Midterm 2 Çıkmışları Flashcards
With regard to hypertension in pregnancy, which statement is most appropriate?
A Normal physiological change is for an increase in blood pressure from the first trimester onwards.
B The most important regulatory factor of maternal blood pressure in pregnancy is a fall in peripheral resistance.
C A diastolic reading of >90 mmHg is more significant than a systolic reading of >140 mmHg.
D Pre-eclampsia is defined as the development of hypertension after 20 weeks.
B The most important regulatory factor of maternal blood pressure in pregnancy is a fall in peripheral resistance. This is the correct answer.
Info. Normal physiological change is for a decrease in blood pressure (BP) from the first trimester onwards with a later gentle rise to pre-pregnancy levels in the third trimester. More emphasis is now paid to the systolic reading, especially >160 mmHg, as there is a greater tendency for cerebral haemorrhage, and there is a strong recommendation to immediately treat and bring the systolic BP <150 mmHg and preferably <140 mmHg. Hypertension after 20 weeks is gestational in the absence of proteinuria, and the diagnosis would be pre-eclampsia in the additional presence of significant proteinuria. Several factors may contribute to a rise in BP, although it is known that there is a fall in peripheral resistance due to vasodilatory hormones, including oestrogen and progesterone. In pre-eclampsia the vasoconstrictor thromboxane and vasodilatory prostacyclin, mainly liberated by the platelets and endothelial cells of blood vessels, play a major role.
Infertility evaluation is initiated on a 44-year-old couple. She was on oral contraceptives for 15 years and has been off them for 2 years. She had chlamydia and pelvic inflammatory disease in college and was treated with confirmed cure. Her cycles are regular. Her husband was married before, and his wife did not get pregnant although they were trying to conceive. He was smoker at the time but quit 9 years ago. He uses antihypertensive treatment.
All of the following factors may be responsible for this couple’s fertility problem EXCEPT one:
Decreased ovarian reserve
Tubal obstruction
Long term oral contraceptive usage
Male factor
Except Long term oral contraceptive usage
Info: Pelvic inflammatory disease may results in tubal factor infertility.
Failure to have a child from a previous relationship should suggest male infertility.
Advanced female age is a risk factor for decreased ovarian reserve.
There is no effect for long term oral contraceptive usage on fertility
Complete the following sentences regarding congenital infections:
Varicella Zoster Virus infection causes [A]
Zika virus infection causes [B]
Parvovirus B19 infection causes [C]
Rubella virus infection causes [D]
Toxoplasmosis infection causes [E]
Treponema pallidum infection causes [F]
1) chorioretinitis and hydrocephalus
2) anemia and hydrops fetalis
3) hepatosplenomegaly and placental thickening
4) cicatricial skin lesions
5) cataract and cardiac malformations
6) severe microcephaly
Varicella Zoster Virus infection causes cicatricial skin lesions (A- 4)
Zika virus infection causes severe microcephaly (B- 6)
Parvovirus B19 infection causes anemia and hydrops fetalis (C- 2)
Rubella virus infection causes cataract and cardiac malformations (D- 5)
Toxoplasmosis infection causes chorioretinitis and hydrocephalus (E- 1)
Treponema pallidum infection causes hepatosplenomegaly and placental thickening (F- 3)
Additional information: Congenital Zika virus infection characteristics are ventriculomegaly, severe microcephaly, intracranial calcifications.
The classic triad of congenital toxoplasmosis are chorioretinitis, hydrocephalus and periventricular calcifications.
Congenital VZV infection characteristics are cicatricial skin lesions, limb abnormalities, ocular defects, CNS abnormalities
Fetal syphilis infection manifestations are hepatosplenomegaly, ascites, polyhydramnios, placental thickening, and hydrops fetalis.
Congenital Parvovirus B19 infection characteristics are abortion, severe fetal anemia, nonimmune hydrops fetalis, and even fetal demise.
Fetal Rubella virus infection manifestations are deafness, cataracts, retinopathy, central nervous system anomalies (microcephaly), cardiac malformations, growth retardation, hepatosplenomegaly, hemolytic anemia, and thrombocytopenia.
Which of the following histologic findings are seen with condyloma acuminatum?
Flat cells with centrally located, spindle-shaped nuclei
Thickened epithelium with koilocytes with perinuclear vacuolization
Columnar cells in areas replacing squamous cells
An increased number of squamous cells with hyperkeratosis
Round cells with centrally located nuclei
Thickened epithelium with koilocytes with perinuclear vacuolization
Info: The histopathologic features are compatible with condyloma acuminatum. Mainly the histopathologic findings of condyloma acuminatum are; papillary, exophytic, fingerlike (treelike) fibrovascular cores of stroma covered by thickened squamous epithelium. The epithelial cells have viral cytopathic effect; koilocytic atypia (Nuclear enlargement, Hyperchromasia and cytoplasmic perinuclear halo)
Which of the following describes the clinical presentation of vulvar lichen sclerosus?
Pale gray parchment-like skin around the introitus, with atrophy and fibrosis
Excessive itching around the vulva at night, with small burrows in the skin
Small, grayish-brown papules on the labia
White vaginal discharge with erythema of the labia
Foul-smelling, greenish vaginal discharge
Pale gray parchment-like skin around the introitus, with atrophy and fibrosis
Info: Lichen sclerosus is a non-neoplastic epithelial disorder of vulva. The surface resembles porcelain or parchment paper. Labia become atrophic, and the vaginal orifice may constrict. Most common risk factor is postmenopausal period. Microscopically it is characterized by marked thinning of the epidermis and bandlike lymphocytic infiltrate in the underlying dermis. Although lichen sclerosus is not itself a premalignant lesion, women with symptomatic lichen sclerosus have a slightly increased risk of developing SCC of the vulva.
Which of the following testicular neoplasia is macroscopically well demarcated; microscopically have sheets or lobular configuration with fibrous septae and lymphocytic infiltrate with plasma cells?
Seminoma
Yolk sac tumor
Embryonal carcinoma
Teratoma
Choriocarcinoma
Seminoma
Info: Seminomas are the most common type of testicular neoplasia. Grossly tumor is a solid tumor that is well demarcated, homogeneous and cream or grey colored. Microscopically tumor is shows sheets or lobular configuration with fibrous septae. Tumor cells are uniform with characteristic cytological features (cell membranes are well defined with distinct cell boundaries). A lymphocytic infiltrate is present (T lymphocytes) with plasma cells and also germinal centers may occur.
A 32-year-old female presents to the outpatient clinic with complaints of lesions on her vulva. She has no pain, discharge, or fever. She denies any trauma or use of illicit drugs. However, she was on holiday and had unprotected sex. Six weeks after returning, she noticed the lesions. The rest of his medical history is unremarkable. On physical exam, there are two 1 cm irregular brown papular eruptions on the left labium majus. The lesions have a fern-like appearance and are non-tender to palpation. Bloodwork is unremarkable.
Which of the followings could be responsible for the patient’s complaints?
Treponema pallidum
Chlamidia trochomatis
HPV type 6 and 11
HPV type 16 and 18
HPV type 6 and 11
Info: Genital HPV infections have an estimated prevalence of 10% to 20% with clinical manifestations in 1%. The incidence of HPV infection has been increasing. About 80% of those infected are between the ages of 17 and 33 years, with the peak age group being 20 to 24.
Genital warts are typically diagnosed visually with confirmatory biopsy generally unnecessary. These exophytic lesions form due to enlargement of the dermal papillae and are lined by hyperplastic squamous epithelium that shows koilocytes, which are squamous epithelial cells characterized by an acentric, hyperchromatic nucleus displaced by a large perinuclear vacuole.
Genital warts may occur separately or in clusters. They may be found in the anal or genital area, including the penile shaft, scrotum, vagina, or labia majora. They also can be found on internal surfaces of the vagina and the anus.
They can be small (5 mm or less in diameter) or spread into large masses in the genital or anal area. Their color is variable but tends to be skin-colored or darker, and they may occasionally bleed. HPV types 6 and 11 cause genital warts. There are over 200 different known types of HPV viruses. HPV is spread through direct skin-to-skin contact with an infected individual, usually during sex.
What is the primary mechanism of action of clomiphene as a synthetic ovulation stimulant?
As an estrogen antagonist that promotes negative feedback to the anterior pituitary
As an estrogen agonist that inhibits negative feedback to the anterior pituitary
As an estrogen antagonist that inhibits negative feedback to the anterior pituitary
As an estrogen agonist that promotes negative feedback to the anterior pituitary
As an estrogen antagonist that inhibits negative feedback to the anterior pituitary
Info: Clomiphene, a selective estrogen receptor modulator (SERM), a competitive inhibitor at estrogen nuclear receptors (a drug with antagonist/partial agonist properties), interferes with the negative feedback of estrogens on the hypothalamus by binding to estrogen receptors and thereby causes an increase in the secretion of GnRH and gonadotropins (LH, FSH).
Which of the following observations would likely require futher assesment in a newborn?
Cyanosis of the hand and feet
Blueberry muffins
Mongolian spot
Erythema toxicum
Vernix caseosa
Blueberry muffins
Info: Skin findings such as erythema toxicum, Mongolian spots, peripheral cyanosis, and vernix caseosa are common and normal in newborns but blueberry muffin rash, characterized by purplish-red nodules or lesions on the skin, can be indicative of congenital infections such as cytomegalovirus or rubella.
Match the following histopathologic features with the diagnosis of cervical lesions.
Chronic inflammatory condition characterized by thinning of the epithelium and atrophic and sclerotic changes [A]
Severe dysplasia involving the full thickness of the cervical epithelium, with marked nuclear abnormalities, loss of cellular polarity, and increased mitotic activity [B]
Mild dysplasia involving the lower third of the cervical epithelium, characterized by nuclear enlargement, hyperchromasia, and mild disorganization of cell architecture [C]
Malignant tumor of the cervix arising from the cervical epithelium, characterized by invasion beyond the basement membrane into the stroma or surrounding tissues [D]
Abnormal cervical cytology indicating severe dysplasia or carcinoma in situ [E]
Moderate dysplasia involving the lower two-thirds of the cervical epithelium, with nuclear abnormalities and cellular disorganization [F]
Chronic inflammatory condition characterized by hyperplasia of the squamous epithelium, hyperkeratosis, and acanthosis [G]
Abnormal cervical cytology indicating mild to moderate dysplasia [H]
1 Cervical Intraepithelial Neoplasia I
2 Cervical Intraepithelial Neoplasia II
3 Cervical Intraepithelial Neoplasia III
4 Low Grade Squamous Intraepithelial Lesion (LSIL)
5 High Grade Squamous Intraepithelial Lesion (HSIL)
6 Cervical Cancer
7 Lichen Sclerosus
8 Lichen Simplex Chronicus
Chronic inflammatory condition characterized by thinning of the epithelium and atrophic and sclerotic changes, Lichen Sclerosus A- 7
Severe dysplasia involving the full thickness of the cervical epithelium, with marked nuclear abnormalities, loss of cellular polarity, and increased mitotic activity, Cervical Intraepithelial Neoplasia III B- 3
Mild dysplasia involving the lower third of the cervical epithelium, characterized by nuclear enlargement, hyperchromasia, and mild disorganization of cell architecture, Cervical Intraepithelial Neoplasia I C-1
Malignant tumor of the cervix arising from the cervical epithelium, characterized by invasion beyond the basement membrane into the stroma or surrounding tissues, Cervical Cancer D- 6
Abnormal cervical cytology indicating severe dysplasia or carcinoma in situ, High Grade Squamous Intraepithelial Lesion (HSIL) E-5
Moderate dysplasia involving the lower two-thirds of the cervical epithelium, with nuclear abnormalities and cellular disorganization, Cervical Intraepithelial Neoplasia II F-2
Chronic inflammatory condition characterized by hyperplasia of the squamous epithelium, hyperkeratosis, and acanthosis, Lichen Simplex Chronicus G- 8
Abnormal cervical cytology indicating mild to moderate dysplasia, Low Grade Squamous Intraepithelial Lesion (LSIL) H- 4
Which of the following behaves like competitive androgen receptor antagonist that has been used in the treatment of prostatic carcinoma and may also be useful in the management of excess androgen effect in women?
Finasteride
Flutamide
Raloxifene
Dutasteride
Flutamide
Info: Flutamide is a nonsteroidal potent antiandrogen agent used in the treatment of prostatic carcinoma as well as in the management of polycystic ovary syndrome (PCOS), a very common endocrine disorder characterized by chronic anovulation, clinical and/or biochemical hyperandrogenism, and/or polycystic ovaries. Dutasteride and finasteride inhibit convertion of testosterone to its active form, dihydro-testosterone (DHT) which stimulates prostate growth.
Which type of nipple discharge has a high risk for malignancy?
Discharge with provocation
Discharge in pre menopausal women
Discharge with blood
Discharge from both nipples
Discharge with blood
Info: Bloody, serous nipple discharge is high risk, nipple discharge with provocation is a low risk
A 26-year-old woman presents to an outpatient clinic for increased vaginal discharge and burning sensation over the last week. The discharge is foul-smelling. Her menstrual cycles are regular and last 4–5 days. She denies postcoital or intermenstrual bleeding. Her last menstrual period was 1 weeks ago. She has been sexually active with two new partners over the past 2 months and uses condoms inconsistently. Her past medical history is unremarkable. Her vitals are in normal limits. A gynecologic exam reveals a thin, yellow-green discharge accompanied by a pink, edematous vagina and an erythematous cervix.
Which of the following is the most likely diagnosis?
Candida vaginitis
Chlamidia cervicitis
Trichomonas vaginitis
Bacterial vaginosis
Trichomonas vaginitis
Response Feedback:
Trichomonas vaginitis is caused by the sexually transmitted parasite Trichomonas vaginalis. Trichomoniasis is associated with a copious, mucopurulent, and malodorous vaginal discharge. Vulvar pruritus may accompany the vaginal discharge. Pelvic examination reveals patchy vaginal erythema (“strawberry cervix”).
Which of the following features is not correct for lactational mastitis?
Most common microorganism is staphylococcus aureus
Breastfeeding should be discontinued in lactational mastitis
If a breast abscess develops, surgical drainage is required
Patients with lactational mastitis typically present with a swollen and tender region of the breast, which may also be red in patients with lighter skin tone.
Breastfeeding should be discontinued in lactational mastitis.
This sentence is incorrect as breastfeeding can, in fact, helps the regression of the infection as it reduces stasis.
Match the following screenings and examinations that should be performed in antenatal care with the periods that should be performed.
Administering anti-D immunglobulin tp RhD-negative pregnant patient [A]
Measurement of fetal nuchal translucency [B]
Screening for group B beta-hemolytic Streptococus [C]
Screening for gestational diabetes [D]
Screening for Syphilis [E]
1 in the first antenatal visit
2 in each antenatal visit
3 at the 11-13 weeks of gestation
4 at the 24-28 weeks of gestation
5 at the 28 weeks of gestation
6 at the 36-41weeks of gestation
7 at the time when labor started
Administering anti-D immunglobulin tp RhD-negative pregnant patient Correct at the 28 weeks of gestation A5
Measurement of fetal nuchal translucency Correct at the 11-13 weeks of gestation B3
Screening for group B beta-hemolytic Streptococus Correct at the 36-41weeks of gestation C6
Screening for gestational diabetes Correct at the 24-28 weeks of gestation D4
Screening for Syphilis Correct in the first antenatal visit E1
Make the appropriate pairings between the clinical conditions which given below and hormonal counterparts of female ovulatory disorders.
Thyroid dysfunction with the problem of abnormal uterine bleeding [Blank-1]
Ovarian insufficiency with the problem of irregular bleeding and amenorrhea [Blank-2]
Androgen excess with the problem of oligomenorrhea [Blank-3]
Anorexia nervosa [Blank-4]
A Hypogonadotropic hypoestrogenic
B Normogonadotropic normoestrogenic
C Hypergonadotropic hypoestrogenic
D Normogonadotropic hyperestrogenic
thyroid dysfunction with the problem of abnormal uterine bleeding—> Normogonadotropic normoestrogenic 1-b
Ovarian insufficiency with the problem of irregular bleeding and amenorrhea Correct Hypergonadotropic hypoestrogenic 2-c
Androgen excess with the problem of oligomenorrhea Correct Normogonadotropic hyperestrogenic 3-d
Anorexia nervosa Correct Hypogonadotropic hypoestrogenic 4-a
Additional info: WHO Classification of anovulation:
WHO type I: (hypogonadotropic hypogonadism) can be caused by any lesion affecting the pituitary or hypothalamus and affecting gonadotropin production.
WHO type II: (normogonadotropic hypogonadism) is by far the commonest cause of anovulation and is most commonly caused by polycystic ovarian syndrome. Other endocrin diseases ar in this class.
WHO type III: (hypergonadotropic hypogonadism) is usually an indication of ovarian failure
Which of the following gestational trophoblastic disease shows immature placental tissue admixed with vesicles, fetal parts and scattered grape-like villi?
Partial hydatidiform mole
Choriocarcinoma
Complete hydatidiform mole
Epithelioid Trophoblastic Tumor (ETT)
Placental Site Trophoblastic Tumor (PSTT)
Partial hydatidiform mole
Info: Partial hydatidiform mole shows immature placental tissue admixed with vesicles that tend to be smaller and less numerous than those of a complete mole. The lesion contains fetal parts and scattered grape-like villi. Also gestational sac may be present.
A 34-year-old pregnant woman at 30 weeks of gestation presents with a past medical history of preeclampsia. Her medications include daily prenatal vitamins and aspirin 75 mg once a day. A 75 g oral glucose tolerance test done at 28 weeks was 200 mg/dL at the 1st hour, and 170 mg/dL at the 2nd hour. Diet and exercise were started.
What is the pathophysiologic mechanism of this patients current diagnosis?
Failure to excrete glucose in the urine
Failure to take up glucose in tissues
Excessive glucose intake
Decreased insulin production
Failure to take up glucose in tissues
Info: Gestational and type 2 diabetes are characterized by inadequate glucose uptake in the tissues.
About 90% of patients with gestational diabetes have deficient insulin receptors even before pregnancy.
10% have inadequate insulin production.
Human placental lactogen blocks insulin receptors.
Which of the following is a pretesticular cause of infertility?
Postsurgical obstruction
Testicular radiation
Immotile cilia syndrome
Cirrhosis of the liver
Testicular tuberculosis
Cirrhosis of the liver
Info: Testicular tuberculosis, testicular radiation, Kartagener syndrome and postsurgical obstruction are among testicular/ post testicular causes. Pretesticular causes includes extragonadal and endocrine causes. They may originate from glands or systemic conditions that cause hormonal changes like cirrhosis of the liver.
Match the following pregnancy complications with the obstetric conditions that may cause them.
[1] Acute renal failure
[2] Stillbirth
[3] Bronchopulmonary dysplasia
[4] Placenta previa
[5] Intraventricular hemorrhage
[6] Urinary tract infection
[7] Disseminated intravascular coagulation
[8] Gestational diabetes
A Preterm birth
B Postpartum hemorrhage
C Multiple pregnancies
Postpartum hemorrhage Acute renal failure
Correct Multiple pregnancies Stillbirth
Correct Preterm birth Bronchopulmonary dysplasia
Correct Multiple pregnancies Placenta previa
Correct Preterm birth Intraventricular hemorrhage
Correct Multiple pregnancies Urinary tract infection
Correct Postpartum hemorrhage Disseminated intravascular coagulation
Correct Multiple pregnancies Gestational diabetes
A 25-year-old female is being investigated for an irregular bordered cyst on her right ovary. AFP levels are found to be increased. The excisional biopsy of the cyst revealed presence of Schiller-Duval bodies.
Which of the following tumor is the most likely diagnosis?
Teratoma
Granulosa cell tumour
Dysgerminoma
Yolk sac tumour
Krukenberg tumour
Yolk sac tumour
Info: Dysgerminoma: This tumour would appear similar to a testicular seminoma with diffuse sheets, nests and cords of large uniform tumour cells.
Granulosa cell tumour: This tumour would contain Call-Exner bodies
Krukenberg tumour: This tumour is a metastasis from a diffuse-type gastric adenocarcinoma, so would have a typical signet cell histology appearance.
Teratoma: This would contains ectodermal, mesodermal and endodermal tissues.
Yolk sac tumour: Schiller-Duval bodies are pathognomonic of this tumour. It also secretes AFP.
A 35 year old woman presents to physician with abnormal bleeding and chronic pain in abdominal area. She had her first successful pregnancy 4 years ago and delivered a healthy baby girl via a spontaneous vaginal delivery. The patient mentioned an intrauterine device (IUD) installation for contraception after pregnancy and the removal of the IUD about 1 year ago for a new plan for pregnancy. The tests of patient reveals normal hCG levels and no signs for pregnancy in sonography. The endometrial curettage biopsy showed irregular proliferation of endometrial glands and plasma cells in the stroma.
Which of the following situation is likely to exist in this patient?
Adenomyosis
Acute endometritis
Chronic endometritis
Endometrial hyperplasia
Endometriosis
Chronic endometritis
Feedback info: Acute endometritis is an uncommon disease and mostly limited to bacterial infections that arise after delivery, miscarriage or using an iud. The most common etiologic agents are group A hemolytic streptococci, staphylococci. In microscopy microabscesses consisted of neutrophils; infiltration and destruction of glandular epithelium is observed.
Chronic endometritis is associated with chronic pelvic inflammatory disease (PID), retained gestational tissue, postpartum or post- abortion, IUD, tuberculosis or without a cause (non-specific endometritis). Clinical manifestations include abnormal bleeding, pain, discharge and infertility. In microscopy showed irregular proliferation of endometrial glands and plasma cells in the stroma are observed.
Endometriosis is defined as ectopically located endometrial tissue (in rectovaginal septum, peritoneal surfaces, ovaries, etc.) consisting of both endometrial type glands and stroma. 6–10% of women of reproductive age is affected from endometriosis but the overall risk of an endometriosis-associated cancer is low (0.3–0.8%). Clear cell ovarian and endometrioid ovarian carcinomas may arise from endometriosis. The most common presenting symptom is cyclical pelvic pain, which occurs at time of menstruation. Also symptoms according to the locations can be observed like dysmenorrhea (Severe cramping or sharp, knifelike pelvic pain during menstruation), dyspareunia, dyscheiza, dysuria. 1/3 of the patients are asymptomatic. Adenomyosis is an endometrial tissue located within the myometrium. Symptoms similar to endometriosis including menorrhagia, metrorrhagia, menometrorrhagia, dysmenorrhea, chronic pelvic pain and dyspareunia.
Endometrial Hyperplasias are important cause of abnormal bleeding (menorrhagia, metrorrhagia, menometrorrhagia). In microsopy increased proliferation of the endometrial glands relative to the stroma (increased gland-to-stroma ratio) is seen and this situation is associated with prolonged estrogenic stimulation of the endometrium. WHO classifies endometrial hyperplasias as Non-atypical endometrial hyperplasia (Benign EH) and Atypical hyperplasia /Endometrioid intraepithelial neoplasia (AH / EIN). AH / EIN is considered as a premalignant condition (risk of both progression to and simultaneous endometrial endometrioid adenocarcinoma).
A 24-year-old woman presents with fluid leaking per vagina that she noticed earlier this morning. She is G1P0 at 38 weeks gestation. She denies vaginal bleeding and reports good fetal movement. Her medical history is noncontributory, and she has no known drug allergies. Her pre-pregnancy weight was 78 kg, and her current weight is 90 kg. Sterile speculum examination shows fluid pooling in the posterior fornix, confirming term prelabor rupture of membranes. Ultrasound shows a single viable fetus in breech presentation, reduced amniotic fluid index, and a high anterior placenta.
Which of the following steps are appropriate for the management of the case above? (Choose as many as required)
Fetal fibronectin test
Corticosteroid administration
Cesarean section
Prophylaxis for group B streptococcus
Labor induction
Only Cesarean section and Prophylaxis for group B streptococcus
A 38-year-old woman in her 28th week of pregnancy presented to the clinic for a follow-up visit. She is known to have hypertension, and she takes labetalol during her current pregnancy, and she is normotensive on prior visits to the clinic. Her vitals are a blood pressure of 126/87 mmHg, heart rate of 78/min regular, and oxygen saturation of 98% on room air. Her cardiac exam shows a low-grade systolic murmur, and the chest exam is clear for auscultation. Her fasting glucose is 141 mg\dL. The urine analysis shows bacteria but negative leukocyte esterase, and she denies any urinary symptoms, and it is positive for protein.
Which of the findings in this patient’s case should alert the physician to the worsening of pre-existing hypertension?
Patient’s age
Presence of bacteria in urine
Presence of proteinuria
Fasting glucose level of 141 mg\dL
Presence of cardiac systolic murmur
Presence of proteinuria
Info: This patient has chronic hypertension for which she is on labetalol. However, hypertension in pregnancy needs to be monitored closely even if the patient is normotensive; there is a need to check the presence of proteinuria.
Pre-eclampsia is defined per ACOG guidelines as meeting either above hypertension criteria with greater than or equal to 300 mg urine protein excretion in a 24-hour period, a protein/creatinine ratio of greater than or equal to 0.3, or a urine dipstick protein reading of at least 1+ (only used if above methods are unavailable).
Treatment/management of gestational and chronic hypertension in pregnancy is always indicated when blood pressures are in the severe range (greater than 160/110 mmHg). Several studies recommend consideration for the treatment of pressures in the mild to the moderately hypertensive range (140-160/90-110 mmHg). Commonly used therapies include calcium channel blockers, beta-blockers, and methyldopa.
Low-grade heart murmurs are common in pregnant women due to the increase in circulating volume and cardiac output.
A 24-year-old G1P0 female at 26-week gestation comes to the clinic for a routine antenatal care. Her vitals are normal and abdominal examination reveals uterine fundus nearby the xiphisternum. A transabdominal ultrasound reveals the presence of two fetuses with dual placentation and two amniotic sacs. Compared with a single fetus, her gestation has a reduced risk of which of the following condition?
Abnormal placentation
Gestational diabetes
Maternal preeclampsia
Post-term pregnancy
Post-term pregnancy
Info: This patient has presented for a routine ante-natal follow up. Her physical examination reveals the presence of a uterus that is large for the date. Ultrasound confirms the presence of dichorionic diamniotic twins. Twin gestation is associated with an increased risk of many adverse pregnancy outcomes except post-term pregnancy.
Multiple gestations lead to preterm labor rather than post-term pregnancy. The limited intrauterine space may cause fetal growth restriction and preterm labor.
Roughly half of the multiple gestations are born before 37 weeks. The reasons include limited uterine expansion, abnormal placentation, and twin to twin transfusion syndrome.
All pregnancy-related risks are increased in twin pregnancies except post-term pregnancy and fetal macrosomia. Increased placental mass increases the risk of maternal preeclampsia.
Which of the following is a potentially embryo/fetotoxic agent causing spina bifida?
Ethyl alcohol
Carbamazepine
Cocaine
Warfarine
Carbamazepine
Info: Spina bifida (a type of neural tube defect, NTD, that affects the spine and is usually apparent at birth) was the only major congenital abnormality that was confirmed to be related to carbamazepine use, with no increased risk of others such as cleft lip or diaphragmatic hernia. Carbamazepine is an anticonvulsant medication used in the treatment of epilepsy and neuropathic pain.
What is the most likely etiology of bloody discharge from the nipple?
Intraductal papilloma
Fibrocystic disease
Mastitis
Pregnancy
Galactorrhea
Intraductal papilloma
Info: Solitary papillomas (solitary intraductal papillomas) are single tumors that often grow in the large milk ducts near the nipple. They are a common cause of clear or bloody nipple discharge, especially when it comes from only one breast.
Also bloody discharge can be seen in breast carcinomas.
Which of the following conditions are risk factors for breast cancer? (Choose as many as required)
Correct
Female sex
Correct
Diet rich in saturated fats
Correct
Ethanol consumption
Breast feeding
Early menopause
Regular exercise
Early pregnancy
Correct
BRCA mutations
Correct
Older age
Düzenle
A 21-year-old female who is overweight presents to her primary care provider’s office with complaints of irregular menstrual cycles and excessive facial hair. Serum testosterone levels are found to be elevated. An ultrasound examination of her ovaries shows large ovaries with numerous follicles.
What type of ovarian follicle will most likely predominate in this patient?
Preantral and early antral follicles
Primordial follicles
There is no predominance of a certain type, just an increased number of follicles overall
Periovulatory follicles
Preantral and early antral follicles
Info: The described clinical condition is suggestive for PCOS, a disorder featuring excessive androjen, menstruel cycle abnormalities, and polycycstic ovaries.
Polycycstic ovaries have increased numbers of preantral and early antral follicles. The follicles do not develop properly throught the antral stage and degenerate into cystic structures.
Patients with PCOS also have an increased LH to FSH ratio with increased levels of androgens.
Match the following histopathologic features with the lesions of breast.
Sheets of malignant cells forming irregular tubules with infiltrative borders [A]
Proliferation of stromal and epithelial (glandular) components, forming a well-circumscribed, rubbery mass [B]
Proliferation of malignant ductal epithelial cells confined within the ductal structures, with an intact basement membrane [C]
Uniform proliferation of malignant cells within the lobules, with loss of E-cadherin expression, with an intact basement membrane [D]
Cysts lined by epithelial cells, accompanied by stromal fibrosis and varying degrees of inflammation [E]
Single-file infiltrative pattern of malignant cells, lacking cohesiveness [F]
Invasive Lobular Carcinoma
Fibrocystic disease
Ductal Carcinoma In Situ
Fibroadenoma
Invasive Ductal Carcinoma
Lobular Carcinoma In Situ
Sheets of malignant cells forming irregular tubules with infiltrative borders Correct Invasive Ductal Carcinoma
Proliferation of stromal and epithelial (glandular) components, forming a well-circumscribed, rubbery mass Correct Fibroadenoma
Proliferation of malignant ductal epithelial cells confined within the ductal structures, with an intact basement membrane Correct Ductal Carcinoma In Situ
Uniform proliferation of malignant cells within the lobules, with loss of E-cadherin expression, with an intact basement membrane Correct Lobular Carcinoma In Situ
Cysts lined by epithelial cells, accompanied by stromal fibrosis and varying degrees of inflammation Correct Fibrocystic disease
Single-file infiltrative pattern of malignant cells, lacking cohesiveness Correct Invasive Lobular Carcinoma
A 31-year-old G2P1 women at 41 weeks of gestation by definite last menstrual period and 16-week ultrasound apply to the health office. She continues to note fetal movement and her examination is normal: BP 120/68 mm Hg, urine dipstick negative for protein and glucose, fundal height 42 cm, fetus is vertex, FHR 156 bpm. Her cervix is soft, anterior, 2 to 3 cm dilated, 50% effaced, and +1 station.
According to the information above the pregnant patient has [A] pregnancy, and her labor phase is [B].
preterm
term
postterm
latent phase of first stage
active phase of first stage
second stage
According to the information above the pregnant patient has–> term pregnancy, and her labor phase is –> latent phase of first stage.
Info: Early term: 37 0/7 weeks through 38 6/7 weeks
Full term: 39 0/7 weeks through 40 6/7 weeks
Late term: 41 0/7 weeks through 41 6/7 weeks
Postterm: 42 0/7 weeks and beyond.
The first stage of labor is further subdivides into two phases, defined by the degree of cervical dilation. The latent phase is commonly defined as the 0 to 6 cm, while the active phase commences from 6 cm to full cervical dilation.
Match the case presentations below with the correct diagnosis:
A 33-year-old woman at 37 weeks’ gestation, presents with vaginal bleeding. She is noted on sonography to have an umbilical vessel is seen overlying the cervical internal os. [A]
A transabdominal ultrasound examination of a 31-year-old female at 26 weeks’ gestation reveals the presence of two fetuses with dual placentation and two amniotic sacs. [B]
A 25-year-old woman at 32 weeks’ gestation presents with painless vaginal bleeding. Leopold maneuvers shows that there is no presenting part. [C]
A 29-year-old woman has a scheduled cesarean at 37 weeks. Upon cesarean
section, bluish tissue densely adherent between the uterus and maternal bladder is noted. [D]
Placenta previa
Vasa Previa
Abruptio placenta
Placenta accreata
Placenta percreata
Monochorionic diamniotic twinnig
Dichorionic diamniotic twinnig
Breech presentation
A 33-year-old woman at 37 weeks’ gestation, presents with vaginal
bleeding. She is noted on sonography to have an umbilical vessel
is seen overlying the cervical internal os. Vasa Previa
A transabdominal ultrasound examination of a 31-year-old female
at 26 weeks’ gestation reveals the presence of two fetuses with
dual placentation and two amniotic sacs. Dichorionic
diamniotic twinnig
A 25-year-old woman at 32 weeks’ gestation presents with painless
vaginal bleeding. Leopold maneuvers shows that there is no
presenting part. Placenta previa
A 29-year-old woman has a scheduled cesarean at 37 weeks. Upon
cesarean section, bluish tissue densely adherent between the
uterus and maternal bladder is noted. Placenta percreat
The blue tissue densely adherent between the uterus and bladder is ve
characteristic of percreta, where the placenta penetrates entirely throug
myometrium to the serosa and adheres to the bladder.
In vasa previa, fetal blood vessels are present in the membranes cover
internal cervical os. On ultrasound examination, vasa previa appears as
sonolucent area that passes over the internal os. Color Doppler flow an
analysis show umbilical artery or vein waveforms and confirms that the
is a blood vessel.
Inflammatory breast cancer presents with which of the findings on physical examination? (Choose as many as required)
Pruritus
Edema
Skin thickening
Localized discoloration
Peau d’orange skin changes
Breast erythema
Edema, Skin thickening, Peu d’orange skin changes, breast erythema,
Info: Breast cancers clinically presenting with diffuse breast erythema, edema and skin thickening are named as inflammatory carcinoma. It is not a specific histologic or molecular type. Peau d’orange appearance can be seen and also it is a sign of very poor prognosis
A 28-year-old G3P2 at 38+4/7 weeks of gestation presents with pelvic pressure and a sudden gush of fluid per vagina two hours ago. She also reports increasing lower abdominal pain and uterine tightening. She is otherwise fit and well, and her vital signs are within normal limits. Speculum examination demonstrates the pooling of clear, meconium-free fluid in the vagina. Digital examination reveals a cervix dilated to six centimeters and 80% effaced and mentum anterior face presentation.
Which of the following statements are correct in the clinical condition above? (Choose as many as required)
Vaginal delivery is not possible
Chorioamnionitis is possible
Active phase of the first stage of the labor
Station is not described
Active phase of the first stage of the labor
Station is not described
A 60-year-old woman would be expected to have what levels of circulating hormones?
Estrogen ↑, Progesterone ↓, FSH ↓, LH ↓, Inhibin ↑
Estrogen ↓, Progesterone ↓, FSH ↑, LH ↑, Inhibin ↑
Estrogen ↓, Progesterone ↓, FSH ↑, LH ↑, Inhibin ↓
Estrogen ↓, Progesterone ↓, FSH ↓, LH ↓, Inhibin ↓
Estrogen ↓, Progesterone ↓, FSH ↑, LH ↑, Inhibin ↓
Info: Menopause occurs at approximately 51 years of age. Thus estradiol and progesterone levels are low. There is no negative feedback on GnRH, so LH and FSH are high. Because FSH is high, inhibin is low.
A 28 year old woman presents to physician with cyclical pelvic pain, which occurs at time of menstruation. She stated that she’s been married for 3 years but she did not have pregnancies even she is not using any contraception. In sonographic examination of the patient, a cystic mass is observed in the right ovary with 24x12x10 mm size. The excision of the cyst revealed a brown colored cyst content in gross; glandular lining of cyst wall, stroma and hemosiderin-laden macrophages in microscopic examination.
Which of the following is the most likely diagnosis?
Endometrial hyperplasia
Adenomyosis
Chronic endometritis
Acute endometritis
Endometrioma
Endometrioma
Acute endometritis is an uncommon disease and mostly limited to bacterial infections that arise after delivery, miscarriage or using an iud. The most common etiologic agents are group A hemolytic streptococci, staphylococci. In microscopy microabscesses consisted of neutrophils; infiltration and destruction of glandular epithelium is observed.
Chronic endometritis is associated with chronic pelvic inflammatory disease (PID), retained gestational tissue, postpartum or post- abortion, IUD, tuberculosis or without a cause (non-specific endometritis). Clinical manifestations include abnormal bleeding, pain, discharge and infertility. In microscopy showed irregular proliferation of endometrial glands and plasma cells in the stroma are observed.
Endometriosis is defined as ectopically located endometrial tissue (in rectovaginal septum, peritoneal surfaces, ovaries, etc.) consisting of both endometrial type glands and stroma. 6–10% of women of reproductive age is affected from endometriosis but the overall risk of an endometriosis-associated cancer is low (0.3–0.8%). Clear cell ovarian and endometrioid ovarian carcinomas may arise from endometriosis. The most common presenting symptom is cyclical pelvic pain, which occurs at time of menstruation. Also symptoms according to the locations can be observed like dysmenorrhea (Severe cramping or sharp, knifelike pelvic pain during menstruation), dyspareunia, dyscheiza, dysuria. 1/3 of the patients are asymptomatic.
Endometriomas are endometriotic cyst of ovary which are also named as chocolate cyst. In microscopic evaluation presence of endometriotic glands (glandular lining of cyst wall) and stroma and hemosiderin-laden macrophages are seen.
Adenomyosis is an endometrial tissue located within the myometrium. Symptoms similar to endometriosis including menorrhagia, metrorrhagia, menometrorrhagia, dysmenorrhea, chronic pelvic pain and dyspareunia.
Endometrial Hyperplasias are important cause of abnormal bleeding (menorrhagia, metrorrhagia, menometrorrhagia). In microsopy increased proliferation of the endometrial glands relative to the stroma (increased gland-to-stroma ratio) is seen and this situation is associated with prolonged estrogenic stimulation of the endometrium. WHO classifies endometrial hyperplasias as Non-atypical endometrial hyperplasia (Benign EH) and Atypical hyperplasia /Endometrioid intraepithelial neoplasia (AH / EIN). AH / EIN is considered as a premalignant condition (risk of both progression to and simultaneous endometrial endometrioid adenocarcinoma)
A 65-year-old woman presents to the clinic for evaluation. She has been postmenopausal for 15 years, but several weeks ago, she experienced two days of vaginal spotting. She undergoes a pelvic ultrasound, and her endometrium measures 2 mm thick.
Which of the following is the next best step in the management of this patient?
Call for repeat ultrasound in 6 months
Perform dilatation and curettage in the operating room
Give reassurance and send home to come back if it happens again
Perform an in-office endometrial sampling biopsy
Give reassurance and send home to come back if it happens again
The most common cause of postmenopausal bleeding is atrophy of the vagina and/or endometrium.
Transvaginal ultrasonography usually is sufficient for an initial evaluation of postmenopausal bleeding if the ultrasound images reveal a thin endometrial echo (less than or equal to 4 mm), given that an endometrial thickness of 4 mm or less has a greater than 99% negative predictive value for endometrial cancer.
Levonogestrel releasing intrauterine device [Blank-1]
Progestin only pills [Blank-2]
Combined oral contraceptives [Blank-3]
Copper T intrauterine device [Blank-4]
Vasectomy [Blank-5]
prevention of fertilization
blocking the egg and sperm from meeting
thickening the mucus in the cervix
making the endometrium atrophic
blocking sperm travelling from testes
inhibition of ovulation
blocking HPV transmission
Make the appropriate pairings between the contraceptive methods which given below and the main mechanisms of action.
Levonogestrel releasing intrauterine device Correct making the endometrium atrophic
Progestin only pills Correct thickening the mucus in the cervix
Combined oral contraceptives Correct inhibition of ovulation
Copper T intrauterine device Correct prevention of fertilization
Vasectomy Correct blocking sperm travelling from testes
A 22-year-old G2P1 at gestational age 6 weeks and 3 days by last menstrual period presents with 2 days of vaginal bleeding with severe cramps. Serology tests confirm blood type is A+ and an hCG level of 20,000 mlU/mL. On examination the abdomen is soft, pelvic exam reveals cervical os dilated. Some tissue part and clots are seen in vagina. A bedside ultrasound shows irregular tissue inside the uterin cavity.
Based on the information given, which of the following is the most likely diagnosis?
Complete abortion
Incomplete abortion
Threatened abortion
Missed abortion
Incomplete abortion
Info: Missed abortion: The missed death of the embryo or fetus without symptoms or expulsion of the products of conception (POC).
Threatened pregnancy loss: Symptoms (eg, bleeding and cramping) of an impending early pregnancy loss; however, the cervical os remains closed, and the embryo or fetus still appears viable on ultrasound.
Incomplete pregnancy loss: POC that remains within the uterus and the open cervical os after the diagnosis of an early pregnancy loss.
Complete pregnancy loss: The passage of all POC.
A 39-year-old gravida 2, para 2, female is diagnosed with endometrial cancer. She initially presented to the emergency department with the passage of clots and heavy vaginal bleeding. Her blood pressure was 107/56 mmHg, and pulse was 98 beats per minute. Further evaluation reveals that she underwent menarche at the age of 16, and her past medical history is significant for estrogen-receptor-positive, BRCA 1 and 2 negative, breast cancer diagnosed 4 years ago. She underwent a bilateral mastectomy, bilateral salpingo-oophorectomy, and has been taking tamoxifen for the last 46 months.
What aspect of her history conveys the greatest risk for developing endometrial cancer?
Age less than 40 years old
Heavy menstruel bleeding
Menarche at 16 years old
Multiparity
Use of Tamoxifen
Use of Tamoxifen
Info: Although the peak age for endometrial cancer is 60 years, most clinicians agree that women who are 40 years of age or older are at increased risk. Contrary to its anti-estrogenic effect on breast tissue, tamoxifen has a stimulatory effect on the endometrium. As a result, patients taking tamoxifen are at an increased risk of developing endometrial cancer.Other risk factors include diabetes mellitus, irregular menstrual cycles, and the presence of atypical glandular cells (AGC) on a Pap smear. Use of oral contraceptive pills, cigarette smoking, and multiparity are considered protective factors.
A 37-year-old woman at 13 weeks gestation presents to the clinic for a regular visit. Screening for aneuploidy, including trisomy 18, is planned.
Which of the following sets of parameters is most appropriate to be ordered as a screening test in this case?
Fetal nuchal translucency measurement, inhibin, human chorionic gonadotropin
Biparietal diameter measurement, human chorionic gonadotropin, alpha fetoprotein
Fetal nuchal translucency measurement, alpha fetoprotein, human chorionic gonadotropin alpha fetoprotein
Fetal nuchal translucency measurement, pregnancy-associated plasma protein A, human chorionic gonadotropin
Fetal nuchal translucency measurement, pregnancy-associated plasma protein A, human chorionic gonadotropin
First-trimester screening is used to screen for trisomy (21, 18, and 13) which includes:
*fetal nuchal translucency measurement
*pregnancy-associated plasma protein A (PAPP-A)
*free or total β-hCG
A 46-year-old woman presents to her gynecologist with vaginal bleeding between her periods. According to the patient’s history, she had a single partner for 15 years. She defines painful sexual intercourse and weight gain due to her increased appetite in the last 3 months. Her first menstruation was at the age of 11, she never had a pregnancy. She was diagnosed with “High grade Squamous Intraepihelial Lesion (HSIL)” in the pap smear taken a year ago, and then biopsy was recommended, but the patient ignored this. The patient has no history of cigarette use.
According to the information given above, the doctor initially suspects cervical cancer and plans the further tests. Considering the risk factors, signs and symptoms of cervical cancer; which of the following mentioned informations support this suspicion? (Choose as many as required)
Previous PAP test result
Menarche age
Dyspareunia
Nulliparity
Long term monogamy
Not to smoke
Previous PAP test result
Menarche age
Dyspareunia
Info: Early stage cervical cancer is generally asymptomatic But if it is symptomatic or at the advanced stages; vaginal bleeding, vaginal discharge, dyspareunia, pelvic pain and weight loss can be seen.
The known risk factors of developing cervical cancer are human papilloma virus (HPV), low socio-economic status, smoking, marrying before age 18 years, young age at the first coitus, multiple sexual partners, multiple childbirths, early menarche and late menopause.
A 28-year-old woman presents to the gynecology clinic with a complaint of pain and swelling in her genital area. She reports that she first noticed the swelling two days ago, and since then, it has gradually increased in size and become more painful, especially during physical activity and sitting. She denies any recent trauma to the area or previous episodes of similar symptoms. Her menstrual cycles are regular, and she has no history of sexually transmitted infections. On physical examination, a tender, fluctuant mass is palpated at the posterior aspect of the vaginal opening. There is surrounding erythema and mild local warmth. No other abnormalities are noted on genital examination, and the remainder of the physical examination is unremarkable.
Urethral diverticulum
Vulvar intraepithelial neoplasia
Endometriosis
Vaginal candidiasis
Bartholin’s gland cyst/abscess
Bartholin’s gland cyst/abscess
Info: Bartholin’s gland cyst/abscess Bartholin’s gland cyst or abscess presents with pain and swelling in the genital area, especially at the posterior aspect of the vaginal opening. It is characterized by the formation of a tender, fluctuant mass due to obstruction of the Bartholin’s gland duct.
Vaginal candidiasis can present with symptoms such as vaginal itching, burning, and discharge, it typically does not cause a palpable mass or localized swelling.
Endometriosis can cause pelvic pain and discomfort, but it usually presents with symptoms related to menstruation and is not associated with a tender, fluctuant mass at the posterior aspect of the vaginal opening.
Urethral diverticulum may cause symptoms such as dysuria, urinary frequency, and post-void dribbling, but it typically does not present as a tender mass in the genital area.
Vulvar intraepithelial neoplasia (VIN) refers to precancerous changes in the skin of the vulva. While it may present with symptoms like itching or burning, it is not associated with a palpable mass or localized swelling.
A 45-year-old woman presents to the breast clinic with complaints of a palpable mass in her left breast. She noticed the mass about two months ago, and since then, it has gradually increased in size. She denies any history of trauma to the breast or nipple discharge. She has no significant past medical history. On physical examination, a well-defined, firm, and mobile mass measuring approximately 4 cm in diameter is palpated in the upper outer quadrant of the left breast. The overlying skin appears normal without any signs of erythema or dimpling. There are no palpable axillary lymph nodes. On microscopic Examination; biopsy of the breast mass reveals hypercellular stromal tissue with leaf-like projections lined by a double layer of epithelial and myoepithelial cells. Stroma shows mild stromal cellularity with minimal nuclear atypia and very low mitotic activity.
Which of the following is the most likely diagnosis of this patient?
Malignant phyllodes tumor of the breast
Fibroadenoma
Invasive ductal carcinoma
Ductal carcinoma in situ
Benign phyllodes tumor of the breast
Benign phyllodes tumor of the breast
Info: Benign phyllodes tumors are rare fibroepithelial tumors of the breast, characterized by leaf-like projections lined by a double layer of epithelial and myoepithelial cells. They typically present as well-defined, firm masses and have low malignant potential. Microscopically, they show mild stromal cellularity, minimal nuclear atypia, and low mitotic activity.
Malignant phyllodes tumors are aggressive fibroepithelial tumors with marked stromal cellularity, significant nuclear atypia, and increased mitotic activity. They have a higher risk of local recurrence and distant metastasis compared to benign phyllodes tumors.
Fibroadenomas are benign breast tumors composed of both glandular (epithelial) and stromal (connective tissue) components. They typically present as well-defined, mobile, rubbery masses and are more common in younger women. Microscopically, fibroadenomas show epithelial and stromal proliferation without significant atypia.
Invasive ductal carcinoma is the most common type of breast cancer, characterized by the infiltration of malignant cells through the ductal basement membrane into the surrounding stroma. It often presents as a firm, irregular mass with associated skin or nipple changes. Microscopically, invasive ductal carcinoma shows infiltrative growth patterns and nuclear atypia.
Ductal carcinoma in situ (DCIS) is a non-invasive form of breast cancer where malignant cells are confined within the ductal system and have not invaded the surrounding tissue. It is typically detected on mammography as microcalcifications and presents as ductal proliferation without invasion on histopathology.
