1
Q
A 16-year-old with secondary amenorrhoea and BMI 17. Healthy, no PMH. Most appropriate initial investigation?
A) Bone mineral density scan
B) FSH measurement
C) DHEAS measurement
D) Karyotype
E) Thyroid function test
A
Answer: E) Thyroid function test
2
Q
55-year-old, post-hysterectomy 8 years ago. Symptoms: hot flushes and vaginal dryness. Strong family history of osteoporosis. First treatment option?
A) Combined sequential HRT
B) A selective estrogen receptor modulator
C) Estrogen-only HRT
D) Oral calcium therapy only
E) SSRI
A
Answer: C) Estrogen-only HRT
Explanation: Estrogen-only HRT is the most effective treatment for vasomotor symptoms and osteoporosis prevention. Progestogens are not required as she has no uterus.
3
Q
18-year-old, 10 weeks amenorrhea, light bleeding. TVS shows an irregular gestational sac with no fetal pole. Likely diagnosis?
A) Anembryonic pregnancy
B) Complete miscarriage
C) Hydatidiform mole
D) Incomplete miscarriage
E) Threatened miscarriage
A
Answer: A) Anembryonic pregnancy
Explanation: A gestational sac without an embryo is termed an anembryonic pregnancy (blighted ovum). It is a form of non-viable pregnancy.
4
Q
Primigravida, 39 weeks, spontaneous labour. At 18:00, cervix 6cm. At 22:00, cervix still 6cm. Fetus is OP. Most appropriate action?
A) Amniotomy
B) Commence intravenous oxytocin
C) Membrane sweep
D) Repeat VE after 2 hours
E) Repeat VE after 4 hours
A
Answer: A) Amniotomy
Explanation: In cases of slow or no progression in the first stage of labour with intact membranes, Artificial Rupture of Membranes (ARM) is the first-line intervention.
5
Q
17-year-old, sexually active, presents with painful vulval ulceration and dysuria. Most likely diagnosis?
A) Candida albicans
B) Herpes simplex virus
C) Herpes varicella virus
D) Human papillomavirus
E) Syphilis
A
Answer: B) Herpes simplex virus
Explanation: HSV typically presents with painful ulcers and dysuria. Syphilis (primary chancre) is usually painless.
6
Q
Woman on antenatal ward collapses and is unresponsive. Airway open but not breathing. Next step?
A) Commence artificial ventilation
B) Commence cardiac compressions
C) Get help
D) Give a precordial thump
E) Left lateral tilt
A
Answer: C) Get help
Explanation: Standard BLS/ALS guidelines mandate calling for help immediately upon finding a collapsed, unresponsive patient before starting CPR.
7
Q
Emergency call for PPH (1 litre blood loss). What is your first action?
A) Assess ABC and administer oxygen (15 l/min)
B) Bimanual compression of the uterus
C) Catheterise the bladder
D) Obtain blood for cross-match (4 units)
E) Site two large-bore IV cannulae
A
Answer: A) Assess the woman’s airway, breathing and circulation…
Explanation: Always follow the ABC protocol in an emergency. Assessing responsiveness and providing oxygen is the priority.
8
Q
Emergency call for PPH (500 ml blood loss). What is the most likely cause?
A) Cervical trauma
B) Coagulopathy
C) Retained placental tissue
D) Uterine atony
E) Vaginal tear
A
Answer: D) Uterine atony
Explanation: Uterine atony accounts for approximately 70% of all cases of postpartum haemorrhage.
9
Q
CTG shows type 1 variable decelerations. What is the cause?
A) Fetal head compression
B) Fetal hypoxia
C) Fetal movements
D) Placental insufficiency
E) Umbilical cord compression
A
Answer: E) Umbilical cord compression
Explanation: Variable decelerations are caused by cord compression. Early = head compression; Late = placental insufficiency/hypoxia.
10
Q
Woman receiving Magnesium Sulphate for pre-eclampsia has absent deep tendon reflexes and low urine output (5ml/2hr). What other observation is priority?
A) Blood pressure
B) Glasgow coma score
C) Pulse rate
D) Respiratory rate
E) Temperature
A
Answer: D) Respiratory rate
Explanation: Absent reflexes are an early sign of magnesium toxicity. Respiratory depression is a life-threatening late sign; RR must be monitored closely.
11
Q
What are the key features of polyglactin (Vicryl) sutures?
A) Braided, absorbable and synthetic
B) Braided, non-absorbable and synthetic
C) Non-braided, absorbable and natural
D) Non-braided, absorbable and synthetic
E) Non-braided, non-absorbable and natural
A
Answer: A) Braided, absorbable and synthetic
Explanation: Polyglactin is a synthetic, absorbable material. It is braided to provide better knot security.
12
Q
Nulliparous, 41 weeks, ROM. At 18:00, cervix 3cm. At 22:00, cervix 3cm. Fetus OP. Most appropriate action?
A) Administer prostaglandin per vaginam
B) Caesarean section
C) Commence intravenous oxytocin
D) Membrane sweep
E) Repeat VE after 4 hours
A
Answer: C) Commence intravenous oxytocin
Explanation: As the membranes have already ruptured and there is no progress, oxytocin augmentation is indicated.
13
Q
68-year-old, PMB, BMI 23. ET 4mm. Pipelle shows neoplasm. Likely diagnosis?
A) Leiomyoma
B) Endometrial hyperplasia
C) Endometrial polyp
D) Endometrioid adenocarcinoma
E) Serous carcinoma
A
Answer: E) Serous carcinoma
Explanation: Serous carcinoma is an aggressive “Type 2” endometrial cancer seen in older women, often with a thin endometrium and unrelated to BMI.
14
Q
75-year-old, weight gain, hair loss, cold intolerance. High prolactin, normal electrolytes. Cause?
A) Antiemetic use
B) Hypothyroidism
C) Neuroleptic use
D) Prolactinoma
E) Renal failure
A
Answer: B) Hypothyroidism
Explanation: Primary hypothyroidism causes high TRH levels, which stimulates the lactotrophs in the pituitary to secrete prolactin.
15
Q
34-year-old multigravida, 7cm dilated. CTG variability <5 (after pethidine). Fetal blood sample (FBS) pH 7.23. Next step?
A) Delivery is indicated
B) Reassure the woman
C) Repeat FBS after 1 hour
D) Repeat FBS if FHR abnormality persists
E) Repeat FBS within 30 minutes
A
Answer: E) Repeat FBS within 30 minutes
Explanation: A pH of 7.21–7.24 is considered “borderline.” The FBS should be repeated within 30 minutes to monitor for deterioration.
16
Q
30-year-old primigravida (IVF), severe pain. Empty uterus on scan, β-hCG 5,500. Action?
A) Expectant management
B) Laparoscopy and salpingectomy if ectopic confirmed
C) Laparoscopy and salpingotomy if ectopic confirmed
C) Methotrexate injection
E) Repeat scan in 7 days
A
Answer: B) Laparoscopy and salpingectomy if there is an ectopic pregnancy
Explanation: High hCG (>1500–2400) with an empty uterus and severe pain indicates surgical management (salpingectomy is standard if the other tube is healthy).
17
Q
Ovarian cancer suspected. Which lymph nodes does the disease drain to first?
A) External iliac
B) Hypogastric
C) Inguinal
D) Internal iliac
E) Para-aortic
A
Answer: E) Para-aortic lymph nodes
Explanation: Ovarian lymphatics follow the ovarian vessels directly to the para-aortic nodes at the level of the renal vessels.
18
Q
Perineal tear involves 60% of the external anal sphincter. Internal sphincter and mucosa are intact. Classification?
A) Second degree
B) 3a degree
C) 3b degree
D) 3c degree
E) Fourth degree
A
Answer: C) 3b degree tear
Explanation: 3a = <50% EAS; 3b = >50% EAS; 3c = Both EAS and IAS involved.
19
Q
Where is the flexion point on the fetal head for ventouse application?
A) 3 cm anterior of anterior fontanelle
B) Directly over anterior fontanelle
C) Directly over posterior fontanelle
D) Sagittal suture, 2 cm posterior to posterior fontanelle
E) Sagittal suture, 3 cm anterior to posterior fontanelle
A
Answer: E) On the sagittal suture line, approximately 3 cm anterior of the posterior fontanelle
Explanation: Proper application at the flexion point ensures the smallest diameter of the head presents through the pelvis.
20
Q
Previous C-section, Term, 6cm dilated. Contractions stop suddenly followed by fetal bradycardia. Likely diagnosis?
A) Placental abruption
B) Scar dehiscence
C) Scar rupture
D) Tetanic uterine contractions
E) Uterine atony
A
Answer: C) Scar rupture
Explanation: Loss of contractions and fetal distress (bradycardia) are classic signs of a ruptured uterine scar.
21
Q
Previous C-section, Term, 6cm dilated, 3 contractions in 10 min. What is the initial management?
A) Fetal blood sample
B) Continuous fetal monitoring (CFM) and VE 2 hours later
C) CFM and syntocinon infusion
D) Intermittent monitoring
E) Suggest mobilisation
A
Answer: B) You suggest continuous fetal monitoring (CFM) and vaginal assessment 2 hours following the last VE
Explanation: Women in VBAC (Vaginal Birth After Caesarean) require CFM and more frequent progress checks to detect early signs of scar failure.
22
Q
15-year-old girl requests contraception. She has a history of thromboembolism and dysmenorrhea. Which medical law applies?
A) Abortion Act 1967
B) Bolam
C) Bolitho
D) Fraser
E) Gillick
A
Answer: D) Fraser
Explanation: “Fraser guidelines” specifically refer to providing contraceptive advice/treatment to minors without parental consent.
23
Q
Long-distance runner, secondary amenorrhoea for 6 months. Scan shows polycystic ovaries. What investigation is required?
A) Vaginal ultrasound
B) MRI pelvis
C) Pituitary CT scan
D) DEXA scan
E) Adrenal ultrasound
A
Answer: D) DEXA scan
Explanation: In women with amenorrhoea lasting >6 months (especially with high exercise/low weight), bone density must be assessed to rule out osteoporosis.
24
Q
19-year-old, Bulimia, BMI 17. Amenorrhoea for 8 months. Most appropriate treatment to restore menses?
A) Cyclical northisterone
B) Daily injections of gonadotrophin
C) COCP
D) Oral estrogen and clomiphene
E) Estrogen patch and cyclical oral progesterone
A
Answer: E) Estrogen patch and cyclical oral progesterone
Explanation: Transdermal estrogen and cyclical progesterone is the recommended HRT regimen for hypothalamic amenorrhoea to protect bone health.
25
Laparoscopic cystectomy. To reduce vascular injury, what is the ideal camera tilt angle?
A) Zero degree
B) 10 degrees
C) 20 degrees
D) 30 degrees
E) 40 degrees
Answer: A) Zero degree
Explanation: Keeping the camera at zero degrees prevents disorientation and misidentification of anatomical structures.
26
Diagnostic laparoscopy, BMI 20. Target intra-abdominal pressure to be maintained during the procedure?
A) 5-10 mmHg
B) 10-15 mmHg
C) 15-20 mmHg
D) 20-25 mmHg
E) 25-30 mmHg
Answer: B) 10-15 mmHg
Explanation: 20–25 mmHg is for entry; 10–15 mmHg is the standard maintenance pressure to allow adequate visualization and ventilation.
27
Vulval melanoma, 1.5 cm lesion, labium majus. Breslow thickness 1.5 mm. Minimum surgical excision margin?
A) 0.5 cm
B) 1 cm
C) 1.5 cm
D) 2 cm
E) 2.5 cm
Answer: D) 2 cm
Explanation: For stage II melanoma (Breslow 1.1–2.0 mm), a 2 cm margin is standard NICE recommendation.
28
70-year-old, vulval melanoma with painful spinal metastases. Most appropriate palliative treatment?
A) Interferon-γ
B) Interleukin-2
C) Vemurafenib
D) Radiotherapy
E) Stereotactic radiosurgery
Answer: D) Radiotherapy
Explanation: Radiotherapy is highly effective at palliating pain from bone metastases.
29
15 weeks gestation, Syphilis (TPPA positive). Allergic to penicillin. Suggested treatment?
A) Metronidazole
B) Erythromycin
C) Ceftriaxone
D) Azithromycin
E) Amoxicillin and probenecid
Answer: C) Ceftriaxone
Explanation: In penicillin-allergic pregnant patients, Ceftriaxone is an alternative. Erythromycin/Azithromycin do not treat the fetus effectively.
30
Stage 3 ovarian cancer. CA125 dropped from 436 to 30 IU/ml (normal) 6 weeks post-chemo. Management?
A) Surgical resection
B) Radiotherapy
C) No treatment is indicated
D) Further chemotherapy
E) Brachytherapy
Answer: C) No treatment is indicated
Explanation: Normalization of CA125 within 1.5 months suggests complete remission; surveillance is then appropriate.
31
Emergency, left adnexal mass consistent with torted ovarian cyst. Recommended management?
A) Open left oophorectomy
B) Laparoscopic left oophorectomy
C) Laparoscopic detorsion and interval cystectomy
D) Laparoscopic detorsion and immediate cystectomy
E) Conservative management
Answer: C) Laparoscopic detorsion and interval cystectomy
Explanation: Current guidelines suggest detorsion and returning to perform the cystectomy after 2–3 weeks once the inflammation/oedema has resolved.
32
48-year-old, IVF (donor eggs), 12 weeks gestation. BMI 24. Recommended medication?
A) 400 mg progesterone
B) 200 mg ferrous sulphate
C) 150 mg aspirin
D) 40 IU clexane
E) 5 mg folic acid
Answer: C) 150 mg aspirin
Explanation: Conceived by egg donation is a moderate risk factor for pre-eclampsia. NICE recommends aspirin from 12 weeks.
33
46-year-old, singleton pregnancy, 36 weeks. Jehovah’s Witness. Risk of postpartum haemorrhage?
A) 1:2
B) 1:4
C) 1:6
D) 1:8
E) 1:10
Answer: B) 1:4
Explanation: Statistical risk of PPH in women of very advanced maternal age (over 45) is approximately 25%.
34
Stillbirth at 27 weeks due to abruption. When can she conceive again without increasing risk of recurrence?
A) Immediately
B) After resumption of menses
C) After 3 months
D) After 6 months
E) After 12 months
Answer: A) Immediately
Explanation: There is no clinical evidence that a short interpregnancy interval increases the risk of recurrent stillbirth.
35
Stillbirth at 35 weeks, weight 3rd centile. Placental villitis of unknown aetiology found. Subsequent pregnancy medication?
A) Aspirin, Vit D, LMWH, Hydroxychloroquine, Prednisolone
B) Aspirin, Vit D, LMWH, Hydroxychloroquine
C) Aspirin, Vit D, LMWH
D) Aspirin and Vit D
E) Aspirin only
Answer: D) Aspirin and vitamin D
Explanation: Standard prophylaxis for suspected placental insufficiency/villitis of unknown cause is Aspirin. LMWH/Steroids are reserved for specific histiocytic intervillositis.
36
Urinary stress incontinence and symptoms of obstructed defecation (finger in perineum to empty rectum). Best investigation?
A) Pudendal nerve latency
B) Pelvic MRI
C) Endoanal ultrasound
D) Defecating proctography
E) Anorectal manometry
Answer: D) Defecating proctography
Explanation: Defecating proctography is the gold standard for diagnosing structural causes of obstructed defecation like rectoceles or intussusception.
37
33 weeks gestation, upper abdominal pain. Amylase 4x normal. Suspected gallstone pancreatitis. Best imaging?
A) Ultrasound of upper abdomen
B) Plain abdominal X-ray
C) MRI with gadolinium
D) MRCP
E) CT scan
Answer: A) Ultrasound scan of upper abdomen
Explanation: Ultrasound is safe and the first-line investigation for gallstones and pancreatitis in pregnancy.
38
Severe abdominal pain at 22 weeks, acute pancreatitis. Nutrition advice?
A) Total parenteral nutrition
B) NBM and IV fluids
C) Nasojejunal feeding
D) Nasogastric feeding
E) Oral diet and fluids
Answer: E) Oral diet and fluids
Explanation: Current guidelines for mild-to-moderate pancreatitis encourage early oral feeding as tolerated to maintain gut integrity.
39
Breastfeeding mother takes Ulipristal Acetate (EllaOne) for emergency contraception. Breastfeeding advice?
A) Stop breastfeeding
B) Express and discard for 7 days
C) Express and discard for 72 hours
D) Express and discard for 24 hours
E) Continue as before
Answer: B) Express and discard breast milk for 7 days after dose
Explanation: Ulipristal is excreted in breast milk; as a precaution, breastfeeding is not recommended for one week after use.
40
50-year-old, PMB, BMI 24. ET 6mm, biopsy inadequate, bleeding has stopped. Next step?
A) TVS in 6 months
B) Reassure and discharge
C) Outpatient hysteroscopy in 6 months
D) Prescribe cyclic progestogen
Answer: B) Reassure the patient and discharge her
Explanation: (Note: Clinical judgment varies, but in this specific scenario where ET is only slightly elevated and bleeding has completely stopped with a low-risk profile, some protocols allow for discharge).
41
55-year-old, PMB, BMI 32. ET 7mm, biopsy negative but occasional spotting persists. Next step?
A) TVS
B) No further investigation
C) MRI scan
D) Endometrial biopsy
E) Hysteroscopy
Answer: E) Hysteroscopy
Explanation: Persistent postmenopausal bleeding with a thickened endometrium (≥5mm) requires visual inspection via hysteroscopy to rule out focal pathology (e.g., polyps) missed by biopsy.
42
Laparoscopic hysterectomy. Preoperative fasting advice?
A) NBM 10 hrs pre-op
B) NBM 8 hrs pre-op
C) No food 8 hrs, clear fluids until 4 hrs
D) No food 6 hrs, clear fluids until 2 hrs
E) NBM 6 hrs pre-op
Answer: D) No food for 6 hours with clear fluids until 2 hours preoperatively
Explanation: Standard "Fast Track" or ERAS guidelines recommend 6 hours for solids and 2 hours for clear fluids.
43
Correct statement concerning pelvic organ prolapse management?
A) Consider pessary alone or with pelvic floor training
B) Treat vaginal atrophy with estrogen before pessary
C) Review pessary patients every 6 months
D) Supervised pelvic floor training for stage 1-2
E) All of the above
Answer: E) All of the above
Explanation: These reflect current NICE and RCOG recommendations for the conservative management of prolapse.
44
Recognised surgical treatment for urodynamic stress incontinence?
A) Tension-free vaginal tape (TVT)
B) Posterior colporrhaphy
C) Augmentation cystoplasty
D) Laparoscopic hysterectomy
E) Urethral suspension
Answer: A) Tension free vaginal tape
Explanation: Mid-urethral slings like TVT are standard surgical treatments for stress incontinence.
45
40-year-old, stress incontinence. Which investigation should be performed in primary care?
A) Urinary diary
B) Urine cytology
C) Cystoscopy
D) Pelvic ultrasound
E) Pelvic X-ray
Answer: A) Urinary diary
Explanation: A 3-day bladder diary is a mandatory first-line assessment for any patient presenting with urinary incontinence.
46
Which of the following is a recognized cause of urinary stress incontinence?
A) Multiple sclerosis
B) Nulliparity
C) Young age
D) Endometriosis
E) Controlled diabetes
Answer: A) Multiple sclerosis
Explanation: Neurological diseases (like MS), age, pregnancy/parity, obesity, and smoking are known risk factors for incontinence. Nulliparity and young age are generally protective.
47
60-year-old woman with urge incontinence treated with oxybutynin. How frequently should she be reviewed by her GP once stable?
A) Every 6 weeks
B) Every month
C) Every 3 months
D) Every 6 months
E) Annually
Answer: E) Annually
Explanation: Long-term drug treatment for OAB should be reviewed annually in primary care. However, for women over 75, reviews should occur every 6 months.
48
Which is a recognized effect of Beta-3 receptor agonists (e.g., Mirabegron) on the urinary bladder?
A) Increased residual volume
B) Decreased bladder compliance
C) Decreased bladder capacity
D) Increased bladder capacity
E) All of above
Answer: D) Increased bladder capacity
Explanation: Beta-3 agonists stimulate receptors in the detrusor muscle to promote relaxation during the storage phase, thereby increasing bladder capacity and decreasing urgency.
49
In the post-operative patient, hyperchloraemia caused by 0.9% saline infusion is associated with:
A) Renal vasoconstriction
B) Renal vasodilatation
C) Increased GFR
D) Increased urine output
E) Metabolic alkalosis
Answer: A) Renal vasoconstriction
Explanation: Excess chloride (hyperchloraemia) causes renal vasoconstriction and a reduction in GFR, which hinders the kidneys' ability to excrete sodium and water.
50
Carbohydrate-rich beverages 2-3 hours before induction of anaesthesia are associated with:
A) Increased risk of bowel injury
B) A reduction in post-operative nausea and vomiting
C) Higher risk of vomiting during induction
D) Higher risk of aspiration pneumonitis
E) Increase in post-operative insulin resistance
Answer: B) A reduction in post-operative nausea and vomiting
Explanation: Pre-op carbohydrates improve well-being, reduce anxiety/thirst, attenuate insulin resistance, and reduce PONV.
51
Which one of the following is a recognised physiological effect of laparoscopy?
A) A fall in pulmonary vascular resistance
B) An increase in renal blood flow
C) An increase in splanchnic blood flow
D) An increase in hepatic blood flow
E) A reduction in urine output
Answer: E) A reduction in urine output
Explanation: The pneumoperitoneum increases intra-abdominal pressure, which decreases renal blood flow and GFR, leading to transient oliguria during the procedure.
52
Which of these is the single most effective intervention in managing shoulder dystocia?
A) Removal of anterior arm
B) McRoberts manoeuvre
C) Suprapubic pressure
D) Episiotomy
E) Internal rotation
Answer: B) McRoberts manoeuvre
Explanation: McRoberts (hyperflexion of maternal hips) is the most effective first-line intervention, with success rates reported up to 90%.
53
35-year-old taking therapeutic LMWH. When should she take her last dose before elective C-section?
A) 6 hrs
B) 12 hrs
C) 18 hrs
D) 24 hrs
E) 30 hrs
Answer: D) 24 hrs
Explanation: For therapeutic (high) doses of LMWH, the last dose should be 24 hours prior to surgery to ensure regional anaesthesia safety and reduce bleeding risk.
54
Post-hysterectomy, when should a maintenance dose of Warfarin be resumed?
A) Next day of surgery
B) 3 days after surgery
C) 7 days after surgery
D) 10 days after surgery
E) 2 weeks after surgery
Answer: A) Next day of surgery
Explanation: Because Warfarin has a slow onset of action, it can be resumed the evening of or the day after surgery if haemostasis is stable.
55
For minor procedures like LLETZ, what is the best agent to use for unexpected bleeding?
A) Suturing
B) Thermal cauterization
C) Monsel's solution
D) Cellulose gel
E) Vaginal packing
Answer: C) Monsel's solution
Explanation: Monsel’s solution (ferric subsulphate) or silver nitrate are standard topical haemostatic agents used for cervical procedures.
56
Emergency laparotomy for disturbed ectopic. Patient is on Warfarin. Best management for haemostasis?
A) Stop anticoagulant and check INR
B) Continue on Warfarin
C) Stop Warfarin and give LMWH
D) Stop Warfarin and give four-factor prothrombin complex
E) Stop Warfarin and give nothing
Answer: D) Stop Warfarin and give four-factor prothrombin complex
Explanation: In a life-threatening emergency (disturbed ectopic), Prothrombin Complex Concentrate (PCC) provides rapid reversal of Warfarin effects.
57
When should Clopidogrel be stopped before a hysterectomy?
A) Day of surgery
B) 5 days before
C) 7 days before
D) 2 weeks before
E) 3 weeks before
Answer: C) 7 days before surgery
Explanation: Clopidogrel irreversibly inhibits platelets for their entire lifespan (approx. 7–9 days).
58
What percentage of women aged 20 and above have urinary incontinence?
A) 5%
B) 10%
C) 25%
D) 30%
E) 35%
Answer: C) 25%
Explanation: Studies show that approximately 1 in 4 women over the age of 20 experience some form of involuntary urine loss.
59
Regarding the para-median abdominal incision:
A) Tendinous intersections of the rectus need to be dissected off
B) Anterior and posterior sheaths are opened in the midline
C) Skin incision is typically on the left side
D) Risk of hernia is higher than midline
E) Rectus is split in direction of fibres
Answer: A) The tendinous intersections of the rectus abdominis need to be dissected off
Explanation: The rectus muscle is retracted laterally, requiring dissection of these intersections. This incision is considered stronger than a midline incision.
60
Which statement regarding the Varicella Zoster vaccine is correct?
A) Confers life-long immunity
B) Routinely given to non-immune pregnant women
C) Is a live attenuated virus vaccine
D) Is not licensed in the UK
E) Termination recommended if given in pregnancy
Answer: C) Is a live attenuated virus vaccine
Explanation: It is a live vaccine and therefore contraindicated during pregnancy. Non-immune women should be vaccinated postpartum.
61
Effective intervention for a healthy woman with overactive bladder?
A) Pelvic floor physiotherapy
B) Vaginal oestrogen cream
C) Colposuspension
D) Bladder drill
E) Treatment with duloxetine
Answer: D) Bladder drill
Explanation: Bladder retraining (bladder drill) is the first-line behavioral therapy for OAB. Pelvic floor muscle training is first-line for stress incontinence.
62
Which symptom does NOT typically occur in women with detrusor overactivity?
A) Urinary urgency
B) Urinary frequency
C) Urinary incontinence during coitus
D) Urinary retention
E) Stress urinary incontinence
Answer: D) Urinary retention
Explanation: Detrusor overactivity involves an overactive bladder (urgency, frequency, urge leakage). Retention is associated with an underactive detrusor or obstruction.
63
Which definition relating to urinary incontinence is correct?
A) Stress incontinence – provoked by anxiety
B) Urge incontinence – leakage on coughing
C) Urgency – sudden desire to urinate difficult to defer
D) Nocturia – incontinence at night
E) Frequency – voiding once every 4 hours
Answer: C) Urinary urgency – sudden desire to urinate that is difficult to defer
Explanation: This is the standardized ICS definition. Nocturia is waking to void; nocturnal enuresis is incontinence while asleep.
64
When should a non-breastfeeding woman start the COCP postpartum?
A) 3 months after delivery
B) 7 days after delivery
C) 21 days after delivery
D) 6 months after delivery
E) None of the above
Answer: C) 21 days after delivery
Explanation: If not breastfeeding, the COCP can be started on Day 21. Before Day 21, there is an increased risk of VTE.
65
Which statement regarding syphilis is true?
A) Secondary syphilis is characterised by a chancre
B) Primary syphilis involves generalised lymphadenopathy
C) Primary syphilis presents with a painful ulcer
D) The chancre is usually in the perianal region, genitalia or mouth
E) Primary syphilis in women is typically symptomatic
Answer: D) The chancre is usually present in the perianal region, genitalia or mouth
Explanation: The primary chancre is typically a single, painless ulcer. In women, it is often asymptomatic if located on the cervix.
66
Which feature suggests severe OHSS?
A) Ultrasound evidence of ascites
B) Urine output of 500 mls over 24 hrs
C) Haematocrit > 45%
D) Ovarian size of 8–12 cm
E) Mild abdominal pain
Answer: C) Haematocrit > 45%
Explanation: Severe OHSS is marked by haemoconcentration (Hct > 45%), clinical ascites (not just ultrasound), and oliguria.
67
Which is true about primary amenorrhea?
A) First sign of puberty is menstruation
B) Absence of menses by age 14 if no secondary sexual characteristics
C) Absence of menses by age 12 if normal growth
D) Axillary hair begins at 9 years
E) First sign of puberty is axillary hair
Answer: B) Absence of menstruation by the age of 14 years in the absence of pubertal growth spurt and secondary sexual characteristics
Explanation: The first sign of puberty is usually breast budding (thelarche), followed by pubic hair (adrenarche), and finally menstruation (menarche).
68
Starting the POP—which does NOT require additional contraceptive cover?
A) Start 10 days after 1st trimester miscarriage
B) Start on day 7 of menstrual cycle
C) Start 7 days after TOP
D) Start within 6 weeks post-partum
E) Start within 21 days post-partum
Answer: E) Start within 21 days post-partum
Explanation: The POP can be started up to Day 21 postpartum without additional protection. If started after Day 5 of a menstrual cycle, 48 hours of protection is needed.
69
Which is NOT a contraindication (UKMEC 3 or 4) to Depo-Provera?
A) Active viral hepatitis
B) Suspicious vaginal bleeding
C) Healthy 38-year-old smoker
D) Diabetic retinopathy
E) History of stroke
Answer: C) Healthy 38-year-old smoker
Explanation: Progesterone-only injectables are generally safe (UKMEC 1 or 2) for smokers. Combined methods would be contraindicated (UKMEC 3/4).
70
40-year-old with intermenstrual bleeding and an endocervical polyp. Next step?
A) Cervical smear
B) Review in 6 months
C) Avulse polyp and send for histology
D) Hysteroscopy and endometrial biopsy
E) Dilatation and curettage
Answer: C) Avulse polyp and send for histology
Explanation: Most symptomatic endocervical polyps can be removed in the clinic via avulsion and sent for pathological confirmation.
71
Regarding CIN, which is true?
A) CIN II: Lower 2/3 of epithelium involved
B) CIN II: Middle 1/3 involved
C) CIN I: Upper 2/3 involved
D) CIN I: Upper 1/3 involved
E) CIN III: Lower 2/3 involved
Answer: A) CIN II: Lower 2/3 of epithelium involved
Explanation: CIN I = lower 1/3; CIN II = lower 2/3; CIN III = full thickness (but not past basement membrane).
72
40-year-old books at 16 weeks. Which test should be offered for Down’s syndrome screening?
A) Anomaly scan
B) Doppler ultrasound
C) Combined test
D) Quadruple test
E) Nuchal translucency scan
Answer: D) Quadruple test
Explanation: The "Combined test" is done between 11+0 and 13+6 weeks. If she books at 16 weeks, she has missed that window and should be offered the quadruple test (up to 20+0).
73
When should the combined test be offered?
A) 9–11 weeks
B) 15–20 weeks
C) 20–25 weeks
D) 11–13 weeks
E) 11–20 weeks
Answer: D) 11–13 weeks
Explanation: Specifically, between 11+0 and 13+6 weeks gestation.
74
All are indications for referral to secondary care EXCEPT:
A) Multiparity
B) Current breast cancer
C) Severe asthma
D) HIV infection
E) Previous UI surgery
Answer: A) Multiparity
Explanation: Normal multiparity is not an indication for consultant-led care. History of malignancy, severe chronic disease (asthma), or previous pelvic floor surgery are.
75
Which is an indication for referral to secondary care for antenatal care?
A) Multiparity
B) IVF singleton
C) Nulliparity
D) Previous 2nd degree tear
E) Previous 4th degree tear
Answer: E) Previous 4th degree tear
Explanation: A history of major perineal trauma (3rd or 4th degree) requires specialist review for birth planning.
76
15 weeks pregnant, contact with Fifth disease (Parvovirus B19). Which is correct?
A) Virus poses no risk
B) If IgM negative, reassure
C) If IgG and IgM negative, re-test in 3 weeks
D) If IgG negative and IgM positive, re-test in 3 weeks
E) If IgG negative, reassure
Answer: C) If the woman is IgG negative and IgM negative, she should be re-tested 3 weeks after exposure
Explanation: Negative results mean she is susceptible but not yet infected; re-testing at 21 days confirms whether she contracted it from the exposure.
77
Regarding abdominal incisions:
A) Midline allows more rapid entry than transverse
B) Midline is associated with more bleeding
C) Midline cannot be used under local anaesthesia
D) Midline is harder to extend
E) Midline is technically more difficult than transverse
Answer: A) The mid-line incision allows more rapid entry into the abdomen compared to the transverse incision
Explanation: Midline is favored in emergencies for its speed and lack of major muscle/vessel disruption.
78
Compared to Pfannenstiel, the Joel-Cohen incision is associated with:
A) Longer operating time
B) Higher blood loss
C) Higher post-op pyrexia
D) Higher morbidity
E) Less post-operative pain
Answer: E) Less post-operative pain
Explanation: Joel-Cohen involves straight transverse entry and blunt dissection, leading to less pain, less blood loss, and shorter operative times compared to Pfannenstiel.
79
Regarding the incidence of vaginal vault prolapse:
A) 1–2% after hysterectomy for prolapse
B) 1–2% after hysterectomy for non-prolapse
C) 5–9% after hysterectomy for non-prolapse
D) 0.1–1% after hysterectomy for prolapse
E) 20–27% after hysterectomy for prolapse
Answer: B) Vault prolapse occurs after 1-2% of hysterectomies performed for non-prolapse indications
Explanation: The risk is much higher (approx. 11.6%) if the original surgery was indicated for prolapse.
80
Vaginal bleeding at 8 weeks gestation. Possible cause?
A) Ovarian cyst
B) Candida infection
C) Cervical ectropion
D) Bacterial vaginosis
E) Placenta previa
Answer: C) Cervical ectropion
Explanation: Ectropion is a common cause of contact bleeding in pregnancy. Placenta previa cannot be diagnosed until later gestations (usually after 20 weeks).
81
Missed miscarriage at 10 weeks gestation. Which is correct?
A) Repeat scan in 1 week to confirm
B) Medical management contraindicated >9 weeks
C) Expectant management contraindicated
D) If spontaneous complete, anti-D is not necessary
E) Give anti-D immediately if Rhesus negative
Answer: D) If she has a spontaneous complete miscarriage, anti-D immunoglobulin is not necessary
Explanation: For gestations <12 weeks, anti-D is NOT needed for spontaneous miscarriage unless there is heavy bleeding, pain, or surgical intervention.
82
All are risk factors for ectopic pregnancy EXCEPT:
A) Assisted reproduction
B) Progesterone only contraception
C) Cervical ectropion
D) Previous ectopic
E) Pelvic inflammatory disease
Answer: C) Cervical ectropion
Explanation: Ectropion is a benign finding and not a risk factor for ectopic pregnancy. PID and previous ectopic are the strongest risk factors.
83
Which feature is indicative of miscarriage rather than ectopic?
A) Cervical excitation
B) Hypotension/tachycardia with minimal bleeding
C) Shoulder-tip pain
D) Heavy vaginal bleeding with clots and tissue
E) Minimal bleeding with empty uterus
Answer: D) Heavy vaginal bleeding with clots and tissue
Explanation: Miscarriage typically presents with heavy red blood and tissue; ectopic often presents with dark "prune juice" spotting and disproportionate pain.
84
30-year-old with pain and bleeding at 8 weeks. Indicative of ectopic?
A) Past history of miscarriage
B) Presence of shoulder-tip pain
C) Heavy bleeding with clots
D) Loss of grape-like vesicles
E) Uterine size larger than dates
Answer: B) Presence of shoulder-tip pain
Explanation: Shoulder-tip pain is a classic sign of haemoperitoneum from a ruptured ectopic pregnancy.
85
Complete molar pregnancy. Which is correct?
A) Recurrence risk is 1 in 1000
B) IUCD can be inserted immediately
C) No follow-up needed after next full term pregnancy
D) Mirena should not be used until cycles re-establish
E) Start COCP as soon as possible
Answer: D) The MIRENA IUS should not be used until her periods have re-established
Explanation: IUS/IUCD should be avoided until hCG is normal and cycles return to avoid perforation. COCP is avoided until hCG is normal to prevent interference with follow-up.
86
A 37-year-old woman has a complete molar pregnancy. Which one of the following is NOT correct?
A) Should be registered with a national screening centre
B) Mirena IUS should not be used until periods re-established
C) Should start using the COCP as soon as possible
D) Avoid pregnancy until 6 months after hCG is normal
E) Needs follow-up after future full-term pregnancies
Answer: C) She should start using the combined oral contraceptive pill as soon as possible to avoid pregnancy
Explanation: COCP should be avoided until hCG levels have returned to normal, as oral contraceptives may theoretically increase the risk of post-molar gestational trophoblastic neoplasia.
87
A 40-year-old woman with premature ovarian failure will be suffering from:
A) Vaginal dryness
B) Heavy menstrual bleeding
C) Deep dyspareunia
D) Dysmenorrhoea
E) Menorrhagia
Answer: A) Vaginal dryness
Explanation: POF leads to low oestrogen levels, causing menopausal symptoms such as hot flushes, night sweats, and vaginal dryness (atrophic vaginitis).
88
Which statement concerning counselling/investigation for suspected syphilis is correct?
A) Biopsy should be taken from genital ulcers
B) Biopsy should be taken from vagina
C) Samples from lesions should be sent for culture
D) Partner should be notified immediately
E) Blood should be sent for VDRL test
Answer: E) Blood should be sent for VDRL test
Explanation: Syphilis is diagnosed serologically (VDRL/RPR for screening/monitoring; EIA/TPHA for confirmation). It cannot be cultured, and partner notification follows confirmation.
89
All are contraindications to external cephalic version (ECV) EXCEPT:
A) Previous C-section
B) Previous episiotomy
C) Ruptured membranes
D) Placenta praevia
E) Vaginal bleeding
Answer: B) Previous episiotomy
Explanation: A previous episiotomy has no bearing on the safety of ECV. Previous C-section, ruptured membranes, and bleeding are major contraindications.
90
Management of bacterial vaginosis (BV) at 16 weeks gestation:
A) Partner should be tested and treated
B) Risk of pre-term delivery is not increased
C) Should be treated with oral metronidazole
D) Does not require antenatal antibiotic treatment
E) Requires IV antibiotics during labour
Answer: C) She should be treated with oral metronidazole
Explanation: BV is associated with pre-term birth. While partner treatment isn't required, the symptomatic pregnant woman should be treated with oral metronidazole or clindamycin.
91
35-year-old with diabetes mellitus planning pregnancy. Which is correct?
A) Rapid-acting insulin analogues are contraindicated
B) Metformin should be discontinued and restarted after 1st trimester
C) If treated with statins, these should be discontinued
D) ACE-inhibitors may be continued
E) Methyldopa should not be used until pregnancy confirmed
Answer: C) If she is treated with statins, these should be discontinued
Explanation: Statins and ACE-inhibitors are teratogenic and must be stopped. Rapid-acting insulin is safe. Methyldopa is a preferred alternative for hypertension.
92
30 weeks gestation, BP 170/110 mmHg, 2+ proteinuria. Booking BP was normal. What is the next step?
A) Re-check BP after 4 hours rest
B) In-patient treatment is indicated
C) Woman has pre-existing hypertension
D) Woman has pre-existing renal disease
E) Re-check BP after 24 hours
Answer: B) In-patient treatment is indicated
Explanation: This is a diagnosis of severe pre-eclampsia. Immediate admission for monitoring and management of blood pressure/fetal wellbeing is required.
93
Which one of the following is usually recorded on the partogram?
A) Fetal position
B) Fetal heart rate variability
C) Maternal pulse
D) Fetal sex
E) Fetal weight
Answer: C) Maternal pulse
Explanation: The partogram monitors maternal vitals (pulse, BP, temp), fetal heart rate (baseline), and progress of labour (dilatation/station).
94
Which description of placental abruption is correct?
A) Bleeding in late pregnancy
B) Bleeding from fetal blood vessels
C) Bleeding from adherent placenta at C-section
D) Bleeding from a normally sited placenta
E) Bleeding from the placenta after delivery
Answer: D) Bleeding from a normally sited placenta
Explanation: Abruption is the premature separation of a normally implanted placenta before delivery.
95
Regarding laparoscopy, Palmer's point is located:
A) 3 cm below right costal margin (midclavicular)
B) 3 cm below right costal margin (midaxillary)
C) 3 cm below left costal margin (midaxillary)
D) 3 cm below left costal margin (midaxillary)
E) 3 cm below left costal margin (midclavicular)
Answer: E) 3 cm below the left costal margin in the midclavicular line
Explanation: Palmer's point is an alternative entry site used when umbilical adhesions are suspected (e.g., after previous laparotomy).
96
Regarding outpatient management of Mild OHSS:
A) Discontinue progesterone support
B) Regular analgesia with Ibuprofen
C) Drink to thirst rather than excessively
D) Bed rest
E) Regular sexual intercourse
Answer: C) Drink to thirst rather than excessively
Explanation: Patients should avoid NSAIDs (risk of renal impairment) and bed rest (VTE risk). Progesterone support should continue. Drink-to-thirst prevents fluid overload.
97
Which condition would NOT necessarily indicate hospital admission for OHSS?
A) Monitoring not possible at home
B) Moderate OHSS with uncontrolled pain
C) Abdominal bloating
D) Severe OHSS
E) Moderate OHSS with worsening symptoms
Answer: C) Abdominal bloating
Explanation: Simple bloating is a feature of mild OHSS, which can be managed at home. Severe OHSS or uncontrolled symptoms require admission.
98
Which is a recognised risk factor for developing OHSS?
A) Hypertension
B) Diabetes mellitus
C) High BMI
D) Old age (>40)
E) PCOS
Answer: E) PCOS
Explanation: Polycystic Ovary Syndrome, young age (<30), and low BMI are significant risk factors for an exaggerated response to gonadotrophins.
99
Which statement regarding sub-fertility is correct?
A) Female factors account for >60%
B) 1.5% of couples experience difficulty
C) 50% have no cause found
D) Male factors account for 10%
E) Male factors account for 30%
Answer: E) Male factor problems account for 30% of causes of sub-fertility
Explanation: Roughly 30% is male-factor, 30% is female-factor, 25% is unexplained, and the rest involve both partners. Approximately 15% of couples seek help.
100
25-year-old with secondary infertility and history of Chlamydia. Best test for tubal patency?
A) Ultrasound
B) Laparoscopy and dye hydrotubation
C) Hysteroscopy
D) Hysterosalpingogram (HSG)
E) Open laparotomy
Answer: B) Laparoscopy and dye hydrotubation
Explanation: If tubal pathology (like Chlamydia-induced damage) is suspected, laparoscopy and dye is the gold standard as it allows direct visualization of adhesions.
101
All are indications for early referral to a specialist (tertiary) centre EXCEPT:
A) Secondary infertility, regular sex once a week
B) Carrier of Hepatitis B
C) HIV infection
D) Carrier of Hepatitis C
E) Following cancer treatment
Answer: A) Secondary infertility in a woman who has regular unprotected intercourse once a week
Explanation: If there are no known risk factors, referral is usually after 1 year of regular sex. Carriers of viral infections or post-cancer patients should be referred early.
102
Which one of the following is indicative of ovulation?
A) Withdrawal bleed from progestogen challenge
B) A history of regular menstrual cycles
C) Menstrual cycles every 12 to 45 days
D) Absence of male pattern hair in PCOS
E) Serum oestradiol >30 nmol/ml on Day 21
Answer: B) A history of regular menstrual cycles
Explanation: Predictable, regular cycles are the best clinical indicator of ovulation. A Day 21 progesterone (not oestradiol) >30 nmol/L confirms it biochemically.
103
Which description of assisted reproduction (ART) is correct?
A) IUI: timed introduction of washed sperm into uterine cavity
B) ICSI: mixing sperm and oocyte in vitro for embryos
C) IVF: sperm directly injected into oocyte in vitro
D) IUI: washed sperm into fallopian tube
E) ICSI: mixing sperm and oocyte in vitro
Answer: A) Intrauterine insemination: timed introduction of washed motile sperm into the uterine cavity
Explanation: IVF involves mixing sperm/eggs; ICSI involves injecting a single sperm into an egg. Both transfer embryos to the uterus.
104
Which should NOT be used to treat Pre-Menstrual Syndrome (PMS)?
A) COCP
B) Oestrogen implant + cyclical progestogens
C) SSRIs
D) Oestrogen patch + cyclical progestogens
E) Cyclical progestogens alone
Answer: E) Cyclical progestogens alone
Explanation: Evidence shows that cyclical progestogens alone are ineffective for PMS and may actually worsen symptoms in some women.
105
Which statement on the development of puberty is correct?
A) First sign is axillary hair
B) Axillary hair begins at age 9
C) Breast development begins at age 9
D) First sign is onset of menstruation
E) Majority with primary amenorrhoea have an identifiable cause
Answer: C) Breast development begins around the age of 9 years old
Explanation: Thelarche (breast budding) is the first sign of puberty, usually around age 9-10. Axillary hair (adrenarche) usually follows later.
106
All are associated with maternal IDDM (Type 1 Diabetes) EXCEPT:
A) Increased risk of Down syndrome
B) Increased perinatal mortality
C) Increased risk of fetal macrosomia
D) Increased risk of caesarean section
E) Increased risk of IUGR
Answer: A) Increased risk of Down syndrome
Explanation: Diabetes increases risks of structural anomalies (cardiac/neural tube) and growth issues, but it does NOT increase the risk of chromosomal aneuploidy like Down syndrome.
107
Which statement regarding continuous electronic fetal monitoring (EFM/CTG) is correct?
A) Lower risk of operative vaginal delivery
B) Lower risk of cerebral palsy
C) Recommended for low-risk women
D) Lower risk of caesarean section
E) Lower risk of neonatal seizures
Answer: E) It is associated with a lower risk of neonatal seizures when compared to intermittent auscultation
Explanation: Continuous CTG halves the risk of neonatal seizures but significantly increases the risk of C-sections and instrumental deliveries.
108
CTG/Oxytocin at 42 weeks. What is the strength of uterine contractions on the trace?
A) Not measurable
B) Tetanic
C) Mild
D) Moderate
E) Strong
Answer: A) Not measurable
Explanation: External tocodynamometry (the CTG pressure sensor) only measures the frequency and duration of contractions; it cannot accurately measure intrauterine pressure (strength).
109
Which serum marker effect for Down’s syndrome is listed correctly?
A) Black ethnic origin – higher AFP
B) IVF – higher unconjugated oestriol
C) Obesity – higher free beta-hCG
D) Black ethnic origin – lower free beta-hCG
E) IVF – lower free beta-hCG
Answer: A) Black ethnic origin – higher maternal serum AFP levels
Explanation: AFP and hCG are roughly 10-15% higher in Black women. Obesity generally lowers serum marker concentrations due to volume dilution.
110
The integrated test to screen for Down’s syndrome is undertaken at:
A) 11–14 and 14–20 weeks gestation
B) 9–11 weeks gestation
C) 14–20 weeks gestation
D) 9–11 and 11–14 weeks gestation
E) 11–14 weeks gestation
Answer: A) 11–14 and 14–20 weeks gestation
Explanation: The integrated test combines markers from both the first (NT, PAPP-A) and second (AFP, uE3, hCG, Inhibin A) trimesters.
111
45-year-old with frequency and bothersome nocturia. Recommended treatment?
A) Imipramine
B) Flavoxate
C) Propantheline
D) Duloxetine
E) Desmopressin
Answer: E) Desmopressin
Explanation: Desmopressin (DDAVP) is an antidiuretic specifically used to reduce nocturia. It must be used with caution in older patients due to hyponatraemia risk.
112
Which is a non-contraceptive benefit of the COCP?
A) Reduced risk of VTE
B) Reduced risk of breast cancer
C) Reduced risk of dementia
D) Reduced risk of ovarian cancer
E) Increased incidence of dysmenorrhoea
Answer: D) Reduced risk of ovarian cancer
Explanation: The COCP halves the risk of endometrial and ovarian cancers. It also treats dysmenorrhoea and reduces benign breast disease.
113
Which regarding copper IUCD emergency contraception is correct?
A) Works by preventing ovulation
B) Contraindicated in previous C-section
C) Contraindicated in nulliparous women
D) 75% effective within 5 days
E) Can be used >5 days after unprotected intercourse
Answer: E) Can be used more than 5 days after unprotected intercourse
Explanation: It can be used up to 5 days after the earliest predicted date of ovulation, which may be more than 5 days after sex. It is >99% effective.
114
Which statement regarding termination of pregnancy (TOP) in the UK is correct?
A) Not performed after 20 weeks
B) Requires signature of one doctor
C) Most commonly performed under Clause A
D) Anti-D not required before 12 weeks
E) Medical abortion may be performed at 8 weeks
Answer: E) Medical abortion may be performed at 8 weeks gestation
Explanation: Medical TOP is common at 8 weeks. UK law requires 2 doctors' signatures. Anti-D is required for all non-sensitized Rh-negative women.
115
Appropriate treatment to prevent post-abortion infection?
A) Co-amoxiclav IV during TOP
B) Azithromycin orally on day of TOP
C) Metronidazole rectally during TOP
D) Co-amoxiclave orally for 7 days post-TOP
E) Metronidazole orally for 7 days post-TOP
Answer: B) Azithromycin 1G orally on day of termination
Explanation: Standard prophylaxis involves Azithromycin (1g single dose) OR Metronidazole plus Doxycycline to cover Chlamydia and anaerobes.
116
Which of these is useful in treating Pre-Menstrual Syndrome (PMS)?
A) Testosterone implants
B) Mefenamic acid
C) Combined oral contraceptive pill
D) Tranexamic acid
E) Progesterone-only pill
Answer: C) Combined oral contraceptive pill
Explanation: New-generation COCPs (especially those containing drospirenone, like Yasmin) are effective at suppressing the ovulation cycle that triggers PMS.
117
Typical symptom of endometriosis?
A) Superficial dyspareunia
B) Deep dyspareunia
C) Inter-menstrual bleeding
D) Post-coital bleeding
E) Secondary amenorrhoea
Answer: B) Deep dyspareunia
Explanation: Endometriosis typically causes "3D" pain: Dysmenorrhoea (secondary), Dyspareunia (deep), and Dyschezia (pain on defecation).
118
Which one of the following is a recognised cause of secondary amenorrhoea?
A) Endometriosis
B) Polycystic ovaries
C) Combined oral contraceptive pills
D) Uterine fibroid
E) All of above
Answer: B) Polycystic ovaries
Explanation: PCOS is a leading cause of secondary amenorrhoea. COCPs cause withdrawal bleeds; they don't cause amenorrhoea (unlike the POP or Mirena).
119
All is true about syphilis EXCEPT:
A) Transmitted via sexual intercourse
B) Transmitted by contact with lesion
C) Caused by Treponema pallidum
D) Transplacental spread does not occur
E) Incubation is 9–90 days
Answer: D) Transplacental spread does not occur
Explanation: Syphilis can cross the placenta, leading to congenital syphilis, which can cause fetal death or severe multisystem disease in the neonate.
120
Post-menopausal woman with Lichen Sclerosus. Which is true?
A) All patients have family history of autoimmune disease
B) Vagina is characteristically involved
C) Refer to GUM if suspicion of malignancy
D) Potent steroids are the mainstay of treatment
E) Typically affects Afro-Caribbean race
Answer: D) Potent steroids are the mainstay of treatment
Explanation: Clobetasol propionate is the standard treatment. The vagina is never involved in LS (unlike Lichen Planus).
121
Which statement regarding Parvovirus B19 is correct?
A) Causes rash within 24h of infection
B) Is a non-teratogenic virus
C) Is an RNA virus
D) Children are infectious when rash appears
E) Early pregnancy infection is an indication for TOP
Answer: B) It is a non-teratogenic virus
Explanation: Parvovirus is a DNA virus. It causes fetal hydrops and anaemia, but does not cause structural malformations (teratogenicity). Children are no longer infectious once the "slapped-cheek" rash appears.
122
Which one of the following is a risk factor for gestational diabetes?
A) Family origin with high prevalence of hypertension
B) Previous baby weighing 4.5 kg or more
C) BMI above 23 kg/m2
D) Previous growth restricted fetus
E) None of above
Answer: B) Previous baby weighing 4.5 kg or more
Explanation: Major risk factors include BMI >30, previous macrosomia (≥4.5kg), previous GDM, and high-risk ethnic groups (South Asian, Black Caribbean, Middle Eastern).
123
Which statement regarding Varicella zoster is correct?
A) Women from tropical countries more likely immune
B) Incubation period is 3-6 weeks
C) Not infectious once rash appears
D) 10% of UK pregnant women are IgG positive
E) Infectious 48h before rash appears
Answer: E) It is infectious 48h before the rash appears
Explanation: Varicella is infectious from 48h before the rash until all lesions crust over. Women from tropical climates are lesslikely to be immune (seroprevalence is lower than in temperate regions).
124
Which statement regarding Hepatitis B (HBV) is NOT correct?
A) Adulthood infection results in 90% chronic carriers
B) Persistent HBsAg >6 months indicates chronic hepatitis
C) HBV is not teratogenic
D) Causes sub-clinical infection in the majority
E) HBV is a DNA virus
Answer: A) Infection in adulthood results in 90% of individuals becoming chronic carriers
Explanation: In adults, 90% clear the virus; only 10% become chronic. Conversely, 90% of neonates infected at birth become chronic carriers.
125
Which is typically associated with obstetric cholestasis?
A) Increased risk of liver adenoma
B) Increased risk of post-partum haemorrhage
C) 10-fold increase in stillbirth rate
D) Increased risk of pre-eclampsia
E) Increased risk of congenital anomalies
Answer: B) An increased risk of post-partum haemorrhage
Explanation: Cholestasis can cause Vitamin K malabsorption, leading to coagulopathy and an increased risk of PPH.
126
35-year-old IDDM planning pregnancy. Which is true?
A) Risk of Down’s syndrome is increased
B) If well controlled, anomaly risk is same as background
C) May start trying if HbA1c is 12%
D) Improved glycaemic control before pregnancy improves outcome
E) Impaired renal function improves during pregnancy
Answer: D) Improved glycaemic control before pregnancy is associated with improved pregnancy outcome
Explanation: Pre-conception control significantly reduces the risk of congenital malformations and miscarriage. Renal function typically deteriorates in diabetic women during pregnancy.
127
28-year-old on Ramipril for hypertension planning pregnancy. Correct advice?
A) Ramipril is safe in 1st trimester
B) Restart Ramipril in 2nd trimester
C) Change Ramipril to Methyldopa
D) Advise against pregnancy
E) Stop and restart after delivery
Answer: C) Ramipril should be changed to methyldopa
Explanation: ACE inhibitors (Ramipril) are contraindicated in pregnancy due to risks of fetal renal dysgenesis and skull defects. Methyldopa or Nifedipine are safe alternatives.
128
Which statement regarding continuous EFM (CTG) is correct?
A) Normal baseline is 120–170 bpm
B) Variability of 3 bpm is normal
C) Deceleration is fall >15 bpm lasting >15s
D) Baseline of 100 bpm is normal
E) Acceleration is increase >5 bpm lasting >5s
Answer: C) A deceleration is a fall in fetal heart rate by more than 15 beats per minute and lasting more than 15 seconds
Explanation: Normal baseline is 110–160 bpm. Normal variability is 5–25 bpm. Accelerations are defined as >15 bpm for >15s.
129
Regarding pelvic floor muscle training (PFMT), which is correct?
A) Offer to primigravida to prevent UI
B) Comprise 8 contractions per minute
C) Continue for 3 months in urgency UI
D) Electrical stimulation should not be used
E) Should not be offered for mixed UI
Answer: A) Pelvic floor muscle training should be offered to women in their first pregnancy to prevent urinary incontinence
Explanation: NICE recommends PFMT for all primigravidas as a preventative measure. For treatment, a 3-month supervised trial is first-line for stress/mixed UI.
130
Which ovarian tumour secretes CA125?
A) Choriocarcinoma
B) Endometrioid tumour
C) Granulosa cell tumour
D) Dysgerminoma
E) Yolk sac tumour
Answer: B) Endometrioid tumour
Explanation: CA125 is the marker for epithelial ovarian tumours (serous, endometrioid). Dysgerminoma (LDH), Yolk Sac (AFP), and Granulosa Cell (Oestrogen/Inhibin) use different markers.
131
Which is a recognised risk factor for endometrial cancer?
A) PCOS
B) Endometriosis
C) Low BMI
D) High parity
E) Progesterone secreting tumors
Answer: A) PCOS
Explanation: Chronic anovulation in PCOS leads to "unopposed oestrogen," which increases the risk of endometrial hyperplasia and cancer.
132
27-year-old with 4 months of painful periods and deep dyspareunia. Exam is normal. Next step?
A) Day 21 progesterone
B) Cervical smear
C) High vaginal swab
D) Endometrial biopsy
E) Screening for Chlamydia
Answer: E) Screening for chlamydia infection
Explanation: In a young woman with new-onset pelvic pain and dyspareunia, Pelvic Inflammatory Disease (PID) must be excluded first via STI screening.
133
Which is within normal limits for semen analysis (WHO)?
A) Motility >18% progressive
B) pH ≥ 7.2
C) Vitality 28%
D) pH 6.9
E) Volume 1.2 ml
Answer: B) pH of greater than 7.2
Explanation: WHO criteria: pH ≥ 7.2, Volume ≥ 1.5ml, Concentration ≥ 15 million/ml, Progressive Motility ≥ 32%, Morphology ≥ 4% normal forms.
134
26 weeks pregnant with chickenpox rash (started <24h ago). Correct action?
A) Give VZIG
B) Do not offer Aciclovir
C) Admit for IV Aciclovir
D) VZIG regardless of timing
E) Give oral aciclovir
Answer: E) Give oral aciclovir if rash onset was within last 24 hours
Explanation: Oral aciclovir is recommended if the woman is >20 weeks and presents within 24h of rash onset. VZIG is for post-exposure prophylaxis, not treatment.
135
Suspected sepsis in 20wk pregnancy (BP 88/56, Fever, Loin pain). What lactate level indicates hypoperfusion?
A) >40 mmol/L
B) >8 mmol/L
C) >10 mmol/L
D) >1 mmol/L
E) >4 mmol/L
Answer: E) >4 mmol/L
Explanation: A serum lactate ≥ 4 mmol/L is a critical marker for tissue hypoxia and severe sepsis/septic shock.
136
19-year-old with Hyperemesis Gravidarum (HG). Initial treatment?
A) IV Dextrose
B) IV Pabrinex (Thiamine)
C) IV Pyridoxine
D) IV Dextrose + KCl
E) IV Metoclopramide
Answer: B) IV Pabrinex 10ml solution in 100ml saline
Explanation: Thiamine (B1) must be replaced in severe HG to prevent Wernicke's encephalopathy. Dextrose should be avoided until thiamine is given, as it can precipitate Wernicke's.
137
18-year-old wants the pill for moderate acne. Best first-line option?
A) Marvelon
B) Dianette
C) Cerazette
D) Yasmin
E) Norimin
Answer: A) Marvelon (Ethinylestradiol/Desogestrel)
Explanation: A standard COCP with a less androgenic progestogen (like Desogestrel) is preferred first-line. Dianette is reserved for severe acne due to higher VTE risk.
138
10 weeks pregnant, severe vomiting, BP 96/62, Ketones ++. Diagnosis?
A) Vitamin D toxicity
B) Diabetic ketoacidosis
C) Gastroenteritis
D) Hyperemesis gravidarum
E) HONK
Answer: D) Hyperemesis gravidarum
Explanation: Triad of >5% pre-pregnancy weight loss, dehydration, and electrolyte imbalance/ketosis in early pregnancy.
139
76h post-hysterectomy, flank pain, fever, elevated creatinine, haematuria. Diagnosis?
A) Bladder Injury
B) Ureter Injury
C) Renal Calculus
D) UTI
E) Retroperitoneal haematoma
Answer: B) Ureter Injury
Explanation: Classic presentation of accidental ureteric ligation or injury during hysterectomy: flank pain, fever, and rising creatinine.
140
Regarding outpatient diagnostic hysteroscopy:
A) CO2 is superior to saline
B) Avoid NSAIDs
C) Routine cervical dilation
D) Use 2.7mm miniature hysteroscope
E) Routine opiate analgesia
Answer: D) A miniature hysteroscope (2.7mm) should be used
Explanation: Small-diameter scopes reduce pain. Saline is preferred over CO2 for better visualization. Opiates are avoided; NSAIDs are recommended 1 hour prior.
141
Earliest appropriate gestation for amniocentesis?
A) 10 weeks
B) 11 weeks
C) 13 weeks
D) 14 weeks
E) 15 weeks
Answer: E) 15 weeks
Explanation: Amniocentesis before 15 weeks (early amniocentesis) is associated with higher rates of pregnancy loss and fetal talipes (clubfoot).
142
20 weeks gestation, Vaginal discharge: N. gonorrhoeae (Penicillin resistant). Treatment?
A) Azithromycin 2g
B) Ceftriaxone 500mg IM + Azithromycin 1g oral
C) Ciprofloxacin twice daily
D) Cipro + Doxycycline
E) Doxycycline
Answer: B) Ceftriaxone 500 mg IM plus 1 g oral azithromycin as single doses
Explanation: Dual therapy is used to combat resistance and cover potential co-infection with Chlamydia. Doxycycline is avoided in pregnancy.
143
7 weeks gestation, spotting, closed cervix, fetal heart seen on scan. Diagnosis?
A) Complete miscarriage
B) Incomplete miscarriage
C) Inevitable miscarriage
D) Septic miscarriage
E) Threatened miscarriage
Answer: E) Threatened miscarriage
Explanation: Bleeding in early pregnancy with a closed cervix and a viable intrauterine fetus defines a threatened miscarriage.
144
Accepted normal range for CTG variability?
A) 1–5 bpm
B) 5–15 bpm
C) 1–15 bpm
D) 10–20 bpm
E) >15 bpm
Answer: B) 5–25 beats per minute (Note: Choice B is the closest standard)
Explanation: RCOG/NICE define normal variability as 5–25 bpm. <5 bpm for >50 mins is non-reassuring.
145
Rhesus iso-immunisation. Doppler of which vessel monitors fetal anaemia?
A) Middle cerebral artery (MCA)
B) Umbilical artery
C) Umbilical vein
D) Uterine artery
E) Uterine vein
Answer: A) Middle cerebral artery
Explanation: Peak Systolic Velocity (PSV) of the MCA increases in fetal anaemia. A value >1.5 MoM indicates a high risk of moderate-to-severe anaemia.
146
26 weeks gestation, reduced fetal movements. Initial investigation?
A) Biophysical profile
B) CTG
C) Doppler auscultation
D) Ultrasound biometry
E) Uterine artery Doppler
Answer: C) Doppler auscultation (Handheld)
Explanation: Between 24+0 and 28+0 weeks, the first step is to confirm the fetal heart is present via handheld Doppler. CTG is typically used after 28 weeks.
147
Reduction in risk of intraventricular haemorrhage (IVH) with antenatal corticosteroids?
A) 5%
B) 12%
C) 26%
D) 40%
E) 46%
Answer: E) 46%
Explanation: Antenatal steroids significantly reduce RDS, NEC, and IVH (by approximately 46%) in preterm infants.
148
40-year-old with Heavy Menstrual Bleeding (HMB). Initial investigation?
A) Coagulation screen
B) Endometrial biopsy
C) Pelvic ultrasound
D) Serum ferritin
E) Full blood count
Answer: E) Full blood count
Explanation: FBC is the mandatory first-line investigation for all women with HMB to assess for anaemia.
149
HMB, Hb 123, Normal scan. First-line pharmacological treatment?
A) Tranexamic acid
B) COCP
C) Cyclical Norethisterone
D) Levonorgestrel IUS (Mirena)
E) Depo Provera
Answer: D) Levonorgestrel containing intrauterine system
Explanation: NICE guidelines specify the LNG-IUS as the first-line treatment for HMB if the woman is willing to use it.
150
18-year-old on enzyme-inducing drugs, unprotected sex Day 18. Refuses IUD. Alternatives?
A) Copper IUD only option
B) Hormonal EC and stop drugs
C) Ulipristal acetate (ellaOne)
D) Double dose Levonorgestrel (3mg)
E) No need (infertile days)
Answer: D) Offer a single 3 mg dose of levonorgestrel (two Levonelle® tablets)
Explanation: Enzyme-inducers (e.g., Carbamazepine) increase the metabolism of LNG. Therefore, the dose must be doubled. Ulipristal is not recommended for those on enzyme-inducers.
151
27 weeks gestation, Fever 39.5°C, BP 80/50, Protein/Leucs in urine. Best action?
A) Admit to ICU/HDU
B) Ultrasound of renal tract
C) 7-day oral antibiotics
D) IM steroids
E) Referral to physicians
Answer: A) Admit to ICU/HDU for intravenous antibiotics and supportive care
Explanation: The patient has septic shock secondary to pyelonephritis. This is a medical emergency requiring aggressive IV fluids and antibiotics in a high-dependency setting.
152
Pinpoint pupils and respiratory suppression after Morphine. Reversal agent?
A) Buprenorphine
B) Flumazenil
C) Atropine
D) Naloxone
E) Pethidine
Answer: D) Naloxone
Explanation: Naloxone is the specific opioid antagonist used to reverse respiratory depression from morphine overdose.
153
Fever 18 hours after abdominal hysterectomy. No other symptoms. Most likely cause?
A) DVT
B) Pelvic collection
C) UTI
D) Wound infection
E) Pulmonary atelectasis
Answer: E) Pulmonary atelectasis
Explanation: Fever within the first 24 hours post-op is most commonly due to atelectasis (collapse of small airways). Infections (UTI, wound) usually take 48–72 hours to manifest.
154
Additional cases of breast cancer per 1000 women using HRT for 5 years?
A) 3 cases
B) 6 cases
C) 9 cases
D) 12 cases
E) 14 cases
Answer: B) 6 cases per 1000 women
Explanation: Current data (NICE/WHI) suggests approximately 6–8 extra cases of breast cancer per 1000 women over 5 years of combined HRT use.
Mrcog Part 1
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