women for 2 of 4
You are called to see a 2-day old neonate who has poor feeding, lethargy, and a temperature of 38.5 degrees Celsius (101.3F). Blood cultures demonstrate gram positive cocci in chains. Which of the following interventions would have helped prevent this occurrence? tx?
Appropriate screening and antibiotic therapy during labor dx:neonatal sepsis secondary to Group B Streptococcal (GBS) infection, Intrapartum penicillin is first line treatment for patients who are vaginal or perianal carriers of Group B streptococcus (GBS)
A 19-year-old G1P0 presents during her 35th week of gestation for a regular prenatal visit. Her blood pressure is 122/75. As part of the visit you drew a CBC which was within normal limits except for a platelet count of 105,000. Platelets were within normal limits 4 weeks ago. You diagnose gestational thrombocytopenia. What is the most likely outcome of this condition?*********"look at preg physiology"
She will continue to be asymptomatic and her thrombocytopenia will resolve spontaneously postpartum.
Dysmenorrhea would most likely occur in which of the following patients? A A young teenager who just started having her menses B A woman on birth control pills C A marathon runner with one menses per year D A 35 year-old woman with regular cycles
A 35 year-old woman with regular cycles Dysmenorrhea is caused by a excess of prostaglandin F 2 alpha.
A 16 year-old nulliparous acutely ill female presents with bilateral lower abdominal pain. She has a temperature of 100.4 degrees F and on examination has a tender, enlarged left adnexa. Cervical culture is positive for Chlamydia. Ultrasound reveals a complex tubular structure in the left adnexal area. What is the recommended treatment?
Hospitalization with parenteral doxycycline and cefoxitin dxpelvic inflammatory disease and most likely a tubo-ovarian abscess. It is recommended that the patient be hospitalized and treated tubo-ovarian abscesses, surgical drainage is often necessary.
Human papilloma virus has been strongly associated with the development of which of the following?
Human papilloma virus (types 16, 18, and 31) has been linked to the development of cervical carcinoma.
A. A 15-year-old sexually active female presents with non-pruritic mucopurulent cervicitis and post coital bleeding. She was given medication for the same symptoms three weeks ago but reports she did not take it. Which of the following is the best treatment? B A 20-year-old nulliparous woman presents to the emergency department (ED) complaining of pelvic pain and fever and chills. Her symptoms have been going on for 3 days. She has had no new sexual partners, but does not routinely use condoms with her current partner because they "have been dating for 1 year." Clinically, her cervix is erythematous, friable, and there is a mucopurulent discharge. The cervical motion tenderness is significant. Her pregnancy test is negative and there are no adnexal masses. What is the MOST likely pathogen causing her symptoms? C. On physical examination of a 24-year-old nulligravida, an erythematous cervix with a yellow discharge is visualized. The patient has had one new partner in the past 60 days. She uses oral contraceptives for birth control and rarely uses condoms. She has not noticed any pruritus, discharge, or vaginal pain. The wet prep reveals no hyphae or clue cells. Which of the following etiologic organisms BEST fits the clinical information given?
# mc STI chlamydia azithromycin x 1 dose plus Since this patient has a history of non-compliance, the one dose medication, taken in the office, is the treatment of choice. She must also be counseled on having her sexual partner(s) treated.
1)A 39-year-old woman, G3, P3, complains of severe, progressive secondary dysmenorrhea and menorrhagia. Pelvic examination demonstrates a tender, diffusely enlarged uterus with no adnexal tenderness. Endometrial biopsy findings are normal. Which diagnostic examination is needed next? 2) A 47-year-old G3, P1 woman comes into the office complaining of heavy, painful, and irregular menstrual bleeding that has been going on for the past 6 months to a year. She has not been sexually active for the past year. On physical examination, her uterus is estimated to be the size of a uterus at 12 weeks' gestation. Pelvic ultrasound confirms the presence of a leiomyoma. Her hematocrit is 29%, mean corpuscular volume (MCV) is 68 fL, and serum ferritin is 10 g/L. What should be the first-line therapy?
1) transvaginal and abdominal ultrasound Common causes of secondary dysmenorrhea in this age group are endometriosis, adenomyosis, and the presence of an intrauterine device. For this patient, it would be important also to rule out leiomyomas, endometrial polyps, and tumors. ---------------------------------------------- 2)combined estrogen-progestin contraceptive therapy in standard doses dxleiomyoma only curative treatment is a myomectomy or hysterectomy.
What is the treatment of magnesium sulfate toxicity?
10% calcium gluconate
When is the best time to draw maternal serum alpha fetoprotein?
15-18 weeks
During a routine prenatal visit, the fundal height is found to be midway between the pubic symphysis and umbilicus. The number of weeks gestation is estimated to be
16 to 18 wks
What is the fasting blood sugar cutoff required to warrant further testing for gestational diabetes?
95 mg/dL
A 20-year-old G2P1 female with gestational diabetes and a pre-pregnancy BMI of 43 presents to her obstetrician in labor. Although the labor originally progresses without complications, delivery becomes stalled as the patient attempts to push the child's shoulders through the vagina. All of the following are appropriate next steps
A Apply suprapubic pressure B Pushing the fetal head back into the vaginal canal in preparation for C-section C Flexion of maternal hips D Delivery of the posterior arm E Rotation of the fetal shoulders 180 degrees
Which of the following is the most common presenting clinical manifestation of breast cancer?
A breast mass is the most common presenting clinical manifestation of breast cancer Nipple retraction is a later finding of breast cancer and indicates ductal involvement.
A 33 year-old female presents for follow-up of her Pap smear that showed cervical dysplasia. Which of the following is the most appropriate diagnostic procedure?****
A colposcopy-directed biopsy is the first diagnostic evaluation indicated for cervical dysplasia
Which of the following is the most significant factor in the production of menopausal symptoms?
A decrease in estrogen is responsible for the majority of menopausal symptoms including, but not limited to, hot flashes, sleep disturbances, genital tract atrophy and mood changes.
Your patient has just delivered her baby vaginally without difficulty. The patient has a laceration of the vaginal mucosa including the perineal body. You repair it without difficulty. On the chart you document this as what type of tear?********
A second degree tear involves the underlying subcutaneous tissues, but not the rectal sphincter or rectal mucosa ----------------------------------------- A first degree tear involves the vaginal mucosa or perineal skin, but does not involve the underlying tissue. A third degree tear extends through the rectal sphincter, but not into the rectal mucosa. A fourth degree tear extends into the rectal mucosa.
A 27-year-old G2P0101 at 25 weeks gestation presents to clinic for a routine prenatal visit. Her pregnancy has not had any complications to-date, and her past medical history is significant only for prior cervical dysplasia 5 years ago requiring cold knife conization. After completing the pelvic exam, the patient's physician decides to conduct a transvaginal ultrasound. What is the most likely reason this practitioner elected to pursue this test?
Cervical length appearing less than 2.5 cm on pelvic exam potential dx of cervical incompetence or insufficiency. A cervical length appearing less than 2.5 cm on pelvic exam at 23-28 weeks gestation is concerning
In which of the following maternal-fetal blood type pairings should the mother receive Rho-GAM?
AB negative mother, spontaneous abortion It is also indicated at 28 weeks gestation and within 72 hours of delivery of an Rh-positive infant.
A 47 year-old female presents to the clinic with complaints of prolonged, heavy menses that have been getting progressively worse for 3 years. She denies any pain. On physical examination, enlargement of the uterus with multiple smooth, spherical, firm masses is noted. A CBC is consistent with a mild anemia. Which of the following is the most likely diagnosis?
Leiomyoma Abnormal uterine bleeding and irregular enlargement of the uterus are most consistent with leiomyoma. Pain is rarely present unless vascular compromise occurs.
A 25 year-old G2P2 married female presents to the clinic for birth control counseling. Her past history includes deep vein thrombosis with her last pregnancy. She does not want another pregnancy for at least 4 years. The birth control method that would be best for this patient is which of the following?
Levonorgestrel releasing IUD
A 25-year-old G3P1 female presents to her obstetrician for an anatomy scan. The fetus is 22 weeks gestation, and the study results are all within normal limits. Which of the following biometric parameters are all appropriate for estimating fetal gestational age?
Abdominal circumference, cerebellar diameter, femur length, biparietal diameter of the skull
A 67-year-old nulliparous white female with a history of diabetes presents with postmenopausal bleeding. Further gynecologic history reveals menarche at age 10 and menopause at age 59. For the most likely diagnosis, which of the following is the most common type?
Adenocarcinoma is the most common type of endometrial carcinoma.
An 18 year-old G1P0 female presents for her 35 week prenatal visit with complaints of headache, blurred vision and right upper quadrant discomfort. Vital signs show BP of 170/100 mmHg and brisk patellar reflexes. Urinalysis shows 3+ proteinuria. Fetal heart tones are 150. What is your next step in the care of this patient?
Admit to hospital and prepare for delivery dx:Severe preeclampsia 2)Delivery is indicated if gestational age is 34 weeks or greater.
It is determined that a woman has a nonexistent rubella titer level during her first trimester of pregnancy. When should she receive the rubella vaccine?*****
After delivery of the infant The patient should not receive the rubella vaccine during the course of her pregnancy as the possibility of transmission of the rubella virus does exist. During the time that the patient is without protective titer she should avoid anyone with active rubella infection. The proper time to receive the vaccine is after delivery of the infant.
A 54 year-old female comes to your office with the complaint of vaginal itching. Her last menstrual period was three years ago. On examination the patient's vulva is smooth and somewhat shiny; her vaginal mucosa is pale and thin with a mild yellowish discharge with a pH of 6.0. The most likely cause of these symptoms is which of the following?
Atrophic vaginitis ntense itching and thin vaginal mucosa with a resultant yellowish discharge that has a pH > 5.5.
A very firm ovarian mass estimated at 8 cm is found in a 33-year-old woman at her annual examination. Which of the following interventions should be considered first?
surgical consult The size and firmness of the ovarian mass suggests endometrioid carcinoma
Which of the following is the most common underlying cause of early postpartum hemorrhage?
uterine atony Predisposing factors include any conditions that cause excessive uterine enlargement, abnormal labor or conditions that interfere with uterine contraction.
A 24 year-old female presents with complaints of dysuria associated with fever, malaise, myalgias and headache for the past 3 days. Today she noticed some lesions on her genitalia. Physical examination reveals the presence of multiple clear vesicles and erythematous ulcers with tender bilateral inguinal adenopathy. Which of the following is the most appropriate treatment for this patient?
valacyclovir (Valtrex) dx:herpes genitalis
A A 32-year-old G1P0 at 36 weeks gestation presents to your clinic with severe headache. Temperature is 37.1 degrees Celsius, pulse is 90/min, respiratory rate is 20/min, and blood pressure is 175/105 mmHg. The patient denies contractions, and her cervix is long, closed, and posterior. Urine protein is 3.5 g/24 hours. Which of the following is the most appropriate next step in management for this patient? B A 36-week pregnant patient presents to the ED with hypertension. Physical examination reveals 2+/4+ edema in the lower extremities with hyperreflexia and clonus bilaterally. A urinalysis reveals 3+ protein. Which of the following is the best treatment option for this patient?
Blood pressure control and seizure prophylaxis(Magnesium sulfate) dx:severe preeclampsia. Magnesium sulfate is excreted solely from the kidneys and urine output must be preserved to prevent accumulation of the drug. Magnesium sulfate does nothing to prevent HELLP syndrome.
A 45-year-old woman is noted to have four yeast infections in 1 year. Appropriate management of this patient should be
Blood test to look for the presence of diabetes and HIV infection
A 26-year-old female visits your office concerned about a mass in her left breast. The patient explains that her mother was diagnosed with breast cancer at the age of 60 and her aunt was diagnosed with breast cancer at age 65. The patient's last menstrual period was one week ago. Physical examination reveals a 1 cm, painless, firm, solitary mass in the lateral upper quadrant of her left breast. Which of the following is an appropriate next step in the patient's management: A 28-year-old woman presents to the clinic after feeling a lump in her left breast. The patient has no past medical history and takes no medications. Family history is remarkable for her mother who survived breast cancer at the age of 44. On physical exam, a firm, well-circumscribed, mobile lump less than 1 cm in width can be appreciated in the upper outer quadrant of the left breast. What is the most likely diagnosis?
Breast ultrasound dx:fibroadenoma
Which of the following is recommended to reduce the risk for perinatal transmission of HIV in a patient with a viral load of >1000 copies/mL?
Cesarean section prior to onset of labor and rupture of membranes
a bluish or purplish discoloration of the vagina and cervix. This is called Which of the following physical examination findings is present in a 12 week singleton pregnancy?
Chadwick's sign
You are following a patient in labor at term. You evaluate the fetal monitoring tracing and note the presence of variable, repetitive decelerations in the heart rates. The contractions have a sharp deceleration slope. What is the recommended treatment for these decelerations?
Change maternal position dx:Variable decelerations occur from umbilical cord compression and oligohydramnios
A. A 25-year-old nulliparous woman complains of dysmenorrhea that has become progressively worse over the past 2 years. Her pain is described as a constant, aching pain. It begins 2 to 7 days prior to onset of bleeding and does not subside until the menstrual flow decreases. In addition, she complains of pain with intercourse. She has never been pregnant and uses condoms and foam for contraception. You make the presumptive diagnosis of endometriosis. Which of the following is the BEST way to confirm the diagnosis definitively? B. A 25 year-old female presents with constant premenstrual pelvic pain. She also notes dysmenorrhea and dyspareunia. Which of the following is the most likely diagnosis?
Diagnostic laparoscopy is the only definitive way to diagnose endometriosis.
A patient presents with infertility due to chronic anovulation. Laboratory testing reveals a normal follicle stimulating hormone, estradiol, and prolactin levels. The patient's progestin challenge test was positive. Which of the following is the drug of choice for the treatment of infertility in this patient?
Clomiphene citrate is the first drug of choice in patients with infertility due to anovulation with normal hormone levels. agent of choice for women younger than 36 years of age who need induction of ovulation
A 40 year-old female presents with a Pap smear abnormality revealing atypical glandular cells (AGUS). What is the most appropriate intervention?
Colposcopy and endometrial samplin AGUS Pap results because glandular cells are associated with squamous and glandular precursor lesions and carcinoma.
A 56 year-old female presents to the clinic wanting testing for ovarian cancer. Her best friend was just diagnosed with Stage 4 primary cancer of the ovary. She denies family history of breast or ovarian cancer. According to screening guidelines, which of the following do you recommend?
Continue her yearly women's health examinations
A first-time mother presents to the obstetric clinic with breast pain 2 weeks after giving birth. She has had some difficulty with breast feeding, as her newborn has not been able to latch onto her nipples easily. Exam reveals a painful and erythematous lobule in the outer quadrant of her left breast. What is the most appropriate treatment plan? what are three abx options for this condition
Local warm compresses to the breast, a well-fitting undergarment, and antibiotic treatment (i.e. cephalosporins, methicillin, or dicloxacillin) are also indicated. dx:mastitis milk stasis can be averted by continuing breast feeding or the utilization of a breast pump.
An increased incidence of breast cancer is associated with
Nulliparous women have a 1.5 times higher incidence of breast cancer than multiparous women.
On rectovaginal examination of a 72 year-old post-menopausal female a 3 cm by 3 cm right adnexal mass is palpated. The rest of her physical examination is unremarkable. Her last gynecological examination was last year and was unremarkable. Which of the following is the most likely diagnosis?*********
Ovarian cancer Ovaries should not be palpable in the postmenopausal patient. Consider ovarian cancer until proven otherwise
A 30-week pregnant patient presents with sudden onset of profuse, painless vaginal bleeding. Which of the following is the most likely diagnosis?
Placenta previa presents with sudden, painless, profuse bleeding in the third trimester
A 23-year-old G1P0 female at 11 weeks gestation presents to her obstetrician's office for a prenatal visit. Past medical history is unremarkable. The patient's medications include prenatal vitamins. She does not smoke and has not used alcohol since learning of her pregnancy. Ultrasonography shows a gestational sac with an absence of fetal heart tones. Pelvic examination demonstrates a cervix that is long, closed, and posterior. Which of the following is the most appropriate next step in the management of this patient?????
Elective dilation and curettage dx:This patient presents with a gestational sac without heart tones without vaginal bleeding or cervical dilation consistent with a missed abortion.
To relieve dependent edema in a pregnant patient, which of the following should be instituted as treatment?
Elevate the legs
A 17-year-old patient presents to her primary care physician assistant. She reports feeling worried, because she has not yet begun menstruating, although she began developing breasts at age 12. On laboratory evaluation she is found to have increased levels of both follicle stimulating hormone (FSH) and luteinizing hormone (LH), and an adnexal ultrasound is shown here. The patient has an increased risk of which of the following cancers?
Endometrial cancer dx:polycystic ovarian syndrome (PCOS). Patients with this condition have an increased risk of endometrial cancer.
A 26 year-old monogamous female presents with cyclic pelvic pain that has been increasing over the last 6 months. She complains of significant dysmenorrhea and dyspareunia. She uses condoms for birth control. On physical examination her uterus is retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative. Which of the following is the most likely diagnosis?
Endometriosis uterus is often fixed and retroflexed in the pelvis. The palpable mass is an endometrioma or "chocolate cyst". The patient with endometriosis also often has dysmenorrhea, dyspareunia, and dyschezia.
A 27-year-old nulligravida female presents to her primary care doctor with heavy, painful periods and dyspareunia. She notes that she is recently divorced, but she did not become pregnant after having unprotected sex for two years with her ex-husband. She has a significant family history of painful periods and believes her mother underwent surgery for her condition. Which of the following is LEAST likely to be effective in treatment for this patient's pain?
Estrogen-only oral contraceptive pill dx:endometriosis, Estrogen-only contraceptive pills, as they can promote endometrial growth.
A 35 year-old female presents with a solitary breast mass. Fine needle aspiration reveals bloody fluid with no malignant cells. What is the next best step in the care of this patient?
Excisional biopsy is the next step in cases of bloody fluid, residual mass or thickening
Which of the following clinical manifestations is common in candidal vulvovaginitis?
Extreme vulvar irritation Candida infection presents with pruritus, vulvovaginal erythema, and white, cheese-like (curd) discharge that may be malodorous.
Which of the following tests is the most specific for the diagnosis of syphilis?
FTA-ABS is used to diagnose syphilis.
A 40 year-old female presents with a 1.5 cm well-circumscribed mass noted on mammography in the right upper, outer quadrant. Which of the following procedures is most appropriate and should be done next?
Fine needle aspiration Although BRCA 1 and BRCA 2 genetic tests are used in the risk assessment for possible breast and ovarian cancer, it would not replace the need to perform a more definitive evaluation of an identified breast mass.
A 32 year-old female complains of severe irritability and emotional lability accompanied by weight gain, breast tenderness, and headache starting mid-cycle each month and abating with the onset of menses. She has tried relaxation therapy, exercise, dietary changes and over the counter pharmacologic interventions with minimal relief of her symptoms. Which of the following prescription medications is the best choice to relieve her symptoms?
Fluoxetine (Prozac) dx: premenstrual syndrome (PMS)
A 21 year-old obese woman complains of menstrual irregularity since menarche at age 17. She is 5'5" and weighs 180 pounds. Exam of her face reveals excessive hair growth as well as acne. Her abdomen shows midline hair growth and truncal obesity. A previous pelvic ultrasound shows many small fluid filled ovarian cysts bilaterally. Which of the following is the most appropriate diagnostic study to make the initial diagnosis in this patient?
Free testosterone dx:polycystic ovarian syndrome Hyperandrogenism, as evidenced by elevated free testosterone,
Which of the following is NOT a pathogen that requires treatment for the partner as well?
Gardnerella vaginalis
A 30 year-old female presents to the clinic for her 6 week post partum examination. She was diagnosed with gestational diabetes mellitus during her pregnancy and was successfully treated with diet alone. Which of the following patient education statements is most appropriate for this patient?
Glucose testing every 1-3 years is recommended
Progesterone influence on the breast tissue prior to menstruation causes\ vs estrogen
Growth of the lobules and alveoli estrogen= Proliferation of the mammary ducts
A 29-year-old G2P1 female at 37 weeks gestation presents to her obstetrician with a 3-day history of an abrupt onset of extremely pruritic and urticarial papules and blisters on the abdomen and trunk. Her husband recently had an upper respiratory infection. Her physical exam is shown here. This patient is most likely suffering from which of the following conditions?
Herpes gestationis Erythematous urticarial patches and plaques (classically periumbilical) that progress to tense vesicles and blisters in a pregnant woman pruritic blistering dermatologic disorder unique to pregnancy. It is not associated with past or present herpes infection. triggered by pregnancy, with antibodies against hemidesmosomal proteins. It is associated with other autoimmune diseases such as Hashimoto's thyroiditis, Grave's disease, or pernicious anemia.
A 46 year-old G4P4 African American female presents to the clinic complaining of heavy and prolonged menstrual flow over the past 6 months. Gynecological history includes menarche age 12 and LMP 3 weeks prior. Pelvic exam reveals a 14-week size, irregular uterus. Pelvic ultrasound shows the presence of a large intramural fibroid with normal endometrial lining. Which of the following is the most appropriate management for this patient?*********
Hysterectomy dx: large fibroid
A 20-year-old G0 female presents with 4 days of fever, pelvic pain, and left-sided adnexal tenderness. Physical examination reveals cervical motion tenderness and left adnexal fullness. Erythrocyte sedimentation rate (ESR) is elevated. Complete blood count values are as follows: White blood cell count: 17,000/mm^3 Hemoglobin: 12 g/dL Hematocrit: 36% Platelet count: 200,000/mm^3 A CT scan of the pelvis is shown here. Which of the following is the most appropriate treatment for this patient's condition?
IV cefoxitin and IV doxycycline dx:physical examination findings, and imaging consistent with pelvic inflammatory disease (PID) complicated by tubo-ovarian abscess,
A sexually active 25-year-old woman comes to your office desiring a new contraceptive. After seeing an advertisement in a magazine, she asks you about implantable contraceptives. Which of the following is a true statement regarding this form birth control?
Implantable and injectable contraceptives have the lowest failure rate of any non-permanent method and can remain implanted for 3-5 years. They lead to irregular bleeding and typically have a return to fertility by 18 months but can be difficult to remove secondary to scarring.
A 13-year-old female presents 15 months after initial onset of menses. Her cycles have been irregular in timing as well as severity of bleeding. At times the bleeding is so heavy she misses school. Which of the following would be the most appropriate initial diagnostic step?
In younger patients (adolescents), a pelvic exam and ultrasonography should be performed to rule out pregnancy or pathology. ------------------------------------------- A)n older, premenopausal patients evaluation should include hysteroscopy as well. --------Endometrial biopsy would be indicated in older patients with dysfunctional uterine bleeding to rule out pathologic causes such as endometrial cancer. B)D&C is a treatment option for patients whose bleeding cannot be controlled with hormonal therapy. It is indicated if the patient is symptomatically anemic and whose lifestyle is significantly affected by the irregular bleeding.
What is the primary treatment for an infected Bartholin's duct cyst?*****
Incision and drainage is the treatment of choice for a Bartholin duct cyst
A 53-year-old woman presents to her primary care physician for a routine examination. She notes that she began having hot flashes several months prior to presentation along with occasional painful urination. She notes that her periods have become more frequent and irregular, but have become lighter overall. Which of the following is most likely to be true regarding this patient's levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), and androstenedione?
Increased FSH, increased LH, no change in androstenedione dx: Menopause is diagnosed when there are 12 months of amenorrhea in the absence of other biological or physiological causes.
A 17-year-old girl presents to a women's health clinic requesting contraception. She is prescribed combination estrogen-progesterone oral contraceptives. The patient returns 3 weeks later stating that she has gained 10 kilograms of body weight. In addition she complains of headaches of new onset. On exam you note a pudgy, overweight and disgruntled young woman who aggressively blames you for the weight change stating that her boyfriend left her and wants to be taken off of oral contraceptives. Otherwise there are no other abnormalities. Her blood pressure is 145/90 mmHg with a pulse of 90/minute. Due to her recent stress she has began smoking. Which of the following symptoms are attributable to this patient's recent medication change?
Increased blood pressure and headaches dx:oral contraceptive pills (OCPs) will cause weight gain, there has been no evidence to demonstrate that OCPs have any effect on patient's' weight. The patient's increased blood pressure and headaches however can be associated with OCP use.
On physical examination of a pregnant patient, which can be considered a normal finding? A Increased second heart sound split with inspiration B Diastolic murmur C Facial edema D Hyperreflexia
Increased second heart sound split with inspiration is common in pregnancy due to the increased blood flow across the aortic and pulmonic valves.
A 22 year-old G1P0 female presents at 12 weeks gestation with 24 hours of vaginal bleeding. She complains of continued cramping and bleeding requiring pad change every two hours. Vital signs are normal. Vaginal examination shows bleeding with a dilated cervix. Which of the following is the most likely diagnosis?
Inevitable abortion
A 25 year-old female, G2 P1001, presents to your office at 11-weeks gestation with vaginal bleeding, mild lower abdominal cramping, and bilateral lower pelvic discomfort. On examination, blood is noted at the dilated cervical os. No tissue is protruding from the cervical os. The uterus by palpation is 8-9 weeks gestation. No other abnormalities are found. Which of the following is the most likely diagnosis?*****
Inevitable abortion ================================================+ r/o Incomplete abortion is when the cervical os is open and allows passage of blood. The products of conception may remain in utero or may partially extrude through the open os.
A 24-year-old female with a BMI of 36 undergoes a Caesarian section after prolonged labor led to fetal distress. On postoperative day 2, she is noted to have exquisite uterine tenderness and decreased bowel sounds. Her temperature is 38.8 degrees Celsius, heart rate is 102 beats per minute, and blood pressure is 132/78. Which of the following is TRUE regarding this patient's most likely condition? A 25-year-old woman who is postpartum day 3 presents with a temperature of 38.4 C, leukocytosis, and mild sore throat. Her delivery was complicated by a second-stage arrest which required an emergent cesarean section with general anesthesia and endotracheal intubation. On physical exam she has no flank tenderness, but does have lower abdominal pain to palpation. A chest x ray is shown here. Urinalysis was remarkable for 1 WBC and 1 RBC per HPF. What is the most likely cause of her fever?
Intraoperative antibiotics decreases the risk of this condition dx:postpartum endometritis.
A 37-year-old G4P2 female presents to her obstetrician's office for chorionic villus sampling. She reports that she has one child with Down syndrome, and she would like to know if her current gestation also has trisomy 21. Which of the following is TRUE regarding this procedure?
It is associated with an increased risk of limb reduction defects when performed <10 weeks gestation
A 25 year-old female presents with vulvar pruritus and a thick, white vaginal discharge. Which of the following tests will be most helpful in making the correct diagnosis?
KOH prep is used to assist in the diagnosis of vaginal candidiasis, which presents with vulvar pruritus and white curd like, cheesy vaginal discharge.
A 17-year-old girl is brought to her pediatrician for a well-child visit. During the interview, she notes that she has not yet had a period, although she notes that she has been exercising more often during the past few months. On exam, she has a BMI of 22, breasts are Tanner stage I, and measured follicle stimulating hormone (FSH) level is 167 mIU/mL (normal 0.3-10 mIU/mL). Which of the following is the next best step?*******
Karyotyping dx:This patient's clinical presentation is consistent with Turner's Syndrome (TS), which can be diagnosed by karyotyping
A 24 year-old sexually active woman presents to the clinic complaining of dysmenorrhea, dyspareunia and backache that occurs premenstrually. Pelvic examination shows pain upon uterine motion and uterosacral nodularity in the posterior vaginal fornix. The definitive diagnosis for this patient requires which of the following?
Laparoscopy with biopsy dx:endometriosis
A 30 year-old female presents to the emergency room having passed out at home 30 minutes prior to arrival. Her last menstrual period was 6 weeks ago and pregnancy test was reported positive 5 days ago. She started having vaginal bleeding last night. Vital signs are BP 70/40 mmHg, P 140 bpm, R 22. She is pale and diaphoretic. The next step in the evaluation of this patient's condition should be which of the following?*****
Laparotomy dx:ectopic pregnancy in an unstable patient -------------------------------------------------- MRI is useful in cases of unusual ectopic locations in stable patients. in this case she is not stable
At the time of ovulation in a normal menstrual cycle, there is a peak in the serum concentration of which of the following?
Luteinizing hormone
A 16 year-old G0P0 patient presents complaining of lower pelvic pain that alternates from right to left side of her pelvis. She states that it is related to her cycle and occurs most commonly midcycle. She denies sexual activity. She reports that she has taken ibuprofen at the time of the discomfort with some relief. Her pelvic examination is unremarkable. Which of the following is the most likely diagnosis?
Mittelschmerz pain at the time of ovulation, may alternate side to side
What phase of the female menstrual cycle occurs at the time of elevated estrogen and LH/FSH surge?
Ovulation
When is the recommendation for the next Pap smear in a 36 year-old patient with a history of 3 consecutive negative annual Pap smears and no history of cervical dysplasia?
Pap smear in 3years Women who have had 3 consecutive negative annual Pap smears results may be screened every 2 or 3 years if they are 30 or older with no history of CIN 2 or 3, immunosuppression, HIV infection, or diethylstilbestrol (DES) exposure in utero.
Colposcopic examination of the cervix of a 38 year-old woman with a high-grade lesion on Papanicolaou (Pap) smear yields a positive endocervical canal curettage (ECC) as its only abnormality. Which of the following is the most appropriate next step in this patient?****
Perform a conization of the cervix
Patient education for a 23-year-old with a history of seizure disorder using oral contraceptives should include which of the following?
Phenytoin may decrease the effectiveness of oral contraceptives. antiseizure drugs (e.g., phenytoin, carbamazepine, phenobarbital, primidone,)
What is the recommended initial first trimester screening test for fetal aneuploidy?
Pregnancy-associated plasma protein A (PPA), beta-hCG, and ultrasound of nuchal transparency
A couple presents having not been able to conceive over the past 12 months. Evaluation of the male has been normal. The female has had regular menses. Ovulation can be confirmed with mid-luteal phase measurement of which of the following?*******
Progesterone
What is the initial treatment of choice for hyperthyroidism in a 10-week pregnant patient?
Propylthiouracil (PTU)
A 21-year-old G1P0 female at 17 weeks gestation presents to the emergency room because of vaginal bleeding. Upon further description, she says she has seen "some blood" on two pads "similar to a light period". Her past medical history is unremarkable. She has received all indicated prenatal care and does not smoke and has not used alcohol since learning of her pregnancy. Ultrasonography shows a fetus appropriate for the gestational age. Pelvic examination demonstrates a cervix that is long, closed, and posterior. Which of the following is the most appropriate next step in the management of this patient? B 27 year-old G1P0 female presents complaining of painless spotting since this morning. She is known to be 12 weeks pregnant. Pelvic examination reveals the presence of blood within the vagina with a closed cervical os. The uterus is consistent with a 10-12 week gestation and nontender to palpation. Which of the following is the most likely diagnosis?
Reassurance with outpatient follow-up dx: threatened abortion prior to the 20th week of gestation is classified
A 72 year-old female presents with vulvular pruritus for the last nine months, which has progressively worsened over the last two months. She states that she went through menopause at age 54 and has been on estrogen and progesterone therapy since that time. Physical examination reveals red lesions with white plaques on the vulva. What should the next course of management include?.
Refer to a gynecologist for biopsy dx:Vulvular squamous cell hyperplasia causes thickening and hyperkeratosis of the vulva. The lesions are red and moist and cause intense pruritus over time the area becomes thickened and a white plaque may develop. Biopsy must be done to evaluate for intraepithelial neoplasm or invasive tumor.
Pharmacologic treatment of a patient with gestational diabetes should consist of which of the following?
Regular insulin The oral anti-hyperglycemic agents Glyburide and Metformin are safe alternatives and are a reasonable alternative for women who fail nutritional therapy and refuse to take, or are unable to comply with, insulin therapy.
Maternal blood pressure normally decreases the most during what period of pregnancy?
Second trimester of pregnancy
If a woman has a normal 28-day menstrual cycle what tissue and hormonal phase occurs during the last 14 days?
Secretory luteal phase under the influence of estrogen and progesterone from the corpus luteum. During this phase, the endometrium becomes more vascularized and slightly edematous.
What should be the initial evaluation of the etiology of infertility in a 25 year-old female who has been trying to conceive for 1 year?
Serum progesterone levels to determine ovulatory function) and transvaginal ultrasound (to rule out the possibility of fibroids or polycystic ovaries), are first-line investigations.
A 33-year-old presents to your clinic for a 28-week prenatal visit. She denies any contractions, vaginal bleeding, fluid leakage, or illness. On physical exam you find her to be 4 cm dilated with membranes intact. What condition is most likely present in this patient's past gynecologic/obstetric history?
Severe cervical dysplasia dx:cervical incompetence #Ehlers-Danlos syndrome risk factor*******ROSH*** A risk factor for this condition is prior cervical surgery, including loop electrosurgical excision procedure (LEEP) and conization procedures performed in the diagnosis and treatment of cervical dysplasia.
A woman comes to your office for a prescription for an oral contraceptive. Which of the following characteristics would be an absolute contraindication for prescribing a combined oral contraceptive in this patient?*****
She is 37-years-old and has occasional migraines with aura
A 52-year-old G3P3 woman with a BMI of 24 presents to her physician complaining of "wetting" herself. She reports a light leak of urine whenever she coughs or laughs. She has had this problem now for several years. Upon the recommendation of a friend, she has been trying to strengthen her pelvic floor muscles by performing Kegel exercises. She has been performing these regularly for the last 2 weeks, but has had no improvement in her symptoms. She has no other complaints. Which is the appropriate recommendation?
She should continue Kegel exercises for a total of 3 months. dx:stress incontinence. First-line therapy includes 3 months of conservative management with pelvic floor muscle strengthening known as Kegel exercises.
A 17-year-old G2P1 female presents to the emergency room in labor. She reports that she has had minimal prenatal care, but has been meticulous about taking a prenatal vitamin every day for the entire course of the pregnancy. Her external pelvic exam is shown here. Which of the following is TRUE regarding this patient's condition?
She should undergo a Caesarian section dx:genital herpes simplex virus (HSV) lesions. She should undergo a Caesarian section. Tzanck smear is used to diagnose herpes infections.
A 21-year-old female presents for an elective abortion at 10 weeks gestation. Which of the following would be the safest and most effective method?****** comlpication of other options and when can they be used?
Suction curettage is the safest and most effective method for termination of pregnancies up to 12 weeks ----------------------------------- A)methotrexate/misoprostol: woman presents less than 49 days (7 weeks) from LMP. b)Induction of labor by vaginal prostaglandins can initiate a midtrimester abortion. There are significant complications and risks with this method (e.g., retained placenta, higher incidence of live abortion, hemorrhage and coagulopathy). C)Surgical curettage has increased risks for complications (e.g., bleeding, cervical or uterine damage, uterine synechiae [Asherman's syndrome]).
A 26 year-old woman requests screening after her boyfriend was treated for a sexually transmitted infection recently. On examination you find a painless vulvar ulcer. Which of the following is the most likely diagnosis?
Syphilis The primary lesion of syphilis presents as a painless ulcer or chancre. Secondary syphilis presents with a skin rash lymphadenopathy and mucocutaneous lesions.
A 56 year-old female patient comes to the office for evaluation. She complains of dyspareunia and a thin vaginal discharge. On physical examination atrophic vulvar changes are noted associated with vaginal petechiae and a thin clear discharge. What medication is recommended to treat this patient's symptoms?
Topical estrogen (Estrace) cream dx:atrophic vaginitis
A 58-year-old woman who is 8 years postmenopausal complains of urinary urgency, frequency, and occasional incontinence. On pelvic examination, her vaginal mucosa appears shiny, pale pink with white patches, and bleeds slightly to touch. Her urinalysis and urine cultures are negative. Which of the following is the BEST treatment for this patient?
Topical vaginal estrogens dx:postmenopausal atrophic changes
A 52 year-old obese patient with persistent heavy menses undergoes an endometrial biopsy and is diagnosed with atypical adenomatous hyperplasia. What is the next step in the management of this patient?
Total abdominal hysterectomy ////////////////////////////////////// in a patient with endometrial hyperplasia without atypia. A. Endometrial curettage would remove the hyperplasia and progesterone will decrease the endometrial glandular proliferation. This would be appropriate managemen B. Oral progesterone for 10 days of the month will cause the patient to have a withdrawal bleed every month. This would be an appropriate treatment in a premenopausal patient
A. A 32-year-old female presents to her gynecologist noting that she missed her menstrual period two weeks ago. She denies pelvic pain, but notes that she has a very regular cycle and typically does not miss periods. She is concerned and states she would like to have an abortion if she is pregnant. Her blood pressure is 135/81 mmHg, heart rate is 82 beats per minute, and she is afebrile. A pelvic ultrasound is performed, which shows no sign of a gestational sac in the uterus, and her beta-human chorionic gonadotropin (HCG) level is found to be 2600 mIU/mL. She tested negative for Rh and the father's Rh status is unknown. Her liver and renal function tests are normal. Which of the following is the next best step? B A 25 year-old presents with pelvic pain and uterine bleeding. Her Beta-HCG was 1200 mIU/L six days ago. Her current Beta-HCG is 1600 mIU/L. What is the next best test in the evaluation of this patient? c. A 30 year-old female presents to the emergency department with a syncopal episode. She has a history of irregular menstrual cycles and infertility. She has scanty, persistent vaginal bleeding and sharp pelvic pain. A left adnexal mass is palpated. The most likely diagnosis is
Transvaginal ultrasound dx:ectopic pregnancy (EP) Is less than 6 weeks old (and therefore less than 3 cm), with a risk for Rh sensitization confirm an ectopic pregnancy before being treated with methotrexate and RhoGAM for a medical abortion.
A 35 year-old female presents with multiple ulcerative lesions on her labia and perineum. A Tzanck preparation of one of the lesions reveals multinucleated giant cells. Which of the following is the most likely diagnosis?
Tzanck preparation is characteristic of HSV
A 25 year-old female presents for a routine gynecological examination. You palpate a 2 cm breast mass in her right breast. Her menstrual period was last week. She has no family history of breast cancer. What is the modality of choice to further evaluate her breast mass?
Ultrasound
A 31-year-old G3P2 presents for a first-trimester prenatal visit. You perform the standard first-visit tests including blood type and screen, Rh type, CBC, immunization status, urinalysis for protein, and Pap smear. Which of the following first-visit tests will you also administer in the third trimester? A HIV B Rubella C Hepatitis B and C D Urinalysis E Pap smear
Urinalysis
You are performing a routine gynecological examination on a 49-year-old female. She states that for the last six months her periods have been getting heavier and lasting for seven days duration. She also tells you that she has been experiencing urinary frequency and constipation. Her abdominal exam is unremarkable. Pelvic exam reveals a closed cervical os with an irregularly shaped abdominal mass with no adnexal tenderness. Which of the following is the most likely diagnosis?
Uterine fibroids
A 48 year-old G3P3003 female presents to the office complaining of severe secondary dysmenorrhea and menorrhagia over the last 6 months. On physical examination her uterus feels enlarged and irregular. Which of the following is the most likely diagnosis?***** a) endometriosis b) Uterine fibroids
Uterine leiomyomata reason :severe dysmenorrhea and menorrhagia. An enlarged, irregular uterus is noted on examination. ------------------------------------------------ r/o Endometriosis most commonly presents with dysmenorrhea, dyschezia, and dyspareunia. Usually, the uterus is not enlarged
A 22-year-old woman is considering breast implants. Which of the following messages is important to relay to this patient?
Women with breast implants experience the same incidence of breast cancer as women without implants and should be screened at the same intervals.
A woman presents at 30 weeks gestation complaining of a slow constant trickle of fluid from her vagina x 3 days. Physical exam shows positive pooling in the posterior fornix and the ferning test is positive. External monitoring shows the fetal heart rate at 140 beats per minute with beat to beat variability and accelerations; biophysical profile is 10. What is the next step in management?
admit to hospital for bedrest and monitoring dx premature membrane rupture why 1)fetus is preterm (under 37 weeks gestation) 2)no sign of distress other options are done if A)Induction of labor would be warranted if the gestational age was at least 36 weeks, since it is assumed that the fetal lungs are mature. B)Cesarean section : indicated if the fetus was showing signs of distress on the fetal heart tracing or the biophysical profile.
A Papanicolaou (Pap) smear is performed on a 40-year-old patient who has not had a Pap smear since the birth of her last baby (15 years ago). Today's Pap smear result indicates squamous cell carcinoma. The reason she sought medical care was for postcoital bleeding. At the time of the Pap smear, there was a friable lesion present. At this point, the MOST appropriate step in this patient's management is ***********
biopsy visualized lesion and refer patient for gynecologic consult There is no generalized clinical picture of cervical carcinoma, but there are two symptoms often associated with it. They are postcoital bleeding and abnormal uterine bleeding. The average age at diagnosis is 50. Lesions on the cervix that should be considered for immediate biopsy include new exophytic, friable, or bleeding lesions. . When lesions are visualized and the biopsy confirms carcinoma, no colposcopic assessment is needed.
A 23-year-old female who is G1P0 and 16 weeks pregnant presents to the emergency department with painless vaginal bleeding x 2 hours. She denies fever or abdominal pain or cramping. Ultrasound confirms intrauterine gestation. Fetal heart tones (FHTs) are strong at 165 bpm. She had a normal Pap smear 2 years ago. Exam reveals cervical dilation at 2 cm. What is the most appropriate intervention at this time?
cervical cerclage dx:cervical insufficiency. A cervical cerclage is recommended between 13-16 weeks' gestation. Contraindications to cerclage placement include bleeding of unknown etiology, infection, labor, ruptured membranes and fetal anomalies.
A 28-year-old female is diagnosed with cervical intraepithelial neoplasia (CIN II) after a routine Pap smear. What is the treatment of choice at this time? A 32 year-old female G4P4 with a history of multiple sexual partners is seen in follow-up for recent findings of high grade squamous intraepithelial lesions (HSIL) on a Pap smear. Which of the following is the most appropriate next step?
colposcopy or leep /colposcopy with endocervical curettage dx:HSIL is associated with a high risk of CIN 2,3 or cervical cancer. I
A 31-year-old G1P0 with a history of hypertension presents to the emergency department because she believes that she is in labor. She is in her 38th week of pregnancy and her course has thus far been uncomplicated. This morning she began feeling painful contractions and noted vaginal bleeding. She is experiencing lower abdominal and pelvic pain between contractions as well. On exam, she is afebrile, blood pressure is 145/85 mmHg, heart rate is 102 bpm, and respiratory rate is 16 rpm. You note a gravid, hypertonic uterus on exam and moderate blood in the vaginal vault. Ultrasound reveals no abnormalities. Which of the following is the most likely diagnosis?
dx:Abruptio placentae -------This woman with a history of hypertension and painful antepartum hemorrhage with a normal ultrasound is most likely experiencing abruptio placentae.--------------
A 30 year-old female presents to the emergency department with a syncopal episode. She has a history of irregular menstrual cycles and infertility. She has scanty, persistent vaginal bleeding and sharp pelvic pain. A left adnexal mass is palpated. The most likely diagnosis is A. Ectopic pregnancy. B. pelvic inflammatory disease. C ruptured ovarian cyst
dx:ectopic preg Infertility increases the risk of developing ectopic pregnancy. The onset of vaginal bleeding, pelvic pain, and formation of an adnexal mass makes this the most likely diagnosis. -=================================================- Rule out ruptured ovarian cyst.= Acute pelvic pain may occur secondary to bleeding from the rupture of a hemorrhagic ovarian cyst, but no adnexal mass would be palpable on pelvic examination. Pelvic inflammatory disease typically presents with fever, abdominal pain, purulent vaginal discharge, and cervical motion tenderness.
A 26 year-old gravida 0 sexually active female presents to the emergency room complaining of colicky pain in her lower abdomen for the past 12 hours. She passed out earlier in the day while trying to have a bowel movement. Her last menstrual period was 6 weeks ago. She has noted vaginal spotting over the last 24 hours. Vital signs show Temp 37 degrees C, BP 96/60mmHg, P 110, R 16, Oxygen Sat. 98%. Abdominal exam is positive for distension and tenderness. Bowel sounds are decreased. Pelvic exam shows cervical motion and adnexal tenderness. Which of the following is the most likely diagnosis?********** A)ectopic B)Pelvic inflammatory dz
ectopic preg ==================================================== ruled out In pelvic inflammatory disease the temperature is usually above 38 degrees C and pelvic pain usually follows onset of cessation of menses.
Which of the following is the earliest and most reliable clinical manifestation of pre-eclampsia?
elevation of blood pressure
A 65 year-old postmenopausal female presents with complaints of new onset of vaginal bleeding. She relates a history of two episodes of vaginal bleeding during the past month, each lasting about four days. Which of the following diagnostic evaluations is the most reliable to evaluate the suspected diagnosis?
endometrial biopsy dx:endometrial cancer
Which of the following is associated with meconium-stained amniotic fluid during labor?
fetal distress
A round and firm mobile nontender mass does not change with the menstrual cycle and are slow growing. Most are found as an incidental finding on physical examination or during self-breast examination. A 22 year-old G0P0 asymptomatic female is seen for her yearly gynecologic examination. She denies performing self-breast exams and any family history of breast or gynecologic cancers. On palpation of her left breast, a solitary 1 cm rubbery, firm, well-circumscribed, non-tender breast mass is noted. In review of her records, similar findings were noted on last year's examination. Which of the following is the most likely diagnosis?
fibroadenoma,
Multiple, painful, bilateral mobile masses are consistent with associated symptoms include size fluctuation of the masses, and onset or increase of mastodynia premenstrually.
fibrocystic disease of the breast.
A 25-year-old patient is complaining of depression and anxiety just prior to her menses. The symptoms have been going on for more than 1 year, but are now starting to interfere with her relationships and her productivity at work. One week prior to menses each month she experiences a depressed mood, a feeling of being on edge, increased irritability, difficulty sleeping, a feeling of being overwhelmed, and is easily fatigued. She charted her symptoms daily in a log and returned to the office two cycles later. The log is consistent with the history. Her physical examination and general laboratory profile showed no abnormalities. Which of the following is the MOST effective treatment choice for this disorder?
fluoxetine dx:premenstrual dysphoric disorder (PMDD
A 20-year-old nulligravida comes to your office complaining of pelvic pain and irregular menstrual bleeding. She denies sexual activity, and her β-hCG urine test is negative. She has never been on oral contraceptives. On pelvic examination, you find unilateral tenderness on the left side, and a palpable cystic mass approximately 4 to 5 cm in size. The MOST likely diagnosis is******
functional ovarian cyst follicular cyst Symptoms associated with a functional ovarian cyst include mild to moderate unilateral pain and alteration in the menstrual cycle.
Which of the following is a major risk factor for an ectopic pregnancy?
history of salpingitis major risk factor for ectopic pregnancy since damage to the fallopian tube prevents the fertilized ovum from reaching the uterus prior to implantation.
A 28-year-old female describes a one year history of weight gain, irritability and increased tension which occur 5 days before onset of menses. Which of the following dietary modifications will most likely decrease her symptoms? A 29-year-old female presents to the gynecology office with complaints of headache, breast tenderness, and pelvic pain. She further admits to bloating and irritability. These symptoms predictably occur about a week before the onset of menses. What is the most likely diagnosis?
imiting caffeine, alcohol, tobacco, and chocolate has been found to help with some patients. thought that estrogen and progesterone may influence serotonin centrally, causing the symptoms of PMS Exercising consistently can help too occur in the luteal phase of the menstrual cycle dx. premenstrual syndrome (PMS)
A 22-year-old obese female presents complaining of anovulation and hirsutism. Testosterone levels are mildly elevated and LH/FSH ratio is 4. She does not wish to become pregnant at this time. Which of the following is the best treatment? A 25-year-old nulliparous white woman has a chief complaint of heavy and frequent menstrual bleeding for the past year. She has never been sexually active; is moderately overweight; and has hirsutism and acne. She denies vaginal dryness, mood swings, or hot flashes. She also denies hot or cold intolerance, diarrhea, or heart palpitations. Which part of this history suggests polycystic ovarian syndrome? (weight, skin, and hair changes)
medroxyprogesterone acetate dx:polycystic ovarian syndrome (PCOS). If contraception is desired, a low dose oral contraceptive can be used. Often, the use of insulin-sensitizing agents (metformin) is successful in promoting ovulation.
A 26-year-old G1P0 at 14 weeks has consistent blood pressure readings of 166/110 despite sodium restriction and avoidance of alcohol and tobacco. There is no evidence of end organ damage; urinalysis is normal. What is the first line anti-hypertensive therapy for this patient?
methyldopa recommended as the first-line treatment for hypertension in pregnancy.
A woman has undergone a suction curettage for a hydatidiform mole and was diagnosed with benign gestational trophoblastic neoplasia (GTN). Following this INITIAL treatment, which choice of monitoring should be done for patients in order to prevent the development of choriocarcinoma?
monitor serum radioimmunoassay β-hCG once per week until three to four normal values are obtained, and then monthly for 6 months to 1 year
A 34-year-old African-American female G2P2002 presents with heavy menstrual bleeding. CBC shows a microcytic, hypochromic anemia. Physical exam reveals several smooth, spherical uterine masses. She and her husband would like have another child. Which of the following would be the best treatment option?
myomectomy dx: uterine fibroids maintain fertility and retain the uterus. There is, however, a significant risk for recurrence of leiomyomas. Fibroids occur 2-3 times more often in black women than white women.
A 23-year-old G1P1 presents to the clinic for her annual examination. She has no history of abnormal Pap smears, but the results from today's test show low-grade squamous intraepithelial lesions (LSIL). Which of the following is the BEST option for what should be done next????????
recheck Pap in 1 year Based on the latest ASCCP guidelines women ages 21-24 years of age with LSIL should undergo repeat cytology at 12 months. Those 25 and up with LSIL should undergo colposcopy.
A 32-year-old G2P1001 presents at 27 weeks gestation. Glucose challenge returns at 165 mg/dl. Results of a glucose tolerance test are: fasting: 90 mg/dl 1-hour: 195 mg/dl 2-hour: 145 mg/dl 3-hour: 130 mg/dl According to the White Classification, which of the following is the best diagnosis? /////////////////////////////////// An obese, 32-year-old G3P2A0L2 woman presents to her obstetrician for follow-up at week 26 of her pregnancy. She previously had a random plasma glucose during her pregnancy of 140 mg/dL. One hour after a 75 g oral glucose load, the patient's plasma glucose level is 200 mg/dL. Which of the following is a potential complication of her diagnosis?
no gestational diabetes Initially a 50-gram non fasting glucose load is performed. If the results are over 140 mg/dL, a fasting 3-hour glucose tolerance test is done. Normal values are: fasting: <95 mg/dL; 1-hour: < 180 mg/dL; 2-hour: < 155 mg/dL; 3 hour: < 140 mg/dL. To make the diagnosis of gestational diabetes, at least two values must be elevated. Only the 1-hour glucose level is high in this patient /////////////////////////////////////////////// Type II diabetes after completion of her pregnancy
A young otherwise healthy adult female complains of painful periods. Further history reveals that the pain occurs on the initial day of her menses and is associated with headaches. Which of the following will most likely be found on physical exam?
no significant pelvic findings dx:primary dysmenorrhea. At times, the patient may have generalized pelvic tenderness.
A 36-year-old G2, P2 comes to your office complaining of heavy menstrual bleeding for the past year. The patient is bleeding through a super tampon and a heavy pad every hour of the first three days of her cycle. Her cycle lasts 5 days and the cycle length has decreased to having a period every 20 days. She complains of fatigue. Her physical examination and laboratory work-up are normal (negative β-hCG, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, clotting times, liver function, and renal function tests), except for the complete blood cell count (CBC) and further labs indicating she has iron deficiency anemia. The patient's weight is 298 lb. In addition to iron supplementation, which of the following is the BEST INITIAL therapy for this patient?
oral contraceptives dx:the iron deficiency anemia also can cause menometrorrhagia. OCP use is contraindicated, such as in smokers older than age 35 and women at risk for thromboembolism.
A postpartum female is suspected of having a breast abscess. Which of the following breast exam findings would be most consistent with this diagnosis?
palpable mass with tenderness and induration
A decrease in the fetal heart rate (FHR) occurring late during contractions is noted. The FHR returns to the baseline slowly after the uterine contraction. The physician assistant should be alerted to the possibility of
placental insufficiency dx:late decelerations.
Which of the following elements of a patient's history is the greatest risk factor for endometrial cancer?
postmenopausal bleeding
A 13 year-old female presents with a six month history of lower mid-abdominal pain that is spasmodic in nature and radiates to the inner thighs. The pain usually starts within a few hours of the onset of menses and lasts about 2 days. The patient's menarche began 2 years ago. She denies any sexual activity. Physical examination, including pelvic, is unremarkable. Which of the following is the most likely diagnosis?
primary dysmenorrhea
A man and woman in their 20s have been trying unsuccessfully to conceive for the last year. The woman has regular menses and a 28-day cycle. In the initial evaluation, which of the following tests or evaluations should be considered first line?
semen analysis (1) does the woman ovulate? (if not, why not); (2) does the semen have normal characteristics? (3) is there a female reproductive tract abnormality? Noninvasive tests should be done first line
Metronidazole 2 g orally as a single dose or 500 mg twice daily for 7 days is the treatment regimen for which of the following vaginal infections?
trichomoniasis
