MCQs
1 A 23-year-old nulliparous woman is considering
changing from the combined oral contraceptive (COC) to a
progestogen only implant.
For each situation, choose the single option you feel is
most correct.
a. Progestogen only implant is not as effective as the
COC as it does not inhibit ovulation
b. Bleeding will be predictable, unlike the COC
c. The risk of deep venous thrombosis is decreased in
COC users
d. The progestogen only implant protects against
sexually transmitted infections (STIs)
e. A common reason for discontinuing progestogen
only methods is unpredictable bleeding
2 A 49-year-old woman presents to her GP with hot
flushes and night sweats and wonders if she is going
through the menopause.
Which of the following statements is the single best
answer?
a. A menstrual history will not be useful in the
assessment of this patient
b. A serum follicle stimulating hormone (FSH) level of
70 IU/L is diagnostic of the menopause
c. Herbal remedies can safely be used alongside
prescribed medication
d. Oestrogen levels consistently <0.11 mmol/L indicate
ovarian failure
e. Combined hormone replacement therapy (HRT)
consists of two different oestrogens
3 A 79-year-old patient with chronic obstructive airways
disease and ischaemic heart disease presents with a 2-year
history of ‘something coming down’. Her body mass index
(BMI) is 38 and she smokes 15 cigarettes a day.
Which of the following statements is the single best
answer?
a. Your consultation should include review of her
respiratory symptoms and smoking
b. A Cusco ’ s speculum should be used for vaginal
examination
c. Pelvic floor exercises should be performed on a
weekly basis
d. Surgical management should be considered as first
line treatment
e. A ring pessary is unlikely to be useful for this patient
because of her comorbidity
4 In the normal uterine cervix, which of the following
statements is the single best answer?
a. Stratification of the squamous epithelium results
from maturation and differentiation
b. The squamo - columnar junction is sited at the
external cervical os
c. Squamous metaplasia results from human
papillomavirus (HPV) infection
d. A normal cervical appearance on examination
excludes a Chlamydia infection
e. Cervical ectopy usually requires treatment with
cryotherapy
Obstetrics and Gynaecology: Clinical Cases Uncovered.
By M. Cruickshank and A. Shetty. Published 2009 by Blackwell
Publishing. ISBN 978-1-4051-8671-1.MCQs 173
PART 3: SELF-ASSESSMENT
5 A 28-year-old nulliparous woman is referred to
colposcopy with a moderately dyskaryotic smear.
Which of the following statements is the single best
answer?
a. Sixty per cent of women with moderate dyskaryosis
will have abnormal vaginal bleeding
b. Referral was inappropriate as she has a low risk of
having high grade cervical intraepithelial neoplasia
(CIN)
c. A diagnostic biopsy must be taken before treatment
with cold coagulation
d. Most women require a general anaesthetic for the
treatment of CIN
e. She should be offered HPV vaccination to treat her
abnormal smear
6 A 54-year-old woman presents with postmenopausal
bleeding after the menopause at age 50. She had a
right-sided mastectomy and lymph node sampling 2 years
previously for breast cancer and is currently on tamoxifen.
Which of the following statements is the single best
answer?
a. Tamoxifen is an oestrogen antagonist and reduces
the risk of endometrial cancer
b. Thickened endometrium with cystic spaces on TV
scan suggests endometrial cancer
c. She should have a speculum examination to identify
any cervical pathology
d. She should be investigated by an outpatient
endometrial biopsy
e. The mostly likely cause of her symptoms is
metastatic breast cancer
7 A 75-year-old woman presents with a 10-year history of
vulval itch and irritation. This has failed to respond to
avoiding irritants and topical emollients. On examination,
the skin is thickened and white round the introitus and
perianal skin with superficial ulceration at the fourchette.
Which is the single most likely cause of her symptoms?
a. Vulval vestibulitis
b. Vulvovaginal thrush
c. Bartholin ’ s abscess
d. Lichen sclerosus
e. Genital warts
8 A 33-year-old para 2 is admitted as an emergency with
rapid onset of acute right iliac fossa pain. On admission,
she has tenderness and guarding in her right iliac fossa.
Her temperature is 37.8°C, her pulse is 92beats/minute
and her blood pressure 115/75mmHg, her white cell
count and neutrophil count are both raised.
Which of the following is the single most likely
diagnosis?
a. Endometriosis
b. Torsion of an ovarian cyst
c. Threatened miscarriage
d. Unruptured ectopic pregnancy
e. Mittelschmerz
9 In the investigation of a 32-year-old para 2 an incidental
finding of a pelvic mass is made.
Which of the following statements is the single best
answer?
a. Pregnancy needs to be excluded
b. CT scan is the imaging method of choice
c. Ovarian cancer is the most likely diagnosis
d. Premenopausal status increases her risk of the mass
being malignant
e. The diagnosis is unlikely to be fibroids as she is
asymptomatic
10 A 36-year-old woman complains of vaginal discharge
and a high vaginal swab shows bacterial vaginosis.
Which of the following statements is the single best
answer?
a. This is caused by a Trichomonas vaginalis infection
b. This is a sexually transmitted infection
c. This may have been caused by her intrauterine
device
d. She may have noticed a fishy smell
e. Her partner should be treated with penicillin174 Part 3: Self-assessment
PART 3: SELF-ASSESSMENT
11 A 23-year-old woman presents to her GP with rapid
onset of severe vulval pain. On examination, her vulva is
very swollen and tender.
Which of the following statements is the single best
answer?
a. A full sexual history should be taken initially to
make a diagnosis
b. Examination is not essential as a good history and
self - sampling will lead to the diagnosis
c. A tender fluctuant swelling over the mons pubis
suggests a Bartholin ’ s abscess
d. A herpes infection may be complicated by acute
urinary retention
e. A skin biopsy may be required to make the diagnosis
12 An 18-year-old girl presents with a 3-month history of
recurrent postcoital bleeding. She denies any recent sexual
activity.
Which of the following statements is the single best
answer?
a. In view of her history, she does not need a
Chlamydia test
b. She should be offered a cervical screening test
c. You should ask about her current method of
contraception and its usage
d. You do not need to offer her a chaperone if the
doctor is female
e. She should be referred for colposcopy
13 In the management of a woman with dysfunctional
uterine bleeding.
Which of the following statements is the single best
answer?
a. Mirena intrauterine system (IUS) is a recognized
treatment
b. An endometrial biopsy is not usually recommended
in a woman aged 45 years
c. Hysterectomy is often recommended as first line
therapy
d. Following endometrial ablation, women can
discontinue their contraception
e. Gonadotrophin releasing hormone (GnRH)
analogues can be used for long - term management
14 A 32-year-old woman is being investigated for primary
infertility. She has not used any contraception for the last
18 months and her normal menstrual cycle is κ = 5–7/35.
Which of the following statements is the single best
answer?
a. The prevalence of infertility in the UK population is
1 in 17
b. You should check her serum progesterone on day 14
to detect ovulation
c. You need to check her serum testosterone level
because of her cycle length
d. Her rubella immunity should be checked
e. First line investigations include laparoscopy and dye
test to check tubal patency
15 Her partner is aged 35 and has no previous children or
significant past medical history.
Which of the following statements is the single best
answer?
a. A semen analysis should be performed only if his
partner ’ s infertility investigations are normal
b. The normal reference range for minimum sperm
count with ejaculate is >30,000,000
c. The presence of small testicular size and azoospermia
is suggestive of an obstructive cause
d. The finding of azoospermia suggests that you should
arrange to repeat his semen analysis
e. The finding of azoospermia suggests that you should
perform a cystic fibrosis screen
16 A 37-year-old para 2 who is 36 weeks pregnant
presents to the day assessment ward with fresh bleeding
per vaginum.
What feature on history and examination would make
placenta praevia an unlikely diagnosis?
a. Transverse lie of the fetus
b. A tender hypertonic uterus
c. Her first two deliveries having been by caesarean
section
d. Stable maternal condition
e. Good fetal movements, stable fetal condition (e.g.
normal fetal heart)MCQs 175
PART 3: SELF-ASSESSMENT
17 A 24-year-old para 0 is 29 weeks pregnant and
presents with leaking clear fluid per vaginum. Her uterus is
soft and she is not in labour. The baby is in a cephalic
position with the head four-fifths palpable per abdomen,
and the fetal heart is regular. Preterm prelabour rupture of
membranes is diagnosed.
What would you not do?
a. Perform a vaginal swab
b. Administer a course of steroids for fetal lung
maturity
c. Take bloods for full blood count (including white
cell count) and C - reactive protein
d. Start antibiotics (erythromycin)
e. Induce labour as soon as possible
18 Which of these is not a risk factor for atonic
postpartum haemorrhage?
a. A long labour with oxytocin augmentation
b. High parity
c. Multiple pregnancy
d. Epidural for pain relief
e. Placental abruption
19 Which of these is not a symptom or sign of impending
eclampsia?
a. Headaches
b. Epigastric pain
c. Frequency of micturition
d. Blurring of vision
e. Hyper - reflexia
20 Which of these is a routinely offered antenatal
screening test in the UK?
a. Chorionic villus sampling
b. Amniocentesis
c. Screening for HBV infection
d. Screening for group B streptococcus
e. Screening for toxoplasmosis
21 Which of these is not a risk factor for venous
thrombosis?
a. Hyperemesis gravidarum
b. Malposition of the fetus
c. Smoking
d. Postpartum haemorrhage
e. Puerperal sepsis
f. Increasing maternal age
22 Which of the following is a relative contraindication for
an external cephalic version?
a. Previous caesarean section
b. Multiparity
c. Extended breech presentation
d. >38 weeks ’ gestation
e. Maternal shoe size 3
23 Which of these are not a sign of scar rupture or
dehiscence with a vaginal birth after caesarean section
(VBAC)?
a. Fresh bleeding per vaginum
b. Tense and hypertonic uterus
c. Scar tenderness
d. Maternal tachycardia
e. Fetal heart deceleration
24 Components of the cervical Bishop’s score.
Which is the odd one out?
a. Station of the fetal head
b. Position of the fetal head
c. Cervical dilatation
d. Length of the cervix
e. Consistency of the cervix176 Part 3: Self-assessment
PART 3: SELF-ASSESSMENT
25 Which of the following is a complication of
pre-eclampsia?
a. Fetal macrosomia
b. Pulmonary odema
c. Prelabour preterm rupture of membranes
d. Polyhydramnios
e. Fetal malposition
26 Which of these statements about twin pregnancies is
not true?
a. All dichorionic pregnancies are dizygotic
b. A monochorionic placenta is only seen with
monozygotic twins
c. Chorionicity can be diagnosed on scan in >98% of
pegnancies in the first trimester
d. Twin – twin transfusion syndrome is seen with
monochorionic twins
e. Chorionicity not zygosity is an important
determinant of risk with twin pregnancies
27 Which of these is not usually associated with an
increased risk of hyperemsis gravidarum?
a. Molar pregnancy
b. Multiple pregnancy
c. Previous history of hyperemesis
d. First trimester of pregnancy
e. Increasing maternal age
28 Which one of these is not an option for pain relief in
the first stage of labour?
a. TENS
b. Entonox
c. Epidural
d. Pudendal block
e. Morphine
29 With which of these maternal infections is there no risk
of intrapartum transmission to the fetus?
a. Hepatitis B
b. HIV
c. Chlamydia
d. Hepatitis C
e. Rubella
30 Which of the following help with prenatal screening
for Down’s syndrome?
a. Maternal age
b. Fetal nuchal thickness
c. Mid - trimester maternal serum screening with bHCG
and alpha - fetoprotein levels
d. Acetylcholinesterase estimation in the amniotic fluid
e. The integrated first and second trimester screening
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