2 set

Question 1

A 25-year-old G1P1 comes to see you 6 weeks after an uncomplicated vaginal delivery for a routine postpartum examination. She denies any problems and has been breast-feeding her newborn without any difficulties since leaving the hospital. During the bimanual examination, you note that her uterus is irregular, firm, nontender, and about a 15-week size. Which of the following is the most likely etiology for this enlarged uterus?
A. Subinvolution of the uterus
B. The uterus is appropriate size for 6 weeks postpartum
C. Fibroid uterus
D. Adenomyosis
E. Endometritis

Answer 1

C. Fibroid uterus

Question 2

Match this ethical concern or principal with the appropriate definition: what are the needs of society?
A. Patient preferences
B. Beneficence
C. Quality of life
D. Nonmaleficence
E. Autonomy
F. Medical indication
G. Contextual issues
H. Justice

Answer 2

G. Contextual issues

Question 3

A 32-year-old G3P2 at 39 weeks gestation presented to the hospital with ruptured membranes and 4 cm dilated. She has a history of two prior vaginal deliveries, with her largest child weighing 3800 g at birth. Over the next 2 hours she progresses to 7 cm dilated. Two hours later, she remains 7 cm dilated. The estimated fetal weight by ultrasound is 3200 g. Which of the following labor abnormalities best describes this patient?
A. Prolonged latent phase
B. Protracted active-phase dilation
C. Hypertonic dysfunction
D. Secondary arrest of dilation
E. Primary dysfunction

Answer 3

D. Secondary arrest of dilation

Question 4

You have a patient who is very health conscious and regularly ingests a large number of vitamins in megadoses and herbal therapies on a daily basis. She is a strict vegetarian as well. She is going to attempt pregnancy and wants your advice regarding her diet and nutrition intake. Which of the following is true regarding diet recommendations in pregnancy?
A. Because herbal medications are natural, there is no reason to avoid these dietary supplements in pregnancy.
B. It is recommended that in pregnancy the majority of the protein consumed be supplied from animal sources.
C. Routine supplementation of vitamin A is necessary during pregnancy because dietary intake alone does not provide sufficient amounts needed during pregnancy.
D. During pregnancy, vegetarians obtain sufficient amounts of vitamin B12 in their diet needed for the fetus.
E. Vitamin C supplementation in pregnancy is to be avoided because excessive levels can result in fetal malformations.

Answer 4

B. It is recommended that in pregnancy the majority of the protein consumed be supplied from animal sources.

Question 5

A 38-year-old G1P1 comes to see you for her first prenatal visit at 10 weeks gestational age. She had a previous term vaginal delivery without any complications. You detect fetal heart tones at this visit, and her uterine size is consistent with dates. You also draw her prenatal labs at this visit and tell her to follow up in 4 weeks for a return OB visit. Two weeks later, the results of the patient’s prenatal labs come back. Her blood type is A-, with an anti-D antibody titer of 1:4. Which of the following is the most appropriate next step in the management of this patient?
A. Schedule an amniocentesis for amniotic fluid bilirubin at 16 weeks
B. Repeat the titer in 4 weeks
C. Repeat the titer at 28 weeks
D. Schedule Percutaneous Umbilical Blood Sampling (PUBS) to determine fetal hematocrit at 20 weeks
E. Schedule PUBS as soon as possible to determine fetal blood type

Answer 5

B. Repeat the titer in 4 weeks

Question 6

A pregnant woman is discovered to be an asymptomatic carrier of Neisseria gonorrhoeae. A year ago, she was treated with penicillin for a gonococcal infection and developed a severe allergic reaction. Which of the following is the treatment of choice at this time?
A. Tetracycline
B. Ampicillin
C. Spectinomycin
D. Chloramphenicol
E. Penicillin

Answer 6

C. Spectinomycin

Question 7

What type of obstetric anesthesia is frequently associated with fetal bradycardia?
A. Paracervical block
B. Pudendal block
C. Spinal block
D. Epidural block

Answer 7

A. Paracervical block

Question 8

A 32-year-old G2P1001 at 20 weeks gestational age presents to the emergency room complaining of constipation and abdominal pain for the past 24 hours. The patient also admits to bouts of nausea and emesis since eating a very spicy meal at a new Thai restaurant the evening before. She denies a history of any medical problems. During her last pregnancy, the patient underwent an elective cesarean section at term to deliver a fetus in the breech presentation. The emergency room doctor who examines her pages you and reports that the patient has a low-grade fever of 37.7°C (100°F), with a normal pulse and blood pressure. She is minimally tender to deep palpation with hypoactive bowel sounds. She has no rebound tenderness. The patient has a WBC of 13,000, and electrolytes are normal. Which of the following is the most appropriate next step in the management of this patient?
A. The history and physical examination are consistent with constipation, which is commonly associated with pregnancy; the patient should be discharged with reassurance and instructions to give herself a soapsuds enema and follow a high-fiber diet with laxative use as needed.
B. The patient should be prepped for the operating room immediately to have an emergent appendectomy.
C. The patient should be reassured that her symptoms are a result of the spicy meal consumed the evening before and should be given Pepto-Bismol to alleviate the symptoms.
D. The patient should be sent to radiology for an upright abdominal x-ray.
E. Intravenous antiemetics should be ordered to treat the patient’s hyperemesis gravidarum.

Answer 8

D. The patient should be sent to radiology for an upright abdominal x-ray.

Question 9

A 20-year-old G1 patient delivers a live-born infant with cutaneous lesions, limb defects, cerebral cortical atrophy, and chorioretinitis. Her pregnancy was complicated by pneumonia at 18 weeks. What is the most likely causative agent?
A. Cytomegalovirus
B. Group B streptococcus
C. Rubella virus
D. Treponemal pallidum
E. Varicella zoster

Answer 9

E. Varicella zoster

Question 10

A 34-year-old G2P1 at 31 weeks gestation with a known placenta previa presents to the hospital with vaginal bleeding. On assessment, she has normal vital signs and the fetal heart rate tracing is 140 beats per minute with accelerations and no decelerations. No uterine contractions are demonstrated on external tocometer. Heavy vaginal bleeding is noted. Which of the following is the best next step in the management of this patient?
A. Administer intramuscular terbutaline
B. Administer methylergonovine
C. Admit and stabilize the patient
D. Perform cesarean delivery
E. Induce labor

Answer 10

C. Admit and stabilize the patient

Question 11

A 25-year-old G3 at 39 weeks delivers a small-for-gestational-age infant with chorioretinitis, intracranial calcifications, jaundice, hepato- splenomegaly, and anemia. The infant displays poor feeding and tone in the nursery. The patient denies eating any raw or undercooked meat and does not have any cats living at home with her. She works as a nurse in the pediatric intensive care unit at the local hospital. What is the most likely causative agent?
A. Cytomegalovirus
B. Group B streptococcus
C. Hepatitis B
D. D
E. Parvovirus
F. T. gondii

Answer 11

A. Cytomegalovirus

Question 12

Three days ago you delivered a 40-year-old G1P1 by cesarean section following arrest of descent after 2 hours of pushing. Labor was also significant for prolonged rupture of membranes. The patient had an epidural, which was removed the day following delivery. The nurse pages you to come to see the patient on the postpartum floor because she has a fever of 38.8°C (102°F) and is experiencing shaking chills. Her blood pressure is 120/70 mm Hg and her pulse is 120 beats per minute. She has been eating a regular diet without difficulty and had a normal bowel movement this morning. She is attempting to breast-feed, but says her milk has not come in yet. On physical examination, her breasts are mildly engorged and tender bilaterally. Her lungs are clear. Her abdomen is tender over the fundus, but no rebound is present. Her incision has some serous drainage at the right apex, but no erythema is noted. Her pelvic examination reveals uterine tenderness but no masses. Which of the following is the most likely diagnosis?
A. Pelvic abscess
B. Septic pelvic thrombophlebitis
C. Wound infection
D. Endometritis
E. Atelectasis

Answer 12

D. Endometritis

Question 13

A 34-year-old G6P5 presents to labor and delivery by ambulance at 33 weeks gestational age complaining of the sudden onset of profuse vaginal bleeding. The patient denies any abdominal pain or uterine contractions. She denies any problems with her pregnancy to date but has had no prenatal care. She admits to smoking several cigarettes a day, but denies any drug or alcohol use. The fetal heart rate tracing is normal. There are no contractions on the tocometer. What is the placenta type?
A. Fenestrated placenta
B. Succenturiate placenta
C. Vasa previa
D. Placenta previa
E. Membranaceous placenta
F. Placenta accrete

Answer 13

D. Placenta previa

Question 14

A 27-year-old woman who has previously received no prenatal care presents at term. On ultrasound, she is shown to have a placenta previa, but refuses to have a cesarean section for any reason. Important points to consider in her management include which of the following?
A. The obstetrician’s obligation to the supposedly normal fetus supersedes the obligation to the healthy mother.
B. The inclusion of several people in this complex situation raises the legal risk to the physician.
C. Child abuse statutes require the physician to get a court order to force a cesarean section.
D. Court-ordered cesarean sections have almost always been determined to achieve the best management.
E. A hospital ethics committee should be convened to evaluate the situation.

Answer 14

E. A hospital ethics committee should be convened to evaluate the situation.

Question 15

A physician is being sued for malpractice by the parents of a baby born with cerebral palsy. Which of the following is not a prerequisite for finding the physician guilty of malpractice?
A. A doctor— patient relationship was established.
B. The physician owed a duty to the patient.
C. The physician breached a duty to the patient.
D. The breach of duty caused damage to the plaintiff.
E. The physician failed to give expert care to the patient.

Answer 15

E. The physician failed to give expert care to the patient.

Question 16

A 32-year-old poorly controlled diabetic G2P1 is undergoing amniocentesis at 38 weeks for fetal lung maturity prior to having a repeat cesarean section. Which of the following laboratory tests results on the amniotic fluid would best indicate that the fetal lungs are mature?
A. Phosphatidylglycerol is absent
B. Lecithin/sphingomyelin ratio of 1:1
C. Lecithin/sphingomyelin ratio of 1.5:1
D. Lecithin/sphingomyelin ratio of 2.0:1
E. Phosphatidylglycerol is present

Answer 16

E. Phosphatidylglycerol is present

Question 17

A 29-year-old G3P2 presents to the emergency center with complaints of abdominal discomfort for 2 weeks. Her vital signs are: blood pressure 120/70 mm Hg, pulse 90 beats per minute, temperature 36.94°C, respiratory rate 18 breaths per minute. A pregnancy test is positive and an ultrasound of the abdomen and pelvis reveals a viable 16-week gestation located behind a normal-appearing 10x6x5.5 cm uterus. Both ovaries appear normal. No free fluid is noted. Which of the following is the most likely cause of these findings?
A. Ectopic ovarian tissue
B. Fistula between the peritoneum and uterine cavity
C. Primary peritoneal implantation of the fertilized ovum
D. Tubal abortion
E. Uterine rupture of prior cesarean section scar

Answer 17

D. Tubal abortion

Question 18

A 17-year-old primipara at 41 weeks wants an immediate cesarean section. She is being followed with biophysical profile (BPP) testing. Which of the following is correct information to share with the patient?
A. BPP testing includes amniotic fluid volume, fetal breathing, fetal body movements, fetal body tone, and contraction stress testing.
B. The false-negative rate of the BPP is 10%.
C. False-positive results on BPP are rare.
D. Spontaneous decelerations during BPP testing are associated with significant fetal morbidity.
E. A normal BPP should be repeated in 1 week to 10 days in a post-term pregnancy.

Answer 18

D. Spontaneous decelerations during BPP testing are associated with significant fetal morbidity.

Question 19

A 32-year-old G5 delivers a stillborn fetus at 34 weeks. The placenta is noted to be much larger than normal. The fetus appeared hydropic and had petechiae over much of the skin. What is the most likely causative agent?
A. Herpes simplex
B. Parvovirus
C. Rubella virus
D. T. pallidum
E. Varicella zoster

Answer 19

D. T. pallidum

Question 20

A 23-year-old G1P0 at 42 weeks is undergoing induction of labor. She is receiving intravenous oxytocin. She complains that her contractions are very painful and seem to be continuous. Choose the appropriate fetal heart rate tracing. If none of the tracings apply, answer E (none).
(Reproduced, with permission from: Cunningham FG, Leveno KL, Bloom SL, et al. Williams Obstetrics, 22nd ed., New York, McGraw-Hill, 2005,
A. A
B. B
C. C
D. D
E. E
F. None

Answer 20

A. A

Question 21

What is the recommendation regarding poliomyelitis vaccination in pregnancy?
A. Recommended if the underlying disease is serious
B. Recommended after exposure or before travel to endemic areas
C. Not routinely recommended, but mandatory during an epidemic
D. Contraindicated unless exposure to the disease is unavoidable
E. Contraindicated

Answer 21

C. Not routinely recommended, but mandatory during an epidemic

Question 22

A 37-year-old G3P2 presents to your office for her first OB visit at 10 weeks gestation. She has a history of Graves disease and has been maintained on propylthiouracil (PTU) as treatment for her hyperthyroidism. She is currently euthyroid but asks you if her condition poses any problems for the pregnancy. Which of the following statements should be included in your counseling session with the patient?
A. She may need to discontinue the use of the thionamide drug because it is commonly associated with leukopenia.
B. Infants born to mothers on PTU who are euthyroid may develop a goiter and be clinically hypothyroid.
C. Propylthiouracil does not cross the placenta.
D. Pregnant hyperthyroid women, even when appropriately treated, have an increased risk of developing preeclampsia.
E. Thyroid storm is a common complication in pregnant women with Graves disease.

Answer 22

B. Infants born to mothers on PTU who are euthyroid may develop a goiter and be clinically hypothyroid.

Question 23

A 16-year-old G1P0 at 38 weeks gestation comes to the labor and delivery suite for the second time during the same weekend that you are on call. She initially presented to labor and delivery at 2:00 PM Saturday afternoon complaining of regular uterine contractions. Her cervix was 1 cm dilated, 50% effaced with the vertex at -1 station, and she was sent home after walking for 2 hours in the hospital without any cervical change. It is now Sunday night at 8:00 PM, and the patient returns to labor and delivery with increasing pain. She is exhausted because she did not sleep the night before because her contractions kept waking her up. The patient is placed on the external fetal monitor. Her contractions are occurring every 2 to 3 minutes. You reexamine the patient and determine that her cervix is unchanged. Which of the following is the best next step in the management of this patient?
A. Perform artificial rupture of membranes to initiate labor
B. Administer an epidural
C. Administer Pitocin to augment labor
D. Achieve cervical ripening with prostaglandin gel
E. Administer 10 mg intramuscular morphine
F. Perform a cesarean section

Answer 23

E. Administer 10 mg intramuscular morphine

Question 24

A 21-year-old G1 at 40 weeks, who underwent induction of labor for severe preeclampsia, delivered a 3900-g male infant via vaginal delivery after pushing for 2½ hours. A second-degree midline laceration and side-wall laceration were repaired in the usual fashion under local analgesia. The estimated blood loss was 450 cc. Magnesium sulfate is continued postpartum for the seizure prophylaxis. Six hours after the delivery, the patient has difficulty voiding. Which is the most likely cause of her problem?
A. Preeclampsia
B. Infusion of magnesium sulfate
C. Vulvar hematoma
D. Ureteral injury
E. Use of local analgesia for repair

Answer 24

C. Vulvar hematoma

Question 25

Match this ethical concern or principal with the appropriate definition: what are the treatment alternatives?
A. Patient preferences
B. Beneficence
C. Quality of life
D. Nonmaleficence
E. Autonomy
F. Medical indication
G. Contextual issues
H. Justice

Answer 25

F. Medical indication

Question 26

A multiparous woman has had painful uterine contractions every 2 to 4 minutes for the past 17 hours. The cervix is dilated to 2 to 3 cm and effaced 50%; it has not changed since admission. What is the most appropriate treatment for this clinical situation?
A. Epidural block
B. Meperidine (Demerol) 100 mg intramuscularly
C. Oxytocin intravenously
D. Midforceps delivery
E. Cesarean section

Answer 26

B. Meperidine (Demerol) 100 mg intramuscularly

Question 27

On postoperative day 3 after an uncomplicated repeat cesarean delivery, the patient develops a fever of 38.2°C (100.8°F). She has no complaints except for some fullness in her breasts. On examination she appears in no distress; lung and cardiac examinations are normal. Her breast examination reveals full, firm breasts bilaterally slightly tender with no erythema or masses. She is not breast-feeding. The abdomen is soft with firm, nontender fundus at the umbilicus. The lochia appears normal and is nonodorous. Urinalysis and white blood cell count are normal. Which of the following is a characteristic of the cause of her puerperal fever?
A. Appears in less than 5% of postpartum women
B. Appears 3 to 4 days after the development of lacteal secretion
C. Is almost always painless
D. Fever rarely exceeds 37.8°C (99.8°F)
E. Is less severe and less common if lactation is suppressed

Answer 27

E. Is less severe and less common if lactation is suppressed

Question 28

You see a 42-year-old patient in your office who is now 5 weeks pregnant with her fifth baby. She is very concerned regarding the risk of Down syndrome because of her advanced maternal age. After extensive genetic counseling, she has decided to undergo a second-trimester amniocentesis to determine the karyotype of her fetus. You must obtain informed consent prior to the procedure. During your discussion you should tell the patient which of the following?
A. Transient leakage of amniotic fluid is common after amniocentesis so she should not be concerned if she notices a watery vaginal discharge for a few days.
B. Chorioamnionitis, although an uncommon complication of amniocentesis, can be treated with broad spectrum oral antibiotics.
C. Fetal loss rate after amniocentesis is around 5%.
D. Amniocentesis has not been associated with fetal limb reduction defects.
E. Karyotyping may not be possible as cell culture failure of the amniocytes occurs frequently.

Answer 28

D. Amniocentesis has not been associated with fetal limb reduction defects.

Question 29

A 38-year-old G6P4 is brought to the hospital by ambulance for vaginal bleeding at 34 weeks. She undergoes an emergency cesarean delivery for fetal bradycardia under general anesthesia. In the recovery room 4 hours after her surgery, the patient develops respiratory distress and tachycardia. Lung examination reveals rhonchi and rales in the right lower lobe. Oxygen therapy is initiated and chest X-ray is ordered. Which of the following is most likely to have contributed to her condition?
A. Fasting during labor
B. Antacid medications prior to anesthesia
C. Endotracheal intubation
D. Extubation with the patient in the lateral recumbent position with her head lowered
E. Extubation with the patient in the semierect position (semi-Fowler position)

Answer 29

E. Extubation with the patient in the semierect position (semi-Fowler position)

Question 30

A nulliparous woman is in active labor (cervical dilation 5 cm with complete effacement, vertex at 0 station); the labor curve shows protracted progression without descent following the administration of an epidural block. An IUPC shows contractions every 4 to 5 minutes, peaking at 40 mm Hg. What is the most appropriate treatment for this clinical situation?
A. Epidural block
B. Meperidine (Demerol) 100 mg intramuscularly
C. Oxytocin intravenously
D. Midforceps delivery
E. Cesarean section

Answer 30

C. Oxytocin intravenously

Question 31

A patient presents to you for a well-woman examination. On physical examination she has a café au lait lesion on her back, along with multiple smooth, flesh-colored, dome-shaped papules scattered over her entire body. Match this clinical situation with the appropriate inheritance pattern.
A. Autosomal dominant
B. Autosomal recessive
C. X-linked recessive
D. Codominant
E. Multifactorial

Answer 31

A. Autosomal dominant

Question 32

A 33-year-old G2P1 is undergoing an elective repeat cesarean section at term. The infant is delivered without any difficulties, but the placenta cannot be removed easily because a clear plane between the placenta and uterine wall cannot be identified. The placenta is removed in pieces. This is followed by uterine atony and hemorrhage.
What is the placenta type?
A. Fenestrated placenta
B. Succenturiate placenta
C. Vasa previa
D. Placenta previa
E. Membranaceous placenta
F. Placenta accrete

Answer 32

F. Placenta accrete

Question 33

A healthy 23-year-old G1PO has had an uncomplicated pregnancy to date. She is disappointed because she is 40 weeks gestational age by good dates and a first-trimester ultrasound. She feels like she has been pregnant forever, and wants to have her baby now. The patient reports good fetal movement; she has been doing kick counts for the past several days and reports that the baby moves about eight times an hour on average. On physical examination, her cervix is firm, posterior, 50% effaced, and 1 cm dilated, and the vertex is at a-1 station. As her obstetrician, which of the following should you recommend to the patient?
A. She should be admitted for an immediate cesarean section.
B. She should be admitted for Pitocin induction.
C. You will schedule a cesarean section in 1 week if she has not undergone spontaneous labor in the meantime.
D. She should continue to monitor kick counts and to return to your office in 1 week to reassess the situation.

Answer 33

D. She should continue to monitor kick counts and to return to your office in 1 week to reassess the situation.

Question 34

A 20-year-old G1 at 41 weeks has been pushing for 2½ hours. The fetal head is at the introitus and beginning to crown. It is necessary to cut an episiotomy. The tear extends through the sphincter of the rectum, but the rectal mucosa is intact. How should you classify this type of episiotomy?
A. First-degree
B. Second-degree
C. Third-degree
D. Fourth-degree
E. Mediolateral episiotomy

Answer 34

C. Third-degree

Question 35

A 24-year-old G1P1 presents for her routine postpartum visit 6 weeks after an uncomplicated vaginal delivery. She states that she is having problems sleeping and is feeling depressed over the past 2 to 3 weeks. She reveals that she cries on most days and feels anxious about taking care of her newborn son. She denies any weight loss or gain, but states she doesn’t feel like eating or doing any of her normal activities. She denies suicidal or homicidal ideation. Which of the following is true regarding this patient’s condition?
A. A history of depression is not a risk factor for developing postpartum depression.
B. Prenatal preventive intervention for patients at high risk for postpartum depression is best managed alone by a mental health professional.
C. Young, multiparous patients are at highest risk.
D. Postpartum depression is a self-limiting process that lasts for a maximum of 3 months.
E. About 8% to 15% of women develop postpartum depression.

Answer 35

E. About 8% to 15% of women develop postpartum depression.

Question 36

A 30-year-old G5P3 has undergone a repeat cesarean delivery. She wants to breast-feed. Her past medical history is significant for hepatitis B infection, hypothyroidism, depression, and breast reduction. She is receiving intravenous antibiotics for endometritis. Which of the following would prevent her from breast-feeding?
A. Maternal reduction mammoplasty with transplantation of the nipples
B. Maternal treatment with ampicillin
C. Maternal treatment with fluoxetine
D. Maternal treatment with levothyroxine
E. Past hepatitis B infection

Answer 36

A. Maternal reduction mammoplasty with transplantation of the nipples

Question 37

Which of the following is not a requirement for hospitals according to the Federal Patient Self-Determination Act?
A. To provide all adults with information about their right to accept or refuse treatment in the event of life-threatening conditions
B. To state the institution’s policy on advance directives
C. To prohibit discrimination in care provided to a patient on the basis of the patient’s advanced directive
D. To require donation of organs after death
E. To allow patients to decide who has the right to make decisions for them

Answer 37

D. To require donation of organs after death

Question 38

Fetal death at 15 weeks gestation without expulsion of any fetal or maternal tissue for at least 8 weeks. What is the type of abortion?
A. Complete abortion
B. Incomplete abortion
C. Threatened abortion
D. Missed abortion
E. Inevitable abortion

Answer 38

D. Missed abortion

Question 39

Your patient is a 44-year-old G4P4 with symptomatic uterine fibroids that are unresponsive to medical therapy. The patient has severe menorrhagia to the point that when she menstruates, she cannot leave the house. You recommend to her that she undergo a total abdominal hysterectomy. You counsel her that she may need a blood transfusion if she has a large blood loss during the surgical procedure. Her current hematocrit is 25.0. The patient is a Jehovah’s Witness who adamantly refuses to have a blood transfusion, even if it results in her death. The patient requests that you do not talk at all to her husband about her medical care.
This request falls under which of the following ethical concepts?
A. Informed consent
B. Confidentiality
C. Nonmaleficence
D. Advanced directive

Answer 39

B. Confidentiality

Question 40

A 32-year-old G2P1 at 28 weeks gestation presents to labor and delivery with the complaint of vaginal bleeding. Her vital signs are: blood pressure 115/67 mm Hg, pulse 87 beats per minute, temperature 37.0°C, respiratory rate 18 breaths per minute. She denies any contraction and states that the baby is moving normally. On ultrasound the placenta is anteriorly located and completely covers the internal cervical os. Which of the following would most increase her risk for hysterectomy?
A. Desire for sterilization
B. Development of disseminated intravascular coagulopathy (DIC)
C. Placenta accreta
D. Prior vaginal delivery
E. Smoking

Answer 40

C. Placenta accreta

Question 41

What is the recommendation regarding mumps vaccination in pregnancy?
A. Recommended if the underlying disease is serious
B. Recommended after exposure or before travel to endemic areas
C. Not routinely recommended, but mandatory during an epidemic
D. Contraindicated unless exposure to the disease is unavoidable
E. Contraindicated

Answer 41

E. Contraindicated

Question 42

A 30-year-old class D diabetic is concerned about pregnancy. She can be assured that which of the following risks is the same for her as for the general population?
A. Preeclampsia and eclampsia
B. Infection
C. Fetal cystic fibrosis
D. Postpartum hemorrhage after vaginal delivery
E. Hydramnios

Answer 42

C. Fetal cystic fibrosis

Question 43

A 33-year-old G3P2 at 30 weeks gestation has an infection in pregnancy. Which of the following is a reactivation and therefore not a risk to the fetus?
A. Group B coxsackievirus
B. Rubella virus
C. Chickenpox virus
D. Shingles
E. Herpesvirus type 2

Answer 43

D. Shingles

Question 44

A 20-year-old G1 at 36 weeks is being monitored for preeclampsia; she rings the bell for the nurse because she is developing a headache and feels funny. As you and the nurse enter the room, you witness the patient undergoing a tonic-clonic seizure. You secure the patient’s airway, and within a few minutes the seizure is over. The patient’s blood pressure monitor indicates a pressure of 160/110 mm Hg. Which of the following medications is recommended for the prevention of a recurrent eclamptic seizure?
A. Hydralazine
B. Magnesium sulfate
C. Labetalol
D. Pitocin
E. Nifedipine

Answer 44

B. Magnesium sulfate

Question 45

Your patient had an ultrasound examination today at 39 weeks gestation for size less than dates. The ultrasound showed oligohydramnios with an amniotic fluid index of 1.5 centimeters. The patient’s cervix is unfavorable. Which of the following is the best next step in the management of this patient?
A. Admit her to the hospital for cesarean delivery.
B. Admit her to the hospital for cervical ripening then induction of labor.
C. Write her a prescription for misoprostol to take at home orally every 4 hours until she goes into labor.
D. Perform stripping of the fetal membranes and perform a BPP in 2 days.
E. Administer a cervical ripening agent in your office and have the patient present to the hospital in the morning for induction with oxytocin.

Answer 45

B. Admit her to the hospital for cervical ripening then induction of labor.

Question 46

You are delivering a 33-year-old G3P2 and encounter a shoulder dystocia. After performing the appropriate maneuvers, the baby finally delivers, and the pediatricians attending the delivery note that the right arm is hanging limply to the baby’s side with the forearm extended and internally rotated. Which of the following is the baby’s most likely diagnosis?
A. Erb palsy
B. Klumpke paralysis
C. Humeral fracture
D. Clavicular fracture
E. Paralysis from intraventricular bleed

Answer 46

A. Erb palsy

Question 47

A 25-year-old female in her first pregnancy delivers a 6-lb male infant at 38 weeks. The infant develops fever, vesicular rash, poor feeding, and listlessness at 1 week of age. What is the most likely cause of the infant’s signs and symptoms?
A. Cytomegalovirus
B. Group B streptococcus
C. Hepatitis B
D. Herpes simplex
E. Listeria monocytogenes

Answer 47

D. Herpes simplex

Question 48

While you are on call at the hospital covering labor and delivery, a 32-year-old G3P2002, who is 35 weeks of gestation, presents complaining of lower back pain. The patient informs you that she had been lifting some heavy boxes while fixing up the baby’s nursery. The patient’s pregnancy has been complicated by diet-controlled gestational diabetes. The patient denies any regular uterine contractions, rupture of membranes, vaginal bleeding, or dysuria. She denies any fever, chills, nausea, or emesis. She reports that the baby has been moving normally. She is afebrile and her blood pressure is normal. On physical examination, you note that the patient is obese. Her abdomen is soft and nontender with no palpable uterine contractions. No costovertebral angle tenderness can be elicited. On pelvic examination her cervix is long and closed. The external fetal monitor indicates a reactive fetal heart rate strip; there are rare irregular uterine contractions demonstrated on the tocometer. The patient’s urinalysis comes back with trace glucose, but is otherwise negative. The patient’s most likely diagnosis is which of the following?
A. Labor
B. Musculoskeletal pain
C. Urinary tract infection
D. Chorioamnionitis
E. Round ligament pain

Answer 48

B. Musculoskeletal pain

Question 49

A 30-year-old G1 with twin gestation at 28 weeks is being evaluated for vaginal bleeding and uterine contractions. A bedside ultrasound examination rules out the presence of a placenta previa. Fetal heart rate tracing is reactive on both twins, and the uterine contractions are every 2 to 3 minutes and last 60 seconds. A sterile speculum examination is negative for rupture membranes. A digital examination indicates that the cervix is 2 to 3 cm dilated and 50% effaced, and the presenting part is at -3 station. Tocolysis with magnesium sulfate is initiated and intravenous antibiotics are started for group B streptococcus prophylaxis. Betamethasone, a corticosteroid, is also administered. Which of the following statements regarding the use of betamethasone in the treatment of preterm labor is true?
A. Betamethasone enhances the tocolytic effect of magnesium sulfate and decreases the risk of preterm delivery.
B. Betamethasone has been shown to decrease intraamniotic infections.
C. Betamethasone promotes fetal lung maturity and decreases the risk of respiratory distress syndrome.
D. The anti-inflammatory effect of betamethasone decreases the risk of GBS sepsis in the newborn.
E. Betamethasone is the only corticosteroid proven to cross the placenta.

Answer 49

C. Betamethasone promotes fetal lung maturity and decreases the risk of respiratory distress syndrome.

Question 50

A 38-year-old G3P3 begins to breast-feed her 5-day-old infant. The baby latches on appropriately and begins to suckle. In the mother, which of the following is a response to suckling?
A. Decrease of oxytocin
B. Increase of prolactin-inhibiting factor
C. Increase of hypothalamic dopamine
D. Increase of hypothalamic prolactin
E. Increase of luteinizing hormone-releasing factor

Answer 50

D. Increase of hypothalamic prolactin

Question 51

A 22-year-old G1 at 14 weeks gestation presents to your office with a history of recent exposure to her 3-year-old nephew who had a rubella viral infection. In which time period does maternal infection with rubella virus carry the greatest risk for congenital rubella syndrome in the fetus?
A. Preconception
B. First trimester
C. Second trimester
D. Third trimester
E. Postpartum

Answer 51

B. First trimester

Question 52

Match this ethical concern or principal with the appropriate definition: what impact will the proposed treatment have on the patient’s life?
A. Patient preferences
B. Beneficence
C. Quality of life
D. Nonmaleficence
E. Autonomy
F. Medical indication
G. Contextual issues
H. Justice

Answer 52

C. Quality of life

Question 53

A 21-year-old G2P1 at 25 weeks gestation presents to the emergency room complaining of shortness of breath. She reports a history of asthma and states her peak expiratory flow rate (PEFR) with good control is usually around 400. During speaking the patient has to stop to catch her breath between words; her PEFR is 210. An arterial blood gas is drawn and oxygen therapy is initiated. She is afebrile and on physical examination expiratory wheezes are heard in all lung fields. Which of the following is the most appropriate next step in her management?
A. Antibiotics
B. Chest X-ray
C. Inhaled B-agonist
D. Intravenous corticosteroids
E. Theophylline

Answer 53

C. Inhaled B-agonist

Question 54

A patient comes to see you in the office because she has just missed her period and a home urine pregnancy test reads positive. She is extremely worried because last week she had a barium enema test done as part of a workup for blood in her stools. She is also concerned because her job requires her to sit in front of a computer screen all day and she uses the microwave oven on a regular basis. The patient is concerned regarding the deleterious effects of radiation exposure on her fetus. Which of the following statements is true regarding the effects of exposure to radiation and electromagnetic fields during pregnancy?
A. There is ample evidence in humans and animals that exposure to electromagnetic fields such as from high-voltage power lines, electric blankets, microwave ovens, and cellular phones causes adverse fetal outcomes.
B. There are documented adverse fetal effects with exposure to radiation doses of less than 5 rads.
C. A single diagnostic procedure, such as a barium enema, results in a radiation dose that will adversely affect the embryo or fetus.
D. There is no consistent data that exposure to radiation used for a single diagnostic study is associated with an increased risk of childhood leukemia in the fetus.
E. There is an increased risk of mental retardation when radiation exposure occurs at less than 8 weeks, even with low doses of radiation.

Answer 54

D. There is no consistent data that exposure to radiation used for a single diagnostic study is associated with an increased risk of childhood leukemia in the fetus.

Question 55

A patient presents for her first initial OB visit after performing a home pregnancy test and gives a last menstrual period of about 8 weeks ago. She says she is not entirely sure of her dates, however, because she has a long history of irregular menses. Which of the following is the most accurate way of dating the pregnancy?
A. Determination of uterine size on pelvic examination
B. Quantitative serum human chorionic gonadotropin (HCG) level
C. Crown-rump length on abdominal or vaginal ultrasound
D. Determination of progesterone level along with serum HCG level
E. Quantification of a serum estradiol level

Answer 55

C. Crown-rump length on abdominal or vaginal ultrasound

Question 56

A 27-year-old has just had an ectopic pregnancy. Which of the following events would be most likely to predispose to ectopic pregnancy?
A. Previous cervical conization
B. Pelvic inflammatory disease (PID)
C. Use of a contraceptive uterine device (IUD)
D. Induction of ovulation
E. Exposure in utero to diethylstilbestrol (DES)

Answer 56

B. Pelvic inflammatory disease (PID)

Question 57

A 40-year-old G2P1001 presents to your office for a routine OB visit at 30 weeks gestational age. Her first pregnancy was delivered 10 years ago and was uncomplicated. She had a normal vaginal delivery at 40 weeks and the baby weighed 7 lb. During this present pregnancy, she has not had any complications, and she reports no significant medical history. She is a nonsmoker and has gained about 25 lb to date.
Despite being of advanced maternal age, she declined any screening or diagnostic testing for Down syndrome. Her blood pressure range has been 100 to 120/60 to 70. During her examination, you note that her fundal height measures only 25 cm. Which of the following is a likely explanation for this patient’s decreased fundal height?
A. Multiple gestation
B. Hydramnios
C. Fetal growth restriction
D. The presence of fibroid tumors in the uterus
E. Large ovarian mass

Answer 57

C. Fetal growth restriction

Question 58

A 30-year-old G1P0 with a twin gestation at 25 weeks presents to labor and delivery complaining of irregular uterine contractions and back pain. She reports an increase in the amount of her vaginal discharge, but denies any rupture of membranes. She reports that earlier in the day she had some very light vaginal bleeding, which has now resolved. On arrival to labor and delivery, she is placed on an external fetal monitor, which indicates uterine contractions every 2 to 4 minutes. She is afebrile and her vital signs are all normal. Her gravid uterus is nontender. The nurses call you to evaluate the patient. Which of the following is the most appropriate first step in the evaluation of vaginal bleeding in this patient?
A. Vaginal examination to determine cervical dilation
B. Ultrasound to check placental location
C. Urine culture to check for urinary tract infection
D. Labs to evaluate for disseminated intravascular coagulopathy
E. Apt test to determine if blood is from the fetus

Answer 58

B. Ultrasound to check placental location

Question 59

A 22-year-old G1P0 at 28 weeks gestation by LMP presents to labor and delivery complaining of decreased fetal movement. She has had no prenatal care. On the fetal monitor there are no contractions. The fetal heart rate is 150 beats per minute and reactive. There are no decelerations in the fetal heart tracing. An ultrasound is performed in the radiology department and shows a 28-week fetus with normal-appearing anatomy and size consistent with dates. The placenta is implanted on the posterior uterine wall and its margin is well away from the cervix. A succenturiate lobe of the placenta is seen implanted low on the anterior wall of the uterus. Doppler flow studies indicate a blood vessel is traversing the cervix connecting the two lobes. This patient is most at risk for which of the following?
A. Premature rupture of the membranes
B. Amniotic fluid embolism.
C. Fetal exsanguination after rupture of the membranes
D. Torsion of the umbilical cord caused by velamentous insertion of the umbilical cord
E. Placenta accrete

Answer 59

C. Fetal exsanguination after rupture of the membranes

Question 60

A 20-year-old G1 at 38 weeks gestation presents with regular painful contractions every 3 to 4 minutes lasting 60 seconds. On pelvic examination, she is 3 cm dilated and 90% effaced; an amniotomy is performed and clear fluid is noted. The patient receives epidural analgesia for pain management. The fetal heart rate tracing is reactive. One hour later on repeat examination, her cervix is 5 cm dilated and 100% effaced.
Which of the following is the best next step in her management?
A. Begin pushing
B. Initiate Pitocin augmentation for protracted labor
C. No intervention; labor is progressing normally
D. Perform cesarean delivery for inadequate cervical effacement
E. Stop epidural infusion to enhance contractions and cervical change

Answer 60

C. No intervention; labor is progressing normally

Question 61

You performed a forceps-assisted vaginal delivery on a 20-year-old G1 at 40 weeks for maternal exhaustion. The patient had pushed for 3 hours with an epidural for pain management. A second-degree episiotomy was cut to facilitate delivery. Eight hours after delivery, you are called to see the patient because she is unable to void and complains of severe pain. On examination you note a large fluctuant purple mass inside the vagina. What is the best management for this patient?
A. Apply an ice pack to the perineum
B. Embolize the internal iliac artery
C. Incision and evacuation of the hematoma
D. Perform dilation and curettage to remove retained placenta
E. Place a vaginal pack for 24 hours

Answer 61

C. Incision and evacuation of the hematoma

Question 62

A patient who works as a nurse in the surgery intensive care unit at a local community hospital comes to see you for her annual gynecologic examination. She tells you that she plans to go off her oral contraceptives because she plans to attempt pregnancy in the next few months. This patient has many questions regarding updating her immunizations and whether or not she can do this when pregnant. Which of the following is the most appropriate recommendation?
A. The patient should be checked for immunity against the rubella (German measles) virus prior to conception because the rubella vaccine contains a live virus and should not be given during pregnancy.
B. The patient should be given the tetanus toxoid vaccination prior to becoming pregnant because it is a live virus vaccine that has been associated with multiple fetal anomalies when administered during pregnancy.
C. The Centers for Disease Control and Prevention recommends that all pregnant women should be vaccinated against the influenza virus during the first trimester.
D. If she is exposed to chicken pox while she is pregnant she can be immunized at that time since the chicken pox vaccine is safe during pregnancy.
E. Because of her occupation, the patient is at high risk for hepatitis B; she should complete the hepatitis B vaccination series before she conceives, since that vaccine has been associated with neonatal jaundice.

Answer 62

A. The patient should be checked for immunity against the rubella (German measles) virus prior to conception because the rubella vaccine contains a live virus and should not be given during pregnancy.

Question 63

During a routine return OB visit, an 18-year-old G1PO patient at 23 weeks gestational age undergoes a urinalysis. The dipstick done by the nurse indicates the presence of trace glucosuria. All other parameters of the urine test are normal. Which of the following is the most likely etiology of the increased sugar detected in the urine?
A. The patient has diabetes.
B. The patient has a urine infection.
C. The patient’s urinalysis is consistent with normal pregnancy.
D. The patient’s urine sample is contaminated.
E. The patient has kidney disease.

Answer 63

C. The patient’s urinalysis is consistent with normal pregnancy.

Question 64

A 22-year-old primigravida presents to your office for a routine OB visit at 34 weeks gestational age. She voices concern because she has noticed an increasing number of spidery veins appearing on her face, upper chest, and arms. She is upset with the unsightly appearance of these veins and wants to know what you recommend to get rid of them. Which of the following is the best advice to give this patient?
A. Tell her that this is a condition which requires evaluation by a vascular surgeon
B. Tell her that you are concerned that she may have serious liver disease and order liver function tests
C. Refer her to a dermatologist for further workup and evaluation
D. Tell her that the appearance of these blood vessels is a normal occurrence with pregnancy
E. Recommend that she wear an abdominal support

Answer 64

D. Tell her that the appearance of these blood vessels is a normal occurrence with pregnancy

Question 65

A healthy 31-year-old G3P2002 patient presents to the obstetrician’s office at 34 weeks gestational age for a routine return visit. She has had an uneventful pregnancy to date. Her baseline blood pressures were 100 to 110/60 to 70, and she has gained a total of 20 lb so far. During the visit, the patient complains of bilateral pedal edema that sometimes causes her feet to ache at the end of the day. Her urine dip indicates trace protein, and her blood pressure in the office is currently 115/75. She denies any other symptoms or complaints. On physical examination, there is pitting edema of both legs without any calf tenderness. Which of the following is the most appropriate response to the patient’s concern?
A. Prescribe Lasix to relieve the painful swelling.
B. Immediately send the patient to the radiology department to have venous. Doppler studies done to rule out deep vein thromboses.
C. Admit the patient to L and D to rule out preeclampsia.
D. Reassure the patient that this is a normal finding of pregnancy and no treatment is needed.
E. Tell the patient that her leg swelling is caused by too much salt intake and instruct her to go on a low-sodium diet.

Answer 65

D. Reassure the patient that this is a normal finding of pregnancy and no treatment is needed.

Question 66

E. Urinary tract infection
A 29-year-old G3P2 black woman in the thirty-third week of gestation is admitted to the emergency room because of acute abdominal pain that has been increasing during the past 24 hours. The pain is severe and is radiating from the epigastrium to the back. The patient has vomited a few times and has not eaten or had a bowel movement since the pain started. On examination, you observe an acutely ill patient lying on the bed with her knees drawn up. Her blood pressure is 100/70 mm Hg, her pulse is 110 beats per minute, and her temperature is 38.8°C (101.8°F). On palpation, the abdomen is somewhat distended and tender, mainly in the epigastric area, and the uterine fundus reaches 31 cm above the symphysis. Hypotonic bowel sounds are noted. Fetal monitoring reveals a normal pattern of fetal heart rate (FHR) without uterine contractions. On ultrasonography, the fetus is in vertex presentation and appropriate in size for gestational age; fetal breathing and trunk movements are noted, and the volume of amniotic fluid is normal. The placenta is located on the anterior uterine wall and no previa is seen. Laboratory values show mild leukocytosis (12,000 cells per mL); a hematocrit of 43; mildly elevated serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), and bilirubin; and serum amylase of 180 U/dL. Urinalysis is normal. Which of the following is the most likely diagnosis?
A. Acute degeneration of uterine leiomyoma
B. Acute cholecystitis
C. Acute pancreatitis
D. Acute appendicitis
E. Severe preeclamptic toxemia

Answer 66

C. Acute pancreatitis

Question 67

A 32-year-old female presents to the emergency department with abdominal pain and vaginal bleeding. Her last menstrual period was 8 weeks ago and her pregnancy test is positive. On examination she is tachycardic and hypotensive and her abdominal examination findings reveal peritoneal signs, a bedside abdominal ultrasound shows free fluid within the abdominal cavity. The decision is made to take the patient to the operating room for emergency exploratory laparotomy. Which of the following is the most likely diagnosis?
A. Ruptured ectopic pregnancy
B. Hydatidiform mole
C. Incomplete abortion
D. Missed abortion
E. Torsed ovarian corpus luteal cyst

Answer 67

A. Ruptured ectopic pregnancy

Question 68

A 27-year-old G2P1 at 38 weeks gestation was admitted in active labor at 4 cm dilated; spontaneous rupture of membranes occurred prior to admission. She has had one prior uncomplicated vaginal delivery and denies any medical problems or past surgery. She reports an allergy to sulfa drugs. Currently, her vital signs are normal and the fetal heart rate tracing is reactive. Her prenatal record indicates that her Group B streptococcus (GBS) culture at 36 weeks was positive. What is the recommended antibiotic for prophylaxis during labor?
A. Cefazolin
B. Clindamycin
C. Erythromycin
D. Penicillin
E. Vancomycin

Answer 68

D. Penicillin

Question 69

A 35-year-old G3P3 presents to your office 3 weeks after an uncomplicated vaginal delivery. She has been successfully breast-feeding. She complains of chills and a fever to 38.3°C (101°F) at home. She states that she feels like she has flu, but denies any sick contacts. She has no medical problems or prior surgeries. The patient denies any medicine allergies. On examination she has a low-grade temperature of 38°C (100.4°F) and generally appears in no distress. Head, ear, throat, lung, cardiac, abdominal, and pelvic examinations are within normal limits. A triangular area of erythema is located in the upper outer quadrant of the left breast. The area is tender to palpation. No masses are felt and no axillary lymphadenopathy is noted. Which of the following is the best option for treatment of this patient?
A. Admission to the hospital for intravenous antibiotics
B. Antipyretic for symptomatic relief
C. Incision and drainage
D. Oral dicloxacillin for 7 to 10 days
E. Oral erythromycin for 7 to 10 days

Answer 69

D. Oral dicloxacillin for 7 to 10 days

Question 70

A new patient presents to your office for her first prenatal visit. By her last menstrual period she is 11 weeks pregnant. This is the first pregnancy for this 36-year-old woman. She has no medical problems. At this visit you observe that her uterus is palpable midway between the pubic symphysis and the umbilicus. No fetal heart tones are audible with the Doppler stethoscope. Which of the following is the best next step in the management of this patient?
A. Reassure her that fetal heart tones are not yet audible with the Doppler stethoscope at this gestational age.
B. Tell her the uterine size is appropriate for her gestational age and schedule her for routine ultrasonography at 20 weeks.
C. Schedule genetic amniocentesis right away because of her advanced maternal age.
D. Schedule her for a dilation and curettage because she has a molar pregnancy since her uterus is too large and the fetal heart tones are not audible.
E. Schedule an ultrasound as soon as possible to determine the gestational age and viability of the fetus.

Answer 70

E. Schedule an ultrasound as soon as possible to determine the gestational age and viability of the fetus.

Question 71

Passage of some but not all placental tissue through the cervix at 9 weeks gestation.
What is the type of abortion?
A. Complete abortion
B. Incomplete abortion
C. Threatened abortion
D. Missed abortion
E. Inevitable abortion

Answer 71

B. Incomplete abortion

Question 72

You are doing postpartum rounds on a 23-year-old G1P1 who is postpartum day 2 after an uncomplicated vaginal delivery. As you walk in the room, you note that she is crying. She states she can’t seem to help it. She denies feeling sad or anxious. She has not been sleeping well because of getting up every 2 to 3 hours to breast-feed her new baby. Her past medical history is unremarkable. Which of the following is the most appropriate treatment recommendation?
A. Time and reassurance, because this condition is self-limited
B. Referral to psychiatry for counseling and antidepressant therapy
C. Referral to psychiatry for admission to a psychiatry ward and therapy with Haldol
D. A sleep aid
E. Referral to a psychiatrist who can administer electroconvulsive therapy

Answer 72

A. Time and reassurance, because this condition is self-limited

Question 73

A 30-year-old woman presents for a physical examination for work. She denies any medical problems or surgeries in the past. She has had no
pregnancies. She is sexually active and has been using oral contraceptive pills for the past 6 years. She denies any allergies to medications. On examination, her weight is 62 kg, blood pressure 120/78 mm Hg, pulse 76 beats per minute, respiratory rate 15 breaths per minute, temperature 36.8°C (98.4°F). Her physical examination is normal. Laboratory evaluation is also done. Which direct effect of birth control pills could be noted in the laboratory results?
A. Decreased glucose tolerance
B. Decreased binding globulins
C. Decreased high-density lipoprotein (HDL) cholesterol
D. Decreased triglycerides
E. Decreased hemoglobin concentration

Answer 73

A. Decreased glucose tolerance

Question 74

A 41-year-old woman undergoes exploratory laparotomy for a persistent adnexal mass. Frozen section diagnosis is serous carcinoma. Assuming that the other ovary is grossly normal, what is the likelihood that the contralateral ovary is involved in this malignancy?
A. 5%
B. 15%
C. 33%
D. 50%
E. 75%

Answer 74

C. 33%

Question 75

In an amenorrheic patient who has had pituitary ablation for a craniopharyngioma, which of the following regimens is most likely to result in an ovulatory cycle?
A. Clomiphene citrate
B. Pulsatile infusion of GRH
C. Continuous infusion of GRH
D. Human menopausal or recombinant gonadotropin
E. Human menopausal or recombinant gonadotropin followed by human chorionic gonadotropin (hCG)

Answer 75

E. Human menopausal or recombinant gonadotropin followed by human chorionic gonadotropin (hCG)

Question 76

A healthy 59-year-old woman with no history of urinary incontinence undergoes vaginal hysterectomy and anteroposterior repair for uterine prolapse, large cystocele, and rectocele. Two weeks postoperatively, she presents to your office with a new complaint of intermittent leakage of urine. What is the most likely cause of this complaint following her surgery?
A. Detrusor instability
B. Overflow incontinence
C. Rectovaginal fistula
D. Stress urinary incontinence
E. Vesicovaginal fistula

Answer 76

D. Stress urinary incontinence

Question 77

A 36-year-old morbidly obese woman presents to your office for evaluation of irregular, heavy menses. An office endometrial biopsy shows complex hyperplasia of the endometrium without atypia. The hyperplasia is most likely related to the excess formation in the patient’s adipose tissue of which of the following hormones?
A. Estriol
B. Estradiol
C. Estrone
D. Androstenedione
E. Dehydroepiandrosterone

Answer 77

C. Estrone

Question 78

An 18-year-old patient presents to you for evaluation because she has not yet started her period. On physical examination, she is 5 ft 7 in tall. She has minimal breast development and no axillary or pubic hair. On pelvic examination, she has a normally developed vagina. A cervix is visible. The uterus is palpable, as are normal ovaries. Which of the following is the best next step in the evaluation of this patient?
A. Draw her blood for a karyotype.
B. Test her sense of smell.
C. Draw her blood for TSH, FSH, and LH levels.
D. Order an MRI of the brain to evaluate the pituitary gland.
E. Prescribe a progesterone challenge to see if she will have a withdrawal bleed.

Answer 78

B. Test her sense of smell.

Question 79

What is the most appropriate rate of use effectiveness (percentage of pregnancies per year of actual patient use) for postcoital douche?
A. 80%
B. 40%
C. 15% to 25%
D. 5% to 15%
E. 3% to 10%

Answer 79

A. 80%

Question 80

One of your patients with polycystic ovarian syndrome presents to the emergency room complaining of prolonged, heavy vaginal bleeding. She is 26 years old and has never been pregnant. She was taking birth control pills to regulate her periods until 4 months ago. She stopped taking them because she and her spouse want to try to get pregnant. She thought she might be pregnant because she had not had a period since her last one on the birth control pills 4 months ago. She started having vaginal bleeding 8 days ago. She has been doubling up on superabsorbant sanitary napkins 5 to 6 times daily since the bleeding began. On arrival at the emergency room, the patient has a supine blood pressure of 102/64 mm Hg with a pulse of 96 beats per minute. Upon standing, the patient feels light-headed. Her standing blood pressure is 108/66 mm Hg with a pulse of 126 beats per minute. While you wait for lab work to come back, you order intravenous hydration. After 2 hours, the patient is no longer orthostatic. Her pregnancy test comes back negative, and her Hct is 31%. She continues to have heavy bleeding. Which of the following is the best next step in the management of this patient?
A. Perform a dilation and curettage.
B. Administer a blood transfusion to treat her severe anemia.
C. Send her home with a prescription for iron therapy.
D. Administer high-dose estrogen therapy.
E. Administer antiprostaglandins.