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1-50 Flashcards

1
Q

A 14-year-old boy with a history of epilepsy complains of progressive lower limbs weakness and tngling sensaton since last two days. His face, trunk and upper limbs are not involved. He has had fever and runny nose 10 days ago. On physical examinaton, there is 3/5 muscle strength in both lower limbs with absent refexes. Blood pressure 120/80 mmH Heart rate 85 /min Respiratory rate 18 /min Temperature 37.4° C Which of the following is the most likely diagnosis?
A. Polymyosits
B. Multple sclerosis
C. Acute poliomyelits
D. Guillain-barre syndrome

A

D. Guillain-barre syndrome

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2
Q

A 5-year-old boy is brought to the Emergency Department afer an episode of convulsion that involved all limbs 1 hour ago. It contnued for 3 minutes and associated with drooling and loss of consciousness. He had runny nose, mild cough and fever for last 3 days. On physical examinaton, he was fully actve with mild congested throat. Blood pressure 120/80 mmHg Heart rate 98 /min Respiratory rate 22 /min Temperature 37.9° C Which of the following is the most appropriate treatment?
A. Phenytoin
B. Diazepam
C. Amoxicillin
D. Paracetamol

A

D. Paracetamol

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3
Q

Which of the following measures would decrease the incidence of Sudden Infant Death Syndrome?
A. Pacifer at bedtime
B. Sleep in prone poton
C. Sof sleeping matress
D. Sleep positon support device

A

A. Pacifer at bedtime

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4
Q

In which conditons circumcision should be avoided?
A. Phimosis
B. Hypospadias
C. Unilateral Cryptorchidism
D. Posterior urethral valve

A

B. Hypospadias

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5
Q

A 6-year-old girl presents with sudden involuntary abnormal movement in her limbs that started 10 minutes ago. It was associated with inability to speak. Few hours ago, she took metoclopramide, hyoscine butylbromide and oral rehydraton soluton afer being diagnosed with viral gastroenterits. The physical examinaton showed facial grimacing and protrusion of tongue. Which of the following is most appropriate treatment?
A. Tizanidine
B. Epinephrine
C. Cyproheptadine
D. Diphenhydramine

A

D. Diphenhydramine

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6
Q

A 4-month-old boy presents to the clinic with rash over the neck for 3 days. The rash is not itchy (see image). Which of the following is the most likely diagnosis?
A. Cellulits
B. Candidal intertrigo
C. Erythema Multform
D. Seborrheic dermatts

A

B. Candidal intertrigo

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7
Q

A 3-year-old boy presents to the clinic with blood in his diapers for 2 days. There is no associated abdominal pain or constpaton. He had similar presentaton 3 months ago. The physical examinaton shows pale conjunctva and dry oral mucosa. Blood pressure 130/75 mmHg Heart rate 124 /min Respiratory rate 35 /min Temperature 37.4° C which of the following is the most likely diagnosis?
A. Juvenile polyp
B. Intussusceptons
C. Hirschsprung disease
D. Meckel’s divertculum

A

D. Meckel’s divertculum

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8
Q

A 6-year-old boy presents to the Outpatent Department with frequent and brief episodes of rapid eyes blinking for 2 weeks. The episodes are not associated with pain, redness, tearing or discharge. During the episode, he communicated well with his parents. The physical examinaton shows normal visual acuity. Which of the following is the most likely diagnosis?
A. Tic disorder
B. Pett mal seizure
C. Dry eye syndrome
D.Tourete syndrome

A

A. Tic disorder

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9
Q

A 2-week-old girl presents with persistent vomitng since birth. She vomits about 1 hour afer feeding. She passes stool 3 tmes per day. The physical examinaton shows a small non-tender mass in the epigastrium. Blood pressure 95/55 mmH Heart rate 135 /min Respiratory rate 35 /min Temperature 37.1° C Which of the following is the most appropriate investgaton?
A. Barium swallow
B. Abdominal X-ray
C. Abdominal CT scan
D. Abdominal ultrasound

A

D. Abdominal ultrasound

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10
Q

A 13-year-old boy comes to clinic complaining of fatgue, non-productve cough, low-grade fever and night sweats over the past 7 weeks. He also mentoned that he has had 2 episodes of hemoptysis. Which of the following is the most likely diagnosis?
A. Tuberculosis
B. Bronchiectasis
C. Lung neoplasm
D. Mycoplasma pneumonia

A

A. Tuberculosis

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11
Q

A 6-year-old child presents with a high-grade fever, malaise, conjunctvits, coryza, and a cough. A rash of discrete pink macules recently began on the face and extends to the hands and feet. The child also had small, whitsh spots inside the mouth before the rash appeared. Which of the following is the most likely diagnosis?
A. Toxic shock syndrome
B. Gonococcal bacteremia
C. Measles
D. Rubella

A

C. Measles

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12
Q

A 40-year-old Healthy Primigravida with a history previous deep venous thrombosis Which of the following is the most appropriate management?
A. Aspirin
B. Heparin
C. Enoxaparin
D. No anticoagulation

A

D. No anticoagulation

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13
Q

A 29-year-old G4 P3003 at 12 weeks’ gestaton. Her current pregnancy has been uneventul. One week ago she has notced swelling of her ankles and feet (see lab results). Blood pressure 150/95 mmHg Heart rate 84 /minute Temperature 36.9°C Respiratory Rate 15 /minute Test Result Normal Values Hb 11.9 120-158 g/ Creatnine 65 58-145 mol/L Uric acid 210 140-360 mol/L Urine analysis Trace protein Which of the following is the most appropriate therapy?
A. Methyldopa
B. Atenolol
C. Captopril
D. Losartan

A

A. Methyldopa

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14
Q

During a difcult forceps delivery, an obstetrician misapplied the blade of the forceps at the child’s lef stylo-mastoid foramen where the forceps crushed its contents. What would be the baby’s residual defect?
A. Inability to close the left eyelid
B. Reduced blood supply to the lef ear
C. Loss of sensaton from the lef side of the face
D. Loss of taste from anterior 2/3rd of the tongue

A

A. Inability to close the left eyelid

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15
Q

A 34-year-old G4 P0030 at 32 weeks’ gestaton presented to the Emergency Department with tonic clonic convulsions. Temperature 37.2 Blood pressure 140/95 mmHg Respiratory rate 16/ minute Pulse 90/minute What is the most efectve drug to control her seizures?
A. Magnesium sulphate
B. Hydralazine
C. Phenytoin
D. Diazepam

A

A. Magnesium sulphate

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16
Q

A 27-year-old primigravida had a glucose tolerance test (see lab results). Patent’s results Normal Values Fastng 5.7 3.3 to 5.5 Mmol/ 1 hour 9.4 Less than 11.1 Mmol/ 2hour 9.8 Less than 8.6 Mmol/I 3 hour 7.2 Less than 7.8 Mmol/ Which of the following is the next best step in management?
A. Take a random glucose level
B. Obtain a haemoglobin A1c
C. Adjust the patent’s diet
D. Repeat the GTT

A

C. Adjust the patent’s diet

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17
Q

A 35-year-old G2 P1001 at 30 weeks’ gestaton with poorly controlled gestatonal diabetes on diet.Which of the following medicatons is the most appropriate treatment?
A. Pioglitazone HCI
B. Metormin HCI
C. Glyburide
D. Insulin

A

D. Insulin

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18
Q

A 35-year-old nulliparous on treatment for hyperprolactnemia for the past year. When would pituitary imaging be indicated?
A. Prolactn level is twice the normal
B. Persistent galactorrhea
C. Blurred vision
D. Pregnancy

A

B. Persistent galactorrhea

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19
Q

A 40-year-old woman is on Tamoxifen 20 mg daily as a hormonal treatment of breast cancer. She complains of heavy and prolonged menstrual period. Her transvaginal ultrasound revealed the presence of 28 mm endometrial thickness with cystc changes. Which of the following is the next step in the patent’s evaluaton?
A. Endometrial sampling
B. Cancer cell surface antgen 125
C. Computed tomography of the pelvis
D. Serum follicular and luteinizing hormones

A

A. Endometrial sampling

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20
Q

A 24-year-old obese woman, no previous pregnancy, complains of irregular menstrual periods Menarche was at age of 14 and her periods were irregular in tming, duraton and fow. The last menstrual fow was scanty 3 months ago. History of weight gain since menarche along with facial acne and mild facial hirsutsm (see lab results). Test Result Normal Values Testosterone 3.4 0.7-2.8 mol/L Sex hormone-binding globulins 9 13-17 mol/L Luteinizing hormone 31 5-22 U/L Follicie-stmulatng hormone 2.1 5-20 IU/L Random Glucose 6.1 3.9-5.5 mmol/L Which of the following is the most likely diagnosis?
A. Turer’s syndrome
B. Exogenous obesity
C. Premature ovarian failure
D. Polycystic ovary syndrome

A

D. Polycystic ovary syndrome

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21
Q

A 25-year-old breasteeding mother, who delivered a month ago, presents with fever and pain in the right breast for the past 2 days. The fever comes with chills and malaise. On examinaton, the right breast shows a skin wound on the areolar with a reddened and indurated surrounding area. Blood pressure 110/70 mHg Heart rate 86 /min Respiratory rate 18 /min Temperature 39.0° C Which of the following is the most likely causing pathogen?
A. Escherichia coli
B. Staphylococcus aureus
C. Haemophilus infuenzae
D. B-haemolytc streptococci

A

B. Staphylococcus aureus

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22
Q

A 22-year-old woman has multple small cysts within the ovary, as well as excessive androgen producton from the ovaries, anovulaton, insulin resistance, hypertension, and hirsutsm. Which of the following is the most likely diagnosis?
A. Gynecomasta
B. Kailman’s syndrome
C. Klinefelter’s syndrome
D. Stein-leventhal syndrome

A

D. Stein-leventhal syndrome

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23
Q

A 22-year-old woman has multple small cysts within the ovary, as well as excessive androgen producton from the ovaries, anovulaton, insulin resistance, hypertension, and hirsutsm. Which of the following is the most likely diagnosis?
A. Gynecomasta
B. Kailman’s syndrome
C. Klinefelter’s syndrome
D. Stein-leventhal syndrome

A

D. Stein-leventhal syndrome

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24
Q

A 28-year-old woman presents to the Maternal Health Clinic and reports that she has not had a menstrual period for the past 2 months. Human chorionic gonadotropin tested positve. Her signifcant health history included a needle-stck injury 1 year ago from a patent with hepatts C. She was treated with interferon and has received monthly screening examinatons. She asked if she would be able to breasteed her newborn. Which of the following complicatons would most likely prevent breasteeding?
A. Lack of routne newborn immunizations
B. Neonatal oral candidiasis
C. Materal anaemia
D. Cracked nipples

A

D. Cracked nipples

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25
Q

A 22-year-old woman presents to the Women’s Health Clinic for a routne examinaton. Her menstrual cycle occurs every 28 days and lasts for 5 days with moderate bleeding. Clinical breast examinaton showed bilateral symmetry with no abnormal fndings on palpaton. However, she reported regular breast tenderness that began 3 days prior to menses. There was no known maternal or paternal history of cancer. She wishes to become pregnant within the next 2 years. Which of the following screening tests should be done?
A. Breast ultrasound
B. Papanicolaou smear
C. Human papilloma virus
D. Group beta streptococcus

A

B. Papanicolaou smear

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26
Q

A 30-year-old multparous woman at 10 weeks’ gestaton presented to the Maternal Health Clinic complaining of nausea and vomitng. She was unable to keep down any food or fuid. Her tongue appeared dry and covered with a white coatng. The skin turgor was reduced; refll tme and urine output was scant. She was admited to the High Risk Maternity Unit for observaton and was started on an intravenous infusion of 10% glucose in normal saline. A urinalysis sent to the laboratory for examinaton, Blood pressure 90/60 mmHg Heart rate 120 /min Respiratory rate 16 /min Temperature 37.0° C oral Which urinalysis fnding would most likely confrm the diagnosis?
A. Leukocytes
B. Glucose
C. Ketones
D. Proteins

A

C. Ketones

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27
Q

A 25-year-old woman is 10 days postpartum and breasteeding on demand. For 48 hours before presentaton to the clinic, she has had episodes of chills with feeling weak and tred. Physical examinaton revealed redness of the lef breast, and tenderness and excoriaton of the areola. A lef breast tender, mobile 3 cm dominant lump was found in the upper outer quadrant on palpaton and lef axillary lymphadenopathy was present (see lab results). Blood pressure 110/70 mmH, Heart rate 115 /min, Respiratory rate 20/min, Temperature 39.0° C Test Result Normal Values Hb 115 120-160 g/L WBC 14 4.5-10.5 x 109/L Neutrophils 80 40-60% Band cells 7 3-5% Basophils 1 0.5-1 % Eosinophils 1 1-4 % Lymphocytes 50 20-40 % Monocytes 2 2-8 % Which of the following is the most likely diagnosis?
A. Fibrocystc breast disease
B. Infammatory carcinoma
C. Puerperal sepsis
D. Breast abscess

A

D. Breast abscess

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28
Q

A 35-year-old woman atended the Gynecological Clinic complaining of greenish-yellow purulent vaginal discharge that has started afer her period. Upon vaginal examinaton, there was multfocal rounded macular erythematous lesions (like a spoted rash or bruise), and there was pelvic tenderness. Which of the following conditons is the most likely diagnosis?
A. Vaginal candidiasis
B. Bacterial vaginosis
C. Atrophic vaginits
D. Vaginal trichomoniasis

A

D. Vaginal trichomoniasis

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29
Q

A 65-year-old post-menopausal woman complains of on and of vaginal bleeding that started 2 months ago. The amount of bleeding is mild to moderate of fresh blood. The woman is diabetc, hypertensive and obese. She has used hormone replacement therapy to control post- menopausal symptoms. Body mass index 37 kg/m2 Which of the following investgatons is essental to establish the diagnosis?
A. Pelvic magnetc resonance image
B. Pelvic ultrasonography
C. Endometrial biopsy
D. Tumor markers

A

C. Endometrial biopsy

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30
Q

A 67-year-old woman atended the Gynecological Clinic for the follow up of lichen sclerosus diagnosed few years earlier. Upon examinaton, a small mass measuring 0.5 x 0.5 cm was identfed on her right labia majora. Punch biopsy was taken from the lesion and sent for histopathology. Which of the following is the most likely histopathological fnding?
A. Adeno-squamous carcinoma
B. Squamous cell carcinoma
C. Adenocarcinoma
D. Melanoma

A

B. Squamous cell carcinoma

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31
Q

A 29-year-old woman complaining of a heavy vaginal discharge for the past 2 weeks. The discharge was thin and a greyish white color with a slight fshy vaginal odor. On examinaton, a copious, thin, whitsh discharge is seen adherent to the vaginal wall. Vaginal pH 5.5 Which of the following is the most appropriate treatment?
A. Metronidazole
B. Oral difucan
C. Tetracycline
D. Doxycycline

A

A. Metronidazole

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32
Q

A 57-year-old menopausal woman, presents for evaluaton of post-menopausal bleeding. She is morbidly obese, hypertensive and diabetc. Endometrial sampling showed complex endometrial hyperplasia with atypia. Which of the following is the most appropriate treatment?
A. Myomectomy
B. Oral progesterone
C. Uterine artery embolizaton
D. Total abdominal hysterectomy

A

D. Total abdominal hysterectomy

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33
Q

A 55-year-old woman presented to the clinic with urinary leakage for the last 6 weeks. She cannot hold her urine and urine leaks even before she reaches the bathroom. History revealed she has been menopause for the last 6 years. Which of the following is the frst step in the evaluaton?
A. Cystourethroscopy
B. Intravenous pyelogram
C. Urethral pressure profle
D. Urine analysis and culture

A

D. Urine analysis and culture

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34
Q

A patent who had a vaginal delivery 3 months ago is complaining of fecal incontnence and passage of vaginal fatus. These symptoms have started 1 week postpartum. Which of the following is the most likely diagnosis?
A. Hemorrhoids
B. Puerperal sepsis
C. Partal perineal tear
D. Recto-vaginal fstula

A

D. Recto-vaginal fstula

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35
Q

A 60-year-old woman’s recent pap smear yielded a result of Atypical squamous cells of undetermined signifcance (ASC-US). She was given topical vaginal estrogen for one month and was scheduled for another pap smear a week afer the treatment cycle has completed. The second pap smear showed ASC-US as well. Which of the following is the most appropriate next investgaton?
A. Repeatng pap smear afer 6 months
B. Endometrial biopsy
C. HPV testng
D. Colposcopy

A

D. Colposcopy

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36
Q

A 25-year-old woman complained of swelling on one side of the labia. The swelling was frst notced 24 hours ago and has not improved despite warm tub soaking. There was a non-tender 3 cm slightly mobile cystc mass at approximately 7 o’clock on the right side of the vaginal introitus. Blood pressure 110/70 mmH, Heart rate 76 /min, Respiratory rate 18 /min, Temperature 37° C Which of the following is the most likely diagnosis?
A. Bartholin cyst
B. Vulvar myoma
C. Vaginal adenosis
D. Skene’s duct cyst

A

A. Bartholin cyst

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37
Q

A 33-year-old woman comes to the clinic complaining of recent onset of vaginal itching. Physical examinaton of the vagina revealed a thick, odorless white cotage cheese-like vaginal discharge that adheres to the mucosa. She has recently fnished a course of antbiotcs for an upper respiratory tract infecton. Which of the following is the most likely diagnosis?
A. Chlamydia
B. Candidiasis
C. Gardnerella
D. Trichomoniasis

A

B. Candidiasis

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38
Q

A 48-year-old woman patent sufers from several episodes of vaginal discharge and itching around the genital area. The discharge is white and curd-like. The patent’s spouse does not have any related conditon. Microscopy of the discharge revealed budding yeast and pseudohyphae. The patent’s symptoms might be associated with which of the following conditons?
A. Sarcoidosis
B. Tuberculosis
C. Diabetes mellitus
D. Lupus erythematosus

A

C. Diabetes mellitus

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39
Q

A 56-year-old postmenopausal woman presents with a 1-year history of recurrent irritaton in the pubic area. The patent reported itchiness with blood-stained discharge at tmes. The patent has tried a metronidazole suppositories as well as topical cream over the labia with litle relief. Recently. the patent feels a pea-sized lump on the labia. Which of the following is the most likely diagnosis?
A. Bartholin cyst
B. Cystc adenosis
C. Bartholin gland carcinoma
D. Squamous cell carcinoma of vulva

A

D. Squamous cell carcinoma of vulva

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40
Q

A 21-year-old patent presented to the clinic complaining of difuse abdominal pain for the past 3 days. Her history included dyspareunia, nausea, and several episodes of vomitng. On examinaton, external genitalia and cervix appeared normal. However, the patent reported cervical moton, adnexal, and lower abdominal tenderness. Blood pressure 120/60 mmHg Heart rate 72 /min Respiratory rate 16 /min Temperature 38.4° C Which of the following is the most likely diagnosis?
A. Pelvic infammatory disease
B. Chronic cholecystts
C. Acuter appendicits
D. Cervicits

A

A. Pelvic infammatory disease

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41
Q

A 23-year-old woman who just recently had an intrauterine device fted, complaining of watery brown vaginal discharge and abdominal pain. Which of the following is the most likely diagnosis?
A. Uterine rupture
B. Bacterial vaginosis
C. Twisted ovarian mass
D. Pelvic infammatory disease

A

D. Pelvic infammatory disease

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42
Q

A 21-year-old woman patent complained of severe vulvovaginal itching and discharge. There are no urinary or other symptoms, and annual papanicolaou tests have all been normal. On inspecton, Vulvar erythema with swelling. Speculum examinaton revealed a thick, white, curdy discharge adherent to the vaginal walls with no dour. A gross and microscopic examinaton of the vaginal discharge was done; the wet mount revealed no evidence of clue cells or trichomonads and the KOH prepped slide confrmed several pseudohyphae (see lab results).
Test Result Normal Values pH 4.0 3.8-4.5 Whif test negatve negatve Which of the following is the most likely diagnosis?
A. Trichomoniasis
B. Bacterial vaginosis
C. Physiologic discharge
D. Vulvovaginal candidiasis

A

D. Vulvovaginal candidiasis

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43
Q

A young adult was being treated with Cefriaxone for acute salpingits and pelvic infammatory disease without beneft. Which of the following is the most likely diagnosis?
A. Adenovirus infecton
B. Herpes virus infection
C. Neisseria gonorrhea infecton
D. Chlamydia trachomats infecton

A

D. Chlamydia trachomats infecton

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44
Q

A 34-year-old woman non-smoker with 2 previous normal deliveries presented for a routne pap smear and her last pap was normal 7 years ago. The patent has had 1 episode of venereal warts at 18 year-old with no recurrence. The rest of her history is not signifcant (see report). Pap smear: A typical squamous cells of undetermined signifcance. What will be the frst step in management?
A. Another pap smear
B. Hysterectomy
C. Colposcopy
D. HPV testng

A

D. HPV testng

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45
Q

A woman comes to the clinic for having a history of increasing pelvic pain, which is cyclic in nature and increasing in intensity just before menses. Which of the following is an acceptable method for diagnosing endometriosis?
A. Magnetc resonance image
B. Diagnostic laparoscopy
C. Endometrial biopsy
D. Ultrasound

A

B. Diagnostic laparoscopy

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46
Q

A 67-year-old woman presented with vaginal itching and buming. Currently, she is only on calcium supplements. Physical examinaton revealed thinning and pallor of the vaginal mucosa and no discharge. Wet prep from the scant material present was negatve for any organisms. Which of the following is most appropriate inital treatment?
A. Topical cortcosteroid cream
B. Metronidazole vaginal gel
C. Vinegar and water douche
D. Estrogen vaginal cream

A

D. Estrogen vaginal cream

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47
Q

A 23-year-old woman presented with a yellowish green malodorous vaginal discharge. Speculum exam showed the cervix was slightly red and infamed. A probe for chlamydia was collected and wet prep confrmed Trichomonas vaginalis Which of the following is the frst step in management?
A. Doxycycline
B. Clindamycin
C. Metronidazole
D. Follow-up wet prep

A

C. Metronidazole

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48
Q

A 28-year-old woman presented with a history of a copious white vaginal discharge associated with intense vulvar irritaton and itching for four days. Microscopic examinaton revealed evidence of pseudohyphae. Which of the following is the most appropriate treatment?
A. Terconazole vaginal cream
B. Metronidazole
C. Doxycycline
D. Ganciciovir

A

A. Terconazole vaginal cream

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49
Q

A 24-year-old married woman presented with severe abdominal pain followed by vaginal bleeding for the last 6 hours. She reported having amenorrhea for the past 8 weeks as well. The patent looked drowsy with a tense abdomen, Blood pressure 90/60mmHg Heart rate 120 /min Respiratory rate 18 /min Temperature 36.6° C Which of the following is the most likely source of bleeding?
A. Ovary
B. Cervix
C. Peritoneum
D. Fallopian tube

A

D. Fallopian tube

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50
Q

A 58-year-old multparous woman is complaining of urine leakage at laugh or cough. She is not able to hold her urine along with feeling of “dragging” or “balloon-like” sensaton in the genital area for the past 4 months. Physical examinaton is normal except for bulging of the lower anterior vaginal wall. Which of the following is the most likely cause of those symptoms?
A. Cystocele
B. Rectocele
C. Enterocele
D. Urethrocele

A

D. Urethrocele

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51
Q

A 30-year-old married woman has had an abnormal Papanicolaou test result. Repeated smears were suggestve of high-grade intrepithelial lesions. Pelvic and rectal examinatons were normal. Which of the following is the next step in management?
A. Total hysterectomy
B. Cervical cone biopsy
C. Therapeutc irradiaton
D. Colposcopy directed biopsy

A

D. Colposcopy directed biopsy

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52
Q

A 68-year-old woman underwent a total abdominal hysterectomy and bilateral salpingo- oophorectomy. 3 days following the surgery, urinary catheter was removed and she was able to independently void 1 hour with an output of 35 ml/hr. She has been receiving fuids by contnuous intravenous drip. She described the incisional pain as uncomfortable and rates it at a level 5 on the pain assessment scale. For pain relief, she was taking Ibuprofen 800 milligrams every 6 hours. The doctor considered her ready for discharge (see lab results). Blood pressure 118/68 mmHg, Heart rate 70 /min, Respiratory rate 20 /min, Temperature 37.4° C oral Test Result Normal Values НСТ 0.37 0.37-0.48 Hb 122 120-160 g/L Which of the following would be a reason for this patent to remain in hospital?
A. Decreased hemoglobin and hematocrit.
B. Absence of oral fuid intake
C. Inadequate urinary output
D. Increased body temperature

A

B. Absence of oral fuid intake

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53
Q

A 56-year-old nulliparous and menopaused for 4 years, presented to the clinic with intermitent vaginal bleeding for the last 4 weeks. The bleeding was scanty and bright in color. Pelvic examinaton shows healthy vagina and cervix with a small amount of blood in the cervical os. Which of the following is the next step in management?
A. No treatment necessary
B. Dilaton and curetage
C. Endometrial biopsy
D. Pelvic ultrasound

A

B. Dilaton and curetage

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54
Q

A 30-year-old para 3 woman presented with a signifcant history of smoking 2 packs of per week for the past 7 years. She was using a progestn-only pills. She has had annual Papanicolaou examinatons for the past 9 years and all results have been normal. Bimanual pelvic examinaton showed normal fndings. Papinicolaou smear repeated with results of low-grade epithelial lesions. Which of the following is the most appropriate next step in management?
A. Colposcopy
B. Repeat test in 1 year
C. Cold-knife conisaton
D. Loop electrosurgical incision

A

A. Colposcopy

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55
Q

A patent comes for a follow-up 2 weeks afer a vaginal hysterectomy with anterior and posterior repair; the patent had leakage of urine from the vagina during micturiton. Which of the following is the most likely diagnosis?
A. Cystts
B. Vesicovaginal fstula
C. Ureterovaginal fstula
D. Urethrovaginal fstula

A

D. Urethrovaginal fstula

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56
Q

A 38-year-old woman presented with dysuria and increased frequency of urinaton. History reveals, she is allergic to sulfa, penicillin, and shellfsh (see report). Blood Pressure 120/80 mmHg, Heart Rate 80 /min, Respiratory Rate 16 /min, Temperature 38.0° C Urine Dipstck: Positve for leukocyte esterase. Which of the following is the most appropriate treatment?
A. Nitrofurantoin
B. Trimethoprim-sulfamethoxazole
C. Cephalexin
D. Amoxicillin

A

A. Nitrofurantoin

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57
Q

A 25-year-old woman had severe pelvic infammatory disease 2 years ago that was treated by intravenous antbiotcs. The isolated organism was chlamydia trachomats. Since then the patent was trying for pregnancy but failed to do so. She had normal regular period and normal seminal analysis of her husband. Which of the following investgatons is recommended?
A. Ultrasound monitoring of her ovulaton
B. Magnetc resonance image of the pelvis
C. Computed tomography of the pelvis
D. Hysterosalpingogram

A

B. Magnetc resonance image of the pelvis

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58
Q

A 25-year-old woman had severe pelvic infammatory disease 2 years ago that was treated by intravenous antbiotcs. The isolated organism was chlamydia trachomats. Since then the woman was trying for pregnancy failed to conceive. She had normal regular period and her husband had a normal seminal analysis. Hysterosalpingogram revealed normal uterine cavity and no free spillage of the injected dye bilaterally (see lab results). Body mass index 35 kg/m2 Test Result Normal Values Follicle-stmulatng hormone 4.5 5-20 IU/L Luteinizing hormone 3.9 5-22 U/L Which of the following is the most appropriate method of management?
A. In-vitro-fertlizaton and embryo transfer
B. Inducton of ovulaton followed by normal intercourse
C. Inducton of ovulaton followed by intrauterine inseminaton
D. Weight reducton to reach body mass index of 23 kg/m2

A

A. In-vitro-fertlizaton and embryo transfer

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59
Q

A 22-year-old diabetc woman presented with vaginal discharge and pruritus. The discharge is thick, grey and odorless. On physical examinaton, her vulva was erythematous and swollen. The vagina has a white-grey discharge that is adherent to the mucosa. Microscopic examinaton of the discharge confrmed the presence of spores. Which of the following is the most likely pathogen?
A. Trichomonas vaginalis
B. Pediculosis pubis
C. Candida albicans
D. Herpes simplex

A

C. Candida albicans

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60
Q

A 27-year-old woman presented with vaginal itching and an unpleasant smelling discharge. Itching gets worse at night and afer intercourse. Physical examinaton confrmed a frothy and yellow-green vaginal discharge. Her vulva is erythematous and edematous and the cervix is infamed and friable (see report). Wet Preparaton: Flagellated protozoa. Which of the following is the most likely diagnosis?
A. Chlamydia
B. Gonorrhea
C. Trichomoniasis
D. Bacterial vaginosis

A

C. Trichomoniasis

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61
Q

A 48-year-old woman has had 2 infammatory pap smears 3 months apart and a normal pelvic examinaton. A colposcopically directed biopsy of a normal appearing cervix revealed invasive carcinoma. Which of the following is the best next step in management?
A. Clinical staging of the disease
B. Conizaton of the disease area
C. Radical hysterectomy and chemotherapy
D. Radical hysterectomy and radiotherapy

A

A. Clinical staging of the disease

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62
Q

A 34-year-old woman G5 P4004 presented to with amenorrhea, tredness, nausea and vomitng during the morning hours for 3 months. Human chorionic gonadotropin test was positve. A physical examinaton showed no swelling in the lower extremites. The thyroid was enlarged on palpaton. The tongue, conjunctva and nail beds appeared pale. The uterine fundus was palpable 3 cm above the pubic symphysis. A peripheral blood smear showed macrocytc red blood cells and hypersegmented neutrophils (see lab results). Blood pressure 100/60 mmH, Heart rate 120 /min, Respiratory rate 26 /min, Temperature 37.0° Coral Test Result Normal Values Hb 85 120-160 g/L НСТ 0.32 0.37-0.48 MCHC 332 320-360 g/L MCV 100 80-95 f Thyroid-Stmulatng Hormone 0.44 0.4 - 5.0 jU/L Which of the following is the most appropriate treatment?
A. Intravenous rehydraton
B. Folic acid supplements
C. Observaton
D. Iron tablets

A

B. Folic acid supplements

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63
Q

A 20-year-old nulliparous woman at 20 weeks’ gestaton has been on iron supplement therapy throughout her pregnancy to treat anemia. She complained of weakness and becoming easily tred (see lab results). Test Result Normal Values Hb 78 120-160 g/L MCV 60 80-95 f RBC 5.4 4.2-5.4 x 1012/L Which of the following is the most likely diagnosis?
A. Pregnancy associated hypothyroidism
B. Vitamin B12 defciency
C. Iron defciency anemia
D. Beta thalassemia

A

D. Beta thalassemia

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64
Q

A 20-year-old woman has a history of 3 frst trimester abortons. She was diagnosed last year with pulmonary embolism (see lab results). Test Result Normal Values Prothrombin tme 11 10-13 sec APTT 69 30-40 sec Platelets count 320 150-400 x 109/L Lupus antcoagulant positve
Which of the following is the most likely diagnosis?
A. Factor V Leiden
B. Factor V deficiency
C. Protein C defciency
D. Antphospholipid syndrome

A

D. Antphospholipid syndrome

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65
Q

A woman in her last month of pregnancy is diagnosed with right lower lobe pneumonia. Immune response to this infecton leads to the formaton of specifc IgG antbodies. The fetus would be immunologically protected when born owing to which of the following mechanisms?
A. Actve artfcial immunity
B. Actve natural immunity
C. Passive natural immunity
D. Passive artfcial immunity

A

C. Passive natural immunity

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66
Q

A 21-year-old woman presented with an abnormal vaginal discharge, burning on micturiton, and blood spotng for the past 2 months. On genital examinaton, there was an eroded and friable (strawberry appearance) cervix, with a yellow-green mucopurulent discharge (see report). Lab Testng: >10 PMNs per oil immersion feld. Which of the following is the most likely diagnosis?
A. Gardnerella vaginalis
B. Trichomonas vaginalis
C. Neisseria gonorrhoeae
D. Chlamydia trachomats

A

D. Chlamydia trachomats

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67
Q

A 23-year-old woman presented with vaginal discharge with an unpleasant smell. Examinaton confrmed a homogenous grayish-white vaginal discharge that has a high PH. A saline wet- preparaton examinaton of the discharge showed “clue cells* and with applicaton of potassium hydroxide a fshy smell was generated. Which of the following is the most likely diagnosis?
A. Phthirus pubis
B. Pediculosis pubis
C. Candida albicans
D. Bacterial vaginosis

A

D. Bacterial vaginosis

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68
Q

A 28-year-old woman presented with pain, fever, spasm of lower abdominal muscles and profuse purulent vaginal discharge for the past 2 days. On examinaton, there was suprapubic tenderness. Vaginal examinaton revealed tendemness in the fornices. Blood pressure 108/56 mmH Heart rate 110 /min Respiratory rate 14 /min Temperature 38.4 ° C Which of the following is the most likely diagnosis?
A. Acute cervicits
B. Acute salpingits
C. Acute appendicitis
D. Chronic appendicits

A

B. Acute salpingits

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69
Q

A 34-year-old primigravida presented to the obstetrician for an inital prenatal visit afer self- confrming pregnancy with a home pregnancy test. She complained of breast tendemess and occasional nausea. There were no complaints of urinary frequency or urgency. Urine dipstck analysis was performed and a mid-stream urine sample was obtained (see lab results and report). Test Result Normal Values Nitrites +* Negatve Leukocyte esterase Positve Negatve Culture Report: Escherichia coli count is 50,000 CFU/ml. Which of the following is the most likely diagnosis?
A. Cystts
B. Pyelonephritis
C. Gonococcal infecton
D. Asymptomatic bacteriuria

A

D. Asymptomatic bacteriuria

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70
Q

A 26-year-old nulliparous patent presented to the clinic with vaginal itching and increased vaginal discharge. She had been diagnosed with a positve pregnancy test 3 months ago. A pelvic examinaton showed a yellow-white discharge at the vaginal introitus. The labia were infamed and covered with scratch marks. The vaginal discharge was fshy smell pH 4.8. Which of the following is the most appropriate treatment?
A. Cefriaxone tablets
B. Ampicillin capsules
C. Clotrimazole cream
D. Metronidazole tablets

A

D. Metronidazole tablets

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71
Q

A 35-year-old woman G4 P2012 at 26 weeks’ gestaton, uneventul pregnancy presented for a 50-gram oral glucose tolerance test. 1 hour later by fnger stck sample glucose was 8.1 mmol/L. Which vaginal infecton is she at the highest risk of contractng?
A Candidiasis
B. Vulvodynia
C. Trichomoniasis
D. Bacterial vaginosis

A

A Candidiasis

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72
Q

A 25-year-old woman presented to the clinic with an unpleasant-smelling discharge. A speculum examinaton showed vaginal discharge, grey-green in color. The cervix was covered with papillae with light-red color. A specimen of vaginal secretons was obtained for a wet-prep microscopy which showed unicellular organisms with fagella. Which of the following is the most appropriate management?
A. Oral metronidazole
B. Topical imidazole
C. Oral fuconazole
D. Clindamycin

A

A. Oral metronidazole

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73
Q

A 28-year-old woman at 24 weeks’ gestaton presented to the clinic for a routne examinaton. A pelvic examinaton showed a watery grey-colored discharge, fsh-like smell. There were no signs of infammaton of the vagina or cervix. She reported some itching and moderate discomfort. The vaginal pH 5.1. A sample of the vaginal discharge was collected for analysis. Which of the following is the most likely fnding?
A. Branching hyphae
B. Granular epithelial cells
C. Giant multnucleated cells
D. Overproducton of lactobacilli

A

B. Granular epithelial cells

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74
Q

A 32-year-old woman presents with smelly vaginal discharge associated with intense itching. Her husband has history of slight urethral discharge. A pelvic examinaton confrmed strawberry spots on the cervix. Which one of the following is the most appropriate treatment?
A. Progestogen cream
B. Sulfonamide cream
C. Estrogen cream
D. Metronidazole

A

D. Metronidazole

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75
Q

A 3-year-old girl presents to the Emergency Department with vaginal bleeding and pain. Her mother reports that has been passing stools in her pants for 2 weeks despite being toilet trained. On examinaton, there is bruises on with blood staining labia majora (see lab results). Test Result Normal Values Hb 120 112-165 g/L WBC 9.4 4-10.5 x 109/L Platelet count 344 150-400 × 109/L Prothrombin tme 13 12-14 sec APTT 36 30-40 sec Which of the following is the most likely diagnosis?
A. Sexual abuse
B. Herpetc vaginits
C. Precocious puberty
D. Gonorrheal vaginits

A

A. Sexual abuse

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76
Q

A 33-year-old woman was referred to the Gynecology Clinic because of secondary infertlity. Detailed clinical history revealed that she has history of severe dysmenorrhea Which of the following will typically be the cause of her dysmenorrhea?
A. Ovarian thecoma
B. Ovarian fbroma
C. Endometriosis
D. Leiomyoma

A

C. Endometriosis

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77
Q

A 25-year-old woman complained of crampy, lower abdominal pain that occurs during the frst day of her menses and usually improves by the third day. Her periods is regular and all clinical assessment and pelvic ultrasound within normal. Which of the following most likely explains her clinical presentaton?
A. Adenomyosis
B. Endometriosis
C. Primary dysmenorrhea
D. Pelvic infammatory disease

A

C. Primary dysmenorrhea

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78
Q

A 19-year-old girl complained of recurrent painful menstruaton that starts on day one of her menses and subsides between day 3 to 4. The pain is severe enough to afect her daily actvites and school atendance. All investgatons were negatve. She was started on non-steroid ant-infammatory drugs, her pain severity became less and she was able to resume normal functon during menses. The patent is stll not satsfed and insistng to receive a stronger pain killer. Which of the following is an appropriate management?
A. Additon of diazepam
B. Counseling and educaton on self-care
C. Additon of magnesium tablets orally
D. Uterine tocolytcs during pain episodes

A

B. Counseling and educaton on self-care

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79
Q

A 53-year-old woman has missed her period over the last 12 months. Which of the following hormones is likely to be altered as a result of the conditon?
A. Serum estradiol
B. Serum testosterone
C. Serum progesterone
D. Follicular stmulatng hormone

A

D. Follicular stmulatng hormone

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80
Q

A 45-year-old woman has undergone a total abdominal hysterectomy and bilateral salpingo- oophorectomy for a benign reason. Immediately post operaton, she started to have acute vasomotor symptoms. Accordingly. she was counselled for hormone replacement therapy and agreed. Which of the following is the most appropriate hormone replacement therapy regimens?
A. Transdermal estrogen only patches
B. Levonorgestrel-releasing intrauterine device
C. Cyclical estrogen and progesterone replacement
D. Contnuous estrogen and progesterone replacement

A

C. Cyclical estrogen and progesterone replacement

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81
Q

A pricharavida woman at 32 weeks’ gestaton brought to the Emergency Room with vaginal bleeding and abdominal pain. On examinaton: Fundal height equals to 30 weeks and abdomen is tense. Cardiotocography revealed fetal tachycardia, reduced variability and late deceleratons. Which of the following is the most likely diagnosis?
A. Abrupto placenta
B. Placenta previa
C. Cervical polyp
D. Vasa previa

A

A. Abrupto placenta

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82
Q

A 25-year-old woman complained of recurrent behavioral symptoms that started few days before her menstrual cycles and usually disappeared around the second day of the cycle. These symptoms have led to reduced work productvity, increased work absenteeism, and increased visits to ambulatory healthcare. What is the most common afectve or behavioral symptom for her diagnosis?
A. Irritability
B. Mood swings
C. Depressed mood
D. Anxiety and tension

A

B. Mood swings

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83
Q

A 25-year-old woman complained of recurrent behavioral symptoms that started few days before her menstrual cycles and usually disappear around the second day of the cycle. These symptoms have led to reduced work productvity, absenteeism from work, and increased visits to ambulatory healthcare. Which of the following is the most reliable method to establish the diagnosis?
A. Serum progesterone
B. Pelvic ultrasonography fnding
C. Clinical symptoms
D. Cerebrospinal fuid analysis

A

C. Clinical symptoms

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84
Q

A 35-year-old healthy woman atended the Gynecological Clinic for her regular Pap smear screening. Upon speculum pelvic examinaton, the uterine cervix appeared raised irregular mass measuring 10 X 12 mm localized on the cervix lef lateral aspect.Which of the following is the most appropriate next step?
A. Excise the lesion
B. Tissue biopsy from the mass
C. Human papilloma virus infecton test
D. Reassurance untl the pap smear result

A

B. Tissue biopsy from the mass

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85
Q

A 38-year-old woman atended Outpatent Clinic complaining of fresh vaginal bleeding occurring afer each intercourse. This problem has been disturbing her over the last 3 months. Upon examinaton, her speculum examinaton revealed normal cervix. The report of Pap smear is showing squamous cell carcinoma. Which of the following is the most appropriate next immediate acton?
A. Radiotherapy
B. Neo-adjuvant chemotherapy
C. Total abdominal hysterectomy
D. Colposcopy directed cervical biopsy

A

D. Colposcopy directed cervical biopsy

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86
Q

A 39-year-old woman, who is a mother of 3 children and has completed her family, she is a known case of endometrioma in the right ovary that has been removed 2 years ago. She came to the clinic complaining of mild to moderate dysmenorrhea and deep pain during intercourse along with her chronic lower abdomen pain. Pelvic ultrasonography revealed the presence of lef ovarian cyst measuring 6X7 cm that appeared to be an endometriotc cyst. Which of the following is the most appropriate next step?
A. Removing the cyst when the size becomes more than 10 cm
B. Aspiraton of the content of cyst under ultrasound guidance
C. Total abdominal hysterectomy and bilateral salpingo-oophorectomy
D. Removing the cyst laparoscopically with ablaton of any endometriotc spot

A

D. Removing the cyst laparoscopically with ablaton of any endometriotc spot

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87
Q

A 35-year-old woman delivered her ffh baby by vacuum extracton due to prolonged second stage of labor 3 months ago. The woman was complaining of leakage of urine when she coughed, sneezed or laughed. The symptoms have started afer delivery and persisted since then Which of the following is the most likely diagnosis?
A. Detrusal instability
B. Stress incontnence
C. Urethro-vaginal fstula
D. Over fow incontnence

A

B. Stress incontnence

88
Q

A post-menopausal woman undergoing tamoxifen treatment for breast cancer, she had her last gynecological assessment by ultrasonography during her pre-menopausal period 5 years ago. At that tme, she had intramural uterine fbroid measuring 2 x 3 cm. The patent complained of on and of moderate amount of vaginal bleeding and her ultrasound confrmed intramural uterine fbroid measuring 5 x 8 cm and homogenous endometrium 5 mm in thickness. Which of the following is the most likely diagnosis?
A. Leiomyoma
B. Leiomyosarcoma
C. Endometrial adenocarcinoma
D. Metastatc ovarian carcinoma

A

B. Leiomyosarcoma

89
Q

A 48-year-old asymptomatc woman atended the Gynecology Clinic for her Pap smear screening. During pelvic examinaton, pelvic mass was felt, further assessment by transvaginal ultrasonography indicated the presence of solitary uterine fbroid on the uterine fundus measuring 5 x 6 cm. Which of the following is the most appropriate management?
A. Immediate myomectomy
B. Immediate hysterectomy
C. Regular follow up with yearly pelvic ultrasound
D. Regular follow up with pelvic ultrasound and complete blood count every two months

A

C. Regular follow up with yearly pelvic ultrasound

90
Q

A 16-year-old girl is complaining of infrequent cycle occurring once every 6 to 8 weeks. Which of the following is most likely the cause?
A. Endometrial hyperplasia
B. Ovarian mucinous cystadenoma
C. Physiological variaton in menstrual period tming
D. Uterine benign masses in partcular uterine fbroids

A

C. Physiological variaton in menstrual period tming

91
Q

A 24-year-old woman is complaining of failure to conceive over the last 16 months despite regular intercourse. She has infrequent menstruaton occurring once every 6 to 8 weeks, with increased facial hair and acne. On ultrasound. her ovaries had multple small follicles each is 2.5 mm in diameter on the surface. Body mass index 37 kg/m2. Which of the following is the most likely diagnosis?
A. Polycystic ovarian syndrome
B. Premature ovarian failure
C. Adrenocortcal tumor
D. Hypothyroidism

A

A. Polycystic ovarian syndrome

92
Q

A 24-year-old woman is complaining of failure to conceive over the last 16 months despite regular intercourse. She has infrequent menstruaton occurring once every 6 to 8 weeks along with increased facial hair and acne. On ultrasound, her ovaries had multple small follicles each is 2-5 mm diameter on the surface. She indicated that her main aim is getng pregnant. Body mass index 37 kg/m2 Which of the following is the inital step in management?
A. Weight reducton, danazol and metormin
B. Weight reducton, metformin and clomiphene citrate
C. Weight reducton, in vitro fertlizaton and salicylic acid
D. Weight reducton, laparoscopic ovarian wedge resecton and metormin

A

B. Weight reducton, metformin and clomiphene citrate

93
Q

A 45-year-old woman comes to the clinic complaining of loss of appette, bloatng and abdominal pain. Clinical assessment and investgatons confrmed the presence of moderate ascites, pleural efusion and bilateral ovarian masses. Cancer antgen 125 (CA 125) was 95 unit/ml. Which of the following is the most likely diagnosis?
A. Sex cord stromal ovarian tumor
B. Ovarian germ cell tumor
C. Epithelial ovarian tumor
D. Gonadoblastoma

A

C. Epithelial ovarian tumor

94
Q

A 45-year-old woman comes to the clinic complaining of loss of appette, bloatng and abdominal pain. Clinical assessment and investgatons confrmed the presence of moderate ascites, pleural efusion and bilateral ovarian masses. Cancer antgen 125 (CA 125) was 100 unit/mi. Which investgaton is the most helpful in making a diagnosis?
A. Tumor markers
B. Tissue histopathology
C. Genetc testng for hereditary cancers
D. Magnetc resonance imaging of the pelvic sof tssue

A

B. Tissue histopathology

95
Q

A 25-year-old woman complains of velvety, hyperpigmented plaques on her neck and under arm. She fails to conceive over the last 2 years despite regular intercourse. Her menses are infrequent and occurring once every 6 to 8 weeks. She notces recently increased facial hair. Her husband is healthy with a normal seminal analysis. Which of the following is the most likely diagnosis?
A. Diabetes mellitus
B. Internal malignancy
C. Polycystic ovarian syndrome
D. Systemic lupus erythematous

A

C. Polycystic ovarian syndrome

96
Q

A 25-year-old woman complains of velvety, hyperpigmented plaques on her neck and axillae. She fails to conceive over the last 2 years despite regular intercourse. Her menses are irregular and occurring once every 6 to 8 weeks. She starts recently to experience increased facial hairs. What is the appropriate term of her skin hyperpigmentaton?
A. Acanthosis nigricans
B. Linea nigra
C. Melanoma
D. Stria

A

A. Acanthosis nigricans

97
Q

A 26-year-old married woman presents to Endocrinology-Gynecology clinic for a follow-up of her investgaton results. Accordingly, a polycystc ovarian syndrome is made. She is counselled about plan of management and metormin use in her conditon. What does metormin do in the above conditon?
A. Ant-androgen efect
B. Reducing insulin resistance
C. Increasing P450 in the liver
D. Lowering blood sugar by increasing consumpton

A

B. Reducing insulin resistance

98
Q

A 47-year-old woman, poorly controlled diabetc, complains of polymenorrhagia every couple of weeks.Body mass index 37 kg/m2 Which of the following is most appropriate investgaton to establish the diagnosis?
A. Coagulaton profle
B. Endometrial biopsy
C. Ultrasonography of the pelvis
D. Magnetc resonance imaging of the pelvis

A

B. Endometrial biopsy

99
Q

A 55-year-old woman comes to the Gynecology Clinic complaining of a mass protruding through her vagina when standing for quite sometmes especially during cough and straining. She has 7 children that were delivered vaginally. The last delivery was complicated by prolonged second stage and ended up with vacuum extracton delivery of a 4.2 Kg baby. Which of the following is the most appropriate next step?
A. Bonney’s test
B. Uro-dynamic studies
C. Retro grade cysto-urethrogram
D. Speculum examinaton of vagina

A

D. Speculum examinaton of vagina

100
Q

A 30-year-old woman G2 P2002 at 32 weeks’ gestaton presents to Emergency Department complaining of lower abdominal and back pain, which has increased in frequency and intensity over the last few hours. Abdominal examinaton shows fundal height equals to 32 cm, longitudinal lie fetus and cephalic presentaton. Fetal heart was positve and cardiotocography is reactve with 2-3 uterine contractons per 10 minutes. Vaginal examinaton shows 1 cm dilated cervix, 70% efacement, -3 staton and cephalic. Which of the following is the most appropriate step in management?
A. Inform neonatologist, administer cortcosteroids and strict bed rest
B. Inform neonatologist, administer cortcosteroids and hydrate the patent
C. Inform neonatologist, administer tocolytcs and start intravenous antbiotcs.
D. Inform neonatologist, administer intravenous antbiotcs and strict bed rest

A

B. Inform neonatologist, administer cortcosteroids and hydrate the patent

101
Q

A 30-year-old woman G2 P2002 at 32 weeks’ gestaton presents to Emergency Department complaining of lower abdominal and back pain which has increased in frequency and intensity over the last few hours. Abdominal examinaton shows fundal height equals to 32 cm, longitudinal lie fetus and cephalic presentaton. Fetal heart was positve and cardiotocography is reactve with 2-3 uterine contractons/10 minutes. Vaginal examinaton shows 1 cm dilated cervix, 70% efacement, -3 staton and cephalic. Which of the following is the next step to confrm the diagnosis?
A. Contnuous cardiotocography
B. Lecithin-sphingomyelin rato
C. Repeat vaginal assessment in two hour-tme
D. Cervical length assessment by ultrasound scanning

A

C. Repeat vaginal assessment in two hour-tme

102
Q

A 23-year-old woman G3 P02002 at 20 weeks’ gestaton with history of previous 2 preterm deliveries atends Antenatal Clinic. Current pregnancy is uneventul. An ultrasound shows size correspond to date, anterior placenta and cervical length is 30 mm. Which of the following is the most appropriate interventon?
A. Strict bed rest tll term
B. Immediate cervical cerclage
C. Aspirin 81 mg oral tablet daily
D. Progesterone supplementaton

A

D. Progesterone supplementaton

103
Q

A 26-year-old woman G2 P1001 admited to the hospital in actve labor and ruptured membranes at 38 weeks of gestaton. Upon vaginal examinaton, the cervix was 6 cm dilated and 1 cm long. The orbital ridge and orbits, saddle of the nose, mouth, and chin were palpable. What is the scientfc term for this fetal presentaton?
A. Compound presentaton
B. Cephalic presentaton
C. Brow presentaton
D. Face presentaton

A

D. Face presentaton

104
Q

A primigravida at 37 weeks gestaton known to have bicornuate uterus complains of subcostal discomfort and fetal kicking is appreciated in the lower abdomen mainly. Leopold maneuver; shows global sof presentng part with sluggish ballotement by frst and second pelvic grips. Fetal heart detected at the level of maternal umbilicus. Which of the following is the most likely fetal presentaton?
A. Face presentaton
B. Brow presentaton
C. Breech presentation
D. Shoulder presentaton

A

C. Breech presentation

105
Q

A primigravida at 37 weeks gestaton known to have bicornuate uterus complains of subcostal discomfort and fetal kicking is appreciated in the lower abdomen mainly. Leopold maneuver; shows global sof presentng part with sluggish ballotement by frst and second pelvic grips. Fetal heart detected at the level of maternal umbilicus. What is the recommended method of delivery if this fetal presentaton persisted?
A. Spontaneous vaginal delivery
B. Ventouse delivery
C. Forceps delivery
D. Cesarean secton

A

D. Cesarean secton

106
Q

A 32-year-old woman G3 P2002 presented at 38 weeks’ gestaton to Antenatal Clinic. She has had history of 2 previous normal deliveries of 3 Kg babies. Current pregnancy, fetus found to be breech in presentaton. The patent was counselled and consented for exteral cephalic version. On the scheduled day, an estmated fetal weight is 2.6 Kg by ultrasound, fexed fetal head, and uterus is bicomuate with average liquor measured. Which of the above fndings is contraindicated external cephalic version?
A. Flexed fetal head
B. Bicornuate uterus
C. Average liquor
D. Fetal weight

A

B. Bicornuate uterus

107
Q

A 24-year-old primigravida is found during antenatal care at 22 weeks gestaton to have a blood pressure of 140/95 mmH in 2 diferent measurements documented 4 hours apart. Her urine test for protein was negatve and she was asymptomatc. Which of the following is the most likely diagnosis?
A. Preeclampsia
B. Chronic hypertension
C. Gestatonal hypertension
D. Transient hypertension of pregnancy

A

C. Gestatonal hypertension

108
Q

A 30-year-old woman G2 P1001 at 32 weeks’ gestaton is admited to labor and delivery complaining of lower abdominal and back pain. She has a signifcant previous history of severe preeclampsia (see lab results). Blood pressure 140/90 mmHg Test Result Normal Values Platelets count 80 150-400 x 109/L Uric Acid 460 140-360 umol/L Which of the following fndings would indicate severe preeclampsia?
A. Abdominal pain
B. Blood pressure
C. Uric acid level
D. Platelet count

A

D. Platelet count

109
Q

A 38-year-old woman G3 P2002 at 34 weeks’ gestaton is admited to labor and delivery complaining of headache, epigastric pain and blurred vision. Non-stress test is reassuring. Blood pressure 170/120 mmHg Which of the following is the most appropriate management?
A. Inform anesthesia and deliver the patent immediately
B. Stabilize general conditon, administer magnesium sulfate and deliver the patent
C. Administer magnesium sulfate, stabilize general conditon and wait tll 37 weeks’ gestaton
D. Stabilize general conditon, administer cortcosteroids and deliver the patent

A

B. Stabilize general conditon, administer magnesium sulfate and deliver the patent

110
Q

A 24-year-old woman presents at 7 weeks’ gestaton complaining of mild vaginal bleeding and lower abdominal pain colicky in nature. Upon examinaton; normal vital signs and speculum examinaton shows the cervix is closed and fresh bleed coming through the cervix. Which of the following is the most likely cause of the bleeding?
A. Septc aborton
B. Inevitable aborton
C. Incomplete aborton
D. Threatened aborton

A

D. Threatened aborton

111
Q

A 22-year-old primigravida at 7 weeks’ gestaton is brought to Emergency Department complaining of moderate vaginal bleeding with passage of tssue like material and lower abdominal colicky pain. Speculum examinaton; tssue is in the vagina, uterine cervix is opened and admitng one fnger. Product of concepton is protruding through cervical canal. Bimanual examinaton reveals bulky uterus corresponding to seven-eight weeks gestaton. Adnexa were free and there was no cervical excitaton. Which of the following is the most likely diagnosis?
A. Inevitable aborton
B. Incomplete aborton
C. Threatened aborton
D. Complete molar pregnancy

A

B. Incomplete aborton

112
Q

A woman presents at her 9th week of pregnancy with severe vaginal bleeding, lower abdominal pain and passage of the fetus through the vagina. On vaginal examinaton; cervix is open and tssue seen in the cervix. Which of the following the most appropriate management?
A. Fluid replacement and evacuaton and curettage
B. Fluid replacement and expectant management
C. Fluid replacement and uterine massage
D. Fluid replacement and hysterectomy

A

A. Fluid replacement and evacuaton and curettage

113
Q

A 40-year-old woman has just delivered her 7th child at 38 weeks with 4 kg baby boy vaginally 10 minutes ago. The placenta is stll in place and she starts to bleed profusely. The estmated amount of blood loss visually is around 800 ml. Which of the following best describes this case?
A. Secondary post-partum hemorrhage
B. latrogenic post-partum hemorrhage
C. Primary post-partum hemorrhage
D. Tertary post-partum hemorrhage

A

C. Primary post-partum hemorrhage

114
Q

A 38-year-old G9 P8008 woman presented at 38 weeks gestaton in labor and diagnosis of prolonged 2nd stage of labor was entertained and fnally delivered 4.3 Kg baby by vacuum extracton. Antcipated management was taken because of risk of postpartum hemorrhage and hypovolemic shock. Which of the following is considered a best reliable indicator of above complicatons?
A. Visual estmaton of blood loss
B. Maternal pulse rate
C. Hemoglobin level
D. Hematocrit level

A

B. Maternal pulse rate

115
Q

A 37-year-old woman G8 P7017 at 36 weeks’ gestaton has history of recurrent postpartum that required blood transfusion. She has no signifcant medical problem. Which of the following is the most appropriate preventve measure at delivery?
A. Deliver the patent in the operatng room
B. Perform an electve cesarean secton at 38 weeks gestaton
C. Perform active management of 3rd stage of labor
D. Give the patent preload of crystalloid fuids while in labor to overcome the possible post- delivery hypovolemia

A

C. Perform active management of 3rd stage of labor

116
Q

A 14-year-old healthy giri has painless vaginal bleeding occurring at interval of 3 weeks to 2 months. The bleeding usually lasts 2 to 4 days, not preceded by premenstrual symptoms and not associated with clots. Review of systems is not signifcant. Physical examinaton shows a normal appearing pubertal girl along with normal development of secondary sex characteristcs (see lab results). Test Result Normal Values Hemoglobin 120 112-165 g/L RBC 6 4.6.4.8 x 1012/L WBC 4.8 4.5-10.5 x 109/L Platelets count 220 150-400 x 109/L Pregnancy test Negatve Which of the following is the most appropriate management?
A. Follicie stmulatng hormone and prolactn
B. Oral contraceptves pills
C. Metormin
D. Reassure

A

D. Reassure

117
Q

A 50-year-old woman presented with amenorrhea for the last 6 months and has unwanted hot fushes disturbing her night sleep. Which of the following serum levels would confrm the diagnosis?
A. Follicle stimulating hormone
B. Luteinizing hormone
C. Progesterone
D. Oestrogen

A

A. Follicle stimulating hormone

118
Q

A 22-year-old primigravida presented at 38 weeks’ gestaton in labor. Vaginal examinaton showed 7cm dilated cervix, full efacement and vertex. An hour later the obstetrician notced a loop of the umbilical cord below the fetal head. Foetal Heart Rate 120 beat/min. Which of the following is the most appropriate immediate management?
A. Vacuum extracton
B. Cesarean secton
C. Forceps delivery
D. Fetal monitoring

A

B. Cesarean secton

119
Q

A 30-year-old woman G2 P1002 admited at 40 weeks’ gestaton with onset of labor and ruptured membranes. Her cervix was 5 cm dilated and 100% efaced with 0 staton vertex for 3 hours. A fetal monitoring strip showed 2 contractons in 10 minutes with a reassured non-stress test. Which of the following is the most appropriate management?
A. Augmentation with oxytocin
B. Prostaglandin E1 analogue
C. Contnue observaton
D. Dinoprostone

A

A. Augmentation with oxytocin

120
Q

A 33-year-old woman presents with a history of amenorrhea for a year following dilataton and curetage because of abnormal uterine bleeding. She underwent to both progesterone and combined estrogen and progesterone withdrawal tests with no response. Her serum FSH level was normal, Which of the following syndromes is the most likely diagnosis?
A. Kallman
B. Sheehan
C. Asherman
D. Polycystic ovarian

A

C. Asherman

121
Q

A 25-year-old woman was brought to the Emergency Department 7 weeks afer her last menstruaton with positve pregnancy test. Abdominal and transvaginal ultrasound showed no intrauterine pregnancy sac. She has lower abdominal pain, mostly on the lef side and mild vaginal bleeding. Which of the following is the most probable diagnosis?
A. Ruptured corpus luteum
B. Extra uterine pregnancy
C. Twisted ovarian cyst
D. Molar pregnancy

A

B. Extra uterine pregnancy

122
Q

A 29-year-old woman G7 P5015 Is admited at 30 weeks’ gestaton in labor room with leaking liquor for observaton. Which of the following most likely confrm the diagnosis?
A. Chemical examinaton of liquor
B. Bimanual vaginal examinaton
C. Sterile speculum examination
D. Ultrasound examinaton

A

C. Sterile speculum examination

123
Q

A 28-year-old woman G5 P3013 is seen in the Antenatal Clinic. Her previous pregnancies were term normal deliveries. Currently, she is 10 weeks’ gestaton confrmed by a pregnancy test and ultrasound examinaton. Which of the following is the most important purpose of the frst antenatal visit?
A. Identify the risk factors
B. Confrm viable pregnancy
C. Confirm the gestational dating
D. Estimate the hemoglobin level

A

C. Confirm the gestational dating

124
Q

A 28-year-old healthy woman presents to her gynecologist with history of inability to conceive afer 2 years of trying. Menarche at 13-year-old, regular cycles every 36-40 days and 5-day periods. Not on any medicatons. Semenanalysis of husband showed normospermia, Cervical component examinaton is required. The basal body temperature showed a monophasic patern. Which of the following is the most probable cause of the infertlity?
A. Pelvic infammatory disease
B. The coital factor
C. Vaginal factor
D. Anovulaton

A

D. Anovulaton

125
Q

A 25-year-old woman G5 P2022 presented to the clinic at 10 weeks’ gestaton with painless vaginal bleeding. During her hospital admission, she developed heavy vaginal bleeding and lower abdominal pain. She has notced passage of tssue. On examinaton, mild pain, vital signs normal. Pelvic examinaton showed trickling blood through cervix and os is open. Which of the following is most likely diagnosis?
A. Inevitable aborton
B. Incomplete aborton
C. Threatened aborton
D.Septc incomplete aborton
.

A

B. Incomplete aborton

126
Q

A 45-year-old woman who has had last normal pregnancies 15 years ago presents with amenorrhea for 7 months duraton. Pregnancy test is negatve. She expresses her desire to become pregnant again. Which of the following is most appropriate investgaton?
A. LH and FSH levels
B. Endometrial biopsy
C. Hysterosalpingogram
D. Thyroid functon tests

A

A. LH and FSH levels

127
Q

A 39-year-old primigravida atended her routne prenatal visit at 39 weeks’ gestaton. She denied any headache, visual changes, nausea, vomitng or abdominal pain. Urinalysis was negatve for protein (see lab results). Vital signs at this visit: Blood pressure 160/90 mmH, Heart rate 84 /min Vitals signs at all other visits: Blood pressure 120/70 mmHg, Heart rate 68 /min Test Result Normal Values НСТ 0.34 0.37-0.48 Platelets count 165 150-400 x 109/L Alanine aminotransferase 12 5-40 IU/L Aspartate aminotransferase 22 12-40 IU/L Which of the following is the most likely diagnosis?
A. Eclampsia
B. Chronic hypertension
C. Gestatonal hypertension
D. Superimposed preeclampsia

A

C. Gestatonal hypertension

128
Q

A 33-year-old woman presented to the Emergency Department with severe lower abdominal pain. On examinaton, abdomen was difuse tenderness, more in the lower quadrants, Bimanual pelvic exam showed bilateral adnexal masses and palpable. A diagnosis of bilateral tubo- ovarian abscesses was entertained. Blood pressure 130/70 mmH Heart rate 100 /min Respiratory rate 22 /min Temperature 39.9° C Which of the following is the most appropriate next step in management?
A. Exploratory laparotomy
B. Intravenous antbiotc therapy
C. Emergent laparoscopic drainage
D. CT-guided percutaneous drainage

A

B. Intravenous antbiotc therapy

129
Q

A 25-year-old woman G2 P1001 was admited at 39 weeks’ gestaton in Labor Suite with labour pains. On Abdominal examinaton, 3 moderate contractons every 10 minutes. The cervix was 6 cm dilated, 80% efaced. Mouth, lips, nose and orbital hollows were palpable. Which of the following is the most appropriate next step in management?
A. Advise CT pelvimetry
B. Emergency caesarean secton
C. Augment labour with oxytocin
D. Monitor partographic progress

A

D. Monitor partographic progress

130
Q

A 26-year-old woman presented to the clinic with secondary amenorrhea of 6 months duraton. She gave history of breast tenderness. On examinaton; bilateral breast whitsh discharge from nipples. Her urine pregnancy test was negatve and elevated serum prolactn levels. Which of the following radiological assessment is most appropriate?
A. Lumbar spine
B. Sella-turcica
C. Kidneys
D. Pelvis

A

B. Sella-turcica

131
Q

A 20-year-old pregnant woman presented with loss of fetal movements, followed by decreased urinary output and difculty breathing (see lab results and report). Test Result Normal Values Hb 100 120-160 g/L DLCO 70 75-140% Platelets count 75 150-400 x 109/L Creatnine 105 44-115 mol/L Prothrombin tme 24 10-13 sec APTT 60 30-40 sec Fibrinogen 1.6 2-4 g/L Chest X-ray: Difuse ground glass opacites. Which of the following is the most appropriate diagnosis?
A. Acute glomerulonephrits
B. Acute amniotc embolism
C. Disseminated intravascular coagulation
D. Autoimmune thrombocytopenic purpura

A

B. Acute amniotc embolism

132
Q

A 16-year-old presented to the clinic for evaluaton of primary amenorrhea. Examinaton showed normal adult-size breasts. But coarse pubic and axillary hair (see lab result). Test Result Normal Value Testosterone 13.86 0.7-2.8 mol/L Which of the following is the most likely diagnosis?
A. Mayer-Rokitansky-Kuster-Hauser syndrome
B. Complete androgen insensitvity syndrome
C. Asherman’s syndrome
D. Turner syndrome

A

B. Complete androgen insensitvity syndrome

133
Q

A 14-year-old child presented to the clinic afer being sexually abused 6 hours earlier. Genital examinaton confrmed anogenital erythema and mild bleeding vaginally, and labia majora was swollen and bruised. Blood pressure 120/70 mmHg, Heart rate 90 /min, Respiratory rate 20 /min Temperature 36.6° C, What is the most likely site of hymeneal tear that is suggestve of penile penetraton?
A. 2 o’clock
B. 4 o’clock
C. 6 o’clock
D. 8 o’clock

A

C. 6 o’clock

134
Q

A young couple has been trying to conceive a baby for 6 months with no success. The wife has regular cycles every 23 days and 4-day periods. Which of the following is most appropriate investgaton?
A. Serum TSH
B. Serum prolactn
C. Urinary FSH / LHS
D. Day 21 progesterone

A

D. Day 21 progesterone

135
Q

A 19-year-old woman presented with crampy, lower abdominal pain beginning with the onset of menses every month, and lastng for 2 to 3 days. There was no pain between menses, but reported radiaton of pain to the lower back and upper thighs, along with nausea, fatgue, and headache which has been present for several years and progressively getng worse. Physical examinaton normal. Which of the following is the most likely diagnosis?
A. Secondary dysmenorrhea
B. Premenstrual syndrome
C. Primary dysmenorrhea
D. Endometriosis

A

C. Primary dysmenorrhea

136
Q

A 24-year-old married nulliparous has an 18-month history of cyclic, debilitatng pelvic pain related to menses which are regular and heavy requiring 10-15 thick pads on the days of heaviest fow. For the past year, the patent has been engaging in regular intercourse without contracepton in an atempt to conceive. Pelvic examinaton showed normal-size, immobile, retroverted uterus with nodularity and tenderness on palpaton of the uterosacral ligaments. Which of the following is the most likely diagnosis?
A. Pelvic infammatory disease
B. Uterine fbroids
C. Endometriosis
D. Adenomyosis

A

C. Endometriosis

137
Q

A 27-year-old nulliparous presents for a routne examinaton. Her gynecological history indicates a 5-year history of oligomenorrhea with only about 2-3 menses a year. She denies inter-cycle spotng or premenstrual symptoms. The last menses was 3 months ago. The physical examinaton confrmed a moderate amount of facial hair and infammatory acne while the pelvic examinaton is normal. Weight 60 kg, Blood pressure 120/75 mmHg, Heart rate 72 /min, Respiratory rate 17 /min. which of the following is the most likely diagnosis?
A. Polycystc ovary syndrome
B. Hyperprolactnemia
C. Hypothyroidism
D. Hypopituitarism

A

A. Polycystc ovary syndrome

138
Q

A 27-year-old nulliparous is concerned about not having conceived afer a year of regular, unprotected intercourse. The patent denied any major medical illnesses and takes no medicatons. The patent’s spouse is reported to be healthy but has never fathered a child. What is the most appropriate inital step in evaluaton afer history and examinaton?
A. Referral to a reproductve specialist
B. Basal body temperature chartng
C. Hysterosalpingogram
D. Semen analysis

A

A. Referral to a reproductve specialist

139
Q

A 25-year-old nulliparous presented with an 18-month history of cyclic and debilitatng pelvic pain related to menses. Menses is regular and heavy, requiring 10-15 thick pads on the days of heaviest fow. The patent has been engaging in regular intercourse without contracepton for 1 year in an atempt to conceive. Pelvic examinaton revealed a normal-sized, immobile, retroverted uterus with nodularity and tenderness on palpaton of the uterosacral ligaments. Which of the following would most likely help in the diagnosis?
A. Ultrasound
B. Laparoscopy
C. Hysteroscopy
D. Hysterosalpingogram

A

B. Laparoscopy

140
Q

A 48-year-old woman nulliparous presented to the Emergency Department with heavy vaginal bleeding associated with slight dizziness. No other signifcant past medical history except heavy menstruaton in the past few months. The examinaton was normal apart from the presence of a large amount of blood in the vaginal vault (see lab results). Supine: Blood pressure 110/70 mmHg, Heart rate 90 /min Standing: Blood pressure 104/66 mmHg, Heart rate 100 /min Temperature 36.6° C Test Result Normal Values Hb 10 120-160 g/L Pregnancy test -ve Which of the following is the frst step in management?
A. Non-steroidal ant-infammatory agents
B. Medroxyprogesterone
C. Conjugated estrogen
D. Blood transfusion

A

C. Conjugated estrogen

141
Q

A 41-year-old patent presents to the Gynecological Clinic with heavy bleeding. Afer a complete evaluaton, the gynecologist determines the patent has dysfunctonal uterine bleeding. Which of the following is the frst step in management?
A. Dilaton and curetage
B. Oral contraceptve pill
C. Endometrial ablaton
D. Hysterectomy

A

B. Oral contraceptve pill

142
Q

A 14-year-old girl has a 6-month history of lower mid-abdominal pain colicky in nature, radiates to the back and upper thighs. It ofen begins with onset of menses which lasts for 2-4 days. She has missed several days of school during the last 2 months because the severity of pain. Physical examinaton is normal for abdomen and pelvis. Normal secondary sexual development is also noted, Which of the following is the frst step in management?
A. Nonsteroidal ant-infammatory drugs
B. Oral contraceptve pills
C. Acetaminophen
D. Clomiphene

A

A. Nonsteroidal ant-infammatory drugs

143
Q

A 23-year-old woman presented with breast tenderness, abdominal bloatng, and food cravings. She has a 6-month history of tredness, anxiety, emotonal lability, difculty concentratng and insomnia. There are no menstrual irregularites or prodromal life stressors. The symptoms recurred on a regular basis during the week leading up to the menstrual period but completely resolve within the frst 3 days of menses. The patent felt totally incapacitated when symptomatc, and the symptoms adversely afect personal and professional life. Which of the following is the best-evidenced treatment?
A. Selectve serotonin uptake inhibitors
B. Oral medroxyprogesterone acetate
C. Progesterone vaginal suppositones
D. Transdermal estrogen patches

A

A. Selectve serotonin uptake inhibitors

144
Q

A 22-year-old married woman has had severe, recurrent depression associated with multple suicide atempts. She has been stabilized for the past 3 months on paroxetne and is now pregnant. Which of the following is the most appropriate management?
A. Discontinue paroxetne due to avoid prematurity
B. Continue paroxetne and monitor for depression
C. Discontinue paroxetne to avoid fetal damage
D. Continue paroxetne and add lithium

A

B. Continue paroxetne and monitor for depression

145
Q

A 32-year-old primigravida at 34 weeks’ gestaton presents for urgent care afer falling down a fight of stairs. The patent complains of uterine tenderness and reduced fetal movement in the 45 minutes since the fall. There has been a small amount of dark red vaginal bieeding. The fetal heart monitoring revealed a heart rate of 150 bpm with irregular uterine contractons every 3 to 4 minutes. Her pregnancy has been uncomplicated. She has positve history of cigaretes smoking. Which of the following is the most likely diagnosis?
A. Placenta previa
B. Uterine rupture
C. Placental abrupton
D. Latent phase of labor

A

C. Placental abrupton

146
Q

A 34-week pregnant woman presents in labor with contractons occurring every 4 minutes, she also has vaginal bleeding which is heavier than normal menstrual fow. The fetus is in a back- down positon, transverse lie, and the cervix is dilated 3 cm with bulging membranes. The fetal heart rate is 170 bpm. The sonography showed a posterior fundal placenta with a retroplacental sonolucent area. Which of the following is the most appropriate inital management?
A. Administraton of a tocolytc agent
B. Oxytocin augmentaton
C. Caesarean secton
D. Amniotomy

A

C. Caesarean secton

147
Q

A 40-year-old sexually actve patent presents for cervical cancer screening. Physical examinaton is unremarkable, menstruaton is regular with a 28-day cycle and last menstrual period was 5 days ago. Which of the following is the best advice about Pap smear?
A. Yearly screening recommended
B. Every 5 years is recommended
C. No routne screening recommended
D. Three negatve results and no further screening

A

A. Yearly screening recommended

148
Q

A 42-year-old obese nulligravida patent with polycystc ovary syndrome has had irregular vaginal bleeding since menarche. She has used no medicaton to control her periods (see lab results and report). Test Result Normal Values Cortsol 8 a.m. 335 138-635 mol/L Estrogen 630 90-550 pmol/L Follicie-stmulatng hormone 38 5-20 IU/L Testosterone 3.1 0.7-2.8 mol/L
Prolactn 590 < 870 pmol/L T3 (Total serum) 1.2 0.9-2.8 mol/L Thyroxine (T4 Total serum) 82 64. 155 mol/L Thyroid-Stmulatng Hormone 4.5 0.4 - 5.0 NU/L Endometrial Biopsy: Adenomatous hyperplasia. Which of the following is the most likely cause of the adenomatous hyperplasia?
A. Human papilloma virus
B. Unopposed estrogen
C. Cellular apoptosis
D. Menopause

A

B. Unopposed estrogen

149
Q

A 42-year-old obese woman presented with a 5-year history of irregular vaginal bleeding. Thyroid studies are normal. She notced that her irregular in menstruaton has started to put on weight (see report). Body mass index 35 kg/m2 Endometrial Biopsy: Adenomatous hyperplasia. Which of the following is the most likely cause?
A. Adrenal hyperplasia
B. Hepatc dysfuncton
C. Local genetc mutaton of the endometrium
D. Peripheral conversion of precursors to estrogen

A

D. Peripheral conversion of precursors to estrogen

150
Q

A 43-year-old woman gravida 2 para 2 has had oligoovulaton due to polycystc ovary syndrome and used cyclic progesterone for withdrawal bleeding. Approximately 5 years ago, she discontnued taking progesterone. Which of the following risks is increased?
A. Hip fracture
B. Cervical dysplasia
C. Ectopic pregnancy
D. Endometrial carcinoma

A

D. Endometrial carcinoma

151
Q

A 30-year-old woman P1+0 presented to Obstetrics and Gynecology Clinic complains of inability to conceive for the last 3 years. During that tme. she was not on contraceptve and her menstrual periods every 45 days but no period for the last 6 months (see lab results). Test Result Normal Values Thyroid-Stmulatng Hormone 9.2 NU/L 0.4 - 5.0 wU/L Follicular phase 5-20 IU/L Mid cycle peak 15-35 IU/L Follicle-stmulatng hormone 5.3 yU/L. Luteal phase 5-15 IU/L Postmenopausal women 50-100 |U/L Men 5-20 IU/L Men 3-15 U/L Luteinizing hormone 7.2 U/L Follicular phase 5-22 U/L Luteal phase 5-22 U/L Ovulatory phase 30-250 U/L Postmenopausal Women > 30 U/L Prolactn 140 ng/ml < 25 ng/ml Which of the following is the most likely diagnosis?
A. Hypothyroidism
B. Hypopituitarism
C. Hyperprolactnemia
D. Polycystc ovary syndrome

A

A. Hypothyroidism

152
Q

A young primigravida presents with signifcant edema of the lower extremites and hands. The patent was admited for evaluaton and management. Blood pressure 150/95 mmHg Heart rate 76 /min Respiratory rate 18/min Temperature 36.6° C Which of the following would be the most appropriate management?
A. Diuretcs
B. Low-salt diet
C. Oral labetalol
D. Continued evaluation

A

D. Continued evaluation

153
Q

A 30-year-old woman with a history of infertlity for 6 years complains of severe dysmenorrhea unrelieved by naproxen. Which of the following is the most likely diagnosis?
A. Endometrits
B. Leiomyomata
C. Endometriosis
D. Pelvic congeston

A

C. Endometriosis

154
Q

A 40-year-old woman complains of Post-coital bleeding. Speculum examinaton reveals cervical mass. Which of the following is the most appropriate next investgaton?
A. Pap smear
B. Cone biopsy
C. RNA analysis
D. Directed biopsy

A

D. Directed biopsy

155
Q

A 48-year-old obese woman complains of nausea. Patent LMP was 2 months ago. She is using barrier method (condoms) as a birth control method. Examinaton is normal except for a slight dusky discoloraton of her cervix. Which of the following is the next step in management?
A. Progesterone challenge
B. Pelvic ultrasound
C. Beta-hCG test
D. Huhner’s test

A

C. Beta-hCG test

156
Q

A hemodynamically stable woman has a tubal, ectopic pregnancy measuring 2.5 x 3 cm by ultrasound (see lab result). Test Result Normal Value Human chorionic gonadotropin N 5000 < 5 mlU/mL. Which of the following is the most appropriate treatment?
A. Laparoscopy
B. Observaton
C. Laparotomy
D. Medical

A

D. Medical

157
Q

A 25-year-old woman in her frst trimester of pregnancy has come for a routne prenatal visit. She used to smoke one pack of cigaretes per day, and is now being advised to quit smoking. Which of the following is the greatest risk to her unborn child?
A. Macrosomia
B. Low birth weight
C. Transient tachypnea
D. Neonatal hypoglycemia

A

B. Low birth weight

158
Q

A 32-year-old woman 16 weeks pregnant presents to the clinic with vaginal bleeding, abdominal enlargement and vomitng for the past 4 days. On examinaton, the uterine size is larger than expected for the gestatonal age (see lab result and report). Test Result Normal Value Human chorionic gonadotropin 80,000 < 5 mlU/mL Ultrasound: Snowstorm-like appearance. Which of the following is the most likely diagnosis?
A. Complete hydatdiform mole
B. Chorioadenoma destruens
C. Partal hydatdiform mole
D. Choriocarcinoma

A

A. Complete hydatdiform mole

159
Q

A 30-year-old woman presents to the Gynecology Clinic with difuse lower right-sided abdominal pain and low back pain that has been progressively worsening for the past month. The pain intensity worsens afer sexual intercourse. Patent menstrual periods occur irregularly and with heavy bleeding. Palpaton reveals a tender mass in the lower right quadrant. Ultrasound pelvis scan shows a 9X9 centmetre heterogeneous mass flled with a calcifcatons. Which of the following is most appropriate method of treatment?
A. Watchful waitng
B. Dilaton and curetage
C. Operative laparoscopy
D. Methotrexate administraton

A

C. Operative laparoscopy

160
Q

A 28-year-old gravida 3. para 2 presents to Obstetric Triage Unit at 37 weeks’ gestaton following spontaneous rupture of the amniotc membranes confrmed by physical examinaton. On admission to labour and delivery room she was complaining of abdominal pain. Digital examinatng it reactve wits baseline feta near d 17% stacement with the presentng part at o staton. CTG is reactve with baseline fetal heart of 170 bpm. Blood pressure 138/78 mmH Heart rate 111 /min Respiratory rate 24 /min Temperature 38.4° C oral Which of the following is the next step in management?
A. Provide spinal analgesia
B. Intravenous intrapartum antbiotcs
C. Urgent delivery by caesarean secton
D. Administer intramuscular dexamethasone

A

B. Intravenous intrapartum antbiotcs

161
Q

A 24-year-old multparous woman is in the second stage of labour. She has a history of asthma and she uses an albuterol inhaler as needed. She has a prior herpes simplex virus infecton and reports outbreaks about once per year. As a child, she contracted rheumatc fever and takes prophylactc antbiotcs when needed for mitral valve stenosis. Which signifcant medical history indicates benefcial use of forceps?
A. Herpes
B. Asthma
C. Mitral stenosis
D. Prolonged labour

A

C. Mitral stenosis

162
Q

A 30-year-old woman presents to the Women’s Health Clinic afer a spontaneous rupture of membranes occurred at home 1 hour before. Patent medical records indicate a positve history of recurrent vaginal herpes simplex. Which of the following is the next best step in management?
A. Pelvic speculum examinaton
B. Prepare for instrumental delivery
C. Proceed to caesarean secton deliver
D. Intravenous acyclovir administraton

A

A. Pelvic speculum examinaton

163
Q

A gravida 3, para 2 is 16 weeks’ pregnant presents to the obstetrics Clinic concerned about outbreak of illness in her child’s school and the potental efects on the fetus. Which of the following vaccines is recommended at this tme?
A. Rubella
B. Varicella
C. Smallpox
D. Infuenza

A

D. Infuenza

164
Q

A 32-year-old multparous woman is admited for inducton of labour at 41 weeks and 2 days’ gestaton. She had prior 2 uneventul vaginal deliveries. A pelvic examinaton shows the cervix is dilated at 2 cm and is 50% efaced with a medium consistency and mid-anterior positon. The presentng part is at -2 staton. Which of the following methods would be most appropriate for labour inducton?
A. Artfcial rupture of membranes
B. Intravenous oxytocin infusion
C. Indwelling catheter inserton
D. Cervical ripening agent

A

D. Cervical ripening agent

165
Q

A 30-year-old woman gravida 4, para 3 woman presents to Antenatal Clinic at 32 weeks’ gestaton with headache and swelling of the feet. At the inital antenatal visit, there was +2 pitng edema of the lower extremites and the face appears swollen. Dipstck of the urine shows proteinuria. The fundal height is 28 cm and fetal heart rate was 140-150 beats per minute with good variability. She reports regular fetal movements. Blood pressure 150/100 mmg, Heart rate 90 /min, Respiratory rate 26 /min, Temperature 37.1° C Which additonal clinical fnding would be associated with intrauterine growth restricton?
A. Elevated maternal liver enzymes
B. Gestatonal diabetes
C. Oligohydramnios
D. Polyhydramnios

A

C. Oligohydramnios

166
Q

A nulliparous woman is admited to the hospital at 42 weeks’ gestaton for inducton of labour with cervical prostaglandin gel. On admission, a pelvic examinaton shows the cervix is closed, thick and posterior facing. A non-stress test shows the fetal heart rate is 130-140 beats per minute with good variability. There are 3 acceleratons and 2 fetal movements during the examinaton. 1 hour afer applying the prostaglandin gel, the fetal heart tones are 80 beats per minute and the contractons last for two minutes. Which of the following interventon is the most important?
A. Administer oxygen at 10 L/min by facemask
B. Prepare for an urgent caesarean secton
C. Administer subcutaneous terbutaline
D. Assess for cord prolapse

A

C. Administer subcutaneous terbutaline

167
Q

A 25-year-old nulliparous woman at 37 weeks’ gestaton presents to the hospital with regular contractons and spontaneous rupture of membranes. A pelvic examinaton shows cervical dilaton of 6 cm and 90% efacement. Fetal heart rate 130-140 bpm with good variability. Ultrasound examinaton shows the fetus in a breech positon and the patent is admited for a caesarean secton. When would be the optmal tme to administer intravenous antbiotcs?
A. During pre-operatve preparaton
B. Upon closure of the skin wound
C. Afer umbilical cord is clamped
D. Postoperatve

A

A. During pre-operatve preparaton

168
Q

A 30-year-old woman presented to the Emergency Department at 03:00 o’clock with right-sided abdominal pain in the lower quadrant. She rates the pain at a level 9 on the 1-10 pain scale. The pain was sudden, associated with nausea and vomitng. A human chorionic gonadotropin urine test was negatve. On palpaton, there is tenderness and a mass is noted. An ultrasound confrms a mass of 6 cm diameter. Blood pressure 120/70 mmHg Heart rate 110 /min Respiratory rate 20 /min Temperature 37.0° C oral Which of the following is the most likely diagnosis?
A. Ectopic pregnancy
B. Ovarian torsion
C. Ruptured cyst
D. Appendicits

A

B. Ovarian torsion

169
Q

A 34-year-old woman presented to the hospital 7 days before with right-sided lower abdominal pain. In additon, she had slight bright red vaginal bleeding. A blood serum sample of B-human chorionic gonadotropin was 2900 IU/Liter. She was administered intramuscular methotrexate. A week later, she reported to the hospital with severe right-sided lower abdominal pain. A blood serum sample of B-human chorionic gonadotropin was drawn and shown to be 6.000 IU/Liter. Which of the following would be most appropriate?
A. Exploratory laparoscopy
B. Repeat methotrexate
C. Salpingectomy
D. Salpingostomy

A

A. Exploratory laparoscopy

170
Q

A 34-year-old multparous woman presents at 37 weeks’ twins gestaton with regular contractons. Which of the following fetal presentatons is favourable for vaginal delivery?
A. Transverse-cephalic
B. Cephalic-cephalic
C. Breech-breech
D. Breech-cephalic

A

B. Cephalic-cephalic

171
Q

A 26-year-old primigravida woman presented to the clinic at 37 weeks’ gestaton for a routne antenatal care. She reports feeling ill and has a frontal headache. A urine dipstck analysis is performed and shows proteinuria 2+. She is admited to the hospital High Risk Unit and started on an intravenous infusion of magnesium sulfate. Blood pressure 152/102 mmHg, Heart rate 72 /min, Respiratory rate 16 /min, Temperature 37.2° C oral. Which of the following is the primary reason for administering the intravenous medicaton?
A. Prevent pulmonary congeston
B. Control vascular vasospasms
C. Reduce blood pressure
D. Prevent seizures

A

D. Prevent seizures

172
Q

A 28-year-old primigravida 8 weeks gestaton woman atended her frst antenatal appointment. During the history assessment, she reports that she never had chickenpox. A serum blood tter is drawn and is negatve for antbodies. Which of the following is the next best step in management?
A. Avoid exposure
B. Varicella vaccinaton
C. Prophylactc acyclovir
D. Zoster immunoglobulin

A

A. Avoid exposure

173
Q

A 34-year-old gravida 2 para 1 woman 10 weeks gestaton known to have a hypertension taking labetalol 100 milligrams twice per day. In her frst pregnancy had no complicatons and resulted in a healthy infant. During this pregnancy which of the following risks is increased?
A. Intrauterine growth restriction
B. Abnormal fetal presentaton
C. Adherent placenta
D. Uterine rupture

A

A. Intrauterine growth restriction

174
Q

A multparous woman presents to the Maternal Health Clinic at 37 weeks’ gestaton with regular contractons occurring every 2 minutes lastng for 45-60 seconds with moderate intensity. Last pregnancy ended up with low transverse incision caesarean secton. She is now pregnant with twins. Twin A is breech and twin B is cephalic. There has been small amount of clear fuid leaking from the vagina for the past hour. A nitrazine paper test turns blue-green in color. Pelvic examinaton shows a cervical dilaton of 4 cm and 80% efacement. The obstetrician informs her that a caesarean secton is necessary. Which of the following is the most likely reason for a caesarean secton?
A. Ruptured membranes
B. Previous caesarean
C. Fetal presentaton
D. Fetal age

A

B. Previous caesarean

175
Q

A 35-year-old nulliparous woman presents to the Maternal Health Clinic at 24 weeks’ gestaton. The signifcant medical history includes insulin-dependent diabetes class F with nephrits. Additonally, she has chronic hypertension which is controiled with medicaton. The pregnancy has been uncomplicated so far. The uterine funds measured 25 cm above the symphysis and fetal heart tones show a baseline of 160 beats per minute. Which of the following complicatons is most likely to occur?
A. Stllbirth
B. Pre-eclampsia
C. Shoulder dystocia
D. Large for gestatonal age infant

A

B. Pre-eclampsia

176
Q

A 30-year-old para 1 woman presents to the Maternal Health Clinic at 20 days postpartum. She has delivered a full-term girl vaginally by forceps-assisted delivery. The weight at birth is 3.54 kg. She presents with a yellow-white colored vaginal discharge. The discharge is odorless and there is no itching or discomfort. An examinaton shows a pink cervix and absence of uterine tenderness. A microscopic analysis of the vaginal fuid is positve for leukocytes and epithelial cells. Which of the following is the most appropriate management?
A. Dipstck urinalysis
B. Culture discharge
C. Metronidazole
D. Reassurance

A

D. Reassurance

177
Q

A 40-year-old woman underwent a laparoscopic tubal ligaton during the postpartum period following the delivery of her 4th child 4 years ago. She presents to the Maternal Health Clinic complaining of bright red vaginal spotng. Patent last menstrual cycle was 6 weeks ago. A pelvic examinaton shows fullness over the right adnexa. There is no pain or tenderness. Her last pregnancy resulted in an emergency caesarean secton with a mid-line incision. Which of the following is the best next step in management?
A. Laparoscopy
B. Pregnancy test
C. Pelvic ultrasound
D. Endometrial biopsy

A

B. Pregnancy test

178
Q

A 24-year-old nulliparous woman presents to the Maternal Health Clinic in the evening at 34 weeks’ gestaton and complaining of decreased fetal movement. She says she had been at work all day and then came directly to the hospital when she notced that the baby has not been moving as much as usual. There has been no leaking of amniotc fuid. There are no uterine contractons and also no vaginal bleeding. Which of the following is the most appropriate next step in management?
A. Non-stress test
B. Biophysical profle
C. Pelvic examinaton
D. Vibro-acoustc stmulaton

A

A. Non-stress test

179
Q

A gravida 2 para 0 woman presents to the Maternal Health Clinic reportng that she has not menstruated for the past 2 months. The previous pregnancy had resulted in a stllbirth at 34 weeks’ gestaton. A human chorionic gonadotropin test is now positve. She has been trying to conceive for the past 6 months. She is afraid of having another stllbirth and asks to be vaccinated against everything. Which of the following vaccines is most appropriate to administer?
A. Rubella
B. Measles
C. Influenza
D. Varicella

A

C. Influenza

180
Q

A 30-year-old woman presents to the Maternal Health Clinic with the inability to conceive despite trying for the past 18 months. Patent menstrual cycles were regular untl 2 years ago, and since then she has had irregular vaginal bleeding. there is hair covering the upper lip and chin. A pelvic examinaton confrms bilaterally enlarged ovaries. DHEA and 17-OH progesterone values are normal. Body mass index 30 kg/m2 Which of the following laboratory values is most likely fnding?
A. Normal testosterone levels
B. Decreased free androgen index
C. Increased thyroid hormones
D. A Follicle Stmulatng Hormone to Leutenizing Hormone rato of 1:3

A

D. A Follicle Stmulatng Hormone to Leutenizing Hormone rato of 1:3

181
Q

A 20-year-old woman presented to the Maternal Health Clinic with severe facial acne and irregular menstrual bleeding. Examinaton shows fne hair growth on the chin, upper back. breasts and lower abdomen. A pregnancy test is returned negatve. She returns to the clinic on the 5th day of her menstrual cycle and has a serum sample drawn for analysis (see lab results). Test Result Normal Values Follicle-stmulatng hormone 10 5-20 IU/L Luteinizing hormone 28 5-22 U/L Prolactn 890 < 870 pmol/L Testosterone 3.2 0.7-2.8 mol/L Which additonal laboratory values should be obtained?
A. Thyroid stmulatng hormone and free T3 and T4
B. Progesterone and thyroid stmulatng hormone
C. Dehydroepiandrosterone and androstenolone
D. Glucose tolerance and lipid profle

A

D. Glucose tolerance and lipid profle

182
Q

A paediatrician is called to atend a caesarean secton delivery of 38 week’s gestaton baby. On delivery, the neonate does not cry immediately, appears cyanotc and foppy. Afer drying suctoning and stmulatng the baby under the radiant warmer, the following evidence is recorded at 5 minutes (see table). Heart rate 120 beats per minute Breathing Irregular, gasping Refex irritability Coughs, and cries with stmulaton Actvity Arms and legs fexed, litle movement Appearance Rosy with blue extremites What is the most accurate Apgar score?
A. 6
B. 7
C. 8
D. 9

A

C. 8

183
Q

A 31-year-old woman P2 presented to the Women’s Health Clinic for a routne physical examinaton. She has presented to routne health examinatons annually for the last 5 years. Records indicate that in the previous year, she has negatve tests for both the human papilloma virus and the papanicolaou cervical smear. This year both tests are with no abnormal fndings. When should the tests be repeated?
A. 6 months
B. 1 year
C. 2 years
D. 3 years

A

D. 3 years

184
Q

A patent is seen at 8 weeks’ gestaton in an Antenatal Clinic with a diagnosis of cervical incompetence. Which of the following is the most appropriate management?
A. Inserton cervical suture the same week
B. Confrm the diagnosis by Hegar dilator
C. Insert cervical suture at 14 - 16 weeks
D. Begin beta mimetc drugs

A

C. Insert cervical suture at 14 - 16 weeks

185
Q

A 15-year-old unmarried girl presents with history of pain during menstruaton. Her menarche was at age of 13 and menses are regular. Physical and pelvic examinatons are normal for her age. Which of the following is the most appropriate management?
A. Non-steroidal ant-infammatory medicaton
B. Estrogen-progestn oral contraceptve
C. Cervical dilataton
D. Danazol

A

A. Non-steroidal ant-infammatory medicaton

186
Q

A 23-year-old nulligravida patent complains of inability to become pregnant afer 3 months of trying. Patent periods are regular and normal. She had no prior reproductve problems. She currently is not on any contracepton. Examinaton is normal. Her husband is 25-year-old healthy and has one autstc cousin and one with trisomy 21. Which of the following is the best acton?
A. Sperm count
B. Continue trying
C. Genetc testng
D. Tubal patency test

A

B. Continue trying

187
Q

A 24-year-old married woman presented to the clinic with severe abdominal pain followed by vaginal bleeding, for the last 6 hours. Patent’s LMP was 8 weeks ago. On examinaton: she is drowsy and has a tense abdomen. Blood pressure 90/60 mmg Heart rate 120 /min Respiratory rate 20 /min Temperature 36.8 ° C Which of the following is the most likely diagnosis?
A. Threatened aborton
B. Ectopic pregnancy
C. Complete aborton
D. Anovulatory cycle

A

B. Ectopic pregnancy

188
Q

A 24-year-old wornan presents to the clinic with complaining of failure to conceive for more than 2 years of regular trials. Patent has history of irregular periods occurring once every 6 to 7 weeks and is usually scanty (see report). Body mass index 35 kg/m2 Transvaginal ultrasound: Revealed the presence of multple small cysts; each is 3-5mm, lining the ovarian periphery, representng pearl necklace appearance. which of the following is the most likely factor contributng to her infertlity?
A. Tubal factor
B. Cervical factor
C. Ovulatory factor
D. Endometrial factor

A

C. Ovulatory factor

189
Q

A 17-year-old woman comes at 39 weeks’ gestaton to the Emergency Department with no previous antenatal care. She delivered a healthy baby boy normally with no complicatons reported. Then she was given an injecton of RhoGAM. What is the indicaton of RhoGAM?
A. Mother is Rh- and the baby is Rh+
B. Father is RH+ and the baby is Rh-
C. Mother is Rh+ and the baby is Rh-
D. Father is Rh- and the baby is Rh+

A

A. Mother is Rh- and the baby is Rh+

190
Q

A 37-year-old primigravida presented to the clinic with amenorrhea for 12 weeks, hyperemesis gravidarum, and raised human chorionic gonadotropin levels. Uterus size is equivalent to 16 weeks’ gestaton (see report). Ultrasound: Fetus is small for dates. Which of the following is the most likely diagnosis?
A. Choriocarcinoma
B. Hydatdiform mole
C. Toxemia of pregnancy
D. Placental site trophoblastc tumor

A

B. Hydatdiform mole

191
Q

A 26-year-old multparous woman in labor is requestng pain relief. While in the lithotomy positon, the obstetrician performs a pudendal nerve block, and injects a local anesthetc into the sacrotuberous ligament close to the ischial spine. Which of the following structures will remain fully sensitve despite this pudendal nerve block?
A. Urogenital diaphragm
B. Perineal body
C. Rectum
D. Vulva

A

C. Rectum

192
Q

A 45-year-old woman presents to the Gynecological Clinic with history of genital warts that were treated by electrocutery 2 years back. The woman complained of recurrent occurrence of scanty fresh bleeding afer intercourse. Which of the following is the likely source of her bleeding?
A. Uterine cervix
B. Uterine body
C. Vagina
D. Vulva

A

A. Uterine cervix

193
Q

A 34-year-old multparous woman presents to the Maternal Health Clinic at 28 weeks’ gestaton with coughing and difculty in breathing. She appeared restless and uncomfortable. Auscultaton of the lung felds shows bilateral rhonchi. The nail beds and oral mucous membranes appear pale. She is allergic to dust, pollen, mold and animal hair. There is no history of smoking. She reports that the symptoms began 2 days prior and had started with coughing up clear-colored phlegm. Blood pressure 124/72 mmHg Heart rate 120 /min Respiratory rate 24 /min Temperature 37.5° C oral Which of the following tests is initally most appropriate?
A. Spirometry
B. Chest X-ray
C. Arterial blood gas levels
D. Hemoglobin estmaton

A

A. Spirometry

194
Q

A 28-year-old woman with mild intermitent asthma presents to the Health Clinic at 24 weeks’ gestaton and says that her symptoms have worsened as the pregnancy progresses. Prior to the pregnancy, she had an occasional exacerbaton of asthma and used only an albuterol inhaler for treatment as needed. However, she now complains of daily symptoms and once per week symptoms at night tme. A forced expiratory volume in 1 second test shows 70% of normal. Which of the following medicaton regimen is now most appropriate?
A. Short-actng bronchodilators and oral glucocortcoids
B. Inhaled glucocortcoids and short-actng bronchodilators
C. Inhaled glucocortcoids and long-actng bronchodilators
D. Long actng beta2 agonist and inhaled glucocortcoids

A

C. Inhaled glucocortcoids and long-actng bronchodilators

195
Q

A 28-year-old woman G 4 P2012 immigrant presented to the Maternal Health Clinic at 20 weeks’ gestaton with a cough and night chills for the past month. The cough is productve and produces thick sputum. She had been prescribed treatment by a general practtoner for the cough and it had not responded to treatment. Patent nail beds and conjunctva appeared pale
and the cervical lymph nodes are palpable. Auscultaton of the chest shows crepitaton over the upper lef lobe. She had received a BC vaccine as a child. A blood test is positve for interferon-gamma release assays. Blood pressure 110/70 mmHg Heart rate 84 /min Respiratory rate 18 /min Temperature 37.5° C oral Which of the following is the next best step in obtaining a defnitve diagnosis?
A. Chest X-ray
B. Sputum culture
C. Tuberculin skin test
D. Sputum smear cytology

A

B. Sputum culture

196
Q

A 23-year-old primigravida presented in labour. The mid wife advised mediolateral episiotomy during the 2nd stage of labour. What is the advantage of a mediolateral episiotomy?
A. Easy repair
B. Less infecton
C. Tighter introitus
D. Less anal extension

A

D. Less anal extension

197
Q

A 23-year-old G2 P1001 at 22 weeks’ gestaton presented with a complaint of her abdomen is larger than her previous pregnancy (see report). Ultrasound: Showed dizygotc twin pregnancy. Which of the following best described membranes and placenta of dizygotc twins?
A. Monochorionic and monoamniotc for conjoined twins
B. Monochorionic and diamniotc for the foetuses of same sex
C. Dichorionic and monoamniotc for the foetuses of same sex
D. Dichorionic and diamniotc regardless of the sex of the foetuses

A

D. Dichorionic and diamniotc regardless of the sex of the foetuses

198
Q

A 25-year-old woman has delivered a boy. On inspecton of the umbilical cord, a single artery was notced. Which of the following is associated with the above fnding?
A. African race
B. Matemal diabetes
C. Low foetal mortality
D. Major foetal malformaton in 80%

A

B. Matemal diabetes

199
Q

A 33-year-old pregnant woman G4 P2012 at 38 weeks’ gestaton presented with a complaint of dizziness, light-headedness and faintng sensaton especially in bed for 2 weeks duraton (see lab results). Blood pressure 110/70 mmHg, Heart rate 100 /min, Respiratory rate 24/min, Temperature 36.6° C Test Result Normal Values Hb 95 120-160 g/L WBC 9 4.5-10.5 x 109/L Platelet count 200 150-400 × 109/L Which of the following is the best management?
A. Blood transfusion
B. Refer to a neurologist
C. Avoid sleep on the back
D. ECG and echocardiography

A

C. Avoid sleep on the back

200
Q

A 28-year-old woman is diagnosed with an ectopic pregnancy. Which of the following is the most likely predisposing factor?
A. Inducton of ovulaton
B. Previous tubal pregnancy
C. Pelvic infammatory disease
D. Use of an intrauterine contraceptve device

A

C. Pelvic infammatory disease

201
Q

A 21-year-old woman G2 P1001 presents to the Emergency Room with a severe lower abdominal pain for 1 day. Pain is dull and intermitent that last for 10-15 minutes and associated with nausea and vomitng. Examinaton confrms tenderness and guarding in the lower abdomen, it is more on right side and slight fullness in the right iliac fossa (see report). Blood pressure 90/60 mmHg Heart rate 110 /min Respiratory rate 13 /min Temperature 37.6° C Pregnancy Test: Negatve. Which of the following is the most likely diagnosis?
A. Acute cystts
B. Ovarian torsion
C. Acute appendicits
D. Ectopic pregnancy

A

B. Ovarian torsion

202
Q

A 35-year-old pregnant woman at 34 weeks of gestaton presented with labour pains. On physical examinaton, the cervix was 4 cm dilated. Cardiotocography was performed (see image). Blood pressure 135/88 mmH Heart rate 89 /min Respiratory rate 18 /min Temperature 37.4” C Which of the following is the most likely diagnosis?
A. Placenta previa
B. Head compression
C. Umbilical cord compression
D. Uteroplacental insufciency

A

D. Uteroplacental insufciency

203
Q

A 28-year-old woman G3 P0020 at 5 weeks’ gestaton presents with vaginal bleeding associated with some blood clots that has started 3 hours ago. She had been diagnosed with cervical incompetence in her 2 prior second-trimester abortons. A history of dilataton and curetage in her last aborton declared. On examinaton; the cervical os is open and no on-going bleeding. Which of the following is the most likely cause of her current diagnosis of vaginal bleeding?
A. Luteal phase defect
B. Asherman’s syndrome
C. Cervical incompetence
D. Chromosomal abnormality

A

D. Chromosomal abnormality

204
Q

A 59-year-old woman comes to the clinic with headache, dyspnea on exerton and occasional palpitatons (see lab results). Test Result Normal Values Hb 95 130-170 g/L (Male) 120-160 g/L (Female) MCV 68 80-95 f1 Platelets count 530 150-400 x 109/L Total iron binding capacity 30 11.6-31.3 mol. (Male) 9-30.4 pmol/L (Female) Ferritn 3 20-300 g/L (Male) 20-120 pg/L (Female) Which of the following is the most likely diagnosis?
A. B12 defciency
B. Folate defciency
C. Iron defciency anemia
D. Anemia of chronic disease

A

C. Iron defciency anemia

205
Q

A 59-year-old woman comes to the clinic with headache, dyspnea on exerton and occasional palpitatons (see lab reults). Test Result Normal Values Hb 95 130-170 g/L (Male) 120-160 g/L (Female) MCV 68 80-95 f Platelets count 530 150-400 x 109/L Total iron binding capacity 28 11.6-31.3 mol/. (Male) 9-30.4 umol/L (Female) Ferritn 3 20-300 pg/L (Male) 20-120 pg/L (Female) Apart from startng iron supplement, which of the following is the most appropriate next step in management?
A. Urea breath test
B. Stool occult blood
C. CT-scan abdomen and pelvis
D. Endoscopy and colonoscopy

A

D. Endoscopy and colonoscopy

206
Q

A 46-year-old man comes to the clinic with dyspnea on exerton and palpitatons. On examinaton, he has patches of vitligo (see lab results). Test Result Normal Values Hb 89 130-170 g/L (Male) 120-160 g/L (Female) MCV 103 80-95 f Platelets count 128 150-400 x 109/L Ferritn 105 20-300 g/L (Male) 20-120 g/L (Female) Vitamin B12 (Men) 122 160-900 ng/L Folic Acid (Men) 8 <4 ug/L Which of the following is the most appropriate test to be ordered next?
A. Gastroscopy and antral biopsy
B. Intrinsic factor antibodies
C. Ant-gliadin antbodies
D. Colonoscopy

A

B. Intrinsic factor antibodies

207
Q

A 59-year-old man has unsteady gait. On examinaton, he has decreased propriocepton in the lower limbs with positve planter refexes (positve Babinski) and absent ankle and knee’s refexes. He has anemia. Peripheral smear done (see image). Which of the following is the most likely diagnosis?
A. Alcoholism
B. Iron defciency
C. B12 defciency
D. Hypothyroidism

A

C. B12 defciency

208
Q

A 65-year-old-woman has decreased concentraton (see lab results). Test Result Normal Values Hb 89 130-170 g/L (Male) 120-160 g/L (Female) MCV 106 80-95 f1 Platelets count 129 150-400 x 109/L Vitamin B12 (Women) 0,46 0. 12-0.66 mol/L Folic Acid (Women) 0.03 <0.1 umol/L Which of the following would be found on further testng?
A. High methyl malonic acid and normal homocysteine
B. High methyl malonic acid and high homocysteine
C. Normal methyl malonic acid and high homocysteine
D. Low methyl malonic acid and low homocysteine

A

C. Normal methyl malonic acid and high homocysteine

209
Q

A 46-year-old man has dyspnea on exerton and palpitatons. On examinaton, he has patches of vitligo and has absent refexes with positve Babinski in the lower limbs (see lab results). Test Result Normal Values Hb 91 130-170 g/L (Male) 120-160 g/L (Female) MCV 103 80-95 f1 Platelets count 129 150-400 × 109/L Ferritn 120 20-300 g/. (Male) 20-120 g/L (Female) Vitamin B12 (Men) 124 160-900 ng/L Folic Acid (Men) 6 <4 ug/L Which of the following is the most appropriate management?
A. Oral iron supplement
B. Oral b12 supplement
C. Folate supplement
D. Parenteral b12 supplement

A

D. Parenteral b12 supplement

210
Q

A 35-year-old woman has fever and headache for 2 days. On examinaton, she has a scatered petchiae over her body. Her platelets are 32. Peripheral smear done (see image and lab results). Temperature 38.6 °C Test Result Normal Values Platelets count 32 150-400 x 109/L Hb 11.2 130-170 g/L (Male) 120-160 g/L (Female) MCV 102 80-95 f1 Retculocyte 4.9 0.2-1.2 % Lactate dehydrogenase 690 60-160 IU/L Indirect bilirubin 43 3.2-12.1 umal/L Total bilirubin 65 3.5-16.5 mol/L Creatnine 66 44-115 mol/L APTT 36 30-40 sec INR 1.1 0.8-1.2 Prothrombin tme 11 10-13 sec Which of the following is the most likely diagnosis?
A. Immune thrombocytopenia (ITP)
B. Hemolytc uremic syndrome (HUS)
C. Thrombotc thrombocytopenic purpura (TTP)
D. Disseminated intravascular coagulopathy (DIC)

A

C. Thrombotc thrombocytopenic purpura (TTP)

211
Q

A 38-year-old woman has fever and headache for 2 days. On examinaton, she has a scatered petchiae over her body. Peripheral smear done (see image and lab results). Temperature 38.6 °C Test Result Normal Values Hb 112 130-170 g/L (Male) 120-160 g/L (Female) Retculocyte 5.6 0.2-1.2 % Platelets count 32 150-400 x 109/L Indirect bilirubin 48 3.2-12.1 mol/L Total bilirubin 76 3.5-16.5 mol/L Lactate dehydrogenase 690 60-160 IU/L APTT 33 30-40 sec INR 1.0 0.8-1.2 Prothrombin tme 10 10-13 sec Which of the following is the most appropriate treatment?
A. Intravenous immunoglobulin and prednisone
B. Transfuse platelets
C. Plasma exchange
D. Argatroban

A

C. Plasma exchange

212
Q

A 48-year-old man develops right popliteal vein thrombosis post-sleeve surgery. He is started on enoxaparin and warfarin. What is the target therapeutc internatonal normalizaton rato range for this patent?
A. 1-1.9
B. 2-3
C. 3.1-4
D. No need for monitoring

A

B. 2-3

213
Q

A 53-year-old woman admited to the hospital with pneumonia. She has diabetes, hypertension and is on hemodialysis for end-stage renal disease (see lab results). Test Result Normal Values Hb 98 130-170 g/L (Male) 120-160 g/L (Female) Platelets count 151 150-400 x 109/L APTT 33 30-40 sec INR 0.9 0.8-1.2 Prothrombin tme 9.8 10-13 sec Creatnine 460 44-115 mol/L Which of the following is the most appropriate venous thromboembolism prophylaxis for this patent?
A. Graded compression stockings
B. Unfractonated heparin
C. Fondaparinux
D. Enoxaparin

A

B. Unfractonated heparin

214
Q

A 38-year-old woman admited with pyelonephrits. 2 days afer admission, she develops sudden severe shortness of breath (see report). Blood pressure 84/50 mmHg Heart rate 124 /min Oxygen saturaton 84 % CT-pulmonary angiogram: A saddle embolus at the bifurcaton of the pulmonary artery and multple segmental pulmonary emboli bilaterally. which of the following is the most appropriate treatment?
A. Unfractonated heparin and warfarin
B. Enoxaparin
C. Alteplase
D. Apixaban

A

C. Alteplase

215
Q

A 59-year-old man has diabetes, hypertension, dyslipidemia and chronic renal impairment. He was admited 5 days ago to the Coronary Care Unit for a non-ST-elevaton myocardial infarcton (NSTEMI). He is receiving unfractonated heparin. His labs upon admission were normal. Day 5 of his admission, labs as shown (see lab results). Test Result Normal Values Hb 13.1 130-170 g/L (Male) 120-160 g/L (Female) Platelets count 65 150-400 x 109/L WBC 10.3 4.5-10.5 x 109/L Creatnine 88 44-115 umol/L APTT 36 30-40 sec INR 1.1 0.8-1.2 Prothrombin tme 11 10-13 sec Which of the following is the most likely cause of his thrombocytopenia?
A. Immune thrombocytopenia (ITP)
B. Heparin induced thrombocytopenia (HIT)
C. Thrombotc thrombocytopenic purpura (TTP)
D. Disseminated intravascular coagulopathy (DIC)

A

B. Heparin induced thrombocytopenia (HIT)

SMLE (8 decks)

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