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WH Practice Questions

Terms in this set (124)

A 22-year-old woman presents to the emergency department for one day of abdominal pain and vaginal spotting. The woman reports she is sexually active with one partner, but uses a non-hormonal intrauterine device to prevent pregnancy. Heart rate is found to be 126 bpm with a blood pressure of 88/60 mm Hg. Physical examination reveals right-sided adnexal tenderness and minimal blood in the vaginal vault. Cervical os is closed. Laboratory values reveal an hCG of 4,100 mU/mL. No intrauterine pregnancy is visualized on transvaginal ultrasound. What is the most likely diagnosis?

AEctopic pregnancy
BHydatiform mole
CSpontaneous abortion
DThreatened abortion
AEctopic pregnancy
A 25-year-old G1P0 at 33 weeks' gestation presents to her obstetrician for follow up visit. She states she has been having menstruation-like cramping and lower back pain every ten minutes or so for the last 24 hours. On physical exam, her cervix is dilated to 4 cm. Qualitative fetal fibronectin is positive. Which of the following confirms preterm labor?

A 5 uterine contractions every 20 minutes, cervical dilation of 2 cm, and cervical length of 20 mm on transvaginal ultrasound
B 5 uterine contractions every 20 minutes, cervical dilation of 4 cm, and cervical length of 18 mm on transvaginal ultrasound
C 8 uterine contractions every 70 minutes, cervical dilation of 2 cm, and cervical length of 22 mm on transvaginal ultrasound
D 8 uterine contractions every 70 minutes, cervical dilation of 3 cm, and cervical length of 20 mm on transvaginal ultrasound
B 5 uterine contractions every 20 minutes, cervical dilation of 4 cm, and cervical length of 18 mm on transvaginal ultrasound
Preterm Labor Criteria
A 42-year-old woman presents to your office for a health care maintenance visit. You counsel her on perimenopause, symptoms, and management. Which of the following is the most common symptom of this perimenopause?

Abnormal uterine bleeding
Hot flashes
Sexual dysfunction
Vaginal dryness
Hot Flashes
A 45-year-old woman presents for her annual physical exam and is diagnosed with iron deficiency anemia. Upon further questioning, the patient reveals that she has been having heavy and irregular periods for the past year. She has three children and does not plan to have any more. Pelvic examination is normal. You order a pelvic ultrasound. Which of the following findings is not consistent with the diagnosis of abnormal uterine bleeding?

AEndometrial hyperplasia
BEndometrial lining thickness of four mm
CPresence of endometrial polyps
DPresence of uterine fibroids
B Endometrial lining thickness of four mm
Activation of the hypothalamic-pituitary-adrenal axis through excess fetal or maternal stress has been implicated as one causative factor of preterm labor. Which of the following best describes the physiologic cascade triggered by stress in a pregnant patient?

A Increased adrenocorticotropic hormone inhibits estrogen receptors, allowing stimulation of oxytocin receptors in the myometrium, thus producing uterine contractions
B Increased adrenocorticotropic hormone stimulates cortisol, which in turn inhibits cyclooxygenase-2 receptors in the amnion, leading to rupture of membranes
C Increased circulating cortisol inhibits corticotropin-releasing hormone through a negative feedback loop, which leads to decreased prostaglandin synthesis and cervical ripening
D Increased cortisol leads to increased corticotropin-releasing hormone, which activates prostaglandins that cause cervical change and rupture of membranes
D Increased cortisol leads to increased corticotropin-releasing hormone, which activates prostaglandins that cause cervical change and rupture of membranes
True or false: A woman whose sister had a spontaneous preterm birth is at greatly increased risk of having spontaneous preterm birth herself.
True. The risk of spontaneous preterm birth is 80% greater in a woman with a sister who experienced the phenomenon.
A 32-year-old woman presents to the emergency department with vaginal bleeding. She is 10 weeks pregnant and began spotting this morning. The bleeding has become heavier throughout the day and now she has pelvic discomfort and cramping. A pelvic exam is completed and the cervix is found to be dilated with products of conception in the cervical canal. What is the most likely diagnosis?
A Incomplete abortion
B Inevitable abortion
C Missed abortion
D Threatened abortion
A Incomplete abortion
At what age should routine annual pelvic exams begin in nonpregnant women?
A 13 years
B 18 years
C 21 years
D 25 years
C 21 years
A 24-year-old woman, G1P0, presents to your office at 27 weeks gestation for a prenatal visit. Her body weight prior to pregnancy was within the normal range, and her gestational weight gain has been appropriate. You order a one-hour glucose challenge test with a 50 g oral glucose load to screen for gestational diabetes. For which of the following results would you recommend a diagnostic three-hour glucose tolerance test?
A 120 mg/dL
B 145 mg/dL
C 310 mg/dL
D 70 mg/dL
B 145 mg/dL
Screening criteria for Gestational DM
A 36-year-old woman presents to labor and delivery at 34 weeks and 2 days gestational age for new-onset headache and severe right upper quadrant pain. She reports this headache has been going on the last two days and has not resolved with oral acetaminophen. Her blood pressure on admission is 165/112 mm Hg, and repeat four hours later is 172/115 mm Hg. She has never been pregnant before and has no significant past medical history. Which of the following is the most likely diagnosis?
A Chronic hypertension
B Gestational hypertension
C Preeclampsia with severe features
D Preeclampsia without severe features
C Preeclampsia with severe features
A 60-year-old woman presents to her gynecologist with postmenopausal bleeding. She is currently taking tamoxifen following recent breast cancer treatment and is on estrogen replacement therapy for symptoms of menopause. An endometrial biopsy shows Stage 1 adenocarcinoma. Which of the following is the most appropriate intervention for this patient?

A Hysterectomy and bilateral salpingo-oophorectomy
B Hysterectomy and bilateral salpingo-oophorectomy, lymph node excision and radiation
C Increase tamoxifen dosage
D Progestin treatment
A Hysterectomy and bilateral salpingo-oophorectomy
What is the cause of endometrial hyperplasia?
unopposed estrogen
A pregnant 26-year-old woman presents for an ultrasound at 16 weeks gestation. She has a past medical history significant for a pregnancy loss at 22 weeks gestation prior to her current pregnancy. Ultrasound confirms a shortened cervix. Following cervical cerclage, what additional lifestyle modifications should be recommended for this patient?
A Avoid coitus
B Bed rest
C Cessation of exercise
D No lifting over five pounds
A Avoid coitus
A 32-year-old pregnant woman who is 28 weeks presents with an elevated blood pressure to the emergency room at the direction of her clinician. Her last two office visits blood pressures have been 172/112 mm Hg and 168/110 mm Hg. Which of the following medications would be the best choice to use initially in this patient?
A Captopril
B Hydralazine
C Nitroprusside
D Spironolactone
B Hydralazine
A 23-year-old G0 woman presents to the emergency department with lower abdominal pain for the past three days. She reports associated foul-smelling vaginal discharge. Her medical history is significant for chlamydia, which was treated three years ago, and an appendectomy when she was 12 years old. Her social history is significant for THC use and 15 lifetime sexual partners. A urine pregnancy test is negative. On pelvic examination, you note a mucopurulent discharge from the cervical os, two strings protruding from the cervical os, and cervical motion tenderness on bimanual exam. Which of the following historical risk factors places this patient at the highest risk for the suspected diagnosis?
A Age less than 25
B History of chlamydia
C Intrauterine device in place
D Multiple sexual partners
D Multiple sexual partners
A 55-year-old postmenopausal woman presents to the clinic for her annual physical exam. She has a history of estrogen receptor-positive infiltrating ductal carcinoma and is status post lumpectomy and radiation therapy. Following local treatment, she was started on anastrozole. The patient remains asymptomatic and her most recent mammogram was normal. Which of the following screening evaluations is the most appropriate recommendation for this patient?
A Bone density scan
B Breast magnetic resonance imaging
C Breast ultrasound
D Positron emission tomography scan
A Bone density scan
A 22-year-old woman presents with irregular vaginal bleeding and pelvic pain. Her last menstrual period was six weeks ago and she states that her menstrual cycle is typically 26 to 28 days in length. A urine pregnancy test is positive and a pelvic examination reveals mild right adnexal tenderness. Transvaginal ultrasound shows a right adnexal mass. Serum human chorionic gonadotropin (hCG) level is 3,520 IU/L. Which of the following is the next best step in managing this patient?
A Administer methotrexate
B Expectant management
C Prepare for emergent salpingostomy
D Repeat ultrasound in 48 hours
A Administer methotrexate
A 32-year-old woman presents to the ED at 39 weeks of gestation in active labor. Her axillary temperature is 98.6°F, pulse is 88 beats per minute, and blood pressure is 120/80 mm Hg. Upon vaginal examination, an umbilical cord is noted to be protruding from the cervix which is dilated to five centimeters. While awaiting a surgical suite for an emergency cesarean section, which of the following agents would be most appropriate to administer?
A Intramuscular dexamethasone
B Intravenous ampicillin
C Intravenous oxytocin
D Subcutaneous terbutaline
D Subcutaneous terbutaline
A 29-year-old G2P1011 woman is two days postpartum from a spontaneous vaginal delivery. She had a prolonged labor course and was diagnosed with intraamniotic infection intrapartum. Today, the nurse informs you that the patient is febrile and complaining of abdominal pain. On evaluation, you note uterine tenderness. She is exclusively breastfeeding her infant. What is the most appropriate treatment?
A Ampicillin
B Ciprofloxacin and ceftriaxone
C Clindamycin and gentamicin
D Metronidazole
C Clindamycin and gentamicin
A 17-year-old G1 girl presents at 36 weeks gestation for routine prenatal care. She has no significant medical history. Blood pressure is 146/92 mm Hg, and she has 1+ protein on urine dipstick. Platelet count has decreased from within normal range on initial prenatal labs to 90,000/mcL today. She reports no headache or visual changes. Which of the following must be present to meet the diagnostic criteria for preeclampsia?
A Blood pressure ≥ 140 mm Hg systolic or ≥ 90 mm Hg diastolic at least 4 hours later
B Proteinuria ≥ 300 mg in a 24-hour urine collection
C Serum creatinine ≥ 1.1 mg/dL
D Urine protein to creatinine ratio ≥ 0.3
A Blood pressure ≥ 140 mm Hg systolic or ≥ 90 mm Hg diastolic at least 4 hours later
A 60-year-old G2P2 woman presents to the clinic for a progressively worsening bulge sensation in her vagina for the past eight months and urinary incontinence when she laughs. Vaginal exam reveals a palpable break in the anterior vaginal fascia which becomes more prominent with Valsalva. Which of the following historical aspects put this woman most at risk for the most likely diagnosis?
A Connective tissue disorders
B Early age at menarche
C Radiation therapy
D Vaginal hysterectomy
A Connective tissue disorders
Which of the following fetal heart tracings patterns is indicative of uteroplacental insufficiency?
A Early decelerations
B Late decelerations
C Sinusoidal
D Variable decelerations
B Late decelerations
What is the most common pathogen involved in infective lactational mastitis?
A Bacteroides species
B Escherichia coli
C Staphylococcus aureus
D Streptococcus pyogenes
C Staphylococcus aureus
A 28-year-old G1P0 at 18 weeks gestation presents to the clinic to follow up on her Pap smear results. The cervical cytology report results indicated "atypical squamous cells: cannot exclude high-grade squamous intraepithelial lesion." Which of the following is the most likely next step in diagnosis?
A Colposcopy
B Human papillomavirus testing
C Loop electrosurgical excision procedure
D Repeat Pap smear
A Colposcopy
A 42-year-old woman with a history of hypertension and a body mass index of 32 presents to the office with her fourth incidence of vaginal candidiasis in the past year. Besides a wet mount and fungal culture, which of the following screening test should be ordered?
A Complete blood count
B Glycated hemoglobin
C Pap smear
D Urine culture
B Glycated hemoglobin
Which of the following would be considered normal when taking a focused gynecologic history from a patient?
A Intermenstrual bleeding
B Lack of menarche by age 16
C Postmenopausal bleeding
D Whitish, watery, odorless discharge
D Whitish, watery, odorless discharge
A 30-year-old woman presents to the clinic with concerns about preterm delivery. She suffered premature rupture of membranes with her first pregnancy. Which of the following would be the best choice for anticipatory guidance in this patient?
A Avoidance of dental procedures during pregnancy
B Douching regularly to prevent bacterial vaginosis
C Prophylactic use of nitrofurantoin to avoid urinary tract infection
D Smoking cessation
D Smoking cessation
A 22-year-old woman presents with a new lump in her right breast that she noticed while she was doing a self-exam in the shower about one week ago. The lump has not changed in size. Upon physical exam, you note a 2 cm discrete lump that is round, mobile and nontender to palpation to the upper outer quadrant of the right breast. The lump is solitary and you do not notice any other abnormalities. Which of the following statements is most likely given the suspected diagnosis?
A They are usually rapid growing and develop in one breast
B They usually have a cobblestoning texture
C They usually have ill defined borders
D They usually regress after menopause
D They usually regress after menopause
A 32-year-old P0 woman at 33 weeks gestation has confirmed rupture of membranes. The patient is not in labor, and the fetal status is reassuring with a category 1 tracing. The fetus is vertex, and the cervix appears to be closed and long. What is the best next step in the management?
A Antibiotics
B Antibiotics, betamethasone
C Antibiotics, betamethasone, and induction of labor
D Antibiotics, betamethasone, and magnesium
B Antibiotics, betamethasone
A 38-year-old G3P2 at 16 weeks' gestation presents to the clinic for a regular prenatal visit. She describes symptoms of morning sickness that are "worse than with my other two pregnancies." Vitals are normal. On exam, her fundal height measured 18 cm. Labs show an elevation in human chorionic gonadotropin hormone and maternal serum alpha-fetoprotein. Which of the following is the next best step?
A Observe and follow up in two weeks
B Order abdominal ultrasound
C Order additional blood tests
D Refer to a high-risk obstetric specialist
B Order abdominal ultrasound
A 24-year-old woman had an uncomplicated vaginal delivery 20 minutes prior to your shift starting. The placenta delivered spontaneously and the reported estimated blood loss was 400 mL. Shortly after receiving sign out, the patient's nurse calls you about bleeding. You present bedside to evaluate. An additional 200 mL of blood is on the peripad, the patient appears pale, and she has ongoing minimal bleeding. Her vital signs are notable for a heart rate of 120 beats per minute and a blood pressure of 95/50 mm Hg. Which of the following characteristics gives this patient a diagnosis of postpartum hemorrhage?
A Additional bleeding of at least 200 mL after delivery of placenta
B Bleeding associated with signs or symptoms of hypovolemia within 24 hours of delivery
C Estimated blood loss of 400 mL after vaginal delivery
D Estimated blood loss of 600 mL after vaginal delivery
B Bleeding associated with signs or symptoms of hypovolemia within 24 hours of delivery


Explanation:
Up to 3% of all deliveries in the United States are complicated by postpartum hemorrhage; of these, more than half require blood transfusion. The most common cause of postpartum hemorrhage is uterine atony (when the uterus does not effectively contract after placental delivery), but it can also be due to uterine trauma, abnormal placentation, or coagulopathy. In 2017, the American College of Obstetricians and Gynecologists (ACOG) updated the diagnostic criteria for postpartum hemorrhage. The diagnostic criteria is cumulative blood loss ≥ 1 000 mL regardless of mode of delivery or bleeding associated with signs or symptoms of hypovolemia within 24 hours of delivery. Thus, though she does not meet the estimated blood loss threshold for postpartum hemorrhage, she qualifies due to her pale appearance, hypotension, and tachycardia. Prior to 2017, ACOG defined postpartum hemorrhage by an estimated blood loss ≥ 500 mL after vaginal delivery or ≥ 1 000 mL after cesarean delivery. This diagnostic threshold was problematic for multiple reasons: the mean estimated blood loss after vaginal delivery is 400 to 600 mL and after cesarean delivery is 1 000 mL. Also, maternal blood is often mixed with amniotic fluid at delivery (falsely increasing the subjectively or objectively reported estimated blood loss). The new criteria were created to decrease the rate of false diagnoses of postpartum hemorrhage.
A 50-year-old woman with no history of endocrine disease presents complaining of insomnia, fatigue, and hot flashes for the past year and a half, and she hasn't had a menstrual period in over a year. She denies galactorrhea. Physical exam is unremarkable. Which of the following laboratory findings is most likely to be increased?
A Estradiol
B Follicle-stimulating hormone
C Prolactin
D Thyroid-stimulating hormone
B Follicle-stimulating hormone
A 28-year-old woman, G2P1, presents at 38 weeks gestation complaining of painful contractions and mild vaginal bleeding. Her prenatal care course is complicated by cocaine and tobacco use. On physical exam, her uterus is firm. Fetal heart rate tracing reveals a baseline of 135 bpm with moderate variability in the absence of accelerations. Tocometer reveals regular contractions. A vaginal exam performed reveals a cervix that is 7 cm dilated and a fetus in cephalic presentation. A transabdominal ultrasound is suspicious for placental abruption as the etiology of her vaginal bleeding. Which of the following is the most appropriate management?
A Cesarean delivery
B Expectant management
C Misoprostol
D Terbutaline
B Expectant management

Placental abruption is a complication of pregnancy that can result in significant maternal and fetal morbidity and mortality. The degree of morbidity associated with placental abruption is affected by extent and dynamics of the detachment, with partially stable detachments being less likely to affect the mother and the fetus compared to active and complete abruptions. The classic clinical presentation of abruption is abdominal pain with vaginal bleeding that occurs during or prior to the onset of labor. On physical exam, suspicious findings include a firm and tender uterus. Although ultrasound has low sensitivity for detecting placental abruptions, its ease of performance and low cost explain its use in this setting. A retroplacental collection of fluid of different echogenicity between the placenta and the uterine wall is typically seen. Management of placental abruption in a woman at term and in active labor is dependent on fetal and maternal status. In the absence of fetal heart rate abnormalities or maternal hemodynamic instability, labor is allowed to progress, and expectant management is preferred. Placental abruption is not an indication for cesarean delivery in this setting.
A 68-year-old woman presents to clinic to discuss surgical management of her pelvic organ prolapse. She has had stage III prolapse of the uterus for the past five years. Pelvic muscle exercises and pessary use have not relieved her symptoms of heaviness and discomfort. Her past medical history is significant for sarcoidosis for which she takes oral prednisone. Which of the following is the most appropriate surgical option for this patient?
A Anterior colporrhaphy
B Hysterectomy with synthetic mesh vaginal repair
C Hysterectomy with uterosacral ligament suspension
D Posterior colporrhaphy
C Hysterectomy with uterosacral ligament suspension
A 24-year-old woman presents to clinic for her annual gynecologic exam. She has no concerns and takes no medications. She is sexually active with women only. During her pelvic exam, her physician palpates an irregular uterine contour. Further ultrasound workup reveals one 3 cm intramural fibroid. Which of the following is the most appropriate next step?
A Combined oral contraceptive pill
B Expectant management
C Levonorgestrel intrauterine device
D Nonsteroidal anti-inflammatory drug
B Expectant management
An asymptomatic G2P2 58-year-old woman presents to the clinic for routine gynecologic examination. Pelvic exam reveals a posterior vaginal bulge and a palpable break in the rectovaginal fascia. Which of the following interventions is the best next step?
A Fit the patient for a pessary
B Observe with yearly examination
C Order abdominal and pelvic computed tomography
D Refer the patient for pelvic floor muscle strengthening
B Observe with yearly examination
A 46-year-old woman presents to your office for a second opinion. She has been experiencing abnormal uterine bleeding for more than two years. Her periods are heavy, prolonged, and associated with clotting. Imaging of her uterus was unremarkable. A recent hysteroscopy with directed biopsies was negative. She has three children, all born by uncomplicated vaginal deliveries, and is not interested in future conception. She declines hormonal therapy and would like to proceed with surgical therapy. Which of the following is recommended?
A Abdominal hysterectomy
B Dilation and curettage
C Endometrial ablation
D Wedge resection of the uterine wall
C Endometrial ablation
Which of the following factors is more indicative of secondary dysmenorrhea than primary dysmenorrhea?
A Presence of nausea, headache, and malaise
B Progressive worsening of pain severity
C Symptom improvement with hormonal contraceptives
D Symptom onset in adolescence
B Progressive worsening of pain severity
Which of the following is associated with a decreased risk for endometriosis?
A Avoiding oral contraceptives
B Increasing consumption of long-chain omega-3 fatty acids
C Increasing consumption of trans unsaturated fat
D Maintaining a low body mass index
B Increasing consumption of long-chain omega-3 fatty acids
A 25-year-old G1P0 at 39 weeks' gestation has been admitted to the labor and delivery department. On admission, a digital cervical examination was performed. Which of the following best describes the appropriate time for repeat cervical examinations during labor?
A After administration of anesthesia
B Every 15 minutes during stage two
C Every hour during stage one
D When the woman feels the urge to push
D When the woman feels the urge to push
A 28-year-old G2P1 Rh-negative woman presents to the clinic for an initial prenatal visit. Which of the following should be performed at this visit?
A Anti-D antibody screen
B Fasting blood glucose test
C Group B beta-hemolytic streptococcus screen
D Ultrasound screening for cervical length
A Anti-D antibody screen
A previously healthy 29-year-old G2P1A0 at 37 weeks and 4 days gestation presents to obstetric triage complaining of right upper quadrant pain that has been consistent since this morning. She also endorses a mild headache. Her blood pressure is 161/90 mm Hg and then 165/93 mm Hg on repeat 10 minutes later. Her pulse is 80 beats per minute. The fetal heart tracing is reassuring. Her physical exam is notable for hyperreflexia and her laboratory testing is remarkable for platelets at 80,000 platelets/microL. Which of the following is the best next step?
A CT of the head
B Delivery
C Expectant inpatient management
D Outpatient management
B Delivery
A 58-year-old postmenopausal woman presents to the clinic complaining of a vulvar lesion and pruritus that has become progressively worse. She does not recall when the mass first appeared, but states that it has now become painful and occasionally bleeds. She has a history of an abnormal Papanicolaou smear and previous positive human papillomavirus testing. A complete pelvic examination is performed and reveals a unifocal, firm, skin-colored ulcerating nodule on the left labium majus. The remainder of the pelvic examination is normal. Which of the following is the most likely diagnosis?
A Bartholin duct abscess
B Chancre
C Lichen sclerosus
D Vulvar cancer
D Vulvar cancer
A 54-year-old woman presents with progressively worsening vaginal irritation and dyspareunia for three years. She denies dysuria or urinary frequency. She has no past medical history of abnormal cervical cytology, and hasn't had any vaginal bleeding in the past two years. She hasn't tried any over the counter treatments for her symptoms. There is introital narrowing on external genital exam, and pelvic exam reveals dry, smooth and shiny vaginal epithelium. What is the best next step in management?
A Initiate estrogen therapy
B Initiate non-hormonal vaginal moisturizer and lubricant therapy
C Obtain cervical cytology
D Obtain vaginal epithelium biopsy
B Initiate non-hormonal vaginal moisturizer and lubricant therapy
A 32-year-old woman is having abnormal uterine bleeding for several weeks after a normal vaginal delivery. Serum hCG levels are tested and found to be elevated. They remain elevated at persistently low levels when retested after 2 months. A pelvic ultrasound reveals a hyperechoic intrauterine mass. Which of the following is the most likely diagnosis?
A Choriocarcinoma
B Pituitary adenoma
C Placental site trophoblastic tumor
D Pregnancy
C Placental site trophoblastic tumor
A 30-year-old woman who just delivered a 9 lb 12 oz baby vaginally after a prolonged labor suddenly develops heavy vaginal bleeding, tachycardia and altered mental status. What finding is most likely to be present to confirm the underlying cause of hemorrhage?
A A boggy, enlarged uterus upon palpation of the pelvis
B A cervical laceration
C A retained portion of the placenta within the uterus
D Thrombocytopenia on complete blood count
A A boggy, enlarged uterus upon palpation of the pelvis
A 38-year-old woman with a 20-year history of smoking one pack of cigarettes per day and with a history of iron deficiency anemia presents to the office to discuss contraceptive methods. She has two children and is otherwise healthy. Medical history reveals that her father had a heart attack at the age of 52. Which of the following is a contraindication to starting combination oral contraceptives in this patient?
A Anemia
B Cigarette smoking
C Family history of myocardial infarction
D Patient's age
B Cigarette smoking
A 24-year-old woman presents with sudden onset of lower right sided abdominal pain, nausea, and vomiting. She is not currently sexually active and pregnancy test is negative. She is found to have a right adnexal mass on exam. A pelvic ultrasound reveals an heterogenous enlarged ovary with decreased doppler flow. Which of the following is the most common risk factor for the suspected diagnosis?
A Intra-abdominal malignancy
B Ovarian mass
C Pregnancy
D Premenopausal age
B Ovarian mass
A 48-year-old woman presents to the office for her annual physical exam. She has not had a period for over 12 months. Which of the following hormonal changes are likely to occur during the menopausal transition?
A A decrease in estrone, decrease in estradiol, and an increase in testosterone
B A decrease in estrone, increase in estradiol, and no change in testosterone
C An increase in estrone, decrease in estradiol, and decrease in testosterone
D An increase in estrone, decrease in estradiol, and no change in testosterone
D An increase in estrone, decrease in estradiol, and no change in testosterone
A 28-year-old G2P1 woman at 23 weeks gestation presents to the emergency room for painless vaginal bleeding. Prior to performing a digital vaginal examination, an ultrasound of the uterus is performed, which reveals placental tissue lying over the internal cervical os. Based on the ultrasound findings, what would you expect to learn from the patient's history that would put her at increased risk of the likely diagnosis?
A Exposure to influenza during the first trimester
B Fetus was determined to be female at the last ultrasound
C Increase in vaginal intercourse in the past week
D Previous cesarean section
D Previous cesarean section
Which of the following tests would be performed first in a reverse-sequence screening algorithm for syphilis?
A Direct fluorescent antibody (DFA)
B Rapid plasma reagin (RPR)
C Treponemal enzyme immunoassays (EIA)
D Venereal Disease Research Laboratory (VDRL)
C Treponemal enzyme immunoassays (EIA)
A 25-year old woman presents with dysuria and purulent vaginal discharge for four days. Which of the following physical exam findings would best support the diagnosis of acute cervicitis?
A Edematous and erythematous uterine cervix
B Tenderness with movement of the uterine cervix
C Tenderness with palpation in the hypogastric region
D Thick, white, curd-like vaginal discharge
A Edematous and erythematous uterine cervix
A 72-year-old G5P5005 woman presents to the office with the complaint of a bulge "down there." She states she has had it for a while now but has noticed some vaginal bleeding and is now concerned. On exam, you note the cervix has descended halfway past the hymen, and there are multiple small ulcerations. What grade of the Baden-Walker halfway system would you give her prolapse, based on her physical exam?
A Grade 1
B Grade 2
C Grade 3
D Grade 4
C Grade 3
A baby is delivered via cesarean section at 39 weeks of gestation due to the mother's history of a previous cesarean section. At one minute after birth the baby is found to have an Apgar score of seven. The score is to be reassessed at the five-minute mark. The baby is found to be actively moving and pulls away with minor stimulation. The baby is pink without cyanosis and vigorously crying. Heart rate is 96 bpm. What is the baby's five-minute Apgar score?
A Eight
B Nine
C Seven
D Ten
B Nine
A 32-year-old woman presents with complaints of painful lumps in her breasts that worsen with her menstrual cycle. Which of the following hormones is considered a causative factor in the development of the suspected diagnosis?
A Estrogen
B Progesterone
C Prolactin
D Relaxin
A Estrogen
A 55-year-old woman presents to her primary care physician with a complaint of incontinence. She states that it is worse when she sneezes or when she lifts anything heavy. What is the best initial treatment to help alleviate these symptoms?
A Duloxetine
B Kegel exercises
C Pessary
D Topical vaginal estrogen
B Kegel exercises
A 25-year-old G1P0 at 39 weeks' gestation presents to the hospital as she believes she is in labor. Which of the following would suggest that the woman should be admitted to the labor and delivery unit?
A Cervical dilation of 4 cm
B Intact membranes
C Mucus plug discharge
D Sporadic painful uterine contractions
A Cervical dilation of 4 cm
A 22-year-old woman presents to the clinic complaining of abdominal bloating, nausea, irritability, and anxiety for the past six months. She reports that symptoms consistently happen for the week leading up to her period and then stop quickly after she starts her period. She has no history of mood disorders and denies suicidal ideation. Which of the following is the most likely diagnosis?
A Dysthymic disorder
B Major depressive disorder
C Premenstrual dysphoric disorder
D Premenstrual syndrome
D Premenstrual syndrome
A 60-year-old woman presents to her gynecologist with complaints of urinary frequency, urgency and incontinence. A cystocele is diagnosed on pelvic exam. The patient has undergone pelvic floor muscle training but symptoms have only improved slightly. What is the mainstay of nonsurgical treatment for this patient?
A Estrogen therapy
B Mirabegron
C Oxybutynin
D Vaginal pessary
D Vaginal pessary
A 30-year-old G2P1 at 36 weeks' gestation with a history of tobacco use and chronic hypertension presents to the emergency department with acute onset of vaginal bleeding, abdominal pain, and contractions. Physical exam reveals patient in a moderate distress. Vital signs are temperature 37°C, heart rate 95 beats per minute, respiratory rate 16 breaths per minute, blood pressure 130/85 mm Hg, and pulse oximetry 100% on room air. Pelvic exam reveals firm and tender uterus with blood visualized in vaginal vault. Which of the following is the most likely explanation for these findings?
A Labor
B Placenta previa
C Placental abruption
D Subchorionic hematoma
C Placental abruption
A 29-year-old woman is in active labor. Her history is significant for shoulder dystocia during the birth of her previous child. Which of the following would best diagnose shoulder dystocia in her current labor?
A Gentle downward traction on the fetal head fails to deliver the anterior shoulder
B Head-to-body expulsion time is greater than 30 seconds
C The fetal anterior shoulder presents before the posterior shoulder
D The fetal head retracts into the uterus after expulsion
A Gentle downward traction on the fetal head fails to deliver the anterior shoulder
A 26-year-old woman is newly diagnosed with gestational diabetes mellitus at 26 weeks gestation. Her past medical history is otherwise benign and she is on no chronic medications. Which of the following is the most appropriate first-line treatment for this patient?
A Insulin therapy
B Medical nutritional therapy
C Oral glyburide
D Oral metformin
B Medical nutritional therapy
A 48-year-old woman presents to the clinic worried that she has not had a period in over a year. In the past, she had irregular periods for several years. She reports vaginal dryness, insomnia, and increased irritability. Vitals are normal, but she is 12 lbs heavier than she was at her last appointment six months ago. Serum human chorionic gonadotropin and prolactin levels are normal, but follicle-stimulating hormone is elevated. Which of the following is the most likely diagnosis?
A Menopause
B Pituitary adenoma
C Polycystic ovary syndrome
D Primary ovarian insufficiency
A Menopause
A 25-year-old woman presents to the emergency room two weeks postpartum complaining of fevers and breast tenderness. On exam, she is febrile to 102.1°F (39°C) with right-sided breast tenderness and a 4 cm x 4 cm fluctuant mass next to her nipple. What is the best next step in diagnosis?
A Breast milk culture
B Breast ultrasound
C Fine-needle aspiration
D Mammogram
B Breast ultrasound
A 31-year-old woman presents to the clinic complaining of groin pain. The patient states that she returned from a trip to the Caribbean three weeks ago, and had unprotected sex with a male partner during her trip. She noticed a painless genital ulcer that appeared prior to returning home, but states that it was gone three days later. A few days ago, she noticed some pain and swelling in her groin, which has become progressively worse. On physical examination, there are inflamed superficial and deep inguinal lymph nodes forming a "groove" sign bilaterally. Which of the following is the most likely diagnosis?
A Chancroid
B Granuloma inguinale
C Lymphogranuloma venereum
D Syphilis
C Lymphogranuloma venereum
A 19-year-old woman presents to the clinic for evaluation of ongoing vaginal irritation and discharge. She reports that the discharge has been thin, yellow, and foul smelling. She is currently sexually active with one partner. Vaginal pH is 5.5. Amine test is positive. Wet mount reveals motile trichomonads with absence of hyphae and clue cells. Based on the most likely diagnosis, what other physical examination finding would you likely discover in the patient?
A Discharge adherent to the vaginal wall
B Loss of vaginal rugae
C Punctate hemorrhages on the cervix
D Vesicovaginal fistula
C Punctate hemorrhages on the cervix

Trichomonas vaginalis is a sexually transmitted genitourinary infection. It is the most common non-viral sexually transmitted disease in the world. Common symptoms include purulent foul smelling discharge. Women often experience burning, vaginal itching, and discomfort during intercourse. Men may experience dysuria. Physical examination often reveals erythema of the vulvovaginal area, punctate hemorrhages on the cervix (strawberry cervix) and green "frothy" malodorous discharge. Initial diagnostic studies include wet mount and amine testing. Wet mount reveals motile trichomonads. Women can also have a positive amine or "whiff" test. Vaginal cultures and nucleic acid amplification testing (NAAT) can be used for follow up testing if initial studies are non-diagnostic. Treatment includes a metronidazole 500 mg twice per day for 7 days, orally. Oral medications are preferred to intravaginal treatments. Sex partners should also be treated promptly. Sexual intercourse should be avoided for both partners until seven days after the last antibiotic dose.
An obese, 56-year-old woman presents to the clinic with a new and persistent non-tender mass in her right breast, which she had noticed a month ago. Past medical history is significant for menarche at age 16 years, first pregnancy at age 17 years, and breastfeeding all of her children. On exam, there is one firm, immovable mass in the right breast as well as right axillary adenopathy. Diagnostic mammogram reveals a spiculated soft-tissue mass. Which of the following risk factors likely increased this woman's risk for the most likely diagnosis?
A Becoming pregnant earlier in life
B Breastfeeding her children
C Late age at menarche
D Obesity
D Obesity
A 59-year-old G2P2 woman presents to clinic complaining of difficulty urinating. She states that she feels she is not completely emptying her bladder when she voids. Her medical history is significant for two vaginal deliveries and chronic obstructive pulmonary disease. In addition to her problems voiding, she senses a vaginal bulging when she coughs. Which of the following would you expect to find on physical exam?
A Displacement of rectovaginal wall on rectal examination during Valsalva maneuver
B Downward displacement of the anterior vaginal wall on speculum exam during Valsalva maneuver
C Pain on insertion of digits during pelvic exam
D Upward movement of the posterior vaginal wall on speculum exam during Valsalva maneuver
B Downward displacement of the anterior vaginal wall on speculum exam during Valsalva maneuver
A 24-year-old woman presents to the clinic complaining of cyclical pelvic pain and painful intercourse for the past year. She states that the pelvic pain occurs a few days prior to the start of menstruation. She denies any menorrhagia, abdominal pressure or vaginal discharge. She denies any history of sexually transmitted infections. Vital signs are within normal limits. Pelvic examination reveals lateral displacement of the cervix but is otherwise normal. Which of the following is the most likely diagnosis?
A Adenomyosis
B Endometriosis
C Leiomyoma
D Pelvic inflammatory disease
B Endometriosis
A 16-year-old G1P0 girl presents to clinic with her mother and father. Her point-of-care pregnancy test is positive, and she states she found out she was pregnant this week and tried to get an abortion while accompanied by her mother but was told at that clinic she was "too far along." Dating by ultrasound shows a 28-week-sized fetus with positive heart tones. When asked if she would consider adoption, she shakes her head no and states she doesn't want the baby to "end up like me." Which of the following is the most appropriate next step?
A Ask her parents to step out of the room so you can interview her privately
B Ask her whether she has any history of unwanted sexual touching
C Ask her whether this pregnancy is the result of an assault
D Inform her she can schedule a dilation and evacuation at this clinic
A Ask her parents to step out of the room so you can interview her privately
A 24-year-old woman presents to the clinic with complaints of nausea, headache, fatigue, and mood swings that have been occurring during the week leading up to her period. She has routinely had to miss work due to her symptoms. Her symptoms go away shortly after menses begin. She denies suicidal ideation. She has no pre-existing endocrine or mood disorders. Which of the following is the best initial treatment for this patient?
A Daily exercise and relaxation techniques
B Gonadotropin-releasing hormone agonist
C Hormonal contraception
D Selective serotonin reuptake inhibitor
D Selective serotonin reuptake inhibitor
Which of the following factors is more indicative of premenstrual dysphoric disorder than premenstrual syndrome?
A Missing work and school
B Presence of symptoms for most of the preceding year
C Symptom onset during the week before menses
D Symptom onset in early 20s
B Presence of symptoms for most of the preceding year
A 36-year-old woman presents to the office for a painful right breast for the past two days. She is two weeks postpartum. The patient reports swelling and redness of the right breast in addition to pain. She is febrile to 101.2°F. On physical examination, the lower lateral quadrant of the right breast is erythematous, firm, warm, and markedly tender to palpation. Enlarged right axillary lymph nodes are noted on exam. In addition to cool compresses, which of the following would be the most appropriate course of treatment?
A Cease breastfeeding from the affected breast
B Incision and drainage
C Initiation of dicloxacillin 500 mg four times daily
D Initiation of trimethoprim-sulfamethoxazole 800 mg-160 mg two times daily
C Initiation of dicloxacillin 500 mg four times daily
A 20-year-old woman presents to the clinic for well-woman exam. The patient states that she has not had a period in over 90 days. She was 12 years old when she had her first menstrual bleeding. The patient is active on her college cross country team, and runs about 80-100 miles per week. She is a vegan and tries to eat regularly, but due to her demanding class load and practice schedule, she often skips meals. Upon physical examination, the patient is well-developed but is noticeably thin with a body mass index of 18. You do not note any other abnormalities. A pregnancy test is negative. Based on patient's history, which of the following is the most likely diagnosis?
A Functional hypothalamic amenorrhea
B Hypothyroidism
C Polycystic ovarian syndrome
D Primary amenorrhea
A Functional hypothalamic amenorrhea


And she needs a psych eval, she is running more than 10 miles a day. Sister needs to chill
Which of the following best represents a positive prognostic variable for successful external cephalic version of a breech fetus?
A Amniotic fluid index less than ten
B Anterior placental location
C Non-longitudinal fetal position
D Thinner myometrial thickness
C Non-longitudinal fetal position
A 24-year-old woman presents with fever, chills, and painful lumps to the groin area for the past three weeks. She is sexually active with men only. Pregnancy test is negative. Upon physical examination, you note tender inguinal and femoral lymphadenopathy bilaterally with some anal fissures. There are no lesions noted on labia majora or minora. Which of the following is the treatment of choice for this patient?
A Amoxicillin
B Azithromycin
C Doxycycline
D Erythromycin
C Doxycycline

Lymphogranuloma venereum is an uncommon, sexually transmitted disease caused by Chlamydia trachomatis. It is rare in industrialized countries, but it has been increasingly seen in women who are engaged in unprotected anal sex and men who have sex with men. Infection occurs after direct contact with the skin or mucous membranes of the infected partner. The organism travels to the regional lymph nodes and causes systemic disease. The disease is characterized by painless genital papules or ulcers that are self-limited, followed by painful inguinal or femoral lymphadenopathy. Patients with this condition may also present with rectal ulcerations and symptoms of proctitis. Lymphogranuloma venereum occurs in three stages. The first stage involves a rapidly healing, painless genital papule or ulcer. The second stage involves painful inguinal lymphadenopathy (appearance of "grooves sign" or large bubo) that usually occurs two to six weeks after the primary lesion. Constitutional symptoms may include fever, chills, myalgias, and malaise. This stage is when most men are diagnosed. The third stage is characterized by proctocolitis and symptoms include bloody purulent discharge, rectal pain, and tenesmus. This stage may occur many years after the original infection. Women are more likely to be diagnosed in the third stage because they usually lack symptoms in the first or second stage. Doxycycline is the drug of choice in patients who are not pregnant. Erythromycin should be used in patients who are pregnant or lactating. Sexual partners who had contact with the patient within the past 60 days should be treated for exposure with doxycycline or azithromycin.
During which period of labor progression does a pregnant woman deliver her fetus?
A Active phase
B Latent phase
C Second stage
D Third stage
C Second stage
A 23-year-old woman returns to her obstetrician seven days postpartum. She is concerned with severe pain in the perineum and discharge following the sensation of "popping" in that area. She has been running a fever for the past day. A fourth-degree laceration was repaired following labor. Physical exam shows separated sutures and an erythematous perineal wound. What is the appropriate management of this patient?
A Debride and leave wound open, pain management
B Expectant management, without secondary repair
C Systemic antibiotics, debridement, and secondary repair
D Topical anesthetics, squirt bottle, and sitz bath
C Systemic antibiotics, debridement, and secondary repair
A 23-year-old female presents to her clinician for an annual physical for work. She reports that she became sexually active at the age of 21, has had 4 sexual partners in the last 3 months, consumes 6 alcoholic beverages per day, and regularly douches. Which of the following factors in the patients history increases her risk for cervical cancer?
A Excessive alcohol consumption
B Multiple sex partners
C Vaginal douching
D Younger age of sexual intercourse
B Multiple sex partners
A 28-year-old G2P1 woman at 38 weeks of gestation presents to labor and delivery after experiencing a gush of vaginal fluid at home. The patient reports she has not yet experienced contractions. A sterile speculum examination is performed which shows pooling of fluid in the vaginal vault. No cord prolapse is visualized on speculum examination. Which of the following can be used to further confirm the diagnosis?
A Biophysical profile
B Kleihauer-Betke test
C Nitrazine test
D Nonstress test
C Nitrazine test
A 22-year-old woman with history of an ovarian cyst presents to the ED with sudden onset of sharp right lower quadrant pain. She is not sexually active and denies vaginal discharge or bleeding. Vital signs are normal. Physical exam findings include bowel sounds present throughout all four quadrants. Abdomen is tender to palpation in the right lower quadrant with no rebound or guarding. Pelvic exam reveals right adnexal mass. Urine pregnancy test is negative. Which of the following is the most likely diagnosis?
A Appendicitis
B Ectopic pregnancy
C Pelvic inflammatory disease
D Ruptured ovarian cyst
D Ruptured ovarian cyst
A 62-year-old G4P4 woman presents to the clinic with a persistent pressure sensation in her vagina for the past year. She also reports that she has to push against the inside wall of her vagina in order to defecate. She reports no rectal or vaginal bleeding. Past medical history is significant for four vaginal deliveries. Which of the following is the most likely diagnosis?
A Cervical polyp
B Chronic constipation
C Colorectal cancer
D Rectocele
D Rectocele
A 32-year-old woman with bilateral breast pain that is worse before her period and resolves after her period is diagnosed with fibrocystic breast disease. Which of the following descriptions would describe fibrocystic breast changes on ultrasound?
A Hypoechoic irregular nodules with spiculated margins
B Prominent fibroglandular tissue with small cysts but no discernable mass
C Subtle echogenic masses with reticular patterns and a well-defined thin capsule
D Well-circumscribed, uniform round mass with thin pseudocapsule
B Prominent fibroglandular tissue with small cysts but no discernable mass
A 65-year-old woman undergoes primary surgical cytoreduction for epithelial ovarian cancer. She has suboptimally cytoreduced disease with greater than 1 cm of residual disease still present. Which of the following is the best pharmaceutical treatment option for this patient?
A Carboplatin and paclitaxel intravenously
B Carboplatin intraperitoneally
C Cisplatin and docetaxel intravenously
D Cisplatin intraperitoneally and paclitaxel intravenously
A Carboplatin and paclitaxel intravenously
A 19-year-old sexually active woman presents with lower abdominal pain and purulent vaginal discharge of two weeks duration. Temperature is 98.6 °F, heart rate is 70 beats per minute, and blood pressure is 122/74 mm Hg. On exam, the patient expresses tenderness to palpation in right and left lower abdominal quadrants, has purulent cervical discharge, and expresses extreme tenderness with uterine cervical movement. Urine pregnancy test is negative. Which of the following options is the most appropriate therapy?
A Amoxicillin 500 mg PO twice daily for 14 days + ofloxacin 300 mg PO twice daily for seven days
B Cefoxitin 2 g IM + single dose probenecid 1 g PO + sulfamethoxazole/trimethoprim 800 mg/160 mg PO twice daily for seven days
C Ceftriaxone 500 mg IM + doxycycline 100 mg PO twice daily for 14 days + metronidazole 500 mg twice daily for 14 days
D Levofloxacin 500 mg PO once daily for 14 days + single dose azithromycin 1 g PO
C Ceftriaxone 500 mg IM + doxycycline 100 mg PO twice daily for 14 days + metronidazole 500 mg twice daily for 14 days
A 32-year-old woman presents to your office for a follow-up visit regarding her complaints of painful breasts bilaterally occurring right before she menstruates and resolving after her period. She has no family history of breast cancer. Which of the following is the best treatment for her symptoms?
A Danazol
B Oral contraceptive pills
C Supportive bra and analgesicsD Tamoxifen
C Supportive bra and analgesics
A 24-year-old woman with a two-week-old infant who was born six weeks premature presents to your office with localized redness, swelling, and pain to the right breast. What information would you give this patient on how to care for her condition at home?
A Avoid taking any pain medications while breastfeeding
B Continue breastfeeding from the affected breast to help clear out the ducts
C Stop breastfeeding altogether to reduce the risk of developing mastitis in the future
D Take the antibiotic prescribed and stop when symptoms improve
B Continue breastfeeding from the affected breast to help clear out the ducts
Which of the following best describes a normal physiologic change of pregnancy?
A Decreased cerebral blood flow
B Decreased clotting factor VII
C Increased cardiac afterload
D Increased red blood cell mass
D Increased red blood cell mass
A 25-year-old woman presents to her obstetrician for her first prenatal visit. She is advised to begin taking prenatal supplements. Which of the following supplements has been proven to be teratogenic if taken in excess?
A Choline
B Folic acid
C Vitamin A
D Vitamin C
C Vitamin A
Which of the following would increase the chance of intrauterine device expulsion or failure?
A Age of 25 years or less
B Nulliparity
C Retroverted uterus
D Uterine cavity length
A Age of 25 years or less
What is the most common risk associated with gestation of multiples?
A Congenital abnormalities
B Discordant growth
C Fetal intrauterine growth restriction
D Premature birth
D Premature birth
A 26-year-old woman presents to your office for health care maintenance. She reports chronic pelvic pain. A review of her records reveals several emergency room visits for acute pelvic pain with a negative evaluation. You are suspicious for domestic violence. She does not report abuse. Her physical examination is normal. Which of the following is the best next step?
A Ask about specific types of abuse
B Call the police
C Discuss concerns with the patient's partner
D Schedule a follow-up visit
A Ask about specific types of abuse
A 23-year-old woman presents to the clinic complaining of abdominal bloating, fatigue, insomnia, mood swings, and persistent irritability for the past nine months. Symptoms have been occurring during the week leading up to her period and remit completely within a few days after onset of menses. She requests a note excusing her from work because she has missed several days due to these symptoms. She has no pre-existing endocrine or psychiatric disorders, and she has sought care at the clinic for several years only for routine screening and infrequent acute illnesses. Which of the following is the most likely diagnosis?
A Factitious disorder
B Major depressive disorder
C Premenstrual dysphoric disorder
D Premenstrual syndrome
C Premenstrual dysphoric disorder
A 55-year-old postmenopausal woman presents to the clinic with frequent episodes of vaginal spotting, which she began noticing over the past month. She has a history of diabetes and hypertension. She reports no history of abnormal Papanicolaou smears. A pelvic examination reveals a small amount of blood coming from the external os but is otherwise normal. What is the best way to diagnose this condition?
A Endometrial biopsy
B Papanicolaou smear
C Transabdominal ultrasound
D Transvaginal ultrasound
A Endometrial biopsy
A 20-year-old woman with a known history of chronic abnormal uterine bleeding presents to the emergency department with tachycardia, hypotension, heavy vaginal bleeding, and hemoglobin of 6.2 g/dL. Pregnancy test is negative. The patient was started on fluids and given a blood transfusion. A uterine curettage was performed, but bleeding still persisted. Which of the following is the most appropriate next step?
A Combined oral contraceptives
B Hysterectomy
C Intravenous estrogen
D Medroxyprogesterone acetate
C Intravenous estrogen
An 18-year-old woman presents to the clinic with heavy and painful periods for the past two years. She has never been pregnant and a pregnancy test in the office is negative. The patient has a normal body mass index, and her pelvic ultrasound and pelvic examination are unremarkable. Which of the following is the most likely diagnosis?
A Abnormal uterine bleeding
B Bleeding diathesis
C Hyperprolactinemia
D Polycystic ovarian syndrome
A Abnormal uterine bleeding
A 24-year-old woman who gave birth to a premature baby girl at 30 weeks gestation presents to your office for a follow-up visit after being diagnosed with mastitis three days ago. You had prescribed her amoxicillin, but after taking it as directed, she has not had any improvement of symptoms. The patient now has a fever of 103℉ with increased pain to the left breast. Physical exam shows a severely tender fluctuant mass in the breast that is red and warm to touch. What is the most appropriate next step for treatment of this patient?
A Admit her to the hospital immediately and start a course of IV antibiotics
B Recommend that patient stop breastfeeding altogether, change the antibiotic to oral cephalexin and send her home
C Refer patient to a surgeon for incision and drainage
D Refer to oncologist to rule out inflammatory carcinoma
C Refer patient to a surgeon for incision and drainage
A 28-year-old primigravida presents in her 34th week of gestation with dichorionic twins. Her prepregnancy body mass index was 20 kg/m². Her blood pressure is 120/80 mm Hg and her hemoglobin is 11 g/dL. Which of the following represents the best counseling to offer this patient?
A Aim for a total pregnancy weight gain of 55-65 pounds
B Observe bedrest from 37 weeks of gestation until delivery
C Prepare for a cesarean section, no matter how the fetuses present at delivery
D Take two prenatal vitamins with iron daily instead of one
D Take two prenatal vitamins with iron daily instead of one
A 32-year-old woman who is 35 weeks pregnant presents for a routine prenatal examination. Upon palpation of the uterus, the firm resistance of the fetal head is not able to be felt above the symphysis pubis. Upon further palpation, the fetal head seems to be located in the left upper quadrant. Which of the following is the next best step?
A Order an abdominal ultrasound
B Perform external version procedure
C Perform fetal non-stress test
D Plan an immediate cesarean delivery
A Order an abdominal ultrasound
A 21-year-old woman presents for a routine exam. She is noted to have a two centimeter, singular, circular, mobile, nontender mass in her left breast at the five o'clock position. The overlying skin is normal. She denies knowledge of this lesion prior to this visit. She also denies constitutional symptoms, breast tenderness, firmness, nipple changes or discharge, or heaviness with her menstrual cycle. What is the most likely diagnosis?
A Breast cancer
B Fibroadenoma
C Fibrocystic breast disease
D Galactocele
B Fibroadenoma
A 25-year-old patient presents to the walk-in clinic for vaginal bleeding. She has been on low-dose combined oral contraceptive pills but has been noncompliant to her medication recently. She is unsure when her last menstrual period was since she only gets minimal spotting while on birth control. Her urine pregnancy test is positive, and a serum quantitative beta-human chorionic gonadotropin level is 1,032 IU/L. A transvaginal ultrasound is performed and reveals an empty endometrial cavity. Her gynecologic history is significant for one episode of chlamydia cervicitis treated by antibiotics at the age of 18 with a negative test of cure, and an ectopic pregnancy at the age of 23 treated by methotrexate. She smokes 10 cigarettes per day. Which of the following is the strongest risk factor for recurrence of ectopic pregnancy?
A Chlamydia infection
B Previous history of ectopic pregnancy
C Smoking
D Use of birth control pills
B Previous history of ectopic pregnancy
A 48-year-old premenopausal woman is being evaluated for an adnexal mass palpated on bimanual exam. A pelvic ultrasound reveals a fixed right ovarian 6 cm complex mass and a large amount of free fluid. CA-125 is 193 units/mL, (carcinoembryonic antigen) CEA is 2.8 ng/mL. Which of the following supports referral to a gynecologic oncologist?
A CA-125 level
B CEA level
C Premenopausal status
D Ultrasound findings
D Ultrasound findings
A 30-year-old woman presents with a new thin vaginal discharge with a foul odor for the past two weeks. The woman is 24 weeks pregnant. The pregnancy has been uncomplicated. She denies any associated pain or vaginal bleeding. Vaginal swab is obtained for point of care microscopy which shows the presence of clue cells. Which of the following is the best next step in management?
A Initiate clindamycin intravaginally
B Initiate metronidazole orally
C Monitor symptoms throughout pregnancy
D Wait until the third trimester to initiate therapy
B Initiate metronidazole orally
A 21-year-old non-pregnant woman presents for her first Papanicolaou screening test. Cervical cytology shows low-grade squamous intraepithelial lesions. Which of the following is the best next step in management?
A Colposcopy
B Cone biopsy
C Endocervical curettage
D Repeat cervical cytology in one year
D Repeat cervical cytology in one year
A 53-year-old woman presents to the office complaining of hot flashes. She states that they interfere with her daily activities as well as with her sleep at night. Her past medical and surgical history is significant for asthma and a vaginal hysterectomy for abnormal uterine bleeding. Which of the following is the best option for this patient to provide the most relief?
A Acupuncture
B Estrogen
C Estrogen and progesterone
D Venlafaxine
B Estrogen
A 24-year-old woman presents for her annual checkup. She weighs 290 lb after losing 20 lb since starting a new exercise routine. She was recently informed by one of her sexual partners that he tested positive for gonorrhea. What treatment regimen would you offer to her?
A Ceftriaxone 1,000 mg IM once
B Ceftriaxone 1,000 mg IM once with doxycycline 100 mg bid PO for 7 days
C Ceftriaxone 250 mg IM once with azithromycin 1 g PO once
D Ceftriaxone 500 mg IM once with doxycycline 100 mg bid PO for 7 days
D Ceftriaxone 500 mg IM once with doxycycline 100 mg bid PO for 7 days
A 25-year-old woman presents for her initial prenatal visit. What is the most accurate method for determining her estimated date of delivery?
A Crown-rump length
B Gestational sac size
C Naegele's rule
D Uterine size
A Crown-rump length
A 25-year-old woman is recovering from uncomplicated vaginal delivery she had 24 hours ago. Which of the following physiologic changes is a major mechanism preventing postpartum hemorrhage?
A Cervical contraction
B Endometrial regeneration
C Uterine involution
D Vaginal contraction
C Uterine involution
A 22-year-old woman presents with persistent purulent vaginal discharge for one week which began after having intercourse with a new partner. On exam, her cervix is erythematous and edematous and there is a purulent cervical discharge. There is no cervical motion tenderness. Which of the following is the most appropriate diagnostic test?
A Culture from cervical specimens
B Gram's stain of cervical discharge
C Nucleic acid amplification testing of cervical discharge
D Urinalysis
C Nucleic acid amplification testing of cervical discharge
A 37-year-old woman presents for a routine gynecologic visit. She mentions that she has had multiple genital warts that have been treated in the past using an immune-mediated therapy. She is unsure what exactly was used but would like the same treatment. Which of the following is an immune-mediated therapy used to treat human papillomavirus?
A Cryoablation
B Fluorouracil
C Imiquimod
D Trichloroacetic acid
C Imiquimod
A 25-year-old woman presents to her primary care physician complaining of nausea and breast tenderness. She is sexually active, last unprotected sexual intercourse was 9 days ago. She states she does not remember the date of her last menstruation and that her cycles are irregular. A home pregnancy test this morning was negative as is the in-office urine pregnancy test. Which of the following is the best next step in management?
A Qualitative serum pregnancy test
B Repeat urine pregnancy test in one week
C Ultrasound of pelvis
D Urine pregnancy test 14 days after last unprotected intercourse
D Urine pregnancy test 14 days after last unprotected intercourse
A 31-year-old G1P1 woman at 39 weeks gestation has a normal spontaneous vaginal delivery. The patient is evaluated immediately after delivering for possible obstetric perineal laceration. On physical examination, the patient is found to have a laceration through the perineal fascia and musculature extending into the external anal sphincter. Based on the description of the laceration, which of the following would be the patient's correct diagnosis?
A First-degree laceration
B Fourth-degree laceration
C Second-degree laceration
D Third-degree laceration
D Third-degree laceration
A 14-year-old girl presents to the clinic with lower abdominal cramping that started six months ago. The cramping always starts a day or two before her menstrual cycle and resolves after about two days. She rates the pain as "severe"; she has gone home from school and missed sports practices due to the pain. Which of the following is the most appropriate initial therapy?
A Acetaminophen
B IbuprofenC Norgestimate/ethinyl estradiol
D Tramadol
B Ibuprofen
A 28-year-old woman presents with a persistent painless labial lesion for one week. She denies dysuria or any change in her vaginal discharge. On exam, she has one erythematous ulcerated sore on the labia majora with a punched-out appearance. The rest of physical exam is unremarkable. Which of the following is the most appropriate therapy?
A Acyclovir PO
B Azithromycin PO
C Penicillin G benzathine IM
D Penicillin G IV
C Penicillin G benzathine IM
A 35-year-old woman presents for routine gynecologic screening. Cervical cytology shows atypical squamous cells of undetermined significance. Reflex human papillomavirus testing is positive for strain 16. Which of the following is the best next step in management?
A Ablation
B Colposcopy
C Excision
D Repeat cytology with HPV co-test in one year
B Colposcopy
A 23-year-old woman presents with several erythematous, painful ulcers on the vaginal introitus which have been present for seven days and began as small red papules, which then evolved to pustules and then ulcerations. There is marked lymphadenopathy of bilateral inguinal nodes. Polymerase chain reaction for herpes simplex virus is negative. Which of the following additional diagnostic tests is necessary before diagnosing chancroid in this patient?
A Gram stain of the ulcer exudate showing gram-negative rods
B Negative Tzanck smear
C Negative venereal disease research laboratory test
D Positive polymerase chain reaction for Haemophilus ducreyi
C Negative venereal disease research laboratory test
Which person is statistically most likely to be phenotypically Rh(D)-negative?
A A 31-year-old man from Nigeria
B A 40-year-old woman from the Basque Country
C A 49-year-old man from Canada
D A 51-year-old woman from Japan
B A 40-year-old woman from the Basque
A 24-year-old woman recently treated with an antibiotic for a urinary tract infection presents with severe vaginal itching and burning for two days. Upon physical examination, you note thick, white, curd-like vaginal discharge. Which of the following microscopic findings you would most likely see on a wet mount?
A Clue cells
B Motile protozoa
C Pseudohyphae
D White blood cells
C Pseudohyphae
A 23-year-old woman with a diagnosis of polycystic ovarian syndrome and a history of infertility presents to her primary care provider with a positive pregnancy test. She began treatment for her diabetes mellitus type 2 a few months ago. What medication to treat her diabetes may have helped her to achieve pregnancy?
A Glipizide
B Insulin
C Metformin
D Pramlintide
C Metformin
A 28-year-old woman presents to clinic for follow-up of a palpable breast mass. A diagnostic mammogram revealed a suspicious lesion in her right breast, and follow-up ultrasound was concerning for malignancy. During a discussion of surgical options with the patient, she states that she would like further imaging with breast magnetic resonance imaging. Which of the following is an advantage of magnetic resonance imaging in this patient's case?
A Breast magnetic resonance imaging can easily distinguish between invasive disease and benign breast disease
B Breast magnetic resonance imaging is more sensitive than mammogram and ultrasound
C Breast magnetic resonance imaging will expedite the time to surgery by eliminating the need for future biopsies
D Breast magnetic resonance imaging will lower the total monetary cost to the patient
B Breast magnetic resonance imaging is more sensitive than mammogram and ultrasound
A 30-year-old G1P0 at 36 weeks gestation presents to the clinic for a routine check-up. Fetal position cannot be determined during the abdominal exam. Transabdominal ultrasound reveals fetal head in the fundus with both hips and knees flexed. Which of the following describes this fetal position?
A Complete breech
B Frank breech
C Incomplete breech
D Transverse fetal lie
A Complete breech
A 68-year-old woman presents to the clinic with progressive lower abdominal bloating for the past six months. Ascites is present on exam, and a right-sided adnexal mass is palpable. Pelvic ultrasonography reveals a solid complex mass on the right ovary and confirms presence of associated ascites. Which of the following is the most likely diagnosis?
A Endometrioma
B Epithelial carcinoma
C Mature cystic teratoma
D Sex cord-stromal tumor
B Epithelial carcinoma
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