smarty pance reproductive
A 29 year-old female presents for routine prenatal visit at 26 weeks gestation. She has no complaints and has completed all the initial routine obstetrical diagnostic tests to date. Her physical examination and all initial diagnostic evaluations are unremarkable. Which of the following is the most appropriate diagnostic test to order at this time?
1-hour post-Glucola blood glucose
During a routine prenatal visit, the fundal height is found to be midway between the pubic symphysis and umbilicus. The number of weeks gestation is estimated to be
16 to 18
On examination of a pregnant patient the physician assistant notes the fundal height is at the level of the umbilicus. This corresponds to what gestational age?
20 weeks
What is the recommended method for screening pregnant women for gestational diabetes?
50 gram glucose load followed by a blood sugar in 1 hour
Dysmenorrhea would most likely occur in which of the following patients?
A 35 year-old woman with regular cycles
In which of the following maternal-fetal blood type pairings should the mother receive Rho-GAM?
AB negative mother, spontaneous abortion
An 18 year-old G1P0 female presents for her 35 week prenatal visit with complaints of headache, blurred vision and right upper quadrant discomfort. Vital signs show BP of 170/100 mmHg and brisk patellar reflexes. Urinalysis shows 3+ proteinuria. Fetal heart tones are 150. What is your next step in the care of this patient?
Admit to hospital and prepare for delivery
It is determined that a woman has a nonexistent rubella titer level during her first trimester of pregnancy. When should she receive the rubella vaccine?
After delivery of the infant
A 54 year-old female comes to your office with the complaint of vaginal itching. Her last menstrual period was three years ago. On examination the patient's vulva is smooth and somewhat shiny; her vaginal mucosa is pale and thin with a mild yellowish discharge with a pH of 6.0. The most likely cause of these symptoms is which of the following?
Atrophic vaginitis
What is the treatment of magnesium sulfate toxicity?
Calcium gluconate
Human papilloma virus has been strongly associated with the development of which of the following?
Cervical carcinoma
Which of the following is recommended to reduce the risk for perinatal transmission of HIV in a patient with a viral load of >1000 copies/mL?
Cesarean section prior to onset of labor and rupture of membranes
On examination of a pregnant patient the physician assistant notes a bluish or purplish discoloration of the vagina and cervix. This is called
Chadwick's sign
Which of the following physical examination findings is present in a 12 week singleton pregnancy?
Chadwick's sign
A patient presents with infertility due to chronic anovulation. Laboratory testing reveals a normal follicle stimulating hormone, estradiol, and prolactin levels. The patient's progestin challenge test was positive. Which of the following is the drug of choice for the treatment of infertility in this patient?
Clomiphene citrate
A 29 year-old female has been diagnosed with infertility due to anovulation. Her provider suggests using a medication that will block the feedback inhibition of estradiol on the hypothalamus and pituitary leading to an increase in FSH. Which of the following medications is the most appropriate for this patient?
Clomiphene citrate (Clomid)
A 40 year-old female presents with a Pap smear abnormality revealing atypical glandular cells (AGUS). What is the most appropriate intervention?
Colposcopy and endometrial sampling
A 33 year-old female presents for follow-up of her Pap smear that showed cervical dysplasia. Which of the following is the most appropriate diagnostic procedure?
Colposcopy-directed biopsy
A 56 year-old female presents to the clinic wanting testing for ovarian cancer. Her best friend was just diagnosed with Stage 4 primary cancer of the ovary. She denies family history of breast or ovarian cancer. According to screening guidelines, which of the following do you recommend?
Continue her yearly women's health examinations
Which of the following autosomal disorders results from the chromosomal abnormality of trisomy 21?
Down's syndrome
A 26 year-old gravida 0 sexually active female presents to the emergency room complaining of colicky pain in her lower abdomen for the past 12 hours. She passed out earlier in the day while trying to have a bowel movement. Her last menstrual period was 6 weeks ago. She has noted vaginal spotting over the last 24 hours. Vital signs show Temp 37 degrees C, BP 96/60mmHg, P 110, R 16, Oxygen Sat. 98%. Abdominal exam is positive for distension and tenderness. Bowel sounds are decreased. Pelvic exam shows cervical motion and adnexal tenderness. Which of the following is the most likely diagnosis?
Ectopic pregnancy
To relieve dependent edema in a pregnant patient, which of the following should be instituted as treatment?
Elevate the legs
A 25 year-old female presents with constant premenstrual pelvic pain. She also notes dysmenorrhea and dyspareunia. Which of the following is the most likely diagnosis?
Endometriosis
A 26 year-old monogamous female presents with cyclic pelvic pain that has been increasing over the last 6 months. She complains of significant dysmenorrhea and dyspareunia. She uses condoms for birth control. On physical examination her uterus is retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative. Which of the following is the most likely diagnosis?
Endometriosis
A 35 year-old female presents with a solitary breast mass. Fine needle aspiration reveals bloody fluid with no malignant cells. What is the next best step in the care of this patient?
Excisional biopsy
Which of the following clinical manifestations is common in candidal vulvovaginitis?
Extreme vulvar irritation
A 40 year-old female presents with a 1.5 cm well-circumscribed mass noted on mammography in the right upper, outer quadrant. Which of the following procedures is most appropriate and should be done next?
Fine needle aspiration
Which of the following tests is the most specific for the diagnosis of syphilis?
Fluorescent treponemal antibody absorption (FTA-ABS)
A 32 year-old female complains of severe irritability and emotional lability accompanied by weight gain, breast tenderness, and headache starting mid-cycle each month and abating with the onset of menses. She has tried relaxation therapy, exercise, dietary changes and over the counter pharmacologic interventions with minimal relief of her symptoms. Which of the following prescription medications is the best choice to relieve her symptoms?
Fluoxetine (Prozac)
Which of the following prenatal vitamins has been shown to decrease the risk of neural tube defects?
Folic acid
A 21 year-old obese woman complains of menstrual irregularity since menarche at age 17. She is 5'5" and weighs 180 pounds. Exam of her face reveals excessive hair growth as well as acne. Her abdomen shows midline hair growth and truncal obesity. A previous pelvic ultrasound shows many small fluid filled ovarian cysts bilaterally. Which of the following is the most appropriate diagnostic study to make the initial diagnosis in this patient?
Free testosterone
A 30 year-old female presents to the clinic for her 6 week post partum examination. She was diagnosed with gestational diabetes mellitus during her pregnancy and was successfully treated with diet alone. Which of the following patient education statements is most appropriate for this patient?
Glucose testing every 1-3 years is recommended
A 35 year-old female presents with multiple ulcerative lesions on her labia and perineum. A Tzanck preparation of one of the lesions reveals multinucleated giant cells. Which of the following is the most likely diagnosis?
Herpes Simplex Virus (HSV)
Which of the following is the most common manifestation of polycystic ovarian syndrome?
Hirsutism
A 16 year-old nulliparous acutely ill female presents with bilateral lower abdominal pain. She has a temperature of 100.4 degrees F and on examination has a tender, enlarged left adnexa. Cervical culture is positive for Chlamydia. Ultrasound reveals a complex tubular structure in the left adnexal area. What is the recommended treatment?
Hospitalization with parenteral doxycycline and cefoxitin
A 46 year-old G4P4 African American female presents to the clinic complaining of heavy and prolonged menstrual flow over the past 6 months. Gynecological history includes menarche age 12 and LMP 3 weeks prior. Pelvic exam reveals a 14-week size, irregular uterus. Pelvic ultrasound shows the presence of a large intramural fibroid with normal endometrial lining. Which of the following is the most appropriate management for this patient?
Hysterectomy
What is the primary treatment for an infected Bartholin's duct cyst?
Incision and drainage
On physical examination of a pregnant patient, which can be considered a normal finding?
Increased second heart sound split with inspiration
A 22 year-old G1P0 female presents at 12 weeks gestation with 24 hours of vaginal bleeding. She complains of continued cramping and bleeding requiring pad change every two hours. Vital signs are normal. Vaginal examination shows bleeding with a dilated cervix. Which of the following is the most likely diagnosis?
Inevitable abortion
A 25 year-old female, G2 P1001, presents to your office at 11-weeks gestation with vaginal bleeding, mild lower abdominal cramping, and bilateral lower pelvic discomfort. On examination, blood is noted at the dilated cervical os. No tissue is protruding from the cervical os. The uterus by palpation is 8-9 weeks gestation. No other abnormalities are found. Which of the following is the most likely diagnosis?
Inevitable abortion
A pregnant 28 year-old female presents at 30 weeks gestation complaining of fatigue and headache. Her vital signs and physical examination are normal. Routine hemoglobin screening is 10.1 g/dL. Peripheral smear shows microcytic, hypochromic red blood cells. Besides the physiologic dilution of pregnancy, what type of anemia is most likely in this patient?
Iron deficiency
A 29 year-old female G1P1 presents to the office with a one-month history of amenorrhea and a positive home pregnancy test. The first day of her last menstrual period (LMP) was April 4. Using Nägele's rule what is her EDC?
January 11
A 25 year-old female presents with vulvar pruritus and a thick, white vaginal discharge. Which of the following tests will be most helpful in making the correct diagnosis?
KOH prep
A 24 year-old sexually active woman presents to the clinic complaining of dysmenorrhea, dyspareunia and backache that occurs premenstrually. Pelvic examination shows pain upon uterine motion and uterosacral nodularity in the posterior vaginal fornix. The definitive diagnosis for this patient requires which of the following?
Laparoscopy with biopsy
A 30 year-old female presents to the emergency room having passed out at home 30 minutes prior to arrival. Her last menstrual period was 6 weeks ago and pregnancy test was reported positive 5 days ago. She started having vaginal bleeding last night. Vital signs are BP 70/40 mmHg, P 140 bpm, R 22. She is pale and diaphoretic. The next step in the evaluation of this patient's condition should be which of the following?
Laparotomy
A 47 year-old female presents to the clinic with complaints of prolonged, heavy menses that have been getting progressively worse for 3 years. She denies any pain. On physical examination, enlargement of the uterus with multiple smooth, spherical, firm masses is noted. A CBC is consistent with a mild anemia. Which of the following is the most likely diagnosis?
Leiomyoma
A 25 year-old G2P2 married female presents to the clinic for birth control counseling. Her past history includes deep vein thrombosis with her last pregnancy. She does not want another pregnancy for at least 4 years. The birth control method that would be best for this patient is which of the following?
Levonorgestrel releasing IUD
At the time of ovulation in a normal menstrual cycle, there is a peak in the serum concentration of which of the following?
Luteinizing hormone
A 36-week pregnant patient presents to the ED with hypertension. Physical examination reveals 2+/4+ edema in the lower extremities with hyperreflexia and clonus bilaterally. A urinalysis reveals 3+ protein. Which of the following is the best treatment option for this patient?
Magnesium sulfate
A female patient presents with a vaginal discharge that has a fishy odor. On wet mount examination of the discharge a few white blood cells and many stippled epithelial cells are noted. Which of the following is the treatment of choice for this patient?
Metronidazole
A 16 year-old G0P0 patient presents complaining of lower pelvic pain that alternates from right to left side of her pelvis. She states that it is related to her cycle and occurs most commonly midcycle. She denies sexual activity. She reports that she has taken ibuprofen at the time of the discomfort with some relief. Her pelvic examination is unremarkable. Which of the following is the most likely diagnosis?
Mittelschmerz
A 28 year-old woman is complaining of heavy uterine bleeding and pelvic pressure that has progressively worsened over the past year. Evaluation reveals multiple moderate-sized uterine fibroids. The patient desires to have more children. The most appropriate definitive treatment is
Myomectomy
On rectovaginal examination of a 72 year-old post-menopausal female a 3 cm by 3 cm right adnexal mass is palpated. The rest of her physical examination is unremarkable. Her last gynecological examination was last year and was unremarkable. Which of the following is the most likely diagnosis?
Ovarian cancer
What phase of the female menstrual cycle occurs at the time of elevated estrogen and LH/FSH surge?
Ovulation
When is the recommendation for the next Pap smear in a 36 year-old patient with a history of 3 consecutive negative annual Pap smears and no history of cervical dysplasia?
Pap smear in 3years
Colposcopic examination of the cervix of a 38 year-old woman with a high-grade lesion on Papanicolaou (Pap) smear yields a positive endocervical canal curettage (ECC) as its only abnormality. Which of the following is the most appropriate next step in this patient?
Perform a conization of the cervix
Treatment of the patient with Pediculosis pubis consists of which of the following?
Permethrin (Nix) cream
A 30-week pregnant patient presents with sudden onset of profuse, painless vaginal bleeding. Which of the following is the most likely diagnosis?
Placenta previa
What is the most common cause of secondary amenorrhea?
Pregnancy
Which of the following best describes the purpose of intravenous magnesium sulfate in patients with preeclampsia?
Prevention of convulsions
A couple presents having not been able to conceive over the past 12 months. Evaluation of the male has been normal. The female has had regular menses. Ovulation can be confirmed with mid-luteal phase measurement of which of the following?
Progesterone
What is the initial treatment of choice for hyperthyroidism in a 10-week pregnant patient?
Propylthiouracil (PTU)
A 72 year-old female presents with vulvular pruritus for the last nine months, which has progressively worsened over the last two months. She states that she went through menopause at age 54 and has been on estrogen and progesterone therapy since that time. Physical examination reveals red lesions with white plaques on the vulva. What should the next course of management include?
Refer to a gynecologist for biopsy
Pharmacologic treatment of a patient with gestational diabetes should consist of which of the following?
Regular insulin
Patient education for a 23 year-old using oral contraceptives should include which of the following?
Rifampin may decrease the effectiveness of the oral contraceptives
Your patient has just delivered her baby vaginally without difficulty. The patient has a laceration of the vaginal mucosa including the perineal body. You repair it without difficulty. On the chart you document this as what type of tear?
Second degree
Maternal blood pressure normally decreases the most during what period of pregnancy?
Second trimester of pregnancy
If a woman has a normal 28-day menstrual cycle what tissue and hormonal phase occurs during the last 14 days?
Secretory luteal phase under the influence of estrogen and progesterone.
What should be the initial evaluation of the etiology of infertility in a 25 year-old female who has been trying to conceive for 1 year?
Serum progesterone levels
Mastitis associated with breastfeeding is most commonly caused by what bacteria?
Staphylococcus aureus
A 26 year-old woman requests screening after her boyfriend was treated for a sexually transmitted infection recently. On examination you find a painless vulvar ulcer. Which of the following is the most likely diagnosis?
Syphilis
A 35 year-old G2P1001 female presents to the office at 11 weeks gestation with vaginal bleeding, mid-lower abdominal cramping, and bilateral lower pelvic discomfort. On examination, bright red blood is seen coming from the cervical os. The cervix is closed. The uterus is 9-11 weeks in size by palpation. Her blood pressure is 120/70 mmHg and her pulse rate is 96. What is the patient's most likely diagnosis?
Threatened abortion
A 56 year-old female patient comes to the office for evaluation. She complains of dyspareunia and a thin vaginal discharge. On physical examination atrophic vulvar changes are noted associated with vaginal petechiae and a thin clear discharge. What medication is recommended to treat this patient's symptoms?
Topical estrogen (Estrace) cream
A 52 year-old obese patient with persistent heavy menses undergoes an endometrial biopsy and is diagnosed with atypical adenomatous hyperplasia. What is the next step in the management of this patient?
Total abdominal hysterectomy
A 25 year-old presents with pelvic pain and uterine bleeding. Her Beta-HCG was 1200 mIU/L six days ago. Her current Beta-HCG is 1600 mIU/L. What is the next best test in the evaluation of this patient?
Transvaginal ultrasound is the best test to separate ectopic from intrauterine pregnancy.
An 18 year-old female comes to the clinic with the complaint of increased vaginal discharge and vaginal odor. She also complains of urinary frequency. On physical examination there is evidence of a green-yellow, frothy, malodorous discharge in the vagina. The cervix appears erythematous and the vaginal pH is 6. Which of the following is the most likely diagnosis?
Trichomonas vaginitis
A 30 year-old presents with persistent vaginal discharge and vulvar pruritus. The discharge is profuse, frothy, greenish, and foul smelling. pH of the vagina is 6.0. Which of the following is the most likely diagnosis?
Trichomoniasis
A 25 year-old female presents for a routine gynecological examination. You palpate a 2 cm breast mass in her right breast. Her menstrual period was last week. She has no family history of breast cancer. What is the modality of choice to further evaluate her breast mass?
Ultrasound
You are performing a routine gynecological examination on a 49 year-old female. She states that for the last six months her periods have been getting heavier and lasting for seven days duration. She also tells you that she has been experiencing urinary frequency and constipation. Her abdominal exam is unremarkable. On pelvic examination you feel a slightly enlarged uterus and a left adnexal mass that moves with the uterine fundus. Which of the following is the most likely diagnosis?
Uterine fibroids
A 48 year-old G3P3003 female presents to the office complaining of severe secondary dysmenorrhea and menorrhagia over the last 6 months. On physical examination her uterus feels enlarged and irregular. Which of the following is the most likely diagnosis?
Uterine leiomyomata
A 23 year-old female is in active labor and has progressed from 3 cm to 6 cm in the last six hours. Fetal monitoring demonstrates mild repetitive late decelerations. Which of the following is the most likely cause of this finding?
Uteroplacental insufficiency
Which of the following is the most common presenting clinical manifestation of breast cancer?
breast mass
A 32 year-old female G4P4 with a history of multiple sexual partners is seen in follow-up for recent findings of high grade squamous intraepithelial lesions (HSIL) on a Pap smear. Which of the following is the most appropriate next step?
colposcopy with endocervical curettage
Which of the following is the most significant factor in the production of menopausal symptoms?
decrease in estrogen
A 30 year-old female presents to the emergency department with a syncopal episode. She has a history of irregular menstrual cycles and infertility. She has scanty, persistent vaginal bleeding and sharp pelvic pain. A left adnexal mass is palpated. The most likely diagnosis is
ectopic pregnancy.
Which of the following is the earliest and most reliable clinical manifestation of pre-eclampsia?
elevation of blood pressure
A 65 year-old postmenopausal female presents with complaints of new onset of vaginal bleeding. She relates a history of two episodes of vaginal bleeding during the past month, each lasting about four days. Which of the following diagnostic evaluations is the most reliable to evaluate the suspected diagnosis?
endometrial biopsy
A patient with preterm labor may be given corticosteroids to
enhance fetal lung maturity
Which of the following is associated with meconium-stained amniotic fluid during labor?
fetal distress
A 22 year-old G0P0 asymptomatic female is seen for her yearly gynecologic examination. She denies performing self-breast exams and any family history of breast or gynecologic cancers. On palpation of her left breast, a solitary 1 cm rubbery, firm, well-circumscribed, non-tender breast mass is noted. In review of her records, similar findings were noted on last year's examination. Which of the following is the most likely diagnosis?
fibroadenoma
Progesterone influence on the breast tissue prior to menstruation causes
growth of the lobules and alveoli.
Which of the following is a major risk factor for an ectopic pregnancy?
history of salpingitis
Which of the following is a contraindication to prescribing oral hormonal contraceptives?
history of smoking in a patient older than age 35
An 18 year-old female presents with 2-day duration of dysuria, vulvovaginal pruritus, and a green-yellow, frothy, malodorous discharge. Punctate hemorrhages are visible on the vagina and cervix. Which of the following results would be expected?
mobile flagellated protozoa on a normal saline preparation
An increased incidence of breast cancer is associated with
nulliparity
A decrease in the fetal heart rate (FHR) occurring late during contractions is noted. The FHR returns to the baseline slowly after the uterine contraction. The physician assistant should be alerted to the possibility of
placental insufficiency.
A 13 year-old female presents with a six month history of lower mid-abdominal pain that is spasmodic in nature and radiates to the inner thighs. The pain usually starts within a few hours of the onset of menses and lasts about 2 days. The patient's menarche began 2 years ago. She denies any sexual activity. Physical examination, including pelvic, is unremarkable. Which of the following is the most likely diagnosis?
primary dysmenorrhea
27 year-old G1P0 female presents complaining of painless spotting since this morning. She is known to be 12 weeks pregnant. Pelvic examination reveals the presence of blood within the vagina with a closed cervical os. The uterus is consistent with a 10-12 week gestation and nontender to palpation. Which of the following is the most likely diagnosis?
threatened abortion
Which of the following is the most common underlying cause of early postpartum hemorrhage?
uterine atony
A 24 year-old female presents with complaints of dysuria associated with fever, malaise, myalgias and headache for the past 3 days. Today she noticed some lesions on her genitalia. Physical examination reveals the presence of multiple clear vesicles and erythematous ulcers with tender bilateral inguinal adenopathy. Which of the following is the most appropriate treatment for this patient?
valacyclovir (Valtrex)
