Gynecology

·      Anatomy Review

1.    Vulva.

***) All of the following structures are included in the term vulva, except:

A.    Clitoris

B.     Urethral orifice

C.     Labia minora

D.    Nabothian cysts

E.     Bartholin’s glands

Answer: D* Nabothian cysts

***) The nerve supply to the vulva is derived from all of the following nerves, except:

A.    The pudendal nerve

B.     The ileo-inguinal nerve

C.     The genito-femoral nerve

D.    The posterior cutaneous nerve to the thigh

E.     The inferior hemorrhoidal nerve

Answer: E* The inferior hemorrhoidal nerve

2.    Vagina.

***) All of the following are true about vagina, except:

A.    The pH is 4

B.     It contains no glands

C.     Whitish non-offensive discharge is normal finding

D.    Doderlein's bacilli is abnormal finding

E.     Posterior wall is longer than anterior wall

Answer: D* Doderlein's bacilli is abnormal finding

***) The normal vagina in the reproductive age is characterized by all of the following, except:

A.    Contains Doderlein’s bacilli

B.     Lined by stratified squamous epithelium

C.     Has a pH of 4.5

D.    The epithelium contains secretory cells

E.     Is divided by the cervix into four fornices

Answer: D* The epithelium contains secretory cells

***) The lining epithelium of the vagina is:

A.    Stratified squamous epithelium

B.     Simple columnar epithelium

C.     Tall columnar epithelium

D.    Transitional epithelium

E.     Ciliated columnar epithelium

Answer: A* Stratified squamous epithelium

***) All of the following effects occur on the vagina by estrogen, except:

A.    The vagina becomes more vascular

B.     The vaginal epithelium grows

C.     The vaginal glands start to secret

D.    The epithelium cells become filled with glycogen

E.     The glycogen is broken by Doderlein's bacilli which cause lowering of vaginal pH

Answer: C* The vaginal glands start to secret

3.    Uterus.

***) The uterine artery is a branch of one of the following:

A.    External iliac artery

B.     Internal iliac artery

C.     Common iliac artery

D.    Middle sacral artery

E.     Obturator artery

Answer: B* Internal iliac artery

***) The best support to the uterus is by:

A.    The broad ligaments

B.     Infundibulopelvic ligaments

C.     Round ligament

D.    Utero-ovarian ligament

E.     Cardinal ligament

Answer: E* Cardinal ligament

***) The round ligament of the uterus terminates in one of the following:

A.    Symphysis pubis

B.     Iliac crest

C.     Upper portion of labium majus

D.    Upper portion of labium minus

E.     Upper portion of inguinal canal

Answer: C* Upper portion of labium majus

***) Regarding lower uterine segment, all the following are true except:

A.    It represents isthmus in non pregnant uterus

B.     It lies between the anatomical and histological internal os

C.     It is a passive segment compared to the upper segment which is active

D.    In obstructed labor it can form Bandl's ring

E.     It is the least site of rupture in obstructed labor with no previous CS scar

Answer: E* It is the least site of uterus in obstructed labor with no previous CS scar

4.    Ovaries.

***) The left ovarian vein empties in one of the following:

A.    Vena cava inferior

B.     Left common iliac vein

C.     Left internal iliac vein

D.    Left renal vein

E.     Left external iliac vein

Answer: D* Left renal vein

***) The most inner part of a mature Graafian follicle is:

A.    Theca interna

B.     Theca externa

C.     Granular cell layer

D.    Zona pellucida

E.     Ovarian stroma

Answer: D* Zona pellucida

***) Maximal number of germ cells in the ovary occurs at:

A.    22 weeks of intrauterine life

B.     30 weeks of intrauterine life

C.     Birth

D.    Menarche

E.     Age of 25 years

Answer: A*22 weeks of intrauterine life

***) Ovarian failure causes atrophic changes in all of the following, except:

A.    Uterus

B.     Vagina

C.     Urethra

D.    Bone

E.     Rectum

Answer: C* Urethra

·      Menstruation

1.    Menstrual Cycle.

***) Regarding menstrual cycle, all the following are true except:

A.    Increasing levels of FSH from anterior pituitary gland

B.     FSH release is influenced by gonadotropin releasing hormone from hypothalamus

C.     FSH promotes follicular development in the ovary

D.    Ovulation occurs 14 days from 1^st day of the cycle

E.     The endometrium undergoes proliferation during 1st half of the cycle

Answer: B* FSH release is influenced by GnRH from hypothalamus

***) In a normal menstrual cycle of 35 days duration, ovulation occurs:

A.    Two weeks before menstrual flow

B.     Mid cycle

C.     Time of maximum progesterone production

D.    Two weeks after the onset of the menstrual flow

E.     Time of maximum prolactin production

Answer: A* Two weeks before menstrual flow

***) Severe hyperstimulation syndrome associated with gonadotropin therapy may be manifested clinically by the following, except:

A.    Abdominal pain

B.     Ascites

C.     Follicular cysts

D.    Hypovolemic shock

E.     Thrombo-embolic episodes

Answer: A* Abdominal pain

***) Physiologic processes that are estrogen dependent in women include all the following except:

A.    Menses

B.     Vaginal cornification

C.     Hirsutism

D.    Appearance of axillary hair

E.     Production of cervical mucus

Answer: C* Hirsutism

·      Common Procedures

1.    Dilatation and Curettage.

***) In a 38 years old woman complaining of irregular and heavy periods, the first line of management is:

A.    Vitamin K injections

B.     Dilatation and curettage (D&C)

C.     Hormone therapy

D.    Immediate hysterectomy

E.     Radiotherapy

Answer: B* Dilatation and curettage (D&C)

***) Complication of Dilation and Curettage D&C include all of the following, except:

A.    Uterine perforation

B.     Injury of the urethra

C.     Cervical laceration

D.    Cervical stenosis

E.     Asherman's syndrome

Answer: B* Injury of the urethra

2.    Laparoscopy.

***) Laparoscopy is a useful investigation to diagnose one of the following conditions:

A.    Adenomyosis

B.     Congenital uterine abnormalities

C.     Premature ovarian failure

D.    Endometriosis

E.     Vaginal atresia

Answer: D* Endometriosis

3.    Hysteroscopy.

***) The following are contraindications for Hysterosalpingography, except:

A.    Uterine bleeding

B.     Active pelvic infection

C.     Suspected pregnancy

D.    Bicornuate uterus

E.     Active cervicitis

Answer: D* Bicornuate uterus

·      Disorders of Menstruation 

1.    Amenorrhea.

***) Concerning primary amenorrhea, all the following are true except:

A.    Investigations include serum FSH

B.     Is associated with karyotype 45 XO

C.     May be due to congenital adrenal virilism (hyperplasia)

D.    May be due to Mullerian duct fusion failure

E.     May be due to granulous cell tumors of the ovary

Answer: E* May be due to granulous cell tumors of the ovary

***) All of the following may cause primary amenorrhea, except:

A.    Cryptomenorrhea (imperforate hymen)

B.     Testicular feminization syndrome

C.     Turner's syndrome

D.    Gonadal agenesis

E.     Dermoid cyst of the ovary

Answer: E* Dermoid cyst of the ovary

***) Amenorrhea in a 16 years old girl may result from all of the following conditions, except:

A.    Imperforate hymen

B.     Androgen insensitivity syndrome (testicular feminization syndrome)

C.     Turner's syndrome

D.    Bicornuate uterus

E.     Pituitary tumor

Answer: D* Bicornuate uterus

***) Absence of vagina is common in:

A.    Congenital adrenal hyperplasia

B.     Turner's syndrome

C.     In Mullerian atresia with absent uterus

D.    With absent uterus in testicular feminization syndrome

E.     Drug induced masculinization

Answer: C* In Mullerian atresia with absent uterus

***) The following statements are true regarding hematocolpos, except:

A.    It causes primary amenorrhea

B.     The patient may present with urine retention

C.     The patient may present with abdominal mass

D.    The treatment is incision of hymen

E.     Breasts atrophy may occur

Answer: E* Breasts atrophy may occur

***) An imperforate hymen in a girl may be associated with all of the following, except:

A.    Retention of urine

B.     Hematocolpos

C.     Periodical abdominal pain

D.    Amenorrhea

E.     Absent uterus

Answer: E* Absent uterus

***) Concerning secondary amenorrhea, all the following are true except:

A.    May be due to thyrotoxicosis

B.     May be due to anorexia nervosa

C.     Investigations include prolactin levels

D.    Oral contraceptives can be used in treatment

E.     Clomiphene can be given as treatment

Answer: E* Clomiphene can be given as treatment

***) All of the following may cause secondary amenorrhea, except:

A.    Lactation (breast feeding)

B.     Endometriosis

C.     Pituitary failure

D.    Early menopause

E.     Pregnancy

Answer: B* Endometriosis

***) One of the following investigations is necessary in patients with primary amenorrhea:

A.    Serum TSH

B.     Serum prolactin

C.     Dilation and Curettage

D.    Chromosomal analysis

E.     Hysteroscopy

Answer: D* Chromosomal analysis

***) In secondary amenorrhea, elevated FSH over 40 nmol/u, indicates:

A.    Polycystic ovary syndrome

B.     Ovarian failure or resistance

C.     Pituitary failure

D.    Anorexia nervosa

E.     Hypothalamic amenorrhea

Answer: B* Ovarian failure or resistance

***) Raised FSH levels are found in all of the following, except:

A.    Post menopausal woman

B.     Turner's syndrome

C.     Prepubertal girls

D.    Gonadal dysgenesis

E.     Kleinfelter's syndrome

Answer: C* Prepubertal girls

***) All of the following are true about effect of androgens on the external genitalia of a female fetus, except:

A.    Clitoral hypertrophy

B.     Labia fusion to form scrotum

C.     May give varying degrees of hypospadia

D.    It may cause adrenogenital syndrome

E.     It may cause closure of the Bartholin gland duct

Answer: E* It may cause closure of the Bartholin gland duct

***)  Signs of virilism include all of the following, except:

A.    Excessive body hair

B.     Muscle development

C.     Deepening of the voice

D.    Clitoromegaly

E.     Occipital balding

Answer: E* Occipital balding

***) The most common pelvic mass associated with amenorrhea in a reproductive age woman is:

A.    Follicular cyst

B.     Corpus luteum cyst

C.     Benign cystic teratoma

D.    Leiomyoma

E.     Pregnancy

Answer: E* Pregnancy

2.    Abnormal Uterine Bleeding.

***) The most likely cause of abnormal genital bleeding in a 13 year old girl is:

A.    Uterine cancer

B.     Ectopic pregnancy

C.     Threatened abortion

D.    Cervical cancer

E.     Anovulation

Answer: E* Anovulation

***) Regarding dysfunctional uterine bleeding all of following are true, except:

A.    It is an abnormal menstrual pattern

B.     There is no organic disease in the uterus

C.     It may cause menorrhagia

D.    It may cause prolonged period

E.     It is a pre-malignant condition of the endometrium

Answer: E* It is a pre-malignant condition of the endometrium

***) All of the following are true for hemorrhagic metropathia, except:

A.    It is a condition of variable periods of amenorrhea

B.     It occurs more common with fibroid in the uterus

C.     Periods are heavy, continuous and painless

D.    It is found more common nearer the menopause

E.     It is a feature of anovular cycles in which estrogen levels are high

Answer: B* It occurs more common with fibroid in the uterus

***) The most common cause of heavy bleeding in adolescent girls is:

A.    Uterine fibroid

B.     Endometriosis

C.     Dysfunctional uterine bleeding

D.    Cervical erosion

E.     Hypothyroidism

Answer: C* Dysfunctional uterine bleeding

***) Vaginal bleeding in the newborn female infant is most commonly due to:

A.    Trauma

B.     Estrogen withdrawal

C.     Infections

D.    Neoplasms

E.     Hemorrhagic disease of the newborn

Answer: B* Estrogen withdrawal

***) A 4 days old female healthy baby presented to your clinic with vaginal bleeding, the most appropriate action to do is:

A.    Refer to gynecologist

B.     Do PT and PTT

C.     Reassure the parents

D.    Do pelvic US

E.     Give vitamins and iron

Answer: C* Reassure the parents

***) One of the following drugs is commonly used for dysfunctional uterine bleeding DUB:

A.    Progesterone

B.     Testosterone

C.     Estrogen

D.    Epsilon aminocaproic acid

E.     Prostaglandin

Answer: A* Progesterone

***) One of the following is associated with dysfunctional uterine bleeding:

A.    Uterine infection

B.     Placental polyp

C.     Cervical polyp

D.    Polycystic ovary

E.     Endometrial carcinoma

Answer: D* Polycystic ovary

3.    Dysmenorrhea.

***) Regarding dysmenorrhea all of the following are true, except:

A.    It is a painful menstruation

B.     The spasmodic type is the primary

C.     The congestive type is the secondary

D.    Membranous dysmenorrhea is most uncommon

E.     D&C is the treatment of choice

Answer: E* D&C is the treatment of choice

***) All of the following are true about spasmodic dysmenorrhea (primary), except:

A.    The pain occurs with the onset of menstruation

B.     The pain in colicky in nature

C.     It may associate with nausea and vomiting

D.    It is more common in multi parous women

E.     The pain may radiate from lower abdomen to the inner aspects of the thighs

Answer: D* It is more common in multi parous women

***) Primary dysmenorrhea at the time of menstruation is caused by:

A.    Uterine atony

B.     Uterine ischemia

C.     Ovulation

D.    High level of estrogen

E.     Uterine hyper contractility due to prostaglandins release

Answer: E* Uterine hyper contractility due to prostaglandins release

4.    Postmenopausal bleeding.

***) Regarding post menopausal bleeding, all the following are true except:

A.    May be caused by estrogen therapy

B.     Can only occur six months after the cessation of menses

C.     May occur due to atrophic vaginitis

D.    Dilatation and curettage are mandatory

E.     Rarely is due to malignant changes in the endometrium

Answer: E* Rarely is due to malignant changes in the endometrium

***) All of the following may cause postmenopausal bleeding, except:

A.    Estrogen therapy

B.     Atrophic changes of the vagina

C.     Testosterone therapy

D.    Cervical malignancy

E.     Endometrial malignancy

Answer: C* Testosterone therapy

***) The following are causes of post menopausal bleeding, except:

A.    May be caused by estrogen therapy

B.     Atrophic vaginitis

C.     Endometrial malignancy

D.    Cervical carcinoma

E.     May be caused by non hormone-producing ovarian tumors

Answer: E* May be caused by non hormone-producing ovarian tumors

***) Causes of post menopausal bleeding are the following, except:

A.    Endometrial cancer

B.     Cervical cancer

C.     Urethral carbuncle

D.    Ovarian tumor

E.     Prolapse of the uterus

Answer: C*Urethral carbuncle

***) Post menopausal bleeding is managed primarily by:

A.    Hormonal replacement

B.     Papanicolau smear

C.     Dilatation and curettage (D&C)

D.    Cervical biopsy

E.     Contraceptive pills

Answer: C* Dilatation and curettage (D&C)

***) Postmenopausal bleeding is usually caused by all the following except one:

A.    Cervical lesions

B.     Vaginal lesions

C.     Hematologic disease

D.    Gastroenterological lesions

E.     Urinary lesions

Answer: C* Hematologic disease

·      Endometriosis 

1.    Endometriosis.

***) Regarding endometriosis all of the following are true, except:

A.    The endometrium is found in situation other than the uterine cavity

B.     It may be found in myometrium

C.     The principle feature is menorrhagia

D.    It may cause infertility

E.     The treatment of choice in young age is hysterectomy

Answer: E* The treatment of choice in young age is hysterectomy

***) Concerning endometriosis, all the following are true except:

A.    Causes deep dyspareunia

B.     Is often asymptomatic

C.     Is frequently pre-malignant

D.    Often present as secondary dysmenorrhea

E.     Rare outside the pelvis

Answer: C* Is frequently pre-malignant

***) The following are characteristics of endometriosis, except:

A.    Period pain is congestive type

B.     Periods may be heavy

C.     There is intermenstrual bleeding

D.    May cause infertility

E.     May cause ovarian cysts

Answer: C* There is intermenstrual bleeding

***) All of the following symptoms are associated with endometriosis, except:

A.    Dyspareunia

B.     Dysmenorrhea

C.     Menorrhagia

D.    Back pains

E.     Amenorrhea

Answer: E* Amenorrhea

***) The most common site of endometriosis externum is:

A.    The uterus

B.     The pouch of Douglas

C.     The ovaries

D.    The fallopian tubes

E.     The cervix

Answer: C* The ovaries

***) All of the following are theories for causation of endometriosis except:

A.    Coelomic metaplasia

B.     Endometrial hyperplasia

C.     Retrograde menstruation

D.    Immunologic deficiency

E.     lymphatic spread of endometrial fragment

Answer: B* Endometrial hyperplasia

???) Endometriosis is often associated with all the following except:

Dysmenorrhea

Dyspareunia

Infertility

Amenorrhea

Pelvic pain

Answer: D* Amenorrhea

·      Adenomyosis GY17-GY17.

1.    Adenomyosis.

***) In adenomyosis the endometrial glands are localized at:

A.    Pelvic cavity

B.     Ovaries

C.     Fallopian tubes

D.    Bowels

E.     Uterine muscle

Answer: E* Uterine muscle

·      Leiomyomata (Fibroids)

1.    Leiomyomata.

***) Concerning uterine fibroids the following are true, except:

A.    Rarely cause infertility

B.     They are not a cause of post menopausal bleeding

C.     May be asymptomatic during pregnancy

D.    May undergo red degeneration during pregnancy

E.     May cause antepartum hemorrhage

Answer: B* They are not a cause of post menopausal bleeding

***) The most common tumor of the uterine corpus is:

A.    Adenocarcinoma

B.     Squamous carcinoma

C.     Leiomyoma

D.    Sarcoma

E.     Lymphoma

Answer: C* Leiomyoma

***) All of the following complications are associated with intramural fibroid, except:

A.    Excessive uterine bleeding

B.     Red degeneration during pregnancy

C.     Fatty degeneration

D.    Hyaline degeneration

E.     Sarcomatous changes in 20% of cases

Answer: E* Sarcomatous changes in 20% of cases

***) The following changes may occur in a fibroid, except:

A.    Cystic changes

B.     Sarcomatous changes

C.     Calcified called "womb stone"

D.    Acute fatty degeneration

E.     Hyaline degeneration

Answer: D* Acute fatty degeneration

***) The commonest type of bleeding encountered with uterine leiomyoma (fibroids) is:

A.    Post coital bleeding

B.     Menorrhagia

C.     Metrorrhagia

D.    Postmenopausal bleeding

E.     Intra-abdominal bleeding

Answer: B* Menorrhagia

***) Uterine fibroid may be associated with all of the following, except:

A.    Amenorrhea

B.     Menorrhagia

C.     Frequency of micturition

D.    Infertility

E.     Abdominal enlargement

Answer: A* Amenorrhea

***) In a 42 years old female who has menorrhagia due to a uterine fibroid, the best treatment is:

A.    Radiotherapy

B.     Myomectomy

C.     Total abdominal hysterectomy

D.    Hormonal therapy

E.     Repeated D&C operations

Answer: B* Myomectomy

***) The most common pelvic mass in postmenopausal women is:

A.    Follicular cyst

B.     Corpus luteum cyst

C.     Germ cell tumor

D.    Leiomyoma

E.     Endometrioma

Answer: D* Leiomyoma

***) The most common uterine neoplasm is:

A.    Sarcoma

B.     Adenocarcinoma

C.     Choriocarcinoma

D.    Adenomyosis

E.     Leiomyoma

Answer: E* Leiomyoma

·      Contraception 

1.    Contraception.

***) The ideal method of contraception for a cardiac patient with mitral valve disease who desires no more children is by:

A.    Birth control pills

B.     IUCD (Intra Uterine Contraceptive Device)

C.     Laparoscopic tubal ligation

D.    Immediate post partum tubal ligation

E.     Tubal ligation 40 days after delivery by laparotomy

Answer: E* Tubal ligation 40 days after delivery by laparotomy

2.    Hormonal Methods.

***) The most effective contraceptive known is:

A.    Diaphragm

B.     Condom (Sheath)

C.     Synthetic progestin

D.    Combined contraceptive pills (estrogen + progesterone)

E.     Intrauterine device

Answer: D* Combined contraceptive pills (estrogen + progesterone)

***) About combined oral contraceptive pills one is true:

A.    Predispose to pelvic inflammatory disease (PID)

B.     Predispose to breast tumors

C.     Predispose to ovarian cyst

D.    May be used in patient with heart lesion

E.     Less effective in patient with epilepsy on treatment

Answer: E* Less effective in patient with epilepsy on treatment

***) One of the following is contraindicated in combined oral contraceptive pills:

A.    Multiparity

B.     Chronic liver disease

C.     Primary dysmenorrhea

D.    Bronchial asthma

E.     Endometriosis

Answer: B* Chronic liver disease

***) All of the following are contraindications for the use of combined oral contraceptive pills, except:

A.    Liver disease

B.     Secondary amenorrhea

C.     Thrombo-embolic disease

D.    Sickle cell disease

E.     Endometriosis

Answer: E* Endometriosis

***) Absolute contraindication for oral contraceptive pills are the following, except:

A.    Carcinoma of the breast

B.     Heart disease

C.     Lactating mother

D.    Liver diseases

E.     Thrombo-embolic disease

Answer: C* Lactating mother

***) Contraindications to birth control pills include all of the following, except:

A.    Migraine headache

B.     Deep vein thrombosis

C.     Hypertension

D.    Liver adenoma

E.     Hirsutism

Answer: E* Hirsutism

***) All of the following are side effects of oral contraceptives, except:

A.    Weight gain

B.     Hypertension

C.     Deep vein thrombosis

D.    Strike

E.     Hypoglycemia

Answer: E* Hypoglycemia

***) The effectiveness of oral contraceptives is reduced following interaction with the following drugs, except:

A.    Ampicillin

B.     Phenobarbitone

C.     Phenytoin

D.    Thyroxine

E.     Carbamazepine

Answer: D* Thyroxine

***) Regarding oral contraceptive pills, one is true:

A.    Inhibit release of gonadotropic hormones

B.     May lead lo thinning of cervical mucus

C.     Lead to reduced platelet aggregation

D.    Lead lo increased antithrombin III

E.     Increase fallopian tube smooth muscle activity

Answer: A* Inhibit release of gonadotropic hormones

***) The use of combined oral contraceptive pills may increase the risk of one of the following conditions:

A.    Fibrocystic breast disease

B.     Hepatic adenoma

C.     Salpingitis

D.    Ovarian cancer

E.     Endometrial cancer

Answer: B* Hepatic adenoma

***) The most common side effect of low-dose oral contraceptive pills is:

A.    Breakthrough bleeding

B.     Dysmenorrhea

C.     Nausea

D.    Hypertension

E.     Breast pain

Answer: A* Breakthrough bleeding

3.    Intrauterine Device.

***) Concerning Intrauterine Contraceptive Device IUCD, choose the correct answer:

A.    Failure rate 2-3 % women every year

B.     Increases the incidence of cervical erosion

C.     Increases the incidence of Candida infection

D.    Contraindicated in patients with cervical polyp

E.     Cryocautery to the cervix can be done while IUCD is in situ

Answer: A* Failure rate 2-3 % women every year

***) Intrauterine contraceptive devices (inert type) prevent pregnancy by all of the possible mechanisms, except:

A.    Increase the motility of fallopian tubes

B.     Increase the contractility of the uterus

C.     Causing aseptic inflammatory reaction in the endometrium

D.    Increasing the potential space of uterine cavity

E.     Increasing the hostility of the cervical mucus to the spermatozoid

Answer: A* Increase the motility of fallopian tubes

***) One of the following is an absolute contraindication to Intrauterine Contraceptive Device IUCD:

A.    Uterine fibroids

B.     Bicornuate uterus

C.     Grand multi-parous woman

D.    Previous caesarian section

E.     Lactation

Answer: B* Bicornuate uterus

***) Contraindications of IUCD are the following, except:

A.    Pregnancy

B.     Pelvic infection

C.     Multigravida

D.    Dysfunctional uterine bleeding

E.     Patient with heart disease

Answer: C* Multigravida

***) Intrauterine contraceptive device may be associated with following complications, except:

A.    Pelvic infection

B.     Uterine perforation

C.     Ectopic pregnancy

D.    Cervical erosion

E.     Menorrhagia

Answer: D* Cervical erosion

***) The most common method of contraception in Jordan is:

A.    Intrauterine device (IUCD)

B.     Long acting progesterone injection (Depo-Provera)

C.     Diaphragm

D.    Spermicidal cream

E.     Lactation

Answer: A* Intrauterine device (IUCD)

·      Infertility

1.    Female Factors.

***) A 27 years old woman has tried unsuccessfully for 5 months to become pregnant, The recommended investigation in this case would be:

A.    Hormonal assay

B.     Hysterosalpingogram (HSG)

C.     Endometrial biopsy

D.    Laparoscopy

E.     None of the above

Answer: E* None of the above

***) All the following are complications of ovulatory inducers, except:

A.    Multiple pregnancy

B.     Ectopic pregnancy

C.     Hypotension

D.    Ascites

E.     Hypoproteinemia

Answer: E* Hypoproteinemia

***) What percentage of couples in the reproductive age is unable to conceive after one year of coitus without contraception:

A.    1-2%

B.     15%

C.     30%

D.    50%

E.     75%

Answer: B* 15%

***) All of the following are possible indications of ovulation, except:

A.    Increased plasma levels of progesterone in the second half of the cycle

B.     Increased basal temperature in the second half of the cycle

C.     Follicular stimulating hormone surge at the mid cycle

D.    Change in the cervical mucus

E.     Mid cycle abdominal pain

Answer: C* Follicular stimulating hormone surge at the mid cycle

***) Ovulation can be diagnosed by the following, except:

A.    Measuring day 14 serum progesterone

B.     Observing a rise in basal body temperature in the second half of the menstrual cycle

C.     Study of cervical mucus

D.    Endometrial biopsy

E.     Day 20 serum prolactin

Answer: E* Day 20 serum prolactin

???) Ovulation can be diagnosed by all the following except one:

Measuring day 14 serum progesterone

Observing a rise in basal body temperature in the second half of the menstrual cycle

Study of the cervical mucus

Endometrial histology

Mittle schmerz (midcyclic pain)

Answer: 1* Measuring day 14 serum progesterone

***) Tests to detect ovulation include all of the following, except:

A.    Basal body temperature

B.     Endometrial biopsy

C.     Estrogen level

D.    Progesterone level

E.     Vaginal wall cytology

Answer: C* Estrogen level

***) Induction of ovulation may be achieved by giving:

A.    Clomiphene citrate

B.     Cyproterone acetate

C.     Letrozole

D.    FSH and LH

E.     Tamoxifen

Answer: A* Clomiphene citrate

***) Clomiphene citrate is contraindicated in one of the following:

A.    Endometrial hyperplasia

B.     Post pill amenorrhea

C.     Polycystic ovary (Stein-Leventhal syndrome)

D.    Ovarian tumors

E.     Infrequent ovulation

Answer: D* Ovarian tumors

2.    Male Factors.

***) Normal semen should have the following characteristics, except:

A.    Volume 2.5-5 cc

B.     Liquefaction in 30 minutes

C.     Motility 60-70% after 3 hours

D.    After 6 hours only 30% remain motile

E.     Sperm count the average normal specimen is 10-20 million per 1 cc

Answer: E* Sperm count the average normal specimen is 10-20 million per 1 cc

***) All of the following may cause azoospermia, except:

A.    Blockage of the ducts

B.     Klinefelter syndrome

C.     Orchitis due to mumps

D.    Varicoceles

E.     Surgical trauma to the spermatic artery

Answer: D* Varicoceles

***) Male sterilization (vasectomy) causes:

A.    Azoospermia

B.     Loss of libido

C.     A decrease in the volume of the ejaculate

D.    Impotence

E.     Infection

Answer: A* Azoospermia

***) All of the following are causes of abnormal spermatogenesis except:

A.    Cryptorchidism

B.     Genetic abnormality

C.     Varicoceles

D.    Cold environment

E.     Drugs

Answer: D* Cold environment

***) All the following environmental factors might adversely affect spermatogenesis except:

A.    Prolonged sitting

B.     Febrile illness

C.     Hot bath

D.    Swimming

E.     Frequent saunas

Answer: D* Swimming