Module 1

Question 1

-Sectional nephrolithotomy is performed because of coronary artery disease. To reduce blood loss it is
shown:

Answer 1

Administration of epsilon-aminocaproic acid in the pre-vein

Question 2

-A 26-year-old G3P0030 has had three consecutive spontaneous abortions in the first trimester. As part
of an evaluation for this problem, which of the following tests is most appropriate in the evaluation of
this patient?

Answer 2

Chromosomal analysis of the couple

Question 3

-A 61-year-old man with a history of stone disease and multiple bilateral ureterolithotomies is seen with
a fever of 103◦F, pyuria and microheamaturia. An IVP reveals a 6-mm right mid-ureteral calculus with
delayed function of the right kidney and marked obstruction. In addition to beginning parenteral
antibiotics, the most reasonable immediate management option is:

Answer 3

placement of a ureteral stent to bypass the obstruction

Question 4

-A 19-year-old G1P0 presents to the obstetrician’s office for a routine OB visit at 34 weeks gestation. Her
pregnancy has been complicated by gestational diabetes requiring insulin for control. She has been
noncompliant with diet and insulin therapy. She has had two prior normal ultrasounds at 20 and 28
weeks gestation. She has no other significant past medical or surgical history. During the visit, the fundal
height measures 38 cm. Which of the following is the most likely explanation for the discrepancy
between the fundal height and the gestational age?

Answer 4

Polyhydramnios

Question 5

-diagnosis of kidney aplasia is based on:

Answer 5

Angiography

Question 6

-A 38-year-old G6P4 is brought to the hospital by ambulance for vaginal bleeding at 34 weeks. She
undergoes an emergency cesarean delivery for fetal bradycardia under general anesthesia. In the
recovery room 4 h after her surgery the patient develops respiratory distress and tachycardia. Lung
exam reveals rhonchi and rales in the right lower lobe. Oxygen therapy is initiated and chest x-ray is
ordered. Which of the following is most likely to have contributed to her condition?

Answer 6

Extubation with the patient in the semierect position (semi-Fowler’s)

Question 7

-Your patient had an ultrasound examination today at 39 weeks gestation for size less than dates. The
ultrasound showed oligohydramnios with an amniotic fluid index of 1.5 centimeters. The patient’s cervix
is unfavorable. Which of the following is the best next step in the management of this patient?

Answer 7

Admit her to the hospital for cervical ripening then induction of labor

Question 8

-the patient is 16 years old, has congenital phimosis. What can be suitable for him:

Answer 8

Circumcision

Question 9

-A 39-year-old wants first-trimester prenatal diagnosis. Which of the following is an advantage of
amniocentesis over CVS?

Answer 9

CVS has a higher complication rate than midtrimester amniocentesis

Question 10

-A 36-year-old obese woman with known PCOS presents to your infertility practice. She was diagnosed
with PCOS at the age of 24 years, at which time she reports having had a battery of tests done. She has
been followed by her general gynecologist who has maintained her on oral contraceptive pills since that
time. She reports she is otherwise healthy. She now desires to get pregnant and is coming to you for
advice. What is one of the most important tests to perform at this time?

Answer 10

2-hour oral glucose tolerance test

Question 11

-You are following a 38-year-old G2P1 at 39 weeks in labor. She has had one prior vaginal delivery of a
3800-g infant. One week ago, the estimated fetal weight was 3200 g by ultrasound. Over the past 3 h
her cervical exam remains unchanged at 6 cm. Fetal heart rate tracing is reactive. An intrauterine
pressure catheter reveals two contractions in 10 min with an amplitude of 40 mmHg each. Which of the
following is the best management for this patient?

Answer 11

Administration of oxytocin

Question 12

-You are a world-renowned reproductive endocrinologist and are asked to make a diagnosis for a patient
who has ambiguous genitalia. Here are the data: Karyotype XY Spermatogenesis Absent Müllerian
structures Absent Wolffi an structures Present External genitalia Male hypospadias Breast Gynecomastia
The diagnosis is:

Answer 12

Reifenstein syndrome

Question 13

-A mother brings her 18-year-old daughter in to see you because she has not started to develop breasts
and has not had a period. You diagnose delayed puberty. Which one of the following statements is true?

Answer 13

Hypergonadotropic hypogonadism affects approximately 50% of patients presenting with delayed
puberty

Question 14

-A 15-year-old girl, gravida 0, para 0, presents with a history of severe midline lower abdominal pain
associated with her periods since the age of 12 years. Vaginal examination is not performed because the
patient is still virginal. An abdominal ultrasound reveals normal pelvic anatomy. The patient’s mother
and two older sisters have a history of endometriosis. She has tried NSAIDs and oral contraceptive pills
to control her pain but neither has helped. What is the next step in your management?

Answer 14

Diagnostic laparoscopy

Question 15

-An 8-year-old girl is brought to your office by her mother because of occasionally bloody vaginal
discharge. Her mother suspects sexual abuse because she does not “know of any other reason why a
little girl should be bleeding from her vagina.” She has no other medical history except for a throat
infection a few weeks ago, which was treated with penicillin. On physical examination, she has
enlargement of both breasts and enlarged areolae. There is no axillary hair growth. No pubic hair is
apparent. The external genitalia have an age-appropriate clitoris and normal labia minora. There are no
bruises, hematomas, or lacerations. You take a culture of the vaginal discharge, which is pink to red
colored and not foul smelling. You are not able to perform a more thorough examination. The most
likely cause of her vaginal bleeding is:

Answer 15

Bacterial infection

Question 16

-the peak of occurrence of urolithiasis coincide with:

Answer 16

Max Temp

Question 17

-A 30-year-old G2P0 at 39 weeks is admitted in active labor with spontaneous rupture of membranes
occurring 2 h prior to admission. The patient noted clear fluid at the time. On exam her cervix is 4 cm
dilated and completely effaced. The fetal head is at 0 station and the fetal heart rate tracing is reactive.
Two hours later on repeat exam her cervix is 5 cm dilated and the fetal head is at +1 station. Early
decelerations are noted on the fetal heart rate tracing. Which of the following is the best next step in
her labor management?

Answer 17

Initiate Pitocin augmentation

Question 18

-You are delivering a 33-year-old G3P2 and encounter a shoulder dystocia. After performing the
appropriate maneuvers, the baby finally delivers, and the pediatricians attending the delivery note that
the right arm is hanging limply to the baby’s side with the forearm extended and internally rotated.
Which of the following is the baby’s most likely diagnosis?

Answer 18

Erb palsy

Question 19

A 30-year-old woman presents to your office with an ultrasound report stating she has “polycystic
appearing ovaries.” She has a friend who has PCOS and is currently having trouble conceiving and wants
to know what this means for her. You tell her that she may have PCOS if she also

Answer 19

Is hirsute

Question 20

-You performed a forceps-assisted vaginal delivery on a 20-year-old G1 at 40 weeks for maternal
exhaustion. The patient had pushed for 3 hours with an epidural for pain management. A second-degree
episiotomy was cut to facilitate delivery. Eight hours after delivery, you are called to see the patient
because she is unable to void and complains of severe pain. On examination you note a large fluctuant
purple mass inside the vagina. What is the best management for this patient?

Answer 20

. Incision and evacuation of the hematoma

Question 21

-A pediatrician asks you to consult on a case of a baby that was born with because they are not able to
assign a gender. There is a significant degree of clitoral enlargement and labial folds are
uncharacteristically large and partially fused. You recommend:

Answer 21

C Serum sodium level

Question 22

-An 11-year-old girl presents with a 1.5-month history of a persistent white colored vaginal discharge
that is watery and odorless. There is no associated pain or pruritis. Examination reveals Tanner stage III
breasts and stage II pubic hair. Wet mount is negative for clue cells and yeast. Please select the most
appropriate management:

Answer 22

Observation

Question 23

-A 65-year-old man has continuous urinary dribbling following a trans-urethral resection of the prostate
for benign hyperplasia. Possible explanations include:

Answer 23

all of the above

Question 24

-A 24-year-old woman is in a car accident and is taken to an emergency room, where she receives a
chest x-ray and a film of her lower spine. It is later discovered that she is 10 weeks pregnant. Which of
the following is the most appropriate statement to make to the patient?

Answer 24

The fetus has received less than the assumed threshold for radiation damage

Question 25

-A man of 60 is investigated for symptoms of bladder outlet obstruction and the diagnosis is made of
moderate benign prostatic hypertrophy leading to an obstructed urinary flow and incomplete bladder
emptying. It is decided to treat him conservatively with medication. He is on no other medication and is
otherwise fit. Appropriate drugs would include:

Answer 25

all of the above

Question 26

-Diagnosis of Urethritis is based on all except:

Answer 26

Blood clinical analysis and prostate secretion analysis

Question 27

-The most common location of the urethral hole during hipospady is

Answer 27

On the ventral surface of the penis

Question 28

-The most common histological type of testicular, genital cancer is:

Answer 28

Seminoma

Question 29

-. A healthy 34-year-old G1P0 patient comes to see you in your office for a routine OB visit at 12 weeks
gestational age. She tells you that she has stopped taking her prenatal vitamins with iron supplements
because they make her sick and she has trouble remembering to take a pill every day. A review of her
prenatal labs reveals that her hematocrit is 39%. Which of the following statements is the best way to
counsel this patient?

Answer 29

Tell the patient that she needs to take the iron supplements even though she is not anemic in order to
meet the demands of pregnancy

Question 30

-the patient is 40 years old, has a solitary cyst of the middle segment of the kidney 7X8X8 cm without
any signs of urodynamic disturbance and inflammation. It is more advisable..?

Answer 30

percutaneous puncture of the cyst, aspiration and insertion of a sclerosing solution into the cavity of the
cyst

Question 31

in men with benign prostatic hyperplasia, the symptoms which correlate most with obstruction are all
the following except:

Answer 31

Urgency

Question 32

• A 28-year-old women with PCOS and her husband present to your infertility clinic for consultation. She
  stopped taking her oral contraceptive pills 6 months ago and has not had a period since. She is morbidly
  obese and her past medical history is significant for sleep apnea and diabetes. She and her husband
  want get pregnant and ask for your help. What would be your first recommendation to increase their
  chances of conception at this time?

Answer 32

Weight loss program

Question 33

-A 28-year-old G1P0 presents to your office at 18 weeks gestational age for an unscheduled visit
secondary to right-sided groin pain. She describes the pain as sharp and occurring with movement and
exercise. She denies any change in urinary or bowel habits. She also denies any fever or chills. The
application of a heating pad helps alleviate the discomfort. As her obstetrician, what should you tell this
patient is the most likely etiology of this pain?

Answer 33

Round ligament pain

Question 34

-While acute cystitis, which type of examination is shown:

Answer 34

Cystoscopy (in most cases)

Question 35

-A 26-year-old woman presents complaining of intermenstrual spotting over the last 3 months,
accompanied by minimal flow during her menses. She has been taking the same low-dose combined oral
contraceptive faithfully for the last 5 years. Her physical examination is unremarkable. The most
probable explanation for her symptoms is:

Answer 35

Progesterone breakthrough bleeding

Question 36

-the torsion of the testis is characterized by:

Answer 36

Sudden onset of the disease, with rapidly increasing scrotal oedema, pronounced pain syndrome, scrotal
hyperthermia

Question 37

-32-year-old female, gravida 1, para 1, presents with worsening pelvic pain with her period. She reports
that her previous providers told her she likely has endometriosis based upon a longstanding history of
dysmenorrhea but lately her pain is worse. She also complains of left-sided pain with intercourse and
when she is jogging. She is sexually active with a single partner and uses condoms for birth control. She
has had no prior surgeries and no other medical problems. On physical examination she is afebrile, has a
nontender abdomen but on pelvic examination, has an enlarged left adnexal mass that is approximately
5 cm and is mildly tender to palpation. The next appropriate step is:

Answer 37

Obtain a pelvic ultrasound to evaluate the pelvis

Question 38

• During the follicular phase, hormone X provides negative feedback and suppresses FSH expression
  from the pituitary. Hormone Y is responsible for stimulation of the LH surge. Hormone Z is responsible
  for the conversion of primary oocytes to secondary oocytes.

Answer 38

Hormones X and Y are the same

Question 39

-A 23-year-old G1 at 40 weeks gestation presents to the hospital with the complaint of contractions. She
states they are occurring every 4 to 8 minutes and each lasts approximately 1 minute. She reports good
fetal movement and denies any leakage of fluid or vaginal bleeding. The nurse places an external
tocometer and fetal monitor and reports that the patient is having contractions every 2 to 10 minutes.
The nurse states that the contractions are mild to palpation. On examination the cervix is 2 cm dilated,
50% effaced, and the vertex is at −1 station. The patient had the same cervical examination in your
office last week. The fetal heart rate tracing is 140 beats per minute with accelerations and no
decelerations. Which of the following stages of labor is this patient in?

Answer 39

False labor

Question 40

-a 15-year-old female is brought to your office complaining of severe dysmenorrhea that has become
progressively worse since the onset of menses. Menarche occurred at age 13. The pain is located
predominantly on the right side, lasts for the duration of the menstrual fl ow, and at its worst is
associated with nausea and vomiting. She has had to miss school with every menstrual period for the
past year. She has tried nonsteroidal medications, which initially helped but no longer relieve the pain
significantly. The next step in management is:

Answer 40

Obtain a pelvic ultrasound

Question 41

• A 41-year-old G1P0 at 39 weeks, who has been completely dilated and pushing for 3 hours, has an
  epidural in place and remains undelivered. She is exhausted and crying and tells you that she can no
  longer push. Her temperature is 38.3°C (101°F). The fetal heart rate is in the 190s with decreased
  variability. The patient’s membranes have been ruptured for over 24 hours, and she has been receiving
  intravenous penicillin for a history of colonization with group B streptococcus bacteria. The patient’s
  cervix is completely dilated and effaced and the fetal head is in the direct OA position and is visible at
  the introitus between pushes. Extensive caput is noted, but the fetal bones are at the +3 station. Which
  of the following is the most appropriate next step in the management of this patient?

Answer 41

Attempt operative delivery with forceps

Question 42

-the paradoxal ishuria is:

Answer 42

Combination of urinary retention with involuntary urinary incontinence

Question 43

-Urethral stricture may develop in men as a consequence of

Answer 43

All of the above

Question 44

-In which age is urolithiasis most common?

Answer 44

20-40

Question 45

-A 38-year-old woman, gravida 3, para 3, undergoes a laparoscopy and bilateral tubal ligation. During
her laparoscopy, you find incidentally that she has endometriotic lesions on her uterosacral ligaments
and the peritoneum overlying her bladder. She is not consented for fulguration of her endometriosis;
therefore, you only perform her tubal ligation. She comes to your office for her postoperative visit. She
has no symptoms from her endometriosis. Your next step in her management is:

Answer 45

Expectant management

Question 46

-A 23-year-old G1 at 38 weeks gestation presents in active labor at 6 cm dilated with ruptured
membranes. On cervical examination the fetal nose, eyes, and lips can be palpated. The fetal heart rate
tracing is 140 beats per minute with accelerations and no decelerations. The patient’s pelvis is adequate.
Which of the following is the most appropriate management for this patient?

Answer 46

Allow spontaneous labor with vaginal delivery

Question 47

-anterior and medial to the left kidney

Answer 47

Pancreas

Question 48

-after a caesarean section, a 30-year-old woman underwent lower-third ureteral occlusion at 5 cm in
length. percutaneous nephrostomy was performed. Hereafter the optimal treatment is

Answer 48

Nephrectomy

Question 49

-A 15-year-old girl presents to your office with her mother because she has never had a period. They
report that she seemed to grow and develop breasts at the same time as the other girls in school, but
that she has not yet started to menstruate. She is active in sports at her school and plays the piano. She
is 5’4’’, 128 lb; an examination reveals Tanner IV breast and pelvic examination reveals a blind vaginal
pouch. Ultrasound confirms absence of a uterus. An FSH level is normal at 5.8 mIU/mL. The next step in
the evaluation is:

Answer 49

Karyotype

Question 50

-The most informative method of the diagnosis of para-nephritis is:

Answer 50

Puncture of para-nephral space

Question 51

-A healthy 30-year-old G1P0 at 41 weeks gestational age presents to labor and delivery at 11:00 PM
because she is concerned that her baby has not been moving as much as normal for the past 24 hours.
She denies any complications during the pregnancy. She denies any rupture of membranes, regular
uterine contractions, or vaginal bleeding. On arrival to labor and delivery, her blood pressure is initially
140/90 but decreases with rest to 120/75. Her prenatal chart indicates that her baseline blood pressures
are 100 to 120/60 to 70 mm Hg. The patient is placed on an external fetal monitor. The fetal heart rate
baseline is 180 beats per minute with absent variability. There are uterine contractions every 3 minutes
accompanied by late fetal heart rate decelerations. Physical examination indicates that the cervix is
long/closed/−2. Which of the following is the appropriate plan of management for this patient?

Answer 51

Proceed with emergent cesarean section

Question 52

-A 38-year-old G3P2 at 40 weeks gestation presents to labor and delivery with gross rupture of
membranes occurring 1 hour prior to arrival. The patient is having contraction every 3 to 4 minutes on
the external tocometer, and each contraction lasts 60 seconds. The fetal heart rate tracing is 120 beats
per minute with accelerations and no decelerations. The patient has a history of rapid vaginal deliveries,
and her largest baby was 3200 g. On cervical examination she is 5 cm dilated and completely effaced,
with the vertex at −2 station. The estimated fetal weight is 3300 g. The patient is in a lot of pain and
requesting medication. Which of the following is the most appropriate method of pain control for this
patient?

Answer 52

Epidural block

Question 53

-A 22-year-old primigravida presents to your office for a routine OB visit at 34 weeks gestational age.
She voices concern because she has noticed an increasing number of spidery veins appearing on her
face, upper chest, and arms. She is upset with the unsightly appearance of these veins and wants to
know what you recommend to get rid of them. Which of the following is the best advice to give this
patient?

Answer 53

Tell her that the appearance of these blood vessels is a normal occurrence with pregnancy

Question 54

-The optimal treatment for in situ bladder carcinoma is :

Answer 54

Intravesical BCG

Question 55

-a 30-year-old G1P0 at 8 weeks gestation presents for her first prenatal visit. She has no significant past
medical or surgical history. A friend of hers just had a baby with Down syndrome. The patient denies any
family history of genetic disorders or birth defects. You should tell her that she has an increased risk of
having a baby with Down syndrome in which of the following circumstances?

Answer 55

She has had three first-trimester spontaneous abortions

Question 56

• A 15-year-old female is referred to you because of worsening dysmenorrhea, associated with nausea
  and vomiting. She has had such severe vomiting that she has not been able to go to school for the past 6
  months and has forced out of the cheerleading squad because of her frequent absences. The rest of her
  medical history is notable for asthma, irritable bowel, and renal agenesis diagnosed during her fetal
  ultrasound. Her abdominal examination reveals no masses, but is mildly tender. Her external genetalia
  appear normal, but she refuses an internal examination. Her pediatrician has given her a diagnosis of
  “cyclic vomiting syndrome” and is treating her with antinausea medication and antidepressants and has
  referred her to a psychiatrist. Her mother is at her wits end and is coming to you for a second opinion.
  You recommend:

Answer 56

Pelvic ultrasound

Question 57

-A 46-year-old woman, gravida 6, para 4, presents complaining of a 2-year history of heavy menstrual fl
ow lasting 9 days, with occasional episodes of soaking her clothes and bedsheets with menstrual blood.
She has a history of bilateral tubal ligation. Her menses are occurring every 26 days, and she denies any
bleeding between menses. The rest of her history is unremarkable. The test most likely to aid in
diagnosis would be:

Answer 57

Pelvic ultrasound

Question 58

-A 33-year-old G3P2012 presents for an annual examination. She had a Pap smear showing ASC-US at
age 22. She has received annual Pap tests since that time and all have been normal. She is in a
monogamous relationship with her husband of 15 years. She had never had an STI. She uses an IUD for
birth control. She asks you how she should be screened for cervical cancer. You inform her:

Answer 58

Both B and C are correct

Question 59

-How many times more frequently does urolithiasis occur in men than women:

Answer 59

3-4x

Question 60

-A 20-year-old woman, G1P0, at 33 weeks of gestation arrives to labor and delivery reporting profuse
vaginal bleeding and abdominal pain. Her vitals are as follows: T – 36 C, BP - 78/40, P - 138, R - 28. Her
abdomen is firm and tender to touch. Fetal heart tones are in the 160s with minimal variability and late
decelerations. Tocometer demonstrates contractions every 1 to 2 minutes. Ultrasound shows a cephalic
fetus; placenta is fundal and free of the os without a retroplacental clot. Cervical examination is 3/90/ ⫺
1. Which is the most appropriate management plan?

Answer 60

Immediate cesarean delivery with appropriate maternal and fetal resuscitation;

Question 61

-Operative treatment of penile hypospadias is shown in the following cases:

Answer 61

Always;

Question 62

-Theories of urinary stone formation include the following:

Answer 62

Renal hypersecretion of stone-forming Salts;

Question 63

-While having varicocele, Ivanisevich’s operation implies:

Answer 63

Ligation of the testicular vein in the middle

Question 64

-A 29-year-old Caucasian primigravid patient is 20 weeks pregnant with twins. She found out today on
her routine ultrasound for fetal anatomy that she is carrying two boys. In this patient’s case, which of
the following statements about twinning is true?

Answer 64

. If division of these twins occurred after formation of the embryonic disk, the twins will be conjoined

Question 65

-A primipara is in labor, and an episiotomy is about to be cut. Compared with a midline episiotomy,
which of the following is an advantage of mediolateral episiotomy?

Answer 65

Less extension of the incision;

Question 66

-A 24-year-old primigravida with twins presents for routine ultrasonography at 20 weeks gestation.
Based on the ultrasound findings, the patient is diagnosed with dizygotic twins. Which of the following is
true regarding the membranes and placentas of dizygotic twins?

Answer 66

They are dichorionic and diamniotic regardless of the sex of the twins.

Question 67

-After a first pregnancy resulted in a spontaneous loss in the first trimester, your patient is concerned
about the possibility of this recurring. Which of the following is the most appropriate answer regarding
the chance of recurrence?

Answer 67

d. It is no differ

Question 68

-A new patient presents to your office for her first prenatal visit. By her last menstrual period she is 11
weeks pregnant. This is the first pregnancy for this 36-year-old woman. She has no medical problems. At
this visit you observe that her uterus is palpable midway between the pubic symphysis and the
umbilicus. No fetal heart tones are audible with the Doppler stethoscope. Which of the following is the
best next step in the management of this patient?

Answer 68

Schedule an ultrasound as soon as possible to determine the gestational age and viability of the fetus

Question 69

-The typical symptom of acute urethritis is:

Answer 69

Frequent urination, pains during urination; urethral
discharge

Question 70

-You are following a 22-year-old G2P1 at 39 weeks during her labor. She is given an epidural for pain
management. Three hours after administrating the pain medication, the patient’s cervical examination is
unchanged. Her contractions are now every 2 to 3 minutes, lasting 60 seconds. The fetal heart rate
tracing is 120 beats per minute with accelerations and early decelerations. Which of the following is the
best next step in management of this patient?

Answer 70

. Place an IUPC

Question 71

-A 16-year-old girl had had irregular vaginal bleeding every 1 to 4 weeks since she fi rst started
menstruating approximately 10 months ago. The bleeding is usually light but sometimes is heavy. Her
last episode of bleeding (moderate in quantity) lasted for about 2 weeks. The next best step is to:

Answer 71

Obtain a pregnancy test

Question 71

-A 32-year-old G3P2 at 39 weeks gestation presented to the hospital with ruptured membranes and 4
cm dilated. She has a history of two prior vaginal deliveries, with her largest child weighing 3800 g at
birth. Over the next 2 hours she progresses to 7 cm dilated. Two hours later, she remains 7 cm dilated.
The estimated fetal weight by ultrasound is 3200 g. Which of the following labor abnormalities best
describes this patient?

Answer 71

Secondary arrest of dilation

Question 71

-a healthy 12-year-old girl complains of several weeks of vaginal itching. She denies having vaginal
discharge or a foul odor. The patient leads an active lifestyle—she is on the swim team, plays soccer, and
performs gymnastics. She does well in school and desires to become a veterinarian. Her mother
accompanies her to the office visit. You suspect a vaginal yeast infection and would like to prepare a
slide for microscopy. The appropriate steps include:

Answer 71

Both B and D are correct

Question 72

-A 25-year-old G1P0 patient at 41 weeks presents to labor and delivery complaining of gross rupture of
membranes and painful uterine contractions every 2 to 3 minutes. On digital examination, her cervix is 3
cm dilated and completely effaced with fetal feet palpable through the cervix. The estimated weight of
the fetus is about 6 lb, and the fetal heart rate tracing is reactive. Which of the following is the best
method to achieve delivery?

Answer 72

Perform an emergent cesarean section

Question 72

-Urinary tract cancers most common among children are:

Answer 72

Wilms Tumor

Question 73

-A 32-year-old G3P2 at 39 weeks gestation presented to the hospital with ruptured membranes and 4
cm dilated. She has a history of two prior vaginal deliveries, with her largest child weighing 3800 g at
birth. Over the next 2 hours she progresses to 7 cm dilated. Two hours later, she remains 7 cm dilated.
The estimated fetal weight by ultrasound is 3200 g. Which of the following labor abnormalities best
describes this patient?

Answer 73

Secondary arrest of dilation

Question 74

-A 25-year-old G1P0 patient at 41 weeks presents to labor and delivery complaining of gross rupture of
membranes and painful uterine contractions every 2 to 3 minutes. On digital examination, her cervix is 3
cm dilated and completely effaced with fetal feet palpable through the cervix. The estimated weight of
the fetus is about 6 lb, and the fetal heart rate tracing is reactive. Which of the following is the best
method to achieve delivery?

Answer 74

Perform an emergent cesarean section

Question 75

A 43-year-old G1P0 who conceived via in vitro fertilization comes into the office for her routine OB visit
at 38 weeks. She denies any problems since she was seen the week before. She reports good fetal
movement and denies any leakage of fluid per vagina, vaginal bleeding, or regular uterine contractions.
She reports that sometimes she feels crampy at the end of the day when she gets home from work, but
this discomfort is alleviated with getting off her feet. The fundal height measurement is 36 cm; it
measured 37 cm the week before. Her cervical examination is 2 cm dilated. Which of the following is the
most appropriate next step in the management of this patient?

Answer 75

Instruct the patient to return to the office in 1 week for her next routine visit.

Question 76

During in vitro fertilization, medical stimulation causes multiple follicles to develop to the stage of
ovulation, rather than just one dominant follicle. What hormone is responsible for this multifollicular
development?

Answer 76

FSH, because the high FSH levels support the growing follicles

Question 77

-A concerned mother brings her 17-year-old daughter to your offi ce for a second opinion. The patient
appears to have normal female secondary sexual characteristics with normal breast development as well
as normal pubic and axillary hair growth. However, the mother is very concerned because her child still
has not gotten her period. After review of the records you learn that the initial gynecologist made a
diagnosis of a müllerian agenesis after obtaining an abnormal pelvic ultrasound and a normal (46,XX)
karyotype. You recommend:

Answer 77

Complete retroperitoneal ultrasound to evaluate for renal or urinary tract anomalies

Question 78

-A 26-year-old female is referred to your office by her primary care doctor. She reports regular menses
in the past, but has not had a period for 2 years. She did not bleed after a course of progesterone
prescribed by her doctor. On examination she is 58 inches tall, has normal secondary sexual
characteristics. Laboratory test reveals an FSH level of 82 mIU/mL and estradiol of 26 pg/mL. What is the
next step in her evaluation?

Answer 78

Karyotype

Question 79

-A 32-year-old woman returns to your care 5 months after the birth of her child. She had a postpartum
hemorrhage following vaginal delivery of her son, requiring emergency surgery and multiple blood
transfusions. She complains of fatigue, constipation, and states that her periods have not returned
despite the fact that she has not been able to breastfeed. Her laboratory test reveals an FSH level of 1.2
mIU/mL, TSH of 0.3 IU/mL, and prolactin of 1 ng/mL. The most likely etiology of her secondary
amenorrhea is:

Answer 79

Sheehan’s syndrome

Question 80

-34-year-old woman, gravida 0, presents to you reporting bleeding between her periods with cycles that
seem irregular and more than 40 days apart. She has never had monthly periods. She is bothered by
acne as well as hair growth on her face, chest, and abdomen. She would like to become pregnant. She
denies any medical problems but states that her doctor has advised her to lose weight because of
borderline diabetes. She is 5 feet 4 inches tall and weighs 230 lb. Her gynecologic examination is
unremarkable. The most likely explanation for her abnormal uterine bleeding is:

Answer 80

Polycystic Ovarian syndrome

Question 81

-A pregnant woman who is seven weeks from her LMP comes into the office for her first prenatal visit.
Her previous pregnancy ended in a missed abortion in the first trimester. The patient, therefore, is very
anxious about the well-being of this pregnancy. Which of the following modalities will allow you to best
document fetal heart action?

Answer 81

Transvaginal sonogram

Question 82

-During the routine examination of the umbilical cord and placenta after a spontaneous vaginal delivery,
you notice that the baby had only one umbilical artery. Which of the following is true regarding the
finding of a single umbilical artery?

Answer 82

. It is an indicator of an increased incidence of congenital anomalies of the fetus;

Question 83

-A 62-year-old G2P2002 presents for a routine examination. Her last period was 10 years ago and she
has had no postmenopausal bleeding. She brings a copy of her records that indicate a history of normal
Pap tests for the past 20 years, with the most recent 1 year ago. Her last mammogram was 2 years ago.
She takes a calcium and vitamin D supplement. She took estrogen and progesterone replacement
therapy in early menopause but stopped 8 years ago. Her vasomotor symptoms are minimal. She is
otherwise healthy and on no medications. She has no family history of breast or ovarian cancer. You
recommend the following screening tests.

Answer 83

Mammogram

Question 84

-. A 22-year-old G1P0 at 28 weeks gestation by LMP presents to labor and delivery complaining of
decreased fetal movement. She has had no prenatal care. On the fetal monitor there are no
contractions. The fetal heart rate is 150 beats per minute and reactive. There are no decelerations in the
fetal heart tracing. An ultrasound is performed in the radiology department and shows a 28-week fetus
with normal-appearing anatomy and size consistent with dates. The placenta is implanted on the
posterior uterine wall and its margin is well away from the cervix. A succenturiate lobe of the placenta is
seen implanted low on the anterior wall of the uterus. Doppler flow studies indicate a blood vessel is
traversing the cervix connecting the two lobes. This patient is most at risk for which of the following?

Answer 84

Fetal exsanguination after rupture of the membranes

Question 85

-You are seeing a patient in the hospital for decreased fetal movement at 36 weeks gestation. She is
healthy and has had no prenatal complications. You order a BPP. The patient receives a score of 8 on the
test. Two points were deducted for lack of fetal breathing movements. How should you counsel the
patient regarding the results of the BPP?

Answer 85

The results are normal, and she can go home

Question 86

-A 41-year-old had a baby with Down syndrome ten years ago. She is anxious to know the chromosome
status of her fetus in her current pregnancy. She is currently at eight weeks of gestation. Which of the
following tests will provide the most rapid diagnosis of Down syndrome?

Answer 86

Chorionic villus sampling(CVS);

Question 87

-An 18-year-old college student presents to your offi ce feeling depressed and irritable from 3 days prior
to her menses until the day after her menses start. She reports that she frequently has to stay home
from classes and is worried about its potential impact on her performance. She reports she is otherwise
healthy. Menarche was at age 12, and her menses are currently regular each month. She denies signifi -
cant menstrual cramping or bloating. She is sexually active with one partner, using condoms for

contraception. She reports a penicillin allergy. Providing that her symptoms are prospectively
documented and confi rmed, what would be possible treatments for this woman?

Answer 87

Calcium carbonate

Question 88

-A 14-year-old nulligravid girl presents to the emergency department by ambulance because she passed
out on the fl oor of her house and is covered in blood. She is now conscious. She has been bleeding off
and on for the past 5 months since onset of menarche. Her BP 98/48, P 106, RR 16, and T 96.2. Physical
examination is unremarkable. Pelvic ultrasound is also unremarkable. Serum human chorionic
gonadotropin (hCG) is negative, and her hemoglobin is 7 g/dL. You begin a low-dose combination oral
contraceptive taper. The next best step in management of this patient is:

Answer 88

Coagulation profile

Question 89

-The patient has a scrotal lesion, a large hematoma; the next steps must be:

Answer 89

Operative treatment, revision and drainage;

Question 90

-Specify the optimal time for operative treatment in uncomplicated hipospady:

Answer 90

1-2 years

Question 91

-Renal hypoplasia is characterized by:

Answer 91

arterial hypertension

Question 92

-The normal amount of blood, circulated in the adult human kidney is on average

Answer 92

At 1100 ml / min

Question 93

-The blood supply of the penis is provided:

Answer 93

2. Internal and external genital arteries

Question 94

• most common congenital abnormality of the kidney are:

Answer 94

Kidney and ureter duplication

Question 95

• Struvite stone is:

Answer 95

3. Stone caused by infection

Question 96

-5-year-old patient has been diagnosed with “right sided orchitis”….?

Answer 96

Testicular torsion

Question 97

-which type of urinary incontinence is seen mostly in female patients?

Answer 97

-which type of urinary incontinence is seen mostly in female patients?

Question 98

-all of the above is true of cryptocurrency except one:

Answer 98

spontaneous migration of the gland may occur or association with hernia

Question 99

-disorder of the structure of the kidney is:

Answer 99

solitatory cyst

Question 100

• A 17-year-old female presents to you complaining of never having had a period. She reports breast
  development at the age of 13 years. She is 55 and weighs 125 lb. You
  suspect she has MRKH and not CAIS. Which one of the following is consistent with the diagnosis of
  MRKH but not with CAIS?

Answer 100

Scant/absent pubic hair, normal axillary hair

Question 101

-A 24-year-old female comes in for a new patient visit with the complaint of missed menstrual cycles.
She states her period has never been regular, and that in the past it was common for her to skip a
month or two between cycles. Now, however, she has not had a period in the past 7 months. She denies
sexual activity, reports no medical problems, and her only prescribed medication is a face wash for acne.

On review of systems she reports a weight gain of 10 lb over the past year. Her laboratory test reveals
an FSH level of 8.7 mIU/mL, LH of 22.2 mIU/mL, estradiol of 45 pg/mL, TSH of 2.2 mIU/mL, prolactin of
12 ng/mL, and total testosterone of 98 ng/dL. The most likely diagnosis is:

Answer 101

Polycystic ovary syndrome

Question 102

• A 29-year-old nulligravida comes to your offi ce due to vaginal discharge for 3 weeks. The discharge is
  described as yellow-green, copious, and malodorous. She also has vulvar irritation. She informs you that
  she has been in a monogamous same-sex relationship for 3 years. She otherwise has no complaints. The
  most appropriate next step in management is to:

Answer 102

E Obtain a vaginal swab for office microscopy to assess for bacterial vaginosis and trichomoniasis

Question 103

• A 25-year-old woman comes to your offi ce complaining of irregular menses and hair on her chin,
  upper lip, and chest that requires frequent plucking. She reports that she is otherwise healthy. On
  physical examination, you notice increased hair on her lower abdomen and upper back, but the rest of
  the examination and her vitals are normal. Which laboratory tests would you NOT order for this patient?

Answer 103

24-hour urinary free cortisol

Question 104

• A 51-year-old woman, gravida 1, para 1, presents to your offi ce with complaints of heavy menstrual fl
  ow that has been persistent over the last 6 weeks, occurring after a 7-month break from her periods.
  Her periods were monthly and regular until the age of 46 years. Review of systems is negative and she
  specifi cally denies lightheadedness. Her speculum examination is unremarkable. The bimanual
  examination reveals a slightly enlarged, regular contour, anteverted uterus that is nontender to
  palpation. The next best step in management is:

Answer 104

Endometrial biopsy

Question 105

. A 24-year-old woman has had three first-trimester spontaneous abortions. Which of the following
statements concerning chromosomal aberrations in abortions is true?

Answer 105

Despite the relatively high frequency of Down syndrome at term, most Down fetuses abort
spontaneously

Question 106

A 27-year-old woman (G3P2) comes to the delivery floor at 37 weeks gestation. She has had no
prenatal care. She complains that, on bending down to pick up her 2-year-old child, she experienced
sudden, severe back pain that now has persisted for 2 hours. Approximately 30 minutes ago she noted
bright red blood coming from her vagina. By the time she arrives at the delivery floor, she is contracting
strongly every 3 minutes; the uterus is quite firm even between contractions. By abdominal palpation,
the fetus is vertex with the head deeply engaged. Fetal heart rate is 130 beats per minutes. The fundus
is 38 cm above the symphysis. Blood for clotting is drawn, and a clot forms in 4 minutes. Clotting studies
are sent to the laboratory. Which of the following actions can most likely wait until the patient is
stabilized?

Answer 106

d. Administering oxytocin

Question 107

• A 44-year-old G3P3 female presents with severe pelvic pain. Her history is notable for a laparoscopy 3
  years ago for severe endometriosis requiring laser ablation of endometriosis on her uterosacral
  ligaments, dissection of pelvic adhesions and excision of a 4-cm endometrioma from her left ovary. She
  had been managed by GnRH agonist therapy for 4 months postoperatively followed by continuous oral

contraceptive pill use. She had initial relief of symptoms; however, she is now bothered by daily pain,
dyspareunia, and dyschezia. Pelvic examination reveals a fi xed retroverted uterus and bilateral
uterosacral ligament nodularity. A pelvic ultrasound shows a normal uterus and right ovary and a 3-cm
homogenous echogenic cyst consistent with an endometrioma of the left ovary. She does not desire
future childbearing and desires the most effective therapy to relieve the pain. The most appropriate
management is:

Answer 107

Total abdominal hysterectomy bilateral salpingo-oophorectomy (TAH/BSO)

Question 108

-stranguria is found:

Answer 108

at all times listed

Question 109

• A 25-year-old G3P2 at 39 weeks is admitted in labor at 5 cm dilated. The fetal heart rate tracing is
  reactive. Two hours later, she is reexamined and her cervix is unchanged at 5 cm dilated. An IUPC is
  placed and the patient is noted to have 280 Montevideo units (MUV) by the IUPC. After an additional 2
  hours of labor, the patient is noted to still be 5 cm dilated. The fetal heart rate tracing remains reactive.
  Which of the following is the best next step in the management of this labor?

Answer 109

Perform a cesarean section

Question 110

-the higher the degree of reflux, the degree of renal damage

Answer 110

increases

Question 111

-A previously fit young woman of 28 years presents with acute loin pain and a fever. An emergency IVU
shows a right hydronephrosis with obstruction of the right ureter caused by a 10-mm stone impacted in the right ureter at the level of a sacroiliac joint. The most appropriate immediate treatment will be:

Answer 111

. immediate cystoscopy and the passage of a ureteric catheter by-passed the stone to relieve the
obstruction

Question 112

-which of the following include the highest amount of oxalate?

Answer 112

Tea and coffee

Question 113

-cystitis is most commonly reported at age:

Answer 113

21-40

Question 114

-the etiological factors contributing to the development of renal cancer are:

Answer 114

tobacco

Question 115

• A 27-year-old woman presents to your offi ce complaining of not getting her period. She came off of
  the birth control pill 9 months ago to attempt pregnancy and has not had a period since. Multiple home
  pregnancy tests have been negative. She states she underwent menarche at the age of 12 years, and
  that she did not always get a period every month during high school but was told this was normal
  because she was an athlete. She continues to be very athletic, running 5 to 6 times per week and also
  bikes. She is 56 and 124 lb and has no hirsutism or acne.

Answer 115

Functional hypothalamic amenorrhea

Question 116

• You diagnose the previous patient with PCOS and she would like to know what she can do to help with
  the excessive hair growth. She is currently on no medications. Which one of the following treatments for
  hirsutism would you NOT prescribe to her alone?

Answer 116

Flutamide

Question 117

• A 40-year-old woman pregnant at 6 weeks gestation presents to your office for prenatal care. She is
  interested in prenatal testing for genetic abnormalities. She read on the Internet that an ultrasound
  measurement of the neck of the fetus can be used in prenatal diagnosis. Which of the following is
  correct information to tell your patient regarding ultrasound measurement of the fetal nuchal
  translucency for prenatal diagnosis?

Answer 117

It is a screening test for Down syndrome performed between 10 and 13 weeks of pregnancy

Question 118

2-month-old boy diagnosed with cryptorchidism inguinal retention form, combined with the clinically
pronounced hernia. It is mandatory to:

Answer 118

Operational intervention

Question 119

Chronic urine retention in prostatic hypertrophy is:

Answer 119

painless