1.

A Study in 2005of 158 women aged 20-29 years who presented between 1996
-20--- with irregular periods in whom ultra sound diagnosis of polysistic ovary
syndrome made in the general clinic prior to referral to gynecologist. What type of
study is the ----
A.Cohort
B.Cross sectional
C.Retrospective
D.Prospective

2.In community data in 2006, total number of population was 22 millions. Above
18 live births there was 24 maternal deaths and 120 fetal deaths what is the main
mortality rate?
A.24\18900 x 100000
B.24+120\22 million
C.24\22 million
D.24\18900x1000

3.A 67 YEARS OLD WOMEN COMES TO THE Physician because of pain with
unnation and frequent unnation. She has hypertension for which she takes a beta
blocker but other medical problems she states that she is not sexually active. She
does not smokes and drink carberry juice daily. Examination shows mild suprpubic
tenderness and genital atrophy but is otherwise unremarkable. Urinalysis shows
100 leukocytes/high powered field (hpf) and 5 to 10 erthirocyted/hpf. Which of the
following is MOST Likely cause of the infection?
A.Cardiac disease
B.Hypoestrogenism
C.Nephroesthiliasis
D.Sexual intercourse

4.A 12 year old female comes to the physician because of vaginal discharge. The
discharge started before 2 months ago and is whitish in color. There is no odor the
patient has no complaints of itching, burning or pain. The patient started breast
development at 9 years of age and her pubertal development has proceeded normal
to this point. She has not had her first menses and she is not sexually active. She
has no medical problems. Examination is normal for a 12 year old female.
Microscopic evidence of the discharge shows no evidence of pseudohypae, clue
calls or trichomonads.
Which of the following is MOST Likely diagnosis?
A.Bacterial vaginosis
B.Candela vulvovaginitis
1
 C.Physiologic leucorrhea
D.Trichomoniasis.

5.Women of the following types of fibroids are relatively resistant to uterine

fibroid embolization:
A.Submucous fibroid
B.Broad ligament fibroids
C.Subserous fibroids
D.Intra mural fibroids

6.The most common late complication post-LEEP cone biopsy is:

A.Bleeding
B.Cervical stinosis
C.Cervical incompetence
D.Premature delivery

7.Anti-D immunoglobulin:
A.If given 72 hours after birth is associated with 70% decreased incidence of
RH allimunization 6 months after birth.
B.There is no prophylactic immunoglobulin to prevent kell
allimunization
C.A dose of 300 Ug protects against 50 ml of fetal whole blood in the
maternal circulation.
D.The risk of fetometarnal hemmorhagre <30 mis is about 10%

8.Precipitious labor is:

A.Expulsion of fetus in less than 5 hour.
B.More than 3 cm per hour of cervical dilatation in nullipara
C.Not related to fatal mortality
D.Amniotic fluid embolism is one of its complication

9.Which of the following is the most common non- infectious vulvar disease at the
reproductive age?
A.Eczema
B.Malenoma
C.Basal cell carcinoma
D.Litchen sciecrosis

10. Recurrent miscarriage:

A.Is defined as the loss of three or more pregnancies
2
 B.Diabetes mallitus is not associated with recurret miscarriage
C.Activated protein C resistance (APCR) is found in 20% of women with
ahistory of recurret miscarriage
D.If investigations for recurret miscarriage are negative thechance of a
live birth in a subsequent pregnancy is 65-70%.

11.Pre-eclamiptia:
A.Consists of a trad of elevated blood pressure, proteinuria and oridima in
the first trimester
B.The diagnosis depends on the presence of proteinuria of more then 20g in
24 h
C.There is increase in the hypertension in later life.
D.Elevated plasma uric acid occurs after the development of proteinuria

12.The MOST common type of HPV found in the vulvar intraepithelial

neoplasia(VIN) and squamous cell carcinoma is?
A.HPV 6
B.HPV 11
C.HPV 18
D.HPV 16

13.Mnagement of hydatidiform moles:

A.Following a complete mole, approximately 80% of patients need
treatment for persistent trophoblastic disease.
B.The combined oral contraceptive pill is contraindicated during following
up.
C.Metastatic low risk patients are best treated with methotraxate
D.Myelosuppression is a common side effect of methotraxate

14.Predicting pre term birth risk in singleton pregnancy:

A.Cervical length assessment should be done easily 2nd trimester in
high risk patients.
B.Ultrasound Cervical length assessment is the preferably done Trans
abdominally.
C.In a symptomatic women with a history of spontaneous preterm birth,
cervical cerclage should be done.
D.In a symptomatic women who present with membranes at or protruding
past the external cerviacal os, an emergency cerclage should be considered.

3
15.The combined oral contraceptive pills (COCP) interacts with the following
drugs:
A.Barbiturates
B.Aspirin
C.Chloroquine
D.Insulin

16.In Rh iso immunization and ABO incompatability, the origin of fatal and
neonatal. IgM is:
A.It is almost entirely maternal in origin
B.It is approximately 75% maternal and 25% fetal origin
C.It is almost entirely fetal in origin
D.It 25% maternal and 75% fetal origin.

17.Ovarian cancer:
A.Nulliparous women are at increased risk
B.Stage 2 disease is confined to the ovary
C.The five year survival rate for parents with stage 4 disease is 70%
D.Tumors of low maligent potential usually require chemotherapy

18.Endometrosis:
A.Tissue must include endometrial stroma ang glands in order to
diagnose the condition
B.Disease severity is an indicator of amount of pain experienced by the
patient
C.The incidence is highest in those investigated for chronic pelvic pain
D.Commonly presents with superficial dyspareunia

19.Premature rupture of membranes:

A.Infection is occasionally implicated in its aetiology.
B.Infection decreases the production of prostaglandins in preterm rupture
membrane
C.Conservative management is the treatment of choice in all the cases
D.Culture of amniotic fluid is as use full to the peditritions as to the
obstratitions

20.Contradiction of medical abortion with mifipristone\mifoprostol include all

EXCEPTS:
A.Active Liver disease
B.Uncontrolled seizure disorder
4
 C.Cardiovascular disorder
D.HIV

21.Female sexual disfunction

A.Rarely caused vaginismus
B.Is successfully treated with sildenafil (VIAGRA)
C.Rarely has a physical cause
D. Simple counselling and psychotherapy may help many couples

22.FOLIC ACID:
A.FOLIC ACID absorption is decreased in pregnancy patients taking
antiepiteptic medication
B.Fotate levels are not affected by sickle cell disease
C.In maternal fotate deficiency, the fetus also usually develops fotate
deficiency
D.fotate deficiency leads to hypodeficiency of the neurophills

23.Amnecocentesis:
A.There is a procedure related miscarriage rate of approximately 0.1%
B.FISH (Flourescene in situ hybridization). May be used to exclude the
common aneuoploidies
C.The cell culture will fall in approximately 5% of samples
D.Genetic amneosentesis is recommended before 15 weeks of gestation

24.Hormone replacement therapy(HRT):

A.Reduces the risk of depressive symptoms
B.Does not affect the incidence of alzeimers disease
C.Does not reduce bone loss in the presence of established osteoporosis
D.Is the first line of treatment in patients with established osteoporosis and
fracture

25.A 22 Year old presents kallmans syndrome and infertility. What is the best drug
to prescribe if she wants to convince?
A.Clomiphine citrane
B.Estrogen and progesterone
C.Progesterones
D.Gonadotrophins
26.Neural tube defects:
A.The recurrence risk if one siblings has been affected is 1:4
5
 B.The prognosis is poor if spina bifida is found in association with
hydrocephalus
C.The ultrasound finding of a banana shaped cerebellum is a marker for
spina bific occulata.
D.Preconceptual folic acid (400 micrograms per day) reduces the risk of
recurrence

27.Mifepristone is contraindicated for:

A.Ecotopic pregnancy
B.Fibroid
C.Contraception use
D.Threatened abortion

28.A 26 year old female, G2P1+0 who had a cone biopsy at 24 weeks of which the
pathology revealed at 2mm depth of invasion with no lymphovuscular invasion and
margins free she delivered vaginally at term your management post-delivery
should be.
A.Abdominal histerctomy 6-8 weeks following delivery
B.Radical histerctomy 6-8 weeks following delivery
C.Pap smear with or without copiscopy 6-8 weeks following delivery
D.Repeat cone biopsy 6-8 weeks following delivery

29.Preterm Labor:
A.It is defined as regular uterine contradictions and the presence of cervical
diataion occurring before 36 weeks gestation
B.A urinary tract infection is the aetiological factor in 90% of cases
C.Congential anomalies are a risk factor for preterm labor
D.The main cause of perinatal morbidity is sepsis

30.Breast feeding:
A.The frequency of breast milk transmission for HIV infection is 15-20%
B.The predominant immunoglobulin found n breast milk is secretary IgE.
C.A women in mastis should discontinue breast feeding
D. Breast feeding is contraindicated in mothers with active herpers
simplex virus

31.Ectopic pregnancy:
A.Exposure to diethylystillbestrol is a risk factor
6
 B.Most pregnancies occur in the fimbrial end of the tube.
C.At presentation, patients are usually mildy febrite
D.Methotrexate is useful in the treatment of ectopic pregnancy due to its
interference with RNA synthesis

32.Patients with a history of poly ovarian disease are at increased risk of:
A.Ostecporosis
B.Endometrial neoplasia
C.Late onset adrenal enzyme deficiencies
D.Insulin dependent diabities mellitus

33. During Inguinal lymph node dissection for vulvar cancer:

A.The femoral nerve enters the femoral sheath and lies lateral to the
femoral vessels
B.Branches of femoral archery includes the inferior epigastric artery
C.The femoral artery lies medial to the femoral nerve
D.The femoral artery is the continuation of the external iliac artery after
passing over the inguinal ligament

34.Neonatal lupus erythematosis (NLE) is associated with:

A.Hydrocephalus
B.Thrombocytosis
C.Aplastic anemia
D.Hepatospenomegaly

35.Urodynamic investigation:
A.Detrusor instability is the common cause of incontinence
B.Has a relatively low sensitivity and specificity for Detrusor instability
C.A decreased maximum flow rate may indicate damage to the urethral
sphincter
D.Genuine stress incontinence must be diagnosed by urodynamic study

36.A 22 year para 2 represented to the emergency room with acute onset of left
lower quadrant pain and cervical motion tenderness. Ultrasound findings showed
an enlarged left ovary laparoscopy revealed a twisted left adnexal 6cm cyst the
next step should be to:
A.Untwist the left adnexa and perform systectomy
B.Untwist the left adnexa
C.Ligate the left infundibunopelvic ligament
D.Perform the left salpingo oophorectomy
7
37.Endometrial Hyperplasia:
A.Will develop in a carcinoma in an average time of approximately 5 years
B.10% of hyperplasia without atypia will progress to carcinoma
C.If accompanied by atypia 50% will develop in carcinoma in 1 year.
D.If repeated endrometrial sampling shows normal or atrophic
endometrium after 3-6 months of progesterone no further follow up is
required.

38.Hysterestopic treatment for menorrphagia:

A.Is not an acceptable alternative to hysterectomy
B.Offers a solution for menorrphagia as well as irreversive contraceptions
C.Patients exhibit a lower rate of postoperative infection then hysterectomy.
D.Approximately 50% of patients will eventually request further
treatment after and endometrial procedure

39.The following treatment are true following preterm breech fetus:

A.It should always be delivered by caesarian section
B.Ceribaliar damage is a rare complication of vaginal delivery
C.An experienced doctor should attend all vaginal deliveries
D.Are best delivered by the vaginal routine

40.A 45 year old women nulliparous complaints of moderate vaginal bleeding of 3

weeks after her period that lated several hours, moderately stained two pads and
then stopped she is otherwise fells well non obese and in good general health her
menses are usually regular occurring every 28 days and lasting for 3-4 days Which
of the following is MOST important next step?
A.Endometrial biopsy
B.Pap smear
C.Pelvic ultrasound
D.Hysteroscopy

41.Bandis ring is also called:

A.Contruction ring
B.Schroeders ring
C.Retractive ring
D.Cervical dystocia

8
42.A 35 year old women G5 P4+0 PREVIOUS CAESARIAN Section has
spontaneous vaginal delivery at term of 4 kgm infant and she has retained placenta
for 20 minutes for next step in management of this patient?
A.Perform cord traction
B.Await spontaneous placenta separation
C.Promptly remove the placenta manually
D.Assume placenta accrete and prepare for operative intervention

43. Hirustism:
A.Obese Women are more prone to Hirustism despite the presence of a
normal serval testosterone
B.The maximum score on the ferimman galwey scoring system is 22
C.Prevalence does not vary according to race
D.Less than 10% of women with idiopathic Hirustism have polycystic
ovarian disease

44.Trombocytopenia in pregnancy:
A.Is encountered in 20%
B.Autoimmune thrombocytopenia is associated with antiphospholipid
antibodies
C.Autoimmune thrombocytopenia usually deteriorates in pregnancy
D.Antipatilent antibodies do not cross the placenta

45.Cardiovascular drugs with possible adverse fetal effects:

A.Amiodrone hydrochloride (anti-arrhytmic) may cause nonantal jaundice if
give a mother during pregnancy
B.Angeotensin converting enzyme (ACE) inhibitors may affect fetal liver
function.
C.Infra uterine growth retardation may result from using a beta-
blocker during pregnancy
D.Mrthyldopa may cause a positive indirect coombs tests in the neonate

46.Years old present to your clinic complaint of try dysmenorrhoea. All her
investigations was normal what is your initial management for the patient?
A. Combination of Fish oil\Vitamin B12
B.Non steroid anti-inflammatory Drugs(NASID)
C.Vitamin E (daily) in addition to lbuprofin
D.Oral contraceptive pills

9
47.The principle of distributive justice deals with issue of treating patients equally
is:
A.EQUALITY
B.FAIRNESS
C.Do not harm
D.Autonomy

48.Maternal steroid therapy:

A.Increases the incidence of intraventricular hormone haemorrhage
B.Reduces the incidence of respiratory Distress syndrome infants born
preterm by 40-60%
C.Reduces the incidence of hypoxic ischaemic encypalopathy in the neonate.
D.Reduces the incidence of Transient tachypnoea of the new born

49.Evidence based medicine anti-D Immunoglobulin is not given to D NEGETIVE

Women in case of:
A.Pseudocyesis
B.Missed abortion
C.Complete abortion
D.Tubal pregnancy

50.You performed biophysical profile for a pregnant patient with type 2 diabatic
maletus at 36 weeks and her score was 10, the recommended after ward
management is:
A.Plan the mode of birth
B.Repeat the test weekly
C.Repeat the test twice a week
D.Repeat the test AFTER 2 WEEKS

51.What is the most common symptom in the pregnancy patient with cholestasis of
pregnancy?
A.Nausea and vomiting
B.Mid epigastric pain
C.Pruritis without an apparent rash
D.Macular popular rash of straie

52.Regarding the etiology of the female infertility is TRUE:

A.Ovulatory Dysfunction is a major cause of infertility
B.Smoking may cause fertility
C.Treatment of mild endometriosis enyhances infertility
10
 D.A history of intermenstrual bleeding may suggest the possibility of
tubal disease as a cause of infertility.

53.REPAIR of perinial trauma:

A.Vicryl rapide is fully absorbed within 40 days
B.No difference in the incidence of short term pain with continuos sutus
combined with interrupted sutures
C.Silk sutures are associated with a decreased incidence of perineal pain
copared to polyglycolic acid sutures
D.Vicryl sutures are associated with more tissue reactions than chromic
catgut suture.

54.20 Year old African lady with severe anemia found to have an elevated Hb F
and elevated HbA2 (MORE THAN 3.5%) on haemoglobin electrophalasis what is
the MOST Likely diagnosis:
A.Alpha thallasemia
B.Sickle cell anemia
C.Beta thallasemia
D.Hemolytic anemia

55.A 6cm non tender, mobile, right adnexal mass in % in a 19 year old women.
One year ago, while using oral contraceptives, she was hospitalized for left leg
deep vein thrombophlebitis recent trans vaginal sonography shows a 4cm
unlloculor smooth ovarian cyst without internal excerensenses. A Serum pregnancy
test is negative you advise:
A.Observation
B.Oral contraceptives
C.Laparoscopy
D.Latarotomy

56.The following screening should be performed prior to treatment of pagets

disease of the vulva EXPECT:
A.Mammography
B.Cytological and colposcopy evaluation of the cervix, vagina and vulva
C.Eye examination
D.Breast examination

57.With regards to peritoneal healing:

A.After an intra-abdominal surgical procedure, it is complete within 10-
14 days
11
 B.Non closure of the pretonium does predispose patients to increase
infectious complications
C.Non closure of the pretonium decreases wound integrity
D.Suturing of the peritoneum increases the incidence of adhensions
postoperatively

58.Surgical management of endometriosis:

A.Asymptomatic patient with an incidental finding during surgery require
medical treatment intervension post op
B.Primary treatment in case of sever pain associated with endometriosis
should be surgical
C.Ovarian endometrioma more then 3cm associated with pain should be
executed if possible
D.Presacrial neurectomy to be done at same time of endometrioma excision
for mid moderate pelvic pain.

59.Anemia in pregnancy:
A.Cardiac output falls in the presence of anemia
B.Is the most common disease in pregnancy
C.Ferric salts are better absorbed then ferrous salts
D.Iron absorption occurs predominantly in the jejunum.

60.A lady presented to you with history of recurrent early pregnancy loss what is
the investigation to be ordered:
A.Thoxoplasma serology
B.Rubella screen
C.Thrombophilia screen
D.VDRL

61.An 18 year old primigravida at 18 weeks gestation complaints of nausea and

vomiting over the past week occurring on daily basis. Which of the following signs
or systems indicates a more serious diagnosis of hyperemesis graviderum
A.Hypothrodidum
B.Hypokalemia
C.Proteinuria
D.Diarrhea

62.Conserning Endometrial Cancer:

A.Most patients with early endometrial cancer will benefit from routine
pelvic lymph node biopsies
12
 B.Lymph node discretion adds major morbidity to surgery
C.Adjuvant radiotherapy has no effect on local pelvic reccurence
D.The risk station of the patient cannot be assessed by cronic section

63.Hyperprolactinaemia:
A.Is a frequent cause of oestrogen deficient amenhorrea and infertility
B.Is associated with Hypoparathypoidism
C.May be caused by dopamine agonists
D.Is harmful to the fetus

64.Breast lump:
A.A Breast lump with irregular margins is usually benegin
B.A newly diagnosed lump in a 75 year old women is unlikely to be
malignant
C.A normal mommgram in a women with a paipable mass excludes the
diagnosis of malignancy.
D.In mammography the false negative rate is higher in young women.

65.Haemoglobinopathies:
A.Alpha thalasaeimia is always due to a deteirorial defect
B.The thalasaeimia is an inherited defect of haemoglobin resulting in a
structural abnormality of a globin.
C.HbA (2 Alpha 2 Beta) should comprise over 50% of the total circulating
haemoglobin in the adult
D.Sickle cell anemia is diagnosed if Hb S is more than 50%

66.Cervical distotia is usually present at:

A.Level of external os
B.Level of internal os
C.Level of isthmus
D.Level of cervical canal

67.What abnormal placenta may increase the risk of pre-term delivery?

A.Battedore placenta
B.Circumvalate placenta
C.Marginal placenta
D.Succenturiate placenta

13
68.A patient undergoes IVF and conceives twins, which of the following is most
likely:
A.Gestational diabetes
B.Pre eclampsia
C.Preterm delivery
D.Hyperemsis

69.What is the rate of false normal fetal biophysical profile?

A.1 IN 10
B.1 in 100
C.1 In 1000
D.1 in 10,000

70.Which of the following is a sign of chronic fetal distress?

A.Diseminished fetal movement
B.Loss of fetal tone
C.Absent fetal breathing
D.Oligohydramnios

71.With regards to fetal hydrops:

A.THE appropriate incidence of fetal hydrops in 10% of those women with
antibodies.
B.The ratio of non-immune to immune hydrops approximately 2:1
C.Non immune hydrops is defined as the presence of excess extracellular
fluid in two or more sites with identifiable circulating antibodies to red
blood cell antigens
D.Non immune hydrops has a mortality rate of 50-90%

72.A 26 Year old Women is diagnosed to have molar pregnancy at 12 weeks

gestation when phrophlactic chemotherapy is indicated after EVACULATION:
A.Initial level of urine HCG is 40,000 IU after 6 weeks of evaculation.
B.Heptopathology confirmed complete mole.
C.Theica leutein cyst more than 4 cm
D. Uterine size less than 20 weeks

73.Sustained bradicardia seen with fetal heart tracing is suggestive of:

A.Multiple gestation
B.Cord prolapse
C.Placenta previa
D.Osgohydramnios
14
74.Postpartum hemorrhage (PPH):
A.Secondary PPM is classified occurring in between 24 H and 6 months
post delivery
B.Occurs most frequently in the 4th week of peuperium
C.Is a minor cause of maternity mortality.
D.Routine use of oxytocin in the third stage of labor reduces the risk of
hemorrhage by 30-40%

75.What would you tell pregnant women with synthetic lupus erythromatosis?
A.There is high risk of puperal exacerbation
B.Is associated with symptoms similar to pre aclampsia
C.Should never be treated with azathloprine
D.The presence of lupus anticoagulant decreases the risk of thrombosis

76.Which of the following treatments is not licensed for the prevention and
treatment of osteoporosis:
A.Etidronate (Didronel)
B.Alendronate (fosamax)
C.Dietary calcium
D.Reloxifene (evista)

77.Unconsious pregnant patient in third trimester is admitted with BP60\25 and

Pulse 130. She has been no vaginal bleeding, what is executed as diagnosis?
A.Abruption placenta
B.Eclamptia
C.Placenta previa
D.Emniotic fluid embolism

78.A 34 year pld G2p1 at 31 weeks gestation with a known placenta previa
presented to hospital with vaginal bleeding on examination her vital sign and CTG
was normal with goodacceleration. Heavy vaginal bleeding is noted. Which of the
following is best next step?
A.Administer intramuscular terbauline
B.Admit and stabilize the patient
C.Perform caesarian section
D.Induce labor

79.Regarding cervical cerclage:

A.It is done electively at 14-18 weeks
B.Emergency cerclage cant be d one at 22 weeks
15
 C.As long as the patient has no complaint no need to do cervical
cultures
D.Suture of Trans abdominal cerclage is placed at istmus

80.ACOG recommend about regional anesthesia and anticoagulants:

A.Patient on un Fractionated heparin is able receive regional analgesia
regardless of APTT Level:
B.Patient on prophylactic dose of UFH and aspirin is not able to receive
regional anesthesia
C.Patient on once daily dose of LMWH can receive regional analgesia after
6 hours from the last dose
D.Patient on once daily dose of LMWH can receive regional analgesia
after 12 hours from the last dose

81.Regarding the management of thromboembolic disease:

A.A ventilation perfusion VQ Scan for the diagnosis of pulmonary embolism
is contraindicated during pregnancy
B.Warfarin is excreated in breast milk
C.Long term warfarin therapy may lead to maternal osteoporosis
D.Protamine sulphate is used for heparin overdosage

82.vaccum extraction:
A.The incidence of neonatal scalp injuries is related to the type of
vaccum extraction cup
B.The recommended operating vaccum pressure is between 6.0 to 8.0 kg\cm

C.The flexian point is located 2 cm anterior to the posterior fontanel

D.The desired vacuum pressure may be achieved in one step and traction
commenced after 2 min

83.Treatment of varicella zoster:

A.Acycloviris category A drug
B.Neonatal infection should be treated with Acyclovir
C.Varicella pneumonia is an indication for oral Acyclovir
D.There are no existing resistant varicella zoster virus (VZV) strains to
Acyclovir

84.What is NOT recommended for shoulder distocia?

A.Soft fundal pressure
B.Macroberts maneuver
16
 C.Suprapublic pressure
D.Woods maneuver

85.Ca125 (normal range <35 u\ml):

A.Is increased in 5% of stages I ovarian cancers
B.Is decreased in pelvic inflammatory disease (PID)
C.Usually raised by urinary tract infection
D.Is elevated in patients with pancreatic cancer

86.Regarding using injecting medroxyprogesterone for contraceptive it:

A.Has no effect on bone mineral density (BMD)
B.Has no effect on body mass index (BMI)
C.Is contraindicated in breast feeding
D.Does not protect against STDs

87.The placental size tumors characterizes by?

A.Are composed of a pre dominance of intermediate cytotrophoblast
cells arising at the sight of the implantation
B.There are high proportion of syncytiotrophoblast
C.Human placental lactogen (HPL) is a nonreliable marker
D.A high % metastasized extra uterine

88.Cervical incompetence:
A.Is characterized by painful cervical dialation in the second trimester
B.May be caused by diethysteboestrol
C.LEEP (Loop electro cautarry excision procedure) is commonly associated
D.May be treated with intravenous ritodrine

89.A 10 year old girl with a 6 month history of regular menstruation and well
developed 2ry sex characters. Her sister attained menarche at 13 and 14 years.
What is your next step?
A.Reassurence
B.Hormonal profile
C.Pelvic ultrasound
D.Karyotype
90.The MOST common site of metastate spread in stage I adenocarcinoma of the
endometrium is the:
A.Pelvic Lymph nodes
B.Para aortic lymph nodes
C.Vaginal apex
17
 D.Peritoneal surface
91.24 years old pregnant women at her 23 weeks of gestation with migranes
headache:
A.Migranes attack up to 40% of pregnant women
B.Acetaminophen alone or with coediene is the first drug of choice
during all trimester
C.Most women with migraine without aura gets worse during pregnancy
D.Naproxen and ibuprofen are safe after 28 weeks of gestation

92.Antibiotic prophylaxis in gynaceology procedure:

A.All women undergoing an abdominal or vaginal hysterectomy should
receive antibiotic prophylaxis for 24 hours
B.No need for prophylactic antibiotic women undergoing laparoscopic or
laparoscopy assisted vaginal hysterectomy
C.Administration of antibiotics solely to prevent endocarditic is
recommended for patients who undergo a genitourinary procedur.
D.Should be administered 10 to 60 min prior to skin incision no
additional doses are recommended

93.A patient presents to your clinic complains with decreased fetal movement at 36
weeks gestation she is healthy and has normal antinetal follow by visits her BPP
8\10 2 Point deduced for breathing movement how should you council the patient
regarding the result of her BPP?
A.The result is equivocal and need to repeat it within 24 hours
B.The result is abnormal and she should be induced
C.The result is normal and she can home
D.The result is abnormal and she should undergo umbilical artery Doppler
velocimiter

94.38 Year old patient with hyperthyroidism:

A.Total triodothyronine decreased during pregnancy
B.TSH is least likely to cross the placenta
C.Fetal thyroid begin concentrating iodine between 30-36 weeks
D.The most common etiology of hyperthyroidism in pregnancy is hashimoto
disease

95.Counciling primiviganda about epidural analgesia should not include:

A.Prolong labor for one hour
B.Central nervous system toxicity
C.Decrease the need of instrumental delivery
18
 D.Increase need of oxytocin

96.External cepathic version (ECV) in breech presentation:

A.With a trained operator about 90% of ECV attempts will be successful
B.Ecv should be offered from 34 weeks in nulliparous women and from 36
weeks in multiparous women
C.The use of tacolysis with beta sympethomematis may be offered to
women undergoing ECV as it has been shown to increase the success
rate
D.Where ECV falls the possibility of a further attempt should be abundant

97.Congentional Heart DISEASE (CHD):

A.It is the second commonest congential melformation in children:
B.Trisomy 13(pataus syndrome) is the most common aneuploidy associated
with congential heart disease
C.Is more likely if there is increased nuschal translucency and a normal
karyotype in the first trimester
D.The four chamber view of the fetal heart is a good screening test

98.An otherwise healthy 32 year old P2 is referred to you as a pelvic mass

discovered during a routine examination 10 weeks ago. An ultrasound examination
performed at that time revealed 6 cm right adnexal cyst without separation and
with scant internal echoes there is no free fluid in the pelvis repeat ultrasound
reveals a slight increase in size from the earlier study to 6.5 x 5.6 x 7.8 cm. the
MOST appropriate amangement of the patient is:
A.Reavaluation in six weeks
B.Oral contraceptive therapy
C.Leuprolide acetate (LUPROX DEPOT)
D.Surgical intervention

99.Magnesium sulphate and eclamptia:

A.Used properly prevents all seizure activity
B.A loading dose of 40mg is recommended
C.Loss of deep tendon reflexes indicates the need for further magnesium
sulphate
D.Acts by revealing cerebral vasospasm

100. Placental abruption:

A.The commonest reason is blunt trauma to the abdomen
B.Causes are usually obvious clinical
19
 C.Many patients with placental abruption are diabetic at presentation
D.Nearly 50% of patients are in established labor

101.Following a difficult vertex delivery, an infect does not move his right arm
etiologic diagnostic possibilities do not include the following:
A.Erbs Palsy
B.Fractured Right Clavicle
C.Fractured Right Humerus
D.Cephalhematoma

102.A Nineteen Year Old Women Presents with Primary Amenorrhea. Her serum
prolactin level is 900 Ug\liter(Normal 20) and The CT Scan Shows a 2cm Pitutery
Mass. The Diagnosis is:
A.Craniopharyngioma
B.Macroproiactinoma
C.Pseudoprolactinoma
D.MicroProlactinoma

103.Which Of Thr Following is MOST Effective Measure In Prevention Of

Preterm abor:
A.Device A Scoring System to Identify Women at High Risk
B.Routine Trans Vaginal UltraSound scanning for Measuring of Cervical
Length.
C.Screening for Bacterial Vaginosis
D.Screening for fatal Fibronectin at 24 Weeks

104.A 38 Year old Nulliparous Women presents in your Clinic Requesting a

bilateral Salpingo-oopherectomy. Her Mother Died Of Ovarian Cancer at Age 64
and Her Sister at 48 Her BRCA 1/2 mutation is negative and there is No Family
History of Other Cancers. You Advise Her Risk of Developing Ovarian Cancer is:
A.1 to 2%
B.5 to 7%
C.10 to 20%
D.30 to 40%

105.The Most Common Side Effect With The Use of mefformin for ovulation
induction is:
A.Visual Disturbance
B.Hyperglycemia
20
 C.Hot Flashes
D.Gastrointestinal Upset

106.A 35 Year OLD Women with intra uterine contractive Device Found To a
Pregnancy Weeks. This Patient is at significantly increased likelihood of:
A.Ectopic Pregnancy
B.Fetal MalFormation
C.Spontanious Abortion
D.Septic Abortion

107.Considering Doppler UltraSound:

A.Abnormal Uterine Doppler Flow Always Indicate fetal Hyprotactin
B.Abnormal umbilical artery Flow indicates Poor placement perfection.
C.Fetal anemia is not associated with Redistribution of Blood flow
D.Fetal Hypoxaemia is associated with hyper dynamic ovaculation

108.The Progestrone only pills is associated with:

A.Poor cyclic control
B.Intrahipatic cholestasis
C.Fibrodenosis of the breast
D.Inhabitation of the lactation

109.What is the incidence of fatal growth restriction:

A.<1%
B.3 TO 10%
C.15 TO 20%
D.20 TO 25%

110.Polysyastic Ovulation Syndrome

A.Is associated with LH hyper Secretion
B.Is associated with low TSH Levels
C.Typically presents with primary Amenorrhaea
D.Is associated with markedly elevated serum protactin.

111.A 25 Year old women, G3P With no specific Complaints presented to the
clinic for annual Routine checkup. She completed her HPV immunization vaccine
2 times. Her examination is normal and her liquid based cyctology reveals cells of
undetermined significance. The MOST Appropriate Next step in her management
is to:
21
 A.Administer a booster injection of the HPV vaccine
B.Repeat the cytological screening in 6 month
C.Perform a calposcopy
D.Perform cryotherapy

112.A 34 Year P3 lady wishes to have contraceptives her examination revealed is

second degree cystocele and rectosele and first degree uterine decent of the
following options the least effective method of contraception would probably Be:
A.Oral Combined conterseptive pills
B.Condoms
C.Progesterone pills
D.Oaphragm

113.Internal veration and extraction at term is indicated in:

A.Face presentation
B.Shoulder presentation
C.Perasifrence brow
D.The second twin

114.Permenapsual Women Wth abnormal uterine require indometrial sampling to

rule out Endromentrial disease:
A.Biopsies show endrometrial cancer in 2% of cases.
B.Biopsies show normal endometrium in more than 50% of cases
C.Biopsies show polyps in less than 5% of cases
D.Biopsies show endometrial hyperplasia in more than 50% of cases

115.A 29 year old women, G2P2 has a pap test which showed a typical glandule
cells (AGC) not otherwise specified, her Gynacalogical and Medical history is
unremarkable and she is not on any medications. The MOST appropriate next
procedure would be:
A.Repeat Pep test in 6 months
B.Cervical cone biopsy
C.Dilatation and curettage
D.Colposcopy with cervical biopsy and endrometrial biopsy

116.After Successful conceptions the following STATEMENTS are TRUE:

A.The Embryo remains in the fallopian tube 6-8 days
22
 B.Myornetrial cytokines modulate cytrophoblastic proteotytic activity
C.Implantation usually occurs at the anterior wall of the uterus
D.Human chorionic gonadotrophin is produced by the corpus letum X

117.Rubella infection in pregnancy:

A.Is associated with conjential Heart Defects
B.Immunity accuired for vaccination is lifelong
C.Termination of pregnancy should be offered if immunization occurs
during first tremester
D.Defection of rubella IGM implies immunity to Rubella

118.Granulosa Cells Tumors May be Associated with:

A.Polysiastic ovarian syndrome
B.Congenital adrenal hyperplasia
C.Dysgenetic gonads
D.Endometrial hyperplasia

119.The use of oral contraceptive may increase the risk of wich of the following
conditions:
A.Fibrosystic Breast Disease
B.Hepatic Adenoma
C.Salpingitis
D.Ovarian Cancer

120.Cesarean section is NOT indicated in:

A.A nulliparous Women at 7cm who has not progressed over A 2 hour period
B.A multiparous women at 3cm with oxytocin infusion who is contracting
once every 5 minutes with no progress over 6 hours
C.A Women who has previously been delivered by cesarean section and the
servix remain at 7cm for more than 2 hours.
D.An overweight Multiparous women who has an induced labour and
the cervix reached at 8cm but there is a marked caput and moulding on
vaginal examination and the head is still at 0 station.

121.A 37 Year old women asks you to discuss birth control options. She has a
history of postpartum depression, no other past medical history and has no allergies
23
to medications and she is passive smoker. What is the most efficacious method of
contraception for this patient without any contradiction?
A.Depo provera
B.Combined oral contraceptive pills OCPs
C.Progestin only pills
D.Cooper-T IUD

122.Many of the common disease of adulthood such as hypertension, coronery

artery, and diabetes mellitus and schizophrenia are inherited in which of the
following way:
A.Mitrochondrial Inheritance
B.Genomic imprinting
C.Uniparental disomy
D.Multifactorial inheritance

123.The most common uterine sarcoma is a (an):

A.Leiomyosarcoma
B.Endometrial stromal sarcoma
C.Endolymphatic stromal myosis
D.Malignant mixed mullerian tumor (Carsinosarcoma)

124. A third degree tear:

A.Is less common with midline epiciotomy
B.Should be repaired under local anesthesia
C.Should have the anal sphinster repaired before the vaginal skin
D.the anal sphinster should be repaired using vicryl rapide

125.The presence of everted firmbria, proliferation of tubal folds, and giant cells
within the fallopian tube should lead to the diagnosis of:
A.Endometriosis
B.AndenoCarsinoma
C.Tuberculosis
D.Gonorrheal salpingitis

126.Administration of EpiDural analgesia in early labor is associated with:

A.Increased risk of caesarian section
B.Prolongation of the first stage of labor, compared to use of
intramuscular opioids
C.Prolongation of the second stage of labor, compared to use of
intramuscular opioids
24
 D.Lower intrapartum pain scores, compared to use of intramuscular opioids

127.Chorionic villus sampling:

A.Should be followed positive serum screening for neutral tube defects
B.Should not be perform after 20 weeks of gestation
C.May be performed by Trans abdominal and trascervical routes
D.Is contraindicated in a women with recurrent miscarriage.

128.Leuteinizing Hormone (LH):

A.Is bound to plasma proteins
B.Secretion is stimulated by falling levels of estrogen
C.Production is increased by sustained continuous administration of g
anodotrophin releasing Harmone Analogs
D.Stimulates testosterone production in the female

129.Risk factors of preterm delivery includes all of these EXCEPT:

A.Previous preterm delivery
B.Anemia
C.Tobacco use
D.High body mass index

130.A 34 year old women is 16 weeks pregnant and has a pap smear suspicious for
cancer, u advise her to:
A.Have colposcopy with biopsy
B.Have colposcopy but biopsy is too risky in pregnancy
C.Have a repeat pap smear in 3 months
D.Undergo a termination of pregnancy and undergo complete termination

131.Which of the following ovarian epithelial tumor MOST commonly has

external papillary excrescenses?
A.Mucinous cystadinoma
B.Serous cystadinoma
C.Brennor tumors
D.Endometrioid epithelial tumor

132.There is recognized association between intrauterine death of the fatus and the
following EXCEPT:
A.Maternal CMV infection
B.Sickle call trait
C.Listeriosis
25
 D.Gestational Diabetes

133.Which of the following is true about multiple pregnancy?

A.Monozygotic twin is more common than dizygotic twins
B.In genesis of twin, the earlier division the more chance of embryo to have
a common placenta
C.More than 95% of twin diagnosed by early ultra sound continue to
delivery
D.Ultrasound is the most important diagnostic tool

134.In Gestational trophoblastic:

A.Partial hydatidiform is chromosomally 45XX
B.Invasive mole may metastasis to the lungs
C.Complete hydatidiform mole characteristically invades the
myometrium.
D.Choriocarcinoma is best treated by hysterectomy

135.The most common typer of clinical significant chromosomal abnormality is:

A.Aneuploidy
B.Triploidy
C.Tetraploidy
D.Deletion

136.Congential androgen insensitivity syndrome is secondary to defective

androgen:
A.Synthesis
B.Metabolism
C.Receptor action
D.Excretion

137.Which of the following nipple discharge is not associated with Breast cancer?
A.Watery Discharge
B.Greenish Discharge
C.Serous Discharge
D.Sarosanguineous Discharge
26
138.A 63 year old patient is seen for routine examination. An ex-coriated 2cm
lesion is found on her left labium majus which she states to be present for 3months
the next best step is:
A.Prescribe hydrocortisone cream
B.Schedule colposcopy
C.Perform excisional biopsy
D.Prescribe burows solution soaks

139.The Major site of material clearance betamethasone is:

A.Kidney
B.Lung
C.Liver
D.Brain

140.Which of the following contraceptive methods has the lowest pregnancy rate
in 100 women years using the method for 1 year?
A.Intrauterine device
B.Long acting progestin (Depo provera, Norplant)
C.Diaphragm
D.Oral contraceptives

141.Which of the following medications should not be used to treat

gasteroesophageal reflux in pregnancy?
A.Cimitidine
B.Ranitidine
C.Metoclopradine
D.Misoprostol

142.Which of the following structures is not part of broad ligament of the uterus?
A.Fallopian Tubes
B.Ureter
C.Ovarian blood vessels
D.Lymphatic vessels

143.The following statement is NOT True regarding lactation:

27
 A.Normal milk secretion is more than 60cc per day.
B.Human milk is isotonic to plasma and more than 50% of its osmotic
pressure is due to its lactose content
C.Iron reserve affects milk iron contents.
D.Lactation is contraindicated in drug abusers

144.A 30 year old women presents with vaginal discharge associated with
dyspariunia fresh examination of the discharge revealed clue cells the
diagnosis is:
A.Bacterial Vaginosis
B.Monilia Vaginitis
C.Vaginal Trichomoniasis
D.Gonococcal cervisitis

145.In pregnant women over the age of 35 there is increased risk of the following
EXCEPT:
A.Increased Risk of Multiple pregnancy
B.Increased Risk of Hyperthyroidism
C.Increased Risk of gestational Diabetes
D.Increased Risk of hypertension in pregnancy

146.A Young Girl with congenital adrenal hyperplasma and irregular menstruation
is best treated with:
A.Cyclic Progestrone
B.Daily glucocordicoids
C.Cyclic estrogens
D.Daily GnRH analogue

147.With regard to obligue lie of the fetus

A.The incidence is unaffected by party
B.There is a recognized association with fetal renal agencies
C.There is no association with placenta previa
D.This incidence is increased in multiple pregnancy

148.Which of the following is NOT characteristics of Precocious puberty:

A.Results in tall stature
B.Can be differentiated from pseudo precocious puberty by measurement of
LH Levels.
28
 C.Brest buds are the first signs
D.Has no causative factors in 80% of the girls

149.One hour after vaginal delivery with episiotomy the patient was found to have
an 6 x 5 cm, bluish and painful swelling in the perineum. Appropriate management
of this case is:
A.Aspiration
B.Removal of stitches, drainage, identification and legation of the
bleeding vessel.
C.Manual exploration of the uterus under anesthesia
D.Observation ice pack, and analgesia

150.The following is NOT true regarding oligohydramnious:

A.Can be associated with amniocentesis
B.Can be associated with postmaturity
C.Can be caused by diabetes
D.Can cause fatal hypoxia

151.The most effective treatment of vulvar pruritus associated with atrophic

vulvitis is:
A.Anti-Histamines
B.Hydrocortisones
C.Alcohol Injection
D.Topical Estrogen therapy

152.In a Patient with an Isolated Grade 3 uterine prolapse. The MOST Likely
affected part of her pelvic organs support is:
A.Pubo cervicals ligaments
B.Broad ligaments
C.The complex ring of ligaments (uterosacral and cardinal)
D.Recto vaginal septum

153.The persistence of which of the following is usually incompatible with

spontaneous delivery at term?
A.Occiput left posterior
B.Mentum posterior
C.Mentum anterior occiput
D.Occiput anterior

29
154.The following is NOT an indications for ventouse Delivery:
A.Fetal distress during the second stage of labor
B.Persistent occipito posterior position
C.Persistent mento posterior
D.Maternal distress during the second stage

155.An 18 year old women consults you for a painful swelling of her left labium
that has progressively worsened over the first past 3 days. On examination of a
6cm swollen, red, tender, tense cystic mass is present in the left labium majus. The
MOST Appropriate next step in the care of this patient is:
A.Excision of the mass
B.Oral antibiotics
C.Intramuscular or intravenous antibiotics
D.Incision and drainage of the mass

156.Which of the following is NOT true regarding abruption placenta:

A.Often occurs in hypertensive patients
B.Coagulopathy is a common sequelae
C.Often occurs in primigravida patients
D.Separation of placenta reduces the effective nutrient exchange

157.Choose of the current imaging technique of choice for the diagnosis of

Hydratidiform mole:
A.Ultrasound
B.Computed tomography
C.Magnetic resonance imaging
D.Plain film of abdomen

159.Low Foreceps can be applied under these circumstances:

A.The fatal head leading point should be at +2 station
B.The fatal head leading point should be above +2 station
C.The fatal head is on the pelvic floor
D.Sagittal suture is anteroposterior

30
160.Chlamydia trahomatis:
A.Is a gram positive intracellular organism
B.Cannot be cultured in a lab
C.Produces intracellular particles called recticule bodies which are infectious
D.Produces infectious particles known as elementary bodies

161.The following is NOT true regarding causes of utirary ---------- with overflow
in pregnancy
A.Retroverted gravid uterus
B.Fibroid occupying the pouch of Douglas
C.Ovarian cyst incarcerated in pouch of Douglas
D.Cystocele in pregnancy

162.Which of the following types of endometrial carcinomas has the best

prognosis?
A.Adenosquamous carcinoma
B.Cell clear adino carcinoma
C.Pepillary serous carcinoma
D.Endometriod carcinoma

163.A 34 year primigravida presents with abdominal pain and uterine contradiction
at 33 weeks gestation.
A.Tocolytics should not be administered
B.Erythromycin should be prescribed
C.The presence of a normal heart rate excludes abruption
D.A --------- Kiehorria test may be useful if placemental abruption is
suspected

164.Dietary folate Supplimentation has been shown to decrease the risk of

recurrence of neural tube defects by as much as:
A.20%
B.30%
C.40%
D.50%

165.Breakthrough bleeding(BTB) Occuring as a side effect of continuous

combined hormone replacement therapy (HRT):
A.Occurs in 10-15 % of patients during the first 6 months of treatment.
31
 B.Occurs in 5% after the first year.
C.Is Different in mechanism then that seen with oral contraceptives
D.May require a change to a sequential program if it persists beyond 1
year

166.Which of the following has a recognized association with PROM(Premature

rupture of membranes):
A.Diabetes in pregnancy
B.Breech Presentation
C.Rh Isoimmunization
D.Bacterial Vaginosis

167.What is the effective measure in the measurement of preterm labor in a women

at 30 weeks of gestation?
A.Hydration
B.Administration of magnesium sulphate as tocolytic
C.Transfer to a tertiary care nenonatal unit
D.Prophylactic antibiotics

168.A 38 year old WOMEN Complaints of regularly heavy periods but NO other
Symptoms And NO abnormality is detected in examination:
A.Endometrial sampling is recommended
B.If she is a smoker low dose oral contraceptive pills is contraindicated
C.Norethisterone administered for 5-10 days during luteal phase is
effective in reducing in menstrual loss
D.Norethisterone administered for 21 days per cycle is effective in
reducing menstrual loss.

169.A Postpartum Patient had been running a low grade fever. On her 6th
postpartum day, she developed a tender area over the posterior right leg. The pain
and fever increased and tachycardia developed. Later the leg become red and
tender with edema and groin pain become pronounced. The MOST Likely
Diagnosis is:
A.Varicose Veins
B.Pelvic cellulites
C.Endometrites
D.Thrombophlebitis

32
170.The following is not true regarding causes that increase perinatal morbidity
and mortality in pregnancies complicated by diabetes:
A.Birth Injuries
B.Neonatal Hyperglycemia
C.Hyaline membrane disease
D.Hypocalcemia

171.Most uterine Leiomysarcoma are diagnosed by:

A.Sudden Uterine Enlargement
B.Vaginal bleeding
C.Histologic examination of excised myoma
D.Lung metastasis

172.After Birth Which of the following vessels does not constrict(s)?

A.Ductus artiriosus
B.Umbilica arteries
C.Ductus venosus
D.Hepatic portal vein

173.Which of the following pathologic feeling is MOST Helpful in distinguishing

complete hydratidiform mole from normal placenta?
A.Trophoblastic proliferation
B.Absence of blood vessels
C.Hydropic Degeneration of villi
D.Cellular atypia.

174.A 26 Year old lady was first seen at 32 weeks gestation. Her physical
examination reveals the presence of a large posterior cervical leiomyoma filling the
pelvis. The patient was relatively asymptomatic, Mnagement should be:
A.Immediate myomectomy
B.Immediate cesarean section
C.Close observation until term
D.Progesterone therapy to decrease the myoma size

175.The Most common skin disease affecting the vulva is:

A.Lichen Planus
B.Psoriasis
C.Seborrheic dermatitis
D.Contact derm

33
176.The bacteria found MOST frequently in puerperal mastitis is:
A.Anaerobic Streptococcus
B.E.coli
C.Staphylococcus
D.Aerobic streptococcus

183.Even after menopause most women have circulating estrogen. In high enough
levels, this can promote the development of endometrial cancer. It mainly
originates from the aromatization of:
A.Androstenedione of estrone by ovarian granulose cells
B.Androstenedione of estrone by ovarian theca cells
C.Androstenedione of estrone by adipose tissue
D.Testosterone to estradiol by adipose tissue

184.The drug of chice in parenteral treatment of acute severe hypertention in a

pregnant women is:
A.Nicardipine
B.Hydralayzine
C.Labetolol
D.Sodium nitropruside

185.The colposcopy permits:

A.View the cervix 1-4 power magnification
B.See the entire transformation zone in all patients
C.Choose the most suspicious areas on the cervix to biopsy
D.Treat invasive cancer with a biopsy

186.Thyroid stimulating Harmone(TSH):

A.Is a glycoprotein
B.Levels are increased in normal pregnancy
C.Has betasubunits similar to those of lutinizing hormone
D.Secretion is stimulated by stress

187.Which of the following is the major ultrasound marker for trisomy 21 in the
fetus?
A.Echogenic foci in the heart
B.Hyperecogenic bowel
C.Choroid plexus cysts
D.Nuchal edema

34
188.During clinical pelvimetry the following can NOT be measured
A.Diagonal conjugate
B.Transverse diameter of the inlet
C.Shape of the public arch
D.Ischial spines

189.Excessive fatal activity, has been observed with which of the following fetal
problems?
A.Growth restriction
B.Macrosomia
C.Anensepathy
D.Hypeximia

191.The most common cause of rectovaginal fistula is:

A.Obstetrical delivery
B.Irradiation to the pelvis
C.Hemorrhoidecto
D.Carcinoma

192.The factor MOST indicative of invasive cancer on colposcopic examination is:

A.Mosaic pattern
B.Puctation
C.Leukoplakia
D.Abnormal blood vessels

193.Which of the following is MOST Likely to cause vulvar pruritus?

A.Vaginal trichomoniasis
B.Leukimia
C.Personal Hygene products
D.Secondary sephills

194.Which statement is not true Regarding occipito posterior positions?

A.They are detected by finding the anterior fontenelle in the posterior
aspects of the pelvis.
B.Majority will rotate prior to full dilatation
C.Usually delivered by cesarean section
D.Incidence decreased where the presenting part is very low in the pelvis.

35
159.160.161.162.163.164. missing questions

36