Make me 250 Mcqs from Gynaecology Ten Teachers
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Here are your 250 Gynaecology MCQs sourced from Berek & Novak's Gynecology (the most authoritative comprehensive gynaecology textbook available in the library - "Gynaecology by Ten Teachers" is not in the collection, but this covers identical core content at a deeper level).
Summary of Coverage
| Section | Topic | Questions |
|---|---|---|
| 1 | Reproductive Physiology & Endocrinology | Q1-30 |
| 2 | Contraception | Q31-60 |
| 3 | Benign Uterine Conditions & Fibroids | Q61-90 |
| 4 | Endometriosis & Pelvic Pain | Q91-110 |
| 5 | PCOS & Ovarian Disorders | Q111-140 |
| 6 | Urogynecology & Urinary Incontinence | Q141-165 |
| 7 | Early Pregnancy Loss & Ectopic Pregnancy | Q166-190 |
| 8 | Gynaecological Oncology | Q191-225 |
| 9 | Menopause, HRT & Sexual Dysfunction | Q226-250 |
Total: 250 MCQs - each with 4 options and the correct answer marked with ✓.
All answers are directly derived from textbook content covering the HPO axis, menstrual physiology, contraception failure rates, fibroid surgery, endometriosis criteria, PCOS management (including the Legro 2014 NEJM trial on letrozole vs clomiphene), urodynamics terminology (ICS definitions), spontaneous abortion statistics, ovarian tumour classification, and menopause/HRT evidence.
Make them into a file I can download
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mkdir -p /home/daytona/workspace/gynaecology-mcqs
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~/gynaecology-mcqs/generate_mcq_pdf.py
from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, HRFlowable, PageBreak, Table, TableStyle
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY
OUTPUT = "/home/daytona/workspace/gynaecology-mcqs/Gynaecology_250_MCQs.pdf"
doc = SimpleDocTemplate(
OUTPUT,
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leftMargin=2*cm,
topMargin=2*cm,
bottomMargin=2*cm,
title="250 Gynaecology MCQs",
author="Berek & Novak's Gynecology"
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question_style = ParagraphStyle(
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# ─────────────────────────────────────────────
# DATA (all 250 MCQs)
# Format: (number, question_text, [options], correct_index_0based)
# ─────────────────────────────────────────────
sections = [
{
"title": "SECTION 1: Reproductive Physiology & Endocrinology (Q1–30)",
"questions": [
(1, "GnRH is secreted by which structure?",
["Anterior pituitary", "Posterior pituitary", "Hypothalamus", "Ovary"], 2),
(2, "GnRH regulates which two pituitary hormones simultaneously?",
["Prolactin and TSH", "LH and FSH", "ACTH and GH", "ADH and oxytocin"], 1),
(3, "The pulse frequency of GnRH determines:",
["The size of the ovarian follicle", "The relative amounts of LH and FSH secreted",
"The thickness of the endometrium", "The length of the luteal phase"], 1),
(4, "In the early menstrual cycle, the ovary primarily produces:",
["Progesterone", "Estrogen", "hCG", "Prolactin"], 1),
(5, "After ovulation, the main hormone produced in significant quantities is:",
["Estrogen", "LH", "Progesterone", "FSH"], 2),
(6, "The normal reproductive process involves all of the following EXCEPT:",
["Hypothalamus", "Anterior pituitary", "Thyroid", "Endometrium"], 2),
(7, "Which structure is responsible for maintaining meiotic arrest of the oocyte?",
["Granulosa cells", "Corpus luteum", "Thecal cells", "The oocyte itself, under follicular regulation"], 3),
(8, "The corpus luteum forms from which structure after ovulation?",
["Primary follicle", "Dominant follicle after rupture", "Primordial follicle", "Stroma of the ovary"], 1),
(9, "During the luteal phase, which hormone transforms the endometrium into a state ideal for implantation?",
["Estrogen", "FSH", "Progesterone", "Prolactin"], 2),
(10, "The suckling of an infant during breastfeeding elevates which hormone to suppress ovulation?",
["Oxytocin", "Prolactin", "LH", "Estrogen"], 1),
(11, "Breastfeeding suppresses ovulation by reducing which hypothalamic hormone?",
["TRH", "Somatostatin", "GnRH", "CRH"], 2),
(12, "For maximum contraceptive reliability during lactational amenorrhoea, feeding intervals should NOT exceed:",
["2 hours during the day and 4 hours at night", "4 hours during the day and 6 hours at night",
"6 hours during the day and 8 hours at night", "8 hours during the day and 10 hours at night"], 1),
(13, "The six-month pregnancy rate for couples relying solely on breastfeeding as contraception is:",
["0.1% to 0.5%", "0.45% to 2.45%", "5% to 10%", "15% to 20%"], 1),
(14, "Cyclic changes of the endometrium are primarily driven by:",
["FSH fluctuations", "LH surges", "Sequential estrogen then progesterone", "hCG"], 2),
(15, "Follicular development in the ovary is stimulated primarily by:",
["LH", "FSH", "Progesterone", "Prolactin"], 1),
(16, "The LH surge triggers:", ["Corpus luteum regression", "Ovulation", "Menstruation", "Follicular atresia"], 1),
(17, "Anti-Mullerian hormone (AMH) is a marker of:",
["Pituitary function", "Endometrial receptivity", "Ovarian reserve", "Uterine anomaly"], 2),
(18, "Serum AMH was found to be significantly lower 3 months following:",
["Laparoscopic ovarian drilling", "Myomectomy", "Hysterectomy", "Salpingectomy"], 2),
(19, "Which statement about the luteal phase is correct?",
["FSH is the dominant hormone", "The corpus luteum produces progesterone",
"Endometrium undergoes proliferative changes", "Follicular atresia is absent"], 1),
(20, "Which feedback mechanism is responsible for the LH surge at midcycle?",
["Negative feedback of estrogen on the pituitary",
"Positive feedback of estrogen on the pituitary and hypothalamus",
"Negative feedback of progesterone", "Positive feedback of FSH"], 1),
(21, "Normal menstrual cycle length is:",
["14–21 days", "21–35 days", "35–45 days", "10–14 days"], 1),
(22, "The proliferative (follicular) phase of the menstrual cycle is characterised by:",
["Progesterone dominance", "Corpus luteum activity",
"Estrogen-driven endometrial proliferation", "Decidualisation"], 2),
(23, "Which nucleus in the hypothalamus is primarily responsible for GnRH secretion?",
["Supraoptic nucleus", "Arcuate nucleus", "Paraventricular nucleus", "Ventromedial nucleus"], 1),
(24, "Inhibin B is secreted by:",
["Theca cells", "Granulosa cells", "Corpus luteum", "Endometrium"], 1),
(25, "The dominant follicle is selected due to:",
["Highest estrogen production", "Highest number of FSH receptors",
"Largest size at start of cycle", "Proximity to the corpus luteum"], 1),
(26, "Meiosis II in the oocyte is completed:",
["Before ovulation", "At the time of fertilisation", "During the luteal phase", "At birth"], 1),
(27, "Aromatase in granulosa cells converts:",
["Cholesterol to pregnenolone", "Progesterone to estrone",
"Androgens to estrogens", "LH to FSH"], 2),
(28, "Estradiol is primarily produced by:",
["Theca cells alone", "Granulosa cells alone",
"Two-cell, two-gonadotropin cooperation", "Corpus luteum alone"], 2),
(29, "The secretory phase of the endometrium corresponds to:",
["The follicular phase", "The luteal phase", "Menstruation", "The periovulatory period"], 1),
(30, "If fertilisation does not occur, the corpus luteum degenerates after approximately:",
["7 days", "14 days", "21 days", "28 days"], 1),
]
},
{
"title": "SECTION 2: Contraception (Q31–60)",
"questions": [
(31, "Coitus interruptus requires:",
["Complete withdrawal before ejaculation", "Withdrawal after ejaculation",
"Use of a condom", "Hormonal pretreatment"], 0),
(32, "The perfect-use pregnancy rate for coitus interruptus per 100 women in the first year is approximately:",
["1", "4", "10", "22"], 1),
(33, "The typical-use failure rate for coitus interruptus per 100 women in the first year is approximately:",
["4", "10", "22", "28"], 2),
(34, "'Forgettable' contraceptive methods include all of the following EXCEPT:",
["Etonogestrel subdermal implant", "Levonorgestrel IUS",
"Copper T380A IUD", "Combined oral contraceptive pill"], 3),
(35, "Typical-use pregnancy rate for 'forgettable' methods is:",
["Less than 1%", "1–3%", "5–8%", "Greater than 10%"], 0),
(36, "Which IUD is a non-hormonal contraceptive?",
["Levonorgestrel IUS", "Copper T380A", "Etonogestrel implant", "Progesterone IUD"], 1),
(37, "Eflornithine hydrochloride (DFMO) cream works by irreversibly blocking:",
["Aromatase", "5-alpha reductase", "Ornithine decarboxylase (ODC)", "Dihydrotestosterone receptors"], 2),
(38, "The failure rate of no contraception (typical use) per 100 women in the first year is:",
["50", "85", "28", "15"], 1),
(39, "For lactational amenorrhoea method (LAM), ovulation is unlikely before:",
["3 months", "4 months", "6 months", "9 months"], 2),
(40, "Spermicides have a typical-use pregnancy rate of:",
["5%", "10%", "18%", "28%"], 3),
(41, "Etonogestrel is the active metabolite of:",
["Levonorgestrel", "Desogestrel", "Norethindrone", "Gestodene"], 1),
(42, "The copper IUD's primary mechanism of contraception is:",
["Inhibition of ovulation", "Spermicidal and prevention of fertilisation",
"Thickening of cervical mucus", "Inhibition of LH surge"], 1),
(43, "Combined oral contraceptive pills primarily prevent pregnancy by:",
["Preventing implantation", "Inhibiting ovulation",
"Causing anovulatory cycles", "Preventing fertilisation"], 1),
(44, "Emergency contraception with levonorgestrel is most effective when taken within:",
["24 hours", "48 hours", "72 hours", "120 hours"], 2),
(45, "The progestogen-only pill ('mini-pill') works mainly by:",
["Inhibiting ovulation", "Thickening cervical mucus",
"Preventing implantation", "Reducing sperm motility"], 1),
(46, "Breastfeeding reduces the mother's lifetime risk of:",
["Ovarian cancer", "Endometrial cancer", "Breast cancer", "Cervical cancer"], 2),
(47, "Combined oral contraceptives are contraindicated in:",
["Dysmenorrhoea", "Migraine with aura", "Endometriosis", "PCOS"], 1),
(48, "Which contraceptive method has the lowest typical-use failure rate?",
["Male condom", "Combined OCP", "Copper IUD", "Injectable progestogen"], 2),
(49, "Fertility-awareness based methods have a typical-use failure rate of:",
["5%", "18%", "24%", "28%"], 2),
(50, "The levonorgestrel-releasing IUS (Mirena) releases how many micrograms of levonorgestrel per day?",
["5 mcg/day", "10 mcg/day", "20 mcg/day", "50 mcg/day"], 2),
(51, "A subdermal contraceptive implant is effective for at least:",
["1 year", "3 years", "5 years", "10 years"], 1),
(52, "Which method is most appropriate for a woman who cannot take oestrogen?",
["Combined OCP", "Vaginal ring", "Progestogen-only pill", "Combined patch"], 2),
(53, "The copper T380A IUD is effective for up to:",
["3 years", "5 years", "7 years", "10 years"], 3),
(54, "DMPA (depot medroxyprogesterone acetate) injection is given every:",
["4 weeks", "8 weeks", "12 weeks", "16 weeks"], 2),
(55, "Which OCP formulation has the highest androgenic activity?",
["Desogestrel", "Gestodene", "Levonorgestrel", "Norgestimate"], 2),
(56, "The diaphragm should be left in place for at least how long after intercourse?",
["2 hours", "4 hours", "6 hours", "12 hours"], 2),
(57, "Ulipristal acetate (ella) for emergency contraception is effective up to:",
["48 hours", "72 hours", "96 hours", "120 hours"], 3),
(58, "Which contraceptive is most appropriate immediately postpartum in a breastfeeding mother?",
["Combined OCP", "Progestogen-only pill", "Vaginal ring", "Combined patch"], 1),
(59, "The main advantage of the IUD over OCP for contraception is:",
["Lower cost", "No user compliance required", "Better cycle control", "Fewer side effects"], 1),
(60, "Male condoms protect against STIs when used:",
["Inconsistently", "Correctly and consistently", "Only after exposure", "Combined with spermicide only"], 1),
]
},
{
"title": "SECTION 3: Benign Uterine Conditions & Fibroids (Q61–90)",
"questions": [
(61, "During myomectomy, which vasoconstrictive agent is commonly injected to reduce blood loss?",
["Epinephrine", "Vasopressin", "Oxytocin", "Misoprostol"], 1),
(62, "Vasopressin is chemically known as:",
["Oxytocin", "Antidiuretic hormone", "Aldosterone", "Renin"], 1),
(63, "In which group of patients is myomectomy at caesarean section considered potentially safe?",
["All patients with fibroids", "Carefully selected patients in experienced hands",
"Only subserosal fibroids", "Only fibroids larger than 5 cm"], 1),
(64, "After hysterectomy (without oophorectomy), serum AMH is significantly lower at:",
["1 month", "3 months", "6 months", "12 months"], 1),
(65, "Compared to hysterectomy, AMH levels following myomectomy at 3 months are:",
["Significantly lower", "Significantly higher", "Similar to preoperative levels", "Undetectable"], 2),
(66, "The 'cell saver' device intraoperatively:",
["Prevents blood loss", "Collects and reinfuses the patient's own blood",
"Filters blood for pathogens", "Measures intraoperative blood loss"], 1),
(67, "A uterus larger than how many cm is considered very large for myomectomy in reported series?",
["10 cm", "12 cm", "16 cm", "20 cm"], 2),
(68, "The most common benign gynaecological tumour is:",
["Endometrial polyp", "Dermoid cyst", "Uterine fibroid (leiomyoma)", "Brenner tumour"], 2),
(69, "Uterine fibroids are composed of:",
["Endometrial glands and stroma", "Smooth muscle and fibrous tissue",
"Adipose tissue", "Squamous epithelium"], 1),
(70, "The most common type of uterine fibroid by location is:",
["Submucosal", "Subserosal", "Intramural", "Cervical"], 2),
(71, "Submucosal fibroids most commonly present with:",
["Urinary frequency", "Pelvic pain", "Abnormal uterine bleeding", "Constipation"], 2),
(72, "The gold standard for visualising the uterine cavity is:",
["Transabdominal ultrasound", "MRI", "Hysteroscopy", "CT scan"], 2),
(73, "Which imaging modality is best for assessing the inside of adnexal masses?",
["CT scan", "MRI", "Ultrasonography", "Plain X-ray"], 2),
(74, "GnRH agonists for fibroid treatment work by:",
["Directly destroying fibroid tissue", "Creating a hypoestrogenic state causing fibroid shrinkage",
"Blocking progesterone receptors", "Inhibiting aromatase in fibroid tissue"], 1),
(75, "Uterine artery embolisation (UAE) is contraindicated in:",
["Symptomatic fibroids", "Women wishing to preserve fertility",
"Menorrhagia due to fibroids", "Multiple fibroids"], 1),
(76, "Which surgical approach for myomectomy is associated with the greatest risk of adhesion formation?",
["Laparoscopic myomectomy", "Robotic myomectomy",
"Abdominal myomectomy", "Hysteroscopic myomectomy"], 2),
(77, "Adenomyosis is defined as:",
["Endometrial glands outside the uterus", "Endometrial glands within the myometrium",
"Fibroids within the myometrium", "Cervical polyps"], 1),
(78, "The classic feature of adenomyosis on imaging is:",
["Thin endometrium", "Uniformly enlarged, globular uterus", "Multiple fibroids", "Bicornuate uterus"], 1),
(79, "Hysteroscopic myomectomy is most suitable for which fibroid type?",
["Intramural", "Subserosal", "Submucosal", "Broad ligament"], 2),
(80, "Which medication is used for medical management of uterine fibroids via progesterone receptor modulation?",
["Mifepristone", "Clomiphene", "Metformin", "Spironolactone"], 0),
(81, "Red degeneration of a fibroid is most commonly seen in:",
["Postmenopausal women", "Pregnancy", "Young nulliparous women", "After UAE"], 1),
(82, "Pedunculated subserosal fibroids may be confused clinically with:",
["Endometrial polyp", "Ovarian tumour", "Cervical fibroid", "Haematometra"], 1),
(83, "Which of the following features favours a leiomyosarcoma over a benign fibroid?",
["Calcification", "Rapid growth", "Whorled appearance on MRI", "Hyaline degeneration"], 1),
(84, "Fibroid recurrence after myomectomy is approximately:",
["5%", "15–30%", "50%", "70%"], 1),
(85, "Fibroids that cause urinary frequency are typically:",
["Submucosal", "Intramural", "Anterior subserosal (bladder compression)", "Pedunculated"], 2),
(86, "Homologous blood transfusion during myomectomy was required in what percentage of patients who used the cell saver in one large series?",
["1%", "10%", "20%", "30%"], 1),
(87, "The intraluminal contour of the uterus is best shown by all of the following EXCEPT:",
["Hysteroscopy", "Contrast hysterosonography", "HSG", "Laparoscopy"], 3),
(88, "MRI is superior to laparoscopy for assessment of:",
["Peritoneal endometriosis", "Pelvic adhesions",
"Soft tissue and intramural myomas", "Ovarian surface lesions"], 2),
(89, "In a comparison study of hysterectomy vs myomectomy for fibroids, complications occurred in what percentage of the hysterectomy group?",
["5%", "10%", "13%", "20%"], 2),
(90, "Which technique of ovarian drilling in PCOS was associated with fewer adhesions?",
["15 punctures per ovary", "10 punctures per ovary",
"4 punctures per ovary", "20 punctures per ovary"], 2),
]
},
{
"title": "SECTION 4: Endometriosis & Pelvic Pain (Q91–110)",
"questions": [
(91, "Laparoscopy is the standard method for surgical diagnosis of:",
["Uterine fibroids", "Endometriosis and pelvic adhesions",
"Submucosal polyps", "Adenomyosis"], 1),
(92, "Laparoscopy is superior to other imaging for endometriosis because it provides:",
["Better soft-tissue resolution", "The greatest sensitivity and specificity for diagnosis",
"Non-invasive evaluation", "Hormonal assessment"], 1),
(93, "Which condition is correctly associated with pelvic adhesions?",
["Endometriosis", "Submucosal fibroid", "Endometrial polyp", "Ovarian dermoid"], 0),
(94, "Endometriosis most commonly involves:",
["The ovaries", "The fallopian tubes", "The cervix", "The vaginal walls"], 0),
(95, "Endometrioma (chocolate cyst) is a feature of:",
["PCOS", "Serous cystadenoma", "Ovarian endometriosis", "Dermoid cyst"], 2),
(96, "Medical treatment options for endometriosis include all of the following EXCEPT:",
["Combined OCP", "GnRH agonists", "Danazol", "Clomiphene"], 3),
(97, "The revised ASRM classification of endometriosis has how many stages?",
["2", "3", "4", "5"], 2),
(98, "Deeply infiltrating endometriosis most commonly affects:",
["Ovaries", "Uterosacral ligaments", "Fallopian tubes", "Appendix"], 1),
(99, "The primary symptom of endometriosis associated with deep dyspareunia is:",
["Subperitoneal implants", "Uterosacral involvement",
"Ovarian endometrioma", "Superficial peritoneal implants"], 1),
(100, "GnRH agonist treatment for endometriosis should generally not exceed how long without add-back therapy?",
["3 months", "6 months", "12 months", "18 months"], 1),
(101, "Aromatase inhibitors are used in endometriosis because:",
["They inhibit GnRH secretion", "They reduce local estrogen production in lesions",
"They block progesterone receptors", "They prevent adhesion formation"], 1),
(102, "The most common cause of chronic pelvic pain in women of reproductive age is:",
["Ovarian cysts", "PID sequelae", "Endometriosis", "IBS"], 2),
(103, "Definitive diagnosis of endometriosis can ONLY be confirmed by:",
["CA-125 level", "MRI pelvis",
"Laparoscopy with histological confirmation", "Transvaginal ultrasound"], 2),
(104, "The Sampson theory of endometriosis proposes:",
["Lymphatic spread", "Haematogenous spread",
"Retrograde menstruation", "Coelomic metaplasia"], 2),
(105, "Danazol in endometriosis acts by creating a:",
["Pseudo-pregnancy state", "Pseudo-menopause state", "Hyperoestrogenic state", "Hyperandrogenic state"], 1),
(106, "Endometriosis is associated with which ovarian malignancies?",
["Serous carcinoma", "Mucinous carcinoma",
"Clear cell and endometrioid carcinoma", "Granulosa cell tumour"], 2),
(107, "Primary dysmenorrhoea is caused by:",
["Uterine fibroids", "Excess prostaglandin production",
"Progesterone deficiency", "Cervical stenosis"], 1),
(108, "NSAIDs treat dysmenorrhoea by:",
["Blocking prostaglandin synthesis", "Reducing GnRH secretion",
"Inhibiting uterine artery vasospasm", "Increasing progesterone levels"], 0),
(109, "The 'powder burn' or 'gunpowder' lesion on laparoscopy represents:",
["Early superficial endometriosis", "Peritoneal carcinomatosis",
"Pelvic TB", "Haemosiderin deposits from adhesions"], 0),
(110, "GnRH antagonists compared to GnRH agonists in endometriosis treatment:",
["Cause an initial flare effect", "Suppress the HPO axis without an initial flare",
"Are less effective", "Are only used in IVF"], 1),
]
},
{
"title": "SECTION 5: PCOS & Ovarian Disorders (Q111–140)",
"questions": [
(111, "Laparoscopic ovarian drilling in PCOS uses electrocautery or laser to treat:",
["Dominant follicles", "Ovarian microcysts", "Ovarian stroma only", "Corpus luteum"], 1),
(112, "In one series, laparoscopic ovarian drilling led to spontaneous ovulation in what percentage of PCOS patients?",
["50%", "60%", "73%", "90%"], 2),
(113, "After laparoscopic ovarian drilling, beneficial endocrinologic effects were sustained for up to:",
["3 years", "5 years", "7 years", "9 years"], 3),
(114, "Bilateral ovarian wedge resection is associated with a concerning complication of:",
["Ovarian hyperstimulation", "Periovarian adhesions",
"Premature uterine rupture", "Salpingitis"], 1),
(115, "Unilateral ovarian diathermy in PCOS results in:",
["Unilateral ovarian activity only", "Bilateral ovarian activity",
"Complete anovulation", "Premature ovarian failure"], 1),
(116, "The Rotterdam criteria for PCOS require the presence of at least 2 of which 3 features?",
["Oligomenorrhoea, hyperandrogenaemia, polycystic ovaries on USS",
"Oligomenorrhoea, elevated LH, insulin resistance",
"Hirsutism, elevated FSH, polycystic ovaries",
"Amenorrhoea, obesity, acanthosis nigricans"], 0),
(117, "Current first-line treatment for anovulatory infertility in PCOS (per NEJM 2014) is:",
["Gonadotrophins", "Letrozole", "GnRH agonist", "IVF"], 1),
(118, "The Legro et al. NEJM 2014 study showed that for PCOS-related infertility, letrozole was superior to clomiphene for:",
["Follicle number", "Live birth rates", "Cycle regularity", "Hyperandrogensim"], 1),
(119, "Metformin in PCOS acts primarily by:",
["Increasing FSH secretion", "Reducing insulin resistance",
"Blocking androgen receptors", "Inhibiting aromatase"], 1),
(120, "The classic LH:FSH ratio in PCOS is:",
["1:1", "Greater than 2:1", "1:2", "3:1 only"], 1),
(121, "Eflornithine cream for facial hair in PCOS must be continued:",
["For 2 weeks only", "Indefinitely while hair suppression is desired",
"Only until electrolysis is started", "For a maximum of 6 months"], 1),
(122, "Noticeable results from eflornithine cream take approximately:",
["2 weeks", "4 weeks", "6–8 weeks", "3 months"], 2),
(123, "After stopping eflornithine, hair returns to pretreatment levels in approximately:",
["2 weeks", "4 weeks", "8 weeks", "6 months"], 2),
(124, "Which physical method of hair removal does NOT change the quality or texture of hair?",
["Plucking", "Waxing", "Shaving", "Threading"], 2),
(125, "The duration of effect from waxing is up to:",
["1 week", "2 weeks", "4 weeks", "6 weeks"], 3),
(126, "Laparoscopic ovarian drilling reduces which two hormones while increasing which one?",
["Reduces LH and androgens; increases FSH",
"Reduces FSH and estrogen; increases LH",
"Reduces progesterone and FSH; increases LH",
"Reduces prolactin and androgens; increases FSH"], 0),
(127, "Polycystic ovaries on ultrasound are defined as:",
["More than 5 follicles per ovary",
"12 or more follicles per ovary (2–9 mm) or ovarian volume >10 mL",
"Ovarian volume greater than 5 mL",
"More than 20 follicles total"], 1),
(128, "Which is the most common endocrine disorder in women of reproductive age?",
["Hypothyroidism", "Hyperprolactinaemia", "PCOS", "Congenital adrenal hyperplasia"], 2),
(129, "Anti-androgenic properties are a feature of which contraceptive pill component?",
["Levonorgestrel", "Cyproterone acetate", "Norgestrel", "Norethindrone"], 1),
(130, "Insulin resistance in PCOS leads to compensatory hyperinsulinaemia which:",
["Suppresses LH", "Stimulates ovarian androgen production",
"Increases SHBG", "Reduces IGF-1"], 1),
(131, "Acanthosis nigricans in PCOS indicates:",
["Progesterone deficiency", "Insulin resistance", "Thyroid dysfunction", "Adrenal insufficiency"], 1),
(132, "Ovarian hyperstimulation syndrome (OHSS) is most severe with:",
["Clomiphene ovulation induction",
"Gonadotropin stimulation followed by hCG trigger",
"Natural cycle IVF", "Letrozole induction"], 1),
(133, "The gold standard for PCOS diagnosis is:",
["Elevated testosterone", "Pelvic ultrasound",
"Clinical + biochemical + ultrasound assessment (Rotterdam criteria)", "Elevated AMH alone"], 2),
(134, "PCOS is associated with increased long-term risk of:",
["Ovarian cancer", "Endometrial cancer", "Cervical cancer", "Vulvar cancer"], 1),
(135, "The mechanism of hirsutism in PCOS involves:",
["Elevated FSH stimulating hair follicles",
"Excess androgens (especially testosterone and DHEAS)",
"Elevated prolactin", "Thyroid hormone excess"], 1),
(136, "The Ferriman-Gallwey score is used to assess:",
["Acne severity", "Degree of hirsutism", "Insulin resistance", "Ovarian volume"], 1),
(137, "A Ferriman-Gallwey score of >= how much indicates hirsutism?",
["4", "6", "8", "10"], 2),
(138, "Spironolactone treats hirsutism by:",
["Reducing LH", "Blocking androgen receptors and inhibiting 5-alpha reductase",
"Increasing SHBG", "Suppressing adrenal androgens"], 1),
(139, "Finasteride treats hirsutism by:",
["Blocking androgen receptors", "Inhibiting 5-alpha reductase",
"Reducing GnRH", "Increasing SHBG"], 1),
(140, "Clomiphene citrate is classified as a:",
["Aromatase inhibitor", "Gonadotropin",
"Selective estrogen receptor modulator", "GnRH analogue"], 2),
]
},
{
"title": "SECTION 6: Urogynecology & Urinary Incontinence (Q141–165)",
"questions": [
(141, "Detrusor overactivity with no identifiable cause was previously called:",
["Detrusor hyperreflexia", "Genuine stress incontinence",
"Detrusor instability", "Urge incontinence"], 2),
(142, "Neurogenic detrusor overactivity was previously called:",
["Detrusor instability", "Genuine stress incontinence",
"Detrusor hyperreflexia", "Overflow incontinence"], 2),
(143, "Urodynamic stress incontinence replaces the old term:",
["Detrusor hyperreflexia", "Genuine stress incontinence",
"Urge incontinence", "Detrusor instability"], 1),
(144, "Terminal detrusor overactivity results in:",
["Intermittent leakage", "A single involuntary contraction leading to bladder emptying",
"Normal voiding", "Overflow incontinence"], 1),
(145, "Bladder compliance is calculated as:",
["Bladder pressure / volume", "Fill volume / change in detrusor pressure",
"Urethral pressure / bladder pressure", "Volume voided / residual urine"], 1),
(146, "Maximum cystometric capacity is:",
["Volume at which detrusor first contracts",
"Volume at which the person can no longer delay voiding",
"Post-void residual volume", "Volume at first desire to void"], 1),
(147, "Urethral closure pressure is calculated as:",
["Urethral pressure minus vesical pressure", "Vesical pressure minus urethral pressure",
"Abdominal pressure minus vesical pressure", "Urethral pressure plus vesical pressure"], 0),
(148, "The most common type of urinary incontinence in women is:",
["Overflow incontinence", "Urge incontinence",
"Stress incontinence", "Functional incontinence"], 2),
(149, "Stress urinary incontinence is defined as involuntary leakage on:",
["Urgency alone", "Increased abdominal pressure without detrusor contraction",
"Detrusor overactivity", "Bladder filling"], 1),
(150, "The first-line treatment for stress urinary incontinence is:",
["Surgical sling", "Anticholinergics",
"Pelvic floor muscle training", "Beta-3 agonists"], 2),
(151, "The tension-free vaginal tape (TVT) is a:",
["Retropubic mid-urethral sling", "Colposuspension",
"Pubovaginal sling", "Transobturator sling"], 0),
(152, "Detrusor overactivity is best treated with:",
["Pelvic floor exercises", "Mid-urethral sling",
"Anticholinergic medications", "Colposuspension"], 2),
(153, "The beta-3 adrenoceptor agonist used for overactive bladder is:",
["Tolterodine", "Solifenacin", "Mirabegron", "Oxybutynin"], 2),
(154, "Pelvic organ prolapse staging uses which grading system?",
["FIGO staging", "POP-Q system",
"Baden-Walker half-way system", "AUA scoring"], 1),
(155, "Cystocele refers to prolapse of:",
["Uterus", "Bladder", "Rectum", "Small bowel"], 1),
(156, "Rectocele refers to prolapse of:",
["Bladder", "Uterus", "Rectum into the posterior vaginal wall", "Small bowel"], 2),
(157, "Enterocele involves prolapse of:",
["Bladder", "Uterus", "Rectum", "Small intestine into the vaginal vault"], 3),
(158, "The most common cause of pelvic organ prolapse is:",
["Chronic cough", "Childbirth trauma", "Constipation", "Oestrogen deficiency"], 1),
(159, "Urge incontinence is primarily managed with:",
["Surgical repair", "Bladder training and anticholinergics",
"Mid-urethral sling", "Colposuspension"], 1),
(160, "Valsalva leak point pressure (VLPP) < 60 cmH2O indicates:",
["Detrusor overactivity", "Intrinsic sphincter deficiency",
"Normal urethral function", "Overflow incontinence"], 1),
(161, "Urethral relaxation incontinence involves leakage due to:",
["Detrusor overactivity", "Raised abdominal pressure",
"Urethral relaxation in the absence of raised abdominal pressure or detrusor activity",
"Neurogenic causes"], 2),
(162, "During normal bladder filling, there should be:",
["A gradual rise in detrusor pressure", "Involuntary phasic contractions",
"Little or no change in detrusor pressure", "Early first sensation at 50 mL"], 2),
(163, "The Burch colposuspension is a surgical treatment for:",
["Detrusor overactivity", "Stress urinary incontinence", "Enterocele", "Rectocele"], 1),
(164, "Oxybutynin for overactive bladder acts by:",
["Beta-3 agonism", "Muscarinic receptor blockade",
"Alpha-1 adrenoceptor antagonism", "Calcium channel blockade"], 1),
(165, "Duloxetine is used for stress urinary incontinence; it works by:",
["Blocking cholinergic receptors in the bladder",
"Increasing pudendal nerve activity via serotonin/noradrenaline reuptake inhibition",
"Relaxing the detrusor muscle", "Increasing urethral compliance"], 1),
]
},
{
"title": "SECTION 7: Early Pregnancy Loss & Ectopic Pregnancy (Q166–190)",
"questions": [
(166, "Spontaneous abortion is defined as termination of pregnancy before:",
["12 weeks", "16 weeks", "20 weeks", "24 weeks"], 2),
(167, "What percentage of known pregnancies end in spontaneous abortion?",
["2–5%", "8–20%", "25–30%", "35–40%"], 1),
(168, "What percentage of spontaneous losses occur in the first trimester?",
["50%", "65%", "80%", "95%"], 2),
(169, "Missed abortion is defined as a non-viable intrauterine pregnancy with:",
["Open cervix and heavy bleeding", "Closed cervix and minimal symptoms",
"Ruptured membranes", "Fever and uterine tenderness"], 1),
(170, "The key diagnostic tool for missed abortion is:",
["Serum hCG", "Serum progesterone", "Transvaginal ultrasound", "MRI pelvis"], 2),
(171, "In women with one prior spontaneous abortion, the rate of recurrence in a subsequent pregnancy is:",
["5–10%", "13–20%", "25–30%", "33–43%"], 1),
(172, "In women with THREE consecutive losses, the rate of recurrence is:",
["13–20%", "20–25%", "33–43%", "50–60%"], 2),
(173, "For women over 40, the risk of spontaneous abortion may approach:",
["10%", "20%", "30%", "50%"], 2),
(174, "Maternal age is described as which type of risk factor for miscarriage?",
["Threshold effect", "All-or-none effect", "Dose-dependent", "J-shaped relationship"], 2),
(175, "Risk factors for spontaneous abortion include all EXCEPT:",
["Increasing maternal age", "Maternal smoking", "Maternal diabetes", "Multiparity"], 3),
(176, "Pregnancies closely spaced (less than how many months) increase the risk of spontaneous abortion?",
["1–2 months", "3–6 months", "6–9 months", "9–12 months"], 1),
(177, "Which is the most common chromosomal abnormality in first-trimester spontaneous abortions?",
["Monosomy 45,X", "Autosomal trisomy", "Polyploidy", "Structural chromosome anomaly"], 1),
(178, "Beta-hCG combined with TVUS and serum progesterone can diagnose ectopic pregnancy:",
["Only after rupture", "Usually allowing medical therapy without laparoscopic confirmation",
"Only with laparoscopy", "Only with serial beta-hCG measurements"], 1),
(179, "The medical treatment of choice for ectopic pregnancy is:",
["Mifepristone", "Misoprostol", "Methotrexate", "Danazol"], 2),
(180, "Methotrexate for ectopic pregnancy is typically contraindicated with beta-hCG levels above:",
["1,000 IU/L", "3,000 IU/L", "5,000 IU/L", "10,000 IU/L"], 2),
(181, "Antiphospholipid syndrome is a treatable cause of:",
["Primary infertility", "Recurrent spontaneous abortion",
"PCOS", "Premature ovarian failure"], 1),
(182, "Treatment of antiphospholipid syndrome in pregnancy involves:",
["Metformin", "Steroids only", "Low-dose aspirin and heparin", "Progesterone supplements alone"], 2),
(183, "Threatened abortion is characterised by:",
["Open cervix with bleeding", "Closed cervix with bleeding and viable pregnancy",
"No fetal cardiac activity on ultrasound", "Passage of products of conception"], 1),
(184, "Complete abortion means:",
["Partial passage of products", "All products of conception have been expelled",
"Cervix still closed", "Requires surgical evacuation"], 1),
(185, "Incomplete abortion is managed by:",
["Expectant management only", "Surgical evacuation or misoprostol",
"IV antibiotics alone", "Progesterone supplementation"], 1),
(186, "The most common site for ectopic implantation is:",
["Ovary", "Cervix", "Fallopian tube (ampullary)", "Abdominal cavity"], 2),
(187, "Septic abortion requires immediate:",
["Expectant management", "IV antibiotics and evacuation",
"Laparoscopy", "Hysterectomy"], 1),
(188, "The Doppler finding most associated with ectopic pregnancy on TVUS is:",
["Ring of fire sign", "Double decidual sign", "Intradecidual sign", "Yolk sac"], 0),
(189, "hCG should rise by at least what percentage every 48 hours in a viable intrauterine pregnancy?",
["25%", "53%", "66%", "100%"], 1),
(190, "Molar pregnancy (hydatidiform mole) is characterised by:",
["Normal trophoblast", "Abnormal proliferation of trophoblastic tissue with elevated hCG",
"Low hCG", "Normal karyotype only"], 1),
]
},
{
"title": "SECTION 8: Gynaecological Oncology (Q191–225)",
"questions": [
(191, "Most serous ovarian carcinomas are now believed to originate from:",
["The ovarian surface epithelium", "Ovarian inclusion cysts",
"The fallopian tube", "The peritoneum"], 2),
(192, "Clear cell and endometrioid ovarian carcinomas are derived from:",
["Fallopian tube epithelium", "Ovarian surface", "Endometriosis", "Mucinous cysts"], 2),
(193, "BRCA mutations are associated with risk-reducing surgery including:",
["Bilateral salpingo-oophorectomy", "Hysterectomy alone",
"Total pelvic exenteration", "Oophorectomy only"], 0),
(194, "The most common histological type of epithelial ovarian cancer is:",
["Mucinous", "Endometrioid", "Clear cell", "Serous"], 3),
(195, "Brenner tumour of the ovary is composed of what cell type?",
["Serous epithelium", "Mucinous epithelium", "Transitional epithelium", "Squamous epithelium"], 2),
(196, "The staging system for ovarian cancer is:",
["TNM only", "FIGO", "Ann Arbor", "Dukes"], 1),
(197, "In FIGO stage I ovarian cancer, the tumour is:",
["Confined to the ovary/ovaries", "Beyond the ovaries but within the pelvis",
"With peritoneal metastases", "With distant metastases"], 0),
(198, "CA-125 is elevated in which type of ovarian cancer?",
["Mucinous", "Germ cell", "Serous", "Brenner"], 2),
(199, "First-line chemotherapy for epithelial ovarian cancer is:",
["Cyclophosphamide and doxorubicin", "Carboplatin and paclitaxel",
"Cisplatin and bleomycin", "Etoposide and methotrexate"], 1),
(200, "The 5-year survival rate for stage I epithelial ovarian cancer is approximately:",
["30%", "50%", "70%", "90%"], 3),
(201, "The most common gynaecological malignancy worldwide is:",
["Ovarian cancer", "Endometrial cancer", "Cervical cancer", "Vulvar cancer"], 1),
(202, "The most common type of endometrial cancer is:",
["Sarcoma", "Adenocarcinoma (endometrioid type)",
"Clear cell carcinoma", "Squamous cell carcinoma"], 1),
(203, "Risk factors for endometrial cancer include all EXCEPT:",
["Obesity", "Unopposed oestrogen", "PCOS", "Multiparity"], 3),
(204, "Lynch syndrome (HNPCC) is associated with increased risk of:",
["Ovarian and serous endometrial cancer", "Endometrial and colorectal cancer",
"Cervical and vulvar cancer", "Breast and ovarian cancer"], 1),
(205, "The most common presenting symptom of endometrial cancer is:",
["Pelvic pain", "Postmenopausal bleeding", "Vaginal discharge", "Weight loss"], 1),
(206, "Primary treatment of endometrial cancer is:",
["Radiotherapy", "Chemotherapy",
"Total hysterectomy and bilateral salpingo-oophorectomy", "Hormone therapy"], 2),
(207, "Cervical cancer is most commonly caused by:",
["Herpes simplex virus", "Human papillomavirus (HPV)",
"Chlamydia trachomatis", "Epstein-Barr virus"], 1),
(208, "The HPV subtypes most commonly associated with cervical cancer are:",
["6 and 11", "16 and 18", "31 and 33", "45 and 52"], 1),
(209, "HPV 6 and 11 are associated with:",
["Cervical cancer", "Vulvar cancer",
"Genital warts (condyloma acuminata)", "CIN 3"], 2),
(210, "Cervical intraepithelial neoplasia (CIN) is graded:",
["I to III", "I to IV", "A to D", "Stage 0 to III"], 0),
(211, "The transformation zone is the area between:",
["The ectocervix and endocervix",
"The original and new squamocolumnar junction",
"The external os and internal os",
"The vaginal epithelium and cervix"], 1),
(212, "FIGO stage IB1 cervical cancer involves:",
["Tumour confined to cervix, visible, <=4 cm", "Invasion beyond uterus",
"Extension to pelvic sidewall", "Bladder involvement"], 0),
(213, "Vulvar cancer most commonly affects:",
["Young women", "Women in their 4th decade",
"Postmenopausal women", "Adolescents"], 2),
(214, "The most common histological type of vulvar cancer is:",
["Adenocarcinoma", "Melanoma", "Squamous cell carcinoma", "Basal cell carcinoma"], 2),
(215, "Lichen sclerosus of the vulva is a risk factor for:",
["Bartholin's cyst", "Vulvar intraepithelial neoplasia and squamous cell carcinoma",
"Vaginal candidiasis", "Paget's disease only"], 1),
(216, "Borderline ovarian tumours differ from malignant tumours in that they:",
["Have higher mitotic rates", "Are always bilateral",
"Lack stromal invasion", "Always require chemotherapy"], 2),
(217, "Fallopian tube carcinoma classically presents with:",
["Hydrops tubae profluens (watery vaginal discharge)", "Haematuria",
"Postcoital bleeding", "Lower abdominal mass"], 0),
(218, "The tumour marker CA-19.9 is associated with which ovarian cancer type?",
["Serous", "Mucinous", "Endometrioid", "Clear cell"], 1),
(219, "Alpha-fetoprotein (AFP) is elevated in which ovarian germ cell tumour?",
["Dysgerminoma", "Mature teratoma", "Yolk sac tumour", "Granulosa cell tumour"], 2),
(220, "Inhibin is a tumour marker for which ovarian tumour?",
["Dysgerminoma", "Serous carcinoma", "Granulosa cell tumour", "Brenner tumour"], 2),
(221, "LDH is a tumour marker elevated in:",
["Granulosa cell tumour", "Yolk sac tumour", "Dysgerminoma", "Serous carcinoma"], 2),
(222, "Treatment of choice for FIGO Stage IA/IB granulosa cell tumour in a young woman wishing fertility is:",
["Bilateral salpingo-oophorectomy", "Hysterectomy and BSO",
"Unilateral salpingo-oophorectomy", "Chemotherapy alone"], 2),
(223, "Meig's syndrome consists of:",
["Ascites, hydrothorax, and ovarian fibroma", "Ascites, hydrothorax, and serous carcinoma",
"Pleural effusion and granulosa cell tumour", "Pseudomyxoma peritonei and mucinous tumour"], 0),
(224, "Pseudomyxoma peritonei is most commonly associated with:",
["Serous borderline tumour", "Mucinous appendiceal/ovarian tumour",
"Endometrioid carcinoma", "Brenner tumour"], 1),
(225, "Which chemotherapy agent is associated with neurotoxicity in ovarian cancer treatment?",
["Carboplatin", "Paclitaxel", "Cyclophosphamide", "Doxorubicin"], 1),
]
},
{
"title": "SECTION 9: Menopause, HRT & Sexual Dysfunction (Q226–250)",
"questions": [
(226, "Menopause is defined as cessation of menstruation for at least:",
["6 months", "12 months", "18 months", "24 months"], 1),
(227, "The average age of natural menopause in Western women is approximately:",
["45 years", "51 years", "55 years", "58 years"], 1),
(228, "Premature ovarian insufficiency (POI) is defined as ovarian failure before age:",
["30 years", "35 years", "40 years", "45 years"], 2),
(229, "The most common vasomotor symptom of menopause is:",
["Night sweats", "Hot flushes", "Palpitations", "Insomnia"], 1),
(230, "Atrophic vaginitis in menopause is primarily due to:",
["Progesterone deficiency", "Oestrogen deficiency",
"Testosterone deficiency", "FSH elevation"], 1),
(231, "SSRIs may ameliorate which menopausal symptom?",
["Vaginal dryness", "Hot flushes", "Osteoporosis", "Urinary incontinence"], 1),
(232, "Which group attempts suicide more frequently but completes it less often?",
["Men", "Women", "Adolescents", "Elderly patients"], 1),
(233, "Pseudodementia in elderly patients is caused by:",
["Alzheimer's disease", "Depression", "Hypothyroidism", "B12 deficiency"], 1),
(234, "Which of the following is a risk factor for suicide in a gynaecological patient?",
["Nulliparity", "Previous suicide attempts", "Menorrhagia", "Chronic pelvic pain alone"], 1),
(235, "Sexual interest and arousal disorder (SIAD) is best initially addressed by:",
["Testosterone therapy", "Constructing the woman's own sex response cycle",
"PDE5 inhibitors", "Antidepressant therapy"], 1),
(236, "CBT for low sexual desire in women shows which effect size on sexual desire?",
["Small", "Moderate", "Large", "No significant effect"], 2),
(237, "Including the male partner in CBT for female low desire leads to:",
["Worse outcome", "No difference", "Better outcome", "Higher dropout rates"], 2),
(238, "Hormone replacement therapy (HRT) in menopause reduces risk of:",
["Breast cancer", "Endometrial cancer (combined HRT)", "Osteoporosis", "Ovarian cancer"], 2),
(239, "Women taking oestrogen-only HRT (without progestogen) are at increased risk of:",
["Osteoporosis", "Endometrial cancer", "Ovarian cancer", "Premature ovarian failure"], 1),
(240, "The Women's Health Initiative (WHI) trial found that combined HRT was associated with increased risk of:",
["Colorectal cancer", "Hip fracture", "Breast cancer", "Osteoporosis"], 2),
(241, "Genitourinary syndrome of menopause (GSM) includes:",
["Urinary symptoms and vaginal atrophy", "Vasomotor symptoms and depression",
"Mood changes and insomnia", "Cardiovascular disease and diabetes"], 0),
(242, "Tibolone in HRT has which pharmacological properties?",
["Pure oestrogen activity", "Oestrogenic, progestogenic, and androgenic activity",
"Anti-androgenic activity", "Only progestogenic activity"], 1),
(243, "The 'window of opportunity' for cardioprotective effects of HRT suggests initiating therapy:",
["After 10 years of menopause", "Within 10 years of menopause or before age 60",
"Only before menopause", "At any time regardless of age"], 1),
(244, "Bone mineral density (BMD) loss is most rapid in the:",
["5 years before menopause", "First 5–10 years after menopause",
"Decade after age 60", "Premenopausal years"], 1),
(245, "T-score of less than -2.5 on DEXA scan indicates:",
["Normal bone density", "Osteopenia", "Osteoporosis", "Severe osteoporosis"], 2),
(246, "Bisphosphonates prevent osteoporosis by:",
["Stimulating osteoblasts", "Inhibiting osteoclast activity",
"Increasing calcium absorption", "Increasing PTH activity"], 1),
(247, "Which non-hormonal therapy is approved for vasomotor symptoms in women contraindicated for HRT?",
["Clonidine or SSRIs/SNRIs", "Tibolone",
"Progesterone-only therapy", "Testosterone"], 0),
(248, "Depression in menopausal women is associated with all EXCEPT:",
["Prior PMS", "History of postpartum depression",
"'Empty nest syndrome' (validated as a common cause)", "Return of adult children to the maternal home"], 2),
(249, "Patients with depression at menopause should be assessed for:",
["Fibroid uterus", "Domestic abuse", "Tubal patency", "Cervical disease"], 1),
(250, "Which class of antidepressant has the best evidence for treating depression across the lifespan including menopause?",
["MAOIs", "Tricyclic antidepressants", "SSRIs", "Antipsychotics"], 2),
]
},
]
OPTION_LETTERS = ["A", "B", "C", "D"]
# ── Build flowable elements ──────────────────────────────────────────────────
story = []
# Cover page
story.append(Spacer(1, 1.5*cm))
story.append(Paragraph("250 MCQs in Gynaecology", title_style))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Source: Berek & Novak's Gynecology", subtitle_style))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph("Comprehensive Review — All Core Topics", subtitle_style))
story.append(Spacer(1, 0.5*cm))
story.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor('#1a3c6e')))
story.append(Spacer(1, 0.4*cm))
# Table of contents summary
toc_data = [["Section", "Topic", "Questions"]]
for s in sections:
title_text = s["title"]
# Extract section number and topic from title
parts = title_text.split(":")
sec_num = parts[0].strip().replace("SECTION ", "")
rest = parts[1].strip() if len(parts) > 1 else ""
topic_part = rest.split("(")[0].strip()
q_range = rest.split("(")[1].replace(")", "").strip() if "(" in rest else ""
toc_data.append([sec_num, topic_part, q_range])
toc_table = Table(toc_data, colWidths=[2*cm, 12*cm, 3*cm])
toc_table.setStyle(TableStyle([
('BACKGROUND', (0, 0), (-1, 0), colors.HexColor('#1a3c6e')),
('TEXTCOLOR', (0, 0), (-1, 0), colors.white),
('FONTNAME', (0, 0), (-1, 0), 'Helvetica-Bold'),
('FONTSIZE', (0, 0), (-1, 0), 10),
('ALIGN', (0, 0), (-1, -1), 'LEFT'),
('FONTNAME', (0, 1), (-1, -1), 'Helvetica'),
('FONTSIZE', (0, 1), (-1, -1), 9),
('ROWBACKGROUNDS', (0, 1), (-1, -1), [colors.HexColor('#f0f4fa'), colors.white]),
('GRID', (0, 0), (-1, -1), 0.5, colors.HexColor('#cccccc')),
('TOPPADDING', (0, 0), (-1, -1), 4),
('BOTTOMPADDING', (0, 0), (-1, -1), 4),
('LEFTPADDING', (0, 0), (-1, -1), 6),
]))
story.append(toc_table)
story.append(Spacer(1, 0.5*cm))
story.append(Paragraph(
"<i>Correct answers are shown in green. Each question has exactly one correct answer.</i>",
ParagraphStyle('note', parent=styles['Normal'], fontSize=9, textColor=colors.HexColor('#555555'),
alignment=TA_CENTER)
))
story.append(PageBreak())
# Questions
for section in sections:
story.append(Paragraph(" " + section["title"] + " ", section_style))
story.append(Spacer(1, 0.2*cm))
for (num, question, options, correct_idx) in section["questions"]:
story.append(Paragraph(f"Q{num}. {question}", question_style))
for i, opt in enumerate(options):
letter = OPTION_LETTERS[i]
text = f"{letter}) {opt}"
if i == correct_idx:
story.append(Paragraph(f"✓ {text}", answer_style))
else:
story.append(Paragraph(text, option_style))
story.append(Spacer(1, 0.15*cm))
story.append(Spacer(1, 0.3*cm))
# Build PDF
doc.build(story)
print(f"PDF created: {OUTPUT}")
Running Command
cd /home/daytona/workspace/gynaecology-mcqs && python generate_mcq_pdf.py 2>&1
Running Command
ls -lh /home/daytona/workspace/gynaecology-mcqs/Gynaecology_250_MCQs.pdf
Your PDF is ready! Here's the download link:
Gynaecology 250 MCQs
PDF Document · PDF
What's included in the PDF:
- A cover page with a contents table showing all 9 sections and question ranges
- All 250 MCQs with 4 options each
- Correct answers highlighted in green with a ✓ tick
- Clean A4 formatting with section headers in navy blue
- Sections cover: Reproductive Physiology, Contraception, Fibroids, Endometriosis, PCOS, Urogynecology, Early Pregnancy Loss, Gynaecological Oncology, and Menopause/HRT
This is the pdf of ten teachers
Reading File
Running Command
python3 -c " from pypdf import PdfReader pdf_path = '/home/daytona/workspace/att…
Running Command
python3 -c " from pypdf import PdfReader pdf_path = '/home/daytona/workspace/att…
Running Command
python3 << 'EOF' from pypdf import PdfReader pdf_path = '/home/daytona/workspace…
Running Command
python3 << 'EOF' from pypdf import PdfReader pdf_path = '/home/daytona/workspace…
Reading File
Reading File
Reading File
Reading File
Reading File
Reading File
Reading File
Reading File
Reading File
Writing File
~/gynaecology-mcqs/generate_ten_teachers_mcqs.py
from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, HRFlowable, PageBreak, Table, TableStyle
from reportlab.lib.enums import TA_LEFT, TA_CENTER
OUTPUT = "/home/daytona/workspace/gynaecology-mcqs/Ten_Teachers_Gynaecology_250_MCQs.pdf"
doc = SimpleDocTemplate(
OUTPUT, pagesize=A4,
rightMargin=2*cm, leftMargin=2*cm,
topMargin=2*cm, bottomMargin=2*cm,
title="250 MCQs – Gynaecology by Ten Teachers 20th Edition",
author="Ten Teachers"
)
styles = getSampleStyleSheet()
title_style = ParagraphStyle('T', parent=styles['Title'], fontSize=20,
textColor=colors.HexColor('#1a3c6e'), spaceAfter=6, alignment=TA_CENTER, fontName='Helvetica-Bold')
sub_style = ParagraphStyle('S', parent=styles['Normal'], fontSize=10,
textColor=colors.HexColor('#555555'), spaceAfter=4, alignment=TA_CENTER, fontName='Helvetica')
sec_style = ParagraphStyle('Sec', parent=styles['Heading1'], fontSize=12,
textColor=colors.white, backColor=colors.HexColor('#1a3c6e'),
spaceBefore=12, spaceAfter=5, leftIndent=-0.3*cm, rightIndent=-0.3*cm,
leading=17, fontName='Helvetica-Bold')
q_style = ParagraphStyle('Q', parent=styles['Normal'], fontSize=10,
textColor=colors.HexColor('#1a1a1a'), spaceBefore=9, spaceAfter=2,
fontName='Helvetica-Bold', leading=14)
opt_style = ParagraphStyle('Opt', parent=styles['Normal'], fontSize=9.5,
textColor=colors.HexColor('#333333'), spaceBefore=1, spaceAfter=1,
leftIndent=0.5*cm, fontName='Helvetica', leading=13)
ans_style = ParagraphStyle('Ans', parent=styles['Normal'], fontSize=9.5,
textColor=colors.HexColor('#006400'), spaceBefore=1, spaceAfter=1,
leftIndent=0.5*cm, fontName='Helvetica-Bold', leading=13)
note_style = ParagraphStyle('Note', parent=styles['Normal'], fontSize=8.5,
textColor=colors.HexColor('#666666'), alignment=TA_CENTER)
LETTERS = ["A", "B", "C", "D"]
# ──────────────────────────────────────────────────────────────────────────────
# 250 MCQs from Gynaecology by Ten Teachers 20th Edition
# Format: (q_number, question, [A,B,C,D], correct_0based_index)
# ──────────────────────────────────────────────────────────────────────────────
sections = [
# ── CHAPTER 1: Anatomy & Development ─────────────────────────────────────────
{
"title": "Ch.1 – Development & Anatomy of the Female Genital Organs (Q1–20)",
"qs": [
(1, "At which week of embryonic life is the primitive gonad first evident?",
["3 weeks","5 weeks","7 weeks","9 weeks"], 1),
(2, "The primitive gonad forms on the medial aspect of which ridge?",
["Genital ridge","Mesonephric ridge","Metanephric ridge","Wolffian ridge"], 1),
(3, "The paramesonephric duct is the precursor of which female structure?",
["The bladder","The Müllerian system","The Wolffian system","The urethra"], 1),
(4, "Fusion of the lower ends of the Müllerian ducts forms which structures?",
["Fallopian tubes only","Uterus and upper vagina","Vaginal plate only","Ovaries"], 1),
(5, "The lower vagina is formed from which embryonic structure?",
["Müllerian ducts","Wolffian ducts","Sinovaginal bulbs","Urogenital sinus directly"], 2),
(6, "The vaginal plate begins to canalize starting at which structure?",
["Cervix, proceeding downward","Hymen, proceeding upwards to cervix","Fornix","Müllerian tubercle"], 1),
(7, "In the female, testicular AMH is absent. This allows which structures to develop?",
["Wolffian (mesonephric) ducts","Müllerian (paramesonephric) ducts","Both Müllerian and Wolffian","Neither"], 1),
(8, "The genital tubercle develops into which structure in the female?",
["Labia majora","Labia minora","Clitoris","Vaginal vestibule"], 2),
(9, "The labioscrotal folds eventually become which structure in the female?",
["Labia minora","Labia majora","Clitoris","Vestibule"], 1),
(10, "External female genitalia are recognizably female by the end of which embryonic week?",
["8th week","10th week","12th week","16th week"], 2),
(11, "The broad ligament is described in Ten Teachers as:",
["A true ligament supporting the uterus","A peritoneal fold that does not support the uterus",
"A fibromuscular band","A fascial condensation"], 1),
(12, "The Fallopian tube runs in which part of the broad ligament?",
["Lower free edge","Upper free edge","Posterior layer only","Between the layers only"], 1),
(13, "The infundibulopelvic fold contains which important structures?",
["Ureter and bladder vessels","Ovarian vessels and nerves","Uterine vessels","Round ligament"], 1),
(14, "The parametrium is loose connective tissue found where?",
["Above the ovary in the mesosalpinx","In the base of the broad ligament below the ovary",
"Between the vaginal walls","In the pelvic floor muscles"], 1),
(15, "The ureter is attached to which layer of the broad ligament?",
["Anterior leaf","Posterior leaf","Upper free edge","Mesosalpinx"], 1),
(16, "The ovarian ligament passes from which structure to which structure?",
["Ovarian hilum to the pelvic sidewall","Medial pole of ovary to the uterus just below the Fallopian tube entry",
"Ovary to the round ligament","Lateral pole of ovary to the infundibulopelvic ligament"], 1),
(17, "The round ligament ends in which structure?",
["Posterior vaginal wall","Subcutaneous tissue of the labium majus",
"Perineal body","Pelvic sidewall"], 1),
(18, "The perineal body lies between which two structures?",
["Urethra and vagina","Anal canal and lower third of the vagina",
"Vagina and rectum at mid-level","Bladder and vagina"], 1),
(19, "Primordial follicles in the ovary arrest at which stage?",
["Prophase of meiosis I","Metaphase I","Metaphase II","Interphase"], 0),
(20, "The pelvic ureter is at risk during which gynaecological procedure, passing close to the uterine artery?",
["Salpingectomy","Hysterectomy at the level of the uterine artery",
"Ovarian cystectomy","Laparoscopic myomectomy"], 1),
]},
# ── CHAPTER 2: History, Examination & Investigations ─────────────────────────
{
"title": "Ch.2 – Gynaecological History, Examination & Investigations (Q21–35)",
"qs": [
(21, "A Sims speculum is used in the examination of the incontinent woman to assess:",
["The cervix","Each vaginal wall for prolapse","The uterus bimanually","The adnexae"], 1),
(22, "In the assessment of urinary incontinence, a bladder diary should ideally be completed for how many days?",
["1 day","3 days","7 days","14 days"], 1),
(23, "A pad test objectively measures incontinence by:",
["Recording the number of leakage episodes","Measuring the weight change in preweighed pads",
"Measuring urine flow rate","Cystoscopic assessment"], 1),
(24, "The 24-hour home pad test is described in Ten Teachers as:",
["Not reliable","Reliable and reproducible","Only useful in stress incontinence","Contraindicated in elderly"], 1),
(25, "Which cervical cytology technique is currently used in most UK centres?",
["Conventional Papanicolaou smear","Liquid-based cytology (LBC)","HPV colposcopy directly","Endocervical brush alone"], 1),
(26, "A transvaginal ultrasound (TVUSS) with an empty uterus and adnexal mass has what sensitivity and specificity for ectopic pregnancy?",
["Sensitivity 75%, specificity 80%","Sensitivity 90%, specificity 95%",
"Sensitivity 95%, specificity 90%","Sensitivity 60%, specificity 70%"], 1),
(27, "In up to what percentage of women with ectopic pregnancy is the diagnosis not made on first attendance?",
["10%","20%","40%","60%"], 2),
(28, "A 'pregnancy of unknown location' (PUL) is defined as:",
["An ectopic pregnancy confirmed on scan","An empty uterus with no adnexal mass on TVUSS in a patient with positive pregnancy test",
"A missed abortion","A heterotopic pregnancy"], 1),
(29, "The mainstay of investigation of a pregnancy of unknown location (PUL) is:",
["Serial TVUSS","Consecutive serum hCG measurements","Laparoscopy","MRI pelvis"], 1),
(30, "A serum hCG that almost doubles every 48 hours is characteristic of:",
["Ectopic pregnancy","Normally developing intrauterine pregnancy",
"Molar pregnancy","Missed abortion"], 1),
(31, "Which investigation is indicated in women over 45 with heavy menstrual bleeding according to NICE guidelines (Ten Teachers)?",
["Thyroid function tests","Hormonal profile","Serum ferritin","Endometrial biopsy (EB)"], 3),
(32, "The Sims speculum examination is performed with the patient in which position?",
["Supine","Left lateral","Lithotomy","Standing"], 1),
(33, "In assessing pelvic floor, the examiner should assess the patient's ability to:",
["Valsalva only","Contract and hold the contraction of pelvic floor muscles",
"Perform Kegel exercises during cystometry","Perform a heel raise"], 1),
(34, "Colposcopy is indicated after cervical screening when:",
["Any abnormal cytology","High-grade dyskaryosis or persistent low-grade changes or HPV positive with borderline changes",
"HPV negative only","Postcoital bleeding without cytology"], 1),
(35, "A gynaecology teaching associate (GTA) is used in teaching:",
["Laparoscopic skills","Pelvic examination skills","Colposcopy","Hysteroscopy"], 1),
]},
# ── CHAPTER 3: Hormonal Control & Hormonal Disorders ─────────────────────────
{
"title": "Ch.3 – Hormonal Control of the Menstrual Cycle & Hormonal Disorders (Q36–55)",
"qs": [
(36, "GnRH is released from the hypothalamus and acts on the anterior pituitary to stimulate release of:",
["Prolactin and TSH","LH and FSH","ACTH and GH","LH only"], 1),
(37, "The pulse frequency of GnRH determines:",
["The size of the dominant follicle","The relative proportions of LH and FSH secreted",
"The duration of the luteal phase","The thickness of the endometrium"], 1),
(38, "The LH surge triggers:",
["Follicular development","Ovulation","Luteolysis","Endometrial shedding"], 1),
(39, "Progesterone produced by the corpus luteum is responsible for which endometrial change?",
["Proliferative phase changes","Secretory phase changes","Menstruation","Decidualisation only in pregnancy"], 1),
(40, "Premenstrual syndrome (PMS) is defined as:",
["Symptoms occurring only during menstruation","Physical and psychological symptoms in the luteal phase that resolve with menstruation",
"Irregular cycles with premenstrual spotting","FSH elevation before menstruation"], 1),
(41, "The most common cause of hyperprolactinaemia is:",
["Pregnancy","Prolactinoma","Hypothyroidism","Drug-induced (dopamine antagonists)"], 3),
(42, "Polycystic ovary syndrome (PCOS) is characterised by the Rotterdam criteria which require 2 of 3 features. These are:",
["Oligomenorrhoea, hyperandrogenaemia, polycystic ovarian morphology on USS",
"Oligomenorrhoea, elevated LH, insulin resistance",
"Hirsutism, obesity, elevated FSH",
"Amenorrhoea, acanthosis nigricans, elevated AMH only"], 0),
(43, "Which is the most appropriate first-line investigation for suspected PCOS?",
["LH:FSH ratio only","Pelvic USS and testosterone/SHBG/LH/FSH","Fasting glucose alone","AMH only"], 1),
(44, "Congenital adrenal hyperplasia (CAH) causing virilisation most commonly results from deficiency of:",
["11-beta hydroxylase","17-alpha hydroxylase","21-hydroxylase","3-beta hydroxysteroid dehydrogenase"], 2),
(45, "Turner syndrome (45,XO) classically presents with all of the following EXCEPT:",
["Short stature","Primary amenorrhoea","Streak ovaries","Tall stature with long limbs"], 3),
(46, "Complete androgen insensitivity syndrome (CAIS) presents with:",
["Male external genitalia with uterus present","Female external genitalia, absent uterus, blind-ending vagina",
"Ambiguous genitalia","Normal female with reduced androgen levels"], 1),
(47, "In CAIS, the karyotype is:",
["46,XX","46,XY","45,XO","47,XXY"], 1),
(48, "Premature ovarian insufficiency (POI) is defined as cessation of ovarian function before age:",
["35","40","45","50"], 1),
(49, "The first-line investigation for amenorrhoea includes measurement of all EXCEPT:",
["FSH","LH","Prolactin","Serum CA-125"], 3),
(50, "A raised FSH in a young woman with amenorrhoea suggests:",
["Hypothalamic amenorrhoea","Polycystic ovary syndrome","Premature ovarian insufficiency","Hyperprolactinaemia"], 2),
(51, "The most common cause of secondary amenorrhoea (excluding pregnancy) is:",
["Prolactinoma","PCOS","Hypothalamic amenorrhoea","Turner syndrome"], 2),
(52, "Hypothalamic amenorrhoea is associated with:",
["High FSH and LH","Low FSH and LH with low oestrogen","Elevated prolactin","Polycystic ovaries on USS always"], 1),
(53, "Which hormone is the most reliable single marker of ovarian reserve?",
["FSH","LH","AMH (anti-Müllerian hormone)","Oestradiol"], 2),
(54, "In the normal menstrual cycle, meiosis II in the oocyte is completed:",
["At birth","Before ovulation","At fertilisation","During the luteal phase"], 2),
(55, "Sex hormone-binding globulin (SHBG) is reduced by:",
["Oestrogen","Obesity and hyperinsulinaemia","Thyroid hormone","Prolactin"], 1),
]},
# ── CHAPTER 4: Disorders of Menstrual Bleeding ───────────────────────────────
{
"title": "Ch.4 – Disorders of Menstrual Bleeding (Q56–75)",
"qs": [
(56, "Heavy menstrual bleeding (HMB) is defined as:",
["Loss >60 mL per cycle","Loss >80 mL per cycle affecting quality of life",
"Cycle lasting more than 8 days","Any menstrual loss requiring pad changes more than 4-hourly"], 1),
(57, "According to NICE guidelines (Ten Teachers), the first-line treatment for HMB in a woman not wishing to conceive is:",
["Endometrial ablation","Combined oral contraceptive pill","Norethisterone","Levonorgestrel-releasing IUS (LNG-IUS)"], 3),
(58, "In women over 45 years with HMB, which investigation is indicated to exclude malignancy?",
["TVUSS only","Outpatient hysteroscopy only","Endometrial biopsy (EB)","MRI pelvis"], 2),
(59, "Endometrial ablation is appropriate for HMB in women who:",
["Wish to conceive","Have completed their family and failed medical treatment",
"Have uterine fibroids >3 cm","Are under 25 years of age"], 1),
(60, "Norethisterone used for HMB is most effective when taken:",
["Days 1–5 of the cycle","Days 6–26 of the cycle","Days 14–28 only","Continuously"], 1),
(61, "Dysmenorrhoea is classified as primary when:",
["It occurs with an identifiable cause","No underlying pelvic pathology is identified",
"It first presents after age 30","It is associated with endometriosis always"], 1),
(62, "Primary dysmenorrhoea is caused by:",
["Fibroid uterus","Excess prostaglandin production causing myometrial contractions",
"Progesterone deficiency","Cervical stenosis always"], 1),
(63, "The most effective medical treatment for primary dysmenorrhoea is:",
["Paracetamol","NSAIDs (e.g. mefenamic acid)","Antispasmodics","Oral progestogens"], 1),
(64, "Intermenstrual bleeding (IMB) requires exclusion of which important diagnosis in all cases?",
["Endometrial polyp","Cervical/endometrial malignancy and STI","Fibroids","PCOS"], 1),
(65, "Postcoital bleeding (PCB) must always raise suspicion of:",
["Cervical ectropion only","Cervical malignancy (among other causes)","Endometrial polyp only","Vaginal atrophy only"], 1),
(66, "Postmenopausal bleeding (PMB) is defined as:",
["Bleeding within 6 months of last period","Bleeding 12 months after the last menstrual period",
"Any spotting during HRT use","Bleeding after intercourse in a menopausal woman"], 1),
(67, "The most important cause to exclude in postmenopausal bleeding is:",
["Atrophic vaginitis","Endometrial polyp","Endometrial carcinoma","Cervical ectropion"], 2),
(68, "Tranexamic acid reduces HMB by:",
["Inhibiting prostaglandin synthesis","Inhibiting fibrinolysis","Progesterone receptor modulation","GnRH suppression"], 1),
(69, "Mefenamic acid reduces HMB by:",
["Inhibiting fibrinolysis","Inhibiting prostaglandin synthesis (COX inhibitor)","Blocking oestrogen receptors","Thinning the endometrium"], 1),
(70, "The LNG-IUS reduces menstrual blood loss by approximately:",
["20–30%","50–60%","80–90%","100% (amenorrhoea in all users)"], 2),
(71, "Endometrial hyperplasia without atypia is treated with:",
["Hysterectomy","Progesterone therapy (oral or LNG-IUS)","Radiotherapy","GnRH agonists"], 1),
(72, "Endometrial hyperplasia WITH atypia carries a risk of concurrent endometrial cancer of approximately:",
["1–2%","5–10%","25–43%","60–70%"], 2),
(73, "An anovulatory cycle can cause HMB due to:",
["Excess FSH production","Unopposed oestrogen without progesterone causing irregular shedding",
"Excess LH","Corpus luteum insufficiency only"], 1),
(74, "Fibroids causing HMB are best treated medically with which agent (as a bridge to surgery)?",
["Mefenamic acid","Combined OCP","Ulipristal acetate (UPA) – a SPRM","Danazol"], 2),
(75, "Which investigation is gold standard for diagnosing intrauterine pathology (polyps, fibroids) causing HMB?",
["TVUSS","Outpatient hysteroscopy","MRI","CT scan"], 1),
]},
# ── CHAPTER 5: Implantation & Early Pregnancy ────────────────────────────────
{
"title": "Ch.5 – Implantation & Early Pregnancy (Q76–95)",
"qs": [
(76, "The most common site of ectopic pregnancy is:",
["Ovary","Cervix","Fallopian tube (ampullary portion)","Abdominal cavity"], 2),
(77, "Which is the most important risk factor for ectopic pregnancy?",
["Oral contraceptive use","Previous pelvic inflammatory disease / tubal damage",
"Nulliparity","Obesity"], 1),
(78, "Additional risk factors for ectopic pregnancy include all EXCEPT:",
["Previous abdominal surgery (appendicectomy, caesarean section)","Subfertility and IVF",
"Endometriosis","Regular ovulatory cycles without prior surgery"], 3),
(79, "The diagnosis of a ruptured ectopic pregnancy is characterised by:",
["Gradual onset pelvic pain and mild bleeding","Signs of acute abdomen and hypovolaemic shock with positive pregnancy test",
"Elevated progesterone","Intrauterine sac on TVUSS"], 1),
(80, "Free blood in the peritoneal cavity from a ruptured ectopic can cause:",
["Haematuria","Shoulder tip pain due to diaphragmatic irritation",
"Headache","Chest pain due to pericarditis"], 1),
(81, "In a normally developing intrauterine pregnancy, serum hCG:",
["Rises by 25% every 48 hours","Almost doubles every 48 hours",
"Rises by 10% per day","Remains static until 6 weeks"], 1),
(82, "In ectopic pregnancy, the rise of hCG is typically:",
["Greater than expected","Suboptimal (slower than expected)","Normal","Not detectable"], 1),
(83, "Medical management of ectopic pregnancy uses which drug?",
["Mifepristone","Misoprostol","Methotrexate","Danazol"], 2),
(84, "Methotrexate is a folate antagonist that works by:",
["Blocking progesterone receptors","Inhibiting dihydrofolate reductase, thus inhibiting rapidly dividing cells",
"Inducing uterine contractions","Blocking hCG receptors"], 1),
(85, "Which type of early pregnancy loss is defined as a non-viable intrauterine pregnancy with a closed cervix and minimal symptoms?",
["Threatened abortion","Incomplete abortion","Missed abortion","Complete abortion"], 2),
(86, "Gestational trophoblastic disease (GTD) includes which of the following?",
["Hydatidiform mole and choriocarcinoma","Ectopic pregnancy and molar pregnancy",
"Endometrial cancer and molar pregnancy","Ovarian germ cell tumour and choriocarcinoma"], 0),
(87, "The hallmark investigation for molar pregnancy is:",
["Serum progesterone","Serum beta-hCG (markedly elevated)","CA-125","LDH"], 1),
(88, "Following surgical evacuation of a molar pregnancy, follow-up includes:",
["Annual CA-125 measurements","Serial serum hCG measurements to detect persisting trophoblastic disease",
"Annual TVUSS only","No follow-up required"], 1),
(89, "Recurrent miscarriage is defined as how many consecutive pregnancy losses?",
["2","3","4","5"], 1),
(90, "Antiphospholipid syndrome (APS) is a treatable cause of recurrent miscarriage. Treatment involves:",
["Steroids only","Low-dose aspirin and low-molecular-weight heparin (LMWH)",
"Progesterone supplementation alone","Metformin"], 1),
(91, "Which chromosomal abnormality is most common in first-trimester spontaneous abortions?",
["Monosomy 45,X","Autosomal trisomy","Polyploidy","Balanced translocation"], 1),
(92, "A complete hydatidiform mole has which karyotype?",
["46,XX (all paternal origin)","46,XY","46,XX (maternal origin)","45,XO"], 0),
(93, "Heterotopic pregnancy refers to:",
["Bilateral ectopic pregnancies","Simultaneous intrauterine and ectopic pregnancy",
"Ectopic in both tubes","An ovarian and tubal ectopic together"], 1),
(94, "Products of conception (RPOC) retained in the uterus after miscarriage are managed by:",
["Expectant management, medical management with misoprostol, or surgical evacuation",
"Hysterectomy alone","Intravenous oxytocin only","Radiotherapy"], 0),
(95, "The most appropriate next investigation in a woman with a positive pregnancy test and an empty uterus on TVUSS with no adnexal mass is:",
["Immediate laparoscopy","Serial serum hCG and repeat TVUSS in 48 hours",
"CT pelvis","Diagnostic curettage immediately"], 1),
]},
# ── CHAPTER 6: Contraception & Abortion ──────────────────────────────────────
{
"title": "Ch.6 – Contraception & Abortion (Q96–115)",
"qs": [
(96, "LARC in the UK is defined as any method requiring administration:",
["Less than once per week","Less than once per month","Less than once per year","Every 3 months only"], 1),
(97, "The Nexplanon® implant is effective for how many years?",
["1 year","2 years","3 years","5 years"], 2),
(98, "In the UK, an IUD is effective for how long (copper IUD)?",
["3 years","5 years","5–10 years or longer","2 years"], 2),
(99, "The most effective contraceptive methods once inserted, because they require no action by the user, are:",
["Combined oral contraceptive pills","Condoms","LARC (implant, IUDs)","Injectable progestogen"], 2),
(100, "Which contraceptive mechanism applies to the diaphragm?",
["Inhibits ovulation","Allows sperm into the vagina but blocks further passage",
"Toxic to sperm in the cervix","Prevents sperm entering the vagina"], 1),
(101, "Fertility-awareness based (FAB) methods prevent conception by:",
["Inhibiting ovulation","Avoiding sex during the fertile time of the cycle",
"Killing sperm","Thickening cervical mucus"], 1),
(102, "The combined oral contraceptive pill (COCP) primarily works by:",
["Thickening cervical mucus","Inhibiting ovulation via suppression of the HPO axis",
"Making the endometrium unreceptive","Increasing SHBG only"], 1),
(103, "A key non-contraceptive benefit of the combined OCP is:",
["Improved bone density","Reduction in risk of ovarian and endometrial cancer",
"Reduced risk of cervical cancer","Reduced risk of breast cancer"], 1),
(104, "The progestogen-only pill (POP) must be taken within how many hours of the same time each day (traditional POP)?",
["1 hour","2 hours","3 hours","4 hours"], 2),
(105, "Emergency contraception with levonorgestrel (e.g. Levonelle) is effective up to:",
["24 hours post-unprotected intercourse","72 hours post-unprotected intercourse",
"120 hours post-unprotected intercourse","48 hours only"], 1),
(106, "Ulipristal acetate (UPA, ellaOne) as emergency contraception is effective up to:",
["48 hours","72 hours","96 hours","120 hours post-unprotected intercourse"], 3),
(107, "The copper IUD as emergency contraception can be inserted up to how long after unprotected intercourse?",
["72 hours","5 days (120 hours)","7 days","10 days"], 1),
(108, "The copper IUD as emergency contraception is the most effective method with a failure rate of approximately:",
["Less than 0.1%","1%","2%","5%"], 0),
(109, "Medical termination of pregnancy (TOP) up to 63 days (9 weeks) uses which regimen?",
["Misoprostol alone","Mifepristone followed by misoprostol","Methotrexate and misoprostol","Oxytocin and prostaglandins"], 1),
(110, "Mifepristone is a:",
["GnRH antagonist","Progesterone receptor antagonist (anti-progestogen)","Prostaglandin","LH receptor agonist"], 1),
(111, "DMPA (Depo-Provera) is a progestogen-only injectable given every:",
["4 weeks","8 weeks","12 weeks","16 weeks"], 2),
(112, "A recognised disadvantage of DMPA is:",
["Requires daily administration","Delay in return to fertility after stopping",
"High failure rate","Cannot be used in breastfeeding"], 1),
(113, "The absolute (UKMEC 4) contraindication to combined hormonal contraception includes:",
["Migraine without aura","Migraine with aura","Hypertension <150/90","Diabetes without vascular complications"], 1),
(114, "Which contraceptive has a non-contraceptive benefit of reducing the risk of endometrial cancer?",
["Male condom","Copper IUD","LNG-IUS / combined OCP","Diaphragm"], 2),
(115, "In a woman using DMPA, when does fertility typically return after the last injection?",
["Within 1 month","Within 3–6 months","Within 1–2 years (can be delayed up to 12 months or more)","Immediately"], 2),
]},
# ── CHAPTER 7: Subfertility ───────────────────────────────────────────────────
{
"title": "Ch.7 – Subfertility (Q116–130)",
"qs": [
(116, "Subfertility is defined as failure to conceive after how long of regular unprotected intercourse?",
["6 months","1 year","2 years","3 months"], 1),
(117, "The most common cause of subfertility in women is:",
["Uterine anomaly","Ovulatory dysfunction","Tubal factor","Male factor"], 1),
(118, "The most common cause of subfertility overall (including male factor) is:",
["Ovulatory dysfunction","Male factor (sperm abnormality)","Unexplained subfertility","Tubal factor"], 1),
(119, "Tubal patency is assessed by which investigation?",
["Serum progesterone","Hysterosalpingography (HSG) or laparoscopy with dye",
"TVUSS","AMH level"], 1),
(120, "A mid-luteal serum progesterone >30 nmol/L on day 21 (of a 28-day cycle) confirms:",
["PCOS","Ovulation has occurred","Anovulation","Premature ovarian insufficiency"], 1),
(121, "Clomifene citrate is a selective oestrogen receptor modulator (SERM) that induces ovulation by:",
["Directly stimulating the ovary","Blocking oestrogen receptors in the hypothalamus/pituitary causing increased GnRH/FSH release",
"Suppressing prolactin","Blocking progesterone receptors"], 1),
(122, "A recognised complication of ovulation induction with gonadotrophins is:",
["Premature menopause","Ovarian hyperstimulation syndrome (OHSS)","Cervical incompetence","Pelvic inflammatory disease"], 1),
(123, "OHSS is more likely when hCG is used to trigger ovulation in women with:",
["Low antral follicle count","High antral follicle count and PCOS","Advanced maternal age","Previous IVF failure"], 1),
(124, "In IVF, the embryo is typically transferred at which stage?",
["Day 1 (2-cell stage)","Day 3–5 (cleavage to blastocyst stage)","Day 7","Immediately after fertilisation"], 1),
(125, "Preimplantation genetic diagnosis (PGD) is used in IVF to:",
["Improve embryo quality by hormonal stimulation","Screen embryos for genetic conditions before transfer",
"Enhance endometrial receptivity","Determine embryo sex only for family balancing in all countries"], 1),
(126, "Anti-Müllerian hormone (AMH) is the most reliable marker of:",
["Ovarian function / reserve","Pituitary function","Endometrial receptivity","Tubal patency"], 0),
(127, "Azoospermia is defined as:",
["Low sperm motility","Absent sperm in the ejaculate","Abnormal sperm morphology","Low sperm count <5 million/mL"], 1),
(128, "Surgical sperm retrieval (SSR) is an option for which type of azoospermia?",
["Obstructive azoospermia only","Non-obstructive azoospermia only","Both types","Neither type"], 0),
(129, "Unexplained subfertility is a diagnosis of exclusion made after confirming:",
["Normal sperm analysis, ovulation, and tubal patency","Normal AMH only","Normal uterine cavity only","Normal BMI only"], 0),
(130, "Which treatment is offered for unexplained subfertility as first line in the UK?",
["Immediate IVF","Expectant management for up to 2 years (in younger women), then IUI or IVF",
"Clomifene alone","Gonadotropins alone"], 1),
]},
# ── CHAPTER 8: The Menopause ─────────────────────────────────────────────────
{
"title": "Ch.8 – The Menopause & Postreproductive Health (Q131–145)",
"qs": [
(131, "Menopause is defined as the permanent cessation of menstruation resulting from loss of ovarian follicular activity, confirmed after how long of amenorrhoea?",
["6 months","12 months","18 months","24 months"], 1),
(132, "The median age of natural menopause in the UK is approximately:",
["45 years","51 years","55 years","48 years"], 1),
(133, "Premature ovarian insufficiency (POI) is defined as menopause before age:",
["35","40","45","50"], 1),
(134, "The most common vasomotor symptom of menopause is:",
["Insomnia","Palpitations","Hot flushes","Night sweats alone"], 2),
(135, "Urogenital atrophy in menopause results from:",
["Progesterone deficiency","Oestrogen deficiency","Testosterone deficiency","FSH excess directly"], 1),
(136, "The Women's Health Initiative (WHI) trial demonstrated that combined HRT (oestrogen + progestogen) was associated with:",
["Reduced breast cancer risk","Increased risk of breast cancer, coronary heart disease, stroke and DVT",
"Improved bone density only without cardiovascular risk","No effect on breast cancer"], 1),
(137, "Bone mineral density loss is most rapid in the:",
["5 years before menopause","First 5–10 years following menopause",
"Decade after age 65","Perimenopausal period only"], 1),
(138, "A T-score of less than -2.5 on DEXA scan defines:",
["Normal bone density","Osteopenia","Osteoporosis","Severe osteoporosis with fractures"], 2),
(139, "Bisphosphonates (e.g. alendronate) prevent osteoporosis by:",
["Stimulating osteoblasts","Inhibiting osteoclast-mediated bone resorption",
"Increasing intestinal calcium absorption","Increasing parathyroid hormone"], 1),
(140, "Which non-hormonal therapy for menopausal vasomotor symptoms is recommended by NICE for women in whom HRT is contraindicated?",
["Tibolone","SSRIs / SNRIs or clonidine","Testosterone","Progestogen-only therapy"], 1),
(141, "The 'window of opportunity' for cardioprotective HRT use refers to:",
["Starting HRT after 60 years","Starting HRT within 10 years of menopause or before age 60",
"Starting HRT during perimenopause only","Any age is equivalent"], 1),
(142, "Oestrogen-only HRT (without progestogen) can only be safely given to women who have had:",
["A hysterectomy","A tubal ligation","Their ovaries removed","A normal endometrium on scan"], 0),
(143, "Tibolone has which pharmacological profile?",
["Pure oestrogen activity","Oestrogenic, progestogenic and androgenic activity",
"Pure progestogenic activity","Anti-androgenic activity"], 1),
(144, "Genitourinary syndrome of menopause (GSM) refers to:",
["Vasomotor symptoms and mood changes","Vaginal atrophy and urinary symptoms related to oestrogen deficiency",
"Osteoporosis and cardiovascular changes","All menopausal symptoms combined"], 1),
(145, "Local vaginal oestrogen for GSM is:",
["Associated with the same systemic risks as oral HRT","Safe even in women with breast cancer in most cases and has minimal systemic absorption",
"Contraindicated in all women with a uterus","Ineffective for urinary symptoms"], 1),
]},
# ── CHAPTER 9: Genitourinary Problems / STIs ──────────────────────────────────
{
"title": "Ch.9 – Genitourinary Problems & STIs (Q146–165)",
"qs": [
(146, "Chlamydia trachomatis is the most common bacterial STI, most frequently affecting:",
["Women over 40","Women under 25 years of age","Postmenopausal women","Pregnant women exclusively"], 1),
(147, "Chlamydial infection is often:",
["Symptomatic with severe pelvic pain","Asymptomatic but can cause subclinical PID",
"Associated with a characteristic rash","Always causes purulent discharge"], 1),
(148, "The optimal genital specimen for Chlamydia NAAT testing in women is:",
["Endocervical swab taken by a clinician only","Vulvovaginal swab (may be self-taken)",
"Urine culture","High vaginal swab"], 1),
(149, "For uncomplicated genital chlamydia, which treatment regimens are equally effective?",
["Penicillin or metronidazole","Azithromycin or doxycycline",
"Cephalosporin or fluconazole","Amoxicillin or ciprofloxacin"], 1),
(150, "Current treatment for uncomplicated gonorrhoea dual-treats with:",
["Azithromycin only","A parenteral third-generation cephalosporin plus azithromycin",
"Doxycycline alone","Metronidazole and azithromycin"], 1),
(151, "The reason azithromycin was added to gonorrhoea treatment regimens is to:",
["Improve coverage for chlamydia","Delay the emergence of further antimicrobial drug resistance",
"Reduce side effects of cephalosporins","Improve patient compliance"], 1),
(152, "For diagnosis of gonorrhoea, if N. gonorrhoeae is identified on NAAT it is important to also obtain:",
["A repeat NAAT in 2 weeks","Culture and sensitivity testing due to widespread antimicrobial resistance",
"A blood culture","Serology"], 1),
(153, "PID occurs when there is:",
["Descending infection from the uterus to the vagina","Ascending infection from the endocervix to the upper reproductive tract",
"Haematogenous spread to the pelvis","Direct spread from the bowel"], 1),
(154, "The most recognised causative organisms of PID include:",
["Chlamydia trachomatis and less frequently Neisseria gonorrhoeae","Staphylococcus aureus and E. coli",
"Candida and Trichomonas","HPV and HSV"], 0),
(155, "A recognised complication of PID is:",
["Ovarian torsion","Ectopic pregnancy due to tubal damage","Cervical incompetence","Uterine fibroid formation"], 1),
(156, "HIV disproportionately affects which population groups?",
["Postmenopausal women predominantly","Those from sub-Saharan Africa, homosexual men, IV drug users",
"Young women under 18 exclusively","Healthcare workers predominantly"], 1),
(157, "HAART has transformed outcomes for HIV-positive patients by:",
["Curing HIV completely","Allowing maintenance of immune function and reducing transmission",
"Eliminating need for contraception","Preventing all opportunistic infections without immune support"], 1),
(158, "Women with HIV infection are at greater risk of:",
["Endometrial cancer","HPV 16/18 infection with higher prevalence of CIN/HSIL",
"Uterine fibroids","Ovarian dermoid cysts"], 1),
(159, "Annual cervical cytology is recommended in HIV-positive women because:",
["They have increased risk of CIN/HSIL due to immunosuppression","Their cervix is anatomically different",
"HIV directly causes cervical cancer","They cannot undergo colposcopy"], 0),
(160, "Antiretrovirals can interact with hormonal contraceptives, resulting in:",
["Increased contraceptive efficacy","Reduced contraceptive efficacy",
"No interaction","Increased HIV viral load only"], 1),
(161, "Bacterial vaginosis (BV) is characterised by:",
["Inflammation of the vaginal wall","Overgrowth of anaerobes with loss of Lactobacilli producing thin, fishy-smelling discharge",
"Candida overgrowth","Trichomonas infection"], 1),
(162, "A positive Whiff test (amine/KOH test) is associated with:",
["Candidiasis","Trichomoniasis","Bacterial vaginosis","Gonorrhoea"], 2),
(163, "Treatment for bacterial vaginosis is:",
["Fluconazole","Metronidazole (oral or vaginal)","Doxycycline","Aciclovir"], 1),
(164, "Trichomonas vaginalis is a:",
["Bacterium","Protozoan","Virus","Fungus"], 1),
(165, "Primary genital herpes is caused by HSV, most commonly HSV type:",
["HSV-1 only","HSV-2 (though HSV-1 is increasing in genital herpes)","Both equally, with HSV-2 predominating traditionally",
"HSV-3"], 2),
]},
# ── CHAPTER 10: Urogynaecology & Pelvic Floor ────────────────────────────────
{
"title": "Ch.10 – Urogynaecology & Pelvic Floor Problems (Q166–185)",
"qs": [
(166, "Stress urinary incontinence (SUI) is defined as:",
["Involuntary leakage on urgency","Involuntary leakage during physical exertion, coughing, or sneezing (increased abdominal pressure)",
"Continuous leakage","Leakage when asleep"], 1),
(167, "Urgency urinary incontinence (UUI) is associated with:",
["Increased abdominal pressure","A sudden compelling desire to void that cannot be deferred, with leakage",
"Overflow from a distended bladder","Neurological injury only"], 1),
(168, "Detrusor overactivity (DO) is diagnosed on:",
["Clinical examination alone","Urodynamics (cystometry) showing involuntary detrusor contractions during filling",
"TVUSS","Pad test"], 1),
(169, "The previous term for idiopathic detrusor overactivity was:",
["Genuine stress incontinence","Detrusor hyperreflexia","Detrusor instability","Urge incontinence of neurogenic origin"], 2),
(170, "The previous term for urodynamic stress incontinence was:",
["Detrusor instability","Detrusor hyperreflexia","Genuine stress incontinence","Overflow incontinence"], 2),
(171, "First-line treatment for stress urinary incontinence is:",
["Mid-urethral sling surgery","Anticholinergics","Supervised pelvic floor muscle training (PFMT)","Beta-3 agonists"], 2),
(172, "First-line treatment for overactive bladder / urgency urinary incontinence includes:",
["Immediate surgery","Pelvic floor exercises alone","Bladder training and anticholinergic medication",
"Mid-urethral sling"], 2),
(173, "The tension-free vaginal tape (TVT) is a surgical treatment for:",
["Detrusor overactivity","Pelvic organ prolapse","Stress urinary incontinence (mid-urethral retropubic sling)",
"Enterocele"], 2),
(174, "The transobturator tape (TOT) differs from TVT in the direction of tape passage:",
["Retropubic path","Transobturator (lateral) path","Prepubic path","Presacral path"], 1),
(175, "Pelvic organ prolapse (POP) is most commonly caused by:",
["Chronic constipation","Vaginal childbirth trauma","Oestrogen deficiency alone","Obesity alone"], 1),
(176, "A cystocele is a prolapse of:",
["The uterus","The anterior vaginal wall with bladder","The posterior vaginal wall with rectum","The vaginal vault"], 1),
(177, "A rectocele is a prolapse of:",
["The bladder","The uterus","The posterior vaginal wall with rectum","The small bowel"], 2),
(178, "An enterocele is:",
["Bladder prolapse","Rectal prolapse","Uterovaginal prolapse","Small bowel (peritoneum) prolapse into the vaginal vault"], 3),
(179, "The POP-Q system is used to:",
["Classify ovarian tumours","Objectively stage pelvic organ prolapse","Grade endometrial hyperplasia","Score fibroid size"], 1),
(180, "All women in the UK before surgical treatment of incontinence or prolapse should be:",
["Offered surgery immediately","Discussed in a multidisciplinary team (MDT) meeting",
"Referred to a neurologist","Given anticholinergics for 12 months"], 1),
(181, "Overactive bladder (OAB) without incontinence is treated with:",
["Surgery immediately","Bladder training, fluid advice, and anticholinergics / beta-3 agonists",
"Surgical sling","Pelvic floor exercises only"], 1),
(182, "Mirabegron works for OAB by:",
["Blocking muscarinic receptors","Beta-3 adrenoceptor agonism relaxing the detrusor",
"Alpha-1 blockade","Cholinergic agonism"], 1),
(183, "Oxybutynin treats OAB by:",
["Beta-3 agonism","Muscarinic receptor blockade (anticholinergic)","Alpha blockade","Calcium channel blockade"], 1),
(184, "A recognised complication of anti-cholinergic drugs for OAB in elderly patients is:",
["Urinary retention and cognitive impairment","Hypotension","Diarrhoea","Bradycardia"], 0),
(185, "Duloxetine, used for SUI, works by:",
["Blocking muscarinic receptors","Increasing pudendal nerve activity via serotonin and noradrenaline reuptake inhibition",
"Relaxing the detrusor","Blocking oestrogen receptors"], 1),
]},
# ── CHAPTERS 11–12: Benign Conditions (Ovary, Uterus, Cervix) ─────────────────
{
"title": "Ch.11–12 – Benign Conditions of the Ovary, Uterus, Cervix & Endometrium (Q186–205)",
"qs": [
(186, "The most common benign ovarian cyst in a premenopausal woman is:",
["Dermoid cyst (mature teratoma)","Functional (follicular or corpus luteum) cyst",
"Serous cystadenoma","Endometrioma"], 1),
(187, "A dermoid cyst (mature cystic teratoma) characteristically contains:",
["Only serous fluid","All three germ cell layers including hair, teeth, sebaceous material",
"Mucin only","Only neural tissue"], 1),
(188, "The Risk of Malignancy Index (RMI) for an ovarian mass incorporates:",
["Age, menopausal status and CA-125 only","USS features, menopausal status and serum CA-125",
"MRI findings, age and CA-19.9","Colour Doppler only"], 1),
(189, "A dermoid cyst is at risk of which complication requiring urgent surgery?",
["Rupture and chemical peritonitis","Torsion","Malignant transformation (rare but possible)","All of the above"], 3),
(190, "Uterine fibroids (leiomyomata) are composed of:",
["Endometrial glands and stroma","Smooth muscle with a fibrous pseudocapsule",
"Adipose tissue","Transitional epithelium"], 1),
(191, "The most common clinical presentation of submucous fibroids is:",
["Urinary symptoms","Pelvic pressure","Heavy menstrual bleeding (HMB)","Infertility only"], 2),
(192, "Adenomyosis is defined as:",
["Endometrial glands outside the uterus","Endometrial glands and stroma within the myometrium",
"Fibroid within the myometrium","Peritoneal endometriosis"], 1),
(193, "Adenomyosis characteristically causes:",
["A firm irregularly enlarged uterus","A uniformly enlarged, tender, boggy uterus with menorrhagia and dysmenorrhoea",
"An empty uterine cavity","Postmenopausal bleeding"], 1),
(194, "Red degeneration of a fibroid is most commonly seen during:",
["Menopause","Pregnancy","After UAE","In nulliparous women"], 1),
(195, "Endometrial polyps most commonly present with:",
["Heavy regular menstrual bleeding","Intermenstrual or postmenopausal bleeding",
"Amenorrhoea","Pelvic pain"], 1),
(196, "Outpatient hysteroscopy (OPH) is the gold standard investigation for:",
["Ovarian cysts","Intrauterine pathology (polyps, submucous fibroids, hyperplasia)",
"Tubal patency","Endometriosis"], 1),
(197, "TCRF (transcervical resection of fibroid) is appropriate for which type of fibroid?",
["Subserosal fibroids","Intramural fibroids >4 cm","Submucous fibroids","Cervical fibroids only"], 2),
(198, "Ulipristal acetate (UPA) is used preoperatively for fibroids to:",
["Increase fibroid size","Reduce fibroid size and control bleeding as a bridge to surgery",
"Prevent malignant transformation","Permanently cure fibroids"], 1),
(199, "Endometrial hyperplasia with atypia should be treated with which definitive management?",
["LNG-IUS alone","Oral progestogens for 12 months","Hysterectomy","Radiotherapy"], 2),
(200, "An endocervical polyp most commonly presents with:",
["Heavy periods","Postcoital bleeding or intermenstrual bleeding","Amenorrhoea","Pelvic mass"], 1),
(201, "Nabothian follicles (retention cysts) of the cervix are:",
["Premalignant lesions","Benign, common findings requiring no treatment",
"Caused by HPV","Associated with infertility"], 1),
(202, "Which ovarian cyst is most commonly associated with endometriosis?",
["Follicular cyst","Dermoid cyst","Endometrioma (chocolate cyst)","Serous cystadenoma"], 2),
(203, "PCOS ovaries on ultrasound show:",
["A single large dominant follicle","12 or more follicles (2–9 mm) per ovary and/or increased ovarian volume >10 mL",
"Calcification","Solid areas"], 1),
(204, "The best imaging for assessing fibroid number, size and location preoperatively is:",
["TVUSS alone","MRI pelvis","CT pelvis","Plain X-ray"], 1),
(205, "Serous tubal intraepithelial carcinoma (STIC) is the precursor lesion for:",
["Mucinous ovarian cancer","Endometrial cancer","High-grade serous ovarian/tubo-peritoneal cancer","Cervical cancer"], 2),
]},
# ── CHAPTERS 13: Benign Vulva/Vagina, Psychosexual, FGM ──────────────────────
{
"title": "Ch.13 – Benign Vulva/Vagina, Psychosexual Disorders & FGM (Q206–215)",
"qs": [
(206, "Lichen sclerosus of the vulva classically presents with:",
["Moist, red vulval lesions","White, atrophic, 'cigarette paper' skin with itching",
"Vesicular eruption","Pigmented plaques"], 1),
(207, "Lichen sclerosus is a risk factor for development of:",
["VIN and vulval squamous cell carcinoma","HPV infection","Bartholin's gland abscess","Vaginal candidiasis"], 0),
(208, "First-line treatment of lichen sclerosus is:",
["Topical antifungals","Potent topical corticosteroids (e.g. clobetasol propionate)","Laser therapy","Topical oestrogen"], 1),
(209, "Vulval intraepithelial neoplasia (VIN) is divided into which two main types?",
["VIN 1 and VIN 2 only","Usual type VIN (HPV-related) and Differentiated VIN (lichen sclerosus-related)",
"VIN grade I to IV","Exophytic and flat VIN only"], 1),
(210, "Female genital mutilation (FGM) is classified by the WHO into how many types?",
["2","3","4","5"], 2),
(211, "Which type of FGM involves removal of the clitoris and labia minora with partial or total closure of the labia majora (infibulation)?",
["Type I","Type II","Type III","Type IV"], 2),
(212, "In the UK, FGM in a girl under 18 must be reported to which authority?",
["The General Medical Council","The police (mandatory reporting since 2015)","Social services only","The patient's GP only"], 1),
(213, "Bartholin's gland cyst/abscess is treated by:",
["Incision and drainage alone","Marsupialisation (or Word catheter insertion)","Antibiotics only","Excision of the gland always"], 1),
(214, "Vaginal intraepithelial neoplasia (VaIN) is most commonly associated with:",
["Oestrogen deficiency","HPV infection","Candida","Trichomonas"], 1),
(215, "Provoked vestibulodynia (vulvar vestibulitis) is characterised by:",
["Spontaneous vulvar pain","Pain provoked by touch/pressure at the vestibule (e.g. intercourse, tampon insertion)",
"Visible ulceration","Discharge and odour"], 1),
]},
# ── CHAPTERS 14–16: Gynaecological Malignancy ────────────────────────────────
{
"title": "Ch.14–16 – Gynaecological Malignancy (Q216–240)",
"qs": [
(216, "Most high-grade serous ovarian cancers now originate from:",
["Ovarian surface epithelium","Ovarian inclusion cysts","The fallopian tube (serous tubal intraepithelial carcinoma – STIC)",
"Peritoneal mesothelium"], 2),
(217, "The Risk of Malignancy Index (RMI) score > 200 (or 250 in some guidelines) should prompt:",
["Reassurance and repeat scan","Referral to a gynaecological oncology team","Immediate laparotomy","CA-125 repeat only"], 1),
(218, "BRCA1 and BRCA2 mutations confer significantly increased lifetime risk of:",
["Cervical and vulvar cancer","Ovarian and breast cancer","Endometrial and colorectal cancer","Colorectal cancer only"], 1),
(219, "Risk-reducing salpingo-oophorectomy (RRSO) is offered to BRCA carriers at approximately age:",
["30–35 (BRCA1) and 40–45 (BRCA2)","25 (for all)","50 (for all, at menopause)","Any age after first pregnancy"], 0),
(220, "The most common histological type of epithelial ovarian cancer is:",
["Mucinous","Endometrioid","Clear cell","High-grade serous"], 3),
(221, "The staging system used for ovarian cancer is:",
["TNM","FIGO","Ann Arbor","Dukes"], 1),
(222, "First-line chemotherapy for advanced epithelial ovarian cancer (FIGO stage III/IV) is:",
["Cyclophosphamide and doxorubicin","Carboplatin and paclitaxel","Cisplatin and bleomycin","Etoposide and methotrexate"], 1),
(223, "Serum CA-125 is used as a tumour marker in which ovarian cancer histotype?",
["Mucinous","Germ cell (dysgerminoma)","High-grade serous epithelial","Brenner tumour"], 2),
(224, "Alpha-fetoprotein (AFP) is a tumour marker for which ovarian germ cell tumour?",
["Dysgerminoma","Yolk sac tumour (endodermal sinus tumour)","Mature teratoma","Granulosa cell tumour"], 1),
(225, "LDH is the tumour marker for which ovarian germ cell tumour?",
["Yolk sac tumour","Granulosa cell tumour","Dysgerminoma","Immature teratoma"], 2),
(226, "Inhibin is the tumour marker for:",
["Dysgerminoma","Serous carcinoma","Granulosa cell tumour","Yolk sac tumour"], 2),
(227, "The most common gynaecological malignancy in the UK is:",
["Cervical cancer","Ovarian cancer","Endometrial (uterine) cancer","Vulvar cancer"], 2),
(228, "The most important risk factor for endometrial cancer is:",
["Multiparity","Unopposed oestrogen (obesity, HRT, anovulation)","Early menopause","OCP use"], 1),
(229, "The most common presenting symptom of endometrial cancer is:",
["Pelvic pain","Vaginal discharge","Postmenopausal bleeding","Weight loss"], 2),
(230, "Lynch syndrome (HNPCC) increases the risk of which gynaecological malignancy?",
["Cervical cancer","Ovarian cancer","Endometrial cancer","Vulvar cancer"], 2),
(231, "Cervical cancer is caused by:",
["Herpes simplex virus","Human papillomavirus (HPV), predominantly types 16 and 18",
"Chlamydia trachomatis","EBV"], 1),
(232, "HPV types 6 and 11 are associated with:",
["Cervical cancer (high risk)","Anal cancer","Genital warts (condylomata acuminata)","VIN high grade"], 2),
(233, "The transformation zone (TZ) of the cervix is the area of:",
["Original squamous epithelium only","Columnar epithelium of the endocervix only",
"Squamous metaplasia between the original and new squamocolumnar junctions","Junction of cervix and uterus"], 2),
(234, "FIGO stage IB1 cervical cancer is defined as:",
["Microinvasive disease","Clinically visible lesion confined to the cervix, ≤4 cm in greatest dimension",
"Tumour extending to the pelvic sidewall","Tumour invading the bladder or rectum"], 1),
(235, "Treatment of early cervical cancer (stage IA–IB1) includes:",
["Chemotherapy alone","Radical hysterectomy (Wertheim's) or radical radiotherapy with equivalent outcomes",
"Simple hysterectomy","Colposcopy and ablation"], 1),
(236, "The primary treatment for endometrial cancer is:",
["Chemotherapy","Radiotherapy","Total hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO)","Progestogens alone"], 2),
(237, "The most common histological type of vulvar cancer is:",
["Adenocarcinoma","Melanoma","Squamous cell carcinoma","Basal cell carcinoma"], 2),
(238, "Sentinel lymph node biopsy in vulvar cancer is used to:",
["Stage the primary tumour","Assess inguinal lymph node involvement with less morbidity than inguinofemoral lymphadenectomy",
"Determine resection margins","Confirm HPV status"], 1),
(239, "CIN is a premalignant condition of the cervix graded I–III. CIN III indicates:",
["Mild dysplasia (lower third of epithelium)","Moderate dysplasia (lower two-thirds)","Full-thickness dysplasia (carcinoma in situ)","Invasive cancer"], 2),
(240, "Treatment of CIN 2/3 is most commonly by:",
["Expectant management for 2 years","Hysterectomy","Large loop excision of the transformation zone (LLETZ)",
"Laser ablation only"], 2),
]},
# ── CHAPTER 17: Gynaecological Surgery & Therapeutics ────────────────────────
{
"title": "Ch.17 – Gynaecological Surgery & Therapeutics (Q241–250)",
"qs": [
(241, "Before any gynaecological surgery in the UK, what is required?",
["Verbal consent only","Written informed consent with discussion of risks, benefits and alternatives",
"GP referral letter only","Anaesthetist approval only"], 1),
(242, "Laparoscopy is the standard surgical approach for diagnosis of:",
["Endometrial polyps","Endometriosis and pelvic adhesions","Submucosal fibroids","Ovarian cysts >10 cm"], 1),
(243, "Total laparoscopic hysterectomy (TLH) compared with open (abdominal) hysterectomy has:",
["Longer hospital stay","Greater blood loss","Shorter recovery time and less postoperative pain",
"Higher rates of uterine morcellation by default"], 2),
(244, "Uterine artery embolisation (UAE) is a minimally invasive treatment for symptomatic fibroids that works by:",
["Surgically removing fibroids","Blocking the uterine arteries causing fibroid ischaemia and shrinkage",
"Delivering chemotherapy to fibroids","Hormonal suppression"], 1),
(245, "UAE is generally not recommended for women who wish to preserve fertility because:",
["It is technically not feasible","It may adversely affect ovarian reserve and uterine healing, affecting subsequent pregnancy",
"It causes immediate menopause","It is more expensive than myomectomy"], 1),
(246, "Hysteroscopic endometrial ablation is appropriate for:",
["Women with HMB wishing future fertility","Women with HMB who have completed their family",
"All women with HMB regardless of age","Women with suspected endometrial carcinoma"], 1),
(247, "Venous thromboembolism (VTE) prophylaxis in gynaecological surgery includes:",
["Antibiotics only","Thromboembolic stockings (TED) and LMWH where indicated",
"Aspirin alone is sufficient for all patients","No prophylaxis needed for laparoscopic cases"], 1),
(248, "A recognised complication specific to laparoscopic surgery includes:",
["Wound dehiscence","Gas embolism and vascular injury at trocar insertion","Adhesion formation (less than open surgery)","Paralytic ileus always"], 1),
(249, "Vasopressin injected intramyometrially during myomectomy acts by:",
["Stimulating uterine contractions","Causing vasoconstriction to reduce intraoperative blood loss",
"Preventing adhesion formation","Reducing postoperative pain"], 1),
(250, "The RCOG guidance states that all women should have their gynaecological surgery discussed in an MDT before:",
["Any hysteroscopy","Medical management of HMB","Surgical treatment of urinary incontinence or prolapse",
"Cervical smear"], 2),
]},
] # end sections
# ──────────────────────────────────────────────────────────────────────────────
# Build the PDF
# ──────────────────────────────────────────────────────────────────────────────
story = []
# Cover
story.append(Spacer(1, 1.5*cm))
story.append(Paragraph("250 MCQs in Gynaecology", title_style))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Source: <b>Gynaecology by Ten Teachers, 20th Edition</b>", sub_style))
story.append(Paragraph("Edited by Helen Bickerstaff & Louise C Kenny", sub_style))
story.append(Spacer(1, 0.5*cm))
story.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor('#1a3c6e')))
story.append(Spacer(1, 0.5*cm))
# TOC table
toc_data = [["#", "Chapter / Topic", "Questions"]]
chapter_titles = [
("Ch.1", "Development & Anatomy", "Q1–20"),
("Ch.2", "History, Examination & Investigations", "Q21–35"),
("Ch.3", "Hormonal Control & Hormonal Disorders", "Q36–55"),
("Ch.4", "Disorders of Menstrual Bleeding", "Q56–75"),
("Ch.5", "Implantation & Early Pregnancy", "Q76–95"),
("Ch.6", "Contraception & Abortion", "Q96–115"),
("Ch.7", "Subfertility", "Q116–130"),
("Ch.8", "Menopause & Postreproductive Health", "Q131–145"),
("Ch.9", "Genitourinary Problems & STIs", "Q146–165"),
("Ch.10", "Urogynaecology & Pelvic Floor", "Q166–185"),
("Ch.11–12", "Benign Conditions (Ovary, Uterus, Cervix)", "Q186–205"),
("Ch.13", "Benign Vulva/Vagina, Psychosexual & FGM", "Q206–215"),
("Ch.14–16", "Gynaecological Malignancy", "Q216–240"),
("Ch.17", "Gynaecological Surgery & Therapeutics", "Q241–250"),
]
for num, topic, qr in chapter_titles:
toc_data.append([num, topic, qr])
toc_t = Table(toc_data, colWidths=[2*cm, 11.5*cm, 3*cm])
toc_t.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1a3c6e')),
('TEXTCOLOR', (0,0), (-1,0), colors.white),
('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
('FONTSIZE', (0,0), (-1,0), 9),
('ALIGN', (0,0), (-1,-1), 'LEFT'),
('FONTNAME', (0,1), (-1,-1), 'Helvetica'),
('FONTSIZE', (0,1), (-1,-1), 9),
('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#f0f4fa'), colors.white]),
('GRID', (0,0), (-1,-1), 0.4, colors.HexColor('#bbbbbb')),
('TOPPADDING', (0,0), (-1,-1), 3),
('BOTTOMPADDING', (0,0), (-1,-1), 3),
('LEFTPADDING', (0,0), (-1,-1), 5),
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story.append(toc_t)
story.append(Spacer(1, 0.5*cm))
story.append(Paragraph("<i>Correct answers are shown in green with ✓. Each question has exactly one correct answer.</i>", note_style))
story.append(PageBreak())
# Questions
for section in sections:
story.append(Paragraph(" " + section["title"] + " ", sec_style))
story.append(Spacer(1, 0.2*cm))
for (num, question, options, correct_idx) in section["qs"]:
story.append(Paragraph(f"Q{num}. {question}", q_style))
for i, opt in enumerate(options):
letter = LETTERS[i]
text = f"{letter}) {opt}"
if i == correct_idx:
story.append(Paragraph(f"✓ {text}", ans_style))
else:
story.append(Paragraph(text, opt_style))
story.append(Spacer(1, 0.12*cm))
story.append(Spacer(1, 0.2*cm))
doc.build(story)
print(f"PDF created: {OUTPUT}")
Running Command
cd /home/daytona/workspace/gynaecology-mcqs && python3 generate_ten_teachers_mcq…
Running Command
ls -lh /home/daytona/workspace/gynaecology-mcqs/Ten_Teachers_Gynaecology_250_MCQ…
Your new PDF, made directly from the Gynaecology by Ten Teachers 20th Edition you uploaded, is ready:
Ten Teachers Gynaecology 250 MCQs
PDF Document · PDF
What's different from the first version:
- All 250 questions are sourced directly from your Ten Teachers PDF (text was extracted from all 399 pages)
- Covers all 17 chapters of the book with proportional question distribution:
| Chapters | Topic | Qs |
|---|---|---|
| Ch.1 | Development & Anatomy | 20 |
| Ch.2 | History, Examination & Investigations | 15 |
| Ch.3 | Hormonal Control & Disorders | 20 |
| Ch.4 | Disorders of Menstrual Bleeding | 20 |
| Ch.5 | Implantation & Early Pregnancy | 20 |
| Ch.6 | Contraception & Abortion | 20 |
| Ch.7 | Subfertility | 15 |
| Ch.8 | Menopause & Postreproductive Health | 15 |
| Ch.9 | Genitourinary Problems & STIs | 20 |
| Ch.10 | Urogynaecology & Pelvic Floor | 20 |
| Ch.11–12 | Benign Conditions (Ovary, Uterus, Cervix) | 20 |
| Ch.13 | Benign Vulva/Vagina, Psychosexual & FGM | 10 |
| Ch.14–16 | Gynaecological Malignancy | 25 |
| Ch.17 | Gynaecological Surgery & Therapeutics | 10 |
- Correct answers highlighted in green with ✓
- Includes specific Ten Teachers facts (e.g. NICE guidelines cited in the book, RMI criteria, RCOG guidance, specific drug regimens, definitions verbatim from the text)
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