[GYNE] LE2 Flashcards
1
Q
Q: Which of these ultrasound images shows a normal ovary?
A. Image A
B. Image B
C. Image C
A
a. A
(A) Normal; (B) Polycystic Ovary- normal size but w/
several follicles that failed to mature; (C) Hemorrhagic
Corpus Luteum
2
Q
Q: Identify the structure shown in the image:
A. Phallus
B. Clitoromegaly
C. Ambiguous genitalia
D. Normal vulva
A
C. Ambiguous genitalia
3
Q
Q: Which of these hysteroscopic images shows a normal endometrial cavity?
A. Image A – Myoma
B. Image B – Uterine septum
C. Image C – Normal cavity
A
C represents a normal endometrial cavity.
4
Q
Q: Which of these images exhibits a positive Schiller test?
A. Image A
B. Image B
A
Image B
Rationale: A positive Schiller test shows pale yellow areas where abnormal cells fail to take up iodine, indicating possible dysplasia. Image B reveals such pale regions, while Image A stains uniformly (negative).
5
Q
Q: Identify the image that shows a normal cervix after a Visual Inspection with Acetic Acid (VIA) procedure:
A. Smooth, uniform surface without acetowhite lesions
B. Irregular staining or acetowhite areas
A
A. Smooth, uniform surface without acetowhite lesions
Rationale: A normal VIA result reveals no acetowhite changes. Acetowhite lesions suggest areas of potential dysplasia and warrant further evaluation.
6
Q
Q: TM, a 38-year-old with 12 years of infertility, underwent hysterosalpingography (HSG). Which image explains her infertility?
A. Image A – No peritoneal spillage
B. Image B – Normal spillage
A
Image A – No peritoneal spillage
Rationale: Image A shows contrast stopping at the tubes without peritoneal spillage, indicating tubal blockage—a common cause of infertility. Image B shows normal tubal patency.
7
Q
Q: Identify the anomaly shown in the image:
A. Normal hymen
B. Transverse vaginal septum
C. Imperforate hymen
D. Urethral prolapse
A
Imperforate hymen
Rationale: Imperforate hymen presents as a bulging, tense membrane covering the vaginal introitus, often with a bluish hue from retained menstrual blood (hematocolpos).
8
Q
Q: BM, a 24-year-old G2P2 (2002), had her last menstrual period on September 27, 2022. Which ultrasound image best describes her endometrial lining?
A. Image A – Early proliferative
B. Image B – Late proliferative
C. Image C – Menstrual phase
D. Image D – Secretory phase
A
Image D – Secretory phase
Rationale: The secretory phase occurs after ovulation and features a thick, echogenic endometrium, which is consistent with Image D.
The menstrual cycle consists of different phases, each characterized by distinct changes in the endometrial lining:
Early proliferative phase: Thin endometrial lining, around days 5-9.
Late proliferative phase: Thickening of the endometrial lining, around days 10-14.
Secretory phase: Thick, echogenic endometrium, occurring after ovulation around days 15-28.
9
Q
Identify the uterus:
A. Bicornuate uterus
B. Uterine didelphis
C. Septated uterus
D. Normal uterus
A
Bicornuate uterus
Rationale: A bicornuate uterus has a single cervix and a heart-shaped endometrial cavity with two horns due to incomplete fusion of the Müllerian ducts.
10
Q
Identify the uterus:
A. Bicornuate uterus
B. Uterine didelphis
C. Septated uterus
D. Normal uterus
A
Normal uterus
Rationale: The uterus shows a single, smooth, and regular endometrial stripe without division or indentation, consistent with normal uterine anatomy.
11
Q
Identify the uterus:
A. Bicornuate uterus
B. Uterine didelphis
C. Septated uterus
D. Normal uterus
A
Septated uterus
Rationale: A septated uterus has a fibrous or muscular septum dividing the endometrial cavity, best confirmed by hysteroscopy or 3D ultrasound. It can increase the risk of infertility and miscarriage.
12
Q
Q: Identify the type of hymen shown in the image:
A. Virginal hymen
B. Cribriform hymen
C. Septate hymen
D. Parous hymen
A
Cribriform hymen
Rationale: A cribriform hymen contains multiple small openings rather than a single orifice. It may lead to menstrual difficulties and may require surgical intervention.
13
Q
A. Vaginal agenesis
B. Transverse vaginal septum
C. Imperforate hymen
D. Longitudinal vagibal septum
A
B. Transverse vaginal septum
14
Q
A. Bicornuate uterus
B. Septate uterus
C. Unicornuate uterus
D. Uterus didelphis
A
D. Uterus didelphis
15
Q
Q: Colposcopy during pregnancy is difficult due to:
A. All of the above
B. Decidual changes in the epithelium can be confused with CIN
C. Blood supply to the cervix is increased
D. The vaginal walls tend to obstruct the view of the cervix
A
All of the above
Rationale: Colposcopy is more complex in pregnancy because of hormonal and anatomical changes such as decidualization, increased vascularity, and altered anatomy.
16
Q
Q: A 7-year-old child presents with vaginal pruritus, dysuria, and constipation. A whitish lesion in a figure-8 distribution is noted. How will you confirm the diagnosis?
A. Scotch tape test
B. Vaginal culture
C. Vaginoscopy
D. Punch biopsy
A
Punch biopsy
Rationale: The presentation is classic for lichen sclerosus, which is confirmed by punch biopsy to evaluate characteristic histologic changes.
17
Q
- Normal development of ovaries in a
female with absent uterus and vagina
indicates which of the following genetic
conditions?
A. Turner’s syndrome
B. Testicular feminizing syndrome
C. Mullerian agenesis
D. Gonadal dysgenesis
A
C. Mullerian agenesis
Explanation: In Mullerian agenesis, the ovaries develop normally, but the uterus and vagina are absent or underdeveloped, as this condition affects the Mullerian ducts, which form these structures.
18
Q
- A 32 yo patient with regular menstrual
interval complains of inter menstrual
vaginal bleeding for the past 3 months.
Transvaginal ultrasound revealed a
thickened endometrium with a hyper
echoic mass within. What is the next
appropriate diagnostic exam?
(1 Point)
A. Reassure the patient
B. Sonohysterography
C. Hysterosalpingography
D. Repeat Transvaginal Ultrasound after three
months
A
B. Sonohysterography
Explanation: Sonohysterography provides a clearer view of the uterine cavity and is used to better evaluate abnormalities like endometrial polyps, which may be the cause of intermenstrual bleeding.
19
Q
- In case of ambiguous genitalia, gender
assignment is best carried out through?
A. Parent’s choice of gender is considered
B. Phallic adequacy is followed
C. Observe until puberty
D. Karyotyping
A
D. Karyotyping
Explanation: Karyotyping is the most appropriate method to determine genetic sex, which can help guide gender assignment decisions in cases of ambiguous genitalia.
20
Q
Q: All of the following are common indications for rectal examination in a female child EXCEPT:
A. Genital tract bleeding
B. Sexual abuse
C. Pelvic pain or mass
D. Foreign body
A
Sexual abuse
Rationale: While sexual abuse evaluation includes thorough genital examination, rectal exam is not routinely indicated for suspected abuse unless clinically necessary (e.g., trauma assessment).
21
Q
- A 43 yo nulligravid consulted because
of abdominal enlargement. On
ultrasound, a large ovarian mass was
noted. Which of the ff characteristics of ovarian mass correlates with non-
malignant findings?
a. high resistance on Doppler velocimetry
b. cystic lesions with solid components
c. high color flow on Doppler ultrasound
d. echogenic sturctures protruding into the mass
A
A. High resistance on Doppler velocimetry
Explanation: High resistance on Doppler velocimetry correlates with benign masses because malignant masses typically have low resistance due to poorly formed new vessels.
22
Q
- All of the following are the reasons for the susceptibility of a child to vulvar
infection EXCEPT.
A. The vaginal epithelium of prepubertal child has slightly acidic pH
B. No significant geographic barrier between the vagina and anus
C. Poor perineal hygiene
D. Epithelium of vulva and vagina lacks the protective effect of estrogen
A
A. The vaginal epithelium of prepubertal child has slightly acidic pH
Explanation: The slightly acidic pH of the vaginal epithelium in a prepubertal child acts as a protective mechanism, reducing susceptibility to infection.
23
Q
- A 3 year old child was brought to the
clinic due to purulent vaginal discharge.
Microscopy revealed Trichomonas and
Neisseria gonorrhea infection. What is
the most likely diagnosis?
A. Physiologic discharge
B. Nonspecific vulvovaginitis
C. Foreign body
D. Sexual abuse
A
D. Sexual abuse
Explanation: The presence of Trichomonas and Neisseria gonorrhea, which are sexually transmitted pathogens, strongly indicates the possibility of sexual abuse in a child.
24
Q
Q: What is an advantage of transvaginal ultrasound?
A. May be used for large pelvic masses
B. Done on a full bladder
C. Clearer pelvic images
D. Variations in pelvic structures are better seen
A
Clearer pelvic images
Rationale: Transvaginal ultrasound provides higher resolution images of pelvic organs because of the proximity of the probe to the structures, especially useful in evaluating the uterus and ovaries.
25
Q: What is the most common foreign body found in girls between 3–9 years old?
A. Paper clip
B. Toilet paper
C. Crayon
D. Small toy
Toilet paper
Rationale: The most common foreign body in prepubertal girls is toilet paper, usually introduced unintentionally during hygiene practices.
26
Q: A 16-year-old female is diagnosed with gonadal dysgenesis. Which lab finding is most likely elevated?
A. Estrogen
B. Progesterone
C. Prolactin
D. Follicle stimulating hormone
a. Follicle Stimulating Hormone (FSH)
Explanation: In cases of gonadal dysgenesis, FSH levels are elevated because the ovaries fail to produce sufficient hormones, leading to a lack of negative feedback on the pituitary gland.
27
Q: A 62-year-old woman presents with a 2x1 cm ulcerated cervical mass. What is the next best step?
A. VIA
B. Pap smear
C. Conization
D. Biopsy
d. Biopsy
Explanation: A biopsy is the next appropriate step for any visible mass on the cervix to determine whether it is malignant or benign.
28
Q: Which congenital reproductive tract anomaly represents failure of resorption?
A. Uterine septum
B. Mayer-Rokitansky-Küster-Hauser syndrome
C. Uterine didelphys
D. Congenital adrenal hyperplasia
a. Uterine septum
Explanation: A uterine septum is a congenital anomaly caused by the failure of resorption of the tissue that separates the two Mullerian ducts.
29
Q: In a septate uterus, the septum has poor blood supply and contains fibrous and/or myometrial tissues.
TRUE
FALSE
TRUE
Explanation: A septate uterus typically has a septum with poor blood supply, composed of fibrous or myometrial tissues, leading to potential reproductive complications.
30
Q: The fused caudal ends of the Müllerian ducts form the uterus, cervix, and upper 2/3 of the vagina.
TRUE
FALSE
FALSE
Explanation: The fused caudal ends of the Mullerian ducts form the uterus, cervix, and the upper 1/3 of the vagina, not the upper 2/3.
31
Q: A 25-year-old with 3 years of infertility and regular ovulation. What is the best test to determine fallopian tube patency?
A. Hysterosalpingography
B. Diagnostic laparoscopy
C. Transvaginal ultrasound
D. Sonohysterography
A. Hysterosalpingography
Explanation: Hysterosalpingography is a diagnostic procedure that uses contrast to visualize the uterine cavity and fallopian tubes, allowing assessment of tubal patency, which is important in evaluating infertility.
32
Q: What is an absolute contraindication to hysteroscopy?
A. IUD-related infection
B. Active bleeding
C. Genital herpes
D. Pelvic adhesions
A. IUD-related infection
Explanation: Hysteroscopy is contraindicated in cases of acute pelvic or vaginal infections, including IUD-related infections, as the procedure can disseminate the infection into the pelvic cavity.
33
Q: What position allows the vagina to fill with air for better visualization?
A. Frog leg position
B. Sitting on mother's lap
C. Lithotomy position
D. Knee-chest position
D. Knee-chest position
Explanation: The knee-chest position allows the vagina to fill with air, improving visualization for examination.
34
Q: What finding is true of a positive Lugol’s test?
A. Presence of uniform uptake of stain
B. Presence of pale yellow areas against a darker background
B. Presence of pale yellow areas against a darker background
Explanation: A positive Lugol's test shows pale yellow areas where there is less uptake of iodine, indicating abnormal cells, against a darker background of healthy tissue.
35
Q: Sonography with hysterosalpingography has a low predictive value for distinguishing between septate and bicornuate uterus.
A. True
B. False
B. False
Explanation: Sonography with hysterosalpingography has a high predictive level of accuracy in distinguishing between a septate and bicornuate uterus.
36
26. In Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome:
A. The ovaries are streak
B. It is usually combined with agenesis of the uterus, cervix, and upper vagina
C. Karyotype is 46,XY
D. Due to arrest of development of both Wolffian ducts
B. Is usually combined with agenesis of the uterus, cervix, and upper vagina
Explanation: In Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, affected individuals typically have agenesis of the uterus, cervix, and upper vagina, though they have normal external genitalia and functioning ovaries.
37
27. An infant was brought to the clinic due to vaginal bleeding. What is the best position to evaluate the external genitalia?
A. Frog-leg position
B. Sitting on the mother’s lap
C. Lithotomy position
D. Knee-chest position
A. Frog leg position
Explanation: The frog leg position provides good access and visualization for examining an infant's external genitalia.
38
28. True of Sonohysterosalpingogram (saline infusion sonography), EXCEPT:
A. Best to do a week before menses
B. Used to check patency of the tubes
C. Prophylactic antibiotic is given 1 day before the procedure
D. Used to evaluate the endometrial cavity
A. Best to do a week before menses
Explanation: Sonohysterosalpingogram is typically performed after menstruation, not before, to avoid interfering with menstrual flow and to improve visualization.
39
29. This procedure offers direct visualization of the endometrial cavity via the cervix using an endoscope and a light source:
A. Colposcopy
B. Sonohysterography
C. Laparoscopy
D. Hysteroscopy
D. Hysteroscopy
Explanation: Hysteroscopy allows for direct visualization of the endometrial cavity through the cervix using an endoscope and light.
40
30. During early fetal development, the ____ has the capacity to develop into the male reproductive system, and the ____ develops into the female reproductive system.
A. Wolffian duct; Müllerian duct
B. Müllerian duct; Wolffian duct
C. Genital tubercle; Urogenital sinus
D. Urogenital sinus; Genital tubercle
C. Wolffian duct, Mullerian duct
Explanation: The Wolffian duct has the potential to develop into the male reproductive system, while the Mullerian duct can develop into the female reproductive system.
41
31. What is the most frequent problem encountered during endometrial sampling?
A. Perforation
B. Cervical spasm
C. Infection
D. Hemorrhage
B. Cervical spasm
Explanation: The most common issue during endometrial sampling is cervical spasm, which can prevent the instrument from entering the uterus.
42
32. Congenital absence of the vagina is most commonly associated with:
A. Absent secondary sexual characteristics
B. Absent uterus
C. Exposure to diethylstilbestrol
D. Turner syndrome
E. Imperforate anus
B. Absent uterus
Explanation: Congenital absence of the vagina, as seen in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, is most commonly associated with an absent uterus, while secondary sexual characteristics are usually normal.
43
33. In cases of recurrent abortions, the most common uterine malformation seen is:
A. Müllerian fusion defects
B. Uterine syncytium
C. Uterine dysgenesis
D. Unicornuate uterus
A. Mullerian fusion defects
Explanation: Mullerian fusion defects, specifically a uterine septum, are the most common uterine malformations associated with recurrent pregnancy loss (RPL).
44
34. A 19-year-old patient came to the outpatient department with complaints of primary amenorrhea. She had well-developed breasts and pubic hair. However, there was absence of the vagina and uterus. The likely diagnosis is:
A. XYY
B. Müllerian agenesis
C. Gonadal dysgenesis
D. Klinefelter’s syndrome
B. Mullerian agenesis
Explanation: Mullerian agenesis (MRKH syndrome) is characterized by the absence of the uterus and vagina, despite normal secondary sexual characteristics such as breast and pubic hair development.
45
35. A 7-year-old girl with vulvar trauma had her complete immunization more than 5 years ago. What booster injection should be given?
A. Hepatitis B booster
B. Measles booster
C. Tetanus toxoid booster
D. BCG booster
C. Tetanus toxoid booster
Explanation: For vulvar trauma, a tetanus toxoid booster is recommended if the last immunization was more than 5 years ago.
46
37. Ovarian malignancy is least likely with the following ultrasound finding:
A. Solid nodules/structures
B. Ascites
C. Tumor size more than 10 cm
D. Sonic shadowing
D. Sonic shadowing
Explanation: Sonic shadowing is associated with benign ovarian lesions, such as dermoid cysts, and is less likely to indicate ovarian malignancy.
47
38. Which of the following is NOT relevant in the assessment of Müllerian duct anomalies?
A. Hysterosalpingography
B. Pelvic ultrasound
C. MRI
D. Colposcopy
D. Colposcopy
Explanation: Colposcopy is not relevant for assessing Mullerian duct anomalies. Imaging methods such as hysterosalpingography, pelvic ultrasound, and MRI are more commonly used.
48
39. A 6-year-old was brought to the clinic due to nocturnal vulvar and perianal itching. What is the most likely etiologic agent?
A. Bacteria
B. Mycotic infection
C. Pinworms
D. Nonspecific
C. Pinworms
Explanation: Pinworms (Enterobius vermicularis) are a common cause of nocturnal vulvar and perianal itching in children.
49
42. A 12-year-old girl, Shella, has been experiencing lower abdominal discomfort. A medical examination revealed that menstrual fluid has been collecting in her vagina and not being expelled. This would most likely be explained as:
A. Vaginitis
B. Secondary dysmenorrhea
C. Imperforate hymen
D. Secondary amenorrhea
C. Imperforate hymen
Explanation: An imperforate hymen can prevent menstrual fluid from being expelled, causing accumulation in the vagina and leading to abdominal discomfort, a condition known as hematocolpos.
50
43. Which collecting device can be utilized when doing a Pap smear?
A. Cotton pledget
B. Cytobroom
C. All of the above
D. Ayers spatula
C. All of the above
Explanation: Devices such as the cotton pledget, cytobroom, and Ayers spatula can all be used for collecting cervical cells during a Pap smear.
51
45. An unsatisfactory Pap smear result may be due to the following, EXCEPT:
A. Sample contamination
B. No label
C. Presence of infection
D. Scant cellularity
C. Presence of infection
Explanation: The presence of infection does not make a Pap smear unsatisfactory. Unsatisfactory results are typically due to issues like sample contamination, no label, or scant cellularity.
52
46. A 4-year-old was brought to the clinic due to vaginal pruritus with discharge and erythema. What is the most common cause of vulvovaginitis in this age group?
A. Nonspecific vulvovaginitis
B. Bacterial vulvovaginitis
C. Mycotic vulvovaginitis
D. Pinworms
A. Nonspecific vulvovaginitis
Explanation: Nonspecific vulvovaginitis is the most common cause of vulvovaginitis in prepubertal girls, often related to poor genital hygiene, causing irritation and discharge.
53
47. Which of the following is TRUE of a positive Lugol’s test?
A. Presence of pale yellow areas against a darker background
B. Presence of uniform uptake of stain
A. Presence of pale yellow areas against a darker background
Explanation: A positive Lugol's test shows pale yellow areas indicating abnormal cells that do not take up the iodine stain, contrasting against the darker background of healthy cells.
54
50. Hysteroscopy is contraindicated in which of the following conditions?
A. Acute pelvic infections
B. Persistent bleeding after negative endometrial sampling
C. Uterine septum and synechiae
D. Endometrial polyp
A. Acute pelvic infections
Explanation: Hysteroscopy is contraindicated in cases of acute pelvic infections due to the risk of spreading the infection into the pelvic cavity.
55
51. In Visual Inspection with Acetic Acid (VIA), which solution is used as the agent?
A. KOH
B. Iodine
C. CH₃COOH
D. KI
C. CH3COOH (Acetic acid)
Explanation: Acetic acid (CH3COOH) is used in Visual Inspection with Acetic Acid (VIA) to detect cervical lesions.
56
52. The general approach to a 3-year-old child includes all of the following, EXCEPT:
A. Gain the child’s confidence and establish authority
B. Demonstrate gentleness and patience
C. Allow child participation during examination
D. Keep instruments and speculums out of sight
C. Allows child participation during examination
Explanation: While it's important to gain the child's confidence and demonstrate patience, allowing a young child full participation during an exam may not be feasible or appropriate.
57
53. The Bethesda System in reporting Pap smear results includes the following, EXCEPT:
A. Adequacy of the sample
B. None of the above
C. Presence of infection
D. Hormonal status
E. Cellular elements of the sample obtained
C. Presence of infection
Explanation: The Bethesda System focuses on adequacy of the sample, hormonal status, and cellular elements, but the presence of infection is reported separately and is not a primary component of the Bethesda criteria.
58
54. The congenital transverse vaginal septum is most commonly located at the level of the:
A. Cervix
B. Hymen
C. Lower and middle third of the vagina
D. Upper and middle third of the vagina
D. Upper and middle third of the vagina
Explanation: A transverse vaginal septum most commonly occurs in the upper and middle third of the vagina.
59
55. Uterine anomalies have been associated with patients exposed to diethylstilbestrol (DES) in utero.
True
False
True
Explanation: Diethylstilbestrol (DES) exposure in utero has been linked to various uterine anomalies, including partial transverse vaginal septa.
60
56. On ultrasound, the fundal contour of the uterus will have a normal outline with didelphic and bicornuate uteri.
True
False
False
Explanation: In didelphic and bicornuate uteri, the fundal contour is abnormal, with a deep indentation, unlike the smooth contour seen in a normal uterus.
61
57. Females with congenital adrenal hyperplasia:
A. Show precocious early sexual development
B. Often have webbed hands and feet
C. Show feminization of the external genitalia
D. All of the above
A. Show precocious early sexual development
Explanation: Congenital adrenal hyperplasia (CAH) is often associated with precocious sexual development due to excess androgen production.
62
58. A 5-year-old child was brought to the clinic due to vaginal pruritus. What is the best position to evaluate the external genitalia?
A. Frog-leg position
B. Sitting on mother’s lap
C. Lithotomy position
D. Knee-chest position
A. Frog leg position
Explanation: The frog leg position is ideal for evaluating the external genitalia in young children, as it provides good exposure and comfort during the exam.
63
59. The upper one-third of the vagina is derived from the:
A. Sinovaginal bulb
B. Müllerian duct
C. Wolffian duct
D. Genital ridge
B. Mullerian duct
Explanation: The upper two-thirds of the vagina is derived from the Müllerian duct, while the lower third is from the urogenital sinus.
64
60. Which of the following is TRUE of the transformation zone?
A. It is the area between normal columnar and mature squamous epithelium
B. It is an area of rapid turnover
C. Most cases of squamous neoplasia of the cervix begin here
D. All of the above
B. All of the above
Explanation: The transformation zone is an area between the columnar and squamous epithelium, prone to rapid turnover, and is the site where most cases of cervical squamous neoplasia begin.
65
61. 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
D. 2:1
Explanation: In children, the cervix is relatively larger compared to the uterus, with a ratio of approximately 2:1.
66
62. In VIA, which of these cells will NOT exhibit acetowhitening?
A. Cells infected with HPV
B. Dysplastic cells
C. Normal epithelial cells
D. Metaplastic cells
C. Normal epithelial cells
Explanation: In Visual Inspection with Acetic Acid (VIA), normal epithelial cells do not exhibit acetowhitening, whereas dysplastic and HPV-infected cells do.
67
63. This condition is commonly encountered in females exposed to DES in utero:
A. Labial fusion
B. Vaginal adenosis
C. Imperforate hymen
D. Vaginal septum
B. Vaginal adenosis
Explanation: Vaginal adenosis, which involves the presence of columnar epithelium in the vagina, is a common condition in females exposed to diethylstilbestrol (DES) in utero.
67
64. What hormone is responsible for the thick, elastic, redundant hymen in newborns?
A. Progesterone
B. Estrogen
C. Testosterone
D. Aromatase
B. Estrogen
Explanation: Estrogen is responsible for the redundant, thick, and elastic hymen seen in newborns.
68
65. The endpoint of HSG examination for tubal patency is:
A. Tubal filling with intraperitoneal spilling
B. Increasing pelvic pain
C. Both A and B are correct
D. Both A and B are incorrect
A. Tubal filling with intraperitoneal spilling
Explanation: Tubal patency is confirmed by observing tubal filling and intraperitoneal spilling of the contrast medium during hysterosalpingography (HSG).
69
66. Treatment for imperforate hymen involves a cruciate incision extending to the ____ o’clock positions:
A. 10, 2, 6
B. 4, 7, 12
C. 9, 3, 6
D. 3, 9, 12
A. 10, 2, 6
Explanation: The standard treatment involves making a cruciate incision at the 10, 2, and 6 o'clock positions.
70
67. Normal ovarian development in a female with absent uterus and vagina indicates which condition?
A. Turner syndrome
B. Testicular feminization syndrome
C. Müllerian agenesis
D. Gonadal dysgenesis
C. Mullerian agenesis
Explanation: In Mullerian agenesis (MRKH syndrome), the ovaries develop normally, but the uterus and vagina are absent.
71
68. A 6-year-old cancer patient undergoing chemotherapy presents with vaginal pruritus and erythema. What is the most likely etiologic agent?
A. Bacteria
B. Mycotic
C. Pinworms
D. Nonspecific
B. Mycotic
Explanation: Mycotic (fungal) infections are common in immunocompromised patients, such as those undergoing chemotherapy.
72
69. Hysteroscopy is contraindicated in which of the following?
A. Endometrial polyp
B. Acute pelvic infections
C. Persistent bleeding after negative endometrial sampling
D. Uterine septum and synechiae
B. Acute pelvic infections
Explanation: Hysteroscopy is contraindicated in cases of acute pelvic infections due to the risk of spreading the infection.
73
70. What is the most common physiologic ovarian mass among adolescents?
A. Teratoma (dermoid)
B. Functional physiologic cyst
C. Sex cord tumor
D. Epithelial tumor
B. Functional physiologic cyst
Explanation: A functional physiologic cyst is the most common ovarian mass found in adolescents.
74
71. A 5-year-old was brought to the clinic due to vaginal discharge secondary to a foreign body. What is the next best step?
A. Visualization of the introitus using nasal speculum
B. Visualization of the introitus using otoscope
C. Visualization of the introitus using colposcope
D. Visualization of the introitus using hysteroscope
A. Visualization of the introitus using a nasal speculum
Explanation: A nasal speculum is commonly used to visualize the introitus in young children for the evaluation of foreign bodies.
75
72. 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
D. 2:1
Explanation: In children, the cervix is proportionally larger than the uterus, with a ratio of approximately 2:1.
76
73. The surgical technique for neovagina creation where labial skin is sutured to form a vaginal "kangaroo pouch" is called:
A. Abbe-McIndoe procedure
B. Intestinal vaginoplasty
C. Vecchietti procedure
D. Williams procedure
A. Abbe-McIndoe procedure
Explanation: The Abbe-McIndoe procedure is a surgical technique for creating a neovagina by suturing labial skin together to form a "kangaroo pouch."
77
74. A full bladder is required prior to performing which type of ultrasound?
A. Transperineal
B. Transvaginal
C. Transabdominal
D. Transectal
C. Transabdominal
Explanation: A full bladder is required for a transabdominal ultrasound as it acts as an acoustic window, improving visualization of pelvic structures.
78
75. The uterus develops from the:
A. Müllerian duct
B. Wolffian duct
C. Both
D. Paramesonephric duct
A. Mullerian duct
Explanation: The Mullerian duct develops into the uterus, fallopian tubes, and the upper part of the vagina.
79
79. A 5-year-old child with a straddle injury incurred a 2x2 cm non-expanding vulvar hematoma. What is the best management?
A. Evacuation and repair
B. Observe and perform serial examinations
C. Laser treatment
D. Perform vaginoscopy
B. Observe and do serial examination
Explanation: For a nonexpanding vulvar hematoma, observation and serial examination are typically the best management, unless complications arise.
80
80. A 4-year-old child was brought to your clinic due to vaginal bleeding. Physical examination revealed hymenal transection between 3 and 9 o’clock. What is the likely cause of the bleeding?
A. Trauma
B. Congenital
C. Sexual abuse
D. Infection
C. Sexual abuse
Explanation: Hymenal transection is often an indicator of sexual abuse in children, especially when located between 3 and 9 o'clock.
81
82. A 45-year-old patient comes in with a complaint of vaginal bleeding. Her last menses was 15 months ago. Pregnancy test is negative. Ultrasound reveals an endometrial thickness of 5 mm. What is the next best step?
A. Dilatation and curettage
B. Repeat ultrasound after 6 months
C. Reassure the patient
D. Endometrial biopsy
C. Reassure the patient
Explanation: An endometrial thickness of 5 mm in a postmenopausal woman without other concerning symptoms is typically not worrisome, so reassurance is appropriate.
82
84. Endometrial sampling is contraindicated in which of the following?
A. Dysfunctional uterine bleeding
B. Pelvic tuberculosis
C. Pregnancy of unknown viability
D. Endometritis
C. Pregnancy of unknown viability
Explanation: Endometrial sampling is contraindicated in suspected pregnancy, as it may interfere with an early pregnancy, particularly when the viability is unknown.
83
85. A 4-year-old child was brought to the clinic due to vaginal bleeding. On genital inspection, a red donut-like structure was noted. What is the initial impression?
A. Imperforate hymen
B. Labial fusion
C. Lichen sclerosus et atrophicus
D. Urethral prolapse
D. Urethral prolapse
Explanation: Urethral prolapse presents as a red donut-like structure around the urethral meatus, which is common in prepubertal girls with vaginal bleeding.
84
86. A 5-year-old child with a history of fall came in for consult. What maneuver will you ask for better visualization of the introitus?
A. Upward lateral traction of the thighs
B. Downward lateral traction of the thighs
C. Upward lateral traction of the legs
D. Downward lateral traction of the legs
B. Downward lateral traction of the thighs
Explanation: Applying downward lateral traction of the thighs allows the introitus to gape open, providing better visualization of the vaginal structures.
85
87. A 7-year-old with vulvar trauma had complete immunization more than 5 years ago. What booster injection should be given?
A. Hepatitis B booster
B. Measles booster
C. Tetanus toxoid booster
D. BCG booster
C. Tetanus toxoid booster
Explanation: A tetanus toxoid booster is recommended after trauma if the last dose was administered more than 5 years ago.
86
88. You requested hysteroscopy for a 35-year-old patient with abnormal uterine bleeding. When is the best time to schedule the procedure?
A. Day 3–5
B. Day 1–2
C. Day 18–20
D. Any day of the menstrual cycle
A. Day 3-5
Explanation: The best time for hysteroscopy is during the follicular phase after menstruation, typically between days 3-5, when the endometrium is thinnest and visualization is optimal.
87
89. A 19-year-old patient presents with primary amenorrhea. She has well-developed breasts and axillary and pubic hair. Ultrasound reveals an absent vagina. What is the most likely diagnosis?
A. XYY syndrome
B. Gonadal dysgenesis
C. Müllerian agenesis
D. Klinefelter’s syndrome
C. Mullerian agenesis
Explanation: Mullerian agenesis is characterized by the absence of the uterus and vagina, despite normal secondary sexual characteristics like breast and pubic hair development.
88
90. Gartner duct cyst is a remnant of which embryologic structure?
A. Müllerian duct
B. Wolffian duct
C. Urogenital sinus
D. Genital ridge
B. Wolffian duct
89
91. Which of the following is NOT true regarding congenital uterine anomalies?
A. They are associated with preterm labor
B. Incidence is approximately 1%
C. They are associated with intrauterine growth restriction
D. They assist in better implantation of the embryo
D. They assist in better implantation of the embryo
Explanation: Congenital uterine anomalies do not improve implantation. In fact, they are associated with complications like preterm labor and intrauterine growth restriction (IUGR).
90
92. There is a high association between uterine malformations and congenital renal anomalies, especially renal agenesis and ectopia.
A. True
B. False
A. True
Explanation: There is a well-documented association between uterine malformations and congenital renal anomalies, particularly renal agenesis and ectopia.
91
93. One reassuring aspect of sonography is the absence of adverse clinical effects from the energy levels used, based on the thermal index. With modern ultrasound machines, the thermal index is usually:
A. 1
B. Less than 1
C. 2
D. 1.5
B. Less than 1
Explanation: The thermal index (TI) used in modern ultrasound machines is typically less than 1, ensuring safety during diagnostic procedures.
92
94. In a septate uterus, the septum has poor blood supply and contains fibrous and/or myometrial tissue.
True
False
True
Explanation: A septate uterus contains a septum with poor blood supply, often composed of fibrous or myometrial tissues.
93
95. A 2-year-old asymptomatic child was brought to the clinic due to fusion of the labia minora. What is the best management?
A. Manual separation under anesthesia
B. Topical estrogen cream
C. Topical betamethasone cream
D. Antibiotics and steroids
B. Topical estrogen cream
Explanation: Topical estrogen cream is the first-line treatment for labial fusion, especially if it causes discomfort or difficulty urinating.
94
96. The lower one-fourth of the vagina is derived from:
A. Urogenital sinus
B. Paramesonephric duct
C. Mesonephric duct
D. Müllerian duct
A. Urogenital sinus
Explanation: The lower one-fourth of the vagina is derived from the urogenital sinus, while the upper portion is formed from the Mullerian ducts.
95
97. Complete failure of Müllerian duct fusion results in:
A. Uterine didelphys
B. Arcuate uterus
C. Septate uterus
D. Unicornuate uterus
A. Uterine didelphys
Explanation: Complete failure of Mullerian duct fusion results in uterine didelphys, where two separate uteri are present.
96
98. The success of hysteroscopy depends on the medium used to distend the uterine cavity. Which medium has a risk of causing hyponatremia?
A. CO₂
B. Glycine
C. Mannitol
D. Normal saline
B. Glycine
Explanation: Glycine is a non-electrolyte distending medium that can cause hyponatremia during hysteroscopy if absorbed in large amounts.
97
99. A 7-year-old child was brought to the clinic due to vaginal pruritus, dysuria, and constipation. On genital inspection, a whitish lesion in a figure-8 formation was noted around the labia majora and anus. What is the initial impression?
A. Imperforate hymen
B. Labial fusion
C. Lichen sclerosus
D. Urethral prolapse
C. Lichen sclerosus
Explanation: Lichen sclerosus typically presents with a whitish lesion in a figure-8 or hourglass formation around the labia and anus, and it is associated with pruritus.
98
100. 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
D. 6.5 - 7.5
Explanation: The vaginal pH of prepubertal girls is typically between 6.5 and 7.5, reflecting a more neutral to slightly alkaline environment.
99
Q: A 22-year-old female presents with grapelike structures in her breast. What is the most likely diagnosis?
A. Fibrocystic changes
B. Fibroadenoma
C. Phyllodes tumor
D. Invasive ductal carcinoma
Fibrocystic changes
Rationale: Fibrocystic changes commonly occur in younger women and present as tender, mobile lumps described as "grapelike" or nodular tissue changes.
100
Q: What is the appropriate management for fibrocystic breast changes?
A. Mechanical support and dietary changes
B. Immediate biopsy
C. Tamoxifen therapy
D. Surgical excision
Mechanical support and dietary changes
Rationale: First-line management includes supportive bras, caffeine reduction, and symptom relief. Invasive interventions are not typically required.
101
Q: A 30-year-old female, two weeks postpartum, presents with a firm, erythematous, swollen left breast. What is the most likely diagnosis?
A. Mastitis
B. Fibroadenoma
C. Galactocele
D. Breast abscess
Mastitis
Rationale: Mastitis is a common postpartum breast infection caused by milk stasis and bacterial entry, usually Staphylococcus aureus.
102
Q: What is the initial management for postpartum mastitis?
A. Antibiotics
B. Surgical drainage
C. Hormonal therapy
D. Needle aspiration
Antibiotics
Rationale: First-line treatment includes antibiotics effective against Staphylococcus species (e.g., dicloxacillin or cephalexin).
103
Q: What advice would you give to a breastfeeding patient with mastitis?
A. Continue breast pumping the affected breast to decrease engorgement
B. Stop breastfeeding immediately
C. Apply cold compresses only
D. Switch to formula feeding
A. Continue breast pumping the affected breast to decrease engorgement
104
Q: A patient with mastitis is not improving with antibiotics. What is the next best step in management?
A. Increase antibiotic dose
B. Perform an ultrasound to rule out a breast abscess
C. Refer for mastectomy
D. Observe for 3 more days
Perform an ultrasound to rule out a breast abscess
105
Q: A patient has a suspected breast abscess confirmed on ultrasound. What is the next step in management?
A. Oral steroids
B. Aspiration or drainage of the abscess
C. Repeat mammography
D. Observe and reassess in 1 week
Aspiration or drainage of the abscess
106
Q: A 35-year-old female presents with a hard, non-mobile, irregular breast lump. What is the most likely diagnosis?
A. Fibroadenoma
B. Breast cancer
C. Cyst
D. Phyllodes tumor
Breast cancer
107
Q: What is the best imaging modality to evaluate a suspicious breast mass in a 35-year-old woman?
A. Mammography
B. CT scan
C. Ultrasound
D. PET scan
Ultrasound
Rationale: In women under 40, especially those with dense breast tissue, ultrasound is superior to mammography for initial evaluation of a breast mass.
108
Q: A 45-year-old female undergoes mammography showing microcalcifications. What is the next step in management?
A. Repeat mammography in 6 months
B. Core needle biopsy
C. MRI of the breast
D. Lumpectomy
Core needle biopsy
109
Q: A 40-year-old woman with a family history of breast cancer asks about genetic testing. Which gene mutation is her brother most likely to test positive for?
A. BRCA1
B. BRCA2
C. TP53
D. CHEK2
A. BRCA2
110
Q: What is the primary choice for breast cancer screening in women aged 40 and older?
A. Breast ultrasound
B. Clinical breast exam
C. Breast MRI
D. Mammography
A. Mammography
111
Q: When is the best time to perform a proper breast self-exam?
A. 3–5 days after menstruation
B. Mid-cycle
C. During menstruation
D. Just before menstruation
A. 3-5 days after menstruation
112
Q: Once a woman develops carcinoma in one breast, what is the approximate annual risk of developing cancer in the other breast?
A. 1% per year
B. 5% per year
C. 10% per year
D. 0.5% per year
A. 1% per year
113
Q: What does a BI-RADS class 2 indicate on a mammogram?
A. Suspicious finding
B. Probably benign
C. Benign findings
D. Incomplete—additional imaging needed
A. Benign findings
114
Q: A 45-year-old woman presents with a palpable breast lump. What is the next best step in management?
A. Clinical breast exam only
B. Biopsy immediately
C. Mammography and/or ultrasound, depending on the nature of the lump
D. MRI of the breast
Mammography and/or ultrasound, depending on the nature of the lump
115
Q: A patient with a family history of breast cancer asks about preventive options. Which of the following is a valid strategy?
A. Annual breast MRI starting at age 25
B. Chemoprevention (e.g., tamoxifen)
C. Radical mastectomy
D. Monthly breast self-exam only
Chemoprevention (e.g., tamoxifen)
116
Q: What is the most common histologic type of breast cancer?
A. Invasive lobular carcinoma
B. Mucinous carcinoma
C. Medullary carcinoma
D. Invasive ductal carcinoma
Invasive ductal carcinoma
117
Q: A 30-year-old woman presents with a breast mass that is round, smooth, and mobile. What is the most likely diagnosis?
A. Fibrocystic changes
B. Fibroadenoma
C. Lipoma
D. Phyllodes tumor
Fibroadenoma
118
Q: A 60-year-old woman with a palpable breast mass has a biopsy that reveals ductal carcinoma in situ (DCIS). What is the best treatment?
A. Observation
B. Total mastectomy
C. Chemotherapy
D. Lumpectomy with radiation
Lumpectomy with radiation
Rationale: DCIS is non-invasive but has the potential to become invasive. Breast-conserving surgery with adjuvant radiation lowers the recurrence rate and is considered standard of care.
119
Q: Evaluation of a breast mass includes all of the following in the triple test EXCEPT:
A. Clinical breast examination
B. Imaging (ultrasound or mammography)
C. Core biopsy
D. Fine-needle aspiration cytology (FNA)
Fine-needle aspiration cytology (FNA)
Rationale: The triple test consists of clinical examination, imaging, and core needle biopsy, not FNA, which has limited accuracy compared to core biopsy.
120
Q: The use of breast ultrasound as an adjunct to mammography is most useful for:
A. Women with dense breasts
B. Differentiating cystic from solid masses
C. Pregnant women
D. All of the above
All of the above
Rationale: Ultrasound is ideal for evaluating dense breast tissue, safe for pregnancy, and helps distinguish between cysts and solid lesions.
121
Q: Women classified as low risk for developing breast cancer have approximately what percentage lifetime risk?
A. 12%
B. 25%
C. 5%
D. 30%
12%
Rationale: The average lifetime risk for breast cancer in women without additional risk factors is about 12%, or 1 in 8.
122
Q: Screening mammography is recommended up to what age in average-risk women?
A. 74
B. 65
C. 55
D. 80
A. 74
123
Q: Cervical cytology reports will NOT include which of the following?
A. Sample adequacy
B. Cellular morphology
C. Hormonal status
D. Infection
Infection
124
Q: Visual inspection of the cervix can be used as a screening tool.
A. TRUE
B. FALSE
TRUE
Rationale: VIA (Visual Inspection with Acetic Acid) is a low-cost, effective screening method for cervical abnormalities in resource-limited settings.
125
Q: In colposcopy, what is applied to the cervix to highlight abnormal areas?
A. Acetic acid
B. Lugol’s iodine
C. Saline solution
D. Potassium hydroxide
Acetic acid
Rationale: 3–5% acetic acid is applied to cause coagulation of nuclear proteins in abnormal cells, making them appear acetowhite under colposcopy.
126
Q: Cervical screening is NOT recommended in which of the following patients?
A. Postmenopausal woman
B. Status post hysterectomy for benign disease
C. HIV-positive patient
D. Women with prior abnormal cytology
Status post hysterectomy for benign disease
Rationale: Women who had a total hysterectomy for benign reasons and have no history of CIN2 or higher do not require further cervical screening.
127
Q: What is an absolute contraindication to performing hysteroscopy?
A. Cervical stenosis
B. Uterine fibroids
C. Acute pelvic infection
D. Irregular uterine bleeding
Acute pelvic infection
Rationale: Acute pelvic infection is an absolute contraindication to hysteroscopy due to the risk of spreading infection through the uterine cavity.
128
Q: What is the normal vaginal pH in prepubertal girls?
A. 3.5–4.5
B. 4.5–5.5
C. 5.5–6.5
D. 6.5–7.5
6.5–7.5
Rationale: In prepubertal girls, vaginal pH is typically neutral to alkaline due to low estrogen levels, making them more susceptible to infections.
129
Q: What is the normal vaginal pH in pubertal girls?
A. 3.5–4.5
B. 4.5–5.5
C. 5.5–6.5
D. 6.5–7.5
3.5–4.5
Rationale: After puberty, estrogen increases glycogen in vaginal epithelium, promoting lactobacilli which lower the pH to 3.5–4.5, providing protection against infections.
130
Q: All of the following are common indications for a rectal exam in a child EXCEPT:
A. Genital tract bleeding
B. Pelvic mass
C. Foreign body
D. Sexual abuse
Sexual abuse
Rationale: A rectal exam is not routinely indicated for sexual abuse evaluation unless there are signs of trauma or suspicion of deeper injuries.
131
Q: Which hormone is responsible for the thick, elastic redundancy of the hymen in newborns?
A. Estrogen
B. Progesterone
C. Testosterone
D. Prolactin
Estrogen
Rationale: Maternal estrogen exposure in utero leads to thickened, estrogenized hymenal tissue in newborns.
132
Q: A 4-year-old child presents with vaginal bleeding and hymenal lacerations at 3 and 9 o'clock. What is the most likely cause of bleeding?
A. Sexual abuse
B. Foreign body
C. Trauma from fall
D. Vulvovaginitis
Sexual abuse
Rationale: Hymenal transections between 3 and 9 o'clock are highly specific findings suggesting sexual abuse.
133
Q: One of the following is NOT a reason why children are more susceptible to vulvar infections:
A. Vaginal epithelium of a prepubertal child has slightly acidic pH
B. Lack of estrogen effect on the epithelium
C. Poor perineal hygiene
D. Short anogenital distance
Vaginal epithelium of a prepubertal child has slightly acidic pH
Rationale: Prepubertal children have a neutral to alkaline vaginal pH, making them more, not less, prone to infections.
133
Q: A 4-year-old girl presents with vaginal pruritus, discharge, and erythema. What is the most common cause of vulvovaginitis in this age group?
A. Non-specific vulvovaginitis
B. Candidiasis
C. Bacterial vaginosis
D. Gonorrhea
Non-specific vulvovaginitis
Rationale: Poor hygiene, irritation, and lack of estrogen in young girls contribute to non-specific vulvovaginitis, the most common cause of discharge in this age group.
134
Q: A 6-year-old girl with nocturnal vulvar and perianal itching is most likely suffering from:
A. Ringworms
B. Pinworms
C. Candidiasis
D. Mycotic vaginitis
Pinworms
Rationale: Enterobius vermicularis causes nocturnal itching around the anus and vulva; diagnosed via Scotch tape test.
135
Q: A 6-year-old cancer patient on chemotherapy presents with vaginal pruritus and edema. What is the most likely cause?
A. Mycotic infection
B. Bacterial vaginosis
C. Gonorrhea
D. HSV
Mycotic infection
Rationale: Immunosuppression from chemotherapy predisposes patients to fungal infections, especially Candida albicans.
136
Q: What is the treatment for asymptomatic fusion of the labia minora in a 2-year-old child?
A. No treatment is necessary
B. Manual separation under anesthesia
C. Estrogen cream
D. Betamethasone cream
No treatment is necessary
Rationale: In asymptomatic cases, labial adhesions often resolve spontaneously and do not require intervention unless causing urinary symptoms.
137
Q: A red donut-like structure observed at the vaginal introitus is most likely due to:
A. Urethral prolapse
B. Hymenal tag
C. Imperforate hymen
D. Vaginal polyp
Urethral prolapse
Rationale: Urethral prolapse presents as a red, circular “donut” structure, typically in prepubertal girls, often with minor bleeding.
138
Q: "Figure of 8" appearance is associated with which condition?
A. Lichen sclerosus tropicus
B. Labial fusion
C. Urethral prolapse
D. Imperforate hymen
Lichen sclerosus tropicus
Rationale: Lichen sclerosus in children commonly presents with a "figure-of-8" pattern involving the vulva and perianal area, associated with pruritus and white lesions.
139
Q: What is the diagnostic test of choice for confirming lichen sclerosus ("figure of 8" lesion)?
A. Punch biopsy
B. Vaginal culture
C. Scotch tape test
D. Wet mount microscopy
Punch biopsy
Rationale: A punch biopsy provides histologic confirmation of lichen sclerosus, especially when the diagnosis is uncertain or the lesion does not respond to treatment.
140
Q: What is the most common foreign body found in girls aged 3–9 years?
A. Toilet paper
B. Beads
C. Crayon pieces
D. Food particles
Toilet paper
Rationale: Toilet paper is the most commonly encountered vaginal foreign body due to poor hygiene habits in young girls.
141
Q: A 6-year-old girl presents with vaginal discharge, negative cultures, and no signs of sexual abuse. What is the most likely cause?
A. Non-specific vulvovaginitis
B. Trichomoniasis
C. Foreign body
D. Candidiasis
Non-specific vulvovaginitis
Rationale: Most cases in this age group are non-specific, due to poor hygiene and lack of estrogen. The discharge is often mild, and cultures are negative.
142
Q: A child presents with a urethral mass that prolapses during straining. What is the diagnosis?
A. Urethral prolapse
B. Imperforate hymen
C. Urethral caruncle
D. Prolapsed bladder
Urethral prolapse
Rationale: Urethral prolapse appears as a red, donut-shaped mass at the urethral opening, especially in prepubertal girls and may protrude more with straining.
143
Q: A 12-year-old girl has cyclic abdominal pain but no menarche. What is the most likely diagnosis?
A. Imperforate hymen
B. Vaginal agenesis
C. Transverse vaginal septum
D. Turner syndrome
Imperforate hymen
Rationale: Cyclic pain with primary amenorrhea suggests menstrual flow is blocked. Imperforate hymen causes hematocolpos, and diagnosis is clinical or via ultrasound.
144
Q: A 15-year-old girl presents with primary amenorrhea and no secondary sexual characteristics. What is the most likely diagnosis?
A. Turner syndrome
B. Müllerian agenesis
C. Kallmann syndrome
D. Polycystic ovarian syndrome
Turner syndrome
Rationale: Turner syndrome (45,XO) presents with streak ovaries, leading to absent estrogen and lack of secondary sexual development and amenorrhea.
145
Q: A young girl presents with labial adhesions. What is the best treatment?
A. Observation only
B. Topical estrogen cream
C. Manual separation under anesthesia
D. Oral antibiotics
Topical estrogen cream
Rationale: Topical estrogen applied to the adhesion site is effective in separating the fused labia and restoring normal anatomy over time.
146
Q: During early fetal development, the Wolffian duct develops into the male reproductive system while the Müllerian duct develops into the female reproductive system.
A. TRUE
B. FALSE
TRUE
Rationale: Wolffian ducts (mesonephric) give rise to male internal genitalia; Müllerian ducts (paramesonephric) give rise to female reproductive organs (uterus, fallopian tubes, upper vagina).
147
Q: Females with congenital adrenal hyperplasia (CAH) will show:
A. Normal genitalia
B. Ambiguous genitalia
C. Delayed puberty
D. Webbed neck
Ambiguous genitalia
Rationale: CAH causes excess androgen production, leading to virilization of female genitalia and ambiguous appearance at birth.
148
Q: What is the term used for the accumulation of blood in the vaginal canal due to outflow tract obstruction?
A. Hematocolpos
B. Hematometra
C. Menorrhagia
D. Hydrometra
Hematocolpos
Rationale: Hematocolpos is the collection of menstrual blood in the vagina due to obstruction, such as in imperforate hymen, leading to cyclic pelvic pain and amenorrhea.
149
Q: Which of the following is a derivative of the paramesonephric (Müllerian) duct?
A. Ovaries
B. Uterus
C. Labia minora
D. Clitoris
Uterus
Rationale: The Müllerian (paramesonephric) duct develops into the fallopian tubes, uterus, cervix, and upper 1/3 of the vagina. Ovaries derive from the gonadal ridge, not the Müllerian ducts.
150
Q: Which of the following is a derivative of the urogenital sinus?
A. Hymen
B. Uterus
C. Fallopian tubes
D. Ovaries
Hymen
Rationale: The hymen is derived from the urogenital sinus, specifically from invagination where the sinovaginal bulbs contact the vaginal plate.
151
Q: In the case of ambiguous genitalia, how is gender assignment best carried out?
A. Based on phallic adequacy
B. Based on parental preference
C. Observe until puberty
D. Karyotyping
Karyotyping
Rationale: Karyotyping is essential to determine chromosomal sex, which guides further hormonal, imaging, and clinical evaluation in ambiguous genitalia.
152
Q: Complete failure of the Müllerian ducts to fuse results in which anomaly?
A. Uterine didelphys
B. Septate uterus
C. Bicornuate uterus
D. Unicornuate uterus
Uterine didelphys
Rationale: Uterine didelphys occurs due to complete failure of fusion of the Müllerian ducts, resulting in two uteri and typically two cervices.
153
Q: In complete Müllerian duct aplasia, all of the following structures are absent EXCEPT:
A. Ovaries
B. Uterus
C. Cervix
D. Upper vagina
Ovaries
Rationale: The ovaries develop from the genital (gonadal) ridge, independently of the Müllerian ducts, which form the uterus, fallopian tubes, and upper vagina.
154
Q: Which Müllerian duct anomaly is associated with the presence of two cervices?
A. Uterine didelphys
B. Septate uterus
C. Bicornuate uterus
D. Unicornuate uterus
Uterine didelphys
Rationale: Uterine didelphys involves two separate uterine cavities and typically two cervices, due to failure of Müllerian duct fusion.
155
A patient presents with a 5 cm vulvar hematoma. What is the best way to manage it?
A. Apply compression and ice packs
B. Observation and bed rest
C. Surgical evacuation of the hematoma
D. Administration of anticoagulants
E. Prescribe analgesics for pain management
C. Surgical evacuation of the hematoma
156
Question 7:
A 27-year-old woman complains of excessive perineal pruritus. On physical examination, her vulva appears leathery, inflamed, and weeping. She mentions buying a new fabric softener last month. What is the pathogenesis of this condition?
A. Lichen sclerosus
B. Lichen simplex chronicus
C. Candidal vulvovaginitis
D. Contact dermatitis
E. Psoriasis
D. Contact dermatitis
157
What is the best management for the patient in Question 7? (Contact dermatitis)
A. Topical corticosteroids and avoidance of the allergen
B. Antifungal medication
C. Oral antihistamines only
D. Long-term systemic steroids
E. Antibiotic therapy
A. Topical corticosteroids and avoidance of the allergen
158
Question 9:
A 35-year-old, single, nulligravida woman arrives at the ER with profuse vaginal bleeding and sharp pain after coitus. What is the most common site of postcoital laceration?
A. Posterior fornix of the vagina
B. Anterior fornix of the vagina
C. Cervix
D. Hymen
E. Labia minora
A. Posterior fornix of the vagina
The posterior fornix is the deepest part of the vaginal canal and is most susceptible to lacerations during intercourse, especially if there is inadequate lubrication or aggressive activity.
159
35-year-old, single, nulligravida woman arrives at the ER with profuse vaginal bleeding and sharp pain after coitus.
How should you manage the patient described in Question 9?
A. Suture the laceration under anesthesia
B. Apply pressure dressing and observe
C. Recommend abstinence and allow healing naturally
D. Prescribe antibiotics to prevent infection
E. Perform a hysterectomy
A. Suture the laceration under anesthesia
160
What type of degeneration is characterized by myoma with carneous degeneration?
A. Hyaline degeneration
B. Myxoid degeneration
C. Red degeneration
D. Cystic degeneration
E. Calcific degeneration
C. Red (carneous) degeneration
Red or carneous degeneration is a common type of degeneration seen in uterine fibroids (myomas), especially during pregnancy. It occurs due to hemorrhage within the fibroid and leads to pain and redness of the fibroid tissue.
161
What condition involves abnormal microvascular pattern and function of the vessels of the endometrium?
A. Endometriosis
B. Asherman's syndrome
C. Adenomyosis
D. Endometrial hyperplasia
E. Endometrial dysfunction
E. Endometrial dysfunction
162
What is the method to assess hirsutism in PCOS?
A. Modified Ferriman-Gallwey
B. Rotterdam criteria
C. Ultrasound assessment
D. Androgen index measurement
E. Skin biopsy
Answer:
A. Modified Ferriman-Gallwey
163
What is the role of obesity in the pathogenesis of PCOS?
A. Exacerbates insulin resistance in PCOS
B. Decreases androgen production
C. Improves ovulation rates
D. Enhances estrogen sensitivity
E. Reduces cardiovascular risk
A. Exacerbates insulin resistance in PCOS
Obesity worsens insulin resistance, which plays a key role in the pathogenesis of PCOS. Increased insulin levels contribute to hyperandrogenism and anovulation
164
What condition is characterized by a low-grade leaf-like pattern?
A. Invasive ductal carcinoma
B. Phyllodes tumor
C. Lobular carcinoma in situ
D. Fibroadenoma
E. Paget's disease
B. Phyllodes tumor
Phyllodes tumors are characterized by a leaf-like or "leafy" growth pattern and can be benign, borderline, or malignant. They typically arise from the stromal tissue of the breast.
165
Which of the following are risk factors for the development of breast cancer?
A. BRCA-1 gene carrier
B. Family history of breast cancer
C. Biopsy results showing atypical ductal hyperplasia
D. All of the above
D. All of the above
All these factors significantly increase the risk of developing breast cancer. BRCA mutations, family history, and atypical ductal hyperplasia are strong predictors of breast cancer development.
166
Which of the following is NOT included in the Modified Ferriman-Gallwey scoring system for assessing hirsutism?
A. Lower leg
B. Upper lip
C. Chin
D. Abdomen
E. Chest
A. Lower leg
The Modified Ferriman-Gallwey scoring system focuses on hair growth in areas typically sensitive to androgens, such as the face, chest, and abdomen. The lower leg is not one of the areas scored.
167
What is the central pathophysiology of PCOS?
A. Insulin resistance
B. Hypothalamic-pituitary axis dysfunction
C. Decreased FSH secretion
D. Increased LH levels
E. Ovarian hyperandrogenism
A. Insulin resistance
Insulin resistance is a key driver in the pathophysiology of PCOS, contributing to hyperinsulinemia, which worsens hyperandrogenism and disrupts ovulatory function.
168
A patient complains of a breast mass during her midcycle. What is the best plan of management?
A. Reassure and observe
B. Immediate biopsy
C. Mammogram
D. Ultrasound-guided aspiration
E. Refer to oncologist
A. Reassure and observe
Breast masses that occur during the menstrual cycle are often due to hormonal changes and are typically benign. Observation and reassurance are usually recommended unless other worrisome features are present.
169
After breast surgery, a patient typically undergoes:
A. Radiation therapy
B. Chemotherapy
C. Hormone therapy
D. Immunotherapy
E. Observation
A. Radiation therapy
After breast-conserving surgery (lumpectomy), radiation therapy is often administered to reduce the risk of local recurrence. In certain cases, additional treatments like chemotherapy or hormone therapy may also be considered.
170
Women with PCOS have increased biologically active estradiol. What is the reason?
A. Increased aromatization of androgens to estradiol
B. Reduced sex hormone-binding globulin (SHBG) levels
C. Increased ovarian estrogen production
D. Decreased hepatic metabolism of estradiol
E. Increased adipose tissue activity
B. Reduced sex hormone-binding globulin (SHBG) levels
Women with PCOS often have reduced SHBG levels, leading to an increase in biologically active (free) estradiol because more estradiol remains unbound and active in circulation.
171
FBS (Fasting Blood Sugar) is a poor predictor for diabetes in PCOS. True or false?
A. True
B. False
A. True
Fasting blood sugar alone is not a reliable predictor of diabetes in PCOS because insulin resistance plays a key role. More sensitive tests, like the oral glucose tolerance test (OGTT), are better at identifying glucose metabolism issues in PCOS patients.
172
Which PCOS phenotype has the highest cardiovascular disease (CVD) risk?
A. Types A and B
B. Type C
C. Type D
D. Type E
E. None of the above
A. Types A and B
The "classic" phenotypes (A and B) of PCOS, characterized by hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology, carry the highest risk for cardiovascular disease due to the combination of metabolic and reproductive abnormalities.
173
PCOS patients have a higher risk for breast cancer. True or false?
A. True
B. False
B. False
While PCOS is associated with higher risks of endometrial cancer due to unopposed estrogen, there is no conclusive evidence that it significantly increases the risk of breast cancer.
174
Women with PCOS have increased levels of LH. These can be brought down to normal by the use of:
A. Oral contraceptive pills (OCPs)
B. Insulin-sensitizing agents
C. Clomiphene citrate
D. GnRH agonists
E. Androgen blockers
A. Oral contraceptive pills (OCPs)
OCPs help to suppress LH levels by providing exogenous estrogen and progesterone, which regulate the hypothalamic-pituitary-ovarian axis and reduce the elevated LH levels commonly seen in PCOS.
