üOverview of general gynecology

üAbnormal uterine bleeding

üAmenorrhea
üChronic pelvic pain ex: PCOS/Endometriosis
üPID
üMenopause
üGyne Infection
üEndometrial hyperplasia and endometrial cancer
Abnormal uterine bleeding
• A 32 YO presented with excessive uterine bleeding for the last 4
months ,how to mange this pateints ?

Causes:

1)Genital tract causes: (inflammatory ,benign

growth,malignancy,iatrogenic,Pregenancy related,DUB)

2)Systemic disease: (bleeding disorder,anticoagulant,thyroid

disease,dm)
• Start with:
• history:hpi, past medical and surgical history,drug history,family
history.
• Examination: general examination,neck ,breast ,abdominal,pelvic.
• Investigation: cbc ,upt ,u/s,pap smear,endometrial biopsy .
Mangements of AUB ?

1. Correction of anemia
2. Traeting the underlying cause

Treatment options for DUB:

1. Pharmacological : hormonal /non hormonal
2. Surgicall : ablation , hysterectomy
AUB MCQ
1) Most common cause of intermenstrual bleeding in a 13 years old?
A. Ovulation
B. Bleeding
Answers is:
3) What is most likely to be indicative of a cervical source of bleeding?
A. post coital bleeding
B. Dyspareunia
C. color of blood
Answer is: A
4) Most common site for postcoital bleeding ?
A. Uterine cervix
B. Uterine body
C. Vagina
D. Valvula
Answer is: A
5) Patient 40-50 years old presented with post coital bleeding , weeks
ago she was treated for genital wart by electrocautery what is the source
of bleeding? in other recall: Hx of Genital warts and treated, after 2
years she complain of bleeding after intercourse, where is the lesion?
A. Uterine cervix
B. Uterine body
C. Vagina
Answer is: A
6) Lady known to have vulvar ulcer-treated- came with postcoital
bleeding, source of bleeding?
A. Cervix
B. Vagina
C. Vulva
Answer is : A
7) Pt with post coital bleeding, what is the best investigation?
A. Inspect vagina and cervix
B. Colposcopy

Answer is A
8) 41 YO female presented with heavy bleeding. She has dysfunctional
uterine bleeding. First line of management?
A. OCP
B. D&C
C. Hysterectomy
D. Uterine ablation
Answer is : A, by exclusion
9) 27 years old women come with abnormal uterine bleeding the
interval between onset of episode less than 21 days, heavy and
prolonged. BMI 21 What’s the best next step in management?

A. Thermal ablation
B. GNRH injection
C. endometrial sample
D. oral contraceptives
Answer is: D
10) old age female with AUB what is first line treatment?
A. Oral progestin
B. Tamoxifen
Answer is: A
• 11) Patient with active pv bleeding, what is your management?
A. Ocp
B. Progesterone
C. Conjugated estrogen
Answer is: B
12) Patient with active pv bleeding, what is your first line management?
A. D and c
B. Iv conjugated estrogen
C. Endometrial ablation
D. Hysterectomy
Answer is : B
13) 48 years old women with irregular menses, Abnormal uterine
bleeding, they ask about best Tx?
• Answer is: Medroxyprogesterone
• 14) heavy menstrual bleeding . whats treatment to reduce bleeding?
A. Progesteron

Answer is: OCP

• 15) Case of patients not pregnant with heavy vaginal bleeding what's
your appropriate management?
A. medroxyprogesterone
B. blood transfusion
C. conjugated estrogen
Answer is: If stable- progesterone, Unstable- blood transfusion
16) A female patient present with heavy PV bleeding. Her bleeding is
associated with pain and of large volume. Upon vaginal examination,
you noticed pooling of blood. Pregnancy test is negative. BP low Labs:
RBC low Hb low What is your next step in management?
A. Progesterone
B. Conjugated estrogen
C. Blood transfusion
Answer is: C
• 17) 60 y/o female patients complain of scanty bleeding only the little
on her pads. What is the source?
A. Lower genital tract
B. Uterus
C. Ovarian
D. Fallopian tube
Answer is: B
• 18) PV bleeding in old female patients, where’s the bleeding from?
A. Uterus
B. Fallopian tubes Ovaries
C. Lower genital tract
Answer is: A
19) Post menopausal women with on/off mild bleeding. When you
examine you found a healthy cervix with scanty blood. What is the next
step?
A. US
B. Biopsy
Answer is : A
• 20) Old women post menopause And nulliparous has abnormal uterine
bleeding on examination she had blood spot on the cervix what you
will do ?
A. Dilation and curettage
B. Endometrial biopsy
Answer is : B until prove otherwise US First.
21) postmenopause women with AUB what to do?
A. Endometrial biopsy
B. CBC
C. D and C
Answer is: A
• 22) 32 years old with menorrhagia she not complaining of pain or
anything else Her BMI is 41 No hx of ovarian or endometrial ca what
is the most appropriate next step ?
A. Hysterectomy
B. MRI pelvis
C. Embolization
D. Endometrial biopsy
Answer is: D
23) Case of 47 years old with menorrhagia what best next step?
A. Pelvic MRI
B. Endometrial sample
Answer is: B
• 24) 36y female complains of AUB for 8month ask about first for
assess?
A. endometrial biopsy
B. hysteroscopic resection
C. US
• Answer is: C
25) 47 years old female diabetic uncontrolled , present by
polymennorrhea every 2 week with heavy bleeding, her bmi 37 what’s
the test you will do for diagnosis?
A. Laparoscopy
B. US
C. Endometrial biopsy
D. MRI pelvic
Answer is: C
26) A 47 y/o female with abnormal bleeding. With frequent, prolonged
and heavy period. Rx?
A. Oral progesterone
B. Progesterone
C. IUD
D. Endometrial sampling
• Answer is: C
27) 41YO P5 +3 presented to the clinic complaining of abnormal
uterine bleeding her Menstrual period is regular, associated with
blood clots and pain that is not relieved by analgesic she had
previous myomectomy, she is a known case of PCOS & her BMI
is 40?
A-Adenomyosis(answer)
B-Endometriosis
C-Uterine fibroid
D-Endometrial hyperplasia
28) 43 years old with inter-menstrual bleed, US showed 13 mm
long mass from the endometrium, most appropriate
management?
A. endometrial sample
B. hysteroscopy with removal of mass(answer)
C. US after 6 months
D. serial progestin in 3 months
29) 40s old female, with heavy bleeding came to ER, what to do?
A- IUD
B- D/C
C- Hysterectomy
D- Mefenamic acid(answer)
Mcq not resolved
• Bleeding diagnosed with Ovulatory dysfunction treatment?
A. OCP
B. IV Conjugated estrogen
C. Cryo ablation
D. Nsaids
• Answer is:
Chronic Pelvic pain (PCOD&Endometriosis)
1) scenario about a female with hx of uterine fibroid did myectomy and
2 D&C for misscariage C/O dysmenorrhea and per vaginal bleeding on
examination , found bulky uterus with no palpable adnexal masses and
tender uterus what is the diagnosis ?
A. Uterine fibroid
B. endometriosis
C. adenomyosis
D. Uterine cancer
Answer is : C
• 2) 55 years old come with heavy painful menstrual bleeding in each
cycle With previous hx of myomectomy 12 y ago , on examination :
symmetrical uterus no other signs no US finding Most likely dx?
A. dysmenorrhea and dyspareunia
B. Endometrial hypertrophy (hyperplasia not sure)
C. Uterine fibroid
D. Endometriosis
E. Adenomyosis
Answer is: E
• 3) 40years old women have hx of dysmenorrhea and excess bleeding
per examine...abdomen tender and bulky uterus?
A. Adenomyosis
B. Endometriosis
Answer is: A
• 4) 40 year old DM,HTN, BMI 35, complain of vaginal bleeding
between her periods, she has regular periods every 30 days , on
examination there was no adnexal mass , but the uterus was big and
tender ?
A. Endometrial ca
B. Endometriosis
C. Fibroid
D. Adenomyosis
Answer is: D
• 5) 40 years old female come complaining of pain with menstruation
and severe bleeding her menstruation is regular diagnosis?
Answer is: Adenomyosis
• 6) 45 female hx of myomectomy 12 years ago.. PCOS patient with
painful and heavy menstruation not relived by NSAID Uterus normal
size no adnexal mass what is the cause?
A. Adenomyosis
B. Endometriosis
C. Endometrial hyperplasia
Answer is: A
7) Adenomyosis case of 42y women, Sx : dysmenorrhea, menorrhagia,
Clinically : large uterus ,best investigation?
A. MRI
B. Pelvic X ray
C. Pelvic and abdomen US
Answer is: A
8) 15 years old symptoms of primary dysmenorrhea or menstrual pain +
some days absence from school because of the symptoms treatment? in
other recall 14 years old girl with pain during menstruation prevent her
from going to school. Treatment?
A. NSAIDS
B. OCP
C. SSRI
Answer is: A
9) 13yr girl with primary dysmenorrhea, what is the best treatment?

A. OCP
B. NSAIDs
C. Medroxyprogesterone
D. Acetaminophen
Answer is: B
10) 21 years old female have cycling pain and can't do her activities
normally and absent from school, she used analgesics and didn't
improve what is your advice ?

A. Life style modification

B. diazepam
Answer is A
11)17 Years old Female, having painful menses low abdomen and inner
thighs , affecting daily life , given NSAID , improved but still in pain
asking for more . How to manage?
A. Consult about
B. Life style modification
Answer is : B Lifestyle if not in choices > OCP’s
12) Young lady was suffering of dysmenorrhea was prescribed NSAIDS
which improved the symptoms markedly but insists on increasing the
dose what will u do?
A. Prescribe mg
B. Provide psycho support
C. Prescribe diazepam
Answer is: B
14) 26 female married with hx of debilitated pelvic pain with
menstruation, tried to conceive for years but failed, menorrhagia 10-15
pads per day, tender ligament in palpation and nodularity?
A. PID
B. Fibroid
C. Endometriosis
D. Adenomyosis
Answer is: C
15) Female trying to get pregnant for 3 years ,her period irregular with
severe pain , by examination there is nodule at uterosacral ligament;
what’s the diagnosis?
A. Endometriosis
Answer is: A
16) Pt with hx of previous myomectomy, now came with bleeding
mostly during period increases associated with pain,not relieved with
analgesics, on Abdominal Examination uterus was small , on US uterus
was normal size ,Dx?
A. Endometriosis
B. Adenomyosis
C. Fibroid
Answer is: A
• 18) Ground glasses appearance IN uterus associated with?
A. Infertility
ِAnswer is : a case of Endometriosis
19) Female trying to get pregnant for 3 years ,her period irregular with
severe pain , by examination there is nodule at uterosacral ligament,
what’s the diagnosis?
A. Endometriosis
Answer is: A
22) Most acceptable to diagnose endometriosis. In other recall Which of
the following is appropriate to diagnose endometriosis?

A. Pelvic US
B. MRI
C. Exploratory laparoscopy
D. Hysteroscope
Answer is : C
• 25) Patient with hx of surgery removal of endometriosis and came
with recurrence in other ovary, she completed her family, what is your
management?
A. Mass removal
B. Hysterectomy and ovarian removal
Answer is b
28) chocolate cyst (6*7 size) management?
A. observe until size 10
B. resection with ablation to any endometrioid spot
Answer is Lap cystectomy. If preservation of fertility is desired, the
procedures can be performed in many cases through laparoscopic
approach.
• 29) 39 years female, completed her Family, presented with recurrent
endometrioma 6*7, these is lower abdominal pain, dysmenorrhea,
dyspareunia, management?
A. Ablation
B. Aspiration of cyst
C. Removal of cyst
D. Immediate hysterectomy /salpingectomy /oophorectomy
Answer: D
• 30) 28 years old female who has three children, and completed her family
diagnosed as endometrioma which was removed 2 years ago, right ovary
cyst she presented to the clinic with mild to moderate dysmenorrhoea and
dyspareunia during intercourse and chronic lower abdominal pain Pelvic
ultrasound :shows Left ovary endometrioma cyst 6x7 in size?
A. removal of cyst
B. aspiration of cyst content under ultrasound guidance
C. immediate hysterectomy and salpingectomyophrectomy
D. removal of cyst by laparascopic ablation of endometrioma spots.
Answer is C
31) Most acceptable to diagnose endometriosis? In other recall Which of
the following is appropriate to diagnose endometriosis?
A. Pelvic US
B. MRI
C. Exploratory laparoscopy or Diagnostic
D. Hysteroscope
Answer is C
32) Female trying to get pregnant for 3 years ,her period irregular with
severe pain , by examination there is nodule at uterosacral ligament
what’s the best modality to diagnose?
A. Laparoscopy
Answer is A
36) pic of ground glass appearance Uterus on U/S, asking what you
should tell the patient? In other recall Round glass appearance
(Endometrioma) , what it may cause ?
A. Infertility
B. infection
Answer is A
37) Female 28 years complaining of dysmenorrhea and dysparuneia
pelvic ultrasound done and shows a hypoechoic mass (ground glass)
what statement is true?
A. Highly malignant
B. partner need to be treated
C. antibiotics should be given
D. future fertility is a concern
Answer is D
38) Women diagnosed with endometriosis wants to know here chances
of getting cancer what will you tell her ?
A. it’s linked to ovarian cancer
B. linked to endometrial cancer
Answer is A
40) Patient obese and diabetic has PCOS, which of the following
Has the highest risk for endometrial CA:
A- DM.
B- PCOS(answer)
C-BMI
41) 25 years Obese female with hirsutism ,amenorrhea since
about 5 months with dark rash in neck and shoulders?
A. stria
B. Acanthosis nigricans(answer)
C. other choices like (Purple stria , stria nigra not sure)
Pelvic inflammatory Disorder
Menopause
1) Postmenopausal complain of hot flashes what is hot flashes?

Answer is: Increase in core body temp due to hormones

2) Pathogenesis of post menopausal hot flushes?
Answer is: Cutaneous thermoregulators or low Estrogen
3) Patient I think 51 with s & s of menopause, asking about causes of
flushing?
A. Peripheral vasoconstriction in response to core body temperature
B. Peripheral vasoconstriction in response to high FSH and LH
C. Peripheral vasodilation response to core body temp
D. peripheral vasodilation response to sudden decrease in level of estrogen
Answer is: D
4) A woman came with menopause symptoms, what to check to confirm
the diagnosis? In other recall menopausal women and asking about one
test to make a ddx ?
A. FSH
B. LH
C. Estrogen
D. progesterone
Answer is : A
5) 45 years female, her last pregnancy was 15 years ago, she came with
History of 7 months amenorrhea, pregnancy test was negative. She
wants to get pregnant, what is the most appropriate inv. to do?
A. Endometrial sample
B. FSH and LH levels
C. TSH levels
D. Hysterosalpingography
Answer is: B
6) Female with hysterectomy and salpingectomy, with vasomotor
symptoms (written like this) What to give to relive her sx?
A. Progesterone IUD
B. Transdermal patch of estrogen only
C. Continuous combined estrogen and progesterone
D. Cyclic estrogen and progesterone
Answer is: B
7) Patient total hysterectomy، 41 yrs with Severe post-menopausal
symptoms What hormonal therapy should take?
A. Intra uterine device (she already remove uterus??)
B. Cyclic progesterone and progesterone
C. Continued prog And estrogen.
D. Conjugated estrogen
Answer is: d
8) Patient with Amenorrhea. lab tests showed: high FSH, LH. She is at
risk for ?
A. Endometrial Ca
B. Ovarian Ca
Answer is: A
9) women with amenorrhea for 8 months. All her lab are normal except
high FSH and LH (estrogen and progesterone were no mentioned)

A. she is at risk for endometrial cancer

B. she is at risk for ovarian cancer
C. she is at risk for osteoporosis
Answer is: C
Amenorrhea
• Primary amenorrhea :
a. No period by age of 14 and no growth of secondary sexual cccs
b. No period by age 16 regardless of secondary sexual ccs

• Secondary amenorrhea :
a. Cessation of regular menstruation for >3 consecutive cycle or >3
consecutive months
• A 16 yo female is complainig of amenorrhea .how to mange this
patient?

Etiology may be
Axis1: hypothalmaus / Axis2: pituitary/ Axis 3: ovaries/ Axis 4 : uterus
and outflow tract .

A. Take a history,examination
B. Investigation:pregenancy test ,tsh ,t3 , prolactin
C. Algorithm for diagnosis in next page ..
Amenorrhea
1-Girl not menstruated and mother want easy test to do?
• TFT
• FSH-LH
• Estrogen
• Answer is: B
3:17- years- old female athlete in her school came due to delayed
menarche; she has breast and pubic hair; tanner 5 but later than her
friends, Dx?
• hypogonadotropic hypogonadism
• gonadal agenesis
• transverse vaginal septum
• abnormal uterine development > Outflow obstruction
• Answer is: D
• 7:18 years old female with developed breasts and pubic hair but no
menstruation what can be the cause?
• High testosterone level
• Could be outflow obstruction, mallarian agenesis.
• Answer is: A
• 9: Pt has amenorrhea pupic hair and axilary hair and high testosterone?
• Mullerian agenesis ( another name Mayer Rokitansky Kuster Hauser
syndrome )
• Androgen insensitivity
• Answer is: A
10: Female 15yo come with primary amenorrhea, normal breast
development and hair in axilla and pubic, lab show High testosterone,
Diagnosis?
• turner
• 17- hydroxy.
• Androgen insensitivity syndrome
• Answer is: B
11: 17 years old medically free brought to Gynecology clinic by her
mother with history of no menstruation. On examination there was low
hairline, high BP and short stature. Both mother and father were having
short stature at her age. What is the most likely diagnosis?

• Answer is: Turner syndrome

• 12: 17 years old short stature webbed neck, complaining of primary
amenorrhea. What is the fastest easiest test to reach a diagnosis?
• A. LH/FSH
B. testosterone C. Estrogen
D. TFT
• Answer is: A
• 13:How to confirm turner?
• Estrogenlevel
• TSH and T4 level
• FSH and LH level
• Answer is: C
• 14: Turner syndrom presented by amenorrhea next?
• TSH
• FSH
• prolactin
• Estrogen
• Answer is: B
• 15: 15-year female no menstruation come with galactorrhea which
investigation should do first ?
• 16: Female married irregular menses, LMP 6 weeks ago, now we do
for her CT with contrast first we :
• A. Ask about pregnancy
• Answer is: A
17:Primigravid with irregular cycle came with abdominal pain she has
hx of trying to conceive for the past 3 months?
• Confirm pregnancy test
• Pelvic us
• Answer is: A
18: femall with Irregular menses for a long time and during examination
she has frank galactorrhea; which test will be very helpful for dx?, in
other recall Married 3 years ago with irregular menses and milk
expressed manually. next step?
• Prolactin level
• Pregnancy test
• Answer is: B, always pregnancy test first.
19 : Lady LMP 2 months ago, her husband uses condom, during exam
cervical is dusky, investigation?
• A. B-hCG Answer is: A
20 : patient with irregular cycle, hx of amenorrhea for 3 month complain
of vaginal spotting trying to conceive for 3 years?
• A. Make investigation for infertility
Answer is:
21: Girl started her menstruation 8 months ago, but her period is
irregular now what is the cause?
• A. Hormone (or Endocrine) abnormality
Answer is: A
• 22: 13 year old female presents with amenorrhea after menarche for 1
year, how would you manage?
A. OCP
B. Medroxyprogesterone
Answer is: B
• 23: scenario of hyperprolactinemia Amenorrhea for months, breast
milk discharge , Lab shows high prolactin. Next appropriate step is
imaging of?
• A. Sella turcica
• B. Kidney
Answer is: A (MRI)
• 24: 16 y/o female with galactorrhea 3 month ago with amenorrhea,
menarche in age of 13 years, now tanner is stage 2, what is
investigation to do?
• prolactin
• estrogen
• progesterone
• luteinizing hormone
• Answer is: A
• 25: Patient young age with irregular cycle, last menses 6 months ago,
not on any contraception, want to get pregnant, labs: A lot of labs
given for FSH, LH (can’t remember) high TSH , High prolactin (no
androgens given, and no T3 or T4) ?
• Hyperprolactinemia
• Hypopituitary
• Hypothyroidism
• PCOS
• Answer is: C
26: Female C/O amenorrhea for several months with hx of D&C
procedure. What is the name of this syndrome?
• A. Asherman
• B. Sheehan
Answer is: A
• 27:Case of post D/C with amenorrhea what is the layer affected? in
another recall no menstruation after myomectomy, which zone
injured?
• Functional zone
• Spongy zone
• Basalis zone
• Answer : C
28) Female patients complaining of amenorrhea for 4-months T4
low Prolactin 200 What the diagnosis?

A- primary hypothyroidism(answer)
B- hyperprolactinemia
GYNE INFECTION
1) 24 years old female use herbal cream on her vulva noticed redness
itchiness and tenderness around the area of application?
A. Allergic contact dermatitis
Answer is: A
2) Pt presented with milky vaginal discharge; +ve Whiff test, fishy odor
(picture of clue cells provided)?
A. Bacterial vaginosis
B. Candida
C. Trichomaniasis
Answer is: A
3) Woman with vaginal discharge offensive fishy odor revealed clue test
ddx in other recall: Fishy smelling vaginal discharge, positive whiff test
,+ microscopic pic ?
A. Bacterial vaginosis
Answer is: A
4) Epithelial cells in urine?
A. Trichomoniasis
B. Bacterial vaginosis
Answer is: B
5) Patient with symptoms and signs of Bacterial vaginosis we took a
sample and analyzed it what will be there in other recall Female with
vaginal discharge Fishy in odor Ph 5.2 What will u see in biopsy or
swap nor sure?
A. Over production of Lactobacillus
B. Multinucleated giant cells
C. Granular epithelial cells
Answer is: C
6) what vaginal infection can cause incompetency?
A. Bacterial vaginosis
B. Candida
C. Trichomoniasis
Answer is: A
7) Female with Thin gray vaginal discharge whiff test positive and Ph
above 5 treatment? In other recall gray fish discharge ,in other recall
clue cell was positive *
A. Cipro
B. Amoxicillin
C. Metronidazole
D. Cefixime
Answer is: C
8)Female with Repeated fishy smell discharge and itching , on vulva
scratch mark treatment?
Answer is: Metronidazole tablet
9) Pregnant lady symptoms of bacterial vaginosis management?
A. Local imidazole
B. Metronidazole
Answer is: B
10) Female come with grayish vaginal discharge + PH Dx, bacterial
vaginosis what is treatment?
A. Oral metronidazole
Answer is: A
11) pregnant (diagnosed 3 months back), with bacterial vaginosis,
what’s the most appropriate treatment?
A. Metronidazole
B. Ampicillin
C. Ceftriaxone
Answer is A, metronidazole use is controversial in pregnancy, can be
used when needed, avoid in 1st trimester.
12) Lady with vaginal discharge fishy odor and clue cell, how to treat
her husband?

Answer is: No need treat

13) Female with vaginal discharge green purulent microscopy shows
flagellate microbe what is Dx?, in other recall: Yellow green discharge?
foul smell + strawberry appearance?
A. Trichomonas vaginalis
Answer is: A
14) 34 years old female complaining of green discharge that started after
her menstruation, Upon examination: red lesions “like bruises” What's
the diagnosis?
A. Atrophic vaginitis
B. bacterial vaginosis
C. candidiasis
D. trichomonas
Answer is: D
15) Strawberry cervix With post coital bleeding, whats the management
and organism responsible?
Answer is: Trichomonas and management by : metronidazole
16) Yellowish greenish vaginal discharge increase with intercourse, O/E
Strawberry cervix, what is the management?
A. Metronidazole
Answer is: A
17) 3 months pregnant have itching and yellow green discharge ( labs
revealed protozoa, 5 vaginal pH) management?
A. IV ceftriaxone
B. clotrimazole topical cream
C. oral metronidazole
Answer is: C
18) Female with green discharge how will you manage her husband?

Answer: metronidazole, The sexual partner should be treated.

19) Old Female DM, MCC of vaginal infection?
A. Candidate
B. Bacterial vaginosis
C. Trichomoniasis
Answer is: A
20) Case with vaginal discharge, described as white, associated with
itchiness Exam showed mucus in the vagina white-gray colored Smear
showed spores (only that no ph) Dx? in other recall on speculum with
spurs or something like that. She is at risk of ?
A. Trichomonas
B. Candida
C. Herpes
Answer is: B
21) Candida management? In other recall Fungal infections of vagina?

Answer is: fluconazole/miconazole cream topically (start with it)

22) A woman presented with itchiness and white patchy vaginal lesions.
There were thick white secretions but she denied them being foul
smelling. What is the most appropriate treatment? + pseudo hyphae cell
under microscope ?
A. topical fluconazole
B. Metronidazole
Answer is: A
23) Female with vaginal discharge Cheese segment What will you give
the husband?
A. cipro
B. Metronidazole
C. No need for ttt

Answer is: C , N.B: cheesy > candida no need for treatment to partner
24) Postmenopausal female, vaginal itching and irritation, watery
vaginal discharge. Diagnosis? + watery odorless secretions + itching
and clear odorless vaginal discharge + on examination scratches and
scaly ?
A. Trichomoniasis
B. Atrophic vaginitis
C. Candida
D. BV
Answer is: B
25) Atrophic vaginitis classic itching, dryness, bleeding in
postmenopause , treatment? + with symptoms of vaginal atrophy what is
the Tx? + dyspareunia and sexual dysfunctions ?
A. Estrogen
B. Progesterone
Answer is: A, topical
26) Old lady with vaginal bleeding, uterus looks healthy, but the vulva
looks shiny, bleeds with touch?
Answer is: Atrophic vaginitis
27) Post menopause DUB.. Last menstrual cycel since 12y..vaginl
bleeding. Found sever vaginl atroghy dry vagina.. Us normal most
common the cause?
A. Adenomyosis
B. Atrophic vagina
Answer is: B
28) Female patients came with dysurea abdominal pain and
heaviness with vaginal discharge her husband diagnosed with
gonorrhea recently ,What investigation should be done ?

• Blood culture
• Urine culture (answer)
• Vaginal swab
29) patient treated with antibiotics for salpingitis but not effective what is
the most causative organism?
A) N. gonorrhea
B. C. Trachomatis

Other recall:
30)Acute salpingitis case not responding to ceftriaxone treatment what is
the cause ?
A-HSV
B-Gonnorhea
C-Chlamydia (Answer)
31) Patient came with vaginal discharge she have done CS with
episiotomy 10 days ago , the obstetrician diagnosed her with UTI
and described Abx , but she did not improve then she went to
another obstetrician and he found infected vaginal swab , What is
the medical error done by the first obstetrician?
A. let the midwife assist him and depend on her
B. doctor failed to follow the surgical safety protocol in the
OR(answer)
32) Women came vaginal pain test show flagellated cells what’s
the cause ?

A- bacterial vaginosis
B- candida infection
C- trichomononas vaginalis(answer)
33) Pregnant with candida?
A. Oral anti fungal
B. Topical anti fungal (answer)
C. Oral abx
34) Vaginal discharge burning itching, dyspareunia thin yellow to
green. Examination revealed erythematous vulva and red
inflamed friable cervix. Microscopy examination reveled
flagellated protozoa. What’s is causative organism?
A. -bacterial vaginosis (clue cells)
B. -trichomoniasis(answer)
C. -gonorrhea
D. -syphilis
36) How to diagnose pregnant woman with candidiasis?
A) cervical swab
B) high vaginal swab(answer)
C) anorectal swab
37) A female presented complaining of abdominal pain with
watery and greenish vaginal discharge. She recently entered
IUD. What is the diagnosis?

A. PID(answer)
B. Bacterial vaginosis
C. Uterine rupture
Endometrial cancer and Endometrial
Hyperplasia
1) 40y.o postmenopausal with History of DM for 5 years , complain of
vaginal bleeding, she menarche start at age 15 what the risk factor of
E. Cancer?
A. DM
B. Early menopausal
C. Late menarche
Answer is: A
2) Which is the highest risk for endometrial cancer?
A. Late menopause
B. Early menarche
C. Progestin
Answer is: A
3) Female nulliparity with Family history of thyroid cancer and she is
taking progesterone to control her cycle, what risk factor of endometrial
cancer?
A. Nulliparity
B. Progesterone
C. FH of thyroid cancer
Answer is: A
4) patients have PCOS not taking medication cause of endometrial
cancer?
Answer is: Unopposed estrogen
5) What is the most common cause of increased endometrial thickness
after menopause?
Answer is: unopposed estrogen
6) Elderly female with previous history of myomectomy and PCOS,
Now complain of vaginal bleeding ,Diagnosis?
A. Fibroid
B. Endometriosis
C. Endometrial hyperplasia
Answer is: C, incomplete.
7) female diabetic hypertensive obese, I think history suggested
endometrial hyperplasia .. what is the most appropriate thing to do to
reach diagnosis?
A. Pelvic ultrasound
B. Endometrial biopsy
Answer is: if premenopausal > sample. if post> US
8) 60 y/o female with AUB, which of the following is the best next
investigation?
A. endometrial biopsy
B. TVS
C. Abdominal x-ray
Answer is: B
9) 59 years old woman who has abnormal uterine bleeding, last period
12 years ago, on examination pale & dry vagina and loss of rugae,
uterus normal size with no masses. ultrasound show endometrial
thickness of 15 mm otherwise nothing to report? what's the next step?
A. pelvic MRI
B. endometrial sampling
C. exploratory laparotomy
Answer is: B
10) Female pt. History breast cancer, on Tamoxifen, postmenopausal
bleeding, The investigation of choice is?
A. TVS
B. MRI pelvic to rule out mets
C. Endometrial biopsy

Answer is: C
11) woman in her 30s with irregular cycles and anovulatory cycles since
several years endometrial biopsy was done and showed atypical
hyperplasia what is the best treatment?
A. High dose oral progesterone
B. Tamoxifen
Answer is: A
12) Endometrial hyperplasia with atypia + menopause , MX?
A. oral progesterone
B. Hysterectomy
Answer is: B
13) old with Endometrial biopsy shows hyperplasia with atypia what is
the treatment?
Answer is: TAH
14) Case of PMB and US shows endometrial thickness of 14 mm. I
think asking what is the management ?
A. Hysterectomy
Answer is : hysterectomy after biopsy if result is hyperplasia with atypia
15) 65ys complain of AUB and endometrial mass (15 mm) what is the
best management?
A. Total Abdominal Hysterectomy
B. Lap hysterectomy
C. Vaginal hysterectomy
D. Hysterescopy and biopsy
Answer is: d
16) Lymphatic drainage of uterine fundus cancer? In other recall k/c of
uterine Ca, what lymph node to discect?
A. Internal Iliac
B. Superficial Inguinal
C. Para aortic
D. Deep Inguinal
Answer is : C
17) Tamoxifen for breast ca the came with abnormal uterine bleeding or
something like that?
A. Endometrial ca
B. Endometriosis
Answer is: A
18) 53yeers women history of fibroid and do myomectomy after 8years
come with excess bleeding and endometrial thickining ?
A. endometriosis
B. endometrial ca
C. leiomyosarcoma
D. Myosarcoma
Answer is B
19) 60 years old with Abnormal uterine bleeding, history of
myomectomy 12 years ago, 2 D&C, abdomen bulky and tender, no
adnexal mass, with US picture “18 mm thickeness” Dx?
A. Endometriosis
B. Adenomyosis
C. Endometrial CA
D. Fibroids
Answer is: C
20) Post menopausal with AUB she is on tamoxifen , US showed fibroid
and homogeneous uterus with thickness more than 4 mm, Dx,?
A. Endometrial adenocarcinoma
B. Leiomyoma
Answer is: A
21) 60 years old complain of postmenopausal bleeding, she is HTN,DM
, BMI 40 , on examination no tenderness no adnexal mass no
enlargement?
A. Endometrial ca
B. Endometriosis
C. Fibroid
D. Adenomyosis
Answer is: A
23) elderly female presented with post-menopausal bleeding US showed
endometrium of 15 mm. What is your next step?
A. Endometrial sampling
B. US guided biopsy (written like this didn't specify from where)
Answer is : A
24) 39 years old female who has three children and completed her family
diagnosed as endometrioma which was removed 2 years ago, right ovary
cyst she presented to the clinic with mild to moderate dysmenorrhea and
dyspareunia during intercourse and chronic lower abdominal pain. Pelvic
ultrasound shows: Left ovary endometrioma cyst 6x7 in size?
A. Removal of cyst more than 10 in size
B. Aspiration of cyst content under ultrasound guidance
C. Immediate hysterectomy and salpingectomy oophorectomy
D. Removal of cyst by laparoscopic ablation of endometrioma spots.
Answer is : C
26) case of PCOS complain of abnormal uterine bleeding and she did
pap smear and colposcopy you find adenomatous hyperplasia what is
the cause of this ?
• A. Unopposed estrogen
Answer is: A
27) patient with PCOS cut her medication “progesterone” from 5 years,
she is risk of develop?
Answer is: Endometrial cancer
28) 43 y women had oligo ovulation due to PCOS, taking cyclic
progesterone for withdrawal bleeding. 5 years ago stopped taking
progesterone ,Which of the following risk increase?
A. hip fracture
B. endometrial cancer
Answer is: B
29) Post menopause Patient known to have fibroid 2*3 Cm on
tamoxifen now, fibroid increased in size 5*8 Cm and endometrial
thickness is 5mm, what is the diagnosis?
A. endometrial cancer
B. leiomyoma
C. Leiomyosarcoma
Answer is: C
30) 56 years old female being treated with Tamoxifen for breast ca,
years ago there was a uterine fibroid measures 2*3. Now on US, it’s 5*6
and endometrial thickness of 5mm, dx?
A. Endometrial adenocarcinoma
B. Leiomyoma
C. Leiomyosarcoma
Answer is: C
31) 59 years old female came for checkup she stated that she had her routine
gynecological checkup 12 years ago when she was still premenopusal and it
showed fibroid it was small( I don't remember the size) and it wasn't treated.
Now when you examined her the fibroid increased in the size and you found
endometrial thickening(5 mm size) what is the most likely diagnosis?
A. Leiomyoma
B. Leiomyosarcoma
C. Metastasis from ovarian cancer
D. Endometrial cancer
Answer is : B
32) 56 years with uterine cancer, what the most appropriate ttt At
this age ?
A. laparoscopic hysterectomy(answer)
B. abdominal hysterectomy
C. myomectomy
D. follow up
33) Strongest risk factor of Endometrial carcinoma?

A. PCOS(answer)
B. Multiple gestation
C. smoking(protective factor)
34) Postmenopausal female with Breast cancer 6 years ago on
tamoxifen, at this time there was 4×5 uterine fibroid,, presenting
now symptoms of uterine cancer, which type?
• Lieomyosarcoma
• Endometrial adenocarcinoma(answer)
• Lieomyoma
35) Highest causing factor of endometrial cancer:
A. late menarche.
B. early menopause.
C. DM (answer)
D. progesterone tumor
 Thank you

Any Questions?