🏠/MRCOG Part 1 — Study Book/Appendices/Mock Exams/Mock Exam 05

Mock Exam 05

Final Mock 5

MRCOG Part 1 practice — 164 questions with answers and explanations. Cleaned for readability.

Q1. The probability of sarcomatous change occurring in fibroid is - A) 0.1% - B) 1% - C) 5% - D) 10% - E) 15%

Explanation: The incidence of sarcomatous transformation in benign uterine leiomyomas is reported to be 0.1-0.8%, or less than 1%

Q2. The most common site of endometriosis is - A) Uterosacral ligament - B) Ovary - C) Vagina - D) Rectum - E) Oviduct

Explanation: Q3. A 27-year-old woman after normal vaginal birth develops - A) shortness of birth and seizures. Despite resuscitation she dies within 20 - B) minutes. At autopsy squamous cells and fetal hair are found in lungs. - C) What is the most likely cause of death? - D) Placental abruption - E) Eclampsia Pulmonary embolism Postpartum hemorrhage Amniotic fluid embolism

Explanation: Amniotic fluid embolism is a rare but serious condition that occurs when amniotic fluid — the fluid that surrounds a baby in the uterus during pregnancy — or fetal material, such as fetal cells, enters the mother's bloodstream.

Q4. A 19-year-old woman gives birth to her first child. She begins - A) breast feeding the infant. She continues breast feeding for almost a year - B) with no difficulties and no complications. - C) Which of the following cellular processes that occurred in the breast - D) during pregnancy allowed her to nurse the infant for this period of time? - E) Stromal hypertrophy Epithelial dysplasia Steatocyte atrophy Ductal dilation Lobular hyperplasia

Explanation: During pregnancy Under the influence of estrogen, ductal proliferation and growth, as well as, to a lesser degree, alveolar-lobular growth, begin in the first trimester of pregnancy. Expansion of the glandular tissue results in the invasion of adipose tissue, which progresses gradually, occurring simultaneous to increased vascularity and blood flow. During the second and third trimesters, progesterone induces lobular (acinar) hyperplasia. At the end of pregnancy, high levels of estrogens and progesterone counteract prolactin, thus inhibiting milk production, although colostrum production occurs in the alveolar cells. Ductal dilatation occurs progressively through pregnancy Postnatal The reduction in estrogen and progesterone levels after delivery results in the continuous release of prolactin, caused by stimulation of prolactinreleasing factor in the hypothalamus, and the physical stimulation of the nipple by the newborn promotes the release of oxytocin by the anterior pituitary gland, in order to maintain lactation.

Q5. Choriocarcinoma is a malignant form of gestational trophoblastic - A) disease. When Choriocarcinoma metastasises, it has a propensity for - B) which type of spread? - C) Direct invasion - D) Hematogenous - E) Lymphatic Surface implantation Transcoelomic

Explanation: Hematogenous

Q6. The epithelial lining of the cervix exterior to transformation zone is - A) which of the following tissue types? - B) Transitional - C) Stratified squamous keratinized - D) Stratified squamous nonkeratinized - E) Stratified columnar Simple columnar

Explanation: Stratified squamous nonkeratinized Q7. What histology constitutes the majority of vulvar cancers? - A) Squamous cell carcinoma - B) Basal cell carcinoma - C) Merkel cell carcinoma - D) Adenocarcinoma - E) Melanoma

Explanation: Squamous cell carcinoma Q8. What is the most common congenital solid tumour of the - A) newborn? - B) Astrocytoma - C) Willim's tumour - D) Neuroblastoma - E) Sacrococcygeal teratoma Hepatic hemangioma

Explanation: Teratomas, particularly sacrococcygeal teratomas, are the most common neonatal tumor. Neuroblastoma is the second most common neoplasm in neonates and the leading cause of malignancy. Neuroblastoma is the most common cancer in infants. Q9. Which ovarian tumor is associated with Meig's syndrome? - A) Cystadenoma - B) Teratoma - C) Fibroma - D) Mucinous - E) Granulosa cell tumour

Explanation: Meigs syndrome is defined as the triad of benign ovarian tumor with ascites and pleural effusion that resolves after resection of the tumor. Ovarian fibromas constitute the majority of the benign tumors seen in Meigs syndrome.

hormone replacement therapy (HRT) to control the effects of menopause. The use of hormone replacement therapy (HRT) will decreases the risk of which cancer? - A) Breast cancer - B) Endometrial carcinoma - C) Hepatoma - D) Ovarian cancer - E) Colorectal cancer

Explanation: Combined HRT can be associated with a small increase in the risk of breast cancer even if used for short term period. Estrogen-only HRT increases the risk of breast cancer, but only when used for more than 10 years. Both oestrogen-only and combined HRT slightly increase the risk of ovarian cancer. But when HRT is stopped, the risk starts to go back to what it would have been if HRT wasn't taken. An appropriate combination of estrogen and progestin does not appear to increase, and may even decrease, the risk of endometrial cancer.

girl whose mother was treated with diethylstilbestrol during the pregnancy is likely to be a - A) Brenner cell tumor of ovary - B) Teratoma of ovary - C) Sarcoma botryoides of vagina - D) Clear cell carcinoma of vagina - E) Squamous cell carcinoma of vulva

Explanation: Diethylstilbestrol (DES) is a synthetic form of the female hormone estrogen. It was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labor, and related complications of pregnancy. The use of DES declined after studies in the 1950s showed that it was not effective in preventing these problems. The drug continued to be prescribed to pregnant women in Europe until 1978

have bilateral multiple tiny ovarian cysts along with an enlarged uterus at 12 weeks’ gestational age. The quantitative β-hCG level of 300,000 mIU/mL. What is the most likely type of these ovarian cysts? - A) Polycystic ovaries - B) Granulosa cell cyst - C) Follicular cyst - D) Theca lutein cyst - E) Corpus luteum cyst

Explanation: Theca-lutein cysts can occur in the setting of gestational trophoblastic disease (hydatidiform mole and choriocarcinoma), multiple gestation, or exogenous ovarian hyperstimulation. These cysts are associated with maternal androgen excess in up to 30% of cases but usually resolve spontaneously as the hCG level falls. Q10. Which of the following is the most related to endometrial - A) carcinoma? - B) Simple hyperplasia - C) Complex atypical hyperplasia - D) Complex hyperplasia - E) Simple atypical hyperplasia Polypoid adenoma

Explanation: Endometrial intraepithelial neoplasia (EIN) also known as complex atypical hyperplasia is a premalignant lesion of the uterine lining that predisposes to endometrioid endometrial adenocarcinoma.

bleeding for the past 2 months. She had a history of removal of cervical polyp 3 years ago and her cervical smears are normal. On physical examination, there are no remarkable findings. Her Hb level is normal. A pelvic ultrasound scan shows endometrial thickness of 19 mm and a round hyperechoic mass in the endometrial cavity measuring 10X8mm. What is the most likely diagnosis? - A) Adenomyosis - B) Endometriosis - C) Endometrial hyperplasia - D) Endometrial polyp - E) Submucous fibroid

Explanation: This question can have two answers unless for the presence of this word “hyperechoic mass“ Both endometrial polyp and submucosal fibroid can present as round mass in endometrial cavity.

Q11. An 18-year-old woman has had pelvic discomfort for several - A) months. On pelvic examination, there is a right adnexal mass. Ultrasound - B) picture of the right ovary shows cystic lesion measuring 3.3x 2.5 cm with - C) echogenic septa. - D) What is the most likely finding? - E) Hemorrhagic cyst Benign teratoma Ovarian carcinoma Serous cystadenoma Follicular cyst

Explanation: There are various types of ovarian cysts, such as dermoid cysts and endometrioma cysts. However, functional cysts are the most common type. The two types of functional cysts include follicle and corpus luteum cysts, but both are present as simple unilocular, anechoic cysts with a thin, smooth wall. There should be no enhancing nodules or other solid components, no enhancing septations, and no more than physiologic ascites, typically spontaneously resolve within 6 weeks. Hemorrhagic ovarian cysts (HOCs) usually result from hemorrhage into a corpus luteum or other functional cyst. Radiographic features are variable depending on the age of the hemorrhage. They typically resolve within eight weeks. Serous cystadenomas : These appear as smooth, thin walled, anechoic, fluid-filled structures. They are bilateral in 15% of cases and their mean size is 5–8 cm, Some contain fine septations whilst others have areas of haemorrhage appearing as small echogenic areas. They are the commonest type of ovarian epithelial neoplasm. The peak incidence is at the 4th to 5th decades of life. A cystic ovarian mass with septa (particularly when thin) but without a solid component is likely to be a benign neoplasm, though occasionally may be malignant when there are a very large number of septa. A cystic mass with multiple, smooth, thin septa and no nodularity is suggestive of a mucinous cystadenoma Most ovarian cysts in children and adolescents are benign. Of the complex benign cysts, germ cell tumours are the most common in children and adolescents. Of these, 55–70% are mature cystic teratomas (dermoid cysts).They usually occur between the ages of 6 and 15 years and 10% may be bilateral. Cystic teratomas of the ovary can occur in persons of any age, although they are diagnosed most frequently during the reproductive years. The peak incidence in most series is at age 20-40 years. International Ovarian Tumour Analysis Group rules to classify benign and malignant lesions on ultrasound (IOTA)

Q12. From which organ / system does the Krukenberg tumor of the - A) ovaries originate from? - B) Lung - C) Brain - D) Kidney - E) Uterus GIT

Explanation: A Krukenberg tumor refers to a malignancy in the ovary that metastasized from a primary site, classically the gastrointestinal tract, although it can arise in other tissues such as the breast. Gastric adenocarcinoma, especially at the pylorus, is the most common source.

Q13. An 18 year-old woman is found to have a largely solid ovarian - A) neoplasm. Tumor markers were obtained and demonstrated a markedly - B) elevated LDH value. The hCG and a-Fetoprotein were negative. - C) Which of the following tumors is the most likely histology for this - D) neoplasm? - E) Theca cell tumour Dysgerminoma Immature teratoma Brenner cell tumour Endodermal sinus tumour

Q14. Explanation: - A) What is the most likely histological subtype of ovarian cancer - B) associated with endometriosis? - C) Clear cell carcinoma - D) Serous adenocarcinoma - E) Borderline serous tumour Muscinous cystadenocarcinoma Granulosa cell tumour

Explanation: Endometriosis is associated with an increased risk of developing epithelial ovarian cancer (EOC), mainly the endometrioid and clear cell cancer.

A) Mons pubis
B) Labia majora
C) Labia minora
D) Clitoris
E) Posterior fourchette

Explanation: Most malignancies are associated with the skin of the labia. Malignancies arising from the clitoris and vestibular glands are extremely rare. Vulvar cancer most commonly affects the outer lips of the vagina. The most common subtype is squamous cell carcinoma.

Q15. A 65-year-old nulliparous women presents with vaginal spotting. - A) She has been postmenopausal for 15 years and does not take hormones. - B) An ultrasound shows a mass in the uterine fundus. A hysterectomy is - C) performed, and pathologic examination of the removed uterus reveals - D) heterologous components of a malignant tumor of the endometrial glands - E) and metaplastic cartilage. Which of the following is the most likely diagnosis? Endolymphatic stromal myosis Endometrial stromal sarcoma Endometrial carcinosarcoma Endometrial adenosarcoma Endometrioid carcinoma

Explanation: Carcinosarcoma is defined as adenocarcinoma intimately admixed with identifiable malignant soft tissue elements. These neoplasms, in which the sarcomatous component may be either homologous (composed of tissues normally found in the uterus) or heterologous (containing tissues not normally found in the uterus, most commonly malignant cartilage or skeletal muscle) usually occur in elderly postmenopausal women and are extremely aggressive, with a very poor overall prognosis.

Q16. A 27-year-old woman at 30 weeks of gestation has gross - A) hematuria. Ultrasound shows a normal pregnancy and a maternal urinary - B) bladder lesion. Cystoscopy reveals a 3 cm multifocal pedunculated - C) papillary lesion. The remainder of the urinary bladder is normal. - D) The most likely diagnosis of this bladder lesion is - E) Transitional cell carcinoma Squamous cell carcinoma Adenocarinoma Small cell carcinoma Bladder calculi

Explanation: Bladder tumors during pregnancy, with transitional cell carcinoma being the most common (70%). Q17. Which of the following ovarian tumor is most prone to undergo - A) torsion during pregnancy? - B) Serous cystadenoma - C) Mucinous cystadenoma - D) Dermoid cyst - E) Theca lutein cyst Corpus luteium cyst

Explanation: Dermoid cysts are the most common adnexal cystic lesions diagnosed after 16 weeks of gestation, Dermoid cysts greater than 6 cm are prone to torsion. In their review, Yen et al. suggest the risk of torsion to be about 27%

A) Ischemia
B) Calcification
C) Infection
D) Gangrene
E) Rupture of capsule

Explanation: The exact mechanism is not known, but it results due to decreased blood supply and is associated with severe infection and torsion of a pedunculated fibroid. Q18. Which type of epithelium lines the distal urethra near the external - A) urethral orifice? - B) Transitional - C) Stratified squamous keratinized - D) Stratified squamous nonkeratinized - E) Stratified columnar

(Page 2) 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. Stratified columnar Simple columnar

Explanation: Stratified squamous nonkeratinized

pain for 3 months. She is previously received a treatment for Chlamydia. Her ultrasound revealed a 4-cm diffuse homogeneous hypoechoic focal lesion with low-level internal echoes with little fluid in the douglas pouch, empty uterus with ET 4 mm and normal adnexa are seen bilaterally. What is the most likely diagnosis? - A) Para-ovarian cyst - B) Hydrosalpinx - C) Mucocele appendix - D) Cornual ectopic pregnancy - E) Endometrioma

Explanation: The characteristic US features of endometrioma are homogeneously diffuse low-level echoes in the cyst, compromising the so called groundglass appearance. Adnexa refer to the anatomical area adjacent to the uterus, and contains the fallopian tube, ovary, and associated vessels, ligaments, and connective tissue. Q19. Which pattern of endometrium do simple endometrial hyperplasia - A) most likely resemble? - B) Proliferative endometrium - C) Secretory endometrim - D) Endometritis - E) Endometrial polyp Endometrial carcinoma

Explanation: “Disordered proliferative endometrium" is a somewhat vague term that generally indicates the unusual growth of endometrial cells. The term can refer to a form of simple endometrial hyperplasia or the abnormal thickening of the endometrial lining. Q20. What type of epithelial tissue undergoes malignant change in the - A) majority of bladder cancers? - B) Columnar - C) Pseudostratified - D) Squamous - E) Stratified Transitional

Explanation: Transitional Q21. What is the single best description for the histological appearance - A) of the secretory endometrium? - B) Simple columnar - C) Simple columnar with subnuclear vacuolation - D) Stratified columnar - E) Stratified cuboidal Simple cuboidal epithelium

Explanation: During the early secretory phase the endometrium shows the effects of both progesterone and estrogen influence. The endometrial glands undergo progressive distension, appear plumper and more tortuous and are lined by low columnar cells. Subnuclear cytoplasmic glycogen vacuoles may discharge into the gland lumina. Q22. Which neoplasm is characteristically associated with - A) paraneoplastic syndrome of inappropriate antidiuretic hormone (SIADH)? - B) Renal cell carcinoma - C) Breast carcinoma - D) Small cell lung carcinoma - E) Papillary thyroid carcinoma Cancer colon

Explanation: Small cell lung carcinoma

abdominal discomfort. Exam of uterus is enlarged. Biopsy shows normal appearing glands in myometrium. What is the most likely diagnosis? - A) Adenocarcinoma - B) Basal cell carcinoma - C) Leiomyosarcoma - D) Adenomyosis - E) Endometriosis

Explanation: Adenomyosis is a medical condition characterized by the growth of cells that build up the inside of the uterus (endometrium) atypically located within the cells that put up the uterine wall (myometrium).

hemiparesis. On arrival in hospital her symptoms and neurological examination is suggestive of a cerebrovascular incident. Subsequent imaging supports the diagnosis of an ischaemic stroke, affecting her left cerebral hemisphere. Which of the following forms of tissue necrosis is associated with her loss of function? - A) Caseous necrosis - B) Coagulative necrosis - C) Colliquative necrosis - D) Fat necrosis - E) Gangrenous necrosis

Explanation: Liquefactive necrosis (or colliquative necrosis) is a type of necrosis which results in a transformation of the tissue into a liquid viscous. Types of Necrosis Liquefactive necrosis: in brain, Caseous necrosis: Infection with Mycobacterium tuberculosis, Fat necrosis: Liver and pancreas, Coagulative necrosis: Necrosis of kidney, liver, or heart muscle, Gangrene: Necrosis of an appendage, usually limbs.

lichen planus on the vulva. What type of cancer is linked to lichen planus? - A) Squamous cell carcinoma - B) Basal cell carcinoma - C) Merkel cell carcinoma - D) Malignant melanoma - E) Kaposi sarcoma

Explanation: Lichen planus (LP) is an autoimmune dermatosis of mucosal and cutaneous sites affecting 1% to 2% of the population. It is associated with cancer, especially squamous cell carcinoma (SCC).

endometrial biopsy is obtained approximately 5 to 6 days after the predicted time of ovulation. This biopsy specimen reveals ''marked glandular growth and mitosis, stromal edema with subnuclear vacuoles and prominent coiled spiral arterioles'’ This finding are consistent with what histological type of endometrium? - A) Atrophic - B) Proliferative - C) Secretary - D) Simple Hyperplasia - E) Arias-Stella phenomenon

Explanation: Secretary

Q23. A 40-year-old female suffers from a 2 x 2-cm vulval lesion. Biopsy - A) demonstrates a malignant melanoma. - B) The prognosis of this tumour best depends upon - C) Grade of tumour - D) Darkness of lesion - E) Degree of color variation Depth of invasion Duration of the growth

Explanation: Tumor thickness: Known as Breslow thickness or Breslow depth, this is a significant factor in predicting how far a melanoma has advanced. In general, a thinner Breslow depth indicates a smaller chance that the tumor has spread and a better outlook for treatment success. Q24. What is the most common clinically significant congenital heart - A) disease? - B) Atrial septal defect - C) Ventricular septal defect - D) Patent ductus arteriosus - E) Tetralogy of Fallot Coarctation of aorta

Explanation: Ventricular septal defect Q25. Which is the commonest type of malignant ovarian neoplasm? - A) Endometrioma - B) Serous cystadenocarcinoma - C) Clear cell carcinoma - D) Germinal cell carcinoma - E) Mucinous cystadenoma

Explanation: Surface epithelial-stromal tumour, also known as ovarian epithelial carcinoma, is the most common type of ovarian cancer, representing approximately 90% of ovarian cancers. It includes serous tumor, endometrioid tumor, and mucinous cystadenocarcinoma. Less common tumors are malignant Endometrioid ovarian cancer, Clear cell ovarian cancer, and Brenner tumor (transitional cell carcinoma of the ovary). Epithelial ovarian cancers develop from the epithelium, a layer of cells that covers the ovary. Q26. Which type of pituitary gland tumors increase growth hormone - A) secretion lead to acromegaly? - B) Adenoma - C) Glioma - D) Fibroma - E) Sarcoma Schwannoma

Explanation: Most acromegaly cases are caused by a noncancerous (benign) tumor (adenoma) of the pituitary gland.

more than one year. An ultrasound scan is arranged which shows a 5 cm well defined cystic lesion in the right adnexa with mixed echoes. There is no fluid in the cul-de- sac with the following sonographic image What is the most likely diagnosis for the image of the adnexa? - A) Benign cystic teratoma - B) Endodermal sinus tumour - C) Endometrioma - D) Mucinous cystadenoma - E) Serous cystadenoma

Explanation: Mixed echoes = mixed cell lines that teratoma is characterized with.

bloated which showed bilateral ovarian masses with no solid areas associated with abdominal ascites. She is post menopausal and otherwise well. She was sent for a CA 125 which comes back as 50 U/mL. What is her risk of malignancy index score (RMI)? - A) 5 - B) 10 - C) 150 - D) 300 - E) 450

Explanation: RMI is a tool used for ovarian cancer detection. It combines three presurgical features: serum CA125 (CA125), menopausal status(M) and ultrasound score (U). The formula is RMI = U x M x CA125.

A) Endometrial hyperplasia
B) Endometrial cancer
C) Atrophic vaginitis
D) Endometrial polyp
E) Ovarian cancer

Explanation: The most common causes are: inflammation and thinning of the vaginal lining (atrophic vaginitis) or womb lining (endometrial atrophy) – caused by lower oestrogen levels. cervical or womb polyps – growths that are usually non-cancerous.

Q27. Peripartum cardiomyopathy resembles to which type? - A) Hypertrophic cardiomyopathy - B) Heart failure - C) Dilated cardiomyopathy - D) All of above - E) None of above

Explanation: Peripartum cardiomyopathy (PPCM), also known as postpartum cardiomyopathy, is an uncommon form of heart failure that happens during the last month of pregnancy or up to five months after giving birth. Cardiomyopathy literally means heart muscle disease. PPCM is a dilated form of the condition, which means the heart chambers enlarge and the muscle weakens. This causes a decrease in the percentage of blood ejected from the left ventricle of the heart with each contraction.

Q28. Psammoma bodies are a histologic feature of ovarian papillary - A) serous cystadenoma. - B) 'Psammoma bodies' are composed of - C) Lipid - D) Mucin - E) Fibrin Calcium Iron

Explanation: Calcium Q29. Which cancer is most commonly diagnosed in pregnancy and - A) postpartum - B) Breast cancer - C) Cervical cancer - D) Ovarian cancer - E) Skin cancer Vulval cancer

Explanation: Breast cancer, although uncommon, is the most prevalent malignancy encountered in pregnancy and the postpartum period.

A) Glomerular Vascular endotheliosis
B) Glomerulonephritis
C) Acute renal failure
D) Kidney stone
E) None of above

Explanation: Pathologically, the kidneys in women with preeclampsia exhibit glomerular endotheliosis, a manifestation of systemic extensive endothelial damage in preeclampsia. Q30. Most common cancer type in Fallopian tube - A) Squamous cell carcinoma - B) Adenocarcinoma - C) Sarcoma - D) All of above - E) None of above

Explanation: Fallopian tube cancers are most often epithelial or surface carcinomas, which means that they form on the tissue that lines or covers the fallopian tubes. More than 95 percent of fallopian tube cancers are papillary serous adenocarcinomas. This type of cancer grows from the cells lining the fallopian tubes. Q31. Ovarian solid mass on ultrasound benign histopathology with - A) spindle shaped cells chest Xray showing pleural effusion diagnosis? - B) Fibroma - C) Leiomyoma - D) Endomerioma - E) All of above None of above

Explanation: Ovarian fibromas constitute the majority of the benign tumors seen in Meigs syndrome. Meigs syndrome, however, is a diagnosis of exclusion, only after ovarian carcinoma is ruled out. Q32. Most commonly seen female urethral cancer? - A) Transitional cell - B) Squamous cell carcinoma - C) Adenocarcinoma - D) All of above - E) None of above

Explanation: Squamous cell carcinoma

A) Decrease antithrombin III
B) Increase antithrombin III
C) Decrease Factor 5 and 8a
D) Increased Factor 5 and 8a
E) None of above

Explanation: Because activated protein C degrades coagulation factors Va and VIIIa, deficiency of protein C predisposes to venous thrombosis.

bilateral ovarian mass with solid areas on scan and CA 125 of 100. What is her RMI score? - A) 250 - B) 450 - C) 600 - D) 700 - E) 900

Explanation: 900

A) Hypothalamus
B) Anterior pituitary
C) Posterior pituitary
D) Thyroid
E) Adrenal cortex

Explanation: Sheehan's syndrome, also known as postpartum pituitary gland necrosis, is hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth. The most common initial symptom of Sheehan's syndrome are agalactorrhea (absence of lactation) and/or difficulties with lactation. Growth-hormone deficiency is the most common symptom of hypopituitarism seen in Sheehan’s syndrome.

Q33. Regarding Wound healing process. - A) What is the first stage ? - B) Wound contraction - C) Proliferation - D) Inflammation - E) Remodeling Hemostasis

Q34. Explanation: - A) What is the incidence of pregnancies complicated by cancer? - B) 1/300 - C) 1/500 - D) 1/1000 - E) 1/3000 1/5000

Explanation: A cancer diagnosis during pregnancy is thankfully a rare occurrence. It is estimated that this coexistence only affects 1 in every 1000 pregnant women. However, in addition to being uncommon, cancer is especially difficult to detect in pregnant women. Q35. Which of the following ovarian cysts most prone to undergo - A) torsion? - B) Mucinous cyst - C) Serous cyst - D) Dermoid cyst - E) Endodermal sinus tumour Hemorrhagic cyst

Explanation: Dermoid tumors are most common. Malignant tumors are much less

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discolouration. examination reveals pale white discoloured areas to the vulva. A biopsy shows epidermal atrophy with subepidermal hyalinization and deeper inflammatory infiltrate. What is this characteristic of? - A) Lichen Simplex Chronicus - B) Vulval intraepithelial neoplasia - C) Vitiligo - D) Extramammary Pagets - E) Lichen Sclerosus

Explanation: Lichen Sclerosus Atrophic skin resembles cigarette paper (crinkly atrophy); often with loss of labia. Also white / red ill defined patches. No vaginal involvement. Q36. What is the most common solid benign tumour of ovary? - A) Serous tumour - B) Mucinous tumour - C) Endodermal sinus tumour - D) Benign teratoma - E) Yolk sac tumour

Explanation: The mature teratoma is by far the most common ovarian germ cell tumor. It is a benign tumor that usually affects women of reproductive age (teens through forties). It is often called a dermoid cyst because its lining is made up of tissue similar to skin (dermis).

hemoptysis. Chest xray done showing infiltrations. With the following findings what is the tumor marker that is possibly elevated? - A) AFP - B) CEA - C) HCG - D) Ca 125 - E) LDH

Explanation: Choriocarcinoma is a malignant, trophoblastic cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs. Human chorionic gonadotrophin (hCG) was the first major tumour marker to be identified and in gestational choriocarcinoma remains the closest we have to the ideal indicator of tumour activity. Q37. What is the most common cause of the female urethral caruncle? - A) Trauma - B) Tumour - C) Infection - D) Hypoestrogenism - E) Congenital

Explanation: Caruncles are most common in post-menopausal women and in some cases pre-pubertal girls. They are thought to arise due to reduced oestrogenisation of urethral smooth muscle leading to lack of support for the urethral mucosa. This urogenital atrophy allows the mucosa of the urethra to prolapse. Q38. Which is the most common cause of the premature ovarian - A) failure? - B) Idiopathic - C) Autoimmune - D) Chromosomal - E) Infection Iatrogenic

Explanation: The cause of POI is idiopathic in 90% of cases. Some cases of POI are attributed to autoimmune disorders, genetic disorders such as Turner syndrome and Fragile X syndrome, metabolic defects, and enzyme defects.

painful periods. USG showing the following picture. What is the likely diagnosis? - A) Functional cyst - B) Physiologic cyst - C) Ovarian endometrioma - D) Ovarian teratoma - E) Germ cell tumor

Explanation: Symptoms of Endometrioma Painful periods. Pelvic pain, not related to monthly periods. Irregular periods. Heavy periods. Pain during sexual intercourse. Functional (physiological) cysts Most ovarian cysts do not cause any noticeable symptoms and are found incidentally upon physical examination or ultrasound. Some women with functional ovarian cysts report a dull sensation or heaviness in the pelvis. Corpus luteum cysts are more likely than follicular cysts to cause pain, peritoneal irritation, and delayed menses. As an ovarian cyst enlarges, the patient may notice increased abdominal girth or pressure. Acute, severe lower abdominal pain may indicate torsion or cyst rupture.

white, firm, spindle shape cells. Diagnosis? - A) glioma - B) fibroma - C) leiomyoma - D) sarcoma - E) adenoma

Explanation: Remember meigs syndrome, commonest mass is fibroma of the ovary. Q39. Ovarian CA associated with mutation of mismatch repair genes - A) clear cell CA - B) endometriod CA - C) papillary CA - D) serous CA - E) mucinous CA

Explanation: Various histological types of ovarian cancer are caused by MMR mutation. While serous adenocarcinoma is the main histological type of ovarian cancer caused by BRCA mutation. Lynch syndrome (LS) is caused by germline mutations in the DNA mismatch repair (MMR) genes. Ovarian clear cell carcinoma (OCCC) is second subtype of ovarian epithelial carcinoma reported to be closely related to Lynch syndrome. Among gynaecological cancers, endometrial carcinoma is the most common tumour related to LS followed by ovarian cancer. Q40. What type of necrosis is seen in the heart after an acute - A) myocardial infarction? - B) Liquefactive necrosis - C) Coagulative necrosis - D) Caseous necrosis - E) Gangrenous necrosis Fibrinoid necrosis

Explanation: Coagulative necrosis occurs primarily in tissues such as the kidney, heart and adrenal glands. Severe ischemia most commonly causes necrosis of this form.

A) hyperplasia
B) hypertrophy
C) atrophy
D) metaplasia
E) dysplasia

Explanation: hypertrophy

assessment unit. She presents with itching... more on the area of the abdominal striae. Lab results given which showed normal ALP, normal bilirubin levels. Diagnosis? - A) Intrahepatic Obstetric Cholestasis - B) Polymorphic Eruption of Pregnancy - C) Fatty Liver - D) Acute Hepatitis - E) Cholecystitis

Explanation: The condition initially presents with pruritic, erythematous papules commonly located within the abdominal striae and with periumbilical sparing. It progresses to the trunk and extremities, sparing the palms and soles in the majority of cases, and does not affect the face.

multiple fibroids. What is the most common form of fibroid degeneration? - A) Red degeneration - B) Hyaline degeneration - C) Carneous degeneration - D) Myxoid degeneration - E) Cystic degeneration

Explanation: Take care that the common form in pregnancy is red degeneration. Q41. What is the most common cause of hyperthyroidism in pregnant - A) woman? - B) Adenoma - C) Graves disease - D) Iodine excess - E) Subacute thyroiditis Toxic multinodular goiter

Explanation: The most common cause of hyperthyroidism in pregnancy (which affects up to 0.2% of pregnant women) is Graves' disease (85–90%).

breathlessness, tachycardia and menstrual irregularity. Her Investigations revealed: Serum hCG negative Serum T4 178 mmol/l Serum TSH 0.05 mU/L Prolactin 400 mmol/l What is the most likely diagnosis? - A) Primary hypothyroidism - B) Graves' disease - C) Hashimoto's thyroiditis - D) Multi-nodular goitre - E) DeQuervain's thyroiditis

Explanation: Type explanation here... Q42. Which electrolyte is involved in central pontine mylenosis due to - A) fluid overload? - B) Potassium - C) Sodium - D) Calcium - E) Magnesium Chloride

Explanation: The most common cause of CPM is a rapid increase in blood sodium levels. Central pontine myelinolysis (CPM) is a neurological disorder that most frequently occurs after too rapid medical correction of sodium deficiency (hyponatremia). The rapid rise in sodium concentration is accompanied by the movement of small molecules and pulls water from brain cells.

5x5cm - A) Wait no follow up - B) Follow up at anomaly scan for size - C) First trimester surgery - D) CS + cystectomy - E) Remove immediately

Explanation: Adnexal masses in pregnancy are common, with a prevalence of 0.19– 8.8%. The incidence of ovarian malignancy is 1 in 1500–32 000 pregnancies. Up to 76% of adnexal masses in pregnancy will be simple ovarian cysts of less than 5 cm in diameter. These are often functional cysts that resolve spontaneously by 16 weeks of gestation and require no followup in pregnancy. A follow-up ultrasound scan should be offered for larger or complex cysts at around 14–16 weeks of gestation. Intervention should be delayed until 14–16 weeks to allow spontaneous resolution of functional cysts and, more importantly, to prevent surgery on a luteal cyst that might be supporting the pregnancy. Persistent ovarian or para-ovarian simple cysts have a low risk of malignancy and can be managed conservatively. Complex adnexal masses, which on ultrasound examination appear to be benign, such as ovarian dermoid tumours, can be managed conservatively in the absence of symptoms. Indications for surgery Acute abdomen Mass suspicious for malignancy Rapidly growing masses (an increase in size >20%) are at higher risk of malignancy Cysts greater than 10 cm, which may cause obstruction to labour

Q43. 25 y/o first pap smear, low grade dyskaryosis, next step? - A) Colposcopy - B) HPV testing - C) Repeat after 6 months - D) Repeat after 12 months - E) Hysterectomy

Explanation: HPV testing Q44. What is the most common cause of secondary - A) hyperparathyroidism? - B) Parathyroid adenoma - C) Multiple myeloma - D) Sarcoidosis - E) Chronic renal failure Multiple endocrine neoplasia type 1

Explanation: The most common cause of primary hyperparathyroidism is an adenoma, Tertiary hyperparathyroidism is observed most commonly in patients with chronic secondary hyperparathyroidism who have been on dialysis therapy for years.

uterus. History of painful menses. Diagnosis? - A) Polyp - B) Adenomyosis - C) Leiomyoma - D) Adenocarcinoma - E) Sarcoma

Explanation: Two of the most common causes of an enlarged uterus are uterine fibroids and adenomyosis. Q45. What type of epithelium is in the fallopian tubes? - A) cuboidal - B) squamois stratified - C) pseudostratified columnar - D) simple columnar - E) None of above

Explanation: The Fallopian tube was found to be lined with a simple columnar epithelium which consisted of two types of cell (a) ciliated and (b) secretory

screening shows: Hb: 10.1 Platelets: 135 Protein C: normal Protein S : decreased Anticardiolipin antibodies: -ve - A) acquired thrombophilia - B) congenital thrombophilia - C) normal pregnancy changes - D) all of above - E) none of above

Explanation: Protein S is a cofactor of protein C which lowers the activated factors VIII and V. Pregnancy reduces the level of protein S to 40-50% of normal levels but it is not clear whether the lowered protein S levels increase the risk of developing thromboembolism during pregnancy.

Q46. Patient with heavy menstrual bleeding, identify the picture - A) Adenomyosis - B) Leiomyoma - C) Polyp

D) (Page 4)*
E) 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. Polyp Adenocarcinoma Sarcoma

Explanation: Polyp Q47. Minor Postpartum hemorrhage is called - A) 500ml blood loss - B) 500-1000ml with no signs of shock - C) >1000ml with no signs of shock - D) 1500ml with no signs of shock - E) None of above

Explanation: PPH can be minor (500–1000 ml) or major (more than 1000 ml). Major could be divided to moderate (1000–2000 ml) or severe (more than 2000 ml)

report Cardiac disease Venous thromboembolism Haemorrhage Epilepsy Sepsis

Q48. Explanation: - A) Operated for ca cervix and TAH+BSO is performed, Ovarian - B) histopathology shows which type of carcinoma: - C) Metastatic carcinoma - D) Carcinosarcoma - E) Lymphoma Leimyoma None of above

Explanation: Metastatic carcinoma

ulcers over vulva - A) Behchets disease - B) Herpes - C) Lichen sclerosis - D) Lichen planus - E) None of above

Explanation: The ISG criteria defined Behçet's disease as recurrent oral ulceration plus two of the following: recurrent genital ulcerations, eye lesions, skin lesions, or a positive pathergy test. Herpes is a sexually transmitted disease. Q49. Woman have history of eclampsia in previous pregnancy, now - A) she is 12 weeks pregnant. - B) What is her risk of preeclampsia in current pregnancy? - C) 10 % - D) 15-20 % - E) 30 % 55%

Explanation: Overall one in six women who have had pre-eclampsia will get it again in a future pregnancy. Of women who had severe pre- eclampsia, or eclampsia: • one in two women will get pre-eclampsia in a future pregnancy if their baby needed to be born before 28 weeks of pregnancy • one in four women will get pre- eclampsia in a future pregnancy if their baby needed to be born before 34 weeks of pregnancy Q50. Woman have history of salpingectomy due to ectopic pregnancy, - A) recurrent risk in next pregnancy of ectopic is - B) 1-3 % - C) 5-10% - D) 15-20% - E) 30-40% None of above

Explanation: 15-20%

A) 5-10%
B) 15-20%
C) 25-35%
D) 45-55%
E) 70-80%

Explanation: A previous diagnosis of gestational diabetes (GDM) carries a lifetime risk of progression to type 2 diabetes of up to 60% Q51. Gravida 2 at 18 weeks papules around umbilicus itchy, and all - A) over abdomen she also have same in previous pregnancy - B) PUPP - C) Gestational pemphigoid - D) Atopic dermatitis - E) Eczema None of above

Explanation: Gestational pemphigoid

the fetus? - A) 5 - B) 10 - C) 20 - D) 30 - E) 40

Explanation: Fetal compromise (preterm delivery,asphyxial events,meconium staining of amniotic fluid and membranes) increased by 1–2% for each additional micromole/litre of bile acid concentration; further statistical analysis suggested that, compared with control pregnancies, these rates increased significantly at bile acid levels ≥40 micromoles/litre, which was defined as four times the upper limit of normal in that laboratory.

she has regular cycle with history dysmenorrhea that she used to take ibuprofen for that. Her LMP 3 weeks ago - A) Corpus luteal cyst - B) Haemorrhagic cyst - C) Ovarian torsion - D) Endometriosis - E) Germ cell tumour

Explanation: Haemorrhagic cyst featuring a reticulated pattern of internal echos (as a spider’s web)

Q52. Feature of imminent preeclampsia - A) hyperreflexia / clonus - B) headache - C) epigastric tenderness - D) facial edema - E) All of above

Explanation: Feature of imminent preeclampsia - Headache Feature of imminent eclampsia - Hyperreflexia / clonus

Q53. At 3 weeks wound tensile strength is - A) 10 percent - B) 20 percent - C) 40 percent - D) 80 percent - E) 100 percent

Explanation: As the phase progresses, the tensile strength of the wound increases. Collagen will reach approximately 20% of its tensile strength after 3 weeks, increasing to 80% by 12th week. Q54. Most common mutation in high grade serous ovarian carcinoma - A) P53 - B) BRAF - C) KRAS - D) All of above - E) None of above

Explanation: The tumor protein p53 (TP53) gene is mutated in over 96% of cases in HGSOC, the most common subtype of ovarian cancer.

level should fibrinogen be maintained? - A) 0.5 g/l - B) 1 g/l - C) 2 g/l - D) 5 g/l - E) 7 g/l

Explanation: Fibrinogen levels should be maintained above 2.0 g/l by the use of FFP as above or two pools of Cryoprecipitate. Q55. Most common non epithelial vaginal cancer - A) Clear cell carcinoma - B) Germ cell tumour - C) Squamous cell cancer - D) Rhabdomyosarcoma - E) None of above

Explanation: Embryonic Rhabdomyosarcoma It is the most common soft tissue sarcoma occurring in children. Q56. Most common vaginal tumor carcinoma - A) Adenocarcinoma - B) Squamous cell carcinoma - C) Rhabdomyosarcoma - D) All of above - E) None of above

Explanation: Squamous cell carcinoma is by far the most common type, accounting for 85-87% of all cases of primary vaginal carcinoma. Q57. Ovarian Mismatch repair genes in - A) Mucinous - B) Fibroma - C) Serous - D) Clear cell carcinoma - E) All of above

Explanation: Clear cell carcinoma

A) Endometrial changes like
B) Proliferative
C) Secretary
D) Non proliferative & secretary
E) None of above

Explanation: Proliferative Q58. Most common Uterine sarcoma - A) Uterine leiomyosarcoma - B) Endometrial stromal sarcoma - C) All of above - D) Adenosarcoma - E) None of above

Explanation: Uterine leiomyosarcoma

A) Primitive node
B) Primitive streak
C) Gonadal ridge
D) All of above
E) None of above

Explanation: The germ cells originate in the primitive streak and migrate via the gut of an embryo to the developing gonads. There, they undergo meiosis, followed by cellular differentiation into mature gametes, either eggs or sperm.

A) 15 day
B) 18 day
C) 20 day
D) 22 day
E) 28 day

Explanation: Neural tube closure usually occurs by the fourth week of pregnancy (28th day after conception)

embryological origin of the structure? The ventral mesentery The dorsal mesentery

Explanation: The falciform ligament derives from the ventral mesentery, which is a part of the embryological foregut and forms a connection between the ventral abdominal wall and the liver. Falciform ligament contains ligamentum teres which is the obliterated umbilical vein.

Q59. Appendix testes derived from - A) Endoderm - B) Ectoderm - C) Mullerian duct - D) Wolffian duct

Explanation: The appendix testis (or hydatid of Morgagni) is a vestigial remnant of the Müllerian duct, present on the upper pole of the testis and attached to the tunica vaginalis. It is present about 90% of the time.

Q60. Vitelline duct connects - A) foregut and allantois - B) midgut and allantois - C) midgut and yolk sac

Explanation: The vitelline duct (VD) is an embryonic structure providing communication from the yolk sac to the midgut during fetal development. Normally, it obliterates spontaneously and separates from the intestine between approximately the 5th and 9th weeks of gestation. Meckel's diverticulum is a true intestinal diverticulum that results from the failure of the vitelline duct.

Q61. The developing liver and billiary duct arises from - A) allantois - B) ventral mesentry - C) ventral foregut endoderm

Explanation: The hepatic diverticulum, a ventral outpouching of the distal foregut observed early in the fourth week of gestation (3-mm embryo), is the origin of the hepatobiliary system. This outgrowth of proliferating endodermal cells infiltrates the embryonal ventral mesentery and extends into the septum transversum to form the early liver primordium The liver develops within the ventral mesentery. The pancreas and spleen develop within the dorsal mesentery. The ventral mesentery anterior to the liver and attaching it to the anterior abdominal wall later becomes the falciform ligament, containing the umbilical vessels.

Q62. During development of liver and biliary system , hepatic bud - A) invaginates into which structure - B) Endoderm - C) Ectoderm - D) Septum transversum

Explanation: The hepatic diverticulum (or liver bud) arises as an outpouching of the lumen of the distal foregut during the fourth week of development. The liver bud gives rise to the gallbladder and bile ducts, as well as to the parenchyma of the liver. During craniocaudal folding a connective tissue structure is formed caudal to the developing heart: septum transversum. The caudal part of the septum transversum is invaded by the hepatic diverticulum which divides within it to form the liver and thus gives rise to the ventral mesentery of the foregut, which in turn is the precursor of the lesser omentum, the visceral peritoneum of the liver and the falciform ligament.

Q63. Lowest part of vagina is derived from - A) endoderm - B) mesoderm - C) ectoderm

Explanation: The vagina forms from the fused müllerian ducts and the urogenital sinus. The upper four-fifths of the vagina is müllerian derived, and the lower fifth is of urogenital sinus in origin. The epithelium of the mammalian vagina arises from two distinct germ layers, endoderm from the urogenital sinus and mesoderm from the Müllerian duct.

Q64. Allantois is derived from - A) ectoderm - B) endoderm

Explanation: endoderm

Q65. Ureteric bud is derived from - A) endoderm - B) ectoderm - C) mesonephric duct - D) paramesonephric duct

Explanation: mesonephric duct

Q66. Female homologue of prostate? - A) Bartholins gland - B) Skenes gland

Explanation: Skene's paraurethral glands and ducts are homologous to the male prostate.

Q67. Structure which appears in inner cell mass and give symmetry - A) and site of gastrulation - B) primitive streak

C) (Page 5)*
D) 107.
E) 108. 109. 110. 111. 112. 113. 114. 115. 116. 117. 118. 119. 120. 121. 122. 123. 124. 125. 126. 127. 128. 129. 130. 131. 132. 133. 134. primitive streak notochord amnion

Explanation: Primitive streak

Q68. Placenta separates at delivery from endometrium to form - A) nitabuch - B) basalis

Explanation: The layer of fibrin that was thought to separate the uterine decidua from the fetoplacental trophoblast after birth was named the Nitabuch layer or Nitabuch membrane.

Q69. Endometrial cavity obliterated by fusion of - A) decidua capsularis and parietals - B) capsularis and basalis

Explanation: The decidua of the remainder of the cavity of the uterus is called the decidua parietalis. When the enlarging embryo finally completely fills the endometrial cavity during the third or fourth month of pregnancy, the decidua capsularis fuses with the decidua parietalis opposite it and obliterates the endometrial cavity.

Q70. Hemorrhagic luteal cyst most vascularized portion - A) Theca - B) Cumulus oophorus - C) Mural granulosa - D) Basal lamina

Explanation: Theca

Q71. Functional unit of kidney develops from? - A) Metanephros - B) Mesonephros - C) Endoderm - D) Ectoderm

Explanation: Metanephros Q72. Gastrulation is process of - A) Fusion of sperm and ovum - B) Type of mitotic division - C) Formation of GIT - D) Formation of neural tubes - E) Development of three germ layer

Explanation: Development of three germ layer Q73. What is the most common site for tubal ectopic pregnancy? - A) Ampulla - B) Isthmus - C) Infundibulum - D) Interstitial portion - E) Fimbrial end

Explanation: The ampullar portion of the fallopian tube is more distendable than other areas.

The most likely embryological mechanism responsible for this anomaly is - A) Absent paramesonepheric ducts - B) Absent fusion of paramesonepheric ducts - C) Incomplete fusion of paramesonephric ducts - D) Incomplete lateral fusion/septum resorption - E) Incomplete fusion of sinovaginal bulb with mullerian system

Explanation: Fusion of the caudal portion of the paramesonephric ducts forms the uterine body, cervix, and (cranial) vagina. Complete failure of fusion results in uterus didelphys, a condition in which the uterine body, cervical canal, and cranial vagina are all duplicated. A transverse septum forms during embryogenesis when the Müllerian ducts do not fuse to the urogenital sinus. A complete transverse septum can occur across the vagina at different levels. Menstrual flow can be blocked, and is a cause of primary amenorrhea.

gubernaculums is the - A) Transverse cervical ligament - B) Suspensory ligament of the ovary - C) Round ligament of the uterus - D) Broad ligament - E) Uterosacral ligament

Explanation: Round ligament of the uterus Q74. What part of the embryo is the origin of primordial germ cells? - A) Gonadal ridge - B) Yolk sac endothelium - C) Coelomic epithelum - D) Extraembryonic mesoderm - E) Primitive sex cord

Explanation: Gametes are derived from primordial germ cells (PGCs) that are formed in the epiblast during the second week and that move to the wall of the yolk sac. During the fourth week these cells begin to migrate from the yolk sac toward the developing gonads.

oxygenated blood directly into the inferior vena cava? - A) Ductus venosus - B) Ductus arteriosus - C) Foramen ovale - D) Right hepatic vein - E) Portal vein

Explanation: The fetal circulatory system uses 3 shunts. The shunt that bypasses the lungs is called the foramen ovale. This shunt moves blood from the right atrium of the heart to the left atrium. The ductus arteriosus moves blood from the pulmonary artery to the aorta. The ductus venosus is also a shunt that lets highly oxygenated blood bypass the liver to the inferior vena cava and then to the right atrium of the heart. A small amount of this blood goes straight to the liver to give it the oxygen and nutrients it needs. Q75. While performing laparoscopy, the lateral umbilical folds can be - A) seen on the anterior abdominal wall in the adult. - B) This structure contains - C) Ovarian vessels - D) Obliterated umbilical arteries - E) Remnant of urachus Obturator vessels Inferior epigastric vessels

Q76. Explanation: - A) Whenever the intestinal midgut loop fails to return from the - B) umbilical cord into the abdominal cavity, the defect is known as which of - C) the following? - D) Gastroschisis - E) Exompholos Meckel’s diverticulum Vitelline fistula Left-sided colon

Explanation: embryonic structures? - A) Dorsal mesoduodenum - B) Dorsal mesogastrium - C) Pericardioperitoneal canal - D) Pleuropericardial membranes - E) Ventral mesentery

Explanation: The greater omentum is derived from the dorsal mesentery, while the lesser omentum originates from the ventral mesentery. Q77. What is the embryonic origin of the trigone of urinary bladder? - A) Mesonephric duct - B) Paramesonephric duct - C) Ureteric bud - D) Urogenital sinus - E) Caudal of cloaca

Explanation: The trigone of the bladder is derived from the caudal end of mesonephric ducts, which is of mesodermal origin (the rest of the bladder is endodermal). In the female the mesonephric ducts regress, causing the trigone to be less prominent, but still present.

ovulation? - A) 14 days - B) 28 days - C) 85 days - D) 120 days - E) 375 days

Explanation: From preantral stage to ovulation 90 days

ultrasound scan. Abnormalities of placentation are detected and a magnetic resonance imaging (MRI) scan is organized by the fetal medicine consultant. The MRI report shows: ‘The placenta is lower anterior in which invades through the myometrium up to the uterine serosa’. What is the most likely diagnosis? - A) Placenta accreta - B) Placenta percreta - C) Placenta increta - D) Placenta praevia - E) Vasa previa

Explanation: Percreta- Penetration to or through uterine serosa +/- adjacent organs

Q78. Besides the skull, the axial skeleton is derived from which - A) structure? - B) Neural crest - C) Neural tube - D) Paraxial mesoderm - E) Somatic mesoderm Splanchnic mesoderm

Explanation: Paraxial mesoderm

Q79. The rectum originates from which structure? - A) Allantois - B) Primitive Cloaca - C) Ectoderm of proctodeum - D) Endoderm of hindgut - E) Urorectal membrane

Explanation: Endoderm of hindgut Q80. Which option correctly identifies the embryological origin, - A) Beginning and ending of the round ligament of the uterus? - B) Paramesonephric duct ,Anteroinferior to uterine cornua ,labium majus - C) Paramesonephric duct ,Posterosuperior to uterine cornua ,labium - D) minus - E) Gubernaculum ovarii ,Anteroinferior to uterine cornua ,labium minus Gubernaculum ovarii ,Posterosuperior to uterine cornua ,labium majus Gubernaculum ovarii ,Anteroinferior to uterine cornua ,labium majus

Explanation: Gubernaculum ovarii ,Anteroinferior to uterine cornua ,labium majus Q81. What is the name of structure that shunts oxygenated blood from - A) the right to left atrium in the fetus? - B) Ductus arteriosus - C) Ductus venosus - D) Foramen ovale - E) Ligamentum venosum Pulmonary trunk

Explanation: Foramen ovale

be a Gartner duct. What is the embryological origin of this structure? - A) Cloaca - B) Genital tubercle - C) Mesonephric duct - D) Paramesonephic duct - E) Urogenital septum

Explanation: Gartner's duct, also known as Gartner's canal or the ductus longitudinalis epoophori, is a potential embryological remnant in human female development of the mesonephric duct.

A) Endoderm
B) Intermediate mesoderm
C) Lateral mesoderm
D) Paraxial mesoderm
E) Surface ectoderm

Explanation: Intermediate mesoderm

Q82. The immediate layer around the oocyte of the tertiary follicle is - A) known as the - B) Lamina propria - C) Cumulus oophorus - D) Zona granulosa - E) Zona pellucida Theca interna

Explanation: Zona pellucida Q83. Which artery supplies the structures derived from the midgut of - A) the embryo? - B) Coeliac trunk - C) Inferior mesenteric - D) Middle rectal - E) Renal Superior mesenteric

Explanation: Superior mesenteric

A) Lateral plate mesoderm
B) Extraembryonic mesoderm
C) Splanchnic mesoderm
D) Somatic mesoderm
E) Paraxial mesoderm

Explanation: Paraxial mesoderm Q84. While performing laparoscopy the surgeon identified the medial - A) umbilical folds on the deep surface of the anterior abdominal wall. The - B) two medial umbilical folds represent remnants of which of the following - C) structures? - D) Urachus - E) Inferior epigastric vessels Obliterated umbilical veins Obliterated umbilical arteries Round ligaments of the uterus

Explanation: Obliterated umbilical arteries Q85. Which of the following is in direct contact with maternal blood in - A) lacunae of the placenta? - B) Chorion - C) Amnion - D) Fetal capillaries - E) Fetal endothelium Maternal epithelium

Explanation: The surface of the chorionic villi is formed by the syncytiotrophoblast Syncytiotrophoblasts are multinucleated cells that are located on the outer layer of the chorionic villi. In between the syncytiotrophoblast layer, lacunae form to serve as a direct connection to the maternal blood. Q86. What are the cells in the region represented by Arrow X in the - A) picture called? - B) Decidua - C) Blastocele - D) Inner cell mass - E) Cytotrophoblast cells Syncytiotrophoblast cells

Explanation: (Page 6) 135. 136. 137. 138. 139. 140. 141. 142. 143. 144. 145. 146. 147. 148. 149. 150. 151. 152. 153. 154. 155. 156. 157. 158. 159. 160. 161. 162.

A) 30,000
B) 300,000
C) 3,000,000
D) 30,000,000
E) 300,000,000

Explanation: Each sperm cell takes between 65-75 days to form and around 300 million are produced every day. Q87. Which process establishes the three definitive germ layers? - A) Neurulation - B) Gastrulation - C) Craniocaudal folding - D) Lateral folding - E) Angiogenesis

Explanation: Gastrulation

adult structure? - A) Ligamentum venosum - B) Ligamentum arteriosum - C) Ligamentum teres - D) Medial umbilical ligament - E) Median umbilical ligament

Explanation: Ligamentum venosum Q88. Which part of the endometrium is deep to the fetus and forms the - A) maternal component of the placenta? - B) Decidua capsularis - C) Decidua rubra - D) Decidua vera - E) Decidua basalis Decidua menstruales

Q89. Explanation: - A) Which of the following is a remnant of the mesonephric duct in - B) the female? - C) Round ligament - D) Ovarian ligament - E) Broad ligament Gartner duct Mullerian tubercle

Explanation: - A) Intramural part - B) Isthmus - C) Ampulla - D) Infundibulum - E) Fimbriae

Explanation: Intramural part

division occur? - A) At birth - B) At fertilization - C) At menarche - D) At ovulation - E) Before fertilization

Explanation: Second meiotic division in female egg do not get completed before the entry of sperm. Hence, second meiotic division takes place after ovulation, inside fallopian tube. As the sperm head enters egg cytoplasm, second meiotic division proceeds to its final phase, giving out a second polar body.

A) Theca interna
B) Theca externa
C) Zona pellucida
D) Zona granulosa
E) Lamina propria

Explanation: Theca externa

blastocyst. Which of the following regions is represented by the arrow? Allantois Yolk sac Amniotic cavity Chorionic cavity Extraembryonic coelom

Q90. Explanation: - A) What happened to decidua basalis in third trimester? - B) Remain decidua basalis - C) Become nitabuch - D) Disappear - E) Merge with placenta

Explanation: Decidua basalis remains as Decidua basalis. Decidua capsularis and parietalis merge 4th month in pregnancy. The region of fibrinoid deposition where trophoblasts meet the compact portion of the decidua basalis is called Rohr's layer, while the fibrinoid deposits that occur between the compact and spongy layer of the decidua basalis is termed Nitabuch's layer. Nitabuch layer is a layer of fibrin deposition on Decidua basalis, where placental separation happens at term and defect of which causes placenta accreta. This layer is absent in placenta accreta.

Fetal paraumbilical veins Fetal umbilical arteries Lateral umbilical fold Urachus

Explanation: Fetal umbilical arteries

Q91. Embryological origin of GnRH neurons - A) Neural crest - B) Neural tube - C) Olfactory bulb - D) Hypothalamus

Explanation: Most GnRH neurons are born from stem cells in the nasal placode (embryonic nasal tissue). More recently, it was discovered that a subset of GnRH neurons can trace their origins not from the nasal placode, but from the neural crest earlier in embryogenesis. This subset of cells migrates into the nasal placode, where they intermix with GnRH neurons born in this region, and migrate together into the brain. Q92. Which types of cells are phagocytic for residual bodies left over - A) from the process of spermiogenesis? - B) Testicular mesenchymal cells - C) Testicular macrophages - D) Fibroblast cells - E) Interstitial cells of leydig Sertoli cells

Explanation: One of the functions of Sertoli cells is the phagocytic removal of apoptotic germ cells and residual bodies during spermatogenesis.

A) Ductus arteriosus
B) 4th pharyngeal arch
C) 6th Pharyngeal arch
D) Sinus venousus
E) Dorsal arch

Explanation: Ductus arteriosus Q93. What is the Direct arterial blood supply of decidua ? - A) Uterine artery - B) Basal arteries - C) Spiral arteries - D) Straight arteries - E) Arcuate arteries

Explanation: Spiral arteries are the exclusive supplier of maternal blood to the placenta. Q94. What is the component of Placental barrier at term pregnancy? - A) Endothelium and cytotrophoblast - B) Syncitiotrophoblast & cytotrophoblast - C) Endothelium and connective tissue - D) Syncitiotrophoblast and fetal endothelium - E) Syncitiotrophoblast and connective tissue

Explanation: At term mainly consists of the syncytiotrophoblast (ST) cell and the fetal capillary (FC) endothelial cell. The placental barrier consists of the trophoblastic epithelium, covering the villi, the chorionic connective tissue, and the fetal capillary endothelium. The average thickness of the barrier varies from the first trimester (20–30 µm) to the third trimester (2–4 µm), it gets thinner towards term. Placental Barrier Constituents

external genitalia of male and female is identical ? - A) 6 weeks - B) 12 weeks - C) 20 weeks - D) 25 weeks - E) 30 weeks

Explanation: Gonads are histologically distinguishable by 6–8 weeks of gestation. Males become externally distinct between 8 and 12 weeks, as androgens enlarge the phallus and cause the urogenital groove and sinus to fuse in the midline, producing an unambiguous penis with a phallic urethra, and a thinned, rugated scrotum. Dihydrotestosterone will differentiate the remaining male characteristics of the external genitalia. Q95. Which of the following is male homologous of bartholin gland ? - A) Prostatic gland - B) Skene gland - C) Prostatic utricle - D) Bulbouretheral gland - E) Seminal vesicles

Explanation: Clitoris in female is homologous to glans penis of the males. Skene's glands are homologous with the prostate gland in males, Below and to either side of the urethral orifice are openings of two small ducts leading to the paired lesser vestibular glands (Skene’s glands). Bartholin's gland in females secrete mucus and are homologous to the bulbourethral glands (Cowper gland) of the male.

What is the first sensation developed in the fetus? - A) hearing - B) touch - C) smell - D) taste - E) eyesight

Explanation: This is the very first sense to form, with development starting at around 8 weeks

identified sometimes it is patent. In the adult the patent segment supplies which vessel? - A) internal iliac - B) inferior vesical - C) superior vesical - D) external iliac - E) internal pudendal

Explanation: The umbilical artery gives rise to both a nonfunctional remnant of the fetal circulation and an active vessel giving supply to the bladder. In the adult, the obliterated area of the vessel is identifiable as the medial umbilical ligament and the patent segment is the superior vesical artery.

Q96. In the development of the oocyte, when does the second meiotic - A) division occur? - B) At birth - C) When sperm penetrates the zone pellucida - D) At Ovulation - E) When sperm enters the tube Before the sperm enters the zone pellucida

Explanation: When sperm penetrates the zone pellucida

Q97. A 28-year-old woman has undergone emergency hysterectomy - A) due to obstetric haemorrhage during her 3rd pregnancy. The previous - B) pregnancies were both term C-section deliveries. Examination of the - C) uterus shows the placenta has not invaded the myometrium. - D) What is the most likely diagnosis? - E) Placenta praevia Placenta accreta Placenta increta Invasive mole Placenta percreta

Explanation: Q98. Homologue of round ligament in males - A) Vas deferens - B) Gubernaculum testis - C) Rete testis

Explanation: Males- The upper part of the gubernaculum degenerates. The lower part persists as the gubernaculum testis ("scrotal ligament"). This ligament secures the testis to the most inferior portion of the scrotum, tethering it in place and limiting the degree to which the testis can move within the scrotum.

Q99. Primary mechanism of shunting blood away from the pulmonary - A) circulation - B) Foramen Ovale - C) Ductus Arteriosus - D) Ductus Venosos

Explanation: Foramen Ovale

Q100. Picture of a Testis. Arrow on something looking like Ductus - A) deferens and asking of the embryonic origin - B) Mullerian duct - C) Mesonephric duct - D) Gartners duct

Explanation: Mesonephric duct

Q101. Ductus arteriosus is completely obliterated after birth to form what - A) adult structure? - B) truncus arteriosus - C) 4th aortic arch - D) 6th aortic arch - E) ligamentum arteriosum

Explanation: The ligamentum arteriosum has no useful function. It is a vestige of the ductus arteriosus The ligamentum arteriosum plays a role in major trauma. It fixes the aorta in place during abrupt motions

Q102. placenta previa early confirmed at what gestational age ? - A) 24 weeks - B) 28 weeks - C) 32 weeks - D) Choice 4

Q103. Derivative of Gartner duct cyst?

A) 163.
B) 164.
C) Logout
D) Paramesonephric duct
E) Mesonephric duct

Explanation: Q104. Fetus start to produce urine - A) 6 weeks - B) 10 weeks - C) 12 weeks

Explanation: 12 weeks Q105. Monochorionic and diamniotic occurs at which stage? - A) Morula - B) Blastocyst - C) Implanting blastocyst

Explanation: According to RCOG Before 4 days - DCDA 4-8 days - MCDA 8-12 days - MCMA After 12 days - Conjoint twin

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