COLLECTION PROMETRIC 2014

1.

MCQ PROMETRIC 1 2014

1 Shortest Diameter Of The Pelvic Outlet Is:

A Interspinous Diameter B Antero Posterior Diameter
C Posterior Saggital Diameter D None Of The Baove

2 The Main Source Of Progesterone In Early Pregnancy Is From

A Placenta B Corpus Luteum
C Adrenal D None Of The Abvoe

3 All Of The Following Are Harmone Dependent Carcinoma Except :

A Prostate Ca B Endometrium Ca
C Breast Ca D Ovary Ca

4 Predicatiction Of Preterm Labor In Women Done With:

A Fetal Fibronectin B Salivary Progesterone
C Cervical Length D Uterine Height

5 The Left Ovarian Vein Terminates In

A Inferior Vena Cava B Internal Iliac Vein
C Left Renal Vein D None Of The Above

6 In Vitro Fertilization Is Indicated In

A Tubal Pathology B Uterine Dysfunction
C Ovarian Pathology D Azoospermia

7 A 18 Wks Pregnant Lady With Previous History Of Downs Syndrome Should

Be Best Evaluated By
A Chorionic Villus Sampling B Beta H C4 +alpha Fetoprotein
C Riple Test D Amniocentesis

8 Ccf Is Most Likely In Pregnancy At:

A 32 Weeks B 1st Stage Of Labour
C 3rd Stage Of Labour D 4th Stage Of Labour

9 The Commonest Presentation Of Anencephaly Is By

A Vertex B Face
C Brow D Shoulder

10 The Uncommon Change To Occur In A Myoma Is

A Calcification B Red Degeneration
C Malignant Change D Hyaline Change

11 Laparoscopic Sterilisation Is Contraindicated In:

A Post Partum B Gynaecologic Tumours
C Following Mtp D If The Patient Has More Than 3 Children

12 Which Is Used To Detect Anti Sperm Antibodies?

A Fern Test B Spinn Barkiet Test
C Palm Leaf Test D Post -coital Test

13 Dna Analysis Of Chorionic Villous Biopsy Is Done In All Except

A Hemophilia B Duchennes Muscle Dystrophy
C Sickle Cell Anaemia D Tay Sachs Disease

14 Kleihuer Count Is Useful To Detect The Following

A Maternal Anaemia B Abo-incompatibility
C Foetomaternal Transfusion D Rhisoimmunization

15 Most Commonintrauterine Infection Is

A Cytomegalovirus B Rubella
C Toxoplasmosis D Herpes

16 Most Commoncause Of Intrauterine Infetion

A Rubella B Toxoplasma
C Hepatiis D Cytomegalovirus

17 Earliest Engagement Takes Place In

A Frank Breech B Fiexed Breech
C Incomplete Breech D Complete Breech

18 In A Vertex Delivery, The Babys Head Is Born Out By A Process Of

A Flexion B Efxtension
C Restitution D Lateral Flexion

19 Percentage Of Pregnant Females With Significant Bacteriuria

A 2-10% B 11%
C 21% D 30%

20 Most Common Ovarian Tumor In Less Than 20 Year Age Group Is

A Epithelial Tumour B Germ Cell Tumour
C Metastatic Tumour D Sexcord Stromal Tumour

21 Arm Is Contraindicated In
A Previa B Hydramios
C Acc.hem D Twins

22 Most Important Diameter Of The Pelvic Inlet Is:

A Diagonal Conjugate B Obstetrical Conjugate
C Anatomical Conjugate D Transverse Diameter

23 Which Of The Following Can Occurs In Ovary, Rectum And Appendix

A Metastasis B Nebothian Follicles
C Para Ovarian Cyst D Endometriosis

24 Pelvic Examination Is Advised In A Pelvic Tuberculosis Patient

A As Routine B After 2 Months Of Treatment
C When There Is Resistant D After 12 Months Of Treatment

25 All The Following Att Are Given In Preganacy Except

A Rifampicin B Ethambutol
C Inh D Streptomycin

26 All Of The Following Are Mechanisms Of Action Of Emergency

Contraception Except :
A Delaying Ovulation B Inhibiting Fertilization
C Preventing Implantation Of The Fertilizd Egg D Interrupting An Early
Pregnancy

27 Correct Statement Regarding Rh Incompatibility Is

A Serial U S G Can Diagnose Hydrops Early B Antibody Titre > 4 I U/ml In

Mother Indicate Serve
C Prognosis Does Not Depend On Parity D Increase With A B O Incompatibility

28 A Lady Withprolapsed Uterus After Fothergills Repair Will Complain Of

Following Except
A First Trimester Abortion B Cervical Dystocia
C Premature Laboure D Premature Rupture Of Membrane

29 The Most Common Malignancy To Metastaize To The Placenta Is:

A Melanoma B Breast Carcinoma
C Uterine Adenocarcinoma D Lymphoma

30 Precocious Puberty Is Seen With Which Ovarian Tumour:

A Dermoid B Gynandroblastoma
C Granulosa Cell Tumour D Arrhenoblastoma
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3.

1. c
2. B
3. D
4. C
5. c
6. A
7. D
8. A
9. B
10. C
11.B
12. D
13. D
14 D
15. A
16.
17.
18.
19.
20.
21.

D
A
B
A
B
B

22. A
23. D
24. A

25. D
26. D
27. A
28. A
29 A
30. C

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MCQ PROMETRIC 2
MCQ Gynecology 1
A married 52 year old woman who has a FHx of breast cancer has been
experiencing mild discomfort for a few hours following intercourse for the last
month. She is worried about using hormones. The most helpful treatment would be
a) Clonidine J Vaginal lubricant
b) Combined Oestrogen and progestogen replacement therapy
c) vaginal estrogens
d) vaginal lubricant
e) Mineral supplements

MCQ Gynecology 2
Amenorrhea in a 28 year-old with a high LH and high LH/FSH ratio is a most
recognised feature of:
a) ovarian failure
b) hyperprolactinemia
c) Sheehans syndrome
d) Hypothyroidism
e) Asherman's syndrome
MCQ Gynecology 3
Genital warts:
A. are due to herpes virus infection
B. may be treated with Diflucan
C. are grounds for Caesarean section to prevent neonatal infection
D. podophyllin therapy should be avoided in pregnancy
E. are grounds for more frequent than normal cervical smears
Gynecology MCQs 4
You diagnose Trichomonas vaginitis in a 25-year-old white female, and treat her and
her partner with metronidazole (Flagyl), 2 g in a single dose. She returns 1 week
later and is still symptomatic, and a saline wet prep again shows Trichomonas.
Which one of the following is the most appropriate treatment at this time?

A) Metronidazole gel 0.75% (Metro Gel) intravaginally for 5 days

B) Metronidazole, 2 g orally, plus metronidazole gel 0.75 % intravaginally for 5 days
C) Metronidazole, 500 mg orally twice a day for 7 days
D) Clindamycin cream (Cleocin) 2 % intra vaginally for 7 days
E) Sulfadiazine (Microsulfon), 4 g orally in a single dose, plus pyrimethamine
(Daraprim), 200 mg orally in a single dose

Gynecology MCQs 5
A 19-year-old married white female complains of vaginal discharge, odor,
and itching. Speculum examination reveals a homogeneous yellow
discharge, vulvar and vaginal erythema, and a "strawberry" cervix.
The most likely diagnosis is:
A) candidal vaginitis.
B) bacterial vaginosis.
C) trichomonal vaginitis.
D) chlamydial infection.
E) herpes simplex type 2

MCQ 01 ANSWER
The correct answer is D

A vaginal lubricant would be appropriate since although most of the estrogen acts
locally, some of it is rapidly absorbed into the systemic circulation.Considerable
experimental and epidemiological evidence suggests that elevated endogenous sex
steroids (oestrogens) promote breast tumour development.About 60 percent of
all breast cancers are oestrogen-positive or progesterone-positive. And additionally
she has a family history of breast cancer too.

MCQ 02 ANSWER
The Correct Answer is A
This is defined as menopause occurring in women prior to the age of 40
years.It is also known as premature ovarian insufficiency, primary
ovarian insufficiency , premature menopause, primary ovarian failure,
hypergonadotropic hypogonadism, as well as gonadal dysgenes. It is a not
uncommon cause of amenorrhoea.
The cause of POF is usually idiopathic. Some cases of POF are attributed
to autoimmune disorders, others to genetic disorders such as Turner
syndrome and Fragile X syndrome.Chemotherapy and radiation
treatments for cancer can sometimes cause ovarian failure.
Diagnosis requires elevated gonadotrophins - FSH above 40 IU per litre
together with raised LH and low oestradiol (less than 100 pmol per litre)

on at least two occasions.

Ultrasound usually reveals small ovaries, a small uterus and a thin
endometrium
MCQ 03 ANSWER
The Correct Answer is D
Genital warts are due to the human papilloma virus, particularly types 6,
11, 16 and 18.It is a highly contagious sexually transmitted disease.It is
spread through direct skin-to-skin contact during oral, genital, or anal
sex with an infected partner.
There is no cure for HPV, but there are methods to treat visible warts,
which could reduce infectivity
A 0.15% 0.5% podophyllotoxin (also called podofilox) solution in a gel or
cream is the tandard treatment,which can be applied by the patient to
the affected area and is not washed off.It is the purified and
standardized active ingredient of the podophylli .Podofilox is safer and
more effective than podophyllin.
Podophyllin and podofilox should not be used during pregnancy, as they
are absorbed by the skin and could cause birth defects in the fetus.
Other Treatment Options are Imiquimod (Aldara) is a topical immune
response cream,Liquid nitrogen cryosurgery,Surgical excision,Laser
ablation and Electrocauterization
Liquid nitrogen cryosurgery is safe for pregnancy.
Cervical cancer is believed to be due to the wart virus, so patients with
proven infection, be it clinical warts or evidence of wart infection on
cytology, are at increased risk. So patients should be subjected to annual
smears.
There is debate about the role of Caesarean section for patients with
active herpes, but not for patients with warts.
MCQ 04 ANSWER
The Correct Answer is C
The preferred treatment for Trichomonas vaginitis is metronidazole, 2 g
given in a single oral dose. Certain strains of Trichomonas vaginalis,
however, have diminished sensitivity to metronidazole.
Patients who fail initial treatment with metronidazole should be
retreated with 500 mg orally twice a day for 7 days. If treatment fails
again, the patient should be treated with 2 g daily for 3-5 days.
Metronidazole gel and clindamycin cream are useful for treating bacterial
vaginosis, but are not effective in the treatment of Trichomonas
vaginitis. Sulfadiazine and pyrimethamine are used to treat
toxoplasmosis.
MCQ 05 ANSWER
The Correct Answer is C
Discharge that is yellow/green, offensive, frothy discharge - suggestive of
trichonomiasis And Colpitis macularis (strawberry cervix) is often present

Bacterial vaginosis is suggested by a thin, offensive(fishy odour), greywhite, adherent discharge

Erythema and oedema of the vulvovaginal area, excoriation of the vulva
and presence of curd-like discharge with white plaques- suggestive of
candidiasis
Chlamydia may cause a yellowish cervical discharge and symptoms of
pelvic inflammatory disease or, alternatively, may be totally
asymptomatic
Herpes simplex type 2 causes ulcerations on the vulva and vaginal
mucosa which are exquisitely tender, often with marked surrounding
erythema and edema

MCQ Gynecology 10
A 16-year-old female comes to the physician because of an increased
vaginal discharge. She developed this symptom 2 days ago. She also
complains of dysuria. She is sexually active with one partner and uses
condoms intermittently. Examination reveals some erythema of the
cervix but is otherwise unremarkable. A urine culture is sent which
comes back negative. Sexually transmitted disease testing is performed
and the patient is found to have gonorrhea. While treating this patient's
gonorrhea infection, treatment must also be given for which of the
following?
A. Bacterial vaginosis
B. Chlamydia
C. Herpes
D. Syphilis
E. Trichomoniasis
MCQ Gynecology 11
A 16-year-old nulligravid woman comes to the emergency department
because of heavy vaginal bleeding. She states that she normally has
heavy periods every month but missed a period last month and this
period has been unusually heavy with the passage of large clots. She has

no medical problems, has no history of bleeding difficulties, and takes no

medications. Her temperature is 37 C (98.6 F), blood pressure is 110/70
mm Hg, pulse is 96/minute and respirations are 12/minute. Pelvic
examination shows a moderate amount of blood in the vagina, a closed
cervix, and a normal uterus and adnexae. Hematocrit is 30%. Urine hCG
is negative. Which of the following is the most appropriate management?
A. Expectant management
B. Hysteroscopy
C. Oral contraceptive pills
D. Laparoscopy
E. Laparotomy
MCQ Gynecology 12
A 12-year-old female comes to the physician because of a vaginal
discharge. The discharge started about 2 months ago and is whitish in
color. There is no odor. The patient has no complaints of itching,
burning, or pain. The patient started breast development at 9 years of
age and her pubertal development has proceeded normally to this point.
She has not had her first menses and she is not sexually active. She has
no medical problems. Examination is normal for a 12-year-old female.
Microscopic examination of the discharge shows no evidence of
pseudohyphae, clue cells, or trichomonads. Which of the following is the
most likely diagnosis?
A. Bacterial vaginosis
B. Candida vulvovaginitis
C. Physiologic leukorrhea
D. Syphilis
E. Trichomoniasis

MCQ 10 ANSWER
Correct Answer is B
This patient has a gonorrhea infection.Gonorrhea is one of the most
common sexual transmitted diseases
Infection with gonorrhea is more common in certain groups of people.
The highest reported infection rates occur in the following groups:
Adolescents and young adults
People (often poor) living in urban areas and Southern states
African Americans

Drug users
Gonorrhea is caused by the Neisseria gonorrhoeae bacteria. Up to 80% of
women infected with the organism are asymptomatic or only have vague
symptoms.
In Women
No symptoms 30-40% of the time
Gonorrhea may cause pelvic inflammatory disease
Infection and irritation of the cervix
Need to urinate often
Itching and burning of the vagina
Usually with a thick yellow/green vaginal discharge
Infection and irritation of the vagina
Postcoital spotting or intermenstrual bleeding

Previously, fluoroquinolones [ciprofloxacin , ofloxacin , and levofloxacin

(Levaquin)] was widely used in the treatment of gonorrheal infection.
Because of increasing resistance of many tested samples of N.
gonorrheae to the fluoroquinolone drugs, the CDC now recommends that
only one class of antibiotics, the cephalosporins, be used to treat
gonorrheal infections.
However, because Chlamydia trachomatis can be isolated in 25%-40% of
women with gonorrhea and because women treated for gonorrhea only
may soon go on to develop Chlamydia or pelvic inflammatory disease
(PID), any woman receiving treatment for gonorrhea should also be
treated for Chlamydia.Either Azithromycin (Zithromax) or doxycycline
can be used to treat chlamydia infections.The sexual partners of women
who have had either gonorrhea or chlamydia must receive treatment for
both infections since their partners may be

MCQ 11 ANSWER
Correct Answer is C
This patient has menorrhagia.menorrhagia is defined as total blood loss
exceeding 80 mL per cycle or menses lasting longer than 7 days.(A
normal menstrual cycle is 21-35 days in duration, with bleeding lasting
an average of 7 days and flow measuring 25-80 mL)

The endometrial changes in normal menstrual cycle

1. During the follicular phase, estrogen stimulation results in an
increase in endometrial thickness
2. The luteal phase or secretory phase, progesterone causes
endometrial maturation
3. If fertilization occurs, the implantation phase is maintained
4. Without fertilization, estrogen and progesterone withdrawal
results in menstruation

This patient menorrhagia is more likely due to dysfunctional uterine

bleeding (DUB) secondary to anovulation as history and examination
findings didnot provide any clues to the etiology of the
menorrhagia.During the first few years after menarche, it is common for
women to have some anovulatory cycles and irregular menses.
Without ovulation, the corpus luteum fails to form, resulting in no
progesterone secretion. Unopposed estrogen allows the endometrium to
proliferate and thicken. The endometrium finally outgrows its blood
supply and degenerates. The end result is asynchronous breakdown of
the endometrial lining at different levels. This also is why anovulatory
bleeding is heavier than normal menstrual flow.
Combination OCP is the common treatment for DUB. They contain the
hormones estrogen and progestin, and are taken daily.Progestin works as
an antiestrogen by minimizing the effects of estrogen on target cells,
thereby maintaining the endometrium in a state of down-regulation.
Other treatment Options are Intrauterine Device,hysterectomy and
endometrial ablation
Other Common causes of Mennorragia
Organic Causes
Genitourinary infections -Simple vaginitis (eg, candidal, bacterial
vaginosis) may cause intermenstrual bleeding, while gonorrhea and
chlamydia may present with heavier bleeding
Coagulation disorders - von Willebrand disease, factor II, V, VII, and IX
deficiencies, prothrombin deficiency; idiopathic thrombocytopenia
purpura (ITP)
hepatic or renal failure

Endocrine causes

Hypothyroidism and Hyperthyroidism

Prolactin-producing pituitary tumors
Polycystic Ovary Syndrome - hallmarks are anovulation, irregular menses,
obesity, and hirsutism
Imbalance between the thromboxane A2 and prostaglandin E2

Anatomical causes

Pregnancy - most common cause of irregular bleeding in women of

reproductive age.In this case to note that pregnancy was ruled out with a
negative urine hCG test.
uterine fibroids
endometrial polyps
Endometrial hyperplasia
Endometrial cancer

Iatrogenic causes of menorrhagia

IUDs, steroid hormones, chemotherapy agents, and anticoagulants

Significance of Blood Clots in menstrual blood!!!
Normally body releases anticoagulants to keep menstrual blood from
clotting as it's being released. But when your period is heavy and blood is
being rapidly expelled, there's not enough time for anticoagulants to
work. That enables clots to form.In mennorharia therefore large blood
clots are formed.
Expectant management would not be appropriate. This patient is losing
enough blood to have dropped her hematocrit to 30%. If one does not
intervene, there is the risk that the patient will continue to bleed and to
drop her hematocrit even further.
Hysteroscopy would not be the most appropriate option. With such
severe vaginal bleeding, hysteroscopy will likely not provide sufficient
visualization of the endometrium. Also, hysteroscopy exposes the patient
to the risks of surgery (e.g. perforation of the uterus, damage to internal
organs) for a problem that can be managed effectively medically.
Laparoscopy and laparotomy will provide a view of only the exterior of

the uterus (the serosal surface) and thus will not be an effective
approach to this problem

MCQ 12 ANSWER
Correct Answer is C
Physiologic leukorrhea can be seen during 2 different periods of
childhood. Some female neonates develop a physiologic leukorrhea
shortly after birth as maternal circulating estrogens stimulate the
newborn's endocervical glands and vaginal epithelium. The discharge in
these neonates is often gray and gelatinous. Physiologic leukorrhea can
also be seen during the months preceding menarche. During this time,
rising estrogen levels lead to a whitish discharge not associated with any
symptoms of irritation. This patient has a whitish discharge, no other
symptoms, and she has had normal pubertal development up to this
point. The discharge itself has no characteristics of infection. Therefore,
physiologic leukorrhea is the most likely diagnosis

---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------1Recognised associations with hypermesis gravidarum include:

A. Hydatidiform mole
B. Age More than 30 years
C. Smoking
D. Primiparous women under 20 years of age
E. Pre-eclampsia
2-You are called to attend the delivery of a 24-year-old primiparous female. After a prolonged 18-hour labor
requiring oxytocin agumentation, she delivered a 4200 gm male infant. A vacuum-assisted delivery was
performed , and the mother required repair of a third degree perineal laceration.Few minutes after the
delivery you were reported that the mothers blood pressure is 80 mmHg systolic and her bed is soaked with
blood.The most likely cause of this problem is:
A.occult cervical lacerations.
B.hematoma.
C.uterine atony.
D.uterine rupture.
E.disseminated intravascular coagulopathy.
3-Treating preterm labor with beta agonists has been shown to decrease the rate of which one of the
following?
A.Perinatal deaths
B.Preterm delivery
C.Low birth weight infants
D.Delivery within 48 hours of treatment

EXPLANATIONS

MCQ 01 ANSWER
The Correct Answer is A
The cause of severe nausea and vomiting in pregnancy has
not been identified. Hyperemesis Gravidarum may also have a
genetic component.
Hyperemesis is also associated with hyperemesis in prior
pregnancy, female gestation, multiple gestation, triploidy,
trisomy 21, current or prior molar pregnancy, and hydrops
fetalis.
Women with history of motion sickness, migraine headaches,
psychiatric illness, pregestational diabetes, high or low
pregestational weight, hyperthyroidism, pyridoxine
deficiency, and gastrointestinal disorders are also at an
increased risk.
Cigarette smoking and maternal age older than 30 years
appear to be protective.
MCQ 02 ANSWER
The Correct Answer is C
Ninety percent of early and immediate postpartum
hemorrhage is due to failure of the uterus to contract
satisfactorily (uterine atony). Other less frequent causes are
lacerations of the cervix, vagina, or perineum; hematomas,
usually located near lacerations or episiotomy repairs; and
uterine rupture, either spontaneous or iatrogrenic. All of
these occur in the immediate postpartum period. Delayed
hemorrhage, occurring beyond the first 24 hours after
delivery, is usually caused by retained placental fragments.
Interestingly, placenta accrete is among the most common
causes of postpartum hemorrhage necessitating
hysterectomy.
MCQ 03 ANSWER
The Correct Answer is D
In women with premature labor, beta-adrenergic agonists
have been clearly shown to reduce the incidence of delivery
within 24 and 48 hours of administration. These tocolytic
agents have not been shown to consistently reduce the rates
of preterm delivery, low birth weight, severe respiratory

distress, or perinatal death. A statistically non-significant

trend toward reduced perinatal mortality has been
suggested in women given beta-adrenergic agonists earlier
in pregnancy, for preterm labor before 28 weeks gestation.
It appears that more effective use of the 24-48 hours gained
by tocolysis with beta-adrenergic agonists holds promise for
reducing perinatal morbidity and mortality, perhaps through
more liberal use of predelivery glucocorticoid therapy.

--------------------------------------------------------------------------------------------------------------The pressure on the urinarybladder is more common with

A. Cervical Myomata
B. Intramural fibroids
C. Submucous fibroids
D. Subserous fibroids
The correct answer is D
Submucosal (or Submucous) fibroid - This type is located beneath the lining of the uterus. The
.fibroid can develop a thin stalk or even enter the vagina
.Intramural fibroid - They stay mostly embedded within the middle of the wall of the uterus
Subserosal (or Subserous) fibroid - This type grows towards the outside of the uterus and can press
.on the organs surrounding the uterus such as the bladder or rectum
Pedunculated fibroid - This type of fibroid can develop when a fibroid grows on a stalk, which is
called a pedicle. This can be a subserosal fibroid growing out into the abdomen or a submucosal fibroid
growing into the endometrial cavity. The stalk can get twisted which can cause severe pain, although
.this is extremely rare
Interligamentous fibroid - It can grow sideways between the layers of the broad ligament (a band of
fibrous connective tissue that supports the uterus