1. 24-year-old G2P1 has a Pap smear performed on her 1st prenatal clinic visit at 10 weeks gestation.

The results return in 2 weeks as high grade s!uamous intraepithelial lesion suggestive of severe dysplasia . "hat is the ne#t step in the management of this patient$ a. %old knife coni&ation of the cervi# '. %olposcopy with 'iopsy of any suspicious lesions c. %olposcopy with 'iopsy of any suspicious lesions with endocervical curettage d. (epeat Pap smear at 2) weeks e. Termination of the pregnancy followed 'y cold knife coni&ation 2. *n 1)-year-old G1P+ presents at 10 weeks gestation stating she received the ru'ella vaccine at ) weeks. ,he tells you she is concerned a'out fetal anomalies and would like to terminate the pregnancy. -ow should you counsel this patient$ a. Termination of the pregnancy is recommended since congenital ru'ella is likely following vaccination. '. Termination of the pregnancy is not indicated 'ecause the vaccine does not contain live virus. c. Pregnancy termination is not recommended 'ecause there are no reports of congenital ru'ella follow ing maternal ru'ella vaccination. d. Termination of the pregnancy is recommended since congenital ru'ella cannot 'e detected 'y ultra sound. e. Termination of the pregnancy is recommended only if the she develops ru'ella anti'odies indicating infection occurred. .. "hat constitutes a positive contraction stress test$ a. The occurrence of any late decelerations in a 10 minute period '. /ate decelerations occurring with greater than 001 of contractions c. /ate decelerations occurring with every contraction in a 10 minute period d. 2ecreased 'eat to 'eat varia'ility with varia'le decelerations e. 2ecreased 'eat to 'eat varia'ility with or without decelerations 4. "hat constitutes a suspicious contraction stress test$ a. /ate decelerations occurring with less than 001 of contractions '. /ate decelerations occurring with greater than 001 of contractions c. /ate decelerations occurring with every contraction in a 10 minute period d. 2ecreased 'eat to 'eat varia'ility without decelerations e. /ate deceleration occurring with greater than 001 of contractions 'ut with good 'eat to 'eat varia'ili ty 0. "hich is considered the most accurate method to predict the e#pected date of delivery$ a. *ccurate last menstrual period '. 1st trimester pelvic e#amination c. 1st trimester crown-rump length ultrasound d. 3arly 2nd trimester 'iparietal diameter e. 3arly 2nd trimester femur length 4. -ow is iron transferred across the placenta to the fetus$ a. simple diffusion '. facilitated diffusion c. active transport d. protein 'ound e. iron does not cross the placenta to the fetus 5. -ow is insulin transferred across the placenta to the fetus$ a. simple diffusion '. facilitated diffusion c. active transport d. protein 'ound e. 6nsulin does not cross the placenta to the fetus

). "hat are maternal fasting glucose levels compared with non-pregnant women$ a. 7ot different '. 6ncreased c. 2ecreased d. Twice increased e. Three times increased 8. "here is the first site of hemoglo'in formation in the fetus$ a. 'one marrow '. spleen c. liver d. placenta e. yolk sac 10. The concentration of fetal serum a fetoprotein peaks at what gestational age$ a. ) weeks '. 10 weeks c. 22 weeks d. .0 weeks e. term 11. The concentration of maternal serum alpha-fetoprotein peaks at what gestational age$

a. 8 weeks b. 15 weeks c. 22 weeks d. 30 weeks e. term

12. "hat mechanism is responsi'le for the increased risk of 2own syndrome with advanced maternal age$ a. 9alanced translocation '. (o'ertsonian translocation c. Primary mitotic nondis:unction d. Primary meiotic nondis:unction e. ,econdary meiotic nondis:unction 1.. * patient;s maternal serum alpha-fetoprotein <=,*>P? concentration is elevated. "hich of the following options is recommended as the ne#t step in the management of this$ a. (epeat =,*>P levels '. (eferral to maternal fetal medicine specialist for comprehensive ultrasound. c. *mniocentesis with amniotic fluid *>P concentration d. =aternal serum acetylcholinesterase determination e. =aternal serum pregnancy associated plasma protein * <P*PP-*? determination. 14. "hat is the ne#t step in the management of a patient with a low maternal serum alpha-fetoprotein $ a. (epeat =,*>P determination '. @ltrasound to confirm dates c. Targeted ultrasound to determine if there is any ultrasound evidence of 2own syndrome present. d. *mniocentesis for fetal karyotyping e. a or ' are correct 10. "hich of the following ultrasound findings would 7+T increase the risk of fetal aneuploidy$ a. 2ou'le 'u''le sign in the fetal a'domen '. *'normal 4 cham'er view of the heart c. +mphalocoele d. Gastroschisis e. =id line cleft lip and palate

14. "hy is the resin T. uptake <rT.? test decreased in pregnancy$ a. The normal hyperthyroid state of pregnancy '. 6ncreased thyroid 'inding glo'ulin c. 6ncreased 'asal meta'olic rate in pregnancy d. -uman placentaA lactogen e. >etal T. productio 15. Total serum thyro#in levels in pregnancy compared to non-pregnant women areB a. not different '. decreased c. increased d. undetecta'le 1). 1).* 24 year old gravida one patient at 14 weeks presents with an elevated free thyro#in <T4? level$ "hat is the diagnosis$ a. -yperthyroidism '. 3levated free T4 is normal in pregnancy c. %annot 'e determined without knowing the T,- level d. %annot 'e determined without confirmation with the resin T-. uptake test 18. Possi'le conse!uences of Grave;s disease in pregnancy includeB a. Thyroid storm '. 6ncreased perinatal mor'idity and mortality c. 7ew'orn Graves disease d. Poor maternal weight gain e. *ll of the a'ove 20. Cou have :ust delivered .2 year old woman who was diagnosed with Graves disease 10 years earlier. *t that time she was successfully treated with 11.1 D 'ut developed hypothyroid as a conse!uence of treatment. ,he took levothyro#ine 200 meg daily.throughout the entire pregnancy. The 'a'y is found to have a pulse of 200 'pmD e#opthalamusD and a resting tremor. The pediatrician suspects hyperthyroidism. "hich of the following is the most likely cause of this new'om;s signs and symptoms$ a. =aternal thyro#ine ingestion caused symptoms of hyperthyroidism in the neonate '. Thyroid stimulating hormone <T,-? crossed the placenta causing neonatal hyperthyroidism c. Thyroid stimulating anti'odies crossed the placenta d. %ongenital Graves disease since Graves disease is an autosomal dominantly inherited disease and the 'a'y acc!uired the a'normal gene from the mother. e. *ll of the a'ove 21. %onse!uences of maternal hypothyroidism include all of the following 3E%3PTB a. infertility '. spontaneous a'ortion c. maternal 'radycardia d. fetal macrosomia e. increased maternal weight gain 22. -ow does low dose aspirin decrease the incidence of throm'osis in at risk patients$ a. the direct vasodilatory effect of aspirin '. decreased throm'o#ane c. decreased prostaglandin 32 d. decreased prostacyclin e. increased nitric o#ide production 2.. *ll of the following factors is /3*,T commonly associated with shoulder dystocia$ a. =aternal dia'etes '. >etal macrosomia c. Post term pregnancies d. =aternal o'esity e. 7ulliparity

24. "hat is the term for two cell lines with different chromosome num'ers in the same individual$ a. aneuploidy '. triploidy c. chimeras d. mosicism e. translocation 20. "hich of the following characteristics are typical of anthropoid pelves$ a. the anterior-posterior diameter of the pelvic inlet is shorter than the transverse '. most commonly seen in +rientals c. associated with occiput anterior presentations d. wide pu'ic arch e. long sacrospinous ligament 24. "hat is the most common position of the fetal verte# with a true anthropoid pelvis$ a. +cciput anterior '. +cciput posterior c. +cciput transverse d. 9row presentation 25. "hat maternal pelvic type has the worst prognosis for vaginal delivery$ a. Gynecoid '. *nthropoid c. *ndroid d. Platyploid 2). "hen does the first stage of la'or 'egin$ a. the onset of regular uterine contractions '. the onset of the active phase of la'or c. the onset of 9ra#ton--icks contractions d. when the cervi# is completely dilated e. when the fetus delivers 28. "hat is the most common position of the fetal verte# with a true platyploid pelvis$ a. +cciput anterior '. +cciput posterior c. +cciput transverse d. 9row presentation e. >ace presentation .0. "hich forceps is designed to deliver the after coming head in 'reech presentations$ a. ,impson '. Tucker-=clane c. Piper d. 3lliot e. Fielland .1. "hat is the immediate precursor for the production of estriol produced$ a. maternal liver '. maternal adrenal gland c. fetal adrenal gland d. fetal liver e. placenta .2. -ow is engagement of the fetal verte# defined$ a. a fetal head is no longer floating '. a fetal head whose leading edge has entered the pelvic inlet c. a fetal head whose widest part has traversed the pelvic inlet d. a fetal head that has internally rotated to an occiput anterior position e. a fetal scalp that is visi'le at the introitus

... Galproic acid use in the 1st trimester is associated with what fetal anomaly$ *. 7eural tu'e defects 9. 3pstein;s anomaly %. duodenal atresia 2. (enal agenesis <Potter;s syndrome? 3. %ystic hygroma .4. /ithium use in the 1st trimester is associated with what fetal anomaly$ a. 7eural tu'e defects '. 3pstein;s anomaly c. 2uodenal atresia d. (enal agenesis <Potter;s syndrome? e. %ystic hygroma .0. "hat is the most common cause of death in live 'om infants with renal agenesis$ a. a&othemia <renal failure? '. prematurity c. hypertension d. pulmonary hypoplasia e. associated cardiac defects .4. "hat is necessary for a drug to cause a fetal anomaly$ a. ingestion of the drug when the organ is developing '. fetal suscepti'ility to the adverse effects of the drug c. the a'ility of the drug to cross the placenta d. the concentration of the drug in the maternal circulatory system e. all of the a'ove .5. "hat is the most common first trimester ultrasound finding in a fetus with Turners syndrome$ a. short e#tremities '. coartation of the aorta c. cystic hygroma d. we''ed neck e. omphalocoele .). "hich of the following is the most common infectious cause of neonatal death$ a. -erpes simple# virus '. Group 9 'eta-hemolytic streptococcus c. To#oplasmosis d. Garicella <chicken po#? e. %ytomegalovirus .8. "hich of the following carries the highest risk for the development of neonatal herpes simple# virus <-,G? infections$ a. recurrent out'reak at the onset of la'or '. prolonged rupture of the mem'ranes c. positive -,G culture 1 day prior to he onset of la'or d. primary maternal infection e. positive maternal 6g= anti'odies to -,G 40. "hat is the mechanism of action of o#ytocin;s a'ility to cause uterine contractions$ a. 'eta 2 receptor antagonism '. 'eta 2 receptor stimulation c. causes e#trusion of calcium from the myometrial cells via calcium channels d. decreased production prostaglandin p2a e. causes release of calcium from the sarcoplasmic reticulum

41.

"hat is the mechanism of action of ritadrine;s a'ility to inhi'it uterine contractions$ a. phosphorylation of myosin '. 'lockade of uterine muscle alpha receptors c. increases intracellular adenosine triphosphate <*TP? levels d. increases intracellular calcium concentrations e. increases intracellular cyclic adenosine monophosphate <c*=P? levels "hat is the most relia'le method to diagnosis premature rupture of the mem'ranes$ a. vaginal pooling of fluid '. positive nitra&ine test <alkaline vaginal fluid? c. positive fern test d. ultrasound evidence of oligohydramnios e. negative wet prep for vaginal infection "hat is the karyotype of a complete molar pregnancy$
a. b. c. d. 46XX 47XX +21 47XX+18 45X

42.

4..

e. triploidy <48EEE or 48EEC? 44."hat is the karyotype of a partial molar pregnancy$ a.44EE '.45EE H21 c. 45EEH1) d. 40E e.triploidy <48EEE or 48EEC? 40. * .4-year-old G2P1 has a pelvic e#amination performed on her 1st prenatal visit at 4 weeks gestation in which a 4cm right adne#al mass is palpated. *n ultrasound confirms the presence of an intrauterine pregnancy with a comple# cystic and solid mass most likely originating from the right ovary. =alignancy cannot 'e ruled out. "hat is the ne#t step in evaluating or treating this patient$ a. immediate laparoscopy or laparotomy '. o'tain tumor markersD and if normal o'serve c. laparoscopy at 14 weeks gestation d. laparotomy at 14 weeks gestation e. repeat pelvic e#amination and ultrasound at 14 weeks 44.6f the a'ove findings in !uestion 40 were discovered at 14 weeks gestationD what would 'e the most appro priate course of action$ a. immediate laparoscopy or laparotomy '. o'tain tumor markerD and if normal o'serve c. repeat the pelvic e#amination and ultrasound in 4 weeksD and if the mass is still present proceed with laparotomy d. cesarean section at term with a right oophorectomy e. repeat pelvic e#amination and ultrasound 4 weeks post partumD and if the mass is still present pro ceed with laparotomy 45."hat hormone triggers the /- surge prior to ovulation$ a. Gn('. >,c. 15-.- estradiol
d. prolactin

e. testosterone

4)."hat is thought to cause the amenorrhea seen in female athletes$ a. polycystic ovarian disease '. hyperprolactinemia c. hypothyroidism d. androgen e#cess e. hypothalamic dysfunction

48. "hy is epidural anesthesia discouraged in patients with 3isenmenger;s syndrome$ a. preload of intravenous fluids can lead to pulmonary edema '. high spinal is more likely c. decreased 'lood pressure increases right to left shunting d. cardiac to#icity of the local anesthetic e. venous pooling can lead to decreased cardiac output Matching (50-63) =atch the following histological and clinical findings with the pathologic diagnosis.
00. 01. 02. 0.. 04. 00. 04. 05. 0). 08. 40. 41. 42. 4.. =ature cystic teratoma /ipid cell ovarian neoplasms ,erous tumors Granulosa cell tumor -ypersecretory endometrium 9renner tumor Fuken'erg tumor 6mmature teratoma ,truma ovarii 3ndodermal sinus tumor %lear cell adenocarcinoma -eterologous mi#ed mesodermal sarcoma Pseudomy#oma peritonei >allopian tu'e carcinoma a. '. c. d. e. f. "althard rests crystals of (einke 'enign ovarian tumor with thyroid gland tissue ho'nail nuclei psammoma 'odies signet ring cells g. %ari-3#ner 'odies h. ,hiller-2uval 'odies ovarian tumor with primitive neural tissue sarcoma i. :. with malignant cartilage k. *rias ,tella reaction peritoneal mucinous cell implants causing ascites 6. m. hydrops tu'ae profluens n. (okitanski protu'erance

44. "hat condition is associated with primary amenorrheaD lack of development of secondary se#ual characteris ticsD and anosmia$ a.Fallman;s syndrome '.=ayer-(okitansky-Fuster--auser ,yndrome <mullerian agenesis? c. *ndrogen insensitivity syndrome d.,wyer;s syndrome <EC gonadal dysgenesis? e.Turners syndrome <40E? 40. Cou have :ust delivered a 'a'y whose se# cannot 'e easily determined 'ecause the genitalia are am'igu ous. "hich of the following is the most likely cause$ a.*ndrogen secreting tumor '.*ndrogen insensitivity syndrome c. =aternal 21-cc-hydro#ylase deficiency d.>etal 21- a -hydro#ylase deficiency e.>etal 15-hydro#ylase deficiency 44.* 20-year-old woman presents with a 4-month history of amenorrhea and galactorrhea. * prolactin level returns 00ngIml <normal J 20ngIml?. * lateral coned down view of the sella tursica shows enlargement of the sella tursica. %omputeri&ed tomography <%T? scan shows pituitary enlargement. "hat is the ne#t step in the management of this case$ a. 9egin 'romocriptine '. Transphenoidal hypophysectomy with removal of pituitary adenoma c. %raniotomy with removal of pituitary adenoma d. +'tain T,- levels e. +'tain o#ytocin levels

67-71. Matching: =atch the ovarian tumor with the hormone it secretes.
45. 4). 48. 50. 51. 3strogen -uman gonadotroping Testosteron *lpha-fetoprotein Progesterone a. '. c. d. e. 3ndodermal sinus tumor ,ertoli-leydig cell chorionic tumor %horiocarcinoma Granulosa cell tumor none of the a'ove

52. *10 year old woman presents with primary amenorrhea. ,he is 04 inches tall <4;-4 ?D with Tanner stage 6 'reast and pu'ic hair development. ,peculum and 'imanual e#aminations confirm the presence of a normal vaginal lengthD and a normal cervi# and uterus. +varies cannot 'e palpated. * karyotype is o'tained and returns 44.EC. "hat is the diagnosis$ a. *ndrogen insensitivity syndrome <testicular femini&ation? '. ,wyer syndrome c. =ayer-(okitansky-Fuster--auser ,yndrome <mullerian agenesis? d. Turner syndrome <40E? e. Fallman;s syndrome 5.. * 20-year-old marathon runner presents with secondary amenorrhea. ,he failed to menstruate when given a progesterone challengeD and her >,- level returned elevated. "hat is the diagnosis$ a. Polycystic ovarian disease '. *sherman;s syndrome c. -ypothalamic amenorrhea d. Premature ovarian failure e. Gonadal dysgenesis 54. "hat is the ne#t step in the management of the case descri'ed in !uestion 5.$ a. 'egin oral contraceptive pills '. hysteroscopy c. 'egin 'romocriptine d. advise your patient to stop long distance running e. o'tain a karyotype 50. 9y definitionD what time period is re!uired to diagnosis a couple with infertility$ a. 4 months '. 12 months c. 1) months d. 24 months

e. .0 months

54. *n infertility patient is found to have e#tensive scaringD dilationD and occlusion of 'oth fallopian tu'es. ,he gives no history of pelvic painD une#plained feversD dyspareuniaD or pelvic inflammatory disease. "hat is the most likely diagnosis$ a. %hlamydia salpingitis '. Gonococcal salpingitis c. 3ndometriosis d. Tu'erculosis salpingitis e. 6n utero e#posure to diethylstil'esterol <23,? 55. %ondyloma lata is caused 'y what organism$ a. %hlamydia trachomatous '. human papilloma virus c. syphilis d. gonorrhea e. %ondyloma lata is not caused 'y an infectious agent 5). /ymphogranuloma venereum is caused 'y what organism$ a. %hlamydia trachomatous '. human papilloma virus c. %ytomegalovirus d. calymmato'acterium granulomatis e. haemophilis ducreyi 58. "hat is the most important first step in the management of a new'orn infant with am'iguous genitalia$ a. serum electrolyte levels

'. karyotype

c. estradiol levels d. 'uccal smear e. testosterone level

)0. * patient complaining of urinary incontinence is administered a cystometrogram. 6f the patient has genuine urinary stress incontinenceD what finding would 'e e#pected$ a. elevated resting 'ladder tone '. reduced 'ladder capacity c. involuntary 'ladder contractions d. leakage of water from the urethra 2 seconds following coughing e. none of the a'ove )1. * 02-year-old patient presents with an a'normal papaniculau smear. %olposcopic e#amination shows an ascetic acid stained lesion whose 'iopsy confirms the presence of a s!uamous intraepithelial lesion. The patient re!uests hysterectomy 'ecause of symptomatic uterine descendsus. "hen would this 7+T 'e appropriate$ a. the entire lesion is visi'le with colposcopy '. the endocervical curettage agrees with the Pap findings c. the transitional &one is entirely visuali&ed d. there is 27*-pro'e evidence of the presence of human papilloma virus in the 'iopsy specimen e. the pap smear agrees with tissue diagnosis )2. "hat is the treatment of choice for /ymphogranuloma venereum$ a. penicillin G '. amo#icillin c. metronida&ole d. do#ycycline e. sulfametho#i&oleItrimethoprin ).. "hich of the following is an indication for ,wan&-Gan& catheri&ation with severe preeclampsia$ a. 6n order to safely administer a fluid challenge if oligouria develops. '. * 'lood pressure of greater than 140I110 mm-g 20 minutes following a 0 mg intravenous 'olus of hydrala&ine. c. Preeclampsia associated with severe pulmonary edema d. Preeclampsia associated with -3//P syndrome e. *ll are indications for ,wan&-Gan& catheri&ation )4. * patient with carcinoma of the cervi# presents with a pelvic e#amination that is suggestive of right parametrial involvementD 'ut does not e#tend to the pelvic sidewalk %ystoscopy and proctoscopy are negative for 'lad der or rectal involvement. 6GP shows 'ilateral hydronephrosis. "hat is the stage of this disease$ a. =* '. =9 c. 1=9 d. 6ll <urinary? e. 6G* )0. "hat ovarian neoplasm is most commonly associated with acute hemorrhage$ a. 9renner tumor '. 3ndodermal sinus tumor c. 9enign cystic teratoma d. ,erous cystadenocarcinoma e. Granulosa cell tumor )4. "hat is the most common malignant ovarian tumor seen in pregnancy$ a. ,erous cystadenocarcinoma '. =ucinous cystadenocarcinoma c. %lear cell adenocarcinoma d. 2ysgerminoma e. 6mmature teratoma

)5. "hich of the following is the ma:or draw'ack to low-molecular-weight heparin use in pregnant women at risk of throm'osisD or during treatment for an active throm'otic event. a. @nlike conventional heparin therapyD low-molecular-weight heparin freely crosses the placenta and places the fetus at risk for intraventricular hemorrhage during delivery. '. /ow-molecular-weight heparin has a longer half-life and 'ioavaila'ilty c. /ow-molecular-weight heparin has a more predicta'le dose-response d. Partial throm'oplastin time <P6T? levels need to 'e followed more fre!uently with lowmolecular-weight heparin. e. 3pidural anesthesia cannot 'e used with patients taking low-molecular-weight heparin 'ecause of reports of epidural hematomas )). "hat ovarian tumor is most sensitive to radiation therapy$ a. ,erous cystadenocarcinoma '. =ucinous cystadenocarcinoma c. %lear cell adenocarcinoma d. 2ysgerminoma e. Granulosa cell tumor )8. "hat is the most common primary carcinoma metastatic to the ovary$ a. 'reast '. malignant melanoma c. stomach d. lung e. leukemia 80. "hat is the most common primary carcinoma that can metastasi&e to the fetus$ a. 'reast '. malignant melanoma c. stomach d. lung e. cervical 81. "hat is the most common genital tract malignancy$ a. vulva '. vagina c. cervi# d. endometrial e. ovary . 82. "hat genital tract malignancy is responsi'le for the most annual deaths$ a. vulva '. vagina c. cervi# d. endometrial e. ovary 8.. "hich is 7+T a reason why radical hysterectomy is recommended over radiation therapy for cervical can cer$ a. higher 0 year survival rate '. preservation of vaginal function c. preservation of ovarian function d. less long term mor'idity e. all are reasons why radical hysterectomy and pelvic lymphadectomy is preferred 84. "hat is the most common cause of precocious pu'erty$ a. constitutional '. craniopharyngioma c. ovarian carcinoma d. adrenal tumors e. =c%une- *l'right syndrome

80. "hat is the preferred treatment of constitutional precocious pu'erty$ a. danocrine '. depoprovera c. Gn(- agonist therapy d. continuous oral contraceptive pills e. clomiphine citrate 84. "hich is a true statement concerning osteitis pu'is$ a. 6t is more commonly seen following a 9urch procedure than a =arshall-=archetti-Frant& procedure '. 6t can lead to vessicovaginal fistula c. %orticosteroids are not effective d. 6t is thought to 'e caused 'y 'acterial infection e. Presents with intense pain over the symphysis pu'is 85. %hancroid is caused 'y what organism$ a. %hlamydia trachomatous '. human papilloma virus c. %ytomegalovirus d. calymmato'acterium granulomatis e. haemophilis ducreyi 8). "hich of the following statements is true concerning scheduled cesarean section to prevent the vertical transmission of the human immunodeficiency virus <-6G? from the mother to the fetus. a. The *%+G committee on +'stetrical Practice concluded that -6G-infected women should 'e offered a scheduled cesarean section to decrease the rate of vertical transmission. '. 7o 'enefit from cesarean section is found if the mother;s viral load is J 10D000 copiesIml of plasma. c. Gertical transmission rates are decreased from 0-)1 to 0.01 with cesarean section d. The 'enefits of cesarean section are 7+T affected 'y the presence of la'or or rupture of the mem 'ranes. e. *mniocentesis can 'e routinely employed to document fetal lung maturityD prior to cesarian 'irth. 88. Granuloma inguinalA is caused 'y what organism$ a. %hlamydia trachomatous '. human papilloma virus c. %ytomegalovirus d. calymmato'acterium granulomatis e. haemophilis ducreyi 100. -ow is the diagnosis of lichen sclerosis of the vulva made$ a. inspection '. culture c. wet prep d. radioimmunoassay e. 'iopsy 101. *n 1) year old woman presents with primary amenormea. ,he is 4) tall <0;) ? and has Tanner stage 0 <*dult contour? 'reast developmentD and ,tage 2 <prese#ual? pu'ic hair growth. ,he is found to have a short vagina and no visi'le cervi#. The uterus cannot 'e palpated on 'imanual e#amination. -er total serum testos terone level returns 400 ngIdl <normal female J )0 ngIdl?. "hat is the likely diagnosis$ a. *ndrogen insensitivity syndrome <testicular femini&ation? '. ,wyer;s syndrome c. =ayer-(okitansky-Fuster--auser ,yndrome <mullerian agenesis? d. Turner syndrome <40E? e. Fallman;s syndrome

102. *n 1) year old woman presents with primary amenorrhea. ,he is 4) tall <0;) ? and has Tanner stage 0 <*dult contour? 'reast developmentD and ,tage 0 <adult? pu'ic hair growth. ,he is found to have a short vagina and no visi'le cervi#. The uterus cannot 'e palpated on 'imanual e#amination. -er total serum testosterone level returns 50 ngIdl <normal female J )0 ngIdl?. "hat is the likely diagnosis$ a. *ndrogen insensitivity syndrome <testicular femini&ation? '. ,wyer;s syndrome c. =ayer-(okitansky-Fuster--auser ,yndrome <mullerian agenesis? d. Turner syndrome e. Fallman;s syndrome 10.. "hy do patients with ,wyer syndrome <44.EC gonadal dysgenesis? have a uterus$ a. /ack of androgen production '. /ack of mullerian inhi'itory hormone production c. *'sent testes determining region on the E-chromosome d. *'sence of androgen receptors on target cells e. ,wyer syndrome patients do have a uterus 104. * woman 4-weeks postpartum is evaluated for dia'etes mellitus. ,he was diagnosed with gestational dia 'etes during her pregnancy. -er fasting serum glucose returns 1.0mgIdl. *n oral 50gm glucose tolerance test is administered and the 1-hour value returns 210mgIdl <7/ J 200mgIdl?. The other glucose values are normal. "hat is the diagnosis$ a. The patient does not dia'etes mellitus '. The patient has impaired glucose tolerance c. The patient has dia'etes mellitus type 6 d. The patient has dia'etes mellitus type 66 e. >urther evaluation is re!uired to esta'lish a diagnosis. Questions 105-106: *n 1)-year-old woman presents with a one-year history of increasing hair growth on her faceD chestD and lower a'domen. -er testosterone returns within normal limitsD 'ut the dehydroepiandrosteronesulfate <2-3*-sulfate? level returns significantly elevated. 100. "here is the e#cess androgen production 'eing secreted to e#plain her hirsuitism$ a. pituitary '. lung carcinoma c. adrenal gland d. ovary e. endometrium 104. ,he is found to have an elevated 15-hydro#yprogesterone level. "hat is the diagnosis$ a. pituitary adenoma '. carcinoid tumor c. adult onset 21- a -hydro#ylase deficiency d. ovarian carcinoma e. complete 21- a -hydro#ylase deficiency 105. "hen ligation of the hypogastric artery is re!uired 'ecause of massive pelvic hemorrhageD how should the right angle clamp 'e passed under the hypogastric artery$ a. medial to lateral '. lateral to medial c. superior to inferior d. inferior to superior e. any method is appropriate 10). "hat is the most common symptom of ureteral in:ury in a post operative hysterectomy patient$ a. une#plained fever '. flank pain c. ascites d. decreased urinary output e. asymptomatic

108. "hat is the most common cause of death from cervical cancer$ a. hemorrhage '. sepsis c. renal failure d. 'owel o'struction e. malnutrition 110. "hat is the most common cause of death from ovarian cancer$ a. hemorrhage '. sepsis c. renal failure d. 'owel o'struction e. malnutrition 111. "hich of the following genital tract malignancies has the highest 0-year survival rate$ a. s!uamous cell cervical carcinoma '. adenocarcinoma of the endometrium c. s!uamous cell carcinoma of the vulva d. ovarian carcinoma e. choriocarcinoma 112. * patient with polycystic ovarian disease presents with hirsuitism 'ut has 7+(=*/ testosterone and 2-3*, levels. -ow can this 'e e#plained$ a. other androgens are elevated '. decreased se# hormone 'inding glo'ulin c. decreased >,- levels d. elevated luteal hormone </-? levels e. decreased progesterone 11.. "hich of the following can 'e used to treat hirsuitism$ a. oral contraceptive pills '. de#amethasone c. cimetadine <Tagamet? d. spironolactone e. all the a'ove 114. * patient presents with a painless vulvar lesion in which you suspect primary syphilis. "hat is the 'est method to confirm this$ a. G2(/ <venereal disease research la'oratory? slide test '. (P( <rapid plasma reagin? c. >T*-*9, <fluorescent-la'eled Treponema anti'ody a'sorption? d. 2ark field e#amination e. TP6 <Treponema immo'ili&ation test? 110. * patient who is 20 weeks pregnant presents for prenatal care. (outine la'oratory studies return with a pos itive G2(/ and TP-*. * review of her records indicates she had a negative G2(/ 5 months earlier. ,he is aller gic to penicillin. "hat is the recommended treatment$ a. 2esensiti&ation followed 'y treatment with 2.4 million units of 9en&athine penicillin G intramuscularly. '. 2esensiti&ation followed 'y treatment with 2.4 million units of 9en&athine penicillin G intramuscularly once a week for . treatments. c. Tetracycline 000mg per os 4 times a day for 10 days d. 3rythromycin ,++mg per os 4 times a day for 10 days e. *&ythromycin one gram per os as a single dose 114. "hich medication is associated with neonatal throm'ocytopenia when given prenatally to the mother$ a. hydrochlorothia&ide '. methyldopa <*ldomet?

c. prednisone d. catapress

e. diltia&em <%ardi&em?

115. "hich medication has long term studies to show 'oth safety and efficacy when used to treat maternal essential hypertension in pregnancy$ a. hydrochlorothia&ide '. methyldopa c. propanolol d. nifedipine e. apresoline 11)."hich maternal anti'odies are associated with congenital heart'lock$ a. antinuclear anti'ody <*7*? '. anticardiolipin c. lupus anticoagulant d. anti-,,*<rho? anti'odies e. all of the a'ove 118."hich of the following is 7+T associated with the antiphospholipid syndrome$ a. prolonged activated partial throm'oplastin time <aPTT? '. increased risk of hemorrhage c. ha'itual a'ortion d. intrauterine growth retardation e. still'irth 120. * patient with chronic renal disease presents for preconceptional counseling. "hich of the following findings has the worst prognosis for a successful pregnancy$ a. creatinine clearance less than 00ccImin '. serum creatinine greater than 1.2mgIdl c. renal disease secondary to dia'etes mellitus d. diastolic 'lood pressure K110mm-g e. greater than 0 grams of proteinuria in a 24 hours urine collection 121. * .0-year-old patient with systemic lupus erythematosus presents for preconceptional counseling. "hich factor would 'est predict a successful pregnancy outcome$ a. antinuclear anti'ody <*7*? less that 1B44 '. high %. and %4 levels c. negative anti-27* liter d. negative ,mith anti'ody liter e. !uiescent disease for 4 months prior to conception 122. "hich of following vaccinations is contraindicated in pregnancy$ a. (a'ies '. -epatitis 9 c. >lu d. Pneumococcal e. =umps

12..* .2-year-old term pregnant primigravid woman presents in active la'orD 0cm dilatedD and 801 effacedD and &ero station. Three hours later she is 4cm dilatedD 801 effacedD and &ero station. "hat is the diagnosis$ a. normal progress of la'or '. arrest of descent c. prolongation disorder d. protraction disorder e. cephalopelvic disproportion

124.-ow does a 9urch procedure help improve the symptoms of urinary stress incontinence$ a. restores the normal anatomical position of the urethra '. restores the normal vessico-urethral angle c. prevents cystocoele formation d. retains the intra-a'dominal position of the upper urethra during valsalva maneuvers e. all of the a'ove

120. "hich drug is contraindicated in pregnancy for the treatment of asthma$ a. epinephrine

'. ter'utaline

c. aminophyllin d. corticosteroids e. a&ythromycin 124. "hat drug is contraindicated in pregnancy for the treatment of essential hypertension$ a. methyldopa '. apresoline c. clonidine

d. captopril
e. nifedipine

127-131. Matching:
=atch the following hormones with their 'iochemical structure 125. 3stradiol 12). Testosterone 128. Progesterone 1.0. 3strone 1.1. 3striol

OH

-+;

-+;

1.2. 6n womenD when is meiosis 66 completed$ a. the onset of pu'erty '. during recruitment for ovulation c. during ovulation d. following ovulation 'ut 'efore fertili&ation e. following fertili&ation 1... * .1-year-old woman with a history of systemic lupus erythematosus presents at 24 weeks gestation with elevated 'lood pressuresD edema of the hands and faceD and increased proteinuria. "hich of the following find ings would indicate that these findings are secondary to a flare-up of systemic lupus erythematosus and not preeclampsia$

a. positive *7* '. elevated serum creatinine c. decreased compliment levels d. no elevation in liver function studies e. the presence of throm'ocytopenia

1.4. "hich of the following is 7+T associated with detrussor insta'ility a. multiple sclerosis '. spinal cord in:uries c. decreased 'ladder capacity d. urgency incontinence e. increased post void residual volumes 1.0. "hich of the following medical conditions improves in a ma:ority of patients during pregnancy$ a. epilepsy '. systemic lupus erythematosis c. ulcerative colitis d. rheumatoid arthritis e. %rohn disease 1.4. "hat is the 'est method to diagnosis the presence of an enterocoele$ a. speculum e#amination with inspection of the vaginal floor '. digital e#amination of the vaginal floor c. simultaneous digital e#amination of the vagina and rectum d. rectal e#amination e. vaginal pro'e ultrasound 1.5. "hat is the most common cause of an a'normal post coital test$ a. decreased >,'. increased estradiol c. decreased estradiol d. decreased progesterone e. the test was performed on the wrong day of the menstrual cycle 1.). "hat is the first histological sign of ovulation$ a. su'nuclear vacuoles '. glandular secretions c. stromal edema d. cilia formation e. loss of nuclear mitoses 1.8. "hich of the following would 'est suggest the diagnosis of the inade!uate corpus luteum syndrome$ a. endometrial 'iopsy returns dated day 22D two days 'efore the patient;s actual period '. 21-day serum progesterone of 14 ngIml c. a'normal post coital test d. decreased temperature elevation on 'asal 'ody temperature assessment e. short follicular phase 140. "hich of the following can 'e used to treat the inade!uate corpus luteum syndrome$ a. oral microni&ed progesterone '. progesterone vaginal suppositories c. intramuscular 15-hydro#yprogesterone d. clomiphene citrate e. all of the a'ove 141. "hat drug has 'een shown to prevent dia'etic nephropathy in patients with dia'etes mellitus$ a. thalidamide '. diethelstil'esterol c. angiotension converting en&yme inhi'itors d. 'eta-'lockers e. calcium channel 'lockers

142. * woman who has a 'rother with cystic fi'rosis is now pregnant at ) weeks. -er hus'and has no family his tory of cystic fi'rosis. The incidence of the carrier state in the general population in 1 in 20. "hat is the risk of this fetus having cystic fi'rosis$ a. 1 in 00 '. 1 in 120 c. 1 in 140 d. 1 in 240 e. 1 in 420 Luestions 14.-144B * woman 10-weeks pregnant presents with a low-grade temperatureD malaiseD and a slap cheek rash over her face. 14.. "hat is the most likely diagnosis$ a. systemic lupus erythematosus '. ru'ella c. ru'eola d. parvovirus 9-18 e. %ytomegalovirus 144. what is the risk to the fetus$ a. hydrocephaly

'. cardiac defects %. hydrops fetalis

d. intracranial calcifications e. neural tu'e defects 140. "hat is the immediate precursor for the production of estriol$ a. 15-hydro#yprogesterone '. dihydroepiandrosterone <2-3*? c. dihydroepiandrosterone - sulfate <2-3*-,? d. 14-hydro#y-dihydroepiandrosterone <14-+--2-3*? e. 14-hydro#y-dihydroepiandrosterone - sulfate <14-+--2-3*-,? 144. "hich maternal congenital heart lesion carries the highest maternal mortality risk$ a. 3isenmenger;s syndrome '. Tetralogy of >allot c. =itral stenosis d. Patent ductus arteriosus e. *ortic stenosis 145. * 42-year-old patient presents with a one-month history of menstrual irregularitiesD increasing hair growth on her faceD chestD and lower a'domenD deepening of her voiceD clitoral enlargementD and male pattern 'ald ness. /a'oratory data shows a serum testosterone level of 400ngIdl <7/ M J40ngIdl?D normal 2-3*-, levelsD and normal 15-hydro#yprogesterone levels. "hat is the most likely diagnosis$ a. Polycystic ovarian disease '. *dult onset adrenal hyperplasia c. *ndrogen secreting ovarian neoplasia d. *ndrogen secreting adrenal tumor e. Gushing syndrome 14). "hich statement 'elow 'est descri'es the partial pressure of o#ygen <p+2? in the right compared with the left ventricles of the fetus in utero$ a. The p+2 on the right is greater than the left '. The p+2 on the left is greater than the right c. The p+2 on the left is e!ual to the right d. 2uring uterine contractions the p+2 on the right is greater than the left

148. "hat is the treatment of choice for la'ial agglutination$ a. Topical estrogen cream '. Topical steroid cream c. +ral estrogen d. +ral progesterone e. Gn(- agonists 100. "hat is the mechanism for the onset of follicular development at pu'erty$ a. The growth spurt increases >,- levels '. The maturation of the positive feed'ack of estradiol to trigger the /- surge c. The level of estrogen re!uired to inhi'it >,- increases d. The level of growth hormone increases e. 6ncreased androgens from the adrenal gland

151-155: Matching
=atch the homologous structures in the male and female 101. 102. 10.. 104. 100. Phallus Prostate gland %owpers <'ul'o-urethral? gland ,crotum 7one a. '. c. d. e. vagina clitoris /a'ia ma:ora ,kene;s ducts 9artholin glands

104. .* 20-year-old-gravida 1 para 1 presents for preconceptional counseling. -er first pregnancy was compli cated 'y fetal anencephaly. "hich of the following options should 'e offered to this woman$ a. >olic acid 4 mg per day 'eginning one month prior to conception until 12 weeks gestation '. =aternal serum alpha-fetoprotein screening at 10-weeks gestation c. *mniocentesis for amniotic fluid alpha-fetoprotein levels d. *mniotic fluid acetylcholinesterase screening if the amniotic fluid alpha-fetoprotein level is elevated. e. all of the a'ove can 'e offered 105. * 41- year-old gravida 2 para 1 presents at 10 weeks for genetic counseling and possi'le amniocentesis. -er first pregnancy at age .4 was complicated 'y fetal trisomy 1). "hich of the following 'est descri'es the risk of this fetus having aneuploidy compared to women her same ageD with no history of aneuploidy$ a. The risk for aneuploidy is not different '. The risk for aneuploidy is dou'led c. The risk is for aneuploidy is tripled d. The risk for aneuploidy is slightly increased e. The risk for aneuploidy is slightly decreased 10). * .0-year-old woman presents with primary infertility. 2uring the taking of her history and physical e#amina tion you discover she has e#perienced a rapid weight gain and lack of energy over the past 4 months. -er rest ing pulse is 00 'eats per minute. Cou suspect hypothyroidism. "hich of the following tests should 'e ordered$ a. Total T4 '. Total T. c. (esin T. uptake d. T,e. *ll the a'ove 108. * woman with adult onset adrenal hyperplasia 'eing treated with de#amethasoneD presents 0 weeks from her last menstrual period. -er urine pregnancy test is positive. -er hus'and has a sister who was 'orn with am'iguous genitalia. "hich of the following should 'e offered to this patient$ a. 2iscontinue the de#amethasone immediately '. Taper the de#amethasone gradually and then discontinue c. Perform a *%T- stimulation test on her hus'and d. 2ou'le her dose of de#amethasone e. "ait for fetal se# determination to determine if treatment is needed.

140. "hat is the final hormone event of pu'erty that 'rings a'out the onset of ovulation$ a. The set point to inhi'it >,- secretion 'y estrogens is increased '. =aturation of the positive feed'ack of estradiol to induce the /- surge c. 3piphyseal plate closure triggers ovulation d. The adrenal gland 'egins secretion of androstenedione e. *ndrogen production 'y the ovary 'egins. 141. "ho should 7+T receive the annual flu vaccine$ a. ,ickle cell anemia patients '. Pregnant patients c. Patients over 00-years-old d. 6mmuno-compromised patients e. *ll of the a'ove patients should receive the flu vaccine 142. (isk groups for invasive group 9 streptococcal disease includes all 3E%3PTB a. 7eonates '. 2ia'etics c. Pregnant women d. Patients positive for the human immunosuppressive virus <-6G? e. *ll of the a'ove are at risk 14.. (isk factors for early onset streptococcal new'orn disease include which of the following$ a. /ow maternal %24 count '. Prior low 'irth weight infant

c. =aternal G9, 'acteruria d. Post-term delivery

e. >etal macrosomia

144. * 24-year-old gravida 2 para 1 has a Pap smear performed on her 1st prenatal clinic visit at 10 weeks ges tation. The results return in 2 weeks as high grade s!uamous intraepithelial lesion indicating possi'le invasive cancer . %olposcopically directed 'iopsies return microinvasive s!uamous cell carcinoma "hat is the ne#t step in the management of this patient$ a. %old knife coni&ation of the cervi# '. Termination of the pregnancy followed 'y cold knife coni&ation c. Termination of the pregnancy followed 'y intra-fascial hysterectomy d. Termination of the pregnancy followed 'y e#tra-fascial hysterectomy e. *llow the pregnancy to go to termD followed 'y an e#tra-fascial hysterectomy ) weeks post partum. 140. -ow soon after initiating chemoprophyla#is for G9, is the primary 'enefit found$ a. J1 hour '. K1-2 hours c. K2-4 hours d. K4-) hours f. K)-12 hours 144. %ommon pathogens for amnionitis include all of the following 3E%3PTB a. 3 coli '. Fle'siella c. Group 9 streptococci d. /isteria monocytogenes e. 9acteriodes 145. "hich of the following is not associated with %horioamnionitis$ a. *'normal la'or '. 7ew'orn sepsis c. *'ruption d. >etal tachycardia e. @terine atony

14). "hich of the following occurs more fre!uently in multiple gestation when compared with singleton pregnan cies$ a. Pyelonephritis '. =aternal acidosis c. PlacentaA a'ruption d. >etal macrosomia e. %hronic hypertension 148. 2ivision of the 'lastocyst 'etween the 4-)th day is associated with what type of twinning$ a. 2iamnioticD dichorionic '. 2iamnioticD monochorionic c. =onoamnioticD dichorionic d. =onoamnioticD monochorionic e. %on:oined 150. The mean gestational age for delivery of triplets isB a. .) weeks '. .4 weeks c. .4 weeks d. .2 weeks e. .0 weeks 151. "hich of the following is not true concerning a'ortions in the @nited ,tates$ a. There are appro#imately 1.20 million a'ortions in the @nited ,tates yearly. '. "omen having a'ortion are predominately whiteD young and single. c. %atholics are less likely to have an a'ortion d. =ore that half of women seeking a'ortion was using contraception in the month of their pregnancy. e. +ne third have condom failure as source of their pregnancy. 152. %omplications of first trimester vacuum curettage include which of the following$ a. infection '. 3ctopic pregnancy c. 6ncomplete a'ortion d. *llergic reaction to medications e. *ll of the a'ove 15.. "hich of the following is not a part of the Post *'ortion Triad $ a. Pain '. vasovagal reaction c. 9leeding d. infection

174-179. Matching:
=atch the following procedures with the common complications. 154. 150. 154. 155. 15). 158. -igh dose +#ytocin ,aline termination -ysterotomy N -ysterectomy =ethotre#ate N =isoprostol =ifepristone N =isoprostol =isoprostol a. '. c. d. e. f. -ighest mor'idity and mortality. -igh success rate for first trimester termination. @sed in all trimesters for cervical ripening. -ighest success rate in first trimester a'ortions worldwide 6ncreased mor'idity from incomplete a'ortions and 26G. /ess effective with increased risk of water into#ication.

1)0. ,upport of level 6 and 66 includes all of the following structures e#ceptB a. *rcus tendineus attachment of the pu'ocervical fascia. '. @terosacral cardinale comple#. c. 2enonvilliers fascia and its attachments d. (ound ligament e. /evator ani

1)1. "hen -yskon is a'sor'ed systemicallyD which of the following is the least common complication$ a. -yponatremia '. Pulmonary 3dema c. 3ncephalopathy d. adult respiratory distress syndrome e. 2isseminated intravascular coagulation 1)2. >or the following P+PL values select the appropriate answer. *aMH1D 9aMH1D %M-4D *pMH2D *pMH2D G-M0D P9M4D TG/M8 a. ,tage 66 cystoceleD ,tage 6 uterine prolapseD ,tage 666 rectocele '. ,tage 66 cystoceleD ,tage 66 vault prolapseD ,tage 66 rectocele c. ,tage 66 cystoceleD ,tage 6 vault prolapseD ,tage 666 rectocele d. ,tage 666 cystoceleD ,tage 66 vault prolapseD ,tage 666 rectocele 1).. "hich of the following procedures gives 7+ apical support of the vagina$ a. ,acrospinous ligament fi#ation '. =c%all culdopasty c. Perineorrhaphy d. ,acrocolpope#y e. Paravaginal repair 1)4. The rectovaginal septum <2enonvilliers? attachments include all of the following e#cept a. The cul de sac '. Perineal 'ody c. The levator ani posterior to the arcus tendineus d. The sacrospinous ligament e. The uterosacral ligaments 1)0. "hich of the following statements are not true concerning an enterocele. a. *n enterocele has pelvic peritonium in direct contact with vaginal epithelium. '. 3nterocele e#ists when the pu'ocervical fascia andIor rectovaginal septum is not in continuity with the uterosacral ligament comple#. c. /igation of the enterocele sac will prevent enterocele. d. 6t is difficult to distinguish 'etween a high rectocele and an enterocele clinically 1)4. %osts are lower with which type of hysterectomy$ a. *'dominal hysterectomy '. /aparoscopically assisted c. ,upracervical hysterectomy d. Pelviscopic intrafascial hysterectomy e. Gaginal hysterectomy 1)5. Postoperative hemorrhage is most common with which operative procedure$
a. 3ndometrial *'lation

'. *'dominal -ysterectomy c. ,upracervical -ysterectomy d. /*Ge. Gaginal -ysterectomy 1)). *dvanced paternal age increases which of the following autosomal dominant disorders$ a. 7eurofi'romatosis '. *chondroplasia c. *pert syndrome d. =arfan syndrome e. *ll of the a'ove

1)8. *dvanced paternal age increases the risk of E-linked disorders in which of the following cases$ a. Transmission to affected male off-spring '. Transmission to affected female offspring. c. Transmission to his daughter <'ecomes a carrier? and then to an affected grandson < grandfather effect ? d. Transmission to his daughter <'ecomes a carrier? and then to an affected granddaughter < grand daughter effect ? e. 7one of the a'ove. 180. *ccording to the 7ational 6nstitutes of -ealth %onsensus Panel (ecommendationsD which of the following descri'es their recommendations concerning antenatal steroids in the presence of premature ruptured mem 'ranes <P(+=?$ a. antenatal steroids should 'e offered if less than .2-.4 weeks of pregnancy '. antenatal steroids should 'e offered if less than .0-.2 weeks of pregnancy c. the presence of chorioamnionitis is 7+T an a'solute contraindication for antenatal steroids with P(+= d. antenatal steroids are offered in this setting to decrease the incidence and severity of respiratory dis tress syndrome of the new'orn. 181. "hich of the following is a true statement concerning 'acterial vaginosis <9G? infections in pregnancy$ a. /arge clinical trials have failed to find an association 'etween 9G and preterm 'irth. '. +ral and topical metronida&ole therapies are e!ually effective for the treatment of 9G in pregnancy. c. *%+G currently recommends screening all pregnant patients for 9G. d. ,creening for 9G should only 'e considered in patients at risk for preterm 'irth. e. 9G has 'een identified as a causative factor for preterm 'irth. 182. "hat is the risk of hepatitis % transmission to the 'a'y of an infected pregnant woman$ a. There is no significant transmission risk '. 0-41 c. 10-141 d. 20-.11

e. 35-41%

18.. "hich statement is true concerning recommendations a'out 'reastfeeding and maternal hepatitis % infec tions$ a. 6nfected women can 'reastfeed their new'orn infants. '. There is a slightlyD 'ut statistically significant higher rate of transmission in 'reastfed infants com pared with 'ottle-fed infants of hepatitis % infected mothers. c. @nlike -6G infectionsD the viral load for hepatitis % plays no role in the risk of transmission. d. There are no studies concerning 'reastfeeding Gs 'ottle-feedingD and thus 'reastfeeding should 'e avoided until more is known. 184. "hat is the estimated percentage of 'reast and ovarian cancers that are attri'uta'le to the 9(%* 1 or 9(%* 2 mutation$ a. 0-51 '. 0-151 c. 20-251 d. 401 e. 001 180. -ow are the 9(%* mutations transmitted to offspring$ a. *utosomal dominant '. *utosomal recessive c. E-linked recessive d. E-linked dominant e. =ulti-factorial

184. "hat is the lifetime risk of a woman with the 9(%* 1 mutation developing 'reast cancer$ a. 201 '. 401 c. 401 d. )01

e. 100%

185. * .0-year-old woman presents with a family history of 'reast cancer in her maternal grandmother and mother who are 'oth deceased from their disease. -er ..-year-old sister was recently diagnosed with 'reast cancer. ,he re!uests 9(%* screening. "hich of the following statements is =+,T correct concerning 9(%* screening in this patient$ a. ,he is a candidate for screening immediatelyD 'ut only after genetic counseling and informed consent. '. ,he is a candidate for screeningD 'ut the affected sister should 'e screened firstD to determine whichD if any mutation is present in this family. c. This patient should 'e discouraged from screening 'ecause her insurance carrier would consider this a pree#isting condition if she tests positive and not cover future e#penses if she develops 'reast can cer. d. This patient should 'e discouraged from screening 'ecause therapeutic options for carriers have not 'een esta'lished. e. 9(%* screening has not yet 'een proven to 'e 'eneficial or cost-effectiveD and currently should not 'e offered to any patient. 18). "hat is the lifetime risk of a woman with the 9(%* 1 mutation developing ovarian cancer$ a. 201 '. 401

c. 65%

d. )01 e. 1001 188. "hich of the following conditions cannot 'e relia'le diagnosed 'y chorionic villus sampling$ a. >ragile E syndrome '. 2own syndrome c. Turner syndrome
d. %ystic fi'res is

e. ,ickle cell disease 200. "hich of the following statements is true concerning cystic fi'rosis <%>? carrier screening$ a. The 7ational 6nstitutes of -ealth "orkshop on Population ,creening for %> recommended screening all ethnic groups at risk for %> even without a family history. '. 6f one or 'oth of the parents screening test returns negativeD there is no risk of delivering a child with %>. c. ,creening can 'e offered to patients with a family history of %> d. The most common mutation associated with %> is the *>20) mutation. e. ,creening has not 'een proven relia'le and should not 'e offered to any patient at this time. 201. "hich of the following conditions is <are? associated with an increased risk for throm'osis. a. The antiphospholipid anti'ody syndrome </upus anticoagulant syndrome? '. >actor G /eiden mutation c. Protein % deficiency d. Protein , deficiency e. *ll are associated with an increased risk for throm'osis. 202. "hich of the following is the main 'enefit for o'taining the fetal fi'ronectin test$ a. 6t identifies asymptomatic patients who will e#perience a preterm 'irth. '. 6t identifies symptomatic patients at risk for preterm 'irth with high sensitivity and specificity. c. 6t can identify patients who will not deliver within the ne#t 2 weeksD even if they are symptomatic. d. 6dentifies which patients re!uire long-term oral or su'cutaneous tocolytic therapy. e. 7one of the a'ove statements are correct.

20.. >ragile E syndrome is an E-linked disorder and only males are affected. a. True '. >alse Luestions 204-206: 7early all cases of the fragile E syndrome involve e#pansion of a triplet repeat consisting of the 'ases cytosine-guanine-guanine on the E chromosome. The num'er of repeats determines the severity of the disease. 204. 9elow which num'er of triplet repeats will the individual 'e unaffected and not at risk for transmission to their off spring$ a. 20 '. 00

c. 100

d. 200 e. .00 200. "hat range of triplet repeats needs to 'e present for a woman to 'e considered to have a premutation <unaffectedD 'ut capa'le of transmission?$

a. 25-50 b. 50-200 c. 200-300 d. 300-400 e. 400-600

204. *'ove which num'er of triplet repeats will the individual 'e affected 'y the fragile E syndrome$ a. 20 '. 00

c. 100

d. 200 e. .00 205. "hich of the following radiation e#posures is the threshold for the increased risk for a'ortionsD congenital anomaliesD or growth restriction with #-ray or nuclear medicine studies$ a. 0 mrad '. 1 rad c. 0 rad d. 10 rad e. 10 rad 20). "hich of the following statements is correct a'out the use and safety of magnetic resonance imaging <=(6? in pregnancy$ a. The 7ational (adiological Protection 9oard advises against =(6 use in all pregnant women regard less of their gestational age even though there have 'een no adverse reports. '. *dverse fetal effects have 'een reported with =(6 use in pregnancy and should not 'e used. c. The adverse fetal effects are caused 'y the high ioni&ing radiation doses with =(6. d. =(6 has not 'een shown to cause fetal harmD and has 'een shown to 'e useful in diagnosing fetal central nervous system anomaliesD and 6@G(. e. The 7ational (adiological Protection 9oard states =(6 can 'e used in the first trimester 208. "hich nuclear medicine diagnostic study or treatment is contraindicated in pregnancy$ a. 6odine 1.1 for the treatment of Graves disease. '. 2iagnostic 6odine 12. in a patient with a thyroid nodule suspicious for thyroid cancer. c. Gentilation-perfusion scans for the diagnosis of pulmonary em'olism. d. Technetium Tc 88m for 'rainD 'oneD renalD or cardiovascular scans. e. *ll can 'e given in pregnancy without fetal conse!uences.

210. "hich of the following is a true statement concerning the *%+G committee opinion concerning home uter ine activity monitoring <-@*=?. a. -@*= may 'e usefulD 'ut only in patients with the highest risks for preterm 'irth. '. -@*= has never 'een shown to 'e a 'enefit in prolonging pregnancy or preventing preterm 'irthD and therefore cannot 'e recommended. c. *%+G does not recommend -@*= primarily 'ecause of the high cost. d. -@*= may 'e useful in patients with documented contractions that cannot 'e perceived 'y the patient. 211. "hich of the following patients may 'e considered for incidental appendectomy <when no pathology is seen? at the time of laparotomy or laparoscopy$ a. "omen 'etween 10-.0 years 'eing evaluated for right lower !uadrant pain. '. "omen with a previous history of %rohn disease. c. "omen with prior radiation therapy. d. "omen with the presence of vascular grafts. e. 6ncidental appendectomy should not 'e considered in any patient. 212. "hich of the following statements are true concerning *%+G;s committee opinion concerning la'or induc tion with misoprostol <%ytotec?. a. =isoprostol may 'e used with caution in patients with a history of cesarian sectionD if they !ualify as a candidate for G9*%. '. =isoprostol is less effective than Prostaglandin 32 preparations for cervical ripening. c. =isoprostol has proven to decrease the cesarean delivery rate. d. =isoprostol given 20mcg every . hours reduces the rate of uterine hyperstimulation compared with a 00 meg every 4 hour dosing schedule. e. The committee recommends the 20-mcg dose initially. 21.. "hich is an improper use of laparoscopically assisted vaginal hysterectomy </*G-?. a. /*G- may 'e used when vaginal hysterectomy would otherwise 'e impossi'le. '. /*G- may 'e used for lysis of adhesions c. /*G- may 'e used for the treatment of pelvic endometriosis. d. /*G- can 'e used when removal the ovaries are also desired. e. Physicians ine#perienced with vaginal hysterectomy can use /*G-. 214. * pregnant woman presents at term for induction of la'or with o#ytocin 'ecause of a history of a T-4 spinal cord transection and an ina'ility to perceive la'or. "hile on 10 muImin of o#ytocin she suddenly develops a severe headacheD sweatingD flushingD and nasal congestion. -er 9PD which was normal until now is markedly elevated. ,he is also found to have an irregular pulse of 40 'eats per minute and the fetal monitor shows new onset of late decelerations. "hat is the most likely diagnosis$ a. Preeclampsia with impending eclampsia '. -ypersensitivity reaction to o#ytocinD which is commonly seen in spinal cord in:ury patients. c. *utonomic dysrefle#ia d. @ndiagnosed pheochromocytoma e. 7one of the a'ove. 210. "hat is the most important aid to diagnosis premenstrual syndrome$ a. The initial history showing symptoms only in the second half of the menstrual cycle. '. 3valuation a daily symptom diary filled out prospectively 'y the patient. c. 9asal 'ody temperature charts d. 3ndometrial 'iopsy e. =enstrual cycle day 21 serum progesterone. 214. "hich of the following treatments has no proven efficacy for the treatment of premenstrual syndrome$ a. 3#ercise '. >luo#etine <Pro&ac? c. Progesterone d. ,pironolactone e. Gitamin 94

215. * 10-year-old patient presents for a routine e#amination. 2uring your history taking she e#hi'its signs and symptoms of depression. *fter some hesitationD she admits that she has recently thought of suicide. ,he asks you not to tell her parents a'out this. "hat is the most appropriate way to manage this case$ a. *ccept her wish and not tell her parentsD so your relationship with her will not 'e compromisedD 'ut 'egin antidepressant therapy. '. 2o not tell her parentsD 'ut make an appointment for her to see a child psychiatrist the following day. c. 6nsist that she tell her parents herself. d. 6nform her that this information cannot 'e kept secretD and inform her parents so that they can take steps to remove firearmsD medications and other potentially harmful o':ects from the home. e. +nly inform the parents if you feel she was really serious a'out committing suicide. 21). 6n a non-pregnant woman with a high risk factor for the development of dia'etes Ohistory of gestational 2=D o'esityD hypertensionD 1st degree relative with 2=D mem'er of a high-risk ethnic group <*frican-*mericanD -ispanicD 7ative *merican?PD how often should you o'tain a fasting glucose to screen for 2=$ Cearly a. 3very other year '. 3very . years c. 3very 0 years d. 3very 10 years 219-222: Matching: =atch the most common cause of death in women for each age group. 218. 220. 221. 222. *ge 1.-18 *ge 18-.8 *ge 40-44 *ges 40 and greater *. -eart 2isease 9. %ancer %. *ccidents 2. %er'rovascular accidents 3. 2ia'etes mellitus

22.. *fter how many consecutive ade!uate and normal Pap tests can reduced fre!uency of screening 'e offered in low-risk patients$ a. 2 '. . c.4 d. 0 e. +ne should never recommend reducing the fre!uency of Pap tests 224. "hat are the current recommendations for lung cancer screening in high-risk patients$ a. Cearly chest #-rays '. Cearly chest e#aminations <auscultation and percussion? c. Cearly sputum cytology screenings d. There are no effective screening methods to diagnosis lung cancer 220. "hat are the current recommendations for colorectal cancer screening and prevention$ a. /ow-fat diet '. Cearly digital rectal e#aminations after age 00. c. ,igmoidoscopy every .-0 years after age 00. d. Cearly stools for occult 'lood after age 00. e. *ll of the a'ove. 224. =ammography has 'een proven to reduce the death rate from 'reast cancer a'ove what age$ a. .0 '. 40 c. 00 d. 40 e. =ammography has never 'een shown to lower death rates in any age group.

225. "hich medication has 'een shown to reduce the rate of 'reast cancer in high-risk patients$ a. tomo#ifen '. Gn(- agonist therapy c. ralo#ifene d. medro#yprogesterone acetate e. 7one of the a'ove 22). "hich of the following statements is correct concerning *pgar scoresD perinatal asphy#iaD and cere'ral palsy$ a. /ow initial *pgar scores <1 and 0 minutes? increase the risk for cere'ral palsy and this proves perina tal asphy#ia was the cause. '. /ow *pgar scores are usually caused 'y perinatal asphy#ia. c. The *pgar score was developed as a method to !uickly evaluate the clinical status of the new'orn. d. %ere'ral palsy has never 'een linked with perinatal asphy#ia. e. /ow *pgar scores <0-.? even after 20 minutes does not increase the risk of poor future neurological development. 228. "hat level 'est defines clinically significant acidemia from an um'ilical artery p- assessment$ a. J5.20 '. J5.20

c. <7.15
d. J5.10 e. J5.00

2.0. 7ormal um'ilical artery p- values e#clude intrapartum hypo#emia as a pro#imate cause of neonatal depression. a. True '. >alse 2.1. "hat is the vertical transmission rate of human immunodeficiency virus <-6G? from mother to fetus without &idovudine prophyla#is$ a. 0-)1 '. 201 c. 401 d. 401

e. 90%

2.2. "hat is the rate of vertical transmission of human immunodeficiency virus <-6G? from mother to fetus with &idovudine prophyla#is$ a. 1-.1 '. 0-)1 c. 201 d. 401 e. 401 2... "hich of the following findings would mandate in-patient intravenous anti'iotic treatment for suspected pelvic inflammatory disease. a. =ultiparous patient '. (e'ound tenderness in the lower a'domen c. *llergy to penicillins d. Presence of an 6@2 e. The presence of cervical motion tenderness 2.4. "hich of the following presents with a painful lesion of the vulva$ a. %hancroid '. ,yphilis c. %ondyloma accuminata d. /ymphogranuloma Genereum e. Granuloma 6nguinalA

2.0. "hat is the preferred and most cost-effective treatment for Gonococcal cervicitis$ a. %eftria#one 120mg 6= times one '. %efi#ime 400mg P+ times one c. %iproflo#acin ,++mg P+ times one d. +flo#acin 400mg times one. e. *ll of the a'ove are e!ually preferred and cost effective. 2.4. "hich of the following medications is 7+T effective for the treatment for %hlamydia cervicitis$ a. 2o#ycycline 100mg P+ twice a day for 5 days '. *&ithromycin 1gm P+ times one c. 3rythromycin ,++mg P+ 4 times a day d. +flo#acin ,++mg P+ twice a day for 5 days e. *ll of the a'ove are effective treatments. 2.5. "hich of the following is 7+T effective for the treatment of recurrent genital herpes simple# virus infections of the vulva$ a. +ral acyclovir '. +ral famcoclovir c. +ral famciclovir d. Topical acyclovir e. *ll of the a'ove are effective treatments. 2.). * non-pregnant patient presents with a palmar rashD which you suspect represents syphilis. Cou successful ly treated her for syphilis . years earlier. "hich of the following findings would confirm your suspicion$ a. Positive rapid plasma reagin <(P(? '. (ising !uantitative G2(/ liters c. Positive >T*-*9, d. Positive =-*-TP e. *ll of the a'ove findings indicate a repeat infection 2.8. -ow is microinvasive carcinoma of the vulva defined$ a. 2epth of invasion J 1mm '. 2epth of invasion J .mm c. 2epth of invasion J 0mm d. The lesion is J 2cm in diameter e. There is no microinvasive category for cancer of the vulva. Luestions 240-241B * 0.-year-old woman has a .cm lesion of the right vulva. 6t is located in the mid-la'ia ma:oraD 4cm from the clitoris. The 'iopsy returns invasive s!uamous cell carcinoma. There are no palpa'le inguinal nodes. 240. "hat is the stage of this cancer$ a. -er stage cannot 'e determined since vulvar cancer is surgically staged. '. ,tage 6. c. ,tage 66. d. ,tage 666. e. ,tage 6G. 241. "hat is the preferred treatment for this lesion$ a. (adical vulvectomy and 'ilateral superficial and deep inguinal node dissection. '. (adical local e#cisionD with no inguinal node dissection. c. (adical local e#cision with 'ilateral inguinal node dissection. d. (adical local e#cision with ipsilateral inguinal node dissection. e. -emi-vulvectomy with ipsilateral inguinal node dissection.

242. *n e#ploratory laparotomy is performed for suspected ovarian cancer. *scitic fluid is sent for cytologyD a total a'dominal hysterectomyD 'ilateral salpingoophorectomyD omentectomyD retroperitoneal lymph node sam plingD and removal of a 1cm nodule from the surface of the liver. *ll specimens return positive for serous cystadenocarcinoma of the ovary. "hat is the stage of her disease$ a. 6G*. '. 6G9. c. 6=* d. 1=9. e. 6=%. 24.. "hich is 7+T a risk factor for endometrial cancer$ a. Tamo#ifen '. ,moking c. 3arly menarche d. 7ulliparity e. 3strogen replacement therapy Luestions 244-240. >ollowing a staging laparotomy the following pathology results are o'tained. Peritoneal washings M negativeQ cervi# M no evidence of malignancy Q uterine corpus M adenocarcinoma grade 6 invading over half the myometriumD no serosal involvementD ovaries M no evidence of malignancyQ pelvic and paraaortic lymph node sampling M no evidence of malignancy. 244. "hat is the stage of her disease$ a. 6*G1 '. 69 G1 c. 1% G1 d. 66*G1 e. 669 G2 240. "hat is the ne#t step in the management of this patient$ a. 7o further treatment is re!uired. '. 3#ternal radiation therapy c. ,ingle agent chemotherapy d. =ulti-agent chemotherapy e. Tamo#ifen Luestions 244-245. * patient has a cold-knife coni&ation pathology specimen return invasive s!uamous cell carcinoma. *n e#amination under anesthesia is negative for parametrial involvement. There is no evidence of spread to the vagina. %ystoscopy and protoscopy are negative. The intravenous pyelogram is normal. ,he is staged as a ,tage 69 cervical carcinoma. The patient elects for radical surgery. -oweverD at surgeryD a suspicious paraaortic node is palpated prior to performing the radical hysterectomy. * fro&en section confirms the node to 'e positive for s!uamous cell carcinoma. 244. -ow should this case 'e managed$ a. (adical hysterectomyD pelvic and paraaortic node dissection. '. (adical hysterectomyD pelvic and paraaortic node dissectionD with post-operative radiation therapy. c. %ancel the planned surgery and perform e#ternal 'eam radiation therapy. d. %ancel the planned surgery and perform intracavitary 'rachytherapy plus e#ternal 'eam radiation therapy. e. ,imple hysterectomy followed 'y e#ternal 'eam radiation therapy. 245. "hat is the correct stage of her disease$ a. 69. '. =6*. c. 6669. d. 6G*. e. 6G9.

Luestions 24)-200. Matching: =atch the chemotherapeutic agent with its common adverse effect. 24). Tamo#ifen <7olvade#? 248. Paclita#el <Ta#ol? 200. =ethotre#ate 201. 9leomycin <9leno#ane? 202. Gincristine <+ncovin? 20.. %is-dichlorodiammine <%isplatin? 204. %yclophosphamide <%yto#an? 200. 2o#oru'icin <*driamycin? a. Peripheral neuropathy '. mucosal ulceration c. %ystitis d. %ardiac to#icity e. renal to#icity f. pulmonary fi'rosis g. retinopathy h. hypersensitivity reactions

204. *ll of the following conditions are associated with a heavy vaginal discharge containing numerous "9%;s e#ceptB a. %andidiasis '. 2es!uamative Gaginitis c. *trophic Gaginitis d. >oreign 'ody vaginitis e. Trichomoniasis 205. *ll of the following organisms may 'e found with 'acterial Gaginosis e#ceptB a. =o'iluncus species '. /isteria monocytogenes c. 9acteroides species d. Peptococcus e. peptostreptococcus 20). ,e# partners of females affected 'y which of the following conditions should 'e treated B a. 9acterial Gaginosis '. Gaginitis emphysematosa c. %andidiasis d. Trichomoniasis e. >oreign 'ody Gaginitis 208. "hich of the following vaginal entities increases the incidence of vaginal and cervical dysplasiaB a. 3pithelial polyps '. /eiomyoma c. Gartner;s duct cyst d. 3ndometriosis e. Gaginal adenosis 240. The least common symptom associated with su'urethral diverticulum isB a. 2ysuria '. @rinary fre!uency c. @rinary urgency d. 2yspareunia e. Post-mictural dri''ling 241. "hich of the following disease entities may 'e associated with des!uamative vaginitisB a. /ichen sclerosus '. %rohn;s disease c. 9ehcet;s syndrome d /ichen planus e. /ichen simple# chronicus 242. "hich of the following conditions affects the apocrine glands of the vulva$ a. Psoriasis '. 3rythrasma c. >o#->ordyce disease d. ,e'orrheic dermatitis e. /ichen planus

24.. %rohn;s disease of the vulva may 'e helped 'y which of the following medications$ a. 3rythromycin '. =etronida&ole c. %lindamycin d. *ugmentin e. 2o#ycycline 244. "hich of the following disease entities may cause oral and vulvar ulcerations and inflammatory vasculitis of the eye$ a. -ailey--ailey disease '. Pemphigus vulgaris c. 9ehcet;s disease d. 2arier disease e. Tu'erculosis 240. "hich of the following vulvar lesions may 'e confused with adenocarcinomaB a. ,yringoma '. 3ctopic 'reast tissue c. 3ndometriosis d. 7eurofi'roma e. -idradenoma 244. "hich of the following is not an indication for pelvic ultrasound$ a. 3valuation of uterine anomalies '. To determine who re!uires an endometrial 'iopsy in a post-menopausal patient with 'leeding sus pected of having endometrial atrophy. c. Guidance for interventional procedure d. /ocation of 6@2 245. * hemorrhagic cyst can persist for as long as si# monthsB a. True '. >alse 24). "hich of the following is seen with ultrasound imaging in the presence of ovarian torsion$ a. The ovary is normal si&ed '. %olor 2oppler shows increased flow c. The right ovary is more commonly involved d. * pre-e#isting mass is more often malignant 248. * 44 year old female presents in 7ovem'er for a general check-upD lacking any known immuni&ations and otherwise healthy. ,he should 'e offered which of the following$ a. >lu vaccine '. Pneumova# c. Td to#oid d. -epatitis * vaccine e. %hoices *D 9D and % 250. -epatitis 9 vaccine is indicated for which of the following conditionsB a. -epatitis % patients '. Partners of those with -epatitis 9 c. 3nd stage (enal 2isease patients d. -ealthcare workers e. *ll of the a'ove 251. 2uring fetal lifeD serum concentrations of >,- and /- reach adult levels at mid-gestation. a. True '. >alse

252. 9y mid-to-late pu'erty the maturations of the positive feed'ack relationship 'etween estradiol and >,- is esta'lished. a. True '. >alse 25.. ,e#ual precocity is associated with premature menopause and adult short stature. a. True '. >alse 254. The most common form of se#ual precocity in females is idiopathic. a. True '. >alse 250. Gn(- agonist treatment is effective for =c%une-*l'right syndrome or noncentral forms of precocious pu'erty. a. True '. >alse 254. The highest incidence of ectopic pregnancies occurs in women agedB a. 1 0 - 1 8 '. 20 - 24 c. 20 - 28 d. .0 - .4 e. .0 and older 255. *ll of the following are contraindications to medical treatment of ectopic pregnancy with methotre#ate e#ceptB a. (enal 2isease '. 6mmunodeiciency c. 3ctopic mass of . cm d. -epatic 2isease e. 9reast feeding 25). (ecurrent ectopic pregnancy rates are highest for which of the following surgical managements of ectopic pregnancyB a. >im'rial 3vacuation '. ,alpingostomy c. ,alpingectomy d. @nilateral ,alpingoophorectomy e. ,egmental (esection of >allopian Tu'e 258. "hich of the following statements is 7+T true with regards to ovarian cancerB a. +varian cancer is the most common malignancy affecting women worldwide. '. The ma:ority of ovarian cancer patients are postmenopausal. c. +varian cancer cause more deaths than any other malignancy affecting the female pelvis. d. .01 of ovarian masses in postmenopausal women are malignant. 2)0. "hich of the following factorsD when presentD does 7+T increase a woman;s risk of developing ovarian cancer. a. low parity '. %aucasian race c. * family history of ovarian cancer d. %hronically elevated gonadotropins e. (are or infre!uent ovulation <oligo-ovulation? 2)1. The ma:ority of ovarian cancer patients have pathology consistent withB a. =ucinous tumors '. ,erous tumors c. 3ndometriod tumors d. %lear cell tumors e. 9renner tumors

2)2. "hen a proper staging laparotomy is performed for a patient with ovarian cancerD the most likely site where metastatic disease will 'e found isB a. 2iaphragm '. +mentum c. Para-aortic lymph nodes d. +'turator lymph nodes e. %ommon iliac lymph nodes 2).. "ith proper surgical stagingD appro#imately .01 to 401 of apparent ,tage 6 cases will 'e upstaged to a higher stage. a. Rure '. >alse 2)4. Gestational tropho'lastic neoplasia includes a spectrum of tropho'lastic diseasesD including all e#ceptB a. -ydatidiform '. 6nvasive mole c. 3ndodermal sinus tumor d. %horiocarcinoma 2)0. (isk factors for hydatidiform mole include all e#ceptB a. 7utritional deficiency of animal fat or fat solu'le vitamin carotene '. -istory of prior spontaneous a'ortions c. Professional occupation d. *ge 'etween 20 and .0 e. -istory of previous molar pregnancy 2)4. "hich of the following statements is incorrect with regard to the management of hydatiform mole$ a. ,uction curettage is the management method of choice '. %hemotherapy should 'e started immediately if the h%G rises or plateaus or if matastatic disease is detected at any time. c. -ysterectomy is never an option in the primary management of hydatiform mole. d. *fter a moderate amount of tissue is removedD a Pitocin drip should 'e started. e. %hest #-rays should 'e taken initiallyD 'ut should only 'e repeated if the h%G titer plateaus or rises. 2)5. 6n order to make a diagnosis of hydratiform mole or gestational tropho'lastic neoplasiaD it si always manda tory to perform a 'iopsy. a. True '. >alse 2)). * new'orn after .5 complete weeks may 'eB a. small for gestational age <,G*? '. *de!uate for gestational age <*G*? c. Growth restricted d. *ll of the a'ove 2)8. %auses of growth restriction may 'eB a. 6nfection '. Genetics c. 7utritional d. 7one of the a'ove e. *ll of the a'ove 280. "hich of the following is an environmental to#in$ a. =aternal dia'etes '. +ligohydramnios c. ,moking d. 7one of the a'ove

281. *ntepartum fetal assessments for growth retardation includeB a. 9iophysical profile '. 3striol <@rinary? c. T,- levels d. >etal fi'ronectin studies 282. 6ntrauterine restricted growth can produce what pro'lem or pro'lems in the new'orn$ a. 7eonatal asphasia '. -ypolglycemia c. >uture learning defects d. *ll of the a'ove e. 7one of the a'ove 28.. The prere!uisite<s? for a forceps delivery is <are?B a. +perative skill '. Presenting part engaged c. %ervi# completely dilated d. *ll are correct 284. "hat factor increases mor'idity when delivery is accomplished with forceps$ a. =aternal "eight '. *'normal position c. >etal cardiac a'normalities d. Trisomy 21 fetus 280. 9ird;s ,afety (ules for Gacuum delivery of a fetus include<s?B a. %up must not 'e applied more than twice '. -eadD not :ust the scalpD must advance c. The head should 'e delivered within 10 minutes d. 7one of the a'ove e. *ll of the a'ove 284. * fetal complication that may cause death from a vacuum delivery isB a. ,calp laceration '. %on:unctivaA hemorrhage c. ,u'galeal -ematoma d. Poor maternal cooperation 285. * 22 year old se#ually active women presents to you for routine gynecologic care. ,he has no physical complaints and her last P*P smear was 2 years ago. ,he has had one se#ual partner over the past 2 years and currently is on oral contraceptives. ,he reports infre!uent use of condoms. ,he has no past history of a'normal P*P smears. "hich of the following is appropriate management of this patient$ a. (outine pelvic e#amination with P*P smear. '. (outine pelvic e#amination alone. c. (outine pelvic e#aminationD P*P smearD and test for gonorrhea d. (outine pelvic e#aminationD P*P smearD test for gonorrhea and %hlamydia e. ,chedule colposcopy 28). "hich of the following is not recommended for the treatment of gonorrhea %ervicitis$ a. Penicillin GD a!ueous procaine 4.) million units '. %eftria#one 120 rng 6= # 1 c. %efi#ime 400 mg P+ # 1 d. %iproflo#acin 000 mg P+ # 1 e. +flo#acin 400 mg P+ # 1

288. "hich of the following statements a'out pelvic inflammatory disease <P62? is not true$ a. ,uita'le outpatient treatment of P62 is ceftria#one 200 mg 6= and do#ycycline 100 mp P+ '.i.d. for 14 day '. The incidence of infertility after P62 is appro#imately 21 c. Gonorrhea and %hlamydia account for more than 001 of cases d. Precise diagnosis of P62 is difficult and is most accurately made 'y invasive tests. e. 6n developing countriesD tu'erculosis is a common cause of P62 .00. "hich of the following statements concerning genital ulcer disease is true$ a. -erpes simple# virus <-,G? is the most common cause of genital ulcers in developing countries '. The incidence of syphilis in the @, is increasing over the past 0 years. c. * reasona'le initial work up for a patient who presents with a genital ulcer in the @nited ,tates is swa''ing the lesion for darkfield e#amination and -,G culture d. /ymphogranuloma vemereum is caused 'y -emophilus ducreyi e. 2onovan 'odies are found in lymph nodes 'iopsies from patients with chancroid. .01. (easona'le empiric treatment of postoperative gynecologic infection is all 'ut one of the followingB a. %efo#itin '. %lindamycinIgentamicin c. *mpicillinIgentamicin d. TicarcillinIclavulanic acid <Timentin? e. %iproflo#acin .02. The most common cause of ha'itual a'ortion isB a. Genetic '. 6diopathic c. *natomical d. 6nfectious .0.. 6nade!uate luteal phase can 'e diagnosed 'yB a. 3ndometrial dating '. /uteal phase less than 11 days c. =id luteal phase serum progesterone of less than 0 =ganIml d. *ll of the a'ove .04. 6f one partner has a 'alanced translocationD the chance of a successful pregnancy isB a. 01 '. 201 c. 001 d.?1 .00. The mor'idity and mortality risk is the same regardless of the 9=6 value. a. True '. >alse .04. +'esity associated-risk is the same for men as for women. a. True '. >alse .05. Patients with 9=6 of 20 or greater should 'e considered candidates for drug therapy. a. True '. >alse .0). The composition of the diet is more important than calories for the treatment of o'esity. a. True '. >alse

.08. The most successful approach for the treatment of o'esity includes dietD e#erciseD and 'ehavior modifica tion. a. True '. >alse .10. The rate of Group 9 streptococcal coloni&ation of the new'orn effectively falls how soon after administration of ampicillin$ a. J 1 hour '. J 2 hours c. J 4 hours d. J ) hours e. ) hours .11. "hich of the following tests on amniotic fluid are consistent with intra-amniotic infection$ a. Gram stain showing "9%s '. Glucose M .0 mgIdl c. /2- M 180 d. Gram stain showing 'acteria e. *lkaline phosphatase M .0 .12. "hich of the following are true concerning single dose gentamicin$ a. 6nfuse in 10 - 10 minutes '. =ay 'e used with reduced renal function c. (e!uires peak and trough levels d. *dminister at 0 - 5 mgIkg every 24 hours e. =ore to#ic than standard therapy .1.. "hich of the following is the most likely complication of multifetal gestation$ a. *'ruption

'. Growth restriction

c. @terine atony d. Preterm delivery e. Pre-eclampsia

.14. =ono&ygote twins that divide at . days post conception are most likelyB a. 2iamnioticD dichorionic '. 2iamnioticD monochorionic c. =onoamnioticD dichorionic d. =onoamnioticD monochorionic e. %on:oined .10. ,pontaneous triplets occur how often$ a. 1 in 100 '. 1 in 1000 c. 1 in )000 d. 1 in 10000 e. 1 in 20000 .14. * 2) year old P+ 100 presents to your office at 11 weeks gestation for a first prenatal visit. -er last preg nancy ended in an intrauterine fetal demise after an a'ruption. ,he re!uired 4 units of packed (9%s 20 unites of cryoprecipitateD 4 units of plateletsD and 2 units of fresh fro&en plasma during the delivery. The patient;s 'lood type is + negative. -er -ematocrit on today;s visit is .81. The patient is considering a termination of pregnan cyD as she does not want to have a similar e#perience in this pregnancy. ,he in!uires a'out her risk of a recur rence of a'ruption in this pregnancy. Cou inform her that her risk of recurrent a'ruption in this pregnancy isB a. 21 '. 51

c. 17% d. 201
e. 001

.15. The patient decides to continue the pregnancy. *t 24 weeks she presents to /a'or and 2elivery complain ing of vaginal 'leeding for the past 2 hoursD decreased fetal movementD and cramping. * transvaginal ultra sound report descri'es a placenta completely covering the internal cervical osD with a hyperchoic fluid collection 'etween the placental edge and the choriamniotic mem'ranes. 3lectronic fetal monitoring shows contractions every 0 minutes with a 'ackground of uterine irrita'ilityD and a fetal heart rate 'aseline of 100 'pmD without decelerations. -ematocrit today is 241. >i'rinogen level is 420 mgIdl. Platelet count is 18)D000Iml. The cor rect diagnosis isB a. Total placenta previa '. Total placenta previa with su'chorionic a'ruption c. Partial placenta previa d. Partial placenta previa with su'chorionic a'ruption e. Total palcenta previa with preplacental a'ruption .1). *fter discussion of treatment options with the patientD you decide to attempt conservative management to prolong the pregnancy. "hich of the following measures is least likely to contri'ute to a good maternal and fetal outcome$ a. Transfusion of 2 units of packed (9%s '. Fleihauer-9etke test c. 6ntravenous magnesium sulfate d. 6ntramuscular 'etamethasone e. ,u'cutaneous ter'utaline .18. *fter 24 hours of treatmentD the patient;s vaginal 'leeding su'sides. *fter a period of o'servation in the hospitalD she is discharged to her home on 'edrest and pelvic rest. ,he e#periences no further episodes of 'leeding during her pregnancy. *t .4 weeksD she undergoes a transvaginal ultrasound that descri'es a placenta completely covering the cervical os. The most appropriate management at this point isB a. 6mmediate cesarean delivery '. 2ou'le setup e#amination to determine appropriateness for trial of la'or c. ,chedule patient for cesarean delivery in 1 week d. *mniocentesis for fetal lung maturity and cesarean delivery if indices are mature. e. %orticosteroids and cesarean delivery 4) hours later. .20. * 22 year old Para + well-known to your staff as a cocaine a'user presents to la'or and delivery at 28 weeks with complications of the sudden onset of contractions and a'dominal pain. =aternal vital signs show a pulse of 124D 'lood pressure of 1.0I)2D respiratory rate of 20. 3lectronic fetal monitoring shows contractions occurring every minuteD lasting .0 seconds. The nurse reports increased uterine tone 'etween contractions. The fetal heart rate is 140 with occasional varia'le decelerations. @ltrasound findings show a fundal placenta with no a'normalitiesD and appropriately-grown fetus with normal amniotic fluid inde#. Cou suspect a'ruption as the cause of this patient;s condition. This would 'e classified asB a. Grade 1 a'ruption '. Grade 2 a'ruption c. Grade . a'ruption d. 7o a'ruption at allD there is no vaginal 'leeding or ultrasound signs of a'ruption .21. 6nitial la' work is drawn and sent. * red-topped tu'e is drawn and o'served for clot formation. * clot forms after 4 minutes of o'servation. Cou immediately cancel the order for the fi'rinogen level as you know the pro'a'le fi'rinogen level is closest toB a. 400 mgIdl '. .00 mgIdl c. 200 mgIdl d. 100 mgIdl e. @na'le to determineD as the test was not performed correctly .22. The initial la's show a -%T of 221D a fi'rinogen of 120 mgIdlD platelet count of 102D000ImlD and a normal PTIPTT. The most appropriate initial 'lood component therapy should includeB a. 2 units P(9%D 2 units fresh fro&en plasmaD 10 units platelets '. 4 units P(9%D 4 units cryoprecipitate c. 4 units P(9%D 4 units fresh fro&en plasmaD 4 units platelets d. 2 units P(9%D 4 units cryoprecipitate e. 7o 'lood component therapy is necessaryD as the patient is normotensive and not actively 'leeding

.2.. Polycystic ovary syndrome patients may 'e treated using the following medications 3E%3PTB a. +%( '. ,pironolactone c. =etformin d. /ipitor .24. %hronic anovulation may 'e caused 'y the following conditionsB a. -yperprotactinemia '. Thyroid disease c. ,tress d. -yperinsuline e. *ll of the a'ove .20. %linical conse!uences of polycystic ovary syndrome includes which of the followingB a. 6nfertility '. 2ia'etes =ellitus c. 3ndometrial %ancer d. -irsutism e. *ll of the a'ove .24. *ll of the following is true regarding Thalassemias 3E%3PTB a. 6nvolves !uantitative pro'lem with hemoglo'in chain production. '. 6ncreased risk in +riental and *frican populations c. 6n utero compromise never develops d. Prenatal testing is availa'le .25. "ith ,ickle %ell trait all of the following should 'e considered in the management of pregnant women 3E%3PTB a. 6ncreased perinatal mortality '. 6ncreased risk of pyelonephritis c. monthly urine cultures d. Paternal sickle cell testing .2). ,ickle cell disease in pregnancy is associated with all of the following 3E%3PTB a. 6ncreased still'irths '. 6ncreased pregnancy induced pre eclampsia c. 6ncreased pyeloneshritis d. 2ecreased osteomyelitis .28. * person with normochromic microcytic anemia with normal iron indicesD an increase in -g' *2 would 'e suggestive of which disorderB a. ,ickle cell disease '. 9eta thalasseima c. *lpha thalasseima d. ,ickle %ell trait ..0. ,ickle cell anemia is associated with which mutationB a. %hange value for glutamic acid at postion S4 on 'eta chain. '. %hange lysne for value at position S20 on alpha chain c. %hange value for glutamic acid at position S12 on alpha chain d. 7one of the a'ove ..1. 7ormal physiologic changes in pregnancy include all 3E%3PTB a. 3levation of diaphragm '. =ild compensated respiratory alkalosis c. 6ncreased respiratory rate d. 2ecreased total lung capacity

..2. *ll of the following are worrisome signs in a pregnant asthmatic 3E%3PTB a. Prior hospital admissions '. Prior intu'ations c. ,teroid dependency d. 6ntermittent use of 42 antagonist inhalers .... Garicella pneumonia in pregnancy is characteri&ed 'y all of the following 3E%3PTB a. %omplicates 0.51 all pregnancies with varicella '. 6ncreased mortality rate if pregnant c. Pulmonary symptoms 2-. days after peak of rash d. ,low progression to pulmonary compromise ..4. Plasma volume increases 'y what percent in pregnancy$ a. 101 '. .01 c. 001 d. 501 ..0. (ed 'lood cell mass increases 'y what percent in pregnancy$ a. 101 '. .01

c. 50%
d. 501

..4. The ma:ority of plasma volumeIcardiac output increases occur 'y what time in pregnancy$ a. =id first trimester '. =id second trimester c. =id third trimester d. /a'or ..5. "hich of the following medications is considered safe in pregnancy for the treatment of epilepsy$ a. 2ilantin '. Tegretol c. Galproic acid d. Pheno'ar'ital e. 3ach drug has associated increased risk ..). The 'est treatment of %horioamnionitis in a pregnant patient with myasthenia gravis isB a. *mpicillin '. *mpicillin and Gentamycin c. Gentamycin and %leocin d. @nasyn ..8. "hich antiepileptic agent does not stimulate the cytochrome P400 en&yme system$ a. 2ilantin '. Galproic acid c. Pheno'ar'ital d. Primidone .40. 9reast-feeding is contraindicated in patients on antiepileptic drugs. a. True '. >alse .41. 9reast-feeding is contraindicated in patients with =yasthenia Gravis. a. True '. >alse .42. %ranial %T scans are contraindicated in pregnancy. a. True '. >alse

.4.. *n otherwise healthy .0 year old woman is undergoing an intravenous pyelogram. The risk of mortality isB a. 1 in 1000 '. 1 in 10D000 c. 1 in 100D000 d. 1 in 1 million e. 7one in patients with no known drug allergies .44. "hich of the following antihypertensive medications should 'e discontinued 'efore surgery$ a. %lonidine '. 9eta 9lockers c. 2iuretics d. %alcium channel 'lockers e. =*+ inhi'itors .40. 6n a patient with chronic o'structive pulmonary disease which of the following tests should 'e o'tained preoperatively$ a. Genous Po2 '. (esidual capacity c. >orced e#piratory volume at one second d. %ardiac echocardiogram e. >unctional reserved capacity .44. The most likely sign of pulmonary em'oli isB a. %rackles '. Tachacardia c. Tachypnea d. %hest pain e. *gitation .45. "ound dehiscence is associated with B a. *n incision through a previous scar '. * %hemey incision c. %losure with synthetic a'sor'a'le suture d. 6nternal 'leeding e. *ir-fluid levels on a'dominal #-ray prior to dehiscence .4). Pressure from a retractor on the psoas muscle can damage the nerve coursing on the anterior surface of this muscle with resultant anesthesia on the medial thigh and lateral la'ia ma:ora. "hat is the nerve affected$ a. 6lioninguinal '. +'turator c. ,ympathetic %hain d. Genitofemoral e. >emoral .48. /ymphatic drainage from the lower vagina will track initially to which nodes$ a. ,uperficial inguinal '. /um'ar <paraortic? c. 6nternal iliac d. 3#ternal iliac e. 7one of the a'ove .00. 6n performing a laparotomy for a'dominal e#plorationD why would you not want to make a paramedian verti cal incision immediately lateral to the rectus a'dominus muscle$ a. %ould damage inferior epigastric artery entering the rectus sheath '. %ould damage the ilioinguinal nerve c. %ould damage segmental nerve supply to the rectus a'dominus muscle d. *ll of the a'ove e. * and % only

.01. +f the following structuresD which is most anterior as it crosses the posterior aspect of the pelvic 'rim$ a. %ommon iliac artery '. %ommon iliac vein c. @reter d. ,ympathetic chain ganglia e. (ound ligament of the ovary Luestions .02 T .04 =atching T =atch the following sonographic findings with the ovarian tumor with which they are commonly associatedB .02. ,mooth wallD no internal echoes .0.. >i'rin strands in a mostly cystic structure .04. Papillary e#cresences .00. Ground glass appearance .04. %alcifications a. 3ndometrioma '. -emorrhagic cyst c. =alignant neoplasm d. %ystic teratoma e. Physiologic cyst

.05. "hich of the following is not a type of epithelial ovarian tumor$ a. 9renner cell '. =ucinous c. ,erous d. >i'roma e. %lear cell f. 3ndometriod Luestions .0) T .42 =atching T =atch the following ovarian lesions with the most appropriate therapy. .0). 9renner %ell Tumor .08. Premenopausal 4 cm cystic mass .40. Postmenopausal 4 cm cystic mass .42. %ystic teratoma in adolescent a. 3#pectant with @I, follow-up '. +varian cystectomy c. +ophorectomy

40