“200”, Aptitude Test Questions and Answers for Medical Specialist Gynaecologist II – MDA & LGA.
ABSTRACT
This package contains 200 multiple-choice
aptitude test questions and answers for candidates preparing for the Medical
Specialist – Gynaecologist II (Daktari Bingwa wa Magonjwa ya Akina Mama Daraja
la II) MDA & LGA Public Service Online Aptitude Test in Tanzania. The
questions emphasize advanced clinical reasoning and decision-making across
obstetrics, gynaecology, reproductive health, emergencies, maternal and fetal
care, research, teaching, supervision, quality improvement, medico-legal
practice, outreach, health policy, planning, and budgeting. Each question
includes closely related answer choices, the correct answer, and a detailed
rationale to strengthen specialist knowledge and examination readiness.
Prepared by: Medical
Specialist Gynaecologist II
Based in Dar-es-salaam.
0628729934.
Date: July 31, 2026
Dear applicants,
This collection of questions and answers
has been carefully prepared to help all of you to understand the key areas
tested during the interview. The goal is to provide a useful, and practical
study guide so you can all perform confidently and fairly in the selection
process. I wish you the best of luck, and may this resource support you in
achieving success!
Warm regards,
Physiotherapist II
For Personal Use by Applicants Preparing
for MDA and LGA Medical Specialist Gynaecologist II interview at Public Service
Recruitment Service.
ALL
QUESTIONS ARE COMPILED TOGETHER.
1. A 29-year-old primigravida at 36 weeks
presents with blood pressure of 170/115 mmHg, severe headache, visual
disturbance, and right upper quadrant pain. The fetal heart rate is reassuring.
What is the most appropriate immediate management approach?
A. Stabilize the mother, control severe
hypertension, give magnesium sulfate, and plan delivery B. Perform immediate
caesarean delivery before initiating antihypertensive or anticonvulsant therapy C.
Administer corticosteroids and continue pregnancy under close observation until
37 weeks D. Begin antihypertensive treatment and discharge after the blood
pressure falls below 160/110 mmHg
Answer: A. Stabilize the mother, control
severe hypertension, give magnesium sulfate, and plan delivery
Rationale: This patient has pre-eclampsia with
severe features, demonstrated by severe hypertension and neurological and
hepatic symptoms. The immediate priority is maternal stabilization, including
treatment of severe hypertension and magnesium sulfate for seizure prophylaxis,
followed by delivery once sufficiently stabilized. Delivery should not precede
essential maternal stabilization merely because severe disease is present, and
expectant outpatient management would be unsafe. Magnesium sulfate is
recommended for prevention of eclampsia in severe pre-eclampsia.
2. A 32-year-old woman at 34 weeks with
known placenta previa develops sudden painless vaginal bleeding. Her pulse is
122 beats/min, blood pressure is 88/56 mmHg, and fetal heart rate is 170
beats/min. What should be the specialist's priority?
A. Perform digital vaginal examination to
assess cervical dilatation B. Stabilize maternal circulation while preparing
for urgent delivery C. Observe bleeding while continuously monitoring the
fetal heart rate D. Administer corticosteroids and postpone intervention for
48 hours
Answer: B. Stabilize maternal circulation
while preparing for urgent delivery
Rationale: Major haemorrhage with maternal
haemodynamic instability and fetal compromise requires simultaneous
resuscitation and preparation for urgent delivery. Maternal stabilization takes
priority because maternal perfusion directly affects fetal perfusion. Digital
vaginal examination is inappropriate when placenta previa is suspected or known
because it may provoke severe haemorrhage. Corticosteroid benefit does not
justify delaying indicated delivery in an unstable patient.
3. A woman at 39 weeks undergoing
induction develops recurrent late fetal heart rate decelerations with minimal
variability while receiving an oxytocin infusion. Contractions occur six times
in ten minutes. What is the most appropriate initial action?
A. Increase oxytocin to shorten the
remaining duration of labour B. Continue oxytocin while reassessing the
tracing after 30 minutes C. Stop oxytocin and institute measures to correct
uterine tachysystole D. Perform immediate operative delivery without
attempting corrective measures
Answer: C. Stop oxytocin and institute
measures to correct uterine tachysystole
Rationale: Six contractions in ten minutes indicate
uterine tachysystole, and the associated recurrent late decelerations and
minimal variability suggest impaired fetal oxygenation. When oxytocin is
contributing to excessive uterine activity, it should be stopped promptly while
reversible causes are addressed and fetal status is reassessed. Increasing or
continuing oxytocin may worsen uteroplacental perfusion. Operative delivery may
become necessary if the abnormal fetal heart pattern persists despite
appropriate corrective measures.
4. A multiparous woman develops
postpartum haemorrhage immediately after vaginal delivery. The uterus is firm
and well contracted, but brisk vaginal bleeding continues. What is the most
likely cause?
A. Retained placental tissue causing
inadequate uterine contraction B. Uterine atony despite apparently
satisfactory uterine consistency C. Coagulopathy presenting primarily through
failure of uterine contraction D. Genital tract trauma requiring prompt
systematic examination
Answer: D. Genital tract trauma requiring
prompt systematic examination
Rationale: Persistent postpartum bleeding in the
presence of a firm, contracted uterus should strongly raise suspicion of
genital tract trauma, including cervical, vaginal, or perineal lacerations.
Uterine atony typically produces a soft or poorly contracted uterus, while
retained placental tissue commonly interferes with effective contraction. The
specialist should therefore promptly inspect the birth canal while haemorrhage
resuscitation proceeds.
5. A woman at 31 weeks has severe
pre-eclampsia. Her blood pressure is controlled, laboratory results remain
stable, fetal assessment is reassuring, and the hospital can provide continuous
specialist maternal and fetal surveillance. Which approach is most appropriate?
A. Consider carefully selected expectant
management with intensive inpatient surveillance B. Discharge her with oral
antihypertensives and arrange review after one week C. Perform immediate
caesarean section because severe disease prohibits expectant care D. Continue
pregnancy routinely until 37 weeks provided her blood pressure remains
controlled
Answer: A. Consider carefully selected
expectant management with intensive inpatient surveillance
Rationale: Before 34 weeks, carefully selected
women with severe pre-eclampsia and a viable fetus may undergo expectant
management in an appropriately equipped facility when hypertension is
controlled and there is no progressive maternal organ dysfunction or fetal
compromise. This requires intensive inpatient surveillance and readiness to
deliver if deterioration occurs. It is not routine continuation of pregnancy,
nor is outpatient management appropriate. WHO guidance recognizes expectant
management before 34 weeks under these conditions.
6. A woman presents at 38 weeks with
spontaneous rupture of membranes 18 hours earlier. She is not in labour, fetal
status is reassuring, and there are no clinical features of infection. What is
the most appropriate obstetric plan?
A. Perform caesarean section because
membrane rupture has exceeded 12 hours B. Recommend induction of labour rather
than prolonged expectant management C. Wait for spontaneous labour until
maternal fever or fetal compromise develops D. Discharge the patient and
instruct her to return when contractions become regular
Answer: B. Recommend induction of labour
rather than prolonged expectant management
Rationale: At term, prelabour rupture of membranes
increases infectious risk as the interval between membrane rupture and delivery
lengthens. In the absence of another indication for caesarean section,
induction is appropriate rather than surgery solely because membranes have
ruptured. WHO recommends induction of labour for term prelabour rupture of
membranes, with oxytocin regarded as a first option in this context.
7. A specialist is preparing a clinical
report in Microsoft Word and wants to save the current document immediately
using a standard keyboard shortcut. Which shortcut should be used?
A. Ctrl + P B. Ctrl + S C. Ctrl + F D.
Ctrl + H
Answer: B. Ctrl + S
Rationale: In Microsoft Word, Ctrl + S saves the
current document. Frequent saving is important when preparing clinical reports,
research documents, teaching materials, budgets, and other professional records
because it reduces the risk of losing recent work. Ctrl + P opens the print
interface, Ctrl + F opens the Find function, and Ctrl + H opens Find and
Replace.
8. A 35-week pregnant woman experiences a
generalized seizure after presenting with severe hypertension and headache.
After immediate stabilization and control of the seizure, what is the
definitive obstetric principle?
A. Continue pregnancy until 37 weeks once
neurological symptoms resolve B. Avoid delivery until the blood pressure
becomes completely normal C. Continue pregnancy for 48 hours solely to
complete corticosteroid therapy D. Proceed toward delivery after maternal
stabilization regardless of prematurity
Answer: D. Proceed toward delivery after
maternal stabilization regardless of prematurity
Rationale: Eclampsia represents severe maternal
disease and delivery is indicated after stabilization. Initial priorities
include maintaining maternal safety, treating seizures with magnesium sulfate,
controlling severe hypertension, and assessing maternal and fetal condition.
Delivery should then proceed based on obstetric circumstances; prematurity
alone is not a reason to continue a pregnancy complicated by eclampsia.
Magnesium sulfate remains the recommended anticonvulsant for treatment of
eclampsia.
9. A 30-year-old woman at 33 weeks
presents with painful vaginal bleeding, a tense tender uterus, and fetal
tachycardia. Ultrasound does not demonstrate placental separation. What is the
most appropriate interpretation?
A. Placental abruption remains a clinical
diagnosis despite a negative ultrasound B. Placental abruption is excluded
because ultrasound shows no retroplacental clot C. Placenta previa becomes the
most likely diagnosis because bleeding is present D. Labour should be excluded
because uterine tenderness suggests infection instead
Answer: A. Placental abruption remains a
clinical diagnosis despite a negative ultrasound
Rationale: Placental abruption is primarily a
clinical diagnosis, and ultrasound has limited sensitivity for detecting an
acute abruption. Painful bleeding, uterine tenderness or hypertonicity, and
fetal compromise provide a highly suggestive clinical picture even when imaging
is unrevealing. A negative scan therefore must not create false reassurance or
delay management when maternal or fetal condition requires intervention.
10. A woman develops heavy bleeding after
delivery. The uterus is enlarged and poorly contracted despite initial uterine
massage and appropriate first-line uterotonic treatment. What should guide the
specialist's subsequent management?
A. Wait for laboratory confirmation of
anaemia before escalating treatment B. Escalate haemorrhage management
promptly while identifying and treating the cause C. Transfer the patient
before undertaking further haemorrhage-control interventions D. Observe the
response for one hour because most uterine atony resolves spontaneously
Answer: B. Escalate haemorrhage
management promptly while identifying and treating the cause
Rationale: Postpartum haemorrhage is time-critical.
An enlarged poorly contracted uterus strongly suggests uterine atony, but
management should combine prompt haemorrhage control, resuscitation, assessment
of the cause, and escalation when initial measures are insufficient. Waiting
for haemoglobin results is inappropriate because acute blood loss may not
initially be reflected accurately by haemoglobin concentration. Delay also
increases the risks of shock, coagulopathy, organ injury, and maternal death.
11. A gynaecologist is reviewing a long
Microsoft Word report and needs to locate every occurrence of the term
“endometriosis” quickly. Which keyboard shortcut should be used?
A. Ctrl + N B. Ctrl + K C. Ctrl + F D.
Ctrl + E
Answer: C. Ctrl + F
Rationale: Ctrl + F opens the Find or Navigation
function in Microsoft Word, allowing the user to search quickly for specific
words or phrases throughout a document. This is useful when reviewing lengthy
reports, research papers, clinical guidelines, or teaching materials. Ctrl + N
creates a new document, Ctrl + K is commonly used to insert a hyperlink, and
Ctrl + E centers the selected paragraph.
12. During vaginal examination after
spontaneous rupture of membranes, a pulsating loop of umbilical cord is felt
below the presenting part and fetal bradycardia develops. What is the priority?
A. Commence oxytocin to achieve rapid
cervical dilatation and vaginal birth B. Attempt to replace the cord
completely into the uterine cavity C. Observe fetal heart rate because cord
prolapse may resolve with descent D. Relieve cord compression while arranging
immediate expedited delivery
Answer: D. Relieve cord compression while
arranging immediate expedited delivery
Rationale: Overt umbilical cord prolapse with fetal
bradycardia is an obstetric emergency because compression of the cord can
rapidly compromise fetal oxygenation. Immediate management aims to reduce
pressure on the cord while arranging the fastest safe mode of delivery,
commonly emergency caesarean delivery when vaginal birth is not imminent.
Manipulating the cord excessively or waiting for spontaneous resolution risks
worsening fetal compromise.
13. A woman at 37 weeks with severe
pre-eclampsia has received magnesium sulfate. She develops respiratory
depression, absent patellar reflexes, and marked oliguria. What is the most
likely explanation?
A. Magnesium toxicity associated with
impaired renal elimination B. Progression to eclampsia despite adequate
anticonvulsant therapy C. Acute pulmonary embolism producing secondary
neurological changes D. Placental abruption producing concealed haemorrhagic
shock
Answer: A. Magnesium toxicity associated
with impaired renal elimination
Rationale: Magnesium is eliminated predominantly
through the kidneys, so significant oliguria increases the risk of accumulation
and toxicity. Loss of deep tendon reflexes and respiratory depression are
particularly concerning manifestations. This presentation should trigger urgent
assessment and management of suspected magnesium toxicity rather than being
interpreted as progression of pre-eclampsia itself.
14. A 38-year-old multiparous woman
presents with painless third-trimester bleeding. Placenta previa is suspected
but placental location has not yet been confirmed. Which examination should be
avoided until previa has been excluded?
A. Abdominal assessment of lie,
presentation, and uterine activity B. Digital vaginal examination to determine
cervical dilatation C. Maternal observations including pulse and blood
pressure measurement D. Appropriate ultrasound assessment to determine
placental location
Answer: B. Digital vaginal examination to
determine cervical dilatation
Rationale: Digital vaginal examination can disrupt
a placenta overlying or near the cervical os and precipitate major haemorrhage.
Therefore, when placenta previa is suspected, placental location should first
be established and examination undertaken only in an appropriate setting when
clinically indicated. Maternal observations, abdominal examination, and
ultrasound assessment remain important components of evaluation.
15. A woman develops sudden hypotension,
respiratory difficulty, altered consciousness, and diffuse bleeding from
intravenous and operative sites during labour. Which diagnosis best integrates
this presentation?
A. Severe uterine atony causing isolated
hypovolaemic shock B. Pulmonary thromboembolism without associated coagulation
disturbance C. Amniotic fluid embolism complicated by disseminated
coagulopathy D. High neuraxial block producing hypotension and surgical
bleeding
Answer: C. Amniotic fluid embolism
complicated by disseminated coagulopathy
Rationale: The abrupt combination of cardiovascular
collapse, respiratory compromise, neurological deterioration, and disseminated
bleeding strongly suggests amniotic fluid embolism with associated
coagulopathy. Pulmonary embolism may cause respiratory and cardiovascular
collapse but does not characteristically produce sudden disseminated
coagulopathy. Management requires immediate multidisciplinary resuscitation and
simultaneous treatment of haemodynamic, respiratory, and haemostatic
abnormalities.
16. A woman at 32 weeks presents with
severe hypertension, right upper quadrant pain, platelets of 72 × 10⁹/L, elevated liver enzymes, and
laboratory evidence of haemolysis. What diagnosis best explains the findings?
A. Acute fatty liver of pregnancy without
hypertensive disease B. Gestational thrombocytopenia with coincidental hepatic
inflammation C. Immune thrombocytopenia complicated by chronic hypertension D.
HELLP syndrome representing severe pregnancy-related hypertensive disease
Answer: D. HELLP syndrome representing
severe pregnancy-related hypertensive disease
Rationale: HELLP refers to haemolysis, elevated
liver enzymes, and low platelet count and is a serious manifestation within the
spectrum of hypertensive disorders of pregnancy. Right upper quadrant or
epigastric pain may reflect hepatic involvement. Gestational thrombocytopenia
is generally mild and does not explain haemolysis, hepatic injury, and severe
hypertension. The combination requires urgent specialist assessment because
maternal and fetal deterioration can occur rapidly.
17. A specialist accidentally deletes a
paragraph while editing a Microsoft Word document and wants to reverse the most
recent action immediately. Which shortcut is most appropriate?
A. Ctrl + Z B. Ctrl + X C. Ctrl + Y D.
Ctrl + A
Answer: A. Ctrl + Z
Rationale: Ctrl + Z is the standard Undo command
and reverses the most recent editing action in Microsoft Word and many other
applications. It is useful after accidentally deleting, moving, or modifying
text. Ctrl + X cuts selected content, Ctrl + Y commonly redoes or repeats an
action, and Ctrl + A selects all content in the current document.
18. A woman with dichorionic twin
pregnancy reaches 37 weeks. Twin A is cephalic, Twin B is non-cephalic, both
fetuses have appropriate estimated weights, and there are no other
complications. What is the best principle when deciding mode of delivery?
A. All twin pregnancies require planned
caesarean delivery after 36 weeks B. Planned vaginal birth may be appropriate
when the first twin is cephalic C. Non-cephalic presentation of the second
twin absolutely contraindicates vaginal birth D. Delivery should be postponed
until both fetuses demonstrate cephalic presentation
Answer: B. Planned vaginal birth may be
appropriate when the first twin is cephalic
Rationale: The presentation of the first twin is
particularly important when planning delivery. When Twin A is cephalic and
there are no other contraindications, planned vaginal birth may be appropriate
provided skilled obstetric care and capacity to manage complications involving
the second twin are available. A non-cephalic second twin does not
automatically mandate planned caesarean delivery in every appropriately
selected case.
19. A 40-week primigravida has been fully
dilated for a prolonged period. The fetal head is low, position is known,
membranes are ruptured, and fetal compromise now requires rapid birth. What is
the most important consideration before attempting operative vaginal delivery?
A. Whether the patient has previously
delivered vaginally B. Whether epidural analgesia has been administered during
labour C. Whether prerequisites for safe operative vaginal birth are satisfied D.
Whether spontaneous delivery might occur if another hour is allowed
Answer: C. Whether prerequisites for safe
operative vaginal birth are satisfied
Rationale: Fetal compromise does not justify an
unsafe instrumental attempt. Before operative vaginal birth, the clinician must
establish that essential prerequisites are satisfied, including full cervical
dilatation, ruptured membranes, engagement and accurately determined position
of the fetal head, adequate assessment of the pelvis, appropriate expertise,
informed consent where feasible, and immediate capacity to proceed to
alternative delivery if the attempt fails. The urgency determines speed, not
abandonment of safety criteria.
20. Immediately after birth, a woman
develops severe pelvic pain and haemorrhage. The uterine fundus cannot be
palpated abdominally, and a smooth mass is visible at the vaginal opening. What
diagnosis is most likely?
A. Prolapsed submucosal uterine fibroid
after placental separation B. Cervical prolapse caused by prolonged
second-stage labour C. Concealed uterine rupture with extrusion of the
placenta D. Acute uterine inversion associated with obstetric haemorrhage
Answer: D. Acute uterine inversion
associated with obstetric haemorrhage
Rationale: Acute uterine inversion should be
suspected when postpartum haemorrhage and severe pain occur with absence of the
uterine fundus from its expected abdominal position and a mass is seen or felt
vaginally. It can cause rapid haemodynamic deterioration. Recognition must be
immediate because management requires urgent resuscitation and restoration of
uterine anatomy, followed by measures to maintain uterine contraction and
control haemorrhage.
21. A specialist prepares an official
report in Microsoft Word and wants the same hospital name and document title to
appear automatically at the top of every page. Which feature is most
appropriate?
A. Footnote B. Text Box C. Bookmark D.
Header
Answer: D. Header
Rationale: A header is the section of a document
used to display recurring information at the top of pages, such as an
institution name, report title, department, or other document identifiers.
Using a header provides consistent professional formatting without manually
typing the information on every page. A footnote provides supplementary
information at the bottom of a page, a text box places movable text within the
document, and a bookmark marks a location for navigation or linking.
22. During a difficult vaginal delivery,
shoulder dystocia is recognized after delivery of the fetal head. Which
principle should guide immediate management?
A. Apply strong fundal pressure to force
the anterior shoulder beneath the symphysis B. Call for assistance and
institute established shoulder-dystocia manoeuvres promptly C. Apply
progressively stronger traction to the fetal head until the shoulder delivers D.
Wait for the next contraction before intervening to avoid unnecessary
manipulation
Answer: B. Call for assistance and
institute established shoulder-dystocia manoeuvres promptly
Rationale: Shoulder dystocia is an unpredictable
obstetric emergency requiring immediate recognition, additional skilled
assistance, and systematic use of accepted manoeuvres designed to release the
impacted shoulder. Forceful traction and fundal pressure can increase the risk
of maternal and neonatal injury and should not substitute for proper
manoeuvres. Accurate documentation of events and interventions is also
important after the emergency has been resolved.
23. A pregnant woman at 34 weeks presents
with fever, uterine tenderness, maternal tachycardia, fetal tachycardia, and
foul-smelling fluid after prolonged rupture of membranes. What management
principle is most appropriate?
A. Delay intervention until culture
results identify the responsible organism B. Use antipyretic therapy and
continue pregnancy if fetal monitoring improves C. Initiate treatment for
intra-amniotic infection and proceed toward delivery D. Suppress labour to
prolong pregnancy until fetal maturity improves
Answer: C. Initiate treatment for
intra-amniotic infection and proceed toward delivery
Rationale: Fever, uterine tenderness, maternal and
fetal tachycardia, and offensive fluid following prolonged membrane rupture
strongly suggest intra-amniotic infection. Management requires prompt
antimicrobial treatment and delivery rather than attempts to prolong the
pregnancy. Waiting for culture confirmation delays necessary treatment, while
tocolysis in the presence of suspected intrauterine infection is inappropriate
because ongoing pregnancy may expose both mother and fetus to increasing
infectious risk.
24. A woman undergoing trial of labour
after a previous caesarean delivery requires augmentation because contractions
have become inadequate. Which approach reflects the safest specialist
principle?
A. Augmentation is absolutely prohibited
in every patient with a uterine scar B. High-dose stimulation should be used
because scarred uteri respond poorly C. Scar status is irrelevant once
spontaneous labour has already commenced D. Any augmentation requires careful
selection, cautious use, and close monitoring
Answer: D. Any augmentation requires
careful selection, cautious use, and close monitoring
Rationale: A previous caesarean scar does not make
every form of labour augmentation automatically impossible, but it changes the
risk assessment because excessive uterine stimulation may increase concern for
scar complications. Decisions should consider the indication, previous uterine
incision, labour progress, fetal condition, available monitoring, and immediate
capacity for emergency operative delivery. Aggressive stimulation or treating
the scar as clinically irrelevant would be unsafe.
25. A district hospital reviewing
maternal near-miss cases finds repeated delays in recognizing severe
pre-eclampsia, inconsistent magnesium sulfate availability, and poorly
coordinated referrals. As the specialist leading quality improvement, which
intervention is most likely to produce sustainable improvement?
A. Establish standardized protocols,
reliable emergency supplies, team training, audit, and feedback B. Issue
written warnings to individual clinicians involved in the previous adverse
cases C. Refer every hypertensive pregnant patient to a tertiary hospital
regardless of severity D. Restrict management of hypertension in pregnancy
exclusively to specialist doctors
Answer: A. Establish standardized
protocols, reliable emergency supplies, team training, audit, and feedback
Rationale: The review reveals a systems problem
involving recognition, essential medicine availability, clinical response, and
referral coordination. Sustainable quality improvement therefore requires
interventions targeting the whole care pathway: standardized protocols,
dependable availability of essential treatment, multidisciplinary training,
clear escalation and referral processes, and repeated audit with feedback to
determine whether performance improves. Punishing individual clinicians does
not correct recurrent system failures, while indiscriminate referral or
restricting care to specialists may delay treatment and weaken capacity at
lower-level facilities. WHO emphasizes magnesium sulfate as a lifesaving
treatment that should be available across levels of the health system.
26. A 28-year-old woman presents with 7
weeks of amenorrhoea, lower abdominal pain, and light vaginal bleeding.
Transvaginal ultrasound shows no intrauterine pregnancy and a 3.5 cm right
adnexal mass. Serum β-hCG is above the expected discriminatory level. She is
haemodynamically stable. What is the most likely diagnosis?
A. Incomplete miscarriage with retained
intrauterine tissue B. Right tubal ectopic pregnancy requiring further
management C. Ruptured haemorrhagic ovarian cyst with resolving pregnancy D.
Early viable intrauterine pregnancy not detectable by ultrasound
Answer: B. Right tubal ectopic pregnancy
requiring further management
Rationale: In a woman with amenorrhoea, pain,
vaginal bleeding, an adnexal mass, and no intrauterine pregnancy on
high-quality transvaginal ultrasound when β-hCG is above the expected
discriminatory range, ectopic pregnancy is highly concerning. Although β-hCG
should never be interpreted in isolation, the combined clinical, biochemical,
and imaging findings strongly support a tubal ectopic pregnancy. A viable
intrauterine pregnancy becomes substantially less likely, while incomplete
miscarriage would usually be supported by intrauterine findings or an
appropriate history of pregnancy tissue passage.
27. A 36-year-old woman presents with
acute severe lower abdominal pain, vomiting, and a 9 cm adnexal mass.
Ultrasound demonstrates an enlarged ovary with peripheral follicles and reduced
Doppler flow. What is the most appropriate management?
A. Observe for 24 hours and repeat
Doppler assessment B. Aspirate the cyst under ultrasound guidance for
decompression C. Begin broad-spectrum antibiotics for presumed tubo-ovarian
infection D. Arrange urgent operative assessment for suspected ovarian torsion
Answer: D. Arrange urgent operative
assessment for suspected ovarian torsion
Rationale: Acute severe pelvic pain, vomiting, an
adnexal mass, ovarian enlargement, peripheral follicles, and reduced blood flow
strongly suggest adnexal torsion. Torsion is a surgical emergency because
prolonged vascular compromise may lead to ovarian necrosis. Doppler findings
support the diagnosis, but normal flow would not reliably exclude it because
intermittent torsion and dual ovarian blood supply can preserve detectable
flow. Observation risks losing potentially salvageable ovarian tissue.
28. A specialist is preparing a report in
Microsoft Word and wants selected text to appear in bold. Which keyboard
shortcut should be used?
A. Ctrl + B B. Ctrl + I C. Ctrl + U D.
Ctrl + L
Answer: A. Ctrl + B
Rationale: Ctrl + B applies or removes bold
formatting from selected text in Microsoft Word. Bold formatting is commonly
used to emphasize headings, important findings, or key sections in professional
documents. Ctrl + I applies italics, Ctrl + U applies underlining, and Ctrl + L
aligns a paragraph to the left.
29. A specialist has copied a paragraph
from one section of a Microsoft Word document and wants to insert the copied
content at another location. Which shortcut should be used?
A. Ctrl + X B. Ctrl + Z C. Ctrl + V D.
Ctrl + F
Answer: C. Ctrl + V
Rationale: Ctrl + V pastes previously copied or cut
content at the current cursor location. This allows text, tables, and other
supported content to be moved or duplicated efficiently when preparing reports
and other documents. Ctrl + X cuts selected content, Ctrl + Z reverses the
previous action, and Ctrl + F opens the Find function.
30. A 44-year-old woman with heavy
menstrual bleeding has a 4 cm submucosal fibroid that markedly distorts the
uterine cavity. She has completed childbearing. Which factor is most important
when selecting definitive management?
A. Her haemoglobin concentration as the
sole determinant of treatment B. Symptom severity, fibroid characteristics,
preferences, and reproductive plans C. Her chronological age regardless of
symptoms or anatomical findings D. The presence of any fibroid because all
fibroids require surgical removal
Answer: B. Symptom severity, fibroid
characteristics, preferences, and reproductive plans
Rationale: Fibroid management should be
individualized according to symptoms, fibroid size, number and location, cavity
distortion, patient preferences, reproductive goals, associated anaemia, and
suitability for available therapies. A submucosal fibroid causing significant
bleeding and cavity distortion may warrant procedural treatment, but no single
variable such as age or haemoglobin should determine management in isolation.
Asymptomatic fibroids do not automatically require surgery.
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