A 26-year-old female presents to the ER complaining of severe RLQ pain. She is immediately taken to the OR for presumed appendicitis. At the time of her surgery her appendix is normal. The surgeon sees a large mass on the R ovary and removes the ovary. Fr
Removing the corpus luteum will affect the pregnancy
(Pregnancy before 8 weeks of gestation depends on the corpus luteum to produce progesterone.)
A 36-year-old woman, gravida 3, para 2, at 8 weeks' gestation, presents to your clinic reporting painless vaginal bleeding. Her vital signs are: T 99.9F, BP 162/94, P 100, R 18. Her uterus is consistent with a 14-week pregnancy. Her serum hCG is 320,000 I
Thyroid
(Molar pregnancy. hCG possesses TSH-like properties and can cause hyperthyroidism.)
A 29-year-old pregnant woman just found that her hCG level is elevated. Which is true?
A high level of hCG in the second trimester is the most sensitive marker for Down syndrome.
(A high level of hCG in the first trimerster is suggestive of molar pregnancy. hCG is part of the quadruple screen in the second trimester.)
Estrogens are produced by the mother, fetus, and placenta. Which one of the following is true?
Estriol is produced primarily by the placenta.
Increases myometrial gap junction function
Estriol
Suppresses maternal lymphocyte activity
Progesterone
Necessary for development of male external genitalia
hCG
Most sensitive marker for abnormal karyotype
hCG
Elevates ketone levels
hPL
Produced by the uterus
Prolactin
Inhibits lactation during pregnancy
Estriol
Lack of this hormone can cause spontaneous abortion in the first trimester
Progesterone
Lack of this hormone is associated with an enzyme deficiency in the placenta
Estriol
Elevated levels of this hormone are associated with twin pregnancy
hCG
Anecephaly causes lack of production of this hormone
Estriol
A 24-year-old woman, gravida 4, para 3, at 18 weeks' gestation dated by her last menstrual period, receives an ultrasound to confirm her "due date" and to evaluate fetal anatomy. Her first pregnancy was an infant with spina bifida. Her other two pregnanci
Portal vein; inferior vena cava
A 37-year-old woman, gravida 1, para 1, just delivered at term a viable male infant weighing 3980 grams with APGARs of 9 and 9 at 1 and 5 minutes, respectively. Delivery was via spontaneous vaginal delivery without any complications. After clamping of the
Closure of foramen ovale and ductus arteriousus
The cardiac output and oxygen consumption in a fetus are approximately what multiple of that compared with an adult, respectively?
3; 3
(Fetal cardiac output is 200 mL/kg/min, whereas adult cardiac output is 70 mL/kg/min. Fetal oxygen consumption is 8 mL/kg/min, whereas adult oxygen consumption is 3 mL/kg/min.)
The most oxygenated blood is found in
Ductus venosus
Route of transfer of glucose across the placenta is
Facilitated transport
Route of transfer of iron across the placenta is
Endocytosis
Route of transfer of amino acids across the placenta is
Active transport
Route of transfer of carbon dioxide across the placenta is
Passive diffusion
Highest concentration of hemoglobin containing two alpha and two beta chains occurs during which trimester?
Third trimester
Amniotic fluid volume derived from transudation occurs during which trimester?
First trimester
Significant amniotic fluid volume contribution from the lung occurs during which trimester?
Early second trimester (weeks 14-21)
Production of red blood cells by the spleen occurs during which trimester?
First trimester
Thyroxine levels first detectable in serum occurs during which trimester?
First trimester
A 23-year-old primigravida woman just delivered an infant weighing 4350 g by spontaneous vaginal delivery. After 5 minutes of gentle traction on the umbilical cord, you deliver the intact placenta. You begin massaging the uterine fundus and ask the nurse
Prostaglandin F2-alpha 0.25 mg IM
(Uterine atony is the most common cause of postpartum hemorrhage.)
Forty hours ago, a 19-year-old primigravida delivered a viable female infant weighing 3600 g. The baby's APGARs were 9 and 9 at 1 and 5 minutes, respectively. The patient is breastfeeding and reports minimal lochia. Review of her labor records reveals tha
Urinalysis and culture
(Incomplete emptying results from excessive residual urine, overdistention, and stasis, and intermittent or Foley catheterization during labor.)
A 27-year-old woman, gravida 2, para 1, presents for her first prenatal visit after testing positive on a home pregnancy test. She reports regular cycles every 35 days. She denies use of birth control pills, Depo-Provera, or other contraceptive in the las
January 15
(Naegle's rule, count back 3 months and add 7 days to FDLMP, and add additional length of cycle over 28 days)
A 16-year-old primigravida presents to labor and delivery with reports of abdominal pain. Her pain is "constant" and located in both the RLQ and LLQ. There is no radiation and no associated symptoms other than constipation. The patient ate lunch a few hou
Round ligament
(Round ligament pain, common during the second trimester, results from stretching of the round ligaments attached to the uterus on each side and the lateral pelvic wall.)
A 20-year-old woman presents to labor and delivery in labor. She has not had any prenatal care. On examination of her cervix, you palpate a bulging membrane but no fetal parts. The cervix is 4-cm dilated. Ultrasound demonstrates that the fetal head is in
Complete breech
(Wrong Answer. Complete breech is the presentation. Longitudinal is the fetal lie.)
A woman presents for prenatal care. She has had two abortions, two second-trimester miscarriages, one ectopic pregnancy, a fetal demise at 37 weeks' gestation, and two live births. Her son, who is now 13-years-old, was delivered at 34 weeks' gestation by
G9 P3; P2142
A 34-year-old woman, gravida 2, para 1, at 32 weeks' gestation, presents for routine prenatal care. She delivered her daughter vaginally at 39 weeks without any complications. Her past medical history is unremarkable, and her current pregnancy has been un
Follow-up in 2 weeks
(Uncomplicated pregnancy should be seen every 4 weeks for the first 28 weeks, every 2 weeks until 36 weeks, and weekly thereafter until delivery.)
A 28-year-old woman, gravida 3, para 2, at 5 weeks' gestation, presents for confirmation of pregnancy and possible prenatal care. Her first pregnancy resulted in vaginal delivery of a viable female infant weighing 3900g at term. Her daughter has a bilater
Increase your folic acid intake to 10 times your prepregnancy amount.
(Folic acid intake 4 mg/day during pregnancy.)
The largest contributor to weight gain during pregnancy?
Blood volume
(Contributors to weight gain during pregnancy: fetus > blood volume > uterus, lower extremity edema > amniotic fluid. Normal weight gain during pregnancy is about 30 lb.)
A 24-year-old woman, gravida 2, para 1, at 27 weeks' gestation, presents for routine prenatal care. She reports plenty of fetal movement and denies spotting or regular contractions. She does report increasing vaginal discharge that is white to yellow in c
Bacterial vaginosis, clindamycin
A 39-year-old woman, gravida 3, para 3, is contemplating pregnancy. She delivered three healthy boys by vaginal delivery at ages 17, 23, and 27 years. Her first pregnancy was complicated by low birth weight. Her second pregnancy was unremarkable. She incu
Twins
A 34-year-old primiparous woman is considering a second pregnancy. She is afraid to get pregnant given the outcome of her first pregnancy. At 32 years-of-age, she delivered a term infant with Down syndrome. During that gestation, a serum screen for aneupl
Low MSAFP, low estriol, high hCG, and high inhibin A
A 28-year-old woman, gravida 6, para 1 presents because she tested positive on her home pregnancy test. Her last menstrual period occurred 40 days ago. She normally has regular, 28-day cycles and her periods last 3-4 days. She delivered a preterm infant w
Transvaginal ultrasound
(Woman with a history of an ectopic pregnancy and chlamydial infection who may be pregnant must have a transvaginal ultrasound to rule out another ectopic pregnancy and confirm intrauterine pregnancy.)
A 33-year-old woman, gravida 3, para 2, at 32 weeks' gestation, presents for her routine prenatal care. She delivered her first baby by cesarean due to nonreassuring fetal heart rate pattern on the fetal monitor. Her second baby was delivered by cesarean
Vaginal delivery is not recommended because the risk of uterine rupture approaches 8%
(A classical uterine incision is a contraindication to a trial of labor and vaginal delivery with a subsequent pregnancy.)
A 41-year-old woman, gravida 8, para 4, at 18 weeks' gestation, presents for her first prenatal visit. She has a history of three therapeutic abortions as a teenager. She has four healthy children -- the first two delivered at 32 weeks' gestation, and her
Delivery history
(History of two previous preterm deliveries is the strongest risk factor for another spontaneous preterm delivery.)
A 25-year-old woman, gravida 2, para 1, at 8 weeks' gestation, presents to the high-risk clinic for prenatal care. Her first pregnancy was complicated by delivery of a premature infant with respiratory problems. Her past medical history is remarkable for
Diabetes mellitus
Which combination of markers is suggestive of Down syndrome?
Low AFP, high hCG, low estriol, high inhibin A
Which of the following canNOT be detected on a second-trimester ultrasound exam?
Tay-Sachs disease
(2nd trimester ultrasound can detect anatomic anomalies such as anencephaly, renal agenesis, two-vessel cord, tetralogy of Fallot)
A 32-year-old woman, gravida 1, para 1, comes for genetic counseling. Her first child was born with sickle cell disease. She has since remarried, and is requesting prenatal testing. Which of the following is appropriate to offer the patient first?
Paternal hemoglobin electrophoresis
Which of the following procedures poses the lowest risk for fetal loss?
Fetal echocardiography
Which of the following is NOT an indication for prenatal diagnosis?
Paternal age 45 years
(Paternal age has minimal effect on chromosomal anomalies.)
A 23-year-old woman who was seen in the emergency department yesterday for a superficial gunshot wound to the wrist tested positive on a routine serum beta-hCG screen. Her cycles have always been regular and occur every 28 days and are 4 days in duration.
8000 IU
A 28-year-old woman, gravida 2, para 1, at 11 weeks' gestation, who just moved from another state is seen for her first prenatal visit. She has an idiopathic respiratory disease that predisposes her to recurrent lung infections. She tells you that she can
No adverse outcome
A 28-year-old woman just tested positive on a home pregnancy test even though she and her husband use condoms regularly. Her last menstrual period was 36 days ago. Her periods usually occur every 30 days. Her past medical history is unremarkable and she d
Pregnancy outcome is usually favorable even after exposure to this vaccine.
A 19-year-old woman, gravida 1, para 0, presents to you at 7 weeks' gestation by her last menstrual period for prenatal care. Her history and physical exam are completely unremarkable. You educate her about nutrition and exercise during pregnancy and perf
Minimize hot tube use in the first trimester because it may cause malformations
Which teratogenic agent causes persistent patent ductus arteriosus?
Rubella
Which teratogenic agent causes endocardial fibroelastosis?
Mumps
Which teratogenic agent causes triad of heart, eye, and ear defects or malformations?
Rubella
Which teratogenic agent causes skin scarring and shortened limbs?
Varicella zoster
Which teratogenic agent causes aplastic anemia?
Parvovirus
Exposure to ___ rad may have some adverse fetal effects
10
After week ___, exposure to radioactive iodine may affect fetal thyroid development.
10
Baseline risk of major congenital anomaly is ___%
3%
Intrauterine fetal growth retardation is increased ___ times in excessive drinkers
3
Infants born to epileptic mothers have ___% incidence of congenital abnormalities
6%
Rate of congenital anomalies in pregnant women taking antipsychotic medications is ___%
6%
An 18-year-old student enjoys drinking once or twice with her college friends. Lately, she has been drinking more than 10 mixed alcoholic beverages each time she goes out. Although she gets a severe "hangover" after each night of drinking, she still enjoy
Abuse
A 30-year-old woman, gravida 2, para 1, at 8 weeks' gestation, likes to drink one glass of red wine at night with dinner and doesn't believe it will harm her developing fetus. She drank the same amount throughout her last pregnancy and she delivered a nor
Heart
(There is no safe level of alcohol in pregnancy.)
A 20-year-old woman, gravida 4, para 3, presents to you at 22 weeks' gestation for routine prenatal care. She has missed her last two appointments. All of her previous pregnancies were complicated by preterm labor and delivery of small infants with signif
Placental abruption
(High BP, anxiety, needle-track marks, history of preterm deliveries, and history of myocardial infarction in a young healthy woman are suspicious for cocaine use.)
A 25-year-old woman, gravida 1, para 0, at 13 weeks' gestation, presents for routine prenatal care. She says her baby moves frequently and keeps her up part of the night. She also reports increasing vaginal discharge that is odorless and otherwise asympto
Confront her about your findings
A 35-year-old woman, gravida 3, para 2, at 20 weeks' gestation, is seen for a routine prenatal visit. She has no complaints. Her previous pregnancies have been unremarkable. She has chronic hypertension and a history of cholecystectomy. She has no known d
Educate her about the possibility of delivering a small infant.
(Marijuana causes increased risk of perinatal mortality, preterm delivery, PROM, and low birth weight.)
A 25-year-old woman, gravida 2, para 1, at 36 and 4/7 weeks' gestation with a history of prior cesarean delivery, presents with abdominal pain and vaginal bleeding. She admits to using cocaine. Her vital signs are: T 99.9F, HR 120, BP 170/100. Fetal heart
Placental abruption
A 39-year-old woman, gravida 5, para 4004, presents at 38 weeks with complaints of severe headache, abdominal pain, and vaginal bleeding. Her past obstetric history is significant for an emergent cesarean section in the setting of placental abruption with
History of previous cesarean section
(Risk factors for placental abruption include hypertension, history of previous placental abruption, increased maternal age, multiparity.)
A 20-year-old woman, gravida 1, para 0, at 28 weeks' gestation, arrives to labor and delivery reporting continuous vaginal bleeding and back pain. She denies sexual intercourse within the last 48 hours. She also denies trauma to the abdomen. You perform a
Betamethasone
(Placental abruption management at 28 weeks requires betamethasone to decrease complications of prematurity should delivery occur.)
A 34-year-old woman, gravida 2, para 1, at 34 and 2/7 weeks' gestation, presents to labor and delivery reporting painless vaginal bleeding. You immediately perform a transvaginal ultrasound and note the placenta completely overlying the internal os, a fet
Hospitalization
(Hospitalize until the bleeding subsides.)
A 28-year-old woman, gravida 3, para 1, at 37 weeks' gestation, presents to labor and delivery for a scheduled repeat cesarean section with possible cesarean hysterectomy. She has a history of two previous low transverse cesarean sections. The first was b
Kidney
(Also at risk for Sheehan syndrome, which is pituitary necrosis.)
A 26-year-old woman, gravida 2, para 1, at 39 weeks' gestation, is admitted to the hospital in labor with ruptured membranes. Her cervix is dilated 5 cm and is 100% effaced, and fetal vertex is at +1 station. You place a fetal scalp monitor and an intraut
Cesarean section
A 22-year-old woman, gravida 1, para 0, at 40 weeks' gestation, presents to labor and delivery reporting regular contractions for the last 2 hours. She denies loss of fluid from the vagina and reports good fetal movement. Her cervix is dilated 2 cm and 50
Walk for 1 to 2 hours then return to check her cervix.
A 29-year-old woman, gravida 2, para 1, at 32 weeks' gestation, presents to labor and delivery reporting flank pain, fever, chills, and cramping. She is having contractions every 3-4 minutes, and the fetal heart rate baseline is 180. You check her cervix
Pulmonary edema
(Pulmonary edema is a known complication of magnesium sulfate.)
A 24-year-old woman, gravida 1, para 0, at 39 weeks' gestation, is crowning. The fetal head is not emerging from the vagina after two pushes. You palpate a thick hymenal ring of tissue at the introitus. Fetal monitoring strip shows bradycardia after the t
Avoids fourth-degree laceration
A professor of obstetrics is explaining the seven cardinal movements of labor: first--the greatest transverse diameter of the fetal head passes through the pelvic inlet; second--the fetal head descends; third--the fetal chin is brought into close contact
Rotation of occiput to transverse position
A 25-year-old woman, gravida 1, para 0, at 39 weeks of gestation, has been laboring for a few hours. Her cervix is dilated to 6 cm and 80% effaced, and fetal vertex is at 0 station. Membranes have been ruptured for 20 hours and her labor is being augmente
Discontinue oxytocin
A 27-year-old woman, gravida 1, para 0, at 40 and 3/7 weeks' gestation, is in the middle of the first stage of labor. Her cervix is dilated to 4 cm and a decision has been made to place an epidural. Prior to placement of the epidural, she receives a 500-m
Ephedrine
(To prevent hypotension from epidural blockade, anesthesiologists hydrate patients before placement of the epidural and then give ephedrine to keep the BP near baseline.)
A 22-year-old woman, gravida 2, para 1, at 41 weeks' gestation, is laboring. Her cervix is dilated to 8 cm and 100% effaced, and fetal vertex is at +1 station. Membranes have been ruptured for more than 24 hours, and labor is being augmented with oxytocin
Terbutaline
A 19-year-old woman, gravida 1, para 0, at 38 weeks' gestation, is in active labor. Her cervix is dilated to 5 cm and fetal vertex is at +1 station. The tocodynamometer displays contractions every 2 to 3 minutes, lasting 1 minute, and producing 50 mmHg of
Respiratory acidosis
A 26-year-old woman, gravida 2, para 1, at 20 weeks' gestation, seen for prenatal care. Her fundus measures 18 weeks and you are unable to hear fetal heart tone by Doppler. You perform an ultrasound and confirm lack of fetal heart activity and lack of fet
Missed abortion
Chromosomal abnormalities account for the majority of first-trimester spontaneous abortions. If one was to analyze the chromosomal composition of the products of conception that are extruded in a spontaneous abortion, which of the following would be the m
Trisomy
(Trisomy 16)
A 30-year-old woman, gravida 4, para 3, at 12 weeks' gestation, is seen for prenatal care. Her first pregnancy ended with a successful vaginal delivery, at term, of a health boy. Her second pregnancy was uncomplicated and resulted in a cesarean section wi
You are an excellent candidate for VBAC
You are an attending obstetrician in charge of a busy hospital. You are monitoring the progress of a woman (gravida 2, para 0) who has been in labor for the past 24 hours; her membranes have been ruptured for 17 hours. Three hours ago, her cervix was 10 c
An additional obstetrician in the room
(Requirements for forceps delivery include: adequate anesthesia, completely dilated cervix, ruptured membranes, and confirmation of fetal head position.)
Risk of sensitization in Rh-negative woman after D&E if RhoGAM not given
0-10%
Risk of uterine perforation after D&E
0-10%
After three spontaneous abortion (SABs), risk of SAB if no history of liveborn
35-45%
Annual percent of births by cesarean section in the United States
25-30%
Risk of endomyometritis after cesarean section
35-45%
Uterine atony as the indication for cesarean hysterectomy
35-45%
Success rate for VBAC after one previous low transverse cesarean section for fetal distress and two previous successful VBACs
71-80%
A 24-year-old parturient is at 20 weeks' gestation. Her past medical history is notable for mitral stenosis secondary to rheumatic heart disease as a child. What physiologic changes places her at risk for the development of heart failure during her pregna
Increase in stroke volume
A parturient at 40 weeks' gestation is scheduled for a magnetic resonance imaging scan to assess for placenta accreta. The radiologist is unable to complete the study due to nausea whenever the patient is supine. What do you recommend to the radiologist?
Tilting the patient to the left
A 24-year-old parturient with severe preeclampsia requires urgent cesarean delivery for nonreassuring fetal heart rate. The anesthesiologist plans general anesthesia. Which of the following maneuvers would you recommend to increase the safety for airway m
Have small-diameter endotracheal tubes available
A 28-year-old parturient at 40 weeks' gestation requires general anesthesia for cesarean delivery due to umbilical cord prolapse. With induction of anesthesia, there is a rapid decline of the oxygen saturation. This decline is a result of a decrease in wh
Residual
The pain of the second stage of labor is conveyed by which nerve?
Pudendal
A 25-year-old woman requires cesarean section during epidural anesthesia. Prior to the injection of local anesthetic, the anesthesiologist administers a test dose of 3 mL lidocaine 1.5% with epinephrine 1:200,000. The patient complains of tinnitus and a r
Intravascular injection
A 24-year-old parturient at 40 weeks' gestation is in active labor and requests epidural analgesia. During epidural placement, the dura is punctured. The patient is at increased risk for the development of which of the following complications postoperativ
Headache
A 21-year-old parturient is considering epidural analgesia. Which of the following is increased in patients with epidural analgesia?
Prolonged labor
A 33-year-old woman, gravida 2, para 1, who is in the third trimester presents for her first prenatal care. She is not sure of her due date because she has been given three different dates by three different doctors. She tells you that her periods are irr
April 19, 2008
A 22-year-old woman, gravida 1, para 0, at 15 weeks' gestation by her last menstrual period, presents for an ultrasound exam to confirm her due date. Which of the following measurements on the fetus is the best at predicting her actual due date?
Biparietal diameter
A 25-year-old woman, gravida 3, para 0, at 42 weeks' gestation, presents for prenatal care. She has accurate dating and has been receiving twice-weekly NSTs for the last week. Underdevelopment of which structure in the fetus may contribute to prolongation
Adrenal cortex
A 34-year-old, gravida 3, para 1, abortions 1, at 42 1/7 weeks' gestation by a week-6 ultrasound, presents to your clinic. Her NST is reactive and amniotic fluid volume (AFV) is 8.5. Her cervix is 0.5 cm dilated, 20% effaced, midposition, and firm, and th
Prostaglandin analog
(At 42 weeks, prostaglandins will "ripen" the cervix for induction.)
A 25-year-old woman, gravida 3, para 2, comes to labor and delivery at 30 weeks' gestation complaining for regular uterine contractions. Cervical exam reveals 3-cm dilation and 80% effacement. The patient is administered corticosteroids and tocolytics. Th
Discontinue the tocolytic therapy
A 28-year-old woman, gravida 3, para 2, at 28 weeks' gestation, has been admitted to the hospital for several days to treat her preterm labor. Her cervix was dilated to 3-cm and 100% effaced when MgSO4 was started at 2.5 g/hr after a bolus over 30 minutes
Delay delivery for 2 days
A 22-year-old woman, gravida 1, para 0, at 33 weeks' gestation, presents to labor and delivery and reports cramping and lower back pain. She denies leaking fluid from the vagina. You perform a speculum exam that shows no pooling, and Nitrazine paper stays
Corticosteroids and tocolytic therapy
A 29-year-old woman, gravida 3, para 1, spontaneous abortions 1, at 30 weeks' gestation, is in preterm labor. She has received an initial bolus of 6 g of MgSO4 over 30 minutes, and she has been placed on a maintenance rate of 4 g/hr for the last 2 days to
Discontinue MgSO4
You have been seeing a 23-year-old woman, gravida 1, para 0, at 28 weeks' gestation, throughout her pregnancy. She has no known medical history. She denies blurry vision, epigastric or RUQ pain, severe headache, or trouble breathing. Her blood pressure an
Severe preeclampsia
A 20-year-old primigravid woman at 37 weeks' gestation (confirmed by a first-trimester ultrasound) presents to the clinic for routine prenatal care. She reports active fetal movement and abdominal pain. Her blood pressure is 162/103 initially and she has
Prostaglandin analog and magnesium sulfate
A 26-year-old primigravida at 35 weeks' gestation complains of mild headache and facial edema. Her blood pressure is 160/100 and her reflexes are brisk. You suspect that she has preeclampsia. Her urinalysis is likely to show which of the following?
Proteinuria
The diagnosis of preeclampsia would be advanced to eclampsia if the woman developed which of the following?
Grand mal seizures
A 38-year-old African-American woman, gravida 1, presents for a routine visit at 39 weeks' gestation. Her blood pressure is persistently 140/90 mmHg, and her urine protein is 2+. Physical exam is otherwise unremarkable, and she is completely asymptomatic.
Induction of labor
A 25-year-old Asian woman, gravida 2, para 0, presents at 33 weeks' gestation for a routine visit. Her blood pressure is 150/100 mmHg, and her urine protein is 3+. Physical exam is otherwise unremarkable. She reports mild headache, but no RUQ pain or visu
Admission to hospital
A 26-year-old nurse, gravida 2, para 1, at 32 weeks' gestation, presents to labor and delivery because of elevated blood pressures. She says her systolic blood pressures have been in the high 170s and her diastolic blood pressures have been in the low 110
Betamethasone
A 35-year-old woman, gravida 5, para 1, at 6 weeks' gestation, is seen because she just found out she is pregnant. She has a 6-year history of essential hypertension controlled on a diuretic agent. After you perform a routine prenatal exam, you change her
It decreases the risk of maternal end-organ damage
Which of the following is an independent risk factor for pregnancy-induced hypertension?
Age older than 40 years
Which of the following might be found in a patient with MILD preeclampsia?
Proteinuria in excess of 3 g per 24 hours
A 24-year-old primigravida is seen for her first prenatal visit. After confirming her pregnancy, you take a complete history and perform a physical exam. She has had type 2 diabetes for 6 years now and has been on oral medications for blood sugar control.
Low calcium (hypocalcemia)
A 22-year-old woman, gravida 2, para 0, at 22 weeks' gestation, presents for her routine prenatal visit. She has been seeing you throughout her pregnancy. She had diabetes prior to becoming pregnant and was taking an oral hypoglycemic agent to control her
Perform fetal echocardiograph
A 28-year-old woman, gravida 2, para 1, at 20 weeks' gestation, presents with increased sweating and palpitations. Her fundus measures 17-cm. T 98.8F, BP 115/80, P 132, R 16. She is found to have elevated total T4, total T3, and free T4, and TSH less than
Propranolol
(Propranolol is the initial treatment for palpitations and tachycardia from hyperthyroidism.)
An 18-year-old woman, gravida 3, para 2, at 28 weeks' gestation, is admitted with right-sided back pain, fever, chills, and severe nausea. She has bilateral costovertebral angle tenderness, with greater discomfort on the right side. T 102.6F, with normal
Perform an ultrasound
(Renal ultrasound to rule out an abscess or renal calculi.)
A 20-year-old woman just delivered a viable male neonate at 38 weeks' gestation after being a restrained passenger in a car accident. Upon arriving at the emergency department she was "cleared" by the trauma and orthopedic teams and sent to the labor and
Assess neonatal Rh antigen status
A 24-year-old woman, gravida 1, para 0, at 24 weeks' gestation by her last menstrual period, presents to the emergency department because of vaginal bleeding. T 97.8, BP 135/88, P 105, R 16. Her fundus is below the umbilicus and there are no fetal heart t
Maternal X + Paternal X + Paternal X
(Incomplete molar pregnancy: uterus is smaller than dates, normal ovum is fertilized by two sperm, fetal tissues are present.)
A 24-year-old woman, gravida 1, para 0, at 24 weeks' gestation by her last menstrual period, presents to the emergency department because of vaginal bleeding. T 97.8, BP 135/88, P 105, R 16. Her fundus is below the umbilicus and there are no fetal heart t
Two-vessel umbilical cord
(Incomplete molar pregnancy)
A 33-year-old woman, gravida 4, para 3, at 16 weeks' gestation by her last menstrual period, presents to labor and delivery complaining of vaginal bleeding. Her vital signs are: T 98.9F, BP 150/94, P 103. Fundal height measures 23-cm. A pelvic ultrasound
Lung
(Following D&C of a molar pregnancy, the lungs can be injured by emboli from trophoblastic tissue, fluid overload, or thyroid storm.)
A 27-year-old nulliparous woman presents to the emergency room reporting hemoptysis. She has no medical history other than a pregnancy 3 months ago that resulted in spontaneous abortion. She also has had intermittent vaginal spotting since the miscarriage
Methotrexate and leucovorin
A 36-year-old multiparous woman just underwent a hysterectomy because of a molar pregnancy. Other than her treatment for gestational trophoblastic disease, she has no medical problems. She had an appendectomy 3 years ago. She is allergic to penicillin and
beta-hCG in 1 week
(Following treatment of a molar pregnancy, the patient needs a 48-hour hCG level, then weekly hCG until the results are negative three times, then every month for 6 months, and then annually.)
A 24-year-old woman, gravida 1, para 1, is seen because every month since age 19 she has had severe lower pelvic pain during her periods. She says the pain is similar to "labor pains" and it interferes with her ability to concentrate at work and during le
Ibuprofen
(Best treatment for dysmenorrhea is NSAIDs (eg ibuprofen).)
Two female medical students are having a discussion about ovarian reserve. Medical student #1 claims that because women are born with a finite number of follicles and because she has been taking birth control pills since age 16, she has slowed down loss o
There is no way to slow down depletion of eggs.
Hormone X and Y are secreted in the follicular phase and are responsible for suppressing FSH in the late follicular phase prior to ovulation. Hormone Z is responsible for allowing the oocytes to progress through to metaphase II. What are hormones X, Y, an
Estrogen, inhibin A, and LH
Many infertility patients undergo in vitro fertilization (IVF) and embryo transfer (ET) in order to become pregnant. IVF-ET uses many of the principles of the normal menstrual cycle to achieve pregnancy. The patients are given FSH hormone to stimulate mul
There is excess FSH available
A 24-year-old nulligravid woman presents because of amenorrhea of 4 months' duration. She was started on birth control pills at age 18 due to irregular menses. She continued the pills until 4 months ago when she was in a terrible motorcycle accident and h
Turner syndrome
(Most common cause of secondary amenorrhea is Turner syndrome.)
An 18-year-old nulligravid female is seen because she has not had a period for the last 8 months. She is a freshman in college majoring in dance. She enjoys hiking to relieve stress. She is sexually active. She began her menses at age 13 and had irregular
Decreased FSH
(Anorexia nervosa causes decreased gonadotropins (FSH and LH) and low estrogen, but normal free T4, TSH, and prolactin.)
A 25-year-old nulligravid female presents because she has not had a period for the last year. She didn't think too much of it initially due to her hectic schedule, but is concerned now because she recently stated a serious relationship. Although she admit
Hypothalamus
(Any excessive stress changes neurotransmission in the hypothalamus.)
A 25-year-old nulligravid female presents because she has not had a period for the last year. She didn't think too much of it initially due to her hectic schedule, but is concerned now because she recently stated a serious relationship. Although she admit
Norgestimate and ethinyl estradiol
(Optimal treatment of hypogonadotropic amenorrhea is either hormone replacement therapy or birth control pills. Since this patient is not ready to become pregnant, birth control pills are more reasonable.)
A 16-year-old presents because she has never had a period. She has no past medical or surgical history. She has never had a major illness. She has no known drug allergies. She is a senior in high school and has been accepted to an Ivy League university. I
Mayer-Rokitansky-Kuster-Hauser syndrome
(Most common disorder of the outflow tract.)
A 21-year-old nulliparous woman reports several years of irregular menses, occurring only four to five times a year. On physical exam you notice hair on her neck, chin, upper lip, and lower abdomen. Your laboratory workup of this patient include all of th
Lutienizing hormone/ follicle-stimulating hormone
(Workup for PCOS includes TSH, serum testosterone, 17-OH progesterone, and prolactin.)
A 17-year-old woman complains of increased hair growth over the past 6 months, requiring her to wax her upper lip and chin. Her menses have been irregular. Laboratory testing suggests she has PCOS. What is the best recommendation for treating excess hair
Combined hormonal contraceptive, antiandrogen, and laser or electrolysis
An obese 38-year-old woman complains of several episodes of irregular vaginal spotting throughout the past 6 months. She has a long history of irregular periods and was diagnosed with PCOS as a teenager. She is not sexually active and has never been on ho
Endometrial biopsy
(A woman over 35-year-old with history of irregular menses is at increased risk of endometrial hyperplasia and endometrial cancer.)
A 27-year-old obese nulliparous woman has been on oral contraceptives since age 16 for irregular periods. She comes to you becomes she stopped taking her pill 6 months prior but has not had a period since stopping her pill. She and her husband would like
If she lost weight, she may start to have periods on her own
(Obesity compounds the effects of PCOS and causes problems during pregnancy.)
A 32-year-old female, gravida 0, presents with her husband because they want to conceive. She has PCOS diagnosed by you 14 years ago and has been maintained on oral contraceptives and antiandrogens since then. She stopped those medications and started pre
Clomiphene citrate
(Clomiphene citrate is the first-line medication to induce ovulation.)
Which hormone/substance/enzyme is most likely to account for rapidly progressive hirsutism?
Androstenedione
Which hormone/substance/enzyme is most likely to account for hirsutism in a woman with regular menses and no abnormal hormonal measurements?
5alpha-reductase
Which hormone/substance/enzyme is most likely to account for hyperplasia of adrenal gland as source of androgen excess?
17-hydroxyprogesterone
A 33-year-old woman, gravida 2, para 1, spontaneous abortions 1, reports increasing dark hair growth on her chin, upper lip, and lower abdomen. This growth has occurred over many years and has forced her to wax and bleach more often. She denies changes in
Spironolactone
(Spironolactone is an androgen receptor blocker and 5(alpha)-reductase inhibitor, thus preventing DHT binding and production respectively.)
A 23-year-old woman, gravida 1, para 0, abortion 1, has irregular, unpredictable menstrual periods every 30 to 90 days. Physical exam reveals acne on her face and back and several dark, coarse hairs on her chin and lower abdomen. The initial step in diagn
17-hydroxyprogesterone
(Diagnosis of PCOS requires exclusion of other causes of hyperandrogenism, including nonclassic adrenal hyperplasia (NCAH) by measuring 17-hydroxyprogesterone level.)
A 22-year-old African-American female complains of severe hirsutism on her face. She is currently shaving daily and is very distressed. After you evaluate her you diagnose PCOS. You give her what advice for the best way to manage her hirsutism symptoms?
Combined hormonal contraception with spironolactone is the best option
A 50-year-old woman, gravida 3, para 2, spontaneous abortions 1, reports abnormal vaginal bleeding. Her menstrual cycles used to occur regularly every 30 days for the last 6 months. She denies any past medical or surgical history. Review of systems is neg
Endometrial biopsy
(Women over age 40 years with abnormal uterine bleeding should be evaluated for endometrial carcinoma.)
A 14-year-old nulligravid girl reports menstrual bleeding every 45 to 50 days and bleeding for 4 days. She experienced menarche at age 13. She is not sexually active. Her physical exam is unremarkable, and her serum pregnancy test is negative. The next be
Reassurance
(Irregular bleeding following menarche should evolve into a pattern of regular bleeding by 2 years from menarche.)
A 32-year-old woman, gravida 1, para 1, reports bleeding between her periods and lengthening of the time between her periods to more than 40 days. Review of systems is remarkable for a 70-lb weight gain since her pregnancy 2 years ago. She denies any medi
Increased endogenous estrogen
(Adipose tissue contains 5(alpha)-reductase that synthesizes estrogen.)
An 18-year-old nulligravid girl presents to the emergency department by ambulance because she passed out on the floor of her house and is covered in blood. She is now conscious. She has been bleeding off and on for the past 5 months. Her BP 98/48, P 120,
Low-dose combination oral contraceptive pills
(Low-dose oral contraceptive given as three pills a day with taper over 3-4 days is an effective way to stop dysfunctional bleeding quickly in a stable patient.)
A 25-year-old woman, gravida 4, para 4, with a history of leiomomas, presents to the emergency room reporting pelvic pressure. She denies cardiac, renal, or hepatic symptoms. A pelvic ultrasound shows a 10-cm left uterine mass that has the echogenicity of
Varicose veins
A 30-year-old woman, gravida 2, para 2, presents to you for her annual gynecologic visit. Currently, she has no symptoms. You perform a Pap smear and a pelvic exam that reveals an enlarged, nontender, irregular uterus and no adnexal mass or tenderness. Th
Subserosal pedunculated fibroid (7-cm size)
A 22-year-old woman, gravida 2, para 1, at 20 weeks' gestation, presents to the emergency department reporting acute-onset lower abdominal pain. She has a history of fibroids and an unknown abdominal surgery. Her vital signs are: T 99.2F, BP 105/68, P 110
Leiomyomatous degeneration
A 27-year-old woman, gravida 2, para 1, at 30 weeks' gestation, presents to the clinic for a routine prenatal visit. Her pregnancy has been unremarkable thus far. "Serosal fibroids" are listed under her "problem list." Her fundus measures 37-cm. In discus
Breech presentation
A 49-year-old woman, gravida 3, para 2, spontaneous abortions 1, who has a known myomatous uterus presents because of heavy bleeding during her periods and occasional spotting in between her periods. Her menses occurs every 5 to 6 weeks and lasts 6 to 10
Endometrial biopsy
(A woman over 35-year-old with history of irregular menses is at increased risk of endometrial hyperplasia and endometrial cancer.)
A 34-year-old woman, gravida 0, has been trying to get pregnant for the last 3 years and has been unsuccessful. Her history is also significant for pelvic pain for several years and deep dyspareunia. On pelvic exam, you palpate a nodular, tender uterosacr
Laparoscopy with cystectomy
A 23-year-old woman, gravida 1, para 1, reports lower abdominal pain of 1 year's duration. She says that the pain is constant and dull and is worse around the time of her periods. She has no significant medical history and is taking birth control pills fo
Oral contraceptive therapy
Which of the following patients is unlikely to have endometriosis?
A 28-year-old with menorrhagia and a 4-cm submucosal myoma
(Myomas are benign proliferations of uterine smooth muscle.)
What blocks production of estrogen within the endometriosis implant?
Aromatase inhibitor
Patient with red hemorrhagic vesicles and white lesions who has a pelvic peritoneal defect on laparoscopy
Allen-Master lesion
Reason why naproxen may alleviate pain symptoms in a patient with endometriosis
Prostaglandins
Complication of extraperitoneal endometriosis
Prostaglandins
A 32-year-old woman, gravida 2, para 2, reports chronic abdominal and pelvic pain. The pain is intermittent, 6/10 intensity, worse when she lies on her left side, and nonradiating, and occurs at different times throughout her menstrual cycle. Her past med
Adhesive disease
A 19-year-old female, gravida 0, has had increasingly severe menstrual cramps since menarche. Her pain is worse around the time of her menses, but she also complains of dyspareunia, and the pain is worse with movement. She denies any nausea or vomiting, d
Gencologic, urologic, or musculoskeletal
An 18-year-old nulligravid woman presents with painful periods. She says she only has pain during the first 2 days of her periods, which are regular. The pain is always midline and 2-cm below the level of the umbilicus. She says Motrin helps ease the pain
Sympathetic fibers to T11
A 33-year-old woman, gravida 5, para 4, therapeutic abortion (TAB) 1, presents with LLQ pain for 2 days. She describes the pain as intermittent initially but now constant, 7/10 intensity, nonradiating, and not associated with any other symptoms. Her last
Serum beta-hCG
A 25-year-old woman, gravida 4, para 3, spontaneous abortions 1, presents for the first time reporting pelvic pain. She has had this pain for the last 10 years and has seen several physicians. She describes the pain as continuous and dull (4/10 intensity)
Psychogenic cause
(History of depression, suicide attempts, sexual abuse, long-standing pain, and pain unrelated to her menstrual cycle.)
A 25-year-old womna, G1, P0, is in the emergency room complaining of lower pelvic pain and spotting for the past week. Her last normal menstrual period was 7 weeks ago. You have obtained a serum beta-hCG, which was 4000 IU/L, and a transvaginal ultrasound
Dilation and curretage
A 28-year-old woman, gravida 2, para 1, ectopic 1, presents to your clinic for an annual exam. She and her partner would like to try to have another child. Her menstrual cycles are regular, occurring every 28 days. You tell her that it is very important f
Her risk of a recurrent ectopic is approximately 30%
A 23-year-old woman, gravida 3, para 1, ectopic 1, presents to your office because she missed her last period and has felt a sharp, intermittent pain in her left lower abdomen. She has no past medical history other than a left-sided ectopic pregnancy a fe
Laparoscopic salpingectomy
A 36-year-old nulligravid woman is seen for her annual gynecologic care. She has a past medical history significant for pulmonary fibrosis. Within the past 3 years, all of the following are remarkable: bacterial vaginosis, Candida, chronic endometriosis,
Infertility
A 24-year-old woman, gravida 3, para 1, spontaneous abortions 1, presents to the emergency room reporting irregular vaginal bleeding. She is found to be pregnant and her serum hCG is 3500 mIU/mL. She has a past medical history significant for diabetes mel
Methotrexate
A 25-year-old woman, gravida 2, para 2, has been trying to get pregnant for the last 2 years. She has no medical problems. She had surgery for a ruptured appendix 5 years ago. Her periods are regular and last 3 to 4 days. She denies smoking, drinking alco
Tubal factor
A 29-year-old woman, gravida 5, para 1, spontaneous abortions 4, presents to you because she has not been able to carry a pregnancy successfully since the birth of her son 8 years ago. Although she becomes pregnant easily, she miscarries the pregnancy at
Uterine factor
A 30-year-old nulligravid woman presents because she and her husband have been trying to get pregnant for the past 2 years. She has no prior medical history. She has regular, 30-day menstrual cycles and denies dysmenorrhea. Her pelvic exam is normal. Labo
Unexplained
A 39-year-old woman, gravida 1, para 0 (spontaneous abortion 2 years ago), presents with 2 years of secondary infertility. She has no other medical history and has regular 30-day menstrual cycles. On her pelvic ultrasound, you noted an antral follicle cou
Oocyte quality
(low antral follicle count)
A 27-year-old woman, gravida 2, para 2, presents to you because she has not been able to get pregnant after reversal of her husband's vasectomy. She has no medical problems. What is the most likely cause of infertility?
Male factor
A 22-year-old nulligravid woman and her husband have been trying to get pregnant for the last 18 months. She has no known medical problems and has never had any surgery. She says her periods are irregular. She gets about four to five periods per year. She
Ovulation
(Polycystic ovarian syndrome)
Among 100 healthy, fertile couples, approximately how many will become pregnant within 1 month if they have regular interourse?
20
A 26-year-old nulligravid and her 26-year-old husband are seeing you because they have not been able to get pregnant for the last 3 years. The woman has regular periods every 30 days that last 4 days. Both of them have no medical problems or past surgical
Karyotype, FSH, testosterone, Y microdeletion testing
A patient with a history of three miscarriages presents to your office. The only workup she has had done so far was a lab evaluation that showed: lupus anticoagulant negative, anticardiolipin IgA high positive, IgG low positive, and IgM normal. What would
None of the above
A couple with recurrent pregnancy loss (RPL) gets karyotype analysis and the male partner is found to have a robertsonian translocation involving chomosomes 14 and 21. The female partner is normal. The next most appropriate step in the treatment of this c
Send the couple for a consult with a genetic counselor
A patient with a history of three miscarriages presents to your office. The only workup she has had done so far was a lab evaluation that showed the following results: lupus anticoagulant screen negative, anticardiolipin IgG high positive, and IgM normal.
B & C. Repeat antiphosphlipid screen in 6 to 8 weeks & Order a hysterosalpingogram
A 15-year-old female comlains of severe dysmenorrhea that has become progressively worse since the onset of menses. Menarche occurred at age 13. The pain is located predominantly on the right side, lasts for the duration of the menstrual flow, and at it's
Obtain a pelvic ultrasound
An 8-year-old girl is brought to you by her mother because of occassionally bloody vaginal discharge. Her mother suspects sexual abuse becase she doesn't "know of any other reason why a little girl should be bleeing from her vagina." She has no other medi
Bacterial infection
A 6-year-old girl is brought to you because she had four urinary tract infections within the last 3 months. While the mother is holding her, you examine her genitalia. There is lack of pubic hair. The labia minora are in apposition but are easily separabl
Sitz bath
(Prolapsed urethra- small, hemorrhagic, friable (blood on cotton swab), painless mass surrounding the urethra.)
A 24-year-old woman, gravida 1, para 1, just delivered a live female infant by natural birth. The infant weighed 3990 g and had APGARs of 8 and 9 at 1 and 5 minutes, respectively. Upon inspection of the neonate, the pediatricians are unable to assign a ge
Serum sodium level
(Congenital adrenal hyperplasia--21-hydroxylase deficiency-- is the MCC of virilization. Salt-wasting type of CAH can be life threatening.)
You are a world-renowned reproductive endocrinologist and are asked to make a diagnosis for a patient who has ambiguous genitalia. Here are the data:
Karyotype XY
Spermatogenesis Absent
Mullerian structures Absent
Wolffian structures Present
External geni
Reifenstein syndrome
(Incomplete androgen insensitivity syndrome)
A 50-year-old woman has menses every 2-3 months and hot flashes that wake her. She falls asleep in the afternoon at work because she doesn't sleep well at night. She is otherwise healthy and has no medical risk factors. She asks you if she is at risk for
Discuss using a low-dose combination hormonal contraceptive with her
A healthy 35-year-old woman, G2P2, presents with a history of regular menses since age 14, until her last period 1 year ago. Her hCG is negative, serum estradiol less than 20 pg/mL, FSH and LH greater than 100 mIU/mL, and prolactin less than 20 ng/mL. She
This is a typical menopausal woman
(Premature ovarian failure: menopause prior to age 40. Increased fracture risk.)
Current studies regarding the risks and benefits of HT/ET put perimenopausal and menopausal women in a treatment dilemma. Which of the following is true?
HT/ET should be given in the lowest doses for the shortest duration of time needed to achieve the desired effect
A frail 70-year-old woman with her FMP at age 51 complains of back pain and a 4-inch loss in height. Spine films confirm the presence of multiple osteoporosis-related vertebral compression fractures. Her DEXA hip T-score = -2.7. Your concerns for manageme
Concern that the patient's positive smoking history will exclude her from therapy to prevent future fractures
A 55-year old woman with her FMP at age 50 presents with a history of 3 days of light vaginal bleeding. You should:
Take a history, perform a physical exam, perform endometrial tissue sampling, and order a pelvic ultrasound or perform hysteroscopy
A 24-year-old woman, gravida 3, para 3, who just delivered a healthy boy and is breastfeeding him. She is a successful model and cannot tolerate excessive weight gain. She had never been able to remember to take a pill daily. Which is the best method of c
Progesterone IUD
A 29-year-old woman who has factor V Lediden deficiency and a bicornuate uterus. She is a librarian who exercises 6 days a week in order to maintain her physique. She has had several tummultuous relationships this year. She tries to use condoms in additio
Progestin-only pill (minipill)
A 28-year-old nulliparous physician who has a history of major depression. She is on call in the hospital every 4 days and sometimes forgets to take her antidepressant medication. She has been in a new relationship for the past 2 months. She always uses c
Vaginal contraceptive ring
A 26-year-old woman, gravida 4, para 4, is happily married. She has regular periods that last 9 to 10 days, are extremely heavy, and are associated with severe cramping. She is fairly sure she has completed childbearing. Which is the best method of contra
Progesterone IUD
Your 24-year-old multiparous patient is interested in long-term contraception, but is concerned that the copper IUD acts as an abortifacient. The best guidance you could giver her is:
The main way in which the copper IUD prevents pregnancy is by acting as a spermicide
A 25-year-old woman, gravida 1, para 0, therapeutic abortions (TAB) 1, presents to the emergency department and is being evaluated for date rape, which occurred 12 hours ago. She says that the rapist forced himself onto her and had time to ejaculate insid
Plan B 150 mg now
Papular rash, arthitis, and perihepatic "violin-string" adhesions. What is the causative agent?
Gram-negative diplococcus
Vulvar ulcer, marked inguinal lymphadenopathy, diagnosis by complement fixation. What is the causative agent?
Obligatory intracellular bacteria (L subtypes)
Congenital infection consisting of nonimmune hydrops, skin rash, and hepatomegaly. What is the causative agent?
Spirochete
Presence of lesion associated with prodromal symptoms. What is the causative agent?
ds-DNA virus (subtypes 1 and 2)
Vaccine currently available. What is the causative agent?
ds-DNA virus (subtypes 6/11 and 16, 18, 35, etc.)
A 22-year-old nulligravid woman presents to you because of a 5-day history of frequent urination and dysuria. She was seen by a doctor 2 days ago and prescribed ampicillin. She has no remarkable medical history. She is sexually active and recently began h
Azithromycin
(Chlamydia - nongonoccal urethritis)
A 26-year-old woman, gravida 1, para 0, at 14 weeks of gestation, presents to you because of increased vaginal discharge. You perform a wet mount and test for gonorrhea and chlamydia by NAAT. The results of NAAT are positive for chlamydia. The next step i
Azythromycin (patient and partner) + TOC 5 weeks + RS 4 months
(Azythromycin is safe in pregnancy.)
A 20-year-old presents to you with a deep, excavating, painless lesion above the clitoris, overlying the pubic bone. Her serum VDRL is positive. A lumbar puncture and analysis of her CSF also yields a positive VDRL. The best term to describe her lesion is
Gumma
A 17-year-old adolescent presents to your office reporting intense itching "down there." You perform a wet mount and KOH prep but are unable to find anything remarkable. Examination of her pubic hair in the area of the mons with a hand lens reveals severa
Permethrin 5% for 10 hours + wash bed sheets
(Scabies treatment requires more potent agents, longer duration of treatment, and neck-down treatment -- in contrast to lice. Additionally, all bedding and clothing must be washed and decontaminated.)
A 19-year-old woman, whose LMP was 32 days ago and who is sexually active, presents to the emergency department reporting a 5-day history of lower abdominal pain. Her vitals are: T 101F, BP 110/75, P 80, R 16. Speculum exam revelas purulent exudate at the
Clindamycin and gentamicin intravenously
(PID during pregnancy.)
The most important reason that PID must be recognized and treated promptly is prevention of:
Tubo-ovarian abscess
A 17-year-old woman has symptoms suggestive of PID. However, the patient is adamant that she is a virgin. If the signs of PID are present because of inflammation involving the uterus, tubes, and ovaries, the most likely diagnosis is:
Appendicitis
A 22-year-old woman, gravida 1, para 0, total abortions 1, presents to the emergency department reporting a 6-day history of lower abdominal pain and purulent vaginal discharge. She denies past medical history or surgery. Her vitals are: T 102F, BP 118/78
Pelvic ultrasound
A 22-year-old woman, gravida 1, para 0, total abortions 1, presents to the emergency department reporting a 6-day history of lower abdominal pain and purulent vaginal discharge. Bimanual exam reveals severe cervical motion tenderness and uterine tendernes
Pelvic examination
A married, 26-year-old woman, gravida 4, para 3, at 30 weeks' gestation, presents to you for routine prenatal care. Her medical history is remarkable for active hepatitis B and moderate asthma. She had an appendectomy 4 years ago. She has no known drug al
Are you afraid of your husband?
A 27-year-old woman, gravida 3, para 2, spontaneous abortions 1, has been beaten many times by her husband. She wants help, but she has not told anyone about what has been happening. The most likely reason that she has not told the physician is:
She is afraid of retaliation by the partner, especially on the children
A woman discloses to her physician that her husband beats her when he is drunk and that she is afraid of him. The physician's main role is to:
Focus on patient safety issues, such as exit plans and copies of important documents
Intimate partner violence significantly increases in incidence:
Shortly after the birth of an infant
A 36-year-old woman gravida 4, para 4, presents to your clinic because she has had bilateral white-colored nipple discharge for the last 3 months. She breastfed her last baby, but that ended almost 2 years ago. She has no past medical history other than d
Obtain a prolactin level
A 30-year-old woman, gravida 2, para 2, presents to your office reporting a mass in her right breast that she just noticed on breast self-examination. She has no medical problems. There is no history of breast or ovarian cancer in her family. Her examinat
Obtain an ultrasound of the mass
(If the lesion is cystic, then aspirate. If it is solid, then get a mammogram.)
A 60-year-old woman, gravida 3, para 2, spontaneous abortions 1, presents to your clinic reporting brownish red-colored discharge from her left nipple. Her past medical history and medications, respectively, are diabetes, oral hypoglycemic; hypertension,
Ultrasound
(?The first step is obtaining a mammogram. An ultrasound could be considered if a mass is seen on mammogram.)
A 28-year-old woman, gravida 2, para 2, who delivered a healthy female infant 10 days ago, comes to labor and delivery because of a tender breast mass on the right. She is breastfeeding exclusively. On examination of her breasts you note bilateral mild en
Heat compresses
Embryologic homolog in the male is the floor of the penile urethra. What is the female anatomic site?
Labia minora
Embryologic homolog in the male is the Cowper glands. What is the female anatomic site?
Bartholin gland
Contains sebaceous glands but not hair follicles or sweat glands; is a paired structure. What is the female anatomic site?
Labia minora
Source of vaginal lubrication during intercourse. What is the female anatomic site?
Cervical
Azygous artery of the vagina. What is the female anatomic site?
Cervical
A 23-year-old woman, gravida 2, para 1, at 10 weeks' gestation, presents to your office and reports increasing yellow vaginal discharge that has an odor. A vaginal smear reveals clue cells. She denies pruritis. She does not have any significant medical hi
Vaginal metronidazole
A 25-year-old woman, gravida 1, para 1, presents to your office reporting four recurrent yeast infections within the last 2 months. You perform a wet mount and a 10% KOH prep and confirm presence of many pseudohyphae and absence of clue cells or leukocyte
Screen for HIV
A 19-year-old woman complains of increasing discharge and odor. Her pH is 5.5, and wet mount reveals lack of leukocytes and protozoa. What is the diagnosis?
Bacterial vaginosis
A 24-year-old woman who is 2 months pospartum and is breastfeeding reports itching and dyspareunia. Speculum examination reveals pale, dry vaginal walls. What is the diagnosis?
Atrophic vaginitis
(?Atrophic vaginitis is unlikely in a young woman who is not estrogen deprived.)
A wet mount shows a predominance of cells with large nuclei (parabasal cells). What is the diagnosis?
Atrophic vaginitis
A 60-year-old woman, gravida 5, para 4, spontaneous abortions 1, has been treated with vaginal estrogen therapy, various pelvic muscle rehabilitation therapies, and pessaries for symptoms of pelvic prolapse without incontinence for the past 2 years. She d
Vaginal hysterectomy and anterior repair
(Hysterectomy cures uterine prolapse, anterior repair cures cystocele. Since anterior repair is performed vaginally, the hysterectomy should also be done vaginally.)
A 32-year-old woman, gravida 3, para 3, just delivered a viable female infant weighing 4000 g via cesarean section for nonreassuring fetal heart rate pattern. She received intrathecal (spinal) anesthetic and narcotic for pain relief during the procedure.
Overflow incontinence
A 56-year-old woman, gravida 2, para 2, who reports leaking urine when she coughs and exercises, is diagnosed with genuine stress urinary incontinence. A regimen of Kegel exercises does not improve her symptoms, and she denies more definitive treatment. H
Risk of urinary retention
A 67-year-old woman, gravida 3, para 3, presents to your office reporting incontinence. She tells you that she voids almost 40 times during the day and has several episodes of nocturia. She says she feels like voiding two to three times an hour and that w
Urinalysis
(Rule out urinary tract infection.)
A 55-year-old Caucasian woman, gravida 3, para 3, who delivered all of her children by scheduled cesarean sections (prior to initiation of labor), has mild pelvic organ prolapse. She had her last period 3 years ago and since that time has been on estrogen
Genetic
Advanced cervical cancer can affect this structure by extension and pressure effects.
Ureter
Advanced ovarian cancer often affects this structure by spread and encroachment
Intestine
HPV is associated with the development of cervical, vaginal, vulvar, and anal cancers. Which of the following statements is true?
The quadrivalent vaccine that is currently approved for prevention of HPV infection is over 95% effective in preventing HPV 16- and 18-related cervical cancers
A 40-year-old woman, gravida 1, para 1, presents to you because she wants to derease her risk of ovarian cancer via a prophylactic oophorectomy. She has no chronic medical problems except obesity. Her gynecologic history is remarkable for first sexual int
Family history
A 23-year-old woman, gravida 1, para 0, spontaneous abortions 1, has undergone colposcopy for evaluation of high-grade lesion found on Pap smear. The squamocolumnar junction was visible in its entirety, and the endocervical curettage was normal. A directe
Cold knife conization of cervix (CKC)
Most common histology for cervical cancer
Squamous
Subtype of endometrial cancer with very poor prognosis; is also type of borderline ovarian tumor
Papillary serous
Most common malignant germ cell tumor
Dysgerminoma
Uncommon, aggressive vulvar cancer that is known as the most common cancer to metastasize to the placenta
Melanoma
Most common endometrial cancer
Endometroid
It is important for a physician to _____ when counseling a couple who wishes artificial insemination
Explain that there is no guarantee of pregnancy if protocol is followed
An obstetrician is called at home by a woman who is in labor. Although she has never been to see the obstetrician for a prenatal visit, she would like him to deliver her infant. The obstetrician refuses to attend to her because he is in the middle of dinn
The physician never accepted the woman as his patient
A gynecologist has a longstanding relationship with a patient. The woman becomes pregnant but does not inform her gynecologist of her pregnancy and is not scheduled to see him until the next annual visit. One Saturday she calls to report nausea and vomiti
The premature delivery and fetal death was unrelated to the physician's time on vacation
A 34-year-old woman, gravida 1, para 1, delivers a boy with Tay-Sachs disease. Eight year later, she and her husband obtain the services of a lawyer and sue the physician, alleging that he was remiss in genetic counseling, and because of this, a child wit
Wrongful birth
(Wrongful birth action is brought by the parents of a child with a congenital defect, alleging that a physician was remiss in genetic counseling, and as a result a defective child was allowed to be born.)