DE LA SALLE HEALTH SCIENCES INSTITUTE

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

CLINICAL CLERKSHIP 2019 – 2020

COMPREHENSIVE EXAMINATION
AUGUST – SEPTEMBER 2019

Name: ____________________________________ Date: _________________

GENERAL INSTRUCTIONS:

1. READ THE INSTRUCTIONS BEFORE STARTING THE EXAMINATION.

2. FOLLOW THE INSTRUCTIONS 3 AND 4 BEFORE ANSWERING THE
QUESTIONS
3. Fill up completely ALL data asked in the answer sheet
4. Write your SEAT NUMBER on the RIGHT upper hand corner of your answer
sheet
5. Total number of items = 120
6. NO ERASURES ALLOWED. DO NOT USE SIGN PEN. No extra answer sheet
will be provided

MULTIPLE CHOICE: CHOOSE THE BEST ANSWER.

1. A 24-year-old delivered at home to a term livebirth baby boy weighing 3.0 kg via
VSD assisted by a midwife. On inspection of the genitalia, a second-degree
laceration was noted. What are the structures involved (from superficial to deep) in
this type of laceration?
a. Fourcette, perineal skin, vaginal mucosa, superficial transverse perineal
muslce, bulbocavernosus muslce
b. Fourcette, perineal skin, vaginal mucosa, bulbocavernosus muslce,
superficial transverse perineal muslce
c. Fourcette, vaginal mucosa, perineal skin, bulbocavernosus muslce,
superficial transverse perineal muslce
d. Perineal skin, vaginal mucosa, bulbocavernosus muslce, superficial
transverse perineal muslce, external anal spincter

2. A 35-year-old G2P2 (2002) consulted at a clinic because of right vaginal mass. On

inspection, there is a 3.0 x 3.0 cm non-tender cystic mass on the right lateral portion
of the vaginal canal. What is the most likely diagnosis?
a. Skene’s gland cyst
b. Wolffian duct cyst
c. Gartner’s duct cyst
d. Bartholin’s duct cyst

3. Fourth degree perineal laceration involves structures up to the:

a. External anal sphincter
b. Internal anal sphincter
c. Anus
d. Rectum

4. What blood vessel is traversed on the lateral portion of a Maylard’s incision?

a. Inferior epigastric artery
b. External pudendal artery
c. Superficial circumflex iliac artery
d. Superficial epigastric artery
5. A 23-year-old G1P1 (1001) complains of numbness of the anterior abdominal wall
above the CS incision site. She is 10 days post Cesarean section via Pfannensteil
incision. What nerve branches have been severed at the time of the procedure?
a. Subcostal and ilioinguinal
b. Intercostal and iliohypogastric
c. Iliohypoastric and ilioinguinal
d. Intercostal and subcostal nerves

6. A 26 year old G3P2 (20020 on her 30 weeks AOG, consulted due to icteric sclerae
and generalized puritus. Physical examination revealed normal vital signs, fundic
height is 36 cms, with good fetal heart tones. No skin lesions except for excoriations
from scratching. Her serum transaminase level is elevated (100 U/L); hepatobiliary
tree ultrasound result is normal. What is the most likely diagnpsis?
a. Acute Fatty Liver of Pregnancy
b. Eczema of Pregnancy
c. Intrahepatic Cholestasis of Pregnancy
d. Pemphigoid Gestationis

7. A 4 year old child was brought to the clinic because of voiding difficulties. Vital signs
are unremarkabe. Physical examination revealed a fused labia minora forming a
translucent vetical midline line. The mother observed that she would see streaks of
blood in child’s underwear. What is the most likely diagnosis?
a. Imperforate Hymen
b. Labial Adhesions
c. Condyloma Accuminata
d. Vaginal Agenesis

8. A 30 year old primigravid complains of fever for two days, at 28 weeks age of
gestation. She has cought with yellow-green sputum a day before fever started
physical examination shows: HR: 96 bpm, RR: 26 cpm, T: 38.1 oC with rales over
both lower lung fields. What is the appropriate antibiotic?
a. Ceftriaxone
b. Azithromycin
c. Levofloxacin
d. Piperacilliin – Tazobactam

9. A 27 year old primigravid at 28 weeks age of gestation has a BP of 150/100 mmHg

taken 30 minutes apart. Previous BP was noted to be normal. Laboratory tests show
urinary albumin of +3 with normal levels of AST, ALT, LDH and creatinine. Complete
blood count show: Hb: 12.1 g/dL, Hct: 0.41, platelets: 210,00 /uL. What is the
diagnosis?
a. Chronic hyperrtension
b. Gestational hypertension
c. Preeclampsia
d. Chronic hypertension with superimposed preeclampsia

10. A 25 year old primigravid was rushed to the hospital room at 32 week age of
gestation for a 1 minute episode of generalized tonic-clonic convulsions at home.
During examination, she had another episode of convulsion. What is the appropriate
management?
a. Give 2g MgSO4 intravenously
b. Intravenous Diazepam
c. Administer maintenance dose of MgSO4 at next schedule
d. Give intravenous barbiturate

11. A 16 year old nulliparara at 18 weeks age of gestation has a CBC with low
hemoglobin. Peripheral blood smear shows large cells with increased
nuclear/cytoplasmic ratio and hypersegmented neutrophils. What nutrient deficiency
is most possible for her condition?
a. Folic acid
b. Iron
c. Pyruvate kinase
d. Vitamin B12
12. A 23 G1P0, at 15 weeks AOG has the following Hepatitis profile: HbsAg: Reactive;
Anti Hbs Ab: Non-reactive; HBc IgM: Reactive: Total Hbc Ab: Non-reactive; Hbe Ag:
Non-reactive; Anti Hbe Ab: Reactive. Interpret her profile result.
a. Chronic Hepatitis B, low infectivity
b. Chronic Hepatitis B, high infectivity
c. Acute Hepatitis B, low infectivity
d. Acute Hepatitis B, high infectivity

13. A 28 G2P1 (1001), at 10 weeks AOG consulted because her 2-year-old daughter
had Rubella infections 2 days ago. The patient could not recall having had rubella
during childhood and is also unsure of her vaccination history. She now experiences
low grade fever, cough but with no noted rashes. What is the best approach to
prevent development of congenital rubella infection?
a. Administer Rubella vaccine immediartely
b. Give Rubella Immunoglobulin vaccine immediately
c. Consider antiviral treatment so as to shorten the course of infection
d. Check for Rubella IgG titer; if positive, explain to the patient

14. A 35 G0, married for 3 years consulted because of heavy and prolonged menses for
the past 3 months. Patient also noted 10% weight loss for 3 months with an
increasing abdominal girth. TVS done showed thickened endometrium of 1.8 cm.
She is presently on anti Kochs medication for 1 month for her Pulmonary TB. What
is the best method to diagnose the possible cause of her present problem?
a. Menstrual blood AFB
b. CT Scan
c. Endometrial biopsy
d. Laparoscopy

15. A 22 G1P0 35 weeks AOG complains of genital lesions 3 days ago, pruritic and
slightly tender when touched. On PE, there were noted multiple vulvar warty lesions
(largest measure 4 cm) and lesions on the vaginal canal (largest measure 2 cm).
What is the most applicable management for this patient?
a. Do elective cesarean section at 38 – 39 weeks AOG and electrocautery of
the warty lesions
b. Apply Trichloroacetic Acid on the lesions weekly until her delivery
c. Do excision of the lesions ASAP and given HPV vaccine after delivery
d. Await spontaneous labor, then do excision of the lesion immediately after
the delivery

16. A 24 y/o, G2P1 (1011) underwent suction curretage for a hydatidiform mole. What
tumor marker should be monitored on outpatient follow-up?
a. CEA
b. AFP
c. Beta-HCG
d. HPL

17. A 19 y/o primigravid, 11 weeks APG, consulted due to vaginal bleeding and
passage of meaty material. On internal examination, the cervix is open and the
uterus is slightly enlarged. There is no adnexal mass/tenderness. How will you
manage the patient?
a. Advice bed rest
b. Give methyergonovine maleate per orem
c. Evacuate the uterine contents
d. Do serial serum beta-HCG determinations

18. A 21 y/o primigravid, 34 weeks AOG, with vaginal spotting has an ultrasound
showing the placenta to be totally covering the internal cervical os. What is the
diagnosis?
a. Low-lying placenta
b. Placenta previa
c. Placenta partialis
d. Placenta marginalis
19. A 37 y/o, G4P2 (2012), 38 weeks AOG, s/p 2 previous Cesarean sections, consults
you for prenatal check-up. Pelvic ultrasound shows loss of the normal hypoechoic
retroplacental zone between the placenta and uterus, and placenta accreta. How will
you manage the delivery of this patient?
a. Repeat CS + bilateral tubal ligation
b. Repeat CS + hysterectomy
c. Repeat CS + methotrexate IM
d. Repeat CS

20. A 33-year-old G2P1 (1001) at 31 weeks age of gestation consulted at the

emergency room due to labor pains. Past medical history is unremarkable. On
physical examination vital signs are normal, fundic height of 36 cm, FHT: 135 bpm.
Biophysical profile score of 8/8 with amniotic fluid index of 30 cm. Which of the
following tocolytics is the best choice for her case?
a. Nifedipine
b. Isoxsuprine
c. Indomethacin
d. Magnesium sulphate

21. Whichof the following cases below describes preterm labor in a 28-year-old
primigravida?
a. 18 weeks age of gestation with vaginal spotting associated with menstrual
like cramps. Cervix is 2 cm dilated.
b. 19 weeks age of gestation with vaginal bleeding associated with
menstrual like cramps. Cervix is 2 cm dilated.
c. 20 weeks age of gestation with hypogastric pain. Cervix is 1 cm dilated.
Ultrasound was done the estimated fetal weight 400 grams.
d. 21 weeks age of gestation with regular uterine contractions. Cervix is 2
cm dilated. Ultrasound was done estimated fetal weight 550 grams.

22. What is the correct dosage of corticosteroid therapy for fetal lung maturation?
a. Betamethasone 8 mg IV as a single dose
b. Betamethasone 6 mg IM every 8 hours for 4 doses
c. Dexamethasone 6 mg IM every 12 hours for 4 doses
d. Dexamethasone 12 mg IM every 24 hours for 2 doses

23. A 40-year-old G5P4 (4004), consulted for prenatal care. Her ultrasound shows two
fetuses both at 19 weeks, one placenta and two amnionic sacs. What could be the
timing of division of her zygote in days?
a. 0-3
b. 4-8
c. 8-12
d. 13-15

24. A 26-year-old with twin pregnancy has a pre-pregnancy BMI of 19 kg/m2. How many
pounds should she gain in her entire pregnancy?
a. 34
b. 35
c. 36
d. 37

25. A high risk pregnant patient at 37 weeks age of gestation underwent Biophysical
Profile. Which of the following parameters is affected first during fetal hypoxia?
a. Tone
b. Heart rate activity
c. Movement
d. Breathing
26. A 28 year-old G3P2 (2001), at 34 weeks age of gestation not in labor uderwent Non
stress test and showed the following trace (see below). What is the interpretation?

a. Reactive NST
b. Non reactive NST
c. Positive NST
d. Negative NST

27. A 35 year old G3P2 (2002) at 20th week age of gestation came in at the ER due to
severe epigastric pain with radiation to the back of 3 hours duration. She is
tachycardic and febrile, abdomen is slightly distended with tenderness at the
epigastric area. What laboratory examination should be done to confirm your
diagnosis?
a. Aminotransferases
b. Bilirubin
c. Serum amylase
d. Hepatobiliary ultrasound

28. A 40 year old G5P4 (4004), delivered via vaginally, developed atony and
subsequently had hysterectomy and blood transfusion. Then oliguria sets in with
increasing creatinine levels. What is the next management for this patient?
a. Monitor hemoglobin and transfuse as needed
b. Do dialysis
c. Monitor creatinine every 6 hours
d. Do MRI of the kidneys

29. A pregnant patient at 9th week of gestation complains of nausea and vomiting of 3
days duration. PE shows sunken eyeballs, dry lips and tongue and with poor skin
turgor. What is the most appropriate management for this patient?
a. Send patient home and give Vitamin B complex
b. Admit patient and give oral meds
c. Admit patient and hydrate patient and give IV meds
d. Give parenteral nutrition

30. Please give the appropriate answer to his particular case (questions 30 – 36). A 28
y/o G1P0, on her 37 weeks AOG consulted due to watery vaginal discharge for 24
hours duration. No uterine contractions appreciated. Fetal heart tones are good.
EFW is 2.8 kg, cephalic presentation on Leopold’s maneuver. What is the next best
step?
a. Perform speculum exam
b. Do a thorough pelvic exam
c. Request for Biophysical Examination
d. Hook patient to Cardio-tocogram

31. Which among the following laboratory tests will be significant for this case?
a. Urinalysis
b. CBC
c. VDRL
d. HbA1C
32. Patient went into spontaneous labor. On the 12 th hour of labor, the cervis is 6 cm
dilated, station -1, with good fetal heart tones. Uterine contractions come every 5
minutes, 30 seconds in duration, moderate to strong in intensity. How is the uterine
contraction best described?
a. Hypotonic
b. Normal
c. Hypertonic

33. What is the best management at this point?

a. IV sedation
b. Start Oxytocin drip
c. Ask mother to bear down during contractions
d. Do emergency Cesarean Section

34. On the 14th hour of labor, patient reached second stage of labor. The fetal head is at
station +2 with the occiput felt posteriorly. What cardinal movement must occur in
the next several contractions prior to delivery of the head?
a. Flexion
b. External rotation
c. Internal rotation
d. Extension

35. Upon delivery of the head, a loose loop of umbilical cord is felt around the fetal neck.
What is the best management?
a. Continue to apply gentle traction on the fetal head until anterior shoulder
is delivered
b. Insinuate a hand under the umbilical cord and slip the cord over the
anterior shoulder and the rest of the body during delivery
c. Apply two clamps on the loop of umbilical cord and cut prior to delivery of
the shoulders
d. Do emergency Cesarean Section

36. Eight hours post-partum, the patient complained of inability to void. A hypogastric
fixed cystic mass is appreciated, non-tender, 8 cm in widest diameter. No other
significant pelvic examination findings were obtained. What is the next best step?
a. Do a speculum examination
b. Request for a Transvaginal ultrasound
c. Schedule patient for an abdominal CT scan
d. Catheterize the urinary bladder

37. A 25-year old primigravida at term consulted due to regular uterine contractions.
Internal examination revealed a 4 cm dilated cervix with the fetal ischial tuberosities
palpated at the level of the ischial spines. What is the most appropriate mode of
delivery for this patient?
a. Spontaneous vaginal delivery
b. Partial breech extraction
c. Vacuum-assisted vaginal delivery
d. Cesarean section

38. A tern neonate delivered via cesarean section, was noted to have tachypnea which
spontaneously resolved after several hours of oxygen support. What is the most
likely diagnosis?
a. Transient Tachypnea of the Newborn
b. Respiratory Distress Syndrome
c. Meconium Aspiration Syndrome
d. Neonatal Pneumonia

39. The following statements are signs of placental separation during the third stage of
labor, EXCEPT:
a. Sudden gush of blood into the vagina
b. Fundus becomes globular and firmer
c. Placenta descends into the vagina
d. Umbilical cord lengthens
40. What is the most possible cause of secondary postpartum hemorrhage with features
of empty endometrial cavity, contracted uterus and normal vaginal vault with no
discharge?
a. Retained placental fragments
b. Cervical hematoma
c. Placental site involution
d. Incomplete remodeled uteroplacental arteries

41. A 37 year old G5P5 had a sudden profuse vaginal bleeding seven days after vaginal
delivery. PE showed a parous cervix, open internal os and the uterus palpable just
below the umbilicus with moderate bleeding. What is the most likely working
diagnosis?
a. Puerperal endometritis
b. Retained placental fragments
c. Late postpartum hemorrhage

42. A 34 year old G4P4 complained of excessive vaginal discharge pale in color and
non foul smelling a week postpartum. Pelvic examination showed normal findings.
What is the lochial discharge of the patient?
a. Alba
b. Rubra
c. Serosa
d. Vera

43. Which maternal condition would still be considered safe to initiate breastfeeding
during the puerperal period?
a. HIV and undergong retroviral treatment
b. Intake of illicit drugs and alcohol
c. Stage 3 breast cancer with ongoing chemotherapy
d. Pulmonary tuberculosis with medications for the last 3 months

44. An 18 yr old G1P1 delivered vaginally with third degree lacerations and repair. One
week later she had difficulty in urination and her episiorrhaphy site was tender,
edematous with purulent discharge with intavt skin and fascial layer. What is the
most likely diagnosis?
a. Necrotizing fascitis
b. Perineal infection
c. Perineal wound dehiscence
d. Toxic shock syndrome

45. What is the best therapeutic option in the management of breast abscess?
a. Surgical incision and draining under general anesthesia
b. Sonographically guided aspiration of breast mass
c. One week treatment of broad spectrum antibiotics for polymicrobial
organisms
d. Warm compress over the affected breast and discontinuation of
breastfeedig

46. A 25 G2P1 (1001) on her 12th week AOG consulted with severe abdominal pain. Her
transvaginal ultrasound 2 weeks ago showed an alive embryo with a cystic mass on
the right adnexa measuring 8 x 4 x 6 cms. Vital signs are stable, abdmomen is rigid
with direct and rebound tenderness on all quadrants. Cervix was closed and no
bleeding. Uterus and adnexae cannot be assessed due to muscle guarding. What is
your diagnosis?
a. Appendicitis
b. Cholecystitis
c. Twisted ovarian new growth
d. Pyelonephritis
47. A 29 y/o G1P0, at 21 weeks AOG, developed epigastric pain, non-radiating, hours
prior to admission. This was accompanied by anorexia, low-grade fever, and three
episodes of vomiting. 2 hours PTC, pain shifted to the right paraumbilical area. PE
revealed a soft abdomen but with direct tenderness localized on this area. CBC
showed a WBC of 20,000 with predominance of neutrophils. What is your plan of
management?
a. Antiobiotic therapy
b. Appendectomy
c. Cholecystectomy
d. Salphingo-oophorectomy

48. The following are the clinical pelvimetry findings of a primigravid parturient:
Prominent ischial Spines; Narrow sacrosciatic notch; Flat sacrum; diagonal
conjugate of 12 cm. What is the most probable contracted pelvic diameters?
a. All planes are contracted
b. Midpelvis
c. Inlet
d. Outlet

49. A parturient was in active labor eight hours. Cervix is fully dilated station minus one,
cephalic presentation, sagittal suture is transversely palpated with posterior
fontanelle on maternal left. The dystocia is most probably secondary to contracted?
a. Inlet
b. Midpelvis
c. Outlet
d. Inlet and midpelvis

50. A 10-centimeter myoma was recently docmented in a G2P1 parturient and is

currently palpable at the anterior wall of the uterus. She came at the emergency
room in labor, cervix is at 5 cm dilated, station plus 1, cephalic, intact bag of water.
Choose below an item that is included in the initial management.
a. Give oxytocin
b. Administer a hormone to decrease the size of the myoma
c. Perform an emergency cesarean section
d. Monitor progress of labor

51. During a planned vaginal delivery of a G3P2 patient, you discovered that the
presentation is indeed a complete breech. What diameter or structure should pass
the pelvic inlet so that engagement can happen?
a. Biparietal diameter
b. Most dependent part of breech
c. Bitrochanteric diameter
d. Anus

52. Which is the most dystocic event in the delivery of a fetus in breech presentation?
a. Extraction of the lower extremities
b. Delivery of the shoulder
c. Delivery of the aftercoming head
d. All of the choices

53. A parturient came in at the emergency room and allegedly was in labor for one day.
Clinical findings include BP = 100/70; Heart rate = 105 bpm; Temperature = 39.5
degrees Celcius. Fundic height = 25; Leopold Maneuvers one and three = empty;
Fetal heart tone = absent; Cervix is 7 cm dilated, ruptured membrane, extremity
palpated at the level of hymen. What is the recommended mode of delivery?
a. Cesarean section
b. Forceps extraction
c. Spontaneous vaginal delivery
d. Fetal morcellation
54. A 24 year old G2P1 is on her second stage of labor. Clinical data include: BP=
130/80 HR=80 bpm; Height = 152 cm; Weight = 86 kg Fundic height = 40 cm,
FHT=140 bpm. Upon delivery of the head, it took more than a minute for the delivery
of the fetal body. What kind of dystocia is encountered?
a. Shoulder dystocia
b. Uterine dysfunction
c. Poor expulsive forces
d. Cephalopelvic disproportion

55. A 28 year old G4P3 (3003) is on her second stage of labor. Clinical data include:
BP= 130/80 HR=80 bpm; Height = 152 cm; Weight = 86 kg Fundic height = 40 cm,
FHT=140 bpm. Upon delivery of the head, there is difficulty of delivering the rest of
the fetal body. Which of the following maneuver is correctly described and
applicable to deliver safely the rest of the fetus?
a. Reach for the accessible shoulder and pushed towards the chest to effect
abduction
b. Remove legs from stirrups and sharply extend the legs
c. Release the posterior shoulder by rotating the anterior shoulder 180° in a
corkscrew fashion
d. Perform Zavanelli maneuver by cephalic replacement of the delivered
head and then perform cesarean section

56. A primigravid complaines of difficulty of urinating with abdominal distention.

underwent one after a primary CS. There is minimal vaginal bleeding. Vital signs are
normal and no pallor. What is the most likely complication?
a. Partial gut obstruction
b. Bladder atony
c. Vesicovaginal fistula
d. Large hematoma formation

57. A primigravid delivered vaginally after two hours in second-stage of labor. The
following day at the wards, there was a high stepping gait and numbness on right
shin. What is the most possible reason for this complication?
a. Laceration of common fibular nerve during episiotomy and repair
b. Presenting part wedged into pelvic inlet, causing ischemia of nerve
c. Impingement of common peroneal nerve during leg positioning in stirrups
d. Thinning of the lower uterine segment, and with laceration

58. Based on the partogram below, what is the functional division on the 5 th hour of
labor?

a. Prep
aratory
b. Dilatational
c. Pelvic

59. Based on the partogram shown below, the cardinal movements of labor (descent,
flexion, internal rotation...) are expected to be commencing on what hour of labor?
 a.
a.
a.
a.
a.
a.
a.
a.
5th
b. 7th
c. 9th
d. 11th

60. A 25 year old primigravida on her 6th hour of labor experienced painful contractions
Fetal heart tones ranged from 130 to 150 bpm, with good variability; contractions
every 1.5 to 2 minutes, duration ranged from 60 to 100 seconds, strong intensity.
Internal examination: cervix= 2 cm, cephalic, Intact membrane, station plus 1. What
is the recommended management?
a. Sedation
b. Observation
c. Cesarean section
d. Administer tocolytic agent

61. A nullipara was admitted with cervix dilated at 6 centimeters, ruptured bag of water,
station minus 1. After 3 hours of good uterine contractions, cervix is 6 centimeter
dilated, station minus 1. What condition is she in?
a. Protracted active phase dilatation
b. Prolonged deceleration phase
c. Arrest in cervical dilatation
d. Failure of descent

62. A nullipara was admitted on the 12th hour of labor. Findings include 3 centimeter
dilated cervix, ruptured bag of waters, station minus 3. After 8 hours of adequate
uterine contractions, with good fetal heart tones and variability, partogram was
plotted below. What is the recommended management?

a. E
x
t
e
n
d

the observation for two more hours

b. Allow the patient to rest
c. Sedate or give epidural anesthesia
d. Perform cesarean section.

63. A 22 year old G1P0, on her 39 weeks age of gestation consulted due labor pains for
the past 12 hours. FH=34 cm. Baseline IE = 6 cm dilated cervix, fully effaced,
ruptured amniotic membranes, Station minus 1. After 5 hours of monitoring at the
 labor room, repeat IE is shown at the partograph below. What is the cause of this
labor abnormality?

a. Ut
eri
ne

dysfunction
b. Asynclitism
c. Midplane contraction
d. Any of the choices is correct

64. Using the WHO partogram below, the red line represents the labor course of a
primigravid that is being observed in a lying -in health center. What is the
recommended next step in the management?

a. Perform cesarean section

b. Transfer the patient to a hospital facility
c. Ask an Obstetrician to check the patient
d. All of the choices are correct

65. Using the WHO partogram below, the red line represents the labor course of a
primigravid that is being observed in a hospital facility. Uterine contractions are
adequate with good fetal heart tones. What is the recommended next step in the
management?

a. Oxytocin augmentation
b. Venoclysis and hydration
c. Cesarean section
d. Close monitoring

66. A primigravid in active labor reached full cervical dilatation at 7 in the morning. She
is pain-free because of the effect of epidural anesthesia. Up to what time is the
waiting period that she should be delivered vaginally?
a. 8 AM
b. 9 AM
c. 10 AM
d. 11 AM
67. A primigravid is in labor for 23 hours with the following partogram. Which of the
following are the labor abnormalities?
 a. Second stage arrest of descent
b. Second stage failure of descent
c. Protracted descent with prolonged deceleration phase
d. All abnormalities are depicted in the partogram

68. A 37 year old G5P4 with a term gestation was brought at the emergency room.
Baseline internal examination was 1 cm dilated cervix, uneffaced, station 0. After
two hours and thirty minutes, spontaneous delivery of the baby occurred. What is
the most probable fetal complication that may have happened?
a. “Baby Fall” to the floor
b. Infection
c. Caput formation
d. Uterine rupture

69. Which of the following non-contraceptive benefits may be expected in a patient on

progestin containing IUD?
a. Regular menstruation
b. Decrease risk of cervical cancer
c. Decrease in size of ovarian cysts
d. Relief of heavy menstrual bleeding

70. A 24 year old on combined oral contraceptives, missed taking pills for three days in
a row during the second week of the pills. She denies any history of vaginal contact
within 5 days. Which of the following advice should be given?
a. Discard current pack and start taking pills from the new pack
b. Take one pill as soon as possible and use back up method for one week
c. Take thee pills as soon as possible and use back up method for one week
d. Discard current pack, start a new pack and use back up method for 7
days

71. An 11 year old girl who just had her menarch 1 year ago complains of heavy
menstrual bleeding that caused her to collapse. Her menstruation after her
menarche was irregular with periods of amenorrhea, oligomenorrhea and
menometroraghia. What is the most likely cause of her AUB?
a. Leiomyoma
b. Anovulation
c. Coagulation defect
d. Endometrial dysfunction

72. A 48 year old, G5P5 with abnormal uterine bleeding for 10 days has an ultrasound
findings of a thickened endometrium. What would be the appropriate next step to
do?
a. Endometrial biopsy
b. Iron supplementation
c. Total abdominal hysterectomy
d. Repeat ultrasound after a month
73. A 52 year old menopause for 2 years complained of a lipomatous mass on the right
labia majora measuring 8.0 x 5.0 cm. What is the most appropriate diagnostic
modality to differentiate between a benign and a malignant mass?
a. CT scan
b. MRI
c. Ultrasound
d. X-ray

74. A 39 year old G1P1 consulted because of an enlarging mass of 3 years duration.
Pelvic ultrasound revealed a 10 x 10 cm unilocular cystic mass containing
echogenic dots and dashes with an echogenic core. What is the most appropriate
management?
a. Observation
b. Ovarian cystectomy
c. Salphingo-oophorectomy
d. Total Abdominal Hysterectomy with Bilateral Salphingo-oophorectomy

75. A 32 year old G2P2 presented with mood swings and anxiety associated with
headache, hypersomnia, difficulty concentrating and food cravings starting 5 days
before her menstrual period and relieved on day 4 of menses. She was diagnosed
with depression. BMI is 26. Physical examination is normal. What is the appropriate
diagnostic test?
a. CT scan
b. DSM – V Criteria
c. MRI
d. PMS diary

76. A 13-year-old presented with hypogastric pain every month for the past 12 months.
No menarche yet. Physical examination: BMI is 22. Abdomen has hypogastric
fullness with a soft tender hypogastric mass measuring 7 x 7 cm. Genitalia revealed
presence of pubic hair and a bluish membrane coverin the vaginal introitus. What is
the most appropriate management?
a. Observation
b. Cox-2 inhibitors
c. Cystectomy
d. Hymenectomy

77. A 26-year-old nulligravida consulted due to painful menstruation and dyspareunia.

She has been unable to concieve for 5 years with her husband, who has a child with
another woman. Pelvic examination is notable for nodularity of the uterosacral
ligament and tender adnexal masses. What diagnostic modality is utilized to
establish a definitive diagnosis in this patient?
a. CT scan
b. MRI scan
c. Transvaginal ultrasound
d. Laparoscopic examination with biopsy

78. A 27-year-old nulligravida presents to her primary care doctor with heavy, painful
periods and dyspareunia. She aslo revealed that they have a hard time getting
pregnant even after being married for the past 5 years. Which of the following is
LEAST likely to be effective in treatment for this patient’s pain?
a. Danazol
b. Estrogen-only oral contraceptive pill
c. Gonadotrophin-releasing hormone agonists
d. Non-steroidal anti-inflammatory medications

79. Which of the following is the best diagnostic test to rule out congestive heart failure?
a. ECG
b. Echocardiogram
c. Chest MRI
d. Arterial Blood Gas
80. A 28-year-old G2P1 (1001) with mitral valve prolapse at 37 weeks age of gestation
was admitted for labor pains. On PE, (+) mid-systolic click at the apex. FH = 32 cm,
FHT = 146 bpm, uterine contractions every 2-3 minutes, 50-60 seconds duration,
strong. Internal examination: cervix fully dilated, fully effaced, with ruptured
membranes, clear amniotic fluid, cephalic, station +4. What is the most appropriate
management at this time?
a. Epidural analgesia
b. Mandatory cesarean section
c. Mandatory infective endocarditis prophylaxis
d. Assisted vaginal delivery by forceps or vacuum

81. A 17-year-old G1P1 (1001) diagnosed with mitral stenosis came for follow up at the
after giving birth 6 weeks ago by vaginal delivery. She expressed her desire of
spacing her childbearing but is wary of possible side effects, difficulty in adherence
and failure rates of some family planning methods. What is the most appropriate
contraceptive method for this patient?\
a. Intrauterine device
b. Subdermal implant
c. Bilateral tubal ligation
d. Combined oral contraceptive pills

82. The most appropriate management for the problems concerning vaginal complaints
during menopause is:
a. Oral estrogen
b. Vaginal estrogen suppository
c. Estrogen patch
d. Injectable estrogen

83. The best choice of test in the detection of osteoporosis is:

a. Conventional radiograph of the spine
b. Single x-ray absorptiometry of forearm
c. Radiographic absorptiometry of the arm
d. Dual energy x-ray absorptiometry of the vertebra

84. A 22 year old medical student sought consult due to acne which only started when
she entered 3rd year. Which of the following is needed to establish the diagnosis of
polycystic ovary syndrome?
a. Menstrual cycle of every 30 days
b. Presence of 2 – 9 follicles in her right ovary
c. Presence of significant alopecia at the crown of the scalp
d. Presence of excess hair growth on her legs and upper lip

85. What is the appropriate management for the medical student? (refer to the above
case)
a. Glucocorticoids
b. Progestin ony pil
c. Combined oral contraceptives
d. All of the above

Refer to this case for items 86 to 88:

A 19 year old sought consult due to primary amenorrhea. Physical examination revealed
the presence of female external genitalia.

86. Thorough evaluation of the patient would NOT include:

a. Tanner staging
b. Onset of menarche
c. Height measurement
d. Presence or absence of cyclic abdominal pain
87. If on physical examination the patient is noted to have tanner stage I for breast,
stage III for pubis, the most common differential diagnosis for her amenorrhea would
be included in:
a. Category I
b. Category II
c. Category IV
d. All of the above categories

88. Karyotyping would NOT be necessary in the above patient in the presence of the
following findings:
a. Absence of secondary sexual characterisitics and presence of a uterus
b. Presence of secondary sexual characterisitics and absence of a uterus
c. Absence of both secondary sexual characteristics and uterus

89. Infertility patients will respond to Clomiphene if they belong to the class _____ of the
WHO classification of amenorrhea
a. I
b. II
c. III
d. IV

90. In 1 year, ______% of normal fertile couples will get pregnant.

a. 30%
b. 50%
c. 70%
d. 90%

91. Identify the kind of ambiguity in the picture shown below

a. Clitoromegaly
b. Labial fusion
c. Clitoromegaly and labial fusion
d. Clitoromegaly, scrotal formation and labial fusion

92. A newborn with genital ambiguity has the following clinical and laboratory findings:
hyponatremia, elevated hydroxyprogesterone, hypokalemia. What threatens the life
of this newborn?
a. Accelerated bone maturation
b. Pituitary failure
c. Adrenal crisis
d. Any of the above
93. A thirteen-year-old female consulted because of amenorrhea with accompanying
cyclic monthly hypogastric pains. There is a perineal bulging noted upon
examination (see picture below). What is the most probable diagnosis?

a. Vaginal septum
b. Imperforate hymen
c. Vaginal agenesis
d. Ambiguous genitalia

94. If there is failure of 1 of the 2 paramesonephric ducts to develop, what other

structure is most concomitantly absent?
a. Ovary
b. Fallopian tube
c. Kidney
d. None of the choices

95. Which of the following Mullerian anomalies result from complete or incomplete
failure of the resorption of the uterovaginal septum after the fusion of the
paramesonephric ducts?
a. Unicornuate
b. Septate uterus
c. Didelphys uterus
d. All of the above

96. What is/are the common obstetrical complication/s of a septate uterus?

a. Preterm birth
b. Fetal death
c. Congenital malformation
d. All of the above

97. A 55 years old G4P4 4004 patient consulted the OPD due to post-menopausal
bleeding. Endometrial biopsy was done with report of endometrial adenocarcinoma.
Which of the following is the best management?
a. Intermittent progestin therapy
b. Continuous high dose progestin therapy
c. Hysterectomy
d. Hysterectomy with surgical staging

98. A 62 years old consulted due to abdominal enlargement. Ultrasound shows a huge
abdomino-pelvic mass with papillary solid areas within the mass measuring 5 x 5
cms. Tumor markers were elevated. What is the complete surgical plan for this
patient?
a. Total Hysterectomy with bilateral salphingo-oophorectomy
b. Total Hysterectomy with unilateral salphingo-oophorectomy
c. Peritoneal fluid cytology, Total Hysterectomy with bilateral salphingo-
oophorectomy with omentectomy, and lymphadenectomy
d. Peritoneal fluid cytology, Total Hysterectomy with unilateral salphingo-
oophorectomy with omentectomy, and lymphadenectomy
99. A 24 year old patient consulted the out-patient clinic with biopsy result showing
Schiller-Duvall bodies. What is the tumor marker of choice for her post-operative
monitoring?
a. Ca-125
b. LDH
c. Alpha-fetoprotein
d. B-HCG

100. During a laparotomy of a 33 years old patient, the left ovary was enlarged to a 17 x
15 cm cystic mass with smooth surface. The rest of the abdomino-pelvic organs
were smooth. Histopathology report showed serous papillary carcinoma with
metastasis to the left external iliac nods. Based on the latest FIGO staging, what is
the patient disease stage?
a. Stage IC
b. Stage IIB
c. Stage IIIA
d. Stage IVA

101. A 32 year old G2P2 patient consulted for 2 months history of serosanguinous
vaginal discharge with colicky abdominal pain with right lower quadrant palpable
mass. What is the most probable diagnosis?
a. Ovarian cancer
b. Fallopian tube cancer
c. Primary Peritoneal Cancer
d. Cervical cancer

102. A patient diagnosed of cervical cancer stage IA1, her cancer is most probably
_________.
a. Limited to the cervix
b. With cervical stromal invasion
c. Not grossly visible
d. All of the above

103. A patient diagnosed of cervical cancer consulted due to note of fecaloid material
oozing out of her vagina. The most probable stage of her disease is Stage:
a. I c. III
b. II d. IV

104. A 40 year old multigravida consulted due to postcoital bleeding. Speculum exam
revealed a 4 x 4 cm fungating mass along the anterior lip of the cervix and anterior
vaginal fornix. What is the most appropriate diagnostic management?
a. Pap smear
b. Direct punch biopsy
c. Transvaginal ultrasound
d. CT scan of the pelvis

105. If Stage I cervical cancer is undetected or left untreated, the first organ it will
metastasize to is the:
a. Endometrium
b. Vagina
c. Parametria
d. Bladder

106. A 35 year old multigravida consulted due to vaginal bleeding. Her LNMP = 19
weeks ago. Pelvic exam revealed cervix to be nodular with a 3 x 3 cm fungating
mass along the posterior lip. The parametria is nodular and not fixed to the pelvic
sidewall. If the diagnostic evaluation revealed a maligant neoplasm, what would be
the most appropriate management?
a. Surgery
b. Radiotherapy alone
c. Concurrent chemotherapy and radiotherapy
d. Await for the fetus to reach age of viability then give appropriate treatment
107. Which of the following risk factors pose the highest risk of developing Cervical
cancer?
a. Persistent HPV infection
b. Multiple sexual partners
c. Heavy smoking habit
d. Prolonged use of oral contraceptive pills

108. A 50 year old G6P6, menopaused, vendor, who is chronically constipated noted a
posterior vaginal wall bulge. Which of the following is the most likely diagnosis?
a. Urethrocele
b. Rectocele
c. Cystocele
d. Uterine prolapse

109. A 49 year old, G2P2, business woman, sexually active, presents with sensation of
something coming out of her vagina. On physical examination, the vagina was pale
and smooth. POP-Q examination revealed the following:
+3 +6 +7
6 1.5 10
+3 +6 -10
What is the appropriate management for the patient?
a. Vaginal Hysterectomy with anterior and posterior colporrhaphy
b. Sacrocolpopexy
c. Halban’s Procedure
d. Le Fort Colpocleisis

110. What is the first anatomical structure identified within the gestational sac?

a. Amnion
b. Embryo
c. Placenta
d. Yolk sac

111. What is the sonologic cystic structure noted within the embryonic brain? (arrow)

a. Diencephalon
b. Telencephalon
c. Mesencephalon
d. Rhombencephalon
112. What does the endometrium shown below indicate?

a. Proliferative endometrium
b. Periovulatory endometrium
c. Secretory endpmetrium
d. Endometrial hyperplasia

113. What is the structure below being fed by blood vessels?

a. Endocervical polyp
b. Endometrial polyp
c. Subserous myoma
d. Submucous myoma

114. What is the ultrasound structure pointed by the arrows?

a. Polyp
b. Myoma
c. Ovarian tumor
d. Endometrial cancer

115. What is the pink structure seen in this Pap smear slide?
 a. Parabasal cell
b. Intermediate cell
c. Normal squamous cell
d. Abnormal squamous cell

116. What is the organism shown below?

a. Candida albicans
b. Treponema pallidum
c. Gradnerella vaginalis
d. Trichomonas vaginalis

117. What is the organism causing the infection shown below?

a. Candida albicans
b. Treponema pallidum
c. Gradnerella vaginalis
d. Trichomonas vaginalis

118. What type of myoma is at the tip of the pointer?

 a. Subserous
b. Submucous
c. Intramural
d. intraligamentary

119. What is the specimen shown below?

a. Brenner’s tumor
b. Endometrial cyst
c. Mature cystic teratoma
d. Immature cystic teratoma

120. What is the specimen shown below?

a. Follicular cyst
b. Endometrial cyst
c. Serous cystadenoma
d. Hemorrhagic corpus luteum cyst

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