TRY OUT EXAMINATION UI 2009

1. In which surgical approach to ectopic pregnancy is the tube opened to

remove the gestational products, then left unsurtured?
a. salpingectomy
b. salpingotomy
c. salpingorrhaphy
d. salpingostomy
2. A prolonged latent phase in a nulliparous patient is one lasting longer than
how many hours?
a. 10
b. 14
c. 16
d. 20
3. Oligohydramnios is often seen in which of the following clinical conditions?
a. maternal diabetes
b. postterm gestation
c. fetal esophageal atresia
d. fetal spina bifida
4. Which class of drugs is strongly associated with oligohydramnios?
a. angiotensin converting enzyme inhibitors
b. adrenergic blockers
c. calcium channel blocking agents
d. hydralazine
5. Which of the following is a relative contraindication for delivery using vacuum
extraction?
a. Face presentation
b. 35 week gestation
c. chorioamnionitis
d. post term pregnancy
6. Which of the following is NOT a risk factor for breech?
a. multiple fetuses
b. hydramnios
c. uterine anomalies
d. low parity
7. Which type of vaginal delivery should prompt inspection of the cervix and
vagina following the delivery?
a. breech extraction
b. low forceps delivery
c. outlet vacuum extraction
d. all vaginal deliveries
8. Which of the following is the most dangerous consequence of delivering the
placenta by cord traction?
a. endomiritis
b. cord avulsion
c. uterine inversion
d. cervical laceration
9. Predisposing factors for uterine atony include which of the following?
a. low parity
b. preeclampsia
 c. precipitous labor
d. oligohydramnios
10.In a woman with an unfavorable cervix and an estimated fetal weight of 3800
g, which is the most appropriate management at 42 weeks gestation?
a. Sonography to redate pregnancy
b. Cesarecan delivery
c. Hospitalization with bedrest
d. Cervical ripening, then labor induction
11.Which of the following ultrasound measurements is the most reliable index of
fetal size?
a. biparietal diameter
b. abdominal circumference
c. femur length
d. intrathoracic ratio
12.Uterine anomalies are associated with what reproductive problems?
a. abnormal fetal lie
b. preterm delivery
c. recurrent miscarriage
d. all of the above
13.What is the best pregnancy management of a 40 year old nullipara who has
undergone a prior myomectomy during which the endometrial cavity was
entered?
a. labor allowed
b. labor allowed, with low forceps delivery to shorten second stage
c. cesarean delivery near term prior to labor
d. oxytocin induction at 38 weeks
14.At what time are most nonobstetrical surgical procedures performed when
required during pregnancy?
a. first trimester
b. second trimester
c. third trimester
d. postpartum
15.When is heart failure and cardiac related maternal death most common?
a. first trimester
b. second trimester
c. third trimester
d. peripartum
16.Which of the following pregnancy related hemodynamic changes is thought
responsible for the negligible effects of aortic and mitral insufficiency during
pregnancy?
a. increased cardiac output
b. decreased resting heart rate
c. decreased vascular resistance
d. increased ventricular contractility
17.Which of the following is a possible complication of unrepaired ventricular
septal defect?
a. bacterial endocarditis
b. eisenmenger syndrome
c. pulmonary hypertension
d. all of the above
18.Most state of the art serum pregnancy test have a sensitivity for detection of
-hCG of 25 mLU/mL. such tests wold diagnose pregnancy as early as?
a. 5 days after conception
b. 24 hours after implanation
c. the day of the expected (missed) period
d. 5 weeks’ gestation
19.Which of the following histories might lead you to suspect the existence of
diabetes in a patient now pregnant for the third time?
a. Spontaneous rupture of the membranes occurred during the second
trimester in both preceding pregnancies
b. Jaundice appeared in the last trimester of her second pregnancy
c. Both preceding infants were premature
d. Unexplained intrauterine death occurred 38 weeks gestation in
her last pregnancy
e. Abruption placentae occurred in the second pregnancy
20.Folic acid deficienty results in
a. microcytic anemia
b. megalobastic anemia
c. aplastic anemia
d. glucose 6 phosphate dehydrogenase (G6PD) deficiency
e. white blood cell (WBC) stippling
21.The greatest diameter of the normal fetal head is the
a. occipitofrontal
b. occipitomental
c. subocciput bregmatic
d. bitemporal
e. biparietal
22.The relationship of the long axis of the fetus of the long axis of te mother is
called the
a. lie
b. presentation
c. position
d. attitude
e. none of the above
23.A placenta accrete is most likely to cause bleeding
a. during the first stage of labor
b. prior to labor
c. because of consumption coagulopathy
d. after amniotic membrane rupture
e. during attempts to remove it
24.Which of the following is the BEST method to time intercourse for procreative
means?
a. thermogenic shift in basal body temperature
b. urinary luteinizing hormone (LH) kittesting
c. serum progesterone level
d. profuse, thin, acellular cervical mucus
e. mittelschmerz
25.A 28 years old patient complains of amenorrhea after dilatation and curettage
(D&C) for postpartum bleeding. The most likely diagnosis is
a. Gonadal dysgenesis
 b. Sheehan syndrome
c. Kallmann syndrome
d. Mayer – Rokitansky – Kuster – Hauser syndrome
e. Asherman’s syndrome
26.A 35 year old woman wearing an IUD complains of amenorrhea of 5 weeks’
duration/ a serum pregnancy test is positive. Because of the presence of the
IUD, this patient is at significantly increased likelihood of
a. ectopic pregnancy
b. fetal malformations
c. spontaneous abortion
d. septic abortion
e. placental abruption
27.The use of OCs may increase the risk of which of the following conditions?
a. fibrocystic breast disease
b. hepatic adenoma
c. salpingitis
d. ovarian cancer
e. endometrial cancer
28.An 88 year old woman who lives in a nursing home and is in poor general
health complains of difficulty initiating urination and with defecation. On
examination, she has fourth degree uterovaginal prolapse. What is your
recommendation?
a. Transabdominal uterine suspension operation
b. Transvaginal uterine suspension operation
c. Trial of a pessary
d. The use of diapers and tight fitting underclothing for support
e. Surgical closure of the vaginal introitus
29.Ten days after an abdominal hysterectomy for abnormal bleeding, a woman
begins to have continuous drainage of urine from the vagina. She wants this
condition repaired as soon as possible. You advise her that the best time for
repair is
a. immediately
b. within 2 weeks
c. not before 1 to 3 months
d. not before 6 to 8 months
e. not before 12 months
30.The most likely cause of abnormal genital bleeding in a 13 – year old girl is
a. Uterine cancer
b. Etcopic pregnancy
c. Anovulation
d. Systematic bleeding diatheses
e. Threatened abortion
31.A nine years old has breast and pubic hair development. Evaluation
demonstrates a pubertas respon to GnRH stimulation test and prominent
increase in LH pulse during sleep. This findings are characteristic of patient
with which of the followings?
a. Theca sel tumour
b. Iatrogenik sexual precocity
c. Premature thelarche
d. Granulosa cell tumours
 e. Constitusional precocious puberty
32.You are going to perform a forceps-assisted vaginal delivery on 20 years old
G1, at 40weeks for maternal exhaustion. The patient has been pushing for 3
hours, with an epidural for pain management. The fetal head is moulded with
a large caput. The position id idrect occiput anterior and the head is visible at
the introitus between pushes. The most apropriate forceps to use for this
delivery is:
a. Kielland
b. Piper
c. Simpson
d. Zavanelli
e. Neigel
33.You are going to perform a forceps-assisted vaginal delivery on 26 years old
G3P2002, at 40weeks. She has a history of two previous uncomplicated
vaginal deliveries and has had no complications in this pregnancy. After 15
minutes of pushing the baby head delivered spontaneously, but then retracts
back against the perineum, as you apply gentle downward traction to the
head, the baby’s anterior shoulder faileds to delivered. Which of the
followings is the best next step:
a. Call for help
b. Symphysiotomy
c. Instruct the nurse to apply fundal pressure
d. Perfom a Zavanelli manuver
e. Perform McRobert manuver
34.A 27-years old had just have an ectopic pregnancy. Which of the followings
events would be most likely to predispose to ectopic pregnancy:
a. Previous cervical conization
b. Pelvic inflamatory disease (PID)
c. Use of IUD
d. Induction of ovulation
e. Exposure in utero to DES
35.A 22-years old present to your clinic for follow-up of evacuation of a complete
hydatidiform mole. She is asymptomatic and her exams is normal, which of
the followings would be an indication to start single agent chemoterapy:
a. Raise in hCG titer
b. A Plate au of hCG titer for a week
c. Return of a hCG titer to normal at six weeks after evacuation
d. Appearance of liver metastatis
e. Appearance of brain metastasis
36.On pelvic exams of a patient in labor at 34 weeks, the cervic noted to be 6
cm dilated, completely effaced, with the fetal nose and mouth papable, the
chin is ponting toward the maternal left hip. This is an example of which of
the followings?
a. Tranverse lie
b. Mentum transverse position
c. Occiput transverse position
d. Brow presentation
e. Vertex presentation
37.A Patient presents with amenorrhea and galactorrhea. Her prolaktin levels are
elevated. She is not and never has been pregnant. In addition to evaluating
 her for her prolactinoma, one also needs to evaluate for othe causes that
could increase prolactin such as elevated
a. corticotrophin-releasing hormone
b. dopamine
c. gamma amino butyric acid (GABA)
d. histamin type 2 receptor activation
e. Thyrotrophin releasing hormone (TRH)
38.A 32-years old purely controlled diabetic G2P1 is undergoing amniocentesis at
37 weeks for fetal lung maturity prior to having a repeated SC. Which of the
following laboratory test perfom indicated the fetal lung is mature?
a. Fosfatidil glyserol is absent
b. Lecithin/sphingomielin ratio of 1:1
c. Lecithin/sphingomielin ratio of 1,5:1
d. Lecithin/sphingomielin ratio of 2:1
e. Shake test is positive
39.A 22-years old G3P2 undergoes a normal spontaneous vaginal delivery
without complication. The placenta is spontaneously delivered and appeared
intact. The patien is brought to post partum floor where she start to bleed
profusely, physical exam revealed a boggy uterus and a bedside sonogram
indicate the present of placenta tissue. What is the appropiate placenta type
in this case?
a. Vasa previa
b. Succenturiate placenta
c. Membranous placenta
d. Placenta accreta
e. Fenestrated placenta
40.Which of the following embryonic tissue contribute to the adult fallopian tube?
a. Coelomic epithelium
b. Mesenkhim
c. Mesonefric duct
d. Paramesonefric duct
e. Urogenital ridge
41.The three principal estrogens in women in decreasing order of potency are:
a. estradiol, estriol, estrone
b. estradiol, estrone, estriol
c. estriol, estradiol, estrone
d. estriol, estrone, estradiol
e. estrone, estriol, estradiol
42.Given that prostaglandin appear to be involved in preterm labor, which of the
following medication might provide some help in stopping preterm labor?
a. ACTH
b. Indometacin
c. Progesterone
d. Prolactin inhibiting factor (PIF)
e. Thyroid hormone
43.What is the primary pathophysiological basis of the meconeum aspiration
syndrome?
a. airway blockage
b. chemical pneumonitis
c. pulmonary hipoplasia
 d. unknown
44.The followings maternal blood testing should be done as part of the
evaluation of the unexplained stillbirth, EXCEPT:
a. antiphospholipid antibody
b. Kleihauer-Betke stain
c. Serum glucose
d. Fibronectin
45.Which of the following statements applies to the outlet of the true pelvis?
a. it begins at the iliopectineal line
b. it is the most cephalad of the three planes
c. it is gynecoid in shape
d. it has lateral walls
e. it consists of anterior and posterior triangles
46.Of the following ligaments, those providing the most support to the uterus (in
terms of preventing prolapse) are the
a. broad ligaments
b. infundibulopelvic ligaments
c. utero-ovarian ligaments
d. cardinal ligaments
47.Which of the following is predominant type of bacteria in the vagina during
pregnancy?
a. Lactobacillus sp.
b. Peptostrptococcus sp.
c. Listeria monocytogenes.
d. Strptococcus agalactiae.
48.Which of the following is commonly associated with mullerian duct
deformities?
a. Cardiac anomalies
b. Renal anomalies
c. Gastrointestinal tract anomalies
d. Limb anomalies
49.Vaginal atresia is seen in which of the following disorders?
a. Androgen insensitivity syndrome
b. Asherman syndrome
c. Congenital adrenal hyperplasia
d. 5α-reductase deficiency
50.The followings uterine anomalies are associated with reproductive problems,
EXCEPT:
a. Abnormal fetal lie
b. Preterm delivery
c. Recurrent miscarriage
d. Placenta acreta
51.The followings are true about interstitial pregnancy, EXCEPT
a. Represents 3% of tubal pregnancies
b. Frequently ruptures later (8 to 16 weeks)
c. Is usually associated with massive hemorrhage if ruptured
d. Is usually associated with dyspareunia
52.Primary treatment of molar pregnancy is which of the following?
a. Hysterectomy
b. Suction curettage
 c. Oxytocin induction
d. Misoprostol induction
53.The hallmark sign of gestational trophoblastic neoplasia is which of the
following?
a. Fever
b. Seizures
c. Uterine bleeding
d. Pelvic vein thrombosis
54.Which of the following fetal activities is monitored during a contraction stress
test?
a. Breathing
b. Eye movements
c. Heart rate
d. Body movements
55.Fetal death within 7 days of a normal nonstress test occurs most commonly
with which indication for testing?
a. Postterm pregnancy
b. Gestational diabetes
c. Gestational hypertension
d. Fetal growth restriction
56.The stage of gestational development at which endometrial implantation
occurs is
a. Eight cell embryo
b. Zygote
c. Morula formation
d. Blastocyst
e. Embryonic disk
57.During growth of the embryo, the inner cell mass is referred to as the
embryonic disk. This embryonic disk differentiates initially into
a. Decidua
b. Cytotrophoblast
c. Ectoderm and endoderm
d. Syncytiotrophoblast
e. Mesoderm
58.A 38 years old multigravid woman complains of the painless loss of urine,
beginning immediately with coughing, laughing, lifting, or straining.
Immediate cessation of the activity stops the urine loss after only a few
drops. This history is most suggestive of
a. Fistula
b. Stress incontinence
c. Urge incontinence
d. Urethral diverticulum
e. UTI
59.The most common cause of rectovaginal fistula is
a. Obstetrical delivery
b. Irradiation to the pelvis
c. Carcinoma
d. Hemorrhoidectomy
e. Crohn’s disease
60.Of the following, the most common indication for primary cesarean section is
 a. Dystocia
b. Prolapsed cord
c. Diabetes
d. Toxemia
e. Malpresentation
61.Correct statement regarding contraception in bresst feeding women include
which of the following
a. depo-medroxyprogesterone lowers the quality of breast milk
b. progestine only birth control pills do not affect the quantity of
breast milk
c. estrogen-progesterone birth control pills do not affect the quality of breast
milk
d. estrogen-progestine birth control pills do not affect the quantity of breast
milk
62.Which of the following immunizations should not be given post partum
a. diptheria-tetanus
b. anti D immune-globulin
c. MMR
d. no restriction for any of these
63.Congenital adrenal hyperplasia (CAH) is BEST treated with
a. cyclic progesterone
b. cyclic estrogen
c. daily glucocorticoids
d. daily GnRH analogue
e. daily oral contraceptives
64.Rubella in pregnancy is associated with
a. severe fetal congenital malformations and pregnancy wastage
b. increased maternal mortality
c. a rapidly declining incidence
d. the maternal development of type 2 diabetes
e. all of the above
65.The diagnosis of endometriosis is confirmed histologically by identifying
extragenital implants containing
a. Endometrial glands and stroma
b. Hypertrophic smooth muscle
c. Hemorrage and iron pigment deposits
d. Fibrosis
e. Stromal decidualization
66.Women who have had a pregnancy complicated by preeclampsia are more
likely to suffer from which of the following long term problems?
a. renal disease
b. hepatic disease
c. neurologic disease
d. cardioimmune disease
e. autoimmune disease
67.You are called to the operating room by the general surgeons at a local
children’s hospital. A 4-year-old girl with acute ebdominal pain was thought
to have appendicitis, instead she has a large right ovary. The most likely
diagnosis is
a. germ cell tumor
 b. epithelial stromal tumor
c. sex-cord stromal tumor
d. non-neoplastic follicle or theca-luthein cyst
e. metastatic tumor
68.Which of the following is most strongly associated with successful external
cephalic version?
a. Frank breech
b. Anteriorly located fetal spine
c. Ample amniotic fluid
d. Increasing parity
69.Which of the following is NOT associated with a successful external cephalic
version?
a. Postterm gestation
b. Large amniotic fluid volume
c. Unengaged fetus
d. High parity
70.A common cause of subinvolution includes which of the following?
a. Puerperal pelvic infection
b. Fetal macrosomia
c. Antenatal polyhydramnios
d. Cessation of breast feeding
71.Three days ago your patient underwent vaginal delivery complicated by a
fourth-degree laceration. She now complains of perineal pain despite local ice
pack treatments and oral analgetics. Her temperature is 38.5°C. Physical
examination reveals erythema, induration, and purulent discharge at her
episiotomy site. Clinical management of this patient should involve which of
the following?
a. Opening of episiotomy plus intravenous antimicrobial therapy
b. Wound observation plus intravenous antimicrobial therapy
c. Opening of episiotomy plus hydrotherapy
d. Opening of episiotomy plus topical broadspectrum antimicrobial therapy
72.Recommended treatment of the episiotomy defect following dehiscence
currently includes which the following?
a. Rectal flap repair approximately 1 week following dehiscence
b. Wound healing through secondary intention
c. Reapproximation repair approximately 1 week following
dehiscence
d. Rectal flap repair approximately 3 months following dehiscence
73.How is the pathophysiology of preeclampsia characterized?
a. vasodilatation
b. vasospasm
c. hemodilution
d. hypervolemia
74.Which of the following cardiac signs is NOT a normal finding in pregnancy?
a. Pericardial friction rub
b. 2/6 midsystolic murmur
c. Brisk and diffuse cardiac apex pulsation
d. Supraclavicular continuous venous hum
75.Which of the following is NOT an electrocardiographic change seen in normal
pregnancy?
 a. Atrial premature beats
b. 15-degree left-axis deviation
c. P wave voltage increase of 50%
d. Mild ST changes in the inferior leads
76.Which of the following is most useful in screening for thyroid disorders?
a. Thyroid-binding globulin (TBG)
b. Thyroid-releasing hormone (TRH)
c. Thyrotropin-stimulating hormone (TSH)
d. None of the above
77.What is the primary treatment approach for thyrotoxicosis during pregnancy?
a. medical
b. surgical
c. combination of medical and surgical
d. no treatment necessary
78.The following were suitable for Follicle Stimulating Hormone, except:
a. is a glycoprotein
b. is produces by the chromophil cells of the anterior lobe of the pituitary
gland
c. stimulates the interstitial cell of Leydig in the male
d. has alpha subunit which are the product of the same gene that
controls the alpha subunits of luteinizing hormone and Thyroid
Stimulating Hormon
e. serum levels are increases during the climacteric
79.A 16 years old woman has not experienced menarche. Examination shows
absence of breast development and small but otherwise normal female pelvic
organ. Which of the following diagnostic test is most useful in determining the
etiology of the amenorrrhea?
a. serum FSH
b. serum Estradiol
c. serum Testosteron
d. MRI of the head
e. Ovarian biopsy
80.Prolactin secreting pituitary adenomas (prolactinomas) usually
a. diminish in size during pregnancy
b. inrease in size over time
c. are symptomatic during lactation
d. impinge upon the olfactory nerve
e. respond to medical therapy
81.Clomiphene citrate
a. Result in decrease GnRH release
b. Result decreased cervical mucous production
c. May result in ovarian hyperstimulation
d. Blocks FSH release
e. Directly result in ovarian hyperstimulation
82.The normal lining of the fallopian tube is:
a. Squamous ephitelium with cilia
b. Transitional epithelium with cilia
c. Cuboid epithelium with cilia
d. Columnar epithelium with cilia
e. Fibrous connective tissue
83.Which of the following causes for infertility may be treatable by assisted
reproductive technology?
a. Fallopian tube obstruction
b. Low sperm count
c. Cervical mucus abnormalities
d. Unexpalined infertility
e. All of the above
84.Patients with the following conditions typically present with secondary
amenorrhea:
a. Imperforata hymen
b. Testicular feminization
c. Untreated congenital adrenal hyperplasia
d. Premature ovarian failure
e. None of above
85.The following relate to hydatidiform mole:
a. the complete mole arises from fertilization of an empty ovum
b. in the complete mole, half the chromosomes are paternally derived
c. the usual chromosome pattern in the partial mole is a triploidy
d. partial hydatidiform chromosomes are paternally derived
e. 2-3% of complete moles will progress to choriocarcinoma
86.The following are characteristic features of antiphospholipid antibody
syndrome:
a. recurrent miscarriages
b. severe fetal growth retardation
c. large placental infarcts
d. venous thrombosis
e. a lower risk of pregnancy loss with a new partner
87.Sloughing of the endometrium during menstruation is thought to be triggered
by which of the following?
a. pressure necrosis from stromal edema
b. vascular stasis from spiral artery coiling
c. atrophy from cessation of stromal cell mitosis
d. pressure necrosis from inspissated gland glycoproteins
88.Which of the following is thought to be a mediator of dysmenorrhea?
a. interleukin-8
b. enkephlinase
c. prostaglandin F2a
d. monocyte chemotactic factor-1
89.The decidua found directly beneath the site of blastocyst invasion is termed
which of the following?
a. vera
b. basalis
c. parietalis
d. capsularis
90.Which of the following represents the fetal period?
a. implantation through week 8
b. implantation through week 12
c. week 9 until term
d. week 12 until term
91.By how many weeks of gestation is formation of the heart complete?
 a. 8
b. 10
c. 12
d. 14
92.What is the goal of antepartum fetal surveillance?
a. prevent fetal deaths
b. prevent early deliveries
c. increase fees for obstetricians
d. delay delivery until lung maturity achieved
93.The base of the occiput is brought into contact with the inferior margin of the
symphysis during which cardinal movement of labor?
a. extension
b. expulsion
c. descent
d. flexion
94.Which of the following describes a frank breech presentation?
a. flexion of the hips and extension of the knees
b. flexion of the hips and flexion of the knees
c. extension of the hips and flexion of the knees
d. extension of the hips and extension of the knees
95.Which of the following substances stimulates GnRH secretion?
a. dopamine
b. norepinephrine
c. beta endorphin
d. serotonin
e. dynorphin
96.The three principal estrogens in women in decreasing order of potency are
a. estriol, estradiol. estrone
b. estrone, estriol, estradiol
c. estradiol, estrone, estriol
d. estradiol, estriol, estrone
e. estriol, estrone, estradiol
97.A patient with polycystic ovarian syndrome will often have an increase in
insulin resistance. This will result in
a. an increase in hepatic production of sex hormone-binding globulin
b. an increase in circulating free testosterone levels
c. a decrease in free estrogen
d. an increase in follicle-stimulating hormone ( FSH )
e. none of the above
98.The midcycle LH surge
a. enhances thecal cell androgen production
b. luteinizes granulosa cells
c. initiates resumption of meiosis
d. facilitates oocyte expulsion
e. all of the above
99.CST and NST are used for evaluation of fetal well being, a TRUE statement
about them is
a. NST is contraindicated in situations where labor is contraindicated
b. A positive nonreactive CST contraindicates labor
c. A positive CST is an excellent predictor of fetal well being
 d. A CST is falsely negative less frequently than an NST is falsely
reactive
e. none of the above
100. The most common reportable bacterial STD in women is
a. gonorrhea
b. syphilis
c. Chlamydia
d. herpes
e. chancroid