FEU Gyne Ratio Finals COMPLETE 1

GYNECOLOGYFINALSAPRIL 2016 MEDICINE 2017
ABNORMAL UTERINE BLEEDING

Questions & Answers Ratio
1. GF consulted because of profuse vaginal bleeding
consuming 2 adult diapers per day occurring at FORMS OF UTERINE BLEEDING
regular intervals, what form of abnormal uterine Infrequent Amenorrhea- no menses for at least 6 months
bleeding does the patient have? episodes
Oligomenorrhea-interval between bleeding vary
a. Oligomenorrhea from 35 days to 6 mos.
b. Metrorrhagia Frequent interval Metrorrhagia- uterine bleeding occurring at
c. Menorrhagia irregular but frequent intervals in variable amount
d. Menometrorrhagia Polymenorrhea- uterine bleeding occurring at
regular intervals less than 21 days
ANSWER: C Excessive flow or Menorrhagia/ hypermenorrhea- prolonged >7 days
Prolonged or excessive >80 mL bleeding occurring at regular
duration intervals
Menometrorrhagia- prolonged uterine bleeding
occurring at irregular intervals
Intermenstrual Bleeding of variable amounts occurring between
bleeding regular menstrual period
2. S.T. 45 year old, G5P5 was seen at the ER because

of heavy menstrual bleeding. Internal Problem: SYMMETRICALLY enlarged uterus
examination revealed a symmetrically enlarged
Leiomyoma
boggy uterus. What is the most likely cause?
a. Leiomyoma Diagnosis of Myoma: Clinically, the diagnosis of uterine myomas is usually
b. Adenomyosis confirmed by physical examination. Upon palpation, an enlarged, firm,
c. Endometrial polyp irregular uterus may be felt.
d. Placental polyp
Adenomyosis- growth of endometrial glands &stroma into the uterine
ANSWER: B myometrium to a depth of at least 2.5mm from the basalis layer of
endometrium. Sometimes called internal endometriosis. On PE: uterus
DIFFUSE ENLARGEMENT, globular usually 2-3x normal size.
Endometrial Polyp - Localized overgrowths of the endometrial glands and

stroma projecting beyond the endometrial surface
3. A 15 year old presented at the ER with heavy Problem: PALE PALPEBRAL CONJUNCTIVA with stable vital signs
menstrual bleeding. She has pale palpebral Diagnosis of AUB
conjunctivae with stable vital signs. What • Thorough history: frequency, duration and amount of bleeding
INITIAL test should be done? • Indirect assessment of MBL, Hgb concentration, serum iron levels, serum
a. Complete blood count ferritin
b. Pelvic ultrasound • Other laboratory test:
c. HCG determination o hCG determination
d. Blood coagulation studies o TSH and prolactin
o Screening for coagulation defects
ANSWER: A o Document ovulation: serum progesterone, endometrial biopsy
o Pelvic sonography
o Investigate endometrial cavity: hysteroscopy or SIS
o Dilatation and curettage
Note: first rule out the possibility of pregnancy à do pregnancy testing
INITIAL test to be done since the patient showed sign of anemia.
COMPLETE BLOOD COUNT - assess rbc count, hemoglobin and hematocrit
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4. A 34 year old was administered with this PROGESTINS for DUB
medication for 3 months to treat her DUB.
She experienced weight gain and has
deranged lipid profile. What medication is
the MOST likely cause?
a. Progesterone
b. Combined OCP
c. Danazol
d. GnRh agonists
ANSWER: A.
Ergot Androgenic steroids for DUB
GnRH agonists for DUB
5. Which of the condition is NOT a systemic cause of

abnormal uterine bleeding?
a. Prothrombin deficiency
b. Idiopathic thrombocytopenia
c. Non - Hodgkin's Lymphoma
d. Hypersplenism
Answer: C
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6. D.W. sought consult because of profuse vaginal

bleeding. Which medication is the BEST option to
treat the acute bleeding?
a. Combined Oral Contraceptive Pills

b. Progesterone
c. Ergots
d. GnRH agonists
ANSWER: A
7. What is the BEST option for long term treatment of

a 17 - year old girl with anovulatory dysfunctional
bleeding.
a. Conjugated equine estrogen

b. Combined Oral Contraceptive Pills
c. Progestins
d. Danazol
ANSWER: C
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8. A 45 year old nulligravid underwent endometrial

endometrial curettage because of heavy menstrual
bleeding. Histopathology result revealed complex
hyperplasia with atypia. What is the IDEAL
management?
a. High dose progestin

b. GnRH agonist
c. Endometrial ablation
d. Hysterectomy
ANSWER: D
BENIGN GYNECOLOGIC LESIONS

9. Which of the following case profiles of women can Bartholin’s Duct Cyst
be diagnosed to have Bartholin’s duct abscess?  Most common large cyst of the vulva
A. 55 y/o with LMP 4 years ago has fleshy  Bartholin’s Glands: rounded, pea-sized glands deep in the
outgrowth at distal urethral edge perineum
B. 40 y/o with LMP 2 weeks ago has 3x4cm  At entrance of vagina at 5 & 7 o’clock
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tender mass at lower 3 right labia majora  Bartholin’s Gland Duct is ~2cm long, open in a groove between
C. 35 y/o with LMP 3 weeks prior has 3x3cm firm hymen & labia minora in posterior lateral wall of vagina
mass upper half left labia majora  Could be obstruction of duct secondary to non-specific
D. 20 y/o with regular menses has 0.8 multiple inflammation or trauma
small aggregate fluctuant mass vulva  Normally, gland is not palpable
 Mostly are asymptomatic
 No treatment in women <40 y/o unless infected or symptomatic
Answer: B  Treatment of Choice for symptomatic or infected cases:
Marsupialization
 In women >40 y/o, marsupialization & biopsy is performed to
exclude adenocarcinoma of the Bartholin’s gland
Urethral Caruncle
 Small, fleshy outgrowth
 Distal edge of the urethra
 Most frequently in postmenopausal women
 Secondary to chronic irritation or infection
 Classified according to histologic appearance: Papillomatous,
Granulomatous, Angiomatous
 Majority are asymptomatic
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 Diagnosis through biopsy
 Initial therapy: Oral or Topical Estrogen; Avoidance of Irritation
Fibroma
 Most common benign solid tumor of vulva
 Commonly found in the labia majora (usual location: upper half)
 Slow growing but may attain gigantic portion
 Low-grade for becoming malignant
 Treatment: Operative Removal
Vulvar Epidermal Inclusion Cyst

 Most inclusion cysts of the vulva are not related to trauma
 Alternative theories of histogenesis: embryonic remnants &
occlusion of pilosebaceous duct of sweat glands
 Histology: characterized by an epithelial lining of keratinized,
stratified squamous epithelium with a center of cellular debris
that grossly resembles sebaceous material
 Most vulvar epidermal cysts do not have sebaceous cells or
sebaceous material identified on microscopic examination
 Usually there are multiple cysts, with the majority being less
than 1 cm in diameter
 These cysts are asymptomatic unless they are secondarily infected
SOURCE: Benign Gynecologic Lesions (MRA trans), Comprehensive

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Gynecology 6 edition
10. A 37 year old female consulted due to dysuria, Urethral Diverticulum

dyspareunia & dribbling of urine. With compression of  A permanent, epithelialized, sac-like projection arising from the
the urethra, a purulent material was expressed. What posterior urethra
is the most likely diagnosis?  Maybe congenital or acquired
A. Gartner’s duct cyst  Symptoms:
B. Skene’s duct cyst o urinary urgency
C. Urethral Caruncle o frequency
D. Urethral Diverticulum o dysuria
 Diagnostic tool:
o Cystourethrography (better for demonstration of
Answer: D outpouching)
o Cystourethroscopy
o Urinalysis ( to rule out UTI)
 Differential Diagnosis: UTI, Gartner’s Duct Cyst, Ectopic ureter that
empties into urethra, Skene’s glands cysts
 Management:
o Excisional Surgery
 Done when not acutely infected
 Complications: urinary incontinence &
urethrovaginal fistula
o Marsupialization
 If located in the distal third of the urethra
Dysontogenic Cysts
 Thin-walled soft cyst of embryonic origin
 Types:
o Gartner’s Duct Cyst: from mesonephros
o Mullerian cyst: from perimesonephrium
o Vestibular cyst: from urogenital sinus
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 Mostly asymptomatic
 Operative excision indicated for chronic symptoms
o Marsupialization: for infected cases
o Excision: for uninfected cases
Skene’s Duct Cyst

 Rare
 Usually small
 May present with symptoms of discomfort or be found on routine
examination
 Arise secondary to infection & scarring of the small ducts
 Differential Diagnosis: Urethral Diverticula
 Clinically, physical compression of the cyst should not produce
fluid from the urethral meatus
 Asymptomatic cysts in premenopausal women may be managed
conservatively
 Treatment: Excision with careful dissection to avoid urethral injury
Urethral Caruncle
 Small, fleshy outgrowth
 Distal edge of the urethra
 Most frequently in postmenopausal women
 Secondary to chronic irritation or infection
 Classified according to histologic appearance: Papillomatous,
Granulomatous, Angiomatous
 Majority are asymptomatic
 Diagnosis through biopsy
 Initial therapy: Oral or Topical Estrogen; Avoidance of Irritation
SOURCE: Benign Gynecologic Lesions (MRA trans); Comprehensive

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Gynecology, 6 edition
11. A 43 year old housewife consulted due to Endocervical & Cervical Polyps
postcoital bleeding for the past 3 weeks. On  Most common benign neoplastic growths of the cervix
speculum exam, a 0.5x0.5cm pale pink mass is  Most common in multiparous women in their 40’s & 50’s
protruding through the cervical os, which bled with  Majority of polyps are smooth, soft, reddish purple to cherry red,
touch. What would be the appropriate and fragile
management?  They readily bleed when touched
A. Insertion of luminaria tent  Endocervical polyps may be single or multiple and are a few
B. Polypectomy millimeters to 4 cm in diameter
C. Wide excision  The stalk of the polyp is of variable length and width
D. No treatment necessary  Polyps may arise from either the endocervical canal (endocervical
polyp) or ectocervix (cervical polyp)
o Endocervical polyps are more common than are cervical
Answer: B polyps. Polyps whose base is in the endocervix usually
have a narrow, long pedicle and occur during the
reproductive years
o Polyps that arise from the ectocervix have a short, broad
base and usually occur in postmenopausal women
 Classic symptom of an endocervical polyp is intermenstrual
bleeding, especially following contact such as coitus or a pelvic
examination
 Histologic Subtypes:
o Adenomatous (80%)- Cystic
o Fibrous- Vascular
o Inflammatory- Fibromyomatous
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 Malignant degeneration: Rare
 Management: Polypectomy

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12. Which of the following statements is/are true Endometrial Polyp
regarding endometrial polyp?  Localized overgrowths of endometrial glands & stroma projecting
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A. Peak age incidence is the 4 decade of life beyond endometrial surface
B. Secondary to gynecologic surgery  Peak age incidence: 40-49 years
C. Malignant degeneration is not common  Cause: unknown
D. A & C only  Mostly are asymptomatic, detected by sonography
E. All of the above  Common manifestation: Abnormal Uterine Bleeding
 3 histological components: Endometrial Glands, Endometrial
Stroma, Central Vascular Channels
Answer: C  Malignancy in an endometrial polyp is related to patient’s age and
is most often of a low stage and grade
o Overall the incidence of malignancy is 3% to 4%
o The question of an association with endometrial polyps
and endometrial carcinoma is still debated
 Increase Risk of subsequent Endometrial Cancer in women with
Endometrial Polyp is 2-fold
 Differential Diagnosis:
o Submucous leiomyoma
o Adenomyoma
o Retained products of conception
o Endometrial hyperplasia
o Endometrial carcinoma
o Uterine sarcoma
 Management: Removal by Hysteroscopy with D & C

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13. A 20 year-old sexually active nulligravid Hematometra
st
complained of pelvic pain every 1 week of the  Uterus is distented with blood secondary to gynatresia (failure of
month. She has not had her menarche yet. part of vaginal canal to develop)
Pregnancy test is negative. Which step/s will be  Usually suspected by history of amenorrhea & cyclic abdominal
appropriate to identify the cause? pain
A. Request for ultrasound  Common Congenital causes:
B. Perform cystourethroscopy o Imperforate hymen
C. Conduct a thorough physical examination o Transverse vaginal septum
D. A & C only o Congenital absence of the cervix, vagina
E. All of the above  Common Acquired causes:
o Senile atrophy of endocervical canal & endometrium (can
become so thin that it can easily bleed)
Answer: D o Scarring of the isthmus by synechiae
o Cervical stenosis associated to surgery, radiation therapy,
cryotherapy or electrocautery, endometrial ablation
o Malignant disease of endocervical canal (masses that
block outflow)
 Pelvic Exam: mildly tender, globular uterus
 Diagnosis: Confirmed by Ultrasonography
o Probe the cervis with dilator & with release of dark
brownish black blood
 Management: depends on the operative relief of lower genital
obstruction
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SOURCE: Benign Gynecologic Lesions (MRA trans)

14. Which of the following management scheme is Pruritus
appropriate among women complaining of pruritus?  Single most common gynecologic problem
A. Improve local hygiene  It is a symptom of intense itching with an associated desire to
B. Treat offending cause scratch and rub the affected area
C. Perform wide excision biopsy  Not uncommonly, secondary vulvar pain develops in association or
D. A & B only subsequent to pruritus
E. All of the above  In some women pruritus becomes an almost unrelenting
symptom, with the development of repetitive “itch-scratch” cycles
o The itch-scratch cycle is a complex of itching leading to
Answer: D scratching, producing excoriation and then healing
o The healing skin itches, leading to further scratching.
 Pruritus is a nonspecific symptom
 The differential diagnosis includes a wide range of vulvar diseases,
including skin infections, sexually transmitted diseases, specific
dermatosis, vulvar dystrophies, lichen sclerosus, premalignant and
malignant disease, contact dermatitis, neurodermatitis, atrophy,
diabetes, drug allergies, vitamin deficiencies, pediculosis, scabies,
psychological causes, and systemic diseases such as leukemia and
uremia
 The management of pruritus involves establishing a diagnosis,
treating the offending cause, and improving local hygiene
 For successful treatment the itch-scratch cycle must be
interrupted before the condition becomes chronic, resulting in
lichenification of the skin, lichen simplex chronicus
 During the latter process the skin becomes white, thickened, and
“leathery”
 The resulting dry, scaly skin frequently cracks, forms fissures, and
becomes secondarily infected, thus complicating the treatment.
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SOURCE: Comprehensive Gynecology, 6 edition
15. Which of the following women can be typically Leiomyoma
diagnosed with leiomyoma uteri?  Benign tumors of muscle cell origin
A. 50 y/o G4P4 with the uterus which enlarged  The most frequent pelvic tumor and the most common tumor in
4x greater than normal in 3 months women
 Highest prevalence: 5 decade
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B. 45 y/o nulligravid, obese with asymmetrically
enlarged uterus to 3 months size o Found in 30-50% of perimenopausal women
C. 35 y/o G1P1 previous CS with globular uterus  Symptomatic leiomyomas are primary indication for ~30% of all
3x diffusely enlarged than normal hysterectomies
D. 25 y/o nulligravid with enlarged uterus, cyclic  Malignant transformation is 0.3-0.7%
pelvic pain and scanty menses o usually into a Sarcoma
 Risk Factors:
o Increasing age
Answer: B o Early menarche
o Low parity
o Tamoxifen use
o Obesity
o High fat diet
 3 most common types:
o Intramural
o Subserous
 Problematic if located near uterine vessels
 Difficult to remove due to excessive bleeding
 Knobby or pedunculated
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o Submucous
 Most likely to cause bleeding
 Distortion of uterine cavity causing infertility or
abortion
o Other types: Intraligamentary & Parasitic myomas (both
extremely problematic)
 Clinical Characteristics:
o Rare before menarche, diminish in size after menopause
o Enlarges during pregnancy & OCP use
 Gross Appearance:
o Lighter in color than the normal myometrium
o Cut surface: Glistening,m pearl-white with smooth muscle
arranged in trabeculated or whorl configuration
 Histologic Appearance:
o Proliferation of mature smooth muscle cells
o Nonstriated muscle fibers are arranged in interlacing
bundles with variable amount of fibrous connective tissue
in between
 Clinical manifestations:
o Most common symptoms:
 Pressure from an enlarging mass
 Pain including dysmenorrhea
 Abnormal uterine bleeding
o Rapid growth after menopause: consider
Leiomyosarcoma
 Diagnosis:
o Physical examination (Internal examination)
 Palpation of an enlarged, firm, irregular uterus
o Ultrasonography
o Hysteroscopy
o CT scan or MRI
 Differential Diagnosis:
o Pregnancy
o Adenomyosis
o Ovarian Neoplasm
 Management:
o Observation (for small & asymptomatic)
o Operative:
 Myomectomy
 Hysterectomy (best to remove vaginally)
o Medical
 GnRH Agonists
 Danazol
 Medroxyprogesterone Acetate
 RU 486
o Uterine artery embolization
o Gelatin sponge (Gelfoam) silicon spheres
o Metal coils
o Polyvinyl alcohol (PVA) particles
o Gelatin microspheres
Adenomyosis (Endometriosis Interna)

 Histologically defined as: presence of endometrial glands &
stroma within the myometrium more than one low power field
(2.5 mm) from the basalis layer
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 Clinical Presentation:
o Over 50% are asymptomatic
o Symptomatic cases: between ages of 35-50 y/o
 Classic symptoms:
o Secondary dysmenorrhea
o Menorrhagia
 Diagnosis:
o Pelvic examination findings
 Uterus is diffusely enlarged, globular, usually 2-3x
normal size
o Diagnosis confirmed following histologic examination of
hysterectomy specimen

16. A 32 year old G1P0 (0010) diagnosed with an 8 cm Classic indications for a myomectomy:
subserous myoma uteri is complaining of pelvic pain  Persistent abnormal bleeding
& heaviness. What is the most appropriate  Pain or pressure
management?  Enlargement of an asymptomatic myoma to more than 8 cm in a
A. Medical management with woman who has not completed childbearing
medroxyprogesterone acetate
B. Total abdominal hysterectomy Contraindications to a myomectomy
C. Hysteroscopy guided myomectomy  Pregnancy
D. Myomectomy performed through  Advanced adnexal disease
laparotomy  Malignancy
 Situation in which enucleation of the myoma would severely
reduce endometrial surface so that the uterus would not be
Answer: D functional
Indications for Hysterectomy

 All indications for myomectomy
PLUS
 Asymptomatic myomas when the uterus that has reached the size
of 14-16 weeks gestation
 Rapid growth of uterine myomas after menopause
o This is the classic symptom of a leiomyosarcoma, and
thus the patient should have a total abdominal
hysterectomy so that the tissue may be examined
histologically
Submucous myomas may be resected via the cervical canal using the
hysteroscope
Disadvantages of Pre-operative GnRH Agonist Treatment

 Delay to final tissue diagnosis
 Degeneration of some myomas, necessitating piecemeal
enucleation at myomectomy
 Hypoestrogenic side effects (Trabecular bone loss, Vasomotor
symptoms)
 Cost
 Need to self-administer or receive injections in many cases
 Vaginal hemorrhage in approximately 2% of patients
 The majority of the reduction in size occurs within the first 3
months. After cessation of therapy, myomas gradually resume
their pretreatment size. By 6 months after treatment, most
myomas will have returned to their original size
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17. A 28 year old female with her LMP 2 weeks ago Paratubal Cysts
followed up with her ultrasound result which  They are often multiple and may vary from 0.5 cm to more than
showed an adnexal mass on the right lateral aspect 20 cm in diameter
of the uterus 3x3cm thin-walled cystic. Which of the  Most cysts are small, asymptomatic and slow growing
 Discovered during: 3 & 4 decades of life
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following is/are the possible diagnosis?
A. Paratubal cyst  Hydatid Cysts of Morgagni
B. Follicular cyst o When paratubal cysts are pedunculated & near the
C. Adenomatoid mass fimbrial end of the oviduct
D. A & B only  Majority of grossly defined paratubal cysts are accessory lumina of
E. Any of the above the fallopian tubes
 Thin-walled & smooth and contain clear fluid
 Majority of paratubal cysts are asymptomatic and are usually
Answer: D discovered incidentally during ultrasound or during gynecologic
operations
 When paratubal cysts are symptomatic, they generally produce a
dull pain
 During a pelvic examination, it is difficult to distinguish a paratubal
cyst from an ovarian mass
 At operation the oviduct is often found stretched over a large
paratubal cyst. The oviduct should not be removed in these cases
because it will return to normal size after the paratubal cyst is
excised.
 Paratubal cysts may grow rapidly during pregnancy, and most of
the cases of torsion of these cysts have been reported during
pregnancy or the puerperium
 Treatment: simple excision
Follicular Cyst
 Most frequent cystic structures in normal ovaries of young
menstruating women
 Translucent, thin-walled filled with watery, clear to straw-
colored fluid
 Minimum diameter to be considered a cyst: 2.5-3.0 cm
 Dependent on gonadotrophins for growth
 May arise from:
o Dominant mature follicle’s failure to rupture (Persistent
follicle)
o Immature follicle’s failure to undergo atresia
 Symptoms are varied & non-specific to the ovary
o Most common: Pain
 Management Options: Observation
o Majority will disappear spontaneously in 4-8 weeks
(reabsorption of the cyst fluid, silent rupture)
 Medical management: OCP (decrease FSH production since this is
the source of stimulation of the follicles)
 Surgery:
o For persistent ovarian masses
o Cystectomy is commonly done
o Best if by Laparoscopy
Adenomatoid Tumor/Angiomyoma
 Most prevalent benign tumor of the oviduct
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 Small, gray-white, circumscribed nodules, 1-2cm in diameter
 Usually unilateral & present as small nodules just under the
tubal serosa
 These small nodules do not produce pelvic signs or symptoms
 also found below the serosa of the fundus of the uterus and the
broad ligament
 Microscopically, they are composed of small tubules lined by a
low cuboidal or flat epithelium
 These tumors do not become malignant
 However, they may be mistaken for a low-grade neoplasm when
initially viewed during a frozen-section evaluation

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18. Which of the following patient profile is typical of Fibroma
Meig’s syndrome?  Most common benign, solid neoplasm of the ovary
A. 32 year old with bilateral cystic ovarian mass  Arise from undifferentiated fibrous stroma of the ovary
and severe dysmenorrhea  Extremely slow growing
B. 40 year old asymptomatic with 5x5cm solid  Incidence of ascites is directly proportional to the size of the
mass, left ovary tumor
C. 48 year old with a 6X8cm solid right ovarian  Average age of affected women: 48 years old
mass, ascites, hydrothorax  Symptoms:
D. 56 year old with bilateral solid mass size o Pressure on adjacent structures
ranged from 5-15cm o Abdominal enlargement
 Meig’s Syndrome: Association of ovarian fibroma, ascites and
hydrothorax
Answer: C  Grossly:
o Heavy, solid, well-encapsulated and grayish white
o Cut surface: homogenous white or yellowish white solid
tissue with trabeculated or whorled appearance
 Histologically: Connective tissue, stromal cells and varying
amounts of collagen, spindle-shaped, mature fibroblast
 Management: Surgery (TAHBSO)
ENDOMETRIAL HYPERPLASIA
Questions and Answers Ratio

19. The chance of developing endometrial carcinoma Rate of progression:
with complex hyperplasia with atypia is- Simple hyperplasia – 1%
Complex hyperplasia without atypia- 3%
A. 1% Complex atypical hyperplasia- 29%
B. 3%
C. 7%
D. 29%
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Source: Comprehensive Gynecology, 6 edition
Answer: D.
20. A 50 y/o underwent endometrial sampling due to Complex Endometrial Hyperplasia:
abnormal vaginal bleeding. Histologic finding  Highly crowded glands with little endometrial stroma
revealed highly crowded glands with little stroma,  Crowding of glands with disparity in their size and  irregularity in their
presence of hyperchromatic nucleoli and cytomegaly. shape  
What do these findings pertain to?
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typical Endometrial Hyperplasia:
A. Simple hyperplasia without atypia  Nuclear atypia 
B. Simple hyperplasia with atypia o Loss of polarity
C. Complex hyperplasia without atypia o Increased N:C ratio
D. Complex hyperplasia with atypia o Irregular size and shape of the nuclei 
o Prominent nucleoli 
Answer: D. o Thick nuclear membrane
 Crowdingofglands  
 Epithelial stratification,  scalloping and tuffin  
 Cytomegaly, loss polarity, hyperchromatism, prominence of nucleoli  
Source: Lecture
21. A 60 y/o had episodes of postmenopausal scanty “A measurement of ≥ 5 mm in the postmenopausal woman and ≥ 15 mm in
bleeding. Transvaginal ultrasound was done and the premenopausal woman warrant further investigation with
revealed 6mm endometrial thickness. What would be sonohysterography, transvaginal color doppler and/or endometrial tissue
the NEXT BEST thing to do? sampling.”
A. Observe (Sumpaico&Teodoro, Obstetric & Gynecologic Ultrasound for the Practicing

B. Hysterectomy Clinician, 1996)
C. Endometrial ablation
D. Endometrial biopsy
Answer: D.
22. A 35 y/o has history of profuse menstrual “A measurement of ≥ 5 mm in the postmenopausal woman and ≥ 15 mm in
bleeding with endometrial thickness of 2cm on the premenopausal woman warrant further investigation with
ultrasound. What would be the next step? sonohysterography, transvaginal color doppler and/or endometrial tissue
sampling.”
A. Repeat ultrasound after 3 months
B. Saline infusion sonography (Sumpaico&Teodoro, Obstetric & Gynecologic Ultrasound for the Practicing
C. Hysteroscopy Clinician, 1996)
D. Hysterosalpingogram
Answer: C.
23. A 28 y/o diagnosed to have feminizing ovarian
tumor sought consult due to irregularity of menses.
She is a smoker and hypertensive for 5 years. BMI=18 Risk Factors:
kg/m2. Which of the following is/are considered risk -Hypertension
factor/s in developing endometrial hyperplasia? -Obesity
-Nulliparity
A. Weight -DM
B. Smoker -Anovulation
C. Hypertension -Smoking
D. B and C
E. ABC *Base on the case patient is not obese.
Answer: D.
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24. A 35 y/o has an endometrial biopsy result of
complex hyperplasia with atypia. What is the
management?
A. Observe
B. Intermittent progestin therapy
C. Continuous low dose progestin therapy
D. Continuous high dose progestin therapy
Answer: D.
25. A 56 y/o has an endometrial biopsy result of

simple hyperplasia without atypia. What will be the
management?
A. Hysterectomy
B. Continuous high dose of progestin therapy
C. Intermittent progestin therapy
D. Observe
Answer: C.
26. A 45 y/o Gravida 6 Para 6 (6006) ongoing Endometrial Ablation  

treatment for congestive heart failure. She consulted
for heavy menstrual bleeding in spite of 3 months  Used as an alternative to hysterectomy when other medical  modalities
progestin therapy. What would be the BEST fail or when there are contraindications to their  use  
management on this case?  Indicated for women with severe menorrhagia who have  medical
contraindications against performing a hysterectomy, women with
A. Dilatation and curettage ovulatory DUB who do not wish to take medications, and for patients
B. Hysterectomy who are increased risk for neoplasia  
C. Endometrial ablation  Should not be used in women who wish to maintain their reproductive
D. Hysterectomy capacity
 Complications: fluid overload, uterine hemorrhage, uterine perforation,
Answer: C. thermal damage to adjacent organs, and hematometria  
 Most of these complications occur because the ablation extends too
deeply into the endometrium, opening up uterine vessels and exposing
adjacent tissues to thermal injury  
Source: Lecture
15
FAMILY PLANNING– Doc Ona/Doc Alensuela

26. Which barrier method is most associated with Barrier Method Advantage Disadvantage
cervical dysplasia? Diaphragm  Safe, reversible  UTI–may compress
A. male condom  Married, motivated urethra, especially if it
B. female condom women is too big
C. cervical cap  Failure rates decrease  Vaginal epithelial
D. diaphragm w/ age & duration of ulcerations
use
Answer: C Cervical cap  Safe, reversible  Requires more
 Good continuation training for the
rates provider to fit it &
 Placed longer than for user to use
diaphragms Adverse effects:
 More comfortable  Ulceration,
unpleasant odor &
infection if left for
>48hrs
 Adverse effects on
cervical tissue
Male Condom  Safe, reversible
 Relatively cheap & readily available
 Prevent STD transmission
 Highly effective for the well-motivated couple
Female Condom  Fitting not needed   Noisy
 Can be inserted before
starting sex
 Can be left in place for a
longer time after
ejaculation  
 Additional protection
for external genitalia  
 Less likely to rupture
than male condom  
 Also reduces risk for
HIV and HPV
28. In practicing the Billing’s Method, the woman Billing’s Method Abstinence:
notes that the last day she can stretch the vaginal  Everyday during menses
discharge between her thumb and forefinger on  Every other day after the menses
Day 17of her cycle. What day can she resume ends until the first day that
coital activity with the least risk for pregnancy? copious, slippery mucus. (SAFE)
A. 17 *Every other day abstinence to give
B. 18 cervical mucus time to disregard
C. 20 effect of ejaculate
D. 21  Every day thereafter until 4days
after the last day when the
Answer: C/D characteristic mucus is present
(the “peak mucus day”) UNSAFE
*Try to check yung chart for easier visualization,

medyomagulokasiatayung explanationsa trans, sorry!. So infertile days
are safe days wherein one can have sex with least risk for pregnancy.
16
29. What is the MAIN mechanism of action of CONTRACEPTIVE METHOD MOA
combined OCPs? COMBINED OCP  Main: Inhibition of midcycle
A. Production of spermicidal effect (same MOA for patch and gonadotropin surge and prevention of
B. Triggering endometrial inflammation vaginal ring) ovulation(more consistent for estrogen
C. Suppression of LH & FSH surge than progesterone)
D. Thickening of cervical mucus  Progestin action- thick, viscid, scanty
cervical mucus; impaired transport of
Answer: C ovum and sperm; alters endometrium
DMPA & IMPLANT 3 MOAs:
 Inhibition of ovulation
 Thinning of endometrium – prev
implantation
 Cervical mucus changes
IUD  Up to 12 years
 Spermicide (local sterile inflammation)
 Impedance of sperm transport and
viability in the cervical mucus (Copper)
* since it is a foreign body, it incited
inflammatory factord that kill the sperm
IUS  Spermicide
Progestin effects
30. Which component of the combined OCP is MORE Coagulation Parameter Effects (Estrogen)
thrombogenic as the dose is increased? o increase: some coagulation factors (e.g. fibrinogen) enhances
A. Estradiol thrombosis
B. Levonogestrel o dose dependent (dose = more thrombogenic)
*this is why also that pop is more preferred for patients with history or
Answer: A active cardiovascular diseases
31. A G1P1 mother on her sixth month of lactation Daily progestin only pill (POP)/minipill
amenorrhea. She would like to start contraception  low dose progestin
but would like to continue breastfeeding her baby.  taken daily at same time (need to be exact sinceyou have no back up
Which of the following is the MOST ideal for her? estrogen)
A. Combined oral contraceptive  no steroid/pill free interval
B. Progestin only pill  ideal for nursing mothers (combi pills will decrease milk prod)
C. Bilateral tubal ligation  POP may be indicated:
D. Spermicidal gel  Conditions that affect a woman’s eligibility for using estrogen
 Some women have experienced side effects from estrogen or
Answer: B concerns about estrogen
32. Which has an absolute contraindication for oral ABSOLUTE CONTRAINDICATIONS RELATIVE CONTRAINDICATIONS
contraceptive pills? TO OCP USE TO OCP USE
A. 45 year old heavy smoker  History of vascular disease  Heavy smokers (<35 years old)
B. 22 year old obese  Systemic diseases affecting  Migraines – unpredictable effect
C. 30 year past history of hepatitis A vascular system of OCP on migraine patients
D. 14 year old newly menstruating girl  Smokers > 35yo- this is an  Undiagnosed cause of
independent factor for amenorrhea
Answer: A thrombogenic effects  Depression
 Uncontrolled hypertension  Prolactin-secreting
 Existing breast and endometrial macroadenomas
cancer
 Undiagnosed uterine bleeding
 Elevated triglycerides
 Pregnancy
 Functional heart disease
 Active liver disease
17
33. A 22-year-old woman has a strong family history OCPS: NON CONTRACEPTIVE HEALTH BENEFITS
of endometrial cancer. She is nulligravid, 1. Endometrial cancer-protective
overweight, has acne, and has episodes of 2. Ovarian cancer-protective
oligomenorrhea. She is desirous of contraception. 3. Colorectal cancer-protective
Which of the following is the best method for her? 4. Antiestrogenic effects of progestin
A. Combined oral contraceptive  reduction of menstrual blood loss and less risk for IDA
B. Intrauterine device  less incidence of menorrhagia, irregular menses and intermenstrual
C. Cervical cap bleeding
D. Bilateral tubal ligation  less likely to develop endometrial adenoCA
 reduction of incidence of benign breast diseases
Answer: A 5. Inhibition of Ovulation
 less dysmenorrhea and premenstrual tension
 protection against development of functional ovarian cysts
For this case, it is important to take note that the  reduction in size of functional ovarian cyst
patient has a strong family history of endometrial  protectionvs ovarian cancer
cancer. Remember that COCPs are ECO protective-- *IUD and cervical cap will have a chance to incite endometrial inflammation
Endometrial, Colorectal and Ovarian cancer protective or hyperplasia, which might trigger neoplasia.
*BTL is also not agood choice since she is just 22 and is nulligravid.
34. A woman on the pill is asked to follow up after 3 OCP USERS: FOLLOW-UP
months of starting the method. What should be  Lab test not necessary for healthy women
done at this time?  Non-directed history and BP after 3 months
A. Non-directed history  Annual visits: BP, weight, complete PE, cytology
B. Lipid profile
C. BP monitoring
D. AB and C
E. A and C
Answer: E
35. Which long acting hormonal method requires a DMPA AND IMPLANT ADVANTAGES
minor surgical intervention?  No daily intake of pills
A. IUS  Infrequent administration
B. Injectable  Maybe appropriate for those with contraindications to estrogen
C. Subdermal implants  Benefits (DMPA) (Definite risk reduction of: )
D. Hormonal patches  PID and salpingitis  Dysmenorrhea
 endometrial cancer  Endometriosis
Answer: C  iron deficiency  Epileptic seizures
anemia  Vaginal candidiasis
 sickle cell problems
36. Which of the following COMMON side effects of  Ovarian cysts
injectable contraceptives?
A. Delayed resumption of ovulation INJECTABLES & IMPLANTS DISADVANTAGE AND ADVERSE EFFECTS
B. Unscheduled bleeding or spotting  Unscheduled or irregular uterine bleeding *
C. Mental depression  Delayed resumption of ovulation*
D. AB and C *Definite adverse effect
E. A and B  Need for minor surgical procedure to insert & remove (implant)
 Operative site-potential site for infection (uncommon)
Answer: E  Weight gain-unclear
 Depression & mood changes- no clinical trials for evidence
 Headache- not enough studies
 Metabolic effects  insignificant effects on lipid*, glucose and protein
metabolism
*lowers HDL but DMPA not demonstrated to accelerate atherosclerosis
 Bone loss: suggested in some studies but is reversible
 calcium supplementation
 Neoplastic effects  Does not affect incidence of breast, cervical and
18
ovarian cancers
37. A woman requesting contraceptive advice. She ADVANTAGES OF IUD/IUS POTENTIAL ADVERSE EFFECTS
says that her busy schedule makes her forget  Highly effective  Uterine bleeding; Increase
many things and will not have enough time for  No associated systemic menstrual blood volume & more
frequent follow-ups. She has a severe metabolic effects (IUD) painful dysmenorrhea (Copper
dysmenorrhea. On physical exam, physician notes  Single act of motivation T380A)
pallor. Hemoglobin is 8.9. Which of the following is  The IUD has the highest  Perforation during insertion
the BEST method for her? continuation rate of all  Infection
A. Injectable reversible methods  Complication relating to
B. IUS  No permanent effects on pregnancy with IUD-in-utero
C. IUD fertility
D. Vaginal ring  LNG IUS- reduces Menstrual
Blood Loss
Answer: B Important to take note in this case 37: Busy schedule and anemia.
39. A woman is requesting a long-acting Schedule- on the choices, IUD has the least frequent follow-up since it can
contraception so that she does not have to worry be placed for 12 years and IUS can only be up to 5 years, still great
of missing a pill. She is hypertensive and has a difference between every 3months injectable & every month vaginal ring.
slight elevation of her LDL and triglyceride levels. Anemia- Injectable DMPA & OCPs has a benefit risk reduction for IDA, so
Which will have LEAST effect on her lipid profile? they are good for patient’s condition, but they require frequent pill intake
A. IUD and every 3 months injecting. LNG-IUS t can reduce menstrual blood loss
B. IUS contrary to Copper IUD, which can render increase in blood loss.
C. Subdermal implant BEST CHOICE FOR PATIENT WOULD BE IUS.
D. Injectable
Case 39: All hormone-containing contraceptives have effect on lipid levels.
Answer: A
38. A woman requests that for IUD insertion a day IUD INSERTION: Anyday of the cycle provided the receiver is NOT
after her last menstrual period. She has had no PREGNANT
sexual contact with her husband for the last week. *Only consideration on insertion would be pregnancy since if patient
Last pap test three months prior was normal. happens to be pregnant and you insert an IUD, ectopic pregnancy would
When is the BEST time to insert IUD in this case? result.
A. At the time for consult
B. At the end of current menstrual cycle Sabingani Doc Gabaldon, wag nanggawanngkwentoang patient sa cases
C. At the end of next menses pag exam. So wanangisipinnanagsisinungalingsya. 
D. After the second normal pap result
Answer: A
40. Which is/are complications of BTL? Complications of BTL
A. Bleeding  Bleeding
B. Infection  Infection
C. Bowel injury  Anesthetic complications
D. AB and C  Bowel injury (laparoscopic electrocoagulation)
 Uterine perforation and device expulsion (microinserts)
Answer: D
41. Which of the following is the MOST suitable In 2002 in the United States, sterilization of one member of a couple was
candidate for sterilization procedure? the most widely used method of preventing pregnancy. The popularity of
A. 38 year old, G5P5 sterilization was greatest if (1) the woman was older than age 30, (2) the
B. 32 year old, nulligravid couple had been married more than 10 years, and (3) the couple desired no
th
C. 25 year old, G1P0 (0010) additional children. – Comprehensive Gynecology 6 ed
D. 17 year old, G2P2 (2002)
A. 38 year old, G5P5 –bet candidate since she is almost 40 and has 5
Answer: A children already
B. 32 year old, nulligravid – no child yet, there’s still chance hehe.
Choices C & D are too young.
Might be helpful:
19
PS: Didn’t put much input from the book since both profs are highly dependent on their lecture for exams. Good luck! 
MENOPAUSE BY Dr. Lim
QUESTION RATIO
42.Which of the following is/are true of hormonal PERIMENOPAUSE
changes associated with perimenopause?  A variable time beginning a few years before and continuing after
the even of menopause
A. Decreased Ovarian Inhibin  The time between the onset of irregular menses and permanent
B. Increased Activin cessation of menstruation
C. Very Slow Decline in Androgen  Average duration is about 4 years.
D. A and C
E. E. All of the above HORMONAL CHANGES DURING THE PERIMENOPAUSE
 Decreased ovarian inhibin production accompanied by an
increase in pituitary FSH release
 Increase in Inhibin (d/t increase in FSH)
 Reduction in ovarian estrogen production: major reduction occurs
6 months before menopause
 Very slow decline in androgen status – phenomenon of aging
(because ovaries also produces androstenedione)
43.What is a major factor that appears to affect the DETERMINANTS of AGE of MENOPAUSE
age of a woman’s menopause?  By age 58, 97% of women will have gone through menopause
 GENETICS explains up to 87% of the variance in menopausal age.
A. Socioeconomic status (It’s th primary determinant)
B. Body Mass Other factors
C. Genetics  General health status
D. D. Geographic Location  Socioeconomic Status
 Higher parity  Later menopause
20
 Smoking  Earlier menopause
 Body mass  Higher the BMI, the Later the menopause
 Ethnic Differences – (Earlier in Asians (47-48), Later in Blacks,
Hispanics
 Geographic Loaction – Earlier in those living in high altitudes
44.Which of the following statement/s is/are TRUE of THE HOT FLUSH
hot flushes?  Pathognomonic sign of the menopause
 Hot flushes occur for 2 years after the onset of estrogen
A. Reduction in core body temperature deficiency, but can persist for 10 or more years
B. Decreased skin resistance associated with  10-15% of women, these sx are severe and disabling (Unable to
diaphoresis sleep and wake up at night sweating and cannot function well
C. Precipitated by fall in estrogen during the day)
D. A and C  Sx are greates in Hispanic and Black, lowest in Asians
E. A, B, C  Severity decreases with time but can be bothersome for 10 or
more years.
 CAUSE: Fall in estrogen levels precipitate the vasomotor symptoms
CHARACTERISED BY:
 Heat dissipation as witnessed by an increase in peripheral
temperature (fingers, toes)
 Decrease in skin resistance, associated with diaphoresis
 Reduction in core body temperature
45.A 42 y/o woman complains of hot flushes. Her The patient is already in the perimenopausal state.
periods are irregular occurring every 30, 60 days.
Serum FSH is elevated. What is the best management  Medication can only be given to symptomatic patients.
option?  ESTROGEN - decline can cause symptoms such as hot flushes
 What should you give? – Combined ESTROGEN and
A. Observe her symptoms and re-evaluate after PROGESTERONE pills because they can alleviate the symptoms of
6 months the patient
B. Start calcium supplements  Low doses only because increased doses of Estrogen can lead to an
C. Begin low dose oral combined increased thromboembolic cardiovascular mortality.
contraceptive pill  Progesterone is added to the management because the patient
D. Use progestin supplementation still has a uterus this will protect her from risks of endometrial
hyperplasia compared if estrogen is given alone.
46. A 60 year-old with coronary artery disease. Which
of the following condition explains the increased risk
for the development of atherosclerosis in this
patient?
A. Accelerated risk in total cholesterol after

menopause
B. Endothelin production decreases
C. Reduced nitric oxide synthetase activity
D. A and C
E. E. A, B, C
 It should only be A and C because Endothelin production
INCREASES not DECREASES.
47. A 52 year old woman sought consult because of GOLDEN RULE: ESTROGEN THERAPY ONLY GIVEN TO SYMPTOMATIC
dyspareunia and vaginal dryness. She has a family PATIENTS!!!!
history of breast Cancer. What is the BEST
management? Vulvovaginal complaints are associated with estrogen deficiency
 Dryness: 21-47%
A. Reassure patient  Atrophic changes: 15-55%
B. Oral replacement therapy  Dyspareunia: 41%
C. Vaginal Estrogen  PE: Thin, paler mucosa, moisture is low, pH increases and the
D. Phytoestrogen mucosa may exhibit inflammation and small patechiae
21
 CERVICAL SMEAR: Presence of parabasal cells
 WITH ESTROGEN TX: Vaginal pH decreases, vaginal blood flow
increases, and the electropotential difference across the vaginal
mucosa increases to that found in premenopausal women.
 The patient is already symptomatic so estrogen may be applied
to the vagina for the specific complaint of dyspareunia and
vaginal dryness
48. A 56-year old woman went to the OPD. She had TIBOLONE: has mixed estrogenic, antiestrogenic, androgenic and
menopause 4 years ago and is bothered by hot progestrogenic properties
flushes and sleep disorder. She has a family history of  Does not seem to cause uterine or breast cell proliferation and
breast cancer. Which of the following is BEST for her? also is beneficial for vasomotor symptoms (has effects on hot
flushes)
A. Conjugated equine estrogen 0.625 mg  This is used for the treatment of OSTEOPOROSIS and as well as
B. Vaginal estrogen changes brought about by the decrease of estrogen (e.g. HOT
C. Tibolone FLUSHES)
D. D. Low dose combined OCP
49. A 65 year old woman has DEXA scan which OSTEOPOROSIS – defined as >- 2.5 SD in the DEXA Scans.
revelead osteoporosis. What is the BEST management
for this patient? Bisphosphonates - has been shown to have a significant effect on the
prevention and treatment of OSTEOPOROSIS only.
A. Observe  Incorporation of the bisphosphonate with hydroxyapatite in bone
B. HRT increases bone mass
C. Bisphosphonate  Skeletal half-life of bisphosphonates in bone can be as long as 10
D. Phytoestrogen years and reduce both spine and hip fractures
Ratio for answer:

 Patient already has osteoporosis, observation will not improve her
condition, it might worsen it if you don’t do anything.
 HRTs – Hormonal replacement such as Estrogen and Progesterone
pills doesn’t have an effect once the osteoporosis has already set
in. They can only have some effect in the PREVENTION
 Phytoestrogens – these are just an alternative estrogen-like
compounds
50. Which of the ff statements are true of hormonal HORMONAL REPLACEMENT THERAPY
replacement therapy?  Key timing of initiation is probably best within 3 years of
menopause (GOLDEN PERIOD)
A. HRT should be started for women with signs  Important in cardiovascular health as well as any potential
and symptoms of menopause cognitive benefit.
B. Estrgogen should be used at the lowest dose ESTROGEN
that can control symptoms  Short-term tx of symptoms only: should be used at the LOWEST
C. Progesterone should be added to all patients DOSE that can control hot flushes or can be administered via the
D. A and B vaginal route for symptoms of dryness or dyspareunia
E. A, B, C.  PROGESTERONE should be added to the regimen if the patient has
a uterus because ESTROGEN alone might increase the risk for
endometrial hyperplasia.
51. A 55 year-old, postmenopausal patient consulted RISKS ASSOCIATED WITH ESTROGEN REPLACEMENT THERAPY
for hot flushes. Which of the ff. factors in the
patient’s history is a contraindication in giving of  Return of menstrual bleeding
estrogen replacement therapy?  Somatic complaints such as breast tenderness and bloating
 Indiosyncratic reactions like hypertension and allergic
A. History of Stroke manifestations
B. Family history of Breast Ca  Two-fold increase in venous thromboembolic phenomena with
C. History of Diabetes oral estrogen – women who have a family hx of thrombosis or
D. History of hypertension have had a thrombotic event linked to oral contraceptives or any
prior estrogen use should be monitored closely.
22
SOURCE: Gynecology – Menopause (2016 ppt and recording) – Wini Ong trans
PELVIC ORGAN PROLAPSE
52. Women commonly develop pelvic organ prolapse PELVIC ORGAN PROLAPSE
due to  condition characterized by the failure of various anatomic
A. Loss of levatorani bulk structures to support the pelvic viscera  
B. Congenital reasons  common in parous women (30-50%)
C. Severe pelvic endometriosis  mostly asymptomatic
D. Operative procedure in the vagina  in most cases the relaxation affects all the support  structures of
the pelvis  
Answer: A
Pathophysiology
1. Multifactorial
2. LOSS OF LEVATOR ANI BULK from
 Muscle atrophy from denervation from childbirth injuries
 Muscle wasting from muscle insertion detachment during
childbirth
 Decrease in estrogen
Risk Factors
 Vaginal birth
 Aging – muscle atrophy due to lack of estrogen
 Hysterectomy
 Obesity
 Prior Pelvic Surgery
 Constipation – Straining
 Genetic conditions
 Neurologic injury
 Obstetrical Trauma* – forceps delivery

 Abdominal Tumors*
 Accident*
 Coughing *
(*) - From lecture
23
Loss of levatorani bulk is the main pathophysiology of developing pelvic
organ prolapse. Factor D (choice D), is a risk factor.
53. A Cystocele can be seen as Abnormalities that result from these relaxation problems include
A. Soft bulge on the bilateral side walls of the vagina  Urethrocele
B. The cervix seen at the level of the introitus  Cystocele
C. Urine coming out of urethra when the patient  Rectocele
coughs  Enterocele
D. Out pouching from the anal opening  Uterine prolapse (descensus of the cervix and uterus)
Answer: A CYSTOCELE– protrusion of the bladder into the vagina, signifying the
relaxation of fascial supports of the anterior vaginal wall.
If a cystocele and aurethroceleare present, it invariably follows that the

bladder neck is not supported. For determining the type of cystocele
present, a ring forceps can be used with the split speculum. If supporting
the lateral anterior vaginal walls to the arcustendineus fascia pelvis causes
the cystocele to disappear with straining, a paravaginal defect is present.
Signs and symptoms:

 Sensation of fullness
 Pelvic pressure or vaginal bulge
 “falling out” sensation
 Urgency
 Incomplete emptying
 Urinary symptoms, stress incontinence
 Soft, bulging mass on anterior wall
 Symptoms worsen later in the day after upright activities
Often only a cystocele is present, and generally in these cases the patient is
continent.When aurethrocele is present as well, the woman usually often
suffers from stress incontinence.
A. Soft bulge on the bilateral side walls of the vagina although, our
books tell us that cystocele presents at the anterior vaginal wall,
this statement best decribes cystocele (relative to the other
options).
B. The cervix seen at the level of the introitusuterine prolapse
C. Urine coming out of urethra when the patient coughs
urethrocoele
D. Out pouching from the anal openingrectal prolapse
54. A 45-year old G6P6, all delivered via normal CYSTITIS (URINARY TRACT INFECTION)
spontaneous delivery, was seen with complaints of The definition of a symptomatic UTI is a woman with dysuria, frequency,
passing out urine WHEN COUGHING. What is the urgency, and/or suprapubic pain with pyuria.UTI may be associated
diagnosis? withurgency, frequency, dysuria, and even incontinence. This is not
A. Recurrent UTI associated with coughing.
B. Vesicovaginal fistula
C. Stress incontinence VESICOVAGINAL FISTULA
D. Prolapse of the uterus The classic clinical symptom of a urinary tract fistula is the painless and
almost CONTINUOUS LOSSof urine, usually from the vagina. On occasion,
Answer: C the uncontrolled loss of urine may be related to change in position or
posture. When urine loss is intermittent and related to position, one should
suspect aureterovaginal rather than a vesicovaginal fistula. Urinary
24
incontinence that presents within a few hours of the operative procedure is
usually secondary to a direct surgical injury to the bladder or ureter that
was not appreciated during the surgery.
The woman can cough and/or performthe Valsalva maneuver to detect

stress incontinence in the absenceof a detrusor contraction.
STRESS INCONTINENCE
 occurs when increased intraabdominal pressure is not transmitted
equally to the bladder and the functional urethra
Separation of the supports that hold the upper vagina and urethra to the
pubic symphysis neuromuscular damage to the pelvic fascia and
musculature secondary to childbearing or the aging process, from some
sort of trauma, or from an altered connective tissue metabolism causing
decreased collagen production.
25
FACTORS INDEPENDENTLY ASSOCIATED WITH URINARY INCONTINENCE

IN WOMEN
MODIFIABLE FACTORS
Gynecologic Comorbid Diseases
 Cystocele  Diabetes
 Uterine prolapse  Stroke
 Nonnormal gynecologic  Elevated systolic BP
examination  Cognitive impairment
 Poor pelvic floor muscle  Parkinsonism
contraction  Arthritis
 Back problems
Urologic and Gastrointestinal  Hearing and visual
 Antibiotics impairment
 Recurrent UTI
 Dysuria Medications
 Fecal Incontinence  Diuretics
 Constipation  Estrogen
 Bowel Problems  Benzodiazepines
 Tranquilizers
Other Factors  Antidepressants
 Smoking  Hypnotics
 High caffeine intake  Laxatives
 Higher body mass index
 Functional impairment
NONMODIFIABLE FACTORS Other Factors

Gynecologic Factors  Age
 Hysterectomy in older  White race
women  Higher education
 Prolapse surgery  Childhood enuresis
26
 Presence of two or more
Pregnancy-related factors comorbid disease
 Vaginal delivery
 Forceps delivery
 CS
 Increased parity
 Fetal birth weight
55. Which of the following is the BEST management Treatment of urethroceles and cystoceles may be nonoperative or
for mild cystocele in a 30-year old G2P2? operative and depends on patient preferences and goals.
A. Estrogen
B. Pessary Nonoperativetreatment consists of supporting the herniation of the
C. Perineorraphy anterior vaginal wall with the use of the Smith-Hodge, ring, cube, or
D. Kegel’s exercise inflatable pessary (Fig. 20-8), or even with the intermittent use of a large
tampon.
Answer: D
Kegel exercises(see Chapter 21, Urogynecology) help to strengthen the
pelvic floor musculature and thereby may relieve some of the pressure
symptoms produced by the cystocele. Although there is little direct
evidence that pelvic floor muscle training prevents or treats POP, it may be
beneficial for mild POP and it is effective for concomitant symptoms of
urinary and fecal incontinence.
nd
56. A 28-year old G2P2 suffered from a 2 degree The soft bulge at the posteriorvaginal wall is probably a rectocele. The
perineal laceration during her delivery at home. 2 management is POSTERIOR COLPORRAPHY.
years prior to consultation, she noticed a soft bulge at
the posterior vaginal wall. The rest of the PE were A rectocele is a protrusion of the rectum into the vagina, signifying a
within normal. What is the management? relaxation of the posterior vaginal wall. It may be identified by retracting
A. Estrogen cream alone the anterior vaginal wall upward with one half of a Graves or Pederson
B. Posterior colpoperineorraphy speculum and having the patient strain. The rectum will bulge into the
C. Kegel’s exercise vagina, and this bulge may protrude through the introitus.
D. None
Operative management of a rectocele (posterior colporrhaphy) is often
Answer: B performed at the time of an anterior colporrhaphywith or without
enterocele repair or operation for uterine descensusor vaginal vault
prolapse after hysterectomy. Most women with rectoceles also have a
gaping genital hiatus and a defect in their perineal body. Therefore, as
part of a rectocele repair, a perineorrhaphyis performed as well
57. Enterocoele can be easily diagnosed by which of ENTEROCELE

the following procedures?  True hernia of peritoneal cavity emanating from the pouch of
A. Ultrasound Douglas (cul-desac) between the uterosacral ligaments into the
B. Transillumination rectovaginal septum and usually contains small bowel.
C. Digital rectal examination
D. CT Scan CAUSE
 Frequently occurs after an abdominal or vaginal
Answer: B hysterectomy(DOES NOT SPONTANEOUS ARISE)and generally is
the result of a weakened support for the pouch of Douglas and the
58. Which of the following statements is TRUE of loss of vaginal apical support by the uterosacral ligaments.
enterocoele?
A. This condition often arises spontaneously. DIAGNOSIS
B. Prevented by incorporation of the uterosacrals and  PE: It may be noticed as a separate bulge above the rectocele and
cardinals in the vault repair at times, may be large enough to prolapse through the vagina.
27
C. No intervention is necessary o It may be possible to make the specific diagnosisof
D. This is just an incidental finding. enterocele by transilluminating the
bulge(TRANSILLUMINATION) and seeing small bowel
Answer: B shadows within the sac.
o Differentiate from rectocele by rectovaginal examination
 The contents are always small bowel and may also include the
omentum. The contents may be easily reducible or may be fixed to
the peritoneum of the sac by adhesions.
PREVENTION
 The uterosacral and cardinal ligaments are the most important
support structures and should be incorporated into the vault
repair at the time of a hysterectomy and the ligaments from each
side joined together.
59. Which of the following may NOT be associated UTERINE PROLAPSE

with prolapse of the uterus?  Protrusion of the cervix and uterus into the barrel of the vagina but
A. Stress incontinence often associated with cystocoele, rectocoele and enterocoele
B. Injuries to the endopelvic fascia  Injuries of endopelvic fascia, uterosacrals and cardinals, levatorani
C. Child birth trauma leading to pelvic floor relaxation
D. Pelvic trauma  Child birth trauma
 Almost always associated with rectocele and cystocele and, at times,
enterocele, supporting the concept of overall damage to the pelvic
Answer: A support structures.
Signs and symptoms

 Heaviness, fullness, falling out
 “tumor” bulging out of introitus
 Similar symptoms of cystocoele* and rectocoele
 Inflammation and ulcers, pain and bleeding, infection of prolapsed
uterus
*(Often only a cystocele is present, and generally in these cases the patient
is continent. When aurethrocele is present as well, the woman usually
often suffers from stress incontinence.)
OVARIAN CANCER (DR. DELOS REYES) – YEN RUIZ AND JEROME ESCAÑO

60. An oophorocystectomy may be indicated in
this/these case/s:
E. 19 y/o with a non-regression of a 5 cm
ovarian cyst after 3 months of observation
F. 35 y/o with a 3 cm ovarian cyst
G. 24 y/o with on and off RLQ and an ovarian
cyst
H. All of the above
I. A & C only
Answer: E
 Option A is correct because the tumor (>5cm) never regresses in a
span of 6-8 weeks.
 Option C is also correct because the recurrent RLQ may suggest
28
torsion or rupture of the ovarian cyst.
 Option B is incorrect because the cyst size (3cm) is not yet indicative
for surgery.
61. If a patient presented with a solid ovarian mass,

what would be the differential diagnosis?
A. Peduculated myoma
B. Hydrosalpinx
C. Functional ovarian mass
D. Distended bowels with feces
Answer: A
The question specifically asks for a differential diagnosis that suggest a SOLID
adnexal mass, therefore among the options, only Pedunculated Myoma is
included in the SOLID Masses, the rests of the options are cystic…
29
62. A 35 year old, Gravida 4 Para 4 (4004) Epithelial Ovarian Neoplasms
underwent oophorectomy for an ovarian mass.
Microscopically, it showed low columnar 1. Serous Cystadenomas – resembles those of fallopian tube
epithelium with occasional cilia and psammoma Gross Microscopic
bodies. What is the most probable diagnosis? Papillary projections on surface Low columnar epithelium with
E. Serous cystadenoma – Psammoma bodies! Inner cyst wall mostly smooth occasional cilia
F. Mucinous cystadenoma – rich in mucin Multicystic smooth capsule Psammoma bodies – indication of
G. Clear cell carcinoma – rich in glycogen, hobnail poor prognosis
apperance Small granules, end products of
H. Brenner tumor – coffee bean pattern degeneration of papillary implants
Indicative of functional
Answer: A immunologic response
2. Mucous Tumors – resembles cells of the endocervix

Mucinous cystadenoma – reproductive years
Mucinous cystADENOcarcinoma – 30 to 60 years age range
Gross Microscopic
May become huge (>300 lbs) Lining epithelium is tall, pale
Usually unilocular staining secretory type with nuclei
Round or ovoid, smooth capsule at basal pole, rich in mucin
usually translucent or bluish to Associated with recurrent bowel
whitish gray obstruction
Supports a primary appendiceal
origian therefore appendectomy is
indicated
3. Clear Cell Carcinoma – cells with abundant glycogen

MC epithelial ovarian neoplasm associated with paraneoplastic calcemia
Strong relationship with endometriosis
Gross Microscopic
Ranges up to 30 cm in diameter Solid pattern characterized by
with mean of 15 cm sheets of polyhedral cells
Cut surfaces – thick walled Abundant clear cell cytoplasm
unilocular cyst with multiple separated by delicate fibrovascular
yellow-beige fleshy nodules septae or dense hyalinized fibrotic
protruding into the lumen stroma
Multiloculated cystic mass with Tubulopapillary pattern –
cysts containing watery or columnar with hobnail appearance,
mucinous fluid with nucleus protruding from the
papillae, gland, or cyst into the
lumen
4. Brenner Tumor – from Walthard cell rests – from connective tissue of

fallopian tubes but also seen in mesovarium, mesosalpinx and ovarian
hilus
Microscopic
Marked hyperplastic fibromatous matrix interspersed with nest of
epithelioid cells
“Coffee bean pattern” – longitudinal grooving of nuclei
All are benign but there are scattered reports of malignant Brenner;
associated endometrial hyperplasia
Transistional epithelial cell type – relatively uniform population of
stratified cells with ovoid nuclei displaying nuclear grooves – resemblance
to urothelium
Source: Ovarian CA trans by JC Torres III
30
63. A 30 year old, nulligravid came in due to This is a case of a 30 year old nulligravid with a Borderline Tumor of the
hypogastric pain. Transvaginal ultrasound showed a Ovary.
left ovarian solid mass. She underwent exploratory
laparotomy with frozen section of the mass which
showed stratification of epithelial lining of papilla,
atypical cells, epithelial pleomorphism without
stromal invasion. What is the best management for
this case?
A. Unilateral salpingooophorectomy
B. Oophorectomy, left
C. Total abdominal hysterectomy with bilateral
salpingooophorectomy
D. Unilateral salpingooophorectomy, peritoneal
fluid cytology, partial omentectomy
Since this is a case of a Borderline Tumor and the patient is still in
Answer: D reproductive age and nulligravid (desirous of pregnancy), the best treatment
option for her will be a Conservative Surgery.
64. Who among the following is at risk of Risk Factors for Developing Ovarian Carcinoma
developing ovarian carcinoma??  Genetic
A. 28 year-old, Gravida 1 Para 1 (1001), - A strong family history of either BREAST or OVARIAN cancer is the
breastfeeding most important risk factor for the development of epithelial ovarian
B. 30 year-old, Gravida 2 Para 2 (2002), smoker, cancer
with strong family history of DM - Breast-ovarian cancer family syndrome – with BRCA1 mutation, 40
C. 35 year old, Gravida 4 Para 4 (4004), heavy %; with BRCA2 mutation, 10-20%
alcoholic beverage drinker - Site specific ovarian cancer – BRCA1 mutation; there is excess
D. 48 year old, nulligravid, with family history of ovarian CA but not breast CA
breast carcinoma - Hereditary Non-Polyposis Colon Cancer (HNPCC) Syndrome or
Lynch Syndrome II – 1% of all ovarian cancers, cumulative incidence
Answer: D is 12%
 Lactation
- Protection against ovarian cancer risk most significant with duration
of 18 months or more (parang mas matagal, mas maganda)
 Alcohol consumption
- No association between moderate alcohol intake and ovarian ca risk
 Smoking
- Increases risk of developing mucinous epithelial ovarian ca ONLY
- Stopping smoking returns risk to normal in long term
Increased Risk Decreased Risk

Genetic- breast-ovarian cancer Multiparity (>5)
family syndrome (BRCA); HNPCC or Lactation
Lynch Syndrome, site-specific OCP use
ovarian CA Tubal ligation and hysterectomy
HRT use – because of unopposed
estrogen
31
Endometriosis
Pelvic Inflammatory Disease
Polycystic Ovarian Disease (high
hormonal level)
Obesity
Smoking
Dietary factors
Age at menarche and menopause are weak predictors

Source: Ovarian CA trans by JC Torres III
66. 50 year-old, nulligravid, underwent exploratory
laparotomy due to a huge pelvoabdominal mass.
Intraoperatively, there was 500 cc of ascites. The
right ovary was enlarged to 20 x 18 x 16 cm, cystic,
with gelatinous material within. Which of the
following is TRUE regarding the ovarian mass?
A. Composed of ciliated epithelial cells that
resemble those of the fallopian tube
B. Consists of epithelial cells filled with mucin,
resembling cells of the endocervix or
intestinal cells
C. Most common epithelial ovarian neoplasm to
be associated with paraneoplastic
hypercalcemia
D. Consists of cells resembling those of the
endometrium
Answer: B
This is actually a case of Pseudomyxoma Peritonei, a complication associated

with Mucinous Cystadenomas. As you will notice, the question already gave
us a clue, ‘right ovary enlarged to 20 x 18 x 16 (HUGE), cystic, with
GELATINOUS material within, so we just have to choose among the options
that characteristically describe a Mucinous Cystadenomas.
 Option A describes a Serous Cystadenoma
 Option C described Clear Cell Carcinoma
32
 Option D described Endometrioid Adenocarcinoma
 Therefore only Option B fits the description of Mucinous

Cystadenomas/Pseudomyxoma Peritonei because it contains
MUCIN…
65. A 40 year old, Gravida 1 Para 1 (1001) came in STAGING

with abdominal enlargement. She underwent STAGE 1: Confined to Ovaries
exploratory laparotomy and the left ovary was Tumor limited to 1 ovary, capsule intact, no tumor on surface,
1A
enlarged to 10 x 8 x 6 cm, mostly solid, irregularly negative washings (fluid cytology)
shaped, with papillary excrescences. The uterus, 1B Involves both ovaries otherwise like IA
fallopian tube were grossly normal. The entire Tumor limited to 1 or both ovaries
omentum was studded with 3-5 cm nodular 1C – 1 Surgical spill (ruptured intraop)
lesions. The liver, spleen and subdiaphragmatic Capsule rupture before surgery or tumor on
areas were smooth. What is the stage? 1C 1C – 2
ovarian surface
A. II – pelvic extension or primary peritoneal Malignant cells in the ascites or peritoneal
cancer 1C – 3 washings (positive fluid cytology)
B. III A - </> 10mm LN
C. III B - <2 cm LN STAGE 2: Tumor involves 1 or both ovaries with pelvic extension (below
D. III C – Stage III na because of omental node pelvic brim) or primary peritoneal cancer
involvement, and 3C because these nodes are 2A Extension and/or implant on uterus and/or Fallopian tube
3-5 cm. 3C says that >2 cm na. Although it says
Extension to other pelvic intraperitoneal tissues (below linea
din that there should be extension to capsule
2B terminalis or pelvic inlet; beyond is stage3/4)
of liver and spleen, the node size counts for
3C.
STAGE 3: Tumor involves 1 or both ovaries with cytologically or
histologically confirmed spread to the peritoneum outside the pelvis
Answer: D
and/or metastasis to the retroperitoneal LN
67. Upon opening of the abdomen of a 44 year-old
Positive retroperitoneal LN and/or microscopic metastasis
patient, it showed that the left ovary was enlarged
beyond the pelvis
to 15 x 15 x 10cm, irregularly shaped, mostly solid,
Positive retroperitoneal LN only
with a 1 x 1 cm rupture at the posterior surface of
3A 3A – 1 (I) Mets < or = 10 mm
the mass. The peritoneal fluid, omentum is 3A - 1
Mets > 10 mm
negative for malignant cells. What is the stage of 3A – 1 (II)
the patient?
A. IA - 1 ovary Microscopic, extrapelvic (above the brim)
3A - 2
B. IB – both ovaries peritoneal involvement (+/-) retroperitoneal LN
C. IC – ruptured na eh. Substage of 1C depends Macroscopic, extrapelvic, peritoneal mets < or = 2cm (+/-)
on how it ruptured and if it involves the 3B retroperitoneal LN, includes extension to the capsule or
peritoneal washings/ascites. liver/spleen
D. II – pelvic extension Macroscopic, extrapelvic peritoneal mets > 2cm (+/-)
3C retroperitoneal LN, includes extension to capsule of
Answer: C liver/spleen
STAGE 4: Distant metastasis excluding peritoneal metastasis
Pleural effusion with positive cytology
4A
Hepatic and/or splenic parenchymal metastasis, metastasis to
4B extraabdominal organs (including inguinal LN and LN outside
the abdominal cavity)
Sources: Jose Torres Trans (60-62, 64-67), & MRA trans for 63
33
NEOPLASM OF THE UTERUS
68. Who among the following increases the risk of * Complex atypical hyperplasia
malignancy? - results from increased estrogen stimulation of the endometrium and is a
precursor to Endometrial cancer
A. Menstruating at 55 years old
B. Slim and athletic during high school Increases risk:
C. On low dose oral contraceptive pills even 40  Unopposed estrogen stimulation
years old  Unopposed menopausal estrogen replacement therapy (4-8x)
D. Perimenopausal, nulliparous with BMI 25  Menopause AFTER 52 years (2-4x)
 Obesity (2-5x)
Ans: A  Nulliparity
 Diabetes (2.8x)
 Feminizing ovarian tumors
 PCOS
 Tamoxifen therapy for breast CA
 HRT including Estrogen and Progesterone does not increase the risk for
malignancy
Diminishes the risk:

- Ovulation
- Progestin therapy
- Combination oral contraceptives
- Menopause before 49 years old
- Normal weight
- Multiparity
69. TRUE of histogenic type 1 endometrial cancer
EXCEPT:
A. p53 is common
B. Favorable prognosis
C. Aneuploidy is present
D. Endometrial hyperplasia is the precursor lesion
Ans: C
70. Extension of endometrial cancer to the aorta Route of Spread

may be seen primarily in this route? 1. Small lymphatic branch along the round ligamentthat runs to the inguinal
nodes
A. Cardinal ligament 2. Lymphatic branches from the fallopian tubes
B. Suspensatory ligament 3. Ovarian pedicles (Infundibulopelvic ligaments), which are large lymphatics
C. Round ligament that drain into the paraaortic nodes
D. Fallopian tube 4. Broad ligament lymphatics that drain directly to the pelvic nodes
34
Ans: B Other name
Infundibularpelviclig. Suspensatory ligament
Cardinal ligament Lateral transverse cervical
or Mackenrodt’s ligament
Direct Peritoneal Spread

1. Through the uterine wall
2. Lumen of the Fallopian tube
71. A 50 year old, single, nulligravid came in at the Risk factors present in the patient:
OPD due to changes in bleeding pattern. She has  BMI of 35
been experiencing this condition for the past 9  Uncontrolled DM
months described as prolonged spotting after
blood clots noted for 2 days, occurring every other Primary symptoms of Endometrial CA
month, consuming 1-2 pads per day with no - abnormal perimenopausal and postmenopausal bleeding
dysmenorrhea. Her BMI is 35 with uncontrolled - presence of
diabetes and hypertension due to poor compliance
with her medications. What is the best advice to Transvaginal Ultrasound
her? - Adjunct only, cannot be used to diagnose
- It is done before doing biopsy
A. Take her medication regularly and her bleeding - Endometrial lining
pattern will resume to normal. o <5mm: little benefit for biopsy
B. Admit the patient, have her medical evaluation  Only do biopsy if:
and schedule for endometrial curettage. o 5/= mm in a postmenopausal women
C. Try to insert the speculum and do endometrial o >15/= mm in premenopausal
biopsy
D. Re-assure her that these are due to Endometrial Biopsy - not used initially
perimenopausal status and uncontrolled medical  Indications
condition o Women >35 years old
o Perimenopausal women with irregular bleeding
Ans: B o Postmenopausal women with any vaginal bleeding
72. Endometrial sampling was done to the 50 year Endometriod Carcinoma

old patient with abnormal bleeding. Biopsy - most common histological type
revealed malignancy. Which of the following - related to unopposed estrogen level
histology most likely seen? - better prognosis that the other types
A. Squamous cell carcinoma *Less common histological types:

B. Endometriod carcinoma Clear Cell – more common in postmenopausal
C. Clear cell carcinoma Serous Papillary – highly virulent, resembles Papillary
D. Serous papillary carcinoma Serous CA of the Ovary
Mucinous CA – extremely rare
Ans: B
35
73. Leiomyosarcoma belongs to which of the
following?
A. Pure homologous non epithelial neoplasm

B. Pure heterologous non epithelial neoplasm
C. Mixed sarcomas
D. Mixed mesodermal tumor
Ans: A
74. Which of the following should be staged as

carcinoma of the endometrium? Sarcoma – benign
Carcinoma – malignant  staging
A. Adenocarcinoma
B. Carcinocarcinoma *Hindi akomakahanap ng reason for this sorry peroganyankosiyainisip hahaha
C. Endometrial stromal sarcoma
D. Leiomyosarcoma
Ans: B
75. Among the patients with endometrial cancer

who completed their treatment, they have their  Routine cytologic examination (Pap smear)from the exocervix, which
follow up. Which of the following should be screens for cervical neoplasia, detectsendometrial carcinoma in only
routinely done every visit? approximately 50% of cases.
A. Pelvic exam
B. Pelvic exam and Pap smear
C. Pelvic exam, Pap smear and CXR
D. Pelvic exam, Pap smear, CXR and
Abdominopelvic CT scan or Whole abdominal
ultrasound
Ans: A
THANK YOU VOLUNTEERS!

KIM VILLANUVA MENOPAUSE WINI ONG FAMILY PLANNING
NICOLLETTE PALABRICA BENIGN GYNECOLOGIC SALLY WALINSUNDIN & AUB
LESION LARA C. ADOR DIONISIO
THEA TORIBIO NEOPLASM OF THE AGNES CAYCO UTERINE PROLAPSE AND
UTERUS URINARY INCONTINECE
JEROME ESCANO & YEN OVARIAN CA ANGEL PESEBRE ENDOMETRIAL
RUIZ HYPERPLASIA
36

FEU Gyne Ratio Finals COMPLETE 1

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GYNECOLOGYFINALSAPRIL 2016 MEDICINE 2017

ABNORMAL UTERINE BLEEDING

2. S.T. 45 year old, G5P5 was seen at the ER because

Endometrial Polyp - Localized overgrowths of the endometrial glands and

Ergot Androgenic steroids for DUB

GnRH agonists for DUB

5. Which of the condition is NOT a systemic cause of

6. D.W. sought consult because of profuse vaginal

a. Combined Oral Contraceptive Pills

7. What is the BEST option for long term treatment of

a. Conjugated equine estrogen

8. A 45 year old nulligravid underwent endometrial

a. High dose progestin

BENIGN GYNECOLOGIC LESIONS

Questions & Answers Ratio

Vulvar Epidermal Inclusion Cyst

SOURCE: Benign Gynecologic Lesions (MRA trans), Comprehensive

10. A 37 year old female consulted due to dysuria, Urethral Diverticulum

Skene’s Duct Cyst

SOURCE: Benign Gynecologic Lesions (MRA trans); Comprehensive

SOURCE: Benign Gynecologic Lesions (MRA trans); Comprehensive

SOURCE: Benign Gynecologic Lesions (MRA trans); Comprehensive

SOURCE: Benign Gynecologic Lesions (MRA trans)

Adenomyosis (Endometriosis Interna)

SOURCE: Benign Gynecologic Lesions (MRA trans)

Indications for Hysterectomy

Disadvantages of Pre-operative GnRH Agonist Treatment

SOURCE: Benign Gynecologic Lesions (MRA trans); Comprehensive

SOURCE: Benign Gynecologic Lesions (MRA trans); Comprehensive

SOURCE: Benign Gynecologic Lesions (MRA trans)

Questions and Answers Ratio

A. Observe (Sumpaico&Teodoro, Obstetric & Gynecologic Ultrasound for the Practicing

25. A 56 y/o has an endometrial biopsy result of

26. A 45 y/o Gravida 6 Para 6 (6006) ongoing Endometrial Ablation

Questions & Answers Ratio

*Try to check yung chart for easier visualization,

MENOPAUSE BY Dr. Lim

A. Accelerated risk in total cholesterol after

Ratio for answer:

PELVIC ORGAN PROLAPSE

 Obstetrical Trauma* – forceps delivery

If a cystocele and aurethroceleare present, it invariably follows that the

Signs and symptoms:

The woman can cough and/or performthe Valsalva maneuver to detect

FACTORS INDEPENDENTLY ASSOCIATED WITH URINARY INCONTINENCE

NONMODIFIABLE FACTORS Other Factors

57. Enterocoele can be easily diagnosed by which of ENTEROCELE

59. Which of the following may NOT be associated UTERINE PROLAPSE

Signs and symptoms

Questions & Answers Ratio

61. If a patient presented with a solid ovarian mass,

2. Mucous Tumors – resembles cells of the endocervix

3. Clear Cell Carcinoma – cells with abundant glycogen

4. Brenner Tumor – from Walthard cell rests – from connective tissue of

Increased Risk Decreased Risk

Age at menarche and menopause are weak predictors

This is actually a case of Pseudomyxoma Peritonei, a complication associated

 Option A describes a Serous Cystadenoma

 Option C described Clear Cell Carcinoma

 Therefore only Option B fits the description of Mucinous

65. A 40 year old, Gravida 1 Para 1 (1001) came in STAGING

Diminishes the risk:

26. A 45 y/o Gravida 6 Para 6 (6006) ongoing Endometrial Ablation  