend termination of
trimester pregnancy
e) associated with postcoital spotting e) immediate hysterotomy
13. the most significant risk factor for 16. A 29yrs old G1P0 woman at 39wks
abruption placentae is: gestation delivered vaginally. Her placenta
a) prior cesarean delivery does not deliver easily. A manual
b) breech presentation extraction of the placenta is attempted
c) trauma and the placenta seems to be adherent to
d) diabetes Mellitus the uterus. A hysterectomy was planned
e) placenta accreta but the patient is refusing it totally due to
her strong desire to get children. The cord
is ligated with suture as high as possible.
14. A 33yrs old G3P2 woman (previous
The patient is given the option of
2CS) is currently at 38wks gestation. She is
methotrexate therapy. Most likely
noted to have a posterior placenta. On
complication after intervention:
ultrasound, there is evidence of possible a) coagulopathy
placenta accreta. The patient is counseled b) utero-vaginal fistula
about the possible risk of need for c) infection
hysterectomy. The most accurate d) malignant transformation
statement: e) placental autolysis
a) having prior cesareans is associated
with 50% risk for placenta accreta. 17. A 32yrs old woman undergoes
b) placenta accreta is associated with a myomectomy for subserous uterine
defect in the myometrial layer. fibroids. The endometrial cavity was not
c) if the patient had gestational entered. Which of the following
diabetes, the risk for placenta statements is most likely to be correct
accreta would be even higher regarding the risk of placenta accreta?
d) the posterior placenta may be a) her risk of accreta is most likely to be
associated with less of a risk for increased due to the myomectomy
accreta than an anterior placenta b) her risk of accreta is most likely to be
e) none of the above decreased due to myomectomy
c) her risk of accreta is most likely not
affected by the myomectomy
15. A 25yrs old woman at 34wks gestation
d) she has an increased risk of placental
is noted to have a placenta previa after
polyp
she presented with vaginal bleeding and e) she has an increased risk of twin
has undergone sonography. At 37wks, she pregnancy
has a scheduled cesarean. Upon cesarean
section, bluish tissue densely adherent 18. A 32yrs old G1P0 woman at 40wks
between the uterus and the maternal gestation undergoes a normal vaginal
bladder is noted. Which of the following is delivery. Delivery of the placenta is
the most likely diagnosis? complicated by an inverted uterus with
a) placenta accreta subsequent hemorrhage and loss of
b) placental melanoma 1500ml blood. She is managed by
c) placenta percreta transfusion of packed RBCs. Which of the
d) placental polyp following is the best explained of the
e) placental hematoma mechanism of hemorrhage?
a) inverted uterus stretches the blood 21. A 29yrs old 4thGP3 with previous 3CS
vessels causing their trauma leading is diagnosed with a placenta accreta at
to bleeding 28wks gestation. When is the placenta
b) inverted uterus leads to inability for accreta most likely to cause bleeding?
an adequate myometrial contraction a) during the first stage of labor
effect b) prior to labor
c) after amniotic membrane rupture
c) inverted uterus causes a local
d) during attempts to remove it
coagulopathy reaction to the uterus
e) postpartum
and endometrium
d) inverted uterus causes muscular 22. A 26yrs old woman is first seen at
abrasions and lacerations leading to 28wks gestation. Her history and physical
bleeding examination are normal except for the
e) all of the above presence of a 2cm posterior cervical
leiomyoma. Best management for this
19. An unconscious obstetric patient is patient:
admitted in 28th wks GA with BP 60/20 a) myomectomy at 36wks
and pulse 120. There is no vaginal b) progesterone therapy to decrease
bleeding. You may exclude: the myoma size
a) concealed accidental hemorrhage c) watchful waiting
b) placenta praevia d) elective cesarean delivery at term
e) cesarean section and myomectomy
c) premature rupture of membranes
at the same setting
with septic shock
d) eclampsia
23. A patient sustained a laceration of the
e) rupture uterus and internal perineum during delivery. It involves
hemorrhage muscles of the perineal body but not the
anal sphincter. Such a laceration would be
20. The following statements most classified as:
accurately describes postpartum a) first degree
hemorrhage: b) second degree
a) grand multiparity is a risk factor c) third degree
b) women with severe pre-eclampsia d) fourth degree
are more tolerant of heavy blood loss e) fifth degree
c) changes in pulse and BP are good
early indicators of excessive blood 24. The following situation has the
loss greatest risk for the mother and infant:
a) rupture of an intact uterus
d) placenta accreta is the most frequent
b) rupture of a previous uterine scar
cause
c) physiological constriction ring
e) none of the above d) Bandl's ring
e) dehiscence of a uterine scar
Questions from 25-26 are preceded by a 28. A 30yrs old woman G4P2A1 has been
list of options, select the one letter which seen in the emergency department at
is most closely associated with the 29weeks gestation because of the sudden
condition. Each letter can be used once, onset of painless vaginal bleeding that
soaked four perineal pads and has now
multiple or not at all.
ceased. Her vital signs and Htc are normal.
a) rupture of a classic uterine scar
FHS are regular at 140bpm. At this time,
b) dehiscence of a uterine scar what should you do?
c) spontaneous rupture of an intact a) perform a vaginal examination
uterus b) order an ultrasound examination
d) cervical tear c) perform a cesarean section
e) traumatic rupture of the intact d) send the patient home on bed rest
uterus e) administer hemostatics
25. A G5P5 patient develops marked 29. Which woman is most likely to have
bleeding after delivery of the infant that placenta previa at 32weeks?
continues as severely after the a) 19yrs old G1P0 vertex presentation
spontaneous delivery of the placenta that b) 20yrs old G2P0 breech presentation
appears intact on inspection. The bladder is c) 24yrs old G2P1 breech presentation
empty. The uterine fundus is firm at the d) 34yrs old G5P3A1 vertex
presentation
umbilicus. She has an epidural.
e) 36yrs old G7P6A0 transverse lie
26. A 25yrs old G3P2 with prior low
transverse cesarean delivery is found to 30. The following screening is
have a paper thin lower uterine segment recommended as part of routine
covered with only peritoneum at the time postpartum visit:
a) complete blood count
of a repeat cesarean section. She has no
b) screening for depression
bleeding.
c) thyroid function tests
d) glucose tolerance testing
27. Vaginal examination is contraindicated e) urine dipstick
in which situation during pregnancy:
a) carcinoma of the cervix 31. Breast engorgement in a woman eager
to breastfeed is best managed by:
b) gonorrhea
a) frequent nursing
c) prolapsed cord
b) diuretics
d) placenta praevia c) oxytocin nasal spray
e) rupture of membranes d) tight binder until condition relieved
e) bromocriptine administration
32. A woman with one or more previous 34. Maternal collapse 4hrs following
cesarean section scars and an anterior ventouse delivery, moderate vaginal
placenta are at risk of placenta accreta. bleeding and placenta checked to be
Which of the following tests provide compete. She has undergone CS delivery
highest sensitivity and specificity for 2yrs ago. Abdominal examination reveals a
antenatal diagnosis of placenta accreta? tender moderately contracted uterus and
a) color Doppler urinary catheter shows new onset
b) 3-D power Doppler hematuria.
c) contrast CT 35. Heavy vaginal bleeding 12days
d) Gadolinium contrast MRI following elective CS for twin pregnancy.
e) Grey scale Ultrasound Abdominal examination reveals tender
slightly enlarged uterus. She has a low-
33. A 28yrs old PG has delivered normally grade pyrexia and malodorous vaginal
and has had early cord clamping and 10 IU discharge.
oxytocin and controlled cord traction. The
placenta has not delivered yet. After how 36. Intrapartum hemorrhage just prior to
long would you call it prolonged third delivery that appears watery. She
stage of labor? presented with H/O of APH, abdominal
a) 10minutes pain and stillbirth at 36wks GA. She also has
b) 20minutes bleeding from nostrils and IV cannulation
c) 30minutes sites.
d) 45minutes 37. Profound hypotension and maternal
e) 60minutes collapse one minute after delivering the
placenta, difficult placental delivery
Questions 34-38 are clinical scenarios for requiring considerable cord traction forces
postpartum hemorrhage, there is a list of and moderate vaginal bleeding. Abdominal
options of causes or PPH, for each clinical palpation reveals an indented uterine
scenario, choose the SINGLE most fundus. PV reveals a bulging pulsating mass
appropriate cause from the list of options, that does not feel like a remnant placenta.
each option can be used once, more than 38. Heavy vaginal bleeding immediately
once or not at all. following spontaneous term delivery of
a) atonic uterus diabetic mother. Baby birth weight is 4.8kg.
b) broad ligament hematoma Known to have polyhydramnios before
c) cervical trauma delivery, labor augmented with oxytocin.
d) DIC Abdominal examination reveals a boggy
e) endometritis enlarged uterus extending well above the
f) extrauterine pelvic hematoma umbilicus which contracts down on manual
g) perineal tear uterine massage. No perineal tear occurred
h) retained placental tissue at delivery and the placenta was checked to
i) uterine inversion be complete and intact.
j) uterine rupture.
39. A 24yrs old woman is 22wks GA in her 42. A pregnant woman at 26wks gestation
second pregnancy. She has one previous presents with minimal painless bleeding
CS delivery and her routine 20wks US following sexual intercourse. She is
revealed a low-lying anterior placenta hemodynamically stable and has had no
partially covering the cervical os. Which such episodes in the past. Which of the
following confirms the diagnosis of
SINGLE action is most appropriate?
placenta previa:
a) organize elective CS at 39wks a) abnormal lie of the fetus with high
b) organize MRI pelvis at 32weeks to presenting part
check position of placenta b) speculum examination showing
c) re-assess at 38wks and allow vaginal healthy cervix, vagina and showing
delivery if fetal head is clinically bleeding through os
engaged and there has been no c) spongy tissue felt during PV
antenatal bleeding examination
d) repeat US at 32wks to check position d) tightening of the abdomen during
of placenta clinical examination
e) US showing placenta inserted in the
e) repeat US at 38wks to check position
LUS.
of placenta
43. You are about to counsel a patient
40. Which of the following is a known risk with placenta previa complete centralis
factor for vasa previa? who have just repeated the scan at 32wks
a) bipartite placenta GA. She had H/O of CS for breech
b) placental photocoagulation presentation 4yrs ago. Her US shows an
c) breech presentation anterior placenta covering the internal os
d) septate uterus with irregular retroplacental sonolucent
e) succenturiate lobe zone and hypervascularity in serosa-
bladder interface. She has not had any
episodes of bleeding in this pregnancy.
41. A pregnant woman is seeking advice What is the most appropriate action?
about the effects of smoking in pregnancy. a) immediate CS
The following is correct in relation to b) immediate MRI as it will definitively
pregnancy risks as a result of smoking: diagnose or rule out placenta
a) decreased risk of abruption accreta.
b) increased risk of gestational diabetes c) plan for elective CS at term with
c) increased risk of pre-eclampsia appropriate precautions for placenta
d) increased risk of sudden infant death accreta.
syndrome (SIDS) d) plan for cesarean hysterectomy
e) rescan for placental localization at
e) no effect on the risk of preterm
36wks as in the majority of cases,
delivery there is upward migration of
placenta due to LUS development.
44. A 24yrs old woman presents to ER with received an epidural analgesia before
a 12hrs H/O of right sided chest pain and delivery. Estimated blood loss is 700ml.
shortness of breath. She is at days 7 The likely cause of excessive vaginal
postnatal having delivered her baby by bleeding is:
emergency CS at 34wks. Her pregnancy a) excessive epidural analgesia
was complicated by severe hypertension b) retained placenta
and postpartum hemorrhage of 1L blood. c) uterine atony
She has BMI of 32, BP: 130/80, pulse d) uterine inversion
110/min, temp: 37.2 and oxygen e) uterine rupture
saturation 94%. MOST likely diagnosis:
a) anemia 47. Which of the following best defines
b) myocardial infarction secondary PPH?
c) pneumonia a) abnormal genital bleeding 24hrs
d) pulmonary embolism after delivery to 7days postpartum
e) subphrenic abscess b) abnormal genital bleeding between
delivery to 7days
45. A 40yrs old woman with history of CS c) abnormal genital bleeding between
experiences brisk vaginal bleeding delivery to 6weeks postpartum
immediately following VD of a 36wks GA d) abnormal genital bleeding 24hrs
baby (BW: 3.8kg). 10min prior to delivery, after delivery to 6weeks postpartum
there was acute onset fetal bradycardia e) abnormal genital bleeding 48hrs
and cessation of uterine contractile after delivery to 6weeks postpartum
activity. The urinary catheter shows
hematuria. The placenta was delivered 48. P1 woman is brought to ER 3days after
without complication. Bimanual VD with ragged membranes noted at
compression for the uterus was extremely delivery. Her observations include pulse
painful. Despite an estimated blood loss of 130/min, BP: 80 systolic, RR: 24/min and
500ml, she appears pale and clammy with Temp: 39. She feels cold and clammy. She
BP: 90/30 and pulse 120/min. Most likely reports heavy offensive lochia. She has
diagnosis: been fluid resuscitated now and
a) excessive epidural analgesia commenced on oxygen by mask. The next
b) retained placenta immediate step in management:
c) uterine atony a) broad spectrum IV antibiotics
d) uterine inversion b) blood culture, high vaginal swab,
e) uterine rupture urine analysis
c) EUA in theater with removal of
46. A 40yrs old woman who has had retained tissue undercover of
previous 3 VD experiences brisk vaginal antibiotics
bleeding immediately following VD of a d) imaging-pelvic US
36wks twins (BW: 2kg and 1.9kg). e) measurement of serum lactate
Episiotomy was not required. The placenta
was delivered without complication. She
49. A 34yrs old 1112 presents at 40wks to

ER with painful contractions and no
vaginal bleeding or leakage of fluid. Her
1st VD was induced for oligohydramnios at
41wks. Her 2nd was emergency CS at
35wks due to plascental abruption. She
choosed VBAC in this pregnancy. PV on
arrival: 4cm cervical dilatation, 80%
effaced, station -1 and contractions every
3min. 2hrs later, contractions were more
painful. She requests epidural and is now
5cm dilated, 100% effaced and 0 station.
An hour later, there is worsening of the
pain despite epidural. Fetus shows
variable deceleration till 70/min and
passage of bright red blood. She is 5cm
dilated, 100% effaced and station -3.
Persistent late deceleration occured so
you decided emergency CS. What do u
expect at time of fetal delivery?
a) placental abruption
b) vasa previa
c) uterine rupture
d) loops of cord around the neck
e) no abnormality is suspected
50. 30yrs old 2ndGP1 at 30wks comes with

to ER after RTA. She was found awake,
alert and oriented but with pelvic pain, no
vaginal bleeding and bruises on the
abdomen from the seat belt. She is
afebrile, BP: 120/70, HR: 120/min and O2:
100%. CTG shows contractions every 2min
with persistent late deceleration. PV:
closed cx with no bleeding. US: anterior
placenta, low lying with small
retroplacental hematoma and normal AFI.
Most likely cause of late deceleration is:
a) umbilical cord compression
b) preterm labor
c) concealed placental abruption
d) fetal head compression
e) placenta previa
ANSWERS
1 A 36 D
2 C 37 I
3 C 38 A
4 A 39 D
5 B 40 E
6 B 41 D
7 E 42 E
8 D 43 C
9 E 44 D
10 C 45 E
11 D 46 C
12 C 47 D
13 C 48 C
14 D 49 C
15 C 50 C
16 C
17 C
18 B
19 B
20 A
21 D
22 C
23 B
24 A
25 D
26 B
27 D
28 B
29 E
30 B
31 A
32 B
33 C
34 J
35 E
Obs 3: Normal-Abnormal-Malpres. (100 marks)

Choose the most correct answer: c) her weight does not impact her
chances for successful TOLAC
1. You perform a PV for a 34year old d) her age does not impact her chance
P0101 who is in labor. Fetal nose and for successful TOLAC
mouth palpable. The chin is pointing e) if she goes into labor spontaneously
toward the maternal left hip. This is: before 40wks, her chances for
a) transverse lie successful TOLAC will increase
b) mentum transverse position
c) occiput transverse position 4. A healthy 30yrs old P1001 at 24wks GA
d) brow presentation comes for routine ANC visit. Her
e) vertex presentation pregnancy has been uncomplicated and
her last pregnancy was uncomplicated but
2. You are counseling a 36yrs old obese her obstetrician performed an US at every
G2P1 at 36wks GA about the route of visit to reassure her. She requests that you
delivery. She was induced in her first perform an US at every visit to
pregnancy at 41wks for mild preeclampsia reassurance her. How should you counsel
and delivered by CS due of fetal distress. her regarding the safety of US during
She likes to know if she can have a TOLAC. pregnancy?
Best response to this patient: a) US is completely safe and agree to
a) no since she has never had a vaginal perform one at every visit
delivery b) US is completely safe but you don't
b) yes but only if she had a low have time to perform one at every
transverse uterine incision visit
c) no because once CS always CS c) tell her that having multiple
d) yes but only if her skin incision was a ultrasounds has been associated with
Pfannesteil adverse fetal effects
e) yes but she must wait until she goes d) prenatal US should only be used
into labor spontaneously when clinically indicated for the
shortest amount of time with the
3. The previous patient wants to know lowest level of acoustic energy
about the probability of success if she compatible with an accurate
chooses to undergo TOLAC. What are the diagnosis in order to maximize safety
factors that affect success in TOLAC? e) US is completely safe and
a) the probability of successful TOLAC is recommend that she pay out of her
increased because she is hispanic pocket for extra ultrasounds in order
b) she is likely to have successful TOLAC to provide keepsake videos and
as she has never had a vaginal photos.
delivery
5. A 43yrs old G1P0 who conceived via IVF a) allow the patient to undergo a
comes for her routine ANC at 38wks. She vaginal breech delivery whenever
reports good DFMC and no leakage of b) send the patient to OR immediately
fluid, vaginal bleeding or regular uterine for an emergent cesarean delivery
c) tell her to return in 1week for
contractions but sometimes she feels
reevaluation of fetal presentation
cramps at the end of the day that is d) schedule an external cephalic version
alleviated by rest. The fundal height is (ECV)
36cm. It measured 37cm the week before. e) allow the patient to go into labor and
Her cervix is 2cm dilated and the fetal do ECV at that time
head is engaged. Most appropriate next
step is: 8. A 26yrs old G1 at 37wks GA presents to
a) instruct the patient to return to the the hospital in active labor. She has no
office in lweek for her next routine medical problems and has normal prenatal
course except for IUGR. She undergoes an
visit
uncomplicated VD of a female infant
b) admit the patient for induction of weighing 1950gm. The infant is at risk for
labor for a diagnosis of IUGR the following complication:
c) send the patient for an ultrasound to a) hyperglycemia
determine the amniotic fluid index b) fever
d) order the patient to undergo a non- c) hypertension
stress test (NST) d) anemia
e) do a fern test in the office e) hypoxia
Questions 9-11: a healthy 23yrs old G1P0

6. lf a woman has her LMP on April 17,
has had an uncomplicated pregnancy to
using Naegle's rule, her EDD is: date. She is disappointed because she is
a) January 17 40wks and still hasn't delivered. She
b) January 24 reports good DFMC and no contractions.
c) July 24 On PV, her cervix is firm, posterior,
d) February 17 50%effaced, 1cm dilated and the vertex is
e) January 10 station -1.
9. Which of the following you recommend
7. A 30yrs old G2P1001 presents at 37wks as the best next step in management:
a) she should be admitted for an
for her routine ANC. Her first pregnancy
immediate cesarean delivery
resulted in VD of a 4.4kg boy after b) she should be admitted for oxytocin
30minutes of pushing. On doing Leopold induction
maneuvers the fetus is found breech. On c) she should be scheduled for CS in
PV: cervix is 2cm and 50% effaced. The lweek if she has not gone into labor
breech is high out of the pelvis. The EFW is d) she should continue to monitor
3.15kg. The patient has no contractions. DFMC and to return in 1week to
US confirms double footling breech reassess
presentation with normal AFI and e) she should walk as much as possible
to stimulate contractions
hyperextended head. The best next step in
management:
10. The patient presents in 1week for a 12. A 32yrs old G3P2 is in labor at term wz
follow up visit. She is now 41wks GA. She uncomplicated prenatal course. As you
reports good DFMC, and she has been deliver the fetus its head retracts against
having intermittent contractions for the perineum. Downward traction fails to
several days. On PV, her cervix is 3cm free the anterior shoulder. The most
appropriate action is:
dilated, 70% effaced, anterior, soft and
a) apply increasingly strong downward
vertex is station 0. Best next step in traction of the fetal head
management: b) have an assistant apply fundal
a) allow her to continue the pregnancy pressure
and await spontaneous labor c) deliberately fracture the clavicle of
b) schedule her for induction of labor the fetus
because now her cervix is favorable d) begin an IV nitroglycerine drip
c) strip her membranes and instruct her e) place the mother's thigh on her
to return in 1week for reevaluation abdomen
d) schedule her for a cesarean delivery
13. A healthy 30yrs old G2P1001 presents
by the following day
at 34wks for routine ANC. She has a
e) order a NST to assess fetal well being history LSCS due to footling breech. Her
current pregnancy has been
11. What would be the next step in uncomplicated. She tells her physician that
management if this patient were 41wks she would like to undergo a TOLAC.
with an unfavorable cervix and However, the patient is interested in
oligohydramnios by US? permanent sterilization and wonders if it
a) admit her to the hospital for would be better to undergo another
cesarean delivery scheduled CS so she can have a bilateral
b) admit her to the hospital for cervical tubal ligation at the same time. How
should the physician counsel this patient?
ripening and induction of labor
a) a previous low transverse cesarean is
c) give her misoprostol orally every a contraindication to TOLAC
4hours at home until she goes into b) her risk of rupture uterus with TOLAC
labor is 4% to 9%
d) perform stripping of the fetal c) her chance of having a successful
membranes and perform a BPP in VBAC is less than 6%
2days d) she should schedule an elective
e) administer a cervical ripening agent induction if not delivered by 38weeks
in your office and have the patient e) it is safer for her to undergo a vaginal
present to the hospital in the delivery followed by a postpartum
tubal ligation rather than an elective
morning for induction with oxytocin
repeat cesarean with intrapartum
bilateral tubal ligation
Questions 14-15: a 30yrs old G1P0 at 8wks a) order ultrasound

GA comes for her first ANC. She has no b) tell the patient that she is most likely
significant past medical or surgical history. having twins
A 29yrs old friend of hers just had a baby c) teach her how to do fetal kick counts
with Down syndrome and she is concerned and instruct her to return in lweek
about her risk of having a baby with the d) tell her that her baby will be very
same problem. The patient reports no large and recommend a cesarean
family history of genetic disorders or birth delivery
defects. e) order a glucose tolerance test
14. She has an increased risk of having a
baby with Down syndrome in case of: 17. US shows singleton fetus with an EFW
a) the age of the father of the baby is in the 53rd percentile. The amniotic fluid is
40years or older 30cm consistent with polyhydramnios.
b) her pregnancy was achieved by How should you counsel this patient?
induction of ovulation and IUI a) she does not require any further
c) she has an incompetent cervix evaluation
d) she has a luteal phase defect b) the incidence of associated
e) she has had first-trimester malformations is approximately 3%
spontaneous abortions c) maternal edema especially of the
lower extremities and vulva is rare
15. You offer her a first trimester US to d) esophageal atresia is accompanied
look for US markers associated with Down by polyhydramnios in nearly 10% of
syndrome. Marker most closely associated cases
with Down syndrome is: e) potential complications include
a) choroid plexus cyst placental abruption, uterine
b) ventriculomegaly dysfunction and PPH.
c) increased nuchal translucency (NT)
d) intracardican focus 18. A 32yrs old G2P0101 comes to ER at
e) echogenic bowel 36wks GA with regular uterine
contractions every 5minutes for the past
Questions 16- 17: a 24yrs old G1P0 comes several hours associated with the passage
at 30wks GA for a new ANC visit. Her last of clear fluid from the vagina. The external
follow up was at 12 wks with official fetal monitor demonstrates a reactive FHS
report of a dated US. She has normal BMI with contractions occurring every 3-
and no medical problems. She reports 4minutes. Sterile speculum examination
some abdominal cramping and shortness demonstrates a closed cervix with a pool
of breath. During her visit, you examine of clear fluid in the vagina. A sample of
her cervix and it is closed. You measure this fluid is fern and nitrazine positive. T:
her fundal height at 50cm. 38.8, HR: 102 and BP: 100/60. Her fundus
16. What is the next best step in is tender on palpation. Her WBCs: 19.000.
management? The patient is very concerned because her
previous baby delivered at 35weeks
developed RDS. You perform a bedside US 20. The following statements describes the
which shows oligohydramnios, the fetus is potential benefits of tocolysis:
AGA and cephalic presentation. Most a) tocolysis provides fetal
appropriate next step in the management neuroprotection
of this patient: b) tocolysis allows the pregnancy to
a) administer betamethasone progress to term
b) administer tocolytics
c) the incidence of preterm delivery is
c) place a cervical cerclage
decreased with tocolysis
d) administer antibiotics
d) tocolysis can provide short-term
e) perform emergent cesarean section
pregnancy prolongation in order to
19. A 30yrs old G1P0 at 25wks presents to administer steroids and transfer to a
ER complaining of irregular uterine tertiary care center
contractions and back pain. She reports no e) tocolysis decreases the risk of
leakage of fluid from her vagina but some necrotizing enterocolitis
very light vaginal bleeding which has now
resolved. She has no prenatal care. She is 21. The following is a contraindication to
placed on an external fetal monitor which the use of indomethacin in this patient:
demonstrates uterine contractions every a) intact membranes
2-4minutes. She is afebrile and her vital b) gestational age greater than 26weeks
signs are all normal. Her gravid uterus is c) vaginal bleeding
nontender and measures 25cm. Most
d) oligohydramnios
appropriate first step in evaluation in this
e) fetal growth restriction
patient:
a) vaginal examination to determine
cervical dilatation 22. The following describes McRobert
b) ultrasound to assess the placental maneuver:
location a) suprapubic pressure
c) urine culture to evaluate for UTI b) delivery of the posterior arm
d) laboratory tests to evaluate for DIC c) maximal flexion and abduction of the
e) vaginal swab to determine vaginitis. maternal hips
d) rolling the mother to an “all-fours”
Questions 20-21: a 30yrs old G1 at position
28weeks gestation is admitted to the e) rotation of the fetal head
hospital for preterm labor with painful
contractions every 2minutes. She is 3cm Questions 23-24: a 38yrs old G4P3 at
dilated with intact membranes. Her 33wks gestation presents for a routine
pregnancy has been complicated by
ANC visit. Her fundal height is 29cm. EFW
chronic hypertension well controlled on
in the 5th percentile for GA. BPD and AC
oral antihypertensive therapy. US shows
cephalic fetus with AGA and are concordant in size:
oligohydramnios.
23. Which of the following is associated repeat PV, her cervix is 5cm dilated and
with this condition? 100% effaced.
a) nutritional deficiencies 26. A 30yrs old G2P0 at 39weeks gestation
b) chromosomal abnormalities is admitted in labor with regular uterine
c) hypertension contractions and spontaneous ROM 2hours
d) uteroplacental insufficiency ago. O/E: cervix is 4cm dilated, 100%
e) gestational diabetes. effaced, fetal head at station 0 and FHR
tracing is reactive. Two hours later, her
24. Which of the following factors would cervix is 5cm dilated and the fetal head is at
indicate delivery of this fetus? +1 station. Early decelerations are noted on
a) BPP of 8/10 the fetal heart tracing.
b) EFW in the 5th percentile
c) normal umbilical artery dopplers 27. A 38yrs old G2P1 at 39wks presents in
d) absence of interval growth on a labor. She has had one prior VD of a 3.8km
repeat ultrasound in 2weeks infant. One week ago, the EFW was 3.2kg
e) amniocentesis demonstrating fetal by US. Over the past 3hours her cx remains
trisomy 21 unchanged at 6cm. FHR tracing is reactive.
An IUPC reveals two contractions in
Questions 25-29: for each description of 10minutes with amplitude of 40mmHg
labor, select the SINGLE most appropriate each.
next step in management. Each option 28. A 22yrs old G2P1 at 39weeks presents
may be used once, more than once or not in labor. At 4cm dilated, she is given
at all. epidural for pain management. Three hours
a) initiate oxytocin augmentation later, her cervical examination is
b) place intrauterine pressure catheter unchanged. Her contractions are now every
(IUPC) 2-3 minutes lasting 60seconds. The FHR
c) perform a cesarean section tracing is 120b/min with accelerations and
d) place a fetal scalp electrode early decelerations.
e) no intervention, labor is progressing 29. A 25yrs old G3P2 at 39weeks is
normally admitted in labor at 5cm dilated. Her FHR
f) perform amniotomy tracing is reactive. 2 hours later, her cervix
25. A 20yrs old G1at 38wks presents with is unchanged at 5cm dilated. An IUPC is
regular painful contractions every 3- placed and the patient is noted to have
4minutes lasting 60seconds. PV: cervix is 280MVUs. After another 2hours, she is still
3cm dilated and 90% effaced. Amniotomy 5cm dilated. FHR tracing remains reactive.
is performed and clear fluid is noted. The
FHR tracing is reactive. 1hour later on
30. A 38yrs old G6P4 undergoes primary 32. A 32yrs old G3P2 at 39weeks gestation
CS under regional analgesia for presented to labor with ROM. She is
malpresentation of twins at 37wks. contracting regularly and her cervix is 4cm
Immediately after the delivery of the dilated. She has 2 prior vaginal deliveries
placenta, the anesthesiologist notes with her largest child weighing 3800gm.
maternal seizure with profound hypoxia Over the next 2hours she progressed to
and hypotension. The patient is intubated 7cm dilatation. 4 hours later, she remains
and given vasopressors. Massive 7cm dilated with regular contractions and
hemorrhage from the surgical site ensues IUPC showed MVUs of 220. EFW is
and the patient is given uterotonic agents 3200gm. The following labor abnormalities
and blood products. The most likely cause best describe this patient:
of her hemorrhage is: a) prolonged latent phase
b) protracted active phase
a) amniotic fluid embolism c) hypertonic dysfunction
b) halogenated anesthetic agent d) secondary arrest of dilatation
c) placenta accrete e) second stage arrest
d) severe preeclampsia with HELLP
e) uterine atony from overdistended 33. A 29yrs old P0 at 41weeks presents in
uterus labor. At delivery, shoulder dystocia
occurs and a mediolateral episiotomy is
31. A 23yrs old G1at 38weeks gestation cut to assist in delivery manoeuvers.
presents in active labor at 6cm dilated Compared with a midline episiotomy, it
with ruptured membranes. On cervical has the following advantage:
examination, the fetal nose, eyes and lips a) ease of repair
can be palpated anteriorly. The FHR b) fewer breakdowns
tracing is 140b/min with accelerations and c) less blood loss
no decelerations. Best next step is: d) lower incidence of dyspareunia
a) perform immediate cesarean e) less chance of extension of the
delivery incision
b) allow spontaneous labor with vaginal
delivery Questions 34-37: match each description
c) perform ventouse delivery in the with the most appropriate type of
second stage of labor obstetric anesthesia. Each lettered option
d) allow the patient to labor may be used once, more than once or not
spontaneously until complete at all.
cervical dilatation is achieved and a) intravenous meperidine
then perform an IPV with breech b) pudendal block
extraction c) spinal anesthesia
e) manual conversion of the face to d) epidural analgesia
vertex in the second stage of labor
34. Appears to lengthen the second stage Questions 41-43: select the SINGLE most
of labor. appropriate diagnosis for each clinical
situation described. Each lettered option
35. Is associated with fetal sedation. may be used once, more than once or not
36. May be complicated by profound at all.
hypotension. a) first stage arrest
b) second stage arrest
37. May be associated with increased need c) failed induction of labor
for augmentation of labor with oxytocin d) protracted first stage
and instrument-assisted delivery. e) protracted second stage
41. No progress in descent for 4hours in a
Questions 38-40: for each clinical fully dilated nulliparous woman with an
epidural or 3hours or more in a
description, select the SINGLE most
multiparous woman with an epidural.
appropriate procedure. Each lettered
42. No cervical change for 4hours with
option may be used once, more than once
adequate uterine contractions at 6cm
or not at all. dilatation with membranes rupture.
43. Failure to generate regular contractions
a) external cephalic version and cervical change after at least 24hrs of
b) internal podalic version oxytocin and with amniotomy if feasible.
c) low transverse cesarean
44. A 23yrs old G1 at 39wks GA comes to
d) classical cesarean triage with a chief complaint of uterine
38. A 24yrs old P0 at 25weeks gestation contractions. They began 2hours ago,
presents with breech presentation. She painful and occurring every 4-8minutes.
She reports good fetal movement and no
changes from 4cm to 6cm dilatation and is
bleeding or leaking fluid. CTG:
contracting regularly. contractions every 5-15minutes and is
39. A 34yrs old P2002 with no prenatal care reactive. PV: cervix is 1cm dilated, 60%
presents in labor. She is completely dilated effaced and the fetal vertex at -1 station.
The patient had the same cervical
and effaced. She progresses within minutes
examination in your office last week. The
VD of a 2500gm infant. The uterus still feels most appropriate next step in
large and on PV a second set of membranes management is:
is bulging and you feel a small part a) send her home
presenting in the sac. FHS is 60b/min. b) admit her for epidural for pain
control
40. A 24yrs old woman G3P2 is at 37weeks
c) perform an amniotomy
gestation. The fetal presentation is a d) administer terbutaline
transverse lie by US. e) augment her labor with pitocin
45. A 38yrs old G3P2 at 40wks GA comes 48. You performed a forceps assisted
to ER with ROM 1hour ago. On CTG, she is vaginal delivery on a 20yrs old G1 at
having contraction every 3-4minutes and
40wks for maternal exhaustion. The
each lasting 60seconds. FHR is 120b/min
with accelerations and no decelerations. patient had pushed for 3.5hours with an
The patient has a history of rapid VD and epidural for pain management. An
her largest baby was 3.2kg. PV: she is 5cm episiotomy was cut to facilitate delivery. 8
dilated, 100% effaced and vertex at -2 hours after delivery, you are called to see
station. EFW is 3.3kg. The patient is in lot
of pain and requesting medication. Most the patient you note a large fluctuant
appropriate pain control for her is: purple mass inside the vagina. The best
a) intramuscular mepiridine management is:
b) pudendal block a) apply an ice pack to the perineum
c) perineal block
b) embolize the internal iliac artery
d) epidural analgesia
e) general anesthesia c) incise and evacuate the hematoma
d) perform dilatation and curettage to
Questions 46-47: a 35yrs old G2P1at remove retained placenta
39weeks gestation presents to ER in active e) place a vaginal pack for 24hours
labor. Her cervix is 5cm dilated, 80%
effaced and vertex is at 0 station. CTG
shows contractions every 3minutes. FHR is Questions 49-50: you are delivering a
140b/min with moderate variability, 26yrs old G3P2002 at 40wks. She has a
accelerations and no decelerations. history of two previous uncomplicated VD
46. This FHR tracing may best be
and has no problems during this
interpreted as which of the following:
a) normal pregnancy. After 15minutes of pushing,
b) mildly distressed the baby's head delivers spontaneously
c) moderately distressed but then retracts back against the
d) severely distressed perineum. As you apply gentle downward
traction to the head, the baby's anterior
47. One hour later, her membranes shoulder fails to deliver.
rupture spontaneously and she develops
recurrent variable decelerations. What is 49. Which of the following is the best next
the best next step in management?
step in the management of this patient?
a) continue to monitor as variable
decelerations don't require a) call for help
intervention b) cut a symphysiotomy
b) change the maternal position and c) instruct the nurse to apply fundal
continue monitoring pressure
c) since she is remote from delivery,
perform a cesarean d) perform a Zavanelli maneuver
d) administer oxygen by nasal cannula e) push the baby's head back into the
e) administer terbutaline pelvis
50. After performing appropriate Questions 53-54: a 25yrs old G1P0 patient
maneuvers, the baby delivers. The at 37wks gestation comes to ER reporting
pediatricians note that the Rt arm is gross ROM and painful uterine
hanging to the baby's side with the contractions. CTG shows contractions
forearm extended and internally rotated. every 2-3minutes and reactive FHR. On PV,
Most likely diagnosis: cervix is 4cm dilated 100% effaced &
a) Erb's palsy
presenting part -3 station. The presenting
b) Klumpke's palsy
c) humeral fracture part is soft and felt to be fetal buttock. A
d) clavicular fracture bedside ultrasound reveals a breech
e) paralysis from intraventricular bleed presentation with both hips flexed and
knees extended. The EFW is 2.7kg.
51. A 20yrs old G1 at 40weeks has been
pushing for 2.5hours. The fetal head 53. Which of the following is the best
begins to crown. You cut an episiotomy method to achieve delivery?
that extends to the anal sphincter but the a) deliver the fetus vaginally by breech
rectal mucosa is intact. How should you extraction
classify this type of episiotomy? b) delivery the baby vaginally after ECV
a) first degree c) perform an emergent cesarean
b) second degree delivery
c) third degree d) perform an IPV
d) fourth degree e) perform a forceps-assisted vaginal
e) mediolateral episiotomy breech delivery
52. A 16 year old G1P0 at 38wks comes to
54. What type of breech presentation is
ER for the second time during the same
weekend. She initially presented at 2pm described?
Saturday complaining of regular uterine a) frank
contractions. Her cervix was 1cm dilated, b) incomplete, single footling
50% effaced with the vertex station -1 and c) incomplete, double footling
she was sent home after walking for d) complete
2hours with no cervical change. It is now e) knee position
Sunday at 8pm and she returns with
increasing pain. She is exhausted because 55. A 21yrs old G2P2 calls her physician
her contractions kept her awake. On CTG, 7days postpartum because she is
contractions are occurring every 2- concerned that she is still experiencing
3minutes. Her cervix is unchanged. The vaginal bleeding. She describes the
best next step is: bleeding as light pink to bright red and less
a) perform artificial rupture of
heavy than the first days postdelivery. She
membranes to initiate labor
b) administer an epidural reports no fever or pain. On examination,
c) administer pitocin to augment labor she is afebrile and has an appropriately
d) achieve cervical ripening with sized non tender uterus. The vagina
prostaglandin gel contains about 10cc old dark blood. The
e) administer 10mg intramuscular cervix is closed. Most appropriate
morphine treatment:
a) antibiotics for endometritis 57. Which of the following is the most

b) high dose of oral estrogen for likely diagnosis?
placental sub-involution a) pelvic abscess
c) oxytocin for uterine atony b) septic thrombophlebitis
d) suction dilatation and curettage for c) wound infection
retained placenta d) endometritis
e) reassurance e) atelectasis

56. A 32yrs old G2P1 at 41wks is
appropriate antibiotic to treat this
undergoing an IOL for oligohydramnios.
patient?
During the course of her labor, FHR a) oral bactrim
showed recurrent variable decelerations b) oral dicloxacillin
not responding to change in postion, c) oral ciprofloxacin
oxygen or IV fluids. The cervix is 4cm d) intravenous ampicillin
dilated. So LSCS is performed. After e) intravenous gentamycin and
delivery, you sent a cord blood gases that clindamycin
showed: pH 7.29. This indicate that:
a) normal fetal status 59. A 22yrs old G1P1 is brought to ER after
b) fetal academia having a seizure at home. She is 2weeks
c) fetal hypoxia postpartum after an uncomplicated
d) fetal asphyxia spontaneous VD. She has no medical
e) fetal metabolic acidosis problems and her pregnancy, labor and
immediate postpartum period were
Questions 57-58: three days ago you unremarkable. On arrival, her vitals were:
delivered a 40yrs old G1P1 by CS following BP 165/95, pulse: 82 and RR 20/min. Most
arrest of descent after 2hours of pushing. appropriate next step in management:
a) begin MgSo4 therapy
Labor was also significant for prolonged
b) request a neurology consult
ROM. The patient had an epidural which c) order a head CT
was removed the following day. The nurse d) start phenytoin therapy
calls you to come to see the patient on the e) order a toxicology screen
postpartum floor because she has a fever
of 38.8 and is experiencing shaking chills. 60. A 40yrs old G4P5 at 39wks GA has
Her BP is 120/70 and pulse is 120b/min.
progressed rapidly in labor with reassuring
She has been eating a regular diet without
FHR. She had an uncomplicated pregnancy
difficulty and had a normal bowel
with normal prenatal laboratory tests
movement this morning. She is attempting
to breastfeed but says her milk has not including an amniocentesis for advanced
come yet. On physical examination, her maternal age. The patient begins the 2nd
breasts are mildly engorged and tender stage of labor and after 15minutes of
bilaterally. Her lungs are clear. Her pushing, starts to demonstrate recurrent
abdomen is tender over the fundus but no variable heart rate decelerations. You
rebound is present. Her incision has some deliver the baby by low outlet forceps. As
serous drainage at the right apex but no soon as the baby handed to neonatologist,
erythema is noted it lets a strong spontaneous cry. The infant
is pink with slightly blue extremities that a) oxytocin with group B Strept
are actively moving and kicking. The heart prophylaxis
rate is noted to be 110b/min on b) misoprostol 25microgm, group B
auscultation. What is the APGAR score of strept prophylaxis
this baby at 1 minute? c) expectant management with group B
a) 10
strept prophylaxis
b) 9
c) 8 d) allow vaginal delivery with ventouse
d) 7 e) cesarean section
e) 6
64. A 21yrs old PG at 39wks gestation
61. A woman has an EFW by US of 4kg. To presents to labor and delivery with
estimate the pelvic capacity, you perform complaints of uterine contractions since
clinical pelvimetry. This procedure 5am. Her cervix is 2cm dilated, 50%
measures: effaced, midposition and moderate in
a) true conjugate consistency with fetal vertex at 0 station.
b) transverse diameter of the inlet
Reexamination at 7pm shows no
c) shape of the pubic arch
d) diameter of greatest pelvic significant cervical change. FHS are
dimension reassuring. She begs you to admit and
e) elasticity of the levator muscles augment because she is tired of her
pregnancy. You explain that she and her
62. In the previous patient, you estimate fetus are doing well. What is her Bishop
the pelvic outlet. The interspinous score?
diameter of a normal pelvis should be at a) 7
least how many centimeters: b) 4
a) 5 c) 2
b) 6-8
d) 6
c) 9-11
d) 12 e) 10
e) 13
65. In the previous patient, what would be
63. A 21yrs old primigravida presented to the optimal management at that time?
the emergency at 41wks gestation with a) performance of primary cesarean
rupture of membranes 12hrs ago. On section for prolonged labor with
examination, EFW: 3.6kg, she has thick presumed CPD.
meconium, her cervix is 3cm dilatation b) reassurance and rest and offering
and presenting part is station -2. narcotics to aid relaxation and sleep
Presenting part is a face mento-posterior.
c) artificial rupture of membranes
FHS are excellent and she is not
contracting. What is the best d) cervical ripening with misoprostol
management? e) admit her until true labor occur
66. A 32yrs old woman G3P1A1 at termis 69. A relative contraindication for
admitted with 6cm cervical dilatation, induction of labor includes:
complete effacement and vertex -1 a) prolonged pregnancy
station. EFW is 3.2kg. Her previous b) severe preeclampsia
pregnancy resulted in uncomplicated c) IUGR
vaginal delivery and the baby was 3.2kg d) PROM
also. After 2hrs, there is no cervical. e) previous myomectomy entering the
Uterine contractions were 3/10minutes uterine cavity at the fundus
each of strength of 40mmHg. The
abnormality in this labor is: 70. The maximum normal time for the
a) active phase arrest second stage of labor in a primigravida is:
b) failure of descent a) 20 minutes
c) arrest of latent phase b) 60 minutes
d) protraction of descent c) 120 minutes
e) no abnormality and labor is d) 180 minutes
progressing normally e) 240 minutes
67. In the previous patient, what is the Questions from 71-74 are preceded by a
best course of action? list of options; select the SINGLE letter
which is most closely associated with the
a) wait for 2 more hours and repeat
condition. Each letter can be used once,
cervical examination
b) start oxytocin augmentation
a) first stage of labour
c) perform cesarean section
b) second stage of labour
d) therapeutic rest with analgesia and
c) third stage of labour
short acting anti-anxiety medication
d) effacement
e) apply ventouse
e) lightening
f) fourth stage of labour
68. Normal labour is dependent on the
g) postpartum period
unique aspects of the uterine smooth
h) engagement
muscle. Which statement characterizes
71.D ropping of fetal head into the pelvis.
uterine muscle cells?
a) the muscle regains full strength 72. Ends with complete dilatation of the
between contractions cervix.
b) the entire uterus contracts 73.B egins with the delivery of the baby.
simultaneously
c) they demonstrate a contractile 74.E nds with the delivery of the baby.
sensitivity to oxytocin
d) muscle cells return to the original Questions from 75-78 are preceded by a
length after contraction list of options, select the SINGLE letter
e) muscle cells doesn't respond to which is most closely associated with the
oxytocin stimulation during active condition. Each letter can be used once,
phase multiple or not at all.
a) McRoberts maneuver 81. In which of the following cases might

b) Mauriceau-Smellie-Viet maneuver internal podalic version be indicated?
c) External cephalic version a) vertex delivery of the first twin and
d) Ritgen maneuver transverse lie of the second twin
e) Leopold's maneuver b) term transverse lie with cervix
f) Fergusson maneuver completely dilated and membranes
g) Crede maneuver intact
h) Wood's corkscrew maneuver c) impacted shoulder presentation
75. At 39weeks gestation, a woman is d) compound presentation
admitted to labor. Her cervix is long and e) primi breech at term
closed. The fetus is found to be vertex 82. The pathological retraction ring of
examination by palpation. Bandl is most commonly associated with:
a) premature
76. Gentle constant abdominal pressure is b) obstructed labor
applied to cause the fetal vertex to rotate c) precipitate labor
out of the fundus area and into the lower d) multiple gestation
uterine segment. e) normal labor
77. The vertex delivers but gentle
downwards traction fails to effect delivery 83. A 35yrs old woman 7thGP5A1 is in
of the anterior shoulder. active phase of labor with vertex
presentation at station -1. She complains
78. A rapid labor with a vertex presentation
of abdominal pain with the contractions.
has taken place and the infant is crowning.
At the height of one contraction, the pain
Mother is in poor control so attempts are
becomes very intense. Following This
made to slow the delivery of the vertex to
intense pain, uterine contractions cease.
avoid perineal/vaginal lacerations.
The maternal systolic BP drops 15mmHg.
What is the best course of action?
79. Transverse lie in a multipara at term in a) immediately perform a pelvic
labor is best treated by: examination
a) external version b) place the patient on her side and
b) internal version and extraction reassure her
c) cesarean delivery c) begin oxytocin
d) oxytocin induction d) perform ultrasound
e) internal podalic version and breech e) perform immediate hysterectomy
extraction
84. In the previous patient, on abdominal
80. The following is a contraindication to examination, you discover a firm mass. It
use oxytocin for stimulating labor: does not feel like the presenting fetal part.
a) fetal demise The mass is most likely:
b) hypertonic uterine dysfunction a) the placenta
c) hypotonic uterine dysfunction b) uterine fibroid
d) twin gestation c) the contracted uterus
e) PROM d) the fetal head
e) fetal buttocks
85. A 17yrs old 3rdGP0 woman with no Questions from 88-90: a 19yrs old PG at
prenatal care at 29wks gestation presents term has been in active labor for 4hours.
with painful contractions and pressure. The membranes have just ruptured station
Her cervix is 3cm, 40% effaced and breech -3, FHS 140 regular and cervix is 4cm
at -2 station. There is no evidence of dilated. Contractions every 5minutes that
ruptured membranes. Her contractions
last approximately 40seconds.
are every 3minutes. FHS 150 with
88. What is the next step?
accelerations. Maternal signs are: T 36.8,
HR: 96 and BP: 110/70. What should you a) patient ambulation
do: b) oxytocin augmentation
a) begin tocolytic agents c) cesarean section
b) do a fetal fibronectin d) clinical pelvimetry and estimation of
c) observe to look for cervical change fetal size
d) give IV Hydration e) corticosteroids therapy
e) immediate cesarean section
89. The patient continues to have
86. The previous patient continues to
infrequent contractions. Your clinical
contract and repeated pelvic examination
pelvimetry is within normal. EFW is 3kg.
shows: cervix 3cm and 90% effaced. What
should you do? Pelvic findings are unchanged. The next
a) give antenatal steroids step is:
b) start antibiotics a) patient ambulation
c) give IV sedation b) oxytocin infusion
d) continue tocolysis c) cesarean section
e) prepare for cesarean delivery d) await vaginal delivery
e) forceps delivery
87. A 28yrs old 4thGP2 presents in labor at
37wks. On PV examination, you feel the 90. Three hours later, the cervix is 5cm
nose and mouth of the fetus with the chin
dilated and contractions are irregular
closest to the maternal symphysis. She is
despite oxytocin infusion. The station is -2
5cm, 100% effaced, station 0, FHS
reassuring and EFW is 2.6kg. Next step is: and the head is molded. The FHS are
a) perform cesarean section normal. Next step in management:
b) allow labor to progress a) forceps delivery
c) give epidural and very gently b) increased oxytocin
manually rotate the baby to vertex c) heavy sedation
d) give low dose oxytocin until the head d) ventouse delivery
rotates to vertex e) cesarean delivery
e) apply ventouse
91. A G1P0 woman at 37wks comes to ER 95. A pregnant woman presents in labor at
with regular painful contractions. PV: 39wks gestation. She is 10cm dilated and
footling presentation is found. The most station 0. Membranes are bulging. The
appropriate management is: most appropriate management is:
a) expectant vaginal delivery a) cesarean
b) tocolysis b) oxytocin
c) cesarean section c) tocolysis
d) augmentation of labor with oxytocin d) amniotomy
e) ECV e) epidural analgesia
92. Your patient is in 2nd labor stage and 96. The following indicates that the
fetus is face presentation with mento- patient entered in second stage of labor:
anterior. Progress has been rapid and FHS a) small amount of bloody mucus
normal. You would now: discharge (bloody show)
a) perform immediate cesarean section b) Braxton Hicks contractions
b) proceed with midforceps delivery c) spontaneous rupture of membranes
c) anticipate vaginal delivery with close d) complete dilatation of cervix
fetal monitoring e) successful delivery of the placenta
d) manually convert to vertex
presentation 97. The following is characteristic of first
e) shorten second stage by ventouse stage of labor:
a) uterine shape changes from discoid
93. A PG at term presents in labor. Her to globular with rise in fundal height
pregnancy is twin gestation. The most b) regular uterine contractions are
common presentation of these twins at confirmed
delivery is: c) in absence of anesthesia, this stage
a) transverse/ breech lasts 20-50minutes
b) breech/transverse d) each contraction stimulates the urge
c) vertex/vertex to push
d) vertex/breech e) an episiotomy should be performed
e) breech/vertex during this stage of labor
94. A woman in labor with twins 98. A 19yrs old PG at 40wks has been in
successfully delivers her first baby labor for the last 8hrs. FHS: 135/min with
vaginally. PV revealed second baby normal variability, multiple accelerations
breech. The least appropriate and no decelerations. She has been fully
management is: dilated for the last hour. With pushing, the
a) cesarean section head descended from +1 to +3 station.
b) assisted breech delivery Position is direct occipito-anterior. Your
c) partial breech extraction next action is:
d) total breech extraction
e) Piper’s forceps
a) forceps assisted vaginal delivery

b) vacuum-assisted vaginal delivery
c) continue to push
d) oxytocin augmentation
e) cesarean section
99. An expectant mother in labor is

brought to hospital. 4 hours after
admission, her labor is progressing
normally and the cervix is dilated to 10cm.
Best sign to monitor labor at this stage is:
a) fetal station
b) Bishop score
c) frequency and rhythm of uterine
contractions
d) rate of dilatation of cervix
e) fetal heart rate
100. Risk for shoulder dystocia include all

of the following EXCEPT:
a) maternal obesity
b) fetal macrosomia
c) maternal diabetes
d) operative vaginal delivery
e) preterm pregnancy
ANSWERS
1 B 36 C 71 E
2 B 37 D 72 A
3 E 38 D 73 C
4 D 39 B 74 B
5 A 40 A 75 E
6 B 41 B 76 C
7 D 42 A 77 A
8 E 43 C 78 D
9 D 44 A 79 C
10 A 45 D 80 B
11 B 46 A 81 A
12 E 47 B 82 B
13 E 48 C 83 A
14 E 49 A 84 C
15 C 50 A 85 A
16 A 51 C 86 A
17 E 52 E 87 B
18 D 53 C 88 D
19 B 54 A 89 B
20 D 55 E 90 E
21 D 56 A 91 C
22 C 57 D 92 C
23 B 58 E 93 C
24 D 59 A 94 A
25 E 60 B 95 D
26 A 61 C 96 D
27 A 62 C 97 B
28 B 63 E 98 C
29 C 64 A 99 A
30 A 65 B 100 E
31 B 66 A
32 D 67 B
33 E 68 C
34 D 69 E
35 A 70 C
Obs 4: Medical Preg. Disorders (50 marks)

Choose the most correct answer: 4. A 29yrs old G1P0 woman at 28wks
gestation is admitted to the hospital for
1. A 29yrs old female G2P1 pregnant pre-eclampsia. Her BP: 150/100 and
28wks gestation had a normal protein in urine is 500mg/24hrs. On day 7
haemoglobin 4weeks ago at her first in the hospital, she was diagnosed with
prenatal visit, complains now of fatigue severe features of pre-eclampsia and the
with drop of Hb to 7.0g/dl. She noted dark
decision is made to administer magnesium
colored urine after taking an antibiotic for
sulfate and deliver the baby. Most likely
a urinary tract infection. The most likely
diagnosis: presentation necessitating delivery:
a) iron deficiency anemia a) elevated uric acid
b) thalassemia b) being primigravida
c) hemolysis c) 5mg proteinuria in 24hrs
d) folate deficiency d) platelet count of 115000/ml
e) aplastic anemia e) INR: 1.9 and PTT: 50sec
2. A 27yrs old G1P0 is at 31weeks 5. The best management of an 18yrs old

gestation is seen by her physician for right G1P0 woman at 28wks gestation with a
leg pain and calf tenderness. A Doppler BP: 160/110, elevated liver enzymes and
study indicates a deep venous thrombosis platelets of 60.000/ml is:
of the right lower extremity. The reason
a) oral antihypertensive therapy
for the increased incidence of venous
b) platelet transfusion
thromboembolism in pregnancy:
a) venous stasis c) magnesium sulfate therapy and
b) decreased clotting factors levels induction of labor
c) elevated platelet count d) intravenous immunoglobulin therapy
d) endothelial damage e) immediate cesarean section
6. A 33yrs old woman at 29yrs gestation is
3. A 38yrs old G2P1 woman had been noted to have a BP: 150/90. Platelet count
diagnosed with a DVT of the right leg and liver functions are normal. Which of
when she was 8wks GA. She has been on the following is the best management for
subcutaneous heparin for 6months. The this patient?
most likely result of long-term heparin a) induction of labor
therapy: b) cesarean section
a) osteoporosis
c) antihypertensive therapy
b) thrombophilia
d) magnesium sulfate
c) fetal intracranial hemorrhage
d) diabetes mellitus e) expectant management
e) all of the above
7. A 32yrs old G2P1 woman is at 35wks a) elevation of serum total thyroxine

gestation with chronic hypertension. Her levels
BP is 140/95. The best management plan b) decrease in serum thyroid binding
is: globulin levels
a) antihypertensive agent c) decrease in serum free T4 levels
b) biophysical profile d) elevated free T4 levels
c) magnesium sulfate and delivery e) no effect on TSH or total thyroxine
d) continuous observation
e) immediate cesarean section 11. A 25yrs old G1P0 at 16wks gestation
complains of palpitations and feeling very
8. A 28yrs old G1P0 woman is at 30wks warm despite the air conditioning. The
gestation with superimposed pre- most probable diagnosis:
eclampsia. Her BP is 150/90 and platelet a) hyperthyroidism
count is 95.000. Liver enzymes are b) heart failure
elevated double fold. BPP: 8/8. Your best c) anemia
management plan is: d) hypertension
a) corticosteroids e) hypothyroidism
b) antihypertensive agent
c) magnesium sulfate and delivery 12. A 36yrs old G1P0 at 27wks is noted to
d) continued observation have fever, right flank tenderness and
e) immediate cesarean section pyuria. She is diagnosed with
pyelonephritis. A urine culture is
9. A 30yrs old G2P1 woman is at 34wks performed. Commonest organism for
gestation with chronic hypertension. Her pyelonephritis in pregnancy:
BP is 160/95. Urine protein is negative. a) Proteus species
Your best management plan is: b) Candida species
a) corticosteroids c) Esherichia coli
b) antihypertensive agent d) Klebsiella species
c) magnesium sulfate and delivery e) Staph aureus
d) continued observation
e) immediate cesarean section 13. A 36yrs old G2P1 woman presents for
her initial prenatal visit at 6wks gestation.
10. A 25yrs old G1P0 has been diagnosed She has a 9year history of type 2 diabetes
with borderline hypothyroidism 4yrs ago. mellitus which is managed by oral
Since then, annual thyroid studies are hypoglycemic medications. The best
done. Last year, her thyroid panel was indicator for fetal outcome of the
within normal limits. She is currently at pregnancy:
15wks gestation and had a thyroid panel a) blood sugar value in the office
drawn today. Which of the following b) fasting blood sugar
changes is likely to have occurred today as c) HbA1c
compared to last year’s result? d) nuchal translucency on ultrasound
e) umbilical artery Doppler at 18wks
14. A 24yrs old G2P1 woman is at 34wks 17. The most worrisome symptom of
gestation and noted to be icteric. She also possible serious pathology in late
has nausea, vomiting and malaise. A pregnancy:
diagnosis of acute fatty liver of pregnancy a) swollen ankles
is made and the obstetrician recommends b) constipation
immediate delivery. The most consistent c) visual changes
with AFLP: d) nocturia
a) elevated serum bile acid levels e) backache
b) hypoglycemia requiring glucose IV
c) proteinuria of 500mg/24hrs 18. Which of the following histories might
d) oligohydramnios noted on lead to suspect the existence of diabetes
ultrasound in a patient now pregnant for the third
e) none of the above time?
a) spontaneous rupture of the
15. A 19yrs old G2P1 woman at 13wks membranes occurred in the second
gestation comes for her first prenatal visit. pregnancies
Among other tests, a urine culture is b) jaundice appeared in the last
performed showing 100.000/ml E.coli. The trimester of her second pregnancy
patient has no symptoms and has not had c) both preceding infants were
pyelonephritis, dysuria or fever. The best premature
next step for this patient: d) previous twin pregnancy
a) observation as no therapy is needed e) unexplained IUFD occurred at
b) no therapy needed unless the patient 38weeks gestation in her last
develops symptoms pregnancy
c) initiation of antibiotic therapy
d) no therapy needed at this time but 19. You are seeing a 28yrs old woman
antibiotics should be given during 4thGP2 with suspected UTI. To obtain a
labor urine specimen, which of the following
e) cystoscopy should you order?
a) clean void midstream
16. A 30yrs old G1P0 woman at 29wks b) catheterization
gestation is noted to have a urinary tract c) 24hour urine
infection with 100.000/ml E. coli. Common d) first morning void
manifestation of upper UTI rather than e) suprapubiccystocath
simple cystitis:
a) fever Questions 20-21: a 28yrs old G2P0 at
b) urgency 39wks gestation. Her cervix is 2cm dilated
c) hesitancy and 90% effaced. Contractions every 4-
d) dysuria 5minutes. FHS are reassuring. Her nurse
e) hematuria steps out for a moment and returns to find
her having a seizure.
20. The nurse administers 4gm MgSo4 24. A patient in the early third trimester
bolus. The seizure stops. FHS variability is complains of chills, fever, nausea and
flat but there are no decelerations. Your backache. The urine analysis reveals
next step is:
bacteria and WBCs. It is most likely:
a) reducing edema with diuretics
b) administer antihypertensives a) acute appendicitis
c) giving 3gm of MgSo4 every 3hours b) asymptomatic bacteriuria
d) prepare for immediate delivery by c) pyelonephritis
cesarean Section d) abruption placentae
e) keeping the patient free of e) acute PID
convulsions, coma and acidosis
21. The most common sign/symptom of 25. A patient at 34wks gestation develops
her eclamptic seizure is: marked pruritis especially on her palms
a) proteinuria and soles, mildly elevated liver function
b) severe headache tests and elevated bile acids. Your most
c) increased BP˃160/120mmHg probable diagnosis:
d) epigastric pain a) pancreatitis
e) lower limb edema
b) urticaria
22. A 14yrs old girl is seen for her first c) hyperthyroidism
prenatal visit at 34wks gestation. Her BP is d) diabetes insipidus
150/95 and her fundus measure 33cm. Her e) cholestasis of pregnancy
urine dipstick is 1+ for protein. The most
likely diagnosis is: 26. In the previous patient, pruritis and
a) preeclampsia
jaundice are likely to recur in:
b) hypertensive disease with
superimposed preeclampsia a) menopause
c) normal third trimester pregnancy b) after discontinuation of breast
d) chronic hypertension feeding
e) gestational hypertension c) with poor diet
d) with another pregnancy
23. A 23yrs old PG is pregnant 11weeks
and develops persistent nausea and
vomiting that progress to a constant
retching. She has no fever or diarrhea. She 27. A 26yrs old Caucasian woman presents
lost 3kg in a week and appears for her first prenatal visit. She is 14weeks
dehydrated. What is your diagnosis: pregnant and has had a history of DVT in
a) anorexia nervosa her left leg when she was on COCPs 3years
b) morning sickness ago. She was tested and found to be
c) hyperemesis gravidarum
homozygous for factor V Leiden. What
d) gastroenteritis
e) acute fatty liver of pregnancy should you advise the patient?
a) close follow up and observation 30. A 19yrs old woman at 36wks GA with
b) low dose aspirin (81mg) should be BP 150/100, oedema, 2+ proteinuria with
taken during pregnancy and no other symptoms.
postpartum 31. A 21yrs old woman in early labor at
c) she should be placed on prophylactic 39wks gestation who has convulsed.
warfarin therapy since she is past the
1st trimester 32. A 16yrs old woman at 37wks GA with a
d) she would benefit from prophylactic BP 165/105, 2+ proteinuria and pulmonary
doses of LMWH until 6weeks oedema.
postpartum 33. A 35yrs old woman G5P4 32wks
e) since she has already had one DVT, gestation with BP 180/120, no proteinuria
she should be on therapeutic doses or edema but retinal exudates and
of SC Heparin until after delivery hemorrhage as well as history of
when estrogen levels will fall hypertension for 8yrs.
28. A patient with suspected cholestasis of 34. A 25year old female at 36wks presents
pregnancy develops a slight for a routine ANC. BP is 120/80, urine
hyperbilirubinemia and slight elevation of shows no protein or glucose. Fundal height
SGOT. Serum bile salts are positive. Relief shows appropriate fetal size and she feels
of pruritis may be obtained by: well DFMC. On palpation of her legs, there
a) amitriptyline is 2+ pitting edema bilaterally. The
b) bland diet following is true regarding this condition:
c) oral H2 blockers a) you should order a 24hrs urine for
d) cholestyramine protein
e) none of the above b) a workup for possible cardiac
abnormalities is necessary
Questions from 29-33 are preceded by a c) her leg swelling requires no further
list of options. Select the one letter which evaluation
is most closely associated with the d) she most likely has preeclampsia
condition. Each letter can be used once, e) she most likely has DVT
a) mild preeclampsia 35. During routine analysis in pregnancy,
b) severe preeclampsia the following is likely a normal finding:
c) chronic hypertensive disease a) glucosuria
d) eclampsia b) hematuria
e) chronic renal disease c) pyuria
f) lupus nephritis d) bacteriuria
29. A 30yrs old woman at 16wks GA with a e) proteinuria
BP 145/95, no edema and no proteinuria.
36. The recommended time to screen 40. 40wks pregnant admitted with
asymptomatic pregnant women for headache, BP 150/105 and proteinuria +++.
gestational diabetes is: US shows IUGR. Booking BP was 100/60.
a) in the first trimester Her urine analysis showed no abnormality.
b) at 16-20weeks gestation
c) at 24-28weeks gestation 41. 34wks pregnant with worsening
d) at 35-37 weeks gestation hypertension and proteinuria over 4 weeks.
e) at 38-40weeks gestation Booking BP was 160/100 with 3g
proteinuria/24hrs. Oral labetalol therapy
Questions from 37-44 show clinical
scenarios involving pregnancy. Select the commenced at booking. Now BP 180/100
most likely diagnosis from the list of and 9g proteinuria/24hrs.
options. Each option can be used once,
42. Associated with presence of lupus
a) chronic hypertension anticoagulant and/or antiphospholipid
b) chronic hypertension and antibody and adverse pregnancy event
superimposed pre-eclampsia (such as RPL in first trimester, abruption or
c) chronic renal disease early onset pre-eclampsia).
d) Cushing’s syndrome
e) gestational hypertension 43. Rare but serious systemic thrombo-
f) hyperthyroidism hemorrhagic disorder that may be trigerred
g) pheochromocytoma by amniotic fluid embolism, severe
h) pre-eclampsia hemorrhage, stillbirth and placental
i) acute fatty liver of pregnancy abruption.
j) antiphospholipid syndrome
k) systemic lupus erythematosus 44. Rare life threatening complication of
l) disseminated intravascular third trimester of pregnancy associated
coagulopathy with nausea, vomiting, jaundice,
37. A 20wks pregnant, has warm hands, hypoglycemia, elevated WBCs, deranged
palpitations, sweating and tremor. BP: LFTs and clotting profile.
130/80.
38. 13wks pregnant with BP: 160/100. H/O 45. A 35yrs old G4P3 is currently 16wks
of childhood glomerunephritis. Urine shows
pregnant and has uncomplicated chronic
+++ proteinuria. Similar BP recorded at pre-
pregnancy counseling review 6months hypertension. The ideal target BP with ttt
earlier. is:
a) less than 200/110
39. 32wks pregnant with proteinuria b) less than 160/100
(0.2g/24hrs) and BP 150/100. Booking BP at c) less than 150/100
12wks was 90/60. BP at 20wks was 95/ 60. d) less than 140/100
No urine proteinuria detected until 32wks.
e) less than 130/90
Normal fetal growth. Mild peripheral
edema.
46. A 19yrs old PG at 34wks was admitted 49. A patient is found to have
with BP 160/100 and no proteinuria. Her hyperthyroidism in pregnancy. Which
BP is currently controlled with labetalol condition causes 95% of cases of
200mg tds. Fetal growth and liquor hyperthyroidism in pregnancy?
volume is normal but she is very anxious a) thyroiditis
about delivery. What is the most b) multinodular goiter
appropriate advice regarding delivery? c) toxic adenoma
a) deliver with steroid cover after d) Grave’s disease
34wks
e) subacute thyroiditis
b) deliver at around 36wks
c) cesarean section at 37wks
50. A woman suffers a massive
d) deliver after 37wks
e) MgSo4, steroids and deliver soon postpartum hemorrhage during
emergency cesarean section. She is Rh-D
47. A PG at 35wks presents with pain in Rt negative and receives two units of Rh
hypochondrium and Rt side of her back. positive FFP and cryoprecipitate. What
There is no nausea, vomiting, additional therapy should be given in this
hypertension, urinary symptoms and case?
bowel problems. Pulse 106, BP: 125/75 a) 250iu of Anti-D Ig
and T: 38.1. Abdominal examination is b) 500iu of Anti-D Ig
normal and chest is clear. Fetal monitoring c) check Kleihauer and then decide
is normal. Urine shows 2+ leucocytes and dose
1+ blood and WBCs 16.000.000/L. Most d) no Anti-D is required
likely diagnosis: e) 1500iu Anti-D is given
a) appendicitis
b) cholecystitis
c) pyelonephritis
d) abruption
e) right basal pneumonitis
48. An Asian PG at 32wks presents for

routine ANC. She complains of tiredness
and looks slightly pale. Her Hb is 10.5g%
despite Hb of 13g% at time of booking. All
her other investigations were normal. She
is vegetarian. the best course of action to
improve her Hb:
a) balanced diet
b) oral iron
c) IV iron sucrose
d) IV iron dextrose
e) recombinant human erythropoietin
injection
ANSWERS
1 C 36 C
2 A 37 F
3 A 38 C
4 E 39 E
5 C 40 H
6 E 41 B
7 B 42 J
8 A 43 L
9 B 44 I
10 A 45 C
11 A 46 D
12 C 47 C
13 C 48 B
14 B 49 D
15 C 50 D
16 A
17 C
18 E
19 A
20 E
21 B
22 A
23 C
24 C
25 E
26 D
27 D
28 D
29 C
30 A
31 D
32 B
33 C
34 C
35 A
Obs 5: Fetology (50 marks)

Choose the most correct answer: 4. A 25yrs old woman G2P2 with chronic
hypertension is at 38wks gestation. US
shows AFI is 4cm and EFW ˂10th
1. Which of the following is not associated
percentile. NST is nonreactive with absent
with IUGR? variability. Bishop score is 4. the best next
a) absence if fetal weight gain step is:
b) maternal short stature a) cordocentesis for fetal karyotype
c) low fundal height b) cordocentesis for fetal blood ph
c) BPP
d) maternal cigarette smoking
d) Immediate delivery
e) decreased blood flow in the uterus e) repeat NST in one week
and placenta
5. An 18yrs old female at 30wks presents
2. A 25yrs old PG at 34wks gestation is with uterine contractions 10minutes
apart. Her previous pregnancy 18months
thought to be small for dates by her ago resulted in PTL at 29wks. Most
physician and is sent for evaluation. US accurate test to determine need for
shows BPD appropriate for 30wks tocolysis is:
gestation. AC appropriate for 26wks a) serum Corticotropin releasing
gestation. EFW ˂10th percentile for 34wks hormone
b) maternal serum alpha fetoprotein
gestation. Amniotic fluid is decreased. The c) serum HCG
most likely diagnosis is: d) salivary estriol concentration
a) symmetrical IUGR e) vaginal fetal fibronectin
b) asymmetrical IUGR
6. The commonest cause of perinatal
c) congenital anomaly
mortality is:
d) congenital infection a) IUGR
e) unknown gestational age b) congenital abnormality
c) infection
3. The most common maternal cause for d) prematurity
e) chromosomal anomalies
IUGR is:
a) chronic hypertension 7. Oligohydramnios is seen in what
b) alcohol intake perinatal condition:
c) autoimmune disease a) renal agenesis
d) fetal aneuploidy b) trisomy 21
c) esophageal agenesis
e) multiple gestation d) twin gestation
e) tracheoesophageal fistula
8. Oligohydramnios is associated with 12. The most worrisome finding in a past-

which of the following fetal conditions? dated pregnancy is:
a) trachea-esophageal fistula a) decreased fetal movement reported
b) talipes equinovarus (club foot) by mother
c) anencephaly b) non-reassuring NST
d) fetal erythroblastosis c) no increase in mother’s weight for
e) Down syndrome 2weeks
d) decrease fundal height
9. A previously low risk PG is found to e) no increase infetal weight for 1week
have uterine measurement of 33cm at her
37wks. There is no fluid leakage. US shows 13. A 24yrs old G2P1 at 39wks who is not
AFI 6.5. No anomalies and EFW at 50th in active labor is evaluated for decrease
percentile. NST is reactive. The most DFMC. Her BP is 120/ 75. NST shows
appropriate to be done at this point is: absent acceleration with fetal movement.
a) ccesarean delivery The best management at this point is:
b) induction of labor a) immediate Cesarean section
c) amniocentesis and induction of labor b) BPP
if fetal lung maturity is confirmed c) urinary estriol estimation
d) repeat NST and AFI measurement in d) repeat NST in 2days
few days e) HPL determination
e) amnioinfusion and immediate
delivery 14. The following are contraindications to
epidural anesthesia EXCEPT:
10. The strongest risk factor for preterm a) hypovolemia
birth is: b) bleeding diathesis
a) prior preterm delivery c) infection at site of injection
b) being overweight d) decreased blood pressure
c) first-trimester bleeding e) pre-eclampsia
d) smoking before pregnancy
e) blood pressure 130/85 15. A woman who delivers after a
prolonged labor presents to you after
11. The test used to diagnose cervical 2days. All the following suggest
incompetence in a pregnant woman is: endometritis EXCEPT:
a) abdominal ultrasound a) tender uterus
b) HSG b) foul smelling lochia
c) CT pelvis c) uterus 9cm below umbilicus
d) TVS d) pyrexia
e) MRI e) lower abdominal pain and guarding
16. The most appropriate IV antibiotic 19. Late decelerations on fetal monitoring
regimens for postpartum endometritis is: indicate:
a) ciprofloxacin plus nafcillin a) fetal head compression
b) ciprofloxacin plus doxycycline b) umbilical cord compression
c) gentamycin plus methicillin
c) fetal sleep
d) gentamycin plus clindamycin
e) clindamycin plus metronidazole d) uterine hypotonus
e) uteroplaental insufficiency
17. A 23yrs old multipara has been in
active labor for the last 8hrs. Cervix is 8cm 20. A pregnant woman at 20wks has a
dilated and vertex is station +2. EFW is uterine size of 25cm. All the following are
average (she delivered previously possibilities EXCEPT:
uncomplicated VD of a 4kg baby). a) normal pregnancy
Recently, her contractions have been b) wrong estimation of gestational age
augmented by oxytocin, membranes
c) twin pregnancy
ruptured and liquor is clear. She is afebrile
and normotensive. There is recent change d) bilateral renal agenesis
in the fetal heart rate tracing and upon e) polyhydramnios
your arrival there is late deceleration. The
most appropriate next step is: 21. An infant is born at 1minute, HR is
a) immediate forceps delivery 120/min, respiratory effort is a good
b) immediate cesarean delivery strong cry, muscle tone is active, reflex
c) amnioinfusion of the fetus and irritability is absent and color is pink with
oxygen to the mother blue extremities. The Apgar at 1minute is:
d) discontinue oxytocin infusion and
a) 5
supplement with oxygen to the
mother b) 6
e) observation and re-evaluate in 2 c) 7
hours d) 8
e) 9
18. A 28yrs old PG has been in active labor
for the last 4hrs. She is induced with 22. A 24yrs old G1P0 at 34wks describes
oxytocin, cervix is 6cm, vertex station +1, passing large volume of clear fluid per
EFW: 2.8kg and maternal pelvis is vagina for 36hrs. Temp is 38.5, no uterine
adequate. ROM with clear liquor. Patient
contractions, vague lower abdominal
is afebrile and normotensive. Upon your
arrival, you note early deceleration. The tenderness, FHS: 185bpm, WBC: 19000
most appropriate next step: and +ve nitrazine test. The most likely
a) immediate forceps delivery diagnosis is:
b) immediate cesarean delivery a) PROM
c) amnioinfusion of the fetus and b) PROM and chorioamnionitis
oxygen to the mother c) premature labor
d) discontinue oxytocin infusion and d) acute pyelonephritis
supplement with oxygen to the e) acute vaginitis of pregnancy
mother
e) observation and re-evaluate in 2
hours
23. The most frequent signs and 26. A patient at 40wks gestation had a
symptoms of chorioamnionitis is: fundal height 3-4cm greater than her
a) maternal leukocytosis dates. US shows vertex presentation with
b) maternal tachycardia EFW: 4.2kg. PV: cervix is closed, long,
c) uterine tenderness posterior, firm with station -2. Her
d) maternal fever pregnancy is uncomplicated. Appropriate
e) purulent vaginal discharge management at this point is:
a) cesarean delivery
24. A 25yrs old at 35wks presents with b) induction of labor with oxytocin
painful contractions every 3mintes. Cervix c) cervical ripening with prostaglandins
is 3cm dilated, 50% effaced, membranes d) schedule a routine cesarean in
intact and FHS reassuring. She is treated 1week
with tocolysis, betamethasone, IV e) schedule a routine prenatal visit in
hydration and culture for group B Strept. 1week
Contractions cease and cervical changes
stopped so she was discharged after 2 27. A 29yrs old G2P0 presents at 21wks
days of observation. One week later, she gestation with mucus and blood discharge.
returns with contractions for the last 8hrs. Her last pregnancy ended preterm at
Cervical changes are the same and culture 22wks 18months ago. She denies
for group B Strept was negative. Most contrations. PV: cervix is 5cm dilated and
appropriate next step is: 80% effaced. The most likely cause of
a) repeat tocolysis, betamethasone and preterm labor is:
IV hydration a) SLE
b) betamethasone and IV hydration b) Fetal chromosomal abnormalities
only c) placenta previa
c) tocolysis only d) cervical insufficiency
d) antibiotics and IV hydration only e) HPV infection
e) expectant management
28. If the embryonic disc divides 14days
25. Postterm pregnancy is a pregnancy after fertilization, the result is:
that has reached: a) diamniotic dichorionic placentation
a) 39weeks gestation b) diamniotic, monochorionic
b) 40weeks gestation placentation
c) 41weeks gestation c) velamentous cord insertion
d) 42weeks gestation d) conjoined twins
e) 43weeks gestation e) acardia
29. A 26yrs old G2P1 at 36wks fell off her 32. A 28yrs old woman noted loss of fetal
bicycle 2hrs ago. She says that she has not movement at 36wks gestation. Patient
felt any fetal movement since the fall. She went for follow up at 40wks, her FHS were
has abrasions on the left forearm and left not heard. The uterus measures 30cm
leg otherwise uninjured. The most from symphysis pubis. The following tests
would be valuable to perform:
sensitive indicator of fetal compromise is:
a) maternal serum estriol
a) continuous electronic fetal monitor b) clotting screen
b) uterine ultrasonography c) lecithin/sphingomyelin (L/S) ratio
c) vaginal bleeding d) karyotype of amniotic cells
d) uterine tenderness e) maternal serum progesterone
e) frequent uterine contractions
33. A woman with 2 previous miscarriages
30. A 30yrs old PG asks about the benefits and family history of neural tube defects is
and drawbacks of corticosteroids therapy planning a pregnancy within next
for PTL: 6months. The best advice you would give:
a) start folic acid now
a) therapy decreases the risk of
b) start multivitamins now
neonatal necrotizing enterocolitis
c) start calcium now
b) weekly corticosteroid injections until d) start vitamin D now
34wks gestation is the standard e) none of the above
regimen
c) therapy is associated with higher rate 34. What is the diagnostic test used to
of neonatal intraventricular confirm a diagnosis of Down syndrome in
hemorrhage the fetus of a pregnant woman at 14weeks
d) therapy is associated with higher rate gestation?
of persistent PDA a) chorionic villus sampling
b) amniocentesis
e) therapy decreases the risk of RDS but
c) ultrasound
not total neonatal mortality
d) triple screen
e) double test
31. In women with polyhdramnios, what is
the most common cause? 35. Amniocentesis is used in all the
a) fetal urinary tract anomalies following EXCEPT:
b) maternal diabetes a) identification of trisomy 21
c) postmature pregnancy b) detection of metabolic errors
d) anencephaly c) evaluate for neural tube defects
e) idiopathic d) identification of genitourinary
anomalies
e) identification of trisomy 18
36. The commonest indication for a) instruct the patient to labor and
amniocentesis is: delivery for a contraction stress test
a) hypertensive treatment of mother b) reassure the patient that one fetal
movement per hour is within normal
b) teenage pregnancy
limits and no worry
c) advanced maternal age c) recommend the patient be admitted
d) family history of Down syndrome to the hospital for delivery.
e) family history of cystic fibrosis d) counsel the patient that the baby is
probably sleeping, and she should
37. A 26yrs old healthy smoker G1P0 at continue to monitor fetal kicks. if she
34wks GA with evidence of IUGR in still experiences no movement by
morning, she should call you back for
previous US, shows that Doppler S/D ratio
further instructions
is much higher than it was on her last e) instruct the patient to go to labor
ultrasound 3wks ago and there is now and delivery room for a NST
reverse diastolic flow. The following is
correct information to share with the 39. A 39yrs old G2P1001 presents for a
patient: routine ANC visit at 30wks. She delivered a
a) the Doppler studies indicate that the 2.7kg baby at 40wks 10years ago following
uncomplicated pregnancy. Her current
fetus is doing well
pregnancy has also been uncomplicated.
b) with advancing gestational age, the She has no medical troubles and does
S/D ratio is expected to rise smoke. She weighed 40kg prior to
c) these Doppler findings are normal in pregnancy and she has gained 9kg to date.
someone who smokes Her 20week anatomy US was normal. Her
d) reverse diastolic flow is normal as a BP range has been 100 to 120/60 to 70.
O/E: fundal height measures 26cm. Most
patient approaches full term
likely cause for this decreased fundal
e) the Doppler studies are worrisome, height is:
and the fetal status is deteriorating a) autosomal trisomy
b) constitutionally small mother
38. A 27yrs old G3P2002 who is 34wks GA, c) poor weight gain
calls the on-call obstetrician on a Saturday d) lifestyle factors
10pm reporting decreased fetal e) uteroplacental insufficiency
movement. She says that the previous day
Questions from 40-43, select the SINGLE
her baby moved only once per hour. For most appropriate investigation from the
the past 6hours, she felt no movement. list below for the given clinical scenario.
She is healthy, has had regular ANC and Each option can be used once, more than
reports no complications so far during the once or not at all.
pregnancy. Best advice for her:
a) amniocentesis 45. PG at 37wks has low risk

b) fetal blood sampling uncomplicated pregnancy. She presents to
c) chorionic villus sampling (CVS) ER with decreased DFMC for one day. CTG
d) maternal Doppler study is normal/reactive. She continues to
perceive reduced movement despite a
e) fetal blood sampling
normal CTG. The following ttt option is
f) fetal fibronectin
best for her:
g) NT scan a) induction of labor
h) cervical length by TVS b) reassurance and kick counts at home
i) fetal ultrasound and Doppler study c) repeat CTG in 6hr
40. Consanguineous couple now 11wks d) repeat CTG in 24hrs
e) US for fetal growth, liquor and
pregnant G4P2L1A1. Her only alive child
Doppler study
has thalassemia minor. One previous child
died of thalassemia major and one 46. A 17yrs old PG presents at 39wks at ER
termination of pregnancy following fetal with 2nd episode of decreased DFMC. She
diagnosis. is smoker and has poor access to care. CTG
41. A 34yrs old woman at 17wks GA has risk is reassuring/reactive. US reveals
abnormally grown fetus with normal
of Down syndrome on the quadruple test
liquor volume and normal umbilical artery
and wants to confirm fetal karyotype.
Doppler. Best ttt is:
42. A G3P2 with previous two preterm a) induction of labor after consultant-
births of AGA fetuses at 22-24wks GA due led counseling
to cervical incompetence. Now 11wks. b) reassurance and kick counts at home
c) repeat CTG in 6h
43. A 32yrs old at 29wks GA has an SGA d) repeat CTG in 24h
fetus with reduced amniotic fluid. She is e) stretch and sweep
perceiving reduced fetal movements since
one day. 47. A 40yrs old woman at 11wks comes for
ANC. She is concerned about the risk of
Down syndrome. Most appropriate
44. If fetal crown rump length is disparate management for her anxiety and
in twins at the 12weeks scan. Select the consistent with antenatal screening is:
best method of dating the pregnancy. a) measure NT and check
Gestation is age can be done according to: presence/absence of nasal bone
a) average CRL of the two fetuses b) measure NT, PAPPA and HCG at
b) CRL of the bigger fetus 12wks
c) CRL of the smaller fetus c) offer amniocentesis at 15wks
d) CRL of the smaller fetus added to half d) offer fetal anatomy US to check for
fetal congenital malformations at
of the CRL of the bigger fetus
20wks
e) dating is best done by LMP in such e) offer maternal biochemical
cases quadruple screening at 16wks.
48. Which one of the following statements

relates IUGR and SGA?
a) all fetuses that are IUGR are in less
than 10th percentile for EFW
b) all fetuses that are SGA are IUGR
c) constitutionally small SGA fetuses
are at increased risk of antepartum
stillbirth
d) SGA is defined as growth at the 10th
or less percentile for weight of all
fetuses at that gestational age
e) the most common cause for SGA is
fetal chromosomal abnormality
49. A 20yrs old PG at 33wks has 6h H/O of

regular painful uterine contractions with
intact membranes. Obstetric US confirms
AGA and cephalic fetus. She is on early
stage of PTL. Most appropriate in her
counseling:
a) prophylactic antibiotics improves
neonatal outcome
b) antenatal steroids are not indicated
as tocolysis may successfully prevent
PTL
c) antenatal steroids will reduce the risk
of neonatal RDS and neonatal
mortality if PTL occurs
d) fetal fibronectin testing is necessary
to predict the time interval for PTL
e) tocolysis is strongly recommended
50. The following is an indication for

immediate delivery by LSCS of a SGA fetus:
a) EFW 480g at 28wks and steroid
covered.
b) EFW 1220g at 35wks, steroid covered
and normal Doppler
c) EFW 1350g at 35wks, steroid covered
and static growth for 3wks
d) EFW 1800g at 37wks, steroid covered
and normal Doppler
e) EFW 1800g at 37wks, steroid covered
and normal Doppler
ANSWERS
1 B 36 C
2 B 37 E
3 A 38 E
4 D 39 B
5 E 40 C
6 D 41 A
7 A 42 H
8 B 43 I
9 D 44 B
10 A 45 E
11 D 46 A
12 B 47 B
13 B 48 D
14 E 49 C
15 C 50 C
16 D
17 D
18 E
19 E
20 D
21 C
22 B
23 D
24 E
25 D
26 E
27 D
28 D
29 A
30 A
31 E
32 B
33 A
34 B
35 D
Obs 6: All (120 marks)

Choose the most correct answer: 4. The single best predictor for a successful
VBAC:
1. A triple test is performed for Down a) spontaneous labor pains
screening at 16wks in a 40yrs old woman. b) previous vaginal birth
The results suggest a high risk for trisomy c) previous cesarean section at full
1. What would the results typically show? dilatation
a) reduced AFP, reduced estriol and d) BMI˂30
increased B-HCG e) epidural analgesia
b) increased AFP, reduced estriol and
5. A 35yrs old PG has been admitted at
increased B-HCG
27wks GA with confirmed PPROM. Her
c) reduced AFP, increased estriol and
blood counts have been normal and high
increased B-HCG vaginal swab is culture negative. The most
d) reduced AFP, increased estriol and appropriate ttt for her:
reduced B-HCG a) no antibiotics till culture suggest
e) increased AFP, increased estriol and growth
increased B-HCG b) commence oral erythromycin
c) commence oral augmentin
2. A patient who wishes to have cell free d) commence low dose aspirin
fetal DNA (cff DNA) testing enquires about e) commence LMWH
how soon it can be done. What would you
advice? 6. This serological test is routinely done at
a) 1st trimester antenatal booking:
a) hepatitis A
b) early 2nd trimester
b) hepatitis B
c) late 2nd trimester
c) influenza
d) 3rd trimester
d) CMV
e) just before conception e) Varicella
3. The approximate incidence of breech 7. Breast feeding immediately after

presentation at 28wks GA is: delivery can reduce the risk of bleeding by
a) 4% causing uterine contraction. Which
b) 8% hormone is released to cause this?
c) 10% a) VEGF
d) 15% b) oxytocin
e) 20% c) prolactin
d) prostacyclin
e) prostaglandin F2α
8. During labor, occipito-posterior position 12. During labor ward handover, the
of the fetal head is favored in which type coordinator informs you that there is a
of pelvis? 35yrs old P1 in labor with a face
a) android presentation. A junior doctor is keen to
b) platypeloid learn more about this presentation. What
c) anthropoid
is the engaging diameter in a face
d) gynecoid
e) mixed type presentation?
a) bitemporal diameter
9. A 20yrs old PG presents with history of b) occipito-frontal diameter
vomiting and nausea. She is 12wks c) submento-bregmatic diameter
pregnant. In hyperemesis gravidarum. d) suboccipito-bregmatic diameter
What would u give to prevent Werniche’s e) vertico-mental diameter
encephalopathy?
a) vitamin B1 13. A 30yrs old PG presents in
b) vitamin B2 spontaneous labor at 41wks. PV: cervix is
c) vitamin B6
fully dilated and vertex is direct occipito-
d) vitamin B12
e) pantothenic acid posterior. What will be the distending
diameter of the vulva?
10. A woman delivered 30minutes ago and a) bitemporal
had retained placenta with 600ml blood b) occipito-frontal
loss. Which drug would you first c) submento-bregmatic
recommend after diagnosing a retained d) suboccipito-bregmatic
placenta? e) vertico-mental
a) IV oxytocin infusion
b) umbilical vein oxytocin injection 14. You are attending a teaching session
c) IM ergometrine
on labor management. You have been
d) IM carboprost
e) umbilical artery oxytocin injection asked a series of questions regarding the
mechanism by which the head is
11. The cardiovascular system undergoes spontaneously born in face presentation.
immense physiological changes in By what mechanism is the head delivered
pregnancy. Which of the following does in a face presentation?
NOT change in pregnancy? a) extension
a) cardiac output b) external rotation
b) central venous pressure c) flexion
c) heart rate d) internal rotation
d) stroke volume
e) restitution
e) systemic vascular resistance
15. A low risk PG is admitted in 17. You are teaching a midwife how to
spontaneous labor at term with intact perform McRobert maneuver. Which of
membranes. She is contracting strongly the following best describes McRobert?
three in 10minutes. The cervix is fully a) extension and abduction of maternal
effaced, 5cm dilated, occipito-anterior hips
with no caput or moulding and station -1. b) extension and adduction of maternal
4hrs later, she is 6cm dilated, all the other hips
findings are unchanged and intermittent c) flexion and abduction of maternal
auscultation is normal. What is your hips
diagnosis and recommended d) flexion and abduction of maternal
management? knees
a) adequate progress in 1st stage and e) flexion and adduction of maternal
vaginal examination in 4hrs hips
b) confirmed delay in 1st stage,
amniotomy and vaginal examination 18. A 30yrs old PG is admitted in labor at
in 2hrs 36wks. PV: cervix is 6cm dilatation,
c) confirmed delay in 1st stage, membranes have just ruptured and soon
amniotomy and vaginal examination blood stained liquor is detected. FHR then
in 4hrs changed and showed a sinusoidal rhythm.
d) suspected delay in 1st stage, Most appropriate management:
amniotomy and vaginal examination a) augmentation with oxytocin
in 2hrs b) cesarean section
e) suspected delay in 1st stage, c) fetal blood sampling
amniotomy and vaginal examination d) NST
in 4hrs e) ultrasound with Doppler
16. A woman is being treated with MgSo4 19. A 25yrs old PG with twin pregnancy
for severe pre-eclampsia. There is concern has just had a 24wks US. Report shows
about magnesium toxicity. What is the twin 1 with a deep pocket of liquor (DPL)
sign of magnesium toxicity? measuring 1.4cm and twin 2 with DPL of
a) bradycardia 10.8cm. Most likely diagnosis:
b) decreased urine output a) chromosomal abnormality of twin 1
c) loss of deep tendon reflexes b) CMV
d) reduced consciousness c) discordant fetal growth
e) respiratory depression d) twin reversed arterial perfusion
e) twin to twin transfusion syndrome
20. A 35yrs old P3 (all vaginal deliveries) at 22. A 36yrs old obese PG labors
39wks presents with no fetal movements. spontenesously at term. The fetal head
Diagnosis of IUFD is made and misoprostol delivered but the midwife can’t deliver the
is given to induce labor. Repeated doses shoulders. Shoulder dystocia occurred and
are given until contractions start. help is called. The woman is put in
Contractions develop quickly then she McRobert. What is the next most
reports continuous severe pain. O/E: she is appropriate immediate course of action?
profoundly shocked with tender abdomen a) downward traction of the fetus
and profuse vaginal bleeding. She is taken b) posterior axilla sling with foley
to theater and laparotomy is performed catheter
but unfortunately the woman dies. An c) routine axial traction of fetus
inquiry is held and the dose of misoprostol d) Rubin maneuver
used is criticized for being too high. What e) Zavanelli maneuver
would b the suitable dose in this case?
a) misoprostol 25-50mcg 4hourly 23. A 28yrs old PG labours spontaneously
b) misoprostol 200mcg 4hourly then at 40+6wks. 1st stage of labor is
100mcg 4 hourly augmented at 5cm and lasted for 11hrs.
c) misoprostol 200mcg 4hourly After 2hrs of passive 2nd stage, she pushes
d) misoprostol 200mcg 4hourly for another 2hrs and is exhausted. O/E:
followed by misoprostol 25 to 50mcg the fetus is cephalic, 2/5 of head is
4hourly palpable in abdomen, cervix is fully
e) misoprostol 400mcg 4hourly dilated, direct OP with 2+ caput 3+
followed by misoprostol 25-50mcg moulding and station 1. She is contracting
4hourly strongly at 4/10min. CTG is normal and
epidural is working well. Best
21. In normal labor, the midwife asks you management:
about the length of suboccipito-bregmatic a) cesarean section
diameter: b) continue pushing and reassess in an
a) 8.5cm hour
b) 9.5cm c) trial of OP delivery with
c) 10cm nonrotational forceps in theater
d) 11.5cm d) trial of Kieland forceps in theater
e) 13cm e) trial of rotational ventouse delivery
in theater
Questions from 24-30, for each of the 27. CTG decelerations for 40min then
clinical scenarios, select the SINGLE most prolonged deceleration for 4min withour
appropriate clinical management. All recovery. Currently FHR is 80bpm. CTG was
scenarios refer to a 25yrs old woman at normal prior to deceleration. Cx is 5cm and
40wks, in spontaneous onset labor and membranes ruptured 3hrs ago. Woman in
low risk pregnancy. Each option from the left lateral position, no epidural, no
oxytocin augmentation and contractions
list can be used once, more than once or
2/10min.
not at all:
a) amniotomy 28. Ruptured membranes for 24hrs with no
b) cesarean section onset of uterine contractions. FHR 150bpm,
c) change maternal labor position maternal temp 37.1 and pulse: 100bpm. IV
d) start CTG antibiotics started. Cx closed, firm and
e) start intermittent FHR auscultation uneffaced.
f) episiotomy
29. Quick recovery variable decelerations
g) PGs on CTG for 40min. Baseline FHR 165bpm.
h) IV antibiotics Contractions 5-6/10min. Vaginal PG
i) IV Fluids and analgesics inserted an hour ago and just removed. Cx
j) instrumental (forceps or ventouse) 5cm with ruptured membranes. No vaginal
delivery bleeding.
k) fetal blood sampling
l) IV oxytocin 30. Appearance of meconium-stained
m) repeat vaginal examination at liquor following amniotomy at 5cm cx
dilatation. Intermittent FHR monitoring
suitable interval
prior to amniotomy showed normal FHR.
24. In 2nd stage of labor, active pushing for
2hrs. CTG shows deep deceleration. Fetal
head visible at the vulva at peak of 31. A 32yrs old presents at 10wks GA.
maternal expulsive effort, epidural on and Based on her LMP, this is her 3rd
pregnancy. Her sons aged 4 and 2yrs are
uterine contractions are 4/10min.
fit and healthy. You are looking for risk
25. Appearance of meconium-stained factors to offer her screening for
liquor following amniotomy at 5cm cervical gestational diabetes. The following
dilatation. Intermittent FHR monitoring condition will NOT offer her such
screening:
prior amniotomy showed normal FHR.
a) BMI above 30
26. Progressed from 5 to 9cm cervical b) family history of diabetes
dilatation in 4hrs, intact membranes and c) family origin with a high prevalence
uterine contractions 2-3/10min. of diabetes
d) previous macrosomic baby weighing
Intermittent FHR monitoring shows normal
4.5kg or above
FHR and no urge to push.
e) previous type 2 diabetes
32. Flights of more than 4hrs are known to a) ECV may b offered and has around
be increase the risk of: 60% success rate for ceonversion to
a) abruption placentae cephalic
b) antepartum depression b) footling is considered favorable for
c) DVT VD
d) PROM c) if opting for VD, induction at 38wks is
e) PTL recommended to avoid excessive
fetal growth
d) intermittent FHR monitoring is
33. Drugs prescribed in pregnancy have
recommended for spontaneous
their positive effects outweighs any harm
onset VD
on mother and fetus. Based on this, which
e) LSCS and VD birth have similar rates
of the following would be contraindicated of perinatal and early neonatal
for antenatal use? morbidity
a) indomethacin
b) labetalol 36. You are seeing a 30yrs old PG at her
c) low dose aspirin booking visit. Her sister had DVT last year.
d) LMWH She has heard that pregnancy increases
e) metformin risk for venous thrombosis and wants you
to address her concern. Most appropriate
34. A 20yrs old PG at 33wks, presents with action:
6hrs H/O of painful regular uterine a) heparin
contractions. O/E: average sized fetus, b) low dose aspirin
longitudinal lie, cephalic presentation and c) reassure
FHR: 155bpm. PV: fully effaced cx, 5cm d) test for thrombophilia
dilated with intact membranes. Best next e) warfarin
step:
a) administer IM betamethasone 37. A 35yrs old Rh-ve woman is pregnant
b) start IV atosiban for 3rd time. Her 1st child is 5yrs and
c) start oral nifedipine Rh+ve. During her 2nd pregnancy, 2yrs
d) insert cervical cerclage ago, she was found iso-immunized and
e) recommend emergency cesarean lost her baby due to hydrops at 24wks.
section She subsequently had a divorce and is now
re-married and pregnant for third time.
35. A 20yrs old PG at 36wks comes to ANC. Pregnancy test was positive yesterday and
US confirms breech presentation with she comes for further care. The most
normal growth and liquor. She has no important investigation in this situation:
medical or obstetric disorders. She is a) maternal anti-D antibody levels
deciding between planned vaginal or b) maternal blood group/Rh typing
elective CS. The following is correct in her c) maternal blood test for B-HCG
counseling: d) maternal hemoglobin level
e) paternal blood group/Rh typing
38. A pregnant lady at 36wks has 43. The following are category B/C drugs
undergone ECV for breech presentation. in pregnancy EXCEPT:
She is known Rh-ve and nonsensitized. She a) aspirin
had 2 anti-D injections at 28 and 34wks.
The following best suits her: b) cyclophosphamide
a) anti-D is not needed as she had c) prednisolone
already received it at 34wks d) sulphamethoxazole
b) 500IU of anti-D at once e) heparin
c) 500IU of anti-D if the test of fetal
bloof group is positive 44. The following about thyroid hormones
d) 500IU of anti-D within 72hrs
e) postnatal anti-D administration only in pregnancy are true EXCEPT:
a) free T3 level is unchanged
39. A G2P0+1 at 14wks had previous 2 b) increased thyroid binding globulin in
midtrimesteric abortions. TVS shows blood
cervical length of 28mm. Best ttt: c) total T3 and T4 levels are increased
a) abdominal/laparoscopic cerclage d) TSH rises in 3rd trimester
b) expectant management
c) history indicated cerclage e) T3 crosses the placental barrier
d) US indicated cerclage
e) US surveillance of the cervix 45. Of the following statements regarding
hyperthyroidism in pregnancy, select the
40. Clinical signs suggesting sepsis include correct one:
all the following EXCEPT: a) during pregnancy, ttt is aimed at
a) hypothermia
b) polyuria keeping thyroid hormones at lower
c) pyrexia limit of normal range
d) tachycardia b) fetal hypothyroidism is a common
e) tachypnoea complication in these patients
c) pregnancy worsens thyroid status
41. The following is not a hallmark in AFLP: especially in 3rd trimester
a) DIC
b) elevated liver enzymes d) propylthiouracil can be safely
c) hypoglycemia continued in pregnancy
d) jaundice e) propylthiouracil don’r cross the
e) proteinuria placenta
42. The following are known obstetric 46. Hypopituitarism presents with all the
complications of cholestasis in pregnancy
EXCEPT: following EXCEPT:
a) intrauterine deaths a) adrenocortical insufficiency
b) maternal pruritis b) amenorrhea
c) meconium stained liquir c) anosmia
d) neonatal jaundice d) failure to lactate
e) PTL e) hypothyroidism
47. Hyperprolactinemia can be caused by 51. A PG at 29wks has been diagnosed

all the following EXCEPT: with gestational diabetes on her OGTT.
a) dopamine antagonists Her FBS was 225gm/dl. Which of the
b) hyperthyroidism following ttt option best suits her?
c) pituitary adenoma a) dietary modification alone
d) PCO b) diet+exercise
e) pregnancy c) insulin+diet+exercise
d) metformin+ diet+exercise
48. The following statement regarding e) glibenclamide+ diet+exercise
metformin use in pregnancy is true:
a) it has no reported adverse fetal 52. Severe twin to twin transfusion
outcomes syndrome diagnosed before 26wks is best
b) it is licensed for use during treated by:
pregnancy a) amnioreduction
c) it is effective in achieving good b) laser ablation of vessels
glycemic control in pregnancy c) selective fetal reduction
d) it is classified as a category C drug d) septostomy
e) lactic acidosis is a complication e) termination of pregnancy
49. The following are pre-existing risk In question 53-57, shows clinical
factors for development of type 2 DM
scenarios, for each one, select the SINGLE
EXCEPT:
most likely diagnosis from the list of
a) ART
options showing recognized causes of
b) increased parity
puerperal pyrexia. Each option can be
c) maternal age
used once, more than once or not at all.
d) maternal BMI
a) pulmonary embolism
e) maternal HTN
b) pneumonia
c) breast abscess
50. A 35yrs old PG at 33wks has a one day
d) uterine endometritis
H/O of headache and blurred vision. Her
e) infected perineum
BP is 180/110. Urine analysis shows +++
f) superficial leg vein thrombosis
protein. One week earlier, her BP was
120/70 and no proteinuria. The most g) leg DVT
appropriate INITIAL drug to administer: h) wound infection
a) IM betamethasone i) infected pelvic hematoma
b) IV MgSo4 j) UTI
c) IV furosemided 53. Pelvic pain, fever, malodorous vaginal
d) IV diazepam discharge that persists 3days post-delivery.
e) oral methyldopa H/O of 36hrs ROM prior to delivery.
54. Low grade pyrexia, localized superficial 59. A PG at term is in 2nd stage, after
lower abdominal pain and erythema delivery of fetal head, shoulder dystocia
around skin incision day 4 post CS. No was diagnosed and McRobert maneuver
pelvic pain, vaginal bleeding and mobilizing had not effected the delivery of the
well. shoulders. Next best step:
a) all four position
55. Low grade fever 5 days following b) delivery of posterior arm
uncomplicated spontaneous vaginal c) suprapubic pressure
delivery without perineal trauma with d) internal rotation maneuvers
e) Zavanelli maneuvers
epidural analgesia. Foley catheter
reinserted 48hrs post-delivery for 24hrs 60. Elective cesarean section is best
due to inability to sense a full bladder and recommended to prevent morbidity from
void. shoulder dystocia in which of the
following?
56. Pyrexia day 1 postdelivery. General a) all women at term with suspected
anaesthetic emergency CS with difficult macrosomia
intubation. Saturation 92% on air. Known b) diabetic women with suspected
smoker. Basal crepitation on chest macrosomia
auscultation. c) prelabor rupture of membranes at
term
57. Low grade fever, pleuritic chest d) previous shoulder dystocia
discomfort 9days postdelivery. No e) women with previous two cesarean
productive cough, had emergency CS for births
abruption. Required 4units transfusion.
BMI: 36. Normal wound on inspection. No 61. All the following are known factors for
anal sphincter injury during delivery
clinical swelling. Saturation 94% on air. RR: EXCEPT:
24. No added breath sound on a) expected fetal weight more than 4kg
auscultation. b) induction of labor
c) mediolateral episiotomy
d) primiparous
58. The following is the least likely to be a e) second stage more than 1hour
complication of LSCS:
62. Of the following, the most consistent
a) anal sphincter injury finding in uterine rupture is:
b) bladder domeinjury a) abnormal CTG
c) colonic perforation b) acute scar tenderness
d) intra-abdominal hemorrhage c) hematuria
d) maternal tachycardia
e) transient tachypnea of newborn e) severe abdominal pain referred to
the shoulder tip
63. A gestational diabetic PG at 38wks in d) engagement, descent, flexion,

spontaneous labor was assessed at 1pm internal rotation, restitution,
and had progressed to 5cm cx dilatation.
external rotation, extension,
She was examined at 5pm and was found
to be 6cm dilated, 50%effaced with intact expulsion
membranes and station 0. Next e) engagement, descent, flexion,
appropriate step: internal rotation, extension,
a) adequate progress and PV in 4hrs restitution, external rotation,
b) AROM+ oxytocin +PV in 2hrs expulsion
c) AROM+ oxytocin+PV in 4hrs
d) AROM+ PV in 2hrs
e) AROM+ PV in 4hrs 66. A 25yrs old PG at 40wks is in 2nd stage
of labor. She has been pushing actively for
64. As regard the third stage of labor, 2hrs and is exhausted. CTG shows baseline
which of the following is correct? of 150bpm, normal variability, occasional
a) active management reduces the risk
of hemorrhage and shortens 3rd accelerations and infrequent typical
stage compared to physiological variable decelerations. She is contracting
management 3-4/10min. PV: fully dilated, fetal head
b) early cord clamping achieves better direct occipitoanterior and station +1.
infant hematological outcomes than Most appropriate next step:
delay cord clamping
a) cesarean section delivery
c) if actively managed, the mean
duration is 30minutes b) episiotomy
d) if the placenta is retained then its c) fetal blood sampling
manual removal should only be d) instrumental delivery
conducted under GA e) start IV oxytocin augmentation
e) physiological management involves
cord clamping and placenta is
delivered by controlled cord traction 67. A 25yrs PG at 40wks in 2nd stage of
but no use of oxytocin labor, has been actively pushing for 1hr.
CTG shows a baseline of 180bpm, reduced
65. The following is the correct sequence baseline variability, no accelerations and
of events in relation to mechanism of frequent atypical variable decelerations.
labor in vertex presentation: She is contracting 3-4/10min. PV reveals
a) descent, flexion, engagement, fully dilated cx with fetal head direct
internal rotation, restitution, occipito-anterior and station +1. Most
external rotation, extension, appropriate next step:
expulsion
a) cesarean delivery
b) descent, engagement, flexion,
b) episiotomy
extension, restitution, external
c) fetal blood sampling
rotation, internal rotation, expulsion
c) engagement, descent, flexion, d) instrumental delivery
extension, restitution, external e) start IV oxytocin augmentation
rotation, internal rotation, expulsion
68. A 38wks pregnant with one previous 71. A 28yrs old PG has leaking fluid per
CS presents in spontaneous labor and has vagina for the past 3hrs at 32wks. On
an agreed plan for VBAC. She now speculum examination, leakage of clear
complains of pain in the CS scar. The amniotic fluid is confirmed. She is clinically
following is consistent with uterine stable with no signs of infection. US shows
singleton fetus in cephalic presentation,
rupture:
AGA, normal liquor and Doppler. It is
a) abnormal CTG correct to say:
b) acute onset scar tenderness a) almost 10% of pregnancies have
c) hematuria PPROM
d) severe abdominal pain, persisting b) frequent digital examination is
inbetween contractions recommended to help to assess her
e) vaginal bleeding Bishop score
c) erythromycin should be given orally
69. You are evaluating a woman who has for 10days following diagnosis of
been in 1st stage for the past 10hrs. The PPROM
d) if NICU beds are available, it is better
following is the least relevant information
to deliver her immediately after
for further clinical management: steroids cover
a) cervical dilatation and rate of change e) vaginal PGE2 can be used for
b) ethnicity inducing her labor now
c) parity
d) the woman’s emotional state 72. A G3P2 at term is undergoing an
e) uterine contraction emergency CS under GA as she presents in
labor with previous 2CS with an APH.
70. A 23yrs old PG is in threatened During CS, an anterior low-lying placenta
preterm labor at 32wks. Cortecosteroids fails to separate after delivery of the baby.
A clear cleavage plane can’t be identified.
are administered. While explaining the
The bleeding is minimal. She has
rational of this ttt. The following are consented to a sterilization as her family is
correct EXCEPT: complete. The following ttt options best
a) steroids are known to be safe to the suited her:
mother a) attempt to separate placenta and
b) they reduce the risk of cesarean hysterectomy if bleeding
intraventricular hemorrhage occurs
c) they reduce the risk of maternal b) elective cesarean hysterectomy
inflammation c) leaving the placenta in situ with
d) they reduce the risk of neonatal postoperative methotrexate
d) removal of the bulk of the placenta
deaths
and cord and closure
e) they reduce the risk of RDS e) removal of the placenta piecemeal
and closure of bleeding points
73. The following is recommended as a 77. A 32yrs old woman presents to

method of induction of labor: delivery suite with 3days history of
a) extra-amniotic PGE2 worsening pelvic pain and vaginal bleeding
b) intracervical PGE2 with clots. She is at 5days postnatal having
c) intravaginal PGE2 delivered her baby by ventouse at 41wks.
d) sublingual PGE2 Her BMI is 32, BP: 130/ 80, pulse: 108bpm
e) oral PGE2 and temp: 37.9. She has pelvic tenderness
on examination. Most likely diagnosis:
74. A PG at 35wks has an US today a) cervical carcinoma
revealing an extended breech baby. What b) bacterial vaginosis
is the incidence of breech at term? c) endometritis
a) ˂1% d) UTI
b) 1-2% e) uterine rupture
c) 3-4%
d) 4-8% 78. The single drug that is most likely
e) 8-10% contraindicated for maternal use when
breastfeeding is:
75. A 38wks pregnant woman developed a) cabergoline
1ry genital Herpes. She is now treated b) LMWH
with acyclovir. She has now confirmed c) nifedipine
ROM. The following ttt best suited her: d) POP
a) CS after adequately nil per oral (6hrs) e) warfarin
b) CS after steroids cover (24- 48hrs)
c) immediate CS 79. Incidence of clinically recognized
d) immediate induction of labor with IV miscarriage in pregnancy is about:
acyclovire. induction of labor after a) less than 1%
24hrs with IV acyclovir b) 1-2%
c) 5-10%
76. You have just examined a woman in d) 10-20%
postpartum ward complaining of breast e) 20-30%
pain and sicomfort. She has postpartum
mastitis. All the following are ttt options 80. The following route of administration
for her EXCEPT: is inappropriate for misoprostol:
a) analgesics a) oral
b) antibiotics if infective mastitis b) subdermal
c) gentle hand expression to promote c) sublingual
drainage d) rectal
d) local measures like hot and cold e) vaginal
compress
e) stopping breastfeeding
81. A 20yrs old at 12wks has a 2days H/O 84. A patient with positive pregnancy test,
of vaginal bleeding and lower abdominal small amount of PV bleeding and no
pain. US shows a 25mm fetal pole with abdominal pain. She has a single TVS scan
absent FHR. Pelvic examination reveals showing an intrauterine gestational sac
her cx to be a 4cm dilated with bulging with CRL of 5mm and no fetal heart beats.
intact membranes. The most likely Most appropriate management plan:
diagnosis: a) advise to carry out a pregnancy test
a) cervical incompetence in 3weeks
b) incomplete abortion b) offer medical management of
c) inevitable abortion miscarriage
d) pregnancy of uncertain viability c) offer rescan after 7days
e) threatened abortion d) offer rescan in 48hrs
e) offer surgical management of
82. A 29yrs old woman pregnant at 6wks is abortion
diagnosed to have a right tubal ectopic
pregnancy by TVS. The following would 85. A 25yrs old woman presents to ER with
enable systemic methotrexate to be left iliac fossa pain, vaginal bleeding and
offered as a medical ttt option for ectopic: +ve pregnancy test. Which symptom may
a) ectopic adnexal mass is 5x4cm in size be associated with ectopic pregnancy?
b) initial serum HCG 1000IU/L a) passage of tissue
c) presence of FHR in ectopic pregnancy b) urinary symptoms
d) US evidence of hemoperitoneum c) rectal pressure and/or pain on
˃50ml defecation
e) woman has had previous d) breast tenderness
salpingostomy so further e) all of the above
salpingectomy surgery is
contraindicated 86. A PG 7wks pregnant presents to ER
with dark brown discharge for 1day and
83. A 29yrs old woman pregnant in 6wks, mild lower abdominal discomfort. TVS:
presents with slight vaginal spotting. TVS gestational sac, yolk sac, fetal pole of
shows no evidence of intrauterine or 7.5mm and no fetal heart activity. Best ttt
extrauterine pregnancy. A serum B-HCG is option for her:
measured at initial presentation and a) discuss management options for
repeated 48hrs later. The following B-HCG miscarriage
results are suspicious for ectopic: b) rescan in 1week
a) 500,1200 c) serum B-HCG
b) 800,200 d) serum HCG and progesterone
c) 1000,400 e) serum progesterone to assess
d) 1000,3000 viability
e) 2000,2500
87. A PG, 7wks pregnant presents to ER and antibody +ve. The father is Rh+ve.
with 1day dark brown discharge and mild What is the lowest titre that you start
lower abdominal pain. TVS: gestational sac concern about development of fetal
20
26mm with no fetal pole. Best ttt option hydrops?
for her: a) 1:4
a) discuss management options for b) 1:8
miscarriage c) 1:16
b) rescan in 1week d) 1:64
c) serum B-HCG d. serum HCG and e) 1:256
progesterone
d) serum progesterone to assess 91. A common complication of epidural
viability and spinal anesthesia is:
a) maternal hypotension
88. The following is not an example of b) maternal hyperventilation
gestational trophoblastic disease: c) fetal tachycardia
a) chorioangioma d) titanic uterine contractions
b) choriocarcinoma e) chorioamnionitis
c) complete mole
d) partial mole 92. Which of the following is not a sign of
e) placental site trophoblastic tumour active labor?
a) bloody show
89. A PG at 34wks has been diagnosed b) palpable contractions
with cholestasis and started c) nausea and vomiting
ursodeoxycholic acid. She is very d) fever and chills
concerned about the fetal well being. The e) maternal pain
following investigation would accurately
predict the risk of fetal death: 93. A 37yrs old G3P1103 at 10+3wks
a) fetal growth scans every 2-3wks presents for ANC. She has chronic
b) no such test is available hypertension, type 2 DM and smokes one
c) routine CTG monitoring once or packet per day. Her last pregnancy was
twice weekly induced at 35wks due to pre-eclampsia.
d) transcervical amnopscopy for Risk factors for development of pre-
detection of meconium eclampsia in current pregnancy include all
e) weekly umbilical artery Doppler the following EXCEPT:
a) smoking
90. A 24yrs old G2P0010 at 22wks presents b) DM
for intial ANC. She had miscarriage c) H/O of preeclampsia in last
6months ago while she was travelling pregnancy
abroad. She has H/O of migraine d) advanced maternal age
headache. US: intrauterine pregnancy with e) chronic hypertension
FHR: 154. Prenatal screening reveals Rh-ve
94. A 25yrs old G1P0 at 31wks presents 97. A 33yrs old G2P0101 at 34wks is
with BP: 160-170/110- 120 and severe evaluated with US for fetal size less than
headache. PLT: 72000, AST: 226 and dating. Fundal height today is 31wks. She
creatinine: 1.4. Your plan is: had US at 18wks showing normal anatomy
a) betamethasone and expectant and growth in the 30th percentile. She has
management history of drug abuse. She delivered her
b) hydralazine and expectant first child at 36wks after PPROM. Her US
management today shows small fetus with head and
c) MgSo4 and expectant management abdominal circumference at the 5th
percentile and femur length less than 10th
d) immediate delivery
percentile. There are abnormal findings
e) MgSo4, hydralazine, betamethasone
with the placenta. The following placental
and immediate delivery
conditions do NOT increase a fetus risk for
IUGR:
95. A 24yrs old G1P0 at 28+5wks presents a) chronic placental abruption
for routine ANC. She has increased b) placenta previa
discharge today. She first noticed it after c) thrombosis
going to bathroom. When she stood up, d) chorioamnionitis
she notices little urine contined to leak. e) marginal cord insertion
Throughout the afternoon, she has 98. A 26yrs old G1P0 at 33+3wks presents
continued to feel like water is leaking from for routine ANC. She reports contractions
the vagina. There is no vaginal bleeding or on and off for the past few weeks but
abdominal pain. The discharge is clear today they are becoming regular and
odorloss. Her pregnancy has been occurring every 5min. She denies leaking
otherwise uncomplicated. The first step in or vaginal bleeding. The baby is active. She
evaluating this patient: had elevated 1hour OGTT but normal 3hrs
a) amni-dye test/ tampon test OGTT. O/E: fundal height is 37wks. You
b) US to check AFI palpate firm contractions every 2-
c) sterile speculum examination 3minutes. FHS normal. PV: cx closed, 25%
d) amni-Sure test effaced and station -3. US shows AFI: 28
and posterior placenta. An hour later, PV
e) amniocentesis to rule out
is unchanged. She continues to have
choriomanionitis
contractions but are now every 5min and
less painful. Polyhydramnios is NOT
96. The following is most likely to improve associated with the following conditions:
outcome in a patient with PPROM: a) gestational diabetes
a) tocolysis b) congenital anomalies
b) administration of betamethasone c) multiple gestations
c) hospital observation and bed rest d) Potter syndrome
d) augmentation of labor e) neural tube defects
e) immediate CS
99. A 19yrs old G1P0 presents at 35wks for 101. A 25yrs old PG at 9wks comes for her
ANC. Her BP: 142/88 and urine is -ve for initial ANC visit. Series of blood test and
protein. She has no headache, visual urine analysis were done. She is
asymptomatic and asks why these tests
symptoms or right hypochondral pain.
must be performed. You counsel her:
Labs (CBC, LFTs, Cr) are all within normal. a) even though she is asymptomatic,
Your diagnosis and plan: she is still at risk of STDs and this is
a) gestational hypertension- expectant one way to screen them
management b) asymptomatic bacteriuria if not
b) preeclampsia- expectant treated has been associated with
management higher rates of chorioamnionitis
c) she is at increased risk of having
c) rule out preeclampsia- send 24hrs
asymptomatic bacteriuria compared
urine protein to non pregnant patients
d) gestational hypertension- delivery d) asymptomatic bacteriuria increases
e) pre-eclmapsia- delivery her risk of cystitis, pyelonephritis,
and preterm birth
100. A 36yrs old G3P2 at 35wks presents e) u r worried that she has
for routine ANC. Her previous pregnancies pyelonephritis
were VD at 10 and 12yrs ago. She gained
102. A 23yrs old G2P0101 at 28wks comes
weight, now her BMI: 29 and was for urgent visit. She complains of severe
diagnosed gestational diabetes that is vaginal irritation and increased thin gray
well-controlled with insulin. All the discharge. She denies leakage of fluid,
following would be appropriate in her vaginal bleeding or contractions. The baby
management EXCEPT: is moving well. She has no dysuria, or
frequency. On speculum examination,
a) induce labor at 39wks
there is no leakage of fluid. A wet mount
b) offer and obstetric US for EFW at and KOH show clue cells and positive
35wks to decide route of delivery Whiff test with no hyphae. If this had gone
c) offer and elective CS if EFW is greater untreated, it would increase the risk of
than 4.5kg what during her pregnancy:
d) upon admission, regulate blood a) increased risk of neonatal blindness
glucose by winsulin and dextrose b) increased risk of neonatal sepsis and
admission to NICU
drips
c) increased risk of PPROM
e) allow VD if no macrosomia is d) increased risk of placental abruption
suspected e) increased risk of congenital
malformations
103. A 32yrs old comes for pre- 106. A 34yrs old G2P0010 at 39wks
conceptional counseling. She had epilepsy presents to ER in active labor. She has mild
at 12yrs old and is currently on phenytoin to moderate aortic stenosis and no
and carbamazepine. She has been seizure symptoms of heart failure or arrhythmia.
free for 1.5yrs. She and her husband are Best management to minimize her
planning to conceive within the next year. cardiovascular risks during the
What should you advice to decrease the intrapartum and postpartum period:
risks for the coming pregnancy? a) start ampicillin for endocarditis
a) stop all seizure medications prophylaxis
b) optimize her seizure regimen to b) monitor strict intake and output,
include minimum number of place early epidural and plan
medications with least possible dose instrumental delivery to shorten 2nd
c) start taking prenatal vitamin and stage
400mcg folic acidd. keep the same c) proceed immediately to CS to
dose of both medications and start minimize cardiac stress
taking 4mg of folic acid d) admit to ICU and place CVP
d) transition off both her current e) to maintain cardiac output, give lasix
medications and start taking valproic to decrease afterload
acid for monotherapy
107. A 22yrs old G2P1001 at 39wks
104. The following ttt are most presents with contractions/3min for the
appropriate for varicose veins in past 2hrs. Her prior pregnancy was
pregnangy: induced at 41wks+3 and her 1st stage
a) diuretics lasted 9hrs during her 2nd stage. She
b) pressure stockings and lower pushed for 2hrs and delivered a male
extremity elevation weighing 3.8kg. She denies now ROM or
c) low sodium diet and fluid restriction vaginal bleeding or decreased DFMC. PV:
d) surgical intervention cx 2cm dilated, 50% effaced and station -2.
e) antihypertensive medication Her cervical examination last week was
2cm, 25%effaced and station -2. You
105. A 39yrs old G1P0 at 11wks presents decide to have her ambulate and repeat
for NT screening. She has no medical or cervical examination after 2hrs. After 2hrs,
family H/O but is worried for her age. NT the patient is painfully contracting,
revealed increased thickness. Best next requesting epidural, her cx is 4cm dilated,
step: 100% effaced and station -1. You admit
a) repeat the test in 1week her to labor ward for expectant
b) repeat the test in 2weeks management and she receives epidural for
c) offer CVS now pain control. Which of the following will
d) offer amniocentesis now cause u to recommend a CS at this time?
e) offer termination of pregnancy
a) fetus in right occiput posterior 110. A 33yrs old G3P2012 presents with
position amenorrhea for 6months. Her pregnancy
b) maternal hypotension test is -ve. She states she isn’t sexually
c) development of vaginal bleeding active. She has been increasingly fatigued
with decrease in hematocrite from lately and her hair becomes more brittle
33 to 32 and coarse, she attributes this to the
d) repetitive fetal decelerations to stress at home due to separation from her
80bpm wwith absent variability husband and exhaustion with the 2
e) her slow progress in labor children. She denies any other medical
problems and she had no surgeries. She
breastfed for 6months after her most
108. Labor is divided into stages and
recent child without difficulty. O/E: HR:
phases that are used for communication
58, BP is normal, skin is coarse and dry.
about progress of labor. First stage: CBC, PRL, FSH, estradiol are normal, TSH is
a) begins at the time of full cervical markedly elevated and T4 is low. You
dilatation recommend T4 replacement. She is hoping
b) has a latent phase that ends with to have another pregnancy and wonders
dilatation exactly at 6cm about how the medication will affect that
c) has an active phase that begins with pregnancy. You inform her that:
repetitive contractions a) she will need less thyroid medication
d) has an active phase with at least during pregnancy
1cm/hr dilatation in nulliparous b) she will be able to stop her thyroid
e) has a latent phasewith a rapid rate of medication in pregnancy
cervical change c) her thyroid medication will not need
adjustment because the fetus
109. A 28yrs old G1P0 woman presents at autoregulates its own thyroid
10wks for her initial ANC visit. In addition d) she will need more medication
to routine screening, she wishes to obtain during pregnancy
screening for Down. The highest sensitivity e) the dose of her thyroid medication
investigation will be through: will be tripled upon confirmation of
pregnancy till the end
a) NT at 11wks
b) combined NT, PAPPA and B-HCG at
111. A 34yrs old afro-american presents at
12wks
her 12wks GA (diamniotic-dichorionic twin
c) maternal serum triple test (AFP, pregnancy) with her partner. She has H/O
estriol and B-HCG) at 17wks of poorly controlled chronic hypertension,
d) second trimester ultrasound she is taking 200mg labetalol and her BP
e) sequential screening with combined today 134/80. She used to smoke but quit
screening in first trimester and quad now due to pregnancy. Her mother and
screening in second sister have diabetes and she was told to
be pre-diabetic few yrs ago. You counsel
her that her pregnancy is at risk for a
number of complications due to her twin 113. A 25yrs old presents to ER with
gestation, chronic hypertension and H/O vaginal bleeding. Her LMP was 6wks ago.
of insulin resistance. You explain that she She is sexually active and doesn’t use
is at increased risk of PTL, PPROM, pre- contraception. O/E: temp: 37, BP: 115/80,
eclampsia, need for CS and IUGR but may pulse: 75 and RR: 16. PV: small amount of
not be SGA. What is the difference dark blood in vagina, cx is 1-2cm dilated,
between the terms SGA and IUGR?
uterus is mildly enlarged, AVF and non
a) SGA refers to the fetus whereas IUGR
tender. Urine pregnancy test is +ve. US:
is specific to neonates
b) IUGR describes growth disorders intrauterine gestational sac with yolk sac,
related only to placental or maternal no fetal pole or cardiac motion. Your
disease diagnosis:
c) SGA refers to growth disturbance a) incomplete abortion
owing to chromosomal abnormalities b) threatened abortion
or toxins c) ectopic pregnancy
d) SGA refers to a neonate in whom d) missed abortion
cause of small size is uncertain e) inevitable abortion
whereas IUGR describes the fetus
and suggests an intrauterine etiology 114. A 21yrs old woman undergoes
for growth restriction
hysteroscopy and curettage for persistent
e) IUGR refers to a neonate in whom
uterine bleeding after her term VD
the cause of growth disruption is not
8months ago. Pathology shows:
identified whereas SGA refers to a
fetus and suggests a known cause for choriocarcinoma with invasion of
growth restriction. myometrium and B-HCG: 50.000. The
following is NOT currently indicated:
112. A 24yrs old G1P0 at 25wks presents a) imaging for distant metastatic lesions
for routine ANC. She is sexually active, her b) surgical intervention with
BMI: 29 and physical examination is hysterectomy
unremarkable. She was surprised to be c) chemotherapy
screened +ve for diabetes and was never d) close surveillance of serum B-HCG
told to have diabetes before. The most e) reliable contraception
likely etiology of her diabetes:
a) type 2 DM - autoimmune destruction
115. The following is the most reassuring
of B-islet cells
when assessing FHR:
b) type 1 DM - elevated progesterone
level a) FHR: 140 with marked variability
c) gestational Diabetes - HPL effect b) FHR: 100 with minimal variability
d) type 1 DM - preexisting peripheral c) FHR: 150 with moderate variability
insulin resistance d) FHR: 90 with absent variability
e) gestational diabetes - recently e) FHR: 190 with moderate variability
acquired HCV infection
116. A 25yrs old G2P1 at 36wks gestation 118. A 34yrs old Asian woman G4P3003 at
by 24wks US presents to ER with painful 34wks presents to ER complaining of
uterine contractions every 2-4min for the hematuria, dysuria and occasional
last hour. She was late in ANC, her first US contractions for 1week. She also notes
was at 28wks was normal, no anomalies, occasional spotting over the last 3days.
normal liquor and anterior placenta with
She denies any leakage or discharge. She
velamentous insertion of the cord.
Doppler showed crossing of the fetal denies back or flank pain but has had
vessels on internal os. After that, she lost some suprapubic discomfort. She had an
follow up till she presents today. She anatomy US at 24wks showing normal
denies any fluid leakage or vaginal fetal anatomy, normal AFI and anterior
bleeding. PV: cx is 6cm dilated, complete placenta previa. She has
90%effaced, FHR reactive with no unremarkable medical history and has
deceleration. Most appropriate plan: H/O of previous 3CS: her first one 8yrs ago
a) expectant management, VD in china for breech at term. She didn’t
b) AROM, Intrauterine pressure repeat US at 30wks as adviced. She had
catheter (IUPC), VD not had recent intercourse. The following
c) emergency CS
is NOT appropriate initial test to
d) oxytocin augmentation
e) continuos CTG monitoring and CS determine etiology of hematuria:
whenever distress occurs a) urine analysis
b) urine culture
117. A 38yrs old afro-american G1P0 c) sterile speculum examination
presents at 34wks complaining of painful d) CT scan of abdomen and pelvis
uterine contractions for the last 2hrs. She e) abdominal ultrasound of uterus
denies fluid leakage or discharge. She
reports vaginal bleeding that started 119. A 14yrs old girl presents in OPD with
30min ago. She has unremarkable medical irregular vaginal bleeding for the last 2-
H/O but has surgical H/O of myomectomy 3months. She has been rather stressed out
in which a large anterior fibroid was with her school which adversely affected
removed. O/E: she was afebrile and vital
her routine life and can’t recollect her
signs were stable. US: fetus vertex, normal
AFI, no retroplacental hematoma, dates or menstrual pattern well. She was
posterior placenta. On speculum on pill for the past year. Lately, she lost
examination: 100cc bright blood in the appetite with nausea, vomiting and
vaginal vault, no leakage and no ferning. fullness of lower abdomen. She has lost
Her cx is 3cm dilated, FHR: 120s with weight in the last 3months due to poor
moderate variable decelerations down to food intake. O/E: vesicles are seen in the
60s with each contraction. She is vagina close to cervical os. Most likely
contracting every 2-4min. The most likely diagnosis:
cause of her APH is: a) contact dermatitis
a) PPROM b) genital herpes
b) uterine rupture
c) molar pregnancy
c) cervical laceration
d) placenta previa d) sarcoma Botryoides
e) vasa previa e) vaginal carcinoma
120. A 7wks pregnant has H/O of 3

consecutive first trimesteric abortions. She
is 28yrs old, her lupus anticoagulant and
anticardiolipin are negative. Her hormonal
levels including progesterone is normal
and her US is normal. She has
unremarkable medical history and there is
no H/O of consanguinity. Etiology of her
miscarriages remains unexplained. Which
of the following ttt options are best to
her?
a) aspirin
b) aspirin and LMWH
c) HCG injections
d) progesterone supplementation
e) reassurance and expectant ttt
ANSWERS
1 A 36 D 71 C 106 B
2 A 37 E 72 B 107 D
3 E 38 D 73 C 108 D
4 B 39 B 74 C 109 E
5 B 40 B 75 C 110 D
6 B 41 E 76 E 111 D
7 B 42 D 77 C 112 C
8 A 43 B 78 A 113 E
9 A 44 E 79 D 114 B
10 A 45 D 80 B 115 C
11 B 46 C 81 C 116 C
12 C 47 B 82 B 117 B
13 B 48 A 83 E 118 D
14 C 49 A 84 C 119 C
15 D 50 B 85 E 120 E
16 C 51 C 86 B
17 C 52 B 87 B
18 B 53 D 88 A
19 E 54 H 89 B
20 A 55 J 90 C
21 B 56 B 91 A
22 C 57 A 92 D
23 A 58 A 93 A
24 J 59 C 94 E
25 D 60 B 95 C
26 M 61 C 96 B
27 B 62 A 97 D
28 G 63 D 98 D
29 I 64 A 99 C
30 D 65 E 100 B
31 E 66 D 101 D
32 C 67 D 102 C
33 A 68 A 103 B
34 A 69 B 104 B
35 A 70 C 105 C
Obs 7: All (100 marks)

Choose the most correct answer: 5. In a vertex presentation, the position is
determined by the relationship of which
1. A pregnant lady has her LMP on June fetal part to the mother’s pelvis:
30, so her EDD will be on: a) mentum
a) March 23 b) sacrum
b) April 7
c) acromion
c) March 28
d) April 23 d) occiput
e) March 7 e) sinciput
2. Hyperextension of the fetal head is 6. Persistence of which of the following is

found in: usually incompatible with spontaneous
a) vertex presentation delivery at term?
b) face presentation a) occiput left posterior
c) shoulder presentation b) mentum posterior
d) breech presentation c) mentum anterior
e) hydrocephalic baby
d) occiput anterior
e) sacrum posterior
3. During clinical pelvimetry, which of the
following is routinely measured?
a) bi-ischeal diameter 7. The relation of the fetal parts to one
b) transverse diameter of the inlet another determines:
c) shape of the pubic arch a) presentation of the fetus
d) flare of the iliac crest b) lie of the fetus
e) elasticity of the levator muscles c) attitude of the fetus
d) position of the fetus
4. During the delivery, the fetal head e) none of the above
follow the pelvic axis as described:
a) a straight line
8. The relationship of the long axis of the
b) a curved line, 1st anteriorly then
caudal fetus to the long axis of the mother is:
c) a curved line, 1st posteriorly then a) lie
caudal b) presentation
d) curved line, 1st posteriorly then c) postion
cephalic d) attitude
e) none of the above e) none of the above
9. Engagement is strictly defined as: 13. All the following regarding episiotomy
a) when the presenting part goes are true EXCEPT:
through the pelvic inlet a) median episiotomy is less painful
b) when the presenting part is at the than the mediolateral one
level of the ischial spines b) mediolateral may be associated with
c) when the greatest BPD passes more blood loss
through the pelvic inlet c) indications for episiotomy include
d) when the greatest BPD is at the level avoiding an imminent perineal tear
of the ischial spines d) the earlier the episiotomy the more
beneficial in speeding the delivery
e) episiotomy incisions are repaired
10. The station where the presenting part
anatomically in layers
is at the level of the ischial spines is:
a) -2
14. The heart rate of a normal fetus at
b) -1
c) 0 term ranges from:
d) +1 a) 80-100bpm
e) +2 b) 100-120bpm
c) 120-160bpm
11. A primipara is in labor and an d) 160-180bpm
episiotomy is to be cut. Compared with a e) there is no baseline heart rate
midline episiotomy, an advantage of
mediolateral episiotomy is: 15. Which of the following fetal scalp ph
a) ease of repair should prompt immediate delivery?
b) fewer break downs a) 7.30
c) lower blood loss b) 7.22
d) less dyspareunia c) 7.18
e) less extension of the incision d) 7.26
e) 7.25
12. A patient sustained a laceration of the
perineum during delivery, it involves 16. Pregnancy is associated with all the
muscles of the perineal body but not the following changes EXCEPT:
anal sphincter. Such a laceration is:
a) increase cardiac output
a) first degree
b) increase venous return
b) second degree
c) increase peripheral resistance
c) third degree
d) increase pulse rate
d) fourth degree
e) increase stroke volume
e) fifth degree
17. Lowered hemoglobin during normal 22. All the following hormones are
pregnancy is a physiologically due to: produced by the placenta EXCEPT:
a) low iron stores in all women a) HCG
b) blood lost to the placenta b) HPL
c) increased plasma volume c) prolactin
d) increased cardiac output resulting in d) progesterone
greater red cell destruction e) estriol
e) decreased reticulocytosis
23. All the following are possible causes of
18. The maternal blood volume in normal polyhydramnios EXCEPT:
pregnancy: a) diabetes
a) remains stable b) multiple pregnancy
b) decreases 10% c) fetus with hydrops fetalis
c) increases 10% d) fetus with duodenal atresia or neural
d) increases 40% tube defect
e) decreases 40% e) IUGR
19. During pregnancy, maternal estrogen 24. Which of the following causes of
levels increases markedly from: polyhydramnios is more common?
a) ovaries a) twin pregnancy
b) adrenals b) diabetes
c) testes c) hydrops fetalis
d) placenta d) anencephaly
e) uterus e) idiopathic
20. The resting pulse in pregnancy is: 25. If a 38weeks pregnant lady faint while
a) decreased by 30bpm lying on your examination table, you will:
b) decreased by 10-15bpm a) give blood transfusion
c) unchanged b) turn the patient on her side
d) increased by 30bpm c) give oxygen by face mask
e) increased by 10-15bpm d) give IV saline solution
e) give her antihypotensive medication
21. All the following causes
oligohydramnios EXCEPT: 26. Sure sign of pregnancy is:
a) renal agenesis a) amenorrhea
b) poor placental perfusion b) Chadwick sign
c) post term pregnancy c) nausea and vomiting
d) anencephaly d) auscultation of the fetal heart
e) urinary obstruction e) abdominal distension
27. The following US measurement is most 32. A serum progesterone value ˂5ng/ml
useful in 8weeks pregnant lady: excludes pregnancy viability in:
a) crown rump length a) 20% of cases
b) biparietal diamtere b) 40% of cases
c) femur length c) 60% of cases
d) placental site d) 80% of cases
e) abdominal circumference e) 100% of cases
28. All the following are true regarding 33. In normal pregnancy, the value of B-
vomiting in pregnancy EXCEPT: HCG doubles every:
a) may be cured by admission to a) 2days
hospital b) 4days
b) is commonest in the third trimester c) 8days
c) associated with multiple pregnancy d) 10days
d) is associated with trophoblastic e) 14days
disease
e) is associated with urinary tract 34. The B-HCG curve in maternal serum in
infection a normal pregnancy peaks at:
a) 6weeks of pregnancy
b) 8weeks of pregnancy
29. The following ultrasonic
c) 10weeks of pregnancy
measurements is used to confirm or
d) 14weeks of pregnancy
establish GA:
e) 18weeks of pregnancy
a) crown rump length
b) nuchal pad thickening
35. The following are normal symptoms of
c) amniotic fluid volume pregnancy EXCEPT:
d) yolk sac volume a) backache due to increased lumbar
e) biophysical profile lordosis
b) lower abdominal pain and groin pain
30. Antenatal booking investigations due to stretch of round ligament
include all the following EXCEPT: c) visual disturbance
a) complete blood count d) calf pain due to muscle spasm
b) blood sugar e) increased vaginal discharge
c) hepatitis screening
d) toxoplasmosis 36. A woman in early pregnancy is worried
e) meningococcal antibodies because of several small raised nodules on
areola of both breasts. Your immediate
31. An ultrasound in the first trimester of management should be:
pregnancy is done for: a) reassurance after thorough
a) placental location examination
b) detecting the fetal weight b) needle aspiration of the nodules
c) assessment of amniotic fluid volume c) surgical removal of the areola
d) detecting the fetal breathing d) mammography
e) dating pregnancy e) radical mastectomy
37. The source of progesterone that 42. The following drugs cross the placenta
maintains the pregnancy in 1st trimester to the fetus EXCEPT:
is: a) heparin
a) placenta b) tetracycline
b) corpus luteum c) warfarin
c) corpus albicans d) diazepam
d) adrenal glands e) paracetamol
e) endometrium
43. Hypoplasia and yellow discoloration of
38. During normal pregnancy, an average teeth occur in infants whose pregnant
weight gain anticipated is: mothers were treated by:
a) 5-10kg a) sulphonamides
b) 10-15kg b) penicillin
c) 15-20kg c) streptomycin
d) 20-30kg d) dihydrostreptomycin
e) 30-40kg e) tetracycline
39. The following protects neural tube 44. Antenatal fetal monitoring cannot be
defects when given in early pregnancy: accomplished by:
a) vitamin B6 a) fetal kick chart
b) iron b) fetal scalp sampling
c) folic acid c) non-stress test
d) zinc d) obstetric US and BPP
e) magnesium e) acoustic stimulation
40. Measures performed during ANC for 45. The following procedures allow the
an uncomplicated pregnancy at 36wks earliest retrieval of DNA for prenatal
include the following EXCEPT: diagnosis in pregnancy:
a) symphysis-fundal height a) fetoscopy
b) maternal blood pressure b) amniocentesis
c) maternal weight c) chorion villous sampling
d) mid-stream urine specimen for d) percutaneous umbilical blood
culture and sensitivity sampling (PUBS)
e) listening to the fetal heart e) fetal biopsy
41. High alpha fetoprotein is found in all 46. Fetal assessment include the following
EXCEPT: EXCEPT:
a) IUFD a) fetal BPP
b) multiple pregnancy b) fetal Doppler velocimetry
c) some ovarian cancer c) fetal biometry
d) trisomy 21 d) fetal cardiotocography
e) neural tube defect e) fetal blood sugar sampling
47. A BPP includes all the following 52. Which of the following is known to be
assessment parameters EXCEPT: the commonest presentation in twins?
a) fetal movement a) breech, cephalic
b) fetal weight b) cephalic, breech
c) fatal tone c) cephalic, cephalic
d) fetal breathing movements d) breech, breech
e) amniotic fluid volume e) cephalic, transverse
48. Apgar score consists of all the 53. The major cause of the increased risk
following EXCEPT:
of morbidity and mortality among twin
a) newborn breathing
pregnancy is:
b) newborn tone
a) gestational diabetes
c) newborn heart rate
d) newborn color b) placenta previa
e) newborn ph c) malpresentation
d) preterm delivery
49. Immediate therapy for infants with e) congenital anomalies
suspected meconium should include:
a) corticosteroid 54. If twin A is transverse lie and twin B is
b) antibiotic vertex. The most appropriate route for
c) sodium bicarbonate delivery:
d) clearing of the airway a) cesarean section
e) giving O2 under positive pressure b) internal podalic version followed by
breech extraction
50. In twin deliveries, which of the c) both
following is true? d) neither
a) the first twin is at greater risk than e) 1st baby by CS and second baby
the second vaginal delivery
b) they usually go post date
c) epidural analgesia is best avoided 55. Twins pregnancy:
d) commonest presentation is cephalic
a) presentation of the second twin
and second breech
dictates the mode of delivery
e) there is increased risk of postpartum
b) internal podalic version should not
hemorrhage
be performed for the second twin
51. The most common cause of uterine c) monozygotic twin always having the
size date disproportion is: same sex
a) fetal macrosomia d) commonly goes postterm
b) polyhydramnios e) should be delivered by cesarean
c) inaccurate last menstrual period date section
d) multiple pregnancy
e) molar pregnancy
56. Excessive increased level of B-HCG os 60. A 25yrs old PG with 8weeks
expected in: threatened abortion, ultrasound would
a) ectopic pregnancy most likely reveal:
b) pregnancy of diabetic mothers a) thickened endometrium with no
c) twin pregnancy gestational sac
d) incomplete abortion b) fetal heart motion in the adnexa
e) cervical carcinoma c) empty gestational sac
d) collapsed gestational sac
57. Multiple gestation is frequently e) intact gestational sac with fetus
associated with all the following EXCEPT:
61. Bleeding in early pregnancy could be
a) hypertension
caused by all the following EXCEPT:
b) hydramnios
a) an ectopic pregnancy
c) fertility drugs
b) trophoblastic disease
d) postmaturity c) carcinoma of the ovary
e) preterm labor d) invasive carcinoma of the cervix
e) threatened abortion
58. A 14wks pregnant woman had
abortion and she was told that it is a Questions 62-64: a 26years old married
complete abortion. This is true regarding woman whose LMP was 2.5months ago,
complete abortion: developed bleeding, uterine cramps and
a) uterus is usually bigger than date passed some tissue per vagina. 2 hours
b) cervical os is opened with tissue later, she began to bleed heavily. O/E: she
inside the cervix is vitally stable, the uterus is 8weeks size
c) need to have evacuation of the and the cervix is open.
uterus
d) after complete abortion, there is 62. The most likely diagnosis:
minimal pain and minimal bleeding a) twin pregnancy
e) follow up with B-HCG for one year b) threatened abortion
c) inevitable abortion
59. Management of a patient with d) premature labor
e) incomplete abortion
threatened abortion includes all EXCEPT:
a) ultrasound
63. The bleeding is most likely due to:
b) physical examination
a) retained products of conception
c) CBC
b) ruptured uterus
d) detailed menstrual history c) systemic coagulopathy
e) dilatation and curettage d) vaginal lacerations
e) bleeding hemorrhoids
64. Best treatment option is: 69. Which of the following is a

a) hysterectomy contraindication for the use of amnio-
b) vaginal packing hook?
c) compression of the hemorrhoids
a) placenta previa
d) IV fibrinogen
e) uterine curettage b) abruption placenta
c) breech presentation
65. The following factors affect the choice d) IUGR
of methotrexate for ttt of ectopic EXCEPT: e) face presentation
a) size of the ectopic
b) presence or absence of cardiac
70. A 24yrs old G2P1 comes to ER at 34wks
pulsation
c) level of B-HCG with vaginal bleeding. The following can
d) parity of the patient be done EXCEPT:
e) integrity of the tube a) admit the patient
b) resuscitate the patient
66. Which of the following is a c) do digital examination immediately
contraindication to medical treatment in d) cross match blood
ectopic pregnancy:
e) do ultrasound
a) an intact tubal pregnancy
b) the size is less than 3cm
c) the presence of hemoperitoneum 71. Velamentous insertion of the cord is
d) the absence of fetal cardiac pulsation associated with an increased risk for:
e) a serum B-HCG of 1500 a) premature rupture of membranes
b) fetal bleeding before labor
67. Antepartum hemorrhage may be
c) torsion of the umbilical cord
caused by all the following EXCEPT:
a) placenta previa d) fetal malformation
b) cervical cancer e) uterine malformations
c) abruption placenta
d) ectopic pregnancy 72. Anti-D prophylaxis:
e) vasa previa a) should be given to all sensitized Rh-
ve women after delivery
68. A 33yrs old woman at 37wks
confirmed by early US, presents with b) should be given to all Rh-ve women
moderate to severe vaginal bleeding and is after amniocentesis
noted by US to have placenta previa. Best c) should be given to all Rh+ve women
management for her is: who give birth to Rh-ve babies
a) induction of labor d) should be given to all women whose
b) give tocolytic drugs babies are Rh-ve
c) cesarean section
e) is contraindicated during pregnancy
d) expectant management
e) artificial rupture of the membranes if the women is Rh-ve
73. The following circumstances should 78. Advantage of LSCS over the classical
alert an obstetrician to an increased incision includes:
likelihood of PPH EXCEPT: a) ease of repair
a) prolonged labor b) decreases blood loss
b) rapid labor c) lower probability of subsequent
c) past date pregnancy uterine rupture
d) oxytocin stimulation
d) decreases dange of intestinal
e) twin pregnancy
obstruction
74. A 28yrs old patient complains of e) all of the above
amenorrhea following D&C for moderate
PPH. Most likely diagnosis is: 79. All the following are possible causes
a) Gonadal dysgenesis for premature labor EXCEPT:
b) Sheehan’s syndrome a) multiple pregnancy
c) kallman’s syndrome b) polyhydramnios
d) Mayer Rokitansky Kuster Hauser c) bicornuate uterus
syndrome d) anencephaly
e) Asherman’s syndrome e) perineal infection
75. The best uterine scar a patient can 80. The following are used in the
have for cesarean section is: conservative management of PROM
a) transverse upper segment EXCEPT:
b) longitudinal upper segment
a) frequent vaginal examination to
c) transverse lower segment
assess cervical dilatation
d) longitudinal lower segment
b) serial complete blood count to
e) T shaped incision
diagnose rising WBCs
76. The following is a contraindication for c) close monitoring of maternal vital
trial of labor after cesarean section: signs
a) prior classical incision d) ultrasound to assess fetal weight and
b) prior cesarean delivery for dystocia amount of liquor
c) prior IUFD e) monitoring of the fetus by doing
d) ultrasound EFW of 3500gm cardiotocogram
e) prior secarean delivery for breech
81. Indications of tocolysis include:
77. Which of the following is an absolute a) severe PIH
indication for CS? b) severe antepartum hemorrhage
a) twin pregnancy c) IUGR
b) breech presentation d) chorioamnionitis
c) severe PIH e) preterm breech presentation
d) major degree placenta previa
e) IUGR
82. The following may be indicative of 87. Breast feeding accelerates the
chorioamnionitis EXCEPT: involution of the uterus through:
a) maternal pyrexia a) the increased level of prolactin
b) maternal tachycardia b) the release of oxytocin
c) tender uterus c) the increased level of estrogen
d) fetal bradycardia
d) the decreased level of progesterone
e) increased maternal WBCs
e) the decreased level of HPL
83. The following is a contraindication for
induction of labor: 88. Regarding eclampsia, which of the
a) history of upper segment cesarean following is true?
section a) cesarean section must be carried out
b) severe PIH at 36weeks in all cases
c) gestational diabetes on insulin at b) hypotensive drugs should not be
39weeks used
d) post term pregnancy c) urinary output is increased
e) chorioamnionitis
d) antidiuretic drugs are essential in all
84. Which of the following is an indication cases
for induction of labor? e) ergometrine should be avoided in
a) placenta previa the third stage of labor
b) post-term pregnancy
c) cord presentation 89. Immediate response in an eclamptic
d) prior classical CS seizure include all the following EXCEPT:
e) active genital herpes
a) ultrasound for fetal growth
85. Which of the following has not been b) maintain adequate oxygenation
shown stimulate the onset of labor?
c) administer magnesium sulfate
a) amniotomy
b) prostaglandins d) prevent maternal injury
c) enemas e) monitor fetal heart rate
d) breast stimulation
e) overeating 90. Antihypertensive drugs are given in
PIH to decrease the:
86. Complications of AROM include all the a) incidence of IUGR
following EXCEPT: b) incidence of oligohydramnios
a) abruption placenta c) incidence of fetal death
b) amniotic fluid embolism d) incidence of placental abruption
c) fetal distress
e) risk of maternal complications such
d) meconium aspiration
e) cord prolapsed as stroke
91. The most consistent finding in 96. A 30wks PG presented with BP of

eclampsia patients is: 150/95 and proteinuria of 3+. Which of the
a) hyperreflexia following is best next step?
b) proteinuria 4+ a) immediate CS
c) generalized edema b) 24hrs urine collection, CBC, LFT and
d) diastolic blood pressure greater than coagulation profile
110mmHg c) send her home and see her after
4weeks
e) convulsions
d) advice not to get pregnant again
e) macrosomia is a recognized
92. All the following antihypertensive are complication of this problem
considered safe for short term use in
pregnancy EXCEPT: 97. Control of gestational diabetes is
a) captopril accomplished with the following EXCEPT:
b) methyldopa a) insulin
c) hydralazine b) diet
d) nifeddipine c) oral hypoglycemic agents
e) labetalol d) exercise
e) insulin and diet
93. Which of the following laboratory tests
would be most suggestive of 98. The following items in a pregnant
preeclampsia? patients’s history suggests the possibility
a) elevated bilirubin of her having diabetes:
b) decreased hematocrite a) IUGR
b) past history of twins
c) elevated LDH
c) 1st trimester bleeding
d) elevated uric acid
d) diabetic husband
e) elevated creatine e) unexplained still births
94. HELLP syndrome includes all the 99. Infants of mothers with GDM have an
following EXCEPT: increased risk of all the following EXCEPT:
a) hemolysis a) hypoglycemia
b) increased AST b) hyperglycemia
c) increased platelets c) hypocalcemia
d) increased ALT d) hyperbilirubinemia
e) decreased Hemoglobin e) polycythemia
95. Criteria of severe preeclampsia include 100. The most common type of anemia in
all the following EXCEPT: pregnancy is due to:
a) diastolic BP of 110mmHg or more a) iron deficiency
b) proteinuria more than 5gm/24hrs b) sickle cell disease
c) folate deficiency
c) presence of epigastric pain
d) hemolytic disease
d) decreased hematocrite
e) vitamin B12
e) oliguria
ANSWERS
1 B 36 A 71 B
2 B 37 B 72 B
3 C 38 B 73 C
4 C 39 C 74 E
5 D 40 D 75 C
6 B 41 D 76 A
7 C 42 A 77 D
8 A 43 E 78 E
9 C 44 B 79 D
10 C 45 C 80 A
11 E 46 E 81 E
12 B 47 B 82 D
13 D 48 E 83 A
14 C 49 D 84 B
15 C 50 E 85 E
16 C 51 C 86 D
17 C 52 C 87 B
18 D 53 D 88 E
19 D 54 A 89 A
20 E 55 C 90 E
21 D 56 C 91 E
22 C 57 D 92 A
23 E 58 D 93 D
24 E 59 E 94 C
25 B 60 E 95 D
26 D 61 C 96 B
27 A 62 E 97 C
28 B 63 A 98 E
29 A 64 E 99 B
30 E 65 D 100 A
31 E 66 C
32 E 67 D
33 A 68 C
34 C 69 A
35 C 70 C
Dr.Nadine Alaa Sherif , OBGYN Lectures 2019 / 2020 ( section ) , Revision tests ( playlist )
OBGYN TEST (100 marks)

I. Choose the most correct answer: 5. Several follicles begin to grow in a
menstrual cycle. Their ultimate fate is:
1. A patient wishes you to explain the a) ovulation
concept of CIN which has been diagnosed b) dominance
from her cervical biopsy after a LGSIL c) cyst formation
found on Pap smear. What can u correctly d) atresia
tell her about CIN III? e) regression
a) it is an invasive cancer
b) it includes CIS 6. During normal pregnancy, the major
c) it requires no further ttt cause for lowered hemoglobin is:
d) it is due to a bacterial infection a) low iron stores
b) blood lost to the placenta and fetus
c) increased plasma volume
2. Universal blood donors have a blood
type whose alleles don’t produce an d) decreased reticulocytes
antigen. The following alleles has no e) hemolysis
detectable product:
a) A of the ABO blood group 7. A 34yrs old woman G3P2 at 39wks is
b) B of the ABO blood group presenting in labor with 5cm cervical
c) O of the ABO blood group dilatation. US showed transverse lie with
d) D of the Rh group fetal back towards the maternal legs. The
e) None of the above procedure of choice is:
a) tocolysis
3. Precocious puberty has many physical b) external version
and psychological effects. One of the c) cesarean section
effects is not reversible or correctable and d) expectant management expecting
has major long-term implications: forceps rotation after complete
a) epiphyseal closure dilatation
b) hair growth e) internal podalic version and breech
c) genital development extraction
d) breast tissue development
e) start of menstruation
8. A 26yrs old G2P1 at 39wks gestation in
active labor. At 5cm dilatation, she
4. A patient develops excessive salivation
during pregnancy. This is called: experiences spontaneous ROM. Then she
a) deglutition experiences bloody amniotic fluid and late
b) emesis decelerations. There is loss of beat to beat
c) eructation variability with fetal heart sounds
d) diaphoresis 190b/min. What is your next step?
e) ptyalism
a) begin antibiotics 12. In an attempt of VBAC at 7cm,

b) terbutaline to slow contractions contractions suddenly stop. The fetal parts
c) prepare for cesarean section are felt abdominally, FHS are 80b/min and
d) ventouse delivery fetal feet are at -2 station. You should do:
e) ultrasound to verify placental a) immediate laparotomy
b) an immediate ultrasound to evaluate
position
fetal position and well-being
c) given oxytocin to prevent maternal
9. A 22yrs old PG presents for ANC. She bleeding
had had a Lt lower leg thrombosis 3yrs d) give terbutaline to stop the
prior, while on COCPs. A thrombophilia contractions
workup identified her as a heterozygous e) continue close monitoring on CTG
for prothrombin mutation. She is currently
without symptoms. What therapy would 13. When asked about the fetal safety of a
you recommend for her condition? category B drug when taken by a pregnant
a) unfractionated heparin woman, a drug in this category has which
b) no therapy antepartum unless she is of the following:
a) fetal risk but the benefits far
confined to bed rest
outweigh the risks
c) warfarin until 38weeks and changing
b) studies showing adverse effects in
to heparin until labor animals but there are no human data
d) aspirin 81mg daily c) minimal risks in animal studies, these
e) close observation risks are not shown in human studies
d) no fetal risks and the medication is
10. A patient presents at 30wks in active thus considered safe in pregnancy
labor. Lung maturity is unlikely. Fetal lung e) none of the above
surfactant production may be increased by
a number of factors. The following is 14. When counseling a patient regarding
clinically useful: fetal abnormalities during prenatal care,
a) estrogen the greatest advantage of chorionic villus
sampling (CVS) over amniocentesis:
b) thyroxine
a) the ability to provide results early
c) glucocorticosteroids b) a decreased fetal risk
d) alpha-fetoprotein c) obtaining far superior cellular sample
e) sphingomyelin d) a lack of maternal cell contamination
e) all of the above
11. The following is the only hormone 15. When performing clinical pelvimetry in
relevant to the embryogenesis of the a gynecoid pelvis, the diagonal conjugate
external genitalia: should be at least how many centimeters?
a) androgens a) 7.5cm
b) thyroxine b) 9.5cm
c) estrogens c) 11.5cm
d) 13.5cm
d) HCG
e) 14.5cm
e) progesterone
16. An infant has an Apgar score of 0 at 20. Ritodrine is a beta adrenergic receptor
1minute despite clearing the airway and stimulator that is used to arrest preterm
gentle stimulation. The next best step in labor. A major maternal risk associated
management is: with its use is:
a) immediately intubate and ventilate a) hypertension
b) dry and warm the baby b) decreased plasma glucose
c) continue suction
c) decreased serum potassium
d) administer intracardiac epinephrine
d) decreased serum sodium
e) administer a narcotic antagonist
e) cardiac arrhythmias
17. A patient has profuse thin cervical
mucus with a degree of stretchability and 21. A 29yrs old PG with uncomplicated
a palm-leaf pattern. The following is history is having PPH. The placenta
compatible with this finding: delivered spontaneously and intact. Labor
a) the secretory phase of the menstrual took 9hrs and was unremarkable. The
cycle infant weighed 3.4kg. There were no
b) preovulatory estrogen surge obvious lacerations. What is your next
c) on combination birth control pills step?
d) being postmenopausal a) order coagulation studies
e) early follicular phase b) add oxytocin to her IV solution
c) ultrasound for retained placental
18. Implantation of a placenta in which
parts
there is a defect in the fibrinoid layer,
d) uterine curettage with a large
allowing the placenta villi to invade and
curette
penetrate into but not through the
myometrium called: e) re-evaluate after 2 hours
a) placenta accreta
b) placenta increta 22. A 21yrs old nulliparous woman
c) placenta percreta presents for preconceptional counselling.
d) placenta previa On PV, the vagina showed a complete
e) circumvallate placenta longitudinal septum. In this condition,
which of the following is true?
19. You are checking a term patient in a) delivery is usually difficult
labor. The fetal presentation feels b) the uterus is less likely to be
unusual. The following is incompatible abnormal
with spontaneous delivery: c) there is an above average incidence
a) occiput posterior of urinary tract abnormalities
b) mentum posterior
d) prophylactic cesarean delivery is
c) mentum anterior
indicated
d) brow acynclitic
e) occiput transverse e) all of the above
23. The hemostatic mechanism most 26. A newborn is noted to have a

important in combating PPH is: darkened swelling of the scalp that does
a) increased blood clotting factors in not cross the midline. This is most likely:
pregnancy a) caput succedaneum
b) contraction of the interlacing uterine b) cephalhaematoma
muscle bundles c) subarachnoid hemorrhage
c) markedly decreased blood pressure d) subdural hemorrhage
in the uterine muscle e) intracranial hemorrhage
d) enhanced platelet aggregation during
pregnancy 27. After delivery, paralysis is noted on
e) iron infusion during delivery one side of the face in a newborn. This is
often associated with:
24. A 32yrs old woman (G4P3) at 38wks a) abnormalities of the central nervous
gestation presents with painless moderate system
vaginal bleeding. The previous b) facial swelling
pregnancies were normal. The bleeding c) forceps induced nerve injury
presently has ceased and no uterine d) pressure on the trigeminal nerve
contractions are present. FHS are 140bpm. during delivery
What is the best course of action? e) ventouse delivery
a) perform a complete pelvic
examination 28. A couple comes to your clinic for
b) reassure the patient and send her infertility evaluation. Semen analysis
home to await spontaneous labor showed 35million/ml, 50% motile and 60%
c) perform an ultrasound normal morphology. HSG shows normal
d) perform an immediate cesarean endometrial cavity with unilateral
section proximal tubal block. The female has
e) perform admission and labor regular menstrual cycles and progesterone
induction level is 15ng/ml. DHL showed no
adhesions with bilateral free spill. The
25. A patient has an uncomplicated most appropriate diagnosis:
vaginal delivery of 3.5kg. The placenta a) luteal phase defect
delivers spontaneously in 15minutes. b) male factor of infertility
Forty five minutes after delivery, you are c) tubal factor of infertility
notified by a nurse that the patient has an d) peritoneal factor of infertility
unusual amount of bleeding but the vital e) unexplained infertility
signs are stable. The best course of action:
a) examine the patient 29. A 31yrs old patient comes to your clinic
b) have the nurse call you back in 1hour with irregular menstrual cycles and
if bleeding persists infertility for 2yrs. After evaluation, you
c) order pitocin IV see that clomiphene citrate is appropriate
d) Reassure the nurse and wait therapy. The following should be
e) order immediate laparotomy explained to pt:
a) 25% of patients will respond by a) vulvar carcinoma

ovulating with this medication b) vulvar intraepithelial neoplasm
b) the risk of multiple pregnancy is 7% c) hyperkeratosis
c) the risk of severe ovarian d) condyloma lata
hyperstimulation syndrome is 25% e) lichen sclerosis
d) There is an increased risk of fetal
anomalies if pregnancy results.
33. An 18yrs student presents with severe
e) there is increased risk of ectopic
menstrual cramps cause her to miss
pregnancy with the drug
classes. Other history, physical
30. A 22yrs old woman experiences examination and laboratory testing are
amenorrhea of 6months duration. unremarkable. She is not sexually active
Examination shows normal breast and is not interested in contraception at
development and normal pelvic organs. this time. Most effective method for this
There is no hirsutism or galactorrhea. woman is:
Serum TSH and PRL levels are normal. a) depot medroxyprogesterone acetate
Pregnancy test is negative. Next course of b) birth control pills
action is: c) presacral neurectomy
a) administer progesterone d) GnRH agonist
b) administer estrogen followed by e) PG synthetase inhibitors
progesterone
c) measure circulating estrogen levels
34. Removal of corpus luteum before
d) measure circulating testosterone
42days gestation most likely results in:
levels
a) prolonged gestation
e) measure circulating progesterone
b) spontaneous miscarriage
31. A 32yrs old woman has an IUFD at c) reduction of BBT
25weeks gestation. The following d) masculinization in a male fetus
pregnancy termination method is e) ectopic pregnancy
associated with highest complications:
a) IV oxytocin 35. A 35yrs old NG complains of increasing
b) intravaginal prostaglandin dysmenorrheal and pelvic pain. She has
c) sublingual prostaglandin not become pregnant over her 3yrs. PV
d) hysterotomy shows tenderness of a 4cm right ovarian
e) dilatation and curettage cyst. Her most likely diagnosis is:
a) adenomyosis
32. A 58yrs old woman consults you for b) pelvic congestion syndrome
vulvar pruritus. On pelvic examination you
c) endometriosis
note thin, atrophic skin with whitish
d) chronic pelvic inflammatory disease
coloration over the entire vulva. Most
likely this patient has: e) dermoid cyst
36. A 53yrs old woman who has not incomplete bladder emptying with
menstruating for 1year and is started HRT. residuals around 200ml. Her bladder
She has scanty vaginal bleeding for 2days. capacity is 350ml. Most appropriate
She is healthy, her BMI is 21, normal BP management is:
and used OCPs until 42yrs of age. She a) teach her clean intermittent self
refuses an endometrial sampling. Most catheterization
appropriate next step is: b) place a Foley catheter
a) begin a menstrual (bleeding) c) start her on anticholinergic type
calendar medication
b) take a Pap smear including d) start her on PG inhibitor medication
endocervical sampling e) do a sling operation
c) insist on endometrial sample
d) perform a transvaginal 39. A 1year old girl has an abdominal
ultrasonography to measure mass. PR demonstrates a mass extending
endometrial thickness into the right pelvis. The cervix is not
e) give her hemostatics palpable. Abdominal sonography shows
that the uterus and vagina are absent.
37. A 65yrs old woman G3P3 is counseled Both ovaries appear normal. Most likely
regarding the risks of having a Burch origin of the mass is:
operation for SI. She has had a prior a) gastrointestinal
hysterectomy. On examination, she has a b) renal
second-degree cystocele. Urodynamics c) musculoskeletal
confirm genuine SI. The most common d) hepatic
early complication of this procedure: e) none of the above
a) vaginal bleeding
b) urinary retention 40. A 6cm non-tender mobile right adnexal
c) ureteral injury mass is present in a 19yrs old woman. One
d) development of an enterocele year ago, while using OCPs, she was
e) urethrovaginal fistula hospitalized for left leg deep vein
thrombophlebitis. TVS shows a 4cm
38. A vigorous 79yrs old woman with unilocular smooth ovarian cyst without
worsening urinary incontinence over the internal excrescences. A serum pregnancy
past year comes to see you. The leakage test is negative. Best next step:
seems to be without warning. She denies a) observation
neurologic symptoms, stress incontinence b) OCPs
or voiding problems. She is diabetic on c) estrogen therapy
insulin. Urodynamics show uninhibited d) laparoscopy
detrusor contractions with voiding but has e) hysteroscopy
41. A 17yrs old girl experiences sudden Rt 44. While reviewing a cervical biopsy,
lower abdominal pain. Her LMP was squamous cell atypia is noted. It extends
7weeks ago. She has severe nausea and from the basal layer to a little more than
breast tenderness. BP is 120/80, pulse 80 one half the thickness of the epithelium.
Beyond that level, maturation is evident.
and afebrile. Abdominal examination is
There is no invasion of stroma. The correct
unremarkable. PV shows blood in the diagnosis of these findings:
vagina and normal appearing cervix. The a) CIN I
uterus is slightly enlarged. A tender 4cm Rt b) CIN II
adnexal mass is felt. Most appropriate c) CIN III
initial diagnostic test is: d) CIS
a) hematocrit e) Invasive squamous cell carcinoma
b) white blood count
c) ESR 45. According to FIGO staging of cancer
cervix, stage III is assigned when the
d) serum HCG
following occurs:
e) serum progesterone a) the carcinoma has infiltrated the
bladder base
42. A 28years old woman is seen for her b) the carcinoma involves the distal
first ANC. Her LMP was 8weeks ago. Her vaginal mucosa
history is significant for infertility due to c) the carcinoma has extended into the
chronic salpingitis and she required IVF parametrium but not the pelvic wall
with multiple embryo transfer. A serum d) X-ray reveals tumor
pregnancy test is positive. A e) brain and blood spread
transabdominal US shows an enlarged
46. A 62yrs old obese woman on
uterus containing five living fetuses. You unopposed estrogen develops abnormal
advise her that the optimal outcome can vaginal bleeding. Her cervical Pap smear is
be achieved by: normal. She is best evaluated by:
a) close supervision a) TVS
b) embryo reduction b) cervical conization
c) progestin therapy c) endometrial biopsy
d) termination of the pregnancy d) endometrial cytology
e) methotrexate therapy e) colposcopy and cervical biopsy
47. In which of the following patients is

43. A 69yrs old woman presents with a uterine sarcoma most likely to be found?
2cm firm nodule in the right labium majus a) 10years old girl with recent onset
without inflammatory signs. Best vaginal bleeding
management is: b) 9yrs old girl with a rapidly enlarged
a) excisional biopsy pelvic mass
b) reassurance c) 55yrs old woman with a rapidly
c) topical cortisone cream enlarging uterus
d) simple vulvectomy d) 40yrs old woman with a slowly
enlarging uterus
e) incisional biopsy
e) 28 years old multipara with
menorrhagia
48. A patient has a ruptured mucinous 51. A 21yrs old medical student presents
cystadenoma. The following sequelae is with increasing nervousness, fatigue,
most likely to result: weight loss and palpitations. She has
stressful academic load but normal
a) pulmonary metastases monthly menses. She lost 4kg in one
b) liver metastases month, has warm skin but no goiter. She
c) pseudomyxoma peritoneii also has tachycardia without murmurs or
d) ureteral obstruction clicks. What is the next step in her
e) intraperitoneal hemorrhage evaluation?
a) initiate antianxiety medications
b) provide psychiatric/ psychological
49. A 19yrs old woman is seen in the referral for stress management
emergency room with a history of c) perform thyroid scan
amenorrhea for 8weeks and 1week of d) measure TSH levels
unilateral adnexal pain. On examination, e) perform CT brain
there is diffuse tenderness and fullness in
52. You describe the normal ovaries to a
the right adnexa. Laboratory evaluations student. The following characteristics of
reveal CBC that is roughly normaland a the normal ovary is correct:
positive pregnancy test. The most a) they normally remain constant in size
appropriate imaging for diagnosis is: throughout a woman’s lifetime
b) they are supported by the round
a) TVS
ligaments
b) Transabdominal ultrasonography c) they secrete hormones and store
c) CT pelvis germ cells
d) MRI d) they are immobile
e) HSG e) they are 1x2x3 inches in diameter
53. A 25yrs old healthy woman complains

50. A 32yrs old G2P0 (0101) who had a
of breast tenderness and amenorrhea of
classical CS in her last pregnancy due to 6weeks duration. She uses condom for
prolapsed pulsating cord at 32weeks. She birth control and doesn’t take any
presents at 34weeks with abdominal medication. Examination demonstrates a
cramps and pain. Best method to whitish breast discharge. Pregnancy test is
negative, serum TSH is normal and serum
determine the extent and severity of
PRL is 80ng/ml. The next step of
uterine damage when uterus rupture is: management is to obtain radiological
a) Transabdominal ultrasonography assessment on:
b) TVS a) lumbar spine
c) MRI b) sella turcica
c) chest
d) CT
d) pelvic organs
e) Exploratory surgery e) abdominal organs
54. The relationship of the long axis of the 57. During delivery of a 3,8kg infant, the
fetus to the long axis of the mother is: mother sustained a third degree perineal
a) lie laceration with involvement of the rectal
b) presentation mucosa. The best course of action is:
c) position a) leave the tear to heal primarily by
d) attitude
itself, because of contamination
e) engagement
b) pack the defect open for secondary
55. A 2year old girl is brought in for closure
evaluation of vaginal bleeding. Physical c) repair the anal sphincter and
examination shows grape like lesions perineal muscles only
protruding from the vaginal introitus. The d) repair the defect in layers
most likely diagnosis: e) repair the defect en mass
a) condyloma acuminate
b) hymenal tags 58. A patient after a prolonged 2nd stage
c) sarcoma botryoides delivers the vertex with an immediate
d) vaginal polyps turtle sign. Mc Roberts maneuver does not
e) condyloma lata
affect delivery. The following would be a
helpful maneuver:
56. A 31yrs old woman G6P0 (0231) comes
at 10weeks gestation with a history of a) fundal pressure
having progressively earlier deliveries, all b) internal podalic version
without painful contractions. Her first c) Ritgen maneuver
child was born at 34weeks and survived, d) forceps delivery
the next delivered at 26weeks, the next e) Wood’s screw maneuver
two at 22weeks and the last one at
20weeks. No congenital abnormalities 59. A patient presents with galactorrhea.
were found. On examination, her uterus is Prolactin level shows three folds
10-12weeks size. FHS are normal, cervix is elevation. The following is a normal
soft, 2cm dilated and mildly effaced. Your
physiologic reason for such condition:
diagnosis is:
a) enlarged sella turcica
a) genetic disease
b) incompetent cervical os b) galactorrhea
c) premature labor c) pregnancy
d) progesterone lack d) secondary amenorrhea
e) uterine fibroid e) primary hypothyroidism
60. A patient presents to the ER with a) instruct the patient to ambulate

abdominal pain and an approximate LMP b) turn the patient on her side and
of 10weeks before that would give an EDD administer oxygen by face mask
of November 15. Ultrasound shows a CRL c) await vaginal delivery
with 8weeks giving an EDD of November d) use ventouse delivery
30. Patient doesn’t return for follow up e) give terbutaline to stop contractions
until 3months later. Due to a BMI of 45,
fundal height is difficult to determine so 63. A 20yrs old primigravida presents at
an ultrasound is done with EDD of 39weeks. She has a headache and a loss of
November 15. A subsequent appetite. Her face and hands are swollen
ultrasonography done 4weeks later is and she can’t wear her rings. Her BP is
consistent with EDD of November 8. An 170/90 with protein +1. The fetus has a
additional one gives an EDD of November reassuring monitoring. The best treatment
60. Which is the most accurate EDD? for her preeclampsia is:
a) November 1 a) magnesium sulfate
b) November 8 b) delivery either by cesarean or by
c) November 15 vaginal
d) November 21 c) an antihypertensive drug that does
e) November 30 not affect uterine blood flow
d) gentle dieresis with careful
61. A 25yrs old G3P0 has an arrest of labor monitoring of intake and output
for 4hours with no cervical change from e) close observation
6cm, -1station. She has been on oxytocin
with adequate contractions for the last 64. The diagnosis of valvular heart disease
2hours. The fetus has a reassuring FHS. in pregnancy is made when there is:
The best management is: a) history of rheumatic fever
a) continue oxytocin b) arrhythmia
b) increase oxytocin c) diastolic murmur
c) offer vaccum extraction d) soft systolic murmur
d) offer forceps delivery e) water hammer pulse
e) cesarean section
65. You are evaluating a pregnant woman
62. A 29yrs old woman G2P1 has a rapid for her hemoglobin of 8.3. Her folate
labor. Within minutes of her admission, levels are deficient. Which results are
the cervix was found fully dilated with secondary to the folic acid deficiency?
vertex at station 0 and she begins pushing. a) microcytic anemia
You are called by her nurse to evaluate b) megaloblastic anemia
her. Contractions are regular, every 2- c) aplastic anemia
3minutes and strong on palpation. FHS are d) G6PD deficiency
70bpm. Position is ROP with no caput but e) hemolytic anemia
thick meconium. Your first step is:
66. A pregnant patient at 16weeks 70. A healthy 30years old PG presents at

gestation has normal BP, proteinuria 34wks GA. She has been experiencing
(4g/day), serum albumin 2g/dl, creatinine abdominal discomfort that increases after
0.8mg/dl and peripheral edema. Most eating especially when in the recumbent
appropriate diagnosis is: position. A series of tests are performed.
a) pregnancy induced hypertension She has normal vital signs, unremarkable
b) nephrotic syndrome examination, fundal heightis of 33cm and
c) polycystic kidney disease negative urine analysis. Thefollowing are
d) chronic renal failure abnormal test results:
e) hypoalbuminemia
a) alkaline phosphatase double that of
the reference range
67. MgSo4 is used in the treatment of
b) hemoglobin of 9gm/dl
eclampsia. It is characterized by:
a) is metabolized by the liver c) serum albumin of 3g/dl
b) has vitamin K as an antidote d) serum creatinine level of 0.8mg/dl
c) can cause convulsions if given in e) all of the above
excess
d) can be given IM or IV 71. A 34yrs old patient developed an
e) can promote uterine contractions endometritis postpartum and was treated
for 6days in the hospital with bed rest,
68. A 6yrs old girl experiences irregular antibiotics and fluids. She was improving
vaginal bleeding. She is taller than her on the eight day, when shortness of
peers and has early breast development. breath, chest pain and tachycardia
Serum gonadotropin levels are low. Most occurred suddenly. Most likely diagnosis:
likely diagnosis: a) amniotic fluid embolism
a) corpus luteum cyst b) myocardial infarction
b) endometrioma c) pelvic abscess
c) fibroma d) pulmonary embolism
d) teratoma e) air embolism
e) granulose cell tumour
72. A 40yrs old nulligravida is complaining
69. Which of the following occurs with the
of irregular vaginal bleeding of 1year
increase in RBCs during pregnancy?
duration. She has not been using birth
a) causes the hematocrite to rise
b) is due to the prolonged life span of control and had hoped to conceive.
the erythrocytes Endometrial biopsy revealed endometrial
c) is due to increased production of hyperplasia. She would like medical
erythrocytes treatment and wants to know which factor
d) results despite decreased levels of is most important in determining
erythropoiesis in maternal plasma premalignant potential. Best way to advise
e) decreased destruction by the spleen her:
a) degree of cystic hypertrophy 76. The most important prognostic

b) persistence of bleeding indicator of survival from ovarian
c) thickness of endometrial hyperplasia carcinoma:
d) degree of cytological atypia a) stage of disease
e) none of the above b) grade of tumour differentiation
c) nutritional status
73. A 32yrs old woman with PCOS has d) body mass index
infertility of 1year duration. Her menses e) age of the patient
occur at irregular intervals and BBTs are
monophasic. An endometrial biopsy 77. A 58yrs old woman is having surgery
shows endometrial hyperplasia with mild for an ovarian mass. At surgery there are
cytologic atypia. The most appropriate external papillae. The pathologist on
therapy is: frozen notes psammoma bodies. Most
a) medroxyprogesterone acetate likely etiology of her mass is:
b) OCPs a) mucinous cystadenoma
c) clomiphene citrate b) serous cystadenoma
d) human menopausal gonadotropins c) dermoids
e) none of the above d) Brenner tumours
e) granulosa cell tumour
74. An 80years old woman, who never
took estrogen, develops a pink vaginal 78. A 16yrs old phenotypic girl is seen for
discharge. An endometrial biopsy shows primary amenorrhea. Karyotyping shows
adenocarcinoma. Pap smear is negative. 46XY. In counseling, you advise
Most important prognostic indicator: gonadectomy under which of the
a) level CA125 following:
b) age of the patient a) when she is finishing growing
c) nutritional status b) if the gonads are not in the normal
d) histologic type of tumour location in the pelvis
e) presence of peptide hormone c) primarily because of the risk of
receptors malignancy
d) primarily because she will become
75. A 60yrs old woman with a 4months virilized
history of pelvic pain, constipation, urinary e) before marriage
urgency and a complex adnexal mass with
ascites, is counseled by a gynecologic 79. A 75yrs old woman has bilateral solid
oncologist about the potential diagnosis of adnexal masses. Mammography is normal.
ovarian cancer. The most important GI studies show a stomach lesion
principle in treatment of ovarian cancer is: suspicious for malignancy. The most likely
a) removal of all resectable disease diagnosis is:
b) examination of tumour cells cultured a) Kruckenberg’s tumour
in vitro b) Brenner tumour
c) choice of chemotherapy c) struma ovarii
d) calculation of radiation dose d) carcinoid
e) none of the above e) fibroma
80. Ovarian tumour can be derived from 83.A newly born showed a HR of 120bpm
each of the embryologic components of at 1minute, respiratory effort is good,
the ovary. The following ovarian tumours there is strong cry, muscle tone is active,
is derived from ovarian epithelium: reflex irritability is absent, color is pink
a) fibroma with blue extremities. Apgar score is:
b) theca cell a) 5
c) endometrioid b) 6
d) teratoma c) 7
e) struma ovarii d) 8
e) 9
81. A 25yrs old PG at 34weeks gestation is
thought to be small for dates by her 84. A 36yrs old female presents with a
physician and is sent for a sonographic mucopurulent discharge. Gram stain of a
evaluation. The ultrasound shows BPD to cervical swab shows gram -ve diplococcic.
be appropriate for 30weeks gestation. The Which of the following is correct?
estimated fetal weight is ˂10th percentile. a) if untreated this condition is likely to
The BPD was within normal while resolve spontaneously
abdominal circumference was decreased. b) the most likely diagnosis is Stret.
The amniotic fluid is decreased. Most group B
likely diagnosis is: c) appropriate treatment is
a) symmetrical IUGR metronidazole vaginal cream
b) asymmetrical IUGR d) appropriate treatment is a single IM
c) congenital anomaly dose of 250mg ceftriaxone
d) unknown gestational age e) hospitalization and IV antibiotics are
e) normal fetus for a primigravida necessary
82. A 32yrs old G5P4 presents with 8weeks 85. A 24 yrs old G1P0 is seen in emergency
amenorrhea and suggestive symptoms of department. Her LMP was 8weeks ago.
pregnancy. PV revealed an irregular She is experiencing abdominal cramping
enlarged uterus 16wks. Ultrasound and heavy vaginal bleeding with clots.
confirms the presence of an 8weeks viable Examination reveals a soft abdomen with
pregnancy and a multiple fibroid uterus. mild lower abdominal tenderness. On
Best management of this patient: pelvic examination, the vagina is filled
a) termination of pregnancy with with blood and clots. The cervical os is
concomitant myomectomy opened and tissue protruding. The uterus
b) close observation with elective CS at is enlarged 6weeks. Most likely diagnosis:
term a) ectopic pregnancy
c) close observation anticipating b) threatened abortion
possible vaginal delivery c) placenta previa
d) myomectomy and follow pregnancy d) incomplete abortion
in usual way e) complete abortion
e) any of the above can be done
86. The pathology report following a 91. A fishy vaginal discharge with clue cells
therapeutic abortion shows Arias-stellar on microscopy is most likely:
reaction. The most appropriate next step a) be due to gardenerella vaginalis
for this patient would be:
b) can be treated with metronidazole or
a) repeat a pregnancy test
clindamycin
b) laparoscopy
c) reassure the patient c) with the addition of KOH may see
d) repeat D&C hyphae or spores
e) antibiotics and ecbolics d) is rarely associated with inflamed or
itchy vulva
87. An O-ve female whose husband is e) can be sexually transmitted
O+ve, Rh immunoglobulin should be given
in all EXCEPT:
92. Which of the following is associated
a) artificial rupture of membranes
b) amniocentesis with breech presentations?
c) spontaneous abortion a) FHS best heard in the upper
d) therapeutic abortion abdomen
e) ECV b) prolapsed of the umbilical cord
c) increased fetal mortality
88. Risk factors for shoulder dystocia d) increased fetal morbidity
include all the following EXCEPT:
e) all of the above
a) macrosomia
b) maternal diabetes
c) prolonged second stage of labor 93. Causes of secondary amenorrhea
d) contracted pelvis include:
e) outlet forceps delivery a) Turner syndrome
b) anorexia
89. The commonest type of bleeding c) androgen insensitivity syndrome
encountered with uterine leiomyoma is:
d) imperforate hymen
a) post-coital spotting
b) mid-cycle bleeding e) transverse vaginal septum
c) hypermenorrhea
d) oligomenorrhea 94. Risk factors for cervical carcinoma
e) postmenopausal bleeding include all the following EXCEPT:
a) HPV type 16 and 18
90. All the following are cardiovascular b) smoking
adaptations to pregnancy EXCEPT:
c) nulliparity
a) cardiac output increases 33-45%
b) heart rate decreases 12-18bpm d) multiple sexual partners
c) systolic BP decreases 4-5mmHg e) recurrent cervicitis
d) diastolic BP decreases 8-15mmHg
e) pulse pressure increases
95. A 35yrs old NG has severe pain during 99. A 55yrs old female presents with a
menses which radiates to the anal region. period like vaginal bleeding for 5days that
On PV, she has a small RVF uterus, tender stopped spontaneously. Your approach to
nodules on palpation of the uterosacral the problem would be:
ligaments. She most likely has: a) reassure the patient and manage
a) chronic PID expectantly
b) adenomyosis b) administer provera 10mg OD for
c) fibroids 15days
d) Kruckenberg tumours c) obtain endometrial tissue
e) endometriosis d) administer hemostatics
e) perform Pap smear plus endocervical
96. Which of the following statements curettage
regarding malignant cervical lesion is true?
a) 95% are squamous cell carcinoma 100. With respect testicular feminization,
b) CA 125 levels to monitor which of the following is true?
effectiveness of treatment are a) genotype is XY
indicated b) breast development and uterus are
c) the majority of lesions arise outside absent
the transformation zone c) serum testosterone is below normal
d) they are not associated with HPV male range
infection d) secondary sex characteristics are
e) mostly involves the endocervix male
97. In the first 100days of pregnancy, HCG
titer doubles:
a) every day
b) every week
c) every 2days
d) every 2weeks
e) every 2months
98. A young female enters your office

wanting to start oral contraceptive pills.
You counsel her the reasons she may not
start pills, which are:
a) impaired liver functions
b) undiagnosed uterine bleeding
c) past history of thrombophlebitis
d) history of breast lesion
e) all of the above
ANSWERS
1 B 36 D 71 D
2 C 37 B 72 D
3 A 38 A 73 A
4 E 39 B 74 D
5 D 40 A 75 A
6 C 41 D 76 A
7 C 42 B 77 B
8 C 43 A 78 C
9 A 44 B 79 A
10 C 45 B 80 C
11 A 46 C 81 B
12 A 47 C 82 C
13 C 48 C 83 C
14 A 49 A 84 D
15 C 50 E 85 D
16 A 51 D 86 B
17 B 52 C 87 A
18 B 53 B 88 E
19 B 54 A 89 C
20 E 55 C 90 B
21 B 56 B 91 A
22 C 57 D 92 E
23 B 58 E 93 B
24 C 59 C 94 C
25 A 60 E 95 E
26 B 61 E 96 A
27 C 62 B 97 C
28 E 63 B 98 E
29 B 64 C 99 C
30 A 65 B 100 A
31 E 66 B
32 E 67 D
33 E 68 E
34 B 69 C
35 C 70 B
OBGYN TEST (150 marks)

I. Choose the most correct answer: 4. A 24years old PG in labor for 16hrs and
the cervix is arrested at 9cm for 3hours,
1. A 20years old G2P1 presents at 28wks ROP, station 0 and molded. There are fetal
for routine ANC. The first delivery was late decelerations over the last 30minutes.
NVD at 39weeks with no complications. All Delivery is best by:
the following are appropriate as part of a) forceps rotation then traction
ANC EXCEPT: b) ventouse (vacuum) extraction
a) measles, mumps, rubella vaccine c) craniotomy then forceps
b) 50gm glucose tolerance test d) lower segment cesarean section
c) 300microgm anti-D if Rh negative (LSCS)
d) CBC e) upper segment cesarean section
e) hepatitis screening (USCS)
2. A 38years old G1P0 presents for the 5. Diabetes with pregnancy increases the
preconceptional care. She is diabetic with risk for the following conditions EXCEPT:
BMI of 42. Her obstetric history includes a) cesarean section
elective termination at 18weeks for b) malpresentation
anencephalic fetus. She desires c) congenital malformations
conception. Your recommendation would d) unexplained stillbirths
include the following EXCEPT: e) twin pregnancy
a) supplement diet with high dose folic
acid 6. Polyhydramnios may be associated with
b) start diet program to reduce weight the following conditions EXCEPT:
c) proper glycemic control before a) diabetes mellitus
pregnancy to reduce the risk of b) esophageal atresia
congenital malformation c) intrauterine infection
d) stop smoking d) twin to twin transfusion
e) hemoglobin electrophoresis to e) placental insufficiency
screen for thalassemia
7. A 27years G3P2 has missed period and
3. A PG with mitral stenosis and fully positive pregnancy test despite using
dilated cervix for one hour, head station IUCD. Her LMP was 6weeks ago. She feels
+1, direct occipito-anterior is best safely mild pain and discomfort in the lower
delivered by: abdomen. Serum B-HCG is 2240IU/ml.
a) cesarean section What is the next step in this case?
b) forceps delivery a) expectant management
c) vacuum extraction b) start methotrexate
d) internal podalic version then breech c) laparoscopy
extraction d) remove the IUCD
e) expectant management e) transvaginal pelvic sonography
8. A 25years old G1P1 recently delivered 11. What is the appropriate next step in
4days ago by CS. She has been ambulant the management of this patient?
few hours after surgery and tolerated food a) conservative management
very well. She noticed that her b) immediate termination by rupture of
temperature is elevated 38.5. All the membrane
following are essential to confirm the c) immediate delivery by cesarean
etiology of pyrexia EXCEPT: section
a) urine analysis d) initiate blood transfusion
e) immediate induction of labor by
b) pelvic and abdominal ultrasound
oxytocin infusion
c) breast examination
d) MRI
Questions 12-13: A 35years old 3rd
e) examination of lower limbs Gravida, 36wks attended the ANC clinic,
complaining of headache. Her previous
Questions 9-11: A 39years old PG at 30wks deliveries were by CS. She has 2 children.
came to ANC clinic complaining of mild She reports hypertension during the
vaginal bleeding that was painless but previous pregnancies and she was treated
recurrent since last week. Bleeding is mild and delivered at 37 completed weeks by
and not related to intercourse. She feels CS. The neonatal weights in these
good fetal kicking. BP was 120/80, pulse pregnancies were 2.2 and 2.3kg
82 and weight of 78kg. Her CBC was respectively. She claims that the fetal
normal along with the liver and kidney movement are somewhat reduced. Her BP
function test as well as random blood is 150/90.
sugar.
12. Which of the following investigations
9. What is the next step in the must be done?
management of this case? a) abdominal ultrasound
a) send her home and reassurance b) liver and kidney function tests
c) Doppler study for evaluation of the
b) perform a sterile digital examination
placental and fetal blood flow
c) perform an amniocentesis to rule out
d) fetal movement chart
infection
e) all of the above
d) perform a sterile speculum
examination 13. What is the appropriate method for
e) perform an abdominal ultrasound termination of this pregnancy?
examination a) cesarean section
b) waiting for the spontaneous onset of
10. What is the most likely diagnosis? labor
a) cervical polyp c) induction by prostaglandin
b) preterm labor d) forceps delivery to shorten the
c) placental abruption second stage of labor
d) placenta previa e) induction by rupture of membrane
e) submucous uterine fibroid and oxytocin infusion
14. A missed abortion on US examination 18. Obstetric ultrasound is useful for

may include all the following findings diagnosis of the following clinical
EXCEPT: conditions EXCEPT:
a) gestational sac size less than the a) twin gestation
period of amenorrhea b) small for date fetus
c) oligohydramnios
b) absent fetal heart pulsations
d) accidental hemorrhage
c) sub-chorionic hemorrhage e) puerperal sepsis
d) CRL less than the duration of
amenorrhea 19. The fetal biophysical profile on
e) amniotic fluid index less than 7 ultrasound includes the following
parameters EXCEPT:
15. Breech presentation in a PG at term in a) fetal movements
labor is best managed by: b) fetal tone
a) external cephalic version c) fetal weight
b) internal cephalic version and d) fetal breathing movements
e) amniotic fluid volume
extraction
c) cesarean section Questions 20-21: A 21years old PG at
d) oxytocin induction 39wks came to ER with painful
e) internal podalic version and breech contractions every 3minutes. PV: cervix is
extraction 3cm dilated, 60% effaced, FHS 150/min
and reactive. 5 hours later, PV: 6cm
16. The following ultrasonographic cervical dilatation, fetal head at -1 station,
parameters are used in assessing fetal FHS showed late deceleration with each
weight EXCEPT: contraction and decreased variability
a) biparietal diameter
b) head circumference
appropriate next step in management?
c) amniotic fluid index a) expectant management
d) femur length b) episiotomy
e) abdominal circumference c) forceps vaginal delivery
d) vacuum-assisted vaginal delivery
17. The maximum normal time for the e) cesarean delivery
second stage of labor in PG is:
a) 20minutes 21. The fetus immediately after delivery
b) 60minutes may have:
c) 120 minutes a) lowered glucose level
b) low PH
d) 180 minutes
c) jaundice
e) 240 minutes d) cephalhematoma
e) Erb’s palsy
Questions 22-23: A 19years old PG is Questions 25-26: A 36years old woman

expecting her first child, she is 12weeks with 5 children and a history of previous
gestation. She has vaginal bleeding and an short labors, delivered her baby
enlarged for dates uterus. In addition, no 10minutes ago. She had been in labor on
fetal heart sounds are heard. The this occasion for 12hours after
ultrasound shows no fetus and no spontaneous onset. She continues to
placenta and snow storm appearance bleed heavily.
22. What is the most likely diagnosis of 25. What is/are the risk factor(s) for
this woman’s condition? postpartum hemorrhage in this case?
a) sarcoma Botryoids a) the age being above 35
b) missed abortion b) spontaneous onset of labor
c) submucous fibroids c) prolonged labor
d) hydatidiform mole d) multiparity
e) normal pregnancy e) a, c and d
23. What is the appropriate management 26. The next step in the management
of this case? should be:
a) abdominal hystrotomy a) immediate hysterectomy
b) abdominal total hysterectomy b) antishock measures
c) dilatation and curettage c) bimanual compression of the uterus
d) suction evacuation d) bilateral ligation of internal iliac
e) exploratory laparotomy arteries
e) selective embolization of the uterine
24. A 27years old PG, pregnant 24wks, arteries
attended the ANC clinic complaining of
tiredness, shortness of breath, orthopnea 27. Oligohydramnios is diagnosed when
and had to put 2 pillows to sleep. She has the amniotic fluid index is:
no history of chest disease and her a) less than 5cm
pregnancy was not complicated but she b) less than 10cm
has history of recurrent rheumatic fever c) less than 15cm
and was on long acting penicillin and d) less than 20cm
stopped 5years before pregnancy. Which e) less than 25cm
of the following investigations must be
done? 28.Ultrasound is most useful during
a) chest X-Ray pregnancy for the diagnosis of the
b) echo examination of the heart followings EXCEPT:
c) serum ESR a) placenta previa
d) EEG b) accidental hemorrhage
e) abdominal ultrasound c) fetal height
d) fetal weight
e) twin pregnancy
29. Clinical studies include the following 34. A 28years old married female
types EXCEPT: presenting to ER with repeated vomiting
a) descriptive
and amenorrhea of 2months duration. The
b) analytical
c) progressive following clinical conditions are possible
d) retrospective association EXCEPT:
e) prospective a) twin pregnancy
b) vesicular mole
30. Symmetrical IUGR occurs in the
following conditions EXCEPT: c) missed abortion
a) congenital anomalies of the baby d) hyperemesis gravidarum
b) osteogenesis imperfecta e) diabetes
c) trisomies 21, 18 and 13
d) pre-eclampsia
35. Pethidine injections less than two
e) fetal infections as rubella, CMV and
syphilis hours before delivery may be complicated
by:
31. A 20years old G2P1 at 6weeks a) neonatal jaundice
gestation complains of some vaginal b) motor block with weakness of lower
spotting. No gestational sac and no
adnexal masses are seen by TVS. B-HCG is limbs
1500IU/ml. The best management is: c) neonatal respiratory depression
a) laparoscopy d) postpartum hemorrhage
b) hysteroscopy e) inborn error of metabolism
c) follow up HCG after 48hours
d) dilatation and curettage
e) expectant management 36. Regional analgesia during labor and
delivery includes all the following EXCEPT:
32. A viable pregnancy on ultrasound a) epidural analgesia
examination include all the following b) para-cervical block
EXCEPT:
a) gestational sac size corresponding to c) pethidine administration
the period of amenorrhea d) local infiltration anesthesia
b) positive fetal heart pulsation e) pudendal nerve block
c) positive fetal chest movement
d) fetal limb movement
37. Indications of induction of labor may
e) fetal breathing movement
include all the following EXCEPT:
33. The diagnosis of molar pregnancy rests a) maternal diabetes mellitus
on the following criteria EXCEPT: b) eclampsia
a) snow storm appearance c) prelabor rupture of membranes
b) very high B-HCG
c) high temperature d) placenta previa incomplete centralis
d) hyperemesis gravidarum e) postdate pregnancy
e) ovarian cysts on ultrasound
38. Concerning the Bishop score, all the 42. A 32years old G3P3 is admitted to the
following are correct EXCEPT: labor ward with a confirmed diagnosis of
a) used to assess the favorability of the missed abortion. She is 16weeks as
cervix before induction of labor determined by the date of her LMP. All
previous deliveries were normal vaginal
b) a total score of ˂5 indicates
deliveries in hospitals. Her pelvic
favorability for labor induction examination reveals closed, formed and
c) firm consistency takes the score of soft cervix. The most appropriate method
zero of induction of abortion for this patient is:
d) it takes account of cervical dilatation a) uterine massage under epidural
e) an unfavorable cervix increases the analgesia
chances for cesarean section b) cervical dilatation using surgical
dilators followed by forceps
39. Methods of induction of labor includes extraction
c) abdominal hysterotomy under
all the following EXCEPT:
general anesthesia
a) prostaglandin vaginal tablets d) oral and/or vaginal prostaglandin E2
b) oxytocin drip in repeated doses
c) amniotomy e) dilatation and evacuation (D&C)
d) oral anti-progesterone under general anesthesia
e) amniotomy followed by oxytocin drip
43. The followings are true concerning
40. Complications of surgical evacuation prerequisites for vaginal birth after CS
includes all the following EXCEPT: EXCEPT:
a) non persistent cause of previous CS
a) introduction of infection
b) no cephalopelvic disproportion
b) uterine perforation c) vertex presentation with engaged
c) Asherman syndrome head
d) hyperactive uterine action d) previous CS was upper segment
e) cervical lacerations e) no tenderness over the CS scar
41. A 25years old PG at 34wks is thought 44. The following statements concerning
to be small for dates by her physician and cesarean section scars are true EXCEPT:
sent for evaluation. US show BPD a) The scar in the lower segment is
stronger than in the upper segment
appropriate for 30wks, AC appropriate for
b) the uterus is usually closed in 2 or 3
26wks. EFW is ˂10th percentile for age. layers
Amniotic fluid is decreased. The most c) the scar in the LUS carries a higher
likely diagnosis is: risk of infection than in the upper
a) symmetrical IUGR segment
b) Asymmetrical IUGR d) it could be performed through a
c) congenital anomaly transverse lower abdominal incision
d) congenital infection (Pfannesteil) or longitudinal
e) unknown gestational age subumbilical suprapubic incision
e) a Doyen retractor is used to retract
the urinary bladder and to protect it
45. Absolute indications for cesarean 49. A 33years old G5P5 who is being
section include all the following EXCEPT: induced for pre-eclampsia, delivers a 4kg
a) contracted pelvis baby. Upon delivery of the placenta,
b) twin pregnancy uterine inversion is noted. The physician
c) large condylomata accuminata of attempts to replace the uterus but the
HPV in the vagina
cervix is tightly contracted, preventing
d) placenta previa complete centralis
reposition. The best therapy is:
e) cervical dystocia
a) vaginal hysterectomy
46 .The following statements are known b) abdominal hysterectomy
complications of episiotomy EXCEPT: c) halothane anesthesia
a) infection d) discontinue the magnesium sulfate
b) dyspareunia e) infuse oxytocin intravenously
c) hematoma formation
d) laceration of the cervix 50. A 32years old woman has severe
e) increased blood loss during the postpartum hemorrhage that does not
second stage
respond to medical therapy. The
obstetrician states that surgical
47. Comparing median to medio-lateral
episiotomy, which statement is management is best therapy. The patient
INCORRECT? desires future fertility. The most
a) it is easier to repair appropriate to achieve the therapeutic
b) less pain in the perineum goals is:
c) less blood loss a) unilateral internal iliac artery ligation
d) faulty healing is rare b) bilateral internal iliac artery ligation
e) extension to the anal sphincter is less c) supracervical hysterectomy
common d) ligation of the external iliac artery
e) cervical cerclage
48. A 24years old woman underwent a
normal vaginal delivery of a term female.
51. Vaginal examination is contraindicated
After delivery, the placenta wasn’t
delivered even after 60min. The next step in the following situation during
for this patient: pregnancy:
a) wait for an additional 30minutes a) carcinoma of the cervix
b) hysterectomy b) gonorrhea
c) attempt a manual extraction of the c) prolapsed cord
placenta d) placenta previa
d) misoprostol intravaginally e) rupture of membranes
e) bilateral internal iliac arteries ligation
52. A 29years old G1P0 at 39wks delivered 55. A patient with positive pregnancy test
vaginally. Her placenta does not deliver had her LMP was on February 28, her EDD:
easily & manual extraction is attempted. a) March 23
The placenta seems to be adherent to the b) December 7
uterus. Due to her strict desire to get c) April 23
children, the cord is ligated with suture as d) March 7
high as possible. The patient is given the e) September 7
option of methotrexate therapy. Most
likely complication after this intervention: 56. A 28years old woman noted loss of
a) coagulopathy fetal movement at 36wks. Patient went
b) utero-vaginal fistula for follow up at 40wks and FHS were not
c) infection heard. The uterus measures 30cm from
d) malignant transformation symphysis pubis. The following test would
e) infertility be most valuable to perform:
a) maternal serum estriol
53. A 36years old G1P0 at 27wks is having b) clotting screen
right flank tenderness and pyrexia. She is c) lecithin/sphingomyelin (L/S) ratio
diagnosed with pyelonephritis. A urine d) karyotype of amniotic cells
culture is performed. The commonest e) maternal serum progesterone
organism would be:
a) proteus species 57. A patient at 34wks develops marked
b) candida species pruritis especially on her palms and soles,
c) esherishia coli and mildly elevated liver function tests
d) klebsiella species and elevated bile acids. What is your most
e) staph aureus probable diagnosis?
a) pancreatitis
54. A 36years old G2P1 woman presents b) urticaria
for her initial prenatal visit at 6weeks c) hyperthyroidism
gestation. She has 9years history of type 2 d) diabetes insipidus
diabetes mellitus which is managed by e) cholestasis of pregnancy
oral hypoglycemic medications. Which is
the best indicator for fetal outcome of the 58. A 26years old Caucasian woman
pregnancy? presents for her first ANC visit. She is
a) blood sugar value in the office 14weeks pregnant and had a history of
b) fasting blood sugar DVT in her left leg when she was on COCPs
c) HbA1C 3years ago. She was tested and found to
d) nuchal translucency be homozygous for Factor V Leiden. What
e) umbilical artery Doppler at 18weeks should you advise the patient?
a) close follow up and observation 62. When is the placenta accrete most
b) low dose aspirin 81mg should be likely the cause bleeding?
taken during pregnancy and a) during the first stage of labor
puerperium b) antepartum period
c) she should be placed on prophylactic c) after rupture of membrane
warfarin therapy till the end of d) during attempts to remove the
pregnancy placenta
d) she would benefit from prophylactic e) postpartum
doses of LMWH until 6weeks
postpartum
63. What is the best surgical technique for
e) she should be on therapeutic doses
this patient?
of SC heparin until after delivery
a) lower segment CS
59. Antepartum assessment of fetal b) upper segment CS
wellbeing include all EXCEPT: c) upper segment CS and then proceed
a) non stress test to hysterectomy
b) ultrasound biophysical profile d) bilateral internal iliac ligation
c) daily fetal counting e) hysterectomy with bilateral salpingo-
d) fetal blood sampling oopherectomy
e) color Doppler study
64. Cervical insufficiency occur in the
60. Ultrasound during the first trimester of following conditions EXCEPT:
pregnancy evaluates the following a) congenital uterine anomalies
EXCEPT: b) patients with history of cervical
a) crown rump length lacerations
b) fetal heart pulsation c) multiple pregnancy
c) fetal movement d) uterine fibroids
d) fetal weight e) cervical conization
e) twin pregnancy
65. A 33years old woman at 37wks
61. The pathological retraction ring of
presents with moderate vaginal bleeding.
Bandl is most commonly associated with:
She is noted on US to have placenta
a) prematurity
previa. The best management for this
b) obstructed labor
c) precipitate labor patient is:
d) multiple gestation a) induction of labor
e) normal labor b) tocolysis of labor
c) cesarean delivery
Questions 62-63: A 35years G5P4 with d) cesarean hysterectomy
previous 4 CS is diagnosed with placenta e) expectant management
accreta at 28wks by US.
66. Maternal mortality rate in Egypt in 70. A 22years old pregnant woman has
2013 was 52/100.000, its commonest just been diagnosed with toxoplasmosis.
cause is: The following risk factor is most likely to
a) puerperal sepsis have contributed to her condition:
b) pulmonary embolism a) eating raw meat
c) obstetric hemorrhage b) eating raw fish
d) anesthesia complications c) owning a dog
e) heart disease complications d) English nationality
e) having viral infections in early
67. Transverse lie in multipara at term in pregnancy
labor is best managed by:
a) external version 71. A 30years old patient came in labor
b) internal version and extraction with ruptured membrane since 2hrs. On
c) cesarean section PV, the fetal nose and mouth were
d) oxytocin induction palpable. The chin is pointing toward the
e) internal podalic version and breech sacrum, this is a case of:
extraction a) left mento-anterior position
b) direct mento-posterior position
68. Icterus gravis neonatorum, all are true c) occipito transverse position
EXCEPT: d) brow presentation
a) it is the commonest and moderate e) vertex presentation
form of RH incompatibility
b) baby delivered anemic and never 72. Which of the following indicates that
jaundiced at birth the patient entered in second stage of
c) IUFD usually occurs due to severe labor?
hemolytic anemia a) small amount of bloody mucus
d) jaundice develops within 48hours discharge (bloody show)
after birth b) regular uterine contractions 4 in ten
e) hepatosplenomegaly is usually minutes
present c) spontaneous rupture of membranes
69. An 18years old G1P0 at 8weeks d) complete dilatation of the cervix
gestation presents to our office for her e) uterine contractions of 100mmHg
first prenatal visit. She reports daily
nausea and vomiting over the past week. 73. Rupture uterus could occur in the
The following signs or symptoms would following conditions EXCEPT:
indicate diagnosis of hyperemesis a) improper use of uterine stimulants
gravidarum: b) previous uterine scar
a) hypothyroidism c) grand multipara
b) hypokalemia d) small for date baby
c) weight gain e) instrumental delivery
d) proteinuria
e) diarrhea
74. The following describes McRobert 78. The possible differential diagnosis of
maneuver: this case include all EXCEPT:
a) suprapubic pressure a) dysfunctional uterine bleeding
b) delivery of the posterior arm b) uterine fibroid
c) maximal flexion and abduction of the c) endometrial polyp
maternal hips d) adenomyosis
d) rolling the mother to an “all-fours” e) ectopic pregnancy
position
e) rotation of the fetal head 79. The following investigations are
recommended EXCEPT:
75. Advantages of LSCS over USCS includes
a) complete blood picture
b) bleeding profile
a) better healing
b) less hemorrhage c) pelvic ultrasound
c) less incidence of recurrence of d) prolactin assay
previous successful repair of high e) endometrial biopsy
vesicovaginal fistula
d) less abdominal distension and ileus 80. Surgical treatment of abnormal uterine
e) less mortality rate bleeding include the following options
EXCEPT:
76. Pelvic ultrasound is a useful tool in the a) abdominal hysterectomy
diagnosis of the following conditions b) vaginal hysterectomy
EXCEPT: c) endometrial ablation
a) adenomyosis d) bilateral oophorectomy
b) uterine leiomyoma e) hysteroscopic polypectomy
c) uterine septum
d) ovarian cysts 81. The following are true about
e) cervicitis randomized controlled studies (RCTs)
EXCEPT:
77. TVS is preferable to abdominal US in a) people participating in the trial are
diagnosis of the following clinical
randomly allocated to the groups in
condition EXCEPT:
the study
a) endometrial assessment
b) it is a prospective study
b) monitoring ovulation
c) uterine septum c) RCTs are often used to test the
d) ascites efficacy of various medical
e) ectopic pregnancy interventions
d) can be single blind or double blind
Questions 78-79: A 48years old married e) it involves the analysis of data
woman presenting with heavy period for collected from a population at one
8months duration. Her periods are getting specific point in time
increasingly heavy.
82. The success rate of IVF/ICSI cycles Questions 86-87: A 23years old female
depend upon these factors EXCEPT: comes to the physician because of a
a) wife’s age painful swelling in her vulva that started
b) husband’s age 3days ago and has been growing larger
c) quality of oocytes retrieved since. Examination shows a cystic tender
d) quality of embryos transferred mass 4cm in diameter in the posterior
e) quality of endometrium aspect of the labia majora with erythema.

83. The following represents the steps
likely diagnosis?
performed in IVF EXCEPT:
a) condyloma lata
a) ovarian stimulation
b) granuloma inguinale
b) ovulation monitoring c) infected Bartholin’s cyst
c) oocyte retrieval d) Gartner’s cyst
d) oocyte division e) vulvar cancer
e) embryo transfer
87. Management should be:
84. Normal fertilization of the oocyte can a) antibiotics
be confirmed under the microscope when: b) reassurance and discharge
a) no pronucleus is visualized c) colposcopy
b) one pronucleus is visualized d) surgical excision
c) two pronuclei are visualized e) surgical drainage
d) three pronuclei are visualized
e) four pronuclei are visualized 88. The following are advantages of
laparoscopy in the diagnosis of infertility
85. A 26yrs old NG comes to ER with EXCEPT:
severe right lower quadrant pain that a) good evaluation of tubal factor
started last night. This morning she was b) diagnosis of endometriosis
c) diagnosis of Asherman’s syndrome
awakened with severe pain in the same
d) localization of pelvic adhesions
area. During the episode of pain she had
e) diagnosis of polycystic ovaries
nausea, vomiting and diaphoresis.
Examination is significant for right lower 89. A 26 years old presents to the fertility
quadrant tenderness and a tender right clinic with regular cycles. She has been
adnexal mass on pelvic examination. Urine married for 2years with failure of
HCG is negative. TVS reveals an 8cm right conception. Her hormonal evaluation is
ovarian mass. Which of the following is normal and her ovulation was followed
the most likely diagnosis? and found to be normal. Her pelvic US
a) appendicitis revealed normal finding. She has a recent
b) ectopic pregnancy normal HSG and her husband semen
c) nephrolithiasis analysis was normal. Her family history is
d) ovarian torsion irrelevant. Which of the following
e) pelvic inflammatory disease procedures is advisable for the diagnosis
of the cause of infertility?
a) basal body temperature chart 94. Uterine leiomyoma can be a cause of

b) pituitary CT scan infertility. The mechanism by which
c) diagnostic laparoscopy and leiomyoma can cause infertility includes
hysteroscopy
d) repeat HSG
e) cervical mucus study a) interfere with implantation due to
distortion of the cavity if submucous
90. What is the most common tumor of b) tubal obstruction caused by multiple
the ovary? fibroids including bilateral cornual
a) mucinous cystadenoma fibroids
b) fibroma c) interfere with sperm motility in case
c) theca cell tumor of large cervical fibroid
d) benign teratoma
d) interfere with fertilization due to lack
e) endodermal germ cell tumor
of capacitation
91. What is the most common cystic lesion e) pedunculated myoma protruding
of the ovary? from the cervix
a) dermoid cyst of the ovary
b) follicular cyst 95. HSG is used to diagnose the following g
c) ovarian abscess EXCEPT:
d) endometrioma of the ovary a) subserous leiomyoma
e) ovarian pregnancy
b) tubal obstruction
92. An enterocele is best characterized by c) peritubal adhesions
which of the following statements: d) Asherman syndrome
a) it is not a true hernia e) unicornuate uterus
b) it is a herniation of the bladder floor
into the vagina
c) it is a prolapsed of the uterus and 96. The followings are true about
vaginal wall outside the body
complications to intrauterine
d) it is protrusion of the pelvic
peritoneal sac and vaginal wall into contraception device EXCEPT:
the vagina a) it is contraindicated in undiagnosed
e) it is a prolapsed of the vaginal wall vaginal bleeding
with the lower rectum b) it is contraindicated in cases with
history of PID
93. The following about HPV infection are c) it is contraindicated in patients with
correct EXCEPT: a history of ectopic pregnancy
a) it is the most common viral STDs
d) it is contraindicated in patients with
b) it may lead to CIN and cervical cancer
c) it is due to RNA virus uterine anomalies making insertion
d) infection may be warty or flat difficult
condyloma e) it is contraindicated in lactating
e) HPV types 6 and 11 are the usual patients
causes of visible external warts
97. The following side effects of COCPs are 101. A 58years old woman has presented
true EXCEPT: with complains of postmenopausal
a) weight loss bleeding for the past two weeks. The most
b) hypomenorrhea essential investigation would be:
c) thromboembolic disorders a) colposcopy
d) breakthrough bleeding b) Pap smear
e) breast tenderness c) cone biopsy
d) D&C (dilatation & curettage)
98. Cervical intraepithelial neoplasia grade
e) hysteroscopy
I refers to:
a) atypical cells occupy the lower one
third of the thickness of the 102. All the following risks can commonly
epithelium occur with diagnostic hysteroscopy
b) atypical cells occupy the upper one EXCEPT:
third of the thickness of the a) failure to visualize the cavity
epithelium b) injury of the bladder
c) atypical cells occupy the middle one c) pelvic infection
third of the thickness of the d) uterine perforation
epithelium e) vaginal bleeding
d) atypical cells are present throughout
the thickness of the epithelium Questions 103-105: A 30years old G1P1L1
e) atypical cells invading the basement presented to ER with acute left iliac fossa
membrane pain and vaginal bleeding. She uses IUCD
and her periods are regular except this
99. Magnetic resonance imaging (MRI) is time she noticed 1week delay
used for the diagnosis of the following
EXCEPT: 103. What is the first investigation to be
a) differentiating ovarian tumors
ordered?
b) evaluation of uterine fibroids to
identify the size, numbers and a) serum B-HCG
location of the fibroids b) abdominal ultrasound
c) monitoring ovulation c) transvaginal ultrasound
d) differentiate between adenomyosis d) CBC
and uterine leiomyoma e) serum prolactin
e) diagnosis of uterine sarcoma
104. B-HCG was 800IU/ml. The patient was
100. The following about candida infection vitally stable, abdominal examination
are correct EXCEPT: revealed tenderness but no rigidity. US
a) it is the second most common cause revealed empty uterus and no adnexal
of vaginitis in the childbearing period masses. The next step is:
b) the infection is common with a) perform diagnostic laparoscopy
pregnancy b) repeat ultrasound in one week
c) vaginal PH is usually alkaline c) repeat B-HCG after 48hours
d) vulval itching may occur d) ask for MRI pelvis
e) vaginal isoconazole or miconazole e) reassure and discharge
are effective
105. Which of the following is not a likely 110. The commonest cause of pelvi-
differential diagnosis: abdominal swellings in women in the
a) threatened abortion reproductive age is:
b) ectopic pregnancy a) subserous myoma
b) mucinous cystadenoma
c) vesicular mole
c) pregnancy
d) missed abortion d) vesicular mole
e) incomplete abortion e) obesity
106. Laparoscopy can be used to perform 111. Cystic adnexal swellings include all
all these procedures in gynecology the following EXCEPT:
EXCEPT: a) broad ligament hematoma
a) ovarian cystectomy b) tubo-ovarian abscess
b) myomectomy c) hematometra
d) pyosalpinx
c) subtotal hysterectomy
e) benign cystic teratoma
d) radical hysterectomy (radical lymph
node dissection) 112. The instrument used to assess the
e) simple vulvectomy direction and length of the uterine cavity
is:
107. Hysteroscopy can be used in the a) hegar dilator
following gynecological procedure: b) cusco speculum
a) removal of a subserous myoma c) foley’s catheter
b) removal of a submucous myoma d) sound
e) curette
c) salpingectomy
d) pelvic lymphadenectomy 113. The ideal patient position during D&C
e) ovarian cystectomy is:
a) dorsal position
108. Of the following maneuvers, which will b) trendlenberg position
decrease the risk of uterine perforation c) lithotomy position
before D&C? d) knee elbow position
a) uterine sounding e) none of the above
b) uterine dilatation
114. Postoperative reactionary
c) filling the bladder
hemorrhage after vaginal operation:
d) bimanual examination a) is hemorrhage occurring during the
e) transvaginal sonography operation
b) occurs usually on the 10th
109. All the following are complications of postoperative day due to sepsis
HSG, EXCEPT: c) occurs usually within 24hours after
a) allergic reaction surgery
b) shock d) in these cases, it is recommended to
c) oil embolism avoid any sutures in the friable
tissues
d) infertility
e) flaring up of infection
115. A 65years old woman is noted to 119. The risk of endometrial carcinoma is
have suspected uterine fibroids on the highest with the following histological
physical examination. Over the course of pattern:
1year, she is noted to have an a) simple hyperplasia without atypia
b) simple hyperplasia with atypia
enlargement of her uterus from 12weeks
c) complex hyperplasia without atypia
size to 20weeks size. Which of the d) complex hyperplasia with atypia
following is the best management? e) atrophic endometrium
a) continued careful observation
b) GnRH agonist 120. Woman with postmenopausal
c) exploratory laparotomy and bleeding needs endometrial sampling if
hysterectomy endometrium is thicker than:
a) 1mm
d) progestin therapy
b) 2mm
e) estrogen treatment
c) 5mm
d) 8mm
116. Most common symptom of e) 10mm
endometriosis is:
a) dysmenorrhea 121. Presence of pyometra in a
b) menorrhagia postmenopausal female strongly suggests:
c) amenorrhea a) diabetes mellitus
b) degenerating myoma
d) pelvic mass
c) senile endometritis
e) vaginal discharge
d) malignancy
e) sexual promiscuity
117. The gold standard investigation for
endometriosis is: 122. Which are the most pathogenic HPV
a) CT subtypes that are responsible for most
b) MRI cancers?
c) US a) 2 and 16
b) 14 and 15
d) Plain X-Ray
c) 16 and 18
e) Laparoscopy d) 31 and 33
e) 36 and 45
118. The cut-off size for excision of ovarian
endometrioma is: 123. The commonest cause of death in
a) 1cm cancer cervix is:
b) 2cm a) infection
c) 4cm b) uremia
c) hemorrhage
d) 10cm
d) cachexia
e) 15cm e) distant metastasis
124. The lymphatic drainage of the cervix 127. A 54years old woman comes to the
is to the following lymph nodes EXCEPT: physician for routine annual examination.
For the past year, she has been taking
a) femoral lymph nodes tamoxifen for the prevention of breast
b) internal iliac lymph nodes cancer after her physician determined her
c) para-aortic lymph nodes to be at high risk on the basis of her strong
d) pre-sacral lymph nodes family history, nulliparity and early age of
menarche. She takes no other
e) obturator lymph nodes medications. Examination is within normal
limits. Which of the following is this
125. A 62years old woman comes to the patient most likely to develop while taking
tamoxifen?
physician because of vaginal bleeding. She
a) breast cancer
states that her LMP was 11years ago and b) elevated LDL cholesterol
that she has had no bleeding since that c) endometrial changes
time. She has hypertension and type 2 d) myocardial infarction
e) osteoporosis
diabetes mellitus. Examination shows a
mildly obese woman in no apparent 128. Cervical carcinoma spread and
distress. An endometrial biopsy is staging: micorinvasion of the basement
performed that shows grade 1 membrane ˂5mm across with no
lymph/vascular invasion:
endometrial adenocarcinoma. Which of a) stage 1b
the following is the most appropriate next b) stage 3
step in management? c) stage 4
d) stage 1a
a) chemotherapy
e) stage 2a
b) cone biopsy
c) dilatation and curettage 129. The area where cervical carcinoma
d) hysteroscopy usually originates is:
a) neoplastic zone
e) hysterectomy b) metaplastic zone
c) retrograde area
126. Acetic acid turns a portion of the d) transformation zone
e) transition field
cervix ……….. in a patient with CIN:
a) green 130. Cervical carcinoma characteristically
b) blue spreads in the:
c) brown a) tissue
b) lymph
d) orange
c) bone
e) white d) blood
e) mucus
131. A 39years old woman para 6 has 135. Most vaginal cancers develop in
presented with complaint of potcoital which part of the vagina?
bleeding for the past three months. Your a) upper third
first investigation should be: b) middle third
a) dilatation and curettage c) lower third
b) cone biopsy of the cervix d) lateral vaginal walls
c) Pap smear e) none of the above
d) colposcopy
e) laparoscopy 136. The levator ani muscle:
a) is a voluntary muscle
132. A 58years old woman had presented b) is attached laterally to the white line
with complaints of postmenopausal of the pelvis
bleeding for the past two weeks. The most c) is composed of pubococcygeus and
essential investigation would be: iliococcygeus muscles
a) colposcopy d) contracts to prevent spillage of urine
b) Pap smear during strain
c) cone biopsy e) all of the above
d) D&C (dilatation and curettage)
e) hysteroscopy 137. The commonest cause of stress
incontinence is:
133. The most common symptom of a) constipation
endometrial hyperplasia is: b) raised intraabdominal pressure
a) vaginal discharge c) congenital weakness of sphincter
b) vaginal bleeding d) childbirth trauma
c) amenorrhea e) estrogen deficiency
d) pelvic pain
e) abdominal distension 138. All the following are supports of the
uterus EXCEPT:
134. Carcinoma in situ of the cervix a) Machenrodt’s ligaments
implies: b) uterosacral ligaments
a) extensive glandular involvement of c) brad ligament
cancer cells d) pubocervical fascia
b) full thickness epithelium e) rectovaginal fascia
replacement by undifferentiated
cancer cells 139. Prolapsed after menopause is mainly
c) partial epithelial replacement of attributed to the deficiency of which
stratified basal cells hormone?
d) reserve cell hyperplasia a) estrogen
e) nests of malignant basal cells b) progesterone
throughout epithelium c) testosterone
d) cortisone
e) androgens
140. In Turner syndrome: which is true: 143. The contraceptive injection, which
a) genetically is 46XO lasts for 3months, contains which of the
b) has testis in inguinal area following?
c) usually presents with primary a) depot medroxyprogesterone acetate
amenorrhea b) ethinyl estradiol
c) etonogestrel
d) has low IQ
d) levonorgestrel
e) usually tall e) norethindrone
141. A 63years old patient with symptoms 144. As regards emergency contraception
of vaginal itching, vaginal dryness, and and levonorgestrel, which is correct?
dyspareunia. Which of the following is the a) it is teratogenic
most appropriate medical therapy? b) it decreases the risk of ectopic
a) orally administered estrogen for the pregnancy
first 25days of each month c) it is ineffective if it is taken 24hours
b) vaginal estrogen cream daily after unprotected sexual intercourse
d) can be administered as a single dose
c) orally administered progesterone 5-
of 1.5mg or 2doses of 0.750microgm
10mg daily for 10days each month 12hours apart
d) testosterone tablets 10mg/d e) tablets could be taken orally or
e) estrogen 20mg administered vaginally
intravenously
145. A woman complains of whitish
142. A 22years old woman presents to her discharge with fishy odor and no itching. It
GP for advice regarding postnatal is most likely:
contraception. She is bottle feeding her a) bacterial vaginosis
baby. She and her partner are keen to b) trichomoniasis
c) candidiasis
space out child bearing by 1-2years. She
d) malignancy
has a history of irregular menstrual cycles e) urinary tract infection
and polycystic ovarian syndrome. Select
the MOST appropriate contraceptive 146. A 36years old woman attends family
option: planning clinic as she wants to use COCPs
a) combined oral contraceptive pill for the next 3 years. When is the highest
b) copper intrauterine device risk of venous thromboembolism?
c) levonorgestrel-releasing intrauterine a) after 5years
system (Mirena) b) after 4 years
d) progestogen only pill c) after 3 years
d) after 2 years
e) progestogen only injectable
e) in the first year of use
147. The absolute contraindications to

COCPs include all the following EXCEPT:
a) blood pressure ˂140/90
b) smoking cigarettes (40/day)
c) diabetes retinopathy
d) migraine with aura
e) BMI˃ 40
148. Serum prolactin levels are highest in

which of the following conditions?
a) menopause
b) ovulation
c) parturition
d) sleep
e) running
149. Most likely cause of abnormal uterine

bleeding in 13years old girl is:
a) uterine cancer
b) ectopic pregnancy
c) anovulation
d) systemic bleeding diathesis
e) trauma
150. The normal vagina is richly colonized

by bacterial flora predominantly consisting
of:
a) mycoplasma hominis
b) gardnerella
c) actinomyces viscosus
d) chlamydia trachomatis
e) lactobacillus
ANSWERS
1 A 41 B 81 E 121 D
2 E 42 D 82 B 122 C
3 B 43 D 83 D 123 B
4 D 44 C 84 C 124 A
5 E 45 B 85 D 125 E
6 E 46 D 86 C 126 E
7 E 47 E 87 A 127 C
8 D 48 C 88 C 128 D
9 E 49 C 89 C 129 D
10 D 50 B 90 D 130 B
11 A 51 D 91 B 131 C
12 E 52 C 92 D 132 D
13 A 53 C 93 C 133 B
14 E 54 C 94 D 134 B
15 C 55 B 95 A 135 A
16 C 56 B 96 E 136 E
17 C 57 E 97 A 137 D
18 E 58 D 98 A 138 C
19 C 59 D 99 C 139 A
20 E 60 D 100 C 140 C
21 B 61 B 101 D 141 B
22 D 62 D 102 B 142 A
23 D 63 C 103 A 143 A
24 B 64 D 104 C 144 D
25 E 65 C 105 C 145 A
26 B 66 C 106 E 146 E
27 A 67 C 107 B 147 A
28 C 68 C 108 D 148 C
29 C 69 B 109 D 149 C
30 D 70 A 110 C 150 E
31 C 71 B 111 C
32 A 72 D 112 D
33 C 73 D 113 C
34 C 74 C 114 C
35 C 75 C 115 C
36 C 76 E 116 A
37 D 77 D 117 E
38 B 78 E 118 C
39 D 79 D 119 D
40 D 80 D 120 C

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1.

Gyn 1: Endocrinology 1 (80 marks)

5. Steroidogenesis in the corpus luteum is 9. Inhibin inhibits the synthesis and

20. Which of the following is an indication 24. Ovulation occurs:

a) Androgen insensitivity syndrome athletic. There is similar history of

35mIU/mL and FSH is 9mIU/mL. c) Has no effect on quality of cervical

Gyn 2: Endocrinology 2 (90 marks)

a) clomid 34. the most suitable treatment for a 34yrs

32. Asymptomatic endometriosis found on 38. A definitive treatment for menorrhagia

39. Which of the following is true regarding a) COCP

88. HSG and laparoscopy plus dye instillation,

85. A 17yrs old NG complains of severe pain

86. A 16yrs old G0P0 female complains of

Gyn 3: General (85 marks)

7. A 22-year-old breast feeding woman who has had a peritonitis secondary to

contraception, such as condoms for 17. Amenorrhea is often seen in women

39. In developing countries, most a) cystometric examination

For each description in questions 58-63, a) pelvic floor exercise

Gyn 4: Oncology (90 marks)

8. Most appropriate treatment for a 12. What is the commonest genetic

f) carcinosarcoma of the uterus 67. A 48yrs old woman attends the

73. Ectopy. 82. The following are risk factors for

Gyn 5: Oncology 2 (140 marks)

76. Associated with appendiceal tumours d) endometroid tumour

113. Mainstay of treatment of ovarian 127. The following are appropriate

Gyn 6: Infections (95 marks)

a) Chlamydia trachomatis 57. A patient is found to have bilaterally

84. The following are causes of benign

Gyn 7: Basic (30 marks)

Obs 1: Bleeding In Early Preg. (70 marks)

2. Which of the following is the most 6. Appropriate management of such

17. The management of an abdominal 22. Patients with complete molar

51. The abnormal proliferation of 60. In second trimesteric abortion,

Obs 2: Normal Labor (70 marks)

56. The levator ani muscles form the pelvic

Obs 3: Abnormal Labor (75 marks)

12. Compared to singleton pregnancies, 17. The differential diagnosis of suspected

36. The following pregnancy complications c) HELLP syndrome

Obs 4: Comp. Of 3rd Stage (85 marks)

21. While rubbing up the uterine 27. A 32-year-old woman G2P1 of 38

47. A retraction ring of Bandl is commonly 51. Shoulder dystocia:

62. A PG presents at term wz placenta

63. Antepartum haemorrhage is defined 67. Expectant management for accidental

II. For each of the statements below, mark

78. Progress in labor is measured by:

79. Progress in labor is measured by: the

80. Progress in labor is measured by:

81. Progress in labor is measured by:

82. Progress in labor is measured by: the

83. Consequences of placental abruption

Obs 5: Late Complications (90 marks)

2. AFV is a balance between production 6. What is the only reliable indicator of

For each of the descriptions in questions d) baseline variability

54. Oligohydramnios is associated with: 69. Antenatal steroid administration has

82. Fetal anemia is best assessed using

Obs 6: Med. & Surg. Comp. (130 marks)

65. Thyrotoxicosis in pregnancy is treated e) discussion with hematologist for

100. You are councelling a pregnant 110. Management of pre-eclampsia may

123. High levels of serum ferritin confirms

124. Iron deficiency anemia during

125. Iron deficiency anemia during

126. Carbamazepine in pregnancy is

127. Breastfeeding is contraindicated in