Gyna Final Reveision

8/19/2019 Gyna Final Reveision

1/252

Revision

On

Gyna Obstetrics

2008

By/

Dr Adel Abdel Hamid


2/252

2 Gyna & Obstetrics Reveision by/Dr.adool 2008

Index

1- All gyna & obstetrics last year exams classified according to chapters…………………..( 4 )

2- Examples of short questions……………………………………….………………………………………… ( 11 )

3- Mcqs & false or true questions on gyna & obstetrics classified according to chapters.( 18 )

4- Mcqs exams…………………………………………………………….…………………………………………..(218)

Exam 1 ……………………………………………………………………………………………………….…….(219)

Exam 2 ………………………………………………………………………………………………….………….( 227)

Exam 3 …………………………………………………………………………………………….……………….(232 )

Exam 4 …………………………………………………………………………………………….……………….(239)


3/252


Contents

This book contains

1- 1st

part

All gyna & obstetrics last year exams classified according to chapters

2- 2nd

part

Examples of short questions

3- 3rd

part

Mcqs & false or true questions on gyna & obstetrics classified according to chapters

4- 4th

part

Mcqs exams


4/252


1st

part

الرحم

الرحن

ا

م

والل في جع الاث البقت قت ي ح الشبر اسئت اببث بدة الب

A Gynecology

1)Anatomy & Embryology

1-Congenital anomalies of Uters 96

2-Anatomy of Cervix & Cervical ligaments. 99

3-Anatomy & anomalies of Corpus Uteri 2000

4-Anatomy of Fallopian tubes. 98

5- Anatomy of Fallopian tubes & its role in infertility 2001

6- Anatomy of Broad ligament . 2002

7- Anatomy of Perineal body 2003

8-Embryology of Vulva 2003

2)Reproductive development of female genital tract

1-Amenorrhea 98

2-Uterine causes of Amenorrhea 95, 96, 98, 2007

3-Causes & investigation of Ovarian Amenorrhea. 99, 2001

4-Spasmodic dysmenorrhea. 2003

5-Postpartum Amenorrhea 2003

-D.D 2006

Causes & Discuss one Pathological cause. 2003

6-Cryptomenorrhea 2004

7-Aetiology & investigations of bleeding in early pregnancy . 98

8-Precocious puberty 2003, 2007

9-Tubal factor of infertility 96

10-Cervical causes of infertility 98


5/252


11-Ovarian factor of infertility 2007

12-Diagnosis &TTT of anovulation 2006

13-Diagnosis of ovulation 96

14-Induction of ovulation 98

15-Postmenopausal bleeding diag. & TTT 2003

16-Complications of ovarian cyst 98, 2007

17-Testicular Feminization Syndrome. 2002

3)Reproductive Tract Infection

1-Gardenella vaginalis 95

2-Vaginal discharge (Leucorrhea) 2002

-Investigations 96, 99, 2003, 2006

-Defintion, causes 2003, 2006

3-Trichomons Vaginalis 98, 2004

-Diagnosis & TTT 96

4-Bacterial vaginosis 98, 2001

5-1ry vaginitis 2003

6-Aetiology & management of recurrent vaginal moniliasis. 2000

4) Displacement, Trauma & Urogynecology.

1-Vesicovaginal fistulae

-Causes 96, 98, 2004

-Diagnosis 96,, 203, 2004, 2006, 2007

-TTT 2006

2-Postoperative care of repaired Vesicovaginal fistulae 2003

3-Definition & types of female urinary incontinence 2003

4-Investigation of true urinary incontinence 2002

5-Uretrovaginal fistula 98


6/252


6-Uetrovaginal support 2002

7-Genital prolapse

-Recurrent Genital prolapse 2003, 2007

Causes of prolapse 96, 2004-

8-Etiology & diagnosis of uterine prolapse 2006

9-Diagnosis & mang. Of old complete perineal tear 2006, 2007

10-Pregnancy of RVF uterus 2002

5) Diseases & Swelling of Vulva & Vagina

1-Vaginal cyst 2001

2-D.D of Vulval Ulcers 2003, 2007

6)Benign tumors of Uterus & Endometriosis

1-S&S of Adenomyosis Uteri 96

2-Endometriosis 96

-Diag. & TTT 99

-Mang. Of pelvic endometriosis 2000

3-Complications of Benign Ovarian tumors

7)Oncology

1-Aetiological factors & diagnosis of uterine body carcinoma 95

2-Chemotherapy "indication& complication" in gynecological practice 95

3-Cervical intraepithelial neoplasia CIN 98, 2003, 2006

-Diagnosis & TTT 96, 2002

4- Diagnosis & TTT of Uterine carcinoma 96

5- Diagnosis & TTT of endometrial carcinoma 98

Mang. 2001-

-Epidmiology, staging & prognosis 2003

6-Spread of cervical carcinoma 2003, 2004


7/252


7-Clinical staging of cervical carcinoma 2004, 2006, 2007

8-Complications of ovarian tumors 2003

9-Early detection of cancer cervix

10-Complications of ovarian cyst 98, 2007

8)Contraception & Fertility control1-Comp. of IUD 2002, 2003, 2006

Mang. 2006

2-Emergency contraception 2003, 2006, 2007

B Obestetrics

1)Normal Pregnancy

1-Placental functions & morphology 96

2-D.D of Pregnancy 96

3-Cardiovascular adaptations during normal pregnancy 2001, 2003, 2007

4-Diag. of pregnancy in 1st trimester 2001, 2002

5-Instructions given to pregnant lady at her 1st

antenatal care visit 2003

6-Vomiting in early pregnancy causes & mang. 2006

7-S&S of early pregnancy

2)Abnormal pregnancy

1-Ovarian pregnancy 95

2-Diagnosis of Molar pregnancy 2003

3-Diag. of advanced extrauterine pregnancy 2003

4-Aetiology & Investigations of bleeding in early pregnancy 98

5-Abnormal vaginal bleeding in childbearing period 2002

6-Accidental Hge

-Mang. 98


8/252


-Causes & diagnosis 99

7-Hazards of abruption placentae 2002

8-Mang. of placenta previa 2006

9-Habitual abortion 2003

-Etiology 2004, 2007

-Diag. 96, 2004, 2007

-TTT 96 & Mang. 98

10-Polyhydramnios 98

11-Preeclampsia

-Cardiovascular changes in severe preeclampsia 2002

-Severe Preeclampsia 2002

-Diag. & TTT 2003

-Mild Preeclampsia Diag. & TTT 2006

-Mang. Of preeclampsia remote of term 2003

12-Eclampsia

-Diag. & Ttt of eclamptic fit 96

-Mang. 2006

-TTT 2004, 2007

3)Normal Labor

1-Mang. Of 2nd stage normal labor 96, 2004

2-Mang. Of 3rd

stage normal labor 2007

3-Pain relief in labor 98

4)Malpresentation & Malpositioning.

1-Mang. Of persistent occipitotransverse

2-Deep transverse arrest of fetal head 96, 2003

3-Deep transverse arrest of fetal face. 2002

4-Diag. & Mang. Of Face presentation 98


9/252


5-Mang. Of breech presentation in labor 98

6-Fetal hazards in breech delivery 2003, 2007

7-Arrest of fetus after coming in breech presentation. 2001

8-Complicated breech delivery 2000

9-Charcters of vaginal delivery in breech presentation 2006

10-Neglected shoulder 2003

11-Mechanism of labor in occipitoposterior position 2000

12-Occipitoposterior position of fetal head 2006

5)Abnormal Labor

1-Atonic postpartum haemorrage 2004

-Predisposing factors & Mang. 95

-Causes 96

2-Causes & diag. of 1ry postpartum Hge 96

3-2ry postpartum Hge. 98, 2003

4-Retained placenta 2000

-Causes & TTT 2006

5-Mang. Of pelvic outlet contraction 98

6-Obestetric pelvic outlet 2002

7-Postpartum collapse 2001

8-PROM

-Definition 2003, 2007 & -Diag. 2007

-Mang. 98, 2003, 2007

9-Hypofibrinogenemia in relation to obstetrics 2003

10-Complications of 3rd stage labor 98

11-Etiology & mang. of preterm ( premature) labor 98, 2000

12-Impending rupture of the uterus 2002, 2007

13-Uterine rupture during pregnancy 2003


10/252


6)Fetus

1- IUFD

-Diag. & TTT 96 & -Complications 2003

-Mang. Of IFUD at 30 week of pregnancy 95

2-Fetal circulation 96

3-Prenatal screening & diagnosis of fetal anomalies. 96

4-Intrapartum fetal monitoring 99, 2003, 2007

5-Tests for fetal maturity 2000

6-Antepartum evaluation of fetal morphology & genetics 2001

7-Biophysical evaluation of fetal health 2006

8-Fetal health evaluation 2006

9-Diagnosis of intrapartum fetal distress 2003

10-Fetal head birth injuries 2003

7)Neonates

1-Neonatal asphyxia 2006

8)Operative

1-Epsiotomy

2-Indications & complications of craniotomy 96

3-Indications & contraindications of vaccum extractions "Ventose" 96

4-Indications & compl. Of CS 2004, 2007

5-Induction of labor 96

-Methods & indications 99

9)Miscellaneous

1- Amniocentesis, therapeutic & diagnostic values 2002


11/252


2nd

part

Short Questions

1-Differences between the upper and the lower uterine segments:

2-Cardiovascular changes with pregnancy

3-Urinary changes with pregnancy

4-Drug categories during pregnnacy according to FDA classification:

5-Causes of Bleeding in early pregnancy

6-AETIOLOGY OF SPONTANEOUS ABORTION

7-TYPES OF ABORTION

8-Management of:

- Threatened abortion:

- Inevitable abortion

- INCOMPLETE ABORTION

- missed abortion

- SEPTIC ABORTION

9-AETIOLOGY OF RECURRENT ABORTION (RPL)

10-Antiphospholipid Syndrome

11-MANAGEMENT OF CASES WITH RPL

12-Diagnosis of isthmic incompetence:

13-Treatment of isthmic incompetence:

14-AETIOLOGY of TUBAL PREGNANCY

15-PATHOLOGY of tubal Ectopic pregnancy

16-CLINICAL PICTURE of tubal Ectopic pregnancy

17-TREATMENT of TUBAL PREGNANCY

18-PATHOLOGY of hydatidiform mole:


12/252


19-CLINICAL FEATURES of hydatidiform mole

20-TREATMENT of hydatidiform mole

21-FOLLOW-UP of hydatidiform mole

22-CAUSES of Antepartum haemorrhage

23-CLINICAL DIAGNOSIS OF PLACENTA PRAEVIA

24-MANAGEMENT OF APH due to PLACENTA PRAEVIA

25-AETIOLOGY Of ACCIDENTAL HAEMORRHAGE

26-DIAGNOSIS OF ACCIDENTAL HAEMORRHAGE

27-MANAGEMENT OF APH due to ACCIDENTAL HAEMORRHAGE

28-Complications of accidental haemorrhage

29-MANAGEMENT of hyperemesis gravidarum

30-CLINICAL PICTURE OF PREECLAMPSIA

31-COMPLICATIONS OF PREECLAMPSIA

32-Criteria of severity of PE

33-PREVENTION and TREATMENT OF PREECLAMPSIA

34-Effect of Pregnancy on Diabetes

35-Effects of Diabetes on Pregnancy

36-Management OF DIABETES WITH PREGNANCY

37-Management OF CARDIAC DISEASES WITH PREGNANCY

38-Management OF Rh Incompatibility (Erythroblastosis Fetalis)

39-Management OF asymptomatic bacteruria WITH PREGNANCY

40-ENGAGEMENT

41-MANAGEMENT of occipito-posterior

42-MANAGEMENT of face presentation

43-Management Of Brow Presentation

44-DIAGNOSIS OF BREECH PRESENTATION

45-MANAGEMENT options in breech presentations


13/252


46-Indications of CAESAREAN SECTION IN BREECH PRESENTATION

47-Management Of transverse lie

48-Management Of Cord prolapse

49-MANAGEMENT OF TWIN PREGNANCY

50-Indications of C.S. in multifetal pregnancy

51-Complications of multifetal pregnancy

52-MANAGEMENT OF Hypotonic inertia

53-MANAGEMENT OF Hypertonic inertia

54-MANAGEMENT OF Precipitate labor

55-MANAGEMENT OF CONTRACTION (CONSTRICTION) RING

56-MANAGEMENT OF CERVICAL DYSTOCIA

57-MANAGEMENT of contracted pelvis

58-Cephalopelvic disproportion (CPD) tests

59-Management of labour in contracted pelvis

60-Trial of labour (TOL)

61-Indications of Caesarean section in contracted pelvis:

62-Management of OBSTRUCTED LABOUR

63-MANAGEMENT OF RUPTURE UTERUS

64-MANAGEMENT OF CERVICAL LACERATIONS

65-Management of PRIMARY POST PARTUM HAEMORRHAGE

66-Management of Retained placenta

67-Management of Acute inversion of the uterus

68-Assessment of Antepartum: fetal wellbeing

69-Assessment of Intrapartum: fetal wellbeing

70-INTRAUTERINE GROWTH RESTRICTION (IUGR)

71-FETAL MACROSOMIA

72-Management of Preterm labour:


14/252


73-Management of Post-term pregnancy

74-Management of Spontaneous Prelabour Rupture Of the Membranes

75-Management of OLIGOHYDRAMNIOS

76-Management of POLYHYDRAMNIOS

77-PHYSIOLOGICAL CHANGES IN THE PUERPERIUM

78-PUERPERAL PYREXIA

79-Management of PUERPERAL SEPSIS

80-METHODS OF INDUCTION OF LABOUR

81-METHODS OF INDUCTION OF ABORTION

82-The Bishop score

83-Classification of forceps operations

84-Indications for the use of forceps

85-Prerequisites before forceps application

86-COMPLICATIONS OF FORCEPS PROCEDURES

87-Classification of forceps operations

88-Indications for the use VACUUM EXTRACTOR

89-Prerequisites before VACUUM EXTRACTOR

90-COMPLICATIONS OF VACUUM EXTRACTOR

91-Episiotomy

92-INDICATIONS OF C.S

93-Advantages f the L.S.C.S

94-Causes of MATERNAL MORTALITY

B)Gynecology

95-Causes of infertility

96-Investigations of infertile couples

97-Treatment of infertility

98-CLASSIFICATION OF URINARY INCONTINENCE


15/252


99-Management of stress incontinence

100-Management of Menopause

101-Causes of 2ry amenorrhea

102-Causes of 1ry amenorrhea

103-Diagnosis of amenorrhea

104-Treatment of amenorrhea

105-Primary dysmenorrhea

106-Secondary dysmenorrhea

107-Premenstrual tension syndrome

108-AETIOLOGY OF ANOVULATION:

109-DIAGNOSIS OF OVULATION

110-TREATMENT OF ANOVULATION

111-Management of PCO

112-Management of LPD

113-Management of Hirsutism

114-Management of:

-Trichomonas Vaginitis

-Monilia Vaginitis (Candidiasis)

-BACTERIAL VAGINOSIS

(Non-specific Vaginitis, Gardnerella Vaginitis)

-Acute Cervicitis

-Chronic Cervicitis

-Cervical Erosion

-PELVIC INFLAMMATORY disease (PID)

-Endometrosis

-GENITAL PROLAPSE

115-AETIOLOGY OF GENITAL PROLAPSE


16/252


116-AETIOLOGY OF Perineal Lacerations AETIOLOGY OF Rectovaginal Fistula

117-Management of Perineal Lacerations Management OF Rectovaginal Fistula

118-AETIOLOGY OF VESICOVAGINAL FISTULA

119-Management of VESICOVAGINAL FISTULA

120-Management of URETERO-VAGINAL FISTULA

121-AETIOLOGY OF URETERO-VAGINAL FISTULA

122-Management of UTERINE LEIOMYOMATA

123-DIAGNOSIS OF CIN

124-TREATMENT OF CIN

125-PATHOLOGY Of INVASIVE CARCINOMA OF THE CERVIX

126-STAGING OF CERVICAL CARCINOMA

127-Management of INVASIVE CARCINOMA OF THE CERVIX

128-Management of Endometrial Hyperplasia

129-PATHOLOGY OF ENDOMETRIAL CARCINOMA

130-GRADING AND STAGING OF ENDOMETRIAL CARCINOMA

140-Management OF ENDOMETRIAL CARCINOMA

141-PATHOLOGY OF CHORIOCARCINOMA

142-Management OF CHORIOCARCINOMA

143-non neopl. cysts OF THE OVARY

144-CLASSIFICATION OF OVARIAN NEOPLASMS

145-Pathology of benign ovarian tumours

146-Management of benign ovarian tumours

147-Pathology of malignant ovarian tumours

148-Management of malignant ovarian tumours

149-COMPLICATIONS OF BENIGN OVARIAN NEOPLASMS

150-Surgical staging of primary ovarian cancer:

151-Complications of IUD


17/252


152-Contraindications for IUCD

153-Complications of OCPS

154-Contraindications for OCP

155-Complications of Injectable Contraceptives

156-Contraindications for Injectable Contraceptives

157-Contraception Methods For Lactating Females


18/252


3rd

part

GYNa MCQs

Index

(1) *Anatomy & Embreology &Physiology……………………………………………………………………………………… 19

(2) * Amenorrhea …………………………………………………………………………………………………………………………. 29

(3) * Dysmenorrhea ……………………………………………………………………………………………………………………. 35

(4) *Abnormal genital tract bleeding …………………………………………………………………………………………… 41

(5) * Ovulation and its disorders ………………………………………………………………………………………………… 51

(6) * Infertility & Hirsutism …………………………………………………………………………………………………………. 70

(7) * Displacements, traumatic lesions, urogynecology …………………………………………………………….. 76

* Genitourinary fistula ………………………………………………………………………………………………….. 76

* URINARY INCONTINENCE ……………………………………………………………………………………………. 82

* Old complete perineal tear …………………………………………………………………………………………… 86

(8) * Diseases of vulva& Infection ……………………………………………………………………………………………… 88

(9) * Endometriosis ……………………………………………………………………………………………………………………. 93

(10) * CANCER CERVIX ……………………………………………………………………………………………………………….. 93

(11) * CERVIX ... NONE NEOPLASTIC LESIONS …………………………………………………………………………….. 111

(12) * Endometrial carcinoma ………………………………………………………………………………………………….. 113

(13) * Choriocarcinoma ………………………………………………………………………………………………………….. 122

(14) * Ovarian tumours ............................................................................................................. 125

(15) * The ovary ……………………………………………………………………………………………………………………….. 136

(16) * Family planning and contraception ……………………………………………………………………………….. 140


19/252


(1) *Anatomy & Embreology &Physiology

1) In the embryology of genital organs what is the false?

a) Ovary from the genital ridge

b) Tubes, uterus and whole vagina from Wolffian ducts

c)

Clitoris from genital tubercle

d)

Labia minors from genital folds

e) Labia majora from genital swellings

2) What is false in failure of the longitudinal fusion Mullerian ducts?

a) Double (bodies, cervices) = uterus didelphys

b) Double bodies and one cervix = bicornuate unicollis

c)

Intra-uterine septum = Septate & Subseptate

d) Fundal depression = Arcuate uterus

3) What is the false in anatomy of vulva?

a)

Nerves: pudenda!, perineal, Genito-femoral and ilio-inguinal

b)

Lymphatics to inguinal lymph nodes

c)

Totally covered with keratinized epithelium

d)

Bartholin's and Skene’s glands open in vestibule

e)

Blood vessels are pudendals (internal and external)

4) What is false about the hymen?

a)

Incomplete membrane covered with stratified epithelium

b)

Between upper and lower vagina

c)

Annular, crescenteric, biperforate, cribriform and imperforate

d)

Its remnants are carunculae myrtiformes

5) The vagina in a young woman has the followings except:

a)

Both anterior and posterior walls = 8 cm

b)

Consists of mucosa, submucosa, musculosa and adventitia


20/252


c)

Is supported by multiple ligaments and muscles

d)

Has 4 types of lining cells which are sensitive to steroid hormones

6) What is false in the following anatomical features of the uterus?

a)

Corpus is the main part

b)

Fundus is the part above insertion of the round ligaments

c)

Isthmus is between the anatomical os (above) and the histological (below)

d)

Isthmus forms the lower segment of pregnancy

e)

Mobile RVF uterus is normal in 15-20%

7) What is the false in anatomy of the broad ligaments?

a)

Peritoneal leaves from the uterine side to the pelvic side

b)

True ligaments contain two false ligaments (round & ovarian)

c)

Contain tubes, ligaments (round & ovarian), vessels, nerves and Wolffian remnants

d)

All the contents are extraperitoneal

8) The ovary has the following characters except:

a)

2 poles (upper & lower)

b)

2 surfaces (medial & lateral

c)

2 borders (anterior & posterior

d)

2 veins drain into the inferior vena cava (IVC)

e)

3 areas (cortex, medulla & hilum) and 3 x 2 x 1 cm

9) The non-pregnant cervix has the following anatomical features except:

a)

One spindle shape canal with mucus folds [arbor vitae uteri]

b)

One cm length

c)

Two [portions, orifices & types of epithelium]

d)

Three [layers (mucosa, muscle & adventitia) and ligaments]

10) The normal menstruation needs the followings except:

a)

Normal hypothalamic pituitary ovarian functions .

b)

Patent uterine tubes


21/252


c)

Healthy responsive endometrium (to steroids)

d)

Patent outflow tract

11) Progesterone leads to the following effects except:

a)

Secretory and decidual endometrial changes with myometrial relaxation

b)

Viscid scanty cervical mucus

c)

Proliferation of the vaginal squamous cells

d)

Proliferation of the glandular breast tissue

12) LH surge stimulates the followings except:

a)

Completion of meiosis of primary oocyte

b)

Lutenization of granulosa cells

c)

Synthesis of follicular progesterone, prostaglandins and proteolytic enzymes

d)

Ovulation

e)

None of above

13) Regarding hypoplasia of the uterus the followings art true except:

a) Uterine index < I

b) May cause oligomenorrhea, hypomenorrhea, amenorrhea,& spasmodic dysmenorrhea

c)

Is of three types

d) Diagnosed by sounding &US

e) Treated by cyclic estrogen and progestin therapy

14) The imperforate hymen is characterized by the followings except:

a) Bulging bluish membrane

b) Monthly abdominal pain

c)

Collection of menstrual blood as hemato (colpos, metra and salpinx) )

d) Causes true amenorrhea

e) Treated by cruciate incision


22/252


15) What is false in anatomy of the Labia minora?

a)

Thick folds of hairy skin with sebaceous glands and fat

b)

Divided anterior into the prepuce (above) and the frenulum (below) the clitoris

c)

United posterior to form the fourchette

d)

Contain erectile vascular and sensitive tissue

16) The pelvic floor includes the followings except:

a)

From perineal skin up to peritoneum of the Douglas pouch

b)

Perineal muscles (deep & superficial) and membranes

c)

Levator ani & coccygeus and pelvic fascia

d)

Obturator internus muscle

17) What is false in anatomy of the adult nulliparous uterus?

a)

4 parts: fundus, corpus, isthmus and cervix

b)

3 layers: endometrium, myometrium and perimetrium

c)

3 blood supply: uterine, ovarian and vaginal

d)

3 inches (length) x 2 breadth (at fundus) x one thickness (add ½ inch for each in multipara).

e)

Has thin myometrium

18) The cervix has the following anatomical features except:

a)

Contains glands

b)

Portiovaginalis and supravaginalis

c)

The squamo-columnar junction is the origin of neoplasia

d)

Sensitive for traction and dilatation and insensitive for cutting and heat

19) What is the false about the ovary during reproductive life?

a)

Receives 2 blood supply (ovarian & uterine)

b)

Has 2 functions (ova and steroid hormones)

c)

Contains 2 types of follicles (functioning & degenerated)

d)

Attached by 2 ligaments (ovarian & infundibulo-pelvic)

e)

Has peritoneal covering


23/252


20) What is false in the clinical effects of the following abnormalities?

a)

Bicomuate uterus may cause habitual abortion &oblique lie

b)

Rudimentary horn may cause ectopic pregnancy

c)

Uterine hypoplasia causes menorrhagia

d)

Cervical incompetence causes habitual abortion

21) Regarding the innervations of the genital organs the followings true except?

a)

Only autonomic nerve supply

b)

The sympathetic from the thoracic and the lumbar roots

c)

The parasympathetic from the sacral roots

d)

The nerve plexuses are the superior & inferior hypogastric

22) The followings are associations of ovulation except:

a)

L.H. surge

b)

Follicular prostaglandins synthesis

c)

Oocyte reduction division

d)

Reduction of the follicle size with follicular fluid in the Douglas pouch

e)

Depression [reduction] in FSH

23) Estrogen has the following effects except:

a)

Proliferation of the endometrium

b)

Growth of ducts and stroma of the breast

c)

Growth of the clitoris and pubic hair

d)

Production of a copious watery thin cervical mucus

e)

Proliferation of the vaginal squamous cells

24) Ovulation is due to:

a)

FSH surge

b)

Progesterone synthesis

c)

Increased follicular prostaglandins and proteolytic enzymes

d)

Increased androgens synthesis


24/252


25) The embryological causes of cryptomenorrhea include Ike followings except:

a) Imperforate hymen

b) Turner syndrome

c) Complete transverse vaginal septum

d)

Vaginal aplasia.

e) Cervical atresia

26) What is the false about the congenital vaginal anomalies in females?

a) Aplasia of upper 4/5 of vagina, uterus and tubes (Rokitansky syndrome)

b) Transverse and longitudinal septa

c) Congenital fistulae with the bladder and the rectum

d)

Short blind pouch in testicular feminization syndrome (TFS)

27) The clitoris has the following features except:

a)

Cavernous erectile sensitive organ attached to front of the pubis by the suspensory ligament

b)

Estrogen dependant organ

c)

Consists of glans & body

d)

Excised during circumcision

28) What is false about the perineal body?

a)

Pyramidal fibro-muscular mass between tower vagina & rectum

b)

Contains decussating fibers of levator ani, superficial &deep perineal muscles

c)

Includes the anterior part of external anal sphincter

d)

Surgically incised (episiotomy) or torn during some labors

29) What is the false in the anatomy of the uterus?

a)

In center of the true pelvis

b)

Has 5 ligaments.

c)

Forward bending of cervix on vagina by 90° (anteversion)

d)

Forward bending of corpus on cervix by 160° (anteflexion)

e)

Internal os is at the level of the ischial spine


25/252


30) What is the false in anatomy of the broad ligaments?

e)

Peritoneal leaves from the uterine side to the pelvic side

f)

True ligaments contain two false ligaments (round & ovarian)

g)

Contain tubes, ligaments (round & ovarian), vessels, nerves and Wolffian remnants

h)

All the contents are extraperitoneal

31) The ovary has the following characters except:

f)

2 poles (upper & lower)

g)

2 surfaces (medial & lateral

h)

2 borders (anterior & posterior

i)

2 veins drain into the inferior vena cava (IVC)

j)

3 areas (cortex, medulla & hilum) and 3 x 2 x 1 cm

32) The non-pregnant cervix has the following anatomical features except:

e)

One spindle shape canal with mucus folds [arbor vitae uteri]

f)

One cm length

g)

Two [portions, orifices & types of epithelium]

h)

Three [layers (mucosa, muscle & adventitia) and ligaments]


e)

Normal hypothalamic pituitary ovarian functions .

f)

Patent uterine tubes

g)

Healthy responsive endometrium (to steroids)

h)

Patent outflow tract

34) L.H. has the following actions except:

a)

Lutenization of the granulosa and theca cells

b)

Stimulation of progesterone [P] synthesis

c)

Stimulation of androgen synthesis

d)

Production of L.H. receptors on the granulosa cells


26/252


35) What is false in the effects of excess androgens in the adult female?

a)

Atrophy of the secondary sex organs

b)

Oligomenorrhea then amenorrhea

c)

Hirsutism, deepening of the voice & clitoromegaly

d)

All the above changes are irreversible

36) Normal menstruation is characterized by the followings except:

a)

Regular every >3-5 weeks

b)

Average duration 3-5 days (2-7 range)

c)

Unclotted blood loss about 25-80 ml

d)

The first one is menarche at age of 11-13 years

e)

Usually it is asymptomatic [silent]

37) What is false in the following arteries of the genital organs ?

a)

The ovarian from the aorta

b)

The uterine from the internal iliac

c)

The vaginal and the internal pudendal from the int. iliac [to the vagina

d)

The external pudendal from the int. iliac [to the vulva]

38) Mechanism of menstruation includes the followings except:

a)

Constriction of the spiral arteries [PG]

b)

Endometrial ischemia

c)

Endometrial desquamation & shedding

d)

Excessive estrogen secretion

39) The luteal phase has the following features except:

a)

Low basal body temperature [uni-phasic curve]

b)

Secretory changes of the endometrium

c)

Progesterone [P] dependant

d)

Predominance of the intermediate vaginal cells

e)

Fixed length (12-14 days)


27/252


40) The average duration of normal menstrual cycle is:

a)

5 weeks ± one week

b)

40 days

c)

3 weeks ± one week

41) What is false about the pelvic portion of the ureter?

a)

Retroperitoneal with 15 cm length

b)

Enters the pelvis infront of the sacro-iliac joint and common iliac artery bifurcation

c)

At level of ischial spine passes medially and forwards under uterine artery

d)

Pierces Mackenrodt's ligament 5 cm lateral to the cervix

42) Fallopian tubes have the following anatomical features except:

a)

2 [in number, functions &blood supply]

b)

3 [layers & types of the lining cells]

c)

4 [parts & inches in length]

d)

Complete peritoneal covering

43) What is false in the following anatomical features of the uterus?

f)

Corpus is the main part

g)

Fundus is the part above insertion of the round ligaments

h)

Isthmus is between the anatomical os (above) and the histological (below)

i)

Isthmus forms the lower segment of pregnancy

j)

Mobile RVF uterus is normal in 15-20%

44) What is the fake in the anatomy of the vagina?

a)

Elastic fibro -muscular canal from vulva to cervix

b)

Directed up and backwards by 60-70° angle on horizon

c)

Lined with keratinized stratified squamous epithelium with multiple glands

d)

Has multiple blood supply [vaginal, uterine, vesical and rectal (mid. & inferior) arteries]

50) What is the false about anatomy of Bartholin's gland?

a)

Two racemose pea sized glands with columnar epithelium


28/252


b)

Palpable at junction of upper 2/3 and lower 1/3 of L. minora

c)

Secrete lubricant serous fluid during coitus

d)

Duct is lined by transitional epithelium

51) What is the false about the Wolffian remnants?

a)

Koblet's tubules, epoophoron, paroophoron & Gartner's duct

b) Give to paroovarian cyst in the broad ligament

c) Give to Gartner's cyst in the anterolateral vaginal wall

d) Give to Skene's cyst

52) The followings can cause pregnancy loss and malpresentations except:

a) Uterine hypoplasia

b)

Cervical incompetence

c)

Septate & bicornuate uteri

d) Imperforate hymen

(2) * Amenorrhea,

1) The fallowings cause true amenorrhea [A] except:

(a) Alternations in hypothalamic-pituitary-ovarian axis

(b) Endometrial pathology

(c) Obstructed outflow tract

(d) Systemic disease [auxiliary factors]

2) What is false in the following definitions?

(a) Absence of menses up to age of 16 with developed secondary characters = primary one

(b) Absence of menses up to age of 14 without developed secondary sex characters = primary one

(c) Delayed period for 2 weeks = secondary type

(d) Missed periods for 3 cycles = secondary type

(e) Eumenorrhea means normal menstruation


29/252


3) What is false in classifications of amenorrhea?

(a) Physiological, pathological

(b) Primary, secondary

(c) False (crypto.), true

(d) Cervical, vaginal & vulvar

(e) Hypothalamic, pituitary, ovarian, uterine

4) What is false in cause of physiological amenorrhea?

(a) Before puberty (low GnRH )

(b) During pregnancy (high estrogens and progesterone)

(c) During lactation (high oxytocin)

(d) After menopause (low estrogens)

5) What is false about the primary amenorrhea?

(a) Of hypothalamic causes

(b) Of pituitary causes

(c) Of ovarian & uterine causes

(d) Means absent periods after menarche

(e) Caused also by imperforate hymen

6)Cryptomenorrhea occurs with the fallowings except:

(a) Imperforate hymen

(b) Vaginal aplasia

(c) Incomplete transverse vaginal septum

(d) Cervical obstruction [congenital & acquired]

7) What is false in causes of the true amenorrhea?

(a) C.N.S. and hypothalamus

(b) Pituitary

(c) Ovarian

(d) Uterine


30/252


(e) No other causes more than the above

8) The CNS and hypothalamic amenorrhea include the fallowings except:

(a) Psychological (anorexia nervosa, pseudocyesis, emotional trauma)

(b) Organic lesions (tumors, trauma, meningitis)

(c) Galactorrhea amenorrhea syndromes

(d) Infantilism

(e) Postpill amenorrhea

9) Pituitary amenorrhea includes the fallowings except:

(a) Simmond & Sheehan syndrome

(b) Adenomas

(c) Pituitary infantilism

(d) Halpan’s disease

10) Physiological ovarian amenorrhea is due to:

(a) Congenital agenesis and genetic (Turner's)

(b) Excision, destruction (surgery, TB, malignancy, irradiation)

(c) Postmenopausal absence of primordial follicles

(d) Virilizing ovarian tumors (Arrhenoblastoma)

11) Uterine amenorrhea includes the fallowings except:

(a) Congenital aplasia, and severe hypoplasia

(b) Removal & destruction

(c) Septate uterus

(d) Endometrial receptor defect

(e) Asherman's syndrome

12) Galactorrhea [G] amenorrhea [A] syndromes include the fallowings except:

(a) Chiari-Frommel

(b) Froehlich’s syndrome

(c) Forbs & Albright's


31/252


(d) Del Castillo's

13) In Asherman 's syndrome what is false?

(a) Intra uterine synechiae (endometrial trauma plus infection)

(b) Clinically: amenorrhea, refractory endometrium, infertility, abortion, and placenta accreta

(c) Diagnosed by laparoscopy

(d) Cut adhesions by resectoscope leave IUD, give estrogens

14) What is false in Cushing's syndrome?

(a) Pituitary acidophil adenoma

(b) Secondary amenorrhea & infertility

(c) Moon face, hirsutism, hypertension, diabetes,....

(d) May due to suprarenal hyperplasia & neoplasia

I5) Sheehan's syndrome has the fallowing features except:

(a) Complete or incomplete anterior pituitary necrosis due to severe postpartum bleeding

(b) Lactational amenorrhea

(c) Panhypopituitrism ->low (gonadotropins, prolactin, ACTH, TSH) -> hypofunction of the target

glands

(d) Needs hormonal replacement therapy

16) What is false in features of Frohlich 's syndrome?

(a) Hypothalamic pituitary defect

(b) Primary amenorrhea with genital hypoplasia

(C) Generalized body obesity

(d) Needs cyclic hormonal therapy

17) Kallmann's syndrome has the following characters except:

(a) Pituitary defect

(b) Anosmia

(c) Primary amenorrhea

(d) Sterility


32/252


18) What is false about galactorrhea?

(a) Always is hyperprolactinemic

(b) iatrogenic

(c) Physiological

(d) Pathological

19) Pituitary prolactinoma has the fallowings except:

(a) Micro (2 cm)

(b) Prolactin level > 100 ng/ml

(c) Galactorrhea, secondary amenorrhea, may blurring of vision

(d) Diagnosed by C.T

20) Hyperprolactinemia may lead to the fallowings except:

(a) Secondary amenorrhea, infertility

(b) Galactorrhea

(c) Luteal phase defect

(d)Hirsutism

21) Empty sella syndrome has the fallowing features except:

(a) Congenital dural defect in roof of sella diagnosed by MRI

(b) Pressure of C.S.F. on pituitary with widening of its fossa

(c) CSF rhinorrhea, galactorrhea

(d) Hypofunction of thyroid and suprarenal glands

22) Turner's syndrome has the following features except:

(a) Negative buccal smear (45XO)

(b) Long stature

(c) Primary amenorrhea

(d) Sterility

23) Athletic amenorrhea has the fallowing features except:

(a) Amenorrhea, oligomenorrhea


33/252


(b) Excess catecholamines, prolactin, endorphin, and cortisone

(c) Normal ovarian function

(d) Underweight

24) A woman 47 year old with amenorrhea 7 month and sensation of harness on chest & face especially

during night, what is the possibility?

(a) Pregnancy

(b) Pituitary tumor

(c) Asherman's syndrome

(d) Postmenopausal

25) A woman 32 year old with missed period for 2 weeks all the fallowings

should be done except:

(a) Clinical examination

(b) Serum pregnancy test

(c) Pelvic ultrasound

(d) Hysteroscopic examination

26) A girl 17-year-old has never menstruated, she is dwarf, underdeveloped breast and scanty pubic hair,

what is the possible cause of amenorrhea?

(a) Imperforate hymen

(b) Uterine aplasia

(c) Pituitary infantilism, or Turner's syndrome

(d) Asherman's syndrome

27) A girl 18-year-old comes to you informing that she has never menstruated with monthly lower

abdominal pain, by examination she has well-developed body, breast and pubic hair with Suprapubic

cystic mass what is the possibility?

(a) Hypothalamic-pituitary ovarian defect

(b) Uterine aplasia

(c) Imperforate hymen

(d) Testicular feminization syndrome (TFS)


34/252


28) A woman 38-year-old comes to gynecological clinic with amenorrhea 4 month, milky nipple discharge

with blurring of vision and persistent headache, by examination she has a normal sized uterus what is

the possibility?

(a) Pregnancy

(b) Pituitary macroadenoma

(c) Hypothalamic dysfunction

(d) Premature menopause

29) A woman 29 year old comes to you presented with uterine bleeding for 12 days after absent periods

for 3 cycles, by US examination she has an enlarged empty uterus with unilateral cystic ovary,

pregnancy test is negative what is the possibility?

(a) Ectopic pregnancy

(b) DUB (metropathia hemorrhagica)

(c) Threatened abortion

(d) Feminizing ovarian tumor

30) What is false in causes of galactorrhea [G]?

(a) Always pathological

(b) iatrogenic

(c) Prolactinoma

(d) Empty sella syndrome

31) Investigations of amenorrhea include:

(a) History and examination

(b) Laboratory

(c) Imaging technique

(d) Therapeutic tests

(e) All of above

32) What is false in evaluation of a girl with primary amenorrhea?

(a) Look for the height either normal or abnormal

(b) Look for the genital & somatic development


35/252


(c) Do US, karyotyping pituitary necrosis due to severe g and hormonal assays

(d) Local examination is not needed

33) What is false in treatment of amenorrhea?

(a) Correction of the general factors as anemia ,obesity,

(b) Correction of the causal factors as removal of a tumor

(c) Cyclic estrogen and progestogen therapy for all cases

(d) Give ovulating drugs in cases with infertility

(3) * Dysmenorrhea,

1) Dysmenorrhea is:

(a) Heavy menstruation

(b) Painful menstruation

(c) Irregular menstruation

(d) Pain not related to menses

2) The common type of dysmenorrhea is:

(a) Crescendo (endometriosis)

(b) Membranous

(c) Spasmodic or congestive

(d) Ovarian

3) Spasmodic dysmenorrhea has the followings except:

(a) Intermittent lower abdominal colicky pain radiating to back

(b) Starts few hours premenstrual, persists for 1-3 days

(c) Maximum pains during the first menstrual day, then improves

(d) PV or PR examination —» pelvic pathology

4) Primary dysmenorrhea has the followings except:

(a) Starts with menarche

(b) Improves after labor

(c) Colicky pain may with low backache, nausea & vomiting an


36/252


(d) Treated by PG synthetase inhibitors & spasmolytics

5) The most accepted etiology of primary dysmenorrhea is:

(a) Cervical stenosis

(b) Uterine hypoplasia

(c) Excess prostaglandins (PGF2a)

(d) Psychological

6) The suitable therapy for spasmodic dysmenorrhea includes:

(a) Reassurance, anti PG, spasmolytics

(b) >l Ovulation (pills, estrogen, androgens)

(c) Cervical dilatation (up to 12 Hegar)

(d) Laser uterine nerve ablation (LUNA)

7) Crescendo dysmenorrhea has the followings except:

(a) Present with myoma

(b) Starts premenstrual

(c) More severity during menses

(d) Needs causal treatment

8) Membranous dysmenorrhea is:

(a) Common

(b) Painful menses with a cervical membrane

(c) Pain with total endometrial shedding as a membrane

(d) Pain with endometriosis

9) The main treatment of membranous dysmenorrhea is:

(a) Pelvic decongestants

(b) Sedatives & analgesics

(c) Cervical dilatation

(d) Anti prostaglandins + repeated D & C.


37/252


10) Spasmodic dysmenorrhea occurs with:

(a) Membranous endometrial shedding

(b) IUD

(c) Passage of uterine clots

(d) Bicornuate uterus

(e) Any of above

11) Unilateral dysmenorrhea does not occur in:

(a) Unilateral endometriosis

(b) Corneal unilateral myoma

(c) Uterine prolapse

(d) Rudimentary horn

12) Congestive (secondary) dysmenorrhea is only induced by:

(a) Any cause of pelvic congestion

(b) Constipation

(c) Adenomyosis, endometriosis

(d) IUIX PID, adhesions

(e) Neoplasm, displacement

13) What is false in congestive dysmenorrhea?

(a) Localized lower abdominal colic

(b) 2-3 days premenstrual

(c) Relief by onset of menstruation

(d) Radiation to back

14) Ovarian pain includes the fallowings except:

(a) Ovarian dysmenorrhea

(b) Tubal ectopic pregnancy

(c) Corpus luteum hematoma

(d) Mittel Schmerz


38/252


15) Investigations of secondary dysmenorrhea include:

(a) CBP, ESR

(b) Endoscopy

(c) Pelvic sonogram

(d) Bacteriological cultures

(e) All of above

16) The therapy of congestive dysmenorrhea includes:

(a) Causal TTT

(b) Pelvic decongestants

(c) Anti-prostaglandins

(d) Daily cold baths, correction of faulty environment

(e) All of above

17) Low backache has the following characters except:

(a) Extra-genital or genital causes

(b) Genital backache is localized and radiates to the heel

(c) Mainly of non-genital origin (bone, muscle, joints,.)

(d) May be caused by pelvic congestion

18) What is false in premenstrual tension syndrome (PMS) ?

(a) Premenstrual (5-11 days) symptoms

(b) Has underlying pelvic pathology

(c) Physical symptoms as backache, headache, mastalgia,....

(d) Psychological symptoms as irritability, depression, anxiety

19) Theories of PMS include the fallowings except:

(a) Increased B endorphin

(b) + E / P ratio

(c) Renin-angiotensin-aldosterone

(d) Pelvic pathology


39/252


20) Treatment of PMS includes the fallowings except:

(a) Sedatives, tranquilizers

(b) Progestogen

(c) Cervical dilatation

(d) Primrose oil

21) What is false in pelvic pain ?

(a) Acute or chronic

(b) Chronic pain is cyclic & acyclic

(c) Dysmenorrhea is acyclic pain

(d) Endometriosis leads to acute & chronic pelvic pain

(e) Gynecological & non-gynecological pain

22) What is False in nervous transmission of pelvic pain?

(a) Parasympathetic: S2,3 & 4

(b) Sympathetic: TIO - LI

(c) Pudendal -» 82,3 & 4

(d) Vagina : only autonomic nerves

23) Clinical type of pelvic pain is:

(a) Cramping, colicky

(b) Constant

(c) Sharp

(d) Dull

(e) Any of above

24) Pain is induced by:

(a) Distension, contraction, obstruction, rupture, infection of a hollow organ

(b) Stretch, torsion, ischaemia, inflammation of a solid organ

(c) Peritoneal irritation

(d) Perforation, hemorrhage


40/252


(e) All of above

25) Epigastric pain suggests a problem in:

(a) Stomach

(b) Duodenum

(c) Pancreas

(d) Liver & gall bladder

(e) Any of above

26) Peri-umbilical pain suggests a problem in the following organs except:

(a) Liver & gall bladder

(b) Small intestine

(c) Appendix

(d) Upper ureters

27) Suprapubic (hypogastric) pain suggests a problem in the following organs except:

(a) Uterus

(b) Urinary bladder

(c) Colon

d) Upper ureters


41/252


(4) *Abnormal genital tract bleeding,


(a) Normal hypothalamic pituitary ovarian functions

(b) Patent uterine tubes

(c) Healthy responsive endometrium (to steroids)

(d) Patent outflow tract

(e) Healthy body

2) Mechanism of menstruation includes the followings except:

(a) Constriction of the spiral arteries [PG]

(b) Endometrial ischaemia

(c) Endometrial desquamation & shedding

(d) Excessive estrogen secretion

5) The Proliferative (follicular) phase has the following features except:

(a) Fixed length

(b) Growth of ovarian follicles

(c) Secretion of estrogens

(d) Proliferation of endometrium

(e) FSH dependant

4) The followings are associations of ovulation except:

(a) L.H. surge

(b) Follicular prostaglandins synthesis

(c) Oocyte reduction division

(d) Reduction of the follicle size with follicular fluid in the Douglas pouch

(e) Depression [reduction] in FSH

5) L.H. has the following actions except:

(a) Lutenization of the granulosa and theca cells

(b) Stimulation of progesterone [P] synthesis


42/252


(c) Stimulation of androgen synthesis

(d) Production of L.H. receptors on the granulosa cells

6) The luteal phase has the following features except:

(a) Low basal body temperature [uni-phasic curve]

(b) Secretory changes of the endometrium

(c) Progesterone [P] dependant

(d) Predominance of the intermediate vaginal cells

(e) Fixed length (12-14 days)

7) Progesterone leads to the following effects except:

(a) Secretory and decidual endometrial changes with myometrial relaxation

(b) Viscid scanty cervical mucus 1

(c) Proliferation of the vaginal squamous cells

(d) Proliferation of the glandular breast tissue

8) Estrogen has the following effects except:

(a) Proliferation of the endometrium

(b) Growth of ducts and stroma of the breast

(c) Growth of the clitoris and pubic hair

(d) Production of a copious watery thin cervical mucus

(e) Proliferation of the vaginal squamous cells

9) What is false in the effects of excess androgens in the adult female?

(a) Atrophy of the secondary sex organs

(b) Oligomenorrhea then amenorrhea ..

(c) Hirsutism, deeping of the voice & clitoromegaly

(d) All the above changes are irreversible

10) The average duration of normal menstrual cycle is:

(a) 5 weeks ± one week

(b) 40 days


43/252


(c) 3 weeks ± one week

(d) 4 weeks ± one week

11) LH surge stimulates the followings except:

(a) Completion of meiosis of primary oocyte

(b) Lutenization of granulosa cells

(c) Synthesis of follicular progesterone, prostaglandins and proteolytic enzymes

(d) Ovulation

(e) None of above

12) Ovulation is due to:

(a) FSH surge

(b) Progesterone synthesis

(c) Increased follicular prostaglandins and proteolytic enzymes

(d) Increased androgens synthesis

13) Normal menstruation is characterized by the followings except:

(a) Regular every >3-5 weeks

(b) Average duration 3-5 days (2-7 range)

(c) Unclotted blood loss about 25-80 ml

(d) The first one is menarche at age of 11-13 years

(e) Usually it is asymptomatic [silent]

14) Polymenorrhea (epimenorrhea) has the followings except:

(a) Frequent cyclic menstruation less than 4 weeks

(b) Normal amount of menstrual blood loss

(c) Due to dysfunction of hypothalamic-pituitary ovarian axis

(d) TTT: luteal phase progestin support or cyclic E & P therapy

15) Menorrhagia (hypermenorrhea) has the followings except:

(a) Cyclic regular heavy menstruation (3/28)

(b) May prolonged periods (8/28) with normal amount


44/252


(c) May with heavy arid prolonged period

(d) Always is of organic etiology

16) Metrorrhagia has the following characters except:

(a) Irregular amount

(b) Acyclic bleeding

(C) Often prolonged in duration

(d) Usually dysfunctional

17) What is the false in characters of hypomenorrhea?

(a) Menses < 2 days

(b)


45/252


(c) Systemic disease

(d) Hormonal withdrawal bleeding

21) One of the followings can cause postmenopausal bleeding:

(a) Pre-invasive cervical carcinoma

(b) Benign ovarian teratoma

(c) Endometrial carcinoma

(d) Atrophic subserous fibroid

22) What is false in dysfunctional uterine bleeding (DUB)?

(a) Ovular & non-ovular

(b) Cyclic and acyclic

(c) Ovarian dysfunction

(d) Can be caused by a small Myoma

23) Ovular (cyclic) DUB includes the followings except:

(a) Poor corpus luteum (CL) function- irregular endometrial ripening menorrhagia

(b) Slow degeneration of C.L. irregular shedding menorrhagia

(c) Short phase (follicular or luteal) Polymenorrhea

(d) Persistent Graffian follicle oligomenorrhea

24) Recent classification of DUB includes the followings except:

(a) Hypothalamic-pituitary-ovarian dysfunction primary DUB

(b) General causes of bleeding secondary DUB

(c) Drugs, steroids, IUD, iatrogenic DUB

(d) Genital infection pelvic congestion DUB

25) What is false in the features of metropathia hemorrhagica?

(a) Acyclic anovular bleeding due to persistent Graffian follicles

(b) Cystic glandular endometrial hyperplasia

(c) Painless prolonged bleeding after short amenorrhea (6-8 weeks)

(d) Bilateral cystic ovaries with excess androgens & hirsutism


46/252


26) Threshold bleeding has the following features except:

(a) Irregular anovular bleeding in early and late reproductive life

(b) Excess estrogen

(c) Thin endometrium

(d) Treatment: cyclic therapy of estrogen and progestogen [E&P]

27) All the followings are valuable in diagnosis of abnormal uterine bleeding except:

(a) History and examinations (general, abdominal & local)

(b) Laboratory tests (pregnancy, CBP, hormones,... etc)

(c) Imaging technique (US, MRI) and endoscopy (colposcopy, hysteroscopy & laparoscopy)

(d) D & C without biopsy

(e) Diagnostic and fractional curettage, cytology

28) Choose the suitable line of treatment for abnormal uterine bleeding?

(a) Medical: iron, vitamins, anti-PG, tranexamic acid...)

(b) Hormonal (cyclic E & P, and progestogen for 2nd half, pills)

(c) Surgical (D & C, hysterectomy, ablation)

(d) Induction of artificial menopause

(e) One or more of above according to clinical data of each case

29) What is the dangerous cause of post-menopausal bleeding?

(a) Estrogen withdrawal bleeding

(b) Malignancy

(c) Systemic causes as purpura, anticoagulant therapy

(d) Senile endometritis and vaginitis

(30) Investigations of the postmenopausal bleeding include:

(a) History and examinations

(b) Cytology, biopsy & culture

(c) Endoscopy: colposcopy, hysteroscopy

(d) US, CT, MRI & barium enema


47/252


(e) All of above

31. Dysfunctional uterine bleeding:

A. May be associated with hypothyroidism.

B. May be associated with postmenopausal bleeding.

C. May be associated with functional ovarian cysts.

D. May present as menorrhagia.

E. May present as metropathia hemorrhagica.

A. True B. False C. True D. True E. True

32. Dysfunctional uterine bleeding:

A. Dysfunctional menorrhagia is usually associated with poor function of the

corpus luteum.

B. Dysfunctional polymenorrhea means excessive but not prolonged menstruation.

C. Dysfunctional polymenorrhea shows tendency to spontaneous correction.

D. Metropathia hemorrhagica is the commonest type of dysfunctional

uterine bleeding.

E. Threshold bleeding occurs when estrogen level reaches high values.

A. True B. False C. True D. True E. False

33. Treatment of dysfunctional uterine bleeding may include:

A. Progestins.

B. Danazol.

C. GnRH analogues.

D. Hysterectomy.

E. Endometrial ablation.

A. True B. False C. False D. True E. True

34. Metropathia hemorrhagica:

A. Is the commonest type of DUB.

B. It is usually due to overproduction of gonadotropins by the pituitary.

C. Is commonly associated with theca lutein cysts.

D. Is associated with a variable period of amenorrhea followed by bleeding.

E. Is associated with endometrial hyperplasia.

A. True B. False C. False D. True E. True

35. Diagnosis of metropathia hemorrhagica:

A. The majority of cases are premenopausal.

B. A common presentation is a variable period of amenorrhea followed by

prolonged bleeding.

C. Ultrasonography usually reveals a follicular cyst.

D. Ultrasonography usually reveals thickened endometrium.

E. The uterus is usually asymmetrically enlarged.

A. True B. True C. True D. True E. False


48/252


36. Management of metropathia hemorrhagica:

A. Some cases require blood transfusion.

B. Fractional curettage.

C. Oral contraceptive pills are contraindicated.

D. Young patients may benefit from induction of ovulation.

E. Some cases require hysterectomy.

A. True B. True C. False D. True E. True

37. Management of metropathia hemorrhagica:A. Progestins have no role in treatment.

B. Endometrial ablation is the modern substitute of hysterectomy in all cases.

C. Some cases benefit from thyroxin.

D. Young patients should receive danazol therapy.

E. Antifibrinolytics may be used as adjuvant therapy.

A. False B. False C. True D. False E. True

38. Endometrial ablation:

A. May be an alternative to surgery in some cases of dysfunctional uterine bleeding.

B. May be an alternative to surgery in cases with asymptomatic fibroids.

C. Does not require any preparation.

D. Does not require anesthesia.

E. Is always followed by amenorrhea.

A. True B. False C. False D. False E. False

39. Premenopausal bleeding may be a presentation of:

A. Endometriosis.

B. Adenomyosis.

C. Metropathia hemorrhagica.

D. Complications of pregnancy.

E. Thecoma.

A. True B. True C . True D. True E. False

40. Premenopausal bleeding may be a presentation of:

A. Carcinoma of the cervix.

B. Atrophic endometritis.

C. Fibroids.

D. Cervical erosion.

E. Endometrial carcinoma.

A. True B. False C. True D. True E. True

41. Postmenopausal bleeding may be a presentation of:

A. Carcinoma of the cervix.

B. Atrophic endometritis.

C. Fibroids.

D. Cervical erosion.



49/252



42. Investigation of a case of postmenopausal bleeding includes:

A. Full history.

B. General examination.

C. Local examination.

D. Vaginal ultrasonography.

E. Fractional curettage.

A. True B. True C. True D. True E. True43. Menorrhagia:

A. Is a term describing excessive and/or prolonged menstruation.

B. There may be no organic cause.

C. May be associated with use of combined oral contraceptive pills.

D. May be associated with hypertension.

E. May be associated with hypothyroidism.


44. Menorrhagia may be associated with:

A. Intrauterine contraceptive device.

B. Subserous fibroid.

C. Adenomyosis.

D. Chronic PID.


A. True B. False C. True D. True E. False

45. Metrorrhagia:

A. Means irregular bleeding not related to menstruation.

B. The majority of cases are due to local lesions.

C. May be due to irregular use of contraceptive pills.

D. Is not related to dysfunctional uterine bleeding.E. Is not related to malignant tumors of the genital tract.

A. True B. True C. True D. False E. False

(46)In metropathia hoemorrhagica, the uterine size is:

A) Normal.

B) Decreased.

C) 6 – 8 weeks’ pregnancy size.

D) None of the above.

(47)In metropathia hoemorrhagica there is:

A) Normal ovulation.

B) Anovulation.

C) Defective corpus luteum.

(48)The endometrium, in cases of metropathia hoemorrhagica, is:

A) Secretory.

B) Shows swiss – cheese appearance.

C) Shows luteal phase defect.


50/252


(49)Diagnosis of metropathia hoemorrhagica depends upon the following, EXCEPT:

A) Clinical examination.

B) Hysteroscopy.

C) Hysterosalpingoraphy.

D) Ultrasonography.

(50)GnRH analogues are used in the following conditions EXCEPT:

A) Treatment of endometriosis.B) Treatment of uterine leiomyoma.

C) Treatment of ovarian cystadenoma.

D) Treatment of ovarian polycystic disease.

E) IVF.

(51)Estrogen is used in the following conditions EXCEPT:

A) Postmenopausal syndrome and prevention of osteoporosis.

B) Turner’s syndrome.

C) Fibroadenome of the breast.

D) Atrophic vaginitis.

E) In contraceptive pills.

(52)Progesterone needs oestrogen-priming in the following condition EXCEPT:

A) Secretory transformation of proliferative endometrium.

B) Alveolr development of glandular-breast tissue.

C) Increased bulk of uterine muscle.

D) Biphasic body temperature.

(53)Progesterone (not progestins) is used in:

A) Contraceptive pills.

B) Injectable contraceptives.

C) Luteal phase defect.

D) Treatment of recurrent cancer endometrium.E) Treatment of dysfunctional uterine bleeding.

(54)Colposcopy in valuable in detection of epithelial abnormalities in the following organs, EXCEPT:

A) Vulva.

B) Vagina.

C) Cervix uteri.

D) Corpus uteri.

* Say true or false.

a- I.U.D. can cause menorrhagia through disturbance in the level of carbonic anhydrase enzyme.

b- Excessive intake of aspirin and other anti-inflammatory drugs can increase the menstrual blood flow through co

disturbance.

c- Luteal phase defect may present by infertility, habitual abortion or menorrhagia

d- Bleeding in cases of metropathia hemorrhagica is mild following period of amenorrhea.

e-The cycle length in a patient of menorrhagia is prolonged.

f- Pathological changes of the endometrium in cases of abnormal bleeding include endometrial polyps.


51/252


g-The commonest cause of post-menopausal bleeding is atrophic endometrium

h- Thyroid abnormalities are a very common cause of irregular vaginal bleeding.

i- Dysfunctional uterine bleeding is commonest around the age of 40 years.

j- Curettage of the endometrium in cases of metropathia hemorrhagica shows evidence of luteal phase defect.

k- Bilateral ovarian corpus luteum cyst is common in cases of metropathia hemorrhagica.

l- Induction of ovulation can be tried in cases of metropathia hemorrhagica in young age females.

m- Androgens are effective treatment for dysfunctional uterine bleeding.

n- Progestogens are the main line of treatment for cases of dysfunctional uterine bleeding.

o- Estrogen may be used in treatment of cases of severe dysfunctional bleeding to stop the bleeding by endometrial growth.

p- Cases of delayed shedding are diagnosed by doing curettage postmenstrual on day 7.

q-Hypertension might be a cause of cases of dysfunctional bleeding.

r-the commonest cause of postmenopausal bleeding is malignant tumors.

s-The commonest cause of bleeding at the childbearing period is pregnancy complications.

t- Pelvic congestion may result into menorrhagia and polymenorrhea.

(5) * Ovulation and its disorders

Enumerate : Tests for detection of ovulation :

Enumerate : Causes of luteal phase defect :

1.The following are inconsistent with a diagnosis of PCOS:

A. A-regular 26-day cycle.

B. Normal ovarian morphology on ultrasound scan.

C. LH:FSH ratio


52/252


4. Acceptable methods for confirmation of ovulation include:

A. Folliculometry.

A. Folliculometry.

B. Positive thread test of cervical mucus.

C. Serum estrogen level on day 14.

D. Serum progesterone on day 21.

E. Premenstrual endometrial biopsy.

5. Luteal phase defect:A. Is associated with delayed menses.

B. May be due to inadequate progesterone production.

C. Is a common cause of infertility.

D. Is a common cause of recurrent abortion.

E. The endometrium shows weak secretory changes.

6. With luteal phase defect:

A. Cycles may be short.

B. The basal body temperature chart is not biphasic.

C. Ovulatory pain is absent.

D. A defective corpus luteum can be diagnosed by ultrasonography.

E. Luteal support is best provided by progestins.

7. Luteal phase defect may be associated with:

A. Short cycles.

B. Endometriosis.

C. Low estrogen levels.

D. Endometrial biopsy showing weak secretory changes.

E. Low prolactin levels.

8- The female human sexual response cycle includes all expect:

A) excitement phase

B) plateau

C) resolution

D) refractory phase

9- The climacteric , all are true EXCEPT:

A)

the average age of the menopause in Egypt has been shown to be 51 years

B)

demineralisation of bone takes place after the menopause

C) the level of prolactin rises after the last period

D)

the severity of flushing has been shown to be related to the level of oestrogen in the blood

E)

clinical studies have shown that the later the menarche the earlier the menopause

10- Barr bodies in the buccal cells of a female are characteristic of:

A) Turner’s syndrome.

B) Normal female

C) Short stature

D) Sterility.


53/252


E) Mental retardation.

11- A 50- year-old female complains of fewer periods recently. You might expect her:

A) FSH and LH to be high.

B) FSH and LH to be low.

C) FSH and estrogen to be high.

D) FSH and estrogen to be low.

E) FSH and progesterone to be low.

12- At the midpoint in the menstrual cycle, ovulation is triggered by a sudden seven-fold increase in the amount

of....................

A)

estrogen

B)

progesterone

C) LH

D)

FSH

13- The average menstrual cycle is:

A) 14 days.

B) 18 days.C) 24 days.

D) 28 days

14- Anovulatory cycles , all are true EXCEPT:

A) are typical of the early years after the menarche.

B) are associated with endometrial hyperplasia.

C) are a risk factor for ovarian cancer.

D) may be due to polycystic ovary syndrome.

E) are associated with menstrual cycles of variable length.

15- A Graafian follicle is one that:

A)

is dormant, awaiting a signal to begin to develop

B)

has already ruptured and released the ovum

C) is fully mature and ready to rupture

D)

has been damaged through exposure to radiation or chemicals

16- What pituitary hormone(s) control ovulation and production of female hormones by the ovary?

A) estrogen

B) gonadotropin releasing hormone

C) human chorionic gonadotropin (HCG)

D) follicle stimulating hormone (FSH) and lutenizing hormone (LH)

E)progesterone

17- In a "typical" 28 day female reproductive cycle, on which day following the beginning of the menstrual period

is the level of luteinizing hormone most likely to be highest?

A) day 5

B) day 7

C) day 14

D) day 21

E) day 28

http://localhost/var/www/apps/conversion/tmp/Desktop/04t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/04t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/04t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/04c.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/04t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/05t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/05t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/05t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/05t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/05c.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/05t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/05t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/05t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/05t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/05c.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/05t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/05t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/04t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/04c.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/04t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/04t.htmlhttp://localhost/var/www/apps/conversion/tmp/Desktop/04t.html


54/252


18- During the human menstrual cycle, the body temperature:

A) rises slightly at ovulation

B) falls slightly at ovulation

C) rises slightly at the start of menstruation

D) falls slightly at the start of menstruation

19- Testosterone and other androgens:A)

are found only in men.

B) are found in higher concentrations in men than women.

C)

are found in equal concentrations in men and women.

D)

are found in higher concentrations in women than men.

E)

are found only in women

20- During the early to mid follicular phase of the female reproductive cycle, the direct effect of inhibin is to:

A) inhibit the release of follicle stimulating hormone.

B)

inhibit the release of luteinizing hormone.

C)

inhibit ovulation.

D)

inhibit endometrial proliferation.

E)

inhibit uterine contractions.

21- The primary source of progesterone during the reproductive cycle of a non-pregnant female is (are) the:

A)

granulosa cells.

B)

theca cells.

C) corpus luteum.

D)

pituitary.

E)

hypothalamus.

22- GnRH, all are false EXCEPT:

A)

is distinct from LH-RH

B)

is produced in the posterior pituitary

C) is a decapeptide produced in pulses at ninety minute intervals

D)

exerts its main effect directly on the ovary

E)

is used to induce ovulation in IVF programmes

23- The Anterior Pituitary, all are not true EXCEPT:

A) has a portal circulation

B) produces GnRH in pulsatile fashion

C)

produces oxytocin

D)

produces prolactin, under the influence of prolactin releasing hormone secreted by the hypothalamus

24- Life cycle of Corpus luteum is completed in:

A) 6 - 12 days

B) 12 - 14 days

C) 14 - 18 days

D) 18 - 22 days


55/252


25- Human ovulation occurs:

A) At mid-luteal phase.

B) On day 10 of a 28-day cycle.

C) 14 days before menstrual bleeding.

D) Before rupture of the corpus luteum.

E) At the end of the secretory phase.

26- During nonnal menstrual cycle. ovulation occurs as a result of

A) excess Estrogen level

B) low Estrogen level

C) surge of leutenizing hormone

D) low level of HCG

27- The following statements concerning the menstrual cycle are true EXCEPT:

A)

The follicular phase in the ovary is associated with a rise in the blood levels of estradiol

B)

Ovulation is associated with a sudden rise in blood LH levels

C)

The proliferative phase of endometrial growth depends on estradiol secretion

D) Ovulation can be prevented by non-steroidal anti-inflammatory drugsE)

During the secretory phase of the uterus, cervical mucus becomes more viscous

28- The squamous epithelium is target tissue for sex hormones. The vaginal epithelium of a 60-year- old female is

similar to that of a:

A) 2-day-old female.

B) 5-year- old female.

C) 11- year- old female in puberty.

D) 21-year-old female.

E) 26-year- old female on oral contraceptives.29- The endometrium becomes secretory during the second half of the menstrual cycle under the influence of:

A)

prolactin

B)

oxytocin

C)

estrogen

D) progesterone

30-The intercellular chemical signal that is released by cells and has a local effect on the same cell type as that from

which the chemical signal is released is:

A) autocrine chemical signal

B) pheromone

C) paracrine chemical signalD) hormone

E) neurotransmitter

31- Neurohormones are intercellular chemical signals that are:

A) produced by groups of cells and affect neurons.

B) released by cells and affect other cell types locally.

C) produced by neurons and act like hormones.


56/252


D) released by neurons and stimulate or inhibit other neurons.

32- Which is released by cells and affect other cell types locally without being transported in blood?

A) Autocrine chemical signals

B) Pheromones

C) Paracrine chemical signals

D) Hormones

E) Neurotransmitters

33- The lipid hormones are either…….. or derivatives of fatty acids.

A) glycolipids

B) phospholipids

C) steroids

D) triglycerides

E) glycerols

34- Estrogen,progesterone, testosterone, and glucocorticoids are all examples of:

A) proteins.

B) glycoproteins.

C) polypeptides.

D) amino acid derivatives.

E) steroids.

35- The monthly change in secretion of reproductive hormones that occurs in women during their reproductive years

is an example of:

A) acute hormone regulation.

B) chronic hormone regulation.

C) cyclic hormone regulation.

D) None of the above

36- Which one of the following statements is false?

A) Sperm are produced in seminiferous tubules of testes.

B) FSH effects the enlargement of ovarian follicles

C) FSH effects the ovarian secretion of estrogen.D) LH enhances the effect of FSH.

E) FSH triggers ovulation.


A) Inhibin inhibits GnRH.

B) The corpus albicans is a regressed corpus luteum.

C) The menstrual cycle averages 28 days.


57/252


D) The follicular phase of the menstrual cycle embraces menstruation and preovulation.


A) When the size of a secondary follicle becomes 2 cm, it is a Graafian follicle.

B) By day 6 of the menstrual cycle, usually one follicle is significantly larger than the others

C) A part of a Graafian follicle protrudes as a blister on the surface of an ovary.

D) Under the influence of an increasing concentration of LH, the preovulatory follicle produces estrogen at an

elevated rate.

E) Within 1-2 days prior to ovulation, the mature follicle produces a small amount of LH.

39- Which one of the following statements about preovulation and ovulation is false?

A) Follicles that secrete estrogens during preovulation stimulate cells of the stratum basalis to restore the stratum

functionalis via mitosis.

B) The endometrium and its arterioles and glands grow.

C) When the concentration of estrogens reaches a certain threshold, the hypothalamus is incited to release GnRH.

D) In response to GnRH, the adenohypophysis releases FSH, and not LH.

40- Which one of the following statements about day 14 of the menstrual cycle is false?

A) The surge of LH impels the preovulatory follicle to rupture and expel a 2nd polar body.B) The surge of LH impels the preovulatory follicle to rupture and expel into the pelvic cavity a secondary oocyte that

is surrounded by a zona pellucida and corona radiata.

C) The secondary oocyte is usually swept into a uterine tube.

D) The positive feedback effect of estrogens on the hypothalamus and adenohypophysis is enhanced by

progesterone.

E) Following ovulation, the bleeding remnant of the Graafian follicle is a corpus hemorrhagicum.


A) Under the influence of LH, the corpus hemorrhagicum becomes a corpus luteum.

B) Postovulation typically continues from days 15-28 of the menstrual cycle.

C) The hormones that the corpus luteum secretes stimulates the secretion of GnRH, FSH, and LH.D) Should the ovulated secondary oocyte not be fertilized, the corpus luteum regresses, and gonadotropins are

secreted. Hence, another menstrual cycle begins.

42- Which of these is an example of positive-feedback regulation in the endocrine system?

A) an increase in blood glucose causes an increase in insulin secretion; insulin moves glucose into cells

B) an increase in TSH causes an increase in thyroid hormone secretion; thyroid hormones inhibit TSH secretion

C) before ovulation, an increase in LH causes an increase in estrogen, which causes an increase in LH

D) an increase in TRH causes an increase in TSH secretion; thyroid hormone inhibits TRH secretion

E) an increase in blood calcium causes an increase in calcitonin secretion; calcitonin moves calcium into the blood.

43- Intracellular hormone receptors are located:

A) floating freely in the cytoplasm of target cells.

B) in the nucleus.

C) in the mitochondria.

D) in the endoplasmic reticulum.


58/252


E) both a and b

44- Peptide hormones and protein hormones affect a cell by:

A)

attaching to the chromosomes and altering the expression of the genes.

B)

increasing the insulation provided by the myelin sheath.

C) attaching to receptors on the membrane of a cell.

D)

entering the cell and being metabolized as a source of energy.

45- Which of the following is an Incorrect statement about human oogenesis.A) One ovum is produced from each parent cell.

B) Primary oocytes can sit halted in prophase I for years.

C) After puberty begins, one primary oocyte, on average, reenters meiosis every 28 days.

D) One polar body is produced from each parent cell.

E) Meiosis II begins after a secondary oocyte is fertilized by sperm.

46- Which of the following statements about the menstrual cycle is False?

A) LH is produced by the pituitary in response to GnRH from the hypothalamus.

B) LH acts on the follicle, causing ovulation, around the 14th day of the cycle.

C) Birth control pills that contain estrogen and progesterone would inhibit the secretion of FSH by the pituitary.

D) The phase of menstruation at which pregnancy is most likely to occur is the secretory phase.

E) FSH and estrogen production are highest during days 25-28 of the menstrual cycle

47- Which structures controls the cyclic nature of the menstrual cycle?

A) oviducts and uterus

B) pituitary and testes

C) ovaries and umbilical cord

D) pituitary and ovaries

E) oviduct and thyroid

48- The primary function of progesterone in the menstrual cycle is to:

A) stimulate development of the egg.

B) stimulate development of the endometrium.C) stimulate development of the corpus luteum.

D) stimulate development of the follicle.

E) trigger ovulation

49- What two hormones influence the development of the secondary sexual characteristics of the female?

A) testosterone and estrogen

B) androgen and estrogen

C) FSH and LH

D) progesterone and estrogen

E) testosterone and progesterone

50- Which one of the following statements about oogenesis is false?

A) Primordial germinal cells originate in ovarian epithelium.

B) Primordial germinal cells differentiate into oogonia.

C) Most oogonia experience atresia.

D) Oogonia develop into diploid oocytes.

E)


59/252


51- Which one of the following statements about oogenesis is false?

A) Usually, only one primary oocyte per month completes meiosis I, and experiences cytoplasmic division.

B) Most primary oocytes experience atresia.

C) In primordial follicles, a primary oocyte is partially surrounded by a single layer of squamous cells.

D) In primary follicles, an oocyte is surr

Documents

Gyna Final Reveision