MARCH 2016 SBA (Recall)

1. What percentage of lymphocytes is present in peripheral blood?

A. 2-8%
B. 15-20%
C. 20-40%
D. 50-70%
E. 70-80%
ANSWER : 20-40%

2. A 65-year-old woman has a sudden onset loss of speech and hemiparesis. On

arrival in hospital her symptoms and neurological examination is suggestive of a
cerebrovascular incident. Subsequent imaging supports the diagnosis of an
ischaemic stroke, affecting her left cerebral hemisphere. Which of the following
forms of tissue necrosis is associated with her loss of function?
A. Caseous necrosis
B. Coagulative necrosis
C. Colliquative necrosis
D. Fat necrosis
E. Gangrenous necrosis
ANSWER : Colliquative necrosis

3. Which of the following immunoglobulin class has a dimeric structure?

A. IgG
B. IgA
C. IgM
D. IgD
E. IgE
ANSWER : IgA

4. Which of the following is the main cellular origin of clotting factor VIII
(antihemophilic factor)?
A. Hepatocytes
B. Histiocytes
C. Megakaryocytes
D. Plasma cells
E. Vascular Endothelium
ANSWER : Vascular Endothelium

5. Which class I major histocompatibility complex human leucocyte antigen (HLA)

is expressed only in extravillous trophoblast?
A. HLA-A
B. HLA-B
C. HLA-C
D. HLA-F
E. HLA-G
ANSWER : HLA-G
6. How many sperm are produced in the testes each day?
A. 30,000
B. 300,000
C. 3,000,000
D. 30,000,000
E. 300,000,000
ANSWER : 300,000,000

7. Clomifene citrate is a commonly used drug for the induction of ovulation. What
type of drug is clomifene citrate?
A. Androgenic steroid
B. Estrogenic steroid
C. Progestogenic steroid
D. Gonadotropin analogue
E. Selective estrogen receptor modulator
ANSWER : Selective estrogen receptor modulator

8. The complement system consists of a number of small proteins found in the

blood. Which of the following is the major site of synthesis of complement
proteins?
A. Liver
B. Spleen
C. Thymus
D. Bone marrow
E. Intestinal epithelium
ANSWER : Liver

9. Botulinum toxin is now used to treat neurogenic bladder because of its ability to
A. Block storage of acetylcholine ACH in neuronal vesicles
B. Inhibit the release of acetylcholine ACH from the neurons
C. Inhibit acetylcholine ACH synthesis
D. Block bladder nicotinic receptors
E. Block bladder muscarinic receptors
ANSWER : Inhibit the release of acetylcholine ACH from the neurons

10. Which of the following structures passes through the lesser sciatic foramen?
A. Iliococcygeus
B. Piriformis
C. Sciatic nerve
D. Posterior femoral cutaneous nerve
E. Tendon of obturator internus
ANSWER : Tendon of obturator internus
11. A 50-year-old woman, recently diagnosed with ovarian cancer, started her first
cycle of chemotherapy. Several days after a treatment, she notes that she has
blood in her urine. Cystoscopy reveals haemorrhagic cystitis. Which of the
following antineoplastic drugs is most likely responsible for this side effect?
A. Etoposide
B. Methotrexate
C. Paclitaxel
D. Cyclophosphamide
E. Vincristine
ANSWER : Cyclophosphamide

12. Luteinizing hormone (LH) is structurally related to what other glycoprotein

hormones?
A. ADH, oxytocin and FSH
B. FSH, TSH and growth hormone
C. HCG, FSH and TSH
D. HCG, ADH and FSH
E. TSH, growth hormone and HCG
ANSWER : HCG, FSH and TSH

13. Approximately what percentage of the total human DNA is mitochondrial DNA?
A. 1%
B. 20%
C. 50%
D. 80%
E. 99%
ANSWER : 1%

14. Your consultant asks you to prescribe a 3 month course of ulipristal acetate to a
patient with fibroids prior to having a hysterectomy. To which class of drugs does
ulipristal acetate belong?
A. Aromatase inhibitor
B. Gonadotrophin releasing hormone (GnRH) antagonist
C. Progestogen antagonist
D. Prostaglandin analogue
E. Selective estrogen receptor modulator (SERM)
ANSWER : Progestogen antagonist

15. Which of the following arteries supplies foregut derivatives of the digestive
system?
A. Celiac trunk
B. Superior mesenteric artery
C. Inferior mesenteric artery
D. Right umbilical artery
E. Intercostal artery
ANSWER : Celiac trunk
16. What of the following is the major buffer in urine?
A. Bicarbonate
B. Phosphate
C. Ammonia
D. Calcium carbonate
E. Potassium chloride
ANSWER : Phosphate

17. Glucocorticoids are secreted from which region of the adrenal gland?
A. Adrenal capsule
B. Zona reticularis
C. Zona glomerulosa
D. Zona fasciculata
E. Adrenal medulla
ANSWER : Zona fasciculata

18. How many carbon atoms do androgens contain?

A. 18
B. 19
C. 20
D. 21
E. 22
ANSWER : 19

19. From which germ cell layer is the allantois derived?

A. Endoderm
B. Ectoderm
C. Paraxial mesoderm
D. Intermediate mesoderm
E. Lateral plate mesoderm
ANSWER : Endoderm

20. Which process establishes the three definitive germ layers?

A. Neurulation
B. Gastrulation
C. Craniocaudal folding
D. Lateral folding
E. Angiogenesis
ANSWER : Gastrulation

21. Which one of the following is the termination of round ligament?

A. Labia minora
B. Labia majora
C. Deep Inguinal ring
D. Superficial Inguinal ring
E. Lateral vaginal wall
ANSWER : Labia majora
22. Ductus venosus is completely obliterated after birth to form what adult
structure?
A. Ligamentum venosum
B. Ligamentum arteriosum
C. Ligamentum teres
D. Medial umbilical ligament
E. Median umbilical ligament
ANSWER : Ligamentum venosum

23. An inherited metabolic disorder called phenylketonuria (PKU) can result in

serious problems in infancy. Via which pattern of inheritance is the PKU?
A. Mitochondrial
B. Autosomal dominant
C. Autosomal Recessive
D. X-Linked Dominant
E. X-Linked Recessive
ANSWER : Autosomal Recessive

24. The ureteric bud is derived from which of the following embryonic structures?
A. Allantois
B. Pronephros
C. Mesonephros
D. Mesonephric duct
E. Metanephric blastema
ANSWER : Mesonephric duct

25. Which part of the endometrium is deep to the fetus and forms the maternal
component of the placenta?
A. Decidua capsularis
B. Decidua rubra
C. Decidua vera
D. Decidua basalis
E. Decidua menstruales
ANSWER : Decidua basalis

26. Choriocarcinoma is a malignant form of gestational trophoblastic disease.

When choriocarcinoma metastasises, it has a propensity for which type of spread?
A. Haematogenous
B. Implantation
C. Lymphatic
D. Transcoelomic
E. Transplantation
ANSWER : Haematogenous
27. Ondansetron is an effective antiemetic. Which of the following best describes
the mechanism of action of Ondansetron?
A. Histamine H1-receptor agonist
B. Histamine H1-receptor antagonist
C. Serotonin 5-HT3 receptor antagonist
D. Dopamine D2 receptor agonist
E. Dopamine D2 receptor antagonist
ANSWER : Serotonin 5-HT3 receptor antagonist

28. What type of joint is formed at the sacroiliac joint?

A. Primary cartilaginous
B. Secondary cartilaginous
C. Gomphosis
D. Condyloid
E. Synovial
ANSWER : Synovial

29. Which one of the following stages of the cell cycle is cell prepared for DNA
synthesis?
A. Synthetic phase (S)
B. Gap phase 1 (G1)
C. Gap phase 0 (G0)
D. Gap phase 2 (G2)
E. Mitotic phase (M)
ANSWER : Gap phase 1 (G1)

30. The formation of uric acid from purines is catalyzed by the action of
A. Nucleoside phosphorylase
B. Xanthine oxidase
C. Glutaminase
D. Urease
E. Uricase
ANSWER : Xanthine oxidase

31. A 19-year-old woman gives birth to her first child. She begins breast feeding the
infant. She continues breast feeding for almost a year with no difficulties and no
complications. Which of the following cellular processes that occurred in the breast
during pregnancy allowed her to nurse the infant for this period of time?
A. Stromal hypertrophy
B. Epithelial dysplasia
C. Steatocyte atrophy
D. Ductal dilation
E. Lobular hyperplasia
ANSWER : Lobular hyperplasia
32. What is the embryonic origin of the trigone of urinary bladder?
A. Mesonephric duct
B. Paramesonephric duct
C. Ureteric bud
D. Urogenital sinus
E. Caudal of cloaca
ANSWER : Mesonephric duct

33. Misoprostol is a commonly used drug in the medical treatment of miscarriage.

What type of drug is misoprostol?
A. Cyclooxygenase inhibitor
B. Progesterone antagonist
C. Synthetic prostaglandin E1 analogue
D. Synthetic prostaglandin E2 analogue
E. Synthetic prostaglandin f2α analogue
ANSWER : Synthetic prostaglandin E1 analogue

34. What is the most common contrast agent used for MRI examinations?
A. Iodine
B. Barium
C. Thallium
D. Gadolinium
E. Gallium
ANSWER : Gadolinium

35. Defective feedback control of calcium hemostasis may lead to secondary

hyperparathyroidism. It is usually associated with
A. Parathyroid gland tumour
B. Chronic liver disease
C. Thyroid carcinoma
D. Chronic kidney disease
E. Syndrome of inappropriate antidiuretic hormone (SIADH)
ANSWER : Chronic kidney disease

36. What is the mechanism of action of labetalol?

A. Antimuscranic
B. Selective alpha 1 receptors antagonist
C. Non selective beta receptors antagonist
D. Combines selective alpha 1 and non selective beta receptors antagonist
E. Direct-acting smooth-muscle relaxant
ANSWER : Combines selective alpha 1 and non selective beta receptors antagonist
37. The deep circumflex iliac artery is a branch of which artery?
A. Internal iliac artery
B. Internal pudendal artery
C. External iliac artery
D. Common iliac artery
E. Femoral artery
ANSWER : External iliac artery

38. What is the SI unit for the absorbed dose of ionizing radiation?
A. Gray
B. Sievert
C. Rad
D. Roentgen
E. becquerels
ANSWER : Gray

39. Which organ is the principal site of urea synthesis via the urea cycle?
A. Liver
B. Kidneys
C. GIT
D. Lungs
E. Bone marrow
ANSWER : Liver

40. What is the most common cause of caushing's syndrome?

A. Pituitary adenoma
B. Adrenal adenoma
C. Adrenal carcinoma
D. Adrenal hyperplasia
E. Iatrogenic steroid administration
ANSWER : Iatrogenic steroid administration

41. Which of the following is a remnant of the mesonephric duct in the female?
A. Round ligament
B. Ovarian ligament
C. Broad ligament
D. Gartner duct
E. Mullerian tubercle
ANSWER : Gartner duct

42. What is the most common cause of hyperprolactinemia?

A. Macroprolactinoma
B. Microprolactinoma
C. Primary hypothyroidism
D. Chronic renal failure
E. Pituitary stalk interruption syndrome (PSIS)
ANSWER: Primary hypothyroidism
43. Where in the kidney is the majority of bicarbonate reabsorbed?
A. Bowman's capsule
B. Collecting duct
C. Distal convoluted tubule
D. loop of Henle
E. proximal convoluted tubule
ANSWER: proximal convoluted tubule

44. What type of inheritance pattern does duchenne muscular dystrophy follow?
A. Mitochondrial
B. Autosomal dominant
C. Autosomal Recessive
D. X-Linked Dominant
E. X-Linked Recessive
ANSWER : X-Linked Recessive

45. What is the Lymphatic drainage of cervix and upper vagina?

A. Internal iliac LN
B. External iliac LN
C. Aortic LN
D. External iliac + internal iliac + common iliac + aortic LNs
E. External iliac + internal iliac + obturator + sacral LNs
ANSWER : External iliac + internal iliac + obturator + sacral LNs

46. Vertical transmission of HIV infection mostly occurs

A. In the first trimester
B. In the second trimester
C. In the third trimester
D. During labour and delivery
E. In the neonatal period through breastfeeding
ANSWER : During labour and delivery

47. From what parent compound are most eicosanoids derived?

A. Arachidonic acid
B. Leukotriene
C. Prostacyclin
D. Prostaglandins
E. Cholesterols
ANSWER : Arachidonic acid

48. What kind of epithelium lines the ectocervix?

A. Columnar
B. Statified Squamous, non keratinised
C. Statified Squamous, keratinised
D. Cuboidal
E. Transitional
ANSWER : Statified Squamous, non keratinized
49. A patient asks you how long it will be before her C-section wound is "at
maximum strength." What is the typical time taken for wounds closed by primary
intention to reach maximum tensile strength?
A. 14 days
B. 21 days
C. 42 days
E. 90 days
D. 120 days
ANSWER : 120 days

50. In the developing foetal testis, the cells that produce mullerian-inhibiting
substance are the
A. Interstitial cells of leydig
B. Interstitial macrophages
C. Sertoli cells
D. Myoid cells
E. Germ cells
ANSWER : Sertoli cells

51. A 27-year-old woman who is 8 weeks' gestation presents to your clinic with
increased sweating on her face. On examination there are no remarkable findings.
Which of the following endocrine glands is related to increase activity of sweat
glands during pregnancy?
A. Adrenal cortex
B. Placenta
C. Pancreas
D. Parathyroid
E. Thyroid
ANSWER : Thyroid

52. A 60-year-old woman presents with an erythematous erosive lichen planus on

the vulva. What type of cancer is linked to lichen planus?
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Merkel cell carcinoma
D. Malignant melanoma
E. Kaposi sarcoma
ANSWER : Squamous cell carcinoma

53. Which of the following hormones enhances urinary excretion of calcium?

A. Insulin
B. Cortisol
C. Calcitonin
D. parathyroid hormone
E. Antidiuretic hormone
ANSWER : Calcitonin
54. Which immunoglobulin is a key to passive neonatal immunity?
A. IgD
B. IgE
C. IgM
D. IgA
E. IgG
ANSWER : IgG

55. Which of the following tocolytic agents exert their effects by blocking the
function of the oxytocin receptor?
A. Atosiban
B. Magnesium sulphate
C. Nifedipine
D. Progesterone
E. Terbutaline
ANSWER : Atosiban

56. Which of the following hormones increase after ovulation and decrease the
proliferation of endometrium?
A. Progesterone
B. Follicle-stimulating hormone (FSH)
C. Estrogen
D. Luteinizing hormone (LH)
E. Gonadotropin-releasing hormone (GnRH)
ANSWER : Progesterone

57. You are assessing a patient with an ovarian mass and are using the Risk of
Malignancy Index (RMI) score. Which of the following is used to calculate the RMI?
A. U (ultrasound score) x M (menopause score) x Ca125 level
B. U (ultrasound score) + M (menopause score) + Ca125 level
C. U (ultrasound score) / M (menopause score) x Ca125 level
D. U (ultrasound score) x M (menopause score) / Ca125 level
E. U (ultrasound score) þ M (menopause score) / CA19-9 level
ANSWER : U (ultrasound score) x M (menopause score) x Ca125 level

58. What is the most common adverse effect experienced by women using depot
medroxyprogesterone acetate (DMPA)?
A. Menstrual abnormalities
B. Loss of bone mineral density
C. Weight gain
D. Injection site reactions
E. Headache
ANSWER : Menstrual abnormalities
59. A 24-year-old female presents with a 2-year history of infertility. An
endometrial biopsy is obtained approximately 5 to 6 days after the predicted time
of ovulation. This biopsy specimen reveals ''marked glandular growth and mitosis,
stromal edema with subnuclear vacuoles and prominent coiled spiral arterioles''
This finding are consistent with what histological type of endometrium?
A. Atrophic
B. Proliferative
C. Secretory
D. Simple Hyperplasia
E. Arias-Stella phenomenon
ANSWER : Secretory

60. A 28-day-old baby is brought to the clinic because of projectile vomiting after
feeding. Until this time, the baby has had no problems in feeding. On examination,
a small knot is palpated at the right costal margin. A diagnosis of hypertrophic
pyloric stenosis is suspected. Which metabolic abnormalities are seen in congenital
hypertrophic pyloric stenosis?
A. Hypochloremic hypokalemic metabolic alkalosis
B. Hyperchloremic hypokalemic metabolic alkalosis
C. Hypochloremic hypokalemic metabolic acidosis
D. Hyperchloremic hyperkalemic metabolic acidosis
E. Hyperchloremic hypokalemic metabolic acidosis
ANSWER : Hypochloremic hypokalemic metabolic alkalosis

61. Following is the narrowest part of fallopian tube?

A. Intramural part
B. Isthmus
C. Ampulla
D. Infundibulum
E. Fimbriae
ANSWER : Isthmus

62. Lancefield grouping of streptococci is based on the presence of

A. Carbohydrate antigen on cell wall
B. Hemolytic reactions on blood agar
C. M protein
D. Pigment production
E. Sugar fermentation
ANSWER : Carbohydrate antigen on cell wall

63. Which enzyme found in red blood cells which buffers blood CO 2?
A. Cytochrome-b5 reductase
B. 5-nucleotidase
C. Glucose-6-phosphate dehydrogenase
D. Carbonic anhydrase
E. Pyruvate kinase
ANSWER : Carbonic anhydrase
64. A 35-year-old pregnant woman with multiple drug resistant (MDR) tuberculosis
is receiving prolonged treatment with streptomycin. Prolonged administration of
streptomycin during pregnancy may result damage to the
A. Optic nerve
B. Trigeminal nerve
C. Facial nerve
D. Vestibulocochlear nerve
E. Glossopharyngeal nerve
ANSWER : Vestibulocochlear nerve

65. Increased glomerular filtration rate during normal pregnancy is a physiological

finding results mainly from
A. Increased cardiac output
B. Increased Plasma volume
C. Decreased peripheral vascular resistance
D. Constriction of the afferent arteriole
E. Compression of the renal capsule
ANSWER : Increased Plasma volume

66. Which of the following describes the correct order of musculature of the anal
canal from deep to superficial?
1. Deep part of external sphincter
2. Subcutaneous part of external sphincter
3. Internal sphincter
4. Superficial part of external sphincter
A. 1,4,2,3
B. 2,1,4,3
C. 3,1,4,2
D. 3,2,1,4
E. 2,4,1,3
ANSWER : 3,1,4,2

67. A 33-year-old woman with an intrauterine contraceptive device develops

symptoms of acute salpingitis. On laparoscopy, sulfur granules appear at the
fimbria of the tubes. Which of the following is the most likely organism?
A. C. trachomatis
B. Nocardia species
C. N. gonorrhea
D. T. pallidium
E. Actinomyces species
ANSWER : Actinomyces species
68. A 30-years-old primigravida presents in a spontinous labour at 41 weeks of
gestation. On vaginal examination the cervix is 8 cm dilated and the position of the
vertex is left occipto-posterior. What is the presenting diameter?
A. Bitemporal
B. Occipito Frontal
C. Submento Bregmatic
D. Sub-occipito Bregmatic
E. Vertico Mental
ANSWER : Occipito Frontal

69. A neoplasm of the female genital tract occurring in an 18-year-old girl whose
mother was treated with diethylstilbestrol during the pregnancy is likely to be a
A. Brenner cell tumor of ovary
B. Teratoma of ovary
C. Sarcoma botryoides of vagina
D. Clear cell carcinoma of vagina
E. Squamous cell carcinoma of vulva
ANSWER : Clear cell carcinoma of vagina

70. Six hours after undergoing a laparoscopic tubal ligation, a 32-year-old woman
complains of suprapubic pain and oozing. On examination there is a tender
palpable suprapubic mass rising up to the umbilicus that is dull to percussion. Her
hemoglobin level is 11 g/dl. What is the most likely diagnosis?
A. Bladder injury
B. Intra-abdominal bleeding
C. Ureteric trauma
D. Urinary retention
E. Fluid overload
ANSWER : Urinary retention

71. A grand multiparous woman has a postpartum haemorrhage soon after

delivery. One liter of a colloid solution has already been given intravenously. She
has a pulse rate of 140 beats per min, is anxious, confused and hypotensive with a
capillary refill time of 3 seconds. What do you think is the estimated blood loss as a
percentage of blood volume thus far based on clinical findings?
A. 5-10%
B. 15-20%
C. 25-30%
D. 30-40%
E. 45-55%
ANSWER : 45-55%
72. A 31-year-old nulliparous woman has heavy bleeding at 8 weeks’ gestation. An
early pregnancy scan is suggestive of a molar pregnancy, and no fetus is observed.
What is the most likely genotype of a complete molar pregnancy?
A. 46 XX
B. 46 XY
C. 69 XXX
D. 69 XXY
E. 92 XXXY
ANSWER : 46 XX

73. Mechanism of action of Neostigmine is

A. Choline ester
B. Cholinomimetic
C. Muscarinic antagonist
D. Anticholinesterase
E. Nicotinic antagonist
ANSWER : Anticholinesterase

74. Which term best describes a homogeneously black area on an ultrasound

image?
A. Anechoic
B. Hypoechoic
C. Isoechoic
D. Hyperechoic
E. Normoechoic
ANSWER : Anechoic

75. Which of the following arteries may occasionally arise as a branch of the
external iliac artery or inferior epigastric artery instead of as a branch of the
internal iliac artery?
A. Internal pudendal artery
B. Obturator artery
C. Superior gluteal artery
D. Umbilical artery
E. Uterine artery
ANSWER : Obturator artery

76. Blood supply to the medial part of the anterior abdominal wall below the
umbilicus
A. Superficial epigastric artery
B. Superior epigastric artery
C. Superior mesenteric artery
D. Inferior epigastric artery
E. Inferior mesenteric artery
ANSWER : Inferior epigastric artery
77. Some-town in the UK, has a population of 350,000. During 2010, data
pertaining to deliveries and there outcome is as follows:
Total number of live births: 20000
Total number of in utero deaths delivered bet. 22+0 and 23+6 weeks gestation: 200
Total number of stillbirths: 140
Total number of neonatal deaths during first week after birth: 40
Total number of neonatal deaths during second to fourth weeks after birth: 80
Which of the following represents the perinatal mortality rate in this town during
2009?
A. 140/20,120
B. 140/20,120
C. 180/20,140
D. 180/20,260
E. 380/20,140
ANSWER : 180/20,140
perinatal mortality rate (UK) = Stillbirths (≥24W) + Early neonatal
deaths (1st W) / Total live births + Stillbirths
perinatal mortality rate (WHO) = Late fetal losses (between 22 +0 and 23+6) +
Stillbirths (≥24W) + Early neonatal deaths (1st W) / Total live births + Stillbirths

78. A 30-year-old woman with bipolar disorder is 12-week pregnant. She has been
taken her lithium every night. Which of the following abnormality may occur if she
continues to take lithium?
A. Tetralogy of Fallot's
B. Dandy walker syndrome
C. Ebstein's anomaly
D. Limb reduction deformity
E. Renal agenesis
ANSWER : Ebstein's anomaly

79. Which part of the cell cycle is noted for sister chromatids separating and
moving to opposite sides of the cell?
A. Anaphase
B. Metaphase
C. Prophase
D. Synthesis phase
E. Telophase
ANSWER : Anaphase

80. Remifentanil is an ideal controlled analgesia for management of labour pain

because
A. It is a strong μ receptor antagonist
B. It has a long duration of action
C. It is rapidly metabolized by tissue estrases
D. Multiple smaller doses over time decrease the incidence of side effects
E. It cannot cross the placenta
ANSWER : It is rapidly metabolized by tissue estrases
81. In the development of the oocyte, when does the second meiotic division
occur?
A. At birth
B. At fertilisation
C. At menarche
D. At ovulation
E. Before fertilisation
ANSWER : At fertilisation

82. A 48-year-old woman visits her GP complaining of pain on the inner surface of
her right thigh. A detailed history reveals that she has recently experienced some
dull, diffuse pain in the lower right abdominal wall. She is sent for a CT scan which
reveals an inflamed right ovary. Which nerve is referring pain from the parietal
peritoneum near the ovary to the inner thigh?
A. Ilioinguinal
B. Saphenous
C. Anterior femoral cutaneous
D. Obturator
E. Femoral
ANSWER : Obturator

83. The following cell contain haploid number of chromosomes and results after
completion of the 1st meiotic division
A. Oogonium
B. 2nd polar body
C. 1ry oocyte
D. 2ry oocyte
E. Zygot
ANSWER : 2ry oocyte

84. Which of the following techniques is used to increase the number of copies of a
specific DNA sequences?
A. Western blotting
B. Southern blotting
C. DNA chip
D. Polymerase chain reaction (PCR)
E. Fluorescent in situ hybridization (FISH)
ANSWER: Polymerase chain reaction (PCR)

85. A 40-year-old female suffers from a 2 x 2-cm vulval lesion. Biopsy demonstrates
a malignant melanoma. The prognosis of this tumour best depends upon
A. Grade of tumour
B. Darkness of lesion
C. Degree of color variation
D. Depth of invasion
E. Duration of the growth
ANSWER : Depth of invasion
86. The estrogen receptor is an example of a
A. Guanylate cyclase receptor
B. Nuclear transcription factor
C. Tyrosine kinase nuclear receptor
D. Ligand-gated ion channel in the cell membrane
E. G protein coupled receptor on the Golgi complex
ANSWER : Nuclear transcription factor

87. A 28-year-old woman has undergone emergency hysterectomy due to obstetric

haemorrhage during her 3rd pregnancy. The previous pregnancies were both term
C-section deliveries. Examination of the uterus shows the placenta had invaded the
myometrium up to the serosa. What is the most likely diagnosis?
A. Placenta praevia
B. Placenta accreta
C. Placenta increta
D. Invasive mole
E. Placenta percreta
ANSWER : Placenta increta

88. Which of the following metabolic processes produces the most energy needed
for uterine contraction during parturition?
A. Aerobic glycolysis
B. Anaerobic glycolysis
C. krebs cycle
D. Oxidative phosphorylation
E. Beta oxidation
ANSWER : Oxidative phosphorylation

89. A couple with primary subfertility, who have been trying to conceive for over
12 months, attends a reproductive medicine clinic. The male partner has already
given a semen sample for analysis with the following results:
Progressive motility: 35%
Total sperm number: 32 million spermatozoa
Normal morphology: 5%
Vitality: 63% live spermatozoa
Liquefaction time: 30 min
pH: 7.3
What is the correct interpretation of this semen analysis?
A. Normal semen analysis
B. Low sperm count (oligospermia)
C. Decreased motility (Asthenospermia)
D. High ph indicate an infection
E. Teratospermia
ANSWER : Normal semen analysis
90. What is the most common inherited bleeding disorder?
A. Von Willebrand’s disease
B. Hemophilia A
C. Hemophilia B
D. Protein C deficiency
E. Thrombotic thrombocytopenic purpura
ANSWER : Von Willebrand’s disease

91. Which of the following structure consists of two bands of connective tissue and
also support the bladder?
A. Urachus
B. Pubocervical ligament
C. Uterosacral ligament
D. Coccygeus muscle
E. Levator ani muscle
ANSWER : Pubocervical ligament

92. A 40-year-old woman complains of heavy menstrual bleeding for five years.
Ultrasound scan has revealed no abnormality. Her family is complete. She desires
an endometrial ablation. Which part of the uterus must be destructed to stop
bleeding?
A. The basal layer of endometrium
B. The functional layer of endometrium
C. Both layer of endometrium
D. The entire myometrium
E. The spiral artery
ANSWER : Both layer of endometrium

93. The rate of growth hormone secretion follows a circardian rhythm. When is the
highest peak of growth hormone release?
A. Early morning
B. After exercise
C. Afternoon
D. Early sleep
E. Deep sleep
ANSWER : Deep sleep

94. The optimal ratio between suture and wound length that is associated with a
lower rate of incisional hernia is
A. 5:1
B. 4:1
C. 1:2
D. 2:1
E. 1:1
ANSWER : 4:1
95. Which nerve is identified by its position on the anterior surface of the psoas
major muscle?
A. Ilioinguinal
B. Femoral
C. Obturator
D. Genitofemoral
E. lateral femoral cutaneous
ANSWER : Genitofemoral

96. How many days does it take from the resting follicle stage to ovulation?
A. 14 days
B. 25 days
C. 80 days
D. 120 days
E. 300 days
ANSWER : 300 days

97. The capsule of the developing Graafian follicle is

A. Theca interna
B. Theca externa
C. Zona pellucida
D. Zona granulosa
E. Lamina propria
ANSWER : Theca externa

98. The probability of sarcomatous change occurring in uterine fibroids is

A. 1/5
B. 1/10
C. 1/100
D. 1/1000
E. 1/3000
ANSWER : 1/1000

99. After an elective caesarean section the anesthetic team decided to perform an
ultrasound-guided transversus abdominis plane block for analgesia. If the needle is
correctly positioned where will be deposit the local anesthetic
A. Beneath the peritoneum
B. Into the transversus abdominis muscle
C. Between the transversus abdominis muscle and the internal oblique muscle
D. Between the transversus abdominis muscle and the external oblique muscle
E. Between the internal oblique and the external oblique muscle
ANSWER : Between the transversus abdominis muscle and the internal oblique
muscle
100. The most common in uetro infection causing fetal anemia in the UK is
A. Syphilis
B. Toxoplasmosis
C. Rubella
D. Parvovirus B19
E. Cytomegalovirus
ANSWER : Parvovirus B19

101. A 25-year-old woman has a routine smear test for the first time. She
complains of discomfort during the procedure. Which nerve or nerve plexus
provided sensory innervations to the cervix?
A. Pudendal nerve
B. Sacral splanchnic nerve
C. Pelvic splanchnic nerve
D. Superior hypogastric plexus
E. Inferior hypogastric plexus
ANSWER : Pelvic splanchnic nerve

102. In a female who has BRCA 1 gene, besides hereditary breast and ovarian
cancer, what is the next most common cancer she may develop?
A. Cancer colon
B. Cancer stomach
C. Pancreatic cancer
D. Cervical cancer
E. Endometrial cancer
ANSWER : Pancreatic cancer

103. What is the most common clinically significant congenital heart disease?
A. Atrial septal defect
B. Ventricular septal defect
C. Patent ductus arteriosus
D. Tetralogy of Fallot
E. Coarctation of aorta
ANSWER : Ventricular septal defect

104. Warfarin inhibits which clotting factors?

A. Factor II
B. Factor V
C. Factor VI
D. Factor VIII
E. Factor XI
ANSWER : Factor II
105. The enzyme which builds an mRNA strand complimentary to the DNA
transcription unit is called?
A. DNA polymerase
B. RNA polymerase
C. Reverse transcriptase
D. Helicase
E. DNA ligase
ANSWER : RNA polymerase

106. Haemophilus ducreyi is the causative agent of

A. Hard chancre
B. Chancroid
C. Granuloma inguinale
D. Lymphogranuloma venereum
E. Sarcoid
ANSWER : Chancroid

107. Which of the following divisions of cell growth precedes Mitosis in the cell
cycle?
A. Synthetic phase (S)
B. Gap phase 1 (G1)
C. Gap phase 0 (G0)
D. Gap phase 2 (G2)
E. Gap phase 3 (G3)
ANSWER : Gap phase 2 (G2)

108. A 26-year-old pregnant woman is found to have an Hb of 11 g/dL on a routine

blood test, with an MCV of 70. Serum electrophoresis reveals an Hb F of 0.5 per
cent, Hb A1 of 60 per cent, Hb A2 of 2 per cent and Hb S of 40 per cent. Her ferritin
levels are normal. The most likely diagnosis is
A. Iron deficiency anemia
B. α-thalassemia
C. β-thalassemia
D. Sickle cell trait
E. Sickle cell disease
ANSWER : Sickle cell trait

109. A 22-year-old primiparous woman books her pregnancy at 11 weeks’

gestation. Her booking blood tests reveal a haemoglobin level of 10.1 g/dL.
Haemoglobin electrophoresis reveals homozygous for HbS, she has no HbA
A. Sickle cyprositis
B. Sickle cell disease
C. Sickle cell trait
D. Sickle cell anemia
E. Sickle beta thalassemia
ANSWER : Sickle cell anemia
110. A 28-year-old Asian woman G2P2 is 26 weeks pregnant. Her BMI is 30 kg/m2.
Her oral glucose tolerance test reports (75 g load) are as follows:
Fasting serum glucose: 4.2 mmol/l
2-hour serum glucose: 7.4 mmol/l
What is the diagnosis?
A. Normal
B. Impaired glucose tolerance
C. Impaired fasting glucose
D. Postprandial hyperglycemia
E. Gestational D.M
ANSWER : Normal

111. You see a patient on the ward who is acutely short of breath and perform an
arterial blood gases (ABG). The results are as follows:
pH 7.25
pO2 8.6 kPa
pCO2 8.4 kPa
HCO3- 28 mmol/l
What is the acid-base disturbance?
A. Mixed Alkalosis
B. Respiratory Acidosis
C. Respiratory Alkalosis
D. Metabolic Acidosis
E. Metabolic Alkolosis
ANSWER : Respiratory Acidosis

112. Which hemoglobin (Hgb) result represents the lowest acceptable value for a
woman in the second trimester of pregnancy?
A. 9.5 g/dl
B. 10 g/dl
C. 10.5 g/dl
D. 11 g/dl
E. 11.5 g/dl
ANSWER : 10.5 g/dl

113. Terbutaline is a β-adrenergic receptor stimulator that is used to arrest

preterm labor. Which of the following is a major maternal risk of its use?
A. Hypertension
B. Decreased plasma glucose
C. Decreased serum potassium
D. Tachyarrhythmia
E. Asthma
ANSWER : Tachyarrhythmia
114. A 32-year old woman complains of amenorrhea since delivery of a baby 15
months ago. The delivery was complicated by excessive hemorrhage that required
transfusion of 2.5 liters of blood. Few days later she complained of failure to
produce any breast milk. The most likely cause for this is damage to which of the
following endocrine glands?
A. Hypothalamus
B. Anterior pituitary
C. Posterior pituitary
D. Thyroid
E. Adrenal cortex
ANSWER : Anterior pituitary

115. During which week of pregnancy are normal cardiovascular and hematological
changes early begin?
A. 4 weeks
B. 8 weeks
C. 10 weeks
D. 12 weeks
E. 14 weeks
ANSWER : 4 weeks

116. Which of the following eicosanoids cause arteriolar vasospasm before

menstruation?
A. Leukotriene LTB4
B. Thromboxane TXA2
C. Prostacyclin PGI2
D. Prostaglandin E2
E. Prostaglandin F2α
ANSWER : Prostaglandin F2α

117. One month after cesarean section, a 25 year old woman palpates a small
nodule beneath the skin at the site of the healed incision. The skin was closed
using absorbable sutures. The nodule is excised, and polarizable refractile material
is seen in the nodule. Which of the following cell types is most likely to be most
characteristic in this inflammatory response?
A. Neutrophil
B. Macrophage
C. Plasma cell
D. Lymphocyte
E. Langhans giant cell
ANSWER : Langhans giant cell
118. Which two HPV subtypes are responsible for around 90% of genital warts and
are targeted in HPV vaccines?
A. 6 and 11
B. 16 and 18
C. 31 and 35
D. 31 and 45
E. 73 and 82
ANSWER : 6 and 11

119. A 16-year-old girl has recently become sexually active. She complains of
intensely irritating greenish frothy vaginal discharge. The organism is seen under
microscope in a drop of saline and PH is 6. What is the most likely causative
organism?
A. Candida albicans
B. Chlamydia trachomatis
C. Gardnerella vaginalis
D. Neisseria gonorrhoeae
E. Trichomonas vaginalis
ANSWER : Trichomonas vaginalis

120. Caput medusae are due to engorgement of which of the following vessels?
A. Hepatic vein
B. Splenic vein
C. Umbilical vein
D. Umbilical artery
E. Superficial epigastric artery
ANSWER : Umbilical vein

121. Regarding cardiac changes during pregnancy. Which of the following ECG
findings during pregnancy should be considered normal?
A. Prolonged QT interval
B. Absent QRS complex
C. T-wave flattening in lead II
D. Q-wave in lead III and aVF
E. Right axis deviation due to elevated diaphragm
ANSWER : Q-wave in lead III and aVF

122. A woman is 8 weeks pregnant attends for genetic counseling. She is known to
be a carrier of cystic fibrosis and her sister has a child with cystic fibrosis. Her
husband is Caucasian and the carrier rate for cystic fibrosis in the Caucasian
descent is 1 in 25. What is the risk of the child having cystic fibrosis?
A. 1%
B. 12.5%
C. 25%
D. 75%
E. 100%
ANSWER : 1%
123. A woman and her husband are known carriers of cystic fibrosis. What is the
probability of them having an affected child?
A. 1%
B. 12.5%
C. 25%
D. 50%
E. 75%
ANSWER : 25%

124. A 30-year-old woman primiparous at 34 weeks' gestation comes to the

prenatal facility concerned about reddish purple striae she has increasingly
developed on her breast and abdomen. Which of the following hormones is the
most likely responsible for her symptoms?
A. Melanocyte-stimulating hormone
B. Estrogen
C. Progesterone
D. Aldosterone
E. Cortisol
ANSWER : Cortisol

125. The process of programmed gene directed cell death characterized by

blebbing, cell shrinkage, nuclear condensation and fragmentation is known as
A. Apoptosis
B. Autophagy
C. Pyknosis
D. Chromatolysis
E. Necrosis
ANSWER : Apoptosis

126. You see a 21-year-old woman in clinic complaining of vaginal discharge for the
last 3 days. She has recently become sexually active with a new boyfriend. Analysis
of the discharge reveals gram-negative intracellular diplococci with scant
neutrophils. Which organism is most likely to be responsible?
A. Chlamydia trachomatis
B. Neisseria gonorrhoeae
C. Gardnerella vaginalis
D. Treponema pallidum
E. Mycoplasma hominis
ANSWER : Neisseria gonorrhoeae

127. The most biologically active form of vitamin D is

A. Calcidiol
B. Ergosterol
C. 7-dehydrocholesterol
D. 1, 25-Dihydroxycholecalciferol
E. 24, 25-Dihydroxycholecalciferol
ANSWER : 1, 25-Dihydroxycholecalciferol
128. You review a 65-year-old woman with known urinary urgency and prescribe
oxybutynin. Which of the following diseases is aggravated by the use of this drug?
A. Parkinsonism
B. Bronchial asthma
C. Closed angle glaucoma
D. Diabetes mellitus
E. Diarrhea
ANSWER : Closed angle glaucoma

129. Which of the following drugs is most appropriate for treating uncomplicated
Chlamydia?
A. Azithromycin
B. Clindamycin
C. Neomycin
D. Penicillin
E. Metronidazole
ANSWER : Azithromycin

130. A 26-year-old woman has just given birth and her newborn baby undergoes
assessment. His body is pink with blue extremities and has a pulse of 105 bpm. He
appears to be limp and taking slow, gasping breaths. He also grimaces in response
to stimuli. What is his APGAR score?
A. 4
B. 5
C. 6
D. 7
E. 8
ANSWER : 5

131. A 23-year-old primigravida is booked with midwife at 21 weeks. She reveals

that she had female circumcision done when she was a child. On examination the
clitoris is completely absent. You are to document the type of female genital
mutilation. What type of female genital mutilation is this best described as?
A. Type 1
B. Type 2
C. Type 3
D. Type 4
E. Atypical presentation
ANSWER : Type 1

132. The most common cause of delay in puberty in males is

A. Constitutional delay in growth
B. Klinefelter's syndrome
C. Low BMI
D. Pituitary failure
E. Primary hypothyroidism
ANSWER : Constitutional delay in growth
133. What is the mechanism of antibacterial action of penicillin?
A. Alteration of cell membrane permeability
B. Inhibition of cell wall synthesis
C. Inhibition of arabinogalactan synthesis
D. Inhibition of nucleic acid synthesis
E. Inhibition of folate metabolism
ANSWER : Inhibition of cell wall synthesis

134. The ratio between indirect to direct maternal cause of death in UK is

A. 1:2
B. 2:1
C. 1:3
D. 3:1
E. 1:1
ANSWER : 2:1

135. What type of joint is formed at the symphysis pubis?

A. Fibrous
B. Primary cartilaginous
C. Secondary cartilaginous
D. Synarthrodial
E. Synovial
ANSWER : Secondary cartilaginous

136. Which muscles form the pelvic diaphragm?

A. Levator ani and coccygeus
B. Levator ani and piriformis
C. Obturator internus and coccygeus
D. Obturator internus and levator ani
E. Obturator internus and piriformis
ANSWER : Levator ani and coccygeus

137. Biological actions of progesterone on estrogen include which of the following?

A. Estrogen precursor
B. Methylation of estrogen receptors gene
C. Decreased estrogen receptors
D. Increased sex hormone binding globulins (SHBG)
E. Stimulation of the estrogen positive feedback in the luteal phase
ANSWER : Decreased estrogen receptors

138. Which is the commonest type of malignant ovarian neoplasm?

A. Endometrioma
B. Serous cystadenoma
C. Clear cell carcinoma
D. Germinal cell carcinoma
E. Mucinous cystadenoma
ANSWER : Serous cystadenoma
139. At the end of surgery you notice an area of burn near the attached diathermy
plate. The diathermy plate seems to be partially detached. Which of the following
would be the most likely aetiology?
A. Due to the plate not being secured properly, the current density was concentrated
in the smaller area where the plate was attached
B. High voltage was used
C. The injury may have resulted from insulation failure
D. The power output was accidentally turned up
E. The surgeon may have accidently touched the instrument to the patient’s thigh
ANSWER : Due to the plate not being secured properly, the current density was
concentrated in the smaller area where the plate was attached

140. Which type of pituitary gland tumors increase growth hormone secretion lead
to acromegaly?
A. Adenoma
B. Glioma
C. Fibroma
D. Sarcoma
E. Schwannoma
ANSWER : Adenoma

141. The ovarian artery is a branch of

A. Abdominal aorta
B. Common iliac artery
C. External iliac artery
D. Internal iliac artery
E. Uterine artery
ANSWER : Abdominal aorta

142. A 62-year-old postmenopausal woman presents for her annual physical exam.
On exam of you find a small pink exophytic lesion outgrowth out of the urethra.
Otherwise there is no remarkable finding. What is the most likely diagnosis?
A. Urethrocele
B. Urethral caruncle
C. Urethral diverticulum
D. Condyloma acuminatum
E. Squamous cell carcinoma
ANSWER : Urethral caruncle

143. Which type of cell junctions helps in transmission of small molecules or ions
from one cell to another?
A. Adherens junctions
B. Desmosomes
C. Diffusion spheres
D. Tight junctions
E. Gap junctions
ANSWER : Gap junctions
144. A 15-year-old girl attends the genitourinary medicine clinic complaining of
frothy yellow vaginal discharge. She is sexually active with her 17-year-old
boyfriend and uses the oral contraceptive pill. Speculum examination reveals
haemorrhages on her cervix. A urine pregnancy test is negative. Considering the
most likely diagnosis, what is the most appropriate first line antibiotic?
A. Amoxicillin
B. Azithromycin
C. Metronidazole
D. Entamizole
E. Spiramycin
ANSWER : Metronidazole

145. Which of the following investigations is used to determine hormone receptor

expression 'receptor status' of the breast cancer?
A. Mammogram
B. Magnetic resonance imaging
C. Fine needle aspiration cytology
D. Immunohistochemical staining
E. Pestron emission computed tomography
ANSWER : Immunohistochemical staining

146. A 24-year-old female presents with severe pain during menses. To treat her
symptoms, you advise her to take indomethacin in the hopes that it will reduce her
pain. What type of drug is indomethacin?
A. Mixed opioid agonist antagonist
B. Cyclo-oxygenase inhibitor
C. Derivative of 17α-ethinyltestosterone
D. Synthetic prostaglandin analogue
E. Synthetic steroid hormone
ANSWER : Cyclo-oxygenase inhibitor

147. Which neurotransmitter is secreted onto the adrenal medulla?

A. Acetylcholine
B. Norepinephrine
C. Epinephrine
D. Dopamine
E. Serotonin
ANSWER : Acetylcholine

148. Which of the following defines perinatal mortality using the International
classification of diseases-10 (ICD-10)?
A. Number of stillbirths from 20 weeks and 7 days neonatal deaths
B. Number of stillbirths from 22 weeks and 7 days neonatal deaths
C. Number of stillbirths from 24 weeks and 7 days neonatal deaths
D. Number of stillbirths from 22 weeks and 28 days neonatal deaths
E. Number of stillbirths from 24 weeks and 28 days neonatal deaths
ANSWER : Number of stillbirths from 22 weeks and 7 days neonatal deaths
149. A 27-year-old woman has a smear test as part of the UK screening
programme. Following an abnormal result she attends a colposcopy clinic. On
colposcopy, the whitened appearance of her cervix on application of acetic acid is
suggestive of a human papilloma virus (HPV) infection. Which of the following HPV
subtypes is high-risk for the development of cervical intraepithelial neoplasia?
A. HPV 1, 2
B. HPV 6, 11
C. HPV 16, 18
D. HPV 32, 34
E. HPV 73, 82
ANSWER : HPV 16, 18

150. The non pregnant uterus of a 20-year-old female measured 7 x 4 x 3 cm. She
became pregnant, and just before delivery of a term infant, the uterus measured
34 x 18 x 12 cm. Which of the following cellular processes was the major reason for
the increase in the size of the uterus?
A. Endometrial glandular hyperplasia
B. Myometrial fibroblast proliferation
C. Endometrial stromal hypertrophy
D. Myometrial smooth muscle hypertrophy
E. Vascular endothelial hyperplasia
ANSWER : Myometrial smooth muscle hypertrophy

151. A 27-year-old woman is seen because it is exactly 8 weeks since her last
menstrual period, which was on March 1, 2016. Her menstrual cycles had
previously been regular with a 35-day interval. What is this patient’s estimated
date of delivery?
A. February 8 of the next year
B. February 11 of the next year
C. December 8 of the same year
D. December 11 of the same year
E. December 15 of the same year
ANSWER : December 15 of the same year

152. A 47-year- old woman with choriocarcinoma is treated with very high doses of
methotrexate. You anticipate significant host cell toxicity so immediately after
giving methotrexate you administer which of the following agents?
A. Erythropoietin
B. MESNA (2-mercaptoethane sulfonate)
C. Acetylcysteine
D. Foloinic acid
E. Folic acid
ANSWER : Foloinic acid
153. A 27-year-old woman is 2 weeks' postpartum with her first child. Suddenly
she becomes very tearful, irritable and sleepless. She has strange thoughts of
hurting herself and feels it difficult to breast-feed her baby. Her physical
examination is within normal limits. Which of the following is the best term to
describe her symptoms?
A. Maternity blues
B. Bipolar disorder
C. Schizophrenia
D. Postpartum depression
E. Postpartum psychosis
ANSWER : Postpartum psychosis

154. Healthcare workers must have appropriate safe disposal of sharps waste.
Sharps containers must be located in a safe position to avoid spillage. According to
NICE guidance where we have to put the sharps containers in the hospital?
A. Out of reach of kids and visitors
B. Near to medication cupboard
C. Near to garbage
D. Under patient's beds
E. Outside the hospital wards
ANSWER : Out of reach of kids and visitors

155. A woman presents at 12 weeks of pregnancy. She has had two previous
spontaneous abortions at the first trimester. She has had one live birth at term
with the birth of a live baby at 26 weeks who died within a few minutes. Which
one of the following correctly expresses her gravidity and parity?
A. Gravida 4 Para 1 + 2
B. Gravida 4 Para 2 + 2
C. Gravida 5 Para 1 + 2
D. Gravida 5 Para 2 + 2
E. Gravida 5 Para 1 + 3
ANSWER : Gravida 5 Para 2 + 2

156. Glucose-6-phosphatase deficiency is a common metabolic disease in Africa.

What is the function of the enzyme glucose-6-phosphatase in carbohydrate
metabolism?
A. Adds glucose to glycogen ends
B. Adds phosphate to glucose
C. Production of ATP in aerobic and anaerobic oxidation
D. Production of NADPH in red blood cells
E. Converts glucose-6-phosphate to glucose
ANSWER : Converts glucose-6-phosphate to glucose
157. A newborn girl is found to have multiple midline malformations. Her physician
suspects a chromosomal disorder and orders a karyotype (picture below).

Which of the following is the most likely diagnosis?

A. Cri-du-chat syndrome
B. Down syndrome
C. Turner syndrome
D. Edward syndrome
E. Patau syndrome
ANSWER : Patau syndrome

158. The null hypothesis states that a given variable is without effect. What type of
error is present when the null hypothesis is incorrectly not rejected?
A. Type I error
B. Type II error
C. Type III error
D. Type IV error
E. Type V error
ANSWER : Type II error

159. In the development of the oocyte, when does the second meiotic is
completed?
A. At birth
B. At fertilization
C. At menarche
D. At ovulation
E. Before fertilization
ANSWER : At fertilization
160. A 45-year-old female patient with a history of ischaemic heart disease is being
reviewed in the pre-operative clinic prior to undergo endometrial ablation. You
review her Electrocardiogram (ECG) below:

Which of the following is the most likely diagnosis?

A. Atrial flutter
B. 1st degree heart block
C. 2nd degree heart block
D. 3rd degree heart block
E. Wolff-parkinson-white syndrome
ANSWER : 3rd degree heart block

161. Forms the lateral wall of the ischio-rectal fossa

A. Skin
B. Anal canal
C. Obturator internus fascia
D. Vagina
E. Rectum
ANSWER : Obturator internus fascia

162. You are fast-bleeped to attend a major post-partum hemorrhage on labour

ward. The midwife estimates that the patient has lost approximately 1000 ml of
blood. The patient requires many units of blood transfusion, after how many units
of packed red cells transfusion fresh frozen Plasma should be given?
A. Two units
B. Three units
C. Four units
D. Five units
E. Six units
ANSWER : Six units
163. The following diagram is concerning about a 12-day-old blastocyst.

Which of the following regions is represented by the arrow?

A. Allantois
B. Yolk sac
C. Amniotic cavity
D. Chorionic cavity
E. Extraembryonic coelom
ANSWER : Amniotic cavity

164. A 25-year-old woman who is 20 weeks pregnant was admitted via A&E with
severe loin pain, shivering and vomiting. Her temperature is 38.8°C, pulse is 110
bpm and blood pressure is 88/56 mmHg. Urine dip shows leucocytes ++ and
protein ++. Her midstream urine sample result shows:
Culture: E.coli +++
Sensitivities:
Trimethoprim: Resistance
Amoxicillin: Resistance
Nitrofurantoin: Sensitive
Cephalexin: Sensitive
Gentamicin: Sensitive
What is the drug of choice for the treatment?
A. Trimethoprim oral
B. Nitrofurantoin oral
C. Cephalexin oral
D. Cephalexin injection
E. Gentamicin injection
ANSWER : Cephalexin injection

165. Which system organs have the highest risk of teratogenicity in the embryonic
period?
A. Cardiovascular system
B. Genitourinary system
C. Respiratory system
D. Digestive system
E. Central nervous system
ANSWER : Genitourinary system
166. A 25-year-old woman presents with right-sided pelvic pain for more than one
year. An ultrasound scan is arranged which shows a 5 cm well-defined cystic lesion
in the right adnexa with mixed echoes. There is no fluid in the cul-de-sac with the
following sonographic image:

What is the most likely diagnosis for the image of the adnexa?
A. Benign cystic teratoma
B. Endodermal sinus tumour
C. Endometrioma
D. Mucinous cystadenoma
E. Serous cystadenoma
ANSWER : Benign cystic teratoma

167. You are carrying out analysis of a new test for DVTs and decide to plot a
receiver operating characteristic curve. What are the axes of the curve?
A. Sensitivity versus Specificity
B. Specificity versus Sensitivity
C. Positive Predictive Value versus Negative Predictive Value
D. Sensitivity versus (1-Specificty)
E. (1-Sensitivity) versus Specificity
ANSWER : Sensitivity versus (1-Specificty)

168. Which antibiotic is effective against staph. aurus exotoxin?

A. Vancomycin
B. Co-amoxiclave
C. Metronidazole
D. Methicillin
E. Clindamycin
ANSWER : Clindamycin
169. Consider the figure. Muscle lactate is transported in liver and converted to
glucose by the process of

A. Rapport luebering cycle

B. Glucose alanine cycle
C. Cori's cycle
D. Citric acid cycle
E. Glycolysis
ANSWER : Cori's cycle

170. A 42-year-old woman presents in her first pregnancy with monochorionic

twins at ten weeks gestation. Antenatal screening for anemia in multiple
pregnancies should be undertaken
A. As per routine antenatal care
B. Once in every month
C. At booking and at 16 weeks
D. At booking, 28 and 36 weeks
E. At booking, 24 and 28 weeks
ANSWER : At booking, 24 and 28 weeks

171. Which cell type, in the islets of Langerhans, secretes glucagon?

A. Alpha cells
B. Beta cells
C. Delta cells
D. Epsilon cells
E. PP cells
ANSWER : Alpha cells

172. Which of the following growth factors is the most important for formation of
granulation tissues during wound healing?
A. Epidermal growth factor (EGF)
B. Transforming growth factor α (TGF-α)
C. Platelet-derived growth factor (PDGF)
D. Vascular endothelial growth factor (VEGF)
E. Transforming growth factor β (TGF-β)
ANSWER : Vascular endothelial growth factor (VEGF)
173. The following diagram describes a structural chromosomal abnormality. What
does this structural chromosomal abnormality represent?

A. Insertion
B. Inversion
C. Deletion
D. Duplication
E. Translocation
ANSWER : Inversion

174. A study is conducted to investigate whether there is a relationship between

soy milk and improve menopause symptoms. The Null hypothesis represents which
of the following statements?
A. A relationship between soy milk and improve menopause symptoms
B. A positive relationship between soy milk and improve menopause symptoms
C. A negative relationship between soy milk and improve menopause symptoms
D. A difference between soy milk and improve menopause symptoms
E. No relationship between soy milk and improve menopause symptoms
ANSWER : No relationship between soy milk and improve menopause symptoms

175. A 21-year-old woman presents with heavy menstrual bleeding for 8 months.
She has a regular 28 day cycle and her LMP was 3 weeks ago. For the past few
months she has been feeling generally tired and noticed some weight gain. Pelvic
examination demonstrates an enlarged uterus. What are the recommended
investigations you would offer?
A. FBC, pelvic ultrasound scan
B. FBC, thyroid profile, pelvic ultrasound scan
C. FBC, pelvic ultrasound scan, Endometrial sampling
D. FBC, coagulation profile, thyroid profile, pelvic ultrasound scan
E. FBC, coagulation profile, thyroid profile, pelvic ultrasound scan, Endometrial
sampling
ANSWER : FBC, thyroid profile, pelvic ultrasound scan
176. What pattern of inheritance does this picture most likely illustrate?

A. X-Linked Recessive
B. X-Linked Dominant
C. Autosomal dominant
D. Mitochondrial
E. Autosomal Recessive
ANSWER : X-Linked Recessive

177. During childbirth a bilateral pudendal nerve block may be performed to

provide anesthesia to the majority of the perineum and the lower one fourth of
the vagina. To do this an anesthetic agent is injected near the pudendal nerve.
During the procedure blood comes in on withdrawl the plunger of the anesthetic
syringe. Which of the following vessels has been entered?
A. Obturator
B. Femoral
C. Vaginal
D. External pudendal
E. Internal pudendal
ANSWER : Internal pudendal

178. Whooping cough vaccine leads to provide long immunity from

A. Memory B cells
B. Cytotoxic T cells
C. Naïve B cells and TH cells
D. Innate immune cells
E. Inoculation of microorganism
ANSWER : Memory B cells

179. Carbon dioxide gas laser is better preferred for the removal of endometriotic
implants as
A. It does not capable to vaporize tissue
B. It penetrates deeply into tissue
C. It has a minimal lateral thermal tissue damage
D. It is less transmitted in soft tissue that contains water
E. It produces an invisible beam and does not affect the one who use it
ANSWER : It has a minimal lateral thermal tissue damage
180. The diagram below illustrates some of the steps (reactions) of steroidogenesis
in their proper sequence.

Which substance is indicated by letter 'X' in the above diagram?

A. Estrone
B. Testosterone
C. Dihydrotestosterone
D. Androstenedione
E. Dehydroepiandrosterone sulphate
ANSWER : Androstenedione

181. When using gestational age, when does crown rump length (CRL) get to 40
mm?
A. 6 weeks
B. 7 weeks
C. 8 weeks
D. 9 weeks
E. 11 weeks
ANSWER : 11 weeks

182. What is the most common congenital solid tumour of the newborn?
A. Astrocytoma
B. Willim's tumour
C. Neuroblastoma
D. Sacrococcygeal teratoma
E. Hepatic hemangioma
ANSWER : Sacrococcygeal teratoma
183. A 25-year-old woman patient presents with number of small genital blisters. A
swab results reveals a diagnosis of genital herpes. Which of the following is the
best drug to be used to treat this patient?
A. Topical acyclovir
B. Topical gabapentin
C. Topical tacrolimus
D. Topical ultrapotent steroid
E. Steroid with antifungal
ANSWER : Topical acyclovir

184. A 24-year-old G2P0 woman is seen in clinic at 12 weeks gestation. She is

known to have epilepsy with grand mal seizures, for which she is currently on
lamotrigine. Her last fit was one year ago. Her full blood count result shows:
Haemoglobin 9.9 g/dl
Hematocrit 35%
Mean corpuscular volume (MCV) 110 fl
Mean corpuscular hemoglobin (MCH) 34 pg
Platelets 198 x 109/l
Total white cell count 8.0 x 109/l
What is the most likely interpretation of this blood count?
A. Physiological hyderemia of pregnancy
B. Iron deficiency anaemia
C. Folate deficiency
D. β-thalassemia trait
E. Hemolytic anemia
ANSWER : Folate deficiency

185. A 23-year-old woman who is six weeks by dates is referred to EPU with
vaginal spotting, which continuous today. Ultrasound shows a fetal pole with a CRL
of 4 mm. There is no fetal heart action noted. The ovaries and adnexa appear
normal. What is the most likely diagnosis?
A. Heterotopic pregnancy
B. Viable intrauterine pregnancy
C. Could be a viable pregnancy
D. Non viable pregnancy
E. Threatened miscarriage
ANSWER : Could be a viable pregnancy

186. The blood test of a 36-year-old fertility patient shows elevated luteinising
hormone (LH) levels and high estradiol levels. What is the most likely cause of this?
A. Hypogonadotrophic hypogonadism
B. Ovarian failure
C. Midcycle LH surge
D. Polycystic ovary syndrome
E. Weight-related amenorrhoea
ANSWER : Midcycle LH surge
187. A 30-year-old woman presents with a three month history of amenorrhea. In
addition, her periods are irregular of two years' duration. She is overweight and
complains of increasing lethargy. Nothing abnormal is found on examination. Her
hormone profile was a follows:
βhCG < 5 IU/L
LH = 4 IU/L
FSH = 3.5 IU/L
Prolactin = 400 mIU/L
TSH = 7 mIU/L
Free T4 = 9 IU/L
What is the most likely diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Normal pregnancy
D. kallmann syndrome
E. Polycystic ovary syndrome
ANSWER : Hypothyroidism

188. While you are attending to the hospital you found a pregnant woman
unresponsive and collapsed in the car parking lot. During your initial evaluation
you open her airway but she is not breathing. Which of the following is the
appropriate initial management?
A. Make safe environment
B. Shake and shout
C. Call for help
D. Left lateral tilt
E. Commence cardiac compressions
ANSWER : Call for help

189. A woman presents in spontaneous labour at term with her first baby; then she
delivered at term and the baby was fine. Six hours post delivery she finds to have
group B streptococcus on a high vaginal swap done three days previously when she
was seen in another maternity unit. What is the most appropriate management
plane to prevent early-onset neonatal group B streptococcal disease?
A. Reassure that no action is necessary
B. Immediately refer to the neonatologist
C. Start antibiotics to the baby
D. Start antibiotics to the mother
E. Inform the mother to be given antibiotics in the next pregnancy
ANSWER : Immediately refer the neonatologist
190. A 55 year-old woman has recurrent urinary retention after a radical
hysterectomy done for stage I carcinoma of the cervix. Which of the following
nerves should be preserved in radical hysterectomy?
A. Obturator
B. Pudendal
C. Genitofemoral
D. Superior hypogastric plexus
E. Inferior hypogastric plexus
ANSWER : Inferior hypogastric plexus

191. The following table shows the following results:

Lab test +ve Lab test ‐ve
New test +ve 20 5
New test‐ve 15 60
What is the negative predictive value of the new test?
A. 25%
B. 57%
C. 75%
D. 80%
E. 92%
ANSWER : 80%

192. In a given sample for a group of size 16, the standard deviation of the data is
12 and the mean is 2. What is the standard error of mean (SEM)?
A. 2
B. 3
C. 4
D. 5
E. 6
ANSWER : 3

193. A publication reports the outcome of a new therapy in a placebo controlled

primary prevention of venous thromboembolism (VTE). 200 patients were
randomised to receive the new therapy and 200 allocated to placebo. The study
was completed over a 2 year period. In the placebo group there were 50 have
venous thromboembolism and in the group treated with the new therapy there
were 100 have venous thromboembolism. What is the number needed to treat to
prevent one VTE over the course of this study?
A. 2
B. 4
C. 10
D. 20
E. 40
ANSWER : 4
194. In an investigation to study the effect of smoking in cancer cervix, it is
observed that 30 of the 60 patients were smokers as compared to 20 out of 60
control subjects. The odds ratio of cancer cervix associated with smoking will be?
A. 0.33
B. 0.5
C. 1.5
D. 2
E. 3
ANSWER : 2

195. A 25-year-old female presents with a sharply circumscribed nodule on the

interlabial fold. The nodule has a tendency to ulcerate and bleed. This nodule can
be completely cured by surgical excision. Which of the following is most likely?
A. Merkel cell carcinoma
B. Papillary hidradenoma
C. Squamous cell carcinoma
D. Basal cell carcinoma
E. Adenocarcinoma
ANSWER : Papillary hidradenoma

196. A 33-year-old woman is admitted with surgical wound infection after

emergency caesarean section for suspected fetal compromise. Culture of the
wound demonstrates methicillin-resistant Staphylococcus aureus (MRSA). She has
no known allergies. Which is the most appropriate treatment?
A. Cephalosporins
B. Clindamycine
C. Vancomycin
D. Clindamycine and vancomycin
E. Piperacillin/tazobactam
ANSWER : Clindamycine and vancomycin

197. A primiparous woman at 39 weeks of gestation is in labour at 8 cm dilation.

The cardiotocography (CTG) has been classified as pathological due to a base rate
of 105 bpm and persistent, long standing typical decelerations. Fetal blood
sampling (FBS) has been performed, showing a pH of 7.29. What is the most
appropriate management option?
A. Needs caesarean section immediately with general anaesthetic due to fetal
hypoxia
B. Needs delivery within 30 minutes due to fetal hypoxia
C. Repeat FBS in no more than 1 hour if CTG remains the same
D. Repeat FBS in no more than 20 minutes independent of CTG findings
E. Repeat FBS in no more than 30 minutes is CTG remains the same
ANSWER : Repeat FBS in no more than 1 hour if CTG remains the same
198. A 37-year-old lady had a hysterectomy for multiple fibroids at 15:00 am. She
felt unwell and developed a spiking fever of over 38.2ºC on the first postoperative
day at 22:00 am. Which of the following is the most likely?
A. Deep venous thrombosis
B. Pulmonary embolism
C. Post operative inflammation
D. Surgical site infection
E. Reactive temperature spike response to surgery caused by stress hormones and
cytokines
ANSWER : Reactive temperature spike response to surgery caused by cytokines

199. A 25-year-old woman intending to commence the combined contraceptive

pills wishes to discuss the risk of venous thromboembolism (VTE). She has no other
risk factors for VTE. Which type of COCP is associated with the highest risk of VTE?
A. Loestrin 30 (ethinylestradiol / norethisterone)
B. Microgynon 30 (ethinylestradiol / levonorgestrel)
C. Microgynon 50 (ethinylestradiol / levonorgestrel)
D. Yasmin (ethinylestradiol / drosperinone)
E. Cilest (ethinylestradiol / norgestimate)
ANSWER : Microgynon 50 (ethinylestradiol / levonorgestrel)

200. 19. A 37-year-old multiparous woman with gestational diabetes is in labour.

On examination her cervix is 3 cm dilated with intact membranes. The labour is
being continuously monitored using a cardiotocograph (CTG). She is reviewed by
the obstetric team and the parameters of the CTG are noted.
Baseline < 100 beats per minute
Accelerations: Absent
Variability: < 5 beats per minute for 50 minutes
Decelerations: late decelerations for 20 minutes
Contractions: three to four contractions in 10 minutes
What is the most appropriate course of action?
A. Continuous fetal monitoring and reassess in 1 hour
B. Turn to left lateral position with oxygen therapy
C. Perform a Fetal blood sampling
D. Proceed to Category 1 C.S
E. Proceed to Category 2 C.S
ANSWER : Proceed to Category 1 C.S

Note: RECALLS are collected from the students, who appeared in the previous exam,
Answers of these questions are not verified (Use RECALL only for the purpose of
Exam pattern/trend understanding)
Edited by DR A. KH – DR E. AH
Pray for us and good luck