LE2 Flashcards
- Which of these ultrasound images will
show a normal ovary?
a. A
b. B
c. C
a. A
(A) Normal; (B) Polycystic Ovary- normal size but w/
several follicles that failed to mature; (C) Hemorrhagic
Corpus Luteum
Identify the structure:
A. Phallus
B. Clitoromegaly
C. Ambiguous genitalia
D. Normal vulva
C. Ambiguous genitalia
- Which of these hysteroscopic image shows normal endometrial cavity?
A represents a myoma.
B represents a uterine septum.
C represents a normal endometrial cavity.
C represents a normal endometrial cavity.
24 Which of these images exhibit a
positive Schiller test?
a. B
b. A
a. B
A positive Schiller test shows pale yellow areas where abnormal cells fail to take up iodine, indicating potential dysplasia or abnormal cell growth.
Image B shows the pale yellow area, which is indicative of a positive Schiller test.
Image A shows normal staining, which would indicate a negative Schiller test.
- Identify a normal cervix after (Visual Inspection with Acetic Acid) procedure.
A. shows a smooth, uniform surface without any acetowhite lesions
B. shows irregular staining or acetowhite areas
A. shows a smooth, uniform surface without any acetowhite lesions
- TM, a 38 yo G0, married for 12 years,
was diagnosed to have primary infertility.
Which of the two HSG images will explain
her infertility?
A
B
Image A explains TM’s infertility, as the lack of spillage into the peritoneal cavity suggests a tubal blockage.
A shows that although contrast medium has passed through the fallopian tubes and the uterine cavity, it has not spilled into the peritoneal cavity, indicating possible tubal blockage or abnormality. This can lead to infertility since it prevents the egg from traveling to the uterus for fertilization.
B shows the contrast medium filling the fallopian tubes and spilling into the peritoneal cavity, indicating that the tubes are patent and not blocked.
41 Identify the anomaly
Imperforate hymen
- BM, 24 yo G2P2 (2002) consulted at
the OPD for gyne check up. Her last
menstrual period was Sept 27, 2022.
Which of this ultrasound scan will best
describe her endometrial lining?
A. A
B. B
C. C
D. D
Image D shows a thick, echogenic endometrial lining consistent with the secretory phase.
Thus, the best ultrasound scan describing her endometrial lining is 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.
Identify the uterus:
A. Bicornuate uterus
B. Uterine didelphis
C. Septated uterus
D. Normal uterus
A. Bicornuate uterus
Identify the uterus:
A. Bicornuate uterus
B. Uterine didelphis
C. Septated uterus
D. Normal uterus
D. Normal uterus
Identify the uterus:
A. Bicornuate uterus
B. Uterine didelphis
C. Septated uterus
D. Normal uterus
C. Septated uterus
- dentify the type of hymen
A. Virginal hymen
B. Cribriform hymen
C. Septate hymen
D. Parous hymen
B. Cribriform hymen
A. Vaginal agenesis
B. Transverse vaginal septum
C. Imperforate hymen
D. Longitudinal vagibal septum
B. Transverse vaginal septum
A. Bicornuate uterus
B. Septate uterus
C. Unicornuate uterus
D. Uterus didelphis
D. Uterus didelphis
- 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
Explanation: Colposcopy during pregnancy can be challenging due to several factors: decidual changes in the epithelium that can be confused with cervical intraepithelial neoplasia (CIN), increased blood supply to the cervix, and obstruction of the view due to the vaginal walls. All these factors make it harder to perform and interpret colposcopy accurately during pregnancy.
- A 7 year old child was brought to the
clinic due to vaginal pruritus, dysuria and
constipation. Upon inspection of the
genitalia, a whitish lesion appears in an
hourglass or figure-8 formation around
the area of the labia majora and anus .
How will you confirm your diagnosis?
Scotch tape test
Vaginal culture
Vaginoscopy
Punch biopsy
Punch biopsy
Explanation: A small punch biopsy can confirm the diagnosis of lichen sclerosus, which is often suspected in cases of pruritus and whitish lesions in this characteristic pattern.
- 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
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.
- 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
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.
- 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
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.
- All of the following are common
indications for rectal exam in a female
child EXCEPT.
Genital tract bleeding
Sexual abuse
Pelvic pain/ mass
Foreign body
Sexual abuse
- 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. 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.
- 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. 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.
- 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
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.
12 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
C. clearer pelvic images
Explanation: Transvaginal ultrasound provides clearer images of pelvic structures because the probe is closer to the organs being evaluated, leading to better resolution.
13 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
B. Toilet paper
Explanation: Toilet paper is the most commonly found foreign body in young girls, often due to accidental insertion.
- A 16-year-old female is evaluated for
lack of pubertal development. She is
diagnosed with gonadal dysgenesis.
Which of the following laboratory findings
are likely to be elevated?
a. Follicle stimulating hormone
b. Estrogen
c. Progesterone
d. Prolactin
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.
- A 62 yo complains of vaginal
bleeding. During a speculum exam, you
see a 2 x 1 cm ulcerated mass on the
cervix. The next best step is to do
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.
- Which of the following congenital
reproductive tract anomalies represent
failure of resorption?
a. uterine septum
b. Mayer Rokitansky Kuster 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.
- 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.
- The fused caudal ends of the two
mullerian 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.
20 A 25 yo patient comes to you with a
history of 3 years infertility. She has
regular ovulatory cycles. Which test will
determine the patency of the fallopian
tubes?
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.
21 Absolute contraindication of
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.
- the position that allows the vagina to
be filled 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.
- 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.
- Sonography with
hysterosalpingography has a low
predictive level of accuracy in
distinguishing between a 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.
- In Mayer-Rokitansky Kustner Hauser
syndrome
A. The ovaries are streak
B. Is usually combined with agenesis of the
uterus, cervix and upper vagina
C. Karyotype 46XY
D. Due to arrest of development of both wollfian
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.
27.An infant was brought to the clinic due
to vaginal bleeding. What is the best
position to evaluate the external
genitalia?
Frog leg position
Sitting on mother’s lap
Lithotomy position
Knee-chest positio
A. Frog leg position
Explanation: The frog leg position provides good access and visualization for examining an infant’s external genitalia.
- 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 1day before the
procedure
D. Used to evaluate 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.
- This procedure offers a 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.
30.During the early fetal development,
the ____has the capacity to develop into
the male reproductive system and the
____develop into the female reproductive
system
Wolffian duct, corpus luteum
Parotid duct, mullerian duct
Wolffian duct, mullerian duct
Mullerian duct, wolffian duct
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.
- What is the most frequent problem in
performing endometrial sampling ?
perforation
cervical spasm
infection
hemorrhage
B. Cervical spasm
Explanation: The most common issue during endometrial sampling is cervical spasm, which can prevent the instrument from entering the uterus.
- 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. Imperforated 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.
- In cases of recurrent abortions, most
common uterine malformation seen is?
A. Mullerian fusion defects
B. Uterine synctium
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).
- A 19 year old patient came to the Out
patient department with complaints of
primary amenorrhea. She had well
developed breast and pubic hair.
However, there was absence of the
vagina and uterus. Likely diagnosis is:
A. XYY
B. Mullerian 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.
- A 7 year old with vulvar trauma had
her complete immunization more than 5
years ago. What booster injection should
be given to the patient?
A. Hepatitis B booster
B. 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.
- Ovarian malignancy is least likely with the following ultrasound finding :
A. solid nodules / structures
B. ascites
C.t umor size more than 10 cms
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.
- Which of the following is not relevant
in the assessment of Mullerian 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.
- 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
C. Pinworms
D. Nonspecific
C. Pinworms
Explanation: Pinworms (Enterobius vermicularis) are a common cause of nocturnal vulvar and perianal itching in children.
42 12 year Shella has been experiencing
lower abdominal discomfort. A medical
examination revealed that menstrual fluid
has been collecting in her vagina and not
being expelled as it should. This would
most liekly explained as:
A. Vagintis
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.
- Collecting device that can be utilized
when doing papsmear
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.
- Unsatisfactory papsmear result may
be due to the ff 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.
- A 4-year old was brought to the clinic
due vaginal pruritus with vaginal
discharge and erythema. What is the
most common cause of vulvovaginitis?
Non specific vulvovaginitis
Bacterial vulvovaginitis
Mycotic vulvovaginitis
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.
- 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.
- Hysteroscopy is contraindicated in
the following:
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.
- In VIA, which of these solutions can
be used as agent?
KOH
iodine
CH3COOH
KI
C. CH3COOH (Acetic acid)
Explanation: Acetic acid (CH3COOH) is used in Visual Inspection with Acetic Acid (VIA) to detect cervical lesions.
52.The general approach to a 3-year-old
child includes all of the following
EXCEPT.
(1 Point)
A. Gain child’s confidence and establish
authority.
B. Demonstrate gentleness and patience.
C. Allows child participation during examination.
D. Instruments and speculums should be 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.
- The Bethesda System in reporting
papsmear result includes the ff except?
A. adequacy of the sample
B. none of the above
C. presence of infection
D. hormonal status
E. cellular element 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.
- The congenital transverse vaginal
septum is located most commonlat 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.
- Uterine anomalies have been
associated with patients exposed to
diethylstilbestrol in utero
True
False
True
Explanation: Diethylstilbestrol (DES) exposure in utero has been linked to various uterine anomalies, including partial transverse vaginal septa.
56 On ultrasound, the fundal contour of
the uterus will have a normal outline with
didelphic and bicornuate uterus
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.
- Females with congenital adrenal
hyperplasia
a. Show precocious early sexual development
b. Often have webbed hands and feet
c. Show feminisation 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.
- 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.
- Upper one third of vagina is derived
from:
A. Sinovaginal bulb
B. Mullerian duct (2/3)
C. Wollfian duct
D. Gential 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.
- True of the transformation zone
A. It is the area that lies between normal columnar
epithelium and mature squamous epithelium
B. All of the above
C. It is an area of rapid turnover
D. Most cases of squamous neoplasia of the cervix
begin in this anatomic area
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.
61 The relative ratio of cervix to uterus in
a child:
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.
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.
- This condition is commonly
encountered in females who were
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.
- What is the hormone responsible for
the thick elastic redundant hymen of
newborn?
a. progesterone
b. estrogen
c. testosterone
d. aromatase
B. Estrogen
Explanation: Estrogen is responsible for the redundant, thick, and elastic hymen seen in newborns.
- 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).
- Treatment for imperforate hymen is to
make a cruciate incision into the hymen
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.
- Normal development of ovaries in a
female with
absent uterus and vaginaindicates which
of the following
genetic conditions?
Turner’s syndrome
Testicular feminizing syndrome
Mullerian agenesis
Gonadal dysgenesis
C. Mullerian agenesis
Explanation: In Mullerian agenesis (MRKH syndrome), the ovaries develop normally, but the uterus and vagina are absent.
- A 6 -year old cancer patient on going
chemotherapy was brought to the clinic
due to vaginal pruritus with 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.
69 Hysteroscopy is contraindicated in 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.
70 What is the most common physiologic
mass among adolescent?
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.
- a 5 year old was brought to a clinic
due to vaginal discharge secondary to
foreign body. what is the next best thing
to perform?
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.
- The relative ratio of cervix to uterus in
a child
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.
- The surgical technique done for
creation of a neovagina where the labial
skin is apposed and sutured together to
create a vaginal “kangaroo pouch” as
receptacle for penile insertion
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.”
- A full bladder is a prerequisite prior to
doing a ___________________
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.
- Uterus develops from
A. Mullerian 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.
- A 5 year old child with straddle injury
incurred 2x2 nonexpanding vulvar
hematoma. What is the best
management?
Do evacuation and repair
Observe and do serial examination
Do laser treatment
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.
- 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 likely cause of the bleeding?
Trauma
Congenital
Sexual abuse
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.
- A 45 year old patient comes in with a
chief complaint of vaginal bleeding. Her
last menses was 15 months ago.
Pregnancy Test negative. Ultrasound
results show an endometrial thickness of
5mm. What is the next best step?
A. Dilatation & 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.
- Endometrial sampling is
contraindicated in the following:
A. dysfunctional uterine bleeding
B. pelvic TB
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.
85.A 4 year old child was brought to the
clinic due to vaginal bleeding. Upon
inspection of the genitalia, a red donut
like structure was noted. What is the
initial impression?
A. Imperforate hymen
B. Labial fusion
C. Lichen sclerosus 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.
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?
Upward lateral traction of the thighs
Downward lateral traction of the thighs
Upward lateral traction of the legs
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.
87.A 7 year old with vulvar trauma had
her complete immunization more than 5
years ago. What booster injection should
be given to the patient?
A. Hepatitis B booster
B. 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.
- You requested for a hysteroscopy to
a 35 yo 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.
- A 19 year old patient presents with
primary amenorrhea. She has well
developed of breasts and axillary and
pubic hair. Ultrasound revealed absent
vagina. The diagnosis is most likely?
XYY SYNDROME
Gonadal dysgenesis
Mullerian agenesis
Klinefelter’s syndrom
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.
- Gartner duct cyst is the remnant of
the following embryology of all structure
XYY SYNDROME
Gonadal dysgenesis
Mullerian agenesis
Klinefelter’s syndrome
Mullerian agenesis
91 Which of the following is not true
regarding congenital uterine anomalies?
A. They are associated with preterm labor
B. incidence of occurrence 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).
- There is 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.
- One of the reassuring aspects of
sonography is the absence of adverse
clinical
effects from the energy levels used in
diagnostic studies based on its thermal
index. With modern ultrasound machines,
usually the thermal index is:
A. 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.
- In a septate uterus, the septum has
poor blood supply and contains fibrous
and/or myometrial tissues
True
False
True
Explanation: A septate uterus contains a septum with poor blood supply, often composed of fibrous or myometrial tissues.
95.A 2 year old asymptomatic child was
brought in to the clinic due to fusion of
labia minora. What is the best
management?
Manual separation of the fusion under anesthesia
Topical estrogen cream
Topical betamethasone cream
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.
- Lower one fourth of vagina is formed
from
A. Urogenital sinus
B. Paramesonephric duct
C. Mesonephric duct
D. Mullerian 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.
- Complete failure of Mullerian duct
fusion will result 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.
- The success of hysteroscopy
depends on the media used to expand
the uterine cavity. Which of these media
has risk of 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.
- A 7 year old child was brought to the
clinic due to vaginal pruritus, dysuria and
constipation. Upon inspection of the
genitalia, a whitish lesion appears in an
hourglass or figure-8 formation around
the area of 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.
- 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.
- A 22-year-old female presents with grapelike structures in her breast. What is the most likely diagnosis?
A. Fibrocystic changes
- What is the management for fibrocystic breast changes?
A. Mechanical support and dietary changes
- A 30-year-old female, two weeks postpartum, presents with left breast swelling, erythematous, and firm. What is the most likely diagnosis?
A. Mastitis
- What is the initial management for mastitis?
A. Antibiotics
- What advice would you give to a patient with mastitis?
A. Continue breast pumping the affected breast to decrease engorgement
- A patient with mastitis is not improving with antibiotic treatment. What would be the next best step in management?
Perform an ultrasound to rule out a breast abscess
- A patient with a suspected breast abscess on ultrasound needs further evaluation. What is the next step?
Aspiration or drainage of the abscess
- A 35-year-old female presents with a breast lump that is hard, non-mobile, and irregular in shape. What is the most likely diagnosis?
Breast cancer
- What is the best imaging modality to evaluate a suspicious breast mass in a 35-year-old woman?
Ultrasound, as mammography is less sensitive in dense breasts
- A 45-year-old female undergoes a mammogram and is found to have microcalcifications. What is the next step in management?
Core needle biopsy
- 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. BRCA2
- What is the primary choice for breast cancer screening in women aged 40 and older?
A. Mammography
- When is the best time to perform a proper breast exam?
A. 3-5 days after menstruation
- Once a woman develops carcinoma of one breast, what is the approximate percent chance per year of developing carcinoma in the other breast?
A. 1% per year
- What does a BI-RADS class 2 indicate?
A. Benign findings
- A 45-year-old woman presents with a palpable breast lump. What is the next best step in management?
Mammography and/or ultrasound, depending on the nature of the lump
- A patient with a positive family history of breast cancer asks about preventive options. Which of the following is a valid prevention strategy?
Chemoprevention (e.g., tamoxifen)
- What is the most common histologic type of breast cancer?
Invasive ductal carcinoma
- A 30-year-old woman presents with a breast mass that is round, smooth, and mobile. What is the most likely diagnosis?
Fibroadenoma
- A 60-year-old woman with a palpable breast mass has a biopsy that shows ductal carcinoma in situ (DCIS). What is the best treatment?
: Lumpectomy with radiation
- Evaluation of a breast mass includes all of the following in the triple test except:
Fine-needle aspiration cytology (FNA) (Triple test includes clinical examination, imaging, and biopsy)
- The use of breast ultrasound as an adjunct to mammography is most useful for:
D. All of the above (Women with dense breasts, differentiating cystic from solid masses, pregnant women)
- Women classified as low risk for developing breast cancer have approximately what percentage risk?
A. 12%
- Screening mammography is recommended up to what age?
A. 74
- Cervical cytology will not include the following:
Infection
- Visual inspection of the cervix can be used as a screening tool:
True
- In colposcopy, what is applied to the cervix?
: A. Acetic acid
- Cervical screening is not recommended for the following:
. Status post hysterectomy
- What is an absolute contraindication for hysterectomy?
: C. Acute pelvic infection
- What is the normal vaginal pH in prepubertal girls?
A. 6.5-7.5
- What is the normal vaginal pH in pubertal girls?
A. 3.5-4.5
- All of the following are common indications for a rectal exam except:
A. Sexual abuse
- Which hormone is responsible for the thick elastic redundancy in newborns?
Estrogen
- A 4-year-old child presents with vaginal bleeding and hymen lacerations at 3 and 9 o’clock. What is the most likely cause of the bleeding?
- Answer: A. Sexual abuse
- One of the following is NOT a reason for the susceptibility of a child to vulvar infection:
- Answer: A. Vaginal epithelium of a prepubertal child has slightly acidic pH
- A 4-year-old with vaginal pruritus, vaginal discharge, and erythema. What is the most common cause of vulvovaginitis?
- Answer: A. Non-specific vulvovaginitis
- A 6-year-old with nocturnal vulvar and perianal itching is most likely suffering from:
- Answer: A. Ringworms
- A 6-year-old cancer patient undergoing chemotherapy presents with vaginal pruritus and edema. What is the most likely cause?
- Answer: A. Mycotic infection
- What is the treatment for fusion of the labia minora?
- Answer: A. No treatment is necessary
- A red donut-like structure in the vaginal area is most likely:
- Answer: A. Urethral prolapse
- “Figure of 8” appearance is associated with which condition?
- Answer: A. Lichen sclerosus tropicus
- What is the diagnostic test of choice for “Figure of 8” lesions?
- Answer: A. Punch biopsy
- What is the most common foreign body found in girls ages 3-9 years old?
- Answer: A. Toilet paper
- A 6-year-old girl presents with vaginal discharge, no signs of sexual abuse, and negative culture. What is the most likely cause of the discharge?
- Answer: Non-specific vulvovaginitis
- A child presents with a urethral mass that prolapses during straining. What is the diagnosis?
- Answer: Urethral prolapse
- A 12-year-old girl presents with cyclic abdominal pain and no menstrual periods. What is the most likely diagnosis?
- Answer: Imperforate hymen
- A 15-year-old girl presents with primary amenorrhea and no visible secondary sexual characteristics. What is the most likely diagnosis?
- Answer: Turner syndrome
- A young girl presents with labial adhesions. What is the best treatment?
- Answer: Topical estrogen cream
- During early fetal development, the Wolffian duct has the capacity to develop into the male reproductive system while the Mullerian duct develops into the female reproductive system.
True
- Females with congenital adrenal hyperplasia will show:
- Answer: Ambiguous genitalia (due to increased androgen levels)
- What is the term used for the accumulation of blood in the vaginal canal secondary to an outflow tract obstruction?
- Answer: A. Hematocolpos
- Which of the following is a derivative of the paramesonephric (Mullerian) duct?
- Answer: Uterus, fallopian tubes (not ovaries, which are derived from the gonadal ridge)
- Which of the following is a derivative of the urogenital sinus?
- Answer: A. Hymen
- In the case of ambiguous genitalia, how is gender assignment best carried out?
- Answer: D. Karyotyping
- Complete failure of the Mullerian duct results in:
- Answer: A. Uterine didelphys (presence of two uteri)
- In complete Mullerian duct aplasia, all of the following structures are absent except:
- Answer: A. Ovaries
- Which Mullerian duct anomaly is associated with the presence of two cervices?
- Answer: A. Uterine didelphys
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
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
Answer:
D. Contact dermatitis
What is the best management for the patient in Question 7?
A. Topical corticosteroids and avoidance of the allergen
B. Antifungal medication
C. Oral antihistamines only
D. Long-term systemic steroids
E. Antibiotic therapy
Answer:
A. Topical corticosteroids and avoidance of the allergen
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.
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
What type of degeneration is characterized by myoma with carneous degeneration?
A. Hyaline degeneration
B. Myxoid degeneration
C. Red (carneous) 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.
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
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
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
