Gynecology

·      Polycystic ovarian syndrome 

1.    PCOS.

***) Regarding polycystic ovary syndrome all are true, except:

A.    Is best treated by clomiphene

B.     Wedge resection is the treatment of choice

C.     Absence of LH surge

D.    Low or normal FSH

E.     High testosterone level

Answer: A* Is best treated by clomiphene

***) Stein-Leventhal syndrome (polycystic ovary) is usually characterized by all the following, except:

A.    Hirsutism

B.     Infertility

C.     Menorrhagia

D.    Obesity

E.     Anovulation

Answer: C* Menorrhagia

***) All of the following problems may occur with an ovarian cyst, except:

A.    May undergo torsion

B.     May undergo rupture

C.     May undergo hemorrhage

D.    Retention of urine is common

E.     May undergo malignant changes

Answer: D* Retention of urine is common

***) Primipara 20 weeks pregnant was found to have ovarian cyst 7x7 cm, the proper treatment is:

A.    Weekly assessment of the size of the cyst

B.     Termination of pregnancy

C.     Cystectomy after puerperium

D.    Cesarean section and cystectomy after 37 completed weeks

E.     Laparotomy and cystectomy as soon as discovered

Answer: E* Laparotomy and cystectomy as soon as discovered

***) A 65 years old woman was found to have ovarian cyst 6x6 cm, the proper treatment is:

A.    Observation

B.     Laparoscopy

C.     Laparotomy and cystectomy

D.    Hysterectomy

E.     Treatment no need

Answer: C* Laparotomy and cystectomy

***) Regarding polycystic ovaries all are true except:

A.    Are associated with hirsutism

B.     Are associated with infertility

C.     Have an increased risk of malignant change in the ovaries

D.    Are associated with obesity

E.     Show dense thickening of the capsule

Answer: C* Have an increased risk of malignant change in the ovaries

·      Gynecological Infections 

1.    Vulvovaginitis.

***) One of the following about childhood vulvovaginitis is true:

A.    Is commonly due to staphylococcal infection

B.     Is commonly due to monilial infection

C.     Is caused by thread worms

D.    Estrogen cream is of little help

E.     Commonly requires treatment with systemic antibiotic

Answer: E* Commonly requires treatment with systemic antibiotic

***) Pruritus vulvae may be present in all of the following, except:

A.    Monilial infection

B.     Diabetes mellitus

C.     Gonorrhea

D.    Psychological problems

E.     Leukoplakia (vulvar dystrophy)

Answer: E* Leukoplakia (vulgar dystrophy)

***) Which of the following conditions is the most likely cause of vulvovaginal symptoms in children:

A.    Foreign body

B.     Lichen sclerosus

C.     Physiologic leucorrhea

D.    Trauma

E.     Non-specific

Answer: E* Non-specific

***) The most common skin disease affecting the vulva is:

A.    Psoriasis

B.     Vulval cancer

C.     Vulval injury

D.    Vulval abscess

E.     Contact dermatitis

Answer: E * Contact dermatitis

***) Which of the following is most likely to cause vulval pruritus:

A.    Anemia

B.     Leukemia

C.     Heart failure

D.    Hypertension

E.     Personal hygiene products

Answer: E * Personal hygiene products

*** The most effective treatment of vulvar pruritus associated with atrophic vulvitis is:

A.    Antihistamines

B.     Hydrocortisone

C.     Alcohol injection

D.    Tranquilizers

E.     Topical estrogen therapy

Answer: E* Topical estrogen therapy

***) In a patient complaining of bad smelling, frothy and irritative vaginal discharge, wet smear showed "clue cells", the causative organism is:

A.    Candida albicans

B.     Gardnerella vaginalis

C.     Bacteroides

D.    Mycoplasma

E.     Trichomonas vaginalis

Answer: B* Gardnerella vaginalis

***) Profuse cream frothy vaginal discharge is characteristic of:

A.    Moniliasis

B.     Trichomoniasis

C.     Gonorrhea

D.    Tuberculosis

E.     Syphilis

Answer: B* Trichomoniasis

***) Regarding vaginal candidiasis, all the following are true except:

A.    Caused by yeast

B.     Acid media in the vagina

C.     Best treated by metronidazole

D.    Commonly associated with vulvar pruritus

E.     Patients partner may need treatment

Answer: C* Best treated by metronidazole

***) All of the following are predisposing factors for monilial infection, except:

A.    Combined oral contraceptive pills

B.     Diabetes mellitus

C.     Pregnancy

D.    Intrauterine contraceptive device

E.     Patients on broad spectrum antibiotics

Answer: D* Intrauterine contraceptive device

***) The commonest cause of vaginal itching during pregnancy is:

A.    Non specific vaginal infection

B.     Trichomonal vaginal infection

C.     Vaginal moniliasis

D.    Gonorrhea

E.     Cervical erosion

Answer: C* Vaginal moniliasis

***) Blood stained vaginal discharge occurs in the following, except:

A.    Carcinoma of the cervix

B.     Moniliasis

C.     Cervical polyp

D.    Senile vaginitis

E.     Carcinoma of the body of the uterus

Answer: B* Moniliasis

***) The following might increase vaginal discharge during pregnancy except one:

A.    Bacterial vaginitis

B.     Trichomonas vaginalis

C.     Candida vaginitis

D.    Simple ovarian cyst

E.     Physiological

Answer: D* Simple ovarian cyst

***) In vulvo-vaginal hematoma, all the following are true except:

A.    Usually related to child birth

B.     Is usually painless purple colored swelling

C.     Incision and evacuation is the treatment of choice

D.    The bleeding is usually of arterial origin

E.     Packing is rarely necessary

Answer: C* Incision and evacuation is the treatment of choice

2.    Sexually Transmitted Infections.

***) Sexually transmitted diseases include all of the following except:

A.    Trichomonas vaginalis

B.     Type II herpes hominis

C.     Condyloma acuminate

D.    Chlamydial infections

E.     Tuberculosis

Answer: E* Tuberculosis

***) All of the following are sexually transmitted diseases, except:

A.    Trichomoniasis

B.     Candidiasis (moniliasis)

C.     Condyloma acuminate

D.    Gonorrhea

E.     Syphilis

Answer: B* Candidiasis (moniliasis)

***) Gonorrhea may affect all of the following, except:

A.    Fallopian tubes

B.     Urethra

C.     Vagina

D.    Cervix

E.     Bartholin gland

Answer: C* Vagina

***) All the following are true about Neisseria gonorrhoeae, except:

A.    Is a Gram-negative coccus

B.     Is a Gram-negative bacillus

C.     Occurs in pairs

D.    Has a capsule

E.     Sensitive to penicillin

Answer: B* Is a Gram-negative bacillus

***) Regarding Neisseria gonorrhea culture during pregnancy, the highest positive culture is got from:

A.    Urethra

B.     Cervix

C.     Vagina

D.    Rectum

E.     Throat

Answer: A* Urethra

***) Identification of donovan bodies in large mononuclear cells in Gimsa-stained from vulval lotion during pregnancy is diagnostic of:

A.    Chancre

B.     Chancroid

C.     Granuloma inguinale

D.    Lymphogranuloma venereum

E.     Sarcoid

Answer: C* Granuloma inguinale

***) Sexually transmitted diseases include all of the following except:

A.    Trichomonas vaginalis

B.     Type II herpes hominis

C.     Condyloma acuminate

D.    Chlamydial infections

E.     Type I herpes hominis

Answer: E* Type I herpes hominis

***) All of the following diseases are transmitted sexually, except:

A.    Cytomegalovirus

B.     Hepatitis B

C.     Herpes simplex

D.    Scabies

E.     Granuloma annulare

Answer: D* Scabies

???) All of the following diseases are transmitted sexually, except:

Chancroid

Hepatitis B

AIDS

Gonorrhea

Pemphigoid

Answer: 1* Chancroid

3.    Bartholin Gland Abscess.

***) In bartholin abscess, one of the following statements is true:

A.    It occurs bilaterally in most cases

B.     Treatment is by surgery (marsupialization)

C.     It may cause infertility

D.    The most common causing agent is staphylococcus

E.     Antibiotic treatment is enough

Answer: B* Treatment is by surgery (marsupialization)

4.    Pelvic Inflammatory Disease.

***) All of the following microorganisms may cause acute salpingitis, except:

A.    Neisseria gonorrhea

B.     Chlamydia

C.     Bacteroids

D.    Candida albicans

E.     Gram negative streptococci

Answer: D* Candida albicans

***) All of the following conditions may be confused with acute salpingitis, except:

A.    Acute appendicitis

B.     Tubal pregnancy

C.     Acute pyelonephritis

D.    Bartholin's abscess

E.     Ruptured ovarian cyst

Answer: D* Bartholin's abscess

***) Management of septic pelvic thrombophlebitis usually will include:

A.    Bed rest and analgesics alone

B.     Antibiotics alone

C.     Antibiotics and heparinization

D.    Heparinization alone

E.     Immediate vena cava ligation

Answer: C* Antibiotics and heparinization

***) Pelvic fallopian tube adhesions causing infertility may be due to all of the following, except:

A.    Appendicitis

B.     A post abortion infection

C.     A post puerperal sepsis

D.    Adenomyosis

E.     Pelvic endometriosis

Answer: D* Adenomyosis

***) Symptoms of PID include all of the following except:

A.    Abdominal pain

B.     Dyspareunia

C.     Amenorrhea

D.    Abnormal vaginal discharge

E.     Fever and chills

Answer: C* Amenorrhea

***) PID differential diagnosis includes all of the following except:

A.    Ectopic pregnancy

B.     Endometriosis

C.     Spontaneous abortion

D.    Intrauterine pregnancy

E.     Diverticulitis

Answer: D* Intrauterine pregnancy

***) About tuberculosis of the genital tract, all the following are true except:

A.    Most commonly affects the fallopian tubes

B.     It is transmitted by hematogenous spread

C.     Causes infertility

D.    Causes amenorrhea

E.     Predisposes to endometrial carcinoma

Answer: E* Predisposes to endometrial carcinoma

·      Menopause

1.    Menopause.

***) Concerning menopause the following are correct, except:

A.    Serum androstenedione levels increase

B.     The quantity of estrogens present increase by obesity

C.     Therapy is rarely needed for more than 4 months

D.    Combined estrogen and progesterone therapy is best

E.     Withdrawal bleeding following combined therapy is not an indication for curettage

Answer: C* Therapy is rarely needed for more than 4 months

***) During menopause one of the following is true:

A.    Serum FSH only is elevated

B.     Serum LH only is elevated

C.     Both FSH and LH are elevated

D.    Serum FSH is low

E.     Serum FSH and LH are low

Answer: C* Both FSH and LH are elevated

***) All of the following may occur in menopausal women, except:

A.    The breast tend to decrease in size

B.     The uterus atrophies

C.     The endometrium hyper-atrophies

D.    The vaginal mucosa becomes thin

E.     The pH of the vagina rises

Answer: C* The endometrium hyper-atrophies

***) All of the following symptoms are true for menopause, except:

A.    Irritability

B.     Headache

C.     Vasomotor instability

D.    Backache

E.     Ovulation

Answer: E* Ovulation

***) Regarding the climacteric, all the following are true except:

A.    Headache

B.     Palpitation

C.     Hot flushes

D.    Low FSH

E.     Sweating

Answer: D* Low FSH

***) Menopause is associated with all of the following, except:

A.    Hot flushes

B.     Insomnia

C.     Decreased incidence of myocardial infarction

D.    Osteoporosis

E.     Loss of libido

Answer: C* Decreased incidence of myocardial infarction

·      Urogynecology 

1.    Pelvic Prolapse.

***) Symptoms of uterine prolapse are the following, except:

A.    Retention of urine

B.     Backache

C.     Vaginal discharge

D.    Vaginal bleeding

E.     Heaviness in the vagina

Answer: A* Retention of urine

2.    Urinary Incontinence.

***) Concerning stress urine incontinence the following are correct, except:

A.    Can be caused by rectocele

B.     Is more common in multi parous

C.     Long term antibiotic therapy will not improve it

D.    Can be treated by anterior colporrhaphy

E.     Can be treated by colposuspension

Answer: A* Can be caused by rectocele

·      Gynecological Oncology

1.    Uterus.

***) Risk factors of endometrial carcinoma include all of the following except:

A.    Estrogen therapy

B.     Early menopause

C.     Obesity

D.    Low parity

E.     Adenomatous hyperplasia

Answer: B* Early menopause

***) A 47 year old woman complains of heavy post-coital bleeding. The most likely origin of his bleeding would be:

A.    Cervical polyp

B.     Ectropion

C.     Carcinoma

D.    Nabothian cyst

E.     Infection

Answer: C* Carcinoma

***) One of the following drugs causes endometrial hyperplasia:

A.    Progesterone hormone

B.     Clomiphene citrate

C.     Estrogens

D.    Combined oral contraceptive pills

E.     Bromocriptine

Answer: C* Estrogens

***) The most common symptom of endometrial hyperplasia is:

A.    Vaginal discharge

B.     Vaginal bleeding

C.     Amenorrhea

D.    Pelvic pain

E.     Abdominal distention

Answer: B* Vaginal bleeding

***) Endometrial carcinoma is most common in which of the following:

A.    10 to 25 years

B.     25 to 30 years

C.     30 to 40 years

D.    40 to 50 years

E.     More than 60 years

Answer: E* More than 60 years

***) A 69 years old postmenopausal woman is being admitted for surgical treatment of endometrial cancer. Which of the following is the best preoperative test to look for metastasis:

A.    Chest X-Ray

B.     Hysterosalpingogram

C.     Pelvic US

D.    Intravenous pyelogram (IVP)

E.     Barium enema

Answer: A* Chest X-Ray

***) The primary mode of treatment for endometrial carcinoma confined to the uterine body is:

A.    External beam radiation

B.     Intracavitary radium

C.     Hysterectomy

D.    Chemotherapy

E.     Progestin therapy

Answer: C* Hysterectomy

***) All of the following are estrogen actions on the uterus, except:

A.    It causes an active development of the myometrium

B.     The endometrium undergoes proliferation

C.     Stimulates the growth of the glandular component

D.    It causes increase of cervical mucus

E.     Has no effect on enlargement of the uterus during pregnancy

Answer: E* Has no effect on enlargement of the uterus during pregnancy

2.    Ovaries.

***) One of the following ovarian tumors is more likely to cause hirsutism:

A.    Theca lutein cyst

B.     Androblastoma

C.     Krukenberg tumor

D.    Serous cystadenoma

E.     Follicular cyst

Answer: B* Androblastoma

***) One of the following ovarian tumors is malignant:

A.    Follicular cyst

B.     Luteal cyst

C.     Dysgerminoma

D.    Chocolate cyst

E.     Dermoid cyst

Answer: C* Dysgerminoma

***) Concerning dermoid cysts the following are correct, except:

A.    Are germ cell tumors

B.     Are bilateral in 10% of cases

C.     Are the commonest cysts defected during pregnancy

D.    Are malignant in less than 5% of cases

E.     Are frequently XY (karyotype)

Answer: E* Are frequently XY (karyotype)

***) Concerning malignant ovarian tumors, all the following are true except:

A.    Are often bilateral

B.     Often present as an asymptomatic mass

C.     More common post menopause

D.    Have a good prognosis after treatment

E.     Are mostly hormone secreting

Answer: E* Are mostly hormone secreting

***) The most frequent diagnosed type of ovarian cancer is:

A.    Epithelial

B.     Germ cell

C.     Specialized stromal cell

D.    Non-specialized stromal cell

E.     Metastatic disease to the ovary

Answer: A* Epithelial

***) The first line of treatment for ovarian cancer is:

A.    Radiotherapy

B.     Surgery

C.     Chemotherapy

D.    Radiotherapy and chemotherapy

E.     Observation

Answer: B* Surgery

***) The primary lesion of Krukenberg ovarian tumor is commonly in:

A.    Large bowels

B.     Brain

C.     Stomach

D.    Bone

E.     Liver

Answer: C* Stomach

***) A 65 years old woman was found to have ovarian cyst 6x6 cm, the proper treatment is:

A.    Observation

B.     Laparoscopy

C.     Laparotomy and cystectomy

D.    Hysterectomy

E.     Treatment no need

Answer: C* Laparotomy and cystectomy

***) Childhood neoplastic ovarian masses most commonly from:

A.    Gonadal epithelium

B.     Gonadal stromal

C.     Germ cells

D.    Sex cord

E.     Metastatic disease

Answer: C* Germ cells

***) The most common complication of large cystic teratoma during the first trimester is:

A.    Torsion

B.     Rupture

C.     Intracystic hemorrhage

D.    Solid degeneration

E.     Luteinization

Answer: A* Torsion

***) A medium-size ovarian cyst may be subjected to the following except:

A.    Torsion

B.     Necrosis

C.     Infection

D.    Rupture

E.     Malignant changes if she gets pregnant

Answer: E* Malignant changes if she gets pregnant

???) The commonest malignant tumors of the ovary are:

Germ cell tumors

Epithelial tumors

Metastases from other tumors

Stomal tumors

Knikenburg tumors

Answer: B* Epithelial tumors

???) Most common neoplastic ovarian masses in postmenopausal women originate from:

Ovarian epithelium

Ovarian stroma

Ovarian germ cells

Ovarian sex cord

Metastatic disease

Answer: 1* Ovarian epithelium

???) Benign cystic teratoma (dermoid cyst) is characterized by one of the following:

It occurs bilaterally in 50% of cases

It is formed of squamous epithelium only

It is formed of squamous epithelium and sebaceous glands only

It is formed of all three germ cell layers

The commonest ovarian tumor associated with pregnancy

Answer: 1* It occurs bilaterally in 50% of cases

3.    Cervix.

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

A.    Cervical smear is a screening method

B.     In the early stages of the disease there are no symptoms

C.     Cervical cancer spreads only by direct spread

D.    Post coital bleeding can be first sign

E.     Adenocarcinoma of the cervix account for 5% of cases

Answer: C* Cervical cancer spreads only by direct spread

***) The lining of cervical erosion is:

A.    Squamous epithelium

B.     Squamous epithelium with keratin

C.     Columnar epithelium

D.    Transitional epithelium

E.     Cervical stroma

Answer: C* Columnar epithelium

***) The histologic differentiation between invasive carcinoma of the cervix and carcinoma in situ depends upon one of the following:

A.    The Papanicolau smear report

B.     The basement membrane having been penetrated by abnormal epithelial cells

C.     The finding of cluecells in the basement membrane

D.    The finding of increased eosinophilic cytoplasm in the surface epithelium

E.     The surface epithelium taking up nils blue sulfate staining

Answer: B* The basement membrane having been penetrated by abnormal epithelial cells

***) In case of cervical carcinoma in situ in 50 years old woman, the treatment of choice is:

A.    Hysterectomy

B.     Cervical cryo-surgery

C.     Cervical cone-biopsy

D.    Selective biopsy under colposcopy

E.     Radiotherapy

Answer: A* Hysterectomy

***) One of the following is recommended for cervical cancer screening:

A.    Aspiration from the anterior fornix

B.     Cervical canal curettage

C.     Aspiration from the posterior fornix

D.    Ultrasound to the genital tract

E.     Papanicolau (pap) smear

Answer: E* Papanicolau (pap) smear

***) Asymptomatic cervical erosion in a pregnant patient is best managed by:

A.    Heat cautery

B.     Pap smear and follow up

C.     Cone biopsy

D.    Cryocautery

E.     Cervical amputation

Answer: B* Pap smear and follow up

***) Invasive carcinoma of the cervix commonly present with all the following, except:

A.    Post coital bleeding

B.     Intermenstrual bleeding

C.     Vaginal discharge

D.    Acyclic vaginal bleeding

E.     Menorrhagia

Answer: E* Menorrhagia

***) The most common benign neoplasm of the cervix and endocervix is:

A.    Leiomyoma

B.     Endometriosis

C.     Metastasis of uterine cancer

D.    Metastasis of ovarian cancer

E.     Polyps

Answer: E* Polyps

***) Often the first symptom of cervical cancer is:

A.    Leg pain

B.     Pain during intercourse

C.     Vaginal bleeding

D.    Weight loss

E.     Vulvar pruritus

Answer: B* Pain during intercourse

???) Cervical smear is a method to detect early cancer of:

Ovarian

Endometrial

Vaginal

Cervical

Urethral

Answer: D* Cervical

4.    Vulva.

***) The etiologic agent for vulvar cancer is:

A.    Squamous cell hyperplasia

B.     Atrophic dystrophy

C.     Chronic granulomatous disease

D.    Chronic irradiation

E.     Unknown

Answer: E* Unknown

***) The most common symptom of vulvar cancer in elderly woman is:

A.    Abnormal bleeding

B.     Foul smell

C.     Pruritus

D.    Vulvar atrophy

E.     Painful intercourse

Answer: C* Pruritus

***) A blue swelling on the vulva is most likely due to:

A.    Melanoma

B.     Varicosity

C.     Endometriosis

D.    Lipoma

E.     Hemangioma

Answer: B* Varicosity

5.    Vagina.

***) The most common histopathological finding in primary carcinoma of the vagina is:

A.    Clear cell carcinoma

B.     Melanoma

C.     Squamous cell carcinoma

D.    Sarcoma

E.     Choriocarcinoma

Answer: C* Squamous cell carcinoma