Best Practice & Research Clinical Obstetrics and Gynaecology 24 (2010) A1–A5

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Best Practice & Research Clinical

Obstetrics and Gynaecology
journal homepage: www.elsevier.com/locate/bpobgyn

Adolescent and Paediatric Gynaecology

Multiple Choice Questions
for Vol. 24, No. 2
1. In the presence of a vulvovaginits with predominant isolation of Streptococcus pyogenes, recurrent
after oral ampicillin treatment, the following option(s) should be considered
a) check the child and the parents for pharyngeal colonization
b) take a specimen from the rectum of the child for culture
c) add a short antibiotic course with a non beta-lactamase sensitive drug
d) prescribe ceftriazone 150 mg parenterally
e) use topical clindamicin

2. The diagnosis of warts in the ano-genital region of a 3 year-old child calls for careful evaluation of
the possibility of sexual abuse, even where other modes of transmission are proved. What would
you consider useful in this situation?
a) speak immediately and clearly with the mother and the father of the child about this possibility
b) ask the child directly
c) discreetly question the mother about where her daughter lives during the day and who are the
preferential caregivers
d) ask the mother about the possibility of a HPV genital infection during pregnancy or the pres-
ence of skin warts on her hands
e) perform a HPV typing test

3. The following is/are true concerning the 46XY female

a) In complete AIS the testes produce normal amounts of testosterone
b) In complete AIS testosterone cannot be converted to dihydrotesteosterone
c) In 5a reductase deficiency there is an increased risk of malignancy in the gonad
d) In 5a reductase deficiency there is more than one isoform of the enzyme
e) In partial AIS the testes produce increased amounts of testosterone to overcome the resistance

4. Which cases require early gonadectomy because of the risk of virilisation?

a) Swyer syndrome
b) Complete AIS
c) 5a reductase deficiency
d) Partial AIS
e) Frasier syndrome

5. Estrogens have a principally

a) positive effect on the osteogenesis
b) proliferative effect on the epithelium of the uterus, tubes, vagina and urinary tract
c) negative effect on the cardiovascular system

1521-6934/$ – see front matter

doi:10.1016/j.bpobgyn.2010.02.011
A2 Appendix / Best Practice & Research Clinical Obstetrics and Gynaecology 24 (2010) A1–A5

d) negative effect on the CNS

e) vasodilator effect

6. Hormonal Developmental Therapy (HDT) in childhood and adolescence

a) must be applied in absolute estrogen deficiency states
b) should be finished as soon as secondary sexual characteristics have been developed
c) need increasing doses individually
d) must be started with an estrogen/progestagen combination
e) has identical goals to HRT

7. Long-term HDT in women suffering from absolute deficiency of estrogens

(a) is needed to maintain the appropriate stages of sexual development and for prevention of
osteoporosis and cardiovascular disease
(b) has no proven risks
(c) should be finished on request of the patient
(d) when finished is often followed by a pseudo-menopause in hypogonadal women
(e) is needed just as much in cases of relative deficiency of estrogens

8. Clinical signs of hyperandrogenism include

a) Acne
b) Hirsutism
c) Clitoromegaly
d) Vaginal aplasia
e) Decreased muscular mass

9. Functional Hypothalamic Amenorrhea (FHA) is defined as a non-organic and reversible disorder

and may be accompanied by
a) Lower mean frequency of LH pulses
b) Complete absence of LH pulsatility
c) Normal-appearing LH and GnRH secretion pattern
d) Streak ovaries
e) Higher mean frequency of LH pulses

10. Which of the following is/are true regarding hyperprolactinaemia in adolescents?

a) It is associated with decreased estradiol concentrations
b) It usually presents with amenorrhea
c) It has a frequency of about 7% in adolescents
d) The severity of the menstrual disorders do not correlate with the prolactin levels
e) Galactorrhoea is always present

11. Type II autoimmune polyglandular syndrome is characterized by all of the following except:
a) Adrenal insufficiency
b) Autoimmune thyroid disease
c) Hyperprolactinemia
d) Premature Ovarian Failure
e) Type I diabetes mellitus

12. The following statement(s) concerning the pathogenesis of PCOS is/are true
a) There is an intrinsic ovarian theca cell defect leading to androgen overproduction
b) There is impaired hypothalamic-pituitary sensitivity to ovarian steroid feedback
c) There is a primary defect of gonadotropin synthesis leading to preferentially increased LH
synthesis
d) The increased LH concentrations may result from the androgen-induced impairment of
hypothalamic sensitivity to ovarian steroid feedback
e) It results from a primary hypothalamic defect leading to increased GnRH pulse generator
frequency
 Appendix / Best Practice & Research Clinical Obstetrics and Gynaecology 24 (2010) A1–A5 A3

13. The estimated risk of developing PCOS in girls with premature pubarche is:
a) 5–10%
b) 15–20%
c) 30–40%
d) 45–55%
e) 60–65%

14. The risk of developing PCOS appears to be higher in girls with

a) ordinary premature adrenarche
b) exaggerated premature adrenarche
c) atypical central precocious pubarche
d) premature thelarche
e) delayed adrenarche

15. Which of the following factor(s) has/have been implicated in the pathogenesis of PCOS
a) Low birth weight
b) High birth weight
c) Intrauterine androgen excess
d) In vitro fertilization
e) Maternal diabetes

16. Which type of diet may exacerbate the reproductive and metabolic aberrations of PCOS?
a) Calorie excess
b) High-AGE diet
c) Low-AGE-diet
d) High protein content
e) Low calorie intake

17. The term ‘‘Premature adrenarche’’ includes the ordinary form and the exaggerated form, which are
distinguished by serum androgen levels, as follows:
a) The exaggerated form is indicated by DHEA-S levels above 185 mg/dl and/or androstenedione
levels exceeding the range of 75–99 ng/dl
b) The exaggerated form is indicated by androstenedione levels exceeding the range of 75–99
ng/dl
c) The ordinary form is indicated by DHEA-S levels in the range of 40–130 mg/dl
d) The ordinary form is indicated by DHEA-S levels less than 40 mg/dl
e) The ordinary form is indicated by androstenedione levels exceeding the range of 75–99 ng/dl

18. Vaginal aplasia is associated with the following

a) Male pseudo-hermaphroditism
b) Female pseudo-hermaphroditism
c) Mayer-Rokitansky-Küster-Hauser syndrome
d) McCune–Albright syndrome
e) CNS tumours

19. Male pseudo-hermaphroditism is classified to the following subtype(s) according to etiological

factors:
a) testicular hyper-responsiveness to hCG and LH
b) defective testosterone synthesis
c) end-organ hyper-responsiveness to androgen
d) defective testicular organogenesis
e) defects in anti-Müllerian hormone.

20. The following is/are true concerning female pseudo-hermaphroditism:

a) patients have 46 XX karyotype
A4 Appendix / Best Practice & Research Clinical Obstetrics and Gynaecology 24 (2010) A1–A5

b) patients have normal ovaries

c) the degree of genital ambiguity is highly variable
d) virilization is caused by excessive production of only maternal androgens
e) hyperandrogenaemia occurs due to enzymatic defects in steroid synthesis

21. The following is/are true of McCune-Albright syndrome:

a) it is caused by mutations in the GNAS2 gene
b) it is inherited in a Mendelian fashion
c) early sexual development occurs more commonly in girls than boys
d) bony fractures are another feature of the syndrome
e) café-au-lait spots are a classic feature of the syndrome

22. Women with MRKH syndrome may present with the following
a) Primary amenorrhea
b) 46,XX karyotype
c) Male type external genitalia
d) Streak ovaries
e) Uterus is absent or rudimentary

23. All the following is/are surgical techniques for neo-vagina creation:
a) Vecchietti procedure
b) McIndoe’s method
c) Williams’ technique
d) Frank’s technique
e) Creatsas’ vaginoplasty

24. Complications of Creatsas’ vaginoplasty include

a) Hematoma
b) Hematometra
c) Wound opening
d) Pyosalpinx
e) Wound infection.

25. The following statement(s) regarding surgical correction of uterine anomalies is/are true:
a) Rudimentary uterine horns containing endometrial tissue should be removed.
b) Septoplasty in patients with uterine septa may improve implantation.
c) Strassman reunification is the first step to maximize obstetric outcomes in patients with
uterine didelphis.
d) When performing septoplasty in the case of a uterine septum, the cervical portion of the
septum should always be removed.
e) Surgical correction of an obstructed mullerian anomaly serves as a treatment modality for
endometriosis.

26. The following aetiologies might explain the jeopardized obstetric outcomes associated with
mullerian anomalies
a) Abnormal uterine vasculature
b) Decreased muscularity of the cervix
c) Malpresentation secondary to abnormal uterine configuration
d) Diminished gestational capacity leading to increased risk of preterm labor
e) Genetic mutations associated with patient’s who have mullerian anomalies

27. The following statement(s) is/are true regarding rudimentary uterine horns
a) Rudimenentary uterine horns should always be removed
 Appendix / Best Practice & Research Clinical Obstetrics and Gynaecology 24 (2010) A1–A5 A5

b) The endometrial cavity associated with a rudimentary uterine horn may or may not be in
communication with the dominant endometrial cavity
c) Obstructed rudimentary horns are often associated with retrograde menses, pain, and
endometriosis
d) Ectopic pregnancy can occur in a rudimentary horn which does not communicate with the
dominant uterine cavity
e) The gold standard for diagnosis aberrant uterine anatomy is laparoscopy

28. Which of the following options would you consider for the treatment of osteopenia in a girl who
has almost completely recovered normal weight after a severe form of anorexia nervosa?
a) moderate physical activity and nutritional monitoring
b) oral contraceptives
c) calcium supplements
d) oral vitamin D supplements
e) bisphosphonates

29. Which of the following conditions may be associated with a 16 year-old girl with BMI ¼ 30 Kg/m2
and oligomenorrhea?
a) a road accident with brain injury
b) the prolonged use of topiramate
c) complete physical inactivity for almost 5 months
d) overweight father and grandfather
e) transient diabetes insipidus

30. On comparing international information on the evolution of adolescent Fecundity and the Prev-
alence of use of contraceptives, we see that
a) The countries with the higher fecundity rates in adolescents of 15 to 19 years of age, always
have a prevalence of contraceptive use of below 40%.
b) The countries with lower fecundity rates in adolescents of 15 to 18 years of age, always have
a prevalence of contraceptive use of over 70%.
c) Adolescent pregnancy rates in the past 13 years have fallen more in the less developed regions
in the planet.
d) Countries in most of the Regions of the world have higher rates of adolescent fecundity in
association with lower rates contraceptive use.
e) Available data establishes that there is no relationship between the prevalence of contraceptive
use and Adolescent Fecundity.