LE6 GYNE Flashcards
Question: What is the vaginal pH of pubertal girls?
A. 3.5 - 4.5
B. 4.5 - 5.5
C. 5.5 - 6.5
D. 6.5 - 7.5
A. 3.5 - 4.5
Rationale: Estrogen stimulates lactobacilli, which produce lactic acid, maintaining an acidic vaginal environment (pH 3.5 - 4.5) to protect against infections.
Question: Based on ICS (International Continence Society) staging of pelvic floor prolapse, if the points Aa, Ap, Ba, Bp are all at -3 cm, at which stage can you categorize the prolapse?
A. Stage 0
B. Stage I
C. Stage II
D. Stage III
A. Stage 0
Explanation:
The International Continence Society (ICS) Pelvic Organ Prolapse Quantification (POP-Q) System defines Stage 0 as no prolapse detected. The criteria for Stage 0 include:
✅ All measured points (Aa, Ap, Ba, Bp) are at -3 cm (indicating normal support).
✅ Either Point C or D (representing the cervix or vaginal apex) is between Total Vaginal Length (TVL) -2 cm.
Since the question states that Aa, Ap, Ba, and Bp are all at -3 cm, this perfectly fits Stage 0, meaning no pelvic organ prolapse is present.
Question: What is the vaginal pH of prepubertal girls?
A. 3.5 - 4.5
B. 4.5 - 5.5
C. 5.5 - 6.5
D. 6.5 - 7.5
D. 6.5 - 7.5
Rationale: In prepubertal girls, the vaginal pH is neutral to slightly alkaline (6.5 - 7.5) due to low estrogen levels, which limit lactobacilli proliferation.
Question: The relative ratio of cervix to uterus in a child is:
A. 0.5:1
B. 0.75:1
C. 1:1
D. 2:1
D. 2:1
Rationale: In prepubertal girls, the cervix is twice the size of the uterine corpus (2:1 ratio). This changes at puberty when the uterine body enlarges.
Question: An anterior compartment defect and the most common site of pelvic organ prolapse?
A. Cystocele
B. Procidentia uteri
C. Rectocele
D. Enterocele
A. Cystocele
Rationale: Cystocele is the most common pelvic organ prolapse, where the bladder herniates into the anterior vaginal wall due to weakened pelvic support.
Question: Based on ICS staging of pelvic floor prolapse, if the points Aa, Ap, Ba, Bp are all everted more than the total vaginal length, at which stage can you categorize the prolapse?
A. Stage I
B. Stage III
C. Stage III
D. Stage IV
D. Stage IV
Rationale: Stage IV pelvic organ prolapse occurs when the prolapsed organs completely evert beyond the total vaginal length.
Question: An anterior compartment defect and the most common site of pelvic organ prolapse?
A. Cystocele
B. Procidentia uteri
C. Rectocele
D. Enterocele
A. Cystocele
Rationale: Cystocele is the most common pelvic organ prolapse, where the bladder herniates into the anterior vaginal wall due to weakened pelvic support.
Question: Based on ICS staging of pelvic floor prolapse, if the points Aa, Ap, Ba, Bp are all everted more than the total vaginal length, at which stage can you categorize the prolapse?
A. Stage I
B. Stage III
C. Stage III
D. Stage IV
D. Stage IV
Rationale: Stage IV pelvic organ prolapse occurs when the prolapsed organs completely evert beyond the total vaginal length.
Question: In which of the following cases can we legally break the principle of confidentiality?
A. A patient who discloses to his doctor a plan to commit murderous acts on her relatives and neighbors
B. A relative purchases a casket for a dying patient, prompting the doctor to divulge medical information
C. A physician deliberately omits vital medical information about a patient’s condition
D. None of the above
A. A patient who discloses to his doctor a plan to commit murderous acts on her relatives and neighbors
Rationale: Confidentiality may be broken if a patient poses a serious threat to others (e.g., planned homicide or violence), aligning with the Tarasoff ruling on the duty to warn.
Question: An ER doctor tries to save the life of a patient by initiating immediate life-saving treatment and stabilizing a patient who is massively bleeding and unconscious due to severe blood loss. He decided to do an emergency procedure despite no signed consent (patient had no relatives with him at the ER). What is the bioethical principle involved?
A. Principle of Non-Maleficence
B. Principle of Respect for Autonomy
C. Principle of Beneficence
D. Principle of Justice
C. Principle of Beneficence
Rationale: Beneficence refers to acting in the patient’s best interest, including providing life-saving treatment in emergencies under implied consent when the patient cannot consent.
Question: An obstetrician-oncologist performs a radical hysterectomy on a pregnant patient (G4P3, 16 weeks AOG) diagnosed with stage 2A cervical cancer after fully explaining that a radical hysterectomy is the best management for early-stage cervical cancer. What bioethical principle is involved?
A. Principle of Human Dignity
B. Principle of Totality
C. Principle of Confidentiality
D. Principle of Double Effect
D. Principle of Double Effect
Rationale: The Principle of Double Effect applies when a necessary medical treatment (hysterectomy for cancer) has an unintended but foreseen negative consequence (loss of pregnancy).
Question: The rectovaginal septum is paper-thin and involves the posterior vaginal wall. What is the diagnosis?
A. Cystocele
B. Procidentia uteri
C. Rectocele
D. Enterocele
C. Rectocele
Rationale: Rectocele occurs when the rectum bulges into the posterior vaginal wall due to weakened pelvic support, causing difficulty with defecation.
Question: In cases of incompetent patients who cannot provide consent, who among the following shall be the appointed proxy decision-maker?
A. Spouse
B. Legal guardian
C. Parents
D. All of the above
D. All of the above
Rationale: In cases where a patient is incapacitated, the spouse, legal guardian, or parents may serve as proxy decision-makers based on legal and ethical guidelines.
Question: Giving equal and fair medical treatment to all patients, regardless of whether they are rich or poor. What is the bioethical principle involved?
A. Principle of Non-Maleficence
B. Principle of Respect for Autonomy
C. Principle of Beneficence
D. Principle of Justice
D. Principle of Justice
Rationale: The Principle of Justice emphasizes fair and equitable distribution of healthcare resources without discrimination.
Question: During hysterectomy, incorporation of the uterosacral ligaments into the vault repair can prevent which complication?
A. Cystocele
B. Procidentia uteri
C. Rectocele
D. Enterocele
D. Enterocele
Rationale: Enterocele (herniation of the small bowel into the vaginal vault) can occur after hysterectomy due to loss of uterine support. Incorporating the uterosacral ligaments into the vault repair helps prevent this.
Question: A 35-year-old G0 came to the clinic complaining of foul-smelling, yellowish vaginal discharge. On speculum exam, you noted copious, yellowish, frothy discharge. A wet mount of the discharge showed motile, flagellated protozoa. What is the diagnosis?
A. Bacterial vaginosis
B. Trichomoniasis
C. Vaginal candidiasis
D. Toxic Shock Syndrome (TSS)
B. Trichomoniasis
Rationale: Trichomoniasis is characterized by yellow-green, frothy discharge, vaginal irritation, and the presence of motile trichomonads on wet mount microscopy.
Question: What is the preferred treatment for Trichomoniasis (Case #1)?
A. Metronidazole
B. Clotrimazole
C. Clindamycin + Cloxacillin
D. Clindamycin + Vancomycin
A. Metronidazole
Rationale: Metronidazole (oral or vaginal) is the first-line treatment for Trichomonas vaginalis.
Question: For Trichomoniasis (Case #1), should we treat the sexual partner?
A. YES
B. NO need
A. YES
Rationale: Trichomoniasis is a sexually transmitted infection (STI), and partner treatment is required to prevent reinfection.
Question: A 45-year-old nulligravid came to the clinic due to vaginal pruritus for 3 days. On speculum exam, you noted a thick, curd-like, whitish vaginal discharge. What is your diagnosis?
A. Bacterial vaginosis
B. Vulvovaginal Candidiasis
C. Toxic Shock Syndrome (TSS)
D. Trichomoniasis
B. Vulvovaginal Candidiasis
Rationale: Vulvovaginal candidiasis presents with thick, white, curd-like vaginal discharge, pruritus, and erythema, often caused by Candida albicans.
Question: What is the treatment for Vulvovaginal Candidiasis (Case #4)?
A. Metronidazole
B. Clotrimazole
C. Clindamycin + Vancomycin
D. Clindamycin + Cloxacillin
B. Clotrimazole
Rationale: Clotrimazole (topical) or fluconazole (oral) are first-line antifungal treatments for Candida infections.
Question: For Vulvovaginal Candidiasis (Case #4), should we treat the sexual partner?
A. YES
B. NO need
B. NO need
Rationale: Candida infections are not considered sexually transmitted; therefore, partner treatment is not necessary unless symptomatic.
Question: What is an important lab test that you should include when diagnosing a patient with Vulvovaginal Candidiasis (Case #4)?
A. CBC
B. Urinalysis
C. 75g OGTT
D. Chest X-ray
C. 75g OGTT
Rationale: Recurrent vaginal candidiasis is associated with diabetes mellitus, so an oral glucose tolerance test (OGTT) is recommended to screen for undiagnosed diabetes.
Question: A 30-year-old G1P0, 20 weeks AOG, came to the clinic due to vaginal discharge with a fishy odor. Speculum exam showed grayish, foul-smelling discharge. A wet mount smear of the discharge showed CLUE cells. What is your diagnosis?
A. Bacterial vaginosis
B. Trichomoniasis
C. Toxic Shock Syndrome (TSS)
D. Vulvovaginal Candidiasis
A. Bacterial vaginosis
Rationale: Bacterial vaginosis (BV) is characterized by grayish vaginal discharge, fishy odor (positive Whiff test), and Clue cells on wet mount.
Question: What is the treatment for Bacterial Vaginosis (Case #8)?
A. Metronidazole
B. Clotrimazole
C. Clindamycin + Vancomycin
D. Clindamycin + Cloxacillin
A. Metronidazole
Rationale: Metronidazole (oral or vaginal) is first-line therapy for Bacterial Vaginosis.
Question: For Bacterial Vaginosis (Case #8), do we need to treat the sexual partner?
A. YES
B. NO need
B. NO need
Rationale: Bacterial vaginosis is not a true STI, so partner treatment is not required unless symptomatic.
- What is the most likely causative agent of syphilis?
A. Virus
B. Spirochete
C. Protozoa
D. Fungi
B. Spirochete
Rationale: Syphilis is caused by Treponema pallidum, a spirochete bacterium. It is a sexually transmitted infection that progresses through multiple stages if untreated.
- A 21-year-old nulligravida presents with a genital ulcer on her right labia minora. The ulcer is painless, soft, and associated with unilateral inguinal lymphadenopathy. What is the most likely diagnosis?
A. HIV
B. Granuloma inguinale
C. Syphilis
D. Chancroid
C. Syphilis
Rationale: Primary syphilis presents as a painless, well-demarcated ulcer (chancre) with associated regional lymphadenopathy.
- A 24-year-old G3P3 presents with painless vesiculopapular rashes on the vulva and inguinal lymphadenopathy. The inguinal lymph nodes are suppurative. What is the causative organism?
A. Neisseria gonorrhoeae
B. Haemophilus ducreyi
C. Chlamydia trachomatis
D. Treponema pallidum
C. Chlamydia trachomatis
Rationale: Lymphogranuloma venereum (LGV), caused by Chlamydia trachomatis, presents with painless genital ulcers followed by suppurative inguinal lymphadenopathy.
- What is a characteristic manifestation of secondary syphilis?
A. Chancre
B. Condyloma acuminata
C. Condyloma latum
D. Gumma
C. Condyloma latum
Rationale: Condyloma latum are broad, flat, wart-like lesions found in moist intertriginous areas in secondary syphilis.
- A patient is diagnosed with lymphogranuloma venereum. What is the confirmatory test?
A. Gram stain
B. VDRL
C. Nucleic acid amplification test (NAAT)
D. Dark-field microscopy
C. Nucleic acid amplification test (NAAT)
Rationale: NAAT is the most sensitive and specific test for diagnosing Chlamydia trachomatis, the causative agent of LGV.
- Vaginal squamous cells with multi-coccal organisms are indicative of which infection?
A. Neisseria gonorrhoeae
B. Gardnerella vaginalis
C. Trichomonas vaginalis
D. Chlamydia trachomatis
B. Gardnerella vaginalis
Rationale: Gardnerella vaginalis is the primary cause of bacterial vaginosis, which presents with clue cells (epithelial cells covered with bacteria) on microscopy.
- Genital lesions appearing as grouped vesicles mixed with inflamed ulcers are most likely caused by?
A. Treponema pallidum
B. Chlamydia trachomatis
C. Herpes simplex virus
D. Haemophilus ducreyi
C. Herpes simplex virus
Rationale: Genital herpes presents as painful vesicles on an erythematous base, which progress to ulcerations.
- A patient presents with dysuria, crops of vesicles, and some areas of crusting on the external genitalia. What is the most likely diagnosis?
A. Syphilis
B. Chancroid
C. Genital herpes
D. Lymphogranuloma venereum
C. Genital herpes
Rationale: HSV infection causes recurrent painful vesicles and ulcers in the genital area.
- The inner surface of the labia minora shows rough, carpet-like areas interspersed with warty growths. What is the diagnosis?
A. Condyloma acuminata
B. Condyloma latum
C. Herpes simplex virus
D. Syphilis
A. Condyloma acuminata
Rationale: Human papillomavirus (HPV) causes condyloma acuminata, which appear as cauliflower-like or flat, hyperpigmented lesions.
- What is the causative agent of AIDS?
A. Hepatitis B virus
B. Epstein-Barr virus
C. Human immunodeficiency virus (HIV)
D. Cytomegalovirus
C. Human immunodeficiency virus (HIV)
Rationale: HIV is a retrovirus that causes progressive immune suppression, leading to AIDS.
- Klebsiella granulomatis causes which condition?
A. Granuloma inguinale
B. Syphilis
C. Bacterial vaginosis
D. Lymphogranuloma venereum
A. Granuloma inguinale
Rationale: Klebsiella granulomatis is the causative agent of granuloma inguinale (donovanosis), characterized by painless, beefy-red ulcers.
- Buboes are associated with which condition?
A. Bacterial vaginosis
B. Syphilis
C. Chancroid
D. Lymphogranuloma venereum
D. Lymphogranuloma venereum
Rationale: LGV, caused by Chlamydia trachomatis, is characterized by painful inguinal lymphadenopathy (buboes).
- A 20-year-old overseas worker presents with dark spots on both hands. What is the most likely diagnosis?
A. Syphilis
B. Chancroid
C. HIV
D. Lymphogranuloma venereum
A. Syphilis
Rationale: Secondary syphilis presents with symmetrical, non-pruritic maculopapular rashes on the palms and soles.
- A 25-year-old presents with painful blisters on the vulva, low-grade fever, and inguinal lymphadenopathy. What is the most likely diagnosis?
A. Syphilis
B. Chancroid
C. Genital herpes
D. HPV infection
C. Genital herpes
Rationale: Herpes simplex virus causes painful genital ulcers with systemic symptoms such as fever and malaise.
- Painful, tender, soft chancre is a clinical sign of which infection?
A. Chancroid
B. Syphilis
C. Lymphogranuloma venereum
D. Genital herpes
A. Chancroid
Rationale: Haemophilus ducreyi causes chancroid, characterized by painful ulcers with ragged edges and soft consistency.
- A 26-year-old commercial sex worker presents with a sore in the vulva, a shallow painless ulcer on the labia minora, and tender inguinal lymphadenopathy. What is the diagnosis?
A. Syphilis
B. Genital herpes
C. Chancroid
D. Lymphogranuloma venereum
A. Syphilis (Treponema pallidum)
Rationale:
The shallow painless ulcer on the labia minora with tender inguinal lymphadenopathy is characteristic of primary syphilis caused by Treponema pallidum.
- An 18-year-old patient presents with mucopurulent vaginal discharge, lower abdominal pain, and fever towards the end of her menstrual period. Her boyfriend has profuse penile discharge, most noticeable in the morning. What is the most likely diagnosis?
A. Syphilis
B. Lymphogranuloma venereum
C. Gonorrhea
D. Bacterial vaginosis
C. Gonorrhea
Rationale: Gonorrhea, caused by Neisseria gonorrhoeae, presents with mucopurulent discharge and is common in young sexually active individuals. It can lead to pelvic inflammatory disease and is a marker for concomitant Chlamydia trachomatis infection in up to 40% of cases.
- What is the confirmatory test for syphilis?
A. ELISA
B. Fluorescent treponemal antibody absorption (FTA-ABS)
C. Dark-field microscopy
D. VDRL
B. FTA-ABS
Rationale: FTA-ABS detects Treponema pallidum antibodies and is used to confirm syphilis after an initial non-treponemal test (e.g., VDRL or RPR).
- What is the most common site of gonorrhea infection in females?
A. Vagina
B. Endocervix
C. Urethra
D. Ovaries
B. Endocervix
Rationale: The endocervix is the primary site of gonorrhea infection in females. Infection of Bartholin’s glands is also common.
- What is the most common site of lymphogranuloma venereum in females?
A. Vagina
B. Vulva
C. Cervix
D. Rectum
B. Vulva
Rationale: LGV, caused by Chlamydia trachomatis, primarily affects the vulva and presents with painless ulcers followed by suppurative inguinal lymphadenopathy (buboes).
- A 22-year-old commercial sex worker presents with a painless beefy-red ulcer. What is the most likely diagnosis?
A. Syphilis
B. Lymphogranuloma venereum
C. Granuloma inguinale (Donovanosis)
D. Chancroid
C. Granuloma inguinale (Donovanosis)
Rationale: Klebsiella granulomatis causes granuloma inguinale, characterized by painless, beefy-red ulcers with a tendency for slow progression.
- A 34-year-old patient presents with a fleshy, slightly raised non-tender papule at the posterior vulva. Application of acetic acid results in whitening. What is the diagnosis?
A. Condyloma acuminata
B. Condyloma latum
C. Genital herpes
D. Syphilis
A. Condyloma acuminata
Rationale: Human papillomavirus (HPV) causes condyloma acuminata, which appear as warty lesions. Acetic acid application leads to whitening of the lesions.
- In a patient with AIDS, when can antibodies be detected in serum after exposure?
A. 4-5 weeks
B. 6-12 weeks
C. 13-18 weeks
D. 19-24 weeks
B. 6-12 weeks
Rationale: Most HIV antibody tests detect infection within 23-90 days after exposure.
- Which of the following conditions is characterized by painful inguinal buboes accompanied by multiple ulcers?
A. Bacterial vaginosis
B. Syphilis
C. Chancroid
D. Genital herpes
C. Chancroid
Rationale: Haemophilus ducreyi causes chancroid, characterized by painful soft ulcers with tender inguinal lymphadenopathy (buboes).
- A 28-year-old G4P4 presents with purulent vaginal discharge, rebound tenderness, and direct tenderness on the lower abdomen. What is the most likely diagnosis?
A. Bacterial vaginosis
B. Pelvic inflammatory disease (PID)
C. Gonorrhea
D. Chlamydia
B. Pelvic inflammatory disease (PID)
Rationale: PID presents with lower abdominal pain, purulent vaginal discharge, and cervical motion tenderness. It is commonly caused by Neisseria gonorrhoeae and Chlamydia trachomatis.
- What is a major sequela of pelvic inflammatory disease (PID)?
A. Ovarian cyst
B. Endometriosis
C. Ectopic pregnancy
D. Uterine fibroids
C. Ectopic pregnancy
Rationale: PID causes scarring and adhesions in the fallopian tubes, leading to an increased risk of ectopic pregnancy, infertility, and chronic pelvic pain. Severe PID increases the ectopic pregnancy risk to 50%.
- A 26-year-old presents with pelvic peritonitis, spiking fever, and an enlarged pelvic mass. Endocervical culture is positive for Neisseria gonorrhoeae. What is the most likely diagnosis?
A. Endometritis
B. Tubo-ovarian abscess
C. Ectopic pregnancy
D. Cervicitis
B. Tubo-ovarian abscess
Rationale: TOA is a severe complication of PID, characterized by an inflammatory mass involving the fallopian tube and ovary. It often requires hospitalization and IV antibiotics.
- The “tobacco pouch” sign seen on transvaginal ultrasound is associated with which condition?
A. Endometriosis
B. Ovarian cyst
C. Salpingitis
D. Cervical cancer
C. Salpingitis
Rationale: The “tobacco pouch” sign represents an enlarged, distended fallopian tube with everted fimbriae, commonly seen in genital tuberculosis and salpingitis.
- A 77-year-old multigravida presents with a palpable fleshy mass on the vulva measuring 3x4 cm. What is the best differential diagnosis?
A. Abscess
B. Uterine prolapse
C. Carcinoma
D. All of the above
B. Uterine prolapse
Rationale:
* Uterine prolapse occurs due to weakened pelvic support structures, leading to descent of the uterus into the vaginal canal.
Key signs:
* Palpable fleshy mass at the vulva
* History of multiple pregnancies (multiparity)
* Pelvic pressure and incontinence
* Abscesses are usually painful and fluctuant, while carcinomas are typically irregular, firm, and non-reducible.
- On rectovaginal exam, the mass is soft and replaceable in the vaginal canal. The total vaginal length is 8 cm. On Valsalva maneuver, the most distal part of the mass is 3 cm away from the hymen. Based on ICS staging, what is the stage?
A. Stage 0
B. Stage I
C. Stage II
D. Stage III
E. Stage IV
D. Stage III
Rationale: According to the International Continence Society (ICS) staging system:
Stage 0: No prolapse is present.
Stage I: The most distal portion of the prolapse remains more than 1 cm above the hymen.
Stage II: The most distal portion of the prolapse is within 1 cm of the hymen.
Stage III: The most distal portion of the prolapse is more than 1 cm below the hymen but does not completely evert the vaginal canal.
Stage IV: Complete vaginal eversion.
Since the most distal part of the prolapse is 3 cm below the hymen, this classifies it as Stage III.
- What is the best treatment option for the patient in question #67 (Stage III uterine prolapse)?
A. Surgery
B. Pessary
C. Kegel exercises
D. Observe
A. Surgery
- What are the weak anatomical areas contributing to pelvic organ prolapse?
A. Cardinal ligaments
B. Uterosacral ligaments
C. Pubocervical fascia and vaginal wall
D. All of the above
D. All of the above
Rationale: Normal pelvic organ support is provided by:
Level I: Uterosacral and cardinal ligaments (support for the vaginal apex and cervix).
Level II: Connective tissue attachments to the arcus tendinous fasciae pelvis (support for the mid-vagina).
Level III: Perineal membrane, muscles, and connective tissue attachments (support for the distal vagina).
- Based on ICS staging of pelvic organ prolapse, the patient was lost to follow-up for 12 months. The vulvar mass has increased to 8x7 cm with areas of inflammation. The total vaginal length is 8 cm, and on Valsalva, the mass extends 8 cm beyond the hymen. What is the prolapse stage?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
D. Stage IV
Rationale:
Stage I: The most distal portion of the prolapse is more than 1 cm above the hymen.
Stage II: The prolapse is ≤1 cm proximal or distal to the hymen.
Stage III: The prolapse is >1 cm below the hymen but does not completely evert the vaginal canal.
Stage IV: Complete eversion of the lower genital tract.
Since the mass extends 8 cm beyond the hymen, this is classified as Stage IV pelvic organ prolapse, which represents complete vaginal eversion.
- What is the best treatment option for the patient in question #70? (Stage 4)
A. Pessary
B. Kegel exercises
C. Observation
D. Surgery
D. Surgery
Rationale:
Stage IV pelvic organ prolapse requires definitive surgical intervention to restore pelvic anatomy and function.
The preferred surgical approach includes vaginal hysterectomy with vaginal vault suspension and anterior-posterior colporrhaphy.
Any associated ulcers or infections should be treated first before proceeding with surgery.
Since the patient has complete vaginal eversion (Stage IV prolapse), surgery is the only definitive treatment.
- A 68-year-old grandmother presents with urinary incontinence. She reports that she can only urinate if she pushes a protruding vulvar mass. On pelvic exam, a fleshy mass is observed in the vulvar area. On rectovaginal exam, the mass occupies the anterior vaginal wall. The cervix is located 4 cm above the hymen, and no mass is palpated at the posterior vaginal wall. What is the initial diagnosis?
A. Cystocele
B. Urethrocele
C. Rectocele
D. Uterine prolapse
A. Cystocele
Rationale:
The patient’s symptoms of urinary incontinence and the need to push a protruding vulvar mass to urinate strongly suggest a cystocele, which is the herniation of the bladder into the anterior vaginal wall.
Key Features of a Cystocele:
• Urinary symptoms: Urinary incontinence, difficulty urinating, incomplete bladder emptying
• Pelvic pressure or bulging sensation in the vagina
• Mass visible at the vulva, especially with straining
• Exam findings:
• Fleshy mass in the vulvar area
• Anterior vaginal wall involvement
• Cervix remains in normal position (not significantly prolapsed)
A 68-year-old grandmother presents with urinary incontinence. She reports that she can only urinate if she pushes a protruding vulvar mass. On pelvic exam, a fleshy mass is observed in the vulvar area. On rectovaginal exam, the mass occupies the anterior vaginal wall. The cervix is located 4 cm above the hymen, and no mass is palpated at the posterior vaginal wall. What is the initial diagnosis?
- Using the POP-Q system, which anatomical reference point is involved in this patient?
A. Point Ba
B. Point C
C. Point Aa
D. Point Ap
C. Point Aa
Rationale:
Point Aa is located in the midline of the anterior vaginal wall, 3 cm proximal to the urethral meatus, corresponding to the urethrovesical junction.
Since the prolapse in this case involves the anterior vaginal wall, Point Aa is the primary reference point affected in this patient.
Point C
Most distal part of the cervix (or vaginal apex post-hysterectomy)
“Patient had a hysterectomy, and bulging is seen at the vaginal apex.”
Point D
Posterior fornix (Pouch of Douglas), attachment of uterosacral ligaments
“Pelvic exam reveals prolapse involving the posterior fornix.”
- The total vaginal length is 8 cm, and the mass protrudes 1 cm below the hymen. Based on ICS staging, what is the prolapse stage?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
B. Stage 2
Rationale:
Stage I: The most distal portion of the prolapse remains more than 1 cm above the hymen.
Stage II: The prolapse is ≤1 cm proximal or distal to the hymen.
Stage III: The prolapse is >1 cm below the hymen but does not completely evert the vaginal canal.
Stage IV: Complete vaginal eversion.
Since the mass protrudes 1 cm below the hymen, this is classified as Stage II pelvic organ prolapse.
- What would be the best treatment for the patient in question #72?
A. Surgery
B. Kegel exercises
C. Pessary
D. Observation
C. Pessary
Rationale:
Non-operative management is the first-line treatment for Stage I and II pelvic organ prolapse.
Options include:
Pessary support (most effective conservative treatment).
Large tampons (temporary support).
Kegel exercises (strengthen pelvic floor muscles).
Estrogen vaginal creams (help maintain tissue integrity).
Surgery is typically reserved for Stage III and IV prolapse.
- A 72-year-old multiparous patient presents with a complaint of something coming out of her perineal area. She also has difficulty continuing urination and bowel movements. On rectovaginal exam, the cervix is located 5 cm above the hymen. Total vaginal length is 7 cm. There is a palpable, fleshy soft mass protruding out of the vulva measuring 4x5 cm. On Valsalva, the most distal part descends about 2.5 cm below the hymen. What are the differential diagnoses?
A. Enterocele
B. Urethrocele
C. Both
C. Both
Rationale:
Enterocele involves herniation of the small intestine into the vaginal wall, causing bowel dysfunction.
Urethrocele involves urethral descent into the vaginal wall, causing urinary difficulties.
Since the patient has both urinary and bowel dysfunction, both conditions must be considered.
- During the Valsalva maneuver, the mass is coming from the posterior vaginal wall. How can you differentiate it from a rectocele or enterocele?
A. Digital rectal exam
B. Cystoscopy
C. Transillumination
D. Ultrasound
C. Transillumination
Rationale:
Transillumination can help differentiate an enterocele (fluid-filled sac of intestines) from a rectocele (soft tissue of rectum).
Rectoceles do not transilluminate, whereas enteroceles often do.
- What is the treatment for enterocele?
A. Transabdominal reduction
B. McCall Stitch
C. Abdominal sacrocolpopexy
D. All of the above
D. All of the above
Rationale:
McCall Stitch is commonly used during vaginal hysterectomy to prevent enterocele formation.
Abdominal sacrocolpopexy is a more definitive surgical repair option for enterocele.
Transabdominal reduction may be required for severe enterocele cases.
- What is the diagnosis based on the symptomatology of the patient?
A. Uterine prolapse
B. Urethrocele
C. Enterocele
D. All of the above
D. All of the above
Rationale:
Urethrocele: Descent of the urethra and bladder neck, leading to urinary symptoms such as incontinence or retention.
Enterocele: Herniation of the pouch of Douglas containing small intestines into the rectovaginal septum, commonly seen post-hysterectomy.
Pelvic organ prolapse (POP): Encompasses multiple forms of prolapse, including urethrocele, cystocele, rectocele, and enterocele.
- Based on the physical exam findings, what is the stage of prolapse?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
C. Stage 3
Rationale:
Stage I: Prolapse is more than 1 cm above the hymen.
Stage II: Prolapse is within 1 cm of the hymen.
Stage III: Prolapse is more than 1 cm below the hymen but not completely everted.
Stage IV: Complete eversion of the vaginal canal.
Since the most distal part of the prolapse is more than 1 cm below the hymen but does not completely evert the vaginal canal, this is classified as Stage III.
- Based on ICS staging, if the most distal part is more than 1 cm above the hymen, what is the prolapse stage?
A. Stage 0
B. Stage 1
C. Stage 2
D. Stage 3
B. Stage 1
Rationale:
Stage 0: No prolapse.
Stage 1: Most distal part of the prolapse remains >1 cm above the hymen.
Stage 2: Prolapse is ≤1 cm above or below the hymen.
Stage 3: Prolapse extends >1 cm below the hymen but does not completely evert the vaginal canal.
Stage 4: Complete eversion of the vaginal canal.
- Based on ICS staging, if the most distal part is more than 1 cm below the hymen but not more than 2 cm or not less than the total vaginal length, what is the prolapse stage?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
C. Stage 3
Rationale:
Stage 3: Prolapse extends >1 cm below the hymen but does not completely evert the vaginal canal.
This is distinct from Stage 4, which is complete vaginal eversion.
- This point is measured from the posterior margin of the posterior vaginal wall to the middle anal opening. What is it called?
A. Point C
B. Perineal body
C. Point Ba
D. Point D
B. Perineal body
Rationale:
The perineal body (PB) is the distance between the posterior vaginal wall and rectum.
It provides support for the perineum and anal sphincter.
- What is the point described as the most distal part of the remaining upper posterior vaginal wall, ranging from -3 cm to the total vaginal length (TVL)?
A. Point Ba
B. Point Bp
C. Point C
D. Point D
B. Point Bp
Rationale:
Point Bp is a posterior vaginal wall reference point used in POP-Q (Pelvic Organ Prolapse Quantification).
It measures the descent of the posterior vaginal wall in prolapse evaluation.
- What is the point measured from the posterior fornix?
A. Point C
B. Point Ba
C. Point D
D. Point Ap
C. Point D
Rationale:
Point D represents the posterior fornix in the POP-Q system.
It is used to evaluate uterine and vaginal vault prolapse.
- If ICS staging points Ap, Aa, Ba, and Bp are all at -3 cm, what is the prolapse stage?
A. Stage 0
B. Stage 1
C. Stage 2
D. Stage 3
A. Stage 0
Rationale:
Stage 0: No prolapse is demonstrated. Points Aa, Ap, Ba, and Bp are all at -3 cm.
This means the pelvic support structures remain intact.
- If points Aa, Ap, Ba, and Bp are all at -3 cm, what is the prolapse stage?
A. Stage 0
B. Stage 1
C. Stage 2
D. Stage 3
A. Stage 0
Rationale:
No prolapse is present when all these points are at -3 cm, confirming Stage 0 pelvic organ prolapse.
- What is the most common site of pelvic organ prolapse (POP) in the anterior compartment?
A. Urethrocele
B. Cystocele
C. Enterocele
D. Rectocele
B. Cystocele
Rationale:
Cystocele is the most common anterior compartment defect, involving prolapse of the bladder into the vagina.
Symptoms include urinary incontinence, retention, and urgency.
- The rectovaginal septum is paper-thin and involves the posterior vaginal wall. What is the diagnosis?
A. Urethrocele
B. Cystocele
C. Rectocele
D. Enterocele
C. Rectocele
Rationale:
Rectocele occurs when the rectum bulges into the vaginal wall, often worsening with straining or defecation.
Diagnostic methods:
History and physical examination
Rectovaginal exam (thin rectovaginal septum and bulging of rectum into the vagina).
- During a hysterectomy, incorporating the uterosacral and cardinal ligaments into vault repair prevents which condition?
A. Cystocele
B. Urethrocele
C. Enterocele
D. Rectocele
C. Enterocele
Rationale:
Enterocele (herniation of small intestine into the rectovaginal septum) can occur after a hysterectomy due to loss of apical vaginal support.
Prevention:
Incorporating the uterosacral and cardinal ligaments into vault repair prevents vaginal vault prolapse and enterocele formation.
- Is pelvic organ prolapse more common in multiparous women?
A. True
B. False
A. True
Rationale:
Multiparity is a major risk factor for POP due to weakened pelvic support structures from repeated childbirth.
- In almost all cases of pelvic organ prolapse, 46% are attributed to menopausal age, history of childbirth, and heavy physical activity.
A. True
B. False
A. True
Rationale:
Menopause, aging, childbirth history, and heavy physical activity contribute significantly to pelvic floor weakening and prolapse.
- Common risk factors for pelvic organ prolapse include obesity and prior pelvic surgery.
A. True
B. False
A. True
Rationale:
Obesity increases intra-abdominal pressure, worsening pelvic organ prolapse.
Pelvic surgery may weaken supporting ligaments, predisposing to prolapse.
- Heavy lifting is a non-controversial risk factor for pelvic organ prolapse.
A. True
B. False
B. False
Rationale:
Heavy lifting is debated as a risk factor because:
It increases intra-abdominal pressure, which may worsen existing prolapse.
However, evidence does not consistently link it to new cases of prolapse.
- The loss of levator ani muscle function is due to decreased estrogen levels.
A. True
B. False
A. True
Rationale:
Estrogen helps maintain pelvic floor muscle tone.
Estrogen deficiency post-menopause leads to pelvic floor muscle weakening, increasing prolapse risk.
- Does pelvic organ prolapse pathophysiology involve muscle atrophy from denervation due to childbirth injuries?
A. True
B. False
A. True
Rationale:
Pelvic organ prolapse (POP) occurs due to denervation injuries from childbirth, leading to levator ani muscle atrophy and weakening of pelvic support structures.
- Is the pathophysiology of pelvic organ prolapse multifactorial?
A. True
B. False
A. True
Rationale:
POP results from multiple contributing factors, including:
Pregnancy and childbirth trauma (levator ani and connective tissue injury).
Menopause and estrogen deficiency (weakened pelvic floor support).
Chronic increased intra-abdominal pressure (e.g., obesity, chronic cough, constipation).
- Does first-stage pelvic organ prolapse involve only the upper barrel of the vagina?
A. True
B. False
A. True
Rationale:
Stage I POP is when the most distal portion of the prolapse remains more than 1 cm above the hymen.
At this stage, prolapse is limited to the upper barrel of the vagina and does not descend near the vaginal opening.
- Is the ICS staging system an objective quantitative description of pelvic organ prolapse?
A. True
B. False
A. True
Rationale:
ICS staging (POP-Q system) is a standardized, quantitative method for describing pelvic organ prolapse.
It provides objective measurements of vaginal support loss at specific anatomical points.
- Is the genital hiatus measured from the external urethral opening to the anal opening?
A. True
B. False
B. False
Rationale:
The genital hiatus (GH) is measured from the middle of the external urethral meatus to the posterior hymen.
It is not measured to the anal opening, as the perineal body separates the genital hiatus from the anal region.
- An OB-GYN decides to perform an emergency hysterectomy for an atonic uterus that caused massive postpartum bleeding, despite exhausting all medical treatments. What ethical principle applies?
A. Principle of Human Dignity
B. Principle of Totality
C. Principle of a Well-Informed Conscience
D. Principle of Confidentiality
B. Principle of Totality
Rationale:
The Principle of Totality states that medical interventions can be performed on a body part if they serve the overall well-being of the person.
In this case, a hysterectomy is performed to save the patient’s life, even though it results in the loss of reproductive capability.
The decision follows the ethical concept that removal of an organ is justified if it benefits the person’s overall health.
- A general practitioner refers a patient to a medical specialist after admitting that they are not well-trained to competently perform an important surgical procedure. What ethical principle applies?
A. Principle of Non-maleficence
B. Principle of Beneficence
C. Principle of Respect for Autonomy
D. Principle of Justice
A. Principle of Non-maleficence
Rationale:
The Principle of Non-maleficence states that physicians should not cause harm and should refer patients when the care required is beyond their expertise.
By referring the patient to a qualified specialist, the general practitioner avoids potential harm that could result from an improperly performed procedure.
- A physician considers professional, legal, financial, personal, and social aspects in a patient’s decision-making. What ethical principle applies?
A. Principle of Autonomy
B. Principle of Non-maleficence
C. Principle of Beneficence
D. Principle of Justice
C. Principle of Beneficence
Rationale:
The Principle of Beneficence requires physicians to act in the best interest of the patient, considering factors beyond medical aspects, such as patient preferences, quality of life, and contextual features that affect decision-making.
- Transparency is an important aspect of which ethical principle?
A. Principle of Justice
B. Principle of Beneficence
C. Principle of Autonomy
D. Principle of Non-maleficence
C. Principle of Autonomy
Rationale:
The Principle of Autonomy states that patients must receive timely, relevant, and adequate information to make informed choices.
Withholding information violates this principle and compromises the patient’s ability to make informed decisions.
- One of the ethical obligations of an OB-GYN is to give treatment advice based on which approach?
A. Paternalism
B. Deliberative Clinical Management
C. Medical Necessity
D. Shared Decision Making
B. Deliberative Clinical Management
Rationale:
Deliberative Clinical Management ensures that treatment recommendations align with medical evidence and ethical principles.
- When is an OB-GYN ethically justified in making recommendations?
A. When at least one medically reasonable alternative exists
B. When the physician has absolute certainty about the best choice
C. When no legal constraints are present
D. When the patient is unsure of their options
A. When at least one medically reasonable alternative exists
Rationale:
Physicians should only recommend interventions that have medical validity and ethical justification.
- What type of counseling does the physician use in question #44?
A. Non-directive
B. Directive
C. Shared Decision Making
D. Both A & C
D. Both A & C
Rationale:
Non-directive counseling provides neutral information, allowing the patient to decide.
Shared Decision Making involves a collaborative approach between physician and patient.
OB-GYNs often use both approaches in ethical decision-making.
- What is an ethical obligation of OB-GYNs toward other physicians?
A. Ensure strict individual practice
B. Prioritize personal judgment over collaboration
C. Create a culture that supports professional collaboration
D. Avoid discussions about treatment plans
C. Create a culture that supports professional collaboration
Rationale:
Ethical medical practice involves interdisciplinary teamwork, ensuring the best possible patient care.
- Which of the following does NOT violate the physician-patient relationship?
A. Accepting expensive gifts from a patient
B. Texting about lab results
C. Discussing a patient’s case in a public setting
D. Performing an unnecessary procedure for financial gain
B. Texting about lab results
Rationale:
Texting results to a patient does not breach confidentiality, as long as it maintains privacy and security.
- What should be included in informed consent?
A. Diagnosis
B. Purpose of treatment
C. Method and duration of treatment
D. All of the above
D. All of the above
Rationale:
Informed consent requires patients to understand their diagnosis, treatment purpose, methods, duration, risks, and alternatives before agreeing.
- Confidentiality necessitates which of the following?
A. Open access to all patient records
B. Publicly discussing cases for educational purposes
C. Secure electronic medical records with security protocols
D. Allowing unauthorized family members to access records
C. Secure electronic medical records with security protocols
Rationale:
Patient confidentiality requires secure handling of medical records, including password-protected electronic systems.
- Can a 17-year-old student request condoms or oral contraceptive pills from a healthcare provider?
A. Yes, if they have parental/guardian written consent
B. Yes, regardless of parental consent
C. No, contraception is never given to minors
D. No, unless the student is married
A. Yes, if they have parental/guardian written consent
Rationale:
Minors require parental or guardian consent before receiving contraceptives under legal guidelines.
- A 32-year-old G3P3 patient requests oral contraceptive pills, but the physician refuses due to moral reasons. What should the physician do?
A. Dismiss the patient’s request without explanation
B. Provide an affidavit stating the reason for refusal
C. Refer the patient to a religious organization
D. Convince the patient against using contraceptives
B. Provide an affidavit stating the reason for refusal
Rationale:
Physicians with moral objections should document their stance in an affidavit for legal protection.
- The use of oral contraceptive pills (OCPs) is based on which ethical principles?
A. Beneficence and Autonomy
B. Non-maleficence and Justice
C. Paternalism and Confidentiality
D. Totality and Justice
A. Beneficence and Autonomy
Rationale:
Beneficence supports contraception as a preventive health measure.
Autonomy allows patients to make informed reproductive choices.
- A 48-year-old G6P6 patient undergoing spontaneous vaginal delivery requests bilateral tubal ligation (BTL). However, she refuses to give written consent. What should the OB-GYN do?
A. Proceed with BTL since it is medically indicated
B. Obtain verbal consent and document it
C. Respect the patient’s decision and not perform BTL
D. Ask the husband to sign consent instead
C. Respect the patient’s decision and not perform BTL
Rationale:
Sterilization requires explicit informed consent from the patient.
Even if medically advisable, the patient has full autonomy over her reproductive choices.
- Which of the following should NOT be included in informed consent for surgical sterilization?
A. Explanation of the procedure
B. Risks and benefits of the procedure
C. Alternative contraceptive methods
D. Explanation that sterilization procedures have an insignificant failure rate
D. Explanation that sterilization procedures have an insignificant failure rate
Rationale:
No sterilization method is 100% effective; the failure rate must be discussed as part of informed consent.
- A 21-year-old woman consults for emergency contraception (EC) after unprotected sexual contact 48 hours ago. What should you do?
A. Give emergency contraception and discuss future strategies.
B. Inform the patient that giving EC at this time will not be effective.
C. Inform the patient that giving EC is against the law.
D. Inform the patient that giving EC is not available in the Philippines.
A. Give emergency contraception and discuss future strategies.
Rationale:
Emergency contraception (EC) is effective if given within 72 hours of unprotected intercourse.
EC is not illegal and is available in the Philippines, though it depends on the OB-GYN whether they choose to prescribe it.
- A patient presents with persistent vaginal bleeding. Examination reveals a 5x6 cm cervical mass. A biopsy confirms squamous cell carcinoma. The patient is referred for radiation and chemotherapy. What ethical principle applies?
A. Principle of Totality
B. Principle of Double Effect
C. Principle of Autonomy
D. Principle of Justice
B. Principle of Double Effect
Rationale:
The principle of double effect applies when a treatment has both good and bad effects.
The treatment is directed toward the pathologic organ (cervix) and not intended to harm the fetus, even if it may indirectly lead to fetal loss.
The act itself is not intrinsically evil, and the bad effect (fetal harm) does not outweigh the good effect (life-saving cancer treatment for the mother).
- Which of the following criteria must be met under the principle of double effect?
A. The act itself is intrinsically evil.
B. The bad effect causes the good effect.
C. The bad effect outweighs the good effect.
D. The act itself is not intrinsically evil.
D. The act itself is not intrinsically evil.
Rationale:
The principle of double effect states that an action can be morally permissible even if it has negative side effects, as long as:
The act itself is not intrinsically evil.
The bad effect does not cause the good effect.
The bad effect does not outweigh the good effect.
There is a proportionate reason to tolerate the bad effect.
- A 35-year-old G2P1 (1001) at 39 weeks, with a previous normal spontaneous delivery (NSD), requests a cesarean section (CS) due to a bad labor experience 5 years ago. There is no obstetric indication for CS. What should the OB-GYN do?
A. Proceed with the cesarean section immediately.
B. Deny the request without discussion.
C. Obtain valid informed consent and seek approval from the hospital ethics committee.
D. Convince the patient to attempt a vaginal delivery.
C. Obtain valid informed consent and seek approval from the hospital ethics committee.
Rationale:
Cesarean section on maternal request (CSMR) requires ethical considerations, especially in the absence of medical indications.
The OB-GYN must discuss risks and benefits with the patient and obtain valid informed consent.
Ethics committee approval may be necessary to ensure that the decision aligns with hospital policies and ethical standards.
- A physician’s consideration of professional, personal, financial, and legal aspects on the patient’s side is part of which ethical principle?
A. Beneficence
B. Non-maleficence
C. Justice
D. Autonomy
A. Beneficence
Rationale:
Beneficence requires that physicians consider all aspects of patient well-being, including professional, personal, financial, and legal factors, to ensure the best possible care.
- Transparency in the doctor-patient relationship is an integral part of which ethical principle?
A. Non-maleficence
B. Autonomy
C. Justice
D. Confidentiality
B. Autonomy
Rationale:
Autonomy requires that patients receive timely, relevant, and adequate information about their medical condition and treatment. Withholding information may lead to uninformed decisions that could negatively impact the patient.
- One ethical obligation of an OB-GYN is to provide treatment advice based on which principle?
A. Paternalism
B. Deliberative clinical management
C. Medical necessity
D. Patient preference
B. Deliberative clinical management
Rationale:
Deliberative clinical management ensures that treatment recommendations are based on evidence, ethical principles, and patient-centered care.
- Under what medical condition is an OB-GYN ethically justified in making a treatment recommendation?
A. When at least one medically reasonable alternative exists
B. When the physician has absolute certainty about the best choice
C. When no legal constraints are present
D. When the patient is unsure of their options
A. When at least one medically reasonable alternative exists
Rationale:
Physicians should only recommend treatments that have medical validity and ethical justification.
- What type of counseling is referred to in question #4?
A. Directive counseling
B. Non-directive counseling
C. Shared decision-making
D. Both B and C
A. Directive counseling
Rationale:
Directive counseling occurs when a physician recommends a specific treatment option based on clinical evidence and medical ethics.
- An OB-GYN’s ethical obligation to other physicians includes:
A. Creating a culture that supports professional collaboration
B. Working independently without consulting other specialists
C. Avoiding discussions about patient cases with colleagues
D. Limiting professional engagement to personal preferences
A. Creating a culture that supports professional collaboration
Rationale:
Interdisciplinary teamwork ensures high-quality patient care and ethical decision-making.
- The following actions violate the physician-patient relationship, EXCEPT:
A. Patient texting the doctor their lab test results
B. Physician ignoring patient questions about their treatment
C. Sharing confidential medical details with an unauthorized person
D. Accepting expensive gifts from a patient
A. Patient texting the doctor their lab test results
Rationale:
Communicating via text for medical results is not a breach of ethics, as long as privacy and security are maintained.
- Informed consent should include which of the following?
A. Diagnosis, purpose, method, and duration of treatment
B. Patient’s financial background
C. Religious beliefs of the physician
D. The physician’s personal opinion on the procedure
A. Diagnosis, purpose, method, and duration of treatment
Rationale:
Informed consent ensures that the patient understands the diagnosis, procedure, risks, benefits, and alternatives before agreeing to treatment.
- Confidentiality necessitates which of the following?
A. Electronic medical records require security protocols
B. Physicians can share patient information with family without consent
C. Employers can access patient medical records without permission
D. Physicians can discuss cases publicly for educational purposes
A. Electronic medical records require security protocols
Rationale:
Patient confidentiality mandates secure handling of medical records to protect personal health information.
- A 17-year-old student requests condoms or oral contraceptive pills from a healthcare provider. When is this allowed?
A. If the student presents a written consent form from a parent or guardian
B. If the student verbally requests it
C. If the student has a valid school ID
D. If the physician personally approves it
A. If the student presents a written consent form from a parent or guardian
Rationale:
Minors require parental/guardian consent before receiving contraceptives, in accordance with legal guidelines.
- A 32-year-old G3P3 patient requests an oral contraceptive prescription, but the OB-GYN refuses due to moral reasons. What should the physician do?
A. Obtain a DOH affidavit stating the refusal and reason
B. Ignore the request without explanation
C. Refer the patient to a religious organization
D. Persuade the patient to avoid contraception
A. Obtain a DOH affidavit stating the refusal and reasonA. Non-maleficence
Rationale:
Physicians with moral objections must document their stance in an affidavit for legal protection.
- A patient’s choice of oral contraceptives is primarily based on which ethical principle?
A. Non-maleficence
B. Beneficence
C. Justice
D. Confidentiality
A. Non-maleficence
Rationale:
Non-maleficence ensures that contraceptive choices prioritize patient safety and well-being, minimizing potential harm.
- A 48-year-old G6P6 (006) who delivered vaginally with two full-term live babies at a government charity hospital requests bilateral tubal ligation (BTL). However, she refuses to give written consent. What should you do?
A. Do not perform bilateral tubal ligation
B. Proceed with the procedure after informing the husband
C. Obtain verbal consent from the patient and document it
D. Ask the hospital ethics committee for approval
A. Do not perform bilateral tubal ligation
Rationale:
Sterilization requires explicit written informed consent from the patient.
Even if medically advisable, autonomy dictates that the patient has full control over her reproductive choices.
- The following should be part of informed consent for surgical sterilization, EXCEPT:
A. Explanation that sterilization procedures have an insignificant failure rate
B. Alternative contraceptive methods
C. Risks and benefits of the procedure
D. Possibility of regret and irreversible infertility
A. Explanation that sterilization procedures have an insignificant failure rate
Rationale:
No sterilization method is 100% effective. Failure rates, though low, must be disclosed as part of informed consent.
- A 21-year-old consults for emergency contraception after unprotected sexual contact 48 hours ago. What should you do?
A. Give emergency contraception and discuss future contraceptive strategies
B. Inform the patient that EC is ineffective at this time
C. Tell the patient that EC is illegal in the Philippines
D. Refuse to prescribe EC due to religious beliefs
A. Give emergency contraception and discuss future contraceptive strategies
Rationale:
Emergency contraception (EC) is effective within 72 hours of unprotected intercourse.
EC is not illegal in the Philippines, and it is at the discretion of the OB-GYN whether to prescribe it.
- A 33-year-old G1P1 at 8 weeks AOG presents with persistent vaginal bleeding. Examination reveals a 5x6 cm cervical mass. A biopsy confirms squamous cell carcinoma. You advise radiotherapy with chemotherapy. What ethical principle applies?
A. Principle of Totality
B. Principle of Double Effect
C. Principle of Autonomy
D. Principle of Non-maleficence
B. Principle of Double Effect
Rationale:
The Principle of Double Effect applies when a treatment has both beneficial and harmful effects.
The intent is to treat the pathology (cervical cancer), not to harm the pregnancy, even though fetal loss may occur as an indirect consequence.
- The following criteria must be satisfied under the Principle of Double Effect, EXCEPT:
A. The act itself is intrinsically evil
B. The bad effect does not cause the good effect
C. The act itself is not intrinsically evil
D. There is proportionate reason to tolerate the bad effect
A. The act itself is intrinsically evil
Rationale:
The Principle of Double Effect states that an action must not be intrinsically evil and that the bad effect must not outweigh the good effect.
- When dealing with gynecologic cancers during pregnancy, OB-GYNs must empower patients to make informed decisions based on an unbiased presentation of treatment options. What ethical principle applies?
A. Autonomy
B. Beneficence
C. Justice
D. Non-maleficence
A. Autonomy
Rationale:
Patients have the right to make informed decisions regarding their treatment, especially in complex cases like cancer in pregnancy.
- A 35-year-old G2P1 at 39 weeks with a previous NSD requests a cesarean section due to a bad labor experience five years ago. However, there is no medical indication for CS. What should the OB-GYN do?
A. Obtain valid informed consent and seek approval from the ethics committee
B. Proceed with the CS immediately upon request
C. Dismiss the patient’s request and refuse the procedure
D. Convince the patient to attempt vaginal delivery
A. Obtain valid informed consent and seek approval from the ethics committee
Rationale:
Cesarean section on maternal request (CSMR) requires ethical consideration when there is no medical indication.
The OB-GYN must discuss risks and benefits and obtain ethics committee approval if needed.
- A proper informed consent process includes all of the following, EXCEPT:
A. Ongoing process
B. Voluntary decision-making
C. Disclosure of risks and benefits
D. Doctor’s personal opinion on treatment choice
D. Doctor’s personal opinion on treatment choice
Rationale:
Informed consent is an ongoing process that involves disclosure of information, voluntary decision-making, and patient understanding.
- Reasonable access to healthcare services regardless of social status, educational level, or gender orientation falls under which ethical principle?
A. Autonomy
B. Justice
C. Beneficence
D. Non-maleficence
B. Justice
Rationale:
Justice ensures fairness in medical treatment, including equal access to healthcare services.
- An OB-GYN who offers treatment options without recommending one specific option, allowing shared decision-making, follows which type of counseling?
A. Non-directive
B. Directive
C. Paternalistic
D. Persuasive
A. Non-directive
Rationale:
Non-directive counseling allows the patient to explore all options without physician bias.
- An OB-GYN who refuses to provide healthcare based on religious or ethical convictions is called a:
A. Conscientious objector
B. Paternalistic physician
C. Ethical dissenter
D. Medical advocate
A. Conscientious objector
Rationale:
A conscientious objector is a healthcare provider who refuses to perform certain legal medical services due to personal ethical or religious beliefs.
- What is true about the role of OB-GYNs in handling adolescent pregnancies?
A. Secure consent from parents or guardians before any procedure
B. Provide confidential services regardless of age
C. Require the patient to be married for treatment
D. Automatically perform termination if requested
A. Secure consent from parents or guardians before any procedure
Rationale:
Minors (<18 years) require parental/guardian consent for medical procedures, as required by law.
- An OB-GYN’s role in contraception should include which of the following?
A. Encourage male partners to share responsibility
B. Emphasize that contraception is solely a woman’s responsibility
C. Require written consent from male partners
D. Discourage male involvement in contraceptive decisions
A. Encourage male partners to share responsibility
Rationale:
Both partners share responsibility in ensuring safer sex and contraception use to prevent unplanned pregnancy and sexually transmitted infections (STIs).
- A 22-year-old G1P0 at 10 weeks AOG presents to the ER with vaginal bleeding. She admits to having induced an abortion by taking misoprostol. What is the ethical action for the OB-GYN?
A. Assess the patient and perform completion curettage
B. Report the patient to legal authorities
C. Refuse to provide medical care due to personal beliefs
D. Dismiss the patient from the ER
A. Assess the patient and perform completion curettage
Rationale:
Dilation and curettage (D&C) is performed to remove remaining uterine tissue after a miscarriage or abortion to prevent complications such as infection and hemorrhage.
Ethical responsibility dictates that the physician must provide medical care, regardless of personal or legal considerations regarding the abortion.
- Which ethical principle states that the associated risk of harm and injury must be reasonable, minimized, and remedied with appropriate measures?
A. Non-maleficence
B. Beneficence
C. Autonomy
D. Justice
A. Non-maleficence
Rationale:
Non-maleficence is the obligation of a physician not to harm the patient and to minimize avoidable risks in medical care.
- Which condition should be considered when managing a pregnant woman who is brain dead?
A. Health status of the fetus
B. Maternal prognosis
C. Family’s financial situation
D. Socioeconomic status of the mother
A. Health status of the fetus
Rationale:
When managing a brain-dead pregnant woman, the health and viability of the fetus must be assessed to determine if continued pregnancy is medically feasible.
- What stage of cancer is characterized by tumor extension outside the uterus but limited to genital structures such as the adnexa?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
B. Stage II
Rationale:
Stage I: Cancer is confined to the uterus.
Stage II: Cancer extends outside the uterus but is limited to genital structures such as the adnexa (ovaries, fallopian tubes), cervix, or vagina.
Stage III: Cancer spreads beyond the genital structures but remains within the pelvis.
Stage IV: Cancer spreads to distant organs outside the pelvis.
A 77-year-old multigravida presents with a palpable mass at the vulva. Examination reveals a fleshy mass in the vulvar region measuring 3x4 cm.
- Based on the initial presentation, what is the most likely differential diagnosis?
A. Bartholin’s cyst
B. Prolapse
C. Vulvar carcinoma
D. Abscess
B. Prolapse
Rationale:
Pelvic organ prolapse (POP) occurs when weakened pelvic floor muscles cause descent of pelvic organs.
A fleshy, reducible mass in an elderly multigravida strongly suggests pelvic organ prolapse rather than a cyst, abscess, or malignancy.
A 77-year-old multigravida presents with a palpable mass at the vulva. Examination reveals a fleshy mass in the vulvar region measuring 3x4 cm.
- On rectovaginal exam, the mass is soft and replaceable into the vaginal canal. The total vaginal length is 8 cm. With the Valsalva maneuver, the most distal part of the mass is 3 cm away from the hymen. What is the stage based on ICS staging?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
C. Stage III
Rationale:
Stage I: Prolapse >1 cm above the hymen.
Stage II: Prolapse ≤1 cm proximal or distal to the hymen.
Stage III: Prolapse >1 cm below the hymen but does not completely evert the vaginal canal.
Stage IV: Complete vaginal eversion.
Since the most distal part of the mass is 3 cm below the hymen, this is classified as Stage III pelvic organ prolapse.
A 77-year-old multigravida presents with a palpable mass at the vulva. Examination reveals a fleshy mass in the vulvar region measuring 3x4 cm.
- What is the best treatment option for the patient in Stage III pelvic organ prolapse?
A. Kegel exercises
B. Pessary
C. Surgery
D. Observation
C. Surgery
Rationale:
Stage III prolapse usually requires surgical intervention as conservative treatments (pessaries, Kegel exercises) are less effective.
Surgical options include vaginal hysterectomy with vaginal vault suspension and anterior-posterior colporrhaphy.
A 77-year-old multigravida presents with a palpable mass at the vulva. Examination reveals a fleshy mass in the vulvar region measuring 3x4 cm.
- What anatomical areas are involved in pelvic organ prolapse?
A. Perineal muscles
B. Cardinal ligament
C. Pelvic fascia
D. All of the above
D. All of the above
Rationale:
The pelvic support system is made up of multiple structures, including:
Perineal muscles (support vaginal and rectal walls).
Cardinal ligaments (support the uterus and upper vagina).
Pelvic fascia (provides connective tissue support).
A 77-year-old multigravida presents with a palpable mass at the vulva. Examination reveals a fleshy mass in the vulvar region measuring 3x4 cm.
- The patient was lost to follow-up for 12 months. Upon return, the mass has increased to 8x7 cm with areas of inflammation. The total vaginal length remains 8 cm, but with the Valsalva maneuver, the most distal part of the mass is now 8 cm away from the hymen. What is the ICS staging?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
D. Stage IV
Rationale:
Stage IV is characterized by complete vaginal eversion.
Since the mass extends 8 cm beyond the hymen, this is classified as Stage IV pelvic organ prolapse.
77-year-old multigravida presents with a palpable mass at the vulva. Examination reveals a fleshy mass in the vulvar region measuring 3x4 cm.
- What is the best treatment option for a patient with Stage IV pelvic organ prolapse?
A. Pessary
B. Kegel exercises
C. Surgery
D. Observation
C. Surgery
Rationale:
Stage IV prolapse requires definitive surgical correction to restore pelvic anatomy and prevent complications.
Surgical options include vaginal hysterectomy with vaginal vault suspension and anterior-posterior colporrhaphy.
- Based on the patient’s symptoms and examination findings, what is the initial consideration?
A. Urethrocele
B. Cystocele
C. Rectocele
D. Enterocele
A. Urethrocele
Rationale:
Urethrocele occurs when the urethra and bladder neck prolapse into the vaginal wall, leading to urinary incontinence or retention.
Symptoms:
Difficulty urinating unless manually repositioning the prolapse.
Anterior vaginal wall involvement, distinguishing it from rectocele (posterior wall prolapse).
- Using the POP-Q system, which anatomical point is most likely involved?
A. Aa
B. Ap
C. Ba
D. C
A. Aa
Rationale:
Point Aa is located in the midline of the anterior vaginal wall, 3 cm proximal to the urethral meatus, corresponding to the urethrovesical junction.
Because the prolapse involves the anterior vaginal wall, Point Aa is the primary reference point affected.
🔹 QUICK IDENTIFICATION TIPS FOR CASES
✅ Anterior bulge? → Think Aa/Ba (anterior vaginal wall prolapse)
✅ Posterior bulge? → Think Ap/Bp (posterior vaginal wall prolapse)
✅ Cervical prolapse? → Look at Point C
✅ Post-hysterectomy apex prolapse? → Check Point C & D
✅ Rectovaginal symptoms (splinting, constipation)? → Consider PB involvement
🔹 High-yield clinical clues:
If the bulge worsens with straining → assess Aa, Ba, Ap, Bp.
If anterior prolapse + urinary incontinence → consider urethral hypermobility (stress incontinence).
If posterior prolapse + constipation → suspect rectocele.
- The total vaginal length is 8 cm, and the mass protrudes 1 cm below the hymen. Based on ICS staging, what is the prolapse stage?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
B. Stage 2
Rationale:
Stage 1: Prolapse remains >1 cm above the hymen.
Stage 2: Prolapse is ≤1 cm above or below the hymen.
Stage 3: Prolapse extends >1 cm below the hymen but does not completely evert the vaginal canal.
Stage 4: Complete vaginal eversion.
Since the most distal part of the prolapse is 1 cm below the hymen, this is classified as Stage II pelvic organ prolapse.
- What is the best treatment option for this patient?
A. Surgery
B. Pessary
C. Kegel exercises
D. Observation
B. Pessary
Rationale:
Stage I and II prolapse are often managed conservatively.
A pessary is the first-line treatment, providing mechanical support to the pelvic organs, reducing symptoms, and avoiding surgery.
A 72-year-old multigravida presents with a complaint of “something coming out of her perineal area.” She also reports urinary and bowel incontinence. On rectovaginal exam, the cervix is 5 cm above the hymen, and a fleshy, soft mass measuring 4x5 cm protrudes from the vulva. On Valsalva maneuver, the most distal part descends 2.5 cm below the hymen.
- What are the possible differential diagnoses?
A. Cystocele and enterocele
B. Urethrocele and rectocele
C. Bartholin’s cyst and cystocele
D. Vulvar carcinoma and rectocele
A. Cystocele and enterocele
Rationale:
Cystocele: Occurs when the bladder protrudes into the vaginal wall, causing urinary incontinence or retention.
Enterocele: Involves herniation of the small intestine into the vaginal wall, leading to bowel dysfunction.
Since the patient experiences both urinary and bowel incontinence, both conditions must be considered.
A 72-year-old multigravida presents with a complaint of “something coming out of her perineal area.” She also reports urinary and bowel incontinence. On rectovaginal exam, the cervix is 5 cm above the hymen, and a fleshy, soft mass measuring 4x5 cm protrudes from the vulva. On Valsalva maneuver, the most distal part descends 2.5 cm below the hymen.
- On Valsalva maneuver, the mass is coming from the posterior vaginal wall. How can you differentiate a rectocele from an enterocele?
A. Digital rectal exam
B. Transillumination
C. MRI
D. Ultrasound
B. Transillumination
Rationale:
Enterocele contains loops of small intestine, which can be transilluminated.
Rectoceles do not transilluminate because they consist of the rectum and surrounding soft tissue.
A 72-year-old multigravida presents with a complaint of “something coming out of her perineal area.” She also reports urinary and bowel incontinence. On rectovaginal exam, the cervix is 5 cm above the hymen, and a fleshy, soft mass measuring 4x5 cm protrudes from the vulva. On Valsalva maneuver, the most distal part descends 2.5 cm below the hymen.
- What is the best treatment option for this patient?
A. Transabdominal reduction
B. McCall stitch
C. Abdominal sacrocolpopexy
D. All of the above
D. All of the above
Rationale:
McCall stitch: Used to prevent enterocele formation during vaginal hysterectomy.
Abdominal sacrocolpopexy: Definitive surgical repair for advanced pelvic organ prolapse.
Transabdominal reduction: May be necessary in severe enterocele cases.
A 72-year-old multigravida presents with a complaint of “something coming out of her perineal area.” She also reports urinary and bowel incontinence. On rectovaginal exam, the cervix is 5 cm above the hymen, and a fleshy, soft mass measuring 4x5 cm protrudes from the vulva. On Valsalva maneuver, the most distal part descends 2.5 cm below the hymen.
- Based on the patient’s symptoms and examination findings, what is the most likely diagnosis?
A. Pelvic organ prolapse, urethrocele, enterocele
B. Rectocele, cystocele, and vulvar carcinoma
C. Uterine prolapse, Bartholin’s cyst, and cystocele
D. Vulvar hematoma, rectocele, and urethral diverticulum
A. Pelvic organ prolapse, urethrocele, enterocele
Rationale:
Pelvic organ prolapse (POP): Protrusion of pelvic organs into the vaginal wall due to weakened support structures.
Urethrocele: Prolapse of the urethra into the anterior vaginal wall, affecting urination.
Enterocele: Herniation of the small intestine into the vaginal wall, leading to bowel dysfunction.
A 72-year-old multigravida presents with a complaint of “something coming out of her perineal area.” She also reports urinary and bowel incontinence. On rectovaginal exam, the cervix is 5 cm above the hymen, and a fleshy, soft mass measuring 4x5 cm protrudes from the vulva. On Valsalva maneuver, the most distal part descends 2.5 cm below the hymen.
- Based on the physical examination findings, what is the ICS staging for pelvic organ prolapse?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
C. Stage III
Rationale:
Stage I: Prolapse remains >1 cm above the hymen.
Stage II: Prolapse is ≤1 cm above or below the hymen.
Stage III: Prolapse extends >1 cm below the hymen but does not completely evert the vaginal canal.
Stage IV: Complete vaginal eversion.
Since the mass descends 2.5 cm below the hymen, this is classified as Stage III pelvic organ prolapse.
- Based on ICS staging of pelvic floor prolapse, if the most distal part is more than 1 cm above the hymen, at which stage can you categorize the prolapse?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
A. Stage I
Rationale:
Stage I: Prolapse remains more than 1 cm above the hymen.
Stage II: Prolapse is ≤1 cm above or below the hymen.
Stage III: Prolapse is >1 cm below the hymen but does not completely evert the vaginal canal.
Stage IV: Complete vaginal eversion.
- Based on ICS staging of pelvic floor prolapse, if the most distal part is more than 1 cm below the hymen but not more than 2 cm less than the total vaginal length, what is the stage?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
C. Stage III
Rationale:
Stage III: Prolapse is more than 1 cm below the hymen but does not reach the total vaginal length minus 2 cm.
This stage represents moderate to severe pelvic organ prolapse, where surgical intervention is often considered.
- This anatomical point is measured from the posterior margin of the posterior vaginal wall to the middle of the anal opening. What is it called?
A. Point C
B. Perineal body
C. Point Ba
D. Point Bp
B. Perineal body
Rationale:
The perineal body (PB) is the fibromuscular structure located between the posterior vaginal wall and rectum, providing support for the perineum and anal sphincter.
- What is the term used to describe the most distal part of the remaining upper posterior vaginal wall, with a range of -3 cm to the total vaginal length?
A. Point Aa
B. Point Bp
C. Point C
D. Point D
B. Point Bp
Rationale:
Point Bp is a posterior vaginal wall reference point in the Pelvic Organ Prolapse Quantification (POP-Q) system, used to assess posterior compartment prolapse.
🔹 QUICK IDENTIFICATION TIPS FOR CASES
✅ Anterior bulge? → Think Aa/Ba (anterior vaginal wall prolapse)
✅ Posterior bulge? → Think Ap/Bp (posterior vaginal wall prolapse)
✅ Cervical prolapse? → Look at Point C
✅ Post-hysterectomy apex prolapse? → Check Point C & D
✅ Rectovaginal symptoms (splinting, constipation)? → Consider PB involvement
🔹 High-yield clinical clues:
If the bulge worsens with straining → assess Aa, Ba, Ap, Bp.
If anterior prolapse + urinary incontinence → consider urethral hypermobility (stress incontinence).
If posterior prolapse + constipation → suspect rectocele.
- Which point is measured using the posterior fornix?
A. Point C
B. Point Ba
C. Point D
D. Point Ap
C. Point D
Rationale:
Point D is used in ICS staging to assess uterine and vaginal vault prolapse, representing the posterior fornix location.
🔹 QUICK IDENTIFICATION TIPS FOR CASES
✅ Anterior bulge? → Think Aa/Ba (anterior vaginal wall prolapse)
✅ Posterior bulge? → Think Ap/Bp (posterior vaginal wall prolapse)
✅ Cervical prolapse? → Look at Point C
✅ Post-hysterectomy apex prolapse? → Check Point C & D
✅ Rectovaginal symptoms (splinting, constipation)? → Consider PB involvement
🔹 High-yield clinical clues:
If the bulge worsens with straining → assess Aa, Ba, Ap, Bp.
If anterior prolapse + urinary incontinence → consider urethral hypermobility (stress incontinence).
If posterior prolapse + constipation → suspect rectocele.
- Level I normal support of the pelvic organs is provided by which anatomic structure(s)?
A. Perineal muscles
B. Uterosacral ligaments
C. Arcus tendineus
D. Endopelvic tissues
B. Uterosacral ligaments
Rationale:
Level I support is pro2. Level II normal support of the pelvic organs is provided by which anatomic structure(s)?
A. Perineal muscles
B. Uterosacral ligaments
C. Arcus tendineus
D. Endopelvic tissuesvided by the uterosacral and cardinal ligaments, which suspend the uterus and vaginal apex to the sacrum and pelvic sidewalls.
- Level II normal support of the pelvic organs is provided by which anatomic structure(s)?
A. Perineal muscles
B. Uterosacral ligaments
C. Arcus tendineus
D. Endopelvic tissues
C. Arcus tendineus
Rationale:
Level II support comes from the arcus tendineus fascia pelvis, which anchors the mid-vagina to the pelvic sidewalls.
- Level II support is responsible for stabilizing which structure?
A. Vaginal apex
B. Cervix
C. Mid-vagina
D. Inferior vagina
C. Mid-vagina
Rationale:
Level II support stabilizes the mid-vagina by attaching it to the arcus tendineus fascia pelvis, preventing vaginal wall descent.
- What is the most common risk factor for pelvic organ prolapse (POP)?
A. Vaginal birth
B. Menopause
C. Heavy exercise
D. Constipation
A. Vaginal birth
Rationale:
Vaginal birth (parity) is the strongest risk factor due to direct trauma to pelvic floor muscles, nerves, and connective tissue, leading to weakened pelvic support.
- According to the POP-Q system, if the cervix and uterus prolapse more than 1 cm below the hymen but no farther than 2 cm less than the total vaginal length, what is the stage?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
C. Stage III
Rationale:
Stage III: Prolapse extends more than 1 cm below the hymen but does not reach total vaginal length minus 2 cm.
Stage IV: Complete vaginal eversion.
- An elderly multigravida presents with urinary incontinence and a soft, pliable mass at the introitus. Pelvic exam shows the cervix is 2 cm above the hymen. What is the POP-Q stage?
A. Stage 0
B. Stage I
C. Stage II
D. Stage III
B. Stage I
Rationale:
Stage I: Prolapse remains more than 1 cm above the hymen.
The cervix is 2 cm above the hymen, which qualifies as Stage I POP.
- What is the best management for an elderly multigravida with a Stage I pelvic organ prolapse?
A. Pessary
B. Estrogen cream
C. Vaginal hysterectomy
D. No treatment necessary
A. Pessary
Rationale:
Mild prolapse (Stage I-II) is managed conservatively using pessaries, pelvic floor exercises, and estrogen therapy.
Surgery is reserved for more severe cases (Stage III-IV) or persistent symptoms.
- A fascial break in the pubocervical fascia results in what type of prolapse?
A. Enterocele
B. Rectocele
C. Cystocele
D. Urethrocele
C. Cystocele
Rationale:
Cystocele occurs when the pubocervical fascia weakens, allowing the bladder to protrude into the anterior vaginal wall.
- Prevention of which type of pelvic organ prolapse (POP) can be done by incorporating uterosacral ligaments into vault repair?
A. Enterocele
B. Rectocele
C. Cystocele
D. Urethrocele
A. Enterocele
Rationale:
Enterocele (herniation of the small intestine into the vaginal canal) can be prevented by suturing the uterosacral ligaments during pelvic reconstructive surgery.
- A 52-year-old multigravida presents with a complaint of “something coming out of her vulva.” Examination shows that the most distal part of the prolapse is less than 1 cm from the hymen and is located at the anterior vaginal wall. According to the POP-Q system, which points are most likely involved?
A. Aa
B. Ap
C. Ba
D. Bp
A. Aa
Rationale:
Point Aa: Located 3 cm proximal to the urethral meatus; represents anterior vaginal wall descent.
- In which situation should a C-section be performed in a brain-dead pregnant woman?
A. Fetal heart rate at 120 bpm
B. Mother died 60 minutes ago
C. Baby’s suspected father wishes the baby to live
D. No indication for a C-section delivery
A. Fetal heart rate at 120 bpm
Rationale:
A viable fetus with a detectable heart rate may be delivered via emergency C-section in a brain-dead mother.
Maternal death beyond a certain time frame (e.g., 60 minutes) reduces the likelihood of a successful fetal outcome.
- What is the initial step in establishing safe motherhood?
A. Abstinence
B. Family planning
C. Coitus interruptus
D. Marriage
B. Family planning
Rationale:
Family planning ensures optimal maternal health, reduces unplanned pregnancies, and improves pregnancy outcomes.
Abstinence and marriage are personal choices, but contraception and birth spacing are evidence-based approaches for safe motherhood.
- True or False: Based on the Professional Responsibility Model, “A physician is an entrepreneur rather than a professional.”
A. True
B. False
B. False
Rationale:
The Professional Responsibility Model emphasizes that a physician is a professional who prioritizes patient care over financial gain.
Entrepreneurship should not override ethical responsibilities in medical practice.
- All of the following are necessary conditions for informed consent, EXCEPT:
A. Timely, irrelevant, adequate information
B. Competent person
C. No undue pressure, threat, or reward
D. Not irrevocable
A. Timely, irrelevant, adequate information
Rationale:
Informed consent must include timely, relevant, and adequate information for the patient to make an informed decision.
The inclusion of “irrelevant” information negates the principle of providing necessary details.
