Obstetrics and Gynecology
Given a healthy woman with no history of abnormal paps and no history of abnormal mammograms what is the minimum age a female can stop getting pap smears and mammograms?
65 yrs old for paps, 70 for mammograms
A 15 yr old female presents to the local health department concerned about several pruritic fleshy raised lesions on her labia. The patient is diagnosed with genital warts upon examination. She is counseled on the low-risk HPV types and the rare association with cancer. Which of the following subtypes of HPV was she most likely exposed to? A: 6 and 11 B: 11, 12, 73 C: 31, 58 D: 22,78 E: 39,82
A: 6 and 11
A 27 yr old female complains of multiple painful labial ulcerations that appeared about 4 hrs ago. A genital swab was obtained and was found to be herpes simplex viral polymerase chain reaction (HSV PCR) positive. Which of the following would be the best treatment option for this patient? A: Acyclovir 400mg po 3x daily for 7 days B: Ceftriaxone 1g IM one dose C: Ciprofloxacin 250mg po, 2x daily for 5 days D: Ibuprofen 800mg po, 3x daily for 3 days E: Peniciclovir 1% topical every 2hrs for 3 days
A: Acyclovir 400mg po 3x daily for 7 days
A 26 yr old G1P0 at 28 weeks gestation presents to LND complaining of low abdominal pain. Her contractions are regular and occur every 15 minutes. The fetal heart rate is 139bpm and the monostress test is reassuring. Cervical dilation is is 1cm iwth no effacement. patient denies any fluid loss via the vagina. Which of the following medications should be administered next? A: Betamethasone B: Magnesium sulfate C: Nifedipine D: Ritodrine E: Terbutaline
A: Betamethasone
A 58 yr old female presents to the clinic complaining of a pruritic bump she found on her labia. She has not had a pelvic examination in 10 yrs since her vaginal hysterectomy. On exam there is a 1 cm irregularly shaped raised brown lesion on her left labia. What is the best initial intervention for this patient? A: Biopsy of the lesion B: Oral prednisone C: Pelvic MRI D: Topical corticosteroids E: Vaginal estrogen therapy
A: Biopsy of the lesion Dx: Vulvar intraepithelial neoplasia or vulvar cancer.
A 40 yr old G2P2 complains of postcoital bleeding. Her last pap smear was 15 yrs ago. On exam, she had a friable lesion on her cervix and her cytology demonstrates squamous cell carcinoma. At this point, the most appropriate step in this patient's management is which of the following? A: Biopsy visualized lesion and refer patient for gynecologic consult B: Colposcopy with endocervical curettage and directed biopsy C: Loop electrosurgical excision procedure (LEEP) or cervical conization D: Radical hysterctomy and radiation therapy E: Repeat pap in 4-6 months
A: Biopsy visualized lesion and refer patient for gynecologic consult
A 50 yr old postmenopausal woman presents to the clinic complaining of vulvar pruritus for the past year. Upon examination, the patient has whitening patches of her vulvar skin in the shape of a figure eight down to her anus. Which of the following is the best course of treatment for this patient? A: Clobetasol topical to area twice daily for 14 days B: Miconazole topical to area twice daily for 14 days C: Oral conjugated estrogens daily D: Prednisone 5 mg orally, twice daily for 14 days E: Vaginal estrogen therapy daily
A: Clobetasol topical to area twice daily for 14 days Dx: Lichen sclerosis
A 25 yr old G1P1 presents to the clinic for her annual exam. She has no history of abnormal pap smears, but the results from today's test shows low-grade squamous intraepithelial lesions (LSIL). Which of the following is the best option for what should be done next? A: Colposcopy B: HPV testing C: Recheck pap in 1 yr D: Repeat pap in 4-6 months using traditional slide method E: Reapeat pap in 4-6 months using liquid-based cystology
A: Colposcopy
A 27 yr old G3P3 presents to an OP clinic for her wellness examination. Last year her pap was normal. This year, however, her pap results indicate atypical squamous cells of undetermined significance (ACSUS) and the reflex HPV testing results high-risk HPV. What is the most appropriate next step in her evaluation? A: Colposcopy B: Endometrial biopsy C: Loop electrosurgical excision procedure (LEEP) D: Repeat cytology at 6 and 12 months E: Repeat reflex HPV testing
A: Colposcopy
A 52 yr old woman comes in for her annual PE. A thorough medical history shows no Famhx of breast cancer or cervical cancer. Her PE reveals no breast skin changes however a firm 1cm mass can be palpated on the left breast lateral to her areola. Her screening and diagnostic mammogram confirms the mass as suspicious for breast cancer. What is the next best step in the management of this patient/ A: Core needle biopsy B: Fine - needle aspiration biopsy C: Open surgical biopsy D: Lumpectomy E: US
A: Core needle biopsy
22-year-old G3 P1021 woman recently delivered and is now breastfeeding her baby. She comes to the outpatient clinic with fever and chills and reports a reddened and swollen right breast. Her temperature of 38.4oC (101.1oF), and pulse rate of 112/min. All other vital signs are within normal limits. On physical examination, the nipples are cracked and the breasts are engorged. Which of the following is the most appropriate next step in the management of this patient? A: Dicloxacillin B: Hospitalization and IV antibiotic therapy C: Incision and drainage
A: Dicloxacillin Dx: Mastitis
Which of the statements about Neural Tube Defects is true? A: Folic acid use should be started 3 months prior to conception B: You can get neural tube defect from a virus C: Age of the mother is an important factor
A: Folic acid use should be started 3 months prior to conception
A 27 yr old female, 38 week's gestation presents to the clinic complaining of abdominal cramping for the past 2 hrs and spontaneous rupture of membranes. Upon pelvic exam, cervix is dilated to 7cm. After 4 hrs of active labor, the external fetal monitor shows several decelerations and fetal distress is a major concern. What is the best course of action for this patient? A: Immediate cesarean delivery B: Reposition patient to left lateral decubitus C: Start IV oxytocin D: Start an epidural E: Wait until she has dilated to 10cm for vaginal delivery
A: Immediate cesarean delivery
A 25-year-old Caucasian woman at 38 weeks of gestation presents to the office for a routine prenatal visit. Prior prenatal history is unremarkable. Vital signs reveal a blood pressure of 170/110 mmHg. Physical examination shows mild right upper quadrant abdominal pain to palpation. A urine dipstick is obtained and reveals 3+ protein. Laboratory analysis reveals a hemoglobin of 9.0 g/dL, a platelet count of 90,000/mm3, an LDH of 650 u/L, an AST of 80 u/L, and an ALT of 100 u/L. Which of the following is the most appropriate management for this patient? A: Immediate induction of labor with plan for vaginal delivery B: Immediate Caesarean section delivery C: Administration of betamethasone
A: Immediate induction of labor with plan for vaginal delivery
Among the following, what is the most optimal fetal position in labor? A: LOA B: LOP C: ROP D: Breech
A: LOA
A 25 yr old nulliparous woman complains of dysmenorrhea that has become progressively worse over the past 2 years. Her pain is described as a constant aching pain. It begins 2-7 days prior to onset of bleeding and does not subside until the menstrual flow decreases. In addition she complains of pain with intercourse. She has never been pregnant and uses condoms and foam for contraception. Which of the following is the best way to confirm the most likely diagnosis definitively? A: Laparoscopy B: MRI C: Pelvic examination D: Pelvic US E: Trial of prostaglandin synthetase inhibitors
A: Laparoscopy Dx most likely Endometriosis
You are seeing an 18-year-old G1 who smokes one half pack per day of cigarettes. She denies alcohol or drug use. When advising her to quit smoking, you explain that cigarette smoking during pregnancy has been associated with which of the following? A: Low birth weight B: Facial dysmorphia C: Neonatal withdrawl
A: Low birth weight
2900-g (6.4-lb) male newborn is delivered at 39 weeks' gestation. His temperature is 37.1°C (98.8°F), pulse is 100/min, and respirations are 44/min. Physical examination shows poor muscle tone with absent Moro reflex. At five minutes he is oxygenating well, but his tone has only minimally improved. He is taken to the neonatal intensive care unit. 3 hours later, his tone has significantly improved and his Moro reflex is normal. The treatment for which of the following maternal conditions most likely caused his initial symptoms? A: Preeclampsia B: Gestational diabetes C: Heroin dependence D: Infection with group B streptococcus
A: Preeclampsia Preeclampsia is a hypertensive disorder that generally affects women in their third trimester of pregnancy. It is characterized by the presence of hypertension along with a sign of end- organ dysfunction . These signs include proteinuria , thrombocytopenia , and elevated transaminase levels. Preeclampsia is defined as having severe features if the mother develops a blood pressure ≥160 mm Hg systolic or ≥110 mm Hg diastolic , a platelet count <100,000/mm3, serum creatinine >1.1 mg/dL , or liver enzymes ≥2 times the upper limit of normal.
A 30-year-old nulliparous woman comes to the office because of concerns about infertility. She says that she and her husband have been trying to conceive for the past two years. For the last five years, she has regular cycles with normal menstrual flow but has severe pain during her periods which is managed with hot packs and prescription narcotics. She also says she has pain upon defecation during menstruation. Which of the following is the most likely underlying cause of her complaints? A: Presence of endometrial tissue outside the uterus B: Presence of endometrial tissue within the myometrium C: Endometrial hyperplasia D: Proliferation of fibrous tissue within the uterine wall
A: Presence of endometrial tissue outside the uterus Dx: Endometriosis
An 18 yr old female college student presents to the ED stating that she was sexually assaulted 2hrs earlier. Appropriate initial medical professional intervention for the pt should be: A: Provide acute medical care B: Prophylaxis therapy for sexually transmitted infections and pregnancy C: Psychology consult D: referral to counseling services E: reporting to local authorities
A: Provide acute medical care
A healthy 19-year-old G1 is seeing you for her initial prenatal visit. After you complete her history and physical exam, you explain that you will be ordering some routine labs. Which of the following is not part of the routine prenatal screening panel? A: TSH B: Syphillis C: Rubella D: Hep B
A: TSH
At 8 weeks gestation, a 24 yr old primipara was seen a week prior complaining of vaginal bleeding and lower abdominal cramping. Her B-hCG level was 1,000mIU/mL at that time. Today, she has no abdominal pain or evidence of tissue passed per vagina. Trans-vaginal US shows no adnexal masses as well as no intrauterine pregnancy. Her repeat B-hCG level is 1,100 mIU/mL. What can be concluded from this information? A: The patient has a pregnancy that is nonviable but its location is unknown B: She has had a spontaneous abortion and must have a dilation and curettage C: The hCG level needs to be repeated in 48 hrs for more information on viability D: This is definitely an ectopic pregnancy E: This is a molar pregnancy
A: The patient has a pregnancy that is nonviable but its location is unknown
A 25 yr old nullipara female presents for consultation because she suddenly stoped menstruating. On questioning her further it is found that she recently lost 19 lbs after starting long-distance running. The most appropriate step in her evaluation is measurement of: A: hCG concentration B: Serum estradiol - 17b concentration C: Serum Prolactin concentration D: Serum testosterone concentration E: TSH concentration
A: hCG concentration We have to r/o prego
Characteristically, menopausal transition begins with a variable period of menstrual cycle irregularity and extends to 1 year after permanent cessation of menses. The menopause transition typically spans how many years? A: 2 to 4 years B: 4 to 7 years C: 7 to 10 years D: 1 to 2 years
B: 4 to 7 years
A 23 yr old female, G1P0, at 12 weeks' gestation presents for routine prenatal care with a normal medical history. Which of the following should be done at today's visit? A: 3 hr glucose tolerance test after 100g oral glucose load B: CBC, HIV testing, and UA C: Chorionic villus sampling D: Trichomonas vaginalis screening E: XR pelvimetry
B: CBC, HIV testing, and UA
A 47 yr old female presents to the clinic concerned about a growing mass on her left labia that is now causing discomfort while sitting. Patient denies any fever, chills, or vaginal discharge. On PE a 3cm fluctuant mass is palpated at the 7 o'clock position. Her best course of tx would be which of the following? A: Amoxicillin/clavulanate (Augmentin) B: Catheter drainage C: Cephalexin (Keflex) 500mg po, 3x daily for 7 days D: Conservative tx with warm compress E: Surgical removal
B: Catheter drainage
A 28 yr old female has had several recurrent spontaneous abortions secondary to an incompetent cervix. At her most recent office visit, her pregnancy test was positive and a viable pregnancy was seen on US at 8weeks and 3days. Which of the following is the best way to avoid a miscarriage or a premature birth for this patient? A: Bed rest B: Cerclage C: Magnesium sulfate D: Pessary E: Terbutaline
B: Cerclage
A healthy 20 yr old woman is using a low dose triphasic contraceptive pill for birth control. She experiences breakthrough bleeding during the third week of each cycle for the past few months. Her pregnancy test is negative. The PE is normal. There is no infx or thyroid problem. The patient desires to stay on oral contraceptives. What is the best way to manage her therapy? A: Continue current OCP but add extra estrogen during the third week B: Change the pill to one with higher progestin component C: Prescribe a progestin-only pill D: Reassure her and have her return in 1 month E: Switch to a pill with a higher estrogenic component
B: Change the pill to one with higher progestin component
A 21 yr old female presents to the family planning clinic at her local health department for an annual examination. patient is currently sexually active and has had 3 new partners over the past year. She uses oral contraceptives, however rarely uses condoms during her sexual encounters. Other than increased vaginal discharge, patient is asymptomatic. Speculum examination shows a mildly friable, erythematous cervix with no active discharge. Pregnancy test is negative and no cervical motion tenderness or adnexal masses. Two weeks later, her vaginal nucleic acid amplification test (NAAT) comes back positive. What is the most likely pathogen causing the + test? A: Candida albicans B: Chlamydia trachomatis C: Escherichia Coli D: Herpes simplex virus E: Neisseria gonorrhoeae
B: Chlamydia trachomatis
A 25 yr old female at 10 weeks gestation presents to an OP clinic concerned about vaginal bleeding and passing pieces of tissue. Which of the following is the most likely etiology of her spontaneous abortion? A: An incompetent cervix B: Chromosomal anomalies C: Inadequate progesterone D: Maternal drug abuse E: The presence of maternal lupus anticoagulant
B: Chromosomal anomalies
A 30 yr old woman presents with bilateral breast pain and nodularity. The tenderness and size of the nodules increase premenstrually. She has no family history of breast cancer. On PE multiple tender "rope-like" nodules are palpated. There is no dominant mass and the lymph nodes are not palpable. After reassuring the patient regarding cancer probability, which of the following is recommended for initial management? A: 200 mg danazol daily during luteal phase menses B: Decreasing use of caffeine and tobacco C: Fine needle aspiration to determine atypia D: Galactography to determine if lesions are focal E: US for definitive diagnosis
B: Decreasing use of caffeine and tobacco Dx: · Fibrocystic Breast Changes aka Glandular Hyperplasia
A 47 yr old G3P3 woman comes into the office complaining of heavy, painful, and irregular menstrual bleeding that has been going on for the past 6mo-1yr. She has not been sexually active for the past year. On PE her uterus is estimated to be the size of a uterus at 12 weeks gestation. Pelvic US confirms the presence of a leiomyoma. Her hematocrit is 29%, MCV is 68fL, and serum ferritin is 10g/L. What should be the first line therapy? A: Ablation therapy B: Depo-Provera C: Hysterectomy D: Myomectomy of leiomyoma E: Oral contraceptive therapy in standard dose
B: Depo-Provera Pt is signifantly anemic. IDA. we need to control her bleeding and tx her anemia before surgery. Depot can be used 28 days, only curative tx is a myomectomy or hysterectomy
A 19-year-old patient calls in your office requesting emergency contraception because a condom she and her boyfriend were using broke during intercourse last night. You counsel the patient appropriately and provide a suitable method of contraception. Which of the following statements correctly describes emergency contraception? A: Plan B requires a prescription B: Ella is less effective if over 195 pounds C: ParaGard IUD is less effective as oral EC D: Delay taking EC as long a possible
B: Ella is less effective if over 195 pounds
A 27 yr old G1P0 presents to LND with progressively severe and frequent contractions over the past 10 hours. Her contractions are lasting about 50 seconds with 4 minutes in between each contraction. Cervical examination shows dilation to 6cm with 75% effacement. The stage of labor for this patient would be assessed as: A: First stage, latent phase B: First stage, active phase C: First stage, transition phase D: Second stage E: Third stage
B: First stage, active phase
A 32 yr old woman, G2P1, with gestational diabetes is delivering at 39 weeks' gestation. The fetus appears to be about 4,100 g. The woman has experienced 5 hours of stage 1 labor and currently is in her second hour of stage 2 labor. The head is delivering but the shoulders are not. Which of the following descriptions includes the best option for delivering this infant? A: Flexing the mothers thighs, pitocin augmentation, and suprapubic pressure B: Flexing of the mother's thighs, suprapubic pressure and cutting an episiotomy C: Elevation of the mothers legs, suprapubic pressure and oxygen for the mother D: No elevation of the mother's legs, pitocin and fundal pressure E: No elevation of the mother's legs, suprapubic pressure and cutting an episiotomy
B: Flexing of the mother's thighs, suprapubic pressure and cutting an episiotomy - McRoberts Maneuver Dx: Shoulder Dystocia
A 26 yr old patient is complaining of depression and anxiety just prior to her menses. The symptoms have een going on for more than 1 year, but are now starting to interfere with her relationships and her productivity at work. One week prior to menses each month she experiences a depressed mood, feeling of being on edge, increased irritability, difficulty sleeping, a feeling of being overwhelmed and is easily fatigued. She charted her symptoms daily in a log and returned to the office two cycles later. The log is consistent with the history. Her PE and general labs show no abnormalities. Which of the following is the MOST effective treatment choice for the patient? A: Alprazolam (Xanax) B: Fluoxetine (Prozac) C: Ibuprofen D: Progestin-only oral contraceptive E: Spironolactone (Aldactone)
B: Fluoxetine (Prozac) Dx: PMDD
A 25-year-old woman presents to her physician for her annual gynecologic examination. She has no complaints and takes no medications. Her menstrual cycles occur in regular 28-day cycles and lasts for 4 days. She says that her last menses began 12 days ago. She is not currently sexually active. Which of the following is true about her hormone levels at this stage of her menstrual cycle? A: The corpus luteum is secreting estrogen B: Granulosa cells are secreting high levels of estrogen C: Theca cells are secreting high levels of LH D: The corpus luteum is present but no longer producing progesterone E: The level of luteninizing hormone is decreasing back to baseline levels
B: Granulosa cells are secreting high levels of estrogen
A 22 yr old nulliparous woman presents with a chief complaint of heavy, irregular menstrual bleeding over the past year. Patient has a body max index (BMI) of 35 with hirsutism, acne and borderline HTN. Pt denies any vaginal dryness, mood changes, hot flashes, hot or cold intolerance, diarrhea, or heart palpitations. She is currently not sexually active. Which of the following would be the best diagnostic tool for the most likely diagnosis? A: CT scan of abdomen and pelvis B: H&P C: Labs-estradiol, LH and FSH D: Transvaginal US E: Wet mount
B: H&P Dx: PCOS
At 16 weeks gestation, a 19 yr old G1P0 Asian patient presents with a complaint of vaginal bleeding. She also has been experiencing severe nausea and vomiting. Her quantitative B-hCG is much higher than expected and her fundal height is approximately at 18-20 week size. Although she denies a past history of HTN, her BP is 140/90. No fetal heart sounds can be heard on doppler and there is no sign of a fetus on US. What is the most likely diagnosis? A: Fetal demise at 16 weeks B: Hydatidiform mole C: Incomplete abortion D: Threatened abortion E: Twin gestation
B: Hydatidiform mole
Before menopausal transition, women have a much lower risk for cardiovascular events compared with men of their same age. Reasons for protection from cardiovascular disease in premenopausal women are complex. However, a significant contribution can be assigned to an effect of estrogen that results in which of the following? A: Decreased high-density lipoprotein levels B: Increased high-density lipoprotein levels C: Increased total cholesterol and low-density lipoprotein levels D: Increased low-density lipoprotein levels
B: Increased high-density lipoprotein levels
A 34 yr old african amerian female presents to the office concerned about worsening lower abdominal bloating, pelvic pressure, mild deep dyspareunia, and heavy menstrual bleeding. On pelvic examination, a 20 week size uterus is palpated and transvaginal US confirms a large leiomyoma. The patient and her husband have been trying to conceive over the past year and have been unsuccessful. What tx option would be the best course for this patient? A: Endometrial ablation B: Laparoscopic-assisted myomectomy C: Leuprolide acetate (Lupron Depot) D: Oral contraceptive E: Total abdominal hysterectomy
B: Laparoscopic-assisted myomectomy
A 32 yr old woman, G2P1 at 35 weeks gestation presents with a complaint of intermittent bleeding over the past week. However, she has had no evident pain or cramping. Upon PE, fetal HR is noted to be normal. These clinical characteristics are most consistent with which of the following? A: Placental abruption B: Placenta previa C: Premature labor with blood mucous discharge D: Premature rupture of membranes E: Vasa previa
B: Placenta previa
A 90-year-old G5P5 with multiple medical problems is brought into your office accompanied by her granddaughter. Her medical history is significant for hypertension, chronic anemia, coronary artery disease, and osteoporosis. She is alert and oriented, and lives in an assisted living facility. She takes numerous medications, but is very functional at the current time. She is a widow and is not sexually active. Her chief complaint is a sensation of heaviness and pressure in the vagina. It is uncomfortable when she sits. She reports no significant urinary or bowel problems. On physical examination, you note that the cervix to the level just inside the introitus. Based on the physical examination, which of the following is the most likely diagnosis? A: First-degree uterine prolapse B: Second-degree uterine prolapse C: Third-degree uterine prolapse
B: Second-degree uterine prolapse The degree or severity of pelvic relaxation is rated on a scale of 1 to 3, based on the descent of the organ or structure involved. First-degree prolapse involves descent limited to the upper two-thirds of the vagina. Second-degree prolapse is present when the structure is at the vaginal introitus. In cases of third-degree prolapse, the structure is outside the vagina. Total procidentia of the uterus is the same as a third-degree prolapse, which means that the uterus would be located outside the body. Uterine prolapse that does not bother the patient or cause her any great discomfort does not require treatment. This especially applies to patients who are elderly or poor surgical candidates. Placement of a pessary provides mechanical support to pelvic tissue, while hysterectomy and the Le Fort procedure are surgical treatments for prolapse. An anterior colporrhaphy is a surgical method to reduce a cystocele. Pessaries provide mechanical support for the pelvic organs. These devices come in a variety of sizes and shapes and are placed in the vagina to provide support. Pessaries are ideal for patients who are not good surgical candidates. Potential complications from pessaries include vaginal trauma, necrosis, discharge from inflammation, and urinary stress incontinence.
A 36 yr old woman at 22 weeks' gestation presents for her regular check-up. Her hemoglobin level is 10.8g/dL. Which of the following statements regarding this patient's hemoglobin level is TRUE? A: This patient has iron deficiency anemia B: This patient has physiologic anemia of pregnancy, no further work up necessary. This patient should receive ferrous sulfate 300mg 1-2x per day D: repeate hemoglobin in 2 months when more accurate reading can be obtained E: A complete evaluation of the anemia, including serum ferritin needs to be done
B: This patient has physiologic anemia of pregnancy, no further work up necessary.
A 22 year old nulliparous woman makes an appointment at the gynecology clinic to obtain birth control. She is sexually active with one male partner and does not desire children at this time. She first became sexually active at age 19 and has had three other male sexual partners in her life. She says that her partners have used condoms "most of the time". She tells you her older sister has an intrauterine device (IUD) for birth control and that she is interested in getting an intrauterine device too. The patient has no medical problems and has regular menstrual periods. She hasn't had any unusual vaginal discharge or odor. She has never been tested for any sexually transmitted infections. She's very busy and requests to have her intrauterine device placed today. Can you insert an intrauterine device for this patient today? A: No, all women should be tested for sexually transmitted infections and be treated for any infections prior to intrauterine device insertion. B: Yes, an intrauterine device can be placed concurrently with sexually transmitted infection testing if the patient is asymptomatic. C: No, all women at high risk for sexually transmitted infections should be tested for them and be treated for any infections prior to intrauterine device insertion. D: No, the intrauterine device cannot be used in nulliparous women.
B: Yes, an intrauterine device can be placed concurrently with sexually transmitted infection testing if the patient is asymptomatic.
At an OP clinic, a 24 yr old female 16 weeks gestation presents complaining of copious amounts of white vaginal discharge for the past 3 days. She is also complaining of vulvar irritation, dysuria, and pruritis. Wet mount reveals hyphae and budding yeast. Her best course of treatment would be: A: Ciprofloxacin 250mg orally, twice daily for 7 days B: Clindamycin 300mg orally, twice daily for 7 days C: Clotrimazole 100mg vaginal suppository D: Fluconazole 150mg orally, one dose only E: Metronidazole 500mg, 2x daily for 7 days
C: Clotrimazole 100mg vaginal suppository
A 20 yr old nulligravida presents with pelvic pain and irregular menstrual bleeding. She denies sexual activity, and her B-hCG urine test is negative. She has never been on oral contraceptives. On pelvic exam, unilateral tenderness on the left side and a palpable cystic mass approximately 4-5cm in seize are present. The most likely diagnosis is: A: Choriocarcinoma B: Ectopic pregnancy C: Functional ovarian cyst D: Molar pregnancy E: Sarcoma
C: Functional ovarian cyst
Which of the following is a normal physiologic change that occurs during pregnancy? A: Decreased glomerular filtration rate B: Increased blood pressure C: Hypercoagulable state D: Decreased cardiac output E: Increased total lung capacity
C: Hypercoagulable state
A 30 yr old G2P1 woman whose last menses was 8 weeks ago presents with heavy vaginal bleeding and left lower quadrant (LLQ) pain. She noted passage of something "that that looked like liver" the previous day. Pelvic examination reveals a 2cm cervical dilation. Which of the following is the most likely diagnosis? A: Complete abortion B: Incompetent cervix C: Incomplete abortion D: MIssed abortion E: Threatened abortion
C: Incomplete abortion
A 32 yr old nulliparous woman is seeking contraceptive advice. She is in a monogamous relationship and is a nonsmoker and has a history of one ectopic pregnancy 5 yrs ago. She wishes to consider childbearing in the future. Her hx includes mild, well-controlled HTN, and frequent UTIs. Which of the following contraceptive options would be contraindicated? A: Condoms and spermicide B: Diaphragm C: Intrauterine device D: Low-dose combined oral contraceptive E: Progesterone-only oral contraceptive
C: Intrauterine device
A 36 yr old female presents to the family planning clinic about birth control options. She is a .5 pack - day smoker and the only med she is taking is lisinopril for her HTN. Which of the following contraceptives is most appropriate for this patient. A: Combined oral contraceptive pill B: Depot medroxyprogesterone acetate C: Intrauterine device D: Transdermal contraceptive patch E: Vaginal ring (NuvaRing)
C: Intrauterine device It is an absolute CI to give OCP to a women who is >35 and a smoker - the risk of stroke, PE, and HTN outweigh the benefits. NuvaRing and Patch can increase risk of vascular events. Depot acetate should be used w/ caution bc of the pts hx of HTN and tobacco use. The patient should have an IUD either levonorgesterel or copper.
An 18-year-old female presents with abdominal pain determined to be related to ovulation. In reviewing the hormones of the menstrual cycle, you correctly remember that which of the following is responsible for ovulation? A: Follicle stimulating hormone (FSH) B: Estrogen C: Luteinizing hormone (LH) D: Progesterone
C: Luteinizing hormone (LH)
A 44 yr old G2P2 who had 2 normal pregnancies (13 and 11 yrs ago) presents with complaint of amenorrhea for 8 months She has remarried and would like to become pregnant again. A pregnancy test is negative. Her PE is normal . Which of the following tests is next indicated in the evaluation of this patient's amenorrhea? A: Endometrial biopsy B: Hysterosalpingogram C: Luteinizing hormone, follicle stimulating hormone and estradiol levels D: Ovarian antibody assay E: Testosterone and dehydroepiandosterone level
C: Luteinizing hormone, follicle stimulating hormone and estradiol levels She could have already gone into menopause
A 27 yr old G1P0 woman has received regular prenatal care throughout her pregnancy. She presents to the ED at 34 weeks with facial edema, severe HA, and epigastric pain. On PE she has a BP of 160/110 elevated LFTs and a platelet count of 60,000. The baby is noted to be alve. UA indicates 4+ proteinuria. Which therapy should be next in managing the patient? A: Colloid solution for plasma volume expansion B: IV immunoglobulin therapy C: Magnesium sulfate therapy and induction of labor D: Oral antihypertensive therapy E: Platelet transfusion
C: Magnesium sulfate therapy and induction of labor
A 35 yr old female presents to an OP clinic for evaluation of amenorrhea. All of her lab work came back normal except for a positive pregnancy test. Her last menstrual cycle was August 4th, 2019. Her estimated date of delivery will be: A: April 26, 2020 B: May 3, 2020 C: May 11, 2020 D: May 17, 2020 E: June 3, 2020
C: May 11, 2020 Aug. 4 + 7 days = Aug 11... - 3 months = May 11
A 26 yr old woman has undergone a suction curettage for a hydatidiform mole and was diagnosed with benign gestational trophoblastic neoplasia (GTN). Following this initial treatment, which choice of monitoring should be done for patients in order to prevent the development of choriocarcinoma? A: Administer prophylactic chemotherapy B: Follow-up every 2 weeks with a urine prego test C: Monitor serum hCG once per week until 3-4 normal values are obtained and then monthly for a year D: Monitor serum hCG levels after 6 months and again at 1 yr E: Monitor serum hCG levels monthly accompanied by chest XR to r/o metastases
C: Monitor serum hCG once per week until 3-4 normal values are obtained and then monthly for a year
A 24 yr old Hispanic woman, G3P2 presents for routine prenatal care at 20 weeks' gestation. her urine is positive for glycosuria (2+). This finding would likely indicate: A: Gestational diabetes B: need to follow-up with a 3 hr glucose tolerance test C: Need for a 50g, 1 hr glucose challenge test D: Need for instituting dietary control. E: Normal increase in renal threshold for glucose
C: Need for a 50g, 1 hr glucose challenge test
A 17 yr old complains of severe dysmenorrhea since her first menses at age 13. The dysmenorrhea is often accompanied by nausea and vomiting the first 2 days of her menstrual period; analgesics or heating pads do not relieve the pain. She is sexually active and does not want to get pregnant. Her pelvic exam is normal. Which of the following medications is most appropriate for this patient? A: Luteal progesterone B: Narcotic analgesics C: Oral contraceptives D: Oxytocin E: Prostaglandin synthetase inhibitor
C: Oral contraceptives
A 44 yr old female presents for cancer testing after her mother was recently diagnosed with breast cancer 6 months ago. Her laboratory work confirms a positive result for BRCA-1 gene mutation. Which of the following types of cancer is she most increased risk for developing? A: Cervical cancer B: Endometrial cancer C: Ovarian cancer D: Vaginal cancer E: Vulvar cancer
C: Ovarian cancer
A 62 yr old female presents to clinic complaining about a bulge from her vagina. She states that the area has grown in seize over the past 6 months and has had worsening pelvic pressure after a vaginal hysterectomy over 1 yr ago. Patient does complain of vaginal dryness and the feeling that she does not empty her bladder to completion with each void. On PE there is a bulge from the upper one third of the vagina and 1cm protrusion from the vaginal introitus with valsalva as well as weak pelvic floor muscles and vaginal atrophy. What is the best course of treatment? A: Oral anticholinergics B: Oral estrogen therapy C: Pessary insertion D: Surgical intervention E: Vaginal estrogen therapy
C: Pessary insertion Dx: Cystocele
A 20-year-old woman comes to the office because of symptoms related to her menstrual periods. History reveals she experiences severe abdominal bloating and irritability several days before her period that affects her daily function. Her menses are regular and symptoms usually resolve within days of the start of her menses. She is not currently sexually active. She is not currently on any medications. Vitals reveal a blood pressure of 120/80 mmHg, a heart rate of 70/min, a temperature of 37.0°C (98.6°F), a respiratory rate of 13/min, and her BMI is 22. Physical examination is unremarkable. Pelvic examination is unremarkable. Laboratory results -- including a complete metabolic profile, complete blood count, and TSH -- are all within normal limits. A urine beta-hCG is negative. Which of the following is the most likely diagnosis in this patient? A: Abnormal uterine bleeding B: Anxiety disorder C: Premenstrual syndrome D: Depressive disorder E: Premenstrual dysphoric disorder
C: Premenstrual syndrome
An 18-year-old female presents to the office with the complaint of a missed period. History reveals her last menstrual period was six weeks ago. She is sexually active with one partner and takes no medications. A urine pregnancy test is obtained in the office and is positive. Laboratory studies reveal a quantitative hCG of 500 mIU/mL. Pelvic examination reveals a closed non-tender cervix and no adnexal masses. A transvaginal ultrasound is obtained and reveals no intrauterine pregnancy and no ectopic pregnancy. Which of the following is the next best step in management? A: Prescribe methotrexate B: Obtain a transabdominal ultrasound C: Repeat hCG in 48 hours D: Perform a laparoscopy
C: Repeat hCG in 48 hours... the quant should double in 48 hrs.
55-year-old female presents to the office with the complaint of hot flashes. History reveals she has been having hot flashes that awake her several times a night and interfere with her ability to perform duties at work. Gynecologic history reveals menopause at age 51. Past medical history is significant for breast cancer that was treated with a mastectomy 6 years ago. What is the most appropriate treatment in this patient? A: Estrogen B: Combination selective estrogen receptor modulator and conjugated estrogen C: Selective serotonin reuptake inhibitor (SSRI) D: Phytoestrogens
C: Selective serotonin reuptake inhibitor (SSRI)
A 44 yr old female presents to an OP clinic with her 14 yr old daughter and is interested in the HPV vaccine. Which of the following should be discussed with the patient and her daughter? A: The vaccine only protects against external genital warts B: The vaccine only protects against cervical cancer C: The vaccine must be given in three separate doses: 0, 2, and 6 months D: The vaccine cannot be given until age 18 E: Once the vaccine is given, papanicolaou testing is not necessary
C: The vaccine must be given in three separate doses: 0, 2, and 6 months
The North American Menopause Society term genitourinary syndrome of menopause (GSM) encompasses which of the following signs and symptoms? A: Dyspareunia B: Vulvar dryness C: Urinary urgency and dysuria D: All of the above
D: All of the above
A 17-year-old girl is brought to the clinic by her mother complaining of irregular and heavy periods. She had her first menstrual period at the age of 13 years and has had irregular periods since then. She sometimes has 3 months between menstruations. Her last menstrual period was 6 weeks prior to evaluation during which she required 7-8 pads per day for 7 days. She denies any pain. She is sexually active with her boyfriend and uses condoms for contraception. Her history is otherwise unremarkable and her vaccinations are up to date. She has Tanner stage 3 breasts, axillary hair, and pubic hair. Speculum and pelvic exams are unremarkable. Her hemoglobin level is 12.3 g/dL. A pregnancy test is negative and coagulation studies are within normal limits. Which of the following is the most appropriate next step in the management of this patient? A: Packed red blood cell transfusion B: Provide NSAIDS C: Initiate warfarin treatment D: Combined oral contraceptive pills E: Iron supplementation
D: Combined oral contraceptive pills
A 23 yr old female presents to the OP clinic with irregular menses and abnormal menstrual bleeding. Based on the most likely diagnosis of dysfunctional uterine bleeding in this patient's age group, which of the following symptoms would likely be elicited during the history? A: Deep thrust dyspareunia, pelvic pain and HA B: Dysmenorrhea, HA, insomnia, and pelvic pain C: Dysuria, introital dyspareunia, insomnia and pelvic pain D: Dysmenorrhea, deep thrust dyspareunia and pelvic pain E: Dysmenorrhea, introital dyspareunia, constipation and dysuria
D: Dysmenorrhea, deep thrust dyspareunia and pelvic pain
A 30-year-old woman, G0P0 comes to the office because of difficulty becoming pregnant. She states that has been having regular, unprotected intercourse with her partner for two years without any pregnancies. Her periods are regular, occurring every 28 days, and are associated with heavy bleeding and severe cramping. She also reports intermittent pelvic pain over the last 5 years, and pain with intercourse. Pelvic examination shows adnexal tenderness. Which of the following is the most likely diagnosis? A: Asherman syndrome B: Polycystic ovarian syndrome C: Premature ovarian failure D: Endometriosis
D: Endometriosis
A 14 yr old female presents to the ED complaining of fullness in her lower abdomen, lower back pain, urinary urgency and constipation. patient is not sexually active and denies menarche. UA and CBC are within normal limits. On PE she has suprapubic discomfort to palpation and pelvic examination shows a thin, bulging, dark bluish membrane covering her vaginal introitus. What would be the best initial intervention for this patient? A: BIopsy B: I&D C: General surgery consult D: Gynecology consult E: Papanicolaou test
D: Gynecology consult
A 29-year-old Caucasian woman at 35 weeks of gestation comes to the emergency department with right upper quadrant pain, nausea, and vomiting. Her pregnancy course to this point has been uncomplicated. However, she has a history of preeclampsia from her last pregnancy. Her blood pressure is 150/110 mmHg and urinalysis reveals 2+ protein. The following laboratory values are obtained: Hct: 30.5g/dL WBC: 6,000 cells/mm3 Platelets: 80,000 cells/mm3 LDH: 650 U/L AST: 100 U/L Which of the following is the most likely diagnosis? A: Pre-existing hypertension B: Preeclampsia C: Eclampsia D: HELLP Syndrome
D: HELLP Syndrome
A 27-year-old woman comes to the clinic because of concerns about her inability to conceive. She and her husband have been trying to conceive, without success, for two years. She says that her menstruations are often light, and occasionally absent. She has no past surgical history. She is an avid runner and her BMI is 16.5 kg/m2. Laboratory results show a decrease in luteinizing hormone and follicle-stimulating hormone. Which of the following is the most likely cause of this condition? A: Polycystic ovarian syndrome B: Menopause C: Asherman syndrome D: Hypothalamic dysfunction E: Sheehan syndrome
D: Hypothalamic dysfunction
A 26 yr old mother who is nursing presents to the clinic complaining of right breast tenderness and fever. Upon PE she has a 2cm fluctuant mass at the site of erythema and tenderness. The patient had been seen 4 days ago and was placed on oxacillin, which she has been taking. At this point, the best treatment is: A: Changing abx to vancomycin and discontinue nursing B: Discontinuation of nursing and hot soaks C: Hot packs and manual emptying of breasts D: Incision and drainage, hot soaks, abx, and breast emptying E: Surgical drainage and continuation of nursing
D: Incision and drainage, hot soaks, abx, and breast emptying
When counseling a 53 yr old post menopausal femal regarding the risks and benefits of a short course (<5 yr) of hormone replacement therapy, which of the following is a documented risk that should be discussed? A: Increased risk of endometrial cancer B: Increased risk of breast cancer C: Decreased bone mineral density D: Increased risk of thromboembolism E: Increased risk of colon cancer
D: Increased risk of thromboembolism
A 32-year-old woman comes to the clinic for a routine pap smear. During the course of the visit, she describes severe dysmenorrhea which forces her to remain in bed for days at a time. She also reports dyspareunia, and chronic pelvic pain that has bothered her for years. She has no history of sexually transmitted infection. Which of the following is the best diagnostic test for the most likely underlying condition? A: Cervical biopsy B: Hysterosalpingogram C: Pelvic ultrasound D: Laparoscopy E: CT scan of the pelvis
D: Laparoscopy Dx: Endometriosis
Which of the following is the most significant risk factor for the development of abruption placentae? A: Abdominal trauma B: Advanced maternal age C: Gestational DM D: Maternal HTN E: Previous miscarriage
D: Maternal HTN
A 20 yr old sexually active woman complains of a profuse, whitish gray vaginal discharge with a fishy odor that becomes stronger after intercourse and during menses. She denies any irritation and states that her sexual partner has no symptoms. Microscopic eval of the discharge reveals granular-appearing epithelial cells. Which of the following is the best therapy? A: Ciprofloxacin B; Doxycycline C: Fluconazole (Diflucan) D: Metronidazole (Flagyl) E: Miconazole Cream (Monistat)
D: Metronidazole (Flagyl) Dx: Bacterial vaginosis
A 20 yr old female college student presents complaining of recent onset vaginal pruritus, discharge, and odor. On PE a thin yellow discharge is observed with 'strawberry spots' on the cervix. The wet prep reveals a pH of 6.0 positive whiff test, and mobile protozoan. What is the best treatment for this patient? A: Acyclovir 400mg by mouth 3x daily for 7 days B: Fluconazole 150mg po one dose C: Metronidazole 500mg po 2x daily for 7 days D: Metronidazole 2g po one dose E: Miconazole 2% cream, 5g intravaginally for 7 days
D: Metronidazole 2g po one dose Dx: Trichomoniasis The Metronidazole 500mg po 2x daily for 7 days is the treatment regimen for Bacterial vaginosis
During a routine well woman examination on a 34 yr old female patient, cervical cysts are noted while performing a papincolaou test. The most likely treatment is: A: LEEP B: Metronidazole (Flagyl) 500mg po 2x daily for 14 days C: Miconazole vaginal suppository 2x daily for 3 days D: No tx is needed E: Trichloroacetic acid topical weekly until gone
D: No tx is needed
A 46 yr old perimenopausal woman presents to an OP clinic complaining of hot flashes affecting her QOL. Her menstrual cycles have been irregular for the past year and is currently on no medications. She has tried lifestyle modification however nothing has improved her symptoms and is interested in hormonal replacement therapy. What would be her best treatment option? A: Alpha agonist B: Oral estrogen only C: Oral Progesterone only D: Oral combination estrogen/progesterone E: SSRI
D: Oral combination estrogen/progesterone
Which of the following elements of a patient's history is the greatest risk factor for endometrial cancer? A: Age >70 B: Combination progestin and estrogen hormone therapy C: Obesity D: Postmenopausal bleeding E: Tobacco use
D: Postmenopausal bleeding
A 15-year-old girl is brought to the clinic by her mother complaining of irregular and heavy periods. She had her first menstrual period at the age of 13 years and has had irregular periods since then. She sometimes has 3 months between menstruations. Her last menstrual period was 6 weeks prior to evaluation during which she required 7-8 pads per day for 7 days. She denies any pain. She is sexually active with her boyfriend and uses condoms for contraception. Her history is otherwise unremarkable and her vaccinations are up to date. Physical exam reveals an afebrile teenage girl with normal vital signs. She has Tanner stage 3 breasts, axillary hair, and pubic hair. Speculum and pelvic exams are unremarkable. Her hemoglobin level is 9.6 g/dL. Which of the following is the most appropriate next step in management of this patient? A: Serum TSH B: Iron studies C: Reassurance D: Pregnancy test E: Ultrasound
D: Pregnancy test
A 30 yr old woman who is nursing presents to the clinic complaining of breast tenderness. PE reveals a warm, erythematous, tender area with induration of the right breast. The next step in management is: A: Culture breast drainage to determine causative organism B: Discontinue nursing, empty breasts, and apply hot soaks to affected breast C: Observe for fever and rest while continuing breast feeding without medication D: Prescribe dicloxacillin (Dynapen) E: Prescribe topical mupirocin and continue breastfeeding
D: Prescribe dicloxacillin (Dynapen)
A 36 yr old female presents to an OP clinic complaining of burning pain on her left labia radiating to her inner thigh. Patient states that the pain is worsened with tight fitting clothes and prolonged sitting. She states that her primary care provider could not find anything abnormal on PE and her UA was negative. Labs performed today are negative for candida, sexually transmitted infx, and vaginal atrophy. She does tell you that 6 months ago she had a motorcycle accident and bruised her pelvis. What is the next best step to confirm the most likely diagnosis? A: CT scan B: CT scan of pelvis C: MRI of pelvis D: Q-tip test E: Wet mount
D: Q-tip test
A previously desensitized Rh-negative woman in her second pregnancy is seen in her 26th week. She complains of edema in her legs and some tingling in her left hand. What is the next step in managing this patient? A: Amniocentesis B: Analysis of the husband's blood type C: Intramuscular Rho (Anti-D) immune globulin D: Rh antibody titer E: Ultrasonic evaluation of amniotic fluid volume
D: Rh antibody titer
A man and woman in their 20s have been trying unsuccessfully to conceive for the last year. The woman has regular menses and a 28 day cycle. In the initial evaluation, which of the following tests or evaluations should be considered first line? A: Endometrial biopsy B: Hysterosalpingogram C: Postcoital testing D: Semen analysis E: Transvaginal US
D: Semen analysis
A 37 yr old female in her third week postpartum presents complaining of recent onset of breast pain with firmness to her right upper outer quadrant. She is lactating and breastfeeding. Upon examination, her breast is firm, warm, edematous, and erythematous. Which of the following is the most common pathogen causing this patient's diagnosis? A: Enterococcus faecalis B: Escherichia coli C: Group B Streptococcus D: Staphylococcus Aureus E: Streptococcus pyogenes
D: Staphylococcus Aureus Dx: Mastitis
At 33 weeks gestation, a 28 yr old patient G1P0 calls the office with a complaint of a fluid gush from her vagina. She is not having contractions or evidence of bleeding. She is advised to go to LND to be examined. Which of the following procedures should be performed first? A: Administration of abx to prevent infx B: Digital cervical exam to determine whether patient is in labor C: Induction of labor D: Sterile speculum examination or nitrazine testing E: US to estimate amniotic fluid volume
D: Sterile speculum examination or nitrazine testing
A 58 yr old woman who is 8 yrs postmenopausal complains of urinary urgency, frequency and occasional incontinence. On pelvic exam her vaginal mucosa appears shiny, pale pink with white patches and bleeds slightly to touch. Her urinalysis and urine cultures are negative. Which of the following is the best treatment for this patient? A: Oral abx B: Surgical procedure C: Topical testosterone cream to affected areas D: Topical vaginal estrogens E: Vaginal suppositories containing sulfa antibiotics
D: Topical vaginal estrogens
A 28 yr old primigravida woman at 42 weeks gestation delivers a 4,000g newborn. Labor stages are as follows: first stage 17 hrs, second stage 4 hrs, third stage 35 minutes. After an episiotomy was performed, the baby was delivered with low forceps. The placenta appeared to be intact. Ten minutes after delivery, she experiences vaginal bleeding estimated to be 500mL over a 5 minute period. Upon examination, her uterus feels soft and boggy. Which of the following is the most likely cause of the hemorrhage? A: Disseminated intravascular coagulation B: Genital tract laceration C: Retained placental tissue D: Uterine atony E: Uterine inversion
D: Uterine atony
A 15 year old nulliparous woman makes an appointment at the gynecology clinic to obtain birth control. She has recently become sexually active with one male partner and does not desire children at this time. She does want to have children when she gets older. She tells you her older sister has an intrauterine device (IUD) for birth control and that she is interested in getting an intrauterine device too. The patient has no medical problems and has regular menstrual periods. Is an intrauterine device an appropriate choice of birth control for this patient? A: No, the intrauterine device cannot be used in nulliparous women. B: No, the intrauterine device should not be used in women who desire future fertility C: No, the intrauterine device cannot be used in women under the age of 25. D: Yes, an intrauterine device is an appropriate choice of birth control for this patient.
D: Yes, an intrauterine device is an appropriate choice of birth control for this patient.
A 50-year-old woman comes to the office because of complaints of hot flashes, mood changes, and a decreased libido. A recent DEXA scan indicates a T-score of 2.7 standard deviations below the mean. Which of the following is associated with the most likely diagnosis in this patient? A: Decreased estrogen , increased FSH, decreased LH and decreased GnRH B: Increased estrogen , increased FSH, increased LH and increased GnRH C: Decreased estrogen , increased FSH, increased LH and decreased GnRH D: Decreased estrogen , decreased FSH, decreased LH and decreased GnRH E: Decreased estrogen , increased FSH, increased LH and increased GnRH
E: Decreased estrogen , increased FSH, increased LH and increased GnRH
Which of the following risk factors places a woman at the highest risk of developing an ectopic pregnancy? A: Advanced maternal age B: Amenorrhea C: History of spontaneous abortion D: History of oral contraceptive use E: History of pelvic inflammatory disease
E: History of pelvic inflammatory disease
A 22-year-old woman presents to your office for her well-woman examination and contraception. She has no medical problems or prior surgeries. She does not smoke or drink. Her vital signs and physical examination are normal. You explain the risks and benefits of combination oral contraceptive pills to the patient. She wants to know how they will keep her from getting pregnant. Which of the following mechanisms best explains the contraceptive effect of birth control pills that contain both synthetic estrogen and progestin? A: Impairment of sperm transport caused by uterotubal obstruction B: Production of uterine secretions that are toxic to developing embryos C: Direct inhibition of oocyte maturation D: Impairment of implantation hyperplastic changes of the endometrium E: Inhibition of ovulation
E: Inhibition of ovulation The marked effectiveness of the COC pill, which contains a synthetic estrogen and a progestin, is related to its multiple antifertility actions. The primary effect is to suppress gonadotropins at the time of the midcycle LH surge, thus inhibiting ovulation. The prolonged progestational effect also causes thickening of the cervical mucus and atrophic (not hyperplastic) changes of the endometrium, thus impairing sperm penetrability and ovum implantation, respectively.
A 28 yr old primigravida presents for routine prenatal care at 32 weeks gestation. Her pregnancy has been uneventful and she has been receiving regular prenatal care. At her visit today, the fundal height measurement is 36cm. Of the possibility below which of the following is the least likely cause for the increased fundal height? A: Fetal macrosomia B: Fetal position C: Fibroid uterus D: Multiple gestation E: Oligohydraminos
E: Oligohydraminos
A 36 yr old G2P2 complains of heavy menstrual bleeding for the past year. The patient is bleeding through a super tampon and a heavy pad every hour of the first 3 days of her cycle. Her cycle lasts 5 days and the cycle length has decreased to having a period every 20 days. She complains of fatigue. Her PE and laboratory work-up are normal (Negative hCG, LH, FSH, Prolactin, clotting times, liver function, and renal function tests), except for the CBC and further labs indicating she has iron deficiency anemia. The patient's weight is 298lb. In addition to iron supplementation, which of the following is the best initial therapy for the patient? A: Daily dosing of aspirin B: Dilation and Curettage of the endometrium C: Hysterectomy D: Long term conjugated estrogen therapy E: Oral contraceptives
E: Oral contraceptives
A 32 yr old G2P0 presents to an OP clinic at 34 weeks gestation. Her prenatal care has been routine for twin gestations without any complications. Today, she is complaining of low pelvic 'cramping'. While at the office she has had four 'cramping' episodes in the last 20 minutes and upon pelvic examination is at least 2cm dilated. What is of greatest concern for this patient at this time? A: Incompetent cervix B: Intrauterine fetal demise C: Gestational DM D: Preeclampsia E: Preterm labor
E: Preterm labor
A 35 yr old primipara at 39 weeks' gestation is in LND suite for a non-stress test. She has had an uneventful pregnancy but has not felt the fetus moving much in the past 24 hrs. A subsequent external fetal monitoring tracing demonstrates a repetitive late heart rate deceleration. The first step in managing this patient is? A: Administration of a tocolytic agent B: Checking maternal oxygen sat C: Evaluation of maternal hypotension D: Evaluation of fetal acid-base status E: Repositioning of the patient
E: Repositioning of the patient
At her annual examination, a 36 yr old woman is concerned about worsening abdominal bloating, urinary urgency and anorexia over the past 6 months. Upon pelvic examination, a very firm right ovarian mass is palpated. Which of the following interventions should be considered first with this patient? A: Chemotherapy B: Exploratory laparoscopy C: Oral contraceptives D: Radiation therapy E: Surgical oncologist consult
E: Surgical oncologist consult Dx: Ovarian cancer
A 39 yr old woman, G3P3, complains of severe progressive secondary dysmenorrhea and menorrhagia. Pelvic exam demonstrates a tender diffusely enlarged uterus with no adenexal tenderness. Endometrial biopsy findings are normal. Which diagnostic exam is needed next? A: CT scan on pelvis B; Hysterosalpingography C: Laparoscopy D: MRI E: Transvaginal and abd US
E: Transvaginal and abd US We are looking for the cause of her dysmenorrhea - she probs has Endometriosis or Adenomyosis
A 45 yr old female, G4P4, presents concerned about increased pelvic pressure and a large bulge protruding from her vaginal introitus. Exam reveals a large uterine prolapse. Surgical repair of her prolapse will most likely involve repairing which of the following structures? A: Detrusor muscle B: Levator ani muscle C: Obturator internus muscle D: Sacral nerve E: Transverse and uterosacral ligaments
E: Transverse and uterosacral ligaments
A 26 yr old female at 24 weeks' gestation presents concerned about lack of fetal movement. An US and stress test is ordered. Which of the following non-stress test results is most reassuring? A: No change in the fetal HR with fetal movements over a 30 minute period B: Two decelerations with fetal movements over a 40 minute period C: One acceleration with fetal movements over a 1 hr period D: Five decelerations with fetal movements over a 20 minute period E: Two accelerations with fetal movements over a 20 minute period
E: Two accelerations with fetal movements over a 20 minute period
A 28 yr old patient presents for annual well woman physical. She is concerned about 1cm right breast mass she found on self breast examination last month. During the clinical breast examination the mass is easily mobile, firm, painless upon palpation and rubbery in consistency. What diagnostic study should be considered first in this patient? A: Fine needle aspiration biopsy B: MRI C: Mammogram D: Open breast biopsy E: US
E: US
A 17 yr old female patient presents to an OP clinic and is requesting emergency contraception after having unprotected intercourse 4 days ago. Should this patient receive emergency contraception based on her time frame for the greatest effectiveness in preventing a pregnancy? A: NO, time frame should be: 0-24 hrs B: NO, time frame should be: 24-48 C: NO, time frame should be: 48-72 D: NO, time frame should be: 72 - 96 E: Yes, time frame should be < 120 hrs
E: Yes, time frame should be < 120 hrs Prescribe her Ella
A 37 yr old G2P2 woman presents to your office complaining of low libido for the past year. She is currently in a monogamous relationship with her husband and denies any vaginal dryness, dyspareunia, or anorgasmia. Current medications include metoprolol, sertraline, omeprazole, cetirizine, and a multivitamin. Which of the following meds is most likely contributing to the patient's symptoms?
Sertraline (ZoLOft) - LOw libido
