2012 module exam Flashcards
What is the tanner stage?
Stage IV
A 42-year old woman presented with pelvic discomfort. On physical examination, the gynecologist discovered complete uterine prolapse. Which ligament provides direct support to the uterus?
§ Uterosacral ligament § Round ligament of the uterus § Broad ligament § Arcus tendinous fascia pelvis § Levator ani
§ Uterosacral ligament
Note: The uterosacral ligaments and the transverse cervical (cardinal) ligaments are the two main ligaments stabilizing the uterus. They help to inhibit the uterus from prolapsing into the vagina. The round ligament of the uterus is related to the descent of the ovaries in embryologic development and continues into the inguinal canal. This ligament is the remnant of the gubernaculum ovary. The broad ligament is the peritoneal covering over the uterine tubes, uterus, and vessels. The arcus tendineus fascia pelvis joins the muscle fascia of the levator ani to the pubocervical fascia on the vagina and is not directly associated with the uterus or its ligaments. The levator ani muscles contribute to the floor of the pelvis and support all of the pelvic viscera indirectly; it does not, however, prevent prolapse of the uterus into the vagina
What is a characteristic of Klinefelter syndrome?
- Karyotype XXY
- Female body habitus
- Karyotype XXY
Which of the following is bounded laterally by the rami of the pubic bones, ischial tuberosities, and sacrotuberous ligaments?
§ Pelvic outlet § Pelvic inlet § Mixed pelvis § Platypelloid pelvis § Gynecoid pelvis § Anthropoid pelvis § Android pelvis
§ Pelvic outlet
Which of the following is has a transverse diameter =13 cm and anterioposterior diameter=11 cm?
§ Pelvic inlet § Pelvic outlet § Mixed pelvis § Platypelloid pelvis § Gynecoid pelvis § Anthropoid pelvis § Android pelvis
§ Pelvic inlet
Which of the following is diamond-shaped in two planes? § Pelvic outlet
§ Pelvic inlet § Mixed pelvis § Platypelloid pelvis § Gynecoid pelvis § Anthropoid pelvis § Android pelvis
§ Pelvic inlet
What originates from the ceolmic epithelium?
Sertoli cells
What originates from the paramesonephric duct?
Uterine tube
What structure does the uterus develop from?
Paramesonephric duct
A girl with primary amenorrhea and cyclic pelvic pain presented with imperforated hymen. What is the embryological cause?
§ Failure of sinovaginal bulb formation
§ Failure of vaginal plate to canalize
§ Failure of sinovaginal bulb formation
- ”Incomplete vertical fusion (sinovaginal bulb with descending Mullerian system) results in imperforate hymen”
What is the arterial supply of the bulbospongiosus muscle?
Internal pudendal artery
What innervates the bulbospongiosus muscle?
Perineal branch of pudendal nerve
Pain afferents traveling from the body of the uterus in which of the following nerves?
Lumbar splanchnic nerves
During ligation of the ovarian artery, which structure is most likely to be injured?
Ureter
*Ligation of ovarian vessels or uterine artery may injure the ureter. Ligation of the
fallopian tube injures ovarian artery
After delivery of her 3rd child, a 41-year old woman presented with urinary incontinence. Which structure is most likely injured?
§ Tendinous arch of pelvic fascia
§ Tendinous arch of levator ani
§ Pelvic diaphragm
§ Perineal membrnae
§ Tendinous arch of pelvic fascia
What moves along the path in the abdomen formed by the gubernaculum?
Processus vaginalis
What is lymphatic drainage of the prostate gland?
Internal iliac lymph nodes
A woman presents with ascites and the doctor want to drain the fluid through the vagina. To where should he insert the needle?
Rectouterine pouch
A 32-year old woman presented with primary infertility. Endometrial biopsy showed tortuous endometrial glands and subnuclear vacuolization. What describes her endometrium?
Early secretory endometrium
A 40-year old woman presented with dysmenorrhea and menorrhagia. On an ultrasound, she had an enlarged asymmetrical mass in her uterus. On further investigation, it was found that the endometrium invaded the myometrium. What does she have?
Adenomyosis
Endometrial glands and stroma seen in a biopsy of the cul-de-sac of Douglas. Diagnose.
Endometriosis
An increase in pulsatile secretion of GnRH from the hypothalamus accompanied by an increase in LH and FSH describes which of the following?
A 12-year old child
Which of the following best describes a woman with a 28-day cycle with a menstruation of 1-2 days with scanty bleeding?
Hypomenorrhea
Which of the following store sperm for maturation?
§ Testes § Seminal vesicle § Prostate § Epididymis § Vas deferens
§ Epididymis
The secretions of what is important for sperm maturation?
Seminal vesicle
What is the normal volume of blood in a normal period?
20-80 ml
Which of the following represents hormone levels during menopause?
§ High FSH, low estradiol, low inhibin, low AMH
§ High FSH, low estradiol, low inhibin, high AMH
§ High FSH, low estradiol, low inhibin, low AMH
How to diagnose a woman with secondary amenorrhea for 14 months with hot flashes?
§ Low serum estradiol
§ Low serum estradiol, high FSH
§ Low serum estradiol, high FSH
Which phase of the sexual response cycle is characterized by involuntary muscle contraction, sudden, forceful release of sexual tension, and a sexual flush appearing over the entire body?
§ Excitement
§ Plateau
§ Recovery
§ Orgasm
§ Orgasm
What is a risk factor for endometrial cancer?
§ Clomiphene treatment for 6 months
§ PCOS being treated with combined contraceptives
§ Woman with BMI=22
§ Woman with induced labor at 42 weeks
§ Clomiphene treatment for 6 months
What assists in thermoregulation?
§ Bulbospongiosus
§ Dartos muscle
§ Dartos muscle
*Contraction of bulbospongiosus is to empty urethra from residual urine or semen. Dartos and cremaseter muscle both assist in thermoregulation. Pampiriform plexus also acts as a cooling mechanism.
What forces blood from the crura to the distal parts of the penis to increase distention of the penis during erection?
Ischiocavernosus muscle
What characterizes the proliferative phase of the menstrual cycle?
§ It is under the effect of estrogen
§ Occur after ovulation
§ Stroma is edematous
§ It is under the effect of estrogen
What is responsible for the increase in temperature in scrotum and sperm mortality?
Varicocele
Most folded mucosal lining is located in which part of the uterine tubes?
§ Fimbria
§ Ampulla
§ Infundibulum
§ Isthmus
§ Infundibulum
A pregnant lady gave birth and she had high-grade fever, abdominal pain, and foul- smelling vaginal discharge. What is the cause?
§ Retained products of conception
§ Candida infection
§ Trichomonas vaginalis infection
§ Retained products of conception
*This patient has postpartum endometritis which can be due to Gardnerella vaginalis and Chlamydia trachomatis but also due to retained products of conception (most common cause of chronic endometritis)
What is true regarding lactogenesis?
Exocytosis is responsible for secretion of lactose, protein, and water
A 25-year old female who’s G4 P(2 + 0 + 2 +2) and who was using IUCD presented with fever, low abdominal pain, and an offensive purulent vaginal discharge. Diagnose.
§ PID Group B Streptococcus § PID C. trachomatis and N. gonorrhea § PID Trichomonas vaginalis and Mycoplasma hominis § Uterine fibroids § Endometriosis
§ PID C. trachomatis and N. gonorrhea
During palpation of a pregnant women’s abdomen, the fetal head was felt in the right hypochondrium and his buttocks in the left iliac fossa. What describes his position?
§ Diagonal lie § Unstable lie § Vertical lie § Oblique lie § Horizontal lie
Oblique lie
Calculate the estimated date of delivery if the last menstrual period was on 10 – 1 – 2016 (Days – months –years).
17–10–2016
A woman delivered for the 2nd time 3 days ago. Both deliveries happened at 34 weeks of gestation and resulted in live infants. What describes her status?
G2P(0+2+0+2)
A woman delivered 3 days ago in 38 weeks of gestation. She used IVF after 5 years of infertility and gave birth to twins (boy and girl). What describes her status?
G1P(1+0+0+2)
A pregnant woman is brought to the emergency in preterm labor at 32 weeks of gestation. What can be administered to decrease the myometrial contractions?
Β2 agonists
Who is at increased risk of delivery a baby above weight?
§ 20-year-old woman with well-controlled diabetes
§ 30-year old woman in labor that is preterm at 36 weeks
§ 20-year old woman who has gained 10 Kgs during pregnancy
§ 30-year old woman with BMI=22
§ 30-year-old woman who came to induce labor at 42 weeks of gestation
§ 30-year-old woman who came to induce labor at 42 weeks of gestation
A cohort study is conducted among renal disease patients and the adjusted relative hazard of death [95% CI] associated with adequate physical activity (compared to physically inactive) is .55 [.28 - .98] and p=.04. Assuming the study is not biased, asses the effect size (magnitude of association) and if the sample is sufficient.
§ Moderate affect size, sufficient sample
§ Large affect size, sufficient sample
§ Large affect size, insufficient sample
§ Moderate affect size, sufficient sample
What measure of association is used for cohort study?
§ Cumulative incidence
§ Relative risk
§ Relative risk
What descriptive analysis is used for time-to-event data?
Kaplan-Meier curve
A woman had a child with cleft palate. She claimed that she had taken amoxicillin prior to being pregnant. What would you tell her to disprove the causal relationship between amoxicillin and the cleft palate?
§ IV amoxicillin is only teratogenic
§ She took the drug before the “all or none” phase of pregnancy
§ More than 7 days of amoxicillin is teratogenic
§ The dosage of amoxicillin was below threshold
§ She took the drug before the “all or none” phase of pregnancy
Where would the fetal heart sounds be heard best?
§ Anterior shoulder
§ Posterior shoulder
§ Anterior shoulder
Which age represents a female with atrophic endometrium due to low estrogen secretion?
Menopause
The secretions of which of the following will cause masculinization of the external genitalia?
Interstitial cells of Leydig
A patient presented with superficial, painful, and tender ulcers preceded by vesicles. Diagnose.
Genital herpes
What is the most common cause of non-gonococcal urethritis?
Chlamydia
A pregnant lady at 28th week of gestation suffers from thirst and ultrasound showed a big baby with increased amniotic fluid. What does she have?
Gestational diabetes
What is the embryological origin of the somites?
§ Anterior neuropore
§ Posterior neuropore
§ Primitive streak
§ Mesoderm
§ Mesoderm
What causes the cranial caudal polarity of the cell?
§ Paraxial mesoderm
§ Primitive streak
§ Anterior neuropore
§ Posterior neuropore
§ Primitive streak
A 20-year old female G3 P(0 + 0 + 3 + 0), who is sexually active with her husband only, seeks advice for the ideal contraceptive. Which method of contraception she should use?
§ Copper intrauterine contraceptive device § Diaphragm § Condom § Rhythmic ovarian monitoring § Cervical cap and spermicide
§ Copper intrauterine contraceptive device
What is true regarding a pregnant woman during the first half of pregnancy?
Increased lipogenesis
Through which method are amino acids transported from the mother to the fetus?
§ Active transport
§ Facilitated diffusion
§ Active transport
A solitary lesion in the principal lactiferous duct causing serosanguineous nipple secretions. Diagnose
§ Small duct papilloma
§ Ductal carcinoma
§ Large duct papilloma
§ Large duct papilloma
*Confirmed by Dr. Das
A woman with breast cancer has metastasis to the vertebral spines. What could be the route of transmission?
§ Cephalic veins
§ Intercostal veins
§ Thoracodorsal veins
§ Axillary veins
§ Intercostal veins
Section from the endometrium showed necrosis associated with synctiotrophoblasts and cytotrophoblasts. What will be increased?
Human chorionic gonadotropin
*This patient has choriocarcinoma
What is thelarche?
Development of breast tissue
Which cells invade the placenta and engulf the vessels?
§ Intermediate trophoblasts
§ Synctiotrophoblasts
§ Cytotrophoblasts
§ Intermediate trophoblasts
What is the most important factor for prognosis of breast cancer?
§ Hormonal receptor
§ Lymph node metastasis
§ Lymph node metastasis
Breast cancer with which of the following will respond to herceptin?
HER2/neu gene amplification
*Trastuzumab (INN; trade names Herclon, Herceptin) is a monoclonal antibody that interferes with the HER2/neu receptor. It can be an effective treatment both before and after surgery for people with HER2-positive breast cancer.
What best describes the mammillary glands?
Modified apocrine sweat glands
Which hormone repels the immune cell of the mother in the first trimester?
Human chorionic gonadotropin
What is the correct order of implantation stages?
Apposition → adhesion → invasion
What leads to inadequate milk production?
§ Inadequate mother nursing
§ Inappropriate breastfeeding technique (latching)
§ Inadequate mother nursing
*Poor latching results in poor milk EXTRACTION, and of course inhibitors of lactation will accumulate with time (if she doesn’t manually extract the milk) and hence decrease milk production. However, the doctor wrote “insufficient nursing results in inadequate milk production” since Sheehan syndrome can result in decreased prolactin and decreased milk PRODUCTION
Major portion of the lymphatic drainage will eventually drain into which group of lymph nodes?
§ Central axillary lymph nodes
§ Deep cervical lymph nodes
§ Deep cervical lymph nodes
- “Glandular lymphatics drain into axillary (pectoral) nodes → central axillary nodes → apical nodes → deep cervical nodes → subclavicular (subclavian) nodes”. “Apical (through which all the other axillary nodes drain) at the apex of the axilla….”
Thoracodorsal nerve is injured during the resection of which lymph nodes?
Subscapular lymph nodes
What describes ductal carcinoma in situ with involvement of malignant cells in epidermis?
Paget’s disease
What is responsible for glucosuria in pregnancy?
Decreased threshold for glucose absorption
What causes decrease in blood pressure in the first trimester?
Decreased peripheral vascular resistance
What is the pathophysiology in fibrocystic changes?
§ Hormonal imbalance in estrogen
§ Hormonal imbalance in progesterone
§ Hormonal imbalance in estrogen
Antibodies against what are found in pre-eclampsia?
§ Endoglin
§ Angiotensin I receptor
§ Nitric oxide synthase
§ Angiotensin I receptor
Expression of what is regulated by LXR/RXR dimer?
Endoglin
What impairs the binding of TGF-β1 to its receptor?
Soluble endoglin
What prevents normal vascular endothelial growth factor to attach to its receptor?
sFLT-1
Which mediator of pre-eclampsia can be safely removed by aphaeresis in a pregnant woman to abolish hypertension and proteinuria?
sFLT-1
What facilitates oxygen diffusion through placenta from mother to fetus despite fetal tissue pO2=30 mmHg?
Fetal hemoglobin shifts oxygen dissociation curve to the left
Which of the following describe a neoplastic cyst?
§ Corpus luteal
§ Follicular
§ Endometriod
§ Invasive
§ Invasive
An obese, hypertensive, and diabetic woman with an endometrial mass. Biopsy showed PTEN mutation. What does she have?
§ Serous carcinoma
§ Endometrial carcinoma
§ Clear cell carcinoma
§ Endometrial carcinoma
*This patient has type I endometrial carcinoma which is estrogen-dependent and occur in young and obese nulliparous women with PTEN and KRAS mutation. Serous and clear cell carcinoma occur in type II endometrial carcinoma which is non-estrogen dependent and occurs in thin multiparous women with p53 mutation.
What is a late consequence of menopause?
§ Bone loss
§ Memory impairment
§ Bone loss
A female with a high-grade squamous intraepithelial (HSIL) lesion is at risk of developing what?
Squamous cell carcinoma
Ovarian cancer metastasis is first detected in this lymph node?
Lumbar lymph nodes
A woman who had previous cervicitis presented with pain in the abdomen. She also had fever and ascites. What is the cause?
§ Blocked fallopian tubes § Adnexal mass
§ Blocked fallopian tubes
A biopsy near to adenocarcinoma revealed a mild nuclear enlargement, pleomorphism, and epithelial hyperplasia. Diagnose.
Intraepithelial prostate neoplasia
A male presents with low testosterone, FSH, and LH. Diagnose.
Kallman syndrome
Intrauterine insemination is highly recommended in which case of male infertility?
- Mumps orchitis
- Klinefelter 47 XXY
- Spinal cord injury
- 5α-reductase
?
Which lifestyle modification has proven to improve fertility in women?
- Smoking cessation
- Heavy anaerobic exercise
- Low calorie diet (<800)
- Avoidance of hormonal contraceptives
- Coitus every other day throughout menstrual cycle
?
A 65-year old man with stony hard prostate on rectal examination with PSA of 20 ng/ml. Diagnose
- Prostate cancer
- Prostate hyperplasia
?
