E1 Flashcards
1) Which of the following contains the receptors for SRY antigens? A. Pronephros B. Genital ridge C. Mullerian duct D. Wolffian duct
Answer: B
2) Which of the following will form the Wolffian duct? A. Pronephros B. Mesonephros C. Metanephros D. Paramesonephric duct
Answer: B
3) Anomaly wherein a female has a solitary opening for the vaginal secretions and urinary tract? A. Cloaca B. Urethro-vaginal fistula C. Urogenital sinus D. Recto-vaginal fistula
Answer: C
4) Which of the following chromosomal abnormalities would have a male phenotype? A. XXX B. XO C. XXXX D. XYY
Answer: D
5) The following structures are not developed in a patient with DHT-deficient male A. Seminal vesicles B. Prostate C. Vas deferenes D. Epididymis
Answer: B
DHT-deficiency leads to malformation of the external male genitalia, which includes the penis, scrotum, and prostate. A, C, D are derivatives of the Wolffian duct, which is stimulated to differentiate by testosterone.
6) Which of the following results from an appropriate response of the androgen receptors? A. Gonadotropin regulation B. External virilization C. Prostate enlargement D. Pubertal maturation
Answer: B
7) The gonads are derived from the following EXCEPT A. Mesothelium B. Endothelium C. Mesenchyme D. Primordial germ cells
Answer: B
8) For an indifferent gonad to become a testis,
A. only the cortex develops
B. only the medullary part develops
C. both the cortex and medulla develop
D. none of the cortical and medullary parts would develop
Answer: B
In males, the cortex regresses and the medulla develops. In females, the cortex develops and the medulla regresses.
9) The secretion of the Sertoli cells would cause
A. Development of male internal genitalia
B. Development of male external genitalia
C. Development of mullerian duct
D. NOTA
Answer: D
Sertoli cells release the Mullerian Inhibiting Substance (MIS) which causes the regression of the Mullerian duct. (Review: Mullerian duct develops into the fallopian tube, uterus, cervix and upper 1/3 of the vagina.) Leydig cells produce testosterone which stimulates the development of the male internal genitalia from the Wolffian duct. Testosterone is reduced to DHT which in turn is responsible for the development of the male external genitalia.
10) The Mullerian duct will eventually form the following EXCEPT A. Cervix B. Uterus C. Fallopian tube D. Ovaries
Answer: D
13) The genotype of an individual is determined at: A. Fertilization B. 9-16 weeks after fertilization C. 8 weeks after fertilization D. Birth
Answer: A
14) The external sex organs acquire distinct male or female characteristics at: A. Fertilization B. 8 weeks after fertilization C. 12 weeks after fertilization D. Birth
Answer: C
15) A newborn patient presented with an ambiguous genitalia. On PE, gonads were not palpated at the labio-scrotal areas. Ultrasound done visualized no uterus. The 17 OH progesterone was normal. Karyotyping showed 46 XY. The possible cause of the ambiguous genitalia is:
A. Persistent mullerian duct syndrome
B. Androgen insensitivity
C. Athletic mother taking androgenic substances
D. Congenital adrenal hyperplasia
Answer: B
16) A 3 year old female was referred because her parents noted, since birth, her urine and stools were coming from the same opening. The most likely problem of the child is: A. Urogenital sinus B. Persistent cloaca C. Rectovaginal fistula D. Lack of hygiene
Answer: B
17) A 14 year old female consulted for a hypogastric mass which was noted to be painful a few days in a month. The mass was gradually increasing in size. On PE, she was noted to have normal looking labia but a bulging cystic mass was bulging at the vaginal canal. The most likely problem of the child is: A. Hydrocolpos B. Hematometrocolpos C. Patent urachus D. Ovarian tumor
Answer: B
History of a hypogastric mass that only becomes painful a few days in a month points to hematometrocolpos (i.e. accumulation of menstrual blood within the uterus and vagina).
18) An androgen insensitivity syndrome individual will have: A. 46 XX chromosome B. Breast development C. Menstruaton D. Normal female internal structures
Answer: B
19) Features of a patient with uterine abnormalities include: A. Symptomatic immediately after birth B. Problematic delivery C. Common anomaly D. Fertile
Answer: B
Verbatim from the trans on Alternatives of Development of the Male and Female Genital Tracts, Part 2, uterine anomalies are not symptomatic during childhood and have problems related to infertility or complications of pregnancy.
23) The equivalent of the female labia majora in males is: A. Scrotal swelling B. Urethral fold C. Urethral groove D. Glans penis
Answer: A
24) Which anomaly resulted from anomaly of the urorectal septum? A. Urogenital sinus B. Vaginal atresia C. Imperforate anus D. Hypospadias
Answer: C
25) Which anomaly results from failure of the mullerian ducts to fuse to form the mullerian tubercle? A. Complete vaginal atresia B. Proximal vaginal atresia C. Distal vaginal atresia D. Urogenital sinus
Answer: B
26) Menstrual regularity of menses refers to: A. Cycle length B. Cycle to cycle variation C. Length of menstrual flow D. Amount of menstrual flow
Answer: B
27) The following are true regarding the defined limits of normal menstruation EXCEPT
A. Frequency is normal if cycle length is between 24-38 days
B. Regularity is regular if the cycle to cycle variation over a 12 month period is between 2-20 days
C. Duration of flow is normal if between 2.5-8 days per menses
D. Volume of blood loss is normal if between 5-80 ml per menstrual period
Answer: C
Normal duration of flow should be between 4.5-8 days per menses.
28) The following are considered standard accepted nomenclature based on recent consensus guidelines EXCEPT A. Chronic abnormal uterine bleeding B. Dysfunctional uterine bleeding C. Heavy menstrual bleeding D. Intermenstrual bleeding
Answer: B
29) The following accepted or discarded terms of menstrual bleeding refer to the same abnormality EXCEPT A. Menorrhagia B. Heavy menstrual bleeding C. Polymenorrhea D. Hypermenorrhea
Answer: D
The first three are hemorrhagic, promoting menstruation while tissue factors promote hemostasis
31) With the absence of pregnancy, the elimination of the stratum functionale during menstruation is carried out with the help of the following EXCEPT A. Proteolytic enzymes from MMPs B. PMNs and eosinophils C. Macrophages D. Tissue factors
Answer: D
The first three are hemorrhagic, promoting menstruation while tissue factors promote hemostasis
32) Which of the following type of leiomyoma is most likely to result in heavy menstrual bleeding? A. Submucous Type 0 B. Submucous Type 2 C. Subserous Type 7 D. Parasitic Type 8
Answer: A
The more submucosal the leiomyoma, the heavier the bleeding.
33) The postulated mechanism of abnormal uterine bleeding among endometrial polyps: A. Aberrant blood vessels B. Deranged local hemostasis C. Deranged systemic hemostasis D. Hormonal imbalance
Answer: A
34) The following events promoted a hemorrhagic environment EXCEPT
A. Progesterone withdrawal
B. Breakdown of the corpus luteum
C. Prolonged unopposed estrogen administration
D. Short-term estrogen administration
Answer: D
35) In the PALMCOEIN classification of abnormal uterine bleeding, “E” refers to AUB due to:
A. Endometrial cycle abnormalities
B. Endometriosis
C. Abnormal local endometrial hemostasis with normal endometrial structure and ovulatory cycles
D. Endocervical abnormalities
Answer: C
36) A 35 year old single woman has been on cyclic combined OCP for \_\_\_\_ and menstrual bleeding has been very regular and normal. Suddenly, she developed intermenstrual bleeding in the past 2 months. Your most likely diagnosis based on the PALMCOEIN classification: A. AUB-O B. AUB-I C. AUB-C D. Not sure pending sonography
Answer: B
AUB-I (Iatrogenic) is defined as unscheduled uterine bleeding during the use of local or systemic gonadal steroid therapy (i.e. estrogen, progesterone).
37) Aside from history, PE, and laboratory tests, the minimum required modalities to establish an accurate diagnosis in the PALMCOEIN classification are:
A. Contrast sonography and/or hysteroscopy
B. Ultrasound and/or MRI
C. Endoscopy and/or MRI
D. Tissue sampling and/or 3D ultrasound
Answer: A
38) Least important factor affecting the choice of treatment for AUB A. Cause of AUB B. Age of woman C. Desire for future reproduction D. Profession of husband
Answer: D
39) A 28 year old mother of 1 presents with heavy menstrual bleeding. Evaluation revealed a Type I submucous myoma. Pending full evaluation, the most likely options in treatment shall include the following except
A. Medical, using LNG-IUS
B. Medical, using contraceptive pills
C. Surgical, laparoscopic resection of myoma
D. Surgical, hysteroscopic resection of myoma
Answer: C
40) Options for treatment of AUB in PCOS except
A. Cyclic complete OCPs
B. Estrogen only pills for initial control of acute heavy menstrual bleeding
C. Insulin sensitizers
D. Operative hysteroscopy
Answer: D
41) Which is not correct concerning Neisseria? A. Gram-negative diplococci B. Produce IgA protease C. Strict anaerobe D. Oxidase-positive
Answer: C
42) Carbon dioxide is important in isolation of which organism A. N. gonorrhea B. S. aureus C. T. pallidum D. C. diptheria
Answer: A
43) An appropriate agar for the selective isolation of gonococci is A. BAP B. Tellurite agar C. Chocolate agar D. Sheep blood agar
Answer: C
44) Gonococci can be isolated from this clinical specimen A. Pharyngeal exudates B. Urethral discharge C. CSF D. Blood
Answer: B
45) Which of the following components of N. gonorrhea does NOT contribute to its virulence? A. IgA protease B. Lipopolysaccharide (endotoxin) C. Outer membrane proteins D. Axial filaments
Answer: D
46) Gonococci is most commonly found within A. Monocytes B. Polymorphonuclear cells C. Neurons D. Uroepithelial cells
Answer: B
47) In a sexually active otherwise health female, gonorrhea most often presents as A. Urethritis B. PID C. Asymptomatic disease D. Cervicitis
Answer: C
48) Which is an incorrect statement regarding gonorrhea?
A. Infection in men is more frequently symptomatic than in women
B. The definitive diagnosis can be made by detecting at least a 4-fold rise in antibody titer to N. gonorrhea
C. The main host defenses against gonorrhea are antibodies, complement, and neutrophils
D. A presumptive diagnosis can be made by finding gram-negative kidney-shaped diplococci within neutrophils
Answer: C
49) Virulence factors for pathogenic Neisseria spp include (choose combinations) A. pH and IgA protease B. Fimbriae and IgA protease C. H antigens and lecithinase D. Oxidase and glutamic capsules
Answer: B
50) Chlamydia are obligate intracellular parasites because they
A. Lack cell wall
B. Needs energy from host
Answer: B
51) Chlamydia trochomatis may be responsible for all the clinical conditions EXCEPT A. Inclusion conjuctivitis B. Encephalitis C. Pneumonitis in newborn D. Lymphogranuloma
Answer: B
52) Gumma in the bones, skin, and CNS is a manifestation of what kind of syphilis? A. Primary B. Secondary C. Tertiary D. Quaternary
Answer: C
53) The most distinguishing characteristic of Mycoplasma spp is A. Produce spores B. Unique life cycle C. Lack cell wall D. Energy parasites
Answer: C
54) On microscopic examination, infected cells are examined for the presence of iodine-staining inclusion bodies. Iodine stains glycogen in the inclusion bodies. The suspected causative agent of STD is: A. Neisseria gonorrhea B. Treponema pallidum C. Chlamydia trachomatis D. Hemophilus ducreyi
Answer: C
55) Which of the following is FALSE about H. ducreyi?
A. More fastidious than H. influenzae but can be grown on chocolate agar supplemented with Isovitale X in 5%-10% CO2 atmosphere
B. Produces characteristic school of fish or railroad track arrangement
C. Requires both X (hemin) and V (NAD) for growth
D. An STD producing chancroid or soft chancre
Answer: C
It only requires X (hemin) factor.
56) The best diagnostic tool to determine tubal patency A. Sonohysterogram B. Transvaginal ultrasound C. Hysteroscopy D. Hysterosalpingogram
Answer: D
All the other three are for uterine factors.
57) The usual first line pharmacologic agent for treatment of oligomenorrhea in infertility A. Estrogen B. Clomiphene citrate C. Letrozole D. Pioglitazone
Answer: B
First line drug for ovulation induction by reducing negative feedback of estrogen to the hypothalamus thus increasing GnRH, LH, FSH and eventually ovarian estrogen production.
58) In vitro fertilization is associated with an increased chance for A. Multiple gestation B. Fetal malformations C. Pre-eclampsia D. Placenta previa
Answer: A
59) Part of the work-up of infertile women presenting with oligomenorrhea A. Estradiol B. Testosterone C. TSH D. Hysterosalpingogram
Answer: A
60) Initial infertility work-up includes the following EXCEPT A. Semen analysis B. Laparoscopy C. Documentation of ovulation D. Evaluation of fallopian tubes
Answer: B
61) The probability that a single cycle will result in a live birth A. Fecundity B. Fecundability C. Fertility D. NOTA
Answer: A
Fecundity is the probability of achieving a pregnancy within one cycle and fertility is the ability of a man and woman to reproduce.
63) Ovum is viable until A. 24 hours after ovulation B. 48 hours after ovulation C. More than 48 hours after ovulation D. As much as 72 hours after ovulation
Answer: A
64) Which of the following should merit earlier infertility evaluation?
A. 35 year old female married for 6 months
B. 40 year old male married for 6 months
C. History of 1 miscarriage
D. Use of DMPA for 3 years
Answer: B
65) Adjuncts to ovulation induction in PCOS patients EXCEPT A. Aromatase inhibitors B. Metformin C. Human menopausal gonadotropin D. Cyclic progesterone
Answer: A
66) The most common cause of infertility in couples A. Tubal B. Male C. Anovulatory D. Unexplained
Answer: C
67) Characteristic of a drug effective in the treatment of BACTERIAL VAGINOSIS is best described by which of the following? A. Broad spectrum B. Empiric C. Anti-anaerobe D. Potent
Answer: C
Etiology of bacterial vaginosis are mostly anaerobes.
68) Intra-amniotic infection is most commonly associated with which of the following? A. Abdominal delivery B. PROM C. Vaginal delivery D. Poor hygiene
Answer: B
69) Aside from anaerobes, which of the following pathogens is notoriously associated with PID, resulting in tubal infertility? A. Gonorrhea B. Chlamydia C. E. coli D. Trichomonas
Answer: B
70) In patient with PID, one should strongly consider doing surgery in the presence of A. Pain B. Fever C. Abscess > 5 cm D. Vomiting
Answer: C
71) In puerperal sepsis, the most likely organism involved when onset of fever in relation to delivery to 48 hours is: A. Chlamydia B. S. aureus C. Group B strep D. E. coli
Answer: D
72) You can never go wrong if you did this to an abscess
A. Do ultrasound
B. Drain
Answer: B
73) Without a permanent cure A. Chancroid B. G. herpes C. Chancre D. LGV
Answer: B
74) Resistant to antibiotics A. Gonorrhea B. Chancre C. Trichomonas D. Syphilis
Answer: A
75) Known classically for causing profuse frothy discharge and strawberry cervix A. N. gonorrhea B. Chlamydia trachomatis C. Trichomonas vaginalis D. H. simplex virus
Answer: C
76) The predominant organism in the vaginal ecosystem of a normal adult female are A. Anaerobes B. Lactobacilli C. Chlamydia D. Enterococci
Answer: B
77) To avoid several adverse pregnancy outcomes and infectious morbidity following surgery, one must diagnose and treat bacterial vaginosis by actively searching for A. Foul discharge B. Fever C. Urethral discharge D. Fever
Answer: A
78) Which of the following statements is CORRECT?
A. The primary targets of FSH activity are the ovarian granulosa and testicular Sertoli cells
B. The primary targets of LH activity are the ovarian granulosa and testicular Leydig cells
C. The primary targets of FSH activity are the ovarian theca and testicular Sertoli cells
D. The primary targets of LH activity are the ovarian theca and testicular Leydig cells
Answer: A
FSH targets granulosa and Sertoli, LH targets theca and Leydig.
79) The following drug can be used to stimulate ovulation A. Mestranol B. Tamoxifen C. Estradiol D. Letrozole
Answer: D
80) When given to a pregnant woman, this drug may cause vaginal carcinoma in the offspring during puberty A. Clomiphene B. Danazol C. Ethinyl estradiol D. Mestranol E. Diethylstilbestrol
Answer: E
81) Medroxyprogesterone acetate has the following action
A. Inhibits the replenishment of estrogen receptors in the cell
B. Activates aromatase enzyme
C. Increases progesterone receptors
D. Induces 5-alpha reductase
Answer: A or C
82) What is the mechanism of action of COCs?
A. The estrogenic agent suppresses LH and the progestational agent suppresses FSH
B. The estrogenic agent suppresses FSH and the progestational agent suppresses LH
C. The estrogenic and progestational agents suppress LH
D. The estrogenic and progestational agents suppress FSH
Answer: B
83) Third generation low dose combined hormonal contraceptives will include the following
A. 50 ug of ethinyl estradiol plus norgestimate
B. 20 ug of ethinyl estradiol plus dimethisterone
C. 35 ug of ethinyl estradiol plus desogestrel
Answer: C
85) The most appropriate drug that can be used for contraception by lactating mothers A. Clomiphene B. Progestin only pills C. Combined OCPs D. Cyclic progestins
Answer: B
86) The CORRECT combination of drug and its mechanism of action
A. Flutamide – androgen synthesis inhibitor
B. Clomiphene – estrogen synthesis inhibitor
C. Mifepristone – progesterone synthesis inhibitor
D. Letrozole – estrogen receptor antagonist
E. Spironolactone – andorgen receptor antagonist
Answer: E
87) The two-cell, two-gonadotropin theory of the control of steroidogenesis
A. States that the rate of aromatization in the theca cell is directly related to the androgen substrates
B. States that stimulation of the LH receptors in the Leydig cells increases androgen synthesis
C. States that stimulation of the FSH receptors in the Sertoli cells increases the synthesis of androgen binding protein which is important in spermatogenesis
D. AOTA
Answer: B or C
88) All of the following are recognized effects of natural androgens or androgenic steroids EXCEPT
A. Growth of facial hair
B. Induction of a growth spurt in pubertal boys
C. Increased muscle bulk
D. Increased milk production in nursing women
Answer: D
89) Aside from an intact hypothalamic pituitary ovarian axis, the prerequisite/s for a normal menstruation include
A. Progesterone-induced proliferative endometrium
B. Ovulation at midcycle
C. Estrogen-induced secretory endometrium
D. AOTA
Answer: B
It should be progesterone-induced SECRETORY endometrium and estrogen-induced PROLIFERATIVE endometrium.
90) True of the metabolic effects of estrogen A. Increases HDL B. Decreases LDL C. Decreases triglyceride D. AOTA
Answer: A or B
Estrogen increases HDL and triglyceride but decreases LDL.
91-95) List down 5 of the 12 universally accepted reproductive health and rights key concepts and briefly explain each one
Right to life
Right to liberty and security of a person
Right to equality and to be free from all forms of discrimination
Right to privacy
Right to freedom of thought
Right to information and education
Right to choose whether or not to marry and to found and plan a family
Right to decide whether or when to have children
Right to health care and health protection
Right to the benefits of scientific progress
Right to freedom of assembly and political participation
Right to be free from torture and ill treatment
96-100) List down 5 of the 10 elements of reproductive health and briefly explain its relevance at this time
Maternal and child health and nutrition
Family planning
Adolescent reproductive health
Prevention and treatment of reproductive tract infections including STDs, HIV, and AIDS
Education and counselling on sexuality and sexual health
Prevention and management of abortion and its complications
Breast and reproductive tract cancers and other gynecological conditions
Men’s reproductive health
Violence against women and children
Prevention and treatment of infertility and sexual disorders
