Gynecology written exams

A young lady 18 years old, comes to the outpatient clinic with chief complaint
of never had any menstruation until now. She says that she never had any
pelvic operation procedure or radio/chemotherapy before. Her breast is not
develop yet and there is no pubic hair growth as well.
Physical examinations shows no sign of acanthosis nigricans, hirsutism or
thyroid enlargement. Tanner stage is M1 and P1. Rectal touché: uterus cannot
be palpated and there is no adnexal mass.

1. In this case, what kind of hormone that responsible for breast and
uterine development?
a. Testosterone
b. Dihydrotestosterone
c. Progesterone
d. Estrogen
e. Estriol
2. What is the next diagnostic procedure to this case?
a. MRI
b. Hormonal evaluation
c. Karyotype
d. Genitogram
e. Progestin challenge
3. What is the first goal of hormonal treatment for this patient?
a. To induce Folliculogenesis
b. To induce development of secondary sex characteristics
c. To induce Thickening of endometrial layer
d. To induce menarche
e. To maintain bone mineral density

A 25 years old lady, P2 comes to the outpatient clinic due to vaginal discharge
since 5 days ago. She does not have any fever or pelvic discomfort. Physical
exams show whitish vaginal discharge with odor. No pelvic tenderness or
adnexal mass can be identified.

4. How steroid hormone can influence normal vaginal flora in this patient?
a. Estrogen induce glycogen rich environment
b. Estrogen increase thickening of cervical mucus
c. Estrogen can increase numbers of T lymphocytes
d. Estrogen can decrease lactobacillus
e. Estrogen can increase vaginal pH
5. What diagnostic finding that expected from this patient that lead to
suspicious of bacterial vaginosis?
a. Vaginal pH < 3.5
b. Microscopic examination shows abundant leukocytes
c. Microscopic examination shows abundant clue cells
d. KOH addition to vaginal secret produce sweet odor
e. Vaginal secretion is gray with itchy sensation
6. This patient has been diagnosed for bacterial vaginosis. What is the
best advice to this patient?
 a. Give antibiotics which kills anaerobes but poor activity on
lactobacillus
b. Ask her sexual partner to be treated in the same time
c. Ask the patient to use vaginal douche antiseptic solutions
d. Oral antibiotics administrations is more preferred instead of
vaginal route
e. Ask her to flush her vagina with running water

A 47 years old lady, P5 comes to the outpatient clinic with chief complaint of
post-coital bleeding since 6 months ago. She was also complaining for
recurrent vaginal discharge since a year ago. She gave birth 5 times by
spontaneous delivery. No history of contraceptive method. She still has
regular menstrual cycle every month. General state shows normal vital signs.
There is no sign of anemia. Inspeculo shows smooth portio, and no sign of
any abnormal mass.

7. What is the most possible cause of post-coital bleeding in this patient?

a. Cervicitis
b. Nabothian cyst
c. Cervical polyp
d. Precancerous lesion
e. Hormonal imbalance
8. Patient was having Pap test result a week ago and the result shows
LGSIL and koilocytosis with satisfactory result. What does it mean?
a. Cervical cancer
b. HPV infection
c. Inflammation of the cervix
d. Bacterial vaginosis
e. Secondary metastasis
9. Choose correct statement below regarding to the accuracy of Pap test!
a. The sensitivity of Pap test in general is 60%
b. Increasing the number of test to three times annually increases
false positive
c. A small size of cervical lesion can cause sampling errors
d. Specimen fixation by air dry will make better interpretation
e. Liquid base medium could alleviate interpretation errors