GYNECOLOGY WRITTEN EXAMS

A young lady 18 years old, comes to the outpatient clinic with chief complaint of
never had any menstruation until now. She says that she never had any pelvic
operation procedure or radio/chemotherapy before. Her breast is not develop yet
and there is no pubic hair growth as well. Physical examinations shows no sign of
acanthosis nigricans, hirsutism or thyroid enlargement. Tanner stage is M1 and P1.
Rectal touché: uterus cannot be palpated and there is no adnexal mass.

1. In this case, what kind of hormone that responsible for breast and uterine
development?
a. Testosterone
b. Dihydrotestosterone
c. Progesterone
d. Estrogen
e. Estriol
2. What is the next diagnostic procedure to this case?
a. MRI
b. Hormonal evaluation
c. Karyotype
d. Genitogram
e. Progestin challenge
3. What is the first goal of hormonal treatment for this patient?
a. To induce Folliculogenesis
b. To induce development of secondary sex characteristics
c. To induce Thickening of endometrial layer
d. To induce menarche
e. To maintain bone mineral density

A 25 years old lady, P2 comes to the outpatient clinic due to vaginal discharge since 5
days ago. She does not have any fever or pelvic discomfort. Physical exams show
whitish vaginal discharge with odor. No pelvic tenderness or adnexal mass can be
identified.

4. How steroid hormone can influence normal vaginal flora in this patient?
a. Estrogen induce glycogen rich environment
b. Estrogen increase thickening of cervical mucus
c. Estrogen can increase numbers of T lymphocytes
d. Estrogen can decrease lactobacillus
e. Estrogen can increase vaginal pH
5. What diagnostic finding that expected from this patient that lead to
suspicious of bacterial vaginosis?
a. Vaginal pH < 3.5
b. Microscopic examination shows abundant leukocytes
c. Microscopic examination shows abundant clue cells
d. KOH addition to vaginal secret produce sweet odor
e. Vaginal secretion is gray with itchy sensation
 6. This patient has been diagnosed for bacterial vaginosis. What is the best
advice to this patient?
a. Give antibiotics which kills anaerobes but poor activity on
lactobacillus
b. Ask her sexual partner to be treated in the same time
c. Ask the patient to use vaginal douche antiseptic solutions
d. Oral antibiotics administrations is more preferred instead of vaginal
route
e. Ask her to flush her vagina with running water

A 47 years old lady, P5 comes to the outpatient clinic with chief complaint of post-
coital bleeding since 6 months ago. She was also complaining for recurrent vaginal
discharge since a year ago. She gave birth 5 times by spontaneous delivery. No
history of contraceptive method. She still has regular menstrual cycle every month.
General state shows normal vital signs. There is no sign of anemia. Inspeculo shows
smooth portio, and no sign of any abnormal mass.

7. What is the most possible cause of post-coital bleeding in this patient?

a. Cervicitis
b. Nabothian cyst
c. Cervical polyp
d. Precancerous lesion
e. Hormonal imbalance
8. Patient was having Pap test result a week ago and the result shows LGSIL and
koilocytosis with satisfactory result. What does it mean?
a. Cervical cancer
b. HPV infection
c. Inflammation of the cervix
d. Bacterial vaginosis
e. Secondary metastasis
9. Choose correct statement below regarding to the accuracy of Pap test!
a. The sensitivity of Pap test in general is 60%
b. Increasing the number of test to three times annually increases false
positive
c. A small size of cervical lesion can cause sampling errors
d. Specimen fixation by air dry will make better interpretation
e. Liquid base medium could alleviate interpretation errors

10. Examination of an asymptomatic 2-day-old infant girl shows a distended

abdomen. The urinary bladder and rectal ampulla are empty. A solitary
unilocular cyst is visualized with ultrasonography. the next best step the
management of this patient is
a. observation
b. intravenous pyelogram (IVP)
c. cytoscopy
d. barium enema
e. exploratory surgery
11. You are called to the operating room to evaluate a pelvic mass in an
infant girl. Laparoscopy shows a 3-cm cystic mass in the broad ligament
between the fallopian tube and ovarian hillum. The next best step is
a. observation
b. cyst aspiration
c. vystectomy
d. adnexectomy
e. laparotomy
12. Childhood neoplastic ovarian masses most commonly originate from?
a. gonadal epithelium
b. gonadal stroma
c. germ cells
d. sex cord
e. metastatic disease
13. A 6-year-old firl has a history of 2 weeks of abdominal pain. She is
significantly taller than her peers. Physical examination shows early breast
development and abdominal distention. Blood is present at the introitus, and
pelvic examnination is attempted but cannot be accomplished. Serum
gonadothropin levels are in the prepubertal range and do not change after
gonadothropin-releasing hormone (GnRH) administration. Abdominal
sonography shows a 6-cm solid right adnexal mass. The most likely diagnosis?
a. epoophoron
b. granulose cell tumor
c. corpus lutheum cyst
d. endometrioma
e. fibroma
14. A colleague asks you to evaluate a 5-year-old Caucasian girl with sexual
precocity. Areas of mucocutaneous pigmentation are present. Rectal
examination demonstrates a 4-cm pelvic mass. Prepubertal levels of serum
gonadothropins do not changes after GnRH administration. In addition t the
findings noted above, the patient is most likely to have?
a. dextrocardia
b. renal agenesis
c. gastrointestinal polyps
d. skeletal anomalies
e. mullerian anomalies

15. An 8-year-old girl has acute right lower abdominal pain. The pain began last
night in the periumbilical area and shifted this morning to the right lower
abdomen. She noted a loss of apetite over the past day and has vomited
three times since yesterday. She has not had a bowel movement today. Vital
signs are: blood pressure, 120/60; pulse, 90bpm; and temperature, 101.8oF.
Abdominal examination demonstrates tenderness halfway between the
umbilicus and the right anterior superior iliac spine. Bowel sounds are absent.
Rectal examination shows a fluctuant, fixed, ill defined right pelvic mass. A
hematocrit is 34% (normal, 3 to 10,000/mL). Stool guaiac is negative for
 occult blood. Abdominal radiogram shows a calcified fecalith in the right
lower quadrant. The most likely diagnosis is
(A) regional enteritis
(B) ulcerative colitis
(C) Meckel’s diverticulum
(D) appendicitis
(E) ovarian torsion

16. A 22-years-old female patient present with 3 months of amenorrhea and

some gastrointestinal complaints. On examination, she is bloated with a
masses appreciated in the lower pelvis approximately 12 cm in diameter and
cystic feeling. Which is the most probable diagnosis
a. Follicular cyst
b. corpus lutheum cyst
c. benign cystic teratoma
d. leiomyoma
e. pregnancy

17. A 14-year-old girl has had progressively increasing cyclic left pelvic pain since
menarche. She is not sexually active. Menses occur at monthly intervals.
Pelvic examination demonstrates a uterus deviated to the right. an elongated
left adnexal structure is palpable above a left-sided vaginal mass. You should
suspect the presence of
a. an ovarian cyst
b. a uterine anomaly
c. cervical stenoais
d. vaginal adenosis
e. a pelvic kidney

18. A 23-year-old woman desiring conception has amenorrhea of 5 weeks’

duration. She noticed an elevation in her basal body temperatures (BBTs)
since unprotected coitus 3 weeks ago. Her vital signs are: blood pressure,
120/60; pulse, 80bpm; and temperature, 98.6oF. Physical examination is
normal with the exception of the pelvic examination, which demonstrates a
tender 3-cm right adnexal mass. A heatocrit is 38% (normal, 35 to 45%). A
serum pregnancy test is negative. The next best step is
a. observation
b. estrogen therapy
c. progesterone therapy
d. RU 486 therapy
e. laparoscopy

19. You are asked to evaluated a 28-year-old unconscious woman involved in a

motor vehicle accident. An abdominal radiogram shows two teeth in the right
pelvis. Pelvic examination demonstrated a 7-cm semisolid mass in the right
adnexa. The most likely diagnosis is
 a. severe head and facial trauma
b. fetal demise
c. petus papyraceus
d. calcified leiomyoma
e. mature teratoma

20. A 39-year-old woman with acute right lower abdominal pain is seen in the
emergency department. She is nauseated and had vomited four times today.
She is monogamous and uses a diaphragm for contraception. Vital signs
are: blood pressure, 190/40; pulse, 110bpm; and temperature, 102.4oF.
Physical examination demonstrated a rigid abdomen with rebound
tenderness. Pelvic examination shows a fluctuant 3-cm right adnexal mass. A
hematocrit is 35% (normal 35 to 45%); white blood count, 28,000/mL (normal
3 to 10,000/mL). At laparotomy, you find a pelvic abcess and a ruptured
fingerlike pouch arising 40cm proximal to the ileocecal junction. The most
likely diagnosis is
a. regional enteritis
b. diverticulitis
c. Meckel’s diverticulum
d. chronic appendicitis
e. Walthard rest

21. You are asked to see a 34-year-old woman with intermittent abdominal pain
and bloody diarrhea. She has experienced similar symptoms previously but
has always recovered. She is married and use a diaphragm for contraception.
Vital signs are blood pressure, 130/80; pulse, 90bpm; and temperature,
101.0oF. A localized area of tenderness is present in the right lower
abdominal quadrant. Pelvic examination shows a fluctuant 4-cm right adnexal
mass. A hematocrit is 35% (normal 35 o 45%); white blood count, 27,000/mL
(normal, 3 to 10,000/mL). Stool testing shows blood intermixed with white
blood cells (WBCs). Gastrointestinal studies show mucosal changes and
narrowing of the terminal ileum. The best next step is
a. corticosteroid therapy
b. estrogen therapy
c. appemdectomy
d. colectomy
e. salpingo-oophorectomy

22. A 23-year-old woman has left lower abdominal pain of 1 week’ duration.
Her last menstrual period (LMP) was 8 weeks ago. Vital signs are: blood
pressure, 130/72; pulse, 76 bpm; and temperature, 98.6oF. abdominal
examination is unremarkable. Pelvic examination demonstrates an enlarged
uterus and tender 4.5-cm left adnexal mass. A serum human chorionic
gonadothropin (hCG) levels is 3,500 mIU/mL. Transvaginal sonography shows
a single viable intrauterine pregnancy and left echogenic adnexal mass. The
cyst most likely represents a
(A) heterotopic ectopic pregnancy
 (B) follicular cyst
(C) hemorrhagic corpus lutheum
(D) cystic teratoma
(E) leiomyoma

23. A 21-year-old woman has amenorrhea, transient late-cycle spotting, and

pelvic pain. Her vital signs are: blood pressure, 90/50; pulse, 110 bpm; and
temperature, 98.6oF. Abdominal examination shows left lower quadrant
tenderness with rebound. Pelvic examination demonstrates a painful 4-cm
left adnexal mass. A serum pregnancy test is positive. A hematocrit is 22%
(normal, 35 to 45%). The next best step is
a. observation
b. estrogen therapy
c. progesterone therapy
d. methotrexate therapy
e. surgery

24. A 38-year-old healthy woman comes for prenatal care. Her past medical
history is unremarkable. General physical and pelvic examinations before
conception were normal. She undergoes chorionic villous sampling, which
shows a 46,XX karyotype. She has noticed progressive hirsutism during
pregnancy. She eventually delivers an infant with ambiguous genitalia. A
maternal pelvic examination in the delivery room confirms a 6- cm left
adnexal mass. The most likely diagnosis is a
a. luteoma
b. theca luthein cyst
c. persistent corpus lutheum
d. luteinized unruptured follicle
e. liteinized endometrioma

25. A 8-cm cystic ovarian tumor is detected during routine prenatal examination.
The most common complication of such a tumor during the first trimester of
pregnancy is
a. torsion
b. rupture
c. intracystic hemorrhage
d. solid degeneration
e. luteinization

26. The most common pelvic mass in a post menopausal woman is a

a. follicular cyst
b. corpus lutheum cyst
c. germ cell tumor
d. leiomyoma
e. endometrioma
27. Most neoplastic ovarian masses in post menopausal women orginate from
a. ovarian epithelium
b. ovarian stroma
c. ovarian germ cell
d. ovarian sex cords
e. metastatic disease

28. Signet ring cell are characteristic findings in which tumor of the ovary?
a. Brenner tumor
b. Krugkenberg tumor
c. dermoid cyst
d. endometrioid carcinoma
e. dysgerminoma

29. A 1-year-old girl has an abdominal mass. Rectal examination

demonstrates a mass extending into the right pelvis. The cervix is not
palpable. abdominal sonography shows that the uterus and vagina are
absent. Both ovaries appear normal. The origin of the mass is most likely
a. gastrointestinal
b. renal
c. musculoskeletal
d. hepatic
e. pancreatic

30. a 27- year-old woman is undergoing ovulation induction for assisted

reproductive treatment of infertility. On an ultraosonographic evaluation of
folicular maturation, bilateral 4-cm solid ovarian tumors and moderate
collections of peritoneal fuid are found. Which of the following is the most
appropriate management of these finding
a. exploratiory laparotomy
b. diagnostic laparoscopy
c. measurement of serum CA-125
d. human menopausal gonadotropin therapy
e. delay conception for at least 1 month

31. An 18-years-old patient is seen for a school physical examination. Mild right
lower abdominal tenderness is noted. And on pelvic examination, a smooth,
mobile, mildly tender 4-cm cystic mass is found in the right adnexa. The
patient has had reguler periods since her menarch at age 12. She is not
sexualy active. What is the most apprpiate next step in the management of
this lession?
a. exploratory laparotomy
b. diagnostic laparoscopy
c. measurement of serum Ca 125
d. oral contraceptive theraphy
e. re-examination in 1 to 2 months
32. when compared to age-matched women, those with higher parity are at
lower risk for uterine leiomyomata due to which of the following?
a. reduced estrogen exposure
b. myometrial stretch
c. inhibition of cellular growth hormones
d. lower levels of sex hormone-binding globulin
e. reduced number of lifetime ovulation

33. Which is the preferred treatment of an interstitial ectopic pregnancy?

a. suction D&C
b. hysterectomy
c. cornual resection
d. hysteroscopy excision

34. Finding of a positive pregnancy test result and first trimester serum
progesteron level <5 ng/mL strongly suggest which of the following?
a. viable twin gestation
b. nonviable pregnancy
c. viable intauterine pregnancy
d. physiologic corpus luteum decline

35. Which of the following sonographic adnexal finding is most suggestive of

ectopic pregnancy?
a. tubal halo
b. ring of fire
c. ovarian cyst
d. extrauterine yolk sac

36. what is the cutt of time for B-HCG levels with an early normal intrauterine
pregnancy?
a. 24 hours
b. 48 hours
c. 72 hours
d. 96 hours
37. what is the lowest percent increase for B-HCG level in early normal
intrauterine pregnancies during a 48-hour interval?
a. 15-25
b. 35-45
c. 55-65
d. 75-85

38. In which surgical approach is the tube opened to remove the gestational
products, the left unsutured?
a. salphingotomy
b. salphingostomy
c. salphingectomy
d. salphingorraphy
39. One sample of laboratory test that distinguish cyst torsion from tubo ovarial
abcess is?
40. Dysmenorrhea is common findings of endomteriosis. This symptom on grade
III and IV will be treated best using?