🏠/MRCOG Part 1 — Study Book/Appendices/Recalls/2024 07 Recall

2024 07 Recall

July 2024

Crowd-sourced recall questions from the MRCOG Part 1 exam.

Thanks to all colleagues who participated in the Recall discussion in DR. FATH MRCOG telegram groups since This is a part of the preparation course for MRCOG / MRCPI, follow us on https://www.drfathmrcog.com All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers. Ab game arball (sda ayes sleall clus (ya U gusil Y

  1. By how much does the glomerular filtration rate (GFR) increase during pregnancy? A) 0-10% B) 15-20% C) 30-40% D) 50-60% E) 80-90% Answer: C) 30-40% Explanation: GFR increases by approximately 30-40% during pregnancy due to increased renal plasma flow and changes in hormonal regulation, facilitating enhanced clearance of waste products.
  2. Which structure forms the lateral boundary of the ischio-rectal fossa? A) Gluteus maximus B) Gluteus minimus C) Levator ani muscle D) Obturator internus muscle E) Piriformis muscle Answer: D) Obturator internus muscle Explanation: The lateral wall of the ischio-rectal fossa is formed by the obturator internus muscle covered by the obturator fascia.

  3. What is the primary mode of action of methotrexate? A) Acts as a fraudulent nucleotide B) DNA chelating agent C) Inhibition of dihydrofolate reductase D) Inhibition of thymidylate synthase E) Inhibition of topoisomerase II Answer: C) Inhibition of dihydrofolate reductase Explanation: Methotrexate is an antimetabolite that inhibits dihydrofolate reductase, preventing tetrahydrofolate formation essential for DNA synthesis.

  4. How many genes are encoded by mitochondrial DNA? A) 12 B) 19 C) 23 D) 37 E) 58 Answer: D) 37 Explanation: Human mitochondrial DNA encodes 37 genes, including 13 proteins, 22 tRNAs, and 2 rRNAs.

  5. What is the most common inherited coagulation disorder in humans? A) Haemophilia A B) Haemophilia B C) Immune thrombocytopenic purpura (ITP) D) Protein C deficiency E) Von Willebrand Disease (VWD) Answer: E) Von Willebrand Disease (VWD) Explanation: VWD is the most common inherited bleeding disorder caused by a deficiency or dysfunction of von Willebrand factor.

  6. What is the course of the piriformis muscle? A) Anterior (lumbar) surface of sacrum — greater sciatic foramen — greater trochanter B) Pelvic surface of sacrum — greater sciatic foramen — greater trochanter C) Pelvic surface of sacrum — lesser sciatic foramen — greater trochanter D) Pelvic surface of sacrum — lesser sciatic foramen — lesser trochanter E) Pelvic surface of sacrum — lesser sciatic foramen — obturator internus fascia B) Pelvic surface of sacrum — greater sciatic foramen — greater trochanter Explanation: The piriformis originates from the pelvic surface of the sacrum and exits the pelvis through the greater sciatic foramen to insert on the greater trochanter.

  7. In DNA base pairing, which base pairs with adenosine? A) Adenine B) Cytosine C) Guanine D) Thymine E) Uracil Answer: D) Thymine Explanation: In DNA, adenine pairs with thymine via two hydrogen bonds.

  8. How are amino acids transported across the placenta between mother and fetus? A) Active transport B) Direct hematogenous transfer C) Facilitated diffusion D) Passive diffusion E) Receptor-mediated endocytosis Answer: A) Active transport Explanation: Amino acids are transported actively against a concentration gradient through specific transporters in the placenta.

  9. How many telomeres are present on chromosomes during metaphase? A)2 B)4 C) 6 D)8 E) 10 Answer: B) 4 Explanation: Each chromosome has two arms; each arm has one telomere, so a single chromosome has two telomeres. During metaphase, chromosomes are duplicated, resulting in 4 telomeres per chromosome pair.

  10. Which human cell lacks mitochondria? A) Hepatocyte B) Mature red blood cells C) Myocyte D) Nephron cells E) Neurons Answer: B) Mature red blood cells Explanation: Mature erythrocytes lack mitochondria to maximize space for haemoglobin and rely on anaerobic metabolism.

  11. What are the primary bile acids synthesized in the liver? A) Cholic acid and cholic acid B) Cholic acid and chenodeoxycholic acid C) Chenodeoxycholic acid and lithocholic acid D) Deoxycholic acid and lithocholic acid E) Glycocholic acid and taurocholic acid Answer: B) Cholic acid and chenodeoxycholic acid Explanation: These two primary bile acids are synthesized from cholesterol in the liver.

  12. CRISPR/Cas9 gene editing technology consists of: A) Enzyme-enzyme interaction B) DNA-enzyme interaction C) DNA-transcription factor interaction D) Enzyme-DNA interaction E) Protein-protein interaction Answer: C) DNA-transcription factor interaction (Note: According to your document, "CRISPR/CAS 9 DNA - DNA-transcription factor" was indicated) Explanation: CRISPR/Cas9 uses a guide RNA to direct Cas9 (an enzyme) to target specific DNA sequences, acting somewhat like a transcription factor targeting DNA.

  13. At what gestational age does fetal kidneys begin producing urine? A) 6 weeks B) 12 weeks C) 18 weeks D) 24 weeks E) 30 weeks Answer: B) 12 weeks Explanation: Fetal kidneys begin urine production around 12 weeks of gestation, contributing to amniotic fluid.

  14. Which lung volume decreases during pregnancy? A) Functional residual capacity (FRC) B) Minute ventilation (MV) C) Peak flow rate (PFR) D) Tidal volume (TV) E) Vital capacity (VC) Answer: A) Functional residual capacity (FRC) Explanation: FRC decreases due to the upward displacement of the diaphragm by the enlarging uterus.

  15. What is the ratio of T4 to T3 in blood? A) 1:7 B) 2:1 C) 3:1 D) 7:1 E) 14:1 Answer: E) 14:1 Explanation: The blood contains about 14 times more T4 than T3, but T3 is the more biologically active thyroid hormone.

  16. What causes hyperprolactinemia in PCOS? A) Unopposed estrogen B) Opposed estrogen C) Pituitary adenoma D) Hypothyroidism E) Dopamine antagonist drugs Answer: A) Unopposed estrogen Explanation: Chronic anovulation in PCOS leads to unopposed estrogen stimulation, increasing prolactin secretion.

  17. What percentage of pituitary cells are lactotrophs? A) 10-15% B) 20-25% C) 30-35% D) 40-45% E) 50-55% Answer: A) 10-15% Explanation: Lactotrophs comprise about 10-15% of anterior pituitary cells and secrete prolactin.

  18. What stimulates aldosterone release from the adrenal cortex? A) Angiotensin II B) Renin C) Angiotensin I D) ACTH E) Potasstum Answer: A) Angiotensin IT Explanation: Aldosterone secretion is primarily stimulated by angiotensin II as part of the renin-angiotensin-aldosterone system.

  19. What level of HbAIc is considered high risk for congenital anomalies, advising women not to get pregnant? A) 46 mmol/mol B) 56 mmol/mol C) 66 mmol/mol D) 76 mmol/mol E) 86 mmol/mol Answer: E) 86 mmol/mol Explanation: HbAIc levels above 86 mmol/mol (about 10%) are associated with increased risk of congenital anomalies.

  20. SARS in COVID-19 virus is: A) Single-stranded RNA (ssRNA) B) Single-stranded DNA (ssDNA) C) Double-stranded RNA (dsRNA) D) Double-stranded DNA (dsDNA) E) Retrovirus Answer: A) Single-stranded RNA (ssRNA) Explanation: SARS-CoV-2, the virus causing COVID-19, is a single-stranded RNA virus.

  21. Zika virus is classified as: A) Single-stranded RNA (ssRNA) B) Single-stranded DNA (ssDNA) C) Double-stranded RNA (dsRNA) D) Double-stranded DNA (dsDNA) E) Retrovirus Answer: A) Single-stranded RNA (ssRNA) Explanation: Zika virus is a single-stranded RNA flavivirus transmitted by mosquitoes.

  22. The inner cell mass of the blastocyst is formed from: A) Epiblast and hypoblast B) Gastrulation C) Ectoderm, endoderm, and mesoderm D) Cleavage stages E) Trophoblast cells Answer: A) Epiblast and hypoblast Explanation: The inner cell mass differentiates into the epiblast (which forms embryo proper) and hypoblast (which forms extra-embryonic tissues).

  23. The epidural space lies between: A) Arachnoid and pia mater B) Wall of vertebra and dura mater C) Pia mater and ependyma D) Dura mater and arachnoid mater E) Ligamentum flavum and dura mater Answer: B) Wall of vertebra and dura mater Explanation: The epidural space is the potential space between the vertebral canal and dura mater.

  24. The internal anal sphincter is continuous with which muscle? A) Circular muscle of rectum B) Longitudinal muscle of external anal sphincter C) Longitudinal muscle of rectum D) Puborectalis E) Levator ani Answer: A) Circular muscle of rectum Explanation: The internal anal sphincter is a thickening of the circular smooth muscle layer of the rectum.

  25. The superficial and deep perineal spaces are separated by the: A) Endopelvic fascia B) Perineal membrane C) Colle's fascia D) Superficial fascia E) Urogenital diaphragm Answer: B) Perineal membrane Explanation: The perineal membrane separates the superficial perineal pouch from the deep perineal pouch.

  26. Androgens are secreted primarily from which adrenal cortex zone? A) Zona reticularis B) Zona glomerulosa C) Zona fasciculata D) Adrenal medulla E) Zona intermedia Answer: A) Zona reticularis Explanation: The zona reticularis is the innermost layer of the adrenal cortex and secretes androgens.

  27. How does progesterone act as an anti-estrogen at the cellular level? A) Reduces synthesis of estrogen receptor B) Reduces estrone activity C) Inactivates estrogen receptor D) Methylates estrogen E) Inhibits aromatase Answer: A) Reduces synthesis of estrogen receptor Explanation: Progesterone downregulates estrogen receptor expression, reducing estrogen's effects.

  28. When is the second meiotic division completed in oocytes? A) At birth B) At fertilization C) At menarche D) At ovulation E) Before ovulation Answer: B) At fertilization Explanation: The second meiotic division completes only upon fertilization by sperm.

  29. Which structure allows blood flow from the right atrium to the left atrium in the fetus? A) Ductus venosus B) Foramen ovale C) Ductus arteriosus D) Ligamentum arteriosum E) Umbilical vein Answer: B) Foramen ovale Explanation: The foramen ovale is an opening in the atrial septum allowing right￾to-left atrial blood flow in fetal circulation.
  30. In a study of 700 women assessed for preterm labour test, 320 tested positive; of these, 80 had preterm labour. Among 380 test-negative women, 20 had preterm labour. What is the positive predictive value (PPV) of the test? A) 25% B) 33% C) 60% D) 80% E) 95%

Answer: A) 25% Explanation: PPV = True Positives / (True Positives + False Positives) = 80 / 320 = 25%. 31. Thyrotropin-releasing hormone (TRH) is a: A) Decapeptide B) Tripeptide C) Polypeptide D) Octapeptide E) Pentapeptide Answer: B) Tripeptide Explanation: TRH is a tripeptide hormone that stimulates the release of TSH and prolactin. 32. 90% of cases of congenital adrenal hyperplasia (CAH) are caused by a mutation in the CYP21 gene, located on which chromosome? A)6 B) 10 C) 14 D) 18 E) 22 Answer: A) 6 Explanation: The CYP21 gene coding 21-hydroxylase is located on chromosome 6.

  1. The postpartum reduction in uterine size due to shortening of myometrial fibres is called: A) Contraction B) Inversion C) Retraction D) Reduction E) Remodelling Answer: D) Reduction Explanation: Uterine involution primarily occurs by reduction in length of muscle fibres (reduction).
  2. The protective outer layer surrounding the Graafian follicle is the: A) Theca externa B) Theca interna C) Zona pellucida D) Corona radiata E) Cumulus oophorus Answer: A) Theca externa Explanation: The theca externa is a fibrous connective tissue layer protecting the follicle.

  3. Growth hormone secretion shows a circadian rhythm with the highest peak during: A) Early morning B) After exercise C) Afternoon D) Early sleep E) Deep sleep Answer: D) Early sleep Explanation: Growth hormone secretion peaks shortly after sleep onset, during early slow-wave sleep.

  4. The angle that the pelvic brim makes with the horizontal plane is approximately: A) 45 degrees B) 60 degrees C) 90 degrees D) 120 degrees E) 135 degrees Answer: B) 60 degrees Explanation: The pelvic brim is inclined at about 60 degrees to the horizontal plane.

  5. The structure connecting the umbilical vein to the inferior vena cava (IVC) is: A) Ductus venosus B) Foramen ovale C) Ductus arteriosus D) Ligamentum teres E) Umbilical artery Answer: A) Ductus venosus Explanation: Ductus venosus shunts oxygenated blood from the umbilical vein to the IVC.
  6. The difference between jejunum and ileum includes: A) Jejunum is thin-walled, longer, with long arcades; ileum is thick-walled, shorter with short arcades B) Jeyunum is thin-walled, longer, with short arcades; ileum is thick-walled, shorter with long arcades C) Jejunum is thick-walled, shorter with long arcades; ileum is thin-walled, longer with short arcades D) Jeyunum and ileum have similar walls and arcades E) Jejunum is more vascular than ileum

Answer: C) Jejunum is thick-walled, shorter with long arcades; ileum is thin￾walled, longer with short arcades Explanation: Jeyunum has thicker walls and longer arterial arcades, while ileum has thinner walls and shorter arcades. 39. The motor supply to the detrusor muscle of the bladder is derived from: A) Pelvic splanchnic nerve B) Pudendal nerve C) Inferior hypogastric plexus D) Superior hypogastric plexus E) Lumbar sympathetic nerves Answer: A) Pelvic splanchnic nerve Explanation: Parasympathetic fibres from pelvic splanchnic nerves stimulate detrusor contraction. 40. In vacuum (ventouse) delivery, the cup is placed on the: A) Temporal bone B) Frontal bone C) Sagittal suture D) Coronal suture E) Occipital bone Answer: C) Sagittal suture Explanation: The cup is placed over the flexion point near the sagittal suture to facilitate safe traction. 41. The lateral wall of the ischio-rectal fossa is formed by: A) Levator ani B) Anal sphincter C) Obturator internus

D) Obturator externus E) Gluteus maximus Answer: C) Obturator internus Explanation: The obturator internus muscle forms the lateral boundary of the ischio-rectal fossa. 42. Which phase of the cell cycle immediately precedes mitosis? A) G1 phase B) G2 phase C) S phase D) M phase E) GO phase Answer: B) G2 phase Explanation: The G2 phase is the gap following DNA synthesis and before mitosis. 43. The variable type for ‘country of birth' is: A) Category B) Nominal C) Ratio D) Interval E) Ordinal Answer: B) Nominal Explanation: Country of birth is a nominal categorical variable with no intrinsic order.

  1. Which nerve, other than the pudendal nerve, arises from the sacral plexus? A) Sciatic nerve B) Genitofemoral nerve C) Lateral femoral cutaneous nerve D) Femoral nerve E) Obturator nerve Answer: A) Sciatic nerve Explanation: The sciatic nerve originates from the sacral plexus along with the pudendal nerve.
  2. The appendix of the testis originates from which embryological structure? A) Paramesonephric (Miillerian) duct B) Mesonephric (Wolffian) duct C) Urogenital sinus D) Genital tubercle E) Gonadal ridge Answer: A) Paramesonephric (Miullerian) duct Explanation: The appendix testis is a remnant of the paramesonephric duct.

  3. The bulbourethral gland is located in which anatomical space? A) Deep perineal pouch B) Superficial perineal pouch C) Ischio-rectal fossa D) Deep inguinal space E) Retropubic space Answer: B) Superficial perineal pouch Explanation: The bulbourethral glands lie within the superficial perineal pouch.

  4. The embryonic origin of the trigone of the bladder is: A) Ureteric bud B) Urogenital sinus C) Mesonephric duct D) Paramesonephric duct E) Cloaca Answer: C) Mesonephric duct Explanation: The trigone develops from the mesonephric duct (Wolffian duct) embryologically.

  5. The posterior fontanelle typically closes by: A) 3 months B) 6 months C) 9 months D) 12 months E) 18 months Answer: A) 3 months Explanation: The posterior fontanelle usually closes by 3 months of age.

  6. The positive likelihood ratio is calculated as: A) Sensitivity / (1 - Specificity) B) Sensitivity - Specificity C) Sensitivity + (1 - Specificity) D) (1 - Sensitivity) / Specificity E) Specificity / Sensitivity Answer: A) Sensitivity / (1 - Specificity) Explanation: A Positive likelihood ratio indicates how much the odds of disease increase when a test is positive.

  7. Standard error of the mean (SEM) is calculated as: A) SD x YN B) SD/N C) SD/ VN D) Mean / SD E) Variance / N Answer: C) SD / VN Explanation: SEM is the standard deviation divided by the square root of the sample size.

  8. What is the approximate failure rate of laparoscopic tubal ligation and vasectomy as contraceptive methods? A) 1/2000 for both B) 1/200 for both C) 1/200 for tubal ligation and 1/2000 for vasectomy D) 1/1000 for tubal ligation and 1/2000 for vasectomy E) 1/100 for both Answer: C) 1/200 for tubal ligation and 1/2000 for vasectomy Explanation: Vasectomy is more effective, with lower failure rates than tubal ligation.

  9. After ovulation, the endometrium becomes: A) Luteal phase B) Secretory phase C) Proliferative phase D) Menstrual phase E) Ischemic phase Answer: B) Secretory phase Explanation: Progesterone from corpus luteum induces secretory changes post￾ovulation.

  10. The highest incidence of cervical cancer occurs in women aged: A) 20-24 B) 30-34 C) 40-44 D) 50-54 E) 60-64 Answer: E) 60-64 Explanation: Peak incidence of invasive cervical cancer is seen in women aged 60-64.

  11. The most abundant protein in colostrum is: A) Casein B) Galactose C) Lactalbumin D) Lactoglobulin E) Lactoferrin Answer: A) Casein Explanation: Casein is the major milk protein, especially abundant in colostrum.

  12. Which receptor causes bronchodilation, vasodilation, and increased glucagon release? A) Alpha-2 (a2) B) Histamine-2 (H2) C) Dopamine-2 (D2) D) Beta-2 (B2) E) Muscarinic-2 (M2) Answer: D) Beta-2 (B2) Explanation: B2 receptors mediate smooth muscle relaxation and increase glucagon secretion.

  13. A 32-year-old pregnant woman has an anomaly scan at 20 weeks showing clenched hands, low-set ears, and rocker-bottom feet. The most likely diagnosis is: A) Gilbert syndrome B) Patau syndrome C) Edward syndrome D) Down syndrome E) Turner syndrome Answer: C) Edward syndrome (Trisomy 18) Explanation: These features are classic for Trisomy 18.

  14. A woman with 5 children (1 CS, 2 NVD, 2 forceps deliveries) complains of urine leakage on coughing or lifting a heavy weight. The most likely cause is: A) Pelvic organ prolapses B) Weak pelvic floor muscles C) Cystocele D) Stress urinary incontinence E) Urge urinary incontinence Answer: D) Stress urinary incontinence Explanation: Leakage with increased intra-abdominal pressure indicates stress incontinence.

  15. Which structure attaches to the iliac tuberosity? A) Coccygeus B) Inguinal ligament C) Iliolumbar ligament D) Sacroiliac ligament E) Sacrotuberous ligament Answer: D) Sacroiliac ligament Explanation: The sacroiliac ligament attaches to the iliac tuberosity stabilizing the sacroiliac joint.

  16. The SI unit for measuring radioactivity is: A) Gray B) Sievert C) Rad D) Roentgen E) Becquerel Answer: E) Becquerel Explanation: Becquerel measures radioactive decay (disintegrations per second).

  17. Syndrome with complete or partial absence of one X chromosome is: A) Turner syndrome B) Down syndrome C) Edward syndrome D) Patau syndrome E) Klinefelter syndrome Answer: A) Turner syndrome Explanation: Turner syndrome results from monosomy X (45,X).

  18. Robertsonian translocations involve which chromosomes? A) 11, 12, 13, 14, 15 B) 13, 14, 15, 21, 22 C) 21, 22, 23, 24, 25 D) 14, 15, 16, 17, 18 E) 1, 2,3, 4,5 Answer: B) 13, 14, 15, 21, 22 Explanation: Robertsonian translocations commonly occur between acrocentric chromosomes 13,14,15,21, and 22.

  19. According to RCOG, grade B recommendation corresponds to: A) Randomized controlled trials (RCT) without meta-analysis B) Expert opinion C) Well-controlled study without randomization D) Well-designed controlled study with or without randomization E) Meta-analysis of RCTs Answer: C) Well-controlled study without randomization Explanation: Grade B evidence is from well-controlled non-randomized studies.

  20. Which HPV types are most commonly associated with cervical cancer? A) HPV 6 and 11 B) HPV 16 and 18 C) HPV 31 and 33 D) HPV 45 and 52 E) HPV 58 and 59 Answer: B) HPV 16 and 18 Explanation: HPV 16 and 18 cause approximately 70% of cervical cancers.

  21. Hyperventilation during panic attack causes: A) Respiratory alkalosis B) Respiratory acidosis C) Metabolic acidosis D) Metabolic alkalosis E) Normal blood gases Answer: A) Respiratory alkalosis Explanation: Hyperventilation lowers CO2, leading to respiratory alkalosis.

  22. Major histocompatibility complex (MHC) class I antigens NOT expressed by extravillous cytotrophoblasts include: A) HLA-A and HLA-B B) HLA-B and HLA-C C) HLA-C and HLA-D D) HLA-G E) HLA-DQ and HLA-DR Answer: A) HLA-A and HLA-B Explanation: Extravillous trophoblasts lack HLA-A and HLA-B but express HLA-C and HLA-G.

  23. Chickenpox virus belongs to which family? A) Adenovirus B) Herpesvirus C) Poxvirus D) Polyomavirus E) Papillomavirus Answer: B) Herpesvirus Explanation: Varicella-zoster virus is a member of the herpesvirus family.

  24. Apixaban’s mechanism of action is: A) Factor V inhibitor B) Factor Xa inhibitor C) Thrombin inhibitor D) Vitamin K antagonist E) Platelet aggregation inhibitor Answer: B) Factor Xa inhibitor Explanation: Apixaban selectively inhibits Factor Xa.

  25. Metronidazole acts by: A) Covalent binding to microbial DNA B) Inhibiting cell wall synthesis C) Inhibiting folate synthesis D) Blocking protein synthesis E) Disrupting bacterial membranes Answer: A) Covalent binding to microbial DNA Explanation: Metronidazole causes DNA strand breaks by covalent binding in anaerobic bacteria.

  26. HLA antigens often absent in recurrent implantation failure include: A) HLA-A and HLA-B B) HLA-B and HLA-C C) HLA-C and HLA-D D) HLA-DQ and HLA-DR E) HLA-G Answer: E) HLA-G Explanation: HLA-G expression is important for implantation; absence may contribute to failure.

  27. Ovarian cancer associated with endometriosis is commonly: A) Serous adenocarcinoma B) Endometrioid carcinoma C) Mucinous carcinoma D) Clear cell carcinoma E) Germ cell Tumor Answer: D) Clear cell carcinoma Explanation: Clear cell carcinoma is strongly linked with endometriosis.

  28. The typical endometrial pattern seen in granulosa cell tumors is: A) Luteal phase B) Secretory phase C) Proliferative phase D) Atrophic E) Hyperplastic Answer: C) Proliferative phase Explanation: Granulosa cell tumours secrete estrogen, causing proliferative endometrium.

  29. What percentage of Brenner cell tumours of the ovary are malignant? A) 5% B) 10% C) 15% D) 20% E) 25% Answer: A) 5% Explanation: Brenner tumours are usually benign; around 5% are malignant.

  30. What percentage of Leydig cell tumours of the ovary are malignant? A) 5-10% B) 15-20% C) 25-30% D) 35-40% E) 45-50% Answer: A) 5-10% Explanation: Leydig cell tumours have low malignant potential (~5-10%).

  31. The primary pathology causing renal damage in pre-eclampsia is: A) Glomerulonephritis B) Vascular endothelial injury C) Pyelonephritis D) Tubular necrosis E) Interstitial nephritis Answer: B) Vascular endothelial injury Explanation: Endothelial dysfunction leads to glomerular damage and proteinuria.

  32. 90% of genital and anal warts are caused by which HPV types? A) HPV 6 and 11 B) HPV 16 and 18 C) HPV 31 and 33 D) HPV 45 and 52 E) HPV 58 and 59 Answer: A) HPV 6 and 11 Explanation: Low-risk types of HPV 6 and 11 cause most genital warts.

  33. Ovarian cancer associated with a BRCA mutation is usually: A) Clear cell carcinoma B) Serous cystadenocarcinoma C) Endometrioid carcinoma D) Mucinous carcinoma E) Germ cell Tumor Answer: B) Serous cystadenocarcinoma Explanation: BRCA mutations predispose to high-grade serous ovarian carcinoma.

  34. A 71-year-old woman has a unilateral simple ovarian cyst 3 mm in size and CA-125 of 25. What is the Risk of Malignancy Index (RMI)? A)0 B) 25 C) 75 D) 150 E) 225 Answer: A) 0 Explanation: Simple cyst and normal CA-125 indicate low risk; RMI is essentially zero.

  35. Schiller-Duval bodies are characteristic of which tumour? A) Choriocarcinoma B) Yolk sac tumour C) Dysgerminoma D) Teratoma E) Endometrial sinus tumour Answer: B) Yolk sac tumour Explanation: Schiller-Duval bodies are pathognomonic for yolk sac tumours.

  36. A patient has slight vaginal bleeding, irregular periods, and ultrasound shows intrauterine gestational sac with fetal pole CRL 6 mm but no fetal heart rate. The next best step is: A) Admit and start mifepristone B) Arrange the evacuation of retained products C) Arrange a laparoscopy D) Check serum beta-hCG E) Repeat ultrasound in 7-10 days Answer: D) Check serum beta-hCG Explanation: Confirm viability with serial beta-hCG before further management.

  37. A woman 150 cm tall, weighing 90 kg, has a BMI of 40. What category does she belong to? A) Normal weight B) Overweight C) Obesity Class I D) Obesity Class II E) Obesity Class III Answer: E) Obesity Class III Explanation: BMI > 40 defines Class HI obesity (morbid obesity).

  38. A 65-year-old postmenopausal woman with urinary frequency and dysuria is treated with topical estrogen. The improvement is mainly due to its effect on: A) Bladder mucosa B) Bladder trigone C) Lower vagina D) Upper vagina E) External genitalia Answer: B) Bladder trigone Explanation: Estrogen improves urogenital atrophy and urinary symptoms via effects on bladder trigone.

  39. The most common type of episiotomy performed in the UK is: A) Mediolateral B) Median C) Paramedian D) Lateral E) J-shaped Answer: A) Mediolateral Explanation: Mediolateral episiotomy is favoured in the UK to reduce risk of anal sphincter injury.

  40. The most common type of fallopian tube malignancy is: A) Serous carcinoma B) Transitional carcinoma C) Clear cell carcinoma D) Endometrioid carcinoma E) Mucinous carcinoma Answer: A) Serous carcinoma Explanation: High-grade serous carcinoma is the most common malignancy in fallopian tubes.

  41. The risk of miscarriage following amniocentesis is approximately: A) 1% B) 5% C) 10% D) 15% E) 20% Answer: A) 1% Explanation: Procedure-related miscarriage risk after amniocentesis is about 1%.

  42. Elevated serum LDH levels are commonly seen in: A) Dysgerminoma B) Brenner cell tumour C) Immature teratoma D) Endodermal sinus tumour E) Granulosa cell tumour Answer: A) Dysgerminoma Explanation: Dysgerminomas secrete LDH, making it a useful tumour marker.

  43. A normal T-score on bone density testing is: A) Above -1 B) Below -1 C) Above -2.5 D) Below -2.5 E) Between -1 and -2.5 Answer: A) Above -1 Explanation: T-score > -1 indicates normal bone density.

  44. The 'sparkling' effect seen in coagulation over a large area is termed: A) Fulguration B) Coagulation C) Vaporization D) Desiccation E) Electrosection Answer: A) Fulguration Explanation: Fulguration is superficial coagulation with electric spark effects.

  45. Carboprost is a synthetic analogous of: A) PGE1 B) PGE2 C) PGF2a D) PGI2 E) Thromboxane A2 Answer: C) PGF2a Explanation: Carboprost mimics PGF2q and is used for uterine contraction.

  46. Natural killer (NK) cells develop from which type of cell? A) Lymphocyte B) Monocyte C) Basophil D) Neutrophil E) Eosinophil Answer: A) Lymphocyte Explanation: NK cells are lymphoid lineage innate immune cells.

  47. Lactational mastitis is most commonly caused by: A) Staphylococcus aureus B) Group B Streptococcus C) Lactobacilli D) Escherichia coli E) Candida albicans Answer: A) Staphylococcus aureus Explanation: S. aureus is the primary pathogen in lactational mastitis.

  48. The infectious period of chickenpox is: A) 2 days before rash and 2 days after crust disappears B) 2 days before rash until crust appears C) 10—14 days after rash appears D) 24 hours after rash appears E) When lesions are crusted Answer: B) 2 days before rash until crust appears Explanation: Varicella is contagious from about 2 days before rash onset until lesions crust over.

  49. Botulinum toxin injection treats an overactive bladder by: A) Stimulating acetylcholine release B) Inhibiting acetylcholine release at neuromuscular junction C) Blocking adrenergic receptors D) Enhancing detrusor muscle contractility E) Acting as a muscarinic agonist Answer: B) Inhibiting acetylcholine release at neuromuscular junction Explanation: Botulinum toxin blocks presynaptic acetylcholine release, relaxing bladder muscle.

  50. A pregnant woman with a rash and joint pain in the first trimester has an ultrasound showing isolated fetal ascites. The most likely infection is: A) Parvovirus B19 B) Varicella-zoster virus C) Toxoplasmosis D) Cytomegalovirus E) Rubella Answer: D) Cytomegalovirus Explanation: CMV can cause fetal hydrops, including ascites and non-structural defects.

  51. Finasteride inhibits which enzyme? A) 3B-Hydroxysteroid dehydrogenase B) 5a-Reductase C) 17B-Hydroxysteroid dehydrogenase D) 21-Hydroxylase E) Aromatase Answer: B) 5a-Reductase Explanation: Finasteride inhibits 5a-reductase converting testosterone to dihydrotestosterone.

  52. The mode of action of atosiban is: A) Progesterone agonist B) Progesterone antagonist C) Oxytocin antagonist D) Oxytocin agonist E) Prostaglandin inhibitor Answer: C) Oxytocin antagonist Explanation: Atosiban blocks oxytocin receptors, inhibiting uterine contractions.

  53. A woman dies at 38 weeks gestation due to a road traffic accident. The maternal death classification is: A) Coincident maternal death B) Direct maternal death C) Indirect maternal death D) Perinatal death E) Late maternal death Answer: B) Direct maternal death Explanation: Death from trauma during pregnancy is classified as a direct maternal death.

  54. A pregnant woman dies 2 weeks postpartum from asthma complications. The maternal death classification is: A) Coincidental maternal death B) Direct maternal death C) Indirect maternal death D) Perinatal death E) Late maternal death Answer: C) Indirect maternal death Explanation: Death from a pre-existing medical condition aggravated by pregnancy is indirect.

  55. The most common cause of delayed puberty in males is: A) Idiopathic constitutional delay B) Gonadal dysgenesis with normal karyotype C) Kallmann syndrome D) Klinefelter syndrome E) Orchitis Answer: A) Idiopathic constitutional delay Explanation: Most cases of delayed puberty are constitutional and benign.

  56. The most common cause of hyperthyroidism is: A) Graves' disease B) Hashimoto thyroiditis C) Toxic multinodular goiter D) Thyroid adenoma E) Thyroiditis Answer: A) Graves' disease Explanation: Graves' disease is the leading cause of hyperthyroidism.

  57. The genotype of a partial hydatidiform mole is usually: A) 46, XX B) 69, XXY C) 47, XXX D) 45, X E) 46, XY Answer: B) 69, XXY Explanation: Partial moles are typically triploid with 69 chromosomes.

  58. Duchenne muscular dystrophy inheritance is: A) Autosomal dominant B) Autosomal recessive C) X-linked recessive D) X-linked dominant E) Mitochondrial inheritance Answer: C) X-linked recessive Explanation: Duchenne dystrophy is inherited via an X-linked recessive pattern.

  59. The biologically active metabolite of vitamin D is: A) 1,25-Dihydroxycholecalciferol (calcitriol) B) 25-Hydroxyvitamin D C) Vitamin D2 (ergocalciferol) D) Vitamin D3 (cholecalciferol) E) 24,25-Dihydroxyvitamin D Answer: A) 1,25-Dihydroxycholecalciferol (calcitriol) Explanation: Calcitriol is the active hormonal form regulating calcium homeostasis.

  60. The progesterone receptor is: A) Nuclear transcription factor receptor B) Membrane receptor C) G-protein coupled receptor D) Ion channel receptor E) Tyrosine kinase receptor Answer: A) Nuclear transcription factor receptor Explanation: Progesterone acts through intracellular nuclear receptors regulating gene transcription.

  61. A woman with secondary amenorrhea and high FSH, LH, and TSH on repeated tests most likely has: A) Polycystic ovarian syndrome (PCOS) B) Premature ovarian insufficiency (POI) C) Kallmann syndrome D) Sheehan syndrome E) Hypothyroidism Answer: B) Premature ovarian insufficiency (POT) Explanation: High gonadotropins indicate ovarian failure in POI.

  62. In a diagnostic test scenario with 44 positive TVUS cases: 36 true positive (TP), 9 false positive (FP), 2 false negative (FN), and 26 true negative (TN), the positive predictive value (PPV) is: A) 0.75 B) 0.80 C) 0.85 D) 0.90 E) 0.95 Answer: B) 0.80 Explanation: PPV = TP / (TP + FP) = 36/ (36 + 9) = 0.80.

  63. An odds ratio calculation gives which of the following values? A) 0.5 B) 2 C)4 D) 10 E) 20 Answer: C) 4 Explanation: This is an example; odds ratios >1 indicate increased odds.

  64. The anterior superior iliac spine is the attachment site of: A) Inguinal ligament B) Coccygeus ligament C) Obturator internus D) Sacroiliac ligament E) Sacrotuberous ligament Answer: A) Inguinal ligament Explanation: The inguinal ligament extends from the anterior superior iliac spine to the pubic tubercle.

  65. A non-pregnant woman with generalized fatigue has elevated ALP (230), with normal ALT, GGT, albumin, and bilirubin. The most likely cause is: A) Epstein-Barr virus infection B) Non-alcoholic fatty liver disease C) Hepatitis D) Gallstones E) Vitamin D deficiency Answer: E) Vitamin D deficiency Explanation: Vitamin D deficiency can cause elevated ALP due to bone turnover.

  66. The preferred contraceptive for a 28-year-old epileptic woman on carbamazepine is: A) Depot medroxyprogesterone acetate (DMPA) B) High-dose combined oral contraceptive pill (COCP) C) Levonorgestrel-releasing intrauterine system (Mirena) D) Implant E) Progestogen-only pill (POP) Answer: C) Levonorgestrel-releasing intrauterine system (Mirena) Explanation: Mirena is unaffected by enzyme-inducing drugs like carbamazepine.

  67. A pregnant woman’s LMP is 6 weeks ago, urine pregnancy test positive, and transvaginal scan shows an intrauterine sac with MSD 23 mm but no visible fetal pole. The diagnosis is: A) Pregnancy of unknown viability B) Missed miscarriage C) Anembryonic pregnancy D) Ectopic pregnancy E) Threatened miscarriage Answer: A) Pregnancy of unknown viability Explanation: Absence of fetal pole with sac size <25 mm needs repeat scan; viability uncertain.

  68. A woman returning from northern South America has reactive VDRL but non-reactive TP-PA and FTA-Abs tests. The most likely interpretation is: A) Past treated syphilis B) Latent syphilis C) Early syphilis D) Biological false positive E) Active syphilis Answer: D) Biological false positive Explanation: Reactive non-treponemal but non-reactive treponemal tests suggest a false positive.
  69. Ultrasound causes tissue lysis primarily by: A) Cavitation B) Reflection C) Scatter D) Heating E) Absorption

Answer: A) Cavitation Explanation: Cavitation causes microbubble formation and collapse leading to cell damage. 114. Which drug is known to cause ototoxicity (deafness)? A) Carbimazole B) Phenobarbital C) Phenytoin D) Methyldopa E) Streptomycin Answer: E) Streptomycin Explanation: Aminoglycosides like streptomycin are ototoxic antibiotics. 115. Red degeneration of fibroid is caused by: A) Ischemia of fibroid B) Infection C) Haemorrhage D) Malignant transformation E) Cystic degeneration Answer: A) Ischemia of fibroid Explanation: Rapid growth causes infarction and red degeneration. 116. The Kleihauer test identifies: A) Degree of fetomaternal haemorrhage B) Fetal Rh status C) Maternal Rh status D) Fetal haemolysis E) Maternal haemoglobin level

Answer: A) Degree of fetomaternal haemorrhage Explanation: It quantifies fetal red cells in maternal blood. 117. Second-generation progesterone used in contraception is: A) Levonorgestrel B) Norethisterone C) Desogestrel D) Drospirenone E) Medroxyprogesterone Answer: A) Levonorgestrel Explanation: Levonorgestrel is a second-generation synthetic progestogen. 118. A female patient with inferior myocardial infarction and multiple drug abuse; which drug is commonly implicated? A) Heroin B) Cocaine C) Benzodiazepines D) Amphetamine E) Methadone Answer: B) Cocaine Explanation: Cocaine induces vasospasm and thrombosis causing MI. 119. In HIV infection, which cell type undergoes lysis? A) CD4+ T cells B) CD8+ T cells C) B cells D) Macrophages E) Natural killer cells

Answer: A) CD4+ T cells Explanation: HIV primarily infects and depletes CD4+ T helper cells. 120. For suppression of lactation after stillbirth, the drug of choice is: A) Cabergoline B) Metoclopramide C) Methyldopa D) Cyclizine E) Bromocriptine Answer: A) Cabergoline Explanation: Cabergoline inhibits prolactin, suppressing milk production. 121. On Doppler ultrasound, the direction of blood flow towards the transducer is usually shown as: A) Blue B) Green C) Orange D) Red E) Yellow Answer: D) Red Explanation: By convention, red indicates flow towards the transducer. 122. Magnesium is primarily excreted by: A) Kidney unchanged B) Liver metabolism C) Fecal elimination D) Sweat glands E) Pulmonary excretion

Answer: A) Kidney unchanged Explanation: Magnesium is filtered and excreted primarily by the kidneys. 123. Non-ergot dopamine agonist used for lactation suppression is: A) Quinagolide B) Cabergoline C) Bromocriptine D) Metoclopramide E) Domperidone Answer: A) Quinagolide Explanation: Quinagolide is a non-ergot dopamine agonist used for prolactin suppression. 124. A woman has Hb 11 g/dL, MCV 65 fl, ferritin 97 ug/L, and CRP 78 mg/L. The likely deficiency is: A) Vitamin B12 deficiency B) Folate deficiency C) Iron deficiency D) Lead poisoning E) Hypothyroidism Answer: C) Iron deficiency Explanation: Low MCV with normal/high ferritin but raised CRP suggests functional iron deficiency.

  1. A pregnant woman has positive HCV antibody but negative HCV PCR. This indicates: A) Chronic infection B) Past infection or cleared virus C) Acute infection D) False positive antibody test E) Vaccinated Answer: B) Past infection or cleared virus Explanation: PCR negativity indicates no active viremia.
  2. A pregnant woman exposed to chickenpox has VZV IgG positive and IgM negative. This indicates: A) Immunity to varicella infection B) Acute infection C) Susceptible to infection D) False positive IgG E) Active infection Answer: A) Immunity to varicella infection Explanation: IgG positivity with negative IgM indicates past immunity.

  3. A pregnant woman has HBsAg positive, anti-HBs negative, anti-HBc IgG positive, and anti-HBc IgM negative. The most likely diagnosis is: A) Vaccinated B) Susceptible C) Chronic carrier D) Acute HBV infection E) Resolved infection Answer: C) Chronic carrier Explanation: Positive HBsAg with anti-HBc IgG positive and IgM negative indicates chronic carrier state.

  4. The main side effect of progestogen-only pills (POP) is: A) Deep vein thrombosis B) Hypertension C) Migraine D) Erratic bleeding E) Ectopic pregnancy Answer: D) Erratic bleeding Explanation: Irregular bleeding is common with POP use.

  5. The primary mechanism of combined oral contraceptive pills (COCP) is: A) Inhibition of ovulation B) Inhibition of implantation C) Interference with ovum and sperm viability D) Local uterine inflammation E) Thickening of cervical mucus Answer: A) Inhibition of ovulation Explanation: COCP mainly prevent ovulation via suppression of gonadotropins.

  6. The best fetal abnormality associated with warfarin use is: A) Nasal hypoplasia B) Cardiac defects C) Neural tube defects D) Limb reduction defects E) Cleft palate Answer: A) Nasal hypoplasia Explanation: Warfarin embryopathy includes nasal hypoplasia and stippled epiphyses.

  7. Iodine uptake into thyroid cells is co-transported with: A) Sodium B) Magnesium C) Chloride D) Potassium E) Calctum Answer: A) Sodium Explanation: Iodide is transported into thyroid follicular cells by a soditum-iodide symporter.

  8. A 32-week pregnant woman has a positive Group B Streptococcus (GBS) urine culture >1000 CFU/mL with dysuria. The management is: A) Treat UTI and give intrapartum antibiotic prophylaxis (IAP) during labour B) Treat UTI, do urine culture, no need for IAP if culture negative C) Give IAP only during labour D) Treat UTI and consider IAP during labour E) No treatment needed Answer: D) Treat UTI and consider IAP during labour Explanation: Treat infection and administer IAP to reduce neonatal GBS infection risk.

  9. Paralytic ileus is commonly associated with which electrolyte disturbance? A) Hypokalaemia B) Hyperkalaemia C) Hypocalcaemia D) Hypercalcemia E) Hyponatremia Answer: A) Hypokalaemia Explanation: Low potassium impairs gut motility, causing ileus.

  10. In pelvic floor operative delivery, when the fetal head is on the pelvic floor, the type of forceps used is: A) Inlet forceps B) Outlet forceps C) Low forceps D) High forceps E) Caesarean section Answer: B) Outlet forceps Explanation: Outlet forceps are used when the head is visible at the introitus.

  11. Neisseria gonorrhoeae is a: A) Gram-negative aerobic cocci B) Gram-negative aerobic bacilli C) Gram-positive anaerobic cocci D) Gram-positive aerobic bacilli E) Gram-negative anaerobic bacilli Answer: A) Gram-negative aerobic cocci Explanation: Gonococcus is a gram-negative diplococcus requiring aerobic conditions.

  12. The treatment of herpes simplex virus (HSV) infection is: A) Acyclovir B) Penicillin C) Ciprofloxacin D) Metronidazole E) Fluconazole Answer: A) Acyclovir Explanation: Acyclovir inhibits viral DNA polymerase and treats HSV infections.

  13. Ultrasound finding of fetal ascites in pregnancy is most commonly associated with: A) Cytomegalovirus (CMV) infection B) Rubella infection C) Parvovirus B19 infection D) Toxoplasmosis E) Syphilis Answer: C) Parvovirus B19 infection Explanation: Parvovirus causes fetal anaemia and hydrops, including ascites.

  14. A pregnant woman has flu-like symptoms and delivers a baby with jaundice, hepatosplenomegaly, and bradycardia. The most likely infection is: A) Listeria monocytogenes B) Varicella-zoster virus C) Herpes simplex virus D) Cytomegalovirus E) Rubella Answer: A) Listeria monocytogenes Explanation: Listeriosis can cause neonatal sepsis with jaundice and hepatosplenomegaly.

  15. Which analgesic should NOT be given to breastfeeding mothers? A) Tramadol B) Naproxen C) Morphine D) Paracetamol E) Ibuprofen Answer: A) Tramadol Explanation: Tramadol is contraindicated due to risk of neonatal respiratory depression.

  16. The structure that penetrates the hepatic diverticulum during development is the: A) Septum transversum B) Vitelline duct C) Allantois D) Urachus E) Omphalomesenteric duct Answer: A) Septum transversum Explanation: Septum transversum forms the diaphragm and contributes to liver mesenchyme.

  17. Prophylactic low molecular weight heparin (LMWH) should be stopped how long before regional anaesthesia? A) 12 hours B) 24 hours C) 36 hours D) 48 hours E) 72 hours Answer: A) 12 hours Explanation: Guidelines recommend stopping prophylactic LMWH 12 hours before neuraxial blocks.

  18. The steroidogenesis pathway includes: A) DHEA — androstenedione — testosterone B) Cholesterol -- DHEA — cortisol C) Progesterone — aldosterone — cortisol D) Testosterone — estradiol — cortisol E) DHEA — progesterone — aldosterone Answer: A) DHEA — androstenedione — testosterone Explanation: DHEA is converted to androstenedione, which is converted to testosterone.

  19. Northern blot analysis detects: A) RNA B) DNA C) Protein D) Lipids E) Carbohydrates Answer: A) RNA Explanation: Northern blotting is used to detect specific RNA sequences.

  20. Maternal antibodies protecting the fetal gut are predominantly: A) IgA B) IgG C) IgM D) IgE E) IgD Answer: A) IgA Explanation: Secretory IgA is present in colostrum and protects the neonatal gut.

  21. Bendroflumethiazide causes which ECG change? A) Hypokalaemia B) Hyperkalaemia C) Hypocalcaemia D) Hypercalcemia E) Prolonged QT Answer: A) Hypokalaemia Explanation: Thiazides increase potassium excretion, leading to hypokalaemia.

  22. Chancroid is caused by: A) Haemophilus ducreyi B) Treponema pallidum C) Neisseria gonorrhoeae D) Herpes simplex virus E) Gardnerella vaginalis Answer: A) Haemophilus ducreyi Explanation: Haemophilus ducreyi causes painful genital ulcers characteristic of chancroid.

  23. The major urinary buffer is: A) Phosphate B) Chloride C) Sodium D) Potassium E) Bicarbonate Answer: A) Phosphate Explanation: Phosphate acts as a major urinary buffer to maintain acid-base balance.

  24. A history of heavy bleeding after hysterectomy specimen shows: A) Endometrial polyp B) Adenomyosis C) Fibroids D) Endometrial hyperplasia E) Malignancy Answer: A) Endometrial polyp Explanation: Polyps are common benign causes of abnormal uterine bleeding.

  25. A specimen showing heavy menstrual bleeding and dysmenorrhea after hysterectomy is most likely: A) Adenomyosis B) Endometriosis C) Leiomyoma D) Endometrial carcinoma E) Pelvic inflammatory disease Answer: A) Adenomyosis Explanation: Adenomyosis causes menorrhagia and dysmenorrhea due to ectopic endometrium.

  26. The sensory innervation of the ovary corresponds to which spinal segment? A)T10 B) T12 C) L2 D) $2 E)L4 Answer: A) T10 Explanation: Ovarian pain refers to the T10 dermatome.

  27. Autosomal dominant inheritance is characteristic of which condition? A) Huntington’s disease B) Cystic fibrosis C) Duchenne muscular dystrophy D) Haemophilia A E) Sickle cell anaemia Answer: A) Huntington’s disease Explanation: Huntington’s disease is inherited in an autosomal dominant pattern.

  28. Identify the structure: a yellowish hormone-secreting ovarian structure present after ovulation. A) Corpus luteum B) Corpus albicans C) Graafian follicle D) Primordial follicle E) Theca interna Answer: A) Corpus luteum Explanation: Corpus luteum forms from the ruptured follicle and secretes progesterone.

  29. Identify the cavity surrounding the fetus in early pregnancy: A) Amniotic cavity B) Chorionic cavity C) Yolk sac D) Allantoic cavity E) Amniotic sac Answer: A) Amniotic cavity Explanation: The amniotic cavity contains amniotic fluid and surrounds the embryo/fetus.

  30. Which lung volume decreases during pregnancy? A) Functional residual capacity (FRC) B) Tidal volume (TV) C) Minute ventilation (MV) D) Peak expiratory flow rate (PEFR) E) Vital capacity (VC) Answer: A) Functional residual capacity (FRC) Explanation: Diaphragmatic elevation reduces FRC in pregnancy.

  31. The most common cause of inherited coagulation disorder is: A) Haemophilia A B) Von Willebrand Disease (VWD) C) Haemophilia B D) Protein C deficiency E) Factor V Leiden Answer: B) Von Willebrand Disease (VWD) Explanation: VWD is the most common inherited bleeding disorder.

  32. The pelvic structure that forms the lateral boundary of the ischio-rectal fossa is: A) Levator ani B) Obturator internus C) Gluteus maximus D) Coccygeus E) Piriformis Answer: B) Obturator internus Explanation: Obturator internus muscle forms the lateral wall of the ischio-rectal fossa.

  33. The structure allowing blood flow from the right atrium to the left atrium in fetal circulation is: A) Ductus venosus B) Foramen ovale C) Ductus arteriosus D) Umbilical vein E) Umbilical artery Answer: B) Foramen ovale Explanation: The foramen ovale allows blood to bypass fetal lungs.

  34. The main mechanism of action of methotrexate is: A) DNA chelation B) Thymidylate synthase inhibition C) Dihydrofolate reductase inhibition D) Topoisomerase II inhibition E) Fraudulent nucleotide incorporation Answer: C) Dihydrofolate reductase inhibition Explanation: Methotrexate blocks tetrahydrofolate production, inhibiting DNA synthesis.

  35. The DNA base pairing with adenine is: A) Guanine B) Thymine C) Cytosine D) Uracil E) Adenine Answer: B) Thymine Explanation: Adenine pairs with thymine via two hydrogen bonds in DNA.

  36. The transport of amino acids across the placenta occurs mainly by: A) Passive diffusion B) Active transport C) Facilitated diffusion D) Receptor-mediated endocytosis E) Direct hematogenous transfer Answer: B) Active transport Explanation: Placental amino acid transport is an energy-dependent active process.

  37. Which cell lacks mitochondria? A) Hepatocyte B) Mature red blood cell C) Neuron D) Myocyte E) Kidney tubule cell Answer: B) Mature red blood cell Explanation: Mature erythrocytes lack mitochondria to maximize haemoglobin content.

  38. The main component of bile acids synthesized by the liver is: A) Cholic acid and chenodeoxycholic acid B) Cholic acid and deoxycholic acid C) Chenodeoxycholic acid and lithocholic acid D) Deoxycholic acid and lithocholic acid E) Glycocholic acid and taurocholic acid Answer: A) Cholic acid and chenodeoxycholic acid Explanation: These are the two primary bile acids synthesized from cholesterol.

  39. The gene-editing technology CRISPR/Cas9 involves: A) Enzyme-enzyme interaction B) DNA-enzyme interaction C) DNA-transcription factor interaction D) Enzyme-DNA interaction E) Protein-protein interaction Answer: B) DNA-enzyme interaction Explanation: The Cas9 enzyme, guided by RNA, cleaves specific DNA sequences.

  40. At what gestational age does the fetal kidney begin producing urine? A) 6 weeks B) 12 weeks C) 18 weeks D) 24 weeks E) 30 weeks Answer: B) 12 weeks Explanation: Fetal urine production starts at about 12 weeks of gestation.

  41. Which lung volume decreases during pregnancy? A) Functional residual capacity (FRC) B) Minute ventilation (MV) C) Peak flow rate (PFR) D) Tidal volume (TV) E) Vital capacity (VC) Answer: A) Functional residual capacity (FRC) Explanation: The upward displacement of the diaphragm reduces FRC.

  42. The ratio of T4 to T3 in the blood is approximately: A) 1:7 B) 2:1 C) 3:1 D) 7:1 E) 14:1 Answer: E) 14:1 Explanation: T4 is present in much higher amounts than T3 in circulation.

  43. Causes of hyperprolactinemia in PCOS include: A) Unopposed estrogen B) Opposed estrogen C) Pituitary adenoma D) Dopamine agonists E) Hypothyroidism Answer: A) Unopposed estrogen Explanation: Chronic anovulation in PCOS results in unopposed estrogen, raising prolactin.

  44. Lactotroph cells comprise what percentage of anterior pituitary? A) 10-15% B) 20-25% C) 30-35% D) 40-45% E) 50-55% Answer: A) 10-15% Explanation: Lactotrophs represent about 10-15% of anterior pituitary cells.

  45. Aldosterone release from adrenal cortex is primarily stimulated by: A) Angiotensin II B) Renin C) Angiotensin I D) ACTH E) Potassium Answer: A) Angiotensin IT Explanation: Angiotensin II directly stimulates zona glomerulosa aldosterone secretion.

  46. An HbA Ic level considered too high for pregnancy, advising against conception, is approximately: A) 46 mmol/mol B) 56 mmol/mol C) 66 mmol/mol D) 76 mmol/mol E) 86 mmol/mol Answer: E) 86 mmol/mol Explanation: HbA1c >86 mmol/mol (~10%) is associated with increased fetal anomaly risk.

  47. SARS-CoV-2, the virus causing COVID-19, is classified as: A) Single-stranded RNA (ssRNA) B) Single-stranded DNA (ssDNA) C) Double-stranded RNA (dsRNA) D) Double-stranded DNA (dsDNA) E) Retrovirus Answer: A) Single-stranded RNA (ssRNA) Explanation: SARS-CoV-2 is a positive-sense ssRNA virus.

  48. Zika virus belongs to which category of viruses? A) Single-stranded RNA (ssRNA) B) Single-stranded DNA (ssDNA) C) Double-stranded RNA (dsRNA) D) Double-stranded DNA (dsDNA) E) Retrovirus Answer: A) Single-stranded RNA (ssRNA) Explanation: Zika virus is an ssRNA flavivirus transmitted by mosquitoes.

  49. The inner cell mass of the blastocyst consists of: A) Epiblast and hypoblast B) Gastrulation layer C) Ectoderm, mesoderm, and endoderm D) Trophoblast cells E) Syncytiotrophoblast Answer: A) Epiblast and hypoblast Explanation: The inner cell mass differentiates into the epiblast and hypoblast layers.

  50. The epidural space is located between: A) Arachnoid mater and pia mater B) Vertebral canal wall and dura mater C) Pia mater and ependyma D) Dura mater and arachnoid mater E) Ligamentum flavum and dura mater Answer: B) Vertebral canal wall and dura mater Explanation: The epidural space lies between the dura mater and vertebral canal wall.

  51. The internal anal sphincter is continuous with: A) Circular muscle of the rectum B) Longitudinal muscle of the external anal sphincter C) Longitudinal muscle of the rectum D) Puborectalis muscle E) External sphincter Answer: A) Circular muscle of the rectum Explanation: The internal sphincter is a thickening of the rectal circular smooth muscle.

  52. The superficial and deep perineal spaces are separated by: A) Endopelvic fascia B) Perineal membrane C) Colle’s fascia D) Superficial fascia E) Urogenital diaphragm Answer: B) Perineal membrane Explanation: The perineal membrane divides the superficial from the deep perineal space.

  53. Androgens are secreted by which adrenal cortex layer? A) Zona reticularis B) Zona glomerulosa C) Zona fasciculata D) Medulla E) Zona intermedia Answer: A) Zona reticularis Explanation: The zona reticularis secretes androgens.

  54. Progesterone acts as an anti-estrogen by: A) Reducing estrogen receptor synthesis B) Reducing estrone activity C) Inactivating estrogen receptor D) Methylating estrogen E) Inhibiting aromatase Answer: A) Reducing estrogen receptor synthesis Explanation: Progesterone downregulates estrogen receptor expression.

  55. The second meiotic division in oocytes is completed at: A) Birth B) Fertilization C) Menarche D) Ovulation E) Before ovulation Answer: B) Fertilization Explanation: The second meiotic division completes upon fertilization.

  56. Blood flow from the right atrium to the left atrium in fetal circulation occurs via: A) Ductus venosus B) Foramen ovale C) Ductus arteriosus D) Umbilical vein E) Umbilical artery Answer: B) Foramen ovale Explanation: The Foramen ovale allows oxygenated blood to bypass the fetal lungs.

  57. The positive predictive value (PPV) of a test with 80 true positives out of 320 positives is: A) 25% B) 33% C) 60% D) 80% E) 95% Answer: A) 25% Explanation: PPV = TP/(TP+FP) = 80/320 = 25%.

  58. Thyrotropin-releasing hormone (TRH) is a: A) Decapeptide B) Tripeptide C) Polypeptide D) Octapeptide E) Pentapeptide Answer: B) Tripeptide Explanation: TRH is a tripeptide hormone stimulates TSH release.

  59. The CYP21 gene mutation, causing 90% of congenital adrenal hyperplasia, is located on chromosome: A)6 B) 10 C) 14 D) 18 E) 22 Answer: A) 6 Explanation: The CYP21 gene is on chromosome 6.

  60. Postpartum uterine size reduction by myometrial fiber shortening is called: A) Contraction B) Involution C) Retraction D) Reduction E) Remodeling Answer: D) Reduction Explanation: Uterine involution occurs via reduction in muscle fiber length.

  61. The outer protective layer of the Graafian follicle is: A) Theca externa B) Theca interna C) Zona pellucida D) Corona radiata E) Cumulus oophorus Answer: A) Theca externa Explanation: Theca externa is the fibrous connective tissue layer surrounding the follicle.

  62. Peak growth hormone secretion occurs during: A) Early morning B) Post-exercise C) Afternoon D) Early sleep E) Deep sleep Answer: D) Early sleep Explanation: GH peaks shortly after sleep onset during slow-wave sleep.

  63. The pelvic brim angle with the horizontal is approximately: A) 45° B) 60° C) 90° D) 120° E) 135° Answer: B) 60° Explanation: The pelvic inlet is inclined at ~60° to horizontal.

  64. The structure connecting the umbilical vein to the inferior vena cava is: A) Ductus venosus B) Foramen ovale C) Ductus arteriosus D) Umbilical artery E) Ligamentum teres Answer: A) Ductus venosus Explanation: Ductus venosus shunts oxygenated blood to systemic circulation.

  65. The difference between the jejunum and the ileum includes: A) Jeyunum has long arterial arcades, ileum has short arcades B) Jejyunum is thick-walled, ileum is thin-walled C) Jejunum has more lymphoid tissue D) Jejunum is shorter than ileum E) Both have the same wall thickness Answer: A) Jejunum has long arterial arcades, ileum has short arcades Explanation: Jejunum has longer vasa recta and fewer arcades.

  66. Motor supply to the detrusor muscle is via: A) Pelvic splanchnic nerve B) Pudendal nerve C) Inferior hypogastric plexus D) Superior hypogastric plexus E) Lumbar sympathetic nerves Answer: A) Pelvic splanchnic nerve Explanation: Parasympathetic fibers from pelvic splanchnics contract detrusor.

  67. In ventouse (vacuum) delivery, the cup should be placed on: A) Temporal bone B) Frontal bone C) Sagittal suture D) Coronal suture E) Occipital bone Answer: C) Sagittal suture Explanation: The cup is placed over the flexion point near the sagittal suture to aid safe traction.

  68. The lateral wall of the ischio-rectal fossa is formed by: A) Levator ani B) Anal sphincter C) Obturator internus D) Obturator externus E) Gluteus maximus Answer: C) Obturator internus Explanation: Obturator internus muscle forms the lateral boundary of the ischio￾rectal fossa.

  69. The cell cycle phase immediately preceding mitosis is: A) G1 phase B) G2 phase C) S phase D) M phase E) GO phase Answer: B) G2 phase Explanation: G2 is the post-DNA synthesis phase before mitosis.

  70. “Country of birth” as a variable is classified as: A) Categorical B) Nominal C) Ratio D) Interval E) Ordinal Answer: B) Nominal Explanation: Country of birth is a nominal variable with no intrinsic order.

  71. Which nerve other than the pudendal nerve arises from the sacral plexus? A) Sciatic nerve B) Genitofemoral nerve C) Lateral femoral cutaneous nerve D) Femoral nerve E) Obturator nerve Answer: A) Sciatic nerve Explanation: The sciatic nerve originates from the sacral plexus along with the pudendal nerve.

  72. The appendix testis develops from which embryonic structure? A) Paramesonephric (Miillerian) duct B) Mesonephric (Wolffian) duct C) Urogenital sinus D) Genital tubercle E) Gonadal ridge Answer: A) Paramesonephric (Miullerian) duct Explanation: Appendix testis is a remnant of the Millerian duct.

  73. The bulbourethral gland is located in the: A) Deep perineal pouch B) Superficial perineal pouch C) Ischio-rectal fossa D) Deep inguinal space E) Retroperitoneal space Answer: B) Superficial perineal pouch Explanation: Bulbourethral glands lie in the superficial perineal space.

  74. The embryonic origin of the trigone of the bladder is: A) Ureteric bud B) Urogenital sinus C) Mesonephric duct D) Paramesonephric duct E) Cloaca Answer: C) Mesonephric duct Explanation: The Trigone arises from mesonephric duct incorporation.
  75. The posterior fontanelle typically closes by: A) 3 months B) 6 months C) 9 months D) 12 months E) 18 months Answer: A) 3 months Explanation: The posterior fontanelle usually closes by 3 months of age.

DR. FATH MRCOG ONLINE COURSES This is a part of the preparation course for MRCOG / MRCPI, follow us on https://www.drfathmrcog.com 8 R: FAT HAARCOG \ All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers. Alb sine asball (5 sis ayes

← Previous
2024 07 Recall 2
Next →
Arabic Recall
2024 07 Recall