WOMENS HEALTH FINAL EXAM 1. A 25 year old multigravida consults because of vaginal spotting.

On history taking, you elicit amenorrhea of 2 months. What is the first thing you would do? A. Do a CBC and blood typing B. Do a complete curettage C. Advise admission for observation D. Do a pregnancy test to rule out pregnancy 2. The blood and nerve supply to the ovaries courses through which of the following ligaments? A. Cardinal ligaments B. Infundibulo-pelvic ligaments C. Broad ligaments D. Utero-ovarian ligament 3. In a colposcopic examination the area that is the focus of evaluation is: A. Endocervix B. Ectocervix C. Transformation zone D. Endometrium 4. The normal endocervix is lined with which type of epithelium? A. Columnar B. Squamous C. Transitional D. Metaplastic 5. A 28 y/o at 32 wks of age of gestation consults at a clinic. She had one set of twins both are alive and she had an abortion. Her OB code is: A. G3P2 (2102) B. G3P1 (1012) C. G3P2 (2012) D. G2P1 (1012) 6. In placenta accreta, the placenta is abnormally adherent to the myometrium due to partial or total absence of: A. Decidual capsularis B. Deciduas basalis C. Decidua parietalis D. Decidua vera 7. What is the preferred management of few hours of preterm rupture of membranes at 36 weeks? A. Cesarean section B. Expectant management C. Tocolysis D. Augmentation of labor 8. The most common cause of direct maternal deaths in the Phil is: A. Hypertension B. Hemorrhage C. Infection D. Heart disease 9. The pudendal nerve originates from the A. L4-5, S1-2 B. S1-S3 C. S2-S4 D. S4-S5

11. Which of the ff fetal activities is monitored during a contraction stress test? A. Breathing B. Eye movements C. Heart rate D. Body movements 12. What is the average daily iron requirement during the latter half of pregnancy? A. 1 mg/day B. 3 mg/day C. 5 mg/day D. 7 mg/day 13. What controls fetal heart rate acceleration? A. Autonomic function at brainstem level B. Aortic baroreceptor reflex C. Carotid baroreceptors D. Humeral factos such as atrial natriuretic peptide 14. Early accelerations is compatible with: A. Cord compression B. Head compression C. Uteroplacetal insufficiency D. Multiple factors 15. During early pregnancy, which of the ff replaces the ovary as the main source of progesterone production? A. Amnion B. Chorion C. Trophoblast D. Myometrium 16. Engagement has occurred when this diameter of the fetal head has gone beyond the pelvic inlet A. Suboccipito-bregmatic B. Mento-occipital C. Fronto-occipital D. Biparietal 17. The rate of descent of the fetal head during labor is fastest in this division of labor: A. Preparatory B. Dilatational C. Pelvic D. Deceleration 18. The most common cause of arrest disorders in labor is: A. CPD B. Hypotonic uterine dysfunction C. Malposition D. Excessive sedation/anesthesia 19. Optimal analgesia for the 1st stage labor requires neural blockade at what levels: A. T8-L1 B. T10 L1 C. T8 L2 D. T10 S1 20. What is the maneuver where the index and middle fingers are applied over the maxilla in order to free the head? A. Bracht B. Zavanelli C. Pinard D. Mauriceau

10. If pregnancy occurs, the corpus luteum is necessary for the maintenance of the pregnancy for at least: A. 7 days B. 2 weeks C. 4-5 weeks D. A few months

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21. A history of vaginal leakage of fluid, either continuously or as a gush, should prompt: A. Bed rest B. Speculum exam C. Internal exam D. Delivery 22. Schillers test for cervical punch biopsy utilizes? A. Acetic acid B. Lugols iodine solution C. 10% KOH D. 20% KOH 23. Which of the ff is likely to be present at very low levels in the amniotic fluid of infants of diabetic mothers near term? A. Phosphatidylinositol B. Dipalmitoylphosphatidylcholine C. Lecithin D. Phosphatidylglycerol 24. Regarding traction with forceps, which of the ff statements is incorrect? A. The fetal head should be allowed to recede in intervals B. Delivery should be deliberate and slow C. Gentle traction should be intermittent D. It is preferable to apply traction between contractions to avoid excessive pressure 25. Which of the ff describes a frank breech presentation? A. Flexion of the hips and flexion of the knees B. Flexion of the hips and extension of the knees C. Extension of the hips and flexion of the knees D. Extension of the hips and extension of the knees 26. The uterine artery originates from the: A. Aorta B. External iliac artery C. Common iliac artery D. Internal iliac artery 27. Common cause of subinvolution includes which of the ff? A. Fetal macrosomia B. Puerperal pelvic infection C. Antenatal polyhydramnios D. Cessation of breastfeeding 28. One typical clinical characteristic of uterine afterpains includes which of the ff: A. Resolve after the 7th day of puerperium B. Require analgesics C. Aggravated by breastfeeding D. Relieved by uterine massage 29. How many weeks after delivery does it take the uterus to return to normal non-pregnant size? A. 2 wks B. 3 wks C. 4wks D. 6 wks 30. What is the most common etiologic agent for mastitis? A. Staph epidermidis B. Staph aureus C. Enterocci D. Group A Strep 31. Fever due to breast engorgemtn is commonly characterized by which of the ff: A. Exceeds 39C B. Last <24hr C. Onset within 24 hrs of puerperium D. Last >48 hrs

32. Which of the ff organism is implicated as a cause of late puerperal infection? A. Chlamydia trachomatis B. Neisseria gonorrhea C. BActeroides bivius D. Trichomonas vaginalis 33. On pelvic exam, boundaries of the vestibule are: A. Labia minora, clitoris, posterios fourchette B. Labia majora, mons pubis, post. Perineum C. Clitoris, mons pubis, post fourchette D. Labia minora, labia majora, mons pubis 34. The dreaded complication encountered in a previous classical CS in pregnancy: A. Dehiscence B. Rupture C. Infection D. Preterm labor 35. This change in cardiovascular function is expected in the pregnant state in order to maintain the hemodynamic stability of the mother A. Increase in stroke volume B. Decrease in heart rate C. Increase in SVR D. Decrease in CO 36. Which of the ff pulmonary function changes is observed during pregnancy? A. Decrease in tidal volume B. Decrease in minute ventilatory volumey C. In crease in functional residual capacity D. decreased residual volume 37. This structure is the landmark for measuring adequacy of the midpelvis: A. Ischial spines B. Sacral promontory C. Symphysis pubis D. Ischial tuberosities 38. What number of vessels would a normal cord have? A. 1 artery, 2 veins B. 2 arteries, 1 vein C. 1 artery, 1 vein D. 2 arteries, 2 veins 39. What is the immediate precursor for estrogen biosynthesis in human placenta? A. Acetate B. Cholesterol C. Progesterone D. Dehydroepiandrosterone sulfate 40. What physiological condition causes pregnant women to become hypoxemic more rapidly during periods of apnea? A. Decreased total lung capacity B. Increased residual volume C. Decreased functional residual capacity D. Increased tidal volume 41. Pregnant women with chronic hypertension are at greatest risk compared with nonhypertensive controls for which of the ff adverse events? A. Deep venous thrombosis B. Placental abruption C. First trimester abortion D. Postpartum cardiomyopathy 42. The ff anti-TB drugs can be given in pregnancy except: A. Rifampicin B. Pyrazinamide C. Ethambutol
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D.

Isoniazid

D.

Hypogonadotrophic hypogonadism

43. The DOC for tx of malaria in pregnancy: A. Metronidazole B. Chloroquine C. Fluoroquine D. Pen G 44. Infertility is defined as inability in effective pregnancy after how many years of cohabitation? A. 1 B. 2 C. 3 D. 4 45. To control an acute bleeding episode from dysfunctional uterine bleeding in the young and repro age patient, this regimen has been found clinically useful? A. High dose estrogen admistration B. Sequential high dose estrogen-progestin (ocp) C. Progestin therapy D. A and B only 46. When is the best time to perform a self-breast exam in relation to the menstrual cycle? A. Before B. During C. After D. Anytime 47. The rate of descent of the fetal head during labor is fastest in this division of labor: A. Preparatory B. Dilatational C. Pelvic D. Deceleration 48. At 20 wks gestational age, what is the approximate crown-heel length of the fetus? A. 15 cm B. 20 cm C. 25 cm D. 30 cm 49. Involuntary loss of urine to uninhibited detrusor contractions is associated with which type of incontinence? A. Urge B. Genuine stress C. Mixed D. Overflow 50. What are the cardinal movements of labor (in order)? A. Descent, engagement, flexion, internal rotation, extension B. Descent, flexion, engagement, internal rotation, extension C. engagement, descent, flexion, internal rotation, extension D. engagement, flexion, descent, internal rotation, extension 51. An infertility patient with PCO, iiregular menses and with a BMI index of 30 was seen in the clinic. Fallopian tubes were patent and the husband has normal sperm analysis. First line of management should be? A. Clomiphene citrate 50 mg daily B. Weight loss C. Metformin 500 mg daily D. Metformin 500 mg BID E. B and D 52. Among the patient with anovulatory infertility a common problem which may resistant to clomiphene citrate is : A. PCO B. Hyperprolactinemia C. Hyperandrogenism

53. The most difficult anovulatory problem to solve is: A. Hypergonadotrophic hypogonadism B. Hypogonadotrophiv hypogonadidm C. Normogonadotropic eugonadism 54. A sign and symptom that may suggest insulin resistance among PCO patients include/s: A. Acanthosis nigricans B. Obesity C. Hyperandrogenism D. AOTA 55. Disadvantage/s of HMG therapy for anovulatory infertility include/s: A. Increased risk for ovarian hyperstimulation B. Increased risk of multiple pregnancy C. Need for special monitoring with TVS D. AOTA 56. Acceptable statements relating to the current status in the association of ovarian cancer with the use of drugs for induction of ovulation includes: A. Informed consent is needed B. Therapeutic protocols need to be shortened C. Women treated with these drugs need to br monitored more rigorously D. AOTA 57. Among the patient with infertility who are obese evidence based data suggest that the best treatment is: A. Advice to lose weight B. Use of COS C. Use of IUI D. IVF ET 58. How many times can IUI be done before proceeding to more invasive technique? A. Once B. Three C. Five D. Ten 59. Among PCOS patients the possibility of insulin resistance is suggested by: A. Acanthosis nigricans B. Obesity C. Hyperglycemia D. AOTA 60. all of the ff statements are true regarding preoperative planning except A. Obtaining informed consent is a goal of preoperative planning B. Preoperative laboratory screening tests discover <10% of significant surgical risk factors C. Detailed history and physical exam detects approximate 90% of the facts pertinent to the surgical procedure D. Repetitive history taking is stressful and not advisable 61. The most common serious morbidity associated with elective gynecologic surgeries arise from complications of this organ system A. Respiratory B. Cardiovascular C. Gastrointestinal D. Neuromuscular 62. The effective period in which prophylactic antibiotics are protective take place within what time ff contamination? A. 1 hour B. 3 hours C. 8 hours D. 12 hours
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63. The most important risk factor predisposing to postoperative infection is: A. Preexisting medical condition B. Age C. Socioeconomic class D. Length of operation 64. Preventive measures for developing thromboembolic disease include all except: A. Discontinue oral contraceptive pills 4 weeks before major surgery B. Complete bed rest C. Use of elective stockings and support hose D. Discontinue smoking 2-4 weeks before major elective surgery 65. This condition is thought to be the cause of 90% of fevers in the first 48 hours after gynecologic surgery A. Microatelectasis B. Superficial thrombophlebitis C. Urinary tract infection D. Wound breakdown 66. A true reflection of post operative blood loss is hematocrit drawn within: A. 23 hours after surgery B. 48 hours after surgery C. 72 hours after surgery D. 1 week after surgery 67. Which of the ff is an early sign of hidden internal hemorrhage? A. Dyspnea B. Tachycardia C. Muscle rigidity D. Abdominal distention 68. The gold standard for diagnosis of DVT? A. Venography B. Doppler US C. Real time U/S D. Duplex Doppler imaging 69. Which of the ff hypertensive medications should be discontinued prior to surgical procedure? A. Beta blockers B. Ca channel blockers C. Diuretics D. MAO inhibitors 70. Pregnant GBS colonizers not given antimicrobial prophylaxis during labor may have an increased risk of developing the ff, EXCEPT: A. PROM B. Portpartum metritis C. Pyelonephritis D. Thrombophlebitis 71. A pregnant teenager has a (+) VDRL test result and a (-) FTA-ABS test. Which of the ff statements regarding her case is TRUE: A. She had syphilis in the past but now is cured B. She may transmit the infection to her child C. Her child will have apopositive VDRL and is at risk of having syphilis D. She should be evaluated for a collagen vascular disease 72. Untreated gonorrhea in the female frequently leads to: A. Obstruction of the fallopian tubes B. Ovarian cysts C. Ulceration of the cervix D. Endometrial polyp 73. A 25- year old G2P2 was found to have a 5cm unilocular cyst on the right ovary. This is most probably a: A. Physiologic cyst B. Benign epithelial cyst C. Ovarian cancer

D.

Dermoid cyst

74. Which of the ff ovarian neoplasms is most commonly seen in young women? A. Epithelial ovarian cancer B. Germ cell tumor C. Granulose cell tumor D. Krukenberg tumor 75. Which of the ff is a risk factor for cervical cancer but a protective factor for ovarian and endometrial cancers? A. Early sexual debut B. HPV infection C. OCP D. Multiparity 76. The most common and earliest mode of dissemination of ovarian cancer is: A. Transcoelomic/contiguous B. Lymphatic C. Hematogenous D. Perineural 77. The theory regarding the etiology of ovarian cancer is A. HPV infection B. Unopposed estrogen stimulation C. Frequent ovulation D. Genetic predisposition 78. Metastatic tumors are more common than primary tumors in which of the ff organs: A. Fallopian tubes B. Vagina C. Ovary D. A and B only 79. The most common group of ovarian cancers is: A. Epithelial ovarian cancer B. Germ cell tumor C. Sex cord stromal tumors D. Metastatic tumor 80. The presence of ferning pattern in evaluation of rupture of amniotic membrane is explained by what hormone? A. Estrogen B. Progesterone C. Prolactin D. Estrone 81. Why women find it difficult to leave a violent relationship? A. Concern for the children B. Hoping the partner will change C. Normalization of abuse and violence D. AOTA 82. Characteristics of a batterer and predictors of violence are the ff except: A. High regard to women B. Has low self-esteem C. Externalizes the cause of the behavior D. Can be pleasant or charming between periods of violence 83. Characteristics of dysmennorrhea include: A. Frequently seen in young women B. Ovulatory cycles C. Anovulatory cycles D. Common in multiparous women E. A and B are correct 84. The first microscopic evidence of ovulation in an endometrial biopsy is A. Back to back appearance B. Vascularity
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C. D.

Subnuclear vacuolization Stromal cell proliferation

D.

Hysterectomy

85. Increased circulating prolactin concentration is associated with all of the ff except: A. Stress B. Hyperthyroidism C. Anorexia nervosa D. Acromegaly 86. The most common cause of blood nipple discharge is: A. Breast ca B. Intraductal carcinoma C. Fibrocystic disease D. Galactocoele 87. The most appropriate method of obtaining a tissue diagnosis in a 60y/o woman with a 5cm hard mass with irregular borders is: A. Fine needle aspiration B. core needle biopsy C. Excision biopsy D. Incision biopsy 88. The primary mode of tx of breast CA is: A. Hormonal B. Radiotherapy C. Chemotherapy D. Surgery 89. The appropriate tx after mastectomy for a 43 y/o woman with 3 cm infiltrating ductal carcinoma with metastasis to 5/15 axillary lymph node., whose tumor is estrogen receptor negative and progesterone receptor negative A. Chemotherapy alone B. Radiotherapy to axilla, then chemo with tamoxifen C. Chemo then tamoxifen for 5 yrs, no further tx is needed D. Radiotherapy alone 90. A 29 y/o G3P3 undergoes diagnostic laparoscopy for complains of severe dysmenorrheal and dyspareunia. Laparoscopy confirms Stage III-IV endometriosis. Which is the best management? A. Hormonal therapy B. Conservative surgery wit LUNA C. Total abdominal hysterectomy with retention of 1 or both ovaries D. TAHBSO 91. Anovulatory bleeding is seen in which of the ff histologic entities except: A. Normal proliferative endometrium B. Disorderly proliferative endometrium C. Glandulo-stromal breakdown D. AOTA 92. In a Pap smear, which of the ff morphologic feature is not characteristics of HPV? A. Periuclear halos B. Multi/binucleate cells C. Nuclear atypia D. Intranuclear inclusion 93. Neoplastic lesions associated with HPV infection include the ff EXCEPT: A. Cervical squamous cell CA B. Vaginal squamous cell CA C. Vulvar squamous cell CA D. Endometrial adenoCA 94. A 32 y/o woman with primary infertility of 4 yrs was found to have CIN III on colposcopy-guided punch biopsy. The most appropriate tx is: A. Observation with close ff-up B. HPV vaccine C. Conization

95. The ff are the risk factors in the devt of cervical CA EXCEPT A. Early onset of sexual activity B. Nulliparity C. Multiple sexual partners D. OCP intake 96. the best tx for a 45 yo woman with menorrhagia and diagnosed to have adenomyosis is A. Progesterone therapy B. Danazol C. OCP D. Hysterectomy 97. The clinical staging and natural history of fallopian tube cancer is similar to cancer of the: A. Vulva B. Vagina C. Endometrium D. Ovary 98. During the pelvic exam, we should palpate the area of the posterior third of the labia majora by placing the index finger inside the intoitus and the thumb on the outside of the labium. In this way, we are able to assess the A. Gartners duct B. Bartholin glands C. Skenes duct D. Perineal body 99. A woman who complains of infertility for 4 years will benefit from this initial examination A. Hysterosalpingography B. Diagnostic and therapeutic hystoscopy C. Vaginoscopy D. Diagnostic laparoscopy 100. Which of the ff patients would least likely require endometrial biopsy? A. 48 years old with continuous vaginal bleeding B. 53 years old on hormone replacement therapy complaining of vaginal spotting C. 28 yo suspected of having pelvic TB D. 35 yo diagnosed with endometriosis 101. The ave duration of puberty as determined by the number of years between Tanner Stage B2 to B5 is A. 3.5 yrs B. 4.5 yrs C. 5.5 yrs D. 6.5 yrs 102. A patient consulted the outpatient clinic on January 08, 2007. She was born on August 08, 1990 and have not had her menarche. What will you do? a. Work-up for primary amenorrhea b. Check for the presence of ovarian neoplasms c. Check for the presence of uterine masses d. Observe patient with close follow-up 103. The first index of declining ovarian function leading to menopause is: a. Drastic drop in estradiol levels b. Fall in inhibin levels c. Fall in GnRH secretion d. Steady decline of gonadotrophin levels 104. During menopause, women are more prone to develop osteoporosis because A. There is accelerated Ca excretion B. There is increased production of PTH C. There is poor Ca absorption during menopause D. There is loss of inhibition of PTH by extrogen and progesterone
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105. The ff changes are least likely to be observed by menopausal women A. Increased HDL levels as well as lowered cholesterol and TG levels B. Shift of fat deposition from peripheral sites to the abdomen C. Wrinkling of skin due to decrease in collagen in the dermis brought about by estrogen deficiency D. Vulvar itching and burning sensation due to atrophic vaginitis 106. Girls with precocious puberty have diminished ultimate height because A. They do not experience the period of mazimal growth B. They do not produce growth hormone C. They have accelerated bone growth and premature closure of epiphysis D. The end organs are insensitive to growth hormones 107. A 6 yo girl come to you wit vaginal bleeding 1 week ago wit Tanner stage 1 for breast and pubic hair on examination. U/S showed a 7x6 cm solid mass at the R pelvic area. Initial considerations will be A. Central precocious puberty B. Peripheral precocious puberty C. Incomplete precocious publerty D. Premature adrenarche 108. What Beta HCG level warrant prophylactic chemotherapy for molar pregnancy? A. >10,000 B. >100,000 C. >20,000 D. >200,000 109. Chronic pelvic pain in a sexually active individual in reproductive age with multiple sexual partner is frequently equated with: A. Endometriosis B. Ademoyosis C. PID D. Anovulatory cycles 110. Which of the ff estrogen is used in oral contraceptives? A. Estrone B. Estriol C. Ethinyl estradiol D. Equilin 111. In which surgical approach to ectopic pregnany is the tube opened to remove the gestational products, then closed? A. Salphingostomy B. Salphingitomy C. Salphinhectomy D. Salphingorrhapy 112. A woman has the higher risk of having an ectopic pregnancy when: A. Undergone corrective tubal surgery B. Had previous ectopic pregnancy C. Previous pelvic or abdominal surgery D. Smoking 113. Which of the ff is being studied as possible protective against cerebral palsy and other neurological deficits in the offspring of women treated for preterm labor? A. Indomethacin B. Ritodrine C. Terbutaline D. Mg SO4 114. In a 30 yo G1P1 (1001) 4 weeks postpartum, who is partially breastfeeding and with hx of endometritis the best contraceptive is: A. An IUD B. Lynestrenol contraceptive C. A multiphasic contraceptive D. A monophasic contraceptive

115. The minipill prevents pregnancy by A. Producing a thickened endomentrium B. Producing a scanty cervical mucus C. Inhibiting GnRH secretion D. Inihibiting FSH and LH release 116. Osteoporosis is a common problem encountered in women on: A. OCP B. Depot medroxyprogeterone C. IUD D. Diaphragm with spermicide 117. The best contraceptive option for a mentally challenged 26 yo G1P1 is A. An IUD B. A condom C. An OCO D. Depot medroxyprogeterone 118. Use of contraceptives decreased the risk of: A. Ovarian CA B. Breast CA C. Cervical CA D. Vaginal CA 119. The natural family planning method which depends on vaginal dryness or wetness is the: A. Yuzpe method B. Billings method C. Fernings method D. Chadwicks method 120. A 42 yo male who underwent vasectomy is sterile: A. 1 month after vasectomy B. 2 months after C. After 10 ejaculations D. After 20 ejaculations

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