CC SILVA - RATIONALIZATION
2022
# Question
1 The clitoris is:
A. Lined with columnar epithelium
B. The homologue of the scrotum
C. Contained in the vestibule
D. Bounded on each side by the
Skene’s duct
2 The vagina is:
A. Lined with cornified stratified
squamous epithelium
B. Supplied with blood at its lower
third by the cervicovaginal
branch of the uterine artery
C. The anlage of the corpus
spongiosum is the penis
D. Devoid of glands
3 The typical 28th day menstrual cycle
begins on the ____ day of menstrual
bleeding:
A. First
B. Second
C. Third
D. Fourth
4 Layer of the endometrium that is shed
during menses:
A. Basale
B. Spongiosum
C. Compactum
OBSTETRICS & GYNECOLOGY
Rationale
Answer: C. Contained in the vestibule
Rationale:
● It is located within the vestibule
● A. is false because the clitoris is lined by strat. Squamous epithelium
● B. is false because the clitoris is the homologue of the penis
● D. is false because it is the URETHRAL MEATUS that is bilaterally
bounded by the 2 skene’s duct opening
Source: William’s Obstetrics 25th ed.
Answer: D. Devoid of glands
Rationale:
● The vagina is devoid of glands. The “secretions” are direct
extravasations from blood supply during arousal.
● A. is false because the lining is nonkeratinized
● B. is false because the lower third is supplied by the internal pudendal
artery
● C. Corpus spongiosum is to penis as Vestibular bulb is to clitoris
Source: William’s Obstetrics 25th ed.
Answer: A. First
Rationale:
Answer: B Spongiosum
Rationale:
● The endometrium has three layers: stratum compactum, stratum
spongiosum (which make up the stratum functionalis) and stratum
basalis.
 D. Myometrium
5 The hormone produced in pregnancy
1000-fold compared with nonpregnancy
is:
A. Estradiol
B. Progesterone
C. Cortisol
D. Estriol
6 Which of the following findings would be
unexpected in the progression of a
normal pregnancy?
A. Real-time UTZ evidence of fetal
heart motion 4 weeks after the
last menstrual period
B. Presence of Braxton-hicks
contraction at 30 weeks
C. Fetal heart tones at 13 weeks
detected by doppler utz
D. The fundus of the uterus at the
level of the umbilicus at 20
weeks
7 Prolonged pregnancy can cause the
progressive delivery of nutrition to the
fetus and cause macrosomia. The most
feared fetal trauma associated with
macrosomia
A. Shoulder dystocia
B. Caput succedaneum
C. Cephalhematoma
D. Pneumothorax
8 The so-called ‘anemia of pregnancy’ has
been attributed to
A. Red cell mass expansion
B. Plasma volume expansion
C. Decreased erythropoietin
production
D. Decreased red cell destruction
9 Which of the following statements
concerning the function of progesterone
is incorrect?
A. It prepares the endometrium for
nidation
B. It relaxes the myometrium
C. It elevates the serum binding
proteins
D. It has natriuretic functions
10 Which of the following would you
recommend to a 30 yr old G1P1 (1-0-0-1)
overt diabetic who desires contraception
● The stratum functionalis is a thick superficial layer that is sloughed off
during menstruation and grows anew during each cycle. It is therefore
a temporary tissue with an "unfinished" appearance -- not quite as tidily
organized as the mucosal tissues in most other organs.
Answer: A. Estradiol
Rationale:
● Three Types of Estrogen Produced
○ 1. Estrone – menopausal state
○ 2. Estriol – pregnancy state
○ 3. Estradiol – nonpregnant reproductive state
Answer: A. Real-time UTZ evidence of fetal heart motion 4 weeks after the last
menstrual period
Rationale:
● Fetal Heart Activity detected at
○ UTZ – 5.5 to 6 weeks
○ Doppler – 10 weeks
○ Stethoscope – 20 weeks
● A. should be 5.5 to 6 weeks
● B. True
● C. True
● D. True
Answer: A. Shoulder dystocia
Rationale:
● The most feared complication of fetal macrosomia is shoulder
dystocia, which occurs when the baby's head emerges from the womb
but the shoulders get stuck inside the mother's body, requiring
additional maneuvers to deliver the baby safely.
Answer: B. Plasma volume expansion
Rationale:
● Iron deficiency is the most common cause of anemia in pregnancy.
● The mechanism by which anemia develops in pregnancy is well
understood: haemodilution causes a fall in the hemoglobin
concentration during the first and second trimesters of normal
pregnancies. Negative iron balance throughout pregnancy, particularly
in the latter half, may lead to iron deficiency anemia during the third
trimester.
● Hemodilution = low hematocrit due to increased plasma volume
Answer: C. Elevates the serum binding proteins
Rationale:
● Progesterone then prepares the tissue lining of the uterus to allow the
fertilized egg to implant and helps to maintain the endometrium
throughout pregnancy. It also acts on the myometrium and promotes
relaxation and quiescence of early pregnancy. Progesterone also has
natriuretic effects.
Answer: B. Intrauterine device
Rationale:
 A. Combined oral contraceptive
pills
B. Intrauterine device
C. Progestin only pills
D. Bilateral tubal ligation
11 Which of the following findings in a
pregnant woman indicates that heart
disease is present?
A. Dyspnea
B. T-wave changes
C. Split first second heart sound
D. Grade 3/6 systolic murmur
12 Which of the following statements is true
regarding anatomic and physiologic
changes in the urinary tract during
pregnancy:
A. Enlargement of the kidney is due
to hyperplasia of glomerular
apparatus
B. Hydronephrosis and hydroureter
are more prominent on the right
side
C. Glucosuria is abnormal and
definitely suggestive of overt
diabetes
D. Proteinuria of more than 300
mg/day is still normal
13 During Leopold’s fourth maneuver the
cephalic prominence is palpated on the
same side of the fetal back. This
indicates that the fetal head is extended
and the fetal presenting part is:
A. Vertex
B. Shoulder
C. Face
D. Breech
14 Chromosomal findings associated
abortion is found highest in
A. Euploidy
B. Autosomal trisomy
C. Triploidy
D. Structural anomalies
● Safety of COC use is questionable. Concerns include possible risks for
thrombosis, elevated BP, and altered glucose,carbohydrate and lipid
metabolism.
Source: CPG on DM in pregnancy
Answer: D. Grade 3/6 systolic murmur
Rationale:
● As valvular heart disease may present for the first time during
pregnancy, clinicians should be watchful. The normal flow murmur of
pregnancy is typically soft (grade 1 or 2), located at the pulmonary
region, associated with a normal first and second heart sound, and is
not accompanied by a diastolic murmur.
● Investigation with echocardiography is indicated in women with a
history of resting or worsening dyspnoea, any signs of heart failure, a
grade 3 or greater systolic murmur, or any diastolic murmur.
Answer: B. Hydronephrosis and hydroureter are more prominent on the right
side
Rationale:
● Dilatation of the ureters and renal pelvis (hydroureter and
hydronephrosis) is more prominent on the right than the left, and it has
been observed in 80% of pregnant women due to physiological
dextrorotation of gravid uterus and engorged right ovarian vein
draining into renal vein on the right side.
Answer: C. Face
Rationale:
● Vertex: Same side as small parts (head flexed)
● Shoulder: Acromion or scapula is felt (transverse lie)
● Face: Same side as fetal back (head extended)
● Breech: Buttocks/lower extremities are presenting
○ Frank breech - hips flexed, knees extend
○ Complete breech - hips flexed, knees flexed
○ Incomplete breech - hips flexed (one or both), knees below the
breech (one or both)
Answer: C. Triploidy
Rationale:
● The most common chromosomal abnormality is Trisomy 16 which
occurs in 26% of losses.
15 Which of the following statements is
false regarding breastfeeding?
A. It causes increased contractions
and lessens maternal blood loss
in the early postpartum period
B. It is associated with increased
incidence of breast and ovarian
cancer
C. It promotes birth spacing by
delaying return of ovulation
D. It causes bone demineralization
due to maternal transfer of
calcium to breastmilk
16 This is the term used to refer to the
discharge that originates mainly from the
uterus during the postpartum period
A. Mucosa
B. Leukorrhea
C. Lochia
D. Bloody show
17 A 20 yr old G2P1 (1-0-0-1) 40 weeks
pregnant with PROM is noted to have
hypotonic uterine dysfunction. She is
best managed with
A. Membrane sweeping
B. Oxytocin stimulation
C. Sedation
D. Cesarean section
18 A 30 yr old, 25 week pregnant patient was
brought to the emergency room for
painless vaginal bleeding, a dilated cervix
with membranes ballooning into the
vagina. Fetal heart tones were normal.
She had 2 previous pregnancies with
similar presentations which she delivered
in the early third trimester. What is your
most likely consideration?
A. Inevitable abortio
B. Precipitous delivery
C. Incompetent cervix
Answer: B. It is associated with increased incidence of breast and ovarian
cancer
Rationale:
● Statement A (True)
○ Nipple stimulation or breastfeeding are stimuli that can lead to
the secretion of oxytocin and consequent uterine contractions.
Consequently, uterine contractions can reduce bleeding during
the third stage of labor.
● Statement B (False)
○ Breastfeeding was associated with a 24% lower risk of
invasive ovarian cancer.
○ Breastfeeding can lower breast cancer risk, especially if a
woman breastfeeds for longer than 1 year.
● Statement C (True)
○ Refers to lactation amenorrhea method. LAM is a natural,
short term birth control method in which a woman relies on
exclusive breastfeeding after birth to prevent pregnancy
● Statement D (True)
○ Studies show 4-6% bone loss during the first six months of
lactation because of hypoestrogenic state and calcium loss in
breast milk.
Answer: C. Lochia
Rationale:
● Lochia
○ vaginal discharge that originates from the uterus, cervix, and
vagina
○ Contains erythrocytes, shredded decidua, epithelial cells and
bacteria
○ Lochia Rubra: first few days, bloody discharge
○ Lochia Serosa: 3-4 days, pale discharge
○ Lochia Alba: 10th day, admixture of leukocytes and reduced
fluid; white or yellow-white color
● Leukorrhea: normal type of vaginal discharge present in both pregnant
and non-pregnant people
● Bloody Show: occurs during late pregnancy when a small amount of
blood and mucus is released from the vagina. Occurs when the cervix
starts to soften and thin (efface) and widen (dilate) in preparation for
labor.
Answer: B. Oxytocin stimulation
Rationale:
● Hypotonic labor - slow progression hence augment with Oxytocin
● Term baby; try to deliver vaginally
● Membrane sweeping - ruptured membranes already
● Not indicated for CS yet
Answer: C. Incompetent cervix
Rationale:
● Inevitable abortion - membranes are already ruptured
● Precipitous delivery - mostly risk factor for PPH atony, prolapse
● APAS - recurrent abortions
● Incompetent cervix - painless cervical dilatation in the second trimester
followed by ballooning of membranes into tha vagina and repeats in
other pregnancies.
 D. Antiphospholipid antibody
syndrome
19 A patient is referred to you for exhaustion
due to a prolonged latent phase. Which of
the following treatment options will you
recommend?
A. Amniotomy
B. Oxytocin stimulation
C. Cesarean section
D. Therapeutic rest with strong
sedative
20 Most patients with arrest disorders and
require cesarean delivery have:
A. Cephalopelvic disproportion
B. Fetal malposition
C. Hypotonic uterine dysfunction
D. Excessive sedation and
anesthesia
21 One of the following vaccines is NOT
recommended during pregnancy since
safety data is limited:
A. Tetanus-diphtheria toxoid
B. Human papillomavirus (HPV)
C. Influenza
D. Hepatitis B
22 This is the preferred drug for patients
with hyperthyroidism because it is less
lipid-soluble and more protein-bound,
thus transported less to the fetus and
breastmilk:
A. Carbamazepine
B. Methimazole
C. Propylthiouracil
D. Neomercazole
23 When is hysterectomy an option for the
management of abortion
A. Failed medical management
B. A significant uterine disease is
present
C. Inevitable abortion
Answer: B. Oxytocin stimulation
Rationale:
● A. - increased risk for cord prolapse
● C. - no indications
● D. - Bed rest is the preferred treatment but strong sedatives can further
prolong the latent phase
Answer: A. Cephalopelvic disproportion
Rationale:
Answer: B. human papillomavirus
Rationale:
● HPV not recommended during pregnancy
● Tetanus-diphtheria toxoid is recommended in every pregnancy,
preferably between 27 and 36 weeks to maximize passive antibody
transfer
● Influenza - recommended for all pregnant women, regardless of
trimester, during flu season (October to May)
● Hepatitis B - indicated as preexposure and postexposure for women at
risk of infection
Source: William’s Obstetrics 25th ed.
Answer: C. Propylthiouracil (PTU)
Rationale:
● PTU has been historically preferred because it partially inhibits the
conversion of T4 to T3 and crosses the placenta less readily than
methimazole
Source: William’s Obstetrics 25th ed.
Answer: B. A significant uterine disease is present
Rationale:
● In some women with second-trimester pregnancies who desire
sterilization, hysterotomy with tubal ligation is reasonable. If there is
significant uterine disease, then hysterectomy may provide ideal
treatment. In some cases of a failed second trimester medical
 D. Habitual abortion
24 Management of this type of abortion
requires bed rest and uterine relaxant
A. Threatened abortion
B. Complete abortion
C. Inevitable abortion
D. Habitual abortion
25 A patient with post-term pregnancy has a
ripe cervix but low amniotic fluid index.
Contraction stress test was positive.
Which of the following management is
best?
A. Hydrate patient and await
spontaneous onset of labor
B. Perform amniotomy to initiate
labor
C. Stimulate labor using oxytocin
and deliver vaginally
D. Perform cesarean delivery
induction, either of these may be considered.
Source: William’s Obstetrics 25th ed.
Answer: C. Inevitable Abortion
Rationale:
● Preterm premature rupture of membranes (PPROM) at a previable
gestational age complicates 0.5 %of pregnancies (Hunter, 2012).
Rupture may be spontaneous or may follow an invasive procedure such
as amniocentesis or fetal surgery. Risks for spontaneous rupture at a
previable gestation are prior PPROM, prior second-trimester delivery,
and tobacco use (Kilpatrick, 2006).
● A gush of vaginal fluid that is seen pooling during sterile speculum
examination confirms the diagnosis of inevitable abortion. In suspect
cases, amniotic fluid will fern on a microscope slide or will have a pH
>7, or oligohydramnios will be seen on sonography.
● If expectant care is elected, management is as described in patients
with PPROM. Antibiotics are considered and given for 7 days to extend
latency. Other options include lung-maturing corticosteroids,
magnesium sulfate neuroprophylaxis, group B streptococcus antibiotic
prophylaxis, tocolytics, and neonatal resuscitation efforts.
● POGS: Inevitable Miscarriage - The sudden discharge of fluid is
accompanied or followed by vaginal bleeding. This vaginal bleeding is
often associated with abdominal pain and cramping.
● Gross rupture of the membranes, evidenced by leaking amnionic fluid in
the presence of cervical dilatation, signals almost certain abortion. If,
however, the gush of fluid is accompanied or followed by bleeding, pain,
or fever, abortion should be considered inevitable, and the uterus
emptied. Vaginal bleeding is accompanied by dilatation of the cervical
canal. Bleeding is usually more severe than with threatened
miscarriage.
● Note: ACOG suggests that, although frequently prescribed, bed rest is
only rarely indicated, and ambulation should be considered in most
cases.
Source: William’s Obstetrics 25th ed.
Answer: A. Hydrate patient and await spontaneous onset of labor
Rationale:
● Performing amniotomy can enhance the possibility of cord
compression
● Labor induction via IV oxytocin can be done if cervix is unfavorable after
negative contraction stress test
● Vaginal delivery is possible
26 Meconium in the amniotic fluid
A. Represents fetal passage of
gastrointestinal contents in
conjunction with normal
physiologic process
B. Is always a pathological event
and marker of preexisting fetal
compromise
C. An environmental hazard when
fetal acidemia supervenes
D. A & C
27 Delirium tremens of the newborn is
caused by addiction to
A. Marijuana
B. Amphetamine
C. Nicotine
D. Alcohol
28 Which of the following is the most
important factor in affecting fetal
development if the mother is exposed to
certain medications in pregnancy
A. Genotype of the fetus
B. Timing and exposure of the
medication
C. Dose of drug
D. Duration of exposure to
medication
29 Pregnancy is considered high risk if
Answer: D. A & C
Rationale:
● High incidence of meconium observed in the amniotic fluid during labor
often represents fetal passage of gastrointestinal contents in
conjunction with normal physiological processes.
● Although normal, such meconium becomes and environmental hazard
when fetal acidemia supervenes.
Source: William’s Obstetrics 25th ed. p. 474
Answer: D. Alcohol
Rationale:
● The newborns were suffering from delirium tremens -- commonly
known as the 'DTs' -- because of their mothers' heavy drinking. The DTs
can begin hours after birth and symptoms include body tremors,
seizures and irregular heartbeat.
Answer: B. Timing and exposure of the medication
Rationale:
● First trimester exposure is more dangerous as organogenesis occurs
in here
● Thus, among the choices, timing and exposure are the most important
factors that could affect fetal development. This is why it is important
to know about the pregnancy in its earlier weeks so that the mother can
avoid exposure to harmful or teratogenic medications.
○ In addition, there are some medications that are not safe to
use in the earlier pregnancy but may be okay in the later
trimester.
Answer: D. 16-year-old pregnant for the first time
 pregnant patient is:
A. A 35-year-old woman who had 2
previous term deliveries to
healthy baby boys
B. 28-year-old woman who had
miscarriage
C. 30-year-old pregnant for the
fourth time
D. 16-year-old pregnant for the first
time
Answer: A. Metronidazole
30 A 35 year old woman states that she has
Rationale:
been on Co-amoxiclav antibiotics
because of pneumonia. Upon completing
antibiotics, she noted a thick white
vaginal discharge associated with severe,
vulvar itching. Which of the following
therapies would be the most appropriate?
A. Metronidazole
B. Clotrimazole vaginal
suppository
C. Oral Fluconazole
D. Sulfonamide vaginal cream
Rationale:
● High Risk Pregnancies are:
○ Age < 17 years p;d
○ Primigravid > 35 years old
○ Poor OB History
○ Problems in fetal aging or structure size
○ Placenta previa or Abruptio
○ Medical condition
○ Reproductive tract disorder
○ Malignancy
○ Psychotic state
○ GTDs
○ Oligohydramnios/Polyhydramnios
● Patient has bacterial vaginosis
● Clinical criteria for BV require three of the following:
○ homogeneous, thin, white discharge that smoothly coats the
vaginal walls;
○ clue cells (e.g., vaginal epithelial cells studded with adherent
coccobacilli) on microscopic examination;
○ pH of vaginal fluid >4.5; or
○ a fishy odor of vaginal discharge before or after addition
○ of 10% KOH (i.e., the whiff test).
● Treatment:

Answer: C. Pelvic TB
31 A 32 year old pregnant woman consulted
Rationale:
for infertility. On laparoscopy, there were
● Intraluminal scarring due to adhesions can give rise to a cobblestone
pelvic adhesions and one fallopian tube
pattern in hydrosalpinges. This finding is more likely to be associated
appeared like a tobacco-pouch. What is
with infertility.
the most likely diagnosis?
● Inflammatory fibrosis can eventually lead to complete obstruction of
A. Pelvic endometriosis
the fallopian tubes, which can be seen with or without tubal dilatation.
B. Tubal malignancy
● Tubal obstruction is the most common hysterosalpingography (HSG)
C. Pelvic TB
finding encountered in TB.
D. Cystadenofibroma
○ It can occur at multiple sites; however, TB characteristically causes
obstruction of the isthmico-ampullary segment of the tubes.
○ If the site of obstruction is at the distal ampulla, it leads to
dilatation of the fallopian tube with a club-like appearance to the
ampulla giving rise to the characteristic “tobacco pouch”
appearance on HSG
32 A 4th year high school student presents
to the physician’s clinic because of a
mucopurulent vaginal discharge, lower
abdominal pain, and a fever, which began
toward the end of her menstrual period.
Which STD is most likely involved?
A. Chlamydia trachomatis
B. Neisseria gonorrhoeae
C. Gardnerella vaginalis
D. Group B streptococci
33 Dysfunctional uterine bleeding during the
perimenopausal period can be
associated with which of the following
hormonal situations?
A. Exogenous estrogen therapy
B. Imbalance in estrogen
progesterone ratio
C. Increased aromatization of
androgen precursors
D. An atrophic endometrium
Answer: B. Neisseria gonorrhea
Rationale:
● The patient most likely has PID. Criteria include:
○ lower abdominal pain
○ adnexal tenderness
○ cervical motion tenderness
○ additional criteria that can increase the specificity of the diagnosis:
oral temperature >38.3ºC, abnormal cervical or vaginal discharge,
elevated ESR, elevated C-reactive protein, and laboratory
documentation of cervical infection with Neisseria gonorrhoeae
and/or Chlamydia trachomatis
● Upper tract infection is believed to be caused by bacteria from the lower
reproductive tract that ascend into the upper tract.
○ ascension is enhanced during menstruation due to loss of
endocervical barriers
● N. gonorrhoeae can cause a direct inflammatory response in the human
endocervix, endometrium, and fallopian tube and is one of the true
pathogens of human fallopian tube epithelial cells
● In contrast, intracellular C trachomatis does not cause an acute
inflammatory response, and little direct permanent damage results
from chlamydial tubal involvement. Persistent chlamydial antigens can
trigger a delayed hypersensitivity reaction with continued tubal scarring
and destruction
Answer: B. Imbalance in estrogen progesterone ratio
Rationale:
34 A 26 year old G1P1 (1001) with abnormal
pap smear result underwent colposcopy
and cervical biopsy of an acetowhite
lesion occupying the 3 oclock to 10
oclock area of the cervix. Histopathologic
examination of the biopsy revealed highly
atypical dysplastic cells replacing the
cells up to the third of the epithelial
thickness, with a note of normal looking
superficial cell layer. The most
appropriate treatment for this patient is
A. Cryotherapy, then regular pap
smear every 6 months for 2
years
B. Loop electrosurgical excision
procedure
C. Total hysterectomy
D. Intracavitary brachytherapy
Answer: A Cryotherapy, then regular pap smear every 6 months for 2 years
Rationale:
● CIN 1
○ Involves the presence of neoplastic basaloid cells limited to
the lower third of the cervical epithelium
○ Usually associated to squamous cells with perinuclear halo or
koilocytes (hallmark of CIN1)
○ CIN 1 is considered low-risk or low-grade lesions that are
thought to be manifestations of acute HPV infection, and most
spontaneously regress within a few years
● Ablative techniques – lesion is destroyed in situ
○ Cryotherapy
○ Laser therapy
● Excision techniques – usually to rule out microinvasive CA
○ Loop electrosurgical excision procedure (LEEP)
○ Conization
○ Hysterectomy
○ Avoided for women who still want to get pregnant as they
carry a risk for either cervical stenosis or cervical
incompetence
● Cryotherapy is preferred for young women who are desirous of
pregnancy.
● Triage rules for ablative therapy of CIN
○ New SCJ visualized in its entirety (360°) without disease
extension into endocervical canal
○ No cytologic, colposcopic, histologic evidence of invasive
cancer
○ Concordance to within 1 degree of severity between cytologic
and histologic result
○ No evidence of HSIL on ECC
○ No cytologic/histologic suspicion of high-grade glandular
neoplasia
● Aceto-white epithelium
○ White patches of epithelium in the TZ seen after application of
3-5% acetic acid
○ High-grade CIN lesions: thick, greyish white acetowhite
epithelium with very distinct geographic borders which persist
even after several minutes have passed after acetic acid
application
○ Low-grade CIN lesions: thin, translucent acetowhite reactions
with scalloped or indistinct borders which are transient, often
fading within 1-2 minutes
● For women with an ASC HPV-positive, ASC-H, or LSIL cytology result
 and a negative initial colposcopy examination or a histology result of
CIN 1, optimal follow-up is repeat cervical cytology screening at six
and 12 months or an HPV test at 12 months.
● A hysterectomy is not the standard of care to treat cervical dysplasia.
However, the finding of recurrent cervical dysplasia may be treated with
hysterectomy.

35 The most common HPV types found in Answer: C. HPV types 16 & 18
cervical cancer specimens worldwide are Rationale:
A. HPV types 6 & 11 ● HPV 16 is the most prevalent in cervical cancer worldwide, followed by
B. HPV types 6 & 16 HPV 18.
C. HPV types 16 & 18
D. HP V types 18 & 45

36 A 57 year old G6 P6 came in with a chief Answer: D. Stage IIB

complaint of post-menopausal bleeding. Rationale:
Pelvic exam performed by the Ob-Gyne ● Stage I: The cancer has spread from the cervix lining into the deeper
resident on duty revealed the following tissue but is still just found in the uterus.
findings: Normal external genitalia, ● Stage II: The cancer has spread beyond the uterus to nearby areas, such
smooth vagina, cervix with a 5 x 4 cm as the vagina or tissue near the cervix, but it is still inside the pelvic
wide nodular mass with involvement of area.
the left anterolateral fornix; the left ○ Stage IIA: The tumor is limited to the upper two-thirds of the
parametrium is nochilar and free from vagina.
the pelvic sidewalls, while the right ○ Stage IIB: The tumor has spread to the parametrial area. The
parametrium is smooth and pliable. The tumor does not reach the pelvic wall.
rest of the systemic and pelvic findings
are unremarkable. The patient's FIGO
Stage is:
A. Stage IBl
B. Stage IB2
C. Stage IIA2
D. Stage IIB

37 The most common symptom of Cervical Answer: B. Vaginal bleeding

Cancer is: Rationale:
A. Malodorous vaginal discharge ● Ovarian cancer- most common symptom is pelvic pain
B. Vaginal bleeding ● Anemia can also be present in different gynecologic malignancies
C. Pelvic pain secondary to bleeding
D. Anemia
38 A 60-year-old nulligravid underwent Answer: C. Stage 2C
surgery for a malignant ovarian tumor. Rationale:
Intraoperative findings showed: Ascites ● A. Limited to ovary only
of 800 ml; smooth visceral and parietal ● B. Extension or metastasis to uterus or fallopian tube
peritoneal surfaces including ● C. Extension or metastasis to uterus or fallopian tube with Ascites
subdiaphragmatic surface and liver; right ● D. Implants outside pelvis
ovary converted into a 14 x 12 x 10 cm
complex mass with tumor noted on outer
surface of its capsule and solid areas
within; the ovarian tumor was densely
adherent to the posterior serosa of the
uterus; the right fallopian tube was
slightly dilated and contained several
tumor nodules as its fimbriated end
(largest uterine endometrium,
myometrium, and cervix appeared
unremarkable. Comprehensive surgical
staging and complete debulking was
performed. Histopathologic examination
of the specimen revealed a serous
carcinoma of the right ovary with
metastatic foci found only in the right
Fallopian tube and uterine posterior
serosa. What is the FIGO Stage of this
patient?
A. Stage 1C
B. Stage 2A
C. Stage 2C
D. Stage 3A

39 The most important prognostic factor Answer: C. FIGO stage

determining survival among women with
epithelial ovarian cancer is
A. Age of the patient
B. Completeness of surgical
debulking
C. FIGO stage
D. Tumor Histology
Rationale:
● Epithelial ovarian cancer (EOC) is the most lethal gynecologic cancer..
Some factors that could impact OS (Overall Survival) may include
cancer stage, histological type, early recognition, patient management,
age, comorbidities, and type of hospital
● The most important prognostic factor in all human cancers is the stage
at presentation, which is the anatomic extent of the disease

40 In performing a vaginal hysterectomy, the
last structure to be identified, clamped,
cut and ligated prior to completing the
hysterectomy is the
A. Cardinal ligaments
B. Uterine vessels
C. Utero-ovarian ligament and
uterotubal junction
D. Uterosacral ligaments
Answer: C. Utero-ovarian ligament and uterotubal junction
Rationale:
● Vaginal hysterectomy is a surgical procedure to remove the uterus
through the vagina. During a vaginal hysterectomy, the surgeon
detaches the uterus from the ovaries, fallopian tubes and upper vagina,
as well as from the blood vessels and connective tissue that support it,
before removing the uterus
● Utero-ovarian, round ligament complex, and cornual end of the Fallopian
tube- The upper and the final pedicle can be clamped all together or
separately.
● Delivery of surgical specimen
○ The uterine fundus is delivered posteriorly by placing a
tenaculum or towel clip on the uterine fundus in successive
bites. The utero-ovarian ligament is identified with the
surgeon's finger, then clamped and cut.
Note: Refer to this link for the step by step procedure of vaginal hysterectomy.

https://www.ncbi.nlm.nih.gov/books/NBK554482/#:~:text=Broad%20ligament%2
D%20This%20is%20an,clamped%20all%20together%20or%20separately

41 Which statement regarding pelvic ureter Answer: A. The ureter becomes a pelvic organ as it enters the pelvic brim at the
is true? level of the aorta’s bifurcation into the common iliac arteries
 A. The ureter becomes a pelvic
organ as it enters the pelvic brim
at the level of the aorta’s
bifurcation into the common
iliac arteries
B. The ureter lies medial to and
runs parallel to the
infundibulopelvic ligaments
attached to the pelvic
peritoneum
C. The ureter is located about
1.5cm lateral to the cervix uteri
at the level of the cervical
external os
D. The ureter crosses over the
uterine artery and vein lateral to
the corpus uteri at the level of
the isthmus
42 A 30 yo primipara consulted for a
hypogastric mass which was
approximately 16 weeks size, firm,
nontender and midline on abdominal
exam. Ultrasound showed a solid uterine
mass. 5.0 x 4.3 x 5.5 cm seen
predominantly at the anterior subserosal
surface. She plans to have two more
children. Which of the following is least
among her treatment options.
A. GnRH analogues medications
B. Hysterectomy
C. Observation
D. Myomectomy
43 Which of the following statements holds
true for adenomyosis:
A. Response to hormonal therapy
is good
B. Could be diagnosed by
endometrial biopsy
C. A primary cause of amenorrhea
D. Definitive treatment is
hysterectomy
44 An unruptured dominant ovum may result
in what type of ovarian tumor?
A. Follicular cyst
B. Endometriotic cyst
Rationale:
● B. Ureter runs medially beneath the broad ligament
● C. Approx. >2cm - distance between ureter and cervix
● D. Uterine artery crosses over the ureter
Note:
● The abdominal ureter is the segment of the ureter that extends from
the renal pelvis to the iliac vessels. The pelvic ureter extends from the
iliac vessels to the bladder.
● There is an alternative method of ureteral nomenclature: upper, middle,
and lower segments. The upper ureter extends from the renal pelvis to
the upper border of the sacrum. The middle ureter continues from the
upper to lower borders of the sacrum. The distal ureter continues from
the lower border of the sacrum to the bladder.
Source: Anatomy, Abdomen and Pelvis, Ureter - StatPearls - NCBI Bookshelf
(nih.gov)
Answer: B. Hysterectomy (Least likely option)
Rationale:
● Hysterectomy - definitive treatment especially for those who do not
desire to get pregnant anymore
● Patient still have plans to have children.
● Surgery is indicated for patients:
○ With AUB, causing anemia
○ Severe pelvic pain or secondary amenorrhea
○ Uterine size of >12week obscuring evaluation of the adnexa
○ Urinary frequency, retention, hydronephrosis
○ Growth after menopause
○ Recurrent miscarriage or infertility
○ Rapid increase in size
Answer: D. Definitive treatment is hysterectomy
Rationale:
● Adenomyosis is derived from aberrant glands of the basalis layer of the
endometrium.
● The classic symptoms of adenomyosis are secondary dysmenorrhea
and menorrhagia. Occasionally the patient complains of dyspareunia.
● The diagnosis of adenomyosis is usually confirmed following
histologic examination of the hysterectomy specimen.
○ Attempts have been made to establish the diagnosis
preoperatively by transcervical needle biopsy of the
myometrium. However, even with multiple needle biopsies, the
sensitivity of the test is too low to be of practical clinical value
○ Ultrasound and MRI are both useful to help differentiate
between adenomyosis and uterine myomas.
● There is no satisfactory proven medical treatment for adenomyosis.
○ Patients with adenomyosis have been treated with GnRH
agonists, progestogens, and progesterone-containing IUDs,
cyclic hormones, or prostaglandin synthetase inhibitors for
their abnormal bleeding and pain.
● Hysterectomy is the definitive treatment if this therapy is appropriate
for the woman’s age, parity, and plans for future reproduction.
Source: Comprehensive Gynecology
Answer: A. Follicular Cyst
Rationale:
● Follicular cysts may result from either the dominant mature follicle’s
failing to rupture (persistent follicle) or an immature follicle’s failing to
 C. Theca-lutein cyst
D. Serous cyst
45 Which ovarian neoplasm consists of
tissues that recapitulate the embryonic
primordial layers?
A. Brenner tumor
B. Mucinous cystadenoma
C. Mature teratoma
D. Serous cystadenoma
46 Matilde, 60 years old, complains of
urgency and a feeling of incomplete
emptying of the bladder with voiding.
Upon examination, the physician noted a
soft, bulging mass at the anterior vaginal
wall. Most likely diagnosis is:
A. Cystourethrocele
B. Rectocele
C. Enterocele
D. Uterine prolapse, 2nd degree
47 The case of Matilde in #46 is best
managed by:
A. Anterior colporrhaphy
B. Posterior colporrhaphy
C. Cul-de-sac oblitération
D. Vaginal hysterectomy
undergo the normal process of atresia.
● Endometriomas are most commonly thought to be caused when
seeding of ectopic endometrial tissue, most often present on the ovary,
bleeds, causing a hematoma.
○ These lesions are commonly referred to as chocolate cysts,
due to the thick dark brown appearance of the fluid that is
contained within them.
● Theca lutein cysts arise from either prolonged or excessive stimulation
of the ovaries by endogenous or exogenous gonadotropins or increased
ovarian sensitivity to gonadotropins.
○ The condition of ovarian enlargement secondary to the
development of multiple luteinized follicular cysts is termed
hyperreactio luteinalis
● Serous cystadenoma is an epithelial ovarian neoplasm with a smooth
outer surface and contains one or more thin-walled cysts filled with
clear, watery fluid; usually unilocular but may be multilocular.
Source: Comprehensive Gynecology
Answer: C. Mature teratoma
Rationale:
A. Aka Transitional Cell Tumors; (also an Epithelial Ovarian Neoplasm)
B. Filled with mucin; (Epithelial Ovarian Neoplasm; same with serous
cystadenoma and brenner)
C. A Germ Cell Tumor; derived from germ cells and may resemble any or
all of the three embryonic layers
D. Most frequent ovarian epithelial tumors (Epithelial Ovarian Neoplasm)
Answer: A. Cystourethrocele
Rationale:
● Cystourethrocele - Urethra and bladder prolapse; mentioned also is the
soft bulging mass at the anterior vaginal wall - where your urethra
bladder is located. Rectocele and Enterocele will often present as
posterior wall bulging. Uterine prolapse most commonly occurs as a
delayed result of childbirth injury.
Answer: A. Anterior colporrhaphy
Rationale:
● Symptoms of POP include a sensation of fullness, pelvic pressure,
vaginal bulge, and a feeling that organs are falling out.
○ With anterior vaginal wall prolapse (urethrocele and cystocele),
the woman may also report a feeling of incomplete emptying
with voiding, a slow urinary stream, or urinary urgency.
○ The patient and the physician note a soft, bulging mass of the
anterior vaginal wall.
● Treatment of anterior vaginal wall prolapse may be nonoperative or
operative depending on patient preferences and goals
● Repair usually consists of an anterior colporrhaphy as well as
correction of uterine descensus or apical defect post hysterectomy.
○ Anterior wall repair (colporrhaphy) is performed by plicating
the connective tissue of the anterior vaginal in the midline.
● Operative management of posterior vaginal wall prolapse usually
involves posterior colporrhaphy or a site-specific repair
● Complete obliteration of the cul-de-sac is a manifestation of
endometriosis that causes significant morbidity.
○ It occurs as a result of adhesion formation between the
posterior aspect of the uterus/cervix and surrounding
structures.
 Source: Comprehensive Gynecology

48 When would ovulation likely to occur after Answer: A. 2 weeks after

an early, spontaneous abortion?: Rationale:
A. 2 weeks after ● According to the American College of Obstetricians and Gynecologists
B. 6 weeks after (ACOG), women can ovulate as soon as 2 weeks after a miscarriage, if
C. 1 month after it occurs within the first 13 weeks of pregnancy.
D. 3 months after ● After medical or surgical management of an early pregnancy
termination or loss, ovulation may resume as early as 8 days, but the
average time is 3 weeks

49 Which of the following conditions is the Answer: D. Vasa previa

LEAST likely cause of first trimester Rationale:
bleeding? ● Vasa previa - patient bleeds from a blood vessel located on the
A. Threatened abortion amniotic membranes of the placenta
B. H. mole ○ Occurs in the second half of pregnancy (antepartum
C. Ectopic pregnancy hemorrhage)
D. Vasa previa

50 This procedure is employed in cases of Answer: D. McDonald

cervical incompetence: Rationale:
A. Shirodkar ● Cerclage - suture placed vaginally around the cervix either at the
B. McRoberts cervical-vaginal junction (McDonald) or at the internal os (Shirodkar);
C. Pomeroy ○ McDonald - simple procedure
D. McDonald’s

○ Shirodkar - more complicated operation; reserved for patients

that have had failure with McDonald procedure

51 Common side effects of B agonist in the Answer: B. Fetal tachycardia

management of preterm labor? Rationale:
A. Maternal hypoglycemia ● B-agonist increases the heart rate, conduction, and contraction of the
B. Fetal tachycardia heart.
C. Reduced pelvic pressure
D. Neonatal hyperglycemia

52 Reactive nonstress test is defined as: Answer: B. 2 or more fetal heart rate ACCELERATION within 20 minutes
A. Presence of 1 fetal heart rate Rationale:
acceleration within 20 minutes ● NST is a test of fetal well being. The main principle is that in a normal
observation time fetus, movement of the fetus should result in increased heart rate.
B. Presence of 2 or more fetal
heart rate accelerations within
20 minutes observation time
C. Presence of fetal heart rate
decelerations is more than 50%
uterine contractions
D. Presence of both acceleration
and deceleration
53 53. A G3P2 comes in at the OPD with UTZ
result of Total Placenta Previa AOG is 34
wks. Patient has no complaints with
normal vital signs. Management?
A. Stat C Section
B. Await onset of labor
C. Reassure patient and tell her the
chance of a positive placental
migration
D. Elective C section at term AOG
54 A G6P5 patient is brought to the ER
because of severe abdominal pain
following a sudden gush of fluid per
vagina. AOG is 36 wks. PE reveals slight
pallor but stable VS, tender uterus, (+)
hypertonus, minimal vaginal bleeding,
FHB at 110 bpm. IE reveals 9 cm cervical
dilatation. Management?
A. Stat C section
B. Expedite normal vaginal delivery
C. Start oxytocin
D. Give tocolytics
55 The most-accepted risk factor for
Pre-eclampsia
A. Primipaternity
B. Immunologic factors
C. Primiparity
D. Socioeconomic status
56 Hypertension without proteinuria that
develops after 20 weeks AOG and returns
to normal 12 weeks postpartum is
A. Chronic HPN
B. Pre-Eclampsia
C. Gestational HPN
D. Eclampsia
Answer: D. Elective C section at term AOG
Rationale:
● Route of delivery depends of final placental localization (usually
determined between 32-36 weeks)
● Vaginal delivery (not possible because px has TOTAL PP)
○ Placental edge > 2 cm away from os – trial of labor
○ Placental edge within 0 – 20 mm from os – vaginal delivery is
still possible BUT with caution
● Cesarean section
○ for all women with placenta previa
○ for near term and with no bleeding, schedule elective CS at
term (usually 38 weeks)
Answer: C. Start oxytocin
Rationale:
● In LATE PRETERM (34 to 36 6/7 weeks)
○ Induction of labor to reduce the risks of both clinical and
documented chorioamnionitis
○ No benefit to the neonate with expectant management
○ Risk of prematurity is equal to the risk of infection
○ Up to this point (AOG), risk of prematurity drives management,
whereas beyond this point, the risk of infection motivates
delivery.
Answer: C. Primiparity
Rationale:
● Primiparity is a well accepted risk factor for preeclampsia.
● Pregnancy induced hypertensive disorders, especially preeclampsia,
have been documented to occur primarily in first pregnancies.
● It is associated with approximately 2.4 fold elevated risk of
preeclampsia
Source: CPG on Hypertension in Pregnancy 2015
Answer: C. Gestational Hypertension
Rationale:
● Chronic HPN
○ is hypertension of any cause that predates pregnancy. BP ≥
140/90 before pregnancy of before 20 weeks gestation, or
both
● Pre-Eclampsia
○ is defined as having urine protein spillage of ≥300mg/24
hours, protein-to-creatinine ratio ≥ 0.3 or 1+ urinary protein
dipstick reading
● Gestational HPN
○ NEW ONSET of threshold BP elevations after 20 weeks
gestation in the absence of proteinuria or other systemic
findings alternatively used to support the diagnosis of
preeclampsia
○ it is hypertension in pregnancy that does not show signs of
developing preeclampsia and the elevated BP resolves by 12
weeks postpartum
● Eclampsia
○ Term used in women diagnosed to have preeclampsia and
have convulsions that cannot be attributed to another cause
○ Convulsions are generalized and may occur before, during, or
after labor.
○ Although generally occurring within 48 hours of delivery, 10%
of postpartum eclampsia may initially occur beyond this time
frame.
Source: CPG on Hypertension in Pregnancy 2015
57 Which of the following is a finding on
Leopold's in LOT position:
A. hard concave structure on
mother's right
B. fetal back to mother's right
C. fetal small parts on mother's
right
D. small round nodulations on
mother's left
58 A cardinal movement resulting to a
shorter fetal head diameter
A. Expulsion
B. Extension
C. External rotation
D. Flexion
59 Proteinuria in Pre-eclampsia is
A. > or equal to 0.3 g in 24 hr urine
sample
B. >30 mg/mmol urinary creatinine
in a random urine sample
C. 100 mg random sample taken 6
hrs apart
D. > or equal to 3mg in a 24 hr
urine sample
Answer: C. fetal small parts on mother’s right
Rationale:
(Sample of LOT)
● L1 - Fundal grip - identify which fetal pole occupies the uterine fundus
● L2 - Umbilical grip - determine fetal back
● L3 - Pawlick grip - determine if the presenting part is engaged or not
● L4 - Pelvic grip - degree of fetal extension to the pelvis
● The back - hard, resistant structure
● Fetal extremities - numerous small, irregular, mobile parts
Source: Williams Obstetrics 25th ed.
Answer: D. Flexion
Rationale:
● Expulsion
○ Anterior shoulder appears under the symphysis pubis
● Extension
○ After internal rotation is complete and the head passes
through the pelvis at the nape of the neck, a rest occurs as the
neck is under the pubic arch. Extension occurs as the head,
face and chin are born.
● External rotation
○ Rotation of the fetal body and serves to bring its biacromial
diameter into relation with the anteroposterior diameter of the
pelvic outlet
● Flexion
○ Chin is brought into more intimate contact with the fetal
thorax, and the appreciably shorter suboccipitobregmatic
diameter is substituted for the longer occipitofrontal diameter.
Answer: A. > or equal to 0.3 g in 24 hr urine sample
Rationale:
● Preeclampsia - Hypertension plus proteinuria:
○ >/= 300mg/24h (macroalbuminuria),
○ Urine protein:creatinine ratio >/= 0.3
○ Dipstick 1+ persistent
● Or hypertension plus:
○ Thrombocytopenia (<100,000/uL)
○ Renal Insufficiency (Crea >1.1 mg/dL or 2x)
○ Liver involvement (AST or ALT 2x)
○ Cerebral symptoms
■ Headache
■ Visual disturbances

60 The cardinal movement that brings the
occiput directly underneath the
symphysis pubis
A. Flexion
B. External rotation
C. Internal rotation
D. Descent
61 Mean arterial pressure is
A. Systolic BP + 1/3 Pulse Pressure
B. Diastolic BP + 2/3 Pulse
Pressure
C. Systolic BP + 1/3 Systolic minus
Diastolic BP
D. Diastolic BP + 1/3 Pulse
Pressure
62 Which is NOT a characteristic of Phase 1
of parturition:
A. Contractile tranquility
B. Occurs before implantation til
35-38 weeks AOG
C. Cervical rigidity
D. Functional changes in the
myometrium and cervix
■ Convulsions
○ Pulmonary edema
Source: Williams Obstetrics 25th ed.
Answer: C. Internal rotation
Rationale:
● Seven Cardinal Movements of Labor
○ Engagement - Passage of the widest diameter of the presenting
part to a level at or below the ischial spines
■ BPD (Biparietal diameter) passes thru the pelvic inlet
■ Floating – fetal head has not enter the pelvic inlet or go
beyond the level of ischial spines
■ Marks ONSET OF LABOR
○ Descent - Downward passage of the presenting part through the
Pelvis and is due to 4 forces:
■ Pressure of amniotic fluid
■ Pressure of fundal contractions
■ Maternal Effort
■ Straightening of fetal body
○ Flexion - Chin is brought into contact with the fetal thorax
■ OFD (occipitofrontal diameter - 11 cm)) shifts to SOBD
(suboccipitobregmatic diameter - 9.5 cm)
○ Internal Rotation - Occiput moves from original transverse oblique
position towards directly beneath the symphysis pubis
○ Extension - Chin is starting to distance away from the thorax. due
to 2 opposing factors:
■ Force exerted by the uterus - push occiput posteriorly
■ Resistance of pelvic floor - push fetal head anteriorly
○ External Rotation/Restitution - BSD to APD of pelvic outlet
■ Rotation of the head back to its original position brings the
BISACROMIAL DIAMETER of shoulder to be parallel with the
AP diameter of the pelvic outlet
○ Expulsion - Anterior shoulder is delivered first, followed by posterior
shoulder and the trunk.
■ Anterior shoulder escapes below the symphysis pubis → PULL
DOWNWARD TRACTION
■ Posterior shoulder sweeps over the perineum → PULL
UPWARD TRACTION
Source: Williams Obstetrics 25th ed.
Answer: D. Diastolic BP + 1/3 Pulse Pressure
Rationale:
● A common method used to estimate the MAP is the following formula:
○ MAP = (2 DBP + SBP)/3 or
○ MAP = DBP + 1/3(PP)
● Where DBP is the diastolic blood pressure, SP is the systolic blood
pressure, and PP is the pulse pressure.
Source: NIH - Physiology, Mean Arterial Pressure
Answer: D. Functional changes in the myometrium and cervix
Rationale:
● A- this phase 1 is characterized by uterine smooth muscle tranquility
with maintenance of cervical structural integrity.
● B- Following implantation, more than 95 percent of gestation is spent in
uterine quiescence.
● C- The initial stage of cervical remodeling- termed softening begins in
phase 1 of parturition. It is characterized by greater tissue compliance,
yet the cervix remains firm and unyielding. Cervical softening results
from increased vascularity, cellular hypertrophy and hyperplasia, and
slow, progressive compositional and structural changes in the
extracellular matrix.
● D- During phase 1 , the myometrial cells undergo a phenotypic

63 True regarding monozygotic twins
A. Always identical
B. Equal sharing of hormones
C. Result of teratogenic event
D. Less malformations compared
to dizygotic twins
64 Which is NOT a characteristic of Phase 1
of Parturition
A. Contractile tranquility
B. Occurs before implantation till
35-38 wks AOG
C. Cervical rigidity
D. Functional changes in the
myometrium and cervix
modification to a non contractile state, and uterine muscle is rendered
unresponsive to natural stimuli. Concurrently, the uterus must initiate
extensive changes in its size and vascularity to accommodate fetal
growth and prepare for uterine contractions.
○ Phase 2 myometrial changes prepare it for labor contractions.
This results from a shift in the expression of key proteins that
control uterine quiescence to an expression of
contraction-associated proteins.
○ Cervical modifications during phase 2 principally involve
connective tissue changes- termed cervical ripening. The
cervical matrix changes its total amounts of
glycosaminoglycans, which are large linear polysaccharides,
and proteoglycans, which are proteins bound to these
glycosaminoglycans.
Source: Williams Obstetrics 25th ed.
Answer: C. Result of teratogenic event
Rationale:
● Monozygotic or identical twins, although they have virtually the same
genetic heritage, are usually not identical. Namely, the division of one
fertilized zygote into two does not necessarily result in equal sharing of
protoplasmic material.
● Further, the process of monozygotic twinning is in a sense a
teratogenic event, and monozygotic twins have a higher incidence of
often discordant malformations
Source: Williams
Answer: D. Functional changes in the myometrium and cervix
Rationale:
65 A 13 year old female patient is brought to Answer: A. 10 mg a day in 4 divided doses until bleeding stops
the emergency room for profuse vaginal Rationale:
bleeding of 5 days consuming 3 diapers a
day. The patient had her menarche 3 prior
followed by 2 months of amenorrhea. to
control her acute bleeding episodes oral
conjugated estrogen may be given as
follows
A. 10 mg a day in 4 divided doses
until bleeding stops
B. 20 mg a day in 4 divided doses
until bleeding stops
C. 10 mg once a day until bleeding
stops
D. 2.5 mg once a day until bleeding
stops

66 A 30 year old call center agent came to Answer: C. Herpes genitalis

the clinic complaining of general malaise Rationale:
and fever, vulvar pain, pruritus, and
vaginal discharge. genital examination
shows tender inguinal lymphadenopathy
and vesicles and ulcers on the labia
majora. Most likely diagnosis?
A. Chlamydia infection
B. Chancroid
C. Herpes genitalis
D. Syphilis

67 The “gold standard” in the diagnosis and Answer: D. hysteroscopy

treatment of patients with intrauterine Rationale:
masses is: ● Saline infusion sonography is a simple, minimally invasive, and
A. Saline infusion sonography effective sonographic procedure that is superior to TVS in
B. Laparoscopy differentiating intracavitary lesions as being endometrial, submucous,
C. CT scan or intramural; however, it is not therapeutic.
D. Hysteroscopy ● Laparoscopy is a minimally invasive option for women undergoing intra
abdominal surgery. Laparoscopy with or without histologic examination
is the gold standard in diagnosing endometriosis, but not for
intrauterine masses.
● CT scan

68 A 26 year old teacher complains of foul
vaginal discharge after sexual intercourse
and during menses. The reason for the
odor is:
A. Increased number of anaerobes
B. Breakdown of blood or protein in
the semen
C. Release of amines in an alkaline
milieu
D. Increased number of E.coli
69 The microscopic feature of placenta
accreta:
A. Trophoblastic proliferation
B. Cicatrix
C. Absence of nitabuch layer
D. Hypertrophy of the decidua
70 A pregnant sexually active asymptomatic
woman had (+) RPR test result. A specific
syphilis (FTA-ABS) also yielded (+)
results. She was treated with 2.4M “u” of
benzathine test for penicillin. Expected
result would be:
A. FTA-ABS result to become
negative
B. RPR result to become negative
C. Chancre to develop
D. Rash to develop on her hands
and feet
● Hysteroscopy uses an endoscope and uterine cavity distending
medium to provide an internal view of the endometrial cavity. Its main
advantage is detection of intracavitary lesions that might be missed in
TVS or endometrial sampling and allows simultaneous removal of
lesions once identified.
Source: William’s Gynecology; Comprehensive Gynecology
Answer: C. Release of amines in an alkaline milieu
Rationale:
● Foul smelling vaginal discharge (described as musty or fishy) after
sexual intercourse or during menses is seen in Bacterial vaginosis. BV
is associated with alteration of the normal vaginal flora with marked
decrease of Lactobacilli and concurrent increase in anaerobes. While
there is an increased number of anaerobes in BV, this does not directly
explain the production of odor in circumstances presented.
● The fishy odor is caused by production of amines from anaerobic
bacteria. When vaginal alkalinity increases after sexual intercourse
(with the presence of semen) and during menses (with the presence of
blood), the odor becomes more prevalent.
● The anaerobes involved in BV are G. vaginalis, Prevotella species,
Mobiluncus species, A. vaginae, and other BV-associated bacteria. E.
coli is a part of the normal flora of the GI tract and is not associated
with BV.
Source: Comprehensive Gynecology, p. 538; Am Fam Physician. 2011 Apr
1;83(7):807-815
Answer: A. Trophoblastic proliferation
Rationale:
Source: AGS Year 2 Book of Notes
Answer: B. RPR result to become negative
Rationale:

71 A 27 year old woman with an IUD
consults for amenorrhea of 6 weeks
duration. A urine pregnancy test is
positive. You advise her that:
A. there is an increased risk for
congenital anomalies
B. the IUD may be left in place until
the 2nd trimester
C. The IUD should be removed to
decrease the risk for abortion
D. Prophylactic antibiotics should
be started immediately
72 Development of fetal external genitalia
into male is a result of:
A. Absence of androgens
B. Presence of androgens
C. Absence of estrogens
D. Presence of estrogens
73 A 19 year old student complains of
severe itching of her perineum, wrist, and
breast that worsens at night. On
examination, excoriations in all the above
areas, no hives visible. Most likely
diagnosis:
Source: Williams Obstetrics 25th ed.
Answer: C. The IUD should be removed to decrease the risk of abortion
Rationale:
● For women who conceive with an IUD, ectopic pregnancy should be
excluded. The IUD mechanisms of action are more effective in
preventing intrauterine implantation. Thus, if an IUD fails, a higher
proportion of pregnancies are likely to be ectopic.
● With intrauterine pregnancy, the tail should be grasped and the IUD
removed with gentle outward traction. This action reduces
complications such as abortion, chorioamnionitis, and preterm birth. If
the tail, however, is not visible, attempts to locate and remove the
device may result in abortion.
● After fetal viability is reached, it is unclear whether it is better to remove
the IUD whose strings are visible and accessible or to leave it in place.
Fetal malformations are not greater with a device left in situ.
● Pregnant women with a device in utero who demonstrate any evidence
of pelvic infection are treated with broad spectrum antibiotics and
prompt uterine evacuation.
Source: William’s Obstetrics 25th ed.
Answer: B. Presence of androgens
Rationale:
● Development of external genitalia in the male is under the influence of
androgens secreted by the testes and is characterized by rapid
elongation of the genital tubercle, which is now called the phallus.
Note: Please review the Embryology of the Male and Female Reproductive system
Source: Langman’s Embryology ch. 16 p. 261; AGS Book of Notes 1 B8M2L2
Answer: B. scabies
Rationale:
● Scabies
○ Parasitic infection of the itch mite, Sarcoptes scabiei
○ Transmitted by close contact
○ widespread over the body; no predilection for hairy areas.
 A. Allergy ○ A predominant clinical symptom of scabies is severe but
B. Scabies intermittent itching, more intense pruritus occurs at night
C. Molluscum contagiosum when the skin is warmer and the mites are more active.
D. Pityriasis rosea ○ may present as papules, vesicles, or burrows.
○ Pathognomonic sign of scabies infection is the burrow in the
skin.
■ Usually has the appearance of a twisted line on the
skin surface, with a small vesicle at one end
■ Any area of the skin may be infected, with the hands,
wrists, breasts, vulva, and buttocks being most
commonly involved.
Source: Comprehensive Gynecology

74 Which of the ff fetal head diameters is Answer: B or D (Not sure)

obstetrically the most important: Rationale:
A. Suboccipito-bregmatic ● Biparietal diameter
B. Biparietal ○ ~9.5 cm, the greatest transverse diameter of the head, extends
C. Bitemporal from one parietal boss to the other.
D. Occipitofrontal ○ The mechanism by which the biparietal diameter passes
through the pelvic inlet is designated engagement.
○ In the second trimester, the biparietal diameter (BPD) most
accurately reflects the gestational age, with a variation of 7 to
10 days.
● Occipitofrontal diameter
○ ~11.5 cm which follows a line extending from a point just
above the root of the nose to the most prominent portion of
the occipital bone.

Note: Hello guys, not sure with this answer since it was not explicitly stated in our
reference book and transes if which fetal head diameter is really the most
important.

75 The following placental hormones Answer: C. hCG

characteristically increase in levels Rationale:
towards term, EXCEPT: ● Human chorionic gonadotropin is secreted by the syncytiotrophoblasts
A. Estrogen of the placenta into both the fetal and maternal circulation. Plasma
B. Progesterone levels increase, doubling in concentration every 2-3 days between 60
C. hCG and 90 days of gestation. The average peak hCG level is approximately
D. Hpl 110,000 mIU/mL and occurs at 10 weeks’ gestation. Between 12 and 16
weeks, average hCG decreases rapidly with the concentration halving
every 2 days before reaching 25% of first trimester peak values. Levels
continue to fall from 16 to 22 weeks at a slower rate
● Estriol is first detectable in maternal serum at 9 weeks of gestation.
First detectable at approximately 0.05 ng/ml by 9 weeks, estriol
increases gradually to a range of approximately 10-30 ng/ml at term.
Between 35- and 40-weeks gestational age, estriol concentrations
increase sharply in a pattern that reflects a final surge of intrauterine
steroidogenesis just prior to term.
● From the luteal phase to term, maternal progesterone levels rise six- to
eight-fold. Although progesterone originates almost entirely from the
corpus luteum before 6 weeks' gestational age, its production shifts
more to the placenta after the 7th week. Beyond 10 weeks, the placenta
is the major definitive source of progesterone
● Human placental lactogen is responsible for the marked rise in
maternal plasma IGF-1 concentrations as the pregnancy approaches
term. Human placental lactogen exerts metabolic effects during
pregnancy via IGF-I. It is associated with insulin resistance, enhances
insulin secretion which stimulates lipolysis, increases circulating free
fatty acids, and inhibits gluconeogenesis; in effect, it antagonizes
insulin action.

76 The rate of hCG secretion is highest in Answer: D. Choriocarcinoma

 which of the following?
A. Multiple pregnancies
B. Ectopic pregnancy
C. H-mole
D. Choriocarcinoma
77 Production of this hormone ceases
completely during pregnancy
A. Adrenocorticotropic hormones
(ACTIN)
B. Parathyroid hormone
C. Thyroid hormone
D. Gonadotropin hormone
78 Which of the following changes during
pregnancy is abnormal?
A. Increase in gastric emptying
time
B. Increase in glomerular filtration
rate
C. Increase in cardiac output
D. Increase in serum creatinine
Rationale:
● During normal pregnancy, the beta hCG to hCG ratio appears constant
at approximately 0.5% after 5 weeks of gestation. β-hCG and estradiol
levels were more than two-fold increased in twins than in singletons.
● In contrast, gestational choriocarcinoma was characterized by absolute
serum beta hCG levels varying from three to 280 times greater than the
maximum values observed during pregnancy and by exceedingly high
beta hCG to hCG ratios.
● In complete hydatidiform mole, this ratio was intermediate between
normal pregnancy and choriocarcinoma.
Answer: D. Gonadotropin hormone
Rationale:
● Gonadotroph numbers decline, and corticotroph and thyrotroph
populations remain constant in pregnancy.
○ Gonadotroph
■ Basophilic cells of the anterior pituitary gland
specialized to secrete gonadotropins in response to
elevation in intracellular calcium concentration.
○ Thyrotrophs
■ Located in the anterior pituitary gland and secretes
thyroid-stimulating hormone (also known as
thyrotropin).
○ Corticotrophs
■ Cells in the anterior pituitary that release
adrenocorticotropic hormone (ACTH),
melanocyte-stimulating hormone (MSH), and
lipotropin.
● Parathyroid hormone (PTH)
○ Its release is stimulated by acute or chronic declines in
plasma calcium or acute drops in magnesium levels.
○ Bone resorption, intestinal absorption, and kidney reabsorption
■ Raise extracellular fluid calcium concentrations and
lower phosphate levels.
○ Required in pregnancy for fetal growth
■ Fetal skeletal mineralization requires approximately
30g of calcium, primarily during the third trimester
Answer: D. Increase in serum creatinine
Rationale:
Normal pregnancy:
● Serum creatinine
○ Decreases – due to glomerular hyperfiltration
○ Mean non-pregnancy serum creatinine level of 0.7mg/sL
declines during normal pregnancy to 0.5 mg/dL.
○ Values >/=0.9 mg/dL suggest underlying renal disease and
prompt further evaluation
○ Creatinine clearance in pregnancy averages 30% higher than
the 100 to 115 mL/min in non-pregnant women
● Gastric emptying time
○ Unchanged compared with nonpregnant women
○ During labor, and especially after the administration of
analgesics, gastric emptying time may be appreciably
prolonged.
● Cardiac output
○ Increases significantly during early pregnancy
○ Continues to rise and remains elevated during the remainder
of pregnancy
● Glomerular filtration rate
○ Both GFR and renal plasma flow increase early in pregnancy.
○ Rises by 25% by the second week after conception
○ Rises by 50% by the beginning of the second trimester

79 Which of the following is a characteristic
of a 32 week pregnancy?
A. Fetal weight of 500 grams
B. Non Viability
C. Lecithin to sphingomyelin ratio
of more than 2:1
D. Unengaged presenting part
80 Peripheral vascular resistance is
_________ throughout normal pregnancies:
A. Increased
B. Decreased
C. Unchanged
D. Variable
81 A patient who doesn't want to breastfeed
was complaining of breast engorgement
four days postpartum. Which of the
Two factors that causes hyperfiltration:
1. Hypervolemia-induced hemodilution lowers the protein concentration
and oncotic pressure of plasma entering the glomerular
microcirculation.
2. Renal plasma flow rises by approximately 80%before the end of the
first trimester.
Source: William’s Obstetrics 26th ed. ch. 4
Answer: D. Non-engaged presenting part
Rationale:
● Engagement
○ Passage of the biparietal diameter through the pelvic inlet (if in
an occiput presentation)
○ Fetal head may engage during the last few weeks of
pregnancy or not until after labor commences
○ In many multiparas and some nulliparas, the fetal head is
freely movable above the pelvic inlet at labor onset and is
often referred to as “floating.”
○ In this case, 32 weeks AOG is too early for engagement to occur
● Other choices:
○ Fetal weight of 500 grams - mean weight for 22 weeks AOG
○ Non Viability - early pregnancy loss within the first 12 6/7
weeks of gestation
○ Lecithin to sphingomyelin ratio of > 2:1 - characteristic of
mature fetal lungs
■ By 35 weeks of gestation, the mature surfactant has
been produced and is marked by a sharp increase in
the concentration of lecithin in the fetal lungs and
amniotic fluid
Source: William’s Obstetrics 26th ed.; Ogbejesi C, Tadi P. Lecithin sphingomyelin
ratio. In: StatPearls. StatPearls Publishing; 2022.
Answer: B. Decreased
Rationale:
● Cardiac output is increased as early as 5th week, reflecting ↓systemic
(peripheral) vascular resistance and ↑HR
○ During 1st stage of labor, cardiac output rises moderately
○ During the 2nd stage, greater rise with vigorous expulsive
efforts
● Brachial SBP, DBP, and central SBP decrease
● Resting pulse rate increases
● Between 10-20 weeks: plasma volume expansion begins, preload rises
→ larger left atrial volumes and ejection fractions
Source: Topnotch
Answer: A. Breast binding (Pwede din pero least likely siya since dapat well
fitting siya and not too tight)
Rationale:
● Breast engorgement is common in women who do not breastfeed. It is
 following will you LEAST likely typified by milk leakage and breast pain, which peak 3 to 5 days after
recommend to relieve discomfort? delivery. Up to half of affected women require analgesia for breast pain
A. Breast binding relief, and as many as 10 percent report severe pain for up to 14 days.
B. Analgesics ● Evidence is insufficient to firmly support any specific treatment
C. Ice packs (Mangesi, 2016). That said, breasts can be supported with a well-fitting
D. Nipple stimulation brassiere, breast binder, or sports bra. Cool packs and oral analgesics
for 12 to 24 hours aid discomfort. Pharmacological or hormonal agents
in general are not recommended to suppress lactation.
Source: William’s Obstetrics 26th ed. p. 642
● Reverse pressure softening can be a helpful remedy or preventative
measure if there is a great deal of swelling in the breast. Using gentle
pressure from one or two fingers around the nipple base can move
some of this swelling away from the nipple.
Source: American Pregnancy Association
(https://americanpregnancy.org/healthy-pregnancy/breastfeeding/nipple-pain-rem
edies/)

82 Which type of ectopic pregnancy often Answer: C. Interstitial

requires doing a total hysterectomy? Rationale:
A. Ampulla ● In a total hysterectomy, the uterus and cervix are removed.
B. Abdominal ○ Based on their locations, total hysterectomy can only be
C. Interstitial applied with interstitial pregnancy which can be found within
D. Isthmic the proximal intramural portion of the fallopian tube.
■ Ampullary pregnancies are the most common type
(70%) and may be removed surgically by
salpingostomy (unruptured pregnancy that is < 2cm)
or salpingectomy (complete excision of the fallopian
tube).
■ Abdominal pregnancies (1%) are located in the
peritoneal cavity exclusive of tubal, ovarian, or
intraligamentary implantations. Principal surgical
objectives are delivery of the fetus and careful
assessment of placental implantation without
provoking hemorrhage.
■ Isthmic pregnancies (12%) may be removed by
salpingostomy (less preferred due to high rate of
recurrence of ectopic pregnancy) or by partial or total
salpingectomy (more preferred).

83 Rupture of an ectopic pregnancy occurs
late in which type of ectopic pregnancy?
A. Ampullary
B. Abdominal
C. Interstitial
D. Cervical
84 Which of the following is a characteristic
of complete hydatidiform moles?
A. Presence of fetal RBC
B. Slight trophoblastic proliferation
C. Uterine size larger for
gestational age in half of cases
D. Low potential for malignant
sequelae
85 In the follow up of patients after
evacuation of molar products, which of
the following is most important?:
A. Uterine size
B. hCG titers
C. Chest radiographs
D. Liver function tests
Source: OB Platinum 1st ed. p.192-195
Answer: C. Interstitial
Rationale:
● Interstitial ectopic pregnancy usually rupture following 8-16 weeks of
amenorrhea, which is later than for more distal tubal pregnancies.
Answer: C. Uterine size larger for gestational age in half of cases
Rationale:
Answer: B. hCG titers
Rationale:
● Monitoring of hCG levels remains to be the mainstay in the diagnosis of
any malignant sequelae following a molar pregnancy.
● Serum ß-hCG level is measured 1 week after molar evacuation, then
every 2 weeks until the level becomes normal (<5miu/ml). After 3
consecutive biweekly normal levels, the monitoring is every month for 6
months, then at two monthly intervals for the next six months to insure
that the hCG levels remain undetectable for one year following
remission.

86 Of the following, which is most likely to
develop into choriocarcinoma?
A. Normal term pregnancy
B. Incomplete abortion
C. Ectopic pregnancy
D. Hydatidiform mole
87 What is the most common cause of
primary amenorrhea?
A. Enzyme deficiency
B. Gonadal failure
C. Hypothalamic failure
D. Pituitary failure
Source: Philippine Society for the Study of Trophoblastic Diseases CPG on Molar
Pregnancy
Answer: D. H. Mole
Rationale:
● Choriocarcinoma occurs in 1 out of 40 hydatidiform moles and in 1 out
of 20,000-40,000 pregnancies
● May arise from all types of pregnancies however in 50% of cases it is
preceded by a molar pregnancy
Source: Smith HO, Kohorn E, Cole LA. Choriocarcinoma and gestational
trophoblastic disease. Obstet Gynecol Clin North Am. 2005 Dec. 32(4):661-84
Answer: B. Gonadal failure
Rationale:
● Amenorrhea Classification:
1. Primary - no prior menses
■ The absence of menses in a woman who has never
menstruated by the age of 15 years in the presence of
normal growth and secondary sexual characteristics
■ Girls who have not menstruated within 5 years of
breast development, if occurring by age 10.
■ Breast development (thelarche) should occur by age
13 or otherwise requires evaluation as well.
2. Secondary - cessation of menses
■ Absence of menses for an arbitrary period, usually
longer than 6 to 12 months

88 What is the most frequent antecedent
factor of intrauterine adhesions?
A. Diagnostic curettage
B. Endometrial curettage
associated with pregnancy
C. Metroplasty
D. Myomectomy
89 The LEAST preferred method of hormonal
contraception in lactating mothers:
A. Estrogen progestin
contraceptives
B. “Mini-pills”
C. Progestin implants
D. Medroxyprogesterone depot
(injectable)
90 A 48 year old woman presents with hot
flashes and irregular bleeding for 12
months. She is very bothered by the hot
flashes and insists that she needs
medications. What treatment would be
most appropriate?
A. Estrogen cream
B. Continuous combined estrogen
and progesterone therapy
C. Endometrial biopsy
Source: Williams Gynecology; Topnotch
Answer: B. Endometrial curettage associated with pregnancy
Rationale:
● Intrauterine Adhesions
○ Also known as uterine synechiae and, when symptomatic, as
Asherman syndrome
○ Spectrum of scarring includes filmy adhesions, dense bands,
or complete obliteration of the uterine cavity
○ Endometrial damage may follow vigorous curettage, usually in
association with postpartum hemorrhage, miscarriage, or
elective abortion complicated by infection.
■ Endometrial curettage from pregnancy is the most
frequent antecedent factor of IUA.
○ Damage may also result from other uterine surgery, including
metroplasty, myomectomy, or cesarean delivery, or from
infection related to an intrauterine device.
Source: Williams Gynecology; Topnotch
Answer: A. Estrogen progestin contraceptives
Rationale:
● Combination estrogen–progesterone oral contraceptive pills (OCPs) in
some studies have been shown to decrease milk production, so they
are usually recommended only to those women who are not interested
in breastfeeding or have excellent milk production (not usually known
during the first week postpartum).
● For women who decline LARC, who are interested in hormonal modes
of contraception, and who are breastfeeding, the progesterone-only mini
pill or Depo-Provera is the usual recommended options
● First-line contraception is long-acting reversible contraception (LARC)
usually of an intrauterine device (IUD) or an implantable progestin.
● Medroxyprogesterone acetate is a hormonal medication of the
progestin type. Early administration of progesterone-only
contraceptives do not impair lactation and may actually increase quality
and duration of lactation.
Source: Blueprints Obstetrics & Gynecology
Answer: B. Continuous combined estrogen and progesterone therapy
Rationale:
● Menopausal hormone therapy (MHT) includes both estrogen therapy
(ET) and estrogen + progesterone therapy (EPT). Both ET and EPT
successfully treat the bothersome symptoms of menopause. The use of
unopposed estrogen is contraindicated in women with a uterus and
requires the addition of a suitable progestin to prevent increased
incidence of endometrial intraepithelial neoplasia (EIN), endometrial
hyperplasia, and endometrial cancer
Source: Blueprints Obstetrics & Gynecology
 D. Hysterectomy

91 What is the most popular theory to Answer: C. Retrograde Menstruation

explain the pathogenesis of
endometriosis?
A. Coelomic metaplasia
B. Iatrogenic dissemination
C. Retrograde menstruation
D. Vascular metastasis
Rationale:
● Definitive cause of endometriosis remains unknown, but the most
favored one describes retrograde menstruation through the fallopian
tubes (Sampson Theory)
● Retrograde Menstruation: Implantation of endometrial cells shed during
menstruation, growing as homologous grafts under hormonal influence
● Lymphatic and Vascular Dissemination: The endometrium is
transplanted via lymphatic and the vascular system. Best explains
endometrial implants found in remote sites.
● Metaplasia: Endometriosis arises from metaplasia of the coelomic
epithelium or proliferation of the embryonic rest
● Iatrogenic: Endometrial glands and stroma are implanted during
surgical procedure.

92 What congenital anomaly results from in Answer: C. Vaginal adenosis

utero exposure of a female fetus to DES? Rationale:
A. Imperforate hymen ● DES-Induced reproductive tract abnormalities
B. Transverse vaginal septum ○ In Mid 1900s- DES was often prescribed for pregnancy-related
C. Vaginal adenosis problems
D. Vaginal agenesis ○ DES: is a synthetic, non-steroidal estrogen
○ Vaginal adenosis (which eventually develops to clear cell
adenocarcinoma)- are columnar epithelial cells that reach the
vaginal area
■ It appears red, punctuate, and granular
■ It is the usual reproductive tract abnormality seen in
DES exposure

93 A 36-year-old female sought consult for a Answer: C. Urethral diverticula

mass in the periurethral area. On physical Rationale:
examination, clear fluid can be noted to
emerge from the urethral meatus on
applying pressure at the lower anterior
vagina. What is the most probable
diagnosis?
A. Skene’s duct cyst
B. STI
C. Urethral diverticula
D. Urethral caruncle
94 A 48 yo. Single, obese, female consulted Answer: B. II
for on and off profuse vaginal bleeding. Rationale:
UTZ examination revealed an endometrial
mass measuring 4x5 cm extending into
the endocervical canal with obscured
endometrial halo. A fractional curettage
was done which revealed endometrioid
adenocarcinoma moderately
differentiated on both the endometrial
and endocervical specimens. Based on
the curettage results, what is the clinical
stage of the disease?
A. I
B. II
C. III
D. IV

95 What is the recommended management Answer: C. RHBSO, PFC, BLND, PALS

for this case? Rationale:
A. EHBSO, PFC, BLND, PALS ● Patients with endometrial cancer should undergo hysterectomy, BSO,
(Para-aortic lymph node and surgical staging using the revised FIGO system.
sampling) ○ Simple or extrafascial hysterectomy is sufficient for Stage I
B. Radiation therapy followed by ○ Radical hysterectomy may be preferable for patients with
EHBSO clinically obvious cervical extension (Stage II) of endometrial
C. RHBSO, PFC, BLND, PALS cancer
D. Chemotherapy ○ Upon entering the peritoneal cavity, washings are obtained by
pouring 50 to 100 mL of sterile saline into the abdomen,
manually circulating the fluid, and collecting it for cytologic
assessment.
○ Complete surgical staging with pelvic and paraaortic
lymphadenectomy is recommended by ACOG for ALL patients
with endometrial cancer
○ ALL PATIENTS SHOULD UNDERGO THE 2009 FIGO SURGICAL
STAGING AFTER APPROPRIATE INVESTIGATION AND
CLEARANCE, EXCEPT THOSE WITH
■ Poor surgical risk (morbid obesity, severe
cardiopulmonary disease) or with far advanced
disease who will undergo primary complete
 radiotherapy with or without chemotherapy followed
by appropriate surgery.
■ Take note of the keyword morbid/massive obesity
(BMI ≥35) because it is different from obese (BMI
≥30). Patient was only described as obese and thus
has no contraindication for surgical staging.
● Radiation therapy
○ Usually considered only in rare instances in which a patient is
an exceptionally poor surgical candidate.
● Chemotherapy
○ Cytotoxic chemotherapy is frequently combined, sequences, or
sandwiched with radiotherapy in patients with advanced
endometrial cancer following surgery
Note:
● EHBSO: Extrafascial Hysterectomy with Bilateral
Salpingo-oophorectomy
● RHBSO: Radical Hysterectomy with Bilateral Salpingo-oophorectomy
● PFC: Peritoneal Fluid Cytology
● BLND: Bilateral Lymph Node Dissection
● PALS: Para-aortic lymph node sampling

96 A 60 y.o. female was diagnosed with Answer: C. Radical right hemivulvectomy

lichen sclerosus of the vulva 3 years ago Rationale:
but was lost to follow up. She recently ● Squamous cell cancer of the vagina arises within its stratified non
developed a non healing ulcerative lesion keratinized epithelium.
on the right labia majora measuring 1x1 ● Based on the FIGO staging below, the stage of the vulvar cancer is still
cm. Biopsy lesion revealed squamous at Stage IA since the size of the lesion is <2cm. Thus its corresponding
cell carcinoma in situ. What is the management is radical hemivulvectomy only without
recommended surgical treatment?: lymphadenectomy.
A. Radical vulvectomy with bilateral
inguinal lymphadenectomy
B. Radical right hemivulvectomy
with right inguinal
lymphadenectomy
C. Radical right hemivulvectomy
D. Radical vulvectomy
97 Luteal phase defects are ovulatory
disorders that can be a cause of
infertility. Which of the following
laboratory tests is helping in making this
diagnosis?
A. Day 14 serum estradiol levels
B. Day 14 serum LH levels
C. Day 21 endometrial biopsy
D. Day 21 FSH levels
98 A 32 year old woman and her husband
consult you for infertility for 2 years. Both
the transvaginala and semenanalysis
results are normal. You contemplate on
doing a Hysterosalpingogram. If the
woman has a 28-day cycle, when would
be the best time to perform the
procedure?
A. Day 3
B. Day 8
C. Day 14
D. Day 21
99 It is the erotic or romantic attraction for
sharing sexual expression with the
opposite sex, one’s own sex, or both
sexes:
A. Sexual behavior
B. Sexual practices
C. Sexual orientation
D. Sexual identity
Answer: B. Day 14 serum LH levels
Rationale:
● Monitoring of BBT or urinary LH surge detection, and monitoring of
luteal length, may substantiate normal ovulation and adequate luteal
length.
● The average luteal phase length is 14 days, with a normal variation of
11–17 days.
● A short luteal phase has been described as an interval of less than
9–11 days from the LH peak to the onset of menstrual flow
Answer: B. Day 8
Rationale:
● It is a radiographic tool that can display the shape and size of the
uterine cavity and define tubal status. Hysterosalpingography is
generally performed on cycle days 5 through 10. At this time, few
intrauterine clots should remain to block tubal outow or give the false
impression of an intrauterine abnormality. Furthermore, a woman
theoretically has not ovulated or possibly conceived. For this test,
iodinated contrast medium is infused through a catheter placed into the
uterus. With fluoroscopy, dye is visually followed as it fills the uterine
cavity, then the tubal lumen, and finally spills out of the tubal fimbria
into the pelvic cavity.
Answer: C. Sexual Orientation
Rationale:
● Sexual Orientation
○ Used to refer to a person's pattern of emotional, romantic, and
sexual attraction to people of a particular gender (male or
female)
○ A person's identity in relation to the gender or genders to which
they are sexually attracted; the fact of being heterosexual,
homosexual, bisexual, etc.
● Sexual Practice
○ Activities associated with sexual intercourse
● Sexual Behavior
○ Refers to a broad spectrum of behaviors in which humans
display their sexuality
○ These behavioral expressions contains both biological
elements and cultural influences and involves sexual arousal
(with its physiological changes, both pronounced and subtle, in
the aroused person).
○ Sexual behavior ranges from the solitary (such as
masturbation and autoerotic stimulation) to partnered sex
(intercourse, oral sex, non-penetrative sex, etc.) that is
engaged in periodically
 ● Sexual Identity
○ Pattern of a person’s biological sexual characteristics:
chromosomes, external genitalia, internal genitalia, hormonal
compositions, gonads, secondary sex characteristics
Source: Kaplan and Sadock’s Synopsis of Psychiatry ch. 17 Human Sexuality and
Sexual Dysfunctions

100 A form of tubal ligation where the Answer: C. Kroener

fimbriated end of the fallopian tube is Rationale:
resected and the distal end is ligated:
A. Parkland
B. Irving
C. Kroener
D. Uchida