Objective specific questions

what is glucose load need to be above in gestational diabetes for a 1 hr glucose test?

130 1 hour after 50 g of glucose load

A 24-year-old woman presents for follow-up after an abnormal Pap smear. Colposcopy is performed and reveals a white, sharply demarcated area on the cervix after application of acetic acid. What is the most likely diagnosis?

Cervical Dysplasia

An 18-year-old G1P0A1 woman presents to the OB/GYN office with concern for an unplanned pregnancy. The patient reports having unprotected intercourse with her partner last night. She states she is not planning on becoming pregnant until she is in her late 20s. Vital signs are a BP of 123/78 mm Hg, HR of 86 bpm, RR of 16/min, SpO2 of 98% on room air, and a T of 98.7°F. A human urine chorionic gonadotropin result is negative. On physical exam, normally developed genitalia are noted with no external lesions or eruptions. The vagina and cervix show no lesions, inflammation, discharge, or tenderness. What is the best next step in management?

Copper containing intrauterine device

Which one of the following is the most common atypical presenting complaint in an elderly patient diagnosed with acute coronary syndrome

Dyspnea

A 22-year-old woman at 36 weeks gestation presents with complaints of feeling a sudden gush of water coming from her vagina. She has had regular obstetrical follow-up and a normally progressing pregnancy. Which of the following is the most appropriate next step in management?

FERN testing Microscopic evaluation of Vaginal FLuid PROM

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 Diabetes

A 26-year-old woman presents complaining of yellow vaginal discharge after starting a relationship with a new sexual partner. Physical exam reveals purulent discharge from the external os of the cervix. Microscopy reveals gram-negative diplococci. What is the most likely diagnosis?

Gonococcal Cervicitis because diplococcal

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?

Preclampsia

A 32-year-old man presents with right upper quadrant pain that started earlier today. His symptoms initially included mild generalized abdominal discomfort and nausea before localizing to the right side of his abdomen. He has a low-grade fever but his vital signs are otherwise unremarkable. He has minimal tenderness in the right lower quadrant to palpation. Which of the following signs would be indicative of a retrocecal location of the appendix?

Psoas sign Appendicitis

A 23-year-old G1P0 woman at 30 weeks gestation presents to the emergency department for vaginal bleeding. She has had no prior prenatal care. She reports that she is soaking through one pad every 8 hours, denies abdominal cramping or a gush of water and endorses good fetal movement. Her vital signs are T 37.2°C, HR 100, BP 105/70, RR 18. Her abdomen is soft, non-tender, and consistent with a 30 week pregnancy. A transabdominal ultrasound shows a viable intrauterine pregnancy and a placenta that completely overlies the cervical os. Which of the following investigations is indicated in this patient?

Type and Screen

A 26-year-old G3P2 woman presents to the labor and delivery at 38 weeks and 6 days gestational age with contractions occurring every 5 minutes for the past 3 hours. Vital signs include a HR of 80 bpm, BP of 120/80 mm Hg, RR of 20/min, oxygen saturation of 98% on room air, and T of 98.6°F. Physical examination reveals her cervix to be dilated to 5 cm, cervical effacement of 90%, and fetal head station at 0. The patient is admitted, and her membranes rupture spontaneously with leakage of clear fluid seen from the vagina. The patient's fetal heart tracing is shown above. Which of the following is the most likely etiology of this fetal heart tracing? It shows fetal decelerations.

Umbilical cord prolapse

What are Tocolytics and what are they used for?

Used for Uterine Relaxants Its Not My Time Indomethicin Nifedipine Magnesium sulfate Terbutaline

Which of the following is the most common cell type of ovarian cancer?

epithelial

A 39-year-old woman in her third trimester presents with 2 days of bloody "spotting" on her underwear. This is her third pregnancy, which thus far has been uncomplicated. Her initial delivery was vaginal, and her second delivery was via cesarean section. She is currently sexually active and has a history of trichomoniasis. She denies pelvic pain. Laboratory examination reveals hematocrit of 32%, white blood cell count of 10,000/µL, platelet count of 260,000/µL, international normalized ratio of 1.1, and activated partial thromboplastin time of 32 seconds. Pelvic examination shows a nonerythematous cervix with clear mucus. Which of the following is the most likely diagnosis?

placentae previa

A young woman presents to the ED with 3 days of new-onset intermittent, crampy abdominal pain. She reports one day of diarrhea and one episode of vomiting, but for the last two days, reports little to no bowel movements and increasing abdominal distension. Her medical history is significant for hyperthyroidism, irritable bowel syndrome, laparoscopically treated endometriosis, asthma and chronic tension-type headaches. Abdominal radiograph reveals excessive air in the proximal small bowel and a lack of air in the colon. Which of the following is the most likely cause of this patient's symptoms?

post op adhesions small bowell obstruction

causes of placenta previa

previous placenta previa, multiple gestation, multiparity, prior cesarean section, and previous intrauterine surgery, including dilation and curettage.

A 14-year-old girl presents to clinic with some frustration over never having a menstrual period. She is short in stature and has Tanner stage 2 breast development. As you begin a gynecological exam, you realize you cannot pass a speculum into the vagina. Which of the following is the most likely diagnosis?

primary Amenorrhea

Which of the following is the initial laboratory study used for gestational diabetes screening?

1 hour glucose test

A 32-year-old woman presents with vaginal bleeding for two weeks. She states she has had to change her pad every 2-3 hours with the bleeding. Vital signs are normal and physical exam only reveals blood coming from the cervical os. The patient's hemoglobin is 12 g/dL and her pregnancy test is negative. What treatment is indicated for this patient?

Abnormal Uterine Bleeding Combination OCPs

A 46-year-old woman presents with heavy menstrual bleeding for the past three menstrual cycles. Her bleeding is heavier than normal and her menstrual cycle lasts longer than what has been typical for her. She denies any weight changes or cold intolerance. Labs demonstrate a mild microcytic anemia, but are otherwise within normal limits. A pelvic ultrasound is ordered and shows no abnormalities. An endometrial biopsy showed secretory endometrium and is negative for any malignancy or other abnormalities. What is the most likely diagnosis?

Abnormal uterine bleeding go over types of abnormal uterine bleeding picuture on computer

A 38-year-old pregnant woman at 35 weeks gestation with a history of tobacco use presents to the emergency department with sudden onset painful vaginal bleeding and contractions. On bimanual examination, her uterus feels firm and rigid. Which of the following is the most likely diagnosis?

Abruptio placentae

A 45-year-old woman presents with heavy menstrual bleeding for the past several months. Her cycles are every 30 days and are regular. Each period lasts about 7 days and is the heaviest during the first 5 days, requiring a tampon change once every hour. Her periods are getting more painful, and the pain is not relieved with ibuprofen. Her temperature is 98.5°F, blood pressure is 119/78 mm Hg, heart rate is 98 bpm, and respiratory rate is 22/minute. A bimanual exam reveals a tender, soft, mobile, and uniformly enlarged uterus. Her hemoglobin is 10.1 g/dL, and a pregnancy test is negative. Which of the following is the most likely diagnosis?

Adenomyosis

The presence of which one of the following best differentiates a diagnosis of premenstrual dysphoric disorder from premenstrual syndrome? Affective dysorders Confusion and other cognitive changes Mood stability Serotonin dysfunction

Affective disorders like Depression and bipolar disorders

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 to delay preterm birth usually given to stop infection

A 28-year-old G3P0 woman presents to the office to discuss recurrent pregnancy loss and recent amenorrhea. She has not had a menstrual cycle for the last 2 months. She reports previously having a regular menstrual cycle of 28 days. Age of menarche was 14. Previous medical history is significant for anxiety, controlled well with sertraline. Surgical history is significant for three dilation and curettage procedures for retained products of conception, most recently 3 months ago. Vital signs include HR of 60 bpm, BP of 120/80 mm Hg, RR of 18/min, oxygen saturation of 99% on room air, and T of 98.7°F. Physical examination reveals a well-nourished woman, and findings on the exam are within normal limits. What is the most likely diagnosis?

Asherman syndrome, or intrauterine adhesions, is a condition in which scar tissue develops within the uterine cavity. Intrauterine adhesions that are accompanied by symptoms such as infertility or amenorrhea are referred to as Asherman syndrome.

A G2P1 woman at 13 weeks gestation presents for her initial prenatal visit. She has no ongoing medical conditions but previously underwent induction of labor due to preeclampsia with severe features. Today's vitals include HR of 91 bpm, RR of 18 breaths/min, BP of 129/87 mm Hg, T of 98.6°F, and SpO2 of 99% on room air. Exam reveals a palpable uterine fundus just superior to the pelvic rim with no other abnormal findings. Transvaginal ultrasound indicates a 13-week fetus with a fetal heart rate of 145 bpm. Which of the following is recommended to reduce the risk of preeclampsia in this pregnancy?

Aspirin

A 65-year-old woman, whose last menstrual period was more than 10 years ago, complains of vaginal dryness and irritation. She denies any recent infections or sexual activity. She is afebrile with normal vital signs. Visual inspection of the vaginal canal reveals pale, dry, and shiny epithelium without frank discharge or superficial lesions. Which of the following conditions is the most likely diagnosis?

Atrophic vaginitis

According to the United States Preventive Services Task Force (USPSTF), which of the following is considered to put a pregnant woman at high risk for developing preeclampsia?

Autoimmune disease

A 13-year-old girl presents to the office with her mother, who is concerned she has not had a menstrual cycle. She is an avid runner, logging 30 miles per week. On exam, she exhibits no breast development or axillary or genital hair. Her mother was 15 when she started her menstrual cycle. What is your next step?

Begin workup for primary amenorrhea

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

What is the most common cause of traumatic postpartum hemorrhage?

Cervical Tears

A 33-year-old woman presents to the clinic for obstetric care. She reports a history of two consecutive, painless second-trimester miscarriages. Her past medical history is remarkable for previous conization for cervical intraepithelial neoplasia. She is currently twelve weeks pregnant. Which of the following is the most appropriate next step in management in this patient?

Cervical insufficiency treatment or incompetent cervix

Which of the following signs is a normal finding during early pregnancy?

Chadwicks sign: bluish discoloration of the vagina and cervix caused by an increase in pelvic vasculature.

A 50-year-old woman presents to the emergency department with a two-day history of right upper quadrant pain. She has a history of hypercholesterolemia and her examination is significant for a positive Murphy sign. What is the preferred imaging modality?

Cholecystitis

A 21-year-old woman with no prenatal care presents for evaluation of lower abdominal pain and fever. She estimates that she is approximately 7.5 months pregnant. On questioning, she acknowledges intermittent pain for two days and a gush of fluid shortly after the pain began. Her temperature is 101.8°F. Physical examination is notable for purulent material in the vaginal vault. Which of the following is the most likely diagnosis?

Chorioamnionitis

Which of the following is considered an appropriate regimen for the treatment of bacterial vaginosis?

Clindamycin cream intravaginally for 7 days

A 17-year-old girl presents with dysuria and vaginal itching. A speculum exam reveals the findings seen above. Which of the following statements is correct regarding this diagnosis? A fishy odor is present when vaginal discharge is mixed with potassium hydroxide B Metronidazole is the recommended treatment C Multiple petechiae are often seen on the vaginal wall D The pH of the discharge is < 4.5 E Vaginal discharge is often foul smelling

D

G1P0 woman who is 38 weeks pregnant presents to the clinic reporting a sudden gush of clear fluid from her vagina. The leakage was so significant that it soaked her clothes and bed sheets. She denies contractions. Which of the following would be expected finding in this patient? A Absence of arborization on microscopic exam of vaginal fluid B pH of 4.0 on Nitrazine blue paper testing C Polyhydramnios on ultrasonography D Pooling of amniotic fluid in the vaginal fornix on physical exam

D

Which of the following statements is most accurate regarding health maintenance for a patient with chronic pancreatitis? A: Abstinence from alcohol will improve symptoms but will not decrease mortality B: Enteric coated pancreatic Enzymes require co-administration with an H2 antagonist C: Long chain triglycerides can provide extra calories in patient with weight loss D: Malabsorption of fat soluble vitamins may occur but is rarely clinically symptomatic

D

Endometrial Cancer risk factors

ENDOMET Elderly Nulliparity Dibetes Obesity Menstrual Irregularity Estrogen Monotherpay hyperTension

A 19-year-old G1P0 woman at 26 weeks presents with abdominal pain after being involved in a motor vehicle collision. External pelvic examination reveals vaginal bleeding. Which of the following is true regarding this presentation?

Early fetal monitoring and obstetrics consultation are required

A 29-year-old woman presents with cyclic pelvic pain that has been increasing over the last 7 months. She complains of significant dysmenorrhea, heavy menstrual bleeding, and dyspareunia. She uses condoms for birth control. On physical examination her uterus is retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative. Which of the following is the most likely diagnosis?

Edometriosis

A 30-year-old woman presents with fever and abdominal pain. She is three days postpartum after cesarean section. Physical examination reveals lower abdominal tenderness to palpation and foul smelling vaginal discharge. What management is indicated?

Endometreitis

A 32-year-old woman presents to the office for a wellness visit and to discuss trying to conceive. She reports heavy menstrual bleeding and chronic pelvic pain over the last 12 months. She describes the pain as dull, crampy abdominal pain that persists throughout her cycle and the majority of the month. She also describes dyspareunia and low back pain. She reports no alleviating factors and reports taking ibuprofen 400 mg regularly throughout her menstrual cycle. She reports no significant previous medical history and has never been pregnant. Vital signs include HR of 72 bpm, BP of 120/80 mm Hg, RR of 16/min, oxygen saturation of 99% on room air, and T of 98.7°F. Physical examination reveals vaginal tenderness and suprapubic tenderness. An immobile retroverted uterus is noted, with nodules in the posterior fornix. What is the most likely finding on surgical biopsy of the nodules?

Endometrial gland and stroma Endometriosis Endometriosis is an estrogen-dependent inflammatory disease marked by the presence of endometrial glands and stroma that exist outside the uterine cavity.

A 34-year-old woman presents with lower abdominal pain and fever. She had a full-term delivery via cesarean section 4 days ago. On examination, she has a temperature 38.6°C and a heart rate of 112 beats/minute. Her lower abdominal incision is intact with no fluctuance, surrounding erythema, or drainage. She has midline lower abdominal tenderness to palpation. On pelvic examination, she has uterine tenderness with foul smelling lochia. What is the most appropriate management of this patient?

Endometritis: Clindamycin and Gentamycin

A 25-year-old woman with a recent history of antibiotic use presents to your office with a complaint of vaginal discomfort. For the past week she has been experiencing intense vaginal pruritus and has noticed a white discharge. Which of the following is the most appropriate next step in her management?

FLuconazole andyou can also use miconazole Vulvovaginal candidiasis

A 30-year-old Gravida 2, Para 1 woman at 12 weeks of pregnancy presents for routine prenatal care. She has a history of gestational diabetes mellitus managed with diet alone during her previous pregnancy. She reports no episodes of hypoglycemia. Today, her fasting blood glucose is 145 mg/dL and her hemoglobin A1C is 7.5%. Which of the following represents an ideal intrapartum glycemic target for this patient?

Fasting under 95 1 hr 180 2 hr 155 3 hr 140

A woman in her third trimester of pregnancy is involved in a motor vehicle collision. She presents to the ED with new-onset vaginal bleeding and pelvic pain. Which of the following laboratory abnormalities is consistent with the most likely diagnosis?

Fibrinogenemia Abruptio Placentae

A 24-year-old man presents to an urgent care clinic with diarrhea. His stools are foul-smelling and float in the toilet. He reports a 2-pound unintentional weight loss but does not have bloody stools. When questioned, he reports drinking unfiltered water during a hiking trip 2 weeks ago. Which of the following is the most likely etiology of this man's illness?

Giardia Lamblia

A 22-year-old woman presents with vaginal bleeding with clots that started one hour prior to arrival. She is 10 weeks pregnant based on a previous ultrasound confirming her intrauterine pregnancy. Bedside ultrasound today does not show an intrauterine pregnancy. Her blood type is A negative and the father of the baby's blood type is not currently known. Which of the following is the best strategy for administration of Rh immunoglobulin?

Give Rh immunoglobulin within 72 hrs

A 36-year-old G1P0 woman presents at 32 weeks gestation with right upper quadrant abdominal pain. She has no past medical history and her pregnancy has thus far been uncomplicated. Her vital signs on arrival are T 37.3°C, HR 110 bpm, BP 125/75 mm Hg, RR 24/min. Her physical exam is significant for moderate right upper quadrant tenderness to palpation. Her laboratory studies are remarkable for WBC 14 x 109/L, hemoglobin 9 g/dL, hematocrit 27%, platelets 70 X 109/L, AST 120 U/L, ALT 100 U/L, total bilirubin 1.5 mg/dL and LDH 1,000 U/L. Which of the following is the most likely diagnosis?

HELLP

A healthy 35-year-old G0P0 woman presents to the office as a new patient. She states she has not had routine gynecologic care for the past 10 years. She reports 2 months of heavy vaginal bleeding during menses and postcoital spotting. She describes associated symptoms of malodorous, white vaginal discharge occurring daily and frequent low back pain. She states she has never experienced anything like this before. She reports no significant medical history. She was 12 years of age at menarche. Sexual history is significant for multiple partners over the last 16 years. She currently reports a monogamous sexual relationship with a man. Vital signs include HR of 72 bpm, BP of 120/80 mm Hg, RR of 20/min, oxygen saturation of 97% on room air, and T of 98.7°F. Physical examination reveals a well-nourished woman. Lymphadenopathy is present in the right groin. Pelvic examination reveals a 4 cm exophytic lesion on the right side of the cervix, creating a barrel-shaped cervix. A scant amount of watery, purulent discharge is noted in the vaginal vault. The uterus is enlarged and boggy on bimanual examination. There is no cervical motion tenderness. Which of the following pathogens is most likely responsible for the presumed diagnosis?

HPV Cervical cancer is the third most common gynecologic cancer in the United States. The two major histologic types of cervical cancer are adenocarcinoma and squamous cell carcinoma. Cervical cancer is due to infection with human papillomavirus (HPV)

An 18-year-old G1P0 woman at 16 weeks gestation presents with vaginal bleeding. She has had no prenatal care. Vital signs are unremarkable and physical examination only reveals a small amount of blood in the vaginal vault. A transvaginal ultrasound is performed as seen above. What is the next best step in management of this patient?

Hydatidiform mole Molar pregnancy: A noncancerous tumor that develops in the uterus as a result of a nonviable pregnancy.

A 21-year-old woman G1P0 at 35 weeks gestation presents with headache, blurry vision, and shortness of breath. Vital signs include a blood pressure of 195/110 mm Hg, heart rate of 90 beats per minute, respiratory rate of 21 breaths per minute, oral temperature of 37.1℃, and oxygen saturation of 90% on room air. Urinalysis reveals 3+ protein. A chest radiograph reveals pulmonary edema. In addition to magnesium, which of the following medications should be administered to reduce blood pressure?

Hydralazine

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

Increased LH PCOS

A 43-year-old man is admitted to the hospital with nausea, vomiting, and intermittent diarrhea for the past two weeks. He has a history of abdominal surgery following a motor vehicle crash five years ago. Vital signs are BP 120/70, HR 80, RR 14, and T 37.1°C. On physical exam, you note a distended abdomen. A plain film abdominal X-ray is seen above. Which of the following is the most appropriate step in management?

Insert ng tube for decompression of small bowel obstruction likely due to post op adhesion

A 28-year-old woman with a medical history of bipolar I disorder presents for medication counseling. She is actively trying to conceive and is currently taking valproate. She has no other significant medical history or current issues. Her vital signs are a BP of 122/73 mm Hg, HR of 67 bpm, SpO2 99% on room air, and T of 98.7°F. A physical exam is completed and is within normal limits. Which of the following medications is most appropriate to switch to at this time?

Lamotrigine

A 29-year-old woman who is one week postpartum following a pregnancy complicated by preeclampsia with delivery of a full-term infant is brought in by emergency medical services with an ongoing generalized tonic-clonic seizure. Which of the following medications should be administered first?

Magnesium Sulfate

Best HTN meedication for pregnancy

Methyldopa or aspirin in early pregnancy for prevention

A 36-year-old G1P0 woman at 9 weeks gestation presents to your office complaining of nausea and vomiting. She also reports mild vaginal bleeding. Pelvic exam shows a closed cervical os and dark blood in the posterior vault. The size of the uterus is felt to be larger than expected. Her beta-hCG level is 500,000 IU/L. A transvaginal ultrasound reveals a central heterogeneous mass with many discrete anechoic spaces. Which of the following is the most likely diagnosis?

Molar pregnancy

A 14-year-old girl has been diagnosed with primary amenorrhea. Pelvic ultrasound reveals an absent uterus. Genetic testing confirms a 46,XX karyotype. Which of the following is the most likely diagnosis?

Mullerian Dysgenesis

A 55-year-old woman presents to the gynecology clinic with a 3-month history of gradual progressive dyspnea, rapid weight gain, and abdominal fullness. She also reports urinary frequency and urgency. Her last menstrual period was 5 years ago. Her T is 99.1°F, BP is 123/79 mm Hg, HR is 69 bpm, RR is 18/min, and oxygen saturation level is 98% on room air. Her urinary analysis is normal. Her physical examination reveals a distended abdomen with shifting dullness, and pelvic exam reveals a left adnexal mass. Which of the following would have been an appropriate recommended screening test for her condition before her symptoms started?

No screening recommended for ovarian cancer

Which of the following represents a common risk factor for the development of a rectocele?

Obesity

A 28-year-old G2P1 woman who is 37 weeks pregnant presents in the emergency department with bright red vaginal bleeding with no abdominal pain. Her blood pressure is 120/80 mm Hg and temperature is 98.6° F. The patient has a scar from a previous C-section. Which of the following is the most likely diagnosis?

PLacenta previa

What does the FERN test test for?

PROM

look for phsyiologic changes look at picture on computer

Physiologic changes

A postmenopausal woman presents with abnormal vaginal bleeding. You suspect endometrial malignancy and refer the patient for further investigation. Which of the following modalities is initially used to determine a diagnosis?

Pipelle endometrial suction curette

A 39-year-old woman presents to the office with painless vaginal bleeding in the third trimester (32 weeks) of pregnancy. She has a history of tobacco use and has received no prenatal care. Her five other children were all delivered via cesarean section. She denies any lower extremity edema. Her vital signs are normal. Which of the following conditions should you be most concerned about?

Placentae Previa

A 17-year-old girl is examined for a routine visit. She eats a healthy diet. She also stays active by playing volleyball three times a week. Her grades are mostly Bs. She reports she started to be sexually active for the past six months and has delayed periods for two months now. She had her menarche at 12 years old and has regular periods. She also smokes a quarter of a pack of cigarettes per day. Which of the following is an adverse pregnancy outcome due to maternal smoking?

Placental abruption

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 25-year-old woman presents with a chief complaint of amenorrhea for three months and reports that her menstruation is usually regular. She runs approximately five miles three times per week. Her body mass index is normal. She is sexually active and uses condoms for protection. Other symptoms include fatigue and breast tenderness. What is the most likely cause of her amenorrhea?

Pregnancy

Which of the following is the greatest risk factor for an ectopic pregnancy?

Previous Ectopic pregnancy

A 30-year-old woman presents for follow-up after dilation and curettage for a partial hydatidiform mole. Which of the following laboratory studies is the best method for identifying persistent or recurrent gestational trophoblastic disease?

Quantitiative Beta-HCG

A 26-year-old woman presents to your office for an infertility consult. She and her husband have been trying to conceive for the past three years but have been unsuccessful. Upon questioning, she says that her menstrual cycles are very irregular, sometimes as long as two to three months may pass between periods. Upon examination, you notice that she has facial acne and is overweight with a BMI of 30. You order a transvaginal ultrasound. What sonographic findings would help to confirm your suspected diagnosis?

String and pearls appearance on the ovaries

A 31-year-old G1P0 woman who is 29 weeks pregnant presents to the hospital with contractions. She is found to be in acute preterm labor. Cervical exam reveals that she is 2 cm dilated. Which of following is the next appropriate step in management?

Tocolytics

What is the diagnostic test of choice in a patient with a suspected leiomyoma?

Trans-abdominal and transvaginal US

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

Trich

A 22-year-old woman presents with pelvic pain that has been worsening over the last three days and vaginal discharge for the last week. She has associated nausea and chills. Physical exam reveals cervical motion tenderness and a mass in the right adnexa. Pregnancy test is negative. A pelvic ultrasound reveals a complex multiloculated right adnexal mass. Which of the following is the most likely diagnosis?

Tubo-ovarian abscess

A 26-year-old woman just vaginally delivered twin, macrosomic boys. This was her fourth pregnancy, which has been the longest of them all at 43 weeks gestation. Her delivery was difficult and required forceps to complete. Estimated blood loss was 1,1

Uterine Atony

A 35-year-old obese woman who just delivered a 10 lb baby after 48 hours of labor starts hemorrhaging from the vaginal area and has a sudden drop in blood pressure. She was in her 41st week of gestation when she was admitted to have labor induced. Which of the following is the best initial step in diagnosing the underlying cause of bleeding?

Uterine Atony Palpate to check size and firmness of uterus

A 31-year-old woman at 35-weeks gestation presents with brief painless, bright red vaginal bleeding. In addition to fetal monitoring, which of the following is the most important initial management?

Vaginal US for possible Placentae previa

Which of the following best describes an inevitable abortion?

Vaginal bleeding before 20 weeks with cervical os open

Fetal Heart Rate: Mnemonic VEAL CHOP

Variable: cord compression Early: head compression Accelerations: okay Late: placental insufficiency

A 22-year-old woman with no prior medical history presents with pain and swelling to the vulva. On examination, you notice an area of swelling with induration and central fluctuance at the 8 o'clock position. What is the best next step in management?

Word catheter placement

An 18-year-old woman in her third trimester presents with acute onset of significant pelvic pain and blood per vagina. Thus far, her pregnancy has been normal. Her medical history is significant for hypertension, asthma, and recreational cocaine use. Examination reveals a tender, extremely tense uterus. Which of the following is the most likely diagnosis?

abrupto placentae

A 40-year-old G3P3A0 woman presents to the OB/GYN office for cervical cytology screening results. The results of her previous cervical cytology have been unremarkable. She has a history of diabetes mellitus type 2 and takes metformin 850 mg twice per day. Her vital signs are a BP of 131/81 mm Hg, HR of 81 bpm, RR of 16/min, SpO2 of 98% on room air, and a T of 98.7°F. Upon physical exam, normally developed genitalia are seen with no external lesions or eruptions. The vagina and cervix show no lesions, inflammation, or discharge. Her cervical cytology results show atypical glandular cells. What is the best next step in management?

colposcopy with Endometrial biopsy

A 15-year-old girl presents to clinic with vaginal discharge. She recently became sexually active and states that her partner was recently diagnosed with gonorrhea. Speculum examination reveals white discharge and an erythematous cervix. Bimanual examination is unremarkable. A urine pregnancy test is negative. Which of the following is the most preferred treatment option?

doxy and ceftri

A 44-year-old woman with a history of hypertension presents to her primary care provider's office with complaints of nausea and vomiting. Her last menstrual cycle was six weeks ago. Two years ago she had a bilateral tubal ligation performed. On physical exam, her abdomen is nontender and her uterus is not enlarged. Pelvic exam is unremarkable. Her serum human chorionic gonadotropin level is 5,000 mIU/mL. A transvaginal ultrasound does not demonstrate an intrauterine gestational sac. Which of the following is the most likely diagnosis?

ectopic pregnancy

A 26-year-old healthy woman presents to the emergency department with abdominal pain. She was at home when she developed sudden onset lower abdominal pain followed by a brief syncopal episode. Her vital signs include blood pressure of 88/46 mm Hg, heart rate of 112 bpm, respiratory rate of 18/min, temperature of 37.6°C, and oxygen saturation of 98%. She had a positive home pregnancy test yesterday. After initiating aggressive resuscitation, what is the most appropriate next step in management?

emergent referral OB/GYn

A 67-year-old woman with no significant medical history presents to her gynecologist's office for her routine annual exam. The patient's last Pap smear and HPV cotesting were negative 2 years ago. She has not had any previous abnormal Pap smears. The patient smokes tobacco daily and uses alcohol socially. She continues to be sexually active with her partner of 33 years. Her vital signs are a HR of 74 bpm, RR of 17/min, SpO2 of 99% on room air, BP of 128/86 mm Hg, T of 98.1°F, and BMI of 33.6 kg/m2. On physical exam, her vaginal canal is slightly atrophic, the cervix visualized without scarring or erythema, and there is no tenderness on bimanual exam. What is the most appropriate recommendation for cervical cancer screening for this patient?

ends at 65 no further testing

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

inevitable abortion

What is the surgical intervention method of choice for a premenopausal woman with a leiomyoma who wishes to retain her fertility?

myomectomy

A 26-year-old woman presents to the emergency department with reports of sudden-onset severe right lower abdominal pain, beginning 2 hours ago after leaving the gym. She describes the pain as sharp and localized to her right lower abdomen. She states the pain is aggravated when sitting and reports no alleviating factors. She reports no significant medical history and takes no medications or supplements. Vital signs include a HR of 96 bpm, BP of 125/82 mm Hg, RR of 20/min, oxygen saturation of 98% on room air, and T of 98.6°F. On physical examination, she is tender to palpation in the right lower abdomen. Beta-human chorionic gonadotropin is negative, hemoglobin is 14.1 g/dL, WBC is 9,000/µL, and a transvaginal ultrasound reveals a right ovarian cyst with Doppler flow and a small amount of free fluid. What is the best next step for management of this condition?

observation and reassurance Hemorrhagic ovarian cyst

A 30-year-old woman misses work and presents to the emergency department with severe pelvic pain rated at 6/10. She states it began yesterday with the onset of menstruation. She has regular cycles with a normal amount of blood flow but has not had this pain before. She denies spinal, urologic, and rectal symptoms. Vital signs are normal, and her physical examination and pelvic ultrasound are unremarkable. Serum beta-hCG is negative. Other than referral to a gynecologist for further evaluation, which of the following is the most appropriate initial treatment?

oral Ibuprofen Dysmenorrhea

A 42-year-old woman presents to the emergency department with epigastric abdominal pain for two days. The pain radiates to her back and is associated with nausea and vomiting. Her past history is significant for alcohol use disorder. Which of the following is the most likely diagnosis?

pancreatitis

A 32-year-old gravida 2 para 1 at 33 weeks gestation presents to the emergency room for sharp abdominal pain. She has not had any prenatal care during this pregnancy. Physical exam reveals vaginal bleeding, uterine pain between contractions, and fetal distress. Her first pregnancy was uncomplicated, with a vaginal delivery at term. Which one of the following is the most likely diagnosis?

placenta abruption

A 36-year-old G2P1002 woman who is 38 weeks pregnant presents in active labor. Her vital signs are a HR of 92 bpm, RR of 19/min, BP of 124/86 mm Hg, T of 97.8°F, SpO2 of 99% on room air, and BMI of 29.6 kg/m2. During delivery, the fetal head retracts into the perineum after expulsion, and the anterior shoulder does not deliver. Which of the following is the greatest risk factor for this presentation?

shoulder dystocia and it is DM type 2