Download - Gynecology Test Blue Print

DAVAO MEDICAL SCHOOL FOUNDATIONCOLLEGE OF MEDICINE

DEPARTMENT OF OB-GYNE 3

TEST BLUEPRINTS FOR GYNECOLOGY

Submitted by:

FIDES N. RODRIGUEZ-ABABON, M.D., FPOGSCourse Coordinator - Gynecology

TEST BLUE PRINT – AMENORRHEA

Entry Competency:

At the beginning of the module, the student has background knowledge of the etiology of amenorrhea and its biochemical mechanisms and processes.

Intermediate Competency:

Given a set of 4 questions, the student can demonstrate mastery in the etiology and pathophysiology of amenorrhea. Mastery is achieved when the student answers3 or more of the questions correctly in 5 minutes.

Specific Objectives:

1. Understand the etiology of primary amenorrhea with normal female external genitalia based on the presence or absence of breast development and uterus.

2. Analyze the pathophysiology of secondary amenorrhea according to its different causes.

Type of test: True or False: 0 Multiple choice : 4 items

_______________________ Total Items : 4 items

Minimum Passing Level (MPL): 75%

II. Test Specification Table (Blueprint)

OBJECTIVES & CONTENTS Knowledge Comprehension Application Analysis Synthesis Evaluation Total items

1. Understand the etiology of primary amenorrhea with normal female external genitalia based on the presence or absence of breast development and uterus * Tanner Staging 1 1

* Mullerian Anomalies 1 1

2. Analyze the pathophysiology of secondary amenorrhea according to its different causes.

* Ovarian causes 1 1

* Pituitary causes 1 1

TOTAL ITEMS 2 2 4

Sample Questionnaire

Directions: Each of the following numbered items or incomplete statements is followed by answers or by completions of the statement. Select the best answer. Write the letter on the space provided before each number. Use capital letters only. Erasures will not be credited.

(Items 1 & 2 refer to objective # 1)

D_ 1 ) A 17 year old girl consulted because of primary amenorrhea. Physical examination reveals Tanner stage III breast and pubic hair development with an absent vagina.The most likely diagnosis in this patient is

a. androgen insensitivity syndromeb. isolated gonadotropin deficiencyc. 5-reductase deficiency

d. mullerian agenesis B_ 2) A 17 year old girl with primary amenorrhea complains of cyclic hypogastric pains. On physical exam, she has well developed breasts and a bulging bluish introital mass. The most likely diagnosis is:

a. hyperprolactinemiab. imperforate hymenc. transverse vaginal septumd. Rokitansky-Kuster-Hauser syndrome


C_ 3) A systemic manifestation that is a direct effect of the hyperinsulinemic state in a woman with polycystic ovary syndrome (PCOS) is

a. hirsutismb. obesityc. acanthosis nigricansd. hyperprolactinemia

C_ 4) A 29 year old woman presents with amenorrhea and bilateral galactorrhea. She is taking amitriptyline hydrochloride for depression. Pregnancy test is negative. Serum prolactin is 80 ng/ml and TSH is 0.9 U/ml (normal values: prolactin <20 ng/ml; TSH 0.5 – 5.0 U/ml). The most likely reason for the hyperprolactinemia is

a. hyperthyroidismb. amitriptyline therapyc. pituitary microadenomad. hypothalamic amenorrhea

TEST BLUEPRINT – ABNORMAL UTERINE BLEEDING

Entry Competency:

At the beginning of the module, the student has background knowledge of the definition of abnormal uterine bleeding, its etiology and pathophysiology.


Given a set of 6 questions, the student can demonstrate mastery in the etiology, pathophysiology and management of abnormal uterine bleeding. Mastery is achieved when the student answers 5 or more of the questions correctly in 7 minutes.


1. Know the etiology and pathophysiology of abnormal uterine bleeding according to the 2 major categories:a) Organic causes or anatomical causesb) Dysfunctional causes

2. Analyze and interpret the diagnostic tests indicated for each disorder.

3. Explain the principles in the management of these disorders:a) Medical treatmentb) Surgical treatment

4. Know the possible long term complications of those with abnormal uterine bleeding.

Type of test: True or False : 0 Multiple choice : 6 items __________________________

Total Items: 6 items




1. Know the etiology and pathophysiology of abnormal uterine bleeding according to the 2 major categories:

* organic or anatomical causes 1 1

* dysfunctional causes 2 2

2. Analyze and interpret the diagnostic tests indicated for each disorder. 1 13. Explain the principles in the management of

these disorders: * medical treatment 1 1

4. Know the possible long-term complications of those with abnormal uterine bleeding. 1 1

TOTAL ITEMS 4 1 1 6



(Items 1 to 3 refer to objective # 1)

D _1) Causes of vaginal bleeding in prepubertal girls include the following, except:

a. vaginal foreign bodyb. precocious pubertyc. estrogen-producing ovarian tumorsd. none of the above

_B_2) Dysfunctional uterine bleeding is frequently associated with:

a. endometrial polypsb. anovulationc. cervicitisd. submucous myoma

_C 3) A 14 year old girl who started to menstruate last year complains of abnormal bleeding. Which of the following characterizes bleeding in young adolescent females?

a. midcycle spottingb. regular cycles with heavy mensesc. anovulatory bleedingd. hypothalamic-pituitary maturity

(Item 4 refer to objective # 2)

_B_ 4) A 20 year old woman has irregular, unpredictable menstrual periods every 30-90 days. Physical examination reveals acne on her face and upper back with few, dark coarse hairs on her chin and lower abdomen. The most sensitive marker of androgen excess is

a. total testosteroneb. free testosteronec. fasting insulind. ratio of LH to FSH


_B_ 5) Progestins are synthetic steroids with progesterone-like quality. They are used in treating dysfunctional uterine bleeding. Its functions include all of the following, except:

a. it is an antiestrogenb. increase the effect of estrogen on the endometriumc. antimitotic and antigrowth effect on the endometriumd. support and organize the endometrium to effect uniform sloughing


_ D_ 6) A 27 year old woman has irregular menstrual bleeding with a previous diagnosis of polycystic ovary syndrome (PCOS). Pertinent physical examination findings: she is obese with normal vital signs and minimal excess hair growth. In counseling the patient regarding her long-term prognosis, you tell her that she is at increased risk for

a. postmenopausal osteoporosisb. cervical cancerc. polycystic kidneys

d. diabetes mellitus

TEST BLUEPRINT – FAMILY PLANNING

Entry Competency:

At the beginning of the module, the student has background knowledge of the different methods of family planning and its mechanism of actions.


Given a set of 4 questions, the student can demonstrate mastery of the different methods of family planning and its mechanism of actions. Mastery is achieved when the student answers 3 or more of the questions correctly in 4 minutes.


1. Know the different methods of family planning, their chemical precursors and their mechanism of actions.

2. Identify the indications & contraindications of each method.

3. Analyze the advantages & disadvantages of the different methods of family planning.

Type of test: True or False : 0 Multiple choice : 4 items _______________________ Total Items : 4 items




1. Know the different methods of family planning, their chemical precursors and their mechanism of actions

* prostaglandin – arachidonic acid 1 1

* cervical mucus - “ dry days” 1 1

2. Identify the indications & contraindications of each method. 1 13. Analyze the advantages & disadvantages of the different methods of family planning. 1 1 Total Items 2 1 1 4



(Items 1 and 2 refer to objective # 1)

_B_ 1) Which of the following substance is the precursor of prostaglandin:

a.) Isoleucineb.) Arachidonic acidc.) Linoleic acidd.) Phospholipase A

_C_ 2 ) When using the Cervical Mucus method of contraception, the couple can have a safe sexual intercourse during :

a) the period where mucus is dry and scantb) the “peak” dayc) the “dry days” immediately after the menses until mucus is detectedd) the period when the mucus increases in quantity and becomes progressively more slippery and elastic

until a peak day is reached


_C 3) IUD use is contraindicated in the following situations, except:

a) a history of PIDb) undiagnosed genital bleedingc) hypertensiond) copper allergy


_ D _ 4) Which of the following is NOT a beneficial effect of oral contraceptive use?

a) fewer ectopic pregnancies b) less dysmenorrheac) reduced menstrual blood loss with less anemia

d) decreased incidence of cervical cancer

TEST BLUEPRINT – REPRODUCTIVE PHYSIOLOGY

Entry Competency:

At the beginning of the module, the student has background knowledge of the normal physiology and biochemical processes of the menstrual cycle.


Given a set of 3 questions, the student can demonstrate mastery in the physiology of the endometrium and the biochemical processes that happen every menstrual cycle. Mastery is achieved when the student answers the 3 questions correctly in 3 minutes.


1. Explain the different characteristics of a normal menstrual cycle.

2. Analyze the different biochemical processes and the interplay of the involved hormones during the menstrual cycle.

Type of test: True or False : 0 Multiple Choice : 3 items ________________________ Total Items : 3 items

Minimum Passing Level (MPL) : 80%



1. Explain the different characteristics of a normal menstrual cycle. 1 12. Analyze the different biochemical processes and the interplay of the involved hormones during the menstrual cycle. 2 2 TOTAL ITEMS 1 2 3




_ A_ 1) Normal menstruation is characterized by the following, EXCEPT:

a. average blood loss of more than 80 ml per cycleb. consists mostly of endometrial tissuec. periodic every 21-40 days cycled. mean duration of 4.7 days

(Item 2 & 3 refer to objective # 2)

_ B_ 21) Which of the following statements best describes the estrogen-positive feedback on LH release:

a.) it is unaffected by the duration of estrogen stimulationb.) it is affected by the level of circulating estrogenc.) it is enhanced by the testosteroned.) it is mediated by opioid peptides

_A _ 22) The following events are associated with menstrual flow:

a.) withdrawal of progesteroneb.) prolonged maintenance of estrogenc.) withdrawal of LHd.) prolonged maintenance of progesterone

TEST BLUEPRINT – GESTATIONAL TROPHOBLASTIC DISEASE

Entry Competency:

At the beginning of the module, the student has background knowledge of the different types of gestational trophoblastic diseases, its pathophysiology, characteristics and biochemical processes.


Given a set of 4 questions, the student can demonstrate mastery in the pathophysiology and characteristics of the different types of trophoblastic diseases. Mastery is achieved when the student answers 3 or more of the questions correctly in 5 minutes.


1. Identify the different spectrum of interrelated tumors presenting as gestational trophoblastic disease. 2. Analyze the different characteristics and pathophysiology of complete and partial hydatidiform mole.

3. Explain the different signs and symptoms of a complete hydatidiform mole.

Type of test: True or False : 0 Multiple Choice : 4 items ________________________ Total Items: 4 items




1. Identify the different spectrum of interrelated tumors presenting as gestational trophoblastic disease. 1 12. Analyze the different characteristics and pathophysiology of complete and partial hydatidiform mole. * complete H-mole 1 1

* partial H-mole 1 1

3. Explain the different signs and symptoms of a complete hydatidiform mole. 1 1 TOTAL ITEMS 1 1 2 4




_ D_ 1) Gestational trophoblastic disease is one of the rare human tumors that includes a spectrum of interrelated tumors including, except:

a ) hydatidiform moleb ) placental site trophoblastic tumor

c) choriocarcinoma d ) none of the above(Items 2 & 3 refer to objective # 2)

_ D_ 2) The following statements are characteristics of a complete hydatidiform mole, EXCEPT:

a.) lack identifiable embryonic or fetal tissuesb.) usually have a 46,XX karyotypec.) usually arise from an ovum that has been fertilized by a haploid spermd.) chorionic villi exhibit focal hydatidiform swelling

_B_ 3)Partial hydatidiform moles are characterized by the following pathologic features, EXCEPT:

a.) Prominent stromal invasionsb.) Chorionic villi of varying size with generalized hydatidiform swelling, cavitation and trophoblastic hyperplasiac.) Identifiable embryonic or fetal tissuesd.) Marked villous scalloping


_B_ 4) The following signs and symptoms are typically seen in a patient with a complete H-mole, EXCEPT:

a.) vaginal bleedingb.) smaller uterine sizec.) hyperemesis gravidarumd.) preeclampsia

TEST BLUEPRINT – PELVIC ENDOMETRIOSIS

Entry Competency:

At the beginning of the module, the student has background knowledge on the pathphysiology and biochemical mechanisms and processes of pelvic endometriosis.


Given a set of 4 questions, the student can demonstrate mastery of the pathophysiology , symptomatology and management of pelvic endometriosis. Mastery is achieved when the student answers 3 or more of the questions in 5 minutes.


1. Identify the different signs and symptoms of pelvic endometriosis.

2. Analyze the different modes of management of endometriosis, both medical and surgical.

Types of test: True or False : 0

Multiple Choice : 4 items ______________________ Total Items : 4 items




1. Identify the different presentations and complications of pelvic endometriosis.. 1 12. Analyze the different modes of management of pelvic endometriosis * medical treatment 1 1

* surgical treatment 1 1

3. Analyze the different factors necessary in the treatment of pelvic endometriosis. 1 1 TOTAL ITEMS 1 3 4




_C _ 1) Indication for surgery in women with endometriosis include/s the following, except:

a) endometriomab) infertility and adhesionsc) mild paind) involvement of bowel or urinary tract


_C _ 2) A 45 year old, G3P3 has mild endometriosis confirmed by laparoscopy a year ago.Since that procedure, the patient’s dysmenorrhea have gotten worse. The most reasonable operative procedure at this point is:

a) dilatation & curettageb) uterine suspensionc) total abdominal hysterectomy and bilateral salpingooophorectomyd) presacral neurectomy

_C_ 3) In terms of the side effects and subsequent pregnancy rates, the best sex steroid therapy of endometriosis is:

a) estrogen aloneb) estrogen-progesteronec) oral progesteroned) parenteral progesterone


_D_ 4) Factor /s important in selecting therapy for newly discovered endometriosis include

a) patient’s ageb) wishes and plans of childbearingc) severity of diseased) all of the above

TEST BLUEPRINT – MENOPAUSE

Early Competency:

At the beginning of the module, the student has background knowledge of the pathophysiology and biochemical mechanisms and processes of menopause.


Given a set of 3 questions, the student can demonstrate mastery of the pathophysiology and biochemical processes and management of menopause. Mastery is achieved when the student answers 3 questions correctly in 4 minutes.


1. Analyze the biochemical mechanisms of the hormones involved in menopause.

2. Identify the different complications associated with menopause.

3. Analyze the different modalities of treatment in the menopausal stage; its advantages, disadvantages and contraindications.

Type of test: True or False : 0 Multiple Choice : 3 items ________________________ Total Items : 3 items




1. Analyze the biochemical mechanisms of the hormones involved in menopause. 1 12. Identify the different complications associated with menopause. 1 13. Analyze the different treatment modalities of menopause; its advantages, disadvantages & contraindications. 1 1 TOTAL ITEMS 1 2 3




_ B_ 1) This hormone is elevated as a first sign of menopause

a) estradiolb) follicle stimulating hormonec) luteinizing hormone

d) progesterone


_ D_ 2) Common sites of bone fracture during menopause include the following bones, except:

a) vertebral bodiesb) distal ranusc) femoral neckd) humerus


_ A_ 3) Absolute contraindication of estrogen used during menopause, except:

a) benign breast massb) undiagnosed genital bleedingc) active liver diseased) active thromboembolic disease

TEST BLUEPRINT – REPRODUCTIVE TRACT INFECTIONS

Entry Competency:

At the beginning of the module, the student has background knowledge of the pathophysiology and biochemical processes of reproductive tract infections.


Given a set of 6 questions, the student can demonstrate mastery in the etiology, pathophysiology and management of reproductive tract infections.


1. Identify the different reproductive tract infections in relation to its presenting signs and symptoms.

2. Analyze the different laboratory procedures that are available to clinch the diagnosis of specific reproductive tract infections.

3. Analyze the different therapeutic modalities for patients with reproductive tract infection.

Type of test: True or False : 0 Multiple Choice : 6 items __________________________ Total Items: 6 items




1. Identify the different reproductive tract infections in relation to its presenting signs and symptoms. 4 42. Analyze the different laboratory procedures that are available to clinch the diagnosis of specific reproductive tract infections. 1 13. Analyze the different therapeutic modalities for patients with reproductive tract infections. 1 1 TOTAL ITEMS 4 2 6



Items 1 to 4 refer to objective #1)

A 19 year old woman has vulvar lesions of 3 days duration. She has some discomfort on urination. She had a history of unprotected coitus.

_D_ 1) Lesions which manifest as discharge are the following, EXCEPT:

a) candidiasisb) gonorrheac) chlamydiad) condyloma accuminata

_B_ 2) If the lesions are warty, multiple and painless, the most likely diagnosis is:

a) condyloma latab) condyloma accuminatac) herpes simplexd) chlamydia

_B_ 3) If on speculum examination you note mucopus discharge which is thick, yellowish, mal odorous and the patient also tells you she has dysuria, what is another possible disease entity?

a) chlamydiab) gonorrheac) cervicitisd) condyloma accuminata

_ C_ 4)) If the lesions are vesicular, “kissing lesions”, and extremely painful, the most reasonable diagnosis is:

a) condyloma latab) condyloma accuminatac) herpes simplexd) chlamydia


_ C_ 5) If you suspect herpes, which of the following do you expect to find?

a) microscopic examination of the virus in vaginal secretions mixed with 10% KOHb) (+) Whiff testc) microscopic examination of material from the ulcerated lesions for giant cellsd) (+) cervical culture


_ A_ 6) The most reasonable therapy for the patient could be:

a) soap & waterb) amoxycillinc) podophyllind) metronidazole

TEST BLUEPRINT – BENIGN AND MALIGNANT DISEASES OF THE CERVIX

Entry Competency:

At the beginning of the module, the student has background knowledge of the pathophysiology of the different entities involving the cervix.


Given a set of 3 questions, the student can demonstrate mastery of the pathophysiology of some of the different entities involving the cervix. Mastery is achieved when the student answers 2 or more of the questions correctly in 3 minutes.


1. Identify the common benign lesions of the cervix that are often confused with cervical cancer.

2. Analyze the different histopathologic presentations of cervical carcinoma.

3. Analyze the different modalities of treatment of cervical carcinoma in relation to its histologic type and staging.

Type of test: True or False : 0 Multiple Choice : 3 items ________________________ Total Items: 3 items




1. Identify the common benign lesions of the cervix that are often confused with cervical cancer. 1 12. Analyze the different histopathologic presentations of cervical carcinoma. 1 13. Analyze the different modalities of treatment of cervical carcinoma in relation to its histologic type and staging. 1 1 TOTAL ITEMS 1 2 3




_ D_ 1) Lesion/s commonly confused with cervical cancer is/are, except:

a) polyps

b) tuberculosisc) eversiond) none of the above


_C_ 2) The most common histologic type of cervical carcinoma is:

a) adenocarcinomab) adenosquamous carcinomac) squamous cell carcinomad) adenoacanthoma


_ D_ 3) Radiation therapy in cervical carcinoma treatment consists of:

a) teletherapyb) brachytherapyc) nanotherapyd) A & B only

TEST BLUEPRINT – BENIGN AND MALIGNANT DISEASES OF THE OVARIES

Entry Competency:

At the beginning of the module, the student has background knowledge of the pathophysiology of the different entities involving the ovaries.


Given a set of 4 questions, the student can demonstrate mastery of the pathophysiology of some of the disease entities involving the ovaries. Mastery is achieved when the student answers 3 or more questions in 5 minutes.


1. Identify the different intraoperative findings consistent of an ovarian malignancy.

2. Identify the different histopathologic findings of an ovarian new growth.

3. Analyze the different stages of an ovarian malignancy.

4. Explain the different complications associated with an ovarian neoplasm.

Type of test: True or False : 0 Multiple Choice : 4 items _________________________

Total Items: 4 items




1. Identify the different intraoperative findings consistent of ovarian malignancy. 1 12. Identify the different histopathologic findings of ovarian neoplasm. 1 13. Analyze the different stages of an ovarian malignancy. 1 14. Explain the different complications associated with ovarian neoplasm. 1 1 TOTAL ITEMS 2 1 1 4




_ C_ 1) The following items are intraoperative findings consistent with ovarian malignancy, EXCEPT:

a) adherence to adjacent organsb) presence of ascitesc) bilateralityd) presence of solid areas


_ B_ 2) The cell origin of the most common type of an ovarian neoplasm is

a) germ cellsb) epithelial cellsc) stromal cellsd) lipoid cells


_D_ 3) A 55 year old woman has an asymptomatic ovarian carcinoma in one ovary. Although her peritoneal cavity is free of tumor, she has retroperitoneal nodes positive for the malignancy. The stage of her ovarian tumor is:

a) IAb) IIAc) IIBd) III


_ A_4) Pseudomyxoma peritonei typically is the result of a rupture of

a) a mucinous borderline tumor

b) a serous tumorc) a dysgerminomad) a mature teratoma

TEST BLUEPRINT – BENIGN AND MALIGNANT DISEASES OF THE UTERUS

Entry Competency:

At the beginning of the module, the student has background knowledge on the pathophysiology of the different entities involving the uterus.


Given a set of 4 questions, the student can demonstrate mastery of the pathophysiology of some of the disease entities involving the uterus. Mastery is achieved when the student answers3 or more of the questions in 5 minutes.


1. Identify the clinical presentations of the different malignancies involving the uterus.

2. Know the different drugs that can cause endometrial cancer.

3. Analyze the different staging of endometrial carcinoma.

4. Analyze the different treatment modalities of the various disease entities involving the endometrium.

Type of test: True or False : 0 Multiple Choice : 4 items __________________________ Total Items : 4 items




1. Identify the clinical presentations of the different malignancies involving the uterus. 1 12. Know the different drugs that can cause endometrial cancer. 1 13. Analyze the different stages of an endometrial carcinoma. 1 14. Analyze the different treatment modalities of the various disease entities involving the endometrium. 1 1 TOTAL ITEMS 1 1 2 4




_D_ 1) Abnormal uterine bleeding is the most common complaint associated with malignancies of the, EXCEPT:

a) cervix

b) uterusc) fallopian tubed) ovary


_D _ 2) Which of the following drugs has been known to cause endometrial cancer?

a) Megaceb) GnRH agonistc) Danazold) Tamoxifen


_D 3) A 47 year old woman has a poorly-differentiated endometrial carcinoma and a uterine cavity that measures 10 cm in depth. The endocerrvix has stromal invasion of endometrial carcinoma, but no other structure is involved. What is the stage of her endometrial cancer?

a) IAb) IBc) IIAd) IIB

(Item 4 refer to # objective # 4)

_D 4) A 36 year old woman has had a D&C for irregular bleeding. The procedure reveals adenomatous hyperplasia without atypia (complex hyperplasia). What can you tell the patient?

a) most such cases (more than 50%) progress to carcinoma within 8 to 12 yearsb) treatment should be hysterectomy

c) induction of ovulation is contraindicatedd) cyclic progestin therapy should promote monthly withdrawal

Textbook Reference: NOVAK’S GYNECOLOGY (13th ed) By: Jonathan S. Berek

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