1. Your patient is visiting and expresses a concern about her vision changes and bilateral milky discharge from her nipples. During the exam you find that her vision is missing in the outer half of both her right and left visual fields. The first day of her last menstrual period was a several months ago. What is the most likely diagnosis?
A) Pituitary adenoma
B) Primary amenorrhea
C) Prolactinoma
D) Galactorrhoea
E) Hypothyroidism
Explanation: Prolactinoma is a pituitary tumor causing hyperprolactinemia (milky nipple discharge) and bitemporal hemianopia (visual field defect due to optic chiasm compression). Amenorrhea supports the diagnosis.
2. A 30 years old lady came in gynaecologic OPD with complaints of menstrual irregularities. She used to bleed for 5 days after every 28 days. But for last one year her menstrual cycle has become infrequent, and now she has not menstruated for last 6 months. What term is used for this type of complaint?
A) Premature ovarian failure
B) Menopause
C) Hypomenorrhea
D) Oligomenorrhea
E) Secondary amenorrhea
Explanation: Oligomenorrhea refers to infrequent menstruation (cycles >35 days). Secondary amenorrhea is absence of menses for ≥6 months in a previously menstruating woman (this patient is approaching that threshold).
3. A 20-years old nulliparous woman, known case of mental retardation presents in emergency department with the complaints of amenorrhea 8 weeks, severe pain in left lower abdomen. On examination her blood pressure is 80/60 mmHg, pulse 110 bpm, low volume, marked pallorness positive. Abdomen is tense and tender. Her urine pregnancy test is positive. Ultrasound shows fluid in ‘Pouch of Douglas’. Emergency laparotomy is planned for this patient. Regarding issue of consent for surgery, following approach is NOT preferred:
A) The Patient must be provided with all relevant information about the procedure and consent taken.
B) Clinical decision can be taken by the doctor working in best interest of the patient
C) Consent from family members as patient is incapable of giving consent
D) Seek second opinion from another practitioner
E) Seek advice from legal team
Explanation: In emergencies, doctors can act in the patient’s best interest, but consent from family (if possible) or legal advice is preferred over unilateral decisions. Option B bypasses ethical/legal safeguards.
4. A 35-years old lady para 2, presents in gynaecology outpatient department with complaint of pelvic mass. On examination, a 20-week size firm mass is present in hypogastrium. Ultrasound confirmed a 20 × 20 cm fibroid uterus. She is currently on combined oral contraceptive pills for contraception. She has no past medical or surgical history. Her myomectomy is planned after discussion. What is the most appropriate advice to her regarding prevention of venous thromboembolism?
A) Risk of venous thromboembolism is best assessed at the pre assessment clinic so that plans can be made for postoperative thromboprophylaxis.
B) All women are offered TED anti-embolic stockings.
C) Early mobilization and adequate hydration in early postoperative period.
D) Combined oral contraceptive pills should be stopped 4 weeks before surgery
E) Low molecular weight heparin is given according to venous thromboembolism risk assessment.
Explanation: COCPs increase thrombotic risk and should be stopped 4 weeks pre-surgery. Other measures (A, B, C, E) are also important but secondary to discontinuing COCPs.
5. Overall, 5-year survival rate for stage 3 ovarian cancer is:
A) 15%
B) 80-90%
C) 50-90%
D) 30-50%
E) <5 span="">
Explanation: Stage 3 ovarian cancer (spread to peritoneum or lymph nodes) has a 5-year survival rate of ~30-50%. Stage 1 exceeds 90%, while stage 4 drops to <20 span="">
6. A 16-year-old girl presents to the gynaecology clinic with primary amenorrhea. She is 148 centimetres tall and weighs 54 kilograms. Breast development is assessed as Tanner stage 2 And her pubic hairs are noted to be sparse. Further examination identifies cubitus valgus. She has no other dysmorphic features. What is the most likely diagnosis?
A) Congenital adrenal hyperplasia
B) Down syndrome
C) Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome
D) Testicular feminization
E) Turner syndrome
Explanation: Turner syndrome (45,X) presents with short stature, delayed puberty (Tanner stage 2 breasts at 16), cubitus valgus, and primary amenorrhea due to ovarian dysgenesis.
7. A-30-year-old woman come with C/O painful periods and severe discomfort during sexual intercourse for last six months. On vaginal examination uterus was retroverted, fixed and tender. Which one of the following is most likely diagnosis?
A) Endometriosis
B) Adenomyosis
C) Dermoid cyst
D) Nerve entrapment
E) Chronic pelvic pain
Explanation: Endometriosis classically causes dysmenorrhea, dyspareunia, and a fixed, tender uterus due to adhesions. Adenomyosis would cause a bulky (not fixed) uterus.
8. A 20-years old girl is undergoing laparotomy for advanced endometriosis. On opening peritoneal cavity there was dense adhesions in the pelvis. To avoid ureteric injury in this patient, what will be the best safe surgical step?
A) Reflecting bladder downwards
B) Emptying bladder before surgery
C) Opening Vesico-uterine fold of peritoneum.
D) Opening broad ligament for visualization of ureter
E) Cystoscopy and retrograde ureter stenting
Explanation: Direct visualization of the ureter (by opening the broad ligament) is the gold standard to prevent injury in dense adhesions. Stenting (E) helps identify but doesn’t prevent injury.
9. An 18-years old girl presents in gynaecologic OPD following unprotected sexual intercourse requesting for emergency contraception. What important question would you ask before advising emergency contraception?
A) Sexual health screening
B) Last menstrual period
C) Regular or multiple partners
D) Contraindication to oestrogen-based contraceptives
E) Timing of unprotected sexual intercourse
Explanation: Emergency contraception efficacy depends on time since intercourse (levonorgestrel works up to 72h, ulipristal acetate up to 120h). Other questions are relevant but secondary.
10. In Kartagener syndrome there is:
A) Excessively production of sperms
B) Loss of ciliary function of fallopian tube
C) Increased ability of sperms to penetrate ovum
D) Increased chance of vaginal canal to receive sperms
E) Deficiency of Sperms
Explanation: Kartagener syndrome (primary ciliary dyskinesia) causes immotile sperm due to defective dynein arms in cilia/flagella, leading to male infertility.
11. Which one of the following is most common complication of hysterectomy?
A) Injury
B) Bladder injury
C) Bowel injury
D) Haemorrhage
E) Thromboembolism
Explanation: Hemorrhage is the most frequent complication (1-2% of cases). Bladder/bowel injuries are rarer (<1 a="" but="" common="" is="" less="" risk.="" significant="" span="" thromboembolism="">
12. Which one is the most important acquired predisposing factor in genital organ prolapse?
A) Injury to the supporting structures during vaginal delivery
B) Congenital and acquired weakness of the supporting structures of the uterus
C) Under-nutrition
D) Increased weight of the uterus
E) Genetic predisposition
Explanation: Vaginal childbirth (especially prolonged labor, macrosomia) damages pelvic floor muscles and ligaments, the primary cause of prolapse. Other factors (B, C, D, E) contribute less.
13. Degree of uterine prolapse in which the external os. descends outside the vaginal opening but the uterine body does not protrude and still remains inside the vagina:
A) 0 degree
B) 1st degree
C) 2nd degree
D) 3rd degree
E) 4th degree
Explanation: 2nd-degree prolapse = cervix protrudes beyond introitus but uterus remains inside. 1st degree = cervix descends into vagina; 3rd degree = entire uterus protrudes (procidentia).
14. Starting of menstrual cycle before the age of ten years, is termed as:
A) Post-cocious
B) Precocious
C) Amenorrhea
D) Dysmenorrhea
E) Adolescence
Explanation: Precocious puberty = onset of menstruation before age 10 (or breast development before 8). Requires evaluation for central/peripheral causes.
15. A 25-years old lady is being planned for myomectomy. She is known case of congenital heart disease and is on warfarin. During preoperative assessment, the most important point is to:
A) Arrange additional investigations for high-risk patients.
B) Assess cardiac and lung functions.
C) Get review from haematologist for a detailed bridging plan.
D) Expert anaesthetist review before deciding for surgery.
E) Provision of high dependency unit bed in immediate postoperative periods
Explanation: Warfarin must be bridged with heparin/LMWH perioperatively to balance thrombotic risk (from congenital heart disease) and surgical bleeding risk. Hematologist input is critical.
16. The following type of absorbable suture has longest strength retention, duration:
A) Polyglactin—14-21 days
B) Catgut—rarely used, 7-14 days
C) Poliglecaprone—7 days
D) Polydioxanone—28 days
E) Nylon—indefinite duration, non-absorbable
Explanation: Polydioxanone (PDS) retains tensile strength for ~28 days (longest among absorbable sutures). Polyglactin (Vicryl) lasts 14-21 days, while catgut and poliglecaprone degrade faster.
17. A seventeen-year-old girl who is not sexually active presents with left iliac fossa pain. An ultrasound scan shows a 5 cm cyst on the left ovary which is complex in nature, with solid, calcified elements and fatty deposits noted on MRI. The likely diagnosis is:
A) Thecal luteal cyst
B) Tubo-ovarian abscess.
C) Serous cystadenoma.
D) Fibroma.
E) Dermoid cyst
Explanation: Dermoid cysts (mature cystic teratomas) contain ectodermal tissues (fat, calcifications, hair). Thecal luteal cysts are estrogen-secreting; abscesses occur in sexually active women; fibromas/serous cystadenomas lack fatty deposits.
18. A 35-years old presents in gynaecologic outpatient department with complaint of heat intolerance for last one year. She is amenorrhic for last one year. Her pregnancy test is negative. Serum FSH and LH are increased. The most likely cause is:
A) Idiopathic
B) Chromosomal
C) Autoimmune
D) Enzyme deficiencies
E) Infections
Explanation: Premature ovarian insufficiency (POI) is diagnosed with amenorrhea + elevated FSH/LH. Idiopathic causes account for ~90% of cases. Other causes (B-E) are less common.
19. Which one of the following hormones is primarily responsible for initiating the menstrual cycle?
A) Oestrogen
B) Progesterone
C) Follicle-stimulating hormone (FSH)
D) Luteinizing hormone (LH)
E) Testosterone
Explanation: FSH stimulates follicular growth in the ovary, initiating the menstrual cycle. Estrogen/progesterone are secondary players; LH triggers ovulation mid-cycle.
20. A 40-year-old lady with BMI 32kg/m² presented with 3 months amenorrhoea. Her pregnancy test is negative. Ultrasound report shows normal size uterus with endometrial thickness 10mm, ovaries have polycystic appearance. What would be the recommended management?
A) Abdominal hysterectomy
B) Laparoscopic ovarian drilling
C) Endometrial ablation
D) Withdrawal bleed with progesterone—Dx. PCOS
E) Diagnostic D & C
Explanation: This patient meets Rotterdam criteria for PCOS (oligoamenorrhea + polycystic ovaries). Progesterone induces withdrawal bleed to shed endometrium. Ovarian drilling/hysterectomy are not first-line.
21. A twenty-five-year-old girl presents with mid-cycle pain on a regular monthly basis. She is sexually active and does not take any contraception. The pain quickly resolves after 24 hours. She has a regular 28-day cycle. The likely cause of the pain is:
A) PID
B) Endometriosis
C) Mittelschmerz syndrome
D) Adenomyosis
E) Polycystic ovaries
Explanation: Mittelschmerz (German for "middle pain") is transient ovulation pain due to follicular rupture. PID/endometriosis cause chronic pain; adenomyosis causes dysmenorrhea.
22. Following are high risk factors for vulvovaginal candidiasis:
A) Chronic hypertension and kidney disease
B) COC pills and diabetes mellitus
C) Hepatitis and chronic liver disease
D) Genital herpes and warts
E) Low ferritin
Explanation: COCPs and diabetes increase glycogen in vaginal epithelium, promoting Candida growth. Other options (A, C-E) are unrelated to candidiasis risk.
23. Recommended treatment for stage II cervical cancer is:
A) Palliative treatment
B) Radical chemoradiotherapy
C) Radical hysterectomy
D) Simple hysterectomy
E) LLETZ (large loop excision of the transformation zone)
Explanation: Stage II (parametrial invasion) is treated with chemoradiotherapy. Surgery (C) is reserved for early stages (IA-IB1); LLETZ (E) is for pre-cancerous lesions.
24. Which hormone is most commonly associated with the development of virilism?
A) Estrogen
B) Progesterone
C) Testosterone
D) Insulin
E) Prolactin
Explanation: Virilization (hirsutism, clitoromegaly, voice deepening) results from excess testosterone (e.g., PCOS, adrenal tumors). Insulin resistance (D) exacerbates but doesn’t directly cause virilism.
25. A 52-year-old woman referred to gynae clinic with H/O post coital bleeding and foul-smelling vaginal discharge. Speculum examination shows suspicious looking cervix. What will be the initial investigation?
A) LLETZ
B) Colposcopy
C) Cervical biopsy
D) Pap's smear
E) MRI scan
Explanation: Pap smear is the first step to screen for dysplasia/cancer. Colposcopy (B) and biopsy (C) follow abnormal Pap results. LLETZ (A) is therapeutic; MRI (E) is for staging.
26. What is the most common symptom of vaginal estrogen deficiency?
A) Dryness
B) Dyspareunia
C) Itching
D) Spotting
E) Vaginal discharge
Explanation: Estrogen deficiency (e.g., menopause) causes vaginal atrophy, leading to dryness (A). Dyspareunia (B) and itching (C) are secondary to dryness. Discharge (E) suggests infection.
27. A 55-year-old patient presented with 24 weeks size mass in abdomen for last 6 months. Which one of the following will NOT be included in her differential diagnosis?
A) Fibroids
B) Ovarian mass
C) Peritoneal cyst
D) Ectopic pregnancy
E) Uterine malignancy
Explanation: Ectopic pregnancy is implausible at age 55 (post-menopausal). Fibroids (A) and ovarian masses (B) are common; uterine cancer (E) must be ruled out in this age group.
28. While counselling a woman for hysterectomy due to multiple fibroids, the most appropriate advice that you would give her is:
A) Hysterectomy increases risk of new urinary and prolapse symptoms
B) Oophorectomy is mandatory at time of hysterectomy
C) Decision to remove ovaries should be based on operative findings
D) Abdominal hysterectomy has similar recovery time as vaginal hysterectomy but removal of large fibroids is easier
E) Bladder and ureters are closely related to uterus, cervix, hence injury is common
Explanation: Oophorectomy is optional and depends on age/risk factors (e.g., BRCA). Option A is misleading (hysterectomy may improve urinary symptoms); D is false (abdominal hysterectomy has longer recovery).
29. The uterine arteries are the branches of:
A) Anterior division of internal iliac artery
B) Posterior division of internal iliac artery
C) External iliac artery
D) Common iliac artery
E) Is a continuation of external iliac artery
Explanation: Uterine arteries arise from the anterior division of the internal iliac artery. The posterior division gives rise to gluteal/pudendal arteries.
30. A 24-years old lady, para 1, visits contraceptive clinic requesting for injectable progestogen depot medroxyprogesterone acetate (Depo-Provera) for contraception. She asks you about the benefits and risks associated with this method of contraception. What should be your advice to her?
A) Intramuscular Depo-Provera has more efficacy than subcutaneous Sayana press
B) Return of fertility after discontinuation of Depo-Provera is immediate
C) Depo-Provera cannot be offered to women with HIV infection
D) It is associated with no gain in body weight.
E) It results in reversible loss of bone mineral density
Explanation: Depo-Provera causes reversible BMD loss (most significant in adolescents). Fertility returns after ~9-12 months (B is false). Weight gain (D) is common. It’s safe in HIV (C is false).
31. A 42-year-old para 2 woman comes to your gynaecology clinic with complaining of regular but heavy menstrual bleeding that is affecting her quality of life. Which one of the following investigations is most appropriate at her first clinic visit?
A) Full blood count (FBC)
B) Gonadotrophin assay
C) Thyroid function test
D) Transvaginal Ultrasound
E) Human chorionic gonadotropin
Explanation: FBC is the most appropriate first investigation to assess for anemia due to heavy menstrual bleeding.
32. A 30-years old lady, para 2 is undergoing laparotomy for persistent ovarian cyst of 6 X 6 cm, laparotomy is done by Pfannenstiel incision. Compared to midline incision, following features are UNLIKELY with this type of incisions:
A) Quicker to make and open abdomen.
B) Strong incision.
C) Cosmetically attractive
D) Less prone to herniation
E) Easy to extend
Explanation: Pfannenstiel incision is more difficult to extend compared to midline incision, though it has better cosmetic results and is stronger.
33. A 60-year-old woman underwent staging laparotomy for ovarian cancer. Her clinico-pathological assessment shows tumour confined to abdominal peritoneum with positive inguinal lymph nodes. Appropriate stage will be:
A) Stage II b
B) Stage II a
C) Stage III a
D) Stage IV a
E) Stage III c
Explanation: Ovarian cancer with positive lymph nodes is classified as Stage IIIC regardless of peritoneal involvement.
34. A 50-years old woman underwent total abdominal hysterectomy for multiple fibroids. After 6 hours of surgery, her observations are as follows. Blood pressure 80/40 mmHg, pulse 120 bpm, temperature 36.8 °F, respiratory rate 20 bpm, abdomen tense distended. No urine output since surgery. What is the likely complication?
A) Haemorrhage
B) Ureter injury
C) Bladder injury
D) Bowel injury
E) Venous thromboembolism
Explanation: The signs of hypotension, tachycardia, tense distended abdomen and anuria suggest postoperative hemorrhage.
35. During a routine pelvic examination in a sexually active female patient, the physician palpates a soft, round, mobile mass in the posterior vaginal fornix. The patient is asymptomatic and denies any history of pelvic surgery. What is the most likely diagnosis?
A) Bartholin's gland cyst
B) Nabothian cyst
C) Uterine fibroid
D) Ovarian cyst
E) Rectocele
Explanation: An asymptomatic, soft, mobile mass in the posterior fornix is most likely an ovarian cyst.
36. A 30-year-old woman diagnosed with polycystic ovary syndrome presented with primary sub-fertility of 4 years. Her BMI is 20. Her husband's semen analysis is satisfactory. Hysterosalpingogram has confirmed bilateral tubal patency. What is the most appropriate first line treatment for this couple?
A) In vitro fertilisation
B) Intracytoplasmic sperm injection
C) Intrauterine insemination
D) Ovulation induction by clomiphene citrate
E) Ovulation induction by GnRH and IUI
Explanation: For PCOS with anovulatory infertility, ovulation induction with clomiphene citrate is first-line treatment.
37. In vitro fertilization at which stage of embryologic development fertilized ova, is transferred into the uterine cavity:
A) 1-2 cell stage
B) 2-4 cell stage
C) 4-8 cell stage
D) 16-24 cell stage
E) 8-16 cell stage
Explanation: Embryos are typically transferred at the 8-16 cell stage (day 2-3 after fertilization).
38. A 29-years old woman came to gynae clinic for contraceptive advice after unprotected sexual intercourse. When counselling woman for emergency contraception, what information is most appropriate?
A) Levonorgestrel intrauterine system is licensed for use as emergency contraception
B) The ulipristal acetate is as equally effective as intrauterine contraceptive device when used for emergency contraception.
C) Copper intrauterine device can be inserted up to day 19 of a 28-day cycle.
D) Copper intrauterine device when used for emergency contraception, its effect is to delay ovulation
E) Levonorgestrel intrauterine system is the most effective method of emergency contraception
Explanation: Copper IUD is the most effective EC method and can be inserted up to 5 days (120 hours) after unprotected intercourse.
39. A young 25-years old lady presents in gynae outpatient department with significant and debilitating premenstrual syndrome. She requests for definitive cure for her symptoms, what will be the best advice?
A) A 3-month trial of GnRH analogues is required to suppress ovarian function.
B) Hysterectomy with ovarian conservation to prevent early menopausal symptoms and osteoporosis
C) Hysterectomy and bilateral salpingo-oophorectomy would alleviate the symptoms
D) Bilateral oophorectomy is advised to achieve definite cure.
E) Bilateral oophorectomy with immediate recourse to hormone replacement therapy is advised
Explanation: For severe refractory PMS, bilateral oophorectomy with HRT is the definitive treatment as PMS is ovarian cycle-dependent.
40. A 40-years old multiparous woman presented to gynae clinic with C/O heavy periods associated with pain. Her vaginal examination reveals bulky uterus however no adnexal mass felt. Most probable diagnosis for this lady is:
A) Endometriosis
B) Ovarian cyst
C) Adenomyosis
D) Tubo ovarian abscess
E) Endometrioma
Explanation: Adenomyosis typically presents with heavy painful periods and a diffusely enlarged uterus without adnexal masses.
41. Structures present within the vulval vestibule are:
A) Labia minora and glands of skene
B) Labia majora and labia minora
C) Bartholin gland and Skene gland
D) Labia minora and Bartholin gland
E) Minor vestibular gland only
Explanation: The vulval vestibule contains Bartholin's glands (major vestibular glands) and Skene's glands (paraurethral glands).
42. Amsel's criteria are test of choice for:
A) HIV
B) Bacterial vaginosis
C) Syphilis
D) Gonorrhoea
E) Trichomanial infections
Explanation: Amsel's criteria (homogeneous discharge, pH >4.5, positive whiff test, clue cells) diagnose bacterial vaginosis.
43. A female senior high school teacher complaint that she never developed secondary sexual characteristics like the of her friends. Her breasts never develop and she still hasn't experienced menarche During your review of systems you discovered that she lacks a sense of smell. What is primary diagnosis?
A) Asherman syndrome
B) Sheehan syndrome
C) Turner's syndrome
D) Kallman's syndrome
E) Polycystic ovarian syndrome
Explanation: Kallmann syndrome presents with anosmia and delayed/absent puberty due to GnRH deficiency.
44. Following is true for the vulval vestibule:
A) Covered with keratinized epithelium
B) Devoid of skin adnexa
C) Having pigmented epithelium
D) Having columnar epithelium
E) Does not contain Bartholin glands
Explanation: The vestibule has non-keratinized squamous epithelium without hair follicles or sweat glands (skin adnexa).
45. 32-year-old woman had normal vaginal delivery 6 months ago. She complaints of stress urinary incontinence on coughing and sneezing. Abdominal examination was unremarkable and on pelvic examination there was stress incontinence. What will be the mast appropriate strategy to manage her stress incontinence?
A) No action required
B) Pelvic floor muscle training
C) Ring pessary
D) Sling surgery
E) Urodynamic
Explanation: Pelvic floor exercises are first-line treatment for stress urinary incontinence, especially postpartum.
46. When do progesterone level rise to their highest point daring the normal menstrual cycle?
A) Between ovulation and beginning of menstruation
B) Immediately before ovulation
C) When the blood level of LH is at its highest
D) When 12 primary follicles are developing to antral stage
E) Remain same throughout menstrual cycle
Explanation: Progesterone peaks in the mid-luteal phase (about 7 days after ovulation).
47. Which one of the following is NOT true for Ca. cervix?
A) It is a preventable disease
B) Low grade CIN is low risk for cervical cancer
C) Screening by cervical cytology can detect premalignant lesion
D) HPV vaccine can treat Ca. cervix
E) Regular screening can pick recurrent disease
Explanation: HPV vaccine is prophylactic (prevents infection) but doesn't treat existing cervical cancer.
48. 35-year-old patient presented to gynae clinic with vulvovaginal discharge and itching for last 2 weeks. Discharge is curdy white in nature. She is known diabetic for 2 years. Most likely she had:
A) Trichomonial infection
B) Bacterial vaginosis
C) Candidal infection
D) Genital warts
E) Genital herpes
Explanation: Curdy white discharge with pruritus in a diabetic suggests candidal vulvovaginitis.
49. Most common benign ovarian tumour in young women is:
A) Serous cyst adenoma
B) Ovarian fibroma
C) Thecomas
D) Mucinous cyst adenoma
E) Germ cell tumours
Explanation: Serous cystadenoma is the most common benign ovarian tumor in reproductive age women.
50. A32-years old woman visits contraception clinic. She is seeking a method with lowest risk of thrombosis. She has a family history of venous thromboembolism in her first-degree relatives. What are the risks associated with combined hormonal contraception?
A) It increases the tendency of thrombosis in both venous and arterial circulation.
B) Venous thrombosis frequency is increased in relation to dose of progesterone.
C) Combined pills containing 3rd generation progesterone are safe in comparison to first- and second-generation progestogens
D) First- and second-generation progesterone containing pills are safer than 3rd generation.
E) Risk of venous thrombosis increased with time due to unmasking of thrombophilia
Explanation: Combined hormonal contraception increases risk of both venous and arterial thrombosis, especially in women with personal or family history of thromboembolism.
51. A 46-year-old para 2 woman is referred to your gynaecology clinic complaining of regular but heavy menstrual bleeding which is affecting her quality of life. Which one of the following associated features indicate the need for endometrial biopsy?
A) BMI greater than 30
B) Dysmenorrhoea
C) Failure of previous medical therapy
D) Iron deficiency anaemia
E) Uterus enlarged on vaginal examination
Explanation: An enlarged uterus in a woman >45 years with heavy bleeding requires endometrial biopsy to rule out malignancy.
52. A 16-year-old girl presents with primary amenorrhea you have examined her clinically and found that there is a strong suspicion of Turner syndrome. A peripheral blood test for karyotype has been reported as normal. What would be the next step in the management of this patient?
A) CT scan of the abdomen and pelvis
B) Magnetic Resonance imaging
C) Obtain a karyotype from other tissue such as buccal smear
D) Repeat peripheral karyotype
E) Ultrasound scan to define the pelvic organ size
Explanation: Mosaicism requires karyotyping from another tissue (e.g., skin fibroblasts or buccal cells) when blood karyotype is normal but clinical suspicion remains high.
53. A 45-years old para 5, is undergoing hysterectomy for fibroid uterus. Ultrasound shows a 6 × 6 cm ovarian cyst and a 6 × 6 cm fibroid uterus. On examination, she has first degree uterocervical descent. She requests for definitive treatment. What will be the most appropriate surgical technique for her?
A) Total abdominal hysterectomy and bilateral salpingooophorectomy
B) Laparoscopic assisted vaginal hysterectomy.
C) Total laparoscopic hysterectomy
D) Vaginal hysterectomy.
E) Staging laparotomy.
Explanation: Vaginal hysterectomy is preferred for uterine descent with benign pathology, being less invasive with faster recovery.
54. Before the pre-ovulatory surge in Luteinizing hormone, granulosa cells of the follicle secrete which one of the following hormones?
A) Testosterone
B) Estrogen
C) Inhibin
D) Progesterone
E) Prolactin
Explanation: Granulosa cells produce estrogen under FSH stimulation during follicular phase, which triggers the LH surge.
55. Which one of the following is a standard quantification tool for the measurement of the pelvic organ prolapse?
A) AFS score
B) Baden-Walker halfway scoring system
C) Bristol Female Lower Urinary Tract Symptom (BFLUTS)
D) King's College Health Questionnaire
E) Pelvic Organ Prolapse Quantification system POP-Q
Explanation: POP-Q is the ICS standardized system for objectively quantifying pelvic organ prolapse.
56. A 42-year-old woman is referred to gynaecology clinic with large fibroids. Two are intramural (5 x 6 cm, 6×5, 8 x 4 cm). Which one of the following would be a contraindication for uterine artery embolization (UAE) in her case?
A) Adenomyosis
B) Menorrhagia
C) Endometrial polyps
D) No further wishes for pregnancy.
E) Asymptomatic fibroids
Explanation: Future pregnancy desire is a contraindication for UAE due to potential ovarian dysfunction and pregnancy risks.
57. As menstruation ends oestrogen levels in the blood rise rapidly. What is the source of oestrogen?
A) Corpus luteum
B) Developing follicle
C) Endometrial glands
D) Stromal cells of ovary
E) Anterior pituitary gland
Explanation: Early follicular phase estrogen comes from the developing cohort of antral follicles under FSH stimulation.
58. A 45-years old para 1, obese woman, is undergoing staging laparotomy for ovarian cancer. She is known case of diabetes. Her surgery lasted for one hour and during postoperative period, she developed wound sepsis. Which one of the following factors in this patient puts her at highest risk of venous thromboembolism in immediate postoperative period?
A) Obesity
B) Medical disorder as diabetes
C) Prolonged surgery
D) Malignancy
E) Sepsis
Explanation: Active malignancy is the strongest independent risk factor for VTE (6-7 fold increased risk).
59. A 40-years old lady is being counselled for abdominal hysterectomy for benign pathology. While discussing regarding the removal of ovaries, what should be your advice regarding oophorectomy?
A) A sensible option
B) Is an option only for postmenopausal woman
C) Should be offered to this lady to decrease the risk of later ovarian cancer.
D) Ovaries should be left in-situ to preserve endogenous ovarian function.
E) It should not be offered to perimenopausal women with early menopausal symptoms
Explanation: Ovarian conservation is recommended until at least age 45-50 for endogenous hormone production unless high cancer risk exists.
60. In modern medical practice for early postoperative recovery, the patient preparation should start:
A) 24 hours before date of surgery.
B) 48 hours before admission to hospital.
C) One week before date of surgery
D) Two weeks before date of surgery
E) On day of admission to hospital
Explanation: Enhanced Recovery After Surgery (ERAS) protocols recommend preoperative optimization starting 2-4 weeks preoperatively.
61. A 65-year-old woman had a hysterectomy due to endometrial cancer. She recovered well but complained of dribbling urine for last 2 days. She was given a course of antibiotics for a presumed UTI. On review at 4 weeks later she complaints of continuous urinary incontinence. She has no dysuria no sensation of urgency. She needs to wear a pad at night and intermittently void good volume of urine with normal flow. Urine analysis is normal. What is your likely diagnosis?
A) Fistula
B) Occult underlying stress incontinence
C) Overactive bladder
D) Overflow incontinence
E) Urinary tract infection
Explanation: Continuous urinary leakage after hysterectomy suggests a vesicovaginal fistula, especially with normal voiding and no urgency/dysuria.
62. A 26-year-old girl came to gynae clinic with lower abdominal pain, altered vaginal discharge and dyspareunia. Her speculum examination reveals mucopurulent cervical discharge. Which one of the following is NOT included in her management?
A) Testing for all Sexually transmitted infection's is required
B) Sexual partner should be screened and treated
C) Antibiotics should only be given according to blood culture report
D) Referred to Genitourinary medicine clinic
E) Empirical therapy should be started immediately
Explanation: Empirical antibiotics for cervicitis/PID should begin immediately without waiting for cultures to prevent complications.
63. What will be the most appropriate treatment option for an eighty-year-old woman with a BMI of 25 presenting with post-menopausal bleeding, she is diagnosed Stage 1a endometrial adenocarcinoma on MRI and hysteroscopically guided biopsy?
A) Polypectomy and Mirena
B) Total abdominal hysterectomy and bilateral salpingo-oophorectomy in a local centre
C) Total abdominal hysterectomy and bilateral salpingo-oophorectomy in a cancer centre
D) Total abdominal hysterectomy and bilateral salpingo-oophorectomy and radiotherapy
E) Radiotherapy alone
Explanation: Stage 1a endometrial cancer requires surgical treatment (TAH+BSO), preferably in a cancer centre for optimal care. Adjuvant therapy isn't needed at this stage.
64. 46-year-old nulliparous woman has been referred by her GP. She has been treated for heavy regular menstrual bleeding with cyclical progestogens for a period of 6 months. The treatment has failed to improve her symptoms what is the most appropriate management?
A) Endometrial biopsy
B) Levonorgestrel intrauterine system
C) Non-steroidal anti-inflammatory drug
D) Pelvic ultrasound
E) Tranexamic acid
Explanation: LNG-IUS is first-line for heavy menstrual bleeding unresponsive to other medical treatments, as per NICE guidelines.
65. A 20-years old multiparous woman married for 6 months, came in gynaecologic OPD with complaints of nausea, vomiting and vertigo for last 2-3 weeks. She has no significant past medical or surgical history and currently she is not taking any medication. What is the most important initial question that you would enquire?
A) Date of last menstrual period
B) Regularity of menstrual cycle
C) Episodes of bleeding
D) Medical disorders
E) Risk factors for ectopic pregnancy
Explanation: Pregnancy must be ruled out first in a woman of reproductive age with nausea/vomiting. LMP is the key screening question.
66. Which one of the following factors increases the risk of ovarian cancer?
A) Multiparity
B) Hysterectomy
C) Obesity
D) Tubal ligation
E) COC pills
Explanation: Obesity increases ovarian cancer risk (via chronic inflammation and excess estrogen). Multiparity, COCPs, and tubal ligation are protective.
67. A 22-year-old girl presented with severe vulval itching and soreness. Perineal examination reveals vaginal stenosis and hypopigmentation. Most likely diagnosis is:
A) Vulval cyst
B) Candidal infection
C) Lichen planus
D) Contact dermatitis
E) Lichen sclerosus
Explanation: Lichen sclerosus classically causes itching, hypopigmented "porcelain-white" patches, and stenosis. It's not infectious.
68. After puberty obese patient have low chances of osteoporosis, because of:
A) Fall in FSH level
B) Fall in LH level
C) Conversion of more androgen into estrogen
D) Conversion of more oestrogen into androgen
E) Conversion of more androgen into progesterone
Explanation: Adipose tissue converts androgens to estrogen via aromatase, providing bone-protective effects in obesity.
69. A mother is concerned for 16-years old daughter. Daughter appears to have appropriate secondary sexual development but she never had menstrual period. Which diagnosis matches the daughter's symptoms most appropriately?
A) Primary amenorrhea
B) Oligomenorrhea
C) Secondary amenorrhea
D) Polymenorrhia
E) Gonadal dysgenesis
Explanation: Primary amenorrhea is defined as no menarche by age 15 with normal development or by age 13 without secondary sexual characteristics.
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