MCQs Obs & Gynae - PasTest

PAPER 1 – ANSWERS ANDTEACHING NOTES1.1 CEThe principle supports of the uterus are the transverse cervicalligaments (cardinal ligaments), uterosacral ligaments and theround ligament. The infundibular ligaments attach the ovariesto the posteo-lateral wall of the uterus. The pyriformis musclelines the lateral wall of the pelvis overlying the iliosacralligament.1.2 BCEThe ovary is attached to the uterus by the infundibularligament, the mesovarium and its blood supply which arisesfrom the renal arteries. The pouch of Douglas is posterior to theuterus lying between the rectum and the uterus. Immediatelyfollowing the LH surge the oocyte completes the first stage ofmeiosis extruding the first polar body which is haploid(23 chromosomes).1.3 CEFHIIn a woman over 40 irregular vaginal bleeding may be due toany of the following; cervical ectropion, cervical polyp, cervicalcancer, endometrial hyperplasia (cystic or atypical),endometrial polyp, submucosal fibroid and rarely endometrialcancer. It is unlikely that she has pelvic inflammatory disease,and chlamydia rarely causes irregular vaginal bleeding. Aspeculum examination is an opportunity to detect cervicalabnormalities and perform a smear. A digital vaginalexamination will detect an enlarged uterus suggestive offibroids. Endometrial biopsy alone is indicated in women under40 because the risk of malignancy is greatly reduced. Atransvaginal ultrasound scan will detect endometrial polyps/submucosal fibroids and measure the endometrial thickness. Ahysteroscopy and endometrial biopsy is the gold standard fordetecting endometrial abnormalities in women over 40.1.4 BCEThe urethra is only 3.5 cm long and is anterior to the lowerthird of the vagina. The bladder when empty lies below theuterovesical fold which arises from the junction between theuterine body and the cervix.21