question,answer
"A 26-year-old female patient is referred for surgical resection of a complex ovarian cyst of 7 cm, mostly clear, with a septum and papillary projection of 7 mm. The cyst has been known for 6 months. What is the next step in case management?
A. Administering pills and performing a repeat ultrasound examination in 6 months.
B. Laparoscopic excision of the cyst and its removal in a bag.
C. Draining the cyst under US guidance and sending the fluid for cytology.
D. Laparoscopic surgery and entering the cyst cavity with the laparoscope to discover or rule out malignancy signs.
",C
"What is included in the protocol of Enhanced Enhanced Recovery after surgery (ERAS)?
A. Fast at least 6 hours before surgery.
B. Before surgery, with a high probability of resection and bowel resection, bowel preparation must be performed by emptying.
C. PCA (Patient Controlled Analgesia) should be used to treat pain after surgery.
D. In surgery lasting more than 3 hours, 500 ml of crystalloids must be given for each additional hour of surgery.
",C
"25 years old, without children, would like to give birth in the future.
She underwent a right Salpingo-oophorectomy due to a tumor.
The histological sample from the resection diagnosed a DYSGERMINOMA with a diameter of 7 cm in the right ovary and, in addition, a 5 mm focus of The same growth in the left ovary that was resected completely. No evidence of further dispersion. What is the next step in the management?
A. Follow up every 3 months by voice and markers.
B. Chemotherapy using BEP.
C. Completion of ovariectomy and left fallopian tube and addition to BEP.
D. Completion of left ovary and tubal resection and addition of radiation to the pelvis.
",B
"In surgery for epithelial ovarian cancer, a tumor involving both ovaries was found with a diameter of 5cm that adheres to the rectum without a separation plane.
Hysterectomy and resection of ovaries and omentum were performed, lymph node sampling was performed, and resection of a segment of the rectum was performed.
In pathology: two ovaries with a SEROUS tumor, omentum, and peritoneal biopsies without evidence of tumor, tumor distribution on the intestine's surface that is evident, and positive lymph nodes that were positive for tumor cells were noted. What is the stage of the disease?
A. II.
B. IIIA1.
C. IIIA2.
D. IIIB.
","B,D"
"A 38 year old mother of 3, discovered she was  carrying a BRCA2 mutation after her mother got ovarian cancer at age 55.
She has a Regular menstrual cycle, uses a copper intrauterine device, and does not want another pregnancy.
What is the treatment to reduce this patient's ovarian cancer risk?
A. Surgery to remove the ovaries and fallopian tubes before age 40.
B. Replacing the device with combined pills and Surgery to remove the ovaries and fallopian tubes no more than the age of 45.
C. Expanding genetic testing to determine the degree of risk for ovarian cancer and, depending on the result, determining the timing of surgery For oophorectomy and fallopian tubes.
D. Surgery to remove the ovaries and fallopian tubes about 5 years before the mother's age of diagnosis.
",B
"A 30-year-old married woman without children would like to conceive. She underwent laparoscopic surgery to remove the right ovary and fallopian tube due to a complex cyst.
 Pathology Revealed Endometrioid Ovarian Cancer Grade II. What is the next step in case management?
A. Administration of complementary chemotherapy.
B. Performing PET-CT and, if regular - follow-up every 3 months.
C. Exploratory laparotomy, staging while preserving the uterus and left ovary and, if normal - follow-up only.
D. Exploratory laparotomy, staging while preserving the uterus and left ovary, and, if regular - Administration of chemotherapy.
",C
"A 64-year-old woman was operated on for a stage III mucinous ovarian tumor and left with a small residual disease of less than 1 cm. What is the next treatment?
A. AVASTIN+GEMZAR.
B. Treatment protocol for colon cancer.
C. Taxol + Carboplatin and then maintenance treatment with PARPP inhibitors.
D. Taxol + Carboplatinum combined with AVASTIN.
",D
"What is the treatment for the recurrence of high-grade serous epithelial ovarian cancer?
A. Liposomal Doxorubicin (Caylex) when the disease returned 4 months after the end of the initial chemotherapy treatment.
B. Carboplatinum when the disease returned 8 months after the end of the initial chemotherapy treatment.
C. Taxol (Paclitaxel) when the disease returned 8 months after the end of the initial chemotherapy treatment.
D. Avastin (Bevacizumab) when the disease returned 4 months after the end of the initial chemotherapy treatment.
",A
"In which genes were mutations found in cervical tumors without the presence of HPV?
A. KRAS.
B. TP53.
C. BRCA.
D. POLE.
",A
"What is the lifetime risk of ovarian cancer in a woman with LYNCH SYNDROME?
A. 0.5-1%.
B. Y 6-12%.
C. 18-22%.
D. 30-40%.
",B
"What is the most accurate description of POLE  mutation?
A. Disruption of the segment of 53P associated with prognosis in ovarian malignancy.
B. Disruption of an enzyme involved in DNA repair associated with the prognosis of uterine malignancy.
C. Disruption of the enzyme involved in DNA replication is associated with the prognosis of ovarian malignancy.
D. Disruption of the KRAS segment associated with the prognosis of uterine malignancy.
",B
"A 32 year old, underwent a wide biopsy of the cervix. Histology revealed SQUAMOUS CELL CARCINOMA, with a penetration depth of 8 mm, with penetration into lymphatic vessels and blood vessels. On clinical examination, a tumor with a maximum diameter of 5 cm without evidence of parametrium or vaginal involvement. On imaging, there is no evidence for ectopic tumor involvement. According to the STAGING from 2018, in which disease stage is the patient?
A. I-B-2.
B. I-B-3.
C. II-A-2.
D. III-C-1.
",B
"At what stage of cervical malignancy, without penetration into blood vessels and lymphatic vessels, is it appropriate to perform an excision Radical neck RADICAL TRACHELECTOMY to preserve fertility?
A. I-A-1.
B. I-B-1.
C. I-B-2.
D. I-B-3.
",B
"What is the 5-year survival rate in cases of invasive cervical cancer in stage B-II (according to the latest STAGING)?
A. About 90%.
B. About 70%.
C. About 50%.
D. About 30%.
","B,C"
"Which of the following parameters is a high-risk factor for malignant recurrence of the cervix after surgery?
A. Surgical margins close to the tumor tissue.
B. The size of the tumor.
C. Tumor penetration into more than half of the stroma of the cervix.
D. Penetration into blood vessels or lymphatic vessels.
",A
"What does type II RADICAL HYSTERECTOMY include?
A. Cutting of the uterine artery at its origin from the iliac.
B. Resection of the uterosacral ligament in its entirety.
C. Excision of about half of the cardinal ligament.
D. Excision of half of the vagina.
",C
"What factors affect the chances of detecting the sentinel gland in surgeries for cervical malignant tumors?
A. Performing the previous conization.
B. The size/volume of the tumor tissue.
C. Duration of injection of the dye.
D. The diameter of the injector of the dye.
",B
"In which areas is it acceptable to inject the dye or fluorescence to identify the sentinel gland in surgery due to Cervical malignancy?
A. At 3:00 and 9:00 of the cervix.
B. At 6:00 and 12:00 of the cervix.
C. At 3:00 and 6:00, at 9:00, and 12:00 of the cervix.
D. The injection should be adapted to the location and size of the tumor in the cervix.
",A
"What is the recommendation for the SCREENING survey for the early diagnosis of endometrial cancer in women treated with tamoxifen?
A. Measuring the thickness of the endometrium every six months.
B. Measuring the thickness of the endometrium every year.
C. Endometrial biopsy every year.
D. Following the recommendation in the general population.
",D
"What is the stage of the disease in endometrial malignancy with the involvement of the parametrium?
A. IIB.
B. IIIA.
C. IIIB.
D. IIIC.
",C
"A 65-year-old woman underwent a biopsy from a 5 cm vestibular tumor on her right lip.
On PET-CT, inguinal and vaginal glands were observed and enlarged to about 3-4 cm.
What is the next step in treatment?
A. Radiation therapy for the tumor in the groin and pelvis, followed by surgery to remove the rest of the tumor and the glands.
B. Excision surgery of vulvar cancer and radiation therapy to the glands in the groin and pelvis.
C. Excision surgery of vulvar cancer, excision of the glands in the groin, and postoperative radiation therapy to the groin and pelvis.
D. Excision surgery of vulvar cancer, excision of the glands in the groin and pelvis, and radiation therapy after the surgery to the groin and pelvis.
",D
"What is included in the Enhanced Recovery After Surgery (ERAS) protocol?
A. Fast at least 6 hours before surgery.
B. Before surgery, with a high probability of resection and bowel resection, bowel preparation must be performed by emptying.
C. PCA (Patient Controlled Analgesia) should be used to treat pain after surgery.
D. In surgery lasting more than 3 hours, 500 ml of crystalloids must be given for each additional hour of surgery.
",C
"A 26-year-old female patient is referred for surgical resection of a complex ovarian cyst of 7 cm, mostly clear, with a septum and papillary projection of 7 mm. The cyst has been known for 6 months. What is the next step in case management?
A. Administering pills and performing a repeat ultrasound examination in 6 months.
B. Laparoscopic excision of the cyst and its removal in a bag.
C. Draining the cyst under US guidance and sending the fluid for cytology.
D. Laparoscopic surgery and entering the cyst cavity with the laparoscope to discover or rule out malignancy signs.
",B
"A 17-year-old girl is referred to the emergency room due to two-day history of left abdominal pain and suspicion of ovarian torsion. In her history, the girl has been under follow-up for 3 months due to a simple ovarian cyst on the left with a diameter of 7 cm. On Laparoscopy, left ovarian torsion was observed twice, black in color, without possibly identifying an ovary. The situation has not changed since allowing the release of ovarian torsion. What is the next step during the surgical procedure?
A. Try to identify and cut the fallopian tube only.
B. Identify the cyst and remove it.
C. Release of ovarian torsion without further intervention.
D. Cut out the ovary without identifying findings.
",C
"A 38-year-old female patient was referred for excision of type 2-5 myoma with a diameter of 8 cm before continuing with in vitro fertilization treatments.
What is the correct consideration in choosing the surgical approach: open, endoscopic, robotic approach in relation To the success of in vitro fertilization treatments?
A. In terms of the improvement in fertility, there is no difference between the various surgical techniques, but the recovery is faster, and the rate of Complications is lower in endoscopic surgeries.
B. The improvement in fertility is greater in laparotomy, but the rate of surgical complications is greater in laparotomy, and there is faster recovery in endoscopic surgeries.
C. The improvement in fertility is greater in endoscopic surgeries, especially in robotic surgeries.
D. The consideration of fertility is secondary since a laparotomy must be performed - since a myoma of this size must be removed from the abdominal cavity requires a laparotomy.
",A
"What is the risk of molar pregnancy after successful combined chemotherapy treatment in a woman with GTN?
A. 1%.
B. 5%.
C. 10%.
D. 25%.
",A
"What may be damaged when fixing the vaginal dome to the Sacrospinous ligament?
A. Sacral nerve S3-4.
B. The pudendal nerve.
C. Superior gluteal artery.
D. External pudendal artery.
","A,B"
"What is found in the Bacterial Vaginosis test, and culture of a woman who comes with symptoms of increased secretions and meets the criteria for Desquamative Inflammatory Vaginitis?
A. Proliferation of parabasal cells, proliferation of leukocytes, and proliferation of Gram-positive bacilli.
B. Proliferation of clue cells and proliferation of leukocytes, and gram-negative cocci culture.
C. Proliferation of parabasal cells and inflammatory cells in gram-positive cocci culture, usually streptococci.
D. Proliferation of neutrophils and identification of diplococci (gonococcal).
",C
"A female patient was admitted due to three painful ulcerated lesions on the labia majora on the right side. In testing: The ulcer is very sensitive to touch, and inguinal lymphadenopathy is sensitive to palpation. What is the most likely clinical diagnosis?
A. Herpes.
B. Syphilis.
C. Chancroid.
D. Genital warts.
",C
"A woman before a laparoscopic hysterectomy due to benign uterine pathology wishes to consider a subtotal hysterectomy vs. a total hysterectomy.
What is the difference between the two surgeries in this case?
A. Subtotal hysterectomy has the advantage of preserving sexual function.
B. After a subtotal hysterectomy, there is a 1%-2% chance of repeat surgery for cervicectomy.
C. In subtotal hysterectomy, there is a significant reduction in the risk of urinary incontinence symptoms.
D. In subtotal hysterectomy, there is a lower chance of symptoms of constipation.
",B
"Which index was found to be the most significant predictor of the possibility of completing a hysterectomy with a vaginal approach?
A. The patient's weight.
B. Pubic arch angle.
C. Location and length of the cervix.
D. Previous pelvic surgeries.
",B
"What characterizes the pathogenesis of fibroids?
A. In half of fibroids it is possible to identify a translocation in chromosome 22.
B. Polyclonal tumors that develop from a large number of parent cells.
C. Progesterone does not encourage the appearance and proliferation of fibroids.
D. Growth factors such as beta-TGF or bFGF are overexpressed in fibroblasts.
",D
"What is the correct description for fibroid classification and location according to FIGO?
A. Type 0 - pedunculated - inside the uterine cavity or pedunculated protrudes into the abdominal cavity.
B. Type 2 - pedunculated into the uterine cavity by less than 50% of its diameter.
C. Type 4 - all in the myometrium but reaches the endometrium or serosa.
D. Type 7 - more than 50% of its diameter protrudes from the serosa.
",B
"What is considered a contraindication to treating fibroids by embolizing the uterine arteries?
A. Uterine insufficiency.
B. Heart failure due to rheumatic disease.
C. A multifarious uterus the size of about 20 weeks of pregnancy.
D. A fundal fibroid with a diameter of 10 cm, far from the uterine arteries.
",A
"Which of the following is a protective factor against endometriosis?
A. Smoking.
B. Nulliparity.
C. Increase in BMI.
D. A diet rich in protein.
","A,C"
"What is the expected increase in B-HCG levels within 48 hours in a normal intrauterine pregnancy?
A. At least 50% if the initial ־²HCG level is less than 1,500 mIU /ml.
B. At least 60% if initial ־²HCG level 1,500-3,000 mIU /ml.
C. At least 70% if the initial ־²HCG level is greater than - 3,000 mIU /ml.
D. At least 80% regardless of initial ־²HCG level.
",A
"A 34-year-old woman was referred in the 6th week of her pregnancy due to bloody discharge. No intrauterine or ectopic pregnancy was observed on ultrasound.
B-HCG tracking demonstrates a 40% increase in values by 48 hours.
At what threshold value of B-HCG will medical treatment be given for ectopic pregnancy without a sonographic diagnosis of the location of pregnancy?
A. 1000 mIU/mL.
B. 1500 mIU/mL.
C. 2500 mIU/mL.
D. 3500 mIU/mL.
",D
"A healthy 55-year-old woman has suffered from an increased frequency of urination and occasional urinary urgency with leakage for several years. Physical and gynecological examinations are normal.
What is the necessary test for establishing an initial diagnosis and adjusting treatment?
A. TIP-Q test.
B. General urine test and culture.
C. Urinary tract ultrasound.
D. Urodynamics.
",B
"What is the possible measurement range for the Ba point according to the POP Q method when the TVL value is 8 cm?
A. Between -3 cm and +3 cm.
B. Between -3 cm and +8 cm.
C. Between -8v and +3 cm.
D. Between -5 cm and +5 cm.
",B
"A 40-year-old female patient presented due to prolapse. In her examination the following POP Q values:
Aa: -3cm.
Ba: -3cm.
C: +2cm.
D: -8cm.
Ap: -3cm.
Bp: -2cm.
TVL: 8cm.
What is the diagnosis?
A. STAGE 1 CYSTOCELE.
B. STAGE 2 RECTOCELE.
C. STAGE 3 UTERINE PROLAPSE.
D. STAGE 3 CERVICAL ELONGATION.
","C,D"
"A female patient suffers from STAGE 3 pelvic organ prolapse.
A Cuboid Pessary was fitted since she was not interested in surgical repair.
What should be the frequency of removing and cleaning the Pessary?
A. Every day.
B. Once a week.
C. Once a month.
D. Once every two months.
",A
"A 30 year old has had amenorrhea for 12 months. The level of FSH in her blood is 78 units/liter, and estradiol is 35 picomoles/liter. Which test should she be referred to in order to establish a diagnosis of Premature Ovarian Autoimmune Insufficiency (POI)?
A. To test for antibodies of the Anti 21-Hydroxylase/Anti Adrenal.
B. For ovarian biopsy.
C. Anti-Ovarian Antibodies for testing.
D. Anti-Thyroid Peroxidase/Anti-Thyroglobulin type of antibodies for testing.
",A
"Which cytotoxic drug has the highest genotoxic potential?
A. Bleomycin.
B. Vincristine.
C. Busulfan.
D. Cisplatin.
",C
"Mutations in the G- Protein system can cause genetic diseases.
Of the following, which is the correct combination of mutation and clinical condition?
A. A mutation in the Activating LH receptor will cause male pseudohermaphroditism.
B. A mutation in Gia (stimulatory) will cause hypothyroidism.
C. A mutation in the Inactivating FSH receptor will cause Premature ovarian failure.
D. A mutation in Rhodopsin will cause Diabetes insipidus.
",C
"What is the pathogenesis of  Congenital lipoid adrenal hyperplasia?
A. An autosomal dominant disease resulting from a gene mutation located on chromosome 6.
B. A disease caused by a mutation in the protein gene to the Steroidogenic Acute Regulator (StAR) protein.
C. A disease resulting from a combined deficiency of 3B- hydroxysteroid dehydrogenase and  17c450P.
D. Hereditary disease in which the steroidogenesis process is defective/missing in the adrenal gland and normal in the ovary.
",B
"Which of the following contains the highest amount of triglycerides?
A. VLDL.
B. IDL.
C. LDL.
D. HDL.
",A
"What is the structural difference between OXYTOCIN and VASOPRESSIN-ARGININE?
A. One amino acid in position 2.
B. Two amino acids in positions 3 and 8.
C. Three amino acids in positions 1, 4, 6 and 9.
D. At the position of the bisulfite bridge within the molecule.
",B
"What characterizes the amplitude and frequency of the LH pulses during the menstrual cycle?
A. Maximum amplitude in the mid-luteal phase with the highest frequency in the follicular phase, the early one.
B. The lowest amplitude in the mid-follicular phase, with the highest frequency in the luteal phase, is the late one.
C. Maximum amplitude in the early luteal phase with the lowest frequency in the luteal phase, the late one.
D. The lowest amplitude in the mid-follicular phase with the lowest frequency in the phase.
The late follicular.
",C
"What are the pinopodes in the rooting process?
A. Structures that appear on the stromal cells of the endometrium.
B. Structures appearing on flat epithelial cells without microvilli.
C. Structures that adhere to the blastocyst before fertilization.
D. Cellular structures that appear on day 15 and disappear on day 20 of the menstrual cycle.
",B
"When, for the first time, could messenger RNA to create hCG be detected in the human fetus?
A. After the fertilization of the blastocyst.
B. At the stage of about 100 cells.
C. In the morula stage.
D. At the 6-8 cell stage.
",D
"What is the reaction that the enzyme 21  Hydroxylase catalyzes?
A. 11-Deoxycortisol to cortisol.
B. Deoxycorticosterone to corticosterone.
C. Deoxycortisol-11 to 17-OH-Progesterone.
D. Progesterone to 17-OH-Progesterone.
",C
"A 25 year old has a history of PCOS and a BMI of 30. Her last menstrual period was two months before her application. In a sonographic examination, the endometrium is 10 mm, the ovaries are without a primary follicle. She has a Low blood estradiol level and low progesterone level.
What causes the endometrium to reach this thickness?
A. Estradiol from aromatization of DHEA.
B. Estrone from androstenedione aromatization.
C. DHEA aromatization estriol.
D. Estradiol from aromatization of androstenedione.
",B
"What characterizes the LH in women with PCOS compared to women with regular ovulation?
A. There is an increase in the frequency and amplitude of LH secretion.
B. The biological activity of LH is lower.
C. The common LH isoform in women is more acidic.
D. In these women, the level of LH secreted in response to GnRH is less.
",A
"What is the effect of increased insulin levels on the level of androgens and SHBG in women with PCOS?
A. Increase in androgen production in granulosa cells and decrease in SHBG production.
B. An increase in the production of androgens in granulosa cells and an increase in the production of SHBG.
C. Decrease in androgen production in theca cells and decrease in SHBG production.
D. Increase in androgen production in theca cells and decrease in SHBG production.
",D
"What meets the definition of Metabolic Syndrome?
A. Waist circumference: 78 cm, blood pressure: 145/92, triglycerides: 128, fasting sugar: 90, HDL level: 62.
B. Waist circumference: 90 cm, blood pressure: 130/85, triglycerides: 132, fasting sugar: 96, HDL level: 58.
C. Waist circumference: 78 cm, blood pressure: 135/82, triglycerides: 160, fasting sugar: 110, HDL level: 40.
D. Waist circumference: 90 cm, blood pressure: 135/80, triglycerides: 140, fasting sugar: 95, HDL level: 55.
",C
"A 25 year old has oligomenorrhea, acne, fatigue, muscle pains, and a recently discovered hypertension. What test should be completed for the diagnosis?
A. Dexamethasone test.
B. HOMA -IR test.
C. DHEA level.
D. Thyroid antibodies.
",A
"Which of the following situations is a reason for recurrent miscarriages?
A. Increased in the level of Antithrombin 3.
B. Factor 7 is reduced.
C. Factor 10 is increased.
D. Increased antiplasmin.
",C
"A sample of which of the following is the most reliable for PGT-A (Preimplantation Genetic Testing?).
A. First polar body.
B. Second polar body.
C. Blastomere.
D. Trophectoderm.
",D
"Which of the following conditions is an absolute contraindication to the use of Depo Provera as a contraceptive?
A. Liver adenoma that developed while using birth control pills.
B. Epilepsy.
C. Sickle cell anemia.
D. Three or more proven cases of pelvic inflammatory disease (PID).
",A
"Which contraceptive has the lowest expected failure rate?
A. Sponge with spermicide.
B. Diaphragm with spermicide.
C. Female condom.
D. Male condom.
","B,D"
"Which of the following amenorrhoeic women will not respond to treatment with a GnRH pump to achieve ovulation?
A. A woman with hyperprolactinemia.
B. A woman with long-term GnRH agonist treatment for endometriosis.
C. A woman with PCOS.
D. A woman with amenorrhea due to intense physical activity.
",B
"What is the characteristic of ovulation induction treatment in women with PCOS using letrozole compared to clomiphene Citrate treatment?
A. A lower rate of abortions.
B. A higher rate of multiple pregnancies.
C. Progesterone levels are higher in the luteal phase.
D. Similar ovulation rates after five treatment cycles.
",C
"What is the expected outcome of the induction of menstrual bleeding using progesterone in women with PCOS and amenorrhea who will start treatment with clomiphene citrate compared to starting treatment without menstruation?
A. Shortening the period to achieve ovulation.
B. Increasing pregnancy and birth rates.
C. Extending the time to achieve pregnancy.
D. Help to achieve a thicker endometrium during the treatment.
",C
"Which of the following gonadotropins is not suitable for inducing single follicle ovulation in women with PCOS?
A. Corifollitropin alfa.
B. Follitropin alfa.
C. Follitropin beta.
D. HMG.
",A
"Which of the following gonadotropins is produced in a human cell line?
A. Corifollitropin alfa.
B. Follitropin alfa.
C. Follitropin beta.
D. Follitropin delta.
",D
"How do dopamine agonists induce ovulation in women with hyperprolactinemia?
A. They suppress the production and secretion of estradiol, which leads to an increase in the secretion of FSH.
B. Influence the pituitary to secrete LH+FSH through VEGF receptors.
C. Stimulate the secretion of GnRH from the hypothalamus following the removal of inhibition by prolactin.
D. Release the GnRH receptors in the pituitary occupied by prolactin.
",C
"Which of the following women have an increased incidence of endometriosis?
A. Women with regular physical activity.
B. Women who consume large amounts of coffee.
C. Women who smoke heavily.
D. Women with BMI bigger than 30.
",B
"What characterizes macrophage cell activity in women with endometriosis?
A. The presence of macrophages in the peritoneal fluid is unique to the state of endometriosis.
B. A decrease in VEGF secretion from macrophages contributes to the formation of fibrosis and adhesions in the pelvis.
C. A decrease in the secretion of IL-8 suppresses the response of macrophages to ectopic endometrium.
D. Increase in TNF secretion inhibits macrophage function in response to ectopic endometrium.
",D
"Which of the following hormonal profiles characterizes a man diagnosed with Young's syndrome?
A. Low FSH and LH, low testosterone, low prolactin.
B. High FSH and LH, testosterone is normal, prolactin is normal.
C. High FSH and LH, testosterone is low, prolactin is high.
D. Normal FSH and LH, testosterone is normal, prolactin is normal.
",D
"How does a man's aging affect his fertility?
A. There is no change in the morphology of the sperm cells.
B. Decrease in FSH levels.
C. Decrease in flow volume.
D. Decrease in the concentration of sperm cells.
",C
"Which of the following does not impair male fertility in the presence of a large varicocele?
A. Hypoxia and stasis.
B. Delay in the descent of the testicle in fetal life.
C. An increase in the temperature of the testicle.
D. Delay in the removal of toxins from the testicle.
",B
"What is the most likely diagnosis of a man who is repeatedly tested with high gonadotropin levels and low testosterone?
A. Prolactin secreting tumor.
B. Kalman syndrome.
C. Testicular failure.
D. Congenital Bilateral Absence of Vas Deferens.
",C
"What is the gene responsible for the differentiation of gonads into testes?
A. SOX9.
B. DAXI.
C. BMP15.
D. CYP26B1.
",A
"A one-day-old girl was found with mild virilization of the external genitalia. An ACTH test was performed which found a high level of 17 alpha hydroxypregnenolone.
What is the most likely enzymatic disorder?
A. 3 beta OH dehydrogenase.
B. 21 hydroxylase.
C. 17 beta OH dehydrogenase.
D. 11 beta hydroxylase.
",A
"A girl with a hormonal profile as described:
FSH 2 IU/L LH 2 IU/L ESTRADIOL -30pg/ml DHEAS 50 ng/dL.
What tanner stage is she at?
A. Tanner 1.
B. Tanner 2.
G. Tanner 3.
D. Tanner 4.
",B
"A 4-year-old girl is examined due to an incident of vaginal bleeding. In her examination, her breasts are Tanner 2. Pubic hair is Tanner 1.  She has a low gonadotropin level and a low estradiol level. What is the most likely diagnosis?
A. McCune-Albright syndrome.
B. Functional ovarian follicular cysts.
C. Granulosa cell tumor.
D. Gonadoblastoma.
","A,B,C,D"
"What is the effect of menopausal estrogen therapy on the lipid profile?
A. Increases the amount and activity of lipoprotein receptors.
B. Increases levels of lipoprotein(a).
C. Reduces Triglycerides levels.
D. Reduces catabolism of LDL.
","A,C"
"What constitutes an advantage of adding androgens to menopausal women treated with HRT?
A. Reducing the incidence of breakthrough bleeding.
B. Reducing the frequency and intensity of heat waves.
C. Beneficial effect on bone density.
D. Beneficial effect on the lipid profile.
",C
"A 37-year-old is facing the start of an IVF cycle due to mechanical infertility.
Which of the following measures has the highest sensitivity for predicting the retrieval of fewer than four oocytes?
A. AFC = 7.
B. 0.5 ng/mL = AMH.
C. FSH= 11 IU/L 11 on day 3 of the menstrual cycle.
D. Estradiol = 300 pMol/L on day 3 of the menstrual cycle.
",B
"A 38-year-old is undergoing an IVF treatment cycle with a long agonist protocol.
12 follicles with a diameter of 18-20 mm were suctioned, without pelvic fluid. No eggs are found in the follicular fluid test. What explains the absence of eggs?
A. Injection of the trigger 38 hours before pumping.
B. Using the DECAPEPTYL trigger at a dose of 0.2 mg.
C. Use of rhCG in a reduced dose (125 micrograms).
D. Use of uhCG in a reduced dose (5000 units).
",B
"What is the first histological change observed in the endometrium after ovulation?
A. Ciliogenesis around gland openings.
B. Hematopoietic cell appearance.
C. Stromal cell cytonuclear enlargement.
D. Subnuclear glycogen vacuole appearance.
",D
"What does FSH surge cause during the menstrual cycle cause?
A. Compression of the cumulus cells in the follicle.
B. An increase in OMI (oocyte maturation inhibitor) level in the follicle.
C. Increase in the level of plasminogen activator in the follicle.
D. Decreased expression of LH receptors in the follicle.
",C
"Which of the following is not associated with an increase in FSH secretion during the late luteal phase?
A. Decrease in the level of INHIBIN A in the blood.
B. An increase in the frequency of GnRH secretion.
C. A decrease in the level of progesterone in the blood.
D. Increase in the level of INHIBIN B in the blood.
",D
"A Transgender female receives treatment with estrogen. What is the serum estradiol level that is the treatment goal?
A. 50 Picogram/ml.
B. 150 Picogram/ml.
C. 350 Picogram/ml.
D. 450 Picogram/ml.
",B
"Which of the following will help to treat male Transgender until masculinization is achieved?
A. Spironolactone.
B. Finasteride.
C. Leuprolide acetate.
D. Estradiol Valerate.
",C
"What is the main reason for using ethinyl estradiol instead of natural estradiol In Combined birth control pills?
A. Natural estradiol activity is poor when given together with progestin.
B. Natural estradiol has more side effects.
C. Ethinyl estradiol is metabolized in the liver, unlike estradiol.
D. Natural estradiol has poor activity when administered orally.
",D
"How will a mutation in the LH receptor affect the development of the female reproductive system?
A. Fetal theca cells will not synthesize androgens.
B. The baby will be born with ovarian cysts.
C. The uterus, fallopian tubes, and the upper third of the vagina will not develop properly.
D. There will be no effect on fetal life.
",D
"What is the purpose of testing polymorphic markers during PGT-M? (Preimplantation Genetic Testing for Monogenic Disorders).
A. To enable the diagnosis of more than one mutation.
B. To enable the diagnosis of new mutations (novo-de).
C. Check for aneuploidy/aneuploidy.
D. Reduce the risk of misdiagnosis.
",D
"A 30-year-old woman and a 35-year-old man with a pre-mutation to fragile x (180 repeats) request a pre-implantation examination. What is the most appropriate genetic diagnostic technique in this case?
A. The pre-mutation test and polymorphic markers in the blastocyst.
B. Testing the mutation and polymorphic markers in a 3-day-old fetus.
C. The pre-mutation test and markers for the X chromosome.
D. Diagnosis of the sex of the fetus only.
",D
"What constitutes a bad prognostic marker for complications for the mother and the fetus in the case of placental abruption?
A. Placenta previa.
B. Finding of subchorionic hematoma in ultrasound.
C. Low levels of fibrinogen.
D. Increased level of AFP (fetal protein) in the screening of the second trimester.
",C
"At week 34 of her pregnancy, a woman is preparing for her fifth birth. She has had 4 cesarean sections in the past and is currently pregnant and was diagnosed with a placenta previa. She is arriving due to bloody urine. On admission, she was in good general condition and had normal vital signs. Urine culture is normal. In urinalysis and urine sediment microhematuria is detected. What is the next step in management?
A. Cystoscopy.
B. US Doppler or MRI.
C. Cystography.
D. Kleihauer-Betke test.
",B
"Which of the following Uterotonic drugs has the shortest response time?
A. Misoprostol in oral administration.
B. Methylergonovine (Methergine) intramuscular.
C. Prostaglandin F2 (Hemabate) intramuscularly.
D. Misoprostol in rectal administration.
",B
"What are the expected metabolic changes in the fetus with IUGR (intrauterine growth retardation)?
A. An increase in the amount of ammonia in the amniotic fluid.
B. An increase in the amount of essential amino acids in the fetal blood.
C. An increase in the amount of triglycerides in the fetus's blood.
D. A decrease in the partial pressure of CO2 in the fetal blood.
","A,C"
"The concentration of which of the following hormones decreases according to the severity of placental insufficiency in fetuses with a reduction In intrauterine growth (IUGR?).
A. Corticotropin-releasing hormone.
B. Adrenocorticotropic hormone.
C. Osteocalcin.
D. Cortisol.
",C
"Which biochemical marker in the maternal blood is an indicator for predicting intrauterine growth restriction (IUGR)?
A. Decreased maternal alpha serum fetoprotein (MSAFP).
B. Decreased hCG levels.
C. Decreased pregnancy-associated plasma protein A (PAPP-A).
D. Elevated placental growth factor (PlGF).
",C
"A pregnant woman at 31 weeks of pregnancy is referred for evaluation due to fetal weight assessment in the 3rd percentile. What is the flow-Doppler index whose deterioration will determine making a decision to immediate deliver the newborn ?
A. Umbilical artery.
B. Ductus venosus.
C. Uterine artery.
D. Cerebral-Placental Ratio.
",B
"A pregnant woman at 33 weeks with unbalanced gestational diabetes is treated with insulin, threatening preterm delivery. What is the preferred tocolytic treatment?
A. B Adrenergic receptor agonists.
B. Magnesium sulfate.
C. COX inhibitors.
D. Calcium channel blockers.
",D
"A 30-year-old woman, pregnant for the second time at 25 weeks, arrived due to regular contractions every 4 minutes. The previous pregnancy ended in Premature birth at week 30.
Treatment with Betamethasone, magnesium sulfate, indomethacin, and penicillin was started. What could be the side-effect on this patient?
A. Oligohydramnios.
B. Hypoglycemia of the newborn.
C. Pulmonary hypertension of the newborn.
D. Persistent ductus arteriosus in the newborn.
",A
"What is the follow-up required for women diagnosed with macroadenoma during pregnancy?
A. Blood prolactin levels.
B. Visual field test.
C. MRI head.
D. CT head.
","A,B"
"A woman with mitral valve stenosis arrived for pre-pregnancy counseling. When and why is the maximum load on the valve expected?
A. Weeks 16-28 due to the increase in heart rate.
B. Week 29-36, due to increased pulmonary flow resistance.
C. Weeks 8-16 due to increased blood pressure and peripheral resistance.
D. Weeks 20-36 due to the increase in cardiac output.
",D
"Which of the following factors contributes to the condition of physiological hypercoagulability during pregnancy?
A. Increase in the number of platelets and their activity.
B. Increase in the free fraction of s protein.
C. An increase in the concentration of factors 11.
D. On the fibrinogen concentration.
",D
"What are the recommended tests during pregnancy after achieving pregnancy with preimplantation genetic testing (PGT) due to a balanced translocation to the father?
A. Prenatal ultrasound screening for detection of fetal anomalies.
B. Fetal echocardiography.
C. Cell-free DNA.
D. Amniocentesis.
",D
"What is the typical disorder of an android pelvis during childbirth?
A. Deep transverse arrest.
B. Cephalopelvic disproportion.
C. Arrest of dilatation.
D. Brow presentation.
",B
"Which of the following fetal malformations is most common in women with a high BMI?
A. Polycystic kidney.
B. Anorectal atresia.
C. Sacral agenesis.
D. Hypospadias.
",B
"What is the most common complication in subsequent pregnancies in a woman who has previously had a placenta accreta?
A. Uterine rupture.
B. Placenta accreta.
C. Placental abruption.
D. The uterine hypotonia during childbirth.
",B
"Persistent polyhydramnios in the third trimester is associated with an increased risk of which of the following?
A. Preeclampsia.
B. IUGR.
C. Cholestasis of pregnancy.
D. Amniotic Band Syndrome.
","A,B"
"As part of an prolonged pregnancy follow-up at week 40+ 7 days, a biophysical profile of 8/10 and AFI = 45 mm was observed. What is the fetal risk in this situation?
A. Contractures in the limbs.
B. Lung hypoplasia.
C. Meconium aspiration syndrome.
D. Sepsis.
",C
"A 32 year old, underwent a wide biopsy of the cervix. Histology revealed SQUAMOUS CELL CARCINOMA, with a penetration depth of 8 mm, with penetration into lymphatic vessels and blood vessels. On clinical examination, a tumor with a maximum diameter of 5 cm without evidence of parametrium or vaginal involvement. On imaging, there is no evidence ror ectopic tumor involvement. According to the STAGING from 2018, in which disease stage is the patient?
A. I-B-2.
B. I-B-3.
C. II-A-2.
D. III-C-1.
",D
"What is the indication for cesarean section in women with inflammatory bowel disease?
A. Combined biological treatment with Imuran during pregnancy.
B. Recurrent attacks during pregnancy.
C. Active perianal disease with involvement of the rectum in Crohn's patients.
D. Treatment with Rafassal started in the third trimester.
",C
"What does the passage of glucose through the placenta depend on?
A. GLUT1 1 channels (Glucose Transporter-1) channels which depend on sodium activity.
B. GLUT1 channels that depend on insulin activity.
C. GLUT1 channels that reach 50% saturation when the average sugar level is 90 mg/dL.
D. GLUT4 channels which are not affected by the state of maternal diabetes.
",C
"Which of the following is related to the development of fetal growth retardation?
A. Maternal treatment with steroids.
B. Fetal hypothyroidism.
C. Low levels of IGF2 (Insulin Growth Factor II) in the mother's blood.
D. Increased secretion of insulin by the fetus.
","A,C"
"What is the effect of practicing an emergency simulation of umbilical cord prolapse on a real outcome?
A. Improves the time from the moment of diagnosis until the delivery.
B. Improves the Apgar score of newborns.
C. Reduces the rate of NICU admissions.
D. Lowers the rate of hypoxic-ischemic encephalopathy.
",A
"Which of the following factors increases the risk of damage to the newborn's scalp after a vacuum birth?
A. Using a metal spoon.
B. The duration of the operation lasts about ten minutes.
C. Uniform traction along the axis of the birth canal.
D. One application of the spoon.
",A
"In which of the following clinical situations is it possible to wait 48 hours to complete steroid treatment before the delivery?
A. Week 36 with PET and blood pressure around 180/110 under medication.
B. Week 31 with HELLP without signs of fetal deprivation.
C. Week 29 with PET and a creatinine level of 2 mg/dL.
D. Week 29 with PET and pulmonary edema.
",B
"Which of the following complications is more common in cases of HELLP syndrome?
A. Pulmonary edema.
B. Acute renal failure.
C. Coagulation disorder type DIC.
D. Liver failure.
",C
"What is the relationship between the various factors in preeclampsia?
A. Increased sFlt level, low VEGF free level, low PLGF free level.
B. Increased sFlt level, high VEGF free level, low PLGF free level.
C. Low sFlt level, low VEGF free level, low PLGF free level.
D. Low sFlt level, high VEGF free level, low PLGF free level.
",A
"In which of the following situations may a vaginal delivery be allowed in a twin pregnancy?
A. A Leading twin in breech presentation weighing 2,200 grams, second twin in head presentation weighing 3,000 grams.
B. Lead twin in breech presentation weighing 3,000 grams, second twin in head presentation weighing 2,200 grams.
C. Lead twin in head presentation weighing 2,200 grams, second twin in breech presentation weighing 3,300 grams.
D. Lead twin in head presentation weighing 3,000 grams, second twin in breech presentation weighing 2,100 grams.
",D
"A BCBA twin pregnancy demonstrates a growing gap between the two fetuses (discordance). At week 30, the small fetus was found without a pulse (IUFD).
How should the pregnancy be managed?
A. Performing a brain MRI for the survived fetus to plan delivery at 34 weeks.
B. Continue routine growth monitoring for the fetus that survived and delivery at week 37.
C. Performing Doppler monitoring in the MCA for a fetus that survived and delivery at 34. weeks.
D. To recommend a delivery after completing the Celestone Chronodose course.
",B
"What condition is required for the laboratory definition of subclinical hypothyroidism?
A. TSH level of 12 mIU/L in the presence of FT4 in the normal range.
B. TSH level of 8 mIU/L in the presence of FT4 in the normal range.
C. A TSH level of 4.5 mIU/L in the presence of FT4 is below the normal range.
D. TSH level of 12 mIU/L in the presence of FT4 below the normal range.
",B
"24 years old woman in her first pregnancy, without pregnancy monitoring, presents during active labor. On her examination, cervical effacement is 80% and 5 cm open. Membranes are intact, vertex presentation. What should be done in the first step?
A. Ultrasound to demonstrate the head, neck, and fetal spinal cord.
B. Cesarean section.
C. Start Pitocin at a low dose.
D. Artificial rupture of membranes.
",A
"Which of the following decreases the chance of a successful external cephalic version?
A. Gestational age between 35-34 weeks.
B. Performance in the latent phase of birth.
C. Spinal anesthesia before the procedure.
D. Breech presentation.
",B
"A pregnant woman gave birth via vaginal delivery with significant postpartum bleeding due to atony, characterized by a drop in blood pressure.
She received a transfusion of 4 portions of blood. In a blood test: hemoglobin 8% grams creatinine 2.3 mg/dL. What is the first step in finding out the blood test results?
A. Urine collection for quantitative protein.
B. Fluid administration and creatinine monitoring.
C. Urine collection for potassium.
D. Administering diuretics.
",B
"What is the result of using oxytocin to induce labor in HIGH DOSE vs. LOW DOSE?
A. Increases the rate of cesarean sections.
B. Increases the rate of chorioamnionitis.
C. Increases the rate of uterine ruptures.
D. It shortens the duration of childbirth.
",D
"A woman preparing for her first birth at 41 weeks is  being induced using oxytocin for a duration of 26 hours. On examination: the cervix is open to 3 cm, 70% effacement, head in 1-S, amniotic fluid comes down clean. Fetus Monitoring is Normal. She has 4 contractions in 10 minutes. What should be done next?
A. Cesarean section.
B. Change the bag of oxytocin.
C. Take a break (window) in giving oxytocin.
D. Internal monitoring Calculation of contraction in Montevideo units.
",A
"A woman about to give birth for the first time at 41 weeks is  being induced At a cervical opening of 3 cm, a Rupture of the amniotic membranes was done.
What is expected of the birth process as a result of this action?
A. Shortening the duration of childbirth by an average of two hours.
B. Increasing the probability of cesarean section.
C. Increasing the probability of an instrumental birth.
D. Increasing the probability of neonatal infection.
",A
"A woman in her second pregnancy, at 28 weeks, is admitted with amniotic fluid leaking.
On examination, oral temperature of ֻ38 C, maternal heart rate of 120 beats per minute, sensitivity to palpation above the uterus is noted, and fetal tachycardia on monitoring is 180 beats per minute. What should be done next after antibiotic coverage?
A. Amniocentesis.
B. Administering tocolytics.
C. Administration of steroids and a delivery after 48 hours.
D. Delivery.
",D
"A woman at 35 weeks of pregnancy is hospitalized due to a fever of 39 degrees, weakness, and complaints of upper respiratory infection. The woman was vaccinated against the flu at week 30. Influenza A virus was detected on nose culture. How should it be treated?
A. Start treatment with oseltamivir.
B. Give a booster of the vaccine with nasal drops.
C. Immediate delivery.
D. Azenil treatment.
",A
"A 40 year old, during her first pregnancy, is admitted at 30 weeks due to shortness of breath.
In the examination, blood pressure was 130/80, pulse 100, and saturation was 92% in room air. Limbs without signs suspicious of DVT. What is the next step?
A. Chest X-ray.
B. ECG.
C. V/Q Scan.
D. Doppler leg veins.
",A
"What is the unique contribution to the transfusion of various blood products?
A. FRESH-FROZEN PLASMA contains fibrinogen and coagulation factors V, XI, XII.
B. CRYOPRECIPITATE contains the von Willebrand factor and factor VII.
C. One dose of PACKED RED BLOOD CELLS increases the hematocrit by 1%.
D. One dose of PLATELET CONCENTRATES raises the level of platelets by 20,000.
",A
"Which women are most likely to have a vaginal delivery after cesarean section?
(VBAC).
A. A woman who gave birth in a previous vaginal birth.
B. A woman who had a cesarean section due to ""lack of progress"".
C. The birth that ended in a cesarean section began spontaneously.
D. BMI of 35.
",A
"Which of the following is a risk factor for uterine rupture during an attempted vaginal delivery after a cesarean section (TOLAC).
A. Rupture of membrane over 18 hours.
B. Closing the uterine wall in two layers in the previous surgery.
C. A gap of two years between the surgery and the birth attempt.
D. Induction of labor.
",D
"In which of the following malformations is there in an added value for a fetal MRI test?
A. Complete lack of the CEREBELLAR VERMIS.
B. CPAM.
C. VSD.
D. SACROCOCCYGEAL TERATOMA.
","A,D"
"A woman has a history of one miscarriage in the first trimester and another ׳´chemical׳´ pregnancy underwent an investigation, and as part of it, a TSH level was found at the upper limit of the norm. What is the next step in case management?
A. Testing for the presence of anti-thyroid antibodies.
B. Thyroid hormone replacement therapy.
C. Repeat the test and with a similar result follow-up only.
D. Antithyroid drug treatment.
","C,A"
"A 34-year-old applies for pre-pregnancy counseling. She has a history of portal hypertension. About a year ago, there was significant bleeding from varicose veins in the esophagus, and she underwent Emergency endoscopic ligation. A blood pressure of 130/80 was measured at the visit. What is the recommendation in case of pregnancy?
A. Gastro-esophageal endoscopy in the first trimester.
B. Start treatment with beta-blockers.
C. Prophylactic ligation of the splenic artery in the second trimester.
D. Treatment with LMWH in a prophylactic dose starting from the second trimester.
",B
"A woman is 28 years old and 20 weeks into her first pregnancy. Her background includes pre-gestational diabetes type 1. She came to the ER with abdominal pain, vomiting, and confusion. Blood glucose level was 250 mg/dl, and her Potassium level was 3.8 mEq/L, PH 6.95.
Which of the following is part of the treatment for this woman?
A. Administration of hypertonic saline.
B. Administration of intramuscular insulin immediately.
C. Administration of bicarbonate.
D. Giving calcium.
",C
"A pregnant woman in the 8th week of pregnancy, has chronic hypertension controlled with Enalapril (from the ACE INHIBITORS family). The treatment is Changed to LABETALOL.
What is the recommendation for pregnancy monitoring?
A. Amniocentesis.
B. Fetal echocardiography.
C. Continue pregnancy monitoring as usual.
D. Targeted screening of the fetal kidneys.
",C
"In the blood tests of a 41-year-old pregnant woman, G1P0, after prolonged infertility, the blood type is A minus. Positive anti-D antibodies in a titer of 1:4 are revealed in week 10. In week 24, the titer is 1:32. The partner is unavailable for testing.
A free fetal DNA test in the mother's blood shows that the fetus is RhD-negative and the sex is female. What is the next step in the pregnancy follow-up?
A. Repeating the fetal-free DNA test in the mother's blood.
B. Villous chorionic sampling biopsy.
C. Fetal blood sampling at week 32.
D. Ultrasound examination - Doppler PSV_ MCA every two weeks.
",D
"Which of the organs of the fetus has the ability to self-regulate blood flow autoregulation?
A. Gallbladder.
B. Stomach.
C. Cerebellum.
D. Myocardium.
",D
"A 28 year old G2 P1 LC0 at 30 is diagnosed at weeks with severe fetal growth retardation (below the 1st percentile for Pregnancy age). She underwent tests, and no genetic etiology or infection was found. In the assessment of the fetus and considerations for the timing of the delivery, what is the finding with the highest risk of acidemia and intrauterine fetal death?
A. DV Doppler index elevation below 2SD.
B. Category II fetal heart rate tracing.
C. Absent end diastolic flow in the umbilical artery.
D. Category III fetal heart tracing and oligohydramnios.
",D