1.
A 35-year-old P3 with a Pap smear showing high-grade squamous intraepithelial
lesion of the cervix (CIN III) has an inadequate colposcopy. Cone biopsy shows
squamous cell cancer that has invaded only 1 mm beyond the basement membrane.
There are no confluent tongues of tumor, and there is no evidence of lymphatic or
vascular invasion. The margins of the cone biopsy specimen are free of disease. How
would you classify or stage this patient’s disease?
a. Carcinoma of low malignant potential
b. Microinvasive cancer
c. Atypical squamous cells of undetermined significance
d. Carcinoma in situ
e. Invasive cancer, stage Ia
2. A 35-year-old P3 with a Pap smear showing high-grade squamous intraepithelial
lesion of the cervix (CIN III) has an inadequate colposcopy. Cone biopsy shows
squamous cell cancer that has invaded only 1 mm beyond the basement membrane.
There are no confluent tongues of tumor, and there is no evidence of lymphatic or
vascular invasion. The margins of the cone biopsy specimen are free of disease. Of
the following, appropriate therapy for this lesion is
a. External beam radiation
b. Implantation of radioactive cesium
c. Simple hysterectomy
d. Simple hysterectomy with pelvic lymphadenectomy
e. Radical hysterectomy
3. A 35-year-old P3 with a Pap smear showing high-grade squamous intraepithelial
lesion of the cervix (CIN III) has an inadequate colposcopy. Cone biopsy shows
squamous cell cancer that has invaded only 1 mm beyond the basement membrane.
There are no confluent tongues of tumor, and there is no evidence of lymphatic or
vascular invasion. The margins of the cone biopsy specimen are free of disease. In
CIN 3, which of the following statement is correct?
a. Neoplastic cells extend into the proximal cervical glands whereas the
basal membrane remains intact
b. Cytoplasmic maturation in the upper third of mucosa
c. There is extension of neoplastic epithelium into endocervical glands and the
connective tissue
d. Neoplastic cells derive from both squamous and glandular endocervical
epithelium
e. Glandular acinar formations extend into the endocervical stroma
4. A 34-yo woman came to clinic to have her 6 weeks postpartum check. She just gave
birth to a 3200 grams-baby delivered vaginally 3 months ago. She had a complain of
unable to hold liquid stool and flatus. On examination the external genitalia looks
normal. What is the next diagnostic plan for this patient?
a. Defecography
b. Ultrasound of the anal sphincter
c. Anal manometry
d. Pelvic CT scan
e. Electromyography of the anal sphincter.
5. A 34-yo woman came to clinic to have her 6 weeks postpartum check. She just gave
birth to a 3200 grams-baby delivered vaginally 3 months ago. She had a complain of
unable to hold liquid stool and flatus. On examination the external genitalia looks
normal. What is the next management of this case?
a. Observation on the symptoms and reevaluation 3 months
b. Give constipating agent to prevent liquid stool
c. High fiber diet, hydration of minimum 2 L and reevaluation 6 weeks
d. Sacral neuromodulation
e. Reconstructive surgery
6. A 34-yo woman came to clinic to have her 6 weeks postpartum check. She just gave
birth to a 3200 grams-baby delivered vaginally 3 months ago. She had a complain of
unable to hold liquid stool and flatus. On examination the external genitalia looks
normal. If we want to do a reconstructive surgery to this patient, what is the
recommended suture material that should be use?
a. Chromic catgut
b. Polyethylene teraphthalate
c. Polypropylene
d. Poliglecaprone
e. Polyglactin
7. A 24 year old female came to emergency department with right lower quadrant
abdominal pain since 6 hours ago. She has no fever. Her last menstrual period was 2
weeks ago. Her cycles was 28 days. On physical examination found vital sign within
normal limit, right lower quadrant abdominal tenderness without sign of peritonitis,
and on ultrasound found uterus and left ovary normal, seen mass on right ovary sized
3,5cm, with thin wall and spider web sign, no free fluid found. Pregnancy test was
negative. Hb level 12,3g/dL.
What is the most likely diagnosis of this patient?:
a. Dermoid cyst
b. Torsion of the ovarian cyst
c. Cyst rupture
d. Hemorrhagic of the corpus luteum
e. Tubo ovarial abscess
8. A 24 year old female came to emergency department with right lower quadrant
abdominal pain since 6 hours ago. She has no fever. Her last menstrual period was 2
weeks ago. Her cycles was 28 days. On physical examination found vital sign within
normal limit, right lower quadrant abdominal tenderness without sign of peritonitis,
and on ultrasound found uterus and left ovary normal, seen mass on right ovary sized
3,5cm, with thin wall and spider web sign, no free fluid found. Pregnancy test was
negative. Hb level 12,3g/dL.
What is the next management plan for this patient?
a. Conservative management
b. Antibiotic intravenous for 5 days
c. Emergency Laparoscopic cystectomy
d. Emergency Laparotomy
e. Puncture of the Douglass pouch
9. A 46-year-old P2 obese woman is referred from her primary-care physician because
of increasingly heavy and painful menses over the last 18 months. She has tried an
oral contraceptive with some improvement of her bleeding but no improvement in
her pain. She has never had an abnormal Pap smear and states she has never had
any infections, “down there.” Her only medical problems are her obesity and
hypertension. On examination, you note normal external genitalia, vagina, and
cervix. However, her uterus is slightly enlarged, mildly tender, and softer than you
expected. She has no adnexal mass or tenderness.
Which imaging study listed below would BEST differentiate between adenomyosis
and uterine fibroids?
a. Pelvic ultrasound
b. Pelvic CT
c. Sonohysterogram
d. Pelvic MRI
e. Hysterosalpingogram
10. A 46-year-old P2 obese woman is referred from her primary-care physician because
of increasingly heavy and painful menses over the last 18 months. She has tried an
oral contraceptive with some improvement of her bleeding but no improvement in
her pain. She has never had an abnormal Pap smear and states she has never had
any infections, “down there.” Her only medical problems are her obesity and
hypertension. On examination, you note normal external genitalia, vagina, and
cervix. However, her uterus is slightly enlarged, mildly tender, and softer than you
expected. She has no adnexal mass or tenderness.
After further evaluation suggesting adenomyosis, your patient wants to proceed with
hysterectomy because she is tired of bleeding and experiencing pain. You explain to
her that she needs to undergo a test prior to scheduling her hysterectomy. What test
does the patient need to undergo?
a. Colposcopy
b. Mammogram
c. Endometrial biopsy
d. Colonoscopy
e. Chest X-ray
11. An 8-year-old girl is brought to your office by her parents concerned that she has
started developing breasts too soon. Physical examination reveals a Tanner stage II
breast and pubic hair growth.
You reassure the parents that this is normal. What is typical pubertal sequence?
a. Menarche, pubarche, thelarche, accelerated growth
b. Pubarche, thelarche, accelerated growth, menarche
c. Thelarche, pubarche, accelerated growth, menarche
d. Accelerated growth, thelarche, pubarche, menarche
e. Pubarche, accelerated growth, thelarche, menarche
12. An 8-year-old girl is brought to your office by her parents concerned that she has
started developing breasts too soon. Physical examination reveals a Tanner stage II
breast and pubic hair growth. When can the patient expect her first menses?
a. At 16 years of age
b. At 14 years of age
c. At 11 years of age
d. At 9 years of age
e. It is impossible to tell from the data provided
13. A 51-year-old woman presents to your office amenorrhea for the past year. Since
she has not had any hot flashes, she is wondering if she is menopausal. Which of the
following is NOT a classic symptom of menopause?
a. Hot flashes
b. Insomnia
c. Visual changes
d. Vaginal atrophy
e. Night sweats
14. A 20-year-old young woman presents to your office with a complaint of amenorrhea.
She notes that she has never had a menstrual period, but that she has mild cyclic
abdominal bloating. She reports normal breast development starting at age 12. She
reports that she has become sexually active, but she finds intercourse painful. Her
past medical and surgical history is unremarkable. On physical examination, you note
normal appearing axillary and pubic hair. Her breast development is normal. Pelvic
examination reveals normal appearing external genitalia, and a shortened vagina
ending in a blind pouch. Which of the following tests would be your first step in
determining the diagnosis?
a. Karyotype
b. Pelvic ultrasound
c. Serum follicle-stimulating hormone (FSH)
d. Diagnostic laparoscopy
e. Serum estradiol
15. An 18-year-old young woman presents to your office with a complaint of
amenorrhea. She notes that she has never had a menstrual period, but that she
has mild cyclic abdominal bloating. She reports normal breast development
starting at age 12. She reports that she has become sexually active, but she finds
intercourse painful. Her past medical and surgical history is unremarkable. On
physical examination, you note normal appearing axillary and pubic hair. Her
breast development is normal. Pelvic examination reveals normal appearing
external genitalia, and a shortened vagina ending in a blind pouch. You perform a
bedside ultrasound and find normal appearing bilateral ovaries as well as an
absent uterus and fallopian tubes. What is your most likely diagnosis?
a. Imperforate hymen
b. Transverse vaginal septum
c. Müllerian agenesis
d. Androgen insensitivity syndrome (AIS)
e. Late onset congenital adrenal hyperplasia
16. A 34 years old woman with primary infertility 3 years, oligomenorrhea and a body
mass index (BMI) of 26. Transvaginal ultrasound shows multiple small follicle size 5-8
mm in both ovaries. HSG shows bilateral patent tubes. Her partner’s semen analysis
shows a volume of 2.5 ml, pH of 7 and a sperm count of 25 million/ml. According to
the current International Guidelines. Which of the following is true regarding
ovulation induction in PCOS?
a. Gonadotropin cannot be used as a first line treatment
b. Use of gonadotropin correlate with lower cost of ovulation induction
c. If there are two mature follicles ovulation trigger should be cancelled
d. Use of aromatase inhibitor reserved for Clomiphene failure patients
e. Clomiphene citrate has a higher risk of multiple pregnancy compared to
aromatase inhibitor
17. A 30 years old woman came with chief complain of no menstruation for 6 months.
She has a history of 3 times surgery for endometriosis cyst. From ultrasound uterus
size and shape within normal limit endometrial line 3 mm, both ovaries size is
smaller than normal without any follicles present. Which of the following
management is appropriate for this condition?
a. Adminiester E-P challenge test using combined oral contraception
b. Administer progestin challenge test
c. Measure Ca125 and CRP level
d. Measure FSH and estradiol level
e. None of the above
18. A 26 years old unmarried woman came with chief complain of abdominal mass since
5 months ago. She also has a history of heavy menstrual bleeding with regular cycle
since 6 months accompanied with dysmenorrhea VAS 8. From examination the
uterus enlarged globular with limited mobility, no mass was palpable on both
adnexas. Which of the following ultrasound features that correlate with this
pathology?
a. Lobulated mass in the myometrium with clear border
b. Circumferential vascularity around the mass in the uterus
c. Normal junctional zone
d. Fan shaped shadowing with ill-defined border
e. Thickened endometrial line