Samplex 2017 Flashcards
1
Q
Which of the following is the most frequent neoplastic tumor in adolescents?
A. Follicle cysts
B. Mature cystic teratoma
C. Serous cystadenoma
D. Corpus luteum cyst
A
B
2
Q
A 16 yr old G0 patient came in for an abdominal mass. On history, she had irregular menstrual period. Amenorrhea 8 wks. Which of the following is her most valuable test? A. Transvaginal ultrasound B. Laparoscopy C. Hysteroscopy D. Pregnancy test
A
D
3
Q
After a bout of vulvar itching, a 3 y.o. girl was noted to have fusion of her labia minora at the midline. What is the best management for her? A. Topical steroid cream B. Topical antibiotic ointment C. Topical estrogen cream D. Surgical correction
A
C
4
Q
How can one explain the finding that the inferior pole of a huge abdomino-pelvic mass in a 5 y.o. girl could not be felt at either right or left fornix?
A. Ascitic fluid might have pushed the mass up
B. The mass might be leaking
C. Its huge size could not be accommodated in the pelvis
D. The mass has undergone torsion
A
C
5
Q
An 80 y.o. come in for vaginal spotting. Speculum examination showed a fleshy mass at the urethral meatus. Mass has irregular borders, necrotic, & foul smelling. What is the best differential diagnosis for the patient? A. Urethral caruncle B. Urethral carcinoma C. Cervical polyp D. Cervical cancer
A
B
6
Q
An 8 y.o Came in for foul smelling vaginal discharge. What is the best test/examination for her, to determine the etiology of the discharge?
A. Gram stain of the vaginal discharge
B. Culture & sensitivity of the vaginal discharge
C. Pelvic Ultrasound
D. Speculum Exam
A
A
7
Q
A 30 y.o. G1P1 (1001) consulted for heavy menstrual flow (-) use of OCP, no IUD use. On Internal examination, the cervix is smooth, pink, no lesions; corpus is slightly enlarged. What is the most likely diagnosis for this patient? A. Leiomyoma uteri B. Adenomyosis C. Endometrial polyp D. Any of the above
A
D
8
Q
An endometrial mass was seen on transvaginal ultrasound & the physician wanted to make sure that it is really a mass & not blood clots.
A. hysterosalpingogram
B. laparoscopy
C. saline infusion sonography
D. hysteroscopy
A
C
9
Q
After treatment for abdomino-pelvic TB, the physician wants to determine if the fallopian tubes are patent or not.
A. hysterosalpingogram
B. laparoscopy
C. saline infusion sonography
D. hysteroscopy
A
A
10
Q
A 34 y.o. married for 8 years & still childless. Complaining of severe dysmenorrhea has normal PE findings. TVS was also normal.
A. hysterosalpingogram
B. laparoscopy
C. saline infusion sonography
D. hysteroscopy
A
D
11
Q
An IUD was translocated in a 25 y.o. G1P1
A. hysterosalpingogram
B. laparoscopy
C. saline infusion sonography
D. hysteroscopy
A
B
12
Q
A 34 y.o. asymptomatic patient, had an incidental finding of a nodular uterus, enlarged to 14 wks.
A. Intramural myoma
B. Submucous myoma
C. Subserous myoma
D. Parasitic myoma
A
C
13
Q
A 40 y.o. G4P4 w/ profuse vaginal bleeding has a TVS done w/c showed a 2x2 cm mass w/ 50% encroachment into the uterine cavity.
A. Intramural myoma
B. Submucous myoma
C. Subserous myoma
D. Parasitic myoma
A
B
14
Q
On exploratory laparotomy, a solid mass was seen attached to the intestines.
A. Intramural myoma
B. Submucous myoma
C. Subserous myoma
D. Parasitic myoma
A
D
15
Q
On cut section of the uterus showed a solid mass w/ whorl-like patterns within the myometrium.
A. Intramural myoma
B. Submucous myoma
C. Subserous myoma
D. Parasitic myoma
A
A
16
Q
The following are risk factors for the development of cervical cancer EXCEPT
A. young age at first intercourse
B. multiple sexual partners
C. cigarette smoking
D. nuliparity
E. none of the above
A
D
17
Q
Invasive cancer of the cervix is a preventable cancer because
A. it has a long pervasive state
B. cervical cytology screening programs are available
C. treatment of preinvasive lesions is effective
D. A&B
E. all of the above
A
E
18
Q
True about endometrial cancer except:
A. Patterns of spread through direct extension, lymphatics and less commonly through the blood stream
B. Vaginal bleeding or discharge is most common pathology symptom
C. It is the most common genital malignancy in the Philippines
A
C
19
Q
Surgery for endometrial carcinoma includes the following:
A. Peritoneal fluid sampling for cytology
B. Exploration of the whole abdomen
C. Total hysterectomy and bilateral salpingo-oophorectomy
D. Pelvic and para-aortic lymph node evaluation
E. All of the above
A
E
20
Q
The following factors increase the risk for ovarian epithelial cancers EXCEPT
A. age
B. family history
C. infertility
D. pregnancy
E. ovulatory drugs
A
D
21
Q
Frequent symptoms for vulvar cancer is/are: A. vulvar mass B. ulcer C. pruritus D. binding/discharge E. all of the above
A
E
22
Q
Most common malignant tumor of the ovary A. dysgerminoma B.Immature cystic teratoma C. mucinous cystadenocarcinoma D. granulosa cell tumor
A
C
23
Q
Ovarian cancer staging involves A. clinical staging B. histopathologic staging C. clinico-histopathologIc staging D. clinico-pathologic staging requiring CT scan
A
D
24
Q
The following gynecologic malignancies have precursor lesions EXCEPT A. Ovarian B. Cervical C. Endometrial D. vaginal
A
C
25
```
Most common histology of endometrial carcinoma
A. Serous
B. Mutinous
C. Endometrioid
D. Clear cell
```
C
26
```
A mid-pelvis contraction is suspected if, on clinical pelvimetry, any of the following are noted EXCEPT:
A. convergent pelvic sidewalls
B. prominent ischial tuberosities
C. narrow sacrosciatic notch
D. bispinous diameter >9.5
```
B
27
```
Protraction in cervical dilatation is defined as a rate of <__cm per hour during the active phase of labor in a multipara
A. 1.0
B. 1.2
C. 1.5
D. 2.0
```
C
28
```
When the fetal head has been at the same station for the entire duration of the deceleration phase for >1 hour, this is labeled as:
A. arrest of descent
B. failure of descent
C. protracted descent
D. arrest of dilatation
```
B
29
```
Possible maternal complications of labor in cases of pelvic contraction except;
A. intraamniotic infection
B. fistula formation
C. uterine rupture
D. placental abruption
```
D
30
```
The maneuver employed in the shoulder dystocia drill, which consists of cephalic replacement of fetus followed by cesarean section is called:
A. Barnum
B. McRobert’s
C. Rubin’s
D. Hibbard’s
E. Zavanelli
```
E
31
Uterine dysfunction represents an abnormality in the expulsive forces of labor. This type of uterine dysfunction is characterized by a distorted pressure gradient:
A. hypotonic uterine dysfunction
B. hypertonic uterine dysfunction
C. precipitous labor
D. tetanic uterus
B
32
A 25-year old primigravid on her 34th week of gestation , whose baby is in cephalic presentation, asks you her chances of a successful vaginal delivery. You may make any of the following statements with sufficient certainty.\
A. Insertion/administration or epidural analgesia predisposes to dystocia and increased abdominal delivery
B. Your clinical estimate of her diagonal conjugate of approx 10.5cm is a good sign of adequate pelvic inlet
C. Walking during labor will not decrease the rates of abdominal delivery
D. An xray pelvimetry may be of significant use in determining her pelvic capacity
D
33
```
Flexion of the fetal head is a necessary cardinal movement because it brings the diameter of the fetal head in closest approximation to the maternal pelvis, enabling better chances of delivery because it is the shortest diameter
A. suboccipito-bregmatic
B. bitemporal
C. biparietal
D. occipito-frontal
```
C
34
```
The following is considered a very “unstable" presentation in as much as it may convert to a more physiologIc one during labor
A. occiput
B. transverse
C. brow
D. face
```
C
35
Therapeutic rest is indicated in cases of prolonged latent phase for the following reasons EXCEPT:
A. The parturient may actually be experiencing only false labor pains
B. It is necessarily indicative of cephalopelvic disproportion
C. Oxytocin augmentation may not be entirely successful
D. none of the above
C
36
```
In the clinical differentiation between abnormal fetal presentations, the opening and the bony prominences may be palpated. If these 3 Structures form a straight line on palpation, this is most probably a fetus in ______ presentation
A. Breech
B. Face
C. Chin
D. Occiput transverse
```
A
37
```
You admitted Mrs. AA, a 27 year old primigravid, due to regular uterine contractions She is presently on her 38th week of gestation. On Internal examination, her cervix is 2 cm dilated, beginning effacement, with the fetal head at station -1. After 21 hours of admission, her cervix is now 3 cm, 50% effaced win the fetal head at station 1. Your DX
A. protracted cervical dilatation
B. protracted descent
C. prolonged latent phase
D. arrest of cervical dilatation
```
C
38
Based on the Cochrane collaboration data, which of the following procedures is most effective in controlling postpartum hemorrhage, secondary to uterine atony?
A. Active management of third stage of labor
B. Misoprostol administration after delivery of the placenta
C. Bimanual compression of the uterus
D. Immediate administration of oxytocin and methylergometrine
A
39
```
After all conservative measures have failed in the control of uterine atony in a 23-year old primipara, what is the next best option for her to control postpartum hemorrhage?
A Subtotal hysterectomy
B. Total hysterectomy
C. B-Lynch compression sutures
D. Bilateral hypogastric artery ligation
```
C
40
What is the most common cause of acute uterine inversion?
A. Presence of concomitant placenta accrete
B. Vigorous fundal pressure on the third stage of labor
C. Over-traction of the umbilical cord
D. Presence of a relaxed and atonic uterine
C
41
Which of the following is NOT a definition of postpartum hemorrhage
A Blood loss of more than 500 cc for a vaginal delivery
B. Decrease in postpartum hematocrit of >20% of prenatal value
C. Blood less of more than 1L in caesarian delivery
D. Any bleeding that results in signs and symptoms of hemodynamic instability
B
42
The following procedure is part of the Active Management of Third Stage Labor.
A. Clamping and cutting of the cord within 1 minute of delivery
B. Gentle cord traction and slight fundal pressure
C. Oxytocin infusion prior to placental separation
D. Manual extraction of the placenta
D
43
A 41 y/O G4P3 (3003) was admitted at 40-41 weeks AOG with an ultrasound result of placenta previa (placenta anterior and totally covering the os). Her three previous pregnancies were terminated by Low Segment Cesarean Sections (LSCS), with no complications. What should you anticipate with this delivery?
A. Profuse vaginal bleeding if you wait 3 more days
B. Uterine atony
C. Bleeding sinuses at the lower uterine segment
D. Placenta accreta
B
44
What would you tell the patient in the above case on her mode of management?
A. Wait 3 more days then proceed with repeat CS
B. Immediate repeat LTCS
C. Immediate Classical CS
D. Cesarean hysterectomy
D
45
```
What's the leading cause of maternal death in the Philippines?
A Infection
B. Hypertension
C. Hemorrhage
D. Embolism
```
B
46
```
A 25 year old primigravid is delivered by outlet forceps extraction manifested with bleeding right after delivery despite a well contracted uterus. The most probable diagnosis is:
A. retained placental fragments
B. cervical laceration
C. vaginal hematoma
D. uterine atony
```
B
47
What is the etiology of Placenta Accreta?
A. Partial or total absence of the decidua basalis
B. Development of the Nita buchs layer
C. Contraction and retraction of the myometrium
D. Velamentous insertion of the umbilical cord
A
48
The main cause for blood pressure elevation seen in pregnancy-induced hypertension
A. increase in peripheral vascular resistance
B. increase in cardiac output
C. alterations in vascular sensitivity to endogenous hormones
D. increased production of prostacyclin and thromboxane A2
A
49
```
Several antihypertensive drugs have been used in the treatment of preeclampsia. All of the following may be given EXCEPT
A. beta blockers
B. calcium channel blockers
C vasodilators
D ace inhibitors
```
D
50
```
The criteria for the diagnosis of HELLP syndrome are based on laboratory findings which include the following EXCEPT
A. elevated LDH
B. elevated liver enzymes
C. low platelet count
D. none of the above
```
A
51
```
A patient is said to have severe preeclampsia if she manifests any of the following
A. thrombocytopenia
B. proteinuria >5 g / 24 hours
C. microangiopathic hemolysis
D. elevated serum creatinine
E. all of the above
```
E
52
```
The most frequent symptom preceding eclampsia is
A. headache
B. hyperreflexia
C. proteinuria
D. edema
E. visual signs
```
C
53
```
In order to continue magnesium sulfate treatment the patient should have
A. Patellar reflex
B. urine flow greater than 30 ml/hr
C. respiration greater than 12/Min
D. magnesium blood levels of 4-8 mg/dL
E. all of the above
```
E
54
```
The pathognomonic microscopic finding in renal biopsy among women with preeclampsia
A. fibrinogen deposits
B. glomerular capillary endotheliosis
C. glomerular edema
D. renal capsular edema
```
B
55
```
A 17 y/o G1P0 consulted for absence of fetal movement. She is on her 34th week age of gestation. BP was 160/100. HR=102 and RR=24. She also noted persistent uterine contractions 1 hr PTC. Upon rupture of the bag of waters, it was noted to be bloody. Dx?
A. Placenta previa
B. Abruptio placenta
C. Uterine rupture
D. Vasa previa
```
D
56
A 35 y/o consulted for headache on her 14th week AOG. BP was noted to be 150/110. TM corpus was enlarged to AOG with fetal heart rate of 160 bpm. Urine albumin was +1. Dx?
A Pre-eclampsia mild
B. Pre-eclampsia severe
C. Chronic hypertension with superimposed pre-eclampsia samplex-based
D. Chronic hypertension
C
57
Which of the following statements is FALSE?
A. Preeclampsia can develop before the 20th week of gestation in cases of extensive hydatidiform changes in the chorionic villi or in the presence of lupus anticoagulant
B. Altered consciousness and scotomata are two of the criteria for the diagnosis of preeclampsia severe
C. Gestational hypertension is confirmed if preeclampsia has not developed and the BP has returned to normal 12 weeks postpartum
D. Chronic hypertension is the presence of persistent hypertension of whatever cause before the 20th week age of gestation or persistent hypertension beyond 4 weeks postpartum
B
58
```
What is the Magnesium level necessary to prevent convulsions?
A. 1-3 mEq/L
B. 4-7 mEq/L
C. 8-10 mEq/L
D. 10-17 mEq/L
```
B
59
```
A 29 year Old G2P0 on her 24th week AOG consults for nape pain. On vital signs, you note her blood pressure to be 150/90. There are good fetal heart tones with no evident uterine contractions. You do an albumin dipstick test: the result is +1. Basic laboratory procedures which have to be done on the patient indicate the following EXCEPT
A. Bleeding parameters
B. Complete blood count
C. 24 hour urine collection
D. Chest X-ray
```
D
60
The following are true of Methyldopa EXCEPT
A. Causes drowsiness
B. Central acting anti-adrenergic agent
C. Incompatible with breastfeeding
D. Crosses the placenta and achieves fetal concentrations
B
61
```
A pregnant patient with preeclampsia severe was given the loading dose of MgSO4. Her total urine output for the past 3 hours was noted to be 30 cc. Subsequent doses of MgSO4 was given, an hour after which the patient presented with cyanosis and respiratory rate of 10-14 per minute. What is the immediate management for this case?
A. Fluid hydration
B. Delivery
C Calcium gluconate IV
D. Dialysis
```
C
62
```
Cornerstone of management of gestational diabetes mellitus, EXCEPT:
A. Metformin therapy
B. Diet
C. Exercise
D. Fetal well-being studies
```
D
63
```
Fetal metabolic consequences associated with gestational DM except:
A. hypoglycemia
B. hypocalcemia
C. hyperkalemia
D. hyperbilirubinemia
```
C
64
```
A 38 year old G2P1 (1001) GDM patient with 36 weeks AOG had a routine biometry done. Sonographic estimated fetal weight was 4264 grams by Hadlock. What would be your long term plan for this patient?
A. Induction at 38 weeks AOG
B. Elective CS at 37-38 weeks AOG
C. Elective CS at 38-39 weeks AOG
D. Await spontaneous labor
```
B
65
```
R 28 year old primigravid is in her 23th week age of gestation. She Consults your clinic for her first prenatal check-up. Her mother is a diabetic. What will be the appropriate glucose test this patient?
A. 50g OGCT
B. 75 g OGTT
C 100 g OGTT
D. HbA IC
E. All of the above
```
B
66
```
Which is NOT a fetal effect of diabetes on pregnancy?
A. Congenital anomalies
B. Macrosomia
C. fetal death
D. Diabetic ketoacidosis
```
D
67
The second half of pregnancy is considered a diabetogenic state because of
A. Increased peripheral utilization of glucose
B. fasting hypoglycemia
C. Sensitivity to insulin at the cellular level
D. accelerated starvation
C
68
```
Based on the PGH data, perinatal mortality among diabetic pregnancies is highest among
A. GDM
B. NIDDM
C. IDDM
D. None of the above
```
A
69
```
Congenital malformations are highest among mothers with the following EXCEPT:
A. Vasculopathy
B. Long standing DM
C. GDM
D. Poor preconceptional control
```
C
70
```
A 36 y.o G1P0 on her 38th week of gestation was noted to have uncontrolled 2 hour postprandial blood sugar reaching 200 mg/dl. What is the best management for her?
A. Metformin
B. Diet
C. Insulin
D. Delivery of fetus
```
C
71
```
Based on PGH data, what is the most common cause of heart disease in pregnancy?
A. Cardiomyopathy
B. Congenital heart disease
C. Rheumatic heart disease
D. Mitral valve prolapse
```
D
72
```
Fetal complications of heart disease during pregnancy
A. Premature delivery
B. Complex congenital malformations
C. Fetal edema
D. Poor APGAR
```
A
73
Normal physiologic change of the cardiovascular system during pregnancy:
A. Cardiac output increases by 20%
B. Heart rate decreases
C. Systemic vascular resistance decreases
D. BP increases
C
74
```
A 24 G1P0 consulted the OPD for shortness of breath after walking up 1 flight of stairs. She has no known heart disease. She is on her 30th age of gestation. FH is 28 cm. EFW of 1.2-1.4 kg. She has no cyanosis or edema. Chest findings showed equal chest expansion, clear lungs, distinct S1, no murmurs. What would you advise her?
A. Symptoms are normal
B. Perform chest X-ray
C. Perform 2D echo
D. Perform ECG
```
A
75
Preterm delivery with surgery increases with the following EXCEPT:
A. Long operations
B. Spinal anesthesia
C. AOC 24 weeks
B
76
Which is an ominous finding with regard to pulmonary function in pregnancy?
A Increased pH
B. Increased pC02
C. Decreased HCO3
D. Decreased functional residual capacity
B
77
```
What is the first line therapy for mild persistent asthma?
A. antibiotics
B. beta adrenergic agonists
C. methylamines
D. cromolyn sodium
```
B
78
```
Which is the best screening test for SLE?
A. anti-Sm antibodies
B. cardiolipin antibodies
C. antiplatelet antibodies
D. antinuclear antibodies
```
D
79
```
The thyroid undergoes which of the following changes during pregnancy?
A. Enlarges
B. decreases in size
C. remains the same size
D. becomes nodular
```
C
80
```
Which of the following remains unchanged during pregnancy?
A. total T3 Concentration
B. total T4 Concentration
C. thyrotropin-releasIng hormone (TRH)
D. thyroid-binding globulin
```
B
81
```
A common vaginal infection that is significantly associated with premature delivery
A. Candidiasis
B. Bacterial vaginosis
C. Trichomoniasis
D. Herpes simplex infections
```
B
82
```
Most common cause for indicated premature delivery
A. Abruptio placenta
B. Diabetes mellitus
C. Preeclampsia
D. Fetal Growth Reduction
```
C
83
The preferred management of preterm rupture of membranes
A. Prophylactic antibiotics
B. Tocolytics to delay delivery until 36 weeks
C. Weekly steroids for fetal lung maturity
D. Expectant management
B
84
```
Mechanism through which betamethasone reduces hyaline membrane disease
A. Increased prostaglandin production
B. Delays premature birth
C. Increased surfactant production
D. Increased Cytokine production
```
C
85
Postterm pregnancy refers to
A. Gestation beyond the expected date of delivery as calculated by Naegel’s rule
B. Gestation >42 completed weeks from the first day of the last menstrual period
C. Gestation after 292 days from the first day of the last menstrual period
D. Gestation on the 42nd week from the first day of the last menstrual period
B
86
```
Which of the following is NOT associated with increased perinatal morbidity/mortality in postterm pregnancies?
A. Meconium aspiration
B. fetal growth restriction
C. Down syndrome
D. oligohydramnios
```
C
87
```
A monochorionic diamnionic placenta
A. Monozygosity
B. Ditygosity
C. Fraternal twins
D. Not related to zygosity
```
A
88
```
On serial ultrasound, oligohydramnios was noted in Twin A white polyhydramnios was noted in Twin B with differences in weight more than 30%. On delivery, hemoglobin differences >5 mg/dl was observed. What is your diagnosis?
A. Twin to twin transfusion
B. Twin discordancy
C. hydrops fetalis
D. Conjoined twins
```
B
89
```
All EXCEPT ONE are associated with severe fetal growth restriction
A. Low maternal weight
B. Fetal infections
C. Trisomy 21
D. Smoking
```
C
90
```
The condition least likely to be associated with macrosomia
A. Shoulder dystocia
B. Brachial nerve plexus injury
C. Intraventricular hemorrhage
D. Cephalopelvic disproportion
```
C
91
```
The most common cause of congenital malformations
A. Drugs
B. Chromosomal malformation
C. Infection
D. All of the above
```
B
92
The following statement is true about pregnancy
A. The most commonly prescribed drugs in pregnancy is anti-hypertensive
B. 90% of women are prescribed OTC drugs
C. 90% of pregnant women used prescription and OTC drugs from 48 classes
D. Drugs cause 20% of fetal congenital anomalies
C
93
```
Percentage of women taking this drug class has increased from 1959 to 1975
A. Antimicrobials
B. Analgesics
C. Antiemetics
D. Tranquilizer
```
A
94
Drugs during the second to third trimester can cause
A. Sublethal anatomic defect
B. Abortion
C. altered growth and function of fetal organs
D. Covert embryopathy
C
95
```
A determinant of drug effects on the fetus related to the drug
A. Fetal age
B. Drug potency
C. Maternal diseases
D. Change of Maternal pharmacokinetics
```
D
96
This type of drug is most affected during pregnancy
a. weakly acidic drugs
b. Drugs metabolized by the liver
c. Low volume of distribution
d. High volume of distribution
C
97
```
During pregnancy this change in glomerular filtration rate is commonly observed
A. No change
B. Increased
C. Decreased
D. Unknown
```
B
98
```
Drugs which have been shown by well controlled studies not to show fetal risk during the first trimester is classified according to the US FDA as
A. Category A
B. Category B
C. Category C
D. Category D
```
A
99
```
Was cancer drugs and some anti-convulsants are classified as
A. Category X
B. Category B
C. Category C
D. Category D
```
D
100
The USFDA and the Australian Drug Evaluation Center do not give the same classification to the same drug EXCEPT in the following
A. Acetaminophen
B. Phenytoin
C. Aspirin
D. Paroxetine
B
