Womens Heatlh EOR Exam

A 29-year-old woman is in active labor. Her history is significant for shoulder dystocia during the birth of her previous child. Which of the following would best diagnose shoulder dystocia in her current labor?

Gentle downward traction on the fetal head fails to deliver the anterior shoulder

A 42-year-old woman with a history of hypertension and a body mass index of 32 presents to the office with her fourth incidence of vaginal candidiasis in the past year. Besides a wet mount and fungal culture, which of the following screening test should be ordered?

Glycated hemoglobin

A 26-year-old woman is newly diagnosed with gestational diabetes mellitus at 26 weeks gestation. Her past medical history is otherwise benign and she is on no chronic medications. Which of the following is the most appropriate first-line treatment for this patient?

Medical nutritional therapy

Which of the following is a risk factor for occiput posterior position at birth?

Nulliparity

A 24-year-old G1P0 24 weeks' gestation presents to her gynecologist for follow-up visit. She states that she has been having headaches with blurred vision and some epigastric pain. Her blood pressure is 162/92 although prior to her pregnancy she was normotensive. Protein is noted in her urine. What condition should be considered at this time?

Preeclampsia

During which period of labor progression does a pregnant woman deliver her fetus?

Second stage

A 22-year-old woman presents with a new lump in her right breast that she noticed while she was doing a self-exam in the shower about one week ago. The lump has not changed in size. Upon physical exam, you note a 2 cm discrete lump that is round, mobile and nontender to palpation to the upper outer quadrant of the right breast. The lump is solitary and you do not notice any other abnormalities. Which of the following statements is most likely given the suspected diagnosis?

They usually regress after menopause

A 31-year-old G1P1 woman at 39 weeks gestation has a normal spontaneous vaginal delivery. The patient is evaluated immediately after delivering for possible obstetric perineal laceration. On physical examination, the patient is found to have a laceration through the perineal fascia and musculature extending into the external anal sphincter. Based on the description of the laceration, which of the following would be the patient's correct diagnosis?

Third-degree laceration

A 20-year-old woman with a known history of chronic abnormal uterine bleeding presents to the emergency department with tachycardia, hypotension, heavy vaginal bleeding, and hemoglobin of 6.2 g/dL. Pregnancy test is negative. The patient was started on fluids and given a blood transfusion. A uterine curettage was performed, but bleeding still persisted. Which of the following is the most appropriate next step?

Intravenous estrogen

An obese, 56-year-old woman presents to the clinic with a new and persistent non-tender mass in her right breast, which she had noticed a month ago. Past medical history is significant for menarche at age 16 years, first pregnancy at age 17 years, and breastfeeding all of her children. On exam, there is one firm, immovable mass in the right breast as well as right axillary adenopathy. Diagnostic mammogram reveals a spiculated soft-tissue mass. Which of the following risk factors likely increased this woman's risk for the most likely diagnosis?

Obesity

A 19-year-old woman presents to the clinic for evaluation of ongoing vaginal irritation and discharge. She reports that the discharge has been thin, yellow, and foul smelling. She is currently sexually active with one partner. Vaginal pH is 5.5. Amine test is positive. Wet mount reveals motile trichomonads with absence of hyphae and clue cells. Based on the most likely diagnosis, what other physical examination finding would you likely discover in the patient?

Punctate hemorrhages on the cervix

A 24-year-old woman who gave birth to a premature baby girl at 30 weeks gestation presents to your office for a follow-up visit after being diagnosed with mastitis three days ago. You had prescribed her amoxicillin, but after taking it as directed, she has not had any improvement of symptoms. The patient now has a fever of 103℉ with increased pain to the left breast. Physical exam shows a severely tender fluctuant mass in the breast that is red and warm to touch. What is the most appropriate next step for treatment of this patient?

Refer patient to a surgeon for incision and drainage

An 18-year-old woman presents to the clinic with heavy and painful periods for the past two years. She has never been pregnant and a pregnancy test in the office is negative. The patient has a normal body mass index and Pap smear, and her pelvic ultrasound and pelvic examination are unremarkable. Which of the following is the most likely diagnosis?

abnormal uterine bleeding

A 30-year-old G1P0 at 36 weeks gestation presents to the clinic for a routine check-up. Fetal position cannot be determined during the abdominal exam. Transabdominal ultrasound reveals fetal head in the fundus with both hips and knees flexed. Which of the following describes this fetal position?

complete breach

A 25-year-old woman presents for her initial prenatal visit. What is the most accurate method for determining her estimated date of delivery?

crown rump length

A 28-year-old sexually active woman presents with persistent lower abdominal pain for three days. Which of the following physical exam findings would best support the diagnosis of pelvic inflammatory disease?

Cervical motion tenderness

Which of the following best represents a positive prognostic variable for successful external cephalic version of a breech fetus?

Non-longitudinal fetal position

A 24-year-old woman presents with sudden onset of lower right sided abdominal pain, nausea, and vomiting. She is not currently sexually active and pregnancy test is negative. She is found to have a right adnexal mass on exam. A pelvic ultrasound reveals an heterogenous enlarged ovary with decreased doppler flow. Which of the following is the most common risk factor for the suspected diagnosis?

Ovarian mass

A 30-year-old woman presents to the clinic with concerns about preterm delivery. She suffered premature rupture of membranes with her first pregnancy. Which of the following would be the best choice for anticipatory guidance in this patient?

Smoking cessation

A 32-year-old woman presents to the ED at 39 weeks of gestation in active labor. Her axillary temperature is 98.6°F, pulse is 88 beats per minute, and blood pressure is 120/80 mm Hg. Upon vaginal examination, an umbilical cord is noted to be protruding from the cervix which is dilated to five centimeters. While awaiting a surgical suite for an emergency cesarean section, which of the following agents would be most appropriate to administer?

subcutaneous terbutaline

A 25-year-old G1P0 woman at 33 weeks gestation presents to her obstetrician with a complaint of wetness and leakage from her vaginal area. On physical exam, fluid can be seen coming from the cervical canal. The cervix is not dilated. Fern test is positive. Which of the following medications should be given at this time to delay delivery?

ampicillin

Which person is statistically most likely to be phenotypically Rh(D)-negative?

A 31-year old man from Nigeria

Which of the following would increase the chance of intrauterine device expulsion or failure?

Age of 25 years or less

A 25-year-old woman is recovering from uncomplicated vaginal delivery she had 24 hours ago. Which of the following physiologic changes is a major mechanism preventing postpartum hemorrhage?

Uterine involution

Which of the following would be considered normal when taking a focused gynecologic history from a patient?

Whitish, watery, odorless discharge

At what age should routine annual pelvic exams begin in nonpregnant women?

21

A 25-year-old G1P0 at 33 weeks' gestation presents to her obstetrician for follow up visit. She states she has been having menstruation-like cramping and lower back pain every ten minutes or so for the last 24 hours. On physical exam, her cervix is dilated to 4 cm. Qualitative fetal fibronectin is positive. Which of the following confirms preterm labor?

5 uterine contractions every 20 minutes, cervical dilation of 4 cm, and cervical length of 18 mm on trasvaginal ultrasound

A pregnant 26-year-old woman presents for an ultrasound at 16 weeks gestation. She has a past medical history significant for a pregnancy loss at 22 weeks gestation prior to her current pregnancy. Ultrasound confirms a shortened cervix. Following cervical cerclage, what additional lifestyle modifications should be recommended for this patient?

Avoid colitis

A 27-year-old G2P1 woman at 38 weeks gestation presents to the clinic for a regular prenatal visit. She reports strong "kicks" in her lower abdomen but no other unusual symptoms. Vitals are normal. Physical exam reveals a soft mass in the lower abdomen. Ultrasound is ordered and reveals the fetal head in the fundus. Which of the following is the most likely diagnosis?

Breech presentation

A 65-year-old woman undergoes primary surgical cytoreduction for epithelial ovarian cancer. She has suboptimally cytoreduced disease with greater than 1 cm of residual disease still present. Which of the following is the best pharmaceutical treatment option for this patient?

Carboplatin and paclitaxel intravenously

A 25-year-old G1P0 at 39 weeks' gestation presents to the hospital as she believes she is in labor. Which of the following would suggest that the woman should be admitted to the labor and delivery unit?

Cervical dilation of 4 cm

A 60-year-old G2P2 woman presents to the clinic for a progressively worsening bulge sensation in her vagina for the past eight months and urinary incontinence when she laughs. Vaginal exam reveals a palpable break in the anterior vaginal fascia which becomes more prominent with Valsalva. Which of the following historical aspects put this woman most at risk for the most likely diagnosis?

Connective tissue disorders

A 24-year-old woman presents with fever, chills, and painful lumps to the groin area for the past three weeks. She is sexually active with men only. Pregnancy test is negative. Upon physical examination, you note tender inguinal and femoral lymphadenopathy bilaterally with some anal fissures. There are no lesions noted on labia majora or minora. Which of the following is the treatment of choice for this patient?

Doxycycline

A 22-year-old woman presents to the emergency department for one day of abdominal pain and vaginal spotting. The woman reports she is sexually active with one partner, but uses a non-hormonal intrauterine device to prevent pregnancy. Heart rate is found to be 126 bpm with a blood pressure of 88/60 mm Hg. Physical examination reveals right-sided adnexal tenderness and minimal blood in the vaginal vault. Cervical os is closed. Laboratory values reveal an hCG of 4,100 mU/mL. No intrauterine pregnancy is visualized on transvaginal ultrasound. What is the most likely diagnosis?

Ectopic pregnancy

A 26-year-old woman presents with a monochorionic, diamniotic twin pregnancy at 20 weeks of gestation in which polyhydramnios is visualized on ultrasound in twin one, and oligohydramnios in twin two. Doppler flow from placenta to both fetuses is good. The bladder of twin two is not visualized. Which of the following clinical interventions would be the best choice for this patient?

Fetoscopic laser ablation of placental anastomoses

A 20-year-old woman presents to the clinic for well-woman exam. The patient states that she has not had a period in over 90 days. She was 12 years old when she had her first menstrual bleeding. The patient is active on her college cross country team, and runs about 80-100 miles per week. She is a vegan and tries to eat regularly, but due to her demanding class load and practice schedule, she often skips meals. Upon physical examination, the patient is well-developed but is noticeably thin with a body mass index of 18. You do not note any other abnormalities. A pregnancy test is negative. Based on patient's history, which of the following is the most likely diagnosis?

Functional hypothalamic amenorrhea

A 32-year-old woman presents to the emergency department with vaginal bleeding. She is 10 weeks pregnant and began spotting this morning. The bleeding has become heavier throughout the day and now she has pelvic discomfort and cramping. A pelvic exam is completed and the cervix is found to be dilated with products of conception in the cervical canal. What is the most likely diagnosis?

Incomplete abortion

Activation of the hypothalamic-pituitary-adrenal axis through excess fetal or maternal stress has been implicated as one causative factor of preterm labor. Which of the following best describes the physiologic cascade triggered by stress in a pregnant patient?

Increased cortisol leads to increased cortico-releasing hormone, which activates prostaglandins that cause cervical change and rupture of membranes

A 30-year-old woman presents with a new thin vaginal discharge with a foul odor for the past two weeks. The woman is 24 weeks pregnant. The pregnancy has been uncomplicated. She denies any associated pain or vaginal bleeding. Vaginal swab is obtained for point of care microscopy which shows the presence of clue cells. Which of the following is the best next step in management?

Initiate metronidazole orally

Which of the following factors is more indicative of premenstrual dysphoric disorder than premenstrual syndrome?

Presence of symptoms for most of the preceding year

Which of the following factors is more indicative of secondary dysmenorrhea than primary dysmenorrhea?

Progressive worsening of pain severity

A 25-year-old woman presents to her obstetrician for her first prenatal visit. She is advised to begin taking prenatal supplements. Which of the following supplements has been proven to be teratogenic if taken in excess?

Vitamin A

A 23-year-old female presents to her clinician for an annual physical for work. She reports that she became sexually active at the age of 21, has had 4 sexual partners in the last 3 months, consumes 6 alcoholic beverages per day, and regularly douches. Which of the following factors in the patients history increases her risk for cervical cancer?

Multiple sex partners

A 25-year-old G1P0 woman at 34 weeks gestation presents to the clinic for a regular prenatal visit. She has noticed swelling in her feet but denies any associated pain as well as any other new symptoms. Temperature is 98.0°F, blood pressure is 155/92 mm Hg, and body mass index is 38.0 kg/m². Serum creatinine is 1.8 mg/dL. Which of the following is the most likely diagnosis?

Preeclampsia

A 24-year-old woman recently treated with an antibiotic for a urinary tract infection presents with severe vaginal itching and burning for two days. Upon physical examination, you note thick, white, curd-like vaginal discharge. Which of the following microscopic findings you would most likely see on a wet mount?

Pseudohyphae

A 19-year-old woman presents to the clinic with heavy and painful periods for the past year. Her cycles are irregular lasting up to three to four weeks at a time. The patient is not on any medications, is sexually active, and a pregnancy test in the office is negative. She has a normal body mass index and Pap smear, and the pelvic ultrasound and pelvic examination are unremarkable. Which of the following is the first-line treatment for this condition?

Combined oral contraceptive pills

A 19-year-old sexually active woman presents with lower abdominal pain and purulent vaginal discharge of two weeks duration. Temperature is 98.6 °F, heart rate is 70 beats per minute, and blood pressure is 122/74 mm Hg. On exam, the patient expresses tenderness to palpation in right and left lower abdominal quadrants, has purulent cervical discharge, and expresses extreme tenderness with uterine cervical movement. Urine pregnancy test is negative. Which of the following options is the most appropriate therapy?

Ceftriaxone 500 mg IM + Doxycycline 100 mg PO twice daily for 14 days

A 55-year-old postmenopausal woman presents to the clinic for her annual physical exam. She has a history of estrogen receptor-positive infiltrating ductal carcinoma and is status post lumpectomy and radiation therapy. Following local treatment, she was started on anastrozole. The patient remains asymptomatic and her most recent mammogram was normal. Which of the following screening evaluations is the most appropriate recommendation for this patient?

Bone density scan

A 28-year-old woman who is two weeks postpartum presents to the office with six days of fever, malaise, and left breast pain. Upon examination you notice a large, fluctuant mass to the left breast that is exquisitely tender with some pus upon expression of the nipple. What is the most likely diagnosis?

Breast abscess

A 30-year-old woman who just delivered a 9 lb 12 oz baby vaginally after a prolonged labor suddenly develops heavy vaginal bleeding, tachycardia and altered mental status. What finding is most likely to be present to confirm the underlying cause of hemorrhage?

A boggy, enlarged uterus upon palpation of the pelvis

A 22-year-old woman presents with irregular vaginal bleeding and pelvic pain. Her last menstrual period was six weeks ago and she states that her menstrual cycle is typically 26 to 28 days in length. A urine pregnancy test is positive and a pelvic examination reveals mild right adnexal tenderness. Transvaginal ultrasound shows a right adnexal mass. Serum human chorionic gonadotropin (hCG) level is 3,520 IU/L. Which of the following is the next best step in managing this patient?

Administer methotrexate

A 48-year-old woman presents to the office for her annual physical exam. She has not had a period for over 12 months. Which of the following hormonal changes are likely to occur during the menopausal transition?

An increase in estrone, decrease in estradiol, and no change in testosterone

A 28-year-old G2P1 Rh-negative woman presents to the clinic for an initial prenatal visit. Which of the following should be performed at this visit?

Anti-D antibody screen

A 27-year-old woman presents to the clinic complaining of vaginal discharge. The patient reports she has not been sexually active in six months. She denies any itching, vaginal discomfort, or dysuria. On examination, there is thin, gray, foul smelling vaginal discharge. The patient has a positive whiff-amine test and clue cells were noted on saline wet mount. What is the most likely diagnosis?

Bacterial vaginosis

A 38-year-old woman with a 20-year history of smoking one pack of cigarettes per day and with a history of iron deficiency anemia presents to the office to discuss contraceptive methods. She has two children and is otherwise healthy. Medical history reveals that her father had a heart attack at the age of 52. Which of the following is a contraindication to starting combination oral contraceptives in this patient?

Cigarette smoking

A 35-year-old woman presents for routine gynecologic screening. Cervical cytology shows atypical squamous cells of undetermined significance. Reflex human papillomavirus testing is positive for strain 16. Which of the following is the best next step in management?

Colonoscopy

A 28-year-old G1P0 at 18 weeks gestation presents to the clinic to follow up on her Pap smear results. The cervical cytology report results indicated "atypical squamous cells: cannot exclude high-grade squamous intraepithelial lesion." Which of the following is the most likely next step in diagnosis?

Colposcopy

A 24-year-old woman with a two-week-old infant who was born six weeks premature presents to your office with localized redness, swelling, and pain to the right breast. What information would you give this patient on how to care for her condition at home?

Continue breastfeeding from the affected breast to help clear out the duct

A 52-year-old woman presents to the clinic complaining of hot flashes and difficulty sleeping through the night. She states her last menstrual period was over 12 months ago. Which of the following laboratory results would be expected?

Elevated follicle-stimulating hormone

A 25-year old woman presents with dysuria and purulent vaginal discharge for four days. Which of the following physical exam findings would best support the diagnosis of acute cervicitis?

Edematous and erythematous uterine cervix

A 55-year-old woman presents to the oncology clinic to discuss therapy options for her newly diagnosed, non-metastatic, unilateral, invasive breast cancer. Routine analysis reveals estrogen receptor-positive and progesterone receptor-positive tumor expression. Which of the following therapies will likely be most effective for this patient?

Endocrine therapy

A 55-year-old postmenopausal woman presents to the clinic complaining of frequent episodes of vaginal spotting, which she began noticing over the past month. She has a history of diabetes and hypertension. She denies any history of abnormal Papanicolaou smears. A pelvic examination reveals a small amount of blood coming from the external os, but is otherwise normal. What is the best way to diagnose this condition?

Endometrial biopsy

A 45-year-old woman presents for her annual physical exam and is diagnosed with iron deficiency anemia. Upon further questioning, the patient reveals that she has been having heavy and irregular periods for the past year. She has three children and does not plan to have any more. Pelvic examination is normal. You order a pelvic ultrasound. Which of the following findings is not consistent with the diagnosis of abnormal uterine bleeding?

Endometrial lining thickness of four mm

A 24-year-old woman presents to the clinic complaining of cyclical pelvic pain and painful intercourse for the past year. She states that the pelvic pain occurs a few days prior to the start of menstruation. She denies any menorrhagia, abdominal pressure or vaginal discharge. She denies any history of sexually transmitted infections. Vital signs are within normal limits. Pelvic examination reveals lateral displacement of the cervix but is otherwise normal. Which of the following is the most likely diagnosis?

Endometriosis

A 68-year-old woman presents to the clinic with progressive lower abdominal bloating for the past six months. Ascites is present on exam, and a right-sided adnexal mass is palpable. Pelvic ultrasonography reveals a solid complex mass on the right ovary and confirms presence of associated ascites. Which of the following is the most likely diagnosis?

Epithelial carcinoma

A 32-year-old woman presents with complaints of painful lumps in her breasts that worsen with her menstrual cycle. Which of the following hormones is considered a causative factor in the development of the suspected diagnosis?

Estrogen

A 21-year-old woman presents for a routine exam. She is noted to have a two centimeter, singular, circular, mobile, nontender mass in her left breast at the five o'clock position. The overlying skin is normal. She denies knowledge of this lesion prior to this visit. She also denies constitutional symptoms, breast tenderness, firmness, nipple changes or discharge, or heaviness with her menstrual cycle. What is the most likely diagnosis?

Fibroadenoma

A 32-year-old woman presents to the office for occasional bilateral breast pain that is worse right before menstruation. She also says they feel larger in size during that time and that sometimes she feels lumps in both breasts when she performs a self-exam. She does not currently have any pain as she just finished her cycle. You note bilateral dense breast tissue with rope-like texture and cobblestoning upon palpation with mild tenderness to deep palpation, but no other abnormalities. What is the most likely diagnosis?

Fibrocystic breast changes

A 30-year-old woman presents to her primary care physician with concerns that she has been exposed to syphilis by her partner. She was treated for syphilis in the past. Which of the following diagnostic tools would show a false-positive result due to her prior infection and cannot be used alone to provide a diagnosis of syphilis?

Florescent treponemal antibody absorption (FTA-ABS)

A 50-year-old woman with no history of endocrine disease presents complaining of insomnia, fatigue, and hot flashes for the past year and a half, and she hasn't had a menstrual period in over a year. She denies galactorrhea. Physical exam is unremarkable. Which of the following laboratory findings is most likely to be increased?

Follicle-stimulating hormone

A 33-year-old G3P2 at 26 weeks' gestation presents to the clinic for a regular prenatal visit. She has no complaints at presentation and notes normal fetal movement. Vitals are normal. Body mass index is 35.6 kg/m². A 50 gram oral glucose load is given and one hour later, her glucose level is elevated at 212 mg/dL. The patient has no prior history of elevated glucose readings. Which of the following is the most likely presumptive diagnosis?

Gestational diabestes

A 32-year-old pregnant woman who is 28 weeks presents with an elevated blood pressure to the emergency room at the direction of her clinician. Her last two office visits blood pressures have been 172/112 mm Hg and 168/110 mm Hg. Which of the following medications would be the best choice to use initially in this patient?

Hydralazine

A 60-year-old woman presents to her gynecologist with postmenopausal bleeding. She is currently taking tamoxifen following recent breast cancer treatment and is on estrogen replacement therapy for symptoms of menopause. An endometrial biopsy shows Stage 1 adenocarcinoma. Which of the following is the most appropriate intervention for this patient?

Hysterectomy and bilateral-oophorectomy

A 14-year-old girl presents to the clinic with lower abdominal cramping that started six months ago. The cramping always starts a day or two before her menstrual cycle and resolves after about two days. She rates the pain as "severe"; she has gone home from school and missed sports practices due to the pain. Which of the following is the most appropriate initial therapy?

Ibuprofen

Which of the following best describes a normal physiologic change of pregnancy?

Increased red blood cell mass

Which of the following is associated with a decreased risk for endometriosis?

Increasing consumption of long-chain omega-3 fatty acids

Which of the following factors increases a woman's risk for uterine prolapse?

Increasing parity

A 23-year-old woman presents with intermittent postcoital vaginal bleeding and persistent purulent vaginal discharge for one week. On exam, her cervix is erythematous and friable. There is no cervical motion tenderness on exam. Which of the following is the best next step?

Initiate empiric antibiotic therapy

A 54-year-old woman presents with progressively worsening vaginal irritation and dyspareunia for three years. She denies dysuria or urinary frequency. She has no past medical history of abnormal cervical cytology, and hasn't had any vaginal bleeding in the past two years. She hasn't tried any over the counter treatments for her symptoms. There is introital narrowing on external genital exam, and pelvic exam reveals dry, smooth and shiny vaginal epithelium. What is the best next step in management?

Initiate non-hormonal vaginal moisture and lubricant therapy

A 36-year-old woman presents to the office for a painful right breast for the past two days. She is one month postpartum. The patient reports swelling and redness of the right breast in addition to pain. She is febrile to 101.2°F. On physical examination, the lower lateral quadrant of the right breast is erythematous, firm, warm, and markedly tender to palpation. Enlarged right axillary lymph nodes are noted on exam. In addition to cool compresses, which of the following would be the most appropriate course of treatment?

Initiation of dicloxacillin 500 mg four times daily

A 55-year-old woman presents to her primary care physician with a complaint of incontinence. She states that it is worse when she sneezes or when she lifts anything heavy. What is the best initial treatment to help alleviate these symptoms?

Kegel exercises

A 32-year-old woman presents to the office with one day of fever, malaise, and left breast pain. She has a two-day old infant who she is trying to exclusively breastfeed. What breastfeeding practice in her daily routine is most likely to increase the risk of mastitis?

Long periods of tie between feedings

A 31-year-old woman presents to the clinic complaining of groin pain. The patient states that she returned from a trip to the Caribbean three weeks ago, and had unprotected sex with a male partner during her trip. She noticed a painless genital ulcer that appeared prior to returning home, but states that it was gone three days later. A few days ago, she noticed some pain and swelling in her groin, which has become progressively worse. On physical examination, there are inflamed superficial and deep inguinal lymph nodes forming a "groove" sign bilaterally. Which of the following is the most likely diagnosis?

Lymphogranuloma venereum

A 32-year-old G1P0 woman presents to labor and delivery at 37 weeks gestation for elevated blood pressure and proteinuria noted in her obstetrician's office. The patient endorses a mild temporal headache and nausea. Blood pressure is found to be 168/102 mm Hg. On physical examination, there is edema of bilateral hands and hyperreflexia. On laboratory studies, the patient has 4+ protein on urine dipstick. There is no evidence of hemolytic anemia or thrombocytopenia, but liver enzymes are elevated. In addition to urgently preparing for delivery, which of the following would be the most appropriate next step in the patient's management?

Magnesium sulfate for seizure prophylaxis

A 25-year-old woman presents to the emergency department with abdominal pain in the lower left quadrant. An ultrasound shows an ectopic pregnancy. Which of the following make her a candidate for methotrexate therapy?

Mass size less than 4 cm

A 48-year-old woman presents to the clinic worried that she has not had a period in over a year. In the past, she had irregular periods for several years. She reports vaginal dryness, insomnia, and increased irritability. Vitals are normal, but she is 12 lbs heavier than she was at her last appointment six months ago. Serum human chorionic gonadotropin and prolactin levels are normal, but follicle-stimulating hormone is elevated. Which of the following is the most likely diagnosis?

Menopause

A 23-year-old woman with a diagnosis of polycystic ovarian syndrome and a history of infertility presents to her primary care provider with a positive pregnancy test. She began treatment for her diabetes mellitus type 2 a few months ago. What medication to treat her diabetes may have helped her to achieve pregnancy?

Metformin

A 24-year-old G1P0 woman presents to the emergency department for atraumatic vaginal bleeding at 12 weeks of gestation. The woman's vital signs are within normal limits. On examination, she is found to have blood in the vaginal vault with an open cervical os. Obstetrics is consulted. Rh(D) immunoglobulin is given to the patient after laboratory results are available. Which of the following test results indicated the patient's need for Rh(D) immunoglobulin?

Negative Rh(D) on blood typing and antibody screen

A 23-year-old woman presents with several erythematous, painful ulcers on the vaginal introitus which have been present for seven days and began as small red papules, which then evolved to pustules and then ulcerations. There is marked lymphadenopathy of bilateral inguinal nodes. Polymerase chain reaction for herpes simplex virus is negative. Which of the following additional diagnostic tests is necessary before diagnosing chancroid in this patient?

Negative venereal disease research laboratory test

A baby is delivered via cesarean section at 39 weeks of gestation due to the mother's history of a previous cesarean section. At one minute after birth the baby is found to have an Apgar score of seven. The score is to be reassessed at the five-minute mark. The baby is found to be actively moving and pulls away with minor stimulation. The baby is pink without cyanosis and vigorously crying. Heart rate is 96 bpm. What is the baby's five-minute Apgar score?

Nine (9)

A 28-year-old G2P1 woman at 38 weeks of gestation presents to labor and delivery after experiencing a gush of vaginal fluid at home. The patient reports she has not yet experienced contractions. A sterile speculum examination is performed which shows pooling of fluid in the vaginal vault. No cord prolapse is visualized on speculum examination. Which of the following can be used to further confirm the diagnosis?

Nitrazine test

A 22-year-old woman presents with persistent purulent vaginal discharge for one week which began after having intercourse with a new partner. On exam, her cervix is erythematous and edematous and there is a purulent cervical discharge. There is no cervical motion tenderness. Which of the following is the most appropriate diagnostic test?

Nucleic acid amplification testing of cervical discharge

An asymptomatic G2P2 58-year-old woman presents to the clinic for routine gynecologic examination. Pelvic exam reveals a posterior vaginal bulge and a palpable break in the rectovaginal fascia. Which of the following interventions is the best next step?

Observe with yearly examination

A 38-year-old G3P2 at 16 weeks' gestation presents to the clinic for a regular prenatal visit. She describes symptoms of morning sickness that are "worse than with my other two pregnancies." Vitals are normal. On exam, her fundal height measured 18 cm. Labs show an elevation in human chorionic gonadotropin hormone and maternal serum alpha-fetoprotein. Which of the following is the next best step?

Order abdominal ultrasound

A 32-year-old woman who is 35 weeks pregnant presents for a routine prenatal examination. Upon palpation of the uterus, the firm resistance of the fetal head is not able to be felt above the symphysis pubis. Upon further palpation, the fetal head seems to be located in the left upper quadrant. Which of the following is the next best step?

Order an abdominal ultrasound

A 28-year-old woman presents with a persistent painless labial lesion for one week. She denies dysuria or any change in her vaginal discharge. On exam, she has one erythematous ulcerated sore on the labia majora with a punched-out appearance. The rest of physical exam is unremarkable. Which of the following is the most appropriate therapy?

Penicillin G benzathine IM

A 72-year-old woman with known pelvic organ prolapse presents to the clinic with worsening stress urinary incontinence over the past three years. Point of care urinalysis is unremarkable. Which of the following would most likely improve her symptoms and overall condition?

Perform pelvic floor muscle strengthening exercise

A 30-year-old G2P1 at 36 weeks' gestation with a history of tobacco use and chronic hypertension presents to the emergency department with acute onset of vaginal bleeding, abdominal pain, and contractions. Physical exam reveals patient in a moderate distress. Vital signs are temperature 37°C, heart rate 95 beats per minute, respiratory rate 16 breaths per minute, blood pressure 130/85 mm Hg, and pulse oximetry 100% on room air. Pelvic exam reveals firm and tender uterus with blood visualized in vaginal vault. Which of the following is the most likely explanation for these findings?

Placental abruption

A 32-year-old woman is having abnormal uterine bleeding for several weeks after a normal vaginal delivery. Serum hCG levels are tested and found to be elevated. They remain elevated at persistently low levels when retested after 2 months. A pelvic ultrasound reveals a hyperechoic intrauterine mass. Which of the following is the most likely diagnosis?

Placental site trophoblastic tumor

A male child born at 40 weeks of gestation has an Apgar score of 4 at birth. He is gasping for air and has a pulse of 68 despite positioning and airway clearance. Which of the following would be the best choice for initial clinical intervention in this patient?

Positive pressure ventilation

What is the most common risk associated with gestation of multiples?

Premature birth

A 23-year-old woman presents to the clinic complaining of abdominal bloating, fatigue, insomnia, mood swings, and persistent irritability for the past nine months. Symptoms have been occurring during the week leading up to her period and remit completely within a few days after onset of menses. She requests a note excusing her from work because she has missed several days due to these symptoms. She has no pre-existing endocrine or psychiatric disorders, and she has sought care at the clinic for several years only for routine screening and infrequent acute illnesses. Which of the following is the most likely diagnosis?

Premenstrual dysmorphic disorder

A 22-year-old woman presents to the clinic complaining of abdominal bloating, nausea, irritability, and anxiety for the past six months. She reports that symptoms consistently happen for the week leading up to her period and then stop quickly after she starts her period. She has no history of mood disorders and denies suicidal ideation. Which of the following is the most likely diagnosis?

Premenstrual syndrome

A 28-year-old G2P1 woman at 23 weeks gestation presents to the emergency room for painless vaginal bleeding. Prior to performing a digital vaginal examination, an ultrasound of the uterus is performed, which reveals placental tissue lying over the internal cervical os. Based on the ultrasound findings, what would you expect to learn from the patient's history that would put her at increased risk of the likely diagnosis?

Previous cesarean section

A 32-year-old woman with bilateral breast pain that is worse before her period and resolves after her period is diagnosed with fibrocystic breast disease. Which of the following descriptions would describe fibrocystic breast changes on ultrasound?

Prominent fibroglandular tissue with small cysts but no discernible mass

A 25-year-old woman is admitted to the labor and delivery unit. Fetal heart rate monitor has been placed. Which of the following findings would necessitate the planning for emergent intervention and possible cesarean section or instrumented vaginal delivery?

Recurrent late decelerations

A 62-year-old G4P4 woman presents to the clinic with a persistent pressure sensation in her vagina for the past year. She also reports that she has to push against the inside wall of her vagina in order to defecate. She reports no rectal or vaginal bleeding. Past medical history is significant for four vaginal deliveries. Which of the following is the most likely diagnosis?

Rectocele

A 21-year-old non-pregnant woman presents for her first Papanicolaou screening test. Cervical cytology shows low-grade squamous intraepithelial lesions. Which of the following is the best next step in management?

Repeat cervical cytology in one year

A 22-year-old woman with history of an ovarian cyst presents to the ED with sudden onset of sharp right lower quadrant pain. She is not sexually active and denies vaginal discharge or bleeding. Vital signs are normal. Physical exam findings include bowel sounds present throughout all four quadrants. Abdomen is tender to palpation in the right lower quadrant with no rebound or guarding. Pelvic exam reveals right adnexal mass. Urine pregnancy test is negative. Which of the following is the most likely diagnosis?

Ruptures ovarian cyst

A 24-year-old woman presents to the clinic with complaints of nausea, headache, fatigue, and mood swings that have been occurring during the week leading up to her period. She has routinely had to miss work due to her symptoms. Her symptoms go away shortly after menses begin. She denies suicidal ideation. She has no pre-existing endocrine or mood disorders. Which of the following is the best initial treatment for this patient?

Selective serotonin reuptake inhibitor

An 18-year-old woman presents to the clinic for her annual preventive health examination. She is asymptomatic. There is a new palpable left-sided adnexal mass on pelvic exam. Which of the following imaging modalities is best to initially characterize the mass?

Sonography

Which of the following lifestyle changes commonly leads to secondary amenorrhea?

Strenuous exercise

A 32-year-old woman presents to your office for a follow-up visit regarding her complaints of painful breasts bilaterally occurring right before she menstruates and resolving after her period. She has no family history of breast cancer. Which of the following is the best treatment for her symptoms?

Supportive bra and analgesics

A 23-year-old woman returns to her obstetrician seven days postpartum. She is concerned with severe pain in the perineum and discharge following the sensation of "popping" in that area. She has been running a fever for the past day. A fourth-degree laceration was repaired following labor. Physical exam shows separated sutures and an erythematous perineal wound. What is the appropriate management of this patient?

Systemic antibiotics, debridement, and secondary repair

A 28-year-old primigravida presents in her 34th week of gestation with dichorionic twins. Her prepregnancy body mass index was 20 kg/m². Her blood pressure is 120/80 mm Hg and her hemoglobin is 11 g/dL. Which of the following represents the best counseling to offer this patient?

Take two prenatal vitamins with iron daily instead of one

A 25-year-old woman presents to her primary care physician complaining of nausea and breast tenderness. She is sexually active, last sexual intercourse was 9 days ago. She states she does not remember the date of her last menstruation and that her cycles are irregular. A home pregnancy test this morning was negative as is the in-office urine pregnancy test. Which of the following is the best next step in confirming pregnancy?

Uterine pregnancy test 14 days after last intercourse

A 56-year-old G3P3 woman presents to the clinic as a new patient for routine gynecologic examination. When asked about genitourinary symptoms, she reports a bulge protruding from her vagina for the past two years which becomes more noticeable when she strains. She also has difficulty voiding at times, which is relieved by applying pressure to her perineum. She reports no pain or vaginal bleeding. Which of the following is the most likely diagnosis?

Uterine prolapse

A 60-year-old woman presents to her gynecologist with complaints of urinary frequency, urgency and incontinence. A cystocele is diagnosed on pelvic exam. The patient has undergone pelvic floor muscle training but symptoms have only improved slightly. What is the mainstay of nonsurgical treatment for this patient?

Vaginal pessary

A 25-year-old G1P0 at 39 weeks' gestation has been admitted to the labor and delivery department. On admission, a digital cervical examination was performed. Which of the following best describes the appropriate time for repeat cervical examinations during labor?

When the woman feels the urge to push

A 58-year-old postmenopausal woman presents to the clinic complaining of a vulvar lesion and pruritus that has become progressively worse. She does not recall when the mass first appeared, but states that it has now become painful and occasionally bleeds. She has a history of an abnormal Papanicolaou smear and previous positive human papillomavirus testing. A complete pelvic examination is performed and reveals a unifocal, firm, skin-colored ulcerating nodule on the left labium majus. The remainder of the pelvic examination is normal. Which of the following is the most likely diagnosis?

vulvar cancer