Name: Revision 4: General Gynecology ( 175 Marks)

I. Choose the most correct single answer: (1 Mark each)

1. A 55-year-old woman who undergone a vaginal hysterectomy for third degree uterine
prolapsed one month ago is complaining now of constant fluid leakage per vagina. Your
most likely diagnosis is:
a. Vesicovaginal fistula.
b. Ureterovaginal fistula.
c. Ureteral ligation.
d. Ureteral ischemia leading to injury.
e. Bladder perforation injury.

2. A 39-year-old woman wets her underpants many times each day and she said she needs to
void but she can’t make it to the restroom in time. The best therapy is:
a. Oxybutynin.
b. Surgical repair of fistulous tract.
c. Placement of an artificial urethral sphincter.
d. Intermittent self-catheterization.
e. Sling operation.

3. A 35-year-old woman had undergone 4VD. She notes urinary loss many times per day
with coughing and sneezing. She doesn’t have dysuria or urge to void. Her urine culture is
negative. The best therapy is:
a. Sub urethral sling procedure.
b. Oxybutynin.
c. Surgical repair of fistulous tract.
d. Intermittent self-catheterization.
e. Hodge-Smith pessary.

4. A 28-year-old G1P1 woman complains of severe painful regular menses and severe
dyspareunia. She has no history of STDs or PID. the following most likely identify the
etiology of her infertility:
a. Laparoscopy.
b. Hysteroscopy.
c. BBT chart.
d. HSG.
e. Progesterone assay.

5. A 47-year-old G3P3 complains of severe menstrual cramps and heavy menstrual

bleeding. PV reveals a tender, diffusely enlarged uterus with no adnexal tenderness.
Endometrial biopsy is normal. The most likely diagnosis:
a. Endometriosis.
b. Endometritis.
c. Adenomyosis.
d. Uterine sarcoma.
e. Leiomyoma.

6. In the evaluation of a 26-year-old patient with 4months 2ry amenorrhea, B-HCG test is
positive, and prolactin level is 100ng/ml. this patient requires:
a. Routine obstetric care.
b. CT scan of her brain to rule out pituitary adenoma.
c. Repeat measurements of PRL to ensure that values do not increase more than 300ng/ml.
d. Bromocriptine to suppress prolactin.
e. Evaluation for possible hypothyroidism.

7. On a laparoscopy on a 28-year-old patient, multiple implants of endometriosis on the

uterosacral ligaments and ovaries were detected. you ablated all the visible lesions with
CO2 laser. You recommended postoperative medical treatment due to extensive lesions seen
intra-operatively. The best method used to follow up the prognosis:
a. CT Scan.
b. Ultrasound.
c. Hysteroscopy.
d. Laparoscopy.
e. CA 125.

8. A 28-year-old NG complains of bleeding between periods and heavy menses. She tried
OCPs and NSAIDs with no effect. The most appropriate at this time:
a. Perform a hysterectomy.
b. Perform a hysteroscopy.
c. Perform endometrial ablation.
d. Treat with a GnRH agonist.
e. Start the patient on a high dose progestational agent.

9. A 36-year-old morbidly obese woman presents by irregular heavy menses every 3-

6months. An office endometrial biopsy shows complex hyperplasia of the endometrium
without atypia. the hyperplasia is most likely related to the excess:
a. Estriol.
b. Estradiol.
c. Estrone.
d. Androstenedione.
e. Dehydroepiandrosterone.

10. A 53-year-old postmenopausal woman, G3P3, presents for evaluation of new onset
urinary leakage for the past 6weeks. Most appropriate first step in this patient’s evaluation:
a. Urine analysis and culture test.
b. Urethral pressure profiles.
c. Intravenous pyelogram.
d. Cystourethrogram.
e. Urethrocysoscopy.

11. A 46-year-old woman presents with “something bulging” from her vagina for 1year, but
progressively worse, she has urine leakage upon coughing. She has regular periods
&husband had vasectomy. O/E she has moderate cystocele, no rectocele or uterine
prolapsed. Best plan is:
a. Anticholinergic medications.
b. Antibiotic therapy.
c. Le Fort colpocleisis.
d. Anterior colporrhaphy and mid-urethral sling.
e. Use of vaginal estrogen cream.

12. A 42-year-old G3P3 presents 2weeks after vaginal hysterectomy, anterior colporrhaphy
and mid-urethral sling. She is concerned as she constantly leaks throughout the day. She
reports no urgency or dysuria. The most likely explanation for her complaint is:
a. Failure of the procedure.
b. Urinary tract infection.
c. Vesicovaginal fistula.
d. Detrusor instability.
e. Diabetic neuropathy.
13. In the previous patient, what is the next step to try to confirm your diagnosis:
a. Order an intravenous pyelogram.
b. Perform a cystoscopy.
c. Refer her to urology for further evaluation.
d. Perform a physical examination and an in-office dye study.
e. Order a CT of the pelvis with contrast.

Questions 14- 17: A 90-year-old G5P5 widow with HTN, chronic anemia, coronary heart
disease, is brought by her grand-daughter. She is alert and oriented and lives in an assisted
living facility. She complains of heaviness and pressure in the vagina, no significant urinary
or bowel problems. O/E, the cervix is seen just outside the introitus.
14. This is most likely:
a. Normal examination.
b. First degree uterine prolapse.
c. Second degree uterine prolapse.
d. Third degree uterine prolapse.
e. Complete procidentia.
15. In the previous patient, what is the best next step in her management:
a. Reassurance.
b. Placement of a pessary.
c. Le Fort colpocleisis.
d. Vaginal hysterectomy with apical repair.
e. Anterior colporrhaphy.
16. If instead of the scenario described earlier, this patient told you that she was
asymptomatic from this POP, what would be the best management:
a. Reassurance.
b. Placement of a pessary.
c. Vaginal hysterectomy.
d. Le Fort colpocleisis.
e. Anterior colporrhaphy.
17. If instead of the scenario described earlier, this patient is on Plavix due to her heart
condition, what would be the best management:
a. Reassurance.
b. Placement of a pessary.
c. Le Fort colpocleisis.
d. Vaginal hysterectomy with apical repair.
e. Anterior colporrhaphy.

Questions 18- 20: An 18-year-old G0 comes to see you due to urinary frequency, urgency,
and dysuria. she also noticed bright red blood in her urine. She reports some midline lower
abdominal discomfort. She had intercourse for the first time 5days ago with condom. There
is no flank tenderness and the patient’s temperature is normal.
18. The most likely diagnosis is:
a. Chlamydia cervicitis.
b. Pyelonephritis.
c. Acute cystitis.
d. Acute appendicitis.
e. Monilia vaginitis.
19. Best next step for evaluation of this patient:
a. Urine culture.
b. Intravenous pyelography.
c. Cystoscopy.
d. Wet smear.
e. Treat her with a different antibiotic.
20. The most likely organism causing the above condition is:
a. Chlamydia.
b. Pseudomonas.
c. Klebsiella.
d. Eshrichia coli.
e. Candida albicans.

21. A patient who is 8weeks pregnant, has been using a copper IUD. on vaginal
examination, the string is seen. most appropriate management of this patient:
a. Cut the string high in endocervix, allowing the device to retract as pregnancy develops.
b. Perform laparoscopy to rule out ectopic pregnancy.
c. Recommend therapeutic abortion.
d. Remove the device if signs of infection develop.
e. Remove the device immediately.

22. The main contraceptive action of the copper IUD is:

a. Prevention of implantation of the fertilized ovum.
b. Cessation of ovulation.
c. Induced abortion.
d. Production of a spermicidal environment.
e. Elevation of serum copper level.

23. A copper IUD has a contraception efficacy rate of:

a. 99%
b. 80%
c. 50%
d. 10%
e. 1%

24. Which of the following is true regarding the use of a contraceptive diaphragm:
a. It must be refitted if the patient gains more than 7kg.
b. Use of nonoxynol-9 will prevent HIV.
c. Diaphragms are made only of latex.
d. Diaphragms are recommended for women with a history of toxic shock syndrome.
e. The diaphragm should be removed immediately after intercourse.

25. After fitting a 30-year-old G2P2 for a diaphragm, you advise her not to leave the
diaphragm in place for longer than 24hrs because of the risk of:
a. loss of contraceptive effectiveness.
b. STDs.
c. Toxic shock syndrome.
d. HPV.
e. Adhesions.
26. A 37-year-old woman who complains of heavy painful menses requests contraception.
She smokes a pack of cigarettes a day. Best choice of contraception for this patient:
a. A copper-T IUD.
b. Low dose COCPs.
c. Progesterone implant.
d. Endometrial ablation.
e. Hysterectomy.

27. A 37-year-old woman has severe pain during menses which radiates into the anal region.
On bimanual exam, she has a small, retroverted uterus and tender nodules can be felt on
palpation of the uterosacral ligaments. which of the following does she most likely have?
a. Chronic PID.
b. Adenomyosis.
c. Fibroids.
d. Endometriosis.
e. Uterine carcinoma.

28. A 32-year-old G5P4 presents with an 8week history of amenorrhea and suggestive
symptoms of pregnancy. Physical examination reveals enlarged uterus 16weeks. US
confirms the presence of an 8weeks living pregnancy and a multiple fibroid uterus. The
correct management for this patient is:
a. Termination of pregnancy with elective myomectomy 2months later.
b. Termination of pregnancy with concomitant myomectomy.
c. Prudent observation with elective C-section at term.
d. Prudent observation anticipating probable vaginal delivery.
e. Myomectomy and follow pregnancy in usual way.

29. The commonest type of bleeding encountered with uterine leiomyomas is:
a. Postcoital spotting.
b. Mid-cycle bleeding.
c. Hypermenorrhea.
d. Oligomenorrhea.
e. Post-coital staining.

30. A 36-year-old G1P1 presents with pain and bleeding due to a large uterine fibroid
confirmed by US. The patient requests treatment but wants to preserve her fertility. The
best treatment is:
a. Oral contraceptives.
b. Uterine artery embolization.
c. Metformin.
d. Myomectomy.
e. GnRHa.

31. A 37-year-old P2 presents with a 10day history of heavy vaginal bleeding and lower
abdominal cramping. Pelvic examination reveals a 6cm mass judged to be a prolapsed
submucosal myoma protruding from the cervix on a 1.5cm stalk. Active bleeding is present,
and the patient’s hematocrit is 26%. The following is optimal management:
a. Transfusion and vaginal hysterectomy.
b. Transfusion and abdominal hysterectomy.
c. Biopsy of the mass and transfusion is necessary.
d. Transvaginal myomectomy and transfusion if necessary.
e. High dose birth control pills.

32. At the time of her annual examination, you find an approximately 10week-sized
irregular uterus on an asymptomatic 40-year-old woman. Her last exam 1year ago was
normal. your next step is:
a. Hysterectomy.
b. Endometrial biopsy.
c. Abdominal ultrasound and reexamination in 6months.
d. Fractional dilatation and curettage.
e. GnRHa therapy.

33. A 72-year-old woman complains of a lump protruding through the vagina with local
pressure symptoms. O/E, there is a visible uterine prolapse. All the following may be
etiologic factors EXCEPT:
a. Multiparity.
b. Chronic smoking.
c. History of large babies.
d. Hyperestrogenism.
e. Postmenopausal status.

34. Oral contraceptive pills have been shown to raise the risk of:
a. Ovarian cancer.
b. Breast cancer.
c. Endometrial cancer.
d. Thromboembolic events.
e. Ovarian cysts.

35. Which of the following is also associated with combined oral contraceptive use:
a. Increased risk of ovarian cancer.
b. Decreased risk of ovarian cysts.
c. Increased risk for ectopic pregnancy.
d. Increased incidence of dysmenorrhea.
e. Increased risk of menorrhagia.

36. A 19-year-old female comes to see you because she found a tear in her diaphragm
contraceptive device. She had intercourse the previous day. She is worried about unwanted
pregnancy. What is the appropriate action?
a. Do pregnancy test.
b. Reassurance.
c. Oral contraceptive pills, daily for 2weeks.
d. Levonorgestrel, one pill now and another in 12hrs.
e. Call for OBGYN consult.

37. A 60-year-old P4 on continuous combined HRT, presents with a 2weeks history of

irregular vaginal bleeding. best next step:
a. Dilatation and curettage.
b. Norethisterone 5mg tds.
c. Pipelle endometrial biopsy.
d. Sequential combined HRT.
e. TVS.
38. A 56-year-old woman with BMI: 38 and type 2 DM, presents with daily dark brown
staining on her underwear for the past week. she underwent menopause at 53yrs and has
had no further bleeding or discharge since then. there was no vaginal or vulval trauma and
her cervical smear 6months ago, was normal. O/E her cervix appears normal and no
evidence of external piles. urine test is negative for blood. next step is:
a. Dilatation and curettage.
b. Outpatient hysteroscopy.
c. Pipelle biopsy.
d. Transvaginal ultrasound.
e. Hysteroscopic biopsy.

39. What is the commonest cause of postmenopausal bleeding:

a. Endometrial polyp.
b. Endometrial hyperplasia.
c. Endometrial cancer.
d. Endometrial atrophy.
e. Endometritis.

40. A 33-year-old female presents with 3months irregular vaginal bleeding. prior, her
menstrual periods were normal. The most appropriate initial laboratory test is:
a. Hemoglobin and hematocrit.
b. TSH.
c. LH and FSH.
d. Estradiol.
e. HCG.

41. You are asked to evaluate a 6-year-old girl who has fallen from her bike and is
complaining of severe vulvar pain. The girl will not permit anyone to touch her vulva. The
upper labia majus is blue and there is vaginal bleeding. Next step:
a. Perform the examination under anesthesia.
b. Have her mother restrain her during the examination.
c. Have a medical assistant restrain her during the examination.
d. Send her home to use ice packs and re-examine her for the next day.
e. Perform a laparotomy to evaluate for penetrating trauma.

42. A 53-year-old woman who is amenorrheic for the past year, complains of vaginal
dryness, superficial dyspareunia, and urinary urgency. she has been treated for urinary
infection 2months back, there is no active UTI now, although symptoms persist. she has
been on HRT for the past 6months due to severe palpitations, hot flushes, and night sweats,
she is relieved of those symptoms. The following is appropriate for her:
a. Low-dose steroids are the most effective ttt in this case.
b. Reassure her as she is already on HRT that these symptoms will also subside gradually.
c. Start ttt with vaginal estrogen for relief of symptoms.
d. These symptoms can’t be due to estrogen deficiency as she is already on HRT.
e. Urodynamic study should be advised.

43. The most frequent cause of dyspareunia is:

a. Vaginismus.
b. Endometriosis.
c. Retroverted uterus.
d. Inadequate vaginal lubrication.
e. Pelvic inflammatory disease.

44. A 26-year-old woman is first seen at 28weeks gestation. Her history and physical
examination are normal except for the presence of a 2cm posterior cervical leiomyoma. Best
management for this patient:
a. Myomectomy at 36weeks.
b. Progesterone therapy to decrease the myoma size.
c. Watchful waiting.
d. Elective cesarean delivery at term.
e. Cesarean section and myomectomy at the same setting.

45. A 45-year-old woman had irregular vaginal bleeding, an endometrial biopsy through a
pipelle was insufficient. her BMI is 55, US shows ET of 7mm. Next step of management:
a. Reassure and see again if further bleeding.
b. Arrange for hysteroscopy under general anesthesia.
c. Arrange outpatient hysteroscopy.
d. Arrange a repeat endometrial biopsy.
e. Repeat scan in 6months.

46. A 32-year-old woman complains of heavy menstrual bleeding for 8months. O/E: no
physical abnormality. she feels very fatigued. which investigation you would consider first:
a. CBC.
b. Ferritin.
c. Thyroid profile.
d. Day 2 hormone profile.
e. Coagulation profile.

Questions 47- 50: A 28-year-old recently married (one year ago) NG presents with failure of
conception. She has regular period of 5days, average in amount and associated with pelvic
cramps referred to the back that starts one day before the period and increase with the
flow, start to fade by the end of menstruation. The patient complains of pain during
intercourse especially during penetration and more pronounced on the right side. She
cannot tolerate certain position during intercourse. The frequency of intercourse is twice
weekly. She gave a history of milky nipple discharge.
47. Based on the history, which of the following is most appropriate diagnosis?
a. Primary infertility and superficial dyspareunia.
b. Secondary infertility and deep dyspareunia.
c. Primary infertility and deep dyspareunia.
d. Secondary infertility and superficial dyspareunia.
e. None of the above.
48. The following investigations are considered essential in this case EXCEPT:
a. Pelvic ultrasound.
b. Prolactin.
c. Androstenedione.
d. Basal body temperature chart.
e. TSH.
49. On US, Rt ovary shows a 4cm cyst, unilocular and with ground glass appearance. Both
ovaries are located behind the uterus and close to each other. They are tender on
examination. The most likely cause(s) of infertility:
a. Tubal factor.
b. Ovulatory factor.
c. Peritoneal factor.
d. A and B only.
e. All of the above.
50. The following surgical procedure is indicated in this case:
a. Diagnostic hysteroscopy.
b. Diagnostic laparoscopy.
c. Laparoscopic cystectomy and ablation of endometriotic foci and adhesiolysis.
d. Laparotomy for ovarian cystectomy, adhesiolysis and ablation for endometriotic implants.
e. A and B.

51. A 57-year-old postmenopausal woman complains of “something coming out of her

vagina” and difficulty in opening her bowels. she had 4 children by normal vaginal
deliveries. her last child birth was 18yrs ago. The most likely diagnosis:
a. Anterior vaginal wall prolapse.
b. Genuine stress incontinence.
c. Overflow incontinence.
d. Posterior vaginal wall prolapse.
e. Stress incontinence.

52. The contraceptive injection, which lasts for 3months, contains which of the following:
a. Depot medroxyprogesterone acetate.
b. Ethinyl estradiol.
c. Etonorgestrel.
d. Levonorgestrel.
e. Norethindrone.

53. A 36-year-old woman is diagnosed with mild stage pelvic endometriosis at laparoscopy.
she has regular cycles; her partner has normal semen analysis. The couple have been trying
to conceive for 2years. The preferred initial ttt choice:
a. Clomiphene citrate induction.
b. GnRH agonist.
c. GnRH antagonist.
d. Laparoscopic excision/ ablation of peritoneal endometriosis.
e. Selective progesterone receptor modulator.

54. A 22-year-old woman asks her GP for most appropriate postnatal contraception for her.
she had uncomplicated vaginal delivery 6weeks ago at 40wks GA. she is intermittently
breast feeding. she and her partner are keen to space out childbearing by 2-3yrs and
requesting the most reliable contraception. she admits having difficulty in remembering to
take contraceptive medication. Most appropriate option for her:
a. COCPs.
b. Combined contraceptive vaginal ring.
c. Condoms.
d. Lactational amenorrhea.
e. Progesterone only implant.

55. A 22-year-old woman presents to her GP for advice regarding the most appropriate
postnatal contraception. she had an uncomplicated vaginal delivery at 40weeks gestation
3weeks ago. She is bottle feeding. She and her partner are keen to space out child bearing
by 1-2years and wishing a reliable form of contraception. She has history of irregular
menstrual cycles and PCO. Most appropriate contraceptive option for her:
a. COCPs.
b. Copper IUD.
c. LNG-IUS.
d. POPs.
e. Progesterone only injectable.

56. A 38-year-old woman suffers from 1ry infertility and endometriosis. Her recent TVS
suggests presence of 2.5cm endometrioma. Her pain is well controlled using simple
analgesics. she is due to undergo IVF. Best ttt for this endometrioma
a. Expectant management.
b. Laparoscopic ovarian cystectomy.
c. Laparoscopic ovarian cyst aspiration.
d. Laparoscopic ovarian cyst fenestration and drainage.
e. Laparoscopic salpingoophorectomy.

57. Medical management of fibroids is best indicated when:

a. Fibroid less than 3cm, not distorting the cavity and asymptomatic.
b. Fibroid less than 3cm, distorting the cavity and asymptomatic.
c. Fibroid less than 3cm, not distorting the cavity and causing heavy bleeding.
d. Fibroid more than 3cm, distorting the cavity and asymptomatic.
e. Fibroid more than 3cm, not distorting the cavity and asymptomatic.

58. A 45-year-old patient presents to ER 2days after UAE (Uterine Artery Embolization) for
a 20weeks size fibroid uterus. She has diffuse abdominal pain, generalized malaise,
anorexia, nausea, vomiting, low-grade fever and leukocytosis. Most likely diagnosis:
a. Arterial dissection.
b. Bowel perforation.
c. Endometritis.
d. Myoma expulsion.
e. Reactionary to embolization (post-embolization syndrome).

59. When taking a patient history, the following questions will most accurately ascertain the
length of the patient’s menstrual cycle:
a. How often do you menstruate.
b. Do you menstruate every month.
c. How many days are there between your periods.
d. How many days are there from the beginning of one period to the beginning of the next.
e. How many days are there from the end of one period to the beginning of the next.

60. A 17-year-old girl complains of severe bleeding during her menstrual cycle. she uses 20
tampoons per cycle, and it lasts for 7days. she denies being sexually active. What is the first
line of medical therapy for this patient:
a. NSAIDS.
b. Iron.
c. use more tampons/ PADS.
d. OCP.
e. Dilatation and curettage.
61. A 28-year-old white female consults you for irregular heavy menstrual periods. her
general and pelvic examination as Pap test examination as well as TVS are normal. she has
a negative pregnancy test. CBC and chemistry are normal. the next step should be:
a. Endometrial aspiration.
b. Dilatation and curettage.
c. LH and FSH assays.
d. Administration of estrogen,
e. Cyclic administration of progesterone for 3months.

62. A 24-year-old recently married lady presents for birth control advice. She wants to have
a 6months period of contraception. She has no history of medical or surgical problems. Her
family history is negative. Recommended birth control for this patient:
a. Condoms.
b. Diaphragm.
c. Intrauterine device.
d. Combined oral pills.
e. Tubal ligation.

63. A 36-year-old woman attends the family planning clinic as she wants to use COCP for
the next 3years and she is asking about the risks of thromboembolism. When does she have
the highest risk of venous thromboembolism?
a. After 5years of use.
b. After 4years of use.
c. After 3years of use.
d. In the second year of use.
e. In the first year of use.

64. The most common cause of stress incontinence is:

a. Constipation.
b. Raised intra-abdominal pressure.
c. Congenital weakness of sphincter.
d. Childbirth trauma.
e. Estrogen deficiency.

65. O/E of a 35-year-old multipara complaining of lower abdominal heaviness, uterus was felt
symmetrically enlarged of about 12 weeks size. All the following could be an etiology EXCEPT:
a. Uterine fibroid.
b. Adenomyosis.
c. Pregnancy.
d. Hematometra.
e. Chronic hypertrophic cervicitis.

66. A 35-year-old NG complains of increasing dysmenorrhea and pelvic pain. She has not become
pregnant over her 3years. PV shows tenderness of a 4cm right ovarian cyst. Most likely diagnosis:
a. Adenomyosis.
b. Pelvic congestion syndrome.
c. Endometriosis.
d. Chronic pelvic inflammatory disease.
e. Dermoid cyst.
67. A 65-year-old woman G3P3 is counseled regarding the risks of having a Burch
operation for SI. She has had a prior hysterectomy. O/E, she has a second-degree cystocele.
Urodynamics confirm genuine SI. The most common early complication of this procedure:
a. Vaginal bleeding.
b. Urinary retention.
c. Ureteral injury.
d. Development of an enterocele.
e. Urethrovaginal fistula.

68. In which of the following patients is uterine sarcoma most likely to be found:
a. 10-year-old girl with recent onset vaginal bleeding.
b. 9-year-old girl with a rapidly enlarged pelvic mass.
c. 55-year-old woman with a rapidly enlarging uterus.
d. 40-year-old woman with a slowly enlarging uterus.
e. 28-year-old multipara with menorrhagia.

69. A young female enters your office wanting to start oral contraceptive pills. You counsel
her the reasons she may not start pills, which are:
a. Impaired liver functions.
b. Undiagnosed uterine bleeding.
c. Past history of thrombophlebitis.
d. History of breast lesion.
e. All of the above.

70. A 55-year-old female presents with a period like vaginal bleeding for 5days that stopped
spontaneously. Your approach to the problem would be:
a. Reassure the patient and manage expectantly.
b. Administer provera 10mg OD for 15days.
c. Obtain endometrial tissue.
d. Administer hemostatics.
e. Perform Pap smear plus endocervical curettage.

71. Prolapse after menopause is attributed to the deficiency of which hormone:

a. Estrogen.
b. Progesterone.
c. Testosterone.
d. Cortisone.
e. Prolactin.

72. A 40-year-old, P4+0 with BMI: 25 had undergone subtotal hysterectomy for uterine
leiomyoma with ovarian preservation. She attends the clinic for counseling about hormone
replacement therapy (HRT). What do you suggest?
a. Consider combined estrogen progesterone HRT.
b. Estrogen only HRT should be initiated.
c. Progesterone only pills are quite effective.
d. Follow up by FSH and LH levels.
e. GnRH analogue.

73. A 19-year-old unmarried female presents 1 week after the end of her menses with
sudden onset of Rt lower abdominal pain. This pain is associated with a mild increase in
vaginal secretions and blood spotting. US reveals a normal sized uterus and an adnexal
clear cystic structure 22mm in diameter. What is your provisional diagnosis?
a. Mild PID.
b. Ovulatory pain.
c. Endometriosis.
d. Ectopic pregnancy.
e. Ovarian torsion.

74. Gold standard for the diagnosis of endometriosis is:

a. Laparoscopy.
b. TVS.
c. Hysteroscopy.
d. Midluteal progesterone level.
e. HSG.

75. A 25-year-old P1+0, is seeking a method of contraception. She delivered by CS 3months

ago and is nursing her baby with amenorrhea since delivery. She is planning to delay next
pregnancy for 3-5years. Most appropriate contraceptive method for her is:
a. Lactation suppresses ovulation and no extra protection.
b. Intrauterine contraceptive device.
c. Combined oral contraceptive pills.
d. Progesterone only pills.
e. Safe period.

76. A 38-year-old P1+0 attends the outpatient clinic for a contraceptive advice 2 months
after cesarean delivery. She is nursing her baby with amenorrhea and has not decided yet
for how long she will delay the next pregnancy. Most appropriate contraceptive method:
a. No need as long as lactational amenorrhea is present.
b. Progesterone only pills.
c. Combined oral contraceptive pills.
d. Postcoital douching.
e. Safe period.

77. A 60-year-old multipara, menopausal for 10 years, presents with slight vaginal bleeding.
She is hypertensive with poor control. Speculum examination is free and US reveals normal
size AVF uterus with 10mm endometrial thickness. Best management is:
a. Check FSH and E2 before taking an action.
b. Control hypertension and follow up.
c. Gestagens could be used for 6 months.
d. Fractional curettage.
e. Pelvic MRI for further uterine evaluation.

78. A 60-year-old multipara, menopausal for 10 years, presents by an attack of mild vaginal
bleeding. She is known to be hypertensive with poor control. Ultrasound reveals AVF
normal sized uterus with a 2 mm endometrial thickness. How will you proceed?
a. Control hypertension and follow up.
b. Progestagens for 6 months.
c. Hysterectomy.
d. Uterine artery embolization.
e. Check FSH and LH levels before taking an action.
79. The following is an absolute contraindication to combined oral contraceptive pills:
a. Previous DVT.
b. Previous CS.
c. Previous ectopic pregnancy.
d. Previous PID.
e. Patients with peptic ulcer.

80. Indications to interfere in a uterine myoma include one of the following:

a. Uterine size of 10 weeks size.
b. Intramural fibroid of 2 cm.
c. Non pedunculated subserous myoma.
d. Submucous fibroid polyp in infertile case.
e. Fibroid with hyaline degeneration.

81. A 35-year-old woman presents with inability to feel the threads of IUD which was
applied 2 years ago. Threads are not seen on speculum examination. Pregnancy test is -ve
and TVS shows empty uterus. Next step is:
a. Reassurance and apply another one.
b. Examination under anesthesia.
c. Plain pelvic X-Ray.
d. Hysteroscopic evaluation of the uterine cavity.
e. Laparoscopic evaluation.

82. Regarding malignant transformation of uterine fibroid, choose the correct statement:
a. Occurs in 10- 20% of existing tumors.
b. Most common type is adenocarcinoma.
c. Commonly presents with acute abdominal pain.
d. Post-menopausal growth in absence of replacement therapy is characteristic.
e. It is more common in cervical fibroids.

83. A 48-year-old multipara with regular cycles, presents with repeated attacks of contact
bleeding. Causes may include all the following EXCEPT:
a. Cervical cancer.
b. Cervical erosion.
c. Large submucous fibroid polyp.
d. Atrophic vaginitis.
e. Pelvic endometriosis.
84. In the previous patient, which of the following investigations will be most valuable?
a. Endometrial curettage.
b. Pap smear.
c. Hysteroscopy.
d. HSG.
e. CT pelvis.

85. A 50-year-old P1+2 presented with heavy menstrual flow for one year. TVS revealed a
submucous fibroid 4cm filling the uterine cavity. Best treatment is:
a. Medical treatment with LHRH analogue.
b. Medical treatment with gestagens.
c. Myomectomy.
d. Hysterectomy.
e. Insertion of hormone releasing IUD.
86. A 30-year-old P1+2 presents with heavy menstrual flow for one year. US reveals a
submucous fibroid filling the uterine cavity. Best treatment option is:
a. Medical treatment with GnRH analogue.
b. Medical treatment with gestagens.
c. Open abdominal myomectomy.
d. Laparoscopic myomectomy.
e. Total hysterectomy with bilateral salpingo-oopherectomy.

87. A 37-year-old multiparous woman presents with sexual unsatisfaction and mass
protruding through the vulva on straining. O/E, the mass is soft, pinkish, mainly from the
lower part of posterior vaginal wall. Most probable cause is:
a. Cystocele.
b. Rectocele.
c. Enterocele.
d. Bartholin cyst.
e. Dermoid cyst.

88. A 30-year-old primipara presents 2 months after vaginal delivery with lack of sexual
satisfaction. Examination reveals a weak levator ani tone with intact perineum. Cervix is
felt just above the level of ischial spines. What is the suitable treatment option?
a. Pelvic floor exercise.
b. Posterior colpo-perineorrhaphy,
c. Classical repair.
d. Colposacropexy.
e. Manchester-Fothergill operation.

89. What is the most common presentation of myoma:

a. Menorrhagia.
b. Metrorrhagia.
c. Pelvic pain.
d. Infertility.
e. Asymptomatic.

90. Indications to interfere in asymptomatic myoma include one of the following:

a. Uterine size reached 10weeks size.
b. Intramural fibroid of 2cm.
c. Non pedunculated subserous myoma.
d. Broad ligament fibroid.
e. Fibroid with hyaline degeneration.

91. A 30-year-old P1+2, presented by heavy menstrual flow for 1year. TVS revealed a
submucous fibroid 4cm filling the uterine cavity. Best treatment option to preserve fertility:
a. Medical treatment with LHGH analogue.
b. Medical treatment by progestogens.
c. Open abdominal myomectomy.
d. Laparoscopic myomectomy.
e. Hysteroscopic myomectomy.

92. Common symptoms associating endometriosis are:

a. Low grade fever/ malaise.
b. Habitual abortion/ preterm labor.
c. Menorrhagia/ metrorrhagia.
d. Dysmenorrhea/ dyspareunia.
e. Amenorrhea/ galactorrhea.

Questions 93- 94: a 26-year-old NG comes to ER because of severe right lower quadrant
pain that started last night associated with nausea, vomiting, and diaphoresis. On admission
to ER she required 5mg morphine to control her pain. PV is significant for right lower
quadrant tenderness and a tender right adnexal mass. Urine HCG is negative. Urine
analysis is normal. TVS reveals an 8cm right ovarian mass.
93. Which of the following is the most likely diagnosis:
a. Appendicitis.
b. Ectopic pregnancy.
c. Nephrolithiasis.
d. Ovarian torsion.
e. Pelvic inflammatory disease.
94. The management should be:
a. Conservative.
b. Discharge the patient.
c. Immediate laparotomy.
d. Antibiotics and observation.
e. Transvaginal aspiration.

Questions 95- 96: a 22-year-old woman comes to the physician for advice regarding birth
control. She has tried OCPs twice, for approximately two cycles each time, but stopped
because of irregular bleeding. She has had gonorrhea once. Examination is unremarkable.
95. Which of the following forms of birth control should be recommended for her:
a. Condoms.
b. Diaphragm.
c. Intrauterine device.
d. Progestin only pills.
e. Tubal ligation.
96. What is the advice you should give to the woman:
a. You have to do laparoscopy to check the condition of Fallopian tubes.
b. You should bring your husband for examination for gonorrhea.
c. You have to drain your Bartholin gland.
d. You have to receive treatment on regular basis to prevent reinfection.
e. Nothing specific.

Questions 97- 98: A 65-year-old woman comes to the physician because of bleeding from the
vagina. She has no medical problems and takes no medications. Endometrial biopsy is
performed. The patient complains of discomfort after the procedure but feels well enough to
go home. Later that night, her abdominal pain worsened. She comes to ER. US shows a
normal uterus and adnexae but a complex fluid collection posterior to the uterus.
97. Which of the following is the most likely diagnosis:
a. Bowel perforation.
b. Endometritis.
c. Endometrial cancer.
d. Tubo-ovarian abscess.
e. Uterine perforation.
98. What is the most suitable management:
a. Immediate laparotomy.
b. Antibiotics and observation.
c. Diagnostic laparoscopy.
d. Pan-hysterectomy.
e. Culdocentesis.

Questions 99- 100: A 54-year-old woman complains of hot flushes and cold sweats. Her
LMP was 3years ago. She is on HRT. She noticed vaginal bleeding 2weeks ago. The
bleeding is bright red painless following intercourse. Patient is concerned about tumor risk.
99. What is the following next step in the management of this case:
a. Perform speculum examination and obtain Pap smear
b. Increase the dose of estrogen
c. Reduce the dose of estrogen
d. Reassurance
e. Mefenamic acid
100. TVS revealed endometrial thickness of 8mm. Next step in the management of this case:
a. Expectant management.
b. Decrease the dose of estrogen replacement therapy.
c. Hysteroscopy and endometrial biopsy.
d. Advice hysterectomy.
e. Advice aromatase treatment.

Questions 101- 102: A 35-year-old NG recently married (since 1year) presented because of
her infertility problem. Her menstrual period is irregular and heavy since 6months and
lasts for 8days with cramps and pain in her lower abdomen. She has been diagnosed to have
hypochromic microcytic anemia and she is on iron supplement. Her hormonal analysis
revealed normal FSH, LH, TSH and PRL level. Her BBT chart is biphasic. her HSG that
revealed patent tubes but the uterine cavity showed a 2cm filling defect.
101. What is the most likely diagnosis:
a. Asherman syndrome.
b. Bicornuate uterus.
c. Submucous fibroid.
d. Adenomyosis.
e. Endometrial hyperplasia.
102. What is the most appropriate next step:
a. Diagnostic office hysteroscopy.
b. Endometrial biopsy.
c. Repeat HSG postmenstrual.
d. Order CA125.
e. Order MRI.

Questions 103- 104: A 38-year-old woman G4P4 with all NVD comes to the physician with
involuntary escape of urine. She also noticed a swelling that comes out of her vagina on
straining. She pushes this swelling inside her vagina and rest in bed as treatment. This mass
disappears on lying down but the escape of urine on coughing did not improve.
103. What is the most likely diagnosis:
a. Urethral diverticulum.
b. Gartner cyst.
c. Chronic uterine inversion.
d. Urinary stress incontinence.
e. Elongation of the cervix.
104. Which of the following is the most appropriate next step in management:
a. Expectant management.
b. Surgical repair.
c. Intravenous antibiotics.
d. Incision and drainage.
e. Marsupialization.

105. A 35-year-old multiparous woman has a chronic pelvic pain with bilateral endometriomas. The
gold standard modality for diagnosis and staging is:
a. TVS.
b. Pelvic MRI.
c. Laparoscopy.
d. Staging laparotomy.
e. Sonohysterography.

106. Choose the correct statement as regard treatment of endometriosis:

a. Cyclic OCP could be used for 6monbths.
b. Danazole is the treatment of choice for 1-2years.
c. Long acting GnRh agonists could be used for 6months.
d. Small dose estrogen can be used to reduce the associated pain.
e. Surgical excision should be offered in all patients.

107. A 25-year-old P1+0 attended the outpatient clinic seeking for a method for
contraception. She delivered by CS 3months ago and she is nursing her baby with
amenorrhea since delivery. She was planning to delay next pregnancy for 3-5years. What is
the most appropriate contraceptive method for this case?
a. Lactation suppresses ovulation and no need for extra protection.
b. IUD.
c. COPs.
d. Minipills.
e. Safe period.

108. A 40-year-old P2+0 diabetic attended the clinic for contraception. She had regular cycles but
she used to have more than average blood loss for about 7days. Examination and TVS were
normal. Most appropriate method for contraception for her:
a. Copper IUD.
b. Progesterone medicated IUD.
c. OCPs.
d. POPs.
e. Safe period.

109. A 45-year multipara, presented with a mass protruding from the vulva on straining and lack
of sexual satisfaction. Examination revealed a descent of posterior vaginal wall with deficient
perineum. Cervix was felt at level of ischial spines. Most suitable treatment for her:
a. Vaginal hysterectomy.
b. Posterior colpo-perineorrhaphy.
c. Classical repair.
d. Colposacropexy.
e. Manchester (Fothergill’s) operation.

110. A 50-year patient had undergone a vaginal hysterectomy 3 months ago for a complete
uterine prolapse. Since the operation she complains of involuntary continuous urine leakage
although she feels normal d e s i r e of micturition. Provisional cause for this incontinence:
a. Severe cystitis following surgery.
b. Detrusor instability following surgical manipulations.
c. Untreated stress incontinence.
d. Vesico- vaginal fistula.
e. Uretro-vaginal fistula.

111. Regarding parameters of normal bladder functions on cystometry:

a. Detrusor pressure filling <30cm H2O.
b. Presence of detrusor contractions during filling.
c. First desire to void at 400 ml.
d. No leakage during cough.
e. Residual urine <100ml.

112. The commonest cause of rectovaginal fistula is:

a. Badly healed complete perineal tear.
b. Congenital.
c. Rupture of peri-rectal abscess.
d. Cervical malignancy.
e. Post irradiation.

113. What is the most common presentation of interstitial cervical fibroid?

a. Menorrhagia.
b. Metrorrhagia.
c. Contact bleeding.
d. Pelvic pressure symptoms.
e. Excess cervical discharge.

114. Indications to interfere in asymptomatic myoma include one of the following:

a. Uterine size corresponds to 10 weeks pregnancy.
b. Intramural fibroid more than 4 cm in infertile cases.
c. Non pedunculated subserous myoma.
d. Routine removal during caesarian section.
e. Fibroid with cystic degeneration.

115. An infertile 30-year-old woman suffers from menorrhagia with pelvic pain. U/S
revealed a pedunculated submucous 3cm myoma. Best treatment for this case is:
a. Conservative, hoping spontaneous pregnancy to occur.
b. Abdominal myomectomy.
c. Hormonal treatment by progestins.
d. Hysteroscopic myomectomy.
e. Medical treatment by non-steroidal anti-inflammatory drugs.

116. An unmarried 20-year-old female with an accidently discovered ovarian endometrioma

2cm during ultrasound. Which of the following is the best treatment for her?
a. Aspiration of the cyst guided by ultrasound.
b. Unilateral ovariectomy for fear of subsequent malignancy.
c. Ovarian cystectomy.
d. Assurance, conservative management and follow up.
e. Small dose androgen for 6 months.
117. A 45-year-old multiparous woman had 2ry dysmenorrhea and menorrhagia for 2
years. Examination revealed mild symmetric enlarged uterus with mild tenderness. Pelvic
ultrasound revealed diffuse thickening of uterine muscles. Most likely diagnosis?
a. Endometrial hyperplasia.
b. Uterine leiomyoma.
c. Adenomyosis.
d. Endometriosis.
e. Congenital hypertrophy of uterine muscle.

118. A35 year old P1+0 attended the outpatient clinic asking for a temporary method of
birth control for few months till she decides her plan. She delivered by C.S 2months ago
and she is nursing her baby with amenorrhea since delivery. Most appropriate
contraceptive method for this case:
a. No need as long as she is lactating.
b. Intrauterine contraceptive device.
c. Combined oral contraceptive pills.
d. Progestogen only pills.
e. Safe period.

119. Which of the following is considered a contraindication to IUCD?

a. During lactation.
b. Previous C.S.
c. Previous missed IUD threads.
d. Previous ectopic pregnancy.
e. Patients with scanty cycles.

120. The most common risk factor for pelvic organ prolapse is:
a. Congenital pelvic floor weakness.
b. Menopausal atrophy.
c. Iatrogenic weakness following improperly formed hysterectomy.
d. Old complete perineal tear.
e. Short interval successive deliveries.

121. A 45-year multipara, presented with a mass protruding from the vulva on straining.
This was associated with some urinary frequency and lack of sexual satisfaction.
Examination revealed a descent of both anterior and posterior vaginal wall with deficient
perineum. Cervix was felt at level of ischial spines. Most suitable treatment for her?
a. Pelvic floor exercise.
b. Posterior colpo-perineorrhaphy.
c. Classical repair.
d. Colposacropexy.
e. Vaginal hysterectomy.

122. A 58-year-old woman has presented with complains of postmenopausal bleeding for the
past two weeks. Most essential investigation would be:
a. Colposcopy.
b. Pap smear.
c. Cone biopsy.
d. D& C (dilatation & curettage).
e. Hysteroscopy.
123. The cut-off size for excision of ovarian endometrioma is:
a. 1cm.
b. 2cm.
c. 4cm.
d. 10cm.
e. 15cm.

124. Woman with postmenopausal bleeding needs endometrial sampling if endometrium is

thicker than:
a. 1mm.
b. 2mm.
c. 5mm.
d. 8mm.
e. 10mm.

125. An enterocele is best characterized by which of the following statements:

a. It is not a true hernia.
b. It is a herniation of the bladder floor into the vagina.
c. It is a 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 prolapse of the vaginal wall with the lower rectum.

126. Uterine leiomyoma can be a cause of infertility. the mechanism by which leiomyoma
can cause infertility includes all the following EXCEPT:
a. Interfere with implantation due to distortion of the cavity if submucous.
b. Tubal obstruction caused by multiple fibroids including bilateral cornual fibroids.
c. Interfere with sperm motility in case of large cervical fibroid.
d. Interfere with fertilization due to lack of capacitation.
e. Pedunculated myoma protruding from the cervix.

127. All the followings are true about complications to IUCD EXCEPT:
a. It is contraindicated in undiagnosed vaginal bleeding.
b. It is contraindicated in cases with history of PID.
c. It is contraindicated in patients with a history of ectopic pregnancy.
d. It is contraindicated in patients with uterine anomalies making insertion difficult.
e. It is contraindicated in lactating patients.

128. All the following are side effects of COCPs EXCEPT:

a. Weight loss.
b. Hypomenorrhea.
c. Thromboembolic disorders.
d. Breakthrough bleeding.
e. Breast tenderness.

129. The commonest cause of stress incontinence is:

a. Constipation.
b. Raised intraabdominal pressure.
c. Congenital weakness of sphincter.
d. Childbirth trauma.
e. Estrogen deficiency.
130. A Choose one of the following conditions in which COCPs could be safely prescribed?
a. Previous deep venous thrombosis.
b. Previous treatment for cancer breast.
c. Previous ectopic pregnancy.
d. Active liver disease.
e. Coronary heart disease.

131. Regarding emergency contraception and levonorgestrel, which is correct:

a. It is teratogenic.
b. It decreases the risk of ectopic pregnancy.
c. It is ineffective if it is taken 24hours after unprotected sexual intercourse.
d. Can be administered as a single dose of 1.5mg or 2doses of 0.750microgm 12hours apart.
e. Tablets could be taken orally or vaginally.

132. The absolute contraindications to COCPs include all the following EXCEPT:
a. Blood pressure ˂140/90.
b. Smoking cigarettes (40/day).
c. Diabetes retinopathy.
d. Migraine with aura.
e. BMI˃ 40.

133. Most likely cause of abnormal uterine bleeding in 13-year-old girl is:
a. Uterine cancer.
b. Ectopic pregnancy.
c. Anovulation.
d. Systemic bleeding diathesis.
e. Trauma.

134. All the following are considered a temporary method of contraception EXCEPT:
a. Tubal ligation.
b. Coitus interruptus.
c. Male and female condoms.
d. IUCD.
e. Spermicides.

135. The commonest contraceptive method used in developing countries is:

a. IUCD.
b. Monophasic COCPs.
c. Biphasic COCPs.
d. POPs.
e. Male condom.

136. Regarding IUCD:

a. Is inserted just before the menstruation.
b. Is usually inserted under general anesthesia.
c. Has to be changed annually.
d. It does not affect lactation.
e. It has a failure rate about 5/HWY.
137. A 35-year-old woman presented with inability to feel the threads of IUCD which was applied
2yrs ago. Threads are not seen by speculum examination. All the following could be an etiology
EXCEPT:
a. Uterine perforation.
b. IUCD expulsion.
c. Pregnancy.
d. Retraction of threads into cervical canal.
e. Cervical atresia.
138. Regarding the previous case, the appropriate next step in management:
a. Pelvic plain X-Ray.
b. Pregnancy test.
c. TVS.
d. Diagnostic laparoscopy.
e. Office hysteroscopy.

139. COCPs increase the risk of all the following EXCEPT:

a. Ischemic stroke.
b. Breast cancer.
c. Ischemic coronary heart disease.
d. Ovarian cancer.
e. Transient elevation of liver enzymes.

140. A 24-year-old patient complains of heavy regular menstrual periods. No anatomical

cause. The most effective in reducing her menstrual flow is:
a. Tranexamic acid.
b. Dilatation and curettage.
c. DMPA.
d. Misoprostol.
e. Methergine.

141. A 40-year-old patient presents with DUB. You want to perform an endometrial biopsy.
The risk factor for endometrial hyperplasia in this patient is:
a. Obesity.
b. Postmenopausal.
c. Using DMPA.
d. Using copper IUD.
e. Being multipara.

142. Side effects of COCPs include all the following EXCEPT:

a. Hypertension.
b. Diabetes.
c. Breakthrough bleeding.
d. Amenorrhea after prolonged use.
e. Menorrhagia.

143. Non contraceptive benefits of COCPs include all the following EXCEPT:
a. Can be used to delay menstruation.
b. Treatment of dysfunctional uterine bleeding.
c. Treatment of 2ry dysmenorrhea.
d. Less risk of non-neoplastic ovarian functional cysts.
e. Less risk of PID.
144. A 30-year-old multipara attended the clinic 2 days after unprotected intercourse at day 8 of
the cycle. She was worried that unplanned pregnancy may occur. How can you counsel her?
a. No fear of pregnancy as she was still in the safe period.
b. Vaginal spermicidal gel should be applied immediately.
c. Start daily oral COCPs for 21days.
d. Urgent application of IUCD.
e. Start depot medroxy progesterone acetate injection IM and repeat every 12weeks.

145. Regarding uterine sarcoma, choose the correct statement:

a. It is a common tumor arising in the myometrium.
b. Prognosis is usually favorable.
c. It arises in more than 5% of benign leiomyoma.
d. Usually suspected when rapid recurrence occurs after myomectomy.
e. Treatment of choice is external radiotherapy.

146. Incidence of sarcomatous degeneration in a uterine leiomyoma is:

a. Less than 1%
b. About 3%
c. Ranges from 5-10%
d. About 15%
e. About 30%

147. A 60-year-old obese, hypertensive and diabetic woman presented by recurrent attacks
of mild vaginal bleeding after about 10years of complete cessation of menstruation. All the
following conditions could be an etiology for her EXCEPT:
a. Uncontrolled hypertension.
b. Atrophic vaginitis.
c. Cervical polyp.
d. Endometrial hyperplasia.
e. Benign leiomyoma.

148. A 55-year-old woman had undergone vaginal hysterectomy for a 2nd degree uterine
prolapsed 1 year ago. 3months after surgery, she developed frequency of micturition and
involuntary escape of large amount of urine when having a desire of micturition before
going to WC. Urine analysis showed normal values. Your provisional diagnosis:
a. Vesico-vaginal fistula.
b. Uretero-vaginal fistula.
c. Severe cystitis.
d. Overactive bladder.
e. Genuine stress incontinence.

149. A 35-year multipara discovered accidently that she has an intramural myoma 3cm. Next step:
a. Total abdominal hysterectomy with ovarian preservation.
b. Total abdominal hysterectomy with bilateral salpingo-oopherectomy.
c. Conservative management.
d. Myomectomy.
e. Uterine artery embolization.
150. A 45-year-old multiparous woman had 2ry dysmenorrhea & menorrhagia for 2 yrs.
examination revealed mild symmetrical enlarged uterus with mild tenderness. Pelvic US
revealed diffuse thickening of uterine muscles. Most likely diagnosis is:
a. Endometrial hyperplasia.
b. Uterine leiomyoma.
c. Adenomyosis.
d. Endometriosis.
e. Congenital hypertrophy of uterine muscle.

151. A 26-year-old newly married female attended with her husband due to severe
dyspareunia and failed intercourse since their wedding. All the following can contribute to
this condition EXCEPT:
a. Tough rigid hymen.
b. Pelvic endometriosis.
c. Hydatid cyst of Morgagni.
d. Longitudinal vaginal septum.
e. Vaginismus.

152. A 20-year-old nulliparous woman, presented with complete extrusion of the uterus
outside the vulva. This is best treated by:
a. Pessary treatment.
b. Classical repair.
c. Manchester operation.
d. Abdominal sacro-colpopexy.
e. Vaginal hysterectomy.

153. Indications for surgical removal of myoma include:

a. Uterine size of 10 weeks.
b. Intramural fibroid of 2 cm.
c. Non pedunculated subserous myoma.
d. Small submucus polyp in infertile cases.
e. Evidence of cystic degeneration.

154. A 39-year-old G3 P3 complains of severe, progressive secondary dysmenorrhea and

menorrhagia. Pelvic examination demonstrates a tender, diffusely enlarged uterus with no
adnexal tenderness. Endometrial biopsy shows secretory endometrium. Which of the
following is the most likely diagnosis?
a. Leiomyoma.
b. Endometritis.
c. Adenomyosis.
d. Endometriosis.
e. Uterine sarcoma.

155. A 40-year-old diabetic P3+0 attended the outpatient clinic seeking for a method for
contraception. She delivered by CS 3month ago. She is not lactating and used to have more
than average irregular cycles. What do you suggest for her?
a. No need to use any method.
b. Safe period.
c. Mirena intrauterine contraceptive device.
d. Combined oral contraceptive pills.
e. Progesterone only pills.
156. The commonest indication for ttt of uterine fibroid in a 42yrs old woman is:
a. interference with the reproductive function
b. rapid enlargement
c. excessive uterine bleeding
d. pain
e. dyspareunia

Questions 157- 158, select the most ideal treatment for dysmenorrheal. Each lettered option
may be used once, more than once, or not at all.
a. Acupuncture.
b. Prostaglandin inhibitors.
c. Gonadotropin-releasing hormone (GnRH) analogues.
d. Oral contraceptives.
e. Narcotic analgesic.

157. A 17-year-old consults you for evaluation of disabling pain with her menstrual periods.
The pain has been present since menarche, and is accompanied by nausea and headache.
Her medical history is otherwise unremarkable, and pelvic examination is normal. She is
not currently sexually active, and she has not tried any therapy for her dysmenorrhea.

158. A 19-year-old college student is seen for severe primary dysmenorrhea. She has no
medical problems and a normal pelvic examination. She has recently become sexually active
and doesn’t currently desire pregnancy.

Questions 159-165, refers to women seeking contraception. there is a list of option to be used
for the scenarios. each option can be used once, more than once or not at all.
a. COCPs.
b. Transdermal patches.
c. Copper IUD.
d. Progesterone only implants.
e. Hysteroscopic sterilization.
f. Laparoscopic sterilization.
g. Depot- provera injection.
h. LNG- IUS (Mirena).

159. A 24-year-old with strong family H/O of ovarian cancer, has had one child and is
planning to have bilateral oophorectomy following birth of second child. seeks effective
contraception that would be beneficial to her long-term health.

160. A 30-year-old, always forgetful with contraception, wishes the longest possible interval
between needing to renew contraception, in a stable relationship, nulliparous, not keen on
having things inserted in her vagina or uterus.

161. A 48-year-old, fed up with heavy irregular periods and current contraception of POP.
stable relationship, family complete.

162. A 40-year-old smoker, obese (BMI: 40), 3 previous LSCS, H/O of endometriosis, family
complete, seeks permanent effective contraception.

163. An 18-year-old painful irregular periods, wishes contraception that can help normalize
her periods. She is nulliparous. She doesn’t like tablets.
164. A 20-year-old, sickle cell disease, experiences painful sickle cell crises with
menstruation. She is nulliparous. She has had some symptoms alleviation when using POP,
but she is occasionally forgetful with pill taking. She wants to start a family in 1year.

165. A 26-year-old, infrequent periods, mild hirsutism, mild acne and PCO by US, wishes
effective contraception that may also reduce her hirsutism and acne.

Questions 166- 170 are preceded by a list of lettered options. Select the one letter that is most
closely associated with it. Each letter may be used once, more than once, or not at all:
a. Menorrhagia.
b. Metrorrhagia.
c. Contact bleeding.
d. Normal menses.
e. Hypomenorrhea/ amenorrhea.
f. Postmenopausal bleeding.

166. Adenomyosis.

167. Cervical erosion.

168. Uncomplicated submucous myoma.

169. Subserous fibroid.

170. Androgen producing ovarian tumor.

For each of the below statements, mark True/ False:

171. Non contraceptive use of Mirena IUCD is treatment of early endometrial carcinoma.

172. Laparoscopy is the gold standard for diagnosis and treatment of uterine adenomyosis.

173. An infertile patient was receiving induction of ovulation in the form of injections. Two
days after mid cycle, she experienced severe lower abdominal pain. Ultrasonography
showed bilateral, multilocular large adnexal cysts together with a large amount of free fluid
in the Douglas pouch. This condition is known as polycystic ovarian syndrome.

174. Important causes of dyspareunia include endometriosis and chronic salpingitis.

175. The risk of postoperative thrombo-embolism increases with age, obesity, prolonged bed
rest and use of combined oral contraceptive pills.

Best of Luck☺