1. A baby is born with ambiguous genitalia. Which of the following statements is true? A. A karyotype is rarely needed B. Evaluation should be done by 1 month of age C. It is sometimes associated with a history of a previous sibling with congenital adrenal hyperplasia (CAH) D. A thorough physical examination can usually decide the true sex

2. Puerperal fever from breast engorgement A. Appears in less than 5% of postpartum women B. Appears 3 to 4 days after the development of lacteal secretion C. Is almost painless D. Rarely exceeds 37.8°C (99.8°F) E. Is less severe and less common if lactation is suppressed

3. In the mother, suckling leads to which of the following responses? A. Decrease of oxytocin B. Increase of prolactin-inhibiting factor C. Increase of hypothalamic dopamine D. Increase of hypothalamic prolactin E. Increase of luteinizing hormone–releasing factor

4. Which of the following statements regarding the postpartum development of pulmonary embolism (PE) is true? A. It is a relatively uncommon phenomenon, with an incidence of about 1 in 5000 B. In most cases, the classic triad of hemoptysis, pleuritic chest pain, and dyspnea suggests the diagnosis C. A mismatch in ventilation-perfusion scan is pathognomonic of PE D. The most common finding at physical examination is a pleuritic friction rub

5. Septic pelvic thrombophlebitis may be characterized by which of the following statements? A. It usually involves both the iliofemoral and ovarian veins B. Antimicrobial therapy is usually ineffective C. Fever spikes are rare D. It is usually associated with fever without pain or palpable masses E. Vena caval thrombosis may accompany either ovarian or iliofemoral thrombophlebitis

6. A postpartum woman has acute puerperal mastitis. Which of the following statements is true? A. The initial treatment is penicillin B. The source of the infection is usually the infant’s gastrointestinal (GI) tract C. Frank abscesses may develop and require drainage D. The most common offending organism is Escherichia coli E. The symptoms include lethargy

7. Breast-feeding can be encouraged despite which of the following conditions? A. Maternal hepatitis B B. Maternal reduction mammoplasty with transplantation of the nipples C. Maternal acute puerperal mastitis D. Maternal treatment with lithium carbonate

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8. Which of the following is\are signs of menopause: A. high FSH. B. low FSH C. low estrogen D. high estrogen E. a & c.

9. The main symptom of menopause is : A. hot flashes. B. night sweat C. vaginal dryness. D. sleep disturbance E. all the above.

10. The contraindication for use hormonal replacement therapy(HRT) are : A. smoking B. unexplained vaginal bleeding C. coronary artery disease D. breast cancer E. all the above.

11. A 55 year old woman who has just gone through her menopause is concerned that she may develop vertebral fractures. She has never had any surgery before and has no relevant medical history. What is the most effective way of preventing pathological fractures post-menopause? A. Clonidine J Vaginal lubricant B. Combined Oestrogen and progestogen replacement therapy C. Oestrogen only HRT D. Progestins E. Mineral supplements

12. all of the following appear to decrease hot flushes in menopausal women except ? A. androgens B. raloxifene C. isoflavones D. tibolone

13. Menopause could be diagnosed by A. history of absent menstruation B. High FSH level in young age group C. Absent menstruation for 1 year at the age of 52 year D. Hot flushes E. Insomnia

14. HRT is useful in all except A. Flushing B. Osteoporosis C. Vaginal atrophy D. Coronary heart disease

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15. estrogen replacement for post-menopausal symptoms cause an increase in ? A. LDL B. Cholesterol C. VLDL D. Triglycerides

16. absolute contraindication of hormone replacement therapy is ? A. thrombosis B. fibrocystic disease C. fibroadenoma D. hemorrhage

17. GnRH analogues may be given in all of the following except ? A. prostate carcinoma B. endometrial carcinoma C. fibromyoma of uterus D. precocious puberty

18. estrogen administration in a post menopausal woman increases the ? A. gonadotropin secretion B. LDL – cholesterol C. Bone mass D. Muscle mass

19. Contraindication to postmenpausal estrogen replacement therapy include the following except A. Resent deep vein thrombosis B. Acute liver disease C. High serum triglyceride D. Premenpausal mastectomy for breast cancer E. Diabetes mellitus

20. A 25 years old primigravida reports at 6 weeks gestation with h/o seizure disorder. She has been on phenytoin for the last 6 months. The appropriate management in this case would be One answer only. A. Continue phenytoin and adjust the levels as per serum levels B. Stop phenytoin and start barbiturates C. Terminate pregnancy as phenytoin has had its teratogenic effect D. Stop phenytoin and terminate pregnancy if sonography detects malformations

21. Which vitamin deficiency is most commonly seen in a pregnant mother who is on phenytoin therapy for epilepsy? A. Vitamin B6 B. Vitamin B12 C. Vitamin A D. Folic acid

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22. Which of the following statements is incorrect in relation to pregnant women with epilepsy? A. The rate of congenital malformation is increased in the offspring of women with epilepsy B. Seizure frequency increases in approximately 70% of women C. Breast feeding is safe with most anticonvulsants D. Folic acid supplementation may reduce the risk of neural tube defect

23. Safest antiepileptic drug in pregnancy A. Diazepam B. Phenytoin C. Carbamazepine D. Valproate

24. Which of the following anticonvulsants is most likely to be associated with a neural tube defect? A. phenobarbital B. carbamazepine C. phenytoin D. valproic acid

25. The best period of gestation to carry out chorion villous biopsy for prenatal diagnosis is? A. 8-10 weeks B. 10-12 weeks C. 12-14 weeks D. 14-16 weeks

26. prenatal diagnosis is possible 4 all except A. sickle cell trait B. beta thallasemia C. DMD D. ectodermal dysplasia

27. Prenatal diagnosis at 16 weeks of pregnancy can be performed using all of the following, except: A. Amniotic fluid. B. Maternal blood. C. Chorionic villi. D. Fetal blood.

28. Which one of the following congenital malformation of the fetus can be diagnosed in first trimester by ultrasound ? A. Anencephaly B. Inencephaly C. Microcephaly D. Holoprosencephaly

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29. The best way of diagnosing Trisomy-21 during second trimester of pregnancy is ? A. Triple marker estimation B. Nuchal skin fold thickness measurement C. Chorionic villus sampling D. Amniocentesis

30. A patient with non-metastatic gestational trophoblastic disease can be treated with weekly intramuscular injections of which of the following agents ? A. Cyclophosphamide B. Carboplatinum C. VP-16 (etoposide) D. Actinomycin D E. Methotrexate

31. Five-year survival rates of patients with low-risk, non-metastatic gestational trophoblastic disease approaches ? A. 100% B. 75% C. 50% D. 25% E. 5 to 10%

32. Comparing complete hydatidiform moles gestations, complete and partial moles are more likely to demonstrate all of these characteristics except ? A. more likely to require chemotherapy after evacuation for gestational trophablastic disease B. more likely to present with a uterus large for dates C. more likely to present with theca lutein cysts D. more likely to 'have focal rather than diffuse trophoblastic proliferation E. more likely to diffuse hydopic swelling of villi

33. A woman experiencing a molar pregnancy has an increased risk of which of the following in subsequent gestations ? A. Stillbirth B. Prematurity C. Congenital malformations D. Recurrent molar gestation E. Cancer later in life

34. The most likely karyotype of patient with a complete mole would be ? A. 46, XX B. 46, XY C. Diandric triploidy D. Triploidy with two haploid sets of maternal origin E. Aneuploidy

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35. The most likely karyotype of patient with a partial mole would be ? A. 46, XX B. 46, XY C. Diandric triploidy D. Triploidy with two haploid sets of maternal origin E. Aneuploidy

36. A woman with a complete mole is most likely to present with which of the symptoms ? A. Vaginal Bleeding B. Excessive uterine size C. Hypermesis D. Prominent theca lutein cysts E. Pre-eclampsia

37. 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. Such cysts arise more frequently in patients with complete moles B. Theca lutein cysts are more likely seen in patients with very high hCG levels C. Cysts are filled with serious or serosanguinous fluid and are usually bilateral D. Often require active management with surgical intervention E. Patients with large theca lutein cysts may be at increased risk for postmolar persistence of disease

38. The leading cause of death for woman older than 65 years old is ? A. Cancer B. Pneumonia C. Heart disease D. Stroke E. Alzheimer's

39. A 26 year old presents to your office for preconception counseling. What 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

40. The advantages of a prophylactic oophorectomy at the time of hysterectomy for benign reasons include all of the following except ? A. Lowers the incidence of ovarian cancer B. Lowers the risk of coronary artery disease C. Lowers the risk of subsequent surgery for ovarian pathology D. Accommodates patients request

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41. 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

42. At what age is there no significant difference in survival for prophylactic oophorectomy at the time of hysterectomy for benign disease in woman at low risk for ovarian cancer ? A. 50 years B. 55 years C. 60 years D. 65 years E. 70 years

43. All of the following comprise systemic symptoms of a primary Herpes Simplex outbreak except ? A. Myalgias B. Fever C. Lymphadenopathy D. Crusting of ulcers E. Headaches

44. The minimum diagnostic criteria for Pelvic Inflammatory Disease include all of the following except ? A. Cervical motion tenderness B. Fever C. Pelvic pain D. Adnexal tenderness

45. The best predictive factor for Chlamydia is ? A. >2 Sexual partners in the past six months B. Multiple body piercing C. Age <25 years D. Single status E. Current IUD user

46. The components involved in the calculation of body mass index (BMI) include all of the following except ? A. Height in inches B. Weight in pounds C. Weight in kilogram D. Sex

47. The incriminates of measurement of Body Mass Index (BMI) are ? A. 15-19 B. 19-24 C. 25-30 D. 31-35 E. 36-40

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48. Which racial group has the highest prevalence of obesity in women in America ? A. Black B. White C. Hispanic D. Oriental

49. Which of the following attributes the most increase obesity in adolescent girls ? A. Decreased exercise B. Increased caloric intake C. Hormonal food supplementation D. Smoking E. Pregnancy

50. 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

51. Of the following tests for evaluation of Stress Urinary Incontinence (SUI), the most sensitive is A. Standing stress test (SST) B. Q-tip test C. Valsalva leak point pressure (VLPP) D. Maximal urethral closing pressure (MUCP)

52. A tension free vaginal tape (TVT) is positioned under which anatomical landmark of the urethra ? A. Urethorvesical junction (UVJ) B. Mid-urethra C. Distal urethra D. Proximal urethra

53. 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

54. A Patient undergoes surgical repair of uterine porlapse, enterocele, rectocele, and cystocele. Surgery was coded as 58270 and 57260-51 modifier. Why was the surgery coded this way instead of billing for each procedure separately ? A. bundled coding B. un bundled coding C. none of the above D. all of the above

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55. What type of pelvis is characterized by a short anterior–posterior diameter and a wide transverse diameter? A. gynecoid B. android C. anthropoid D. platypelloid

56. What is the most common deceleration pattern encountered during labor? A. late decelerations B. early decelerations C. variable decelerations D. mixed decelerations

57. Before one decides to perform a cesarean section for dystocia, there should be how much uterine activity? A. 75 to 100 Montevideo units B. 150 to 175 Montevideo units C. 200 to 225 Montevideo units D. 300 to 325 Montevideo UNITS

58. Microinvasion of carcinoma of the cervix involves a depth below the base of the epithelium of no more than A. 1 mm B. 2 mm C. 3 mm D. 4 mm E. 5 mm

59. What is bradycardia? A. baseline fetal heart rate < 100 for > 5 min B. baseline fetal heart rate < 100 for > 15 min C. baseline fetal heart rate < 120 for > 5 min D. baseline fetal heart rate < 120 for > 15 min

60. What is a laceration involving the skin, mucous membrane, perineal body, anal sphincter, and rectal mucosa called? A. 1st degree B. 2nd degree C. 3rd degree D. 4th degree

61. What is the median duration of the second stage of labor in multiparas? A. 5 min B. 10 min C. 20 min D. 30 min

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62. When should the fetal heart rate be auscultated during observation for labor? A. before the contraction B. during the contraction C. at the end and immediately after a con-traction D. anytime

63. A 37 year old woman complains of postcoital bleeding . The least likely cause of her bleeding would be cervical A. Polyp B. Ectropion C. Carcinoma D. Nabothian cyst E. Infection

64. At the eights weeks gestation a women has an IUCD and the strings are visible at the external os. The best management is A. Antibiotics B. Progestrone C. Dilation and curettage D. Removal of IUCD E. Bed rest

65. Genital prolapse is associated with the following except Chronic A. constipation B. Prolonged second stage C. Unreparied hidden perineal tear D. Improper applied forceps E. The use of HRT at the menpause

66. Induction of labor at term is contraindicated in A. breech presentation B. GDM C. Placenta previa D. postmaturity E. A and C

67. Micro invasion of carcinoma of the cervix involves a depth below the base of the epithelium of no more than A. 1 mm B. 2 mm C. 3 mm D. 4 mm E. 5 mm

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68. Rectal examination in the gynecological practice A. Is useful in the diagnosis of enterocele B. Is useful in suspected pelvic abscess C. Is indicated in the assessment of carcinoma of the cervix D. All of the above E. None of the above

69. Risk factors for development of cancer cervix include the following except A. Early sexual activity B. Nulliparous C. HPV infection D. Smoking

70. The best contraceptive method for patients with gestational trophoblastic disease A. Tubal ligation B. Hystrectomy C. Combined contraceptive pills D. IUCD device E. Subcutaneous implant

71. The bishops score is used to assess A. pelvic diameters B. fetal head diameter C. fetal presentation D. the recommended method of delivery E. the recommended method of induction of labour

72. The following investigations are component of routine antenatal care except A. Rh type B. Hemoglobin C. Urine analysis for sugar and protein D. Blood grouping E. Urine culture

73. The following vessels contains oxygenated blood except A. Umbilical artery B. Ductus venosus C. The inferior vena cava as enters the right atrium D. Carotid artery E. Umbilical veins

74. The most common benign mass of the cervix and endocervix is A. Polyp B. Lieomyoma C. Nobothian cyst D. Cervical hood E. Gartner duct cyst

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75. The side effects of combined OCP include the following except A. Nausea B. Dizziness C. Vaginal discharge D. Menorrhagia E. Weight gain

76. The true statement about retroversion of the uterus is A. Is a common cause of infertility B. Should be corrected with a Hodge pessary C. May be corrected with a Fothergill operation D. occurs in 20% of normal women E. Is caused with heavy lifting

77. Which of the following is an absolute contraindication for oral progesterone only contraceptive pills A. Cigarette smoking B. Depression C. Gall bladder stone D. Mild hypertension E. Unexplained vaginal bleeding

78. An enterocele is best characterized by which of the following statement A. It is not true hernia B. It is herniation of the bladder floor into the vagina C. It is prolapse of the uterus and vaginal wall outside the body D. It is protrusion of the pelvic peritoneal sac and vaginal wall into the vagina E. It is a herniation of the rectal and vaginal wall into the vagina

79. All of the following statements with regard to the copper IUCD are correct except A. Modern copper IUCD is effective and safe for at least five years B. It reduce s the number of sperm reaching the fallopian tube and their capacity to fertilize the eggs C. The risk of pelvic infection is low and does not increase with long term use D. Is contraindicated in women with irregular vaginal bleeding E. Levenorgestrel releasing devices are associated with menorrhagia

80. As regard fetal presentation , the incorrect statement is A. Is the part of the fetus that enters the pelvis first B. In face presentation the occiput and back comes into contact C. is usually cephalic D. The denominator is the lowest part of the presenting area E. In cephalic presentation it is more common to be vertex

81. The shortest diameter of the pelvic cavity is A. The external conjugate B. The diagonale conjugate C. The interspines D. The true conjugate E. The transverse

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82. As regard the mechanism of labor , which of the following sequences is correct A. Descent , internal rotation , flexion B. Engagement , flexion , descent C. Engagement , internal rotation , descent D. Engagement , descent , flexion E. Descent , flexion , engagement

83. The following statements regarding ischial spines are correct except A. They make the beginning of the forward curve of the pelvis B. The are landmarks for pudendal nerve block procedure C. They indicate a normal pelvis when particularly prominent D. They help to assess station of the presenting part E. They lie at the level of the plane of least pelvic dimensions

84. Caput succedaneum A. Resolves spontaneously after labor B. May lead to jaundice of the baby postpartum C. Indicate traumatic vaginal delivery D. Indicates that the fetal head engaged E. Is a sign of intrauterine fetal death

85. Variable deceleration on fetal heart rate monitoring are usually due to A. Fetal head compression B. Uteroplacental isufficiency C. Fetal metabolic acidosis D. Umbilical cord compression E. Fetal distress

86. Epidural anaesthesia A. Does not affect uterine activity B. Is contraindicated in patient with heart valve lesions C. Should be routinely administerted during the first stage of labor D. Increase the risk of PPH E. Should be offered to highly selected cases in labor

87. The following hormone is responsible for the contraction of the myoepithelial cells of the breast A. Oxytocin B. Prolactin C. Progestrone D. Placental lactogen E. Estrogen

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88. Maternal mortality refers to the number of maternal deaths that occur as the result of the reproductive process per A. 1000 births B. 10.000 births C. 100.000 births D. 10.000 live births E. 100. 000 live births

89. What are the cardinal movements of labor (in order)? A. descent, engagement, flexion, internal rotation, extension, external rotation, expulsion B. descent, flexion, engagement, internal rotation, extension, external rotation, expulsion C. engagement, descent, flexion, internal rotation, extension, external rotation, expulsion D. engagement, flexion, descent, internal rotation, extension, external rotation, expulsion

90. Which of the following is characteristic of asynclitism? A. Sagittal suture is not parallel to the transverse axis of the inlet. B. Sagittal suture lies midway between the symphysis and sacral promontory. C. Sagittal suture, although parallel to the transverse axis of the inlet, does not lie exactly midway between the symphysis and sacral promontory. D. Sagittal suture rotates 45 degrees from the sacral spines.

91. The chin is brought into intimate contact with the fetal thorax during which cardinal movement of labor? A. flexion B. extension C. engagement D. descent

92. During labor in the occiput posterior position, the occiput has to rotate to the symphysis pubis how many degrees? A. 45 B. 90 C. 135 D. 180

93. What is edematous swelling of the fetal scalp during labor? A. molding B. caput succedaneum C. subdural hematoma D. erythema nodusum

94. During the third stage of labor, which of the following is NOT a sign of placenta separation? A. a gush of blood B. uterus rises in the abdomen C. umbilical cord protrudes out of the vagina D. a sudden, sharp, unrelenting contraction

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95. Which of the following is a complication of the third stage of labor associated with forced placental separation? A. endometritis B. uterine atony C. Asherman syndrome D. uterine inversion

1 C 21 D 41 61 C 81 C2 E 22 B 42 D 62 C 82 D3 D 23 C 43 D 63 D 83 C4 A 24 D 44 B 64 D 84 A5 E 25 B 45 C 65 E 85 D6 C 26 46 D 66 E 86 A7 C 27 D 47 67 E 87 A8 E 28 A 48 A 68 D 88 E9 E 29 D 49 A 69 B 89 C

10 E 30 E 50 A 70 E 90 A11 B 31 A 51 A 71 E 91 A12 B 32 D 52 B 72 E 92 C13 C 33 D 53 B 73 A 93 B14 D 34 A 54 A 74 A 94 D15 35 C 55 D 75 D 95 D16 A 36 A 56 B 76 D17 B 37 D 57 C 77 E18 C 38 C 58 E 78 D19 E 39 59 B 79 E20 A 40 B 60 D 80 D

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