1. The characteristic feature of 'Border line' ovarian tumour is lack of:
A) Cellular atypia
B) Invasion of basement membrane
C) Pleomorphism
D) Local extension
E) Distant metastasis
Explanation: Borderline ovarian tumors show cellular proliferation and nuclear atypia but lack stromal invasion.
2. A 20-years old primigravida comes to outpatient's department at 7 weeks gestation with complaints of mild vaginal bleeding and abdominal cramps. On exam, cervix is closed and ultrasound shows single alive foetus, corresponding to gestational age. The likely diagnosis is?
A) Threatened miscarriage
B) Inevitable miscarriage
C) Missed miscarriage
D) Incomplete miscarriage
E) Complete miscarriage
Explanation: Threatened miscarriage presents with bleeding but closed cervix and viable pregnancy on ultrasound.
3. Regarding ectopic pregnancy: one of the common risk factors include in the history of:
A) Acute appendicitis
B) Appendicectomy
C) Caesarean section
D) Pelvic inflammatory disease
E) Endometriosis
Explanation: PID causes tubal damage which is the most common risk factor for ectopic pregnancy.
4. A 60-years old woman has undergone laparotomy for ovarian cancer. Cancer have found involved the left ovary and uterus along with peritoneal washings were positive for tumour cells. What will be the FIGO staging of ovarian cancer in her case?
A) Stage I c
B) Stage II a
C) Stage II b
D) Stage II c
E) Stage III c
Explanation: Positive peritoneal washings indicate stage III disease regardless of local spread.
5. A 46-year-old obese, diabetic presented with heavy and prolonged menstrual bleeding that is not settled even after taking tranexamic acid and cyclical progesterone. Which of the following investigation you advise?
A) Coagulation test
B) Transabdominal ultrasound
C) Transvaginal ultrasound
D) Endometrial biopsy
E) Serum thyroid stimulating hormone
Explanation: In women >45 years with risk factors (obesity, diabetes), endometrial biopsy is essential to rule out hyperplasia/cancer.
6. A 25-year-old nulliparous lady present for evaluation of sub fertility. Her husband has 2 children from 1st wife. She is obese with mild hirsutism. She has history of infrequent periods. Her likely cause of sub-fertility is:
A) Hypothyroidism
B) Hyperprolactinemia
C) Polycystic ovarian syndrome
D) Premature ovarian failure
E) Adrenocortical hyperplasia
Explanation: Obesity, hirsutism and oligomenorrhea are classic features of PCOS, a common cause of anovulatory infertility.
7. A 22-years old woman, para 0+0 was admitted in gynaecology emergency department with history of overdue 25 days, lower abdominal pain and syncopal attacks. She was looking pale with BP of 90/60 mmHg, low volume and feeble pulse. Clinical diagnosis of acute abdomen due to ectopic pregnancy was made. Which management option will be best to treat her?
A) Diagnostic laparoscopy
B) Laparotomy
C) Treatment of shock and observation
D) Blood transfusion
E) Transvaginal scan
Explanation: Hemodynamically unstable patients with ruptured ectopic pregnancy require immediate laparotomy.
8. A 35-years old woman present with confirmed diagnosis of over active bladder syndrome (OAB). It refers to combination of:
A) Frequency and burning micturition
B) Frequency and urgency of micturition
C) Frequency, dysuria and urge incontinence
D) Frequency, urgency and/or urge incontinence
E) Frequency and dysuria
Explanation: OAB is defined by urinary urgency, usually with frequency and nocturia, with or without urge incontinence.
9. A 55-year-old woman presents with post-menopausal bleeding. She is diagnosed as a case of carcinoma endometrium stage II. What is the best management option?
A) TAH + BSO
B) Radical hysterectomy at cancer cent
C) Radical hysterectomy at local hospital
D) TAH postoperative radiotherapy
E) Brachytherapy+ external beam radiotherapy
Explanation: Stage II endometrial cancer involves cervical stroma, requiring radical hysterectomy (preferably at specialized center).
10.One of the best predictors of imminent ovulation is elevated level of:
A) FSH
B) LH
C) Estrogen
D) Progesterone
E) Both estrogen and progesterone
Explanation: LH surge triggers ovulation within 24-36 hours.
11.Primary dysmenorrhoea describes the painful period since the onset of menarche and is associated with:
A) Fibroid
B) Endometriosis
C) Pelvic inflammatory disease
D) Cervical stenosis
E) No any pathology
Explanation: Primary dysmenorrhea occurs without pelvic pathology due to prostaglandin-mediated uterine contractions.
12.An infertile couple visits to an infertility clinic with semen analysis report. According to 'World health organization' (WHO) criteria; what is the reference limit for total sperm number in an ejaculate?
A) 33 million
B) 36 million
C) 39 million
D) 42 million
E) 45 million
Explanation: WHO 2021 reference lower limit for total sperm count is 39 million per ejaculate (closest option is D).
13.A young 30-year-old woman presents in gynae outpatient clinic with hysterosalpingogram report showing bicornuate uterus and absent left kidney. This defect occurs due to defective development of:
A) Mesonephric ducts
B) Mullerian ducts
C) Sino vaginal bulb
D) Urogenital sinus
E) Müllerian tubercle
Explanation: Bicornuate uterus results from incomplete fusion of Müllerian ducts; renal anomalies are associated due to shared embryologic origin.
14.A 35-years old lady presents in Gynaecology clinic with HMB and dysmenorrhoea. She is fit and healthy otherwise, pelvic examination is unremarkable. She refuses for hormonal methods of treatment. Which treatment would you recommend?
A) Danazol
B) Ethamsylate
C) Mefenamic Acid
D) Norethisterone
E) Tranexamic Acid
Explanation: NSAIDs (mefenamic acid) are first-line for dysmenorrhea and reduce HMB by 20-50% without hormonal effects.
15.Considering fundus of uterus as the commonest site for implantation of concepts, it is said to be ectopic pregnancy when implantation occurs in:
A) Anterior wall of body of uterus
B) Posterior wall of body of uterus
C) Lateral wall of body of uterus
D) Lower segment of uterus
E) Cervix
Explanation: Cervical pregnancy is a rare ectopic type (implantation in cervix); other options are normal uterine sites.
16.Considering Cervical intra epithelial neoplasia (CIN) as a premalignant condition of carcinoma cervix it is classified as low risk when the cellular changes involve:
A) Superficial one third
B) Intermediate one third
C) Bottom one third
D) Top two third
E) Whole thickness of epithelium
Explanation: CIN1 (low-grade) involves basal 1/3 of epithelium; CIN2-3 (high-grade) extends to 2/3 or full thickness.
17.A 38-years old woman presents with pelvic organ prolapse. Clinical examination reveals anterior vaginal wall prolapse. This results from damage to which of the pelvic organ supports:
A) Level 1/apical support
B) Level II support surrounding vagina anteriorly (Pubocervical fascia)
C) Level II support surrounding vagina posteriorly (Rectovaginal fascia)
D) Level III support
E) Perineal body
Explanation: Anterior wall prolapse (cystocele) results from weakened pubocervical fascia (Level II support).
18.Considering the clinical presentation in woman with fibroid, the common presenting symptom is:
A) Abdominal mass
B) Menstrual disturbance
C) Urinary frequency
D) Dysuria
E) Subfertility
Explanation: Heavy menstrual bleeding (HMB) is the most common symptom of fibroids (present in 30% cases).
19.Ureter is at risk of injury during hysterectomy due to its close relationship with:
A) Uterine artery
B) Internal iliac artery
C) Cervix
D) Vault of vagina
E) Uterine artery, Cervix and vault of vagina
Explanation: Ureter crosses under uterine artery ("water under bridge") and passes near cervix/vault, making these areas high-risk for injury.
20.A 30-years old Para 2+0 visits family planning clinic. After evaluation and counselling, she is motivated for combined oral contraceptive pill. The principal mechanism of action of this drug is mediated by:
A) Negative feedback effect on pituitary
B) Negative food back effect on hypothalamus
C) Effects on cervical mucus
D) Effects on tubal motility
E) Effects on endometrial receptivity
Explanation: COCP primarily suppresses FSH/LH via pituitary feedback, inhibiting ovulation (most effective mechanism).
21.A 25-years-old woman, para 0 was found to have an ovarian cyst on TVS during an infertility workup. Vaginal examination revealed a firm, cystic swelling of about 5 x 6 cm in left adnexa, adherent to retroverted uterus. Her periods were painful for 5 years serum C1-125 levels were 45 u/dl. What would be the most probable cause in this scenario?
A) Endometriotic cyst
B) Mucinous cyst adenoma
C) Fibroid uterus
D) Serous cyst adenoma
E) Tubo-ovarian mass (chronic PID)
Explanation: Endometrioma presents with dysmenorrhea, fixed adnexal mass, and mildly elevated CA-125 (<100 iu="" ml="" span="">
22.GnRH agonists being peptide in nature need not to be administered by:
A) Intra muscular injection
B) Slow-release depot-formulation
C) Intra nasal sprays
D) Oral route
E) Sub-dermal patches
Explanation: GnRH agonists are destroyed by gut enzymes; oral administration is ineffective.
23.A 14-year-old girl is brought by her mother due to failure to menstruate. On examination she has short stature, webbed neck, secondary sexual characters are under developed. The most common chromosomal anomaly leading to this disorder is:
A) Monosomy involving sex chromosomes
B) Monosomy involving autosomes
C) Trisomy involving sex chromosomes
D) Trisomy involving Autosomes
E) Chromosomal translocations
Explanation: Turner syndrome (45,X) is the most common cause of primary amenorrhea with short stature/webbed neck.
24.Considering the development of sexual organs gonadal rudiments; it appears as the genital ridge in intermediate mesoderm during the:
A) 2nd week of pregnancy
B) 3rd week of pregnancy
C) 4th week of pregnancy
D) 5th week of pregnancy
E) 6th week of pregnancy
Explanation: Genital ridges form in the 5th week; indifferent gonads develop by 6th week.
25.A young girl of 18-year age came with primary amenorrhea due to absent uterus and she is diagnosed as a case of Mayer-Rokitansky, Kuster Hauser (MRKH) syndrome (Mullerian agenesis). What is the karyotype of this syndrome?
A) 45XO
B) 46XX
C) 46XY
D) 47XXX
E) 47XXY
Explanation: MRKH syndrome involves Müllerian duct agenesis with normal 46XX karyotype and ovarian function.
26.A 35-year-old woman presents with abnormal uterine bleeding for which hysteroscopy is planned. She is at possible risk of:
A) Excessive haemorrhage
B) Perforation of uterus
C) Pelvic infection
D) Injury to urinary bladder
E) Injury to gut
Explanation: Uterine perforation is the most common complication of hysteroscopy (1-2% cases).
27.A 40 years lady presents with multiple uterine fibroids she wishes to undergo uterine artery embolization (UAE). Which essential investigation need to be carried out prior to UAE?
A) Transvaginal ultrasound
B) Computed tomography (CT scan)
C) Magnetic resonance imaging (MRI)
D) Hysteroscopy
E) Hysterosalpingo gram
Explanation: MRI pelvis is mandatory before UAE to map fibroids, exclude malignancy, and assess vascular anatomy.
Report Card
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