It must include nearly all parts in the cutticulum Do not put 2 answers for the same question.

1. It must include nearly all parts in the cutticulum Do not put 2 answers for the same question. There are many different models. Read the questions precisely , take care of the words ( EXCPT, CORRECT, INCORRECT ) Sources ( Study guide, Lange case file, Obs. & Gyne. Books , Text books )

2. Cases + Short questions • 4 حالات( 2 نساء و 2 ولادة ) و كل حالة 5 أسئلة = 20 سؤال كل سؤال 5 درجات تقريبا( لأن ممكن سؤال 4 و ممكن سؤال 6 درجات مثلا ) لذا 5x20= 100 درجة • 10 أسئلة قصيرة كل سؤال 5 درجات = 50 درجة • لذا المجموع 30 سؤال • كل سؤال من ال 30 سؤال تقريبا 3.5 دقائق يصل مجموع الوقت الى 105 ق • المراجعة 15 ق

3. Cases + Short questions 4 Cases ( 2 gynae, 2 Obs. ) 5 questions for every case, 5 marks for each questions= 4x5x5 = 100 marks 10 short questions , 5 marks for each question So 10x5= 50 marks

4. MCQs

5. Benign cystic teratoma (dermoid cyst):All are INCORRECT EXCEPT • It is the commonest ovarian tumor during menopause. • It causes no harm to the patient when ruptures. • Are germ cell tumors. • Never turn into malignant tumor. • Conservative follow up is an option.

6. Risk factors of endometrial hyperplasia DO NOT include: • Anovulatory disorders. • Chronic endometritis.  • Obesity • Tamoxifen. • Unopposed excessive estrogen.

7. Fibroid uterus may be associated with the following EXCEPT: • Precocious puberty  • Menorrhagia • Metrorrhagia • Postmenopausal bleeding • Frequency of micturition

8. The following is the essential step in diagnosis and staging of pelvic endometriosis: • Laparoscopy  • CA-125 • Biopsy form the suspicious nodules • Ultrasonography • Hysteroscopy

9. The INCORRECT statement regarding uretrovaginal fistula: • Might happen during complicated vaginal surgery in third degree uterine prolapse. • Might happen during surgery for broad ligament tumors. • Obstetric causes are the most common cause.  • Injury of the ureter may be at the level of the pelvic brim • Surgical treatment involves laparotomy.

10. Regarding tuberculosis of the genital tract all the following are correct EXCEPT: • The tubes are the commonest site. • It is detected in 5% of infertile patients. • Infection is usually sexually transmitted.  • The treatment is mainly medical. • Menstrual disorders are common.

11. As regards follicle stimulating hormone, all the following are correct EXCEPT: • It stimulates spermatogenesis. • Its plasma concentration is high in Klinefelter syndrome. • It stimulates ovarian estrogen production. • It is secreted by basophilic cells of the adenohypophysis. • It prevents regression of the corpus luteum.

12. The following is characteristic of Sheehan syndrome: • Profuse lactation • Amenorrhea  • Hyperthyroidism • Renal insufficiency • Cushinoid faces

13. The following are contraindications to using combined oral contraceptives EXCEPT: • Pulmonary embolus • Porphyria • Sickle-cell disease • DVT • Depression

14. The following vessels are branches of the internal iliac artery EXCEPT: • Uterine artery. • Obliterated umbilical artery. • Pudendal artery. • Superior rectal artery. • Vaginal artery.

15. The following about Candidal infection are correct EXCEPT: • The infection is common with pregnancy • Vaginal PH is usually alkaline.  • Vulval itching may occur. • Vaginal isoconazole or miconazole are effective. • The organism is yeast-like.

16. Symptoms of adenomyosis uteri include all the following except • Menorrhagia • Dysmenorrhea • Diurnal frequency • Abdominal swelling • hot flushes 

17. A 32-year-old woman complains of a vulval fishy odor and a vaginal discharge. The speculum examination reveals an erythematous vagina and punctuations of the cervix. Which is the MOST LIKELY diagnosis? • Candidalvaginitis • Trichomonalvaginitis • Bacterial vaginosis • Human papilloma virus • Herpes simplex virus

19. He correct statement about the decidua is: • It is modified endometrium of pregnancy. • It is due to action of estrogen on the endometrium. • The deciduabasalis is the part overlying the embryo. • Does not protect against the invasive power of trophoblast. • Is anatomically divided into four parts.

20. Sure signs of pregnancy include all of the following EXCEPT: • Palpation of fetal parts. • Inspection & palpation of fetal movements. • Auscultation of uterine soufflé. • Detection of fetus by ultrasonography.

21. All of the following are causes of oversized uterus EXCEPT: • Incorrect dates. • Transverse lie. • Macrosomic fetus. • Hydrocephalus. • Polyhydramnios.

22. Warning symptoms during pregnancy DO NOT include: • Bleeding per vagina. • Sudden loss of fluid per vagina. • Abdominal pain. • Leg cramps. • Decreased fetal kicks.

23. Indications of amniocentesis include: • Diagnosis of chromosomal anomalies. • Bilirubin estimation in Rhisoimmunization. • Estimation of fetal lung maturity. • All of the above. • B & C only.

24. The following statements regarding obstetric ultrasound are correct EXCEPT: • It can be used with amniocentesis. • It might induce a significant risk to the fetus.  • It can diagnose placental grading. • It is a useful tool in the assessment of amniotic fluid volume. • It could estimate the approximate intrauterine fetal weight.

25. The occipto frontal diameter: • Extends from occipital protuberance to center of bregma. • Measures 9.5 cm at term. • Is the diameter of engagement in after coming head of breech. • Is the diameter of engagement in face presentation with a fully extended head.

26. Caput succedaneum • is due to prolonged pressure on fetal head by maternal tissues.  • is always few millimeters in thickness. • does not cross suture lines. • indicates that the fetus was dead during labor.

27. In management of multifetal pregnancy, the following is true: • Twin pregnancy is considered as a high risk pregnancy.  • The lower the fetal weight, the safer the vaginal route of delivery. • The larger the fetal number, the more small the fetal weight and the safer vaginal route of delivery. • Mono-amniotic twins are associated have less perinatal mortality than diamniotic twins. • If the first twin is presenting by the breech internal podalic version is indicated.

28. Cord presentation is • Descent of the umbilical cord below the presenting part after ROM. • Descent of the umbilical cord below the presenting part before ROM. • Presence of the umbilical cord beside the presenting part. • Presence of the umbilical cord above the presenting part.

29. Regarding shoulder dystocia, which is CORRECT? • It is not related to maternal diabetes mellitus. • Arrest occurs at pelvic inlet. • Oligohydramnios is a predisposing condition. • Most cases can be resolved by fundal pressure. • Facial palsy is a possible complication.

30. The CORRECT statement regarding ruptured uterus: • More common in nulliparous than multiparous women. • More common with malpresentations.  • Is classified into mild, moderate and severe. • Previous uterine scar must rupture in consequence to vaginal delivery. • Increases the fetal mortality but not the maternal mortality.

31. The following IS NOT a risk factor for primary postpartum hemorrhage: • Maternal anemia. • Intrauterine growth retardation.  • History of a previous postpartum hemorrhage. • Uterine fibroids. • Mismanagement of 3rdstage of labor.

32. As regards acute uterine inversion, the INCORRECT statement is: • It only occurs with a relaxed uterus. • It is usually caused by applying fundal pressure. • It is managed by immediate removal of placenta before reposition of the uterus.  • It can be managed by increasing the hydrostatic pressure in the vagina. • Maintaining sufficient intravenous lines is essential.

33. Coagulation failure IS NOT a major complication of the following: • Amniotic fluid embolus. • Abruptio placenta. • Placenta previa. • Gram-negative septicemia. • HELLP syndrome.

34. Causes of acute abdomen during pregnancy include the following EXCEPT: • Placenta abruption. • Complicated fibroid. • Ruptured tubal pregnancy. • Complicated ovarian cyst. • Placenta previa.

35. Maternal mortality refers to the number of maternal deaths that occur as the result of the reproductive process per: • 1000 births. • 10.000 births. • 100.000 births. • 10.000 live births. • 100.000 live births.

36. Which IS NOT a sign of hyaline membrane disease (RDS): • Increased respiratory rate. • Grunting respiration. • Chest wall retraction during inspiration. • Retraction of the subsoctal area. • Jaundice.

37. Uterine stimulants include all of the following EXCEPT: • Oxytocin. • Ritodrine. • Ergometrine. • Prostaglandins.

38. A 30-year-old G1 P1 who underwent a cesarean section 3 days previously has a fever of 40˚ C. The wound is indurated and erythematous. Which of the following is the best management? • Initiation of intravenous ampicillin. • Initiation of intravenous heparin. • Corticosteroids therapy. • Placement of a warm compress on the wound. • Wound drainage.

39. Cases + Short questions Take care of the Language mistakes & the Fatal mistakes

40. Case number 1

41. A 22 year old Primigravida, pregnant at 35 weeks , BL.P 110/70 ,pulse 120 bpm, DROWZY, severe abd. Pain, tender rigid abdomen, FHS( Fetal heart sounds ) not heard , mild dark brown vag. Bleeding, Albuminuria +++, edema up to the knees • What is your provisional diagnosis ? • Explain why there is apparantly normal Bl.P with tachycardia ? • What is the cause of inability to hear FHS? • Enumerate four important investigations required for this case ? • Enumerate lines of treatment

42. Answer

43. provisional diagnosis is PG, 35 weeks gestation, severe PET,complicated by accidental haemorrhage & IUFD • The pt was having severe PET ( severe HT is one of its criteria ) & The haemorrhage (which occurred due to premature separation of the placenta) made the high BL.P as this apparantly normal Bl.P now , this drop in BL.P was associated with tachycardia. • the cause of inability to hear FHS is accidental haemorrhage ( Mostly most if not all the placenta is separated ) this needs to be confirmed by US

44. 4. four important investigations • A-U/S: To rule out placenta previa before vaginal examination. • B-Blood tests , Coagulation profile • Blood type & cross matching, Rh. • CBC, PT, PTT, Fibrinogen, FDPs. • A “poor man’s clot” or “bed side test” consists of placing a specimen of whole blood in a closed tube, the blood should clot in less than 10min, longer clotting times suggest DIC and if the clot dissolves in less than 5 minute means fibrinolytic activity and increase FDPs. • C-Kidney functions if needed. • D-Apt test to differentiate between fetal blood and maternal blood

45. 5-Lines of treatment • As the Bleeding is severe manifested by maternal shock & fetal death  Immediate Anti shock measures + immediate C.S. + ecbolics to treat uterine atony.  • Sometimes hysterectomy is needed in: • Severely lacerated uterus after failure of ecbolic. • Failure of the uterus to contract. • Correction of the PET + the use of MGSO4 to guard against eclamptic fits, better in the ICU + TTT of other complications if occur as DIC , ARF

46. Case number 2

47. A 46-year-old gravida 3 para 3, presented with menorrhagia with dysmenorrhea for the last 5 months. The menstrual flow lasts for about 10 days with unusually heavy flow. She looked pale. Clinical examination did not reveal any pelvic pathology apart from symmetrically enlarged bulky uterus around 10 weeks pregnancy size. Mention the commonest four possible causes? What laboratory investigations to be ordered? What imaging techniques are useful? What is the possibility of malignant genital disease in such case? Mention the role of surgery in the management of this case?

48. Answer

49. 1- Four possible causes • DUB & Endometrial hyperplasia • Ut.Leiomyomata ( Mostly Submucus ) • Adenomyosis uteri • Iatrogenic ( IUD complications if it was there ) • General causes(As advanced liver D, Hypothyroidism ) • Blood disorders ( rare ), • V. rarely End. Carcinoma.

50. 2-Laboratory investigations • Investigations for general causes ( liver f. tests, thyroid hormones, TSH ) • CBC • Coagulation Profile as ---- • Vaginal and cervical smear for --- • Hormonal assay as E2, • Kid. F. tests ( preop prep.)