Published on February 19, 2014
GYNECOLOGY & OBSTETRICS Model Paper - 01 2 hours Single Best Response 01) A 17-year-old girl is brought to the office by her mother because of very irregular menstrual periods and dark hair above her lip. She was 14 years old at menarche and her menstrual cycle has always been unpredictable. The patient has no medical problems and feels well. She denies being sexually active, as the mother is in the room, but does admit to having a serious boyfriend for the past 11 months. On physical examination, she is obese, has acne and dark hair scattered on her chin and upper lip. She also has symmetric, velvet-like, gray-brown hyperpigmentation of the skin along the nape of her neck. Pelvic examination is normal. Ultrasonography of the pelvis demonstrates multiple cysts within both ovaries with a "string of pearls" appearance. At this time, the most appropriate treatment for this patient is A. clomiphene citrate B. laparoscopic electrocauterization of the ovaries C. low-fat diet and exercise D. oral contraceptive pills E. testosterone injections F. wedge resection of the ovaries 02) A 28-year-old pregnant patient comes to the office for a routine physical examination. She is in her 18th week of pregnancy with no complaints. Examination and fetal ultrasound are normal. You notice that laboratory studies from 2 weeks ago show an alkaline phosphatase of 300 U/L. On more detailed questioning, the patient denies any symptoms consistent with gallstones or biliary disease. She coincidentally had an ultrasound of the right upper quadrant a few months ago for another reason, and it did not reveal any gallstones or biliary sludge. The most appropriate management at this time is A. cholecystectomy B. hepatobiliary nuclear scan C. observation and repeat blood test in 3 months D. reassurance E. repeat right upper quadrant ultrasound 03) A 26-year-old woman, gravida 1, with insulin-dependent diabetes mellitus comes to the office at 33weeks gestation, reporting decreased fetal movement for 1 day. She is found to have poor glucose control, with serial blood sugar levels greater than 150 mg/dL. The fetal heart rate on the nipple stimulation test is
non-reactive. The baseline rate is 140/min, and late decelerations are observed in the first 30 minutes of the test with each contraction. The next step in management is A. a biophysical profile (BPP) B. delivery C. a nonstress test (NST) D. a contraction stress test (CST) E. a repeat nipple stimulation in 24 hours 04) A 25-year-old comes to the emergency department because of severe right-sided lower abdominal pain for the past 12 hours. She has also experienced fever and chills, but no change in appetite. She is sexually active with 3 different partners and they use the "withdrawal" method for contraception. Her regular menstrual period began 4 days ago. Her temperature is 39 C (102.2 F), blood pressure is 120/80 mm Hg, pulse is 75/min, and respirations are 20/min. Physical examination shows right-sided lower abdominal tenderness with no rebound or guarding. Pelvic examination shows cervical motion tenderness and a purulent discharge. A Gram stain of the discharge shows Gram-negative diplococci within polymorphonuclear leukocytes. A urine pregnancy test is negative. You prescribe a 14-day course ofloxacin and metronidazole. She agrees to be compliant with this therapy and you send her home with a follow-up visit in 48 hours. She returns to the emergency department in 12 hours with one of her sexual partners because of worsening abdominal pain. Her temperature is 39.3 C (102.8 F), blood pressure is 100/60 mm Hg, pulse is 130/min, and respirations are 28/min. Abdominal examination shows severe tenderness with guarding and rebound. At this time you should A. add cefoxitin to her treatment regimen B. admit her to the hospital and prepare her for immediate surgery C. admit her to the hospital for observation D. evaluate and treat her sexual partner E. measure the serum β-subunit of human chorionic gonadotropin concentration F. order a CT scan of the pelvis 05) A 31-year-old woman comes to the clinic because of "not having a period for over a year, white discharge from both nipples, and severe frontal headaches of 2 years duration". Evaluation reveals a follicle-stimulating hormone (FSH) level of 6.0 mIU/mL, basal serum prolactin level of 82 ng/mL, and thyroid-stimulating hormone (TSH) of 19 micro-U/mL (normal ranges: FSH 2-20 mIU/mL, prolactin, <20 ng/mL, TSH, 0.5-5.0 microU/mL). An MRI reveals pituitary enlargement with a mass measuring 13 mm in diameter. The next step in the management of this patient is
A. evaluation of other pituitary hormones B. formal visual field testing C. referral to a neurosurgeon D. therapy with bromocriptine E. therapy with levothyroxine 06) Regarding management of ectopic pregnancy B) C) D) E) A) Can be excluded by negative beta hCG test. Can be excluded in the absence of a POA. Can be excluded in the absence of cervical excitation. If haemodynamically stable, can be managed by laparoscopy Methotraxate is an management for unruptured ectopic pregnancy 07) 35 year old nulliparous woman planning a pregnancy present with menorrhagia. She is married for 2 years and tried for pregnancy over last 6 months. Investigations reveal her Hb 8.1 g/dL , USS 9 X 10 cm interestitial fibroid. She was treated with medical management and still she is symptomatic. Which of the following is the best treatment option? A) B) C) D) E) uterine artery embolisation endometrial ablation TAH + BSO GnRH analogues myomectomy 08) A couple presented with secondary amenorrhea for 6 years after their first child birth. The man is a healthy school teacher and has no co-morbidities from their last child birth. But he had a febrile illness with swelling of parotid gland. Women is having 30 day regular cycles. Which of the following is the best initial option? A) FSH & LH levels in the woman B) Mid luteal phase progesterone in the woman C) Seminal fluid analysis D) Testosterone injections to male E) Ulltrasound scan of abdomen in the woman 09) A 27 year old primigravida is on labour for 8 hours and her cervical diameter remains 4 cm for 4 hours. On vaginal examination fetus left anterior position, no caput or moulding, station is 1cm below the ischial spine, what is the most appropriate measure to be taken, A) Immediate LSCS B) Forceps delivery C) Review in 4 hours D) Start on Oxytocin infusion
E) Ask the patient to bear down 10) Regarding HIV infected mother, what is the most appropriate measure to be taken to prevent the transmission of the infection to the neonate A) B) C) D) E) Avoid from breast feeding. Avoid breast feeding only if skin lesions are present. Separate the child from mother. Start the neonate on anti-retroviral therapy. Reassure the mother. 11) A 37 year old mother of 3 children presenting with chronic pelvic pain and dysmenorrhea. She does not have further fertility wishes. On investigation there is 10 into 7 cm, right side endometrioma was diagnosed. What is the best treatment option for her, A) TAH+BSO B) Right side oophorectomy C) Ovarian cystectomy D) Aspiration of the cyst E) Treat with Mefenemic acid 12) A 52 year old post-menopausal woman comes after 8 months of her last menstrual period. What is the most appropriate indication to start on HRT, A) B) C) D) E) Backpain Urgency Hot flushes Insomnia Diabetes Mellitus 13) A 48-year old woman has had heavy irregular periods every three to four months; for the last IO years. She had a dilatation and curettage (D&C) performed, in what was hoped to be the premenstrual phase, as part of the assessment of this problem. Which one of the following, if found on histological examination of the curetting from this D&C, is most likely to be the cause other bleeding pattern? A) B) C) D) E) Normal secretory endometrium Cystic glandular hyperplasia Atypical hyperplasia An endometrial polyp Endometrial carcinoma 14) A 30-year- old woman delivered spontaneously 20 minutes ago after a I6-hour labour. She was given 5 units of oxytocin (“Syntocinon") intravenously immediately after the birth and was delivered of her placenta three minutes later. She has since lost 750mL of blood vaginally. After ‘rubbing up’ the uterine fundus manually, which one of the following is the most appropriate next step in management?
A) B) C) D) E) Inspect the placenta. Inspect the vagina and cervix for a laceration Empty the bladder Cross-match blood Give ergometrine intravenously 15) Following a delivery complicoted by shoulder dystocia, a newborn bdby is found to have an asymmetric Moro reflex. The poorly responsive arm hangs limp in adduction, rotated internally at the shoulder, extended and pronoted at the elbow, and flexed at the wrist. Which one of the following pairs of nerve roots is most likely to have been affected ? A) C3 and C4 B) C5 and C6 C) C8 and C11 D) T2 and T3 E) T4 and T5 16) An l8-year-old girl, who had her menarche at I3 years, presents because of severe pain during each of her periods for the last two years. She has tried treatment with aspirin, panadeine ond indomethacin, but little relief has been achieved. She is convinced there is something seriously wrong with her. Which one of the following is the most likely reason for her dysmenorrhoea? A. Endometriosis. B. Uterine myomata C. Chronic pelvic infection D. An endometrial polyp. E. Endometril prostoglondin release. 17) A 32—year-old woman who had a Multiload (Cu375®) intrauterine device (IUCD) inserted six months ago, now presents with six weeks of arnenorrhoea and a positive pregnancy test. On examination, the strings of the device, which would be expected in normal circumstances to be visible protruding through the external os, are not visible on speculum inspection of the cervix.She is keen to proceed with the pregnancy. Which one of the following is the most appropriate immediate next step in management ? A) B) C) D) E) Ultrasound of the pelvis Uterine sounding X—ray the pelvis Hysteroscopy Laparoscopy 18) A 45—year—old woman had a lumpectomy, postoperative radiotherapy, adjuvant chemotherapy and tamoxifen therapy at the age of 42 years for an estrogen receptor—positive breast malignancy. She was prescribed tamoxifen in a dose of lOmg per day and was to take it for the next five years. From the time she completed her chemotherapy three years ago, she had no menstrual periods until one week ago when she had an episode of light vaginal bleeding lasting for 7 days. She is still taking the tamoxifen. Which one of the following is the cause for the recent bleeding?
A) B) C) D) E) Induction of follicular development by the tamoxifen Endometrial polyp formation due to the tamoxifen An endometrial cancer produced by the tamoxifen Endometrial atrophy due to the tamoxifen An endometrial metastasis from the breast cancer 19) 16 year old girl, whose pubertal breast changes commenced about four years ago, has had episodes of lower abdominal pain lasting about three days each month for the last l2 months. She has not yet had her first period. Abdominal examination, when she is not in pain, shows no evidence of any suprapubic mass or tenderness. Blood tests have shown she is ovulating. Which one of the following developmental abnormalities is most likely to be the cause of her abdominal pain? A) Imperforate hymen B) An absent vagina but normal uterus C) A transverse vaginal septum D) Mullerian agenesis E) A uterus obstructed at the level of the cervix 20) 35 year old woman presents with cyclical mastalgia. Clinical examination of the breast is normal. Her mother developed breast cancer at the age of 45 years and subsequently died from metastases. The patient's maternal grand mother also had breast cancer before the age of 50. The patient is on the oral contraceptive and no other medications; her general health is normal. Mammography is normal. An ultrasound of the breasts shows an uncomplicated cyst with no features in the right breast. Apart from advice about use of simple analgesics and evening primrose oil for her mastalgia, which one of the following is the most appropriate advice in the patient’s follow up regimen? A) Cease the OCP, yearly clinical review, yearly mammography and ultrasound B) Remain on the OCP, yearly clinical review, yearly mammography and ultrasound C) Remain on the OCP, six-monthly clinical review, yearly mammography and ultrasound D) Remain on the OCP, two—yearly clinical and mammography review E) Cease the OCP, yearly clinical and ultrasound review 21) 12-year—old girl, whose first period started Two weeks ago, presents because of very heavy bleeding necessitating her To use Ten sanitary pads per day , and the bleeding does not seem to be decreasing. Which one of the following investigations is most likely to define the cause of this problem? A) Haemoglobin level. B) Bleeding/coagulation profile C) Serum ferritin D) Dilatation and curettage E) MRI of the pituitory gland 22) A 21 year-old primigravid woman, at 39 weeks of gestation attends the antenatal clinic at the local hospital for the first antenatal visit. She has just arrived from overseas, having had no antenatal care in her country of origin. Her BP is l20/80mmHg.The fundal height measures 30cm above the pubic symphisis. Fetal heart tones are evident at 144/min. Pelvic examination reveals the cervix is long and closed, and the
baby is presenting cephalically. Which one of the following is the most appropriate next step in management? A) Fetal kick chart B) CTG C) Amniocentesis D) Ultrasound examination E) Umbilical artery waveforms (Doppler) 23) which one of the following findings in a woman in labour, where the cervix is 7cm dilated, would be most consistent with obstructed labour and the need for delivery by Caesarean section? A) A brow presentation in a nulliparous woman B) Caput and moulding of the fetal head C) Early fetal heart decelerations from 160 to 120/min on the CTG D) The fetal head is still just above the ischial spines E) A maternal fever of 37.8°C 24) An otherwise healthy 76 year old woman comes to the physician' office because of uncontrollable voiding of small amounts of urine when she coughs or laughs this also happens when she walks postvoid volumens are small and there is no nocturnal incontinence focused examination shows no abnormalities except for some laxity of pelvic floor musculature which of the following is the most likely diagnosis ? A) bladder tumor causing B) detrusor C) fibrosis of detrusor muscle D) outlet E) small infart of pontine micturition center partial outlet obstruction overactivity incompetence 25) A patient, who appears to be female, is found to be 46,XY. The patient's vagina is very shallow, ending in a blind pouch, and there are palpable masses in the labia. The diagnosis of testicular feminization syndrome is made. Which of the following was most likely present during the early fetal life of this individual? A. A streak ovary B. A uterus C. An oviduct D. Depressed levels of testosterone E. MIF (Mullerian inhibitory factor) 26) A 38-year-old pregnant woman with a past medical history significant for chronic hypertension presents with a blood pressure of 158/105 mm Hg. Which of the following antihypertensive agents would be most suitable for initial therapy in this patient? A. Bumetanide B. Fosinopril
C. D. E. Hydrochlorothiazide Methyldopa Valsartan 27) A surgical pathology specimen from a 24-year-old woman seen at a reproductive medicine clinic demonstrates a ciliated columnar epithelium. From which of the following locations in the female genital tract was the biopsy obtained? A. Cervix B. Endometrium C. Fallopian tube D. Ovary E. Vagina 28) In a genotypic male, the testes fail to develop, and do not secrete testosterone or Müllerian regression factor. Which of the following best describes the in utero reproductive system development of this individual ? A. Both male- and female-type internal reproductive tracts and male-type external genitalia B. Female-type internal reproductive tract and female-type external genitalia C. Female-type internal reproductive tract and male-type external genitalia D. Male-type internal reproductive tract and female-type external genitalia E. Male-type internal reproductive tract and male-type external genitalia 29) A sexually active 18-year-old woman presents with a fever of 102 F for the past 24 hours and lower abdominal pain and anorexia for the past 5 days. On physical examination, there is generalized tenderness of the abdomen, and the cervix is erythematous with motion tenderness. There is no rash nor any lesions on the external genitalia. A smear of the odorless cervical discharge contains sloughed epithelial cells and scant neutrophils. Which of the following would likely be found in the exudate? A. B. C. D. E. F. G. H. A naked, icosahedral double-stranded circular DNA virus Iodine-staining intraepithelial inclusion bodies Intraneutrophilic gram-negative diplococci Intranuclear "owl's eye" inclusion bodies Lactose-fermenting gram-negative bacilli Pear-shaped flagellated protozoa Pleomorphic, gram-negative rods Spirochetes on dark-field microscopy
30) Which cause of A. B. C. D. E. Rickettsia of the following organisms is urethritis that persists after most likely antibiotic True to be therapy & 01) The management of postpartum haemorrhage include: a) vaginal examination to identify cervical tears b) intravenous administration of 75mg of pethidine c) administration of a drip with 20 units of syntocinon d) ligation of internal iliac artery e) subtotal hysterectomy 02) Placental abruption a. is a complication of hypertension in pregnancy b. will be a result of sudden release of liquor in a patient with polyhydramnios c. will lead to rapid labour d. causes retained placenta e. is a cause for disseminated intravascular coagulation 03) Babies born to diabetic mothers are at risk of a. shoulder dystocia at delivery b. respiratory distress syndrome c. neonatal anaemia d. polycythaemia e. neonatal hyperglysaemia 04) The following are compatible with a diagnosis of severe pre eclampsia a) right hypochondrial pain b) polyuria c) thrombocytopaenia d) elevated serum uric acid e) anaemia 05) Intrauterine death is: implicated as a for gonorrhea? Actinomyces Chlamydia Mycobacteria Nocardia Faults
a) b) c) d) e) associated with chromosomal abnormalities result from placental abruption managed by immediate caesarean section a cause of disseminated intravascular coagulation a known cause for postpartum psychosis 06) Congenital anomalies in the uterus in pregnancy are associated with an increased risk of a. retained placenta b. preterm labour c. breech presentation d. miscarriage e. uterine inversion 07) Subfertility due to anovulation is treated with: a) clomiphene citrate b) FSH & LH c) antibiotics d) GnRH analogues e) danazole 08) Endometriosis is treated with: a) Danazol b) Combined oral contraceptive pill c) Corticosteroids d) GnRH analogues e) Antibiotics 09) Effective treatment for genuine stress incontinence include: a) pelvic floor exercises b) antimuscarinics c) colposuspension d) antibiotics e) tension free vaginal tape 10) In vaginal hysterectomy and repair for utero-vaginal prolapse: a. vaginal ulcers should be healed before surgery b. patient mobilization should commence from the 3rd day c. peri operative antibiotics are indicated d. bladder should be routinely drained for 5 days postoperatively e. secondary haemorrhage is a complication 11) Regarding the genetics and development of the genital tract: A. the uterus is developed from the paramesonephric ducts B. there is an association between malformations in the genital tract and renal tract C. individuals with balanced chromosomal translocations develop major structural abnormalities D. trisomy for chromosome number 18 is Down’s syndrome E. the karyotype of Klinefelters syndrome is 47 XXY
12) Turner syndrome A. is characterized by short stature B. is a cause of low oestrogen levels C. has a chromosomal structure of 45 XY D. leads to secondary amenorrhoea E. has a male phenotype 13) Causes of breech presentation include A. prematurity B. placenta praevia C. polyhydramnios D. multiple pregnancy E.macrosomia 14) Polyhydramnios is seen in A. multiple pregnancy B. diabetes mellitus C. fetal renal agenesis D. intrauterine infections E. Oesophagial atresia 15) Post menopausal bleeding A. is defined as vaginal bleeding occurring menstruation B. requires endometrial sampling C. is caused by atrophic vaginitis D. is treated with progesterone only pill E. is investigated by Hysteroscopy more than 2 years after the last 16) Pre-eclampsia A. is commoner in primigravidae B. is best treated with diuretics C. is less common in women who smoke D. associate with fetal IUGR E. has the primary pathology in the kidneys 17) Gestational diabetes mellitus A. is defined as the appearance of glucose intolerance during pregnancy B. is associated with an increased risk of fetal chromosomal anomalies C. is associated with an increase in perinatal mortality D. diagnosed by OGTT E. does not require insulin therapy 18) The Cu T Intrauterine contraceptive device A. prevents implantation B. is teratogenic
C needs to be changed after two years D is contraindicated in the presence of a Caesarean section scar E increases the risk of pelvic infection 19) Important information in the history of a subfertile male include A. Occupation B. Immunization for rubella C. mumps D. previous fertility E. sexual transmitted diseases 20) Ovulation induction is A. B. C. D. a cause of multiple pregnancy a cause for ovarian hyperstimulation syndrome done with tamoxiphen done with clomiphene
E. carried out with danazol 21) Maternal mortality: A) Includes death caused by an ectopic pregnancy. B) Is subjected to a confidential enquiry. C) Must be reported to the Coroner. D) Epilepsy is the commonest cause of indirect maternal death. E) Is most often caused by sepsis. 22) 5 During development of the ovarian follicles: a) The primary oocyte is arrested at the interphase of the second meiotic division. b) Granulosa cells in the corpus luteum are responsible for steroidogenesis. c) Theca cells produce testosterone from cholesterol. d) Meiosis is resumed prior to the luteinizing hormone (LH) surge. e) The first polar body is extruded prior to ovulation. 23) After a successful conception the following statements are true: a) The embryo remains in the fallopian tube for 6–8 days. b) Myometrial cytokines modulate cytotrophoblastic proteolytic activity. c) At 11 days the implantation site can be seen as a red spot on the endometrial mucosa. d) Human chorionic gonadotrophin is produced by the corpus luteum. e) The embryonic disc is formed after the third week postfertilization. 24) Considering embryo development: a) During the third week, the bilaminar embryo generates the mesoderm. b) At day 28, the cephalic neuropore closes. c) Cardiac activity is evident from day 26. d) The lower respiratory system appears as septation of the foregut. e) The fetus is recognizably human at 12 weeks’ gestation. 25) In normal pregnancy: a) Blood pressure falls in the second trimester. b) Plasma volume decreases throughout gestation. c) There is a reduction in erythrocyte production. d) 50 per cent of women have a transient diastolic murmur. e) There is an increase in the number of polymorphonuclear leucocytes. 26) Maternal effects on the physiology of the kidney include: a) There is a 40 per cent increase in renal blood flow. b) There is an increase in the glomerular filtration rate.
c) The urea and creatinine are higher than the non-pregnant state. d) The upper limit of protein excretion in pregnancy is 0.6 g per day. e) The kidneys increase in size. 27) During lung development: a) Alveolar development occurs after 20 weeks. b) The predominant phospholipid is phosphatidylcholine. c) Fetal lung fluid production ceases in the second stage of labour. d) Fetal breathing movement occurs for 30 per cent in the second trimester. e) The production of lecithin is enhanced by cortisol and diabetes. 28) With regard to routine antenatal care: a) There is no evidence in low-risk pregnancies that reduction in antenatal visits increase maternal or fetal mortality. b) The Naegele rule states that the expected date of delivery (EDD) is calculated by adding 7 days to the last menstrual period (LMP) and then taking away 4 months. c) Syphilis testing forms part of the routine booking visit. d) Routine urine testing reduces preterm labour. e) Every patient should have a named consultant. 29) The routine dating scan: a) Allows accurate dating of the pregnancy and a reduction in induction of labour for prolonged pregnancy. b) Allows the detection of placenta praevia. c) Allows early detection of twin pregnancies. d) Allows detection of a failed pregnancy. e) Allows detection of uterine abnormalities. 30) Regarding diagnostic ultrasound: a) It employs the use of low-frequency, high-intensity sound waves. b) Between 12 and 20 weeks, the crown–rump length and femur length are the most reproducible assessment of gestational age. c) It can be used to determine chorionicity accurately in twin pregnancy at the 20-week scan. d) It has shown that an increased nuchal translucency is associated with cardiac defects. e) In 6 per cent of pregnancies, there will be a serious fetal structural abnormality.
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