Chapter I 1. Most adult females have a p0elvic inlet that would be classified as which of the following Cadwell-Moloy types?

(A) Android (B) Platypelloid (C) Anthropoid (D) Gynecoid (E) Triangular

2. Hernias may occur beneath the thickened lower margin of a fascial aponeurosis extending from the pubic tubercle to the anterior superior iliac spine. This thickened fascia is the (A) Inguinal ligament (B) Coopers ligament (C) Linea alba (D) Posterior rectus sheath (E) Round ligament

3. If the inguinal canal in an adult female was surgically opened, which of the following structures would normally be found? (A) A cyst of the canal of Nuck (B) Gartners duct cyst (C) Coopers ligament (D) The round ligament and the illioinguinal nerve (E) The pyramidalis muscle

4. Which option includes all of the bones that make up the pelvis? (A) Trochanter, hip socket, ischium, sacrum, and pubis (B) Illium, ischium, pubis, sacrum, and coccyx (C) Illium, ischium, and pubis (D) Sacrum, ischium, ilium, and pubis (E) Trochanter, sacrum, coccyx, ilium, and pubis

5. Which of the following bears the weight of a seated human? (A) The rami of the ischiun (B) The levator ani muscle and the coccygeus muscle (C) The ileum

(D) The pubis (E) The ischial tuberosities

6. In the female, the true pelvis anatomically (A) Has an oval outlet (B) Has three defining planes, an inlet, a midplane, and an outlet (C) Has an inlet made up of a double triangle (D) Is completely formed by two fused bones (E) Lies between the wings of paired ileum

8. the portion of the pelvis lying above the linea terminalis has little effect on a womans ability to deliver a baby vaginally. This portion is called (A) True pelvis (B) midplane ( C) outlet (D) false pelvis (E) sacrum

9. the plane from the sacral promontorium to the inner posterior surface of pubic symphysis is an important dimension for normal delivery. It is referred to as the (A) true conjugate (B) obstetric conjugate (C) diagonal conjugate (D) bi-ischial diameter (E) oblique diameter

14. Of the following the best definition of perineum is (A) the entire area between the thighs from the symphysis to the coccyx, bounded caudally by the skin and cephalad by the levator muscles of the pelvic diagram

(B) the anus and perineal area (C) the superficial skin layer of the vulva (D) the tendon joining the muscles deep to the external genitalia (E) the complex of the bulbocavernosus, is chiocavernosus, and transverse perineal muscles

16. where do the Bartolins glands ducts open? (A) into the midline of the posterior fourchette (B) bilaterally, beneath the urethra (C) bilaterally, on the inner surface of labia majora (D) bilaterally, into the posterior vaginal vestibule (E) bilaterally, approximately 1 cm lateral to the clitoris

17. Myrtiform caruncles are (A) circumferential nodules in the areola of the breast (B) healing Bartholin cysts (C) remnants of the wollfian duct (D) remnants of the hymen (E) remnants of the mullerian duct

22. Nabothian cysts result from (A) wolffian duct remnants (B) blockage of crypts in the uterine cervix that are lined with columnar epithelium (C) squamnous cell debris that causes cervival irritation (D) carcinoma (E) paramesonephric

23. the uterine corpus is composed mainly of (A) fibrous tissue (B) estrogen receptors (C) muscle tissue (D) elastic tissue

25. of the following ligaments, those providing the most support to the uterus (in terms of preventing prolapsed) are the (A) broad ligaments (B) infudibulopelvic ligaments (C) utero-ovarian ligaments (D) cardinal ligaments

30. when performing a hystrerectomy the surgeon must be aware that at its closest position to the cervix, the ureter is normally separated from cervix by which of the following distances (A) 0,5 mm (B) 1,2 mm (C) 12 mm (D) 3 cm (E) 5 cm

35. the blood supply of the vagina is from which of the following arteries? (A) internal pudendal (B) superior hemorrhoidal (C) inferior mesenteric (D) superior vesical

55. which four of the following ligaments are attached to the uterus? (A) uterosacral (B) broad (C) round (D) cardinal (E) Coopers

Chapter III 143. Meiosis differs from mitosis in several ways. The major difference is that (A) meiosis is confined to germ cells, whereas mitosis occurs in all cells of the body throuhtout life (B) the end product of meiosis is a cell undergoes a single redution-division, whereas in mitosis there are two (C) in meiosis each germ cell undergoes a single reduction-division, whereas in mitosis there are two (D) meiosis occurs in one stage with separation of sister chromosome (E) in meiosis the cells become sex chromatin posistive from the genetic inactivation one half of the cellular material 145.The stage of gestational development at which endometrial implantation occurs is (A) (B) (C) (D) (E) eigh-cell embryo zygote morula formation blastocyt embryonic disk

148. During fetal development, organogenesis, with the exception of the brain, is completed within (A) (B) (C) (D) (E) 2 weeks after ovulation 8 weeks after ovulation 16 weeks after ovulation 24 weeks after ovulation 36 weeks after ovulation

153. Genetic sex is determined (A) At ovulation (B) At conception

(C) By the presence or absence of testosterone (D) In the absence of mullerian inhibiting factor (E) Psychosocially after birth 195. Because a male has only one X chromosome, he would be called which of the following in regard to any X-linked gene? (A) (B) (C) (D) (E) codominant heterozygous hemizygous homozygous intermediate

201. Approximately what percentage of spontaneous first-trimester abortions show chromosomal abnormalities? (A) 1% (B) 10% (C) 25% (D) 50% (E) 75% 202. Live births of infants would demonstrate approximately what precentage of chromosomal abnormalities? (A) (B) (C) (D) (E) less than 1% 1 to 5% approximately 10% 15 to 20% 40 to 50%

287. During which of the following conditions would serum prolactin level be the greatest? (A) (B) (C) (D) menopause ovulation parturition sleep

288. Which of the following statements regarding GnRH-stimulated LH secretion is accurate? (A) (B) (C) (D) (E) It is enhanced by gonadotrope exposure to progesterone. It is increased by gonadotrope exposure to testosterone It is enhanced by gonadotrope exposure to estrogene. It is enhanced by gonadotrope exposure to continuous GnRH. It is associated with steady LH release.

295. Which of the following compuonds was used in the 1950s to 1960s in an attempt to hormonally support a pregnancy and avoid a miscarriage? Instead, it caused vaginal adenosis in female offspring. (A) (B) (C) (D) (E) dehydroepiandrosterone diethylstilbestrol (DES) estradiol strone testosterone

297. A 50-year-old menopausal patient wishes to stay on her oral contraceptive pills. Her health cara provider tries to explain that this provides more estrogen that she needs postmenopausally. What dose of ethinyl estradiol is roughly biologically equivalent to the typical postmenopausal dose of 0.625 mg of conjugated estrogens? (A) (B) (C) (D) (E) 0.005 to 0.010 mg 0.5 to 10 mg 0.05 to 1.0 mg 5.0 to 10.0 mg 50.0 to 100.0 mg

299. A patient with polycystic overian syndrome will often have an increase in insuline resistance. This will result an increase in (A) follicle-stimulatin hormones (FSH) (B) free estogen levels (C) free testosterone level (D) hepatic production of sex hormone-binding globulin 314. A 7-year-old girl is brought in for evaluation. On examination, she has well developed pubic hair and breasts. She is 99% of height for her age. Her mother recently noted some blood stains on her underwear. Which of the following conditions most likely the cause of these findings? (A) (B) (C) (D) (E) Estrogen-producing ovarian cyst Hepatoma Hypothalamic tumor Sex steroid-containing medication Thecal/Leydig cell tumor

Chapter VI 365. Cessation of menses is regarded as a presumptive sign of pregnancy in a menstrual-age female. In what precentage of causes does macroscopic vaginal bleeding occur during an otherwise normal pregnancy that does not abort? (A) (B) (C) (D) never approximately 1% approximately 10% approximately 20%

(E)

approximately 50%

366. Most state-of-the art serumpregnanciy test have a sensitivity for detection of -hCG of 25 mLU/mL. Such tests would diagnose pregnancy as early as (A) (B) (C) (D) 5 days after conception 24 hour after implantation the day of the expected (missed) period 5 weeks gestation

367. Changes on the vagina that occur during pregnancy include (A) (B) (C) (D) (E) decreased secretion decreased vascularity hypertrophy of the smooth muscle vaginall cell appear similar microscopically to those in the follicular phase of the cycle decrease in the thickness of the vaginal mucosa

369. Which of the following cervical changes may be found more frequently in pregnant woman that in the nonpregnant state? (A) (B) (C) (D) (E) atpical glandular hyperplasia dysplasia metaplasia neoplasia vaginal adenosis

370. The increase in total body water in pergnancy (A) begins at 8 to 10 weeks getation (B) occurs in response to increase in plasma osmolality (C) is associatef with elevated plasma level of anti diuretic hormone (ADH) (D) in part due to the decreased clearance of ADH (E) all of the above (F) none of the above 372. A soft, blowing sound that is synchronous with the maternal pulse and heard over the uterus is (A) (B) (C) (D) (E) borborygmus unterine souffle frunic souffle fetal movement maternal femoral vessel bruit

373. The hemostatic mechanism most important in combating postpartum hemorrhage is (A) (B) (C) (D) (E) increased blood clotting factors in pregnancy intramyometrial vascular coagulation due to vasoconstiction contaction of interlacking uterine muscle bundles markedly decreased clood pressure in the uterine venules fibrinolysis inhibition

375. During early pregnancy a pelvic examination may reveal that one adnexa is slightly enlarged. This most likely due to (A) (B) (C) (D) (E) a paraovarian cyst fallopian tube hyperthropy an ovarian neoplasm a follicular cyst a corpus lutheum cyst

384. During normal pregnancy, which of the following phsycologic effects occur? (A) (B) (C) (D) (E) increased serum beta globulins (transport proteins) and decreased triglycerides increased serum corticosteroid-binding globulin and free cortisol increased levels of immunoglobulins A, G, and M increased thyroid-binding globulin and iodide levels dercreased serum ionized calcium levels and parathyroid hormone (PTH)

388. Changes in the urinary tract during normal pregnancy include a/an (A) (B) (C) (D) (E) increase in glomerular filtration rate (GFR) decrease in renal plasma flow (RPF) marked decreased in both GFR and RPF when the patient supine increase the amount pf dead space in the urinary tract increase the blood urea nitrogen (BUN) and creatinine

400. Regarding C-reactive protein in pregnancy, which of the following statements is TRUE? (A) (B) (C) (D) C-reactive protein is elevated in most pregnancies, especially during labor. Gestational age greatly affects C-reactive protein values. In pregnancy, C-reactive protein loses its usefulness as a harbinger of infection A C-reactive protein of twice its normal value would be a good predictor infection of pregnancy.

403. During pregnancy, maternal estrogen increases markedly. Most of this estrogen is produced by the (A) ovaries (B) adrenals (C) fetus (D) placenta (E) uterus 414. Which three of the folllowing proteins produced by the liver are elevated during pregnancy? (A) (B) (C) (D) (E) fibrinogen albumin ceruloplasmin sex hormone-binding globulin (SHBG) prothrombin (factor II)

415. The supine position is important during late pregnancy because it may cause three of the following? (A) (B) (C) (D) (E) an elevation of the uterine artery pressure compared with brachial artery pressure complete occlusion of the inferior vena cava a significant reduction in maternal ventilatory capacity hypotension and syncope a significant reduction in renal blood flow and glomerular filtration

436. Altough the parents want to know the total legth of the infant, the more accurate measurement is the crown-rump length. The average fetus at term is approximately how long from crown to rump? (A) (B) (C) (D) (E) 36 cm 40 cm 50 cm 66 cm 80 cm

Chapter VII 425. The placental cotyledons are formed primarily by (A) (B) (C) (D) (E) mesenchimal defferentiation secondary to unknown factors arterial pressure on the chorionis plate and decidua fetal angiogenesis maternal angiogenesis folding of the yolk sac

426. The fetus is totally dependent on the placenta for transporting nutrients and elimination of wastes. The effectiveness of the placentas as an organ f transfer for any substance is determined by a number of variables. These include (A) (B) (C) (D) (E) rate of maternal blood flow metabolism of the substancce by the placenta concentration of the subtance in fetal and maternal blood rate of fetal blood flow all of the above

1.

427. Because of the fetus is growing rapidly its need for nutrients and energy exceeds the mothers on a gram-for-gram basis. Often, the placental transport will achieve a fetal concentration greater than maternal, but occasionally the converse occurs. Which of the following has a lower concentration in the fetus than in the mother? (A) (B) (C) vitamins phosphate amino acids

(D)

oxygen

432. Labor is induced at 38 weeks due to severe oligohdramnios. The infant is born with a congenital absence of the left hand. This is likely due to (A) (B) (C) (D) (E) maternal trauma amniotic bands chorioangioma true knots in the umbilical chord genetic abnormalities

434. At 30 weeks gestation, the amniocentesis reveals a delta OD at 450 milimicrons of 0.24. The infant continues to look normal on ultrasound. Which of the following should be done? (A) (B) (C) (D) (E) no further study repeatiter in 4 weeks amniocentesis in 1 week intrauterine transfusion immediate delivery

438. The fetal head is usually the largest part of the infant. Depending on the positioning of the head as it enters the pelvis, labor will progress normally or experiencien dystosia due to cephalopelvic disproportion. The smallest circumference of the normal fetal head corresponds to the plane of the (A) (B) (C) (D) (E) suboccipobregmatic diameter occipitofrontal diameter occipitomental diameter bitemporal diameter biparietal diameter

440. Fetal nutrition is dependent on (A) (B) (C) (D) (E) maternal nutrition stores maternal diet placental exchange maternal metabolism all of the above

442. A patient has an emergent cesarian section for an abruption. Due to a large anterior placenta, the placenta was entered during the surgery. The mother is Rh negative. The infant appears anemic and Rh positive. To determine the amount of Rhogam that needs to be given, an estimate to the amount of fetal red blood cells (RBCs) in the maternal circulation is necessary. Fetal RBCs can be distinguished from maternal RBC by their (A) (B) shape resistance to acid elution

(C) (D)

lack of Rh factor lower amounts of hemoglobin

472. Worldwide, the most common problem during pregnancy is (A) (B) (C) (D) (E) diabetes toxemia heart disease urinary tract infection (UTI) iron-deficiency anemia

474. The expected date of delivery of human pregnancy can most correctly be calculated by (A) (B) (C) (D) (E) adding 254 to the date of the start of the last menstrual period (LMP) counting 10 lunar months from the time of ovulation counting 40 weeks from the first day of the LMP counting 280 days from the last day of the LMP counting 256 to the date of the elevated urinary luteinezing hormone (LH) when detected by home testing

476. Pregnancy may occur during a period of amenorrhea such as during lactation or following discontinuitance of hormonal methods of contraception. In such of situation, determination of the most accurate estimated date of delivery can then be made by (A) (B) (C) (D) (E) elicting when breast tenderness or morning sickness begin acessing uterine size by physical exam counting 280 days from the first positive serum pregnancy test asking the patient when she first felt pregnant obtaining fetal biometry by ultrasound prior to 20 weeks gestation

478. A 20-year-old perimigravida who in 24 weeks pregnant express concern about the normality of her fetus after learning that a clse friend has delivered an infant with hydrocephalus. Detail about hydrocephalus that hshould be included in her counseling include the fact that it (A) (B) (C) (D) occur spontaneously in 1 to 500 pregnancies has a multifactorial etiology is usually an isolated defect can be identified as early 10 weeks gestation

479. Fundal height, part of the obstetric examination, is taken from the top of the symphisis pubis to the top of fundus. It is measured (A) (B) (C) (D) (E) by calipers, approximating the week of gestation in inches, approximating the lunar month of gestation in centimeters and devided by 3.5, approximating the lunar month of gestation in centimeters, approximating the weeks of gestation between 18 and 34 weeks by calipers in centimeters, prognosticating the fetal weight

483. Pap smears taken from the uterine cervix during a normal pregnancy (A) (B) (C) (D) (E) should be part of routine obstetric care are indicated only in patients with clinically assessed risks are difficult to interpret because of gestational changes are a cost effective replacement for cultures for sexually transmitted disease (STDs) are likely to induced uterine iritability

485. In acessing risk factors in pregnancy, which of the following would create the most concern? (A) (B) (C) (D) (E) maternal age of 39 maternal age of 17, with menarche at age 13 past history of four normal deliveries history of ovarian dermoid cyst removed 4 years ago a clinically measured pelvic diagonal conjugate of 12 cm

487. Advising a 34-year-old woman at 12 weeks gestation about the risk of chromosomal defects in fetus, you can correctly state that (A) (B) (C) (D) (E) there is little worry regarding Down syndrome before the age of 35 paternal age is very important in the etiology of Down syndrome maternal serum alpha-fetoprotein (MSAFP) is a very spesific test for Down syndrome screening for Down syndrome can be improved by checking amniotic fluis and acethylcolinesterase level efficacy of screening for Down syndrome is improved by adding estriol and hCG concentration of MSAFP

488. Counseling of a pregnant patient during early prenatal care should include advice and education on which of the following? (A) (B) (C) (D) (E) smoking alcohol abuse drug abuse avoiding infection all of the above

490. During late pregnancym which of the following implies urinary tract disease? (A) (B) (C) (D) (E) dreased serum creatinine failure to excrete a concentrated urine after 18 hour without fluids glucosuria dilatation of the ureters decreased creatinine clearance

491. Compared with single pregnancies have a higher rate of which of the following? (A) (B) abortion abnormal presentations

(C) (D) (E)

prolapsed chords vasa previa all of the above

512. A 32-year-od gravida 2, para 1 initiates care at 10 weeks gestation. Which of the following is the most worrisome for poor obsteric ourcome? (A) (B) (C) (D) (E) Trance proteinuria on urine dipstick bllod pressure of 144/92 inaudible fetal heart tone by electronic doppler maternal height of 4ft 10 in the presence of curdlike discharge consistent with Candida on speculum examination

513. Ultrasound is most accurate in dating a pregnancy (A) (B) (C) (D) (E) chapter 15 1015. A 31-year-old infertility patient with regular ovulatory menstrual cycles has begun therapy with chlomiphene citrate. Before she starts therapy, what informatio should you provide her regarding the medication? (A) (B) (C) (D) (E) Tipically, the timing of ovulation is increased by a week. Approximately 40% of patients will respond to clomiphene citrate with increased endometrial thickness. The risk of multiple gestation is 25%. Chlomiphene citrate improves the fecundity rate principally through its efect on the endometrial lining Risk and side effects of chlomiphene citrate include nausea, hot flushes, weight gain and mood swings. between 2 and 4 weeks after LMP between 7 and 9 weeks after LMP between 12 and 14 weeks after LMP between 19 and 21 weeks after LMP between 30 and 32 weeks after LMP

1016. Which of the following statements regarding basal body temperature is TRUE? (A) (B) (C) (D) (E) An oral temperature is taken prior to bedtime. A rise of 0.2oF between 2 cosecutive days reflects ovulation A biphasic temperature shift reflects estrogen action on the hypothalamus. Absence of a biphasic temperatre shift suggest pregnancy. none of the above

1025. Besides infertility, the most common symptom of a lutheal-phase defect is (A) (B) (C) vaginal dryness spontaneous miscarriage tubal occlusion

(D) (E)

breast tenderness ovarian enlargement

1046. Infertility from endometriosis may be due to which four of the following abnormalities? (A) (B) (C) (D) (E) chapter 16 1063. A 25-year-old woman eho underwent menarche at 11 years of age presents with a history of irregular menstrual cycles over the last 12 months, increased weight gain, and bilateral pelvic paiin. Transvaginal ultrasound shows large cystic adnexa, with cysts measuring 7 to 9 cm in size. A urine pregnancy test is negative. Her thyroid stimulating hormone (TSH) level is 7 mIU?mL and prolactin level is 10 ng/mL. What is the treatment of choice for this patient to regain normal menstrual cycle? (A) (B) (C) (D) (E) monophasic birth control pills triphasic birth conrol pills levothyroxine treatment bromocriptine treatment none of the above pelvic adhesions altered fallopian tube motility sperm phagocytosis by peritoneal macrophages evective embryo impantation pituitary failure

1064. A 22-year-old woman with amenorrhea of 6 weeks duration undergoes surgery for appendicitis. At the time of surgery, a 3-cm semisolid overian cyst is discovered. It is vascular and appears to contain a blood-filled central cavity. A serum pregnancy test is positive. Which of the following procedures should be done? (A) (B) (C) (D) (E) ovrian cystectomy ovarian wedge resection oophorectomy salpingo-oovorectomy none of the above

chapter 17 1112. Which contraceptive method has the lowest pregnancy rate in 100 women using the method for year (100 woman-years of use) (A) (B) (C) (D) (E) intrauterine device (IUD) long-acting progestins (Depo-Provera, Norplant) diaphragm oral contraceptives (OCs) spermicidal cream

1117. An 19-year-old woman complains that a condom broke during sexual intercourse. Coitus occurred 1 day ago when she was at midcycle. She does not wish to be pregnant and will terminate the pregnancy if menses does not occur. You advise her that (A) unprotected midcycle coitus haas a 5% risk of pregnancy

(B) (C) (D) (E)

little can be done, since sperm have already entered the cervical mucus postcoital douching is effective in preventing pregnancy postcoital brief course of oral contraception is usually effective in preventing pregnancy postcoital contraception is usually ineffective when given more than 24 hours after coitus

1122. The primary mechanism by which OCs prevent pregnancy is by (A) (B) (C) (D) (E) inhibiting serum follicle-stimulating hormone (FSH) levels inhibiting serum lutheinizing hormone (LH) levels inducing endometrial athropy inducing lymphocytic endometritis increasing cervical mucous vicosity

1168. A patient being trated for prothrombin deficiency develops abnormal uterine bleding. An anatomic lesion has been rulled out. Further management to control the bleeding should begin with (A) (B) (C) (D) (E) gonadotropin-releasing hormone (GnRH) antagonists medroxyprogesterone acetate conjugated equine estrogens OCs transdermal estradiol

1171. Primary dysmenorrhea is caused by (A) (B) (C) (D) (E) uterine hypercontractility uterine ischemia high levels of estrogen coitus during menses ovulation

1172. Of the following, the best therapy for secondary dysmenorrhea tought to be due to adenomyosis is (A) (B) (C) (D) (E) cervical dilation cyclic OCs analgesics hysterectomy testosterone injections