Incorrect MCQ for repetition

Question 1

A 59-year-old woman is being seen for a health maintenance appointment.
She has not seen a doctor for over 10 years. She had undergone a total hysterectomy for uterine fibroids 12 years ago. The patient takes supplemental calcium. The physician orders a fasting glucose level, lipid panel, mammogram, colonoscopy, and a Pap smear of the vaginal cuff. Which of the following statements is most accurate regarding the screening for this patient?
A. The Pap smear of the vaginal cuff is unnecessary.
B. In general colon cancer screening should be initiated at age 60 but this patient has very sporadic care, therefore colonoscopy is reasonable.
C. Because the patient takes supplemental calcium, a DEXA scan is
not needed.
D. Pneumococcal vaccination should be recommended.

Answer 1

A

Question 2

A 63-year-old woman has had annual health maintenance appointments
and has followed all the recommendations offered by her physician.
The physician counsels her about varicella zoster vaccine. Which of the following is the most accurate statement about this vaccine?
A. This vaccine is recommended for patients who are aged 50 and older.
B. This vaccine is not recommended if a patient has already developed
the shingles.
C. This vaccine is a live attenuated immunization.
D. This vaccine has some cross-reactivity with herpes simplex virus
and offers some protection against HSV.

Answer 2

C

Question 3

An 18-year-old adolescent female is being seen for a health maintenance
appointment. She has not had a Pap smear previously. She currently takes oral contraceptive pills. She began sexual intercourse 1 year previously. Which of the following statements is most accurate regarding
health maintenance for this individual?
A. A Pap smear should not be performed in this patient at this time.
B. The HPV vaccine should be administered only if she has a history
of genital warts.
C. The most common cause of mortality for this patient would be
suicide.
D. Hepatitis C vaccination should be offered to this patient.

Answer 3

A

Question 4

A 19-year-old nonpregnant woman marathon runner with amenorrhea.

Answer 4

Hypothalamic dysfunction

Question 5

A 31-year-old G2 P1 woman at 40 weeks’ gestation has progressed in labor from 5-cm to 6-cm cervical dilation over 2 hours. Which of the
following best describes the labor?
A. Prolonged latent phase
B. Prolonged active phase
C. Arrest of active phase
D. Protracted active phase
E. Normal labor

Answer 5

D

Question 6

A 32-year-old woman is diagnosed with an ectopic pregnancy based on hCG levels that have plateaued in the range of 1400 mIU/mL and no chorionic villi found on uterine curettage. She is given 50 mg/m2 of
methotrexate Intramuscularly. Five days later, she complains of increased
lower abdominal pain. Her blood pressure and heart rate are normal. Her
abdomen shows some tenderness in the lower quadrants without guarding
or rebound. Which of the following is the best course of action?
A. Immediate laparotomy
B. Repeat dose of methotrexate
C. Observation
D. Folic acid rescue
E. Epidural analgesia

Answer 6

C

Question 7

A 33-year-old woman G3 P2002 who had two prior cesareans is currently
at 38 weeks’ gestation. She is noted to have a posterior placenta.
On ultrasound, there is evidence of possible placenta accreta. The patient is counseled about the possible risk of need for hysterectomy.
Which of the following is the most accurate statement?
A. Having two prior cesareans is associated with a 50% risk for placenta
accreta.
B. Placenta accreta is associated with a defect in the myometrial layer
of the uterus.
C. If the patient had gestational diabetes, the risk for placenta accreta
would be even higher.
D. The posterior placenta is associated with less of a risk for accreta
than an anterior placenta.

Answer 7

D

Question 8

A 29-year-old G1 P0 woman at 39 weeks’ gestation delivered vaginally.
Her placenta does not deliver easily. A manual extraction of the placenta
is attempted and the placenta seems to be adherent to the uterus.
A hysterectomy is contemplated, but the patient refuses due to strongly desiring more children. The cord is ligated with suture as high as possible.
The patient is given the option of methotrexate therapy. Which of the following is the most likely complication after this intervention?
A. Coagulopathy
B. Utero-vaginal fistula
C. Infection
D. Malignant degeneration

Answer 8

A

Question 9

A 32-year-old woman undergoes myomectomy for symptomatic uterine
fibroids, all of which are subserosal. The endometrial cavity was not entered during the procedure. Which of the following statements
is most likely to be correct regarding the risk of placental accreta?
A. Her risk of accreta is most likely to be increased due to the
myomectomy.
B. Her risk of accreta is most likely to be decreased due to the
myomectomy.
C. Her risk of accreta is most likely not affected by the myomectomy.
D. If the myomectomy incisions are anterior, then she has an increased
risk of a placental polyp.

Answer 9

C

Question 10

A 30-year-old woman is noted to be in active labor at 40 weeks’ gestation.
Delivery of the fetal head occurs, but the fetal shoulders do not deliver with the normal traction. The fetal head is retracted toward the maternal introitus. Which of the following is a useful maneuver for this situation?
A. Internal podalic version
B. Suprapubic pressure
C. Fundal pressure
D. Intentional fracture of the fetal humerus
E. Delivery of the anterior arm

Answer 10

B

Question 11

A 55-year-old woman undergoes a total abdominal hysterectomy and
develops fever and flank tenderness.
Dx

Answer 11

B

Question 12

A 33-year-old woman undergoes pelvic lymphadenectomy for cervical cancer. During the procedure, the right ureter is meticulously and cleanly dissected free and a Penrose drain is placed around it to ensure its safety. She is asymptomatic until postoperative day 9, when she develops profuse nausea and vomiting, and is noted to have ascites on
ultrasound.
Dx

Answer 12

C

Question 13

A 48-year-old healthy postmenopausal woman has a Pap smear performed,
which reveals atypical glandular cells. She does not have a history
of abnormal Pap smears. Which of the following is the best next
step?
A. Repeat Pap smear in 3 months
B. Colposcopy, endocervical curettage, endometrial sampling
C. Hormone replacement therapy
D. Vaginal sampling

Answer 13

B

Question 14

A 57-year-old postmenopausal woman with hypertension, diabetes,
and a history of polycystic ovarian syndrome complains of vaginal
bleeding for 2 weeks. The endometrial sampling shows a few fragments
of atrophic endometrium. Estrogen replacement therapy is begun. The
patient continues to have several episodes of vaginal bleeding 3 months
later. Which of the following is the best next step?
A. Continued observation and reassurance
B. Unopposed estrogen replacement therapy
C. Hysteroscopic examination
D. Endometrial ablation
E. Serum CA-125 testing

Answer 14

C

Question 15

A 21-year-old patient at 28 weeks’ gestation has vaginal bleeding and
is diagnosed with placenta previa. Which of the following is a typical
feature of this condition?
A. Painful bleeding
B. Commonly associated with coagulopathy
C. First episode of bleeding is usually profuse
D. Associated with postcoital spotting

Answer 15

D

Question 16

A 33-year-old woman at 37 weeks’ gestation, confirmed by first-trimester
sonography, presents with moderately severe vaginal bleeding. She is
noted on sonography to have a placenta previa. Which of the following
is the best management for this patient?
A. Induction of labor
B. Tocolysis of labor
C. Cesarean delivery
D. Expectant management
E. Intrauterine transfusion

Answer 16

C

Question 17

An 18-year-old pregnant woman is noted to have vaginal bleeding.
She is bleeding from venipuncture sites, IV sites, and from her gums.
Which of the following is the most likely underlying diagnosis?
A. Placental abruption
B. Placenta previa
C. Gestational diabetes
D. Multifetal gestation
E. Gestational trophoblastic disease

Answer 17

A

Question 18

A 32-year-old woman is seen in the obstetrical unit at the hospital. She
is at 29 weeks’ gestation, with a chief complaint of significant vaginal
bleeding. She had a stillbirth with her prior pregnancy due to placental
abruption. The patient asks the physician about the accuracy of ultrasound
in the diagnosis of abruption. Which of the following statements
is most accurate?
A. Fetal ultrasound is more accurate in diagnosing placental abruption
than placenta previa.
B. Fetal ultrasound is quite sensitive in diagnosing placental abruption.
C. Ultrasound is sensitive in diagnosing abruption that occurs in the
lower aspect of the uterus.
D. Fetal ultrasound is not sensitive in diagnosing placental abruption

Answer 18

D

Question 19

An 18-year-old woman, who had undergone a previous low-transverse
cesarean delivery, is admitted for active labor. During labor, an intrauterine
pressure catheter displays normal uterine contractions every 3 minutes
with intensity up to 60 mm Hg. Fetal bradycardia ensues. Which of the
following statements is most accurate?
A. The normal intrauterine pressure catheter display makes uterine
rupture unlikely.
B. The most common sign of uterine rupture is a fetal heart rate
abnormality.
C. If the patient has a uterine rupture, the practitioner should wait to
see whether the heart tones return to decide on route of delivery.
D. The intrauterine pressure catheter has been found to be helpful in
preventing uterine rupture.

Answer 19

B

Question 20

A 33-year-old G2 P1 woman at 39 weeks’ gestation in active labor is
noted to have a 10-minute episode of bradycardia on the external fetal
heart rate tracing in the range of 100 bpm, which has not resolved.
Her cervix is closed. Which of the following is the best initial step in
management of this patient?
A. Fetal scalp pH assessment
B. Emergency cesarean delivery
C. Intravenous atropine
D. Intravenous terbutaline
E. Assess maternal pulse

Answer 20

E

Question 21

A 38-year-old woman is seen by her physician because of headaches,
amenorrhea, and galactorrhea. Her pregnancy test was negative. Her
prolactin level was markedly elevated and TSH was normal. The physician
makes a presumptive diagnosis of pituitary adenoma and orders an
MRI of the brain. Which of the following clinical presentations is consistent
with a prolactin-secreting pituitary adenoma?
A. Diabetes insipidus
B. Occipital cerebral defect
C. Central field visual defect
D. Amenorrhea due to inhibition of gonadotropin-releasing hormone
Pulsations

Answer 21

D

Question 22

A 33-year-old woman with a microadenoma of the pituitary gland
becomes pregnant. When she reaches 28 weeks’ gestation, she complains
of headaches and visual disturbances. Which of the following is
the best therapy?
A. Craniotomy and pituitary resection
B. Tamoxifen therapy
C. Oral bromocriptine therapy
D. Expectant management
E. Lumbar puncture

Answer 22

C

Question 23

A 31-year-old G2 P1001 woman at 28 weeks’ gestation presents with
generalized pruritus. She has no rashes on her body and is diagnosed
as having probable intrahepatic cholestasis of pregnancy. Which of
the following is most accurate?
A. Hepatic transaminase levels are usually in the 2000 U/L range.
B. Is associated with hypertension.
C. May be associated with an increased perinatal morbidity.
D. Often is associated with thrombocytopenia.

Answer 23

C

Question 24

A 33-year-old woman G1 P0 at 39 weeks’ gestation is in labor. She has
been diagnosed with herpes gestationis with the characteristic pruritus
and vesicular lesions on the abdomen. Which of the following precautions
is best advised for this patient?
A. Cesarean delivery is indicated.
B. Neonatal lesions may be noted and will resolve.
C. Vaginal delivery is permissible if the lesions are not in the introitus
region and provided that oral acyclovir is given to the baby.
D. Tocolysis and oral steroid use is advisable until the lesions are
healed.

Answer 24

B

Question 25

A 24-year-old G0 P0 woman is seen at the local sexually transmitted
disease (STD) clinic. Chlamydia is discovered colonizing the endocervix.
The patient is given oral azithromycin therapy and warned
about the dangers of upper genital tract infection, such as PID. The
physician notes that the patient is at risk for PID. Which of the following
is a risk factor for developing PID?
A. Nulliparity
B. Candida vaginitis
C. Oral contraceptive agents
D. Depot medroxyprogesterone acetate

Answer 25

A

Question 26

A 33-year-old woman with an intrauterine contraceptive device
develops symptoms of acute salpingitis. On laparoscopy, sulfur granules
appear at the fimbria of the tubes. Which of the following is the
most likely organism?
A. C trachomatis
B. Nocardia species
C. N gonorrhoeae
D. T pallidum
E. Actinomyces species

Answer 26

E

Question 27

A third-year medical student is assigned to perform a chart review of
the cases of maternal mortality of a hospital over the past 20 years.
When the cases are collated, the student organizes the deaths by etiology.
Which of the following is most likely to be the common underlying
mechanism of death?
A. Uterine atony
B. Hypercoagulable state
C. Hypertensive disease
D. Sepsis
E. Rupture of pregnancy through the fallopian tube

Answer 27

B

Question 28

A 29-year-old G1 P0 woman at 14 weeks’ gestation is seen in the
emergency room for possible diabetic ketoacidosis. The emergency
room physician is evaluating the arterial blood gas which has been
performed, and the findings are listed below. Based on these findings,
which of the following is the most accurate statement?
pH 7.45; PO2 103 mm Hg; PCO2 31 mm Hg; HCO3 18 mEq/L
A. The markedly decreased bicarbonate level indicates that the
patient likely has DKA.
B. The decreased PCO2 indicates that the patient is likely having a
panic attack.
C. This arterial blood gas result is normal for pregnancy.
D. The elevated arterial pH reading likely indicates a metabolic alkylosis
condition.

Answer 28

C

Question 29

A 19-year-old G1 P0 woman at 29 weeks’ gestation has reactive airway
disease. She has received two nebulized albuterol inhalant treatments
with still some wheezing. Her arterial blood gas findings are listed
below. Based on these findings, which of the following is the most accurate
statement?
pH 7.40; PO2 94 mm Hg; PCO2 35 mm Hg; HCO3 20 mEq/L
A. The low PO2 level indicates significant exacerbation of the reactive
airway disease.
B. The PCO2 level indicates significant retained PCO2 and a worrisome
respiratory failure.
C. The arterial blood gas is normal in pregnancy.
D. The serum bicarbonate level is elevated for pregnancy and indicates
metabolic alkylosis.

Answer 29

B

Question 30

A 29-year-old G2 P1 woman at 39 weeks’ gestation had a myomectomy
for infertility previously. While pushing during the second stage
of labor, she is noted to have fetal bradycardia associated with some
vaginal bleeding. The fetal head, which was previously at +2 station,
is now noted to be at –3 station. Which of the following is the most
likely diagnosis?
A. Submucosal myomata
B. Umbilical cord prolapse
C. Uterine rupture
D. Placental abruption
E. Fetal congenital heart block

Answer 30

C

Question 31

Which of the following is the best management of an 18-year-old G1 P0
woman at 28 weeks’ gestation with a blood pressure of 160/110 mm Hg,
elevated liver function tests, and a platelet count of 60,000/uL?
A. Oral antihypertensive therapy
B. Platelet transfusion
C. Magnesium sulfate therapy and induction of labor
D. Intravenous immunoglobulin therapy

Answer 31

C

Question 32

A 33-year-old woman at 29 weeks’ gestation is noted to have blood
pressures of 150/90 and 2+ proteinuria. The platelet count and liver
function tests were normal. Which of the following is the best management
for this patient?
A. Induction of labor
B. Cesarean section
C. Antihypertensive therapy
D. Expectant management

Answer 32

D