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LE1 - GYNE Flashcards

1
Q

Which of the following produces symptoms of premenstrual syndrome?
A. Progesterone
B. Estrogen
C. LH
D. FSH

A

A. Progesterone

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2
Q

When during the menstrual cycle will you experience the LH surge?
A. Days 11-13
B. Days 14-16
C. Days 17-19
D. Days 20-22

A

A. Days 11-13

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3
Q

Which phase of the menstrual cycle corresponds to the follicular/proliferative phase?
A. Days 1-4
B. Days 5-14
C. Days 15-28
D. Entire cycle

A

B. Days 5-14

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4
Q

Which stage of the uterine cycle corresponds to the secretory phase?
A. Days 1-4
B. Days 5-14
C. Days 14-28
D. Entire cycle

A

C. Days 14-28

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5
Q

During which phase of the menstrual cycle is progesterone highest?
A. Follicular phase
B. Ovulatory phase
C. Luteal phase
D. Menstrual phase

A

C. Luteal phase

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6
Q

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

A

A. LH

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7
Q

Which of the following hormones share the same alpha subunit, except?
A. LH
B. FSH
C. TSH
D. Progesterone

A

D. Progesterone

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8
Q

A 36-year-old nulligravid woman consults for a fertility workup. Which of the following should be included in her evaluation?
A. Request for FSH
B. Antral follicle count
C. Both A and B
D. None of the above

A

C. Both A and B

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9
Q

Which event in folliculogenesis is typically completed by day 5 of the menstrual cycle?
A. Selection of a dominant follicle
B. Antral formation
C. Primordial follicle activation
D. Ovulation

A

A. Selection of a dominant follicle

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10
Q

A 35-year-old nulligravid woman consults for a fertility workup. What should be included in her evaluation?
A. Request for FSH
B. Anti-Müllerian hormone and Antral follicle count
C. Both A and B
D. None of the above

A

C. Both A and B

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11
Q

The presence of some nuclear vacuoles that appear at the base of the cell linings is indicative of which hormone?
A. Progesterone
B. Estrogen
C. LH
D. FSH

A

A. Progesterone

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12
Q

A 35-year-old woman with a history of infertility for 2 years has been undergoing follicular monitoring. The follicle was measured at 1.8 cm. What does this signify?
A. The patient is on her ovulation phase, and this is the best time for them to have sexual contact.
B. The follicle is not yet mature, and further monitoring is needed.
C. The patient is in the luteal phase, and ovulation has already occurred.
D. The follicle is cystic and may require intervention.

A

A. The patient is on her ovulation phase, and this is the best time for them to have sexual contact.

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13
Q

Which of the following statements is true about the hypothalamic-pituitary-ovarian (HPO) axis in utero?
A. GnRH is present in the hypothalamus as early as 10 weeks AOG.
B. FSH and LH are produced as early as 8 weeks AOG.
C. The HPO axis becomes functional at birth.
D. The HPO axis is fully mature by the second trimester.

A

A. GnRH is present in the hypothalamus as early as 10 weeks AOG.

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14
Q

An 11-year-old female comes in for a consult with her mother. The child had her menarche a year ago, and subsequent menses have been occurring every 2-3 months. What is the most likely explanation?
A. Immature HPO axis
B. Polycystic ovary syndrome (PCOS)
C. Hypothyroidism
D. Normal variation in cycle length

A

A. Immature HPO axis

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15
Q

You are examining a 13-year-old girl, and during the examination, you notice a change in contour and the presence of coarse, crinkly hair along the labia majora. What is the Tanner stage?
A. B3H2
B. B2H3
C. B4H3
D. B3H4

A

A. B3H2

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16
Q

Transection of the pituitary stalk will adversely affect the synthesis of which hormone(s) in circulation?
A. FSH and LH
B. Prolactin and Oxytocin
C. ACTH and TSH
D. GH and ADH

A

A. FSH and LH

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17
Q

The mother of a 9-year-old enrolled her child in gymnastics, where she practices 3 times per week. What is expected regarding the timing of the child’s menses?
A. Be delayed with each year of training
B. Occur earlier than average
C. Have no effect on menarche
D. Irregular cycles post-menarche

A

A. Be delayed with each year of training

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18
Q

Twin sisters separated at birth, one weighing 55 kg and the other 45 kg. What principle explains the timing of their menarche?
A. BMI
B. Genetic factors
C. Environmental factors
D. Nutrition

A

A. BMI

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19
Q

According to the two-cell gonadotropin theory, how does luteinizing hormone contribute to estrogen production?
A. By producing androgens
B. By converting androgens to estrogens
C. By stimulating the release of estrogen from granulosa cells
D. By triggering ovulation

A

A. By producing androgens

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20
Q

In a reproductive-age woman who has missed her menses for more than 20 days with a negative pregnancy test, which of the following conditions should be excluded first?
A. Hyperprolactinemia
B. Polycystic Ovary Syndrome (PCOS)
C. Hypothyroidism
D. Pregnancy

A

D. Pregnancy

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21
Q

What is the first diagnostic test to request for a 24-year-old woman with a history of regular menses who presents with sudden amenorrhea?
A. Pelvic Ultrasound
B. Serum Prolactin
C. Thyroid Function Test
D. Pregnancy Test

A

D. Pregnancy Test

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22
Q

What is the most cost-effective diagnostic modality to evaluate the female reproductive tract?
A. Hysterosalpingography
B. MRI
C. Transvaginal Ultrasound
D. Laparoscopy

A

C. Transvaginal Ultrasound

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23
Q

A 25-year-old single woman, previously with normal menstrual cycles, presents with milky white breast discharge. Which test should you request?
A. Thyroid Function Test
B. Serum Prolactin
C. Pregnancy Test
D. Mammogram

A

B. Serum Prolactin

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24
Q

In evaluating a woman with irregular menses and unilateral milky breast discharge, which imaging modality would be most appropriate?
A. Mammogram
B. Pelvic Ultrasound
C. Brain MRI
D. Breast Ultrasound

A

C. Brain MRI

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25
Q

A 17-year-old female presents with hypogastric pain but does not notice blood staining on her underwear. On transrectal exam, a shallow vaginal canal is noted. What is the most likely diagnosis?
A. Transverse Vaginal Septum
B. Imperforate Hymen
C. Vaginal Agenesis
D. Endometriosis

A

A. Transverse Vaginal Septum

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26
Q

For number 55-56, refer to this case: A young woman with primary amenorrhea and absent secondary sexual characteristics. What is the most likely diagnosis?
A. Androgen Insensitivity Syndrome (Testicular Feminization Syndrome)
B. Turner Syndrome
C. Mayer-Rokitansky-Küster-Hauser Syndrome
D. Congenital Adrenal Hyperplasia

A

A. Androgen Insensitivity Syndrome (Testicular Feminization Syndrome)

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27
Q

You advise the young woman for an additional test to confirm your impression of Testicular Feminization Syndrome. What is the confirmatory test?
A. Karyotyping
B. Serum Testosterone Levels
C. Androgen Receptor Assay
D. Pelvic Ultrasound

A

A. Karyotyping

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28
Q

An 18-year-old has not yet had her menses. She has normal pubic hair, and an ultrasound shows an absent uterus but normal ovaries. What is the most likely karyotype?
A. 46XX
B. 46XY
C. 45X
D. Mosaicism

A

The correct answer is:

B. 46XY

Explanation:
The presence of normal secondary sexual characteristics (such as pubic hair) combined with the absence of a uterus but normal ovaries on ultrasound suggests Androgen Insensitivity Syndrome (AIS). AIS is a condition where an individual has a 46XY karyotype but is resistant to androgens, leading to the development of female external genitalia despite having male (XY) chromosomes. The absence of a uterus occurs because the Müllerian ducts regress due to the presence of anti-Müllerian hormone (AMH) produced by the testes, which are typically undescended or located in the abdomen or inguinal region. The ovaries mentioned in the question could be a misinterpretation on ultrasound or might refer to streak gonads rather than functional ovaries.

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29
Q

A 31-year-old G0 woman complains of amenorrhea for the last 6 cycles. During her last delivery, she experienced significant bleeding and was transfused four bags of blood. What is the most likely diagnosis?
A. Sheehan’s Syndrome
B. Asherman’s Syndrome
C. Premature Ovarian Failure
D. Hypothyroidism

A

A. Sheehan’s Syndrome

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30
Q

Case: A 34-year-old nulligravid woman with missed menses for 6 months presents with constipation, lethargy, cold intolerance, and weight gain. What is the most likely diagnosis?
A. Hypothyroidism
B. Hyperprolactinemia
C. Polycystic Ovary Syndrome (PCOS)
D. Cushing’s Syndrome

A

A. Hypothyroidism

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31
Q

A patient has been placed on levonorgestrel intrauterine contraception. If she presents with abnormal uterine bleeding (AUB) after 6 months, what is the most likely cause?
A. Iatrogenic
B. Endometrial Pathology
C. Not Specified
D. Infection

A

A. Iatrogenic

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32
Q

A 34-year-old woman diagnosed with PCOS at the age of 22 complains of intermenstrual bleeding. She has not followed advised lifestyle changes and weight control. What is she at risk for?
A. Diabetes Mellitus
B. Endometrial Hyperplasia
C. Cardiovascular Disease
D. All of the Above

A

D. All of the Above

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33
Q

A woman presents with milky discharge from both breasts. What is the most likely diagnosis?
A. Prolactinoma
B. Mammary Duct Ectasia
C. Breast Cancer
D. Galactorrhea due to Medication

A

A. Prolactinoma

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34
Q

Case:

A 28-year-old woman presents to your clinic with concerns about her menstrual cycle and persistent acne. She reports that her menstrual cycles have become increasingly irregular over the past two years, with some cycles lasting up to 50 days. She mentions that she and her partner have been trying to conceive for the past year without success.

On physical examination, you note the presence of moderate hirsutism on her upper lip and chin. Her BMI is 22 kg/m², and she has a normal waist-to-hip ratio. An ultrasound of her ovaries shows the presence of more than 12 small follicles measuring less than 10 mm in each ovary. Laboratory tests reveal elevated levels of serum testosterone.

The patient is concerned about her difficulty conceiving and wants to know her diagnosis and treatment options.

Question:

Based on the Rotterdam Criteria (2003), what is the most likely diagnosis for this patient?

A. Hypothyroidism
B. Polycystic Ovary Syndrome (PCOS)
C. Cushing’s Syndrome
D. Androgen-secreting tumor

A

B. Polycystic Ovary Syndrome (PCOS)

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35
Q

Polycystic Ovary Syndrome (PCOS)

Follow-up Question:

What are the primary diagnostic criteria used to confirm this diagnosis?

A. Presence of more than 12 ovarian follicles and a history of obesity
B. Irregular menstrual cycles, polycystic ovaries on ultrasound, and exclusion of other causes of hyperandrogenism
C. Elevated thyroid-stimulating hormone (TSH) levels and weight gain
D. Absence of menstruation for more than 6 months and a history of excessive exercise

A

B. Irregular menstrual cycles, polycystic ovaries on ultrasound, and exclusion of other causes of hyperandrogenism

Discussion:

The Rotterdam Criteria (2003) define Polycystic Ovary Syndrome (PCOS) when at least two of the following three features are present:

Oligo-ovulation or anovulation (irregular or absent periods).
Ultrasound findings of polycystic ovaries (more than 12 follicles in each ovary measuring less than 10 mm).
Hyperandrogenism (clinical signs like hirsutism or biochemical evidence of elevated androgens).

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36
Q

Which of the following patients needs hormonal replacement therapy (HRT)?
A. 40-year-old who underwent bilateral salpingo-oophorectomy
B. 50-year-old with a history of breast cancer
C. 60-year-old with a family history of osteoporosis
D. 55-year-old woman with normal menopause

A

A. 40-year-old who underwent bilateral salpingo-oophorectomy

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37
Q

A 70-year-old G2P2, menopausal since age 55, presents to the clinic with pain. What is the most likely diagnosis?
A. Osteoporosis
B. Osteoarthritis
C. Rheumatoid Arthritis
D. Fibromyalgia

A

A. Osteoporosis

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38
Q

What is the gold standard for diagnosing bone mineral density?
A. Central DEXA scan
B. Peripheral DEXA scan
C. X-ray
D. Bone scintigraphy

A

A. Central DEXA scan

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39
Q

What is the recommended treatment for the patient in question #80 (diagnosed with osteoporosis)?
A. Bisphosphonates
B. Calcium supplements
C. Vitamin D
D. Hormonal replacement therapy

A

A. Bisphosphonates

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40
Q

Loss of trabecular bone in the spine is greater with estrogen deficiency than the loss of cortical bone.
A. True
B. False

A

A. True

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41
Q

When Anti-Müllerian Hormone (AMH) becomes undetectable, menopause will most likely occur within:
A. 1-2 years
B. 4-5 years
C. 6-7 years
D. 8-10 years

A

A. 1-2 years

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42
Q

A 30-year-old nulligravid woman presents with a chief complaint of amenorrhea for 1 year, hot flushes, irritability, mood swings, vaginal dryness, and itching. Her FSH level is 45 mIU/mL. What is the most likely diagnosis?
A. Premature Ovarian Insufficiency
B. Hypothyroidism
C. Polycystic Ovary Syndrome (PCOS)
D. Hyperprolactinemia

A

A. Premature Ovarian Insufficiency

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43
Q

What is the recommended treatment for the patient in question #85? (Premature Ovarian Insufficiency)
A. Hormonal replacement therapy
B. Bisphosphonates
C. Antidepressants
D. Oral contraceptives

A

A. Hormonal replacement therapy

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44
Q

What is the recommended workup for the patient in question #85? (Premature Ovarian Insufficiency)
A. Thyroid, adrenal, and other autoimmune disorder screenings
B. Pelvic ultrasound
C. MRI of the brain
D. Genetic testing

A

A. Thyroid, adrenal, and other autoimmune disorder screenings

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45
Q

Maximal GnRH pulse frequency occurs during which phase of the menstrual cycle?
A. Follicular phase
B. Luteal phase
C. Medullary phase

A

A. Follicular phase

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46
Q

Which follicle is gonadotropin-dependent?
A. Primordial follicle
B. Primary follicle
C. Pre-antral follicle
D. Secondary/Antral follicle

A

D. Secondary/Antral follicle

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47
Q

The ovaries secrete which of the following hormones?
A. Estrogen
B. Progesterone
C. Androstenedione
D. All of the above

A

D. All of the above

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48
Q

Which of the following is TRUE regarding the process of a dominant follicle in the menstrual cycle?
A. Promotes cell multiplication
B. Has a well-vascularized theca cell layer
C. Increases estradiol secretion
D. All of the above

A

D. All of the above

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49
Q

Which hormone acts entirely on granulosa cells?
A. FSH
B. LH
C. Progesterone
D. Estrogen

A

A. FSH

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50
Q

Which of the following is a potent physiological inhibitor of GnRH and gonadotropin secretion?
A. Estradiol-17β
B. Progesterone
C. LH
D. FSH

A

B. Progesterone

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51
Q

A 22-year-old medical student is experiencing mild hypogastric pain radiating to the left lower quadrant. She is at midcycle. She understands the following statements are TRUE regarding ovulation, EXCEPT:
A. Signifies follicular rupture
B. Occurs 32 hours after the initial rise of LH surge
C. Occurs 32 hours after the estradiol peak
D. Occurs 12-16 hours after the LH surge peak

A

C. Occurs 32 hours after the estradiol peak

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52
Q

An infertile couple comes to your clinic due to infertility. Which of the following tests can be checked for ovarian reserve?
A. FSH
B. AMH
C. Inhibin
D. All of the above

A

D. All of the above

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53
Q

Which of the following tests can denote ovarian aging?
A. FSH
B. AMH
C. Inhibin
D. Antral follicle count

A

A. FSH

Higher FSH levels measured on day 2 to 3 of the cycle can denote ovarian aging. This occurs due to decreased activity of the estradiol negative feedback loop, leading to fewer recruitable follicles.

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54
Q

What is the typical endometrial thickness immediately after menstruation?
A. 1-2 mm
B. 3-4 mm
C. 5-6 mm
D. 7-8 mm

A

A. 1-2 mm

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55
Q

A 36-year-old nulligravid woman is currently undergoing ovulation induction due to primary infertility for 3 years. She visits her OB-GYN for follicle monitoring on Day 14 of her cycle. The dominant follicle measures 2 cm, and the endometrial thickness is 0.8 cm with a trilaminar appearance. What should be recommended regarding sexual intercourse?
A. The patient is in her peri-ovulatory phase, and this is the best time to have sexual intercourse.
B. The patient is in the luteal phase, and intercourse should be avoided.
C. The patient is not yet ready for ovulation, and intercourse should be delayed.
D. The endometrial thickness is insufficient, and further treatment is needed.

A

A. The patient is in her peri-ovulatory phase, and this is the best time to have sexual intercourse.

56
Q

Which of the following statements is true regarding menstruation?
A. The corpus luteum is sustained.
B. The decidua basalis undergoes necrosis.
C. Matrix metalloproteinases are released.
D. The rise of ovarian steroid levels is continuous.

A

C. Matrix metalloproteinases are released.

57
Q

What is expected to happen after the oocyte is extruded from the mature dominant follicle?
A. Follicle walls become convoluted.
B. Follicle undergoes atresia.
C. Follicle is immediately reabsorbed.
D. Follicle transforms into a cyst.

A

A. Follicle walls become convoluted.

58
Q

What maintains the corpus luteum after fertilization?
A. Beta-hCG
B. Progesterone
C. Estrogen
D. LH

A

A. Beta-hCG

59
Q

Which of the following is true except?
A. Amplitude and frequency of GnRH secretion varies throughout the menstrual cycle.
B. GnRH secretion is regulated by ovarian steroids.
C. If GnRH is given continuously, it will inhibit the gonadotropin surge.
D. GnRH binds to specific receptors in the posterior pituitary gland to release gonadotropins.

A

D. GnRH binds to specific receptors in the posterior pituitary gland to release gonadotropins.

60
Q

This nonsteroidal hormone secreted by the ovary inhibits FSH synthesis and secretion:
A. Follistatin
B. Inhibin
C. Activin
D. Relaxin

A

A. Follistatin

61
Q

The presence of subnuclear vacuoles at the base of the cells lining the glands in the endometrium is an effect of:
A. Estrogen
B. Progesterone
C. FSH
D. LH

A

B. Progesterone

62
Q

These are the effects of estrogen on the female reproductive system except:
A. Increases fundal to cervical ratio
B. Cornification of mucosa in the vagina
C. Growth of the ductal system in the breast
D. Decreases tubal motility

A

D. Decreases tubal motility

63
Q

Which of the following causes vasodilation of the stratum basale?
A. Prostaglandin
B. Thromboxane
C. PGE2
D. PGF2

A

C. PGE2

64
Q

Which of the following events happens during menstruation, except?
A. Recruitment of follicles
B. Shortening of glands in the stratum basalis
C. Thickening of the stratum functionalis due to estrogen release
D. Decrease in inhibin level

A

C. Thickening of the stratum functionalis due to estrogen release

65
Q

During the luteal phase, the corpus luteum produces:
A. Estrogen
B. Progesterone
C. Both A and B
D. LH

A

C. Both A and B

66
Q

What is the first chronological sign of menopause?
A. Irregular menstruation
B. Hot flashes
C. Decrease in inhibin levels
D. Increase in FSH levels

A

C. Decrease in inhibin levels

67
Q

Mika is an 18-year-old student who complains of lower abdominal pain. She has regular menses and is currently on day 14. What is the most likely cause of her pain?
A. Endometriosis
B. Ovulation pain (Mittelschmerz)
C. Appendicitis
D. Urinary Tract Infection (UTI)

A

B. Ovulation pain (Mittelschmerz)

68
Q

What enzyme converts androstenedione to estrone?
A. Aromatase
B. 17β-Hydroxysteroid dehydrogenase
C. 5α-Reductase
D. 3β-Hydroxysteroid dehydrogenase

A

A. Aromatase

69
Q

Which of the following statements supports the presence of the hypothalamo-pituitary-ovarian (HPO) axis in utero and early childhood?
A. GnRH is present in the hypothalamus as early as 10 weeks AOG
B. FSH and LH are detected in the pituitary
C. Maternal steroid hormones exert inhibitory feedback on the fetal hypothalamus and pituitary
D. All of the above

A

D. All of the above

70
Q

A 12-year-old female comes in for consultation because her mother is anxious that her child’s menses are occurring every 3 months. What is the most likely explanation?
A. Immature HPO axis
B. Polycystic Ovary Syndrome (PCOS)
C. Hypothyroidism
D. Normal variation

A

A. Immature HPO axis

71
Q

A 13-year-old with irregular menses is at Tanner Stage 2 (breast budding), with a flat, soft, tender abdomen, and sparse pubic hair. What should be provided to the patient and family?
A. Hormonal therapy
B. Surgical intervention
C. Reassurance that the findings are normal
D. Immediate endocrinology referral

A

C. Reassurance that the findings are normal

72
Q

A 13-year-old girl is undergoing a physical examination with her mother present. You notice the separation of breast contour and the presence of coarse, crinkly hair along the labia majora. What is her Tanner staging?
A. B2PH1
B. B3PH2
C. B3PH3
D. B4PH3

A

B. B3PH2

73
Q

Transection of the pituitary stalk will affect the synthesis of which hormones?
A. FSH and LH
B. Prolactin and Oxytocin
C. ACTH and TSH
D. GH and ADH

A

A. FSH and LH

74
Q

A 9-year-old female gymnast rigorously practicing 3 times a week. What can be expected regarding her menstrual cycle?
A. Early menarche
B. Normal menstrual cycle timing
C. Delayed with each year of training
D. Irregular menstrual cycle

A

C. Delayed with each year of training

75
Q

Twin sisters separated at birth, one weighing 55 kg and the other 45 kg. What principle explains the timing of their menarche?
A. Genetic factors
B. Environmental factors
C. BMI
D. Nutritional status

A

C. BMI

76
Q

According to the two-cell gonadotropin theory, how does luteinizing hormone (LH) contribute to estrogen production?
A. Producing androgen
B. Converting androgen to estrogen
C. Stimulating granulosa cells
D. Triggering ovulation

A

A. Producing androgen

77
Q

A 15-year-old girl had her first menses at 12 years old, with regular cycles, but she has experienced heavy flow for the past 5 cycles and has noted bruises on her extremities. What will you request next?
A. Pelvic ultrasound
B. Endometrial biopsy
C. CBC and PTT
D. Hormonal panel

A

C. CBC and PTT

78
Q

A 28-year-old woman with normal menses now experiences a 40-day delay since her last menses. An ultrasound shows a luteinized unruptured follicle. Which hormone is persistently elevated?
A. Estrogen
B. Progesterone
C. LH
D. FSH

A

B. Progesterone

79
Q

A 45-year-old woman with a BMI of 32 has experienced heavy menstrual bleeding for the past 2 years. She is hypertensive and diabetic. What is the most likely pathology?
A. Endometrial cancer
B. Endometrial carcinoma
C. Uterine fibroids
D. Polycystic Ovary Syndrome (PCOS)

A

A. Endometrial cancer/hyperplasia

80
Q

Which of the following statements characterizes the difference between acute and chronic bleeding?
A. Acute bleeding lasts less than 6 months
B. Chronic bleeding is greater than 6 months
C. Acute bleeding has more severe symptoms
D. Chronic bleeding requires immediate surgical intervention

A

B. Chronic bleeding is greater than 6 months

81
Q

In managing acute episodes of abnormal uterine bleeding (AUB), what is the initial goal of treatment?
A. Diagnose the underlying cause
B. Stop the bleeding
C. Prevent recurrence
D. Prepare for surgical intervention

A

B. Stop the bleeding

82
Q

A reproductive-aged woman has missed her menses for more than 90 days and has a negative pregnancy test. What is the most likely diagnosis?
A. Physiologic Amenorrhea
B. Primary Amenorrhea
C. Secondary Amenorrhea
D. Pregnancy

A

C. Secondary Amenorrhea

83
Q

A 24-year-old woman with regular menses is now presenting with vaginal bleeding. What is the first condition to rule out?
A. Infection
B. Pregnancy
C. Endometrial hyperplasia
D. Cervical dysplasia

A

B. Pregnancy

84
Q

What is the most useful and cost-effective modality to evaluate the female reproductive tract and anatomic causes of vaginal bleeding?
A. Hysteroscopy
B. Transvaginal Ultrasound
C. MRI
D. CT scan

A

B. Transvaginal Ultrasound

85
Q

A 25-year-old single woman with regular menses is now complaining of menses occurring every 2-3 months. On physical examination, she has a milky white breast discharge. What is the laboratory workup?
A. Thyroid function tests
B. Serum prolactin
C. FSH and LH levels
D. Pelvic ultrasound

A

B. Serum prolactin

86
Q

In evaluating a woman with irregular menses and unilateral milky breast discharge, which diagnostic imaging modality would you request?
A. Whole abdominal ultrasound
B. MRI of the brain
C. CT scan of the brain
D. Breast ultrasound

A

B. MRI of the brain

87
Q

What is the expected sequence of events in pubertal development?
A. Pubic hair - Breast budding - Menarche - Growth spurt
B. Breast budding - Growth spurt - Pubic hair - Menarche
C. Breast budding - Pubic hair - Growth spurt - Menarche
D. Growth spurt - Menarche - Breast budding - Pubic hair

A

C. Breast budding - Pubic hair - Growth spurt - Menarche

88
Q
  1. A 33-year-old single woman comes in for a consult. Her menses occurs every 25-29 days, but she notices a change in the number of pads from 3-4 per day to 6 regular pads plus 2 overnight pads fully soaked in the last 8 months. Today is the first day of her menses, and she has soaked 2 diapers already. She has pale conjunctiva, blood pressure of 80/60, and a heart rate of 100 bpm. What is your initial impression?

A. Intermenstrual bleeding
B. Acute AUB
C. Chronic AUB
D. Dysfunctional uterine bleeding

A

C. Chronic AUB
Explanation: Chronic AUB is diagnosed because the patient has been experiencing excessive bleeding for the last 8 months. Acute AUB refers to abnormal bleeding occurring for less than 6 months. The term “Dysfunctional Uterine Bleeding” is no longer used in modern gynecology.

89
Q
  1. Referencing the FIGO Classification of Abnormal Uterine Bleeding, which of the following has replaced the diagnosis of Dysfunctional Uterine Bleeding (DUB)?

A. Abnormal uterine bleeding - Coagulopathy
B. Abnormal uterine bleeding - Ovulatory
C. Abnormal uterine bleeding - Endometrial
D. Abnormal uterine bleeding - Iatrogenic

A

C. Abnormal uterine bleeding - Endometrial
Explanation: Women who present with heavy menstrual bleeding without other abnormalities are often classified under AUB-Endometrial (AUB-E). This category was previously referred to as “ovulatory dysfunctional uterine bleeding.”

90
Q

A 27-year-old nulligravid woman complains of increasing use of pantyliners before and after her regular menses. She has vaginal spotting, and a pelvic ultrasound reveals a single hyperechoic mass in the endometrial cavity. Physical and internal examinations are normal. What is the diagnosis?
A. AUB - Ovulatory
B. AUB - Coagulopathy
C. AUB - Endometrial
D. AUB - Polyp

A

D. AUB - Polyp

91
Q

An adolescent with a projection of areola and papilla, secondary mound formation, and pubic hair extending to the inner thigh is in which Tanner stage?
A. B2PH3
B. B3PH4
C. B4PH5
D. B5PH4

A

C. B4PH5

92
Q

You are examining a 13-year-old girl who has not yet had her menses but complains of monthly hypogastric pain. She is Tanner Stage B3PH3. On examination of the vaginal area, there is a bulging violaceous mass at her introitus. What is the most likely diagnosis?
A. Transverse vaginal septum
B. Imperforate hymen
C. Vaginal agenesis
D. Müllerian agenesis

A

B. Imperforate hymen

93
Q

A mother comes to your clinic with her 10-year-old daughter. She notes that her daughter’s breast development began at 9 years old and is very worried because her daughter has not had her menses yet. What should you tell the mother?
A. Immediate hormonal evaluation is necessary.
B. Reassure the mother that menses will likely occur within 2-2.5 years after the start of breast development.
C. The child may have a developmental delay and needs further investigation.
D. The child needs an ultrasound to evaluate her ovaries.

A

B. Reassure the mother that menses will likely occur within 2-2.5 years after the start of breast development.

94
Q

What would be the next expected change to occur after breast development in puberty?
A. Growth spurt
B. Pubic hair development
C. Menarche
D. Areolar pigmentation

A

B. Pubic hair development

95
Q

A 17-year-old female patient who has never had menses comes for evaluation. On examination, her breasts and pubic hair are Tanner stage 1, and she has normal external genitalia. She is 55 inches tall with a webbed neck, widely spaced nipples, and cubitus valgus. What is your initial working diagnosis?
A. Mayer-Rokitansky-Küster-Hauser Syndrome
B. Androgen Insensitivity Syndrome
C. Testicular Feminization
D. Turner Syndrome

A

D. Turner Syndrome

96
Q

A 21-year-old female had irregular menses starting at 16 years old. For the past 2 years, her cycles have been irregular, and she has been amenorrheic for the past 6 months. What is the most likely diagnosis?
A. Primary Amenorrhea
B. Secondary Amenorrhea
C. Polycystic Ovary Syndrome (PCOS)
D. Hypothyroidism

A

B. Secondary Amenorrhea

97
Q

A 17-year-old girl complains of monthly hypogastric pain but does not notice blood staining on her underwear. On transrectal examination, you note a shallow vaginal canal with a thick band at the lower third that does not even bulge. What is the most likely diagnosis?
A. Imperforate hymen
B. Transverse vaginal septum
C. Vaginal agenesis
D. Müllerian agenesis

A

B. Transverse vaginal septum

98
Q

A 22-year-old woman presents with amenorrhea. She is 5’5” in height, has well-developed breasts, and a thinner extragenital area. Ultrasound reveals no uterus and a short vaginal canal. What is the most likely diagnosis?
A. Androgen Insensitivity Syndrome
B. Turner Syndrome
C. Müllerian agenesis
D. Testicular Feminization Syndrome

A

D. Testicular Feminization Syndrome

99
Q
  1. To confirm a defect in the androgen receptor gene located on the X chromosome, and abnormalities in the binding domains of the receptor, what test should be performed?
    A. Hormonal assay
    B. Pelvic ultrasound
    C. Karyotyping
    D. MRI of the brain
A

C. Karyotyping
Explanation: Karyotyping is used to determine the presence of chromosomal abnormalities, such as defects in the androgen receptor gene located on the X chromosome.

100
Q
  1. An 18-year-old patient with normal Tanner staging is amenorrheic. On ultrasound, there is an absent uterus but normal ovaries. What is the likely karyotype of the patient?
    A. 46XX
    B. 46XY
    C. 45X
    D. Mosaicism
A

A. 46XX
Explanation: The presence of normal ovaries and absent uterus with normal karyotyping (46XX) is typical in cases of Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome).

101
Q
  1. A 31-year-old woman has been hypomenorrheic or oligomenorrheic for the past 6 cycles. She has undergone D&C and myomectomy in the past. What is the most likely diagnosis?
    A. Polycystic Ovary Syndrome (PCOS)
    B. Asherman’s Syndrome
    C. Endometrial Hyperplasia
    D. Uterine Fibroids
A

B. Asherman’s Syndrome
Explanation: Asherman’s syndrome is often a result of scar tissue formation after D&C procedures, leading to hypomenorrhea or oligomenorrhea.

102
Q
  1. A G2P0-0-2-0 patient underwent dilatation and curettage for her previous two abortions and has been oligomenorrheic for the past 9 months. On ultrasound, the endometrial stripe is thin, and ovaries are normal. What is the next best step?
    A. Hormonal therapy
    B. Diagnostic hysteroscopy
    C. MRI of the pelvis
    D. Endometrial biopsy
A

B. Diagnostic hysteroscopy
Explanation: Diagnostic hysteroscopy is recommended to evaluate the endometrial cavity and check for any intrauterine adhesions or abnormalities.

103
Q
  1. A patient with Müllerian agenesis would have the following characteristics except:
    A. XY karyotype
    B. Absent uterus
    C. Normal ovaries
    D. Primary amenorrhea
A

A. XY karyotype
Explanation: Müllerian agenesis typically presents with a 46XX karyotype, absent uterus, and normal ovaries, along with primary amenorrhea.

104
Q
  1. A 19-year-old patient is amenorrheic, has a 46XX karyotype, is Tanner stage 3, and has a short vagina with no palpable midline structures. What is the most likely diagnosis?
    A. Androgen Insensitivity Syndrome
    B. Turner Syndrome
    C. Mayer-Rokitansky-Küster-Hauser Syndrome
    D. Testicular Feminization
A

C. Mayer-Rokitansky-Küster-Hauser Syndrome
Explanation: Mayer-Rokitansky-Küster-Hauser syndrome is characterized by the absence of the uterus and upper two-thirds of the vagina in individuals with normal secondary sexual characteristics and a 46XX karyotype.

105
Q
  1. A patient with Turner Syndrome typically shows which of the following characteristics?
    A. Normal breast and uterus development
    B. Infantile breast and uterus
    C. Regular menstrual cycles
    D. Increased stature and long limbs
A

B. Infantile breast and uterus
Explanation: Turner Syndrome, characterized by a 45X karyotype, often presents with delayed or absent puberty, leading to underdeveloped breasts and a small uterus.

106
Q
  1. A 36-year-old woman complains of amenorrhea for the past 6 months. She received chemotherapy for ovarian malignancy 6 months ago. What is your diagnosis?
    A. Secondary Amenorrhea
    B. Ovarian Hyperstimulation Syndrome
    C. Premature Ovarian Insufficiency
    D. Menopause
A

C. Premature Ovarian Insufficiency
Explanation: Chemotherapy can cause premature ovarian insufficiency, leading to amenorrhea and other menopausal symptoms.

107
Q
  1. A 37-year-old woman has been on oral contraceptives for the past nine months. She stopped taking the pills and now complains of amenorrhea. What is the most likely diagnosis?
    A. Secondary Amenorrhea
    B. Post-pill Amenorrhea
    C. Primary Amenorrhea
    D. Polycystic Ovary Syndrome (PCOS)
A

B. Post-pill Amenorrhea
Explanation: Post-pill amenorrhea is a condition where normal menstruation does not resume immediately after stopping oral contraceptives.

108
Q
  1. A 35-year-old mother of 3 suffered from postpartum hemorrhage and cannot breastfeed. She is now amenorrheic for the past 5 months after delivering 5 months ago. What is your diagnosis?
    A. Asherman’s Syndrome
    B. Sheehan’s Syndrome
    C. Premature Ovarian Failure
    D. Polycystic Ovary Syndrome (PCOS)
A

B. Sheehan’s Syndrome
Explanation: Sheehan’s Syndrome occurs due to postpartum hemorrhage leading to pituitary gland damage, resulting in an inability to breastfeed and subsequent amenorrhea.

109
Q
  1. A 29-year-old woman with no desire to get pregnant has been on contraceptives for the past 3 years but stopped 2 months ago. Her pregnancy test is negative, and TVS is normal. What is the next advice to give?
    A. Start on hormone therapy
    B. Perform an endometrial biopsy
    C. Reassure the patient and ask her to return after 4 months
    D. Prescribe ovulation induction medication
A

C. Reassure the patient and ask her to return after 4 months
Explanation: It is common for menstrual cycles to take time to normalize after stopping contraceptives. Reassurance and follow-up are appropriate.

110
Q
  1. In cases of pure gonadal dysgenesis, patients are phenotypically female. Which of these conditions would require immediate excision of gonads?
    A. XX pure gonadal dysgenesis
    B. XY pure gonadal dysgenesis
    C. Mosaicism
    D. Turner’s syndrome
A

B. XY pure gonadal dysgenesis
Explanation: Patients with XY gonadal dysgenesis are at risk of developing gonadal tumors and therefore require immediate excision of gonads.

111
Q
  1. A 34-year-old nulligravid woman with no previous history of uterine surgery or oral contraceptive use presents with missed menses/amenorrhea for the past 6 months. She has cold intolerance, lethargy, constipation, and noticeable weight gain. What is your diagnosis?
    A. Prolactinoma
    B. Hyperprolactinemia
    C. Hypothyroidism
    D. Hypoparathyroidism
A

C. Hypothyroidism
Explanation: The symptoms described are characteristic of hypothyroidism, which can also cause amenorrhea.

112
Q
  1. A 25-year-old patient consults for amenorrhea of 9 months. The pregnancy test is negative, and on physical examination, you elicit the presence of milky discharge from both breasts. What is your diagnosis?
    A. Prolactinoma
    B. Hyperprolactinemia
    C. Hypothyroidism
    D. Hypoparathyroidism
A

B. Hyperprolactinemia
Explanation: The patient’s symptoms suggest hyperprolactinemia, which is often associated with amenorrhea and galactorrhea. This is commonly caused by a prolactinoma.

113
Q
  1. According to the Rotterdam criteria for PCOS, which of the following characterizes the condition?
    A. Less than 1 cm cyst on both or unilateral ovary
    B. Biochemical findings and ultrasound findings of at least 19-20 peripherally located cysts
    C. Elevated LH and FSH ratio
    D. Regular menstrual cycles
A

B. Biochemical findings and ultrasound findings of at least 19-20 peripherally located cysts
Explanation: The Rotterdam criteria for PCOS includes the presence of multiple small cysts on the ovaries, oligo/anovulation, and signs of hyperandrogenism.

114
Q
  1. A 35-year-old woman has been using a levonorgestrel intrauterine system for contraception but now presents with abnormal uterine bleeding (AUB) for the past 6 months. What is your diagnosis?
    A. AUB-E
    B. AUB-O
    C. AUB-I
    D. AUB-C
A

C. AUB-I
Explanation: AUB-I stands for iatrogenic, meaning the abnormal bleeding is likely related to the levonorgestrel intrauterine system.

115
Q
  1. A 34-year-old single woman previously diagnosed with PCOS at the age of 22 has been experiencing intermenstrual bleeding and has not followed recommendations for lifestyle changes and weight management. You advise her that she has an increased risk of:
    A. Endometrial cancer
    B. Breast cancer
    C. Ovarian cancer
    D. Diabetes mellitus
A

D. Diabetes mellitus
Explanation: Women with PCOS who do not manage their lifestyle and weight are at increased risk for insulin resistance and eventually diabetes mellitus.

116
Q
  1. A 27-year-old presents with amenorrhea for the past 8 months. Her prolactin levels are 200 ng/mL, and she has visual field defects. What is your diagnosis?
    A. Prolactinoma
    B. Hypothyroidism
    C. Cushing’s Syndrome
    D. Hypopituitarism
A

A. Prolactinoma
Explanation: The elevated prolactin levels and visual field defects suggest the presence of a prolactinoma, a type of pituitary tumor.

117
Q
  1. A woman who has been diagnosed with PCOS usually presents with:
    A. Primary amenorrhea
    B. Secondary amenorrhea
    C. A & B
    D. None of the above
A

C. A & B
Explanation: Women with PCOS can present with either primary amenorrhea (if they have never had a menstrual cycle) or secondary amenorrhea (if they previously had regular cycles but then stopped menstruating).

118
Q
  1. When considering between hypothalamic dysfunction and failure, which of the following would be most useful in differentiating these two conditions?
    A. Estradiol levels
    B. FSH levels
    C. LH levels
    D. Prolactin levels
A

A. Estradiol levels
Explanation: Estradiol levels can help differentiate between hypothalamic dysfunction and ovarian failure since estradiol production is affected differently in these conditions.

119
Q
  1. A 38-year-old woman has had amenorrhea for 6 months. She is not on any hormonal medication and has not undergone chemotherapy. She noted dryness of the skin and is experiencing hot flashes. What is your diagnosis?
    A. Premature Ovarian Insufficiency (POI)
    B. Hypothyroidism
    C. Menopause
    D. PCOS
A

A. Premature Ovarian Insufficiency (POI)
Explanation: POI occurs when ovarian function ceases before the age of 40, leading to symptoms similar to menopause.

120
Q
  1. Premature Ovarian Insufficiency/Failure is defined as:
    A. Ovarian failure occurring before the age of 40
    B. Ovarian failure occurring after the age of 40
    C. Ovarian failure associated with PCOS
    D. Ovarian failure secondary to chemotherapy
A

A. Ovarian failure occurring before the age of 40
Explanation: POI is defined by the loss of ovarian function before the age of 40.

121
Q
  1. Osteopenia is defined as:
    A. A T-score between -1 and -2.5
    B. A T-score below -2.5
    C. A T-score above -1
    D. A diagnosis based on ultrasound
A

A. A T-score between -1 and -2.5
Explanation: Osteopenia is characterized by a bone density T-score between -1 and -2.5, indicating lower than normal bone mass but not as severe as osteoporosis.

122
Q
  1. A 69-year-old woman is requesting hormone replacement therapy (HRT). What should be considered in this case?
    A. Contraindicated due to age
    B. Safe if initiated immediately
    C. Safe if used with a patch
    D. Requires only estrogen therapy
A

A. Contraindicated due to age
Explanation: HRT is generally contraindicated in women over the age of 65 due to the increased risk of cardiovascular events, thromboembolism, and cancer.

123
Q
  1. Which of the following patients will most likely experience surgical menopause?
    A. 45-year-old woman who had a tubal ligation
    B. 38-year-old nulligravid woman who underwent a total hysterectomy with bilateral salpingo-oophorectomy
    C. 50-year-old woman who had a hysterectomy without oophorectomy
    D. 42-year-old woman who had a unilateral oophorectomy
A

B. 38-year-old nulligravid woman who underwent a total hysterectomy with bilateral salpingo-oophorectomy
Explanation: Surgical menopause occurs when both ovaries are removed, as they are the primary source of estrogen production.

124
Q
  1. A 45-year-old woman underwent a total hysterectomy with bilateral salpingo-oophorectomy. Immediately post-op, what is the best treatment advisable to this patient?
    A. Give estrogen
    B. Give progesterone
    C. No treatment needed
    D. Start combined hormone replacement therapy (HRT)
A

A. Give estrogen
Explanation: Estrogen replacement is necessary after bilateral oophorectomy to manage symptoms of menopause and prevent bone loss.

125
Q
  1. Brenda wants to conceive but is unable due to poor ovarian reserve. What is the best option for her?
    A. IVF with her own eggs
    B. Oocyte donation
    C. Hormonal therapy
    D. Adoption
A

B. Oocyte donation
Explanation: For women with poor ovarian reserve, oocyte donation is a viable option to conceive.

126
Q
  1. Fatima has vulvovaginal itching but no other symptoms. What is the best treatment?
    A. Systemic hormone replacement therapy
    B. Topical antifungal cream
    C. Local estrogen
    D. Antibiotics
A

C. Local estrogen
Explanation: Local estrogen is effective in treating vulvovaginal atrophy, which can cause itching in postmenopausal women.

127
Q

What is the T-score for osteoporosis?
A. -1.0
B. -2.8
C. 0
D. -1.5

A

B. -2.8
Explanation: A T-score of -2.5 or lower indicates osteoporosis.

128
Q
  1. Which test can help confirm the beginning of menopause?
    A. Estrogen
    B. LH
    C. FSH
    D. Progesterone
A

C. FSH
Explanation: An elevated FSH level is indicative of the onset of menopause as the ovaries produce less estrogen, leading to less feedback inhibition on the pituitary gland.

129
Q
  1. A 76-year-old G2P2 (2002) was referred to you by an orthopedic surgeon due to osteoporosis and recurrent hip fractures. Which of the following treatments would be most appropriate for this patient?
    A. Estrogen
    B. Bisphosphonates
    C. Calcium supplements
    D. Vitamin D supplements
A

B. Bisphosphonates
Explanation: Bisphosphonates are the first-line treatment for osteoporosis, especially in elderly patients with fractures.

130
Q
  1. Why do patients with testicular feminization (androgen insensitivity syndrome) develop breasts?
    A. Excess androgen action
    B. Absence of androgen action allows even low levels of estrogen to cause unabated breast stimulation
    C. High levels of estrogen
    D. Lack of progesterone
A

B. Absence of androgen action allows even low levels of estrogen to cause unabated breast stimulation
Explanation: In androgen insensitivity syndrome, the absence of androgen action permits even small amounts of estrogen to promote breast development.

131
Q
  1. Why is the length of the luteal phase approximately 14 days?
    A. It is determined by the length of the menstrual cycle
    B. It depends on the level of estrogen
    C. Life span of the corpus luteum is limited to a period of about 14 days
    D. It varies from woman to woman
A

C. Life span of the corpus luteum is limited to a period of about 14 days
Explanation: The luteal phase is fixed at about 14 days due to the lifespan of the corpus luteum, which produces progesterone during this time.

132
Q
  1. In a septate uterus, the septum has poor blood supply and contains fibrous and/or myometrial tissues.
    A. TRUE
    B. FALSE
A

A. TRUE
Explanation: A septate uterus has a septum with poor blood supply, often composed of fibrous and/or myometrial tissues, which can impact fertility.

133
Q
  1. A 2-year-old asymptomatic child was brought to the clinic due to fusion of the labia minora. What is the best management?
    A. Surgical separation
    B. Topical estrogen cream
    C. Oral antibiotics
    D. Observation and reassurance
A

B. Topical estrogen cream
Explanation: Topical estrogen cream is often used to treat labial fusion in young girls.

134
Q
  1. What is the effect of estrogen on bone formation?
    A. Inhibits osteoclast activity
    B. Stimulates osteoblast activity
    C. Reduces calcium absorption
    D. Increases bone resorption
A

B. Stimulates osteoblast activity
Explanation: Estrogen promotes bone formation by stimulating osteoblast activity and inhibiting bone resorption.

135
Q
  1. Screening for colorectal cancer starts at what age?
    A. 40
    B. 45
    C. 60
    D. 70
A

B. 45
Explanation: Regular screening for colorectal cancer is recommended to begin at age 45, according to the U.S. Preventive Services Task Force, to prevent and detect colorectal cancer early.

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