1. History & Physical/Obstetrics/Gynecology
A 26 year-old monogamous female presents with cyclic pelvic pain that has been increasing over the last 6
... [Show More] months. She complains of significant dysmenorrhea and dyspareunia. She uses condoms for birth control. On physical examination her uterus is retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative. Which of the following is the most likely diagnosis?
A. Ovarian cancer
B. Endometriosis
C. Functional ovarian cyst
D. Pelvic inflammatory disease
(u) A. It is important to consider ovarian cancer in a patient with a pelvic mass however, ovarian cancer usually occurs in older women over age 55 and patients are often asymptomatic until the disease is more advanced
(c) B. With endometriosis, the uterus is often fixed and retroflexed in the pelvis. The palpable mass is an endometrioma or "chocolate cyst". The patient with endometriosis also often has dysmenorrhea, dyspareunia, and dyschezia.
(u) C. Functional ovarian cysts occur from ovulation and usually are not symptomatic.
(u) D. With PID the patient will have abdominal tenderness, adnexal tenderness, cervical motion tenderness and an elevated temperature.
2. Health Maintenance/Obstetrics/Gynecology
What is the recommended method for screening pregnant women for gestational diabetes?
A. Fasting blood sugar and 2 hour post prandial
B. 50 gram glucose load followed by a blood sugar in 1 hour
C. 75 gram glucose load followed by a blood sugar in 2 hours
D. 100 gram glucose load followed by a blood sugar at 1 hour, 2 hours, and 3 hours
(u) A. Fasting blood sugar and 2 hour postprandial blood test is used to follow patient with gestational diabetes.
(c) B. One hour Glucola is the screening test for gestational diabetes. It is a 50 gram glucose load, with a serum glucose obtained 1 hour after the dose. Normal value is less than 140 mg/dL.
(u) C. A 75 gram glucose load is used in non-pregnant patients.
(u) D. This describes a three-hour GTT, which is ordered if the 1 hour Glucola is elevated above 140 gm/dL.
3. Clinical Therapeutics/Obstetrics/Gynecology
What is the treatment of magnesium sulfate toxicity?
A. Nifedipine
B. Terbutaline
C. Potassium carbonate
D. Calcium gluconate
(u) A. Nifedipine, a calcium-channel blocker is used to treat both preterm labor and hypertension in pregnancy. It works by inhibiting calcium transport through slow-type channels, causing reduction in systemic and pulmonary vascular resistance and tocolysis.
(u) B. Terbutaline is a beta-blocker that is used to treat pre-term labor.
(u) C. Potassium carbonate is a treatment for metabolic acidosis, not magnesium sulfate toxicity.
(c) D. 10% calcium gluconate is used to treat magnesium sulfate toxicity.
4. Clinical Intervention/Obstetrics/Gynecology
A 52 year-old obese patient with persistent heavy menses undergoes an endometrial biopsy and is diagnosed with atypical adenomatous hyperplasia. What is the next step in the management of this patient?
A. Total abdominal hysterectomy
B. Observation and endometrial biopsy in 3 months
C. Endometrial curettage followed by progesterone daily
D. Oral progesterone days 16-25 of the month for 6 months and repeat biopsy
(c) A. Atypical adenomatous hyperplasia contains cellular atypia and mitotic figures in addition to glandular crowding and complexity. This has a 20-30% risk of progression to endometrial cancer and the recommendation is hysterectomy.
(h) B. Observation and biopsy again in 3 months would increase the risk of endometrial cancer for this patient.
(h) C. Endometrial curettage would remove the hyperplasia and progesterone will decrease the endometrial glandular proliferation. This would be appropriate management in a patient with endometrial hyperplasia without atypia.
(h) D. Oral progesterone for 10 days of the month will cause the patient to have a withdrawal bleed every month. This would be an appropriate treatment in a premenopausal patient with endometrial hyperplasia without atypia
5. Diagnostic Studies/Obstetrics/Gynecology
A 23 year-old female is in active labor and has progressed from 3 cm to 6 cm in the last six hours. Fetal monitoring demonstrates mild repetitive late decelerations. Which of the following is the most likely cause of this finding?
A. Fetal hypoxia
B. Head compression
C. Cord compression
D. Uteroplacental insufficiency
(u) A. Fetal hypoxia would be a concern if deep late FHR decelerations were present with absent beat-to-beat variability.
(u) B. Early decelerations are due to head compression of the fetus. Pressure on the fetal head causes an alteration in cerebral blood flow causing a central vagal stimulation and subsequent FHR deceleration. The deceleration is a mirror image of the contraction.
(u) C. Variable decelerations are from cord compression. The decelerations have a sharp, angular, decline in FHR with duration less than 2 minutes.
(c) D. Late decelerations are from uteroplacental insufficiency. The decelerations have a smooth, gradual symmetrical decrease in FHR beginning at or after the peak of the contraction.
6. Diagnosis/Obstetrics/Gynecology
A 16 year-old G0P0 patient presents complaining of lower pelvic pain that alternates from right to left side of her pelvis. She states that it is related to her cycle and occurs most commonly midcycle. She denies sexual activity. She reports that she has taken ibuprofen at the time of the discomfort with some relief. Her pelvic examination is unremarkable. Which of the following is the most likely diagnosis?
A. Endometriosis
B. Mittelschmerz
C. Functional ovarian cyst
D. Pelvic inflammatory disease 29
(u) A. With endometriosis, the uterus is often fixed and retroflexed in the pelvis. The palpable mass is an endometrioma or "chocolate cyst". The patient with endometriosis also often has dysmenorrhea, dyspareunia, and dyschezia.
(c) B. Women may experience pain at the time of ovulation, may alternate side to side.
(u) C. Functional ovarian cysts occur from ovulation and are not usually symptomatic.
(u) D. Patients with pelvic inflammatory disease often present with fever, pain, and more acute symptoms.
7. Clinical Therapeutics/Obstetrics/Gynecology
A patient with preterm labor may be given corticosteroids to
A. decrease uterine activity.
B. prevent chorioamnionitis.
C. enhance fetal lung maturity.
D. prevent the development of gestational diabetes.
(u) A. Tocolytics are given to decrease uterine activity with preterm labor.
(u) B. IV antibiotics are given to patients with chorioamnionitis.
(c) C. Corticosteroids may be given from 24-34 weeks in patients with preterm labor or who have pregnancy complications which may cause premature birth. The corticosteroids enhance pulmonary maturity.
(u) D. There are no medications to prevent the development of gestational diabetes, however, patients who have gestational diabetes may be treated with a diabetic diet and/or insulin to manage the condition and decrease complications.
8. History & Physical/Obstetrics/Gynecology
An 18 year-old female comes to the clinic with the complaint of increased vaginal discharge and vaginal odor. She also complains of urinary frequency. On physical examination there is evidence of thin, gray, frothy discharge in the vagina. The cervix appears erythematous and the vaginal pH is 6. Which of the following is the most likely diagnosis?
A. Candida vaginitis
B. Bacterial vaginosis
C. Trichomonas vaginitis
D. Chlamydia trachomatis
(u) A. Patients with a yeast infection most often present with vulvar/vaginal pruritus, burning, dyspareunia "cottage- cheese" discharge which is odorless, pH is often normal 4-4.5.
(u) B. Symptoms from bacterial vaginosis include ivory to gray discharge, thin, homogeneous, adherent, often increased pH 5-6.5 (basic), distinctive "fishy" odor, itching may be present. Malodorous discharge is especially noticeable by the patient after menses or intercourse.
(c) C. Signs of trichomonas include: thin frothy or bubbly, pale yellow-green to gray adherent vaginal discharge, can have erythema of vulva and vagina, may have petechiae on the cervix, amine odor may be present, may also complain of dysuria and dyspareunia, pH 5 to 6.5 (basic).
(u) D. Patients with Chlamydia are often asymptomatic but may have mucopurulent discharge and cervical inflammation.
9. Scientific Concepts/Obstetrics/Gynecology
Mastitis associated with breastfeeding is most commonly caused by what bacteria?
A. Listeria monocytogenes
B. Escherichia coli
C. Staphylococcus aureus
D. Streptococcus pyogenes
(u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. The most common pathogen associated with postpartum mastitis is Staphylococcus aureus which arises from the nursing infant's throat and nose.
(u) D. See C for explanation.
10. Clinical Intervention/Obstetrics/Gynecology
A 40 year-old female presents with a Pap smear abnormality revealing atypical glandular cells (AGUS). What is the most appropriate intervention?
A. HPV DNA testing
B. Colposcopy with endometrial curretage(ECC)
C. Repeat Pap smear in 3 months
D. Colposcopy and endometrial sampling
(u) A. HPV DNA testing is recommended to further evaluate patients with Pap smears with dysplasia.
(u) B. Colposcopy with ECC would be recommended in patients with ASCUS, LGSIL, HGSIL, or squamous cell findings on a Pap smear.
(u) C. Repeat Pap smear would be recommended in patients with ASCUS, not AGUS, results on a Pap smear.
(c) D. Colposcopy and endometrial sampling are important to perform in patients with AGUS Pap results because glandular cells are associated with squamous and glandular precursor lesions and carcinoma.
11. Health Maintenance/Obstetrics/Gynecology
What is the most common cause of secondary amenorrhea?
A. Pregnancy
B. Ovarian failure
C. Imperforate hymen
D. Hypothalamic amenorrhea
(c) A. Pregnancy is the most common cause of amenorrhea and is essential to exclude by a serum or urine pregnancy test.
(u) B. With ovarian failure, the ovarian follicles are resistant to stimulation. Ovarian failure can be caused by chromosomal abnormalities, premature menopause, or a complication of chemotherapy.
(u) C. An imperforate hymen would prevent menstrual bleeding, this is a cause of primary amenorrhea.
(u) D. The pulsatile release of GnRH is disrupted and the anterior pituitary gland is not stimulated to release FSH and LH. This can be caused by different etiologies including: weight loss, weight gain, excessive exercise, drug induced, tumors, anorexia, and other chronic medical illnesses.
12. Diagnostic Studies/Obstetrics/Gynecology
Which of the following tests is the most specific for the diagnosis of syphilis?
A. Rapid plasma reagin (RPR)
B. Weil-Felix agglutination test
C. Venereal Disease Research Laboratory (VDRL)
D. Fluorescent treponemal antibody absorption (FTA-ABS)
(u) A. The RPR is a non-specific test. False positives are common.
(u) B. The Weil-Felix agglutination test is used for rickettsial infections not syphilis.
(u) C. The VDRL if positive must by confirmed with an additional testing because of a large number of false positives including bacterial and viral infections, pregnancy, chronic liver disease, connective tissue disorders.
(c) D. The FTA-ABS and the MTA-TP are specific treponemal tests used for the confirmation of syphilis. [Show Less]