Download Care of Women KSA Verified 2026 Study Guide, Questions & Answers for Nursing, Midwifery and more Exams Medical Sciences in PDF only on Docsity!
Care of Women KSA Verified
2026 Study Guide, Questions &
Answers for Nursing,
Midwifery & Medical Students
A 24-year-old graduate student comes to your office to be tested for sexually transmitted infections. The medical assistant tells you that the patient was upset when she saw how much she weighed. On questioning, the patient says that for the past year she has experienced episodes of uncontrollable eating followed by self-induced vomiting. Her weight is 82 kg (181 lb) and her BMI is 32 kg/m2. Which one of the following is true regarding treatment for this condition? A. Cognitive behavioral therapy has the best evidence for treatment B. SSRI monotherapy is a first-line treatment option C. Anemia is an indication for hospitalization D. More than half of patients will relapse after treatment - ANSWER-ANSWER: A Eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder, and the DSM-5 added avoidant/restrictive food intake disorder, rumination disorder, and pica to this group in 2014. Mood disorders, anxiety, substance use, and personality or somatic disorders are common in these patients. Screening can include regularly asking questions about mood, body image concerns, and eating behaviors. Before establishing the diagnosis based on history, it is important to perform a physical examination that includes
measurement of orthostatic vital signs and obtain a metabolic panel that includes magnesium and phosphate levels. This patient appears to have bulimia nervosa, which consists of eating an excessive amount of food in a short period of time (often >2000 calories in one sitting), with a concomitant feeling of loss of control. Because patients with bulimia base their self-worth on their body shape and weight, they follow this binge eating with compensatory behaviors to prevent weight gain, such as vomiting, laxative use, food restriction, excessive exercise, or taking diuretics. Episodes occur, on average, one or more times a week for 3 months or longer, and the disorder is associated with a two- to sixfold increase in age-adjusted mortality. After the diagnosis is established and a goal weight has been accepted, the patient is best served with treatment delivered by a team that includes a therapist, a nutritionist, and a clinician, preferably with each having prior experience in caring for patients with eating disorders. Cognitive behavioral therapy (CBT) has the best evidence for treatment of adults with bulimia, while family-based therapy is the first-line treatment for adolescents with this condition. Early behavioral response, with rapidly declining episodes of binge eating, is associat A 35-year-old female presents to your office for treatment of insomnia. You ask if she has experienced any trauma in her life and she discloses that she was sexually assaulted 6 weeks ago. She has not sought medical, legal, or psychological counseling since the assault. During today's visit, you should do which one of the following? A. Assess for symptoms of posttraumatic stress disorder B. Prescribe levonorgestrel (Plan B One-Step), 1.5 mg
You are developing a practice improvement activity in your office centered on substance use disorder (SUD). As part of the training for your clinical staff, you plan to review a variety of clinical vignettes of patients with SUD. One of your goals is to illustrate how SUD has different clinical presentations in women and men. Which one of the following statements is accurate regarding these differences? A. Compared to men, women have a quicker progression from first using a substance to developing dependence B. Compared to men, women with SUD have less severe adverse consequences C. Smaller quantities of drug consumption are associated with development of SUD among men compared to women D. Women are less likely to relapse after treatment than men - ANSWER-ANSWER: A Substance use disorder (SUD) in women is often associated with more severe adverse medical, psychiatric, and functional consequences than in men, often related to the interacting contributions of biological and environmental factors. Physiologically, women with SUD have variation in cravings and drug consumption at different times of the menstrual cycle. There is also evidence that women metabolize nicotine more rapidly than men, making it harder for them to quit using nicotine-containing products. This differential metabolism is a possible reason that nicotine replacement therapies are less efficacious in women. Environmentally, women often attribute their substance use to different reasons than men, including self-treatment of mental health problems, management of chronic pain, and controlling weight. Use of smaller quantities of drugs and a shorter time progression from initial use to dependence are both more likely
among women with SUD. Treatment outcomes are not substantially different by sex, but women are more likely to relapse after treatment. A 23-year-old patient comes to your office 4 weeks after the uncomplicated vaginal birth of her first child, and reports that she feels tired all the time. On further questioning, she describes significant emotional lability during the first week after delivery. She has continued to have a low mood most days and worries about her ability to care for her child. She reports no personal or family history of depressive illness. Her infant is feeding and growing well, and now requires only one nighttime feeding. Which one of the following would be most appropriate at this point? A. Reassurance that the problem will most likely be resolved within 4 weeks B. Reassurance that this condition is unlikely to recur in subsequent pregnancies C. Appropriate screening for underlying medical conditions, including a urinalysis and an erythrocyte sedimentation rate D. Avoiding pharmacologic therapy because she is breastfeeding E. Rec - ANSWER-ANSWER: E Postpartum depression is relatively common and occurs in up to one in seven women. Untreated, it is associated with significant maternal and neonatal mortality. It is disruptive to the family, and it can lead to a higher risk for paternal depression, marital discord, family violence, substance use and abuse, child abuse and neglect, failure to implement child safety and preventive measures, and poorer management of chronic health conditions in children. Postpartum depression is associated with both the early cessation of breastfeeding and reduced maternal-infant engagement, which can both have an adverse effect on infant development. Consequences of maternal depression include negative effects on cognitive development, social-emotional development, and behavior of the child.
B. Flibanserin (Addyi) C. Sertraline (Zoloft) D. Sildenafil (Viagra) - ANSWER-ANSWER: B In order for a lack of sexual interest or arousal to qualify as a dysfunction, the problem must be present more than 75% of the time, persist for more than 6 months, and cause significant distress, and must not be explained by other mental health diagnoses, relationship distress, substance abuse, or a medical condition. The DSM-5 criteria for female sexual interest arousal disorder include a lack of, or significantly reduced, sexual interest and arousal, as manifested by at least three of the following:
- Absent or reduced interest in sexual activity
- Absent or reduced sexual or erotic thoughts or fantasies
- Absent or reduced initiation of sexual activity, and typically being unreceptive to a partner's attempts to initiate sexual activity
- Absent or reduced sexual excitement or pleasure during sexual activity in almost all sexual encounters
- Absent or reduced sexual interest and arousal in response to any internal or external sexual or erotic written, verbal, or visual cues
- Absent or reduced genital or nongenital sensations during sexual activity in almost all sex encounters A challenge to diagnosing and treating sexual concerns is that many lack a single etiology. In addition, many cases are complicated by relationship and psychological factors. Dysfunction may be caused by hypothalamic-pituitary axis dysregulation, hypothyroidism, menopause, premature ovarian failure, or musculoskeletal, inflammatory, neurologic, or vascular issues. Sexual function
changes can be associated with declining levels of estrogen in peri- and postmenopausal women. Decreases in sexual desire and responsivity have been linked to declining levels of estradiol, while no aspect of sexual functioning has been correlated with measured levels of androgens, including total testosterone, free testosterone index, and dehydroepiandro A 24-year-old primigravida at 22 weeks gestation sees you because of a depressed mood. For the last 6 weeks she has felt an increasing lack of energy and spends considerable time at home in bed because of this. She reports that she has been sleeping more than 12 hours a night for the last 2 weeks and has stopped her daily piano playing, which she usually enjoys. She has also noted difficulty concentrating. She indicates that family members are concerned about this change. She does not have any suicidal thoughts or feelings but does report feeling as if she has little hope of feeling better. The pregnancy has gone well up to this point. Which one of the following would be the most appropriate initial step in the management of this patient? A. Scheduling a visit in 4 weeks for follow-up and routine prenatal care B. Recommending an aerobic exercise program as the primary treatment C. Prescribing estrogen D. Prescribing - ANSWER-ANSWER: E For women, the peak age of onset for depressive disorders is during the childbearing years. The criteria for diagnosing major depression in pregnancy are the same as for nonpregnant patients, and this patient meets several of the DSM- 5 criteria for this diagnosis. Depression during pregnancy negatively affects maternal quality of life and is responsible for significant disability and health care utilization. It has been
A. The follicular-proliferative phase B. The follicular-secretory phase C. The luteal-proliferative phase D. The luteal-secretory phase E. The ovulatory phase - ANSWER-ANSWER: D The normal menstrual cycle can be divided into two segments: the ovarian cycle and the uterine cycle. The ovarian cycle is further divided into the follicular, ovulatory, and luteal phases. Similarly, the endometrium cycles through the menstrual, proliferative, and secretory phases, with the secretory phase corresponding to the ovulatory cycle's luteal phase. At the beginning of the menstrual cycle, during the ovarian follicular phase, gonadal hormone (estrogen and progesterone) and LH levels are low, and FSH levels begin to rise. This stimulates the growth of follicles that begin to secrete estrogen, which is the stimulus for the uterine proliferative phase. Just prior to ovulation there is an LH surge, accompanied by a smaller increase in FSH levels. After ovulation, there is a transition to the luteal-secretory phase, characterized by high estrogen and progesterone levels secreted by the corpus luteum, which in turn act centrally to suppress the pituitary release of gonadotropin hormones, resulting in low levels of FSH and LH. Serum progesterone determinations provide a reliable and objective measure of ovulatory function but must be performed at the appropriate time, which is usually a week before the expected onset of menses. A progesterone level > ng/mL is considered to be reliable evidence of recent ovulation. A 14-year-old competitive gymnast presents for a well child examination. The patient's mother is concerned that her daughter has not yet started her period. Over the last year the patient has noted breast development and growth of hair in
the pubic and axillary areas, and she has had a growth spurt. Which one of the following would be appropriate advice for the patient and her mother? A. The patient should have a laboratory evaluation at this visit B. The patient's pubertal development is within the normal range for girls C. Intense training is not associated with menstrual delay D. Increased skeletal growth typically follows menarche in pubertal development - ANSWER-ANSWER: B Puberty is the process leading to physical and sexual maturation that involves the development of secondary sex characteristics, as well as an increase in height, changes in body composition, and psychosocial maturation. The normal age range for the onset of puberty in girls is 8-14 years. The average age at menarche is 12. years, and the absence of any pubertal development by 13 years of age is an indication to evaluate the patient for delayed puberty. This patient has evidence that puberty has begun, including increased skeletal growth, breast development, and the appearance of pubic and axillary hair. Menarche generally follows peak skeletal growth by about a year. Primary amenorrhea is defined as the absence of menarche by age 15, or within 3 years of thelarche. Reassurance would be appropriate for this patient but continued observation is warranted for development of the female athlete triad. This triad is a spectrum of disorders that principally involve three components: low energy availability, menstrual dysfunction, and low bone mineral density. A 28-year-old nulligravida sees you to discuss infertility. She has no history of sexually transmitted infections. Her male partner has a son from a previous relationship. She has been having unprotected intercourse with her partner for 1 year. Her cycle lengths vary from 28 to 33 days. She would like to know when she
B. Monitoring should start as soon as patients have missed a menstrual period or had a positive pregnancy test C. Serum TSH levels should be checked once per trimester for the duration of the pregnancy D. Women with hypothyroidism who become pregnant often need a lower dose of thyroid hormone replacement during the pregnancy E. Adequately treated maternal hypothyroidism is associated with an increased risk for adverse neonatal outcomes - ANSWER-ANSWER: B Among endocrine disorders affecting women of reproductive age, the prevalence of thyroid disease is second only to that of diabetes mellitus. Women with hypothyroidism are advised to achieve euthyroidism before conception because of the risk of lower fertility rates and miscarriage. Untreated or insufficiently treated maternal hypothyroidism is associated with adverse neonatal outcomes, including pregnancy loss, placental abruption, hypertensive disorders, and intrauterine growth restriction. Given that the early gestational period is when the greatest effect of maternal thyroid dysfunction on fetal outcomes occurs, women with pre-existing hypothyroidism should be advised to see their care provider for monitoring as soon as they have missed a period or had a positive pregnancy test. Maternal thyroxine is essential for fetal development, as it supplies thyroid hormone- dependent tissues until maturation of the fetal hypothalamus, pituitary gland, and thyroid gland. This development is nearly complete by 12-14 weeks gestation. After the 14th week fetal brain development may already be irreversibly affected by a lack of thyroid hormones. TSH concentrations are physiologically lower during pregnancy. Beginning at 6 weeks gestation, serum thyroxine-binding globulin (TBG), the major thyroid hormone transport protein in pregnancy, begins to rise due to the estrogen-
mediated increase in hepatic TBG synthesis. Maternal thyroid hormone production is also increased by the thyroid stimulating action of placental hCG. TSH levels will usually have begun to fall by the time of the first prenatal visit, and the nadir is reached at 10-12 weeks gestation. For this reason, early and frequent monitoring of free T4 and TSH is warranted, and the levothyroxine dosage should be adjusted as necessary to reach a goal serum TSH level A 24-year-old gravida 2 para 1 at 22 weeks gestation presents with a 6-week history of increased wheezing following an upper respiratory infection (URI). She quit smoking before this pregnancy, and she has a history of mild, intermittent asthma since childhood. She has managed her asthma adequately for several years with an albuterol (Proventil, Ventolin) metered-dose inhaler (MDI) that she has needed only about once a month. Since the URI she has been using her albuterol MDI 2-3 times a week. She has continued to have a nonproductive cough but no fever or other symptoms. She says the baby is moving normally. On examination she has wheezing throughout both lung fields without crackles, and has no findings to suggest pharyngitis, otitis media, or sinusitis. Her oxygen saturation is 94% on room air. You assess for proper inhaler technique and persistent allergen exposure and find no concerns. Which one of the following - ANSWER-ANSWER: B Asthma is the most common respiratory condition of pregnancy, with a prevalence rate in the United States of 5%-8%, which is similar to that of nonpregnant women of reproductive age. Asthma control has been shown to worsen for 36% of pregnant women with a history of asthma. Exacerbation rates are linked to underlying severity of the disease: 52% of pregnant women with severe asthma have an exacerbation during pregnancy, compared to 26% with moderate asthma and only 13% with mild asthma. Exacerbations can be triggered by nonadherence to treatment, exposure to allergens or cold, upper respiratory infections, and symptoms that are common during pregnancy, such as rhinitis and gastroesophageal reflux. Additionally, cigarette smoking is associated with a higher incidence of exacerbations. Pregnancy complications associated with
D. Neonatal prophylaxis with zidovudine (Retrovir) should be started within 12 hours of birth and continued for 6 weeks if the mother had an HIV RNA viral load >1,000 copies/mL at the time of delivery - ANSWER-ANSWER: A The CDC recommends universal opt-out prenatal screening for HIV. Repeat testing in the third trimester, before 36 weeks gestation, is recommended for women at high risk for HIV infection, including those living in areas with a high incidence of HIV, those with risk factors for transmission, and those with signs or symptoms of acute HIV infection. A rapid HIV test can be used for women with an unknown HIV status who present in labor. An additional recommendation for pregnant women with HIV is to administer the hepatitis B vaccine series during pregnancy if their hepatitis B surface antigen test is negative on initial screening, and to screen for immunity to hepatitis A and immunize as needed. In addition, those with HIV infection should be tested again for hepatitis B antigen at the time of delivery so that the newborn can be given appropriate therapy if indicated. Inactivated influenza vaccine should be administered during the pregnancy and Tdap should be given at 28-36 weeks gestation. Women diagnosed as HIV positive during pregnancy should be informed that the risk of mother-to-child HIV transmission is estimated at 25%-30%, but that interventions such as antiretroviral therapy, cesarean section, and avoidance of breastfeeding can reduce this risk to less than 1%. The goal for maternal treatment is to reduce the viral load as much as possible, preferably to an undetectable level, as this is the most predictive factor for HIV transmission. Use of combination antiretroviral therapy (cART) during pregnancy in HIV-infected women has been shown to prevent perinatal transmission to the fetus by decreasing maternal viral load and by providing pre-exposure prophylaxis to the infant through placental transfer. The risk of adverse events from cART drugs is small. HIV RNA viral loads should be measured monthly, but
You see a 33-year-old female for a routine evaluation. She tells you that she had a positive home pregnancy test and is hoping to schedule her first prenatal visit. This is her first pregnancy, and although it was unplanned she is very happy. She has been overweight or obese for several years but has not recently been actively dieting or exercising. Her past medical history is otherwise unremarkable. On examination her height is 160 cm (63 in) and she weighs 79 kg (174 lb), with a BMI of 31 kg/m2. Her blood pressure is 110/65 mm Hg and her temperature is 37.0°C (98.6°F). A urine β-hCG in the office is positive. By dates she is at 8 weeks gestation. She says she has not yet gained any weight with this pregnancy and that she would like to try to lose weight at this stage. When discussing the relationship between weight and pregnancy, which one of the following would be appropriate advice for this patient? A. She shoul - ANSWER-ANSWER: C This patient has a BMI of 31 kg/m2, which places her in the obese category. Weight gain during pregnancy should be based on preconception BMI. The National Academy of Medicine recommendation for this patient's target weight gain during the pregnancy is 5- 9 kg (11-20 lb). More than 50% of overweight and obese women gain more than this during their pregnancy. Low glycemic and Mediterranean diets are commonly recommended, and a gradual increase in activity to try and reach a goal of 30 minutes of moderate-intensity exercise daily should be encouraged. Exercise has been associated with a reduction in the relative risk for gestational diabetes as well as instrumented and cesarean delivery. Early screening for gestational diabetes should be considered in obese women who are pregnant. This patient's obesity places her at increased risk for miscarriage, thromboembolic disorders, gestational diabetes, a large-for-gestational age (LGA) infant, preeclampsia/eclampsia, and fetal or neonatal death. Her likelihood of operative delivery is increased due to her likelihood of having an LGA infant. Underweight
is recommended for a minimum of 4 hours in any pregnant patient at ≥23 weeks gestation who experiences trauma and has a viable fetus (SOR B). The first step in the evaluation of a pregnant patient with trauma is assessing maternal stability with an initial survey of airway, breathing, and circulation. Once maternal respiratory and cardiovascular stability is ascertained, further evaluation of maternal injuries, as well as assessment of the fetus, can be undertaken. Supplemental oxygen; intravenous fluid such as normal saline or lactated Ringer's solution; and evaluation of maternal injuries, including radiologic studies with abdominal shielding, are all appropriate. Concerns about fetal exposure to radiation should not preclude or delay any needed radiologic evaluation. Radiographic studies that are routinely used in the evaluation of trauma during pregnancy represent a very low risk to the fetus. The workup of the pregnant patient should also include blood type and Rh factor, as uterine trauma has the potential to cause a break in the placental barrier, leading to fetal-maternal transfusion. If the mother is Rh negative and the fetus is Rh positive the materna A 24-year-old female who just learned that she is pregnant has an ultrasound examination that reveals a delayed early pregnancy loss (missed spontaneous abortion) at 8 weeks gestation. Which one of the following would be the most appropriate advice regarding her options? A. Expectant management is appropriate up to 2 weeks after the diagnosis B. Misoprostol (Cytotec) or uterine aspiration is more effective than expectant management for anembryonic gestation or embryonic demise
C. Misoprostol for the treatment of missed spontaneous abortion is effective only when administered vaginally D. Methotrexate is an appropriate medication for missed spontaneous abortion - ANSWER-ANSWER: B A delayed early pregnancy loss (missed spontaneous abortion) refers to demise of an embryo or fetus prior to the 20th week of gestation in which the products of conception remain in utero, typically with a closed internal cervical os. As in this case, ultrasonography will reveal an intrauterine gestational sac (with or without an embryonic/fetal pole), but no embryonic/fetal cardiac activity. The size of the fetus on ultrasonography, not gestational age by last menstrual period dating, is critical information for determining the best management option. Management may be expectant or can be accomplished by a medical or surgical intervention to complete the process. Surgical methods are most effective in managing a miscarriage, followed by medical methods, and then expectant management. Expectant management or placebo has been shown to have the highest chance of serious complications, including the need for unplanned or emergency surgery. It is important to provide medically stable patients with thorough counseling regarding the various management approaches and allow time for the patient to consider the options before making a decision. Some patients have a strong preference for one type of management even before receiving detailed information about the risks and benefits of each.The most effective nonsurgical protocol for managing a delayed early pregnancy loss includes 200 mg of oral mifepristone followed by 800 μg of misoprostol, either vaginally or through buccal administration. Mifepristone is a progesterone receptor antagonist that causes uterine contractions and necrosis of the decidua. Misoprostol is a prostaglandin E1 analogue that ripens the cervix and also causes uterine contractions. While
