Board Exams Ob Gyn 2009
OBSTETRICS & GYNECOLOGY Physician’s Licensure Examination June 4, 2009; 1:00 – 5:00 1. Among the following ligaments, the one that gives major support to the uterus is the: a. broad ligament b. cardinal ligament c. infundibulopelvic ligament d. round ligament 2. A 16 y.o. nulligravid was brought to the ER due to a straddle injury. On inspection, the right vulva was converted to a 5 x 6 cm bluish tender mass. The most probable vessel that is involved in this is the: a. cervicovaginal branch of the uterine artery b. vestibular artery c. pudendal artery d. inferior vesical artery 3. One of the major blood supplies of the pelvic organs is derived from: a. The uterine arteries, which branch directly from the hypogastric arteries b. the ovarian arteries, which branch directly from the internal iliac arteries c. the external iliac arteries, which branch directly from the common iliac arteries d. the cervico-vaginal branches of the uterine arteries 4. A patient with myoma uteri presents with pyelonephritis resulting from ureteral obstruction. The most likely location of the myoma is a. subserous b. intramural c. intraligamentary d. submucous 5. The best predictor of ovulation is: a. estrogen peak b. FSH surge c. LH surge d. Rise in progesterone 6. A patient who regularly has a 34-day ovulatory cycle asks for opinion as to when she is most likely to conceive. Her ovulation most probably occurs on day: a. 16 b. 18 c. 20 d. 22 7. Rationale for giving high dose estrogen to stop bleeding in treating patients with severe menorrhagia secondary to anovulation: a. increases platelet aggregation b. increased spiral artery recoil c. promotes synthesis of prostaglandin d. promotes rapid endometrial growth 8. Which of the following is part of the ovarian phase of the menstrual cycle? a. menstrual phase b. secretory phase c. luteal phase d. proliferative phase 9. The patient with abnormal uterine bleeding is: a. 18 y.o. whose interval of menses is 24 to 30 days b. 41 y.o. whose menses last 8 to 10 days c. 29 y.o. on DMPA with occasional vaginal spotting d. 22 y.o. leukemic patient with menstrual blood loss of 80 ml
OBSTETRICS & GYNECOLOGY Physician’s Licensure Examination June 4, 2009; 1:00 – 5:00 10. This refers to the violaceous discoloration of the vagina because of increased vascularity starting on the 6th week of pregnancy: a. Hegar’s sign b. Goodell’s sign c. Chadwick’s sign d. Spalding’s sign 11. Why is cardiac output in late pregnancy higher in the lateral recumbent rather than in the supine position? a. the gravid uterus impedes cardiac venous return in the supine position b. the uterine vessels become distended in the supine position c. hormonal effects are greater in the lateral recumbent position d. hormonal effects are greater in the lateral recumbent position 12. For which reason is the pregnant woman with asthma more likely to develop hypoxia? a. increased residual volume b. decreased functional residual capacity c. decreased tidal volume d. increased inspiratory capacity 13. Which among the following contribute to pregnancy-induced ureteral dilatation? a. hormonal effect b. compression of the uterus at the pelvic brim c. compression of the sigmoid colon d. dilated right ovarian artery 14. True statement regarding renal hemodynamics during pregnancy: a. serum creatinine and urea nitrogen values increase b. renal plasma flow increases c. protein, amino acid and glucose excretion decrease d. serum osmolality increased by 10 mOsm/L 15. The nausea and vomiting commonly experienced by many women during the first trimester of pregnancy is an adaptation to the increased level of: a. estrogen b. progesterone c. luteinizing hormone d. chorionic gonadotropin 16. Confirmatory diagnosis of pregnancy: a. positive pregnancy test b. cervical mucus beading on microscopy c. morning sickness d. fetal heart tones heard using a fetal Doppler machine 17. The minimum daily requirement for ferrous (iron) to meet increased iron requirements during pregnancy: a. 25 mg b. 26 mg c. 27 mg d. 28 mg 18. A healthy pregnant woman asks you for clearance to travel by plane. You tell her that: a. air travel can be harmful to pregnancy b. she can travel anytime c. she can safely travel up to 36 weeks AOG d. she can travel after the 1st trimester 19. The fetal heart tones can be best heard in this area if the following were the Leopold’s findings:
OBSTETRICS & GYNECOLOGY Physician’s Licensure Examination June 4, 2009; 1:00 – 5:00 L1 - large nodular mass L2 – hard, resistant structure at the right side of the mother Small, irregular, mobile parts on the left side of the mother L3 – movable hard round mass L4 – tips of the fingers able to meet a. b. c. d.
right lower quadrant left lower quadrant right upper quadrant left upper quadrant
20. Ms. X, a fashion model, is very figure-conscious. She inquires about weight gain during pregnancy and how soon she can get back into shape postpartum. What information will you tell her? a. the average weight gain during pregnancy is 14 kg, and is easily shed off during the puerpuerium b. recommended weight gain during pregnancy depends on pre-pregnancy weight c. weight gain should be about 2.7 kg/month, and should commence as early as the first trimester d. regardless of the route of delivery, she can start exercising 4 weeks postpartum 21. A 25 y.o. primigravid, 9 weeks AOG, sought consult with you for the first time for prenatal check up. Which among the labs will you request for? a. 100 g OGTT b. TORCH titers c. Complete blood count d. complete Hepatitis B profile 22. Which vaccine is contraindicated during pregnancy? a. tetanus b. measles c. influenza d. pneumococcus 23. Hepatitis B virus screening of pregnant women prior to delivery will identify new infants who: a. have passive immunity to the hepatitis B virus b. need hepatitis B virus vaccination c. need hepatitis B immunoglobulin injection d. are carriers of hepatitis B virus 24. In a mother positive for Hepatitis B antigen who plans to breastfeed her baby, you tell her that: a. breastfeeding is contraindicated. Just give milk formula b. breastfeeding is not contraindicated c. breastfeeding is allowed once baby has been immunized d. breastfeeding may be done as long as mother is not highly infective 25. The frequency of prenatal visits from 28 to 36 weeks is: a. every week b. every 2 weeks c. every 3 weeks d. every month 26. Smoking during pregnancy has been linked with the following except: a. placental abruption b. placenta previa c. fetal death d. fetal macrosomia
OBSTETRICS & GYNECOLOGY Physician’s Licensure Examination June 4, 2009; 1:00 – 5:00 27. Mrs. X is unsure of her last normal menstrual period since she has irregular menstrual cycle. On abdominal examination, you noted that the fundus is palpable at the level of the umbilicus. What is your estimated age of gestation? a. 16 weeks b. 18 weeks c. 20 weeks d. 24 weeks 28. True statement regarding Braxton-Hicks contractions: a. may occur every 10-20 minutes b. frequently occurs during the second trimester c. almost always painless d. intensity varies between 50 and 75 mm Hg 29. A characteristic of true labor: a. intervals lengthen b. discomfort is relieved by sedation c. contractions occur at regular intervals e. cervix remains closed 30. Who among the following women has an abnormal pattern of labor? a. 32/G3P2 (2002) who started her labor 10 hours ago, her cervix is 2 cm dilated, 50 % effaced b. 25/G1P0 who entered the active phase of labor at 4 cm dilatation 6 hours ago, her cervix is 7 cm dilated c. 28/G4P3 (3003) delivered 20 minutes after full cervical dilatation d. 34/G5P4 (4004) with rate of cervical dilatation of 2 cm/h 31. A 20 y.o. primigravid came in labor with age of gestation 38 weeks. Internal exam showed the cervix to be 7 cm dilated, BOW ruptured, station -1. After an hour, the cervix became fully dilated with the fetal head still at station -1. At this point, your impression is: a. dysfunctional labor, failure of descent b. dysfunctional labor, arrest of descent c. prolonged deceleration phase d. protracted active phase 32. In a multigravid, the minimum rate of cervical dilatation in the active phase of labor is: a. 0.5 cm/h b. 1.2 cm/h c. 1.5 cm/h d. 2.0 cm/h 33. The fetal cardinal movements of labor occur during: a. preparatory division b. dilatational division c. pelvic division d. functional division 34. Which of the following is the correct sequence of the cardinal movements of labor? a. engagement, flexion, extension, internal rotation, external rotation, descent, expulsion b. flexion, internal rotation, engagement, extension, external rotation, descent, flexion c. descent, engagement, internal rotation, flexion, external rotation, extension, expulsion d. engagement, descent, flexion, internal rotation, extension, external rotation, expulsion 35. The young primigravid patient at full cervical dilatation is instructed to bear down several times before delivery of the fetus. Edema was noted over the most dependent portion of the fetal head. The mother is advised that this is:
OBSTETRICS & GYNECOLOGY Physician’s Licensure Examination June 4, 2009; 1:00 – 5:00 a. cephalic prominence b. cephalhematoma c. caput succedaneum d. molding 36. Advantage of mediolateral episiotomy versus midline episiotomy: a. fourth degree laceration is uncommon b. surgical repair of midline episiotomy is more difficult c. postoperative pain is minimal d. faulty healing is rare 37. You are tasked to deliver a mother whom you have been monitoring since admission. After spontaneous delivery of the baby and clamping/cutting of the cord, you note sudden gush of blood. The next best step would be: a. give oxytocin drip to decrease blood loss b. wait for other signs of placental separation c. start pulling on the cord to assist placental delivery d. do manual extraction of the placenta 38. The placenta should be delivered within what period of time following delivery? a. 1-2 minutes b. 3-10 minutes c. 12 – 15 minutes d. 15 – 20 minutes 39. A 28 y.o. G3P2 (2002) was brought to the Delivery Room. Internal examination showed a fully dilated cervix with the head at station +2. On auscultation, the fetal heart tone was noted to be 100 beats per minute associated with uterine contractions but with recovery. The most probable cause of deceleration is: a. fetal head compression b. uteroplacental insufficiency c. umbilical cord compression d. maternal exhaustion 40. The following are important in determining a patient’s cervical ripeness except: a. cervical dilatation b. station of presenting part c. condition of bag of waters d. position of the cervix 41. The latent phase of labor of a 19 y.o. primigravid already exceeded 20 hours. The preferred treatment for this case is: a. therapeutic rest b. oxytocin drip c. cesarean delivery d. expectant 42. True about the use of magnesium sulfate as anti-convulsant in pre-eclampsia a. the loading dose is a total of 14 g given intravenously b. bedside toxicity monitoring includes checking the deep tendon reflexes, respiratory rate, and urine output c. serum magnesium level monitoring is necessary d. anticonvulsant action is carried out peripherally 43. A 24 y.o. primigravid at 37 weeks age of gestation consulted the Emergency Room with a blood pressure of 150/90. Urine albumin was +1. The fundic height is 26 cm with an estimated fetal weight of 1 kg. The cervix was noted to be 2 cm dilated with intact bag of waters. The admitting diagnosis is: a. gestational hypertension b. pre-eclampsia, mild
OBSTETRICS & GYNECOLOGY Physician’s Licensure Examination June 4, 2009; 1:00 – 5:00 c. pre-eclampsia, severe d. chronic hypertension with superimposed pre-eclampsia 44. Therapeutic levels of magnesium sulfate are maintained at this level to prevent eclamptic seizures: a. 4-7 meq/L b. 8-10 meq/L c. 10-12 meq/L d. more than 12 meq/L 45. The patient at the Intensive Maternal Unit was given a loading dose of magnesium sulfate. As the intern-on-duty, you will monitor the following before administering the next dose except: a. patellar reflex b. urine output c. respiratory rate d. muscle strength 46. A 28 y.o. G1P0 admitted at 32 weeks age of gestation with a blood pressure of 190/120, jaundiced, with hematuria, gum bleeding and petechiae all over. The most likely diagnosis is: a. severe pre-eclampsia b. acute fatty liver of pregnancy c. HELLP Syndrome e. fulminant hepatitis 47. When managing a 14 y.o. who is pregnant, the physician should recognize that the adolescent is at risk for: a. glucose intolerance b. fetal chromosomal abnormalities c. incompetent cervix d. iron deficiency anemia 48. Cause of insulin resistance in pregnancy: a. increased human chorionic gonadotropin levels b. decreased cortisone levels c. decreased human placental growth hormone d. increased chorionic somatomammotropin hormone 49. A 27 y.o. G1P0, on her 16th week of pregnancy consults for prenatal check up. Both parents are diabetic. You will advise her to do a: a. 100 gram oral glucose tolerance test immediately b. 50 gram glucose challenge test immediately c. 100 gram oral glucose tolerance test at 24-28 weeks AOG d. 50 gram glucose challenge test at 24-28 weeks 50. Cornerstone in the management of gestational diabetes mellitus except: a. blood glucose monitoring b. exercise c. nutrition d. oral hypoglycemics 51. A 36 y.o. G3P2 (2002) had a 50 gram GCT result of 155 mg/dl. What is to be done next? a. nothing b. a 100 g OGTT c. refer to an endocrinologist for management of GDM d. order for urine ketones 52. A 33 y.o. primigravid on her 38th week of gestation was brought to the Emergency Room by her husband for a sudden gush of fluid from the vagina. On pelvic examination, the
OBSTETRICS & GYNECOLOGY Physician’s Licensure Examination June 4, 2009; 1:00 – 5:00 umbilical cord was noted to be coming out of the vagina. Important management at this point: a. place the patient in trendelenburg position b. apply downward pressure on the presenting part c. await spontaneous vaginal delivery d. ask the patient to start bearing down 53. After a successful cesarean section delivery for breech, the G1P1 mother asked her OBGYN if she has a chance to have vaginal delivery next time she gets pregnant. Which of the following conditions may make vaginal delivery possible? a. mother has contracted pelvis b. previous scar is a low segment cesarean c. malpresented fetus d. abnormal placentation-previa 54. A 40 y.o. G7P6 (6006) was admitted for labor pains. After 3 hours, she delivered her twins vaginally. Ten minutes after the delivery of the second twin, there was profuse vaginal bleeding, BP was 80/50, HR was 110/min. The most probable cause of the bleeding is a. cervical laceration b. placenta accreta c. uterine atony d. retained products of conception 55. Worldwide, the most common cause of pregnancy-related death is: a. HIV infection b. hemorrhage c. sepsis d. hypertension 56. A 25 y.o. primigravid consulted at the Emergency Room on her 36 th weeks age of gestation with abdominal pain and decreased fetal movement. On palpation, there was note of titanic uterine contractions. Internal examination revealed the cervix to be 3 cm dilated, fully effaced. The next best thing to do is: a. amniotomy b. tocolysis c. emergency cesarean section d. augment labor 57. The most expedient procedure in a G2P1 with ruptured ampullary pregnancy with unstable vital signs is: a. salpingectomy b. salpingostomy c. salpingotomy d. fimbrial expression of the ectopic gestation 58. A 41 y.o. G4P3 (3003) was admitted at 40 weeks AOG with an ultrasound result of placenta previa (placenta anterior and totally covering the os). Her three previous pregnancies were terminated by low segment cesarean section with no complications. What should you anticipate with this delivery? a. profuse vaginal bleeding if you wait 3 more days b. uterine atony c. bleeding sinuses at the lower uterine segment d. placenta accreta 59. Factors promoting puerpueral infection include: a. prolonged rupture of membranes b. limited number of vaginal examination c. normal hemoglobin levels d. normal labor
OBSTETRICS & GYNECOLOGY Physician’s Licensure Examination June 4, 2009; 1:00 – 5:00 60. Which of the following organisms is associated with high fever in the first 24 hours after childbirth? a. b. c. d.
group A Streptococcus Bacteroides bivius Peptostreptococcus Bacteroides fragilis
61. The only appropriate drug for syphilis during pregnancy: a. doxycycline b. tetracycline c. benzathine penicillin d. ceftriaxone 62. A 19 y.o. primigravid came in at the ER with vaginal bleeding. Her amenorrhea is 12 weeks. On pelvic exam, the cervix is open and the corpus 8 weeks size. Your diagnosis is: a. incomplete abortion b. completed abortion c. threatened abortion d. septic abortion 63. At least 50 % of early abortions are caused by: a. infections b. immunological factors c. drug use d. chromosomal anomalies 64. A 19 y.o. pregnant cousin asks you regarding a medication which is classified as category C. You tell her that it means that the drug has: a. no fetal risks in human studies b. no fetal risks in human studies c. fetal risks outweigh benefits d. adverse effects in animal studies but no human data 65. The triad of ectopic pregnancy includes a. amenorrhea, abdominal pain, and vaginal bleeding b. amenorrhea, positive pregnancy test and vaginal spotting c. positive pregnancy test, vaginal bleeding, and hypotension d. positive pregnancy test, adnexal tenderness, and vaginal bleeding 66. Risk factors that are classified as high risk for ectopic pregnancy include the following except: a. tubal corrective surgery b. tubal sterilization c. previous ectopic pregnancy d. previous pelvic or abdominal surgery 67. A 55 y.o. G5P5 (5005) consulted for fish-wash like vaginal discharge and on-and-off vaginal bleeding. Pelvic exam showed the cervix to be converted to a 6 x 5 cm nodular, fungating mass extending to the R lateral fornix, the right parametria nodular but free while the left was smooth and pliable. Based on the information given, this patient can be clinically staged as a. IIB b. IIIA c. IIIB d. IVA 68. A 53 y.o. G1P1 (1001) underwent exploratory laparotomy for an ovarian new growth. Intraoperative findings showed the right ovary to be converted to a 10 cm predominantly cystic mass with excrescences on its outer capsule and densely adherent to the fundal
OBSTETRICS & GYNECOLOGY Physician’s Licensure Examination June 4, 2009; 1:00 – 5:00 portion of the uterus. The left ovary was grossly normal. All other abdominopelvic organs were grossly normal. Based on the information given, the Intraoperative stage of this patient is a. IA b. IB c. IC d. IIA 69. Histopath of a a 47 y.o. nulligravid who underwent PFC, THBSO, BLND was read as follows: Endometrial adenocarcinoma, endometrioid type, well-differentiated with less than 50 % myometrial invasion. Chronic endocervicitis with squamous metaplasia Negative for tumor: peritoneal fluid, all harvested lymph nodes. Positive lymphovascular space invasion. No diagnostic abnormality recognized, both ovaries and fallopian tubes What is the stage of the patient? a. Stage IB b. Stage IC c. Stage IIB d. Stage IIIC 70. This woman is at high risk to develop endometrial carcinoma: a. 52 y.o. breast cancer patient on tamoxifen b. 35 y.o. nulligravid with PCOS c. 37 y.o. with BMI of 35 kg/m2 d. all of the above 71. In an epithelial carcinoma of the ovary, the tumor marker that is most likely to be elevated is: a. alpha fetoprotein b. lactic dehydrogenase c. CA 125 d. B-hcg 72. The most common genital tract malignancy in Filipino women based on the 2005 Philippine Cancer Facts and Estimates is: a. vulvar cancer b. cervical cancer c. endometrial cancer d. ovarian cancer 73. A 17 y.o. nulligravid consulted for an Abdominopelvic mass. On physical examination, there were virilizing signs and symptoms. Even before a pelvic exam is done, the primary consideration if this were an ovarian pathology is: a. epithelial tumor b. germ cell tumor c. sex-cord stromal tumor d. metastatic tumor 74. A 27 y.o. primigravid consults at the ER for vaginal spotting of one week duration. She has an amenorrhea of 10 weeks. On pelvic exam, you note the uterus to be boggy and enlarged to 20 weeks age of gestation. Ultrasound showed an endometrial mass with snowstorm pattern. Best management for this case would be: a. subtotal hysterectomy b. total hysterectomy c. suction curettage e. dilatation and curettage 75. According to the American Cancer Society Guidelines for Cervical Cancer Screening, screening using Pap smear should be started
OBSTETRICS & GYNECOLOGY Physician’s Licensure Examination June 4, 2009; 1:00 – 5:00 a. b. c. d.
age 12 age 18 age 21 once the woman is sexually active
76. In low resource settings like the Philippines, this has become an acceptable method of cervical cancer screening: a. Schiller’s test b. Toluidine blue test c. 4-quadrant cervical biopsy d. visual inspection with acetic acid 77. Staging of ovarian cancer is: a. clinical b. surgicopathologic c. clinicopathologic d. histopathologic 78. Speculum exam of a 27 y.o. complaining of leucorrhea showed copious frothy greenish vaginal discharge with strawberry-like mucosa. This is most likely due to: a. candidiasis b. trichomoniasis c. gonococcal infection d. bacterial vaginosis 79. In a patient with mucopurulent cervicitis, the patient is also given doxycycline to take care of: a. Neisseria gonorrhea b. Ureaplasma urealyticum c. Chlamydia trachomatis d. Gardnerella vaginalis 80. Which of the following is not considered a sexually transmitted disease? a. Candidiasis b. Trichomoniasis c. Syphilis d. Genital warts 81. A 20 y.o. commercial sex worker came to you because of multiple, pruritic warty masses at the vulva. The largest measured 2 x 3 cm. Causative agent of these warts: a. pox virus b. bacterial c. treponemes d. human papilloma virus 82. The most accurate method of diagnosing acute PID is: a. history b. pelvic examination c. ultrasound d. diagnostic laparoscopy 83. A 48 y.o. G3P3 (3003) consulted at the Out Patient Clinic for menometrorrhagia since 5 months ago. Pelvic exam showed a corpus irregularly enlarged to 16 weeks size. Ultrasound showed multiple myoma uteri. Best treatment option for this patient would be: a. THBSO b. myomectomy c. GnRH agonist d. progestin supplementation 84. A 35 y.o. G3P3 (3003) consults at the Emergency Room for severe abdominal pain. Pelvic examination reveals a vague mass at the left adnexal area. But a thorough
OBSTETRICS & GYNECOLOGY Physician’s Licensure Examination June 4, 2009; 1:00 – 5:00 examination is difficult due to guarding. On exploratory laparotomy, the left ovary is converted to a 6 x 8 cm cystic mass with a 1 cm point of rupture extruding brownish fluid. Best management for this case would be: a. left oophorocystectomy b. left salpingo-oophorectomy c. TH, LSO d. THBSO 85. A 36 y.o. G1P1 (1001) consulted for menorrhagia of one year duration. Internal examination showed a globular uterus symmetrically enlarged to 14 weeks size. Sonographic impression was consistent with adenomyosis. Definitive management consists of: a. continuous low-dose oral contraceptive pills b. GnRH agonists c. DMPA injections d. total hysterectomy 86. A 6 y.o. child underwent exploratory laparotomy for an ovarian cyst. The most common finding is: a. serous cystadenoma b. dysgerminoma c. dermoid cyst d. physiologic ovarian cyst 87. Endometriosis in this location suggests iatrogenic dissemination: a. spinal column b. anterior abdominal wall c. cul de sac d. ovary 88. Theca lutein cysts may be found in the following conditions: a. gestational trophoblastic diseases and hyperthyroidism b. acute renal failure and syphilis infection c. diabetes mellitus and hypertension d. multiple gestation and tuberculosis 89. The use of combined oral contraceptives will protect a woman from a. ovarian cancer b. breast cancer c. cervical cancer d. liver cancer 90. A 21 y.o. G2P2 (2002) is interested to learn the use of rhythm method. She reports that for the past year, her longest cycle was 38 days while the shortest was 24 days. Abstinence should be observed during the following days of her cycle: a. day 17 to 23 b. day 8 to 21 c. day 6 to 27 d. day 15 to 20 91. The following are known effects of OCP except: a. reduced maternal blood loss and anemia b. increased risk of ectopic pregnancy c. improvement of acne d. decreased risk of endometrial and ovarian cancer 92. A 25 y.o. primipara is desirous of family planning. She is 2 months postpartum and claims to have been partially breastfeeding. The best method would be: a. progestin-only pills b. combined OCP
OBSTETRICS & GYNECOLOGY Physician’s Licensure Examination June 4, 2009; 1:00 – 5:00 c. lactation amenorrhea d. bilateral tubal ligation 93. How many weeks postpartum is menstruation expected to return in a non-breastfeeding woman? a. 1 to 2 weeks b. 3 to 4 weeks c. 6 to 8 weeks d. 12 to 14 weeks 94. Who among the following should be worked up for amenorrhea? a. 14 y.o. with no breast budding b. 15 y.o. with breast Tanner stage 2 c. 12 y.o. with breast Tanner stage 3 d. 16 y.o. who had her menarche 4 months ago but is amenorrheic presently 95. The pathognomonic symptom of menopause: a. wrinkling of skin b. osteoporosis c. hot flush d. decrease in libido 96. During the perimenopausal transition, there is: a. increased FSH b. decreased estradiol c. increased LH d. increased inhibin 97. Which of the following is most effective in reducing postmenopausal bone loss? a. weight-bearing exercise b. calcium supplementation c. estrogen therapy d. vitamin D supplementation 98. In semenalysis, the normal value of sperm motility is: a. at least 20 % b. at least 30 % c. at least 40 % d. at least 50 % 99. Among the different causes of infertility, the treatment of this has the greatest success rate: a. ovulatory dysfunction b. tubal dysfunction c. male factor d. uterine pathology 100. Rectocoele and cystocoele are usually due to: a. relaxation of musculature of the pelvic floor b. injury during childbirth c. infection of the bladder d. trauma in repair of an episiotomy -END-