FINALS GYNE Flashcards

Question 1

Q

Question: An accountant plans to leave her husband. From the start of her married life, she heard news of her husband’s womanizing escapades but she refused to believe. Instead, she chose to accept infidelity as being natural. During confrontation, she gets humiliating insults about her weaknesses and her husband calls her inappropriate names, which make her feel bad about herself. Identify the type of domestic violence.
A. Emotional Abuse
B. Using Male Privilege
C. Intimidation
D. Physical Abuse

Answer

A

A. Emotional Abuse
Rationale: Emotional abuse involves humiliation, degradation, and manipulation that negatively affect self-esteem and emotional well-being. This case describes verbal abuse and psychological manipulation, which classify as emotional abuse.

Question 2

Q

Question: Test for ovarian reserve is advised for:
A. Women with a history of chemotherapy
B. Women with a history of contraceptive intake
C. Women with irregular menses
D. Women with a history of recurrent pregnancy losses

Answer

A

A. Women with a history of chemotherapy
Rationale: Ovarian reserve testing is indicated in women at risk for diminished ovarian function, such as those with a history of chemotherapy, which can cause ovarian toxicity and premature ovarian failure.

Question 3

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Question: Progesterone level is at its highest during the:
A. Follicular phase
B. Ovulation
C. Luteal phase
D. Menstruation

Answer

A

C. Luteal phase
Rationale: Progesterone peaks during the luteal phase (after ovulation) to support implantation and early pregnancy. If pregnancy does not occur, progesterone levels drop, leading to menstruation.

Question 4

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Question: What is the vaginal pH of pubertal girls?
A. 3.5 - 4.5
B. 4.5 - 5.5
C. 5.5 - 6.5
D. 6.5 - 7.5

Answer

A

A. 3.5 - 4.5
Rationale: Estrogen stimulates lactobacilli, which produce lactic acid, maintaining an acidic vaginal environment (pH 3.5 - 4.5) to protect against infections.

Question 5

Q

Question: Which of the following long-term complications of PCOS is due to prolonged unopposed estrogen stimulation?
A. Endometrial cancer
B. Metabolic Syndrome
C. Hirsutism
D. Sleep Apnea

Answer

A

A. Endometrial cancer
Rationale: In PCOS, chronic anovulation leads to continuous estrogen exposure without progesterone opposition, increasing the risk of endometrial hyperplasia and cancer.

Question 6

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Question: Identify the sexual response cycle: The genitals are fully engorged with blood.
A. Excitement Phase
B. Plateau Phase
C. Orgasmic Phase
D. Resolution Phase

Answer

A

B. Plateau Phase
Rationale: The plateau phase is characterized by maximal genital blood flow and increased sexual tension, preparing the body for orgasm.

Question 7

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Question: A 35-year-old G3P3 (3003) underwent a colposcopy for an abnormal pap smear result of HSIL. On colposcopy, what areas on the cervix should be biopsied?
A. Areas with hemorrhage
B. Areas with acetowhitening
C. Areas with (+) Lugol’s uptake
D. Areas with no acetowhitening

Answer

A

B. Areas with acetowhitening
Rationale: Acetowhite epithelium indicates areas of high nuclear density seen in HSIL. These areas should be biopsied to assess for cervical dysplasia or carcinoma.

Question 8

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Question: Based on IOTA Simple Rules, which of these features point to a benign finding?
A. Presence of acoustic shadows
B. Presence of ascites
C. Irregular solid tumor
D. Presence of 6 papillary structures

Answer

A

: A. Presence of acoustic shadows
Rationale: Acoustic shadows suggest benign characteristics such as dermoid cysts or fibromas, whereas ascites, irregular tumors, and multiple papillary projections suggest malignancy.

Question 9

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Question: A 25-year-old, single, nulligravid came to the ER due to profuse vaginal bleeding and sharp pain after coitus. You are considering postcoital laceration. Where is the most common site of postcoital lacerations?
A. Cervix
B. Posterior fornix
C. Distal third of the vagina
D. Anterior fornix

Answer

A

B. Posterior fornix

Rationale:
The posterior fornix is the most common site of postcoital lacerations, particularly after vigorous or traumatic intercourse. This area is anatomically located at the uppermost portion of the vagina, behind the cervix, and is relatively thin and vulnerable to trauma. These lacerations can lead to profuse vaginal bleeding and are typically associated with deep vaginal penetration.

Question 10

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Question: A 25-year-old G2P2 (2002) patient with irregular vaginal bleeding and endometrial biopsy showing hyperplasia without atypia may be managed with the following:
A. Estrogen
B. Endometrial ablation
C. Progestin therapy
D. Total Hysterectomy

Answer

A

C. Progestin therapy
Rationale: Progestin therapy is the first-line treatment for endometrial hyperplasia without atypia, as it helps counteract unopposed estrogen stimulation and promotes endometrial shedding.

Question 11

Q

Question: One of the reassuring aspects of sonography is the absence of adverse clinical effects from the energy levels used in diagnostic studies based on its thermal index. With modern ultrasound machines, usually, the thermal index is:
A. 0.1
B. 0.5
C. 2.2
D. <1.5

Answer

A

D. <1.5
Rationale: The thermal index (TI) of diagnostic ultrasound is generally kept below 1.5 to prevent potential tissue heating effects, ensuring patient safety.

Question 12

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Question: This hormone acts primarily on the theca cells.
A. FSH
B. Estrogen
C. LH
D. Progesterone

Answer

A

C. LH
Rationale: Luteinizing hormone (LH) stimulates the theca cells in the ovarian follicle to produce androgens, which are then converted to estrogen by granulosa cells under the influence of FSH.

Question 13

Q

Question: What is an infectious granuloma similar to a cold abscess with a necrotic center characteristic of the late stage of Syphilis?
A. Bubo
B. Gumma
C. Clue cell
D. Chancre

Answer

A

B. Gumma
Rationale: A gumma is a granulomatous lesion characteristic of tertiary syphilis, presenting as a painless, necrotic mass that can affect the skin, bones, or internal organs.

Question 14

Q

Question: Proliferative phase occurs at what stage in the uterine cycle?
A. Days 1-5
B. Days 14-28
C. Days 5-14
D. Any of the above

Answer

A

C. Days 5-14
Rationale: The proliferative phase occurs after menstruation (Days 5-14) and is driven by estrogen, leading to endometrial regrowth and thickening in preparation for potential implantation.

Question 15

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Question: A 60-year-old woman presents to her physician’s office with postmenopausal bleeding. She undergoes endometrial sampling and is diagnosed with endometrial cancer. Which of the following is a risk factor for endometrial cancer?
A. Multiparity
B. Diabetes mellitus
C. Herpes simplex infection
D. Oral contraceptive use

Answer

A

B. Diabetes mellitus
Rationale: Diabetes mellitus is a risk factor for endometrial cancer due to associated obesity and hyperinsulinemia, which can promote unopposed estrogen stimulation of the endometrium.

Question 16

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Question: Which of the following is the classic type of PCOS?
A. Hyperandrogenism + Polycystic ovaries
B. Obese with polycystic ovaries
C. Chronic anovulation + Polycystic ovaries
D. Hyperandrogenism + Chronic anovulation + Polycystic ovaries

Answer

A

D. Hyperandrogenism + Chronic anovulation + Polycystic ovaries
Rationale: The classic phenotype of PCOS includes hyperandrogenism, chronic anovulation, and polycystic ovarian morphology, in line with the Rotterdam criteria.

Question 17

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Question: A 7-year-old with vulvar trauma had her complete immunization more than 5 years ago. What booster injection should be given to the patient?
A. Hepatitis B booster
B. Tetanus toxoid booster
C. Measles booster
D. BCG booster

Answer

A

B. Tetanus toxoid booster
Rationale: For a child with a wound and a history of immunization more than 5 years ago, a tetanus toxoid booster is indicated to prevent tetanus infection.

Question 18

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Question: A 65-year-old G4P4 (4004) consulted due to rapid enlargement of her abdomen for 3 months with no vaginal bleeding. Transvaginal ultrasound showed multiple myoma uteri. Pertinent physical exam revealed that the cervix was 2 x 2 cm, smooth, with no masses. The uterus was enlarged to 20 weeks gestational size, slightly mobile, and non-tender. What is your diagnosis?
A. Multiple Myoma Uteri
B. Endometrial Carcinoma
C. Leiomyosarcoma
D. Broad Ligament Myoma

Answer

A

C. Leiomyosarcoma
Rationale: Rapid growth of a previously stable myoma in postmenopausal women raises suspicion for leiomyosarcoma, a rare but aggressive uterine malignancy. Unlike benign fibroids, leiomyosarcomas tend to grow rapidly and are more common in older women.

Question 19

Q

Question: What is the recommended cervical cancer screening method for a patient who is 30 years old and above?
A. Pap smear
B. HPV test plus Pap smear
C. Pap smear plus Colposcopy
D. HPV test plus Colposcopy

Answer

A

B. HPV test plus Pap smear
Rationale: For women aged 30 and above, co-testing with Pap smear and HPV testing every 5 years is recommended as it increases detection rates for high-risk HPV types associated with cervical cancer.

Question 20

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Question: Grace, a 25-year-old G0, came to your clinic with a chief complaint of oligomenorrhea. She is morbidly obese with a BMI of 35 kg/m². Transvaginal ultrasound revealed polycystic ovaries. Which of the following is the best first-line approach to managing this case?
A. Prescribe oral contraceptive pills.
B. Advise lifestyle modification (diet and exercise).
C. Start her on clomiphene citrate.
D. Advise gonadotropins.

Answer

A

B. Advise lifestyle modification (diet and exercise).
Rationale: Lifestyle modification, including weight loss through diet and exercise, is the first-line treatment for PCOS-related metabolic and reproductive dysfunction. It improves insulin resistance and hormonal balance, potentially restoring normal ovulation.

Question 21

Q

Question: Which of the following patients need hormone replacement therapy (HRT)?
A. A 66-year-old patient who underwent total hysterectomy with bilateral salpingo-oophorectomy
B. A 48-year-old patient who underwent total hysterectomy
C. A 40-year-old patient who underwent bilateral salpingo-oophorectomy
D. A 28-year-old patient who underwent myomectomy

Answer

A

C. A 40-year-old patient who underwent bilateral salpingo-oophorectomy.
Rationale: Women who undergo bilateral oophorectomy before menopause require HRT to prevent early onset of menopause-associated complications, such as osteoporosis and cardiovascular disease.

Question 22

Q

Question: What is the gold standard test for evaluating ovarian reserve?
A. Follicle Stimulating Hormone (FSH)
B. Luteinizing Hormone (LH)
C. Anti-Müllerian Hormone (AMH)
D. Serum Estradiol

Answer

A

C. Anti-Müllerian Hormone (AMH)
Rationale: AMH is the most reliable marker of ovarian reserve as it reflects the remaining follicular pool, independent of the menstrual cycle phase.

Question 23

Q

Question: Identify the sexual response cycle: Skin becomes flushed.
A. Excitement Phase
B. Plateau Phase
C. Orgasmic Phase
D. Resolution Phase

Answer

A

A. Excitement Phase
Rationale: The excitement phase is characterized by increased blood flow, muscle tension, and vasodilation, leading to skin flushing, which is a common physiological response.

Question 24

Q

Question: A bank executive was fascinated by a respectable and handsome businessman. She married him 10 years ago. Little did she know about his insecurities. When business profits are low, her husband puts her in fear by looks, actions, gestures, and a loud voice. Identify the type of domestic violence.
A. Emotional Abuse
B. Using Male Privilege
C. Intimidation
D. Physical Abuse

Answer

A

C. Intimidation
Rationale: Intimidation is a form of domestic violence where the abuser uses threats, gestures, and aggressive behavior to instill fear and maintain control over the victim.

Question 25

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Question: A 30-year-old G0 complained of severe right hypogastric pain 1 day before consultation. She has a history of missed menses of a few days and is on Day 26 of her cycle. Serum β-hCG is within the non-pregnant level. There were no other symptoms. Pertinent PE revealed that the cervix is closed and firm, and the uterus is not enlarged. There were no adnexal masses, but tenderness was present on deep palpation. What is your diagnosis?
A. Ectopic Pregnancy
B. Ruptured Corpus Luteum Cyst
C. Adnexal Torsion
D. Endometrioma

Answer

A

B. Ruptured Corpus Luteum Cyst
Rationale: A ruptured corpus luteum cyst can present with acute pelvic pain around the luteal phase (Day 26), especially in non-pregnant women. The absence of adnexal masses and a negative β-hCG make ectopic pregnancy unlikely.

Question 26

Q

Question: A 48-year-old woman who presents with post-coital vaginal bleeding is noted to have a cervical exophytic mass. A biopsy of the mass showed carcinoma. If molecular analysis of the cancer is performed, which of the following HPV subtypes is most likely to be found in the specimen?
A. 6 and 11
B. 55 and 57
C. 16 and 18
D. 89 and 92

Answer

A

C. 16 and 18
Rationale: HPV types 16 and 18 are the most oncogenic and responsible for the majority of cervical cancer cases. HPV 6 and 11 are associated with genital warts rather than malignancy.

Question 27

Q

Question: Gartner duct cyst is the remnant of the following embryological structure:
A. Müllerian duct
B. Wolffian duct
C. Cloacal duct
D. Epoophoron

Answer

A

B. Wolffian duct
Rationale: Gartner duct cysts arise from remnants of the Wolffian duct, which normally regresses in females but may persist as cystic structures in the lateral vaginal wall.

Question 28

Q

Question: What is the expected sequence of appearance of pubertal signs?
A. Breast budding, pubic hair, growth spurt, menarche
B. Breast budding, menarche, pubic hair, and growth spurt
C. Menarche, breast budding, pubic hair, and growth spurt
D. Growth spurt, breast budding, pubic hair, and menarche

Answer

A

A. Breast budding, pubic hair, growth spurt, menarche
Rationale: The typical sequence of female puberty is thelarche (breast budding) → pubarche (pubic hair growth) → growth spurt → menarche. Menarche usually occurs around Tanner stage 4.

Question 29

Q

Question: Which of the following is NOT a criterion for PCOS under the Rotterdam criteria?
A. Obesity and Dyslipidemia
B. Anovulatory bleeding
C. Hyperandrogenism
D. Polycystic ovaries

Answer

A

A. Obesity and Dyslipidemia
Rationale: The Rotterdam criteria for PCOS diagnosis require two out of three: (1) Hyperandrogenism, (2) Oligo/anovulation, and (3) Polycystic ovaries on ultrasound. Obesity and dyslipidemia are common but not diagnostic criteria.

Question 30

Q

Question: Which of the following is a derivative of the Paramesonephric (Müllerian) duct?
A. Ovaries
B. Lower 1/3 of the vagina
C. Hymen
D. Upper 2/3 of the vagina

Answer

A

D. Upper 2/3 of the vagina
Rationale: The Müllerian (paramesonephric) duct gives rise to the fallopian tubes, uterus, and upper 2/3 of the vagina. The urogenital sinus contributes to the lower 1/3 of the vagina.

Question 31

Q

Question: A 2-year-old asymptomatic child was brought to the clinic due to fusion of the labia minora. What is the best management?
A. No treatment is necessary
B. Topical steroid cream
C. Topical estrogen cream
D. Manual separation of the fusion

Answer

A

C. Topical estrogen cream
Rationale: Labial adhesions in prepubertal girls are usually asymptomatic and resolve spontaneously. If symptomatic, topical estrogen cream is first-line therapy to separate the adhesion non-surgically.

Question 32

Q

Question: At which stage in the uterine cycle does the secretory phase occur?
A. Days 1-5
B. Days 14-28
C. Days 5-14
D. AOTA (All of the above)

Answer

A

B. Days 14-28
Rationale: The secretory phase occurs after ovulation (Days 14-28) and is dominated by progesterone, which prepares the endometrium for implantation.

Question 33

Q

Question: A 7-year-old child presents with an itchy, whitish lesion on her perineum that appears in an hourglass or figure-8 pattern. What is the diagnostic test of choice to confirm the diagnosis?
A. Scotch tape test
B. Vaginoscopy
C. Vaginal culture
D. Punch biopsy

Answer

A

D. Punch biopsy
Rationale: The figure-8/hourglass pattern is characteristic of lichen sclerosus, a chronic inflammatory skin disorder. Punch biopsy is diagnostic to rule out malignancy or other dermatoses.

Question 34

Q

Question: What does ‘triple negative’ mean?
A. Negative for 3 receptors: HER2, estrogen, progesterone
B. Negative for gene mutations BRCA1, BRCA2, PTEN
C. Negative response to chemotherapy, hormone therapy, and radiation
D. Negative for FSH, LH, estrogen receptors

Answer

A

A. Negative for 3 receptors: HER2, estrogen, progesterone
Rationale: Triple-negative breast cancer (TNBC) lacks estrogen receptor (ER), progesterone receptor (PR), and HER2 expression. It is an aggressive subtype with limited targeted treatment options.

Question 35

Q

Question: Based on ICS (International Continence Society) staging of pelvic floor prolapse, if the points Aa, Ap, Ba, Bp are all at -3 cm, at which stage can you categorize the prolapse?
A. Stage 0
B. Stage I
C. Stage II
D. Stage III

Answer

A

A. Stage 0

Rationale:
According to the International Continence Society (ICS) Pelvic Organ Prolapse Quantification (POP-Q) system, Stage 0 indicates no prolapse, and all measured reference points remain in their normal anatomic positions.

The key points in this system are:
• Aa and Ap: Points on the anterior and posterior vaginal walls, respectively, located 3 cm proximal to the hymen.
• Ba and Bp: The most distal points of the anterior and posterior vaginal walls, respectively.

When Aa, Ap, Ba, and Bp are all measured at -3 cm, it means they are all positioned 3 cm above the hymenal ring, which reflects normal anatomy without any descent or prolapse.

In POP-Q:
• Stage 0 = No prolapse; all points are at -3 cm
• Stage I = Most distal portion of the prolapse is >1 cm above the hymen
• Stage II = Within 1 cm above or below the hymen
• Stage III = More than 1 cm beyond the hymen but not complete eversion
• Stage IV = Complete vaginal eversion

Since all the relevant points are at -3 cm, this matches the criteria for Stage 0, confirming no prolapse is present.

Correct answer: A. Stage 0

Question 36

Q

Question: When levels of serum AMH become undetectable, menopause is likely to occur in — year(s).
A. 1-2
B. 6-8
C. 4-5
D. 8-10

Answer

A

C. 4-5
Rationale: Anti-Müllerian Hormone (AMH) declines before menopause and becomes undetectable about 4-5 years before menopause, making it a useful predictor of ovarian reserve and reproductive lifespan.

Question 37

Q

Question: The _ _ are the best predictors of survival for patients with breast cancer.
A. Family history of breast cancer and BRCA gene mutation
B. Prior chemotherapy
C. Presence and number of axillary node metastasis
D. Younger age at diagnosis

Answer

A

C. Presence and number of axillary node metastasis
Rationale: The number of axillary lymph nodes involved is the most powerful prognostic factor in breast cancer, as lymph node metastasis increases the risk of systemic spread.

Question 38

Q

Question: What is the vaginal pH of prepubertal girls?
A. 3.5 - 4.5
B. 4.5 - 5.5
C. 5.5 - 6.5
D. 6.5 - 7.5

Answer

A

D. 6.5 - 7.5
Rationale: In prepubertal girls, the vaginal pH is neutral to slightly alkaline (6.5 - 7.5) due to low estrogen levels, which limit lactobacilli proliferation.

Question 39

Q

Question: Which of the following Müllerian duct anomalies is associated with the presence of two cervices?
A. Uterine didelphys
B. Subseptate uterus
C. Bicornuate uterus
D. Uterus with a rudimentary horn

Answer

A

A. Uterine didelphys
Rationale: Uterine didelphys occurs due to complete failure of Müllerian duct fusion, resulting in two uteri and two cervices.

Question 40

Q

Question: A working student is married to an aspiring actor. She will soon earn her college degree but plays no role in major family decision-making. Her husband acts like the master of the castle and makes all big decisions for their children. Identify the type of domestic violence.
A. Emotional Abuse
B. Using Male Privilege
C. Intimidation
D. Physical Abuse

Answer

A

B. Using Male Privilege
Rationale: Using male privilege is a form of abuse where a partner exerts dominance by making all major decisions, treating the woman as subordinate.

Question 41

Q

Question: You are examining a 13-year-old girl. Conducting the physical examination with the mother present, you notice that there is separation of breast contour and the presence of coarse, crinkly hair along the labia majora. Your Tanner staging evaluation is:
A. B2, PH2
B. B3, PH3
C. B3, PH2
D. B4, PH4

Answer

A

B. B3, PH3
Rationale: Tanner Stage 3 involves breast contour separation (breast mound enlargement beyond areola) and coarse, dark pubic hair extending over the pubic area.

Question 42

Q

Question: A 32-year-old mother has three children. Since the beginning of her relationship with her live-in partner, slapping her on the face was an ordinary routine. He banged her head on the wall, carried her above his shoulder, and threw her in the air. Identify the type of domestic violence.
A. Emotional Abuse
B. Using Male Privilege
C. Intimidation
D. Physical Abuse

Answer

A

D. Physical Abuse
Rationale: Physical abuse involves intentional bodily harm (e.g., slapping, head-banging, and throwing). It is the most recognizable form of domestic violence.

Question 43

Q

Question: A 71-year-old G3P3 (3003) consulted at the OPD due to vulvar pruritus. On examination of the vulva, there was generalized erythema with skin showing a leathery appearance. What is your diagnosis?
A. Vulvar Candidiasis
B. Lichen simplex chronicus
C. Vulvar contact dermatitis
D. Vulvar Intraepithelial Neoplasia (VIN)

Answer

A

B. Lichen simplex chronicus
Rationale: Lichen simplex chronicus is a chronic inflammatory skin condition due to repetitive scratching, leading to thickened, leathery skin with erythema.

Question 44

Q

Question: The relative ratio of cervix to uterus in a child is:
A. 0.5:1
B. 0.75:1
C. 1:1
D. 2:1

Answer

A

D. 2:1
Rationale: In prepubertal girls, the cervix is twice the size of the uterine corpus (2:1 ratio). This changes at puberty when the uterine body enlarges.

Question 45

Q

Question: In complete Müllerian duct aplasia, all of the following are likely to be absent, except:
A. Ovaries
B. Fallopian tubes
C. Uterus
D. Vagina

Answer

A

A. Ovaries
Rationale: Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome) results in absent uterus, fallopian tubes, and upper vagina but normal ovaries because the ovaries derive from the gonadal ridge, not the Müllerian ducts.

Question 46

Q

Question: A 4-year-old was brought to the clinic due to vaginal pruritus with vaginal discharge and erythema. What is the most common cause of vulvovaginitis?
A. Non-specific vulvovaginitis
B. Mycotic vulvovaginitis
C. Bacterial vulvovaginitis
D. All of the above

Answer

A

A. Non-specific vulvovaginitis
Rationale: Non-specific vulvovaginitis is the most common cause in prepubertal girls due to poor hygiene, irritants, or lack of estrogen, leading to susceptibility to infections.

Question 47

Q

Question: An anterior compartment defect and the most common site of pelvic organ prolapse?
A. Cystocele
B. Procidentia uteri
C. Rectocele
D. Enterocele

Answer

A

A. Cystocele
Rationale: Cystocele is the most common pelvic organ prolapse, where the bladder herniates into the anterior vaginal wall due to weakened pelvic support.

Question 48

Q

Question: Based on ICS staging of pelvic floor prolapse, if the points Aa, Ap, Ba, Bp are all everted more than the total vaginal length, at which stage can you categorize the prolapse?
A. Stage I
B. Stage III
C. Stage III
D. Stage IV

Answer

A

D. Stage IV
Rationale: Stage IV pelvic organ prolapse occurs when the prolapsed organs completely evert beyond the total vaginal length.

Question 49

Q

Question: A full bladder is a prerequisite prior to doing a:
A. Transabdominal ultrasound
B. MRI
C. Transvaginal ultrasound
D. HSG

Answer

A

A. Transabdominal ultrasound
Rationale: A full bladder helps displace the intestines and serves as an acoustic window for better visualization of pelvic structures in transabdominal ultrasound.

Question 50

Q

Question: A 19-year-old patient came to your clinic; she has never had her menses. She has an XX karyotype. On examination, Tanner stage 3 for the breasts and pubic hair, but her vagina is shortened with no palpable midline structures. You suspect:
A. Turner syndrome
B. Mayer-Rokitansky-Küster-Hauser syndrome
C. Asherman syndrome
D. Polycystic ovary syndrome

Answer

A

B. Mayer-Rokitansky-Küster-Hauser syndrome
Rationale: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital condition characterized by Müllerian agenesis (absent uterus and upper vagina) in a phenotypically normal XX female with normal ovarian function.

Question 51

Q

Question: Why is the length of the luteal phase approximately 14 days?
A. The human chorionic gonadotropin (hCG) is produced by the corpus luteum after 14 days
B. The life span of the corpus luteum is limited to a period of about 14 days
C. The LH surge effect lasts for 14 days
D. The estrogen levels increase after 14 days, thus signaling the end of the luteal phase

Answer

A

B. The life span of the corpus luteum is limited to a period of about 14 days
Rationale: The corpus luteum produces progesterone to maintain the endometrium for implantation. If fertilization does not occur, it degenerates after ~14 days, leading to a drop in progesterone and the onset of menstruation.

Question 52

Q

Question: A 20-year-old female patient presents with a transvaginal ultrasound of a unicornuate uterus, with only a left cornu/uterine horn present. Which of the following is most likely an associated additional anomaly in this patient?
A. Absent right kidney
B. Patent ductus arteriosus
C. Dextrocardia
D. Exstrophy of the bladder

Answer

A

A. Absent right kidney
Rationale: Unicornuate uterus is due to incomplete Müllerian duct development and is frequently associated with renal anomalies, particularly renal agenesis on the same side as the missing uterine horn.

Question 53

Q

Question: Identify the sexual response cycle: Clitoris becomes highly sensitive.
A. Excitement Phase
B. Plateau Phase
C. Orgasmic Phase
D. Resolution Phase

Answer

A

B. Plateau Phase
Rationale: During the plateau phase, the clitoris retracts under the clitoral hood and becomes highly sensitive in preparation for orgasm.

Question 54

Q

Question: A 70-year-old G2P2 (2002), menopausal since 55 years old, came to the clinic due to chronic hip pain. A central DEXA scan showed the following results:
* Z-score: -1.6
* T-score: -2.8
She also had a peripheral DEXA scan (foot) with:
* Z-score: -2.0
* T-score: -2.1

Biochemical assay results:
* Osteocalcin: low normal
* Bone alkaline phosphatase: normal

What is the best management?
A. Hormone replacement therapy: combined estrogen and progesterone
B. Hormone replacement therapy: estrogen only
C. Bisphosphonates
D. Calcium with vitamin D

Answer

A

C. Bisphosphonates
Rationale: A T-score ≤ -2.5 confirms osteoporosis, and bisphosphonates (e.g., alendronate, risedronate) are first-line treatment for postmenopausal osteoporosis by inhibiting bone resorption.

Question 55

Q

Question: Elsa is a 39-year-old nulligravid who consults for infertility. She has been married for 6 months to a 40-year-old banker who has a son from a previous failed relationship. She was diagnosed with pelvic endometriosis 5 years ago. When should you start fertility evaluation?
A. The couple should wait until after 1 year of trying to conceive before consulting for an infertility work-up
B. The couple can start an infertility work-up anytime
C. The female partner should complete her treatment for endometriosis before consulting for an infertility work-up
D. The couple should be encouraged to try on their own since the male partner already has a child from a previous relationship

Answer

A

B. The couple can start an infertility work-up anytime
Rationale: In women ≥35 years old or with known risk factors (e.g., endometriosis), an infertility work-up is recommended after 6 months of unprotected intercourse instead of the standard 12 months.

Question 56

Q

Question: Identify the sexual response cycle: Swelling of the areola and engorgement of the breast.
A. Excitement Phase
B. Plateau Phase
C. Orgasmic Phase
D. Resolution Phase

Answer

A

B. Plateau Phase
Rationale: Breast enlargement and areolar swelling occur during the plateau phase as part of increased blood flow and arousal.

Question 57

Q

Question: A 24-year-old presents with a genital papule associated with tender inguinal lymphadenopathy. The primary diagnosis is Lymphogranuloma venereum. What is the best test to confirm the diagnosis?
A. Dark field microscopy
B. Tzanck smear
C. Tissue crush preparation
D. Nucleic acid amplification test (NAAT)

Answer

A

D. Nucleic acid amplification test (NAAT)
Rationale: Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis (serovars L1, L2, L3) and is best diagnosed with NAAT, the most sensitive test for chlamydial infections.

Question 58

Q

Question: The most common histologic type of cervical cancer is:
A. Adenocarcinoma
B. Squamous Cell Carcinoma
C. Glassy Cell Carcinoma
D. Endometrioid Adenocarcinoma

Answer

A

B. Squamous Cell Carcinoma
Rationale: Squamous cell carcinoma (SCC) accounts for ~80-90% of cervical cancers and is strongly associated with HPV infection, particularly types 16 and 18.

Question 59

Q

Question: A 22-year-old came in for absence of menses. On examination, she is 5’5” ft, with well-developed breasts and female external genitalia. Ultrasound reveals the absence of the uterus and a shortened vaginal canal. What is your impression?
A. Pure gonadal dysgenesis
B. Mayer-Rokitansky-Küster-Hauser Syndrome
C. Turner’s syndrome
D. Testicular feminization syndrome

Answer

A

B. Mayer-Rokitansky-Küster-Hauser Syndrome
Rationale: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is due to Müllerian agenesis, leading to congenital absence of the uterus and upper vagina while maintaining normal ovarian function and secondary sexual characteristics.

Question 60

Q

Question: The congenital transverse vaginal septum is located most commonly at the level of the:
A. Cervix
B. Hymen
C. Lower and middle 1/3 of the vagina
D. Upper and middle 1/3 of the vagina

Answer

A

D. Upper and middle 1/3 of the vagina
Rationale: A transverse vaginal septum results from partial failure of canalization and is most commonly found at the junction of the upper and middle third of the vagina, leading to primary amenorrhea and hematocolpos.

Question 61

Q

Question: Complete failure of Müllerian duct fusion will result in:
A. Uterine didelphys
B. Subseptate uterus
C. Arcuate uterus
D. Unicornuate uterus

Answer

A

A. Uterine didelphys
Rationale: Complete failure of Müllerian duct fusion leads to uterine didelphys, resulting in two separate uteri and two cervices, often associated with vaginal septa.

Question 62

Q

Question: Your 67-year-old aunt consulted you for a central DEXA scan reading obtained from her annual medical checkup. It showed the following readings:

T-score: -1.8
Z-score: -2.6
What is your interpretation of her DEXA scan results?
A. Normal
B. Osteoporosis
C. Osteopenia
D. Osteochondritis

Answer

A

C. Osteopenia
Rationale: A T-score between -1.0 and -2.5 indicates osteopenia, a condition of low bone mass that increases fracture risk but does not yet meet the criteria for osteoporosis (T-score ≤ -2.5).

Question 63

Q

Question: Lesions that appear as a group of vesicles mixed with inflamed ulcers are pathognomonic of which of the following sexually transmitted infections?
A. Chancroid
B. Donovanosis
C. Genital herpes
D. Syphilis

Answer

A

C. Genital herpes
Rationale: Genital herpes, caused by HSV-2, presents with painful vesicles and ulcers on an erythematous base that cluster together, often associated with tender inguinal lymphadenopathy.

Question 64

Q

Question: This condition is commonly encountered in females who were exposed to diethylstilbestrol (DES) in utero.
A. Labial fusion
B. Imperforate hymen
C. Vaginal adenosis
D. Vaginal septum

Answer

A

C. Vaginal adenosis
Rationale: Vaginal adenosis is the presence of glandular columnar epithelium in the vagina instead of normal squamous epithelium. It is a precursor for clear cell adenocarcinoma, strongly linked to in utero exposure to DES.

Answer 65

A

D. Hymen
Rationale: The urogenital sinus gives rise to the hymen, lower 1/3 of the vagina, bladder, urethra, and external genitalia, while the Müllerian ducts form the uterus, fallopian tubes, and upper vagina.

Answer 66

A

B. B4 and PH5
Rationale: Tanner Stage 4 (B4) is characterized by secondary mound formation of the areola and papilla. Tanner Stage 5 (PH5) is defined by pubic hair extending onto the inner thighs.

Answer 67

A

D. Granulosa-theca cell tumor
Rationale: Granulosa-theca cell tumors are sex cord-stromal tumors that secrete estrogen, causing precocious puberty or abnormal uterine bleeding.

Answer 68

A

B. T helper cells
Rationale: HIV primarily infects CD4+ T helper cells, leading to immune system dysfunction and increased susceptibility to opportunistic infections.

Answer 69

A

A. 12%
Rationale: The average lifetime risk of breast cancer in women with no significant risk factors is approximately 12% (1 in 8 women).

Answer 70

A

A. A patient who discloses to his doctor a plan to commit murderous acts on her relatives and neighbors
Rationale: Confidentiality may be broken if a patient poses a serious threat to others (e.g., planned homicide or violence), aligning with the Tarasoff ruling on the duty to warn.

Answer 71

A

D. Sexual abuse
Rationale: STIs (e.g., Trichomonas, Chlamydia) in prepubertal children are highly suspicious for sexual abuse and require mandatory reporting.

Answer 72

A

C. Hormone/estrogen therapy may lead to plaque destabilization and thrombosis
Rationale: Estrogen therapy in postmenopausal women with established cardiovascular disease increases thrombotic risk and is not recommended.

Answer 73

A

A. FSH 50 mIU/L
Rationale: Menopause is confirmed by an FSH level >40 mIU/L, as decreased estrogen production leads to loss of negative feedback on FSH.

Answer 74

A

B. 46,XX
Rationale: Müllerian agenesis (MRKH syndrome) presents with a normal 46,XX karyotype, normal ovaries, and absent uterus.

Answer 75

A

C. Müllerian agenesis
Rationale: Müllerian agenesis (MRKH syndrome) is due to Müllerian duct failure, resulting in absent uterus and upper vagina, but normal ovarian development.

Answer 76

A

D. BRCA1 and BRCA2 gene mutation testing
Rationale: The triple test for breast mass evaluation includes:

Clinical breast exam
Imaging (Mammography or Ultrasound)
Tissue sampling (Biopsy or Fine Needle Aspiration Cytology - FNAC)
BRCA testing is only indicated in high-risk patients.

Answer 77

A

C. Principle of Beneficence
Rationale: Beneficence refers to acting in the patient’s best interest, including providing life-saving treatment in emergencies under implied consent when the patient cannot consent.

Answer 78

A

A. Abnormal uterine bleeding - Polyp
Rationale: Endometrial polyps are a common cause of abnormal uterine bleeding (AUB) and appear as hyperechoic masses in the endometrial cavity on ultrasound.

Answer 79

A

D. Principle of Double Effect
Rationale: The Principle of Double Effect applies when a necessary medical treatment (hysterectomy for cancer) has an unintended but foreseen negative consequence (loss of pregnancy).

Answer 80

A

B. Letrozole
Rationale: Letrozole (an aromatase inhibitor) is first-line therapy for ovulation induction in PCOS-related infertility, as it has a higher ovulation and pregnancy success rate compared to clomiphene citrate.

Answer 81

A

C. Size of breast mass
Rationale: Tumor size is the most important predictor of axillary lymph node involvement, with larger tumors having a higher risk of lymphatic spread.

Answer 82

A

D. Spirochete
Rationale: Treponema pallidum, a spirochete, is the causative agent of syphilis and is transmitted sexually or via vertical transmission.

Answer 83

A

A. Western Blot Test
Rationale: The Western Blot Test is more specific than ELISA for detecting HIV antibodies and is used for confirmation of HIV infection.

Answer 84

A

C. Rectocele
Rationale: Rectocele occurs when the rectum bulges into the posterior vaginal wall due to weakened pelvic support, causing difficulty with defecation.

Answer 85

A

B. Inguinal lymph nodes
Rationale: Vulvar squamous cell carcinoma primarily metastasizes to the inguinal lymph nodes, as the vulva drains into the superficial inguinal nodes.

Answer 86

A

D. All of the above
Rationale: In cases where a patient is incapacitated, the spouse, legal guardian, or parents may serve as proxy decision-makers based on legal and ethical guidelines.

Answer 87

A

C. Adenomyosis
Rationale: Adenomyosis is a globular uterine enlargement due to ectopic endometrial glands in the myometrium, causing heavy, painful menstrual bleeding (AUB-HMB).

Answer 88

A

C. Myoma with carneous degeneration
Rationale: Carneous (red) degeneration of a myoma occurs in pregnancy due to vascular compromise, leading to acute pain without contractions.

Answer 89

A

B. Day 3-5 of menses
Rationale: Hysteroscopy is best performed during the early proliferative phase (Day 3-5) when the endometrial lining is thinnest, providing better visualization of the uterine cavity.

Answer 90

A

C. XY karyotype
Rationale: Müllerian agenesis (MRKH syndrome) occurs in 46,XX females and presents with absent uterus and upper vagina but normal ovarian function and secondary sexual development. XY karyotype would suggest Androgen Insensitivity Syndrome (AIS) instead.

Answer 91

A

D. Hysteroscopy
Rationale: A history of multiple D&Cs with decreasing menstrual flow and indistinct endometrial stripe suggests Asherman syndrome (intrauterine adhesions). Hysteroscopy is the gold standard for diagnosis.

Answer 92

A

D. Principle of Justice
Rationale: The Principle of Justice emphasizes fair and equitable distribution of healthcare resources without discrimination.

Answer 93

A

A. Insulin resistance
Rationale: Insulin resistance is the underlying driver of PCOS, contributing to hyperinsulinemia, ovarian androgen excess, and anovulation.

Answer 94

A

B. Karyotyping
Rationale: Karyotyping is crucial for determining genetic sex and guiding gender assignment in cases of ambiguous genitalia.

Answer 95

A

C. Intrauterine adhesions
Rationale: A history of miscarriages, D&Cs, and C-section increases the risk of Asherman syndrome (intrauterine adhesions), leading to secondary amenorrhea.

Answer 96

A

A. Sheehan’s syndrome
Rationale: Sheehan’s syndrome is pituitary infarction due to postpartum hemorrhage, leading to hypopituitarism and menstrual irregularities (hypomenorrhea, amenorrhea).

Answer 97

A

D. Enterocele
Rationale: Enterocele (herniation of the small bowel into the vaginal vault) can occur after hysterectomy due to loss of uterine support. Incorporating the uterosacral ligaments into the vault repair helps prevent this.

Answer 98

A

C. Ovarian Torsion
Rationale: Ovarian torsion presents with sudden severe unilateral lower abdominal pain. A pre-existing ovarian mass (e.g., dermoid cyst) increases the risk of torsion, which is a surgical emergency.