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WorksheetsGEM 7.03
Total questions: 180
Worksheet time: 3hrs 0mins
Name
Class
Date
1.
Which is the primary male reproductive organ?
a)
Epididymis
b)
Seminal vesicle
c)
Testis
d)
Vas deferens
e)
Prostate
2.
Which cell type produces testosterone in the testes?
a)
Spermatogonia
b)
Sertoli cells
c)
Leydig cells
d)
Spermatocytes
e)
Myoid cells
3.
Which hormone acts directly on Sertoli cells?
a)
LH
b)
FSH
c)
Testosterone
d)
GnRH
e)
Inhibin
4.
What ensures high intratubular testosterone concentration in seminiferous tubules?
a)
Aromatase
b)
Inhibin
c)
Androgen-binding protein
d)
Leydig cells
e)
Sertoli tight junctions
5.
Which sugar is the principal energy source for sperm?
a)
Glucose
b)
Galactose
c)
Maltose
d)
Lactose
e)
Fructose
6.
Which is a function of the prostate gland?
a)
Provides fructose
b)
Produces alkaline secretion
c)
Stores sperm
d)
Stimulates Leydig cells
e)
Produces prostaglandins
7.
Which gland secretes mucous-rich fluid aiding urethral lubrication?
a)
Seminal vesicle
b)
Epididymis
c)
Bulbourethral gland
d)
Prostate
e)
Vas deferens
8.
Which of the following is NOT a function of Sertoli cells?
a)
Inhibin B production
b)
Formation of blood-testis barrier
c)
Nourishment of germ cells
d)
Androgen-binding protein secretion
e)
FSH secretion
9.
Which structure is the site of sperm maturation and storage?
a)
Testis
b)
Epididymis
c)
Seminal vesicle
d)
Prostate
e)
Urethra
10.
Which hormone acts on Leydig cells?
a)
FSH
b)
Testosterone
c)
LH
d)
Prolactin
e)
GnRH
11.
A 25-year-old man with a history of untreated mumps orchitis in adolescence presents with infertility. Which structure was most likely damaged, leading to sterility?
a)
Seminiferous tubules
b)
Epididymis
c)
Vas deferens
d)
Prostate
e)
Seminal vesicles
12.
A 30-year-old man presents with infertility. Hormonal studies show low testosterone and high LH. Which cell type is most likely dysfunctional?
a)
Sertoli cells
b)
Leydig cells
c)
Spermatogonia
d)
Hypothalamic neurons
e)
Pituitary gonadotrophs
13.
A researcher blocks androgen-binding protein (ABP) in Sertoli cells. What is the most likely outcome?
a)
Complete absence of sperm production
b)
Reduced intratubular testosterone and impaired spermatogenesis
c)
Normal spermatogenesis but reduced sperm motility
d)
Increased testosterone in systemic circulation
e)
Enhanced Sertoli nourishment of spermatogonia
14.
Which component of semen primarily facilitates penetration of cervical mucus in the female reproductive tract?
a)
Fructose
b)
Calcium
c)
Prostaglandins
d)
PSA (prostate-specific antigen)
e)
Citrate
15.
A 28-year-old man has normal spermatogenesis but very low semen volume. Which structure is most likely affected?
a)
Seminal vesicles
b)
Epididymis
c)
Sertoli cells
d)
Leydig cells
e)
Hypothalamus
16.
In a male with a defective blood-testis barrier, which is the most likely consequence?
a)
Reduced testosterone production
b)
Autoimmune attack against developing sperm
c)
Complete blockage of spermatogenesis
d)
Increased fertility
e)
Impaired semen liquefaction
17.
A 35-year-old man with infertility has normal hormone levels but immotile sperm. Which structure is most likely defective?
a)
Testis
b)
Vas deferens
c)
Epididymis
d)
Prostate
e)
Hypothalamus
18.
Which factor from Sertoli cells provides negative feedback to pituitary FSH secretion?
a)
ABP
b)
Testosterone
c)
Inhibin B
d)
Anti-Müllerian hormone
e)
Oestrogen
19.
A mutation causes failure of Anti-Müllerian hormone (AMH) secretion during male foetal development. Which abnormality is most likely?
a)
Cryptorchidism
b)
Hypospadias
c)
Persistence of female internal ducts
d)
Testicular feminisation
e)
Microorchidism
20.
A patient presents with infertility. Analysis shows acidic semen pH. Which gland is most likely dysfunctional?
a)
Seminal vesicles
b)
Epididymis
c)
Testis
d)
Prostate
e)
Bulbourethral glands
21.
Which of the following is not a function of the epididymis?
a)
Acquisition of motility
b)
Sperm storage
c)
Spermiogenesis
d)
Fertilisation capability
e)
Membrane stabilisation
22.
Where does normal fertilisation most commonly occur?
a)
Infundibulum
b)
Isthmus
c)
Ampulla
d)
Cervix
e)
Uterus
23.
What proportion of ejaculate is contributed by the seminal vesicles?
a)
0.1
b)
0.2
c)
0.3
d)
0.6
e)
0.9
24.
What is considered the lower threshold sperm count for fertility?
a)
10 million/mL
b)
20 million/mL
c)
30 million/mL
d)
50 million/mL
e)
100 million/mL
25.
Which structure provides fructose as the main energy source for sperm?
a)
Epididymis
b)
Seminal vesicles
c)
Prostate
d)
Bulbourethral gland
e)
Sertoli cells
26.
Which phase of ejaculation involves propulsion of semen from urethra?
a)
Emission
b)
Capacitation
c)
Spermiogenesis
d)
Expulsion
e)
Orgasm
27.
Which of the following occurs during capacitation?
a)
Addition of cholesterol to sperm head
b)
Acrosome reaction
c)
Increased membrane cholesterol
d)
Increased intracellular Ca²⁺ permeability
e)
Formation of midpiece mitochondria
28.
Which mechanism guides sperm via a temperature gradient in the fallopian tube?
a)
Chemotaxis
b)
Thermotaxis
c)
Rheotaxis
d)
Phagocytosis
e)
Ciliary activity
29.
What is the function of PSA (prostate-specific antigen) in semen?
a)
Energy source
b)
Neutralises vaginal acidity
c)
Breaks down coagulated semen
d)
Initiates capacitation
e)
Provides sperm motility proteins
30.
Which hormone surge directly triggers ovulation?
a)
FSH
b)
Progesterone
c)
Oestrogen
d)
LH
e)
Prolactin
31.
A 32-year-old man presents with infertility. His semen volume is normal but fructose is absent. Which gland is most likely affected?
a)
Prostate
b)
Epididymis
c)
Seminal vesicles
d)
Bulbourethral gland
e)
Sertoli cells
32.
Which event is directly dependent on sympathetic nervous system activity?
a)
Erection
b)
Emission
c)
Capacitation
d)
Orgasm sensation
e)
Ejaculate expulsion
33.
A 27-year-old woman is found to have thick cervical mucus during luteal phase. Which hormone is responsible?
a)
Oestrogen
b)
LH
c)
FSH
d)
Progesterone
e)
Prolactin
34.
Which change occurs during capacitation?
a)
Addition of glycoproteins to sperm head
b)
Acrosome reaction
c)
Increased membrane cholesterol
d)
Increased intracellular Ca²⁺ permeability
e)
Formation of midpiece mitochondria
35.
A 30-year-old man has azoospermia due to obstructed vas deferens. Which process is directly impaired?
a)
Sperm maturation
b)
Sperm storage
c)
Sperm propulsion to urethra
d)
Capacitation
e)
Acrosome reaction
36.
A semen analysis shows failure of liquefaction after 1 hour. Which enzyme deficiency is most likely?
a)
Hyaluronidase
b)
Prostate-specific antigen
c)
Fibrinolysin
d)
Collagenase
e)
Alkaline phosphatase
37.
Which immune mechanism contributes to removal of excess sperm in the female tract?
a)
NK cells
b)
Complement proteins
c)
IgA and WBC phagocytosis
d)
Mast cell degranulation
e)
Toll-like receptors
38.
In IVF, sperm are incubated in a special medium to mimic which in vivo process?
a)
Spermiogenesis
b)
Emission
c)
Capacitation
d)
Acrosome reaction
e)
Thermotaxis
39.
A patient has retrograde ejaculation into the bladder. Which structure is most likely defective?
a)
External urethral sphincter
b)
Internal urethral sphincter
c)
Bulbospongiosus muscle
d)
Prostate gland
e)
Seminal vesicles
40.
At ovulation, the oocyte released is best described as:
a)
Primary oocyte arrested in prophase I
b)
Primary oocyte arrested in metaphase I
c)
Secondary oocyte arrested in metaphase II
d)
Secondary oocyte arrested in anaphase II
e)
Ovum at telophase II
41.
Tubal transport of the ovum into the uterus normally takes:
a)
24 hours
b)
48 hours
c)
72 hours
d)
80 hours
e)
96 hours
42.
Which structure produces enzymes enabling sperm penetration of the zona pellucida?
a)
Cortical granules
b)
Acrosome
c)
Mitochondria
d)
Tail
e)
Zona pellucida
43.
The enzyme enabling sperm penetration of the cumulus oophorus is:
a)
Hyaluronidase
b)
Acrosin
c)
Trypsin
d)
Relaxin
e)
Prostate-specific antigen
44.
Polyspermy prevention occurs due to:
a)
Acrosomal enzymes
b)
Zona pellucida receptors
c)
Cortical granule reaction
d)
Hyaluronic acid
e)
Sperm mitochondria
45.
Fertilisation restores:
a)
Haploid set of chromosomes
b)
Diploid chromosome number
c)
Triploid chromosome number
d)
Aneuploidy
e)
Polyploidy
46.
The first cleavage division of the zygote occurs approximately:
a)
12 hours after fertilisation
b)
24 hours after fertilisation
c)
30 hours after fertilisation
d)
48 hours after fertilisation
e)
72 hours after fertilisation
47.
At the 16-cell stage, the embryo is termed:
a)
Zygote
b)
Blastocyst
c)
Morula
d)
Gastrula
e)
Trophoblast
48.
The hormone produced by syncytiotrophoblast that maintains the corpus luteum is:
a)
LH
b)
FSH
c)
hCG
d)
Progesterone
e)
Relaxin
49.
Which maternal tissue changes during decidualisation?
a)
Endometrial stroma
b)
Myometrium
c)
Perimetrium
d)
Fallopian tube epithelium
e)
Cervical canal epithelium
50.
Which best describes the role of hCG in the male foetus?
a)
Stimulates Sertoli cells to produce inhibin
b)
Stimulates Leydig cells to produce testosterone
c)
Stimulates adrenal glands to produce cortisol
d)
Stimulates foetal thyroid hormone
e)
Stimulates maternal LH production
51.
Which phase of tubal transport accounts for the majority of the ovum's time before reaching the uterus?
a)
Isthmic rapid phase
b)
Utero-tubal junction phase
c)
Ampullary slow phase
d)
Endometrial phase
e)
Morula stage
52.
Which sperm structure is directly responsible for motility?
a)
Tail (flagellum)
b)
Acrosome
c)
Midpiece mitochondria
d)
Head nucleus
e)
Zona pellucida
53.
Sperm binding to ZP3 primarily induces:
a)
Cortical reaction
b)
Acrosomal reaction
c)
Pronucleus formation
d)
Cleavage divisions
e)
Blastocyst hatching
54.
Which event occurs only after fertilisation is complete?
a)
Ovum completes second meiotic division
b)
Oocyte arrested in metaphase II
c)
Sperm undergoes capacitation
d)
Acrosome reaction
e)
Sperm binding to ZP2
55.
During early cleavage, successive divisions result in:
a)
Smaller blastomeres
b)
Larger blastomeres
c)
No change in blastomere size
d)
Polyploid blastomeres
e)
Haploid blastomeres
56.
At which stage does compaction of blastomeres first occur?
a)
8–9 cell stage
b)
2-cell stage
c)
4-cell stage
d)
16-cell stage
e)
Blastocyst stage
57.
Which structure gives rise to the placenta?
a)
Trophoblast
b)
Embryoblast
c)
Morula
d)
Zona pellucida
e)
Inner cell mass
58.
Which layer of trophoblast is multinucleated and invasive?
a)
Syncytiotrophoblast
b)
Cytotrophoblast
c)
Epiblast
d)
Endometrial epithelium
e)
Hypoblast
59.
Which maternal hormone primes the endometrium for decidualisation?
a)
Progesterone
b)
Oestrogen
c)
hCG
d)
Relaxin
e)
LH
60.
Peak serum hCG concentration occurs at approximately:
a)
10–12 weeks gestation
b)
4 weeks gestation
c)
6 weeks gestation
d)
20 weeks gestation
e)
Term (40 weeks)
61.
The blastocyst normally implants into which uterine layer?
a)
Perimetrium
b)
Endometrium
c)
Myometrium
d)
Cervical canal
e)
Ovarian cortex
62.
The trophoblast differentiates into which two main layers?
a)
Hypoblast and epiblast
b)
Amnion and chorion
c)
Cytotrophoblast and syncytiotrophoblast
d)
Decidua basalis and decidua capsularis
e)
Inner and outer cell mass
63.
Which hormone secreted by syncytiotrophoblast is detected in pregnancy tests?
a)
Oestrogen
b)
Progesterone
c)
hCG
d)
LH
e)
FSH
64.
Which statement about syncytiotrophoblast is correct?
a)
It can proliferate independently
b)
It arises from cytotrophoblast fusion
c)
It forms the embryo itself
d)
It lines the uterine cavity
e)
It is a single nucleus per cell
65.
The most common site of ectopic pregnancy is:
a)
Ovary
b)
Cervix
c)
Peritoneal cavity
d)
Uterine tube
e)
Rectouterine pouch
66.
Which is NOT a recognised risk factor for ectopic pregnancy?
a)
Pelvic inflammatory disease
b)
Endometriosis
c)
Tubal surgery
d)
Smoking
e)
High BMI
67.
A patient with suspected ectopic pregnancy is monitored for 48 hours. Which finding most strongly suggests non-viable pregnancy?
a)
hCG doubling every 48h
b)
Stable hCG levels
c)
>50 % fall in hCG levels
d)
Serum progesterone rising
e)
Ultrasound showing intrauterine gestational sac
68.
What is the most appropriate initial assumption in A&E for a woman with positive pregnancy test and severe lower abdominal pain?
a)
Ovarian cyst rupture
b)
Appendicitis
c)
Miscarriage
d)
Ectopic pregnancy until proven otherwise
e)
Urinary tract infection
69.
A ruptured ectopic pregnancy most likely presents with which clinical sign?
a)
Isolated amenorrhoea
b)
Generalised abdominal tenderness
c)
Raised blood pressure
d)
Asymptomatic
e)
Bimanual exam showing bulky uterus
70.
Which surgical procedure involves removing only the ectopic pregnancy while preserving the tube?
a)
Hysterectomy
b)
Oophorectomy
c)
Salpingectomy
d)
Salpingotomy
e)
Myomectomy
71.
A 27-year-old woman presents with abdominal pain. A positive pregnancy test is noted. Transvaginal ultrasound shows no intrauterine pregnancy, but a heterogeneous mass in the ampulla of the uterine tube. Which structure failed to function correctly to allow normal intrauterine implantation?
a)
Tubal cilia
b)
Zona pellucida
c)
Decidua basalis
d)
Corpus luteum
e)
Cervical mucus
72.
Which best explains why syncytiotrophoblast is essential for continuation of early pregnancy?
a)
Provides structural support for amnion formation
b)
Secretes hormones maintaining corpus luteum function
c)
Initiates gastrulation
d)
Produces zona pellucida proteins
e)
Protects embryo against maternal immune rejection
73.
In placenta praevia, which complication is most likely during the third trimester?
a)
Ectopic implantation in tube
b)
Uterine rupture
c)
Painless antepartum haemorrhage
d)
Postpartum endometritis
e)
Hypertension with proteinuria
74.
Which histological feature distinguishes syncytiotrophoblast from cytotrophoblast?
a)
Location inside blastocoele
b)
Cuboidal epithelial morphology
c)
Rich glycogen storage
d)
Multinucleated continuous mass
e)
High mitotic activity
75.
A 34-year-old woman with endometriosis presents with severe pain and a positive pregnancy test. Ultrasound shows free fluid in rectouterine pouch but no intrauterine pregnancy. What is the most likely diagnosis?
a)
Tubo-ovarian abscess
b)
Pelvic inflammatory disease
c)
Ovarian torsion
d)
Appendicitis
e)
Ruptured ectopic pregnancy
76.
Which maternal structure directly contributes to placental formation?
a)
Decidua basalis
b)
Myometrium
c)
Perimetrium
d)
Endocervical epithelium
e)
Ovarian stroma
77.
Why is salpingotomy sometimes preferred over salpingectomy in managing ectopic pregnancy?
a)
Reduces recurrence risk
b)
Preserves fertility potential
c)
Prevents trophoblast tissue persistence
d)
Avoids intraoperative bleeding
e)
Eliminates infection risk
78.
Which structure ultimately gives rise to chorionic villi, essential for maternal–fetal exchange?
a)
Epiblast
b)
Hypoblast
c)
Cytotrophoblast
d)
Decidua capsularis
e)
Amnion
79.
Which biochemical marker pattern is most consistent with an ectopic pregnancy?
a)
Rapid doubling of hCG every 48 hours
b)
High progesterone with high hCG
c)
Oestrogen dominance with falling hCG
d)
Plateauing or slowly rising hCG
e)
LH surge maintained in luteal phase
80.
A 40-year-old woman with history of smoking presents with vaginal bleeding and mild lower abdominal pain. Serum hCG is falling. What is the most likely outcome if managed conservatively?
a)
Progression to viable intrauterine pregnancy
b)
Development of gestational trophoblastic disease
c)
Transformation into placenta praevia
d)
Chronic pelvic inflammatory disease
e)
Spontaneous resolution resembling miscarriage
81.
Which structure forms the fetal component of the placenta?
a)
Chorion frondosum
b)
Chorion laeve
c)
Decidua basalis
d)
Decidua parietalis
e)
Amnion
82.
Which structure forms the maternal part (basal plate) of the placenta?
a)
Chorion frondosum
b)
Decidua basalis
c)
Syncytiotrophoblast
d)
Amnion
e)
Chorion laeve
83.
Capillaries first appear in which stage of chorionic villus development?
a)
Primary villus
b)
Secondary villus
c)
Tertiary villus
d)
Anchoring villus
e)
Stem villus
84.
Which decidual layer covers the implanted conceptus bulging into the uterine cavity?
a)
Decidua basalis
b)
Decidua parietalis
c)
Chorion frondosum
d)
Decidua capsularis
e)
Chorion laeve
85.
Which statement best describes the chorion laeve?
a)
Leafy villous membrane at embryonic pole
b)
Highly vascular with numerous villi
c)
Fuses with decidua basalis to form basal plate
d)
Site of umbilical cord insertion
e)
Smooth, avascular chorion at the abembryonic pole
86.
Which vessel carries oxygenated blood to the fetus?
a)
Umbilical vein
b)
Umbilical artery
c)
Spiral artery
d)
Maternal uterine vein
e)
Vitelline vein
87.
Uteroplacental circulation is functionally established by approximately:
a)
Week 1
b)
Week 3
c)
Week 5
d)
Week 8
e)
End of first trimester
88.
Which cell type primarily invades the endometrium and digests maternal sinusoids?
a)
Cytotrophoblast
b)
Epiblast
c)
Syncytiotrophoblast
d)
Decidual cell
e)
Hypoblast
89.
After ~the 4th month, the placental membrane:
a)
Thickens with more connective tissue
b)
Gains a new cytotrophoblast layer
c)
Becomes impermeable to maternal IgG
d)
Thins; loses most cytotrophoblast and connective tissue
e)
Is replaced by amnion
90.
Oligohydramnios most directly increases the risk of:
a)
Neural tube defects
b)
Macrosomia
c)
Polycythaemia
d)
Persistent truncus arteriosus
e)
Limb contractures/deformities from compression
91.
Which fetal structure initially suspends the embryo within the chorionic cavity and guides umbilical cord formation?
a)
Amnion
b)
Yolk sac
c)
Connecting stalk
d)
Allantois
e)
Chorion laeve
92.
Which statement best describes the role of Wharton's jelly in the umbilical cord?
a)
Forms the maternal-fetal barrier
b)
Produces amniotic fluid
c)
Protects vessels from compression
d)
Forms early placental capillaries
e)
Becomes the secondary yolk sac
93.
The primary chorionic villus is composed mainly of:
a)
Syncytiotrophoblast only
b)
Extra-embryonic mesoderm
c)
Cytotrophoblast core with syncytiotrophoblast covering
d)
Fetal capillaries
e)
Decidual cells
94.
Which hormone is secreted by syncytiotrophoblast to maintain early pregnancy?
a)
Progesterone from corpus luteum
b)
Estrogen from fetal liver
c)
hCG
d)
Relaxin from decidua
e)
Cortisol from placenta
95.
Which placental layer persists as the main fetal-maternal barrier by the fourth month?
a)
Cytotrophoblast and connective tissue
b)
Amnion
c)
Syncytiotrophoblast
d)
Epiblast
e)
Extra-embryonic mesoderm
96.
Which fetal membrane produces amniotic fluid?
a)
Chorion laeve
b)
Yolk sac
c)
Chorion frondosum
d)
Amnion
e)
Decidua capsularis
97.
Which decidual layer fuses with decidua parietalis as gestational sac grows?
a)
Decidua basalis
b)
Decidua capsularis
c)
Chorion frondosum
d)
Amnion
e)
Chorion laeve
98.
The abembryonic pole of the chorion gives rise to:
a)
Chorion frondosum
b)
Tertiary villi
c)
Chorion laeve
d)
Decidua basalis
e)
Umbilical cord
99.
The tertiary chorionic villus forms:
a)
A cytotrophoblast-covered sac without vessels
b)
Syncytiotrophoblast only
c)
Fetal capillaries within mesoderm core
d)
Decidual cells
e)
Abembryonic chorion
100.
Which structure temporarily serves as a source of embryonic nutrition before placenta is functional?
a)
Amnion
b)
Yolk sac
c)
Umbilical vein
d)
Tertiary villus
e)
Decidua parietalis
101.
Which structure separates maternal blood in the intervillous spaces from fetal circulation?
a)
Amniotic membrane
b)
Decidua basalis
c)
Chorionic villi
d)
Placental membrane
e)
Cotyledons
102.
Cotyledons of the placenta are separated by:
a)
Chorionic villi
b)
Amniotic folds
c)
Intervillous spaces
d)
Placental septa
e)
Umbilical vessels
103.
Which type of placenta praevia carries the highest risk of haemorrhage during labour?
a)
Normal posterior wall implantation
b)
Low-lying placenta
c)
Marginal praevia
d)
Partial praevia
e)
Total praevia
104.
Which condition involves placental invasion through the myometrium and possibly adjacent organs?
a)
Placenta accreta
b)
Placenta increta
c)
Placenta percreta
d)
Placental abruption
e)
Placental insufficiency
105.
Which is a recognised risk factor for placenta accreta?
a)
Nulliparity
b)
Previous caesarean section
c)
Gestational diabetes
d)
Multiple pregnancy
e)
Smoking
106.
Placental abruption most commonly presents with:
a)
Painless vaginal bleeding
b)
Painful vaginal bleeding
c)
No bleeding, incidental finding
d)
Reduced liquor volume
e)
Asymmetrical fetal growth restriction
107.
Placental insufficiency is most likely to result in:
a)
Preterm labour
b)
Polyhydramnios
c)
Low birth weight
d)
Increased risk of monozygotic twinning
e)
Early rupture of membranes
108.
In dizygotic twins, which is the correct placental arrangement?
a)
One placenta, one chorion, one amnion
b)
One placenta, one chorion, two amnions
c)
Two placentas, two chorions, two amnions
d)
One placenta, two chorions, one amnion
e)
Variable, depending on timing of split
109.
Monozygotic twins sharing one amniotic sac are at increased risk of:
a)
Preeclampsia
b)
Umbilical cord entanglement
c)
Placenta accreta
d)
Twin-to-twin transfusion
e)
Conjoined twinning
110.
Conjoined twins arise due to:
a)
Fertilisation of two separate ova
b)
Failure of chorionic villi to separate
c)
Incomplete separation of the embryoblast
d)
Division of the epiblast at two-cell stage
e)
Excessive growth of placental tissue
111.
Which best explains why placenta praevia leads to haemorrhage at the onset of labour?
a)
Shearing of placental attachment during cervical dilation
b)
Compression of umbilical cord vessels
c)
Rupture of fetal membranes
d)
Vasospasm of spiral arteries
e)
Impaired decidualisation of endometrium
112.
Placenta increta is defined as placental villi:
a)
Adhering to but not invading the endometrium
b)
Invading into the myometrium
c)
Extending through myometrium to serosa
d)
Extending beyond uterus into pelvic organs
e)
Invading uterine arteries
113.
A 36-year-old woman with a history of two caesarean sections is diagnosed with placenta praevia at 28 weeks. Which complication is she most at risk of?
a)
Placenta accreta
b)
Twin-to-twin transfusion syndrome
c)
Oligohydramnios
d)
Conjoined twins
e)
Placental abruption
114.
Which placental pathology is most strongly associated with maternal cocaine use?
a)
Placenta praevia
b)
Placenta accreta
c)
Placental abruption
d)
Placenta percreta
e)
Placental insufficiency
115.
Which finding most strongly suggests placental insufficiency?
a)
Polyhydramnios
b)
Small for gestational age fetus
c)
Recurrent antepartum haemorrhage
d)
Maternal hypertension
e)
Preterm labour
116.
Monozygotic twins with two amniotic sacs but one chorion are described as:
a)
Dichorionic diamniotic
b)
Dichorionic monoamniotic
c)
Monochorionic diamniotic
d)
Monochorionic monoamniotic
e)
Dichorionic triamniotic
117.
Which is the main mechanism by which twin-to-twin transfusion syndrome occurs?
a)
Shared amniotic sac
b)
Intertwin vascular anastomoses in placenta
c)
Incomplete separation of embryoblast
d)
Premature rupture of membranes
e)
Umbilical cord compression
118.
Which feature distinguishes placenta praevia from placental abruption?
a)
Associated with severe maternal hypertension
b)
Painless vaginal bleeding
c)
Uterine tenderness
d)
Retroplacental haematoma on ultrasound
e)
Risk increased by cocaine use
119.
In which scenario are monozygotic twins most likely to develop as dichorionic diamniotic?
a)
Division at two-cell stage
b)
Division of inner cell mass
c)
Division of bilaminar disc
d)
Incomplete separation of embryoblast
e)
Abnormal gastrulation
120.
Which condition is most likely if the placenta is small, thin, and poorly vascularised?
a)
Placenta praevia
b)
Placental insufficiency
c)
Placenta percreta
d)
Placental abruption
e)
Placenta increta
121.
Which hormone is primarily responsible for maintaining the corpus luteum in early pregnancy?
a)
Progesterone
b)
Human placental lactogen
c)
Human chorionic gonadotropin
d)
Relaxin
e)
Prolactin
122.
At what gestational age is foetal viability usually reached?
a)
18–20 weeks
b)
20–21 weeks
c)
22–24 weeks
d)
25–26 weeks
e)
28 weeks
123.
Which immune mechanism best explains maternal tolerance of the foetus?
a)
Increased expression of maternal HLA class I
b)
Placental expression of HLA-G
c)
Systemic shift towards Th1 immune response
d)
Maternal cytotoxic T cell activation
e)
Loss of regulatory T cells
124.
Which of the following best describes the spiral artery changes in normal pregnancy?
a)
Vessels become high resistance, low flow
b)
Muscular walls hypertrophy
c)
Trophoblast invasion widens arteries
d)
Endothelial thickening prevents flow
e)
Smooth muscle proliferation
125.
Which pregnancy-related condition is most directly linked to impaired spiral artery remodelling?
a)
Gestational diabetes
b)
Preeclampsia
c)
Placenta previa
d)
Hyperemesis gravidarum
e)
Polyhydramnios
126.
Which hormone up-regulates oxytocin receptors near term?
a)
Progesterone
b)
Relaxin
c)
Oestrogen
d)
hPL
e)
Prolactin
127.
Which of the following crosses the placenta via facilitated diffusion?
a)
Oxygen
b)
Glucose
c)
Calcium
d)
Immunoglobulin G
e)
Carbon dioxide
128.
A 30-year-old pregnant woman presents with persistent vomiting and dehydration at 10 weeks. What is the most likely diagnosis?
a)
Normal morning sickness
b)
Preeclampsia
c)
Hyperemesis gravidarum
d)
Gestational diabetes
e)
Urinary tract infection
129.
Which of the following is the most accurate average weight gain during pregnancy?
a)
5 kg
b)
7.5 kg
c)
10 kg
d)
12.5 kg
e)
15 kg
130.
Which foetal shunt bypasses the pulmonary circulation?
a)
Ductus venosus
b)
Foramen ovale
c)
Ductus arteriosus
d)
Umbilical vein
e)
Umbilical artery
131.
Which maternal cardiovascular change occurs earliest in pregnancy?
a)
Increased cardiac output
b)
Increased systemic vascular resistance
c)
Increased pulmonary vascular resistance
d)
Increased diastolic blood pressure
e)
Decreased plasma volume
132.
Which respiratory change is most characteristic of normal pregnancy?
a)
Decreased tidal volume
b)
Increased functional residual capacity
c)
Respiratory alkalosis
d)
Increased PaCO₂
e)
Reduced minute ventilation
133.
Which renal adaptation occurs during pregnancy?
a)
Reduced renal plasma flow
b)
Decreased glomerular filtration rate (GFR)
c)
Glycosuria due to reduced tubular reabsorption
d)
Increased serum creatinine concentration
e)
Increased serum urea concentration
134.
Which haematological change is expected in normal pregnancy?
a)
Decreased plasma fibrinogen
b)
Decreased clotting factors VII and X
c)
Physiological anaemia
d)
Increased platelet count
e)
Reduced ESR
135.
What is the main role of relaxin in pregnancy?
a)
Maintains corpus luteum
b)
Promotes cervical softening and pelvic ligament relaxation
c)
Up-regulates oxytocin receptors
d)
Stimulates maternal insulin resistance
e)
Enhances alveolar milk secretion
136.
Failure of trophoblastic invasion of spiral arteries most likely results in:
a)
Gestational diabetes
b)
Polyhydramnios
c)
Preeclampsia
d)
Hyperemesis gravidarum
e)
Placenta previa
137.
Which placental transfer mechanism is responsible for IgG antibody passage to the foetus?
a)
Simple diffusion
b)
Facilitated diffusion
c)
Active transport
d)
Pinocytosis (endocytosis)
e)
Filtration
138.
Which foetal shunt directs blood from the pulmonary artery to the descending aorta?
a)
Foramen ovale
b)
Ductus arteriosus
c)
Ductus venosus
d)
Umbilical vein
e)
Umbilical artery
139.
Which endocrine change is characteristic of normal pregnancy?
a)
Decreased thyroid-binding globulin
b)
Increased insulin sensitivity
c)
Increased cortisol and aldosterone
d)
Decreased prolactin secretion
e)
Decreased renin-angiotensin activity
140.
A 36-year-old woman develops sudden hypertension and proteinuria at 30 weeks. What is the most likely underlying mechanism?
a)
Excess oestrogen secretion
b)
Failure of immune tolerance to foetus
c)
Failure of spiral artery remodelling
d)
Excess hPL secretion
e)
Progesterone deficiency
141.
During pregnancy, cardiac output increases primarily due to:
a)
Decreased stroke volume
b)
Increased systemic vascular resistance
c)
Increased stroke volume and heart rate
d)
Reduced plasma volume
e)
Decreased venous return
142.
Systemic vascular resistance in pregnancy decreases by about:
a)
0.1
b)
0.2
c)
0.3
d)
0.4
e)
0.6
143.
Which blood pressure change is most typical in pregnancy?
a)
Both systolic and diastolic rise progressively
b)
Systolic decreases more than diastolic
c)
Diastolic decreases more than systolic
d)
Both remain unchanged
e)
Both fall to pathological levels
144.
Increased GFR during pregnancy is primarily due to:
a)
Reduced plasma volume
b)
Constriction of afferent arterioles
c)
Renal vasodilation mediated by nitric oxide and relaxin
d)
Increased sympathetic tone
e)
Decreased renal blood flow
145.
Which of the following findings is considered a normal adaptation in pregnancy?
a)
Heavy proteinuria (>300 mg/day)
b)
Mild glycosuria
c)
Increased serum creatinine
d)
Reduced plasma volume
e)
Reduced GFR
146.
Which change contributes to the hypercoagulable state in pregnancy?
a)
Increased fibrinolytic activity
b)
Decreased coagulation factors
c)
Shift in coagulation factors favouring clot stability
d)
Reduced platelet activity
e)
Increased anticoagulant proteins
147.
The increase in minute ventilation during pregnancy is due to:
a)
Increased respiratory rate
b)
Increased tidal volume
c)
Decreased oxygen consumption
d)
Reduced sensitivity to CO₂
e)
Decreased progesterone activity
148.
Which factor facilitates oxygen transfer from mother to foetus?
a)
Lower foetal haemoglobin concentration
b)
Foetal haemoglobin with higher O₂ affinity
c)
Higher maternal PaO₂
d)
Reduced foetal haemoglobin levels
e)
Absence of Bohr effect
149.
Which gastrointestinal change is common in pregnancy?
a)
Increased gastric emptying
b)
Reduced lower oesophageal sphincter tone
c)
Increased bowel motility
d)
Reduced colonic water absorption
e)
Reduced risk of aspiration during anaesthesia
150.
Which endocrine change occurs in pregnancy?
a)
Decreased prolactin secretion
b)
Suppression of HCG secretion
c)
Increased thyroid hormone production
d)
Decreased cortisol levels
e)
Reduced oestrogen and progesterone
151.
A pregnant woman at 28 weeks has a leftward and upward displacement of the cardiac apex beat but no other abnormal findings. Which is the best explanation?
a)
Physiological chamber enlargement
b)
Pericardial effusion
c)
Hypertrophic cardiomyopathy
d)
Peripartum cardiomyopathy
e)
Aortic regurgitation
152.
Which mechanism best explains the marked fall in systemic vascular resistance during pregnancy?
a)
Increased sympathetic tone
b)
Nitric oxide–mediated vasodilation
c)
Reduced prostacyclin production
d)
Increased endothelin activity
e)
Spiral artery constriction
153.
At which stage of pregnancy is total peripheral resistance lowest?
a)
First trimester
b)
Second trimester
c)
Late third trimester
d)
Immediately postpartum
e)
Pre-conception
154.
Which of the following would be considered pathological in pregnancy?
a)
Mild proteinuria <300 mg/day
b)
Mild glycosuria
c)
Serum creatinine of 120 µmol/L
d)
Decrease in haematocrit
e)
Increased plasma volume
155.
Why does pregnancy predispose to reflux oesophagitis?
a)
Increased gastric acid secretion
b)
Reduced lower oesophageal sphincter tone
c)
Accelerated gastric emptying
d)
Reduced intra-abdominal pressure
e)
Shortened oesophagus
156.
Which adaptation best explains the facilitation of CO₂ transfer from foetus to mother?
a)
Higher maternal PaCO₂
b)
Lower maternal PaCO₂ due to hyperventilation
c)
Foetal blood being more alkaline
d)
Reduced maternal O₂ affinity
e)
Absence of foetal Bohr effect
157.
In pregnancy, which of the following most contributes to physiological anaemia?
a)
Reduced erythropoietin
b)
Increased haemolysis
c)
Greater rise in plasma volume than RBC mass
d)
Increased iron loss in urine
e)
Increased platelet destruction
158.
Which hormone is primarily responsible for the renal sodium and water retention of pregnancy?
a)
Progesterone
b)
Oestrogen
c)
Relaxin
d)
Aldosterone
e)
Cortisol
159.
Why does pregnancy increase the risk of thromboembolism?
a)
Increased fibrinolysis
b)
Decreased coagulation factors
c)
Increased coagulation factors and reduced fibrinolysis
d)
Increased platelet destruction
e)
Increased anticoagulant protein activity
160.
Which change in lab values would be unexpected in normal pregnancy?
a)
Reduced haematocrit
b)
Increased alkaline phosphatase
c)
Reduced serum creatinine
d)
Increased T4
e)
Increased urea
161.
A 29-year-old woman at 30 weeks' gestation presents with regular uterine contractions. Which is the first-line tocolytic used to delay preterm labour?
a)
Indomethacin
b)
Atosiban
c)
Nifedipine
d)
Ritodrine
e)
Magnesium sulphate
162.
Which condition is contraindication to tocolysis in preterm labour?
a)
Short cervix
b)
Preterm premature rupture of membranes (PPROM)
c)
History of preterm birth
d)
Multiple pregnancy
e)
Maternal obesity
163.
A 35-year-old primigravida develops new-onset hypertension at 32 weeks with proteinuria. What is the definitive treatment for preeclampsia?
a)
Magnesium sulphate
b)
Antihypertensives
c)
Corticosteroids
d)
Delivery of baby and placenta
e)
Bed rest
164.
Which maternal organ dysfunction is not a diagnostic feature of preeclampsia?
a)
Renal involvement
b)
Hepatic dysfunction
c)
Haematological abnormalities
d)
Neurological symptoms
e)
Pulmonary fibrosis
165.
A woman with preeclampsia presents with epigastric pain, nausea, and thrombocytopenia. Which complication is most likely?
a)
Acute fatty liver of pregnancy
b)
HELLP syndrome
c)
Chorioamnionitis
d)
Eclampsia
e)
Intrahepatic cholestasis of pregnancy
166.
Which investigation is most useful in identifying risk of spontaneous preterm birth?
a)
Serum β-hCG
b)
Foetal fibronectin test
c)
Maternal CRP
d)
Serum oestradiol
e)
Amniotic fluid AFP
167.
Which of the following is a long-term complication associated with preterm birth?
a)
Hyaline membrane disease
b)
Intraventricular haemorrhage
c)
Autism spectrum disorder
d)
Chorioamnionitis
e)
Necrotising enterocolitis
168.
A woman with intrauterine growth restriction (IUGR) is found to have asymmetrical growth restriction. Which is the most likely cause?
a)
Chromosomal abnormality
b)
Maternal hypertension
c)
Congenital infection
d)
Genetic smallness
e)
Maternal drug use (early pregnancy)
169.
Which type of dystocia is most likely in a woman with maternal obesity and gestational diabetes?
a)
Power dystocia
b)
Passenger dystocia -- shoulder dystocia
c)
Passage dystocia -- pelvic narrowing
d)
Malpresentation dystocia
e)
Cord prolapse
170.
Which of the following strategies is used for prevention of preterm birth in high-risk women?
a)
Induction of labour at 34 weeks
b)
Bed rest from 20 weeks
c)
Vaginal progesterone
d)
Routine tocolysis at 28 weeks
e)
Daily corticosteroids
171.
A 24-year-old primigravida at 28 weeks presents with regular contractions. Transvaginal ultrasound shows a cervical length of 20 mm. Which intervention is most appropriate to reduce her risk of preterm birth?
a)
Cervical cerclage
b)
Tocolysis with nifedipine
c)
Induction of labour
d)
Antibiotics
e)
Bed rest
172.
Which mechanism best explains the pathophysiology of preeclampsia?
a)
Incomplete spiral artery remodelling → placental hypoperfusion
b)
Increased maternal cortisol → impaired foetal growth
c)
Increased maternal thyroid hormone → uteroplacental vasodilation
d)
Reduced renin-angiotensin activity → systemic hypotension
e)
Excess surfactant production → oxidative stress
173.
A 32-year-old woman at 30 weeks has hypertension, proteinuria, and right upper quadrant pain. Bloods show ALT 220 U/L, Hb 95 g/L, and platelets 70 ×10⁹/L. Which complication is most likely?
a)
Acute fatty liver of pregnancy
b)
HELLP syndrome
c)
Chorioamnionitis
d)
Eclampsia
e)
Intrahepatic cholestasis of pregnancy
174.
Which maternal risk factor is most strongly associated with shoulder dystocia?
a)
Maternal diabetes
b)
Uterine fibroids
c)
Breech presentation
d)
Prematurity
e)
Short maternal stature
175.
A 30-year-old multiparous woman presents with antepartum haemorrhage at 33 weeks. Ultrasound shows placenta covering the cervical os. Which is the most likely diagnosis?
a)
Placenta previa
b)
Placental abruption
c)
Uterine rupture
d)
Vasa previa
e)
Cervical ectropion
176.
A 28-year-old woman presents with preterm premature rupture of membranes (PPROM) at 31 weeks. Which management step is contraindicated?
a)
Corticosteroids for lung maturation
b)
Tocolysis with nifedipine
c)
Broad-spectrum antibiotics
d)
Maternal observation for infection
e)
Foetal monitoring with CTG
177.
Which neonatal complication of prematurity is due to surfactant deficiency?
a)
Respiratory distress syndrome (RDS)
b)
Necrotising enterocolitis (NEC)
c)
Intraventricular haemorrhage (IVH)
d)
Retinopathy of prematurity (ROP)
e)
Sepsis
178.
Which preventive measure is recommended for women at high risk of preeclampsia?
a)
Low-dose aspirin
b)
Magnesium sulphate
c)
Routine corticosteroids
d)
Daily nifedipine
e)
Cervical cerclage
179.
A 22-year-old woman at 29 weeks has painful contractions and fever. Amniocentesis confirms chorioamnionitis. Which is the next best step?
a)
Immediate delivery
b)
Nifedipine tocolysis
c)
Outpatient monitoring
d)
Indomethacin
e)
Vaginal progesterone
180.
A foetus is noted to have symmetrical IUGR on ultrasound. Which is the most likely underlying cause?
a)
Congenital infection
b)
Maternal hypertension
c)
Preeclampsia
d)
Maternal smoking late in pregnancy
e)
Placental insufficiency
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