Download BAYSIDE COUNCIL IN OBSTETRICS AND GYNECOLOGY POST

BAYSIDE COUNCIL IN OBSTETRICS AND GYNECOLOGY
POST TEST IN GYNECOLOGY (DAY 2)
PHYSIOLOGY OF MENSTRUATION, AUB, MENOPAUSE, UROGYNECOLOGY
NAME________________________________
HOSPITAL____________________________
CHOOSE THE BEST ANSWER. ENCIRCLE THE LETTER OF YOUR ANSWER.
1. An ovulatory sequence is characterized by the following order of steps, starting with increased
FSH secretion:
A. increased estradiol and estrogen production, follicular growth, increased progesterone
production, LH surge, ovulation
B. follicular growth, increased estradiol production, LH surge, ovulation, progesterone production
C. follicular growth, increased progesterone production, LH surge, ovulation, increased estradiol
production
D. increased progesterone production, LH surge, ovulation, increased estradiol production,
follicular growth
2. A 15-yr-old high school student came to the clinic with her mother because of irregular menstrual
bleeding since menarche at age 13. Her last mense was 50 days ago. She is not sexually active
but the mother insisted on a pregnancy test which proved negative. PE was unremarkable. What
is the next best step in management?
A. start on combined low-dose pills
C. coagulation profile
B. progesterone only
D. observation and reassurance
3. The primary target of FSH activity is the:
A. adenohypophysis
B. neurohypophysis
C. ovarian granulose
D. ovarian theca
4. Ovulation usually occurs:
A. within 24 hrs before LH peak
B. within 24 hrs after LH peak
C. at the same time as LH peak
D. at the same time as estradiol peak
E. at the same time as progesterone peak
5. Prior to menopause, what is the major source of circulating estrogen?
A. conversion from estriol
D. secretion adrenals
B. conversion from estrone
E. secretion from adipocytes
C. secretion from the ovaries
6. An overweight 47-yr-old comes for a 6-month history of heavy and prolonged menstrual bleeding
lasting 14-18 days. Previous menses were of moderate flow lasting for 4-6 days and occurred at
fairly regular monthly intervals. What is the most likely cause of her heavy flow?
A. endometrial cancer
C. anovulation
B. submucous myoma
D. coagulopathy
7. A 29-yr-old single, nulligravid, medium-level corporate executive, came to the clinic with complaints
of no menses for the last 5 months. Menarche was at 12 yrs of age, became regular about a year
later until this noted amenorrhea. She is doing Ph.D. studies on Friday and Saturday nights and to
relieve stress has joined a running group who run 4 times a week. The group is also training
almost daily in preparation for a marathon. Patient cut down on carbs to run lighter. What structure
is most likely reason for the amenorrhea?
A. Hypothalamus
C. ovaries
B. Pituitary
D. uterus
8. A 34-yr-old G2P2 came for complaints of prolonged menstrual bleeding. She is on her 16 th day of
the cycle and transvaginal ultrasound showed a 7.8cmx7cm uterus with homogenous echopattern.
Endometrium was 0.6cm thick. Adnexa were unremarkable. What is the next best treatment?
A. Estrogens
C. combined low-dose contraceptives
B. Progesterone
D. GnRH analogue
9. The lifespan of the corpus luteum is limited to a period of about 14 days. The only hormone that
can rescue the corpus luteum is:
A. Progesterone
C. LH
B. Hcg
D. FSH
10. After menstruation, regeneration of the endometrium comes from:
A. stratum basale
B. stratum spongiosum
C. stratum functionale
D. all layers of the endometrium
11. Which of the ff is the main action of PGF2alpha in hemostasis?
A. Localized vasoconstriction
C. formation of platelet plug
B. Platelet adhesion
D. reinforcement of the platelet plug
12. Which of the ff definitions has recently been described to refer to a significant disturbance in
menstrual bleeding and has replaced the term menorrhagia?
A. Abnormal uterine bleeding
C. Heavy menstrual bleeding
B. Dysfunctional uterine bleeding
D. Intermenstrual bleeding
13. Which of the ff drugs stimulates arachidonic acid formation and increase PGF2α/PGE ratio?
A. Estrogens
C. NSAIDs
B. Progestins
D. Antifibrinolytic agents
14. A 38-year-old nulligravid consulted because of recurrence of intermenstrual bleeding. She
underwent endometrial curettage last year which revealed an endometrial polyp on histopath.
Which among the ff procedures is the most appropriate to recommend at present?
A. Dilatation and Curettage
C. Hysteroscopy
B. Office Endometrial biopsy
D. Hysterectomy
ITEMS 15-16.
A 20-year-old single nulligravid consulted because of an acute episode of heavy menstrual bleeding
for 7 days. Pelvic exam is unremarkable. Pregnancy test is negative.
15. Which of the ff medications would you give to control the acute bleeding episode?
A. Conjugated equine estrogen 10 mg/day
B. Progesterone 5 mg/day for 5 days
C. Mefenamic acid 500 mg every 6 hours
D. GnRH agonist 3.75 mg
16. Which of the ff medications is the most appropriate to prevent future recurrence of AUB-O?
A. Tranexamic acid
C. Cyclic progestin
B. Danazol
D. NSAID’s
17. A 55-year-old Gravida 6 Para 6 consulted because of recurrence of heavy menstrual bleeding
which resulted to anemia. She underwent 2 endometrial curettages, both revealed proliferative
endometrium; the most recent one was done 2 weeks ago. She tried high dose Tranexamic acid
and high dose Estrogen which did not afford relief of the heavy bleeding. Which of the ff is the
most appropriate mode of treatment?
A. Observation
B. Repeat endometrial curettage
C. Endometrial ablation
D. Hysterectomy
RISER Post Test (Day 2) Page 2 of 5
18. Which of the ff is the main pathogenesis of AUB-O among premenarcheal?
A. Abnormal LH surge because of decreased capacity to secrete estradiol
B. Defect in follicular maturation
C. Estradiol surge not followed by LH surge
D. Tonically elevated LH levels
19. Which of the ff patients would warrant an endometrial sampling?
A. Breast cancer patients on Tamoxifen who complain of abnormal vaginal bleeding
B. Women who are still menstruating after 52 years of age
C. Postmenopausal women with endometrial cells on pap smear
D. All of the above
E. A & B only
20. Give the FIGO classification for AUB for an adolescent who experienced heavy menstrual
bleeding, as a result of Von Willebrand disease:
A. AUB-C
B. AUB- D
C. AUB- O
D. AUB- N
21. Menopause is the permanent cessation of menstruation caused by failure of A. ovarian follicular development
B. estradiol production
C. Gonadotropin production
D. all of the above
E. A and B only
22. The initial endocrinologic change signaling the onset of menopause is a decrease in:
A. Activin
C. LH
B. Inhibin
D. FSH
23. The hallmark feature of declining estrogen status in the brain is:
A. Hot flush
C. depressed mood
B. Disturbed sleep
D. cognitive decline
24. Skin, teeth, and vaginal manifestations of estrogen deficiency is secondary to:
A. muscle atrophy
B. ligament weakening
C. collagen loss
D. thinning of epidermis
25. A woman's risk for developing atherosclerosis is elevated AFTER menopause because:
A. increase cholesterol, body weight and blood pressure
B. increase if nitric oxide synthesis
C. loss of cardioprotection from decrease in estrogen.
D. All of the above
E. A and B only
26. Osteoporosis only happens in women
A. True
B. False
27. Which of the following statements is/are TRUE?
A. Estrogen therapy should be offered to all menopausal women for cardiac protection.
B. Testosterone for cardiac protection can be offered in women with contraindication for estrogen
therapy.
C. Effect of estrogen therapy among menopausal women varies depending on the time of
initiation of therapy.
D. All of the above
E. A and C only
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28. Which of the following patients is NOT going through menopause?
A. 35-year-old, with irregular menses and hot flushes
B. 45-year-old, regular menses, with hot flushes
C. 35-year-old with Osteoporosis by DEXA
D. 45-year-old, with normal DEXA
29. A 47-year-old woman consults because of irregular menses and hot flushes. Best management:
A. Hormone therapy
B. Oral contraceptive pills
C. Observe only because she's not yet menopause
D. Phytoestrogens
30. A 54-yr-old woman, menopause for 3 years, otherwise healthy wants bone protection. Best
management:
A. Advise exercise and increase calcium
B. Tibolone to decrease risk of breast cancer
C. Hormone therapy
D. All of the above
E. A and C only
31. What is the neurotransmitter involved in mediating detrusor contraction?
A. Norepinephrine
C. nitric oxide
B. Acetylcholine
D. glutamate
32. What is the syndrome that is characterized by lower urinary tract symptoms as urgency, frequency
and nocturia?
A. urge urinary incontinence
B. overactive bladder
C. urinary stress incontinence
D. chronic retention of urine
33. The following may be transient causes of urinary incontinence EXCEPT:
A. stool impaction
B. delirium
C. spinal cord trauma
D. atrophic urethritis
34. Norepinephrine acts on this particular type of receptor found in the bladder neck (internal urethral
sphincter) to maintain continence
A. alpha receptors
B. beta receptors
C. delta receptors
D. muscarinic receptors
35. In a patient complaining of frequency, urgency, nocturia and incontinence on sneezing and
coughing, what type of disorder does she have?
A. urinary stress incontinence
B. urge urinary incontinence
C. mixed urinary incontinence
D. overflow incontinence (chronic retention of urine)
36. A healthy 67-year-old patient with a Stage II uterovaginal prolapse claims to have urinary
incontinence but tested negative during a cough stress test on urodynamic studies. What is the
ideal management for her?
A. vaginal hysterectomy only
B. prolapse surgery and reassurance that incontinence might resolve spontaneously post-op
C. anterior and posterior colporrhaphy only
D. prolapse and continence surgeries
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37. A 21-year-old primigravid who delivered 2 days ago to a 3.7 kg baby complains of oliguria
postpartum. On probing, she also has urgency, frequency and stress incontinence since the
delivery. What is your most likely diagnosis?
A. urinary stress incontinence
B. urge urinary incontinence
C. mixed urinary incontinence
D. overflow incontinence
38. A patient with bothersome overactive bladder symptoms (urgency, frequency, nocturia and urge
incontinence) consults. She is adamant in resolving her symptoms as soon as possible. What is
the best option for her?
A. Advise continence surgery.
B. Initiate a program of timed voiding.
C. Advise a stringent regimen of pelvic floor muscle training.
D. Start anticholinergic therapy and bladder training.
39. Best therapy for patients without any neurological disorder who have urinary retention:
A. bladder clamping-unclamping until with no or minimal residual volume
B. indefinite bladder rest to open drainage
C. initiate medical therapy with parasympathomimetic drugs
D. refer for urethral dilatation
40. Anticholinergic drugs are not without any adverse effects. The following are contraindications to
prescribing such drugs EXCEPT:
A. open angle glaucoma
B. colonic motility disorders
C. cardiac problems
D. urinary retention
*** END OF EXAM ***
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