OBGY USS 6st

An 18-year-old nullipara has suddenly stopped menstruating. She recently lost 8.6 kg when she started long-distance running. The laboratory test most consistent with her cause of secondary amenorrhea is which of the following?

A 22-year-old woman with cystic fibrosis is engaged to be married and asks you about childbearing. How should you advise her?

On the first pelvic examination of an 18-yearold nulligravida, a soft, fluctuant mass is found in the superior aspect of the right labia majora. This is asymptomatic. She tells you it has been present for several years and seems to be enlarging slightly. There is no defect in the inguinal ring. Which of the following is the most likely diagnosis?

Your patient has just had twins and wonders if there is any way to determine whether the twins are identical. You correctly tell her which of the following?

An 11-year-old girl has her first menses. Both ovaries contain approximately how many oocytes?

A 34-year-old woman, gravida 3, para 2, at 16 weeks' gestation comes to the physician concerned that she may have been exposed to an infectious disease. Yesterday, she and her 5-year-old son spent a day at the beach with one of his classmates. This morning, the classmate was sent home from school with a fever and rash that the teacher thought, were suspicious for chickenpox. The patient is unsure whether she had chickenpox as a child. Her temperature is 37 0C (98.6 F), blood pressure is 100/70 mm Hg, pulse is 88/min, and respirations are 16/min. Her examination is unremarkable. An inquiry made by the physician confirms that the classmate has chickenpox. Which of the following is the most appropriate next step in management?

A 26-year-old primigravid woman at 10-weeks' gestation comes to the physician for a routine prenatal appointment Her dating is based on a 6-week ultrasound. She has sickle-cell anemia. She has no past surgical history, takes prenatal vitamins, and has no known drug allergies. She tells the physician that she recently learned that the father of the baby has sickle-cell trait. On examination, her uterus is appropriate for a 10-week gestation, and fetal heart tones are heard. Her hematocrit is 37%. What is the most appropriate next step in the management of this patient?

A 17-year-old woman, gravida 1, para 0, at 38 weeks' gestation comes to the labor and delivery ward because of contractions. Her dating was determined by a 7-week ultrasound. Her prenatal course was complicated by gestational diabetes. Her past surgical history is significant for shoulder surgery. She takes insulin and prenatal vitamins. She has no known drug allergies. She smokes 3-4 cigarettes per day. She is initially found to be 4 cm dilated and is contracting every 2-3 minutes. She is admitted to the labor and delivery ward and, over the next 4 hours, progresses to full dilation. After pushing for 2 hours, she delivers the fetal head but has great difficulty delivering the fetal shoulders. Eventually, the fetus is delivered by the posterior arm. In the process of delivery of the newborn's humerus is fractured. Which of the following factors contributed the most to the difficult delivery of the fetus?

A 22-year-old woman comes to the physician seeking advice. Last night, while she was having sexual intercourse, the condom broke. She is very concerned that she may become pregnant and wants to know whether she can do anything at this point. She has no medical problems and has never had surgery. She takes ibuprofen for dysmenorrhea. She is allergic to sulfa drugs. On physical examination, she is anxious and intermittently sobbing. Her temperature is 37 C (98.6 F), blood pressure is 140/90 mm Hg, pulse is 98/min, and respirations are 24/min. The remainder of her physical examination is unremarkable. A urine pregnancy test is negative. Which of the following is the most appropriate pharmacotherapy?

A 42-year-old woman comes to the physician because of vaginal itch and discharge, dysuria, and dyspareunia. These symptoms have been steadily worsening over the past 3 days. Pelvic examination reveals an erythematous vagina and a thin, green, frothy vaginal discharge with a pH of 6. Microscopic examination of the discharge demonstrates the presence of a pear-shaped, motile organism. Which of the following is the most likely pathogen?

A 34-year-old woman, gravida 4, para 3 at 38 weeks' gestation, comes to the labor and delivery ward because of contractions. Her prenatal course was significant for low maternal weight gain. She had a normal 18-week ultrasound survey of the fetus and normal 36-week ultrasound to check fetal presentation. Her blood type is O positive, and she is rubella immune. Three years ago, she had a multiple myomectomy. She takes prenatal vitamins and has no known drug allergies. She smokes one pack of cigarettes per day. Which of the following complications is most likely to occur?

A 39-year-old woman, gravida 3, para 2 at 34 weeks' gestation, with a known history of chronic hypertension, is found to have a blood pressure of 180/115 mm Hg at a routine prenatal visit. Her prenatal course had been otherwise unremarkable. She is transferred to the labor and delivery ward for further management. IV antihypertensive medications should be given to this patient with a goal of which of the following blood pressures?

A 33-year-old woman comes to the physician because she has not had a menstrual period for 6 months. Prior to this she had a normal period every 29 days that lasted for 4 days. She has noted some weight gain in the past few months. She has a history of hepatitis A infection 6 years ago and had an appendectomy at age 12. She takes no medications and has no allergies to medications. Her father died of acute pancreatitis 3 years ago. Her mother is alive and well with no medical problems. Which of the following is the most appropriate next step in diagnosis?

35-year-old G1 PO woman at 35 weeks gestation by last menstrual period and confirmed by a first trimester ultrasound comes to the hospital because of leakage of fluid one hour ago. She received her prenatal care at an outside hospital and the records are not available. She reports no other complications with this pregnancy thus far. She reports no medical problems, takes no daily medications other than a prenatal vitamin, and has no allergies to medications. She is examined and preterm premature rupture of membranes is confirmed by a positive nitrazine test, positive pooling test, and a positive ferning test. She is 2 cm dilated, 50% effaced, and at -2 station. She is admitted to the hospital. Transabdominal ultrasound confirms that the fetus is in a vertex presentation, and the amniotic fluid index is decreased at 3 cm. Fetal heart rate and contraction monitoring is started, and occasional uterine contractions are noted on the monitor. Which of the following is the most appropriate next step in management?

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: 1.020 Specific gravity: trace Blood: negative 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?

A 30-year-old G2 P1 woman at 38 weeks gestation comes to the hospital because of regular and painful uterine contractions that started two hours ago. Pelvic examination reveals bulging membranes, and her cervix is 50% effaced and dilated to 3 cm. Her pregnancy was complicated by first trimester hemorrhage of unknown cause. Her past medical history is unremarkable. Upon observing the fetal heart rate monitor and an external tocometer for 20 minutes, you note 6 contractions. You also note 4 separate 15 - 20 beat/min decreases in the fetal heart rate with every contraction. The depth and duration of decelerations vary with successive uterine contractions. Which of the following is the most appropriate next step in the management of this patient?

A 24-year-old woman presents to your office with a self-palpated breast lump. She discovered the mass 2 days ago while taking a shower and noted that it is mildly tender. Her menstrual periods are regular, occurring every 26 days. Her last menstrual period (LMP) was 3 weeks ago. Her past medical history is insignificant. She has no family history of breast cancer. Physical examination reveals a lump in the superior outer quadrant of the right breast without palpable lymphadenopathy. Which of the following is the most reasonable next step in the management of this patient?

A 22-year-old professional tennis player presents to your office with a 5-month history of amenorrhea. She describes an intense schedule of regular exercise, and says that she eats a balanced diet but avoids fatty foods. She does not smoke or consume alcohol. Her mother suffers from long-standing hypertension. The patient's BMI is 22.5 kg/mm2. Pregnancy test is negative. The patient is at greatest risk for which of the following?

A 25-year-old G1 PO woman at 39 weeks gestation by last menstrual period confirmed by first trimester ultrasound presents to the hospital with complaints of vulvar pain and a "bump" on her vulva. On examination you see clear vesicles and inguinal adenopathy. No cervical or vaginal lesions are present. She is 2 cm dilated, 50% effaced and at -2 station. Fetal heart rate and contraction monitoring is started. She is contracting regularly. No abnormalities are seen. Which of the following is the most effective intervention to reduce neonatal morbidity in this patient?

A 24-year-old woman, gravida 2, para 2, comes to the physician for a yearly physical and birth control counseling. She is currently using the rhythm method of birth control, but has heard that this method has a high failure rate and would like to try a different method. Several of her friends use the intrauterine device (IUD), and she is wondering whether she could also use this method. Past medical history is significant for eczema. Past surgical history is significant for a right ovarian cystectomy 2 years ago. Past gynecologic history is significant for multiple episodes of Chlamydia cervicitis and two episodes of pelvic inflammatory disease (PID), the most recent episode occurring 1 year ago. She takes acetaminophen for occasional tension headaches. She is allergic to penicillin. She smokes onehalf pack of cigarettes per day. Physical examination is unremarkable. Which of the following would be the best recommendation for this patient regarding her birth control method?

A 26-year-old woman, gravida 2, para 1 at 28 weeks' gestation, comes to the physician for a follow-up ultrasound after a previous ultrasound demonstrated a marginal placenta previa. The present ultrasound shows complete resolution of the marginal previa, but the fetus is noted to be in breech presentation. The patient has otherwise had an unremarkable prenatal course. She has no medical problems and has never had surgery. She takes prenatal vitamins and is allergic to sulfa drugs. Assuming that the fetus stays in breech presentation, when should an external cephalic version be attempted?

A seven-year-old girl is brought to the physician's office because of a sudden onset of growth spurt, pubic hair development, and breast enlargement. Her family history is not significant. She has no other medical problems. On examination, there is no hirsutism or acne. Her weight is 70th percentile and her height is 98th percentile. Examination showed a pelvic mass. Pelvic ultrasonogram showed a right ovarian mass. Initial evaluation showed elevated estrogen levels. Which of the following is the most likely diagnosis?

A 36-year-old woman, gravida 3, para 2, comes to the physician for a prenatal checkup. According to her last menstrual period and an ultrasonography performed at 16 weeks gestation, she is at 30 weeks gestation. She missed two antenatal appointments. She does not use tobacco, alcohol, or drugs. Examination shows a fundal height of 26 cm (9.8 in). Fetal heart tones are heard by Doppler. Repeat ultrasound shows a fetal biparietal diameter consistent with 30 weeks and an abdominal circumference below the 10th percentile. Which of the following could most likely be responsible for the observed fetal findings?

A 19-year-old primigravid woman at 34 weeks gestation comes to the physician because of diffuse headache, right upper quadrant pain and visual disturbances. During her last visit two weeks ago she was found to have an elevated blood pressure and 1+ proteinuria. She was advised to follow-up closely and sent home on bed rest. Her blood pressure today is 176/120 mm Hg and pulse is 86/min. Physical examination shows 2+ pitting edema in both legs and right upper quadrant tenderness. Fetal heart tones are audible by Doppler. Urinalysis shows 3+ proteinuria. Serum aspartate aminotransferase (AST) is 88 U/L and alanine aminotransferase (ALT) is 80 U/L. Serum creatinine now is 1.4 mg/dl. Which of the following is the most likely cause of her right upper quadrant pain?

A 26-year-old woman presents to her physician because of pain in her breast. She gave birth 3 months ago and is breast-feeding. Soon after she began lactating she developed cracks in the nipples, and for the past 5 days her left breast has become progressively more tender. On physical examination, her affected breast is red, hot, swollen, and painful to palpation. Her temperature is 38.3 C (101 F), and her white cell count is 13,000/mm3. Which of the following is the most likely diagnosis?

A 32-year-old G3P2 woman at 38 weeks gestation is admitted to the hospital for labor pains. Her prenatal course, prenatal tests, and fetal growth have been normal. Ultrasound at the 16th week showed no abnormalities and an intrauterine gestation consistent with dates. In her second pregnancy, she underwent a cesarean section. The woman is admitted to the delivery room and fetal heart and uterine contraction monitoring is started. Her blood pressure is 100/60 mm Hg, pulse is 115/min, and respirations are 26/min. Pelvic examination shows that the cervix is 60% effaced and 6 cm dilated. Uterine contractions are regular and occur every 4 minutes. Fetal heart tracing shows no abnormalities. The patient suddenly complains of intense lower abdominal pain. She is restless and vaginal bleeding is noted. Fetal heart monitoring shows repetitive variable decelerations, and the fetus has shifted from 0 to -2 station. Which of the following is the most likely diagnosis?

A 36-year-old woman, gravida 2, para 1, at 16 weeks' gestation undergoes amniocentesis for evaluation of Down syndrome. She has no past medical history. Immediately after the procedure she becomes breathless, cyanotic and loses consciousness. Minutes later, she experiences a generalized tonic-clonic seizure. A generalized purpuric rash is noted. Her blood pressure is 90/50 mm Hg, pulse is 110/min, and respirations are 26/min. Oxygen saturation is 75% on 100% facemask. Which of the following is the most appropriate next step in management?

A 23-year-old primigravid woman at 38 weeks gestation is admitted to the delivery room for management of labor. She has been in active labor for 4 hours, during which her cervical dilation has progressed from 3 cm to 8 cm and descent has progressed from the -1 to +1 station. Examination 6 hours later shows the same degree of dilation and descent. The fetal head is in the left occipitoanterior (LOA) position. An external tocometer reveals adequate contractions 3 minutes apart lasting 50 seconds each. Internal pelvic assessment reveals prominent ischial spines. Fetal heart monitoring shows a baseline of 140/min 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?

A 19-year-old primigravid woman at 32 weeks gestation comes to the physician's office because of w eight 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 show s 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 show s 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?

53-year-old obese, menopausal woman comes to the physician for a routine annual examination. Her last menstrual period was one year ago. Upon further questioning, she says that she sometimes experiences hot flashes of mild intensity. She is sexually active and denies vaginal dryness or dyspareunia. Her medical problems include mild hypertension managed with hydrochlorothiazide and a salt-reduced diet. Her obstetrical history is significant for an elective termination of pregnancy at 35 years of age because of an abnormal maternal serum alpha-fetoprotein. Physical examination is normal. Which of the following is a possible cause of the comparatively milder nature of the symptoms the patient is having compared to many other menopausal women with more severe symptoms?

A 39-year-old G5P5 woman delivered a 4.1-kg (9-lb) healthy male infant 20 minutes ago. She is now experiencing heavy vaginal bleeding, with the passage of large blood clots. She had an uncomplicated pregnancy, with a 15.9-kg (35-lb) weight gain. The patient had spontaneous onset of labor and spontaneous rupture of the membranes at 5 cm dilation. Labor lasted 3 hours, including 10 minutes of pushing. She did not have an episiotomy. The placenta delivered spontaneously 5 minutes after the infant, was normal in appearance, and was intact with a 3-vessel cord. The patient's previous 4 pregnancies and deliveries were normal. Her blood pressure is 110/60 mm Hg, pulse is 106/min, and respirations are 20/min. The uterine fundus is soft and at the level of the umbilicus. The patient's peri-pad is saturated with blood, and there are clots extruding from the vagina. Which of the following is the most likely cause of this patient's symptoms?