Section A

MCQ (40 questions)

1) A sure evidence of onset of labor is:
a. Pelvic heaviness.
b. Expulsion of mucus streaked with blood.
c. Reflex bearing down.
d. Head engagement.
e. Progressive cervical dilatation.

2) What is the main task of the physician during the 2nd stage of normal labor?
a. Controlled cord traction (Brand Andrew maneuver) to enhance placental delivery.
b. Jaw flexion shoulder traction to deliver after-coming head in breech presentation.
c. Controlled head extension with perineal support (Ritgen maneuver).
d. Repeated ergometrine injection to ensure strong uterine contractions.
e. Episiotomy once the cervix is fully dilated.

3) A 24 year old multipara underwent a vaginal delivery of a full term infant. The placenta wasn’t
delivered spontaneously for about 60 minutes. Next step in management for this patient is:
a. Repeated fundal pressure to expel the placenta.
b. Hysterotomy.
c. Manual removal of the placenta under anesthesia.
d. Exert marked traction on the cord to pull the placenta out.
e. Cut the cord and leave the placenta for spontaneous autolysis.

4) Commonest cause of decreased hemoglobin concentration level during pregnancy?

a. Iron deficiency.
b. Folic acid deficiency.
c. B12 deficiency.
d. Physiologic hemodilution.
e. Hemolysis.

5) During an abdominal examination of a 28 weeks PG, fundal level was found to be at level of the
xiphisternum. Choose a possible cause:
a. Polyhydramnios.
b. Fetal growth restriction.
c. Normal finding.
d. Contracted pelvis.
e. P.R.O.M.
6) Which of the following is considered a warning symptom in pregnancy?
a. Breathing discomfort on exertion
b. Nausea and appetite change
c. Fluid leak from the vagina
d. Increased quickening
e. Constipation

7) Which of the following is commonly associated with cervical incompetence?

a. First trimester abortion.
b. Blighted ovum.
c. Accidental hemorrhage.
d. P.R.O.M.
e. Cervical length equals or less than 3.5 cm by ultrasound.

8) A full term PG with occipito-posterior malposition during labor. At a cervical dilatation of 7

cm, head was at zero station, membranes ruptured spontaneously with clear liquor but uterine
contractions became infrequent for 1 hour. What is the best management?
a. Oxytocin infusion.
b. Caesarian section.
c. Forceps application.
d. Vacuum extraction.
e. Epidural anesthesia.

9) Which of the following is encouraging for a trial of vaginal delivery in breech presentation?
a. Previous breech delivery.
b. Preterm breech
c. Estimated fetal weight is between 3.5 kg to 4.0 kg.
d. Footling presentation
e. Extended fetal head as detected by ultrasound.

10) Contraindications for oxytocin to augment labor include:

a. Past date fetus
b. previous cesarean section
c. maternal hypertension
d. premature rupture of membrane
e. all cases with antepartum hemorrhage

11) Parameters studied in biophysical profile to diagnose chronic fetal distress include:
a. Active fetal movements.
b. Response of fetal heart to uterine contractions.
c. Degree of placental maturity.
 d. Fetal umbilical artery Doppler.
e. Amniotic fluid turbidity.

12) A 40 year old multipara attends for antenatal care as she had a delayed menstruation for 1
week. She did serum hCG twice, 1st reading was 3000 mIU/ml and the 2nd, two days later, was
2500 mIU/ml. How can you interpret these levels?
a. Non pregnant levels.
b. Not conclusive.
c. Normal pregnancy.
d. Blighted ovum
e. Molar pregnancy.

13) Of the following women, which patient would be at greater risk for ectopic pregnancy:
a. a healthy woman on birth control pills for more than 18months duration
b. Pregnancy after artificial insemination
c. Pregnancy on top of intrauterine contraceptive device
d. a woman with a previous history of polycystic ovarian disease
e. a woman with a past history of vaginitis

14) A 25 year old PG at 32 weeks gestation was admitted to ER due to eclamptic fits. Choose the
most appropriate statement regarding treatment:
a. Diuretics should be given to prevent pulmonary edema.
b. Patient should receive general anesthesia to stop convulsions.
c. Oral antihypertensive agents may be tried 1st to control blood pressure.
d. Control convulsions and continue pregnancy to reach fetal maturity.
e. Magnesium sulphate and pregnancy termination should be done.

15) A 2nd gravida para 1 with previous delivery of a healthy baby attends in the current
pregnancy at 20 weeks gestation for antenatal care. Her RH type was negative and she did not
receive anti D in the previous pregnancy. Indirect comb test was negative. What will be your
recommendation for this case?
a. Cordocentesis.
b. Amniocentesis.
c. Give anti D after labor.
d. Termination of pregnancy is advised.
e. Delivery should be by caesarian section.

16) A healthy 23 years old G2P2 has had an uncomplicated pregnancy to date. She is disappointed
because she is 41 weeks and still had not delivered. She reports good fetal movements. On PV,
her cervix was soft, central, 80% effaced, and 2 cm dilated. The vertex is at zero station and
estimated fetal weight is 3200 gm. What is the recommended management for this case?
a. Schedule her for caesarian section.
b. Induction of labor by vaginal misoprostol.
c. Oxytocin infusion and artificial rupture of membranes.
 d. Continue fetal kick count monitoring and recheck after 2 week.
e. Check fetal lung maturation before making an action.

17) What is the most diagnostic feature of preeclampsia?

a. Blood pressure equals or more than 140/90
b. Lower limb edema.
c. Proteinuria starting early in pregnancy.
d. Polyuria with low urine specific gravity.
e. Marked hemodilution.

18) Regarding disturbed tubal ectopic pregnancy, which of the following is correct?
a. Commonly disturbs during 1st trimester.
b. Usually associated with severe vaginal bleeding.
c. Absent pelvic pain is characteristic.
d. Snow storm appearance on ultrasound is a diagnostic feature.
e. Serum hCG is usually negative.

19) Which of the following causes 2ry post-partum hemorrhage?

a. Marked uterine atony.
b. Retained placental fragments.
c. Acute uterine inversion.
d. Hypo-fibrinogenemia.
e. Rupture uterus.

20) A 30 weeks PG with breech presentation presents by sudden gush of fluid. She has a
temperature of 37o, pulse: 80/minute and a lax abdomen. Leucocytic count is 4000/ml and
ultrasound shows normal for date fetus with AFI: 10. What is the most suitable management
for this case?
a. Conservative management.
b. External cephalic version.
c. Caesarian section.
d. Induction of labor.
e. Cervical cerclage.

21) Which of the following ligaments is responsible for uterine anteverted position?
a. Ovarian ligament.
b. Round ligament.
c. Mackenrodt”s ligament.
d. Broad ligament.
e. Infundibulo-pelvic ligament.
22) Effects of progesterone production in menstrual cycle include:
a. Increases amount of cervical secretions.
b. Facilitates upward transfer of sperms at day of ovulation.
c. Renders the endometrium suitable for implantation.
d. Responsible for colicky pains at onset of menstrual flow.
e. Exerts +ve feedback on FSH and LH in mid-luteal period.

23) A newly married 22 year old presents with right lower abdominal pain 1 week after the end of
her menses. This pain is associated with a mild increase in vaginal secretions and blood
spotting. Ultrasound reveals a normal sized AVF uterus and a right adnexal clear cystic
structure 24 mm in diameter. What is your provisional diagnosis for this case?
a. Acute pelvic inflammatory disease.
b. Ovulatory pain.
c. Endometriosis.
d. Polycystic ovarian disease.
e. Ectopic pregnancy.

24) Hormonal changes in menopause is characterized by one of the following:

a. High FSH and LH levels
b. High FSH and low LH levels
c. Low FSH and high LH levels
d. Low FSH and LH levels
e. High FSH and E2 (estradiol) levels

25) A 45 years old slim woman had undergone total hysterectomy and bilateral salpingo-
opherectomy for uterine leiyomyoma, she came to the clinic counseling about HRT. What
would you suggest?
a. combined estrogen progesterone HRT
b. Estrogen only HRT
c. Progesterone only pills
d. low dose thyroxin
e. GnRH analogue

26) Cryptomenorrhea is caused by one of the following pathologies:

a. complete Mullerian agenesis
b. Androgen insensitivity syndrome
c. Imperforate hymen
d. Asherman syndrome
e. Turner syndrome

27) Polycystic ovarian disease commonly includes one of the following characteristics:
a. elevated FSH and decreased LH
b. low androgen level
c. high progesterone level
d. multiple large dominant follicles in ultrasound
 e. obesity with increased insulin resistance

28) A 30years old P0+1 presented with 2ry amenorrhea for 1year following surgical evacuation of
10weeks pregnancy. She received cyclic oral contraceptive pills for few months but no
withdrawal bleeding occurred. Your provisional diagnosis:
a. Sheehan syndrome
b. Asherman syndrome
c. Turner syndrome
d. polycystic ovarian disease
e. premature ovarian failure

29) Indications to interfere in a uterine myoma include one of the following:

a. Uterine size of 10 weeks size.
b. Intramural fibroid of 2 cm.
c. Non pedunculated subserous myoma.
d. Submucous fibroid polyp in infertile case.
e. Fibroid with hyaline degeneration.

30) A 30 years old P1+2, presents by heavy menstrual flow for 1 year. Transvaginal ultrasound
reveals a submucous fibroid 3 cm filling the uterine cavity. What is the treatment option with
best chance to preserve fertility?
a. Medical treatment with GnRH analogue.
b. Medical treatment with progestagens.
c. Open abdominal myomectomy.
d. Laparoscopic myomectomy.
e. Hysteroscopic myomectomy.

31) A 27yrs old woman P1+0, presents with excess yellow offensive discharge mainly in the past
menstrual period associated with vaginal soreness. Speculum examination reveals
erythematous vagina and cervical punctuations. Which is the most likely diagnosis:
a. Allergic reaction
b. candida vaginalis
c. Trichomonas vaginalis
d. bacterial vaginosis
e. Gonorrhea infection

32) A 60years old multipara, menopausal for 10years, presented by an attack of mild vaginal
bleeding. She is known to be hypertensive with poor control. US revealed AVF normal sized
uterus with a 14 mm endometrial thickness. How will you proceed?
a. control hypertension and follow up
b. progestagens for 6 months
c. fractional curettage
d. check FSH and LH before taking an action
e. Hysterosalpingography for further uterine evaluation
33) A 45 year old multipara presents by repeated bleeding in the form of spotting following sexual
intercourse. Which of the following investigations will be most valuable?
a. Endometrial curettage.
b. Colposcopy.
c. C.T pelvis.
d. CA-125.
e. Diagnostic laparoscopy.

34) An unmarried 20 years old female with an accidentally discovered dermoid cyst 8cm during an
regular ultrasound checkup. Which of the following is the best treatment for her?
a. aspiration of the cyst guided by ultrasound
b. unilateral ovariectomy
c. ovarian cystectomy
d. assurance , conservative management and follow up
e. combined oral contraceptive pills for 3months

35) As regard cancer cervix, choose the correct statement:

a. Primary prevention by H.P.V vaccine is effective.
b. Staging of definite cases should be surgical
c. Spread is mainly through blood born spread
d. Clinical presentation is usually delayed.
e. Radiotherapy is preferred in young patients to preserve ovaries.

36) Which of the following is a predisposing factor for endometrial carcinoma?

a. Early age of 1st intercourse.
b. Sexually transmitted diseases.
c. Multiparity
d. Obesity
e. Prolonged oral contraceptive use

37) A 35years old P1+0 presented with irregular vaginal bleeding. Endometrial curettage revealed
simple endometrial hyperplasia without atypia. She had not yet completed her family. How can
you manage this case?
a. Just follow up
b. Progestagens for 6 months
c. Hysterectomy
d. Pelvic irradiation
e. Endometrial ablation

38) A couple with 1ry infertility for 10 years attended to the clinic. Male semen analysis showed a
count of 1 million/ml with non-progressive motility. Female partner was 37years old with
normal hormone profile and free hysterosalpingography. What is the most suitable line of
treatment?
a. treat the husband and re do semen analysis after 6 months
b. Laparoscopy to confirm tubal patency
c. Intracytoplasmic sperm injection (ICSI)
 d. IUI for 6 cycles
e. induce ovulation with timed intercourse for 6 months

39) A 25years old P1+0 attended the outpatient clinic for a method of contraception. She delivered
by CS 3 months ago and she is nursing her baby with amenorrhea since delivery. She is
planning to delay next pregnancy for 2 years. Most appropriate contraceptive method for this
case:
a. No need ad long as lactational amenorrhea is present
b. IUD
c. COPs
d. Postcoital douching
e. safe period

40) A 45 years multipara, presented with a mass protruding from the vulva on straining and lack
of sexual satisfaction. Examination revealed a descent of posterior vaginal wall with deficient
perineum. Cervix was felt at level of ischial spines. Most suitable treatment for her:
a. Pelvic floor exercise
b. posterior colpo-perineorrhaphy
c. classical repair
d. colposacropexy
e. Manchester (Fothergill’s) operation

True (a) / False (b) (10 questions)

41) Methotrexate is more effective as a medical treatment of undisturbed tubal ectopic
pregnancy with hCG levels up to 1500 mIU/ml and absent fetal pulsations. True

42) Rupture of membranes with drained liquor at 20 weeks may be treated conservatively till
fetal viability under good cover of antibiotics. False

43) Ovarian cysts associating molar pregnancy resolves spontaneously after molar evacuation
as they are hormone dependent. True

44) Down’s syndrome can be accurately screened by US at 11 to 13 weeks gestation True

45) The most common cause of puerperal pyrexia is breast engorgement with milk. True

46) Most commonly used investigation to diagnose ovulation is ultrasound folliculometry. True

47) Non contraceptive use of Mirena IUCD is treatment of endometrial hyperplasia. True

48) Benign ovarian tumor with highest incidence to turn malignant is dermoid cyst. False

49) Laparoscopy is the gold standard to diagnose pelvic endometriosis. True

50) The most common cause of hirsutism is constitutional. True

 EMQ (20 questions)
Questions 51- 55 are preceded by a list of lettered options. Select the one letter that is most closely
associated with it. Each letter may be used once, more than once, or not at all:
a.Uterine massage.
b.Vaginal exploration under anesthesia.
c.Total hysterectomy.
d.Subtotal hysterectomy.
e.B-Lynch compressing sutures.
f.Vaginal pack.
51) A full term 30 yearold P3 + 0, previous 3 CS presents to ER with mild vaginal bleeding.
Pathologically adherent total placenta previa (centralis) invading the bladder is
diagnosed by U/S. C

52) A 35 year old P4+2 with deteriorating general condition and persistent uterine Aton
after vaginal delivery not responding to ecbolics. D

53) A 38 year old P5+0 with persistent vaginal bleeding after prolonged labor of a fetus in
occipito-posterior position that ended by difficult vacuum extraction. Uterus is well
contacted uterus. B

54) A 25 year old PG with repeated episodes of uterine atony encountered during elective
C.S for marked cephalo-pelvic disproportion. E

55) A 2nd GP1 has complete perineal tear and multiple vaginal lacerations after precipitate
labor. After surgical repair there is a continuous trickling of fresh blood though no
uterine atony. F

Questions 56-60 are preceded by a list of lettered options. Select the one letter that is most
closely associated with it. Each letter may be used once, more than once, or not at all:
a.Placenta previa.
b.Pathologically adherent placenta.
c.Concealed accidental hemorrhage.
d.Revealed accidental hemorrhage.
e.Vasa previa.
f.Rupture uterus.
56) A full term P4+3 suddenly collapsed after 1 hour of oxytocin infusion to augment
contractions during 1st stage of labor. Fetus is easily felt , fetal heart becomes inaudible
and there is mild vaginal bleeding. F

57) A full term P5+3 suddenly developed severe attack of vaginal bleeding during 1st stage
of labor. Previous milder attack occurred to her 1 month ago. A

58) After control of eclamptic fit in a 36 weeks primigravida, abdomen is felt hard with
absent fetal heart and the patient vital signs started to deteriorate. C
 59) A full term G2+1, previous CS during the 1st stage of labor; has hematuria and severe
fetal bradycardia following spontaneous ROM at 8 cm cervical dilatation with mild
vaginal bleeding. F

60) Following an ECV, a 32 weeks PG has moderate vaginal bleeding with normal fetal
heart. D

Questions 61-65 are preceded by a list of lettered options. Select the one letter that is most closely
associated with it. Each letter may be used once, more than once, or not at all:
a.Menorrhagia.
b.Metrorrhagia.
c.Post-menopausal bleeding.
d.Contact bleeding.
e.Normal menses.
f.Dysmenorrhea.

61) Adenomyosis. A
62) Pelvic endometriosis F
63) Cervical carcinoma. D
64) Endometrial carcinoma. C
65) Dermoid cyst. E

Questions 66-70 are preceded by a list of lettered options. Select the one letter that is most closely
associated with the tumor. Each letter may be used once, more than once, or not at all:
a.Cancer cervix.
b.Endometrial carcinoma.
c.Primary ovarian carcinoma.
d.Choriocarcinoma.
e.Uterine sarcoma.
f.Uterine fibroid.

66) Prolonged unopposed estrogen is the main predisposing factor. B

67) Has the worst prognosis due to late clinical presentation. C
68) The risk increases with increased parity. A
69) Usually associated with elevated CA-125 tumor marker. C
70) Most responsive to chemotherapy. D
 (Section B)
Obstetrics Clinical sheet (10 questions)
Questions 1-5 : A 25 years old woman P1 +0, lactating for 9 months with regular cycles and
IUCD in situ presents with a missed period for 3 days and +ve pregnancy test.
1) For the time being, how can you check the condition and location of this pregnancy?
a. Doubling of hCG levels over 2 days.
b. Vaginal ultrasound.
c. Serum progesterone level.
d. Speculum examination to visualize IUCD threads.
e. Laparoscopy.
2) If this pregnancy is proved to be healthy intrauterine with LMP at 28/1/2021, what is her
expected date of delivery?
a. 4 /10 /2021
b. 15 /10 /2021
c. 28 /10 /2021
d. 4 /11/2021
e. 11 /11/2021

3) How can you council the patient regarding IUCD with pregnancy?
a. It increases the incidence of abortion if left in place.
b. It should be left in place even if threads are visible.
c. It should be removed even if threads are not protruding from the cervix.
d. Cupper content is teratogenic.
e. Perforated uterus may occur with advancement of pregnancy.

4) After 8 weeks from the initial visit the patient presents to ER with severe vaginal bleeding
and abdominal colics. Cervix is felt opened and ultrasound reveals a living fetus
corresponding to her gestational age. What is your recommended management?
a. Rest and progesterone supplementation.
b. Oral and vaginal misoprostol.
c. Suction evacuation.
d. Abdominal hysterotomy.
e. Cervical cerclage.

5) After managing the severe attack of bleeding, patient gets well and was discharged from the
hospital according to medical rules. She returned back after 1 week with recurrence of
abdominal colics and bleeding though less severe. What is your provisional diagnosis?
a. Inevitable abortion.
b. Uterine perforation.
c. Infected uterine hysterotomy scar.
d. Retained products of conception.
e. Associated tubal ectopic pregnancy.
Questions 6-10: A 30 year old PG at 32 weeks gestation presents for routine antenatal checkup.
Her BP is 150/90, albumin in urine: + , normal fundal height and US reveals single fetus,
breech presentation with normal fetal biometry, fundal placenta and AFI:10
6) How can you interpret the given findings?
a. Unremarkable findings.
b. The main issue is the malpresentation.
c. Mild preeclampsia.
d. Severe preeclampsia.
e. Essential hypertension with pregnancy.

7) What is the main maternal risk in this case?

a. No increased risk.
b. Deep venous thrombosis.
c. Obstructed labor.
d. Amniotic fluid embolism.
e. Convulsions.

8) What is the main fetal risk in this case?

a. No increased risk.
b. Fetal congenital anomalies.
c. Macrosomia.
d. Prematurity..
e. Birth injuries.

9) All the following investigations are informative in this case EXCEPT:

a. Liver enzymes
b. Complete blood picture.
c. Fetal Doppler studies.
d. Coagulation profile.
e. Maternal serum αfetoprotein.

10) What is the suggested plan for this case?

a.Recheck after 1 week.
b.Diuretics are considered.
c.Oral α methyl dopa and close follow up.
d.External cephalic version.
e.Caesarean section.
 (Section C)
Gynecology Clinical sheet (10 questions)
Questions 1-5: A 26 year old woman presents with 1ry infertility for 3 years. She has regular
average cycles associated with severe pelvic cramps that starts 2 days after the actual flow and
increases sharply till 2 days after its end. She also reported an emergency admission to hospital
1 year ago for acute pelvic pain, fever and offensive discharge. This was resolved after IV
antibiotics for 1 week. No hysterosalpingeography was done due to known iodine allergy. Her
husband is 35 year old, heavy smoker, he is an accountant and they have regular sexual life.
1) What could be the clinical significance of smoking for their complaint?
a. It has no relation to this complaint.
b. It is toxic to fertilized ovum.
c. It affects sperm quality.
d. It increases semen volume.
e. It can lead to aspermia.

2) What is the clinical importance of the previous hospital admission in this case?
a. Ovarian reserve could be diminished.
b. PID with subsequent tubal damage.
c. Cervix may be stenosed. .
d. Intrauterine adhesions may follow.
e. Residual inflammatory mediators disturb ovum pickup.

3) What is the clinical significance of this pain pattern associating her menstrual flow?
a. It denotes pelvic congestion.
b. It denotes residual pelvic infection.
c. It denotes cervical erosion.
d. It denotes ovulatory cycles.
e. It suggests endometriosis.

4) Semen analysis for the male in this case reveals a volume of 3 cm, count of 20 million/ml,
motility of 5% (grade A and grade B) and abnormal forms of 20%. How do you consider
these parameters?
a. Normal.
b. Oligospermia.
c. Asthenospermia.
d. Teratospermia.
e. Azoospermia.

5) How can manage this case?

a. Ask the husband to quit smoking and wait for another 1 year.
b. Induction of ovulation with timed intercourse.
c. Consider intrauterine insemination.
d. Request hysterosalpingeography under anesthesia.
e. Laparoscopic evaluation with consent for possible bilateral tubal disconnection.
Questions:6-10 : An unmarried 23 year girl old attends the clinic complaining of frequent delay
in her menstrual periods with increased facial hair and acne. Examination reveals a body mass
index of 30 with marked condensation of fat in trunk area and moderate hirsutism. Ultrasound
reveals increased ovarian volume with increased number of peripheral small follicles in both
sides.
6) What is your most likely diagnosis?
a. Androgen producing ovarian tumor.
b. Polycystic ovarian disease.
c. Constitutional.
d. Psychological stress.
e. Mosaic Turner.

7) The following investigation will be requested in this patient:

a. MRI brain to evaluate sella turcica.
b. Karyotyping.
c. Estradiol level at midcycle.
d. FSH and LH levels at day 3 of the cycle
e. Laparoscopy.

8) Suggest the most suitable medical treatment:

a. Hormone replacement therapy.
b. Metformin.
c. Clomiphene citrate.
d. Human menopausal gonadotropins.
e. Progesterone only pills.

9) If this case is left untreated, which of the following gynecologic pathologies is likely to
develop?
a. Adenomyosis.
b. Malignant ovarian tumor.
c. Uterine sarcoma.
d. Endometrial hyperplasia.
e. Premature menopause.

10) Few months later, this case presents as newly married and seeks for pregnancy. Repeated
induction by oral drugs gave poor response. What is the commonest side effect of
gonadotropin injections if used in this case?
a. Local allergy and abscess at injection site.
b. Decreased receptivity of endometrium.
c. Ovarian hyperstimulation syndrome.
d. Worsen the quality of cervical mucus.
e. Disturbs tubal motility with higher risk of ectopic pregnancy.