In the presence of a vulvovaginits with predominant isolation of Streptococcus pyogenes , recurrent after oral ampicillin treatment, the following option(s) should be considered

• a)
  

  check the child and the parents for pharyngeal colonization

  
  
• b)
  

  take a specimen from the rectum of the child for culture

  
  
• c)
  

  add a short antibiotic course with a non beta-lactamase sensitive drug

  
  
• d)
  

  prescribe ceftriazone 150 mg parenterally

  
  
• e)
  

  use topical clindamicin

The diagnosis of warts in the ano-genital region of a 3 year-old child calls for careful evaluation of the possibility of sexual abuse, even where other modes of transmission are proved. What would you consider useful in this situation?

• a)
  

  speak immediately and clearly with the mother and the father of the child about this possibility

  
  
• b)
  

  ask the child directly

  
  
• c)
  

  discreetly question the mother about where her daughter lives during the day and who are the preferential caregivers

  
  
• d)
  

  ask the mother about the possibility of a HPV genital infection during pregnancy or the presence of skin warts on her hands

  
  
• e)
  

  perform a HPV typing test

The following is/are true concerning the 46XY female

• a)
  

  In complete AIS the testes produce normal amounts of testosterone

  
  
• b)
  

  In complete AIS testosterone cannot be converted to dihydrotesteosterone

  
  
• c)
  

  In 5 α reductase deficiency there is an increased risk of malignancy in the gonad

  
  
• d)
  

  In 5 α reductase deficiency there is more than one isoform of the enzyme

  
  
• e)
  

  In partial AIS the testes produce increased amounts of testosterone to overcome the resistance

Which cases require early gonadectomy because of the risk of virilisation?

• a)
  

  Swyer syndrome

  
  
• b)
  

  Complete AIS

  
  
• c)
  

  5 α reductase deficiency

  
  
• d)
  

  Partial AIS

  
  
• e)
  

  Frasier syndrome

Estrogens have a principally

• a)
  

  positive effect on the osteogenesis

  
  
• b)
  

  proliferative effect on the epithelium of the uterus, tubes, vagina and urinary tract

  
  
• c)
  

  negative effect on the cardiovascular system

  
  
• d)
  

  negative effect on the CNS

  
  
• e)
  

  vasodilator effect

Hormonal Developmental Therapy (HDT) in childhood and adolescence

• a)
  

  must be applied in absolute estrogen deficiency states

  
  
• b)
  

  should be finished as soon as secondary sexual characteristics have been developed

  
  
• c)
  

  need increasing doses individually

  
  
• d)
  

  must be started with an estrogen/progestagen combination

  
  
• e)
  

  has identical goals to HRT

Long-term HDT in women suffering from absolute deficiency of estrogens

• (a)
  

  is needed to maintain the appropriate stages of sexual development and for prevention of osteoporosis and cardiovascular disease

  
  
• (b)
  

  has no proven risks

  
  
• (c)
  

  should be finished on request of the patient

  
  
• (d)
  

  when finished is often followed by a pseudo-menopause in hypogonadal women

  
  
• (e)
  

  is needed just as much in cases of relative deficiency of estrogens

Clinical signs of hyperandrogenism include

• a)
  

  Acne

  
  
• b)
  

  Hirsutism

  
  
• c)
  

  Clitoromegaly

  
  
• d)
  

  Vaginal aplasia

  
  
• e)
  

  Decreased muscular mass

Functional Hypothalamic Amenorrhea (FHA) is defined as a non-organic and reversible disorder and may be accompanied by

• a)
  

  Lower mean frequency of LH pulses

  
  
• b)
  

  Complete absence of LH pulsatility

  
  
• c)
  

  Normal-appearing LH and GnRH secretion pattern

  
  
• d)
  

  Streak ovaries

  
  
• e)
  

  Higher mean frequency of LH pulses

Which of the following is/are true regarding hyperprolactinaemia in adolescents?

• a)
  

  It is associated with decreased estradiol concentrations

  
  
• b)
  

  It usually presents with amenorrhea

  
  
• c)
  

  It has a frequency of about 7% in adolescents

  
  
• d)
  

  The severity of the menstrual disorders do not correlate with the prolactin levels

  
  
• e)
  

  Galactorrhoea is always present

Type II autoimmune polyglandular syndrome is characterized by all of the following except:

• a)
  

  Adrenal insufficiency

  
  
• b)
  

  Autoimmune thyroid disease

  
  
• c)
  

  Hyperprolactinemia

  
  
• d)
  

  Premature Ovarian Failure

  
  
• e)
  

  Type I diabetes mellitus

The following statement(s) concerning the pathogenesis of PCOS is/are true

• a)
  

  There is an intrinsic ovarian theca cell defect leading to androgen overproduction

  
  
• b)
  

  There is impaired hypothalamic-pituitary sensitivity to ovarian steroid feedback

  
  
• c)
  

  There is a primary defect of gonadotropin synthesis leading to preferentially increased LH synthesis

  
  
• d)
  

  The increased LH concentrations may result from the androgen-induced impairment of hypothalamic sensitivity to ovarian steroid feedback

  
  
• e)
  

  It results from a primary hypothalamic defect leading to increased GnRH pulse generator frequency

The estimated risk of developing PCOS in girls with premature pubarche is:

• a)
  

  5–10%

  
  
• b)
  

  15–20%

  
  
• c)
  

  30–40%

  
  
• d)
  

  45–55%

  
  
• e)
  

  60–65%

The risk of developing PCOS appears to be higher in girls with

• a)
  

  ordinary premature adrenarche

  
  
• b)
  

  exaggerated premature adrenarche

  
  
• c)
  

  atypical central precocious pubarche

  
  
• d)
  

  premature thelarche

  
  
• e)
  

  delayed adrenarche

Which of the following factor(s) has/have been implicated in the pathogenesis of PCOS

• a)
  

  Low birth weight

  
  
• b)
  

  High birth weight

  
  
• c)
  

  Intrauterine androgen excess

  
  
• d)
  

  In vitro fertilization

  
  
• e)
  

  Maternal diabetes

Which type of diet may exacerbate the reproductive and metabolic aberrations of PCOS?

• a)
  

  Calorie excess

  
  
• b)
  

  High-AGE diet

  
  
• c)
  

  Low-AGE-diet

  
  
• d)
  

  High protein content

  
  
• e)
  

  Low calorie intake

The term “Premature adrenarche” includes the ordinary form and the exaggerated form, which are distinguished by serum androgen levels, as follows:

• a)
  

  The exaggerated form is indicated by DHEA-S levels above 185 μg/dl and/or androstenedione levels exceeding the range of 75–99 ng/dl

  
  
• b)
  

  The exaggerated form is indicated by androstenedione levels exceeding the range of 75–99 ng/dl

  
  
• c)
  

  The ordinary form is indicated by DHEA-S levels in the range of 40–130 μg/dl

  
  
• d)
  

  The ordinary form is indicated by DHEA-S levels less than 40 μg/dl

  
  
• e)
  

  The ordinary form is indicated by androstenedione levels exceeding the range of 75–99 ng/dl

Vaginal aplasia is associated with the following

• a)
  

  Male pseudo-hermaphroditism

  
  
• b)
  

  Female pseudo-hermaphroditism

  
  
• c)
  

  Mayer-Rokitansky-Küster-Hauser syndrome

  
  
• d)
  

  McCune–Albright syndrome

  
  
• e)
  

  CNS tumours

Male pseudo-hermaphroditism is classified to the following subtype(s) according to etiological factors:

• a)
  

  testicular hyper-responsiveness to hCG and LH

  
  
• b)
  

  defective testosterone synthesis

  
  
• c)
  

  end-organ hyper-responsiveness to androgen

  
  
• d)
  

  defective testicular organogenesis

  
  
• e)
  

  defects in anti-Müllerian hormone.

The following is/are true concerning female pseudo-hermaphroditism:

• a)
  

  patients have 46 XX karyotype

  
  
• b)
  

  patients have normal ovaries

  
  
• c)
  

  the degree of genital ambiguity is highly variable

  
  
• d)
  

  virilization is caused by excessive production of only maternal androgens

  
  
• e)
  

  hyperandrogenaemia occurs due to enzymatic defects in steroid synthesis

The following is/are true of McCune-Albright syndrome:

• a)
  

  it is caused by mutations in the GNAS2 gene

  
  
• b)
  

  it is inherited in a Mendelian fashion

  
  
• c)
  

  early sexual development occurs more commonly in girls than boys

  
  
• d)
  

  bony fractures are another feature of the syndrome

  
  
• e)
  

  café-au-lait spots are a classic feature of the syndrome

Women with MRKH syndrome may present with the following

• a)
  

  Primary amenorrhea

  
  
• b)
  

  46,XX karyotype

  
  
• c)
  

  Male type external genitalia

  
  
• d)
  

  Streak ovaries

  
  
• e)
  

  Uterus is absent or rudimentary

All the following is/are surgical techniques for neo-vagina creation:

• a)
  

  Vecchietti procedure

  
  
• b)
  

  McIndoe’s method

  
  
• c)
  

  Williams’ technique

  
  
• d)
  

  Frank’s technique

  
  
• e)
  

  Creatsas’ vaginoplasty

Complications of Creatsas’ vaginoplasty include

• a)
  

  Hematoma

  
  
• b)
  

  Hematometra

  
  
• c)
  

  Wound opening

  
  
• d)
  

  Pyosalpinx

  
  
• e)
  

  Wound infection.

The following statement(s) regarding surgical correction of uterine anomalies is/are true:

• a)
  

  Rudimentary uterine horns containing endometrial tissue should be removed.

  
  
• b)
  

  Septoplasty in patients with uterine septa may improve implantation.

  
  
• c)
  

  Strassman reunification is the first step to maximize obstetric outcomes in patients with uterine didelphis.

  
  
• d)
  

  When performing septoplasty in the case of a uterine septum, the cervical portion of the septum should always be removed.

  
  
• e)
  

  Surgical correction of an obstructed mullerian anomaly serves as a treatment modality for endometriosis.

The following aetiologies might explain the jeopardized obstetric outcomes associated with mullerian anomalies

• a)
  

  Abnormal uterine vasculature

  
  
• b)
  

  Decreased muscularity of the cervix

  
  
• c)
  

  Malpresentation secondary to abnormal uterine configuration

  
  
• d)
  

  Diminished gestational capacity leading to increased risk of preterm labor

  
  
• e)
  

  Genetic mutations associated with patient’s who have mullerian anomalies

The following statement(s) is/are true regarding rudimentary uterine horns

• a)
  

  Rudimenentary uterine horns should always be removed

  
  
• b)
  

  The endometrial cavity associated with a rudimentary uterine horn may or may not be in communication with the dominant endometrial cavity

  
  
• c)
  

  Obstructed rudimentary horns are often associated with retrograde menses, pain, and endometriosis

  
  
• d)
  

  Ectopic pregnancy can occur in a rudimentary horn which does not communicate with the dominant uterine cavity

  
  
• e)
  

  The gold standard for diagnosis aberrant uterine anatomy is laparoscopy

Which of the following options would you consider for the treatment of osteopenia in a girl who has almost completely recovered normal weight after a severe form of anorexia nervosa?

• a)
  

  moderate physical activity and nutritional monitoring

  
  
• b)
  

  oral contraceptives

  
  
• c)
  

  calcium supplements

  
  
• d)
  

  oral vitamin D supplements

  
  
• e)
  

  bisphosphonates

Which of the following conditions may be associated with a 16 year-old girl with BMI = 30 Kg/m ² and oligomenorrhea?

• a)
  

  a road accident with brain injury

  
  
• b)
  

  the prolonged use of topiramate

  
  
• c)
  

  complete physical inactivity for almost 5 months

  
  
• d)
  

  overweight father and grandfather

  
  
• e)
  

  transient diabetes insipidus

On comparing international information on the evolution of adolescent Fecundity and the Prevalence of use of contraceptives, we see that

• a)
  

  The countries with the higher fecundity rates in adolescents of 15 to 19 years of age, always have a prevalence of contraceptive use of below 40%.

  
  
• b)
  

  The countries with lower fecundity rates in adolescents of 15 to 18 years of age, always have a prevalence of contraceptive use of over 70%.

  
  
• c)
  

  Adolescent pregnancy rates in the past 13 years have fallen more in the less developed regions in the planet.

  
  
• d)
  

  Countries in most of the Regions of the world have higher rates of adolescent fecundity in association with lower rates contraceptive use.

  
  
• e)
  

  Available data establishes that there is no relationship between the prevalence of contraceptive use and Adolescent Fecundity.