*ANC*

1. Ultrasound may be used to confirm or identify an EDD when the LMP is uncertain, which of the
following statements is false?

- A. Transvaginal ultrasound allows for early identification of an embryo and the accurate dating of
pregnancy by measurement of the crown–rump length.

- B. In general, in the first trimester, if the EDC by LMP differs by more than 6 days based on
ultrasound, then the EDC should be adjusted on the basis of ultrasound dating.

- C. Subsequently in the second trimester, if the EDC by LMP differs by more than 10 days based on
ultrasound, then the EDC should be adjusted on the basis of ultrasound dating.

- D. Finally in the third trimester, there is more variation in the size of the fetus, so the EDC should be
adjusted only by ultrasound if the EDC varies by more than 14 days and there is no earlier ultrasound
confirming the EDC.

- E. None of the above

2. A woman presents to your office for prenatal care. She has had two abortions, one ectopic
pregnancy, a fetal demise at 37 weeks’ gestation, and three live births. Her son, who is now 13 years
old, was delivered at 34 weeks’ gestation by spontaneous vaginal delivery. Her daughter, who is now
10 years old, was delivered at 38 weeks’ gestation by cesarean section secondary to fetal distress
during labor. Her youngest daughter, who is now 5 years old, was delivered at 33 weeks. What are her
“Gs and Ps” by simple notation and by TPAL notation, respectively?

- A. G7P3 and G7P2233

- B. G8P3 and G8P2233

- C. G7P3 and G7P3134

- D. G7P3 and G7P2234

- E. G8P3 and G8P4033

3. A 19-year-old woman, gravida 2, para 1 at 28 weeks’ gestation presents to your office for routine
prenatal care. She delivered her daughter vaginally at 39 weeks without any complications. Her
medical history is unremarkable, and her current pregnancy has been complicated by several missed
prenatal visits. Her BP is 108/73; her temperature is 96.8°F, her fundus measures at 28 weeks, she is 5
feet 4 inches tall, her prepregnancy weight was 120 lb, and she now weighs 135 lb. She is rubella non-
immune, hepatitis B surface antigen-negative, O/antibody, RPR nonreactive, and gonorrhea
culture/chlamydia negative. All of the following would be appropriate except:

- A. Measles Mumps Rubella (MMR) vaccine

- B. 50-g glucose tolerance test

- D. CBC

- E. Repeat HIV and syphilis screening

4. A 38-year-old African American woman, gravida 1, para 0010 presents for preconception care. Her
medical history includes obesity with a BMI of 42, diabetes, and tobacco use. Her obstetrical history
is notable for an elective termination at 18 weeks of a fetus with anencephaly. She desires to conceive.
Your recommendations would include the following:

- A. Supplement diet with folic acid, 4 mg daily

- B. Start a diet and exercise program to improve obstetrical outcomes

- C. Obtain optimal glycemic control before conception to reduce risk of fetal anomalies

- D. Tobacco cessation program

- E. Tay-Sachs and sickle cell disease screening

5. An 18-year-old woman, gravida 2, para 1 presents for her first prenatal visit. She reports regular 28
days’ cycles and her LMP was September 9. She is 15 weeks 3 days by LMP. She is measuring size
greater than dates and you perform an ultrasound that differs by 18 days. What is her EDD calculated
by Naegele’s rule and would you continue to use that EDD?

- A. June 16 and no

- B. December 16 and no

- C. December 2 and yes

- D. December 16 and yes

- E. June 16 and yes

*ANSWERS TO ANC*

1. E

2. B

3. A

4. A

5. A

*INFERTILITY*
1. A 25-year-old woman, gravida 2, para 2, has been attempting pregnancy for the past 2 years. She
has no medical problems. She had surgery for a ruptured appendix 5 years ago. Her periods are
regular and last 3 to 4 days. She denies smoking, drinking alcohol, or using drugs. Her husband is 28
years old, is healthy, and has a normal sperm count. What’s the most likely cause of infertility?

- A. Ovulation

- B. Oocyte quality

- C. Tubal factor

- D. Uterine factor

- E. Male factor

- F. Unexplained

2. The initial evaluation of an infertile couple should include:

- A. Ovarian biopsy.

- B. Semen analysis.

- C. D&C.

- D. Laparoscopy.

- E. Sperm penetration assay

3. According to WHO, sperm count shouldn’t be less than:

- A. 50 million/ml

- B. 60 million/ml

- C. 90 million/ml

- D. 20 million/ml

- E. 10 million/ml

4. In male infertility, seminal analysis should be done

- A. Once for diagnosis of male infertility

- B. Twice at an interval of 72 hours

- C. Twice at an interval of 72 days

- D. At least twice 28 days apart.

- A. 15

- B. 20

- C. 35

- D. 45

- E. 85

*ANSWERS TO INFERTILITY*

1. C

2. B

3. D

4. D

5. B

*FERTILIZATION AND EMBRYOLOGY*

1. Fertilised ovum reaches uterine cavity by:

- A. 4 to 5 days after implantation

- B. 6 to 7 days after implantation

- C. 7 to 9 days after implantation

- D. 2 to 3 days after implantation

2. After how many days of ovulation embryo implantation occurs?

- A. 3–5 days

- B. 7–9 days

- C. 10–12 days

- D. 13–15 days

3. The thickness of endometrium at the time of implantation is:

- A. 3–4 mm
- B. 20–30 mm

- C. 15–20 mm

- D. None of the above

4. In which of the following transition meiosis occurs?

- A. Primary to secondary spermatocyte

- B. Second spermatocyte to globular spermatid

- C. Germ cells to spermatogonium

- D. Spermatogonium to primary spermatocyte

5. Primary oocyte:

- A. Is formed after single meiotic division

- B. Maximum in number in 5 months of the fetus

- C. Is in prophase arrest

- D. Both B and C

6. True statement regarding oogenesis is/are:

- A. Primary oocyte arrests in prophase of 1st meiotic division

- B. Secondary oocyte arrest in metaphase of 2nd meiotic division

- C. 1st polar body is extruded during 1st meiotic division of primary oocytes

- D. All of the above

7. In a young female of reproductive age with regular menstrual cycles of 28 days, ovulation occurs
around 14th day of periods. When is the first polar body extruded?

- A. 24 hours prior to ovulation

- B. Accompanied by ovulation

- C. 48 hours after the ovulation

- D. At the time of fertilization

8. Fetal kidneys start producing urine by:

- A. 3 months
- B. 4 months

- C. 5 months

- D. 6 months

9. Fetal stage starts at:

- A. 9 weeks

- B. 3 weeks

- C. 6 weeks

- D. 12 weeks

10. Fetal sex can be detected by USG at:

- A. 14 weeks

- B. 16 weeks

- C. 18 weeks

- D. 20 weeks

11. Zona hatching occurs:

- A. 4 days after fertilisation

- B. 5 days after fertilisation

- C. 6 days after fertilisation

- D. 8 days after fertilisation

12. Time taken for capacitation of sperms is:

- A. 2-4 hours

- B. 4-6 hours

- C. 6-8 hours

- D. 8-10 hours

13. During development of the ovarian follicles:

- A. The primary oocyte is arrested at the interphase of the second meiotic division.

- B. Theca cells in the corpus luteum are responsible for steroidogenesis.

- D. Meiosis is resumed prior to the luteinizing hormone (LH) surge.

- E. The first polar body is extruded prior to ovulation.

14. After a successful conception the following statements are true:

- A. The embryo remains in the fallopian tube for 6–8 days.

- B. Myometrial cytokines modulate cytotrophoblastic proteolytic activity.

- C. At 11 days the implantation site is a red spot on the endometrial mucosa.

- D. Human chorionic gonadotrophin is produced by the corpus luteum.

- E. The embryonic disc is formed after the third week post-fertilization.

15. Considering embryo development:

- A. During the third week, the bilaminar embryo generates the mesoderm.

- B. At day 28, the cephalic neuropore closes.

- C. Cardiac activity is evident from day 26.

- D. The lower respiratory system appears as septation of the hind-gut.

- E. None of the above

*ANSWERS TO FERTILIZATION AND EMBRYOLOGY*

1. A

2. B

3. D

4. A

5. D

6. D

7. B

8. A

9. A

10. A

11. B

12. D
13. E

14. C

15. A

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*HPO-AXIS*

1. A 14 years-old girl complains of irregular vaginal bleeding. Her general examination and pelvic
organs are normal. Which of the following is the most likely cause of anovulatory bleeding
(dysfunctional uterine bleeding) in this patient?

- A. Hypothyroidism

- B. Pituitary adenoma

- C. Polycystic ovarian syndrome (PCOS)

- D. Congenital adrenal hyperplasia (CAH)

- E. Hypothalamic immaturity

2. Which of the following is not true about the anatomy of hypothalamic-pituitary axis?

- A. The capillaries arise from hypophyseal arteries in the hypothalamus and drain into hypophyseal
portal system

- B. There is no ultrashort feedback loop between the pituitary gland and hypothalamic neurons

- C. Retrograde flow exists from pituitary to hypothalamus

- D. The direction of hypophyseal portal system is from hypothalamus to pituitary

3. Which one of the following defines ovarian failure?

- A. Elevated menstrual cycle day 3 FSH greater than 10-12 mlu/ml

- B. An elevated estradiol greater than 80 pg/ml the 3 day menstrual cycle

- C. FSH level greater than 40 mlu/ml with amenorrhea

- D. An elevated FSH greater than 15 mlu/ml with amenorrhea.

4. Which one of the following is true of luteal phase defect?

- A. It is due to defective folliculogenesis

- B. There is adequate growth and function of corpus luteum

- D. There is adequate secretory changes in the endometrium

5. In a 40 days of menstrual cycle the ovulation occurs at:

- A. 14th day

- B. 20th day

- C. 26th day

- D. 30th day

6. The ovarian cycle is initiated by:

- A. FSH

- B. Estrogen

- C. LH

- D. Progesterone

7. The corpus luteum secretes:

- A. Estrogens

- B. Progesterones

- C. Both

- D. None

8. Ovulation occurs:

- A. Before LH surge

- B. After biphasic rise in body temperature

- C. After ripening of follicle by FSH

- D. Before estrogen peak

*ANSWERS TO HPO*

1. E

2. B

3. C

4. A

5. C

6. A

7. C
8. C