Women's Health EOR
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) A boggy, enlarged uterus upon palpation of the pelvis B) A cervical laceration C) A retained portion of the placenta within the uterus D) Thrombocytopenia on complete blood count
A) A boggy, enlarged uterus upon palpation of the pelvis (signs of uterine atony, MC cause of postpartum hemorrhage) Risk factors for uterine atony: prolonged or rapid forceful labor (especially if induced), maternal obesity, induction of labor, large-for-gestational age
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? A) Abnormal uterine bleeding B) Bleeding diathesis C) Hyperprolactinemia D) Polycystic ovarian syndrome
A) Abnormal uterine bleeding
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? A) Administer methotrexate B) Expectant management C) Prepare for emergent salpingostomy D) Repeat ultrasound in 48 hours
A) Administer methotrexate
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? A) Anti-D antibody screen B) Fasting blood glucose test C) Group B beta-hemolytic streptococcus screen D) Ultrasound screening for cervical length
A) Anti-D antibody screen
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? A) Avoid coitus B) Bed rest C) Cessation of exercise D) No lifting over five pounds
A) Avoid coitus
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? A) Bacterial vaginosis B) Candida vaginitis C) Chlamydia trachomatis D) Trichomonas vaginalis
A) Bacterial vaginosis
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? A) Bone density scan B) Breast magnetic resonance imaging C) Breast ultrasound D) Positron emission tomography scan
A) Bone density scan (aromatase inhibitors increase risk of osteoporosis)
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? A) Breast abscess B) Ductal carcinoma C) Fibroadenoma D) Uncomplicated mastitis
A) Breast abscess
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? A) Carboplatin and paclitaxel intravenously B) Carboplatin intraperitoneally C) Cisplatin and docetaxel intravenously D) Cisplatin intraperitoneally and paclitaxel intravenously
A) Carboplatin and paclitaxel intravenously (Platinum and Taxane agents are 1st-line chemo for women who have suboptimally cytoreduced disease after cytoreduction for epithelial ovarian cancer)
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? A) Cervical dilation of 4 cm B) Intact membranes C) Mucus plug discharge D) Sporadic painful uterine contractions
A) Cervical dilation of 4 cm
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? A) Colposcopy B) Human papillomavirus testing C) Loop electrosurgical excision procedure D) Repeat Pap smear
A) Colposcopy
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? A) Combined oral contraceptive pills B) Desmopressin C) Endometrial ablation D) High dose intravenous estrogen
A) Combined oral contraceptive pills
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? A) Complete breech B) Frank breech C) Incomplete breech D) Transverse fetal lie
A) Complete breech
A 25-year-old woman presents for her initial prenatal visit. What is the most accurate method for determining her estimated date of delivery? A) Crown-rump length B) Gestational sac size C) Naegele's rule D) Uterine size
A) Crown-rump length
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? A) Edematous and erythematous uterine cervix B) Tenderness with movement of the uterine cervix C) Tenderness with palpation in the hypogastric region D) Thick, white, curd-like vaginal discharge
A) Edematous and erythematous uterine cervix
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? A) Endometrial biopsy B) Papanicolaou smear C) Transabdominal ultrasound D) Transvaginal ultrasound
A) Endometrial biopsy *GOLD standard for endometrial cancer*
Which of the following hormones is considered a causative factor in the development of fibrocystic breast disease? A) Estrogen B) Progesterone C) Prolactin D) Relaxin
A) Estrogen
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? A) Hysterectomy and bilateral salpingo-oophorectomy B) Hysterectomy and bilateral salpingo-oophorectomy, lymph node excision and radiation C) Increase tamoxifen dosage D) Progestin treatment
A) Hysterectomy and bilateral salpingo-oophorectomy
Which of the following factors increases a woman's risk for uterine prolapse? A) Increasing parity B) Low body mass index C) Presence of cervical polyps D) Presence of vulvovaginal atrophy
A) Increasing parity
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? A) Menopause B) Pituitary adenoma C) Polycystic ovary syndrome D) Primary ovarian insufficiency
A) Menopause
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? A) Order an abdominal ultrasound B) Perform external version procedure C) Perform fetal non-stress test D) Plan an immediate cesarean delivery
A) Order an abdominal ultrasound
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? A) Anemia B) Cigarette smoking C) Family history of myocardial infarction D) Patient's age
B) 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? A) Ablation B) Colposcopy C) Excision D) Repeat cytology with HPV co-test in one year
B) Colposcopy (DOC for HPV strains 16 or 18) *Repeat testing in 1 year if ASC-US with HPV negative
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? A) Avoid taking any pain medications while breastfeeding B) Continue breastfeeding from the affected breast to help clear out the ducts C) Stop breastfeeding altogether to reduce the risk of developing mastitis in the future D) Take the antibiotic prescribed and stop when symptoms improve
B) Continue breastfeeding from the affected breast to help clear out the ducts
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? A) Cytotoxic chemotherapy B) Endocrine therapy C) Mastectomy D) Radiation therapy
B) Endocrine therapy (TOC option for breast cancer with chemotherapy or biologic therapy) -Tamoxifen (an estrogen receptor modulator) significantly reduces the risk of recurrence and death in patients with ER-positive disease
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? A) Endometrial hyperplasia B) Endometrial lining thickness of four mm C) Presence of endometrial polyps D) Presence of uterine fibroids
B) 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? A) Adenomyosis B) Endometriosis C) Leiomyoma D) Pelvic inflammatory disease
B) 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? A) Endometrioma B) Epithelial carcinoma C) Mature cystic teratoma D) Sex cord-stromal tumor
B) Epithelial carcinoma
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? A) Breast cancer B) Fibroadenoma C) Fibrocystic breast disease D) Galactocele
B) Fibroadenoma
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. What is the most likely diagnosis? A) Breast adenocarcinoma B) Fibroadenoma C) Fibrocystic breast changes D) Phyllodes tumor
B) Fibroadenoma
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? A) Direct fluorescent antibody (DFA) B) Fluorescent treponemal antibody absorption (FTA-ABS) C) Polymerase chain reaction (PCR) D) Rapid plasma reagin (RPR)
B) Fluorescent 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? A) Estradiol B) Follicle-stimulating hormone C) Prolactin D) Thyroid-stimulating hormone
B) Follicle-stimulating hormone -Estradiol decreases -TSH and Prolactin should not change with menopause *no labs are needed to make a diagnosis in this patient*
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? A) Diabetes mellitus type 2 B) Gestational diabetes C) Polycystic ovary syndrome D) Pregestational diabetes
B) Gestational diabetes
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? A) Complete blood count B) Glycated hemoglobin C) Pap smear D) Urine culture
B) Glycated hemoglobin or A1c (>4 yeast infections/1 year = suspect DM)
Which of the following medications would be the best choice to use in the treatment of hypertension in pregnancy? A) Captopril B) Hydralazine C) Nitroprusside D) Spironolactone
B) Hydralazine
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? A) Acetaminophen B) Ibuprofen C) Norgestimate/ethinyl estradiol D) Tramadol
B) Ibuprofen
Which of the following is associated with a decreased risk for endometriosis? A) Avoiding oral contraceptives B) Increasing consumption of long-chain omega-3 fatty acids C) Increasing consumption of trans unsaturated fat D) Maintaining a low body mass index
B) Increasing consumption of long-chain omega-3 fatty acids
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? A) Admit the patient for parenteral antibiotic therapy B) Initiate empiric antibiotic therapy C) Obtain cervical culture D) Obtain vaginal discharge swab for nucleic acid amplification testing and follow up results with primary care physician
B) Initiate empiric antibiotic therapy MC etiology of cervicitis: Neisseria gonorrhoeae and Chlamydia trachomatis (+HSV and Trichomonas vaginatis)
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? A) Initiate estrogen therapy B) Initiate non-hormonal vaginal moisturizer and lubricant therapy C) Obtain cervical cytology D) Obtain vaginal epithelium biopsy
B) Initiate non-hormonal vaginal moisturizer and lubricant therapy
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? A) Duloxetine B) Kegel exercises C) Pessary D) Topical vaginal estrogen
B) Kegel exercises
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? A) Free peritoneal fluid B) Mass size less than 4 cm C) Peptic ulcer disease D) Renal insufficiency
B) Mass size less than 4 cm
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? A) Eight B) Nine C) Seven D) Ten
B) Nine Appearance: 2 Pulse: 1 Grimace: 2 Activity: 2 Respiration: 2
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? A) Fit the patient for a pessary B) Observe with yearly examination C) Order abdominal and pelvic computed tomography D) Refer the patient for pelvic floor muscle strengthening
B) Observe with yearly examination (TOC of asymptomatic rectocele)
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? A) Observe and follow up in two weeks B) Order abdominal ultrasound C) Order additional blood tests D) Refer to a high-risk obstetric specialist
B) Order abdominal ultrasound (DOC for suspected multiple gestation pregnancy)
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? A) Drink less caffeine B) Perform pelvic floor muscle strengthening exercises C) Self-catheterize D) Urinate on a schedule every two to three hours
B) Perform pelvic floor muscle strengthening exercises
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? A) Intubation B) Positive pressure ventilation C) Supplemental oxygen by facemask D) Warming, drying, and close observation
B) Positive pressure ventilation
Which of the following factors is more indicative of premenstrual dysphoric disorder than premenstrual syndrome? A) Missing work and school B) Presence of symptoms for most of the preceding year C) Symptom onset during the week before menses D) Symptom onset in early 20s
B) Presence of symptoms for most of the preceding year DSM-5 Criteria: A. Symptoms present for most of the preceding year B. 5 or more symptoms the week before menses, resolving a few days after menses starts C. 1 or more of the following present: -Mood swings, sudden sadness, increased sensitivity to rejection -Anger, irritability -Sense of hopelessness, depressed mood, self-critical thoughts -Tension, anxiety, feeling on edge D. 1 or more of the following (total of 5 symptoms): -Difficulty concentrating -Change in appetite -Diminished interest -Easy fatigability -Feeling overwhelmed or out of control -Breast tenderness, bloating, weight gain, or joint/muscles aches -Sleep changes
Which of the following factors is more indicative of secondary dysmenorrhea than primary dysmenorrhea? A) Presence of nausea, headache, and malaise B) Progressive worsening of pain severity C) Symptom improvement with hormonal contraceptives D) Symptom onset in adolescence
B) Progressive worsening of pain severity TOC: NSAIDs or hormonal contraceptives
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? A) Hypoechoic irregular nodules with spiculated margins B) Prominent fibroglandular tissue with small cysts but no discernable mass C) Subtle echogenic masses with reticular patterns and a well-defined thin capsule D) Well-circumscribed, uniform round mass with thin pseudocapsule
B) Prominent fibroglandular tissue with small cysts but no discernable mass
At what age should routine annual pelvic exams begin in nonpregnant women? A) 13 years B) 18 years C) 21 years D) 25 years
C) 21 years
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? A) Amoxicillin 500 mg PO twice daily for 14 days + ofloxacin 300 mg PO twice daily for seven days B) Cefoxitin 2 g IM + single dose probenecid 1 g PO + sulfamethoxazole/trimethoprim 800 mg/160 mg PO twice daily for seven days C) Ceftriaxone 500 mg IM + doxycycline 100 mg PO twice daily for 14 days D) Levofloxacin 500 mg PO once daily for 14 days + single dose azithromycin 1 g PO
C) Ceftriaxone 500 mg IM + doxycycline 100 mg PO twice daily for 14 days
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? A) Decreased luteinizing hormone B) Elevated anti-müllerian hormone C) Elevated follicle-stimulating hormone D) Elevated inhibin B
C) Elevated follicle-stimulating hormone -LH increases -Anti-mullerian hormone decreases (increase = PCOS) -Inhibin B decreased (increase = ovarian cancer)
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? A) Breast adenocarcinoma B) Fibroadenomas C) Fibrocystic breast changes D) Phyllodes tumors
C) Fibrocystic breast changes
Which of the following lifestyle changes commonly leads to secondary amenorrhea? A) Cigarette smoking cessation B) Discontinued daily NSAID use C) Increased exercise D) Initiated paroxetine therapy
C) Increased exercise
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? A) Cease breastfeeding from the affected breast B) Incision and drainage C) Initiation of dicloxacillin 500 mg four times daily D) Initiation of trimethoprim-sulfamethoxazole 800 mg-160 mg two times daily
C) Initiation of dicloxacillin 500 mg four times daily
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? A) Combined oral contraceptives B) Hysterectomy C) Intravenous estrogen D) Medroxyprogesterone acetate
C) Intravenous estrogen
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? A) Chancroid B) Granuloma inguinale C) Lymphogranuloma venereum D) Syphilis
C) Lymphogranuloma venereum -STI caused by Chlamydia trachomatis serotypes L1, L2, and L3 -MC in tropical and subtropical areas of the world Risk factors: HIV infection, hx of STI, recent travel abroad, and unprotected anal sex
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? A) Betamethasone to promote fetal lung maturity B) Intravenous nitroprusside to reduce blood pressure C) Magnesium sulfate for seizure prophylaxis D) Vigorous intravenous hydration to prevent renal failure
C) Magnesium sulfate for seizure prophylaxis
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? A) Glipizide B) Insulin C) Metformin D) Pramlintide
C) Metformin
Which of the following factors increases the risk for cervical cancer? A) Excessive alcohol consumption B) Family history of cervical cancer C) Multiple sex partners D) Vaginal douching
C) Multiple sex partners
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? A) Decrease in hCG by 40% B) Low hemoglobin and hematocrit on complete blood count C) Negative Rh(D) on blood typing and antibody screen D) Positive Kleihauer-Betke test
C) 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? A) Gram stain of the ulcer exudate showing gram-negative rods B) Negative Tzanck smear C) Negative venereal disease research laboratory test D) Positive polymerase chain reaction for Haemophilus ducreyi
C) Negative venereal disease research laboratory test Dx Criteria for Chancroid: -one or more painful genital ulcers -negative PCR (or culture) for herpes simplex virus -no evidence of Treponema pallidum on darkfield microscopy of the ulcer exudate or a negative venereal disease research lab test (or other serologic test for syphillis) -clinical S/S consistent with chancroid Tx: Ceftriaxone 250mg IM or Azithromycin 1g PO
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? A) Biophysical profile B) Kleihauer-Betke test C) Nitrazine test D) Nonstress test
C) Nitrazine test (DOC to confirm PROM)
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? A) Culture from cervical specimens B) Gram's stain of cervical discharge C) Nucleic acid amplification testing of cervical discharge D) Urinalysis
C) Nucleic acid amplification testing of cervical discharge
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? A) Acyclovir PO B) Azithromycin PO C) Penicillin G benzathine IM D) Penicillin G IV
C) Penicillin G benzathine IM
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? A) Labor B) Placenta previa C) Placental abruption D) Subchorionic hematoma
C) 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? A) Choriocarcinoma B) Pituitary adenoma C) Placental site trophoblastic tumor D) Pregnancy
C) Placental site trophoblastic tumor -cause very low, persistent levels of hCG -malignant tumor -MC after a non-molar abortion or pregnancy -MC S/S: abnormal uterine bleeding and pelvic pressure -Tx: hysterectomy, generally resistant to chemo
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? A) Factitious disorder B) Major depressive disorder C) Premenstrual dysphoric disorder D) Premenstrual syndrome
C) Premenstrual dysphoric disorder DSM-5 Criteria: A. Symptoms present 1 year B. 5 or more symptoms present the week before menses, resolving within a few days after menses starts C. 1 or more of the following present: -Mood swings, sudden sadness, increased sensitivity to rejection -Anger, irritability -Sense of hopelessness, depressed mood, self-critical thoughts -Tension, anxiety, feeling on edge D. 1 or more of the following (total of 5 symptoms): -Difficulty concentrating -Change in appetite -Diminished interest -Easy fatigability -Feeling overwhelmed or out of control -Breast tenderness, bloating, weight gain, or joint/muscles aches -Sleep changes
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? A) Clue cells B) Motile protozoa C) Pseudohyphae D) White blood cells
C) Pseudohyphae
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? A) Discharge adherent to the vaginal wall B) Loss of vaginal rugae C) Punctate hemorrhages on the cervix D) Vesicovaginal fistula
C) 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? A) Admit her to the hospital immediately and start a course of IV antibiotics B) Recommend that patient stop breastfeeding altogether, change the antibiotic to oral cephalexin and send her home C) Refer patient to a surgeon for incision and drainage D) Refer to oncologist to rule out inflammatory carcinoma
C) Refer patient to a surgeon for incision and drainage -Abx after pus drainage -Continue breastfeeding
During which period of labor progression does a pregnant woman deliver her fetus? A) Active phase B) Latent phase C) Second stage D) Third stage
C) Second stage
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? A) Androgen therapy B) Oral contraceptive pills C) Supportive bra and analgesics D) Tamoxifen
C) 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? A) Debride and leave wound open, pain management B) Expectant management, without secondary repair C) Systemic antibiotics, debridement, and secondary repair D) Topical anesthetics, squirt bottle, and sitz bath
C) Systemic antibiotics, debridement, and secondary repair (TOC for a 4th degree lac that has become separated) 1st or 2nd degree lac with separation: expectant management 3rd or 4th degree lac with separation: secondary repair
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? A) Cervical contraction B) Endometrial regeneration C) Uterine involution D) Vaginal contraction
C) Uterine involution (contraction) MOA: myometrial muscles constrict the blood vessels as they contract and prevent postpartum hemorrhage
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? A) Deep vein thrombosis B) Eclampsia C) Lymphedema D) Preeclampsia
D) Preeclampsia
Which of the following best describes a normal physiologic change of pregnancy? A) Decreased cerebral blood flow B) Decreased clotting factor VII C) Increased cardiac afterload D) Increased red blood cell mass
D) Increased red blood cell mass +increased plasma volume (>RBC mass, leading to dilutional anemia), increased CO (2ndry to both SV and HR), decreased BP by 5-10 mmHG (2ndry to decreased vascular resistance)* *1st and 2nd trimesters, 3rd trimester BP should return to prepregnancy levels
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? A) Complete emptying of both breasts during a feeding B) Feeding every 45 minutes C) Frequent skin-to-skin bonding time D) Long periods of time between feedings
D) Long periods of time between feedings
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? A) Becoming pregnant earlier in life B) Breastfeeding her children C) Late age at menarche D) Obesity
D) Obesity Risk factors for breast cancer: increasing age, female gender, obesity, tall stature (>69 in), increased estrogen levels, early age of menarche, nulliparity, pregnancy later in life, alcohol consumption, and hx of invasive breast cancer
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? A) A decrease in estrone, decrease in estradiol, and an increase in testosterone B) A decrease in estrone, increase in estradiol, and no change in testosterone C) An increase in estrone, decrease in estradiol, and decrease in testosterone D) An increase in estrone, decrease in estradiol, and no change in testosterone
D) An increase in estrone, decrease in estradiol, and no change in testosterone
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? A) Eclampsia B) Gestational hypertension C) HELLP syndrome D) Preeclampsia
D) Preeclampsia Dx criteria: Elevated BP and proteinuria (pr thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, cerebral or visual symptoms)
What is the most common risk associated with gestation of multiples? A) Congenital abnormalities B) Discordant growth C) Fetal intrauterine growth restriction D) Premature birth
D) Premature birth
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? A) Dysthymic disorder B) Major depressive disorder C) Premenstrual dysphoric disorder D) Premenstrual syndrome
D) Premenstrual syndrome Dx criteria: 1-4 affective, behavioral, or somatic symptoms or >5 physical or behavioral symptoms with characteristic timing
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 is the most likely diagnosis? A) False labor B) Placenta previa C) Placental abruption D) Preterm labor
D) Preterm labor
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? A) Exposure to influenza during the first trimester B) Fetus was determined to be female at the last ultrasound C) Increase in vaginal intercourse in the past week D) Previous cesarean section
D) Previous cesarean section (risk factor for placenta previa) Placenta previa: -S/S: painless vaginal bleeding -US: placental tissue lying over the internal cervical os -Digital exam: CI -Treatment: f/u US, avoid intercourse and strenuous exercise, +/-hemodynamic stability, c-section delivery
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? A) Cervical polyp B) Chronic constipation C) Colorectal cancer D) Rectocele
D) Rectocele
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? A) Absence of variable decelerations B) Baseline fetal heart rate of 110 to 160 bpm C) Moderate fetal heart rate variability (6 to 25 bpm) D) Recurrent late decelerations
D) Recurrent late decelerations (NICHD category 3 aka increased risk of fetal injury) Other category 3 classifications: absent variability with recurrent variable decelerations, absent variability with bradycardia, sinusoidal pattern
A 21-year-old non-pregnant woman presents for her first Papanicolaou screening test. Cervical cytology shows low-grade squamous intraepithelial lesions and negative for HPV. Which of the following is the best next step in management? A) Colposcopy B) Cone biopsy C) Endocervical curettage D) Repeat cervical cytology in one year
D) 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? A) Appendicitis B) Ectopic pregnancy C) Pelvic inflammatory disease D) Ruptured ovarian cyst
D) Ruptured 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? A) Daily exercise and relaxation techniques B) Gonadotropin-releasing hormone agonist C) Hormonal contraception D) Selective serotonin reuptake inhibitor
D) Selective serotonin reuptake inhibitor (first-line for premenstrual syndromes with documented socioeconomic dysfunction)
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? A) Computed tomography B) Magnetic resonance imaging C) Plain film radiography D) Sonography
D) Sonography
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? A) Intramuscular dexamethasone B) Intravenous ampicillin C) Intravenous oxytocin D) Subcutaneous terbutaline
D) Subcutaneous terbutaline
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? A) Aim for a total pregnancy weight gain of 55-65 pounds B) Observe bedrest from 37 weeks of gestation until delivery C) Prepare for a cesarean section, no matter how the fetuses present at delivery D) Take two prenatal vitamins with iron daily instead of one
D) Take two prenatal vitamins with iron daily instead of one Recommendations for a pt w/twin pregnancy: total weight gain goal of 37-54 points, take 1 prenatal vitamin w/iron during 1st trimester, take 2 prenatals w/iron during the 2nd and 3rd trimester, exercise as tolerated, supplement the diet with 1mg of folate and 1000mg of vitamin D, expect to come to more frequent US, and sleep on the left side during the 2nd and 3rd trimester
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? A) First-degree laceration B) Fourth-degree laceration C) Second-degree laceration D) Third-degree laceration
D) Third-degree laceration
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? A) Repeat urine pregnancy test in one week B) Serum pregnancy test C) Ultrasound of pelvis D) Urine pregnancy test 14 days after last intercourse
D) Urine 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? A) Adenocarcinoma of the endometrium B) Cervical polyp C) Ovarian dermoid cyst D) Uterine prolapse
D) 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? A) Estrogen therapy B) Mirabegron C) Oxybutynin D) Vaginal pessary
D) Vaginal pessary -mainstay of nonsurgical treatment in women with pelvic organ prolapse Estrogen therapy: shows promise but not enough evidence to be first-line Mirabegron and Oxybutynin: both treat overactive bladder
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? A) Bartholin duct abscess B) Chancre C) Lichen sclerosus D) Vulvar cancer
D) Vulvar cancer
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? A) After administration of anesthesia B) Every 15 minutes during stage two C) Every hour during stage one D) When the woman feels the urge to push
D) When the woman feels the urge to push When to check the cervix: -Admission -Every 2-4 hrs during stage 1 -Prior to anesthesia administration -When the woman feels the need to push -Every 1-2 hrs during stage 2 -If FHR abnormalities occur
Which of the following would be considered normal when taking a focused gynecologic history from a patient? A) Intermenstrual bleeding B) Lack of menarche by age 16 C) Postmenopausal bleeding D) Whitish, watery, odorless discharge
D) Whitish, watery, odorless discharge