(Obstetric and Gynecology exam.

2008: ( assessment and final MCQs + essays & short notes + OSCE Done by : Dana Maarafi & Dalia Sadeq

:high level of testosterone and DHEA in women is produced in -1 a- ovary b- adrenal gland c- dysgerminoma Indication of C/S in Kuwait is -2 a- repeat C/S b- failure to progress c- cephalopelvic disproportion : What is NOT true about chorioamionitis -3 a- usually extremely sensitive for chemotherapy b- usually extremely sensitive to radiotherapy c- frequently found to secrete - feto protein genetic screening is indicated in next pregnancy if abortion -4 shows a- polyploidy b- trisomy c- monosomy :chrionic viili detects -5 a- trisomy 13 b- trisomy 18 c- trisomy 21 :what is NOT true about HIV -6 a- C/S if membrane not ruptured , prevents vertical transmission to fetus b- 15% of new born will have the disease at 6 months

c- not transmitted by breast feeding d- can be transmitted to fetus before birth e- it is a retrovirus :spasm at introitus during sexual intercourse -7 Vaginism yr old female complaning of irregular bleeding, endometrial 45 -8 histology : benign prolifrative epithelium, she is suffering from hot : flashes , Best treatment is a- OCP b- sequential contraceptive pill c- progesterone d- unconjugated equine estrogen/ progesterone : yr old female has grade IIA cervical cancer , best treated by 45 -9 a- radiotherapy b- hysterectomy c- hysterectomy and bilateral opherectomy d- hysterectomy with bilateral salpingoopherectomy yr old female has complex hyperplasia with atypia , 60 -10 : treatment of choice is a- TAH-BSO -b : most likely to develop endometrial carcinoma is -11 a- simple atypia b- complex atypia c- adenomysis in rheumatic heart disease . maximum rist is at -12 a- 1st trimester b- 2nd trimester

c- 3rd trimester d- 1st stage labor e- 2nd stage labor

pregnancy is unlikely in -13 a- Vit B12 deficiency b- TTP during antenatal visit , while examining a lady. She became -14 : hypotensive. What is the 1st step to do a- O2 mask b- turn on lateral side :which one of the following is diabetogenic in pregnancy -15 a- progesterone b- HPL (average age at menarche : ( not sure -16 a- 7-9 b- 11-12 c- 12-13 ovarian tumor present bilaterally more likely metastasize to -17 a- LN b- lung c- liver d- brain risk of cervical cancer less in -18 a- early age at 1st sexual intercourse b- late age of 1st intercourse

c- multiple partners : all indicate poor prognosis n cancer except -19 a- menopause b- low grade tumor PID is -20 -a :PCO causes all except -21 a- infertility b- menorrhagia c- dysmenorrheal : Tx of endometriosis -22 a- danazol -b : increase risk of ectopic in -23 a- reversal of sterilization b- bergoline c- clomphine citrate :Tx of amenorrhea -24 a- clomiphine citrate b- low dose progesterone placenta site in mother invaded and lined by : intermediate -25 trophoblast : all are true of deceleration except -26 a- change position b- give O2 c- prepare mother for C/S * d- give oxytosin

: bladder instability -27 a- can be first seen after colposuspension b- caused by MS c- pelvic floor exercise has no rule in management

:about TVTO -28 a- rate of success is 100% if with anterior corporrhaphy b- may cause urinary retention post op c- can cause bladder instability :vaginal secretion in 10 yr old not puberty yet, all except -29 a- systemic steroids b- foreign body c- ring worm d- dysgerminoma e- ectopic ureter :all of the following can cause PID except -30 a- tooth extraction b- IUCD c- multiple partners d- female circumcision :adenomyosis , all true except -31 a- cause bleeding b- diagnosed by endometrial biopsy :in non pregnant uterus , all true except -32 a- endometrium has 2 layers b- has cervix and body

c- 7.5 cm in length d- supplied by ovarian and uterine arteries : which is true about implantation -33 a- 1 wk after fertalization * b- 2 wks after ovulation c- 2 days after ovulation :which is true about menstruation -34 a- 10 days after LMP *b- take place if no fertilization c- occurs in an ovulatory cycle :test used to detect ovulation -35 a- day 10 estradiol b- day 14 LH c- day 21 progesterone * : 5 for reductase is -36 a- enzyme converting testosterone to DHT for development of *male external genetalia b- not present in women :signs of respiratory distress in newborn -37 a- grunting b- subcostal reccession c- nasal flaring d- B& C the correct answer should be all of the above but was ) (not a choice in Rh isoimmunization , all are true except: ( another Q with -38 ( ! more than 1 answer a- it occurs in O- mothers only

b- 2nd attack less severe c- occur after prophylaxis :dose of HRT of progesterone -39 a- 150 l/ day b- 30 l/ day c- 350 l/ day d- 150 ml/day

:ovarian tumor with tubal lining -40 a- serous cystadenoma b- mucinous cystadenoma c- brenner tumor : not a risk factor for osteoporosis -41 a- sedimentary life b- black race c- early age of puberty :most specific test to insure placenta is normal -42 a- U/S b- Doppler flow in umbilical artery TORCH is : toxoplasma, rubella, CMV, herpes -43 :not true about semen -44 a- normal amount is 10 ml * b- 40 or more immobile = asthenozoospermia c- normal count of sperms is 20-250 millions hysteroscopy is contraindicated n : PID -45 :regarding iron deficiency anemia , all true except -46 a- causes PPH

b- contraindicate epidural c- mAcrocytic hypochromic anemia all of the following may occur as complication in pregnancy -47 :except a- TTP b- HELLP syndrome c- B12 deficiency d- fatty changes of liver

:GTD all true except -48 a- 20% progress to malignancy b- complete mostly xx46 c- rate of 2nd molar is 2% :in asymptomatic bacteria, all true except -49 a- 5% have it b- more in multigravida c- 3% have congenital anomalies d- 30% progress to pyelonephritis pain during intercourse = dysparunia -50 :not a component of bishop's score -51 a- fetal position b- head station c- cervical consistency d- effacement :true about placenta accreta -52 infiltrate myometrium to peritoneum making it impossible to separate

: contraindication for vaginal delivery after C-section -53 a- previous 2 or more c-section b- previous T incision c- previous classical incision d- previous rupture e- all of the above :absolute contraindication for ECV -54 a- previous 3 C/S * b- PIH fetal lie : spine of baby parallel to mother spine -55 : causes of high head -56 a- previous uterine surgery b- small pelvis c- deflexed head : commonest uterine neoplasm is -57 a- lieomyoma *

b- endometrial cancer c- MMT d- liemyosarcoma :ectopic pregnancy -58 *a- causes post coital bleeding b- seen in postmenopausal c- is a true ulcer :causes of candidal vagintis , all except -59 a- broad spectrum antibiotic b- COC c- systemic steroids

-d -e :regarding prevention in HIV positive women -60 a- encourage to have monogamous relationship b- use condom with spermaticide c- donate blood generously d- a & b :which is not a thrtapeutic indication of laproscopy -61 a- entdometriosis cautary b- lysis of adhesions * c- peritoneum culture which of the following 2 organisms commonly caused PID: -62 clamydia & gonorrhea : matching 63-67 yr old no puberty , inguinal mass : testicular feminzation 19 -63 months no peiod after an abortion : no abnormalities 2 -64 yr old with amenorrhea : menopause 50 -65 yr old with amnorrhea premature menopause 30 -66 women with galactorrhea : CNS tumor -67 which is not true : first step in repairing perineal tear is suturing -68 the muscl patient has hip pain, anemia, jaundice, pregnant and not -69 ? improving with iron supplement . what to do a- Hb electrophoresis * b- fragility tst c- comb's test d- G6PH level :signs of separation of placenta include -70

a- soft uterus b- visible lengthening of cord * c- impalpable fundus d- membrane visible at introitus : which one is not a manifistation of fibroid -71 a- menorrhagia b- recurrent abortion c- infertility or subfertility d- genuine stress incontinence * :absolute contraindication of OCP -72 a- recent DVT * b- diabetes :regaring liemyosarcoma , all true except -73 a- fleshy texture (b- arise from one cell type ( not sure about choice c- mitosis < 5-10 / high power field hypertion bfore 20 weeks can be caused by : GTD -74 placenta has : 20 -25 segments -75 : bleeding n post-menopausal women can occur in al except -76 a- 6 months use of trivial * b- continuous HRT

women after miscariage should take OCP after : 2 weeks -77

Written exam: assessment

Essay 1 : 30 yr old P0+1+0+1 delivered by emergency C-section at 36 wks for fetal distress. Now she is 37 week pregnant . discusse (her management (fetus was breech but not sure Essay 2: 68 yr old diabetic on oral hypoglycemic , presented with cystic mass arising from the pelvis with ascitis . discuss her management :Shot Notes what is recurrent abortion ? outline the management -1 what is stress incontinence ? list differential diagnosis , outline -2 management list indications, prerequisite and complication of forceps -3 list 5 causes and complications of peurpural pyrexia and how to -4 prevent them list 5 indications, complications and the procedure of D&C -5 what is HELLP ? outline management -6 list 5 causes of STD and management of 1 of them -7 ? -8

Written exam : final

Essay 1: a nurse P 0+0+ 4 + 0 recurrent miscariages at 14-16 wks .. ? gestation. how to manage Essay 2: 72 yr old teacher complaining of 3 days of bleeding per vagina for first time , LMP 10 yrs ago , no abdominal pain , no swelling, no change in bowel habit, no weight loss. Discuss management

:Short notes informed consent of tubal ligation -1 breast feeding : advantages for mother and baby -2 ? HE -3 laproscopy : indications, procedure complications -4

uses of MgSO4 in gyn -5 medical management of ectopic pregnancy -6 chronic pelvic pain : etiology and management -7 pain relief during labor -8

OSCE: final exam

endometriosis : clinical presentation, 2 theories, 4 treatments -1 lady pregnant in her 26 wks (LMP was given only) symphysis fundal -2 hight was 31. Pic of U/S shown (So >> , large for gestational age + pic of polyhydraminous ( U/S Name of A: LGA . list of cases . B: polyhydraminous (how to diagnose B in U/S (list 2 ways induction of labor set : name of each, indications, which one is used if -3 ? bishop's score is 4 multile fibroids : presentation + 4 treatment -4 semen analysis: list 4 abnormalities , 4 Tx, 2 complication to spouse , -5 how to prevent them contraception : name each, effectivness of each, advantage of OCP, C/I -6 ? of IUCD, in emergency contraception what to use (trichomonas vaginalis pic shown ( wet test -7 Question about vaginal secretion Name condition, 4 differentials, how to differentiate between them , list 2 of them STDs, manage 1 scenario of lady with GDM after delivery of baby's head , difficulty in -8 delivery rest of body Pic of macrosomic baby was shown Name condition : shoulder dystocia List risk factor, how to manage ( 4 intial steps) , complication ( 2 for (mother, 2 for baby

case of iron deficiency anemia : 4 abnormalities in lab test, name -9 condition , Tx, 4 investigations