ROSH WH QBANK

35-year-old woman with a 15 pack-year history presents with postcoital bleeding and dyspareunia. On exam, you note a white, sharply demarcated lesion of the cervix after acetic acid is applied. You suspect cervical intraepithelial neoplasia. Which of the following types of human papillomavirus is the most likely type to be present in this patient? 11 16 18 6

16

24-year-old G1P0 woman presents to the clinic for her first prenatal exam. Based on her last menstrual period, she is 6 weeks pregnant. The patient asks when she will start feeling her baby move. At which of the following gestational ages is this patient most likely to start feeling fetal movements? 15 weeks 19 weeks 21 weeks 23 weeks

19 weeks fetal quickening: primiparous 18-20 weeks, multiparous as early as 14 weeks

22-year-old woman presents to the obstetric clinic for her first prenatal visit at 3.5 weeks gestation. She has a human chorionic gonadotropin of 600 mIU/mL. When would the human chorionic gonadotropin be expected to have doubled in value in a normal pregnancy? 1 day 2 days 4 days 5 days

2 days doubles every 29-53 hours in first 30 days

32-year-old G5P4 woman presents for her routine obstetrics visit. She notes concern due to a previous history of gestational diabetes during her last pregnancy. At how many weeks is it appropriate to screen for this condition? 10-12 weeks 15-20 weeks 24-28 weeks 35-37 weeks

24-28 weeks do non fasting 50g oral glucose challenge

During a neonatal assessment at 1 minute, a neonatal boy has a heart rate of 86 bpm and an irregular respiratory rate. He has his upper and lower extremities held in flexion with little movement. His skin is blue around his hands and feet, and he responds to pain with a grimace but no crying. Which of the following is the correct Apgar score? 3 5 7 9

5

32-year-old G3P2 woman presents to the office complaining of heavy menstrual bleeding. Menarche occurred at 12 years of age, and she reports a history of regular menses every 28 days since. After the birth of her second child, her menses were regular, but she now reports heavy menstrual bleeding. She is able to fill a super maxi pad every 2 hours. Her last Pap smear was performed 6 months ago and was normal. Transvaginal ultrasound reveals an 8 cm uterus with a 6 mm endometrial stripe. There are no uterine fibroids. Ovaries are normal and there are no adnexal masses. She is interested in a low-maintenance treatment that will prevent heavy bleeding or one that would cause menses to cease altogether. She is not interested in endometrial ablation or hysterectomy at this time since she is unsure whether she desires to preserve childbearing potential for the future. Which of the following clinical therapeutics is the most appropriate option? 13.5 mg levonorgestrel-releasing intrauterine device 19.5 mg levonorgestrel-releasing intrauterine device 52 mg levonorgestrel-releasing intrauterine device Copper intrauterine device

52 mg levonorgestrel-releasing intrauterine device

A 27-year-old woman presents to her gynecologist with a left-sided breast mass. Physical examination reveals the presence of a 2 cm, firm, immovable, single lesion on the left breast at the 11 o'clock position. An ultrasound reveals a well-visualized, hypoechogenic 2 cm tall x 1.5 cm wide irregular lesion. Which of the following is the most appropriate diagnostic study at this time? Core-needle biopsy Fine-needle aspiration Mammography Surgical biopsy

Core-needle biopsy preferred initial biopsy for suspicious masses

A 27-year-old woman who is positive for HIV presents to the clinic with bumps near her anus. On exam, there are skin-colored cauliflower lesions on the perianal skin. Which of the following is the best clinician-administered treatment? Cryotherapy Imiquimod Podophyllotoxin Rubber band ligation

Cryotherapy condyloma acuminata (genital warts, HPV 6&11) *patient-applied* options include imiquimod, podophyllotoxin, and sinecatechins.

A 35-year-old woman presents to a women's health clinic requesting oral contraceptive therapy. The physician assistant decides to prescribe a combined estrogen-progestin hormonal contraceptive. Which of the following is a relative contraindication to combined estrogen-progestin oral contraception for this patient? Body weight > 198 lbs (90 kg) Current tobacco use of 10 cigarettes/day History of stroke Migraine with aura

Current tobacco use of 10 cigarettes/day History of stroke (C) and migraine with aura (D) are *absolute* contraindications

A 64-year-old woman presents with concerning breast symptoms. She reports the symptoms began nearly 2 years ago when she noticed a left-sided breast mass. Since then, she noticed her left nipple appears to be smaller than the right and she has occasional yellowish nipple discharge from the left side. On physical exam, she has a fixed, poorly defined 0.8 cm mass on the left breast. There is overlying skin erythema with an orange peel appearance, as seen in the image above. You are able to express 0.5 cc of milky-yellow fluid from the nipple, although it is somewhat retracted. She also has left-sided axillary lymphadenopathy. A mammogram is ordered. Which physical exam finding is the most concerning for inflammatory breast neoplasia? Nipple retraction Peau d'orange skin changes of the breast Right upper quadrant breast mass Serous nipple discharge

Peau d'orange skin changes of the breast Inflammatory breast cancer

A 45-year-old woman presents to the office complaining of a new vulvar lesion. She reports the lesion first appeared 2 weeks ago and has become slightly larger. It is not tender and does not bleed. Her past medical history is significant for anxiety, depression, and HIV. She has no drug allergies. Her most recent CD4+ count was 750 cells/microL. She has a history of risky sexual behavior and reports four new sexual partners in the last 2 months. She prefers not to use condoms. On physical exam, there is a 1.1 cm shallow, painless, erythematous ulceration on the mucosal surface of her left labia. Serology testing, including a CD4+ count, is ordered, and results are pending. In the meantime, what is the most appropriate pharmacotherapeutic option for this patient? Doxycycline 100 mg orally for 14 days Imiquimod 1 packet tid for 16 weeks Penicillin 1 dose of 2.4 million units Valacyclovir 1 g bid for 10 days

Penicillin 1 dose of 2.4 million units syphilis

A 42-year-old woman presents to the office due to increasing intermittent breast pain and tenderness that has gotten increasingly worse over the past year. She states the pain peaks about 1 week before her period. She has tried wearing more supportive bras and taking over-the-counter pain relievers for the past 6 months but nothing has helped. She feels like she is not able to work when she experiences this pain. She notices her breasts feel heavy and extremely tender, especially with physical activity. Physical exam reveals very dense breasts upon palpation with rope-like texture bilaterally. Which of the following therapy is the best next step for the treatment of her condition? Danazol Levonorgestrel Oxandrolone Tamoxifen

Tamoxifen fibrocystic breast changes danazol or tamoxifen (which preferred due to fewer side effects)

A 29-year-old G3P1102 pregnant woman presents to labor and delivery at 38 weeks and 0 days gestation complaining of leakage of fluid occurring 12 hours prior to arrival. Vital signs are T of 102.3°F, HR of 125 bpm, BP of 110/75 mm Hg, RR of 20/min, and oxygen saturation of 98% on room air. Physical examination reveals uterine tenderness and purulent drainage from the cervix with speculum exam. Laboratory studies show a white blood cell count of 14,000/μL and a C-reactive protein of 8.1 mg/L. Which of the following is one of the diagnostic criteria for the most likely diagnosis? C-reactive protein of at least 8.0 mg/L Temperature above 102.2°F Uterine tenderness White blood cell count of at least 14,000/μL

Temperature above 102.2°F Intra-amniotic infection (chorioamnionitis)

22-year-old G1P0 woman at 38 weeks gestation presents to the emergency department with contractions. On physical examination, the baby's head is at the level of the maternal ischial spines. Which of the following is the correct station? +5 station 0 station −2 station −5 station

0 station

25-year-old G1P0 woman at 11 weeks gestation presents to her obstetrician for routine prenatal care. She has questions about how much calcium she should be taking. She has no significant medical history. She has annual blood work drawn by her primary care provider and has not had any abnormal results. Which of the following is the daily recommendation of calcium for this patient? 1,000 mg 2,000 mg 5,000 mg 500 mg

1,000 mg

35-year-old G2P1 woman at 16 weeks gestation presents to her obstetrician for a routine visit. Her medical history is significant for gestational diabetes and preeclampsia with her first pregnancy, chronic hypertension, and hypothyroidism. A quadruple test is ordered. Which of the following tests make up the quadruple test? Alpha-fetoprotein, human chorionic gonadotropin, estriol, and inhibin A Parathyroid hormone, thyroid-stimulating hormone, serum thyroxine, and serum triiodothyronine Serum glucose, serum protein, urine glucose, and urine protein Wet prep, Pap smear, human papillomavirus testing, and nucleic acid amplification testing

Alpha-fetoprotein, human chorionic gonadotropin, estriol, and inhibin A done 15-18 wks, screen for genetic abnormalities (esp Down syndrome), neural tube defects, and abdominal wall defects

Which type of pelvis is characterized by convergent side walls of the pelvic midcavity, forward inclination of the sacrum, and a narrow subpubic arch of the pelvic outlet that will most likely lead to labor arrest? Android Anthropoid Gynecoid Platypelloid

Android narrow forepelvis convergent side walls forward inclination of sacrum narrow subpubic arch

24-year-old G1P1001 woman is preparing for hospital discharge after a spontaneous vaginal delivery with no complications. Which of the following is the most appropriate recommendation to give her regarding when she can return to sexual activity? As soon as the woman feels ready after a minimum of 2 weeks As soon as the woman feels ready after a minimum of 4 weeks As soon as the woman feels ready after a minimum of 6 weeks As soon as the woman feels ready after a minimum of 8 weeks

As soon as the woman feels ready after a minimum of 2 weeks

19-year-old woman presents to the urgent care with symptoms of a urinary tract infection. A urine specimen is obtained, and microscopic examination reveals the finding shown in the image above. A pelvic examination is subsequently performed and reveals an inflamed cervix with punctuate hemorrhages and frothy green discharge. Which of the following should the patient be informed about regarding her treatment? Avoid alcohol Night terrors Red-orange discoloration of urine Tendon rupture

Avoid alcohol trichomoniasis - metronidazole (Flagyl) 2g PO

25-year-old G1P0 woman presents to her obstetrician for her first prenatal visit. She would like to know what kind of testing will be done at each visit throughout her pregnancy. Which of the following should be obtained at every visit? Blood pressure Hemoglobin level Serum protein level Urine culture

Blood pressure

53-year-old woman presents to the clinic with hot flashes, difficulty sleeping, and vaginal dryness. She reports the symptoms have progressively gotten worse over the past 3 years. She reports no surgical history. Which of the following cancers would this patient be at significant increased risk of if she is treated with combined menopausal hormone therapy? Breast Colorectal Endometrial Ovarian

Breast

A 32-year-old woman who is 24-hours post-op after delivering her first child via C-section suddenly develops abdominal pain, foul-smelling vaginal discharge, and uterine tenderness. Her vitals are O2 saturation at 99% on room air, blood pressure at 132/86 mm Hg, heart rate at 115 beats per minute, and temperature 102°F. What is the appropriate treatment for this patient's suspected diagnosis? Ampicillin and gentamicin Clindamycin and gentamicin Doxycycline and ceftriaxone First-generation cephalosporin alone

Clindamycin and gentamicin endometritis after C-section C-sections prophylactically given a dose of a first-generation cephalosporin during occurs after a vaginal delivery- ampicillin and gentamicin

50-year-old woman presents with a complaint of vaginal dryness. She reports having some vulvovaginal irritation, and she has noticed decreased vaginal lubrication during intercourse. Her symptoms have been getting worse over the past 2 years since she went through menopause. The patient is in a monogamous relationship with no concern for sexually transmitted infections. Her pelvic exam reveals atrophic skin changes along the vaginal canal with decreased secretions. No other abnormalities are noted. Which of the following is the most likely cause of this patient's symptoms? Decreased estrogen Decreased progesterone Lichen planus Vaginal yeast infection

Decreased estrogen atrophic vaginitis in menopause

65-year-old woman presents to her gynecologist after a visit to the ED. The patient reports that she was having abdominal pain last night and went to the ED. Her abdominal pelvic CT scan showed a 10 cm solid, right ovarian mass with multiple small peritoneal masses. Which of the following is most likely to be increased? Cancer antigen 125 Cancer antigen 15-3 Carbohydrate antigen 19-9 Carcinoembryonic antigen

Cancer antigen 125 Ovarian Cancer(>35 U/mL)

24-year-old pregnant woman presents to the clinic with vaginal itching and discharge. She recently had unprotected intercourse with a new sexual partner. The Gram stain from microscopy is shown above. Which of the following is the recommended treatment? Azithromycin and gemifloxacin Ceftriaxone Ceftriaxone and azithromycin Ceftriaxone and doxycycline

Ceftriaxone and azithromycin gonorrhea in pregnancy (use doxy in not pregnant)

28-year-old G2P1 woman presents to the clinic at 32 weeks gestation for a routine prenatal visit. She has an ultrasound performed to monitor a previously diagnosed placental condition, and it shows persistent homogeneous placental tissue extending over the internal cervical os. The patient reports no vaginal bleeding during her pregnancy. Which of the following is the most appropriate recommendation regarding delivery, assuming the underlying condition persists and the patient remains asymptomatic? Cesarean delivery at 37 weeks Cesarean delivery at 40 weeks Induction of vaginal delivery at 37 weeks Induction of vaginal delivery at 40 weeks

Cesarean delivery at 37 weeks Placenta previa

Which of the following is the most common cause of cervicitis? Bacterial vaginosis Chlamydia trachomatis Neisseria gonorrhoeae Trichomonas vaginalis

Chlamydia trachomatis MC STI

35-year-old woman presents for a follow-up with her gynecologist. She had a Pap smear completed 2 weeks ago, and the results were positive for human papillomavirus with low-grade squamous intraepithelial lesions. Which of the following is the most appropriate next step in management? Colposcopy Endocervical curettage Follow-up in 1 year for a repeat Pap smear and human papillomavirus testing Loop electrosurgical excision procedure

Colposcopy performed on patients with a positive HPV test with ASC-US, HSIL, LSIL, or atypical glandular cells If abnormal areas are seen, then punch biopsy or endocervical curettage should be obtained for further tissue evaluation.

A 68-year-old multiparous woman presents to the clinic with complaints of vaginal fullness and urinary incontinence. She reports no recent pelvic trauma or surgeries. On exam, you note a vaginal bulge through the introitus and soft anterior fullness of the vaginal wall. Urinalysis reveals a few normal epithelial cells. A funnel-shaped bladder is seen on transabdominal ultrasound. Which of the following is the most likely diagnosis? Bladder fistula Cystocele Rectocele Urinary tract infection

Cystocele

21-year-old woman presents to the office with a bump on her labia that appeared 3 days ago. It is not painful to touch nor pruritic. She had unprotected intercourse with a man about 3 weeks ago and has not had any sexual contact with anyone else since. On physical exam, there is a 2 cm nontender, ulcerated, round, skin-colored lesion with an elevated rim that is located on the inside of the right labium majus. There are also palpable lymph nodes to the inguinal area bilaterally. Which of the following tests will provide a definitive diagnosis of her condition? Darkfield microscopy Fluorescent treponemal antibody absorption test Microhemagglutination test for antibodies to T. pallidum Venereal Disease Research Laboratory

Darkfield microscopy syphilis caused by T. pallidum

57-year-old woman presents for a follow-up to a recent abnormal breast exam. She was noted to have a nontender, hard, fixed breast lump with associated enlarged axillary lymph nodes on her annual breast exam. Her mammogram was also significant for a spiculated mass highly suspicious for malignancy. What is the most common form of this patient's diagnosis? Inflammatory breast carcinoma Invasive ductal carcinoma Invasive lobular carcinoma Paget carcinoma

Invasive ductal carcinoma MC type of breast cancer

A 25-year-old woman presents to her gynecologist with complaints of painful cyst-like masses in both breasts. She states her breast masses seem to fluctuate in size rapidly and they are the most painful right before her menstrual cycle begins. Ultrasound of the breasts reveals the presence of multiple small cysts bilaterally with no malignant or concerning features. Which of the following lifestyle modifications should be recommended for this patient? Decreasing dietary fat intake Engaging in weighted interval training Increasing caffeine intake Switching from a tight to a loose brassiere

Decreasing dietary fat intake fibrocystic disease

28-year-old G2P1 woman at 36 weeks gestation presents to the ED with uterine contractions, abdominal pain, and vaginal bleeding for the past 2 hours. Her blood pressure is 88/60 mm Hg, and her heart rate is 115 bpm. Physical examination is notable for a rigid, tender uterus. Ultrasound is significant for a retroplacental hematoma. Fetal heart rate tracing is nonreassuring. The patient is prepped for an emergent cesarean section. Which of the following is the most common potential complication of the patient's condition? Cardiogenic shock Disseminated intravascular coagulation Septic shock Thrombocytopenic thrombotic purpura

Disseminated intravascular coagulation placental abruption - painful vaginal bleeding

27-year-old woman presents to the emergency department with complaints of dull low-back and lower-abdominal pain for the last 2 weeks. She reports no recent trauma, but she did travel to the Caribbean a month ago. She has increased pain with defecation but no constipation. She has had normal menstrual cycles but does seem to have more vaginal discharge than usual. Her sexual history is notable for multiple sexual partners with whom protection is not always used. She reports practicing receptive anal, oral, and vaginal intercourse. She has a history of prior gonorrhea and chlamydia diagnoses and treatments, but she has not seen a clinician for several months. Her exam is notable for tender, enlarged inguinal lymph nodes and a painful anorectal exam with palpation of several indurated tender areas in her rectal canal. A full sexually transmitted infection workup is done, including an anorectal swab sent for nucleic acid amplification testing for Chlamydia trachomatis. She reports no allergies to medications. Which of the following is the best choice for treatment for the suspected diagnosis? Azithromycin 1 g oral once Azithromycin 1 g oral once weekly for 3 weeks Doxycycline 100 mg oral bid for 21 days Doxycycline 100 mg oral bid for 7 days

Doxycycline 100 mg oral bid for 21 days chlamydia caused genital ulcer disease (lymphogranuloma venereum)

35-year-old G2P1 woman at 41 weeks gestation is in a prolonged second stage of labor. Delivery of the fetus is blocked by perineal tissue. A category III tracing is unresponsive to resuscitative measures, and the obstetrician decides to perform an episiotomy. Which of the following is the preferred type of episiotomy to minimize the risk of anal sphincter laceration? Anterior episiotomy J incision Lateral episiotomy Mediolateral episiotomy

Mediolateral episiotomy

27-year-old G2P1001 woman presents to labor and delivery at 33 weeks and 2 days of gestation with regular uterine contractions for 2 hours. She reports no vaginal bleeding or clear leakage of fluid. Pelvic examination reveals cervical dilation to 3 cm. Which of the following is the best recommendation for tocolytic therapy? Indomethacin Nifedipine Terbutaline Tocolytic therapy is not indicated

Nifedipine CCB - nifedipine first-line agent for tocolytic therapy between 32-34 weeks (second-line between 24-32; indomethacin first-line)

56-year-old G1P1001 woman presents to the clinic with the chief complaint of vaginal bleeding. She states she has not had any bleeding since her last menstrual period 5 years ago. A transvaginal ultrasound shows an 8 mm endometrial stripe. Which of the following is the next most appropriate step in management? Dilation and curettage Endometrial biopsy Hysterectomy Hysteroscopy

Endometrial biopsy endometrial cancer

25-year-old G2P1 pregnant woman is in labor. Her cervix is dilated to 7 cm and has been dilating quickly. Which of the following stages of labor is she in? First Fourth Second Third

First active phase of first stage (rapid cervical changes, begins approx. 6cm)

58-year-old woman presents to her primary care provider with complaints of urinary incontinence. She states that, sometimes, she cannot make it to the bathroom in time and wets herself. On speculum examination, the patient is asked to cough, which results in the leakage of a small amount of urine. Her urinalysis is unremarkable. She is diagnosed with mixed urinary incontinence. Which of the following treats urge incontinence rather than stress incontinence? Kegel exercises Oxybutynin Pessary placement Topical estrogen

Oxybutynin antimuscarinic

A 44-year-old woman presents to her gynecologist for her annual visit and raises concerns about recent irregularities to her menstrual cycle. She reports no sexual activity in the last year. She has not been experiencing hot flashes. She does feel moodier than usual but also reports not sleeping well recently and does not think this is related since she just changed jobs. She is otherwise well and reports no abdominal pain or abnormal bleeding. Which of the following is the best test to evaluate whether her symptoms are due to the early onset of menopause? Antimüllerian hormone Clomiphene citrate challenge test Follicle-stimulating hormone Luteinizing hormone

Follicle-stimulating hormone Menopause - low estrogen, high FSH

A 16-year-old high school gymnast presents to her gynecologist with concerns about menstruation. She states that most of her friends started menstruating in middle school, and she is worried because she has never had a period. Her vital signs are normal, her height is in the 5th percentile, and her BMI is 20.1 kg/m2. She states that she has always been the shortest girl in her class. No abnormal weight changes are noted on her growth chart. The patient has appropriate secondary sexual characteristics, and her genitourinary examination is unremarkable. Physical examination is significant for low-set ears, low hairline, and a high arched palate. Urine pregnancy test is negative. Which of the following is the most common cause of the patient's condition? Excessive exercise Gonadal dysgenesis Müllerian agenesis Polycystic ovary syndrome

Gonadal dysgenesis (Turner syndrome) MCC of primary amenorrhea

24-year-old pregnant woman presents to the obstetrics clinic for routine prenatal care at 36 weeks gestation. She is Rh negative. Which of the following prenatal diagnostic or therapeutic tests is appropriate at this visit? Anatomy survey ultrasound Group B Streptococcus screening Oral glucose tolerance test Rho(D) administration

Group B Streptococcus screening done 35-37 weeks US - 18-22 wks GCT - 24-28 wks Rhogam - 26-28 wks and after delivery if baby is Rh+

A 38-year-old woman presents along with her 42-year-old husband to discuss difficulties conceiving. They have had consistent, unprotected intercourse for 8 months without a positive pregnancy test. She has never been pregnant, and he has never fathered a child. She has a history of regular menses occurring every 30 days. They both report no history of sexually transmitted infections. Neither individual has a family history of infertility or genetic diseases. Neither of them smoke or use illicit drugs, although they have an occasional drink with dinner. Which diagnostic study is most appropriate, according to this history? Hysterosalpingography and scrotal ultrasound Hysteroscopy and semen analysis Scrotal ultrasound and semen analysis Semen analysis

Hysteroscopy and semen analysis

30-year-old woman is in labor and has just delivered the fetal head. The fetal head then retracts into the perineum and the rest of the fetus cannot be easily delivered with gentle and downward traction. Which of the following is the most important risk factor for shoulder dystocia? Diabetic pregnancies with normal fetal birth weight Female sex High birth weight in nondiabetic pregnancies Preterm birth

High birth weight in nondiabetic pregnancies turtle sign in shoulder dystocia

50-year-old woman presents to the clinic for a routine well-woman exam. She reports it has been 12 months since her last menstrual period. Which of the following is the most common symptom of menopause? Hot flashes Mood symptoms Sleep disturbance Vaginal dryness

Hot flashes

32-year-old G2P2 woman presents to the office due to left breast tenderness. She is 2 months postpatrum and had a normal vaginal delivery of a healthy baby girl. Her infant is entirely breastfed and has been gaining weight appropriately. Other than left breast tenderness and some redness that she noticed shortly before the appointment, she feels well. She has a history of mastitis with her first pregnancy. Her vital signs show a blood pressure of 119/77 mm Hg, pulse of 88 bpm, temperature of 98.6°F, and respirations of 10 breaths per minute. On physical exam, her left breast is engorged and has a 1.0 cm area of erythema and tenderness on the lateral aspect of the breast. There is no edema or dimpling of the skin. Milk is easily expressed from the left side. Which of the following is the most appropriate initial management for this patient while she continues to completely empty the involved breast? Dicloxacillin 500 mg PO Doxycycline 100 mg PO Ibuprofen 800 mg PO as needed Oxacillin 2 g IV

Ibuprofen 800 mg PO as needed (dicloxacillin 500mg PO for more severe symptoms) lactational mastitis

25-year-old G1P0 woman at 20 weeks gestation presents to her obstetrician for a routine prenatal visit. She is concerned because her hemoglobin is 11.0 g/dL, which is lower than normal for her. Which of the following physiologic changes of pregnancy is most likely responsible for the patient's low hemoglobin level? Decrease in red blood cell mass Decrease in responsiveness to norepinephrine Increase in glomerular filtration rate Increase in plasma volume

Increase in plasma volume dilution anemia

50-year-old woman presents to the gynecologist to discuss her mammogram results. A firm, notender, irregular mass was palpated in the upper outer region of her left breast, and a mammogram identified a lesion suspicious for invasive breast cancer. Which of the following is the most common type of invasive breast cancer? Infiltrating ductal carcinoma Infiltrating lobular carcinoma Medullary carcinoma Tubular carcinoma

Infiltrating ductal carcinoma MC in situ (invasive) breast carcinoma

A 63-year-old woman presents to the gynecology clinic for a routine wellness exam. Physical examination reveals a bulging of the apex of the vaginal vault. Which of the following is recommended to prevent this condition? Abstinence Kegel exercises Smoking cessation Weight lifting

Kegel exercises pelvic organ prolapse

28-year-old woman who is 28 weeks pregnant presents to the emergency department after she was involved in a motor vehicle collision < 1 hour ago. She immediately developed abdominal cramping and scant vaginal bleeding. This is her first child, and she has an Rh-negative blood type. The baby's father was recently tested and found to be Rh-positive. Which of the following tests will give a quantitative measurement of fetal red blood cells in the maternal blood? Direct Coombs test Kirby-Bauer test Kleihauer-Betke test Rosette test

Kleihauer-Betke test *quantitative* measurement of amount of fetal blood cells in maternal blood (Rosette test - initial test *qualitative* test)

A 30-year-old nulliparous woman presents with dysmenorrhea, dyschezia, and dyspareunia. On exam, you note a retroverted uterus and a palpable adnexal mass. Which of the following is needed for the definitive diagnosis of the suspected disorder? Abdominal ultrasound Laparoscopy and biopsy Pelvic MRI Serum cancer antigen 125

Laparoscopy and biopsy endometriosis

25-year-old woman presents to labor and delivery at 38 weeks gestational age with contractions. She reports she has had contractions every 5 minutes for the past 2 hours. Cervical examination reveals she is dilated to 4 cm. The patient is requesting pain medication. Which of the following is a relative contraindication to neuraxial analgesia? Aortic regurgitation Fever Local infection at the site of neuraxial analgesia puncture Preeclampsia

Local infection at the site of neuraxial analgesia puncture elative contraindications include coagulopathy, infection at the site of neuraxial analgesia puncture, and increased intracranial pressure.

woman reports to the office 2 days postpartum due to persistent bloody discharge. She describes the bleeding as red-brown and states it resembles her menstrual discharge. Which of the following is the correct name and appropriate duration of this discharge? Lochia alba, which may continue for up to 8 weeks Lochia rubra, which should subside in a few days Lochia serosa, which should subside in a few days Lochia serosa, which should subside in a few weeks

Lochia rubra, which should subside in a few days followed by loch serosa (pinkish brown coloring lasting 2-3 weeks), then loch alba (yellowish-white discharge up to 8 weeks)

A 40-year-old woman presents to the clinic with concerns for a right breast lump. Physical exam reveals a 3 cm mass located in the right upper quadrant of the right breast. Mammogram reveals a 3 cm by 1.5 cm spiculated mass with notable microcalcifications. A core needle biopsy is also obtained and shows well-differentiated tumor cells that infiltrate the stroma suggestive of a stage I infiltrating ductal carcinoma. Immunohistochemical staining reveals that the mass is estrogen and progesterone receptor positive. What is the next most appropriate step in management? Chemotherapy Hormone therapy Lumpectomy with sentinel lymph node biopsy Mastectomy with removal of the axillary lymph nodes

Lumpectomy with sentinel lymph node biopsy

Which of the following is the best patient education regarding prenatal care to give to a pregnant woman with an uncomplicated pregnancy? Do not engage in sexual intercourse Do not wear a seatbelt Maintain hydration and regularly move your lower extremities during air travel Sleep in a supine position during the third trimester

Maintain hydration and regularly move your lower extremities during air travel inc risk of thromboembolism

A 32-year-old woman presents with a complaint of increased menstrual bleeding for the past several months. She reports that her periods used to be moderate flow for 2-3 days. However, now they last for 7-10 days, and she is changing her pad or tampon every hour. Her pelvic exam is unremarkable, and no blood is seen at this time. Endometrial biopsy shows hyperplasia with atypia. A dilation and curettage reveals no evidence of endometrial carcinoma. The patient is very concerned because she has been trying to get pregnant. Which of the following is recommended for this patient? Anastrozole Hysterectomy Megestrol acetate Observation

Megestrol acetate (or depot medroxyprogesterone acetate) treat with progestin therapy to preserve fertility

22-year-old woman presents with a complaint of painless heavy vaginal bleeding. She reports that her menstrual cycle occurs at irregular intervals and usually lasts more than 35 days. A physical exam is unremarkable at this time and laboratory studies are within normal limits. Which of the following is the most likely diagnosis? Menometrorrhagia Menorrhagia Metrorrhagia Polymenorrhea

Menometrorrhagia heavy, irregular vaginal bleeding

A woman presents to the breast clinic with a new unilateral right-sided breast lesion. Physical examination reveals a well-circumscribed, nontender, and smooth 2.5 cm mass. Ultrasound reveals a solid and well-circumcised lesion. Which of the following additional findings is consistent with the most likely diagnosis? Axillary lymphadenopathy Lesion occurring in a 55-year-old patient Mobile quality to the lesion Nipple discharge

Mobile quality to the lesion Fibroadenomas

Which of the following fetal abnormalities is associated with an elevated alpha-fetoprotein level? Aneuploidy Cystic fibrosis Neural tube defects Tay-Sachs disease

Neural tube defects

A 28-year-old woman presents to the emergency department with acute left-sided pelvic pain and vomiting. Physical examination reveals left-sided lower abdominal tenderness. Urine pregnancy test is negative. The transvaginal ultrasound reveals an enlarged and rounded left ovary with decreased Doppler flow to the left ovary. Which of the following is the most likely diagnosis? Ectopic pregnancy Ovarian cyst rupture Ovarian torsion Pelvic inflammatory disease

Ovarian torsion

32-year-old woman at 37 weeks gestation presents to the hospital with a persistent, severe headache, epigastric pain, and blurred vision. Vital signs indicate HR 96 bpm, RR 16 breaths per minute, BP 162/96 mm Hg, T 98.9°F, and oxygen saturation 98% on room air. While indicated lab results are pending, the patient is given antihypertensives and is started on the appropriate first-line medication for prophylactic seizure prevention. Which of the following can be used to assess the therapeutic level for this agent and monitor for drug toxicity? Blood pressure values Capillary refill Patellar reflex Pupillary response

Patellar reflex preeclampsia with end-organ involvement

A 32-year-old G3P2 woman, who actively smokes tobacco, presents to her obstetrics office reporting bright red vaginal bleeding that she first noticed this morning. She is currently 29 weeks gestation. As per the patient, she is not having any abdominal or pelvic pain or any cramping sensation. On exam, there is no evidence of fetal distress, and there is no evidence the patient is in active labor. She reports no recent trauma. Which of the following is most likely the patient's diagnosis? Placenta previa Placental abruption Spontaneous abortion Vasa previa

Placenta previa painless bright red bleeding

A 20-year-old woman presents to her primary care provider in January with recurrent episodes of increased irritability, anxiety, and sadness for the past 3 months. She states the holidays are a stressful time for her because she does not get along well with her family. Upon further questioning, she states her mood seems normal most of the time, then all of a sudden, her symptoms will begin and last for almost a week. Which of the following is the most likely diagnosis? General anxiety disorder Premenstrual dysphoric disorder Premenstrual syndrome Seasonal affective disorder

Premenstrual syndrome (PMS) (PMD - more severe *5 symptoms* hinder life, most of preceding year)

20-year-old woman presents to the clinic for treatment of newly diagnosed severe rheumatoid arthritis. She currently takes no medications, has no allergies, and her vital signs are within normal limits. Her last menstrual period was 3 weeks ago. She is in a monogamous relationship and does not use contraception. Which of the following is a side effect of methotrexate that makes it a poor initial treatment choice for this patient? Can cause a lethal rash Can cause severe anemia Can cause severe depression in younger patients Teratogenic and embryotoxic

Teratogenic and embryotoxic

15-year-old girl presents with a recurrent, crampy lower abdominal pain, nausea, headache, and malaise. Her symptoms usually start 1 to 2 days before the onset of menstrual bleeding and then gradually diminishes over 12 to 72 hours. On exam, you note tenderness to palpation of the lower abdomen. Laboratory studies and pelvic ultrasound show no abnormal findings. Which of the following is the most likely cause of this patient's symptoms? Lymphoid hyperplasia Prostaglandin production Transmural colonic inflammation Twisting of the ovaries

Prostaglandin production primary dysmenorrhea

25-year-old woman who delivered her child 2 days ago is visited by a lactation consultant, who explains to her the importance of breastfeeding, especially before the body produces mature milk, due to the benefits of colostrum for the baby. Which of the following components is found in high quantities in colostrum? Carbohydrate Fat Protein Water

Protein

A 25-year-old woman presents to the clinic for a routine wellness examination. She reports her husband is routinely controlling and humiliating her. Her husband has isolated her from her friends and family and manipulates her by withholding access to money. Which of the following is the most likely diagnosis? Physical intimate partner violence Post-traumatic stress disorder Psychological intimate partner violence Sexual intimate partner violence

Psychological intimate partner violence

19-year-old woman presents to your office due to sudden onset of malodorous yellowish-green vaginal discharge. She reports her symptoms began 7 days ago after having unprotected sexual intercourse with a new partner, who said he had no concerning symptoms. She reports 10 lifetime sexual partners. Her current medications include an oral contraceptive pill, which she takes reliably. Her past medical history includes bacterial vaginosis and gonorrhea. Upon further questioning, she reports she also has a 5-day history of dysuria and pain with intercourse. What physical exam finding will confirm your diagnosis? Cervical motion tenderness and thick, white vaginal discharge Flagellated protozoa moving in corkscrew motions Punctate macular hemorrhages on the cervix Thin, homogenous vaginal discharge with a fishy odor

Punctate macular hemorrhages on the cervix vaginitis - trichomoniasis

24-year-old woman at 14 weeks gestation reports to the clinic for her second prenatal visit. She reports intense nausea with occasional vomiting that has not resolved with dietary changes, including the addition of ginger and peppermint teas. Which of the following is the best next step in treatment? Chlorpromazine Doxylamine Droperidol Pyridoxine

Pyridoxine (vit B6) can add *doxylamine* if ineffective alone

55-year-old woman presents to the office due to vaginal fullness and pressure that has gotten worse over the past year. She feels a bulge at the opening of her vagina especially after being on her feet for several hours. She is also having more difficulty urinating. She does not have any problems with defecation and does not report vaginal bleeding or pain. She is widowed and has six adult children who were delivered vaginally. Which of the following is the most appropriate next step in treatment? Prescribe her a topical estrogen cream Prescribe her nitrofurantoin Refer her to a gynecologic surgeon for a surgical consult Refer her to a specialist for a pessary fitting

Refer her to a specialist for a pessary fitting initial uterine prolapse tx

36-year-old G2P2 woman with no history of prenatal care for her current pregnancy had a spontaneous home vaginal delivery at 35 weeks gestation and presents with her baby 2 hours after delivery because she thinks he is sick. The infant is admitted to the neonatal intensive care unit with skin edema, ascites, pericardial effusion, pleural effusion, and a hemoglobin of 4.9 g/dL. The mother had no prenatal or postnatal care for her first pregnancy, which occurred 3 years ago. Her first child was delivered vaginally at home without any complications. The mother reports cocaine use during this pregnancy. Which of the following is the most likely contributing factor for the infant's condition? Advanced maternal age Cocaine use Preterm infant Rh incompatibility

Rh incompatibility second pregnancy without rhogam at 28 weeks and again after delivery Rh negative mother carrying Rh positive baby hemolytic disease of the newborn --> hydros fettles

20-year-old woman presents to the office due to abdominal bloating and swelling in her legs and feet that coincides with her menstrual cycle. She starts having some abdominal and pelvic cramping around 1 week before her period, and it gets worse until her period starts. She states these symptoms have been getting worse over the past 6 months, and she has to wear bigger clothes and bigger shoes every month when she is on her period. Which of the following is the best regimen for the patient's symptoms? Acetazolamide Furosemide Spironolactone Tamoxifen

Spironolactone diuretic shown to improve symptoms of PMS (bloating, fluid retention, and breast tenderness)

62-year-old woman presents to her gynecologist with reports of vaginal heaviness and sensations of incomplete bladder emptying. A pelvic examination reveals uterine prolapse. Which stage of uterine prolapse is defined by the uterus located at the level of the hymen? Stage 1 Stage 2 Stage 3 Stage 4

Stage 2

32-year-old woman who is breastfeeding her 12-week-old daughter presents to her primary care office reporting redness and tenderness to her right breast. She states her symptoms started yesterday afternoon and have progressed since then. On physical exam, there is redness, warmth, and swelling to her right nipple with a small amount of nipple discharge. Her left breast is normal. Which of the following is the most common cause of this patient's condition? Candida albicans Malassezia furfur Staphylococcus aureus Staphylococcus epidermidis

Staphylococcus aureus lactational mastitis

A 24-year-old woman presents to the clinic complaining of mood instability. The symptoms are affecting her relationship with her boyfriend and her ability to perform at work. She specifically complains of moodiness, increased appetite, difficulty controlling her emotions, sleeping more than usual, difficulty concentrating, and bloating. Which of the following additional findings is required to fulfill the criteria for the most likely diagnosis? Absence of other psychiatric disease Symptoms occurring predominantly during the follicular phase Symptoms occurring predominantly during the luteal phase Symptoms starting during menses

Symptoms occurring predominantly during the luteal phase PMDD

A 26-year-old woman presents for routine prenatal care at 41 weeks gestation. You decide to induce labor. Which of the following is a known side effect of the medication typically used for labor induction? Headache Hypertension Pruritus Tachysystole

Tachysystole MC side effect of oxytocin to induce labor

A 26-year-old woman presents to the office due to worsening depression, mood swings, anxiety, low energy, and poor concentration that begins about 2 weeks before her period and lasts until her period starts. She states she has had these symptoms since she was a teenager, but lately they have gotten so severe she has had to take many days off work and is currently at risk of losing her job. A physical examination is unremarkable. Which of the following diagnostic tests should be ordered in the workup of her condition? Adrenocorticotropic hormone stimulation test Fasting plasma glucose test Overnight sleep study Thyroid-stimulating hormone test

Thyroid-stimulating hormone test PMDD diagnosis by exclusion

29-year-old G1P0 woman at 11 weeks gestation presents to the ED with vaginal pain and bleeding. Transvaginal ultrasound reveals the presence of an intrauterine pregnancy. Fetal heart rate is 138 bpm. Her serum chorionic gonadotropin level was 39,488 mIU/mL 5 days ago and is currently 153,867 mIU/mL. Pelvic examination reveals the presence of a closed cervical os with a small amount of blood in the vaginal canal. What is the most likely diagnosis? Incomplete abortion Inevitable abortion Missed abortion Threatened abortion

Threatened abortion closed OS, increasing HcG, positive fetal heart rate

A 32-year-old premenopausal woman with no significant medical history presents to the clinic due to a heavy menstrual flow that lasts 12 days on average. This bleeding is not predictable in onset and causes her severe social and physical distress. Urine human chorionic gonadotropin testing is negative. Which of the following is the best initial diagnostic study? Computed tomography Hysteroscopy Magnetic resonance imaging Transvaginal ultrasonography

Transvaginal ultrasonography

27-year-old G1P0 woman at 12 weeks gestation presents to her obstetrician for a routine prenatal visit. Ultrasound confirms the presence of a twin pregnancy. Which of the following is the most likely complication of multiple gestation? Large for gestational age infants Maternal breast cancer Post-term delivery Twin-twin transfusion syndrome

Twin-twin transfusion syndrome

23-year-old G1P0 woman at 37 weeks gestation presents to the labor and delivery unit for an uncomplicated vaginal delivery. Her cervix is 8 cm dilated and 100% effaced. A fetal heart rate monitor is attached, and the baseline fetal heart rate is 140 bpm. Which of the following fetal heart rates is considered reactive? One acceleration of 15 bpm above baseline for 2 minutes in a 20-minute period One acceleration of 20 bpm above baseline for 20 seconds in a 20-minute period Two accelerations of 10 bpm above baseline for 10 seconds each in a 10-minute period Two accelerations of 15 bpm above baseline for 15 seconds each in a 20-minute period

Two accelerations of 15 bpm above baseline for 15 seconds each in a 20-minute period

28-year-old woman presents to the clinic due to mastalgia for the past 2 months. She reports her pain increases with the onset of her menstrual cycle. Physical exam demonstrates a smooth, firm, discrete mobile mass. Which of the following diagnostic studies is best indicated at this time? Core-needle biopsy Diagnostic mammography Fine-needle aspiration Ultrasonography

Ultrasonography fibrocystic disease initial eval if rapid changes develop - need biopsy

55-year-old postmenopausal woman presents to the clinic with vaginal spotting. She says she has not had any vaginal bleeding since her last period 4 years ago. Which of the following is a risk factor for the most concerning diagnosis? Combined hormonal contraception use Late menarche Smoking cigarettes Unopposed estrogen therapy

Unopposed estrogen therapy uterine endometrial cancer RF

A woman who delivered her child vaginally 2 hours ago begins to report a "racing heart," palpitations, and shortness of breath. Blood loss during delivery was estimated at 600 mL, and the patient has had ongoing bleeding since delivery. Initial stabilization included intravenous fluids, tranexamic acid, and an increase in the rate of oxytocin administration. Which of the following procedures is the first-line intervention for the most common cause of this patient's condition after initial stabilization? Arterial embolization B-lynch compression sutures Hysterectomy Uterine massage

Uterine massage Postpartum Hemorrhage (PPH) MCC uterine atony

21-year-old G1P0 woman at 8 weeks gestation presents to her obstetrician for her first prenatal visit. She has been taking multiple over-the-counter vitamin supplements. Which of the following vitamins, if taken in excess, is teratogenic in the first trimester and is associated with spontaneous abortion and fetal malformation? Vitamin A Vitamin C Vitamin D Vitamin E

Vitamin A

44-year-old woman with uncontrolled diabetes mellitus presents to the gynecologic clinic with vulvar pruritus, vaginal burning, vaginal irritation, and dysuria. Physical examination reveals vulvar erythema. Urinalysis has no leukocyte esterase or nitrites. The vaginal pH is 4.25. Which of the following is the most common finding in the most likely condition? Dysuria Vaginal burning Vaginal irritation Vulvar pruritus

Vulvar pruritus vulvovaginal candidiasis pH <4.5

22-year-old woman presents to her primary care provider with recurrent bilateral breast pain each month. Physical exam reveals no masses, skin changes, nipple discharge, or axillary lymphadenopathy. Which part of her menstrual cycle is the most likely timing for this pain to occur in? During menses First week after menses Week before menses Week of ovulation

Week before menses fibrocystic changes

A 24-year-old woman presents to the office for evaluation of infertility after trying to conceive for several years. A transabdominal ultrasound reveals a "string of pearls" appearance to the bilateral ovaries. Which of the following clinical findings will she most likely have on a history and physical examination? Dull facial expression, unexplained weight gain, bradycardia, and dry skin Excessive sweating, weight gain, abdominal striae, and a buffalo hump Increasing fatigue, muscle weakness, darkening skin, and hypotension Weight gain, hirsutism, acne, and insulin resistance

Weight gain, hirsutism, acne, and insulin resistance Polycystic ovarian syndrome (PCOS)

24-year-old G2P2 woman in the labor and delivery unit develops fever, lower abdominal pain, and foul-smelling, purulent lochia 3 days after a cesarean section for prolonged rupture of membranes. Her vital signs are T of 38.4°C (101.1°F), BP of 130/70 mm Hg, HR of 105 bpm, RR of 18 breaths per minute, and oxygen saturation of 98% on room air. Her pregnancy was complicated by bacterial vaginosis and heavy vaginal colonization with Escherichia coli. Which of the following is the most significant risk factor for the patient's current condition? Bacterial vaginosis Cesarean section Heavy vaginal colonization with Escherichia coli Prolonged prelabor rupture of membranes

Cesarean section most important RF for postpartum endometritis

A 38-year-old G5P4 woman is in active labor. She is 6 cm dilated and 100% effaced. On vaginal exam, a smooth, soft mass is palpated, and two feet can be identified as the presenting parts. An abdominal ultrasound is ordered and reveals the knees tucked up against the fetal chest and the feet and buttocks at the birth canal. Which fetal presentation is being described? Complete breech Frank breech Incomplete breech Nonfrank breech

Complete breech

A 22-year-old woman presents to the office due to gential bumps that are pruritic and not painful. Physical exam reveals multiple papillomatous skin-colored lesions, as seen on the image above, on the labia and perianal area. Which of the following is the most likely diagnosis? Condylomata acuminata Condylomata lata Molluscum contagiosum Papulosquamous lichen planus

Condylomata acuminata HPV 6 and 11, cauliflower genital warts

28-year-old otherwise healthy woman presents to the gynecology clinic with 24 hours of right-sided breast pain, redness, and swelling. She is 5 weeks postpartum. Vital signs are T of 100.6°F, HR of 98 bpm, BP of 120/80 mm Hg, RR of 20/min, and oxygen saturation of 98% on room air. Breast examination reveals a local area of erythema and firm edema on the right breast. Which of the following is the recommended treatment? Cessation of breastfeeding and clindamycin Cessation of breastfeeding and dicloxacillin Continuation of breastfeeding and clindamycin Continuation of breastfeeding and dicloxacillin

Continuation of breastfeeding and dicloxacillin lactational mastitis

25-year-old pregnant woman presents to the obstetric clinic at 8 weeks gestation with dysuria for 2 days. She has had urinary frequency and urgency for the past 3 weeks. She reports no flank pain. Physical examination reveals no costovertebral angle tenderness. Urinalysis shows pyuria. Which of the following is the recommended treatment? Ciprofloxacin Fosfomycin Nitrofurantoin Supportive treatment with acetaminophen

Fosfomycin antibiotics (fosfomycin, amoxicillin-clavulanate, cefpodoxime) tx for cystitis

27-year-old woman presents to the office due to new vaginal discharge. She has a long-standing history of recurrent vaginal yeast infections, for which she uses fluconazole 150 mg. She took two doses last week without relief. She reports having a thin, homogenous vaginal discharge that smells fishy. Which of the following organisms contributes to the suspected finding? Candida glabrata Gardnerella vaginalis Treponema pallidum Trichomonas vaginalis

Gardnerella vaginalis vaginitis - tx w metronidazole 500mg POx2 for 7 days

25-year-old G2P1 woman at 33 weeks gestation presents to the emergency department after feeling a gush of vaginal fluid 2 hours ago. On speculum examination, clear fluid is seen pouring out of the cervical os and pooling into the vaginal vault. Nitrazine testing reveals a pH of 7.2, and microscopic examination demonstrates a ferning pattern. Ultrasound is significant for oligohydramnios. Which of the following is the most common risk factor for the patient's condition? Antepartum bleeding Cigarette smoking Gardnerella vaginalis infection Increased body mass index

Gardnerella vaginalis infection Genital tract infection is *MOST COMMON* rf for preterm prelabor rupture of membranes (PPROM)

36-year-old woman is 13 weeks pregnant with twins. There are two distinct fetuses and the presence of a T sign on ultrasound. Which of the following most likely describes this patient's twin gestation? Dichorionic, diamniotic gestation Dichorionic, monoamniotic gestation Monochorionic, diamniotic gestation Monochorionic, monoamniotic gestation

Monochorionic, diamniotic gestation T-sign --> one placenta, two separate amniotic sacs

41-year-old G1P0 woman presents for a routine prenatal visit. She is 35 weeks pregnant. She reports a normal pregnancy course to date and feels well today. She has experienced a 25 lb weight gain over the last 8 months and reports recent lower extremity swelling. The swelling usually resolves when she elevates her feet at night but not always. Her bowel movements have been normal, but she reports frequent urination and lower abdominal pain. The pain is occasional, sharp, and fleeting. It usually occurs after sudden movements. She also reports visual flashes of light, which are infrequent but occur daily. She reports neither eye pain nor blurry vision. Upon arrival, her vital signs show a blood pressure of 134/92 mm Hg, pulse of 80 bpm, temperature of 98.6°F, and respirations of 12 breaths per minute. Pupils are equal, round, and reactive to light and accommodation bilaterally. Cardiovascular exam reveals a regular rate and rhythm without murmurs, rubs, or gallops. The lungs are clear to auscultation bilaterally. Her abdomen measures 35 cm from the pubic symphysis to the uterine fundus. There is no tenderness on palpation. She has 2+ pitting edema bilaterally at her ankles and distal lower legs. The fetal heart rate is 152 bpm. A routine urinalysis is pending. Which aspect of this patient's history and physical exam is most concerning? Elevated diastolic blood pressure Lower extremity edema Occasional flashes of light in her vision Sharp lower abdominal pain

Occasional flashes of light in her vision signs of preeclampsia

35-year-old woman presents to her gynecologist for a follow-up visit to discuss her human papillomavirus (HPV) screening results. Her Pap test report came back positive for low-grade squamous intraepithelial lesion, and her reflex HPV test was negative. She has never had an abnormal HPV screen in the past. Which of the following is the best next step in management? Repeat cotesting in 12 months Repeat cotesting in 5 years Repeat human papillomavirus typing in 12 months Repeat Pap test in 12 months

Repeat cotesting in 12 months In patients ≥ 30 years of age with a Pap test result of low-grade squamous intraepithelial lesion and a negative reflex HPV test, repeat cotesting in 12 months is appropriate

26-year-old woman presents to the ED with sudden-onset pelvic pain, nausea, and vomiting for the past 2 hours. She reports no vaginal discharge or vaginal bleeding. Her medical history is significant for polycystic ovary syndrome. Her serum human chorionic gonadotropin is negative. Which of the following additional physical examination findings is most consistent with the suspected diagnosis? Boggy, tender, enlarged uterus Cervical motion tenderness Fixed, retroverted uterus Right-sided adnexal mass

Right-sided adnexal mass ovarian torsion, hx of ovarian cysts most likely cause torsion

A 47-year-old woman presents to the clinic due to irregular menstrual cycles for the past 6 months. She reports that the time between her menstrual cycles has increased. She also reports hot flashes and difficulty sleeping. Which of the following is the best way to confirm the suspected cause of her symptoms? Serum estradiol Serum follicle-stimulating hormone Serum luteinizing hormone The cause is best identified clinically

The cause is best identified clinically menopausal transition (during transition, hormone can fluctuate and be falsely normal)