Gyn Diagnosis q1 to 50

1)A 16-year-old girl presents to the emergency department complaining of fever, chills, abdominal pain,and vaginal bleeding. She gives a history of unprotected sexual activity with her 17-year-old boyfriend over the past several months. Her last menstrual period was 8 weeks ago. She reports having a dilatation and curettage procedure at an unlicensed abortion clinic recently to try to abort the pregnancy. Her temperature is 38.7C (101.7F), heart rate is 120/min, and blood pressure is 100/70 mmHg. Pelvic examination reveals cervical motion tenderness, tissue in the internal os, and foul-smelling vaginal discharge. Urine is positive for β-human chorionic gonadotropin. Which of the following is the most likely diagnosis?

3)After an appropriate diagnostic evaluation, a 59-year-old woman with postmenopausal bleeding hada total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO). The pathologic diagnosis is adenocarcinoma of the endometrium. An endometrial adenocarcinoma that is confined to the uterus and extends more than 50% through the myometrium is at which stage?

4)A 39-year-old woman at 16 weeks’ gestation complains of headaches, blurred vision, and epigastricpain. Her blood pressure is now 156/104 mmHg. Her uterine fundus is palpable 22 cm above her symphysis pubis. Fetal heart tones could not be heard with a handheld Doppler. She has 3+proteinuria. Which of the following is the most likely diagnosis?

5)A 39-year-old G3P3 complains of severe, progressive secondary dysmenorrhea and menorrhagia.Pelvic examination demonstrates a tender, diffusely enlarged uterus with no adnexal tenderness. Results of endometrial biopsy are normal. Which of the following is the most likely diagnosis?

6)A 28-year-old G3P0 has a history of severe menstrual cramps, prolonged, heavy periods, chronicpelvic pain, and painful intercourse. All of her pregnancies were spontaneous abortions in the first trimester. A hysterosalpingogram (HSG) she just had as part of the evaluation for recurrent abortion showed a large uterine septum. You have recommended surgical repair of the uterus. Of the patient’s symptoms, which is most likely to be corrected by resection of the uterine septum?

7)A 22-year-old woman presents with mouth sores, sore throat, vaginal discharge, fever, and myalgia.She has no other medical problems. She takes oral contraceptive pills. She is in a monogamous relationship and states that her partner occasionally uses barrier contraception. Physical examination reveals a temperature of 38.3 C (101 F), cervical and inguinal lymphadenopathy, exudative pharyngitis, and multiple ulcers on the oral mucosa, the labia, and cervix. The vaginal discharge is profuse, and Gram stain indicates many neutrophils. Which of the following is the most likely diagnosis?

8)A 14-year-old Caucasian female presents to clinic for a routine check-up. She complains that hermenstrual cycles are irregular and that her menses last seven to ten days. She underwent menarche one year ago and her last menstrual period was two weeks ago. She eats a balanced diet and works out in a gym on weekends. Her past medical history is insignificant and her BMI is 25 kg/m2. Which of the following is the most likely cause of this patient's complaints?

9)A 32-year-old female with a history of amenorrhea develops white nipple discharge. She eats abalanced diet and exercises regularly. She is not sexually active. Her family history is significant for her mother dying of breast cancer at age 50. The most likely diagnosis in this patient is:

10)A 37-year-old female presents to your clinic complaining of lower abdominal discomfort. Onbimanual examination the uterus is enlarged. Biopsy reveals normal appearing endometrial glands within the myometrium. The most likely diagnosis is:

11) A 75-year-old woman presents with a pruritic vulvar lesion. Physical examination reveals an irregular white, rough area involving her vulva. Biopsies from this area reveal a combination of squamous hyperplasia of the epidermis (acanthosis) with hyperkeratosis and mild dermal inflammation. No atrophy or dysplasia of the epidermis is seen. What is the best diagnosis?

12) A 65-year-old woman presents with a pruritic red, crusted, sharply demarcated map-like lesion involving a large portion of her labia majora. Histologic sections from this lesion reveal individual anaplastic tumor cells infiltrating the epidermis. Distinctive clear spaces are noted between these anaplastic cells and the surrounding normal epithelial cells. These malignant cells stain positively for mucin and negatively with S100. Which of the following is the most likely diagnosis?

13) A 39-year-old woman presents with severe menorrhagia and colicky dysmenorrhea. A hysterectomy including resection of the fallopian tubes and ovaries is performed. Examination by the pathologist finds a right adnexal cyst measuring approximately 2.3 cm in diameter and filled with clotted blood. Microscopic examination reveals the presence in the wall of the cyst of endometrial glands, stroma, and hemosiderin pigment. What is the best diagnosis?

14) A 23-year-old woman presents with urinary frequency and abnormal uterine bleeding. A careful medical history finds that her abnormal menstrual bleeding is characterized by excessive bleeding at irregular intervals. A pelvic examination finds a single mass in the anterior wall of the uterus, this being confirmed by ultrasonography. Which one of the following clinical terms best describes the abnormal uterine bleeding in this woman?

15) A 25-year-old woman presents with lower abdominal pain, fever, and a vaginal discharge. Pelvic examination reveals bilateral adnexal (ovarian) tenderness and pain when the cervix is manipulated. Cultures taken from the vaginal discharge grow Neisseria gonorrhoeae. Which of the following is the most likely cause of this patient’s adnexal pain?

16) A 28-year-old primigravid woman at 34 weeks gestation is brought to the emergency department following a motor vehicle accident. She had intense abdominal pain and became agitated and restless in the ambulance. She has mild vaginal bleeding and diffuse abdominal pain. She is on continuous fetal heart monitoring. Her prenatal course, prenatal tests and fetal growth have been normal. Prenatal ultrasound at the 16th week showed no abnormalities and an intrauterine gestation consistent with dates. Her blood pressure is 110/60mmHg, pulse is 110/min and respirations are 32/min. Physical examination shows hyperventilation, cold extremities and a distended abdomen with irregular contours. Fetal heart monitoring shows repetitive late decelerations and a long-term variability of 2 cycles/min. Which of the following is the most likely diagnosis?

17) A 22-year-old, gravida 1, para 0, at 13 weeks gestation is brought to the emergency department because of vaginal discharge and lower abdominal discomfort. She has had no passage of tissue from her vagina. She does not use tobacco, alcohol or drugs. She has no history of trauma. Her temperature is 37.0C (98.7F), blood pressure is 128/80 mmHg, pulse is 76/min and respirations are 14/min. Physical examination shows a closed cervix, a slightly tender uterus with a size consistent with gestational age, free adnexae and scant bright red bleeding from the introitus. Ultrasonogram in the emergency department shows normal fetal heart motion. She is anxious and concerned about her baby. Which of the following is the most likely diagnosis?

18) A 32-year-old woman, gravida 3, para 2, at 38 weeks gestation is admitted to the hospital for labor pains. Her prenatal course, prenatal tests and fetal growth have been normal. Prenatal ultrasound at the 16th week showed no abnormalities and an intrauterine gestation consistent with dates. In her second pregnancy, she had to undergo cesarean section. The woman is admitted to the delivery room and fetal heart and uterine contraction monitoring is started. Her blood pressure is 100/60mmHg, pulse is 115/min and respirations are 26/min. Pelvic examination shows the cervix is 60% effaced and 6cm dilated. Uterine contractions are regular and occurring every 4 minutes. Fetal heart tracing shows no abnormalities. Suddenly, the patient starts complaining of an intense lower abdominal pain. She is restless and vaginal bleeding is noted. Fetal heart monitoring shows variable decelerations, and the fetus has shifted to the ‘-2' station from '0' station Which of the following is the most likely diagnosis?

19) A 25-year-old woman, gravida 2, para 1, at 32 weeks gestation is brought to the emergency department because of acute onset severe uterine contractions and moderate vaginal bleeding. Her first pregnancy was uncomplicated. She has a history of cocaine addiction but she is now participating in a drug rehabilitation program. Ultrasonogram performed at the 16th week showed no abnormalities and an intrauterine gestation consistent with dates. Her temperature is 37.0 C (98.7F), blood pressure is 130/80 mmHg, pulse is 90/min and respirations are 15/min. Physical examination shows uterine tenderness, hyperactivity, and increased uterine tone. Fetal heart tracing shows 140/min with good long-term and beat-to-beat variability. Which of the following is the most likely diagnosis?

20) During the evaluation of infertility in a 25-year-old female, a hysterosalpingogram showed evidence of Asherman syndrome. Which one of the following symptoms would you expect this patient to have?

21) A 29-year-old woman presents with complaints of a vaginal discharge. She has had two sexual partners over the past 4 weeks, and she reports that she uses oral contraceptives and that her partners were not using condoms. Examination shows she is afebrile, with no lymphadenopathy. Pelvic examination shows no ulcers, but a thick white discharge is noted at the cervical os on speculum examination. A Gram stain of the discharge reveals gram negative diplococci. A sample of the discharge is also sent out for culture. The patient is appropriately treated and returns unhappily 3 weeks later with identical symptoms. A Gram stain of the discharge is again done, and this time reveals no organisms. Which of the following is the most likely cause of her symptoms?

22) An 18-year-old woman presents with amenorrhea and is found to have normal secondary sex characteristics and normal-appearing external genitalia. Her first menstrual period was at age 13, and her cycle has been unremarkable until now. She states that her last menstrual period was 8 weeks prior to this visit. A urine test for hCG is positive. Which of the following is the most likely diagnosis?

23) A 24-year-old woman delivers a normal 8-lb baby boy at 40 weeks of gestation. She has no history of drug abuse, and her pregnancy was unre-markable. Examination had revealed the placenta to be located normally, but following delivery the woman fails to deliver the placenta and subsequently develops massive postpartum hemorrhage and shock. Emergency surgery is performed to stop the bleeding. Which of the following is the most likely cause of her postpartum bleeding?

24) A 26-year-old woman develops acute lower abdominal pain and vaginal bleeding. While in the bathroom she passes a cast of tissue composed of clot material and then collapses. She is brought to the hospital, where a physical examination reveals a soft, tender mass in right adnexa and pouch of Douglas. Histologic examination of the tissue passed in the bathroom reveals blood clots and decidualized tissue. No chorionic villi or trophoblastic tissue are present. Which of the following conditions is most likely present in this individual?

25) A 26-year-old woman in the third trimester of her first pregnancy develops persistent headaches and swelling of her legs and face. Early during her pregnancy, a physical examination was unremarkable; however, now her blood pressure is 170/105 mmHg and urinalysis reveals slight proteinuria. Which of the following is the most likely diagnosis?

26) A 22-year-old nulliparous woman has recently become sexually active. She consults you because of painful coitus, with the pain located at the vaginal introitus. It is accompanied by painful involuntary contraction of the pelvic muscles. Other than confirmation of these findings, the pelvic examination is normal. Which of the following is the most common cause of this condition?

27) A 35-year-old African-American marathon runner presents to the gynecologist complaining of secondary amenorrhea that developed three months ago. Her cycles are normally 28 days long, and her menses last three to five days with moderate flow. One year ago, the woman adopted a vigorous exercise regimen that lasted between three and five hours every day. Since then, her BMI has declined from 23.4 to 16.5. She has been winning many local races and is considering increasing the difficulty of her exercise regimen, but would like to address the issue of her amenorrhea first. Physical examination reveals a thin woman with well-defined musculature but is otherwise unremarkable. Pregnancy test is negative. What is the most likely etiology of her amenorrhea?

28) A 38-year-old Caucasian female presents to the office complaining of lethargy, weight gain and fatigue. She denies headaches, pruritus or urine discoloration. She just gave birth 2 months ago via vaginal delivery; her baby is in good health and receives formula nutrition. Her delivery was complicated by vaginal bleeding that required blood transfusion, and postpartum endometritis that rapidly responded to antibiotics. She has not had any menstrual periods following delivery. Physical examination shows sparse pubic hair, dry skin and delayed tendon reflexes. Urinalysis shows no glucose or ketones. Which of the following is most likely to be responsible for this patient's condition?

29) A 24-year-old gravida 2, para 1, African American woman at 12 weeks gestation comes for her first prenatal visit. Except for early morning mild headaches and nausea she has no other symptoms. Physical examination shows mild bilateral ankle edema. Blood pressure is measured twice 15 minutes apart and is 150/96 mmHg on both occasions. Blood is drawn for laboratory tests and the patient is sent home with a follow-up appointment 3 days later. She returns 3 days later and repeat blood pressure is the same. Laboratory studies show: Urinalysis: Protein: negative; Blood: negative; Glucose: negative; Ketones: negative; Leukocyte esterase: negative; Nitrites: negative; WBC:1-2/hpf; RBC: 1-2/hpf. Chemistry panel: Serum sodium: 150 mEq/L; Serum potassium: 2.5 mEq/L; Chloride: 100 mEq/L; Bicarbonate: 23 mEq/L; Blood urea nitrogen (BUN): 14 mg/dL; Serum creatinine: 0.8 mg/dL. Ultrasonogram reveals intrauterine gestation consistent with dates; no abnormalities noted. Which of the following is the most likely diagnosis?

30) A 27-year-old female at 30 weeks gestation complains of difficulty hearing, especially on the right side. She denies any ear pain or discharge. Her pregnancy was complicated by acute pyelonephritis at 22 weeks gestation, which was treated with antibiotics. She does not smoke or consume alcohol, and she eats a balanced diet. She has no preexisting medical problems and takes no medications aside from a multivitamin. Her blood pressure is 160/100 mmHg and heart rate is 75/min. Cardiac and pulmonary examinations are unremarkable. No focal abnormalities are found on neurologic examination. When a tuning fork is placed on the right mastoid process, she appreciates the tone louder than when it is held near the external auditory meatus. Audiometry shows right low-frequency hearing loss. Which of the following is the most likely cause of this patient's complaints?

31) You are asked to consult on a 31-year-old woman who is at 26 weeks’ gestation and who has had fever for 2 days. She states that she starting feeling fevers and chills approximately 3 days ago. These symptoms have worsened since that time and she has also experienced myalgias, back pain, malaise, and upper respiratory complaints. She was initially diagnosed with the flu, but her condition seems to be worsening. Her prenatal course has been otherwise uncomplicated. She has no past medical or surgical history. Her past obstetric history is significant for a normal spontaneous vaginal delivery 3 years ago. She takes no medications and is allergic to sulfa drugs. Her physical examination is significant for a temperature of 38.3 C (101.0 F) and mild abdominal tenderness. Her urine culture is negative. Her obstetrician performed an amniocentesis yesterday that demonstrated gram-positive rods. Which of the following is the most likely causative organism?

32) A 54-year-old woman comes to the physician for an annual examination. She has no complaints. For the past year, she has been taking tamoxifen for the prevention of breast cancer. She was started on this drug after her physician determined her to be at high risk on the basis of her strong family history, nulliparity, and early age at menarche. She takes no other medications. Examination is within normal limits. Which of the following is this patient most likely to develop while taking tamoxifen?

33) A 24-year-old woman comes to the physician because of right lower quadrant abdominal pain. She has had the pain off and on for the past month, but it is now increasing. She has no other symptoms and no medical problems. Examination reveals a mildly tender, right adnexal mass. Pelvic ultrasound shows a 7 cm right adnexal complex cyst. Urine hCG is negative. The patient is taken to the operating room for laparotomy and right ovarian cystectomy. Microscopically the cyst has cartilage, adipose tissue, intestinal glands, hair, and a calcification that appears to be a tooth. There is also a large amount of thyroid tissue. Which of the following is the most likely diagnosis?

34) A 60-year-old woman comes to the physician for an annual examination. She has no complaints. She had her last menstrual period at age 55 and has had no vaginal bleeding since. She has no medical problems and has never had surgery. She takes no medications and has no allergies to medications. The physical examination is unremarkable. She is concerned about cancer and wants to know which type is the major cause of cancer death in women. Which of the following is the correct response?

35) A 36-year-old primigravid woman at 36 weeks' gestation comes to the physician for a prenatal visit. She is experiencing good fetal movement and has had no loss of fluid, bleeding from the vagina, or contractions. She has no complaints. Her past medical history is significant for mitral stenosis, which she developed after an episode of rheumatic fever as a child. She also has asthma for which she uses an albuterol inhaler daily. She has herpes outbreaks approximately once a year. At her last visit she was found to be positive for Group B Streptococcus colonization. For which of the following disease processes would this patient benefit by having a forceps-assisted vaginal delivery at the time of delivery?

36) A 14-year-old girl comes to the office for a health maintenance evaluation. She is concerned that she has not yet started her menstrual cycle. Her height has increased by 3 inches since her last visit 1 year ago, and her weight is up by 10 pounds. On physical examination, the physician notes a general enlargement of her breasts and areola. Examination of her genital area reveals pubic hair that is coarse and dark and extends past the medial border of the labia. Which of the following is the most likely diagnosis?

37) A 27-year-old primigravid woman at 10 weeks gestation is brought to the emergency department because of vaginal bleeding and cramping lower abdominal pain. She continues to have cramping in the ER. Her temperature is 37.0 C (98.7 F), blood pressure is 100/76 mmHg, pulse is 84/min and respirations are 14/min. Physical examination shows an effaced and dilated cervix. Gestational tissue is visualized through the internal cervical os. Bimanual examination shows the uterus is soft and enlarged, and vaginal bleeding is seen. Which of the following is the most likely diagnosis?

38) A 30-year-old G2P2 woman comes to the physician with fatigue, mood swings, irritability, breast tenderness, abdominal bloating, and headaches that occur monthly. The symptoms are worse just before her menses and resolve by the third day of her menstrual cycle. The symptoms interfere with her daily activities, including her proficiency at work. The patient's only current medication is a multivitamin. She uses spermicidal foam and condoms for birth control. Her menses are regular. Her sister was diagnosed with hypothyroidism and takes levothyroxine. Examination shows no abnormalities. Which of the following is the most likely cause of her symptoms?

39) At a follow-up routine prenatal visit, the uterine fundus of a healthy 23-year-old pregnant woman is palpated halfway between her symphysis pubis and umbilicus. Which of the following is the most appropriate test to order at this stage of her pregnancy?

40) A 25-year-old woman in her 15th week of pregnancy presents with uterine bleeding and passage of a small amount of watery fluid and tissue. She is found to have a uterus that is much larger than estimated by her gestational dates. Her uterus is found to be filled with cystic, avascular, grapelike structures that do not penetrate the uterine wall. No fetal parts are found. Immunostaining for p57 was negative in the cytotrophoblasts and villi mesenchyme. Which of the following is the best diagnosis?

41) A 24-year-old woman delivered a healthy baby by vaginal delivery at 36 weeks gestation. She had a prolonged premature rupture of the membranes, and mid forceps application was required during delivery. On the second postpartum day she complained of fever and chills. She cannot breast-feed because her "nipples are tender". Her temperature is 38.5C (101.3F), blood pressure is 120/55 mmHg and pulse is 92/min. Bimanual examination shows tender uterus and foul-smelling lochia. Her nipples are cracked but without surrounding erythema or warmth. Physical examination otherwise shows no abnormalities. Which of the following is the most likely diagnosis?

42) A 20-year-old, G1 PO, woman at 35 weeks gestation comes to the hospital because of regular uterine contractions. She noticed a passage of clear fluid per vagina for the past 24 hours. She has no other symptoms. Her pregnancy thus far has been uncomplicated. Her temperature is 38.2 C (100.7 F), blood pressure is 120/68 mmHg, pulse is 110/min and respirations are 17/min. Speculum examination shows a closed cervix and clear fluid pooling in the vaginal fornix. The pH of the fluid is 7.5. Fetal heart monitoring shows a rate of 165/min and uterine contractions occurring every 3-4 minutes. Initial laboratory studies show: Hemoglobin: 10.2 g/L; Platelets: 198,000/mm3; Leukocyte count: 18,500/mm3; Neutrophils: 86%; Lymphocytes: 14%. Which of the following is the most likely diagnosis?

43) A 37-year-old woman comes to the physician for evaluation of infertility. She and her 39-year-old husband have not been able to conceive after 13 months of unprotected and frequent intercourse. She has 28-day regular menstrual cycles. The patient had a pregnancy with her husband at age 31. She has no other genitourinary complaints such as menorrhagia, dyspareunia or pelvic pain. She has no previous history of sexually transmitted diseases or abdominal surgery. The patient does not use tobacco, alcohol, or illicit drugs. She is an aerobics instructor and teaches 230-minute classes daily. Her blood pressure is 130/80 mm Hg and pulse is 84/min. Her body mass index is 23 kg/m2. Complete physical examination is unremarkable. Which of the following is the most likely cause of her condition?

44) A 20-year-old, G1PO, woman at 35 weeks gestation comes to the hospital because of regular uterine contractions and passage of clear fluid per vagina. She has no other symptoms. Her pregnancy thus far has been uncomplicated. Her temperature is 38.2 C (100.7 F), blood pressure is 120/68 mmHg, pulse is 110/min and respirations are 17/min. Speculum examination shows a closed cervix and clear fluid pooling in the vaginal fornix. The pH of the fluid is 7.5. Fetal heart monitoring shows a rate of 165/min and uterine contractions occurring every 3-4 minutes. Initial laboratory studies show: Hemoglobin 10.2 g/L; Platelets 198,000/mm3; Leukocyte count 18,500/mm3; Neutrophils 86%; Lymphocytes 14%. Which of the following is the most likely diagnosis?

45) A 40-year-old G3P3 comes to your office for a routine annual GYN examination. She tells you that she gets up several times during the night to void. On further questioning, she admits to you that during the day she sometimes gets the urge to void, but sometimes cannot quite make it to the bathroom. She attributes this to getting older and is not extremely concerned, although she often wears a pad when she goes out in case she loses some urine. This patient is very healthy otherwise and does not take any medication on a regular basis. She still has regular, monthly menstrual periods. She has had three normal spontaneous vaginal deliveries of infants weighing between 7 and 8 lb. An office dipstick of her urine does not indicate any blood, bacteria, WBCs, or protein. Her urine culture is negative. Based on her office presentation and history, which of the following is the most likely diagnosis?

46) An 18-year-old G0 comes to see you complaining of a 3-day history of urinary frequency, urgency, and dysuria. She panicked this morning when she noticed the presence of bright red blood in her urine. She also reports some midline lower abdominal discomfort. She had intercourse for the first time 5 days ago and reports that she used condoms. On physical examination, there are no lacerations of the external genitalia, there is no discharge from the cervix or in the vagina, and the cervix appears normal. Bimanual examination is normal except for mild suprapubic tenderness. There is no flank tenderness, and the patient’s temperature is normal. Which of the following is the most likely diagnosis?

47) A 17-year-old teenage girl presents to your office with a 10-month history of lower abdominal pain that radiates to the upper thighs and back. The pain is colicky in nature and usually starts a few hours prior to menses, lasting 3-4 days. Menses have occurred at regular 28-day intervals over the past 2 years. She has no inter-menstrual bleeding. She became sexually active 6-months ago and does not use contraception. Physical examination shows healthy external genitalia and well-developed secondary sexual characteristics; the uterus is normal in size and freely mobile. Examination shows no other abnormalities. Which of the following is the most likely cause of her pelvic pathology?

48) You have diagnosed a healthy, sexually active 24-year-old female patient with an uncomplicated acute urinary tract infection. Which of the following is the likely organism responsible for this patient’s infection?

49) A 15-year-old girl is being evaluated for primary amenorrhea. She has no other symptoms. She has not been sexually active. She has no other medical problems and does take any medication. Her family history is unremarkable. On examination, you note fully developed breasts and absent axillary and pubic hair. External genitalia have a normal appearance, but the vagina is abnormally short and blind ended. Initial work-up reveals no uterus on ultrasound, a testosterone level of 400 ng/dl (Normal is 20-80 for a female), and a 46 XY karyotype. Which of the following events is most likely to have caused the absence of in utero development of the internal reproductive organs?

50) A previously healthy 50-year-old gravida 5, para 4, Caucasian woman comes to the physician complaining of passing small amounts of urine while sneezing or coughing for the past five months. She denies any episodes of weakness, numbness or fecal incontinence. There is no history of dysuria, increased frequency of urination, or hematuria. Her symptoms are progressively getting worse. Her other medical problems include diabetes mellitus type 2 diagnosed 3 years ago, treated with glyburide 2.5mg/day. She does not use tobacco, alcohol, or drugs, and has no known drug allergies. She mentions that she is an avid jogger, but her problem causes her significant embarrassment. She now has to wear absorbent pads while jogging. Her vital signs are within normal limits. On examination, the abdomen is soft. Neurological examination is within normal limits. Pelvic examination shows a cystocele. The patient's labs reveal: Urine: Specific gravity: 1.020, Blood: negative, Glucose: negative, Leukocyte esterase: negative, Nitrites: negative, WBC: 5-10/hpf, Bacteria: none. Random blood sugar is 120 mg/dl. Which of the following is the most likely cause of her symptoms?