TESTBANK FOR GYNAECOLOGY BY TEN TEACHERS, 21ST EDITION
,Gynaecology by Ten Teachers, 21st Edition
Comprehensive Premium Test Bank (2026–2027)
Table of Contents
Part I – Foundations
1. The Development and Anatomy of the Female Sexual Organs and Pelvis
2. Gynaecological History, Examination and Investigations
3. Hormonal Control of the Menstrual Cycle and Hormonal Disorders
4. Disorders of Menstrual Bleeding
Part II – Reproductive Health
5. Implantation and Early Pregnancy
6. Contraception and Abortion
7. Subfertility
8. The Menopause and Postreproductive Health
Part III – Gynaecological Disorders
9. Sexually Transmitted Infections and Related Conditions
10. Urogynaecology and Pelvic Floor Problems
11. Benign Conditions of the Ovary and Pelvis
12. Benign Conditions of the Uterus, Cervix and Endometrium
13. Benign Conditions of the Vulva, Vagina, Psychosexual Disorders and Female Genital Mutilation
Part IV – Gynaecological Oncology
14. Malignant Disease of the Ovary
15. Malignant Disease of the Uterus
16. Premalignant and Malignant Disease of the Lower Genital Tract
Part V – Surgical Management
17. Gynaecological Surgery and Therapeutics
Premium Features
• Advanced MRCOG, USMLE, NCLEX & Medical School–Style Clinical Scenarios
, • Four-Option Multiple-Choice Questions (A–D)
• Detailed Evidence-Based Rationales
• Why the Other Options Are Incorrect
• Clinical Pearls
• High-Yield Exam Strategies
• Balanced & Unpredictable Answer Distribution
• Covers All 17 Chapters of the 21st Edition
• Ideal for Undergraduate, Postgraduate, MRCOG Part 2, Board Review, and Clinical Revision
Part I – Foundations
The Development and Anatomy of the Female Sexual Organs and Pelvis
Question 1
During laparoscopic excision of deep infiltrating endometriosis involving the left pelvic sidewall, a
surgeon deliberately develops the pararectal space before dissecting dense fibrosis surrounding the
uterosacral ligament. Which structure is at greatest risk of injury if the medial boundary of the pararectal
space is breached?
A. Internal iliac artery
B. Obturator nerve
C. Ureter
D. External iliac vein
Correct Answer: C. Ureter
Detailed Rationale
Deep infiltrating endometriosis frequently distorts retroperitoneal anatomy, making identification of normal
anatomical landmarks essential before excision.
The ureter descends retroperitoneally along the medial leaf of the broad ligament before passing beneath the
uterine artery and entering the bladder. During development of the pararectal space, the ureter forms one of
the most important medial anatomical landmarks.
Failure to identify the ureter before dissecting dense fibrosis may result in:
, • Thermal injury
• Partial transection
• Complete transection
• Ureteric devascularization
• Delayed ureterovaginal fistula
• Hydronephrosis
• Permanent renal dysfunction
Retroperitoneal ureterolysis is therefore a critical step during advanced endometriosis surgery.
Why the Other Options Are Incorrect
A. The internal iliac artery lies deeper and more laterally and is less commonly injured during careful pararectal
space development.
B. The obturator nerve lies within the obturator fossa and is principally at risk during pelvic lymphadenectomy
rather than uterosacral dissection.
D. The external iliac vein lies along the pelvic brim and is not the principal medial boundary of the pararectal
space.
Clinical Pearl
Whenever severe endometriosis obscures normal anatomy, identify the ureter before dividing any fibrotic
tissue.
Exam Strategy
If the stem contains:
• Deep infiltrating endometriosis
• Retroperitoneal dissection
• Uterosacral ligament
• Pararectal space
• Pelvic sidewall
→ Think "ureter at risk."
, Question 2
A reproductive medicine specialist investigates a woman with recurrent second-trimester pregnancy
loss. Three-dimensional ultrasound demonstrates a normal external uterine fundal contour but complete
division of the endometrial cavity by a fibromuscular septum. Which embryological error most likely
produced this anomaly?
A. Complete failure of Müllerian duct fusion
B. Failure of resorption of the fused Müllerian septum
C. Agenesis of one Müllerian duct
D. Persistence of the mesonephric ducts
Correct Answer: B. Failure of resorption of the fused Müllerian septum
Detailed Rationale
Development of the uterus occurs in two major stages:
1. Fusion of the paired Müllerian ducts.
2. Resorption of the intervening septum.
A septate uterus develops when fusion occurs normally but the central septum fails to regress.
Among congenital uterine anomalies, the septate uterus carries the highest association with:
• Recurrent miscarriage
• Implantation failure
• Infertility
• Preterm birth
Unlike fusion defects, septate uterus is highly amenable to hysteroscopic septal resection, which significantly
improves reproductive outcomes.
Why the Other Options Are Incorrect
A. Produces bicornuate or didelphys uterus.
C. Produces a unicornuate uterus.
D. Mesonephric ducts contribute to male reproductive structures and do not form the uterus.
Clinical Pearl
,A normal external fundal contour strongly favors a septate uterus over a bicornuate uterus.
Exam Strategy
If imaging shows:
• Normal fundal contour
• Divided uterine cavity
→ Think septate uterus.
Question 3
During radical hysterectomy for Stage IB2 cervical carcinoma, the surgeon ligates the uterine artery at its
origin from the internal iliac artery. Which adjacent structure is most vulnerable to injury during this step?
A. Genitofemoral nerve
B. Ureter
C. Femoral nerve
D. Ovarian vein
Correct Answer: B. Ureter
Detailed Rationale
The ureter passes beneath the uterine artery approximately 1–2 cm lateral to the cervix, a relationship
remembered as "water under the bridge."
During radical hysterectomy, extensive parametrial dissection increases the risk of:
• Ureteric transection
• Thermal injury
• Ligation
• Ischemic injury
Injury may present days later with:
• Flank pain
• Fever
• Rising creatinine
, • Urinoma
• Ureterovaginal fistula
Routine visualization of the ureter throughout pelvic dissection is considered a fundamental principle of safe
gynecologic surgery.
Why the Other Options Are Incorrect
A. Courses on the psoas muscle and is not closely related to uterine artery ligation.
C. Lies outside the operative field.
D. Located within the infundibulopelvic ligament rather than adjacent to the uterine artery.
Clinical Pearl
Most ureteric injuries during hysterectomy occur near the uterine artery or cardinal ligament.
Exam Strategy
Whenever you see:
• Radical hysterectomy
• Cardinal ligament
• Uterine artery
→ Immediately consider ureteric injury.
Part I – Foundations
The Development and Anatomy of the Female Sexual Organs and Pelvis
Question 4
A 30-year-old nulliparous woman undergoes pelvic MRI after recurrent first-trimester miscarriages.
Imaging demonstrates complete duplication of the uterus and cervix with a longitudinal vaginal septum.
Which embryological defect most accurately explains these findings?
A. Complete failure of fusion of the paired Müllerian ducts
B. Failure of resorption of the uterine septum
C. Partial regression of one Müllerian duct
,D. Failure of development of the urogenital sinus
Correct Answer: A. Complete failure of fusion of the paired Müllerian ducts
Detailed Rationale
A uterus didelphys develops when the paired Müllerian ducts fail to fuse completely during embryogenesis.
This results in:
• Two separate uterine cavities
• Two cervices
• Frequently a longitudinal vaginal septum
• Increased risk of miscarriage
• Malpresentation
• Preterm birth
MRI provides excellent differentiation between fusion defects and resorption defects because it accurately
demonstrates both the external uterine contour and internal cavity anatomy.
Why the Other Options Are Incorrect
B. Failure of septal resorption produces a septate uterus, which has a normal external fundal contour.
C. Partial regression of one Müllerian duct results in a unicornuate uterus.
D. The urogenital sinus contributes to the lower vagina, not uterine duplication.
Clinical Pearl
Among congenital uterine anomalies, uterus didelphys is strongly associated with a longitudinal vaginal
septum.
Exam Strategy
When the question describes:
• Two uterine cavities
• Two cervices
• Vaginal septum
,→ Think complete Müllerian fusion failure (uterus didelphys).
Question 5
During pelvic lymphadenectomy for early-stage cervical carcinoma, dissection proceeds along the lateral
pelvic wall. Following surgery, the patient is unable to adduct her right thigh against resistance and reports
numbness over the medial thigh. Which structure was most likely injured?
A. Femoral nerve
B. Obturator nerve
C. Pudendal nerve
D. Sciatic nerve
Correct Answer: B. Obturator nerve
Detailed Rationale
The obturator nerve originates from the lumbar plexus (L2–L4) and courses through the obturator fossa
adjacent to the obturator lymph nodes. It is particularly vulnerable during pelvic lymphadenectomy.
Injury produces:
• Weak hip adduction
• Difficulty crossing the legs
• Medial thigh sensory loss
• Gait instability
Recognition during surgery permits immediate microsurgical repair with improved neurological outcomes.
Why the Other Options Are Incorrect
A. Injury primarily causes weakness of knee extension.
C. Supplies the perineum and external sphincters.
D. Produces posterior thigh and lower leg deficits.
Clinical Pearl
The obturator nerve is the nerve most frequently tested in gynecologic oncology examinations.
, Exam Strategy
Pelvic lymph nodes + Loss of thigh adduction = Obturator nerve injury.
Question 6
A 16-year-old girl presents with primary amenorrhea, cyclical pelvic pain, normal breast development,
and a bulging bluish membrane at the vaginal introitus. Which embryological abnormality best explains this
presentation?
A. Failure of Müllerian duct fusion
B. Imperforate hymen due to failure of hymenal canalization
C. Complete vaginal agenesis
D. Failure of ovarian descent
Correct Answer: B. Imperforate hymen due to failure of hymenal canalization
Detailed Rationale
Imperforate hymen results from failure of degeneration of the central hymenal membrane. Menstrual blood
accumulates behind the obstruction causing:
• Hematocolpos
• Cyclical pelvic pain
• Primary amenorrhea
• Bulging bluish hymen
• Occasionally urinary retention
Definitive management is hymenotomy.
Why the Other Options Are Incorrect
A. Produces uterine duplication anomalies.
C. Usually presents without a visible bulging hymen.
D. Does not produce genital tract obstruction.
,Gynaecology by Ten Teachers, 21st Edition
Comprehensive Premium Test Bank (2026–2027)
Table of Contents
Part I – Foundations
1. The Development and Anatomy of the Female Sexual Organs and Pelvis
2. Gynaecological History, Examination and Investigations
3. Hormonal Control of the Menstrual Cycle and Hormonal Disorders
4. Disorders of Menstrual Bleeding
Part II – Reproductive Health
5. Implantation and Early Pregnancy
6. Contraception and Abortion
7. Subfertility
8. The Menopause and Postreproductive Health
Part III – Gynaecological Disorders
9. Sexually Transmitted Infections and Related Conditions
10. Urogynaecology and Pelvic Floor Problems
11. Benign Conditions of the Ovary and Pelvis
12. Benign Conditions of the Uterus, Cervix and Endometrium
13. Benign Conditions of the Vulva, Vagina, Psychosexual Disorders and Female Genital Mutilation
Part IV – Gynaecological Oncology
14. Malignant Disease of the Ovary
15. Malignant Disease of the Uterus
16. Premalignant and Malignant Disease of the Lower Genital Tract
Part V – Surgical Management
17. Gynaecological Surgery and Therapeutics
Premium Features
• Advanced MRCOG, USMLE, NCLEX & Medical School–Style Clinical Scenarios
, • Four-Option Multiple-Choice Questions (A–D)
• Detailed Evidence-Based Rationales
• Why the Other Options Are Incorrect
• Clinical Pearls
• High-Yield Exam Strategies
• Balanced & Unpredictable Answer Distribution
• Covers All 17 Chapters of the 21st Edition
• Ideal for Undergraduate, Postgraduate, MRCOG Part 2, Board Review, and Clinical Revision
Part I – Foundations
The Development and Anatomy of the Female Sexual Organs and Pelvis
Question 1
During laparoscopic excision of deep infiltrating endometriosis involving the left pelvic sidewall, a
surgeon deliberately develops the pararectal space before dissecting dense fibrosis surrounding the
uterosacral ligament. Which structure is at greatest risk of injury if the medial boundary of the pararectal
space is breached?
A. Internal iliac artery
B. Obturator nerve
C. Ureter
D. External iliac vein
Correct Answer: C. Ureter
Detailed Rationale
Deep infiltrating endometriosis frequently distorts retroperitoneal anatomy, making identification of normal
anatomical landmarks essential before excision.
The ureter descends retroperitoneally along the medial leaf of the broad ligament before passing beneath the
uterine artery and entering the bladder. During development of the pararectal space, the ureter forms one of
the most important medial anatomical landmarks.
Failure to identify the ureter before dissecting dense fibrosis may result in:
, • Thermal injury
• Partial transection
• Complete transection
• Ureteric devascularization
• Delayed ureterovaginal fistula
• Hydronephrosis
• Permanent renal dysfunction
Retroperitoneal ureterolysis is therefore a critical step during advanced endometriosis surgery.
Why the Other Options Are Incorrect
A. The internal iliac artery lies deeper and more laterally and is less commonly injured during careful pararectal
space development.
B. The obturator nerve lies within the obturator fossa and is principally at risk during pelvic lymphadenectomy
rather than uterosacral dissection.
D. The external iliac vein lies along the pelvic brim and is not the principal medial boundary of the pararectal
space.
Clinical Pearl
Whenever severe endometriosis obscures normal anatomy, identify the ureter before dividing any fibrotic
tissue.
Exam Strategy
If the stem contains:
• Deep infiltrating endometriosis
• Retroperitoneal dissection
• Uterosacral ligament
• Pararectal space
• Pelvic sidewall
→ Think "ureter at risk."
, Question 2
A reproductive medicine specialist investigates a woman with recurrent second-trimester pregnancy
loss. Three-dimensional ultrasound demonstrates a normal external uterine fundal contour but complete
division of the endometrial cavity by a fibromuscular septum. Which embryological error most likely
produced this anomaly?
A. Complete failure of Müllerian duct fusion
B. Failure of resorption of the fused Müllerian septum
C. Agenesis of one Müllerian duct
D. Persistence of the mesonephric ducts
Correct Answer: B. Failure of resorption of the fused Müllerian septum
Detailed Rationale
Development of the uterus occurs in two major stages:
1. Fusion of the paired Müllerian ducts.
2. Resorption of the intervening septum.
A septate uterus develops when fusion occurs normally but the central septum fails to regress.
Among congenital uterine anomalies, the septate uterus carries the highest association with:
• Recurrent miscarriage
• Implantation failure
• Infertility
• Preterm birth
Unlike fusion defects, septate uterus is highly amenable to hysteroscopic septal resection, which significantly
improves reproductive outcomes.
Why the Other Options Are Incorrect
A. Produces bicornuate or didelphys uterus.
C. Produces a unicornuate uterus.
D. Mesonephric ducts contribute to male reproductive structures and do not form the uterus.
Clinical Pearl
,A normal external fundal contour strongly favors a septate uterus over a bicornuate uterus.
Exam Strategy
If imaging shows:
• Normal fundal contour
• Divided uterine cavity
→ Think septate uterus.
Question 3
During radical hysterectomy for Stage IB2 cervical carcinoma, the surgeon ligates the uterine artery at its
origin from the internal iliac artery. Which adjacent structure is most vulnerable to injury during this step?
A. Genitofemoral nerve
B. Ureter
C. Femoral nerve
D. Ovarian vein
Correct Answer: B. Ureter
Detailed Rationale
The ureter passes beneath the uterine artery approximately 1–2 cm lateral to the cervix, a relationship
remembered as "water under the bridge."
During radical hysterectomy, extensive parametrial dissection increases the risk of:
• Ureteric transection
• Thermal injury
• Ligation
• Ischemic injury
Injury may present days later with:
• Flank pain
• Fever
• Rising creatinine
, • Urinoma
• Ureterovaginal fistula
Routine visualization of the ureter throughout pelvic dissection is considered a fundamental principle of safe
gynecologic surgery.
Why the Other Options Are Incorrect
A. Courses on the psoas muscle and is not closely related to uterine artery ligation.
C. Lies outside the operative field.
D. Located within the infundibulopelvic ligament rather than adjacent to the uterine artery.
Clinical Pearl
Most ureteric injuries during hysterectomy occur near the uterine artery or cardinal ligament.
Exam Strategy
Whenever you see:
• Radical hysterectomy
• Cardinal ligament
• Uterine artery
→ Immediately consider ureteric injury.
Part I – Foundations
The Development and Anatomy of the Female Sexual Organs and Pelvis
Question 4
A 30-year-old nulliparous woman undergoes pelvic MRI after recurrent first-trimester miscarriages.
Imaging demonstrates complete duplication of the uterus and cervix with a longitudinal vaginal septum.
Which embryological defect most accurately explains these findings?
A. Complete failure of fusion of the paired Müllerian ducts
B. Failure of resorption of the uterine septum
C. Partial regression of one Müllerian duct
,D. Failure of development of the urogenital sinus
Correct Answer: A. Complete failure of fusion of the paired Müllerian ducts
Detailed Rationale
A uterus didelphys develops when the paired Müllerian ducts fail to fuse completely during embryogenesis.
This results in:
• Two separate uterine cavities
• Two cervices
• Frequently a longitudinal vaginal septum
• Increased risk of miscarriage
• Malpresentation
• Preterm birth
MRI provides excellent differentiation between fusion defects and resorption defects because it accurately
demonstrates both the external uterine contour and internal cavity anatomy.
Why the Other Options Are Incorrect
B. Failure of septal resorption produces a septate uterus, which has a normal external fundal contour.
C. Partial regression of one Müllerian duct results in a unicornuate uterus.
D. The urogenital sinus contributes to the lower vagina, not uterine duplication.
Clinical Pearl
Among congenital uterine anomalies, uterus didelphys is strongly associated with a longitudinal vaginal
septum.
Exam Strategy
When the question describes:
• Two uterine cavities
• Two cervices
• Vaginal septum
,→ Think complete Müllerian fusion failure (uterus didelphys).
Question 5
During pelvic lymphadenectomy for early-stage cervical carcinoma, dissection proceeds along the lateral
pelvic wall. Following surgery, the patient is unable to adduct her right thigh against resistance and reports
numbness over the medial thigh. Which structure was most likely injured?
A. Femoral nerve
B. Obturator nerve
C. Pudendal nerve
D. Sciatic nerve
Correct Answer: B. Obturator nerve
Detailed Rationale
The obturator nerve originates from the lumbar plexus (L2–L4) and courses through the obturator fossa
adjacent to the obturator lymph nodes. It is particularly vulnerable during pelvic lymphadenectomy.
Injury produces:
• Weak hip adduction
• Difficulty crossing the legs
• Medial thigh sensory loss
• Gait instability
Recognition during surgery permits immediate microsurgical repair with improved neurological outcomes.
Why the Other Options Are Incorrect
A. Injury primarily causes weakness of knee extension.
C. Supplies the perineum and external sphincters.
D. Produces posterior thigh and lower leg deficits.
Clinical Pearl
The obturator nerve is the nerve most frequently tested in gynecologic oncology examinations.
, Exam Strategy
Pelvic lymph nodes + Loss of thigh adduction = Obturator nerve injury.
Question 6
A 16-year-old girl presents with primary amenorrhea, cyclical pelvic pain, normal breast development,
and a bulging bluish membrane at the vaginal introitus. Which embryological abnormality best explains this
presentation?
A. Failure of Müllerian duct fusion
B. Imperforate hymen due to failure of hymenal canalization
C. Complete vaginal agenesis
D. Failure of ovarian descent
Correct Answer: B. Imperforate hymen due to failure of hymenal canalization
Detailed Rationale
Imperforate hymen results from failure of degeneration of the central hymenal membrane. Menstrual blood
accumulates behind the obstruction causing:
• Hematocolpos
• Cyclical pelvic pain
• Primary amenorrhea
• Bulging bluish hymen
• Occasionally urinary retention
Definitive management is hymenotomy.
Why the Other Options Are Incorrect
A. Produces uterine duplication anomalies.
C. Usually presents without a visible bulging hymen.
D. Does not produce genital tract obstruction.
