womenshealth final exam

WOMEN’S HEALTH FINAL EXAM

of 7

1. A 25 year old multigravida consults because of vaginal spotting. On history taking, you elicit amenorrhea of 2 months. What is the first thing you would do?

A. Do a CBC and blood typingB. Do a complete curettageC. Advise admission for observationD. Do a pregnancy test to rule out pregnancy

2. The blood and nerve supply to the ovaries courses through which of the following ligaments?

A. Cardinal ligamentsB. Infundibulo-pelvic ligamentsC. Broad ligamentsD. Utero-ovarian ligament

3. In a colposcopic examination the area that is the focus of evaluation is:A. EndocervixB. EctocervixC. Transformation zoneD. Endometrium

4. The normal endocervix is lined with which type of epithelium?A. ColumnarB. SquamousC. Transitional D. Metaplastic

5. A 28 y/o at 32 wks of age of gestation consults at a clinic. She had one set of twins both are alive and she had an abortion. Her OB code is:

A. G3P2 (2102)B. G3P1 (1012)C. G3P2 (2012)D. G2P1 (1012)

6. In placenta accreta, the placenta is abnormally adherent to the myometrium due to partial or total absence of:

A. Decidual capsularisB. Deciduas basalisC. Decidua parietalisD. Decidua vera

7. What is the preferred management of few hours of preterm rupture of membranes at 36 weeks?

A. Cesarean sectionB. Expectant managementC. TocolysisD. Augmentation of labor

8. The most common cause of direct maternal deaths in the Phil is:A. HypertensionB. HemorrhageC. Infection D. Heart disease

9. The pudendal nerve originates from theA. L4-5, S1-2B. S1-S3C. S2-S4D. S4-S5

10. If pregnancy occurs, the corpus luteum is necessary for the maintenance of the pregnancy for at least:

A. 7 daysB. 2 weeksC. 4-5 weeksD. A few months

11. Which of the ff fetal activities is monitored during a contraction stress test?

A. Breathing

B. Eye movementsC. Heart rateD. Body movements

12. What is the average daily iron requirement during the latter half of pregnancy?

A. 1 mg/dayB. 3 mg/dayC. 5 mg/dayD. 7 mg/day

13. What controls fetal heart rate acceleration?A. Autonomic function at brainstem levelB. Aortic baroreceptor reflexC. Carotid baroreceptorsD. Humeral factos such as atrial natriuretic peptide

14. Early accelerations is compatible with:A. Cord compressionB. Head compressionC. Uteroplacetal insufficiencyD. Multiple factors

15. During early pregnancy, which of the ff replaces the ovary as the main source of progesterone production?

A. AmnionB. ChorionC. TrophoblastD. Myometrium

16. Engagement has occurred when this diameter of the fetal head has gone beyond the pelvic inlet

A. Suboccipito-bregmaticB. Mento-occipitalC. Fronto-occipital D. Biparietal

17. The rate of descent of the fetal head during labor is fastest in this division of labor:

A. PreparatoryB. DilatationalC. PelvicD. Deceleration

18. The most common cause of arrest disorders in labor is:A. CPD B. Hypotonic uterine dysfunctionC. MalpositionD. Excessive sedation/anesthesia

19. Optimal analgesia for the 1st stage labor requires neural blockade at what levels:

A. T8-L1B. T10 – L1C. T8 – L2D. T10 – S1

20. What is the maneuver where the index and middle fingers are applied over the maxilla in order to free the head?

A. BrachtB. ZavanelliC. PinardD. Mauriceau

21. A history of vaginal leakage of fluid, either continuously or as a gush, should prompt:

A. Bed restB. Speculum examC. Internal examD. Delivery

22. Schiller’s test for cervical punch biopsy utilizes? of 7

A. Acetic acidB. Lugol’s iodine solutionC. 10% KOHD. 20% KOH

23. Which of the ff is likely to be present at very low levels in the amniotic fluid of infants of diabetic mothers near term?

A. PhosphatidylinositolB. DipalmitoylphosphatidylcholineC. LecithinD. Phosphatidylglycerol

24. Regarding traction with forceps, which of the ff statements is incorrect?A. The fetal head should be allowed to recede in intervalsB. Delivery should be deliberate and slowC. Gentle traction should be intermittentD. It is preferable to apply traction between contractions to

avoid excessive pressure

25. Which of the ff describes a frank breech presentation?A. Flexion of the hips and flexion of the kneesB. Flexion of the hips and extension of the kneesC. Extension of the hips and flexion of the kneesD. Extension of the hips and extension of the knees

26. The uterine artery originates from the:A. Aorta B. External iliac arteryC. Common iliac arteryD. Internal iliac artery

27. Common cause of subinvolution includes which of the ff?A. Fetal macrosomiaB. Puerperal pelvic infectionC. Antenatal polyhydramniosD. Cessation of breastfeeding

28. One typical clinical characteristic of uterine afterpains includes which of the ff:

A. Resolve after the 7th day of puerperiumB. Require analgesicsC. Aggravated by breastfeedingD. Relieved by uterine massage

29. How many weeks after delivery does it take the uterus to return to normal non-pregnant size?

A. 2 wksB. 3 wksC. 4wksD. 6 wks

30. What is the most common etiologic agent for mastitis?A. Staph epidermidisB. Staph aureusC. EnterocciD. Group A Strep

31. Fever due to breast engorgemtn is commonly characterized by which of the ff:

A. Exceeds 39CB. Last <24hrC. Onset within 24 hrs of puerperiumD. Last >48 hrs

32. Which of the ff organism is implicated as a cause of late puerperal infection?

A. Chlamydia trachomatisB. Neisseria gonorrheaC. BActeroides biviusD. Trichomonas vaginalis

33. On pelvic exam, boundaries of the vestibule are:

A. Labia minora, clitoris, posterios fourchetteB. Labia majora, mons pubis, post. PerineumC. Clitoris, mons pubis, post fourchetteD. Labia minora, labia majora, mons pubis

34. The dreaded complication encountered in a previous classical CS in pregnancy:

A. DehiscenceB. RuptureC. InfectionD. Preterm labor

35. This change in cardiovascular function is expected in the pregnant state in order to maintain the hemodynamic stability of the mother

A. Increase in stroke volumeB. Decrease in heart rateC. Increase in SVRD. Decrease in CO

36. Which of the ff pulmonary function changes is observed during pregnancy?

A. Decrease in tidal volumeB. Decrease in minute ventilatory volumey C. In crease in functional residual capacityD. decreased residual volume

37. This structure is the landmark for measuring adequacy of the midpelvis:A. Ischial spinesB. Sacral promontoryC. Symphysis pubisD. Ischial tuberosities

38. What number of vessels would a normal cord have?A. 1 artery, 2 veinsB. 2 arteries, 1 veinC. 1 artery, 1 veinD. 2 arteries, 2 veins

39. What is the immediate precursor for estrogen biosynthesis in human placenta?

A. AcetateB. CholesterolC. ProgesteroneD. Dehydroepiandrosterone sulfate

40. What physiological condition causes pregnant women to become hypoxemic more rapidly during periods of apnea?

A. Decreased total lung capacity B. Increased residual volume

C. Decreased functional residual capacityD. Increased tidal volume

41. Pregnant women with chronic hypertension are at greatest risk compared with nonhypertensive controls for which of the ff adverse events?

A. Deep venous thrombosisB. Placental abruptionC. First trimester abortionD. Postpartum cardiomyopathy

42. The ff anti-TB drugs can be given in pregnancy except:A. RifampicinB. PyrazinamideC. EthambutolD. Isoniazid

43. The DOC for tx of malaria in pregnancy:A. MetronidazoleB. ChloroquineC. FluoroquineD. Pen G

of 7

44. Infertility is defined as inability in effective pregnancy after how many years of cohabitation?

A. 1B. 2C. 3D. 4

45. To control an acute bleeding episode from dysfunctional uterine bleeding in the young and repro age patient, this regimen has been found clinically useful?

A. High dose estrogen admistrationB. Sequential high dose estrogen-progestin (ocp)C. Progestin therapy D. A and B only

46. When is the best time to perform a self-breast exam in relation to the menstrual cycle?

A. Before B. During C. After D. Anytime

47. The rate of descent of the fetal head during labor is fastest in this division of labor:

A. PreparatoryB. DilatationalC. PelvicD. Deceleration

48. At 20 wks gestational age, what is the approximate crown-heel length of the fetus?

A. 15 cmB. 20 cmC. 25 cmD. 30 cm

49. Involuntary loss of urine to uninhibited detrusor contractions is associated with which type of incontinence?

A. UrgeB. Genuine stressC. MixedD. Overflow

50. What are the cardinal movements of labor (in order)?A. Descent, engagement, flexion, internal rotation, extensionB. Descent, flexion, engagement, internal rotation, extensionC. engagement, descent, flexion, internal rotation, extensionD. engagement, flexion, descent, internal rotation, extension

51. An infertility patient with PCO, iiregular menses and with a BMI index of 30 was seen in the clinic. Fallopian tubes were patent and the husband has normal sperm analysis. First line of management should be?

A. Clomiphene citrate 50 mg daily B. Weight loss C. Metformin 500 mg dailyD. Metformin 500 mg BIDE. B and D

52. Among the patient with anovulatory infertility a common problem which may resistant to clomiphene citrate is :

A. PCOB. HyperprolactinemiaC. HyperandrogenismD. Hypogonadotrophic hypogonadism

53. The most difficult anovulatory problem to solve is:A. Hypergonadotrophic hypogonadismB. Hypogonadotrophiv hypogonadidmC. Normogonadotropic eugonadism

54. A sign and symptom that may suggest insulin resistance among PCO patients include/s:

A. Acanthosis nigricansB. ObesityC. HyperandrogenismD. AOTA

55. Disadvantage/s of HMG therapy for anovulatory infertility include/s:A. Increased risk for ovarian hyperstimulationB. Increased risk of multiple pregnancyC. Need for special monitoring with TVSD. AOTA

56. Acceptable statements relating to the current status in the association of ovarian cancer with the use of drugs for induction of ovulation includes:

A. Informed consent is neededB. Therapeutic protocols need to be shortened C. Women treated with these drugs need to br monitored more

rigorouslyD. AOTA

57. Among the patient with infertility who are obese evidence based data suggest that the best treatment is:

A. Advice to lose weight B. Use of COSC. Use of IUID. IVF ET

58. How many times can IUI be done before proceeding to more invasive technique?

A. OnceB. ThreeC. FiveD. Ten

59. Among PCOS patients the possibility of insulin resistance is suggested by:

A. Acanthosis nigricansB. Obesity C. HyperglycemiaD. AOTA

60. all of the ff statements are true regarding preoperative planning except A. Obtaining informed consent is a goal of preoperative planningB. Preoperative laboratory screening tests discover <10% of

significant surgical risk factors C. Detailed history and physical exam detects approximate 90% of

the facts pertinent to the surgical procedureD. Repetitive history taking is stressful and not advisable

61. The most common serious morbidity associated with elective gynecologic surgeries arise from complications of this organ system

A. Respiratory B. CardiovascularC. Gastrointestinal D. Neuromuscular

62. The effective period in which prophylactic antibiotics are protective take place within what time ff contamination?

A. 1 hourB. 3 hoursC. 8 hoursD. 12 hours

63. The most important risk factor predisposing to postoperative infection is:A. Preexisting medical conditionB. AgeC. Socioeconomic classD. Length of operation

of 7

64. Preventive measures for developing thromboembolic disease include all except:

A. Discontinue oral contraceptive pills 4 weeks before major surgeryB. Complete bed rest C. Use of elective stockings and support hose D. Discontinue smoking 2-4 weeks before major elective surgery

65. This condition is thought to be the cause of 90% of fevers in the first 48 hours after gynecologic surgery

A. MicroatelectasisB. Superficial thrombophlebitisC. Urinary tract infectionD. Wound breakdown

66. A true reflection of post operative blood loss is hematocrit drawn within:A. 23 hours after surgeryB. 48 hours after surgeryC. 72 hours after surgeryD. 1 week after surgery

67. Which of the ff is an early sign of hidden internal hemorrhage?A. DyspneaB. TachycardiaC. Muscle rigidity D. Abdominal distention

68. The gold standard for diagnosis of DVT?A. Venography B. Doppler USC. Real time U/SD. Duplex Doppler imaging

69. Which of the ff hypertensive medications should be discontinued prior to surgical procedure?

A. Beta blockersB. Ca channel blockersC. DiureticsD. MAO inhibitors

70. Pregnant GBS colonizers not given antimicrobial prophylaxis during labor may have an increased risk of developing the ff, EXCEPT:

A. PROMB. Portpartum metritisC. PyelonephritisD. Thrombophlebitis

71. A pregnant teenager has a (+) VDRL test result and a (-) FTA-ABS test. Which of the ff statements regarding her case is TRUE:

A. She had syphilis in the past but now is curedB. She may transmit the infection to her childC. Her child will have apopositive VDRL and is at risk of having

syphilisD. She should be evaluated for a collagen vascular disease

72. Untreated gonorrhea in the female frequently leads to:A. Obstruction of the fallopian tubesB. Ovarian cystsC. Ulceration of the cervixD. Endometrial polyp

73. A 25- year old G2P2 was found to have a 5cm unilocular cyst on the right ovary. This is most probably a:

A. Physiologic cystB. Benign epithelial cystC. Ovarian cancerD. Dermoid cyst

74. Which of the ff ovarian neoplasms is most commonly seen in young women?

A. Epithelial ovarian cancerB. Germ cell tumor

C. Granulose cell tumorD. Krukenberg tumor

75. Which of the ff is a risk factor for cervical cancer but a protective factor for ovarian and endometrial cancers?

A. Early sexual debutB. HPV infectionC. OCPD. Multiparity

76. The most common and earliest mode of dissemination of ovarian cancer is:

A. Transcoelomic/contiguousB. LymphaticC. HematogenousD. Perineural

77. The theory regarding the etiology of ovarian cancer isA. HPV infectionB. Unopposed estrogen stimulationC. Frequent ovulationD. Genetic predisposition

78. Metastatic tumors are more common than primary tumors in which of the ff organs:

A. Fallopian tubesB. VaginaC. OvaryD. A and B only

79. The most common group of ovarian cancers is:A. Epithelial ovarian cancerB. Germ cell tumor C. Sex cord stromal tumorsD. Metastatic tumor

80. The presence of ferning pattern in evaluation of rupture of amniotic membrane is explained by what hormone?

A. EstrogenB. ProgesteroneC. ProlactinD. Estrone

81. Why women find it difficult to leave a violent relationship?A. Concern for the childrenB. Hoping the partner will changeC. Normalization of abuse and violenceD. AOTA

82. Characteristics of a batterer and predictors of violence are the ff except:A. High regard to women B. Has low self-esteemC. Externalizes the cause of the behaviorD. Can be pleasant or charming between periods of violence

83. Characteristics of dysmennorrhea include:A. Frequently seen in young womenB. Ovulatory cyclesC. Anovulatory cyclesD. Common in multiparous womenE. A and B are correct

84. The first microscopic evidence of ovulation in an endometrial biopsy is A. Back to back appearanceB. VascularityC. Subnuclear vacuolizationD. Stromal cell proliferation

85. Increased circulating prolactin concentration is associated with all of the ff except:

A. Stress of 7

B. HyperthyroidismC. Anorexia nervosaD. Acromegaly

86. The most common cause of blood nipple discharge is:A. Breast caB. Intraductal carcinomaC. Fibrocystic diseaseD. Galactocoele

87. The most appropriate method of obtaining a tissue diagnosis in a 60y/o woman with a 5cm hard mass with irregular borders is:

A. Fine needle aspirationB. core needle biopsyC. Excision biopsyD. Incision biopsy

88. The primary mode of tx of breast CA is:A. Hormonal B. RadiotherapyC. Chemotherapy D. Surgery

89. The appropriate tx after mastectomy for a 43 y/o woman with 3 cm infiltrating ductal carcinoma with metastasis to 5/15 axillary lymph node., whose tumor is estrogen receptor negative and progesterone receptor negative

A. Chemotherapy aloneB. Radiotherapy to axilla, then chemo with tamoxifenC. Chemo then tamoxifen for 5 yrs, no further tx is neededD. Radiotherapy alone

90. A 29 y/o G3P3 undergoes diagnostic laparoscopy for complains of severe dysmenorrheal and dyspareunia. Laparoscopy confirms Stage III-IV endometriosis. Which is the best management?

A. Hormonal therapyB. Conservative surgery wit LUNAC. Total abdominal hysterectomy with retention of 1 or both

ovariesD. TAHBSO

91. Anovulatory bleeding is seen in which of the ff histologic entities except:A. Normal proliferative endometriumB. Disorderly proliferative endometriumC. Glandulo-stromal breakdownD. AOTA

92. In a Pap smear, which of the ff morphologic feature is not characteristics of HPV?

A. Periuclear halosB. Multi/binucleate cellsC. Nuclear atypiaD. Intranuclear inclusion

93. Neoplastic lesions associated with HPV infection include the ff EXCEPT:A. Cervical squamous cell CAB. Vaginal squamous cell CAC. Vulvar squamous cell CAD. Endometrial adenoCA

94. A 32 y/o woman with primary infertility of 4 yrs was found to have CIN III on colposcopy-guided punch biopsy. The most appropriate tx is:

A. Observation with close ff-upB. HPV vaccineC. ConizationD. Hysterectomy

95. The ff are the risk factors in the devt of cervical CA EXCEPTA. Early onset of sexual activityB. NulliparityC. Multiple sexual partners

D. OCP intake

96. the best tx for a 45 yo woman with menorrhagia and diagnosed to have adenomyosis is

A. Progesterone therapyB. DanazolC. OCPD. Hysterectomy

97. The clinical staging and natural history of fallopian tube cancer is similar to cancer of the:

A. VulvaB. VaginaC. EndometriumD. Ovary

98. During the pelvic exam, we should palpate the area of the posterior third of the labia majora by placing the index finger inside the intoitus and the thumb on the outside of the labium. In this way, we are able to assess the

A. Gartner’s ductB. Bartholin glandsC. Skene’s ductD. Perineal body

99. A woman who complains of infertility for 4 years will benefit from this initial examination

A. HysterosalpingographyB. Diagnostic and therapeutic hystoscopyC. VaginoscopyD. Diagnostic laparoscopy

100. Which of the ff patients would least likely require endometrial biopsy?A. 48 years old with continuous vaginal bleedingB. 53 years old on hormone replacement therapy complaining of

vaginal spottingC. 28 yo suspected of having pelvic TBD. 35 yo diagnosed with endometriosis

101. The ave duration of puberty as determined by the number of years between Tanner Stage B2 to B5 is

A. 3.5 yrsB. 4.5 yrsC. 5.5 yrsD. 6.5 yrs

102. A patient consulted the outpatient clinic on January 08, 2007. She was born on August 08, 1990 and have not had her menarche. What will you do? a. Work-up for primary amenorrhea b. Check for the presence of ovarian neoplasms c. Check for the presence of uterine masses d. Observe patient with close follow-up

103. The first index of declining ovarian function leading to menopause is: a. Drastic drop in estradiol levels b. Fall in inhibin levels c. Fall in GnRH secretion d. Steady decline of gonadotrophin levels

104. During menopause, women are more prone to develop osteoporosis because

A. There is accelerated Ca excretionB. There is increased production of PTHC. There is poor Ca absorption during menopauseD. There is loss of inhibition of PTH by extrogen and

progesterone

105. The ff changes are least likely to be observed by menopausal womenA. Increased HDL levels as well as lowered cholesterol and TG

levelsB. Shift of fat deposition from peripheral sites to the abdomen

of 7

C. Wrinkling of skin due to decrease in collagen in the dermis brought about by estrogen deficiency

D. Vulvar itching and burning sensation due to atrophic vaginitis

106. Girls with precocious puberty have diminished ultimate height becauseA. They do not experience the period of mazimal growth B. They do not produce growth hormoneC. They have accelerated bone growth and premature closure of

epiphysisD. The end organs are insensitive to growth hormones

107. A 6 yo girl come to you wit vaginal bleeding 1 week ago wit Tanner stage 1 for breast and pubic hair on examination. U/S showed a 7x6 cm solid mass at the R pelvic area. Initial considerations will be

A. Central precocious pubertyB. Peripheral precocious pubertyC. Incomplete precocious publertyD. Premature adrenarche

108. What Beta HCG level warrant prophylactic chemotherapy for molar pregnancy?

A. >10,000B. >100,000C. >20,000D. >200,000

109. Chronic pelvic pain in a sexually active individual in reproductive age with multiple sexual partner is frequently equated with:

A. EndometriosisB. AdemoyosisC. PIDD. Anovulatory cycles

110. Which of the ff estrogen is used in oral contraceptives?A. EstroneB. EstriolC. Ethinyl estradiolD. Equilin

111. In which surgical approach to ectopic pregnany is the tube opened to remove the gestational products, then closed?

A. SalphingostomyB. SalphingitomyC. SalphinhectomyD. Salphingorrhapy

112. A woman has the higher risk of having an ectopic pregnancy when:A. Undergone corrective tubal surgery B. Had previous ectopic pregnancy C. Previous pelvic or abdominal surgeryD. Smoking

113. Which of the ff is being studied as possible protective against cerebral palsy and other neurological deficits in the offspring of women treated for preterm labor?

A. IndomethacinB. RitodrineC. TerbutalineD. Mg SO4

114. In a 30 yo G1P1 (1001) 4 weeks postpartum, who is partially breastfeeding and with hx of endometritis the best contraceptive is:

A. An IUDB. Lynestrenol contraceptiveC. A multiphasic contraceptiveD. A monophasic contraceptive

115. The minipill prevents pregnancy by A. Producing a thickened endomentriumB. Producing a scanty cervical mucusC. Inhibiting GnRH secretion

D. Inihibiting FSH and LH release

116. Osteoporosis is a common problem encountered in women on:A. OCPB. Depot medroxyprogeteroneC. IUDD. Diaphragm with spermicide

117. The best contraceptive option for a mentally challenged 26 yo G1P1 isA. An IUDB. A condomC. An OCOD. Depot medroxyprogeterone

118. Use of contraceptives decreased the risk of:A. Ovarian CAB. Breast CAC. Cervical CAD. Vaginal CA

119. The natural family planning method which depends on vaginal dryness or wetness is the:

A. Yuzpe methodB. Billing’s methodC. Ferning’s methodD. Chadwick’s method

120. A 42 yo male who underwent vasectomy is sterile:A. 1 month after vasectomyB. 2 months afterC. After 10 ejaculationsD. After 20 ejaculations

of 7

womenshealth final exam

Documents