GYNECOLOGY TEST

Q1. A couple come in for infertility investigations. On history taking, you find out that the
husband has recurrent pneumonia, recurrent bronchiectasis, and pancreatic problems. He is
taking pancreatic enzymes, vitamins, and prophylactic antibiotics. What is the best next
investigation?

A. Semen analysis
B. Sweat chloride test
C. Alpha-1-antitrypsin
D. Hysteroscopy

Q2. A married woman is complaining of infertility. She has had 3 abortions managed by D&C after
which she hasn’t been able to conceive. Her hormonal profile is normal. Why can’t she conceive
now?

A. Kallman syndrome
B. Asherman’s syndrome
C. Androgen insensitivity
D. Meig’s syndrome
E. Sheehan syndrome

Q3. A P1+0 young lady is complaining of infertility. She had 1 previous delivery that was
complicated by bleeding and she went into hypovolemic shock. She was also using cocaine in
that pregnancy. She has a low hormone profile. What is the cause of her infertility?

A. Meig’s syndrome
B. Sheehan syndrome
C. Asherman syndrome
D. Androgen insensitivity

Q4. A woman with hirsutism, obesity, amenorrhea for 4 months was

worried that she did not get pregnant after 18 months of her marriage. She also recalls that her
last periods were very heavy.
What is the initial management?

A. Metformin
B. Clomiphene citrate
C. Exercise & 10% weight loss
D. Letrozole

Q5. Q4. A woman with hirsutism, obesity, amenorrhea for 4 months was
worried that she did not get pregnant after 18 months of her marriage. She also recalls that her
last periods were very heavy.
What is the best management for her?

A. Metformin
B. Clomiphene citrate
C. Exercise & 10% weight loss
D. GnRH analogues

Q6. A lady is complaining of infertility for 2 years, amenorrhea, & a small amount of nipple
discharge. She has increased TSH levels and decreased T3 & T4. Prolactin is 90. Next step?

A. Brain CT (sella turcica) scan to look for a tumor

B. Give bromocriptine
C. Give levothyroxine
D. Give cabergoline

Q7. A post-menopausal lady presents with vaginal bleeding. She is vitally stable and not on any
medications. What is the next best step ?

A. USG
B. Endometrial biopsy
C. Hysterectomy
D. Hysteroscopic biopsy

Q8. A 55 y/o lady menopausal for 5 years is complaining of bleeding with brownish
spotting. Examination shows an easily bruising vagina & cervical stenosis. Her last pap smear 3
months ago was normal. Next step?

A. Do US scan
B. Vaginal estrogen cream
C. Cyclic progestin
D. Endometrial biopsy

Q9. A 50-year-old female, P8, menopausal for 5 years, came complaining of brownish vaginal
discharge not related to intercourse (PMB). Pap smear 3 years ago was normal. She has history
of coronary artery disease and angina. Physical and bimanual examinations were normal but
showed atrophic vagina. US showed endometrial thickness of 2 mm . What is the next step in
management?

A. Colposcopy
B. Endometrial US
C. Endometrial biopsy
D. Estrogen cream

Q10. A post-menopausal lady is complaining of dyspareunia. She tried vaginal lubricants and
moisturizers but had no response. What do you give her?

A. Low dose vaginal estrogen

B. High dose vaginal estrogen
C. Combined OCP
D. Progesterone cream

Q11. An office-working lady presents complaining of hot flashes & sleep disturbances. She has
history of breast cancer 2 years ago. Management?

A. HRT
B. Clonidine
C. SSRI
D. Propranolol hydrochloride

Q12. A healthy old lady has menopausal complaints. She is not obese. No family history of
cancers. Best management option?

A. Combined contraceptives
B. Medroxyprogesterone
C. Tamoxifen
D. Clonidine
Q13. A healthy 49-year-old woman, not on any medications, is complaining of hot flashes & a
labile mood that are affecting her life. She had regular cycles that lasted for 23-25 days
previously, but for the past 9 months she has missed 3 cycles. She denies any post-coital
bleeding or stopping. She is asking for medications to help with her symptoms. What would you
give her?

A. SSRI
B. Low-dose combined OCPs
C. Continuous progesterone
D. Cyclic progesterone

Q14. A lady developed hot flashes & other menopausal symptoms after bilateral salpingo-
oophorectomy & hysterectomy. What is the cause of her symptoms?

A. Decreased estrogen
B. Decreased progesterone
C. Decreased estrogen and progesterone
D. Decreased TSH

Q15. A 13-year-old girl came to the PHC complaining of her irregular period. It has been irregular
since her menarche 6 months ago. She is otherwise healthy, her BMI is normal, and there are no
detectable abdominal masses. What is the most likely diagnosis?

A. Pregnancy
B. Anovulatory cycles
C. Prolonged luteal phase
D. Endometriosis

Q16. A lady has signs & symptoms suggestive of PCOS (hirsutism, clitoral enlargement, etc.).
what investigation is LEAST likely to be helpful?

A. DHEA-serum level
B. Free cortisol level
C. Testosterone levels
D. Dexamethasone suppression test

Q17. What investigations do you order for a woman with symptoms of PCOS (hirsutism & acne)?

A. Total testosterone + DHEA + 17 hydroxyprogesterone

B. Total testosterone + estradiol + 17 hydroxyprogesterone
C. Free testosterone + DHEA + 17 hydroxyprogesterone
D. Androstenedione + DHEA + 17 hydroxyprogesterone

Q18. A middle-aged female had ovarian cancer that was removed. Her menarche was at 17 y/o &
she has been taking COCPs in between pregnancies (for a total of 5 years). What increases her
chances of getting endometrial cancer?

A. Medroxyprogesterone
B. COCPs
C. Theca cell tumor
D. Menarche at 17
E. Multiparity

Q19. A 12-week pregnant lady was found to have a large cyst that was removed
laparoscopically. Histology showed a corpus luteal cyst. What is your next step?

A. Expectant management
B. Parenteral progesterone
C. Oral progesterone
D. Oral estrogen

Q20. A 19-year-old presented with vaginal discharge. There was an incidental finding of a 5 cm
simple unilocular cyst in her ovary. What is next regarding management?

A. Ask her to wait for 3 months and follow up

B. Give her OCPs
C. Observation
D. Immediate laparoscopy and evacuation of the cyst

Q21. A pregnant female at 16 weeks of gestation presents with mild dragging pain in the left iliac
fossa. O/E there is an adnexal mass. US showed a 10 x 15 cm, multiseptated, hyperechoic cyst
with calcifications in the left ovary (complex cyst). The right ovary is normal. Management?

A. Laparoscopic / open cystectomy as soon as possible

B. Laparoscopic / open cystectomy at 28 weeks
C. Open cystectomy + C/S at 38 weeks
D. Open/ laparoscopic cystectomy 2-weeks post-partum

Q22. A 44 y/o female G2P2 comes to your clinic. She had her first baby 24 years ago then used
OCPs for 6 weeks after which she had her 2nd baby. She continued OCPs
afterwards. Her mother had history of breast cancer. She is concerned about developing ovarian
cancer. Which of the following increase the risk of getting ovarian cancer?

A. Family history of breast cancer

B. Multiple pregnancies
C. 1st pregnancy at a young age
D. OCPs for > 5 years

Q22. A 35 y/o presented with secondary dysmenorrhea. It is not associated with vomiting or
diarrhea. The pain is localized to the left side. She has tried NSAIDs and OCPs for 6 months. She
is also complaining of infertility for 5 years. Management?

A. Diagnostic laparoscopy
B. Diagnostic laparotomy
C. Diagnostic hysteroscopy
D. Hysterectomy

Q23. A lady has an irregular non-tender pelvic mass on examination. What is the best next step?

A. Ultrasound
B. Laparoscopy
C. Laparatomy
D. CT scan

Q24. A lady presents with heavy vaginal bleeding. USS showed a submucosal fibroid
measuring 4x4 cm. Lab investigations revealed iron deficiency anemia. What is the best
management?

A. Laparoscopic myomectomy
B. Hysteroscopic myomectomy
C. Observation with iron supplement
D. Hysterectomy
E. GnRH agonist

Q25. Which cancer can be caused by a virus?

A. Lung
B. Liver
C. Ovary
D. Cervix

Q26. A 28 y/o newly married female came to the clinic. A pap smear was done, and the results
showed CIN I. After 6 months, another pap smear was done & result showed CN III. What will be
your next step of management?

A. Cone biopsy
B. Colposcopy & biopsy
C. Pap smear after 6 months
D. Repeat pap smear soon

Q27. A female with ASCUS repeated the pap smear but it still showed ASCUS. Next step?
A. Colposcopy
B. Repeat smear
C. Cryotherapy
D. HPV test

Q28. A G3P3 47 y/o patient presented with post-coital bleeding. O/E, she has a fibroid about the
size of 8-10 weeks of gestation. Speculum examination revealed cervical lesions. Pap smear /
colposcopy showed moderate dysplasia & biopsy shows severe dysplasia. What is the
management?
A. Ablation of cervical lesion
B. Hysterectomy
C. Cryotherapy
D. Radiotherapy

Q29. A lady comes complaining of fever & a vulvar mass. O/E there is a 3x4 cm lesion on the
posterior side of her left labia majora that is red & tender. Best management?

A. Aspiration & drainage

B. I&D with antibiotic coverage
C. Oral antibiotics
D. IV antibiotics

Q30. A female presented with copious, clear, non-odorous vaginal discharge and genitalia
discomfort. She has no pruritis. O/E there are multiple ulcers with vaginal discharge. What is your
diagnosis?

A. Chlamydia
B. Gonorrhea
C. Human papilloma virus
D. Trichomonas vaginalis
E. Herpes simplex

Q31. A lady came with frothy discharge that has a fishy smell. Wet mount revealed clue cells, and
there was a positive whiff test. pH was 5.4. What is the diagnosis?

A. Trichomonas vaginalis
B. Vaginal candidiasis
C. Streptococcus vaginalis
D. Gardenella vaginalis

Q32. A 22-year-old primigravida came complaining of white-yellow vaginal discharge with

itching. On examination, she has scratch marks and a fishy odor. How will you treat her?
A. Local antifungal
B. Oral metronidazole
C. Oral ceftriaxone
D. Intramuscular medication

Q33. A woman presented with frothy vaginal discharge associated with itching and burning at
the introitus. On examination, there are hemorrhagic dots on her cervix. Her vaginal pH was 5.8.
What is the most likely cause?

A. Trichomoniasis
B. Candidiasis
C. Herpes
D. Bacterial vaginosis

Q34. A woman came complaining of yellow-green frothy discharge. On examination, her cervix
was hyperemic. Hydrogen peroxide was negative. What do you do?

A. Oral vancomycin for her

B. Oral metronidzole for her
C. Oral metronidazole for her & her partner
D. Oral vancomycin for her & her partner

Q35. An asymptomatic pregnant lady had gonorrhea. What do you do?

A. Terminate the pregnancy

B. Take a swab & treat accordingly
C. Treat her with 24 million penicillin
D. Treat with cefotaxime

Q36. A young lady presents to you requesting contraception. She has a 5 cm cyst in one of her
ovaries. It is uniloculated and cystic in appearance. What do you do?

A. Ask her to wait for 3 months and follow up

B. Give her OCPs
C. Give her POPs
D. Immediate laparoscopy and evacuation of the cyst
Q37. A 44-year-old female had an US showing the thickness of her endometrium to be 4mm. On
sampling, the biopsy showed secretory endometrium. What would you give her?

A. COCPs
B. Estrogen only pills
C. Progesterone only pills
D. Non hormonal treatment

Q38. A 45-year-old lady, known case of uterine myoma, came complaining of vaginal
spotting (intermenstrual bleeding) for 3 months. O/E there is a myoma 8 weeks in size.
Endometrial (pipelle) biopsy showed proliferative endometrium. Next step?

A. Pelvic US
B. Diagnostic hysteroscopy
C. Cyclic hormonal therapy
D. Total hysterectomy

Q39. A female student is going to get married soon so she started taking OCPs. She
complained of nausea after the first course. What will you do for her?

A. Tell her to continue OCPs & that the nausea will improve gradually
B. Tell her to stop for 2 weeks then resume the same OCP
C. Switch to another OCP with higher estrogen dose
D. Advise her to place an IUCD instead

Q40. A patient with an IUCD got pregnant. Her LMP was 7 weeks ago. Next step in
management?

A. Reassure the patient & follow up on week 12

B. Remove the IUCD and confirm with USG
C. Tell the patient that the IUCD might cause structural fetal anomaly
D. Serial US
E. Tell her she should abort before 12 weeks GA

Q41. A patient came wanting contraceptives. She was previously using an IUCD but got pregnant
while having it. She has a history of PID 1-week back which was treated with antibiotics. What is
the contraindication for IUD in this case?

A. History of getting pregnant with IUCD

B. History of PID
C. Previous c-section
D. There is no contraindication

Q42. A 22-year-old lady is getting married and wants to start taking “the pill”. She is
clinically free of disease and so is her partner. She mentions that her mother & sister
have history of Lower limb clots. Her maternal grandmother is diabetic and hypertensive, and her
paternal grandmother had pancreatic cancer. What test should you do before you give her the
pill?

A. Bleeding time
B. Factor V Leiden
C. Pap smear
D. Fasting glucose

Q43. A 15-year-old girl has amenorrhea. O/E, her breasts are developed, she has pubic & axillary
hair, and she has bilateral inguinal masses. Her external genitalia are normal. What is your
diagnosis?

A. Testicular feminization (complete androgen insensitivity)

B. Bilateral inguinal hernia
C. Turner syndrome
D. Kallman syndrome

Q44. A 14-year-old girl is brought by her mom for primary amenorrhea. Her mom had her
menarche at 12 years and is worried because her daughter still did not develop any breasts or
pubertal hair distribution. She reports that the daughter is active at school and involved in
sports. On examination, she is Tanner stage 1. What investigation would you do?

A. Karyotyping
B. FSH level
C. Bone age test
D. Genetic testing
Q45. A 16 y/o girl is brought by her mother as she has not had her period yet. On
examination, she has no breast development & no pubic hair. Her height is 148 cm. USS shows a
small uterus. Lab investigations show increased FSH & LH, and decreased estrogen. Both her
sisters had menarche at the age of 12. Most likely diagnosis?

A. Testicular feminization
B. Kalman syndrome
C. Congenital adrenal hyperplasia
D. Gonadal agenesis / dysgenesis

Q46. A lady presented with amenorrhea but had a negative pregnancy test. She had a 7 cm
adnexal mass. What is the next step?

A. FSH level
B. LH level
C. Ultrasound
D. CT scan

Q47. A 44 y/o is presenting with amenorrhea for 3 months. Her previous cycles were
associated with heavy bleeding. She also gained weight and has hair loss. Next test?

A. B hcg
B. TSH
C. FSH & LH
D. Estrogen

Q48. A 30-year-old lady with secondary amenorrhea for the past 6 months has discontinued
OCPs recently as she wishes to get pregnant. On examination, there was milky discharge from
the nipples. What is the best drug to use?

A. Clomiphene
B. Estrogen
C. Cabergoline
D. Progesterone

Q49. How many hours after the LH surge does ovulation occur?
A. 24-36 hours
B. 48 hours
C. 12-14 hours
D. 6-8 hours

Q50. A 43-year-old lady came complaining of vaginal spotting for 6 months. Her last
menstrual period was 3 months ago, and she reports that her periods are irregular. She also
suffers from obesity and hirsutism. USS showed thickened endometrium .
Diagnosis?

A. Asherman syndrome
B. PCOS
C. Adenomyosisn
D. Endometriosis

Q51. A 28 year old woman presents to the GP surgery with complaints of irregular menstrual
periods and difficulty conceiving. She has been having a milky discharge from her breast over
the past few weeks. She reports that she has been trying to get pregnant for the past year
without success. On further questioning, she mentions occasional headaches but no visual
disturbances. Physical examination reveals no abnormal findings. Which of the following
laboratory investigations would be most useful in establishing a diagnosis?

A. Thyroid function tests

B. Follicle-stimulating hormone (FSH) levels
C. Luteinizing hormone (LH) levels
D. Prolactin levels
E.Progesterone levels

Q52. A 36 year old nulliparous woman attends the GP clinic with difficulty getting pregnant. She
has been trying to get pregnant for the past 2 and a half years. Her husband has one child from a
previous marriage and has a normal sperm count. On further questioning, she has a regular 28
day menstrual cycle with bleeding lasting up to 5 days. She denies any menorrhagia or
dysmenorrhoea. What is the SINGLE best test to assess ovulation?

A. Day 14 serum progesterone

B. Day 14 LH surge
C. Day 14 follicle count on ultrasound
D. Day 21 serum progesterone
E. Basal body temperature testing

Q53. A24 year old woman presents to the sexual health clinic with abnormal vaginal discharge.
She describes the discharge as yellow, smelly and frothy. She also complains of vaginal soreness
and discomfort, but no itching. On examination there is reddening of the vulval, vaginal and
cervical mucosa. Direct wet preparation and microscopy demonstrates motile protozoa. What is
the SINGLE most likely causative organism?

A. Trichomoniasis vaginalis
B. Bacterial vaginosis
C. Chlamydia trachomatis
D. Neisseria gonorrhoeae
E. Candida albicans

Q54. A 48 year old woman with severe menorrhagia is referred to the emergency care
department after her GP found that her haemoglobin was 58 g/L (115-160). She is recommended
to have a blood transfusion and an urgent referral to gynaecology is actioned. The junior doctor
takes her through the consent process. What is the SINGLE most common adverse reaction
following a blood transfusion?

A. Urticaria
B. F e v e r
C. HIV infection
D. Acute Immune Hemolytic reaction
E. Transfusion-Related Acute Lung Injury

Q55. A32 year old woman attends for her routine smear test. The result returns as human
papilloma virus (HPV) positive but with normal cytology. What is the SINGLE most appropriate
management?

A. Reassure
B. Repeat smear in 3 years
C. Repeat smear in 1 year
D. Refer to colposcopy within 2 weeks
E. Refer to colposcopy within 6 weeks

Q56. A 71 year old woman is referred to the two week wait gynaecology dinic following an
episode of vaginal bleeding on wiping. She denies any pain, abnormal vaginal discharge or recent
weight loss. Her last cervical smear was 6 years ago, which was normal. On examination; the skin
of the vulva and vagina appears thin and dry but with no focal abnormalities . The cervix is
normal on speculum examination and endometrial thickness of 2mm is found . What is the
SINGLE most appropriate management ?

A Topical oestrogen
B Hysteroscopy and endometrial biopsy
C. Vulval biopsy
D. Cervical smear
E Topical oestrogen and progesterone

Q57. A 13-year-ofd girl is noted to be short for her age. She has no problems at school and is
able to keep up with her classmates. Her periods have not yet started. On examination, the girl
has a webbed neck with a low hairline and high arched palate Her chest is broad with wide-
spaced nipples but with no evidence of breast bud development. What is the SINGLE most likely
underlying cause?

A. Klinefelter syndrome
B Kallman syndrome
C Marfan syndrome
D Mullerian agenesis
E Turner’s syndrome

Q58. A 43 year old woman attends the day surgical unit fora diagnostic laparoscopy for chronic
pelvic pain. The nurse completes her pre-assessment checks, including observations and a urine
test. The urinary pregnancy result returns as positive, The patient denies the possibility of her
being pregnant and states she has not had recent sexual intercourse What is the SINGLe most
appropnate next step?

A Repeat urine pregnancytest

B Check serum beta human chorionic gonadotropin
C. Proceed with the laparoscopy
D. Perform a pelvic ultrasound
E. Cancel the operation

Q59. A 56 year old woman presents to her general practitioner with

troublesomehotflushes.Herlastperiodwas3yearsago . Shefindsthat she struggles to steep due to
the hot flushes and is irritable throughout the day. She is keen to explore treatment options Her
past medical history includes a deep vein thrombosis 15 years ago which required 6 months of
warfarin treatment What is the SINGLE most appropriate management?

A Oestrogen-only hormone replacement

B Oral oestrogen and progesterone hormone replacement
C Topic oestrogen and oral progesterone hormone replacement
D Advise against treatment
E Venlafaxine

Q60. A 34 year old Ukranian woman presents with hot flushes following cessation of the
combined oral contraceptive pill She had ovarian surgery when she was 15 years old in Ukraine.
She stopped the pill 3 months ago, but has not had a period since . She has had an ultrasound
scan done 2 weeks ago that showed an atrophic left ovary and no visualisation of the right ovary
Blood tests reveal:

FSH 88 U/L (follicular: 3- 11, ovulatory: 5-20, luteal: 18-8)

LH 45 U/L (follicular: 3- 11, ovulatory: 17-110, luteal: 1-13)
Oestradiol <7 pg/mL (30-400)
Prolactin 267 mU/L (<440)
bHCG <5
TSH: 4.1 mU/L (0.5-57)

What is the SINGLE most likely diagnosis?

A Post-pill amenorrhoe
B Premature ovarian failure
C Polycystic ovanan syndrome
D Perimenopause
E Prolactinoma