Name: Revision 8: Gynecologic Infections (140 Marks)

I. Choose the most correct single answer: (1 Mark each)

1. A 20-year-old G2P0 (0020) with a LMP 5days ago presents to ER with increasing pelvic
pain of a day duration, chills and fever. No changes in her bladder or bowel habits. WBC is
18.000. Temperature is 38.8. O/E, her abdomen is diffusely tender with rebound and
voluntary guarding. The most likely diagnosis:
a. Ovarian torsion.
b. Endometriosis.
c. PID.
d. Kidney stone.
e. Ruptured ovarian cyst.
2. For this patient, the most appropriate initial antibiotic treatment regimen:
a. Doxycycline 100mg PO twice daily for 14days.
b. Clindamycin 450mg IV/ 8hrs + gentamycin 1mg/kg/ 12hrs.
c. Ceftriaxone 250mg IM plus doxycycline 100mg twice daily for 14days.
d. Cefoxitin 2g IV every 6hrs with doxycycline 100mg twice daily.
e. Ofloxacin 400mg PO twice daily plus flagyl 500mg PO twice daily for 14days.

3. A 23-year-old woman presents with foul smelling vaginal discharge. She is not sexually
active. A wet mount/ KOH prep show clue cells. the likely diagnosis is:
a. Candida.
b. Bacterial vaginosis.
c. Trichomonas.
d. Chlamydia.
e. Gonorrhea.

4. You see an asymptomatic pregnant woman at 14weeks, with history of preterm labor at
33weeks. Vaginal swab shows bacterial vaginosis. Appropriate treatment is:
a. Oral metronidazole.
b. Vaginal clindamycin.
c. No treatment.
d. Oral tinidazole.
e. IV ceftriaxone.

5. You diagnose trichomonas vaginitis in a 25-year-old female and treat her and her partner
with metronidazole 2g single dose. She returns back with same symptoms. Most
appropriate treatment at this time:
a. Metronidazole gel 0.75% intravaginally for 5days.
b. Metronidazole 2g orally plus metronidazole gel 0.75% intravaginally for 5days.
c. Metronidazole 500mg orally twice daily for 5days.
d. Sulfadiazine 4g orally single dose plus pyrimethamine 200mg orally single dose.
e. Clindamycin cream 2% intravaginally for 7days.

6. A 20-year-old college student presents with lower abdominal pain and fever. O/E,
bilateral abdominal tenderness. PV shows tenderness with cervical mobilization. Her
pregnant test is negative. Most likely diagnosis:
a. Acute salpingitis.
b. Ectopic pregnancy.
c. UTI.
d. Trichomonas vaginitis.
e. Appendicitis.
7. A 16-year-old sexually active nulliparous female complains of pelvic pain and vaginal
discharge. O/E, her temp is 39.8, pain on moving cervix, and mass and tenderness in right
adnexa. According to CDC, most appropriate treatment is:
a. Outpatient with penicillin IM, doxycycline oral for 14days and reexamine in 3days.
b. Outpatient with ceftriaxone IM, doxycycline bid/14days, reexamine in one week.
c. Outpatient with ceftriaxone IM, doxycycline bid/14days and reexamine in 10days.
d. Hospitalization with cefoxitin IV and doxycycline oral twice daily for 14days.
e. Hospitalization with ceftriaxone IM single dose, doxycycline oral for 14days.

8. A 24-year-old female, with multiple sex partners, presents with lower abdominal pain,
dyspareunia, vaginal discharge. There is tender cervix on motion, 8weeks enlarged uterus.
No adnexal masses. An indication for hospitalization and parenteral therapy is:
a. No improvement with 24hrs outpatient antibiotics.
b. A previous history of PID.
c. An elevated ESR and WBC count.
d. Laboratory confirmation of gonorrhea or Chlamydia infection.
e. Pregnancy.

9. PID is characterized by all the following EXCEPT:

a. Leukocytosis.
b. Pelvic pain.
c. Fever.
d. Anemia.
e. Cervical motion tenderness.

10. A 26-year-old female presents with dull aches in lower abdomen and pelvis for 2weeks.
There is no discharge. She had multiple sexual partners and does not use condoms. BP:
110/65, pulse: 80/min, temp: 38.5. On PV there is tenderness on moving cx but no masses.
Pregnancy test is positive. Best next step is:
a. Treat her with penicillin as outpatient.
b. Admit the patient and treat with levofloxacin and doxycycline.
c. Admit the patient for laparoscopy.
d. Treat her with IM ceftriaxone and azithromycin as outpatient.
e. Admit her and treat her with IV cefoxitin and oral azithromycin.

11. A cyclist woman develops swelling in posterolateral aspect of her labia. The area is
painful and red. The most likely diagnosis is:
a. Hematoma.
b. Bartholin cyst.
c. Gartner duct cyst.
d. Lipoma.
e. Sebaceous cyst.

12. A sexually active woman presents with dysuria and vaginal discharge. All the following
may be the cause EXCEPT:
a. Gonorrhea.
b. Chlamydia.
c. Trichomoniasis.
d. Condyloma acuminata.
e. Polymicrobial infection.
13. A 25-year-old woman is 17weeks pregnant. She had positive history of genital HSV
infection. The current best management of this patient is:
a. Daily application of topical acyclovir to site of previous lesions.
b. Cesarean section only if herpes culture is positive.
c. Cesarean section if lesions are present at time of labor.
d. Elective cesarean section at 38weeks in all cases.
e. Vaginal delivery in all cases.

14. Treatment of uncomplicated cervical infection caused by Chlamydia trachomatis is:

a. Azithromycin 1g orally.
b. Doxycycline 200mg orally.
c. Amoxicillin 2g orally.
d. Cefixime 400mg orally.
e. Metronidazole 2g orally.

15. A 24-year-old female has genital herpes in her 25th week gestation. Next step is:
a. She has a high likelihood of miscarriage.
b. She should be treated with antiviral therapy for 7-14days.
c. She should be scheduled for Cesarean section at term.
d. She should be advised against breastfeeding her infant.
e. She should terminate her pregnancy immediately.

16. The following HPV types are commonly associated with condyloma accuminata:
a. 6/ 11
b. 16/ 18
c. 31/ 33
d. 39/ 45
e. 1/ 3

17. A 54-year-old female presents with intense pruritis vulvae which didn’t improve with
topical antifungal treatment. O/E, there is a white thickened excoriated skin. Punch biopsy
reveals lichen sclerosis. Treatment of choice for this condition is:
a. Topical conjugated estrogens.
b. Topical fluorinated corticosteroids.
c. Topical petroleum.
d. Topical 2% testosterone.
e. Topical fluorouracil.

18. A 24-year-old woman presents to ER with pelvic pain and vaginal discharge. O/E, she
has fever 38, with lower abdominal tenderness. PV confirms adnexal and cervical motion
tenderness. All the following are features suggesting PID EXCEPT:
a. Lower abdominal pain which is typically bilateral.
b. Deep dyspareunia.
c. Congestive dysmenorrhea.
d. Abnormal vaginal or cervical discharge which is often purulent.
e. Lower abdominal pain which is typically unilateral.

19. A 26-year-old woman has recently been diagnosed with HIV. Her GP notices her first
smear last year was negative, and asks you about the frequency of cervical smears for this
woman. How often should her cervical smears be undertaken:
a. Every 6months.
b. Every 6months for 2years, then routine recall.
c. Annually.
d. Every 3years.
e. Every 5years.

20. A 21-year-old sexually active woman comes for her first gynecological examination. She
has regular menses with mild dysmenorrhea. On speculum examination, you observe a
small raised 5mm lesion on her non-tender cervix. lesion is smooth, light-bluish and looks
like a bubble under the cervical epithelium. Most likely diagnosis is:
a. Bartholin cyst.
b. Cervical dysplasia.
c. Nabothian cyst.
d. Skene gland cyst.
e. Chlamydial cervicitis.

21. A 68-year-old woman presents with vulvar pruritis for 1year. She tried anti- fungal
treatment, with partial improvement, but recurrence of symptoms. she had menopause at
49-year-old, and not sexually active for 10yrs. O/E: thin white epithelium of the labia
minora with red oval-shaped erosions of 0.5- 1.5cm. Next step is:
a. Culture the vagina and treat with high dose antifungal.
b. Wide local excision of the lesions.
c. Cryotherapy to eradicate the lesion.
d. Punch biopsy of the vulvar lesion.
e. Prescription of moderate-high potency topical steroids.

22. In evaluation of women with vaginal discharge, all the following are true EXCEPT:
a. Allergic reactions can cause excessive vaginal discharge.
b. Douching the vagina as part of daily hygiene helps reduce vaginal infection.
c. Exclusion of infection can help confirm that a vaginal discharge is physiological.
d. There is some association between methods of contraception and vaginal discharge.
e. Women with chronic cervicitis may complain of increased physiological discharge.

23. An 18-year-old G0 comes to see you due to a 3days history of urinary frequency,
urgency, dysuria and bright red blood in her urine. O/E, there is no discharge from the
cervix or in the vagina, there is mild suprapubic tenderness. There is no flank tenderness
and the patient’s temperature is normal. The most likely diagnosis is:
a. Chlamydia cervicitis.
b. Pyelonephritis.
c. Acute cystitis.
d. Acute appendicitis.
e. Monilia vaginitis.

24. A 37-year-old woman has severe pain during menses. On bimanual exam, she has RVF
uterus and tender nodules on the uterosacral ligaments. She is most likely having:
a. Chronic PID.
b. Adenomyosis.
c. Fibroids.
d. Endometriosis.
e. Uterine carcinoma.
25. The following is correct regarding syphilis:
a. Identified preferentially by culture of genital ulcer exudates in artificial media.
b. Dark field microscopy of genital ulcer (chancre) exudates is non-diagnostic.
c. Antibacterial treatment in early pregnancy does not prevent congenital syphilis.
d. 1ry syphilis is associated with mucocutaneous rash.
e. 2ry syphilis is associated with generalized lymphadenopathy.

26. A 26-year-old woman complains of dyspareunia. She has painful period, some vaginal
discharge that is not foul smelling and itchy. She is becoming irritable during her periods.
Speculum examination reveals blue nodules in the vagina. Most likely diagnosis:
a. Bacterial vaginosis.
b. Cervicitis.
c. Endometriosis.
d. Pelvic inflammatory disease.
e. Vulvovaginitis.

27. A 25-year-old patient presents with sudden onset lower iliac fossa pain associated with
nausea and vomiting. She is sexually active, uses IUD. O/E she is tachycardic and there is
tenderness over left iliac fossa. PV: normal cervix with no abnormal discharge, but fullness
and tenderness on left adnexa. Pregnancy test is negative. Most likely diagnosis:
a. Diverticulitis.
b. Ectopic pregnancy.
c. Ovarian torsion.
d. Ruptured corpus luteum.
e. Tubo-ovarian abscess.

28. A 27-year-old woman P1+0, presents with excess yellow offensive discharge mainly in
the post menstrual period associated with vaginal soreness. Speculum examination reveals
erythematous vagina and cervical punctuations. Which is the most likely diagnosis?
a. Allergic reaction.
b. Candida vaginitis.
c. Trichomonas vaginalis.
d. Bacterial vaginosis.
e. Gonorrhea infection.

29. A 45-year-old multipara presents by repeated bleeding in the form of spotting following
sexual intercourse. Which of the following investigations will be most valuable?
a. Endometrial curettage.
b. Colposcopy.
c. CT pelvis.
d. CA-125.
e. Diagnostic laparoscopy.

30. A 21-year-old woman comes to ER complaining of bilateral lower abdominal pain. O/E,
temp is 38.2○C with bilateral adnexal tenderness. What is your first line of investigation?
a. Endocervical swab for gonorrhea and chlamydia.
b. HIV antibody test.
c. Pelvic ultrasound.
d. Pregnancy test.
e. Total leucocyte count.
31. A 23-year-old woman presents complaining of vaginal discharge. She has had recurrent
episodes of vulvovaginal candidiasis. She is worried about use of contraception as she had a
copper IUD inserted two months earlier. What advice would you offer her?
a. Should remove the IUD.
b. Should remove the copper IUD and insert the Mirena coil.
c. Switch to a suitable oral contraceptive.
d. Should continue with this method.
e. Use the condom as an additional method to prevent recurrence of infection.

32. A 21-year-old woman comes complaining of vaginal discharge. Vaginal high-swab

results show that she has bacterial vaginosis. She asks you about treatment of her sexual
partner. Which infection needs treatment of an asymptomatic sexual partner?
a. Bacterial vaginosis.
b. Candidiasis.
c. Human papilloma virus.
d. Tertiary syphilis.
e. Trichomonas vaginalis.

33. A 21-year-old woman comes to ER complaining of bilateral lower abdominal pain. O/E,
her temp is 38.5○C with bilateral adnexal tenderness. She tested negative for gonorrhea and
chlamydia the previous week. What is the management for this woman?
a. Reassure and discharge her.
b. Reassure, give pain killers and ask to repeat gonorrhea and chlamydia testing in one week.
c. Repeat tests for gonorrhea and chlamydia, and start treatment according to the results.
d. Start empirical IV antibiotic treatment.
e. Start empirical oral antibiotic treatment.

34. A 25-year-old woman comes to the outpatient clinic for follow-up after a diagnosis of PID
three weeks previously. Results of swabs were negative for chlamydia and gonorrhea. You
explained the significance of PID and its sequelae. She stated that the symptoms resolved
and she had her antibiotics regularly. What else should you check at this visit?
a. Reassure and do nothing.
b. Review again in four to six weeks.
c. Repeat swabs for chlamydia and gonorrhea.
d. Repeat bloods and C-reactive protein.
e. Screening and treatment of sexual contacts.

35. A 24-year-old woman comes complaining of small multiple groups of painful vulval
ulcers. O/E, the base of the ulcer was erythematous. What is the most likely diagnosis?
a. Chancroid.
b. Granuloma inguinale.
c. Herpes simplex virus (HSV).
d. Lymphogranuloma venereum (LGV).
e. Syphilis.

36. A 24-year-old woman comes complaining of multiple painful ulcers on the vulval area.
O/E, the ulcers are sharply circumscribed with a yellow exudate in the base. There are also
painful inguinal lymph nodes on the left side. What is the most likely causative organism?
a. Campylobacterium granulomatis.
b. Chlamydia trachomatis.
c. Haemophiles ducreyi.
d. HSV-type 2.
e. Treponema pallidum.

37. A young woman presents to the genitourinary medicine clinic. After a swab was taken
from the endocervix, microscopic examination reveals a Gram-negative diplococcus. What
organism looks like this under a microscope?
a. Actinomyces israeli.
b. Chlamydia trachomatis.
c. Haemophilus ducreyi.
d. Neisseria gonorrhea.
e. Trichomonas vaginalis.

38. A 20-year-old pregnant woman presented to the genitourinary medicine clinic two weeks
previously and was found to have a chlamydia infection. She received azithromycin 1 g as a
single dose. You arranged for contact tracing. What is the next step?
a. Follow-up after six months.
b. Full STD screen.
c. Nothing to be done.
d. Test of cure during this visit.
e. Test of cure after five weeks.

39. You made a diagnosis of mild PID in a 24-year-old woman who presented to ER with
lower abdominal pain and pyrexia. You prescribe a combination of a single intramuscular
injection of ceftriaxone and oral doxycycline and antipyretics. She is worried about her
future fertility as a result of her PID. Where is she best treated to preserve her fertility?
a. As an inpatient.
b. As an outpatient.
c. In the ER until her temperature normalizes.
d. In a fever hospital.
e. In an isolation ward.

40. Gonorrhea most commonly causes all the following, EXCEPT:

a. Urethritis.
b. Proctitis.
c. Conjunctivitis.
d. Pharyngitis.
e. Endocarditis.

41. A 20-year-old woman attends the sexual health clinic with symptoms of frothy, yellow
vaginal discharge and associated lower abdominal pain. The organism can be seen when a drop of
saline is added to the vaginal discharge placed on the slide. What is the most likely diagnosis?
a. Chlamydia.
b. Trichomonas vaginalis.
c. Gonorrhea.
d. Candida albicans.
e. Syphilis.

42. A 16-year-old woman attends the sexual health clinic with a complaint of thin homogenous
vaginal discharge for 2 weeks. A wet mount smear shows clue cells. Most likely diagnosis is:
a. Treponema pallidum.
b. ß-Hemolytic streptococci.
c. Gardnerella vaginalis.
d. Herpes simplex.
e. Donovanosis.

43. A 20-year-old sexually active G2P0 with LMP 5 days ago, presents with acute pelvic
pain, chills and fever. T: 39.8, diffusely tender abdomen and marked tenderness on moving
the cervix. Pregnancy test is negative. Urine analysis is normal and TLC is 18.000. Most
likely diagnosis is:
a. Ovarian torsion.
b. Endometriosis.
c. Pelvic inflammatory disease.
d. Kidney stone.
e. Ectopic pregnancy.

44. A diabetic 35-year-old woman, P2+0, presents with white itchy discharge after 10 days
antibiotic therapy for fever and cough. Symptoms are more marked in the premenstrual
period with associated vaginal soreness. Speculum examination reveals sticky white
discharge with hyperemic vulval skin. Which is the most likely diagnosis?
a. Diabetic neuropathy.
b. Candida vaginitis.
c. Trichomonas vaginalis.
d. Bacterial vaginosis.
e. Gonorrhea infection.

Questions 45- 46: A 21-year-old woman has a profuse, malodorous vaginal discharge. PV shows a
greenish gray frothy discharge with a fishy odor and petechial lesions on the cervix. There is no
cervical motion tenderness. Her Temp is 37.5, BP: 120/80, and pulse is 60/min.
45. Microscopic evaluation of the discharge is most likely to show:
a. Clue cells.
b. Gram-negative diplococcic.
c. Gram-positive diplococcic.
d. Motile flagellated organisms.
e. Pseudo hyphae or hyphae.
46. Recurrence of such infection can occur due to:
a. Lowered resistance.
b. Poor personal hygiene.
c. Use of oral contraceptive pills.
d. No treatment of the husband.
e. Young age.

Questions 47- 49: A 23-year-old female comes with a painful swelling in her vulva that
started 3days ago and has been growing larger since. Examination shows a 4cm tender
cystic mass in the posterior aspect of the left labia majora. There is associated erythema.
The rest of the pelvic examination is unremarkable.
47. Which of the following is the most likely diagnosis:
a. Infected Bartholin’s cyst.
b. Condyloma lata.
c. Granuloma inguinale.
d. Gartner’s cyst.
e. Vulvar cancer.
48. Management should be:
a. Antibiotics.
b. Reassurance and discharge.
c. Colposcopy.
d. Surgical excision.
e. Surgical drainage.
49. After the above treatment, the mass still the same with persistent pain and tenderness
and it became tense and pointing. The following management is recommended in this case:
a. Change antibiotic.
b. Surgical drainage.
c. Colposcopy.
d. Surgical excision.
e. Reassurance and discharge.

50. The normal vagina is richly colonized by bacterial flora mainly consisting of:
a. Mycoplasma hominis.
b. Gardnerella.
c. Actinomyces viscous.
d. Chlamydia trachomatis.
e. Lactobacillus.

51. The terminology of pelvic inflammatory diseases indicates:

a. Infection of the vagina.
b. Infection of Bartholin glands.
c. Infection of Skene’s glands.
d. Infection of urinary bladder.
e. Endometritis and salpingo-oophoritis.

52. The most common symptom of cervicitis is:

a. Pruritis.
b. Back pain.
c. Burning.
d. Leucorrhea.
e. Bleeding.

53. A 58-year-old woman consults u for vulvar pruritis. O/E: thin, atrophic skin with
whitish coloration is seen over the entire vulva. Most likely this patient has:
a. Vulvar carcinoma.
b. Vulvar intraepithelial neoplasm.
c. Hyperkeratosis.
d. Condyloma lata.
e. Lichen sclerosis.

54. A 36-year-old female presents with a mucopurulent discharge. Gram stain of a cervical
swab shows gram -ve diplococcic. Which of the following is correct?
a. If untreated this condition is likely to resolve spontaneously.
b. The most likely diagnosis is Strept group B.
c. Appropriate treatment is metronidazole vaginal cream.
d. Appropriate treatment is a single IM dose of 250mg ceftriaxone.
e. Hospitalization and IV antibiotics are necessary.

55. A fishy vaginal discharge with clue cells on microscopy, is most likely:
a. Be due to Gardnerella vaginalis.
b. Can be treated with metronidazole or clindamycin.
c. With the addition of KOH may see hyphae or spores.
d. Is rarely associated with inflamed or itchy vulva.
e. Can be sexually transmitted.

56. A 20-year-old nulligravida presented by a sudden onset of a painful swelling in the

posterior wall of the labia majora. What is your 1st differential diagnosis?
a. Endometriotic cyst.
b. Sebaceous cyst.
c. Inclusion dermoid cyst.
d. Gartner cyst.
e. Bartholin cyst.

57. The following about candida infection are correct EXCEPT:

a. It is the second most common cause of vaginitis in the childbearing period.
b. The infection is common with pregnancy.
c. Vaginal PH is usually alkaline.
d. Vulval itching may occur.
e. Vaginal isoconazole or miconazole are effective.

58. A 32-year-old woman had recent HSG. 3 days later, she presented with fever, headache, malaise,
acute lower abdominal pain with increased vaginal discharge. Pelvic ultrasound revealed a tubo-
ovarian complex with small amount of turbid fluid in Douglas pouch. Most appropriate diagnosis is:
a. Torsion ovary and adnexae.
b. Ectopic pregnancy.
c. Ovarian endometrioma.
d. Acute PID.
e. Rupture ovarian cyst.

59. Regarding TB of the female genital tract, choose the correct statement:
a. It is almost always 1ry TB.
b. Contributes to 5-10% of infertile cases.
c. Endometrium is the most common involved site in the genital tract.
d. Endometrial biopsy should be done in the post-menstrual period.
e. +ve tuberculin test is diagnostic of active disease.

60. A 28-year-old woman in 8weeks pregnancy, suffers from profuse vaginal discharge with
characteristic fishy odor. Examination revealed clue cells. Most appropriate diagnosis:
a. Candida vaginalis vaginitis.
b. Trichomonas vaginalis vaginitis.
c. Atrophic vaginalis with pregnancy.
d. Tuberculous vaginitis.
e. Bacterial vaginosis.
61. The treatment of this case (in the previous question) is:
a. Oral metronidazole.
b. Vaginal metronidazole.
c. Vaginal clindamycin cream.
d. Oral fluconazole.
e. Oral 3rd generation cephalosporins.

62. Regarding diagnosis of acute PID (salpingitis), choose the correct statement:
a. History of recent delivery, abortion or instrumentation is common.
b. Pain is usually felt in the right more than the left iliac fossa.
c. Fever should not exceed 38 C.
d. Culture of the vaginal discharge is the gold standard in diagnosis.
e. Symptoms are usually mild with gonococcal infection.

63. A 21-year-old G0P0 healthy student presents with vulvar pruritis and no discharge. Her
BMI is 24, uses condom with coitus. Her LMP was 4days ago. Last month she was treated
for monilia vaginitis. The most likely diagnosis:
a. Vaginal trichomoniasis.
b. Leukemia.
c. Personal hygiene products.
d. Secondary syphilis.
e. VIN.

64. A 79-year-old woman presents to your office with a 1cm fleshy outgrowth from her
urethra. It bleeds on touch. u perform a biopsy that states “transitional and stratified
squamous epithelium”. The most likely diagnosis is:
a. Urethral leiomyoma.
b. Hidradenitis suppurativa.
c. Senile urethritis.
d. Urethral caruncle.
e. Urethrocele.

65. A patient consults you for recurrent painful draining vulvar lesions. Examination shows
multiple abscesses and deep scars in the labia with foul smelling discharge from the lesions,
similar lesions are found in the axilla. Most likely diagnosis is:
a. Herpetic vulvitis.
b. Hidradenitis suppurativa.
c. Lymphogranuloma venerum.
d. Secondary syphilis.
e. Condyloma accuminata.

66. A 20-year-old patient complains of painful vulvar ulcers. O/E tender, punched out
lesions with a yellow exudates & no induration are seen. They are most likely:
a. Chancroid.
b. Granuloma inguinale.
c. Syphilis.
d. Lymphogranuloma venerum.
e. Condyloma accuminata.

67. A 17-year-old girl desires contraception. O/E an ulcerative tender lesion with irregular
edge and reddish granular base is seen in the vaginal fornix. This lesion is most likely:
a. Vaginal intraepithelial neoplasia.
b. Syphilis.
c. An ulcer caused by the use of tampons.
d. Genital herpes.
e. Vulvar carcinoma.

68. A 58-year-old G2P2 patient, menopausal for 10yrs, presents with severe pruritis vulvae.
Examination shows atrophic vulvitis. The most effective treatment for her is:
a. Antihistaminics.
b. Hydrocortisone.
c. Tranquilizers.
d. Antibiotics.
e. Topical estrogen therapy.

69. A 19-year-old presents to ER with 8wks amenorrhea, unilateral adnexal pain. She has
acute abdomen. Pregnancy test is +ve, Htc is 24%. This is most likely:
a. Ectopic pregnancy.
b. PID.
c. Endometriosis.
d. Appendicitis.
e. Abortion.

70. A 63-year-old patient presents with vaginal itching, dryness, and dyspareunia. The most
appropriate medical therapy is:
a. Oral estrogen for the first 25days of each month.
b. Vaginal estrogen cream daily.
c. Oral progesterone 5-10mg daily for 10days each month.
d. Testosterone tablets 10mg per day.
e. Corticosteroid therapy.

71. A 16-year-old patient reports delayed menses with sudden severe pain and syncope.
Pregnancy test is negative. TLC is 6000, Htc is 42. The likely diagnosis:
a. Ectopic pregnancy.
b. PID.
c. Appendicitis.
d. Endometriosis.
e. Ruptured corpus luteum cyst.
72. On pelvic examination of a 28-year-old multiparous patient, several 3-5mm yellowish
translucent or opaque raised cystic structures are seen on the surface of the cervix. The
patient is asymptomatic. Most appropriate next step in the management of these findings:
a. Excisional biopsy.
b. Incision and drainage of the cysts.
c. Oral antibiotics.
d. Conization.
e. Counseling and reassurance.

73. A 45-year-old woman complains of irregular bleeding. O/E pelvis is fixed. Endometrial
biopsy shows “giant cells, caseation, granuloma formation”. Most likely diagnosis:
a. Syphilis.
b. C. trachomatis.
c. Tuberculosis.
d. N. gonorrhea.
e. HPV.

74. A 51-year-old woman presents with painful swelling under urethra, dysuria,
dyspareunia, dribbling of urine when stands after voiding. This is most likely:
a. Simple cystitis.
b. Infected Skene’s glands.
c. Infected urethral diverticulum.
d. Urethral carcinoma.
e. Cystocele.

75. A 31-year-old patient is preparing to start IVF due to obstructed tubes. Her HSG shows
bilateral hydrosalpinx. What should be your next step:
a. The patient should begin her IVF treatment cycle.
b. The patient should not be offered the opportunity of IVF.
c. Bilateral salpingectomies should be done prior to starting IVF.
d. Hydrosalpinx should be drained via transvaginal aspiration prior to IVF.
e. Her hydrosalpinx should be drained via laparoscopy prior to IVF.

76. The following conditions can be diagnosed with HSG:

a. Endometriosis.
b. Ovarian cyst.
c. Subserosal fibroids.
d. Minimal pelvic adhesions.
e. Hydrosalpinx.

77. A 32-year-old woman comes complaining of 1week history vulval ulcers. She first
noticed two red “bumps” that subsequently opened up, and now extremely painful. She is
sexually active. O/E: two 1.5cm ulcers on left labia minora. ulcers bases are erythematous,
and the borders are irregular but well demarcated. There is tender inguinal LNs on left
side. VDRL and HSV tests are negative. Best initial treatment:
a. Benzathine penicillin G 2.4million units IM once.
b. Ceftriaxone 250mg IM once.
c. Doxycycline 100mg orally twice daily for 2weeks.
d. Erythromycin 500mg orally twice daily for 2weeks.
e. Acyclovir 200mg five times daily for 7days.
78. A 52yrs old G3P2 comes complaining of hot flushes and night sweats. she stopped
having menses 1.5yrs ago. her complains interfere with her quality of life. she hoped to
avoid HRT but her symptoms havn’t improved over the past 1.5yrs, and is now ready for
treatment. which of the following is NOT appropriate option for her treatment?
a. Oral estrogen and progesterone.
b. Topical estrogen and progesterone patch.
c. Low dose vaginal estrogen cream.
d. A SSRI such as paroxetine or fluoxetine.
e. Oral gabapentin (neurotin).

79. 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.

80. Bacterial vaginosis:

a. Is rare vaginal infection.
b. Is always symptomatic.
c. Is usually associated with profound inflammatory reaction.
d. Causes fishy discharge which results from bacterial amine production.
e. Is treated with clotrimazole.

81. Chlamydia trachomatis infection:

a. Are commonly manifested as vaginal discharge.
b. Pap smear usually suggest inflammatory changes.
c. Infection in the male partner present as urethritis.
d. May ascend into the upper genital tract resulting in tubal occlusion.
e. All of the above.

82. All the following can be transmitted sexually EXCEPT:

a. HIV.
b. Chlamydia.
c. Gonorrhea.
d. Vaginal candidiasis.
e. HSV2

83. Genital tract candida occurs more frequently in all these patients EXCEPT:
a. Diabetics.
b. On long term antibiotic therapy.
c. Thyrotoxicosis.
d. On oral contraceptive pills.
e. Pregnant.

84. Treatment of PID include all the following EXCEPT:

a. Oral doxycycline.
b. Removal of IUCD.
c. Clindamycin.
d. Tetracycline.
e. Dilatation and curettage.

85. The differential diagnosis of vulvar swelling includes all the following EXCEPT:
a. Bartholin cyst.
b. Hematoma.
c. Condyloma.
d. Nabothian cyst.
e. Papilloma.

86. The mechanism of infertility in PID include all the following EXCEPT:
a. Polycystic ovary.
b. Peritubal adhesions.
c. Hydrosalpinx.
d. Pyosalpinx.
e. Frozen pelvis.

Questions 87- 91, choose the SINGLE most appropriate answer from the below list of options.
Each option may be used once, more than once or not at all
a. Acute salpingitis.
b. Chronic salpingitis.
c. Acute appendicitis.
d. Twisted ovarian cyst.
e. Ruptured ectopic.
f. None of the above.

87. Pain in the loin.

88. Pain starts at umbilicus.
89. Pain is acute and felt bilaterally.
90. Pain and infertility.
91. Pain followed by vaginal bleeding.

Questions 92- 94, choose the single most likely drug treatment from the above list of options.
Each option may be used once, more than once, or not at all.
a. Azithromycin 1 gm.
b. Ceftriaxone.
c. Metronidazole 500mg tds.
d. Acyclovir 400mg tds.
e. Doxycycline.
f. Benzyl penicillin.

92. A 34-year-old P1 at 15 weeks gestation was referred to your antenatal clinic as her
booking blood showed a positive serology for Syphilis.

93. A 21-year-old woman presented to clinic with excessive vaginal discharge and swab
results confirmed Chlamydia. She was also found to be pregnant on urine pregnancy
test.

94. A 36-year-old woman presents to your ANC with Herpes simplex lesions on her
vulva. She is 37 weeks pregnant and had similar episodes in the past.
Questions 95- 105 are preceded by a list of lettered options. Select the one letter that is most
closely associated with it. Each letter may be used once, multiple times, or not at all:
a. Candida infection.
b. Trichomonas.
c. Bacterial vaginosis.
d. Atrophic vaginitis.
e. Mucopurulent cervicitis.
f. Foreign body.

95. Most common type of vaginitis with a high ph in sexually active patient.

96. In cases of treatment failure, combined oral and intravenous therapy with
metronidazole may be indicated.

97. The patient complains of a white curdy discharge and vaginal burning and itching on
examination. The vaginal ph is 3.0

98. Associated most commonly with Chlamydia or gonorrhea.

99. Diagnosis may require vaginoscopy.

100. The treatment should include intravaginal estrogen therapy.

101. A 44-year-old woman presents to her GP with itching and burning of her vulva. On
examination the vulva is erythematous and swollen and a cheesy discharge is present.

102. A 27-year-old woman presents to her GP with vaginal discharge, dysuria and vulval
irritation. Examination of the vulva shows purulent frothy malodorous discharge and
punctate hemorrhage on the cervix.

103. Itchy white vaginal discharge with vaginal ph˂4.5

104. Associated with microscopic motile throphozoites and vaginal ph˃4.5

105. A 25-year-old woman at 20 weeks gestation is told that her infection can cause
preterm birth but has very little other effect onthe baby.

Questions 106- 113, represents clinical characteristics to particular STDs, from the list of
options, choose the most fitting organisms from the list of options. Each option can be used
once, more than once, or not at all:
a. Gardnerella vaginalis.
b. Chlamydia trachomatis.
c. Hemophilus ducreyi.
d. HSV.
e. HIV.
f. HPV.

106. Specifically targeted by national vaccination programme, with vaccine given to girls
aged 12-13yrs.
107. Vesicular lesions appear within 7days and lead to painful shallow ulcers.

108. Associated with vaginal ph˃4.5 and fishy amine odor.

109. A 25-year-old woman presents to her GP with vulval irritation and finding
difficulty in passing urine. On examination there are vesicles around the introitus.

110. The causative organism for genital condyloma, an etiologic agent or cofactor, for the
development of most intraepithelial neoplasia of the genital tract.

111. A patient reports having intercourse with a new sexual partner 8days ago and now
complains of general malaise and fever, vulvar pain, pruritis, and vaginal discharge; genital
examination shows tender inguinal. lymphadenopathy and vesicles and ulcers on the labia
majora bilaterally.

112. A 35-year-old lady presents with severe PID following TOP (termination of pregnancy)
that was not covered by antibiotics. Her cervical smear report 6 weeks ago shows ‘clue
cells.’

113. A 25-year-old woman is referred because of mild pelvic pain, on laparoscopy, no

abnormality detected, except mild adhesions of the undersurface of the liver capsule.

Questions 114- 122 are preceded by a list of lettered options. Select the one letter that is most
closely associated with it. Each letter may be used once, multiple times, or not at all:
a. Gonorrhea.
b. Syphilis.
c. Chancroid.
d. Lymphogranuloma venerum.
e. Donovanosis.
f. Pediculosis pubis.
g. Actinomyces.
h. Staphylococcus aureus.

114. Diagnosis can be made from culture on Thayer-Martin medium.

115. A 44years old schoolteacher returns from a vacation in Haiti, where she had
unprotected intercourse with a native Haitian approximately 3weeks previously. she now
has a painless vulvar ulcer.

116. A 48yrs Nigerian woman presents with vesicular and pustular lesions with ulceration
of the vulvar areas. she also has painful elevated inguinal nodes.

117. One of the most infectious STDs, lesions are found at the base of hair follicles.

118. A 41yrs old woman returns from a job on a Caribbean cruise ship. she had
unprotected intercourse with a new sexual partner. a few days later, she noticed the growth
of an asymptomatic vulvar nodule. The skin ulcerated over the nodule. The ulcer is painless,
and there are no associated enlarged lymph nodes.
119. Caused by Hemophilus ducreyi, the disease is characterized by a painful ulcer, most
commonly of the vaginal vestibule.

120. A 35-year-old woman in her second pregnancy has been told that her infection can
cause preterm birth and affect the baby’s eyes at birth.

121. A 32-year-old woman who uses tampons for her heavy periods is brought to ER with
pyrexia, hypotension and an erythematous rash. Blood cultures are negative.

122. A 30-year-old woman who uses Copper IUD, is being treated for PID. However, she
is not responding to antibiotics in spite of changing the regime.

For each statement, mark True/ False:

123. Anaerobic bacterial infection is the commonest cause of vaginitis in childbearing
period.
124. Condyloma accuminata is considered a precancerous lesion.
125. In case of syphilis during pregnancy, azithromycin can be used instead of penicillin if
the woman is sensitive to penicillin.
126. Incubation period for HIV is around 3-6months.
127. Nabothian follicles may cause cervical factor of infertility.
128. Bartholin cyst is best treated by marsupialization.
129. Chlamydia infection can cause Fitz-Hugh Curtis syndrome.
130. Candida infection is more common in immune-compromised persons.
131. Trichomonas infection needs treatment of all sexual partners.
132. Bacterial vaginosis is treated by oral miconazole.
133. Doxycycline is the drug of choice for treating cervicitis.
134. Hydatid cysts of Morgagni are sequalae of PID infection.
135. Metronidazole can be given safely in the second trimester.
136. Commonest cause of abnormal vaginal discharge is the frequent use of vaginal
douching.
137. Acyclovir is safely given all through pregnancy.
138. Effective treatment of candidiasis should include all sexual partners.
139. Monilia infection is more common in diabetic, pregnant females and the ones using
COCPs.
140. Oral miconazole are safely given in third trimester.

Best of Luck☺