Gynecology Unit Exam 1

4 Aug 2023

1. What is the most important diagnosis in a child presenting with vaginal bleeding.
A. Vaginal tumor
B. Sexual abuse
C. Lichen sclerosis
D. Labial adhesions

2. treat osteoporosis, except

a. SERM
b. tibolone
c. estrogen
d. Bisphosphonates

3. What is the pH of a prepubertal vagina?

a. Neutral or slightly alkaline
b. Acidic
c. Alkaline
d. None of the above

4. At what age is colonoscopy or fecal occult blood test, sigmoidoscopy, or barium enema
recommended for screening for colorectal cancer among postmenopausal women?
a. 40
b. 50
c. 60
d. 70
5. A sexually active 66 year old G3P3 (3003) came to your clinic with chief complaint of
vulvovaginal dryness and dyspareum

6. A 33 year-old male with recently onset HTN, hyperglycaemia, weight gain. A white purplish
striae over the abdomen, + buffalo hump, + moon face. No glucocorticoid was taken. 8 am
dexamethasone test was done ACTH was 1ng/ml what is the source of information excess
cortisol?
A.
B. Mri n Gadolinium contract
C. Serum cortisol with high dexamethasone stimulate
D. Serum cortisol with acth

7. Which of the following statements is false?

a. After delivery, the obstetrician should systematically observe the newborn's perineum,
beginning with the mons pubis.
b. The clitoris should be examined for any obvious enlargement and the opening of the urethra
should be identified.
c. The rectum should be visualized and should be tested to be sure that it is perforate.
d. Palpation of inguinal area and labia for any masses should be done at the 1st year of life

8. Compared with other mullerian duct defects, a transverse vaginal

septum is associated with lower rate of which of the following?
a. Endometriosis
b. Urologic abnormalities
c. Need for surgical correction
d. Adenomyosis

9. What is the relative size of cervix to uterus in a child?

A) 2:1
B) 1:2
C) 1:1
D) 3:1
10. A newborn was noted to have ambiguous genitalia appearing as bifid clitoris. What condition
is often associated with such ambiguity?
a. unicornuate uterus
b. labial fusion
c. bladder extrophy
d. cervical hypoplasia

11. Septate uterus has a significantly higher spontaneous abortion rate and early pregnancy
loss rate than bicornuate uterus What is the primary mechanism thought to be responsible for
this high pregnancy wastage?
a. Associated cervical anomalies
b. Distortion of the uterine cavity
c. Distortion of the uterine serosal contour
d. Partial or complete implantation on the largely avascular septum

12. What precipitates onset of vasomotor symptoms among menopausal women?

a. Fall in estrogen levels
b. Fall in progesterone levels
c. Fall in androgen levels
d. Fall in FSH levels

13. Which of the following uterine anomalies can retained by surgical procedure
A) Uterus septate
B) Unicornuate uterus
C) MRKH syndrome
D) Arcunate uterus
14. Uterine anomalies that can be corrected by surgical procedures
A. Uterine septate
B. Unicornuate urea
C. MRKH syndrome
D. Arcuate urea Female with masculinised or virilized external genitalia

15. Initial evaluation of ambiguous genitalia involves the following diagnostics, EXCEPT?
A) Karyotyping
B) Transabdominal pelvic ultrasound
C) Serum creatinine
D) Steroid levels

16. What is the pathognomonic sign of labial adhesions?

A. Denuded epithelium.
B. Flat appearance of vagina.
C. Thin narrow translucent line at the site of agglutination.
D. Whitish discoloration.

17. The following are the steps of mullerian duct development in order.
a. Elongation, fusion, resorption, canalization
b. Elongation, fusion, canalization, resorption
c. Fusion, elongation, canalization, resorption
d. Fusion, elongation, resorption, canalization

18. At what age is colonoscopy or fecal occult blood test, sigmoidoscopy, barium enema
recommended for screening of colorectal cancer among postmenopausal women
A. 40
B. 50
C. 60
D. 70
19. What is the most negative effect of menopause?
A. Hot flashes
B. Osteoporosis
C. Decrease libido
D. Vulvovaginal atrophy

20. What is the most important differential diagnosis in a child presenting with vaginal bleeding?
a. Vaginal tumor
b. Sexual abuse
c. Lichen sclerosus
d. Labial adhesions

21. What is the preferred position for the non-invasive examination of the vagina and cervix?
A- sitting on mother's lap
B-knee-chest position
C-frog leg position
D- standing position

22. True of vulvovaginal atrophy during menopause?

A) Often associated decrease follicle stimulating hormone
B) Progestrogen deficiency result thin, pale, decrease mucosa
C) Typically Progressive and not cure on its own
D) Mucosa decrease inflammation because low moisture
23. A 7 year old girl presents to emergency room with perineal injury that is actively bleeding.
You are told she fell on the crossbar of her brother’s bike. History obtained from patient and her
mother is inconsistent. PE shows no bruises over the skin and external genitalia w/ defect
involving the fourchette and extending to perirectal area. Anal orifice is intact. What is the best
next step?
a. Observation in the emergency room
b. Laparoscopy
c. Pelvic sonogram
d. Exam under anesthesia Lichen sclerosus

24. A 16-year-old woman presents or evaluation of peivic pain. She has advanced breast and
sexual hair development. Her examination is significant for the finding below. An ultrasound
shows normal female pelvic anatomy. What is this patient's expected karvotype?
A. 45, X
B. 46. XX
C. 46. XY
D. 45, X/46, XX

25. What is the pH of a prepubertal vagina?

a Neutral or slightly alkaline
b. Acidic
C. Alkaline
D. None of the above

26. Menopause is a normal, natural event defined final period confirmed after ..... year
A) 1 year
B) 2 year
C) 3 year
D) 5 year
27. Which of the following is not derived from mullerian ducts?
A. Cervix
B. Lower vagina
C. Upper vagina
D. Fallopian tube

28. A virilized female fetus with labial fusion was born to a non-virilized mother. What is the most
likely cause of the fetal virilization?
a. Maternal drug exposure to progestins
b. Maternal androgen producing ovarian neoplasms
c. Congenital adrenal hyperplasia
d. Maternal exposure to diethylstilbestrol

29. When recommending hormonal therapy for menopause, women with a uterus need to take
this additional hormone in addition to estrogen, in order to protect the uterus?
A. Progesterone
B. Tibolone
C. Parathyroid hormone
D. SERM

30. standard of care for detection of osteopenia and osteoporosis?

A. Bone X-ray
B. CT scan
C. DEXA scan
D. MRI

31. Females with masculanized or virilized external genitalia are identified as

A. 46 XY
B. 46 XX
C. 46 XX DSD
D. 46 XY DSD
32. Which of the following is standard of care for detection of osteopenia and osteoporosis?
a. Bone x-ray
b. CT scan
c. Dual energy x-ray absorptiometry (DEXA) scan
d. MRI

33. A 16-year-old woman presents or evaluation of pelvic pain. She has advanced breast and
sexual hair development. Her examination is significant for the finding below. An ultrasound
shows normal female pelvic anatomy. What is this patient's expected karyotype?

a. 45, X
b. 46, XX
c. 46, XY
d. 45, X/46, XX

34. Blood test that can help confirm if you are beginning menopause. The test measures the
level of which of these?
A. Follicle-stimulating hormone
B. Estrogen
C. Progesterone
D. Cholesterol
35. Most common foreign body seen inside a child’s vagina?
a. Tissue paper
b. Fecal matter
c. Coins
d. Toys

36. What should be given to reduce vasomotor symptoms, risk of cardiovascular disease?
A. estrogen only
B. Progesterone + estrogen
C. Progesterone
D. testosterone

37. Why are menopause women at high risk of cardio vascular disease?
A. HDL is high
B. LDL is low
C. High cholesterol acceleration
D. All of the above

38. what factor can cause premature menopause?

A) smoking
B) autoimmune disorder
C) your birth parent had early menopause
D) all of the above

39. Labial fusion is most commonly caused by:

a. Mullerian agenesis
b. Androgen insensitivity syndrome
c. Congenital adrenal hyperplasia
d. 12-hydroxylase deficiency
40. What is the classic symptom of a foreign body inside the vaginal canal of a child?
A) Heavy bleeding
B) Hematoma in the perineum
C) Foul smelling purulent bloody discharge
D) Intense itching of the perineum and vagina

41. During a first-trimester ultrasound for pregnancy dating, you discover that your patient has e
subseptate uterus While counseling her, you explain that this mullerian anomaly developed in
utero secondary to failure of the midline uterine septum to reabsorb completely. Normally,
reabsorption of the uterine septum in a fetus should occur by how many weeks of gestation?
A.20
B.28
C.32
D.36

42. Osteoporosis is defined as T score of:

a. Between -1.0 to-2.5
b. Greater than or equal to -1.0
c. Less than or equal to -2.5
d. Greater than or equal to -2.0

43. Androgen exposure after 12 weeks will result in an ambiguous genitalia and primarily
presents as
a. Labiosacral fusion
b. Clitoral hypertrophy
c. Labia majora hypertrophy
d. Imperforate hymen
44. You are called to evaluate a 10-year old patient who came in for abdominal pain Physical
examination is limited by voluntary guarding Abdominal ultrasound showed a left adness mass
measuring 10x9x9 cm, probably ovarian in origin. AFP, HOG, LOH, and CA-125 levels are
within normal range. What is the most likely diagnosis?
A) Endodermal sinus tumor
B) Theca-lute cysts
C) Mucinous cyst
D) Mature cystic teratoma

45. Women with uterovaginal malformations have 50% associated condition of

a. Urinary tract anomalies
b. Adrenal gland anomalies.
c. Pulmonary system anomalies
d Digestive system anomalies

46. What is the major behavioral factor in childhood vulvovaginitis?

A. Poor perineal hygiene
b. Recurrent UTI
c. Tight fitting clothes
d. Scratch-itch cycle

47. Why are menopausal women at high risk for cardiovascular disease?
A. High density lipoprotein cholesterol increases in level
B. Low density lipoprotein cholesterol decreases in level
C. There is an accelerated increase in total cholesterol
D. All of the above

48. Prescribed clobetasol propnoate for

Ans. Lichen Sclerosus
49. What is the major behavioural factor in childhood vulvovaginitis?
A. Poor pereneal hygiene
B. Recurrent UTI
C. Tight fitting clothes
D. Scratch itch cycle

50. What is the most common gynecologic problem in a prepubertal female?

a. Vulvovaginitus
b. Labial adhesions
c. Lichen sclerosus
d. Genial trauma

51. An infant was born to a virilized mother with gestational luteoma. On pediatric evaluation,
ambiguous genitalia was noted. What important initial necessary step would you request for
gender assignment?
A) karyotyping
B) Maternal androgen/ testosterone
C) Ultrasound
D) 21 alpha hydroxylase level

52. What is the primary cause of cushing syndrome

A. Excessive production of cortisol by the adrenal gland
B. Underprodction of cortiosl by the adrenal gland
C. Overproduction of thyroid hormone
D. Abnormality in the pitutary gland
53. A blood test can help confirm if you are beginning menopause. The test measures the level
of which of these?
A. Follicle-stimulating hormone
B. Estrogen
C. Progesterone
D. Cholesterol

54. A virilized female fetus with labial fusion was born to a non- virilized mother What is the most
likely cause of the fetal virilization?
a. maternal drug exposure to progestins
b. maternal androgen producing ovarian neoplasms
c. congenital adrenal hyperplasia
d. maternal exposure to diethylstillbestrol

55. Premature ovarian failure also known as hyper gonadotropic ovarian failure occurring prior
to age _ yr.
a. 35
b. 30
c. 45
d. 40

56. A mother brings her 6 yo daughter to the outpatient department for white discharge and
vulvar erythema for great 2 wks. Child is hesitant to allow her mother to touch her vulvar area
Mother informs you that recently the child............. touched by, an uncle who lives w/ the family.
The physical finding most likely to be found this thing is
a. Posterior hymenal tear
b. vulvar hemangioma
c. Urethral caruncle
d. Labial agglutination
57. true of vulvovaginal atrophy during menopause?
A) Often associated decrease follicle stimulating hormone
B) Progestrogen deficiency resule thin, decrease mucosa
C) Progressive unlike one on it
D) Mucosa decrease inflammation.......
 Gynecology Unit Exam 2
25 Aug 2023

1. Which of the following is a more favored theory to explain the development of endometriosis?
a. Lymphatic spread
b. Coelomic metaplasia
c. Retrograde menstruation
d. Abnormal differentiation of mullerian remnants

2. 59-year-old G3P3 (3003) sought consultation due to loose watery stools with gastric
disorders. Upon examination knife like appearance was noted what will be the impression?
1) Crohn's Disease
2) Psoriasis
3) Sebboric Dermatitis
4) Acanthus Nigricans

3. A 23-year-old having overweight BMI presents to the clinic with Diabetes mellitus and PCOS
complaining of darkening of neck and perineal area. What is the best management and advice
you can give to the patient?
A. Weight loss
B. Corticosteroids
C. Antifungal
D. Incision and biopsy

4. Which of the following is the most common site of endometriosis

A. Ovary
B. Cervix
C. Myometrium
D. Vagina
5. Recommended drugs for the treatment of uncomplicated vaginosis candidiasis except
A. Miconazole
B. Metranidazole
C. Fluconazole
D. Terconazole

6. Compared with the general population, the prevalence of endometrosis is higher in women
with which of the following characteristics?
a. Pelvic pain
b. Infertility
c. Affected family member
d. All of the above

7. Which layer of the endometrium sloughs and there- fore is responsible for observed
menstrual discharge?
a. Spiral
b. Radial
c. Basalis
d. Functionalis

8. When evaluating a woman with endometriosis, which of the following gynecological

conditions may appropriately considered in differential diagnosis?
A) adenomyosis
B) interstitial cystitis
C) chronic tubo ovarian abscess
D) all of the above
9. A 45-year-old woman is diagnosed with primary syphilis. She has a history respiratory
distress and hives with past penicillin use. She re uses to undergo skin test intercom rmher
penicillin allergy and will not undergo desensitization. What is the best Alterna- tive oral
antibiotic to treat her in action?
a. Doxycycline
b. Azithromycin
c. Erythromycin
d. Ciproxacin

10. Which o the following statements regarding bacterial vaginosis in reproductive-aged women
is NOT true?
a. Condom use lowers risk.
b. Douching a ter menses is preventive.
c. It is the most common cause o vaginal discharge.
d. Rates o sexually transmitted disease acquisition are increased in its presence.

11. Which class of medication suppress the production of overian hormones & used to control
sever endometriosis
A) progestin
B) combined oral contraceptive pill
C) androgen
D) GnrH

12. Consider as last resort of endometriosis?

A. Laparoscopy
B. Progestin in pills
C. total hysterectomy with salpingo-oophorectomy
D. NSAISDS

13. Which of the following is the most common site of endometriosis

A. Cervix
B. Overy
C. Myometrium
D. Vagina

14. Which of the following is a structural cause of AUB

A. Malignancy
B. Coagulation
C. Ovulatory dysfunction
D. All of the above

15. To avoid reinfection by pediculous pubis and scabies, treatment should be prescribed for
sexual contact and close household contact with in how may previous weeks
A) Last 6 weeks
B) Last 8 weeks
C) Last 10 weeks
D) Last 12 Weeks

16. All o the ollowing are side e ects o danazol EXCEPT:

a. Hirsutism
b. Voice deepening
c. Breast hypertrophy
d. Vasomotor symptoms

17. Diagnosis of granuloma inguinale maybe established by:

A) Papsmear
B) VDRL & RPR
C) Identifying Donovan bodies in smears and specimens of ulcers
D) Identifying ‘safety pin’ appearance in cytoplasm of large mononuclear dark side cells
18. Best management for lichens simplex chronicus
A. Stop itch cycle
B. Anti-Fungal cream
C. Dapson
D. Antibiotics

19. To treat scabies, CDC recommends except:

A) Permethrin cream
B) Ivermectin
C) Lindane 1%, 1 OZ of location
D) Malathion 0.5% lotion

20. What is the primary causative agent genital herpes

A. Human Papillon virus
B. Herpes simplex virus
C. Chlamydia trachomonus
D. Nesssira gonnoreha

21. Of the following, which is the more likely complaint rom a woman with endometriosis?
a. Dysuria
b. Dyschezia
c. Dyspareunia
d. Anterior abdominal wall pain
22. An advantage of transvaginal sonography for the evaluation of abnormal uterine bleeding
includes which of the following?
a. Reduced use of endometrial biopsy
b. Simultaneous assessment o myometrium and endometrium
c. Greater patient comfort compared with endometrial biopsy or hysteroscopy
d. All of the above

23. A 22-year-old nulligravida undergoes diagnostic laparoscopy or dysmenorrhea and chronic

pelvic
pain. T e extent o her endometriosis is shown here, and these lesions are ablated. She desires
future ertil-ity but is not currently seeking conception. Which o the Following is the most
appropriate postoperative treatment?
a. Androgens
b. Aromatase inhibitors
c. Combination oral contraceptives
d. Gonadotropin-releasing hormone antagonist

24. The primary …… agent of herpes

A. human popillomavirus
B. Herpes simplex virus
C. Chlamydia trachomatis
D. Neisseria grnorr…

25. Which of the following diagnostic tests is used to diagnose endometrium

A. Pelvic laproscopy
B. Endometrial biopsy
C. Ct scan of the pelvic
D. Bimanuval pelvic exam
26. What is the initial treatment for small and asymptomatic Bartholin gland cyst

27. Early initial treatment of Bartholin cyst?

A) Antibiotic Therapy
B) Incision and biopsy
C) Warm compress
D) NSAID'S

28. Which is best regimen treatment for gonorrhea according CDC and prevention 2015.....????
A) erythromycin
B) cefixime+doxycycline
C) ceftriaxone+ adenamycin
D) penicillin g

29. 68 old lady come to chronic pruritus on perineal.clinical diagnosis itchy & scary
A. lichen planus
B. lichen sclerosis
C. Lichen simplex chronicles
D.

30. Which class of medication used to suppress ovarian hormone and used for severe
endometriosis
A. Progestin
B. Combined oral contraceptive pills
C. Androgen
D. GnRH
31. Which factor is thought to contribute to the spread and growth of endometriosis lesions.
A) High estrogen levels
B) Low progesterone levels
C) Low fat diet
D) Excessive exercise

32. A 60- year old postmenopausal woman is present for evolution of genital tract bleeding.
Which is confirmed as uterine in origin of physical examination. Which diagnostic procedure is a
logical first step in her evolution?
A) colposcopy
B) Diagnostic Hysterectomy
C) Transvaginal Sonography
D) Saline infusion Sonography

33. A patient was diagnosed with keratoacanthoma and it's management includes,
a. Excision and biopsy
b. Vulvectomy
c. Corticosteroids
d. Metronidazole

34. What is the typical normal range of vaginal PH

A. 3.0 to 3.5
B. 4.0 to 4.5
C. 5.0 to 5.5
D. 6.0 to 6.5

35. 26 years old G2P2(2002) sought consult. Upon examination noted apocrine was inflamed
with lesion all over the inguinal areas.
A) Seborrheic dermatitis
B) Hidradenitis suppurativa
C) Allergic dermatitis
D) Psoriasis
36. What diagnostic procedure involves the removal of a small part of uterine lining for a patient
with abnormal uterine bleeding
A. Curettage and dilatation
B. Pap smear
C. Endometrial biopsy
D. Hysteroscopy

37. Which surgical procedure consider as the gold standard diagnostic and treating
endometriosis?
A) hysterectomy
B) myomectomy
C) laparoscopy
D) colposcopy

38. Diagnostic criteria or bacterial vaginosis (BV) include clue cells seen on a saline slide
preparation (“wet prep”), a positive potassium hydroxide “whi ” test, and a high vaginal pH (>
4.5). At least what percent-age o squamous cells on wet prep should be clue cellsto con rm the
diagnosis o BV?
a. 20
b. 40
c. 60
d. 80

39. Compared with the general population, the prevalence of endometriosis is higher in women
with the following characteristics
A. Pelvic pain
B. Infertility
C. Affected family member
D. All of the above
40. Which treatment option is most suitable for a women who experiences severe bleeding due
to leiomyoma and has complete child bearing?
A. Myomectomy
B. Uterine atriel embolization
C. Hysterectomy
D. Hormonal therapy

41. Correct pair of age and abnormal genital tract bleeding except
1. Adolescence: Anovulation
2. Childhood: Vulvoviginitis
3. Perimenopause: Anovulation
4. Menopause: endometrial carcinoma

42. Age groups have been correctly paired with the most common etiology of abnormal genital
tract bleeding in all of the following EXCEPT:
A) Adolescence - Anovulation
B) Childhood - Vulvovaginitis
C) Perimenopause - Anovulation
D) Menopause - Endometrial carcinoma

43. Which of the following diagnostic procedure is used to diagnosis of endometriosis??

A) Pelvic laproscopy
B) Endimetrial biopsy
C) CT syphilis scan of pelvis
D) Bimanual exam of pelvic

44. Consider as last resort treatment for endometriosis

A) laparoscopy
B) progestin pills only
C) hysterectomy with salpino-oophorectomy
D) NSAID
45. The Main objective of medical management in endometriosis is?
A) Prevent recurrence & reduce symptoms
B) Induce fertility
C) Definite cure
D) All of the above

46. All of the following are side effects of danazol EXCEPT:

a. Hirsutism
b. Breast hypertrophy
c. Vasomotor symptoms
d. Voice deepening

47. 62yr came in due to severe and deformity erosive vaginitis upon examination you noticed a
chronic erupsive shiny violenous that doesn't involve vagina
A. Lichen sclerosus
B. Lichen planus
C. Lichen nevi
D. Lichen simplex chronicus

48. 78 yr old male G5P5 (5005) came to your clinic and starts complaining of pruritis on
examination .........white papules ....in the form of hour glass figure 8
A. Lichen nevi
B.Lichen sclerosis
C.Lichen simplex chronicus
D.Lichen planus
49. It’s a similar to a severe and deforming erosive vaginitis that has unique chronic eruption of
shiny violaceous papules but does not involve the vagina is most likely to be?
A. Lichen planus
B. Lichen nevi
C. Lichen sclerosis
D. Lichen simplex chronicus

50. What diagnotic procedure involved remove small simple of Uterine lining for examination
with Uterine bleeding?
A) dilatation with currettage
B) pap smear
C) endometrium biopsy
D) hysteroscopy

51. 26 year old G2P2 (2002) , with apocrine gland inflamed all over the inguinal area ?
Ans: Hidradenitis

52. Which of the following is following is false about wound decontamination of radiologic event?
A. It should be conservative as much as possible.
B. The wound should be prevented extensive….and internally by laceration of skin
C. Radiologic shrapnel which damaged internally should be removed
D. Excision of the wound should be attempted surgically

53. Nonstructural causes of abnormal uterine bleeding

A) Hyperplasia
B) Iatrogenic
C) Lu
D) All of the above
54. Which of the following medications used to treat abnormal uterine bleeding-endometrial
(AUB-E) is correctly paired with its mechanism of action?
A. Tranexamic acid-increases plasmin levels
B. Nonsteroidal anti-inflammatory drugs (NSAIDs)-- stimulate cyclooxygenase (COX-1 and
2) production
C. Oral progestinsinhibit endometrial growth and promote organized sloughing following their
withdrawal
D. Combination oral contraceptive pills (COCs)- induce endometrial atrophy but promote
increased prostaglandin synthesis and endometrial fibrinolysis

55. When evaluating a woman with endometriosis, which of the following gynecologic conditions
may appropriately be considered in the differential diagnosis?
A. Adenomyosis
B. Chronic tubo-ovarian abscess
C. Interstitial cystitis
d. All of the above

56. 26-year women present with recurrence vulvar skin lesions that are painful associates with
Apocrine sweat glands?
a. Vitiligo
b. Lichen planus
c. Lichen sclerosus
d. Hidradenitis suppurativa

57. Control of blood loss during menes?

A. Thrombus Formulation
B. Platelets aggravated
C. Vaso contraction
D. All of the above