Infertility and Hirsutism:

 Infertility and Hirsutism:

1. All the following are true, about ovarian hyperstimulation, EXCEPT:

A. It can follow any of ovulation induction drugs

B. In severe type admission to the intensive care unit may be required

C. The ovaries will be very small in size have unilateral cyst.

D. It can diagnosed clinically and by ultrasound

E. Patients with PCO are at increased risk

2. All of the following are true about PCO EXCEPT:

A. To diagnose PCO hormonal analysis can be done at any time of the cycle

B. It is associated with reversed FSH:LH ratio

C. It is associated with increase resistance to insulin

D. Can be associated with increased prolactin level

E. The ovaries have characteristic appearance by the ultrasound

3. Evaluation of infertile couples:

A. History of regular cycles is suggestive of anovulation

B. History of severe dysmenorrhea and dyspareunia is suggestive of

endometriosis

C. Endometriosis is diagnosed by hysteroscopy

D. Hysterosalpingogram is the only means of assisting ectopic pregnancy

E. Thyroid disease does not affect fertility

4. Treatment of infertility

A. Clomiphene citrate helpful in patients with anovulatory premature

ovarian failure

B. Ovarian drilling is helpful in the treatment of infertility endometriosis

C. IVF is not helpful in the treatment of infertility due to male factor

D. Hyperstimulation syndrome can occurs in patient treated by

gonadotropins

E. Spontaneous pregnancy can occur in patients with Müllerian agenesis

5. All of the following possible causes of infertility, EXCEPT:

A. Previous laparotomy for any reason

B. Smoking

C. High body mass index

D. PCO

E. Uterine subserous fibroids

6. The following value of semen analysis indicates abnormal semen quality:

A. Volume less than 2 ml

B. Count of 40 million / ml

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C. Motility 60%

D. Abnormal form 30%

E. Liquefaction complete in 30 minutes

7. Regarding human fertility: Which is true?

A. Fertilization usually occurs 5-7 days before implantation and before the

extrusion of the second polar body

B. Subfertility only treated with IVF

C. An adverse male factor is detectable in 60% of couples with low fertility

D. Mumps in adulthood has no effect on male fertility

E. Oligospermia means that sperm shape is abnormal

8. The commonest cause for infertility

A. Tubal obstruction

B. Male factor

C. Chronic anovulation

D. Hyper androgens

E. Hypothyroidism.

9. All the following are possible causes of anovulation, EXCEPT:

A. High body mass index

B. Anorexia nervosa

C. Polycystic ovarian syndrome

D. Premature ovarian failure

E. Sickle cell trait

10. Polycystic ovarian diseases, all of the following can be seen, EXCEPT:

A. Acne

B. Streak ovaries

C. Insulin resistance

D. Hirsutism

E. Galactorrhea

11. The initial evaluation in an infertile couple should include:

A. Ovarian biopsy.

B. Semen analysis.

C. D & C.

D. Laparoscopy.

E. Sperm penetration assay.

12. Induction of ovulation agents:

A. Clomiphene citrate is an anti-androgen.

B. Clomiphene citrate is given by injection.

C. Gonadotropins is given orally.

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D. Ultrasound scan is not needed with induction.

E. Causes multiple follicles.

13. In polycystic ovary syndrome patients, all the followings are true EXCEPT:

A. They are usually underweight with low body mass index.

B. They have hirsutism.

C. They have Oligomenorrhoea.

D. They have high Prolactin level.

E. They have Subfertility.

14. Which of the following is suggestive of ovulation:

A. Basal body temperature drop at least 0.5 C in the second half of the cycle

B. Day 21 Estrogen level is elevated

C. Progesterone level on day ten of the cycle is elevated.

D. Regular cycle with dysmenorrhea.

E. Oligomenorrhoea

15. Which of the following is a basic investigation for the male infertility :

A. Semen analysis.

B. Sperm penetration assay of cervical mucous.

C. Sperm penetration assay of hamster ova.

D. Splits ejaculate analysis.

E. Sperm antibodies test.

16. Characteristic of normal semen analysis all true EXCEPT:

A. Volume > 2ml

B. pH of 7.2-7.8

C. Sperm count > 2o million /ml.

D. Sperm motility >50%

E. Normal sperm morphology is <20%

17. In Secondary infertility:

A. Is frequently due to tubal problems

B. The problem is often a chromosomal defect in women.

C. Is frequently due to male factor

D. Commonly associated with endometriosis.

E. May be due to hypoprolactenemia

18. 32 year old woman with PCO has infertility of 1 year’s duration. Her menses

occur at irregular intervals, and basal body temperature is monophasic. An

endometrial biopsy shows endometrial hyperplasia with mild atypia. The most

appropriate therapy:

A. Danazol

B. Megrostol acetate

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C. Oral contraceptive

D. Clomiphene citrate

E. Human Gonadotropins.

19. In an infertile couple all are correct EXCEPT:

A. Fibroid can cause infertility.

B. Ovulation can be induced by Clomiphene.

C. Gonadotropins can cause hyperstimulation.

D. Polycystic ovary is a common problem.

E. Hyperprolactenemia can cause infertility.

20. Regarding Hyperprolactenemia all are true EXCEPT:

A. Can be drug induced

B. Stress can play role

C. Can cause infertility

D. In case of pituitary adenoma surgical removal is the best choice

E. Dopamine agonist is the treatment of the choice

21. Galactorrhea (non-gestational lactation) may result from all of the following

EXCEPT:

A. pituitary adenoma

B. Hypothyroidism

C. Renal failure

D. Intrapartum hemorrhage

E. Bronchogenic carcinoma

22. The test used to diagnose ovulation on day 21 in a 28 days menstrual cycle is:

A. Estrogen.

B. FSH.

C. Progestrone.

D. LH.

E. Prolactin.

23. Ovulation induction complications include:

A. Ovarian hyperstimulation.

24. What is the association of ovulation induction for fertility and multiple births?

A. Decreases the incidence multiple pregnancy.

B. Increases the incidence multiple pregnancy.

C. Increases the incidence of only dizygotic twins.

D. Doesn't affect the incidence of twins.

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25. All of the following are true about PCO except:

A. To diagnose PCO hormonal analysis can be done at any time of the cycle

B. It is associated with reversed FSH:LH ratio

C. It is associated with increase resistance to insulin

D. Can be associated with increased prolactin level

E. The ovaries have characteristic appearance by the ultrasound

26. According to WHO, Sperm count shouldn't be less than :

A. 50 million /ml

B. 60 million/ml.

C. 90 million/ml.

D. 20 million/ml.

E. 10 million/ml.

27. PCO, all true EXCEPT:

A. Hirsutism.

B. Imperforated hymen

C. Infertility.

D. Acne.

E. Amenorrhea

28. A woman with bilateral proximal tubal blockage which was diagnosed by

Hysterosalpingiogram and her husband have normal spermogram. There best

chance to have a pregnancy is by:

A. Doing a laproscopic opening of the tube and then expectant management.

B. Giving the woman clomide for 6 months and expectant management.

C. Doing controlled ovarian hyperstimulation and IUI.

D. Doing IVF of the couple.

29. Hyperprolactenemia:

A. Associated with positive progesterone challenge test.

B. Ovulation can be induced with dopamine antagonist.

C. If macro-adenoma is the cause, the management is surgical.

D. May be a cause of Homonymous hemianopia.

E. Galactorrhea is present in 30% of cases.

30. The most likely cause of infertility in a 30 year old women, P2+4 who had

salpingitis after her last abortion, 3 years ago is:

A. Submucous fibroid.

B. Asherman's syndrome (Uterine synechiae).

C. Blocked tubes.

D. Tuberculous endometritis.

E. Endocervicitis.

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31. The following agents are used in ovulation induction in patients undergoing

assisted conception, EXCEPT:

A. Clomiphene Citrate.

B. Human menopausal gonadotropin.

C. GRH analogues.

D. hCG.

E. Aspirin.

32. Regarding ovulation can be diagnosed by the following measures, EXCEPT:

A. Measuring day 14 serum progesterone.

B. Observing a rise in basal body temperature in the 2ND half of the

menstrual cycle.

C. Study of the cervical mucous.

D. Endometrial histology.

E. Ultrasound.

33. Hysterosalpingiogram (HSG) is contraindicated in the following EXCEPT:

A. Suspicious pregnancy.

B. PID.

C. Congenital malformations of the uterus.

D. Presence of abnormal uterine bleeding.

E. Uterine malignancy.

34. Hirsutism can be found in all of the following conditions, EXCEPT:

A. Polycystic ovary syndrome

B. On Danazol therapy

C. Adrenal hyperplasia

D. Patient on oral contraceptive pills

E. Androgen secreting ovarian tumor

36. A 28 year old lady comes to your clinic complaining of progressive hirsutism

(growing a beard) noticed in the past 3 months. Her initial evaluation includes

all the following, EXCEPT :

A. Check her testosterone level.

B. Enhanced CT of the brain.

C. Do US of the ovaries.

D. Do US of the uterus.

E. Check her 17 hydroxy progesterone level.

37. Regarding Hyperprolactenemia, all of the following are CORRECT EXCEPT:

A. Can be drug induced.

B. In cases on pituitary adenoma surgical removal is the best option.

C. Stress can play a role.

D. Can cause infertility.

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E. Dopamine agonist is the treatment of choice.

38. All of the following are true regarding TB infection EXCEPT:

A. Is transmitted by hematogenous spread

B. It causes infertility ,abnormal uterine bleeding ,pelvic pain

C. It causes severe tenderness & cervical excitation on pelvic examination

D. 2/3 have evidence of old pulmonary TB.

E. Diagnosis depends on endometrial biopsy for culture & histopathological

examination.

39. Regarding Infertility:

A. A patient who is P 0 +3 is defined as primary infertility.

B. Painful menstruation suggests unovulatory menstrual cycles.

C. Measuring progesterone level in the follicular phase is the diagnostic

feature for ovulation.

D. Including the husband in the investigation is essential.

E. Estrogen is used in induction of ovulation.