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: A 17-year-old G0 presents to your office with secondary amenorrhea. She menstruated for 4 years, but her last menses was 11 months ago. History and physical exam are otherwise unremarkable. Laboratory testing reveals:
Prolactin 15 ng/mL (3 – 30)
TSH 2.1 mIU/L (0.4 – 4.5)
FSH 45 IU/L (follicular phase 2.5 – 10)
Estrogen 20 pg/mL (follicular phase 19 -144)
HCG < 5 mIU/mL (non-pregnant < 5)
What is the cause of this patient’s amenorrhea?
3) Obstetrics: What is the most likely cause of infertility in a couple with normal HSG and monthly menses?
luteal phase defect
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) Obstetrics: Trisomy results most often as a result of nondisjunction during which phase of the cell cycle?
Maternal meiosis I
Maternal meiosis II
Paternal meiosis I
6) GYN: Which of the following is a risk factor for endometrial ablation failure?
Age older than 40
History of dyspareunia
Parity greater than 5
Prior use of oral contraceptives
7) 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.
8) GYN: A 22-year-old patient has an 8 cm myoma. Which is the least reason to operate?
Heavy menstrual bleeding
9) 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
10) Gynecologic Oncology and Surgery: Which tumor marker is characteristic of a granulosa cell tumor?
11) Gynecologic Oncology and Surgery: ONC: What genetic mutation has the highest risk of breast cancer?
FAP (Familial adenomatous polyposis)
12) Gynecologic Oncology and Surgery: A 32-year-old patient comes in complaining of nipple discharge. A light green nipple discharge is elicited on exam. No mass is palpated. What is the most likely diagnosis?
Ductal carcinoma in situ
13) 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
14)Gynecologic Oncology and Surgery: A 38-year-old G2P2 is BRCA-1 positive. What is the best way for her to lower her risk of cancer?