Form 0990 Y1R SBMA

Appendix F:
SBMA Written Exams and Case Studies for
First-Year Resident Physicians

Form Approved OMB no. 0990-xxxx (Exp. Date XX/XX/XX11)

SBMA Written Exams and Case Studies for
First-Year Resident Physicians

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Written Evaluation

OBGYN RY1

Critical Thinking

1) All of the following typically open onto the vestibule EXCEPT

a. urethra

b. skene ducts

c. bartholin ducts

d. mullerian ducts

2) The vagina is lined most with what type of epithelium?

a. cuboidal epithelium

b. glandular epithelium

c. squamous epithelium

3) Which part of the uterus becomes the lower uterine segment during pregnancy?

a. cervix

b. cornua

c. corpus

d. isthmus

General Knowledge

4) Which one of the following is not one of the major goals of medicine?

a. provide relief from pain and suffering

b. eradicate all disease

c. try to treat disease

d. minimize harm in the process of healing

5) The ethical principle of providing treatment that protects or benefits patients and avoids unnecessary harm is

1. respect for persons

2. beneficence

3. justice

4. autonomy

6) The ethical principle of respecting the patient’s desires and requests is

1. respect for persons

2. beneficence

3. justice

4. autonomy

Ambulatory Care

7) What is the recommendation for the administration of hepatitis B vaccine to pregnant women?

1. contraindicated throughout pregnancy

2. given pre- and postexposure to women at risk

3. given postexposure only

4. restricted to second or third trimester

8) How should a woman be counseled if she inadvertently becomes pregnant within 3 months of

receiving a live-virus vaccine?

1. no fetal risk

2. theoretical, but no definite risks

3. serious fetal risks, but are uncommon

4. significant risk and pregnancy termination is recommended

9) Breast self-examination should be performed

1. Following menstruation

2. At 2-week intervals, on the same day of the week

3. Weekly, on the same day of the week

4. 3 to 5 days before menstruation

Neonatal Care

10) Which is NOT a risk factor for neonatal respiratory distress syndrome?

1. male gender

2. maternal use of glucocorticoids antepartum

3. premature birth

4. white race

11) Which of the following is NOT a sign of neonatal respiratory distress syndrome (RDS)

1. increased respiratory rate

2. chest wall retraction during inspiration

3. grunting

4. systemic hypertension

12) Which of the following increase the likelihood of a premature neonate becoming hypothermic?

1. thin skin

2. large surface area

3. decreased fat

4. all of the above

13) All neonates should receive the following initial care EXCEPT

1. provide warmth

2. low flow oxygen

3. position head and clear airway as necessary

4. dry and stimulate

14) The early stages of neonatal infection may be associated with all of the following clinical signs EXCEPT

1. jaundice

2. respiratory depression

3. hypothermia

4. jitteriness

15) The most common pathogens of ascending infection leading to neonatal sepsis and stillbirth do NOT include which of the following?

1. Escherichia coli

2. Ureaplasma urealyticum

3. Bacteroides fragilis

4. Group B streptococcus

16) Most peri- and intraventricular hemorrhages of the preterm infant develop within what time period following birth?

1. 1 hour

2. 12 hours

3. 3 days

4. 7 days

17) Approximately what percentage of all neonates born before 34 weeks will have evidence of intraventricular hemorrhage?

1. 2

2. 10

3. 20

4. 50

18) Which factor increases a diabetic’s risk for spontaneous abortion?

1. HgA1C = 6.3%

2. Poor general glycemic control

3. Preprandial glucose 115mg/dL

4. Postprandial glucose 125mg/dL

19) Infants of diabetic mothers are at increased risk for which of the following congenital anomalies?

1. cardiac malformations

2. craniofacial malformations

3. reproductive tract malformations

4. cretinism

20) Which of the following can lead to intrauterine passage of meconium?

1. cord compression

2. hypoxia

3. normal bowel peristalsis

4. all of the above

21) What is the primary pathophysiological basis of meconium aspiration syndrome?

1. airway blockage

2. chemical pneumonitis

3. pulmonary hypoplasia

4. unknown

Reproductive Endocrinology

22) Which of the following correctly describes the anatomical portions of the fallopian tube from most lateral to most medial?

1. interstitial, isthmus, ampulla, infundibulum

2. infundibulum, ampulla, interstitial, isthmus

3. interstitial, ampulla, infundibulum, isthmus

4. infundibulum, ampulla, isthmus, interstitial

23) The hormone that triggers ovulation is

1. thyrotropin (TSH)

2. androstenedione

3. estradiol

4. leutonizing hormone (LH)

24) Anatomical changes associated with physiological aging of the ovaries include all of the following EXCEPT

1. increased volume

2. decrease of oocyte number

3. corrugation of the tunica albuginea

4. atrophy of the cortical layer

25) Infertility is defined as a couple’s failure to conceive following unprotected intercourse for

1. 6 months

2. 1 year

3. 2 years

4. 3 years

26) Choose the INCORRECT statement.

1. polymenorrhea is a menstrual cycle interval of less than 21 days

2. oligomenorrhea is a menstrual cycle interval of more than 37 days

3. amenorrhea is the absence of menstrual bleeding for more than 12 months

4. postmenopausal bleeding is uterine bleeding occurring more than 12 months after the last menstrual period in a postmenopausal woman

27) The differential diagnosis of dysfunctional uterine bleeding (DUB) in the perimenarchal girl includes

1. anovulation

2. pregnancy

c. coagulopathies

d. all of the above

28) Hirsuitism and virilization are characterized as

1. estrogen excess disorder

2. androgen excess disorder

3. progesterone excess disorder

4. prolactin excess disorder

29) Bromocriptine has proven efficacy for which of the following conditions during pregnancy?

1. Graves disease

2. Addison disease

3. Primary aldosteronism

4. Pituitary prolactinoma

30) Which of the following is most useful in screening for thyroid disorders?

1. thyroid-binding globulin (TBG)

2. thyroid-releasing hormone (TRH)

3. thyrotropin (TSH)

4. none of the above

31) Untreated maternal subclinical hypothyroidism increases the risk of which of the following?

1. abnormal psychomotor development in child

2. placental abruption

3. preterm delivery

4. all of the above

32) Choose the INCORRECT statement

1. multiple small adhesions on the ovarian surface should be coagulated then removed

2. gentle tissue handling need not be observed during ovarian reconstruction because adhesion formation is uncommon

3. resection of an ovarian cyst through the laparoscope decreases incidence of new adhesion formation

33) Which technique is NOT recommended for evaluation of tubal patency?

1. tubal insufflation

2. hysterosalpingogram

3. chromopertubation at time of laparoscopy/laparotomy

Gynecology

34) Pregnant women with gonorrhea frequently have concurrent infection with which of the following?

1. Chlamydia trachomatis

2. Herpes simplex virus

3. Trichomonas vaginalis

4. Haemophilus ducreyi

35) What is the treatment of choice for uncomplicated gonorrhea in pregnancy?

1. ceftriaxone

2. penicillin

3. erythromycin

4. azithromycin

36) What is the etiology of mucocutaneous external genital warts?

1. Treponema pallidum

2. Human papillomavirus

3. Parvovirus

4. Hemophilus ducreyi

37) The primary treatment of candidal vaginitis is

1. topical synthetic imidazoles

2. systemic corticosteroids

3. topical cephalosporing

4. systemic penicillin

38) Which of the following are possible etiologies for chronic pelvic pain?

1. pelvic organ prolapse

2. ovarian remnant

3. nerve entrapment

4. all of the above

39) In patients with true chronic pelvic pain syndrome

1. duration of pain is 12 months or longer

2. the patient has experienced relief from most previous treatments

3. physical function is significantly impaired at home or work

4. symptoms of depression are rarely exhibited

40) Indications for visualization of an adnexal mass with laparoscopy or laparotomy include which of the following?

1. ovarian mass greater than 6 cm

2. adnexal mass greater than 10cm

3. any mass developing after menopause

4. all of the above

41) Which of the following are nongynecologic causes of an adnexal mass?

1. appendiceal abscess

2. diverticulosis

3. pelvic kidney

4. all of the above

42) Choose the CORRECT statement

1. endometriosis appears to be progressive in most untreated patients

2. pregnancy always results in regression of endometriosis

3. postmenopausal women do not experience symptoms of endometriosis

43) Choose the INCORRECT statement pertaining to diagnosis of endometriosis

1. bimanual examination may reveal uterosacral ligament tenderness and nodularity, induration of the rectovaginal septum, and fixed retroversion of the uterus

2. Ultrasonography can provide specific information to classify extent and severity of disease

3. A painful swelling of suspected implants before or during the time of menstruation is a classic sign of endometriosis

44) Fibrocystic change of the breast

1. occurs mainly in menopausal women

2. presents with breast discomfort in 85%-90% of cases

3. increases the risk of developing breast cancer

45) What is the most common benign breast condition?

1. ductal ectasia

2. fibroadenoma

3. fibrocystic change

4. intraductal papilloma

46) A 54-year-old woman underwent a total abdominal hysterectomy for uterine leiomyomata. The day after surgery, the patient’s temperature is 38.4 C and she complains of pelvic pain, chills, and rectal pressure. Your bedside examination of the patient reveals a vaginal cuff abscess. The most likely source of bacteria that caused this infection is

1. incompletely sterilized surgical instruments

2. vagina

3. the surgeon’s skin

4. residual peritoneal fluid

47) The hospital where you perform the majority of your gynecologic surgeries has recently implemented a policy to reduce postoperative infections. The most important step in preventing the spread of infection is

1. frequent handwashing

2. admitting patients to the hospital 12 to 24 hours before scheduled procedures

3. sterile placement of Foley catheters

Obstetrics

48) What is the average increase in maternal blood volume during pregnancy?

1. 10%

2. 25%

3. 40%

4. 75%

49) Which of the following characterizes arterial blood pressure in normal pregnancy?

1. nadir in midpregnancy, rising thereafter

2. nadir in the first trimester, rising thereafter

3. peaks in the first trimester, falling thereafter

4. peaks in the second trimester, falling thereafter

50) In the fetus or neonate, what are the two sutures between the frontal and parietal bones called?

1. frontal

2. sagittal

3. lambdoid

4. coronal

51) The embryonic heart is completely formed by how many weeks after fertilization?

1. 4

2. 6

3. 10

4. 12

52) If all family members who inherit an abnormal gene express the abnormal phenotype, the gene is most likely inherited in what fashion?

1. X-linked

2. autosomal recessive

3. autosomal dominant

4. multifactorial

53) Most congenital defects have what type of inheritance?

1. X-linked

2. autosomal recessive

3. autosomal dominant

4. multifactorial

54) What is the goal of antepartum fetal surveillance?

1. prevent fetal deaths

2. prevent early deliveries

3. increase fees for obstetricians

4. delay delivery until lung maturity achieved

55) What is the definition of a reactive nonstress test (NST)?

1. 1 acceleration in 20 minutes

2. 2 accelerations in 20 minutes

3. 8 accelerations in 20 minutes

4. 15 accelerations in 20 minutes

56) Forceps applied when the fetal head (left occiput anterior position) has reached the pelvic floor and is at the perineum should be classified as what type of delivery?

1. outlet forceps

2. low forceps

3. midforceps

4. high forceps

57) Which of the following is NOT a prerequisite for forceps application?

1. head must be engaged

2. fetus must present either by the vertex or by the face with the chin posterior

3. cervix must be completely dilated

4. membranes must be ruptured

58) Which of the following is a relative contraindication for delivery using vacuum extraction?

1. face presentation

2. 35-week gestation

3. Chorioamnionitis

4. Post-term pregnancy

59) Which of the following is most likely to have a successful induction of labor?

1. primiparous; cervix 2 cm dilated / 20% effaced / 0 station

2. primiparous; cervix 2 cm dilated / 20% effaced / -1 station

3. multiparous; cervix 2 cm dilated / 80% effaced / -1 station

4. multiparous; cervix 1 cm dilated / 20% effaced / 0 station

60) How long does it take oxytocin to reach steady-state levels in the plasma?

1. 5 minutes

2. 10 minutes

3. 20 minutes

4. 40 minutes

61) Which maternal characteristic is NOT an anesthesia risk factor?

1. anatomic anomaly of the face

2. asthma

3. marked obesity

4. mild hypertension

62) What is an advantage of ketamine when compared to thiopental?

1. not associated with hypotension

2. causes delirium

3. causes hallucinations

4. safer for hypertensive patients

63) Kernicterus is the result of elevated neonatal blood levels of which of the following?

1. albumin

2. bilirubin

3. erythropoietin

4. schistocytes

64) A low 1-minute Apgar score helps to identify which of the following?

1. infant with birth asphyxia

2. normal infant

3. infant destined to develop neurological problems

4. infant who requires resuscitation

65) Which of the following is NOT part of the Apgar score?

1. heart rate

2. respiratory effort

3. color

4. amniotic fluid consistency

66) What is the Apgar score of a neonate at 5 minutes of life whose respiratory effort is irregular, pulse is 90 beats per minute, who is floppy and cyanotic, and who only expresses minimal grimaces?

1. 1

2. 3

3. 5

4. 7

Oncology

67) The etiology of cancer of the cervix is most likely related to

1. genital herpes zoster

2. cigarette smoking

3. HPV infection

68) Known risk factors for endometrial cancer include all of the following EXCEPT

1. age

2. obesity

3. oral contraceptive use

4. nulliparity

69) Current practice guidelines recommend HPV testing as an adjunctive test to help direct management in women with which Pap test diagnosis?

1. inflammation, atypia

2. ASC

3. ASC-H

4. LSIL

70) Referral for colposcopy is recommended for patients with all of the following diagnoses EXCEPT

1. LSIL

2. ASC-US on two consecutive Paps 6 months apart

3. ASC-US, HPV negative

4. AGC

71) You may consider omitting lymphadenectomy as part of the staging procedure for squamous cell vulvar carcinoma when

1. lesion 1.5 cm diameter, less than 5 mm invasion

2. unilateral lesion, less than 5 mm invasion

3. any location, less than 1 mm invasion

4. unilateral lesion 1.3 cm diameter, 3 mm invasion

72) Which of the following tests is used for FIGO staging of cervical cancer?

1. intravenous pyelogram

2. CT scans of abdomen and pelvis

3. Lymphangiogram

4. PET scan

73) A 23-year-old patient is diagnosed with a stage IA malignant ovarian germ cell tumor. Which of the following would be the standard treatment?

1. unilateral oophorectomy

2. bilateral oophorectomy and hysterectomy

3. unilateral oophorectomy followed by chemotherapy

4. ovarian biopsy followed by chemotherapy

74) What is the primary surgical treatment of endometrial carcinoma?

1. total abdominal hysterectomy alone

2. total abdominal hysterectomy with bilateral salpingo-oophorectomy

3. radical hysterectomy

4. pelvic exenteration

Examinee__________________________________

Vaginal Bleeding in Early Pregnancy Case Study # 2

Mrs. B. is a 20 year old Para 2 who came to the health center 2 days ago complaining of irregular vaginal bleeding & abdominal & pelvic pain. Symptoms of early pregnancy were detected & confirmed with a pregnancy test. Mrs. B. was advised to avoid strenuous activity & sexual intercourse & return immediately if her symptoms persisted. Mrs. B. returns to the health center today & reports that irregular vaginal bleeding has continued & she now has acute abdominal pain that started 2 hours ago.

What will you include in your initial assessment of Mrs. B. & why?

What particular aspects of Mrs. B.’s physical examination will help you make a diagnosis & why?

What screening procedures / laboratory tests will you include in your assessment of Mrs. B & why?

You have completed your assessment of Mrs. B, & your main findings include the following:

Mrs. B.’s temperature is 36.8 degrees C, her pulse rate is 130 beats per minute & weak, her blood pressure is 85/60 & her respirations are 20 per minute. Her skin is pale & sweaty. Mrs. B. has acute abdominal & pelvic pain, her abdomen is tense & she has rebound tenderness. She has light vaginal bleeding. On vaginal exam, the cervix is found to be closed & cervical motion tenderness is present. The 6 week size uterus is softer than normal.

Based on these findings, what is Mrs. B.’s diagnosis & why?

Based on your diagnosis, what is your plan of care for Mrs. B & why?

Mrs. B’s postoperative course was without complications and notable for patient tolerating oral intake, having minimal complaints of abdominal pain, ambulating well & spontaneously voiding. She is now ready to be discharged: however, her hemoglobin is 9g/dL. She has indicated that she would like to become pregnant again, but not for at least a year.

Based on these findings, what is your continuing plan of care for Mrs. B. & why?

Examinee__________________________________

Pregnancy Induced Hypertension Case Study # 2

Mrs. C. is a 23 year old gravida 3 para 2 at 37 weeks gestation who is brought to the ER complaining of a severe headache & blurred vision. Mrs. C. has had 4 prenatal care visits during this pregnancy. Her prenatal course has been unremarkable. She was last seen 1 week ago, at which time she was counseled about danger signs in pregnancy & what to do about them.

What will you include in your initial assessment of Mrs. C & why?

What particular aspects of Mrs. C.’s physical examination will help you make a diagnosis or identify her problems / needs & why?

What screening procedures / laboratory tests will you include in your assessment of Mrs. C & why?

Mrs. C reports onset of severe headache 3 hours prior to admission, & blurred vision that began 2 hours after onset of headache. She denies upper abdominal pain, decreased urine output, convulsions or loss of consciousness. She reports normal fetal movement.

Mrs. C. is conscious & alert. Her blood pressure is 150/110. There is no abdominal tenderness. Uterus is 37 weeks size. Fetal movements are normal & fetal heart rate is 120 / minute. Urine shows 3+ protein.

Based on these findings, what is Mrs. C.’s diagnosis & why?

Based on your diagnosis, what is your plan of care for Mrs. C & why?

Examinee__________________________________

Partograph Case Study # 2

Record all information on the partograph

Mrs. B was admitted at 10:00 on September 4, 2006.

Membranes intact

Gravida 1, Para 0

Medical Record number 1443

The fetal head is 5/5 palpable above the symphysis pubis

The cervix is 4cm dilated

There are 2 contractions in 10 minutes, each lasting less than 20 seconds

FH 140

Membranes intact

Blood pressure 100/70

Temperature 36.2

Pulse 80 per minute

Urine output 400mL: negative protein & acetone

What is your diagnosis? ___________________________________________

What action will you take? _________________________________________

10:30 FH 140, Contractions 2/10 each 15 sec, pulse 90

11:00 FH 136, Contractions 2/10 each 15 sec, pulse 88, membranes intact

11:30 FH 140, Contractions 2/10 each 20 sec, pulse 84

12:00 FH 136, Contractions 2/10 each 15 sec, pulse 88, Temp 36.2

The fetal head is 5/5 palpable above the symphysis pubis

The cervix is 4cm dilated, membranes intact

What is your diagnosis? ___________________________________________

What action will you take? _________________________________________

12:30 FH 136, Contractions 1/10 each 15 sec, pulse 90

13:00 FH 140, Contractions 1/10 each 15 sec, pulse 88

13:30 FH 130, Contractions 1/10 each 20 sec, pulse 88

14:00 FH 140, Contractions 2/10 each 20 sec, pulse 90, temp 36.8, blood pressure 100/70

The fetal head is 5/5 palpable above the symphysis pubis

Urine output is 300 mL, negative protein & acetone

What is your diagnosis? ___________________________________________

What action will you take? _________________________________________

The cervix is 4cm dilated, sutures apposed

Labor augmentation with oxytocin 2.5 units in 500 mL IV fluid at 10 drops per minute (dpm) is started

14:30 FH 140, Contractions 2/10 each 30 sec, pulse 88, infusion increased to 20 dpm

15:00 FH 140, Contractions 3/10 each 30 sec, pulse 90, infusion increased to 30 dpm

15:30 FH 140, Contractions 3/10 each 30 sec, pulse 88, infusion increased to 40 dpm

16:00 FH 144, Contractions 3/10 each 30 sec, pulse 92, fetal head is 2/5 palpable above the symphysis pubis, cervix is 6cm dilated, sutures apposed, infusion increased to 50 dpm

16:30 FH 140, Contractions 3/10 each 45 sec, pulse 90

What action will you take? _________________________________________

17:00 FH 138, Pulse 92, Contractions 2/10 each 40 sec, maintain at 50 dpm

17:30 FH 140, Pulse 94, Contractions 3/10 each 45 sec, maintain at 50 dpm

18:00 FH 140, Pulse 96, Contractions 4/10 each 50 sec, maintain at 50 dpm

18:30 FH 144, Pulse 94, Contractions 4/10 each 50 sec, maintain at 50 dpm

19:00 FH 144, Pulse 90, Contractions 4/10 each 50 sec, fetal head is 0/5 palpable above the symphysis pubis, the cervix is fully dilated

19:30 FH 142, Pulse 100, Contractions 4/10 each 50 sec

20:00 FH 146, Pulse 110, Contractions 4/10 each 50 sec

20:10 Spontaneous delivery of a live male infant, Wt 2.654kg

How long was the active phase of the first stage of labor?

How long was the second stage of labor?

Why was labor augmented?

F–18