Gyne 3rd LE.docx

GYNE LE # 3 / 2015 1. Which of the following refers to the complaint of a sudden compelling desire to urinate that is difficult to postpone? a) Urge b) Urgency c) Urinary incontinence d) None of the above 2. Which of the following refers to the complaint of the involuntary loss of urine? a) Urge b) Urgency c) Urinary incontinence d) None of the above 3. Which of the following is the most common pathogen of cystitis in women? a) Escherichia coli b) Klebsiella pneumonia c) Staphylococcus saprophyticus d) Proteus mirabilis 4. What is the origin of Loop I in the autonomic and somatic nervous system feedback loops in the act of voiding? a) Brain stem b) Bladder wall c) Urethra d) Frontal Lobe 5. What is the origin of Loop IV in the autonomic and somatic nervous system feedback loops in the act of voiding? a) Coordination b) Detrusor muscle contraction to empty bladder c) Allows relaxation of urethral sphincter on synchrony with detrusor action d) Volitional content of striated external urethral sphincter 6. Parkinson’s disease, brain tumors and trauma can have an effect on which feedback loop? a) Loop I b) Loop II c) Loop III d) Loop IV 7. Bladder detrusor contractility is stimulated by the activity of the parasympathetic nervous system mediated primarily by which neurotransmitter? a) Acetylcholine b) Norepinephrine c) Dopamine d) Histamine 8.

Intravesical pressure depends on which of the following factors? a) Volume of fluid in the bladder b) Smooth muscle fibers of the urethral submucosal cavernous plexus c) Passive elasticity of the urethral wall

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GYNE LE 3 FEEDBACK

d) 9.

Vascular content of the urethral submucosal cavernous plexus

Pilocarpine, a parasympathomimetic alkaloid can have which of the following actions? a) Stimulates bladder contraction, relaxes urethral sphincter. b) Relaxes detrusor muscle, contracts urethral sphincter. c) Stimulates bladder contraction, contract urethral sphincter d) Relaxes detrusor muscle and urethral sphincter.

10. Terbutaline, a beta adrenergic stimulator, can have which of the following actions? a) Detrusor muscle relaxion b) Detrusor muscle contraction c) Urethral sphincter relaxation d) None of the above 11. Treatment of asymptomatic bacteriuria is recommended in which of the following conditions? a) A 65 years old woman with co-morbidities b) A 40 years old diabetic c) A 28 year old at 26 weeks AOG d) A 32 years old woman. 12. Persistent or recurrent cystitis following the initial infection with the same organism is also termed as: a) Relapse b) Reinfection c) Both a and b d) Neither a or b 13. A patient came to your clinic due to dysuria. Physical examination showed urethra that is tender to palpation with pus expressed from it. Gram stain showed intracellular diplococci. What is your management for this patient? a) Cephalexin 250 mg b) Nitrofurantoin 50 mg TID c) Ceftriaxone 125 mg IM d) Trimethoprim 100 mg 14. The following are methods of pelvic muscle strengthening except? a) Kegel exercises b) Biofeedback c) Isometric with vaginal cones d) Pessary use 15. What is the stage if the most distal portion of the prolapse is less than or equal to 1cm proximal or distal to the plane of the hymen? a) Stage 0 b) Stage I c) Stage II d) Stage III 16. What is the stage if there is essentially complete aversion of the total length of the lower genital tract? a) Stage II b) Stage III

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c) d)

Stage IV Stage V

b) c) d)

17. Non operative management of urethra, and cystocele include which of the following? a) Pessary a) Use of tampons b) Kegel exercises c) All of the above 18. The following are inciting factors in pelvic organ prolapse except a) Childbrith b) Nerve dosage c) Tissue absorption d) Gender 19. Patient ME, 45 years old G3P3 (2003) came fore consult due to “falling out” feeling in the vagina. She also complains of constipation with a feeling of incomplete emptying of rectum at time of management. On pelvic examination, there is bulging of the rectum into the vagina. On rectovaginal exam, the rectovaginal septum is paper thin. Transillumination of the bulge showed small bowel shadows within the sac. What is your diagnosis? a) Rectocele b) Urethrocele c) Enterocele d) Cystocele 20. Which of the following conditions has a high rate of recurrence even after repair? a) Rectocele b) Cystiocele c) Enterocele d) None of the above 21. Which of the following ligaments hold the uterus and upper vagina in the proper location over the levator plane? a) Cardinal and uterosacral ligaments b) Round and cardinal ligaments c) Broad and cardinal ligaments d) Round and uterosacral ligaments 22. Which of the following statements is true regarding the use of estrogen in pelvic organ prolapse? a) In older women, use of vaginal estrogen product may improve vaginal atrophy and patient comfort if the prolapsed vaginal mucosa is irritated or ulcerated. b) Evidence has shown that vaginal estrogen can treat POP. c) Evidence has shown that vaginal estrogen can prevent POP. d) Vaginal estrogen should not be used in irritated vaginal mucosa. 23. Measurements in the quantitative description of the pelvic prolapse are expressed in centimeters above or below which structure? a) Genital hiatus

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Hymen. Perineal body. Symphysis pubis.

24. Differential diagnosis for cystocele and eretherocele includes the following except a) Bladder Tumor b) Bladder Diverticula c) Urethral Diverticula d) Urolithiasis 25. Which of the following is a surgical management f a cystocele or Uretherocele? a) Anterior Colpoplasty b) Perinearhaphy c) Posterior Colporhaphy d) Culdoplasty 26. Which surgical management of uterine prolapse should be intended to younger women who wish to maintain their reproductive abilities as they may lead to cervical incompetence a) Manchester operation b) Le Fort Colpo… c) Anterior Colporhaphy d) Vaginal Hysterectomy 27. Which of the following defines endometriosis a) Presence and growth of stroma in lining of the uterus in an aberrant or heteroectopic location b) Presence and growth of glands and stroma of the lining of the uterus in an aberrant heterotrophic location c) Presence and growth of glands of the lining of the uterus in an aberrant or heterotrophic location d) presence of growth of glands and stroma of lining of the uterus into the uterine myometrium 28. Adenomyosis is the growth of endometrial glands and stroma into the uterine myometrium to what depth? a) to a depth of at least 2.0 mm from the basalis layer of the endometrium b) in a depth of at least 2.5 mm from the basalis layer of the endometrium c) to a depth of at least 2.5 mm from the functionalis layer of the endometrium d) to a depth of at least 2.5 cm from the basalis layer of the endometrium 29. Which of the following theories best explain why endometriosis is frequently found in patients with outflow tract obstruction? a) Metaplasia b) Lymphatic and vascular metaplasia c) Retrograde menstruation d) Immunological changes 30. Endometriosis has been discovered in prepubertal girls, women with congenital absence of uterus and very rarely in men, These examples support which theory od Endometriosis

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a) b) c) d)

Metaplasia Lymphatic and vascular metaplasia Retrograde menstruation Immunologic changes

c) Fixed retroverted uterus with scarring and tenderness posterior to the uterus. d) Fixed retroverted uterus with narrowing of posterior vaginal fornix.

31. This theory helps explain rare and remote sites of endometriosis such as spinal column and nose: a) Metaplasia b) Lymphatic and vascular metastasis c) Retrograde menstruation d) Immunologic changes 32. The 3 cardinal histologic features of endometriosis are a) estrogenic endometrial glands, ectopic endometrial stroma b) ectopic endometrial glands, ectopic endometrial stroma, presence if clue cells c) endometrial growth, endometrial stroma, hemorrhage within the endometrium d) ectopic endometrial glands, hemorrhage into adjacent tissue, hemorrhage within the endometrium. 33. The primary long term goal in management of endometrium is a) Relief of pain b) Promotion of fertility c) attempt to prevent progression and recurrence of disease process d) achieve menstrual suppression 34. Medical therapy for endometriosis initiates the following, except a) Danazol b) Estradiol?? c) GnRH agonists d) GnRH antagonist

39. Which of the following provides the best diagnostic tool for endometriosis a) Ultrasound b) MRI c) CT Scan d) X-ray 40. The average age of menopause among Filipina women is a) 51 years b) 43 years c) 49.5 years d) 47 and 48 years 41. The primary determinants of age of menopause? a) Body mass index b) Age of menarche c) Genetic d) Parity 42. Premature ovarian failure or premature ovarian insufficiency is hypergonadotropic ovarian failure occurring prior to age? a) 40 b) 45 c) 30 d) 35

35. Which of the following is the most active phase of endometriosis a) Red, blood filled lesions b) Clear vesicles c) Black lesions d) White lesions

43. Circulation levels of these hormones decreases in postmenopausal women except a) FSH b) DHEA c) Androstenedione d) Testosterone

36. Which of the following in the most common site of endometrial implant? a) Peritoneum over the uterus b) Round ligaments c) Cervix d) Ovaries

44. Levels of these hormones and gonadal proteins increases in postmenopausal women except a) Activing A b) Luteinizing Hormone c) FSH d) Estradiol

37. Which of the following are the classic sign of endometriosis? a) Cyclic pelvic pain and infertility b) Abnormal bleeding and menorrhagia c) Intermittent constipation and diarrhea d) Dysuria and hematuria

45. The hallmark feature of declining estrogen status in the brain is a) Vasomotor episode b) Cognitive decline c) Memory loss d) Depressed mood

38.Which of the following is a classic pelvic finding of endometriosis? a) Anteverted uterus with narrowing of posterior vaginal fornix. b) Anteverted uterus with scarring and tenderness posterior to the uterus.

46. Which of the following is true of estrogen? a) It has a negative effect on collagen b) It has been shown to reduce recurrent urinary tract infections c) It has no proven effect in wound healing

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GYNE LE 3 FEEDBACK

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d)

It has no effect on growth functions

47. Estrogen deficiency results in which of the following? a) Thick, paler vaginal mucosa b) Higher moisture content of vaginal mucosa c) Increased ph of vaginal mucosa d) Increased vaginal blood loss 48. Which of the following statements is true of bone health in menopause? a) Loss of cortical bone is greater with estrogen deficiency than in loss of trabecular bone b) Bone mass in substantially affected by sex steroids c) Estrogen deficiency in most well established as cause of bone loss d) Postmenopausal bone loss is not a substantial health care problem

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GYNE LE 3 FEEDBACK

49. The following are used to prevent osteoporosis except a) Conjugated Equine estrogens b) Bisphosphonates c) Tibolone d) Testosterone 50. The following are possible causes of PCOS except a) Classical Gonadal Dysgenesis b) 17-α Hydroxylase Deficiency c) Hypothyroidisms d) Chemotherapeutic Agents

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