FCPS Part 1 Obstetrics and Gynaecology Paper 2 MCQs
12 sample questions from the 2337 Obstetrics and Gynaecology Paper 2 questions in FCPS-1 Prep. Choose an answer to see why it is right and why each other option is wrong.
Sample Obstetrics and Gynaecology Paper 2 questions
Question 1Medium
A phenotypic boy with small firm testes is found on karyotyping to be 46,XX. FISH shows a small piece of Y chromosome material translocated onto one X. Which gene on this fragment made his gonads develop as testes?
Answer: SRY
SRY on the short arm of the Y chromosome encodes testis-determining factor. When an X–Y interchange at paternal meiosis carries SRY onto an X, a 46,XX individual develops testes and a male phenotype. SRY switches on SOX9 in the supporting cells, which then become Sertoli cells. WT1 is needed earlier for the genital ridge itself, and AMH is a product of Sertoli cells, not the switch.
Testis-determining factor
SRY on Yp
Turns on SOX9 in supporting cells
Supporting cells become Sertoli cells
SRY on an X gives 46,XX male
Remember No SRY, no testis.
Exam trap SOX9 is essential too, but it is the autosomal target, not the Y gene.
Why the other options are wrong
SOX9 Downstream of SRY and autosomal (chromosome 17).
WT1 Autosomal; needed for kidney and genital ridge formation.
DAX1 On the X; extra copies oppose testis formation.
AMH Made by Sertoli cells after testis forms; regresses Müllerian ducts.
Question 2Medium
In a woman standing upright, the plane of the pelvic inlet is tilted forwards rather than horizontal. Approximately what angle does it make with the horizontal?
Answer: About 55–60 degrees
In the erect posture the pelvis is tilted so that the anterior superior iliac spines and the pubic tubercles lie in roughly the same vertical plane, and the plane of the inlet makes about 55–60 degrees with the horizontal. The plane of the outlet is tilted about 10–15 degrees. A high inclination can delay engagement, and this tilt is why the uterus must direct the head backwards into the brim.
Pelvic inclination
Inlet plane 55–60° to horizontal
Outlet plane 10–15°
ASIS and pubic tubercle in one vertical plane
High inclination delays engagement
Remember The inlet faces forwards and upwards.
Exam trap Do not picture the inlet as horizontal; the head must enter it downwards and backwards.
Why the other options are wrong
About 10–15 degrees This is roughly the tilt of the outlet plane.
About 30 degrees Too small for the inlet in the erect position.
About 90 degrees That would make the inlet vertical.
About 120 degrees Beyond vertical; not anatomically possible here.
Question 3Medium
At laparoscopy for a suspected ectopic pregnancy, blood clot and trophoblast are seen protruding from the fimbrial end of an intact right tube, with blood in the pouch of Douglas. What has happened?
Answer: Tubal abortion via the fimbriae
Pregnancies in the wide, distensible ampulla often separate from the tubal wall and are expelled through the open fimbrial end into the peritoneal cavity rather than rupturing the tube; this is a tubal abortion. Blood collects in the pouch of Douglas, and the tube itself remains intact. Isthmic pregnancies, in the narrow part of the tube, tend to rupture through the wall early. Occasionally an expelled pregnancy reimplants in the abdomen.
Tubal abortion
Usually ampullary pregnancy
Expelled through fimbrial end
Tube intact
Blood in pouch of Douglas
Remember Ampulla aborts; isthmus ruptures.
Exam trap An intact tube does not exclude an ectopic pregnancy.
Why the other options are wrong
Rupture of an isthmic pregnancy Would show a hole in the tubal wall.
Interstitial pregnancy rupture Would rupture near the cornu with heavy bleeding.
Primary ovarian pregnancy The tube would be normal and the sac on the ovary.
Haemorrhage from a corpus luteum The tube would contain no trophoblast.
Question 4Hard
A 52-year-old woman on immunosuppressive drugs after a kidney transplant has recurrent E. coli urinary infections. Cystoscopy shows soft yellow plaques on the bladder mucosa. Biopsy shows sheets of foamy macrophages containing round, laminated, calcified inclusions. What is the diagnosis?
Answer: Malakoplakia
Malakoplakia is a chronic granulomatous inflammation linked to Gram-negative infection, usually E. coli, often in immunosuppressed patients. Macrophages engulf the bacteria but cannot digest them because of defective lysosomal killing. Partly digested bacterial debris calcifies within phagolysosomes to form laminated Michaelis–Gutmann bodies inside large foamy macrophages (von Hansemann cells). It appears as soft yellow mucosal plaques. Tuberculosis shows caseating granulomas, cystitis glandularis shows glandular metaplasia, and schistosomiasis shows eggs.
Malakoplakia
Linked to E. coli, immunosuppression
Defective macrophage killing
Michaelis–Gutmann bodies
Soft yellow plaques in bladder
Remember Foamy macrophages with laminated calcified bodies: malakoplakia.
Exam trap Yellow bladder plaques in an immunosuppressed patient may be inflammatory, not malignant.
Why the other options are wrong
Tuberculous cystitis Shows caseating granulomas with Langhans giant cells.
Cystitis glandularis Shows glandular metaplasia of the urothelium, not foamy macrophages.
Urothelial carcinoma in situ Shows flat, highly atypical urothelial cells.
Schistosomal cystitis Shows schistosome eggs with surrounding granulomas.
In a rural district where most women eat little dairy food, pregnant women are given 1.5–2 g of elemental calcium daily from 20 weeks. Which complication is this supplement mainly intended to reduce?
Answer: Pre-eclampsia
WHO recommends high-dose calcium supplementation in the second half of pregnancy for populations with low dietary calcium, mainly to reduce the risk of pre-eclampsia and its complications. A proposed mechanism is that low calcium intake raises PTH and intracellular calcium in vascular smooth muscle, increasing vascular tone; supplementation reverses this. It does not prevent neural tube defects, which need periconceptional folic acid. Calcium can reduce iron absorption, so doses are separated from iron tablets.
Calcium and pre-eclampsia
For low-intake populations
1.5–2 g daily from 20 weeks
Aim: reduce pre-eclampsia
Take apart from iron
Remember Low-calcium diets: supplement to protect against pre-eclampsia.
Exam trap Calcium and iron tablets taken together reduce iron absorption.
Why the other options are wrong
Gestational diabetes Not prevented by calcium.
Neural tube defects Prevented by folic acid before conception.
Iron deficiency anaemia Calcium may actually reduce iron absorption.
Postpartum haemorrhage Not the target of calcium supplementation.
Question 6Easy
An ovulation kit detected an LH surge on day 13, and the woman ovulated on day 14. Intercourse first occurred on day 17. Why is conception from this cycle unlikely?
Answer: The ovum can be fertilised for only about a day
After ovulation the secondary oocyte can be fertilised for only about 12–24 hours before it degenerates. By day 17, three days after ovulation, no fertilisable ovum remains in the tube. Progesterone also makes cervical mucus thick and less penetrable, though this is a secondary point. The endometrium is not yet receptive on day 17, but that matters only after a week of embryo development, so it is not the reason.
After ovulation
Ovum viable 12–24 h
Then degenerates in tube
Mucus becomes thick (progesterone)
Fertile time ends a day after ovulation
Remember The egg waits only a day.
Exam trap Do not count fertile days after ovulation; they are almost all before it.
Why the other options are wrong
Sperm cannot pass luteal-phase mucus at all Luteal mucus is hostile but not completely impenetrable.
Endometrium is non-receptive on day 17 Implantation occurs days later; this is not the limit.
Tubes close after ovulation The tubes do not close.
The corpus luteum kills sperm The corpus luteum does not kill sperm.
Question 7Medium
Newborn pulse oximetry screening for critical congenital heart disease compares the right hand with a foot. Why is the right hand used for the pre-ductal reading?
Answer: Its artery arises before the ductus
The right subclavian artery arises from the brachiocephalic trunk, proximal to the ductus arteriosus insertion, so the right hand reflects pre-ductal aortic blood. The lower limbs receive post-ductal blood from the descending aorta. A lower foot saturation shows right-to-left flow through the ductus, as in coarctation, hypoplastic left heart or persistent pulmonary hypertension. The left subclavian may arise close to or beyond the ductus, so the left arm is not reliably pre-ductal.
Pre- and post-ductal
Right hand: pre-ductal
Feet: post-ductal
Left arm: unreliable
Foot lower: ductal right-to-left shunt
Remember Right hand before the duct; feet after it.
Exam trap The left subclavian can arise opposite the ductus, so the left hand is not a safe pre-ductal site.
Why the other options are wrong
It has the best capillary perfusion Not the reason.
It is supplied by the left ventricle only Both ventricles' output mixes in the aorta.
It is unaffected by the foramen ovale Foramen ovale shunting lowers all sites.
It is closest to the heart Proximity is not the reason.
Question 8Medium
During general anaesthesia for an emergency caesarean section at 38 weeks, a lower end-tidal sevoflurane concentration than usual keeps the woman adequately anaesthetised. What is the most likely explanation?
The minimum alveolar concentration of volatile agents falls by about a quarter to a third in pregnancy. This is attributed to the sedative effect of high progesterone and raised endorphin levels. Volatile agents are not carried bound to albumin, and the placenta does not metabolise them. A higher cardiac output actually slows the rise in alveolar concentration rather than lowering requirement.
MAC in pregnancy
MAC falls about 25–40%
Due to progesterone and endorphins
Less agent needed for anaesthesia
But beware uterine relaxation at high doses
Remember Pregnant women need less volatile agent.
Exam trap A lower MAC does not mean awareness is rare; caesarean section under GA still carries a high awareness risk.
Why the other options are wrong
Raised cardiac output speeds brain uptake High cardiac output removes more agent from the alveoli and slows induction; it does not lower MAC.
Lower albumin leaves more free agent Volatile agents are carried dissolved, not protein bound.
Placenta metabolises part of the agent Volatile agents cross the placenta but are not metabolised there.
Hyperventilation lowers cerebral blood flow Cerebral blood flow does not determine MAC.
Question 9Medium
A woman with stage IIB squamous carcinoma of the cervix is treated with pelvic radiotherapy plus weekly low-dose cisplatin. The cisplatin dose is too low to control distant disease on its own. What is its main purpose in this regimen?
Answer: Sensitising tumour cells to radiation
In concurrent chemoradiation for cervical cancer, weekly cisplatin acts mainly as a radiosensitiser. Platinum–DNA adducts interfere with repair of radiation-induced DNA damage and help kill hypoxic and cycling cells, so local control and survival improve compared with radiotherapy alone. It is not given to prepare for surgery, as chemoradiation is the definitive treatment at this stage.
Cisplatin with radiotherapy
Weekly low-dose cisplatin
Acts as a radiosensitiser
Blocks repair of radiation damage
Better local control and survival
Remember In cervical cancer, cisplatin helps the radiation work.
Exam trap Concurrent chemotherapy also increases acute bowel and marrow toxicity.
Why the other options are wrong
Preventing radiation cystitis Cisplatin does not protect the bladder.
Shrinking the tumour before surgery Chemoradiation is definitive treatment here, not neoadjuvant.
Protecting the bowel from radiation It does not protect normal tissue.
Reducing nausea from radiotherapy Cisplatin worsens, not reduces, nausea.
Question 10Easy
A 45-year-old woman has invasive squamous cell carcinoma of the cervix. Which single HPV type is found in the largest share of these tumours worldwide?
Answer: HPV 16
High-risk HPV is found in almost all cervical carcinomas. HPV 16 is the single most common type, present in about half or more of squamous carcinomas, and HPV 18 is second, being relatively commoner in adenocarcinoma. Types such as 31, 33 and 45 account for smaller shares. HPV 6 and 11 are low-risk types that cause genital warts and are rarely found in cancers.
HPV in cervical cancer
HPV in almost all cervical cancers
HPV 16: commonest
HPV 18: second, glandular
Vaccines target both
Remember Sixteen is the commonest culprit.
Exam trap Do not confuse wart-causing low-risk types with high-risk oncogenic types.
Why the other options are wrong
HPV 18 Second commonest; relatively more in adenocarcinoma.
HPV 6 Low-risk; causes warts.
HPV 11 Low-risk; causes warts and laryngeal papillomas.
HPV 31 High-risk but much less common than 16.
Question 11Hard
Most B12 measured in serum is bound to haptocorrin, which cells cannot use. Which test measures the fraction of B12 that is actually delivered to cells?
Answer: Holotranscobalamin
In plasma, about 70 to 80% of B12 is bound to haptocorrin and only about 20 to 30% to transcobalamin. The B12–transcobalamin complex, holotranscobalamin, is the form taken up by cells through receptor-mediated endocytosis. Its level falls early in deficiency and is less affected by the pregnancy fall in haptocorrin. Methylmalonic acid is a functional test that rises when cellular B12 is inadequate.
Active B12
Most serum B12 on haptocorrin (inactive)
Holotranscobalamin reaches cells
Falls early in deficiency
Less affected by pregnancy
Remember HoloTC is the B12 cells can use.
Exam trap Transcobalamin, not haptocorrin, is the delivery protein.
Why the other options are wrong
Total serum B12 Mostly haptocorrin-bound, inactive B12.
Anti-parietal cell antibody Shows autoimmune gastritis, not cellular B12.
Serum gastrin Raised in atrophic gastritis; not a B12 measure.
Schilling test An old absorption test, now obsolete.
Question 12Medium
An endocervical swab from a woman with purulent cervicitis is plated on chocolate agar containing vancomycin, colistin and nystatin and incubated in 5–10% carbon dioxide. Why are these antimicrobials added to the medium?
Answer: To suppress the normal genital flora
The genital tract is crowded with commensal bacteria and yeasts that would overgrow the slow, fastidious gonococcus. Thayer–Martin (and modified New York City) media add vancomycin against Gram-positive organisms, colistin against most Gram-negative bacilli, nystatin against yeasts and often trimethoprim against Proteus, while Neisseria species resist these agents. Heating blood in chocolate agar is what releases growth factors.
Thayer–Martin medium
Chocolate agar base
Vancomycin: Gram-positives
Colistin: Gram-negative bacilli
Nystatin: yeasts
Remember Selective medium: kill the crowd, grow the gonococcus.
Exam trap Gonococcus dies quickly on drying and cooling; swabs need prompt plating or transport medium.
Why the other options are wrong
To kill Neisseria gonorrhoeae N. gonorrhoeae resists these agents, so it grows.
To supply growth factors for Neisseria Growth factors come from the heated blood.
To detect penicillin resistance Resistance is tested separately.
To lyse red cells and release haem That is done by heating the blood, not by antibiotics.
Topics covered
Microbiology, Endocrine, Chromosomal disorders, Gestational trophoblastic disease, Haematology, Patterns of inheritance, Parasitology, Endocrine physiology, Pelvis, Genetics, Shock, Reproductive physiology, Abdomen, Obstetrics, Haematopathology, Female inguinal canal, Prolactin control, Cardiovascular, Reproduction, Embryology, Obstetric drugs, Drugs in breastfeeding, Epithelial ovarian tumours, Abdominal incisions, Vulval lesions, Mutations, Respiratory, Liver, Pelvis and perineum, Benign breast disease, Beta-agonist tocolysis, Endometriosis, Grading and staging, Acid–base, Teratogens, Cardiovascular physiology, Laparoscopic anatomy, Abdominal wall nerves, Femoral canal, Breast development
Frequently asked questions
How many FCPS Part 1 Obstetrics and Gynaecology Paper 2 questions are in the bank?
There are 2337 Obstetrics and Gynaecology Paper 2 questions in FCPS-1 Prep, each with an explanation for every option.
Are these past paper questions?
No. Every question is original, written by us and mapped to the published CPSP FCPS Part 1 syllabus.
