OB Gyne Final Exam Flashcards
1
Q
Which of the following is the correct flow of blood from the uterine wall to the endometrium?
A
A. Uterine artery àarcuate artery àradial arteryà straight & coiled spiral artery
2
Q
What is the functional life span of the corpus luteum?
A
B. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 daysB. 14 + 2 days
3
Q
What hormone is secreted by the dominant ovarian follicle?
A
C. estradiol
4
Q
During the embryonic period, where is the formation of blood first demonstrable?
A
B. yolk sac
5
Q
During the secretory phase, what is the uppermost layer from the uterine cavity ?
A
A. Zona compacta
6
Q
What stage of human development is implanted in the uterine cavity?
A
C. blastocyst
7
Q
How many new primary oocytes are there during puberty?
A
A. 0
8
Q
What is the important event that occurs prior to implantation?
A
D. Disappearance of the zona pellucida
9
Q
At what phase does regresson of the corpus luteum occur?
A
C. During menstruation
10
Q
A 34 year old G4P4 delivered vaginally an 8 lb baby at home assisted by a hilot. The placenta was delivered without difficulty. However, a few minutes later, there was profuse vaginal bleeding and the patient wa rushed to the hospital. In the ER, the patient was hypotensive, tachycardic and pale. On abdominal examination, the uterine fundus was soft and above the umbilicus. There were no vaginal or cervical lacerations. What is the most probable diagnosis?
A
D. uterine atony
11
Q
A 33 year old G3P2 PU 18 weeks consulted at the ER because of watery vaginal discharge accompanied by hypogastric pain. Vital signs were normal. Speculum exam revealed pooling of watery discharge. I.E. revealed an open cervix, palpable fetal parts at the os, uterus enlarged to 18 weeks AOG. What is the most probable diagnosis?
A
C. Inevitable abortion
12
Q
At what part of the fallopian tube does tubal rupture occur earliest?
A
C. Isthmic
13
Q
What is the most commonly associated condition for abruption placenta?
A
B. Pregnancy- induced hypertension
14
Q
Which of the following transvaginal utrasonographic cervical findings correlate positively with preterm delivery?
A
B. funneling
15
Q
Preterm infant is an infant who is:
A
C. less than 37 weeks AOG
16
Q
A 35 year old G1P0 had an infertility work-up fro which she was prescribed clomiphene citrate. She got pregnant and was diagnosed to have twin pregnancy. What is the most probable type of twinning?
A
B. Dizygotic
17
Q
Which of the following is the most important parameter in the assessment of patient in true labor?
A
B. cervical dilatation and effacement
18
Q
The level of the presenting part in the birth canal described in relationship to the ischial spines, which is halfway between the pelvic inlet and the pelvic outlet is called
A
D. station
19
Q
The characteristic curve pattern of cervical dilatation in a normal labor is described as:
A
B. sigmoidal
20
Q
A 30 year old G1P0, term was admitted for labor pains. FH- 34 cm, FHT- 140 bpm. IE- cervix is 4 cm dilated, 60% effaced, cephalic, station -2, rupture BOW. Uterine contractions every 2-3 mins, moderate. After 2 hours, IE- cervix 4-5 cm dilated, 70 % effaced, station -2. After 2 hours, IE- cervix is 5-6 cm dilated, 80% effaced, station -1.Describe the progress of labor.
A
B. Protracted cervical dilatation
21
Q
What phase of the active labor reflects the feto-pelvic relationship?
A
D. deceleration phase
22
Q
A 19 year old G1P0 PU 40 weeks, not in labor, was seen at the OPD for decreased fetal movement. She was hooked to an electronic fetal monitor and tracing showed: Baseline FHT- 140’s, good variability, with more than 2 accelerations of 20 bpm lasting for 20 secs. The tracing is interpreted as:
A
A. reactive
23
Q
Fetal tachycardia is defined as a baseline heart rate greater than:
A
C. 160 bpm
24
Q
What is the presentation type when the fetal head is artially flexed with the anterior fontanel or bregma is presenting?
A
D. sinciput
25
You were the intern on duty in the ER and you did an abdominal exam on a 22 year old G2P1 PU 37 weeks who consulted because of hypogastic pain. You found out that the fundus is occupied by a hard ballotable mass. What Leopold’s maneuver did you perform?
A. LM 1
26
There is an increase in the size of cardiac silhouette in X-ray during pregnancy because the heart is displaced to the:
A. left and upward
27
During pregnancy, the diaphragm rises by
B. 4 cm
28
Impaired gall bladder contraction during pregnancy is due to
C. progesterone
29
Naegele’s rule is use to estimate the expected date of delivery by ____.
D. adding 7 days to the first day of LMP and count back 3 months
30
Which of the following is proven teratogen?
A. Vitamin A derivatives
31
Which of the following vaccines is contraindicated during pregnancy?
D. Mumps, measles, rubella
32
The preferred method for the delivery of the aftercoming head is
B. Mauriceau-Smellie-Veit Manuever
33
You were assigned to deliver the baby of a 25 year old G1P0 PU 38 weeks. You applied the forceps on the fetal head with the following findings: head was at station +2 with the sagittal suture at left occiput anterior position. This is classified as
B. low forceps delivery
34
A 22 year old G1P0 patient at 39 weeks AOG was admitted for elective Cesarean Section for breech presentation. She requested to her obstetrician that a transverse suprapubic abdominal incision be done to her. This type of incision is called
C. Pfannensteil
35
Which of the following is one of the requirements that must be present before obstetric forceps must be used?
D. The cervix must be fully dilated and retracted
36
The single most significant risk factor in the development of post-partum pelvic infection is
C. Cesarean delivery
37
The process by which the uterus returns to its normal size, tone and position after delivery is called
A. involution
38
What is the mechanism behind the increase in cardiac output right after delivery?
D. autotransfusion
39
Congenital rubella syndrome is more likely common during which AOG?
A. 8-10 weeks
40
What is the diagnostic procedure of choice for identifying gallstones in pregnancy?
C. Ultrasound
41
A patient consulted because her husband is a seaman and will be coming home in 2 months for a 1-month vacation. She just had her menses 2 days ago. What is the most effective reversible form of contraception will you give?
D. combined oral contraceptives
42
A 30 year old G1P1 consulted at the OPD for Pap smear. According to her, she had an IUD in-situ for 1 year. On PE, you can not visualize the tail of the IUD string. What is the best thing to do for this patient?
C. Perform an transvaginal ultrasound
43
A 35 y.o., G3P3 (3-0-0-3) complained of scanty menstrual flow and continuous severe cramping throughout the menstrual period after undergoing cryotherapy due to chronic cervicitis. What is the most likely cause of her complaint?
C. cervical stenosis
44
A 21 y.o. patient, nulligravid , single came in because of severe vaginal bleeding of 2 days duration. What is the management of choice in this case?
C. High dose estrogen
45
The most common cause of DUB in the premenarcheal and postmenopausal woman is _____.
B. Anovulartory
46
A 32 y.o., G2P2 (2-0-0-2) consuted for amenorrhea since delivery up to almost 1 year after. Breastfeeding was not practiced.The last pregnancy was delivered via NSD with history of uterine atony and blood transfusion. What is the most likely cause of her amenorrhea?
B. Sheehan’s syndrome
47
Menometrorrhagia is defined as:
B. Prolonged uterine bleeding at irregular intervals
48
Which of the following statements is true of DUB?
B. There is continuous estrogen production without corpus luteum formation
49
The most common histologic type of vaginal cancer is:
A. Squamous carcinoma
50
A 69- year old G4P4 (4004) consulted for an ulcerated mass on the right labium majus. She had been to several physicians who have prescribed unrecalled topical creams and solutions without relief. Upon seeing the patient, your recommendation would be:
C. Excision biopsy of the mass
51
The area of the cervix that is most prone to precancerous and cancerous neoplasms is the:
B. Transformation zone
52
Which of the following HPV Types is associated with high oncogenic potential?
D. HPV Type 18
53
A 37 year old, G3P3 was admitted because of vaginal bleeding. Pregnancy test is negative. She underwent diagnostic curettage. While doing the curettage humps and bumps were noted. What is the most likely diagnosis?
C. submucous myoma
54
A 68 year old woman has a biopsy result of atypical complex hyperplasia. What is the most appropriate treatment for her?
D. Perform TAHBSO
55
This granulose-theca cell tumor has this characteristic inclusion body.
B. Call-Exner bodies
56
A 33 year old nulligravid patient consulted in your clinic because of cervical mass. She was diagnosed as a case of prolapsed myoma . What is the best management for her case?
C. Do transcervical resection of the myoma
57
A 28 year old, single, nulligravid patient consulted in the OPD for the result of her pelvic ultrasound. It revealed a 18mm x 10mm x 14mm and a 13mm x 16mm x 10 mm intramural myomatas. She is asymptomatic. How will you manage the patient?
C. Reevaluate the patient at 6-month interval to determine the rate of growth
58
This is the diagnostic procedure of choice for endometrial cancer.
D. Fractional D&C
59
This is the drug of choice for syphilis.
D. Parenteral Penicillin G
60
A 29 year old sexually active female consulted in your clinic because of vulvar lesion. History revealed that it started as paresthesia of the vulvar skin then papule and subsequent vesicle formation. Simple clinical inspection revealed ulcers which are painful when touched with cotton-tipped applicator. The most likely diagnosis is _____.
D. Genital herpes
61
What are the most important goals of the medical therapy of acute PID?
D. resolution of symptoms and preservation of tubal function
62
This occurs when increased intraabdominal pressure is not transmitted equally to the bladder and the functional urethra.
C. genuine stress incontinence
63
This occurs when a bladder is overdistended because of its instability to empty.
B. overflow incontinence
64
A 35 year old G1P0 (0-0-1-0) consulted because failure to become pregnant 1 year after her abortion. Her condition is considered
C. secondary infertility
65
The first drug to offer in women with anovulation is
D. clomiphene citrate
66
The most common cause of tubal/peritoneal factors of infertility is
C. PID
67
Among the factors causing female infertility, the easiest to diagnose and manage is
C. ovulatory factors
68
An absolute contraindication to hormone replacement therapy is:
A. Thromboembolic disease
69
Over the counter pregnancy test kits will test for which placental hormone? ((Baja-Panlilio Chapter 6, p. 64)
D. human chorionic gonadotropin
70
Mefenamic acid taken by pregnant women may result in the closure of what structure? (Baja-Panlilio, Vol I pp. 82-83)
C. ductus arteriosus
71
Hydroureter during pregnancy is more marked on the right than on the left because of: (Baja panlilio Chapter 8 Page 107)
B. dextrorotation of the uterus
72
In which of the following are relatively low levels of hCG detected in maternal blood? (Baja Panlilio Chapter 6 page 64)
D. Impending abortion
73
The majority of spontaneous abortions are due to: (Baja-Panlilio, Chapter 27, p. 317)
C. chromosomal defects
74
A 39 year old, G4P3 (3003) patient with a history of repeated episodes of pelvic inflammatory disease was diagnosed to have an unruptured ectopic pregnancy. The cause of her ectopic pregnancy is: (Baja-Panlilio, Chapter 28, p. 327)
D. salpingitis
75
The best basis for the diagnosis of Preterm Labor in this patient is the presence of: (Baja Panlilio Chapter 37 , page 355)
D. cervical dilatation and effacement
76
A blood pressure of 160/110 mmhg. Proteinuria of 4 gm/day, with elevated liver enzymes is classified as: (Baja-Panlilio, Chapter 35 p 231)
B. preeclampsia severe
77
A 29 year old G1P0, consulted for the 1st time on her 28 weeks AOG. Her BP was 160/120 mmHg. She had severe headache and her fundic height was only at the level of the umbilicus. The appropriate laboratory exams to be done initially is: (Baja-Panlilio, Chapter 35 p. 337
B. doppler velocimetry
78
A 35 year old, G6P5 (5005) on her 12th week of pregnancy was diagnosed on ultrasound to have an h-mole. What will be the management for this case? ((Baja-Panlilio, Chapter 30, p. 350)
D. hysterectomy, followed by prophylactic chemotherapy
79
When the long axis of the fetus parallels the longitudinal axis of the uterus, the lie of the fetus is called: (Panlilio, Textbook of Obstetrics (Pathologic and Physiologic) 2nd ed, Page 210)
B. longitudinal
80
The tracings showed that the fetus: (Baja-Panlilio, Chapter 21 pp. 237
B. has a late deceleration
81
In intrapartum monitoring, the management for severe bradycardia preceded by late deceleration and absent variability is done by: (Baja-Panlilio, Chapter 21 pp. 236
C. immediate termination of pregnancy
82
A 25 year old G1P0, 38-39 wks. AOG consulted at the emergency room due to labor pains. She has no prenatal check-ups and family history revealed diabetes mellitus in sister and mother. Abdominal exam revealed fundic height = 40 cm, uterine contractions every 2-3 mins, 45-50 secs. duration. Internal exam has remained unchanged at 6 cms dilated, fully effaced, station -2, cephalic, (-) BOW for the past 2 ½ hrs. The serious complication during vaginal delivery of this baby where there is arrest in delivery of the shoulder is: (Baja-Panlilio, . 421-422)
A. Shoulder dystocia
83
A well-nourished patient on her third trimester of pregnancy has a Hemoglobin value of 10.5 gms/dl. This low value could be explained by: (Baja Panlilio 2nd Ed Chapter 8 page 112)
B. increase in blood volume
84
Iron supplementation during pregnancy is mandatory because of: (Baja Panlilio 2nd Ed Chapter 8 page 112)
C. increased demand by the increased production of RBCs
85
Pregnancy is said to be a diabetogenic state because of: (Baja Panlilio 2nd Ed Chapter 8 page 114)
D. increased insulin resistance
86
An increase in the following hormone is an indication of Thyrotoxicosis during pregnancy: (Baja Panlilio 2nd Ed Chapter 54 page 595
A. free Thyroxine hormone
87
A puerpera came for her postnatal follow up 2 weeks after an uncomplicated vaginal delivery. The following are expected findings on her physical examination: (Panlilio, Textbook of Obstetrics (Pathologic and Physiologic) 2nd ed, Pages 295-298)
B. lochia alba
88
A week after delivery by emergency cesarean section after a prolonged labor, a patient came because of fever of 38 ۫ C. Puerperal infection is suspected if she has: (Panlilio, Textbook of Obstetrics (Pathologic and Physiologic) 2nd ed, Pages pages 556-561)
B. foul smelling lochia and tender uterus
89
A 42 year old G2P1 at her 32 weeks gestation with known renal disease and hypertension presents with BP of 220/120 mmHg but is asymptomatic. The diagnostic test you will perform to detect chronicity of her illness is: (Baja-Panlilio, Chapter 35 p. 342)
C. fundoscopy
90
The monitoring done to detect increased severity of preeclampsia is: (Baja-Panlilio, Chapter 35, p. 336)
C. serum uric acid
91
The most common pathophysiologic mechanism in perimenopausal bleeding is: (Compre Gyne, 1082)
C. anovulation
92
A 34 yo G3P3 (3-0-0-3) presents with episodes of missed period for 2 cycles then irregular and profuse bleeding for the past two weeks. Her pregnancy test is negative with unremarkable pelvic exam findings except for the moderate bleeding. What is the most likely diagnosis: (Compre Gyne, p. 1082-1083)
C. dysfunctional uterine bleeding
93
A 60 yo G5P5 (5-0-0-5) has been menopausal for the past 12 years presents with minimal vaginal bleeding. What diagnostic exam will you recommend? (Compre Gyne, p. 1082-1083)
D. Transvaginal Ultrasound
94
An adnexal cystic mass was seen appreciated on TVS, 6 cm in diameter, in a 24 yo patient who presents with abnormal vaginal bleeding. What is the most likely diagnosis? (Compre Gyne, p. 506-507)
A. follicular cyst
95
A 5 year old child was initially treated with antibiotics for purulent vaginal discharge for a week. On follow up, the discharge was noted to be foul smelling and bloody. The most probable cause is: (Comprehensive Gynecology, 4th ed, page 274-277)
C. foreign body in the vagina
96
A mother is concerned with the appearance of whitish, non puritic vaginal discharge on her 11 year old child noted since 8 month preceding menarche. It is best to; (Comprehensive Gynecology, 4th ed, page 276)
D. reassure the mother and the child that the discharge is normal
97
The most frequent symptoms of endometrial hyperplasia is: (Compre Gyne, p. 870)
B. abnormal vaginal bleeding
98
A 46 yo G4P4 (4-0-0-4) with a nodular uterus, enlarged to 20 weeks AOG presents with menorrhagia. What is the most likely diagnosis? (Comprehensive Gynecology Chapter 18 Page 502)
B. Submucous myoma
99
A 65 year old nulligravida consulted at the emergency room due to postmenopausal bleeding for 3 yrs. She’s obese and known to be hypertensive for 10 years. Her menstrual history revealed irregularly irregular cycles. She was treated for breast cancer 6 years ago and has been taking tamoxifen for the past 5 years. The most probable cause of her bleeding is a pathology in the: (Compre Gyne, p. 860-867)
B. Endometrium
100
A 35 year old, G6P6 (6006) wife of a seaman, consulted due to postcoital bleeding. Speculum exam revealed a flat warty lesion along the posterior cervical lip. Histopathology of cervical punch biopsy done revealed dysplastic cells involving nearly the whole thickness of the epithelium. The most probable diagnosis is CIN? (Compre Gyne, 802-803)
C. III
101
A 65 year old nulligravida consulted at the emergency room due to postmenopause bleeding x 3 yrs. She’s obese and known to be hypertensive for 10 years. Her menstrual history revealed irregularly irregular cycles. She was treated for breast cancer 6 years ago and has been taking tamoxifen for the past 5 years. The most appropriate diagnostic test is: (Compre Gyne, 870-871)
C. Fractional curettage
102
A 25 year old, G6P0 (0060) consulted at the emergency room due to postcoital bleeding x 3 months duration. She’s a victim of child prostitution. On pelvic exam, there was a 2 cm cauliflower – like lesion on the anterior lip of the cervix. The vagina and parametria are smooth. What is the most appropriate diagnostic test? (Compre Gyne, p. 844)
C. direct punch biopsy
103
A 20 year old commercial sex worker presented at the clinic due to painful shallow ulcers in the vulva associated with burning sensation during urination. She also has multiple oral ulcers at the time of consultation. The most likely diagnosis is: (Compre Gyne, , Chapter 22, page 656)
A. Herpes simplex infection
104
A 38 year old diabeteic patient presented at the clinic due to vaginal pruritus and whitish vaginal discharge. On examination, the vulva is beefy red in appearance with whitish curdled discharge. The most likely diagnosis is: (Compre Gyne, Chapter 22, page 669)
B. Candidiasis
105
The presence of heavy concentration of coccobacilli surrounding vaginal epithelial cells with loss of distinct cell margins is the appearance of; (Compre Gyne, Chapter 22, page 671)
B. Clue cells
106
A patient with chronic ulcers in the vulva had smears done taken from the ulcers. Findings shows presence of dark staining bacteria with a bipolar appearance found in the cytoplasm of large mononuclear cells .These are diagnostic of ; (Compre Gyne, Chapter 22, page 660
A. Granuloma inguinale
107
A patient with painless vulvar ulcers came with a positive screening test for syphilis. Confirmatory test that should be done can either be any of the following except: (Compre Gyne, Chapter 22, page 664)
A. RPR
108
According to CDC, treatment of patients diagnosed with HIV includes the following except: (Compre Gyne Chapter 22, page 686)
C. emotional
109
A patient diagnosed with gonorrhea should: (Compre Gyne, Chapter 22, page 692)
B. also be treated for Chlamydia infection
110
Linda, 65 year old, G7P7 came to your clinic complaining of vaginal itching with burning discomfort. This condition may be due to a decrease in what hormone? (Compre Gyne, p.1223)
C. estrogen
111
Linda, 18 year old, delivered an 8 lbs baby. There was note of laceration on the lateral wall off the vaginal vault with profuse vaginal bleeding. There was a sudden drop of BP. Post partum there was note of amenorrhea. Lab examination shows destruction of the pituitary gland. Linda has what syndrome? (Compre Gyne p. 1116)
B. Sheehan’s syndrome
112
Factors promoting puerpueral infection include:
A. prolonged rupture of membranes
113
The fetal heart tones can be best heard in this area if the following were the Leopold’s findings: 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. right lower quadrant
114
The patient with abnormal uterine bleeding is a:
B. 41 y.o. whose menses last 8 to 10 days
115
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 and fixed while the left was free. Based on the information given, this patient can be clinically staged as
C. IIIB
116
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. 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
C. IC
117
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:
B. trichomoniasis
118
The main arterial blood supply of the uterus is a branch of :
D. hypogastric artery
119
The uterus is derived from the:
C. Mullerian duct
120
The violaceous discoloration of the vagina during pregnancy is called:
C. Chadwick’s sign
121
Which of the following is markedly increased by about 28 weeks gestation?
B. plasma volume
122
This maneuver is done to promote extension of the fetal head:
C. Ritgen’s maneuver
123
One of the following is a presumptive sign of pregnancy:
C. violaceous vaginal mucosa
124
The fundus of the uterus is at this level at 12 weeks gestation:
B. Above the symphysis
125
During the second and third trimester, daily caloric intake should be increased by:
B. 300
126
Lightening is the result of :
B. descent of the fetus
127
The relation of the point of direction to the right and left of the maternal birth canal is called:
C. position
128
Which ligament is considered as the strongest support of the uterus?
C. utero-sacral
129
Average duration of the first stage of labor in primigravidas:
C. 8 hours
130
Average duration of the third stage of labor among multiparous patients:
B. 20 minutes
131
Milk ejection is the result of the action of:
A. Oxytocin
132
Complete anesthesia for abdominal delivery necessitates a block from:
C. T8 to S1
133
The motor pathways to the uterus leaves the spinal cord at the level of:
B. T7T8
134
Phase 0 of parturition is characterized by:
A. uterine tranquility
135
Secondary arrest of cervical dilatation is cessation of cervical dilatation for:
B. two hours or more
136
TRUE of hypertonic uterine contractions EXCEPT:
A. absence of basal hypertonus
137
Method of delivery in a 19 year old primigravid patient, 39 weeks pregnant, transverse lie in labor:
C. emergency classical cesarian section
138
Significant oligohydramnios is defined as an amniotic fluid index of ____ cm. or less:
D. 5
139
Patient with heart disease without any obstetrical indication are best delivered by:
C. outlet forceps extraction under epidural anesthesia
140
Which antihypertensive is NOT recommended during pregnancy?
B. ace inhibitors
141
The following are beta agonist tocolytic agents EXCEPT:
C. indomethacin
142
Which of the following is NOT true in the use of corticosteroids in premature labor?
C. it produces induction of fat cells that regulate fetal lunf maturity
143
Complete expulsion of sperm stored in the reproductive tracr beyond the interrupted vas deferens takes about _____ ejaculations:
C. 20
144
A form of gestational trophoblastic disease characterized by excessive trophoblastic proliferation and edema of the villous stroma without excessive local invasion is:
A. H. mole
145
Internal examination in cases of abruption placenta maybe done to determine:
C. cervical dilatation
146
In uterine atony, the source of bleeding is the:
B. placental implantation site
147
What maneuver in shoulder dystocia involves flexing the maternal thighs on the abdomen?
D. McRoberts
148
A woman using the oral contraceptive pills for the first time should be advised to start taking it :
A. on day 1 of menses
149
Management of choice for procidentia uteri in a 60 year old multiparous patient with marked cystorectocoele:
C. vaginal hysterectomy with anterior-posterior repair
150
The following are characteristics of Rokitansky syndrome EXCEPT:
C. normal uterus
151
The following are congenital anomalies of the mullerian duct EXCEPT:
A. imperforate hymen
152
The so called psammoma bodies are found in:
A. serous cystadenoma
153
Abnormal uterine bleeding during the pubertal and perimenarcheal period is due to:
C. delayed,aynchronous hypothalamic maturation
154
Most common cause of vaginal bleeding among postmenopausal women:
D. atrophic endometrium
155
A woman with postmenopausal bleeding warrants:
A. an endometrial biopsy
156
In Meig’s syndrome, the ovarian newgrowth is a:
A. Fibroma
157
Drug of choice for pregnant patients with Chlamydia infection:
C. erythromycin
158
The so called tobacco pouch appearance of the fallopian tube is seen in:
C. Pelvic tuberculos
159
Type of endometrial hyperplasis which is mot likely to progress to endometrial carcinoma:
D. complex hyperplasia with atypia
160
A post coital test is best done:
C. periovulatory period
161
Hysterosalpingography is best done:
C. after menses
162
Which of the following Pap’s smear will definitely require colposcopic examination of the cervix:
D. HSIL
163
Which of the following is considered a precursor of cervical carcinoma:
B. dysplasia
164
Endometrial carcinoma is LEAST likely if endometrial thickness is:
B. <5mm
165
Cystocele and rectocele occur because of weakness of the (ANS: C page 44)
C. endopelvic fascia
166
The sequence of events leading to menstruation (ANS: C page 106)
C. decrease in endometrial thickness, coiling of the arteries, vasoconstriction, vasodilatation, menses
167
Thromboxane differs from prostacyclin in that it (ANS: A page 89-90)
A. causes vasoconstriction
168
A main action prostaglandin 2a (PGF2a) is ( ANS: C page 89-90)
C. bronchoconstriction
169
A Pap smear is likely to identify all the following except (ANS: B page 150-151)
B. gonorrhea
170
Examination of a 3-year-old reveals labial adhesion. The child is able to void without difficulty. One should initially recommend (ANS: A page 278)
A. topical estrogen
171
The major mechanism of DMPA, which accounts for its contraceptive effect, is the (ANS: A page 327)
A. inhibition of the midcycle gonadotropin surge
172
The most commonly encountered cancer of the breast (ANS: D page 383)
D. ductal infiltrating carcinoma
173
Fibrocystic breast change is characterized by (ANS: B page 364)
B. diffuse bilateral findings
174
A 52-year-old woman has persistent, unilateral, spontaneous bloody nipple discharge and a cluster of microcalcifications identified by xeroradiography to be 3 cm deep under the nipple of the left breast. The next step in her management should be (ANS: B page 429-430)
B. repeat mammography in 3 months
175
The greatest lifetime risk of breast cancer is associated with a(an) (ANS: C page 430)
C. history of oral contraceptive use longer than 10 years
176
Anitiphospholipid antibodies have been found in the circulation of women with (ANS: A page 425-426)
A. recurrent abortions
177
The most consistent symptom of ectopic pregnancy is (ANS: D page 456)
D. abdominal pain
178
A morbidly obese woman undergoes preoperative evaluation for adenocarcinoma of the endometrium. Because of the high risk associated with an abdominal procedure, vaginal surgery is being considered. What tumor marker may be of help in her condition? (ANS D page 934-935)
D. CA-125
179
The cell origin of the most common type of ovarian neoplasm is (ANS B page 958)
B. epithelial cells
180
The most common cause of direct maternal deaths in the Philippines: (ANS: A p.4)
A. Hemorrhage
181
Most perinatal deaths are due to the following maternal factors: (ANS: A p.8)
A. Premature labor
182
The placental circulation (feto-maternal) is established by this day after fertilization (ANS: D p.57)
D. 17th dayD. 17th dayD. 17th dayD. 17th dayD. 17th dayD. 17th dayD. 17th dayD. 17th dayD. 17th dayD. 17th dayD. 17th dayD. 17th dayD. 17th dayD. 17th dayD. 17th dayD. 17th day
183
The greatest concentration of hCG in human plasma/urine is found in this age of gestation: (ANS: A p.63)
A. 8-10 weeks
184
This maneuver of Leopold is often called the umbilical grip and answers the question, “What side is the fetal back?” (ANS: B p.122)
B. second maneuver
185
“Triple screen” as a diagnostic tool for the detection fof Down’s syndrome utilizes the following except: (ANS: D p.153)
D. human placental lactogen
186
The earliest access to the prenatal diagnosis of heritable conditions is provided for by this technique: (ANS: B p.154)
B. chorion villus sampling
187
Relation of the long axis of the fetus to the long axis of the mother; (ANS: C p.183)
C. lie
188
A 28 y/o at 32 weeks age of gestation consults at a clinic. She had one set of twins both are alive and she had an abortion. Her OB code is:
B. G3P1(1012)
189
The most common cause of arrest disorders in labor is:
A. CPD
190
What is the maneuver were the index and middle fingers are applied over the maxilla in order to free the head?
D. Mauriceau
191
The following anti-TB drugs can be given in pregnancy except:
B. pyrazinamide
192
The most common cause of direct maternal deaths in the Philipppines is: (p. 4)
A. Hemorrhage
193
Glucose transfer from the mother to the fetus is through: (p.110)
A. Facilitated diffusion
194
The “fern” formation of dried cervical mucus is due to the effect of: (p.116)
B. Estrogen
195
“Quickening” refers to: (p.114)
B. Perception of first movement by the mother
196
When is the earliest time that can hCG be detected in maternal urine after implantation? (p.116)
C. 8- 9 days
197
A woman who has had three consecutive abortions and no other pregnancies is called: (p.119)
A. Nullipara
198
At what age of gestation should screening for glucose be done in a pregnant woman: (P. 125)
B. 24-28 wks
199
The Biophysical Profile represents all of the following EXCEPT: (p.162)
B. Indirect measurement of fetal oxygenation
200
The fetus is described as complete breech presentation as: (p 185)
A. Legs and thighs are flexed
201
Cervical softening and ripening is brought about by: (p. 196)
A. Collagen breakdown and rearrangement
202
The following characterize uterine changes during phase 2 of parturition: (p. 199)
A. The uterus is divided into an actively contracting upper part and a relatively passive lower segment
203
The most ominous sign of fetal compromise: (p. 237)
B. Late deceleration
204
Failure to maintain temperature regulation in the newborn may lead to one or all of the following: (p. 246)
A. Peripheral vasoconstriction / B. Hypoxia / C. Acidosis / D. All of the above
205
Puerperium lasts for how many weeks: (p. 251)
C. 6 wks
206
What is the average maternal weight loss immediately after delivery? (p. 254)
B. 5 kg
207
The lochia consisting of servical mucus and debris from healing tissues and leucocytes, lighter yellow and creamy in color: (p. 254)
B. Alba
208
The advantage/s of home delivery is/are: (p. 259)
A. Emotional support from family / B. Less expensive / C. Less tendency for nosocomial infections / D. All of the above
209
This refers to 3 or more consecutive spontaneous abortions: (p. 274)
C. habitual abortion
210
The implantation of a fertilized ovum outside the endometrium lining the uterine cavity is called: (p. 279)
A. Eccyesis
211
Most ectopic pregnancies are found in the: (p. 279)
B. Tube
212
The triad of symptoms of ectopic pregnancy are: (p. 282)
D. Amenorrhea, abdominal pain and vaginal bleeding
213
The mechanism of preterm labor in chorioamnionitis is: (p. 294)
B. Increased prostaglandin synthesis
214
HELLP Syndrome is the pnemonic for: (p. 332)
B. Hemolysis, elevated liver enzymes, low platelet count
215
The anticonvulsant of choice control of convulsion secondary to pregnancy-induced hypertension is: (p. 339)
C. Magnesium sulfate
216
Toxicity of magnesium sulfate therapy may be monitored using: (p. 339)
D. All of the above
217
The most common cause of maternal morbidity in hypertensive disease of pregnancy is: (p. 342)
A. Cerebrovascular accidents
218
In case of discordant twins resulting from “twin to twin transfusion”, the smaller twin usually presents with: (p. 348)
A. Severe anemia / B. Growth retardation / C. Oligohydramnios / D. All of the above
219
The fetal mortality rate in multifetal pregnancy is highest in: (p. 348)
C. Monozygotic, monochorionic, monoamnionic
220
A pregnancy is considered portterm if it lasts longer than: (p. 363)
D. 294 days
221
The most common cause of respiratory distress syndrome (RDS) in the preterm neonate is: (p. 395)
A. Hyaline Membrane Disease
222
What antenatal procedure is used to detect fetal lung maturity? (p. 395-396)
B. Amniocentesis
223
In breech presentation, engagement is considered to have occurred when this has passed the pelvic inlet: (p. 434)
B. Bitrochanteric diameter
224
Which is considered an indication for internal podalic version: (p. 445)
B. Delivery of second of twins
225
A carefully monitored trial of labor may be undertaken in normal term pregnancies with average infants following a previous Cesarean section performed for the following indications, EXCEPT: (p. 458-459)
C. Contracted pelvis
226
Cesarean hysterectomy may be indicated as a lifesaving measure in cases of postpartum hemorrhage due to: (p.462)
D. Uterine atony
227
Postpartum hemorrhage is blood loss during the first 24 hours after delivery in excess of : (p.465)
C. 500 cc
228
The following are viral infections known to be related to congenital infection syndromes, EXCEPT: (p. 524-525, 533)
C. Toxoplasmosis
229
What is the daily minimum requirement for elemental iron in pregnancy? (p. 561)
A. 4-6 mg
230
The principal cause of thrombocytopenia in pregnancy is: (p. 564)
D. Pre-eclampsia, eclampsia
231
A primigravid patient at 28 weeks AOG came in due to hypogastric and lumbosacral pain. On physical examination uterine contraction was noted occurring every 5 to 10 minutes. I.E.: cervix is noted to be 1 cm dilated, 50% effaced, intact bag of water. Which of the following is a β-adrenergic receptor stimulant that can be used to inhibit preterm labor in this patient?
A. Isoxsuprine HCL
232
This is the most critical issue in the management of postterm pregnancies? (page 431)
B. Confirmation of gestational age
233
In all growth-restricted fetuses, which of the following biometric parameters will be the first to show discrepancy in measurement? (page 438)
C. Abdominal circumference
234
In a patient with monozygotic twinning, if cell division occurs about 8 days after fertilization, what type of twinning will develop?
A. Monoamnionic, monochorionic twin pregnancy
235
A patient at 38 weeks AOG came in labor. I.E. cervix is 5 cm dilated, 50% effaced, intact BOW, cephalic, station -3. Clinical pelvimetry shows the ischial spine is bilaterally prominent, pelvic sidewalls are convergent and concavity of the sacrum is shallow. With these findings, you suspect the presence of:
B. Midpelvic contraction
236
When the fetal head is fully flexed, the chin lies in front of the chest and the presenting anteroposterior diameter is suboccipitobregmamtic. What type of presentation is this?
A. Vertex (occiput) presentation
237
Which Leopold’s maneuver will identify the location of the cephalic prominence?
D. Leopold’s maneuver 4
238
The cardinal movements of labor were as follows:
A. Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
239
A multigravid patient at 39 weeks AOG came in due to hypogastric and lumbosacral pain. Which of the following additional statements will characterize that the patient is in true labor?
A. The cervix is dilated and effaced
240
This type of deceleration is characterized by symmetrical fall in FHR beginning at or after the peak of a uterine contraction and returning to baseline only after contraction has ended.
C. Late deceleration
241
This is considered as the most crucial event for the further development of an antral follicle
A. activation of the aromatase system by FSH
242
Rubin’s pathologic criteria for cervical pregnancy include the following, EXCEPT:
B. he attachment of the placenta to the cervix must be intimate
243
A 28-year old primigravida comes to your clinic on her 30th week of gestation complaining of chest pain. Which of the following findings will strengthen the diagnosis of heart disease in pregnancy?
C. Cardiomegaly
244
The increase in plasma volume during pregnancy by about 50 to 65% reaches its peak during the:
B. Midtrimester
245
Nayda, an 18-year old primigravida comes to the clinic on her 12th week of gestation for her 1st check-up. She is curious as to when she can start to perceive fetal movements. You will reassure her that this will occur :
C. between the 18th and 20th weekC. between the 18th and 20th weekC. between the 18th and 20th weekC. between the 18th and 20th weekC. between the 18th and 20th weekC. between the 18th and 20th weekC. between the 18th and 20th weekC. between the 18th and 20th weekC. between the 18th and 20th weekC. between the 18th and 20th weekC. between the 18th and 20th weekC. between the 18th and 20th week
246
Which of the following immunizations is recommended for routine use during pregnancy?
B. Tetanus toxoid
247
In vertex presentation, the posterior fontanel is lowermost and the presenting head diameter is the:
C. Suboccipitobregmatic
248
This movement of the head refers to turning of the occiput from its original transverse oblique position towards the symphysis pubis or less commonly towards the hollow of the sacrum:
A. internal rotation
249
Overt diabetes during pregnancy is diagnosed by:
D. fasting plasma glucose of 126 mg/dl or higher
250
Among mothers with thyrotoxicosis. Their neonates are usually
A. euthyroid
251
Subclinical hypothyroidism is diagnosed when there is:
B. high serum thyrotropin level and normal thyroxine
252
A 38 year old G4P3 at 18 weeks age of gestation has BP of 150/100 mmHg with no other signs and symptoms. Her prepregnancy BP was 130-140 / 80-90 mmHg controlled by intake of a calcium channel blocker. Urinalysis is negative for proteinuria. The most probable diagnosis of this patient:
C. chronic hypertension
253
A 28 year old G1P0 at 35 weeks AOG consulted in the ER with chief complaint of severe abdominal pain. Accompanied by moderate vaginal bleeding. Her BP is 180/120 mmHg, PR-88/min, RR: 22/min. On palpation of the abdomen the uterus was tetanically contracted and the FHT was faint. The most probable diagnosis is:
B. abruptio placenta
254
Pneumococcal vaccine recommended for
B. immunocompromised patients
255
A G3P2 PU at 12 weeks is complaining of cough, weight loss and hemoptysis. The most important screening test at this time is
B. tuberculin test
256
Among the anti-TB regimen, the drug which is contraindicated during pregnancy is
D. Streptomycin
257
A 30 year old G3P2 at 24 weeks AOG complained of urinary frequency, dysuria, urgency, fever, chills and costovertebral angle tenderness. Urinalysis showed pyuria and bacteriuria. The most probable diagnosis is
D. acute pyelonephritis
258
This type of forceps has a double pelvic curve to facilitate application to the after coming head in breech presentation
C. Piper forceps
259
The following are contraindications for vacuum extraction EXCEPT
A. fetal postmaturity
260
This is known as the low longitudinal incision of the uterus, used to delivery babies abdominally
C. Kronig incision
261
A 25 y/o G2P2, three weeks postpartum came in because of profuse vaginal bleeding. She was afebrile with a BP of 100/70 mmHg and pulse rate of 105/min. What is the most likely diagnosis?
A. subinvolution
262
What is the first histologic indication of the effect of progesterone on the endometrium?
C. subnuclear vacuolization
263
At this gestational age, gross examination of the external genitalia identifies the sex of the fetus:
D. 16 weeks
264
The most specific test for HIV is
B. Polymerase Chain Reaction
265
A 26 y/o patient was seen in the OPD complaining of a vaginal discharge. The vaginal pH was 4.5. What is the most likely cause of the vaginitis
D. Moniliasis
266
Infections with this virus is strongly linked to CIN :
C. HPV
267
The least of the nodal involvement for distant metastasis of cervical cancer is via the:
D. Presacral nodes
268
A 45 year old G2P2 female came in due to postcoital bleeding. Pelvic exam revealed a nodular cervix which bleeds to touch, sidewalls are free of lesion. What is the stage of the disease?
B. Stage IB
269
Operative treatment for cervical cancer that guarantees the removal of the entire cervix and uterus with the ureters undisturbed.
A. Class I
270
A 54 year old G5P5 woman came in due to metrorrhagia. She’s of heavy build, and a smoker of the following risk factors, what would have the least risk for developing endometrial carcinoma?
C. Multiparity
271
A tumor metastatic to the ovary, usually bilateral, consisting of signet ring cells, that usually originate from GIT is
B. krukenberg tumor
272
A 30 year-old G0P0 was found to have stage 1a grade 1 serous cystadenocarcinoma of the ovary. The best form of management is:
C. USO with follow up Ultrasound of the contralateral ovary
273
A 13 year old who has not had menarche was brought in for consult with the following features: short stature, low breast development, with webbing of the neck. The diagnosis is:
B. Turner syndrome
274
It is a malformation of a 46-XX individual with a normal ovarian function resulting in failure of the uterus and vagina to form
B. Rokitansky Kusterhaus syndrome
275
A 35- year old female came in for infertility work-up. When is the best time to do hysterosalpingography (HSG)?
B. during the week following the end of menses
276
What is the pathognomonic symptoms of menopause caused by estrogen depletion?
A. hot flushes
277
Which of the following statements is true regarding LH?
A. LH acts on the theca cells to produce androgen.
278
What event induces follicular rupture and subsequent ovulation?
B. LH surge
279
Which of the following explains uterine enlargement during pregnancy?
A. It is due to increased number of muscle fibers.
280
Which of the following are endometrial changes during pregnancy?
There is conversion of secretory endometrium into decidua.
281
Which of the following are cervical changes during pregnancy?
The cervix is edematous.
282
Which of the following are cardiovascular changes in pregnancy?
There is an increase in heart beat to 10 beats per minute.
283
The following are respiratory changes in pregnancy except:
Tidal volume is decreased.
284
What is the average increase in maternal blood volume during pregnancy?
C. 50 %
285
Which of the following is a positive sign of pregnancy?
C. Recognition of the fetus by ultrasound
286
A radiologic evidence of fetal death that shows significant overlapping of fetal skull bones
A. Spalding’s sign
287
The mean duration of a normal pregnancy calculated from the first day of LMP averages close to
A. 40 weeks
288
At what age of gestation can fetal cardiac activity be detected by ultrasound?
A. 4 weeks ovulation age
289
At what age of gestation will the testes start to descend?
C. 32 weeks
290
What is the term used to describe the encirclement of the largest fetal head diameter by the vulvar ring?
C. crowning
291
What is the main disadvantage of median episiotomy?
C. rectal extension
292
What is the purpose of the WHO partograph?
B. To identify patients needing timely intervention.
293
A 31 year old, primigravid was admitted 5 cms. station -1 at 12 noon. In an hour she was 7cm, station 0. At 2 pm she was 9 cm Station +1 and was fully dialted at 3 pm. She delivered shortly thereafter. What is your assessment?
A. normal labor
294
A 32 year old G6P5 patient comes in 7cm. dilated at 10 am. What time do you expect her to be fully dilated if labor progress is normal?
A. 11 am
295
A G3P2 patient had a cesarean delivery because of a previous myomectomy. In the ER she was 3-4 cms, breech presentation, with contractions every 4-7 minutes. What is the best management for this patient?
C. Have her prepared for an emergency cesarean delivery.
296
A 21 y/o primigravid presents with severe abdominal pain associated with shoulder pain and dizziness. BP – 90/60, PR – 110/min. These is rebound tenderness on examination of the abdomen and exquisite tenderness on wiggling the cervix. The patient has history of completion of abortion by curettage at 6 weeks gestation 2 weeks prior to consult. Histopath findings reveal decidual reaction. Pregnancy test is (+). The most likely diagnosis is
B. Ruptured ectopic pregnancy
297
A 39 y/o, G4P3, 33 weeks gestation presents with minimal bleeding. Physical examination is unremarkable. Ultrasound report is total placenta previa. The most appropriate treatment is
D. Expectant management
298
A 22 year old G2P1 (1001) at 35 weeks AOG has a chief complaint of regular uterine contractions for 12 hours. She has stable vital signs. Fundic height is 27 cm, estimated fetal weight is 2,400 grams. Fetal heart tones are 148 bpm and presentation is cephalic. On internal examination, the cervix is 7 cm dilated, fetal head at station -1, intact bag of waters. What would be your management?
D. Admit her and allow labor to progress.
299
What is the ACOG recommendation in managing a postterm pregnancy with a favorable cervix?
B. Induction of labor
300
The following finding with postterm pregnancy mandates delivery.
B. oligohydramnios
301
A 17 y/o. primigravid registers at 16 weeks’ gestation with a BP of 100/60. At 38 weeks’ gestation, she is seen in the clinic with a BP of 146/94 and negative proteinuria. She is admitted in the hospital for further evaluation, where, on overnight observation, she has persistent BP above 140/90. A 24-hour urine protein determination is 20mg. What is your diagnosis?
A. Gestational HPN
302
What is the role of the hepatitis B surface antigen (+) patient in the genesis of hepatitis B infection?
A. Chronic carrier state
303
What is the most common mode of transmission of Hepatitis B?
D. Mother-to-infant route
304
A 21 y/o G1P0 12rh week AOG complained of sore throat, cough and fever and developed post-auricular lymphadenopathy. What is your main consideration?
B. Rubella
305
A primigravid at 39 weeks delivered by low forceps extraction. On the first post-partum day, the patient complained of excruciating vulvar pain. On examination, there was a fluctuant, violaceous gray, 8x6 cm mass on the postero-lateral aspect of the vulva, tense and tender on palpation. What is your diagnosis?
D. Vulvar hematoma
306
R.C., 28 y/o, G2P2, delivered spontaneously to a live fetus 8 days ago at home assisted by a nurse. She developed high-grade fever on the 5th post-partum day associated with body malaise, lower abdominal pain & moderate vaginal bleeding. On admission, the patient was febrile and on IE, the cervix was open, the uterus was enlarged to 18 week-size & both adnexae were tender and foul-smelling lochia was noted. Your impression is
A. Puerperal infection
307
You are attending to a 25 y/o, G3P3 who just delivered vaginally to a live term fetus. Five minutes later, signs of placental separation appeared followed by profuse vaginal bleeding. Bleeding before placental delivery is called
C. Third-stage bleeding
308
The definitive treatment in a 40 y/o, G8P5 (5,0,3,5) who developed septic shock due to endomyometritis is
A. Surgical removal of the nidus of infection
309
A 16 y/o girl is complaining of irregular menstruation.What would be the ideal treatment to restore her menstrual cycle?
D. Cyclic progesterone
310
When is it recommended to start doing Pap smear for screening of cervical cancer?
D. At age 18 or earlier when sexually active
311
Which of the following increases the risk of developing endometrial cancer?
C. Polycystic ovarian symdrome
312
What is the most appropriate treatment for a 20 year nulligravid diagnosed with simple hyperplasia without atypia by curettage?
B. Continous or cyclic progestin
313
Which of the following is classified as homologous type of sarcoma?
A. High grade endometrial stromal sarcoma
314
What type of ovarian tumor is Brenner tumor classified?
A. Epithelial tumor
315
A patient underwent THBSO omentectomy and lymph node dissection for an ovarian cancer. Histopathological report showed the tumor in the right ovary measured 10x8x8 cm ruptured with extension to the fallopian tube and omentum. One para aortic node showed malignant cells. What is the stage?
D. Stage III-C
316
What is the primary treatment of malignant epithelial ovarian tumor?
B. Surgical removal of the tumor
317
Definitive diagnosis of vulvar carcinoma is established by
D. Biopsy
318
The major symptom of most vulvar atypias is
C. Pruritus
319
A 3 y/o girl was brought to the Emergency Room because of vaginal bleeding. On inspection of the external genitalia, there was a mass protruding through the vaginal introitus. It measured 4x3 cm and resembled a cluster of grapes forming multiple polypoid masses. The most likely diagnosis is
B. Sarcoma botryoides
320
The most common symptom of vaginal cancer is
B. abnormal bleeding
321
Which of the following patients with PID must be hospitalized?
B. A 21 y/o G1P0 at 10 weeks AOG
322
What is the most common route of spread of the organisms in PID?
D. Ascending route
323
What is the route of spread of abdomino-pelvic Koch’s?
C. Hematogenous spread
324
On histologic sections, what are the findings highly suggestive of AP Kock’s?
C. Langhan’s glant cell
325
Which of the following is an indicator of ovulation?
A. Progesterone level of 10 mg/ml during luteal phase
326
Which of the following is required in semen analysis?
A. 2-3 days abstinence before collection
327
WHO standard for normal semen analysis include
A. 40 M sperm count
328
Which of the following is required for hysterosalpingogram?
A. Done post menstrual, pre-ovulatory
329
Which of the following organisms are hostile to sperm in the vagina?
A. Ureaplsma urealyticum
330
A 12 y/o girl was noted to have breast budding. What is the average age you would expect her to experience menarche?
C. 14 year old
331
A 45 y/o patient consulted at your clinic because of amenorrhea of 10 months duration. She would want to know if indeed she is menopausal already. What laboratory test will you request?
B. FSH assay
332
What will be the first index of declining ovarian function?
B. Declining inhibin levels
333
Which of the following events is associated with menstrual flow?
A. withdrawal of progesterone
334
A 47 year old woman has poorly differentiated endometrial carcinoma and a uterine cavity that measures 10 cm in depth. The endocervix has stromal invasion of endometrial carcinoma but no other structure is involved. What is the stage of her disease?
D. II B
335
What endoscopic procedure is utilized to evaluate tubal disease?
B. laparoscopy
336
Tuberculosis of the genital tract invariably involves the
A. fallopian tubes
337
A 26 year old G1P1 had cervical intraepithelial neoplasia involving the entire thickness of the cervical epithelium. What is the best management?
C. conization
338
A 25 year old woman and her husband use natural family planning as their method of contraception. Her menstrual cycle length range from 26 to 32 days. She does not measure her basal body temperature. The time of her maximum or peak fertility with the first day of her menses defined as day 1 would be between
C. day 8 – 21
339
What is the drug of choice for bacterial vaginosis?
D. metronidazole
340
What type of myoma insinuates itself between the leaves of the broad ligament?
D. intraligamentary
341
What tumor will be positive for the tumor marker HCG?
B. choriocarcinoma
342
What type of abnormal uterine bleeding is excessive in amount and duration of flow occurring at regular interval?
A. Menorrhagia
343
A 67 year old had episodes of vaginal bleeding 15 years after menopause. Biopsy revealed endometrial hyperplasia. Transvaginal sonogram reveals a solid adnexal mass of 4 cm diameter. She is not on hormonal replacement therapy. What is the most likely cause of the bleeding?
B. granulose cell tumor
344
A 40 year old housewife complains of foul smelling vaginal discharge. On examination, discharge was greenish-gray in color, fishy odor, and frothy. What is the primary consideration?
B. Trichomoniasis
345
A 36 year old G2P2 has amenorrhea of 11 months with hot flushes. Examination reveals a small uterus. If this is a case of premature ovarian failure, which finding is applicable?
C. elevated FSH > 40 IU/ml
346
What is a contraindication to hormonal replacement therapy?
A. history of pulmonary thromboembolism
347
Which of these is the most likely site for implantation of endometriosis?
D. peritoneum of culdesac
348
Which disease of the vulva is best treated with wide excision?
A. hidradenitis suppuritiva
349
What ovarian tumor will most commonly cause precocious puberty ?
C. granulosa cell tumor
350
A woman with this type of pelvis is more prone to urethrocoele because of more force of the fetal head on this area during descent in labor
C. gynecoid
351
Stage III vaginal cancer means extension of lesion up to
C. pelvic wall
352
On endometrial biopsy, glycogen-rich subnuclear vacuoles were seen in the base of the cells lining the glands. What does this mean?
B. ovulation has occurred
353
Which theory of endometriosis best explains remote sites of the disease such as in the spinal cord, nasal septum or lungs?
D. lymphovascular metastasis
354
Which is an abnormal semen parameter?
B. sperm morphology 30 %
355
A 32 year old has been having her regular pap smear for the last ten years. Her latest result however revealed low grade SIL. What is the next step to do?
B. repeat smear in 4 months
356
A 19 year old was brought to the ER because of acute pain. There was also vaginal spotting. Examination revealed a small tender adnexal mass. Based on the LMP, she is on day 25 of her cycle. Pregnancy test was negative. What is the most likely diagnosis?
C. ruptured corpus luteum
357
A 28 year old nulligravida with primary infertility and cyclic pelvic pain was diagnosed to have endometriosis. She was placed on hormonal treatment. However, while on this drug, she developed acne, hirsutism, and deepening of the voice. What is a better alternative?
B. GnRH agonist
358
A 35 year old consulted because of vesicular lesions in the vulva. She related that several days prior to the appearance of the vesicles, she felt numbing sensation over her vulvar skin. Which is the best treatment?
B. acyclovir
359
A 17 year old consulted because of lower abdominal pain of 3 days duration described as constant and dull. On speculum exam, purulent vaginal discharge was noted. Patient was febrile at 38.5 C. Pertinent finding on internal exam: tenderness with motion of the uterus and cervix. What is the most likely etiologic agents?
A. Neisseria gonorrheae and Chlamydia trachomatis
360
A woman consulted because of spontaneous milky discharge and missed period of 8 weeks. Pregnancy test was negative. Prolactin levels after appropriate blood collection was 35 ng/ml. What should be the next step in the work-up?
D. TSH determination
361
A patient was diagnosed to have squamous cell cervical cancer. Clinical evaluation revealed that the disease has involved the upper third of the vagina. Parametrial tissues were indurated. However, there was no evidence of pelvic well involvement. What is the best treatment for her?
B. chemoradiation
362
A 19 year old consulted because of primary amenorrhea. On clinical evaluation, the patient was found to have breast development but absent uterus. Which of the following can best help arrive at diagnosis?
C. Karyotyping
363
A 19 year old, primigravida, at 34 weeks gestation comes in for severe headache and visual blurring. Previous blood pressure on prior prenatal check up was at 140/90 mm Hg. Presently, her blood pressure was 170/110 mm Hg. She presented with bipedal edema. There was no uterine contractions. Then she developed generalized tonic-clonic seizures last for about 40 secs. What is most likely diagnosis?
C. Chronic hypertension with superimposed hypertension
364
Which of the following conditions can be predicted by cervicovaginal fibronectin?
C. preterm labor
365
A G2P1 with 7 weeks missed period presents with one week diagnosis of vaginal bleeding and hypogastric pains. Cervix is 1 cm open with intact membranes. What is the diagnosis?
B. Imminent abortion
366
Which is a cause of polyhydramnios?
D. esophageal atresia
367
A 26 year old G3P2, Previous CS I, on her 29th week age of gestation went to the hospital because of episodes of bright red vaginal bleeding upon waking up without other symptoms. Vital signs were normal with no uterine contraction noted. Leopolds maneuver showed a baby in cephalic presentation, floating, FHT was 150/min. What is the diagnosis?
A. placenta previa
368
A nullipara was admitted on active labor at 5 cms., ruptured bag of waters, station -2. After 3 hours of good contractions, cervix was 5 cms dilated, station -2. What condition is she in?
B. arrest of cervical dilatation
369
A patient diagnosed to have asymptomatic bacteriuria is one who has?
A. persistently multiplying bacteria in the urine but no symptoms.
370
Pigmentation of the face during pregnancy is considered as
C. a benign but persistent condition
371
A 25 year old consulted for vaginal spotting and sharp pelvic pain. History revealed 6 weeks amenorrhea. Pregnancy test was positive. Physical exam elicited cervical wriggling tenderness with a vague mass and tenderness in the left adnexae. Posterior vaginal fornix as full and bulging. BP was 100/60 mm Hg., PR 102/min. What should be done next to this patient?
D. immediate exploration
372
A woman on her 32nd week of gestation was admitted for threatened preterm labor. Tocolytic management was initiated with magnesium sulfate. Which of the following needs to be monitored closely while on tocolysis?
C. Blood pressure
373
A 20 year old primigravida at 39 weeks came in due to labor pains. This patient was a diagnosed case of rheumatic heart disease. When should she receive the initial dose of ampicillin-gentamycin?
D. 30 minutes prior to anticipated delivery
374
A puerperal women was rushed to the ER because of profuse bleeding. On examination, a sac-like structure was seen out of the introitus with the placenta still attached. A crater-like depression as noted on abdominal palpation. Which of the following is part of good management?
C. administer fluids and magnesium sulfate for uterine relaxation
375
A pregnant women consulted because of itchy reddish wheal-like rashes. The lesions were first seen in the abdomen eventually spreading to the rest of the body. She denied having any allergies to food or drugs. What treatment is appropriate?
C. corticosteroids
376
A pregnant woman on her 1st trimester of pregnancy was exposed to a neighbor with german measles. What is the initial step in the management?
D. ask history of past infection
377
Immediately after an apparently normal labor and delivery, the mother suddenly manifested with dyspnea and went into convulsions. Blood pressure likewise dropped sharply from 120/80 mm Hg. Cardiopulmonary arrest rapidly ensued. What is the probable cause?
C. amniotic fluid embolism
378
A G5P4 pregnant uterine 39 weeks was in active labor for 3 hours. IE showed cervix 7 cms dilated, fetal head at station -1 to 0. Suddenly, fetal heart rate decelerated and maternal blood pressure dropped from 120/80 to 90/60 mm Hg. On doing IE, the presenting part appeared to retract. What is the most probable diagnosis?
B. spontaneous uterine rupture
379
A G2P1 PU 31 weeks came to the clinic with complaints of watery vaginal discharge. After noting some fluid pooling at the culdesac, the clinician requested for an ultrasound. What information can be derived from an ultrasound pertinent to management?
C. assessment of amniotic fluid volume
380
During clinical pelvimetry, the ischial spines were noted to be prominent, the sidewalls convergent and the sacraosciatic notch is narrow. Of the following, what is the most common consequence of these findings?
B. there is increase likelihood for transverse arrest of fetal head
381
Anticipating a large baby, the patient’s legs were removed from the stirrups and sharply flexed upon her abdomen. What will be the effect of this maneuver?
C. rotates symphysis pubis toward maternal head
382
A primigravida was brought to the ER by the attending midwife after 10 hours of labor. Apparently she has been bearing down for 2 hours already. Exam showed that the fetal scalp is visible at the introitus without separating the labia. The sagittal suture was at AP diameter. The mother appeared weakened by her efforts to bear down. What is the best management?
B. oulet forceps extraction
383
A 20 year old, primigravid, PU 39 weeks presented at the ER in labor for 3 hours. PE revealed multiple vesicular lesions in the vulva and perieal area. IE showed 3 cm cervical dilatation, 50 % effaced, intact bag of waters, cephalic, station -1. Clinical pelvimetry was adequate. What is the best route of delivery?
A. cesarean section
384
A 53 A 29 year old, Gravida 5 Para 4 (4-0-0-4), Pregnancy uterine 37 weeks, complaining of hypogastric pain of 2 hours, came in the emergency room. Her vital signs were normal. Fundic height was 35 cms. Fundus is occupied by a hard, round, ballotable mass, fetal back palpated at the left, as well on the right, another hard, round mass on the hypogastric area, fetal heart tones of 143/min heard at the left periumbical area and 152/min heard at the right lower quadrant. On internal examination, the cervix was 5 cms. Dilated, 1 cm long, ruptured bag of waters, cephalic, station -2. All her previous pregnancies were delivered at home. What is the recommended mode of delivery?
A. an outright cesarean section
385
Which of the histological presentation is a characteristic of complete molar pregnancy?
A. hydropic degeneration and swelling of the villous stroma
386
When the fetal breech presents with both legs extended and the hips flexed, it is classified as
C. frank breech
387
Procedure where the cephalic presented fetus is converted to a footling breech presentation by grasping the fetal legs and turning the position is called
B. internal podalic version
388
Which of the following is associated with Abruptio placenta?
B. Hypertension
389
Which of the following conditions in NOT an indications for classical cesarean section?
A. Myoma occupying the fundus of the uterus
390
What is considered as the major vestibular glands that lie under the constrictor muscles of the vagina
D. Bartholin’s glands
391
A 28 year G1P0 sought her first prenatal check up at 12 weeks gestation. Family history is positive for diabetes mellitus (father). When should she have her GCT?
B. 24 – 28 wks
392
What is the most accurate ultrasonographic parameter for fetal aging in the first trimester ?
D. crown – rump length
393
What do you call a woman who had 3 pregnancies, all of which were aborted?
B. nullipara
394
What is the earliest age of gestation when fetal sex can be identified by gross examination of the external genitalia?
C. 14 weeks
395
What is most common type of the female pelvis?
D. gynecoid
396
When does the 2nd stage of labor end?
B. when the baby is fully delivered
397
How much weight does a average weighted woman gain throughout her pregnancy?
C. 24 lbs
398
On histopathology, a placenta is found to have dense stroma containing round cells with granular and vacuolated cytoplasm with vascular and eccentric nuclei. What is age of this placenta?
D. 40 weeks
399
What CTG finding is indicative of head compression?
C. early deceleration
400
A woman on her 41st week of pregnancy had a BPS with the following findings during the 30 minutes test-sustained breathing movement of 45 secs, five simultaneous limb and trunk movements, 2 episodes of arm flexion and extension, 3 episodes of fetal heart rate accelerations each for 5 secs with fetal movement, amniotic fluid pocket of 3 cms in perpendicular planes. What should be done for this patients based on the BPS score?
D. Repeat the BPS after a week
401
When can a puerperal patient start using a hormonal contraceptive method if does not intend to breast feed?
C. 6 – 8 weeks postpartum
402
On performing the third’s Leopold’s maneuver, the cephalic prominence is palpated on the left lower quadrant and the fetal heart tones is maximally heard at the right lower quadrant, which of the following can be concluded?
B. the vertex is presenting
403
On the 2nd postpartum day, a parturient developed a temperature of 39.0 C. Pertinent PE included breast that were edematous, tender, firm, and nodular. What must be done for this patient?
A. give analgesic and breast support
404
On physical examination of a pregnant woman, the clinician detected a 2/6 systolic murmur intensifying during inspiration. What should be done for this patient with regards this finding?
C. No intervention needed
405
A 21 year old primigravida in labor for 10 hours presented with a 6 cm cervical dilatation. The bag of waters was ruptured and the presenting fetal head was palpated at station 0. What conclusion regarding the pelvis can be made?
A. pelvic inlet is adequate
406
What maneuver will the fetal head undergo right after engagement?
D. descent
407
What part of the uterus forms the lower uterine segment during labor?
D. isthmus
408
What diameter of the pelvic inlet can be assessed clinically?
B. Diagonal conjugate
409
What is the major source of progesterone in early pregnancy?
C. corpus luteum
410
Which of the following antibiotics are contraindicated during pregnancy?
B. tetracycline
411
Myrna, a primigravida, on her 32nd week AOG, came in for prenatal check-up. Auscultation of the FHT yields negative result and the ultrasound revealed fetal death in utero. How will you manage her?
B. wait for spontaneous labor *
412
In which part of labor does the descent of the presenting part of the fetus is most marked?
C. pelvic division of labor
413
Which of the following maternal changes are decreased during pregnancy?
A. gastric emptying time
414
What conclusions can be made when meconium passage in-utero in a term parturient is observed after amniotomy?
B. Can be a sign of fetal hypoxia
415
What is the earliest histological evidence of progesterone action in the endometrium
D. basal vacuolation
416
Which is the most biologically potent estrogen in the normal menstrual cycle?
B. estradiol
417
If her last menstrual period is last Jan 23, 2007, when is her expected date of confinement?
D. Oct 30, 2007
418
Lochia serosa is expected to occur
B. after 3 or 4 days
419
Through what nerve is pain of uterine contractions transmitted?
D. T10 - L1
420
What is the antidote for magnesium toxicity?
A. Calcium gluconate
421
Which of the following is utilized for medical treatment of ectopic pregnancy?
C. Methotrexate
422
Of the following, which is most associated with low birthweight infants?
D. Smoking in pregnancy *
423
A 5 year old was referred to you at the ER due to complaints of perineal pain. What is the best way to examine the vagina of this child?
B. knee-chest position
424
Keanna, 32 y/o “sexy dancer” and ramp model complained of burning sensation over her vulva after a lingerie fashion show where she wore “thongs” and stringed nylon bikinis. There was pruritus so she used a newly-launched vaginal wash. Immediately, the burning sensation became worse but she thought it was normal. The next morning, she found her vulva to be erythematous and inflamed. The redness now reached the peri-anal area. What is the diagnosis?
C. Allergic dermatitis
425
On cut-section of an ovarian mass in a 26 year old nulligravida, there were ufts of hair, sebum and bony cartilage. What type of ovarian mass is most likely in this case?
C. Cystic teratoma (dermoid)
426
What ulcerative lesion of the genital tract is characterized by the presence of “groove sign”?
B. Lymphogranuloma venereum
427
What surgical procedure will prevent a woman from experiencing vaginal coitus?
B. Colpocleisis
428
Which is the most common predisposing factor to ectopic pregnancy?
A. previous genital infection
