WRITTEN TEST

RESIDENCY BASIC
DEPARTEMEN OF OBSTETRIC AND GYNECOLOGY
FACULTY OF MEDICINE UNIVERSITY OF SYIAH KUALA
23TH MAY 2017
Please choose a single best answer for each question!

1 Venous drainage of the left ovary

A Superior mesenteric vein B Inferior vena cava

C Left renal vein D Right renal vein
E Inferior mesenteric vein

2 Attaches the ovary to the lateral pelvic wall

A Mesovarium B Round ligament of the ovary

C Round ligament of the uterus D Infundibulo-pelvic ligament
E Tunica albuginae

3 The uterine artery

A Is a branch of the internal pudendal artery B Is crossed by the ureter

Reaches the cervix at the level of the
C D Does not enter the broad ligament
external os
Is a branch of the anterior division of the
E
internal iliac artery

4 Spermatogenesis

A Begins in-utero B Begins shortly after birth

C Does not begin until puberty D Takes about 3 weeks to complete
Culminates in the production of diploid
E
spermatozoa

5 In the human female ovaries, there are

A 40,000 primordial follicles at birth B 400,000 primordial follicles at puberty

Up to 2 million primordial follicles at
C D Up to 7 million primordial follicles at birth
puberty
Up to 2 million primordial follicles at 12
E
weeks gestation

6 During oogenesis, meiosis II is completed

A At puberty B At ovulation
C By 28 weeks gestation D At birth
E After fertilisation

7 With respect to oogenesis

The first polar body does not undergo a Ovulation occurs when the secondary
A B
second meiotic division oocyte shows spindle formation
The zona pellucida is formed after Resumption of meiosis is triggered by
C D
ovulation ovulation
Resumption of meiosis is triggered by
E
fertilisation

8 Proliferation of granulosa cells is mainly stimulated by

A Oestriol B Oestrone
C Follistatin D Leutenising hormone
E Follicle stimulating hormone

9 Leutenising hormone concentrations are high

In the second half of the follicular phase of
A Before puberty B
the menstrual cycle
C During menstruation D 12-24 hours before ovulation
E 12-24 hours after ovulation

10 With respect to fertilisation

he second meiotic division starts in the Fertilisation occurs in the ampulla of

A B
developing oocyte after fertilisation the fallopian tube
During capacitation, the spermatozoa During capacitation, cortical granules are
C D
loses its tail released into the perivitelline space
Capacitation ensures that the oocyte is
E
fertilised by one spermatozoa only

11 Following fertilisation

The size of the embryo increases 10 fold The blastocyst enters the uterine cavity
A B
within 48 hours 4-5 days after fertilisation
The zona pellucida disintegrates within 48 The blastocyst cavity forms 7-8 days after
C D
hours fertilisation
E Cleavage begins after 5 days
12 During pregnancy, progesterone
 Stimulates myometrial prostaglandin
A B Inhibits decidualisation of the endometrium
production
C Inhibits myometrial contraction D Inhibits decidual prolactin production
Is produced by the corpus luteum until 20
E
weeks gestation

13 The corpus luteum

Is formed 7 days after the LMP in a woman Degenerates 14 days after the LMP in a
A B
with a 28 day cycle woman with a 28 day cycle
Has a maximum diameter of 15-30 mm
C Is formed from the corpus albicans D
which is attained 7 days after the LMP
Secretes oestrogens, progesterone and
E
androgens

14 The second wave of trophoblast invasion occurs at this gestation

A 4-6 weeks B 8-12 weeks

C 12-16 weeks D 16-18 weeks
E 22-24 weeks

15 The volume of amniotic fluid at term

A 100-150 ml B 200-250 ml
C 300-400 ml D 800-1000 ml
E 2000-3000 ml

16 Which one of the above is not a source of amniotic fluid during the third trimester?
A Transudate from fetal skin B Transudate from umbilical cord
C Diffusion across amniotic membrane D Fetal urine
E Fetal lung secretions

17 With respect to changes in renal function during pregnancy

The kidneys increase B The left ureter

A in size and weight becomes more dilated
than the right
Renal plasma flow increases by 20-40% Creatinine clearance increases to ~ 90
C D
by 24 weeks gestation ml/min
Serum creatinine concentration increases
E
by 25-40%

18 With respect to gastro-intestinal changes during pregnancy

A Gut motility is increased B Gastric acid secretion is increased
The risk of peptic ulceration is increased The risk of gastro-oesophageal reflux is
C D
especially during the third trimester increased
E The risk of constipation is reduced

19 With respect to maternal cardiovascular changes during pregnancy

The majority of the change in cardiac

A Cardiac output increases by ~ 40% B
output occurs during the third trimester
Cardiac output is increased by breast- Heart rate increases by 40% during the
C D
feeding first trimester
There is a fall in cardiac output to pre-
E
pregnancy levels after 40 weeks gestation

20 With respect to maternal haematological changes during normal pregnancy

There is a 10-15% increase in red cell

A Plasma volume increases by 40-50% B
mass
The red blood cell mean cell volume There is an increase in mean cell
C D
decreases haemoglobin concentration
E Plasma erythropoietin concentration falls

21 With respect to maternal respiratory changes during pregnancy

The peak expiratory flow rate (PEFR) is

A The FEV1 is increased B
decreased
C The vital capacity is unchanged D The respiratory quotient decreases
E The tidal volume decreases by 15-20%

22 During uterine contraction

There is auto-transfusion of blood from

A Maternal cardiac out-put decreases B
the uterus into the maternal circulation
C Maternal heart rate decreases D Maternal stroke volume decreases
The changes in maternal cardiac output are
E more pronounced in the supine position
compared to the left lateral position

23 With respect to maternal cardiovascular changes during labour and delivery

 Venous return decreases markedly Cardiac output returns to pre-labour values
A B
immediately following normal birth 24-48h after birth
Immediately following delivery,
C maternal cardiac output increases up to D Systolic blood pressure falls during labour
80% above pre-labour values
E Diastolic blood pressure falls during labour

24 Which micro-organism typically crosses the placenta?

A HIV B Listeria monocytogenes

C Group B streptococcus D Plasmodium falciparum
E Bacillus anthracis

25 Infection with listeria monocytogenes during the first trimester is associated with

A An increased risk of congenital anomalies B An increased risk of miscarriage

An increased risk of early onset neonatal An increased risk of gestational diabetes
C D
disease later in pregnancy
E Fetal hydrops

26 Which one is not an autosomal dominant disorder?

A Osteogenesis imperfecta type I B Alpha-1-anti-trypsin deficiency

C Otosclerosis D Myotonic dystrophy
E Facioscapulohumeral dystrophy

27 Which one is an X-linked recessive condition?

A Congenital adrenal hyperplasia B Alpha-1-antitrypsin deficiency

C Protein S deficiency D Freidrichs ataxia
E Androgen insensitivity syndrome

28 With respect to the endometrial cycle

The spiral arterioles are dilated and Secretions appear in the lumen of the
A B
tortuous during the proliferative phase glands during the luteal phase
Rapid regression of stromal oedema Shedding of the spongy and compact
C D
occurs during the proliferative phase layers occurs during the menstrual phase
The luteal phase is predominantly
E
stimulated by oestrogen

29 During the proliferative phase of the endometrial cycle

A Mitotic figures are present in the glands B The endometrial glands are straight
 but not in the stroma and narrow with a compact stroma
The endometrial glands are dilated and
C D The endometrial stroma is oedematous
tortuous
Glandular cells contain sub-nuclear
E
glycogen-containing vacuoles

30 Red degeneration of uterine fibroid during pregnancy is due to

The fibroid out-growing its blood

A Withdrawal of progesterone support B
supply
C Haemorrhage into the fibroid D Rupture of the fibroid capsule
E Pressure from the amniotic cavity

31 Which one is the main immunoglobulin found in saliva, tears and colostrum?

A IgA B IgG
C IgM D IgD
E IgE

1. Adaptive immunity able to increases number of antigen-specific lymphocytes to keep

pace with microbes, this ability is called:
a. Diversity
b. Specialization
c. Specificity
d. Clonal expansion
e. Memory

2. Adaptive immunity able to allows immune system to respond to newly encountered

antigens, this ability is called:
a. Contraction and homeostasis
b. Specialization and specificity
c. Non reactivity to self
d. Clonal expansion
e. Memory and diversity
3. In determining the utility of a clinical test, what is given by the equation: true negatives / (true
negatives + false negatives)?

A Likelihood ratio B Positive predictive value

C Negative predictive value D Sensitivity
E Specificity
32 A new diagnostic test for gestational diabetes has been developed and is being evaluated
against the gold standard test. 1000 women are tested. 10 women have gestational diabetes
and 9 of these test positive. 990 women do not have gestational diabetes and 10 test positive.
The specificity of the test is

A 90% B 10%
C 99% D 90.9%
E 98%

33 What is given by the formula (1 sensitivity) / (specificity) ?

A Sensitivity B Specificity
C Positive likelihood ratio D Negative likelihood ratio
E Diagnostic accuracy

34 What is the correct formula to calculate the sensitivity? TP = true positive; FP = false
positive; TN = true negative; FN = false negative

A TP / TP + FP B TP/ TP + FN
C TP / TN + FN D TN / TP + FN
E TN / TN + FN

35 You wish to investigate the time it takes to perform a caesarean section on women with and
without pre-eclampsia. At the end of the study you have two groups of women with the
duration of caesarean sections recorded for each. It cannot be assumed that these are normally
distributed. Which non-parametric statistic test would you use?

A Mann-Whitney U test B Chi squared test

C Wilcoxon signed rank test D Kruskal-Wallis test
E McNemars test
36 A 17 year old woman presents with frequent and painful contractions at 21 weeks gestation.
Within 30 minutes of attending, her membranes rupture and the fetus is delivered. There is a
heart rate and obvious movements for about 10 minutes before death is confirmed. This death
should be classified as

A A miscarriage B A stillbirth
A stillbirth or neonatal death depending on
C A neonatal death D
the womans wishes
E A pre-neonatal death

37 The neonatal death rate is reported

A Per 1000 maternities B Per 1000 live births

Per 1000 total births (live births +
C D Per 1000 births after 24 weeks gestation
stillbirths)
E Per 1000 births after 28 weeks gestation

38 Which one of the above is not a feature of shoulder dystocia?

Difficulty with delivery of the face and Fetal head remaining tightly applied to the
A B
chin vulva and retracting into the vagina
Failure of shoulders to descend on gentle
C Failure of restitution of the fetal head D
traction
E Persistent occipitoposterior position

39 Which one of the above is the single most effective intervention in managing shoulder
dystocia?

A Episiotomy B McRoberts manoeuvre

C Removal of posterior arm D Internal manoeuvres
E Suprapubic pressure

40 A healthy 25 year old woman presents with vaginal bleeding at 8 weeks gestation. Which one
of the above is a possible cause?

A Placenta previa B Ectopic pregnancy

C Placental abruption D Vasa previa
E Endometrial cancer

41 A healthy 20 year old woman presents with vaginal bleeding at 10 weeks gestation. Which
one of the above investigations should not be undertaken?

A Urine pregnancy test B Blood group

C Fetal viability ultrasound scan D Clotting screen
E Serum HCG levels
42 Without treatment, women with asymptomatic bacteriuria at 32 weeks gestation are at risk of
which complication?

A Pre-eclampsia B Pre-term labour

C Fetal growth restriction D Pyelonephritis
E Chorioamnionitis

43 Regarding urinary tract infections, which micro-organism is most likely to be associated with
bladder catheterisation?

A Staph aureus B Staph epidermidis

C Bacteriodes D Group B Streptococcus
E E. Coli
 44 Which one of the above statements regarding female sterilisation is correct?

A The failure rate is lower than for vasectomyB
It should not be performed in women
C D
below the age of 30 years
E The failure rate is 1 in 2,000
The failure rate is lower in younger women
The failure rate is 1 in 200 over a life
time

45 Which one of the above is a contra-indication to the use of the levonorgestrel-releasing intra-
uterine system?

A Current DVT on anticoagulants B Current breast cancer

C Previous abnormal cervical smears D Previous laparoscopic sterilisation
E HIV positive woman

46 Which one of the above statements regarding copper IUCD emergency contraception is
correct?
75% effective if used within 5 days of
A B Effective by preventing ovulation
intercourse
Should not be used in women with a
C Should not be used in nulliparous women D
previous caesarean section
Can be used more than 5 days after
E
unprotected intercourse

47 Which one of the above statements regarding the first stage of labour is correct?

The first stage begins when the cervix is The active first stage of labour begins when
A B
fully effaced the membranes rupture
The latent first stage of labour includes The latent first stage of labour is when the
C D
cervical dilatation up to 4cm woman has not requested analgesia
The first stage of labour ends when the
E
fetus is delivered

48 Which of the following is the correct order of the cardinal movements of labour?
A. Internal rotation, engagement, descent, flexion, external rotation
B. Engagement, descent, internal rotation, flexion, external rotation.
C. Internal rotation, descent, engagement, flexion, external rotation
D. Engagement, descent, flexion, internal rotation, external rotation
E. Engagement, descent, internal rotation, flexion, external rotation

49 A 32 year old woman is admitted for induction of labour at 42 weeks gestation. Oxytocin is
commenced 7 hours after prostaglandin administration. The frequency of uterine contraction
is:

A 1-2 in 1 minute B 3-4 in 1 minute

C 4-5 in 10 minutes D Over 5 in 10 minutes
E Not measurable
See the CTG below:

49. A healthy 23 year old woman presents in spontaneous labour at 34 weeks gestation. CTG is
commenced at 05:38. The midwife asks you to review the CTG at 06:00. Click on the icon to
view the CTG. The decelerations on this trace are classified as

A Late decelarations B Atypical variable deceleration

C Early decelerations D Typical Variable decelerations
E No deceleration