1
Q
Type of collagen found in basement membranes is:
A) Type 3
B) Type 2
C) Type 1
D) Type 4
E) Type 5
A
Answer: D) Type 4
Type 4 collagen is the main structural component of basement membranes. Type 1 is in bone/skin, Type 2 in cartilage, and Type 3 in granulation tissue/uterus.
2
Q
Features of DIC are all, except:
A) Reduced platelets
B) Reduced fibrinogen
C) Increased FDPs
D) Increased PT & APTT
E) Increased fibrinogen
A
Answer: E) Increased fibrinogen
In Disseminated Intravascular Coagulation (DIC), fibrinogen is consumed, leading to decreased levels, not increased.
3
Q
What is the most common vulval disorder seen in a hospital setting?
A) Dermatitis
B) Vulval candidiasis
C) Lichen simplex
D) Lichen sclerosus
E) Lichen planus
A
Answer: D) Lichen sclerosus
Lichen sclerosus accounts for at least 25% of women seen in dedicated vulval clinics (incidence of 1 in 300 to 1 in 1000).
4
Q
Ms. Isadora is 64 (postmenopausal). Ultrasound: 4cm right ovarian cyst, multiloculated with solid area, no free fluid. Left ovary normal. CA125 is 70 u/ml. What is her RMI score?
A) 25
B) 100
C) 250
D) 630
E) 720
A
Answer: D) 630
$RMI = U \times M \times CA125$.
Postmenopausal ($M=3$). Ultrasound ($U=3$) for $\ge 2$ features (multilocular + solid).
$3 \times 3 \times 70 = 630$.
5
Q
Which is the right pair?
A) α-feto protein – choriocarcinoma
B) β-HCG – yolk sac tumour
C) CEA - thyroid follicular cells
D) Ca-125 - epithelial ovarian carcinoma
E) Calcitonin - colonic carcinoma
A
Answer: D) Ca-125 - epithelial ovarian carcinoma
Correct pairings: AFP/Yolk sac; β-HCG/Choriocarcinoma; CEA/Colonic; Calcitonin/Medullary thyroid cancer.
6
Q
Increase in number of cells in tissues is called:
A) Hyperplasia
B) Hypoplasia
C) Metaplasia
D) Atrophy
E) Hypertrophy
A
Answer: A) Hyperplasia
Hyperplasia is an increase in cell number. Hypertrophy is an increase in cell size.
7
Q
Neoplasm in an 18-year-old whose mother took Diethylstilbestrol (DES) during pregnancy is likely to be:
A) Brenner cell tumour of ovary
B) Teratoma of ovary
C) Sarcoma Botryoides of vagina
D) Clear cell carcinoma of vagina
E) Squamous cell carcinoma of vulva
A
Answer: D) Clear cell carcinoma of vagina
DES exposure in utero is a specific and classic risk factor for vaginal clear cell adenocarcinoma.
8
Q
If choriocarcinoma metastasises, it spreads predominantly by which route?
A) Direct invasion
B) Hematogenous
C) Lymphatic
D) Surface implantation
E) Transcoelomic
A
Answer: B) Hematogenous
Choriocarcinoma is highly vascular and typically spreads via the bloodstream, commonly to the lungs.
9
Q
Which of the following clotting factors remain unchanged in normal pregnancy?
A) Factor vii
B) Factors xi & xiii
C) Factors ii, v & ix
D) Factors vii, viii, x & xi
E) Factors vii, x, xi & xiii
A
Answer: C) Factors ii, v & ix
Most factors increase in pregnancy (prothrombotic state), but Factors II, V, and IX stay relatively stable.
10
Q
Wound healing by secondary intention takes place:
A) When there is irreparable skin loss
B) When the wound becomes infected
C) When the wound does not break apart
D) When the wound edges are brought together
E) All of the above
A
Answer: B) When the wound becomes infected
Secondary intention occurs when edges are not apposed (e.g., infection, trauma with tissue loss, or leaving a wound open to drain).
11
Q
70-year-old with abdominal distension, SOB, weight loss, and CA-125 of 500 u/ml. Most likely diagnosis?
A) Gastric cancer
B) Colorectal cancer
C) Hepatocellular cancer
D) Pancreatic cancer
E) Primary peritoneal cancer
A
Answer: E) Primary peritoneal cancer
Presentation mimics ovarian cancer with high CA-125 and ascites; it is histologically similar to serous ovarian carcinoma.
12
Q
Which tissue is not capable of regeneration?
A) Epidermis
B) Bone marrow
C) Myocardium
D) Liver
E) Skin
A
Answer: C) Myocardium
Cardiac muscle cells are “permanent cells” and lack regenerative capacity; they heal by scarring (fibrosis).
13
Q
Which obstetric phenomenon is of increased prevalence in women with a bicornuate uterus?
A) Breech presentation
B) Stillbirth
C) Postpartum haemorrhage
D) Placenta praevia
E) Placenta accreta
A
Answer: A) Breech presentation
Müllerian duct anomalies like bicornuate uterus restrict space, leading to malpresentation, miscarriage, and preterm birth.
14
Q
Which of the following is characteristic of the cellular changes seen in dysplasia?
A) Absence of mitotic figures
B) Decreased mitotic activity
C) Hyperchromatism
D) Irreversibility
E) Uniformity in cell shape
A
Answer: C) Hyperchromatism
Dysplasia features include hyperchromatism (dark nuclei), pleomorphism, and increased mitotic activity.
15
Q
Near the external os of the cervix, what is found as a normal transition from columnar epithelium?
A) Keratinized epithelium
B) Squamous epithelium
C) Transitional epithelium
D) Cuboidal epithelium
E) Cervical erosion
A
Answer: B) Squamous epithelium
The “Transformation Zone” is where columnar epithelium undergoes metaplasia into stratified squamous epithelium.
16
Q
Which histological description supports the diagnosis of adenomyosis?
A) Metaplastic change of glandular epithelium to muscle
B) Same pattern and location as endometriosis
C) Presence of endometrial glands and stroma deep within uterine muscle
D) Premalignant change of the endometrium
E) Premalignant change of the uterine muscle
A
Answer: C) Presence of endometrial glands and stroma deep within uterine muscle
Adenomyosis is defined as ectopic endometrial tissue found within the myometrium.
17
Q
Correct order of cell layers surrounding an ovarian follicle from the oocyte outward?
A) Zona pellucida, granulosa, theca interna
B) Granulosa, theca interna, zona pellucida
C) Theca interna, zona pellucida, granulosa
D) Theca interna, granulosa, zona pellucida
E) Zona pellucida, theca interna, granulosa
A
Answer: A) Zona pellucida, granulosa, theca interna
The oocyte is immediately coated by the glycoprotein zona pellucida, then granulosa cells, then theca cells.
18
Q
Histologically, the presence of which of the following determines an ovarian teratoma is malignant?
A) Squamous cells
B) All three germ cell lines
C) Immature fetal-like cells
D) Neural ectoderm
E) An ovarian capsule
A
Answer: C) Immature fetal-like cells
Immature teratomas are malignant by definition; they contain primitive (embryonic-like) tissues.
19
Q
Chemical mediators concerned in production of an inflammatory response include:
A) Globulin permeability factor
B) Bradykinin
C) 5-Hydroxytryptamine
D) All the above
E) None of the above
A
Answer: D) All the above
These are all key chemical mediators of the acute inflammatory cascade.
20
Q
Which pathogen is commonly isolated from intra-abdominal pus?
A) Actinomyces
B) Bacillus
C) Clostridia
D) All the above
E) None of the above
A
Answer: C) Clostridia
Anaerobes like Clostridia and Bacteroides are frequent isolates in polymicrobial intra-abdominal infections.
21
Q
Typical genotype of a complete molar pregnancy?
A) 45 XO
B) 46 XX
C) 46 XXX
D) 69 XXY
E) 92 XXXY
A
Answer: B) 46 XX
Complete moles are usually diploid (46,XX) and paternal in origin. Partial moles are typically triploid (69,XXY).
22
Q
Hyperplasia of keratinocytes in the prickle cell layer (stratum spinosum) is descriptive of:
A) Atrophic vulvitis
B) Syphilitic ulceration
C) Acanthosis
D) Lichen sclerosus
E) Parakeratosis
A
Answer: C) Acanthosis
Acanthosis refers specifically to the thickening of the stratum spinosum layer of the epidermis.
23
Q
In addition to mast cells, which of the following cells produces histamine?
A) Basophils
B) Erythrocytes
C) Macrophages
D) Monocytes
E) Neutrophils
A
Answer: A) Basophils
Histamine is released by mast cells (tissues), basophils (blood), and platelets.
24
Q
Findings most suspicious of herpes virus infection?
A) Intranuclear inclusion bodies
B) Intracytoplasmic inclusions
C) Copious glassy cytoplasm
D) Donovan bodies
E) Multiple round nucleoli
A
Answer: A) Intranuclear inclusion bodies
Herpes simplex presents with Cowdry type A intranuclear inclusions and multinucleated giant cells.
25
Which of the following is NOT a predisposing factor for atherosclerosis?
A) Cigarette smoking
B) Diabetes mellitus
C) Hormone replacement therapy
D) Hypertriglyceridemia
E) Systemic arterial hypertension
Answer: C) Hormone replacement therapy
While controversial in some contexts, HRT is generally not considered a primary causativerisk factor like smoking or diabetes.
26
Timeframe from injury when macrophages replace neutrophils in wound healing?
A) 1–2 hours
B) 6–12 hours
C) 18–24 hours
D) 48–92 hours
E) 7–10 days
Answer: D) 48–92 hours
Neutrophils dominate the first 24 hours; macrophages take over the cleanup and repair process between 2 and 4 days.
27
What is the most common pathologic type of breast cancer?
A) Ductal
B) Lobular
C) Paget’s
D) Inflammatory
E) Adenoid cystic
Answer: A) Ductal
Infiltrating ductal carcinoma accounts for approximately 75% of all breast cancers.
28
Which is a cause of generalised lymphadenopathy?
A) HIV seroconversion illness
B) Q fever
C) Syphilis
D) Toxoplasma gondii
E) All of above
Answer: E) All of above
Generalised lymphadenopathy involves multiple non-contiguous lymph node regions.
29
Crush injury, dark urine (blood dipstick positive but no RBCs on microscopy), High CK (>50k). Diagnosis?
A) Glomerulonephritis
B) Renal infarction
C) Papillary necrosis
D) Rhabdomyolysis
E) Ureteral lithiasis
Answer: D) Rhabdomyolysis
Muscle breakdown releases myoglobin, which causes a "false positive" for blood on a dipstick and can cause renal failure.
30
Rigours are characteristic feature of which of the following?
A) Acute cholecystitis
B) Acute pancreatitis
C) Acute pyelonephritis
D) Hodgkin’s disease
E) Ureteric calculi
Answer: C) Acute pyelonephritis
Rigours (shivering with high fever) indicate systemic bacteremia, common in upper urinary tract infections.
31
Type 1 DM, non-healing foot ulcer, rising urea, protein in urine. Renal diagnosis?
A) Crescentic glomerulonephritis
B) Hyperplastic arteriolosclerosis
C) Nodular glomerulosclerosis
D) Papillary necrosis
E) Pyelonephritis
Answer: C) Nodular glomerulosclerosis
Also known as Kimmelstiel-Wilson disease, this is the classic histological finding in diabetic nephropathy.
32
Which of the following is a risk factor for development of ovarian cancer?
A) Early menopause
B) History of breastfeeding
C) Nulliparity
D) Oral contraceptive use
E) Physical activity
Answer: C) Nulliparity
Factors that increase total "ovulatory cycles" (nulliparity, early menarche, late menopause) increase risk.
33
Endometrium rebuilds in the first half of the cycle largely in response to:
A) Progesterone
B) FSH
C) Estrogen
D) LH
E) GnRH
Answer: C) Estrogen
The "proliferative phase" is driven by estrogen; the "secretory phase" is driven by progesterone.
34
Best description of the normal lining of the fallopian tube?
A) Squamous epithelium
B) Transitional epithelium
C) Cuboidal epithelium
D) Columnar epithelium with cilia
E) Fibrous connective tissue
Answer: D) Columnar epithelium with cilia
Cilia help transport the egg/embryo toward the uterine cavity.
35
Ovary with multiple cyst layers, cytologic atypia, stromal invasion, and round laminated calcium bodies. Diagnosis?
A) Proliferative phase follicle
B) Corpus luteum cyst
C) Ovarian endometriosis
D) Borderline ovarian carcinoma
E) Cystadenocarcinoma
Answer: E) Cystadenocarcinoma
The presence of invasion and psammoma bodies (calcium bodies) indicates malignancy.
36
Distinguishing complete mole from normal placenta?
A) Trophoblastic proliferation
B) Absence of blood vessels
C) Hydropic degeneration of villi
D) Cellular atypia
E) Sex chromatin positivity
Answer: B) Absence of blood vessels
Complete moles lack fetal vasculature within the villi, whereas normal placentas are highly vascularized.
37
Which disease is NOT associated with HLA-B8?
A) Graves disease
B) Insulin-dependent diabetes mellitus
C) Multiple sclerosis
D) Myasthenia gravis
E) Sjögren’s syndrome
Answer: C) Multiple sclerosis
MS is strongly associated with HLA-DR2 ($DRB1*15:01$).
38
Apoptosis is characterized by which of the following?
A) Cell swelling
B) Karyorrhexis
C) Release of inflammatory mediators
D) None of the above
E) All the above
Answer: B) Karyorrhexis
Apoptosis involves programmed cell shrinkage and nuclear fragmentation (karyorrhexis) without an inflammatory response.
39
Increase in number of endometrial cells during pregnancy is an example of:
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Metaplasia
E) Dysplasia
Answer: C) Hyperplasia
Increased cell count = hyperplasia.
40
Type of necrosis typically occurs in cerebral infarction?
A) Coagulative
B) Liquefactive
C) Caseous
D) Fat
E) Granulomatous
Answer: B) Liquefactive
The brain is rich in lipids and lysosomes, leading to liquefactive necrosis during ischemia.
41
What epithelium cell type lines the ovaries?
A) Cuboidal
B) Columnar
C) Stratified Squamous
D) Pseudo Stratified Squamous
E) Transitional
Answer: A) Cuboidal
The ovary is covered by a simple cuboidal epithelium (germinal epithelium).
42
Smear shows anisocytosis, poikilocytosis and hyperchromatism. Diagnosis?
A) Atrophy
B) Hypertrophy
C) Dysplasia
D) Metaplasia
E) Hyperplasia
Answer: C) Dysplasia
These are the hallmark cytologic features of dysplastic (precancerous) cells.
43
What epithelium cell type lines the ureters?
A) Stratified Squamous
B) Stratified Squamous, non-keratinised
C) Columnar
D) Cuboidal
E) Transitional
Answer: E) Transitional
Ureters and bladder are lined by transitional epithelium (urothelium) to allow for stretching.
44
What epithelium cell type lines the endometrium?
A) Cuboidal
B) Columnar
C) Stratified Squamous, non-keratinised
D) Stratified Squamous
E) Transitional
Answer: B) Columnar
The endometrium is lined by simple ciliated columnar epithelium.
45
What kind of necrosis is seen in tuberculosis infection?
A) Coagulative
B) Colliquative
C) Caseous
D) Fat
E) Liquefactive
Answer: C) Caseous
Tuberculosis leads to "cheese-like" caseous necrosis within granulomas.
46
What kind of epithelium lines the endocervix?
A) Cuboidal
B) Columnar
C) Stratified Squamous, non-keratinised
D) Pseudo Stratified Squamous
E) Stratified Squamous
Answer: B) Columnar
The endocervix is lined by mucus-secreting simple columnar epithelium.
47
Change of cervical simple columnar epithelium to stratified squamous epithelium is:
A) Dysplasia
B) Neoplasia
C) Metaplasia
D) Hyperplasia
E) Hypertrophy
Answer: C) Metaplasia
The replacement of one mature cell type by another is metaplasia.
48
Increase in size of endometrial cells during pregnancy is an example of:
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Dysplasia
E) Neoplasia
Answer: B) Hypertrophy
Increased cell volume = hypertrophy.
49
Acute pancreatitis with raised amylase. What kind of necrosis is seen?
A) Fat
B) Gangrenous
C) Granulomatous
D) Coagulative
E) Liquefactive
Answer: A) Fat
Release of pancreatic lipases leads to enzymatic fat necrosis of the omentum and peripancreatic tissue.
50
Post-PPH: Tiredness, weight gain, inability to lactate. Diagnosis?
A) Hyperpituitarism
B) Delayed transfusion reaction
C) Idiopathic hypothyroidism
D) Diabetes Mellitus
E) Sheehan's Syndrome
Answer: E) Sheehan's Syndrome
Pituitary infarction caused by severe obstetric hemorrhage.
51
What is the most common heritable thrombophilia?
A) Antithrombin III deficiency
B) Factor V Leiden
C) Protein C deficiency
D) Protein S deficiency
E) Prothrombin G20210A
Answer: B) Factor V Leiden
Factor V Leiden (resistance to activated protein C) is the most prevalent genetic risk factor for VTE in Caucasians.
52
30-year-old 10 days post-CS with intense pain, temp 38.7°C, swelling/redness around scar, and blisters at margins. Likely diagnosis?
A) Cellulitis
B) Erysipelas
C) Gangrene
D) Herpes zoster
E) Necrotising fasciitis
Answer: E) Necrotising fasciitis
Rapid spread along the fascia, systemic toxicity (fever), and skin changes like blistering/dishwater discharge are hallmarks of this surgical emergency.
53
Fibroid at 36 weeks' gestation becomes acutely tender. What cellular process is happening?
A) Cystic degeneration
B) Hyaline degeneration
C) Myxoid degeneration
D) Red degeneration
E) Sarcomatous degeneration
Answer: D) Red degeneration
Also known as necrobiosis, this is common in pregnancy due to rapid growth outstripping blood supply, leading to hemorrhage into the fibroid.
54
Which syndrome causes failure of lactation following major obstetric haemorrhage?
A) Asherman
B) Fitz-Hugh-Curtis
C) Rokitansky
D) Sheehan
E) Swyers
Answer: D) Sheehan
Ischaemic necrosis of the anterior pituitary due to severe PPH. Failure to lactate (prolactin deficiency) is often the first clinical sign.
55
Histology: "oedematous villi surrounded by hyperplasia of trophoblastic tissue. No normal embryonic tissues seen." Likely diagnosis?
A) Choriocarcinoma
B) Complete hydatidiform mole
C) Missed miscarriage
D) Partial mole
E) Placental site nodules
Answer: B) Complete hydatidiform mole
The absence of fetal tissue and "snowstorm" appearance on histology (diffuse trophoblastic hyperplasia) confirms a complete mole.
56
Which ovarian cancer is associated with psammoma bodies?
A) Endometrioid tumour
B) Granulosa cell tumour
C) Mucinous tumour
D) Serous tumour
E) Teratoma
Answer: D) Serous tumour
Psammoma bodies are concentric, laminated calcified concretions typically found in serous cystadenocarcinomas.
57
Which tumour marker is the most specific for pancreatic carcinoma?
A) Alpha feto protein
B) CA125
C) CA15-3
D) CA19-9
E) Human chorionic gonadotropin
Answer: D) CA19-9
CA19-9 is the primary marker for pancreatic cancer. CA15-3 is for breast; CA125 for epithelial ovarian.
58
Which pathological process increases the production of uric acid?
A) Acute renal failure
B) Chronic renal failure
C) Hodgkin lymphoma
D) Hyperparathyroidism
E) Hypothyroidism
Answer: C) Hodgkin lymphoma
Increased cell turnover in malignancies (like Hodgkin) increases uric acid production. Renal failure increases levels by reduced excretion.
59
Which electrolyte is lower than normal in Addison's disease (Primary adrenal insufficiency)?
A) Bicarbonate
B) Calcium
C) Magnesium
D) Potassium
E) Sodium
Answer: E) Sodium
Aldosterone deficiency leads to hyponatraemia (low sodium) and hyperkalaemia (high potassium).
60
Endometrial biopsy: "focal areas of ulceration, caseous necrosis and haemorrhage". Suggestive of?
A) Actinomycosis
B) Hyperplasia with atypia
C) Retained products of conception
D) Sarcoidosis
E) Tuberculosis
Answer: E) Tuberculosis
Caseous necrosis is the pathognomonic histological hallmark of Mycobacterium tuberculosis infection.
61
19-year-old with complex ovarian mass. Appropriate marker tests?
A) CA125 alone
B) CA125 and CEA
C) hCG and AFP
D) CA19-9
E) AFP, hCG, and LDH
Answer: E) AFP, hCG, and LDH
In women <40, markers for Germ Cell Tumours (GCT) must be tested. AFP (Yolk sac), hCG (Choriocarcinoma), and LDH (Dysgerminoma).
62
What are the two most common cancers associated with endometriosis?
A) Endometrioid and Clear Cell
B) Serous and Mucinous
C) Brenner and Teratoma
D) Yolk sac and Dysgerminoma
E) Squamous and Sarcoma
Answer: A) Endometrioid and Clear Cell
These "endometrioid-associated ovarian cancers" (EAOC) are thought to arise from malignant transformation of endometriotic deposits.
63
Vulval biopsy: "epidermis flat and thin with striking hyalinisation of upper dermis". Likely disease?
A) Infective vulvitis
B) Lichen planus
C) Lichen sclerosus
D) Lichen simplex
E) Vulval intraepithelial neoplasia
Answer: C) Lichen sclerosus
Specific histological features: epidermal thinning, basement membrane hyalinisation, and sub-epithelial inflammatory infiltrate.
64
In the presence of inflammation, which of the following is raised?
A) Caeruloplasmin
B) Complement proteins
C) Ferritin
D) Fibrinogen
E) All the above
Answer: E) All the above
These are all "positive acute-phase reactants" whose plasma concentration increases in response to inflammation.
65
Which of the following is correct concerning shock?
A) There may be coagulopathy
B) Hypokalemia occurs
C) Capillary permeability is reduced
D) Hypoxia may not be present
E) There is metabolic alkalosis
Answer: A) There may be coagulopathy
Shock often leads to metabolic acidosis and increased capillary permeability; consumption of factors leads to DIC/coagulopathy.
66
Which disease is NOT associated with HLA-B8?
A) Graves’ disease
B) Ankylosing spondylitis
C) IDDM
D) Myasthenia gravis
E) Sjogren’s syndrome
Answer: B) Ankylosing spondylitis
Ankylosing spondylitis is strongly linked to HLA-B27.
67
Correct statement regarding congenital absence of the uterus?
A) Incidence 1:1,000
B) 45 XO pattern
C) Hirsutism is common
D) Also known as MRKH syndrome
E) Ovaries commonly affected
Answer: D) Mayer-Rokitansky-Küster-Hauser syndrome
Karyotype is 46,XX; ovaries are usually normal and functional, meaning secondary sexual characteristics develop normally.
68
Which is NOT correct regarding choriocarcinoma?
A) Malignant condition
B) More common >40 years
C) Can follow normal pregnancy
D) Syncytiotrophoblasts with eosinophilic material
E) Can commonly metastasise to the brain
Answer: E) Can commonly metastasise to the brain
The most common site of metastasis is the lungs(80%), then vagina (30%). Brain is possible but less "common" than lungs.
69
Genotype in complete molar pregnancy?
A) 69XXY
B) 46XXX
C) 46XY
D) 46XX
E) 45XO
Answer: D) 46XX
Most commonly occurs from an empty egg fertilized by one sperm that duplicates its DNA.
70
Incorrect statement regarding pheochromocytomas?
A) High metanephrines diagnostic
B) Corticosteroid producing tumours
C) Develop in chromaffin cells
D) Surgical resection is treatment
E) Presents with hypertension/palpitations
Answer: B) Corticosteroid producing tumours
Pheochromocytomas produce catecholamines(adrenaline/noradrenaline), not corticosteroids.
71
65-year-old, distension, SOB, CA-125 of 820 U/ml. Likely diagnosis?
A) Pancreatic cancer
B) Gastric cancer
C) Hepatocellular cancer
D) Colorectal cancer
E) Primary peritoneal cancer
Answer: E) Primary peritoneal cancer
High CA-125 in a postmenopausal woman with ascites (distension) and no primary ovarian mass is classic for PPC.
72
Correctly paired paraneoplastic syndrome and malignancy?
A) Acanthosis nigricans – bowel cancer
B) Carcinoid – fibrosarcoma
C) Cushing’s syndrome – small cell carcinoma
D) Dermatomyositis – renal cancer
E) SIADH – testicular cancer
Answer: C) Cushing’s syndrome and small cell carcinoma
Small cell lung cancer often produces ectopic ACTH, leading to Cushing’s syndrome.
73
Bilateral ovarian tumours with signet ring morphology. Likely primary site?
A) Cervix
B) Uterus
C) Pancreas
D) Stomach
E) Thyroid
Answer: D) Stomach
This describes a Krukenberg tumour, most commonly metastasized from a gastric (stomach) adenocarcinoma.
74
Patient with HNPCC (Lynch syndrome). Most at risk of?
A) Cervical SCC
B) Germ cell tumours
C) Sex-cord tumours
D) Endometrial carcinoma
E) Sarcoma botryoides
Answer: D) Endometrial carcinoma
Lynch syndrome carries a high risk for both colorectal and endometrial cancers.
75
Risk of endometrial carcinoma increased by which neoplasm?
A) Melanoma
B) Mesothelioma
C) Granulosa-theca cell tumour
D) Schwannoma
E) Krukenberg tumour
Answer: C) Granulosa-theca cell tumour
These tumors produce estrogen, which causes endometrial hyperplasia and increases the risk of carcinoma.
76
Pleural effusion (right), ascites, benign ovarian fibroma. Diagnosis?
A) Sheehan syndrome
B) Meigs syndrome
C) Asherman’s syndrome
D) Neuroendocrine carcinoma
E) Kikuchi disease
Answer: B) Meigs syndrome
Triad of benign ovarian tumour (usually fibroma), ascites, and pleural effusion. Resolves after tumor removal.
77
UDS shows echogenic "granular/snowstorm" mass, no fetus, β-hCG 10k+. Likely diagnosis?
A) Choriocarcinoma
B) Molar pregnancy
C) Granulosa cell tumour
D) Endometrial carcinoma
E) Pituitary adenoma
Answer: B) Molar pregnancy
The "innumerable anechoic spaces" represent the hydropic villi characteristic of a mole.
78
4-year-old with "grape-like" mass protruding from introitus. Likely diagnosis?
A) Squamous cell carcinoma
B) Leiomyoma
C) Adenocarcinoma
D) Rhabdomyosarcoma
E) Dysgerminoma
Answer: D) Rhabdomyosarcoma
Specifically Sarcoma Botryoides, the most common vaginal malignancy in infants/children under 5.
79
Biopsy: high-grade CGIN. Increased risk of?
A) Endometrial carcinoma
B) Adenocarcinoma of cervix
C) Serous ovarian carcinoma
D) Endometrioid carcinoma
E) Cervical sarcoma
Answer: B) Adenocarcinoma of cervix
Cervical Glandular Intraepithelial Neoplasia (CGIN) is the precursor to adenocarcinoma of the cervix.
80
CIN III. Most likely causative subtype?
A) HPV 6
B) HSV 2
C) HSV 1
D) HPV 1
E) HPV 16
Answer: E) HPV 16
HPV 16 and 18 are the "high-risk" types responsible for most high-grade CIN and cervical cancers.
81
Ovarian cyst with predominantly thyroid tissue. Diagnosis?
A) Angiosarcoma
B) Carcinosarcoma
C) Carcinoid tumour
D) SCC in dermoid cyst
E) Struma ovarii
Answer: E) Struma ovarii
A specialized monodermal teratoma where thyroid tissue makes up >50% of the mass.
82
18-year-old, large mass, markers normal. Histology: "immature neuroepithelial tissue, grade 1". Diagnosis?
A) Choriocarcinoma
B) Dysgerminoma
C) Embryonal carcinoma
D) Immature teratoma
E) Yolk sac tumour
Answer: D) Immature teratoma
Unlike mature dermoids, these contain embryonic tissues (most commonly neuroepithelial) and are malignant.
83
16-year-old, solid/cystic mass, raised AFP and β-hCG. Likely diagnosis?
A) Choriocarcinoma
B) Dysgerminoma
C) Embryonal carcinoma
D) Immature teratoma
E) Yolk sac tumour
Answer: C) Embryonal carcinoma
Embryonal carcinomas typically produce both AFP and hCG. Pure Yolk sac produces AFP; Pure Choriocarcinoma produces hCG.
84
Suspicion of Dysgerminoma. Management includes all EXCEPT:
A) Surgery at cancer centre
B) Fertility sparing surgery
C) Staging extent of disease
D) Biopsy of contralateral ovary
E) Selective removal of enlarged nodes
Answer: D) Biopsy of contralateral ovary
Routine biopsy of a normal-appearing contralateral ovary is not recommended as it may cause adhesions/infertility.
85
Histology: cells with eosinophilic cytoplasm separated by fibrous stroma with T lymphocytes. Diagnosis?
A) Dysgerminoma
B) Endodermal sinus tumour
C) Embryonal carcinoma
D) Choriocarcinoma
E) Immature teratoma
Answer: A) Dysgerminoma
The lymphocytic infiltrate within the fibrous septa is a classic microscopic feature of dysgerminoma.
86
Histology of ovarian tumour reveals Schiller–Duval bodies. Likely diagnosis?
A) Dysgerminoma
B) Endodermal sinus tumour
C) Embryonal carcinoma
D) Choriocarcinoma
E) Immature teratoma
Answer: B) Endodermal sinus tumour
Also known as Yolk Sac Tumour. Schiller-Duval bodies (glomerulus-like structures) are pathognomonic.
87
Which tumour marker is specific to Endodermal Sinus Tumour (Yolk Sac)?
A) Alpha-fetoprotein (AFP)
B) Ca-125
C) Carcinoembryoic antigen
D) hCG
E) LDH
Answer: A) Alpha-fetoprotein (AFP)
AFP is the characteristic marker produced by yolk sac elements.
88
67-year-old with bloating, distension, RMI of 2610 (Solid mass, ascites, omental thickening, CA125: 290). Initial management?
A) MRI pelvis with contrast
B) Omental biopsy
C) Ascitic tap for cytology
D) Refer her to cancer centre
E) Repeat CA125
Answer: D) Refer her to cancer centre
An RMI >200 indicates a high risk of malignancy (75%). Guidelines mandate referral to a multidisciplinary team (MDT) at a specialized cancer centre for further staging (CT) and management.
89
66-year-old, bloating, CA125: 100, US: bilateral multicystic masses with solid components. What is the RMI?
A) 180
B) 250
C) 300
D) 600
E) 900
Answer: E) 900
RMI = $U \times M \times CA125$.
$U$ (US score): 3 (for $\geq 2$ features: bilateral and solid components).
$M$ (Menopause): 3 (postmenopausal).
$CA125$: 100.
$3 \times 3 \times 100 = 900$.
90
Routine screening test available for early precancerous lesions in which organ?
A) Cervix
B) Endometrium
C) Fallopian tube
D) Ovary
E) Vulva
Answer: A) Cervix
Cervical cytology (smear) and HPV testing are the only routine population screening tools for gynecological precancers.
91
8yo male, haematuria, RBC casts, post-sore throat. Biopsy: epithelial humps, IgM, IgG & C3. Likely diagnosis?
A) Acute glomerulonephritis
B) Polyarteritis nodosa
C) UTI
D) Polycystic kidney
E) IgA nephropathy
Answer: A) Acute glomerulonephritis
Specifically Post-Streptococcal Glomerulonephritis (PSGN). "Humps" on electron microscopy are pathognomonic.
92
Young male, hematuria, hemoptysis, autoantibodies against type IV collagen (basement membrane). Diagnosis?
A) Acute glomerulonephritis
B) Polyarteritis nodosa
C) Goodpasture’s disease
D) Polycystic kidney
E) IgA nephropathy
Answer: C) Goodpasture’s disease
A Type II hypersensitivity reaction where antibodies attack the basement membranes of both lungs and kidneys.
93
Most common nephritis characterized by IgA deposition in mesangial cells?
A) Acute glomerulonephritis
B) Polyarteritis nodosa
C) Goodpasture’s disease
D) Polycystic kidney
E) IgA nephropathy (Berger’s)
Answer: E) IgA nephropathy (Berger’s disease)
This is the most common primary glomerulonephritis worldwide, often following a respiratory infection.
94
40yo female, night sweats, hilar lymphadenopathy, biopsy: non-caseating granuloma, raised ACE. Diagnosis?
A) Wegner’s granulomatosis
B) Polyarthritis nodosa
C) Kawasaki’s disease
D) Sarcoidosis
E) Tuberculosis
Answer: D) Sarcoidosis
Non-caseating granulomas and bilateral hilar lymphadenopathy are classic. TB shows caseating (necrotic) granulomas.
95
Preterm male (30wks) via LSCS, respiratory difficulty, X-ray: ground glass appearance. Diagnosis?
A) ARDS
B) Hyaline membrane disease (RDS)
C) Polycystic kidney
D) Giant cell arteritis
E) Takayasu arteritis
Answer: B) Hyaline membrane disease
Caused by surfactant deficiency in premature neonates. X-ray shows the characteristic diffuse "ground glass" opacification.
96
45yo male smoker, pain in leg on walking (claudication). Likely diagnosis?
A) Wegner’s granulomatosis
B) Thromboangiitis obliterans
C) Kawasaki’s disease
D) Giant cell arteritis
E) Takayasu arteritis
Answer: B) Thromboangiitis obliterans (Buerger's)
Strongly associated with smoking in young/middle-aged males; leads to segmental inflammation and thrombosis of limb vessels.
97
2yo child, fever, maculopapular rash, unresponsive to antibiotics. Likely diagnosis?
A) Wegner’s granulomatosis
B) Polyarthritis nodosa
C) Kawasaki’s disease
D) Giant cell arteritis
E) Takayasu arteritis
Answer: C) Kawasaki’s disease
An acute vasculitis of childhood. Risks include coronary artery aneurysms.
98
45yo female, absent radial pulse in both arms, normal BP. Likely diagnosis?
A) Wegner’s granulomatosis
B) Polyarthritis nodosa
C) Kawasaki’s disease
D) Giant cell arteritis
E) Takayasu arteritis
Answer: E) Takayasu arteritis
Known as "pulseless disease," it affects the aortic arch and its primary branches, often in young Asian women.
99
Which tumor marker pair is WRONG?
A) AFP - Yolk sac
B) Beta HCG - Choriocarcinoma
C) Calcitonin - Thyroid follicular cells
D) CEA - Colon carcinoma
E) Ca-125 - Epithelial ovarian
Answer: C) Calcitonin - Thyroid follicular cells
Calcitonin is produced by Parafollicular C-cells. Follicular cells produce Thyroxine ($T_4$) and Triiodothyronine ($T_3$).
100
Which of the following are Immunodeficiency syndromes?
A) X-Linked agammaglobulinemia
B) Di George syndrome
C) SCID
D) Wiskott Aldrich syndrome
E) All of the above
Answer: E) All of the above
These represent various primary deficiencies in B-cells, T-cells, or combined immune pathways.
101
SLE is characterized by which of the following?
A) Affects women more than men
B) Anti-dsDNA is specific
C) Associated with fetal heart block
D) Malar rash and thrombocytopenia
E) All of the above
Answer: E) All of the above
SLE is a multisystem autoimmune disease with a strong female predilection (9:1) and distinct serology.
102
Which of the following is NOT a feature of DIC?
A) Reduced platelets
B) Increased PT/PTT
C) Reduced fibrinogen
D) Increased FDP
E) Increased fibrinogen
Answer: E) Increased fibrinogen
DIC is a consumptive coagulopathy; fibrinogen is used up, so levels are low.
103
Compared to TTP, HUS has:
A) More renal problems
B) No thrombocytopenia
C) More neurological problems
D) Increased PT
E) Increased APTT
Answer: A) More renal problems
HUS is dominated by acute renal failure (common in children post-E. coli), while TTP is dominated by neurological signs.
104
Type of collagen found in the basement membrane?
A) Type 1
B) Type 2
C) Type 4
D) Type 5
E) Type 3
Answer: C) Type 4
Type 4 collagen is the structural backbone of basement membranes.
105
Most common type of collagen in the body?
A) Type 1
B) Type 2
C) Type 3
D) Type 4
E) Type 5
Answer: A) Type 1
Type 1 is found in skin, bone, tendons, and organs; it provides high tensile strength.
106
Characteristic of TTP (Thrombotic Thrombocytopenic Purpura)?
A) Thrombocytopenia
B) Prolonged bleeding time
C) Normal PT/APTT
D) Schistocytes on smear
E) All of the above
Answer: E) All of the above
TTP involves platelet microthrombi (consuming platelets) but does not activate the clotting cascade (hence normal PT/APTT).
107
Which complication is directly associated with PCOS?
A) Fetal growth restriction
B) Cataract
C) Cervical cancer
D) Dyslipidemia
E) Thromboembolism
Answer: D) Dyslipidemia
Metabolic syndrome components (dyslipidemia, insulin resistance) are core metabolic features of PCOS.
108
35yo woman with PCOS (BMI 33). Significant risk for which cancer?
A) Breast cancer
B) Ovarian cancer
C) Vulval cancer
D) Endometrial cancer
E) Cervical cancer
Answer: D) Endometrial cancer
Unopposed estrogen due to anovulation (oligo/amenorrhea) leads to endometrial hyperplasia and malignancy.
109
What is the most common cell type in Hodgkin's disease?
A) B cells
B) T cells
C) Eosinophils
D) Monocytes
E) Basophils
Answer: A) B cells
Reed-Sternberg cells (the hallmark of Hodgkin's) are derived from germinal centre B-lymphocytes.
110
Acute pancreatitis diagnosed (Amylase 450). What necrosis occurs?
A) Coagulative
B) Colliquative
C) Liquefactive
D) Granulomatous
E) Fat
Answer: E) Fat
Pancreatic lipases release fatty acids which combine with calcium (saponification) to cause fat necrosis.
111
True statement regarding cancer risks in PCOS?
A) ET > 7mm may be hyperplasia
B) Induce withdrawal bleed every 6 months
C) Associated with breast cancer
D) Associated with ovarian cancer
E) If thickened, give progesterone
Answer: E) If thickened, give progesterone
Withdrawal bleeds should be induced every 3-4 months. Progesterone is used to protect the endometrium if thickened.
112
Pregnancy US shows a fibroid with a cystic fluid-filled centre. Diagnosis?
A) Adenomyosis
B) Endometriosis
C) Sarcoma
D) Cystic degeneration
E) Red degeneration
Answer: D) Cystic degeneration
While Red degeneration is most common in pregnancy (presenting with pain), "cystic" fluid centers on ultrasound specifically indicate cystic degeneration.
113
Simple ovarian cyst of 60mm. Course of action?
A) Order CA125
B) Order MRI
C) Yearly ultrasound follow-up
D) Laparotomy
E) Discharge
Answer: C) Yearly ultrasound follow-up
RCOG Guideline 62: Simple cysts 50-70mm in premenopausal women need yearly US follow-up.
114
Simple ovarian cyst of 30mm. Course of action?
A) Laparoscopy
B) Discharge with no follow-up
C) Order CA125
D) Annual ultrasound
E) MRI
Answer: B) Discharge with no follow-up
Simple cysts <50mm are physiological and do not require further follow-up.
115
Risk of VIN (Vulval Intraepithelial Neoplasia) developing into SCC?
A) 0.5-5%
B) 15%
C) <0.5%
D) 40%
E) 35%
Answer: B) 15%
Estimated risk for high-grade VIN progressing to Squamous Cell Carcinoma is approximately 9-18.5%.
116
Greatest risk factor for developing bladder cancer?
A) Painting
B) Endometriosis
C) Coffee
D) Rosiglitazone
E) Smoking
Answer: E) Smoking
Smoking is responsible for nearly 40% of bladder cancer cases (3.8x increased risk).
117
Most common Type II congenital thrombophilia?
A) Protein C deficiency
B) Protein S deficiency
C) Prothrombin G20210A
D) APS
E) Factor V Leiden
Answer: E) Factor V Leiden
FVL is the most common inherited risk factor for VTE (Types 1 are deficiencies; Type 2 are functional mutations).
118
RMI score figure that prompts referral to a gynae oncologist/MDT?
A) 100
B) 250
C) 300
D) 350
E) 450
Answer: B) 250
NICE guidance uses RMI $\geq$ 250 for referral. (RCOG uses $\geq$ 200).
119
Placenta invaded the myometrium but NOT the serosa. Diagnosis?
A) Placenta Increta
B) Placenta Praevia
C) Hydatidiform Mole
D) Placenta Percreta
E) Placenta Accreta
Answer: A) Placenta Increta
Accreta = attachment to myometrium; Increta = invasion intomyometrium; Percreta = invasion through to serosa/organs.
120
Responsible for majority of ovarian cancer cases and deaths?
A) Epithelial ovarian cancers
B) Borderline tumors
C) Dysgerminoma
D) Teratoma
E) Germ cell tumors
Answer: A) Epithelial ovarian cancers
EOCs account for ~90% of ovarian malignancies, with High Grade Serous being the most common subtype.
121
Endometriosis with pain on opening bowels and low back pain. Involved structure?
A) Mesovarium
B) Round ligament
C) Suspensory ligament
D) Psoas muscle
E) Uterosacral ligament
Answer: E) Uterosacral ligament
Endometriosis of the uterosacral ligaments often presents with deep dyspareunia and dyschezia (pain on defecation).
122
All are features of Acute Inflammation EXCEPT:
A) Neutrophils are first cells
B) Prostacyclin increases permeability
C) Eosinophilia in asthma
D) Kinins relax smooth muscle
E) Fibrin forms union
Answer: D) Kinins relax smooth muscle
Kinins actually cause contraction of most non-vascular smooth muscle (like bronchioles) while causing vasodilation.
123
Ovarian mass: firm and whitish. Histology: spindle cells in collagenous stroma. Diagnosis?
A) Endometrioid
B) Dermoid
C) Sarcoma
D) Leiomyoma
E) Fibroma
Answer: E) Fibroma
Benign sex-cord stromal tumor. Macroscopically firm/white; microscopically bundles of spindle cells.
124
When to test LFTs postnatally for obstetric cholestasis?
A) 24 hrs
B) 48 hrs
C) 7 days
D) 10 days
E) Postnatal visit (6wks)
Answer: D) 10 days
Wait at least 10 days, as LFTs can transiently rise in the first week post-delivery even in normal pregnancies.
125
Which shows hypertrophy (increase in cell size)?
A) Cervix (inflammation)
B) Ovary (menopause)
C) Liver (resection)
D) Breast (puberty)
E) Myometrium in pregnancy
Answer: E) Myometrium in pregnancy
Uterine growth in pregnancy involves both hypertrophy (size) and hyperplasia (number) of smooth muscle cells.
126
Post-op fever, RR 28, Pulse 103, Urine 10ml/hr. Likely diagnosis?
A) Sepsis
B) Severe sepsis
C) Septic shock
D) Septicemia
E) SIRS
Answer: B) Severe sepsis
Sepsis PLUS evidence of organ dysfunction (Oliguria: <0.5ml/kg/hr). Note: Sepsis definitions are now updated to "Sepsis" and "Septic Shock" in newer guidelines.
127
True statement regarding PCOS health risks?
A) Progestogen bleed every 3-4 months
B) Bariatric surgery at BMI 35
C) Metformin licensed for PCOS in UK
D) Increased breast cancer surveillance
E) Increased ovarian cancer surveillance
Answer: A) Progestogen bleed every 3-4 months
This is the RCOG recommendation to reduce endometrial cancer risk. Bariatric surgery is considered at BMI 40 (or 35 with comorbidities).
128
What is the Shock Index?
A) Late marker
B) SBP / HR
C) Value > 0.5 bad
D) Heart Rate / Systolic BP
E) None of above
Answer: D) Heart rate / Systolic blood pressure
An SI > 0.9 is associated with increased mortality and is an early marker of compromise.
129
% of women diagnosed with breast cancer who subsequently become pregnant?
A) 5%
B) 10%
C) 15%
D) 20%
E) 25%
Answer: B) 10%
130
Endometrial polyps show anomalies in which chromosomes?
A) 1 & 5
B) 5 & 10
C) 6 & 12
D) 6 & 18
E) 12 & 15
Answer: C) Chromosome 6 & 12
Cytogenetic studies of endometrial polyps have frequently identified rearrangements in these chromosomes.
131
Following the Sepsis 6 bundle, which blood test is essential?
A) CRP
B) Fibrinogen
C) Lactate
D) WBC
E) Electrolytes
Answer: C) Lactate
Lactate is the marker used to assess tissue perfusion and guide fluid resuscitation in sepsis.
132
Most common subtype of vulval lichen planus to cause symptoms?
A) Classical
B) Non-classical
C) Hypertrophic
D) Hyperpigmented
E) Erosive
Answer: E) Erosive
The erosive form is the most debilitating and symptomatic vulval presentation of lichen planus.
133
Postmenopausal, vulval itch/soreness, skin like "cigarette paper," adhesions. Diagnosis?
A) Lichen simplex chronicus
B) Lichen sclerosis
C) Lichen planus
D) Eczema
E) Psoriasis
Answer: B) Lichen sclerosis
Thinning, cigarette-paper texture, and labial fusion/adhesions are classic clinical signs.
Mrcog Part 1
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