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OBSTETRICS & GYNECOLOGY
SELECT THE BEST ANSWER:
1. The major blood supply to the pelvis comes from the:
A. Inferior mesenteric artery
B. Internal iliac artery
C. External iliac artery
D. Internal pudendal artery
2. Presence of this hormone is presumptive sign that ovulation has occurred:
A. Follicle stimulating hormone
B. Luteinizing hormone
C. Estrogen
D. Progesterone
3. The preoperative medical history must include the following:
A. Medications being taken as well as those recently discontinued
B. Allergies to food, medications, environmental agents
C. Previous surgical procedures & patient's course following procedure
D. All of these
4. Benefits of laparoscopic surgery include the following:
A. Improved cosmesis and faster recovery
B. Less contamination of the peritoneal cavity
C. Less adhesion formation
D. All of these
5. Obstetric hemorrhage may require ligature of this artery when it is difficult to localize bleeding
to a specific vessel:
A. Internal iliac artery
B. Common iliac artery
C. External iliac artery
D. Internal pudendal artery
6. Damage to these muscles during vaginal delivery may cause rectal incontinence:
A. Coccygeus
B. Deep transverse perineal
C. External & internal sphincter ani
D. Bulbocavernosus
7. Histology of the vaginal mucosa is:
A. Columnar
B. Columnar ciliated
C. Stratified squamous, cornified
D. Stratifies squamous, non-cornified
8. Human papilloma virus infection causes the following changes in cells:
A. Koilocytosis
B. Anaplasia
C. Dysplasia
D. All of these
9. The dangers of aspiration pneumonia during anesthesia for the pregnant woman may be
minimized by:
A. Fasting from solids for at least 8 hours
B. Decreasing gastric acidity with antacids
C. Use of regional anesthesia when feasible
D. All of the above
10.The following conditions are more commonly associated with oligohydramnios EXCEPT:
A. Diabetes mellitus in mother
B. Renal agenesis in fetus
C. Pulmonary hypoplasia in fetus
D. Intrauterine growth retardation
11. The most accurate ultrasonic parameter for fetal aging in the first trimester :
A. Biparietal diameter
B. Crown-rump length
C. Head circumference
D. femur length
12. Mortality in women with cyanotic heart disease is highest with
A. Aortic regurgitation
B. Mitral steenosis
C. Mitral regurgitation
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D. Eisenmenger syndrome
13. Diabetic screening of pregnant women is best done at:
A. 12-16 weeks
B. 18-22 weeks
C. 24-28 weeks
D. 30-34 weeks
14. The shortening of the cervical canal from a length of 2 cm to a more circular orifice with
almost paper-thin edges is called:
A. 1st stage of labor
B. Effacement
C. Dilatation
D. Engagement
15. What is the positive end-point of any fetal stimulation test?
A. Accelerations
B. Change in baseline variability
C. Decelerations
D. Any of the above
16. The Obstetric Conjugate is
A. the shortest antero-posterior diameter through which the head must pass in its descent
through the pelvic inlet
B. shortest distance between the sacral promontory & the symphysis pubis
C. normally measures 10 cm or more
D. none of these
17. The increase in blood volume in normal pregnancy is made up of :
A. Plasma only
B. Red cell mass only
C. More plasma than red cell mass
D. More red cell mass than plasma
18. Which of the following statement is true:
A. The single salutary function of the uterus is for accommodation of the conceptus
B. There is no known endocrine function of the endometrium of myometrium,
independent of pregnancy, that affects the physical well-being of a woman
C. There is no evidence that removal of the uterus shortens the life span of a woman
D. All of these
19. In the menstrual phase, the following changes occur:
A. Increasing progesterone secretion by the ovary until just before ovulation
B. Epithelialization in response to estradiol
C. Severe vasoconstriction of spiral arterioles and desquamation of endometrium
D. Secretory changes in endometrium
20. The most common cause of postpartum bleeding is:
A.Uterine rupture
B. placental retenstion
C. Coagulation disorder
D. Uterine atony
21. A test used for determination of fetal well-being :
A. Mean arterial pressure test
B. Roll-over test
C. Contraction stress test
D. All of these
22. A 34 yr. old G3P2002 comes for check up for spotting. Her LMP was 24 weeks ago, but she
claims her abdomen has not enlarged and she has felt fetal movements 6 weeks before, but
none the past month. On examination, Fundal height is 14 cm, FHT (-); UTZ reveals a dead
fetus.
Management of this patient would be:
A. Wait for spontaneous labor
B. Induction of labor
C. Dilatation & Curettage
D. Hysterotomy
23. One of the hazards of prolonged fetal death in utero on the part of the mother:
A. Hemorrhage from placental abruption
B. Disseminated Intravascular coagulation
C. Hypertensive disorders
D. placental retention due to calcification
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24. Normal fetal heartbeat is characterized by:
A. Oscillation of baseline fetal heart rate
B. Variability of 6-15 beats/min.
C. Rate of 110-160 beats/min.
D. All of these
25. One of the following is NOT a term for a placenta overlying the internal os:
A. Total placenta previa
B. Low-lying placenta
C. Partial previa
D. Marginal placenta
26. Uterine atony is more commonly associated with:
A. Prolonged labor
B. Uterine overdistention
C. Rapid labor
D. All of these
27. A patient was seen in the ER with the possible diagnosis of placenta previa. One of the
following should NOT be done:
A. Leopold's maneuver
B. Pelvic ultrasound
C. Speculum exam
D. Digital vaginal exam
28. Compared with artificially-fed babies, breast-fed infants have lower incidence of:
A. Hemorrhagic disease of the newborn
B. respiratory distress syndrome
C. Diarrhea in infancy
D. Transient tachypnea of the newborn
29. Postpartum, examination of the genital tract is indicated :
A. following a difficult forceps delivery
B. Following a precipitate delivery
C. Presence of profuse bleeding after delivery
D. All of these
30. A 30 yr. old G2P0010 has profuse bleeding at 12 weeks gestation, with crampy hypogastric
pains , passage of meaty tissues. On examination, cervix is 2 cm dilated, with soft tissues at the
os.
Most likely diagnosis is:
A. Missed abortion
B. Threatened abortion
C. Incomplete abortion
D. Inevitable abortion
31. The most appropriate management for the above is:
A. Observation
B. Pelvic ultrasonography to check for tissue retention
C. Serial HCg titer
D. Dilatation & curettage
32. Magnesium sulfate is given in preeclampsia in order to:
A. Prevent convulsions
B. Prevent preterm labor
C. Lower blood pressure
D. Improve uteroplacental perfusion
33. The single most important risk factor for development of postpartum infection is:
A. Bacterial colonization of genital tract
B. Length of labor
C. Time from membrane rupture to delivery
D. Route of delivery
34. Minimum criteria for diagnosis of preeclampsia:
A. Hypertension & edema
B. Hypertension & proteinuria
C. Proteinuria & edema
D. Hypertension & headache
35. Management of a term pregnancy complicated by growth restriction:
A. Serial ultrasonography
B. Tocolysis
C. Administration of corticosteroids
D. Delivery
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36. A 24 yr. old G1P0 at 39 wks. gestation comes for regular uterine contractions occurring every
3-4 minutes. On admission, cervix is 4 cm dilated, 70% effaced, head at Station -3. After 2
hours , cervix is 6 cm, 90% effaced, head at station -3, and 4 hours after admission, with good
contractions, cervix is 7 cm, 90% effaced, head at Station -3. Diagnosis of labor dysfunction in
this case would be:
A. Prolonged latent phase
B. Protracted active phase
C. Secondary arrest of cervical dilatation
D. Protracted descent
37. A short-term maternal adverse effect of corticosteroids especially if used in conjunction with
tocolytic agents is:
A. Hypotension
B. Pulmonary edema
C. Maternal tachycardia
D. Necrotizing enterocolitis
38. Corticosteroid administration to the mother in danger of preterm delivery:
A. Prevents hemorrhagic disease if the preterm newborn
B. Induces pulmonary maturation in the fetus
C. Reduces the incidence of respiratory distress in the newborn
D. B & C
39. Cervicovaginal fibronectin is used as a predictor of :
A. Preeclampsia
B. Fetal growth restriction
C. Preterm labor
D. Preterm rupture of membranes
40. A maternal risk factor for development of fetal macrosomia is:
A. .Diabetes mellitus
B. Chronic hypertension
C. Cardiac valvular disease
D. Intrauterine infection
41. One week after cesarean section, a 30 yr. old woman has persistent fever for 3 days. All of
the following are likely causes, EXCEPT:
A. Breast engorgement
B. Aute pyelonephritis
C. Wound infection
D. Endometritis
42. A 24 yr. old G1 at 37 weeks is admitted for watery vaginal discharges 20 hours prior. Uterine
contraction were noted to occur irregularly. Cervix is 1 cm dilated, 70 % effaced, station 0,
vertex with ruptured membranes. Which of these shoud be done?
A. Give antibiotics,send patient home, wait till contractions improve, reevaluate;
B. Give antibiotics, give uterine tocolytics
C. Give antibiotics, potentiate labor
D. Give antibiotics, do cesarean section
43. Which of the following parameters should be met prior to giving magnesium sulfate?
A. BP not < 140/90
B. Liver enzymes should be normal
C. Heart rate not > 100/min.
D. Patellar reflexes should be present
44. Anencephaly is a risk factor for development of:
A. Preterm labor
B. Postterm pregnancy
C. Preeclampsia
D. Premature rupture of membranes
45. Which of the following is a potential complication of polyhydramnios?
A. Uterine atony
B. Cord compression
C. renal agenesis
D. Limb compression deformities
46. The Billings method of natural family planning is based on:
A. Changes in body temperature
B. Changes in the characteristics of cervical mucus
C. Timing of sexual contact based on the ovulation date of the menstrual cycle
D. Timing of sexual contact on menstrual days
47. A non-contraceptive benefit of combined estrogen/progestin contraceptive pills:
A. Reduction in the severity of acne
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B. Reduction in the incidence of ovarian tumors
C. Reduction in the severity of dysmenorrhea
D. All of these
48. A patient in the last trimester of pregnancy develops acute onset of chills and fever of 39*,
nausea, backache. Urine sediment reveals many WBCs and bacteria. CBC shows leukocytosis.
Abdomen is nontender, soft. Most likely diagnosis is:
A.Pyelonephritis
B.Acte appendicitis
C Acute cystitis
D. Ureteral lithiasis
49. One of the following is NOT true regarding ABO incompatibility
A. Mother is type O, baby is A, B, or AB
B. More common than D-isoimmunization
C. Is rarely seen in firstborns
D. rarely gets progressively worse in succeeding babies
50. One of these anti-TB medications are considered unsafe in pregnancy
A. Ethambutol
B. Isoniazid
C. Strptomycin
D. Rifampicin
51. The following methods have been used to induce uterine contractions:
A. Amniotomy
B. Prostaglandins
C. Oxytocin
D. All of these
52. Immunization that may safely be given in pregnant women:
A. Measles
B. Mumps
C. Varicella
D. Tetanus toxoid
53. After full dilatation, the most important force in expulsion of th fetus is:
A. Fundal pressure by assistant
B. Increased maternal intraabdominal pressure
C. Uterine contractions
D. Relaxation of the lower segment over the presenting part
54. In monitoring fetal heartbeat, careful auscultation
A. Is considered as good as electronic fetal monitoring
B. Should be abandoned in favor of electronic monitoring
C. Timing is best done before onset of contractions
D. None of these
55. Which of the following is true regarding oxytocin:
A. Has an antidiuretic action
B. May cause water intoxication when used in abundance with aqueous solutions
C. Has a short half lif, and contractions rapidly diminish when infusion is stopped
D. All of these
56. Case: A 23 yr. old G1 at 35 weeks AOG comes for severe headache and visual blurring. On
prenatal 1 week prior, her BP was noted to be 130/85 from the usual of 110/70. On
examination, BP= 160/110, FHT 140/min., no contraction after 10 minutes of observation.
Cervix was 1 cm, 30% effaced, intact membranes, station -2.
Most likely diagnosis would be:
A. Chronic hypertension
B. Severe preeclampsia
C. Mild preeclampsia
D. Chronic hypertension with superimposed preeclampsia
57. Plans for the above patient at this point would be:
A. Immediate cesarean section
B. Control hypertension, prevent convulsions, wait 38 weeks, induce labor
C. Control hypertension, prevent convulsions, wait for spontaneous labor
D. Control hypertension, prevent convulsions, induce labor when stable
58. Which of the following signifies development of HELLP syndrome in severe preeclampsia:
A. Platelet count of 90,000/cu mm.
B. Convulsions
C. Low Lactic Dehydrogenase
D. hyperactive deep tendon reflexes
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59. Developmental abnormality prevented by folic acid intake prior to and during early pregnancy:
A. Limb reduction defects
B. Cardiovascular defects
C. Myelocoeles
D. Hydrocephalus
60. A 19 yr. old is admitted for sudden onset of RLQ pain . On examination BP=120/80, PR = 105
/min., afebrile; abdomen tender, (+) direct & rebound tenderness, tender right adnexal mass
with fullness on the culdesac. LMLP= 6 weeks ago.
The most likely diagnosis is:
A. Pelvic inflammatory disease
B. Acute appendicitis
C. Ectopic pregnancy
D. Ureterolithiasis
61. Diagnosis in the above patient would best be done by:
A. Pregnancy test
B. CT-Scan
C. Abdomen flat plate & upright xray
D. Transvaginal sonogram
62. Three weeks postpartum, a woman comes because of vaginal bleeding. She complains of
feeling feverish, and had noted discharges to diminish the preceding 2 weeks, only to become
reddish again. Management of this problem at this stage would be:
A. Broad spectrum antibiotics, uterotonics
B. Broad spectrum antibiotics, uterotonics, curettage
C. Brad spectrum antibiotics, curettage
D. Broad spectrum antibiotics
63. The cardinal movements of the fetus during labor occur principally during the:
A. Preparatory division
B. Dilatational division
C. Pelvic division
D. Latent phase
64. Ideal management of a dead fetus in aneglected transverse lie in a 39 yr. oldG6 P3023:
A. Internal podalic version, breech extraction, antibiotics
B. Cesarean section, bilateral tubal ligation, antibiotics
C. External cephalic version, oxytocin, spontaneous delivery, antibiotics
D. Cesarean hysterectomy, antibiotics
65. The two most common causes of dystocia:
A. Uterine dysfunction & abnormal presentation
B. Uterine dysfunction & cephalopelvic disproportion
C. Fetal distress & Cephalopelvic disproportion
D. Fetal distress & Uterine dysfunction
66. The most important factor for diagnosis of true labor:
A. Location of pain
B. Intensity of pain
C. Response of pain to sedation
D. Cervical response to contraction
67. At present, the main indications for hormone replacement therapy include all of these
EXCEPT:
A. Relief of hot flushes & night sweats
B. Prevention of cardiovascular disease
C. Prevention of osteoporosis
D. Prevention or treatment of uro-genital atrophy
68. Contraindication to hormone replacement therapy:
A. History of pulmonary thromboembolism
B. Hot flushes, insomnia in 50 yr. old with irregular menses
C. History of fibrocystic disease of the breast
D. Elevated serum lipids
69. A 32 yr. old G0 has amenorrhea. A (+) progesterone withdrawal test means that:
A. The ovaries are normal
B. LH is secreted in adequate amounts
C. Ovulation has been stimulated by progesterone
D. Estrogen has stimulated an endometrial response
CASE: A 33 yr. old G4P3003 complains of spotting. Her LMP was 10 weeks ago, cervix is soft,
closed, with scanty bloody discharges; uterus is globularly enlarged, Fundal height = 15 cm.
BP= 140/90, FHT (-). She had a (+) pregnancy test 3 weeks ago.
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70 Considerations in this case would include:
A. Multiple pregnancy
B. Pregnancy with uterine myoma
C. Hydatidiform mole
D. All of these
71. In the above case, Ultrasonography reveals an echogenic mass filling the uterine cavity, with
varying areas of cystic degeneration; both ovaries are enlarged, cystic. Diagnosis would be:
A. Choriocarcinoma
B. Hydatidiform mole
C. Pregnancy with uterine myoma
D. Endometrial carcinoma metastatic to the ovaries
72. In the above case, she passes out tissues which are grape-like in character. Biopsy of these
tissues would reveal:
A. Hydropic degeneration & swelling of villous stroma
B. Absence of blood vessels in swollen villi
C. Trophoblastic proliferation
D. All of these
73. Polycystic ovarian syndrome is associated with:
A. Theca lutein cysts of both ovaries
B. Increased incidence of endometrial hyperplasia & adenocarcinoma
C. Irregular but predominantly ovulatory cycles
D. None of these
74. In which of these is surgery NOT indicated:
A. Asymptomatic 5 cm. myoma in a 50 yr. old perimenopausal G0
B. Asymptomatic 4 cm myoma, 64 yr. old with TVS 1 yr. ago of 1 cm myoma
C. 35 Yr. old G1P1 with bleeding & anemia from a 3 cm submucous myoma
D. 32 yr. old G3P3 with 4 cm myoma in anterior lower uterine segment with urinary
frequency & pelvic pains
75. A 36 yr. old G2P2 has amenorrhea of 11 months, with hot flushes. Examination reveals a
small uterus. If you consider premature ovarian failure, which would you find?
A. Elevated FSH levels > 40 iu/ml
B. Biphasic basal body temperature chart
C. Endometrial hyperplasia
D. None of these
76. Choice for single drug medical management of trophoblastic disease is:
A. Cyclophosphamide
B. Tamoxifen
C. Leukovorin
D. Methotrexate
77. Which of these is true regarding dysmenorrhea?
A. cause is release of prostaglandin from the endometrium
B. Prostaglandins increase uterine contractions, causing pain
C. utyerine contractions cause ischemia, leading to pain
D. All of these
78. A 17 yr. Old complains of pains on the first two days of her cycle. All examinations are
normal. Diagnosis is most likely:
A. PID
B. Primary dysmenorrhea
C. Cervical stenosis
D. Ademyosis
79. A 14 yr. Old has frequent colicky left lower quadrant pains of 3 days duration, aggravated on
movement. She has been confined to bed for a day. Transrectal ultrasound reveals a 5 cm.
thin-walled hypoechoic cyst, diagnosed as a parovarian cyst. Management in this case should
be:
A. Observation; cyst is benign, usually recedes spontaneously
B. Laparoscopy, drainage or excision of cyst
C. Laparotomy, salpingo-oophorectomy
D. Analgesics; surgery if increases to 8 cm size.
80. Uterine myomas increase in size with:
A. Pregnancy
B. Menopause
C. GnRH antagonists
D. All of these
81. It is recommended that a woman should have PAP smears as soon as:
A. She is 20 yrs. old
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B. She has give birth
C. She is sexually active
D. She reaches puberty
82. Management of a 5 cm. aymptomatic,thin-walled unilocular anechoic mass in a 35 yr. old
A. Observation for growth or symptoms; if none, monitor periodically
B. Laparoscopy, ovarian cystectomy
C. CA-125; if elevated, do surgery
D. Laparotomy, oophorectomy
83. A 28 yr.old G0, married 5 yrs. has increasing dysmenorrhea. Pelvic exam reveals shotty
nodules in cul de sac, a fixed reteroverted uterus, and a 3 cm right adnexal mass adherent to
the posterior of the uterus. Most likely diagnosis:
A.Uterine myoma
B. Endometriosis
C PID
D Adenomyosis
84. A 59 yr.old G0 has postmenopausal spotting of 2 months duration; pelvic exam reveals a
small uterus, no adnexal masses. Best approach to management is:
A. reassure her this is common in menopause, advise yearly check-up
B. Transvaginal sonogram
C. Endometrial biopsy
D. Hysterectomy
85. Which of these is true regarding the ovary?
A. Size varies at different ages of reproductive life
B. Follicles are located at the ovarian medulla
C. Corpus luteum cysts are true neoplasms
D. All of these
86. In dysfunctional uterine bleeding:
A. No organic cause has been found
B. Pregnancy is not the etiology
C. Most often is due to failure of ovulation
D. None of these
87. Which of these is the best diagnostic tool for evaluation of uterine bleeding?
A. Dilatation & curettage, biopsy
B. Pap smear
C. Hysteroscopically- guided biopsy
D. Endometrial biopsy
88. A 40 yr. old G1P1 presents with menorrhagia after missing 2 menstrual cycles. Uterus &
ovaries are normal in size; biopsy reveals simple cystic hyperplasia. Therapy is:
A. Cyclic progesterone administration
B. Hysterectomy
C. Dilatation & Curettage
D. Total abdominal hysterectomy, bilateral salpingo-oophorectomy
89. Which of these types of endometrial hyperplasias has the highest rate of progression to
carcinoma:
A. Atypical adenomatous
B. Simple cystic
C. Complex adenomatous
D. Simple adenomatous
90. Which of these ovarian tumors has the highest rate of malignant degeneration?
A. Mucinous cysts
B. Dermoids
C, Serous
D. Endometriomas
91. A 40. yr. old housewife complains of foul-smelling vaginal discharge. On examination,
discharges are greenish-gray in color, foul-smelling, frothy. Primary consideration is:
A. Trichomonas
B. Yeast
C. Chlamydia
D. Bacterial vaginosis
92. A beneficial neonatal effect of breastfeeding compared to formula feeding is:
A. Increase in intelligence
B. Increase in Vit. D intake
C. Decrease in enteric infections
D. Prevention of obesity due to decrease in fat intake
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93. Endometriosis is growth of:
A. Endometrial glands in foci outside the endometrial cavity
B. Endometrial stroma in foci outside the endometrial cavity
C. Endometrial tissue on the ovarian surface
D. All of these
94. A 62. yr. old G8P7016 complains of difficulty in bowel movement, urinary frequency and
urgency. On examination, the cervix is noted at the level of the vaginal introitus, with a soft
bulging mass noted anteriorly as well as posteriorly. Factors which contribute to this condition:
A. Loss of estrogen
B. Chronic constipation
C. Poor pelvic soft tissue support
D. All of these
95. Disease can be caused by presence of ectopic tissue in organs. Which of these does NOT
belong to this group:
A. Tubal pregnancy
B. Adenomyosis
C. Uterine myoma
D. Endometriosis
96. One of these is protective against breast cancer:
A. Breastfeeding
B. Late pregnancy > 30 yrs. Age
C. Herbal supplements
D. Hormone replacement therapy
97. A 67 yr. old has episodes of vaginal bleeding, 15 years after the menopause. Biopsy reveals
cystic endometrial hyperplasia. Transvaginal sonogram reveals a solid left adnexal mass 4 cm
diameter. She is not on hormone replacement therapy. Most likely cause of bleeding is:
A. Dermoid tumor
B. Granulosa cell tumor
C. Serous cystadenocarcinoma
D. Endodermal sinus tumor
98. The incidence of cervical cancer is highest in which age group?
A. Ages 20 - 30
B. Ages 35-45
C. Ages 55-65
D. Ages 70-75
99. A 32 yr. old , married for 9 years seeks consult for infertility and severe dysmenorrhea. On
examination, you feel shotty nodules on the culdesac, a fixed retroverted uterus with a 3 cm. left
ovarian cyst. You diagnose endometriosis. Best treatment option in this patient is:
A. Oral contraceptives to prevent further cyst growth & relieve dysmenorrhea
B. GnRH antagonists to block estrogen and prevent worsening of endometriosis
C. Laparoscopic surgery to remove endometriotic foci , restore pelvic anatomy
D. Total abdominal hysterecetomy, bilateral salpingo-oophorectomy
100. Which of the following is true regarding cervical dilatation :
A. Hydrostatic action of amniotic sac effectively dilates the cervix like a wedge
B. Pressure of the head on the cervix and lower uterine segment is a less
dilating wedge than the amniotic sac
C. Early rupture of membranes consistently retards cervical dilatation
D. None of these
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effective