Obgyn - Infertility

Question 1

OBG - 6.1
We can talk about sterility when conception does not occur in the course of regular sex life without using any contraceptive method:
A) within 1 year
B) within 6 months
C) within 2 years
D) within 10 regular cycles

Answer 1

ANSWER
A) within 1 year
EXPLANATION
In a physiologic case, the real chance of conception is within 2 years, the physiologic pregnancy rate is about 80% within 1 year, it is 50% in the 2nd year, then the chance of spontaneous conception significantly decreases. Obviously if there is a factor causing sterility (for example amenorrhea), it is unnecessary to postpone the examination to the end of the above-mentioned period; likewise over the age of 35, when the inclination for conception is much smaller than in the above mentioned case.

Question 2

OBG - 6.1
We can talk about sterility when conception does not occur in the course of regular sex life without using any contraceptive method:
A) within 1 year
B) within 6 months
C) within 2 years
D) within 10 regular cycles

Answer 2

ANSWER
A) within 1 year
EXPLANATION
In a physiologic case, the real chance of conception is within 2 years, the physiologic pregnancy rate is about 80% within 1 year, it is 50% in the 2nd year, then the chance of spontaneous conception significantly decreases. Obviously if there is a factor causing sterility (for example amenorrhea), it is unnecessary to postpone the examination to the end of the above-mentioned period; likewise over the age of 35, when the inclination for conception is much smaller than in the above mentioned case.

Question 3

OBG - 6.2
Which of the complications listed below is the most common after in vitro fertilization (IVF)?
A) Pelvic inflammatory disease
B) Chronic anovulation
C) Ovarian hyperstimulation syndrome
D) Asherman syndrome

Answer 3

ANSWER
C) Ovarian hyperstimulation syndrome
EXPLANATION
In case of in vitro fertilisation, we try to have several, 6-10 follicles ripened so that several oocytesare will be available to carry out insemination. The stimulation treatment needed to carry it out can result in abnormal hyperstimulation more often than the treatments applied to induce ovulation.

Question 4

OBG - 6.3
Postpartum galactorrhea-amenorrhea syndrome:
A) Morgagni syndrome
B) Sheehan syndrome
C) Chiari-Frommel syndrome
D) Schmidt syndrome

Answer 4

ANSWER
C) Chiari-Frommel syndrome
EXPLANATION
The functional disorder of the hypothalamus lies behind the Chiari-Frommel syndrome in the first place. It causes an enhanced prolactin production, which triggers the major symptoms of the syndrome: galatorrhea, raro-, amenorrhea, sterility.

Question 5

OBG - 6.4
Which of the groups of medicine listed below contains clomifen citrat, which is used to treat infertility?
A) Progesteron
B) Antiprogesteron
C) Oestrogen
D) Antioestrogen
E) GnRh-agonist

Answer 5

ANSWER
D) Antioestrogen
EXPLANATION
Clomiphen citrate is the competitive antagonist of estrogens on estrogen receptors

Question 6

OBG - 6.5
Which of the following options is not true of the Stein-Leventhal syndrome?
A) Obesity
B) Hirsutism
C) Primer amenorrhoea
D) X-linked inheritance

Answer 6

ANSWER
D) X-linked inheritance
EXPLANATION
No X-linked disorder occurs typically in case of Stein-Leventhal syndrome. However, obesity, hirsutism and anovulation –often together with amenorrhea- are the major symptoms of the clinical picture.

Question 7

OBG - 6.6
When detecting hyperprolactinaemia, the first examination to be carried out is:
A) Skull X-ray
B) Measuring the serum FSH level
C) Sella-CT or –MRI
D) Pelvic ultrasound
E) Measuring the serum estradiol level

Answer 7

ANSWER
C) Sella-CT or –MRI
EXPLANATION
In case of hyperprolactinaemia the most important issue is to detach the functional or tumour origin, the first step of which is the imaging of the sella turcica.

Question 8

OBG - 6.7
Medications used to induce ovulation, except for:
A) Clomiphene citrate
B) hMG
C) hCG
D) cyproproteron-acetat

Answer 8

ANSWER
D) cyproproteron-acetat
EXPLANATION
Stimulating folliculogenesis is impossible only with Diane 35 out of the listed ones.

Question 9

OBG - 6.8
Which of the following cannot cause hyperprolactinaemia?
A) Prolactine-producing hypophysis tumour
B) Neuroleptics
C) Pregnancy
D) Hyperthyreosis

Answer 9

ANSWER
D) Hyperthyreosis
EXPLANATION
Hyperprolactinaemia cannot be observed only in case of hyperthyreosis – out of the listed ones.

Question 10

OBG - 6.9
The following methods have an important role in the modern sterility examination, except for:
1) Hysterosalpingography
2) Ultrasound folliculometry
3) Laparoscopy with chromopertubation
4) CTG

A) only options 1, 2, and 3 are correct
B) only options 1 and 2 are correct
C) only options 2 and 4 are correct
D) only option 4 is correct
E) all the 4 options are correct

Answer 10

ANSWER
D) only option 4 is correct
EXPLANATION
Only CTG (out of the listed ones) plays no role in the examination of sterility as CTG is used for monitoring the foetus.

Question 11

OBG - 6.10
Which one or ones of the conditions listed below can cause infertility?
1) Endometriosis
2) Corpus luteum insufficiency
3) PCO syndrome
4) Hyperprolactinaemia

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 3 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all the 4 answers are correct

Answer 11

ANSWER
E) all the 4 answers are correct
EXPLANATION
By different mechanisms, but each of the listed clinical pictures can be a cause of sterility.

Question 12

OBG - 6.11
Which of the following medicines are suitable for inducing ovulation?
1) HMG
2) pure FSH
3) Clomiphene citrate
4) pure LH

A) only options 1, 2, and 3 are correct
B) only options 1 and 2 are correct
C) only options 2 and 4 are correct
D) only option 4 is correct
E) all the 4 options are correct

Answer 12

ANSWER
A) only options 1, 2, and 3 are correct
EXPLANATION
The first three medicines are suitable for inducing ovulation by stimulating folliculogenesis. However, LH has its first independent role in the rupture of the dominant folliculus, it is not suitable for stimulating folliculogenesis in itself.

Question 13

OBG - 6.12
Which one(s) is/are typical of normal ejaculation:
1) Volume: 2-5 ml
2) Motility: at least two-third of the sperms are moving
3) Morphology: at least 60 % is normal-shaped sperms
4) Concentration: 8-10 million sperms/ml

A) only answers 1, 2 and 3 are correct
B) only answers 1 and 2 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all the 4 answers are correct

Answer 13

ANSWER
A) only answers 1, 2 and 3 are correct
EXPLANATION
The first three parameters are the main characteristics of physiological ejaculatum, however, the minimum physiological sperm count is 20 million/ml.

Question 14

OBG - 6.13
The following diagnostic methods are used to verify the cervical factor in infertility evaluation / testing:
1) post-coital cervical mucus test
2) „Spinnbarkeit” test
3) Sims-Huhner test
4) Ultrasound examination

A) only options 1, 2, and 3 are correct
B) only options 1 and 2 are correct
C) only options 2 and 4 are correct
D) only option 4 is correct
E) all the options are correct

Answer 14

ANSWER
A) only options 1, 2, and 3 are correct
EXPLANATION
Only the ultrasound examination –out of the listed diagnostic methods-does not give help to characterize the cervical factor.

Question 15

OBG - 6.14
Determining the serum progesterone level to verify ovulation is suggested in the following cycle:
1) 1st-3rd days
2) 4th-6th days
3) 1st-13th days
4) 19th-23rd days

A) only options 1, 2, and 3 are correct
B) only options 1 and 2 are correct
C) only options 2 and 4 are correct
D) only option 4 is correct
E) all the options are correct

Answer 15

ANSWER
D) only option 4 is correct
EXPLANATION
Examining the serum progesterone can be performed only in the luteal phase to verify ovulation, the other cycles are not suitable for that.

Question 16

OBG - 6.15
The following procedures can be used to examine the possible blockage of the fallopian tubes:
1) Hysterosalpingography
2) Laparoscopy + chromo pertubation
3) Chromo pertubation + Douglas puncture
4) Hystero-salpingo-sonography

A) only answers 1, 2, and 3 are correct
B) only answers 1 and 2 are correct
C) only answers 2 and 4 are correct
D) only answer 4 is correct
E) all the 4 answers are correct

Answer 16

ANSWER
E) all the 4 answers are correct
EXPLANATION
All the methods listed are suitable for verifying the blockage of the fallopian tubes.

Question 17

OBG - 6.16
The following one(s) can cause infertility:
1) Ashermann syndrome
2) Anovulation cycle
3) Blocked fallopian tubes
4) Oligozoospermia

A) only options 1, 2, and 3 are correct
B) only options 1 and 2 are correct
C) only options 2 and 4 are correct
D) only option 4 is correct
E) all the 4 options are correct

Answer 17

ANSWER
E) all the 4 options are correct
EXPLANATION
By different mechanisms, but all the factors listed can cause sterility.

Question 18

OBG - 6.17
The cause of infertility due to blocked fallopian tubes can be:
1) Uterine intervention
2) Uterus hypoplasia
3) Applying intrauterine contraceptive device
4) Frequent pelvic inflammation
5) Vaginism

A) options 1, 2, 4 and 5 are correct
B) all of the options are correct
C) options 2 and 4 are correct
D) options 1, 3 and 4 are correct
E) options 2, 4 and 5 are correct

Answer 18

ANSWER
D) options 1, 3 and 4 are correct
EXPLANATION
Uterus hypoplasia and vaginism – out of the listed ones- do not play a role in stimulating inflammation that causes the blockage of the fallopian tubes.

Question 19

OBG - 6.18
Which are the typical hormonal changes of the classical Stein-Leventhal syndrome?
1) The LH/FSH ratio elevates
2) The prolactine level decreases
3) The testosterone level increases
4) SHBG decreases
5) The androstendiol decreases

A) only answers 1, 2, 4 and 5 are correct
B) all the answers are correct
C) only answers 2 and 4 are correct
D) only answers 1, 3 and 4 are correct
E) only answers 2, 4 and 5 are correct

Answer 19

ANSWER
D) only answers 1, 3 and 4 are correct
EXPLANATION
The increase in the LH/FSH ratio and the testosteron level and the decrease in the SHBG level can almost always be detected in case of Stein-Leventhal syndrome. However, the prolactine and the androstendion levels did not decrease, but increased in different.

Question 20

OBG - 6.19
The progesterone values of the samples taken every other day in the middle of the second half of the cycle are: 6,3-9,5-7,9 ng/ml. What is the probable diagnosis?1) PCO syndrome
2) Luteal insufficiency
3) Anovulation
4) Habitual abortus due to corpus luteum insufficiency
5) Idiopathic Oestrogen Deficiency syndrome

A) Options 1.2.4. and 5. are correct
B) All the options are correct
C) Options 2 and 4 are correct
D) Options 1., 3. and 4. are correct
E) Options 2., 4. and 5. are correct

Answer 20

ANSWER
C) Options 2 and 4 are correct
EXPLANATION
The progesterone values listed verify ovulation and luteal phase deficiency at the same time. The latter can be a cause of either sterility or habitual abortion. The lack of ovulation is typical of the other three values

Question 21

OBG - 6.20
Which one(s) is/are typical of normal andrological findings?
1) The amount of the ejaculatum is 2-5 ml
2) The motility is less than 50%
3) The proportion of sperms showing normal morphology is greater than 60%
4) The number of white blood cells per viewfield is fewer than 10
5) The total liquefaction occurs in more than 80 minutes

A) Options 1.2.4. and 5. are correct
B) All the options are correct
C) Options 2 and 4 are correct
D) Options 1., 3. and 4. are correct
E) Options 2., 4. and 5. are correct

Answer 21

ANSWER
D) Options 1., 3. and 4. are correct
EXPLANATION
The 1st, 3rd and 4th parameters are characteristics of spermatogramm, low motility and slow liquefaction are typical of abnormal findings.

Question 22

OBG-6.21-6.24
Match them.
A) clomiphene citrate
B) corticosteroid
C) bromocriptine
D) hMG (humane menopausal gonadotropin)

OBG - 6.21 - It affects through androgen production
OBG - 6.22 - The increased prolactine level can be decreased by giving this
OBG - 6.23 - Having an antiestrogen effect
OBG - 6.24 - It directly increases the serum level of gondotropins

Answer 22

ANSWER
OBG - 6.21 - It affects through androgen production - B)

OBG - 6.22 - The increased prolactine level can be decreased by giving this - C)

OBG - 6.23 - Having an antiestrogen effect - A)

OBG - 6.24 - It directly increases the serum level of gondotropins - D)

Question 23

OBG-6.25-6.28
Match the therapeutic options with the conditions.
A) GnRH
B) clomiphene citrate
C) oradexon
D) parlodel

OBG - 6.26 - Hyperprolactinaemia

OBG - 6.27 - Infertility with increased testosterone and/or DHEAS (dehydroepiandrosteron-sulfat)

OBG - 6.28 - Hypothalamic insufficiency

Answer 23

ANSWER
OBG - 6.26 - Hyperprolactinaemia - D)

OBG - 6.27 - Infertility with increased testosterone and/or DHEAS (dehydroepiandrosteron-sulfat) - C)

OBG - 6.28 - Hypothalamic insufficiency - A)

Question 24

OBG - 6.30
Administration of GnRH pulsatorically is suggested because continuous infusion causes „down regulation” of the receptors, which results in a reverse effect of what we expect.
A) both are correct, there is causality between them.
B) both are correct, but there is not causality between them
C) the first one is correct in itself, but the second one is incorrect
D) the first one is incorrect, the second one is correct in itself
E) both of them are incorrect

Answer 24

ANSWER
A) both are correct, there is causality between them.
EXPLANATION
GnRH has to be given pulsatorically to stimulate the function of hypophysis (usually every 80-90 seconds), similar to physiological production. By continuous administration, we will attain an opposite effect.

Question 25

OBG - 6.32
A woman with blocked fallopian tubes cannot be considered to be of non-childbearing potential absolutely, because in her case a fallopian tube reconstruction surgery or in vitro fertilization can help.
A) both are correct, there is causality between them.
B) both are correct, but there is not causality between them
C) the first one is correct in itself, but the second one is incorrect
D) the first one is incorrect, the second one is correct in itself
E) both of them are incorrect

Answer 25

ANSWER
A) both are correct, there is causality between them.
EXPLANATION
Blocked fallopian tubes prevent the sperms and the oocyte from meeting. A surgical therapy to remove blockage or in vitro fertilization can be a solution.

Question 26

OBG - 6.33
One of the most common causes of fallopian tube blockage is endometriosis, therefore clarifying obstruction is a base of examining infertility.
A) both are correct, there is causality between them.
B) both are correct, but there is not causality between them
C) the first one is correct in itself, but the second one is incorrect
D) the first one is incorrect, the second one is correct in itself
E) both of them are incorrect

Answer 26

ANSWER
D) the first one is incorrect, the second one is correct in itself
EXPLANATION
The most common cause of blocked fallopian tubes is inflammation and not endometriosis, but examining the blockage of the fallopian tubes is an essential element of sterility examination.

Question 27

OBG - 6.34
During ovulation induction ultrasound examinations of the pelvis are recommended, since the hyperstimulation of the ovaries can occur during treatment.
A) both are correct, there is causality between them.
B) both are correct, but there is not causality between them
C) the first one is correct in itself, but the second one is incorrect
D) the first one is incorrect, the second one is correct in itself
E) both of them are incorrect

Answer 27

ANSWER
A) both are correct, there is causality between them.
EXPLANATION
A patient’s induvidual reaction cannot be foreseen in the course of ovulation induction, therefore controlling the treatment is extremely important.

Question 28

OBG - 6.35
By performing hysterosalpingography we can get information about the blockage of the fallopian tubes, because the contrast medium in a healthy woman gets into the abdominal cavity through the fallopian tubes.
A) both are correct, there is causality between them.
B) both are correct, but there is not causality between them
C) the first one is correct in itself, but the second one is incorrect
D) the first one is incorrect, the second one is correct in itself
E) both of them are incorrect

Answer 28

ANSWER
A) both are correct, there is causality between them.
EXPLANATION
In case of hysterosalpingography the question can be answered by either getting the contrast material into the abdominal cavity or a failure to do so.

Question 29

OBG - 6.36
Homolog intrauterine insemination (IUI) is a commonly used assisted reproduction procedure in treating some forms of sterility, because it is unanimously confirmed that its real effectiveness is more resultful than the opportunities provided by other insemination procedures (praecervicalis, intracervicalis).
A) both are correct, there is causality between them.
B) both are correct, but there is not causality between them
C) the first one is correct in itself, but the second one is incorrect
D) the first one is incorrect, the second one is correct in itself
E) both of them are incorrect

Answer 29

ANSWER
A) both are correct, there is causality between them.
EXPLANATION
By eliminating the cervical factor a more resultful homolog intrauterine insemination may be achieved compared to cervicalis or precervicalis

Question 30

OBG - 6.37
Asherman syndrome can cause secondary amenorrhea, because adhesions are formed in the fallopian tubes.
A) both are correct, there is causality between them.
B) both are correct, but there is not causality between them
C) the first one is correct in itself, but the second one is incorrect
D) the first one is incorrect, the second one is correct in itself
E) both of them are incorrect

Answer 30

ANSWER
C) the first one is correct in itself, but the second one is incorrect
EXPLANATION
Asherman syndrome means the adhesion of the uterine cavity due to lesion of the basal layer. That’s why it causes amenorrhea.

Question 31

OBG - 6.38
What examinations do you recommend?The medical history of a 30-year-old woman contains 5 spontaneous abortions. The miscarriages happened between the 8th and the 14th weeks of pregnancy. The serum progesterone levels were within normal range. The androgen hormone level showed no deviation. The FSH/LH ratio is normal, there is no bleeding disorder. She got her first period at the age of 13. No deviation was shown in the liver and renal functions.
1) examining the husband
2) ovarium biopsy
3) HSG (hysterosalpingographia)
4) determing the lupus-anticoagulant and the anticardiolipid antibodies
5) hysteroscopy

A) options 1., 2., and 4. are correct
B) options 1., 3., and 5. are correct
C) options 2., 3., and 5. are correct
D) options 2., 3., and 4. are correct
E) all the options are correct

Answer 31

ANSWER
B) options 1., 3., and 5. are correct
EXPLANATION
The examination process is examining the husband, HSG and ultrasound examinations and hysteroscopy. The most probable cause of spontaneous miscarriage is the abnormal development of the uterine, or perhaps a myoma of the uterine. Removing the septum with the simplest method possible is a therapeutic option. If a myoma granuloma can be observed by the above-mentioned examinations, it has to be removed

Question 32

OBG - 6.39
Which of the listed conditions is the most probable?The medical history of a 30-year-old woman contains 5 spontaneous abortions. The miscarriages happened between the 8th and the 14th weeks of pregnancy. The serum progesterone levels were within normal range. The androgen hormone level showed no deviation. The FSH/LH ratio is normal, there is no bleeding disorder. She got her first period at the age of 13. No deviation was shown in the liver and renal functions.
A) corpus luteum insufficiency
B) PCO syndrome
C) Abnormal uterus development
D) Turner syndrome

Answer 32

ANSWER
C) Abnormal uterus development
EXPLANATION
The examination process is examining the husband, HSG and ultrasound examinations and hysteroscopy. The most probable cause of spontaneous miscarriage is the abnormal development of the uterine, or perhaps a myoma of the uterine. Removing the septum with the simplest method possible is a therapeutic option. If a myoma granuloma can be observed by the above-mentioned examinations, it has to be removed.

Question 33

OBG - 6.40
What is your therapy recommendation?The medical history of a 30-year-old woman contains 5 spontaneous abortions. The miscarriages happened between the 8th and the 14th weeks of pregnancy. The serum progesterone levels were within normal range. The androgen hormone level showed no deviation. The FSH/LH ratio is normal, there is no bleeding disorder. She got her first period at the age of 13. No deviation was shown in the liver and renal functions.
A) endoscopic septal resection, reconstruction or metroplasty in case of coarse alteration
B) Clostilbegyt therapy starting during the period for 5 days. Ultrasound control is needed because of a possible hyperstimulation.
C) there is no therapeutic opportunity.
D) ovarian wedge resection or laparoscopic ovarian coagulation.

Answer 33

ANSWER
A) endoscopic septal resection, reconstruction or metroplasty in case of coarse alteration
EXPLANATION
The examination process is examining the husband, HSG and ultrasound examinations and hysteroscopy. The most probable cause of spontaneous miscarriage is the abnormal development of the uterine, or perhaps a myoma of the uterine. Removing the septum with the simplest method possible is a therapeutic option. If a myoma granuloma can be observed by the above-mentioned examinations, it has to be removed.

Question 34

OBG - 6.41
Can uterine fibromyoma lie behind the condition in the former case?The medical history of a 30-year-old woman contains 5 spontaneous abortions. The miscarriages happened between the 8th and the 14th weeks of pregnancy. The serum progesterone levels were within normal range. The androgen hormone level showed no deviation. The FSH/LH ratio is normal, there is no bleeding disorder. She got her first period at the age of 13. No deviation was shown in the liver and renal functions.
A) No. This type of tumor does not occur at this age.
B) Yes. The therapy would be the removal of the uterus becuse of the frequent malignization of the juvenile myomas.
C) Yes. Depending on location, myoma enucleation or endoscopic resection is to be performed.
D) No. Myoma causes nothing but bleeding disorder and abdominal pain

Answer 34

ANSWER
C) Yes. Depending on location, myoma enucleation or endoscopic resection is to be performed.
EXPLANATION
The examination process is examining the husband, HSG and ultrasound examinations and hysteroscopy. The most probable cause of spontaneous miscarriage is the abnormal development of the uterine, or perhaps a myoma of the uterine. Removing the septum with the simplest method possible is a therapeutic option. If a myoma granuloma can be observed by the above-mentioned examinations, it has to be removed.