OB-GYNE

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what is the minimum age of gestation wherein fetal gender can be determined? A. 8 weeks B. 10 weeks C. 12 weeks D. 14 weeks E. 16 weeks

301 C. the external genitale are beginning to show definitve signs of male and female gender by the end of 12 weeks of gestation. Williams 22nd ed p93.

which of the following is/are a function of human Chorionic Gonadotropin? A. Rescue and maintenance of the corpus luteum B. To promote male sexual differentiation C. Promote uterine vascular dilatation and myometrial smooth muscle relaxation D. stimulation of maternal thyroid hormone production E. all of the above

302 E. williams 22nd ed - pp72-73

which of the following tocolytics can induce a reversible type of oligohydramnios? A. Magnesium sulfate B. ritodrine C. atosiban D. indomethacin E. Terbutaline

303 D. prostaglandin inhibitors are associated with oligohydramnios. Williams 22nd ed p 871

which of the following fetal malformation is strongly correlated with poorly controlled diabetes mellitus both preconceptionally and during pregnancy? A. Situs inversus B. Spina bifida C. Caudal regression D. Renal agenesis E. Anencephaly

304 C. Williams 22nd ed p1177

use of atenolol as an antihypertensive medication in pregnnacy is associated with which of the following perinatal moribidity? A. Fetal growth restriction B. Cardiac defects C. Hyperglycemia D. Preterm birth E. Renal defects

305 A. Williams 22nd ed p 1051

what is the type of placenta is assoicated with placental abruptio and fetal hemorrhage? A. Bipartite placenta B. Circumvallate placenta C. Succenturiate placenta D. Circummaginate placenta E. Placenta membranacea

306 B. there is an increased risk with circumvallate placentas of antepartum hemmorrhage both from placental abruption and from fetal hemorrhage. Circummarginate placenta risk are less well defined. Placenta membranacea can give rise to serious hemorrhage because of its associated placenta previa or accreta.

What type of forceps should be use in delivery of fetus with molded head ? A. Pipers B. Kielland C. Chamberlain D. Simpsons E. Tucker-Mclane

307 D. In general, Simpsons forceps are used to deliver the fetus with a molded head, as is common in nulliparous women. The tucker-Mclane instrument is often ued for the fetus with rounded head seen in most multiparas. Wlliams 22nd ed p549.

40 y/o G6P5 32-33 weeks AOG complains of vaginal bleeding and severe abdominal pain. VS BP 160/100 PR 123 RR 24 T 37.2C. PE of the abdomen:FH 36cm FH 97bpm, UC: every minute, 50 sec duration, strong. what complication is associated with the above condition?? A placenta accreta B. uterine atony C. DIC D. puerperial infection E. all of the above

308 C. abruptio placenta is associated with DIC, renal failure (ATN), hemorrhagic shock, couvelaire uteurs, and fetal maternal hemorrhage.

The most common symptom in a patient with cervical cancer: A. dyspareunia B. vaginal bleeding C. foul vaginal discharge D. weight loss E. pruritus

336 B. Berek & Novaks Gynecology 14th edition p.1404

True of breast masses: A. It is easier to distinguish between benign phyllodes from fibroadenomas than benign from malignant phyllodes. B. Treatment for phyllodes tumor is radiation therapy. C. Fibroadenomas are not associated with an increased risk of breast cancer. D. Fibroadenomas are benign despite causing some skin dimpling and nipple retraction E. Phyllodes tumors are difficult to distinguish clinically from fibroadenomas but the former are usually bilateral.

337 C. Treatment for phyllodes tumor is wide local excision. Fibroadenomas donâ€™t cause skin dimpling or nipple retraction. Phyllodes tumors are rarely bilateral. Berek & Novaks Gynecology 14th edition pp.657-659

which of the following BPP parameter is the last to be affected by hypoxia ? A. Fetal breathing B. Fetal movement C. Fetal tone D. Amniotic fluid volume E. NST

320 A. During Hypoxia, the first parameter to be affected is NST while the last is the fetal tone.

Component/s of active management of labor is/are: A. oxytocin and cesarean delivery B. cesarean delivery C. oxytocin and amniotomy D. all of the above E. none of the above

321 C. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE. Williams Obstetrics 23rd edition p.405

The most common explanation for fetal tachycardia: A. fetal compromise B. fetal cardiac dysrhythmias C. maternal administration of atropine D. maternal fever from infection

322 D. Williams Obstetrics 23rd edition p.413

An involuntary reflex involving contraction of pelvic muscles precipitated by attempts at vaginal entry is known as: A. dyspareunia B. genital arousal disorder C. orgasmic dysfunction D. vaginismus E. sexual assault

338 D. Novaks p.333

The probability of achieving a live birth within a single cycle is termed: A. fecundability B. fertility C. fecundity D. gestation

339 C. Fecundability - the probability of achieving a pregnancy within a single cycle. Berek & Novaks Gynecology 14th edition p.1186

The fecundability of a normal couple is estimated at: A. 10-15% B. 15-20% C. 20-25% D. 25-30% E. 30-35%

340 C. Berek & Novaks Gynecology 14th edition p.1186

A 23 year old G1P0 on her 15th week of pregnancy consulted because of fever and right flank pains. T - 38.9C; BP - 110/70; PR - 85/min; RR - 20/min; FHT 137/min by Doppler. The rest of the PE was essentially normal. What is the probably diagnosis? A. Asymptomatic bacteriuria B. Cystitis C. Acute pyelonephritis D. Acute glomerulonephritis

349 C.

Which of the following is not an imminent sign of eclampsia? A. Severe headache B. Visual disturbances C. Epigastric pain D. Facial edema

350. D..

What is the anaesthesia of choice for pregnant cardiac patients? A. General anesthesia B. Epidural anesthesia C. Subarachnoid block D. Spinal anesthesia

351 B.

Conjoined twinning occurs when fertilisation occurs after the first: A. 48 hours B. 5 days C. 8 days D. 12 days

352 D.

In evaluating a 28 year old patient complaining of vaginal bleeding, what information is most important? A. Age at menarche B. History of dysmenorrhea C. Last menstrual period D. OCP use

353 C. Always rule out pregnancy first in patients who are of reproductive age

What is the usual cause of dysfunctional uterine bleeding in the postmenarcheal and premenopausal age groups? A. Hematologic disorder B. ncreased prostaglandin C. Anovulation D. Hyperprolactinemia

354 C.

What is the possible aetiology of the PID of a woman who is not responding to the usual antibiotic regimen for acute bacterial PID? A. Gonococcal B. Chlamydia C. Mycoplasma D. Tuberculous

360 D.

Which of the following antihypertensive medications are contraindicated in pregnancy? A. Labetalol B. Methyldopa C. Hydralazine D. Captopril E. None of the above

385 D. ACEIs and ARBs are contraindicated in pregnancy.

Which of the following is a hormonal correlate of the hot flush of menopause? A. Low estrogen B. Low progesterone C. High FSH D. High LH E. Low ACTH

217 D. Hormonal correlates of flush activity: Increased LH, ACTH, B-endorphin. However, these occurences are thought to be epiphenomena that result as a consequence of the flush and not related to its cause.

What laboratory examination can be done to confirm the diagnosis in #185? A. CXR B. Liver Enzymes C. CBC D. 24 hour urine protein E. Ultrasound

286 D. proteinuria would differentiate pre eclampsia with gestatinal hypertension and chronic hypertension

When is the usual onset of quickening among primigravids? A. 12-14 weeks AOG B. 13-15 weeks AOG C. 16-18 weeks AOG D. 18-20 weeks AOG E. 22-24 weeks AOG

291 D. Quickening among multi: 16-18 weeks, for primi: 18-20 weeks

Fetal attitude is primarily determined by what Leopold's maneuver (LM)? A. LM1 B. LM2 C. LM3 D. LM4 E. Both B and C

292 D. LM1 presentation LM2 position LM3 engagement

What would be the best approach for the problem in the previous case? A. None, it is a normal labor pattern B. Emergency CS C. Labor Induction D. Oxytocin Augmentation E. Early amniotomy

298 D. The patient is in the active phase and in cephalic presentation. Adequate Montevideo Units should be >200, hence we can augment labor with oxytocin

After another 2 hours, the repeat IE showed the following findings: cervix 6 cm dilated, 90% effaced, ROA, st-1, (+) BOW, FHT 135 bpm. How would you know manage this case ? A. Expectant management B. Labor Induction C. Cesarean section D. Cervical ripening E. None of the above

299 C. Dx: Arrest in cervical dilatation. Perform CS

Your sister is an excited new mom-to-be, being enthusiastic as she is, she then asks you when would they know the sex of their baby on UTZ? You said that it is as early as: A. 7 weeks AOG B. 9 weeks AOG C. 11 weeks AOG D. 14 weeks AOG E. 20 weeks AOG

414 D. The phenotypic sex is well formed at 17 weeks but can be identified by expert sonologists at 14 weeks.

Which of the following skin changes in pregnancy is an effect of Hyperestrogenemia? A. Linea Nigra B. Chloasma C. Darkening of Areola D. Striae Gravidarum E. Spider Nevi

415 E. All hyperpigmented lesions are due to MSH, Striae gravidarum is due to the effects of corticosteroids.

A 50 year old female had amenorrhea for 12 months, hot flushes, and decreased libido. She wants to improved her libido. What will you give? A. IM testosterone B. IM estrogen C. IM progesterone D. Combined estrogen and progesterone IM E. combined oral contraceptive

468 A. IM testosterone will improved the libido.

One of the following is not a fetal risk factor causing intrauterine growth restriction. A. Chromosomal abnormalities B. Congenital infection C. Tobacco D. Multiple gestation E. Congenital anomalies

474 C. Tobacco is a maternal risk factor, while the rest of the choices are fetal risk factors.

What is the most common symptom of ectopic pregnancy? A. Abdominal pain B. Amenorrhea C. Vaginal bleeding D. Hypotension E. Tachycardia

475 A. Abdominal pain, vaginal bleeding, and amenorrhea are the components of ectopic triad. The most common symptom is abdominal pain. Hypotension, tachycardia, along with peritoneal signs are signs of ruptured ectopic pregnancy.

Which of the following is/are considered physiologic cyst? A. Follicular cyst B. Corpus luteum cyst C. Theca lutein cyst D. All of the choices E. None of the choices

476 D.

A 70 year old female had uterine prolapse. Her cervix descends halfway to the introitus. This is grade: A. I B. II C. III D. IV E. V

477 A. Grading of uterine prolapse is as follows: when the cervix descends half way to the introitus - I; to the introitus - II; outside the introitus - III; entire uterus outside the introitus at all times -IV.

What layer of decidua is eventually lost as pregnancy progresses? A. Decidua parietalis B. Decidua capsularis C. Decidua basalis D. All of the above E. A and B only

478 B. decidua capsularis is the layer overlying the blastocyst.It is lost eventually due to obliteration of the growing fetus.

What is the most common benign solid tumor of the vulva? A. Lipoma B. Bartholin's cyst C. Urethral diverticulum D. Fibroma E. Urethral diverticulum

479 D.

The following should be monitored in patients being given magnesium sulfate, EXCEPT: A. Deep tendon reflexes B. Respiratory rate C. Urine output D. None of the above

494 D. DTR and RR should be monitored to detect signs of toxicity. Monitoring of urine output is vital because MgSO4 is renally excreted.

This ligament of the uterus comes from the posterolateral wall going to the supravaginal portion of the cervix? A. Broad ligament B. Cardinal ligament C. Uterosacral ligament D. Round ligament E. Transverse cervical ligament

581 C. The uterosacrals are the landmarks used by the gynecologist to locate the cervix.

The average duration of the first stage of labor in nulliparous women is? A. 5 hours B. 8 hours C. 10 hours D. 14 hours E. 20 hours

588 B. Average duration of the first stage of labor is 8 hours and 5 hours for nulliparous and multiparous women respectively.

Which of the following characteristics would make a patient NOT amenable to single agent chemotherpay for gestational trophoblastic disease? A. 2 months since pregnancy B. Serum hCG 50, 000 mIU/mL C. Metastasis to the lung D. No prior chemotherapy E. None of the above

589 B. HCG should be below <40,000

22 year old female complains of sudden onset right lower quadrant pain accompanied by vaginal spotting and missed menses. Patient has pallor and tachycardia. Pregnancy test was positive. Pelvic exam is (+) for wiggling tenderness. What is the gold-standard in diagnosing this disorder? A. Transvaginal ultrasound B. Culdocentesis C. Laparoscopy D. Quantitative hCG determintation E. Laparotomy

590 C. Laparoscopy is the gold standard to diagnose ectopic pregnancy

What forceps is used for deep transverse arrest of the head? A. Piper B. Simpson C. Tucker MacLane D. Kielland E. Prague

591 D. Piper - aftercoming head in breeach Simpson - molded head Tucker McLane - round head (mulitparas)

This ligament extend from the lateral portion of the uterus, arising below and anterior to origin of the oviducts, that is continuous with the broad ligament, outward and downward to the inguinal canal terminating at upper portion of labium majus: A. Broad ligament B. Cardinal ligament C. Transverse cervical ligament D. Uterosacral ligament E. Round ligament

504 E.

Mila, 78 year old G5P5 was recently diagnosed to have Endometrial Carcinoma. What is the definitive management? A. Progestin B. Progestin, Do hysterectomy if with bleeding C. Hysterectomy D. TAH-BSO E. Explratory laparotomy

520 D.

37 yo G3P3 consulted at the health center for cervical CA screening. She tested (+) for aceto- whitening. What should be done next? A. Colposcopy B. Annual screening until 2 consecutive normal tests than every 5 years thereafter C. pap smear D. do a punch biopsy E. Treat with antibiotics

554 A.

Ovarian artery/vein is found coursing in the ligament of: A. Infundibulopelvic ligament B. Suspensory ligament C. Ovarian ligament D. All of the above

580 D. They are all referring to infundibulopelvic ligament containing the ovarian vessels

Which of the following structures in the female genital tract comes from the endoderm? A. Ovaries B. Oviducts C. Uterus D. Vagina E. Vulva

600 D. Ovaries, oviducts and uterus came from the mesoderm, the vagina, urethra comes from both the endoderm and mesoderm. Endoderm from the cloaca which are part of the primitive hindgut. The vulva is form from ectoderm.

The female equivalent of the gubernaculum testis is: A. Round ligament B. Ovarian epithelium C. Suspensory ligament of the ovary D. Epoophoron E. None of the above

601 A. Round ligament is the female equivalent of gubernaculum testis. This ligament courses from lateral uterus inserting to the labia majora.

Of the following possible complications, which should be anticipated in a multifetal pregnancy? A. Shoulder dystocia B. Postmaturity C. Multiple congenital abnormalities D. Postpartum hemorrhage E. All of the above

630 D. postpartum hemorrhage is a common complication following a multifetal pregnancy

Fetal flexion, rotation , extension and expulsion occur during which phase of labor? A. Preparatory division B. Acceleration phase C. Phase of maximum slope D. Deceleration phase E.Latent phase

631 D.

The most common cause of secondary amenorrhea is? A. Ovarian tumor B. PCOS C. Imperforated hymen D. A or B E. None of the above

659 E. SPERM is the most common cause of secondary amenorrhea ! ! !

The Paramesonephric duct if the female genital tract corresponds to which organ in the males? A. Prostate gland B. Testicular appendix C. Prostatic utricle D. Bulbourethral gland E. Urinary bladder

667 B. In males, the paramesonephric or mullerian duct regress to form the appendix of testes.

Derivatives of the Urogenital Sinus in females except? A. Lower 3/4 vagina B. Vestibule C. Bladder D. Urethra E. Ureter

668 E. The phallic part of the definitive SUG enlarges to become the vaginal vestibule that is caudally closed off externally by the urogenital membrane. It then tears in the course of the 7th week

Strongest ligament supporting the uterus? A. Mesovarium B. Cardinal ligament of Mackenrodt C. Utersacral ligament D. Suspensory ligament of the Ovary E. Broad ligament

669 B. It attaches the cervix to the lateral pelvic wall by its attachment to the Obturator fascia of the Obturator internus muscle, and is continuous externally with the fibrous tissue that surrounds the pelvic blood vessels. It thus provides support to the uterus

At what gestational age does surfactant production begin in the developing fetal lungs? A. 16 weeks AOG B. 18 weeks AOG C. 20 weeks AOG D. 24 weeks AOG E. 28 weeks AOG

400 D.

A 28 year-old G3P2 (2002) at 38 weeks and 4 days AOG came in due to vaginal bleeding. Her first pregnancy was delivered via low-transverse cesarean section due to malpresentation. For the second pregnancy, she delivered vaginally a healthy baby girl. At present, IE findings are: 5 cm dilated, 80% effaced, cephalic, station -2, intact bag of water. Which factor makes this patient a candidate for normal spontaenous delivery? A. Young age of patient B. Term pregnancy C. The patient is in active phase of labor. D. Prior vaginal delivery E. Low parity

211 D. Any previous vaginal delivery, either before or following a cesarean birth, significantly improves the prognosis for a subsequent vaginal delivery with either spontaneous or induced labor.

A 16 year-old presents with vaginal bleeding for two days. She estimates her last menstrual period to be 3 months ago. Pregnany test is positive. There is crampy right lower quadrant abdominal pain. On IE, the cervical os is closed but with adnexal tenderness on the right. The abdomen is positive for direct and rebound tenderness. Vital signs are BP 80/50, HR 105, RR 22, afebrile. What is the proper management? A. Laparotomy B. Perform TVS C. D&C D. Do serial b-HCG E. Discharge patient

212 A. This is a case of ectopic pregnancy. Patient is hemodynamically unstable. Proceed to surgery.

Women with the Rokitansky-Kuster-Hauser syndrome have an increased risk of developing abnormalities of what other organ system? A. Cardiovascular B. Gastrointestinal C. Renal D. Endocrine E. Nervous system

213 C. RKH syndome is congenital uterine agenesis. Congenital renal abnormalities occur in about one third of these individuals and skeletal abnormalities in about 12%.

This drug achieves â€œpseudomenopauseâ€ among patients with endometriosis. A. Estrogen B. Clomiphene C. Leuprolide D. Danazol E. Goserelin

214 D. Danazol produces a hypoestrogenic and hyperandrogenic effect on steroid-sensitive end organs.

In cervical carcinoma, involvement of the kidneys automatically places the condition at stage ______. A. IIA B. IIB C. IIIA D. IIIB E. IVA

215 D.

A four-year old female patient came in due to vulvar irching. On physical examination, you noted the labia minora to be fused with a translucent vertical midline line. This condition usually affects young girls between 2 and 6 years of age because of: A. Poor hygiene B. Hormonal factors C. Bacterial infection D. Genital trauma E. Congenital defect

216 B. This is adhesive vulvitis. Estrogen reaches a nadir during this time, predisposing the nonestrogenized labia to denudation.

Which of the following trisomies are associated with preeclampsia? A. trisomy 13 B. trisomy 15 C. trisomy 18 D. trisomy 21 E. none of the above

250 A. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, trisomy 13 preeclampsia

A 23 year-old G1P0 at 12 weeks AOG came in due to low-grade fever for three days accompanied by a diffuse maculopapular rash that began on the face and has now spread to the trunk and extremities. On physical examination, she has prominent occipital and post-auricular lymphadenopathy. What is the single most common defect that her fetus might develop? A. Cataract B. Patent ductus arteriosus C. Sensorineural deafness D. Microcephaly E. Mental retardation

218 C. This is a possible case of congenital rubella syndrome.

A 24 year-old G1P0 at 15 weeks AOG came in for her first prenatal check up. She has no subjective complaints. Her BMI is 30. She has no family history of diabetes. When should you screen for diabetes in this patient? A. No need to screen. She is at low risk of developing diabetes. B. Screen her at 20-24 weeks AOG. C. Screen her at 24-28 weeks AOG. D. Screen her at 28-32 weeks AOG. E. Perform screening now.

219 E. High risk patients should be screened as soon as feasbile if one or more of the following are present: severe obesity, strong family history of type 2 diabetes, previous history of GDM, impaired glucose metabolism or glucosuria.

You are treating a 35 year-old female with syphilis. She is concerned whether or not her partner should be treated. You tell her that in syphilis, individuals who are exposed within the ____ days preceding the diagnosis in their sexual partners should be treated presumptively because they may be infected even when seronegative. A. 30 days B. 60 days C. 90 days D. 120 days E. 180 days

220 C.

A 30 y/o G2P1 on her 18th week AOG came to you for her prenatal check up. She is asymptomatic, and PE revealed BP of 150/90, HR 80, RR 19. The rest of her PE was otherwise unremarkable. She claims that this was the first time that she had an elevated BP. What is your initial diagnosis?? A. Gestational htn B. Chronic htn C. Preeclampsia D. Superimposed preeclampsia on chronic htn E. none of the above

221 B. Chronic htn is BP greater than or equal to 140/90 mm Hg before pregnancy or diagnosed before 20 weeksâ€™ gestation not attributable to gestational trophoblastic disease or Hypertension first diagnosed after 20 weeksâ€™ gestation and persistent after 12 weeks postpartum.

Which of the following can be observed at 12 weeks AOG?? A. CRL of 12 cm B. Gender can be determined C. Center of ossification have appeared in most of the fetal bones D. All of the above E. None of the above

222 C. . The CRL of 12 cm is seen at 16 weeks AOG, while gender can be determined by experienced sonologist at 14 weeks AOG

40 y/o G6P5 32-33 weeks AOG complains of vaginal bleeding and severe abdominal pain. VS BP 160/100 PR 123 RR 24 T 37.2C. PE of the abdomen:FH 36cm FH 97bpm, UC: every minute, 50 sec duration, strong. what complication is associated with the above condition? A. placenta accreta B. uterine atony C. DIC D. puerperial infection E. all of the above

223 C. abruptio placenta is associated with DIC, renal failure (ATN), hemorrhagic shock, couvelaire uteurs, and fetal maternal hemorrhage.

What is the type of placental expulsion, wherein the placenta separates first from the periphery? A. Schultze mechanism B. Duncan mechanism C. McRobert mechanism D. Simpson mechanism E. Rubins mechanism

224 B. Duncan mechanism â€" placenta separates from the periphery first. As a result, blood collects between the membranes and the uterine wall and escapes from the vagina. In this circumstance, the placenta descends sideways, and the maternal surface appears first. Schultze mechanism â€" placenta separates from the center first. Blood from the placental site pours into the membrane sac and does not escape externally until after extrusion of the placenta

A 27 y/o G0 patient came to your clinic due to severe dysmenorrhea. She is married for 3 years, and is not able to conceive. Upon IE, you noted that the uterus is fixed and retroverted. There is nodularity on the uterosacral ligament. What is the definitive procedure of choice for the diagnosis? A. Pelvic ultrasound B. Fractional curettage C. Direct visualization and biopsy D. culdocentesis E. MRI

233 C. This patient presents with a classic case of endometriosis. The definitive diagnostic procedure of choice is direct visualization of the endometriotic lesion and pathologic examination via biopsy.

Which of the following is an absolute contraindication for aerobic exercise during pregnancy? A. Restrictive lung disease B. Severe anemia C. Chronic bronchitis D. Poorly controlled hypertension E. All of the above

225 A. Absolute contraindication include:Hemodynamically significant heart disease, Restrictive lung disease, Incompetent cervix/cerclage, Multifetal gestation at risk for preterm labor, Persistent second- or third- trimester bleeding, Placenta previa after 26 weeks, Preterm labor during the current pregnancy, Ruptured membranes, Preeclampsia/pregnancy- induced hypertension. Relative Contraindications include: Severe anemia, Unevaluated maternal cardiac arrhythmia, Chronic bronchitis, Poorly controlled type 1 diabetes, Extreme morbid obesity, Extreme underweight (BMI _12), History of extremely sedentary lifestyle, Fetal-growth restriction in current pregnancy, Poorly controlled hypertension, Orthopedic limitations, Poorly controlled seizure disorder, Poorly controlled hyperthyroidism, Heavy smoker

A 20 y/o G1P0 at 40 weeks AOG came to your hospital. She denied of having any prenatal check up. She then subsequently gave birth to a baby boy. Upon delivery, you noted that the baby had upturned nose, mild midfacial hypoplasia, and long upper lip with thin vermilion border, distal digital hypoplasia. What medication could the mother have been taking during the course of her pregnancy?? A. ACE inhibitor B. Phenytoin C. Warfarin D. Alcohol E. Valproic acid

226 B. This is the characteristic of a baby with fetal hydantoin syndrome.

A 28 y/o G2P1 mother at 35 week AOG came to your clinic with the following biophysical profile scoring: NST has 3 accelerations greater 15 bpm each for more than 15 seconds, 20 seconds of fetal breathing for 30 minutes, 2 discrete body movements, 1 episode of extremity extension then subsequent flexion. AFI 1.2cm. What is your next plan of treatment? A. No fetal indication for intervention. Repeat test weekly B. Deliver C. Repeat BPP D. Observe E. none of the above

227 C. BPP=4 (NST = 2, fetal breathing = 0, fetal movements = 0, fetal tone = 2, AFI =0). For a BPP of 4, there is probable fetal asphyxia. The intervention is to repeat BPP on the same day. If the result if less than or equal to 6, deliver the baby.

The following is a correct criteria for outlet forceps extraction? A. Scalp is visible at the introitus after separating the labia B. Fetal skull has reached pelvic floor C. Sagittal suture is in transverse diameter or right or left occiput anterior or posterior position D. Rotation does not exceed 60 degrees E. Station +2

228 B. The following are the criteria for outlet forcerps extraction: 1. Scalp is visible at the introitus without separating the labia, 2. Fetal skull has reached pelvic floor,3. Sagittal suture is in anteroposterior diameter or right or left occiput anterior or posterior position, 4. Fetal head is at or on perineum, and 5. Rotation does not exceed 45 degrees

What type of placenta is characterized by fetal membranes completely covered by functioning villi?? A. Placenta duplex B. Placenta fenestrata C. Placenta membranacea D. Succenturiate lobe placenta E. Battledore placenta

229 C. Placental membranacea is characterized by all or a large part of the fetal membranes are covered byfunctioning villi. Placenta membranacea may occasionally give rise to serious hemorrhage because of associated placenta previa or accrete. Placenta duplex, or bilobed placenta is characterized by the placenta that forms as separate, near equally sized disks. The cord inserts between the two placental lobesâ€"either into a connecting chorionic bridge or into intervening membranes. Placenta fenestrate is characterized by the missing central portion of a discoidal placenta. In some instances, there is an actual hole in the placenta,but more often, the defect involves only villous tissue, and the chorionic plate remains intact. Succenturiate lobe placenta is similar to placenta duplex, but smaller. One or more small accessory lobes develop in the membranes at a distance from the main placenta, to which they usually have vascular connections of fetal origin.

How many weeks will ovulation resume after delivery?? A. 3 weeks B. 4 weeks C. 3 months D. 4 months E. 2 weeks

230 A. Ovulation may resume as early as 3 weeks after delivery, even in lactating women.

All of the following are the correct pairs of embryonic structures and its derivatives, except? A. Gubernaculum: broad ligament of the uterus B. Metanephric duct: renal pelvis C. Urogenital sinus : greater vestibular glands D. Mesonephric duct: Gartnerâ€™s duct E. none of the above

231 A. Gubernaculum gives rise to round ligament of the uterus.

In what cell stage does the ovum in during its release from the ovary ? A. Prophase I B. Metaphase I C. Prophase II D. Metaphase II E. Anaphase I

232 D. The egg is released from the the ovary at its metaphase II

A 34 y/o G1P1 suddenly developed lack of menstruation for the past 6 months. There were also growing of facial hairs and clitoral enlargement. What type of ovaian tumor should be considered? A. Granulosa theca cell tumor B. thecoma C. dysgerminoma D. sertoli leydig tumor E. none of the above

240 D. sertoli leydig cell tumors exhibit production of testosterone which is responsible for the amenorhea, hirsutism and clitoral enlargement of the patient

5. A 41 y/o came to your clinic due to profuse whitish vaginal discharge. Upon IE, you noted that the discharge was whitish frothy appearance with fishy amine odor. On wet mount, there are numerous clue cells. What is your next plan of management? A. 1% Clotrimazole cream, 5g for 7-14 days B. Metronidazole, 2 g, one dose C. Metronidazole, 500mg, BID for 7 days D. Miconazole, 100mg per vagina for 7 days E. Clindamycin 500mg/tab BID

234 C. This patient presents with bacterial vaginosis. Clue cells are pathognomonic for bacterial vaginosis. The drug of choice for this condition is metronidazole, 500mg, BID for 7 days. B - is for trichomonas infection

Which of the following is true for screening for cervical cancer? A. Initial screening should begin within 1 year after first sexual intercourse or by age 18 B. Annual screening until 30 y/o C. After 30 y/o, if patient has 3 consecutive negative results, can discontinue screening D. Women with their cervix removed for benign reasons need annual screening E. all of the above

235 B. The following are ACOG guidelines for screening for cervical cancer: Initial screening should begin within 3 years after first sexual intercourse or by age 21; annual screening until 30 y/o; after 30 y/o, if patient has 3 consecutive negative results, repeat every 2-3 years; women with their cervix removed for benign reasons do not need annual screening

Which of the following characterizes type 2 endometrial carcinoma? A. Induced by estrogen B. Post menopausal C. Responds to progestins D. Good prognosis E. All of the above

236 B. Type 1 endometrial carcinoma - Grade 1â€"2, Superficial or no myometrial invasion, Coexisting endometrial hyperplasia, Perimenopausal, Induced by estrogen, Responds to progestins, Good prognosis; Type 2 - High grade (grade 3, papillary serous, clear cell), Deep myometrial invasion, Postmenopausal women, Not induced by estrogen, Does not respond to progestins, Poor prognosis

What type of stress incontinence is characterized by involuntary leakage of urine during increased abdominal pressure in the absence of detrusor contraction during urodynamics?? A. Genuine stress incontinence B. Urge incontinence C. Functional incontinence D. Total urinary incontinence E.

237 A. Stress urinary incontinence is involuntary leakage of urine on effort or exertion or on coughing or sneezing. The sign of stress urinary incontinence must occur at the start of coughing and end with the coughing. Urge incontinence is the strong desire to urinate. The patient may sense a degree of urgency if voiding occurs despite the desire not to void. Functional incontinence is involuntary leakage despite normal bladder and urethral function in patients with dementia or disorientation. Total urinary incontinence occurs when the bladder is unable to store urine because the resting urethral pressure is so low that no resistance is present for the passage of urine.

A 68 y/o patient came in your clinic due to intense vulvar pruritus. Upon physical examination, you noted that the vulva is thin, white, wrinkled tissue with a cigarette paper appearance. There was agglutination of the labia minora and prepuce. Biopsy revealed hyperkeratotic epidermis with epithelial atrophy, and flattening of the rete pegs. There is cytoplasmic vacuolization of the basal layer of cells. What is your initial diagnosis? A. Lichen simplex chronicus B. Lichen sclerosus C. Lichen planus D. Squamous cell hyperplasia E.

238 B. This is a case of lichen sclerosus. Lichen simplex chronicus is characterized by thickened white epithelium on vulva. It is generally localized and unilateral. Biopsy reveals hyperkeratosis and acanthosis producing thickening of the epithelium and elongation of the rete pegs. Dermis reveals chronic inflammatory cells, fibrosis, and collagenization. Lichen planus is characterized by erosive lesions at the vestibule with or without vaginal synechiae resulting in stenosis. Biopsy reveals mils, localized, lichenoid, chronic inflammatory process at the epidermal-dermis junction to ulcerative process with fibrosis. Squamous cell hyperplasia is circumscribed, single or multifocal raised white lesions on the vulva or adjacent tissue. Biopsy reveals hyperkeratosis and acanthosis, producing thickening of the epithelium and elongation of the rete pegs. Dermis has no inflammatory infiltrate.

A 37 y/o G1P1 (1001) consulted because of severe dysmenorrhea for 3 consecutive years. Initial consult revealed bilateral adnexal masses about 7cm each with thickened uterosacral ligament. If surgery is an option, what is the most appropriate procedure for this patient? A. TAHBSO B. bilateral oophorocystectomy C. fluid aspiration of the bilateral mass D. no surgical procedure is warranted. E.

239 B. patient is still in a reproductive age. The goal is to remove the mass and to preserve as much as functional ovarian tissue.

A 17 year old female was diagnosed with primary amenorrhea, further work up revealed absent uterus but with normally developed breasts, normal looking external genitalia and pubic hair, which of the following conditions is implicated? A. turner's syndrome B. meyer rokitasky kuster hauser C. androgen insensitivity D. congenital adrenal hyperplasia E. none of the above

241 B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE., meyer rokitansky has normal ovaries, normal karyotype, normal secodnary sexual char no uterus and sometimes no vagina or atrophic

A 24 y/o G2P1 (1001) was admitted due to passage of watery discharge and onset of regular abdominal cramps. Initial IE was 4cm already station -2, 4 hours later patient was 7cm dilated station -2, contractions came in regularly every 3- 5minutes lasting 50-60 seconds, which of the following actions are appropriate? A. augment labor with oxytocin B. observe progress of labor C. prepare patient for emergency CS D. give patient epidural anesthesia E. hydrate and place patient on left lateral decubitus

242 B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, monitor futher progress of labor first before intervention

Mother with preeclampsia was placed on a tocodynamometer and fetal heart monitor during labor, the resident suddenly remarked that there were late decelerations noted on the tracings, what does it connote? A. fetal head compression B. uteroplacental insufficiency C. umbilical cord compression D. placental abruptio E. impending eclampsia

243 B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, head compression early, cord compression variable

A 60 year old female complains of scanty vaginal spotting for the past 2 months, physical examination revealed thinned out vaginal mucosa, smooth cervix, uterus small with no palpable adnexal masses, which of the following most likely is the cause of A. endometrial polyp B. cervical polyp C. endometrial cancer D. atrophic vaginitis E. submucous myoma

244 D. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, atrophic vaginitis, postmenopausal

A 30 year old female G5P1 with history of repeated abortions and preterm labor is pregnant, her doctor tells her to undergo a cerclage procedure to help prevent preterm labor, this procedure is generally done at what age of the pregnancy? A. 8 weeks B. 12 weeks C. 22 weeks D. 24 weeks E. 36 weeks

245 C. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, usually done at the age of viability at around 20 weeks and above

A 40 year old female patient has depressed TSH levels with Increased T4 levels, she experienced palpitations, weight loss, heat intolerance and bouts of diarrhea, which of the following is expected regarding her menses? A. hypomenorrhea B. menorrhagia C. menometrorrhagia D. primary amenorrhea E. any of the above

246 A. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, hyperthyoridism = hypo or and oligomenorrhea

A 16 year old patient comes in with grossly female genitalia, no menses ever since but with positive breast development, further work up revealed absence of ovaries, uterus, karyotyping revealed 46 XY, which of the following is the possible diagnoses A. meyer rokitansky kuster hauser B. androgen insensitivity syndrome C. turners syndrome D. congenital adrenal hyperplasia E. none of the above

247 B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, they mixed up the meyer rokitansky, androgen insensitivity, turners and CAH, androgen insensitivity = grossly female or phenotypically female genitalia and secondary sexual char but XY karyotype. Turners XO, meyer rokitansky XX, CAH = XX with virilization or XY with normal phenotype

A 36 year old female patient with previously regular menses consulted due to amenorrhea for 3 months with episodes of spotting occasionally, pregnancy test was negative, she was given progesterone for 7 days and after 3-5 days of withdrawal of the drug, she had heavy menses. Which of the following is true regarding her condition? A. Her irregular menses are due to a submucous myoma B. she has ectopic pregnancy C. she has endometrial hyperplasia D. she has anovulatory vaginal spotting E. she has an endometrial polyp

248 D. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, progesterone induced withdrawal bleed indicates endometrium is estrogen primed, lack of ovulation causes it to slough off improperly due to lack of progesterone

Which of the following ultrasound findings are indicative of down's syndrome in the fetus ? A. increased nuchal thickening B. increase brain ventricle size C. ambiguous genitalia D. small biparietal diameter for AOG E. all of the above

249 A. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, nuchal thickening is indicative of down's syndrome

An 8 year old female was brought into consult due to difficulty in perineal hygiene, her mother noted that her labia was adherent to one another and was concerned about it hence the consult, which of the following treatments is advisable for this case? A. oral estrogen pills B. topical estrogen cream C. topical 1% hydrocortisone cream D. surgical adhesiolysis E. all of the above

251 B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE a case of adhesive vulvitis, estrogen topical

Which of the following is considered the most important indicator of progress of labor? A. engagement B. descent C. cervical dilatation D. internal rotation E. all of the above

252 B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, descent according to APMC book, descent of the baby infers progress of labor and interaction between the passenger and passageway

Which of the following tests can be used to infer regarding the risk of preterm labor? A. fetal HCG B. D Dimer assay C. fetal fibronectin D. maternal CRP E. amniotic fluid AFP

253 C. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, fetal fibronectin helps infer regarding risk of preterm labor

On instances of complete breach extraction, which of the following forceps is used to deliver the aftercoming head? A. simpsons B. tucker mcclane C. kielland D. pipers E. none of the above

254 D. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE - pipers aftercoming head

A 24 year old G3P3 desires contraception. In giving your advice regarding the various options of birth control, which of the following is a contraindication to placement of an IUD for family planning? A. presence of menstruation B. presence of previous ectopic pregnancy C. no consent from the husband D. presence of ongoing pelvic infection E. all of the above

255 D. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE - husband consent not needed, even in menstruation no contraindication

What is the characteristic liver pathologic finding in preeclampsia? A. Centrilobular necrosis B. Macrovesicular steatosis C. Bridging portal fibrosis D. Periportal necrosis E. None of the above

280 D. Periportal necrosis and sinusoidal thrombin deposition is characteristic of preeclampsia/eclampsia

48 year old G3P3 presents to your clinic for annual check up, she has had no remarkable symptoms since her last check up, you decided to do a pap smear, a week after the results came out, it turned out to be high grade squamous intraepithelial neoplasm, you remember that physical examination including pelvic exam at that time was unremarkable what is the next step in evaluation? A. request a transvaginal ultrasound B. place her on progesterone and wait for withdrawal bleed C. do a repeat pap smear using cytobrush and liquid based cytology for confirmation D. do a colposcopy E. all of the above

256 D. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, colposcopy with acetowhitening or biopsy of suspicious lesion

A 30 year old female G1P1 presented to the clinic with a 2 year history of progressive virilization, facial and bodily hair growth, oligomenorrhea and irregular menses, there was also acne, deepening of voice, examination revealed grossly female genitalia, clitoromegaly, and a palpable right adnexal mass. Ultrasound revealed right complex adnexal mass, which of the following is the possible condition? A. leydig cell tumor B. granulosa cell tumor C. yolk sac tumor D. choriocarcinoma E. dermoid cyst of the ovary

257 A. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, adnexal mass, virilization and masculinization features leydig cell tumor

Which of the following risk factors is considered the greatest risk factor for ectopic pregnancy? A. repeated pelvic infections or PID B. history of tubal instrumentation C. infertility D. congenital uterine abnormalities E. familial chromosomal disorders

258 B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, tubal instrumentation is the strongest risk factor for having ectopic pregnancy, infection comes next

A 26 year old G1P0 was admitted to the labor room due to rupture of bag of waters without accompanying uterine contractions, after 18 hours, on monitoring, mother was slightly febrile at 37.8 degrees celsius and was continuously hydrated with IV fluids, electronic fetal monitoring was done which revealed fetal tachycardia, which of the following is the suspected condition? A. chorioamnionitis B. umblical cord prolapse C. maternal dehydration D. maternal sepsis E. endometritis

259 A. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE, fetal tachycardia = chorioamnionitis

A 35 year old female patient G1P1 came in due to dysmenorrhea and vaginal spotting for the past 3 weeks, PE revealed grossly female external genitalia, no lesions noted, cervix pink smooth, no discharge, cervix closed, uterus symmetrically enlarged to 2 to3 months size, no adnexal masses noted, which of the following conditions is suspected? A. endometriosis B. endometrial hyperplasia C. multiple submucous myomas D. adenomyosis E. endometrial polyp

260 D. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE - adenomyosis symmetrically enlarged uterus dysfunctional bleeding, dysmenorrhea

A 35 year old woman is complaining of increasingly severe mentrual pain with associated heavy and prolonged bleeding. Pelvic examination reveals a diffusely enlarged uterus that feels soft and boggy. What is the pathogenesis underlying the most likely condition that is causing this patient's symptoms? A. Presence of hormone-responsive endometrial tissue in the pelvic peritoneum B. Benign submucous myomatous proliferation C. Atypical endometrial hyperplasia D. Presence of endometrial glands within the myometrium E. None of the above

261 D. Characteristic case of adenomyosis

A sexually active 28 year old female had her first Pap smear revealing low-grade squamous intraepithelial lesion (LSIL). What will be the next step in your management? A. Hysterectomy B. LEEP procedure C. HPV testing D. Repeat Pap smear after 6 months E. Colposcopy-directed biopsy

262. E..ASC-H, LSIL, HSIL - Perform colposcopy with biosy; ASC-US - perform HPV testing or repeat Pap smear after 6 months

A G1P0 preganant comes for prenatal consult in your clinic. History reveals that she takes vitamin supplements because she is afraid of getting sick. You counsel her to avoid taking which of the following? A. Vitamin C B. Vitamin A C. Beta carotene D. Vitamin E E. Folic acid

263 B. Vitamin A megadoses is teratogenic. Beta carotene- rich foods has lesser vitamin A content and is less likely to cause teratogenesis.

Which of the following findings is expected in the cervical cytology of a menopausal woman? A. Parabasal cells B. Superficial cells C. Intermediate cells D. Superficial and intermediate cells E. All of the above

264 A. Menopausal - parabasal; Reproductive nonpregnant - superficial and intermediate; Pregnant - intermediate

A G2P2 patient is in labor undergoes pelvic examination revealing vesicular lesions in the genital area. You are highly suspecting a herpes simplex infection. How will you manage this patient? A. Treat the mother with IV acyclovir and deliever via SVD B. Administer oxytocin to accelerate labor C. Perform cesarean delivery D. Perform forceps extraction when fully dilated E. Continue labor watch.

265 C. Pergnant patients with herpes simplex genital lesions should have cesarean delivery to lessen risk of transmission to newborn

A 30 year G3P3 patient gave birth to a live baby girl 2 days prior via NSVD. Currently, she claims that she feels febrile. Temperature taken was 37.9 degrees Celsius. Bimanual pelvic examination reveals a tender uterus and foul-smelling vaginal discharge. You will most likely isolate which of the following? A. Bacteroides fragilis B. Chlamydia trachomatis C. Neisseria gonorrheae D. Pseudomonas aeruginosa E. Gardnerella vaginalis

266 A. A case of postpartum endometritis. Most are caused by mixed aerobic and anaerobic microorganisms but Bacteroides is frequently isolated in culture

What will be the expected results of a Quad screen in a mother carrying a fetus with trisomy 21? A. Decreased B-HCG and inhibin, Elevated estriol and AFP B. Elevated B-HCG and inhibin, Decreased estriol and AFP C. Elevated B-HCG and inhibin, Elevated estriol and AFP D. Decreased B-HCG and inhibin, Decreased estriol and AFP E. None of THeses

267 B. Elevated AFP - neural tube defects; Decreased AFP, HCG, estriol - trisomy 18

A 34 year old patient comes to your clinic complaining of heavy menses. She claims that she occasionally pass clots and she feels a heavy sensation and a palpable mass on the lower abdominal area. Which of the following is the most likely diagnosis? A. Ovarian cyst B. Endometrial carcinoma C. Endometriosis D. Endometrioma E. Leiomyoma

268 E. Characteristic picture of a case of leiomyoma which is a common cause of heavy menstrual bleeding esp in premenopausal women

An incidental finding of a 6cm multilocular ovarian cyst with solid components was seen during ultrasound in a 30 year old woman. History is unremarkable. What is the next best step in the management? A. Observe for 2-3 months and repeat ultrasound B. Perform percutaneous biopsy C. OCP therapy D. Exploratory laparotomy E. Do nothing.

269 D. Simple ovarian cysts may be managed with observation except if size is >8cm, if 6-8 cm but doesnâ€™t resolve after 2-3 months, if there is rapid increase in size, or if multiloculated or with solid components. These are suspicous for malignancy and have to be treated with surgery

A 30 year old patient who is desirious of pregnancy presented to your infertility clinic with associated symptoms of dysmenorrhea and dyspareunia undergoes fertility evaluation. You are highly suspecting endometriosis as the cause. How will you manage this patient? A. NSAIDS B. Continuous OCP's C. Watchful waiting D. Laparoscopic surgery and fulguration of endometriotic implants E. Danazol therapy

279 D. Endometriosis may be managed medically but if desire for fertility is an issue then treatment should be surgery

A 38 weeks AOG G3P2 mother who has chronic hypertension presents to the ER due to vaginal bleeding associated abdominal pain and uterine contractions. Physical examination reveals a firm, tender uterus with noted regular contractions every 4-5 minutes and cervical dilatation of 4-5cm. Bleeding has subsided and vital signs of the mother is stable. Fetal monitoring is reassuring. Ultrasound reveals a high-lying placenta. How should this patient be managed? A. Stat cesarean delivery B. Give tocolytics C. Monitor progress of labor and do fetal status monitoring D. Send the patient home E. None of the above

270 C. A case of abruptio placenta. May be managed conservatively if vital signs are stable or fetal status is reassuring. If not, immediate delivery is necessary

A G2P0 patient has a previous history of incompetent cervix. If she is to undergo an elective cervical cerclage, at what age of gestation is the ideal time to perform the procedure? A. 8-10 weeks B. 10-12 weeks C. 12-14 weeks D. 18-20 weeks E. 24-28 weeks

271 C.

Examination of a woman reveals presence of fleshy growths covered with small, papillary surface prijections on her external genitalia. What is the most likely diagnosis? A. Condyloma acuminata B. Condyloma lata C. Genital herpes D. Phthirus pubis E. Molluscum contagiosum

272 A. Descriptive of condyloma acuminata/genital wart

A 16 year old female is brought to you by her mother because of amenorrhea. Upon physical examination, patient was noted to have a BMI of 16.1. Dry skin, thinning hair, parotid glnad swelling, and fine body hair were also noted. She tells you that she has not attained her ideal body weight and that she thinks she is fat. Based from these findings, you expect that the amenorrhea is caused by? A. Hyperprolactinemia B. Hypothalamic dysfunction C. Anterior pituitary hormone deficiency D. Increased androgen production E. Anovulatory disorder

273 B. Anorexia nervosa may cause hypothalamic dysfunction leading to imapired release of Gonadotropin releasing hormone

Which of the following is most predictive of recurrent preterm labor? A. Group B streptococcus colonization B. Prior preterm delivery C. History of cigarette smoking D. History of early trimester abortion E. None of the above

274 B.

A patient presents to the ER complaining of amenorrhea, lower abdominal pain, and vaginal bleeding. Pregnancy test is positive. Vital signs are stable. Physical examination reveals a uterus that is small for gestational age, closed cervix and bleeding. No adnexal mass is palpated. TVS fails to reveal an intrauterine pregnancy. Which of the following is the most appropriate management? A. Send the patien home. B. Admit the patient and prepare for dilatation and curettage. C. Repeat TVS when B-HCG level is >1500 D. Perform emergency exploratory laparotomy E. Admit the patient for therapeutic abortion

275 C. Equivocal findings necessitate repeat TVS. Absence of Intrauterine pregnancy at B-HCG levels of >1500 or failure of BHCG to double after 48 hours rules out uterine pregnancy

A 23 year old obese patient has been diagnosed with Polycystic ovarian syndrome. You, therefore, expect decreased levels of which of the following? A. FSH B. LH C. Estrogen D. Androstenedione E. Testosterone

276 A. Increased LH to FSH ratio is characteristic of PCOS. FSH is decreased while estrogen, androgen, and LH are increased

Physiologic changes during pregnancy will include which of the following? A. Increase in systemic vascular resistance B. Increase in tidal volume C. Decrease in hematocrit D. A and B E. B and C

277 E. There is an increase in tidal volume, cardiac output, GFR, and plasma volume. There is a decrease in SVR and hamatocrit

Which of the following cardinal movements of labor allows the narrowest fetal head diameter to present in the birth canal? A. Flexion B. Extension C. Internal Rotation D. Engagement E. Descent

278 A. Flexion allows the narrowest diameter (suboccipitobregmatic diameter) to present. Review cardinal movements of labor

A 19 year old G1P0, 14-15 weeks AOG, consulted due to vaginal bleeding. Vital signs were stable. Fundic height was noted at 23 cm. Internal exam: cervix is soft, long and closed with uterus enlarged to 5 months size. UTZ showed a complex, echogenic mass with numerous cystic spaces with no fetus and aminotic sac seen. Serum Beta HCG is elevated at 170,000 miU/mL. What is the most appropriate management for this case? A. TAH B. TAHBSO C. Radiotherapy D. Suction Curettage E. Any of the above

281 D. Dx: H. mole. Treatment of choice females <35 years old and still desires pregnancy is suction curettage.

What is the maximum blood loss (in mL) to be considered in a normal menstrual cycle? A. 30 B. 40 C. 60 D. 70 E. 80

282 E. Menorrhagia: Prolonged (more than 7 days) or excessive (greater than 80 mL) uterine bleeding occurring at regular intervals.

A 27 year old mulitpara who delivered at home was brough to the ER due to profuse vaginal bleeding. At the ER, BP was 80/50 and HR was 126 bpm. She was visibly pale. Abdomen was soft and the fundus of the uterus was not appreciated. On inspection of the vulva, a pear shaped reddish pink mass was see protruding from the introitus. What is the most common cause of the above condition? A. Abruptio placenta B. Placenta previa C. Strong traction of the umbilical cord D. Short umbilical cord E. None of the above

283 C. DX: Uterine inversion which is most commonly brough about by excessive traction of the umbilical cord upon delivery of the placenta

Which of the following is not an indication for in- patient treatment of patients with Pelvic Inflammatory Disease? A. Acute appendicitis cannot be ruled out B. No response after 24 hours of treatment C. Cannot tolerate oral regimen D. Presence of tubo-ovarian abscess E. Currently pregnant

284 B. Other indications: severe illness, nausea or vomiting. Response to treatment is usually assessed after 3 days (72 hours)

A 38 year old G1P0, 30-31 weeks AOG with no known co-morbids, sought consult due to headache and blurring of vision. Patient had 8 prenatal checkups since 6 weeks AOG. BP monitoring was advised which ranges from 100/70 to 110/80 mmHg. She has a (+) family history for both HTN and DM. VS: BP 180/110 mmHg, PR 87/min, RR 21/min. FH 30 cm, FHT 120 bpm, LM1-cephalic. What is the most probable diagnosis for this case? A. Mild Preeclampsia B. Severe Preeclampsia C. Chronic hypertesion D. Preeclampsia superimposed on Chronic hypertension E. Eclampsia

285 B. In severe pre eclampsia: SBP >160, DBP >110. With proteinuria >5 g/24 hours, (+) headache, visual disturbance, upper abdominal pain, oliguria. Elevated crea. Thrombocytopenia

A 35 year old G4P4 (4004) underwent TAH-BSO with omentectomy, peritoneal washing and pelvic lymph node dissection for a right ovarian new growth. Histopathologic report stated that numerous hyaline droplets were seen. What specific type of ovarian tumor was removed from this patient? A. Yolk sac tumor B. Dysgerminoma C. Granulosa cell tumor D. Mucinous adenocarcinoma E. Sertoli Leydig cell tumor

287 A. Hyaline droplets represent the Schiller Duval bodies which are seen in Yolk sac tumor

What tumor marker would be characteristically elevated in association with the diagnosis in #187 ? A. HCG B. AFP C. LDH D. CA-125 E. CEA

288 B. The tumor marker associated with yolk sac tumor is Alpha feto protein (AFP)

A 40 year old G4P3 (3003), 31-32 weeks AOG, known hypertensive and a heavy smoker was brought to the ER due to severe hypogastric pain and vaginal bleeding. BP 140/90, HR 100/min, RR 21/min. FH 32 cm, FHT 90-100/min, LM1-cephalic, uterine contractions - every 2 minutes with a strong intensity, (+) uterine tenderness. What is the best management for this case? A. Corticosteroids alone B. Tocolysis and corticosteroids C. Labor induction D. Cesarean section E. None of the above

289 D. Dx: Abruptio placenta. Immediate delivery via CS is warranted due to evidence of fetal distress as noted by a decreased fetal heart rate ranging from 90-100 bom

Which of the following is the expected hormonal profile in individuals with Turner's syndrome? A. Hypogonadotropic hypogonadism B. Hypergonadotropic hypogonadism C. Hypogonadotropic normogonadism D. Hypergonadotropic normogonadism E. Normogonadotropic normogonadism

290 B. There is ovarian atresia resulting in depletion of oocytes in Turner's syndrome hence there is decreased estrogen secretion. However since the pituitary function is intact, the decreased estrogen will send feedback impulses to the pituitray increasing its output of FSH and LH

A 34 year old nulliparous sought consult due to progressive dysmenorrhea. Internal examination showed a fixed, retroverted uterus with characteristic nodularities palpated in the uterosacral ligaments and cul-de-sac. A diagnosis of endometriosis was made for which the patient opted to have medical treatment for the moment. Which of the following medications will induce a "medical oophorectomy"? A. Danazol B. Progestins C. OCP D. Leuprolide E. Clomiphene

293 D. Leuprolide acts as an agonist at pituitary GnRH receptors. By interrupting the normal pulsatile stimulation of, and thus desensitizing, the GnRH receptors, it indirectly downregulates the secretion of gonadotropins luteinizing hormone (LH) and follicle-stimulating hormone(FSH), leading to hypogonadism and thus a dramatic reduction in estradiol and testosterone levels in both sexes.

Which of the following is not a sign of midpelvis contraction? A. Prominent ischial spines B. Narrow subpubic arch C. Convergent sidewalls D. Shallow sacral concavity E. Narrow sacroiliac notch

294 B. A narrow subpubic arch is a sign of an inadequate pelvic outlet

A 38 year old G4P4 (4004) who is s/p LTCS due to PROM of 24 hours about 2 days ago now presents with fever and chills. BP 100/60, PR 110/min, RR23/min T 39.5 C. There is noted abdominal tenderness over the hypogastric area. Speculum: (+) foul smelling lochia rubra. IE: cervix soft, long and closed with (+) uterine tenderness. What is the single most important risk factor for this condition? A. Anemia B. Socioeconomic status C. Prolonged labor D. Route of delivery E. Malnutrition

295 D. Dx: Endometritis: Route of delivery is the single most important risk factor for this condition

What is the earliest stage of cervical cancer where in hydronephrosis, renal failure and uremia would be present? A. Stage IIIA B. Stage IIIB C. Stage IIA1 D. Stage IIA2 E. Stage IIB

296 B. Please see FIGO staging system for cervical CA. Of important note, uremia is the most common cause of death in cervical cancer patients.

A 37 year old G3P1 (1011), 39 weeks AOG, was admitted due to labor pains. VS are normal. FH 35 cm, FHT 145 bpm. IE: Cervix 3-4 cm dilated 70% effaced, ROT, st -2, (+) BOW. Labor admission test showed reassuring fetal heart rate pattern. 2 hours after a repeat IE was done: cervix 5 cm dilated 80% effaced, ROT, st -1, (+) BOW, FHT 140 bpm. After another 2 hours, a repeat IE was done: cervix 6 cm dilated, 90% effaced, ROA, st-1, (+) BOW, FHT 143 bpm. EFM tracing showed a reassuring fetal heart rate pattern with 190 Montevideo Units. How would you diagnose the labor pattern of the patient? A. Normal labor pattern B. Arrest in cervical dilatation C. Protracted cervical dilatation D. Prolonged latent phase E. Arrest in descent

297 C. Once in the active phase: rate of cervical dilatation should be 1.5 cm/hour for multiparas.

Which of the following is NOT an indication for classical cesarean section ? A. Anteriorly implanted placenta previa B. Multiple gestation C. Neglected transverse lie D. A large myoma in the lower uterine segment E. Invasive cervical carcinoma

300 B. Other indications: thinned out LUS, severely obese mothers w/c precludes safe access to LUS

309 C. BPP=4 (NST = 2, fetal breathing = 0, fetal movements = 0, fetal tone = 2, AFI =0). For a BPP of 4, there is probable fetal asphyxia. The intervention is to repeat BPP on the same day. If the result if less than or equal to 6, deliver the baby.

A 32 y/o G3P2 went for her 1st prenatal check up. Currently, she is at 18 weeks AOG. Upon doing routine pelvic ultrasound, there was an incidental finding of adnexal mass with solid and cystic structures measuring 13cm. What is the next best management for this case? A. observation with serial sonography B. immediate laparotomy C. laparotomy at 24th week AOG D. sonographic aspiration of the cyst E. laparotomy after delivery

310 B. it seems reasonable to remove all ovarian masses over 10cm because of the substantive risk of malignancy. Tumors from 6-10 cm should be carefully evaluated. For the possibility of neoplastic disease by ultrasound, MRI or both. If evaluation suggests a neoplasm, then resection is indicatied. if the corpus luteum is removed before 10 weeks, then 17OH progesterone IM is given weekly until 10 weeks. cystic mass that are benign with less than 6cm should undergo serial sonography. Williams 22nd ed pp 965-966.

311 B. This is a case of lichen sclerosus. Lichen simplex chronicus is characterized by thickened white epithelium on vulva. It is generally localized and unilateral. Biopsy reveals hyperkeratosis and acanthosis producing thickening of the epithelium and elongation of the rete pegs. Dermis reveals chronic inflammatory cells, fibrosis, and collagenization. Lichen planus is characterized by erosive lesions at the vestibule with or without vaginal synechiae resulting in stenosis. Biopsy reveals mils, localized, lichenoid, chronic inflammatory process at the epidermal-dermis junction to ulcerative process with fibrosis. Squamous cell hyperplasia is circumscribed, single or multifocal raised white lesions on the vulva or adjacent tissue. Biopsy reveals hyperkeratosis and acanthosis, producing thickening of the epithelium and elongation of the rete pegs. Dermis has no inflammatory infiltrate.

312 B. patient is still in a reproductive age. The goal is to remove the mass and to preserve as much as functional ovarian tissue

A 25 y/o nullipara went for consult secondary to 7 years of irregular menses occuring every 2 to 3 months with menorrhaggia lasting for 8 days. Her BMI is 32kg/m2. BP 130/90. PE shows darkened skin flexures particularly in the dorsal neck. hairs are also noted in the upper lip, chin and anterior chest. which of the following is not needed as part of her work up? A. LH/FSH ratio B. TSH, T4 C. Testosterone D. 17-OH progesterone E. estradiol

313 A. exclusion of other causes of hyperandrogenism is needed before arriving at a diagnosis of PCOS. TSH, prolactin should also be checked. Testosterone levels >200ng/dl may suggest adrenal tumor. FSH and estradiol is requested for work up of POF. Although approximately 40-50% of PCOS patient have elevated LH/FSH ratio, it is not required for the diagnosis of PCOS.

A 24 y/o sexually active nullipara went for consult secondary to 4 days of fever and continuous lower abdominal pain. PE noted direct tenderness on (B) adnexal region without palpable mass. IE: (+) cervical motion tenderness. Speculum ex: hyperemic cervix with purulent discharge. pregnancy test is positive, urinalysis shows are within normal limits, CBC: neutrophilic leukocytosis. pelvic ultrasound is unremarkable. what is the next best step in terms of management ? A . IV clindamycin and gentamicin B. IV ampicillin and gentamicin C. IM spectinomycin and ceftriaxone D. levofloxacin and metronidazole E. Laparoscopy

314 A. patient is suffering from severe PID and at the same time, early pregnancy ( as noted by lack of UTZ findings with (+) hcg). The most appropriate treatment for this case is IV clindamycin and gentamicin. B, C- is ineffective since resistance is common in N gonnorrhea infection in the setting of PID. D- fluoroquinolone should never be given in pregnant patient. furthermore, this combination therapy is prescribed in milder cases of PID.

True about cervical cancer screening except? A. Pap testing should be discontinued in patients who underwent hysterectomy regardless of immune status B. Invasive cervical cancer is never been found in women less than 21 years old C. HPV DNA testing and Pap smear should be tested in women >30years old D. Fomite transmission can cause HPV infection. E. none of the above

315 A. A- recommendation indicates that continued Pap testing should be done on hysterectomized patients if she has a history of HSIL, immunocompromised or DES exposure in utero. D- this is the basis of screening at 21 years old even in the absence of sexual activity.

Which of the following is a marker of chronic hypoxia? A. Non stress test B. Contraction stress test C. Amniotic fluid index D. Fetal tone

348 C.

A 29 y/o G4P4 asked you about the best method of contraception. She is currently breastfeeding her 4 month old child and admitted to have a very tight schedule since she is a single parent. Patient is working both as a gym instructor and a fashion model. A. progesterone impregnated IUD B. progestin only pill C. Depot medroxyprogesterone acetate D. combined OCP E. any of the above

316 A. the patient who is currently on breastfeeding and has questionable compliance should be advised to have progesterone IUD as a form of contraception. Progesterone will not affect the quantity and quality of the milk in contrast to estrogen containing contraceptive methods.

Which of the following is true about dysgerminoma ? A. The median age of presentation is 45 years old B. Bilaterality is seen as high as 80% of the cases C. Analogous to seminoma in the male counterpart D. Approximately 90% of the tumors are highly differentiated and HcG producing. E. all of the above.

317 C. Dysgerminoma is the most common malignant germ cell tumors primarily occuring in women younger than 30 years old. Unlike other ovarian malignancy, bilaterality is more commonly seen in dysgerminoma with an estimate of around 10% of the cases. Only 10% of the tumor express HcG. ( SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE). Compre Gyne 5th ed pa 867

Which of the following characterizes type 2 endometrial carcinoma? A. Induced by estrogen B. Post menopausal C. Responds to progestins D. Good prognosis E. all of the above

318 B. Type 1 endometrial carcinoma - Grade 1â€"2, Superficial or no myometrial invasion, Coexisting endometrial hyperplasia, Perimenopausal, Induced by estrogen, Responds to progestins, Good prognosis; Type 2 - High grade (grade 3, papillary serous, clear cell), Deep myometrial invasion, Postmenopausal women, Not induced by estrogen, Does not respond to progestins, Poor prognosis

what chromosomal abnormality accounts for the majority of spontaneous abortion? A. triploidy B. trisomy C. 45 XO D. translocation E. None of the above

319 B. ( SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE). The most common abormality seen in spontaneous abortion is trisomy. While the most common single anomaly seen in abortion is 45XO.

Which is a true statement with regards to variability? A. The baseline HR becomes more variable as rate increases. B. Good variability is an assurance of fetal well- being. C. Normal variability: 10-30 bpm D. Baseline variability is an important index of respiratory function. E. A reduced baseline HR variability is the single most reliable sign of fetal compromise.

323 E. The baselines HR becomes more physiologically fixed as rate increases. Good variability is not necessarily reassuring. Normal variability (moderate): 6-25 bpm. Baseline variability is an important index of cardiovascular function. Williams Obstetrics 23rd edition pp.415-417

What is the most important factor when considering a trial of labor after cesarean delivery? A. type of prior incision B. history of preterm cesarean delivery C. interdelivery interval D. maternal age E. maternal parity

324 A. Williams Obstetrics 23rd edition p.569

True regarding trial of labor after cesarean: A. Twin pregnancy may increase the risk of uterine rupture in VBAC. B. Obesity has no effect in the success of VBAC. C. The most favorable prognositc factor is prior vaginal delivery. D. A woman with a previous low segment rupture has a 16% recurrence risk. E. Women with prior vertical incision in the lower uterine segment without fundal extension are not candidates for VBAC.

325 C. Williams Obstetrics 23rd edition p.568

What is the most common manifestation of postabortal infection? A. septicemia B. endocarditis C. parametritis D. peritonitis E. endomyometritis

326 E. Williams Obstetrics 23rd edition p.222

Which confers the highest risk for ectopic pregnancy? A. infertility B. prior tubal damage C. multiple sexual partners D. previous genital infection E. intrauterine device use

327 B. Williams Obstetrics 23rd edition p.239

A physiologic change in pregnancy: A. transient loss of accommodation B. increase in serum creatinine C. decreased creatinine clearance D. tachypnea E. unchanged tidal volume

328 A. Respiratory rate is unchanged, creatinine is decreased, tidal volume is increased, and creatinine clearance is increased in pregnancy. Williams Obstetrics 23rd edition p.121-130

True regarding gestational diabetes: A. GD causes an increase in fetal anomalies. B. Fetus' brain is unaffected by macrosomia. C. Elective cesarean delivery was found to significantly decrease the incidence of brachial plexus injury. D. There is a 15% likelihood that women with gestational diabetes to develop overt diabetes mellitus within 20 years. E. There is a high risk of fetal death.

329 B. Fetal anomalies are not increased in GD. Elective cesarean delivery has no effect on the incidence of brachial plexus injury. There is a 50% likelihood that women with GD will develop overt DM within 20 years. Williams Obstetrics 23rd edition pp.1111-1112

Which satisfies one of the two clinical criteria for the diagnosis of antiphospholid antibody syndrome? A. >/= 1 unexplained fetal losses after 10 weeks B. >/= 2 consecutive miscarriages < 10 weeks C. preterm delivery for severe preeclampsia at 35 completed weeks D. preterm delivery for placental insufficiency at 35 completed weeks E. none of the above

330 A. Williams Obstetrics 23rd edition p.1153

ACOG recommends single dose treatment of antenatal steroids for women with preterm membrane rupture at an age of gestation of: A. 32-34 weeks B. <24 weeks C. 20-30 weeks D. 24-32 weeks

331 D. There is no concensus regarding giving antenatal steroids at 32-24 weeks. Steroids are not recommended at <24 weeks AOG. Williams Obstetrics 23rd edition p.820

Most frequently occurring congenital malformation in infants of women with overt diabetes mellitus: A. situs inversus B. anencephaly C. cardiac abnormalities D. rectal atresia E. caudal regression

332 E. Williams Obstetrics 23rd edition p.1114 table 52-8

True regarding should dystocia: A. McRoberts is a maneuver most likely to release an impacted shoulder. B. McRoberts is a reasonable approach when all other maneuvers fail. C. McRoberts requires 2 assistants to perform. D. all of the above E. A & B

333 C. There is no evidence that any one maneuver is superior to another in releasing an impacted shoulder. McRoberts is a reasonable INITIAL approach in shoulder dystocia. Williams Obstetrics 23rd edition p.485

A 40-year-old woman reports heavy and prolonged menstrual bleeding, associated with dysmenorrhea. On examination, the uterus is noted to be diffusely enlarged and soft, with its mobility not limited. There is no associated adnexal pathology. What is the most likely diagnosis? A. endometriosis B. ectopic pregnancy C. leiomyoma D. adenomyosis

334 D.

What is considered abnormal after the first two years from onset of menarche? A. cycle lasting 22 days B. menstrual bleeding lasting 10 days C. blood loss amounting 40 cc per cycle D. cycles lasting 30 days E. none of the above

335 B. Abnormal: >42 days cycle, <21 days cycle, bleeding >7 days. Average blood loss: 35 cc. Berek & Novaks Gynecology 14th edition pp.446-447

A 33 year old G6P5 (5005) consulted due to vaginal bleeding. She is currently on her 30th week AOG. Past OB History were all NSD. On PE, BP - 110/70; PR - 78/min; RR - 20/min; T - 36.7C; FH - 31cm; FHT - 132/min; LM3 - breech, no uterine contractions. Speculum exam showed brownish discharge per cervical os. Which of the following is contraindicated in this patient? A. Digital exam B. Speculum exam C. Transvaginal ultrasound D. All of the above

341 A. This is a possible case of placenta previa (patient is G5P5, breech presentation), therefore internal exam is contraindicated.

What is the single most important risk factor for intrauterine infection? A. Age B. Parity C. PROM D. Route of delivery

342 D.

What is the most important criterion for the diagnosis of postpartum metritis? A. Lochia B. Dysuria C. Fever D. Tenderness over the wound

343 C.

A 25 year old G2P1 (1001) just delivered by low forceps extraction to a live baby boy with BW 6 lbs. Continued oozing of bright red blood was noted with BP dropping to 80/50, CR 120/min, RR 20/min, T 37C. In 2009, she had a low transverse cesarean section for placenta previa. What is the most probable cause of the bleeding? A. Abruptio placenta B. Vaginal lacerations C. Rupture of CS scar D. Uterine atony

344 B. Since the patient underwent forceps extraction, the most likely cause of her bleeding would be due to lacerations. Uterine atony is unlikely since she is just only gravida 2, the birth weight is 6 lbs, and there are no other clues in the history that would make the patient at risk for this condition. Rupture of CS scar is also unlikely because her previous CS was a low transverse type.

Which of the following is the most common cause of postpartum hemorrhage? A. Retained placental cotyledons B. Coagulopathies C. Uterine atony D. Lacerations

345 C.

What is the most common cause of spontaneous abortions? A. Maternal systemic disease B. Chromosomal anomalies C. Uterine defects D. Immunologic factors

346 B.

What is the best approach in the management of unruptured tubal pregnancy 5-6 weeks with a live fetus? A. Laparoscopy B. Laparotomy C. Methotrexate D. Watchful observation

347 A. Laporotomy is usually indicated for patient who are hemodynamically unstable or for those with cornual pregnancies. Methotrexate therapy is only done when the ff. criteria are met: patient should be hemodynamically stable with no signs of hemoperitoneum gestational sac should be <=4cm no fetal cardiac activity no tubal rupture beta HCG less than 5000 mIU/mL

A 16 year old patient consulted because of primary amenorrhea. On PE, her breasts are fully developed. Pelvic exam: normal external genitalia; a cotton tip applicator could be inserted 3 cm from the vulvar introitus. On rectal exam, there was nothing palpated. What is the most likely cause of her problem? A. Ovarian agenesis B. Transverse vaginal septum C. Mullerian agenesis D. Imperforate hymen

355 C. (+) breast (-) uterus: Mullerian agenesis or Testicular feminization.

What procedure should be done next when a Pap smear result shows â€œhigh-grade squamous intraepithelial lesionâ€? A. Repeat Pap smear B. Cone biopsy C. Colposcopy D. Random punch biopsies

356 C.

Which histologic type of cervical cancer is associated with a tendency for late diagnosis and a â€œbarrel-shapedâ€ morphology? A. Squamous carcinoma B. Sarcoma C. Adenocarcinoma D. Lymphoma

357 C.

A 16 year old, sexually active nulligravid, complains of vulvar pain. She noted yellowish green foul-smelling vaginal discharge for the past 3 days, and since 1 day ago has been experiencing pain at the start of urination. On PE: (+) firm, tender, bilateral inguinal lymph nodes, (+) multiple vesicular lesions and shallow superficial ulcers. What is the most likely diagnosis for this case? A. Chancroid B. Herpes C. Syphilis D. Lymphogranuloma venereum

358 B. Vesicular lesions, shallow ulcers, and most notably pain, are all characteristic of a herpes infection.

A 23 year old, nulligravid, recently married, consulted because of foul smelling, copious grayish vaginal discharge for the past week. On PE: speculum exam showed copious creamy, grayish, foul-smelling vaginal discharge; cervix is smooth and erythematous. What is the appropriate treatment for this patient? A. None B. Metronidazole C. Doxycycline D. Fluconazole

359 B. This is most likely a case of bacterial vaginosis, the treatment for which is metronidazole.

A patient is diagnosed to have Mayer-Rokitansky syndrome. This patient will have: A. 46XY karyotype B. Normal ovaries C. Infrequent association with skeletal abnormalities D. Normal uterus E. No involvement of the urinary tract

361 B. This syndrome is characterized by congenital absence of the vagina and uterus. These individuals have a 46,XX karyotype. Up to 50% of women with Mullerian agenesis have concur- rent urinary tract anomalies. One study described a 12% incidence of skeletal anomalies, usually involving congenital fusion or absence of vertebrae in these patients. Katz 6th pg 191-192

A 22 year-old primigravid at 35 weeks age of gestation was brought to the emergency room due to severe abdominal pain. Vital signs were BP = 160/100, HR 104, RR 22, T 37C. This was allegedly her first episode of elevated BP. Physical examination revealed a fundic height of 29cm. Stat albumin was 1+ while laboratory tests revealed elevated liver enzymes. What is your diagnosis? A. Gestational Hypertension B. Mild preeclampsia C. Severe preeclampsia D. Chronic hypertension E. HELLP syndrome

362 C.

A 25 year-old, G1P0 is on the 12th hour of labor, cervix 6cm dilated, at station -2 with contracted pelvis. Amniotomy was done. After 2 hours, cervix is now fully dilated, still at station -2. What is the preferred management for this case? A. Sedation and observation B. Augmentation with oxytocin C. Forceps delivery under anesthesia D. Abdominal delivery E. None of the above

363 D. This is a case of failure of descent. Preferred treatment in this case would be cesarean delivery if with CPD and oxytocin if without CPD. Williams 23rd pg 465

A 1 year old was brought to your clinic due to ambiquous genitalia. The patient has normal ovaries with normal development of the uterus. There was also note of virilization with scrotal formation and penile urethra. Karyotyping done revealed a 46XX karyotype. The patient most probably has: A. Congential adrenal hyperplasia B. Mullerian agenesis C. Androgen insensitivity syndrome D. Testicular feminization syndrome E. None of the above

364 A. Congenital adrenal hyperplasia is the most common cause of androgenic excess in fetuses with female pseudohermaphroditism. In this condition, mÃ¼llerian-inhibiting substance is not produced. Androgen exposure is excessive, but variable, for a fetus genetically predestined to be female. The karyotype is 46,XX and ovaries are present. Because mÃ¼llerian-inhibiting substance is not produced, the uterus, fallopian tubes, and upper vagina develop. If androgen levels increase earlier in embryonic develop- ment, then more severe virilization can be seen. This includes formation of labioscrotal folds; development of a urogenital sinus, in which the vagina empties into the posterior urethra; and development of a penile urethra with scrotal formation.

A 36 year old comes to your clinic because of amenorrhea. Her last normal menstrual period was 10 months ago. Physical and internal examination were essentially normal. Endocrine assays reveal estradiol levels as <40pg/ml and FSH was >30mIU/ml. What is your likely diagnosis? A. Hypothalamic-pituitary failure B. Polycystic ovarian syndrome C. Premature ovarian failure D. Hypothalamic-pituitary dysfunction E.

365 C. Premature ovarian failure (POI) or premature ovarian insufficiency (POI), which is the more recently used term, is defined as hypergonadotropic ovarian failure occurring prior to age 40. POI has occurred in 5% to 10% of women who are evaluated for amenorrhea. Patients will have abnormally low levels of estrogen with high levels of FSH.

TRUE of gestational diabetes: A. Screening should be done between 28-32 weeks in those women not known to have glucose intolerance earlier in pregnancy. B. Maternal hyperglycemia prompts fetal hyperinsulinemia particularly during the first half of gestation, which in turn stimulates excessive somatic growth. C. Women diagnosed with GDM have a 25-percent likelihood of developing overt diabetes within 20 years. D. Women with gestational diabetes who do not require insulin seldom require early delivery or other interventions. E. All of the above

366 D. Screening should be done between 24-28 weeks in those women not known to have glucose intolerance earlier in pregnancy. Maternal hyperglycemia prompts fetal hyperinsulinemia particularly during the second half of gestation, which in turn stimulates excessive somatic growth. Women diagnosed with GDM have a 50-percent likelihood of developing overt diabetes within 20 years. Williams 23rd pg 1106-1112

A 27 year old G3P2 on her 36th week of gestation, with a history of chronic hypertension, had severe abdominal pains of several hours with accompanying vaginal bleeding. Vital signs are BP = 140/90, PR = 108bpm, RR = 22/min and T = 37.2 C. Abdomen is tender and cervix is 3cm dilated, membranes are bulging. CTG is non-reactive with hypertonic uterine contractions. The most likely diagnosis is: A. Normal early labor B. Uterine rupture C. Placental abruption D. Placenta previa E. None of the above

367 C. Placental abruption presents with vaginal bleeding in 78 percent, uterine tenderness or back pain in 66 percent, and fetal distress in 60 percent of patients. Other findings included frequent uterine contractions and persistent uterine hypertonus. Williams 23rd pg 765-766

A 56 year-old G0 had abnormal postmenopausal bleeding and biopsy done revealed endometrial adenocarcinoma. Patient underwent EHBSO, PFC, BLND and final histopath showed that tumor is confined to the endometrium. All other pelvic structures and lymph nodes are negative. However, peritoneal fluid cytology was positive. What is the stage? A. IA B. IB C. II D. IIIA E. IIIC

373 A. This is a case of Stage IA endometrial adenocarcinoma since tumor is limited to the endometrium. Positive cytology has to be reported separately without changing the stage. Katz 6th pg 720

A 24 year-old primigravid complains of an ulcer in the genital area. According to her, it started as a shallow painless ulcer three weeks prior to consult. On physical examination, you noted tender inguinal lymph nodes. What is the most likely etiology? A. Chlamydia trachomatis B. Herpes simplex virus C. Hemophilus ducreyi D. Klebsiella granulomatosis E. Treponema pallidum

368 A. Lymphogranuloma venereum (LGV) is a chronic infection of lymphatic tissue produced by Chlamydia trachomatis. There are three distinct phases of vulvar and perirectal LGV. The primary infection is a shallow painless ulcer that heals rap- idly without therapy. One to 4 weeks after the primary infection, a secondary phase marked by painful adenopathy develops in the inguinal and peri- rectal areas. When the disease is untreated, the infected nodes become increasingly tender, enlarged, matted together, and ad- herent to overlying skin, forming a bubo (tender lymph nodes). Katz 6th pg 526

A 34 year old G2P2 presents at the OPD with white thick vaginal discharge associated with vaginal erythema and pruritus. Measurement of vaginal acidity reveals a pH of 4. What is your diagnosis? A. Bacterial Vaginosis B. Trichomoniasis C. Vulvovaginal candiasis D. Atrophic Vaginitis E. Gonorrhea

369 C. Bacterial vaginosis and Trichomoniasis will have a vaginal pH greater than 4.5.

A 26 year-old G2P1 consulted at the Emergency room. On internal examination, you noted that the cervix is 3 cm dilated, at midposition, with 40% effacement, with a soft consistency, and at station - 2. What is the Bishop score? A. 6 B. 7 C. 8 D. 9 E. 10

370 B. 3cm - 2, midposition - 1, 40% - 1, soft - 2, station -2 - 1

What is the mechanism of action of combined oral contraceptives? A. Progesterone suppresses LH action while estrogen suppresses FSH action. B. Progesterone suppresses FSH action while estrogen suppresses LH action. C. Progesterone suppresses GnRH action while estrogen suppresses FSH action. D. Progesterone suppresses FSH action while estrogen suppresses GnRH action.

371 A. Progestins prevent ovulation by suppressing LH and also thicken cervical mucus, thereby retarding sperm passage. In addition, they render the endometrium unfavorable for implantation. Estrogen prevents ovulation by suppressing FSH release. Williams 23rd pg 673

The most common adnexal mass in the adolescent age group. A. Germ cell tumor B. Dermoid cysts C. Infectious cyst D. Functional ovarian cyst

372 D. Most ovarian masses in the pediatric and adolescent age group are functional ovarian cysts, and if a tumor is present it most often is a benign teratoma (dermoid). Malignancies can, however, occur and are most often of germ cell origin, but they can also be sex cord tumors such as a granulosa cell malignancy. Katz 6th pg 211

The following are techniques employed to deliver the aftercoming head EXCEPT: A. Mauriceau maneuver B. Lovesets maneuver C. Modified Prage maneuver D. Pinard's maneuver

374 B. Methods used in the delivery of the aftercoming head include: Piper's Forceps, Mauriceau maneuver, Prague maneuver, Bracht maneuver and Pinard's maneuver. Lovesets maneuver is used to deliver the shoulder. Topnotch

The following can be observed in the puerperium EXCEPT: A. Women approach their self-reported pre- pregnancy weight 3 months after delivery. B. By 2 weeks postpartum, the uterus has descended into the true pelvis. C. Ovulation may resume as early as 3 weeks after delivery, even in lactating women. D. The bladder has increased capacity and relative insensitivity to intravesical pressure.

375 A. Women approach their self-reported pre- pregnancy weight 6 months after delivery but still retain an average surplus of 3 lbs. Williams 23rd pg 649

A 27 year-old G2P1 36 weeks of age of gestation came in the emergency room for uterine contractions. Internal examination revealed 2cm dilatation, station -2, with adequate pelvimetry. After 14 hours, IE revealed 3cm dilatation still at station -2. What is the preferred management in this case? A. Cesarean delivery B. Augment with oxytocin C. Advise bed rest D. Administer tocolytics

376 C. This is case of prolonged latent phase. Preferred management would be bed rest. Administration of oxytocin or abdominal delivery is done if with urgent problem Williams 23rd pg 465

In placenta accreta, what layer is defective or absent? A. decidua basalis B. decidua functionalis C. decidua stroma D. Nitabuch's layer

377 D.

The most common cause of obstetrical hemorrhage is A. Coagulopathy B. Placental abruption C. Placental Accreta D. Retained Placental fragments E. Uterine atony

378 E. Failure of the uterus to contract properly following delivery is the most common cause of obstetrical hemorrhage.

Triad of ectopic pregnancy: A. Amenorrhea, vaginal bleeding and adnexal mass B. Amenorrhea, vaginal bleeding and abdominal pain C. Positive pregnancy test, vaginal bleeding, and an adnexal mass D. Positive pregnancy test, vaginal bleeding and abdominal pain

379 B. The most common symptoms of ectopic pregnancy are abdominal pain, absence of menses, and irregular vaginal bleeding Katz 6th pg 367

The single most important risk factor for the development of uterine infecion after childbirth. A. Prolonged labor induction B. Route of delivery C. Bacterial colonization of the lower genital tract D. Meconium-stained amniotic fluid E. None of the above

380 B. The route of delivery is the single most significant risk factor for the development of uterine infection. Williams 23rd pg 661

Which of the following represents the shortest AP diameter of the pelvic inlet? A. Diagonal conjugate B. Obstetric conjugate C. True conjugate D. Interspinous diameter E. Intertuberous diameter

381 B. Diagonal conjugate: measured clinically and is roughly 1.5 cm longer than the obstetric conjugate.

Which of the following is the most common menstrual abnormality associated with hyperthyroidism? A. Oligomenorrhea B. Menorrhagia C. Metrorrhagia D. Polymenorrhea E. Intermenstrual bleeding

382 A. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE. Oligomenorrhea and hypomenorrhea are the most common menstrual abnormalities in hyperthyroidism.

Which uterine ligament provides the major support to the cervix and vagina? A. Broad ligament B. Cardinal ligament C. Uterosacral ligament D. Round ligament E. Infundibulopelvic ligament

383 B.

The Arias-Stella reaction is seen in which of the following conditions/periods? A. Pregnancy state B. Luteal phase C. Proliferative phase D. Cervical cancer E. Menopause

384 A. Arias-Stella reaction refers to benign endocervical gland hyperplasia of pregnancy. It can cause misdiagnosis of Pap smear specimens from pregnant patients as its appearance mimics endometrial CA.

A 16-year old female presented to your clinic with primary amenorrhea. On physical examination, she has signs of normal breast development. Ultrasound evaluation failed to demonstrate the presence of any uterus and cervix. Karyotype analysis revealed that she is a 46 XX. What is your most likely diagnosis at this point? A. Androgen insensitivity B. Mayer-Rokitansky-Kuster-Hauser syndrome C. Imperforate hymen D. Premature ovarian failure E. Hypogonadotropic hypogonadism

386 B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE.

During pregnancy, the uterus normally undergoes which of the following positional change? A. Rotates to the left B. Rotates to the right C. Flexes anteriorly D. Flexes posteriorly E. None of the above

387 B. The gravid uterus normally rotates to the right due to the presence of the sigmoid colon in the left aspect of the pelvic cavity.

Mittelschmerz pain occurs during which of the following periods? A. Early trimester pregnancy B. Late trimester pregnancy C. Ovulation D. Menstruation E. Perimenopause

388 C. Mittelschmerz refers to the lower abdominal and pelvic pain experienced by some women midway in their menstrual cycle, corresponding to the period of ovulation.

Among pregnant patients, when is the best time to perform screening for Group B streptococcal infection? A. on initial visit B. 24-28 weeks AOG C. 33-35 weeks AOG D. 35-37 weeks AOG E. once labor has begun

389 D.

In a pregnant patient without known risk factors, when is the optimal time to perform OGTT to screen for gestational diabetes? A. on initial visit B. 16-20 weeks AOG C. 24-28 weeks AOG D. 32-36 weeks AOG E. 20-24 weeks AOG

390 C. For high-risk patients, perform OGTT on initial prenatal visit.

A 33-year old pregnant patient on her 36-week AOG was admitted for sudden onset of painful vaginal bleeding. You diagnosed her to have abruptio placenta and decided to perform emergency cesarean delivery. Given the nature of this operation and anticipating severe blood loss, which is of the following types of anesthesia would you recommend for the patient? A. Regional anesthesia B. Epidural anesthesia C. Combined regional and epidural anesthesia D. General anesthesia E. Local anesthesia

391 D. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE. General anesthesia is recommended in the following cases: nternal podalic version, breech decomposition, inverted uterus, severe hemorrhage and emergent C/S. Epidural anesthesia is preferred for severe preeclampsia, eclampsia and CHF.

A G4P4 mother presented with complaints of dysmenorrhea and menorrhagia. Pelvic exam revealed a diffusely and symmterically enlarged uterus. Which of the following would you expect on histopathologic investigation? A. Presence of ectopic endometrial glands and stroma on the peritoneal lining of the uterus B. Presence of endometrial glands and stroma in the myometrium C. Increased endometrial thickness without invasion of the myometrium D. Proliferation of smooth muscle cells in the myometrium with areas of hyaline and cystic degeneration E. Atrophic endometrial mucosa with friable myometrial blood vessels

392 B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE. Diagnosis: adenomyosis.

A 23-year old female came into your clinic due to 5-day history of vaginal discharge. On pelvic examination, you noted green-yellow frothy discharge and multiple erythematous punctate lesions in her vagina. With your diagnosis in mind, which of the following regimens would you prescribe to your patient? A. Metronidazole 2 g PO single dose B. Metronidazole 500 mg BID x 7 days C. Fluconazole 150 mg PO single dose D. Nystatin vaginal wash E. Either A or B is acceptable

393 A. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE. Diagnosis: Trichomoniasis

Which of the following forceps is used to assist in the delivery of the aftercoming head during breech extraction? A. Simpson forceps B. Tucker-McLane forceps C. Kielland forceps D. Piper forceps E. Elliot forceps

394 D. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE.

Which of the following substances is responsible for myometrial contractility and is implicated in dysmenorrhea? A. Oxytocin B. Prostaglandin F2-alpha C. Enkephalinase D. Endothelin E. BMP-15

395 B.

A 4-year old female presented at your clinic with symptoms of UTI. On physical examination, you noted labial adhesion with translucent vertical line at midline. Which of the following would you prescribe in relation to your finding? A. Topical clobetasol cream B. Topical estrogen cream C. Topical testosterone cream D. Low-dose oral estrogen therapy E. Surgical incision of the adhesion

396 B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE. Diagnosis: adhesive vulvitis

A 35-year old female came into your clinic with a Pap smear result indicating "low-grade squamous intraepithelial lesion". What is the next appropriate step in your management? A. Request for transvaginal ultrasound to assess the depth of the lesion B. Request for CT scan to assess regional node status C. Request for colposcopy and biopsy D. Perform definitive management with cold-knife conization since this is a clinical diagnosis E. Performed loop electrosurgical excision procedure.

397 C. Pap smear showing ASC-US, LSIL, HSIL or SCC should always be followed up with colposcopy and biopsy. Therapeutic management would then depend on the result of the biopsy.

A 43-year old multigravid presented with 1-year history of gradually enlarging, friable mass arising from her cervix. On pelvic examination, you noted nodularities in the bilateral parametria. Abdominal ultrasound showed no liver metastasis; however, bilateral ureteropelvocaliectasia was noted. What would be the best management for this patient? A. Radical hysterectomy, followed by radiotherapy and adjuvant chemotherapy. B. Radical hysterectomy, followed by radiotherapy only C. Cisplatin-based chemotherapy with concurrent external beam radiotherapy, followed by brachytherapy D. Cisplatin-based chemotherapy, followed by EBRT, then brachytherapy E. Cisplatin-based chemotherapy only due to presence of ureteropelvocaliectasia

398 C. Diagnosis: cervical CA, stage IIIB. The presence of dilated ureters and renal pelves is an indicator of pelvic side wall involvement.

Which of the following regimens would you recommend for a 18-year female seeking emergency contraception? A. Progestin only pills for 7 days B. Mifepristone x 5 doses C. Copper IUD D. Ethinyl estradiol + levonorgestrel x 2 doses E. Misoprostol x 5 doses

399 D. Ethinyl estradiol + levonorgestrel combination, more popularly known as Yuzpe, is an effective emergency contraception when taken up to 2 days following coitus. Levonorgestrel x 2 doses is also an acceptable alternative.

A 35 year old patient was diagnosed with an Ovarian tumor, a biopsy was done revealing Transitional cells, similar to a urinary bladder-type of histology surrounded by a massive growth of a fibrous stroma. What would be the most appropriate management? A. Unilateral Oophorectomy B. Bilateral Oophorectomy C. Unilateral Salphingo-oophorectomy D. TAH-BSO E. TAH-BSO with lymph node dissection and PF analysis

401 C. This type of Branner's tumor is benign due to the presence of an outer fibrous stroma. All benign tumors require only a unilateral salphingo- oophorectomy. (SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE)

Which of the following cardinal movements is the 1st prerequisite for birth? A. Engagement B. Descent C. Flexion D. Internal Rotation E. Extension

402 B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE

Bartholin's Gland is a derivative of which of the following anlagen? A. Wolffian Duct B. Mullerian Duct C. Genital Tubercle D. Genital Swelling E. Urogenital Sinus

403 E. Derivatives of the Urogenital Sinus include the female urethra, lower vagina (2/3), Bartholin's Gland and Skene's Gland.

A 15-year old patient was brought to you by her mother apparently because she still has not menstruated, secondary sexual characteristics are present in this patient and there is no developmental delay. What would be your next step? A. Measure FSH and LH B. Do a transrectal UTZ C. Do CNS imaging D. Do Karyotyping E. Observe

404 E. Primary amenorrhea in a patient with the presence of secondary sexual characteristics is considered if the patient is already 16 years old. Our patient is just 15, a more appropriate step is to wait for her 16th birthday, if still with no menses then do diagnostics.

The most common symptom of Vulvar Intraepithelial neoplasia is: A. Pruritus B. Pain C. Palpable nontender mass D. Bleeding E. Acanthosis

405 A. Pruritus is the most common symptom of VIN hence in all pruritic valvualr lesions, biopsy is warranted.

True of Lichen sclerosus, EXCEPT: A. Treated with Testosterone cream B. Has a 5-15% risk for CA in premenopausal women C. Pruritus is the most common presentation D. May involve the vaginal wall E. Creates an hourglass appearance

406 D. Lichen sclerosus does not involve the vagina.

A 20-year old Nulligravid has just underwent a Pap Smear revealing a CIN II result, which of the following is the best option for this patient? A. Observe and repeat Pap smear after 3 months B. Ablative therapy C. Perform Hysterectomy only D. Do a TAHBSO E. Do chemoradiation only

407 B. For patients with High grade SIL (CIN II and III) and still desires infertility, ablative therapy or excisional procedures are the options, hysterectomy is only warranted for patients who has no desire for fertility/ or has completed child-bearing years.

Which of the following statements is NOT true regarding Cervical Cancer? A. HPV 6, 11 infections poses a high risk for developing Carcinoma B. Squamous Cell Carcinoma is the most common type C. Vaginal Bleeding is the most common symptom D. Uremia is the most common cause of death E. HPV vaccine can be administered starting 9 years old

408 A. HPV strains 16 and 18 poses a high risk for carcinoma, not 6 and 11 which causes only genital warts.

A 50-year old asymptomatic patient with a Myoma as large as a baseball, sought consult from an OB- GYN, what would be the most appropriate management for this patient? A. Observe B. Medical Therapy with a GnRH Analogue C. Do Myomectomy D. Do embolization E. Do a hysterectomy

409 A. Asymptomatic patients with myoma are managed conservatively.

A patient with a recently discovered endometriosis found on her lungs asks for an explanation from you why this occurred, you would explain which of the following theories of endometriosis? A. Retrograde Menstruation B. Metaplasia of Coelomic Epithelium C. Lymphatic and Vascular Metastasis D. Iatrogenic Dissemination E. Malignant Degeneration

410 C.

A patient with an ovarian fibroma, suddenly developed Meig's Syndrome, among which of the following would be seen in this patient? A. Pneumothorax B. Ascites C. Amenorrhea D. Menorrhagia E. Palpable abdominal mass

411 B. Meig's Syndrome: Ovarian Fibroma, Ascites, Hydrothorax

A patient presenting with a pelvic mass underwent a Pelvic ultrasound, which of the following characteristics will make you suspect that the mass is probably malignant? A. Unilateral Mass B. Absence of septations C. Noted Calcifications D. Multicystic or multilocular mass E. size of less than 8 cm

412 D. all others are probable signs that the mass is benign.

Drugs are categorized according to their safety profile for consumption of pregnant patients, Phenytoin is an example. Phenytoin is found to have positive evidence of human fetal risk based on studies in humans, but potential benefits may warrant use of the drug despite potential risks. What category is Phenytoin classified? A. A B. B C. C D. D E. X

413 D.

A G1P0 on her 34th week AOG underwent a Biophysical Assesment which revealed the following: 1.)Reactive NST, 2.)One breathing period lasting 10 seconds, 3.) 2 discrete movements of arms, 4.) One definite extension and return to flexion, 5.) AF volume with the largest pocket at 1 cm. What would be the nest step of the OB-GYN? A. Observe and repeat per protocol B. Repeat BPF in 24 hours C. Repeat test weekly D. Do a CST E. Deliver

416 E. BPS is 4 with an abnormal AFV hence protocol states that delivery should be prompted.

The earliest prenatal screening that can be done as early as 9 weeks AOG is among which of the following? A. Cordocentesis B. Chorionic villus sampling C. Early amniocentesis D. Percutaneous Umbilical cord blood sampling E. None of the above

417 B. Chorionic villus sampling can be done as early as 9 weeks to 12 weeks AOG.

The highest risk for the development of a future Ectopic Pregnancy is which among the following? A. Previous PID B. Tubal Corrective Surgery C. Previous Ectopic Pregnancy D. IUD placement E. Previous abdominal surgery

418 B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE

A G2P1 patient on her 16th week AOG was rushed in the ED due to severe abdominal pain, hypotension, tachycardia and signs of peritonitis, which among the following would be your consideration? A. Rupture Ectopic Pregnancy, Ampulla B. Ruptured Ectopic Pregnancy, Isthmus C. Ruptured Ectopic Pregnancy, Interstitial D. Abruptio Placenta E. Placenta Previa

419 C. Ectopic pregnancy of the interstitial part of the FT will rupture only at around 16 weeks, rupture of the ampulla occurs at around 8-12 weeks, while the isthmus which is the narrowest will most likely rupture in the first 6-8 weeks of pregnancy. D and E are seen in the 3rd trimester of pregnancy.

CPD can be totally ruled out in a nulligravid patient by which of the following procedure? A. Xray Pelvimetry B. Clinical Pelvimetry C. History taking D. Pelvic CT-Scan E. None of the above

420 E. CPD can not be totally ruled out in a nulligravid patient. A history of CPD in a multipara will give a great idea to a clinician that the patient may again come out with the same problem.

The third stage of labor commences: A. After expulsion of placenta B. After delivery of fetus C. When cervix is fully dilated D. After episiorrhapy E. Cervix is fully effaced

448 B. Delivery of the fetus commences the third stage of labor and is also the end of second stage of labor. First stage of the labor ends when cervix is fully dilated and fully effaced.

A female patient was noted to be of short stature, with webbed neck, shield chest, and a congenital heart disease. She has normal mentation. Genetic analysis, however, revealed a normal karyotype. This patient has: A. Superfemale syndrome B. Turner syndrome C. Rokitansky Kuster Hauser Mayer syndrome D. Noonan syndrome

421 D. Noonan syndrome shares clinical features with Turner syndrome, including the signs mentioned in the item. However, the observation that patients with Noonan syndrome have normal karyotypes is important in allowing the distinction to be made between the two (Turner has the karyotype 45 XO). Significantly, Noonan syndrome patients are able to bear offsprings, however management is complicated with uterine anatomic anomalies which are also common in these patients.

A 35-year old patient was rushed to the OB ER after experiencing excessive pelvic pain and cramping with notable vaginal bleeding. She is febrile and tachycardic but with normal BP and good peripheral pulses and perfusion. During history taking, she admits that she has been working as a prostitute and does not use condoms or OCPs. The first test that you will order for this patient is: A. Pelvic sonography B. Blood culture C. Diagnostic laparoscopy D. Î²-hCG E. None of the above

422 D. All OB-GYN emergencies, especially if the patient is hemodynamically stable, warrants a pregnancy test prior to any intervention. This is a case of secondary dysmenorrhea with several possible etiologies including ectopic pregnancy, septic abortion, pelvic infection, etc.

Which of the following is not true about menopause: A. The age of onset is genetically determined. B. There is a significant decrease in the number of ovarian follicles accompanied by degeneration of granulosa and theca cells. C. Stromal cells of the ovaries sustain their capacity to produce androgenic hormones. D. The remaining estrogen levels in the circulation during menopause is dictated by the proportion of body fat. E. None of the above.

423 E. Menopause is defined as permanent cessation of menstruation, featured with 3 consecutive months of amenorrhea with elevations of FSH and LH. The mean age of onset among Filipinos is said to be at 51. The increase in the gonadotropins as well as the cessation of mestrual cycle is brought about by the loss of ovarian follicles secreting inhibin and estrogen. Estrone (E1) is the predominant estrogen in menopause. It is converted from androstenedione which comes from body fat.

Ferning or arborization of the cervical mucus is brought about by the crystallization of sodium chloride on mucus fibers in the presence of elevated levels of estrogen. This pattern can be normally seen in which phase of the menstrual cycle? A. Proliferative phase B. Secretory phase C. Luteal phase D. Any phase

424 A. On the other hand, BEADING is seen during the secretory phase of the menstrual cycle and is due to high levels of progesterone. When ferning is seen in all phases of the cycle, it suggests infertility, autonomic ovarian failure or menopause.

A 24-year old G2P1 at 38 weeks AOG is admitted at the OB ward. She reports that she has been experiencing regular uterine contractions for 19 hours now. IE reveals cervical dilation remaining at 2 cms. She is afebrile with normal heart rate and BP. Fetal monitoring is also reassuring. You consider prolonged latent phase of labor. What will be your next plan? A. Expectant management B. Induction of labor C. Augmentation of labor D. Refer to a perinatologist

425 A. Prolonged latent phase is considered if the patient has been experiencing regular uterine contractions for >20 hours if nulliparous, or >14 hours if with previous delivery, with cervical dilation remaining at 2 cms. Primary manegement is still expectant and supportive, although one should consider that the mother may suffer from exhaustion or uterine infection.

Cesarean section is an operative procedure requiring a uterine incision which aims to deliver the fetus abdominally . Which of the following is an absolute indication for this procedure? A. Massive maternal obesity B. Transverse lie C. Contracted pelvis D. Placenta previa

426 C. Dystocia, on the other hand, is the most common indication for a primary cesarean section.

A 23-year old G2P2 has just given birth to a live healthy term 2.8 kg baby girl via spontaneous vaginal delivery. She is stable with adequate response to post-delivery care and heading to an unremarkable peuperal stage. At what time is her uterus expected to descend into the true pelvis? A. At 1 week post-partum B. At 2 weeks post-partum C. At 3 weeks post-partum D. At 4 weeks post-partum E. Soon after delivery of the placenta

427 B. Peurperium usually lasts up to 6 weeks. Decidua differentiates in 2-3 days after delivery. At 2 weeks, uterus returns to the true pelvis; at 3 weeks, the entire endometrium becomes restored; and at 4 weeks, the uterus reaches its non-gestational size.

The type of anesthesia ideal for severe pre- eclampsia and eclampsia and is also considered as the gold standard in obstetrical anesthesia is: A. Spinal anesthesia B. Pudendal anesthesia C. Epidural anesthesia D. General anesthesia

428 C. Pudendal block is used in manual exploration of uterine cavity, in outlet forceps delivery and in repair of vagina and cervix. Spinal anesthesia is more commonly used in elective CS (the duration of procedure is more time-limited, since the anesthesia is given as a single shot). While general anesthesia is indicated in breech decomposition, replacement of inverted uterus, and internal podalic version of second twin.

On endometrial biopsy, glycogen-rich subnuclear vacuoles were seen in the base of the cells lining the glands. The hormone that is predominant in this phase is: A. Estrogen B. FSH C. LH D. Progesterone E. Gonadotropin

449 D. Basal vacuolation is the earliest histological evidence of progesterone action.

A 33-year old G3P1 at 36 weeks AOG was referred to your hospital due to abnormal placentation detected sonographically at 29 weeks AOG. She had CS for placenta previa 3 years ago. At the admitting section, the patient reports vaginal spotting but no severe abdominal complaints. Repeat ultrasound reveals a viable baby and CS was immediately performed. The surgeon however noted profuse bleeding that was not ameliorated by any means. Hysterectomy was done. This abnormal condition can be best explained by: A. Velamentous insertion of the umbilical cord B. Absence of the decidua basalis with imperfect development of the Nitabuch layer C. Avulsion of anchoring villi of low implanted placenta D. Uterine ischemia secondary to prolonged myometrial contractions

429 B. This is a case of placenta accreta where chorionic villi penetrate the decidua but not the myometrium (accreta vera, 75%); or deeper into the myometrium but not the seros (increta, 15%); or may reach and even perforate the serosa and invade adjacent structures (percreta, 5%). Option A explains vasa previa while option C pertains to placenta previa.

Which of the following conditions will least likely cause uterine inversion? A. Strong umbilical cord traction B. Myometrial fatigue C. Placenta accreta D. Abruptio placenta

430 D.

A 17-year old primi at 37 weeks AOG, who is expected to deliver in a week, returned to your clinic after observing multiple pruritic vesicular rashes on her torso and head. You know that this is infectious and requires intervention, therefore you will consider: A. Giving pregnancy-graded oral anti-viral medications to prevent spread in the circulation saving the feto-maternal blood circuit. B. Giving vaccine to the mother to prevent transplacental transfer. C. Administering immune globulins to the newborn. D. An emergency cesarean section. E. All can be considered.

431 C. VZV Ig should be given to neonates born to mothers who have clinical evidence of the infection 5 days before or up to 2 days after delivery. Varicella vaccine is not recommended to pregnant women, or to those who expect to conceive in the month following vaccination.

Which Leopold's maneuver will determine the degree of flexion (attitude) of fetal head? A. Leopold's I B. Leopold's II C. Leopold's III D. Leopold's IV

432 D. A FAQ as well. Leopold I is the fundal grip and is used to determine the fetal part that lies in the fundus (presentation). Leopold II identifies the location of fetal back and small parts (fetal lie). While Leopold's III determines engagement and is also known as the Pawlick's sign.

A pre-eclamptic primigravid is admitted at the maternal ICU. Her condition is adequately controlled by MgSO4 drip. You ask the clerk-on- duty to monitor the possible adverse effects of such medication. In your mind, you expect that this patient will start having respiratory depression if her MgSO4 blood level reaches: A. 7 mEq/L B. 10 mEq/L C. 14 mEq/L D. 18 mEq/L E. 30 mEq/L

433 C. There are 3 parameters that we monitor in patients maintained on MgSO4: the deep tendon reflex, RR, and urine output. The therapeutic level of MgSO4 is at 4-7 mEq/L; disappearance of the patellar reflex is set at 10 mEq/L. On the onter hand, respiratory depression sets in if value is >12 mEq/L, and it may require mechanical ventilation if >15 mEq/L. Cardiac arrest is expected to happen at levels >30- 35 mEq/L. Calcium gluconate (1 gm IV) is the antidote.

Which of the following is not found in HELLP syndrome? A. Elevated LDH B. Thrombocytopenia C. Elevated liver enzymes D. Hemorrhage with prolonged PT/PTT E. None of the above

434 D. HELLP means hemolysis (high LDH - enzyme released from RBCs), elevated liver enzymes,and low platelet.

What CNS anomaly in infants is considered to be most specific to maternal DM? A. Down syndrome B. Sacral agenesis C. Cretinism D. Lissencephaly

435 B. However, other causes are presumably involved, as demonstrated by the rare incidence of sacral agenesis compared to diabetes and certainly, not all children born with the condition have diabetic mothers.

Which will you give/recommend to a lactating woman who desires contraception? A. Combined oral pill B. Levonorgestrel C. Minipill D. Copper T IUD

436 C. Please study the methods of contraception, especially the hormonal pills. Minipill is also known as progestin only pill. It has 0.5 mg of progesterone and is considered safe and appropriate for breastfeeding women.

A 27-year old G3P2 mother who is now at her 14 weeks AOG, is rushed to the OB ER after complaining of minimal vaginal spotting. She is afebrile with normal BP and heart rate. On IE, her cervix is closed with uterine size estimating 10 weeks AOG. Which of the following is the next best step? A. Discharge the patient and advise her to have complete bed rest. B. Perform an ultrasound and perform an elective dilatation and curettage. C. Perform a prompt dilatation and evacuation. D. Perform an ultrasound, observe the patient for recurrence of spotting, and advise for expectant management.

437 B. The manifestations are most consistent with a case of missed abortion. Expected findings in the UTZ include an empty gestational sac in blighted ovum or a fetus without cardiac activity. Elective D&C is Complete abortion will have no bleeding and will show an empty cavity on UTZ.

Vulvar carcinoma is strongly related to HPV with an excellent orverall survival rate. It is usually of the squamous cell CA type and may present either as a flat, raised, plaque-like, ulcerated or polypoid masses on the vulva. If a patient with this condition would come to you for consult she would most likely complain of vulvar: A. Pain B. Bleeding C. Itching D. Adhesions

438. C..Pruritus is the most common symptom of vulvar carcinoma.

A subseptate uterus can result in 1st trimester pregnancy loss because of: A. Poor vascularization B. Limited uterine space hence restricting fetal growth C. Increased risk of bacterial invasion and chorioamnionitis D. High chance of placental fragmentation and loss

439 A. Septate and subseptate are associated with first trimester miscarriage due to inadequate vascularization. Pregnancy losses during 2nd trimester can be seen in unicornuate and bicornuate uteri. With these anomalies, fetal growth is more physically restricted.

What is the most common type of uterine myoma? A. Subserosal B. Submucosal C. Intramural D. Cervical

440 C. *FAQ. The submucosal type is the one most commonly associated with heavy and prolonged bleeding.

The presence of heavy concentration of coccobacilli surrounding vaginal epithelial cells with loss of distinct cell margins is the appearance of: A. Donovan bodies B. Chancre C. Clue cells D. Inclusion cells E. Koilocytes

441 C. Clue cells are epithelial cells of the vagina that get their distinctive stippled appearance by being covered with coccobacilli. Donovan bodies are rod- shaped, oval organisms that can be seen in the cytoplasm of mononuclear phagocytes or histiocytes in tissue samples from patients with granuloma inguinale. A chancre is a painless ulcer most commonly found in primary stage of syphilis. Koilocytes are cells found with HPV infection.

Speculum exam of a 27 year-old female complaining of leucorrhea showed copious frothy greenish vaginal discharge with strawberry-like mucosa. This is most likely due to: A. Candida albicans B. Trichomonas vaginalis C. Neisseria gonorrheae D. Chlamydia trachomatis E. Gardnerella vaginalis

442 Trichomoniasis is caused by Trichomonas vaginalis manifested with green-yellow frothy vaginal discharge associated with strawberry cervix. Candidiasis has cottage cheese-like discharge, gonorrhea and chlamydia infection has no dischrage in infected women, Bacterial vaginosis has grayish-white discharge.

A 28 year-old, G1P0 woman was diagnosed of pregnancy-induced hypertension was seen at the ER due to convulsion. The anticonvulsant of choice is magnesium sulfate. Which of the following findings would limit administration of the magnesium sulfate? A. PR of 70bpm B. bradypnea C. +2 tendon reflexes D. BP of 140/90 E. urine output of 35cc/hour

443 B. Magnesium sulfate is the anticonvulsant of choice for preeclampsia and eclampsia. Administration is limited if the patient had depressed tendon reflexes, respiratory rate <12cpm, and urine output <30cc/hour hence, these should be monitored.

It is a metastatic tumor to the ovary, usually bilateral, consisting of signet ring cells, usually originating from gastrointestinal tract: A. Mucinous tumor B. Serous tumor C. Sex-cord stromal tumor D. Krukenberg tumor E. Brenner tumor

444 D. A Krukenberg tumor refers to a malignancy in the ovary that metastasized from a primary site, classically the gastrointestinal tract, although it can arise in other tissues such as the breast. Krukenberg tumors are often found in both ovaries, consistent with its metastatic nature, most commonly from gastric adenocarcinoma. Lymphogranuloma venereum (LGV) is an uncommon sexually transmitted disease (STD) caused by Chlamydia trachomatis.

What ulcerative lesion of the genital tract is characterized by the presence of "groove sign"? A. Granuloma inguinale B. Lymphogranuloma venereum C. Chancroid D. Syphilis E. TB of genital tract

445 B. Lymphogranuloma venereum (LGV) is an uncommon sexually transmitted disease (STD) caused by Chlamydia trachomatis. This condition is characterized by self-limited genital papules or ulcers followed by painful inguinal and/or femoral lymphadenopathy. The â€˜groove signâ€™ characteristic of LGV is seen if both the inguinal and the femoral nodes are involved.

A 25 year-old G1P1 was diagnosed with cervical intraepithelial neoplasia involving the entire thickness of the cervical epithelium. This is best managed by: A. Cryosugery B. Electrocautery C. Conization D. Hysterectomy E. CO2 laser ablation

446 C. Conization is a treatment of choice for women who are still desirous of pregnancy with high grade cervical dysplasia. Conization removes a cone shaped piece of tissue from the cervix. It is also called a cone biopsy and can be used to help diagnose cervical cancer. Cocaine, a small molecule, is able to cross the placenta into the bloodstream of the fetus.

Cocaine use in pregnancy is associated with: A. Spontaneous abortion B. Prematurity C. Abruptio placenta D. A and B E. All of the above

447 E. Cocaine is a a small molecule which is able to cross the placenta into the bloodstream of the fetus. Cocaine-using pregnant women deliver prematurely. There are also data showing that spontaneous abortion and low birth weight. The increased risk of placental abruption with cocaine use has been well documented.

The order of the 4 divisions of the fallopian tubes from the ovary to the uterus are: A. Infundibulum, isthmus, ampulla, interstitium B. Infundibulum, ampulla, isthmus, interstitium C. Infundibulum, ampulla, interstitium, isthmus D. isthmus, ampulla, interstitium, infundibulum E. interstitium, isthmus, ampulla, infundibulum

450 B. The order of the 4 divisions of the fallopian tubes from the ovary to the uterus are infundibulum, ampulla, isthmus, interstitium.

Abdominal enlargement and a positive hormonal test maybe considered: A. Positive signs of pregnancy B. Presumptive signs of pregnancy C. Probable signs of pregnancy D. Negative signs of pregnancy E. None of the above

451 C. Abdominal enlargement, changes in the servix, hegar's sign, goodell's sign, braxton hick's contractions, ballottement, physical outlining of fetus in the uterus and positive pregnancy test are the probable evidence of pregnancy.

Immunization during pregnancy may be given except the one which is absolutely contraindicated is: A. Tetanus B. Rubella C. Hepatitis B D. Poliomyelitis E. Cholera

452 B. Vaccines contraindicated for pregnant women are MMR and varicella.

A 27 year-old, G2P1, 41 weeks AOG was admitted in labor. Fundic height was measured at 30cms with good fetal heart tone. Cervix is 4cm dilated, not effaced, station -1. About 1 hour after admission, IE findings remained the same. What would be the most appropriate thing to do? A. deliver the baby by CS B. observe and evaluate C. give oxytocin drip to augment labor D. ask patient to walk around to hasten labor E. do amniotomy

453 B. The parturient is in the active stage of normal labor. Monitoring, observation is the only appropriate thing to do.

Seven minutes after a normal delivery under pudendal anesthesia, the patient has not completed the third stage of labor. The uterus is discoid and firm, no bleeding is evident. You should: A. Manually remove the placenta B. Pull the cord vigorously C. Invert the uterus D. Gently massage the uterus and wait E. Remove placenta from inverted uterus

454 D. The length of the third stage itself is usually 5-15 minutes. Expectant, or physiologic, management involves waiting for the typical signs of placental separation such as fundal rise, a gush of blood, and lengthening of the umbilical cord, then allowing the placenta to deliver spontaneously.

In vaginal delivery for breech presentation, the forceps of choice in delivery of the aftercoming head is: A. Kielland B. Simpson's C. Piper's D. Tucker-Mclane E. Barton

455 C. Piper's forceps is used in the delivery of the aftercoming head in a vaginal delivery for breech presentation. Simpson forceps is the most common forceps to deliver babies with molded head in nulliparas. Tucker-Mclane is used to deliver babies with rounded head in multiparas. Kielland forceps is ideal for rotating the head with occiput transverse. Barton forceps is used for rotation of the head in transverse arrest.

A 30 year-old, who just delivered a healthy male neonate, had fever, hypogastric pain and odorous vaginal discharge. Infection developed is most likely in the form of: A. Vaginitis B. Salpingitis C. Pelvic abscess D. Endometritis E. Peritonitis

456 D. Endometritis is a uterine infection with polymicrobial cause. Fever is the most important in 2-3 days postpartum associated with abdominal pain and malodorous lochia.

A 26 year-old female with past history of gonococcal infection was seen at the Emergency Room due to moderate to severe lower abdominal pain associated with intermittent vaginal spotting about 6 days duration. Her LMP was 6 weeks prior. Your initial diagnosis is: A. ectopic pregnancy B. ruptured ovarian cyst C. endometriosis D. recurrent gonorrhea E. salpingitis

457 A. Ectopic pregnancy is the implanation of trophoblast other than the endometrium of the uterine cavity. The most frequent site is ampulla of the fallopian tube. Clinical manifestations begin at 6-8 weeks with the triad of amenorrhea, vaginal bleeding and abdominal pain.

A 32 year-old, G1P0 at term suddenly had severe continuous low abdominal pain and tenderness associated with hypotension, tachycradia and nonreassuring fetal heart tone. She is most probably having: A. Start of labor B. Placenta previa C. Abruptio placenta D. Amniotic fluid embolism E. Uterine rupture

458 C. Abruptio placenta is usually a 3rd trimester painful bleeding with crampy abdominal pain in a patient with hypertension or a history of trauma. Stabilization of the mother and immediate delivery of the fetus is warranted.

Overriding of the fetal skull bones in x-ray at term is: A. Halo sign B. Spalding sign C. Indicates fetal prematurity D. Possible cephalopelvic disproportion E. No significance

459 B. Spalding sign is the overlapping of fetal skull bones, a radiographic evidence to establish fetal death.

A 27 year-old woman who has been amenorrheic for 12 weeks has an elevated serum HCG titer. D&C was performed on the patient due to an incomplete abortion. Pathology report was available describing a generalized trophoblastic proliferation, hydropic villi without blood vessels and fetal parts. Diagnosis is most likely: A. Choriocarcinoma B. Partial mole C. Complete mole D. Incomplete abortion E. Complete abortion

460 C. Complete mole is a dyspermic fertilization of an empty egg by one normal sperm. It is characterized by severe trophoblastic hyperplasia, hydropic or swollen chorionic villi and absent fetus and blood vessels.

A 3 year old child was noticed by her mother to frequently scratch her vulva. On examination, labia minora adheres in the midline with a translucent vertical line. What is the treatment? A. topical androgen B. topical combined estrogen and progesterone C. topical progesterone D. Topical estrogen E. Topical steroid

461 D. this is a case of adhesive vulvitis, in which the treatment is topical estrogen

A 32 year old G2P2 mother is on her 2nd week postpartum. She noticed vaginal secretions that are pinkish in color. What do you call this secretions? A. Lochia alba B. Lochia rubra C. Lochia serosa D. Normal secretions E. None of the choices

462 C. The 3 types of secretions during puerperium are as follows: lochia rubra - red color on days 1-3 postpartum; lochia serosa - more pale in color or pinkish on days 4-10; and lochia alba -white to yellowish white on days 10 to 4-8 weeks postpartum.

In preparation for labor, the uterus has increased responsiveness to uterotonins and increased contractility which is mediated primarily by: A. estrogen B. progesterone C. Beta HCG D. glycosaminoglycans E. Prostaglandins

463 A. In preparation for labor, estrogen is the principal mediator, while progesterone level decreases

It is defined as menstrual cycle occuring every >35days with normal flow. A. oligomenorrhea B. polymenorrhea C. hypomenorrhea D. menorrhagia E. Metrorrhagia

464 A. oligomenorrhea is defined as menstrual cycle occuring every >35 days with normal flow, while polymenorrhea is every <21 days. Hypomenorrhea is scanty menstruation, while menorrhagia is excessive heavy menstruation. Metrorrhagia is any bleeding between normal menses.

The nerve supply of suprapubic area comes from: A. Ilioinguinal nerve B. Iliolumbar nerve C. Iliohypogastric nerve D. Obturator nerve E. Pudendal nerve

465 C.

The following are the major criteria for polycystic ovarian syndrome: A. Chronic anovulation B. hyperandrogenemia C. Insulin resistance D. All of the above E. Only A and B

466 E. the major criteria for PCOS are chronic anovulation, hyperandrogenemia and exclusion of other causes. Insulin resistance is one of the minor criteria.

Round ligament is continuous with the broad ligament and extends from the lateral portion of the uterus. In relation to the oviducts, it is located: A. Below and posterior to origin of the oviducts B. Below and anterior to origin of the oviducts C. above and anterior to origin of the oviducts D. above and posterior to the origin of oviducts E. lateral to the origin of the oviducts

467 B. roud ligament arises below and anterior to the origin of the oviducts

A 55 year old nulligravid presents with amenorrhea for 6 months followed by irregular vaginal bleeding. Endometrial sampling done which shows complex hyperplasia with atypia. What is your management? A. Total abdominal hysterectomy with bilateral salpingo-oophoectomy B. high dose progestin C. hysterectomy D. progestin E. repeat endometrial sampling after 3 months

469 C. this is a case of endometrial hyperplasia. The management depends on the age, cytologic atypia and type of hyperplasia. In patients with complex hyperplasia with atypia in menopausal women, the management is hysterectomy, while for premenopausal women, it is high dose progestin.

What is the method used in breech delivery if the entire body is extracted by the doctor? A. Spontaneous breech delivery B. Total breech delivery C. Partial breech delivery D. Internal podalic version E. External cephalic version

470 B. When the entire body is extracted by the doctor, it is total breech delivery; it is partial if breech is delivered spontaneously as far as umbilicus, but the remainder of the body is assisted; it is spontaneous if the baby is expelled entirely without any traction other than support.

A 35 year old G5P5 smoker, hypertensive mother at 34 weeks AOG presents with vaginal bleeding associated with crampy abdominal pain. Upon abdominal palpation, there's extreme tenderness. What is your primary consideration? A. Placenta previa B. Placenta accreta C. Placenta abruptio D. vasa previa E. normal labor

471 C. painful vaginal bleeding after 20 weeks AOG with abdominal or uterine tenderness supports the diagnosis of abruptio placenta. Hypertension, multiparity, advanced age, and smoking are risk factors of abruptio placenta. Placenta previa on the other hand, will present with painless vaginal bleeding.

What is the most common type of cervical cancer? A. Squamous type B. adenocarcinoma C. squamoadenocarcinoma D. Transitional type E. None of the choices

472 A.

A 38 year old female presents with dysmenorrhea and heavy vaginal bleeding. Upon examination, you noted a diffusely enlarged uterus approximately 2x its normal size. What is your diagnosis? A. Endometriosis B. Pregnancy C. Myoma D. Adenomyosis E. none of the choices

473 D. adenomyosis is usually symptomatic, however it is symptomatic in women >35 years old presenting with dysmenorrhea and menorrhagia with classice pelvic exam of diffusely enlarged uterus 2-3x larger.

In the ovarian-endometrial cycle, what is responsible in the regulation of granulosa cells proliferation and differentiation as primary follicles grow? A. Transforming Growth Factor-beta B. Growth differentiation factor 9 C. Insulin-like growth factor D. vascular endothelial growth factor E. epidermal growth factor

480 B. GDF 9- regulates proliferation and differentiation of granulosa cells; TGF-beta - regulates extracellular matrix; epidermal growth factor - stimulates stromal cell differentiation; vascular endothelial growth factor modulates angiogenesis; IGF I and II - differentiation of endometrium.

What is the single most important risk factor for the development of uterine infection? A. Duration of labor B. Route of delivery C. Duration of membrane rupture D. Number of internal vaginal examination

481 B. Cesarean section is the single most significant risk factor for post-partum infections.

Intake of oral contraceptive pills increases which type of cancer? A. cervical B. endometrial C. breast D. Ovarian

482 A. Studies show that the use of OCPs lead to a 2x increase in cervical cancer even when confounding factors such as age at first intercourse, number of sexual partners, exposure to HPV, cytologic screening, and the use of barrier methods were excluded. Some references say that this is due to OCPs effect in everting the transformation zone.

The following are known sequelae for babies of HBV-infected mothers, EXCEPT: A. Low birth weight B. Prematurity C. Congenital malformations D. There is no exception

483 C.

A sexually active female presents with a beefy red lesion with granulation tissue on her vulva. Which is the most likely diagnosis? A. chancre B. chancroid C. granuloma inguinale D. LGV

484 C. Granuloma inguinale or donovanosis is caused by Klebsiella granulomatis. Chancre is a painless ulcerated lesion of primary syphilis. Chancroid is a painful genital ulcer of H. ducreyi. LGV presents with buboes or enlarged, tender lymphnodes.

A prostitute presents at the emergency room with recurrent fever, foul smelling vaginal discharge and hypogastric pain. The gold standard to diagnose the most likely disease of this patient is: A. ultrasound B. laparoscopy C. laparotomy D. endometrial biopsy

485 B. The gold standard for the diagnosis of acute PID is laparoscopy.

How long does it take for the sperm to reach the egg during intercourse? A. 1 minute B. 30 minutes C. 6 hours D. 24 hours

486 B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE. References say that the travel of the sperm from the vagina to reach the egg would take around 15-30 minutes.

At 20 weeks AOG, the fundus of the gravid uterus can be palpated: A. At the level of the symphysis pubis B. Midway between the symphysis pubis and umbilicus C. At the level of the umbilicus D. Within the pelvic cavity

487 C. 12 weeks AOG is at the level of the symphysis pubis, 16 weeks is midway between the symphysis pubis and umbilicus.

A patient at the OPD consulted for post-coital bleeding associated with foul-smelling discharge. On internal exmaination, the cervix is converted to a 5x5 cm nodular and friable mass with no extension to the vagina. The corpus is small. On rectovaginal examination, there was involvement of the parametria. What stage is she in? A. Cervical cancer stage 1B B. Cervical cancer stage 2B C. Cervical cancer stage 3B D. Cervical cancer stage 4B

488 B. Involvement of the parametria is the key phrase for stage 2B. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE. Study the recent FIGO staging.

The pathognomonic symptom of menopause is: A. Hot flushes B. Cessation of menses C. Atrophic vaginitis D. Osteoporosis

489 A. The rest of the choices are also symptoms of menopause.

A 7-year-old girl is seen by her pediatrician for left lower quadrant pain. You identified an ovarian tumor by ultrasound. Of the following, the most common ovarian tumor in this age group is? A. Dermoid cyst B. Germ cell tumor C. Fibrosarcoma D. Papillary serous adenoma

490 B. Germ cell tumors are more likely in the pediatric age group. Dermoid cysts or mature teratomas are more likely in the young adult.

The drug of choice for a patient complaining of dyspareunia, severe cyclical dysmenorrhea and infertility is: A. estrogen B. estrogen with progesterone C. leuprolide D. danazol

491 C. GnRH antagonists are the drug of choice for endometriosis.

A pre-eclamptic patient on prolonged labor has vaginal bleeding accompanied by non-reassuring fetal heart rate pattern. Which is the most likely complication which occurred? A. Placenta previa B. Uterine rupture C. Vasa previa D. Abruptio placenta

492 D. Preeclamptic patients are at risk for developing abruptio placenta.

A syndrome of multiple congenital anomalies including microcephaly, small palpebral fissues, short nose, cleft lip and plate and CNS abnormalities can be see if the mother, during pregnancy: A. Drinks alcohol B. Smokes cigarettes C. Takes phenytoin D. Is diabetic

493 A. This is a classic case of fetal alcohol syndrome.

A 32-year-old G4P3 underwent suction curettage for hydatidiform mole. A chest xray was done revealing essentially normal findings. beta-HCG levels were high. Which is the most appropriate next step? A. Do a hysterectomy B. Monitor beta-HCG levels C. Give methotrexate prophylaxis D. Advice EMACO therapy

495 B. A similar trophoblastic disease question was asked during our board exam. Methotrexate prophylaxis can be considered for high-risk patients (e.g. Metastasis to other organs).

Depot medroxyprogesterone acetate can cause: A. Irregular menstrual bleeding B. Immediate fertility resumption C. Weight loss D. Infertility

496 A. Some disadvantages of DMPA include irregular menstrual bleeding, delay in fertility resumption and weight gain.

The phase normally comprising 95% of pregnancy is: A. Phase 1 B. Phase 2 C. Phase 3 D. Phase 4

497 A. Phase 1, which composes 95% of pregnancy, is characterized by maintenance of cervical anatomical and structural integrity.

A 35-year-old primigravid at 36 weeks AOG consulted for her prenatal care. She complained that her abdomen seems to be smaller and she feels as if "the baby dropped". This is termed as: A. descent B. engagement C. lightening D. Labor progression

498 C.

A 45-year-old G6P6 consulted at the OPD with a finding of LSIL in her Papsmear. The next step in the management of her case is: A. Total hysterectomy with bilateral salpingo- oophorectomy B. conization C. observation D. Colposcopy

499 D. Colposcopy is a diagnostic procedure to closely examine the cervix. This is the next step in order to evaluate an abnormal finding in papsmear.

The presence of a uterus and fallopian tubes in an otherwise phenotypically normal male is due to: A. Lack of mullerian-inhibiting factor B. Lack of testosterone C. Increased levels of estrogen D. Presence of ovarian tissue

500 A. The default sex is female, hence without the mullerian-inhibiting factor, the female internal organs would develop despite the predominant presence of testosterone.

This provides surgical access to the peritoneal cavity: A. Anterior fornix B. Right lateral fornix C. Left lateral fornix D. Posterior fornix E. All of the above

501 D. Topnotch handouts: posterior fornix- for culdocentesis

A 3 year old little girl was brought to the ER because of perineal discomfort and yellowish vaginal discharge. You suspect rape. During the first coitus, which part of the hymen would most likely rupture first? A. 12 o' clock position B. 3 o' clock position C. 6 o' clock position D. 9 o' clock position E. none of the above

502 C. Topnotch handouts

Which of the following is not true regarding perineal body? A. It anchors the anorectum and the vagina. B. It helps maintain urinary and fecal continence. C. It provides physical barrier between the vagina and rectum. D. It prevents expansion of the urogenital hiatus. E. None of the above.

503 E. also prevents expansion of the urogenital hiatus

This segment of the uterine tube is the widest and most tortuous. This is the most common site of occurrence of ectopic prenancy: A. Intramural B. Interstitial C. Isthmus D. Ampulla E. Infundibulum

505 D. Intramural/Interstitial- within muscular wall; ectopic pregnancy here result in severe maternal morbidity Isthmus-narrowest portion; preferred portion for BTL Infundibulum - fimbriated extremity; funnel-shaped opening of the distal end of the fallopian tube

This is the shortest distance between the promontory of the sacrum to the lower margin of the symphysis pubis that can be measured clinically. A. True conjugate B. Obstetrical conjugate C. Diagonal conjugate D. All of the above E. None of the above

506 C. diagonal conjugate has to >11.5cm to be adequate

This is the male homologue of the vagina: A. Prostate gland B. Prostatic utricle C. Bulbourethral gland D. Seminal colliculus E. Penis

507 B. A. Prostate gland - Skene's glands B. Prostatic utricle - vagina C. Bulbourethral gland- greater vestibular glands D. Seminal colliculus-hymen E. Penis - clitoris

A 6 year old girl was incidentally found to have a cystic right adnexal mass measuring 4 cm. What course of management should you advise the mother of patient? A. Observe for 8-12 weeks B. Do exploratory laparotomy C. Reassure mother D. Do serial Transabdominal ultrasound E. Do scout film of the abomen

508 B. Exploratory laparotomy is advised in premenarchal patients with adnexal mass >2cm. -topnotch handout

The following are definitive evidence of prenancy, except: A. Identification of fetal heart action. B. Perception of fetal movement by the doctor. C. Recognition fetus by sonographic exam. D. Beta- HCG titer of more than 1500 IU/L E. None of the above

509 D.

CTG tracing showed mirror images of uterine contractions and fetal heart rate deceleration. What caused this pattern? A. Fetal movement B. Head compression C. Umbilical cord compression D. Uteroplacental insufficiency E. Any of the above

510 B. Early decelerations- head compression Variable decelerations- umbilical cord compression Late deceleration-Uteroplacental insufficiency

Marcia 21 year old G1P0 14 weeks AOG was rushed to the hospital because of vaginal bleeding, watery vaginal discharge and hypogastric pain. Examination revealed cervix to be 4 cm dilated with no fetal cardiac activity on ultrasonography. What is your impression? A. Threatened abortion B. Inevitable abortion C. Complete abortion D. Incomplete abortion E. Missed abortion

511 B. Inevitable or imminent abortion

Maria, 19 year old G1P1, previously treated for PID 2 years ago was brought in the hospital because of severe hypogastric pain and vaginal spotting consuming 3 pads per day, lightly soaked. History revealed delayed menses for 3 weeks now. What is the gold standard procedure for the diagnosis of Ectopic pregnancy? A. Quatitative serum B-HCG B. Sonography C. Laparotomy D. Laparoscopy E. Culdocentesis

512 D.

The 3rd stage of labor includes the period from fetal delivery to placental expulsion. What does Calkin sign refer to? A. Uterus become globular and firmer B. Sudden gush of blood C. Uterus rise in the abdomen D. Lengthening of the umbilical cord E. None of the above

513 A. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE:all refer to the signs of placental separation

What is the therapeutic level of Magnesium sulfate? A. 5 mEq/L B. 10 mEq/L C. 12 mEq/L D. >15 mEq/L E. 30-35 mEq/L

514 A. SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE: 4-7 mEq/L-therapeutic level; 10 mEq/L- disappearance of patellar reflex; >12 mEq/L- respiratory depression; >15mEq/L- respiratory depression with mechanical ventilation; >30-35-cardiac arrest

This syndrome result from meiotic nondysjunction leading to 47, XXY genotype, with associated testicular atrophy, eunuchoid body shape, tall stature, long extremities, gynecomastia and female hair distribution: A. Hermaphroditism B. Klinefelter Syndrome C. Turner Syndrome D. Androgen insensitivity E. Down Syndrome

515 B.

This is the first sign of puberty in females: A. Axillary hair B. Onset of menses C. Growth spurt D. Breast bud formation E. None of the above

516 D. Thelarche or breast bud formation is the first sign of puberty in females

This syndrome is characterized by hypothalamic- pituitary dysfunction caused by congenital absence of GNRH associated with anosmia: A. Savage Syndrome B. Kallman Syndrome C. Turner Syndrome D. Premature ovarian Failure E. None of the above

517 B. Kallman Syndrome- Hypogonadotropic hypogonadism characterized by isolated gonadotropin deficiency associated with anosmia

Shally is a 37 year old G2P2 who came in to your clinic because of absence od menses for the last 8 months. Her mother had her menopause at age 39. What is the most probable diagnosis of Shally's condition? A. Asherman syndrome B. Premature ovarian failure C. Polycystic Ovarian Syndrome D. All of the above E. None of the above

518 B. Asherman syndrome- intrauterine adhesion with history of previous endometrial curettage Premature ovarian failure- cessation of ovarian function before age 40

What is the treatment of choice for hot flushes of menopause? A. Progesterone supplement B. Leuprolide C. Estrogen D. Calcium + vitamin D E. DEXA

519 C.

A 19 year old primigravid at 40 weeks AOG undergoes fetal heart monitoring. Pregnancy has been uncomplicated. External monitoring shows a baseline heart rate of 140 bpm with good variability; over a period of 30 minutes, the rate increases twice to 160 bpm for 25 to 30 seconds. Which of the following is the most appropriate step in management? A) Reassurance B) Biophysical profile C) Oxytocin challenge test D) Induction of labor

521 A.

A 32 year old G2P1 at 40 weeks AOG is brought to the ER by her husband because she has been confused for 45 minutes. Her husband says that she has been in labor for 3 days at home, and she has received all her prenatal care from an alternative provider. On arrival, she is obtunded. Her pulse is 140 bpm, and palpable systolic blood pressure is 60 mmHg. Abdominal examination shows distention and rigidity and a 25-cm irregular, mobile mass in the upper right quadrant. The cervix is 3 cm dilated and 50% effaced. Which of the following is the most likely cause of these findings? A) Coagulopathy B) Uterine rupture C) Endomyometritis D) Uterine atony

522 B.

A previously healthy 23 year old G2P1 at 32 weeks AOG comes to the physician because of urinary urgency and pain with urination or 3 days. Her pregnancy has ben uncomplicated. Examination shows a uterus consistent in size with a 32 week gestation. There is mild suprapubic tenderness but no costovertebral angle tenderness on palpation. Urinalysis reveals numerous WBCs and RBCs and 3+ bacteria. The patient is at greatest risk for which of the following? A) Chorioamnionitis B) Renal failure C) Pyelonephritis D) Abruption placentae

523 C.

A 32 year old woman comes for follow-up examination 1 week after a Pap smear showed a high-grade squamos intraepithelial lesion. Examination shows no abnormalities. Which of the following is the most appropriate next step in management? A) Trichloroacetic acid therapy B) Colposcopic-direct biopsy C) Cone biopsy of cervix D) Repeat Pap smear

524 B.

An 82 year old woman comes to the physician because of a 9 month history of progressive urinary incontinence. At least once daily, she has a strong urge to void, is unable to reach a bathroom in time, and spontaneously passes a large amount of urine. She had a mild cerebral infarction 2 years ago with no residual weakness. She has severe arthritis of her knees and hips, which severely limits her mobility. Current medications include lovastatin and aspirin. Examination, including pelvic examination, shows no abnormalities. Which of the following is the most likely explanation for this patientâ€™s incontinence? A) Detrusor hyperactivity B) Intrinsic weakness of the urethral sphincter C) Poor pelvic support D) Outflow obstruction

525 A.

An 18-year-old primigravid woman comes for her initial prenatal visit at 16 weeks' gestation. She is not sure about the date of her last menstrual period but says that the pregnancy probably occurred immediately after she stopped taking oral contraceptives 5 months ago. Maternal serum Î±- fetoprotein (MSAFP) level is increased to 3 multiples of the median. Which of the following is he most appropriate next step in management? A) Repeat measurement of MSAFP level B) Triple screening for MSAFP, serum Î²-hCG, and serum estriol levels C) Ultrasonography D) Amniocentesis for measurement of Î±- fetoprotein level

526 C.

A previously healthy 87-year-old woman comes to the physician because of a 4-month history of vulvar itching. Examination shows excoriated areas from scratching and a white, thin vulva. The labia minora are absent, and there are small fissures at the introitus. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis? A) Lichen planus B) Lichen sclerosus C) Squamous cell carcinoma D) Atrophic vaginitis

527. B..

Four hours after undergoing a cesarean delivery at term followed by tubal ligation, a 37-year-old woman, gravida 2, para 2, has dizziness and confusion. The operation was uncomplicated, and blood loss is estimated to be 800 mL. Patient- controlled epidural analgesia has been moderately effective for pain. Her blood pressure now is 80/40 mm Hg, decreased from 120/72 mm Hg intraoperatively, and pulse is 152/min, increased from 96/min intraoperatively. Breath sounds are decreased bilaterally. No murmurs are heard. Abdominal examination shows distention and tenderness. Bowel sounds are absent. The incision is intact with no drainage. She is disoriented to person, place, and time. Her hematocrit is 23%; preoperative hematocrit was 35%. Which of the following is the most likely cause of the hemodynamic changes? A) Epidural-related hypotension B) Insufficient intraoperative fluid replacement C) Postoperative intra-abdominal hemorrhage D) Supine hypotensive syndrome

528 C.

A healthy 24-year-old woman comes for a routine health maintenance examination. Menses occur at regular 28-day intervals and last 5 to 6 days. Her last menstrual period was 3 weeks ago. She takes no medications. Bimanual examination shows a 5- cm, mildly tender left adnexa. A pregnancy test is negative. Which of the following is the most appropriate next step in management? A) Repeat examination in 2 weeks B) Measurement of serum CA 125 level C) Measurement of serum Î±-fetoprotein level D) CT scan of the pelvis

529 A.

A 32-year-old woman at 38 weeks' gestation comes for a routine prenatal visit. During routine screening at 28 weeks' gestation, she tested positive for hepatitis B surface antigen. Her pregnancy has been otherwise uncomplicated. Examination shows a uterus consistent in size with a 38-week gestation. Which of the following measures is most likely to decrease the risk for hepatitis B infection in her newborn? A) Recommendation of bottle-feeding rather than breast-feeding B) Maternal administration of hepatitis B immune globulin (HBIG) now C) Neonatal administration of HBIG after delivery and hepatitis B vaccine at 3 months of age D) Neonatal administration of HBIG and hepatitis B vaccine immediately after delivery

530 D.

Five weeks after vaginal delivery of a healthy full- term newborn, a 22-year-old woman, gravida 1, para 1, is brought to the physician by her mother because of depressed mood for 2 weeks. Her mother is concerned that her daughter is not able to take care of her infant. Physical examination shows no abnormalities. She is quiet and tearful and does not engage in conversation easily. She states that she lives alone with her infant and has had thoughts of suicide and infanticide. Which of the following is the most appropriate next step in management? A) Reassurance B) Long-term outpatient counseling C) Admission to the hospital for treatment D) Selective serotonin reuptake inhibitor therapy

531 C. thoughts of suicide and infanticide >> indications for hospitalization

A 23-year-old woman has pain, cramping, and swelling of the right calf 3 days after an uncomplicated labor and delivery. The right foot is swollen, and there is marked tenderness with dorsiflexion and palpation of the right calf. Examination shows no other abnormalities. A complete blood count and serum electrolyte levels are within normal limits. Which of the following is the most likely cause of this condition? A) Hypercoagulable state of pregnancy B) Hyperuricemia C) Peripheral artery aneurysm D) Platelet embolus

532 A.

A 28-year-old nulligravid woman comes for a routine health maintenance examination. She has had progressively severe dysmenorrhea over the past 6 months adequately controlled by nonsteroidal anti-inflammatory agents. Pelvic examination shows a normal vagina and cervix. The uterus is retroverted and fixed, and there is nodularity of the cul-de-sac. A 6-cm left adnexal mass is palpated. Transvaginal ultrasonography shows a 7-cm septated adnexal mass. Four weeks later, there is no change in the size of the adnexal mass. Which of the following is the most appropriate diagnostic test? A) Measurement of serum CA 125 level B) Laparoscopy C) CT scan of the pelvis D) MRI of the pelvis

533 B.

A 32-year-old woman, gravida 2, para 2, comes to the physician because she has been amenorrheic for 4 months. Examination shows a well- estrogenized vagina and no evidence of virilization or other abnormalities. A serum pregnancy test is negative. She is given medroxyprogesterone and has the onset of bleeding 3 days later. Which of the following is the most likely cause of her condition? A) Anovulation B) Asherman's syndrome C) Hypopituitarism D) Premature ovarian failure

534 A. (+) Progestin challenge test >> anovulation

A healthy 37-year-old primigravid woman at 12 weeks' gestation comes for a routine prenatal visit. The pregnancy was achieved by in vitro fertilization. She does not use tobacco, alcohol, or drugs. She is a hematologist and works 10 to 12 hours daily. Two previous ultrasonographies have shown a triplet gestation. She weighs 66 kg (145 lb) and is 178 cm (70 in) tall. Her blood pressure is 116/70 mm Hg, and pulse is 72/min. Examination shows a uterus consistent in size with a 16-week gestation. Her pelvis is normal-sized. This patient is at greatest risk for which of the following? A) Abruptio placentae B) Hepatitis B C) HIV infection D) Preterm labor

535 D.

A 30-year-old woman, gravida 2, para 1, is brought to the emergency department in labor. An episiotomy is performed. Following delivery of the head, the shoulders do not follow with the usual traction and maternal pushing. Which of the following is the most appropriate next step in management? A) Flexing the woman's knees toward her shoulders B) More forceful traction and fundal pressure C) Delivering the posterior arm D) Symphysiotomy

536 A.

A 13-year-old girl is brought for a well-child examination. Menses have occurred every other month since menarche 10 months ago. Her last menstrual period was 1 week ago. She is not sexually active. Sexual development is Tanner stage 3. Examination shows no abnormalities. Which of the following is the most appropriate next step in management? A) Discussion of pregnancy prevention B) Measurement of serum luteinizing and follicle- stimulating hormone levels C) Urine Î²-hCG test D) Pelvic examination

537 A.

A 52-year-old woman comes to the physician because of decreased libido; this symptom began 8 months ago, after she underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for leiomyomata uteri and menorrhagia. She has been taking hormone replacement therapy with conjugated estrogen since the operation. Examination shows a moist, rugated vagina. Which of the following is the most likely cause of these findings? A) Decreased androgens B) Decreased estrogen C) Decreased follicle-stimulating hormone (FSH) D) Decreased luteinizing hormone (LH)

538 A.

A 38-year-old woman, gravida 2, para 1, at 38 weeks' gestation has had no fetal movement for 36 hours. Her prenatal course, prenatal tests, and fetal growth have been normal. Fetal heart tones are heard by Doppler. Which of the following is the most appropriate next step in management? A) Routine prenatal visit in 1 week B) Maternal hydration C) Nonstress test D) Immediate induction of labor

539 C.

A 22-year-old primigravid woman at 16 weeks' gestation is brought to the emergency department because of progressive shortness of breath over the past 48 hours. Her temperature is 37 C (98.6 F), blood pressure is 120/70 mm Hg, pulse is 100/min, and respirations are 24/min. Scattered wheezes are heard. Pelvic examination shows a uterus that extends to the umbilicus. Her hematocrit is 32%, leukocyte count is 11,000/mm3, and serum Î²-hCG level is 300,000 mIU/mL. Pulse oximetry on room air shows an oxygen saturation of 92%. An x-ray film of the chest shows multiple round densities throughout all lung fields. Which of the following is the most likely diagnosis? A) Bacterial pneumonia B) Choriocarcinoma C) Pulmonary embolism D) Tuberculosis

540 B. cannon ball lesions

Which of the following bears the greatest risk for ectopic pregnancy? A. Previous ectopic pregnancy B. Tubal corrective surgery C. Infertility D. Previous genital infection E. Prior Abortion

541 A.

The appearance of stromal nodules in the prostate occurs in the: A. 2nd decade of life B. 3rd decade of life C. 4th decade of life D. 5th decade of life E. 6th decade of life

542 C.

A hot flush is usually followed by A. increased digital perfusion B. increased peripheral skin temperature C. decreased LH D. decreased HR E. decrease in cortisol

543 B.

A 46 year old asymptomatic patient is found to have an 8 week size irregular myomatous uterus. The best management would be: A. administration of GnRH analogues B. reevaluation in 6 to 12 months C. fractional dilatation and curettage D. myomectomy E. hysterectomy

544 E.

Correct use of lactation amenorrhea EXCEPT A. Mother must breast feed day and night B. Baby is more than 6 months old C. Mother has not started menses D. Infant must receive at least 85% of feeding as breastfeeding E. None of the above

545 B. The use of lactation amenorrhea must first fulfill 3 criteria: exclusive or almost exclusively breastfeeding, have not had menses since giving birth, and mother should be less than 6 months post-partum.

A 28 year old patient G2P1 (1001) 39 weeks AOG CIL, is undergoing contraction stress test. You note that there are fetal heart rate decelerations that occur in the presence of contractions lasting longer than 90 seconds. You interpret this as: A. Negative CST B. Positive CST C. Equivocal-suspicious D. Equivocal-hyperstimulatory E. Unsatisfactory

546 D.

The most common cause of benign vaginal bleeding among post menopausal women is: A.) leiomyosarcoma B.) Atrophic vaginitis C.) foreign body vaginitis D.) infectious vaginitis

569 B.

Which of the following INCORRECTLY describes the perineum? A. The pelvic diaphragm consists of the levator ani muscles plus the coccygeus muscles posteriorly. B. The levator ani muscles form a broad muscular sling that originates from the posteriorsurface of the superior pubic rami, from the inner surface of the ischial spine, and between these two sites, from the obturator fascia. C. The major blood supply to the perineum is via the internal pudendal artery and its branches. These include the posterior rectal artery and inferior labial artery. D. The innervation of the perineum is primarily via the pudendal nerve and its branches. The pudendal nerve originates from the S2, S3, and S4 level of the spinal cord.

547 C. there is no posterior rectal and inferior labial arteries. Its supposed to be inferior rectal and posterior labial

A 34 year old G2P1 (1001) patient on her 28th week APG came in at the OBAS for consult. She was referred from the OPD due to BP of 140/90. According to the patient, she has been diagnosed with hypertension since she was 32 yo. Her stat albumin is (-). the diagnosis is A. Gestational Hypertension B. Chronic Hypertension C. Preeclampsia, mild D. Preeclampsia, severe E. Eclampsia

548 A.

L.Q. a 28 yo nulligravid, desirous of pregnancy, presents with 7x4x3 cm myomatous growth by UTZ. She is symptomatic with intermittent colicky hypograstric pain but with no menstrual disturbance. What would be the best management for her? A. hysterectomy B. Myomectomy C. Observation D. Conceptual trial E. Pain relievers

549 B.

Aside from health benefits, the use of OCP has been proven to reduce the incidence of: A. thromboembolic events B. Colon CA C. Benign Breast D. Endometrial CA E. Cervical Ca

550 D.

R.L. 36 year old G1P1 (1001) is 2 weeks post partum. She consults her physician for tenderness of the breast on the upper outer quadrant of the left breast. On Physical examination, it was noted erythema and warmth on the area. Which of the following conditions most likely explains her problem? A. breast abscess B. nipple trauma C. breast cyst D. acute mastitis E. inflammatory breast ca

551 D.

A 32 yo primigravid on her 34th wk AOG came to your clinic for lots of spider veins in the abdomen. What would you advice her? A. she has to have liver function test done to rule out liver disease B. refer her to dermatology for further work-up and evealuation C. This is normal during pregnancy and resolves spontaneously after delivery D. she needs abdominal support to relieve pressure E. Work up for possible liver disease

552 C.

Which of the following is NOT a documented outcome of uncontrolled thyrotoxicosis in pregnancy? A. Preeclampsia B. Preterm delivery C. Still Birth D. Neonatal Goiter

553 D.

A 34 yo G2P1 came to OBAS for labor pains. She has no records of prenatal check-up and was noted to have BP elevations during her 3rd preganancy. She gives you an AOG based on LNMP of 33 wks and 6 days. On PE: BP 160/90 with grade I bipedal edema. Urinalysis reveals albumin +1. On IE, she has a patulous cervix with hard ballotable mass. What is your admitting impression? A. PU 33 6/7 by LNMP, cephalic, NIL, preeclampsia, mild B. PU 33 6/7 by LNMP, cephalic, NIL, chronic HPN w/ superimposed preeclampsia C. PU 33 6/7 by LNMP, cephalic, NIL, gestational HPN D. PU 33 6/7 by LNMP, cephalic, NIL, gestational HPN w/ superimposed preeclampsia E. PU 33 6/7 by LNMP, cephalic, NIL, chronic hypertension

555 A.

A 29 year old female G2P1 (1001) experiences biliary colic for the past 1 week. She is diagnosed to have acute cholecystitis. How do you treat this case? A. Treat as if the patient is not pregnant B. Wait until the fetus is viable then perform surgery C. Medical management and perform intervention after delivery D. Delay treatment and perform surgery at second trimester

556 C.

A 26 year old G1P0 PU 39 weeks AOG CIL, is noted to have a BP of 160/100. You have managed the hypertension by give hydralazine. The next step is toprevent eclampsia by giving magnesium sulfate. How will you administer magnesium sulfate in this patient? A. Loading dose of 4g IV and 5g on each buttock then 5g in alternating buttock every 4 hours to complete a cycle of 24 hours B. Loading dose of 4g IV and 5g on each buttock then 5g in alternating buttock every 4 hours upto 24 hours post delivery C. Loading dose of 4g IV and 5g on each buttock then 5g in alternating buttock every 4 hours until delivery D. Loading dose of 4g IV then 5g in alternating buttock every 4 hours until delivery

557 B.

A 38y y.o. G7P5 came in a stretcher. She appears to be pale, incoherent with cold, clammy extremities. There is note of profuse vaginal bleeding. History from the husband: came from a lying-in clinic where the midwife performed fundal pressure. Rigid abdomen, (-) FHT. What could the patient have? A. Bleeding placenta previa B. Abruptio placenta with full blown DIC C. Ruptured vasa previa D. Uterine rupture

558 D.

A 35 y.o. G1P0 37wks AOG with a history of chronic hypertension presents with severe abdominal pains for several hours. BP 140/90, PR 110, RR 18, T 37C, tender abdomen, cervix 4cm dilated, membranes bulging. CTG is non reactive with hypertonic contraction. Diagnosis? A. Intrauterine infection B. Normal early labor C. Ruptured uterus D. Abruptio placenta

559 D.

What is the complete obstretic score of the patient given the following history? 1. 1970 FT via SVD male, alive 2. 1971 Spontaneous abortion 15 weeks AOG 3. 1980 H. mole 4. 1985 Preterm twin gestation via SVD, both females, 1 died after 1 yr, the other, alive 5. 1986 FT via SVD male, FDU 6. 1987 Ectopic pregnancy 7. 1990 Present pregnancy A. G7P3 (1232) B. G7P3 (2132) C. G7P3 (1232) D. G7P3 (2133)

560 B.

What is the most common presenting feature of adult hypopituitarism? A. Hypogonadism B. Hypothyroidism C. Hypoprolactinemia D. Short stature

561 A. Most common feature of adult hypopituitarism even when other pituitary hormones are deficient Trophic hormone failure associated with pituitary compression or destruction usually occurs sequentially: GH>FSH>LH>TSH>ACTH Childhood: Growth retardation is often the presenting feature Adult: Hypogonadism is the earliest symptom

Most important step in the evaluation of male infertility A. Serum testosterone B. HCG stimulation test C. Semen Analysis D. Testicular biopsy

562 C.

Fetal lung maturity is expected to be completed at: A.) 28 wks AOG B.) 30 wks AOG C.) 34 wks AOG D.) 32 wks AOG

563 C.

Around the middle of the menstrual cycle, the thickening of the cervical mucus is brought about by this hormone: A.) progesterone B.) estrogen C.) oxytonin D.) FSH

564 A.

During hysterectomy, ligating this ligament would cause injury to the uterine artery, vein and ureter. A.) cardinal ligament B.) ligament of Treitz C.) Mackenrodt's ligament D.) A & B E.) A & C

565 E. Cardinal ligament aka Mackenrodtâ€™s ligament

In a fully mature fetal lung, the expected Lecithin/Sphingomyelin ratio should be at least: A.) 1.75 B.) 2.0 C.) 1.0 D.) 1.5

566 B.

Kassandra, a 38-year old G7P6 (6006) just gave birth to a healthy 2.7 kg baby boy via spontaneous vaginal delivery. The Obstetrician on duty noticed continued vaginal bleeding despite absence of any vaginal or cervical lacerations. What is the most prudent thing to do to stop the bleeding? A.) continue packing with OS B.) nipple stimulation C.) administer Oxytocin drip D.) IV fluids and vasopressors

567 C.

On endometrial biopsy, you saw saw-toothed glands, edematous stroma, prominent arterioles and glycogen vacuoles at the cell surfaces. What phase of the menstrual cycle is this? A.) Luteal B.) Proliferative C.) Secretory D.) Follicular

568 C. secretory phase of the menstrual cycle since the presence of glycogen already marks the ovulatory phase

Mary, a 32-year old non-diabetic and non- hypertensive, is currently pregnant with her second child (at 34 wks AOG) suddenly experienced non-painful vaginal bleeding while asleep. Her husband Roel, woke her up in a pool of blood and accompanied her to the nearest private hospital. Roel is anxious to know the cause of her bleeding. As the physician on duty, your primary diagnosis is: A.) abruptio placenta B.) placenta previa C.) pre-eclampsia D.) inevitable abortion

570 B.

Which of the following is responsible for production of beta HCG? A. Syncytiotrophoblast B. cytotrophoblast C. Decidua D. Endometrial glands

571 A.

What is the histologic date of an endometrium showing subnuclear vacuoles and pseudostratified nuclei? A. Day 16 B. day 18 C. Day 20 D. Day 22

572 A.

Which of the following is an expected feature in the placenta of a mother with severe preeclampsia? A. Neutrophilic infiltrates B. granulation C. Infarcts D. Chronic inflammatory pattern

573 C.

The most common predisposing factor to tubal pregnancy? A.Chronic salphingitis B. Congenital tubal defects C. Functional tubal disturbances D. Salphingitis isthmica nodosa

574 A.

As the villi of placenta mature, they begin to form vessels. At how many weeks do the villous vessels become apparent? A. 4 B. 5 C. 6 D. 7

575 C. Answer: 6 weeks

How many arteries do the umbilical cord posses? A. O B. 1 C. 2 D. 3

576 C. 2 arteries and 1 vein

Your patient comes to you 28 weeks pregnant. She asked if she can go to Tacloban by plane to visit her relatives who have been victims of the typhoon Yolanda. Till how many weeks is she considered safe to travel by air? A. 30 B. 32 C. 34 D. 36

577 D.

Strawberry cervix/colpitis macularis. What is the treatment? A. Metronidazole B. clotrimazole C. Ciprofloxacin D. Fluconazole

578 A. This is a case of trichomoniasis treated with Metronidazole

Which of the following vaccines has established evidence of causing harm to the fetus? A. Rubella B. varicella C. Measles D. Smallpox

579 D.

In the menstraul cycle, what is the earliest sign that the endometrium is in its secretory phase? A. Formation and coiling of the spiral arteries B. Decidualization of the endometrium C. Luteinization of the corpus and secretion of progesterone D. Ovum has reached the fallopian tube E. Presence of subnuclear glycogen vacuoles

582 E. Presence of basal vacuolization in the endometrium is the earliest sign of progesterone action in the endometrium. Luteinization of the corpus and ovum reaching the tubes comes before the vacoulization but are not signs that the endometrium has reached the secretory phase. They are signs that the ovaries has reached the luteal phase.

Which of the following is a presumptive symptom of pregnancy? A. Anatomic breast changes B. Perception of fetal movement C. Increased in basal body temperature D. Englargement of the abdomen E. Braxton-Hick's contractions

583 B. Anatomic breast changes and thermal signs are presumptive signs, while enlargement of the abdomen and Braxton Hick's contraction are painless and irregular.

In assessing results of fetal heart monitoring, what is the single best indicator that the fetus is well? A. Reactive Non-stress test B. Negative Contraction stress test C. Presence of accelaration D. Absence of deceleration E. Moderate variability

584 E. The presence of moderate variability (beat to beat variation) will tell us that the fetus is not compromised more than a reactive NST or negative CST.

When the fetal head is engaged, this tells us that the fetal head has pass through which narrowest diameter? A. True/Anatomic conjugate B. Obstetric conjugate C. Diagonal conjugate D. Interspinous diameter E. All of the above

585 B. The shortest and narrowest dimensions that the fetal head must pass through for engagement to occur is the obstetric conjugate. The ischial spine is at the level of the presenting part but the fetal head has not pass through it yet.

A 32 year old primigravid went to your clinic complaining of loss of perceived fetal movements. The fetus is 33 3/7 weeks AOG by early ultrasound. You did a biophysical profile (BPP) with a score of 6 with normal AFV. Lung maturity testing revealed L/S ratio of 2. What is your next step in management? A. Observe and reassure the patient B. Admit the patient and repeat BPP after 24 hours. If on repeat shows improvement, do expectant management and repeat per protocol C. Admit the patient, give Dexamethasone and repeat BPP daily. If not improving, deliver. D. Deliver immediately E. Refer to a perinatologist

586 D. Deliver immediately since we have already documented lung maturity (L/S ratio of 2) and with a BPP of 6, the fetus may be chronically asphyxiated.

Which of the following scenarios will it be LESS likely to form the pathologic retraction ring of Bandl? A. Precipituous labor B. Cephalopelvic disproportion C. Prolonged 2nd stage of labor D. Labor augmentation E. Nulliparous women

587 A. The longer is the duration of labor, the more prone is the uterus to form the pathologic band, precipituous labor would have lesser chance of having this complication.

Which of the following statements regarding multifetal gestation is TRUE? A. Fertilization of two different ova forms fraternal twins. B. Identical twinning has been known to have a hereditary basis. C. Dichorionic diamniotic twins have higher morbidity than those enclosed in one chorion. D. Ischiophagus is the most common type of conjoined twinning. E. Pregnant mothers of twins have a higher incidence of GDM than other pregnant women.

592 A. Fraternal twins have genetic basis, identical twins is an abnormal event. Dichorionic twins have the least complications. Thoracophagus is the most common form of conjoined twins. Mothers have a higher rate of preeclampsia, hypertension or premature birth than other pregnant population groups.

The following statements regarding pre-eclampsia is true EXCEPT? A. The visual disturbances of pre-eclampsia such as serous retinal detachment improves several weeks after the onset of symptoms. B. The most consistent anatomic finding in pre- eclampsia is glomerular capillary endotheliosis in the kidneys. C. The main pathogenesesis of pre-eclampsia is vasospasm and endothelial cell activation leading to increase sensitivity to vasopressors. D. Pathognomonic lesion in eclampsia is the presence of periportal hemorrhagic necrosis in the liver E. Pre-eclampsia tends to be more severe as the parity of women increases.

593 E. Being nulliparous is a risk factor for pre-eclampsia.

A mother brought her 15 year old daughter because of absence of menarche. Physical examination of the child is normal. Sexual maturity index is 3. What is your management? A. Reaasure mother and observe B. Measure FSH and LH C. Request for a transrectal ultrasound D. Karyotyping E. Cranial MRI

594 A. Reasure mother, primary amenorrhea is defined as no menses by age 16 with the presence of sexual characteristics. The patient exhibited secondary sexual characteristic and it will just be a matter of time till menarche sets in.

A couple came in your office who wants to consult regarding fertility issues. They have been trying to conceive for over a year now, however they were unsuccessful. The wife narrated that she was the eldest of 3 siblings and her mother had the same problems and was able to conceive only after 3 years of marriage with consult to a reproductive endocrinologist. Physical examination of the couple is unremarkable. What is your initial procedure in this couple's work-up for infertility? A. Do Semen Analysis B. Request for a Hysterosalpingogram C. Request for a Transvaginal ultrasound D. Do Clomiphene citrate challenge test E. Perform Laparoscopy

595 A. In any work-up of infertility, one must do a semen analysis first no matter what history the husband or wife give. Rationale: Easier to rule out a male factor than a female factor in the extensive work-up of infertility.

A 25 year old model with multiple sexual partners came to your office complaining of vaginal pruritus and discharge accompanied by intermittent pelvic pain. TVS showed normal anatomy of the uterus, oviducts and ovaries. Speculum exam was done which showed mucopurulent discharge with cervical tenderness. Gram stain revealed Gram(-) intracellular diplococci. What is your next step? A. Treat with 250 mg IM Ceftriaxone B. Treat with 1g Azithromycin C. Do Laparoscopy D. Use both ceftriazone and azithromycin E. Do surgical debridement

596 D. Treat with both, you assume there is concomittant chlamydial infection with gonorrheal PID.

Which will confer the highest risk factor for the development of cervical cancer? A. Multiple sexual partners B. HPV 6 infection C. Intercourse at an early age D. Genetic predisposition E. Exophytic mass on ectocervix

597 E. It is known that HPV infection confers the highest risk but it should be the oncogenic serotypes and the presence of a mass in the cervix will confer the highest risk for malignancy

Which ovarian tumor has a higher chance of concommitant endometrial hyperplasia? A. Serous epithelial tumor B. Endometrioid epithelial tumor C. Granulosa-theca cell tumor D. Dysgerminoma E. Meigs syndrome

598 C. Granulosa theca cell tumor are funcional and secrete estrogen, so there is a risk for endometrial hyperplasia or carcinoma.

Which parameter is not included in the Sassone criteria in diagnosis of ovarian malignancy by ultrasound? A. Inner wall structure B. Wall thickness C. Size of mass D. Septa E. Echogenicity

599 C. Size of mass is not one of the 4 criteria of Sassone scoring.

Which of the following statements is/are true regarding the normal menstrual cycle : A. It has an average blood loss of 100 ml B. The average interval between cycles is 28 days C. The average duration of flow is 7 days D. Luteal phase has a variable duration, while secretory phase is constant E. All of the above

602 B. The average interval between cycles is 28 days. A normal menstrual cycle lasts from 21 to 35 days (average of 28 days, +/- 7 days) with 2 to 6 days of flow (average of 4 days) and with a blood loss of 30 - 80 ml (average of 50 ml). Studies of large numbers of normally cycling women have shown that only approximately 2/3 of adult women have cycles lasting 21 - 35 days. Duration of luteal phase is always constant (14 days), while that of the secretory phase is variable.

A 34-year old G4P3 (3003) was sent to the OR for an emergency CS. Aftter repair of the uterus, the obstetrician noted that the left ovary has a cyst with a honeycomb appearance. The physician should: A. Do unilateral oophorectomy B. Obtain a biopsy specimen of the cyst C. Refer intra-op to general surgery for possible presence of gastric CA D. Leave the cyst and do follow-up ultrasound E. Proceed with TAHBSO

603 D. Theca-lutein cyst is common in pregnancy. It is a benign cyst that usually presents with honeycomb appearance on gross inspection. This cyst spontaneously regresses after completion of pregnancy and menstruation resumes.

A 26-year old G1P1 (1001) seeks consult for contraception. She has no co-morbidity and had no complication during her previous pregnancy. Which of the following will be most effective for this patient? A. Intra-uterine device (IUD) B. Spermicidal agent C. Condom D. Oral contraceptives E. Coitus interruptus

604 D. Method effectiveness refers to the pregnancy rate of 100 women using a particular contraceptive method correctly for 1 year (100 women-years of use). The effectiveness reflects failures due to patient misuse of the contraceptive method and is less than method effectiveness. Oral contraceptive is proven by studies to be most effective among female patients when properly used. Coitus interruptus is an unreliable contraceptive method in which the penis is withdrawn from the vagina prior to ejaculation.

Inlet contraction can be diagnosed with which of the following clinical finding: A. Obstetric conjugate of less than 11.5 cm B. Diagonal conjugate of less than 11.5 cm C. Interspinous diameter of less than 10.5 cm D. Sidewalls that are convergent E. All of the above

605 B. The obstetric conjugate is the most important anteroposterior diameter of the inlet which is the shortest distance between the sacral promontory and the mid posterior aspect of the symphysis pubis through which the fetal head must pass. It measures 10 cm or more but may be considerably shortened in abnormal pelvis. The obstetric conjugate cannot be measured directly with the examining finger. Measurement is indirectly done by getting the diagonal conjugate which is the distance between the sacral promontory and inferior margin of the symphysis pubis and subtract 1.5 to 2 cm. The diagonal conjugate length may vary depending on the height and inclination of the symphysis pubis. Therefore inlet contraction is usually defined as a diagonal conjugate of less than 11.5 cm. Obstetric conjugate in inlet contraction should be less than 10cm.

Call Exner bodies are the pathognomonic finding in? A. Sertoli-Leydig cell tumor B. Granulosa-theca tumor C. Endodermal Sinus tumor D. Struma Ovarii E. Choriocarcinoma

657 B.

Cytomegalovirus is the most common cause perinatal infection. This may be transmitted by which of the following routes : A. droplet infections B. coitus C. uteroplacental D. all of the above E. A and C only

606 D. CMV is the most common cause of perinatal infection. This is transmitted horizontally by droplet infection and contact with saliva and urine, vertically from mother to fetus, infant and as a sexually transmitted disease. Williams, 21th ed, p 1468.

A 33-year old G0 came to your clinic complaining of genital lesions. Suspecting syphilis, the most appropriate drug therapy is: A. Ceftriaxone 1gm IM single dose B. Erythromycin 500 mg orally 4 x 1 day for 7 days C. Benzathine Penicillin G, 2.4 million units IM single dose D. Cefoxitin 2 gms IM single dose

607 C. Pen G is the recommended treatment for adult with primary, secondary or early latent syphilis. Patients with latent (patients seroactive without evidence of disease) syphilis should be given 3 doses of 2.4 million. Benzathine Pen G IM, at 1-week intervals.

A 19 year old G1P0 PU 40 weeks, not in labor, was seen at the OPD for decreased fetal movement. She was hooked to an electronic fetal monitor and tracing showed: Baseline FHT- 140â€™s, good variability, with more than 2 accelerations of 20 bpm lasting for 20 secs. The tracing is interpreted as: A. reactive B. non-reactive C. positive D. negative E. inconclusive

608 A. Reactive non-stress test biophysical scoring (8-10) shows normal findings and indicates favorable fetal survival. A non-reactive non-stress test (< 6) refers to poor fetal condition and may be an indication for an emergent delivery.

An obstetrician who attempts to do forceps extraction with the knowledge that there is certain degree of disproportion at the level of the midpelvis is doing a: A. Failed forceps B. Prophylactic forceps C. Elective forceps D. Trial forceps E. Structural forceps

609 D. In trial forceps, the OPB is fully aware that vaginal delivery may not be successful. In elective forceps, vaginal delivery is possible even without operative delivery.

A patient underwent THBSO omentectomy and lymph node dissection for an ovarian cancer. Histopathological report showed the tumor in the right ovary measured 10x8x8 cm ruptured with extension to the fallopian tube and omentum. One para aortic node showed malignant cells. Using the FIGO staging, this patient can be categorized under: A. Stage II-C B. Stage III-A C. Stage III-B D. Stage III-C

610 D. Stage I Growth limited to the ovaries. IA Growth limited to one ovary; no ascites present containing malignant cells. No tumor on the external surface; capsule intact. IB Growth limited to both ovaries; no ascites present containing malignant cells. No tumor on the external surfaces; capsules intact. IC Tumor either stage IA or IB but with tumor on surface of one or both ovaries; or with capsule ruptured; or with ascites present containing malignant cells; or with positive peritoneal washings. II Growth involving one or both ovaries with pelvic extension. IIA Extension and/or metastases to the uterus and/or tubes. IIB Extension to other pelvic tissues. IIC Tumor either stage IIA or IIB, but with tumor on surface of one or both ovaries; or with capsule(s) ruptured; or with ascites present containing malignant cells; or with positive peritoneal washings. III Tumor involving one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes. Superficial liver metastasis equals stage III. Tumor is limited to the true pelvis but with histologically proven malignant extension to small bowel or omentum. IIIA Tumor grossly limited to the true pelvis with negative nodes but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces. IIIB Tumor of one or both ovaries with histologically confirmed implants of abdominal peritoneal surfaces, none exceeding 2 cm in diameter. Nodes are negative. IIIC Abdominal implants greater than 2 cm in diameter and/or positive retroperitoneal or inguinal nodes. IV Growth involving one or both ovaries with distant metastases. If pleural effusion is present, there must be positive cytology to allot a case to stage IV. IVA Parenchymal liver metastasis equals stage IV

In the above case, what is the chance that the patient may still live for the next 5 years? A. 11.1% B. 23.4% C. 36.7% D. 41.1% E. 55.1%

611 B. Stage IA 86.9%, IB 71.3%, IC 79.2%, IIA 66.6%, IIB 55.1, IIC 57.0, IIIA 41.1, IIIB 24.9, IIIC 23.4, IV 11.1 (Comprehensive Gynecology, 4th ed)

The following statement is TRUE about Polycystic Ovarian Syndrome, EXCEPT: A. This disorder begins perimenarcheally B. Clinical manifestations include hirsutism, menstrual irregularity and obesity C. Ovaries contain multiple (>10) small (2- to 10- mm diameter) follicles in the periphery D. Sonographic findings also include echogenicity of the stroma and ovarian enlargement E. None of the above

612 E. Polycystic Ovarian Syndrome (PCOS) is an endocrinologic disorder characterized by excessive ovarian androgen production, abnormal gonadotrophin secretion, and chronic anovulation with morphologic changes in the ovary consisting of multiple small subcapsular follicles, increased amounts of stromal tissue, and ovarian enlargement. This disorder begins perimenarcheally, and its clinical manifestations include hirsutism, menstrual irregularity (oligomenorrhea or amenorrhea), and obesity. Findings upon sonographic visualization of the ovaries include multiple (>10) small (2- to 10-mm diameter) follicles in the periphery, increased echogenicity of the stroma, and ovarian enlargement. (Comprehensive Gynecology, 4th ed)

The major androgen produced by the ovaries is: A. Testosterone B. Dehydroepiandrosterone sulfate C. Androstenedione D. Etiocholanolone E. The ovaries do not produce androgens

613 A. The sources of androgen production in the human female are the ovaries and the adrenal glands. The major androgen produced by the ovaries is testosterone and that of the adrenal glands is dehydroepiandrosterone sulfate (DHEA-S). (Comprehensive Gynecology, 4th ed)

During active labor, the fetus was observed to have episodes of decreased fetal heart rate and return to baseline in association with a contraction. The degree of deceleration is generally proportional to the contraction strength and does not fall below 100 beats/min.Which of the following can be attributed to this phenomenon? A. Fetal hypoxia B. Utero-placental insufficiency C. Umbilical cord occlusion D. Head compression E. A and B

614 D. Early deceleration of the fetal heart rate consists of a gradual decrease and return to baseline associated with a contraction. Freeman and co- authors (2003) defined early decelerations as those generally seen in active labor between 4 and 7 cm dilatation. In their definition, the degree of deceleration is generally proportional to the contraction strength and rarely falls below 100 to 110 beats/min or 20 to 30 beats/min below baseline. Importantly, early decelerations are not associated with fetal hypoxia, acidemia, or low Apgar scores. Ball and Parer (1992) concluded that fetal head compression is a likely cause of early deceleration. Head compression probably causes vagal nerve activation as a result of dural stimulation and that mediates the heart rate deceleration (Paul and co-workers, 1964). (William's obstetrics)

The following are associated with increased risk of placenta previa, EXCEPT: A. Advance maternal age B. Previous caesarean section C. Multiparity D. Smoking E. Family history of placenta revia

615 E. According to William's obstetrics, placenta previa may be assocaiated with 4 etiologies: advanced maternal age, multiparity, prior CS and smoking.

A 26-year old G1P0 at 39 weeks AOG was noted to be 1 cm dilated but without regular uterine contractions during her pre-natal check up. If her obstetrician decides to admit her and plans to do an early amniotomy, the type of amniotomy would be a/an: A. Elective amniotomy B. Amniotomy induction C. Amniotomy augmentation D. Therapeutic amniotomy E. Late amniotomy

616. B..Types of amniotomy include: elective amniotomy, amniotomy induction and amniotomy augmentation. Artificial rupture of the membranes can be used to induce labor, but it implies a commitment to delivery. The main disadvantage of amniotomy when used alone for labor induction is the unpredictable and occasionally long interval to the onset of contractions. In a randomized trial, Bakos and Backstrom (1987) found that amniotomy alone or combined with oxytocin was superior to oxytocin alone. Mercer and colleagues (1995) randomized 209 women undergoing oxytocin induction to amniotomy either at 1 to 2 cm dilatation (early amniotomy) or at 5 cm (late amniotomy). Early amniotomy was associated with significantly shorter labor by approximately 4 hours. There was, however, an increased incidence of chorioamnionitis and cord-compression patterns with early amniotomy.

The most common malignancy gicing rise to a placnetal metastasis is: A. Gastric carcinoma B. Pilocytic astrocytoma C. Rhabdomyosarcoma D. Lung cancer E. Melanoma

617 E. Malignant tumors rarely metastasize to the placenta. Of those that do, melanoma accounts for nearly one third of reported cases, and leukemias and lymphomas comprise another third.

A 3 year-old girl was brought to the ER because of vaginal bleeding. On inspection of the external genitalia, there was a mass protruding through the vaginal introitus. It measured 4x3 cm and resembled a cluster of grapes forming multiple polypoid masses. The most likely diagnosis is: A. Sarcoma botyroides B. Epidermoid carcinoma C. Vaginal adenosis D. Condyloma acuminata E. Congenital vulvar malformation

618 A. Sarcoma Botryoides (Embryonal Rhabdomyosarcoma) is usually diagnosed in the vagina of a young female. Rarely does it occur in a young child over 8 years of age, although cases in adolescents have been reported. The most common symptom is abnormal vaginal bleeding, with an occasional mass at the introitus. The tumor grossly will resemble a cluster of grapes forming multiple polypoid masses.

The first index/indices of declining ovarian function in perimenopausal women is/are: A. Decrease in FSH B. Decrease in LH C. Decrease estradiol D. Decrease inhibin E. A and C

619 D. Inhibin is a glycoprotein produced by the granulosa cells of developing follicles during the follicular phase of the cycle. The gonadal production of inhibin is stimulated by FSH, and inhibin suppresses pituitary FSH secretion as part of a closed-loop feedback system. MacNaughton et al. have shown that circulating follicular phase inhibin levels are significantly lower among women aged 45 to 49 than among women younger than age 45 (Table 42-1) . The fall in inhibin levels may be due to the decreased number of ovarian follicles or to altered granulosa cell function that accompanies increasing age. Because estradiol levels do not undergo a similar significant decrease between ages 45 and 49, it is possible that synthesis of these two hormones are a result of separate functions of the granulosa cells. As inhibin levels fall there is a concomitant rise in FSH, which initially results in greater secretion of estradiol from the follicle.

A 33 year-old G3P2 (2002) went to OPD due to spotting. Her LMP was 28 weeks ago and she claims that she has not felt any fetal movement for the past month. On examination, fundal height is 18 cm, no fetal heart tone detected. Ultrasound was done, revealing no cardiac acitivity. Management of this patient would be: A. Wait for spontaneous labor B. Induction of labor C. Dilatation & Curettage D. Hysterotomy E. Prostaglandin

620 A. Waiting for spontaneous labor is the treatment of choice for intra-uterine fetal death (IUFD). Induction of labor may be done 72 hours without spontaneous labor.

In the clinical pelvimetry of a pateint in the third trimester of pregnancy, which of the following can be measured clinically? A. Transverse diameter of the inlet B. Obstetric conjugate C. Interspinous diameter D. Posterior sagittal diameter of the outlet E. None of the above

621 C. Interspinous diameter and Diagonal conjugate can be measured clinically.

The iron deficiency anemia of pregnancy is due to: A. Expected decreased absorption of iron from the GI tract during pregnancy B. Nausea and vomiting that causes dehydration and electrolyte imbalance C. Expansion of plasma volume without normal expansion of maternal hemoglobin mass D. Decreased expansion of RBC mass because of decreased erythropoietin activity during pregnancy E. Any of the above choices

622 C.

Which of the folloqwing is true regarding maternal mortality in the Philippines? A. Fifty (50%) percent of the women who died had prenatal care B. Hypertension is the leading cause of mortality C. Pulmonary disease is the leading medical cause D. Highest rate is seen in the 40-44 years old age group E. Cervical cancer remain as the second leading cause of maternal mortality

623 D. Highest rate is seen in age group 40-44.

At what age of gestation is scanning for congenital abnormalities best done? A. 5-6 weeks B. 10-14 weeks C. 16-18 weeks D. 24-28 weeks E. 30-32 weeks

624 C. congenital scanning is usually done at 16-18weeks

The following are components of quadruple marker screen, EXCEPT? A. AFP B. B-HCG C. Estriol D. Estradiol E. Inhibin

625 D. Quadruple screen- AFP, BHCG, Estriol and Inhibin

Th e following structures originate from ureteric bud/ metanephric duct , EXCEPT? A. Ureter B. Renal pelvis C. Calyces D. Collecting system E. Renal glomerulus

626 E. glomerulus originates from metanephric mesenchyme.

In females, what is the remnant of mesonephric duct/ wolffian duct ? A. Gartner's Duct B. Bartholin's Gland C. Skene's gland D. Uterus E. Nabothian cyst

627 A. Gartners duct is a remnant of mesonephric duct

The most sensitive test for the diagnosis of abdominopelvic tuberculosis is? A. Tissue biopsy B. Peritoneal fluid culture C. ELISA D. Laparoscopy E. Exploratory laparotomy

628 D. Laparoscopy is the gold standard in the diagnosis of abdominopelvic tuberculosis

Forcep delivery is NOT recommended in which of the following conditions? A. Class II-IV gravidocardiac B. Vaginal delivery after Cesarian section C. Presence of acute pulmonary edema D. Presence of persistent late decelerations at station +4 E. None of the above

629 D.

A 25 year old at 32 weeks AOG is noted to have a BP of 160/100 mmHg with the presence of +2 proteinuria. The platelet count and liver function tests were abnormal. After few hours, patient went into seizure. What is the best management plan in this case? A. Induction of labor B. Intelligent expectancy C. Control the seizure then expectant management D. Cesarian section E. Forcep delivery

632 D. CS is the only cure for eclampsia.

A 26 year old came in to the emergency department due to vaginal bleeding and severe abdominal pain. She was amenorrheic for about 2 months. On physical examination, patient was pale looking and hypotensive. Which of the following events would be most likely predispose this patient to your diagnosis? A. Pelvic inflammatory disease B. Use of IUD C. Previous tubal surgery D. Exposure to diethylstilbestrol E. None of the above

633 A. This is a case of ectopic pregnancy. PID is the most common predisposing factor.

Amor is pregnant and visits your clinic for a regular pre-natal check up. She had one ectopic pregnancy at 4 weeks. She has one baby born at 40 weeks and one born at 32 weeks which is a set of twins. What is her OB score? A. G3P3 (1113) B. G4P2 (1113) C. G3P3 (2113) D. G4P2 (2113) E. G4P2 (1213)

634 B. G4P2 (1 1 1 3)

A primigravid consulted for amenorrhea of 12 weeks. Home pregnancy test was positive but you were unable to appreciate fetal heart tones by doppler. Transvaginal ultrasound showed a fetus within an enlarged uterus without cardiac or somatic activity. IE revealed a closed cervix. The most likely diagnosis is? A. Blighted ovum B. Missed abortion C. Threatened abortion D. Imminent abortion E. Inevitable abortion

635 B. This is a case of missed abortion

The structure that is cut during median episiotomy is the: A. Ischiocavernosus B. Bulbocavernosus C. Internal anal sphincter D. Rectal mucosa E. None of the above

636 B.

When the fetus is in "military attitude", the presenting diameter is? A. Suboccipitobregmatic B. occipitomental C. Occipitofrontal D. Submentobregmatic E. None of the above

637 C.

The most common clinical manifestation of molar pregnancy is: A. Vagial bleeding B. Uterine size smaller than the age of gestation C. Uterine size larger than the expected AOG D. Fetal heart tones absent at 20 weeks AOG E. None of the above

638 A.

A 41 year old had a baby with Down syndrome 5 years ago. She is now anxious to know the chromosome status of her fetus in her current pregnancy . The test that has the fastest lab processing time for karyotyping is? A. Amniocentesis B. Cordocentesis C. Chorionic villous sampling D. Doppler flow ultrasound E. None of the above

639 C. Chorionic villous sampling is usually done in the 1st trimester.

Zavanelli, as a management of shoulder dystocia refers to: A. Cephalic placement into pelvis followed by Cesarian section B. Pressure is applied to the infants jaw and neck in the direction of the mother's rectum with strong fundal pressure applied by the assistant as anterior shoulder is freed C. Cutting of the clavicle with scissors or other sharp instruments D. Surgical incision into the fibrocartilage of the symphysis pubis E. None of the above choices

640 A. Zavanelli- cephalic placement into pelvis followed by CS

Maja Rotzky, a 19 y/o primigravid consulted on your clinic for her first prenatal check-up. The fundic height was measured to be at the level of umbilicus. Assuming that this is NOT a mutifetal pregnancy and there is NO structural, or medical abnormality, approximately how many weeks AOG is this pregnancy? A. 12 weeks B. 16 weeks C. 18 weeks D. 20 weeks E. 24 weeks

641 D. at 12 weeks, FH is at the level of symphysis pubis. At 16 weeks, FH is halfway between the symphysis and umbilicus. At 20 weeks at the level of umbilicus. At 32 weeks about the level of xiphoid process.

Cathy Poe is a 31 year old female who is complaining of cyclic pelvic pains since 8 months PTC. She thought this was just an ordinary case of dysmenorrhea hence she self-medicated with NSAID's. However, 2 weeks PTC, patient experienced defecating with blood. You requeste dultrasound which revealed hyperechoic sacs on both ovaries which possibly blood-containing. What is your diagnosis? A. Teratoma B. Theca Lutein Cysts C. Endometriosis D. Adenomyosis E. Polycystic ovarian syndrome

642 C. Endometriosis is the presence of endometrial tissue outside the uterus. Hence accumulation of blood to solid organs during menstrual periods, causes cyclic pain.

Halley is a 23 year old promiscuous lady who came in due to right upper abdominal pain. Further history revealed previous episodes of STD but did not comply with the complete treatment course. Laparoscopy was done and showed periportal hepatitis with characteristic violin string adhesions. What is your impression? A. Fitz-Hugh Curtis Syndrome B. Weil's Syndrome C. Waterhouse Friderichsen syndrome D. Sheehan's Syndrome E. Asherman Syndrome

643 A. Fitz Hugh Curtis Syndrome is a rare complication of PID due to ascending infection from lower genital tract towrds uterus, oviduct and upto the hepatic capsule.

You are consulted by a 28 year multigravid who is on her 2nd week post-partum because she was unable to express milk for her child. Further history revealed profuse bleeding during her last childbirth. With that kind of history, you are able to diagnose the patient with? A. Fitz-Hugh Curtis Syndrome B. Weil's Syndrome C. Waterhouse Friderichsen syndrome D. Sheehan's Syndrome E. Asherman Syndrome

644 D. Sheehan's syndrome is the postpartum pituitary necrosis. During gestation, the pituitary gland increases it's size to almost 130%. If there is acute blood loss, ischemic necrosis may occur hence oxytocin is not produced, leading to lack of milk ejection, and amenorrhea.

A 24 year-old primigravid with 9 weeks AOG consulted due to passing of meaty material. History started a day PTC, patient had crampy abdominal pain (7-8/10 in pain scale) asscociated with spotting. Few hours PTC, patient noted passing-out of meaty material per vagina. Speculum exam showed closed cervix. To be sure, you requested ultrasound and revealed empty uterine cavity. What is your next step? A. Dilatation and curettage B. Give Tranexamic acid 500mg, 2 capsules 3x a day for 3 days C. Administer 10 units of Oxytocin via 30 minute drip D. Administer 1.2 grams of Co-amoxiclav IV every 12 hours for 3 days E. Do watchful observation

645 E. this is a case of Complete abortion, hence watchful observation is warranted to prevent severe bleeding, sepsis and alike. D and C is not indicated, just like Oxytocin, Tranex and antibiotics (as long that this is NOT an instrumentally-induced)

The most common type of breech presentation is characterized by? A. Lower extremities extended at the hips and extended at the knees B. Lower extremities flexed at the hips and flexed at the knees C. Lower extremities extended at the hips and flexed at the knees D. Lower extremities flexed at the hips and extended at the knees E. None of the above

646 D. Frank breech is the most common type of breech and is characterized by lower extremities flexed at the hips and extended at the knees

The most common symptom found in complete mole is? A. Vaginal bleeding B. Abdominal pain C. Uterine enlargement D. Nausea and vomiting E. A and D

647 A. the question is asking for the MOST COMMON SYMPTOM hence vaginal bleeding is the only and definite answer

A 25 year-old female, with several previous episodes of PID, came in due to severe right lower quadrant pain. No associated fever, diarrhea or vomiting noted. Further history revealed missed menses for 2 months. Pregnancy test revealed positive and you are entertaining ectopic pregnancy. If you are to perform ultrasound, you should know that a gestational sac should be seen once the level of hCG is? A. > 1,500 units B. > 1.50 units C. > 2, 500 units D. > 2.5 units E. > 3,500 units

648 A. The one being asked is the discriminatory level of beta-hCG. Meaning, if beta-hCG is >1,500 units, a gestational sac should be seen via ultrasound

Which among the following statements is/are tru regarding medical treatment of Ectopic pregnancy? A. < 6 weeks AOG B. < 3.5 cms in length C. Beta hCG of < 15,000 miU/mL D. A and C only E. All of the above

649 E.

This is an abnormal uterine bleeding characterized by scanty menstruation. A. Menorrhagia B. Hypomenorrhea C. Oligomenorrhea D. Polymenorrhea E. Metrorrhagia

658 B. Hypomenorrhea refers to scanty menstruation. Oligomenorrhea refers to prolonged intervals of menstruation.

What is the most common cause of DIC in pregnant women? A. Placenta Previa B. Vasa Previa C. Placenta Acreta D. Abruptio Placenta E. Placenta Increta

650 D. premature separation of placenta causes activation of coagulation cascade via exposure to tissue factor which leads to a viscious cycle called DIC.

Vaginal delivery follows a series of fetal movement in relation to uterine contractions, which are called Cardinal movements. Which cardinal movement is the most important and is the first prerequisite for vaginal birth? A. Engagement B. Descent C. Flexion D. Extension E. Internal rotation

651 B. Descent occurs even before engagement and is continuous until the fetus is delivered.

Which of the following is/are criteria for using Oxytocin? A. Cervix should atleast 4cms opened B. CPD is ruled out C. Cephalic presentation D. B and C only E. All of the above

652 E. The judicial use of Oxytocin should start when the labor is already at the active phase (4cms cervical dilatation), no CPD and the child is on cephalic presentation.

A 27 year-old nulligravid have undergone explore laparotomy due to ovarian tumor. Grossly, the tumor contains teeth, hair and bone. What is your impression? A. Dermoid cyst B. Seminoma C. Teratoma D. A and C only E. All of the above

653 D. Dermoid cyst is the most common ovarian tumor in patients less than 30 years old. Since it is derived from all germ layers, it can differentiate into any other tissues like bones, teeth, or cartilage.

Which of the following is/are probable sign/s of pregnancy? A. Positive pregnancy test B. Braxton-Hicks contractions C. Goodell's sign D. A and B only E. All of the above

654 E. Probable signs are changes related to placenta or uterus

Human Placental Lactogen is being pointed-out as the cause of gestational diabetes. Its peak levels can be detected on what age of gestation? A. 20-22weeks B. 22-26weeks C. 24-28 weeks D. 28-32weeks E. 30 weeks

655 C. HPL is at its peak between 24-28 weeks, and this is the ideal time to screen for GDM

The minimum criteria for diagnosing Pelvic Inflammatory Disease includes A. Cervical tenderness B. Uterine tenderness C. Adnexal tenderness D. A and C only E. All of the above

656 E. These are the 3 minimun criteria for diagnosing PID.

A 28 year-old primigravid consulted at ER due to painless vaginal bleeding. She is currently on her 32nd week of gestation. The least you would do is? A. Perform an internal examination B. Do an emergency ultrasound C. Check the Fetal heart tone D. Non-stress test E. No excemption. You should do all of the above

660 A. Internal exam is a NO NO!! The patient is possibly having placenta previa and IE can only be done on a double set-up. You may induce bleeding that is very hard to control.

True of physiologic discharge of puberty? A. Occurs 6-12 months before menarche B. Due to desquamation of vaginal epithelium C. Greenish white in color D. A and b E. All of the above

661 D. Physiologic discharge is grayish - white in color.

True of nabothian cyst, except? A. Most common cervical cyst B. Most common in postmenopausal women C. Due to intermittent blockage of endicervical gland D. Treatment is supportive E. All of the above

662 B. A nabothian cyst (or nabothian follicle) is a mucus- filled cyst on the surface of the cervix. They are most often caused when stratified squamous epithelium of the ectocervix (toward the vagina) grows over the simple columnar epithelium of the endocervix (toward the uterus). This tissue growth can block the cervical crypts (subdermal pockets usually 2-10 mm in diameter), trapping cervical mucus inside the crypts. The transformation of tissue types is called metaplasia. Occurs most comonly in menstruating women.

A 35 year old obese female presented with bleeding in between periods, what would be the initial diagnostic modality of choice? A. Ultrasound B. Biopsy C. Laparotomy D. Progesterone withdrawal test E. None

663 A. An endometrial polyp or uterine polyp is a mass in the inner lining of the uterus.They may have a large flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated). Can be detected by vaginal ultrasound (sonohysterography), hysteroscopy and dilation and curettage.

Triad of polycystic ovary syndrome includes which of the following? A. Hirsutism B. Amenorrhea C. Obesity D. Abdominal Pain E. A, b and c

664 E. The principal features are anovulation, resulting in irregular menstruation, amenorrhea, ovulation- related infertility, and polycystic ovaries; excessive amounts or effects of androgenic hormones, resulting in acne and hirsutism; and insulin resistance, often associated with obesity, Type 2 diabetes, and high cholesterol levels.

Normal semenalysis values? A. Concentration >20M/mL B. pH 8 - 9 C. Motility>30% D. Normal forms>50% E. A and b only

665 A. Concentration >20M/mL Volume 2 - 5 mL pH 7.2 - 7.8 mL motility >50%

Grade of pelvic organ prolapse wherein the prolapsed organ is halfway past the hymenal ring? A. 1 B. 2 C. 3 D. 4 E. 5

666 C. Grade 1 - descend halfway to hymen Grade 2 - level of hymen Grade 3 - halfway past hymenal ring Grade 4 - Prolapsed organ completely outside vagina

True of pelvic conjugates? A. Obstetrical conjugate is the one which can be directly measured clinically B. True anatomic conjugate is the shortest distance between the midpoint of the promontory and inner surface of the symphysis C. Diagonal conjugate cannot be measured clinically D. The obstetrical conjugare is adequate if distance > 10 cms. E. all of the above

670 D. OC - measured by substracting 1.5 to 2 cms from the diagonal conjugate which is the one that can be measured clinically. True anatomic conjugate is the distance between between the promontory and the UPPER border of the inner surface of syphysis.

The fetal heart tones can be heard by Doppler by how many weeks AOG? A. 6 - 7 B. 10 C. 12 D. 19 E. 20

671 B. 6 - 7 weeks by Transvaginal UTZ 10 weeks by UTZ 19 weeks by Stethoscope

This is the earliest histological evidence of progesterone action in the endometrial lining. A. Glandular mitoses B. Stromal edema C. Basal vacuolization D. Secretion E. Pseudostratification of nuclei

672 C. At the time of ovulation the endometrium slows in its growth, and it ceases mitotic activity within days after ovulation, at which time the corpus luteum is producing progesterone in addition to estrogen. The postovulatory endometrium is initially marked by secretory vacuoles beneath the nuclei in the glandular epithelium . This secretory activity is most prominent during the third week of the menstrual cycle, when the basal vacuoles progressively push past the nuclei.

For pregnancy to occur, implantation of what structure must occur on the 8th day of fertilization? A. zygote B. blastomere C. morula D. blastocyst E. Fetus

673 D. Blastocyst implants at around 7 days post - conception within the superior wall of the uterus.

Goodell sign? A. Softening and compressibility of the isthmus occuring on the 6th - 8th week AOG B. Bluish/purplish discoloration of the vagina at 6 weeks AOG C. Mask of pregnancy D. Softening of the cervix E. Ferning pattern

674 D. Goodell's sign is an indication of pregnancy. It is a significant softening of the vaginal portion of the cervix from increased vascularization. This vascularization is a result of hypertrophy and engorgement of the vessels below the growing uterus.

Definitive evidence of pregnancy, EXCEPT? A. Fetal heart action identification B. Fetal movement perception by examiner C. Recognition of embryo or fetus by UTZ D. Positive pregnancy test E. FHT by doppler at 10 weeks AOG

675 D. Pregnancy test is a probable evidence of pergnancy

What is the most frequent site of eccyesis? A. Ampulla B. Isthmus C. Interstitial D. Supero-posterior part of uterus

688 A. Answer: A. Ampulla (pp.35, OB-Gyne, Topnotch Handouts) Notes: Eccyesis is another term for ectopic pregnancy.

Definition of a reactive NST: A. 2 or more accelerations B. Peak at 15 bpm above baseline C. Each acceleration lasts more than 30 seconds D. A and b E. All of the above

676 D. Reactive NST - presence of two or more fetal heart rate accelerations within a 20-minute period, with or without fetal movement discernible by the woman. Accelerations are defined as 15 bpm above baselines for at least 15 seconds if beyond 32 weeks gestation, or 10 bpm for at least 10 seconds if at or below 32 weeks.

Biophysical profile of a pregnant patient was done which revealed BPS of 8 with decreased AF, AOG<37 weeks, what is the management of choice? A. Repeat test per protocol B. Administer steroids C. Deliver D. No fetal indication for intervention E. None

677 A. iHowever, this would be dependent on the AOG. According to our lecture, if AOG <37 weeks, repeat test per protocol. If AOG>37 weeks, deliver.

Type of deceleration wherein a drop of heart rate is seen to start at the peak of contraction but would return to baseline HR after the contraction ? A. Early deceleration B. Head compression C. Late deceleration D. Variable deceleration E. Cord compression

678 C. Late deceleration may signal uteroplacental insufficiency.

An 18 year old female came to the ER presenting with vaginal bleeding. She stated to observe passage of meaty material form the vagina. What would be the management of choice for this patient? A. tocolysis B. Completion curettage C. bed rest D. IV antibiotics E. prostaglandins

679 B. This is a case of incomplete abortion wherein there is already passage of parts of the fetus. The cervical os is open, bag of waters ruptured.

type of version used for delivery of the second twin? A. Internal podalic version B. External cephalic version C. Internal cephalic version D. External podalic version E. None

680 A. Podalic version is an obstetric procedure wherein the fetus is turned within the womb such that one or both feet present through the cervix during childbirth. It is used most often in cases where the fetus lies transversely or in another abnormal position in the womb.

A 25 yo, G3P4 comes to your office for a routine prenatal check-up, complaining of vaginal bleeding. Patient is 16 weeks AOG based on LMP. Upon PE, her uterus is at the level of the umbilicus and no FHTs can be heard. BP is 150/90 mmHg with no prior history of hypertension. Urinalysis showed 2+ proteinuria on dipstick. Which of the following condition should you rule out first? A. IUFD B. Molar pregnancy C. Preeclampsia D. Gestational hypertension

681 B. Answer: B. Molar pregnancy (pp. 19, High-Yield OB- Gyne, 2nd edition) Notes: Molar pregnancy is the only time preeclampsia is diagnosed prior to 20 weeks. * note that the uterine size is larger than the gestational age. *SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE

What is the normal position of the uterus? A. Anteverted and anteflexed B. Anteverted and retroflexed C. Retroverted and anteflexed D. Retroverted and retroflexed

682 A. Answer: A. Anteverted and anteflexed (must know)

What provides the major support of the uterus and the cervix? A. Round ligament B. Uterosacral ligament C. Transverse sacral ligament D. Mackenrodt ligament

683 D. Answer: D. MaCkenrodt ligament (pp. 4, OB-Gyne, Topnotch handouts) Notes: Cardinal ligament synonyms â€" transverse CerviCal ligament or Mackenrodt ligament *There is no such thing as transverse sacral ligament.

Proper recording and evaluation of the periodic changes of the fetal heart rate (FHR) are needed for proper intrapartum assessment. What is the probable etiology if there is gradual decrease in the FHR below the baseline with onset to nadir of at least >30 secs? A. Normal B. Head compression C. Umbilical cord compression D. Uteroplacental insufficiency

684 D. Answer: D. UteroplaCental insuffiCienCy (pp. 21, OB-Gyne, Topnotch Handouts) * Kinds of deceleration were asked 4-5x during the Feb 2013 Boards.

Which sequence of cardinal movements of labor best applies to a fetus delivered via face presentation? A. Descent , Engagement, Internal Rotation, Lateral Flexion B. Descent, Internal rotation, Flexion, Restitution C. Engagement, Descent, Flexion, Internal Rotation D. Engagement, Descent, Extension, External Rotation

685 B. Answer : B. DesCent, Internal rotation, Flexion, Restitution (pp. 27, OB-Gyne, Topnotch Handouts)

How many weeks post-partum does the uterus regresses or involutes to its non-pregnant size? A. 2-3 days B. 2 weeks C. 3 weeks D. 4 weeks

686 D. Answer: D. 4 weeks (pp.32, OB-Gyne, Topnotch Handouts) SIMILAR TO PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE

Benign GTD can be classified as complete and incomplete mole. An incomplete mole has 3 sets of chromosomes due to which of the following reasons? A. A haploid egg is fertilized by 2 normal sperms B. A haploid egg is fertilized by a diploid sperm C. A diploid egg is fertilized by a haploid sperm D. All of these

687 A. Answer: InComplete means one haploid egg is fertilized by 2 haploid eggs, so the outCome is diploid

A 26 yo, G1P1 (1001) complains of amenorrhea. She had hypotensive episodes during her delivery 7 months ago and was transfused 10 units of fresh whole blood. She was not able to breastfeed because her breasts started to sag. She also lost weight, became anorexic and weak. What explains the amenorrhea in this patient? A. Simmondâ€™s syndrome B. Lactational amenorrhea C. Sheehanâ€™s syndrome D. Anorexia nervosa

689 C. Answer: C. Sheehanâ€™s syndrome Notes: Sheehanâ€™s syndrome â€" destruction f pituitary gland as a result of severe bleeding.

A 4 yo girl was brought to the clinic for slight enlargement of the left breast with no other associated signs and symptoms since two years ago. You will tell the parents that premature thelarche is: A. A condition that needs surgical removal of the ovaries B. A benign self-limiting condition that does not require treatment C. A serious condition leading to central precocious puberty D. A condition that requires treatment with hypothalamic suppressive therapy

690 B. Answer: B. A benign self-limiting condition that does not require treatment

A 40 yr-old G4P3 woman comes to the E.R. complaining of vaginal bleeding, pelvic pain, flank pain, foul-smelling discharge and disorientation. Her past medical history is significant for 3 NSVDs and 1 miscarriage. In addition, she did have a history of abnormal Papsmears approx.3 years earlier. What initial lab work-up must be done? A. Complete metabolic panel B. Complete blood count C. B-BHCG levels D. Urinalysis E. All of the above

691 E. Answer: E Differentials include PID, miscarriage, DUB, cervical lesions (including cervical CA), UTI leading to pyelonephritis. CBC & complete metabolic panel are impt.because patient already has disorientation.

Potential sites for ureteral injury during abdominal hysterectomy with bilateral salpigo-oophorectomy include all of the following except: A. Transaction of the round ligament B. Transaction of uterine arteries C. Transaction of cardinal ligaments D. Transition of infundibulopelivc ligaments E. None

692 A. Answer: A In general, ureters do not travel near the round ligament, in a pelvis with normal anatomy.

A 60 yr-old womans visits your clinic with complaints of pelvic pressure and abdominal fullness. Her LMP was 3 yrs ago. BPE and IVP are normal. Staging explore lap is performed. You fin stage 1a ovarian CA. What is the best intervention in this case? A. Start patient on chemotherapy immediately B. Perform TAH-BSO only C. Perform TAH-BSO and infracolic omentectomy D. Cytoreductive debulking will suffice

693 B. Answer: B Histology suggests the CA is confined to the ovary but the 5-yr survival rate is only 80%.

A 19 yr-old primigravida at 32 weeksâ€™ gestation comes to the office for a routine prenatal visit. Her BP is 150/95 mmHg. Her previous BPs have been 120/7- mmHg range. 2 hours later: While receiving IV MgSO4 therapy, her RR have decreased from 20- 5 rpm. Findings are consistent with A. Gestational HTN B. Mild preeclampsia C. Severe preeclampsia D. Eclampsia E. Magnesium toxicity

694 E. Answer: E Antidote for magnesium toxicity is IV calcium gluconate.

A primigravida at 16 weeks by LMP has a fundal height at umbilicus. She has abnormality elevated levels of MS-AFP and B-hCG. You: A. schedule a sonogram to rule out multiple gestation B. are confident itâ€™s Downâ€™s syndrome C. diagnose patient as having molar pregnancy D. admit patient and watch out for variable decelerations

695 A. Answer: A The combination of fundus larger than dates and abnormally elevated levels of MS-AFP and B-hCG suggests multiple gestation.

A 43 yr-old woman comes to the office complaining of involuntary urine loss. Loss of urine occurs continuously day and night along with pelvic pressure. Residual volume is 450 ml. a. Genuine incontinence b. Bypass incontinence c. Overflow incontinence d. Motor urge incontinence

696 C. Answer: C Overflow incontinence occurs uniquely when intravesical pressure from an overdistended hypotonic bladder exceeds urethral pressure.

How many weeks after abortion does ovulation usually occur? A. 2 to 3 weeks B. 4 to 5 C. 5 to 6 D. 6 to 7

697 A.

Duration of pregnancy is most correctly measured clinically by which of the following units? A. Number of weeks, rounded to the nearest whole week since the first day of LMP B. Completed weeks since first day of LMP C. Completed weeks since estimated date of conception D. Numbers of weeks rounded to the nearest whole week since the estimated date of conception

698 B.

In which presentation is the fetal head partially flexed and a large anterior fontanel presenting? A. Vertex B. Face C. Brow D. Sinciput

699 D.

Which of the following is not an indication of severe pregnancy-induced hypertension? A. Upper abdominal pain B. Oliguria C. Creatinine 0.6 mg/dl D. Fetal growth restriction

OB-GYNE

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