1. Among patients with chronic pelvic pain, a significant difference exists in the risk of sexual dysfunction and pelvic floor support problems between those who undergo a total abdominal hysterectomy and those who undergo a supracervical hysterectomy.
A. True
B. False

2. What proportion of women undergoing surgical intervention for the treatment of pelvic pain with clinically suspected endometriosis may experience a placebo effect?
A. 0%
B. 10%
C. 30%
D. 90%

3. Which of the following conditions is a risk factor for ectopic pregnancy? (Mark all that apply.)
A. Previous ectopic pregnancy
B. Pelvic inflammatory disease (PID)
C. Ovulation induction treatment
D. History of tubal ligation

4. Which of the following statements about the treatment of ectopic pregnancy is true?
A. Single-dose methotrexate (Trexall) is 5 times more likely to be unsuccessful compared with a multidose regimen
B. Rates of tubal patency are much higher after medical management than after linear salpingostomy
C. In women with low levels of human chorionic gonadotropin ([hCG] <2000 mIU/mL), ultrasound is incorrect in the diagnosis of ectopic pregnancy 10% of the time
D. In patients who receive single-dose methotrexate, a minimum drop of 50% between days 4 and 7 after treatment is considered effective

5. In the Pelvic Organ Prolapse Quantification system for grading pelvic organ prolapse, what sign is used to describe the point located 3 cm proximal to the external urethral meatus?
A. Aa
B. Ap
C. Ba
D. Bp
E. C

6. In what disorder is the urine storage phase characterized by involuntary detrusor contractions?
A. Genuine stress urinary incontinence
B. Overactive bladder (OAB)
C. Mixed incontinence
D. Overflow incontinence

7. A 74-year-old obese woman presents with complaints of a 2-year history of urinary leakage several times a day, which requires wearing pads that she changes throughout the day. She reports leakage with coughing and sneezing, but it also occurs without associated activity. At about the same time as the leakage began, she noticed decreased urinary frequency and volume. She proudly proclaims that she can hold her urine “the entire day,” voiding once in the morning when she wakes up and once at night before going to bed. She has had recurrent urinary tract infections (UTIs) for the past 18 months that have been treated by her primary care physician. She has noticed increasing vaginal pressure over the past few months. She denies hematuria or pelvic pain. Physical examination reveals a grade-3 cystocele, grade-2 uterine prolapse, and grade-1 rectocele, but no palpable urethral or pelvic masses. The cough stress test is positive in the supine position, with the cystocele reduced. A straight catheterization reveals a postvoid residual volume of 700 cc clear urine. Urinalysis is negative. She wants to have surgery for her incontinence. What would you recommend?
A. Proceed with a suburethral sling procedure to treat her obvious genuine stress urinary incontinence
B. Prescribe a medication for OAB. Since her urinary loss is not always associated with activity, anticholinergic medications may help treat any component of the OAB disorder
C. Evaluate for overflow incontinence
D. All the above

8. A 35-year-old gravida 1, para 0 woman with class B diabetes undergoes an amniocentesis after the detection of an abnormality by ultrasound findings (Figure 1). What will be the most likely karyotype result?
A. 45,XO
B. 46,XX + 21
C. 46,XX t(q21;14)
D. 46,XX

9. A 17-year-old woman is in your office today for her first prenatal visit. She is 29 weeks pregnant and complaining of cramping pain. Tocodynamic monitoring reveals regular uterine contractions. A sterile vaginal examination reveals 2- to 3-cm dilatation and 80% effacement, with intact membranes. As you inform her that she is in preterm labor and has to be admitted to the hospital, she tells you she has been feeling weak lately and shows you the following laboratory test results ordered by her primary care physician:

Blood type, O positive
Antibody screen, positive for the Du antibody titer 1: 8
Hemoglobin, 9.0 mg/dL
Hematocrit, 30.9%
Platelet count, 169 x 109/L
Glucose, fasting, 79 mg/dL
Creatinine, 0.7 mg/dL
Thyroid-stimulating hormone (TSH), 0.60 µU/mL
Anticholinesterase-receptor antibody, positive

Based on these results, what would you tell her?
A. Her baby is probably isoimmunized, and she will need percutaneous umbilical blood sampling
B. She is weak secondary to anemia and will be prescribed magnesium tocolysis
C. Under no circumstance should she be prescribed magnesium tocolysis
D. She is probably hyperthyroid, and she needs further testing

10. A 24-year-old woman, gravida 2, para 1, pre­sents to the emergency department at 36 weeks’ gestation after a motor vehicle accident in which she was a restrained driver. She is complaining of abdominal pain and light vaginal bleeding, with a lot of vaginal pressure. Vital signs are: blood pressure, 100/50 mm Hg; pulse, 99 beats/min; respirations, 20 breaths/min. She has a history of a previous cesarean section for an “abnormal fetal heart rate.” During the secondary survey, the fetus is evaluated. The nurse and the emergency department resident call you to evaluate the fetal heart rate tracing (Figure 2). What is the next step in management?
A. Continued observation
B. Emergency cesarean section
C. Ultrasound to rule out placental abruption
D. Vaginal examination to rule out labor

11. A baby is born with acrocyanosis, a pulse of 110 beats/min, a good cry, and good muscle tone. What would the Apgar score be?
A. 6
B. 7
C. 8
D. 9

12. Three days after delivery, a patient with postpartum endometritis is still febrile despite 36 hours of treatment with intravenous (IV) clindamycin (Cle­ocin) and IV gentamicin. What is the most appropriate management at this point?
A. Wait a total of 48 hours, then consult an infectious disease specialist
B. Add IV ampicillin (Principen) to the regimen
C. Perform blood and urine cultures and a chest x-ray
D. Check gentamycin peak and trough

13. A 62-year-old woman has a 1.5-cm invasive squamous-cell carcinoma of the vulva arising from the right labia majus. Which of the following suggestions best describes the potential route of lymph node spread?
A. Superficial inguinal lymph node to Cloquet’s node to deep inguinal (femoral) lymph node to iliac lymph node
B. Superficial inguinal lymph node to deep inguinal (femoral) lymph node to Cloquet’s node to iliac lymph node
C. Cloquet’s node to superficial inguinal lymph node to deep inguinal (femoral) lymph node to iliac lymph node
D. Superficial inguinal lymph node to deep inguinal (femoral) lymph node to iliac lymph node to Cloquet’s node

14. A 42-year-old woman presents as a new patient. Her family history is notable for ovarian cancer in a paternal grandmother and breast cancer in a paternal uncle. Her father died in a motor vehicle accident at age 36; he had no known illnesses at the time. During the counseling portion of the visit, you should relay your concerns about the potential for harboring a hereditary predisposition to cancer, particularly related to which of the following genes?
A. BRCA1
B. BRCA2
C. MLH1
D. MSH2

15. A 12-year-old girl presents to your office after having been discharged from the emergency department, where she was evaluated for abdominal pain. Imaging studies identified a 9-cm solid mass in the left ovary. No other abnormality was found. Results of laboratory tests ordered by her pediatrician were:
Parameter Finding (normal range)
hCG 2 mIU/mL (nonpregnant women, 0-5 mIU/mL)
Cancer antigen 125 7 U/mL (<35 U/mL)
Alpha-fetoprotein 117 ng/mL (0-44 ng/mL)
Inhibin A 98 pg/mL (age 11-13 years, <160 pg/mL)

Based on these results and the clinical findings, what is the most likely diagnosis?
A. Choriocarcinoma
B. Dysgerminoma
C. Endodermal sinus tumor
D. Low-malignant–potential ovarian cancer