2013 module exam Flashcards
Which of the following is an embryological remnant of the cephalic part of the paramesonephric duct?
A. Appendix of the testes
B. Appendix of epidydimis
A. Appendix of the testes
What is the embryological origin of median umbilical ligaments in adults?
A. Urachus
B. Mesonephros
A. Urachus
Note: This question is based on what we studied in the renal module.
What develops from the mesonephric duct in a male embryo?
A. Vas deferens
B. Seminefrous tubules
A. Vas deferens
XY female presented with failure to menstruate. Analysis showed deletion of the SRY gene. What is the diagnosis?
A. Fragile X syndrome
B. Turner Syndrome
C. Swyer syndrome
C. Swyer syndrome
A tall athlete known to win medals was suspected to have ambiguous genitalia. The case was diagnosed with testicular feminizing syndrome; what is the pathophysiology of this syndrome?
A. Low testosterone level
B. Lack of Androgen Receptors
C. 5 Alpha reductase Deficiency
B. Lack of Androgen Receptors
Which of the following is derived from the paramesonephric duct in a female embryo?
A. Ovary
B. Round ligament
C. Uterine tube
C. Uterine tube
What is the role of Dihydrotestosterone in male sex development?
A. Development of internal genitalia
B. Development of external genitalia
B. Development of external genitalia
Which of the following is a remnant of the distal part of gubernaculum?
A. Cardinal ligament B. Round ligament of uterus C. Broad ligament D. Ovarian ligament E. Suspensory ligament
B. Round ligament of uterus
Note: The proximal part of the gubernaculum gives the ovarian ligament
Which of the following is derived from persistent mesonephric tubules?
A. Efferent ductules
B. Paradydimis
C. Appendix of the epididymis
A. Efferent ductules
Note: The correct answer originally was efferent ductules, but paradydimis was counted correct as well (although it wasn’t mentioned in the note).
Which of the following is an indication of female development in tanner classification?
A. Breast size and shape
B. Ovarian growth
A. Breast size and shape
Endometrial biopsy on day 24 of a 28-day regular cycle showed round glands with dense stroma and no mitosis. What is the most appropriate condition based on this biopsy?
A. Anovulatory cycle
B. Earlysecretory
C. Proliferative endometrium
D. Late secretory
A. Anovulatory cycle
Note: Although taken past-expected ovulatory day, which is day 14, the endometrial biopsy doesn’t show any secretory changes; rather it shows proliferative changes due to unopposed estrogen effect, which means ovulation didn’t happen “anovulatory cycle”.
Choice C “proliferative endometrium” is not appropriate since it doesn’t denote the pathology.
Which structure might be injured during ligation of the uterine artery?
Ureter
Which artery gives testicular artery as a branch?
A. Abdominal aorta
B. Internal iliac artery
A. Abdominal aorta
Which of the following secretes nourishment for sperms?
Seminal vesicle
What is a contraindication for combined oral contraceptives?
A. Cerebrovascular problems
B. Uterine fibroids
C. Endometrial cancer
A. Cerebrovascular problems
Which drug is a Progesterone-receptor blocker that is used to induce abortion?
Mifepristone
Which drug is biotransformed into a metabolite that inhibits FSH?
A. Ethinyl estradiol
B. Mestranol
B. Mestranol
Note: Mestranol is a precursor of Ethinyl estradiol, which acts partly by inhibiting FSH release because it is an estrogen analogue.
Ligation of which of the following arteries would compromise the blood supply to the prostate gland?
A. Inferior vesical artery B. Superior vesical artery C. Umbilical artery D. Internal pudendal artery E. External iliac artery
A. Inferior vesical artery
A female gets her menses regularly every 35 days, on which day does she ovulate?
A. 14
B. 21
C. 24
B. 21
Note: The duration of the luteal phase is constant (14 days) so always subtract 14 from the duration of the menstrual cycle to get the day of ovulation.
Which artery gives a branch to supply the anterior scrotum?
A. External iliac
B. Internal iliac
C. Femoral
C. Femoral
Where does sperm storage and maturation take place?
A. Vas deferens
B. Epididymis
B. Epididymis
Through which of the following structures do ovarian vessels pass?
A. Suspensory ligament
B. Cardinal ligament
C. Ovarian ligament
A. Suspensory ligament
Who of the following has an abnormal menstrual period?
A. 40 year-old woman with 10-day period
B. A 20 year-old who Bleeds 75cc per cycle
C. A 13 year-old girl who gets her period every 30 days
A. 40 year-old woman with 10-day period
What is the mechanism of action of Northindrone as an oral contraceptive?
A. Blocks progesterone receptor
B. Enhances GR secretion
C. Increase sensitivity of pituitary gland
D. Thickens cervical mucosa
E. Increases or enhances follicular growth
D. Thickens cervical mucosa
Which of the following structures covers the fallopian tube?
A. Mesosalpinx
B. Broad ligament
A. Mesosalpinx
Note: The originally-correct answer was mesosalpinx because it is more specific, but after arguing, broad ligament was counted correct as well.
“Soluble fms-like tyrosine kinase 1” is derived from which cytokine receptor?
A. TNF alpha
B. VEGF
B. VEGF
Which of the following acts as a decoy receptor for VEGF?
A. sFLT-1
B. TGFβ receptor
A. sFLT-1
Choose the correct sequence of events for each of the following processes: Sequence of implantation
A. Interaction-penetration-fusion
B. Apposition-adhesion-invasion
C. Adhesion-apposition-invasion
D. Spermatogenesis-capacitation-maturation
E. Spermatogenesis- maturation- capacitation
F. Penetration-interaction-fusion
B. Apposition-adhesion-invasion
Choose the correct sequence of events for each of the following processes: Sequence of fertilization
A. Interaction-penetration-fusion
B. Apposition-adhesion-invasion
C. Adhesion-apposition-invasion
D. Spermatogenesis-capacitation-maturation
E. Spermatogenesis- maturation- capacitation
F. Penetration-interaction-fusion
A. Interaction-penetration-fusion
Choose the correct sequence of events for each of the following processes: Sequence of sperm development
A. Interaction-penetration-fusion
B. Apposition-adhesion-invasion
C. Adhesion-apposition-invasion
D. Spermatogenesis-capacitation-maturation
E. Spermatogenesis- maturation- capacitation
F. Penetration-interaction-fusion
E. Spermatogenesis- maturation- capacitation
Which maternal condition causes the following problems in the fetus: Caudal regression
A. AIDS B. Syphilis C. Myasthenia gravis D. SLE E. Diabetes Mellitus F. Graves’ disease
E. Diabetes Mellitus
Which maternal condition causes the following problems in the fetus: Congenital heart block
A. AIDS B. Syphilis C. Myasthenia gravis D. SLE E. Diabetes Mellitus F. Graves’ disease
D. SLE
Which maternal condition causes the following problems in the fetus: Thyrotoxicosis
A. AIDS B. Syphilis C. Myasthenia gravis D. SLE E. Diabetes Mellitus F. Graves’ disease
F. Graves’ disease
Expression of what factor is regulated by LXR/RXR dimer?
A. Endoglin
B. Endothelin-1
A. Endoglin
Which of the following is the final common pathway in the development of pre-eclampsia?
A. Endoglin
B. TNFa
C. AT 1 AA
D. Endothelin-1
D. Endothelin-1
Which parameter is used to assess the amount of functional trophoblasts at early stages of pregnancy?
A. Chorionic gonadotropin
B. Inhibin A
C. Insulin like growth factor binding protein 1
D. Progesterone
A. Chorionic gonadotropin
Choose the most appropriate term to describe each of the following: Identical twins
A. Monochorionic Diamniotic
B. Dichorionic Monoamniotic
C. Monozygotic
D. Dizygotic
C. Monozygotic
Choose the most appropriate term to describe each of the following: Twins sharing the same placenta but have separate amniotic sacs
A. Monochorionic Diamniotic
B. Dichorionic Monoamniotic
C. Monozygotic
D. Dizygotic
A. Monochorionic Diamniotic
What is the function of the mitochondria in sperms?
A. Source of energy
B. Motility
C. Connects the head with tail
A. Source of energy
Resection of which of the following lymph nodes may injure the thoracodorsal nerve?
Subscapular lymph nodes
Which of the following nerves provide innervation for emission?
A. Lumbar splanchnic nerves
B. Sacral splanchnic
C. Pudendal nerve
D. Pelvic splanchnic nerves
A. Lumbar splanchnic nerves
Which of the following nerves provide parasympathetic innervation for erection?
A. Sacral splanchnic nerves B. Lumbar splanchnic nerves C. Pudendal nerve D. Dorsal nerve of the penis E. Perineal nerve
A. Sacral splanchnic nerves
Note: “Pelvic splanchnic nerves” wasn’t among the choices although it is the only possible correct answer for this question. “Sacral splanchnic nerves” was the answer even though it is not correct (sacral splanchnic nerves are sympathetic). Probably they edited this question in the Q-bank.
Which nerve should be blocked during episiotomy?
Pudendal nerve
A lady presented with severe post-partum bleeding and failure of placental separation at birth due to absence of the decidua and adherence of the placental tissue to the myometrium. What is the diagnosis?
A. Placenta accreta
B. Placenta previa
A. Placenta accreta
What causes doubling of CBG (cortisol-binding globulin or transcortin) during pregnancy?
A. High insulin
B. High Estradiol
C. HCG
B. High Estradiol
Note: Don’t mix CBG with TBG (TBG increases under the effect of BOTH hCG and estrogens).
Choose the appropriate match of the maternal condition and the drug that can be safely prescribed to treat it.
A. Captopril–HTN
B. Insulin – type 2 diabetes
C. Aspirin – pain
D. Quinolone–infection
B. Insulin – type 2 diabetes
What is the inferior border of deep perineal pouch in the anatomical position?
A. Transverse perineal muscle
B. Perineal membrane
B. Perineal membrane
A mother of five children is seeking treatment for her urinary incontinence after her last delivery. What could be the cause?
Injury to tendinous arch of pelvic fascia
A tumor composed entirely of proliferating cytotrophoblasts and syncytiotrophoblasts with areas of hemorrhage but no chorionic villi. What is the diagnosis?
A. Choriocarcinoma
B. Hydatiform mole
A. Choriocarcinoma
On abortion, the products of conception showed a karyotype of 69-XXY. What is the most likely pathology?
A. Partial hyaditiform mole
B. Complete mole
A. Partial hyaditiform mole
Breast cancer metastasizes to vertebral spines. What’s the direct route of transmission?
A. Intercostal veins
B. Lymphatics
A. Intercostal veins
The majority of the lymphatic drainage from the breast tissue eventually goes to which group of lymph nodes?
A. Central axillary
B. Deep cervical
B. Deep cervical
Note: “Deep cervical lymph nodes” is the correct answer because the question said “eventually” (According to Dr. Waleed Renno).
The doctor told me that he edited this question in the bank and put “diaphragmatic LNs” instead of “deep cervical” so only 1 correct answer remained (central axillary LNs).
A pregnant woman developed HTN and seizures. What is the diagnosis?
A. Eclampsia
B. Preeclampsia
A. Eclampsia
Which of the following hormones reaches its maximum concentration in the first trimester of pregnancy?
A. Testosterone
B. hCG
B. hCG
Note: Many students chose testosterone but it is completely wrong. Testosterone increases significantly and reaches male values by the end of the first trimester but it doesn’t “peak”; rather it keeps on increasing till the end of pregnancy (refer to the graph in the note). However, hCG peaks in the 10th week and then declines.
What is responsible for myometrial contraction/activation during labor?
A. Estrogen B. Nitric oxide C. Prostacyclin (PGI2) D. Progesterone E. Relaxin
A. Estrogen
Which muscle helps in the primary support of the pelvic viscera?
A. Obturator externus B. Obturator internus C. Levatorani D. Periformis E. Coccygeus
C. Levatorani
25 year-old female presented with a breast mass. Histological examination showed delicate cellular fibroblastic stroma enclosing glandular and cystic spaces lined by epithelium. What is the diagnosis?
A. Fibroadenoma
B. Fibrocystic change
A. Fibroadenoma
Note: Many students confused fibroadenoma with fibrocystic change because the question mentioned “cystic spaces”.
Three principal features are characteristic of fibrocystic change (usually presents as a painful palpable breast mass): 1) Cyst formation (lining epithelium can show either atrophy or apocrine metaplasia)
2) Increase in fibrous stroma 3) Adenosis (proliferation of terminal duct elements).
What causes decreased gastric emptying rate during pregnancy?
A. Increased gastrin
B. Decreased motilin
C. Decreased intestinal motility
D. Decreased stomach size
B. Decreased motilin
What is the effect of progesterone on the respiratory system during pregnancy?
A. Increases the respiratory rate
B. Increases tidal volume and respiratory minute volume
B. Increases tidal volume and respiratory minute volume
What contributes to copious milk production?
A. Vaginal delivery
B. Stress
C. Preterm C-section
A. Vaginal delivery
Which of the following drugs is considered category X according to the FDA risk classification for drugs?
A. Warfarin
B. Heparin
C. Amoxicillin
D. Phenytoin
A. Warfarin
Examination of the breast shows unilateral absence of glandular tissue, areola, and nipple. What is the diagnosis?
A. Amastia
B. Polythelia
A. Amastia
After miscarriage, D&C showed cystic grape-like structures with edematous chorionic villi and absence of fetal parts. What describes this condition?
A. Placenta accreta
B. Placenta previa
C. Choriocarcinoma
D. Hydadtiform mole
D. Hydadtiform mole
Which of the following is a diabetogenic hormone that is released during pregnancy?
A. hCG
B. hPL
B. hPL
A 25 year-old lady presented with swelling in the axilla, which has enlarged following delivery. FNA smear from the swelling shows benign breast epithelium. What is the diagnosis?
A. Amastia
B. Accessory breast tissue
C. Polythelia
B. Accessory breast tissue
Histopathological examination of a beast mass shows intraductal proliferation of malignant cancer cells with central necrosis and calcification. What is the diagnosis?
A. Comedo DCIS B. Non comedo DCIS C. Adenocarcinoma D. Adenocarcinoma in situ E. Invasive ductal carcinoma
A. Comedo DCIS
A pregnant woman is always thirsty and tired came for antenatal checkup. Ultrasound showed a big baby and polyhydramnios. What could be the cause of these findings?
A. Diabetes Mellitus
B. Diabetes insipidus
A. Diabetes Mellitus
Note: Gestational diabetes mellitus (GDM) develops due to insulin resistance. Pre-existing DM would give the same findings during pregnancy.
Alpha fetoprotein is a tumor marker for which of the following tumors?
A. Adenocarcinoma
B. Serous cystadenoma
C. Endometrial sinus tumor
D. Granulosa-theca tumor
C. Endometrial sinus tumor
Which gene is responsible for Li-Fraumeni syndrome?
A. P53
B. Her2
A. P53
Which patients benefit from treatment with Trastuzumab?
A. Her2-positive breast cancer
B. ER positive – Her2 negative breast cancer
A. Her2-positive breast cancer
A patient was diagnosed with endometrial cancer. Upon history taking, she reported that two of her family members have the same condition. Some family members also have colon cancer. Which of the following syndromes likely runs in this family?
A. Peutz-Jauger Syndrome
B. Lynch Syndrome
C. Cowden Syndrome
B. Lynch Syndrome
Which tumor is characterized histologically by glomerulus-like structures (Schiller-Duval bodies)?
A. Granulosa-thecatumor
B. Yolk sac tumor
C. Embryonal carcinoma
D. Teratoma
B. Yolk sac tumor
The fertility drug Clomiphene increases the risk of which type of ovarian cysts?
A. Follicular cyst
B. Corpus luteum cyst
B. Corpus luteum cyst
Pap smear taken from a 38 year-old female showed hypereosinophilic bizarre-shaped cells with irregular nuclei. What is the diagnosis?
A. LSIL B. HSIL C. Adenocarcinoma D. AdenocarinomaIn-situ E. Squamous cell carcinoma
E. Squamous cell carcinoma
Note: Hyper-eosinophilia means increased keratin within the cytoplasm (orangophilia) & the bizarre cells are likely tadpole cells. This answer is confirmed by Dr. Rola.
A 55 year-old woman presented with a 1-cm mass in her right breast. The mass showed well-differentiated invasive ductal carcinoma with no metastasis to axillary lymph nodes. What is the molecular type of this mass?
A. ER +, PR +, Her2 –
B. ER -, PR -, Her2 +
C. Triple negative
A. ER +, PR +, Her2 –
Note: Most of grade 1 (well-differentiated) breast cancers are ER-positive, Her2-negativebetter prognosis.
Who is more likely to develop menopause earlier (premature menopause)?
A. A lady who Smokes 20 packs of cigarettes per day for 10 years
B. 30 year-old who had unilateral oophorectomy because of torsion
C. 49 year-old with simple hysterectomy
A. A lady who Smokes 20 packs of cigarettes per day for 10 years
Which tumor is characterized by concentric calcification (Psammoma body)?
A. Serous cystadenoma
B. Serous cystadenocarcinoma
B. Serous cystadenocarcinoma
A 55 year-old lady presented with vaginal bleeding and an endometrial mass. Endometrial biopsy showed atrophied endometrium with papillary growth of the glands and marked atypia. What is the diagnosis?
A. Serous adenocarcinoma
B. Endometrioid carcinoma
A. Serous adenocarcinoma
Choose the most accurate diagnosis of the following cervical lesions: Cervical biopsy showed nuclear atypia in the lower one third of the epithelium.
A. CIN2 B. CIN1 C. CIN3 D. Adenocarcinoma E. Adenocarcinoma in-situ F. Squamous cell carcinoma
B. CIN1
Choose the most accurate diagnosis of the following cervical lesions: Glandular proliferation with nuclear atypia and mitosis but no invasion.
A. CIN2 B. CIN1 C. CIN3 D. Adenocarcinoma E. Adenocarcinoma in-situ F. Squamous cell carcinoma
E. Adenocarcinoma in-situ
Endometrial biopsy shows atypical cells and increased gland-to-stroma ratio without invasion. What is the diagnosis?
A. Endometrial hyperplasia
B. Endometrial Carcinoma
A. Endometrial hyperplasia
A patient with an ovarian tumor was also found to have endometrial hyperplasia. What is the reason for the endometrial pathology?
A. Metastasis from ovary to endometrium
B. Estrogen is secreted from the tumor
C. Conversion of androgens to estrogen
B. Estrogen is secreted from the tumor
Abdominal specimen taken from C-section scar shows hemosiderin-laden macrophages. What is the diagnosis?
Endometriosis
A 44 year-old female presented with menstrual irregularities and a palpable mass in the lower abdominal area. What is the first imaging modality that should be used in this patient?
A. US of pelvis
B. MRI of pelvis
A. US of pelvis
Note: The initial radiological investigation for any mass is US.
What is the Initial radiological method for a breast mass in a 20 year-old girl?
A. Ultrasound breast
B. Mammography
C. MRI
A. Ultrasound breast
Which of the following is indicated for pre-operative preparation of ovarian cancer?
A. CT with contrast
B. FNA
C. Hysterosalpingography
D. Excretory urography
A. CT with contrast
Note: Even if MRI was among the choices, CT with contrast is still the best answer.
A 20 year-old woman is seen in the antenatal clinic at 30 weeks of pregnancy. Abdominal examination shows that the fetal head is in the right upper quadrant of the maternal abdomen. What is the fetal lie?
A. Diagonal B. Horizontal C. Oblique D. Transverse E. Vertical F. Unstable
C. Oblique
What happens to B-hCG during the first 10 weeks of gestation? (PBL week 3)
A. Increases by 50% every 24-48 hours
B. Increases by 50% every 48-72 hours
C. Increases by 100& every 24-48 hours
D. Increases by 100% every 48-72 hours
D. Increases by 100% every 48-72 hours
What is the first sign of pregnancy seen on a transvaginal US? (PBL week 3)
- Cardiac activity at 6 weeks
- Fetal pole at 6 weeks
- Gestational sac at 4-5 weeks
- Yolk sac at 4-5 weeks
- Gestational sac at 4-5 weeks
What is the order of the cardinal movements of the fetus during labor/delivery? (PBL week 4)
- Descent-Engagement-Flexion-Internal rotation-Extension-External rotation
- Engagement- Descent- Flexion- Internal rotation- Extension- External rotation
Note: Engagement: The leading edge of the fetal presenting part has descended to the level of the ischial spines of the maternal pelvis “station 0”
What is tamoxifen? (PBL week 5)
A. Eagonist
B. E antagonist
C. E agonist/antagonist
C. E agonist/antagonist
What is the expected date of delivery “EDD” for a pregnant lady who has had her last menstrual period “LMP” at 1/1/2017?
A. 8.10.2017
B. 4.10.2017
C. 10.10.2017
A. 8.10.2017
Choose the appropriate description of the position of the fetus based on abdominal examination: Fetal buttocks is felt in the maternal pelvis during Leopold’s maneuver
A. Breach presentation B. Cephalic presentation C. Cranial presentation D. Transverse lie E. Horizontal lie F. Oblique lie
A. Breach presentation
Choose the appropriate description of the position of the fetus based on abdominal examination: Fetal head in the right lumbar region and his buttocks in the left lumbar region
A. Breach presentation B. Cephalic presentation C. Cranial presentation D. Transverse lie E. Horizontal lie F. Oblique lie
D. Transverse lie
Choose the appropriate description of the position of the fetus based on abdominal examination: Fetal head is felt just above the pubic symphysis
A. Breach presentation B. Cephalic presentation C. Cranial presentation D. Transverse lie E. Horizontal lie F. Oblique lie
B. Cephalic presentation
A 14 year-old girl with developed secondary sexual characteristics (breast, axillary and pubic hair) presented with absence of menses. What is the next step in her management?
A. Reassure and follow up after 1 year B. Reassure and follow up after 2 years C. Karyotyping to diagnose AIS D. Imaging of internal organs E. Investigation for Mullerian agenesis
B. Reassure and follow up after 2 years
Note: Definition of primary amenorrhea: >14 year without secondary sexual characteristics OR >16 years with secondary sexual characteristics
A 40 year-old lady, who is currently 10-week pregnant, reported that she had 4 C-sections previously at 38 weeks of gestation. One of her children died at the age of 3 weeks because of a congenital disease. She also reported having 2 previous miscarriages. What is the parity code for this lady?
A. G6 P4+0+2+4
B. G6 P4+0+2+3
C. G7 P4+0+2+4
D. G7 P4+0+2+3
C. G7 P4+0+2+4
Note: You have to include the current pregnancy in the G code (4 pregnancies ended in C-sections at term + 2 pregnancies ended in miscarriage + 1 current pregnancy = 7).
There is lack of consensus regarding the “L” in the parity code.
L means “live births” not “living children” so the baby who has died should be included in the parity code (This is the coding system that Dr. Jehad follows).
Many doctors in the hospitals follow a different coding system. They told the students that “L” means “living children” so they chose “D” instead of “C”. For this reason, Dr. Jehad removed this question when we informed her. SO ALWAYS STICK TO WHAT SHE SAYS!
EBM: Which of the following is a measure of disease occurrence in a cohort study?
A. Cumulative incidence
B. Relative risk
A. Cumulative incidence
Note: Relative risk is a measure of association not disease occurrence.
EBM: A study was done to assess the risk of asthma in children with pet exposure. The hazard ratio was 3.5. What is the type of the study, the nature of the outcome, and the type of analysis used in this study?
A. Cohort - time to event - Cox
B. Cohort - time to event - linear
C. Cohort - binary - logistic
D. Case control - binary - logistic
A. Cohort - time to event - Cox
EBM: A case control study was done to evaluate the association between breast cancer and oral contraceptives. The cases were collected from breast cancer hospital and the controls from infertility clinic. What is most important concern regarding this study?
A. Controls are inappropriate
B. Recall bias
C. Cases are not representative
A. Controls are inappropriate
Forensic Medicine: A house maid was found hanged in the bathroom. The examiner noticed deep dark bluish hypostasis in both legs. What is the time between death and post-mortem examination?
A. Half an hour
B. 2 hours
C. 4 hours
D. More than 8 hours
D. More than 8 hours
Forensic Medicine: What is the mechanism of rapid death during manual strangulation?
A. Fracture of C1 vertebra
B. Airway obstruction
C. Reflex cardiac inhibition
C. Reflex cardiac inhibition
