1. Topic: Fetal Alcohol Syndrome

Correct Answer: E. All of the above

Explanation: Fetal Alcohol Syndrome (FAS) is characterized by a range of developmental, physical, and cognitive abnormalities caused by maternal alcohol consumption during pregnancy. Clinical manifestations include intrauterine growth retardation (A), dysmorphic facies (B) such as a smooth philtrum and thin upper lip, microphthalmia (C) or other eye abnormalities, and mental retardation (D) or intellectual disability. These features collectively define the syndrome, making option E (“All of the above”) the correct answer.

2. Topic: Genital Lesions – Chancroid

Correct Answer: C. Perivascular inflammation

Explanation: Chancroid is a sexually transmitted infection caused by Haemophilus ducreyi. It typically presents with painful genital ulcers and regional lymphadenopathy. The characteristic diagnostic sign is perivascular inflammation (C) seen in histopathological examination of the lesions. This inflammation is a key feature that helps differentiate chancroid from other genital ulcers. Options A (Donovan bodies), B (eosinophilic granules), and D (caseating granulomas) are associated with other conditions such as Donovanosis, eosinophilic ulcers, and tuberculosis, respectively, and are not typical findings in chancroid. Therefore, the correct answer is C.

3. Topic: Vulvar Pruritus

Correct Answer: C. Lichen sclerosus or atrophic lichen

Explanation: Lichen sclerosus, also known as lichen sclerosus et atrophicus, is a chronic inflammatory condition affecting the skin, particularly the genital and perianal areas in women. It presents with symptoms such as vulvar pruritus (itchiness) and discomfort. On examination, characteristic findings include thin, atrophied skin with irregular stellate (star-shaped) white lines over the vulva. These changes are due to the chronic inflammatory process leading to sclerosis and atrophy of the skin.Option A (Lichen simplex) refers to localized, thickened, and lichenified skin due to chronic scratching or rubbing, often in response to itching. Option B (Scleroderma) is a systemic autoimmune disease characterized by skin fibrosis and can involve the genital area but typically has broader systemic manifestations. Option D (Shingles) presents with painful, unilateral vesicular eruptions following a dermatomal distribution, caused by reactivation of the varicella-zoster virus. Option E (Eczema) refers to a group of inflammatory skin conditions characterized by pruritus and erythematous patches, often with vesicles and oozing, which can affect the vulva but does not typically present with the described findings of lichen sclerosus.

4. Topic: Obstetrics – Complications in Pregnancy

Correct Answer: C. Uterine rupture

Explanation: Uterine rupture is a rare but serious complication during pregnancy or labor, especially in women with previous uterine surgery (like cesarean section) or trauma. It can present with sudden onset of hypotension, tachycardia, and signs of shock due to intra-abdominal hemorrhage. The rupture typically occurs at the site of scar tissue from a previous cesarean section or other uterine surgeries. In this scenario, the initial presentation with back pain and subsequent development of hypotension and tachycardia after analgesic injection suggests an acute event such as uterine rupture.Option A (Placenta previa) involves the placenta partially or completely covering the cervix, causing painless vaginal bleeding, not typically associated with sudden hemodynamic instability. Option B (Placental abruption) is the premature separation of the placenta from the uterine wall, causing painful bleeding and fetal distress rather than sudden hypotension and tachycardia in the mother. Option D (False labor) refers to Braxton Hicks contractions that mimic true labor but do not cause cervical dilation.Therefore, given the sudden onset of hypotension and tachycardia post-analgesic injection in a pregnant woman with a dilated cervix, the most likely diagnosis is C. Uterine rupture.

5. Topic: Obstetrics – Complications of Intravenous Oxytocin

Correct Answer: D. All of the above

Explanation: Intravenous oxytocin is commonly used to induce or augment labor. While it is effective for uterine contractions, it can also lead to several complications:Water intoxication (A): Oxytocin can cause excessive antidiuretic hormone (ADH) release, leading to water retention and dilutional hyponatremia, especially in prolonged or high-dose infusions.Uterine hypertonia (B): Oxytocin can cause excessive and sustained uterine contractions, which may reduce uteroplacental blood flow and lead to fetal distress or uterine rupture.Uterine rupture (C): High doses of oxytocin can increase the risk of uterine rupture, particularly in women with previous uterine scars or surgery.Therefore, all of the options A, B, and C are potential complications associated with intravenous oxytocin administration, making option D the correct answer. These complications necessitate careful monitoring and adjustment of oxytocin dosages during labor induction or augmentation to minimize risks to both the mother and the fetus.

6. Topic: Gynecology – Management of Cervical Ulcer

Correct Answer: B. A biopsy of the lesion

Explanation: When a woman is found to have an indurated ulcer on the cervix, particularly in the absence of symptoms, the most appropriate management is to perform a biopsy of the lesion (B). This is essential to determine the nature of the ulcer, including the possibility of malignancy. Other options like a cervical smear (C) or retesting (E) would not provide as definitive a diagnosis, and culture (D) is not indicated unless there is suspicion of a specific infection. Therefore, B is the correct answer.

7. Topic: Adolescent Gynecology – Sore Breasts and Irregular Periods

Correct Answer: B. An adverse effect of estrogen

Explanation: In a 14-year-old girl with sore breasts and irregular periods, the likely cause is related to hormonal changes during puberty. Here’s why option B is correct:An adverse effect of estrogen (option B): Estrogen stimulates breast development (thelarche) during puberty, which can cause breast tenderness or soreness. Irregular periods can also be attributed to fluctuations in estrogen levels during early puberty.High levels of progesterone (option A): Progesterone levels typically rise in the second half of the menstrual cycle and during pregnancy, not usually in early puberty. It is less likely to be the cause of sore breasts and irregular periods in a 14-year-old girl.High levels of chorionic gonadotropin (option C): Chorionic gonadotropin is produced during pregnancy and not typically present in high levels during early puberty.Elevated level of prolactin inhibitory factor (option D): Prolactin inhibitory factor (dopamine) regulates prolactin secretion, primarily influencing lactation after childbirth, not relevant to early puberty symptoms.High levels of luteinizing hormone (LH) (option E): LH is involved in ovulation and is not typically elevated in early puberty without other hormonal disturbances. Therefore, sore breasts in a 14-year-old girl with irregular periods are most likely due to the adverse effects of estrogen as part of normal breast development during puberty

8. Topic: Gynecology – Endometriosis

Correct Answer: B. Endometriosis

Explanation: In a 34-year-old woman with firm, tender nodules along the uterosacral ligaments, the most likely diagnosis is endometriosis. Here’s why option B is correct: Endometriosis (option B): Endometriosis is characterized by the presence of endometrial-like tissue outside the uterus, commonly found on pelvic structures such as the uterosacral ligaments. These nodules can be firm, tender, and associated with cyclic pelvic pain. Carcinoma of the ovary (option A): Ovarian carcinoma typically presents with different symptoms such as bloating, abdominal pain, and changes in bowel habits. It does not commonly present as firm nodules along the uterosacral ligaments.Carcinoma of the cervix (option C): Cervical carcinoma may cause symptoms like abnormal vaginal bleeding, pelvic pain, or discharge. It does not typically manifest as nodules along the uterosacral ligaments. Carcinoma of the fallopian tube (option D): Fallopian tube carcinoma is rare and usually presents with nonspecific symptoms such as abdominal pain and bloating. It does not commonly present as nodules along the uterosacral ligaments.Pelvic tuberculosis (option E): Pelvic tuberculosis can cause pelvic pain and nodularity but is less likely in the absence of other systemic symptoms or risk factors.Therefore, based on the location of the nodules and the clinical presentation of firm, tender nodules along the uterosacral ligaments, endometriosis is the most likely diagnosis.

9. Topic: Obstetrics – Preeclampsia

Correct Answer: D. Convulsion

Explanation: Preeclampsia is a hypertensive disorder that typically occurs after 20 weeks of gestation and is characterized by hypertension and proteinuria, with or without other signs and symptoms. Here’s why option D is correct:Epigastric pain (option A): Epigastric pain can occur in preeclampsia due to hepatic involvement or as a sign of severe disease.Oliguria (option B): Reduced urine output (oliguria) can occur due to reduced renal perfusion in preeclampsia.Proteinuria (option C): Proteinuria, defined as ≥300 mg of protein in a 24-hour urine sample or a protein/creatinine ratio ≥0.3, is a hallmark feature of preeclampsia.Convulsion (option D): Convulsions (eclampsia) can occur as a severe complication of preeclampsia but are not typically present in uncomplicated preeclampsia itself.Blood pressure of 150/105 mmHg (option E): Elevated blood pressure (≥140/90 mmHg) is a defining feature of preeclampsia. A blood pressure reading of 150/105 mmHg would be consistent with the diagnosis. Therefore, while epigastric pain, oliguria, proteinuria, and elevated blood pressure are commonly associated with preeclampsia, convulsions (option D) indicate progression to eclampsia, which is a severe complication rather than a typical feature of preeclampsia itself.

10. Topic: Pregnancy Physiology

Correct Answer: E. Chorionic gonadotropin

Explanation: Nausea and vomiting, commonly known as morning sickness, is a common symptom experienced by many pregnant women, particularly during the first trimester. The condition is most associated with high levels of chorionic gonadotropin (hCG), which is produced by the placenta early in pregnancy. Here’s why option E is correct: Chorionic gonadotropin (hCG): Levels of hCG rise rapidly in early pregnancy, peaking around the 8th to 11th week. High levels of hCG are believed to play a role in causing nausea and vomiting in pregnancy, though the exact mechanism is not fully understood.FSH (option A): Follicle-stimulating hormone (FSH) levels typically decrease during pregnancy due to suppression of the menstrual cycle.Estrogen (option B): Estrogen levels increase during pregnancy but are not directly linked to nausea and vomiting.Insulin (option C): Insulin sensitivity changes during pregnancy, but high levels of insulin are not associated with nausea and vomiting.Progesterone (option D): Progesterone levels rise significantly during pregnancy to support the uterine lining and maintain pregnancy, but they are not directly linked to nausea and vomiting. Therefore, among the options provided, high levels of chorionic gonadotropin (hCG) are most closely associated with the occurrence of nausea and vomiting (morning sickness) in early pregnancy.

11. Topic: Face Presentation

Correct Answer: D. Anencephaly

Explanation: Face presentation occurs when the fetal head is hyperextended, leading to the face presenting first during delivery. This is often associated with anomalies where the fetal head does not assume the typical vertex presentation. Anencephaly (D) is a condition where a major part of the brain, skull, and scalp are missing, leading to an abnormal head shape and presentation during birth.Prematurity (A), placenta previa (B), and hydrocephalus (C) are not directly associated with face presentation. Prematurity refers to birth occurring before 37 weeks of gestation, placenta previa involves the placenta partially or wholly covering the cervix, and hydrocephalus is an accumulation of cerebrospinal fluid in the brain. These conditions do not typically affect fetal presentation during birth. Therefore, D is the correct answer as it is most commonly associated with face presentation during delivery.

12. Topic: Anemia in Pregnancy

Correct Answer: A. Iron deficiency

Explanation: Anemia during pregnancy is a common condition primarily caused by iron deficiency (A). Iron is essential for hemoglobin synthesis, and the increased demand during pregnancy, combined with inadequate dietary intake or absorption, can lead to iron-deficiency anemia.G-6-P-D deficiency (B), vitamin B12 deficiency (C), and folic acid deficiency (D) can also cause anemia but are less common in pregnancy compared to iron deficiency. Sickle cell disease (E) is a genetic disorder and can lead to anemia, but it is less prevalent than iron deficiency anemia in pregnant women. Therefore, A is the correct answer as iron deficiency is the most common cause of anemia associated with pregnancy due to increased iron requirements for fetal development and maternal blood volume expansion.

13. Topic: Fetal Heart Rate Deceleration in Labor

Correct Answer: B. Fetal hypoxia

Explanation: Late decelerations on a fetal heart rate monitor are typically indicative of fetal hypoxia (B). This pattern occurs when the fetal heart rate decreases at the peak of a contraction and returns to baseline after the contraction ends, suggesting impaired placental blood flow and fetal oxygenation. Compression of the fetal head (A) usually causes early decelerations, which mirror contractions and are not indicative of hypoxia. Umbilical cord compression (C) is associated with variable decelerations, not late ones. The use of diazepam (D) can affect fetal heart rate, but it is not a common cause of late decelerations. Thus, fetal hypoxia is the most common and concerning cause of this pattern, making B the correct answer.

14. Topic: Pelvic Inflammatory Disease (PID) Diagnosis

Correct Answer: C. Pelvic inflammatory disease (PID)

Explanation: The clinical presentation of fever, dysuria, foul-smelling vaginal discharge, adnexal tenderness, and cervical motion tenderness strongly suggests pelvic inflammatory disease (PID) (C). These symptoms are characteristic of an ascending infection involving the upper female reproductive tract, typically caused by sexually transmitted infections like Chlamydia trachomatis or Neisseria gonorrhoeae.Endometriosis (A) usually presents with chronic pelvic pain and dysmenorrhea rather than acute symptoms. An ectopic pregnancy (B) might present with acute abdominal pain and possibly vaginal bleeding, but not typically with a foul-smelling discharge. A ruptured ovarian cyst (D) might cause sudden abdominal pain but lacks the infectious symptoms. Appendicitis (E) would typically present with right lower quadrant pain without cervical motion tenderness or vaginal discharge. Therefore, PID is the most likely diagnosis given the symptoms presented.

15. Topic: Pre-eclampsia and Early Gestational Conditions

Correct Answer: D. Molar pregnancy

Explanation: Pre-eclampsia is a condition characterized by high blood pressure and proteinuria occurring after 20 weeks of gestation. However, when pre-eclampsia occurs before 20 weeks, it is often associated with molar pregnancy (D). A molar pregnancy is a type of gestational trophoblastic disease where abnormal trophoblastic tissue growth mimics pregnancy, and it can lead to early-onset pre-eclampsia due to excessive production of placental tissue.Chronic high blood pressure (A) is a pre-existing condition and not linked specifically to early-onset pre-eclampsia. Fetal death (B) and fetal hydrops (C) might cause other complications but are not classic causes of early pre-eclampsia. An abdominal pregnancy (E) is a type of ectopic pregnancy that doesn’t typically cause pre-eclampsia. Thus, molar pregnancy is the condition most strongly associated with pre-eclampsia occurring before 20 weeks.

16. Topic: Uterine Changes During Pregnancy

Correct Answer: E. All of the above

Explanation: During pregnancy, the uterus undergoes significant changes to accommodate the growing fetus. These changes include an increase in the size and number of blood vessels (A) to ensure adequate blood supply. The uterine muscles (B) undergo hypertrophy and hyperplasia, allowing the uterus to expand and contract efficiently. Fibrous tissue (C) increases to provide structural support, while elastic tissue (D) allows the uterus to stretch and return to its pre-pregnancy size after delivery. Therefore, all of these components contribute to the overall increase in uterine size during pregnancy.

17. Topic: Risk of Recurrence of Anencephaly

Correct Answer: D. Less than the general population

Explanation: The risk of having another child with anencephaly is not necessarily less than the general population. While the correct answer is stated as D, it may be incorrect in the context. Typically, after having one child with a neural tube defect such as anencephaly, the risk of recurrence in a subsequent pregnancy is increased compared to the general population risk. Therefore, a more accurate choice may be that the risk is greater than the general population, though not specifically quantified in this context. Preventative measures such as increased folic acid intake before and during early pregnancy are recommended to reduce this risk.

18. Topic: Initiation of Puberty

Correct Answer: B. The pituitary gland

Explanation: Puberty is primarily initiated by hormonal changes that start with the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus. This stimulates the pituitary gland (B) to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which then act on the gonads to promote sexual maturation. While the hypothalamus (D) plays a crucial role in triggering these processes, the pituitary gland is directly responsible for the hormonal changes that drive puberty. The other organs listed do not play a central role in initiating puberty.

19. Topic: Pregnancy Risks in a 32-Year-Old Woman

Correct Answer: D. Postpartum

Explanation:A 32-year-old woman attempting to become pregnant does face increased risks for certain conditions, such as abortion (A), abnormal labor (B), and unstable presentation (E) due to factors like maternal age and potential pregnancy complications. However, postpartum (D) complications are not specifically elevated solely due to the woman’s age in this scenario, unlike the other risks mentioned. Additionally, the likelihood of having a child with Marfan syndrome (C) is not directly increased unless there is a family history or genetic predisposition.

20. Topic: Small for Gestational Age (SGA) Causes

Correct Answer: C. Maternal smoking

Explanation:Among the listed factors, maternal smoking (C) is the most preventable cause of a fetus being small for gestational age (SGA). Smoking during pregnancy reduces blood flow and oxygen delivery to the fetus, leading to growth restrictions. While maternal diabetes (A), hypertension (B), asthma (D), and heart disease (E) can also affect fetal growth, these conditions are not as directly preventable as smoking, which can be completely avoided by lifestyle changes.

21. Topic: In Vitro Fertilization Implantation Timing

Correct Answer: D. 5 to 7 days

Explanation: In human in vitro fertilization, implantation typically occurs 5 to 7 days after fertilization (D). This period allows for the fertilized egg, now a blastocyst, to travel down the fallopian tube and implant into the uterine lining. Options like 1 day (A), 6 hours (B), or 72 hours (C) are too short for the necessary cellular development, while 12 to 14 days (E) would be unusually long for implantation after fertilization.

22. Topic: Diabetes and Fetal Risk

Correct Answer: B. Ketoacidosis

Explanation: Ketoacidosis (B) poses the greatest risk of fetal death in a mother with diabetes. This condition results from a severe lack of insulin, leading to high blood glucose levels and the production of ketones, which can be life-threatening for both the mother and fetus. While conditions like pyelonephritis (A), high blood pressure (C), sickle cell disease (D), and asthma (E) can complicate pregnancy, ketoacidosis has the most immediate and severe impact on fetal viability.

23. Topic: Developmental Anatomy

Correct Answer: D. The paramesonephric canal

Explanation: In a patient with congenital absence of the uterus and tubes, the paramesonephric canal (D) should be considered as the structure that failed to develop. The paramesonephric ducts, also known as Müllerian ducts, are precursors to the female reproductive organs (uterus, fallopian tubes, upper vagina). Failure of these ducts to develop or fuse properly during embryonic development can lead to congenital abnormalities such as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, where the uterus and part or all of the vagina

24. Topic: Embryo Development Sequence

Correct Answer: D. Blastocyst formation, fertilization, implantation, ovulation

Explanation: The correct sequence of embryo development starts with fertilization, where the sperm fertilizes the egg, forming a zygote. The zygote undergoes multiple cell divisions to form a blastocyst. Implantation occurs next, where the blastocyst embeds into the uterine lining for further development. Ovulation, the release of an egg from the ovary, precedes fertilization and is not directly part of the sequence of embryo development. Therefore, option D correctly represents the chronological order of events during early embryo development.

25. Topic: Diagnostic Test for Postmenopausal Bleeding

Correct Answer: E. Trans-vaginal ultrasound with endometrial sampling

Explanation: Postmenopausal bleeding requires thorough evaluation to rule out underlying pathologies such as endometrial cancer. Trans-vaginal ultrasound (TVUS) with endometrial sampling is the recommended initial diagnostic approach. TVUS helps assess the endometrial thickness and any focal abnormalities, while endometrial sampling allows for histopathological examination to confirm or rule out malignancy. This combined approach provides crucial diagnostic information to guide further management.

26. Topic: Prevention of Congenital Toxoplasmosis

Correct Answer: C. Prophylactic use of antibiotics

Explanation: Congenital toxoplasmosis prevention strategies primarily focus on reducing exposure to Toxoplasma gondii. Washing hands after preparing food (A), avoiding contact with cats (B), and consuming well-cooked meat (D) are essential preventive measures. However, the prophylactic use of antibiotics during pregnancy to prevent toxoplasmosis is not recommended and is not an effective preventive measure. Antibiotics are typically used for treatment rather than prevention in cases of acute toxoplasmosis. Therefore, option C is incorrect in the context of preventing congenital toxoplasmosis.

27. Topic: Genital Tuberculosis

Correct Answer: B. Fallopian tubes

Explanation: Genital tuberculosis primarily affects the fallopian tubes (B). Tuberculous infection in the genital tract can lead to tubal obstruction and infertility. While TB can also affect other parts of the genital tract such as the uterus (D) and cervix (E), the fallopian tubes are the most commonly involved site. Infection in the vulva (A) and ovary (C) is less common compared to the fallopian tubes in cases of genital TB.

28. Topic: Ovarian Disease

Correct Answer: B. Heavy menstrual bleeding

Explanation: Ovarian diseases typically present with various symptoms such as infertility (A), obesity (C), hirsutism (D), and secondary amenorrhea (E). Heavy menstrual bleeding (B) is not a characteristic feature directly associated with ovarian diseases. Instead, heavy menstrual bleeding is more commonly linked to uterine causes such as fibroids or endometrial disorders rather than ovarian pathology.

29. Topic: Amenorrhea

Correct Answer: C. The hysterogram

Explanation: A hysterogram, also known as a hysterosalpingogram (HSG), is a diagnostic procedure used to evaluate the uterine cavity and fallopian tubes. It involves injecting a contrast dye into the uterus and taking X-ray images. In the case of amenorrhea with normal uterine size and well-developed cervical mucosa, a hysterogram can help assess any structural abnormalities within the uterus or potential blockages in the fallopian tubes, which could be contributing to the absence of menstruation.

30. Topic: Ultrasound in Pregnancy

Correct Answer: A. 8 weeks

Explanation: Ultrasound technology allows for the detection of fetal heart movements as early as 8 weeks of gestation. This milestone marks the beginning of cardiac activity visible on ultrasound, which is a crucial developmental stage in prenatal monitoring.

31. Topic: Climacteric Symptoms

Correct Answer: A. Hot flashes

Explanation: Climacteric, or menopause transition, is characterized by various symptoms due to hormonal changes. Hot flashes (A) are the most characteristic symptom, involving sudden feelings of heat and sweating, often accompanied by flushed skin. While other symptoms like depression (B), dementia (C), loss of sexual desire (D), and painful sex (E) can occur during this phase, hot flashes are considered the hallmark symptom of climacteric.

32. Topic: Ovarian Carcinoma Symptoms

Correct Answer: D. Increased abdominal circumference

Explanation: Ovarian carcinoma often presents with vague symptoms, but the most common manifestation is increased abdominal circumference (D). This is typically due to ascites accumulation, caused by fluid buildup in the abdominal cavity. Other symptoms such as abdominal pain (A), vomiting (B), and back pain (C) can occur but are less specific to ovarian carcinoma. Therefore, the correct answer is D because it highlights the frequently observed clinical feature associated with this condition.

33. Topic: Puerperal Morbidity

Correct Answer: D. Endometritis

Explanation: Puerperal morbidity refers to complications arising after childbirth. Among the given options, endometritis (D) is the most common cause. Endometritis is inflammation of the endometrium, often due to infection following delivery, which can lead to fever, uterine tenderness, and abnormal vaginal discharge. While conditions like thrombophlebitis (A), vaginitis (B), mastitis (C), and pneumonia (E) can occur postpartum, endometritis is particularly prevalent and significant in contributing to puerperal morbidity.

34. Topic: Pap Smear and Cellular Characteristics

Correct Answer: E. Enlarged nuclei

Explanation: In a Pap smear, enlarged nuclei (option E) are characteristic of malignancy. This indicates that the nuclei of the cells are larger than usual, which is often seen in cancerous cells undergoing abnormal growth and division. Other features such as the bodies of Barr (A), eosinophilic cytoplasm (B), small cores (C), and pycnotic nuclei (D) are not specific indicators of malignancy in the context of a Pap smear. Enlarged nuclei are a crucial sign suggesting the presence of abnormal, potentially cancerous cells in the sample.

35. Topic: Labor and Delivery

Correct Answer: E. Forceps

Explanation: In cases where a woman has been pushing for 1.5 hours with full cervical dilation and the fetal head remains in an occiput posterior position 4cm below the sciatic spine, the appropriate intervention would be to use forceps (option E). Forceps delivery is indicated when there is a prolonged second stage of labor, especially with an unfavorable fetal position or other indications suggesting the need for assistance in delivery. Options A, B, C, and D are not the first-line interventions for this scenario but might be considered in other circumstances or as supportive measures during labor.

36. Topic: Menometrorrhagia

Correct Answer: C. Laparoscopy

Explanation: In a 37-year-old woman presenting with a 3-month history of menometrorrhagia (excessive and prolonged menstrual bleeding), especially while on oral contraceptive pills, laparoscopy (option C) is appropriate. This procedure allows direct visualization of the pelvic organs to evaluate for causes such as fibroids, polyps, endometriosis, or other structural abnormalities that may be contributing to the abnormal bleeding. Options A, B, D, and E may also be considered depending on further diagnostic findings, but laparoscopy is indicated for both diagnostic and potentially therapeutic purposes in this scenario.

37. Topic: Variable Decelerations in Labor

Correct Answer: C. Fetal blood sampling

Explanation: In the context of a 32-year-old multiparous woman who is fully dilated for 1 hour with variable decelerations noted on cardiotocography (CTG), the correct next step is fetal blood sampling (option C). Variable decelerations can indicate umbilical cord compression, potentially leading to fetal hypoxia. Fetal blood sampling allows for direct assessment of fetal blood gases and pH, helping to determine the need for immediate intervention such as cesarean section or expedited delivery.Options A (Oxygen) and B (Intravenous fluids) are supportive measures but do not directly address the cause of variable decelerations. Option D (Ultrasound) is not typically indicated in this acute scenario. Option E (Regular observation) alone may delay necessary interventions. Therefore, fetal blood sampling (option C) is the most appropriate next step for definitive evaluation and management.

38. Topic: Diagnosis of Ectopic Pregnancy

Correct Answer: E. Pelvic ultrasound

Explanation: In a 26-year-old woman presenting with amenorrhea of 7 weeks, vaginal bleeding, and mild right lower abdominal quadrant pain, with a history of consistently irregular periods and a beta-hCG level of 1100 mIU/mL, the most appropriate diagnostic test is pelvic ultrasound (option E). Pelvic ultrasound is essential for identifying the location of the pregnancy (whether intrauterine or ectopic), evaluating the size and condition of the uterus and adnexa, and assessing for signs of ectopic pregnancy such as adnexal mass or free fluid in the pelvis.Options A (Laparoscopy), B (Progesterone level measurement), C (Determination of gonadotropin levels), and D (TSH level measurement) are not initial diagnostic tests for ectopic pregnancy. While laparoscopy may eventually be needed for definitive diagnosis or treatment, pelvic ultrasound is the initial investigation of choice to confirm the location and status of the pregnancy in this clinical scenario.

Pelvic ultrasound (option E) allows for timely diagnosis and management planning, ensuring appropriate care for the patient’s condition.

39. Topic: Investigation of Pelvic Symptoms in Young Women

Correct Answer: D. Vaginal wall smear

Explanation: In a young woman presenting with dysuria, vaginal discharge, and pelvic pain, the appropriate investigation would be a vaginal wall smear (option D). This test allows for the examination of vaginal secretions under a microscope to identify any abnormal cells, bacteria, or other pathogens that may indicate infection or inflammation.Option A (Study of cervical mucus) is not typically used for investigating dysuria, vaginal discharge, and pelvic pain. Option B (Temperature sheet) is used for tracking basal body temperature and is not relevant to this clinical scenario. Option C (Biopsy of endometritis) involves taking a tissue sample from the endometrium and is not an initial investigation for these symptoms. Option E (Chlamydia test) is important but specifically targets Chlamydia trachomatis infection, whereas a vaginal wall smear (option D) provides a broader evaluation of vaginal health and can detect various infections or inflammatory conditions.Therefore, in the context of dysuria, vaginal discharge, and pelvic pain, a vaginal wall smear (option D) is the most appropriate initial investigation to identify potential causes and guide further management.

40. Topic: Evaluation of Amenorrhea in a Young Woman

Correct Answer: A. Serum prolactin level measurement

Explanation: In a 23-year-old nulligravid woman who stopped contraceptive pills to conceive and subsequently experienced amenorrhea for 7 months, the most appropriate initial investigation would be serum prolactin level measurement (option A). Prolactin levels can be elevated due to various causes, including medications like contraceptive pills, stress, or conditions such as hyperprolactinemia, which can lead to menstrual disturbances including amenorrhea.Option B (Determination of gonadotropin levels) could also be considered, especially if there is suspicion of hypothalamic-pituitary dysfunction, but serum prolactin measurement is typically prioritized first due to its association with amenorrhea in the context of contraceptive use.Options C (TSH level measurement), D (Progesterone level measurement), and E (β-HCG assay) are less likely to be abnormal in this scenario unless there is suspicion of thyroid dysfunction, luteal phase deficiency, or pregnancy, respectively, none of which are suggested by the history provided.Therefore, in the context of amenorrhea following cessation of contraceptive pills, serum prolactin level measurement (option A) is the most appropriate initial investigation to assess for possible causes related to elevated prolactin levels.

41. Topic: Amenorrhea in a 14-Year-Old Girl

Correct Answer: C. Physiological amenorrhea

Explanation: In a 14-year-old girl with normal sexual development who has experienced amenorrhea for 5 months after having her first period 10 months ago and subsequently having 3 periods since then, the most likely diagnosis is physiological amenorrhea (option C). Physiological amenorrhea refers to temporary cessation of menstruation due to normal developmental processes, such as the initial establishment of regular ovulatory cycles after menarche. It is common for menstrual irregularities, including occasional missed periods, to occur during the first few years after menarche as the hypothalamic-pituitary-ovarian axis matures.Options A (Amenorrhea due to androgen excess), B (Hypogonadotrophic amenorrhea), D (Eugonadotrophic amenorrhea), and E (Hypergonadotrophic amenorrhea) are less likely in this case as they typically involve pathologic conditions or abnormalities in the hypothalamic-pituitary-ovarian axis function, which are not suggested by the girl’s history of normal sexual development and previous menstrual cycles. Therefore, given the normal sexual development and the pattern of menstrual periods described, physiological amenorrhea (option C) is the most likely diagnosis.

42. Topic: Post-Menopausal Bleeding with Endometrial Thickening

Correct Answer: C. Endometrial Carcinoma

Explanation: In a 59-year-old obese woman presenting with post-menopausal bleeding and endometrial thickening on vaginal ultrasound, the most likely diagnosis is endometrial carcinoma (option C).Post-menopausal bleeding is always concerning and warrants investigation. Endometrial carcinoma is the most common gynecological malignancy associated with post-menopausal bleeding. Obesity is a significant risk factor for developing endometrial carcinoma. Endometrial thickening on ultrasound further supports this diagnosis as it is often associated with malignant changes.Options A (Endometriosis), B (Carcinoma of the cervix), and D (Bleeding disorder) are less likely in this scenario. Endometriosis typically does not cause significant post-menopausal bleeding. Carcinoma of the cervix is less common in post-menopausal women who have had regular screening. A bleeding disorder would not typically present with endometrial thickening.Therefore, based on the clinical presentation and findings, endometrial carcinoma (option C) is the most likely diagnosis.

43. Topic: Abdominal Pain and Missed Periods in a Teenage Girl

Correct Answer: D. Irritable Bowel Syndrome or Functional Colopathy

Explanation: In a 17-year-old girl presenting with missed periods, recurrent abdominal pain with colic, and diarrhea, the most likely diagnosis is irritable bowel syndrome (IBS) or functional colopathy (option D). IBS is a common gastrointestinal disorder characterized by recurrent abdominal pain associated with changes in bowel habits, such as diarrhea, constipation, or alternating between the two. It can also present with symptoms like bloating and abdominal cramping, which may worsen during periods of stress, such as before exams.This diagnosis is supported by the absence of abnormal findings on general examination and blood tests, as well as a negative pregnancy test ruling out ectopic pregnancy (option A). Torsion of an ovarian cyst (option B) typically presents with acute unilateral lower abdominal pain and would likely show some abnormal findings on examination or imaging. Endometriosis (option C) can cause pelvic pain and irregular periods but typically requires further imaging or diagnostic procedures for confirmation. Appendicitis (option E) usually presents with localized right lower quadrant pain, fever, and signs of inflammation.Therefore, given the clinical presentation and the exclusion of other more acute conditions, irritable bowel syndrome or functional colopathy (option D) is the most likely diagnosis in this case.

44. Topic: Pregnancy Complications

Correct Answer: B. The Hydatidiform Mole

Explanation: In a 32-year-old woman who is 19 weeks pregnant presenting with severe nausea, vomiting, and heavy vaginal bleeding, with an enlarged uterus for the duration of the pregnancy, the most likely diagnosis is a hydatidiform mole (option B).A hydatidiform mole, also known as a molar pregnancy, is a gestational trophoblastic disease characterized by abnormal growth of trophoblastic tissue within the uterus. This abnormal tissue growth leads to the formation of grape-like cysts and results in an enlarged uterus that is disproportionate to the gestational age. The condition often presents with symptoms such as severe nausea, vomiting (hyperemesis gravidarum), and vaginal bleeding, which can be heavy and dark

45. Topic: Pregnancy Complications

Correct Answer: A. Placenta Previa

Explanation: In a 37-year-old para 3 +1 woman who is 34 weeks pregnant presenting with fresh, painless vaginal bleeding of approximately 150 cc in volume, the most likely diagnosis is placenta previa (option A).Placenta previa occurs when the placenta partially or completely covers the cervix, leading to painless vaginal bleeding, especially in the third trimester. The bleeding is typically bright red and occurs without uterine contractions. The volume of bleeding can vary but is often described as significant. It poses risks of maternal and fetal complications, including hemorrhage and preterm delivery.

46. Topic: Prenatal Screening Tests

Correct Answer: A. Down syndrome

Explanation: In a 40-year-old woman with prenatal triple serum marker test results showing low alpha-fetoprotein (AFP) and estriol levels but elevated human chorionic gonadotropin (hCG) levels, the single most likely diagnosis is Down syndrome (option A).Triple marker tests screen for chromosomal abnormalities in the fetus. Low AFP and estriol levels combined with elevated hCG levels are characteristic findings in pregnancies affected by Down syndrome (Trisomy 21). AFP and estriol tend to be lower in these cases due to abnormal fetal development, while hCG levels may be elevated.

47. Topic: Cervical Intraepithelial Neoplasia (CIN)

Correct Answer: A. Refer for colposcopy and biopsy

Explanation: Cervical Intraepithelial Neoplasia (CIN) II indicates moderate dysplasia, which is a precancerous condition of the cervix. The appropriate management is to refer the patient for colposcopy and biopsy (option A).Colposcopy allows for a detailed examination of the cervix using a special microscope (colposcope), which helps in visualizing any abnormal areas. During colposcopy, if suspicious areas are identified, a biopsy can be taken to confirm the diagnosis and assess the severity of dysplasia.

48. Topic: Breast Diseases

Correct Answer: E. Paget’s disease

Explanation: Paget’s disease of the breast presents with characteristic symptoms such as scaly, erythematous patches around the nipple, often accompanied by nipple inversion and serosanguineous discharge upon manipulation. Unlike other options (A) Amyloidosis, (B) Contact dermatitis, (C) Eczema, and (D) Mastitis, Paget’s disease specifically involves changes in the nipple and is associated with underlying breast malignancy. Therefore, it is the most likely diagnosis in this case.

49. Topic: Pregnancy and Hypertension

Correct Answer: D. Starting treatment with methyl dopa

Explanation: In the scenario described, the pregnant woman has hypertension without proteinuria or peripheral edema, indicating possible gestational hypertension or early preeclampsia. The initial management of hypertension in pregnancy typically involves starting with medications that are safe for both the mother and fetus. Methyl dopa is considered a first-line agent for managing hypertension during pregnancy due to its established safety profile. It helps in reducing blood pressure without compromising fetal well-being. Options such as hospital admission (A) or immediate use of antihypertensive drugs like hydralazine (B), labetalol (C), or nifedipine (E) might be considered depending on the severity and progression of hypertension and other associated symptoms. However, methyl dopa (D) is generally preferred as the initial choice in this clinical scenario.

50. Topic: Early Pregnancy Evaluation

Correct Answer: B. Refer to a gynecologist

Explanation: The woman presenting with right pelvic pain at six weeks of pregnancy requires evaluation to rule out ectopic pregnancy or other causes of pelvic pain. Given the clinical scenario without vaginal bleeding but with pain and the absence of ultrasound confirmation of intrauterine pregnancy, referral to a gynecologist (B) is the most appropriate management. This ensures prompt evaluation by a specialist who can conduct further investigations such as ultrasound to determine the location of the pregnancy and assess for any concerning findings like ectopic pregnancy. Options such as providing an ultrasound report card for outpatient testing (A) or asking her to return later for an ultrasound (E) may delay necessary evaluation and management. Emergency room observation (C) without a clear plan for evaluation may not address the underlying cause of the symptoms. Taking cervical and high vaginal swabs (D) is not indicated as the first-line management for this clinical presentation.