OB/Gyn Final Exam - 2008

Student's name:........................................................... Date:.............................

Directions: Each of the numbered items or incomplete statements in this section is followed by answers or by completions of the statement. Select the ONE lettered answer or completion that is BEST in each case.

1. The main two indications for hysterectomy are:

1. Leiomyomas, dysfunctional uterine bleeding

2. Leiomyomas, Pelvic pain

3. Dysfunctional uterine bleeding, Genital prolapse

4. Pelvic pain, Pelvic inflammatory diseases

5. Genital prolapse, Endometriosis

2. During an operation, a midline incision was made at an anatomic location 2 cm below the umbilicus. Which of the following lists (in order) the layers of the anterior abdominal wall as they would be incised or separated?

1. skin, subcutaneous fat, superficial fascia (Camper's), deep fascia (Scarpa's), fascial muscle cover (anterior rectus sheath), rectus muscle, a deep fascial muscle cover (posterior rectus sheath), preperitoneal fat, and peritoneum.

2. skin, subcutaneous fat, superficial fascia (Scarpa's), deep fascia (Camper's), fascial muscle covering (anterior abdominal sheath), transverse abdominal muscle, a deep fascial muscle cover (posterior rectus sheath), preperitoneal fat, and peritoneum

3. skin, subcutaneous fat, superficial fascia (Camper's), deep fascia (Scarpa's), fascial muscle cover (anterior rectus sheath), rectus muscle, a deep fascial muscle cover (posterior rectus sheath), peritoneum, and preperitoneal fat

4. skin, subcutaneous fat, superficial fascia (Scarpa's), deep fascia (Camper's), fascial muscle cover (anterior rectus sheath), rectus muscle, a deep fascial muscle cover (posterior rectus sheath), preperitoneal fat, and peritoneum

5. skin, subcutaneous fat, superficial fascia (Camper's), deep fascia (Scarpa's), fascial muscle cover (anterior rectus sheath), transverse abdominal muscle, a deep fascial muscle covering (posterior rectus sheath), preperitoneal fat, and peritoneum

3. In the female, the true pelvis anatomically

1. has an oval outlet

2. has three defining planes, an inlet, a midplane, and an outlet

3. has an inlet made up of a double triangle

4. is completely formed by two fused bones

5. lies between the wings of the paired ileum

4. The three principal estrogens in women in decreasing order of potency are

1. estriol, estradiol, estrone

2. estrone, estriol, estradiol

3. estradiol, estrone, estriol

4. estradiol, estriol, estrone

5. estriol, estrone, estradiol

5. The normal vaginal pH during the menstrual cycle is

1. 3,0-4,5

2. 4,5-5,5

3. 5,5-6,5

4. 6,5-7,5

5. 7,5-8,5

6. Cardioprotective actions of estrogen may include

1. dilatation of coronary vassels

2. production of thromboxane

3. depression of HDL (high-density lipoprotein) levels

4. elevation of LDL (low-density lipoprotein) levels

5. widening of pulse pressure

7. Stenosis of the cervix can lead to which of the following complications?

1. pyometra

2. adenomyosis

3. primary dysmenorrhea

4. cervical polyps

5. uterus didelphys

8. A 45-year-old patient with uterine leiomyomata found on pelvic examination complains of excessive uterine bleeding. The next step in the management of this patient sholud be

1. myomectomy

2. hysterectomy

3. ultrasonography

4. endometrial biopsy

5. hysteresalpinogography

9. Most neoplastic ovarian masses in postmenopausal women originate from

1. ovarian epithelium

2. ovarian stroma

3. ovarian germ cells

4. ovarian sex cords

5. metastatic disease

10. Indicate the hormone, which can be used as a presumptive sign that ovulation occurred:

1. Prolactine

2. Estradiol

3. Testosterone

4. Progesteron

5. Follitropin

11. Endometrial cancer is

1. mainly estrogen-dependent

2. androgen-dependent

3. progesterone-dependent

4. hormonally independent

5. FSH dependent

12. Endometriosis can be diagnosed only

1. During physical examination

2. By ultrasound examination

3. By CT examination

4. During laparoscopy or laparotomy

5. During X-ray examination

13. A 62-year-old G2P2 woman, menopausal for 12 years, presents to clinic complaining of abdominal bloating for 6 months. During the past 2 monts she has been unable to button her pants, despite a 10-lb weight loss achieved without dieting. A plevic ultrasound reveals massive ascites and a 9 x 10 cm complex right ovarian mass. In addition to obtaining lab work, the next step in management is:

1. Observation with repeat ultrasound in 4 weeks

2. Exploratory laparotomy

3. Diuretic treatment for relief of her ascites

4. A second opinion

5. Chemotherapy

14. A 27-year-old patient complains of 6 months of amenorrhea. A pregnancy test is negative. Which of the following is the most likely cause of secondary amenorrhea in this patient?

1. Abnormal chromosomes

2. Asherman syndrome

3. Hypothyroidism

4. Prolacinomoa

5. Anovulation

15. Mixing vaginal discharge with potassium hydroxide (KOH) creates an odor that is helpful in diagnosing:

1. Bacterial vaginosis

2. Trichomoniasis

3. Moniliasis

4. Gonorrhea

5. Chlamydia

16. Pelvic inflammatory disease is characterized by all of the following EXCEPT:

1. Leukocytosis

2. Pelvic pain

3. Fever

4. Anemia

5. Cervical motion tenderness

17. A postmenopausal women comes to your office for an advice because her best friend has been diagnosed with endometrial cancer. The patient is concerned that she too may develop the disease. You tell her that risk factors associated with endometrial cancer include the following, EXCEPT:

1. Nulliparity

2. Late menopause

3. DES exposure

4. Obesity

5. Polycystic ovarian disease

18. The diagnosis of a complete hydatidiform mole has been confirmed following the suction curettage. What is the most appropriate management for this patient now?

1. Weekly and then monthly hCG testing

2. Repeat D&C if the hCG value is elevated

3. Transvaginal ultrasonographic examination

4. Chemotherapy

5. Radioterapy

19. Fibroids are associated with all of the following except:

1. Hydronephrosis

2. Recurrent pregnancy loss

3. Anemia

4. Endometritis

5. Metrorrhagia

20. What is the most common cystic mass in the vulvovaginal region?

1. Fibroma

2. Epidermal inclusion cyst

3. Hidradenoma

4. Nevus

5. Bartholin cyst

21. A 22-year-old professional dancer (G₀) presents with absence of menses for 6 months. Priot to this her cycles had been irregular. Physical examination finds that she is 5'6”, weighs 98 lbs, and is healthy appearing. The cause of her amennorrhea is most likely:

1. Premature ovarian failure

2. Hypogonadotropic hypogonadism

3. Sheehan syndrome

4. Pregnancy

5. Polycystic ovary syndrome

22. All of the following are associated with increased risk of ectopic pregnancy except:

1. Pelvic surgery

2. In vitro fertilization

3. Gonadotropin ovulation induction

4. Salpingitis

5. Anemia

23. Which serotypes of human papillomavirus (HPV) are associated with cervical cancer?

1. 6, 11

2. 16, 18

3. 1,2,3

4. all of the above

5. none of the above

24. Findings at time of surgery included 6 liters of ascites, diffuse tumor implants over the abdominal peritoneal surfaces and omentumm measuring up to 4 cm in diameter, enlarged para-aortic lymph nodes, and bilateral solid-cystic ovarian masses. All the above sites were histologically confirmed to contain adenocarcinoma. What stage of ovarian cancer did she present with?

1. Stage IIIa

2. Stage IIIb

3. Stage IIIc

4. Stage IV

5. Stage IIC

25. A vulvar carcinoma with tumor positive unilateral nodes and no distant spread would be which FIGO stage?

1. I

2. II

3. III

4. IV

5. cannot be staged without further information

26. Usual time of menses and ovulation returning after labour when women do not nurse a child is:

1. after 7 days postpartum

2. after 6-8 weeks postpartum

3. without any schedule

4. after 6-8 months

5. only following hormonal treatment

27. Breast-feeding is not contraindicated when women:

1. take street drugs and do not control alcohol intake

2. underwent breast cancer operation 10 years ago and there is no reccurency

3. has active non treated tuberculosis

4. has cytomegalovirus infection

5. have child with galactosemia

28. Contraception of choice in brestfeeding women is:

1. Progestin-only pills

2. Combined estrogen-progestin pills with 35 µg of EE

3. There is no need for contraception because all breast-feeding women are infertile

4. Lactational Amenorrhea Method when she has at least three children

5. Depo-Provera i.m. every 3 weeks

29. Fever during breastfeeding is caused by:

1. always mastitis

2. mastitis or puerperal breast engorgement when other sources of infection are excluded

3. flu

4. breast engorgement

5. always endometritis when after cesarean delivery

30. Birth rate is:

1. the number of live birth per 1000 population

2. the number of total birth per 1000 population

3. the number of live neonates of weight between 2500g and 4000g per total population

4. the number of live birth per stillbirth in given population

5. the number of live birth in given population

31. hCG in pregnancy is produced:

1. exclusively by the syncytiotrophoblast and cytotrophoblast

2. by the cytotrophoblast

3. exclusively by the chorionic tissue

4. exclusively by the syncytiotrophoblast

5. by not specified cells in parietal decidua

32. Management of tubal pregnancy is:

1. exclusively surgical

2. exclusively medical

3. not necessary almost in all cases

4. surgical or medical

5. always by adnexectomy

33. In normal pregnancy hCG appearance in maternal plasma is detectable:

1. immediately after conception

2. by 8 to 9 days after ovulation

3. by 14 days after conception

4. by 28 days after ovulation

5. by 8 to 9 days after conception

34. Positive signs of pregnancy are:

1. positive hCG test;

identification of fetal heart action;

perception of active fetal movements by the examiner

2. perception of active fetal movements by the pregnant women;

recognition of the embryo or fetus by sonography;

enlarged abdomen circumference;

3. identification of fetal heart action;

perception of active fetal movements by the examiner;

recognition of the embryo or fetus by sonography;

4. positive hCG test;

recognition of the embryo or fetus by sonography;

enlarged abdomen circumference;

5. identification of fetal heart action;

perception of active fetal movements by the pregnant women;

recognition of the embryo or fetus by sonography;

35. BP≥140/90 mm Hg after 20. weeks' gestation, proteinuria ≥ 300mg/24hours or 1+ dipstick are the minimum criteria to diagnose:

1. Gestational Hypertension

2. Preeclampsia

3. Eclampsia

4. Superimposed Preeclampsia

5. Chronic Hypertension

36. The measuring of following parameters performed prenatally allow the early diagnosis of preeclampsia: 1) body mass, 2) BP, 3) hematocrit, 4) roll-over-test, 5) fibronectin. The true are:

1. 1, 2, 4

2. 2, 5

3. 2, 4

4. none of above

5. all of above

37. Prevention of preeclampsia is possible through:

1. dietary manipulation

2. low-dose aspirin

3. antioxidants

4. none of above

5. all of above

38. Hospital management of preeclamptic patient consists of:

1. daily scrutiny for clinical findings (headache, visual disturbances, epigastric pain, rapid weight gain)

2. weight on admittance and everyday thereafter

3. analysis for proteinuria on admittance and at least every 2 days thereafter

4. BP readings in sitting position

5. measurements of plasma and serum creatinine, hematocrit, platelets, and serum lever enzymes

6. hormonal (estradiol, 17-OH progesterone) estimation on admittance and every 2 days thereafter

7. frequent evaluation of fetal size and amniotic fluid volume

The true are:

1. 1, 2, 3, 4, 5, 6

2. 1, 3, 4, 5, 6, 7

3. 1, 2, 4, 5, 6, 7

4. 1, 2, 3, 4, 5, 7

5. 2, 3, 4, 5, 6, 7

39. Which of the below listed agents is not an antihypertensive drug administered in pregnancies complicated by hypertension

1. magnesium sulfate

2. labetalol

3. nifedipine

4. atenolol

5. methyldopa

40. The chorion laeve is separated from the amnion by the exocoelomic cavity until the end of:

1. first month pregnancy

2. second month of pregnancy

3. third month of pregnancy

4. fourth month of pregnancy

5. fifth month of pregnancy

41. Which statement describing hCG in not correct?

1. it is a glycoprotein composed of two subunits α and β

2. maximal serum levels of hCG are attained at about 8 to 10 weeks of pregnancy

3. serum levels of hCG increase throughout the pregnancy and are the highest beforelabor

4. the best known function of hCG is the maintenance of function of the corpus luteum

5. the hCG serum levels may be increased strikingly in women with hydatiform mole

42. All of the following changes are considered physiological during pregnancy except for:

1. increased water retention

2. postprandial hyperinsulinemia and hyperglycemia

3. increased cardiac output

4. increase of the creatinine and urea serum concentration

5. activation of the coagulation cascade

43. Screening for gestational diabetes should be performed:

1. at the beginning of pregnancy

2. between 14 and 18 weeks of pregnancy

3. between 24 and 28 weeks of pregnancy

4. between 32 and 34 weeks of pregnancy

5. according to the latest guidelines screening is not necessary

44. Which statement describing the Braxton-Hicks contractions is not correct:

1. they are physiological phenomena

2. until the last month of pregnancy they are infrequent

3. their intensity varies between 5 and 25 mmHg

4. they are the sign of the beginning of labor

5. they appear unpredictably and usually are nonrhythmic

45. The term small for gestational age is widely used to categorize an infant whose birthweight is:

1. below the 5^th percentile for its gestational age

2. below the 10^th percentile for its gestational age

3. below the 50^th percentile for its gestational age

4. above the 5^th percentile for its gestational age

5. above the 10^th percentile for its gestational age

46. Preterm delivery means:

1. the spontaneus or induced delivery between 23 and 37 weeks of gestation

2. the spontaneus or induced delivery between 21 and 36 weeks of gestation

3. only the spontaneus delivery between 23 and 37 weeks of gestation

4. only the spontaneus delivery between 21 and 36 weeks of gestation

5. every delivery before 40 weeks of gestation

47. An effective biochemical predictor of preterm delivery is:

1. total HCG

2. fetal phospholipase A

3. fetal fibronectin

4. placental lactogen (HPL)

5. angiotensin II

48. The American College of Obstetricians and Gynecologists has proposed the following criteria to document preterm labour:

1. uterine contractions occuring at frequency of 5 in 30 minutes or 10 in 60 minutes plus progressive change in the cervix

2. uterine contractions occuring at frequency of 5 in 30 minutes or 10 in 60 minutes without progressive change in the cervix

3. uterine contractions occuring at frequency of 4 in 20 minutes or 8 in 60 minutes plus progressive change of the cervix

4. uterine contractions occuring at frequency of 4 in 20 minutes or 8 in 60 minutes without progressive change of the cervix

5. Braxton Hickc contractions

49. Which of the drugs listed below is not a tocolytic agent:

1. magnesium sulfate

2. prostaglandin inhibitors

3. calcium channel blockers

4. corticosteroids

5. nitric oxide donors

50. At the time of physical examination, detection of a lower-abdominal tumor in a 7-year-old girls is best accomplished by palpation of the abdomen coupled with:

1. Rectal examination

2. Vaginal examination

3. Rectovaginal examination

4. Abdominal auscultation

5. Percussion

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