Gyne Prelims 2009

Gyne Prelims 2009 – 2010 1. The sexual history should including the following EXCEPT: a. Coitarche b. Dyspareunia c. Dysuria d. Post-coital bleeding 2. Initial pap smear of a woman who is not sexually active should begin at the age of: a. 35 b. 18 c. 21 d. 15 3. The normal size of the ovary is approximately: a. 1 – 2 cm b. 2 – 3 cm c. 3 – 4 cm d. 4 – 5 cm 4. The following are normal cervical findings during spectrum examination EXCEPT: a. A round external os in a nullipara b. A fishmouth-like external os in a parous woman c. Stellate lacerations in a woman who has delivered vaginally d. NOTA 5. Women between ages 40-64 should have the ff tests done EXCEPT: a. An annual pap smear b. Mammography every 1-2 years until the age of 40 c. Cholesterol levels every 5 years d. Fasting glucose testing every 3 years after age 45 6. Which among the following is the appropriate speculum for the patient: a. A small Grave’s speculum for a 60 year old nulligravid b. A Pederson speculum for a 12 year old c. A large Grave’s speculum for a primigravid who underwent cesarean section due to breech presentation d. A small Grave’s speculum for a sexually active 18 year old 7. Upon doing a bimanual examination of your patient, you are unable to palpate the uterus but were able to do so on rectovaginal examination. Your patient’s uterus is: a. Anteverted b. First degree retroverted c. Second degree retroverted d. Third degree retroverted 8. The proper way to do a bimanual examination includes the ff EXCEPT: a. A lubricated index finger and middle fingers of the dominant hand are placed within the vagina b. The opposite hand is placed on the abdomen above the symphysis pubis c. The patient is placed on supine position d. NOTA 9. Which of the ff depicts a normal menstrual cycle? a. 46 year old with menses occurring every 30 days lasting 7 days b. 21 year old with menses occurring every 42 days lasting 5 days

c. 16 year old with menses occurring every 21 days lasting 2 days d. 13 year old with menses occurring every 42 days lasting 8 days 10. When doing a rectovaginal examination the ff should be palpated EXCEPT a. Retroverted uterus b. Uterosacral ligament c. Rectovaginal septum d. NOTA 11. The middle third of vagina is supported by the ff structures a. Urogenital and pelvic diaphragms b. Levator ani muscles and lower portion of cardinal ligament c. Upper portion of cardinal ligament and parametric d. AOTA 12. It is an important surgical landmark for it provides direct access to the cul-de-sac of Douglas a. Portio vaginalis b. Transformation zone c. Posterior fornix d. A & C 13. True of the Transformation zone of the cervix EXCEPT a. Its position in relation to the long axis of the cervix, depends on her age and hormonal status b. It is where dysplasia of the cervix occurs c. The junction is formed by stratified squamous epithelium on the endocervix and columnar epithelium on the portio vaginalis d. NOTA 14. The layer of the endometrium which responds to the fluctuating hormonal level is/are a. Stratum basale b. Compactum stratum c. Superficial spongy stratum d. A & B e. B & C 15. 2 major arteries, the uterine and ovarian arteries, supply the uterus. The uterine artery originates from the hypogastric artery whereas the ovarian artery originates from: a. Internal iliac artery b. External iliac artery c. Aorta d. Hypogastric artery 16. The 3 prominent ligaments that provides anatomic mobility for the ovary are the a. Posterior portion of the broad ligament, suspensory ligament and ovarian ligament b. Infundibulopelvic ligament, ovarian ligament and mesosalpinx c. Anterior portion of the broad ligament, suspensory ligament and ovarian ligament d. Mesovarium, mesosalpinx, and ovarian ligament 17. The ff are the course of the ureter EXCEPT a. The abdominal portion of the right ureter is lateral to the inferior vena cava b. The pelvic portion of the ureter run along the common iliac artery and then cross over the iliac vessel c. The uterine artery lies on the anterolateral surface of the ureter for 2.5 to 3 cm

d. At the level of the ischial spine it runs forward and laterally to the from the uterosacral ligaments to the base of the broad ligaments e. It runs upward and medially in the visceral uterine ligaments as it enters the bladder 18. The primary muscles of the pelvic diaphragm are the levator ani and coccygeus muscles. Its 3 components are the ff a. Ischiocavernosus, pubococcygeus and puborectalis b. Pubococcygeus, iliococcygeus and puborectalis c. Pubococcygeus, sacrotuberous and puborectalis d. Sacrotuberous, iliococcygeus and pubococcygeus 19. The femoral triangle is bounded by the ff structures EXCEPT a. Adductor longus b. Psoas c. Sartorius d. BInguinal ligament 20. The segment of the fallopian tube which has the most highly developed musculature is the a. Interstitial segment b. Isthmic segment c. Ampullary segment d. Infundibulum 21. The most common benign, slow growing cyst in the vulva whose contents are “cheesy” in character a. Sebaceous cyst b. Epidermal inclusion cyst c. Bartholin’s duct cyst d. Lipoma 22. A permanent, epithelialized, saclike projection that arises from the posterior urethra is a a. Diverticulum of the urethra b. Urethro-vaginal fistula c. Urethral caruncle d. NOTA 23. Which statement is TRUE regarding endometrial polyps? a. Polypoid hyperplasia is a pre-malignant condition b. They are localized overgrowths of endometrial glands and stroma c. Majority of endometrial polyps cause abnormal symptoms d. Polyps have 10% chance of malignant transformation 24. During pregnancy, most myomata a. Grow b. Shrink c. Enlarge and undergo degeneration d. Remain the same size 25. A 23 y/o G1P1 (1001) is found to have a uterine myoma that has a widest diameter of 8 cms. Management will be a. Observation b. Use of GnRh agonist c. Myomectomy d. Hysterectomy

26. A cystadenoma with viscid contents is probably a a. Cystadenofibroma b. Mucinous cystadenoma c. Serous cystadenoma d. Dermoid cyst 27. The ff statements describes follicular cyst EXCEPT a. Found most commonly in young menstruating women b. The initial management is cystectomy c. It spontaneously reabsorbs or silently ruptures within 4 – 8 weeks after diagnosis d. Usually asymptomatic 28. A 24 y/o G0 came in at the ER with complains of sudden, severe, right hypogastric pain. On history taking, she just had sexual contact 4 hours ago, her LMP was Dec. 16, 2009. On PE, her abdomen was soft, (+) direct and rebound tenderness on the RLQ. Pelvic examination revealed cervix is firm, long, close, uterus small, (+) small adnexal mass on the RLQ tender. Pregnancy test was negative. Given the ff information, what is your initial diagnosis? a. Adnexal torsion b. Acute appendicitis c. Ruptured endometrioma d. Ruptured corpus luteum cyst 29. The most common benign solid tumor of the vulva is a. Melanoma b. Pigmented nevus c. Fibroma d. Epidermal inclusion cyst 30. One of the symptoms of cervical myoma is a. Vaginal bleeding b. Perineal tenderness c. Urethral obstruction d. Vaginal discharge 31. Symptoms of hematometra include the ff, except a. Primary amenorrhea b. Cyclic lower abdominal pain c. Dysuria d. NOTA 32. The most common cause of labial fusion: a. Exposure to exogenous androgens b. Congenital adrenal hyperplasia c. Defects in the anterior abdominal wall d. NOTA A32 A complete duplication of the vagina, uterus, and cervix e. Didelphic uterus f. Bicornuate uterus g. Septate uterus h. Arcuate uterus 33. Which among the ff uterine anomalies have been associated with spontaneous or recurrent abortions?

a. b. c. d.

Bicornuate uterus Didelphic uterus Arcuate uterus Unicornuate uterus

34. A single chamber vagina and cervix with a complete or partial septate uterus and two uterine bodies a. Didelphic b. Bicornuate c. Septate d. B & C 35. The uterus appears as a single organ but contains a midline septum that is either partial or complete a. Didelphic b. Bicornuate c. Septate d. Arcuate 36. AJ, 16 y/o presents with primary amenorrhea with cyclic cramping. What is your diagnosis? a. Imperforate hymen b. Transverse vaginal septum c. Vaginal adenosis d. A & B 37. The presence of which of the ff will give you a definitive diagnosis of AJ? a. Bulging at the introitus b. Hematocolpos c. Abdominal mass d. Mucocolpos 38. Diethylstilbestrol exposed females may develop a. Transverse vaginal septum b. Vaginal adenosis c. Imperforate hymen d. A & B 39. Embryologic formation of the genitourinary system where the medial aspect of the more caudal portion of the mullerian ducts fuse forming a median septum occurs a. At the beginning of the 10th week b. 10th to 13th week c. 13th to 20th week d. B & C 40. The vagina develops from a. Paramesonephric duct b. Mullerian tubercle c. Urogenital sinus d. B & C 41. All the ff are risk factors for pelvic organ prolapse EXCEPT a. Pregnancy and childbirth b. Obesity c. Menopause d. Occupation, heavy lifting

e. NOTA 42. Presentation of the pelvic floor relaxation are the ff EXCEPT: a. Pelvic heaviness b. Difficulty defecating c. Low back pain d. Urinary tract infection e. NOTA 43. Ligation of the sac and approximation of the uterosacral ligament is the treatment in: a. Cystocele b. Rectocele c. Enterocele d. Uterine prolapse e. Uretherocele 44. This is most often associated with stress incontinence a. Cystocele b. Rectocele c. Enterocele d. Uterine prolapse e. Uretherocele 45. This hernia develops secondary to the weakness of the pubovesicocervical fascia a. Cystocele b. Rectocele c. Enterocele d. Uterine prolapse e. Uretherocele 46. Vaginal hysterectomy is the treatment of choice in: a. Cystocele b. Rectocele c. Enterocele d. Uterine prolapse e. Uretherocele 47. Which of the ff conditions can be managed with the use of pessary? a. Cystocele b. Rectocele c. Uterine prolapse d. A & C e. AOTA 48. The possible complications of a cystocele include the ff EXCEPT: a. Constipation b. UTI c. Incomplete bladder emptying d. Leakage of urine during sexual activity e. NOTA 49. Which of the ff may lead to strangulation of the intestines? a. Cystocele b. Rectocele c. Enterocele d. Uterine prolapse

e. Uretherocele 50. Invasion of the ff by malignant cells produces retraction of the skin which is a sign of advanced breast ca a. Areola b. Montgomery glands c. Cooper’s ligaments d. Collecting ducts e. A & B 51. A common cause of spontaneous nonmilky nipple discharge a. Intraductal papilloma b. Fibrocystic change c. Fibroadenoma d. A & B e. B & C 52. The classic symptom of fibrocystic change is a. Bilateral cyclic breast pain b. Increased engorgement and density of the breast c. Excessive nodularity d. Tenderness e. Nipple discharge 53. The distinct characteristic of this tumor is hypercellularity of connective tissue microscopically a. Fibrocystic change b. Fibroadenoma c. Cystosarcoma phyllodes d. Intraductal papilloma e. Fat necrosis 54. The second most common type of benign disease of the breast a. Fibrocystic change b. Fibroadenoma c. Cystosarcoma phyllodes d. Intraductal papilloma e. Fat necrosis 55. In mammography, it demonstrates as fine needle stippled calcification and stellate contraction a. Fibrocystic change b. Fibroadenoma c. Cystosarcoma phyllodes d. Intraductal papilloma e. Fat necrosis 56. The ff are true of breast cancer a. The frequency is not age dependent b. Bilateral oophorectomy reduces the risk by 70% c. Obese women are at a higher risk during the premenopausal years d. First term pregnancy at the age of 30 is at a lower risk than one at the age of 20 e. B & D 57. Lobular carcinoma in situ: a. Should be treated as a cancer

b. c. d. e.

Is of higher malignant potential than intraductal carcinoma in situ It can be detected on palpation Is a marker for an increased breast cancer risk AOTA

58. This neoplasia tends to have a multicentric origin in the same breast and tends to involve both breasts a. Infiltrating lobular carcinoma b. Infiltrating ductal carcinoma c. Intraductal carcinoma d. Inflammatory carcinomas e. Paget’s disease 59. This type of neoplasia is recognized clinically as a rapidly growing, highly malignant carcinoma a. Infiltrating lobular carcinoma b. Infiltrating ductal carcinoma c. Intraductal carcinoma d. Inflammatory carcinomas e. Paget’s disease 60. Which of the ff statements is/are true regarding Bartholin’s gland enlargement a. Bartholin’s duct cyst is usually asymptomatic b. In Bartholin’s gland abscess, organism involved are usually organism involved in STD infection c. A Bartholin’s duct cyst is usually due to obstruction of the duct from trauma or non-specific infection d. A & C are correct e. AOTA 61. Which among the ff lower genital tract infections is associated with the development of intraepithelial neoplasia of the lower genital tract a. Molluscum contangiosum b. Herpes simplex virus c. HPV infection d. HIV infection e. AOTA 62. A 30 y/o G3P3 presents with fever and myalgia. After 6 days she developed painful and pruritic vesicles appeared on the vulva with inguinal lymphadenopathy noted. The most likely diagnosis is a. Syphilis b. Herpes simplex virus c. HPV d. Lymphgranuloma venereum 63. After 7 days, the vulvar lesions disappeared without scarring. You should advise the ff a. Since this is a viral infection, the disease is self limiting and the patient is already cured b. The patient is not anymore contagious since the vesicles disappeared already c. The disease is characterized by the recurrent infections of less severe intensity than the primary infection d. B & C are correct e. NOTA 64. Administration of antiviral drug to the above patient, such as Acyclovir will result in

a. b. c. d. e.

Reduction in the period of viral shedding Complete eradication of the virus Lesser incidence of recurrent infections A & B are correct A, B and C

65. Characterized by 3 stages with lymphatic involvement causing manifestations of the disease a. Syphilis b. Chancroid c. Granuloma inguinale d. Lymphogranuloma venereum 66. Painless ulcer with raised rounded borders called chancre a. Primary syphilis b. Secondary syphilis c. Tertiary syphilis d. Chancroid 67. PID symptoms usually manifest after menstruation because of the ff: a. Menstruation causes removal of the cervical mucus allowing organisms to ascend b. Retrograde menstrual flow facilitates transport of bacteria to the fallopian tube c. The immune system response decreases during menstruation d. A & B e. A, B & C 68. A patient comes to you with history of amenorrhea. On PE, you noted a distended abdomen with (+) fluid wave. She also has history of chronic salpingits. Your impression is a. Chronic PID b. Pelvic TB c. Ovarian carcinoma d. Ectopic pregnancy 69. The most important feature of PID is a. Cervicitis b. Endometritis c. Salpingitis d. Oophoritis For numbers 71 – 80, write A if the statement refers to Adenomyosis B if the statement refers to Endometriosis C if the statement refers to BOTH D if the statement refers to NEITHER 70. With fewer estrogen and progesterone receptors than normal endometrium hence very responsive to hormonal therapy. 71. Common among women the reproductive age and rare among the postmenopausal. 72. A malignant disease capable of invading adjacent myometrial layer of the uterus. 73. Uterine muscle is encapsulated with whorl like pattern on cut section of the gross specimen. 74. High estrogen levels causes the endometrial glands and stroma to undergo hyperplasia. 75. Due to the invasion of endometrial tissues of the basalis layer of the endometrium into the myometrium. 76. Most common site is the ovary.

77. More common among young, infertile, career women who defer pregnancy to later age. 78. Presents as dysmenorrhea, pelvic pain, menstrual dysfunction 79. Grossly appear on cut section as spongy tissues with blood filled cystic spaces or blood. For numbers 81 – 90, write TRUE if the statement is true, and FALSE if not. 80. Administration of combined estrogen and progesterone pills is the best modality of treatment for acute bleeding episodes. 81. Progesterone facilitates rapid endometrial proliferation. 82. Amenorrhea is defined as cessation of menstrual flow after the reproductive period. 83. Anorexia nervosa is the most common cause of primary amenorrhea. 84. Secondary amenorrhea is the absence of menses for 12 months in a woman who previously had regular menstrual flow. 85. Dysfunctional uterine bleeding may occur in the absence of demonstrable organic cause, genital or extragenital. 86. Dopamine is a precursor of norepinephrine. 87. The ovary secretes 3 principal steroid hormones: estradiol, progesterone and androstenedione. 88. Recruitment phase corresponds to days 5-8 of the ovarian cycle. 89. LH acts on granulose cells to stimulate follicular growth. MATCHING TYPE 90. Decrease in estrogen after ovulation 91. Short proliferative phase 92. Excessive bleeding at regular interval 93. Variable amount of bleeding at irregular and frequent intervals 94. Self-limiting

A. B. C. D. E. F. G.

Menorrhagia Intermenstrual bleeding Hypermenorrhea Metrorrhagia Midcycle spotting Polymenorrhea Menometrorrhagia

95. Preferred long term treatment for adolescents 96. Given as preoperative treatment 97. Enhances production of coagulation factors 98. Risk of osteoporosis 99. Medical menopause

A. B. C. D. E. F. G. H. I.

Estrogen Progesterone Estrogen + Progesterone Levonogesterol IUD Mefenamic acid Tranexamic acid GnRH analog Danazol NSAID