Obstetrics and Gynaecology 2014 MBBS Recall (MCQ + OSCE) Friday May 9, 2014 9:00 a.m.

Prepared by Da Roux Barrett Class of 2014

Section A
Multiple Choice Questions
Gynaecology
1. The following are true of cervical intraepithelial lesion 3 (CIN 3) except
a. May be associated with HPV 16 and 18
b. May involve full thickness of the epithelium
c. Cone biopsy rather than LETZ/LEEP is the treatment of choice for women wishing future
fertility
d. HPV vaccine can still be given
e. Many women over the age of 30 will clear the virus.

2. Regarding ovarian epithelial cancer. Choose the single best answer.
a. Combine oral contraceptive pill use is a risk factor
b. Postmenopausal bleeding is a common complaint
c. Mucinous cystoadenocarcinoma is the most common histology
d. Staging laparotomy followed by chemotherapy is the treatment of choice
e. 5-year survival is excellent

3. Stage 2 squamous carcinoma of the cervix may be characterized by the following except
a. Hydronephrosis
b. Spread to the upper 1/3 of the vagina
c. Spread to the parametrium
d. Internal iliac node involvement
e. External iliac node involvement

4. Regarding patients with uterine fibroids, choose the single best answer.
a. Being multiparous is a risk factor
b. More than 50% of women are asymptomatic
c. Using the oral contraceptive pill results in rapid growth
d. Myomectomy always improves fertility
e. Leiomyosarcoma occurs in 5% of cases

5. Regarding women with postmenopausal bleeding, choose the single best answer.
a. Is often assoiated with uterine fibroids
b. Endometrial thickness >4mm is significant for malignancy
c. Pipelle sampling is not as sensitive as dilatation and curettage
d. More than 20% of patients have uterine cancer
e. Endometrial ablation is the treatment of choice

6. The non-contraceptive benefits of the oral contraceptive pill includes all of the following except.
Obstetrics and Gynaecology 2014 MBBS Recall (MCQ + OSCE) Friday May 9, 2014 9:00 a.m.
Prepared by Da Roux Barrett Class of 2014
a. Management of Benign ovarian cyst
b. Management of Dysparunia
c. Management of Endometriosis
d. Management of Cervical Cancer
e. Management of Dysfunctional uterine bleeding

7. Regarding cervical smears, choose the single best answer.
a. The presence of endocervical cells indicate an inadequate sample
b. Immersion in 0.95 percent ethyl alcohol reduces drying artifact
c. Aylesbury Spatula is better for endocervical sampling if the transformation zone is not
visible
d. Air drying before immersion in ethyl alcohol fixative improves cytological interpretation
e. Cellular yield is best improved by repetitive smearing of sample the on the slide

8. Which statement concerning endometriosis is true
a. Usually has debilitating spasmodic dysmenorrhea
b. Urinary of gastrointestinal symptoms may be the presenting feature
c. Infertility is uncommon with mild endometriosis
d. Superficial dyspareunia may be associated with nodules in the pouch of Douglas
e. Only has cyclical pain

9. The following are management options for ectopic pregnancy except
a. Misoprostol
b. Methotrexate
c. Salpingectomy
d. Expectant management
e. Salpingostomy

10. A 34 year old sexually active patient complains of vaginal discharge for the past three weeks, it is
malodorous, non-pruritic and not associated with any urinary symptoms. Her abdominal
examination is normal. On speculum examination the copious discharge is greenish grey, frothy
and her cervix is described as strawberry. The likely diagnosis is
a. Candida
b. Bacterial Vaginosis
c. Trichomoniasis
d. Chlamydia Trachomatis
e. Lactobacillus

Obstetrics and Gynaecology 2014 MBBS Recall (MCQ + OSCE) Friday May 9, 2014 9:00 a.m.
Prepared by Da Roux Barrett Class of 2014
11. A couple has been unable to conceive for the past 4 years. The woman is 34 years old and
attained menarche at 13 years with regular menstrual cycles thereafter until three years ago
when they became irregular and subsequently has had no menses for the last 7 months. A
urinary hCG test is negative. She has complained of heat intolerance and mood swings. The
following tests are appropriate except.
a. Prolactin
b. Estradiol
c. FSH levels
d. Fasting glucose and fasting insulin
e. TSH levels

12. A symptomatic patient has 14 week sized uterine fibroids. The preferred method of
hysterectomy would be. Choose the single best answer.
a. Abdominal midline incision
b. Abdominal Pfannenstiel incision
c. Laparoscopic
d. Laparoscopically assisted vaginal
e. Vaginal

13. Bacterial vaginosis is best treated with. Choose the single best answer.
a. Clotimazole
b. Amoxicillin
c. Metronidazole
d. Azithromycin
e. Ceftriaxone

14. Which of the following is least likely to be associated with infertility?
a. Fibroids
b. Pelvic Inflammatory disease
c. Endometriosis
d. Orchitis
e. Previous salpingectomy for ectopic pregnancy

15. The contraceptive effects of prostaglandins involve all the following except
a. Altered tubal motility
b. Inhibition of ovulation
c. Inhibition of follicular development
d. Endometrial atrophy
e. Altered cervical mucus

16. Uterovaginal prolapse. Choose the single best answer.
Obstetrics and Gynaecology 2014 MBBS Recall (MCQ + OSCE) Friday May 9, 2014 9:00 a.m.
Prepared by Da Roux Barrett Class of 2014
a. Nagel exercises aim to contract the pubococcygeus in order to improve symptoms
attributable to a cystocele
b. Vault prolapse involves descent of the cuff of vaginal tissue left after hysterectomy
c. Procidentia involves descent of the anterior vaginal wall through the vaginal introitus
d. Colpochesis is commonly used to repair a rectocele
e. Rectocele presents as a protrusion of the anterior vaginal wall

17. Which is not a recognized complication of diagnostic laparoscopy? Choose the single best
answer.
a. Uterine perforation
b. Water intoxication
c. Pulmonary oedema
d. Air embolism
e. Pneumothorax

18. Regarding fibroids. Choose the single best answer.
a. Fibroids are benign tumors of striated muscle
b. Have the highest incidence in the seventh decade of life
c. Submucosal fibroids lie just below the endometrium
d. 4 percent of fibroids contain malignant tissue
e. After myomectomy any subsequent pregnancy should be delivered by caesarian section

19. Regarding primary dysmenorrhea. Choose the single best answer.
a. Is pelvic pain in the absence of pelvic disease
b. Characteristically results in pelvic pain for the week preceding menstrual flow
c. The level of uterine prostaglandins correlates poorly with the severity of menstrual cramps
d. The combined oral contraceptive pill is an unsuitable treatment
e. Improves with ingesting caffeine

20. Regarding Bartholins cysts. Choose the single best answer.
a. Are due to obstructed mucus secreting glands that are deep to the labia minora
b. Are usually tender
c. Should all be excised
d. Which form abscesses containing a mixture of bacterial organisms
e. Always arise on a background of infection

21. Which of the following is not a feature of Polycystic ovarian syndrome.
a. Hyperandrogenism
b. High levels of progesterone on day 21 of the menstrual cycle
c. Amenorrhea
d. Endometrial hyperplasia
e. Insulin resistance
Obstetrics and Gynaecology 2014 MBBS Recall (MCQ + OSCE) Friday May 9, 2014 9:00 a.m.
Prepared by Da Roux Barrett Class of 2014
22. Which of the following statements regarding miscarriages is false
a. About 15% of recognized pregnancies usually end in the first trimester
b. A pregnant woman who has a threatened miscarriage is not at a higher risk for subsequent
antepartum hemorrhage in the index pregnancy
c. Most cases of early first trimester pregnancies do not require an evacuation of retained
products of conception (ERPC)
d. Rho gam (anti d immunoglobulin) is not necessary with a spontaneous complete
miscarriage at 6 weeks gestation
e. The most common aetiology of first trimester miscarriages is an underlying chromosomal
abnormality

23. Which of the following drugs is used commonly in the management of ectopic pregnancy?
a. Mefanamic acid
b. Metronidazole
c. Methotrexate
d. Misoprostol
e. Mifeprostone

24. A 42 year old woman presents to the outpatient clinic with a feeling of fullness in the vagaina
about six months following the normal delivery of her fifth child; birth weight was 4.4Kg.
Examination reveals some degree of uterine descent with straining. Which ligaments are the
most likely to be damaged in her case? Choose the single best answer.
a. Infundibulo-pelvic
b. Inguinal
c. Ovarian
d. Round
e. Uterosacral/Cardinal

25. A 36 year old woman presents with heavy cyclical periods which do not appear to be associated
with any obvious pathology. Which one of the following is unlikely to solve her problem?
a. Non-steroidal anti-inflammatory agent
b. Norethisterone administered from day 1- day 25 of the cycle
c. Norethisterone administered from day 21-day 28 of the cycle
d. Oral contraceptive pill
e. Tranexamic acid

26. HPV 16 and HPV 18 are implicated in the genesis of what percentage of cervical cancer?
a. 10%
b. 25%
c. 50%
d. 70%
e. 100%
Obstetrics and Gynaecology 2014 MBBS Recall (MCQ + OSCE) Friday May 9, 2014 9:00 a.m.
Prepared by Da Roux Barrett Class of 2014
27. With respect to complete hydatidiform mole which of the following is false?
a. It is more common in western countries than several parts of Asia
b. It occurs more commonly in the extremes of reproductive life
c. No fetus is present
d. The chorionic villi are swollen and have a bunch of grapes appearance
e. Ultrasound gives a typical echogenic pattern

28. A 70 year old female presented with bloating and abdominal distention. The investigations
reveal a pelvic mass with ascites. The had surgical staging and final pathology showed she had a
serous ovarian cancer involving the right ovary. The omentum contained metastatic disease
<1cm and the ascitic fluid was positive for malignant cells. All the other specimens were
negative. What treatment should she receive next. Choose the single best answer.
a. Hormonal therapy
b. Chemotherapy
c. No further treatment
d. Chemoradiation
e. Radiation

29. A veres needle is an instrument used to; Choose the single best answer
a. Aspirate ovarian cysts
b. Biopsy tissue
c. Inject anaesthetic into tissue
d. Insufflate the peritoneal cavity
e. Administer epidural anaesthesia

30. A 40 year old woman with 5 children had high grade squamous intraepithelial lesion (HSIL)
reported on her most recent pap smear. Which of the following treatment options should she
be advised. Choose the single best answer
a. Urgent cold knife cone biopsy
b. Urgent loop excision of the transformation zone
c. Vaginal hysterectomy
d. Colposcopic examination and biopsy of the cervix
e. Urgent repeat pap smear

OBSTETRICS

31. What should not be used in labour if blood pressure reaches 170/110 mmHg
a. elective forceps delivery
b. Anti-hypertensives
c. Ergometrine
d. CTG
e. Oxytocin
Obstetrics and Gynaecology 2014 MBBS Recall (MCQ + OSCE) Friday May 9, 2014 9:00 a.m.
Prepared by Da Roux Barrett Class of 2014

32. Which of the following statements about diabetes in pregnancy is true?
a. The risk of spontaneous abortion is not increased when compared to women without
diabetes
b. The risk of congenital anomalies rises in relation to the maternal hemoglobin A1C
c. The rate of stillbirth is unchanged when compared with non-diabetic women
d. The risk of caesarian birth is unchanged when compared to non-diabetic women
e. Glycaemic control is not related to fetal macrosomia

33. An important use of ultrasound in obstetrics is to evaluate?? fetal wellbeing. One of these
methods in a biophysical profile. Identify the component study that is not a part of the
biophysical profile
a. Fetal tone
b. Breathing movements
c. Cord Doppler evaluation
d. Gross fetal movement
e. Liquor volume

34. What placental abnormality cannot be identified on ultrasound? Choose the single best answer.
a. Placental lakes
b. Circumvallate placenta
c. Placenta previa at 34 weeks gestation
d. Succenturate placenta
e. Placenta previa at 20 weeks gestation

35. A 32 year old chronic hypertensive G2P1 at 32 weeks of gestation presented to labour ward with
bleeding PV. The most likely cause
a. Placenta previa
b. Placental abruption
c. Cervical cancer in pregnancy
d. Cervical polyp
e. Varicosity of vulval veins

36. A 35 year old hypertensive primigravida has a seizure at 16 weeks gestation developed a seizure
attack. She had a history of hyperemesis at 10 weeks gestation which resolved. On examination
she is found to have multiple old facial scars. Ultrasound revealed a live singleton fetus with
normal anatomy and compatible dates. Which differential could most likely be the cause of her
seizure. Choose the single best answer.
a. Eclampsia
b. Metabolic derangement
c. Metastatic molar pregnancy
d. Epilepsy
Obstetrics and Gynaecology 2014 MBBS Recall (MCQ + OSCE) Friday May 9, 2014 9:00 a.m.
Prepared by Da Roux Barrett Class of 2014
e. Drug overdose

37. A 20 year old Gravida 2 para 1 patient at a gestational age of 15 weeks by her LMP was taken to
the A&E department. Her expected date of delivery was in keeping with a dating ultrasound at
12 weeks gestation. Her pregnant progressed well until at 15 weeks she developed vomiting. On
examination she was found to be moderately dehydrated. Her Abdomen only revealed mild
suprapubic tenderness. Blood investigation Random blood glucose of 25mmol/l (450mg/dl)
Dipstick revealed ketosis.

Which is the incorrect answer?
a. Commence antiemetic for the treatment of hyperemesis gravidarum
b. Start hydration with ringers lactate and monitor electrolytes
c. Lower blood glucose with soluble insulin
d. Multi team approach with consultation with the on call medical team
e. Culture a mid stream specimen of urine

38. Which of the following is true regarding abdominal findings in pregnancy. Choose the single best
answer.
a. Fundus first palpable at 20 weeks
b. Fundus at umbilicus at 36 weeks
c. Fundus at xyphoid sternum only at term
d. A high head after 37 weeks in a multiparous woman
e. Breech presentation of 28 weeks

39. Which of the following factors does not put a woman at increased
Of obstetric complications
a. Both extremes of maternal age
b. One previous caesarian section
c. A history of subfertility with use of fertility drugs or assisted
d. Family history of diabetes in a second degree relative
e. Obesity

40. Physical changes in pregnancy include which of the following. Choose the single best answer.
a. Increase of blood volume by 100%
b. Decrease in Hb by 6%
c. Cardiac output 40% decrease
d. Peripheral resistance 50% increase
e. Cardiac output 80% increase

41. Concerning HIV in Pregnancy which of the following is incorrect
a. Pregnancy hastens the progression HIV to AIDS
b. The incidence of pre-eclampsia may be decreased by anti-retroviral therapy
Obstetrics and Gynaecology 2014 MBBS Recall (MCQ + OSCE) Friday May 9, 2014 9:00 a.m.
Prepared by Da Roux Barrett Class of 2014
c. Stillbirth and IUGR appear to be more common in HIV-affected individuals
d. Breast feeding decreases the rate of vertical transmission
e. Delivery by caesarian section is mandatory

42. Which of the following is a typical biochemical and/or hematological abnormality in
pre-eclampsia? Choose the single best answer
a. Reduced Hemoglobin
b. Rise in platelets as part of the acute systemic response
c. Low uric acid
d. A protein:creatinine ratio <30
e. Impaired renal and liver function

43. With respect to aneuploidy screening. Choose the correct answer.
a. Trisomy 19 is the most common
b. An abnormal quadruple screen diagnoses an aneuploidic gestation
c. Down syndrome is more common if the mother is above 35 years
d. Sonographic evaluation begins at 18-22 weeks with the anomaly scan
e. Chorionic villous sampling has a higher rate of fetal wastage than amniocentesis

44. Which of the following is true of polyhydramnios?
a. It is commonly diagnosed between 12-18 weeks gestation
b. It has amniotic fluid index value >8cm as a diagnostic criteria
c. Indomethacin is a treatment option
d. It is more commonly associated with dichorionic twinning than monochorionic twinning
e. Amnioinfusion is a treatment option

45. A 25 year old para 2 gravida 3 presents at 37 weeks gestation complaining of pain at the uterine
fundus and fresh vaginal bleeding. She is tender over the uterine fundus. Which of the following
it most likely to be the diagnosis??
a. Degenerating uterine fibroids
b. Pancreatitis
c. Placenta Previa
d. Torted ovarian cyst
e. Placental abruption

46. Eight days post normal delivery a para 2 gravida 2 female complains of sudden onset of chest
pain and shortness of breath. What is the most likely cause of her pain
a. Myocardia infarction
b. Amniotic fluid embolism
c. Pneumothorax
Obstetrics and Gynaecology 2014 MBBS Recall (MCQ + OSCE) Friday May 9, 2014 9:00 a.m.
Prepared by Da Roux Barrett Class of 2014
d. Pulmonary embolism
e. Pneumonia
47. In a normal pregnancy which of the following is true?
a. Arterial pCO2 levels fall
b. Renal blood flow increases by 10%
c. Serum urea rises
d. Tidal volume decreases
e. Serum aldosterone decreases

48. Which of the following is not a risk factor for pregnancy induced hypertension
a. Primigravida
b. Multiple pregnancy
c. Systemic lupus erythematosus
d. Smoking
e. Molar pregnancy
49. Failure to progress may result from all of the following except
a. Inadequate uterine contractions
b. ??Submucosal fundal uterine fibroid
c. Spinal anaesthesia
d. Placenta previa??
e. ??
50. Causes of antepartum hemorrhage include all of the following except?
a. ??
b. ??
c. ?? pattern on CTG
d. ????
e. Diseminated intravascular coagulation
51. Question about iron deficiency in pregnancy
a. A decrease in
b. Fetal .
c. ??
d. ??
e. ??
52. Question about management of ??seizures in pregnancy
a. Phenytoin
b. Magnesium sulphate
c. Diazepam
d. Carbamazepine??
e. ??

Obstetrics and Gynaecology 2014 MBBS Recall (MCQ + OSCE) Friday May 9, 2014 9:00 a.m.
Prepared by Da Roux Barrett Class of 2014
EMQ themes
Infertility 5 scenarios based on which fertility treatment is ideal in a given clinical scenario eg.
FSH analogue, Adhesiolysis, etc

Seizure 5 scenarios to choose amongst Pre-eclampsia, Epilepsy, Peri-partum cardiomyopathy
etc.

Vulval lesions 5 scenarios to choose amongst vulval carcinoma, Chancre, Bartholins cyst,
Bartholins abscess etc.

Contraception 5 scenarios to choose amongst Diagphragm, OCP, Projestin only, bilateral tubal
ligation, condom etc.

Short answer themes
? Missed Miscarriage/Ectopic pregnancy
?Shoulder dystocia - name and describe any suitable manoeuver you would use in the
management of this condition
?Recurrent 1
st
trimester miscarriages
?Rhesus isoimmunization

Only clinical scenarios were given student had to provide the diagnoses based on the
information given. Hence the ? in the short answer themes above.

OSCE (Unmanned) June 22, 2014 9:00 a.m.
6 stations 5 minutes each

Station 1
CTG showing variable deceleration
State the significant feature of the tracing
Outline the immediate management as the intern
Outline the subsequent steps to be taken by your management team
List 2 fetal comlications of the condition

Station 2
Picture of Heparin
Purpose of drug
List 2 routes of administration
State preoperative precautions concerning a 32 week patient on heparin scheduled to have c-
section
Give 3 factors of the pathophysiology of pregnancy that makes the drug necessary (they want
you to explain the components of virchows triad)

Obstetrics and Gynaecology 2014 MBBS Recall (MCQ + OSCE) Friday May 9, 2014 9:00 a.m.
Prepared by Da Roux Barrett Class of 2014
Station 3
Picture of Curette
Identify instrument
5 indications for use of this instrument
4 complications related to use of this instrument (non-anaesthetic)
Give 2 alternatives to its use and give advantages of these alternatives

Station 4
Picture of ?Dichorionic/Diamniotic twin gestation on ultrasound scan done at 10 weeks
gestation
What is the most likely diagnosis (picture showed lambda sign)
List five maternal complications of this condition
List five fetal complications
How would you deliver this pregnancy and why

Station 5
Picture showing Transabdominal Myomectomy
State the most significant risk of this procedure
In what 2 ways can this risk be minimized
What are some long term complications of the procedure

Station 6
Picture of drug Premarin
Which group of women is this drug most commonly given
Give two routes of administration besides oral
Five two indications of giving this drug
Give 3 complications of this drug with explanations

OSCE (6 Manned stations) 5 minutes each June 29, 2014 9:00 a.m.
1. [OBS]Take a focused obstetric history (patient presented to clinic with 4+ ketones in urine
and a history of vomiting at 8 weeks gestational age)

2. [GYN]Abdominal exam (do the full exam as done on the abdomen station in the medicine
clerkship eg liver span, ballot kidneys, fluid thrills, auscultate bowel sounds etc.)

Perform the abdominal exam on a female patient (examiner asked what clinical
investigations you would like to perform) to supplement the clinical exam findings

Note that you must give the size of the mass in relation to gestation size of a gravid uterus in
weeks eg 16 weeks 20 weeks etc. Also say that it arises from the pelvis as you cannot get
below the mass. Say you would like to complete the exam by performing a bimanual
Obstetrics and Gynaecology 2014 MBBS Recall (MCQ + OSCE) Friday May 9, 2014 9:00 a.m.
Prepared by Da Roux Barrett Class of 2014
examination to differentiate an ovarian (moves independently of cervix) from a uterine
mass (moves with cervix)

3. [OBS]Obstetric abdominal examination [patient has dizziness at 38 weeks] how would you
manage the patient in the immediate setting.

In performing the gravid abdominal exam (obstetric version, Leopolds manoeuvers,
symphisiofundal height, ask to fetal heart rate with pinnard etc ), remember to include
mucus membranes and pedal edema.

4. [GYN] Take a focused history from a patient having abnormal vaginal bleeding. As it turns
out patient had a breakthrough bleeding, she started OCP two weeks prior. Examiner asked:
what advice would you give the patient?

5. [OBS] Obtain informed consent from a patient who is scheduled to have a c-section. Please
note (as reminded by Dr. Taylor) informed consent means explaining the procedure, its
indications and the possible complications arising from same. AVOID/MINIMISE USE OF
MEDICAL JARGON

6. [GYN] Counsel a patient on the appropriate contraceptive method. Patient expressed the
desire for no further children. She wanted information about tubal ligation. Explain the
procedure, the risks involved, failure rate, length of hospital admission etc.
AVOID/MINIMISE USE OF MEDICAL JARGON