Women's Health

What substance must be avoided during metronidazole therapy? a) Nuts b) Seafood c) Alcohol d) Dairy

Alcohol

A 17-year-old girl is seen in clinic due to complaints of excessive body hair. She denies taking any medication. She has irregular menses and denies sexual activity. On exam, her BMI is 31, with moderate hirsutism on upper lip and chest, moderate acne on her face, Tanner 5 breasts and pubic hair. The rest of her exam findings are normal. Which of the following is an expected laboratory finding? a) Increased luteinizing hormone b) Increased cortisol c) Increased follicle-stimulating hormone d) Increased thyroid-stimulating hormone

a) Increased luteinizing hormone (PCOS = While many women with PCOS still have LH and FSH still within the 5-20 mlU/ml range, their LH level is often two or three times that of the FSH level. This situation is called an elevated LH to FSH ratio or a ratio of 3:1. This change in the LH to FSH ratio is enough to disrupt ovulation. While this used to be considered an important aspect in diagnosing PCOS, it is now considered less useful in diagnosing PCOS, but is still helpful when looking at the overall picture.)

A 24 year old woman presents to your office 6 months postpartum. She delivered by cesarean section elsewhere and is nursing full time. She has been living in a homeless shelter and has not had an examination since her delivery. She denies sexual intercourse since the delivery but is concerned because she has not started to menstruate. On examination, galactorrhea is present bilaterally. Her abdominal incision appears well-healed. On pelvic examination, the vaginal walls and external genitalia appear slightly atrophic. The uterus and adnexa are unremarkable. Her pregnancy test is negative. The most likely explanation for her amenorrhea is: a) Scarring of the uterus (Asherman's syndrome) b) A false negative pregnancy test c) Anovulation secondary to breast feeding d) Anovulation secondary to stress

c) Anovulation secondary to breast feeding

A 56 yr old woman complains of vaginal irritation and dyspareunia for the past week. Physical examination reveals vaginal mucosal erythema, a cystocele, and a scant, pink-tinged discharge in the vaginal vault. Urinalysis is significant only for microscopic hematuria. Which of the following is the most likely diagnosis? a) Vaginal candidiasis b) Bacterial vaginosis c) Trichomonas vaginalis d) Atrophic vaginitis

d) Atrophic vaginitis

A 23-year-old woman presents with pain in in the suprapubic area and right lower quadrant of her abdomen that began 4 hours ago. She denies vagina discharge and vaginal bleeding. Her vital signs are BP 115/65, HR 60, RR 12, and T98.1°F. Her last menses was one week ago. Which of the following diagnostic tests should be obtained first? a) Gonorrhea and chlamydia DNA amplification b) Urinalysis c) Complete blood count d) Urine beta-hCG

d) Urine beta-hCG

A 36 year old nulliparous female complains of lower abdominal pressure, bloating, heavy vaginal bleeding, and dysmenorrheal for the past 1 year. On physical exam, the uterus is enlarged with multiple, nontender, discrete, firm irregular masses. What is the most likely diagnosis? a) Uterine carcinoma b) Endometriosis c) Endometrial polyps d) Uterine leiomyomas

d) Uterine leiomyomas (aka uterine fibroids)

In a hemodynamically stable pregnant patient with an ectopic pregnancy, what medication is recommended for medical management? a) Pelvic ultrasound series b) Methotrexate c) Watchful waiting d) Laparoscopy

*Methotrexate* (Methotrexate is a type of medicine that stops cells from dividing. It can be used as a way (other than surgery) to treat a pregnancy that's impla​nted outside the uterus (ectopic pregnancy).

Primary amenorrhea may be diagnosed by age 15 years. What should be present for this diagnosis? Select all that apply. 1. Normal growth 2. Presence of secondary sexual characteristics 3. Elevated testosterone level 4. Hyperprolactinemia

1. Normal growth 2. Presence of secondary sexual characteristics

What differentiates pelvic pain from abdominal pain? 1. Pain below the umbilicus is pelvic pain 2. Duration of pain 3. Gender specific 4. Age of the patient

1. Pain below the umbilicus is pelvic pain

When are teratogenic risks the greatest to the fetus? a) 16-20 weeks b) 0-4 weeks c) 4-12 weeks. d) 20-24 weeks

4-12 weeks.

How many days after implantation is beta-hCG detectable? a) 20 days after implantation b) 1-2 days after implantation c) 7-8 days after implantation d) 30 days after implantation

7-8 days after implantation

At what age should breast cancer screening for women without risk factors stop? a) 65 years b) 80 years c) 50 years d) 74 years

74 years

A 37 year old woman is delighted when she comes into your office because her home pregnancy test was positive. Her last menstrual period was 7 weeks ago, and she and her husband had been attempting pregnancy for the past 3 years. She does report a small amount of spotting in the past week. On examination, her uterus is not enlarged. Her urine pregnancy test in your office was also positive. Your next laboratory tests would include a) A quantitative serum hCG and a transvaginal ultrasound b) A qualitative serum hCG and an abdominal ultrasound c) A qualitative serum hCG and a transvaginal ultrasound d) A quantitative serum hCG and an abdominal ultrasound

A quantitative serum hCG and a transvaginal ultrasound

The primary risk factor for development of breast cancer in women of average risk is: A) age. B) smoking history. C) number of live births. D) exposure to estrogen.

A) AGE Explanation: Age is the most important risk factor for developing breast cancer in women of average risk. Breast cancer is more common in older women and has a higher mortality rate when discovered. Nearly 85% of breast cancer occurs in women who are 50 years of age or older. Exposure to estrogen and genetic factors are important risk factors but do not contribute to development of breast cancer as greatly as age does in women of average risk. Hence, the reason for diligent annual screening in women who are 50 years of age and older.

A young female adult presents with vaginal discharge and itching. Besides trichomoniasis and yeast, what else should be included in the differential? A) Bacterial vaginosis B) Chlamydia C) Herpes genitalis D) Syphilis

A) Bacterial vaginosis Explanation: The most common cause of vaginal discharge in women of child-bearing age is bacterial vaginosis. The most common presentation is a complaint of vaginal discharge with a fishy odor, most noticeable after sexual intercourse. The vaginal discharge is cream colored and thin. Chlamydia produces a discharge but it is not reported as pruritic. Herpes does not produce a discharge. Syphilis produces a lesion.

Which form of birth control presents the highest risk to a female patient if she is exposed to a sexually transmitted disease (STD)? A) Intrauterine device B) Progestin only pill C) Diaphragm D) Oral contraceptives

A) Intrauterine device Explanation: Exposure to an STD always increases the likelihood of contracting an STD. However, the patient is at very high risk of developing pelvic inflammatory disease when there is an implanted foreign body. An example of this is an intrauterine device (IUD). The risk is also increased with a diaphragm, but, because it is not implanted for long periods at a time, the risk is less than with an IUD

24 year-old female patient who is sexually active complains of vaginal itching. If she has bacterial vaginosis, she might complain of: A) a "fishy" vaginal odor after coitus. B) a truncal rash. C) copious vaginal discharge. D) mid-cycle bleeding.

A) a "fishy" vaginal odor after coitus. Explanation: Bacterial vaginosis is a clinical syndrome where high concentrations of anaerobic bacteria replace normal vaginal flora. This produces many symptoms that cause complaints in women. The typical symptoms are a "fishy" odor emanating from the vagina, itching, and vulvovaginal pruritis and burning. A typical complaint is an unpleasant odor after coitus.

Athletic amenorrhea increases the risk of: A) osteoporosis. B) an eating disorder. C) covert hypothyroidism. D) breast cancer.

A) osteoporosis. Explanation: Athletic amenorrhea creates states of prolonged hypoestrogenemia. This results in an increased risk of osteoporosis.

A 13 year old girl has been menstruating for about 1 year without any difficulties. For the past 2 months, however, she has experienced cramping and diarrhea for the first 2 days of her periods severe enough to keep her out of school. She states she has never had sexual intercourse. Her physical examination is normal. What should be the next step in managing this patient? a) Perform a work-up for possible pelvic pathology b) Prescribe oral contraceptives c) Tell her that menstrual discomfort is a normal part of life d) Advise her to start a NSAID just before menses

Advise her to start a NSAID just before menses

Risk factor/s for ectopic pregnancy include: a) Tubal surgery b) PID c) Prior ectopic d) All of the answers are correct

All of the answers are correct

What is expected in a normal pregnancy? a) Serum ß-hCG: b) Transvaginal ultrasound: IUP visualized when ß-hCG > 1500 c) All of the answers are correct d) Transabdominal ultrasound: IUP visualized when ß-hCG > 4000 e) Doppler heart tone at 10 weeks

All of the answers are correct

What is/are the pharmacologic treatment for premenstrual syndrome? a) OCPs b) All of the answers are correct c) SSRIs d) NSAIDs

All of the answers are correct

In the absence of a structural or infectious cause, abdominal cramps due to primary dysmenorrhea is primarily caused by which of the following? a) anoxia brought on by prostaglandins b) contractions c) uteirne vasoconstriction d) All the answers are correct

All the answers are correct

What is the immediate treatment for postpartum hemorrhage? a) Methyprostaglandin b) Bimanual massage c) IV Pitocin d) All the answers are correct

All the answers are correct

What urinary symptoms typically accompany the vaginal symptoms of atrophic vaginitis? a) All the answers are correct b) Urinary frequency c) Recurrent infections d) Dysuria

All the answers are correct

What are the most common complications of a molar pregnancy? a) Preeclampsia/eclampsia b) All the answers are correct c) Hyperemesis gravidarum d) Pulmonary embolism

All the answers are correct (Molar pregnancy = A noncancerous tumor that develops in the uterus as a result of a nonviable pregnancy.)

A 39 year old woman presents to her gynecologist with a 10 month history of dysmenorrhea and menorrhagia. She has a prior medical history of hypertension. She takes no medications. Pelvic examination reveals an enlarged uterine fundus. What is the most appropriate management for this condition? a) Patient should be started on a trial of a gonadotropin-releasing hormone agonist b) An endometrial biopsy should be performed c) Patient should be followed annually to monitor symptom progression d) A total abdominal or vaginal hysterectomy should be performed

An endometrial biopsy should be performed

The presence of which of the following best differentiates premenstrual syndrome from premenstrual dysphoric disorder? a) Anger and irritability b) Mood swings and other mood changes c) Serotonin dysfunction d) Confusion and other cognitive changes

Anger and irritability = dysphoric

This type of bleeding is caused by the failure of the corpus luteal cyst to form leading to absence of progesterone and unopposed estrogen stimulation on the endometrium a) Ovulatory b) Postmenopausal c) Placental d) Anovulatory

Anovulatory

What is an average physiologic change in a pregnant woman vs. a nonpregnant woman? a) Decreased cardiac output and blood volume b) BP increases in 2nd trimester c) Approximate increase of 10 to 15 beats/minute in pregnancy d) Respiratory alkalosis in 1st trimester

Approximate increase of 10 to 15 beats/minute in pregnancy

Where is the uterine fundus palpable at 36 weeks gestation? a) Between the umbilicus and xiphoid process b) At the xyphoid process c) Between the pubic symphysis and umbilicu d) At the umbilicus

At the xyphoid process

What is the treatment of choice for a pregnant women with chlamydia infection? a) Metronidazole b) Azithromycin c) Ciprofloxacin d) Penicillin

Azithromycin

A 25-year-old woman presents to your clinic with concerns about sexually transmitted infections. She admits to unprotected sex with multiple partners. She is asymptomatic, but her last partner told her that he recently tested positive for chlamydia. The most appropriate next step is administration of which of the following? a) Azithromycin b) Metronidazole c) Ciprofloxacin d) Penicillin

Azithromycin = chlamydia (cef = gonorrhea)

A 15-year-old girl presents to clinic with vaginal discharge. She recently became sexually active but states that her partner does not have any symptoms of infection. Speculum examination reveals white discharge and an erythematous cervix. Bimanual examination is unremarkable. Urine PCR is positive for Chlamydia trachomatis. Which of the following is the most appropriate treatment options? a) Azithromycin b) Ciprofloxacin and ceftriaxone c) Correct! d) Azithromycin and ceftriaxone e) Ceftriaxone, amoxicillin and metronidazole

Azithromycin and ceftriaxone

A young female has breast buds bilaterally. This represents Tanner Stage: A) 1 B) 2 C) 3 D) 4

B) 2 Explanation: Tanner Stage II is characterized by the formation and presence of breast buds, small areas of surrounding glandular tissue, and widening of the areola.

A patient who is scheduled for pelvic exam with PAP smear should be advised to avoid douching, sexual intercourse, and tampon use before her exam. For how long should she be advised to avoid these activities for optimal evaluation? A) 24 hours B) 48 hours C) 36 hours D) One week

B) 48 hours Explanation: The general recommendation is to avoid these activities and any vaginal medication for 48 hours prior to PAP smear. Douching and tampon use can remove superficial cells which are the ones collected and used as representative samples on PAP smear. Sexual intercourse should be avoided because there can be specimen contamination by the male partner and semen can make the smear thick and difficult to read. With vaginal medications or creams, either can serve as a barrier to epithelial cell sampling.

In collection of a specimen for a PAP smear, how is the endocervical specimen collected? A) After the ectocervical specimen with a broom B) After the ectocervical specimen with a brush C) Before the ectocervical specimen with a broom D) Before the ectocervical specimen with a brush

B) After the ectocervical specimen with a brush Explanation: Ectocervical specimens are collected first to minimize any bleeding that can occur from endocervix when it is sampled. The brush is considered a superior tool for collection of endocervical specimens because it produces the highest yield of endocervical cells, and thus, is a good reflection of the health of the cervix. Alternatively, a cervical broom can be used to collect cells. It collects endocervical cells and ectocervical cells simultaneously. It is rotated for 5 turns before the samples are placed on the slide. This may be used in pregnant women.

A 16 year-old female is diagnosed with primary dysmenorrhea. She has taken over the counter ibuprofen in 800 mg increments every 8 hours during menses for the past 3 months with minimal relief of symptoms. What intervention will provide greatest relief of dysmenorrhea symptoms? A) Flurbiprofen during menses B) Combined oral contraceptives C) Daily multivitamin with B12 supplementation D) 30 minutes of regular exercise daily

B) Combined oral contraceptives Explanation: NSAIDs and hormonal contraceptives represent the mainstay of pharmacologic treatment for dysmenorrhea. NSAIDs produce an 80-86% response rate when used for dysmenorrhea. The general recommendation is that when one agent (NSAIDs or hormonal contraceptives) does not produce relief of symptoms, the other agent should be tried. Hence, the best choice is oral contraceptives. Both agents should be considered for women who are symptomatic with one agent only.

An adolescent female has had normal menses for almost 2 years. She has not had menses in 3 months. She is diagnosed with polycystic ovarian syndrome (PCOS). What else is a common finding? A) Obesity B) Elevated insulin levels C) Positive pregnancy test D) Elevated blood pressure

B) Elevated insulin levels Explanation: PCOS is a systemic disease characterized by multiple cysts about the ovaries. Overweight states are common but not obesity. Normal weight is also seen in these patients. This patient will not have a positive pregnancy test unless she is pregnant. There is no indication from the information that this is the case. She likely has had not had menses because of anovulation. There is no associated blood pressure elevation, though this should be watched closely. Elevated insulin levels are usual findings in patients who have PCOS.

An initial pharmacologic approach to a patient who is diagnosed with primary dysmenorrhea could be: A) acetaminophen. B) NSAIDs at the time symptoms begin or onset of menses. C) NSAIDs prior to the onset of menses. D) combination acetaminophen and NSAIDs

B) NSAIDs at the time symptoms begin or onset of menses. Explanation: Pain associated with dysmenorrhea is likely due to prostaglandins which can cause prolonged contraction of the uterus. This produces uterine ischemia, sometimes termed "uterine angina". NSAIDs (non-steroidal anti-inflammatory drugs) are prostaglandin synthesis inhibitors. These are usually started at the onset of menses or onset of symptoms and continued for 2-3 days depending on the symptom pattern of the patient. There is no demonstrated increase in efficacy when acetaminophen is added or given alone.

A patient who is 35 years old has identified a small, discrete mass in one breast. How should this be evaluated? A) Ask whether the mass changes at the time of menses. B) Order a mammogram and ultrasound to assess the mass. C) Have her return 3-10 days after next menses. D) Order a mammogram 3-10 days after next menses.

B) Order a mammogram and ultrasound to assess the mass Explanation: Clinical evaluation of a breast mass begins with a good history of the mass and a physical exam of the breasts, lymph nodes, neck, and chest wall. While asking about whether the mass changes with menses is a good question in history, a mammogram should be the first radiographic assessment in females with breast complaints who are over age 30. This patient is 35 years old. An ultrasound is used for evaluation of a focal abnormality in a breast, especially if it has been identified on a mammogram. In this patient, both are prudent since there is a discrete, palpable mass. Re-assessing the mass 3-10 days after next menses may be appropriate for a female younger than age 30 depending on her history and physical exam.

A 54 year-old female presents with a small to moderate amount of vaginal bleeding of recent onset. She has been postmenopausal for approximately 2 years. What diagnosis is least likely? A) Endometrial carcinoma B) Ovarian cancer C) Endometrial hyperplasia D) Uterine polyps

B) Ovarian cancer Explanation: Ovarian cancer may present as an adnexal mass, pelvic or abdominal symptoms and a variety of others. Postmenopausal bleeding (PMB) is a very uncommon presentation of ovarian cancer, but can present this way. In women with PMB, other causes of uterine pathology should be evaluated before considering ovarian pathology. In early menopause, the most common etiology is atrophy of the endometrium or vaginal mucosa. This patient is postmenopausal for approximately 2 years. Other common causes of PMB are polyps, fibroids, and endometrial hyperplasia.

A 28 year-old female presents with a slightly tender 1.5 cm lump in her right breast. She noticed it two days ago. She has no associated lymphadenopathy and there is no nipple discharge. How should she be managed? A) Mammogram B) Ultrasound and mammogram C) Re-examination after her next menses D) Clinical exam only

B) Re-examination after her next menses Explanation: Women who are less than age 35 years, who have no associated suspicious findings of breast cancer should delay imaging studies until re-examination 3-10 days after the last menstrual period to determine whether the lump changes in size or becomes non-palpable. If there are associated suspicious findings on exam like palpable nodes, a large lump (>2.0 cm), or nipple discharge, then diagnostic evaluation should not be delayed. If management involved a return visit for re-examination after menses, and the lump is unchanged, ultrasound is certainly advised. Mammogram may not yield good information in a 28 year-old because of the density of the breast tissue. Baseline mammogram may be advised. Direction from a radiologist or breast surgeon should be sought.

A 20 year old female reports that her grandmother and mother have osteopenia. What should she be encouraged to do to reduce her risk of osteopenia? A) Aerobic exercise, weight loss, low fat diet B) Smoking cessation, weight bearing exercise C) Calcium supplementation, vitamin A, C & D intake D) Optimal caloric intake, vitamin D supplementation

B) Smoking cessation, weight bearing exercise Explanation: Cigarette smoking accelerates skeletal bone loss. The mechanism is unknown, but, it may be due to increased metabolism of estrogen. Therefore, smoking cessation is important in prevention of osteopenia as well as other diseases and conditions. Exercise should occur at least 30 minutes three times per week to maintain bone density. This has also shown to decrease incidence of hip fractures in older women. Walking increases hip and spine density. Vitamin D (at least 1000 IU per day) and calcium intake (1200-1500 mg per day) should accompany weight bearing exercise and smoking cessation.

15 year-old female has never menstruated. She and her mother are concerned. What is most important for the NP to assess? A) Stature B) Tanner stage C) Anemia D) Family history of amenorrhea

B) Tanner stage Explanation: Tanner staging, or sexual maturity ratings are very predictable changes that occur with puberty. These should be assessed. In females, breasts and pubic hair signify specific pubertal changes that constitute maturation. These are not age specific, but at 15 years a Tanner Stage 3 or more would be characteristic of expected maturation. Menses should follow soon.

After a vaginal exam, a patient received a prescription for metronidazole. What was her likely diagnosis? A) Syphilis B) Trichomonas C) Chlamydia D) Gonorrhea

B) Trichomonas Explanation: Trichomonas can be treated with metronidazole orally. This is usually effective and is generally well tolerated as long as the patient avoids alcohol. Alcohol in the presence of metronidazole can produce a disulfiram reaction. Another medication used to treat trichomonas is tinidazole. The exact mechanism of tinidazole is unknown, but is an antiprotozoal.

A 51 year-old female patient presents with a 2 cm palpable breast mass. How should this be evaluated to determine whether it is solid or cystic in nature? A) Mammogram B) Ultrasound C) MRI D) Clinical breast exam

B) Ultrasound Explanation: The diagnostic test of choice to differentiate a solid from a fluid filled breast mass is ultrasound. More than 90% of breast masses in women in the 20s to early 50s are benign. However, they must be evaluated. Clinical breast exam is unable to differentiate fluid filled from solid masses. MRI is not used unless a history of breast cancer is present. Mammography has the potential to evaluate the presence of a mass, but is of inadequate benefit in assessing whether it is fluid filled or not.

Clue cells are found in patients with: A) leukemia. B) bacterial vaginosis. C) epidermal fungal infections. D) pneumonia.

B) bacterial vaginosis Explanation: The hallmark finding in a patient with bacterial vaginosis (BV) is clue cells on microscopic exam. Clue cells are epithelial cells with adherent bacteria. The most common clinical feature is an unpleasant, "fishy" smelling discharge that is more noticeable after sexual intercourse. BV can produce a cervicitis. It is a risk factor for HIV acquisition and transmission. Metronidazole is the most successful therapy. The usual oral regimen is 500 mg twice daily for 7 days. Alcohol should be avoided.

The clinical syndrome resulting from replacement of normal vaginal flora with anaerobic bacteria is: A) candidal vaginitis. B) bacterial vaginosis. C) pelvic inflammatory disease. D) herpes simplex.

B) bacterial vaginosis. Explanation: Bacterial vaginosis (BV), results when normal vaginal flora such as Lactobacillus sp. are replaced with anaerobic bacteria like Prevotella, Mobiluncus and Gardnerella. This is usually, but not always associated with sexual activity. Women who have never been sexually active are less affected.

A patient asks the NP's advice about an herb to help with her hot flashes. The NP knows these: A) are safe to use in all patients. B) may be contraindicated in patients with history of breast cancer. C) substances have a mild estrogenic effect and will halt hot flashes. D) help prevent osteoporosis.

B) may be contraindicated in patients with history of breast cancer. Explanation: The herb that the patient is asking about is probably black cohosh, Actaea racemosa. It is a phytoestrogen. This means that it provides estrogen from a plant source. If estrogen is contraindicated in a patient, then it does not matter whether it comes from plants or is produced synthetically. There is a potential safety concern in using black cohosh in women with breast cancer or who are at high risk of breast cancer because of the estrogenic effects that are possible on the breasts.

A 16-year-old woman presents with vaginal discharge for 4 days. She describes the discharge as gray and malodorous. She denies any pain or itching. On exam, you note vaginal discharge, but no cervical or adnexal tenderness. Microscopy reveals clue cells. Which of the following is the most likely diagnosis? a) Atrophic vaginitis b) Trichomoniasis c) Bacterial vaginosis d) Candidiasis

Bacterial vaginosis

1. A 4 year-old female is brought in to the clinic by her mother who reports that she is constantly scratching "her private part". The patient states that it itches. On exam, the vagina is red and irritated. How should the NP proceed? A) Call child protection for suspected sexual abuse B) Prescribe a cortisone cream C) Collect a vaginal swab of the external vagina for microscopic evaluation D) Prescribe a topical antifungal

C) Collect a vaginal swab of the external vagina for microscopic evaluation Explanation: This child has a vaginitis. There are many diagnoses in the differential including pinworms, yeast, contact irritants from soap or bubble bath, etc. Since the diagnosis is not clear, some evaluation must occur in order to determine the diagnosis so proper treatment can be initiated. Since the description of the problem does not indicate what the diagnosis is, it is inappropriate to treat with a cortisone cream or topical antifungal.

Three of the following interventions are appropriately used to prevent osteoporosis after menopause. Which one is not? A) Limited alcohol intake B) Performance of weight-bearing activities for 40 mins. at least 5 days/week C) Estrogen replacement therapy D) Adequate calcium & vitamin D intake

C) Estrogen replacement therapy Explanation: Prevention of osteoporosis may be optimized by elimination of risk factors and engaging in interventions that maximize bone density. Good nutrition from infancy throughout adulthood is a major component of good bone health. Others include engaging in weight-bearing exercises, adequate intake of calcium and vitamin D, smoking cessation, limiting alcohol consumption to moderate amounts, and avoidance when possible of medications that may decrease bone density (corticosteroids, anticonvulsants). Osteoporosis occurs at accelerated rates in women who are post-menopausal. The lack of estrogen can produce rapid bone loss due to bone resorption. Estrogen replacement is not used to prevent or treat osteoporosis.

A nurse practitioner identifies filamentous structures and many uniform, oval shaped structures during a microscopic exam of vaginal discharge. These are probably: A) bacteria. B) sperm. C) Hyphae and Yeast D) Candida albicans.

C) Hyphae and Yeast Explanation: Filamentous structures likely describe hyphae. Typically, hyphae are the mechanism that allows fungal growth. The uniform oval shaped structures are likely yeast. These can range in size but are usually large and unicellular. Visualization of hyphae and yeast should prompt an immediate diagnosis of a fungal infection. Candida albicans is a specific fungus, often found in vaginal secretions. Since there are many fungi that can produce hyphae and yeast, it is not possible to diagnose Candida albicans specifically.

A female should be told to take her OCP at bedtime if she experiences: A) weight gain. B) headaches. C) nausea. D) spotting.

C) Nausea Explanation: A common side effect of oral contraceptives is nausea. This is probably related to increased hormone levels (estrogen and progesterone). An easy way to combat nausea is to take the pill before going to sleep at night. Most patients will sleep through the symptom of nausea.

A 70 year-old female has been in a mutually monogamous relationship for the past 33 years. She has never had an abnormal Pap smear, what recommendation should be made regarding Pap smears for her? A) They may be continued annually. B) They should be performed every 5 years. C) can be discontinued now. D) They can be discontinued at age 75 years.

C) can be discontinued now. Explanation: Pap smears screen for cervical cancer. Cervical cancer is very uncommon in older women, especially those who have no risk factors. Most learned authorities agree that screening for cervical cancer can be discontinued in women aged 65-70 years unless there are risk factors (previous GYN cancer, HIV positive). This patient still needs to visit the nurse practitioner for an annual exam but sampling of cervical cells can be discontinued in a patient of this age.

An 84 year-old female patient is a resident in an assisted living facility. She has early dementia. She walks daily and has had urinary incontinence for years. Her urinary incontinence is likely to be: A) urge. B) stress. C) mixed. D) unable to be determined.

C) mixed. Explanation: The most common type of urinary incontinence in women is mixed incontinence. This refers to at least two simultaneous mechanisms. Usually detrusor overactivity and impaired urethral sphincter function are present, giving mixed incontinence characteristics of urge and stress (exertional) incontinence. Stress incontinence is characterized by leakage of urine following sneezing, coughing, or laughing. Urge incontinence is characterized by the sudden urge to urinate that cannot be delayed.

Women who use diaphragms for contraception have an increased incidence of: A) sexually transmitted diseases. B) pregnancy. C) urinary tract infection. D) pelvic inflammatory disease.

C) urinary tract infection. Correct Explanation: The exact mechanism for increased urinary tract infections is unknown, but it is believed to be due to nonoxynol-9 induced changes in vaginal flora. Another consideration is the possible contamination that might accompany insertion before each episode of coitus. Care and cleaning of the diaphragm must take place, or that could be a contributor to increased bacteria.

Which U.S. Food and Drug Administration (FDA) category is defined by the following: Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. a) Category D b) Category C c) Category A d) Category B

Category B

A 26-year-old previously healthy woman presents to the Emergency Department with abdominal pain. She was at home when she developed sudden onset lower abdominal pain followed by a brief syncopal episode. Her vital signs include blood pressure of 88/46 mm Hg, heart rate of 112 beats/minute, respiratory rate of 18 breaths/minute, temperature of 37.6°C, and oxygen saturation of 98%. She had a positive home pregnancy test yesterday. After initiating aggressive resuscitation, what is the most appropriate next step in management? a) Consult Obstetrics and Gynecology b) Pelvic ultrasound c) Obtain a complete blood count d) Obtain a serum human chorionic gonadotropin (hCG) level

Consult Obstetrics and Gynecology

When performing a pelvic exam, which of the following cervical changes would be consistent with pregnancy? a) Cyanotic cervix b) Erythematous cervix c) Strawberry cervix d) Multiparious cervix

Cyanotic cervix

A female patient is 35 years old. She has never had an abnormal PAP smear and has had regular screening since age 18. If she has a normal PAP smear with HPV testing today, when should she have the next cervical cancer screening? A) One year B) 2-3 years C) 3 years D) 5 years

D) 5 years Explanation: American College of Obstetricians and Gynecologists recommends screening for women over age 30 years no more frequently than every 5 years if both tests are negative and adequate screening has taken place. If she had been screened with PAP only, the recommendation for screening would be in 3 years. US Preventive Services Task Force recommends screening this patient in 5 years. Human papilloma virus (HPV) testing in combination with cervical cytology has been shown to be more sensitive than cytology alone. However, HPV alone is not recommended as a lone screening modality. Finally, HPV testing is more specific in women over age 30 years.

The frequency for cervical screening depends on the patient and her age. What is the longest recommended time interval between cervical screens for patients who are 21-65 years of age? A) 1 year B) 2 years C) 3 years D) 5 years

D) 5 years Explanation: Women ages 21-65 who have a cervix should be screened for cervical cancer. Screening intervals every 3 years should take place for women of average risk who are aged 21-29 years. Women aged 30-65 of average risk should take place every 3 years if only cytology is performed; or every 5 years if cytology plus HPV screening takes place. Women who are at increased risk of cervical cancer should be screened more frequently. Increased risk includes females who have had cervical cancer, those who are immunocompromised, or have infection with HIV.

The frequency for cervical screening depends on the patient and her age. What is the longest recommended time interval between cervical screens for patients who are 65 years-old or younger? A) 1 year B) 2 years C) 3 years D) 5 years

D) 5 years Explanation: Cervical screening for women aged 21-29 years should take place every 3 years with cytology only. Women aged > 30 years should be screened every 5 years with cytology and HPV. Generally, women who have been adequately screened do not need screening beyond age 65 years.

A 50 year-old female believes that she is "menopausal". She complains of "hot flashes" and has not had menses in 12 months. Which of the following test results may be helpful for confirmation of menopause? A) Increased thyroid stimulating hormone B) Decreased follicle stimulating hormone C)Hypoestrogenemia D) Increased follicle stimulating hormone

D) Increased follicle stimulating hormone Explanation: Follicle stimulating hormone (FSH) begins to rise during menopausal transition. This stage of menopause begins with variation in menstrual cycle length and ends 12 months after the final menses. If the patient is older than 45 years and menstrual cycle dysfunction has been ruled out, menopause should be considered. Possibly the best approach to diagnosing menopause is to ask and observe clinical manifestations. An elevated FSH is not necessary to make a diagnosis of menopause but is commonly done in clinical practice. Diagnosis entails a review of her symptoms. Specifically, changes in bleeding patterns, hot flashes, sleep disturbances, and genitourinary symptoms are characteristic of menopause.

A woman who is 65 years old presents to your clinic with a breast lump. She has had only normal annual mammograms and her last one was 6 months ago. What is true about this lump? A) It is probably breast cancer. B) It may not be a lump at all. C) It is likely a fibroadenoma. D) It is probably a benign lesion.

D) It is probably a benign lesion. Explanation: The vast majority of breast lumps, even in older women are benign. However, because of the risk of breast cancer in any female patient, especially an older patient, she must be evaluated for breast cancer. Fibroadenomas are common in younger women. Cysts are common throughout the lifespan. Sometimes women identify a lump, but, instead it is the lumpiness of the breast tissue and not a distinct lump.

What recommendation should be made to a 70 year-old female regarding mammograms? A) She should continue to have them annually. B) She should have them annually until age 75 years. C) She should have them every three years. D) She should have them annually as long as she has a reasonable life expectancy.

D) She should have them annually as long as she has a reasonable life expectancy. Explanation: Breast cancer is more prevalent in older women. In fact, 85% of breast cancer occurs in women after age 50 years. Older women profit from screening with mammograms and should continue to receive screening. No age limit has been established for discontinuing mammograms.

A female patient who takes oral contraceptives has just completed her morning exercise routine. She complains of pain in her right calf. Her blood pressure and heart rate are normal. She is not short of breath. Her calf is red and warm to touch. What is NOT part of the differential diagnosis? A) Deep vein thrombosis B) Cellulitis C) Calf muscle strain D) Trochanteric bursitis

D) Trochanteric bursitis Explanation: Trochanteric bursitis does not produce pain in the calf. Pain is concentrated in the affected hip. While it is not likely that someone who exercises regularly would have a DVT, this patient does take oral contraceptives. Therefore, DVT should always be part of the differential given the potential risks associated with untreated DVT (pulmonary embolism).

What choice below has no precautions for oral contraceptive pill use? A) Gallbladder disease B) 5 months post-partum and lactating C) Blood pressure 160/100 D) Varicose veins

D) Varicose veins Explanation: One of the major components of gallstones is estrogen. A patient with underlying gallbladder disease should not receive oral contraceptives (OC) since they will increase estrogen exposure and theoretically, formation of gallstones. Patients who are less than 6 months post-partum should avoid OCs until they are 6 months post-partum because OCs can decrease the quantity of breast milk produced. Hypertension is a contraindication to OC use because of the increased risk of stroke. Varicose veins are not a contraindication.

Atrophic vaginitis is most commonly caused by: a) Increase in progesterone b) Decrease in estrogen c) decrease in progesterone d) Increase in estrogen

Decrease in estrogen

What is the effect of cigarette smoking on breastfeeding? a) Increased milk volume production b) Increased antibodies in the milk c) Decreased milk volume production d) Change in milk taste

Decreased milk volume production

A new first-time mother calls for advice on nipple pain with breastfeeding. She is 6 days post partum after an uncomplicated delivery. Which one of the following is most effective for reducing the pain? a) Hydrogel dressing b) Tea bag compresses c) Education on positioning d) Expressed breast milk

Education on positioning

A 55-year-old postmenopausal woman presents to your office with a complaint of vaginal bleeding. Which of the following is the most appropriate next step in management? a) Endometrial biopsy b) Watchful waiting c) Abdominal ultrasound d) Hysterectomy

Endometrial biopsy

A 54-year-old woman presents with chest and neck flushing. She states this began 6 months ago. The "warm feeling", as she describes it, is becoming more frequent, and seems to occur mainly in the evening. She denies any recent infections. There are no dermatologic lesions seen on physical examination. Her final menstrual period was 14 months ago. These symptoms are most likely due to a decline in which of the following hormones? a) Progesterone b) Prolactin c) Follicle-stimulating hormone d) Estradiol

Estradiol

You have been monitoring a 52-year-old perimenopausal woman's hot flashes. She has not had a hysterectomy. Her symptoms have been so mild that she does not require medication. However, for the past two months, her hot flashes have increased in frequency, duration and intensity. She is now asking for a medication. Which of the following is the most appropriate for medical management of her moderate to severe symptoms? a) Estrogen plus progestin b) Androstenedione alone c) Estrogen alone d) Androstenedione plus estrogen

Estrogen plus progestin

What variation breech presentation is shown below?

Frank breech

A 32-year-old woman with fluctuating menstrual intervals comes to your primary care clinic for a pelvic examination. She is not currently pregnant, but has had two normal pregnancies and healthy deliveries. During adnexal palpation, you notice that one ovary is appreciably larger than the other. In your discussion with the patient, you explain that this ovarian enlargement most likely represents which of the following conditions? a) Benign cystic teratoma b) Stromal cell ovarian neoplasm c) Ovarian carcinoma d) Functional ovarian cyst

Functional ovarian cyst

What are some medications useful in treating the vasomotor symptoms of menopause? a) Metronidazole b) Penicillin c) Estradiol d) Gabapentin

Gabapentin = Improves Menopausal Hot Flashes, Other neurophysiological findings indicate that gabapentin also interacts with NMDA receptors, protein kinase C, and inflammatory cytokines

What is the most common cause of dysfunctional uterine bleeding in a postmenopausal woman? a) Endometrial Cancer b) Vulvovaginitis c) Pelvic Inflammatory Disease d) Hormonal Replacement Therapy

Hormonal Replacement Therapy

A 42-year-old woman presents for evaluation of irregular menses, associated with episodes of excessive daytime sweating and palpitations. She has not had a hysterectomy or oophorectomy. She is currently sexually active, although intercourse has been more uncomfortable lately. Which of the following disorders would you consider in this patient's differential diagnosis? a) Hyperaldosteronism b) Hypokalemia c) Hyperthyroidism d) Hyperprolactinemia

Hyperthyroidism

A 25-year-old woman presents to your office with amenorrhea, abdominal cramping, and irregular vaginal bleeding. She usually has monthly menstrual cycles, but has been intermittently spotting over the last 2 months. Her exam shows a firm uterus without tenderness and a dilated cervix with blood in the vaginal vault. Her beta HCG is positive and a bedside ultrasound reveals a yolk sac, fetal pole and no evidence of cardiac activity. What is the most likely diagnosis? a) Physiologic bleeding b) Inevitable abortion c) Threatened abortion d) Septic abortion

Inevitable abortion

What is the most common type of breast cancer among men? a) medullary b) infiltrating lobar c) Infiltrating ductal d) papillary

Infiltrating ductal

Which of the following is the most common type of invasive breast cancer in women? a) Papillary b) Medullary c) Infiltrating lobar d) Infiltrating ductal

Infiltrating ductal

A previously healthy 35-year-old woman presents to your clinic with questions about breast cancer screening. She has no family history of breast cancer and wants to know when she should start screening. Per the United States Preventive Services Task Force, which of the following is the most appropriate next step in management? a) Initiate screening mammography at age 40 b) Initiate screening magnetic resonance imaging at age 40 c) Initiate screening ultrasound at age 50 d) Initiate screening mammography at age 50

Initiate screening mammography at age 50

A 30-year-old woman presents to the office with dysmenorrhea, pelvic pain, and infertility for the last five years. What is the most appropriate test to confirm your suspicion of endometriosis? a) Colposcopy b) Pelvic ultrasound c) Blood work d) Laparoscopy

Laparoscopy = a surgical procedure in which a fiber-optic instrument is inserted through the abdominal wall to view the organs in the abdomen or to permit a surgical procedure.

A 16-year-old sexually active girl presents to your clinic with foul-smelling vaginal discharge. Examination of the vaginal fluid reveals clue cells. The vaginal pH is 5. Which of the following is the best course of treatment for this condition? a) Doxycline b) Azithromycin c) Metronidazole d) Ceftriaxone

Metronidazole

Which of the following is the most appropriate treatment for bacterial vaginosis? a) Metronidazole b) Ceftriaxone c) Azithromycin d) Fluconazole

Metronidazole

A young woman presents with a complaint of "stained underwear." She reports that for the last three days she has noticed a malodorous, greenish discharge emanating from her "groin." You take a thorough history and perform a pelvic examination. Which of the following is the next best step in evaluating this complaint? a) Microscopic examination b) Bacterial culture c) Serum complete blood count and chemistries d) Pelvic ultrasonography

Microscopic examination

What gram stain scoring system provides a more sensitive and specific diagnosis than wet mount? a) MDI score b) Nugent's score c) Whiff test score d) APGAR score

Nugent's score

A 16 year old girl reports to your office complaining of irregular bleeding and cramps. She may be passed some gray-colored substance. She is unsure of her last menstrual period and is not using contraception although she is sexually active. On examination, her uterus is tender and 4 weeks in size. No adnexal masses are appreciated. The cervix appears closed. A moderate amount of blood is noted in the vagina. Her urine pregnancy test is positive. To exclude an incomplete abortion in this situation, you would a) Order a transvaginal ultrasound b) Order both serum hCG and an ultrasound c) Rely on history and physical examination for diagnosis d) Order a serum hCG

Order both serum hCG and an ultrasound

You are treating a patient for primary amenorrhea. Her diagnostic evaluation has determined that the etiology is primary ovarian failure. Which of the following disorders is this patient at risk for? a) Menorrhagia b) Cluster headaches c) Gastrointestinal bleeding d) Osteoporosis

Osteoporosis

Which condition is associated with Fitz-Hugh-Curtis syndrome? a) Endometritis b) Pelvic Inflammatory Disease c) Cervicitis d) Endometriosis

Pelvic Inflammatory Disease

A 30-year-old woman presents with abnormal menstrual bleeding. Her history and physical are unrevealing. Other than laboratory testing, which of the following is the next best step in evaluating this patient? a) Pelvic ultrasonography b) Endometrial biopsy c) Dilatation and curettage d) Hysteroscopy

Pelvic ultrasonography

What is the treatment of choice for primary syphilis infection? a) Metronidazole b) Penicillin G c) Ampicillin d) Gentamicin

Penicillin G

A 17-year-old girl is examined for a routine visit. She eats a healthy diet. She also stays active by playing volleyball three times a week. Her grades are mostly B's. She admits that she started to be sexually active for the past six months and has delayed periods for two months now. She had her menarche at 12 years old and has regular periods. She also smokes a quarter of a pack of cigarettes per day. Which of the following is an adverse pregnancy outcome due to maternal smoking? a) Large for gestational age b) Respiratory distress syndrome c) Hyperbilirubinemia d) Placental Abruptio

Placental Abruptio

A 15-year-old female presents with generalized abdominopelvic pain which occurs every month after her regular, nonpainful menses. The pain, which is associated with headaches, bloating and depressed mood, begins 18 days after the last day of menstruation. She also complains of cyclic ankle swelling but denies a history of increased salt intake. Which of the following is the most likely diagnosis? a) Dysfunctional uterine bleeding b) Premenstrual syndrome c) Dysmenorrhea d) Amenorrhea

Premenstrual syndrome

A 58-year-old woman with no significant medical history presents for an annual wellness physical. She says it has been 16 months since she had any menstrual bleeding and notes moderate vaginal discomfort that makes coitus difficult for her. Which of the following recommendations would be most appropriate for this patient? a) Avoidance of vaginal intercourse b) Prescribe a vaginal ring containing estradiol c) Prescribe an oral conjugated estrogen preparation d) Prescribe gabapentin taken nightly

Prescribe a vaginal ring containing estradiol

Which of the following is the greatest risk factor for an ectopic pregnancy? a) Multiple sexual partners b) Previous pelvic inflammatory disease c) Previous ectopic pregnancy d) Previous abdominal surgery

Previous ectopic pregnancy

A 14-year-old woman presents to clinic with some frustration over never having a menstrual period. She is short in stature and has Tanner stage 2 breast development. As you begin a gynecological exam, you realize that you cannot pass a speculum into the vagina. Which of the following is the most likely diagnosis? a) Primary amenorrhea b) Dysfunctional uterine bleeding c) Sheehan's syndrome d) Secondary dysmenorrhea

Primary amenorrhea

A 14-year-old otherwise healthy boy presents to your clinic with his father. He is concerned because his breasts are enlarged. Appropriate management includes which of the following? a) BRCA gene testing b) Ultrasound c) Reassurance d) Serum estrogen level

Reassurance

A 14-year-old otherwise healthy boy presents to your clinic with his father. He is concerned because his breasts are enlarged. Appropriate management includes which of the following? a) Reassurance b) Serum estrogen level c) Ultrasound d) BRCA gene testing

Reassurance

A 15-year-old girl presents for severe lower abdominal pain that occurs for the first two days of her menstrual cycle each month. She has associated nausea and diarrhea. She denies menorrhagia. She had a normal menarche at age 13 and is not sexually active. Abdominal and pelvic exams are normal. Which of the following is the initial best step in management? a) Recommend ibuprofen starting one day before menses b) Obtain a Pap smear and cervical cultures c) Referral for exploratory laparotomy d) Recommend acetaminophen starting one day before menses

Recommend ibuprofen starting one day before menses

A postmenopausal woman presents with abnormal vaginal bleeding. You suspect endometrial malignancy, and refer the patient for further investigation. Which of the following modalities is initially used in determining a diagnosis? a) Suction curette b) Dilation and curettage c) Solposcopy d) Pap test

Suction curette

Which of the following is true regarding uterine fibroids? a) Increase in size during menopause b) Surgical removal is associated with a 25% to 30% rate of recurrence c) More common in White women than African American women d) Typically occur as a single fibroid

Surgical removal is associated with a 25% to 30% rate of recurrence

A 30-year-old woman presents to the Emergency Department with left lower quadrant pain. The pain started suddenly while she was sleeping and is rated a 10/10 in severity. Which of the following tests will yield a definitive diagnosis of an ovarian torsion? a) Surgical visualization b) Magnetic resonance imaging c) Ultrasound d) Computed tomography

Surgical visualization surgical visualization is always definitive

A 40-year-old woman with a history of asthma presents to the ED with symptoms of wheezing and shortness of breath similar to previous exacerbations. Her vital signs are BP 115/70, HR 80, RR, 14, and pulse oximetry is 99% on room air. The patient is offered and agrees to a point-of-care beta-hCG test that returns positive. On exam, you note mild bilateral wheezing with good air movement. Pelvic exam reveals a closed os without adnexal tenderness or masses. Which of the following is the most appropriate next step in management? a) Treat her asthma as indicated, perform a beta hCG quantitative level, and obtain a pelvic ultrasound b) Delay treating her asthma until her pregnancy status is further clarified c) Correct! d) Treat her asthma as indicated, if improved, discharge with outpatient obstetrical follow-up e) Treat her asthma as indicated, and perform a beta-hCG quantitative level

Treat her asthma as indicated, if improved, discharge with outpatient obstetrical follow-up

Which of the following is the treatment for Primary Amenorrhea? a) Treatment of underlying cause b) Early pap test c) STD panel d) No treatment needed

Treatment of underlying cause

Which organism causes condyloma latum? a) Gram negative bacillus b) Treponema pallidum c) Spirochete d) Gram negative diplococcus

Treponema pallidum

A 26-year-old woman just vaginally delivered twin, macrosomic (a newborn who's significantly larger than average.) newborn boys. This represents her fourth pregnancy, which has been the longest of them all at 43 weeks gestation. Her delivery was difficult and required forceps to complete. Estimated blood loss was 1100 ml. Currently, she is hypotensive, tachycardic and anemic. Which of the following is the most likely diagnosis? a) Rh sensitization b) Uterine atony c) Incision dehiscence d) Amniotic Fluid Embolism

Uterine atony = when the uterus fails to contract after the delivery of the baby, and it can lead to a potentially life-threatening condition known as postpartum hemorrhage.

Which of the following is the most appropriate treatment for stage IV uterine prolapse in a 50-year-old woman with no medical problems and no previous surgical history? a) Abdominal hysterectomy b) Anterior colporrhaphy c) Vaginal hysterectomy d) Posterior colporrhaphy

Vaginal hysterectomy

A 22-year-old woman presents with pain and swelling to the vulva. On examination, you notice an area of swelling with induration and central fluctuance at the 8 o'clock position. Which of the following statements is true regarding this? a) Incision should be performed in the operating room b) Word catheter is placed for four to six weeks c) Gonorrhea and chlamydia are the most common causes d) All patients require antibiotics

Word catheter is placed for four to six weeks = for bartholin gland cyst

What is a septic abortion? a) Any type of abortion accompanied by a uterine infection. b) complete passage of fetal parts and placenta and contracted uterus, without fever or chills c) Retention of a nonviable intrauterine pregnancy within the uterus, no cardiac activity, and a closed cervical os d) Parts of the product of conception have been passed and may be visible in the cervical os or the vaginal canal

a) Any type of abortion accompanied by a uterine infection.

A 15-year-old woman presents to the office with her mother concerned that she has not had a menstrual cycle. She is an avid runner, logging 20 miles per week. On exam she exhibits no breast development or axillary or genital hair. Her mother was 15 when she started her menstrual cycle. What is your next step? a) Begin work-up for primary amenorrhea b) No work up, but provide education on the topic c) Encourage her to stop exercising for 3 months d) Induce cycle with medroxyprogesterone (Provera®)

a) Begin work-up for primary amenorrhea

A 29-year-old woman presents with cyclic pelvic pain that has been increasing over the last 7 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? a) Endometriosis b) Ovarian cancer c) Functional ovarian cyst d) Pelvic inflammatory disease

a) Endometriosis

An absolute contraindication to postmenopausal estrogen replacement therapy ET is: a) Family history of stroke or deep venous thrombosis b) Fibrocystic breast changes c) Estrogen receptor-negative breast cancer d) Undiagnosed abnormal vaginal bleeding

a) Family history of stroke or deep venous thrombosis

Which of the following best describes an inevitable abortion? a) First trimester bleeding with an open internal os b) Retention of a nonviable intrauterine pregnancy within the uterus, no cardiac activity, and a closed cervical os c) First trimester bleeding and a closed internal cervical os d) Parts of the product of conception have been passed and may be visible in the cervical os or the vaginal canal

a) First trimester bleeding with an open internal os

A 23-year-old woman presents with concerns of tender breast enlargement. Two weeks ago, she gave birth to a healthy newborn, whom she currently breast feeds. Examination reveals general erythema, warmth and edema of the right breast. There are no superficial abnormalities, no palpable mass and no purulent nipple discharge is present. The left breast appears normal. Which of the following is the most likely diagnosis? a) Lactation mastitis b) Breast abscess c) Breast engorgement d) Inflammatory breast cancer e) Submission Details:

a) Lactation mastitis

Where is the most common location to find ectopic endometrial tissue in endometriosis? a) Ovaries b) Fallopian tube c) Cervix d) Uterus

a) Ovaries

The most likely diagnosis of a young female with cervical motion tenderness, mucopurulent cervical discharge, positive "Chandelier sign", and dyspareunia is: a) Pelvic Inflammatory Disease b) Endometriosis c) Dysmenorrhea d) Leiomyoma

a) Pelvic Inflammatory Disease

What is the *initial diagnostic test used in evaluating dysmenorrhea*? a) Pelvic ultrasonography to investigate the presence of secondary causes b) MRI to investigate the presence of secondary causes c) Pelvic CT to investigate the presence of secondary causes d) MRA to investigate the presence of secondary causes

a) Pelvic ultrasonography to investigate the presence of secondary causes

Which of the following is the *primary pathophysiological mechanism that is associated with primary dysmenorrhea*? a) Prostaglandin induction of uterine contraction b) Increased secretion of luteinizing hormone c) Heightened progestin stimulation of the endometrium d) Decreased estrogen stimulation of the endometrium

a) Prostaglandin induction of uterine contraction = primary

Which of the following is a contraindication for methotrexate in the treatment of ectopic pregnancy? a) Ruptured ectopic pregnancy b) Ectopic pregnancy earlier than 5 weeks of gestational age c) No cardiac activity of ectopic gestation documented by ultrasound d) Ectopic gestation <3.5 cm

a) Ruptured ectopic pregnancy

A 26-year-old obese woman with a 2-year history of increased acne, abnormal hair growth, and menstrual abnormalities presents to her obstetrician for an infertility workup. A pelvic ultrasound reveals enlarged cystic ovaries. She desires to become pregnant. Which of the following is the *first line treatment?* a) Weight reduction b) Gonadotropin therapy c) Spironolactone d) Clomiphene citrate

a) Weight reduction - for PCOS, this is 1st line

Which of the following is the most common presenting symptom of ectopic pregnancy a) Dizziness b) Abdominal pain c) Amenorrhea d) Fever

b) Abdominal pain

Which of the following statement/s is associated with endometriosis? a) Dysmenorrhea, dyspareunia b) All of the statements are associated c) Treatment include SAIDs, OCPs, GnRH agonists, progestins d) Infertility e) Most common site are the ovaries

b) All of the statements are associated

A 24 year old woman presents to your office 6 months postpartum. She delivered by cesarean section elsewhere and is nursing full time. She has been living in a homeless shelter and has not had an examination since her delivery. She denies sexual intercourse since the delivery but is concerned because she has not started to menstruate. On examination, galactorrhea is present bilaterally. Her abdominal incision appears well-healed. On pelvic examination, the vaginal walls and external genitalia appear slightly atrophic. The uterus and adnexa are unremarkable. Her pregnancy test is negative. The most likely explanation for her amenorrhea is: a) Anovulation secondary to stress b) Anovulation secondary to breast feeding c) A false negative pregnancy test d) Scarring of the uterus (Asherman's syndrome)

b) Anovulation secondary to breast feeding

The 3 D's "dysmenorrhea, dyspareunia, dyschezia" most likely correlates with: a) Pelvic Inflammatory disease b) Endometriosis c) Endometrial Cancer d) Menometrorraghia

b) Endometriosis

Which of the following descriptions is most consistent with uterine fibroids? a) Slightly softened, tender, diffusely globular uterine enlargement b) Firm, irregularly shaped, nontender, enlarged uterus c) Normal size uterus that is slightly softened and tender d) Diffusely enlarged uterus that is firm and globular in shape

b) Firm, irregularly shaped, nontender, enlarged uterus

What is the most concerning complication of a newborn born to a diabetic mother? a) Hyperglycemia b) Hypoglycemia c) Respiratory distress d) Macrosomia

b) Hypoglycemia

A 15-year old girl reports that she has never had menses. She is short in stature and has a webbed neck and wide-spaced nipples. Initial lab work shows a high FSH. Which of the following is best to confirm diagnosis a) LH levels b) Karyotype c) Estrogen levels d) Ultrasonography

b) Karyotype

During the menstruation section of a gynecologic history, you determine that your 36-year-old patient's menstrual periods are increasing in length from four days to eight days, even though she still cycles every 28 days. She also reports more blood flow than typical during the first three days of these new eight day periods. Which of the following terms correctly defines this abnormal uterine bleeding? a) Amenorrhea b) Menorrhagia c) Polymenorrhea d) Metrorrhagia

b) Menorrhagia

An obese female patient complaining of amenorrhea, weight gain, and hirsutism with bilateral ovarian enlargement and acanthosis nigricans upon exam most likely has which of the following diagnosis? a) Dysmenorrhea b) Polycystic ovarian syndrome c) Pelvic Inflammatory Disease d) Endometriosis

b) Polycystic ovarian syndrome

Which of the following vaccinations is considered safe in pregnancy? a) Live attenuated influenza b) Measles, mumps, rubella c) Tdap d) Varicella

c) *Tdap* - Pregnant women should get a dose of Tdap during every pregnancy, to protect the newborn from pertussis. Infants are most at risk for severe, life-threatening complications from pertussis.

What is the recommended treatment for pregnant patients with bacterial vaginosis? a) Gentamicin b) Methotrexate c) Metronidazole d) Flucanazole

c) Metronidazole (the usual)

What is the most common cause of secondary amenorrhea? a) Androgen insensitivity b) Hyperprolactinemia c) Pregnancy d) Obstruction of the outflow tract

c) Pregnancy

A breastfeeding 28-year-old woman presents for evaluation of a painful right breast "lump" three weeks after delivery of a healthy newborn. Examination reveals localized erythematous edema of the right breast, a 7/10 painfully palpable discrete induration and thick, yellow nipple discharge. The nipple and areola are not excoriated. The left breast is unremarkable. You refer the patient for a drainage procedure. In the meantime, which of the following is the most appropriate initial plan? a) Continue breastfeeding with the left breast only; antibiotics are not recommended b) Stop breastfeeding; antibiotics are not recommended c) Start antibiotics and continue breastfeeding with either breast d) Start antibiotics and stop breastfeeding

c) Start antibiotics and continue breastfeeding with either breast

A breastfeeding 28-year-old woman presents for evaluation of a painful right breast "lump" three weeks after delivery of a healthy newborn. Examination reveals localized erythematous edema of the right breast, a 7/10 painfully palpable discrete induration and thick, yellow nipple discharge. The nipple and areola are not excoriated. The left breast is unremarkable. You refer the patient for a drainage procedure. In the meantime, which of the following is the most appropriate initial plan? a) Stop breastfeeding; antibiotics are not recommended b) Continue breastfeeding with the left breast only; antibiotics are not recommended c) Start antibiotics and continue breastfeeding with either breast d) Start antibiotics and stop breastfeeding

c) Start antibiotics and continue breastfeeding with either breast

Which of the following is the most common site of ectopic pregnancy? a) Ovarian b) Abdominal c) Tubal d) Uterine

c) Tubal

What are the symptoms of a functional ovarian cyst? a) Vaginal itching b) Urgency, frequency, & dysuria c) Unilateral lower abdominopelvic pain d) Regular menstrual cycle

c) Unilateral lower abdominopelvic pain

What does postcoital (post sexual intercourse) bleeding suggest in a non-gravid female? a) Endometriosis b) Pelvic Inflammatory Disease c) Menopause d) Cervical cancer, which must be ruled out.

d) Cervical cancer, which must be ruled out.

A 27 year old woman presents to the emergency department complaining of abdominal pain in the lower abdomen for 4 weeks. Physical examination reveals no evidence of guarding or rebound tenderness. A soft tissue mass is felt in the left lower quadrant. Abdominal x-rays show a mass lesion in the left lower quadrant that reveals toothlike structures and areas of calcifications. What is the most likely diagnosis? a) Endodermal sinus tumor b) Mucinous cystadenoma c) Choriocarcinoma d) Cystic teratoma

d) Cystic teratoma (A type of germ cell tumor that may contain several types of body tissue.)

A 22-year-old woman presents with lower abdominal pain and abnormal vaginal discharge for 4 days. She is sexually active with multiple partners and does not consistently use barrier contraception. She has bilateral adnexal tenderness and yellow discharge on pelvic exam. Her urine pregnancy test is negative. In addition to a 1-time dose of ceftriaxone, what is the most appropriate outpatient course of antibiotics for the patient? a) Metronidazole 500 mg PO BID x 14 days b) Ciprofloxacin 500 mg PO BID x 14 days c) Azithromycin 1 gram PO x 1 d) Doxycycline 100 mg PO BID x 14 days

d) Doxycycline 100 mg PO BID x 14 days = PID

A 25-year-old woman presents with difficult menses. She reports significant midline pelvic pain during the first two days of her regular menstrual cycles. The pain is so bad that she frequently misses work. Fortunately, her pain is self-limited, as the rest of her cycle is relatively comfortable. Which of the following is the most likely diagnosis? a) Amenorrhea b) Metrorrhagia c) Mastodynia d) Dysmenorrhea

d) Dysmenorrhea

What is the recommended treatment for Candidiasis? a) Metronidazole b) Clindamycin c) Correct Answer d) Fluconazole e) Gentamicin

d) Fluconazole

What is a possible etiology of gynecomastia? a) Late pubertal changes b) Turner syndrome c) Alcohol d) Klinefelter

d) Klinefelter (Kline "Felt er up")

A 32-year-old woman presents to your office for a physical exam including a Papanicolaou test (Pap smear). Lab results reveal negative cytology and positive human papillomavirus (HPV). Which of the following is the most appropriate next step in management? a) Repeat Pap smear and human papillomavirus testing in five years b) Order colposcopy c) Counsel patient on safe sex practices d) Repeat Pap smear and human papillomavirus testing in one year

d) Repeat Pap smear and human papillomavirus testing in one year

Mastitis is most commonly caused by: a) Strep viridans b) H. influenza c) Coag-negative staph d) S. aureus

d) S. aureus

The patient is a 30 year old woman with a history of fairly regular menstrual cycles. She presents to you with a history of a 2 week delay of menses and left sided abdominal pain. She is not sexually active at present and takes no medications. Her examination is normal except for a left adnexal mass. Ultrasound confirms the presence of a 6 cm ovarian cyst. The most appropriate next step in managing this patient is: a) Referring her for urgent laparoscopy b) Obtaining a serum level of CA-125 c) Following her for 1-2 months d) Starting her immediately on high dose oral contraceptives

d) Starting her immediately on high dose oral contraceptives

A 32-year-old woman 8 weeks pregnant by dates presents to the ED with a 2-cm laceration to her index finger sustained while she was cutting a tomato. On review of systems, she also notes 2 days of vaginal spotting and lower abdominal cramping. Vital signs are within normal limits. Physical exam is consistent with a simple 2-cm laceration. The pelvic exam reveals a closed os and no adnexal tenderness or masses. Which of the following statements best describes the next step in management? a) Treat her laceration as indicated, then discharge with outpatient obstetrical follow-up b) Treat her laceration as indicated, and perform a beta-hCG quantitative level c) Delay treating her laceration until her pregnancy status is further clarified d) Treat her laceration as indicated, perform a beta-hCG quantitative level, and obtain a pelvic ultrasound

d) Treat her laceration as indicated, perform a beta-hCG quantitative level, and obtain a pelvic ultrasound

A 34-year-old woman presents complaining of dysuria and vaginal itching. Your speculum exam reveals thick, white, curdled discharge. Which of the following statements is correct regarding this diagnosis? a) Vaginal discharge is often foul smelling b) A fishy odor is present when vaginal discharge is mixed with potassium hydroxide c) Multiple petechiae are often seen on the vaginal wall d) Metronidazole is the recommended treatment e) The pH of the discharge is less than 4.5

e) The pH of the discharge is less than 4.5

This fetal heart rate response is due to HEAD compression and is benign a) sinusoidal pattern b) late decelerations c) early decelerations d) variable decelerations

early decelerations

What is the most common location for an ectopic pregnancy? a) ovarian b) cervical c) interstitial d) fallopian tube

fallopian tube

Which is *not* a classic symptom of ectopic pregnancy? a) abdominal pain b) amennorhea c) vaginal bleeding d) fever

fever

What is your assessment of this fetal strip?

late decelerations

This fetal heart rate response is a sign of a dying baby a) early decelerations b) late decelerations c) sinusoidal pattern d) variable decelerations

sinusoidal pattern

Which of the following correctly describes physiologic changes which occur in pregnancy? a) Gastrointestinal motility increases b) Blood volume increases c) Functional residual capacity increases d) Hemoglobin concentration increases

Blood volume increases

A 30-year-old woman presents with fever and abdominal pain. She is 3 days postpartum after cesarean section. Physical examination reveals lower abdominal tenderness to palpation and foul smelling vaginal discharge. What management is indicated? a) Clindamycin IV + gentamicin IV b) Metronidazole c) Fluconazole d) Ceftriaxone IM and Azithromycin PO

Clindamycin IV + gentamicin IV

Which of the following antimicrobials is considered category D in pregnancy? a) Penicillin b) Cephalexin c) Ciprofloxacin d) Doxycycline

Doxycycline (D for Doxy)

Which of the following drugs *must* be prescribed in a patient with cervicitis in whom bacterial vaginosis is also suspected? a) Ceftriaxone b) Doxycycline c) Metronidazole d) Azithromycin

Metronidazole (as always)

A patient with an IUP of 36 weeks undergoes a nonstress test (NST). The results are as follows: a fetal heart rate (FHR) of 140 with three accelerations of 15 beats/min, lasting 18 seconds in a 20 minute period. Which of the following statements correctly interpret the NST results for this patient? a) The results indicate a reactive NST b) This is a non-reactive NST and requires intervention c) The results are non-reassuring of fetal well-being d) Weekly or bi-weekly follow-up is recommended

a) The results indicate a reactive NST

What is the most common malpresentation in fetal delivery? a) cephalic presentation b) breech presentation c) shoulder presentation d) facial presentation

breech presentation

The softening and then thinning out of the cervix are called: a) ripening; effacement b) effacement; ripening c) ripening; dilation d) effacement; dilation

ripening (softening); effacement (thinning)

This fetal heart rate response is due to umbilical CORD compression and is worrisome only if severe. a) variable decelerations b) accelerations c) late decelerations d) early decelerations

variable decelerations

What is the most common gynecological condition in prepubertal children? a) vulvovaginitis b) bartholin's cyst c) urinary tract infection d) urethritis

vulvovaginitis

A 14-year-old girl has been diagnosed with primary amenorrhea. Pelvic ultrasound reveals an absent uterus. Genetic testing confirms a 46,XX karyotype. Which of the following is the most likely diagnosis? a) Asherman's syndrome b) Turner's syndrome c) Imperforate hymen d) Mullerian dysgenesis

*Mullerian dysgenesis* (a failure of the Müllerian duct - paired ducts of the embryo that run down the lateral sides of the urogenital ridge and terminate at the sinus tubercle in the primitive urogenital sinus. In the female, they will develop to form the uterine tubes, uterus, cervix, and the upper one-third of the vagina; in the male, they are lost - to develop, resulting in a missing uterus and variable degrees of vaginal hypoplasia of its upper portion.)

A 15-year-old girl complains of vaginal discharge over the past two weeks. She reports recently becoming sexually active but uses condoms consistently during intercourse. Which of the following favors a diagnosis of bacterial vaginosis over trichmoniasis? a) Predominance of gram negative rods on gram stain b) Multiple punctate hemorrhagic cervical lesions c) Improvement on oral metronidazole d) Vaginal pH of 5.5

*Predominance of gram negative rods on gram stain* b) strawberry cervix = trichomoniasis c) both are treated with metronidazole d) both have pH >5

If the fetal station is said to be at +2, where is the fetal head in relation to the mother's pelvis? a) 2 cm below the ischial spine b) at the ischial spine c) 2 cm above the ischial spine d) 2 cm below the vaginal introitus

2 cm below the ischial spine

A 33 year old woman presents to her primary care physician for her routine prenatal appointment. She is currently 24 weeks pregnant with a single fetus. She has no pertinent prior medical or surgical history. Examination results of the heart, lungs, and abdomen are within normal limits. Laboratory results are within normal limits. She is expected to measure a) 24 cm below the xiphoid process b) 24 cm above the symphysis pubis c) 20 cm above the symphysis pubis d) 8 cm above the symphysis pubis

24 cm above the symphysis pubis

A 25-year-old woman with a recent history of antibiotic use presents to your office with a complaint of vaginal discomfort. For the past week she has been experiencing intense vaginal pruritus and has noticed a white discharge. Which of the following is the most appropriate next step in her management? a) Boric acid intravagina for seven days b) Topical nystatin 100,000 units daily for seven days c) Metronidazole 500 mg twice/day for seven days d) A single dose of 150 mg fluconazole

A single dose of 150 mg fluconazole

A 15-year-old girl presents to the Emergency Department with complaints of vaginal pruritus and discharge. She denies sexual activity. Speculum examination reveals a homogenous, grey discharge with a pH > 4.5. A wet prep reveals stippled epithelial cells. What treatment is indicated? a) Metronidazole b) No treatment c) Azithromycin d) Ceftriaxone

Bacterial vaginosis = Metronidazole

A 32-year-old woman presents with fever and lower abdominal pain. She has a history of pelvic inflammatory disease. Her vitals are T 38.4°C, HR 133, and BP 101/60. On examination, the patient is toxic appearing and has marked lower abdominal tenderness to palpation with rebound and guarding. Pelvic examination reveals cervical motion tenderness, scant discharge, and left adnexal tenderness. The patient's urine beta-hCG is negative. A transvaginal ultrasound is performed and reveals a complex cystic, thick-walled, well-defined mass in the left adnexa. Which of the following is the most appropriate next step in management? a) Obtain a CT scan to rule out appendicitis b) Send a serum beta-hCG to rule out ectopic pregnancy c) Administer ceftriaxone and discharge home with a 14-day course of doxycycline d) Begin intravenous antibiotics and admit for possible drainage

Begin intravenous antibiotics and admit for possible drainage

Which United States Food and Drug Administration category describes medications in which the safety of use by pregnant woman is unknown and the drug should not be used unless the potential benefit outweighs the potential risk to the fetus a) Category A b) Category D c) Category B d) Category C

Category C

Medications in which the fetal risks clearly outweigh the benefits are considered to be in what category? a) Category X b) Category B c) Category C d) Category D

Category X

A woman presents with fever and foul-smelling vaginal discharge 3 days after delivery of a full-term fetus. She is febrile, with uterine tenderness on pelvic exam. Which of the following is the *strongest risk factor for postpartum endometritis?* a) Premature rupture of membranes b) Internal fetal monitoring c) Multiple gestation d) Cesarean section

Cesarean section

A 23-year-old woman presents to your office with complaints of pelvic pain and vaginal discharge. She admits to having recent unprotected intercourse with a new partner and her last menstrual period ended three days ago. Which of the following physical exam findings supports the likely diagnosis? a) Chadwick sign b) Goodell's sign c) Chandelier sign d) Hegar's sign

Chandelier sign

A 19-year-old woman with no prenatal care presents for evaluation of lower abdominal pain and fever. She estimates that she is approximately 6 months pregnant. On questioning, she acknowledges intermittent pain for two days and a gush of fluid shortly after the pain began. Her temperature is 102.0°F. Physical examination is notable for purulent material in the vaginal vault. Which of the following is the most likely diagnosis? a) Chorioamnionitis b) Pelvic Inflammatory Disease c) Endometritis d) Urinary Tract Infection

Chorioamnionitis

What serious maternal infection can occur as a complication of preterm rupture of membranes? a) Chorioamnionitis b) Endometritis c) Pelvic inflammatory disease d) Pylonephritis

Chorioamnionitis

What is the pathognomonic finding on microscopic exam to diagnose bacterial vaginosis? a) Spermatozoa b) Ferning c) Clue cells d) Hyphae

Clue cells

A 32-year-old woman presents with vaginal bleeding for 2 weeks. She states she has about 1 pad of bleeding every 2-3 hours. Vital signs are stable and physical exam only reveals blood from the cervical os. The patient's hemoglobin is 12 g/dl and her pregnancy test is negative. What treatment is indicated for this patient? a) Combination oral contraceptives b) Intravenous estrogen therapy c) Admission for dilation and curettage d) Hysterectomy

Combination oral contraceptives

What variation of breech presentation is shown below?

Complete breech

You diagnose lactation mastitis in a postpartum 17-year-old woman. She is currently breast feeding her healthy newborn. She has no allergies. In addition to local ice packs and ibuprofen, which of the following is the most appropriate treatment? a) Dicloxacillin b) Aztreonam c) Metronidazole d) Penicillin V

Dicloxacillin

A 19 yr old G1P0 at 32 weeks gestation returns to the clinic for routine prenatal care. Her last visit was 2 weeks ago. She has gained 10 pounds since then. Her weight gain is most likely a result of which of the following? a) Rapid fetal growth b) A genetically large baby c) Eating too much d) Edema

Edema

What is the most common postpartum infection? a) Thrombophlebitis b) Endometritis c) Mastitis d) Pelvic Inflammatory Disease

Endometritis

A postmenopausal woman presents to the clinic worried about her and her husband's sexual health. As of late, sexual intercourse has been very uncomfortable for the both of them. She thinks it has to do with her recurrent urinary tract infections, however, you explain that as a woman ages, vaginal atrophy occurs due to a significant decrease in which of the following hormones a) Progesterone b) Testosterone c) Estrogen d) Androstenedione

Estrogen

Four women are in labor at term and are having external fetal monitoring performed. Which of the following results should prompt a C-section? a) Fetal heart rate 120 bpm with variability b) Fetal heart rate 100 bpm with late decelerations c) Fetal heart rate 140 bpm with accelerations d) Fetal heart rate 160 bpm with early decelerations

Fetal heart rate 100 bpm with late decelerations

A 31 year old woman, G4P3003, presents to the clinic at 34 weeks of gestation. She has not felt the baby move all day. What is the initial step in evaluating fetal well-being a) Fetal kick counts b) Nonstress test c) Biophysical profile d) Oxytocin challenge test

Fetal kick counts

A 16-year-old girl is seen in clinic due to a concern for a breast mass that she notes has been present for 3 months. The size of the mass has not changed over the previous 3-months. She is otherwise healthy and is not on any medications. On exam you note a 2 cm diameter mass on the right outer quadrant of her right breast that is rubbery, mobile, and not tender. Which of the following is the most likely diagnosis? a) Fibrocystic change b) Metastasis c) Cystosarcoma phylloides d) Fibroadenoma

Fibroadenoma

Which of the following prenatal screening tests is best obtained specifically between 24 and 28 weeks of gestation? a) a-fetaprotein b) Glucose tolerance screening c) Urinalysis d) Ultrasonography

Glucose tolerance screening

A 25-year-old sexually active woman presents to the Emergency Department with a complaint of painful vulvar ulcers and a swollen inguinal lymph node. She denies dysuria and vaginal discharge. Which of the following is most consistent with the description of the offending infectious organism? a) Obligate intracellular gram negative organism b) Gram negative bacillus c) Gram negative diplococcus d) Spirochete

Gram negative bacillus

What are the expected laboratory results in a patient with primary ovarian failure? a) decreased follicle-stimulating hormone, decreased luteinizing hormone, decreased estradiol. b) Increased follicle-stimulating hormone, increased luteinizing hormone, increased estradiol. c) Increased follicle-stimulating hormone, decreased luteinizing hormone, decreased estradiol. d) Increased follicle-stimulating hormone, increased luteinizing hormone, decreased estradiol.

Increased follicle-stimulating hormone, increased luteinizing hormone, decreased estradiol.

A previously healthy 35-year-old woman presents to your clinic with questions about breast cancer screening. She has no family history of breast cancer and wants to know when she should start screening. Per the United States Preventive Services Task Force, which of the following is the most appropriate next step in management? a) Initiate screening mammography at age 50 b) Initiate screening magnetic resonance imaging at age 40 c) Initiate screening mammography at age 40 d) Initiate screening ultrasound at age 50

Initiate screening mammography at age 50

Which of the following confirms an intrauterine pregnancy? a) Intrauterine fetal pole and yolk sac b) Fetal heart activity c) Beta-hCG of 200,000 d) Single layer intrauterine gestational sac

Intrauterine fetal pole and yolk sac

What is the primary reason folic acid supplementation is recommended prior to conception? a) It enhances the nutritional status of the mother b) It corrects an underlying acid-base imbalance c) It decreases the incidence of neural tube defects d) It improves folic acid anemia

It decreases the incidence of neural tube defects

A 23-year-old nulligravida comes to your office for contraception counseling. She has a seizure disorder that is well controlled on carbamazepine. She is a nonsmoker and has no other medical problems or complaints. She is currently in a relationship and does not want to get pregnant in the next several years. Which one of the following contraceptives is the most appropriate? a) Combined oral contraceptives b) Etonogestrel/ethinyl estradiol vaginal ring c) Levonorgestrel intrauterine device d) Progestin-only pills

Levonorgestrel intrauterine device

Which of the following medications commonly used to treat hyperemesis gravidarum is considered Category B? a) Trimethobenzamide b) Prochlorperazine c) Promethazine d) Metoclopramide

Metoclopramide (Reglan)

Prior to allowing a patient to attempt a vaginal birth after cesarean section, it is vital to obtain records regarding: a) Medical history b) Results of prenatal diagnostic tests c) Nature of previous surgical incision d) Previous prenatal record

Nature of previous surgical incision

A 18-year-old G1P0 woman at 16-weeks presents with vaginal bleeding. She had no prenatal care. Vital signs are unremarkable and physical examination only reveals a small amount of blood in the vaginal vault. A transvaginal ultrasound is performed as seen above. Which of the following managements is most likely indicated? a) Intravenous antibiotics b) Administer methotrexate c) CT scan of the abdomen and pelvis d) Obstetrics consultation

Obstetrics consultation

A 32-year-old woman presents with an increase in vaginal secretions. You decide to perform a potassium hydroxide wet preparation of a sample. This test evaluates which of the following secretion qualities? a) Color b) Odor c) pH d) Viscosity

Odor

A 22-year-old woman presents with lower abdominal pain and vaginal discharge. She is sexually active with men with inconsistent barrier protection. Her temperature is 101°F. On examination, there is yellow cervical discharge, no cervical motion tenderness, but uterine and left adnexal tenderness. An ultrasound does not show any evidence of tubo-ovarian abscess. Which of the following is the most appropriate treatment for this patient's condition? a) Cefoxitin 2 gm and metronidazole 500 mg PO BID for 14 days b) Cefoxitin 2 gm IM and clindamycin 600 mg IV c) Ceftriaxone 250 mg IM and azithromycin 1 gm PO d) Ceftriaxone 250 mg IM and doxycycline 100 mg BID for 14 days

PID = Ceftriaxone 250 mg IM and doxycycline 100 mg BID for 14 days

A 25-year old woman presents to her primary care physician for a routine annual visit. Her last Papanicolaou test was three years ago. She smokes cigarettes and is sexually active. Her mother was diagnosed with ovarian cancer at age 50. According to the current guidelines, which of the following should be offered to the patient? a) Mammography b) Papanicolaou test c) Meningococcal vaccine d) Ovarian ultrasound

Papanicolaou test

A previously healthy 21-year-old woman presents to your office with a complaint of lower abdominal discomfort and vaginal discharge for the past 2 weeks. She is currently single, but admits to occasionally "fooling around" with men she meets at parties. She expresses concern that she might be pregnant because of increasing tenderness in her lower abdomen for the past 3 days. Which of the following is the most likely diagnosis? a) Pregnancy b) Pelvic inflammatory disease c) Ectopic pregnancy d) Appendicitis

Pelvic inflammatory disease (casual sex, think STD)

A 15-year-old G0P0 woman presents with sharp, left lower quadrant abdominal pain for 1 hour. The pain is severe and associated with nausea. Pelvic examination reveals tenderness of the left adnexa. The patient's urinalysis is unremarkable. What test should be ordered to diagnose the patient? a) White blood cell count b) Abdominal X-ray c) CT scan of the abdomen and pelvis d) Pelvic ultrasound

Pelvic ultrasound

The fetus experienced persistent bradycardia on fetal monitoring. The next best step would probably be to a) Perform a cesarean section b) Increase administration of oxytocin c) Deliver by forceps d) Continue watchful waiting

Perform a cesarean section

You are seeing a 16-year-old girl in clinic because of menstrual irregularity. She had menarche at 12 years of age and since then has had irregular menses that occur every 80 to 90 days. Her periods last for five to seven days with moderate amount of bleeding. She denies sexual activity. She does not report pain with menses and does not take any medication. She admits to shaving excess hair on her upper lip and chest. On examination, you note BMI of 30, severe acne on face, and Tanner 5 breasts and pubic hair. Her vital signs are normal. Which of the following is the most likely diagnosis? a) Abnormal uterine bleeding b) Polycystic ovary syndrome c) Cushing syndrome d) Anorexia nervosa

Polycystic ovary syndrome

In the clinic, you are evaluating a 15-year-old girl who is complaining of increased vaginal discharge. She had her menarche at 12 years of age and since then has had irregular periods. She uses tampons during her menses. She notes thick yellowish vaginal discharge in between her periods. She denies burning, pain, or pruritus. She started to be sexually active for the past month with one partner. She uses condoms for contraception. On examination, you note Tanner 5 pubic hair and white discharge. You examine the discharge and obtain pH of 4, with negative whiff test and absence of clue cells on microscopy. You perform a pregnancy test, which is negative. Which of the following is the next best step? a) Advise her to stop using tampons b) Provide her with reassurance c) Send culture for Gardnerella vaginalis d) Encourage her to douche after her period

Provide her with reassurance (Bacterial Vaginosis: FISHY, grey, scant, THIN, STICKY, PH > 4.5 (BACTERIA/Trich = BASIC), Wet-prep shows epithelial cells with bacteria coating on surface = "clue cells")

A healthy 40 yr old primipara presents at 8 weeks of gestation for her first prenatal appointment. Her physical examination is consistent with an 8 wk pregnancy. Which of the following would be the most appropriate next step in this patients care a) Schedule an ultrasound to confirm dating b) Refer the patient for genetic counseling c) Give a follow-up appointment in 2 weeks d) Obtain a urine sample to check for proteinuria

Refer the patient for genetic counseling (this answer is likely due to advanced maternal age)

A 24-year-old woman presents for initial evaluation of cyclical symptoms of irritability, painful bloating and depression. These symptoms occur regularly 4-5 days prior to the beginning of menstruation. During these few days, this patient typically has to miss work due to the "awful pain and mental clouding." Which of the following treatment options do you recommend as first-line therapy? a) Anticholinergics b) Oral contraceptive pills c) Selective serotonin reuptake inhibitors d) Hysterectomy

Selective serotonin reuptake inhibitors

A 26-year-old woman reports a history of amenorrhea for the past year. She also had an increased amount of milky discharge from her nipples over the past several months and has lost all interest in sex for the past 6 months. She denies any drug or medication use other than occasional over-the-counter analgesics for frequent headaches. A physical examination confirms the presence of an easily expressed milky discharge, as well as vaginal dryness. A pregnancy test is negative. Which one of the following tests would be most appropriate at this point? a) Dexamethasone suppression test b) Ultrasonography of the breasts c) MRI of the sella turcica d) Serum prolactin level

Serum prolactin level

A 3-year-old girl presents to the ED with her mom and grandmother for evaluation of vaginal spotting. The child has no other complaints and specifically denies sexual abuse or trauma when questioned alone. After watching a news special on sexual abuse, mom is concerned that her daughter may have been sexually assaulted, despite no specific concern. The child is acting appropriately and there are no external lesions or signs of trauma. Internal pelvic exam is difficult due to the patient's age. Which of the following statements is true? a) She may have a vaginal foreign body; consider a nasal speculum to attempt visualization and removal b) Obtain a pelvic x-ray prior to attempting a physical exam c) She is the victim of abuse; do no further evaluation without a trained nurse present and contacting authorities d) Vaginitis is an unusual diagnosis in this age group

She may have a vaginal foreign body; consider a nasal speculum to attempt visualization and removal

A 23 year old woman who is a recent immigrant from Mexico comes into your clinic for her first prenatal visit. You take a through history and discuss with that all routine prenatal labs are normal except a very low IgG titer to rubella, indicating nonimmunity. You advise her that: a) She can be immunized with an MMR at the next visit, but a booster may be needed after the delivery b) IVIG is available should she be exposed to someone with rubella c) She will be immunized after giving birth but remains susceptible during this pregnancy d) She should avoid all children for the duration of the pregnancy

She will be immunized after giving birth but remains susceptible during this pregnancy (Pregnant women shouldn't get live virus vaccines, such as the combined measles, mumps, and rubella vaccine (MMR), because there's a slight chance these will harm the unborn baby.)

A woman presents with right breast pain, fever, and malaise for 3 days. She has been breastfeeding her newborn child for the last 3 weeks. On exam, there is an area of focal erythema and tenderness. No mass or fluctuance is noted. What is the most likely pathogen responsible for causing her condition? a) Streptococcus agalactiae b) Escherichia coli c) Streptococcus pyogenes d) Staphylococcus aureus

Staphylococcus aureus

A 21-year-old woman presents with acute pain in the right pelvis. Which of the following makes the diagnosis of ovarian torsion more likely? a) Elevated WBC count b) Teratoma of the right ovary c) Vaginal bleeding d) Elevated WBC count

Teratoma of the right ovary

A couple comes to you for a preconception visit. You take a thorough history. All of the following would prompt you to refer to a geneticist except: a) The mother worked in a chemical plant for 5 years b) The woman's sister was born with a congenital heart defect c) The couple has had three miscarriages in the past d) The woman has diabetes mellitus that is well controlled

The woman has diabetes mellitus that is well controlled

A 22-year-old woman with regular menstrual cycles presents with symptoms concordant with premenstrual syndrome. In evaluating the large differential of these symptoms, which of the following serum laboratory tests is recommended? a) Estrogen b) Thyroid-stimulating hormone c) Human chorionic gonadotropin d) Follicle stimulating hormone

Thyroid-stimulating hormone (Underactive thyroid is common in women & may cause PMS )

A 58-year old postmenopausal woman presents with painless vaginal bleeding. Her last menses occurred 5 years ago. She reports that her Papanikolaou smears have always been normal; the last one was obtained a year ago. Which of the following is the next step in management? a) Transvaginal ultrasound b) Repeat Papanikolaou smear c) Hysteroscopy d) Colposcopy with endocervical curettage

Transvaginal ultrasound

A 26-year-old sexually active woman presents to the clinic with several days of vulvovaginal discomfort and pruritus. A pelvic exam shows copious frothy green vaginal discharge, inflamed vaginal walls, and a cervix with punctate hemorrhages. This physical exam is most consistent with which of the following causes of vaginitis? a) Vulvovaginal Candidiasis b) Bacterial vaginosis c) Trichomonas vaginalis d) Atrophic vaginitis

Trichomonas vaginalis

Low levels of maternal serum alpha-fetaprotein (MSAFP) are affiliated with what fetal disorder? a) Omphalocele b) Cystic hygroma c) Trisomy 18 d) Open neural tube defect

Trisomy 18 (Edwards Syndrome)

What is the imaging modality of choice for breast abnormalities in the pediatric population? a) Ultrasonography b) CT c) PET d) MRI

Ultrasonography

A 23-year-old woman presents with vulvar itching and vaginal discharge. She is not currently sexually active, and does not use contraceptives. She works in an office, drinks 3 alcoholic beverages a week and recently took up long-distance running. Physical examination reveals a reddened vulva without surface ulcerations, the absence of lice or nits, normal appearing vaginal secretions and an unremarkable vaginal cavity. There is no adnexal tenderness. Which important item is missing from this patient's history? a) Prior deliveries b) Age of menarche c) Use of local irritants d) Family history of endometrial cancer

Use of local irritants

A 41-year-old woman suffers from heavy and irregular menses, which at times leads to fatigue, lightheadedness and dyspnea. She has had three hospitalizations in the past year for such episodes. Her gynecologic evaluation has not revealed any pathological cause. The heavy menses continue despite hormonal therapy. Which of the following treatment options should be considered next? a) Hysteroscopy b) Hysterectomy c) Colposcopy d) Uterine ablation

Uterine ablation (This procedure is used to treat abnormal uterine bleeding.)

Which of the following is the most common cause of post-partum hemorrhage? a) Uterine atony b) Laceration to the cervix c) Uterine rupture d) Retained placenta

Uterine atony

A postmenopausal patient of yours is diagnosed with atrophic vaginitis and dyspareunia. She denies other menopausal complaints. Vaginal lubricants and moisturizers are not helping to decrease her symptoms. Which of the following would be most appropriate to prescribe next? a) Oral estrogen b) Vaginal progesterone c) Vaginal estrogen d) Oral progesterone

Vaginal estrogen

A 28-year-old woman at 31 weeks gestation comes to the emergency department after noticing a gush of clear fluid from her vagina. *Which of the following features is most suggestive of preterm rupture of membranes?* a) Microscopic evaluation of vaginal fluid revealing pseudohyphae b) Presence of bloody vaginal secretions c) Vaginal fluid pH > 6.5 d) Vaginal epithelial cells with a stippled appearance on microscopic evaluation

Vaginal fluid pH > 6.5

Which of the following best describes a REASSURING fetal heart rate (FHR) of a fetus who is 35 wks gestation? a) Acceleration of 15 beats/min lasting 15 seconds or longer b) Early decelerations that are mirror images of contractions c) A baseline FHR of 100-140 d) Minimal to absent variability

a) Acceleration of 15 beats/min lasting 15 seconds or longer

This fetal heart rate response is due to fetal movement and is always reassuring. a) early decelerations b) late decelerations c) accelerations d) variable decelerations

accelerations

A 26-year-old woman presents with abdominal cramping after a positive home pregnancy test. Her vitals are T 98.7°F, HR 94, BP 110/66, RR 18, oxygen saturation 97%. Her exam is unremarkable. Labs reveal a serum beta HCG of 1000 mIU and she is Rh positive. She states that the pregnancy is wanted. An ultrasound is performed as seen above. Which of the following is appropriate management for this patient? a) Administer methotrexate b) Discharge home with repeat beta hCG in 48 hours c) Administer Rhogam and methotrexate d) Administer Rhogam and discharge home with repeat beta hCG in 48 hours

b) Discharge home with repeat beta hCG in 48 hours Rhogam is used to prevent Rh isoimmunization in mothers who are Rh negative, she is Rh positive Methotrexate is used to treat ectopic pregnancies

The cardinal movements of labor are (in order): a) Engagement, extension, descent, internal rotation, extension, external rotation, expulsion b) Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion c) Engagement, descent, internal rotation, flexion, extension, external rotation, expulsion d) Engagement, descent, flexion, external rotation, extension, internal rotation, expulsion

b) Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion

A 19-year-old sexually active woman presents to your office with questions about cervical cancer screening. She wants to know when she should start getting screened since she's been sexually active for two years. Which of the following is the most appropriate next step in management? a) Initiate screening now with cytology and human papillomavirus testing b) Initiate screening at age 21 with cytology only c) Initiate screening now with cytology only d) Initiate screening at age 21 with cytology and human papillomavirus testing

b) Initiate screening at age 21 with cytology only

What is the typical pattern of office visits during routine prenatal care? a) Monthly visits through week 24, then every 2 weeks through week 32, then weekly until delivery b) Monthly visits through week 28 then every 2 weeks through 36 weeks then weekly until delivery c) Monthly visits through week 28, then every 2 weeks through week 32, then weekly until delivery d) Monthly visits through week 20, then every 2 weeks through week 32, then weekly until delivery

b) Monthly visits through week 28 then every 2 weeks through 36 weeks then weekly until delivery

A patient in her first pregnancy is admitted to labor and delivery with contractions every 4 minutes lasting 45 seconds. On admission, she was 4 cm dilated, 1 hour later, she is 5 cm dilated. Which of the following best describes her labor pattern? a) She has reached the second stage of labor b) There is good progress for a first delivery c) There is adequate progress for the latent phase of labor d) Labor is progressing too rapidly

c) There is adequate progress for the latent phase of labor (Part of stage I - onset of labor until full cervical dilation. Latent phase = cervix effacement with gradual cervical dilation | Active phase = rapid cervical dilation usually beginning around 3-4 cm)

You perform a Biophysical Profile Test (BPP) on a 38 week-old fetus. The results show a reactive NST, absent fetal body movement, positive fetal breathing movements, positive flexion of fetal arm, and amniotic fluid volume vertical pocket of 3x3 cm. Based on these findings, the following can be said: a) Results are equivocal b) Score is six c) Follow-up includes 24-hour repetition of the test d) Results are reassuring

d) Results are reassuring

32 year old woman G2 P1 with previous vaginal delivery presents at 38 weeks gestation. On examination, her cervix is 5 centimeters dilated and 40% effaced. The patient is in the a) first stage of labor b) third stage of labor c) fourth stage of labor d) second stage of labor

first stage of labor

A 33 year old female G3P1A1 with an IUP of 38 weeks presents to the Triage with a blood pressure of 140/90. She has a history of preeclampsia with this pregnancy. The external monitor shows no contractions noted and the fetus having a reassuring, reactive strip. Cervical assessment shows a closed cervix, 20% effaced, and a negative 2 station. You decide to initiate her labor by artificial means. This is best described as: a) induction of labor b) prolongation of labor c) augmentation of labor d) active labor

induction of labor

This fetal heart rate response is due to uteroplacental insufficiency and is always worrisome. a) late decelerations b) early decelerations c) variable decelerations d) sinusoidal pattern

late decelerations

What is the fetal position of the picture A & B below?

left occiput anterior (LOA) & left occiput posterior (LOP)

What is the lie and presentation of this picture?

longitudinal; vertex (cephalic)