COLLEGE OF MEDICINE AND

HEALTH SCIENCES
SCHOOL OF MEDICINE &
PHARMACY

OBGYN Exit Written exam for Doc 3 students. Date: 04/8/2022

Student Name…………………………………………………….. Reg N°: …………………………

I .General Gynecology Questions: 10%

1. A patient presents with vulval itching, sore vagina and a profuse, white, curdy discharge with
erythema and redness at the introitus. The likely diagnosis is:
A. Bacterial vaginosis.
B. Trichomonas vaginalis.
C. Candida.
D. Chlamydia.
E. HPV

2. While working at DH, you receive a forty-year-old woman with regular, heavy periods who smokes
20 cigarettes a day has a BMI of 40 and has a normal-size, anteverted uterus on ultrasound scan and
who is sexually active. What would be your best recommendation for treatment?
A.TAH.
B. TAH/BSO.
C. Hysteroscopy Endometrial ablation
D. Combined oral contraceptive pill.
E. Mirena.

3. A twenty five-year-old girl presents with mid-cycle pain on a regular monthly basis. She is sexually
active and does not take any contraception. The pain quickly resolves after 24 hours. She has a
regular 28-day cycle. The likely cause of the pain is:
A. PID.
B. Endometriosis.
C. Mittelschmertz syndrome.
D. Adenomyosis.
E. Polycystic ovaries.

4. While on night duty at your DH, you receive a seventeen-year-old girl who is not sexually active
with left iliac fossa pain. An ultrasound scan shows a 5 cm cyst on the left ovary, which is complex in
nature, with solid, calcified elements and fatty deposits noted on MRI. The likely diagnosis is:
A. Thecal luteal cyst.
B. Tubo-ovarian abscess.
C. Serous cystadenoma.
D. Fibroma.
E. Dermoid cyst.

5. You are in OPD and you receive a 21-year-old G0P0 healthy young woman, complaining of severe
vulvar pruritus. She has a BMI of 24, uses condoms with coitus, and finished her last menses 4 days
prior. Last month she was diagnosed with and successfully treated for monila vaginitis. She denies any
other symptoms including vaginal discharge. What is the most likely diagnosis?
A. Vaginal trichomoniasis
B. Leukemia
C. Personal hygiene products
D. Secondary syphilis
E. Hidradenitis suppurativa
6. You are working at Kabgayi DH and a 63-year-old patient is found with excoriated 2-cm lesion is
found on her left labium majora, which, she states, has been present for at least 3 months. What is the
next best step in the management of this patient?

A. Prescribe hydrocortisone cream

B. Refer her to CHUK for colposcopy
C. Refer her for excisional biopsy
D. Prescribe antiseptic solution
E. Prescribe antibiotics for seven days and reassess later

7. A 15-year-old patient, not yet sexually active, has had menstrual bleeding every 2 to 4 weeks since
menarche 1 year ago. The bleeding can be both heavy and light. It sometimes lasts as long as 2 weeks.
Which of the following is the next best step in the management of her problem?

A. Obtain a pregnancy test

B. Perform an endometrial biopsy
C. Obtain pelvic ultrasonography
D. Initiate oral contraceptives (OCs)
E. Initiate cyclic progestin therapy

8. A 33-year-old patient has been diagnosed as having adenomyosis. Which of the following symptoms
is most consistent with this diagnosis?

A. Dyspareunia
B. Mood swings
C. Painful defecation
D. Secondary dysmenorrhea
E. Infertility

9. A 16-year-old G0P0 patient reports delayed onset of menses, sudden onset of severe pain, and
syncope. A serum pregnancy test is negative. Her CBC reveals an Hct of 42% and a WBC of 8,000.
Which of the following is the most likely diagnosis?

A. Ectopic pregnancy
B. PID
C. Endometriosis
D. Appendicitis
E. Ruptured corpus luteum cyst of the ovary

10. A 19-year-old woman is brought from the emergency department with a history of amenorrhea for
8 weeks, 1 week of unilateral adnexal pain. On physical examination, she is found to have an acute
abdomen with tenderness and absent bowel sounds. Laboratory evaluations reveal a hematocrit that
is 23%, and a positive pregnancy test. Which of the following is the most likely diagnosis?

A. Ruptured ectopic pregnancy

B. Pelvic inflammatory disease (PID)
C. Endometriosis
D. Appendicitis
(E) Ruptured corpus luteum cyst of the ovary
 II. Sexual and Reproductive Health Right: 15%

11. Which one of the following best describes the consequences of unintended pregnancies?
A. Unsafe abortion
B. Poor infant health
C. Infant morbidity and mortality
D. Low investment in human capital
E. All the above

12. The components of reproductive health include all the following except:
A. Family Planning for women aged under 18 years
B. Human sexuality and responsible parenthood
C. Restricting abortion services for women victims of rape
D. Maternal, Neonatal, and Child Health
E. None of the above

13. The Maternal Mortality Ratio refers to:

A. The death of women during pregnancy, childbirth, and the first 42 days of the postpartum period from
any cause related to or aggravated by the pregnancy 
B. The ratio of women who die from a pregnancy-related complication over the total number of women’s
death in a particular period of time
C. The number of maternal deaths during a given time period over 100 000 women of reproductive age
during the same time period
D. The number of maternal deaths during a given time period per 100,000 live births during the same time
period.
E. The ratio of women who die from postpartum hemorrhage per 100 000 live births

14. Which of the followings is not a benefit of contraception uptake in the general population
A. Decreases the incidence of STDs
B. Increase the incidence of sexual activity
C. Decreases the incidence of teen pregnancy
D. All of the above
E. None of the above

15. Which of the following factor is the LEAST common cause of infertility
A. Ovulatory factor
B. Cervical factor
C. Tubal factor
D. Male factor
E. Combined factors

For Questions 16 to 20 in the table below: Link the patterns with their mechanism through
which unintended pregnancy can affect child health.

Pattern Mechanism
16. Short interbirth interval(b) a. Unexperienced parenthood
17. Large families (e) b. Early termination of breastfeeding
18. First born child (a) c. Conscious or unconscious neglect
19. Unwantedness © d. Maternal depletion syndrome
20. Higher order children (d) e. Competition for limited resources
21. The combined oral contraceptive pills (COCP) contain estrogen and progesterone
hormones. Which of the following from of estrogen is contained in the COCP?

A. Estrone
B. Estradiol
C. Estriol
D. Levonorgestrel
E. A combination of estrone and estriol

22. Select which of the following has the highest efficacy as an emergency contraceptive
A. COCP
B. Levonorgestrel (e.g.: Norlevo)
C. Intrauterine contraceptive device
D. Jadelle
E. All are equally effective

23. Which of the following is the difference between primary dysmenorrhea and secondary
dysmenorrhea?
A. Primary dysmenorrhea refers to women who develop dysmenorrhea for the first time while secondary
dysmenorrhea refers to women who have dysmenorrhea for at least the second time
B. Primary dysmenorrhea comes just before the menstrual bleeding while secondary dysmenorrhea comes
during of after the menstrual bleeding
C. Primary dysmenorrhea occurs in women who have never been pregnant while secondary dysmenorrhea
occurs among women who have had at least one pregnancy before
D. Primary dysmenorrhea refers to dysmenorrhea without a pelvic pathology while secondary
dysmenorrhea refers to dysmenorrhea with a pelvic pathology
E. Primary dysmenorrhea occurs before the initiation of sexual activities while secondary dysmenorrhea
occurs after the woman has initiated sexual activities

24. Referring to the WHO and Rwanda medical eligibility criteria for contraception, in
which category can we classify the combined oral contraceptive pills for postpartum
women with hypertensive disorders?
a. Unclassified
b. 1
c. 2
d. 3
e. 4
25. Surgical abortion is contra-indicated in which of the following conditions?
a. A pregnancy of 18 weeks
b. A Pregnancy with placenta previa
c. Twin pregnancy at 12 weeks with thrombocytopenia
d. Pregnancy at 10 weeks with
e. None of the above

III. Basics in Obstetrics and Gynecology: 10%

26. The most important muscle in the pelvic floor is:

A. Bulbo cavernousus.
B. Ischio-cavernosus.
C. Levator ani.
D. Superficial transverse Perineal muscle.
E. Deep transverse Perineal muscle.
27. The pelvis includes which of the following bones:
A. Trochanter, hip socket, ischium, sacrum & pubis.
B. Ilium, ischium, pubis, sacrum & coccyx.
C. Ilium, ischium & pubis.
D. Sacrum, Ischium, ilium & pubis.
E. Trochanter, sacrum, coccyx, ilium & pubis.

28. In Turner syndrome the following are usually present EXCEPT:

A.The ovary is usually well developed.
B. The nipple are widely spaced
C. The girls are of short stature
D. Has web neck
E. The condition can be diagnosed by chromosomal

29. Bicornuate uterus can cause all of the following EXCEPT

A. Abortions
B. Abnormal fetal lie.
C. Infertility.
D. Retained placenta.
E. Congenital anomalies of the baby.

30. Estrogen hormone is produced from all of the following organs EXCEPT:
A. Corpus luteum.
B. Anterior pituitary (anterior lobe of hypophysis).
C. Placenta.
D. Testes,
E. Adrenal glands.
31. Regarding Human Chorionic Gonadotropin, all of the following are true EXCEPT:
A. It is produced by the placenta.
B. Is reversible for the maintenance of corpus luteum.
C. It's level doubles every 48 hours in ectopic pregnancy.
D. Reaches a peak concentration in maternal serum by 10 weeks gestation.
E. Forms the main tumor marker for trophoblastic neoplastic diseases.

32. Which of the following is the primary source of estrogen?

A. Theca interna cells.
B. Theca externa cells.
C. Granulosa cells.
D. Interstitial cells.
E. Epithelial cells.

33. The following are presumptive skin signs of pregnancy except:

A. Chloasma
B. Maculo-papular rash
C. Linea Nigra
D. Stretch Marks
E. Spider Telangiectases
34. The softening of the cervical isthmus that occurs early in gestation is called:
A. Hegar's sign.
B. Chadwick's sign.
C. Braxton Hick's contraction.
D. Von fernwald's sign.
E. Cullen's sign.
35. In fetal circulation:
A. Oxygenated blood goes along the umbilical arteries
B. The fetal lung is bypassed by means of ductus venosus
C. The foramen oval connects the two ventricles
D. Most of the blood entering the right atrium flows into the left atrium
E. The blood in the umbilical arteries is more oxygenated that blood in umbilical Vein
36. Antenatal fetal monitoring can NOT be accomplished by:
A. Fetal kick chart.
B. Fetal scalp sampling.
C. Non-stress test.
D. Obstetric U/S & Biophysical profile.
E. Acoustic stimulation

IV. Pelvic Floor Dysfunction: 5%

37. A 49-year-old G4P4 presents to your office complaining of a 2-month history of leakage of urine
every time she exercises. She has had to limit her physical activities because of the loss of urine. She
has had burning with urination and some blood in her urine for the past few days. Which of the
following is the best next step in the evaluation and management of this patient?

A. Physical examination
B. Placement of a pessary
C. Urinalysis with urine culture
D. Cystoscopy
E. Office cystometrics

38. An obese 46-year-old G6P1051 with type 1 diabetes since age 12 presents to your office complaining
of urinary incontinence. She has been menopausal since age 44. Her diabetes has been poorly controlled
for years because of her noncompliance with insulin therapy. She often cannot tell when her bladder is
full, and she will urinate on herself without warning. Which of the following factors in this patient’s
history has contributed the most to the development of her urinary incontinence?
A. Menopause
B. Obesity
C. Obstetric history
D. Age
E. Diabetic status

39. You receive in your office a patient who was discharged two weeks ago from CHUK where she had a
total vaginal hysterectomy with anterior colporraphy and Burch procedure for uterine prolapse and
stress urinary incontinence. She complains of a constant loss of urine throughout the day. She denies
any urgency or dysuria. Which of the following is the most likely explanation for this complaint?
A. Failure of the procedure
B. Urinary tract infection
C. Vesicovaginal fistula
C. Detrusor instability
E. Diabetic neuropathy

40. How would you treat a 45-year-old woman with previously documented urge incontinence, who
continues to be symptomatic after following your advice for conservative self-treatment?
A. Prescribe Ditropan (oxybutynin chloride).
B. Prescribe Estrogen therapy.
C. Schedule an appointment with an urogynecologist for retro pubic suspension of the bladder neck.
D. Refer her to an urologist for urethral dilation.
E. Send her for urine analysis and treat her accordingly.
41. A 22-year-old woman has been seeing you for treatment of recurrent urinary tract infections over
the past 6 months. She married 6 months ago and became sexually active at that time. She seems to
become symptomatic shortly after having sexual intercourse. Which of the following is the most
appropriate recommendation for this patient to help her with her problem?
A. Refer her to an urologist.
B. Schedule an IVP(Intra Venous Puelography).
C. Prescribe prophylactic urinary antispasmodic.
D. Prescribe suppression with an antibiotic.
E. Recommend use of condoms to prevent recurrence of the UTIs.

V. General Obstetrics/Labor and Delivery: 30%

42. A 36 years old G1P0 is 31w5 days by LMP and is sure of her dates. Her pregnancy has been
complicated by persistence nausea, vomiting, back pain and lower extremity swelling. She comes to you
for a routine prenatal visit. She had a quad screen at 16 weeks that was normal. She is having a girl.
On this visit, her urine is assessed for the presence of protein, glucose, blood, and Leucocyte esterase.
Which of the following results would be most concerning?
A. Absent leucocyte esterase
B. Negative Glucose
C. Trace blood
D. 4+ Protein
E. Leucocyste esterase positive
43. Her Low back pain is no longer relieved by a heating pad and she finds that she needs pain relief to
make it through each work day. Which of the following options would be safest for
A. Ibuprofen
B. Aspirin
C. Oxycodone
D. Flexeril
E. Paracetamol
44. Her Nausea and vomiting has extended past the 1st trimester when most women stop experiencing
these symptoms. What would suggest that she has hyperemesis gravidarum?
A. Less than 5% loss of pregnancy weight
B. Jaundice
C. Syncopal episodes
D. Ketonuria
E. Metabolic acidosis
45. She has started experiencing lower abdominal pain and tightening that occurs (1-2 times/hour) and
irregularly. This is most likely:
A. Preterm labor
B. Round Ligament pain
C. Braxton hick’s contraction
D. An indication of fetal distress
E. Related to constipation

46. A G3P2002 woman at 35w is seen in your office for her prenatal visit. She is concerned because she
has not felt her baby moving as much as she used to. Her pregnancy has been uncomplicated and her
past two pregnancies ended in full term, normal spontaneous vaginal deliveries. A biophysical profile
BPP, is done to assess which of the following?
 A. Diastolic flow in the flow in the umbilical artery
B. Lung maturity
C. Blood flow in the middle cerebral artery
D. Fetal well being
E. Genetic abnormality
47. An indication for early delivery is identified, but a test for fetal lung maturity is done. Which of the
following is true?
A. Type 1 pneumocytes secrete surfactant
B. A lecithin to syphingomyelin ratio L/S greater than 2 is ideal if an early delivery is indicated
C. A low L/S ratio is associated with fever cases of respiratory distress syndrome
D. Typically, lecithin decreases as the lung matures
E. Syphingomylenin decreases beyond 24weeks

48. When formal antenatal testing is done, which of the following is most reassuring?
A. Late decelerations on the fetal monitoring
B. A contraction stress test (CST) with variable fetal heart rate decelerations with contractions but
moderate variability
C. A none stress test (NST) with two accelerations of the FHR in 20 minutes that are at least 15 beats
above the baseline and last for at least 15 seconds
D. An increase in the systolic to diastolic ratio in the umbilical artery blood flow
E. A score of 6 on a BPP

49. Immediate appropriate response to an initial eclamptic seizure include all the following except:
A. Ultrasound for fetal growth
B. Maintain adequate oxygenation
C. Administer Magnesium sulfate
D. Prevent maternal injury
E. Monitor the fetal heart rate

50. The Most important reason to give anti-hypertensive drug for hypertension in pregnancy is to
decrease the:
A. Incidence of IUGR
B. Incidence of Oligohydramnios
C. Incidence of fetal death
D. Incidence of placenta abruption
E. Risk of maternal complication such stroke

51. The following are known complications of pre-eclampsia except:

A. Abruptio placenta
B. Uterine rupture
C. Prematurity
D. Placenta insufficiency
E. IUFD
52. If a woman with pre-eclampsia is not treated prophylactically to prevent eclampsia her risk of seizing
is approximately:
A. 1/10
B. 1/25
C. 1/75
D. 1/200
E. 1/500
53. A 31 years old G1P0 woman at 39 weeks and 4 days’ presents to labor and delivery unit, with regular
contractions occurring every 45 min. her contractions last 30 to 90 seconds she is not sure if she has
been leaking any fluid from the vagina. You take her history and conduct a P/E. ROM would be
supported which of the following?
A. Nitrazine paper remaining orange when exposed to fluid in the vagina
B. A negative fern test
C. An Ultrasound with normal AFI
D. A negative tampon test
E. Speculum examination with evidence of pooling in the vagina

54. You determine her membranes have ruptured and admit her for active management of labor. The
first stage of labor:
A. Includes an active and latent phase
B. Begins when the cervix has completely dilated
C. Is considered prolonged if its duration is longer than 2 hours in a nulliparous woman
D. Begins with onset of Braxton hicks contractions
E. Is commonly associated with repetitive early and variable decelerations

55. On Examination you attempt to determine the presentation of the fetus. Which of the following
presentations and positions would be most favorable to achieve vaginal delivery?
A. Breech
B. Transverse
C. Vertex with occiput posterior
D. Vertex with occiput anterior
E. Vertex with occiput trans
56. The patient dilates without difficulty to 10cm and the second stage of labor begins. She is pushing
effectively but during contractions you notice decelerations on fetal heart tracings. Which of the
following would be concerning?
A. Isolated early decelerations
B. Repetitive variable decelerations that resolve after each contractions
C. Repetitive early decelerations and variable decelerations
D. Repetitive late decelerations and loss of variability between contractions
E. Absent decelerations

57. She pushes the head to the perineum and your delivery the head and shoulders without
complication. The cord is clamped and the placenta delivered. You examine her lacerations. A second
laceration:
A. Involves the anal mucosa
B. Is commonly associated with buttonhole lacerations
C. Involves the mucosa or skin only
D. Will heal well without repair
E. Extend into the perineal body but does not involve the anal sphincter

58. A 25 yo G2P1001 woman at 39w3 is seen is clinic. She has been experiencing more frequent
contractions and thinks she might be in labor. Her last pregnancy ended with c/s with after a stage 1
arrest. There was no evidence of cephalopelvic disproportion. Earlier in the course of her current
pregnancy she had desired a scheduled repeat c/s, but now she might be in labor and would like to
try and deliver vaginally. What would be a contra-indication of a trial of labor after a c/s (TOLAC)?
 A. Prior classical hysterotomy
B. Prior Kerr hysterotomy
C. SGA fetus
D. Oligohydramnios
E. GBS+Mother
59. After counselling and consent the patient agrees to a trial of labor and after dilating to 10cm, she
begins to push. After one hour of pushing the fetal heart tracing has absent variability and a baseline
that has risen to the 180 beats per minute. The baby’s station is low enough to consider using either
forceps or vaccum. Which of the following is not required for forceps delivery?
A. Adequate anesthesia
B. Evidence of cephalopelvic disproportion
C. Full dilation of the cervix
D. At least two station and engaged head
E. Knowledge of fetal position

60. You decide to attempt vacuum extraction. Which of the following is the most common complication
of vacuum extraction?
A. Fetal facial nerve palsy
B. Maternal perineal laceration
C. Cephalohematoma
D. Fetal skull fracture
E. Prolonged stage 3

V. Gynecologic Neoplasia: 10%

61.A 60 years old para 3 mother, post-menopausal for 2 years presented to outpatient clinic with a
compliant of abnormal vaginal bleeding and discharge of 6 months duration. On speculum
examination, there was a 3cm cervical mass. Other examinations were normal. What is the most
appropriate next step in the management of this patient?

A. Abdominopelvic ultrasound examination

B. Simple hysterectomy
C. Punch biopsy from the cervical mass
D. Radical hysterectomy
E. Chemoradiation

62. An MRI scan of the abdomen and pelvis was performed on the above patient. The MRI showed a
4cm cervical mass with right side parametrial extension and enlarged paraaortic lymph nodes. Based
on the available data the stage of the disease is:
A. Stage IA2
B. Stage IIB1
C. Stage IIB2
D. Stage IIIC
E. Stage IV A

63.The HPV subtype that is most likely to be isolated in this patient is

A. Type 16
B. Type 11
C. Type 6
D. Type 18
64. Which of the following is not considered as a primary prevention strategy to reduce the risk of
developing cervical cancer
A. Screening with Pap smear
B. Vaccination against HPV
C. Delaying the age of coitarche
D. Monogamous relation

65. Which of the following could potentially put the above patient at risk of developing the disease
she has
A. Diabetes
B. Hypertension
C. Multiparity
D. Early age at menarche

66. A 30 years of para 2 mother came for a regular gynecologic examination. Which of the following
finding on gynecologic examination is considered abnormal.
A. Nabothian cyst
B. Pink squamocolumnar junction
C. Acetowhite area
D. Ectropion

67. Which of the following statement is WRONG regarding the Human Papilloma virus (HPV)
A. Most women with HPV infection clears the infection
B. It is a DNA virus
C. Can be prevented by Gardasil
D. Infection increases the risk of developing cervical and ovarian cancer

68. Which of the following statement is WRONG about the treatment of precancerous lesions of the
cervix
A. Can be treated with cryotherapy, thermal ablation or radiotherapy
B. Watery discharge is common following cryotherapy
C. Can be detected by painting the cervix with lugols iodine
D. Colposcopy is important in making the diagnosis

69. Which of the following statement is WRONG regarding HPV vaccination

A. Recommended for those aged 9-14 years old
B. Usually 3 dose is given
C. Reduces the risk of genital wart development
D. Boys can also be vaccinated
70. HPV vaccine is categorized as :
A. Toxoid
B. Live attenuated
C. Viral like particle
D. Inactivated vaccine
 Preconception and Prenatal Care: 20%

71. The uterus must increase its volume over the course of a pregnancy from less than 20 cc to over
5L. This is accomplished while still maintaining the ability for the uterine muscles to contract with
enough force to expel the infant during labor. The uterine muscle mass enlarges during pregnancy
primarily because of which of the following?

A. Atypical hyperplasia
B. Anaplasia
C. Hypertrophy and hyperplasia
D. Involution
E. Production of new myocytes

72.During a pelvic examination on a patient that is approximately 8 weeks’ gestation by dates and
pelvic examination, one adnexa is found to be slightly enlarged. This is most commonly due to
which of the following?
A. Corpus luteum cyst
B. Ectopic pregnancy
C. Follicular cyst
D. Ovarian neoplasm
E. Para-ovarian cyst

73. A pregnant patient presents very concerned about some skin lesions/changes she is seeing that
are just like her uncle’s who has liver cirrhosis from hepatitis C. What lesions or changes are she
likely referring to?

A. Hyperpigmentation and spider angiomata

B. Linea nigra and chloasma
C. Spider angiomata and palmar erythema
D. Striae and chloasma
E.Striae and linea nigra

74. A patient presents to labor and delivery complaining of regular uterine contractions. Upon
Reviewing her gestational dating criteria, the following is determined:
Last menstrual period (LMP) places her at 36 weeks’ estimated gestational age (EGA).
Her clinical sizing at her initial obstetrical visit places her at 41 weeks.
Ultrasound done at 10 weeks places her at 38 weeks.
Ultrasound done at this presentation places her at 35 weeks.
Clinical size at presentation places her at 34 weeks.
You determine that she is how many weeks’ EGA?

A. 34 weeks’ EGA
B. 35 weeks’ EGA
C. 36 weeks’ EGA
D. 38 weeks’ EGA
E. 41 weeks’ EGA
75. In the fetus, the most well-oxygenated blood is allowed into the systemic circulation by which of the
following?
A. Ductus arteriosus
B. Foramen ovale
C. Ligamentum teres
D. Ligamentum venosum
E. Right ventricle

76. A patient presents with a positive pregnancy test, the exact date of the start of her last normal
menses, and the date of her luteinizing hormone (LH) surge from a urine kit. Which of the following can
most correctly calculate her expected date of delivery?

A. Adding 254 to the date of the start of the last menstrual period (LMP)
B. Counting 10 lunar months from the time of ovulation
C. Counting 280 from the first day of the LMP
D. Counting 40 weeks from the last day of the LMP
E. Adding 256 to the date of the elevated urinary LH when detected by home testing

77. A patient presents to your clinic complaining of nausea and vomiting. She is currently ingesting
combined oral contraceptive pills (OCP) and has used them for over a year. When you tell her she hasa
positive pregnancy test, she reports that her last bleeding on the OCPs was 8 weeks ago. In such a
situation, determination of the most accurate estimated date of delivery can then be made by which of
the following?

A. Eliciting when breast tenderness or morning sickness began

B. Assessing uterine size by physical examination
C. Counting 280 days from the first positive serum pregnancy test
D. Asking the patient when she first felt pregnant
E. Obtaining fetal biometry by ultrasound prior to 20 weeks’ gestation

78. Fundal height, part of the obstetric examination, is taken from the top of the symphysis pubis to the
top of the fundus. How is it measured?

A. By calipers, approximating the week of gestation

B. In inches, approximating the lunar month of gestation
C. In centimeters and divided by 3.5, approximating the lunar months of gestation
D. In centimeters, approximating the weeks of gestation beyond 22 weeks
E. By calipers in centimeters, prognosticating the fetal weight

79. Using your knowledge of normal maternal physiology, which of the following would you employ if a
patient at 38 weeks became faint while lying supine on your examination table?

A. Aromatic ammonia spirit (smelling salts)

B. Turning the patient on her side
C. Oxygen by face mask
D. Itravenous (IV) drugs to increase blood pressure
E. IV saline solution

80. The management of vaginal bleeding in a first-trimester pregnancy requires a trending of human
chorionic gonadotropin (hCG) levels. Because urine pregnancy tests can typically be less expensive and
results are more rapidly available, it is important to know their sensitivity. Immunologic tests for
pregnancy can detect hCG in the urine in which of the following concentrations?
A. 2 IU/L
B. 20 IU/L
C. 100 IU/L
D. 200 IU/L
E. 1,000 IU/L
81. An abnormal biophysical profile (BPP) predicts which of the following?

A. Higher risk for antepartum death within 1 week

B. A baby that will be small for gestational age (SGA)
C. Maternal preeclampsia
D. Meconium staining
E. Placental abruption

82. There is good evidence that a woman who gave birth to an infant with a neural tube defect (NTD)
can substantially reduce the risk of recurrence by taking periconceptional folic acid supplementation.
What is the recommended dose?
A. 0.4 mg
B. 0.8 mg
C. 1.0 mg
D. 4 mg
E. 8 mg

83. A 19-year-old primigravida with unsure LMP presents to initiate prenatal care. You attempt to
estimate gestational age. The uterine fundus is palpable at the level of the pubic symphysis, and feta
heart tones are audible by electronic Doppler. Based on this information, what is the approximate
gestational age?
A. 8 weeks
B. 12 weeks
C. 16 weeks
D. 20 weeks
E. 24 weeks

84. A complete blood cell count is typically obtained at the initiation of prenatal care. This test is
important as an indicator of general nutritional status. In the pregnant population, anemia can best be
defined as which of the following?

A. High total iron binding capacity

B. A genetic defect in ferritin synthesis
C. Low folic acid
D. A hemoglobin below 11 g/dL
E. Low plasma volume

85. Your patient has microcytic anemia with a hemoglobin of 9g/dl and normal iron stores. What is the
most likely diagnosis?
A. Folate deficiency
B. Vitamin B12 deficiency
C. Thalassemia
D. Vitamin B6 deficiency
E. Acute blood loss

86. A patient at 34 weeks’ gestation develops marked pruritus especially on her palms and soles, and
mildly elevated liver function tests and elevated bile acids. Which of the following diagnostic possibilities
is most consistent with the clinical presentation?
A. Pancreatitis
B. Hyperthyroidism
C. Diabetes insipidus
D. Cholestasis of pregnancy
E. Progesterone allergy

87. During pregnancy, blood tests for diabetes are more apt to be abnormal than in the non pregnant
state. Also nondiabetic women may develop gestational diabetes during the last half of the pregnancy.
This is due in part to which of the following?

A. Decreased insulin production

B.Increased food absorption from the GI tract
C. Increased placental lactogen
D. Decreased hepatic secretion of insulin-binding globulin
E. Hemoconcentration

88. On her first prenatal visit, a 17-year-old single woman (gravida 1, para 0), 32 weeks by good dates, is
found to have vital signs as follows: BP, 135/85; P, 84; T, 37°C; and R, 20. She also has ankle and hand
edema and a uterine fundus measuring 42 cm with breech concordant twins on ultrasound. She has
normal pelvic measurements and the cervix is closed and soft, with the presenting part at station −1.Her
UA revealed no WBCs or bacteria with 2+ protein. Her haematocrit is 38, and her WBC count is
9800. The next step in care of this patient should include which of the following?

A. Trial of home bed rest for 24 hours, with repeat evaluation at that time
B. Hospitalization with bed rest and frequent vital signs
C. Oxytocin induction of labor
D. Antihypertensive drugs
E. Caesarean section because of the twins

89. A 27-year-old woman comes to your practice desiring pregnancy. She has a history of
regular, 28-day cycles and has been using oral birth control pills for contraception. She has had
two pregnancies in the past, one ending in miscarriage at 9 weeks and one vaginal delivery at
39 weeks. Her last Pap smear was 10 months ago, and she has never had an irregular Pap. She
is not taking any medications and has no known medical allergies. On the basis of this woman’s
obstetric history, find out what is her TPAL designation?
A. G3P1011
B. G3P2001
C. G2P1011
D. G2P1101
E. G1P1001

90. Nutritional supplements she should begin before she gets pregnant include which of the
following:
A. Folate to reduce neural tube defects
B. Vitamin B12 to increase RBC production prior to pregnancy
C. Vitamin B1 to reduce beriberi
D. Vitamin C to reduce scurvy
E. No supplementation is necessary until pregnancy is confirmed

91. Before leaving your office, she asks how reliable OTC pregnancy tests are and how quickly
 after conceiving she should expect to test positive. You inform her that:

A. urine pregnancy tests are notoriously unreliable and that she should come in for blood tests if
she thinks she is pregnant
B. OTC tests have high sensitivity for hPL and will be positive around the time of the missed
menstrual cycle
C. OTC tests have high sensitivity for β-hCG and will be positive around the time of the missed
period
D. OTC tests have high specificity, but low sensitivity, so she should repeat the test twice at home
to confirm the results
E. OTC tests are typically positive the day after conception

92. A 32-year-old G4 P2022 presents to the infertility clinic and reports 18 months of infertility
with her new husband of 3 years. She had no difficulties conceiving her two living children. She
had two elective abortions after her children were born and also had a D&C following delivery
of her second child for retained placenta. Her husband has never fathered any children. His
semen analysis shows normal count, motility, and morphology. She has light but regular
menses and per the ovulation predictor kits, usually ovulates on day 14. Her endocrine
evaluation was normal. How would you best evaluate this couple's infertility?
a) Repeat semen analysis, perform an endocrine evaluation on the male partner, and perform a
testicular biopsy
b) Recommend use of clomiphene citrate to induce ovulation along with timed intercourse. No
further evaluation is needed
c) Until this patient has been infertile for at least 24 months, there is no need for further evaluation
d) Perform a pelvic exam, a hysterosalpingogram, and a sonohysterogram to look for intrauterine
abnormalities
e) Perform a transvaginal ultrasound to look for fibroids or polyps that could be the cause of the
infertility.

93. You are working in a DH and you receive a 31-year-old G3 P2002 who presents to labor and
delivery room with vaginal bleeding at 33 weeks' gestation. She states that she woke up in the
middle of the night with blood-stained sheets, and proceeded immediately to the hospital. She
has a history of a repeat cesarean section 2 years ago after a primary cesarean section for
breech presentation 5 years ago. She reports her baby is moving well, and she is comfortable
with stable vital signs. The baby's fetal heart rate tracing is reassuring and the bleeding has
slowed substantially. You review her records and notice a second trimester ultrasound report,
which identifies the placenta as “low-lying.” What is the next immediate step in management?
a) Perform a contraction stress test to evaluate for fetal well-being
b) Perform a cervical examination to evaluate patient for preterm labor
c) Obtain a fetal cell stain to evaluate patient for abruption
d) Perform a bedside ultrasound to evaluate placental location
e) Obtain coagulation studies to evaluate patient for coagulopathy

94. A 26-year-old G2P1 woman at 41 weeks’ gestation has been pushing for 3 hours without
progress. Throughout this time, her vaginal examination has remained completely dilated,
completely effaced, and 0 station, with the head persistently in the occiput posterior position.
Which of the following statements accurately describes the situation?

A. The occiput posterior position is frequently associated with a gynecoid pelvis.

B. The labor progress is normal if the patient does not have an epidural catheter for analgesia, but is
abnormal if epidural analgesia is being used.
C. The patient is best described as having an arrest of descent.
D. The bony part of the fetal head is likely to be at the plane of the pelvic inlet.
E. Misoprostol for cervical ripening.

95. A 24-year-old G2P1 woman at 39 weeks’ gestation presents with painful uterine
contractions. She also complains of dark, vaginal blood mixed with some mucus. Which of the
following describes the most likely etiology of her bleeding?
A. Placenta previa
B. Placenta abruption
C. Bloody show
D. Vasa previa
E. Cervical laceration

96. You are working at Muhima DH and you receive a 24-year-old G2P1001 woman at 38 weeks
by LMP and supported by a 9-week ultrasound. She states that her mother is in town for the
next 4 days and will be available to assist in taking care of her baby. She requests an induction
of labor. Which of the following is the best response to this request?

A. Since the patient is term, there is no increased neonatal complications, but an increased risk of
cesarean as compared to spontaneous labor.
B. If the cervix is unfavorable, then prostaglandin ripening would increase the changes for vaginal
delivery.
C. Induction at 38 weeks increases neonatal complications as compared to delivery to 39 weeks.
D. The patient’s request is reasonable, and induction can be performed with little neonatal or
maternal complications.

97. You are assigned to Labor and Delivery room and a 25-year-old G1P0 woman has a preterm
spontaneous vaginal delivery at 33-weeks. The delivery is uncomplicated. If you wish to
optimize the outcome of the baby, when would clap the cord?
A. Immediately
B. Between 30 and 60 seconds
C. After 60 seconds
D. Leave the cord unclamped until delivery of the placenta
E. It doesn’t’ matter

98. A pregnant woman was diagnosed with an acute DVT at 34 weeks of gestation and was
treated with LMWH (Lovenox). She has delivered this morning (39 weeks). She would like to
discuss warfarin for postpartum thromboprophylaxis as she would rather avoid needles. She
would like to breastfeed. Which of the following treatment options are best suited to her?
A. Warfarin commenced at 48 h postpartum.
B. Warfarin commenced at 72 h postpartum.
C. Warfarin commenced at 96 h postpartum.
D. Warfarin commenced at 120 h postpartum.
E. Warfarin contraindicated, as she is breastfeeding.

99. A male individual (46,XY) with deletion of SRY gene would have:
A. a female phenotype
B. a male phenotype
C. Ambiguous genitalia
D. normal fertility
E. predisposition to cancer of testes

100. Which of the following hereditary cancer syndromes should primarily be considered in a family
consisting of: a man with colon cancer at the age of 55 years, his sister endometrial cancer at 67 years
of age, their father colon cancer at 53 years of age and their paternal grandfather's sister rectal cancer
at 34 years of age?
A. Familial adenomatous polyposis (FAP)
B. Lynch syndrome
C. Peutz-Jeghers syndrome
D. Wermer’s syndrome
E: Polycystic Ovarian Syndrome(PCOS)