GYNE 2015 6th year

about gonadal differentiation which is true:

- if you took the gonads before its differentiation outside the body, the will develop according to its
chromosomal workup

wolffian duct in female is represented by:

- regressed

you were called to examine a child which the nurse can not determine its sex, found genitalia
ambiguous ... the most common cause:
- adrenal hyperplasia

you were called to examine a child which the nurse can not determine its sex, found genitalia
ambiguous ... the most common cause:
- adrenal hyperplasia ?

which of the following make the lower uterine segment:

- isthmus ?
- interstitium
- cornu
- corpus
- cervix

which of the following make the lower uterine segment:

- isthmus ?
- interstitium
- cornu
- corpus
- cervix

in testicular feminisation the tests is removed because:

- high risk of malignancy

about precocious puberty, due to ovarian tumor, wrong:

- high levels of gonadotropine
about androgen insensitivity, wrong:
- small uterus

female with 32 day cycle, to achieve conception advise her to do intercourse around which day:
- 18th

female with amenorrhea, hx of 3 abortions with evacuation, the most likely cause is:
- asherman syndrome

hyperprolactinemia, wrong:
- dopamine agoint increase its levels

the most common cause of irregular menses during adolescence is:

- anovulation
- PCOS ?

Not found in PID :

Deep dysparunia
Oligomenorrhea *
Infertility

wrong about bacterial vaginosis:

- small amount of discharge with no specific odor

all cause perinatal fetal infection except ( all cause teratogenic effect except
- syphilis ?
- chicken box
- HSV
- toxo
- rubella
which of the following is used to diagnose cervical pregnancy:
- ultrasound
- b hcg levels

pregnant 36 wk with painless vaginal bleeding, next step:

- ultrasound

primi, vaginal bleeding, abdominal pain, opened cervical os ... most likely dx:
- incomplete abortion
- inevetable abortion

all are side effects of prostaglandin E1 except:

- water retention
- uterine contraction
- increase bowel peristalsis
- vomiting
- ??
all required to diagnose ectopic pregnancy except:
- clinical suspicion
- good examination
- absent intrauterine sac
- low b hcg
- ???
endomterial caner, localized to uterus, invade more than half of myometrium... later came with
mets ... which stage:
1b

teratoma, wrong:
- usually bilateral
most common ovarian tumor
-risk of malignancy is 1.5%
-rupture can be (bad

Female with loss of urine after she feels desire to void, the most likely cause is :
-unstable bladder
-anatomical stress incontinence
-diverticulum

The mechanism of leaking of urine out of the bladder is :

-detrusor smooth muscle contractions
-detrusor relaxation
-bladder neck relaxation
-contraction of external sphincter
-alpha adrenergic stimulation of internal sphincter

which of the following provide most support to urethra:

- cardinal lig
- posterior pupouerthreal lig

vaginal tear, involve external anal sphincter, not reaching rectal mucosa:
- 3rd degree

wrong:
- yolk sac tumor: AFP
- teratome: AFP
- choriocarcinoma : hcg
- ?? Dysgerminoma is radiosensitive
Dysgerminoma can secrete LDH

engagement means:
- passage of BPD through pelvic inlet

Asynclitism means
Female who had a molar pregnancy before, you tell her all of the following except:
-increased risk of abortion
-increased risk of another molar pregnancy
-increased risk of congenital malformations
-increased risk of postpartum hemorrhage

Female with a baby with closed spina bifida, presents at 10 wks GA (2nd pregnancy) all are true
except :
-risk of neural tube defect in this pregnancy is 10%
-valproic acid is associated with increased risk of NTD
-give her vitamins now
-can be diagnosed by genetic study

In labour , after engagement what happens ?

Descent , flexion , internal rotation , extension the external rotation

Female on tamoxifen to protect against breast cancer for the last 6 months, presented with heavy
vaginal bleeding, you found atypical hyperplasia in uterus, next step :
-increase dose of tamoxifen
-advise hysterectomy
-replace with estrogen

All are true about type 1 endometrial cancer except:

-occurs between 40-60 years
-positive estrogen and progesterone receptors
-extends deeply in the myometrium

All true about labour except:

-female in normal labour is allowed not to be confined to bed
-oral feeding should be discouraged
-moderate contractions last 30 seconds

All are risk factors to ovarian cancer except :

-family history
-age >40
-COCP

All are true about endometrial cancer except:

-risk is increased with increasing parity
-decreased with smoking

Invasion of the ectocervix by columnar epithelium is called :

-cervical eversion
-cervical erosion
-herpes simplex cervicitis
Mirena, all true except :
-associated with risk of ectopic pregnancy
-lower risk of ovarian follicular cysts
-can be used to treat DUB
-used as contraception for 5 years

which of the following occur with intrahepatic cholestasis in pregnancy:

- increase direct bilirubin
-normal bile acids
-normal gamma GT
-normal or increased alkaline phosphatase
-increased serum acid phosphatase

True in pregnancy:
-increased Hb
-increased SVR
-decreased cardiac output by 40%
-increased WBCs

GFR in pregnancy increase by

50%
all true about amniocentesis (done at 14 wks yemken) except :
-increases risk of RDS
-can be used to diagnose toxoplasma infection
-can be used to diagnose turner
-... Down
Not associated with fetal postural abnormalities

in a primigravida the head is delivered by :

a. flexion
b. extension
c. episiotomy

All can cause fetal tachycardia except :

- maternal hyperthermia
- maternal hyperthyroidism
- extreme prematurity
- hypervolemic *
-?

Not expected to be found in a baby with congenital rubella : intracranial calcification

The type of malformation that is expected to be found in rubella : cardiac malformations

The fetal head is delivered by :

- internal rotation
- external rotation
- episiotomy

Non reassuring NST , what is the next step ?

Give the mother orange juice then repeat after a while

Baby with early deceleration , what is the next step ?

Observe the mother

Patient 55 y/o , single , presented with PMB , endometrial Thickness is 8 mm

What is the next step ?
- fractional D& C
- hystectomy
- pap smear

All these situations we can give medical mgx to EP except :

Size > 4 cm

Patient was on tamoxifen for 6 months found to have atypical hyperplasia on endometrial biopsy ,
what is the next step ? No age no parity are mentioned

- advice for hysterectomy

- repeat biopsy
- do pelvic u/s
-Increase the dose of tamoxifen

On pv , fetal nose , mouth were palpated by the doctor

The mentum was facing the left hip , this is called :
Mentotransverse
Occipito transverse

Forceps used in breech delivery is : piper

1st day of menstrual cycle is may 26th 2014

Expected date of delivery is :
March. 2nd 201

One is true about physiologic changes in pregnancy :

Increase in white blood cells

GFR is increased in pregnancy by :

15 %
50 %
80 %
All carry good prognosis in metastatic GTD except
- no antecedent pregnancy ?
- no prior chemotherapy
- shorter duration of symptoms
- low b-hCG

amniotic fluid, true:

- composed 90% of water
- desquamenated fetal skin
- peak at term

I'm the least likely to decrease amniotic fluid tongue emoticon :

-PROM
-decreased maternal fluid intake
-drugs like ACEIs
-fetal diseases like lung, renal
-maternal diseases like DM and thrombophilia

Thrombophilia can cause all of the following except :

-early preeclampsia
-polyhydramnios
-arterial and venous thrombosis

anencephaly, associated with one if the following:

-preterm labour
-prolonged pregnancy

GDM, one is true:

-increased risk of congenital malformations
-beta cell destruction is a causative factor
-usually diagnosed in 2nd trimester

mediolateral episotomy is superior over midline one due to:

- less risk of extension

Contraindication to VBAC :
-previous low transverse CS 2 years ago
-previous myomectomy traversing the cavit

All are true except :

-risk of rupture after low transverse CS scar is 1/200
-1/3 of ruptures occur before onset of labour
-1st sign of rupture is abnormal fetal HR monitoring
-rupture is associated with 50% perinatal mortality

All are defense mechanisms against vaginal infection except :

-low PH
-doderlin bacillus
-opposition of vaginal walls
-bacteriostatic secretions of vaginal glands*
hcg, wrong:
- pepetide hormone
- peak at 20 wks
- stimulate testosterone production from fetus
- alpha subunit is similar to TSH

All are used to detect ovulation except :

-clinical symptoms
-basal body temperature
-endometrial thickness of 6 mm just prior to cycle
-endometrial biopsy premenstrual
-urinary hormones

all are indications to decrease MgSo4 except:

- hyperreflexia

non reassuring NST, next step is:

- ask mother to drink a cup of orange juice then repeat it ?
- give her 1 L normal saline IV then repeat it
- do contractional stress test
- ask mother to walk for 1 hour then repeat i

female with smear result of HSIL, next step:

colposcopy and biopsy

Kielland forceps, wrong

- has a pelvic curve
has a cephalic curve
-has a sliding lock

what is wrong about combined OCP :

a. should be given to a women 3 weeks after delivery if she is breastfeeding
b. if given on the 1st or 2nd day of menstruation then there is no need for the use of another
contraceptive methode
c. it is commonly associated with delayed return in fertility after stopping the pills

OCPs, wrong:
- should be given 3a 3 weeks if not breastfeeding
- if given on 1st or 2nd day no need for another method
- reversal of ovulation takes long time after stopping the pills ?

which of the following result in loss of urine:

- alpha agonist
- detrusser smooth muscle contraction ?
- neck relaxation

n ovarian cancer treatment, all taken into consideration except:

- symptoms?
Other choices
Age
Patient wishes
Depth or spread

least likely to cause urinary incontinence in post menopausal female:

- stress
- overflow
- detrusal hyperactivity
- fistula

65 ur old female with complaint of loss of urine which feeling of urge to void (can't remember the
exact sentence):
Anatomical stress Incontinence
Overflow incontinence
Urge incontinence

Criteria for diagnosing overactive bladder :

Urgency and frequency
Urgency and nocturia
....

Sth about diagnosing cervical ectopic (can't remember the qs well)

- MRI
- Ultrasound
- bhCG
- digital exam
- colposcopy

All of these are good prognostic indicators for malignant GTD except :
No chemo
Short duration;less than a year
No mets to brain , liver
No antecedent pregnancy

During labour Yu palpable fetal mouth and eye, chin is in the left hip:
Mental transverse position
Occupitotransverse
Brow presentation

not a risk factor for breech presentation :

Placenta previa
Large for gestational age
Uterine anomaly

IUGR baby least likely to experience :

Respiratory distress
Asphyxia
Hypoglycemia
Fetal heart tracing shows early deceleration what is the appropriate next step?
- do nothing
- change position
- immediate CS

Not a contraindication for induction of labor :

Active HSV
bishop 5
....

37 weeks, has painless vaginal bleeding, is stable and HCT 42%, what next step?
- immediate C/
- do ultrasound
- induction of labor

Least likely to result in decreased amniotic fluid :

- maternal decreased fluid intake
- maternal chronic disease like CKD, HTN , ..
- maternal use of ACEIs
- rupture of membranes
- fetal anomalies like agenesis of kidneys, lung, heart defects

rubella infection at 5th week GA will most likely lead to :

- cardiac defect
- cataract
- severe deafness
.....

Not a cause of fetal tachycardia :

Maternal hyperthyroidism
Maternal hyperthermia
Fetal hypervolemia

Mother with a previous child with closed spina bifida, now is 10 wl GA, which of these is true to tell
her:
Risk of subsequent NTD is 10%
- valorous acid can cause this
- she should be supplemented with vitamins now
- the baby needs full spinal investigation or sth ...

Umbilical cord prolapse which is not true :

More in multiparous
More in twin gestation and polyhydramnios
0.5% of pregnancies
If the head is not engaged return the umbilical cord

Not true about bacterial vaginosis :

- scant , non odorous discharge
- clue cells characteristic
- treated by metronidazole
Not mainly found in mid productive life females:
Nabothian cyst
Cervical polyp
Cervical cancer

Pelvic inflammatory disease wil not result in :

Dysmenorrhea
Infertility
Chronic pelvic pain
Oligomenorrhea

Most common symptom causes by intramural fibroids;

Intermenstrual bleeding
Pain
Menirrhagia

characteristic symptoms of cervical cancer except :

- vaginal discharge
- postcoital bleeding
- intermenstrual bleeding
- pelvic pain

Female with last menstruated period on 26, may, 2014 and it ended dunno when : when is the
expected date :
-2nd March 2015

Female with period every 32 days, which is true to tell her about the time she will most likely
ovulate ?
- at day 18 of cycle

Most imp structure for continence :

Cardinal ligament
Pubocervical fascia
Posterior pubourerthral fascia

Woman with cramps abdominal pain, vaginal bleeding , amenorrhea for 10 weeks, cervical is open:
Threatened abortion
Inevitable abortion
Complete abortion
Incomplete abortion

During labor head is delivered by :

Extension
External rotation
Internal rotation
Flexion

Not a contraindication for OCP:

Liver adenoma
Cardiovascular dis
Previous ovarian carcinoma especially granulosa cell
Hx of cholestatis in pregnancy and with previous pill use

Not a risk factor for ectopic pregnancy:

- OCP
- previous ectopic
- PID
- tubal surgery
- invetro fertilization

Sth about diagnosing cervical ectopic (can't remember the qs well)

- MRI
- Ultrasound
- bhCG
- digital exam
- colposcopy

Contraindication for methotrexate for abortion

Size more than 4
Reliable for follow up
Stable mother
Untutored ectopic

multiple gestation, wrong:

-usually cephalic cephalic
- usually monochorionic
- monozygotic has paternal factors ?
- dizygotic has familial factos

all of the following are midreproductive age disease except:

- cervical cancer
- cervical errosion
- cervical eversion
- ??

All are contraindications to COCPs except :

-unexplained vaginal bleeding
-stroke and CAD
-treated ovarian cancer especially granulosa
-pregnancy or OCP induced cholestasis
-hepatic tumors

The one with the highest risk for endometrial cancer :

-obese female with history of oligomenorrhea and infertility
-young female with anorexia nervosa
-black postmenopausal female ..,
-??
All are contraindications for induction of labour except :
-active genital herpes
-grade 2 posterior placenta previa
-bishop score 5
-transverse lie
-oblique lie

all result in sensitization in Rh isoimmunization except:

- minimal bleeding before 8 GA
Aminocentesis
Fetal demise

first mioetic division of oocyte is completed at:

- early in proliferative phase

when the cervical columar epithelium grows over .... result in:
- cervical eversion
-??
-??

Irregular ripening, all true except :

-incomplete development of corpus luteum
-may be due to abnormal response of the endometrium
-associated with premenstrual spotting
-biopsy shows progestational areas that should be in the proliferative phase*
-treated with progesterone

all predispose to vulvovaginal candidiasis except:

- DM
- OCPs
- IUCD ?
- immunosupression
- broad spectrum antibiotics

False about fertilization :

-occurs in the tube
-segmentation nucleus is formed by union of male and female pronucleus
-fusion of male and female pronucleus results in 23 chromosomes
-only one sperm can penetrate the ovum
-upon entering the yolk, the sperm loses its tai

True about fertilization :

-if 2 sperms fertilize an ovum the result is a trisomic infant
-requires action of sperm hyaluronidase

Body of the uterus can drain to all of the following lymph nodes except :
-external iliac
-obturator
-superficial inguinal