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WorksheetsGynecology
Total questions: 121
Worksheet time: 1hrs 16mins
Which is the prinicpal gonadotropin and hormone released furing the follicular phase?
FSH
Estrogen
LH
Estrogen
FSH
Progesterone
LH
progesterone
Which hormone is released during luteal phase?
Estrogen
Progesterone
Which gonadotropin triggers ovulation?
FSH
LH
GnRH
Which hormone is released in a pulsatile manner by the hypothalamus and stimulate the pituitary gland to release LH and FSH
GnRH
HCG
Which are uterine ligaments?
Broad ligament
Uterosacral ligament
Round ligaments
Infundibulopelvic ligaments
Uteroovarian ligament
The primary oocyte is arrested in ______ meiosis I until puberty
Prophase I
Metaphase I
Anaphase I
Telophase I
The secondary oocyte is arrested in ______ meiosis II until fertilization (if it happens).
Prophase II
Metaphase II
Anaphase II
Telophase II
What does LH do?
Binds to theca cells and converts colesterol into androgens (e.g. testosterone)
Binds to granulosa cells and converts androgens to estradiol via aromatization
Its surge triggers ovulation
What does FSH do?
Binds to theca cells and converts colesterol to androgens (e.g. testosterone)
Binds to granulosa cells and converts androgens to estradiol E2 via aromatization
If fertilization does not occur, the corpus luteum undergoes apoptosis ____ to ____ days after ovulation
9-11 days
2 weeks
15 days
Ovarian PROGESTERONE production peaks at 25-50mg a day during the...
Follicular phase
Early luteal phase
Midluteal phase
When should we recommend a woman to have her hormonal assessment done?
Day 0-3, at the start of menstruation
Day 3-5 of menstrual cycle, just when period finishes
Day 14 during ovulation
After ovulation, during luteal phase
Choose the correct answers..
Ovary: follicular and secretory phase
Endometrium: proliferative and secretory phase
Endometrium: proliferative and luteal phase
Ovary: follicular and luteal phase
Menarche USUALLY occurs when...
Age: 12 years
Age: >15 years
2-3 years after thelarche
Tanner stage IV
Tanner stage II
Primary Amenorrhea is defined as:
(two correct answers)
failure to reach menarche by age 15
Absence of menstruation for >90 days
failure to reach menarche within 2 years of thelarche
failure to reach menarche within 3 years of thelarche
Mean blood loss per cycle is around:
30 ml
>80 ml
1 ml
Menstrual blood loss >80 ml or changing pads or tampons every 1-2 h is considered...
normal
abnormal
Causes of amenorrhea include:
high prolactin
use of antipsychotics
anorexia
hyperthyroidism
hypothyroidism
Define primary dysmenorrhea
Colic pain in the suprapubic region before or during menstruation, in absence of primary disease
Colic pain in the suprapubic region associated with pelvic disease that persists beyond period
Which statements are true?
Endometriosis is the abnormal growth of endometrial tissue in extrauterine locations
Adenomyosis is when the myometrium grown into the endometrium
Adenomyosis is when the endometrium grows into the muscular wall
Pelvic inflammatory disease is an infection of the female reproductive organs often caused by chlamydia and gonorrhea
Which is the first line of treatment for primary dysmenorrhea
Surgery like hysterectomy
NSAIDs like naproxen, ibuprofen, mefenamic acid and ketoprofen
Combined oral contraceptive (estrogen-progestin)
Low-intensity Exercise
What does hCG do?
Stimulate the pituitary to release LH and FSH
Convert colesterol to tesosterone
Maintain pregnancy by stimulating Corpus luteum to keep producing progesterone
Trigger ovulation
which is the correct order of ejaculation?
1.Before orgasm semen comes from bulbourethral gland
1. semen released from seminal vesicles and prostate gland
2.semen released from seminal vesicles and prostate gland
2.before orgasm, semen comes from bulbourethral gland
3.small amount of fluid is released by vesicle
Which normal findings should we expect in a sperm assessment?
at least 20 million sperm per ml of semen
maximum of 30% abnormal sperm ejaculated
30% must be vigorous swimmers
40% must be vigorous swimmers
60% should be normal size and shape
Which are the sperm and egg's life span?
sperm: 9 days
Egg: 12 hours
Sperm: 7 days
Egg: 48-72 hours
Sperm: 6 days
Egg: 24-48h
What is true regarding fecundation?
First the sperm pass thru the Zona pellucida and THEN thru the cumulus oophorus
First the sperm pass thru the cumulus oophorus and THEN thru the zona pellucidaF
The cortical reaction occurs after the sperm attaches to the egg's basement membrane
The second meiotic division completes after the cortical reaction
Finally the sperm and egg's pronuclei fuses
Parts of the fallopian tube in order (from ovary to uterus lol):
1.fimbrae
2.infundibulum
3.ampulla
4.isthmus
1.fimbrae
2. ampulla
3.infundibulum
4.isthmus
1.isthmus
2.indundibulum
3.ampulla
4.fimbrae
Layers of the endometrium
Functionalis layer
myometrium
Basalis layer
perimetrium
Choose the correct statement regarding the cervix.
Endocervix: stratified squamous epithelium
Ectocervix: simple columnar epithelium
Endocervix: simple columnar epithelium
Ectocervix: stratified squamous
Choose the correct statements regarding the vagina:
Normal pH: 7.5
non-keratinized Stratified squamous epithelium
Normal pH: 4.3
Keratinized stratified squamous epithelium
True facts about GnRH
Half life of 2-4 min
Half life of 10 min
pattern: 60-minute to 4-hour intervals.
pattern: 120-minute to 8-hour intervals.
What are indications for a pelvic exam?
Pregnancy
abnormal bleeding/discharge
Before insertion of IUD
After SA
Pelvic pain
What is pelvic inflammatory disease (PID)
Abnormal growth of endometrial tissue in extrauterine locations
Twisting of an ovary
Infection of the female reproductive organs (uterus, fallopian tubes, ovaries) and may extend into the peritoneum
Implantation of a fertilized egg outside of the uterus
What is true about PID?
PID is more prevalent in women >35 years old
It is common before menarche
PID is more prevalent in women <35 years old
It is linked to STDs like Chlamydia Trachomatis and Neisseria Gonorrhea
Bacterial vaginosis does not increase the risk of PID
What is true regarding the pathophysiology of PID?
The Upper genital tract (UGT) is protected from the vagina's bacterial flora by a mucosal barrier
Disruption of the barrier results in the spread of bacteria to the former sterile UGT
a pH > 4.3 is a protective factor against PID
Bacterial vaginosis can facilitate ascension of bacteria
Iatrogenic causes include: IUD insertion, hysterosapingography, etc)
PID risk factors include:
>35 years old
Multiple sexual partners
Vaginal douching (intravaginal cleansing)
Invasive procedures (IUD insertion, vaginal curettage)
Vaginal pH of 4.3
Signs and Symptoms of PID
"Chandelier Sign" (Cervical motion tenderness)
dyspareunia
Vaginal bleeding or purulent discharge
Lower abdominal tenderness
Fever, nausea
Which are the complication of PID?
x5 more risk of infertility
Endometriosis
Tubo-ovarian abscess
Fitz-Hugh-Curtis syndrome (35%)
endometrial polyps
These are all diagnostic methods for PID. Which of them are DEFINITIVE but rarely required?
lower abdominal pain and Cervical motion tenderness
Laparoscopy to view inflamed tissues
Endometrial biopsy to see endometritis
Imaging (MRI/USG) to see tubo-ovarian abscess
mucopurulent vaginal discharge
What is true regarding PID management?
often involves a combination of ceftriaxone, azythromycin and metronidazole
often involves a combination of ceftriaxone, doxycyclin and fluconazole
often involves a combination of doxycyclin, azythromycin and metronidazole
often involves a combination of ceftriaxone, doxycyclin and metronidazole
Which statements are correct regarding PID management?
Treat sexual partners empirically for gonorrhea and chlamydia too
Sexual intercourse is ok during the length of the therapy (usually 14 days)
Surgery is indicated if an abscess is ruptured or if therapy does not work
Tubo-ovarian abscess can be drained thru laparoscopy
Pregnancy increases metabolic demands, leading to physiological weight gain.
What is the average weight gain at 40 weeks of gestation?
5 kg
8 kg
12.5 kg
17.5 kg
Maternal basal metabolic rate rises progressively, by around ___% each term
5%
20%
40%
50%
Weigh gain during pregnancy can be attributed to:
Maternal reserves (fat storage)
Maternal tissues (breast, uterus, blood volume, extracellular fluids)
Water retention
Uterus and contents (amniotic fluid, fetus, placenta)
Weight gain depends on mother's BMI. Which statements are true????
BMI <18.5 (underweight) should gain 12.5-18 kg
BMI 18.5-24.9 ("normal") should gain 11.5-16 kg
BMI 18.5-24.9 ("normal") should gain 13-17 kg
BMI 25-29.9 ("overweight") should gain 7-11.5 kg
BMI >30 (obese) should gain 5-9 kg
During pregnancy, the threshold for thirst and vasopressin decreases leading to...
more thirst
an increase of plasma osmolarity by 10 mOsm/kg
a decrease in plasma osmolarity by 10 mOsm/kg
Total additional water of 6.5 liters (around 7 kg)
Edema (which may be present) can measure up to 1 liter
Maternal hyperlipidemia...
Often present during early pregnancy
Often present during late pregnancy
Is caused by estrogen and increased insulin resistance
Low effects of insulin increases lipolysis and reduces lipoprotein lipase activity --> more circulation of TG in blood stream
After delivery, lipid levels remain high
In late pregnancy we can often find:
High colesterol >200
Normal triglycerides <150
High LDL >100
High triglycerides >150
Breastfeeding reduces Triglycerides and raises HDL level
True
False
Which are some risk factors of endometriosis:
Late menarche
Early menarche
Cycles shorter than 27 days
Young women 25-29
High BMI
The precise mechanism of endometriosis is unknown but it is believed to be a combination of:
Samson theory - retrograde menstruation thru fallopian tubes --> peritoneal cavity
Lifestyle factors: elevated intake of processed foods
Genetic predisposition
Mayer's theory - metaplasia of coelmic cells (embryological precursor of cells of the peritoneum and endometrium)
Surgical dissemination of endometrial fragments
Which are some clinical manifestations of endometriosis?
abdomino-pelvic pain
dyspareunia, dysmenorrhea
UTI
Heavy menstrual bleeding
Infertility
Which is the most common endometrial lesion found in endometriosis?
Superficial peritoneal endometriosis
Ovarian endometrioma
Deep infiltrating endometriosis
What is true regarding the color of superficial peritoneal endometriosis?
Red- suggest early, active lesions
Black- suggests necrotized endometrium
Black - suggests advances lesions (deoxygenated hemoglobin)
White - suggests healed/scarred endometriosis
White - suggests infected endometrial tissue
Which drugs are recommended as analgesics for endometriosis?
ibuprofen and naproxen
Metronidazole
Antidepressants, SSRIs, (neuromodulators)
GnRH antagonists
Which hormone treatment are recommended for endometriosis?
contraceptives
progestogens
GnRH agonist or antagonist
aromatase inhibitors like anastrozole
Hormone therapy is needed to treat endometriosis as they work by...
Increasing estrogen production
Decrease estrogen production
Induce amenorrhea to reduce growth of the lesions
What is true regarding radical surgery for endometriosis (hysterectomy)
It is done to women with no response to pharmacological treatment and with no desire to conceive
Both the uterus and the ovaries have to be ressected
It is always a curative treatment
It is not necessarily curative
The recommended surgical technique for endometriosis is...
Hysterectomy
Laparoscopy
Presacral neurectomy
laparoscopic ureterosacral ablation (LUNA)
Recurrence of endometriosis is estimated at ______% within 5 years after treatment
10%
15%
20-50%
70-90%
Which is the most common STI worldwide?
Gonorrhea
Chlamydia
HPV
Herpes
Risk factor for HPV infection
Initiating sex life at an early age
multiple partners
Immunocompetent
young women <25
Smoking
High risk types of HPV include:
6
11
16
18
There are 3 HPV vaccines on the market. Which are they?
Bivalent: 16,18
Trivalent: 11,16,18
Tetravalent: 6,11,16,18
Nonavalent: 6,11,16,18,31,33,45,52,58
Treatment for HPV warts include:
Imiquimod (topical)
Retrovirals (oral)
podophyllotoxin (topical)
cryotherapy or electrocautery
trichloroacetic acid (topical)
What are the treatment options for HPV precancerous lesions (anus, vulva, cervix)
cryotherapy or laser ablation
imiquimod (topical)
loop electrosurgical excision
conization
surgery, chemo, or radio in case of invasive cancer
Most common bacterial STD in young women?
herpes
HPV
chlamydia
gonorrhea
This STI is often assymptomatic (70%)
chlamydia
HPV
gonorrhea
herpes
vertical transmission of chlamydia causes:
pneumonia
respiratory papillomatosis
conjunctivitis
neonatal herpes
30-50% of sterility in women is linked to chlamydia
True
False
Which statements are true?
Chlamydia - white yellow or gray discharge
Trichomoniasis - grayish, thin homogenous discharge with fishy oudor
Trichomoniasis - greenish malodorous discharge
Chlamydia - thick, white cottage cheese-like discharge
Which is the gold standard to diagnose chlamydia
antigest test or culture
Clinical history and physical examination
Nuclei acid amplification test (NAAT) like PCR or LCR
We must treat all exposed partners against chlamydia even if assymptomatic
True
False
which antibiotic is indicated to treat pregnant women with chalmydia
Metronidazole
Doxycycline
Azithromycin
What is the treatment for chlamydia?
Azithromycin 1 g PO single dose
Doxycycline 100 mg PO twice daily x 7 days
Metronidazole 500 mg Po once a day < 7 days
Genital herpes can be transmitted even if symptoms are not present
True
False
HSV-1 and HSV-2 establish latency in sensory ganglia, becoming a chronic infection with possible recurrence
True
False
genital herpes is more transmitted from women to men, than from men to women.
True
False
neonatal herpes (due to vertical transmission) can cause:
conjunctivitis
death
encephalitis
sepsis
Which is true regarding genital herpes?
Appears as Clusters of painful vesicles or ulcers on external genitalia, cervix, perineum
Associated symptoms include dysuria, pruritus, abnormal discharge
Genital herpes is NOT associated with tender lymph nodes in the inguinal area
Fever and general malaise is very rarely seen as it is a viral infection
Confirmatory tests for genital herpes include
Visualization of ulcerative or vesicular lesions
PCR (most sensitive)
HSV-1 and HSV-2 antibodies in blood
Viral culture
Treatment for genital herpes include
Acyclovir
Famciclovir
Mentronidazole
Valacyclovir
C-section delivery is recommended to pregnant women with active lesions
True
False
Humans are the only hosts of Trichomonas
True
False
Clinical manifestations of trichomoniasis include:
Green malodorous discharge
Strawberry spots on colposcopy
Vaginal pruritus, dysuria, burning
Dyspareunia
The gold standard for trichomoniasis used to be culture (Diamond's medium) and now it is preferred to do nucleic acid amplification tests (NAAT)
True
False
Nah, the best one is the visualization of flagellated protozoa under microscopy (wet mount technique)
which are the Therapy options for trichomoniasis?
Metronidazole 2 g PO single dose
Azithromycin 1 g PO singe dose
Tinidazole 2 g PO single dose
Doxycyclin 100 mg PO < 7 days
Which vaccines must be administered before pregnancy?
MMR (mumps, measles, rubella)
MPOX (varicella)
Hepatitis B
Hepatitis A
HPV
pneumococcal and meningococcal vaccines must be always administered before pregnancy as routine
true
false, just in special occasions
Vaccines that are safe during pregnancy include:
TDAP (tetanus, diphteria, acellular pertussis)
Covid 19
Life Attenuated influenza
Inactivated influenza
RSV
RSV vaccines are administered during...
week 27-28
week 27-30
week 32-36
TDAP vaccine is administered at...
week 20-24
week 25-28
week 27-36
Inactivated attenuated influenza vaccine is given during
flu season (end of october)
anytime lol
Which vaccines to AVOID during pregnancy?
Covid-19
Varicella
MMR
BCG
Typhoid vaccine should be avoided during pregnancy but is indicated if pregnant woman is in an endemic area
True
False
Rabies vaccines should be avoided during pregnancy but it is indicated when there is high risk of infection:
True
False
After pregnancy, family and friends close to the baby must be injected with
COVID 19 vaccine
Flu vaccine
Hepatitis A vaccine
TDAP
After pregnancy ____ vaccine is given if missed during pregnancy
Tdap
RSV
Hepatitis C
Routine shots cannot be applied while mother is breastfeeding
True
False
Preconception risk factors include:
Maternal age <25 or >30
Overweight or underweight
TORCH infections
History of spontaneous abortions or previous pregnancy complications
Smoking, alohol, drugs
Risk factors during pregnancy include:
TORCH infections, UTIs
Hypertensive gestational disorders (e.g. preeclampsia)
Placental complications (e.g. placenta previa)
Exposure to teratogenics or toxic substances
Stress
A coopland's score for classifying women in risk groups goes as it follows?
Low risk: 0-3
Intermediate risk: 4-6
Intermediate risk: 4-7
High risk >7
High risk >8
Risk prevention includes:
monitor glucose, BP, weight and infections during pregnancy
Receive preconception care: nutritional counseling, vaccines
Avoid smoking, drinking, eat well
Miscarriage is defined as an spontaneous abortion before week ___ of gestation
10
15
20
25
Miscarriage is a complication of EARLY pregnancy that is core common in women:
age <25
age 25-30
age >35
Women experiencing a miscarriage may present:
vaginal bleeding
abdominal pain and cramping
dysuria and nocturia
it is always symptomatic
abnormal discharge
The Best method to suspect a miscarriage is...
USG
hCG levels
If USG is not available, we can use hCG.
If beta-hCG levels decrease over time we can suspect a failed pregnancy.
True
False
Fetal death is diagnosed if cardiac activity is absent after previously being detected during the pregnancy
True
False
Transvaginal USG findings consistent with miscarriage:
CRL >7 mm and NO heartbeat
Mean gestational sac diameter >25 mm and NO embryo
Mean gestational sac <25 mm and NO embryo
Absence of embryo with a heartbeat after a 2 week old scan that showed a gestational sac without a yolk sac
Absence of embryo with a heartbeat after 11 day old scan that showed a gestational sac with a yolk sac
What is the best definition for a threatened miscarriage?
Vaginal spotting in 1st trimester, cervix remains closed and the fetus may still survive. It’s a warning sign.
Heavier bleeding and cramping with cervical dilation. Pregnancy loss cannot be prevented at this stage
Some, but not all, products of conception are expelled. The cervix is open, and bleeding/cramping continue until remaining tissue is removed naturally or medically.
All pregnancy tissue has been expelled. The uterus is empty, the cervix closes, bleeding/cramping gradually resolve.
The product has died but remains in the uterus without bleeding or expulsion for several weeks. Often diagnosed by ultrasound.
What is the best definition for a complete miscarriage?
Vaginal spotting in 1st trimester, cervix remains closed and the fetus may still survive. It’s a warning sign.
Heavier bleeding and cramping with cervical dilation. Pregnancy loss cannot be prevented at this stage
Some, but not all, products of conception are expelled. The cervix is open, and bleeding/cramping continue until remaining tissue is removed naturally or medically.
All pregnancy tissue has been expelled. The uterus is empty, the cervix closes, bleeding/cramping gradually resolve.
The product has died but remains in the uterus without bleeding or expulsion for several weeks. Often diagnosed by ultrasound.
What is the best definition for a incomplete miscarriage?
Vaginal spotting in 1st trimester, cervix remains closed and the fetus may still survive. It’s a warning sign.
Heavier bleeding and cramping with cervical dilation. Pregnancy loss cannot be prevented at this stage
Some, but not all, products of conception are expelled. The cervix is open, and bleeding/cramping continue until remaining tissue is removed naturally or medically.
All pregnancy tissue has been expelled. The uterus is empty, the cervix closes, bleeding/cramping gradually resolve.
The product has died but remains in the uterus without bleeding or expulsion for several weeks. Often diagnosed by ultrasound.
What is the best definition for a inevitable miscarriage?
Vaginal spotting in 1st trimester, cervix remains closed and the fetus may still survive. It’s a warning sign.
Heavier bleeding and cramping with cervical dilation. Pregnancy loss cannot be prevented at this stage
Some, but not all, products of conception are expelled. The cervix is open, and bleeding/cramping continue until remaining tissue is removed naturally or medically.
All pregnancy tissue has been expelled. The uterus is empty, the cervix closes, bleeding/cramping gradually resolve.
The product has died but remains in the uterus without bleeding or expulsion for several weeks. Often diagnosed by ultrasound.
What is the best definition for a missed miscarriage?
Vaginal spotting in 1st trimester, cervix remains closed and the fetus may still survive. It’s a warning sign.
Heavier bleeding and cramping with cervical dilation. Pregnancy loss cannot be prevented at this stage
Some, but not all, products of conception are expelled. The cervix is open, and bleeding/cramping continue until remaining tissue is removed naturally or medically.
All pregnancy tissue has been expelled. The uterus is empty, the cervix closes, bleeding/cramping gradually resolve.
The product has died but remains in the uterus without bleeding or expulsion for several weeks. Often diagnosed by ultrasound.
The cervical Os is dilated in which type of miscarriage?
Threatened
Inevitable
Incomplete
Complete
Missed
The product of conception is NOT expelled or is partially expelled in which types of miscarriage?
Threatened
Inevitable
Incomplete
Complete
Missed
Vaginal bleeding may not be found in this type of miscarriage...
Threatened
Inevitable
Incomplete
Complete
Missed
We may find fetal cardiac activity in:
Threatened
Inevitable
Incomplete
Complete
Missed
Abdominal pain is present in a missed abortion.
True
False
Which are the differential diagnosis of miscarriages
Ectopic pregnancy (empty uterus in USG)
Molar pregnancy snowstorm in USG, very high hCG
Physiological implantation bleeding (spotting in first trimester)
Cervical lesions or infections
