current Diagnosis and Treatment Obstetrics
and Gynecology 12th Edition by Alan Test
Bank
Question 1
A 24-year-old nulligravid woman undergoes a routine pelvic examination. The clinician notes
that the external cervical os appears round and smooth. Which of the following best describes
the normal anatomical appearance of the cervix in a woman who has never given birth
vaginally?
A. Slit-like external os
B. Round, smooth external os
C. Irregular, stellate external os
D. Everted columnar epithelium covering the ectocervix
E. Patent external os measuring 2 cm
Correct Answer: B. Round, smooth external os
Rationale: The external os of a nulliparous woman is classically described as round and smooth.
After vaginal delivery, the external os typically assumes a slit-like or irregular shape due to the
trauma of childbirth and subsequent healing . Option A describes the typical postpartum
appearance. Option D describes cervical ectropion, which can occur normally in adolescents and
pregnant women. Option E describes an abnormally dilated cervix.
Question 2
Which of the following ligaments provides the primary structural support to the uterus by
anchoring the cervix to the pelvic sidewalls?
A. Round ligament
B. Broad ligament
C. Cardinal ligament (Mackenrodt)
D. Uterosacral ligament
E. Ovarian ligament
Correct Answer: C. Cardinal ligament (Mackenrodt)
,Rationale: The cardinal ligaments (Mackenrodt ligaments) extend from the lateral pelvic walls to
the cervix and upper vagina, providing the primary support for the uterus . The round ligament
extends from the uterine cornua to the labia majora and helps maintain uterine anteversion but
provides minimal structural support. The broad ligament is a peritoneal fold that invests the
uterus, tubes, and ovaries but is not a primary supporting structure. The uterosacral ligaments
provide secondary support by anchoring the cervix posteriorly to the sacrum.
Question 3
A 32-year-old woman is undergoing evaluation for infertility. Which of the following structures is
derived from the Müllerian (paramesonephric) ducts?
A. Ovaries
B. Fallopian tubes, uterus, cervix, and upper vagina
C. Lower vagina and vulva
D. Labia majora and labia minora
E. Clitoris
Correct Answer: B. Fallopian tubes, uterus, cervix, and upper vagina
Rationale: The Müllerian ducts give rise to the fallopian tubes, uterus, cervix, and upper two-
thirds of the vagina . The ovaries develop from the gonadal ridges (genital ridges) and are not
Müllerian derivatives. The lower vagina and vulva develop from the urogenital sinus and
external genital swellings. The labia majora develop from the labioscrotal swellings, and the
clitoris develops from the genital tubercle.
Question 4
Fertilization typically occurs in which portion of the fallopian tube?
A. Interstitial portion
B. Isthmus
C. Ampulla
D. Infundibulum
E. Fimbriae
Correct Answer: C. Ampulla
Rationale: The ampulla is the widest and longest portion of the fallopian tube and is the site of
fertilization in approximately 80% of cases . The interstitial (intramural) portion traverses the
,uterine wall. The isthmus is the narrow portion adjacent to the uterus. The infundibulum is the
funnel-shaped distal end, and the fimbriae are finger-like projections that sweep the oocyte into
the tube. After fertilization, the zygote travels to the uterus for implantation.
Question 5
A 28-year-old woman with regular 28-day menstrual cycles asks when ovulation most likely
occurs. On which day of her cycle should ovulation be expected?
A. Day 7
B. Day 10
C. Day 14
D. Day 21
E. Day 28
Correct Answer: C. Day 14
Rationale: Ovulation occurs approximately 14 days before the onset of the next menstrual
period. In a 28-day cycle, this corresponds to cycle day 14 . The LH surge triggers ovulation
approximately 36 hours after its onset. The luteal phase (post-ovulation) is relatively constant at
14 days, while the follicular phase can vary.
Question 6
Which hormone is responsible for triggering ovulation?
A. Follicle-stimulating hormone (FSH)
B. Luteinizing hormone (LH)
C. Estrogen
D. Progesterone
E. Human chorionic gonadotropin (hCG)
Correct Answer: B. Luteinizing hormone (LH)
Rationale: The midcycle LH surge is the trigger for ovulation, occurring approximately 36 hours
after the onset of the surge . FSH stimulates follicular growth and estrogen production. Estrogen
produced by the dominant follicle provides positive feedback to the hypothalamus and pituitary,
leading to the LH surge. Progesterone is produced by the corpus luteum after ovulation. hCG
maintains the corpus luteum in early pregnancy.
, Question 7
A 26-year-old woman is evaluated for primary amenorrhea. Physical examination reveals normal
breast development but absent pubic and axillary hair. Karyotype is 46,XY. Which of the
following is the most likely diagnosis?
A. Turner syndrome
B. Androgen insensitivity syndrome
C. Müllerian agenesis
D. Polycystic ovary syndrome
E. Congenital adrenal hyperplasia
Correct Answer: B. Androgen insensitivity syndrome
Rationale: Androgen insensitivity syndrome (AIS) results from mutations in the androgen
receptor gene on the X chromosome. Affected individuals have a 46,XY karyotype, testes that
produce testosterone and Müllerian-inhibiting substance (MIS), but complete or partial
insensitivity to androgens. This results in absent pubic and axillary hair, normal breast
development (due to peripheral conversion of testosterone to estrogen), and absent Müllerian
structures (uterus, tubes, upper vagina) because MIS is produced. Turner syndrome (45,XO)
presents with short stature, streak gonads, and primary amenorrhea but typically has some
pubic hair. Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome) presents with
normal 46,XX karyotype and normal secondary sexual characteristics but absent uterus and
upper vagina.
Question 8
In a 46,XX female, virilization of the external genitalia during fetal development can result from
exposure to high levels of which of the following?
A. Maternal estrogen
B. Maternal progesterone
C. Maternal androgens
D. Human chorionic gonadotropin
E. Prolactin
Correct Answer: C. Maternal androgens
and Gynecology 12th Edition by Alan Test
Bank
Question 1
A 24-year-old nulligravid woman undergoes a routine pelvic examination. The clinician notes
that the external cervical os appears round and smooth. Which of the following best describes
the normal anatomical appearance of the cervix in a woman who has never given birth
vaginally?
A. Slit-like external os
B. Round, smooth external os
C. Irregular, stellate external os
D. Everted columnar epithelium covering the ectocervix
E. Patent external os measuring 2 cm
Correct Answer: B. Round, smooth external os
Rationale: The external os of a nulliparous woman is classically described as round and smooth.
After vaginal delivery, the external os typically assumes a slit-like or irregular shape due to the
trauma of childbirth and subsequent healing . Option A describes the typical postpartum
appearance. Option D describes cervical ectropion, which can occur normally in adolescents and
pregnant women. Option E describes an abnormally dilated cervix.
Question 2
Which of the following ligaments provides the primary structural support to the uterus by
anchoring the cervix to the pelvic sidewalls?
A. Round ligament
B. Broad ligament
C. Cardinal ligament (Mackenrodt)
D. Uterosacral ligament
E. Ovarian ligament
Correct Answer: C. Cardinal ligament (Mackenrodt)
,Rationale: The cardinal ligaments (Mackenrodt ligaments) extend from the lateral pelvic walls to
the cervix and upper vagina, providing the primary support for the uterus . The round ligament
extends from the uterine cornua to the labia majora and helps maintain uterine anteversion but
provides minimal structural support. The broad ligament is a peritoneal fold that invests the
uterus, tubes, and ovaries but is not a primary supporting structure. The uterosacral ligaments
provide secondary support by anchoring the cervix posteriorly to the sacrum.
Question 3
A 32-year-old woman is undergoing evaluation for infertility. Which of the following structures is
derived from the Müllerian (paramesonephric) ducts?
A. Ovaries
B. Fallopian tubes, uterus, cervix, and upper vagina
C. Lower vagina and vulva
D. Labia majora and labia minora
E. Clitoris
Correct Answer: B. Fallopian tubes, uterus, cervix, and upper vagina
Rationale: The Müllerian ducts give rise to the fallopian tubes, uterus, cervix, and upper two-
thirds of the vagina . The ovaries develop from the gonadal ridges (genital ridges) and are not
Müllerian derivatives. The lower vagina and vulva develop from the urogenital sinus and
external genital swellings. The labia majora develop from the labioscrotal swellings, and the
clitoris develops from the genital tubercle.
Question 4
Fertilization typically occurs in which portion of the fallopian tube?
A. Interstitial portion
B. Isthmus
C. Ampulla
D. Infundibulum
E. Fimbriae
Correct Answer: C. Ampulla
Rationale: The ampulla is the widest and longest portion of the fallopian tube and is the site of
fertilization in approximately 80% of cases . The interstitial (intramural) portion traverses the
,uterine wall. The isthmus is the narrow portion adjacent to the uterus. The infundibulum is the
funnel-shaped distal end, and the fimbriae are finger-like projections that sweep the oocyte into
the tube. After fertilization, the zygote travels to the uterus for implantation.
Question 5
A 28-year-old woman with regular 28-day menstrual cycles asks when ovulation most likely
occurs. On which day of her cycle should ovulation be expected?
A. Day 7
B. Day 10
C. Day 14
D. Day 21
E. Day 28
Correct Answer: C. Day 14
Rationale: Ovulation occurs approximately 14 days before the onset of the next menstrual
period. In a 28-day cycle, this corresponds to cycle day 14 . The LH surge triggers ovulation
approximately 36 hours after its onset. The luteal phase (post-ovulation) is relatively constant at
14 days, while the follicular phase can vary.
Question 6
Which hormone is responsible for triggering ovulation?
A. Follicle-stimulating hormone (FSH)
B. Luteinizing hormone (LH)
C. Estrogen
D. Progesterone
E. Human chorionic gonadotropin (hCG)
Correct Answer: B. Luteinizing hormone (LH)
Rationale: The midcycle LH surge is the trigger for ovulation, occurring approximately 36 hours
after the onset of the surge . FSH stimulates follicular growth and estrogen production. Estrogen
produced by the dominant follicle provides positive feedback to the hypothalamus and pituitary,
leading to the LH surge. Progesterone is produced by the corpus luteum after ovulation. hCG
maintains the corpus luteum in early pregnancy.
, Question 7
A 26-year-old woman is evaluated for primary amenorrhea. Physical examination reveals normal
breast development but absent pubic and axillary hair. Karyotype is 46,XY. Which of the
following is the most likely diagnosis?
A. Turner syndrome
B. Androgen insensitivity syndrome
C. Müllerian agenesis
D. Polycystic ovary syndrome
E. Congenital adrenal hyperplasia
Correct Answer: B. Androgen insensitivity syndrome
Rationale: Androgen insensitivity syndrome (AIS) results from mutations in the androgen
receptor gene on the X chromosome. Affected individuals have a 46,XY karyotype, testes that
produce testosterone and Müllerian-inhibiting substance (MIS), but complete or partial
insensitivity to androgens. This results in absent pubic and axillary hair, normal breast
development (due to peripheral conversion of testosterone to estrogen), and absent Müllerian
structures (uterus, tubes, upper vagina) because MIS is produced. Turner syndrome (45,XO)
presents with short stature, streak gonads, and primary amenorrhea but typically has some
pubic hair. Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome) presents with
normal 46,XX karyotype and normal secondary sexual characteristics but absent uterus and
upper vagina.
Question 8
In a 46,XX female, virilization of the external genitalia during fetal development can result from
exposure to high levels of which of the following?
A. Maternal estrogen
B. Maternal progesterone
C. Maternal androgens
D. Human chorionic gonadotropin
E. Prolactin
Correct Answer: C. Maternal androgens
