3RD YEAR 2ND SEM GYNECOLOGY PREFINALS

1. What is the recommended screening for an 18 year old who had her initial sexual
contact?
a. pap smear every year
b. pap smear every 3 years
c. Pap smear + HPV testing every 5 years
d. no screening is recommended

CURRENT GUIDELINES:
● Age 21: Starting age
● Age 21- 29 every 3 years
● 30-65 pap smear + HPV every 5 years
● 65 above: if negative pap smear, no need for
follow up

2. Which of the following ovarian tumors contain cells with abudant glycogen and hobnail
cells, and is related to DES exposure?
a. mucinous tumors
b. serous tumors
c. endometrioid tumors
d. clear cell tumors

3. A 45 year old nulligravid presented with early satiety and bloatedness. On examination,
the patient was noted to have an abdominopelvic mass with a positive fluid wave. The following
findings point to a possible malignant ovarian tumor except:
a. Weight loss
b. Ascites
c. Multiloculated cystic mass on ultrasound with smooth capsule
d. Serum CA 125 value of 200

Malignant ovarian tumors often present with specific characteristics on imaging studies, such as irregular
borders, septations, solid components, and presence of ascites. While multiloculated cystic masses can
occur in both benign and malignant ovarian tumors, the presence of a smooth capsule is more
suggestive of a benign lesion rather than a malignant one
4. The following helps to prevent endometrial cancer except:
a. OCP
b. Raloxifene
c. Routine screening for low risk patients
d. Routine screening for high risk patients

Routine screening for low-risk patients (option c) is not typically recommended because endometrial
cancer typically presents with symptoms such as abnormal vaginal bleeding, which prompts further
evaluation. As such, routine screening in low-risk patients may not offer significant benefits in terms of
preventing endometrial cancer.

5. On preoperative ultrasound, there was an incidental finding of a 1 x 1 cm bladder

mass..Preoperative cystoscopy was done and biopsy revealed positive for tumor metastasis.
What is then the stage of the patient?
a. stage I
b. stage II
c. stage III
d. stage IV

Stage III typically involves cancer that has spread beyond the primary site to regional lymph nodes or
adjacent structures/organs. In this case, since the tumor metastasis was found in the bladder, it
suggests regional spread of the cancer, which corresponds to Stage III.

6. Which of the following is an atypical change of the vulvar or vaginal epithelium?

a. Increase in the nuclear to cytoplasmic ratio
b. Absence of mitotic figures
c. Presence of mature cells
d. Elongation of rete ridges

An increase in the nuclear to cytoplasmic ratio is a characteristic feature of atypical cells, indicating
abnormal cellular growth or dysplasia. This change is often seen in precancerous or cancerous lesions,
where cells display abnormal nuclei relative to the cytoplasm. The presence of atypical cells with an
increased nuclear to cytoplasmic ratio is concerning for dysplasia or malignancy and would prompt
further evaluation or biopsy.

7. Diagnosing PCOS is important as there are known long term consequences of the
diagnosis warranting lifelong surveillance, most important of is which of the following?
a. AUB
b. CArdiovascular disease
c. risk of ovarian cancer
d. Diabetes mellitus
8. What laboratory test will give you an indirect measurement of the ovarian reserve?
a. LH
b. FSH- this is mostly seen on days 2 and 3 of the cycle
c. Serum Estriol
d. AMH- this is a more stable test at any given time

9. In PCOS, altered GnRH pulsatility leads to what predominant change in hormone levels?
a. increased LH
b. decreased testosterone
c. decreased estrone
d. increased FSH

In PCOS, there is typically an imbalance in the hypothalamic-pituitary-ovarian axis, characterized by increased

frequency and amplitude of GnRH pulses. This dysregulation results in elevated secretion of LH from the anterior
pituitary gland, leading to a high LH to FSH (Follicle-Stimulating Hormone) ratio. The elevated LH levels contribute
to the characteristic hormonal profile observed in PCOS, which includes hyperandrogenism (elevated levels of
androgens such as testosterone) and disrupted ovarian function (such as anovulation and irregular menstrual
cycles). Therefore, in PCOS, the predominant change in hormone levels is elevated LH levels compared to FSH.
10. Which histologic type of epithelial ovarian cancer has the greatest incidence of
bilaterality?
a. Serous
b. Endometrioid
c. Mucinous
d. Clear cell

SEROUS ovarian neoplasms are the most common type of epithelial tumors. Serous adenocarcinomas
tend to be high grade, are the most virulent, and have the worst prognosis of epithelial adenocarcinomas.
They are bilateral in 33% to 66% of cases. -Comprehensive Gynecology, Neoplastic Diseases of the Ovary
Page 778

11. Which of the following vulvar conditions are at risk for developing vulvar cancer?
a. lichen planus
b. lichen sclerosus
c. condyloma acuminata
d. lichen simplex

Vulvar lichen sclerosus is associated with an increased risk of VC, especially in the presence of dVIN and
with advancing age. Ultrapotent topical steroids seem to reduce this risk. An increased risk of developing
VC has been suggested for VLP. Long-standing lichen sclerosus is associated with an increased risk of
developing vulvar cancer, particularly squamous cell carcinoma.

12. Which of the statements is true regarding familial ovarian cancer?

a. Periodic surveillance with transvaginal ultrasonography every 6 months after age
50 is necessary
b. The familial cancer syndromes comprise majority of the ovarian cancer cases
The degree of consanguity which poses an increased ovarian cancer risk is up to the
third-degree relative
c. Prophylactic oophorectomy should be offered to mutation carriers to reduce the
risk of ovarian or peritoneal cancer
13. A 42 year old, G3P3 (3003), came in due to a mass of 5 days duration on the left labia.
There are no other associated signs and symptoms noted. On physical examination, there was
a 6x5 cm mass at the lower lateral aspect of the left labia, non tender. What is the
recommended treatment for this patient?
a. antibiotics
b. word catheterization
c. biopsy
14. Secondary syphilis is always associated with which of the following findings?
a. Chancre
b. Classic rash at the palms and soles and condyloma latum
c. Gumma
d. All of the above

15. The following are risk factors for the development of endometrial hyperplasia and
endometrial carcinoma except:
a. Diabetes mellitus
b. Hypertension
c. PCOS
d. Obesity

16. In which of the following patients should infertility work up be initiated?

a. 37 year old male (female) living in for 6 months with her 25 year old partner
(wrong grammar)
b. 37 year old female living in with her 36 year old partner
c. A 33 year year old, married for 9 months
 D. A 22 year old, married for 2 years
17. For women with idiopathic hirsutism as well as PCOS, the best treatment for hirsutism
that is due to increased peripheral androgen metabolism is which of the following?
a. metformin
b. ketoconazole
c. spironolactone
d. Shaving
18. On histopathologic examination, the tumor cells contain abundant glycogen, resembling
a hobnail in appearance. The most likely histology for this ovarian tumor is:
a. Serous cystadenocarcinoma
b. Mucinous cystadenocarcinoma
c. Endometrioid adenocarcinoma
d. Clear cell carcinoma

19. A 40 year old G3P3 (3003) patient presented with abnormal uterine bleeding. Ultrasound
showed a thickened endometrium. Endometrial biopsy was done which revealed simple
hyperplasia with atypia? What is the best management for this patient? (complex atypical
hyperplasia is also simple hyperplasia with atypia)
a. Endometrial ablation
b. Continuous progestins
c. Hysterectomy
d. Cyclical progestins

20. Infertility work up should be started in patients with:

a. 23 year old female married for 2 years already
b. 37 year old female living in with her 36 year old partner
c. 34 year old female married for 9 months
d. 37 year old male living in for 6 months with her 25 year old partner
21. which of the following statements is true regarding bone health in menopause?
a. Bone mass is substantially affected by sex steroids
b. Estrogen deficiency is not well established as cause of bone loss
 c. Postmenopausal bone loss is not a substantial health care problem
d. Loss of cortical bone is greater with estrogen deficiency than is loss of trabecular
bone

22. In which of the following patients would you do ovarian reserve testing the least?
a. Patient with family history of early menopause
b. patient with poor response to exogenous gonadotropin stimulation
c. patient with previous ovarian surgery
d. 33 year old patient with 15 months infertility
23. Obesity increases the risk factor for endometrial cancer through the following
mechanisms:
a. Conversion of androstenedione to estradiol in adipose tissue
b. Increase in the sex hormone binding globulin
c. both
d. none of the above

24. Which of the following is alpha feto protein not very useful as a marker?
a. endodermal sinus tumor
b. choriocarcinoma
c. immature teratoma
d. Embryonal carcinoma
25. Vulvar cancer spreads through the following mechanism/s:
a. Direct extension
b. Hematogenous
c. Lymphatic
d. all of the above

26. A 23 year old nulligravid comes in for hypogastric pain and vaginal discharge.VS: BP
110/80 HR 110 RR 24 Temp 38.8C On abdominal exam there was direct tenderness more at
the right lower quadrant. On speculum examination there was mucopurulent discharge from
the cervical os. On the internal exam, there was cervical motion tenderness, and right
adnexal tenderness. Ultrasound examination revealed a complex mass at the right adnexal
area measuring 5 x 4 cm, probably a tuboovarian abscess. Your next best step will be to:
 a. screen the patient for other STDs
b. admit the patient for emergency laparotomy
c. admit the patient for IV antibiotics
d. prescribe oral antibiotics and advise the patient to closely follow up
27. What is the recommended screening for a 65 year old G3P3 (3003) who underwent
THBSO for myoma uteri?
a. pap smear every year
b. pap smear every 3 years
c. pap smear with HPV testing
d. None
28. Bacterial vaginosis is a/an:
a. vaginitis that should be documented by culture to identify the specific etiologic
organism (does not need to culture)
b. a polymicrobial infection predominantly caused by anaerobic organisms
c. an infection that can be treated with vaginal suppositories in the pregnant patient
so as to prevent adverse pregnancy outcomes
d. sexually transmitted infection and thus all sexual partners must be treated as well

29. A menopausal patient consults you regarding risks of cancers with hormone replacement
therapy. Which of the following statements will you tell your patient?
a. It has been shown consistently that there is an increased risk of ovarian cancer
(breast cancer dapat) among women with long duration of use of ET/HT
b. There is convincing data showing an increased risk for lung cancer in women
who use HT (not consistent and without convincing data)
c. There is an increased (increase dapat) risk for colorectal cancer in women who
use ET/HT
d. The risk for endometrial cancer in women taking estrogen and progestogen is
similar to women in the general population

30. 65-year old patient presented with a mass at the right labia majora which measured 4 x 4
cm. There is no extension to the surrounding perineal structures. There was a 3 x 3 cm
movable, right inguinal lymph node. Punch biopsy of the mass was done which revealed
squamous cell carcinoma. What is the stage of the patient based on FIGO?
a. stage I
b. stage III
c. stage II
d. stage IV
31. The patient presents with abnormal uterine bleeding, has a BMI of 32, ultrasound
revealed a thickened endometrium of 2 cm. What is the next best step?:
a. Proceed with oral progestin treatment
b. Request for preoperative clearance for surgery
c. Perform an endometrial biopsy
d. Observation only

RATIONALE: An endometrial biopsy is typically recommended when there is

abnormal uterine bleeding, especially in the presence of risk factors such as
obesity (BMI of 32 in this case) and a thickened endometrium on ultrasound.
This procedure helps to evaluate the endometrium for any signs of abnormal
cell growth, such as endometrial hyperplasia or cancer. It provides valuable
information for diagnosis and guides further management.

32. Which ovarian tumor is usually related to precocious puberty?

a. Granulosa cell tumor
b. sertoli leydig cell tumor
c. metastatic ovarian tumor
d. immature teratoma

RATIONALE: Granulosa cell tumors are ovarian neoplasms that can produce
estrogen, leading to hormonal imbalances and manifestations such as
precocious puberty or abnormal uterine bleeding, especially in young girls.
These tumors are derived from granulosa cells, which are part of the ovarian
follicles responsible for estrogen production.

33. The following statements are true for Vaginal intraepithelial Neoplasia (VAIN) except:
a. Risk factors for the development of VAIN are HPV infection, smoking, early age
at first intercourse.
b. Vaginal dysplasia mimics cervical dysplasia with a high prevalence of HPV
infection as opposed to vulvar dysplasia
c. The most common site of involvement is the lower third of the vagina.
d. Routine screening of low risk population is not warranted.

RATIONALE:Vaginal dysplasia does not typically mimic cervical dysplasia in

terms of prevalence of HPV infection. Both vaginal and cervical dysplasia can
be caused by HPV infection, although cervical dysplasia has a higher
association with HPV. Additionally, vulvar dysplasia can also be caused by HPV
 infection. Therefore, the prevalence of HPV infection is significant in all three
conditions.

34. Which category of endometrial hyperplasia confers the greatest risk for malignancy?
a. complex atypical hyperplasia
b. simple hyperplasia
c. complex hyperplasia without atypia

RATIONALE: Complex atypical hyperplasia is considered the highest risk

category among endometrial hyperplasias. It is characterized by glandular
crowding, complexity, and cellular atypia. There is a significant risk of
progression to endometrial cancer if left untreated. Therefore, it requires close
monitoring and often intervention such as hysterectomy or hormonal therapy to
reduce the risk of malignancy.

35. When is the best time to do HSG to test for tubal patency?
a. days 1-3 of the menstrual cycle
b. day 20 onwards
c. days 8-10 of the menstrual cycle
d. Midcycle

RATIONALE:

36. The following factors increase the risk for ovarian cancer except:
 a. Infertility
b. Use of oral contraceptive pills
c. Nulliparity
d. Postmenopausal age

RATIONALE: use of oral contraceptive pills has been associated with a

decreased risk of ovarian cancer. Studies have shown that long-term use of
oral contraceptives can reduce the risk of developing ovarian cancer. Other
factors like infertility, nulliparity, and postmenopausal age have been linked to
an increased risk of ovarian cancer.

37. A 28 year old patient with endometrial cancer on endometrial biopsy, comes for possible
conservative management. Workups were then performed. Which of the following features
would make her an unlikely candidate for conservative management?
a. Well differentiated endometrioid type by histology
b. No adnexal metastasis
c. Positive for lymphovascular space invasion
d. No myometrial invasion

RATIONALE: Lymphovascular space invasion (LVSI) is associated with an

increased risk of metastasis and recurrence in endometrial cancer.
Conservative management typically involves fertility-sparing options like
hormonal therapy or a less aggressive surgery. However, the presence of LVSI
indicates a higher likelihood of systemic spread of cancer cells, making
conservative management less suitable due to the increased risk of recurrence
and poorer prognosis.

38. The patient has a BMI of 32, ultrasound revealed a thickened endometrium of 2 cm.
What is the next best step?:
a. Request for preoperative clearance for surgery
b. Proceed with oral progestin treatment
c. Perform an endometrial biopsy
d. Observation only

RATIONALE: A thickened endometrium, especially in the setting of obesity,

warrants further evaluation to rule out endometrial hyperplasia or endometrial
cancer. An endometrial biopsy is a minimally invasive procedure that allows for
the sampling of endometrial tissue for histological examination, aiding in the
 diagnosis of potential pathology. This step is crucial for proper management
and treatment planning.

39. Which of the following hormones is increased during menopause?

a. DHEA
b. Androstenedione
c. testosterone
d. FSH

RATIONALE: During menopause, there is a decrease in estrogen production by

the ovaries, leading to an increase in follicle-stimulating hormone (FSH) levels.
This increase in FSH is a result of the diminished negative feedback from
estrogen on the hypothalamus and pituitary gland, leading to higher levels of
FSH in an attempt to stimulate ovarian follicles.

40. Which of the following increases the risk of Ovarian epithelial carcinoma?
a. infertility
b. pregnancy
c. OCP
d. breast feeding

RATIONALE: Infertility has been identified as a risk factor for ovarian epithelial
carcinoma. The exact mechanisms are not fully understood, but it is believed
that factors contributing to infertility, such as ovulatory disturbances or
underlying hormonal imbalances, may play a role in the development of ovarian
cancer.

41. The following are risk factors for the development of endometrial hyperplasia and
endometrial carcinoma except:
a. Obesity
b. Hypertension
c. Diabetes mellitus
d. Polycystic ovarian syndrome

Hypertension is not typically considered a risk factor for the development of

endometrial hyperplasia and endometrial carcinoma. However, obesity,
diabetes mellitus, and polycystic ovarian syndrome are all known risk factors
for these conditions.
42. A 30 year old nulligravid presented with irregular menstruation. Ultrasound revealed a
thickened endometrium and polycystic ovaries. Endometrial biopsy showed complex
hyperplasia with atypia. What is the best management for this patient?
a. progestins
b. Endometrial ablation
c. Hysterectomy

RATIONALE: Progestin therapy is often the first-line treatment for complex

hyperplasia with atypia, especially in young patients who desire fertility
preservation. Progestins can help induce regular shedding of the endometrium,
potentially reversing the hyperplastic changes and reducing the risk of
progression to endometrial carcinoma. It is important to monitor the response
to progestin therapy with follow-up endometrial biopsies. Hysterectomy may be
considered if there is persistent or recurrent disease or if fertility is not desired.
Endometrial ablation is typically not indicated for complex hyperplasia with
atypia due to the risk of leaving behind residual disease.

43. What is the first line treatment for women with PCOS who are desirous of pregnancy?
a. Letrozole
b. gonadotropin injection
c. Clomiphene citrate
d. Metformin

RATIONALE: Clomiphene citrate is a selective estrogen receptor modulator that

is commonly used as the first-line treatment for ovulation induction in women
with PCOS who are trying to conceive. It works by blocking estrogen receptors
in the hypothalamus, leading to increased secretion of gonadotropin-releasing
hormone (GnRH), which in turn stimulates the release of follicle-stimulating
hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. This
stimulates ovarian follicle development and ovulation. Letrozole is also used as
an alternative to clomiphene citrate. Gonadotropin injections are typically
reserved for women who do not respond to clomiphene or letrozole, or in cases
where controlled ovarian stimulation is required. Metformin may be used in
combination with clomiphene or letrozole in some cases, especially in women
with PCOS who also have insulin resistance or glucose intolerance, but it is not
typically used as a standalone treatment for ovulation induction.
44. An 8-year old patient presents with precocious puberty. An abdomino-pelvic mass is
noted on examination. Ancillary diagnostics were done which points to an ovarian origin. What
is the most likely histology of the ovarian tumor?
a. Granulosa cell tumor
b. Dysgerminoma
c. Yolk sac tumor
d. Immature teratoma
RATIONALE: Dysgerminoma is a type of germ cell tumor that commonly occurs
in adolescents and young adults and is the most common malignant ovarian
tumor in children. It can present with precocious puberty due to its secretion of
beta-human chorionic gonadotropin (β-hCG). While other ovarian tumors such
as granulosa cell tumors or immature teratomas may also be associated with
precocious puberty, dysgerminoma is particularly common in this age group
and presentation.

45. Clinical treatment of women in perimenopause should address these three general areas
of concern
a. Osteoporosis, symptoms of early menopause, decreased sexual desire
b. Irregular bleeding, hot flushes, osteoporosis
c. Irregular bleeding, inability to conceive, symptoms of early menopause
d. Cessation of menstruation, decreased sexual desire, inability to conceive

RATIONALE: During perimenopause, women commonly experience irregular

menstrual bleeding, hot flushes (or flashes), and are at an increased risk of
developing osteoporosis due to hormonal changes. These are key areas that
clinicians focus on addressing to improve quality of life and reduce the risk of
long-term health complications associated with menopause.

46. Which pathology had the greatest incidence of regression to normal?

a. Simple hyperplasia without atypia
b. Complex hyperplasia without atypia
c. Simple hyperplasia with atypia
d. Complex hyperplasia with atypia

47. Threshold of endometrial thickness for postmenopausal women is which of the

following?
a. >5 mm
b. >3 mm
c. >2 mm
d. >0.5 mm
48. Which of the following is not an effect of estrogen on brain function?
a. Antioxidant properties
b. Protection against apoptosis
c. Decreases cerebral blood flow
d. Enhances glucose transport in the brain

49. A 28 year old, nulligravid came into your clinic due to white and thick vaginal discharge
associated with dysuria and vulvar pruritus. On examination, you noted vaginal erythema as
well as presence of thick, curdy discharge. You obtained a sample of the discharge which was
sent to the laboratory. Which among the following will be seen in the wet mount of the
specimen?
a. Clue cells
b. Motile trichomonads
c. Hyphae and spores
d. All of the above

50. A 60 year old patient presents with vulvar pruritus. The following findings are suggestive
of vulvar atypia except:
a. Skin fissures
b. Diffuse whitish change of the vulvar skin
c. Enlarged and necrotic inguinal lymph node
d. Multifocal pigmented lesions

51. A 27 year old, G2P2 (2002), came in due to vaginal pruritus, associated with thick
cheese like vaginal discharge. Vulvar inspection showed excoriations and erythema and
Speculum examination showed thick curd-like discharge. Which of the following tests will best
confirm your diagnosis?
a. KOH mount
b. culture
c. wet mount
d. VDRL
52. A 32 year old, nulligravid, sexually active,came to your clinic due to vaginal discharge,
described as frothy, yellowish to greenish foul smelling discharge, associated with vaginal
pruritus. Speculum examination showed cervical microhemorrhages or petechiae. What is the
most likely diagnosis?
a. bacterial vaginosis
b. trichomoniasis
c. candidiasis
d. mucopurulent cervicitis

53. Clinical diagnosis of bacterial vaginosis includes which of the following?

a. 10% clue cells on wet mount
b. vaginal pH of<4.5
c. thick viscous discharge
d. + whiff test

54. A 26 year old sex worker consulted in your clinic due to multiple, painful vesicular lesions
at the left labia with associated lymphadenopathy on her left groin. What is the most likely
diagnosis
a. Herpes
b. Lymphogranuloma venereum
c. Syphilis
d. Chancroid
55. Which of the following is the hallmark feature of declining estrogen status in the brain?
a. vasomotor episode
b. cognitive decline
c. depression
d. memory loss

56. A 25 year old, nulligravid, came due to vulvar pain, with appearance of multiple painful
ulcers, with external dysuria, which started 4 days ago. She has no know co morbidities. LMP
was 10 days ago. Physical examination showed multiple, painful ulcer on the vulccar area,
irregularly shaped, with punched out or scalloped borders. What is your primary diagnosis?
a. syphilis
b. genital herpes
c. chancroid
d. granuloma inguinale
57. Which of the following patients have the highest risk for developing vaginal carcinoma
a. a patient who was treated for cervical cancer
b. An immunocompromised patient
c. A patient who underwent treatment for VAIN
d. A patient whose mother has vaginal cancer

58. Sources of androgen production may come from the following, except:
a. Ovaries
b. testes
c. adrenal glands
d. pituitary gland

59. You were doing a speculum examination on a menopausal patient. Which of the
following findings are expected?
a. increased pH of the vaginal mucosa
b. high moisture content in the vaginal mucosa
c. thick, pale vaginal mucosa
 d. increased vaginal blood flow
60. Which of the following statements is true regarding cervical dysplasia during pregnancy?
a. In pregnancy, cervix becomes larger, blood supply is increased and decidual
changes in the epithelium may be confused with CIN
b. Colposcopy is safe, however biopsies should only be performed if there is
suspicion of invasive disease
c. Unlikely for dysplasia to progress during pregnancy
d. ECC should be performed in all pregnant patients