OB E1 Flashcards
Which of the following contains the receptors for SRY antigens? A. Pronephros B. Genital ridge C. Mullerian duct D. Wolffian duct
B
Which of the following will form the Wolffian duct? A. Pronephros B. Mesonephros C. Metanephros D. Paramesonephric duct
B
Anomaly wherein a female has a solitary opening for the vaginal secretions and urinary tract? A. Cloaca B. Urethro-vaginal fistula C. Urogenital sinus D. Recto-vaginal fistula
C
Which of the following chromosomal abnormalities would have a male phenotype? A. XXX B. XO C. XXXX D. XYY
D
The following structures are not developed in a patient with DHT-deficient male A. Seminal vesicles B. Prostate C. Vas deferenes D. Epididymis
B.
DHT-deficiency leads to malformation of the external male genitalia, which includes the penis, scrotum, and prostate. A, C, D are derivatives of the Wolffian duct, which is stimulated to differentiate by testosterone.
Which of the following results from an appropriate response of the androgen receptors? A. Gonadotropin regulation B. External virilization C. Prostate enlargement D. Pubertal maturation
B
The gonads are derived from the following EXCEPT A. Mesothelium B. Endothelium C. Mesenchyme D. Primordial germ cells
B
For an indifferent gonad to become a testis,
A. only the cortex develops
B. only the medullary part develops
C. both the cortex and medulla develop
D. none of the cortical and medullary parts would develop
B
In males, the cortex regresses and the medulla develops. In females, the cortex develops and the medulla regresses.
The secretion of the Sertoli cells would cause
A. Development of male internal genitalia
B. Development of male external genitalia
C. Development of mullerian duct
D. NOTA
D
Sertoli cells release the Mullerian Inhibiting Substance (MIS) which causes the regression of the Mullerian duct. (Review: Mullerian duct develops into the fallopian tube, uterus, cervix and upper 1/3 of the vagina.) Leydig cells produce testosterone which stimulates the development of the male internal genitalia from the Wolffian duct. Testosterone is reduced to DHT which in turn is responsible for the development of the male external genitalia.
The Mullerian duct will eventually form the following EXCEPT A. Cervix B. Uterus C. Fallopian tube D. Ovaries
D
The genotype of an individual is determined at: A. Fertilization B. 9-16 weeks after fertilization C. 8 weeks after fertilization D. Birth
A
The external sex organs acquire distinct male or female characteristics at: A. Fertilization B. 8 weeks after fertilization C. 12 weeks after fertilization D. Birth
C
A newborn patient presented with an ambiguous genitalia. On PE, gonads were not palpated at the labio-scrotal areas. Ultrasound done visualized no uterus. The 17 OH progesterone was normal. Karyotyping showed 46 XY. The possible cause of the ambiguous genitalia is:
A. Persistent mullerian duct syndrome
B. Androgen insensitivity
C. Athletic mother taking androgenic substances
D. Congenital adrenal hyperplasia
B
Only A and B would present with 46 XY karyotype. In persistent mullerian duct syndrome, the mullerian duct persists despite the 46 XY genotype and would thus have a uterus. In androgen insensitivity, testes form, which secrete both androgens and MIS. No female internal structures (i.e. uterus) would develop due to the MIS. At the same time, there is insensitivity to the secreted androgens resulting to the absence of both internal and external male structures. The external genitalia would thus be female and the testes remain undescended. Menstruation would also not occur since there are no female internal structures (i.e. ovary, uterus).
A 3 year old female was referred because her parents noted, since birth, her urine and stools were coming from the same opening. The most likely problem of the child is: A. Urogenital sinus B. Persistent cloaca C. Rectovaginal fistula D. Lack of hygiene
B
A 14 year old female consulted for a hypogastric mass which was noted to be painful a few days in a month. The mass was gradually increasing in size. On PE, she was noted to have normal looking labia but a bulging cystic mass was bulging at the vaginal canal. The most likely problem of the child is: A. Hydrocolpos B. Hematometrocolpos C. Patent urachus D. Ovarian tumor
B
History of a hypogastric mass that only becomes painful a few days in a month points to hematometrocolpos (i.e. accumulation of menstrual blood within the uterus and vagina).
An androgen insensitivity syndrome individual will have: A. 46 XX chromosome B. Breast development C. Menstruaton D. Normal female internal structures
B
Features of a patient with uterine abnormalities include: A. Symptomatic immediately after birth B. Problematic delivery C. Common anomaly D. Fertile
B
Verbatim from the trans on Alternatives of Development of the Male and Female Genital Tracts, Part 2, uterine anomalies are not symptomatic during childhood and have problems related to infertility or complications of pregnancy.
The equivalent of the female labia majora in males is: A. Scrotal swelling B. Urethral fold C. Urethral groove D. Glans penis
A
Which anomaly resulted from anomaly of the urorectal septum? A. Urogenital sinus B. Vaginal atresia C. Imperforate anus D. Hypospadias
C
Which anomaly results from failure of the mullerian ducts to fuse to form the mullerian tubercle? A. Complete vaginal atresia B. Proximal vaginal atresia C. Distal vaginal atresia D. Urogenital sinus
B
Menstrual regularity of menses refers to: A. Cycle length B. Cycle to cycle variation C. Length of menstrual flow D. Amount of menstrual flow
B
The following are true regarding the defined limits of normal menstruation EXCEPT
A. Frequency is normal if cycle length is between 24-38 days
B. Regularity is regular if the cycle to cycle variation over a 12 month period is between 2-20 days
C. Duration of flow is normal if between 2.5-8 days per menses
D. Volume of blood loss is normal if between 5-80 ml per menstrual period
C
Normal duration of flow should be between 4.5-8 days per menses.
The following are considered standard accepted nomenclature based on recent consensus guidelines EXCEPT A. Chronic abnormal uterine bleeding B. Dysfunctional uterine bleeding C. Heavy menstrual bleeding D. Intermenstrual bleeding
B
The following accepted or discarded terms of menstrual bleeding refer to the same abnormality EXCEPT A. Menorrhagia B. Heavy menstrual bleeding C. Polymenorrhea D. Hypermenorrhea
C
With the absence of pregnancy, the elimination of the stratum functionale during menstruation is carried out with the help of the following EXCEPT A. Proteolytic enzymes from MMPs B. PMNs and eosinophils C. Macrophages D. Tissue factors
D
The first three are hemorrhagic, promoting menstruation while tissue factors promote hemostasis
Which of the following type of leiomyoma is most likely to result in heavy menstrual bleeding? A. Submucous Type 0 B. Submucous Type 2 C. Subserous Type 7 D. Parasitic Type 8
A
The more submucosal the leiomyoma, the heavier the bleeding.
The postulated mechanism of abnormal uterine bleeding among endometrial polyps: A. Aberrant blood vessels B. Deranged local hemostasis C. Deranged systemic hemostasis D. Hormonal imbalance
A
The following events promoted a hemorrhagic environment EXCEPT
A. Progesterone withdrawal
B. Breakdown of the corpus luteum
C. Prolonged unopposed estrogen administration
D. Short-term estrogen administration
D
In the PALMCOEIN classification of abnormal uterine bleeding, “E” refers to AUB due to:
A. Endometrial cycle abnormalities
B. Endometriosis
C. Abnormal local endometrial hemostasis with normal endometrial structure and ovulatory cycles
D. Endocervical abnormalities
C
A 35 year old single woman has been on cyclic combined OCP for \_\_\_\_ and menstrual bleeding has been very regular and normal. Suddenly, she developed intermenstrual bleeding in the past 2 months. Your most likely diagnosis based on the PALMCOEIN classification: A. AUB-O B. AUB-I C. AUB-C D. Not sure pending sonography
B
AUB-I (Iatrogenic) is defined as unscheduled uterine bleeding during the use of local or systemic gonadal steroid therapy (i.e. estrogen, progesterone).
Aside from history, PE, and laboratory tests, the minimum required modalities to establish an accurate diagnosis in the PALMCOEIN classification are:
A. Contrast sonography and/or hysteroscopy
B. Ultrasound and/or MRI
C. Endoscopy and/or MRI
D. Tissue sampling and/or 3D ultrasound
A
Least important factor affecting the choice of treatment for AUB A. Cause of AUB B. Age of woman C. Desire for future reproduction D. Profession of husband
D
