Contraception/ POP&SUI/ AUB&DUB/ Medical disorders (except PIH)/ Fetology/ Oncology/ Infections/ Operative/ Puerpurium

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1.During continuous monitoring of 1st stage of labor in a primipara with PROM, fetus had repeated episodes of bradycardia unrelated to uterine contractions pattern. How can you explain this pattern of bradycardia?

1 point

a. Fetal distress.

b. Fetal congenital anomalies

c. Head compression during labor.

d. Insignificant, as long as it returns to normal.

e. Cord compression.

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2. The following is an advantage of medio-lateral episiotomy over median type?

1 point

a. Less bleeding.

b. Less dyspareunia.

c. Less faulty healing.

d. Less extension to anal sphincter.

e. Easier repair.

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3.Choose the correct statement regarding diabetes with pregnancy:

1 point

a. No change in insulin requirements during pregnancy.

b. Intrauterine growth retardation commonly occurs.

c. Oligohydramnios develops with poor diabetes control.

d. Neonatal hyperglycemia usually develops after labor.

e. Fetal open neural tube defects are common.

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4.A 30 years old primipara, known to have a rheumatic mitral stenosis attended to ER during the first stage of labor. Choose the most appropriate statement regarding the management:

1 point

a. Caesarean section should be performed.

b. Profuse I.V fluids should be pushed in 1st stage to ensure proper nutrition.

c. Antibiotics should be avoided.

d. Instrumental delivery should be done to shorten 2nd stage.

e. Ergometrine should be avoided during 3rd stage.

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5.Candida infection is commonly associated with all of the following Except:

1 point

a. Pregnancy.

b. Diabetes.

c. Menopause.

d. Prolonged antibiotic therapy.

e. Use of combined oral contraceptive pills.

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6.As regard diagnosis of acute PID (salpingitis),choose the correct statement:

1 point

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.

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7.A 66-year-old nulliparous obese patient presented with recurrent post-menopausal bleeding. She is hypertensive and diabetic. Ultrasound revealed endometrium thickness of 20 mm. An endometrial biopsy is taken and sent for histopathological assessment. What is the most likely histopathological diagnosis?

1 point

a. Decidua.

b. Adenocarcinoma.

c. Atrophic endometrium.

d. Secretory endometrium.

e. Proliferative endometrium.

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8.A 45 years old multipara with regular average cycles, presented by repeated bleeding following sexual intercourse. Possible causes include:

1 point

a. Cervical cancer.

b. Endometrial carcinoma.

c. Ovarian cancer.

d. Pelvic endometriosis.

e. Atrophic vaginitis.

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9.Which of the following is a predisposing factor for ovarian carcinoma?

1 point

a. Obesity.

b. Increased parity.

c. Hereditary factor.

d. Prolonged oral contraceptive use.

e. Pelvic endometriosis.

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10.Therapeutic uses of laparoscopy include one of the following:

1 point

a. Lysis of intrauterine adhesions.

b. Ovarian cystectomy.

c. Removal of submucous fibroid.

d. Surgical treatment of cervical ectopic pregnancy.

e. Commonly used in ovum pick up in assisted reproduction.

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11.Forty yrs old diabetic P3+0 attended the outpatient clinic seeking contraception. She delivered CS 3month ago. She is not lactating and used to have more than average irregular cycles. What do you suggest for her?

1 point

a. No need to use any method.

b. Safe period.

c. Mirena intrauterine contraceptive device.

d. Combined oral contraceptive pills.

e. Progesterone only pills.

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12. In which of the following conditions, oral contraceptive pills could be safely used:

1 point

a. Previous deep venous thrombosis.

b. Previous treatment for cancer breast.

c. Previous ectopic pregnancy.

d. Active liver disease.

e. Coronary heart disease.

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13.A 45 years multipara, presented with a mass protruding from the vulva on straining and lack of sexual satisfaction. Examination revealed descent of anterior and posterior vaginal wall with deficient perineum. No stress incontinence. The cervix was felt at the level of the ischial spines. What is the most suitable treatment?

1 point

a. Pelvic floor exercise.

b. Posterior colpo-perineorrhaphy.

c. Classical repair.

d. Sacro-colpopexy.

e. Vaginal hysterectomy

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14.a previously healthy 21years old woman has a profuse, malodorous vaginal discharge. PV shows a greenish gray frothy discharge with a fishy odor and petichial lesions on the cervix. Her vital signs are normal.Microscopic evaluation of the discharge will most likely be:

1 point

a. clue cells

b. gram-negative diplococcic

c. gram-positive diplococcic

d. motile flagettated organisms

e. pseudohyphae or hyphae

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15.In the previous patient, Recurrence of such infection mostly occurs due to:

1 point

a. lowered resistance

b. poor personal hygiene

c. use of oral contraceptive pills

d. no treatment of the husband

e. young age

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16. a 32years old woman, G2P2 comes to the physician for follow up of an abnormal Pap smear. Colposcopy demonstrated acetowhite epithelium at 2 O’Clock. A biopsy taken of this area demonstrated HSIL. endocervical curettage was negative. The patient has no other medical problems and takes no medications. Which of the following is the most appropriate next step in management:

1 point

a. repeat biopsy

b. hysteroscopy

c. repeat colposcopy in 6months

d. Loop electrosurgical procedure (LEEP)

e. hysterectomy

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17. In the previous patient. After initial management, the following should be done:

1 point

a. testing for HPV

b. repeat Pap smear

c. advice for use of condom

d. avoid further pregnancies

e. cone biopsy

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18.A 25years old woman is noted to have a 4cm simple cyst of the ovary. She denies any pain, nausea or vomiting. the best next step is:

1 point

a. expectant management

b. laparoscopy

c. exploratory laparotomy

d. chemotherapy

e. ultrasound guided cyst aspiration

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19.A 5years old girl is noted to have breast enlargement, vaginal bleeding and an 8cm pelvic mass. Which of the following is most likely diagnosis:

1 point

a. benign cystic teratoma

b. endometrial sinus tumour

c. Brenner tumour

d. choriocarcinoma

e. granulose-theca cell tumour

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20. A 38years old woman G4P4 with all NVD comes to the physician with involuntary escape of urine upon coughing. She also noticed a swelling that comes out of her vagina on straining. What is the most likely diagnosis:

1 point

a. urethral diverticulum

b. Gartner cyst

c. chronic uterine inversion

d. urinary stress incontinence

e. elongation of the cervix

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21. In the previous patient, the most appropriate next step in management is:

1 point

a. expectant management

b. surgical repair

c. intravenous antibiotics

d. incision and drainage

e. marsupialization

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22.The normal vagina is richly colonized by bacterial flora mainly consisting of:

1 point

a. mycoplasma hominis

b. gardnerella

c. actinomyces viscous

d. Chlamydia trachomatis

e. lactobacillus

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23.Schiller iodine when applied to the cervix will stain:

1 point

a. a dysplastic area

b. a carcinoma

c. an erosion

d. normal columnar epithelium

e. mature squamous epithelium

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24.A patient is found to have bilaterally equal adnexal pain; cervical motion tenderness; direct abdominal tenderness; temp 38.3 and WBC: 12.000/ml. The most likely diagnosis is:

1 point

a. ectopic pregnancy

b. PID

c. endometriosis

d. UTI

e. ruptured corpus luteum cyst of the ovary.

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25.Certain oncogenic factors are associated with the development of CIN:

1 point

a. Chlamydia

b. genital herpes

c. syphilis

d. human papilloma virus

e. gonorrhea

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26.The terminology of pelvic inflammatory diseases indicates:

1 point

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-oopheritis

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27.A 36years old woman attends the family planning clinic as she wants to use COCPs for the next 3years and she is asking about the risks of thromboembolism. When does she have the highest risk of venous thromboembolism?

1 point

a. after 5years of use

b. after 4years of use

c. after 3years of use

d. in the second year of use

e. in the first year of use

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28.The most common cause of stress incontinence is:

1 point

a. constipation

b. raised intra-abdominal pressure

c. congenital weakness of sphincter

d. childbirth trauma

e. estrogen deficiency

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29.Prolapse after menopause is attributed to the deficiency of which hormone:

1 point

a. estrogen

b. progesterone

c. testosterone

d. cortisone

e. prolactin

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30.A 26yrs old PG is admitted with threatened preterm labor at 30weeks and seeks counseling regarding antenatal corticosteroids. What are the benefits associated with antenatal corticosteroid administration in case of premature delivery:

1 point

a. reduced: RDS, incidence of hypoglycemia and neonatal death rates

b. reduced: RDS, VII nerve damage and hypoglycemia

c. reduced: RDS, pneumothorax formation and retinal disease of prematurity

d. reduced: RDS, intraventricular hemorrhage and perinatal death rate

e. reduced: RDS, intraventricular hemorrhage and neonatal necrotizing enterocolitis rates

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