TOPIC WISE REVISION ONLINE PAPER

CLASS – 03
Dr.J.Rajeevan
Topics
1. Endometriosis and chronic pelvic pain
2. Gynacological infection- BV, Chlamydia, Neisseria, Candida
3. Prenatal diagnosis
4. Multiple pregnancy
5. Rh negative pregnancy
6. Anemia complicating pregnancy
7. Thrombocytopenia in pregnancy
8. Menaupause and hormone replacement therapy
9. UV prolapse
10. Urinary incontinence

MCQ (T/F)
1) With regards to the management of endometriosis:
a. Suppression of ovarian function for 6 months with gonadotropin-releasing hormone
analogues has shown to reduce pain associated with endometriosis
b. Ablation of uterine nerve is as effective as ablation of endometriotic lesions with laser
for reducing endometriosis-related pain
c. Endometrioma is an indication for oophorectomy in young woman
d. Endometriosis-associated pain can be reduced by removing the entire lesions in severe
and deeply infiltrating disease
e. Levonorgestrel IUS is an effective treatment in controlling endometriosis associated pain

2) Bacterial vaginosis is associated with:

a. An excess growth of anaerobic organisms in the vagina
b. An excess growth of Gardnerella vaginalis in the vagina
c. A low pH in the vagina
d. A positive amine test
e. An overgrowth of lactobacilli in the vagina

3) Chlamydia trachomatis:
a. Is an obligate intracellular virus
b. Can cause conjunctivitis in the newborn
c. Can cause pneumonia in the newborn
d. Is the causative organism for lymphogranuloma venereum
e. It can lead to female subfertility

Dr.J.Rajeevan
 4) Candida infection:
a. Is more common in sexually active women
b. Is a sexually transmitted disease
c. Is more common in pregnant women
d. Is more common in women with diabetes
e. Is more common in women with a copper intrauterine contraceptive device (IUCD)

5) Neisseria gonorrhoeae:
a. Is a gram-negative organism
b. Is an intracellular diplococcus
c. Is a risk factor for ectopic pregnancy
d. Is sensitive to ciprofloxacin
e. Is sensitive to ampicillin

6) Hormone replacement therapy (HRT):

a. Increases the risk of colon cancer
b. decrease the risk of a breast tumour
c. Increases the risk of stroke
d. Increases the risk of coronary heart disease
e. Increases the risk of venous thromboembolism (VTE)

7) Increased nuchal translucency (NT) in the fetus is associated with:

a. Cardiac abnormalities
b. Abdominal wall defects
c. Renal abnormalities
d. Diaphragmatic hernia
e. Down syndrome

8) With regards to fetal invasive testing:

a. Amniocentesis is usually done at 13 weeks
b. Chorionic villus sampling (CVS) may cause limb defects when undertaken after 11 weeks
c. The risk of miscarriage with CVS is 0.5%
d. Placental mosaicism is more common with amniocentesis compared to CVS
e. Amniotic fluid can leak following amniocentesis

9) Maternal serum alpha fetoprotein (MSAFP):

a. Is synthesized in the maternal gastrointestinal tract
b. Is raised in women carrying a fetus with anencephaly
c. Is raised in women carrying a fetus with Down syndrome
d. Reaches a peak at around 32 weeks of gestation in maternal serum in normal pregnancy
and then falls gradually
e. Is raised in maternal serum if the fetus is diagnosed with exomphalos

Dr.J.Rajeevan
 10) With regards to anti-D administration and rhesus (Rh) isoimmunisation:
a. The sensitisation occurs in about 15% of rhesus (RhD)-negative women during
pregnancy
b. The standard dose which is normally given following delivery will cover a fetomaternal
haemorrhage (FMH) of 50 mL
c. Anti-D is required following medical termination of an 8-week missed miscarriage of
RhD-negative women
d. Routine anti D antenatal prophylaxis recommends 1500 IU of anti-D immunoglobulin to
sensitized RhD-negative women at 28 and 34 weeks of pregnancy
e. Intramuscular anti-D injection is best given into the gluteal region

11) With regards to maternal thrombocytopenia:

a. During pregnancy, the most frequent cause is gestational thrombocytopenia (GT)
b. The second common cause of thrombocytopenia during pregnancy is immunity related
c. Immune causes account for 20% of maternal thrombocytopenia
d. Fetus is affected if maternal platelet count is less than 100 × 109/L and the diagnosis is
GT
e. Maternal platelet count returns to normal within 6 hours of delivery

12) With regards to iron deficiency anaemia and pregnancy:

a. The first laboratory change in iron deficiency anaemia is low serum ferritin
b. Transferrin receptor gives a true reflection of tissue iron deficiency
c. Serum transferrin receptor increases in iron deficiency anaemia
d. Hemoglobin of 8g/dl at 32weeks is an indication for blood transfusion
e. Is a risk factor for PPH

13) The following are complications of surgical management of stress incontinence:

a. Retention of urine
b. Bleeding
c. Enterocele
d. Sexual problems
e. Detrusor instability

14) A 65 year old patient with diabetes mellitus and hypertension presents to the gynaecology clinic
with lump at vulva. She gives a history of several episodes of urinary retention which needed
catheterization at the local hospital. What are the management option for her?
a. Insertion of a polyvinyl ring pessary and application of oestrogen cream
b. Manchester repair
c. Vaginal hysterectomy and repair
d. Abdominal hysterectomy and burch colpo suspension
e. Pelvic floor exercise

15) With regards to incontinence terminologies:

Dr.J.Rajeevan
 a. Stress incontinence is a leakage of urine in response to a decrease in intra-abdominal
pressure
b. Urodynamic stress incontinence is a clinical diagnosis
c. Urgency is a strong desire to void and can be due to increased bladder sensitivity
d. Detrusor instability is an urodynamic diagnosis
e. Urge incontinence is a strong desire to void along with involuntary leakage of urine

SBA

16) A gravida 2 Para 0+1 molar pregnancy is diagnosed with Rhesus isoimmunisation. Doppler
assessment of which vessel is used to monitor fetal anaemia during pregnancy
a. Middle cerebral artery
b. Umbilical artery
c. Umbilical vein
d. Uterine artery
e. Uterine vein

17) A woman with a monchorionic diamniotic twin pregnancy at 25 weeks gestation is assessed at
the regional fetal medicine service. She is found to have severe TTTS (Quintero stage III). What is
the optimal treatment?
a. Amnioreduction
b. Fetoscopic laser ablation
c. Septostomy
d. Termination of the donor twin
e. Termination of the entire pregnancy

18) A gravida 2 Para 1+0 attends the antenatal clinic for booking at 14 weeks. Her previous
pregnancy was an emergency caesarean section for abruption at 38 weeks. Dating scan confirms
a live fetus with a low risk for Down’s syndrome. Routine bloods indicate her to have blood
group B Rh negative and the antibody titre performed 2 weeks prior to the appointment reveals
the anti-D level to be 5 IU/ml. With regards to hemolytic disease of the fetus and newborn
(HDFN), what is the optimal management?
a. Arrange for her partner’s blood group to be tested for his Rhesus status
b. Enquire if she received anti-D following the previous pregnancy and delivery
c. Make a referral for fetal medicine opinion due to risk of HDFN

Dr.J.Rajeevan
 d. Reassure the mother that the HDFN is unlikely at that level and advice repeat
assessment at 28 weeks
e. Repeat the blood test in 4 weeks to assess the anti-D levels again

19) A 40-year-old primigravida is seen in the antenatal clinic with a twin pregnancy conceived
through IVF. Gestation is 11+6 days and the ultrasound scan has confirmed DCDA twins
appropriate for the gestation with normal nuchal thickening. What is the appropriate
monitoring to detect growth discordance?
a. Growth scans at 28 and 34 weeks
b. Serial growth scans every 2 weeks from 20 weeks
c. Serial growth scans with fetal weight estimation every 2 weeks from 16 weeks
d. Serial growth scans with fetal weight estimation every 3–4 weeks from 20 weeks
e. Symphysio-fundal measurement

20) A 55-year-old woman attends the gynaecology clinic. She is suffering with terrible menopausal
symptoms and cannot sleep because of the frequency of hot flushes. She is requesting hormone
replacement therapy (HRT) for symptom relief. She is currently healthy but has a history of a
deep venous thrombosis in her calf following a fractured femur as a result of an accident 10
years ago. Her last menstrual period was 2 years ago and her uterus is intact. What would you
recommend?
a. All HRT is contraindicated in this situation
b. Oestrogen and testosterone implants
c. Oral continuous combined HRT
d. Raloxifene
e. Transdermal continuous combined HRT

21) A 48‐year‐old woman with a BMI of 24 and no personal or family history of note comes to see
you seek out treatment for severe hot flushes which are seriously interfering with her sleep. She
has heavy and irregular periods and also complains of some discomfort during sexual
intercourse.Which of the following treatment options would be most appropriate for this
woman?
a. Tibolone
b. Vaginal oestrogen
c. Mirena intrauterine system and systemic oestrogen
d. Venlafaxine
e. Continuous combined HRT

22) A 22-year-old girl presents with lower abdominal pain, which is cyclical in nature. Which
modality is the only way to reliably diagnose peritoneal endometriosis?
a. Computerised Tomography Scan of the abdomen and pelvis
b. Laparoscopy
c. Magnetic Resonance Imaging of the abdomen and pelvis
d. Trans-abdominal ultrasound scan of the abdomen
e. Trans-vaginal ultrasound scan of the pelvis

Dr.J.Rajeevan
 23) A 29-year-old woman presents with a constant ongoing pain in the pelvis. The pain does not
occur exclusively with menstruation or intercourse and the woman is not pregnant. For what
minimum duration should the pain occur before it is deemed chronic?
a. 1 week
b. 1 month
c. 3 months
d. 6 months
e. 1 year

24) An 84-year-old patient who had a previous history of vaginal hysterectomy presents with a stage
3 vault prolapse. The patient has limited mobility and has previously had difficulty with the use
of vaginal pessaries. What is the most appropriate treatment option?
a. Abdominal Sacrocolpopexy
b. Colpocliesis
c. Physiotherapy
d. Sacrospinous fixation
e. Transvaginal repair with mesh

25) A 55-year-old patient presents with a history of urinary symptoms of urgency, increased
frequency and nocturia. The patient states that she does not have symptoms of hesitancy and
feels as though she empties her bladder completely. What would be the first line of
management?
a. Cystoscopy
b. Neuromodulation
c. Reduce caffeine intake and start anticholinergic medication
d. Ultrasound scan to rule out pelvic pathology
e. Urodynamics

26) A fit and healthy 52-year-old patient with confirmed detrusor overactivity has tried three
different medical treatments (Oxybutynin, Solifenacin, Mirabegron). The procedure that should
be offered to the patient is
a. Botulinum toxin A injections into the bladder
b. Detrusor myomectomy
c. Percutaneous tibial nerve stimulation
d. Sacral nerve modulation
e. Urinary diversion

27) A 35 year old multiparous teacher complains of severe genuine stress incontinence. On
examination there is no evidence of uterovaginal prolapsed. What is the best management
option?
a. Insertion of tension free vaginal tape
b. Burch colposuspension
c. Pelvic floor exercise

Dr.J.Rajeevan
 d. Kelly’s repair
e. Colpocleisis

28) A 25 year old primigravida at 12 weeks of gestation is found to have haemoglobin of 7 g/dl and
she is asymptomatic. What is the most important next step in her management?
a. Advise her to protein rich diet and review in one month
b. Arrange a blood transfusion
c. Perform full blood count and blood picture
d. Prescribe double dose of oral iron
e. Prescribe mebendazole

29) A 32-year-old multigravida with a dichorionic diamniotic twin pregnancy is admitted at 37 weeks
of gestation in labour. The blood pressure is 140/90 mmHg. She also requests sterilization.
Which of the following is the most important factor in deciding the mode of delivery?
a. Blood pressure of 140/90 mmHg
b. Chorionicity of the pregnancy
c. Gravidity of the woman
d. Maternal request for sterilization
e. presentation of the leading twin

30) . A 31-year-old nulliparous woman presents with a history of inability to conceive in spite of
having regular unprotected sexual intercourse for three years. She also complains of
dysmenorrhea. Clinical examination reveals a left adnexal mass and a fixed retroverted normal
sized uterus.Ultrasound scan shows a left ovarian cyst of 6x6 cm size. What is the most
appropriate management of this patient?
a. Combined oral contraceptive pills
b. Depot medroxyprogesterone acetate injections monthly
c. Laparoscopic ovarian cystectomy
d. Ovulation induction with clomiphene citrate
e. Ultrasound guided aspiration of the cyst

Dr.J.Rajeevan