‫اختبار تجريبي ألطباء اإلمتياز‬

‫‪Gynecology and Obstetrics‬‬

‫مدة االمتحان ‪ 50‬دقيقة فقط ***‬

‫اختر اجابة واحدة فقط لكل سؤال ***‬

‫‪2017‬‬
1. Which of the following is considered first-line therapy for primary
dysmenorrhea?
A) Nonsteroidal anti-inflammatory drugs (NSAIDs)
B) Selective serotonin reuptake inhibitors (SSRIs)
C) Antiestrogens
D) Acupuncture
E) Tricyclic antidepressants

2. Preterm labor is defined as regular contractions with cervical change

before
A) 40 weeks’ gestation
B) 39 weeks’ gestation
C) 38 weeks’ gestation
D) 37 weeks’ gestation
E) 36 weeks’ gestation

3. Which of the following bacterial infections is not generally associated

with preterm labor?
A) Ureaplasma urealyticum
B) Mycoplasma hominis
C) Gardnerella vaginalis
D) Bacteroides species
E) All are associated with preterm labor.

4. Which of the following sports is contraindicated in pregnancy?

A) Walking
B) Stationary bicycle
C) Low-impact aerobics
D) Snow skiing
E) Swimming

5. Which of the following is not a contraindication to aerobic exercise

during pregnancy?
A) Pregnancy-induced hypertension (PIH)
B) Incompetent cervix
C) Preterm labor during a prior pregnancy
D) Placenta previa
E) Twin gestation

6. Maternal temperature elevations above _________ can be detrimental to

the fetus in the first trimester of pregnancy.
A) 37°C (98.6°F)
B) 37.8°C (100.0°F)
C) 38.3°C (101.0°F)
D) 38.9°C (102.0°F)
E) Maternal temperature has no detrimental effects on the fetus.

7. Which of the following over-the-counter medications is generally

avoided during pregnancy?
A) Acetaminophen
B) Chlorpheniramine
C) Pseudoephedrine
D) Dextromethorphan
E) Aspirin
8. During labor, the fetal heart tracing shows repeated late decelerations.
You suspect
A) Uteroplacental insufficiency
B) Abnormal presentation
C) Head engagement
D) Rapid descent of the fetus
E) Normal progression of labor

9. A 26-year-old primiparous woman pushed effectively during a 2-hour

second stage with subsequent delivery of the infant’s head followed by a
“turtle sign” with inability to deliver the infant’s shoulders with the normal
amount of downward traction and maternal expulsive efforts. You diagnose
shoulder dystocia and ask the mother to stop pushing and alert staff to this
emergency. The next appropriate step is
A) Place the mother in the left lateral position
B) Perform McRoberts’ maneuver
C) Apply fundal pressure
D) Use a rotational maneuver, either the Rubin II or Wood’s corkscrew
E) Perform a cesarean section

10. The drug of choice for controlling eclamptic seizures is

A) Hydralazine
B) Phenobarbital
C) Phenytoin
D) Diazepam
E) Magnesium sulfate

11. The current diagnosis of preeclampsia consists of which of the

following?
A) Elevated blood pressure and proteinuria
B) Elevated blood pressure, proteinuria, and edema
C) Elevated blood pressure, proteinuria, edema, and seizures
D) Elevated blood pressure, proteinuria, edema, seizure, and headaches

12. An 18-year-old woman pregnant with her first child is in the second
stage of labor. She complains of abdominal pain between uterine
contractions. You suspect
A) Posterior presentation
B) Breech presentation
C) Abruption placenta
D) Vasa previa
E) Uterine atony

13. A 25-year-old presents to your office complaining of abnormal vaginal

bleeding. Your first consideration in the differential diagnosis is
A) Infection
B) Trauma
C) Foreign body
D) Pregnancy
E) Coagulopathy
14. Pregnant patients with established human immunodeficiency virus (HIV)
infection
A) Should avoid all antiviral medications because of their teratogenic
potential
B) Should receive only zidovudine at the time of delivery
C) Do not need to switch off efavirenz if taking it when pregnancy is
diagnosed
D) Should avoid zidovudine because of its limited effectiveness
E) Should receive only zidovudine if their CD4+ counts are unacceptably
Low

15. When repairing perineal lacerations, it has been shown that

A) Skin sutures may increase the incidence of perineal pain.
B) Skin sutures are required for adequate skin approximation.
C) Interrupted transcutaneous sutures are superior to running subcuticular
sutures.
D) Sutures should begin at the anterior point of the skin laceration.
E) Repair with skin sutures leads to better outcomes.

16. A 36-year-old woman has a history of a prior deep venous thrombosis

(DVT). She is pregnant for the first time. In view of her prior history of
DVT, you should recommend
A) Warfarin (Coumadin)
B) Heparin
C) Aspirin
D) Clopidogrel (Plavix)
E) No prophylaxis is necessary

17. When advising mothers concerning antiseizure medications during

pregnancy, which of the following statements is true?
A) Multiple medications are preferred to maintain lower levels of
medication.
B) Antiseizure medications should be discontinued at the time pregnancy
is determined.
C) Seizure activity in mothers has no impact on fetal outcomes.
D) Most antiseizure medications are considered safe (category B).
E) Single agents are preferred to multiple medications.

18. Which of the following statements is true regarding smoking during

pregnancy?
A) Smoking increases the risk of attention-deficit disorder in the child.
B) Nicotine patches are a safe alternative during pregnancy.
C) Bupropion (Zyban) should be avoided during pregnancy.
D) Regardless of when she stops smoking, infants born to mothers with a
smoking history are more at risk for neonatal complications.
E) When compared with total abstinence, reducing the number of cigarettes
smoked has no effect on fetal outcomes.

19. The use of benzodiazepines during pregnancy has been associated with
A) Polydactily
B) Cleft lip
C) Spina bifida
D) Growth retardation
E) Developmental delay
20. Which of the following is not associated with maternal obesity during
pregnancy?
A) Hydrocephalus
B) Maternal hypertension
C) Preeclampsia
D) Maternal diabetes
E) Macrosomic infant

21. A 26-year-old primigravida presents to your office. She is pregnant with

a twin gestation and is in her third trimester. She complains of pruritic,
vesicular skin lesions that have developed on her abdomen. Her face,
palms, and soles are spared. You suspect
A) Varicella
B) Scabies
C) Pruritic urticarial papules and plaques of pregnancy (PUPPP)
D) Herpes zoster
E) Hyperbilirubinemia

22. A 26-year-old woman who is 30 weeks pregnant is involved in a motor

vehicle accident. She has suspected neck trauma and is in need of transport.
You suggest placing her
A) In the left lateral decubitus position
B) In the Trendelenberg position
C) Prone position on a backboard
D) Supine on a backboard with her right hip elevated
E) Supine on a backboard

23. Which of the following statements about the evaluation of infertility is

true?
A) The woman should be evaluated before the man with a postcoital test.
B) A hysterosalpingogram should be performed as the first step in an
infertility workup.
C) The first step is evaluation of the male factor with a sperm analysis.
D) Hormone level determination is the first test that should be ordered for
the woman before the workup for the man.
E) An endometrial biopsy on the woman is the first test to consider in the
workup of infertility.

24. Pregnant women should avoid contact with cat litter because of the risk
for developing
A) Cryptococcus
B) Cytomegalovirus
C) Toxoplasmosis
D) Coccidioidomycosis
E) Erythema infectiosum

25. What percentage of babies born to HIV-positive mothers is HIV

positive?
A) 0% to 1%
B) 20% to 30%
C) 50% to 75%
D) 90% to 100%
E) 100%
26. The most appropriate management for intrauterine fetal demise in the
3rd trimester includes
A) Observation for up to 4 weeks until the mother goes into labor
B) Immediate cesarean section
C) Administration of intravenous oxytocin (Pitocin) after serial
misoprostol 25 to 50 mcg every 4 hours until cervix ripened
D) High-dose misoprostol (200 to 400 mcg every 4 hours)
E) Heparin plus antibiotic prophylaxis and observation for up to 4 weeks

27. Rho(D) immune globulin (RhoGAM) is indicated when

A) The mother has type AB blood
B) The father is Rh negative
C) The mother is Rh positive
D) None of the above

28. When there is first-trimester bleeding, fetal viability can be definitely

determined by which of the following tests?
A) Qualitative β-human chorionic gonadotropin (hCG) determination
B) Serial quantitative β-hCG measurements
C) Transvaginal ultrasonography
D) Serum progesterone levels
E) Both B and C

29. A 27-year-old woman presents for her annual examination. Her body
mass index (BMI) is 31 and she has hirsutism and reports difficulty with
conception. She does not have monthly menses, and typically has a period
only every 5 to 6 months. Based on her likely diagnosis, which of the
following malignancies is she most at increased risk for?
A) Ovarian carcinoma
B) Colon cancer
C) Pancreatic cancer
D) Endometrial carcinoma
E) Breast cancer

30. Which of the following is not a risk factor for group B β-streptococcal
infection in the neonate?
A) Twin gestation
B) Less than 37 weeks’ gestation
C) Prolonged rupture of membranes
D) Maternal fever
E) Maternal Group B-streptococcal anogenital colonization

31. Patients who have difficulty with infertility may have antisperm
antibodies. Which one of the following medications may help lower
antisperm antibodies?
A) Medroxyprogesterone (Depo-Provera)
B) OCPs
C) Gonadotropin-releasing hormone (GnRH) agonist
D) Corticosteroids
E) None of the above

32. A 44-year-old woman presents with irregular vaginal bleeding.

Appropriate initial management includes
A) Endometrial biopsy
B) Trial of oral contraceptives
C) Medroxyprogesterone injection
D) Surgical referral

33. In the management of a pregnant patient, medications are classified

based on their risk to the fetus. Category C medications
A) Should never be given during pregnancy
B) Are considered safe during pregnancy
C) Should only be given in life-threatening situations
D) Have unknown risk for the fetus
E) Are associated with teratogenicity in animals

34. Which of the following medications can be safely used for cervical
ripening for term pregnancies?
A) Terbutaline
B) Methotrexate
C) Thalidomide
D) Misoprostol
E) Bromocriptine

35. Which of the following statements about uterine adenomyosis is true?

A) The condition is associated with the invasion of myometrial tissue into
the peritoneal cavity.
B) The condition commonly causes intense pelvic pain, dysuria, and
dyspareunia.
C) Those affected with uterine adenomyosis have an increased risk of
endometrial cancer.
D) The condition is considered benign and usually causes no associated
symptoms.
E) The condition results from uterine atony after delivery.

36. A 17-year-old girl is seen in the emergency room. She reports high
fever, nausea, vomiting, myalgias, and lethargy. On examination, she is
found to have hypotension and a generalized erythematous rash and
desquamation of the hands and feet. Laboratory tests show an increased
white blood cell count, increased blood urea nitrogen, and increased serum
creatinine with decreased urine output. The most likely diagnosis is
A) Gonorrhea
B) Lyme disease
C) Toxic shock syndrome
D) Tertiary syphilis
E) PID

37. A 35-year-old woman presents to your office complaining of a copious

white vaginal discharge. Microscopic examination shows evidence of
pseudohyphae. The most appropriate treatment is
A) Penicillin G
B) Doxycycline
C) Terconazole (Terazol) vaginal cream
D) Metronidazole (Flagyl)
E) Topical acyclovir
38. Which of the following is not true of oxytocin administration?
A) The drug must be given through a controlled infusion device.
B) Oxytocin must be administered as a continuous infusion or in “pulsed”
doses.
C) The medication can have a diuretic effect with high doses.
D) Hyperstimulation can result from oxytocin administration.

39. The diagnosis of endometriosis is generally made by

A) Detection of increased estrogen levels
B) Endometrial biopsy
C) Pelvic ultrasound
D) Laparoscopy
E) CT of the pelvis

40. A 33-year-old woman who delivered last week presents to your office
with questions about her gestational diabetes that developed during the first
trimester. You explain
A) Her risk of developing type 2 diabetes in the future is no different from
anyone else.
B) She should be screened for diabetes with either fasting blood glucose
measurements or a 2-hour glucose tolerance test 6 weeks postpartum
and yearly thereafter.
C) No further monitoring is necessary unless she develops symptoms of
diabetes.
D) She should be tested for diabetes 6 months after delivery via fasting
blood glucose measurements on two occasions or a 2-hour oral 75-g
glucose tolerance test.

41. Which of the following is most commonly associated with

nongonococcal urethritis?
A) Herpes simplex
B) Ureaplasma
C) Chlamydia
D) Trichomonas
E) Syphilis

42. Dysfunctional uterine bleeding is most common

A) During pregnancy
B) After sexual intercourse
C) At the time of menopause
D) With the development of PID
E) In premenarchal girls

43. The normal amount of blood loss for a vaginal delivery is

A) 250 mL
B) 500 mL
C) 1,000 mL
D) 1,500 mL
E) 2,000 mL
44. Which of the following medications is not used in the treatment of
preterm labor?
A) Ritodrine
B) Magnesium sulfate
C) Terbutaline
D) Propanolol
E) Nifedipene

45. A 27-year-old asymptomatic pregnant woman at 8 weeks gestational

age is found to have hyperthyroidism. Which of the following medications is
the drug of choice for treatment in the first trimester?
A) Propylthiouracil (PTU)
B) Radioactive iodine
C) Methimazole
D) Propranolol
E) Levothyroxine

46. Which of the following is a characteristic of atrophic vaginitis?

A) Vaginal pH of 5 to 7
B) Milky discharge
C) Increased vaginal rugae
D) Endometrial cells noted on wet-mount microscopic examination
E) Increased glycogen levels

47. An 18-year-old woman presents to your office complaining of pelvic

pain, dysuria, and a purulent yellowish-green vaginal discharge. A Gram’s
stain of cervical secretions shows gram-negative diplococci. The most
appropriate medication is
A) Ceftriaxone + azithromycin
B) Penicillin G + azithromycin
C) Cefuroxime + tetracycline
D) Cefoxitin + doxycycline
E) Metronidazole + doxycycline

48. The maximum acceptable cumulative dose of ionizing radiation during

pregnancy is
A) 100 rads
B) 50 rads
C) 10 rads
D) 5 rads
E) 1 rad
49. Which of the following is associated with oral contraceptive use?
A) Increased risk of endometrial cancer
B) Increased risk of ovarian cancer
C) Decreased risk of cervical cancer
D) Decreased risk of liver cancer
E) Fewer ectopic pregnancies

50. A 45-year-old woman is noted to have four yeast infections in 1 year.

Appropriate management of this patient should be
A) Continued observation and treatment only if symptomatic
B) Further evaluation for hypothyroidism
C) Blood test to look for the presence of diabetes and HIV infection
D) Prophylactic therapy with weekly metronidazole
E) Examination for endometrial structural abnormalities
 ‫الرجاء وضع رمز االجابة الصحيحة بجانب رقم السؤال‬

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‫‪7‬‬ ‫‪17‬‬ ‫‪27‬‬ ‫‪37‬‬ ‫‪47‬‬
‫‪8‬‬ ‫‪18‬‬ ‫‪28‬‬ ‫‪38‬‬ ‫‪48‬‬
‫‪9‬‬ ‫‪19‬‬ ‫‪29‬‬ ‫‪39‬‬ ‫‪49‬‬
‫‪10‬‬ ‫‪20‬‬ ‫‪30‬‬ ‫‪40‬‬ ‫‪50‬‬

‫اعداد ‪ :‬د سلمان زبيدات‬

‫ال تنسونا من صالح دعائكم‬

‫‪GOOD LUCK‬‬