OB/Gyn packrat Flashcards
On examination of a pregnant patient the physician assistant notes a bluish or purplish discoloration of the vagina and cervix. This is called Answers A. Hegar's sign. B. McDonald's sign. C. Cullen's sign D. Chadwick's sign
(c) D. Chadwick’s sign is a bluish or purplish discoloration of the vagina and cervix.
On examination of a pregnant patient the physician assistant notes the fundal height is at the level of the umbilicus. This corresponds to what gestational age? Answers A. 16 weeks B. 20 weeks C. 24 weeks D. 28 weeks
(c) B. At 20-22 weeks the fundal height is typically at the level of the umbilicus.
A 25 year-old female presents with vulvar pruritus and a thick, white vaginal discharge. Which of the following tests will be most helpful in making the correct diagnosis? Answers A. KOH prep B. Gram stain C. Tzanck smear D. FTA-ABS
(c) A. KOH prep is used to assist in the diagnosis of vaginal candidiasis, which presents with vulvar pruritus and white curd like, cheesy vaginal discharge.
A 25 year-old presents with pelvic pain and uterine bleeding. Her Beta-HCG was 1200 mIU/L six days ago. Her current Beta-HCG is 1600 mIU/L. What is the next best test in the evaluation of this patient? Answers A. Laparoscopy B. Culdocentesis C. Dilation and curettage D. Transvaginal ultrasound
(c) D. Transvaginal ultrasound is the best test to separate ectopic from intrauterine pregnancy.
A 30 year-old presents with persistent vaginal discharge and vulvar pruritus. The discharge is profuse, frothy, greenish, and foul smelling. pH of the vagina is 6.0. Which of the following is the most likely diagnosis? Answers A. Vulvovaginal candidiasis B. Bacterial vaginosis C. Trichomoniasis D. Atrophic vaginitis
(c) C. Trichomoniasis presents with vulvar pruritus and a profuse, frothy, greenish, foul-smelling vaginal discharge with a pH usually exceeding 5.0.
A 30-week pregnant patient presents with sudden onset of profuse, painless vaginal bleeding. Which of the following is the most likely diagnosis?
Answers
A. Abruptio placentae
B. Uterine rupture
C. Placenta previa
D. Disseminated intravascular coagulation
(c) C. Placenta previa presents with sudden, painless, profuse bleeding in the third trimester.
Which of the following prenatal vitamins has been shown to decrease the risk of neural tube defects? Answers A. Riboflavin B. Niacin C. Thiamine D. Folic acid
(c) D. Folic acid given daily has been shown to effectively reduce the risk of neural tube defects. It should be started 1-3 months prior to pregnancy.
According to the United States Preventive Services Task Force, screening mammography for females without risk factors should be started at what age? Answers A. 35 B. 40 C. 45 D. 50
(c) B. The United States Preventive Services Task Force recommends that women should consider screening mammography at age 40 in order to decrease morbidity and mortality from the disease.
A 35 year-old female presents with a solitary breast mass. Fine needle aspiration reveals bloody fluid with no malignant cells. What is the next best step in the care of this patient? Answers A. Monthly follow-up B. Excisional biopsy C. Hormone therapy D. Repeat fine needle aspiration
(c) B. Excisional biopsy is the next step in cases of bloody fluid, residual mass or thickening.
What is the primary treatment for an infected Bartholin's duct cyst? Answers A. Acyclovir B. Azithromycin C. Warm compresses D. Incision and drainage
(c) D. Incision and drainage is the treatment of choice for a Bartholin duct cyst.
A female patient presents with a vaginal discharge that has a fishy odor. On wet mount examination of the discharge a few white blood cells and many stippled epithelial cells are noted. Which of the following is the treatment of choice for this patient? Answers A. Nonoxynol-9 B. Ceftriaxone C. Metronidazole D. Clotrimazole
(c) C. Metronidazole is the treatment of choice for bacterial vaginosis. Bacterial vaginosis presents with a vaginal discharge with a fishy odor and clue cells on wet mount exam.
A 36-week pregnant patient presents to the ED with hypertension. Physical examination reveals 2+/4+ edema in the lower extremities with hyperreflexia and clonus bilaterally. A urinalysis reveals 3+ protein. Which of the following is the best treatment option for this patient? Answers A. Magnesium sulfate B. Nifedipine (Procardia) C. Diazepam (Valium) D. Captopril (Capoten)
(c) A. Magnesium sulfate is indicated in this patient with preeclampsia to reduce the risk of seizures.
A patient presents with infertility due to chronic anovulation. Laboratory testing reveals a normal follicle stimulating hormone, estradiol, and prolactin levels. The patient's progestin challenge test was positive. Which of the following is the drug of choice for the treatment of infertility in this patient? Answers A. Dehydroepiandrosterone sulfate B. Clomiphene citrate C. Bromocriptine D. Human menopausal gonadotropin
(c) B. Clomiphene citrate is the first drug of choice in patients with infertility due to anovulation with normal hormone levels.
Which of the following autosomal disorders results from the chromosomal abnormality of trisomy 21? Answers A. Edward's syndrome B. Down's syndrome C. Wolf's syndrome D. Cri du chat syndrome
(c) B. Down’s syndrome is due to trisomy 21
Human papilloma virus has been strongly associated with the development of which of the following? Answers A. Cervical carcinoma B. Ovarian carcinoma C. Pelvic inflammatory disease D. Vaginitis
(c) A. Human papilloma virus (types 16, 18, and 31) has been linked to the development of cervical carcinoma.
A 28 year-old female presents with lower abdominal pain and vaginal discharge. On examination the patient
is toxic appearing and her temperature is 39°C. Pelvic examination reveals cervical motion tenderness. What is the next best step in the evaluation of this patient?
A. Abdominal x-ray
B. Endocervical culture
C. Laparoscopy
D. Hysterosalpingogram
(c) B. Endocervical culture would be helpful in the diagnosis of pelvic infection.
A 16 year-old female G1P0Ab0 is 30 weeks pregnant. Her last two monthly prenatal exams have shown a trace to 1 plus proteinuria. The patient denies any previous history of hypertension, seizures, headache, visual disturbances or spotting. On examination, blood pressure is 150/98. The fundal height is 32 cm, the uterus is soft and nontender and fetal heart tones are 160 bpm. DTRs are 4 plus out of 4 plus in the upper and lower extremities, and there is moderate pedal edema bilaterally. The skin examination is unremarkable. Based upon these findings what is the most likely diagnosis?
A. Eclampsia
B. Pre-eclampsia
C. Gestational hypertension D. HELLP Syndrome
(c) B. Pre-eclampsia is the hypertension associated with proteinuria. This occurs in greater frequency in nulliparous, adolescent and black women.
A 34 year-old female G2P1Ab0 at 36 weeks gestation presents to the clinic with a complaint of a sudden gush of fluid from the vagina 18 hours ago. The patient denies any blood in the discharge but describes the fluid as watery. Examination reveals that there is a collection of fluid in the posterior fornix, the Nitrazine test is blue as well as the fluid giving a fern-like crystallization pattern on a slide. Given these findings what is the appropriate clinical intervention? A. Observation B. Induce labor C. Antibiotics D. Corticosteroids
(c) B. Since the patient is 36 weeks gestation and it has been greater than 12 hours since the leakage of fluid, labor should be induced to minimize infection.
In the treatment of endometriosis, which of the following medications has a side effect profile that includes loss of bone mineral density, vasomotor symptoms, vaginal dryness and mood changes? A. Oral contraceptives B. Dantrolene (Danazol) C. Leuprolide (Lupron) D. Progestational agents
(c) C. Leuprolide is a gonadotropin releasing hormone analogue that results in suppression of gonadotropic secretion. This suppression leads to a hypoestrogenic state which contributes to these side effects.
At the time of ovulation in a normal menstrual cycle, there is a peak in the serum concentration of A. luteinizing hormone. B. prostaglandins C. progesterone. D. prolactin.
(c) A. Luteinizing hormone is responsible for ovulation and, therefore, peaks at that time.
A 32 year-old female G5P4Ab0 at 35 weeks gestation presents to the clinic with sudden painless, profuse vaginal bleeding. The patient states that during the first and second trimesters she had spotting but nothing like this episode. On examination the fetus appears in transverse lie and the uterus is soft, relaxed and nontender. The fetus does not appear in distress. Maternal vital signs are normal. What is the most likely diagnosis? A. Placenta previa B. Placenta abruptio C. Active labor D. Uterine rupture
(c) A. Patients who present with placenta previa will have spotting during the first and second trimesters along with a presentation of sudden, painless, profuse bleeding in the third trimester. The uterus usually remains soft and relaxed and nontender as opposed to placenta abruptio, active labor and uterine rupture.
Which of the following immunoglobulins crosses the placenta? A. IgM B. IgG C. IgA D. IgD
(c) B. IgG, the smallest immunoglobulin, is the only immunoglobulin able to freely pass the placenta, therefore fetal and maternal levels are equal.
A postmenopausal patient is diagnosed with rade I breast cancer. The tumor is 0.7 cm in size, estrogen- receptor positive, and axillary nodes are negative. After undergoing a lumpectomy, which of the following adjuvant therapy is indicated for this patient? A. Chemotherapy B. Tamoxifen (Nolvadex) C. Ovarian ablation D. Bisphosphonate therapy
(c) B. Tamoxifen is the adjuvant therapy of choice in post menopausal estrogen receptor positive axillary node negative breast cancer.
A 29 year-old female G1P1Ab0 presents to the office with a one-month history of amenorrhea and a positive home pregnancy test. Her LNMP was April 4. Using Nägele’s rule what is her EDC? A. January 1 B. January 7 C. January 11 D. January 18
(c) C. Nägele’s rule is LMP minus 3 months plus 7 days. April 4 minus 3 months equals January 4 plus 7 days equals January 11.
When interpreting a cervical mucus fern test for ovulation, the Physician Assistant finds a fern frond pattern. Which of the following is consistent with this finding?
A. An estrogenic effect without the influence of progesterone indicating no ovulation
B. An estrogenic effect with the influence of progesterone indicating no ovulation
C. An estrogenic effect without the influence of progesterone indicating ovulation
D. An estrogenic effect with the influence of progesterone indicating ovulation
(c) A. When cervical mucus is spread out on a slide the estrogen causes the mucus to develop a fern frond pattern. Progesterone makes the mucus thick and inhibits the fern frond pattern from developing. Absence of the fern frond pattern indicates that ovulation has occurred.
A 29 year-old female G4P2Ab1 at 20 weeks gestation complains of nausea and vomiting with tenderness in the RUQ. Vital signs reveal the patient to be febrile. On physical examination, the abdominal examination reveals positive bowel sounds in all quadrants with a positive Murphy's sign. Fundus can be palpated at the level of the umbilicus. The skin is warm and dry with slight tenting. Oral mucosa is dry as well. What is the most likely diagnosis? A. Peptic ulcer disease B. Hyperemesis gravidarum C. Cholecystitis D. Viral gastroenteritis
(c) C. Gallbladder disease represents one of the most common medical and surgical conditions seen during pregnancy. This is thought to be due to a decrease in gallbladder contractility and lithogenicity of the bile. There is an increased risk in multiparous women.
What is the drug of choice for reversing magnesium sulfate toxicity in the management of premature labor? A. Calcium gluconate B. Potassium chloride C. Naloxone (Narcan) D. Oxytocin (Pitocin)
(c) A. Calcium gluconate is the drug used to reverse magnesium sulfate toxicity.
When assessing for cervical effacement, the Physician Assistant determines that the cervical os is non- distinguishable from the vagina. What is the percentage of effacement? A. 25 B. 50 C. 75 D. 100
c) D. Cervical effacement or thinning is a determination of how much length is left on the cervix. If the cervix is not able to be distinguished from vaginal tissue then the cervix is fully dilated and is completely effaced.
When starting a patient on oral contraceptives, she should be advised to use an additional form of contraception for how long in order to prevent inadvertent pregnancy? A. 1 week B. 2 weeks C. 3 weeks D. 4 weeks
(c) D. Based upon a 28-day cycle, a good practice to recommend is to use an additional form of contraception during the first cycle to maximize efficacy.
A 28 year-old female with known polycystic ovarian syndrome (PCOS) is seen because of hirsuitism. She does not want to become pregnant at this time. Which of the following is the most appropriate therapy? A. oral contraceptives B. Testosterone C. Clomiphene citrate (Clomid) D. Metformin (Glucophage)
(c) A. Oral contraceptives work to lower the production of steroidogenesis (androgens) by the ovary by inhibiting the secretion of LH. Another important factor for this patient is her desire to not become pregnant.
A 26 year-old female G1P0Ab0 appears to be in the second stage of labor. Vaginal examination reveals the fetal head to be at the level of the maternal ischial spines. What station is this patient at? A. 0 B. Plus 1 C. Plus 2 D. Minus 1
(c) A. Assessment of the fetal head in relation to the ischial spines is known as station. When the fetal head is at the level of the maternal ischial spines it is designated as 0 station. Positive stations are below the maternal ischial spines while negative stations are above the ischial spines.
Which of the following laboratory markers are helpful in establishing the diagnosis of ovarian cancer in a 55 year-old post-menopausal women? A. Ca-125 B. CEA C. LDH D. AFP
(c) A. Ca-125 is one of the best tumor markers in epithelial ovarian cancer.
A 24 year-old sexually active female patient is seen for the first time in the office for a complete history and physical examination. During the history, you find that the patient smokes 2 packs per day and has been sexually active since age 14 with multiple partners without the use of barrier protection. Given this information, what is the patient most at risk for developing? A. Cervical carcinoma B. Ovarian carcinoma C. Uterine carcinoma D. Vulvar carcinoma
(c) A. Human papilloma virus (HPV) is a prime etiologic factor of developing cervical intraepithelial neoplasia (CIN) and cervical cancer. Cigarette smoking and HPV is associated with a two-to-four fold increase in the relative risk for developing cervical cancer.
On examination of a pregnant patient the physician assistant notes a bluish or purplish discoloration of the vagina and cervix. This is called A. Hegar's sign. B. McDonald's sign. C. Cullen's sign D. Chadwick's sign
(c) D. Chadwick’s sign is a bluish or purplish discoloration of the vagina and cervix.
Progesterone influence on the breast tissue prior to menstruation causes
A. proliferation of the mammary ducts.
B. growth of the lobules and alveoli.
C. proliferation of Cooper’s ligaments.
D. increase in the number of glands of Montgomery.
(c) B. Growth of the lobules and alveoli is under the influence of progesterone. Prior to menses, the breast swelling that women notice is a result of the progesterone which is secreted from the corpus luteum. During menses, the swelling subsides.
A 40 year-old female presents with a 1.5 cm well-circumscribed mass noted on mammography in the right upper, outer quadrant. Which of the following procedures is most appropriate and should be done next? A. Fine needle aspiration B. BRCA 1 and BRCA 2 genetic testing C. Serum CA-125 D. Radiation therapy
(c) A. Fine needle aspiration is fairly accurate, easily performed, and has minimal morbidity.
On examination of a pregnant patient the physician assistant notes the fundal height is at the level of the umbilicus. This corresponds to what gestational age? A. 16 weeks B. 20 weeks C. 24 weeks D. 28 weeks
(c) B. At 20-22 weeks, the fundal height is typically at the level of the umbilicus.
Pharmacologic treatment of a patient with gestational diabetes should consist of which of the following? A.Oral hypoglycemic agents B. Regular insulin C. Oral corticosteroids D. Glucagon
(c) B. Regular insulin is the drug of choice as this will maintain the mother’s blood sugar but not cross the placenta.
What is the initial treatment of choice for hyperthyroidism in a 10-week pregnant patient? A. No treatment is necessary. B. Propylthiouracil (PTU) C. Radioiodine treatment D. Subtotal thyroidectomy
(c) B. This is the initial treatment of choice.
Treatment of the patient with Pediculosis pubis consists of which of the following? A. Permethrin (Nix) cream B. Clotrimazole (Gyne-Lotrimin) C. Podofilox (Condylox) solution D. Selenium sulfide (Selsun) suspension
(c) A. Permethrin 1% cream/shampoo is used to kill the louse and remove the eggs from the hair shafts.
Patient education for a 23 year-old using oral contraceptives should include which of the following?
A. Rifampin may decrease the effectiveness of the oral contraceptives.
B. Acetaminophen may decrease the effectiveness of the oral contraceptives.
C. Oral contraceptives may provide some protection from coronary artery disease.
D. Changing to the “minipill” (progestin only) will inhibit ovulation more consistently than combination oral
contraceptives.
(c) A. Rifampin may interfere with the efficacy of the oral contraceptives.
If a woman has a normal 28-day menstrual cycle what tissue and hormonal phase occurs during the last 14 days?
A. Proliferative follicular phase under the influence of estrogen.
B. Secretory luteal phase under the influence of estrogen and progesterone.
C. Proliferative follicular phase under the influence of estrogen and progesterone.
D. Secretory luteal phase under the influence of estrogen.
(c) B. The endometrial changes seen in the latter half of the cycle are under the influence of both estrogen and
progesterone from the corpus luteum. During this phase, the endometrium becomes more vascularized and
slightly edematous.
Which of the following clinical manifestations is common in candidal vulvovaginitis? A. Extreme vulvar irritation B. Firm, painless ulcer C. Tender lymphadenopathy D. Purulent discharge
(c) A. Candida infection presents with pruritus, vulvovaginal erythema, and white, cheese-like (curd) discharge that may be malodorous.
A 35 year-old female presents with multiple ulcerative lesions on her labia and perineum. A Tzanck preparation of one of the lesions reveals multinucleated giant cells. Which of the following is the most likely diagnosis? A. Herpes Simplex Virus (HSV) B. Molluscum Contagiosum Virus (MCV) C. Human Papilloma Virus (HPV) D. Syphilis
(c) A. The presentation seen on the Tzanck preparation is characteristic of HSV.
It is determined that a woman has a nonexistent rubella titer level during her first trimester of pregnancy. When should she receive the rubella vaccine?
A. During the first trimester of pregnancy
B. During the second trimester of pregnancy
C. During the third trimester of pregnancy
D. After delivery of the infant
(c) D. The patient should not receive the rubella vaccine during the course of her pregnancy as the possibility of
transmission of the rubella virus does exist. During the time that the patient is without protective titer she should avoid anyone with active rubella infection. The proper time to receive the vaccine is after delivery of the infant.
A 72 year-old female presents with vulvular pruritus for the last nine months, which has progressively worsened over the last two months. She states that she went through menopause at age 54 and has been on estrogen and progesterone therapy since that time. Physical examination reveals red lesions with white plaques on the vulva. What should the next course of management include?
A. Refer to a gynecologist for biopsy.
B. Refer to a dermatologist for antifungal therapy.
C. Treat with a topical steroid.
D. Treat with estrogen cream.
(c) A. Vulvular squamous cell hyperplasia causes thickening and hyperkeratosis of the vulva. The lesions are red and moist and cause intense pruritus over time the area becomes thickened and a white plaque may develop. Biopsy must be done to evaluate for intraepithelial neoplasm or invasive tumor.
A 30 year-old female presents to the emergency department with a syncopal episode. She has a history of irregular menstrual cycles and infertility. She has scanty, persistent vaginal bleeding and sharp pelvic pain. A left adnexal mass is palpated. The most likely diagnosis is A. placenta abruptio. B. ectopic pregnancy. C. pelvic inflammatory disease. D. ruptured ovarian cyst.
(c) B. Infertility increases the risk of developing ectopic pregnancy. The onset of vaginal bleeding, pelvic pain, and formation of an adnexal mass makes this the most likely diagnosis.
To relieve dependent edema in a pregnant patient, which of the following should be instituted as treatment? A. Limit fluid intake. B. Elevate the legs. C. Prescribe thiazide diuretics. D. Strict avoidance of sodium.
(c) B. Dependent edema is a common and rarely serious complication of pregnancy due to impedance of venous
return. Leg elevation improves circulation.
A 33 year-old female presents for follow-up of her Pap smear that showed cervical dysplasia. Which of the following is the most appropriate diagnostic procedure? A. Cone biopsy B. Aspiration needle biopsy C. Dilation and curettage D. Colposcopy-directed biopsy
(c) D. A colposcopy-directed biopsy is the first diagnostic evaluation indicated for cervical dysplasia.
A decrease in the fetal heart rate (FHR) occurring late during contractions is noted. The FHR returns to the baseline slowly after the uterine contraction. The physician assistant should be alerted to the possibility of A. pelvic dystocia. B. precipitous labor. C. fetal head compression. D. placental insufficiency.
(c) D. Placental insufficiency is the probable cause of fetal distress resulting in late decelerations.
A 47 year-old female presents to the clinic with complaints of prolonged, heavy menses that have been getting progressively worse for 3 years. She denies any pain. On physical examination, enlargement of the uterus with multiple smooth, spherical, firm masses is noted. A CBC is consistent with a mild anemia. Which of the following is the most likely diagnosis? A. Leiomyoma B. Adenomyosis C. Endometriosis D. Endometrial polyps
(c) A. Abnormal uterine bleeding and irregular enlargement of the uterus are most consistent with leiomyoma. Pain is rarely present unless vascular compromise occurs.
A 28 year-old woman is complaining of heavy uterine bleeding and pelvic pressure that has progressively worsened over the past year. Evaluation reveals multiple moderate-sized uterine fibroids. The patient desires to have more children. The most appropriate definitive treatment is A. Myomectomy. B. Hysterectomy. C. GnRH agonists. D. Oral progesterone.
(c) A. Myomectomy is the definitive treatment of choice for moderate-sized uterine fibroids in young women who desire to maintain reproductive capability.
A 22 year-old G0P0 asymptomatic female is seen for her yearly gynecologic examination. She denies performing self-breast exams and any family history of breast or gynecologic cancers. On palpation of her left breast, a solitary 1 cm rubbery, firm, well-circumscribed, non-tender breast mass is noted. In review of her records, similar findings were noted on last year's examination. Which of the following is the most likely diagnosis? A. fibroadenoma B. breast fat necrosis C. fibrocystic changes D. intraductal papilloma
(c) A. Fibroadenoma of the breast most commonly is seen in young females. Typical characteristics include a solitary 1-3 cm firm, painless, freely movable mass that does not change with the menstrual cycle and are slow growing. Most are found as an incidental finding on physical examination or during self-breast examination.
Which of the following is the most common underlying cause of early postpartum hemorrhage? A. uterine atony B. genital tract trauma C. coagulation disorders D. retained placental tissue
(c) A. Uterine atony is the most common cause of postpartum hemorrhage. Predisposing factors include any conditions that cause excessive uterine enlargement, abnormal labor or conditions that interfere with uterine contraction.
Which of the following is the earliest and most reliable clinical manifestation of pre-eclampsia? A. onset of proteinuria B. elevation of blood pressure C. excessive weight gain and edema D. headache and visual distrubances
(c) B. Elevated blood pressure is the most important and reliable diagnostic criterion. It is seen early in the course of pre-eclampsia and may occur suddenly.
