meFinal exam Saudi Board 2009

1. According to a recent Cochrane Database System Review in regard to

Interventions to reduce haemorrhage during myomectomy for fibroids.
Which of the following Is true?
a. There was a significant reductions in blood loss with misoprostol
b. There was no evidence of effect on blood loss with vasopressin and
analogues
c. There was no evidence of effect on blood loss with bupivacaine plus
epinephrine tranexamic acid
d. There was no evidence of effect on blood loss with peri-cervical
tourniquet.
e. There was a significant reductions in blood loss with myoma enucleation
by morcellation or oxytocin.
2. Which of the following treatment modalities is a non invasive promising alternative
to myomectomy
a. Uterine fibroid embolization.
b. focused high-energy MRI-guided ultrasound.
c. MRI-guided laser myolysis.
d. Laparoscopic uterine artery occlusion.
e. Laparoscopic myolysis.

3. Which of the following is true in regard to uterine artery embolization (UFE)?

a. Premature ovarian failure occurs in 5-10 % of patients .
b. The risk of post partum haemorrhage is 10 times that which occurs after
myomectomy.
c. One of the advantages of UFE is the substantial reduced risk of adhesion
formation.
d. The risk of preterm labour after UFE is similar to that which occurs after
myomectomy.
e. Uterine-artery embolization(UFE) should be the first line of treatment for
women with symptomatic uterine fibroids who wish to conceive
4. A 36 years old infertile lady was diagnosed to have an intramural fibroid of 3
centimeters in its largest dimensions and is distorting the endometrial cavity at a
salinesonohystrogram. Post- myomectomy the patient ;
a. Is less likely to have a pregnancy without assisted reproduction.
b. Is less likely to have a miscarriage.
c. Has no change in pregnancy rate prior to myomectomy.
d. Is more likely to have a miscarriage.
e. Has a significant increase in conception rate.

5. In regard to the postcoital test. Which of the following is true?

a. A normal test is said when there is at least 5 motile sperms per high power field
and the cervical mucus should show ferning and >5 cm spinnbarkeit.
 b. The pregnancy rate at 24 months is higher in couples who had the
routine postcoital test versus those who did not.
c. A normal test is said when there is at least 10 motile sperms per high power field
and the cervical mucus should show ferning and >5 cm spinnbarkeit.
d. A normal test is said when there is at least 5 motile sperms per high power field
and the cervical mucus should show ferning and 3 cm spinnbarkeit.
e. A normal test is said when there is at least 10 sperms per high power field and
the cervical mucus should show ferning and 5 cm spinnbarkeit.

6. A 30 years old infertile lady who has a proximal tubal blockage seeks a pregnancy.
Which of the following is the most appropriate treatment?

a. Ovulation induction plus timed intercourse.

b. Ovulation induction plus intrauterine insemination.
c. Tubocornual anastomosis by laparotomy.
d. In Vitro fertilization.
e. selective salpingography with tubal catheterization.

7. In regard to endometrial biopsy for evaluation of ovulation. Which of the

following is true?
a. An endometrial biopsy is considered to be normal if the assigned date
from the histologic examination is within two days of the actual date
calculated from the previous LH surge as day 14.
b. The results of the endometrial biopsy should be interpreted with reference
to the next menstrual period rather than to onset of ovulation ART surgery.
c. Compared to fertile women, infertile women has a higher prevalence of
out-of-phase biopsies.
d. Luteinizing hormone is responsible for major changes in the endometrium.
e. Endometrial biopsy is indicated for patients who are infertile with
oliogomenorrhoea.

8. In regard to At home- semen analysis (Fertell). Which of the following is true?

a. It provides an estimate of the total motile sperm using a "swim-up"
technique and an estimate of morphology.
b. It provides an estimate of the total motile sperm using a "swim-up"
technique and an estimate of pH.
c. It provides an estimate of the total motile sperm using a "swim-up"
technique followed by reaction with a monoclonal antibody against a
sperm surface antigen.
d. It provides an estimate of the total motile sperm using a "swim-up"
technique and an estimate of grade A motility.
e. It provides a visual estimate of the concentration of progressively motile sperm
in a semen sample using a test that is completed within approximately 3 hours
of production of the sample.

9. According to Cochrane Database System Review in regard to Laparoscopic

"drilling" by diathermy or laser for ovulation induction in anovulatory
polycystic ovary syndrome. Which of the following is true when laparoscopic
surgery was compared to gonadotropin therapy?
 a. After twelve months of follow-up, gonadotropin therapy resulted in a
higher rates of ovulation.
b. No significant differences were seen in ongoing pregnancy rates between
the two treatments.
c. ovarian hyperstimulation were reported to be higher in gonadotropin
therapy.
d. The cost per pregnancy appeared to be lower with gonadotropin.
e. less in miscarriage rates were seen in laparoscopic surgery.
10. A 29 years old lady with secondary infertility for five years received
gonadotropin therapy for several cycles with three cycles of intrauterine
insemination. Her hysterosalpingogram showed patent tubes with evidence of
peritubal adhesions. What is the next most appropriate treatment?
a. In Vitro fertilization.
b. Laparoscopy adhesiolysis.
c. Repeat hysterosalpingogram (HSG).
d. Chlamydia prophylaxis and repeat Insemination.
e. Offer another two cycles of ovulation induction and intrauterine
insemination.
11. Compared to Clomiphene citrate; which of the following is an advantage of
Letrozole use for ovulation induction?
a. Pregnancies conceived after letrozole treatment had less miscarriage and
ectopic pregnancy rates.
b. Letrozole yield a higher pregnancy rates in stimulated cycles.
c. Letrozole is more cheaper.
d. Letrozole does not deplete estrogen receptors at target organs.
e. Both drugs have similar fetal effects.
12. In regard to Couples with unexplained infertility; Which of the following is true?
a. couples with unexplained infertility do not have subtle functional
abnormalities in oocyte and/or sperm function.
b. couples with unexplained infertility are preferably treated with advanced
assisted technologies.
c. Sperm function test are must in these conditions.
d. effective fertility treatment for unexplained infertility demonstrates an
increase in the pregnancy rate above baseline fecundability.
e. 10 to 20 percent of couples with unexplained infertility followed
prospectively without active treatment become pregnant each month.

13. In regard to the effect of smoking on fertility. Which of the following is true?
a. Women exposed to cigarette smoke in-utero are found to have similar
fecundability to those who did not.
b. Adult male offspring of mothers who smoked greater than 5
cigarettes/day during pregnancy had lower sperm counts than the sons
of nonsmokers.
c. Odds of pregnancy per number of in vitro fertilization cycles is similar
in smokers compared to nonsmokers.
d. Fecundability is decreased if the female partner smokes greater than
20 cigarettes per day.
e. The subfertility associated with smoking can be reversed within a year
of cessation.
14. Selective tubal catheterization;
 a. is successful in obtaining tubal patency in 20 to 30 percent of patients.
b. is successful in obtaining tubal patency in 40 to 50 percent of patients
c. is successful in obtaining tubal patency in 60 to 80 percent of patients
d. is successful in obtaining tubal patency in 85 to 90 percent of patients
e. is successful in obtaining tubal patency in 10 to 20 percent of patients
15. Tubal anastomosis;
a. Is a better option than In Vitro fertilization in women younger than 37 years who
have 4 cm of residual tube.
b. Previously used sterilization technique has no impact on the anastomosis
success.
c. Laparoscopic tubal anastomosis leads to a better success rate than conventional
microsurgical anastomosis.
d. Ectopic pregnancy rates are higher after conventional microsurgical anastomosis.
e. Hysterosalpingogram should be performed six weeks after the procedure to
confirm tubal patency.
16. In regard to hysterosalpingogram. Which of the following is true?
a. Painful procedure is frequently with the use of oil contrast media rather than
water soluble media.
b. Post HSG pelvic inflammatory disease rate is around 10%.
c. Oil contrast media has a better safety profile and produces higher
quality visualization of tubal mucosa.
d. Spasm may be alleviated by rest followed by slower injection or
intravenous injection of glucagon.
e. Post procedure pregnancy rate are higher after the use of water soluble media.

17. Hydrosalpinx
a. Decreases the pregnancy rate after In Vitro fertilization (IVF) by 70%.
b. Increases the risk of miscarriage by three folds after In Vitro fertilization (IVF)
pregnancies.
c. The relative increase in the pregnancy rate after salpnigectomy is
greatest in women with hydrosalpinx visible on ultrasound.
d. Proximal tubal blockage is as effective as salpnigectomy in improving pregnancy
rates after In Vitro fertilization (IVF).
e. Drainage of the hydrosalpinx at the time of oocyte collection is as
salpnigectomy in improving pregnancy rates after In Vitro fertilization (IVF) and
less invasive.

18. Richter's hernia;

a. occurs usually at 5mm lateral ports sites after laparoscopy.
b. a hernia involving only omentum.
c. can result in bowel strangulation leading to perforation.
d. can be minimized by withdrawing the cannula with its valve closed.
e. commonly occurs if the pneumoperitoneum pressure used is at 10 mm Hg.
19. In regard to gynecologic laparoscopic complications. Which of the following
is true;
a. The diagnosis of an enterotomy is usually delayed in more than 70
percent of cases.
b. The open technique is associated with fewer complications than the
closed technique.
 c. The commonest cause of death in these procedures were due to gas
embolism.
d. Over 50 percent of these complications occurred at entry.
e. Inserting the laparoscopic trocars directly into the peritoneal cavity
before insufflating is associated with more entry complications.
20. Which following interventions effectively reduced pain after laparoscopy?
a. Increasing intra-abdominal pressure.
b. Increasing the insufflation rate.
c. Keeping drains postoperatively.
d. Using other insufflation gases, such as nitrous oxide, helium, or argon.
e. Cooling and humidifying the insufflation gas.
21. In regard to hysteroscopy. Which of the following is true?
a. The best distension media for contact hysteroscopy is carbon dioxide.
b. Bipolar electrocautery is best used with normal saline or Ringer's lactate as
distension media.
c. Mannitol differs from all other electrolyte-poor fluids because it is
hyperosmolar.
d. the risks of fluid absorption are associated mainly with electrolyte
fluids.
e. A deficit of 1200 ml of glycine is generally safe.
22. Which of the following is proved to reduce Fluid overload and electrolyte
imbalance during hysteroscopy?
a. Maintain intrauterine pressure at 120 mmHg.
b. Intracervical injections of a dilute vasopressin solution .
c. Treatment with a gonadotropin-releasing hormone analo g.
d. Limit the procedure time to 2 hours.
e. add an easily measurable tracer to distending media e.g ethanol.

23. Which of the following procedures carries the highest risk of uterine perforation?
a. endometrial resection.
b. Curettage of a postpartum uterus.
c. Dilatation and curettage for gynecological conditions.
d. Dilatation and curettage in the postmenopausal patients.
e. Induced first and second trimester abortions.
f. Endometrial ablation.
24. Suzan is a 30 years old lady who is nulliparous, presented complaining of
oliogomenorrhoea after her last pregnancy which was a missed abortion evacuated
surgically. A hysteroscopy was performed and revealed intrauterine adhesions.
Which of the following is true in regard to her condition?
a. Amenorrhea is the most common reason patients present for
evaluation.
b. The frequency of adhesions with significant postcesarean delivery
endometritis does not differ from those without postcesarean infection.
c. 40 percent of cases of severe intrauterine adhesive disease are related
to curettage for pregnancy complications.
d. The extent of adhesions seen on hysteroscopy correlates well with
degree of menstrual irregularity .
e. Sonohysterography is a better diagnostic tool than
hysterosalpingogram in diagnosing intrauterine adhesions.
25. Which of the following is best to prevent reformation of intrauterine adhesions after
hysteroscopic adhesion resection?
 a. Placement of Intrauterine device postoperatively.
b. Placement of intrauterine Foley's catheter balloon postoperatively.
c. Use of conjugated estrogen one week after the procedure.
d. Use of conjugated estrogen in the period immediately after the procedure.
e. Use of conjugated estrogen four weeks prior to the procedure.
26. Lila is a 16 years old girl who was diagnosed as sever endometriosis. She was put on
GnRH agonist with add-back therapy for sex months which relied her agony, after
stopping this treatment all other treatments failed to control the pain. Which of the
following is an appropriate?
a. Ask for a baseline bone density evaluation and restart the regimen, and if
normal follow up in 2 years.
b. Repeat laparoscopic procedure and all visible lesions of endometriosis should be
cauterized, laser ablated, or resected.
c. Re-start combined oral contraceptive pills.
d. Start Danazole.
e. Restart GnRH agonist.
27. Which of the following describes the relative risk?
a. provide an understanding of the magnitude of risk compared with a
standard.
b. The relative risk equals the incidence in exposed individuals divided by
the incidence in unexposed individuals.
c. The relative risk equals the odds that an individual with a specific
condition has been exposed to a risk factor divided by the odds that a
control has been exposed.
d. It reflects the additional incidence of disease related to an exposure
taking into account the background rate of the disease.
e. refers to the extent to which repeated measurements of a relatively
stable phenomenon fall closely to each other.