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1.

An example of direct maternal death is:


A. Death from complications of mitral valve prolapse
B. Death from exsanguination after uterine rupture
C. Death from motor vehicle accident
D. Death from pulmonary embolism due to antithrombin III deficiency
E. Death from gunshot wound to the abdomen

2. The least likely bacteria isolated from patients with septic shock is:
A. Staphylococcus Aureus
B. Bacteroides
C. Escherichia coli
D. Klebsiella pneumonia
E. Pseudomonas aeruginosa

3. Which second trimester ultrasound finding is most indicative of Trisomy 21?


A. Nuchal fold >6mm
B. Shortened femur
C. Choroid plexus cyst
D. Pyelectasis
E. Shortened humerus

4. What is the most likely complication from induction of a VBAC?


A. Uterine Rupture
B. Admission of neonate to special care nursery
C. Repeat cesarean
D. Fetal distress
E. Uterine dehiscence

5. What is the most likely outcome of delivery in a patient at 42 3/7 weeks


gestation?
A. Uteroplacental insufficiency
B. Meconium aspiration
C. Macrosomic infant
D. Intra uterine infection
E. Low umbilical artery pH

6. What is the most appropriate management of vulvar carcinoma in situ?


A. Wide local excision
B. 5- fluorouracil
C. Radical vulvectomy
D. Laser ablation
E. Aldara Cream

7. A fetus is found to have loops of bowel protruding through an abdominal wall


where the umbilicus is to the left of the defect. What are the other associated
anomalies?
A. Cleft lip and Palate
B. No other anomalies
C. Aneuploidy
D. Beckwith-Wiedemann syndrome
E. Esophageal atresia

8. What is the most common histological type of endometrial cancer?


A. Endometrioid
B. Papillary-Serous
C. Carcinosarcoma
D. Clear cell
E. Mucinous

9. A 19 year old presents with HGSIL on cytology from a family practice physician.
The next best step is:
A. excisional biopsy
B. Repeat cytology is 3 months
C. HPV testing
D. Colposcopy
E. Return for pap at age 21

10. A 22 y/o presents with Kallmans syndrome and infertility. What is the best
drug to prescribe if she wants to conceive
A. Clomiphene citrate
B. Estrogen and progesterone
C. Progesterone
D. Gonadotropins
E. Human chorionic gonadotropin
.
11. What is the mechanism of action of Spironolactone:
A. Androgen receptor agonist
B. Binds to androgen receptor as an antagonist
C. Inhibits 5 alpha reductase type I and II
D. Inhibits ornithine decarboxylase
E. Insulin sensitizer

12. A patient presents at 5 weeks post partum with altered mental status. She is
examined by the neurologist and found to have increased intracranial pressure. On
exam, her uterus is 10-12 cm with a bulging mass on the vaginal wall. What is the
next step:
A. MRI of the brain
B. Serum beta HCG
C. Ultrasound
D. CT of the abdomen and pelvis

E. Observation

13. The most common thrombophilia in the caucasian population is


A. Mutation of G20210A
B. Factor V Leiden mutation
C. Protein C deficiency
D. Protein S deficiency
E. AT III deficiency
14. Operative vaginal delivery is contraindicated if a live fetus is known to have the
following condition EXCEPT:
A. Osteogenesis imperfecta
B. Alloimmune thrombocytopenia
C. Von Willebrands
D. Hemophilia
E. Suspected Macrosomia

15. Therapeutic agents known to be associated with growth restriction include each
of the following EXCEPT:
A. Trimethadione
B. Heparin
C. Warfarin
D. Phenytoin

E. Methotrexate

16. Based on the pharmacokinetic studies of synthetic oxytocin, uterine response to


oxytocin ensues after how many minutes:
A. Less than 60 seconds
B. 60-90 seconds
C. 3-5 minutes
D. 6-8 minutes
E. 10 minutes
17. - In the Prophylaxis of Rhesus Disease, all are true except
A.
B.
C.
D.
E.

25% of failures to administer anti-D occur after miscarriage


250 I.U. anti-D neutralises approximately 2 ml. fetal blood
routine provision of anti-D during pregnancy is recommended by NICE
prophylaxis is unnecessary in threatened miscarriage at 8 weeks
The routine dose of anti-D is 250 I.U.

18. The least likely ultrasound finding suggestive of prehydropic fetal anemia:
A. Pericardial effusion
B. Dilation of cardiac chambers
C. Oligohydramnios
D. Placental thickness > 4cm
E. Enlargement of the spleen and liver

19. All of the following factors affect the interpretation of the quadruple screen
EXCEPT:
A. Gestational Age
B. Maternal Gestational Diabetes
C. Weight
D. Age
E. Incorrect dating of Pregnancy

20. What is an absolute contraindication to laparoscopy:


A. Unstable patient
B. Acute appendicitis
C. Diverticulitis
D. Hemoperitoneum
E. Previous vertical abdominal incision

21. A patient undergoes IVF and conceives twins. Which of the following is the
most likely?
a. Gestational diabetes
b. Pre-eclampsia
c. Pre-term delivery
d. Hyperemesis
e. Twin to twin transfusion

22. What is the most indicated treatment for anaphylaxis?


a. Steroids
b. Epinephrine
c. Benadryl
d. Vasopressin
e. Glucocorticoids

23. An infant you just delivered has ambiguous genitalia, there are fused
labioscrotal folds as well as an enlarged clitoris. No gonads are palpable. The most
likely genotype is:
A. 46 XX
B. 46 XY
C. 45 XO
D. 47 XX +21
E. 47 XYY

24. What is the most common etiology of a false positive serum pregnancy test in
that the hCG is derived from non-trophoblastic tissue:
A. Dysgerminoma
B. Lung carcinoma
C. Molar pregnancy
D. Heterophilic antibodies
E. Antinuclear antibodies

25. A hirsuite patient has a serum testosterone of 130 pg/mL. What is the most
likely diagnosis?
A. Adrenal tumor
B. Ovarian tumor
C. Polycystic ovarian syndrome
D. Cushing syndrome
E. Adult onset congenital adrenal hyperplasia

26. Group B Streptococcus infection is seen least likely with which of the following:
A. Chorioamnionitis
B. Mastitis
C. Postpartum endometritis
D. Urinary tract infection
E. Neonatal sepsis
27. 65 year old otherwise healthy woman presents for pre-operative evaluation for
hysterectomy. The least important test to order is:
A. EKG
B. CBC
C. BUN
D. Electrolytes
E. Cervical cytology

28. Which of the following is least likely to cause neonatal thrombocytopenia:


A. Alloimmune thrombocytopenia
B. Immune thrombocytopenia
C. Hydralazine
D. Gestational thrombocytopenia
E. fetal inection

29. Beta mimetic agents are least likely associated with which of the following:
A. Cardiac Arrhythmia
B. Hypergylcemia
C. Hypokalemia
D. Tachycardia
E. Hypocalcemia

30. A 15 year old primagravida woman with nausea, vomiting and abdominal pain.
How would you rule out appendicitis?
A. Computed tomography
B. Graded compression ultrasound
C. Doppler ultrasound
D. Ultrasound
E. White blood cells count

31. Which of the following is least likely associated with second stage syphilis:
A. Rash
B. Condyloma Latum
C. Chancre
D. Lymphadenopathy
E. all of the above
32. A cystic mass is seen on the lateral wall of the vagina. These lesions are most
commonly:
A. Cyst in the canal of nuck
B. Hidrandenitis
C. Inclusion cyst
D. Fibroma
E. Skenes duct cyst

33. Oral contraceptives should be stopped in which of the following scenarios:


A. Trauma related Deep venous thrombosis
B. Morbid obesity
C. BRCA -1 positive
D. Essential hypertension stable
E. Migraine headache with aura

34. Coagulation screening and CBC with platelets should be ordered for all of the
following disorders in evaluation of abnormal uterine bleeding except ?
A. Family history of coagulopathy
B. Personal history of easy bruising
C. Menorrhaghia secondary to fibroids
D. Adolescents with menorrhaghia
E. Personal history of nose and gum bleeding

35. The most common sign and symptom of uterine rupture is ?


A. Abdominal pain
B. Loss of contractions
C. Recession of the fetal presenting part
D. Fetal heart rate changes
E. Hemorrhage

36. The potential causes for fetal tachycardia include all of the following except ?
A. Fetal behavioral state
B. Chorioamnoinitis
C Meternal fever
D Maternal ingestion of methamphetamine
E Maternal beta blocker drug

37- Which of the following amplitude range in fetal heart rate (FHR) monitoring
defines minimal variabilty ?
A.
B.
C.
D.
E.

Undetectable
> undetectable - < 5 beats per minutes (bpm)
6-25 bpm
>25 bpm
10 to 15 bpm

38- You deliver a depressed fetus whose skin is noted to be meconium stained.
When did meconium passage most likely occur in utero
A.
B.
C.
D.
E.

<3 hours
3-6 hours
12-18 hours
24 hours
48 hours

39- The non reassuring fetal heart rate (FHR) pattern of ischemia is characterized
by all of the following except ?
A.
B.
C.
D.
E.

Initial FHR reactivity with subsequent non-reactivity


Prolonged fetal tachycardia
Abrupt and sudden profound bradycardia
Substantial rise in baseline FHR
Repetitive FHR decelerations

40- The most likely karyotype for patient with a partial mole would be ?
A.
B.
C.
D.
E.

46, XX
46, XY
Diandric triploidy
Triploidy with two haploid sets of maternal origin
Aneuploidy

41- A patient with a complete mole is found to have sizeable ovarian cysts that are
presumed to be theca lutein cysts. All of the following are true about theca lutein
cysts EXCEPT ?
A.
B.
C.
D.
E.

Such cysts arise more frequently in patients with complete moles


Theca lutein cysts are more likely seen in patients with very high hCG levels
Cysts are filled with serious or serosanguinous fluid and are usually bilateral
Often require active management with surgical intervention
Patients with large theca lutein cysts may be at increased risk for postmolar
persistence of disease

42- A patient with idiopathic thrombocytopenic purpura (ITP) is MOST likely to


have which of the following laboratory abnormalities?
A
B
C
D
E

Decreased megalokaryocytes on bone marrow biopsy


Elevated partial thromboplastin time
Decreased percentage of large platelets on peripheral blood smear
Increased levels of platelet-associated immune globulin
Decreased hemoglobin levels

43- Your patient has a microcytic anemia on her first set of prenatal labs.
All of the following statements are correct EXCEPT:
A The most commonly encountered anemia in pregnancy is Iron Deficiency Anemia
which has the following characteristics: microcytic, hypochromic, MCV < 80 f/L,
Serum Fe < 50 mcg/dL, MCHC < 30%, Serum ?Ferritin, ?TIBC
B Combined Fe / folate deficiency is never normocytic, normochromic anemia
C Folate deficiency is a risk for Neural Tube Defect.
D Most common megaloblastic anemia is folate deficiency.
E Vitamin B12 deficiency is associated with malabsorption diseases.

44- The following statements are correct regarding Varicella-Zoster during


pregnancy EXCEPT:

A Varicella-Zoster immune globulin [V-ZIG] should be administered to the newborn if


the mother developed chickenpox within 5 days prior to or 2 days following delivery
B Maternal administration of V-ZIG reduces the occurrence of congenital varicella
syndrome
C) V-ZIG can be considered to treat the pregnant women herself to prevent the
complications of chickenpox
D) All of the above
E) None of the above

45- A 26 year old presents to your office for preconception counseling. When is the
highest probability of pregnancy relative to ovulation ?
A. 5 days before ovulation
B. 2 days before ovulation
C. 1 day before ovulation
D. Day of ovulation
E. 1 day after ovulation
46- The advantages of preserving the ovaries at time of hysterectomy for benign
disease include all of the following except ?
A. Reduces the risk of ovarian cancer
B. Reduces the risk of coronary artery disease (CAD)
C. Lowers the risk of osteoporotic fracture
D. Reduces the risk of breast cancer
E. Prevention of climacteric symptoms
47- What is the least likely effective treatment for a patient with Stress Urinary
Incontinence (SUI) without a cystocele ?
A. Anterior colporraphy
B. Burch retropubic urethropexy
C. Tension free vaginal tape (TVT)

D. Transobturator tape (TOT)


E. Pubovaginal sling with autologous fascia
48- The point of anchorage for a Burch retropubic colposuspension is which
anatomical landmark ?
A. Periosteum of the pubic bone
B. Ileopectineal ligament
C. Sacrospinous ligament
D. Obturator membrane
E. Sacrotuberous ligament
49 - Which of the following symptoms is least associated with Overactive Bladder
(OAB) ?
A. Urgency
B. Urge incontinence
C. Stress urinary incontinence (SUI)
D. Frequency
E. Nocturia

50- A patients undergoes TAH, BSO for a pelvic mass. The pelvic mass is composed
of a 7 cm lesion within the right ovary. A frozen section demonstrates Call-Exner
bodies. What additional pathology is most likely to be demonstrated ?
A. An ovarian epithelial carcinoma
B. A Brenner cell tumor of the ovary
C. Endometrial carcinoma
D. Clear cell carcinoma of the cervix
E. A fallopian tube cancer

51- CA-125 is ?
A. A mucin-type glycoprotein
B. A ganglioside
C. A tumor-specific transplantation antigen
D. Useful for ovarian cancer screening in the general patient population
E. An antigen which is commonly expressed by mucinous ovarian carcinomas

52 All of the following are adverse pregnancy outcomes associated with

maternal hypothyroidism except ?


A. Impairment in fetal intellectual development
B. Placental abruption
C. Preeclampsia
D. Preterm delivery
E. Gestational diabetes mellitus

53- regarding thyroid gland and pregnancy one of the following is wrong
A. Thyroid Stimulating Hormone (TSH) level is the best screen for

hypothyroidism in pregnancy
B. Free T4 level is the most useful to diagnose hyperthyroidism in
pregnancy
C. TSH level is increased normally in late second and third trimeseter of

pregnancy
D. Prophyltiouracil (PTU) is the first line of treatment of hyperthyroidism

during pregnancy

E. Free T3 is the active form of thyroid hormone

54 - Cystic Fibrosis. All are true except


A. is X-linked
B. Affected pregnancies can be detected by chorionic villus biopsy.
C. Most affected males are infertile.
D. affected individuals are at increased risk of diabetes mellitus
E. Affected individuals are at risk of fat malabsorption.
55 - Pre-eclampsia. All are true except

A. is more common in women with a first degree relative who had PET
B. Development of abdominal pain is a serious sign.
C. The condition is more common in women who smoke cigarettes.
D. Regular full blood counts are helpful in monitoring the progress of
the condition.
E. The onset of PET is an adverse development for the baby.

56- Breech Presentation. One is false


A.
B.
C.
D.
E.

occurs in 25% of pregnancies at 28 weeks


is associated with post-partum hemorrhage
Is associated with raised perinatal mortality and morbidity.
Is a ground for Caesarean section.
The risk of vaginal delivery increases at the extremes of fetal
weight.

57- The bladder is at risk of damage at the time of in all of the following
procedures except
A. lower segment Caesarean section
B. Repair of enterocoele.
C. Classical Caesarean section.
D. Laparoscopy.
E. Uterine myomectomy

58- Miscarriage at 10 weeks. One is true


A. Is usually due to hormone deficiency.
B. is due to an abnormal karyotype in ~ 5% of cases
C. Always needs evacuation.
D. Is unlikely if an ultrasound scan shows a pregnancy of normal size and
fetal heart activity.
E. intrauterine pregnancy cannot co-exist with tubal pregnancy

59 Secondary amenorrhoea. One is true


A. is defined as cessation of menstruation for more than 12 months
B. Should not be investigated unless persisting for > 12 months.
C. May be due to Ashermans syndrome.
D. Is commonly due to stress.
E. may be due to testicular feminization syndrome
60 Hyperprolactinaemia. All are true except
A. Is an absolute contraindication to pregnancy if due to a pituitary
adenoma.
B. may be associated with phenothiazine therapy
C. May be associated with acromegaly.
D. May be due to hypothyroidism.
E. May cause male infertility.
61 Bleeding continuing for four weeks after delivery. One is true
A. is most likely to be due to retained products of conception
B. may be physiological
C. is associated with cancer of the endometrium
D. is commonly due to choriocarcinoma
E. contraindication for contraception

62 Lost intra-uterine contraceptive device. One is false


A. a beta HCG should always be arranged to exclude pregnancy
B. alternative contraception should be arranged until the IUCD has
been located
C. the threads may be retrieved in most cases from within the cervical
canal
D. an extra-uterine IUCD should be removed by laparoscopy or
laparotomy
E. may be removed using hysteroscope

63- Normal Labour. One is false


a- the latent phase may last for more than four hours
b- the active phase should be associated with cervical dilatation at a
rate of at least 1 cm. per hour
c- the active phase starts when the cervix is effaced and 3 cm. dilated
d- is best charted using a partogram
e- epidural anaesthesia has an adverse effect on the rate of progress in
the 1st. stage of labour
64 The Cervical Smear. One is true
A. should be performed routinely every five years
B. should show squamous cells to illustrate that the squamo-columnar
junction has been sampled
C. may show evidence of endometrial cancer
D. inflammatory" smears should be repeated after three years
E. accurately reflects cervical pathology
65 Haemoglobin values of less 10g/dl in pregnancy one is wrong
A. Are a recognised side-effect of anti-convulsant therapy

B. Are associated with urinary tract infection


C. Respond rapidly in most cases to oral iron supplements
D. Are complications of multiple pregnancy
E. None of the above

66 Recognised complications of external cephalic version include all of


the following except
A. Positive Kleihauer test
B. Fetal bradycardia
C. maternal hypotension
D. Placental abruption
E. Premature rupture of the membranes

67 Hirsutism. One is true


A. is synonymous with virilisation
B. is pathological in most cases
C. is a side effect of danazol
D. androgens in women are produced solely in the adrenal
E. is a side effect of cyproterone
68 Benefits of breast feeding include, all are true except
A. decreased infant infection
B. reduced risk of sudden infant death syndrome
C. reduced incidence of juvenile diabetes
D. reduced incidence of maternal breast and ovarian cancer
E. reduced incidence of neonatal jaundice

69 - Trisomy 18. All are correct except


A. It is known as Edward's syndrome
B. is almost universally lethal
C. is associated with choroid plexus cysts
D. is associated with raised maternal AFP, but low HCG and oestriol
levels
E. is associated with IUGR

70 - Renal physiology in pregnancy. One is false


A. renal blood flow increases by > 20 %
B. glomerular filtration rate increases
C. urea levels fall
D. creatinine levels fall
E. tubular reabsorption of glucose declines, causing glycosuria in the
presence of normal blood glucose levels

71 Elective episiotomy. One is true


A. is advocated in primigravid patients
B. is advocated in patients who have had a previous 3rd. degree tear
C. is advocated in patients who have had a previous 3rd. degree tear
D. is advocated in premature vaginal delivery to protect the fetal head
E. is advocated in patients who have previously had episiotomy

72 Pulmonary oedema is a recognised complication of all of the following


except
A. syntocinon infusion
B. mitral stenosis
C. beta-sympathomimetic use for premature labour
D. pre-eclampsia
E. phenylketonuria

73 Fragile X. all are true except


A. is the commonest inherited form of mental handicap
B. is associated with clitoral enlargement
C. is associated with prognathism
D. The main feature is intellectual impairment
E. unaffected male carriers are at risk of dementia in middle age

74 The following soft markers and chromosomal abnormalities are


linked except
A. duodenal atresia & T21
B. Bright bowel & triploid
C. cystic hygroma & 45XO.
D. Sandal gap and T21.
E. Choroid plexus cysts & T18.

75 A raised maternal serum alpha-fetoprotein (MSAFP) level at 16 weeks, all are correct
except:
A. May be due to incorrect assessment of gestation.

B.
C.
D.
E.

May be due to gastroschisis.


increases the risk of a "small for dates" baby
should be investigated by amniocentesis
increases the risk of placental abruption

76 Twins pregnancy all are true except


A.
B.
C.
D.
E.

Has increased in incidence in recent decades.


Has five fold perinatal mortality compared to singleton pregnancies
is associated with hyperemesis
Is suitable for biochemical screening for Downs syndrome.
Is usually dizygous.

77 Endometriosis all are true except


A.
B.
C.
D.
E.

is one of Medicines enigmas


may occur as an implantation phenomenon after surgery
does not occur under the age of eighteen
may cause thickening of the utero-sacral ligaments
may cause bowel problems

78 Pelvic examination: which statement is wrong


A.
B.
C.
D.
E.

should be performed routinely in the antenatal booking clinic


Accurately determines gestation between 8 and 12 weeks.
Performed annually is useful in the detection of ovarian cancer.
Can be used to diagnose endometriosis.
All of the above

79 Beta-HCG in early pregnancy, one of the following is true


A.
B.
C.
D.

production peaks at 20 weeks


levels are below normal in hydatidiform mole
always detect a healthy pregnancy by the day the next period is due
modern pregnancy tests may become negative after 20 weeks

E. none of the above


80 Acute Pyelonephritis in pregnancy, all are true except
A.
B.
C.
D.
E.

has reduced in incidence in recent decades


treatment should await identification of the infecting organism and its sensitivity
carries significant hazard to the baby
is usually due to E- coli
may cause sickle cell crises

GOOD LUCK