Obstetrics & Gynecology 4

1. Question

Which of the following is not a clinical criteria in the diagnosis of PID.

Oral temp more than 38⁰c
Abnormal cx and vaginal discharge
Adnexal tenderness
lower back pain
Cervical motion tenderness

2. Question

The followings statements are true of endoscopic surgeries, EXCEPT

Increased overall costs
Less tissue handling and drying out
Less scarring
Shorter convalescence
More rapid return to full activities

3. Question

Select the best option for diagnosis of diabetes in pregnancy:

Fasting blood glucose of equal or greater than 125mg/dl (7.0mmol/L)
A 2 hour plasma glucose level equal or greater than 180mg/dl (10mmol/L) during a 75g oral glucose tolerance test.
A random plasma glucose level equal to or greater than 180mg/dl (10mmol/L) in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis.
Hemoglobin A1C (HbA1C) equal to or greater than 5.5%.
A random plasma glucose level equal to or greater than 200mg/dl (11.1mmol/L) in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis.

4. Question

Abnormal presentations include:

Transverse lie.
Cephalic presentation.
Vertex presentation.
Breech presentation.
Oblique lie.

5. Question

The following are normal vaginal flora except:

Micrococci
Chlamydia trachomatis
Streptococcus Faecals
Anaerobic Streptococcus.
Candida albicans

6. Question

Risk factor for laparoscopy

Obesity
Age
Medical illness
All of the above
None of the above

7. Question

Select the best option in management of a Para 1 (none alive due to intrauterine fetal death) booking at 20 weeks gestation with positive family history of diabetes in her father

2 hours post-prandial plasma glucose estimation at booking.
Fasting plasma glucose estimation at booking
Referral to the physician
Referral to the dietitian
Fasting and 2 hour plasma glucose at booking and arranging for oral glucose tolerance test between 26-28 weeks.

8. Question

Shoulder presentation results from:

Longitudinal lie.
Limb elongation.
Transverse lie.
Hand in the pelvis.
Brow presentation.

9. Question

Select one that is not a cause of genital ulcer.

Chancroid
Granuloma inguinale
Lymphogranuloma venereum
Tuberculoma
Herpes

10. Question

Contraindication to laparoscopy does not include

Severe cardiorespiratory dx.
Severe intra-abdominal bleeding
Severe intra-abdominal adhesions
Large intra-abdominal masses
Early stage of Malignancy

11. Question

One of the following is more of a predictor of IVF success:

Sperm motility
Sperm morphology
Age of the IVF Centre
Oocyte quality
Air quality in the IVF laboratory

12. Question

Twin will result from one of the following

Fertilization of three ova
Fertilization of one ovum
Fertilization of three ova with elimination of one embryo
Fertilization of one ovum with addition of one embryo
C and D above

13. Question

One of this is NOT a complication of hysteroscope

CO toxicity
Fluid overload
Serum electrolyte change
Pulmonary hypertension
Anaphylaxis from high molecular weight dextran

14. Question

Increase in one of the following has negative correlation with IVF:

Embryologist experience
Age of the woman
Age of the man
Previous pelvic surgery in the woman
Use of iron supplements by the woman

15. Question

Concerning Quadripulet

Could be Monozygotic
Paired dizygotic
Quadrizygotic
None of the above
All of the above

16. Question

Challenges facing endoscopy in Nigeria does not include

Training
Availability of skilled personnel and equipment
Cost of equipment
Acceptability of new procedure by the populace
Availability of Centre of Excellence

17. Question

Increasing implantation in oocyte-recipient post-menopausal women is best achieved by

Use of folic acid supplementation
Foley’s catheter insertion pre-embryo transfer
Endometrial scratching
Weekly progesterone injections
Pineapple diet supplementation

18. Question

The following are predisposing factor to twining EXCEPT

Long use of oral contraceptives
Race
Obesity
Older age
Low parity

19. Question

The followings are aim of the antenatal care, EXCEPT

Reduction of perinatal mortality and morbidity.
Reduction in maternal mortality and morbidity.
Ensure safe delivery – hospital or domiciliary delivery.
Provision of social and psychological support to women in pregnancy and puerperium
None of the above

20. Question

Select the best option in management of a young couple with 3 year history of infertility and only notable finding being confirmed severe oligoasthenoterazospermia

Reassurance and review in 6 months
Reassurance and review in 1 year
Counsel for 3 trials of intrauterine insemination
Give broad spectrum antibiotics
Refer to urologist and counsel for in-vitro fertilization

21. Question

Concerning Chorionicity

Division from Day 0-3 results in separate or fused placenta, 2 chorion and 2 amnion. It is rare
Division from Day 4-8 results in a single placenta, a common chorion and 2 amnion. Occurs in 1/3 of cases
Division from Day 8-13 results in a single placenta, chorion and amnion. Occurs in 2/3 of cases
Division from Day 13-15 may result in conjoined twins
All of the above

22. Question

About focus antenatal visit

1^st visit within 12weeks of pregnancy
2^nd visit within 22-26weeks
3^rd visit within 28-34weeks
4^th visit 36-40weeks

23. Question

Trophoblastic diseases include:

Ovarian Tumor.
Breast cancer.
Cervical carcinoma.
Hodgkins disease.
Hydatidiform mole

24. Question

The followings are problems of multiple gestation, EXCEPT

Exaggerated symptoms of pregnancy
Lower risk of UTI
Increased risk of early pregnancy loss
Preeclampsia-Eclampsia
Placenta abnormalities

25. Question

A 42 year old Para 0 + 1 woman who married 6 months ago comes to you in the gynaecological clinic with complaints of inability to conceive. Select the best line of management.

Politely ask her to return in 6 months time for necessary physical examination and examinations.
Politely ask her to go back and invite her husband to come with her.
Take a sexual and psychosocial history to look for causes.
Take a history, conduct a physical examination and request for necessary investigations.
Counsel her on the causes of delay in conception and ask her to return in 3 months time

26. Question

Trophoblastic disease is a spectrum of disorder characterized by the following except:

Abnormal proliferation of placental tissue
Include premalignant and malignant diseases.
The benign form (H. Mole) is not treatable by any known medical method.
The most malignant type (choriocarcinoma) is a systematic disease that spreads widely but usually responds to chemotherapy.
All of the above.

27. Question

Concerning delivery

Give episiotomy if indicated and the cervix is fully dilated.
Do not deliver the placenta of the first twin but give oxytocic
Check for the lie of the second baby but do not rub up the contraction
Examine for any laceration and repair it and the episiotomy promptly if given
Continue oxytocin infusion for about 30minutes after delivery. Add 20IU of oxytocin to 500mls of IVF

28. Question

In the same woman above, you elicit some physical signs. One of which is a 14 week sized pelvic mass. Abdominal, pelvic examination and pelvic ultrasound scan confirm this is a 10 cm pedunculated fibroid. Select the best line of management.

Ask the woman to invite her husband for a fuller discussion and consultation on the options of treatment.
Admit the woman for observation on the ward because of the risk of stalk torsion.
Admit the woman on the ward and prepare for myomectomy.
Prescribe a gonadotrophin releasing-hormone analogue to shrink the fibroid.
Counsel her on the need for endoscopic examination.

29. Question

Commonest form of gestational trophoblastic diseases (GTDs) is

Choriocarcinoma
Chorioadenoma destruens
Placental site trophoblastic tumor
Hydatidiform mole
Persistent trophoblastic tumor

30. Question

Indication for Caesarean section in multiple pregnancy includes all the followings, EXCEPT

High order of multiple gestation ( Triplet and above)
Non vertex T1
Previous Caesarean section
Assisted Conception
None of the above

31. Question

The same woman above has bilateral galactorrhoea, but no obvious breast lumps or masses. Select the best option in her management.

Request for a breast scan.
Request for a mammogram.
Request for a breast and chest magnetic resonance imaging scan.
Request for serum gonadotrophin estimations, serum estradiol, prolactin and progesterone estimations.
Prescribe bromocriptine tablets for the woman.

32. Question

Risk factors for GTDs include the following except:

Commoner at extremes of reproductive life (teens and forties).
Commoner in women of higher parities.
Previous history of GTD.
Diets deficient in protein, folic acid and carotene.
Diets rich in carotene and folic acid.

33. Question

One of the following is not correctly paired

Quintuplets = 5 fetuses
Decalet = 10 fetuses
Septuplets = 6 fetuses
Octalets = 8 fetuses
Nonalet = 9 fetuses

34. Question

The husband finally accompanies his wife for consultation. His semen analysis shows severe oligoasthenoteratozoospermia. Select the best next line of action.

Conduct a physical examination on the man of his genitals.
Conduct a full systemic physical examination on the man, including his genitals.
Enquire from the man how the semen sample was collected.
Repeat the semen analysis.
Counsel the couple on the need for assisted conception techniques.

35. Question

The following statement is correctly matched:

Complete hydatidiform mole: usually euploid and paternal in origin/abnormal conceptus without an embryo or fetus.
Partial (incomplete) mole: triploid abnormal conceptus without an embryo or fetus.
Invasive mole: not locally invasive to myometrium and adjacent structures.
Persistent gestational trophoblastic tumor (PGTT): does not occur after molar evacuation and is not locally invasive.
Placental-site trophoblastic tumor (PSTT): commonest type of GTD and does not follow term pregnancy.

36. Question

Concerning ultrasonography

Linear array: Ideal for Obstetrics especially in the 1st and 2nd Trimesters.
Sector scanner: Ideal for 1^st Trimester scanning and gynecological scanning.
Curvilinear Probe: Has the advantages of linear array and sector scanner.
Transvaginal Probe: ideal for abdomino-pelvic scanning especially for infertility
All of the above

37. Question

A young healthy couple consults you with complaints of infertility of 1 year duration. You request for semen analysis and it shows azoospermia. What is the best step of management?

Counsel on the need for third-party assisted reproductive technology treatment.
Repeat the semen analysis in two months.
Request for a hormone profile on the husband.
Conduct a post-coital test.
Send a consult to the Urologist.

38. Question

Hydatidiform mole truly:

Shows a snow storm appearance on ultrasonic examination.
Can be diagnosed by chest x-ray.
Does not present with vaginal bleeding.
Precedes choriocarcinoma in 25-50% of cases in UK.
All of the above.

39. Question

The commonest use of transvaginal ultrasound scan in infertility management

Monitoring of ovulation
Polycystic ovary
Uterine Synechiae
Anovulation
Luteinized unruptured follicle syndrome

40. Question

In the same young couple above, azoospermia is eventually confirmed. The next best option in management is:

Counsel the couple for in-vitro fertilization treatment.
Counsel the couple for artificial insemination treatment.
Request for tests of tubal patency and a hormone profile on the woman.
Invite the Urologist for co-management of the couple.
Counsel the couple on third-party assisted conception.

41. Question

The following is true about prognosis of GTDs except:

Prognosis is good generally with early presentation, availability of drugs and supportive systems.
Prognosis depends on the level of HCG at presentation.
Prognosis depends on distant metastasis.
Prognosis depends on response to chemotherapy.
Prognosis is same for low risk and high risk GTDs irrespective of the WHO prognosis factors present in the patient (risk scoring system factors).

42. Question

The following will cause vaginal bleeding EXCEPT

Intra-cavitary masses
Hydrosalpingitis
Benign endometrial hyperplasia
Adnexal masses
Missing or loss IUCD

43. Question

Intracytoplasmic injection of spermatozoa during in-vitro fertilization treatment is best indicated in the following circumstances.

In women with a diagnosis of polycystic ovarian syndrome because of the ovarian cortex quality.
Women with history of successful in-vitro fertilization treatment and recurrent early pregnancy losses.
Poor ovarian responders
Men with Praders’s orchidometer sizes less than 28mm bilaterally.
Men with severe oligoasthenoteratozoospermia.

44. Question

Choriocarcinoma is characterized by the following except:

Arises from trophoblastic epithelium involving cytotrophoblast and syncitiotrophoblast.
Hemorrhagic tumor with areas of tissue necrosis.
Often follows non-molar pregnancies.
Has villous pattern.
Associated with vascular invasion and wide spread dissemination resulting in systemic metastasis.

45. Question

The commonest therapeutic use of ultrasound in gynecological practise

During embryo transfer
For intra-cardiac injection of cytotoxic drug in the treatment of ectopic
Useful during insertion of IUCD to confirm correct placement.
To confirm complete evacuation of uterus
For treatment of uterine fibroid

46. Question

A 41 year old Para 0 + ² woman planned for in-vitro fertilization treatment is diagnosed with multiple small uterine fibroids of 3-4cm width on pelvic ultrasound scan. She is asymptomatic and the uterus is 14 weeks size. The next best line of evaluation is:

Perform a hysteroscopy
Perform a saline infusion hysterosonogram
Perform a combined laparoscopy and hysteroscopy
Perform a myomectomy
Reassure the woman.

47. Question

The following statement is true of hydatidiform mole

Are associated with ovarian dermoid and theca lutein cysts
Invade blood vessels and metastasize to the lungs.
Characteristically have a trisomic chromosome constitution.
Characteristically secrete alpha feto protein (AFP)
Occur in 1:1200 pregnancies in the UK and 1:5000 pregnancies in Nigeria

48. Question

Using ultrasound to diagnose early pregnancy

Gestational sac can be visualised as early as 3 weeks of gestation.
Embryo can be observed and measured by about 5½ weeks
Heart beat is first visualized by 8 weeks
Normal Heart Rate at 9 weeks is around 90 -110 beats/min
All of the above

49. Question

A 38 year old para 0+ ⁰who married 4 months ago is recently diagnosed with breast carcinoma and strongly wishes to pursue her reproductive career. The best option here is:

Controlled ovarian stimulation and in-vitro fertilization in her next cycle
Counsel for surrogacy
Counsel for adoption
Controlled ovarian stimulation and oocyte freezing/embryo freezing
Third-party oocyte donation and in-vitro fertilization.

50. Question

The following statements are true about choriocarcinoma except:

Has about 90% cure rate.
Has a prognosis related to time between antecedent pregnancies and diagnosis/treatment with chemotherapy
Is treated primarily by chemotherapy.
Can present after a miscarriage.
Has a better prognosis when it occurs after a term pregnancy than after a molar pregnancy.