Mount Kenya University · School of Medicine · Reproductive Health (Gynaecology)
Paper details
- Unit: MBOG 4212, Year 4 MBChB Gynaecology CAT, Mount Kenya University Medical School.
- Sitting: 15 March 2019 (printed 15/03/19). By the timetable March falls in Trimester 2 (January to April).
- Format: Section A, multiple choice questions, 1 mark each. The paper in the scan has 40 MCQs.
- What this page has: 39 of the 40 MCQs. Question 37 (malignant disease of the cervix) is left out, because its options are worded so loosely that no single answer is safe.
- Topics tested: long-acting contraception, depot medroxyprogesterone, cervical screening and cancer, vulval intraepithelial neoplasia, uterine support and prolapse, urinary incontinence, urinary tract infection, infertility, gestational trophoblastic disease, endometrial hyperplasia and cancer, emergency contraception and benign vulval disease.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Questions that need care: Q2, Q9, Q19, Q27 and Q31 are loosely worded or have more than one defensible option. The explanation says which option is best and why. The pen marks on the scan were ignored.
Multiple choice questions
1. Which of the following is a long-acting reversible contraceptive (LARC)?
- A. Levonorgestrel intrauterine system
- B. Vaginal patch
- C. Diaphragm
- D. Tubal ligation
2. Which one of the following is NOT a mechanism of action of Depo-Provera (DMPA)?
- A. Thickening of cervical mucus
- B. Inhibition of secretion of gonadotropins
- C. Prevention of follicular maturation
- D. Inhibition of ovulation
3. Which of the following statements is false?
- A. The transformation zone is the area between the old and new squamocolumnar junction
- B. Carcinoma in situ is an abnormal change in cells but not invading deeper tissues
- C. Metaplasia is a change of normal epithelium to another type and is not reversible
- D. Neoplasia is the formation of new abnormal tissue that is not reversible
4. Which of the following is NOT a presentation of cervical cancer?
- A. Renal failure
- B. Back pain
- C. Intermenstrual bleeding
- D. Increased uterine fundal height
5. Regarding detection and diagnosis of cervical cancer, which statement is incorrect?
- A. HPV DNA screening is of value to detect high-risk individuals
- B. Visual inspection cannot detect suspected cervical cancer
- C. A Pap smear is recommended for all sexually active women above 30 years
- D. The malignant lesion starts at the squamocolumnar junction
6. Choose the correct statement:
- A. Differentiated type of VIN most commonly occurs in young women
- B. Vulval intraepithelial neoplasia (VIN) can be treated by wide local surgical excision
- C. Topical treatment with imiquimod or 5-fluorouracil is ineffective against vulval intraepithelial neoplasia
- D. VIN 2 is considered low grade and usually goes away on its own
7. All of the following are supports of the uterus EXCEPT:
- A. Pubocervical ligament
- B. Uterosacral ligament
- C. Cardinal ligament
- D. Ligamentum arteriosum
8. An elderly woman comes to the hospital with difficulty in passing urine. Which is the best initial approach in her management?
- A. Prescribe antibiotics
- B. Refer her to a urologist
- C. Take a focused history
- D. Ask her for a urine sample
9. The following are indications for the use of a vaginal pessary EXCEPT:
- A. As a temporary measure to allow treatment of underlying conditions
- B. Patients with ureterovaginal fistula
- C. During pregnancy
- D. Patients medically unfit for surgery
10. Choose the most appropriate statement regarding oestrogen replacement therapy:
- A. It causes ulceration of the vaginal wall
- B. Can cause carcinoma of the vaginal wall
- C. Can help improve a mild degree of vaginal prolapse
- D. Can cause dyspareunia
11. Which of the following is NOT a characteristic of overflow incontinence?
- A. May be caused by an underactive or contractile detrusor muscle
- B. Can be associated with peripheral neuropathy
- C. Can be associated with a cystocele
- D. It is associated with the urodynamic finding of involuntary detrusor contractions
12. Regarding urinary tract infections, choose the most appropriate statement:
- A. Urethritis can present with pelvic pressure
- B. Pyelonephritis can be caused by a blood-borne bacterial infection
- C. Cystitis risk can be reduced by keeping the urinary catheter in place post-operatively for 3 days rather than one day
- D. Urethritis usually presents with back pain
13. A couple has infertility for two years. The WHO criteria for the minimum sperm concentration in normal semen is:
- A. 10 million
- B. 15 million
- C. 40 million
- D. 50 million
14. Which of the following is most helpful in evaluating a woman's cause of infertility who has previous pelvic inflammatory disease?
- A. History about her siblings' offspring
- B. Pap smear
- C. Speculum examination
- D. Hysterosalpingogram
15. Using the Baden-Walker classification, a second degree uterine prolapse is characterised by:
- A. Descent up to the hymen
- B. Descent below the ischial spines
- C. Descent beyond the introitus
- D. Minimal descent
16. Which of the following is NOT a form of prolapse?
- A. Procidentia
- B. Rectocele
- C. Enterocele
- D. Urethral diverticulum
17. In which of the following cases would the combined oral contraceptive pill NOT be prescribed?
- A. A patient with a history of 3 previous miscarriages
- B. A patient with a history of ectopic pregnancy
- C. A patient with a liver tumour
- D. A patient who is 35 years old
18. The following are risk factors for urinary incontinence EXCEPT:
- A. Diabetes
- B. Impaired cognition
- C. Nulliparity
- D. High-impact physical activities
19. A 23-year-old woman is concerned about her risk of cervical cancer. Which of the following will increase her risk?
- A. Her positive HPV screening with strains 6 and 11
- B. That she began smoking after high school
- C. That her mother was diagnosed with cervical cancer
- D. That she began sexual intercourse at 19 years
20. Which of the following are functions of the urinary bladder?
- A. Storage
- B. Emptying
- C. Filling
- D. All of the above
21. Regarding bladder innervation, which is correct?
- A. The sympathetic system is active during bladder emptying
- B. The parasympathetic system is active during bladder filling
- C. The pelvic nerve is involved in bladder emptying
- D. The hypogastric nerve is involved in bladder emptying
22. Regarding gestational trophoblastic disease, choose the correct statement:
- A. Qualitative beta-hCG is used for monitoring
- B. Vitamin A deficiency is not a risk factor
- C. Hydatidiform mole can present with hyperthyroidism
- D. An invasive mole cannot progress to choriocarcinoma
23. Select the most accurate statement regarding choriocarcinoma:
- A. There is absence of chorionic villi
- B. It can only develop from a persistent hydatidiform mole
- C. Direct invasion of the myometrium is typically absent
- D. It originates from intermediate cytotrophoblast cells
24. A 20-year-old has vaginal bleeding two weeks after treatment for a miscarriage. Which is she most likely to have?
- A. Incomplete evacuation of the uterus
- B. Hydatidiform mole
- C. Endometritis
- D. Asherman syndrome
25. The following are differential diagnoses of prolapse EXCEPT:
- A. Vaginal cyst
- B. Cervical polyp
- C. Elongation of the cervix
- D. Tumour of the ureter
26. You suspect a woman with difficulty passing urine has a cystocele. Which of the following will you NOT do?
- A. Use a Sims speculum to aid examination
- B. Take a focused history
- C. Use a Cusco speculum to examine the patient
- D. Perform a cough test
27. Regarding oral contraceptive pills, what qualifies as a very low dose oestrogen formulation?
- A. Equal to or below 15 micrograms of ethinyl estradiol
- B. Equal to or below 50 micrograms of ethinyl estradiol
- C. Equal to or below 35 micrograms of ethinyl estradiol
- D. Equal to or below 20 micrograms of ethinyl estradiol
28. An endometrial sample report reads: "Endometrium has dilated glands with abundant endometrial stroma. The glands are of varied size but not overly crowded. The glandular epithelium is pseudostratified." Which diagnosis fits?
- A. Complex hyperplasia without atypia
- B. Simple hyperplasia with atypia
- C. Complex hyperplasia with atypia
- D. Simple hyperplasia without atypia
29. Which of the following is NOT a risk factor for endometrial carcinoma?
- A. Age above 50
- B. Levonorgestrel intrauterine system
- C. Obesity
- D. Unopposed oestrogen administration
30. A 48-year-old woman has abnormal vaginal bleeding with a foul-smelling discharge, and she worries about cancer. Which is she LEAST likely to have?
- A. Cervical cancer
- B. Endometrial cancer
- C. Vulval cancer
- D. Uterine fibroids
31. A couple has not conceived after 1 year of regular unprotected intercourse. Which of the contributory factors is inaccurate?
- A. Male factor 20 to 30%
- B. Both male and female 10 to 40%
- C. Female factor 60 to 70%
- D. Unexplained infertility 10 to 20%
32. The statements below refer to continence and incontinence. Determine which is true.
- A. Detrusor pressure and extra-abdominal pressure influence bladder pressure
- B. Urethral pressure is not influenced by the inherent urethral muscle tone
- C. Normally, coughing alters the pressure difference and leads to incontinence
- D. Overactive bladder results from uncontrolled increases in detrusor pressure and ensuing increase in bladder pressure beyond that of the urethra
33. Which of the following statements regarding the management of uterovaginal prolapse is incorrect?
- A. Can include physiotherapy and pelvic floor exercises
- B. Involves assessment of bladder function where a patient complains of urinary symptoms
- C. Exclusion of a pelvic mass which may be contributing to the prolapse
- D. Oestrogen replacement may be of benefit in premenopausal women
34. Benign conditions of the cervix: identify the false statement.
- A. When the columnar epithelium of the endocervix is visible as a red area around the os on the surface of the cervix, this is known as a cervical ectropion
- B. Ectropion is a cause of post-coital bleeding and may be treated by cryotherapy without smear testing
- C. Acute cervicitis may result from an STI
- D. Cervical polyps are most common in women over 40
35. Regarding premalignant conditions of the cervix (cervical intraepithelial neoplasia, CIN), identify the false statement.
- A. CIN is the presence of atypical cells within the squamous epithelium, which are dyskaryotic with larger nuclei and frequent mitoses
- B. The histological finding in CIN III is that abnormal cells occupy the entire epithelium
- C. In CIN I, atypical cells are found only in the lower two thirds of the epithelium
- D. CIN can be considered a sexually transmitted disease
36. Regarding progesterone-only methods of contraception, which statement is true?
- A. Failure rates of the POP are 4/100 woman-years
- B. Depo-Provera has a similar mode of action to that of the POP, but is less effective in preventing ovulation
- C. Use of Implanon is associated with a drop in bone density
- D. The POP makes cervical mucus hostile to sperm and in 50% of women inhibits ovulation too
38. Regarding emergency contraception, which statement is inaccurate?
- A. A single dose of 1.5 mg levonorgestrel may be taken, preferably within 24 hours and no later than 72 hours, after unprotected intercourse
- B. If beyond 72 hours since unprotected intercourse, insertion of an IUD usually prevents implantation
- C. The Mirena IUS can be used for emergency contraception
- D. None of the above
39. Benign disorders of the vulva and vagina: which statement is NOT true?
- A. A typical presentation of lichen simplex is with itching and soreness of the labia majora
- B. Lichen planus can affect hair, nails and mucous membranes as well as the labia
- C. Vulval carcinoma can develop in 50% of cases of lichen sclerosus
- D. Vulvodynia is a diagnosis of exclusion
40. Which of the following investigations is best suited to determine whether or not a patient is ovulating?
- A. Temperature charts
- B. Mid-luteal phase serum progesterone
- C. Ultrasound follicular tracking
- D. FSH-based urine predictor kits