REPRO EXAM 2
Good Luck on Exam 2 !
- OBIGs & SOMA
Question 1
27 year old female presents to your office reporting symptoms
of breast tenderness, headaches, bloating, lethargy, and
anxiety in the days prior to her period. She states that these
symptoms are affecting her daily life and making it difficult
to attend school and study. This patient’s most likely
diagnosis is:
a. Major depressive disorder
b. PMS
c. PMDD
d. Menstrual Migraine Headaches
Question 1 (Answer)
27 year old female presents to your office reporting symptoms of breast tenderness,
headaches, bloating, lethargy, and anxiety in the days prior to her period. She
states that these symptoms are affecting her daily life and making it difficult to
attend school and study. This patient’s most likely diagnosis is:
a. Major depressive disorder
b. PMS
c. PMDD
d. Menstrual Migraine Headaches
Correct Answer: C. PMDD
Rationale: This patient has 5/11 symptoms with one core symptom (marked anxiety).
These symptoms are also affecting the patient’s normal daily functioning.
Question 1 (Incorrect Foils)
A. Major depressive disorder: This diagnosis involves persistent
depressive symptoms that are not limited to the luteal phase of
the menstrual cycle and would not typically present with
cyclical physical symptoms like breast tenderness and bloating.
B. PMS: While PMS includes similar symptoms, PMDD is a more
severe form that significantly impacts daily functioning, which
matches the patient's presentation.
D. Menstrual migraine headaches: This condition would primarily
present with headaches linked to the menstrual cycle, without
the broad range of symptoms affecting daily life seen in PMDD.
Question 2
A 14-year-old girl presents with concerns about her menstrual
cycle. She had her menarche at age 12. She reports irregular
periods since then. What is the typical time frame for the
establishment of regular ovulatory cycles after menarche?
A) 6 months
B) 1 year
C) 3 years
D) 5 years
Question 2 (Answer)
A 14-year-old girl presents with concerns about her menstrual cycle.
She had her menarche at age 12. She reports irregular periods since
then. What is the typical time frame for the establishment of
regular ovulatory cycles after menarche?
A. 6 months
B. 1 year
C. 3 years
D. 5 years
Correct Answer: C. 3 Years
Rationale: At the start of menarche the HPO axis is still immature,
so it takes time for hormone levels to regulate.
Question 2 (Incorrect Foils)
A. 6 months: This is too short a period for regular
ovulatory cycles to establish post-menarche.
B. 1 year: While some girls may start to have more
regular cycles within a year, it is more common for
it to take longer.
D. 5 years: This is longer than the typical time
frame for the establishment of regular cycles,
which usually occurs by 2-3 years post-menarche.
Question 3
Which of the following is a contraindication for the use of
combination oral contraceptive pills?
A) History of deep venous thrombosis (DVT)
B) Family history of breast cancer
C) Use of antibiotics
D) Smoking in women under 35 years of age
Question 3 (Answer)
Which of the following is a contraindication for
the use of combination oral contraceptive pills?
A. History of deep venous thrombosis (DVT)
B. Family history of breast cancer
C. Use of antibiotics
D. Smoking in women under 35 years of age
Correct Answer: A. History of DVT
Rationale: OCPs increase the risk of DVT by
increasing clotting factors and leading to a
hypercoagulative state.
Question 3 (Incorrect Foils)
B. Family history of breast cancer: While family
history of breast cancer requires careful
consideration, it is not an absolute contraindication
for COCs.
C. Use of antiobiotics: Most antibiotics do not
interfere with the efficacy of COCs, although
rifampin is an exception.
D. Smoking in women under 35 years of age: Smoking
increases the risk for CV events, but the risk is
significantly higher in women over 35 years of age
who smoke and use COCs. For this age cohort, smoking
is not an absolute COC.
Question 4
What is the primary action of progestin in combination oral
contraceptive pills?
A) Suppressing follicle-stimulating hormone (FSH)
B) Inhibiting sperm migration
C) Suppressing luteinizing hormone (LH) and inhibiting ovulation
D) Increasing endometrial thickness
Question 4 (Answer)
What is the primary action of progestin in combination oral
contraceptive pills?
A. Suppressing follicle-stimulating hormone (FSH)
B. Inhibiting sperm migration
C. Suppressing luteinizing hormone (LH) and inhibiting
ovulation
D. Increasing endometrial thickness
Correct Answer: C. Suppressing LH and inhibiting ovulation
Rationale: Progestin works by inhibiting the mid-cycle surge
of luteinizing hormone (LH), which is necessary for
ovulation. Without this LH surge, ovulation does not occur,
preventing the release of an egg from the ovary.
Question 4 (Incorrect Foils
A. Suppressing follicle-stimulating hormone (FSH):
While progestins may have some effect on FSH levels,
the primary action related to contraception is the
suppression of LH and ovulation.
B. Inhibiting sperm migration: Progestins do increase
the viscosity of cervical mucus, which inhibits sperm
migration, but this is not the primary action.
D. Increasing endometrial thickness: Progestins
actually cause the endometrium to become thinner and
less suitable for implantation, which is a secondary
mechanism of action.
Question 5
The histology shown above shows bluer/ hematoxylin-rich glands
with stratified cells that are piling on top of each other.
This indicates:
a. Atypical hyperplasia
b. Simple hyperplasia without atypia
c. Complex hyperplasia without atypia
d. Normal endometrial proliferation
Question 5 (Answer)
The histology shown above shows bluer/ hematoxylin-rich glands with
stratified cells that are piling on top of each other. This indicates:
a. Atypical hyperplasia
b. Simple hyperplasia without atypia
c. Complex hyperplasia without atypia
d. Normal endometrial proliferation
Correct Answer: A. atypical hyperplasia
Rationale: This description and image is indicative of atypical
hyperplasia of either simple and complex architecture)
Question 5 (Incorrect Foils)
B. Simple hyperplasia without atypia: Characterized
by an increased number of glands, but without
significant crowding of cells or atypia
C. Complex hyperplasia without atypia: Involves
glandular crowding and architectural complexity but
lacks the cytological atypia seen in atypical
hyperplasia.
D. Normal endometrial proliferation: Shows a regular,
organized glandular pattern without significant
crowding or nuclear atypia.
Question 6
A 42-year-old woman presents with lower abdominal pain and
bloating. Pelvic ultrasound reveals a large, multiloculated
ovarian mass with septations and solid components.
Histological and gross pathological findings are seen below.
What is the most likely diagnosis?
A. Serous cystadenoma
B. Follicular cyst
C. Mucinous cystadenoma
D. Corpus luteum cyst
E. Dermoid cyst
Question 6 (Answer)
A 42-year-old woman presents with lower abdominal pain and bloating.
Pelvic ultrasound reveals a large, multiloculated ovarian mass with
septations and solid components. What is the most likely diagnosis?
A. Serous cystadenoma
B. Follicular cyst
C. Mucinous cystadenoma
D. Corpus luteum cyst
E. Dermoid cyst
Correct Answer: C. Mucinous cystadenoma
Rationale: Mucinous cystadenomas are often large, multiloculated ovarian
masses with septations and can contain mucinous material. These
characteristics match the description of the patient's ovarian mass.
Question 6 (Incorrect Foils)
A. Serous cystadenoma: These tumors are usually unilocular or
have few locules and are often filled with clear serous
fluid.
B. Follicular cyst: Typically small, simple cysts that
develop from follicles and do not have multiple locules or
solid components.
D. Corpus luteum cyst: These are usually simple cysts related
to the menstrual cycle, often unilateral, and not typically
large or multiloculated.
E. Dermoid cyst: Also known as mature cystic teratomas, these
can contain a variety of tissue types including hair and
teeth, and are not typically described as multiloculated.
Question 7
A 30-year-old woman with a history of molar pregnancy presents
with bilateral ovarian masses. Ultrasound shows large,
multicystic ovaries. Which type of ovarian cyst is most
likely?
A. Follicular cyst
B. Corpus luteum cyst
C. Serous cystadenoma
D. Mucinous cystadenoma
E. Theca lutein cyst
Question 7 (Answer)
A 30-year-old woman with a history of molar pregnancy presents
with bilateral ovarian masses. Ultrasound shows large,
multicystic ovaries. Which type of ovarian cyst is most likely?
A. Follicular cyst
B. Corpus luteum cyst
C. Serous cystadenoma
D. Mucinous cystadenoma
E. Theca lutein cyst
E. Theca lutein cyst
Rationale: Theca lutein cysts are often associated with
conditions that cause elevated levels of human chorionic
gonadotropin (hCG), such as molar pregnancies. They are
typically bilateral and multicystic.
Question 7 (Incorrect Foils)
A. Follicular cyst: Typically unilateral and simple, not
associated with molar pregnancy.
B. Corpus luteum cyst: Usually unilateral and related to
the menstrual cycle, not typically multicystic.
C. Serous cystadenoma: Typically unilocular or have few
locules, not related to molar pregnancies or elevated
hCG.
D. Mucinous cystadenoma: Usually large and multiloculated
but not typically associated with molar pregnancies or
elevated hCG levels.
Question 8
A 30-year-old male presents to the emergency department with severe,
sudden-onset, left testicular pain that started an hour ago. He denies any
trauma. Physical examination reveals a swollen, erythematous scrotum, and
the left testis is tender to touch with a high-riding position and an
absent cremasteric reflex. What is the most likely diagnosis?
A. Epididymitis
B. Orchitis
C. Testicular torsion
D. Varicocele
E. Hydrocele
Question 8 (Answer)
A 30-year-old male presents to the emergency department with severe, sudden-
onset, left testicular pain that started an hour ago. He denies any trauma.
Physical examination reveals a swollen, erythematous scrotum, and the left
testis is tender to touch with a high-riding position and an absent cremasteric
reflex. What is the most likely diagnosis?
A. Epididymitis
B. Orchitis
C. Testicular torsion
D. Varicocele
E. Hydrocele
C. Testicular Torsion
Rationale: Testicular torsion involves the twisting of the spermatic cord,
leading to ischemia. It presents with sudden-onset severe testicular pain, a
high-riding testis, and an absent cremasteric reflex. It is a surgical emergency
requiring immediate intervention to save the testis.
Question 8 (Incorrect Foils)
A. Epididymitis: Typically presents with gradual onset of pain, swelling, and
tenderness in the epididymis, often accompanied by fever and dysuria. The
cremasteric reflex is usually present.
B. Orchitis: Usually presents with testicular pain and swelling, often
associated with systemic symptoms such as fever. It is often due to infection
(e.g., mumps).
D. Varicocele: Presents with a dull ache or heaviness in the scrotum,
described as a "bag of worms" on palpation. It does not cause sudden severe
pain or absent cremasteric reflex.
E. Hydrocele: Presents with a painless, swollen scrotum that transilluminates.
It does not cause sudden severe pain or absent cremasteric reflex.
Question 9
A 25-year-old man presents with a painless testicular mass.
Physical examination reveals a firm, non-tender mass in the
right testis. Serum tumor markers show elevated AFP and βhCG.
An orchiectomy is performed, and histology shows a mixture of
primitive gland-like structures, immature cartilage, and areas
of hemorrhage and necrosis. What is the most likely diagnosis?
A. Seminoma
B. Embryonal carcinoma
C. Yolk sac tumor
D. Choriocarcinoma
E. Mixed germ cell tumor
Question 9 (Answer)
A 25-year-old man presents with a painless testicular mass. Physical examination
reveals a firm, non-tender mass in the right testis. Serum tumor markers show elevated
AFP and βhCG. An orchiectomy is performed, and histology shows a mixture of primitive
gland-like structures, immature cartilage, and areas of hemorrhage and necrosis. What
is the most likely diagnosis?
A. Seminoma
B. Embryonal carcinoma
C. Yolk sac tumor
D. Choriocarcinoma
E. Mixed germ cell tumor
E. Mixed germ cell tumor
Rationale: Mixed germ cell tumors are composed of more than one type of germ cell
neoplasm, and histology in this case shows features of both embryonal carcinoma
(primitive gland-like structures) and teratoma (immature cartilage). The presence of
elevated AFP and βhCG also supports the diagnosis of a mixed germ cell tumor.
Question 9 (Incorrect Foils)
A. Seminoma: Typically presents with homogenous, well-
circumscribed masses without areas of necrosis or hemorrhage,
and does not usually elevate AFP.
B. Embryonal carcinoma: Can elevate AFP and βhCG, but typically
does not contain teratomatous elements like immature cartilage.
C. Yolk sac tumor: Often has elevated AFP but usually shows
Schiller-Duval bodies on histology, not primitive gland-like
structures and immature cartilage.
D. Choriocarcinoma: Highly aggressive and characterized by
cytotrophoblasts and syncytiotrophoblasts, usually without
gland-like or cartilaginous elements.
Question 10
A 58-year-old male with a history of hypertension and diabetes
presents with complaints of erectile dysfunction (ED). He
reports that he can achieve an erection but is unable to
maintain it. Which of the following is the most likely
underlying cause of his ED?
A. Psychogenic
B. Neurogenic
C. Hormonal
D. Vasculogenic
E. Medication-induced
Question 10 (Answer)
A 58-year-old male with a history of hypertension and diabetes presents with
complaints of erectile dysfunction (ED). He reports that he can achieve an erection
but is unable to maintain it. Which of the following is the most likely underlying
cause of his ED?
A. Psychogenic
B. Neurogenic
C. Hormonal
D. Vasculogenic
E. Medication-induced
D. Vasculogenic
Rationale: Vasculogenic causes are the most common underlying factor in patients
with a history of hypertension and diabetes, as these conditions can lead to
endothelial dysfunction and impaired blood flow, which are critical for maintaining
an erection.
Question 10 (Incorrect Foils)
A. Psychogenic: While psychological factors can contribute to ED, the
patient's medical history of hypertension and diabetes makes a
vasculogenic cause more likely.
B. Neurogenic: Neurogenic causes of ED are related to nervous system
disorders, such as spinal cord injury or multiple sclerosis, which the
patient does not have a history of.
C. Hormonal: Hormonal causes typically involve low testosterone levels,
but the patient’s medical history suggests a vascular issue.
E. Medication-induced: Certain medications can cause ED, but the
patient's history of hypertension and diabetes points more towards a
vasculogenic cause.
Question 11
A 42-year-old female presents with complaints of decreased
sexual desire and difficulty achieving orgasm for the past 8
months, causing significant emotional distress. She reports a
history of depression and is currently taking an SSRI. Which
of the following treatments is most appropriate for addressing
her sexual dysfunction?
A. Flibanserin
B. Estrogen replacement therapy
C. Sildenafil
D. Testosterone therapy
E. Cognitive-behavioral therapy
Question 11 (Answer)
A 42-year-old female presents with complaints of decreased sexual desire and difficulty
achieving orgasm for the past 8 months, causing significant emotional distress. She
reports a history of depression and is currently taking an SSRI. Which of the following
treatments is most appropriate for addressing her sexual dysfunction?
A. Flibanserin
B. Estrogen replacement therapy
C. Sildenafil
D. Testosterone therapy
E. Cognitive-behavioral therapy
A. Flibanserin
Rationale: Flibanserin is specifically indicated for the treatment of hypoactive sexual
desire disorder (HSDD) in premenopausal women and has been shown to improve desire in
women with HSDD. It is effective in improving FSFI scores and is safe to use concomitantly
with SSRIs.
Question 11 (Incorrect Foils)
B. Estrogen replacement therapy: This is typically used to treat
symptoms of genitourinary syndrome of menopause, not primary HSDD.
C. Sildenafil: Primarily used to treat erectile dysfunction in men, and
its effectiveness in women for sexual dysfunction is not well-
established.
D. Testosterone therapy: While testosterone can influence sexual desire,
its use in women is off-label and less supported for treating HSDD
compared to Flibanserin.
E. Cognitive-behavioral therapy: While helpful for addressing
psychological aspects of sexual dysfunction, the patient’s history and
current medication suggest a pharmacological approach targeting HSDD
would be more appropriate.
Question 12
A 65-year-old postmenopausal woman presents with
intense vulvar itching and burning. Physical
examination can be seen to the right. The physician
describes the patient’s vulva as “parchment-like” on
physical examination Which of the following conditions
is most likely, and what is the appropriate first-line
treatment?
A. Lichen sclerosus; clobetasol
B. Lichen planus; oral corticosteroids
C. Psoriasis; hydrocortisone
D. Contact dermatitis; avoidance of irritants
E. Vulvar intraepithelial neoplasia; surgical excision
Question 12 (Answer)
A 65-year-old postmenopausal woman presents with intense vulvar itching and
burning. Physical examination can be seen to the right. The physician describes the
patient’s vulva as “parchment-like” on physical examination Which of the following
conditions is most likely, and what is the appropriate first-line treatment?
A. Lichen sclerosus; clobetasol
B. Lichen planus; oral corticosteroids
C. Psoriasis; hydrocortisone
D. Contact dermatitis; avoidance of irritants
E. Vulvar intraepithelial neoplasia; surgical excision
A. Lichen sclerosus; clobetasol
Rationale: Lichen sclerosus typically presents in postmenopausal women with
symptoms of intense itching and burning. The physical exam findings of thin, white,
crinkled skin (described as "parchment-like") are characteristic. The first-line
treatment is a high-potency topical steroid, such as clobetasol.
Question 12 (Incorrect Foils)
B. Lichen planus: This condition presents with lacy white patches and
erosive lesions, typically within the vagina, not the characteristic
"parchment-like" skin of lichen sclerosus.
C. Psoriasis: Psoriatic lesions are typically raised, red patches with a
silvery scale, not the thin, white appearance of lichen sclerosus.
D. Contact dermatitis: This condition is due to an irritant or allergen
and presents with red, itchy, inflamed skin, but not the thin, white
"parchment-like" appearance of lichen sclerosus.
E. Vulvar intraepithelial neoplasia: Presents with pruritus and raised
lesions but requires biopsy for diagnosis, and the physical exam
findings here are more indicative of lichen sclerosus.
Question 13
You are examining a recent cytological example of cervical cells that
was taken from your patient who neglected to see an Ob/Gyn for the past
10 years. During your examination, you notice cellular findings that are
consistent with HSIL. You dictate these findings to your scribe;
however, upon reviewing your notes you find a descriptive statement out
of place. Which of the following is the most unlikely to be seen with
HSIL?
A. Nuclear hyperchromasia
B. Moderate increased N:C ratio
C. Minimal nuclear membrane cleft
D. Scant binucleation
E. Cellular atypia
Question 13 (Answer)
You are examining a recent cytological example of cervical cells that was taken from your patient
who neglected to see an Ob/Gyn for the past 10 years. During your examination, you notice cellular
findings that are consistent with HSIL. You dictate these findings to your scribe; however, upon
reviewing your notes you find a descriptive statement out of place. Which of the following is the
most unlikely to be seen with HSIL?
A. Nuclear hyperchromasia
B. Moderate increased N:C ratio
C. Minimal nuclear membrane cleft
D. Scant binucleation
E. Cellular atypia
C. Minimal nuclear membrane cleft
Rationale: Cytologic findings typical of HSIL include binucleation, koilocytic atypia, an increased
N:C ratio, and nuclear hyperchromasia. In severe dysplasia, or adenocarcinoma, you’d typically see
a high N:C ratio, overt mitoses, and nuclear membrane irregularities - which was option C.
Question 13 (Incorrect Foils)
A. Nuclear hyperchromasia: Nuclear hyperchromasia, or the dense staining of the
nuclei, is a hallmark of HSIL due to the increased DNA content in these cells is a
typical finding and consistent with HSIL.
B. Moderate increased N ratio: An increased nuclear-to-cytoplasmic (N) ratio is
indicative of cellular abnormalities seen in HSIL. Cells exhibit a relatively larger
nucleus compared to the amount of cytoplasm, which is a characteristic feature of
high-grade lesions.
D. Scant binucleation: Binucleation can occur in HSIL, but it is not a predominant
characteristic. The presence of binucleated cells is more commonly associated with
reactive changes or lower-grade lesions rather than HSIL, which typically shows more
pronounced nuclear abnormalities.
E. Cellular atypia: Cellular atypia, which involves abnormal cell morphology and
architecture, is a defining feature of HSIL. This includes changes in size, shape,
and organization of the cells and nuclei, making it a typical finding in high-grade
lesions.
Question 14
Your patient is a 36-year old female who recently had a pap-smear as
apart of her check-up. The report of the cytology showed atypical
glandular cells. With only this information, what is the best next step
in the management of this patient?
A. Perform a colposcopy and repeat cytology on a separate sample.
B. Perform a colposcopy, endocervical curettage, and take a sampling of
the endometrium
C. Repeat screening test in 6 months
D. Atypical glandular cells commonly mimic dysplasia, routine screening
is indicated
E. Glandular change always warrants evaluation for a primary disease
process, the patient will require an endocrine work-up
Question 14 (Answer)
Your patient is a 36-year old female who recently had a pap-smear as apart of her
check-up. The report of the cytology showed atypical glandular cells. With only
this information, what is the best next step in the management of this patient?
a) Perform a colposcopy and repeat cytology on a separate sample.
b) Perform a colposcopy, endocervical curettage, and take a sampling of the
endometrium
c) Repeat screening test in 6 months
d) Atypical glandular cells commonly mimic dysplasia, routine screening is
indicated
e) Glandular change always warrants evaluation for a primary disease process,
the patient will require an endocrine work-up
B. Perform a colposcopy, endocervical curettage, and take a sampling of the
endometrium
Rationale: Per guidelines, glandular atypia in a patient over 35 warrants a
colposcopy, ECC, and endometrial sampling.
Question 14 (Incorrect Foils)
A. Perform a colposcopy and repeat cytology on a separate sample: This
option is missing the needed endometrial sampling.
C. Repeat screening test in 6 months: Atypical glandular cells warrant
some evaluation, screening is no longer beneficial.
D. Atypical glandular cells are not considered a dysplasia mimic:
Atypical glandular cells commonly mimic dysplasia, routine screening is
indicated
E. Glandular change always warrants evaluation for a primary disease
process, the patient will require an endocrine work-up: AGC are no more
likely than any other neoplasia to be derived from some endocrine
pathology
