1) Female Pelvic Medicine: A 33-year-old multigravida patient presents complaining of dyspareunia and “feeling loose” during intercourse. Obstetrical history includes that of an episiotomy with a 4th-degree extension during her last delivery several years ago. Review of Systems include rare symptoms of stress urinary incontinence, but no complaints of fecal incontinence. Pelvic examination is significant for a widened genital hiatus, scarred posterior fourchette, positive dovetail sign and a tender perineal body that is <0.3cm. The most likely reason that the patient has no symptoms of fecal incontinence is:
The external anal sphincter is mostly intact
The internal anal sphincter is mostly intact
The rectoanal inhibitory reflex is normal
The anorectal angle is less acute
The dependency on the puborectalis muscle is increased
2) REI: What is the most common cause of ambiguous genitalia?
3-beta hydroxysteroid dehydrogenase deficiency
3) REI: A teen has primary amenorrhea, normal external genitalia, but a blind-ending vagina. What would be the most helpful to differentiate androgen insensitivity syndrome from Mullerian agenesis?
Café au lait spots
Urinary tract abnormalities
Increase serum testosterone
4) Obstetrics: A 27-year-old G1P0 presents for her first prenatal visit. She is overall healthy and is an avid exerciser. She is worried about which activities and exercises she should avoid in pregnancy. You inform her that she should avoid all of the following activities in pregnancy except:
Running or jogging
All of the above
5) GYN: A healthy 18-year-old desires contraception. Which of the following should be obtained prior to prescribing contraception?
Guardian or parental consent
6) OFFICE: A 40-year-old African-American female presents for an annual exam with a blood pressure of 145/90. The patient returns the next week with a blood pressure of 155/95. What is the best management choice?
Initiate antihypertensive therapy with ACE Inhibitor
Initiate antihypertensive therapy with angiotensin Receptor Blocker (ARB).
Initiate antihypertensive therapy with hydrochlorothiazide.
Recommend checking blood pressures at home.
Recommend initiating lifestyle changes and recheck blood pressure in 2 months.
Obstetrics: What type of placentation is the most common in monozygotic twins?
8) Urogyn: A patient presents with pelvic pain associated with a change in her bowel habits. Which of the following characteristics meet the criteria to diagnose irritable bowel syndrome?
Pain for at least 3 days monthly with constipation and relief with defecation
Pain for less than a month which onset with constipation, but no change in the form of stool
Pain for 2 months which onset with constipation and increases with defecation
Pain for over 6 months which onset with increased stool frequency and pain increases with laxatives
9) Gynecologic Oncology and Surgery: Which tumor marker is characteristic of a granulosa cell tumor?
10) Gynecologic Oncology and Surgery: What genetic mutation has the highest risk of breast cancer?
FAP (Familial adenomatous polyposis)
11) Gynecologic Oncology and Surgery: A 68-year-old complains of vulvar pruritis. Colposcopy reveals 3 multifocal <1cm lesions. Biopsy reveals vulvar intraepithelial neoplasia (VIN) 3. The best treatment is:
Wide local excision
12) Obstetrics: What is the most likely pregnancy outcome for a patient who contracts Parvovirus B19 causing erythema infectiosum (Fifth Disease) in the first trimester?
No adverse outcome
Childhood developmental delays
Severe fetal anemia
13) Gynecologic Oncology and Surgery: Which ovarian tumor could lead to endometrial intraepithelial neoplasia?