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Answers to various questions related to reproductive health and gynecology, including the diagnosis and management of conditions such as molar pregnancy, cervical cancer, ectopic pregnancy, primary amenorrhea, and postpartum endometritis. It also covers topics like vaginal atrophy, utis, and physiologic changes in pregnancy. Useful for medical students, residents, and practitioners in the field of obstetrics and gynecology.
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A breastfeeding 28 y/o woman presents for evil of a painful R breast "lump" 3 wks after delivery of a healthy newborn. Exam reveals localized erythematous edema of the R breast, a 7/10 painfully palpable discrete induration & thick, yellow nipple discharge. The nipple & areola are not excoriated. The L breast is unremarkable. You refer the pt for a drainage procedure. In the meantime, what is an appropriate initial plan? - Correct answer Start abx & continue breastfeeding w/ either breast What is the MC causative organism of mastitis? - Correct answer S. aureus (tx = dicloxacillin, amoxicillin, or cephalexin) What are appropriate abx choices for tx of mastitis? - Correct answer Dicloxacillin/ amoxicillin/ cephalexin (all anti-staph abx) A 32 y/o woman comes to your office w/ fever & lower abdominal pain. She has a hx of PID. Her vitals are T 38.4°C, HR 133, & BP 101/60. On exam, the pt is toxic appearing & has marked lower abdominal tenderness to palpation w/ rebound & guarding. Pelvic exam reveals CMT, scant discharge, & L adnexal tenderness. The pt.’s urine beta-hCG is negative. A transvaginal USN is performed & reveals a complex cystic, thick-walled, well-defined mass in the L adnexa. What is the most appropriate next step in management? - Correct answer Begin IV abx & admit for possible drainage (dx = likely tubo-ovarian abscess) A 15 y/o girl presents to the ED w/ complaints of vaginal pruritus & discharge. She denies sexual activity. Speculum exam reveals a homogenous, grey discharge w/ a pH
4.5. A wet prep reveals stippled epithelial cells. What tx is indicated? - Correct answer Metronidazole 500mg orally BID for 7 days OR metronidazole gel 0.75% intravaginal QD for 5 days OR clindamycin cream 2% intravaginal QHS for 7 days (dx = BV) A 26 y/o obese woman w/ a 2-yr hx of increased acne, abnormal hair growth, & menstrual abnormalities presents to her obstetrician for an infertility workup. A pelvic USN reveals enlarged cystic ovaries. She desires to become pregnant. What is the first line tx? - Correct answer Weight reduction Next line tx = clomiphene citrate (Clamed) -> gonadotropin therapy -> OCPs (dx = PCOS) A 21 y/o woman G1P0 at 35 wks gestation comes to the ED c/o HA, blurry vision, & shortness of breath. Vitals include a BP of 195/110 mmHg, HR of 90 bpm, respiratory
rate of 21 bpm, oral temp of 37.1℃, & O2 sat of 90% on room air. UA reveals 3+ protein. A chest radiograph reveals pulmonary edema. Which medication should be administered to reduce BP? - Correct answer Hydralazine (dx = severe preeclampsia) Preeclampsia in first trimester think .. - Correct answer Molar pregnancy A 17 y/o G1P0 woman at 25 wks gestation comes in c/o intermittent blurred vision. On presentation, she is asymptomatic. Vitals are: HR 84, BP 175/113, O2 sat 97%. Physical exam reveals 2+ pitting edema on both lower extremities & UA has 3+ protein on dip. What is an appropriate next step? - Correct answer Admit for further OB evil (dx = severe preeclampsia) What are the components of HELP syndrome? - Correct answer Hhemolysis Eelevated Lover enzymes Lown Pplatelets A 15 y/o girl presents to clinic w/ vaginal discharge. She recently became sexually active but states that her partner does not have any symptoms of infection. Speculum exam reveals white discharge & an erythematous cervix. Bimanual exam is unremarkable. Urine PCR is positive for Chlamydia trachomatis. What is the most appropriate tx? - Correct answer Azithromycin & ceftriaxone (pt w/ + chlamydia & cervicitis/urethritis should also be treated for GC) A 16 y/o woman presents to your clinic w/ vaginal discharge for 4 days. She describes the discharge as gray & malodorous. She denies any pain or itching. On exam, you note vaginal discharge, but no cervical or adnexal tenderness. Microscopy reveals clue cells. What is the most likely diagnosis? - Correct answer Bacterial vaginosis (tx = metronidazole) A 19 y/o sexually active woman presents to your office w/ questions about cervical CA screening. She wants to know when she should start getting screened since she's been sexually active for 2 yrs. What do you tell her? - Correct answer Initiate screening @ 21 y/o w/ cytology only (in theory you could do reflex testing as well) A 39 y/o woman presents to the office w/ painless vaginal bleeding in the 3rd trimester (32 wks) of pregnancy. She has had no prenatal care & a hx of tobacco use. She denies any lower extremity edema, & her vitals are normal. She has 5 other children, all of whom were delivered via C/S. Which of the following conditions should you be most concerned about?: (labor/ placenta prevail/ placental abruption/ preeclampsia) - Correct answer Placenta prevail (dx made by USN)
A 65 y/o pt is dyed w/ stage III endometrial adenocarcinoma. You decide to refer her to a gynecologic oncologist. She asks you to explain the "best tx available." In your counseling, you tell her the main tx of endometrial CA is ...? - Correct answer Primary surgical excision A 42 y/o woman presents for evil of irregular menses, awe episodes of excessive daytime sweating & palpitations. She has not had a hysterectomy or oophorectomy. She is currently sexually active, although intercourse has been more uncomfortable lately. Which of the following disorders would you consider in this pt.’s Dads?: (hyperaldosteronism/ hyperprolactinemia/ hyperthyroidism/ hypokalemia) - Correct answer Hyperthyroidism A postmenopausal pt of yours is dxed w/ atrophic vaginitis & dyspareunia. She denies other menopausal complaints. Vaginal lubricants & moisturizers are not helping to decrease her symptoms. What would be most appropriate to prescribe next? - Correct answer Vaginal estrogen (oral estrogen should be reserved for systemic menopausal symptoms) A 18 y/o G1P0 woman @ 16 wks presents w/ vaginal bleeding. She had no prenatal care. Vitals are unremarkable & physical exam only reveals a small amount of blood in the vaginal vault. A transvaginal USN is performed revealing a "snowstorm" or "bag of grapes" appearance. What management is most likely indicated? - Correct answer OB consult A 30 y/o woman comes to your office w/ abnormal menstrual bleeding. Her hx & physical are unrevealing. Other than lab testing, what is the next best step in evaluating this pt? - Correct answer Pelvic USN A 32 y/o woman is c/o an increase in vaginal secretions. You decide to perform a potassium hydroxide wet prep of a sample. This test evaluates which of the following secretion qualities?: (color/ odor/ pH/ viscosity) - Correct answer Odor (whiff test) A 54 y/o woman presents w/ chest & neck flushing. She states this began 6 mos ago. The "warm feeling", as she describes it, is becoming more frequent, & seems to occur mainly in the evening. She denies any recent infections. There are no dermatologic lesions seen on physical exam. Her LMP was 14 mos ago. These symptoms are most likely due to a decline in which of the following hormones?: (estradiol/ FSH/ progesterone/ prolactin) - Correct answer Estradiol (estradiol decline also leads to vaginal atrophy/dryness, depression, memory difficulties, & migraines) A 26 y/o woman just vaginally delivered twin, macrosomic newborn boys. This represents her 4th pregnancy, which has been the longest of them all @ 43 wks gestation. Her delivery was difficult & required forceps to complete. Estimated blood
loss was 1100 ml. Currently, she is hypotensive, tachycardia & anemic. Which of the following is the most likely diagnosis?: (amniotic fluid embolism/ incision dehiscence/ Rh sensitization/ uterine atony) - Correct answer Uterine atony (tx = uterine massage, oxytocin, prostaglandins, & surgery) What is the MCC of postpartum hemorrhage? - Correct answer Uterine atony A 54 y/o woman, whose LMP was > 2 yrs ago, complains of vaginal dryness & irritation. She denies any recent infection or sexual activity. She is afebrile w/ normal vitals. Visual inspection of the vaginal canal reveals pale, dry & shiny epithelium w/o frank discharge or superficial lesions. What is the most likely diagnosis? - Correct answer Atrophic vaginitis A 28 y/o woman at 31 wks gestation comes to the ED after noticing a gush of clear fluid from her vagina. What is suggestive of preterm rupture of membranes? - Correct answer Vaginal fluid pH > 6.5 Farming on glass slide Pooling of fluid in vagina What serious maternal infection can occur as a complication of preterm rupture of membranes? - Correct answer Chorioamnionitis A 30 y/o woman misses work & presents to the ED w/ severe pelvic pain rated at 6/10. She states it began yesterday w/ the onset of menstruation. She has regular cycles w/ normal blood flow amount, but has not had this pain before. She denies spine, urologic & rectal symptoms. Vitals are normal, & physical exam as well as pelvic USN is unremarkable. Serum beta-hCG is negative. Other than referral to a gynecologist for further evaluation, what is the most appropriate initial tx? - Correct answer Ibuprofen (dx = primary dysmenorrhea; OCPs are indicated if NSAIDs/acetaminophen are ineffective) A 15 y/o girl complains of vaginal discharge over the past 2 wks. She reports recently becoming sexually active but uses condoms consistently during intercourse. What finding favors a dx of bacterial vaginosis over trichmoniasis? - Correct answer Gram negative rods on gram stain (clue cells) What is the MCC of vaginitis? - Correct answer Bacterial vaginosis In the clinic, you are evaluating a 15 y/o girl c/o increased vaginal discharge. She had her menarche at 12 y/o & since then has had irregular periods. She uses tampons during her menses. She notes thick yellowish vaginal discharge in between her periods. She denies burning, pain, or pruritus. She started to be sexually active for the past month w/ 1 partner. She uses condoms for contraception. On exam, you note Tanner 5 pubic hair & white discharge. You examine the discharge & obtain pH of 4, w/ negative
whiff test & absence of clue cells on microscopy. You perform a pregnancy test, which is negative. What is the next best step? - Correct answer Provide her w/ reassurance (dx = leukorrhea = physiologic discharge) What is the MC SE of single-dose azithromycin? - Correct answer Nausea During the menstruation section of a gynecologic hx, you determine that your 36 y/o pt's menstrual periods are increasing in length from 4 days to 8 days, even though she still cycles every 28 days. She also reports more blood flow than typical during the first 3 days of these new 8 day periods. What term correctly defines this abnormal uterine bleeding? - Correct answer Menorrhagia (if this was occurring @ irregular intervals it would be considered menometrorrhagia) What does postcoital bleeding suggest? - Correct answer Cervical CA What is the MC type of cervical CA? - Correct answer Squamous cell carcinoma A 40 y/o woman w/ a hx of asthma presents to the ED w/ symptoms of wheezing & SOB similar to previous exacerbations. Her vitals are BP 115/70, HR 80, RR, 14, & O2 sat is 99% on room air. The pt is offered & agrees to a POC beta-hCG test that returns positive. On exam, you note mild bilateral wheezing w/ good air movement. Pelvic exam reveals a closed os w/o adnexal tenderness or masses. What is the most appropriate next step in management? - Correct answer Treat her asthma as indicated &, if improved, discharge w/ outpatient OB f/u A 14 y/o otherwise healthy boy presents to your clinic w/ his father. He is concerned because his breasts are enlarged. Appropriate management includes ...? - Correct answer Reassurance A 26 y/o woman presents for her annual exam & is inquiring about birth control. She is current on her immunizations & her last pap smear was 2 yrs ago. She is in a monogamous relationship w/ her boyfriend & does not have any immediate plans for pregnancy. She has a hx of migraines w/ aura but does not require any prescription medication. Which of the following birth control methods is the best option for her?: (behavioral methods such as the withdrawal method & periodic abstinence/ etonogestrel/ethinyl estradiol vaginal/ medroxyprogesterone acetate/ norelgestromin/ethinyl estradiol transdermal) - Correct answer Medroxyprogesterone acetate (via IUD/ injection/ implant) (migraines w/ aura = CI to estrogen use) Which birth control pill can be taken while lactating? - Correct answer Norethindrone What is the most frequent cystic structure found in the ovary? - Correct answer Follicular cyst
Which U.S. FDA category describes medications in which the safety of use by pregnant woman is unknown & the drug should not be used unless the potential benefit outweighs the potential risk to the fetus? - Correct answer Category C A 25 y/o sexually active woman presents to the ED w/ a complaint of painful vulvar ulcers & a swollen inguinal lymph node. She denies dysuria & vaginal discharge. What type of organism is the likely cause of these symptoms? - Correct answer Gram negative bacillus (dx = chancroid = Haemophilus ducreyi; tx = azithromycin 1g PO/ ceftriaxone 250mg IM/ cipro 500mg PO) Which organism causes condyloma latum? - Correct answer Treponema pallidum (syphilis) The presence of what best differentiates premenstrual syndrome from premenstrual dysphoric disorder? - Correct answer Anger & irritability A 24 y/o woman presents for initial evil of cyclical symptoms of irritability, painful bloating & depression. These symptoms occur regularly 4-5 days prior to the beginning of menstruation. During these few days, this pt typically has to miss work due to the "awful pain & mental clouding." Which of the following tx options do you recommend as 1st-line therapy?: (anticholinergics/ hysterectomy/ OCPs/ SSRIs) - Correct answer SSRI (sertraline, fluoxetine) (OCPs = second-line) What is considered third-line tx of continued severe premenstrual symptoms in women who do not tolerate or respond to SSRIs or OCPs? - Correct answer Gonadotropin- releasing hormone agonists You have been monitoring a 52 y/o perimenopausal woman's hot flashes. She has not had a hysterectomy. Her symptoms have been so mild that she does not require medication. However, for the past 2 months, her hot flashes have increased in frequency, duration & intensity. She is now asking for a medication. What is the most appropriate for medical management of her moderate to severe symptoms? - Correct answer Estrogen + progestin (add progestin in women who have had a hysterectomy to prevent endometrial hyperplasia) If estrogen is contraindicated in a postmenopausal woman, which alternative medication can be used to treat significant hot flashes, especially if there is concurrent sleep disturbance? - Correct answer Gabapentin A 25 y/o woman presents to your office w/ amenorrhea, abdominal cramping, & 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 w/o tenderness & a
dilated cervix w/ blood in the vaginal vault. Her beta HCG is positive & a bedside USN reveals a yolk sac, fetal pole & no evidence of cardiac activity. What is the most likely diagnosis? - Correct answer Inevitable abortion What obstetrical complication occurs most often during the 6th & 8th wk of pregnancy? - Correct answer Ectopic pregnancy A 14 y/o woman presents to clinic w/ some frustration over never having a menstrual period. She is short in stature & has Tanner stage 2 breast development. As you begin a gynecological exam, you realize that you cannot pass a speculum into the vagina. Which of the following is the most likely diagnosis?: (dysfxnal uterine bleeding/ primary amenorrhea/ 2ndary amenorrhea/ Sheehan's syndrome) - Correct answer Primary amenorrhea (defined as absence of menarche by age 16 w/ normal growth & 2ndary sexual development OR age 14 w/o normal growth & 2ndary sexual development) What is the initial work-up of a pt w/ primary amenorrhea? - Correct answer Breast & pelvic exam, pregnancy test, pelvic USN & serum follicle-stimulating hormone A previously healthy 35 y/o woman presents to your clinic w/ questions about breast CA screening. She has no family history of breast CA & wants to know when she should start screening. Per the United States Preventive Services Task Force, what is the most appropriate next step in management? - Correct answer Initiate screening mammography @ age 50 At what age should breast CA screening for women w/o risk factors stop? - Correct answer 74 A 30 y/o woman presents to the ED w/ LLQ pain. The pain started suddenly while she was sleeping & is rated a 10/10 in severity. Which of the following tests will yield a definitive dx of an ovarian torsion?: (CT scan/ MRI/ surgical visualization/ USN) - Correct answer Surgical visualization (other imaging modalities may support your dx of ovarian torsion, but definitive dx is surgical) A 17 y/o girl is seen in clinic due to complaints of excessive body hair. She denies taking any medications. She has irregular menses & denies sexual activity. On exam, her BMI is 31, w/ moderate hirsutism on upper lip & chest, moderate acne on her face, Tanner 5 breasts & pubic hair. The rest of her exam findings are normal. What do you expect her luteinizing hormones to be? - Correct answer Increased (dx = PCOS) What is a biguanide medication used to treat type 2 diabetes & PCOS? - Correct answer Metformin
A 29 y/o woman who is 2 wks postpartum following an uncomplicated pregnancy & delivery of a full-term infant is brought in by EMS w/ an ongoing generalized tonic-clonic seizure. What medication should be administered first? - Correct answer Magnesium sulfate (dx = eclampsia) What is the first clinical manifestation of magnesium toxicity? - Correct answer Loss of deep tendon reflexes A 21 y/o woman presents w/ acute pain in the R pelvis. Presence of what makes the dx of ovarian torsion more likely? - Correct answer Ovarian tumor or cyst (teratomas) Where is the uterine fundus palpable at 36 wks gestation? - Correct answer At the xiphoid process A 30 y/o woman, who had an uncomplicated pregnancy, delivered a healthy newborn a few minutes ago. She just now delivered a placenta w/ absent cotyledons. Copious amounts of blood begin to flow from the vaginal orifice. W/i minutes, the pt becomes lightheaded but maintains consciousness. You attempt manual extraction but the bleeding continues & the BP decreases to 98/68 mmHg. Which of the following is the next best step in management of postpartum hemorrhage?: (blood type & cross/match/ suction curettage/ uterine artery ligation/ uterine packing w/ gauze) - Correct answer Suction curettage What is the tx of last resort for severe & uncontrolled postpartum hemorrhage? - Correct answer Hysterectomy A 14 y/o girl has been dxed w/ primary amenorrhea. Pelvic USN reveals an absent uterus. Genetic testing confirms a 46,XX karyotype. Which of the following is the most likely dx?: (Asherman's syndrome/ imperforate hymen/ Mullerian dysgenesis/ Turner's syndrome) - Correct answer Mullerian dysgenesis What are the expected lab results in a pt w/ primary ovarian failure? - Correct answer Increased FSH Increased LH Decreased estradiol Presence of schistocytes, thrombocytopenia, & elevated aspartate aminotransferase & alanine aminotransferase >500u/l is indicative of what syndrome of pregnancy? - Correct answer HELLP syndrome A 3 y/o girl presents to the ED w/ her mom & grandmother for eval of vaginal spotting. The child has no other complaints & specifically denies sexual abuse or trauma when questioned alone. After watching a news special on sexual abuse, mom is concerned that her daughter may have been sexually assaulted, despite no specific concern. The
child is acting appropriately & there are no external lesions or signs of trauma. Internal pelvic exam is difficult due to the pt's age. What is the likely dx & what is your next step in management? - Correct answer Vaginitis secondary to vaginal foreign body Consider nasal speculum to attempt visualization & removal w/ sedation What is the MC gynecological condition in prepubertal children? - Correct answer Vulvovaginitis What is the most appropriate tx for stage IV uterine prolapse in a 50 y/o woman w/ no medical problems & no previous surgical hx? - Correct answer Vaginal hysterectomy A 32 y/o woman presents to your office for a physical exam including a Pap smear. Lab results reveal negative cytology & positive HPV. What is the most appropriate next step in management? - Correct answer Repeat PAP smear & HPV testing in 1 yr. What are the 2 MC types of cervical CA? - Correct answer Squamous cell carcinoma Adenocarcinoma An 18 y/o woman at 37 wks gestation presents w/ a spontaneous leakage of fluid from the vagina. She has no other signs of active labor. Vitals are unremarkable & the pt has no complaints except for the leakage of fluid. What management is indicated? - Correct answer Admit to OB for delivery (dx = PROM; delivery is preferred if >34 wks gestation) A 23 y/o woman presents w/ concerns of tender breast enlargement. 2 wks ago, she gave birth to a healthy newborn, whom she currently breast feeds. Exam reveals general erythema, warmth & edema of the R breast. There are no superficial abnormalities, no palpable mass & no purulent nipple discharge is present. The L breast appears normal. What is the most likely diagnosis? - Correct answer Mastitis Which of the following confirms an intrauterine pregnancy?: (beta-hCG of 200,000/ fetal heart activity/ intrauterine fetal pole & yolk sac/ single layer intrauterine gestational sac) - Correct answer Intrauterine fetal pole & yolk sac (fetal heart activity alone does not confirm intrauterine pregnancy because it does not differentiate b/w uterine & ectopic pregnancy) What is the MC type of invasive breast CA in women? - Correct answer Infiltrating ductal carcinoma (50-75%) What is the MC type of breast CA among men? - Correct answer Infiltrating ductal carcinoma (MC type of invasive breast CA) A 39 y/o woman in her 3rd trimester presents w/ 2 days of bloody "spotting" on her underwear. This is her 3rd pregnancy, which thus far has been uncomplicated. Her initial delivery was vaginal & her 2nd delivery was via C/S. She is currently sexually
active, & has a hx of trichomoniasis. She denies pelvic pain. Laboratory exam reveals hematocrit of 32%, WBC count of 10,000, platelet count of 260,000 INR of 1.1 & apt of 32 seconds. Pelvic exam shows a non-erythematous cervix w/ clear mucus. What is the most likely diagnosis? - Correct answer Placenta prevail Postpartum hemorrhage is defined as what amount of blood loss? - Correct answer >500 mL What is the MC condition awe placental abruption? - Correct answer Maternal HTN Which U.S. FDA category is defined by the following?: Animal reproduction studies have failed to demonstrate a risk to the fetus & there are no adequate & well-controlled studies in pregnant women. - Correct answer Category B A 21 y/o woman w/ no prenatal care presents for eval of lower abdominal pain & fever. She estimates that she is approx. 7.5 months pregnant. On questioning, she acknowledges intermittent pain for 2 days & a gush of fluid shortly after the pain began. Her temp is 101.8°F. Physical exam is notable for purulent material in the vaginal vault. What is the most likely diagnosis? - Correct answer Chorioamnionitis (RFs = premature ROM, preterm labor, prolonged ROM, multiple vaginal exams, & genital tract infections) A 32 y/o G2P1 @ 33 wks gestation presents to the ED for sharp abdominal pain. She has not had any prenatal care during this pregnancy. Her symptoms include vaginal bleeding, uterine pain between contractions, & fetal distress. Her 1st pregnancy was uncomplicated, w/ a vaginal delivery at term. Which one of the following is the most likely dx?: (placenta prevail/ placental abruption/ uterine rupture/ vasa prevail) - Correct answer Placental abruption What is the clinical condition when the placenta attaches to the myometrium? - Correct answer Placenta accrete A 22 y/o woman w/ regular menstrual cycles comes in c/o symptoms concordant w/ premenstrual syndrome. In evaluating the large differential of these symptoms, which of the following serum lab tests is recommended?: (estrogen/ FSH/ hCG/ TSH) - Correct answer TSH (hypo/hyperthyroidism can result in mood symptoms similar to premenstrual syndrome) What lab abnormalities are used in the dx of premenstrual syndrome? - Correct answer None (no specific lab finding points to a dx of premenstrual syndrome; however, absence of symptoms during the follicular phase of the menstrual cycle - days 1-14 - is key)
You diagnose lactation mastitis in a postpartum 17 y/o woman. She is currently breast feeding her healthy newborn. She has no allergies. In addition to local ice packs & ibuprofen, what is the most appropriate tx? - Correct answer Dicloxacillin (likely causative organism is S. aureus; cephalexin is appropriate as well) A 32 y/o woman presents w/ vaginal bleeding for 2 wks. She states she has about 1 pad of bleeding every 2-3 hrs. Vitals are stable & physical exam only reveals blood from the cervical os. The pt's Hob is 12 g/dl & her pregnancy test is negative. What tx is indicated for this pt? - Correct answer Combination OCPs (dx = dysfunctional uterine bleeding) A 23 y/o woman presents w/ pain in the suprapubic area & RLQ of her abdomen that began 4 hrs ago. She denies vagina discharge & vaginal bleeding. Her vitals are BP 115/65, HR 60, RR 12, & T 98.1°F. LMP was 1 wk ago. Which of the following diagnostic tests should be obtained first?: (CBC/ GC & chlamydia DNA amplification/ UA/ urine beta-hCG) - Correct answer Urine beta-HCG What organism may be identified by a wet mount made from a vaginal swab? - Correct answer Trichomoniasa vaginalis A postmenopausal woman presents w/ abnormal vaginal bleeding. You suspect endometrial malignancy & refer the pt for further investigation. Which of the following modalities is initially used in determining a dx?: (colposcopy/ D+C/ PAP smear/ suction curette) - Correct answer Suction curette (D+C is reserved for difficult/non-diagnostic outpatient biopsies) Most primary endometrial carcinomas are of which histological form? - Correct answer Adenocarcinoma Which of the following medications is the preferred outpatient tx of HTN in pregnancy? - Correct answer Methyldopa @ starting dose of 250mg PO every 6 hrs (labetalol is often used as a first-line tx as well, but may exacerbate asthma) A 29 y/o woman has been trying to get pregnant for 7 yrs. A previous physical exam & lab work were all WNL. An ovulation kit confirms that she is ovulating. She has never been pregnant before & her fiancé has fathered 2 children & recently had a semen analysis that indicated normal fining sperm. Which of the following is the most appropriate test of choice?: (CT scan of the pelvis/ D+C/ hysterosalpingogram/ pelvic USN) - Correct answer Hysterosalpingogram (assesses patency of fallopian tubes; labs will include CBC, UA, STD screen, rubella/varicella immunity, & PAP smear) Infertility is defined as failure of conception after how long of trying to conceive? - Correct answer 1 yr.
A 22 y/o woman presents to your office w/ complaints of pelvic pain & vaginal discharge. She admits to having recent unprotected intercourse w/ a new partner & her LMP ended 3 days ago. What is the most appropriate pharmacologic tx? - Correct answer Ceftriaxone 250mg IM + doxycycline 100mg PO BID x 14 days (dx = PID) What is the MCC of PID? - Correct answer Chlamydia A 30 y/o woman presents w/ fever & abdominal pain. She is 3 days postpartum after C/S. Physical exam reveals lower abdominal tenderness to palpation & foul smelling vaginal discharge. What management is indicated? - Correct answer IV clindamycin + gentamycin (dx = endometritis; RFs = operative delivery, prolonged ROM, lack of prenatal care, & frequent vaginal exams) A 15 y/o G1P0 woman at 23 wks presents w/ sharp, LLQ abdominal pain for 1 hr. She has had an USN confirming the presence of a single intrauterine pregnancy. The pain is severe & awe nausea. Pelvic exam reveals tenderness of the L adnexa. The pt's UA is unremarkable. What test should be ordered to diagnose the pt? - Correct answer Pelvic USN (dx = ovarian torsion) Why is ovarian torsion MC on the R side? - Correct answer Sigmoid colon stabilizes the L ovary Gold standard for ding ovarian torsion? - Correct answer Laparoscopy A 15 y/o female presents w/ generalized abdominopelvic pain which occurs every month after her regular, non-painful menses. The pain, which is awe HAs, bloating & depressed mood, begins 18 days after the last day of menstruation. She also complains of cyclic ankle swelling but denies a hx of increased salt intake. What is the most likely diagnosis? - Correct answer Premenstrual syndrome (key diagnostic feature = absence of symptoms in follicular phase, days 1-14) What is the underlying pathophysiology of the cyclic edema awe premenstrual syndrome? - Correct answer Altered antidiuretic hormone fan secondary to alterations in renin-angiotensin-aldosterone axis A 62 y/o woman is concerned w/ the recent appearance of blood spotting on her underwear, especially since her LMP was 8 yrs ago. She has never had a STD, although she does have a hx of recurrent UTIs. Pelvic exam reveals atrophic vaginal mucosa w/o evidence of bleeding. Adnexal masses are not palpable. Vulvar & urethral exam is unremarkable. Stool guaiac testing is negative. Which of the following is the most likely dx?:
(endometrial malignancy/ ovarian fibroma/ rectal adenocarcinoma/ transitional cell carcinoma) - Correct answer Endometrial malignancy (RFs = elderly, nulliparity, DM, obesity, menstrual irregularity, estrogen immunotherapy, HTN) About 20% of endometrial CA presents during which time period? - Correct answer Per menopause (late 40s to early 50s) What is the MCC of abnormal vaginal bleeding in reproductive women? - Correct answer Dysfxnal uterine bleeding What is the rate of recurrence of uterine fibroids s/p surgical removal? - Correct answer 25-30% What is the preferred method of diagnosing uterine fibroids? - Correct answer USN What is the most frequently occurring pelvic tumor in women? - Correct answer Leiomyoma (uterine fibroid) A 25 y/o woman presents to her PCP for a routine annual visit. Her last PAP smear was 3 yrs ago. She smokes cigarettes & is sexually active. Her mother was dxed w/ ovarian CA at age 50. According to the current guidelines, what should be offered to the pt? - Correct answer Repeat PAP smear (routine screening is not recommended for ovarian CA) True or false: Women who have had a hysterectomy w/ removal of the cervix not related to cervical CA should be screened for cervical CA? - Correct answer False A 28 y/o woman presents w/ difficult menses. She reports significant midline pelvic pain during the first 2 days of her regular menstrual cycles. The pain is so bad that she frequently misses work. Fortunately, her pain is self-limited, as the rest of her cycle is relatively comfortable. What is the most likely diagnosis? - Correct answer Dysmenorrhea (painful menstruation) A 29 y/o woman presents w/ cyclic pelvic pain that has been increasing over the last 7 mos. She complains of significant dysmenorrhea & dyspareunia. She uses condoms for birth control. On physical exam her uterus is retroverted & non-mobile, & she has a palpable adnexal mass on the L side. Her serum pregnancy test is negative. What is the most likely diagnosis? - Correct answer Endometriosis (characterized by dysmenorrhea, dyspareunia, & dyschzia) A 32 y/o woman w/ fluctuating menstrual intervals comes to your primary care clinic for a pelvic exam. She is not currently pregnant, but has had 2 normal pregnancies & healthy deliveries. During adnexal palpation, you notice that 1 ovary is appreciably larger than the other. In your discussion w/ the pt, you explain that this ovarian
enlargement most likely represents what condition? - Correct answer Final ovarian cyst A 25 y/o woman presents to your clinic w/ concerns about STIs. She admits to unprotected sex w/ multiple partners. She is asymptomatic, but her last partner told her that he recently tested positive for chlamydia. The most appropriate next step is administration of what medication? - Correct answer Azithromycin You are treating a pt for primary amenorrhea. Her diagnostic eval has determined that the etiology is primary ovarian failure. Which of the following disorders is this pt at risk for?: (cluster HAs/ GI bleeding/ menorrhagia/ osteoporosis) - Correct answer Osteoporosis What are acceptable tx options for chancroid (Haemophilus ducreyi)? - Correct answer Azithromycin 1g PO or Ceftriaxone 250mg IM or Cipro 500mg PO A 22 y/o woman presents w/ lower abdominal pain & abnormal vaginal discharge for 4 days. She is sexually active w/ multiple partners & does not consistently use barrier contraception. She has bilateral adnexal tenderness & yellow discharge on pelvic exam. Her urine pregnancy test is negative. In addition to a 1-time dose of ceftriaxone, what is the most appropriate outpatient course of antibiotics for the pt? - Correct answer Doxycycline 100 mg PO BID x 14 days (dx = PID) Which of the following medications commonly used to treat hyperemesis gravid arum is considered Category B?: (metoclopramide/ prochlorperazine/ promethazine/ trimethobenzamide) - Correct answer Metoclopramide What category drug is ranitidine? - Correct answer Category B A young woman has a significant family history of gynecologic malignancy. She refuses oophorectomy at this time. In addition to serial ultrasound screening, which of the following serum levels will you monitor?: (CA-125/ desmin/ inhibit/ S-100) - Correct answer CA-125 Which genetic mutations are strongly awe familial ovarian CA syndrome? - Correct answer BRCA 1 & BRCA 2 Which of the following vaccinations is considered safe in pregnancy?: (live attenuated influenza/ MMR/ Tap/ varicella) - Correct answer Tap
What is the tx of choice for pertussis? - Correct answer Azithromycin A 26 y/o previously healthy woman presents to the ED w/ abdominal pain. She was at home when she developed sudden onset lower abdominal pain followed by a brief sync opal episode. Her vitals include BP of 88/46 mm Hg, HR of 112 bpm, respiratory rate of 18 bpm, temp of 37.6°C, & O2 sat of 98%. She had a positive home pregnancy test yesterday. After initiating aggressive resuscitation, what is the most appropriate next step in management?: (OBGYN consult/ obtain CBC/ obtain serum hCG/ pelvic USN) - Correct answer OBGYN consult In a hemodynamically stable pregnant pt w/ an ectopic pregnancy, what medication is recommended for medical management? - Correct answer Methotrexate A postmenopausal woman presents to the clinic worried about her & her husband's sexual health. As of late, sexual intercourse has been very uncomfortable for the both of them. She thinks it has to do w/ her recurrent UTIs, however, you explain that as a woman ages, vaginal atrophy occurs due to a significant decrease in which of the following hormones?: (androstenedione/ estrogen/ progesterone/ testosterone) - Correct answer Estrogen Which of the following drugs must be prescribed in a pt w/ cervicitis in which BV is also suspected?: (azithromycin/ ceftriaxone/ doxycycline/ metronidazole) - Correct answer Metronidazole A woman presents w/ fever & foul-smelling vaginal discharge 3 days after delivery of a full-term fetus. She is febrile, w/ uterine tenderness on pelvic exam. Which of the following is the strongest risk factor for postpartum endometritis?: (C/S/ internal fetal monitoring/ multiple gestation/ PROM) - Correct answer C/S What is the MC malpresentation in fetal delivery? - Correct answer Breech A 23 y/o, sexually active woman, presents w/ abdominal pain. Vitals are normal. Pelvic exam reveals CMT & adnexal tenderness. What treatment is most likely indicated? - Correct answer Ceftriaxone 250 mg IM once + doxycycline 100 mg PO BID x 14 days What is Fitz-Hugh-Curtis syndrome? - Correct answer Perihepatitis awe PID that manifests as RUQ pain & is seen in 10% of pts w/ PID What is the MC cell type of ovarian CA? - Correct answer Epithelial A woman presents w/ R breast pain, fever, & malaise for 3 days. She has been breastfeeding her newborn child for the last 3 wks. On exam, there is an area of focal
erythema & tenderness. No mass or fluctuance is noted. What is the most likely pathogen responsible for causing her condition? - Correct answer S. aureus A 22 y/o woman presents w/ pain & swelling to the vulva. On exam, you notice an area of swelling w/ induration & central fluctuance @ the 8 o'clock position. Which of the following statements is true regarding this?: (all pts require abx/ GC & chlamydia are the MCCs/ incision should be performed in the OR/ word catheter is placed for 4-6 wks) - Correct answer Word catheter is placed for 4-6 wks (dx = Bartholin's abscess) At what age should pts be referred to a gynecologist to r/o Bartholdi gland CA? - Correct answer 40 A 17 y/o girl is examined for a routine visit. She eats a healthy diet. She also stays active by playing volleyball 3/wk. Her grades are mostly B's. She admits that she started to be sexually active for the past 6 mos & has delayed periods for 2 months now. She had her menarche at 12 y/o & 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?: (hyperbilirubinemia/ large for gestational age/ placental abruption/ respiratory distress syndrome) - Correct answer Placental abruption A woman in her 3rd trimester of pregnancy is involved in a MVA. She presents to the ED w/ new onset vaginal bleeding & pelvic pain. Which of the following laboratory abnormalities would you expect to find in this pt?: (decreased prothrombin time/ hypofibrinogenemia/ proteinuria/ thrombocytosis) - Correct answer Hypofibrinogenemia (dx = placental abruption; there is a depletion of platelets, fibrinogen, & other clotting -> thrombocytopenia * hypofibrinogenemia) A 55 y/o postmenopausal woman presents to your office w/ a complaint of vaginal bleeding. Which of the following is the most appropriate next step in management?: (abdominal USN/ EMB/ hysterectomy/ watchful waiting) - Correct answer EMB A 26 y/o woman presents w/ abdominal cramping after a positive home pregnancy test. Her vitals are T 98.7°F, HR 94, BP 110/66, RR 18, O2 sat 97%. Her exam is unremarkable. Labs reveal a serum beta HCG of 1000 mIU & she is Rh positive. She states that the pregnancy is wanted. An USN is performed revealing an early gestational sac w/o a yolk sac or fetal pole within the uterus. Which of the following is appropriate management for this pt?: (administer methotrexate/ administer Rhogam & discharge home w/ repeat beta hCG in 48 hrs/ administer Rhogam & methotrexate/ discharge home w/ repeat beta hCG in 48 hrs) - Correct answer Discharge home w/ repeat beta HCG in 48 hrs
What is the success rate of methotrexate in the management of early ectopic pregnancy? - Correct answer 85-93% A 41 y/o woman suffers from heavy & irregular menses, which at times leads to fatigue, lightheadedness & dyspnea. She has had 3 hospitalizations in the past yr. for such episodes. Her gynecologic eval has not revealed any pathological cause. The heavy menses continue despite hormonal therapy. Which of the following tx options should be considered next?: (colposcopy/ hysterectomy/ hysteroscopy/ uterine ablation) - Correct answer Uterine ablation A young woman presents w/ a complaint of "stained underwear." She reports that for the last 3 days she has noticed a malodorous, greenish discharge emanating from her "groin." You take a thorough hx & perform a pelvic exam. Which of the following is the next best step in evaluating this complaint?: (bacterial culture/ microscopic exam/ pelvic ultrasonography/ serum complete blood count & chemistries) - Correct answer Microscopic exam A 16 y/o woman in her 3rd trimester presents w/ acute onset of significant pelvic pain & blood per vagina. Thus far, her pregnancy has been normal. Her PMH is significant for HTN, asthma & recreational cocaine use. Exam reveals a tender, extremely tense uterus. What is the most likely dx? - Correct answer Placental abruption What is the preferred method of delivery in a woman w/ placental abruption? - Correct answer Oxytocin-induced vaginal delivery Which of the following best describes an inevitable abortion?: (first trimester bleeding & a closed internal cervical os/ first trimester bleeding w/ an open internal os/ parts of the product of conception have been passed & may be visible in the cervical os or the vaginal canal/ retention of a nonviable intrauterine pregnancy w/i the uterus, no cardiac activity, & a closed cervical os) - Correct answer First trimester bleeding w/ an open internal os A 15 y/o girl presents for severe lower abdominal pain that occurs for the first 2 days of her menstrual cycle each month. She has associated N/D. She denies menorrhagia. She had a normal menarche @ age 13 & is not sexually active. Abdominal & pelvic exams are normal. Which of the following is the initial best step in management?: (obtain a Pap smear & cervical cultures/ recommend acetaminophen starting 1 day before menses/ recommend ibuprofen starting 1 day before menses/ referral for exploratory laparotomy) - Correct answer Recommend ibuprofen starting 1 day before menses A 15 y/o woman presents to the office w/ her mother concerned that she has not had a menstrual cycle. She is an avid runner, logging 20 miles/wk. 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? - Correct answer Begin w/u for primary amenorrhea A 19 y/o G1P0 woman @ 26 wks presents w/ abdominal pain after being involved in a MVA. External pelvic exam reveals vaginal bleeding. Which of the following is true regarding this presentation?: (normal USN rules out placental abruption/ disseminated intravascular coagulation is uncommon in placental abruption/ early pelvic digital exam should be performed/ emergent fetal monitoring & OB consult are required) - Correct answer Emergent fetal monitoring & OB consult are required A 25 y/o G2P1 presents to your office @ 32 wks gestation w/ a complaint of severe itching, particularly on the palms of her hands & the soles of her feet. Lab results reveal elevated bile acids. Regarding this dz, which of the following statements is most correct?: (aminotransferases are low/ dz recurrence is rare in subsequent pregnancies/ tx of choice is cholestyramine/ there is an increased risk for fetal demise) - Correct answer There is an increased risk for fetal demise (dx = intrahepatic cholestasis of pregnancy; aminotransferases are often elevated; tx of choice is ursodiol; recurs in >50% subsequent pregnancies) A 25 y/o woman w/ a recent hx of abx use presents to your office w/ a complaint of vaginal discomfort. For the past wk she has been experiencing intense vaginal pruritus & has noticed a white discharge. Which of the following is the most appropriate next step in her management?: (single dose of 150 mg fluconazole/ boric acid intravaginally x 7 days/ metronidazole 500 mg twice/day x 7 days/ topical NY statin 100,000 units daily x 7 days) - Correct answer Single dose of 150 mg fluconazole A 62 y/o woman presents for her annual well woman exam. She wants to discuss her risk of endometrial CA, given a personal history of PCOS & prolonged tamoxifen use during her 50's. Given these RFs she should be cautioned that early endometrial CA normally presents as ...? - Correct answer Abnormal vaginal bleeding What is the name of the syndrome that causes hereditary non-polyposis colorectal CA, in addition to increasing the pt's risk of endometrial CA, ovarian CA, stomach CA, or kidney CA? - Correct answer Lynch syndrome Which of the following correctly describes physiologic changes that occur in pregnancy?: (blood volume increases/ functional residual capacity increases/ GI motility increases/ Hob concentration increases) - Correct answer Blood volume increases What happens to plasma creatinine concentration in pregnancy? - Correct answer Decreases
A 26 y/o sexually active woman presents to the clinic w/ several days of vulvovaginal discomfort & pruritus. A pelvic exam shows copious frothy green vaginal discharge, inflamed vaginal walls, & a cervix w/ punctate hemorrhages. This physical exam is most consistent w/ which cause of vaginitis? - Correct answer Trichomoniasa vaginalis A 26 y/o woman reports a hx of amenorrhea for the past yr. She also had an increased amount of milky discharge from her nipples over the past several months & has lost all interest in sex for the past 6 mos. She denies any drug or medication use other than occasional OTC analgesics for frequent HAs. A physical exam confirms the presence of an easily expressed milky discharge, as well as vaginal dryness. A pregnancy test is negative. Which one of the following tests would be most appropriate at this point?: (dexamethasone suppression test/ MRI of the sella Turkic/ serum prolactin level/ ultrasonography of the breasts) - Correct answer Serum prolactin level (dx = prolactinoma; tx = dopamine agonists or surgical resection) What is the medication of choice for the tx of prolactinoma? - Correct answer Bromocriptine Which of the following statements is correct regarding a dx of vaginal candidiasis?: (fishy odor is present when vaginal discharge is mixed w/ potassium hydroxide/ metronidazole is the recommended tx/ multiple petechial are often seen on the vaginal wall/ pH of the discharge is less than 4.5/ vaginal discharge is often foul smelling) - Correct answer pH of the discharge is less than 4.5 Which of the following is the greatest RF for an ectopic pregnancy?: (multiple sexual partners/ previous abdominal surgery/ previous ectopic pregnancy/ previous PID) - Correct answer Previous ectopic pregnancy Which type of deceleration begins @ or just after the peak of the uterine tx & returns to baseline only after the tx has ended? - Correct answer Late (awe uteroplacental insufficiency) Which type of deceleration has a slow onset that coincides w/ the start of the tx & a slow return to baseline that coincides w/ the end of the tx? - Correct answer Early (awe fetal head compression during cuts) A 34 y/o women presents for her well woman exam & is concerned she may have OP because of L hip pain. The pain started after a fall while jogging 1 wk ago; it is intermittent & relieved w/ NSAIDs. Her 63 y/o mother has severe OP & suffered a hip fx last yr. Pt denies smoking but consumes 1-2 alcoholic drinks daily. Physical exam reveals a 5'9" woman w/ a BMI of 30. She has a resolving bruise on her L buttock. What risk factor place her @ greatest risk for OP?: (age/ gender/ alcohol consumption/ body habitus/ family hx) - Correct answer Family hx
A 26 y/o G2P1 woman @ 26 wks gestation presents for a routine 50-gram glucose challenge test. After receiving a 1-hr blood glucose value of 148 mg/dl, the pt has a follow up 100-g 3-hr oral GTT w/ the following plasma values: fasting 102 (n <95), 1-hr 181 (n <180), 2-hr 162 (n <155), & 3-hr 139 (n <140). What is the most appropriate next step in the management of this pt?: (repeat GTT @ 28 wks gestation/ begin a diabetic diet & blood glucose monitoring/ begin a diabetic diet, an oral hypoglycemic agent, & blood glucose monitoring/ begin a diabetic diet, insulin, & blood glucose monitoring/ reassurance & routine prenatal care) - Correct answer Begin a diabetic diet & blood glucose monitoring A 35 y/o woman presents to the ED w/ heavy vaginal bleeding @ 7 wks gestation. On exam, she has a dilated cervix w/ blood & tissue present @ the cervical os. Which of the following is the most likely chromosomal abnormality to be found in the karyotype eval of the POC?: (autosomal trisomy/ triploid/ tetraploidy/ monosomy X/ fragile X mutation) - Correct answer Autosomal trisomy A 34 y/o G3P1 woman @ 26 wks gestation reports "difficulty catching her breath," especially after exertion for the last 2 mos. She is a non-smoker. She does not have any hx of pulmonary or cardiac dz. She denies fever, sputum, cough or any recent illnesses. On physical exam, her vitals are: BP 108/64, HR 88, respiratory rate 15, she is afebrile & O2 sat 98% on room air. Lungs are clear to auscultation. Heart is regular rate & rhythm w/ II/VI systolic murmur heard @ the upper L sternal border. She has no lower extremity edema. A CBC reveals a Hob of 10 g/ld. What is the most likely explanation for this woman's symptoms?: (PE/ mitral valve stenosis/ physiologic dyspnea of pregnancy/ per partum cardiomyopathy/ anemia) - Correct answer Physiologic dyspnea of pregnancy A 40 yr. old G2P2 woman presents for her first health maintenance exam. She denies any new complaints or symptoms. She has no hx of any gynecologic problems. Family hx is significant for a father w/ HTN & a mother, deceased, w/ breast CA dxed @ age
A 24 y/o G1P0 @ 28 wks gestation reports difficulty breathing, cough & frothy sputum. She was admitted for preterm labor 24 hrs ago. She is a non-smoker. She has received 6L of lactated ringers since admission. She is receiving Mg sulfate & nifedipine. Vitals are: T 100.2F, respiratory rate 24, HR 110, BP 132/85, O2 sat 97% on non-rebreathe mask. She appears in distress. Lungs reveal bibasilar crackles. Uterine tx are regular every 3 minutes. The FHR is 140 bpm. Labs show WBC count 127,500/mL. Potassium & sodium are normal. Which of the following has most likely contributed to this pt's respiratory symptoms?: (increased plasma osmolality/ use of Mg sulfate & nifedipine/ chorioamnionitis/ preterm labor/ increased systemic vascular resistance) - Correct answer Use of Mg sulfate & nifedipine (dx = pulmonary edema; plasma osmolality & systemic vascular resistance are decreased during pregnancy) A 23 y/o G1P1 woman dxed w/ postpartum depression 3 mos after a spontaneous vaginal delivery has suicidal ideation & thoughts of jumping out of her 15th floor window. She says she is desperate for help. Which of the following is the most appropriate next step in the tx of this pt?: (behavioral psychotherapy/ anti-depressant medication/ anti-psychotic medication/ electroconvulsive therapy/ inpatient psych admission) - Correct answer Inpatient psych admission (pt should be admitted considering they have thoughts of suicidal ideation w/ a plan) A 30 y/o G1P0 woman w/ DM1 presents @ 10 wks gestation for a routine visit. She smokes a 1/2 pack of cigarettes per day. Her Hob A1C level is 9.7. What structural anomaly is the fetus @ highest risk of developing?: (cardiac anomalies/ caudal regression malformation/ hydrocephalus/ microcephaly/ limb reductions) - Correct answer Cardiac anomalies A 35 y/o woman, G3P0020, presents to the ED w/ complaints of heavy vaginal bleeding @ 7-8 wks gestation by LMP. Physical exam reveals a dilated cervix w/ tissue present w/i the cervical os. The tissue is removed & submitted for karyotype. Karyotype will most likely reveal which of the following?: (Fragile X mutation/ autosomal trisomy/ triploid/ monosomy X/ tetraploidy) - Correct answer Autosomal trisomy A 29 y/o G4P2010 presents to the ED w/ complaints of vaginal bleeding @ 8 wks gestation by LMP. She denies passage of tissue. Physical exam reveals blood in the vault & a closed cervical os. USN reveals an intrauterine pregnancy w/ a CRL of 8 mm & fetal cardiac activity of 90 bpm. The correct dx is which of the following?: (complete abortion/ missed abortion/ habitual abortion/ incomplete abortion/ threatened abortion) - Correct answer Threatened abortion A 27 y/o G1 woman @ 40 wks gestation presents to L&D w/ tx every 4 minutes. Her cervix is 5 cm dilated, 90% effaced & you palpate a fetal body part that is not a vertex
(upper surface of head). Which of the following is the most likely body part you were palpating?: (shoulder/ foot/ hand/ buttocks/ face) - Correct answer Buttocks A 37 y/o G2P1 woman @ 39-40 wks gestation presents in active labor. Pregnancy is complicated by A1GDM. PMH reveals a hx of uterine fibroids. Pelvic exam reveals her cervix is 4 cm dilated w/ a breech presentation. USN reveals breech presentation w/ an AFI=4 cm, EFW=4100 g & uterine fibroids. Which of the following is the most likely cause of the breech presentation in this patient?: (multiparty/ olgiohydraminos/ microsomal/ gestational DM/ uterine fibroids) - Correct answer Uterine fibroids A 38 y/o G2P1 woman presents @ 16 wks gestation. She is concerned about delivering a child w/ Down syndrome. She denies a significant medical, surgical, family or social hx. Which of the following tests is most effective in screening for Down syndrome in the 2nd trimester?: (nuchal translucency w/ PAPP-A & free beta-hCG/ maternal serum alpha fetoprotein/ amniocentesis for fetal karyotype/ triple screen/ quad screen) - Correct answer Quad screen A 39 y/o G1P0 woman presents for her 1st prenatal visit @ 15 wks gestation. She is concerned about having conceived @ 39 years of age (advanced maternal age) & would like to confirm that her fetus does not have Downs syndrome. Which of the following diagnostic tests would you recommend?: (1st trimester screen/ cell free fetal DNA/ chorionic villus sampling/ amniocentesis) - Correct answer Amniocentesis A 29 y/o G2P1 woman @ 32 wks gestation presents for management of her gestational DM. Despite diet modification, the patient's fasting blood sugars are > 105 mg/dl & therefore requires insulin tx. Her pregnancy is at risk for all the following complications, EXCEPT: (polyhydramnios/ fetal microsomal/ preeclampsia/ neonatal hypoglycemia/ intrauterine growth restriction) - Correct answer Intrauterine growth restriction (DM is awe larger fetuses) A 21 y/o G1P0 woman presents to your office @ 26 wks gestation w/ complaints of R- sided groin pain. She describes the pain as sharp & occurring w/ movement & denies any change in bowel or bladder fan. No hx of ROM or vaginal bleeding. Physical exam reveals a soft, non-tender uterus & no tx are palpable. Pelvic exam reveals a long, closed cervix. Fetal heart tones are stable @ 140 bpm. Which of the following is the most likely etiology of this pt's pain?: (preterm labor/ renal/ureteral stone/ UTI/ round ligament pain/ false labor) - Correct answer Round ligament pain A 26 y/o G1P0 woman @ 39 wks gestation is admitted to the hospital in labor. She is noted to have uterine tx every 7-10 minutes. Her antepartum hx is significant for a non-
immune rubella status. On exam, her BP is 110/70 mmHg & HR is 80 bpm. The estimated fetal weight is 7 lbs. On pelvic exam, she has been noted to have a change in cervical exams from 4 to 7 cm over the last 2 hrs. The pelvis is assessed to be adequate on digital examination. What is your next step in the management of this pt? - Correct answer Continue to observe labor A 31 y/o G2P1 woman @ 39 wks gestation complains of painful uterine tx that are occurring every 3-4 minutes. Her cervix has changed from 1-cm to 2-cm dilation over 3 hrs. Which one of the following management plans is most appropriate?: (C/S/ IV oxytocin/ observation/ fetal scalp pH monitoring/ intranasal gonadotropin therapy) - Correct answer Observation (pt is in latent phase of labor which can take up to 14 hrs) A 31 y/o G2P1 woman @ 40 wks gestation has progressed in labor from 5 to 6 cm cervical dilation over 2 hrs. Which of the following best describes the labor?: (prolonged latent phase/ prolonged active phase/ arrest of active phase/ protracted active phase/ normal labor) - Correct answer Protracted active phase (aka some progress but less than expected, 1.5 cm/hr. in the active phase of labor, >4 cm dilated) A 24 y/o G2P1 woman @ 39 wks gestation presents w/ painful uterine tx. She also complains of dark, vaginal blood mixed w/ some mucus. Which of the following describes the most likely etiology of her bleeding?: (placenta prevail/ placental abruption/ bloody show/ vasa prevail/ cervical laceration) - Correct answer Bloody show A 24 y/o G2P1001 woman @ 38 wks by LMP & supported by a 9 wk USN states that her mother is in town for the next 4 days & will be available to assist in taking care of her baby. She requests an induction of labor. Which of the following is the best response to this request?: (since the patient is term, there is no increased neonatal complications, but an increased risk of C/S as compared to spontaneous labor/ if the cervix is unfavorable, then prostaglandin ripening would increase the changes for vaginal delivery/ induction @ 38 wks increases neonatal complications as compared to delivery to 39 wks/ the pt's request is reasonable, & induction can be performed w/ little neonatal or maternal complications) - Correct answer Induction @ 38 wks increases neonatal complications as compared to delivery to 39 wks A 30 y/o G2P1 woman is dxed w/ asymptomatic placenta prevail @ 20 wks gestation. She had a placenta prevail in her previous pregnancy that ultimately led to C/S delivery. What is an appropriate recommendation?: (abstain from coitus/ bed rest/ cerclage placement/ routine OB care/ weekly USN) - Correct answer Abstain from coitus (placenta prevail necessitates pelvic rest; routine OB care should not be recommended considering this pt should not receive digital/bimanual exams)
A 25 y/o nulliparous female presents for consult because she suddenly stopped menstruating. On questioning her further it is found that she recently lost 19 lbs. after starting long-distance running. The MOST appropriate step in her evaluation is measurement of: (serum hCG/ serum estradiol-17b/ serum prolactin/ serum testosterone/ serum TSH) - Correct answer Serum hCG (pregnancy must always be ruled out as a cause of amenorrhea) A 39 y/o woman, G3P3, complains of severe, progressive 2ndary dysmenorrhea & menorrhagia. Pelvic exam demonstrates a tender, diffusely enlarged uterus w/ no adnexal tenderness. Endometrial biopsy findings are normal. Which diagnostic exam is needed next?: (CT scan of pelvis/ hysterosalpingography/ laparoscopy/ MRI/ transvaginal & abdominal USN) - Correct answer Transvaginal & abdominal USN Which of the following elements of a pt's hx if the greatest RF for endometrial CA?: (>70 y/o/ combo progestin & estrogen hormone therapy/ obesity/ postmenopausal bleeding/ tobacco use) - Correct answer Postmenopausal bleeding A 36 y/o G2P2 complains of heavy menstrual bleeding for the past yr. The pt is bleeding through a super tampon & a heavy pad every hr. of the first 3 days of her cycle. Her cycle lasts 5 days & the cycle length has decreased to having a period every 20 days. She complains of fatigue. Her physical exam & lab work-up are normal (negative B- hCG/ LH/ FSH/ prolactin/ clotting times/ liver fan/ & renal fan) except for CBC & further labs indicating she has iron deficiency anemia. She weighs 298 lbs. In addition to iron supplementation, which of the following is the BEST INITIAL therapy for this pt?: (daily dose of aspirin/ D+C of endometrium/ hysterectomy/ long-term conjugated estrogen therapy/ OCPs) - Correct answer OCPs A 26 y/o pt is complaining of depression & anxiety just prior to her menses. The symptoms have been going on for more than 1 yr., but are now starting to interfere w/ her relationships & her productivity @ work. 1 wk 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, & is easily fatigued. She charted her symptoms daily in a log & returned to the office 2 cycles later. The log is consistent w/ her hx. Her physical exam & general lab profile showed no abnormalities. Which of the following is the MOST effective tx of choice for this pt?: (alprazolam (Xanax)/ fluoxetine (Prozac)/ ibuprofen/ progestin-only OCP/ spironolactone (Lactone)) - Correct answer Fluoxetine (Prozac) A 25 y/o nulliparous woman complains of dysmenorrhea that has become progressively worse over the past 2 yrs. Her pain is described as a constant, aching pain beginning 2- 7 days prior to onset of bleeding & does not subside until the menstrual flow decreases. In addition, she complains of pain w/ intercourse. She has never been pregnant & uses condoms & foam for contraception. Which of the following is the BEST way to confirm the most likely dx definitively?:
(laparoscopy/ MRI/ pelvic exam/ pelvic USN/ trial of prostaglandin synthetize inhibitors)