( New ) Part 6 ( 1483-1529 )(1275-1529) Neymar 7

A vibrant illustration of a pregnant woman in a doctor's office, surrounded by medical charts and educational materials related to women's health care.

Comprehensive Women's Health Quiz

Test your knowledge with our extensive quiz covering various aspects of women's health! This quiz consists of 140 multiple-choice questions designed to challenge your understanding of obstetrics, gynecology, and maternal medicine.

Whether you're a student preparing for exams, a teacher looking for supplemental material, or simply someone interested in women's health issues, this quiz is a great resource. Key features include:

  • Detailed questions based on real-world scenarios
  • Scores to track your performance
  • A great way to review essential concepts in women's health
140 Questions35 MinutesCreated by CaringHeart257
A 29-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the labor and delivery ward with frequent painful contractions. Her prenatal course was significant for a urine culture that showed 100,000 colony forming units/milliliter of Group-B streptococci and asthma, for which she uses an albuterol inhaler. Examination shows that she is contracting every 2 minutes and her cervix is 5 centimeters dilated and 100% effaced. Which of the following medications should this patient be treated with during labor and delivery?
Penicillin
Magnesium sulfate
Betamethasone
Oxytocin
Folic acid
A 32-year-old woman comes to the hospital for an elective repeat cesarean delivery. Four years ago she had a primary cesarean delivery for a nonreassuring fetal heart rate tracing. Two years ago she chose to have an elective repeat cesarean delivery rather than attempt a vaginal birth after cesarean (VBAC). Her prenatal course was uncomplicated except that she has mitral valve prolapse. An echocardiograph demonstrated the mitral valve prolapse, but no other structural cardiac disease. Which of the following is the correct management of this patient?
No antibiotics are needed
Administer oral antibiotics 6 hours after the procedure
Administer intravenous antibiotics 30 minutes prior to the procedure
Administer intravenous antibiotics for 24 hours after the procedure
Administer intravenous antibiotics immediately after the procedure
A 38-year-old woman, gravida 4, para 4, comes to the physician 8 days after a cesarean delivery complaining of redness and pain at the leftmost aspect of her incision. Her cesarean delivery was performed secondary to a non reassuring fetal heart rate tracing. She was feeling well after the operation until 4 days ago, when she developed pain and redness around her incision. Her temperature is 37 C (98.6 F), blood pressure is 118/78 mm Hg, pulse is 88/min, and respirations are 12/min. There is marked erythema and induration around the incision. At the left margin of the incision there is a fluctuant mass. Which of the following is most appropriate next step in management?
Incision and drainage
Laparotomy
Expectant management
IV antibiotics only
Oral antibiotics only
A 39-year-old woman, gravida 3, para 2, at term comes to the labor and delivery ward complaining of a gush of fluid. Examination shows her to be grossly ruptured, and ultrasound reveals that the fetus is in vertex presentation. The fetal heart rate is in the 120s and reactive. After a few hours, with no contractions present, oxytocin is started. Three hours later, the tocodynamometer shows the patient to be having contractions every minute and lasting for approximately 1 minute with almost no rest in between contractions. The fetal heart rate changes from 120s and reactive to a bradycardia to the 80s. Sterile vaginal examination shows that the cervix is 6 cm dilated. Which of the following is the most appropriate next step in management?
Discontinue oxytocin
Perform cesarean delivery
Start magnesium sulfate
Perform vacuum assisted vaginal delivery
Perform forceps assisted vaginal delivery
A 22-year-old primigravid woman at term comes to the labor and delivery ward because of painful contractions every 2 minutes. She has had no gush of fluid and no bleeding from the vagina. Her prenatal course was unremarkable. She takes no medications and has no allergies to medications. Examination shows that her cervix is 6 cm dilated and 100% effaced; the fetus is at 0 station. The fetal heart rate has a baseline in the 150s and is reactive. The patient desires an epidural for pain relief. Which of the following should be given orally shortly before the epidural is placed?
Antacid
Clear liquid meal
Antibiotic
Regular "house" meal
Aspirin
A 39-year-old woman, gravida 4, para 3, comes to the physician for a prenatal visit. Her last menstrual period was 8 weeks ago. She has had no abdominal pain or vaginal bleeding. She has no medical problems. Examination is unremarkable except for an 8-week sized, nontender uterus. Prenatal labs are sent. The rapid plasma reagin (RPR) test comes back as positive and a confirmatory microhemagglutination assay for antibodies to Treponema pallidum (MHA-TP) test also comes back as positive. Which of the following is the most appropriate pharmacotherapy?
Penicillin
Tetracycline
Erythromycin
Metronidazole
Levofloxacin
A 21-year-old woman, gravida 2, para 1, at 22 weeks' gestation comes to the physician because of a malodorous vaginal discharge. She states that she first noticed the discharge 2 days ago and since then it has become more profuse and malodorous. Her prenatal course has been unremarkable during this pregnancy. Her prior pregnancy was complicated by preterm labor and delivery at 31 weeks' gestation. Examination shows a grayish vaginal discharge. A strong amine odor is released when KOH is applied to a sample of the discharge. Examination of a normal saline ("wet") preparation reveals numerous "clue" cells. Which of the following is the most appropriate pharmacotherapy?
Oral metronidazole
Oral penicillin
No treatment is needed
IV penicillin
Intramuscular penicillin
A 23-year-old woman comes to the physician because she thinks that she may be pregnant. She missed her last two periods and feels "different." A urine pregnancy test is positive and an ultrasound reveals a 12-week fetus. The patient is very concerned because she received the measles-mumpsrubella (MMR) vaccine four months ago and was told to wait 3 months before attempting conception. The pregnancy is desired. The patient asks if she should have a termination of pregnancy because she was vaccinated shortly before becoming pregnant. Which of the following is the most appropriate response?
The vaccine risk is low and is not in itself a reason to terminate
The vaccine risk is high and termination is mandated
There is no vaccine risk and termination is completely inappropriate
The vaccine risk is high and termination should be strongly considered
The vaccine risk is moderate and termination should be considered
A 22-year-old woman comes to the physician because of a missed menstrual period. She has a complex past medical history. She has hypothyroidism, for which she takes thyroxine, she has an artificial heart valve, for which she takes Coumadin, and she recently started tetracycline for acne. She does not think that she is pregnant because she is currently on the oral contraceptive pill, but, if pregnant, she would keep the pregnancy. Physical examination, including pelvic examination, is unremarkable. Urine human chorionic gonadotropin (hCG) is positive. Which of the following medications should the patient continue to take during the pregnancy?
Thyroxine
Discontinue all medications
Coumadin
Tetracycline
Oral contraceptive pill (OCP)
A 19-year-old nulligravid woman comes to the emergency department because of severe left lower quadrant pain. She has been noticing this pain intermittently for the past 3 days, but this afternoon it became persistent and severe and was accompanied by nausea and vomiting. Examination shows left lower quadrant tenderness and a tender left adnexal mass. Urine hCG is negative. Pelvic ultrasound shows a 7 cm left ovarian complex mass. Which of the following is the most appropriate next step in management?
Laparoscopy
Oophorectomy
Expectant management
Intravenous antibiotics
Follow-up ultrasound in 6 weeks
A 26-year-old primigravid woman at 12 weeks' gestation comes to the physician because of pain and swelling in her right thigh. She first noted the onset of the pain 2 days ago, and since then it has grown worse. An ultrasound study performed on her lower-extremity venous system reveals evidence of a proximal thrombus in the right leg. She is started on low-molecular-weight heparin injections. Which of the following is an advantage of low molecular-weight heparin compared with unfractionated heparin?
Low-molecular-weight heparin is less likely to cause thrombocytopenia
Ow-molecular-weight heparin is less likely to cross the placenta
Low-molecular-weight heparin has a shorter half-life
Low-molecular-weight heparin is less likely to cause birth defects
Low-molecular-weight heparin is cheaper
A 29-year-old female comes to the physician because of fevers and back pain. She is otherwise healthy with no significant past medical history. Examination is significant for a temperature of 38.3 C (101 F), moderate costovertebral angle tenderness, leukocytosis, and white blood cells and red blood cells in the urine. The patients is diagnosed with pyelonephritis and started on intravenous antibiotics. Over the next two days, she rapidly improves, and by hospital day 3, she is tolerating oral intake, voiding without difficulty, feeling no pain, and she has not had a fever for 48 hours. Which of the following is the most appropriate next step in management?
Discharge home to complete a 2-week course of oral antibiotics
Obtain surgical evaluation
Continue intravenous antibiotics for 2 weeks
Discharge home off all antibiotics
Discharge home and recommend post-coital prophylaxis
A 47-year-old woman comes to the physician for an annual examination. One year ago, she was diagnosed with endometrial carcinoma and underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. She was found to have grade I, stage I, disease at that time. Over the past year, she has developed severe hot flashes that occur throughout the day and night and are worsening. She is also concerned because her mother and several of her aunts have severe osteoporosis. She wonders whether she can take estrogen replacement therapy. Which of the following is the most appropriate response?
Estrogen replacement therapy may be used, but there are risks
Estrogen replacement therapy will lead to cancer recurrence
Estrogen replacement therapy is absolutely contraindicated
Estrogen replacement therapy will lead to breast cancer
Estrogen replacement therapy may be used, and there are no risks
A 32-year-old woman, gravida 3, para 0, at 29 weeks' gestation comes to the physician for a prenatal visit. She has no complaints. She had a prophylactic cerclage placed at 12 weeks' gestation because of her history of two consecutive 20-week losses. These spontaneous abortions were both characterized by painless cervical dilation, with the membranes found bulging into the vagina on examination. Ultrasound now demonstrates her cervix to be long and closed with no evidence of funneling. Which of the following is the most appropriate time to remove the cerclage from this patient?
36-38 weeks
38-40 weeks
30-32 weeks
34-36 weeks
32-34 weeks
A 55-year-old woman comes to the physician because of hot flashes. She first noted them about 9 months ago, and since then they have been worsening. She states that the flashes come on at various times throughout the day, but that they are especially intense at night. She had her last menstrual period approximately 5 months ago. Her medical history is significant for a pulmonary embolus at the age of 36 and severe depression. She takes fluoxetine for depression and has no allergies to medications but smokes one pack of cigarettes per day. Physical examination is unremarkable, including a normal pelvic examination. Which of the following is the most appropriate pharmacotherapy for this patient?
Clonidine
Tamoxifen
Estrogen and progesterone
Glucophage
Estrogen only
A 42-year-old woman, gravida 2, para 1, at 10 weeks' gestation comes to the physician for her first prenatal visit. She has no complaints. She has a history of Trichomonas infection, but no other medical problems. Examination is significant for a 10-week sized, nontender uterus. During the speculum examination, a Pap smear is performed and gonorrhea and Chlamydia screening tests are taken. The next day, the gonorrhea test returns as positive. Which of the following is the most appropriate pharmacotherapy?
Ceftriaxone
Levofloxacin
Clindamycin
Metronidazole
Doxycycline
A 54-year-old woman comes to the physician because of hot flashes. She states that her hot flashes have been steadily worsening over the past year since she had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for menometrorrhagia. Pathology from the surgery showed low grade endometrial hyperplasia. She has no medical problems and takes no medications. Her family history is unremarkable except for a strong family history of osteoporosis. She states that the hot flashes have become absolutely debilitating for her and she wants to take something that will give her the best chance of stopping them. Which of the following is the most appropriate pharmacotherapy?
Estrogen
Oral contraceptive pill
Alprazolam
Raloxifene
Clonidine
A 22-year-old primigravid woman at 8 weeks' gestation comes to the physician for her first prenatal visit. She has had some nausea but no other complaints. She has had no bleeding per vagina or abdominal pain. She had an ovarian cystectomy at age 18 but no other medical or surgical problems. She takes no medications and has no known drug allergies. Examination is unremarkable except for an 8-week-sized non-tender uterus. The patient wants information on vitamin supplementation during pregnancy. Which of the following represents the correct amount of vitamin A supplementation this patient should take daily?
Vitamin A supplementation during pregnancy is not recommended
100,000 IU
10,000 IU
50,000 IU
25,000 IU
A 29-year-old woman comes to the emergency department because of abdominal distension and shortness of breath. Approximately 1 week ago, she underwent fertility treatment with ovulation induction and oocyte retrieval. She has a history of polycystic ovarian syndrome but no other medical problems. She had laparoscopy 1 year ago as part of a fertility evaluation. She has no known drug allergies. Her temperature is 37 C (98.6 F), blood pressure is 80/40 mm Hg, pulse is 130/min, and respirations are 28/min. Physical examination is remarkable for crackles at the lung bases bilaterally and a distended, nontender abdomen with a fluid wave. Ultrasound demonstrates bilaterally enlarged ovaries (each >10 cm) and free fluid in the abdomen. Urine hCG is negative. Which of the following is the most likely diagnosis?
Ovarian hyperstimulation syndrome
Ovarian torsion
Ectopic pregnancy
Tubo-ovarian abscess
Hemorrhagic ovarian cyst
A 24-year-old woman, gravida 3, para 2, comes to the physician for her first prenatal visit. Her last menstrual period was 8 weeks ago, and a home pregnancy test was positive. She states that this pregnancy, like her last two pregnancies, was unintended. She had been using condoms for birth control in all three instances. She had normal vaginal deliveries 2 and 4 years ago. Which of the following is the most likely reason for condom failure?
Improper and inconsistent use
Vaginal infection
Allergic reaction
Manufacturing defects
Breakage
A 38-year-old woman, gravida 1, para 0, at 8 weeks' gestation comes to the physician for a prenatal visit. She has had no bleeding from the vagina or abdominal pain and no complaints. She has a long history of migraine headache and recently developed peptic ulcer disease (PUD). Examination shows a nontender 8-week sized uterus but is otherwise unremarkable. The patient is very concerned that her migraine headaches and peptic ulcer disease will make her pregnancy intolerable. Which of the following is the most appropriate response?
Pregnancy is associated with improvement of migraines and PUD
Pregnancy has no effect on migraines or PUD.
Pregnancy is associated with worsening of migraines and PUD.
Pregnancy is associated with improved migraines and worsened PUD
Pregnancy is associated with worsening migraines and improved PUD
A 31-year-old African-American woman is diagnosed with uterine fibroids. Which of the following types of fibroids is most likely to interfere with conception and pregnancy?
Submucosal
Subserosal
Intracavitary
Pedunculated
Intramural
A 19-year-old nulligravid woman comes to the physician for a routine annual check-up. She complains of weight gain of approximately 10 lbs (4.5 kg) over the last year. She feels that this is related to her oral contraceptive pill use. She has no previous medical problems. She became sexually active at the age of 18. She has been sexually active with one partner for the past 2 months. She and her partner use condoms inconsistently, but use combination oral contraceptive pills regularly for contraception. Vital signs are normal. Her body mass index is 25 kg/m2. Physical examination shows no abnormalities. Which of the following is the most appropriate advice to give to this patient?
Reassure that the weight gain is not related to oral contraceptive pills
Only intrauterine device is useful
Discontinue oral contraceptive pills and perform a Pap smear now
Recommend switching from contraceptive pills to medroxyprogesterone
Recommend continuing oral contraceptive pills and perform a Pap smear now
Mifepristone is an effective abortifacient if given within 72 hours of intercourse. Mifepristone contains which of the following?
Progesterone antagonist
Progestin only
Estrogen and progestin
Prostaglandin
High-dose estrogen only
A 45-year-old African-American woman who was diagnosed with PCOS in her early twenties presents to her gynecologist for her annual visit. One of her close friends has recently been diagnosed with ovarian cancer, so she is concerned about her own cancer risk. Menarche was at age 14 years, and she has yet to go through menopause. She has a healthy 19-yearold daughter. She has no family history of cancer. She does not smoke or drink and exercises regularly. Aside from a diagnosis of PCOS, she is otherwise in good health. Given her health history, which of the following statements is true?
She should have annual mammograms because she has an increased risk of developing breast cancer relative to women without PCOS
She should have annual Pap smears because she has an increased risk of developing cervical cancer relative to women without PCOS
She should have annual mammograms, although her risk of breast cancer is not changed relative to women without PCOS
She should have annual Pap smears because she has an increased risk of developing ovarian cancer relative to women without PCOS
She should have annual Pap smears, although she has a decreased risk of developing cervical cancer relative to women without PCOS
A pregnant woman is discovered to be an asymptomatic carrier of Neisseria gonorrhoeae. A year ago, she was treated with penicillin for a gonococcal infection and developed a severe allergic reaction. Which of the following is the treatment of choice at this time?
Spectinomycin
Chloramphenicol
Tetracycline
Penicillin
Ampicillin
A 17-year-old woman at 22 weeks gestation presents to the emergency center with a 3-day history of nausea, vomiting, and abdominal pain. The pain started in the middle of the abdomen and is now located along her mid to upper right side. She is noted to have a temperature of 38.4C (101.1F). She denies any past medical problems or surgeries. How does pregnancy alter the diagnosis and treatment of the disease?
The incidence is unchanged in pregnancy
The incidence is higher in pregnancy
Owing to anatomical and physiological changes in pregnancy, diagnosis is easier to make.
Fetal outcome is improved with delayed diagnosis.
Surgical treatment should be delayed since the patient is pregnant
An 18-year-old G1 has asymptomatic bacteriuria (ASB) at her first prenatal visit at 15 weeks gestation. Which of the following statements is true?
Twenty-five percent of women with ASB subsequently develop an acute symptomatic urinary infection during the same pregnancy and should be treated with antibiotics
ASB is highly associated with adverse pregnancy outcomes.
The prevalence of ASB during pregnancy may be as great as 30%.
Fifteen percent of women develop a urinary tract infection after an initial negative urine culture.
There is a decreased incidence of ASB in women with sickle cell trait.
A 20-year-old female at 34 weeks of gestation develops a lower urinary tract infection. Which of the following is the best choice for treatment?
Cephalosporin
Ciprofloxacin
Tetracycline
Nitrofurantoin
Sulfonamide
A 30-year-old African-American woman with type-1 diabetes and hypertension comes to the physician's office after obtaining a positive result from a home pregnancy test. She takes insulin and enalapril. She does not use tobacco, alcohol or illicit drugs. Her temperature is 37.2 C (99.0F), blood pressure is 130/80 mm Hg, pulse is 72/min, and respirations are 14/min. Physical examination is unremarkable. Her BUN is 18 mg/dl and creatinine is 1.4 mg/dl. A repeat 13-HCG test performed in the office confirms pregnancy. Which of the following is the most appropriate next step in management?
Stop enalapril and start labetalol
Continue current therapy
Stop enalapril and start furosemide
Stop enalapril and start losartan
Continue enalapril and add methyldopa
A 33-year-old woman at 10 weeks presents for her first prenatal examination. Routine labs are drawn and her hepatitis B surface antigen is positive. Liver function tests are normal and her hepatitis B core and surface antibody tests are negative. Which of the following is the best way to prevent neonatal infection?
Provide immune globulin and the hepatitis B vaccine to the neonate
Provide hepatitis B vaccine to the neonate
Provide immune globulin to the mother
Perform a cesarean delivery at term
Provide hepatitis B vaccine to the mother
A 25-year-old G2P0 at 30 weeks gestation presents with the complaint of a new rash and itching on her abdomen over the last few weeks. She denies any constitutional symptoms or any new lotions, soaps, or detergents. On examination she is afebrile with a small, papular rash on her trunk and forearms. Excoriations from scratching are also noted. Which of the following is the recommended firstline treatment for this patient?
Topical steroids and oral antihistamines
Antibiotic therapy
Delivery
Oral steroids
Cholestyramine
A 23-year-old G3P2002 presents for a routine obstetric (OB) visit at 34 weeks. She reports a history of genital herpes for 5 years. She reports that she has had only two outbreaks during the pregnancy, but is very concerned about the possibility of transmitting this infection to her baby. Which of the following statements is accurate regarding how this patient should be counseled?
Suppressive antiviral therapy can be started at 36 weeks to help prevent an outbreak from occurring at the time of delivery
Starting at 36 weeks, weekly genital herpes cultures should be done.
There is no risk of neonatal infection during a vaginal delivery if no lesions are present at the time the patient goes into labor
The herpes virus is commonly transmitted across the placenta in a patient with a history of herpes
The patient should be scheduled for an elective cesarean section at 39 weeks of gestation to avoid neonatal infection
A 23-year-old G1P0 reports to your office for a routine OB visit at 28 weeks gestational age. Labs drawn at her prenatal visit 2 weeks ago reveal a 1-hour glucose test of 128, hemoglobin of 10.8, and a platelet count of 80,000. All her other labs were within normal limits. During the present visit, the patient has a blood pressure of 120/70 mm Hg. Her urine dip is negative for protein, glucose, and blood. The patient denies any complaints. The only medication she is currently taking is a prenatal vitamin. She does report a history of epistaxis on occasion, but no other bleeding. Which of the following medical treatments should you recommend to treat the thrombocytopenia?
No treatment is necessary
Intravenous immune globulin
Stop prenatal vitamins
Splenectomy
Oral corticosteroid therapy
A 21-year-old G2P1 at 25 weeks gestation presents to the emergency room complaining of shortness of breath. She reports a history of asthma and states her peak expiratory flow rate (PEFR) with good control is usually around 400. During speaking the patient has to stop to catch her breath between words; her PEFR is 210. An arterial blood gas is drawn and oxygen therapy is initiated. She is afebrile and on physical examination expiratory wheezes are heard in all lung fields. Which of the following is the most appropriate next step in her management?
Inhaled β-agonist
Theophylline
Antibiotics
Intravenous corticosteroids
Chest x-ray
A 20-year-old G1 at 38 weeks gestation presents with regular painful contractions every 3 to 4 minutes lasting 60 seconds. On pelvic examination, she is 3 cm dilated and 90% effaced; an amniotomy is performed and clear fluid is noted. The patient receives epidural analgesia for pain management. The fetal heart rate tracing is reactive. One hour later on repeat examination, her cervix is 5 cm dilated and 100% effaced. Which of the following is the best next step in her management?
No intervention; labor is progressing normally
Perform cesarean delivery for inadequate cervical effacement
Begin pushing
Stop epidural infusion to enhance contractions and cervical change
Initiate Pitocin augmentation for protracted labor
A 30-year-old G2P0 at 39 weeks is admitted in active labor with spontaneous rupture of membranes occurring 2 hours prior to admission. The patient noted clear fluid at the time. On examination, her cervix is 4 cm dilated and completely effaced. The fetal head is at 0 station and the fetal heart rate tracing is reactive. Two hours later on repeat examination her cervix is 5 cm dilated and the fetal head is at +1 station. Early decelerations are noted on the fetal heart rate tracing. Which of the following is the best next step in her labor management?
Initiate Pitocin augmentation
Perform cesarean delivery of early decelerations
Administer terbutaline
Perform cesarean delivery for arrest of descent
Initiate amnioinfusion
A 32-year-old G3P2 at 39 weeks gestation with an epidural has been pushing for 30 minutes with good descent. The presenting fetal head is left occiput anterior with less than 45 degree of rotation with a station of +3 of 5. The fetal heart rate has been in the 90s for the past 5 minutes and the delivery is expedited with forceps. Which of the following best describes the type of forceps delivery performed?
Low forceps
Rotational forceps
Outlet forceps
High forceps
Midforceps
A 27-year-old G2P1 at 38 weeks gestation was admitted in active labor at 4 cm dilated; spontaneous rupture of membranes occurred prior to admission. She has had one prior uncomplicated vaginal delivery and denies any medical problems or past surgery. She reports an allergy to sulfa drugs. Currently, her vital signs are normal and the fetal heart rate tracing is reactive. Her prenatal record indicates that her Group B streptococcus (GBS) culture at 36 weeks was positive. What is the recommended antibiotic for prophylaxis during labor?
Penicillin
Vancomycin
Cefazolin
Erythromycin
Clindamycin
A 23-year-old G1 at 38 weeks gestation presents in active labor at 6 cm dilated with ruptured membranes. On cervical examination the fetal nose, eyes, and lips can be palpated. The fetal heart rate tracing is 140 beats per minute with accelerations and no decelerations. The patient’s pelvis is adequate. Which of the following is the most appropriate management for this patient?
Allow spontaneous labor with vaginal delivery
Allow patient to labor spontaneously until complete cervical dilation is achieved and then perform an internal podalic version with breech extraction.
Perform immediate cesarean section without labor.
Attempt manual conversion of the face to vertex in the second stage of labor.
Perform forceps rotation in the second stage of labor to convert mentum posterior to mentum anterior and to allow vaginal delivery.
You are following a 38-year-old G2P1 at 39 weeks in labor. She has had one prior vaginal delivery of a 3800-g infant. One week ago, the estimated fetal weight was 3200 g by ultrasound. Over the past 3 hours her cervical examination remains unchanged at 6 cm. Fetal heart rate tracing is reactive. An intrauterine pressure catheter (IUPC) reveals two contractions in 10 minutes with amplitude of 40 mm Hg each. Which of the following is the best management for this patient?
Administration of oxytocin
Cesarean section
Ambulation
Expectant
Sedation
A primipara is in labor and an episiotomy is about to be cut. Compared with a midline episiotomy, which of the following is an advantage of mediolateral episiotomy?
Less extension of the incision
Less dyspareunia
Ease of repair
Less blood loss
Fewer breakdowns
A 27-year-old woman (G3P2) comes to the delivery floor at 37 weeks gestation. She has had no prenatal care. She complains that, on bending down to pick up her 2-year-old child, she experienced sudden, severe back pain that now has persisted for 2 hours. Approximately 30 minutes ago she noted bright red blood coming from her vagina. By the time she arrives at the delivery floor, she is contracting strongly every 3 minutes; the uterus is quite firm even between contractions. By abdominal palpation, the fetus is vertex with the head deeply engaged. Fetal heart rate is 130 beats per minutes. The fundus is 38 cm above the symphysis. Blood for clotting is drawn, and a clot forms in 4 minutes. Clotting studies are sent to the laboratory. Which of the following actions can most likely wait until the patient is stabilized?
Administering oxytocin
Preparing for cesarean section
Stabilizing maternal circulation
Inserting an intrauterine pressure catheter
Attaching a fetal electronic monitor
A 19-year-old G1 at 40 weeks gestation presents to the hospital with the complaint of contractions. She states they are very painful and occurring every 3 to 5 minutes. She reports good fetal movement and denies any leakage of fluid or vaginal bleeding. The nurse places an external tocometer and fetal monitor and reports that the patient is having contractions every 4 to 12 minutes. The nurse states that the contractions are mild to moderate to palpation. On examination the cervix is 1 cm dilated, 60% effaced, and the vertex is at −1 station. The patient had the same cervical examination in your office last week. The fetal heart rate tracing is 140 beats per minute with accelerations and no decelerations. Which of the following is the most appropriate next step in the management of this patient?
Send her home
Augment labor with Pitocin
Admit her for an epidural for pain control
Administer terbutaline
Rupture membranes
A 38-year-old G3P2 at 40 weeks gestation presents to labor and delivery with gross rupture of membranes occurring 1 hour prior to arrival. The patient is having contraction every 3 to 4 minutes on the external tocometer, and each contraction lasts 60 seconds. The fetal heart rate tracing is 120 beats per minute with accelerations and no decelerations. The patient has a history of rapid vaginal deliveries, and her largest baby was 3200 g. On cervical examination she is 5 cm dilated and completely effaced, with the vertex at −2 station. The estimated fetal weight is 3300 g. The patient is in a lot of pain and requesting medication. Which of the following is the most appropriate method of pain control for this patient?
Epidural block
General anesthesia
Intramuscular Demerol
Local block
Pudendal block
You are following a 22-year-old G2P1 at 39 weeks during her labor. She is given an epidural for pain management. Three hours after administrating the pain medication, the patient’s cervical examination is unchanged. Her contractions are now every 2 to 3 minutes, lasting 60 seconds. The fetal heart rate tracing is 120 beats per minute with accelerations and early decelerations. Which of the following is the best next step in management of this patient?
Place an IUPC
Administer Pitocin for augmentation of labor
Place a fetal scalp electrode
Prepare for a cesarean section secondary to a diagnosis of secondary arrest of labor
Rebolus the patient’s epidural
A 25-year-old G3P2 at 39 weeks is admitted in labor at 5 cm dilated. The fetal heart rate tracing is reactive. Two hours later, she is reexamined and her cervix is unchanged at 5 cm dilated. An IUPC is placed and the patient is noted to have 280 Montevideo units (MUV) by the IUPC. After an additional 2 hours of labor, the patient is noted to still be 5 cm dilated. The fetal heart rate tracing remains reactive. Which of the following is the best next step in the management of this labor?
Perform a cesarean section
Perform an operative delivery with forceps
Continue to wait and observe the patient
Attempt delivery via vacuum extraction
Augment labor with Pitocin
You are delivering a 26-year-old G3P2002 at 40 weeks. She has a history of two previous uncomplicated vaginal deliveries and has had no complications this pregnancy. After 15 minutes of pushing, the baby’s head delivers spontaneously, but then retracts back against the perineum. As you apply gentle downward traction to the head, the baby’s anterior shoulder fails to deliver. Which of the following is the best next step in the management of this patient?
Call for help
Push the baby’s head back into the pelvis
Cut a symphysiotomy
Perform a Zavanelli maneuver
Instruct the nurse to apply fundal pressure
A 41-year-old G1P0 at 39 weeks, who has been completely dilated and pushing for 3 hours, has an epidural in place and remains undelivered. She is exhausted and crying and tells you that she can no longer push. Her temperature is 38.3C (101F). The fetal heart rate is in the 190s with decreased variability. The patient’s membranes have been ruptured for over 24 hours, and she has been receiving intravenous penicillin for a history of colonization with group B streptococcus bacteria. The patient’s cervix is completely dilated and effaced and the fetal head is in the direct OA position and is visible at the introitus between pushes. Extensive caput is noted, but the fetal bones are at the +3 station. Which of the following is the most appropriate next step in the management of this patient?
Attempt operative delivery with forceps
Cut a fourth-degree episiotomy
Deliver the patient by cesarean section
Rebolus the patient’s epidural
Encourage the patient to continue to push after a short rest
A 28-year-old G1 at 38 weeks had a normal progression of her labor. She has an epidural and has been pushing for 2 hours. The fetal head is direct occiput anterior at +3 station. The fetal heart rate tracing is 150 beats per minute with variable decelerations. With the patient’s last push the fetal heart rate had a prolonged deceleration to the 80s for 3 minutes. You recommend forceps to assist the delivery owing to the nonreassuring fetal heart rate tracing. Compared to the use of the vacuum extractor, forceps are associated with an increased risk of which of the following neonatal complications?
Corneal abrasions
Intracranial hemorrhage
Cephalohematoma
Jaundice
Retinal hemorrhage
You performed a forceps-assisted vaginal delivery on a 20-year-old G1 at 40 weeks for maternal exhaustion. The patient had pushed for 3 hours with an epidural for pain management. A second-degree episiotomy was cut to facilitate delivery. Eight hours after delivery, you are called to see the patient because she is unable to void and complains of severe pain. On examination you note a large fluctuant purple mass inside the vagina. What is the best management for this patient?
Incision and evacuation of the hematoma
Place a vaginal pack for 24 hours
Apply an ice pack to the perineum
Perform dilation and curettage to remove retained placenta
Embolize the internal iliac artery
A 20-year-old G1 at 41 weeks has been pushing for 21/2 hours. The fetal head is at the introitus and beginning to crown. It is necessary to cut an episiotomy. The tear extends through the sphincter of the rectum, but the rectal mucosa is intact. How should you classify this type of episiotomy?
Third-degree
Mediolateral episiotomy
First-degree
Fourth-degree
Second-degree
A 16-year-old G1P0 at 38 weeks gestation comes to the labor and delivery suite for the second time during the same weekend that you are on call. She initially presented to labor and delivery at 2:00 PM Saturday afternoon complaining of regular uterine contractions. Her cervix was 1 cm dilated, 50% effaced with the vertex at −1 station, and she was sent home after walking for 2 hours in the hospital without any cervical change. It is now Sunday night at 8:00 PM, and the patient returns to labor and delivery with increasing pain. She is exhausted because she did not sleep the night before because her contractions kept waking her up. The patient is placed on the external fetal monitor. Her contractions are occurring every 2 to 3 minutes. You reexamine the patient and determine that her cervix is unchanged. Which of the following is the best next step in the management of this patient?
Administer 10 mg intramuscular morphine
Achieve cervical ripening with prostaglandin gel
Perform artificial rupture of membranes to initiate labor
Administer Pitocin to augment labor
Administer an epidural
A 24-year-old G1P1 presents for her routine postpartum visit 6 weeks after an uncomplicated vaginal delivery. She states that she is having problems sleeping and is feeling depressed over the past 2 to 3 weeks. She reveals that she cries on most days and feels anxious about taking care of her newborn son. She denies any weight loss or gain, but states she doesn’t feel like eating or doing any of her normal activities. She denies suicidal or homicidal ideation. Which of the following is true regarding this patient’s condition?
About 8% to 15% of women develop postpartum depression
Postpartum depression is a self-limiting process that lasts for a maximum of 3 months.
A history of depression is not a risk factor for developing postpartum depression.
Young, multiparous patients are at highest risk.
Prenatal preventive intervention for patients at high risk for postpartum depression is best managed alone by a mental health professional.
A 35-year-old G3P3 presents to your office 3 weeks after an uncomplicated vaginal delivery. She has been successfully breast-feeding. She complains of chills and a fever to 38.3C (101F) at home. She states that she feels like she has flu, but denies any sick contacts. She has no medical problems or prior surgeries. The patient denies any medicine allergies. On examination she has a low-grade temperature of 38C (100.4F) and generally appears in no distress. Head, ear, throat, lung, cardiac, abdominal, and pelvic examinations are within normal limits. A triangular area of erythema is located in the upper outer quadrant of the left breast. The area is tender to palpation. No masses are felt and no axillary lymphadenopathy is noted. Which of the following is the best option for treatment of this patient?
Oral dicloxacillin for 7 to 10 days
Oral erythromycin for 7 to 10 days
Admission to the hospital for intravenous antibiotics
Incision and drainage
Antipyretic for symptomatic relief
A 30-year-old G5P3 has undergone a repeat cesarean delivery. She wants to breast-feed. Her past medical history is significant for hepatitis B infection, hypothyroidism, depression, and breast reduction. She is receiving intravenous antibiotics for endometritis. Which of the following would prevent her from breast-feeding?
Maternal reduction mammoplasty with transplantation of the nipples
Past hepatitis B infection
Maternal treatment with ampicillin
Maternal treatment with levothyroxine
Maternal treatment with fluoxetine
A 23-year-old G2P2 requires a cesarean delivery for arrest of active phase. During labor she develops chorioamnionitis and is started on ampicillin and gentamicin. The antibiotics are continued after the cesarean delivery. On postoperative day 3, the patient remains febrile and symptomatic with uterine fundal tenderness. No masses are appreciated by pelvic examination. She is successfully breastfeeding and her breast examination is normal. Which antibiotic should be initiated to provide better coverage?
Clindamycin
Vancomycin
Cephalothin
Levofloxacin
Polymixin
A 21-year-old G2P2 calls her physician 7 days postpartum because she is concerned that she is still bleeding from the vagina. She describes the bleeding as light pink to bright red and less heavy than the first few days postdelivery. She denies fever or any cramping pain. On examination she is afebrile and has an appropriately sized, nontender uterus. The vagina contains about 10 cc of old, dark blood. The cervix is closed. Which of the following is the most appropriate treatment?
Reassurance
Oxytocin for uterine atony
Antibiotics for endometritis
Suction dilation and curettage for retained placenta
High-dose oral estrogen for placental subinvolution
A 28-year-old G2P2 presents to the hospital 2 weeks after vaginal delivery with the complaint of heavy vaginal bleeding that soaks a sanitary napkin every hour. Her pulse is 89 beats per minute, blood pressure 120/76 mm Hg, and temperature 37.1C (98.9F). Her abdomen is nontender and her fundus is located above the symphysis pubis. On pelvic examination, her vagina contained small blood clots and no active bleeding is noted from the cervix. Her uterus is about 12 to 14 weeks size and nontender. Her cervix is closed. An ultrasound reveals an 8-mm endometrial stripe. Her hemoglobin is 10.9, unchanged from the one at her vaginal delivery. β-hCG is negative. Which of the following potential treatments would be contraindicated?
Dilation and curettage
Ergonovine maleate (Ergotrate)
Methylergonovine maleate (Methergine)
Prostaglandins
Oxytocin injection (Pitocin)
You are called to see a 37-year-old G4P4 for a fever to 38.7C (101.8F). She is postoperative day 3 after cesarean delivery for arrest of active-phase labor. She underwent a long induction for postdate pregnancy and had rupture of membranes for more than 18 hours. Her other vital signs include pulse 118 beats per minute, respiratory rate 16 breaths per minute, and blood pressure 120/80 mm Hg. She complains of some incisional and abdominal pain, but is otherwise fine. HEENT, lung, breast, and cardiac examinations are within normal limits. On abdominal examination she has uterine fundal tenderness. Her incision has mild erythema around the staple edges and serous drainage along the left side. Pelvic examination reveals a tender uterus, but no adnexal masses. Which of the following is the most appropriate antibiotic to treat this patient with initially?
Intravenous cefotetan
Intravenous gentamicin
Oral Bactrim
Oral ciprofloxacin
Oral dicloxacillin
You are doing postpartum rounds on a 23-year-old G1P1 who is postpartum day 2 after an uncomplicated vaginal delivery. As you walk in the room, you note that she is crying. She states she can’t seem to help it. She denies feeling sad or anxious. She has not been sleeping well because of getting up every 2 to 3 hours to breast-feed her new baby. Her past medical history is unremarkable. Which of the following is the most appropriate treatment recommendation?
Time and reassurance, because this condition is self-limited
A sleep aid
Referral to psychiatry for counseling and antidepressant therapy
Referral to a psychiatrist who can administer electroconvulsive therapy
Referral to psychiatry for admission to a psychiatry ward and therapy with Haldol
A 20-year-old G1P1 is postpartum day 2 after an uncomplicated vaginal delivery of a 6-lb 10-oz baby boy. She is trying to decide whether to have you perform a circumcision on her newborn. The boy is in the wellbaby nursery and is doing very well. In counseling this patient, you tell her which of the following recommendations from the American Pediatric Association?
Circumcisions should not be performed routinely because of insufficient data regarding risks and benefits
Circumcisions should be performed routinely because they decrease the incidence of sexually transmitted diseases
Circumcisions should be performed routinely because they decrease the incidence of male urinary tract infections
Circumcisions should not be performed routinely because it is a risky procedure and complications such as bleeding and infection are common.
Circumcisions should be performed routinely because they decrease the incidence of penile cancer.
You are counseling a new mother and father on the risks and benefits of circumcision for their 1day-old son. The parents ask if you will use analgesia during the circumcision. What do you tell them regarding the recommendations for administering pain medicine for circumcisions?
Analgesia in the form of a penile block is recommended.
The administration of sugar orally during the procedure will keep the neonate preoccupied and happy.
Analgesia is not recommended because there is no evidence that newborns undergoing circumcision experience pain.
Analgesia in the form of oral Tylenol is the pain medicine of choice recommended for circumcisions.
Analgesia is not recommended because it is unsafe in newborns.
You are asked to assist in the well-born nursery with neonatal care. Which of the following is a part of routine care in a healthy infant?
Administration of hepatitis B vaccination for routine immunization
Cool-water bath to remove vernix
Administration of ceftriaxone cream to the eyes for prophylaxis for gonorrhea and chlamydia
Placement of a computer chip in left buttock for identification purposes
Administration of vitamin A to prevent bleeding problems
You are making rounds on a 29-year-old G1P1 who underwent an uncomplicated vaginal delivery at term on the previous day. The patient is still very confused about whether she wants to breast-feed. She is a very busy lawyer and is planning on going back to work in 4 weeks, and she does not think that she has the time and dedication that breast-feeding requires. She asks you what you think is best for her to do. Which of the following is an accurate statement regarding breast-feeding?
Breast-feeding is associated with a decreased incidence of sudden infant death syndrome
Breast-feeding is associated with an increased incidence of childhood obesity
Breast-feeding decreases the time to return of normal menstrual cycles.
Breast-feeding is associated with a decreased incidence of childhood attention deficit disorder
Breast-feeding is a poor source of nutrients for required infant growth.
A 22-year-old G1P1 who is postpartum day 2 and is bottle-feeding complains that her breasts are very engorged and tender. She wants you to give her something to make the engorgement go away. Which of the following is recommended to relieve her symptoms?
Breast binder
Use oral antibiotics
Bromocriptine
Pump her breasts
Estrogen-containing contraceptive pills
A 36-year-old G1P1 comes to see you for a routine postpartum examination 6 weeks after an uncomplicated vaginal delivery. She is currently nursing her baby without any major problems and wants to continue to do so for at least 9 months. She is ready to resume sexual activity and wants to know what her options are for birth control. She does not have any medical problems. She is a nonsmoker and is not taking any medications except for her prenatal vitamins. Which of the following methods may decrease her milk supply?
Combination oral contraceptives
Foam and condoms
Intrauterine device
Depo-Provera
Progestin only pill
A 30-year-old G3P3, who is 8 weeks postpartum and regularly breast-feeding calls you and is very concerned because she is having pain with intercourse secondary to vaginal dryness. Which of the following should you recommend to help her with this problem?
Apply estrogen cream to the vagina and vulva
Apply petroleum jelly to the perineum
Instruct her to stop breast-feeding
Apply testosterone cream to the vulva and vagina
Apply hydrocortisone cream to the perineum
A 39-year-old G3P3 comes to see you on day 5 after a second repeat cesarean delivery. She is concerned because her incision has become very red and tender and pus started draining from a small opening in the incision this morning. She has been experiencing general malaise and reports a fever of 38.8C (102F). Physical examination indicates that the Pfannenstiel incision is indeed erythematous and is open about 1 cm at the left corner, and is draining a small amount of purulent liquid. There is tenderness along the wound edges. Which of the following is the best next step in the management of this patient?
Probe the fascia
Take the patient to the OR for debridement and closure of the skin
Apply Steri-Strips to close the wound
Reapproximate the wound edge under local analgesia
Administer antifungal medication
A 72-year-old G5P5 presents to your office for well-woman examination. Her last examination was 7 years ago, when she turned 65. She has routine checks and laboratory tests with her internist each year. Her last mammogram was 6 months ago and was normal. She takes a diuretic for hypertension. She is a retired school teacher. Her physical examination is normal. Which of the following is the best vaccination to recommend to this patient?
Influenza vaccine
Pneumocystis
Diphtheria-pertussis
Measles-mumps-rubella
Hepatitis B vaccine
A 15-year-old woman presents to your office for her first wellwoman examination while she is on summer break from school. She denies any medical problems or prior surgeries. She had chicken pox at age 4. Her menses started at the age of 12 and are regular. She has recently become sexually active with her 16-year-old boyfriend. She states that they use condoms for contraception. Her physical examination is normal. Which of the following vaccines is appropriate to administer to this patient?
Hepatitis B vaccine
Influenza vaccine
Hepatitis A vaccine
Varicella vaccine
Pneumococcal vaccine
A 26-year-old woman presents to your office for her well-woman examination. She denies any medical problems or prior surgeries. She states that her cycles are monthly. She is sexually active and uses oral contraceptive pills for birth control. Her physical examination is normal. As part of preventive health maintenance, you recommend breast self-examination and instruct the patient how to do it. Which of the following is the best frequency and time to perform breast self-examinations?
Monthly, in the week after cessation of menses
Every 3 months, in the week prior to the start of the menses
Monthly, in the week prior to the start of the menses
Every 6 months, in the week prior to the start of the menses
Monthly, during the menses
A 29-year-old woman, gravida 2, para 1, at 37 weeks gestation was admitted to the hospital. Her previous pregnancy was uncomplicated and she delivered a 3,500 g (7.7lb) baby vaginally. The current pregnancy demonstrated a breech presentation at 30 weeks gestation. A repeat ultrasonogram now shows persistent frank breech presentation with an estimated fetal weight of 2,800 g (6lb). No fetal or uterine abnormalities are noted. She has intact membranes. Examination shows a closed cervix. Fetal heart monitoring is reassuring. Which of the following is the most appropriate next step in management?
External cephalic version
Allow normal vaginal delivery
Cesarean section
Apply forceps now
Internal podalic version
A 19-year-old primigravid woman at 32 weeks gestation comes to the physician's office because of weight gain and mild generalized body swelling. She has no previous medical problems and her pregnancy has been otherwise uncomplicated. Her blood pressure is 150/90 mm Hg. Physical examination shows mild generalized edema; the remainder of her examination is unremarkable. A fetal heart tracing is reassuring. Laboratory studies show: Hematocrit: 48%, Platelets: 230,000/mm3, Serum creatinine: 1.0 g/dl, Alanine aminotransferase: 35 U/L, Urinalysis: 2+protein. Amniotic fluid analysis shows immature fetal lungs. She lives close to the hospital and is compliant with medication follow-ups. Which of the following is the most appropriate next step in management ?
Recommend bed rest at home with frequent follow-up
Start furosemide and lisinopril to prevent further edema from protein
Immediate induction of vaginal delivery
Schedule a cesarean section as soon as possible
Start intravenous magnesium sulfate and admit her for close monitoring
A 32-year-old woman, gravida 3, para 2, at 30 weeks gestation comes to the hospital because of new onset painful, regular uterine contractions that began 5 hours ago. Her pregnancy has been uncomplicated. Her second pregnancy was complicated by preterm labor at 28 weeks gestation. She has no discharge, leakage of fluid or bleeding from the vagina; she has no dysuria or urgency. Her temperature is 37.0C (98.7F), blood pressure is 125/70 mmHg, pulse is 80/min and respirations are 18/min. Pelvic examination shows a soft, partially effaced and posterior cervix dilated to 2cm. A Nitrazine test is negative. Nonstress test shows a reassuring fetal heart pattern and uterine contractions occurring every 7 minutes. Which of the following is the most appropriate next step in management?
Tocolysis
Augment delivery
Amnioinfusion
Cervical cerclage
Reassure and discharge home
A 42-year-old G4P3104 presents for her well-woman examination. She has had three vaginal deliveries and one cesarean delivery for breech. She states her cycles are regular and denies any sexually transmitted diseases. Currently she and her husband use condoms, but they hate the hassle of a coitaldependent method. She is interested in a more effective contraception because they do not want any more children. She reports occasional migraine headaches and had a serious allergic reaction to anesthesia as a child when she underwent a tonsillectomy. She drinks and smokes socially. She weighs 78 kg, and her blood pressure is 142/89 mm Hg. During her office visit, you counsel the patient at length regarding birth control methods. Which of the following is the most appropriate contraceptive method for this patient?
Intrauterine device
Diaphragm
Bilateral tubal ligation
Transdermal patch
Combination oral contraceptives
A 48-year-old G2P2 presents for her well-woman examination. She had two uneventful vaginal deliveries. She had a vaginal hysterectomy for fibroids and menorrhagia. She denies any medical problems, but has not seen a doctor in 6 years. Her family history is significant for stroke, diabetes, and high blood pressure. On examination she is a pleasant female, stands 5 ft 3 in tall, and weighs 85 kg. Her blood pressure is 150/92 mm Hg, pulse 70 beats per minute, respiratory rate 14 breaths per minute, and temperature 37C (98.4F). Her breast, lung, cardiac, abdomen, and pelvic examinations are normal. The next appropriate step in the management of this patient’s blood pressure is which of the following?
Diet, exercise, weight loss, and repeat blood pressure in 2 months
Diuretic
Beta-blocker
NSAID
Calcium channel blocker
A 32-year-old female presents for her yearly examination. She has been smoking one pack of cigarettes a day for the past 12 years. She wants to stop, and you make some recommendations to her. Which of the following is true regarding smoking cessation in women?
No matter how long one has been smoking, smoking cessation appears to improve the health of the lungs.
Stopping cold turkey is the only way to successfully achieve smoking cessation
Ninety percent of those who stop smoking relapse within 3 months
Smokers do not benefit from repeated warnings from their doctor to stop smoking.
Nicotine replacement in the form of chewing gum or transdermal patches has not been shown to be effective in smoking cessation programs.
A 25-year-old woman has a positive cervical culture for Neisseria gonorrhoeae. She has had at least two positive cultures for gonorrhea treated in the past. She is afebrile and has no symptoms. The incidence of penicillin-resistant gonorrhea in some areas of the United States is currently as great as 10%. Because of this, the recommended treatment for gonorrhea includes which of the following?
125 mg intramuscular ceftriaxone as a single dose
2 g metronidazole as a single dose
1 g spectinomycin
2 g intramuscular cefoxitin
2 g ampicillin orally as a single dose
A 34-year-old woman presents to the physician's office for infertility evaluation. Her cycles have been irregular for the past 12 months and she hasn't had any periods for the past 3 months. Previously, her cycles were quite regular. She also has hot flashes, dyspareunia and mood disturbances. She has been married for 6 years and has a three-year-old daughter. She has a history of Hashimoto thyroiditis and is on thyroid replacement therapy. She smokes one pack of cigarettes daily. Vital signs are normal. Pelvic examination reveals atrophic vaginal mucosa. Serum FSH is markedly elevated, and serum prolactin is normal. Serum TSH is within normal limits. Which of the following is the most appropriate treatment for her infertility?
In vitro fertilization
Progesterone supplement
Clomiphene citrate
GnRH agonist
Metformin
You are seeing a 38-year-old woman for her annual gynecologic examination. She asks you for some information regarding the HPV vaccine and whether you think it would be appropriate for her 17year-old daughter. Which of the following statements regarding the quadrivalent human papillomavirus vaccine and HPV is true?
The vaccine is recommended for women ages 11–26 but can be given as young as age 9.
The vaccine is prepared from the proteins of four oncogenic (e.g., high-risk for cervical cancer) strains of HPV.
After vaccination, women no longer need routine Pap smears
Women with a prior history of abnormal Pap smears are not candidates for vaccination.
The vaccine is given every month for 3 months
A 24-year-old woman lost her previous two pregnancies at approximately 20 weeks’ gestation, without having noted any contractions. She is currently at 15 weeks’ gestation and denies having uterine contractions. Her cervix is undilated and uneffaced. Which of the following is the most appropriate management of this patient?
A cervical cerclage
DES
Bed rest
Hydroxyprogesterone
Terbutaline
On a routine annual examination, a 43-yearold woman is found to have a 2-cm mass in the lateral aspect of her right breast. Which of the following is the most appropriate next step in management?
Fine-needle aspiration
Segmental resection
Repeat the breast examination after her next menses
Open biopsy
Mammography
A nurse called to report a low grade temperature in a 20-year-old woman who delivered a healthy baby 12 hours earlier. She had a normal vaginal delivery, and the placenta was delivered spontaneously. She had shaking chills during and ten minutes following the delivery. She continues to have bloody vaginal discharge. Her temperature is 38.0C (100.4F), blood pressure is 120/80 mmHg, pulse is 76/min and respirations are 14/min. Pelvic examination shows bloody discharge along with small blood clots on the introitus and vaginal walls. Her uterus is soft and non-tender. Laboratory studies show a WBC of 11 ,000/mm3 with 78% neutrophils. Which of the following is the most appropriate next step in management?
Reassurance
Obtain urinalysis
Endometrial curettage
Culture of discharge
Start empiric antibiotics
A healthy 32-year-old primigravid woman at 12 weeks' gestation comes for a routine prenatal visit. She has no complaints. She does not smoke or consume alcohol. She has blood group 0, Rh+ and her husband has blood group AB, Rh+. She is concerned about the risk of alloimmunization because her mother had that problem during her second pregnancy. You respond that although the child will have a blood group different from hers, alloimmunization is of little concern because?
Antibodies to ABO antigens do not cross the placenta
Antibodies to ABO antigens are not hemolytic
Immune response is depressed in pregnancy
Mother is tolerant to child's ABO antigens
ABO antigens are weakly antigenic
A 37-year-old pregnant woman has a genetic amniocentesis at 16 weeks’ gestation. A concurrent ultrasound shows normal fetal anatomy. Her prenatal course has been unremarkable. Her prenatal laboratory tests include a B negative blood type, a negative rubella antibody titer, a negative hepatitis B surface antigen, and a hematocrit of 31%. Which of the following is the most appropriate management for this woman?
Administration of Rh immune globulin at the time of the amniocentesis
A follow-up ultrasound in 1 week to assess for intra-amniotic bleeding
Rubella immunization at the time of the amniocentesis
Chorionic villus biopsy at the time of the amniocentesis
A serologic test for the presence of hepatitis B surface antibody
A 19-year-old primigravida at term has been completely dilated for 21/2 hours. The vertex is at 2 to 3 station, and the position is occiput posterior. She complains of exhaustion and is unable to push effectively to expel the fetus. She has an anthropoid pelvis. Which of the following is the most appropriate management to deliver the fetus?
Apply forceps and deliver the baby as an occiput posterior
Apply Kielland forceps to rotate the baby to occiput anterior
Immediate low transverse cesarean section
Cut a generous episiotomy to make her pushing more effective
Immediate classical cesarean section
A pregnant woman has been taking phenytoin (Dilantin) for a seizure disorder. She is concerned that the drug will cause fetal abnormalities. Which of the following defects is the most common anomaly associated with phenytoin?
Cleft lip/palate
Hydrocephalus
Atrial septal defect
Spina bifida
Ventricular septal defect
A 39-year-old woman known to have fibrocystic disease of the breast complains of persistent fullness and pain in both breasts. Which of the following drugs will be most effective in relieving her symptoms?
Danazol
Medroxyprogesterone acetate
Tamoxifen
Hydrochlorothiazide
Bromocriptine
A couple consults you because each has neurofibromatosis and wish to know what their reproductive possibilities are. You should tell them which of the following?
75% or more of their offspring will have the disease.
25% of their offspring will be unaffected
The disease is lethal and results in spontaneous abortion of homozygous fetuses
50% of all offspring will be homozygous for the abnormal gene.
25% of the females will be affected.
A 35-year-old woman at 30 weeks’ gestation discovers a lump in her left breast. Examination reveals a 2–3 cm, firm nodule in the upper outer quadrant. Which of the following is the most appropriate next step in the management of this patient?
Fine-needle aspiration
Application of hot packs
Observation until after delivery
Breast ultrasound
Thermography
A 1-cm carcinoma of the breast is diagnosed by an excisional biopsy in a 36-year-old woman at 14 weeks’ gestation. The axillary nodes are negative. Which of the following is the best management of this patient?
Modified radical mastectomy at the time of diagnosis
Terminate the pregnancy immediately and treat the breast cancer
Induce labor at 34 weeks’ gestation, then give chemotherapy
Monitor the mass throughout pregnancy with serial breast ultrasounds
Perform a cesarean delivery at 36 weeks and treat the breast cancer
A 19-year-old woman, gravida 1, para 1, is immediately status post a normal spontaneous vaginal delivery and normal third stage when she develops brisk bright red bleeding from the vagina. Her prenatal course was unremarkable. She has asthma, which worsened during the pregnancy. Ten years ago, she had a tonsillectomy. She takes a steroid and albuterol inhaler. She has no known drug allergies. Her temperature is 37 C (98.6 F), blood pressure is 100/70 mm Hg, pulse is 115/min, and respirations are 16/min. Her abdomen is soft and non-tender. Her uterus is soft and "boggy" to palpation. Pelvic examination reveals no evidence of a laceration. Which of the following treatments should be avoided in managing this patient's postpartum hemorrhage?
15-methyl-prostaglandin F2ct (PGF2a)
Oxytocin
Acetaminophen
Methylergonovine
IV hydration
A 36-year-old woman, gravida 3, para 3, is 2 days status post cesarean section for dystocia when she begins wandering the hallways of the hospital at 2 AM. She is extremely confused and thinks that she is at the police station. She states that she cannot sleep, feels very anxious, and wants to hurt her baby. Her prenatal course was unremarkable. She has no medical problems and had never had surgery. She has been taking Tylenol with codeine postpartum for incisional pain. Which of the following is the most appropriate next step in the management?
Psychiatric hospitalization
Naloxone
Fluoxetine
Supervised visit to the nursery
Morphine
A 23-year-old woman, gravida 2, para 1 at 26 weeks' gestation, comes to the physician because of fevers and pain in the middle of the back on the right side. Her fevers started 2 days ago, and the back pain began yesterday. Her temperature is 38.3 C (101 F), blood pressure is 110/70 mm Hg, pulse is 110/min, and respirations are 16/min. She has left costovertebral angle tenderness. Her abdomen is benign and gravid. Her laboratory values show leukocytes of 18,000/mm3. Urinalysis reveals white blood cells that are too numerous to count per high powered field. Which of the following is the most appropriate pharmacotherapy for this patient?
Cefazolin
Metronidazole
Acyclovir
Tetracycline
Levofloxacin
A 42-year-old woman, gravida 4, para 3, at 38 weeks' gestation, comes to the labor and delivery ward complaining of contractions. She has had type 1 diabetes since the age of 20. She has a history of syphilis that was adequately treated 4 years ago. She took insulin and prenatal vitamins throughout the pregnancy. Otherwise, her prenatal course was unremarkable, including normal screening. Her blood pressure is 140/90 mm Hg. Her cervix is 4 cm dilated and 100% effaced. She is admitted. Which of the following IV medications will this patient likely require during labor and delivery to prevent neonatal complications?
Insulin
Meperidine
Hydralazine
Penicillin
Labetalol
A 22-year-old female comes to the physician complaining of pain during sexual activity. She is unable to have intercourse because her vagina becomes tense, resulting in intense pain upon penetration. She is living with her boyfriend and this is her first sexual relationship. She now avoids intercourse because of her fear of the pain. She has no history of serious illness. Speculum examination is not possible due to tense perineal musculature. Which of the following is the most appropriate next step in management?
Laparoscopy to visualize endometriosis
Kegel exercises and gradual dilatation
Advise self-stimulation techniques
Refer to a sex therapist
Prescribe vaginal lubricants
A 19-year-old college student presents to her primary care physician for emergency contraception. She had unprotected sexual intercourse 48-hours ago while on a trip to Mexico with her boyfriend. She wants to prevent pregnancy. Her last menstrual period was 18-days ago. She has no previous medical problems. Family history is significant for migraines in her mother. She does not use tobacco, alcohol or drugs. Vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?
Administer levonorgestrel
Prescribe prostaglandin E2 suppository
Tell her not to worry because the chances of getting pregnant are very low
Administer one intramuscular injection of medroxyprogesterone
Tell her it is too late to get emergency contraception
A 26-year-old woman, gravida 2, para 2, complains of loss of small amounts of urine immediately after a spontaneous vaginal delivery. She received epidural anesthesia during labor and delivery because of severe pain. She has no fever, dysuria, urgency, or hematuria. She has no other medical problems, takes no medication except prenatal vitamins, and has no known drug allergies. Her vital signs are normal. Examination shows a soft, non-tender abdomen. Pelvic examination is normal. The patient voids 30-40ml of urine each time; her postvoid residual volume is 400 ml. The patient's labs reveal: Urine: Specific gravity: 1.020, Blood: trace, Glucose: negative, Leukocyte esterase: negative, Nitrites: negative, WBC: 1-2/hpf, RBC: 3-4/hpf. Which of the following is the most appropriate treatment for her incontinence?
Do intermittent catheterization
Prescribe antibiotics
Place suprapubic catheter
Start oxybutynin
Place permanent Foley catheter
A 54-year-old woman undergoes a laparotomy because of a pelvic mass. At exploratory laparotomy, a unilateral ovarian neoplasm is discovered that is accompanied by a large omental metastasis. Frozen section diagnosis confirms metastatic serous cystadenocarcinoma. Which of the following is the most appropriate intraoperative course of action?
Omentectomy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy
Omentectomy and bilateral salpingo-oophorectomy
Excision of the omental metastasis and ovarian cystectomy
Excision of the omental metastasis and unilateral oophorectomy
Omentectomy and ovarian cystectomy
A 58-year-old woman is seen for evaluation of a swelling in her right vulva. She has also noted pain in this area when walking and during coitus. At the time of pelvic examination, a mildly tender, fluctuant mass is noted just outside the introitus in the right vulva in the region of the Bartholin gland. Which of the following is the most appropriate treatment?
Surgical excision
Incision and drainage
Marsupialization
Observation
Administration of antibiotics
A 35-year-old G3P3 with a Pap smear showing high-grade squamous intraepithelial lesion of the cervix (CIN III) has an inadequate colposcopy. Cone biopsy of the cervix shows squamous cell cancer that has invaded only 1 mm beyond the basement membrane. There are no confluent tongues of tumor, and there is no evidence of lymphatic or vascular invasion. The margins of the cone biopsy specimen are free of disease. The patient above now asks you for your advice on how to treat her cervical disease. Your best recommendation is for the patient to undergo which of the following?
Simple hysterectomy
Simple hysterectomy with pelvic lymphadenectomy
Treatment with external beam radiation
Radical hysterectomy
Implantation of radioactive cesium into the cervical canal
A woman is found to have a unilateral invasive vulvar carcinoma that is 2 cm in diameter but not associated with evidence of lymph node spread. Initial management should consist of which of the following?
Radical vulvectomy and bilateral inguinal lymphadenectomy
Radical vulvectomy
Chemotherapy
Simple vulvectomy
Radiation therapy
Stage Ib cervical cancer is diagnosed in a young woman who wishes to retain her ability to have sexual intercourse. Your consultant has therefore recommended a radical hysterectomy. Assuming that the cancer is confined to the cervix and that intraoperative biopsies are negative, which of the following structures would not be removed during the radical hysterectomy?
Both ovaries
The entire parametrium on both sides of the cervix
Uterosacral and uterovesical ligaments
The upper third of the vagina
Pelvic nodes
A 38-year-old woman, gravida 2, para 1, at 10 weeks gestation comes to the physician's office for prenatal counseling of genetic disorders. She has a healthy 3-year-old child. Given her age, she is worried about the risk of Down syndrome, and if her baby test is positive for Down syndrome she would like to terminate the pregnancy. Ultrasonogram shows increased fetal nuchal fold lucency. Which of the following is the most appropriate next step in management?
Chorionic villus sampling
Maternal serum alpha fetoprotein levels (MSAFP)
Second trimester amniocentesis
Cordocentesis
Early amniocentesis
A 57-year-old woman comes to the physician's office for evaluation of vaginal dryness, burning and dyspareunia. She also has dysuria and increased urinary frequency. The symptoms have been present for several months but have intensified recently. She has tried over-the-counter lubricants with little relief. Her last menstrual period was seven years ago. She takes hydrochlorothiazide for hypertension and pravastatin for hypercholesterolemia. Physical examination shows scarce pubic hair and reduced elasticity and turgor of the vulvar skin. Pale, dry and smooth vaginal epithelium is noted. Urine dipstick is normal. Which of the following is the most appropriate next step in management?
Vaginal estrogen replacement
High-potency corticosteroid cream
Ciprofloxacin for one week
Discontinue hydrochlorothiazide
Metronidazole for one week
A 24-year-old woman presents for her first prenatal visit at 12 weeks gestation. She was diagnosed with HIV two years ago, and her most recent CD4 count three months ago was 600cells/mm3. She does not use tobacco, alcohol, or illicit drugs. Physical examination is within normal limits. Which of the following is the single most important intervention for reducing maternal-fetal transmission of HIV infection?
Zidovudine treatment of the mother during pregnancy and of the neonate after birth
Administering HIV immunoglobulin and vaccine to the neonate
Elective cesarean section at 38 weeks gestation
Reassurance
Use of forceps to expedite delivery
A 23-year-old woman presents for evaluation of infertility. For the past 12 months she has been having sexual intercourse without contraception but has not been able to conceive. Her history is significant for irregular periods for the past 2 years. She reports exercising intensely six days per week and acknowledges having a lot of stress at work. She smokes one pack of cigarettes daily. On physical examination, her vital signs are within normal limits. Her BMI is 18 kg/m2. Urine pregnancy test is negative. Laboratory studies show: Serum FSH: low, Serum LH: low, Serum prolactin: normal, Serum TSH: normal. Which of the following therapies would be most helpful for this patient's infertility?
Pulsatile GnRH therapy
In vitro fertilization
Anti-androgen agent
Dopamine agonist
Continuous GnRH therapy
A 26-year-old G1P1 woman requests contraception after delivering a healthy baby three weeks ago. She does not want to get pregnant for at least one year. She has no medical problems and does not take any medication. She does not use tobacco, alcohol or drugs. Physical examination shows no abnormalities. Which of the following is the most preferred method of contraception you can advise for this patient?
Progestin-only oral contraceptives
No contraception needed while nursing
Tubal ligation
Coitus interruptus
Combined estrogen-progestin oral contraceptives
A 24-year-old primigravid woman at 35 weeks gestation comes to the emergency department with uterine contractions. She started these contractions six hours earlier, and they have not increased in intensity since then. The contractions started in the lower abdomen and are irregular. Her pregnancy has been uncomplicated. Her prenatal course, prenatal tests and fetal growth have been normal. She has no history of trauma. She does not use tobacco, alcohol or drugs. Vital signs are normal. Examination shows a firm, posterior and closed cervix. Ultrasonogram in the emergency department shows a gestational age of 35-weeks and the fetus in the vertex presentation. Fetal heart tones are heard. She feels better after mild sedation. Which of the following is the most appropriate next step in management?
Reassure and discharge the patient home
Intravenous penicillin
Admit to the hospital for delivery
Corticosteroids
Begin tocolysis
A 23-year-old primigravid female at 38 weeks' gestation was admitted to the delivery room for management of labor. She was in active labor for 4-hours during which her cervical dilation progressed from 3cm to 8cm, and descent progressed from - 1 to +1 station. Examination 6-hours later showed the same degree of dilation and descent. The fetal head is in the Left Occipita Anterior (LOA) position. An external tocometer is placed and reveals contractions 3 min apart, lasting 50 seconds each. Internal pelvic assessment shows prominent ischial spines. FetaI heart monitoring shows a baseline of 140 bpm with frequent accelerations. Prenatal ultrasound at 37-weeks showed a fetus of average size. Which of the following is the most appropriate next step in management?
Low-transverse C section
Close observation for 2 more hours
Forceps application
Zavanelli maneuver
Administer IV Oxytocin
A 16-year-old female comes to the emergency department because of heavy vaginal bleeding. She has no pain. Since menarche, menses have been irregular. She has a steady boyfriend and uses condoms for contraception. She has no other medical problems. She does not use alcohol, tobacco, or drugs. Her temperature is 37C (99F), blood pressure is 110/60 mm Hg, pulse is 90/min, and respirations are 16/min. Physical examination shows active vaginal bleeding. Pregnancy test is negative. Coagulation studies are within normal limits. Ultrasound shows no abnormalities. Her hemoglobin is 9.8 g/dl and hematocrit is 29%. Which of the following is the most appropriate next step in management?
High dose estrogen therapy
High dose GnRH agonists
Emergency dilatation and curettage
Hysteroscopy
Packed red blood cell transfusion
A 32-year-old woman comes to your office for re-evaluation of her birth control method. She wants her intrauterine device (IUD) removed because it is causing her pelvic pain. She wants to be placed on oral contraceptive pills (OCPs). She has had hypertension for the past five years controlled with hydrochlorothiazide and atenolol. She has a family history of diabetes mellitus and ovarian carcinoma. Her body mass index (BMI) is 34 kg/m2. Physical examination is unremarkable. If she starts taking oral contraceptive pills, which of the following statement is most correct?
Her hypertension may worsen
She is at risk of ovarian cancer
She is at risk of endometrial cancer
She will develop benign breast disease
She will become diabetic
A 24-year-old woman, gravida 2, para 1, at 16 weeks' gestation comes to you for a routine prenatal visit. She has had mild constipation. She has had no nausea, vomiting, fever, burning urination, back pain, or other complaints. She has no history of urinary tract infections. She takes iron and folic acid supplements. She does not use tobacco, alcohol, or drugs. She is afebrile; her blood pressure is 124/74 mm Hg and pulse is 78/min. Examination shows a uterus consistent in size with a 16-week gestation. Physical examination shows no abnormalities. Urinalysis is within normal limits. A routine clean-catch urine culture grows greater than 100,000 colonies/ml of Escherichia coli. Which of the following is the most appropriate next step in management?
Nitrofurantoin for 7 days
Obtain renal ultrasonogram
Ciprofloxacin for 3 days
Trimethoprim and sulfamethoxazole for 7 days
Reassurance and routine follow-up
A 65-year-old woman is found to have osteoporosis on DEXA scan. She underwent right knee surgery five years ago and developed post-operative deep venous thrombosis, for which she was treated with 6 months of warfarin therapy. She also has severe gastroesophageal reflux disease and takes lansoprazole daily. Her mother died of breast cancer, her maternal aunt has endometrial cancer, and her paternal aunt has a history of ovarian cancer. She does not want to use bisphosphonates because of her reflux symptoms, and would like to consider raloxifene. Which of the following is a contraindication to raloxifene in this patient?
History of deep vein thrombosis
History of colon cancer
History of breast cancer in her mother
History of ovarian cancer in her paternal aunt
History of endometrial cancer in her maternal aunt
A 37-year-old obese, hypertensive female comes to the physician because of intermenstrual bleeding and heavy menses. Endometrial biopsy shows "complex hyperplasia without atypia." She has two young healthy children and does not want more children in the future. W hich of the following is the most appropriate next step in management?
Cyclic progestins
Estrogen replacement
Hysterectomy
Raloxifen
Low dose oral contraceptives
A 27-year-old nulliparous woman presents to your office complaining of a 7-week history of amenorrhea with a negative urine pregnancy test. Upon further questioning, she says that she feels fine and does not have any symptoms. She has a steady boyfriend and uses condoms for contraception. Her medical history is unremarkable, and she denies taking any medications beside vitamin supplements to help her in her workout. She is a senior college student and works as a secretary in a law firm. On physical examination, there is no hirsutism or galactorrhea. The rest of the examination reveals nothing abnormal. Her BMI is 28 kg/m2. Initial work-up reveals the following: Serum TSH 2.5 mU/mL (N= 0.55.0), Prolactin 10 ng/ml (< 20 ng/ml). According to these findings, which of the following is the most appropriate next step in the management of this patient?
Determine the endogenous estrogen production
Determine the ovulation status
Determine the activity of the hypothalamus
Determine the prolactin levels one week later
Determine the activity of the pituitary gland
A 32-year-old, gravida 3, para 2 woman at 35 weeks gestation comes to the hospital because of regular and painful uterine contractions occurring every 5 - 6 minutes. She also has continuous leakage of clear fluid from her vagina that started 10 hours earlier. She has chronic hypertension and was prescribed methyldopa throughout pregnancy but has been noncompliant. She also has a history of drug abuse and has missed two previous antenatal appointments. Her temperature is 37.0C (98.7F), blood pressure is 160/100 mmHg, pulse is 80/min and respirations are 16/min. Sterile speculum examination shows pooling of amniotic fluid in the vagina; the cervix is 80% effaced and 3cm dilated. Ultrasound shows a small for gestational age fetus in the vertex presentation with a decreased amniotic fluid index. Fetal heart monitoring shows repetitive late decelerations. Uterine contractions are now occurring every 4 minutes. Which of the following is the most appropriate next step in management?
Cesarean section
Betamethasone IM
Augmentation of labor
Expectant management
Tocolysis
A 24-year-old primigravid woman comes for her initial prenatal visit at 24 weeks' gestation. Her only complaint is low back pain. She has no significant past medical history, and she has had no complications of pregnancy thus far. She does not use tobacco, alcohol, or drugs. Her vital signs are within normal limits. Complete physical examination shows no abnormalities. During the interview she requests screening for diabetes because her friend was diagnosed with gestational diabetes at 26-weeks of gestation. Which of the following is the most appropriate screening procedure for this patient?
One hour 50gram oral glucose tolerance test
Three hour 100gram oral glucose tolerance test
Fasting and random urine sugar
75gram oral glucose tolerance test
One time fasting blood sugar
A 29-year-old woman, gravida 3, para 2, at 37 weeks gestation is rushed to the emergency department because of gushing bright red vaginal bleeding. She has had no uterine contractions. She does not take any medications and has no history of trauma. Her prenatal course, prenatal tests and fetal growth have been normal. Prenatal ultrasound at the 12th week of gestation showed an intrauterine gestation consistent with dates. Her temperature is 37.0 C (98.7F), blood pressure is 120/80 mmHg, pulse is 80/min and respirations are 16/min. Ultrasonogram in the emergency department shows complete placenta previa. After initial resuscitation, bleeding is stopped. She is anxious and concerned about her baby. Which of the following is the most appropriate next step in management?
Scheduled cesarean section
Forceps delivery
Prompt induction of labor
Conservative management at home
Emergency cesarean section
A 23-year-old woman who is 10 weeks pregnant with her first pregnancy is referred to you for smoking cessation. She has been smoking since the age of 21 and has never tried to quit. However, now that she is pregnant she would really like to quit. She has no symptoms of depression. Her past medical history is significant for asthma. She uses an inhaler occasionally for her asthma and takes no other medications. She has never had surgery and has no known drug allergies. Physical examination is normal for a patient at 10 weeks’ gestation. Which of the following is the most appropriate management for this patient?
Refer for smoking cessation counseling
Prescribe the nicotine patch
Address smoking cessation after delivery
Prescribe fluoxetine
Prescribe bupropion
A 42-year-old woman with hypertension and a past history of an ectopic pregnancy 18 years earlier comes to your office and reports one episode of unprotected sexual intercourse 6 days ago. Her last menstrual period was normal and occurred 2 weeks earlier. She is concerned about unintended pregnancy and asks you about the “Morning After” pill. She reports no other complaints, has been healthy recently, and her hypertension has been well controlled. She has smoked one pack of cigarettes per day for the past 20 years. Which of the following factors in this patient would be a relative contraindication to prescribing hormonal emergency contraception?
Greater than 5 days since unprotected intercourse
History of hypertension
Age
Smoking status
History of ectopic pregnancy
A 29-year-old woman, gravida 2, para 1, at 33 weeks’ gestation is referred to your office because of a possible herpes outbreak. She developed a painful vesicular rash a few days ago in her genital area. She has never before had any similar symptoms. She has no other medical problems, takes no medications, and has no known drug allergies. Examination reveals numerous erythematous vesicles and ulcerations. Testing of the lesion demonstrates herpes simplex virus infection and serologic testing reveals that it is a primary outbreak for the patient. Which of the following is the most appropriate management of this patient?
Oral acyclovir
Intravenous acyclovir
Expectant management
Immediate induction of labor
Immediate cesarean delivery
A 35-year-old woman with type 2 diabetes comes to your office seeking pregnancy advice. Although she is not currently pregnant and has never been pregnant, she and her spouse, are planning to have their first child. She has previously managed her diabetes with diet and exercise. Approximately 4 months ago, however, you started her on metformin, as her fasting blood glucose levels were consistently elevated. Her hemoglobin A1c level at that time was 9%. She has no specific complaints today and her physical examination is unremarkable. A hemoglobin A1c level drawn 1 week before today’s visit is 6.2%. She would like to know which, if any, diabetic medications she can take during her pregnancy. Which of the following is the most appropriate pharmacologic monotherapy for her?
Insulin
Metformin
Acarbose
No medication, continue diet and exercise
Glyburide
A 42-year-old woman comes to your office for an annual examination. She states that she has been feeling good over the past year. She exercises three times a week and watches her diet. She has no medical problems. She had an appendectomy at the age of 25, and no other surgeries. She uses a 35μg combined oral contraceptive pill (OCP) daily, and takes no other medications. She has been on “the pill” for birth control for the past 10 years and is happy with it. She has no known drug allergies. Physical examination, including breast and pelvic exams, is normal. She wants to know if she can continue to take the oral contraceptive pill. Which of the following is the most appropriate advice to give her?
Continue on the OCP
Stop the OCP immediately
Change from the combined OCP to hormone replacement therapy (HRT) now
Stop the OCP gradually over the next 3 years
Change to HRT plus aspirin now
A 24-year-old woman comes to your office with vaginal spotting 2 weeks after a missed menstrual period. Her past medical history is significant for pelvic inflammatory disease. She has never had surgery. She takes no medications and is allergic to penicillin. Examination demonstrates scant blood in the vaginal vault and minimal right adnexal tenderness. Laboratory evaluation reveals a beta-hCG value of 1600 mIU/mL. Blood type is O positive. Hematocrit is 39%. Pelvic ultrasound demonstrates nothing in the uterus and a right adnexal mass consistent with ectopic pregnancy. The decision is made to proceed with intramuscular methotrexate for medical treatment of the ectopic pregnancy. Which of the following is the most likely side effect from this treatment?
Stomatitis
Infertility
Alopecia
Neutropenia
Cardiotoxicity
A 4-year-old girl is brought to the physician by her mother because of a bloody, greenish, malodorous vaginal discharge. The discharge was first noted 3 days ago and has worsened since then. The girl has no other symptoms. The mother reports no concerns regarding abuse of the child. Examination is attempted but impossible because of the child's absolute refusal to be examined. Several efforts at persuasion are made but are unsuccessful. Which of the following is the most appropriate next step in management?
Examination under anesthesia
Pelvic examination with physical restraint
Reassurance and expectant management
Police notification
Antibiotic administration
A 22-year-old G3P0030 obese female comes to your office for a routine gynecologic examination. She is single, but is currently sexually active. She has a history of five sexual partners in the past, and became sexually active at age 15. She has had three first-trimester voluntary pregnancy terminations. She uses Depo-Provera for birth control, and reports occasionally using condoms as well. She has a history of genital warts, but denies any prior history of abnormal Pap smears. The patient denies use of any illicit drugs, but admits to smoking about one pack of cigarettes a day. Her physical examination is normal. However, 3 weeks later you receive the results of her Pap smear, which shows a high-grade squamous intraepithelial lesion (HGSIL). Which of the following factors in this patient’s history does not increase her risk for cervical dysplasia?
Use of Depo-Provera
History of genital warts
Young age at initiation of sexual activity
Smoking
Multiple sexual partners
After making a diagnosis in the patient in question 319, you recommended that she wear loose clothing and cotton underwear and to stop using tampons. After 1 month she returns, reporting that her symptoms of intense burning and pain with intercourse have not improved. Which of the following treatment options is the best next step in treating this patient’s problem?
Topical Xylocaine
Valtrex therapy
Podophyllin
Topical trichloroacetic acid
Surgical excision of the vestibular glands
A 29-year-old G0 comes to your office complaining of a vaginal discharge for the past 2 weeks. The patient describes the discharge as thin in consistency and of a grayish white color. She has also noticed a slight fishy vaginal odor that seems to have started with the appearance of the discharge. She denies any vaginal or vulvar pruritus or burning. She admits to being sexually active in the past, but has not had intercourse during the past year. She denies a history of any sexually transmitted diseases. She is currently on no medications with the exception of her birth control pills. Last month she took a course of amoxicillin for treatment of a sinusitis. On physical examination, the vulva appears normal. There is a discharge present at the introitus. A copious, thin, whitish discharge is in the vaginal vault and adherent to the vaginal walls. The vaginal pH is 5.5. The cervix is not inflamed and there is no cervical discharge. Wet smear of the discharge indicates the presence of clue cells. In the patient described in the question above, which of the following is the best treatment?
Metronidazole 500 mg PO twice daily for 1 week
Ampicillin 500 mg PO twice daily for 1 week
Reassurance
Doxycycline 100 mg PO twice daily for 1 week
Oral Diflucan
A 32-year-old women presents to the emergency room complaining of severe lower abdominal pain. She says she was diagnosed with pelvic inflammatory disease by her gynecologist last month, but did not take the medicine that she was prescribed because it made her throw up. She has had fevers on and off for the past 2 weeks. In the emergency room, the patient has a temperature of 38.3C (101F). Her abdomen is diffusely tender, but more so in the lower quadrants. She has diminished bowel sounds. On bimanual pelvic examination, bilateral adnexal masses are palpated. The patient is sent to the ultrasound department, and a transvaginal pelvic ultrasound demonstrates bilateral tubo-ovarian abscesses. Which of the following is the most appropriate next step in the management of this patient?
Admit the patient for intravenous antibiotic therapy
Send the patient home and arrange for intravenous antibiotics to be administered by a home health agency
Admit the patient for emergent laparoscopic drainage of the abscesses
Call interventional radiology to perform CT-guided percutaneous drainage of the abscesses
Admit the patient for exploratory laparotomy, TAH/BSO
A 36-year-old woman presents to the emergency room complaining of pelvic pain, fever, and vaginal discharge. She has had nausea and vomiting and cannot tolerate liquids at the time of her initial evaluation. The emergency room physician diagnoses her with pelvic inflammatory disease and asks you to admit her for treatment. Which of the following is the most appropriate initial antibiotic treatment regimen for this patient?
Cefoxitin 2 g IV every 6 hours with doxycycline 100 mg IV twice daily
Ofloxacin 400 mg PO twice daily for 14 days plus Flagyl 500 mg PO twice daily for 14 days
Doxycycline 100 mg PO twice daily for 14 days
Ceftriaxone 250 mg IM plus doxycycline 100 mg PO twice daily for 14 days
Clindamycin 450 mg IV every 8 hours plus gentamicin 1 mg/kg load followed by 1 mg/kg every 12 hours
A 57-year-old menopausal patient presents to your office for evaluation of postmenopausal bleeding. She is morbidly obese and has chronic hypertension and adult onset diabetes. An endometrial sampling done in the office shows complex endometrial hyperplasia with atypia, and a pelvic ultrasound done at the hospital demonstrates multiple, large uterine fibroids. Which of the following is the best treatment option for this patient?
Total abdominal hysterectomy
Oral progesterone
Oral contraceptives
Myomectomy
Uterine artery embolization
You see five postmenopausal patients in the clinic. Each patient has one of the conditions listed, and each patient wishes to begin hormone replacement therapy today. Which one of the following patients would you start on therapy at the time of this visit?
Mild essential hypertension
Treated stage III endometrial cancer
Liver disease with abnormal liver function tests
Undiagnosed genital tract bleeding
Malignant melanoma
A mother brings her 14-year-old daughter in to the office for consultation. The mother says her daughter should have started her period by now. She is also concerned that she is shorter than her friends. On physical examination, the girl is 4-ft 10 in tall. She shows evidence of breast development at Tanner stage 2. She has no axillary or pubic hair. You reassure the mother that her daughter seems to be developing normally. Educating the mother and daughter, your best advice is to tell them which of the following?
The daughter’s period should start within 1 to 2 years since she has just started developing breast buds.
The daughter will have her growth spurt, then pubic hair will develop, heralding the onset of menstruation
The daughter will start her period when her breasts reach Tanner stage 5.
The daughter’s period should start by age 18, but if she has not had her period by then, she should come back in for further evaluation
The daughter will start her period, then have her growth spurt.
An 18-year-old consults you for evaluation of disabling pain with her menstrual periods. The pain has been present since menarche and is accompanied by nausea and headache. History is otherwise unremarkable, and pelvic examination is normal. You diagnose primary dysmenorrhea and recommend initial treatment with which of the following?
Antiprostaglandins
Danazol
Ergot derivatives
Codeine
Gonadotropin-releasing hormone (GnRH) analogues
A 7-year-old girl is brought in to see you by her mother because the girl has developed breasts and has a few pubic hairs starting to show up. Which of the following is the best treatment for the girl’s condition?
GnRH agonists
Clomiphene citrate
Exogenous gonadotropins
No treatment; reassure the mother that pubertal symptoms at age 7 are normal
Ethinyl estradiol
A 30-year-old female comes to the office complaining of vaginal discharge, dyspareunia and vulvar pruritus. She has a history of hypothyroidism and takes thyroid replacement therapy. She uses tobacco and alcohol every day. On examination, you notice a thin, grayish vaginal discharge and erythema and edema of the vulva and vaginal mucosa. The pH of the discharge is 6.0 and wet-mount examination reveals pear-shaped motile organisms. First line treatment is prescribed for both the patient and her partner. The patient must avoid which of the following during the treatment period?
Alcohol use
Thyroid supplements
Grapefruit juice
Tobacco use
Midday sun exposure
A 19-year-old woman comes to the physician for a routine physical examination. She has no complaints. She has had 2 sexual partners in the past six months and takes oral contraceptive pills. She has no significant past medical history and takes no other medications. She has no known drug allergies. Her temperature is 37.2 C (98.9 F) and blood pressure is 120/72 mm Hg. Complete physical examination, including pelvic examination, is unremarkable. A cervical swab is sent for nucleic acid amplification of Chlamydia trachomatis and Neisseria gonorrhoeae. The nucleic acid amplification test returns positive for chlamydia infection and negative for gonorrhea. The patient is still asymptomatic. Which of the following is the most appropriate next step in management?
Single dose azithromycin
Ceftriaxone and azithromycin
Repeat the test for confirmation
One dose of intramuscular ceftriaxone
Reassurance and no treatment at this time
A 28-year-old woman, gravida 3, para 2, at 35 weeks gestation is rushed to the emergency department because of vaginal bleeding. She was sleeping when she first noticed the bleeding. She has had no uterine contractions. Her prenatal course, prenatal tests and fetal growth have been normal. Prenatal ultrasound at the 14th week of gestation showed an intrauterine gestation consistent with dates and showed no abnormalities. Her previous pregnancies were uncomplicated. Her temperature is 37.0C (98.7F), blood pressure is 90/60 mmHg, pulse is 11 6/min and respirations are 16/min. Physical examination shows cold extremities and bright red vaginal bleeding. Which of the following is the most appropriate next step in management?
Obtain venous access with two large bore needles
Immediate vaginal examination
Emergency transvaginal ultrasonogram
Immediate cesarean section
Obtain blood for PT/INR and PTI
{"name":"( New ) Part 6 ( 1483-1529 )(1275-1529) Neymar 7", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Test your knowledge with our extensive quiz covering various aspects of women's health! This quiz consists of 140 multiple-choice questions designed to challenge your understanding of obstetrics, gynecology, and maternal medicine.Whether you're a student preparing for exams, a teacher looking for supplemental material, or simply someone interested in women's health issues, this quiz is a great resource. Key features include:Detailed questions based on real-world scenariosScores to track your performanceA great way to review essential concepts in women's health","img":"https:/images/course4.png"}
Powered by: Quiz Maker