SBA for part1 exam o&G

1. SBA
MONDAY
20/08/18
30 MINUTES

2. • The following is not true concerning the
normal development of the female
reproductive tract:
• A. The paramesonephric ducts develop at 6 weeks
post-conception.
• B. Anti-Müllerian hormone (AMH) leads to
degeneration of the Müllerian ducts.
• C. The paroophoron develops from the Wolffian
ducts.
• D. The myometrium develops from the Wolffian
ducts.
• E. The vaginal plate is derived from the urogenital
sinus.

3. • Congenital adrenal hyperplasia:
• A. Presents classically as neonatal
hypernatraemia.
• B. Presents classically as a feminized XY
neonate.
• C. Is an autosomal dorminant disorder that
causes a deficiency of cortisol.
• D. Leads to low circulating concentrations of
testosterone.
• E. Requires mineralocorticoid replacement.

4. • The following statements refer to girls
with congenital adrenal hyperplasia
except:
• A. The usual karyotype is 46XX.
• B. Most cases are due to a deficiency of the
21-hydroxylase enzyme.
• C. Müllerian structures develop in utero.
• D. Poor compliance with treatment leads to
raised levels of 17-alpha
hydroxyprogesterone.
• E. Treated females have fertility rates that are
similar to those of unaffected women.

5. • When compared to women with a normal
karyotype, women with Turner’s
syndrome (45X) have an increased
incidence of the following medical
conditions except:
• A. Red/green colour blindness .
• B. Hypertension.
• C. Ovarian cancer.
• D. Osteoporosis.
• E. Deafness.

6. • Central precocious puberty:
• A. Follows a premature suppression of
pituitary luteinizing hormone (LH) and follicle-
stimulating hormone (FSH) secretion due to
activation of ovarian steroid synthesis.
• B. Should be investigated with cranial
imaging techniques.
• C. Is frequently seen in girls with Turner’s
syndrome.
• D. Is frequently accompanied by a cessation
of growth.

7. • In pubertal delay the following are correct
except:
• A. Elevated plasma concentrations of LH and
FSH suggest a readily reversible cause.
• B. Steroids can be given to induce breast
development.
• C. Low concentrations of gonadotrophins are
associated with excessive exercise.
• D. Bone age is retarded in constitutional
delayed puberty.

8. • Unrecognized side effects of danazol
include:
• A. Weight gain.
• B. Vaginal dryness.
• C. Increase in breast size.
• D. Acne.
• E. Hirsutism.

9. • In the management of menorrhagia:
• A. Norethisterone is the treatment of choice for
reducing menstrual loss in simple menorrhagia.
• B. Oestrogen-impregnated intrauterine devices are
useful for reducing menstrual loss.
• C. Hysteroscopy allows visualization of the ovarian
surfaces.
• D. Endometrial sampling on day 7 of the cycle will
usually reveal proliferative endometrium.
• E. GnRH agonists are a cost-effective alternative
to the oral contraceptive pill.

10. • The following relate to dysmenorrhoea except:
• A. Childbirth has a curative effect on primary
dysmenorrhoea.
• B. Women who have smoked for more than 10
years have an increased risk of dysmenorrhoea.
• C. Pain prior to menstruation suggests pelvic
inflammatory disease (PID).
• D. In secondary dysmenorrhoea, laparoscopy
should be considered if a trial of therapy is
unsuccessful.
• E. The contraceptive pill is of value in its
treatment.

11. • With regard to endometriosis:
• A. It is associated with unruptured
luteinized follicle.
• B. It can be treated with 200 mg danazol
daily.
• C. The results of medical treatment are
poor compared to those of surgery.
• D. It cannot occur de novo after
sterilization.

12. • The following statement is true:
• A. IVF is a suitable first-line option for treating
all types of infertility.
• B. Transferring two or three embryos has the
same twin pregnancy rates.
• C. Not proceeding with embryo transfer
prevents late-onset ovarian hyperstimulation
syndrome (OHSS).
• D. Recombinant FSH offers a higher
pregnancy rate compared to high-purity
urinary gonadotrophins.

13. • The wrong statement with regard to OHSS:
• A. It can lead to hypovolaemia and
haemoconcentration in severe cases.
• B. Mild and moderate cases can be treated at
home.
• C. Albumin replacement is only indicated if a
significant drop in serum albumin occurs.
• D. Paracentesis should be avoided at all costs.
• E. It is commoner in polycystic ovarian syndrome
(PCOS) and lean patients.

14. • Polycystic ovarian syndrome:
• A. Is associated with LH hypersecretion.
• B. Is associated with low TSH levels.
• C. Typically presents with primary
amenorrhoea.
• D. Is associated with decreased production of
dehydroepiandrosterone sulphate (DHEAS),
an adrenal androgen.
• E. Is associated with markedly elevated
serum prolactin.

15. • With respect to the management of
anovulatory infertility in a woman with PCOS:
• A. Weight reduction is ineffective in improving
fertility.
• B. Ultrasound follicular tracking is not necessary if
clomiphene citrate is used for fewer than 12
cycles.
• C. Use of clomiphene citrate for fewer than 12
cycles has been shown to be associated with an
increased risk of ovarian cancer.
• D. Tamoxifen is an alternative to clomiphene
citrate.
• E. The recommended duration of use of
gonadotrophin therapy is 6–12 months.

16. • Gonadectomy is indicated because of
the risk of malignancy in women with
primary amenorrhoea and the following
conditions:
• A. Turner’s syndrome.
• B. Androgen insensitivity syndrome.
• C. Gonadal dysgenesis with 46XX
karyotype.
• D. Rokitansky’s syndrome.

17. • The following diagnoses are likely in a 30-
year-old woman with secondary
amenorrhoea and low gonadotrophin
levels:
• A. Premature ovarian failure.
• B. Resistant ovary syndrome.
• C. Sheehan’s syndrome.
• D. Asherman’s syndrome.
• E. Post-pill amenorrhoea.

18. • Regarding treatment of the menopause:
• A. Double-blind studies have shown clonidine
to be effective in the treatment of hot flushes
and night sweats.
• B. Progestogenic side effects include
bloating, mastalgia, fluid retention and acne.
• C. Fifty per cent of women discontinue HRT
within 3 years of starting treatment.
• D. Patients with breast cancer should never
receive HRT.

19. • The following are true for Urogenital
prolapse except:
• A. Accounts for 50 per cent of all
gynaecological procedures.
• B. Rarely occurs in nulliparous women.
• C. May be associated with lower urinary tract
symptoms.
• D. Is more common following the
menopause.
• E. Is found in one third of elderly women.

20. • Chlamydia trachomatis:
• A. Is diagnosed by culture of cervical
purulent discharge.
• B. Has been found to be carried by an
increased number of women using the
COCP.
• C. Is usually symptomatic.
• D. Is routinely treated with penicillins.

21. • With regard to electronic fetal monitoring:
• A. In low-risk pregnancies, continuous monitoring
in labour has been shown to improve long-term
outcomes.
• B. An admission CTG should be performed for all
women in labour.
• C. Continuous fetal monitoring increases
intervention in labour.
• D. An abnormal CTG suggests acidosis in 50 per
cent of fetuses.
• E. Maternal oxygen therapy should be given if the
CTG is pathological.

22. • Regarding progress in labour:
• A. A normal cervicometric curve is associated with
a caesarean section rate of less than 5 per cent.
• B. Primary dysfunctional labour occurs in 10 per
cent of nulliparous labours.
• C. A supportive partner during labour will reduce
the incidence of delivery by caesarean section.
• D. Augmentation with Syntocinon in the latent
phase is associated with a reduction in the
incidence of operative deliveries.

23. • With regard to vulval lichen sclerosus:
• A. Histological diagnosis is mandatory.
• B. Emollient creams are ineffective.
• C. 1% hydrocortisone cream are not very
effective.
• D. Testosterone cream is useful for
maintaining response.
• E. The condition is usually self-limiting.

24. • In vulval vestibulitis:
• A. Pain is occasionally associated with light touch
in the vestibule area.
• B. Vestibular erythema is necessary to make a
diagnosis.
• C. The modified vestibulectomy produces a
success rate of less than 50 per cent in well-
selected patients.
• D. Sensate focus therapy should complement the
physical treatments among those patients with
sexual dysfunction.
• E. Amitryptyline is the first-line treatment of choice.

25. • Malignant germ-cell tumours:
• A. Account for 15 per cent of all ovarian
malignancies.
• B. Represent 60 per cent of ovarian cancers
in children and adolescents.
• C. Are usually bilateral.
• D. Have an overall 5-year survival rate of 38
per cent.
• E. Require treatment that usually results in
infertility.

26. • Which of the following is not true with
regard to postnatal depression:
• A. It may be associated with pre-
conceptual psychiatric illness.
• B. It may be controlled by adjuvant
oestrogen therapy.
• C. Tricyclic antidepressants are less
effective than cognitive therapy.
• D. It may be monitored using the
Edinburgh Score.

27. • Physiologically, the following are important
considerations when resuscitating the
newborn infant:
• A. The ductus arteriosus closes within hours of
birth.
• B. Pulmonary vascular pressures are increased by
excessive use of high-concentration oxygen.
• C. Hypothermia is associated with a worse
neurological outcome.
• D. Restoration of blood volume should be the
priority to ensure adequate tissue perfusion.
• E. Surfactant synthesis is affected by factors such
as temperature, pH and hypoxaemia.

28. • Morbidly adherent and retained
placenta:
• A. Is associated with elevated serum aFP.
• B. Is associated with reduced serum
bhCG.
• C. Is more common in women age of 35
years and above.
• D. Is less common in women who have
placenta praevia.

29. • With regard to pulmonary embolism:
• A. It accounts for >50 per cent of all
maternal deaths in the UK.
• B. In pregnancy the risk is increased two-
fold.
• C. Antenatal presentation is most
common.
• D. It is associated with high body mass
index.

30. • The following are true:
• A. Erb’s palsy involving cervical nerve roots
C3 and C4 is associated with a good
outcome.
• B. Cephalhaematomas that enlarge further at
a few weeks of age indicate further bleeding
and require investigation.
• C. Sternomastoid tumours occur as a result
of minor bleeding into the muscle and need
physiotherapy to prevent shortening of the
muscle as well as disturbance of visual
development.
• D. Fracture of the clavicle from birth requires
immobilization of the arm for 48 hours.

31. • These skin disorders are clinically
significant in the newborn infant:
• A. Erythema toxicum neonatorum.
• B. Traumatic cyanosis.
• C. Aplasia cutis.
• D. Flammeus naevus.
• E. Miliaria.

32. • The following increase the risk of GBS
infection in the newborn infant except:
• A. History of a previous infant with GBS
infection.
• B. Spontaneous onset of premature labour.
• C. A positive urine culture for GBS in the
mother during pregnancy.
• D. Transient tachypnoea of the newborn
following elective lower segment caesarean
section.

33. • The following are normal in the first
stage of labour except:
• A. A scalp pH of 7.24.
• B. A base excess of -13 mmol/L.
• C. Baseline variability on the CTG of 5–10
bpm.
• D. A baseline on CTG of 155 bpm.

34. • In the treatment of vulval cancer:
• A. All stage I vulval cancers require a bilateral inguinal
lymph node dissection.
• B. Superficial inguinal node dissection has the same
rate of groin recurrence as an inguino-femoral node
dissection.
• C. The risk of recurrence following surgery for stage
I/II disease is the same for a triple incision technique
and an ‘en-bloc’ radical vulvectomy.
• D. Adjuvant radiotherapy is not recommended when
there is extracapsular lymph node spread in a single
lymph node.
• E. Chemoradiotherapy has a cure rate equivalent to
that of surgery in the treatment of stage II vulva
cancer.

35. • Concerning Partial hydatidiform moles the
following are true except:
• A. Are usually triploid.
• B. Rarely give rise to persistent trophoblastic
disease.
• C. Often present as a missed miscarriage.
• D. Are easy to diagnose on ultrasound scan.
• E. Often have recognizable embryonic and
fetal tissues.

36. • Malignant germ-cell tumours:
• A. Account for 15 per cent of all ovarian
malignancies.
• B. Represent 60 per cent of ovarian cancers
in children and adolescents.
• C. Are usually bilateral.
• D. Have an overall 5-year survival rate of 38
per cent.
• E. Require treatment that usually results in
infertility.

37. • With regard to the management of urogenital
prolapse:
• A. Physiotherapy has been shown to be effective.
• B. Ring pessaries are the management of choice
in the elderly.
• C. Sacrospinous ligament fixation should be
performed routinely at vaginal hysterectomy to
prevent vault prolapse.
• D. Enterocele formation is increased following
colposuspension.
• E. Anterior repair is an effective treatment for co-
existent stress incontinence.

38. • The following drugs are associated
with hirsutism except:
• A. Danazol.
• B. Phenytoin.
• C. Cyclosporin A.
• D. Norethisterone.
• E. Finasteride.

39. • When a 30-year-old woman presents with
rapidly progressive hirsutism and virilization:
• A. Ovarian hilus cell tumour is a possible
diagnosis.
• B. Ovarian granulosa theca cell tumour is a likely
diagnosis.
• C. A tumour of the adrenal medulla is a possible
cause.
• D. Excision of an androgen-producing ovarian
tumour results in a rapid regression of hirsutism.
• E. PCOS is a possible diagnosis.

40. • The incorrect statement with respect to
androgen production in the female:
• B. Androstenedione is the main ovarian
androgen.
• C. Androstenedione and
dehydroepiandrosterone (DHEA) do not have
androgenic activity.
• D. DHEAS is almost exclusively of adrenal
origin.
• E. Androstenedione and DHEA are converted
to testosterone in peripheral tissues.

41. • The following are long-term
consequences of PCOS except:
• A. Increased mortality from cardiovascular
disease.
• B. Increased risk of ovarian cancer.
• C. Increased risk of endometrial cancer.
• D. Increased risk of insulin-dependent
diabetes mellitus.

42. • Regarding the management of male factor
infertility:
• A. Varicocelectomy is ineffective in improving male
fertility when associated with severe oligospermia.
• B. Bromocriptine is useful in treating sperm
abnormalities and sexual dysfunction in infertile
men.
• C. Patients with Kallmann’s syndrome can be
treated effectively with gonadotrophins.
• D. Sperm washing and intrauterine insemination
are effective in treating asthenospermia due to
anti-sperm antibodies.
• E. Obtaining and freezing a sperm sample from
the epididymis is essential during vasectomy
reversal as the procedure has a high failure rate.

43. • Regarding male factor investigations:
• A. Semen analysis should be performed before
investigations of the female partner.
• B. Testing for anti-sperm antibodies should be
carried out routinely.
• C. The ratio of normal to abnormal sperm
morphology is a sensitive marker of male fertility.
• D. Testicular examination is ideally carried out in
the supine position.
• E. Ten per cent of azoospermic and severely
oligozoospermic men are carriers of the cystic
fibrosis gene.

44. • In the management of female infertility:
• A. Ectopic pregnancy rates are similar
between IVF and gamete intrafallopian
transfer (GIFT) in patients with unexplained
infertility.
• B. Tubal surgery for hydrosalpynx results in
pregnancy in more than 50 per cent of cases.
• C. Infertile patients with mild endometriosis
should be given long-term GnRH agonist
treatment while awaiting IVF treatment.
• D. Salpingectomy in patients with tubal factor
infertility undergoing IVF improves the
pregnancy rates.

45. • When investigating an infertile couple:
• A. Routine hysteroscopy should be carried
out.
• B. A serum progesterone level >30 nmol/L on
cycle day 21 is indicative of ovulation.
• C. Laparoscopy and dye hydrotubation is
more informative of uterine cavity abnormality
than hysterosalpingography.
• D. Urinary LH detection using a commercially
available test kit is diagnostic of ovulation.
• E. A routine cervical smear should be
included in the investigation of infertility.

46. • With regard to premenstrual syndrome:
• A. It is a common clinical phenomenon affecting
40 per cent of the female population.
• B. The symptoms occur at a time of relative
progesterone deficiency.
• C. It is not relieved by the end of menstruation.
• D. Evening primrose oil is effective at relieving the
symptoms.
• E. Suppression of ovulation with transdermal
oestrogen and progesterone for endometrial
protection is an effective treatment.

47. • The diagnosis of adenomyosis requires:
• A. A myometrial thickness of 2.5 cm or more.
• B. Islands of endometrial glands without
stroma in the myometrium.
• C. Accompanying endometriosis elsewhere in
the pelvis.
• D. Extension of the endometrial glands and
stroma in the myometrium with adjacent
smooth muscle hyperplasia.
• E. Subserosal disease near the uterine
surface.

48. • Uterine fibroids:
• A. Are present in up to 25 per cent of women
of reproductive age.
• B. Are the most common site of
leiomyosarcoma development.
• C. If small and submucous, are unlikely to be
associated with menorrhagia.
• D. If palpable abdominally, should be
removed.

49. • With regard to the normal menstrual cycle:
• A. The pulsatile release of gonadotrophin-
releasing hormone (GnRH) increases in the luteal
phase of the cycle.
• B. The oestrogen surge precedes the LH surge by
22 hours.
• C. Oestrogen receptor (ER) and progesterone
receptor (PR) expression is maximal in the late
luteal phase.
• D. Ovulation occurs approximately 32 hours after
the LH surge.

50. • The following is not correct with regard to
laparoscopic clip sterilization:
• A. There is a failure rate of approximately 0.5
per cent.
• B. Most deaths are due to anaesthetic
complications.
• C. The procedure should not be performed
during menstruation.
• D. All women should be counselled that male
sterilization is a safer alternative.
• E. Surgical emphysema is a recognized
complication.

51. • In an ovulatory cycle:
• A. Usually only one follicle develops every
cycle.
• B. Both oestrogen and inhibin B are produced
by the lead follicle.
• D. The LH triggers the completion of the first
mitotic division, resulting in the production of
the first polar body.
• E. Follicular development is dependent on
the gonadotrophins throughout the cycle.