6th Year Obs&Gyne Final Exam - 2015

The exam was 100 questions, 2 forms. Some questions were the same in both forms.

1) All can be detected on 1st trimester ultrasound except:

a. +microcephaly
b. gestational age
c. ensure intrauterine pregnancy
d. chromosomal anomalies
e. number of fetuses
2) Not a cause of superficial dyspareunia:
a. lactation
b. +pelvic adhesions
c. vulvar and vaginal candidiasis
d. psychological
e. vaginal atrophy
3) Not a cause of post-coital bleeding:
a. cervical polyp
b. cervical carcinoma
c. +endometrial polyp
d. cervical ectropion
e. cervicitis
4) Not a cause of primary amenorrhea:
a. turner syndrome
b. mullerian agenesis
c. +asherman's syndrome
d. androgen insensitivity
e. prolactin secreting adenoma
5) Not a recognized indication for IVF:
a. +septate uterus
b. obstructive azospermia
c. severe oligospermia
d. unexplained infertility
e. tubal blockage

6) All are true about clomiphene citrate except:

a. causes hyper-stimulation syndrome
b. causes hot flushes
c. +indicated in premature ovarian failure
d. increases levels of gonadotropins
e. increases possibility of dizygotic pregnancy
7) All are true about primary dysmenorrhea except:
a. +in both ovulatory & non ovulatory cycles
b. starts at the 1st day of menses, subsides by the 3rd
c. associated with vomiting & diarrhea
d. caused by prostaglandins increase in the 2nd half of the cycle
8) Not a tocolytic:
a. +beta blocker
b. nifedipine
c. MgSO4
d. atosiban
e. indomethacin
9) About ovarian cancer, one is false:
a. epithelial is the most common type
b. +tubal ligation increases its risk
c. endometrioid type may be associated with endometrial carcinoma
d. endometriosis is associated with clear cell type
e. multiparity reduces its risk
10) Inhibin is a tumor marker in:
a. +granulosa cell tumor
b. dysgerminoma
11) About drugs in pregnancy, all are true except:
a. ampicillin is relatively safe
b. cephalosporin is relatively safe
c. +tetracycline is safe in 2nd trimester
d. phenytoin is associated with facial clefting

12) Earliest sign of chorioamnionitis:

a. +maternal tachycardia
b. fever
c. abdominal tenderness
d. vaginal bleeding
13) Not an indication for induction of labor:
a. preeclampsia at 39 weeks
b. placental abruption at 37 weeks
c. fetal growth restriction
d. +36 weeks gestation who has well controlled DM
14) Which of the following specifically suggests obstructed labor:
a. +severe moulding
b. fetal distress
c. station -2
d. arrest of dilation
e. occipito-posterior position
15) True about shoulder dystocia:
a. +many affected babies are of normal body weight
b. the best management is to keep pushing & traction
c. obstruction occurs at the pelvic outlet
d. 70% is the risk of recurrence
e. preventable in majority of cases
16) 35 years old P3 has endometriosis and doesn't wish to preserve fertility,
best management:
a. continuous OCPs for 6-9 months
b. hysterectomy and bilateral salpingo-oophorectomy
c. danazol
d. GnRH
e. progesterone secreting IUD
17) All are risk factors for premature ovarian failure except:
a. mumps
b. radiation
c. autoimmune disease
d. +progesterone mini pills
e. smoking

18) All of the following are true regarding antenatal care except:
a. decreases the risk of iatrogenic postmaturity
b. decreases complication on mother and fetus in mother with medical illness
c. prevent iron deficiency anemia
d. +prevents fetal anomalies
19) About folate deficiency anemia, which is wrong:
a. +using anti-convulsant therapy reduces the need for folate
b. MCV increases
c. hyper-segmented neutrophils on blood film
d. second most common anemia
e. folate supplements lower the incidence of neural tube defects
20) About congenital anomalies, all are true except:
a. overall incidence of major congenital anomalies is 3%
b. +most common cause is chromosomal abnormalities
c. common presentation is 1st trimester miscarriage
d. may not be evident at birth
e. might be caused by environmental factors
21) While giving MgSO4, all of the following should be monitored except:
a. +pupillary reflex
b. deep tendon reflexes
c. respiratory rate
d. blood pressure
e. urine output
22) About hyper-emesis gravidarum, all are true except:
a. +polyurea is a sign of severity
b. can be associated with hyperthyroidism
c. can cause Wernicke's encephalopathy in severe cases
d. more with multiple pregnancy
e. usually resolves by 12 weeks
23) About GTN, all are true except:
a. myelosuppresion is an uncommon side effect of methotrexate
b. most common site of metastasis is the lungs
c. +partial mole never makes it to term
d. best treatment is suction and curettage
e. most common karyotype of complete mole is 46XX

24) Which of the following reduces the efficacy of COCPs:

a. +rifampicin
b. ranitidine
c. metochlopramide
d. steroids
e. hydrochlorothiazide
25) A female gave birth by C-section 2 weeks ago, placenta was delivered
completely, now she came febrile with secondary PPH. All are true except:
a. can continue breastfeeding
b. most common cause is retained products of conception
c. best treatment is with ceftriaxone and metronidazole
d. HVS and endocervical swab are recommended
e. uterus palpable 4 cm above the pubic symphysis indicates sub-involution
26) A female gave birth to twins by normal vaginal delivery before 30
minutes, and now she is having bleeding. The most likely cause would be:
a. +uterine atony
b. uterine rupture
27) The most important risk factor for preterm labor:
a. +previous preterm
b. cervical incompetence
c. premature rupture of membrane
28) About normal vaginal delivery after CS (VBAC), all are true except:
a. incidence of rupture is 0.5-1%
b. 70% will deliver vaginally
c. oxytocin use should be avoided
d. +instrumental delivery is contraindicated
e. success rate increases if labor begins spontaneously
29) Smoking can cause all of the following except:
a. IUGR
b. placental abruption
c. +preeclampsia

30) True about cord prolapse:

a. can be diagnosed by palpation while membranes are intact
b. +can be delivered vaginally if cervix was fully dilated
c. common cause of intrapartum fetal death
d. using vaginal PG in induction increases the risk
e. incidence 1 in 5,000
31) All fulfill the criteria of normal vaginal delivery except:
a. +gestational age 36+4
b. bleeding in 3rd stage 300 ml of blood
c. infusion of oxytocin after the delivery of the anterior shoulder
d. CTG used in monitoring in 1st & 2nd stage of labor
32) All are normally done in labor except:
a. +routine artificial rupture of membrane when cervix is 4 cm dilated
b. asses uterine contractions every 30 min
c. vaginal exam every 2-4 hours
33) All are causes for increased AFP except:
a. hydatiform mole
b. anencephaly
c. +Down syndrome
d. fetal demise
e. multiple pregnancy
34) All are true about thyroid disease in pregnancy except:
a. +graves' disease worsens in the 3rd trimester
b. hyperthyroidism is associated with stillbirth
c. propylthiouracil is safe in lactation
d. thyroxine is safe in pregnancy
e. radio-iodine scan is contraindicated in pregnancy
35) All are true about endometrial cancer except:
a. obesity is a risk factor
b. +serous type is associated with good prognosis
c. baseline treatment for all patients is hysterectomy and bilateral salpingooophorectomy
d. post-menopause women have worse prognosis than pre-menopause

36) About candidiasis, all are true except:

a. +recurrence is not common
b. fluconazole is not safe during pregnancy
c. vulva will be edematous and inflamed
d. whiff test is negative
e. occurs more during pregnancy
37) About post menopausal bleeding, all are true except:
a. endometrial thickness >5 mm on ultrasound is an indication for biopsy
b. vaginal atrophy is a recognized cause
c. +endometrial cancer is the most common cause
d. cervical carcinoma should be considered
38) About cervical cancer, all are true except:
a. +cervical smear is diagnostic
b. with stage Ia, 5 year survival is 95%
c. squamous cell carcinoma is the most common
39) In relation to pregnancy, all of the following may increase during
puerperium except:
a. thromboembolism
b. +diabetes
c. thyroiditis
d. torsion of ovarian cyst
e. psychosis
40) All are true about recurrent abortions except:
a. incidence is 1%
b. +defined as 3 consecutive induced abortions
c. can be due to protein C deficiency
d. can be due to anti-phospholipid syndrome
41) All are routinely done in antenatal care except:
a. +HbA1c
b. platelets count
c. screening for asymptomatic bacteriuria
d. pelvic ultrasound
e. urinalysis

42) All are true about antenatal care except:

a. +swimming is contraindicated in the 3rd trimester
b. exercise results in faster labor
c. travel before 36 weeks is allowed for all low risk pregnancies
43) In high grade intraepithelial lesions, all are true except:
a. +endocervical curreting and endometrial biopsy are indicated
b. cone biopsy is indicated if the squamocolumnar junction couldn't be
visualized
c. mostly caused by persistent infection with HPV 16, 18
d. can be asymptomatic
44) About DVT, all are true except:
a. more on the left side
b. +heparin causes cardiac defect
c. in a patient with history of DVT, treatment should continue 6 weeks
postpartum
45) All are true about urodynamic studies except:
a. +bladder capacity is 200-300 ml
b. first desire to void occurs at 150-250 ml
c. flow rate during voiding is > 15 ml/sec
d. it's important for accurate diagnosis of urge incontinence
e. residual volume should be less than 50 ml
46) About stress incontinence, all are true except:
a. can be associated with urge incontinence
b. +can be treated effectively by anti-cholinergic medications
c. they have urine leak upon coughing or sneezing
d. vaginal childbirth is a risk factor
47) All are components of the biophysical profile except:
a. fetal tone
b. fetal movement
c. amniotic fluid index
d. +fetal weight
e. non stress test

48) All are true about breastfeeding except:

a. breastfeeding is not recommended in HIV
b. +breastfeeding is not recommended in HBV +ve mothers
c. lactation is inhibited by bromocriptine
d. lactation is initiated postpartum by falling level of estrogen
49) About bacterial vaginosis, one is wrong:
a. +sexually transmitted
b. clue cells on wet mount are diagnostic
c. usually asymptomatic
d. often presents with foul smelly discharge
e. pH is more than 4.5
50) About chlamydia trachomatis, one is wrong:
a. gram negative intracellular organism
b. may be a cause for neonatal pneumonia
c. +most common cause of vaginal discharge
d. diagnosed by endocervical swab
e. treated by erythromycin during pregnancy
51) About epidural analgesia, one is wrong:
a. +prolongs 1st stage of labor
b. prolongs 2nd stage of labor
c. CTG changes are mainly due to maternal hypotension
d. increases risk of instrumental delivery
e. doesn't increase the risk of CS
52) All can be diagnosed by ultrasound in the 3rd trimester, except:
a. renal agenesis
b. +Turner
c. facial cleft
d. oligohydramnios
53) All are causes for large-for-date uterus, except:
a. +bilateral renal agenesis
b. anencephaly
c. wrong date
d. esophageal atresia
e. full bladder

54) Not a cause of secondary amenorrhea:

a. +ovarian dysgenesis
b. anorexia nervosa
55) 30 years female, para 2, presented with menorrhagia and found to have
intramural fibroid, best management:
a. mirena
b. +myomectomy
c. GnRH analogue
d. COCPs
e. hysterectomy
56) Progesterone-secreting IUD is used in all of the following except:
a. intramural fibroid
b. endometriosis
c. DUB
57) All of the following are risk factors for osteoporosis except:
a. +late menopause
b. low BMI
c. smoking
d. GnRH use
58) About bacterial vaginosis, one is wrong:
a. pH is elevated
b. +profuse foul smelling thick vaginal discharge
c. may be a risk for postpartum endometritis
d. clue cells on wet mount are diagnostic
e. no pruritus
59) Forceps delivery, presented after that with fresh vaginal bleeding, uterus
is contracted, the most likely cause is:
a. +genital tract trauma
b. uterine rupture
c. uterine atony

60) All of the following increase the risk of uterine rupture except:
a. myomectomy
b. instrumental delivery
c. +amniocentesis
d. C section
61) All are components of partogram except:
a. maternal pulse
b. fetal presentation
c. cervical position
d. contractions
62) About CIN:
a. it is a cytological description
b. hysterectomy is a standard treatment of CIN III
c. CIN I can regress in 60% of cases
63) About epidural analgesia, one is true:
a. +CSF leakage is a cause for headache
b. hypertension treated with labetalol is a recognized contraindication
c. contraindicated in a patient with history of DVT
64) Preeclampsia increases the risk of all the following except:
a. IUGR
b. +polyhydramnios
65) In preeclampsia, all of the following are indications for delivery except:
a. BP 160/115
b. +platelet 100,000
c. HELLP syndrome
d. neurological symptoms
e. proteins >5g/24 hr
66) All are indications to give anti-D except:
a. amniocentesis
b. +complete spontaneous abortion at 7 weeks gestation
c. non-sensitized Rh-ve women whose partner is Rh+ve
d. abdominal trauma
e. external cephalic version

67) All are true about Rh-isoimmunization except:

a. intrauterine blood transfusion is the treatment of choice of fetal hydrops
occurs
b. +anti-D should be given to sensitized women
c. middle cerebral artery doppler can be used to assess the severity of anemia
68) 7 weeks amenorrhea, presented with left lower quadrant pain and mild
vaginal bleeding. Her vital signs were stable. On ultrasound, the uterus was
empty. Her beta hCG was 3000 mIU/ml. Your management would be:
a. +single dose IV methotrexate
b. repeat beta hCG after 48 hours
c. repeat ultrasound after one week
d. immediate laparotomy
69) History of amenorrhea for few weeks, presented with abdominal pain
and severe bleeding with passage of tissues. Now the bleeding has stopped
and on ultrasound the uterus is empty. Your management would be:
a. +this is a complete abortion, observe for bleeding
b. repeat beta hCG after 2 days
c. this is a threatened abortion, reassure her
d. antibiotics & evacuation
70) All are considered normal in semen analysis, except:
a. morphology 50% normal
b. +motility 20% forward motile
c. liquefaction within 20 minutes
d. volume 4 ml
e. density 20 million/ml
71) 37 weeks gestation presented with mild placental abruption, cervix is 5
cm dilated, fetal CTG reactive. After stabilization of the patient, what's your
next step:
a. +AROM and give oxytocin
b. emergent CS
c. give prostaglandin
d. admission and regular CTG every two days
e. steroids

72) G3P2, previous deliveries were by C section. Now she's 36 weeks

gestation presenting with painless vaginal bleeding. After resuscitation,
what is your next step:
a. +ultrasound to localize the placenta
b. give steroids
c. vaginal exam
d. give steroids & indomethacin
e. immediate C section
73) All are significant findings in 40 weeks gestation except:
a. epigastric pain
b. vaginal spotting
c. +lower limb edema
d. blurred vision
e. persistent vomiting
74) All are maternal complications of PET except:
a. subcapsular hematoma
b. renal failure
c. +fetal growth restriction
d. DIC
e. abruptio placenta
75) All of the following increase the risk of endometrial cancer except:
a. +progesterone therapy
b. obesity
c. tamoxifen
d. granulosa theca cell tumor
76) About endometrial cancer, only one is correct:
a. progesterone therapy is used for a 59 years old patient with atypical
hyperplasia
b. +tamoxifen has a recognized association with endometrial hyperplasia
77) Treatment of hypertension in pregnancy is to avoid:
a. IUGR
b. IUFD
c. oligohydramnios
d. placental abruption
e. +maternal stroke

78) About diabetes in pregnancy, which one is wrong:

a. well controlled DM can develop macrosomia
b. fetal death may occur in well controlled DM
c. congenital anomalies increase in gestational DM
79) About diabetes in pregnancy, one is correct:
a. +diet control alone increases the risk of developing hypertension
b. normal blood sugar at 20 weeks rules out the development of DM
c. insulin requirement increases in puerperium
80) About delivery in multiple pregnancy, one is wrong:
a. +cephalic presentation of 1st twin and transverse of 2nd is an indication for
C section
b. episiotomy is not routinely done
c. oxytocin augmentation is not contraindicated
d. continuous CTG is recommended for both twins
81) About multiple pregnancy, one is wrong:
a. all dizygotic are diamniotic
b. conjoint twins occur if separation of the zygote happens after 12 days
c. twin-twin transfusion is a recognized complication in monochorionic twins
d. +best time to diagnose chorionicity is 16 weeks gestation
82) About COCPs, one is correct:
a. should be taken with periodic pill breaks
b. +doesn't affect future fertility
c. cause acne
83) About ectopic pregnancy, one is true:
a. can present before missed menses
b. positive pregnancy test and empty uterus on ultrasound are diagnostic
c. fallopian isthmus is the most common site
d. most cases are older than 35 years
e. usually asymptomatic

84) About cholestasis, one is false:

a. +may lead to amniotic fluid embolism
b. it's a diagnosis of exclusion
c. leads to itching in mainly palms and soles
d. associated with fetal distress
e. associated with preterm labor
85) About endometriosis, one is false:
a. has a genetic predisposition
b. +endometrioma can't increase more than 5 cm in diameter
c. ovarian injury during surgery can attribute to infertility
d. transformation to malignancy is rare
e. 1/3 of cases are diagnosed through infertility investigations
86) One of the following is not a vaginal procedure:
a. anterior colporrhaphy
b. +ovarian cystectomy
c. resection of Bartholin cyst
d. vaginal hysterectomy
87) Hormonal replacement therapy can treat all of the following except:
a. +coronary artery disease
b. osteoporosis
c. vaginal dryness
d. hot flushes
e. mood swings
88) About genital prolapse, one is wrong:
a. 2nd degree uterine prolapse is descent of the cervix in the introitus
b. vaginal hysterectomy is a suitable management
c. +uretrocele is descent of the vagina through the upper 1/3 of posterior wall
89) Uterine fibroid can cause all of the following in pregnancy except:
a. IUGR
b. +fetal anomalies
c. recurrent miscarriage
d. abnormal presentation
e. delivery by C section

90) All are recognized causes of organic menorrhagia except:

a. endometriosis
b. granulosa cell tumors
c. fibroids
d. +Sheehan syndrome
91) About abdominal pain in pregnancy, one is wrong:
a. ovarian torsion requires immediate surgical intervention
b. appendicitis is the most common cause of surgical abdominal pain
c. +peptic ulcer disease deteriorates in pregnancy
d. gallstones may cause pancreatitis
92) All are causes for decreased variability on CTG, except:
a. opioids
b. prematurity
c. sleeping
d. +epidural analgesia
e. hypoxia
93) Patient with primary PPH, apart from resuscitation, what is your next
step in managing her bleeding:
a. +uterine massage & oxytocin
b. bimanual compression of the uterus
c. B lynch procedure
d. uterine artery embolization
e. uterine artery ligation
94) Twin pregnancy may increase all of the following complications, except:
a. DM
b. preeclampsia
c. +post maturity
d. malpresentation
95) Of the following, only one is correct:
a. umbilical artery doppler is of no value after 34 weeks gestation
b. meconium in the trachea is a very rare finding
c. +oligohydramnios is found in all IUGR babies
d. small for gestation age babies are all growth restricted
e. IUGR is defined as weight below 15th percentile

96) About iron deficiency anemia in pregnancy, one is wrong:

a. ferretin is low
b. +baseline management is IV iron
c. multiparity increases the risk
97) 24 years old female, primi at 37 weeks gestation, presented with regular
uterine contractions every 3 minutes. Her vital signs were normal, and her
CTG was reactive. What is your management:
a. +allow her to deliver spontaneously
b. ARM & oxytocin
c. vaginal prostaglandin
d. tocolytic
e. steroids
98) All of the following are true about labor, except:
a. 2nd stage of labor may take 3 hours in a primigravida with epidural
analgesia
b. +prolonged 3rd stage is delivery of the placenta after 20 minutes
c. android pelvis increases the risk of malposition
d. occipito-posterior position is normal in early labor
e. epidural analgesia can be given in active phase of 1st stage of labor
99) About puerperium, one is wrong:
a. commonly develops polyurea
b. +warfarin is a contraindication for breastfeeding
c. after 2 weeks, uterus should be at the level of symphysis pubis
d. ofloxacin is given in case of mastitis
100) One of the following is wrong:
a. +suboccipito-bregmatic is face presentation
b. brow presentation must be delivered by C section
101) Compared to partial mole, all are features of complete mole except:
a. +focal trophoblastic proliferation
b. usually presents with large-for-date uterus
c. more association with hyperthyroidism
d. more association with theca-lutein cysts

102) A lactating women, 6 weeks pregnant, has mild abdominal pain and
vaginal bleeding. On ultrasound, there was intrauterine sac. What to do?
a. +reassure and ask her to come after 2 weeks
b. give her methotrexate
c. induce abortion
103) One of the following is true about diabetes in pregnancy:
a. most diabetic patients present as hypertension
b. +babies of controlled diabetic mothers have nearly same complications as
non-diabetic mothers
104) Term pregnant lady, cervical dilatation 6 cm, uterine contractions 2 in
10 minutes lasting 20 seconds. After two hours, nothing changed. What
would you do?
a. +give her oxytocin
b. immediate C section
c. instrumental delivery
105) True about ectopic:
a. +the most common site is the fallopian ampulla
106) False about GTN:
a. +patient can take OCPs before hCG is normal
107) All are risk factors for endometrial cancer except:
a. lynch II
b. +turner
c. tamoxifen
d. estrogen
108) About epidural analgesia, one is wrong:
a. +can be used in a hypotensive patient
109) One of the following is wrong regarding recurrent abortion:
a. paternal age is a risk factor
b. screening for bacterial vaginosis is useful
c. +it is advisable to do screening for toxoplasmosis

110) One of the following ovarian tumors could be bilateral in 10-15% of

cases:
a. +dysgerminoma
b. immature teratoma
c. endodermal sinus tumor

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