1. A 37-yr-old para 3 woman had a difficult forceps delivery for fetal distress.

The baby
was 4.2kg and the delivery was complicated by a shoulder dystocia. She had active
management of the third stage of labour. She develops a primary postpartum
haemorrhage (PPH). The uterus was found to be well contracted. She had no
previous surgeries. Which of the following is the MOST LIKELY the cause of her PPH?

a. Uterine rupture
b. Vaginal Laceration
c. Uterine atony
d. DIC
e. Retained products of conception

2. A 25-year-old Rhesus D negative woman with a parity of 1+1 received routine

antenatal anti-D prophylaxis (RAADP) at 28 weeks. She presented two (2) weeks later
complaining of vaginal bleeding. Which of the following is TRUE?

a. There is no need to administer another dose of anti-D Ig as RAADP was given 2 weeks prior
b. A direct Coomb's test should be performed to assess the amount of feto-maternal
haemorrhage
c. Anti-D Ig should be given regardless of when RAADP was given
d. Cordocentesis should be performed to detrmine the fetus's Rhesus D status
e. Amniocentesis should be performed to assess for feto-maternal haemorrhage

3. A woman visits the gynaecology clinic requesting a long acting reversible

contraception (LARC). When counseling her, which of the following statements is
TRUE?
a. The copper intra-uterine device acts by inhibiting ovulation
b. The intrauterine system (Mirena) contains both estrogen and progesterone and thus has a
very low failure rate
c. Injectable progestogens are contraindicated while breastfeeding
d. The sub-dermal implant (Nexplanon) has the lowest failure rate
e. The sub-dermal implant (Nexplanon) has to be changed every 5 years

4. A 72-year-old lady is found to have an ovarian cyst as an incidental finding while

having a KUB ultrasound. She is referred to the gynaecology clinic for further
 assessment. The consultant asks you to work out her Risk of Malignancy Index (RMI).
What are the parameters used in this calculation?

a. Age, ultrasound findings and lymph nodes on CT

b. Ultrasound findings, clinical features, family history
c. Age, BRCA status, size of mass
d. Age, lymph nodes on CT and CA-125
e. Menopausal status, ultrasound findings and CA-125

5. Which of the following does not contribute a score of one (1) when calculating the
VTE score for an obstetric patient?
a. Parity ≥ 3
b. BMI ≥ 40 kg/m2
c. History of smoking
d. Preterm delivery
e. Prolonged labour

6. Regarding Rhesus iso-immunization, which of the following is TRUE?

a. ABO incompatibility protects against rhesus haemolytic disease

b. Can be diagnosed using the Kleihauer Betke test
c. The direct Coomb’s test is used to detect unbound rhesus antibodies in the maternal
circulation
d. It is a cause of non-immune fetal hydrops
e. It cannot occur in primigravidas

7. Regarding the fetal circulation, which of the following does NOT occur within
minutes of birth?

a. Constriction of the foramen ovale

b. Constriction of the ductus venosus
c. Constriction of the ductus arteriosus
d. Constriction of the umbilical vessels
e. Constriction of the hepatic portal sinus

8. The ureter crosses in front of the internal iliac artery at what level?
a. L4
b. Sacroiliac joint
c. Psoas muscle
d. Ischial spines
e. L5

9. A 28-year-old para 2+0 patient presents to hospital after being referred from the
local health centre for post-dates. You calculate and confirm her estimated date of
delivery. She is found to be 40+2 weeks gestational age. She has no medical
problems and her pregnancy has been uncomplicated. What would be the MOST
APPROPRIATE next step in management?

a. Allow home and advise to return when she is experiencing contractions

b. Perform a membrane sweep and readmit at 41 weeks for IOL
c. Allow home and readmit at 42 weeks for IOL
d. Perform a membrane sweep
e. Admit for IOL

10. In A Rhesus D negative woman at less than 12 weeks gestation, Rhogam is required
in all of the following EXCEPT:
a. Medical management of an ectopic pregnancy
b. Incomplete molar pregnancy
c. Termination of pregnancy
d. Surgical management of an ectopic pregnancy
e. Complete miscarriage

11. You are called to the labour ward to assist in the management of a case of severe
postpartum haemorrhage. Fibrinogen levels were requested and found to be less
than 2g/l. Which of the following blood products should be requested for fibrinogen
replacement?

a. Cryoprecipitate
b. Packed cells
c. Platelets
d. Whole blood
e. Fresh frozen plasma
 12. A 25-year-old primigravida at 38 weeks is sent for an ultrasound. The report indicates
a normally placed placenta with AFI of 8 cm. The fetus moves normally with normal
tone and heart rate but no breathing movements. A non-stress test preformed just
prior to the ultrasound was normal. What is the score on the biophysical profile at
this time?
a. 6
b. 9
c. 8
d. 2
e. 1

13. A 39-year old para 3 has been using an IUCD for the last 4 years as contraception.
She misses her period and has a positive pregnancy test. Although unplanned the
pregnancy is welcomed. What advice would you give her regarding pregnancy with a
copper containing IUCD?
a. The IUCD can be left in-situ and used as a contraceptive after delivery
b. The pregnancy should be terminated as the foreign body can cause structural deformities
c. The pregnancy should be terminated as the copper is teratogenic
d. The IUCD should be removed even if the strings are not visible to avoid migration
e. The IUCD should be removed if the strings are visible to reduce the risk of miscarriage

14. A 33-year old para 2 is admitted with a history of heavy menstrual bleeding and
symptoms of anaemia. She gives a history of severe migraines with aura. She has no
pregnancy plans in the near future. Physical examination is normal other than for
pale mucous membranes. Her haemoglobin is 5.4 g/dl and her MCV 65fl. Pelvic
ultrasound shows a normal uterus. She is being transfused 3 units of packed red
blood cells. What would be the best long-term management for her?

a. Tranexamic acid
b. Mirena IUS
c. Combined oral contraceptive patch
d. Combined oral contraceptive pill
e. Norethisterone 5 mg t.d.s. as continuous therapy

15. Which of the following is the MAIN advantage of performing a medio-lateral

episiotomy?

a. Less anal sphincter damage

b. Reduced incidence of dyspareunia
c. Less pain in the post partum period
d. Less blood loss
e. It is easier to repair

16. A 35-year-old primigravida was diagnosed with gestational diabetes at 26 weeks

gestational age. She was placed on a 1600-1800 calorie diet and advised to record a
blood sugar profile (BSP). She returns at 27 weeks and the results of her BSP over the
last week are shown below. What would be your next step in management?

a. Continue 1600-1800 calorie diet

b. Start short acting insulin (Insulin R) 5U sc tds
c. Start Metformin 500mg po bd
d. Advise on a 1200-1400 calorie diet
e. Start intermediate acting insulin (Insulin N) 5U sc tds

17. A 23-year-old presents at 32 weeks gestation with a history of having passed fluid
per vaginam 1 hour ago. She is not contracting. There is no bleeding, and the fetus is
moving well. She reports having had a positive test for chlamydia in early pregnancy,
but having taken her treatment. Pooling of amniotic fluid is seen. What antibiotic
would you prescribe?

a. Metronidazole
b. Co-trimoxazole
c. Co-amoxiclav
d. Erythromycin
e. Azithromycin

18. Which of the following may be a normal finding in a pregnant patient?

a. Absent P waves on ECG

b. Ejection systolic murmur
c. Diastolic murmur
d. Pansystolic murmur
e. Tall tented T waves on ECG
 19. A 33-year-old para 2 presents with heavy menstrual bleeding. She is sexually active
and doesn’t want any more children. Clinically she is thought to have 12-week sized
uterine fibroids and these are confirmed by transvaginal ultrasound. Which of the
following options for medical management would also shrink her fibroids?

a. Injectable progestogens
b. Tranexamic acid
c. Oral progestogens
d. Ulipristal acetate
e. Combined oral contraceptive pill

20. Which of the following is TRUE?

a. Menopausal symptoms include vasomotor, urogenital and psychological symptoms

b. The average age of menopause is 48 yrs
c. Women on combined oestrogen and progesterone should utilise FSH values if menopause is
suspected
d. Menopause cannot occur before age 45 yrs
e. FSH is routinely used to diagnose menopause

21. The image shows a doppler study of the umbilical artery. What does it demonstrate?

a. Absent End Diastolic Flow

b. Reverse Diastolic Flow
c. High Resistance Flow
d. A high peak systolic velocity
e. Normal Flow

22. A 28-year old attends for a routine Pap smear. The result returns as high-grade
squamous intraepithelial lesion, HSIL. What is the next course of action for this
patient?
a. HPV-DNA testing
b. Colposcopy
c. Cryotherapy
d. Repeat Pap smear in 3-6 months
e.Co-testing in 3-6 months
 23. A 34-year-old primigravida presented to the ward at 11 weeks gestational age with
severe vomiting. She is a known diabetic on insulin. Her RBS was 203 mg/dl. An
ultrasound done showed a twin gestation. Her BP was 141/95 mmHg. A urinalysis
done showed ketones 2++. Blood investigations were done which were as follows.
What is the MOST LIKELY diagnosis?

a. Obstetrics cholestasis
b. HELLP syndrome
c. Hyperemesis gravidarum
d. Acute fatty liver in pregnancy
e. Diabetic ketoacidosis

24. When performing a routine uncomplicated Caesarean section, which of the

following is NOT usually done?

a. A lower transverse uterine incision is made

b. The parietal peritoneum is closed
c. The uterus is closed in 2 layers
d. The uterovesical fold is deflected
e. A Joel-Cohen's incision is made

25. Which of the following is NOT usually associated with shoulder dystocia?

a. If brachial plexus injuries occur, it is usually associated with the anterior arm
b. It is associated with diabetic pregnancies.
c. Most cases are unpredictable
d. If fetal fractures occur, usually occurs with the anterior arm
e. Can result in 3rd and 4th degree perineal lacerations.

26. A patient presents with vulvar irritation and pruritis. Speculum examination reveals a
hyperemic, edematous, vaginal vault with odorless discharge. The pH is 4.0. What is
the MOST likely diagnosis?

a. Gonococcal vaginitis
b. Trichomoniasis
c. Hydradenitis suppurativa
d. Candidiasis
e. Bacterial vaginosis (BV)

27. A patient is being induced for diabetes in pregnancy. The house officer on duty
performed a vaginal examination to determine whether she requires another dose of
prostaglandins. The findings are as follows:
Dilation:4 cm Effacement: 60% (0.5cm long) Position: anterior Cervical consistency:
soft Station: 0
What value is the Bishop’s score MOST LIKELY to be?
a. 15
b. 13
c. 10
d. 5
e. 2

28. A 16-year-old attends the gynaecolgy clinic with her mother complaining of painful
menstruation. She has been using mefenamic acid regularly with no relief in
symptoms. Which of the following would be the most appropriate next step in
management?

a. Danazol
b. Norethisterone enanthate
c. COCP
d. GnRH analogues
e. Tramadol

29. Which of the following is NOT a cause of fetal tachycardia?

a. Beta blockers
b. Maternal hyperthyroidism
c. Salbutamol
d.Chorioamnionitis
e. Anaemia from fetal bleeding

30. Which of the following is TRUE?

a. Causes of primary dysmenorrhea include endometriosis and pelvic inflammatory disease

b. Spasmodic dysmenorrhea is attributed to painful uterine contractions
c. Primary dysmenorrhea is usually due to identifiable pelvic pathology
d. Congestive dysmenorrhea usually starts after the periods
e. Dysmenorrhea can only be diagnosed after 6 months of painful menstruation

31. A 35-year-old woman with a parity of 2+2 had an OGTT done at 28 weeks. The values
were as follows: Fasting - 90mg/dl, 1hr - 160 mg/dl, 2hr - 135 mg/dl. What would be
the next step in management?

a. Reassure and continue routine antenatal care

b. Advise on BSP with a 1600 – 1800 calorie diet
c. Advise on BSP with normal diet
d. Reassure and repeat OGTT in 2-4 weeks
e. Advise on BSP and start Metformin

32. Regarding osteoporosis, which of the following is NOT TRUE?

a. Osteoporosis is a long term complication of menopause

b. It is due to impaired bone remineralization leading to softening of the bone
c. It is due to a loss in bone mineral density
d. The FRAX score is used to estimate the 10 year probability of hip and major osteoporotic
fracture
e. It is diagnosed by a T score of less than -2.5 on a BMD scan

33. The pregnant woman undergoes a variety of physiological and anatomical changes
which may affect resuscitation. Which of the following is NOT TRUE?

a. Acidosis is more likely to develop due to an increase in residual capacity and arterial PCO2
b. An enlarged uterus may cause diaphragmatic splinting making ventilation more difficult
c. Intubation may be more difficult due to weight gain and large breasts
d. Intubation may be more difficult due to laryngeal oedema
e. There is an increased risk of aspiration due to decreased gastric motility

34. Which of the following is not a cause of hypergonadotrophic hypogonadism?

a. Kallman’s syndrome
b. Premature ovarian insufficiency
c. Turners syndrome
d. Fragile X syndrome
e. Irradiation to ovary
 35. A 32-yr-old complains of vulval itching, burning on urination and a yellow foul
smelling discharge. On speculum examination, there were multiple, small, red,
circular lesions stippled throughout the cervix. Which of the following is MOST
applicable?

a. The most likely causative organism is a protozoan

b. She should have a colposcopy performed
c. She should be given antifungals for her symptoms
d. The cervical findings are in keeping with an ectropion
e. A wet mount would reveal clue cells

36. Monozygotic twins:

a. Are always monoamniotic

b. Should be delivered via Caesarean section
c. Are also known as paternal twins
d. Are always monochorionic
e. Are always of the same sex

37. With respect to screening for Down’s syndrome, the TRIPLE TEST:
a. Is performed in the second trimester
b. Involves taking maternal serum for BHCG, AFP, PAPPA
c. Is performed in both the first and second trimester
d. Involves NT at 11 – 13+6 weeks gestational age
e. Is also known as the combined test
38. During which phase of the menstrual cycle are progesterone levels highest?

a. Menstruation
b. Proliferative phase
c. Follicular phase
d. Luteal phase
e. Ovulation

39. Which of the following is LEAST LIKELY to be associated with endometriosis?

a. Ovarian cysts
b. Dyschezia
c. Post-coital bleeding
d. Absence from work/school
e. Infertility

40. A 24-year-old is seen with her partner in the gynaecology outpatient clinic with a
history of 5 first trimester miscarriages and a left femoral DVT. Her partner is 30
years old and has 2 children with a different partner. Which of the following
investigations would be most helpful in reaching a diagnosis?

a. Anti dsDNA
b. Lupus anticoagulant antibodies
c. Prolactin levels
d. Semenalysis
e. BHCG

41. A patient presents to your office for contraceptive advice. She gets severe nausea
when she uses the combined oral contraceptive pill. She is however concerned about
the efficacy of the progestogen only pill. What would you tell her is the mechanism
of action by which the progestogen only pill prevents pregnancy?

a. Endometrial hostility and increased thickness of cervical mucous

b. Endometrial hostility
c. Increased thickness of cervical mucous
d. Decreases sperm motility
e. Suppression of ovulation

42. Ectopic pregnancy can be treated with the following EXCEPT:

a. Laparotomy‎
b. Laparoscopy
c. Methotrexate
d. Observation
e. Misoprostol

43. An ultrasound scan is being performed at 20 weeks of gestation for a patient who is
known to have monochorionic diamniotic twins (MCDA). Which of the following
findings may suggest twin to twin transfusion syndrome (TTTS) and thus require
closer monitoring?
a. Oligohydramnios in twin 1
b. A difference in estimated fetal weight of 5%
c. A thin septum
d. An abdominal circumference above the 50th centile in T1
e. Calcifications in the placenta

44. A 53-year old presents with abnormal vaginal bleeding. She is unsure whether she
has gone through menopause as she has had extended periods of amenorrhoea for
all her reproductive life and was told she had PCOS. Despite this she has had two
children, breast fed both and used the combined oral contraceptive pill
intermittently. When not on the pill she used condoms as contraception. She recalls
having only 2 Pap smears, the last 10 years ago. What factor in her history would
increase her risk of endometrial carcinoma?

a. Condom usage
b. Being para 2
c. Breastfeeding
d. Periods of amenorrhoea
e. COCP usage

45. What is the ultrasound parameter that can be used in the first trimester (11-14
weeks) as a screening tool for chromosomal anomalies?

a. Crown rump length

b. Nuchal translucency
c. Uterine artery doppler
d. Humeral length
e. Nasal bone assessment

46. The midwife on duty asks you to review a patient who has just been seen in the
labour ward admission room. She tells you that the patient has a twin gestation and
is complaining of contractions every 15 minutes. Which of the following factors is
LEAST LIKELY to influence the management of this patient?

a. Period of gestation
b. Presentation of twin 2
c. Chorionicity
d. Cervical dilatation
e. Presentation of twin 1

47. Which of the following is LEAST likely to be used in the treatment of a patient with
severe hyperemesis gravidarum?

a. 5% Dextrose solution
b. Hydrocortisone
c. Low molecular weight heparin
d. Potassium chloride
e. Thiamine

48. A 24-year-old primiparous patient with pre-eclampsia and IUGR is being induced at
38 weeks. She starts having recurrent late decelerations on the cardiotocograph.
Vaginal examination reveals a cervix which is 7 cm dilated, fully effaced and thin.
Amniotomy performed reveals meconium-stained liquor. A fetal scalp blood sample
is performed, and the pH is 7.18. What would be your next step in her management?

a. Left lateral position, extra fluids and repeat scalp pH in 60 min

b. Expedite delivery by Caesarean section
c. Expedite delivery by ventouse extraction
d. Discontinue oxytocin and allow to progress
e. Left lateral position, extra fluids and repeat scalp pH in 30 min

49. A 33-year-old gravida 2, para 1 patient attends for an antenatal visit at 41 weeks and
4 days gestation. She had an uneventful delivery of a 3900g baby boy at 39 weeks in
her last pregnancy. Labour induction is recommended. In counselling her regarding
the risks of going post-term, what would be the MOST IMPORTANT risk you would
like to avoid?

a. Caesarean section
b. Meconium aspiration
c. Macrosomia
d. Stillbirth
e. Instrumental delivery

50. Which of the following is NOT routinely used to minimise blood loss when
performing a myomectomy?
a. Use of a tourniquet intra-opertively
b. Intra-operative vasopressin
c. Pre-operative GnRH analogues
d. Intra-operative oxytocin infusion
e. Pre-operative uterine artery embolisation

51. When proceeding with an operative vaginal delivery in the labour ward, which of the
following is NOT usually done?

a. Contact the pediatrician

b. Obtain written consent
c. Ensure a theatre is available
d. Empty the bladder
e. Determine the position of the fetal head
52. Concerning pre-invasive disease of the cervix, which of the following is TRUE?

a. A family history of cervical cancer increases the risk of acquiring this condition
b. A loop excision or cone biopsy is always required for treatment
c. It can take up to 6-8 years to progress to invasive disease if left untreated
d. Smoking does not increase the risk of acquiring this condition
e. HPV 6 and 11 subtypes are implicated as a cause

53. Which of the following should be avoided when managing a cardiac patient in
labour?

a. Intramuscular Pethidine
b. Episiotomy
c. Intramuscular Syntometrine
d. Forceps delivery
e. Intravenous antibiotics

54. A 30-year-old with a parity of 4+1 presented to the gynaecology ward with mild
vaginal bleeding for 8 days. She has irregular cycles and is unsure of her last
menstrual period. Her urine pregnancy test (UPT) is positive. On examination, the
abdomen is non-tender, the os admits a finger, there is minimal vaginal bleeding and
no products of conception are seen. An ultrasound done showed no intra-uterine
 gestation, no free fluid and no adnexal masses. What would be your next step in
management?

a. Evacuation of retained products of conception (ERPC)

b. Diagnostic Laparoscopy
c. Perform a 0hr and 48hr beta hCG
d. Discharge her and repeat an ultrasound in 1 week
e. Reassure the patient as she most likely had a complete miscarriage

55. Which of the following regarding PPROM is NOT true?

a. It complicates approximately 2% of pregnancies

b. The three main causes of neonatal death are prematurity, sepsis and pulmonary hypoplasia
c. Chorioamnionitis is a major complication of PPROM
d. The Nitrazine test has a higher sensitivity than the Amnisure test for detecting ruptured
membranes
e. Risk factors include urinary and lower genital tract infections, smoking and low
socioeconomic status

56. A 16 yr old girl presents with left iliac fossa pain. An ultrasound scan of the pelvis
shows a 7cm complex ovarian with solid, calcified and fatty deposits. What is the
MOST LIKELY diagnosis?
a. Serous cyst adenoma
b. Mature cystic teratoma
c. Tubo-ovarian abscess
d. Theca luteal cyst
e. Fibroma

57. A 36-year-old presents with amenorrhoea for 7 months. She is not on any hormonal
contraception. Her BMI and examination are normal. FSH and LH are markedly
elevated, prolactin and androgen levels normal. She does not bleed after
progesterone challenge but bleeds after combined estrogen/progesterone
administration. What is the diagnosis?

a. Hypothalamic hypopituitarism
b. Hyperprolactinaemia
c. Polycystic ovary syndrome
d. Pituitary adenoma
e. Premature ovarian failure

58. Of the following, which is the MOST likely genotype of a partial molar pregnancy?

a. 45 X
b. 46 XY
c. 46 XX
d. 69 XXY
e. 23 X

59. Regarding cervical cancer, which of the following is FALSE?

a. It commonly presents with post-coital bleeding or a vaginal discharge

b. Smoking increases the risk of cervical cancer
c. Diethylstilbestrol is associated with clear cell carcinoma of the cervix
d. The treatment for stage 3 disease is radical hysterectomy
e. It is associated with early coitarche

60. During a laparoscopy for an unruptured ectopic pregnancy, the surgeon is indicating
the safe placement of the lateral trocars. He points out blood vessels running on the
peritoneal aspect of the anterior abdominal wall that he is going lateral to. What
vessels are these?

a. Inferior epigastric
b. Superior epigastric
c. Ilioinguinal
d. Ascending femoral
e. Hypogastric