1. A pregnant woman in her 3nd week of pregnancy is prescribed magnesium sulfate for pre-eclampsia the primary clinical indication for hyper magnesium is

A. loss of deep tendon reflexes

B. flaccid paralysis

C. respiratory arrest

D. hypotension

E. stupor

2. following surgery, a patient develops oliguria, you believe that the patient is hypovolemic, but before increasing the intravenous fluids, you ask for additional information or data. this includes

A. natriuria at 28 meq/l

B. urinary chlorides at 25 meq/l

C. fractional sodium secretion less than 1

D. the rate of urinary creatinine/ serum DE 20

E. urinary osmolarity of 350 mosm/kg

3. the surgical risk of patients with polycythemia vera (polycythemia vera) are exposed is that related to

A. an anemic disorder

B. hemorrhage

C. an infection

D. kidney dysfunction

E. cardiopulmonary complications

4. The most common physiological cause of hypoxemia is

A. hypoventilation

B. incomplete diffusion of alveolar oxygen

C. inequality of ventilation-perfusion

D. shunt effect at the pulmonary level

E. a high level of erythrocyte 2.3 diphospho-glycerate

5. If the pressure at the end diastole is kept constant, the increase in which of the following propositions will increase the cardiac index?

A. peripheral vascular resistance

B. pulmonary arterial occlusion

C. heart rate

D. systemic diastolic pressure

E. blood viscosity

6. Which of the following statements concerning local anesthesia is true?

A. when used as an infiltration anesthesia the safe dose of lignocaine is 3.0 mg per kg body weight

B. the administration of adrenaline (1/200000) to the procaine solution of lignocaine or bupibivacaine does not increase the maximum harmless dose but increases the duration of blockage

C. many individuals are hypersensitive to local anesthetics

D. local anesthetic in contact with the nerve trunk will cause loss of sensitivity but not matrix paralysis in the innervated area

E. rapid systemic administration of anesthetic can lead to death without evidence of CNS stimulation

7. Which of the following statements regarding perioperative risk of stroke in patients with a history of stroke is true?

A. morality after postoperative stroke is high

B. most strokes occur directly after surgery and appear to be related to the surgical events

C. the risk of stroke correlates with the time period since the previous stroke

D. general health and disease severity as measured by ASA classification are important predictors of recurrent stroke

E. the risk of vascular accident is correlated with a history of multiple cerebrovascular accidents or post-stroke transient ischemic attacks

8. Atrophy of the intrinsic muscles of the hand may follow an injury

A. ulnar nerve

B. radial nerve

C. from the brachial nerve

D. from the axillary nerve

E. thenar and hypothenar nerves

9. While on duty in the emergency room, a 12-year-old boy arrives with pain and inflammation on the impending metatarsal of his left foot with red streaks extending down the inside of the leg. recalls removing a splinter from the sole of his foot the previous day. the most likely infectious swimmer is

A. clostridium perfringens

B. clostridium tetani

C. staphylococcus

D. Escherichia coli

E. streptococcus

10. The appropriate antibiotic to prescribe while waiting for a specific culture is

A. with penicillin

B. erythromycin

C. tetracycline

D. azathioprine

E. cloxacillin

11. A young boy who fell grom a bicycle was hit by a truck, on arrival in the emergency room he was awake and alert appears frightened but not in distress. the thorax suggests an air-fluid level in the left lower lung field and a nasogastric tube appears upward from the left rib cage. the stage of its care is

A. the placement of a thoracic train

B. immediate thoracotomy

C. an immediate laparotomy

D. esophagogastroscopy

E. the removal and replacement of the diagnostic peritoneal lavage nasogastric tube

12. Sudden trauma to the abdomen most frequently injures which of the following organs

A. the liver

B. the kidney

C. the spleen

D. the intestine

E. the pancreas

13. A 25-year-old woman arrives in the emergency room following a car accident. she presents with acute dyspnea with respiratory rate of 60cycles/min. vesicular murmurs are clearly reduced on the right side. The first step in patient care should be

A. take a chest x-ray

B. take arterial blood for blood gas analysis

C. decompress the right pleural space

D. perform a peri cardiocentesis

E. administer intravenous fluids

14. A chest x-ray of this woman before treatment would reveal

A. air in the right pleural space

B. a deviation of the mediastinum

C. a deviation of the trachea to the right

D. dilation of the intrathoracic vena cava

E. hyper-distension of the left lung

15. A tissue or infection results from the release of tumor necrosis factor (TNF) by which of the following cells?

A. fibroblasts

B. damaged or damaged vascular endothelial cells

C. monocytes/macrophages

D. active T lymphocytes

E. killer T cells

16. The main mechanism of action of cyclosporine A is the inhibition of

A. macrophage function

B. the product of antibodies

C. the production of interleukin 1

D. the production of interleukin 2

E. the efficiency of the cytotoxic T cell

17. Which of the following statements regarding heart transplantation is true?

A. heart transplants are matched by size and ABO blood type rather than tissue typing

B. the survival of a cadaveric graft is significantly lower with heart transplants compared to kidney transplants

C. time D cold ischemia foe donor heart should not be more than 48 hours

D. upper age limit for heart transplant eligibility is 55

E. the first cause of death after the first year of heart transplantation is chronic rejection

18. Which of the following diseases is appropriately treated by a combined heart-lung transplant?

A. primary pulmonary arterial hypertension

B. cystic fibrosis

C. end-stage pulmonary emphysema

D. idiopathic dilated cardiomyopathy with long-lasting pulmonary arterial hypertension

E. end-stage pulmonary fibrosis secondary to sarcoidosis

19. Which of the following g statement regarding adrenal insufficiency is true?

A. treatment with exogenous corticosteroids is usually effective

B. it is frequently observed as a consequence of metastases in your adrenal glands from distant caners such as breast lung cancer

C. adrenal insufficiency (Addison’s disease) in preoperative patient must be recognized by a finding of signs including hyperkalemia

D. death from chronic adrenal insufficiency can occur within hours of surgery

E. the most common underlying cause today is drug-resistant tuberculosis infection

20. Various conditions involving nipple discharge (only one correct answer)

A. a light or milky intermittent flow can be physiological

B. a nipple discharge at the supports is an indication for an open biopsy

C. a bloody discharge is indicative of an underlying malignancy

D. galactorrhea is indicative of an underlying malignancy

E. a pathological flow is usually bilateral

21. Omeprazole has been added to antagonists of as a therapeutic approach to the management of acute gastric and duodenal ulcers. it acts by

A. blocking the degradation of metabolites of NSAIDs harmful to the mucous membranes

B. the provision of a direct cytoprotective effect

C. the buffering effect on gastric acids

D. inhibition of the partial cell potassium -ATPase

E. inhibition of gastric secretion and acid production by parietal cells

22. Which of the following statement regarding pancreatic carcinoma is true?

A. in the majority of the cases presents with only jaundice

B. CT angiography and laparoscopy were infectious in predicting resectability

C. if patient is icteric resectability rate is less than 5%

D. 99% of patients with pancreatic cancer have metastases at diagnosis

E. the 5-year survival rate after surgery by Whipple procedure (pancreatico-duodenectamia) performed as a curative treatment is 30 to 40%

23. A 9-year-old formerly holy child comes to the emergency room with a fulminant upper gastrointestinal hemorrhage. the hemorrhage is more likely the result of

A. esophageal varices

B. Mallory-Weiss syndrome

C. gastritis

D. a gastric ulcer

E. a duodenal ulcer

24. During an acute appendicitis a mass 4cm in diameter is found in the middle part of the appendix. the frozen parts reveal that this lesion is carcinoid. which of the statement is true?

A. there is no indication for another surgery

B. a right hemi colectomy should be performed

C. there is a 50% risk that this patient will develop carcinoid syndrome

D. carcinoid tumors develop part of the islet cells

E. carcinoid syndrome can be remembered only in the presence of liver metastases

25. Of the most likely newborn cardiovascular abnormalities to present with cyanosis is

A. a persistent arterial duct

B. coarctation of the aorta

C. interauricular communication

D. an inter ventricular communication

E. transportation of the great vessels

26. Superior vena cava syndrome occurs more often in association with

A. histoplasmosis

B. the substernal thyroid gland

C. thoracic aortic aneurysm

D. constrictive pericarditis

E. bronchogenic carcinoma

27. Carcinoma of the apex of the lung (Pancoast-tobias syndrome) are bronchogenic carninomas that typically produce which of the following clinical features

A. incriminated apical segment atelectasis

B. Horner’s syndrome

C. pain in D4 and D5 dermatomes

D. a non-productive rate

E. hemoptysis

28. Patients with deep vein thrombosis of the calf confirmed by venography

A. can hope to have a cure without symptoms if they are treated quickly with anticoagulants

B. can be effectively treated with low dose heparin

C. can be effectively treated with compression stockings

D. can be effectively treated with acetylsalicylic acid

E. are at risk of a major pulmonary embolism

29. Conservative management rather than arterial reconstruction surgery is generally recommended for patients with whom any of the following symptoms or signs of arterial insufficiency

A. Ischemic ulceration

B. Ischemic neuropathy

C. Claudication

D. Nocturnal doubt of the foot

E. Gangrene of the toe

30. Symptoms and signs of artherosclerotic occlusive disease of the abdominal aortic bifurcation (Leriche syndrome) include

A. claudication of the buttocks and thighs

B. lower limb causalgia

C. a retrograde ejaculation

D. gangrene of the feet

E. a redness depending on the feet

31. Management of a patient with neurogenic flaccid bladder may include which of the measures?

A. Surgical augmentation of the bladder

B. Self-catheterization

C. Supra bladder urinary deviation

D. Limitation of fluid intake to less than 300ml/day

E. Transurethral resection of the bladder neck

32. A 35-year-old man presents to the emergency room with renal colic. an X-ray reveals a stone 1.5 cm in diameter. Which of the following statements regarding this condition is correct?

A. conservative treatment including hydration and analgesics will not give a satisfactory result

B. serial X-ray of the kidney, ureter and bladder should be done to follow up this patient

C. urinalysis will almost reveal micro haematuria

D. when the acute episode is correctly treated, this disease rarely recur

E. high blood urea and scan serum creatinine are expected

33. Seminoma is correctly described by which of the following statements?

A. It is the most common type of testicular cancer

B. Hepatic and bone metastases are frequently found

C. He does not respond to radiation therapy

D. The 5-year-old survival rate approaches 50%

E. The usual presentation is that of a painful mass that transilluminates

34. A pedestrian is hit by a speeding car, studies obtained in the emergency room including retrograde urethrography are compatible with a fracture of the pelvis and a rupture of the urethra located above the diaphragm management would consist

A. an immediate percutaneous nephrostomy

B. immediate placement of the foley catheter through the urethra into the bladder to align and compress your injured areas

C. immediate reconstruction of ruptured urethra after initial patient stabilization

D. immediate exploration of the pelvis to control the bleeding from the fracture with drainage of the pelvic hematoma

E. immediate placement of a subpubic cystostomy tube

35. Meniscus tears usually result from which of the following circumstances?

A. Hyperextension

B. Flexion and rotation

C. Simple hyperflexion

D. Compression

E. Fracture of the femoral condyle

36. The most serious growth disorder epiphysis probably results from which type of fracture

A. fracture dislocation of a joint adjacent to an epiphysis

B. fracture through the articular cartilage extending into the epiphysis

C. transverse fracture of the bony sleeve on the metaphyseal side of the epiphysis

D. fracture of the epiphysis on the diaphyseal side of the growth lamella

E. crushing lesion compressing the growth lamella

37. In an unsuccessful suicide attempt, a depressed student cuts her radial nerve at the wrist. The expected disability is

A. Loss of the ability to extend the wrist

B. Loss of ability to flex the wrist

C. Atrophy of the intrinsic muscles of the hand

D. Loss of sensation in the thenar eminence and thumb web

E. Palmar insensitivity

38. Which of the following statement regarding the Glasgow coma scale is true?

A. it serves as a scale to assess the long-term sequelae of head trauma

B. a low score is correlated with high mortality

C. it includes the measurement of intracanial pressure

D. it includes the measurement of pupil reflexes

E. it includes the measurement of the verbal response

39. An acute increase in intracranial pressure is characterized by which of the following signs?

A. Respiratory irregularities

B. Drop in blood pressure

C. Tachycardia

D. Retinal hemorrhage

E. Compression of the fifth cranial nerve

40. Which of the following statements concerning cerebral contusions is true?

A. they occur most frequently in the occipital lobes

B. they can occur on the opposite side of the point of cranial impact

C. they are rarely accompanied by bleeding of the parenchyma

D. they can occur spontaneously in patients on anticoagulants

E. anticonvulsants drugs have no role in the early management of this disorder

41. The next proposition in relation to peptic ulcer disease is

A. Ulcers are most reliable detected by barium swallow

B. Pyloric stenosis is the least common complication

C. Planned surgery is usually required

D. A drainage procedure is not always required after vagotomy

E. Radiological evidence of subdiaphragmatic air is always present after perforation of the peptic ulcer

42. The following propositions in relation to common bile duct stones is

A. most are formed mainly in the bile duct

B. La are not associated with a serum alkaline phosphatase level

C. cannot be treated by endoscopy

D. are often associated with palpable gallbladder

E. cause at least one-third of all your episodes of acute pancreatitis

43. Necrotizing pancreatitis

A. complicates half of all episodes of acute pancreatitis

B. is not associated with mediocre becoming

C. can be diagnosed by ultrasound

D. responds to radical surgical debridement

E. is usually sterile

44. Which of the following statement regarding critical limb is ischema false?

A. pain at rest can be relieved by taking a few steps around the bed

B. pain at rest can be felt in the foot and the arteries

C. the diagnosis is confirmed by the absence of pulse

D. most patients will need revascularization

E. primary amputation of gangrenous toes is rarely cured

45. Which of the following is the most common cause of obstructive jaundice in patients with chronic pancreatitis

A. formation of pseudo cyst of the pancreas

B. gallstones

C. tumors of the head of the pancreas

D. narrowing of the bile duct

E. cholangiocarcinoma

46. A 30-year-old cyclist wearing a protective helmet is hit by a car travelling 32km/h. he was taken to the local accident and emergency service. on examination was confused locating doubtful and opening his eyes to speak. which of the following proposition is correct?

A. his Glasgow score is 11

B. his Glasgow score is 12

C. he has a slight lesion by definition

D. he should receive in-line cervical spine traction until radiological and clinical clearance is obtained

E. he should undergo a skull x-ray to exclude a linear fracture

47. A 48-year-old diabetic patient was admitted with diabetic ketoacidosis. on examination there is a peaty, erythematous area on the left over a small ulceration. which is the probable cause of acidosis ketosis. what is the care after resuscitation of the patient?

A. an ultrasound to search for a collection

B. Lin scanner to assess aces and search for surgery

C. request a surgical consultation for surgery

D. magnetic resonance angiography to assess the tissues

E. a plain x-ray of the foot to look for osteomyelitis

48. A 45-year-old patient presents in shock complaining of generalized upper abdominal pain radiating to the right iliac fossa. He reports an episode of vomiting without recurrence since then. the diagnosis is:

A. cecal volvulus

B. pancreatitis

C. a perforated ulcer

D. ascending cholangitis

E. appendicitis

49. A 45-year-old man presents to the emergency department with history of coffee-colored vomiting. he also reports that for 2 days his stools appeared darker than usual. which of the following statements gives the most sensitive indication of the severity of his gastrointestinal menorrhagia

A. to hemoglobin

B. systolic blood pressure

C. the frequency of pouts

D. the volume of vomiting/melena

E. blood pressure in lying and standing position

50. There are many causes of acute abdominal pain some of which are initially managed by conservative means. which of the following always required emergency surgery after diagnosis?

A. acute pancreatitis

B. acute mesenteric ischemia

C. an acute diverticulum

D. acute cholecystitis

E. acute Crohn’s disease

GYNAECOLOGY

INSTRUCTIONS: Choose the best answer from the different propositions provided for each question
51. After an initial pregnancy resulted in a spontaneous loss in the first trimester, your patient is concerned aboutthe possibility of this recurring. An appropriate answer would be that the chance of recurrence

A. Depends on the genetic makeup of the prior abortus

B. Is no different than it was prior to the miscarriage

C. Is increased to approximately 50%

D. Is increased most likely to greater than 50%

E. Depends on the sex of the prior abortus

52. Which of the following regarding twin pregnancy is true?

A. the frequencies of monozygote and dizygote are the same

B. the division after the formation of the embryonic disc results in the formation of twins

C. the monozygotic twin pregnancy index varies with race

D. a dichorionic twin pregnancy always indicate di zygocity

E. twin pregnancy does not lead to an appreciable increase in maternal morbidity and mortality compared to monozygotic pregnancies

53. A healthy 25-year-old GIP0 woman at 40 weeks of pregnancy comes to your practice for a routine obstetric consultation. the patient complains that on several occasions she has had dizziness slight headaches and the feeling that she was going to pass out when she lies on her back to take a nap. what is the appropriate plan of management for this patient?

A. make an ECG

B. monitor her for 24 hours with a Holter monitor rule out arrhythmia

C. do an arterial blood gas analysis

D. refer her immediately to a neurologist

E. reassure her that she is fine and encourage her not to lie on her back

54. The anteroposterieor diameter of the upper strait is called

A. interspinous diameter

B. promonto-sus-pubic diameter

C. promonto-subpubic diameter

D. promoto-retropubic diameter

E. no answer is right

55. Which of the following clinical conditions is not an indication for induction of labor?

A. an intrauterine fetal death

B. severe pre-eclampsia at 36 weeks

C. an incomplete placenta previa

D. chorioamionite

E. a post-term pregnancy

56. Which of the following statements regarding abdominal pregnancy is correct?

A. gastrointestinal symptoms are quite often severe

B. fetal survival is approximately 50%

C. aggressive attempts should be made to remove the placenta at the time of the initial surgery

D. it can cause infectious morbidity before diagnosis

E. it is usually the result of a primary abdominal implantation

57. A 24-year-old woman presents at 30 weeks of gestation with a fundal height of 50cm. Which of the following statements regarding polyhydramnios is true?

A. acute polyhydramnios always causes labor before 28 weeks

B. the incidence of association malformation is approximately 3%

C. maternal edema especially of the lower limbs and vulva is rare

D. esophageal atresia accompanies polyhydramnios in almost 10% of cases

E. complications include separation of the placenta (placenta abruptio) uterine dysfunction and postpartum hemorrhage

58. uterine bleeding at 12 weeks gestation accompanied by dilatation of the cervix without passage of tissue

A. complete abortion

B. incomplete abortion

C. threat of abortion

D. missed abortion

E. inevitable abortion

59. Passage of part of the placental tissue through the cervix at 9 weeks of pregnancy

A. complete abortion

B. incomplete abortion

C. threat of abortion

D. missed abortion

E. inevitable abortion

60. Fetal death at 15 weeks gestation without expulsion of any fetal or maternal tissue for at least 8 weeks

A. complete abortion

B. incomplete abortion

C. threat of abortion

D. missed abortion

E. inevitable abortion

61. An 18-year-old girl has asymptomatic bacteriuria at the first antenatal visit at 15 weeks gestation. which of the following propositions is true?

A. the prevalence of asymptomatic bacteriuria during pregnancy can be up to 30%

B. there is a lower incidence of asymptomatic bacteriuria in multiparas with sickle cell trait

C. fifteen percent of women develop a UTI after an initial negative urine culture

D. ten percent of women with asymptomatic bacteriuria later develop symptomatic acute urinary

E. one percent of women with asymptomatic bacteriuria have pyelographic evidence of chronic infection or births of the urinary tract

62. A 35-year-old GIP0 woman presents to an obstetrician’s office at 8 weeks gestation. she has a history of type 1 diabetes and is very concerned about the possible risks this condition may have on her fetus. As the patient’s physician you are telling her that all of the following are possible risks that may result from the diabetic during pregnancy test

A. fetal malformations

B. spontaneous first trimester abortions

C. macrosomia

D. preterm labor

E. caesarean section

63. You recommend that the patient undergo the following routine tests because of her pregnancy except

A. maternal serum AFP assay at approximately 18 weeks

B. serial ultrasound evolution of fetal growth

C. fetal echocardiography from 18 to 20 weeks

D. the 24-hour urine study

E. fetal monitoring with concentration stress tests from the 28th week

64. Which of the following is most likely associated with inhalation pneumonia?

A. fasting or absolute diet during labor

B. medications before anesthesia

C. endotracheal intubation

D. extubation with the patient lying in lateral decubitus

E. extubation with the half-sitting position

65. Puerperal fever due to breast engorgement

A. appears in 1% of postpartum women

B. appears 3 days to 4 days after the development of milk secretions

C. it’s almost painless

D. rarely reaches 37.8°C

E. is less severe and less common if breastfeeding is suppressed

66. A postpartum woman has acute puerperal mastitis. which of the following propositions is true?

A. the initial treatment is penicillin

B. the source of infection is usually the child’s gastrointestinal tract

C. franck abscesses may develop and require drainage

D. the most common organism involved is Escherichia coli

E. symptoms include lethargy

67. A 23-year-old woman (gravida2 para2) calls her doctor 7 days postpartum because she is concerned that she is still bleeding per vaginally. it would be appropriate to tell this woman that it is normal for bloody lochia lasting up to

A. at 2 days

B. 5 days

C. 8 days

D. 11 days

E. 14 days

68. Which of the following potential treatments for use in the management of late postpartum hemorrhage would be contraindicated?

A. methyl ergonovine maleate (mehergin)

B. injection of oxytocin (Pitocin)

C. ergonovine maleate (ergotrate)

D. prostaglandins

E. dilation and curettage

69. The earliest evidence of pubertal development in girls is usually

A. the onset of menarche

B. the appearance of breast buds

C. the appearance of axillary and pubic hair

D. the installation of growth spurts

E. none of the above

70. The peripheral convention in premenopause of estrogen precursors in the obese patient the formation of

A. estriol

B. estrone

C. androstendione

D. dehydr epi androsterone

E. dehydro epi androsterone

71. Which of the following events of puberty is not dependent on estrogen?

A. menstruation

B. vaginal cornification

C. hair growth

D. reaching adult height

E. cervical mucus production

72. A 48-year-old woman had a biopsy of bleeding friable lesion in her cervix. she has not had a pelvic exam or pap smear in about 12 years. the biopsy results indicates that it is invasive squamous cell carcinoma of the cervix. on bi-manual examination there is induration of the lateral wall of his pelvis. which of the following is the stage of her cervical cancer?

A. IA

B. IB

C. IIB

D. IIIB

E. IV

73. To complete the assessment of the extension of her cancer according to the standards of the classification of the international federation of gynecology and obstetrics -FIGO) she should do the following examinations?

A. lymphography

B. pelvic venography

C. cystoscopy

D. magnetic resonance imaging (MRI) of her abdomen

E. laparoscopy (celioscopy)

74. A 28-year-old woman with a 28-day cycle is trying to conceive and plans to use a home ovulation predictor kit to time intercourse when she ovulates. on what day of her menstrual cycle the level of her luteinizing hormone (LH) goes up. its peak. what would you say to her

A. day 12

B. day 14

C. day 18

D. day 20

E. day 27

75. Your patient has just had the twins and wonders if there is any way to determine if the yellows are identical, which of the following proposals do you make to him?

A. a close examination of the placenta can give this answer

B. it is not possible to tell unless one is a girl and the other a boy

C. only the matching of human lymphocyte antigens could determine this with certainty

D. identical twins occur only once in 89 twin birth

E. it is not probable because the birth weights were different more and more than the 200g

76. A 59-year-old postmenopausal woman presents with a history of prevaginal bleeding. what is the most appropriate diagnostic test

A. cervical smear

B. hysteroscopy

C. pelvic ultrasound

D. a serum FSH level

E. trans vaginal ultrasound with endometrial biopsy

77. A 20-year-old woman presents with breakthrough bleeding. she has a new partner. what is the only relevant investigation to carry out?

A. endocervical and upper vaginal sampling

B. endometrial biopsy

C. Pap smear

D. trans vaginal ultrasound

E. urine examination for chlamydia

78. A patient experience difficult and prolonged obstructed labor) with breech delivery. her baby 3.5 kg but her right arm does not move. what is the probable diagnostic salt?

A. clavicle fracture

B. fracture of the body of the humerus

C. surgical fracture of the humerus

D. elbow elongation

E. shoulder dislocation

79. A 20-year-old woman has heavy periods. she says her periods are irregular. she has a new friend. her pap smear is up to date and normal. what is the only appropriate management?

A. organize a trans vaginal ultrasound

B. prescribe mefenamic acid

C. prescribe norethisterone

D. prescribe transexamic acid

E. suggest starting a combined oral contraceptive

80. A 25-year-old woman would like to know how the mini-pill works. what is the only best answer?

A. change in cervical mucus

B. inhibition of egg implantation

C. ovulation and implantation

D. ovulation inhibitions

E. spermicide

81. A 25-year-old primiparous woman is not progressing in the first stage of labor. what is the most appropriate support?

A. administer 10 IU syntocinon intramuscularly

B. administer 10 IU syntocinon by intravenous bolus

C. administer 10 IU syntocinon diluted in 500ml of Hartman’s solution at 6ml/hour and increase by 6ml every 15 minutes

D. administer 10 IU syntocinon diluted in 500ml of Hartman’s solution at 6ml/hour and increase by 6ml every 30 minutes

E. take to the operating room for a caesarean section

82. A 16-year-old girl needs contraception. she has been dating her stable boyfriend for a month and would like to have intimate relations with him. what is the only appropriate form of contraception

A. condom

B. depo provera

C. microgynon

D. norethisterone

E. estrogen implant

83. For each case presented below, chose the single most appropriate investigation from the options provided. detection of intrauterine malformation and pathology

A. hystero salpingography

B. endometrial biopsy

C. tubal inflation

D. laparoscopy

E. studies of cervical mucus

84. A 23-year-old smoking woman is put on the combined oral contraceptive pill for the first time. she returns after two months complaining of intermenstrual bleeding

A. complete blood count

B. gonadotropin level

C. inspection of the cervix

D. hysteroscopy

E. these investigations are not necessary

85. A 29-year-old primiparous woman at 39 weeks gestation is admitted 2 hours after labor. on examination the cervix is 3 cm dilated and meconium is visible. the examination reveals fetal distress. what is the most appropriate treatment?

A. emergency cesarean

B. elective cesarean (planned)

C. oxytocin

D. regular monitoring

E. ultrasound

86. A 34-year-old obese, multiparous woman presents in onset of labor. on examination, the part that presents itself is not engaged in the lower strait. which of the following is the best support?

A. regular monitoring

B. cesarean in emergency

C. oxytocin

D. ultrasound

E. Intravenous fluids

87. A 31-year-old primiparous woman has been fully dilated for 4 hours and pushing for 1.5 hours. The fetal head is in an occipito-posterior position under the ischial spine. which of the following is the next therapeutic step

A. oxytocin

B. intravenous fluids

C. emergency cesarean

D. oxygen

E. forceps

88. A 23-year-old woman presents with pelvic pain, fever and vaginal discharge. on examination there is intense pain on palpation of the lower abdomen and appendages. mobilization of the cervix is also painful. what is the most likely diagnosis?

A. ectopic pregnancy

B. septic

C. pelvic infection (pelvic inflammatory disease

D. fibrosis

E. endometriosis

89. A 35-year-old woman undergoing infertility treatment presents with pelvic pain, weight gain and abdominal distention. on examination there is a sloping dullness. What is the most likely diagnosis

A. pelvic infection

B. inflammatory bowel disease

C. diverticulitis

D. ovarian hyperstimulation syndrome

E. ovarian cyst rupture

90. A 28-year-old woman who is 18 weeks pregnant presents with painless vaginal bleeding. she complained of vomiting of fat (hyperemesis gravidarum) for several weeks serum levels of B-HCG are low compared to the duration of the pelvic pregnancy reveals an intrauterine sac without fetal parts

A. to a hydatidiform mole

B. hypergonadotrophic amenorrhea

C. amenorrhea due to excess androgens

D. threat of abortion

E. eugonadrotrophic amenorrhea

91. What is the most appropriate element to detect cervical cancer

A. beta-2-microglobulin

B. repeated clinical examinations

C. bone scan

D. the regular pap smear

E. alpha feto protein

92. A young 27-year-old woman followed for infertility consults for metrorrhagia after 10 days of delay. your clinical examination is normal. you nevertheless suspect an ectopic pregnancy (EGU) you must

A. review the patient clinically 4 to 5 days later

B. do a laparoscopy

C. make a hysteroscopy

D. HCG assay and an ultrasound

E. do a progesterone assay

93. Genital prolapse is most commonly diagnosed by which of the following methods

A. on clinical examination

B. ultrasound

C. at hysterography

D. a per operative

E. no answer is right

94. Among the following infections only one is not formal contraindication of osteoprogestogen which?

A. malignant tumors of the breast and uterus

B. thromboembolic events

C. uterine fibroid

D. cholestatic hepatitis

E. pituitary adenoma

95. What should you demand when a pap smear contains malignant cells?

A. a conesation of the cervix

B. a blood count and VS

C. a cervical biopsy under colposcopy

D. lymphography

E. a chest x-ray

96. The following criteria make it possible to diagnose heart disease in pregnancy except one which one?

A. a diastolic murmur

B. cardiomegaly

C. severe arrhythmia

D. hydramnios

E. systolic murmur grade 4 and 5

97. Fever occurring in the immediate postpartum period is most often secondary to which of the following propositions?

A. a puerperal infection

B. acute pyelonephritis

C. lung infection

D. pelvic tuberculosis

E. none of the above pathologies

98. What is the most likely diagnosis in a young woman who consults for vulvar pruritic with on examination a red vaginal mucosa lined with lumpy leucorrhea?

A. gonococcal disease

B. candidiasis

C. trichomonas vaginalis infection

D. a streptococcal infection

E. HIV

99. A 3rd degree perineal tear

A. is more commonly seen with lateral episiotomy

B. should have the anal sphincter repaired before the vagina

C. should always be prepared under general anesthesia

D. may cause vesico-vaginal fistula

E. should be treated with antibiotics

100. The ovary in polycystic ovarian syndrome characteristically shows

A. increased fatty infiltration

B. cell hyperplasia

C. granular fibrosis

D. hyperplasia of the theca cells

E. capsular thinning

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