2013 A Flashcards
A cause of primary amenorrhea
a. Polycystic ovarian syndrome b. Premature ovarian failure c. Kallman syndrome d. Functional hypothalamic amenorrhea
C
A cause of secondary amennorhea
a. Prepubertal hypothyroidism b. Androgen resistance c. Phenothiazine derivatives d. 17, 20 desmolase deficiency
C
Which of the following is a cause of amenorrhea and manifests with presence of the uterus but with absent breast development?
a. MRKH Syndrome b. Turner syndrome c. Agonadism d. 17 α hydroxylase deficiency
B
Which of the following is a cause of amennorhea and manifests with the absence of both uterine and breast development?
a. 46, X abnormal X b. Uterovaginal agenesis c. Congenital anatomic defect in CNS d. Agonadism
D
What causes endometrial bleeding during menses?
a. Progesterone withdrawal from an estrogen-primed endometrium
b. Estrogen withdrawal from a progesterone-primed endometrium
c. High progesterone content
d. High estrogen content
A
What is mennorhagia?
a. Uterine bleeding at regular intervals of 7 days
c. Uterine bleeding more than 35 days apart
d. Uterine bleeding at irregular but frequent intervals
B
Which is a cause of anovulatory bleeding?
a. Coagulopathies b. Intrauterine device c. Adenomyosis d. Gonadal steroids
D
What is most effective in the control of acute uterine bleeding?
a. Paracetamol b. Estrogens c. Androgens d. NSAIDS
B
Which is true of primary dysmennorhea?
a. Dyspareunia is seen.
b. Fixed retroverted uterus with posterior tenderness is seen.
c. Pain is correlated with increased duration and flow of menses.
d. Laparoscopy is the best diagnostic modality.
C
Which is a symptom of Premenstrual Syndrome?
a. Bipedal Edema b. Psychosis c. Joint pains d. Lethargy
D
Preterm labor is defined as:
a. Regular uterine contractions 5-8 minutes apart b. Cervical effacement c. Progressive cervical dilatation d. All of the above
D
Which of the following risk factors has the strongest association with preterm birth?
a. Gestational DM b. History of preeclampsia c. History of preterm birth d. Smoking
D
Which of the following vaginal infections is significantly associated with preterm birth?
a. Candidiasis b. Bacterial vaginosis c. Trichomoniasis d. Herpes simplex infections
B
What is the mechanism of by which betamethasone reduces respiratory distress syndrome?
a. Acts synergistically with beta-adrenergic agents to prolong latency period b. Increased prostaglandin production c. Increased interleukin-1 production d. Increased production of surfactant
D
Which is the most common cause of indicated pre term birth?
a. Abruptio placentae b. Placenta previa c. Preeclampsia d. Gestational diabetes
C
Which of the following tocolytics is associated with premature closure of fetal ductus arteriosus?
a. Ritodrine b. Nifedipine c. Magnesium sulfate d. Indomethacin
D
Postterm pregnancy is defined as pregnancy which extends beyond how many weeks?
a. 37 weeks b. 40 weeks c. 42 weeks d. 44 weeks
C
What is the most important reason for increased fetal morbidity and mortality in post term pregnancy?
a. Placental insufficiency b. Meconium-stained amniotic fluid c. Oligohydramnios and cord compression d. Decreased fetal urination
A
What is the appropriate management for a woman who has reached 42 weeks AOG with a Bishop’s score of 5 and estimated fetal weight of 3850 grams?
a. Expectant management or induction b. Start fetal well-being studies c. Amniocentesis to determine fetal lung maturation d. Elective caesarian section
A
For dichorionic diamnionic membranes to occur in monozygotic twins, when should division occur with reference to fertilitization?
a. < 72 hours b. >72 to 180 hours c. 180 to 240 hours
A
In advising a woman on calendar (rhythm) method, you would advise abstinence on fertile time as computed
a. length of longest cycle – 18 days and length of shortest cycle – 11 days
b. length of shortest cycle – 18 days and length of longest cycle – 11 days
c. length of longest cycle – 14 days and length of shortest cycle – 10 days
d. length of shortest cycle – 14 days and length of longest cycle – 10 days
B
Mechanism of action of copper IUD
a. Thickens cervical mucus b. Blocks LH surge c. Endometrial atrophy d. Sterile inflammation
D
Long acting methods of contraception EXCEPT:
a. depot medroxyprogesterone acetate b. transdermal contraception c. vaginal ring d. cervical cap
D
An absolute contraindication to oral contraceptive pill use
a. acne b. obesity c. history of headaches d. smokers above age 35
D
The best form of contraceptive for a for a nursing mother 6 weeks after delivery
a. mucus method b. progestin only pill c. low dose oral contraceptive pill d. symptothermal method
B
Which of the following is the most common cause of tubal factor infertility?
a. Tuberculosis b. Pelvic inflammatory disease c. Ruptured appendicitis d. Endometriosis
B
Which of the following would best evaluate uterine factors?
a. Endometrial biopsy b. Pap smear c. Hormonal assay d. Hysterosalpingogram
D
Documentation of ovulation is done using the following, EXCEPT:
a. Laparoscopy b. Transvaginal ultrasound follicle monitoring c. Midluteal phase serum progesterone d. Basal body temperature
A
Among the following contraceptive methods, which has the highest failure rate?
a. Bilateral tubal ligation b. Condoms c. Oral contraceptive d. Vasectomy
B
Which of the following is NOT a contraindication for IUD?
a. Subacute pelvic inflammation b. Pregnancy c. Undiagnosed prolonged uterine bleeding d. Menstruation
D
Preferred anticoagulant for pregnancy:
a. Heparin b. Warfarin c. Coumarol d. Phenindione e. All of the above
A
Which of the following drugs can be classified as Category B drugs?
a. Multivitamins b. Penicillin c. Metronidazole d. B&C e. All of the above
D
The most common reason for congenital defects
a. medication errors b. drugs c. chemical agents d. genetics e. none of the above
D
The anti-emetic drug that caused an epidemic of limb deformities during the 60s
a. Thalidomide b. Sulfanilamide c. Alcohol d. Methotrexate e. Metoclopramide
A
The most prescribed drug for therapeutic use is
a. Respiratory drug b. GI drug c. Vitamins d. Analgesic e. Antihypertensives
C
A 28 year old G1P0, with a BP of 150/90, +2 protein in the urine, +2 edema. What is your drug of choice?
a. Methyldopa b. Captopril c. Reserpine d. Metoprolol
A
Which of the following drugs belong to Class X
a. Phenobarbital b. Enalapril c. Methotrexate d. Chloramphenicol e. Diazepam
C
The principles in prescribing medicine includes all of the following EXCEPT:
a. Establish a clear indication
b. Use newer drugs which are better chemically and thus with less side effects
c. Use treatment in the lowest possible dose
d. Assess the benefit and risk to mother and fetus
e. none of the above
B
Drugs that have caused or are suspected to cause reversible adverse side effects but no malformation because of its pharmacologic actions
a. Category X b. Category D c. Category C d. Category B e. None of the above
C
Data required in documenting drug intake during pregnancy
a. Age of gestation b. Type of drug and dosage c. Indication of drug usage d. A & B e. All of the above
E
Which of the following statements is true regarding the physiology of sex hormones?
a. Main source of circulating estrogens in men is from the zona reticularis
b. Estrogen of postmenopausal women is estrone rather than estradiol
c. Complete selectivity of action of different sex hormones because they have separate receptors
d. A & B
e. All of the above
B
The two cell system of the regulation of the menstrual cycle includes:
a. LH stimulation of ovarian theca cells to increase the synthesis of testosterone
b. Aromatization of testosterone to estrogen
c. Expression of FSH receptors in both Sertoli and Granulosa cells
d. LH stimulation to increase the production of androgen binding protein
e. All of the above
C
The following statements are true EXCEPT:
a. COCs exert their contraceptive effect largely through selective inhibition of pituitary function that results in the inhibition of ovulation
b. Continuous use of progestins alone does not always inhibit ovulation
c. The estrogen used in low dose COC is either ethinyl estradiol or mestranol
d. A & B only
e. All of the above
D
The physiologic effects of estrogen include
a. Reduction of the rate of bone resorption by promoting apoptosis of osteoclasts
b. Increased coagulation by production of Factor II, VII, IX, X
c. Alteration of plasma membrane by decrease in triglycerides and total cholesterol
d. A & B only
e. All of the above
D
The following are non-contraceptive incidental benefits of COCs:
a. Lower endometrial cancer b. Lower ovarian cancer c. Lower cervical cancer d. A and B only e. All of the above
D
The following statements are false EXCEPT:
a. Dimethisterone, Gestodene and Norgestimate have lower androgenic activity than older synthetic Progestin
b. Progestins are rapidly absorbed following administration by any route and are almost completely metabolized in one passage thru the liver.
c. Progesterone is responsible for the alveotubular development of the secretory apparatus in the breast.
d. B and C
e. All of the above
E
Which of the following inhibits the conversion of testosterone to dihydrotestosterone?
a. Mifepristone b. Finasteride c. Letrozole d. Flutamide e. Clomiphene
B
Which of the following is an FDA-approved ovulation-inducing agent?
a. Mefipristone b. Finasteride c. Letrozole d. Flutamide e. Chlomiphene
E
Which of the following is a competitive antagonist at the androgen receptor D?
a. Mifepristone b. Finasteride c. Letrozole d. Flutamide e. Clomiphene
D
Which of the following has luteolytic activity?
a. Mifepristone b. Finasteride c. Letrozole d. Flutamide e. Clomiphene
A
A 41 y/o G4P3 (3003) was admitted at 40-41 weeks AOG with an ultrasound result of placenta previa (placenta anterior and totally covering the os). Her three previous pregnancies were terminated by Low Segment Caesarian Sections (LSCS), with no complications. What should you anticipate with this delivery?
a. Profuse vaginal bleeding if you wait 3 more days b. Uterine atony c. Bleeding sinuses at the lower uterine segment d. Placenta accrete
D
What would you tell the patient in the above case on her mode of management?
a. Wait 3 more days then proceed with repeat CS b. Immediate repeat LTCS c. Immediate Classical CS d. Caesarian hysterectomy
D
You perform Outlet Forceps Extraction (OFE) on a primigravid under epidural anesthesia, delivering a 3.1 kilogram baby. Immediate postpartum course was uneventful as the episiotomy is adequately repaired. At the recovery room, her BP was initially 120/80 mmHg but dropped to 90/50 mmHg after 2 hours, with corresponding tachychardia of 120 bpm. She was noted to be pale. On pelvic exam, there was no vaginal bleeding and the episiotomy site was intact with minimal oozing. The corpus was well contracted. What is your present impression?
a. Uterine rupture b. Expanding retroperitoneal hematoma c. Retained Placental secundines d. Incomplete Uterine Inversion
B
A 24 year old primigravid at 37 weeks AOG sought your second opinion. She had an ultrasound at 32 weeks AOG showing the placental edge to be 2.0 centimeters from the internal cervical os. After repeating the ultrasound, it was confirmed that the edge of the placenta was 5 centimeters from the internal cervical os. What would you advise the patient?
a. Assure that she may wait for the onset of labor and attempt vaginal delivery
b. Advise that vaginal delivery may be attempted but if she bleeds profusely in the course of labor, an emergency caesarian section will be performed
c. Repeat the ultrasound after 2 weeks and make decision at that time
d. Elective caesarian section in 1 to 2 weeks
A
One of the major blood supplies of the pelvic organs is derived from
a. Uterine arteries which branch directly from the hypogastric arteries
b. Ovarian arteries which branch directly from the internal iliac arteries
c. External iliac arteries which branch directly from the common iliac arteries
d. Cervico-vaginal branches of the uterine arteries
D
What is the substance released in the circulation that begins the cascade of consumptive coagulopathy?
a. Thrombin b. Thromboplastin c. Factor VII d. High molecular weight kallikrein (HMWK)
B
Which of the following is NOT a definition of pastpartum hemorrhage?
a. Blood loss of >500 cc for vaginal delivery
b. Decrease in postpartum hematocrit of >20% of prenatal value
c. Blood loss of >1 L for caesarian delivery
d. Any bleeding that results in signs & symptoms of hemodynamic instability
D
What is achieved in internal iliac ligation?
a. Increase in pulse pressure of arteries distal to ligation
b. Conversion of arterial system pressure into one approaching the pressure of venous circulation
c. Reduction of pulse pressure in arteries proximal to ligation
d. Conversion of venous system pressure into one approaching the pressure of arterial circulation
B
What will be a risk factor for Abruptio Placenta?
a. Oligohydramnios b. Prematurity c. Hypertension d. Previous Placenta Previa
C
What is the most common cause of acute uterine inversion?
a. Presence of concomitant placenta accrete
b. Vigorous fundal pressure on the 3rd stage of labor
c. Overtraction of the umbilical cord
d. Presence of a relaxed and atonic uterus
C
